HomeMy WebLinkAbout1121 SANDI LN - Building Permits ADDRESS OFBNLEDIG: 1121 SANDI LN - WIT: CITY OF COSTA MESA - BUILDING •PERMIT
ggNERS NAPE IF Igd0Yfi1:
KOSICKI, ANDREW F PERM NO: B 081428
ADDRESS: 2069 MEADOW VIEW LN
11k COSTA MESA, CA 92627 PERMIT NO: B 081428 PLAN CHECK NO: N GOVT : N SUPP : N
APPL.M/d11NG ADDRESS CONSTRUCTION TYPE; V-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OReKaNEER: UC.NO.: JOB DESCRIPTION : T/OFF & INSTALL FIBERGLASS SHAKES SQ FT: 1 , 537
ARCH.OR FNa'S ADDRESS: MMT:
CLAIM VALUE: 1, 537 . 00 CALC-VALUE: 1, 537. 00 GROUP OCC: R-3 /
CONIBACTOMSNAME J D JONES ROOF 'CRAFTER ( 714 ) 826-4827
CONTRACTORS MAldNO 6011 SAN YSIDRO COMMENTS ; RESIDENTIAL REROOF
ADDRESS: BUENA PARK CA uc.ND.: 435996 ******************************************************K-+tzat*** **it**********+E->E**
90620 we: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.
CRT IX.NO.: 029223 IJC.CLASS: C 39 ICC.NO.: 4359 6 EXP: 09/97 MAIN BUILDING ACCESSORY BUILDING4. --
/_3�_q� PRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
Dae: cwwedw LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that mpt from the Contractors license law for the
following reason(Section 7031.5 Business and Professions Code:Any fry or itch requires a permit lo comas,alter,improve. PARKING REQ:
PROV: PARCEL : 42204214 Z N E: REF NO:
demolish,or rapid any structure.prior 10 its issuance,also requires the applicant for euch permit to file a signed statement that he or ahe
is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING N TES>
Business and Professions Ccdej or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > r
7031.5 by any apptimM for apermit subjects the applicant toe civil penalty ofnot more than lice hundred dollars[S500]). *****************************************************************************,**
❑ I.as owner of the property or my employees with wages as their sole compensation,will do the work,and the structures nth intended DEVELOPMENT V E L O P M E N T S E R V I C E S R E U I R E M E N ',T •S
or offered kr sale(Section 7044.Business and Professions Code:The Contractors license Law does not appy to an owner of properly Q
who buddy or improves thereon,and who does such work himself or herself or through his or her own employees.provided that such
improvements are not intended cr offered for sale.If,however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
owner-budder will have the burden of proving he or she did std build or improve for the purpose of sale).
❑ L as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business and / '
Pm!*salons Code:The Contractors License Law does not apply to an owror of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License law). I /—
97
❑ Iamexempt under Semon: B.E.P.C..for this reason. APPLICATION ISSUED BY; DATE:
********************************************* **************** ** *** ***
Date Owner: LEGALIZATION;N F E E SUMMARY STRUCTURAL` SEGMENT:Y
I do hereby certify that I am aware of end understand the requirements of California Health and Safely Code Sections 25505,25533,end
25534.and that I or any Mors building occupant will/will not(circle one)need to comply with said nate codes end the requirements for
a permit for constructionor modification from the Ai Quaky Management District.Residential constngioneppdaelions are exempt horn these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES' GRADING
provisions. PERMIT 51 . 25 . 50
Date: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of m
perjury we of the following dednetio : PLAN
❑ Humehe and MI maintain a certificate of mueru to sell-insure for workers'
compensation,in provided for by Section 3700 of the Labor BUILDING
FEE
Code,for the performanceofheworkforwhichthispermitisissued. BUILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
fa] Ihave and MI manual,workers'aampenaatloninsuranos.asrequired by Section 3700 d the Labor Code,for the wm.
doence of the TOTALS----> 51 . 75 0 . 00 0 . 00 51 . 75 51 . 75 . 00
work for which this panni)is issued.My workers'compensation insurance carrier end policy number are:
Carder: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 51 . 75 OVER/SHORT; . 00
Policy Number. 28 -UNIT00074' 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed I the pennk is kr one hundred dollars(41001 or leas.) 51 . 25 . 50
❑ I certify that in the performance of the work for which this permit is issued,I shell not employ any parson in any manner so as to
become subject to the workers'compensation Laws of California, end agree that B I should become subject Io the workers' *******************************************************************************
Data:
compensation provisions of Section 3700 of the Labor Code.I shall forthwm ply es
the provisions.
