HomeMy WebLinkAbout3115 SAMOA PL - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
w CITY�9OS/TA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.
PceSs 3iis'- S4 4-
., PL C , M ' E337Z6 f � l�
4 " A y} 6 i - ,TYPE OF CONSTRUCTION "❑ NEW IJ ADD LJ^.ALTERATION ❑ REPAIR
Applicant's Mailing/�Address- x .C.-- IS.,/r if d.4" [/-"'/� n
�VY kN • F. [2 4 K C- iv_ Phone"t-1 -1h-)07V ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.#. Zone
Owner's Name yy�� /+ , DESCRIPTION OF WORK/USE OF BLDG.
Address /S - 57,/O/� A(. G''c7-4- --4 Es4_ S Main Building: Accessory Building:.
Arch/Eng. License No. TYPE OF PERMITEl❑ GRADING ❑ FOUNDATION El STRUCTURAL E Front _ G
Address ❑ TENANT J^l ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N
❑ OTHER •
Contractor's Name e Phone C Right N
PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
Address(mailing/ • CONSTRUCTION TYPE VALUATION$ Left
City License No. ZONE GRADING CU.YDS. ACRES $ R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: . . Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. • ' ' T
License Class License No. - S•
Date- Signature PLUMBING I FEES • .
WORKERS'COMPENSATIONn 7000) of D •
Sink Showers ® ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate ..
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink "
3800, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction pole Sub. • .❑ 50+ KW '. .
❑ Certified copy is hereby furnished. _ �--�s
❑ Certified copy is filed with the city Building Division. Bathtubs ' ■ Sewer Connection Cooking Unit Meter '1 up to 100 amps it g 'v
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - ■ Dishwasher - Meter ❑over,100 amps ,
(This section need not be completed if the permit is for one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric ' Sub Panel
I certify t t in the performance of the work for which this permit is issued, I • '
shall no drupe any person in any manner to become subject to the Drinking Fountains ' Solar Tank. ■ Fan Motors L0-1.HP ❑1%-8 ,
Workorgpensatioq.{:pws of Calif , �KYf/Y/
Dat y 44 S' AA .0 Signature J�-r'K�/ Floor Drains Swimming Pool w/Spa F.A.U. • Inc.Solar 09-15 HP 016-15+
NOTICE:-If,after making this declaration,you should become sect to the -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks UrinalFixtures
comply with such provisions or this permit shall .be deemed revoked.
CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet • Device Boxes Pole Light ' • 'hereby affirm that there is a construction lending agency for the performance •
of the work for which this permit is issued (Section 3097 Civ. C.) nt¢rce hors Water Heater
Lender's Name Outlets Range ' .
Lender's Address . • - Kitchen Sink Water Service
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 t�
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundr Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior.to its issuance, also requires the applicant for such permit y Y . Trash Compactor
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 •
' 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 '
Ity of not more than five hundred dollars($500).
I, as owner of the property or rpy..awrplesses with wages as their sole Reinspection Fee $15 Issue Fee $ 3 r a
o pensation, will do the work, and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ Y -
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL , ' I FEES License Law 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 Hood or Type 0 -DEVELOPMENT SERVICES REQUIREMENTS: . -
employees, provided that such improvements are not intended or offered for Boiler
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved By • Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground BUild ing Approved By - ,/}�J Date
grove for the purpose of sale). - _
LJ I. as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By - Date 1/L-1119/
tractorsto construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating • 00-100,000 BTU 0100,000 BTU - • SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- —
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration - BUILDING PERMIT $ SMIP $ .
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ l am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ '
Date _ - • Owner. 2�7-W .z Heating System& Ducting RegistersENERGY P.C. $ ..
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT PLAN CHECK 25% $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ 3 3,SD GRADING $
and state laws relating to building construction, and hereby authorize repre-
sentatives of his city to enter upon th- ab p ye-mentioned property for -
inspection os r L MECHANICAL $ _ TOTAL FEE $ 35.
Signature /����,�' I Date�t5 ^b5"o O Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or SS$ ' - • r',
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor 01 00004792-00004792 T 01"9 33.50
CONSTRUCTION AND PLANNING POOL&SPA
_APPROVALS Permit.# Date Inspector APPROVALS Permit#
1 Date Inspector
;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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test
9. Water,Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,C 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 ❑Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank ❑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. 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 42-74r Cic 80. FOOD CERTIFICATE ISSUED •
33. Final Electric rY2$S(/ lNotes: .�
34. Final Heating & Air Conditioning n''
35. Final Gas 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. Backflow Preventer •
-
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48:-Special Requirements Completed •
49. Electric Release to Edison 4
50. Gas Release to Southern California Gas Co
• 51. CERTIFICATE OF OCCUPANCY l• _ ++ ,
No. Date
OWNER SU'R.LAND LAND CO. DATE 2-28-57
3.115
JOB ADDRESS 468,14 -Samoa Place BUILDING PERMIT NO. #4471
GENERAL CONTRACTOR Owner Bldr. VALUE $ 10,909,00
LOT 99 BLOCK TRACT 2353 Single res. w/att. gar.
