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Home My WebLink About3001 SAMOA PL - Building Permits 51111144-AwCITY OF COSTA MESA 4 BUILDING DIVISION r . pr, r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F I ^-;- . PERMIT M02-00070 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • - MECHANICAL PERMIT Job Address: 3001 SAMOA PL Status: ISSUED Suite No Applied: 02/08/2002 -- Issued: 02/08/2002. 'Vicinity: - • Parcel Number: 13918126 ISSUED BY: Applicant: STEVENS, MARK„ , Address: 9911 LARSON AV' - � Phone: 714-530-2440 GARDEN GROVE,CA Zip: 92844 , ' Owner: ' BUI, HOAN THE - Address: 8 MARSEILLE Phone: IRVINE,CA ' Zip: 92606 ,. Contractor: A AMES PLUMBING, HEAT, AC ( D • Address: 9911 LARSON AVE .(0 ' I D Phone: 714-530-2440,C tkop - GARDEN GROVE,CA - Zip: 926'11 Ild- License:250307 - - SCOPE OF PERMIT , FAU CHANGE OUT ONLY.3 TON FAU. FEE SUMMARY ' - Quantity -- Quantity. ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 - . 'Repair/Alt Refrigeration Unit $0.00 0- Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 • Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 . Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 ' Factory Fireplace $0.00 0 - '•-`-3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 - 15 Tb 30 hp/1,000 k BTU $0.00 0 VAV Box, ' - $0.00 0 30 To 50 hp/.1,750 k BTU $0.00 0 • Vent Fan/Single Duct, $0.00.:,_0 - ' Over 50 hp/'Over,1,750'BTU . $0.00 -0 Appliance . $0.00 0 Boilers , Fire Dampers' ` / '$0.00 • 0 Up" to 3 hp - ' _ ,$0.00 0 Smoke Dampers ` / $0.00 ' '0 -, 3 To 15 hp Inst or Relocate Appl Vent ' ' $0.00 0 15 to 30 hp - $0.00 0 Air Handlers< 10000cfm ' : $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 - 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 ' Investigation Fee $0.00 Plan Check Fee , . $0.00 Reinspection Fee $0.00 .. . ' / TOTAL CALCULATED FEES $38.30 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448.46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'oorkers'compensation Insurance carrier and policy number e{e: / Carrier: , ' Ca M attgl atni /ft) cr(A.A Policy Number: 4J(!'7 76( 1 "/`'0l (This section need not be completed if tte permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and that if I should become subject to the workers'compensation provisions of Section 3700 of t Lab Code,I shall forthwith comply with these provi Applicant Signature: t.// t-t Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provi h; err:(c. - ening with Section 7000)of Division 3 of the Busine56pnd Pop(essi Os C.q[le an y ' ns is in full force and effect.Lic.s / �,J Class a l� LCJ C..,gyp Contractor's Signature: `/ y9' "frin Date: • • CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds 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 or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O l am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ' ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No • (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .1y/Of Legavlw er(}) 2s, 0 to 0^ And/71'e rizr itpp i t ate CODES INSPECTION TYP[ D9I€ INTBIALS LODES INSPECTION TYPF S 1616 Fixed System Final Fire Prevention 206 Final Mechanical a Rn {r 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocldRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WNER ,LEP j, • DATE - 7_7_78 OB ADDRESS 3001 Samna Place BUILDING PERMIT NO. 46347 ENERAL CONTRACTOR pluma-Kool DESCRIPTION of WORK Patio Cover AP No. 139-181-26 LOT 1 TRACT 3115 FIRE ZONE VALUES 1,2800.00 SPECTIONS SIcnature Det* TYPE v GROUP J ZONE g 1 SOIL PERMITS moo `J�\SOI fUlCONTRACTOR MATER ' 'Pare Number Sianefura (�� Plumbing (JROUGH PLUMBING ++PROP. SWR. LINE L.