/-3/-47 ApplicantINDIVIDUAL F E E BREAKDOWN '
warning:Failure to secure workers'compensagon coverage Is unlawful,end II i.et an employer to criminal parades and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one funded thousand dollen($100.00cA M addition to the t I conparwtdn,rapes as Provided for In
Section 3706 of The Labor Code,Interest,and attorneys tees. SFR 1537 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 537 . 00
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
seam-mance of the work for which the permit is issued(Section 3097,Civ.C),
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and nate that the above information is correct.I agree to comply with all city and county ordinances
and state Laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection purposes.REGINA JONES 81-31-1997/12:55 Pp/f51.75
PERMITPTBB 0881421
P int Nesse
�/ /� Date: /- 3/- 99 inza
O5' ure d OwrwlNeenMApp{canVContrador
(5151-46.WP) White-Buidng&Safety:Green-Ale:Canary-Applcant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POO. -. SPA
Date Inspector
APPROVALS Permit # =ADate Inspector
PPROVALS Permit #
1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • . - . - 53. Steel Reinforcement - •- -
•
_3. Electrical ConduitUtility-Undrgrnd. ' 54., Forms - _ '
• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •I - _
. .5. Steel Reinforcement • - ' 56. Rough Plumbing & Pressure Test • -
6. Electrical UFER•Grnd. - I 57. APPROVAL' TO COVER-GUNITE - ..
'l.7- Footings - ', • - 58. Electrical Conduit.Undrgrnd. '
8. Foundation s•-;--..: - . 59. Gas Pipe,'0 Undrgrnd.,Test _ - .
9� Water Pipe-Undrgrnd. • , 60. Backwash Lines,.P-Trap, 0 Undrgrnd.
10: Structural FloorSystem - 61. APPROVALTO_._DE •
CK •
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ,
12. Sewer Cap _ - . 63. Heater & Vent-Final -
13. Roof Drains - ' .64. Plumbing System -1Final _ -
14. Rough Plumbing: - X65; Electrical-Final •
15. Rough Electrical-Conduit - ' 66. Solar System-Final •
16. Rough Electric Wiring - ' 67. Fencing& Access Approval ' _
17. Rough Wiring Sign 68. APPROVED FOR-PLASTERING .
18. Rough Electrical-T Bar Ceiling• - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - TIRE DEPT. REQUIREMENT
_ - - . _ . - _. - C' - _C.- -r
20. Rough Factory Fireplace - - ' ' - APPROVALS Pgrmmit# ` " . •
21. Ducts, in Structure _ - - - 70. Underground Hydro •
22. Ducts, Ventilating.. s - '":;' r 71. Produdi-Piping'O Gas 0Oil
23. Gas Pipe=Rough 8/Test = - - 72. Underground Flush_
•24. Roof Framing- - _- - ' - ' - r. -. y 73, Undergr d.Storage Tank O Gas O Oil
25. Roof"Sheathing _ - Z 9 9' `�_ 74. Overhead Hydro ^ r
26. T-Ba Ceiling (Structural) & Monocoat /// //=�- - 75. Dry Chemical IT, r - s
27. Frame and Flashing_ - :. - -, 76. Dry Standpipe, 7 '
- 28. Lathing & Siding _ _ r -• " '• 77; FIXED' SYSTEM:FINA'L
29. Insulation r ` - 78: FIRE PREV. FINAL r .
30. Drywall Nailing _ - - _ ':,HEALTH DEPT. REQUIREMENT
31. Plaster Brown Goat _ , - 79. FINAL INSPECTION r..- =
- 32. Electrical Power Meter-Final • - • 80. FOOD CERTIFICATE ISSUED
33. Einar Electric < - Notes: - _
34. Final Heating& Air Conditioning: - . _
35. Final Gas Pipe-Test _ - .e r '•
36. Hood or Canopy -. - ' -
. 37. Final:Factory Fireplace_. _ _ , -' ,' _ '
• 38. Final Plumbing _ - -
. - r ji. : -
39. Water Service-Final .-
=
40. Gas Service-Final .. - - : -
41. Solar Domestic-Final :- - - e `
42. Backflow Preventer - , -
.. - r
43. Backf low Irrigation - - _ -`" - .
44. Landscape Irrigation System - ,
. - - - - _ •-• -- - I_
45. Sound Attenuation _ ; ' - ._ _ _ • ` - _ • •
46. Handicap Regulations - - - -- '
47. •FINAL STRUCTURE& BUILDING 104/V7. _
48. FINAL PLANNING .. _
- - - -.
49. Electric Release to Edison " - •
50. Gas•flelease to Southern California Gas Co _ i"�-7
•
-51. CERTIFICATE OF OCCUPANCY X . ,; - - - -
No Date
4111
w.°�� City of Costa Mesa Planning Department 5'% +� �+�t•z,r�,a,�
Post Office Box 1200
. , 77 Fair Drive
17
Costa:41556Mesa,5245California 92626
cE ! a Ilioa
REQUEST FOR OCCUPANCY
(Single Family Residential or
Condominium Units)
Tract No. VS./ Date 8/3/77
Lot No. /2
Address //g3 //I �•`-74-t- / 72a-
The developer of the above entitled tract desires to sell the above
set forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-hey) (was—or—were) e)' advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the
City at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless
from any claim resulting in damage or personal injury to the undersigned by
reason of the aforementioned uncompleted condition.
