HomeMy WebLinkAbout2861 SERANG PL - Building Permits a-
,-
CITY OF COSTA MESA
BUILDING DIVISION
Ft �l) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
".. 11,41111 . FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: M09-00059
PERMIT TYPE MECH '-. STATUS: ISSUED
APN: 13932211 DATE ISSUED: 07116/2009
ISSUED BY: RMD
JOB ADDRESS: 2861 SERANG PL CM Suite/Unit:
Vicinity: SIDE YARD
SQ. FT: 0
SCOPE OF WORK: MECHANICAL PERMIT TO REPLACE AN EXISTING HEATING UNIT< 100 K BTU (SAME
LOCATION-HALLWAY CLOSET),ALTER DUCTING AND INSTALL A NEW NC UNIT< 100 K BTU TO BE LOCATED ON SIDE
YARD OF HOUSE. REF#: E09-00193
OWNER: ROBERTSON, GAIL E TR Address: 2861 SERANG PL Unit:
PHONE: 714-557-4914 City/State/Zip: COSTA MESA,CA
APPLICANT: KOPP,JAMES Address: 26 VIA LUCENA Unit:
PHONE: 949-361-2247 - City/State/zZip: SAN CLEMENTE, CA
CONTRACTOR: SOUTH COUNTY AIR CONDITIONING AND HEATING INC License No. 777525
Address: 26 VIA LUCENAUnit: PHONE: • 949-361-2247
City/State: SAN CLEMENTE, CA ZipCode: 92673 CELL:
•
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $66.80
PLAN CHECK FEE: • $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: - $0.00
TOTAL FEES: $66.80
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODEX. INSPECTION TYPE DATE INITnALS CODEX INSPEC11ON TYPE D7 D ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining 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
1 -A
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
El I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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
c n 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
r :7/ � by this permit,and that no building structure.scaffdding,falsework,ar demolition
Carrie[ edl r or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
�rnas rro be et the permit is valued at one hundred dollars(S100)wless) 2,Art 2,Sec.341,Title 8,California Administrative Code).
Pofic Number: 4 /erge_/�
y ��� lL (J`�`� ❑ As owner-builder, I will not employ anyone to do work which would
0 I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code,I shall frrthwith comply with these provisions.
7'—( / .-O Division of Industrial Safety Permit Number:
CA., -� liQ
LAppum• SSi.'.:a V tlbte =r.- HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
W••• INO' FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes El No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. ern a registration form for acutely hazardous materials? 0 Yes ❑ No
LV#`?'F r Class#*—C/ ?X— 1 (Section 25533 of the California Health and Safety Code, with some
"' ` n exceptions, requires registration with the Costa Mesa Fire Department by
. -. - 7.l�• �l each business which at any one time has on hand a quantity of acutely
/'yCnr �_ •,.. Data _.7 \ 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
ili
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? El Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct, I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contracto(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
A Signature of Leg- Owner(s) Date /�
Signature Date _ 7-16-0�••r
3057-46(3)07) _et_ �- '
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A P PROVED
\ car cosTA MESA
'i TANNING DIVISION
'T TO BLDG. DEPT. REG.
tial i ADDITIONS, DELETIONS,
na c URRECTIONS SHALL BE
APPROVEDlBY THE PLANNING DIV.
BY: 11. V DATE:211.4."...L
4` 9 CITY OF COSTA MESAtrelia
ali
fl BUILDING DIVISION
F • -�I ... DEVELOPMENT SERVICES DEPARTMENT PERMIT N MBER
4• PERMIT
'avPoerree 02-00577
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2861 SERANG PL Status: ISSUED
Suite No Applied: 09/09/2002
Issued: 09/09/2002
Vicinity:
Parcel Nunmber: 13932211 ISSUED BY: I�Ot
Applicant: RUSSELL, STEVE
Address: 2122 S.WRIGHT
Phone:
SANTA ANA CA Zip: 92705
Owner: ROBERTSON, GAIL E TR
Address 2861 SERANG PL
Phone:
COSTA MESA,CA Zip: 92626-4826
Contractor: JAMES H. RUSSELL & SON
Address: 02122 S.WRIGHT
Phone:
SANTA ANA CA Zip: 92705
License: 383209
Arch / Eng :
Address:
• Phone:
Zip:
License:
SCOPE OF PERMIT
GAS RE-PIPE IN EXISTING SFR. 1 ADDITIONAL OUTLET FOR A BBQ.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $6.15 1 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $39.45
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 •
2446-46(6/00)
DECLARATIONS I ' I •
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.
( ❑\ lyave and will maintai works comps tion insuran as required by section 3700 of the Labor Code,for the performance of the work for which this penpit is Issued.