-3 HOUSE CON. Q SPRINKLING SYSTEM 1MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING • TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER q ' ROUGH WIRING Hooting and Vent. TRENCHES ❑ FORMS 0 STEEL REINF. Li FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER, BROWN COAT STRUCTURAL, FINAL Flectric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST n ELECTRIC, FINAL ^ I I v/#1 BUILDING, FINAL S,( ly{^� C torr ui orniuorucurc • 49< r/22G7s' 46A4 1 8606_ "Tit617178 -,'` 21 :50 TC COSTA MESA BUILDING-SAFETY DEPARTMENT "' ' "t,`} "! I P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 AP A ON FOR STRUCTURAL PERMIT For Applicant to Fill in Completely - Use Ink Only RE 0 Y DATE RECEIVED DATE ISSUED r BUILDING 7- 2 -7y ADDRESS .3001 Samoa P1. JLC [' / .9 r! ' OWNER P. Belle A.P. NO/�J/ �/ 0i..- �/- 7 MAIL BUILDING / / ADDRESS Same ADDRESS 3001 �Saamoa Pl. CITY O. 849-0724 TRACT 31 /J 1 LOT BLOCK CONSTRUCTION NEW ADO f ALTER I REPAIR MOVING nEMOLISH LENDER X BRANCH OWNER p�- p Belle �./� ADDRESS &r EAI CLDSEDJALUE$ ARCHITECT TEL, a i0 .�. $ 1,280. 8 OR ENGINEER L. Stu se..r NO. FIRE ADDRESS ZONE5'PE.JZ.. GROUP ICONTRACTOR Alines-Koo1 Alan. Prod. BPPROVED DATE ' ' 7(� ADDRESS 1526 E. Washineton Blvd. / TEL. ZONE NO.OF USE OF NE'Y� CITY L.A. 90021 NO. 748-8241 �� PLANS a BUILDING%'Q h (0,•d' •-• STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. 260090 LIc.No.6367 MAIN BUILDING, ACCESSORY BUILDING W SIZE INO.OF SLOGS. (FROM C/L/SyyTRE T) / �7 I /� 0.. OF LOT NOW ON LOT 1 FRONT ( A a 0,V W FT. Q USE OF 17 .D-, EXISTING BLDG. SFR R.SIDE FT. FT. CA _ 'S'. Separate permits are required for L.SIDE � FT. FT. - F electric,plumbing and heating work. f W - REAR /( i FT. FT. E.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Q� MAIN BLOCS. ACCESS. BLOCS. 8 VAR.# DATE '3 Alum. do Cover with Screen & Glassen( C.U.P.## APPROVED a �f Q > APFR'. • / 7/7K Enclosure: ICBG 3132-P. ..-_a_AP ; DATE w (161X161-256 sa.ft.) O I hereby acknowledge that I have read this application and state n u LL' that the above information is correct and agree to comply with m n• all laws regulating building construction, and I shall not employ {Z any parson in violation of the workman's compensation laws of , the State of California. �5/ X I hereby certify that I am properly licensed as a contractor under (0 SO. FT. w the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses ere In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE Nk„Y)f ;- am exempt from the provisions of the State of California Business VALUATION ! 9 PERMIT FEE $ / and Professions Code,Division 3,Chapter 9. n ��J/J� /] //� �\ PLAN CHECK § m Signature o�� r - ✓r /// .{� $/tQy>r OGV CJI Iii Permittee Y..