GROUP 'j & J TYPE V ZONE FIRE DISTRICT h524
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
��tt /�r ,/ DATE NUMBER
(�
Footing Trench / _ 4 - 17 •
Foundation Forms and Grade to Garage l `
Rough Framing to `4-s�
Plumbing,Rough to Slab ei77— a t , d.S n - y- y-,5-7 rya/ i -
Plumbing,Rough Complete hta5 st e.B-S'7
Temporary Pole
Wiring, Rough JUN 1957 VC: . iAW?f�_ : 3/_O5657 V9�j 4 1/
Heating,Rough het e- 5 5-;-c37 / ' OM_ : i j,27-S7 195V 7/ ✓
Heating, Final Yll e5 a-IRS
Sewer,-Huse 3;74.-' Sewer,St.MPS .,-26_A-7 6: `w- / /- /a -: 2 p
, /
Septic Tank or Cesspool ,T ' v
Lathing, In Y, Out)( p CyJ t�C. c —7th . 7
Plastering Cs--6/4 8 '1.9 '7
Plumbing,Final,Fixtures Complete 414-5 cm •S'7
Plumbing,Final Gas Test /Sd ime5 O- ,...c (i p,,:e 6 - /,^ -%_ •" 2 /n ' -,)---/ 2
Wiring,Final 1^^ Ea 0 -7-y , , i� in _9_o7 .,----"A--•-•-y•-ca
Occupancy /`4 (a a SPS,
FORM 210 3M 10.05
•
' 4524 FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT
P.O.BOX 317 FINANCE DEPT.
COSTA MESA, CALIFORNIA CITY OF COSTA toEU_
FOR APPLICANT TO FILL IN APPLICATION FO RMIT
BUILDING , ,,, 3/'.r BUILDING
ADDRESS 9-crrl SPmnP Pl Pre I�'7
COSTA MESA. CALIFORNIA . FOR OFFICE USE ONLY
RECEIPT NO. P4471
OWNER Suranerland Land Co. _ 4
RECEIVED BY DATE RECEIVED DATE ISSUED
MAIL
ADDRESS 11211 S ��+--ee-�...�--..
So. Beverly Demi'- v7 FIR 2 R 1957
TEcrestview BUILDING
CITY Ting Angeles, Calif. NO. IL�� ``)) ADDRESS
ARCHITECT LIC. -
COSTA MESA. CALIFORNIA
OR ENGINEER G!Il l l i Amg NO.
FIRE
ADDRESS112h ll ?) ,90_ Beverly-Loc ynepleg ZONE
ummerland Land CITY LIC. v5 ZONE PLANS TYPE GRD . /
CONTRXCTOR ('nom NO. 61A5 V�
1124 So. Beverly TELr.12,../1/12)-c
gtyiew APPROVED
ADDRESS Lna kris pl Pc el11 fNO. RR}}1j BY DATE
LEGAL LOT ,..„-, CORRECTIONS
DESCRIPTION NO. BLOCK TRACT 2 11;3
A.P.NO.
SIZE NO.OF BLDGS.
OF LOT hien NOW ON LOT T1n)le
USE OF /"
EXISTING BLDG. L
SETBACK LINE FROM
CENTER OF STREET O I REAR YARD 251
SIDE YARD RIGHT 71 LEFT E I
DESCRIPTION
RIPTION OF WORK
NEW X ALTERATION ADDITION
REPAIR MOVING DEMOLISH
SIZEI
BUILDING NO.OF
12n5 ROOMS 5 STORIES 1
EXTERIOR WA COVERING ti ttnnco COVECNGmZt roc,i s
COVERING }�' Ps
USE OF NEW
BUILDING Single Family Dwelling
g{rest 10_44
/2 VA
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES A STATE LAWS REGULATING BUILDING CONSTRUC-
TION. J VALUATION
SIGNATURE OF ����.,�� �,� ae PERMIT FEE $ 26.00
PERMITTEE 1�2%/'//�fLL4�.liLZ ,
+�/{//:��� �//� /Q ^O 7- PLAN CHECK S13.00
AUTHORIZED AGENT hy�•'y7y 2// TOTAL FEE $ 39.0o �.I