(Ir
workers'co s''tioopR In r nc ar er and poli number are: p�/, (�( g/-9
b^/ /�,
Carrier: b /V.. ✓ J/✓1 Policy Number I ( `-C//1 '� '(/,
(This section need n ttttbbbba completed if the permit i valued at one hundred dollars($100)or less.)
O I certify that in the pert qce dof the or which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensatio aws of:'. '•Alla, nd•• thek If I should become subject to the workers'compensation provisions of Section 3700 qt the Labor Code,I shall forthwith
comply with the-•prAll4 •ns. (//]l /]r--/"--
Applicant Signature: Date:
WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND Drs I ARE($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 ' ense• ,M\ visions of Cha lyt9r. r neplg},�itrection 7000)of Division 3 of the Business and Prof s io ee,a II ' in full
force and effect.Lia# ,1//f C/o ,�(�(/ 1 Glass# [�
Contractor's Signature: �ilM� Date: V' _� �)
CONSTRUCTION LENDING AGENCY: •
❑ 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).
Lenders Name: Lenders 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 properly 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 I,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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Cate:
Owner ID verified by driver's license. 0 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O 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? 0 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 Califomia 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? ❑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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency'? 0 Yes 0 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 Califomia 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
B (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.
g ature 01 Le I rner(s) 9 _LiT tate
And/Or Authorize pplicant Date
CODE I INSPECTION TYPEpA� IXIIIlALS CODEC INSPECTION TYPE y Ifs
1616 Fixed System Final Fire Prevention 206 Final Mechanical _
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical
201 Final Block/Retaining 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
PROJECT ADDRESS: 2861 SERANG PL UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05587°
OWNER'S NAME: GALE ROBERTSON
ADDRESS: 2861 SERANG PL PERMIT NO: B 055879 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA
CA 92627 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O, RESHEATH1/2"CDX, REROOF W/COMP SQ FT: 6, 800
ADDRESS: UNIT:
iiiCLAIM VALUE: 6, 800. 00 CALC-VALUE: 6, 800 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: PETRONELLA ROOFING ( 714 ) 548-1645
ADDRESS: 2626 NEWPORT COMMENTS- SMOKE DETECTOR(S ) REQpUIRED IN HOME
COSTA MESA CA 92627 ****************************** 1.****** t** E*** EE* ET ***** F*xSt ^ C*n C^IQp
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full farce and effect. SETBACKS REQUIRED
CITY LIC.: 032605 STATEUC.:00460707 CLASS: 39
Date: �^ ZZ^9 2 Signal. ► •� '. ri MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: Ih: at 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 thereo ection 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLIcr ND.: 10 7 9 9 8 7-91 EXP.DATE: 07/01 /92
COMPANY: STATE FUND PARKING REQ' PROV: PARCEL: -1-3932211 ZNE: REF NO;
r ❑ Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. PLANNING NUTES>
"---- Date: / 21 '�2 AODlican �/ *****************************************************************************ie*
EXEMPTION FROM WORKERS'COMPENSATION DECLA' r - cion need not be completed it the permi is for one hundred(5100)or less). D E V E .L O P M E N T SERVICES REQUIREMENTS
I certify that in the performance of the work for whic 1 r it is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of Cabfomia. ZONING APPROVED' BY
DATE;
Date: Signature:
NOTICE:If,alter 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 provisions or this permit shall be deemed revoked. p
CONSTRUCTION LENDING AGENCY: I hereby afrm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY:
{'�i DATE
which this permit is issued(Section 3097.Civ.C). **************•**********S�F��F**.31.*. * 3+ *.3.. **************,*„***,** **ie**
LENDER: ************************************3t 3e** ***************3e********le***********
ADDRESS: LEGALIZATION:N F E E SU MARY STRUCTURAL SEGMENT:Y
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 90. 00 68 r
repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business f�'1 SMIP/NON-RES
and Professions Code)or That he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70315 by PLAN
any applicant lot a permit subjects the applicant to a civil penalty 01 not mote than live hundred dollars(s500). ISSUE FEE
I. as owner of the property or my employees with wages as their sale compensation, wit 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----> 90 . 68 0 . 00 0 . 00 90 . 68 90 . 68 . 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 orimREVENUE DIVISION TOTALS--> COLLECTED: 9 0. 68 OVER/SHORT: . 00
forptheepurpose of sate). BLDG
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 PLAN-CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7144,Business 90 . 00 . 68
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******************$*************************.*************************,T(,*********
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: •Owner: SFR 6800 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 6,800. 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 will/will not(circle one)need to comply with said state codes and the requirements for a
permit lar 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 all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this ow to enter upon the above.mentioted
property for inspection purposes.rpnz
Date: l' ZZ 7� Si9 / /
•Driver's License or Social Security C: :1 'J
1 "lCo4=. :•-•":1.10...94: __
1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor 1_, )T�' Qj:'3• �, /\
/'
CONSTRUCTION AND PLANNING POOL .,PA
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, D Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, D 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 Electricat-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 O Gas 0011
23. Gas Pipe-Rough & Test 72. Underground Flush-
24. Roof Framing 73.:Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 4.23-t (j c✓64 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 PREY. FINAL
-30. Drywall Nailing HEALTH DEPT. REQUIREMENT
•
31. Plaster Brown Coat - 1 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 1
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 - -
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 & BUI LDING 2_13_9a
li/�.•� .