��// .LAK C/r� Imo/ TAX § \JV 2 AJ.uma-Kool Alum. Prod. D Authorized Agent TOTAL PAID $2-1. A y -0 8136 J L tCEW EU COSTA MESA BUILDING DEPARTMENTP.0. SOX 317 �IRDEnCp ° 1955 r~ COSTA MESA, CALIFORNIA Y'i�H1�CE DEPT. CEIV Qi NISTA EISA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING ADDRESS 3001 Samna Placa BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY _}) II JJ llVVll RECEIPT NO. 6MIT_I(Dy OWNER Mesa Verde Estates llllJJJJ MAIL RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS 1701 Gisler St. )'h-Y7), ia- 9-CS /I-y -so BUILDING CITY Costa Mesa NO.Ki 5-1751 ADDRESS ARCHITECT LIC. COSTA MESA, CALIFORNIA OR ENGINEER J.R. Shelley NG.G-2170 FIRE ADDRESS Long Beach Ge 9-0908 ZONE CITY LIC. ZONE ae NO.OFF TYPE GROUPY� CONTRACTOR L.G. j�pbipa� NO. 1121T Y ADDRESS 1701 Gisler St. TEL. APPROVED .Ki 5-1751 BV DATE LEGAL LOT CORRECTIONS DESCRIPTION 1NO. 3. BLOCK TRACT 3115 A.P.NO. SIZE NO.OF SLOGS. OF LOT 70 x 100 NOW ON LOT none USE OF EXISTINGBLDG. /Cis re/ SETBACKK LINE LINE FROM CENTER OF STREET 50t plus REAR YARD ipQI plus bT SIDE YARD RIGHT 51p14s LEFT /d0-plus DESCRIPTION OF WORK NEW ][ALTERATION ADDITION REPAIR MOVING pI DEMOLISH BUILDIIV�j&A NO.OF SIZE 1427Sq•Ft• ROOMS 6 STORIES 1 COVERING EXTERIORWA 01,11000 COVERING Asphalt & rock BUILDINGEWResidence & Car Port I HEREBY ACKNOWLEDGE THAT I HAyE READ THIS,y PPLI TION AND STATE THAT THE ABOVE IS CORRE T�AND AGREE TD COMP Y WITH ALL CITY ORDINANCES AND S TE L S REGULATING BUILD G CONSTRUC• TION. VALUATION A / // PERMIT FEE $ 31,_ 0-0 SIGNATURE OF �r ...---- -1.4_4-/1 1,t,. A-,t PERMITTEE O-d $ / 1)11 en PLAN CHECK $ `7, 971 4'L 0-0 ` • AUTHORIZED AGENT TOTAL FEE $ /. - `COSTA MESA BUILDING—SAFETY DEPARTMENT P2-75�`n-57,00 948 d*****5.00 P. O. BOX 1200 Costa Mesa, California PERMIT 4 PLUMBING PERMIT APPLICATION TRACT NO. RECD. BY 2R 3 CONTRACTOR A-AMES PLBG, & HTG, LOT NO. DAIS ISSUED BUILDING USE r+ a 7 Address 10422 TRASK AVE {,t exa-7 CityGARDEN GROVE Tel. No. 530-2 BADDDRESS 3001 PL. State License No. CIOs. COSTA MESA. CALIFORNIA 250307 C-36 NEAREST ww City License No. 6664 CROSS ST. F OWNER GLORIA Eli= KANN A 7> 1` Q NUMBER TYPE OF FIXTURE OR ITEM FEE MAIL Water Closet(Toilet) ADDRESS SAME - J Bath Tub CITY COSTA MESA TEL. No.546-1281 Q Shower > I hereby acknowledge that I have read this application Lavatory(Wash Basin) and state that the above is correct and agree to comply } Kitchen Sink with all City Ordinances and State Laws regulating CC Laundry Tub or Tray plumbing. to Service Sink I certify that I possess the above valid state of Cali- 0- • fornia classification or I am e legal owner of the resi- o Floor Sink dentia) property described a ve. Floor Drain a_ /� S. d Dishwasher Signature of 7. / ®�' Permittee /'/K/ 2 Drinkin Fountain w Urinal I INSPECT! N RECORD Garbage Disposal , 1 1- - Automatic Washing Mach. ' M of �/Ay„w,. 5-.23-DS (Q. 0 Water Softener • r {{{111 Water Neater RC Veni I CC Receptor `` ++ ION w Y I I I' 1 ,tn , 1 ION tl Swim Pool Filter S st cc Gas System . . . Outlets D Lawn Sprinklers O nstallation or Alteration COWater BackFlo rrev APPROVALS Flow Preventer CO Prop. Sewer_ ft. INSPECTOR DATE House Sewer Connection U/G Soil I I _ F Cess ool Septic Tank U/G Water I I Services—Water p Gas 0 I Miscellaneous Rough Plumbing Sprinkler System Gas Property Sewer Pool Receptor Filter System Pool Heater 3 Miscellaneous n0 Issuing Permit -_ - TOTAL FEE I 5h I Final Gas 0 Plumbing Final Fa) S-/2)\r Utility Co. Notified /� PORN DU- BLDG. PERMIT NO. /1