RECEIVED r
CITY OF COSTA MESABy CL2`Cchct. weee _
Pi +naim� .'.nr
Purchaser
811G 2 5 1977 —a.
AM PM 71819110111112111213141516 •By A4A,//)
eve1:117:o Authorized
esentative,'
By
,442,47
By .41V/i O2
Le ,ser
4.� . CMF 0569-26 ,_ -
OWNER PROPERTIES WEST, INC. DATE 10-14-76
JOB ADDRESS 1121N ; 1123 Sandi Lane BUILDING PERMIT NO. 40622
GENERAL CONTRACTOR Owner/Bldr. DESCRIPTION of WORK Duplex w/3 Gars.
n
AP No. 115-031-17 LOT TRACT FIRE ZONE VALUE $51,000.00
1TINSPECTIONS Signature Date TYPE V GROUP I & J ZONE PDR—MD
SOIL
- .::i j2 Ara SUBCONTRACTOR PERMITS ISSUED
N‘,‘GAS C 5 7.r¢.77 Date I Number I Signature
q WATER (, G• 19,4 (.17. ,2 Plumbin
ROUGH PLUMBING ¢=/q 5 3./2.7� ii^Q.' // I S. . 7�
1\PROP. SWR. LINE El HOUSE CON. C , N 77 / ihtI3 �3 r�
]SPRINKLING SYSTEM /" -.6W67---
k-MISCELLANEOUS yMISCEL LANEOUS < e
ROUGH HEATING ANE AIR CONDITIONING v¢/ 5 J26:77 - _
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0
ROUGH WIRING (o�/,�•J1-�J Heatin• •nd Vent.
TRENCHES Li FORMS q
STEEL REINF. GJ� f,- •C•I f/ t. r ' Tann= •' n
� „-
� �
FLOOR SYSTEM /1 • I . • / �tf /i ie
Man
P- .
BEAM • STEEL REINFORCE II AIMIMMIMIIIII
SHEATHING • •
FRAME AND FLASHING aj�t�.
LATHING - IN • OUT •
PLASTER, BROWN COAT ' ”:
STRUCTURAL, FINAL ',/�)/�1771629,_
_ •�/
HEATING, VENT., R@FRIG. AND A.C„ FINAL , �j j// / rj{iiifri 171629 pirKfalr
PLUMBING, FINAL AND GAS TEST r��A SIIIIIISIII
ELECTRIC. FINAL allE:SAF
, BUILDING, FINAL
.
P
46��7 �3075cusrAiO.00i373m it+ r 59.07
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
1 APP C TION FOR STRUCTURAL PERMIT
For Applicant to Fill' o npletely — Us ,Ink (p
BUILDING RECI BY ,>�TEjt�ECEIV;D DATE ISSUED
ADDRESS ia ,� /Z�� '(// iA{ --7(--,
/7 •��.w,•}�}.� �]
OWNER A�,MAIL �/yj"`/��/, � / ./t.62c-c• A.P. NO.1 S. -a3 ' PE 7022
ADDRESS i� Lf-�j /YI/rw/.Taip die(/.'�/ ADBUID RIEG (OS:co s' >• I like/ l��i✓
•
CITY C�^y � "lfj NOLb, # " TRACT (OS[REPAIR
LOT7O BLOCK
CONSTRUCTIO NEW ADD ALTER MOVING DEMOI ISH
LENDER
BRANCH Jr/� sJ �/ /WC
OWNER ' clO - "' c YV/ r
ADDRESS ®���� � ''yy�QQ- ice VALUE 1 n n�
OR ENGINESARCHITECT /Bo" /®.Tt�'�'>a/�/ NOL�/7%z/Z t lr ll
�0 Te g...640-/ Z0 E PE ,•i G R ujl3:1 -
FIRE •
ADDRESS ^^PPL /
CONTRACTOR _ BVPflOVED DATE 1001/? O
4,40 Vw
ADDRESS Si.
TEL.
CITY NO. Ca,'ZONE NO.OF USE OF NEW
$9$1 PLANS Z BUILDING Lutc.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE 0. OF LOT `�ZO ( NO.OF BLDGS. (FR C/ EET)��/y� ` ,
Q USE OF LCI QT if N0ON T RFRS /!/FT. --. AJdr IA
EXISTING BLDG. •
In
F Separate permits are required for ' L.SIDE 7 FT. FT.
InLI' electric,plumbing and heating work. REAR FT. FT.
