HomeMy WebLinkAbout3111 SAMOA PL - Building Permits C
PRDJECT'ADDRESS: 3111 SAMOA PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 048769
' OWNER'S NAME: MICHAEL DONOVAN - '
ADDRESS: SAME PERMIT NO: E 048769 PLAN CHECK NO: N GOVT : N SUPP: N
r CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
850-0224
ARCH/ENGINEER: REO.NO.: JOB DESCRIPTION : UPGRADE EXISTING PEWIT SQ FT :
r ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : /
PERMmEE: MICHAEL DONOVAN (714 ) 850-0224
ADDRESS: 3111 SAMOA PL COMMENTS . X
C.M. CA 92626 er+ryr**e<*eeeEse**erre+red*eruiE************+r*eE*+r**********Nff**+E*>E+esr*x*** ***********et+k****
LICENSER CONTRACTOR DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9(commenting with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in fug tome and effect. SETBACK S
CITY UC.: STATE UC.: CLASS:
MAIN BUILDING ACCESSORY BUILDING
Data: Signature: FRNT: FT IN REAR: FT IN - FRNT : FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT : FT IN
Compensation Insurance,or a certified copy thereof(Section 330°,Lab.C). ..
POLICY N : UP.DATE: PARKING REQ: PROV: PARCEL: 13915320 ZNE: REF NO:
'INFANT:Certified copy is hereby furnished. ❑ Certified copy Is Med with the city Building Division. PLANNING NOTES> •a'
>
**********************************_*********************************************
Date Applicant: DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DEtARAT1ON: (Ills section need no be completed if the permit is for one hundred(S100)or less).
I certify that in the performance of the work for which this permit is
subject to the Workers'Compensation Laws of Caetomia. ZONING APPROVED BY issued.I shall not empty any person in any manner so as to become rt
DATE:
Date: Signature: BUILDING APPROVED BY : - DATE:
NOTICE:If,after mating this declaration,you should become subject to the Workers'Compensation provisions of the Labor a
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. - -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y : DATE: j 7
which this pemdtisissued(Section 3037,Civ.C). *********************************************kk44��************************** ** ***
UNDER: *********************************eC*********************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT :N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the follavMg reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18 . 5 0
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 0 3 SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation o1 Section 7031.5 by ISSUE FEE 15 . 0 0
any applicant for a permit subjects the applicant to a WI penalty of not more than live hundred dollars(5500).
I, as owner of the properly or my a loyees with wagesas their compensation, veal do the wortand the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
L7 structure is not intended or offered for sate(Section 7044 ,Busiss and Professional Code: The Contractors State License Law TOTALS — > 18 . 50 1 S . 0 0 0 . 00 3 3 . S 0 33 . 50 0 0
does not apply to an owner of a property who builds or Improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 33 . 50 OVER/SHORT : . 00
(or
Improvementissold of
one year of completion,the owner will have the burden of proving he/she did not build or Improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PIAN—CHECK
for the purpose of sale).
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 33 . 50
❑ and Professions Code: The Contractors'State License Law does not apply too theownerC00 property who kens Law). thereon ************************************************************************ ******
and who contracts for such projects with a e oor(s)ldense pursuant to the of Contractors'State License Law).I am aware
that proof of their Worker's Compensation Insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.I.P.C.
for this reason: / ' , ,/TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: 1 27-- 90 7:110'm;iELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18 . 50 18 . 50
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wilUa not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. .
Date: Applicant: '
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with an city and county
ordinances and state laws relating to building construction and hereby authors represen a' this ' enter upon the above-mentioned
property for inspection purposes. ///fff .
Date: 27-10 Signator . ` /
Driver's License or Social Security 01 00063465-00068465 707 7 j3,S
184146 White—Building;Green—Cade Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor Oi11 E i 08/27/40 TIME 5 12:34
CONSTRUC'i ION AND PLANNING PG & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
"1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. •
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final -
12. Sewer Cap 63. Heater & Vent-Final -
13. Roof Drains 64. Plumbing System - Final •
14. Rough Plumbing 65. 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 FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final Atei-eci},c480. FOOD CERTIFICATE ISSUED •
33. Final Electric Notes:
34. Final Heatingat & Air Conditioning
35. Final Ga$Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
•
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: ±±?,�0,11 SAMOA PL UNIT: - CITY OF COSTA MESA — 'BUILDING PERMIT PERM NO: P 04.5564 �"
OWNER'SNAMI�MIEHAEL P. DONOVAN
ADDRESS: 3111 SAMOA PL PERMIT NO: P . 045564 PLAN CHECK NO: N GOVT: N SUPP: N ,
COSTA MESA •
CA '92626 CONSTRUCTION TYPE: 5-N PERMIT TYPE: PLU PURPOSE: NEW
ARCNIENG(NEER: ( 714 ) 850-0224 REG.NO.:
JOB DESCRIPTION : INSTALL NEW SEWER LINF. SQ FT:
ADDRESS: UNIT: •
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
PE(1MITTEE: MICHAEL P. DONOVAN ( 714 )850-0224 •
ADDRESS: 3111 SAMOA PL COMMENTS: NO 'B ' PERMIT TO REFERENCE. .
COSTA MESA . CA 92626 *.**�E*+r�E*****�F**�E�E�E�E+ *�r************ar+F�r�F*************�r* •***�L�F**�E****** ***aE*)r*E *if*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.. SETBACKS •
•
CITY UC.: STATE UC.: CUSS: •
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: , FT IN RGHT: FT IN LEFT: FT IN RGHT: FT • IN
POLICY NO:: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL : 13915320 ZNE: REF NO:
0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> '
> . •
Date: Applicant: • *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSKOON DECLARATION: (This section need not be completed if the permit is for one hundred j5100)or less). D E V E L O' P M E N T S E R V I C E S ' R E Q U I R ,E M E N T S •'
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. ZONING APPROVED BY _ DATE:
()ate: - ' • Signature:• ' - - . . . .-
NOTICE:If,after making this declaration,you should become subject to the Workers Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
—
Code,you must forthwith comply with such pravistons'or this permit shall be deemed revoked. tJ
CONSTRUCTION LENDING AGENCY: I hereby affirm that there Is a construction lending agency for the performance of the work for APPL ICAT ION ISSUED BY: Ar A�' DATE: lk*-* -Z. -p
which this permit is issued(Section 3097,Civ.C). ********************** ********** ** ***•*
UNDER: *******************************************************************************
ADDRESS: ' . LEGALIZATION:N F E E S U14 M- A R Y STRUCTURAL SEGMENT:N
•
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT 'PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 5 . 00 .
repair any structure,prior to its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed • 2 5 E SMI P/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/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). ISSUE FEE 3. 00 .
•
L as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV- PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
.❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors',State License Law TOTALS----> 5 . 00 3 . 00 - 0. 00 8 .00 8 .00 . 00
does not apply to an owner of a property who builds or Improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 8 .00 OVER/SHORT: 00
improvement 6 sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
fororthe purpose of sale).
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business • 8 ' 00 '
❑ and Professions Code: The Contractors'State License Law does not apply to an comer of properly who builds or improves thereon '
and who contracts for such projects with acnntractor(s)license pursuant to the Contractors State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL• F E E BREAKDOWN
vo I am exempt under Section:7 0 4 4 e.8 P.C. A l
for this reason: B&P CODES/ALL ORK Y OW . TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST .
Date: /Z �Z 9^ sy ( _ Owner. PLU 1 BUILDING SEWER / TRAILER PARK SEWER 5 .00 5 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wiNwill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the-Ail-Day Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: 7
I hereby certify that I have read this application and state 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 representati rs o,u enter upon the above-mentioned /
property for inspection purposes.^� e /
Date:l.Z_Z/_C I I Signet . . - -�. t/�A-J L A f 01 00050768-00050768 TOT 8.00
• DATE: 12/29/39 TIME: 11:30
Driver's License or Social Security '
1641-46 White-Building:Green-Code Enforcement:Canard-Applicant;Pink-Revenue;Goldenrod-Assessor -
•
. CONSTRUCTION AND PLANNING . POOL & SPA f;
' APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
. Tempotary Electrical Service or Pole - 52. Pool & Equipment Location
j'._Soil-pipe-UndrErndr, 53. Steel Reinforcement
--.=Electrical Condiiit-lJtility-Undrgrnd. 54. Forms c. •
"*.iElectii"cal Condfii-6ndrgrnd. 55. Electrical Bonding
cc 5./Steel Reinforcement; - 56. Rough Plumbing & Pressure Tea[. • _
Q 6.'°'Eiectt�cal UFER rhd. 57. APPROVAL TO COVER-GUNI-tr•.E c
-,5 Footings iC 58. Electrical Conduit-Undrgrnd. - • 0
• x
Foundation >y 59. Gas Pipe, 0 Undrgrnd., Test - "
8. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK ,
11. Property Sewer Lide',& House Connection 62. Backwash & Receptor-Final j," •
12. Sewer Cap c, 63. Heater & Vent-Final 0
ca
13. Roof Drainszil - 64. Plumbing System - Final S
14. Rough Plumbing 65. Electrical-Final • '
15. Rough Electridsi-Conduit 66. Solar System-Final /`
16. Rough Electric Hiring 67. Fencing & Access Approval • -1.
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL '
r
19. Roygh Heating & Air Conditioning • _FIRE DEPT. REQUIREMENT
20 o`u!'gh Facto y Re4Place , .--, w' * S r, Cr: * =APPRQV,At:SE�Permit# ' r.
=�
_r • _ _
21' Ducts, i�Strrictuuet •• " "•� S v ,-'s * __ r `t'='
4.4 •t, MI �x 7.4-1 * O r, r)* * ;70. ;--, round HKdro *
s* IiS : cc* * ,l F:'4". -,n >;
22-m04-is, Ventl ong;* * G < C) 'r* * 471. ProduCt;f rpmg OGas O:OiI
23. Ga,.,Pipe-Rough & Test t1 S ' t^ C r A * 72. Undergro ?nd FkS' fr
24CRoaf Framing ", •rt * ',--> O C r1* * ::73=;Undergrnd.Stor giTankbGas 06
-.f; -
25. Roof Sheathing cc* , `� ` :; r :-i' �t .* 747Overhead Hydro„
* G Gtt1* '' G ' 4 .r7 a26'`u -BaCeiling (Stcu'turall 8r`Monocoat K O .. G* r75_Dry Chemical *
"
27rFrame and Flashrrngc ?Miv,� x 77 Z * I, 76 Dry Stan pipe E-, co - .,
8' Lathing^& Sidinq,x " * 1"
-% r: *41 1574 • i , y 77; FIXED S"y,&TE[VJ-t�F,.INAI -, n
r4'' = _,
29. Insulatitsn r-'Y S •• * C r 788FIRE PREY. FINAL t•
•7-30. DrywallSNailing •^* 44Ir. j .; y; .,.c.,,, c; EALTH;DEPT*, hiECMIRTEMENT
031. Plaster Brown Coit* S ^r * i 1* * T,79. FINAL INSPECTION * +R
... ,^' r,.} E, * I T r rf * .-1 G-
. . .? * C7 i i * flT
;�32..1Electric., PnwertGQ�ier-.- „ x I ,114. a: SO.uF000 CERTIFF�LYYTE IS}SUEDr,
X33 inai E(secirtc ix ^r c kK Ndtes:6./S:30 :7,0. (G R9 •C-r 47-.€_. N1�n
car,
Li ,...n`e1 Heating& AltE .•, tionin`g •rn, r i" * ,S � tee `- ,-',d
* GZ r. �p
35;-Ficial Gas Pipe-Testa 0: •• * r I �': * G =0 v•-+ '* • �'"
t' s36 Hood or Canopy * =r cr.': * . .• * _ IC tr 1.
It r- r- 4 - �r �. ., _ 4.