[-.. USEOF BUILDI G AND WORK'TO BE PERFORMED DISTANCE BET. BET.MAIN&
G ,fig/ it / A_I MAIN BLDGS. ACCESS.BLDGS.
"'�� / VAR.# DATE
.� / ^.,v ��� C.U.P. 75 -5? APPROVED /0-7-'5.--
<
'=- - N et-OR
J QI�'7 'l n �//
�, __ APPROVED
PROVED / t-O \ ATE (6 /d /�
W
MOLD FO/RV SPECIAL F'Ff! uidrpg�AMC
0 I hereby acknowledge that I have read this application and state
in
W that the above Information is correct and agree to comply with
co--
S all laws regulating building construction, and I shall not employ
Z any person In violation of the workmen's compensation laws of �/1 /� .`
T the State of California. 'V% ;o1 /.� _ f/, .
• IV" l/� i `t+'Xy,L'/
3 I hereby certify that I am properly licensed as a contractor under / SQ. FT. �� V' (_7 a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; e
am exempt from provisions of the State of California Business VALUATION v
PERMIT FEE $
and Professions ivision 3, n
Signature oflir ihr�7 PLAN CHECK $ 75- .5v o
Permittee $ - /�tiC" TAX $ "n IC-) u.
<Lc-1/ U
Authorized Agent TOTAL PAID $ ' �
� ,0j
•
1l '^ � �.OW 2 /� J
PAN,n
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completelyyy — Use Ink Only _P'LICA ON FOR STRUCTURAL PERMIT
/l 2� �,�� R�D' ✓ REy.t/ DATE RECEIVED DATE ISSUED
BUILDIUU
ADDRESS NG PERMIT NO.
OWNER A.P. NO. L
MAIL BUILDINGJi (� LY t u/f ' 1 •f
ADDRESS ADDRESS
TEL.
CITY NO. TRACT LOT BLOCK
CONSTRUCTION NEW JADD ALTER REPAIR (MOVING DEMOLISH
LENDER /`x/_ /� �
BRANCH 'PLDPE&T L
OWNER ' .yEz.W v-r ItJc r
ADDRESSa & WO% U?/ ,,,,,,,E ---6--'---6--'ARCHITECT TEL. US $
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
PLANS BUILDING
CITY NO.
1► STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OF SLOGS. (FROM C/L STREET)
C. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
CM EXISTING BLDG. •
R.SIDE FT. FT.
rd
FSeparate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
REAR FT. FT.
0.1
(.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QMAIN BLOC'S. ACCESS.BLDGS.
VAR.# DATE
QC .U.P.# APPROVED
7 APPROVED
)". —EY -DATE
W
CCW
Q1 hereby acknowledge that I have read this application and state n
y4 ' that the above information is correct and agree to comply with
O. all laws regulating building construction, and I shall not employ m
Z any person In violation of the workman's compensation laws ofP.
W.L'
' the State of California. '�'���pp
`
C
I hereby certify that I am properly licensed as a contractor under SQ. FT.
VV
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR co
m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY
• am exempt from the provisions of the State of California Business VALUATION ?
PERMIT FEE $
and Professions Code,Division 3,Chapter 9. /�/ n
PLAN CHECK S n
Signature of C\
Permittee $ TAX $S .
a)
f
ww,, U
Authorized Agent TOTAL PAID $ /N/ arta
I
r7fwasra�:^{� City of Costa Mesa Planning Department
• (�$ "'"' y)
Post Office Box 72(10 �{�'r -,
RI'
jr. r 77 Fair Drive
��f!-.1.��;yri(ufoi Costa Mesa, California� 92626
II„12,,,.1 ., --i.,
REQUEST FOR OCCUPANCY '"_3
(Single Family Residential or c ,..-
Condominium Units) \\
i
•
CITY uF CJS?A MESA r
.
. ' pi.M4fl!t)€= DEPAR ITmEr ' .,:<
Tract No. -_1�tt/---- --- Date /O - /y -7y
Lot No. // ,
Address //a, u-rtes, e /'---)ce .
.
The developer of the above entitled tract desires to sell the above .,'
set forth lot prior to the time that the tract has been completed and its streets ' ' ;
. !,
accepted by the City of Costa Mesa. .
i .(
The undersigned, by executing this agreement, acknowledges that
(he, she, they) (was or were) 2.422.--r2 advised that this tract has
`,
.
not been given final inspection nor has it been accepted by the City of Costa Mesa
d',
as having complied with the conditions of approval which were imposed by the •
City at the time the final tract map was approved. ,y
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless
from any claim resulting in damage or personal injury to the undersigned by •
reason of the aforementioned uncompleted condition. /y
e-ii-71- _ ;
UI CI1 a5y
gyu veloperan r Authorized
Representative /
il
/
ad. i t
BY . .
Leder
•
CPAF 0569-26