-.737.--Final Factory Fireplace- • t-•-- , 41. � I -w x le ^ x * CCJ
x.38. Final Plumbing * r_fJ ' �, ' r * S _ * c7 .-,
G�/4j40 441
`'39. Water Service-Finale i rr + , " ^,: * ,'.
I t tr
• • r40. Gas Service-Final +r t'1 ter^}-•' rS.- t t:; 1 �' :� Om Cr.: *
:41. Solar Domestic-Final ,;. * I* * -; o _cr. * x
42.. Backflow Preventers 1= '+ t .* * r ?c• * t r;
Cl .: ra 17")r I--. #: :i * * riCl `I * s^
* -.J S *. * * .-.;.,, .� J
43. Backflow Irrigation- ).-1 * .x * * u .- x a • '
744. Landscape fi'rieatio'n Systemfir' * Ci G G* -4CR N rJ �O * C
r.• n r lE` •- * d '4: tA: * 7 T e: •7y * S
r 1 * k-+ v, r-, r _* * ; , • x '
�45:"..Sound Attenuati4 o0. ';- - * tr. r tti n* v ., c, e, • f..G r•
T.
C46.•Handica Re ulatio '-; * ~ a: a: S C'c S *
.. p 9 ..ns xS ! I . t* * < O n *
t„477FIri-AL STRUCTU*?E & 8UILDING * ; I I* x c, i
48:7-FINAL PLANNING i i✓- IcCu ; *, c n. n S x ri
c
' '49�Elec}ric Release for Edi8. son : •I * ' x
+-50TGa£Release to Southern California Gas Co * I * - i- ..- • on * O •
m r cc * * * •• 5- 'DO n * Cu O
-51. CERTIFICATE OFOCCUPANCY Y: *-* = i 2 ,`"-'
No. Date
1
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PE IT O. TRACT NO. LOT NO. UNIT NO.
CITY OFCOST�„ ONSTRUC,/T1I{Q�N PERMIT L�.p aa9 - A.P.# Zone
Project Address �mR� Y 1 rr tt S Main Building: I Accessory Building:
Applicant's Mailing Address LI °`2 _ .y s i'. rc: QL• TYPE OF CONSTRUCTION LI NEW LI ADD U ALTERATION U REPAIR E Z
�',: ,,,t— /' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER -- -- T Front 0
Owner's Name �'a�'�T� Nn L�b- Phone 18 N
Address
S A-v✓1 �' DESCRIPTION OF WORK/USE OF BLDG. A Rear I
Arch/Eng, License No. TYPE OF PERMIT U GRADING LI FOUNDATION Li STRUCTURAL C Right G
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left
1 ,.7 ( rt. ❑OTHER Ping. Ref.# Parkin t E
Contractor's Name ea LJ `•- , , , e
fs/ g Req./Provided E
Address(mailing)_1a 2 1?fl& PROJECT DESCRIPTION SQ. FT. OCCUPANCY QM
ie •qJ YQ(/'�.. Planning Notes:
,/-/n CONSTRUCTION TYPE VALUATION$ RECEIVED SEP 1 9 1989 T
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION S'
(c) I hereby affirm that I am lie.•sed under provisions Of C . ter • comme.cing Remarks:
with section 7000) of Divisio • the B • and •rofesslo•s Co.• nd
my license is in f/td1I fore pppp••••������`�n• of • - ELECTRICAL FEES
Dae 1.ras t .e O. ' /
Date Wh'�-.�` PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
Signature,
WORKERS' COMPENSATION DE LA RATION f Construction Pole Sub. • 0 50+KW
C‘ I hereby affirm that I have a certificate of consent to sell-insure or.a certificate Bar Sink Showers l
YJ of Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps
3800. Lab/'Snnty�/••� f q J Backflow Preventer Service Sink
1rrA 1 Policy No..L1WV+w / IJ�1O ltompany,��rlf,ii LO I'd�� Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
BCertified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Cereci ted Pv ed with the city uiljbin vlgpp Bathtubs Sewer Connection •
Date -.5 -6 Applicant -pin ti, re/U/Y�oe' Fan Motors 00-1 HP ❑1'h-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARA ION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred ($100 or — F.A.U. Int Solar ❑9-15 HP ❑16.15+
less). Dishwasher Solar Piping
I certify that in the performance of the work for which this permit is issued,I Fixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:If,after making this declaration,you should become subject to the Outlets Range
Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9
e
comply with such provi5ion5 or this permit shall be deemed revoked. "
CONSTRUCTION LENDING AGENCY „} • Switches Sign
Gas Service Outlets �'• Water Closet 9
I hereby affirm that there is a permit
lending Sefor the performance C.) Garbage Disposal '
—
of the work for which this permit is issued (Section 3097 Civ. C.) 9 sP StandingSections
Interceptors I Water Heater
Lender's Name 00
Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION — '
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code:Any city or •
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
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
enalty of not more than five hundred dollars($500). /1 DEVELOPMENT SERVICES REQUIREMENTS:
I
U I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 0d Zoning Approved By
compensation, will do the work,and the structure is not intended or offered Date
for nse (Section Business and f aProfessional Code: The Contractor'smroves MECHANICAL FEES Building Approved By Date - •" /
thereon Law does not apply to owner if a propertyfwho builds s or improves
tmpioy, and, who does such work ovem if/s arelf or through tende his or her own Application Issued By Dat
employees,If, hthat such or improvement
are ootld intitletl oyear
ered o f c for Boiler Hood oType 0
sale. If, thehowever,wnthe building urden of pro i g within one yearrem- Canopy Type II 0 SUMMARY OF FEES
proven, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose sale). BUILDING PERMIT $ SMIP $
of p
❑ I, as ownerthe property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System
tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU PLUMBING $ O ISSUANCE $
•
builds or Improves thereon.and who contracts for such oroiects with a con-
tractor(s) license pursuant to ane Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $
proof of their worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers MICROFILM $
PLAN CHECK 50% $ /�
Owner als.._ 4 Heating System& Ducting Registers MECHANICAL $ V
I reb 'iv t -t I e read is y its d state that the above ❑0.100,000 BTU 0100,0006TL TOTAL FEE_ $_ �
info •.tion is . ct. I og but
to'i g•
onst with • cid and y uth irepres PLAN CHECK 25% $
and civ laws hal. ng to be •ir 'on nett ab - reby authorize y ,for
sentattio of-this qty to e r u.on the ab• me tioned Pr.pally for
i ignattio •urPoses. ' • J�/f3' I�J—.rIL�4J s�15 e' L"
Si earn' ` �L ate 2/ �� V.I.i s
Drivers' License or SS' • Reinspection Fee $15 Issue Fee $ 3n ,
1 74q'E: 04022r„y 'ItiE' 0:::'.
0865-46,rev. 5/88 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
-4111
.
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS . Permit# Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ; 53. Steel Reinforcement
• 3. Electrical Conduit Utility-Undrgrnd.- _. 54. Forms
^4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement' 56. Rough Plumbing & Pressure Test +N
6. 'Electrical UFER Grrid. • 57. APPROVAL TO COVER-GUNITE
•
7. Footings - <• • 58. Electrical Conduit-Undrgrnd.
8...Foundation : _ 59. Gas Pipe, 0 Undrgrnd., Test
9. Wa'ter'Pipe-Undrgrnd. �• 60. Backwash Lines, P-Trap, 0 Undrgrnd. - • • •
10. Structural Floor.System i - ' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection • L 62. Backwash & Receptor-Final
IN • . t v
12. Sewer Cap -: 63. Heater & Vent-Final •
13. Roof Drains + ' i ' - 64. Plumbing System - Final
14. Rough Plumbing -- • _ 65. 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
a•
181 Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20: Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 71_ Underground Flush
24. Root Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat - - ' - 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. pry
SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:'
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing /(?/TQ ��
ere
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final ="
42. Backflow Preventer
r:e
43. Backflow Irrigation
44. Landscape Irrigation System - r
45. Sound Attenuation ' t
Ly+
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -�
No. Date
OWNER SUMNERLAND LAND CO. DATE 2-28-57
Si II
JOB ADDRESS 1688 -Samoa Place BUILDING PERMIT NO. #4472
GENERAL CONTRACTOR Owner Dldr. VALUE $ 11,424.00
LOT 100 BLOCK TRACT 2353 Single res. w/att. gar.
GROUP l & J TYPE V ZONE FIRE DISTRICT 4525
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
_ ,/ DATE NUMBER
Footing Trench G/�4 f -//-e 7
Foundation Forms and Grade to Garage �1
Rough Framing 6- t, I -7 `3. .
Plumbing,Rough to Slab Yv.G3 y/ti S
Plumbing,Rough Complete {M,c-5 St-XP-.5.7
Temporary Pole
Wiring, Rough JUN 1 1957 VC:.' /i ' / _ , y 57 ,/
Heating,Rough %t e 5 4--?-8-s7 t . ate. _ _ _. _ -.S 95/go ,---
Heating,
Heating, Final 14, e S 0-8-S7
Sewer, House O// Sewer,St. M//-S G-26 S7 /9:/f/a-,. „/• _moo.. - _ _3-0— .1-7 4 r/47 J
Septic Tank or Cesspool - /j /
Lathing, In Out 6--t.--C, to {7
Plastering fl6 I -Z-9 _i —
Plumbing,Final,Fixtures Complete n/G5 /04'S7
Plumbing,Final Gas Test IC CS d 44- ('/1iGCC.2- eci -y-,r7 .. .. -....---L
Wiring,Final }}��,,�� /1 fir -7,47 11 /, /O-9 —S �— —'- ./
Occupancy )77 a-8S> ' /
FORM 210 3M 10.55
4525 FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 317 FINANCE DEPT.
COSTA MESA, CALIFORNIACITY M
FOR APPLICANT TO FILL IN APPLICATIIONOFOREvt.RMIT
BUILDING , n„ 3i%/ BUILDING
ADDRESS ',J--ut Samoa Place
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. 1 PEfD,11T t�l$j-2
OWNER ,Pllmmerl and Land Co. ny47
RECEIVED BY DATE RECEIVES DATE ISSUED
ADDRESS l 1 711 So. RP werl y „.,,,/7--1.,o a-.,Z d2 -r..i / FER P ^ 1nG7
TELcrest 1 W BUILDING
CITY Los Angeles, Calif. NO. 5-8 21 ADDRESS
ARCHITECT LIC. COSTA MESA. CALIFORNIA
OR ENGINEER !'_!l 11i Ryas NO.
112k So. FIRE
ADDRESS Beverly-LosAneles ZONE
Summerland Land CITY LIC. ZONE NO.OF
PLANS TYPE GROU
CONTRACTOR (`.n NO. Al R5• (/ v
1124 So. Beverly TEL4res tLritgw APPROVED
ADDRESS I. 5S. Ansel P.4' I. 1 1 T yO. - V Gly BY DATE
LEGAL LOTCORRECTIONS
DESCRIPTION NO. 100 BLOCK TRACT 235 J
A.P.NO.
SIZE /ln^ NO.OF BLDGS.
OF LOT O 00 NOW ON LOT none
USE OF if
EXISTING BLDG.
SETBACK LINE FROM
CENTER OF STREET (-)t REAR YARD T1 I
SIDE YARD RIGHT 6 I LEFT 5 I
DESCRIPTION OF WORK
NEW 'X ALTERATION I ADDITION
REPAIR MOVING DEMOLISH
BUILDING 1316 NO.OF ,
SIZE ROOMS 0 STORIES 1
EXTERIOR WALL _ ROOF
COVERING Fttlnnn COVERING RHTnai es
USE OF NEW
BUILDING,/ �Single
� /Family Dwelling
Sh Cj(�' as
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILD! G CONSTRUC•
TION. /J VALUATION
SIGNATURE OF (/AA,�,, /7 PERMIT FEE $ 28.00
PERMITTEE K/LZ C/(J/_
PLAN CHECK S 14.00
AUTHORIZED AGENT / (pal417 TOTAL FEE S 42.00 V.ME