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date ,
GOLDEN STATE FIREPLACES
421 SOUTH VINE
ANAHEIM. CALIFORNIA 02605
PHONE (714) 695-1600
CITY OF COSTA MESA JULY 12, 1977
BUILDING DEPARTMENT
ATTN : MR RICHARD OSBORNE 68 �J I?
�f/�i1
MR ED SCHAFER r �f' (/
DEAR SIRS :
THE HEATILATOR (3036) FIREPLACE, INSTALLED AT 2861 SERANG
PLACE COSTA MESA, CA. BY WESTCARRIAGE CONSTRUCTION CO.
IS A ( 0) ZERO CLEARANCE FIREPLACE MANUFACTURED BY HEATILATOR
FIREPLACE, A DIVISION OF VEGA INDUSTRIES. LOCATED IN MT.
PLEASANT, IOWA. THIS UNIT CARRIES ICBG REPORT NO. 1141 ,
BOCA REPORT NO. 69-10. ENCLOSED IS A GENERAL INFORMATION
SHEET PRINTED FOR THIS SPECIFIC UNIT.
\\77 SIN 'LY
�) /
EISON
USTOMER RELATIONS
rn
OWNER ROBERTSON, RICHARD DATE 5-24-77
JOB ADDRESS 22561 Serang Place BUILDING PERMIT NO. 44057
GENERAL CONTRACTOR we Carriage Con ct$ACRIPTION of WORK Enlarge Livingroom
I .
1.9-S22-J1 LOT 7 TRACT FIRE ZONE VALUES 5,'+00.00
I CTIONS Signature Date TYPE V GROUP I ZONE R—1
SOIL • ' SUBCONTRACTOR PEBMITSISSUrED
GAS Dote Number Signature
IPlumWATER
binp
ROUGH PLUMBING
PROP: SWR. LINE n HOUSE CON. Li
SPRINKLING SYSTEM
MISCELLANEOUS
\ ROUGH HEATING AND AIR CONDITIONING Ito ?-2o-7
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING y j �} Hea ina and Vent,
TRENCHES xJ FORMS STEEL REINF. 6- i zehd,t( ,U gone&,4-24-771jgSy----.-
FLOOR SYSTEM
BOND BEAM 0 'STEEL REINFORCE fI
SHEATHING _/-77
FRAME AND FLASHING Q 7•1422:g
LATHING - IN IJQ OUT Rf.,R7 4141PLASTER, BROW OAT 0 72
9 TURAL, FINAL Electric
HE...ING, VENT., REFRIG. AND A.C., FINAL SLC 13(10- ttf/4e0&�1ML� '�a.�e, ti $t3.0-]7 9341.5- I
PLUMBING, FINAL AND GAS TEST n
ELECTRIC. FINAL Cr `-:
BUILDING. FINAL
r 4AY24-77�y��OO1144a ****5!'.5C
44057
r COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PPL A ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only
R C 1 D Y DATE RECEIVED DATE^�• f(S/Jg/U—19
BUILDING )try hLCn F/ v Q •
ADDRESS Ga /6 ...)P///�f /��1Q -/s
?Gh cn,4c/ /`-O 4 . - ' PERMIT NO.
OWNER y..�f O/ A.P. NO n Q
MAIL BUILDINGADDRESS /t S4 1 4 i / �•
ADDRESS ...car
-tiy-,L
TEL.
CITY (1, /•JCSC— NO. Sr7 YVI TRACT/700g LOTS /
(qBLOCK
CONSTRUCiION/1 I` FA rte) ` NEW ADD ALTER REPAIR (MOVING DFMDI ISH
LENDER /�CCJX� /T+ �. .J Y' Xj!�,.�l�/yy/ ��{j/j �a,t•//�- l
BRANCH -C�•Ti LR�(•... itr`c•q tar yr rt�tbe / .5 o/)
OWNER
ADDRESS
.ARCHITECTQ� yyy/ Q e ��ALUE glint,
OR ENGINEER ///I/ /22/<O.✓//DOI\ NOI.r_f)70'7 1 FI / ! ;Js� T
c� 2 ZONE TYPE GROUP ..✓
ADDRESS /3 O Cc.b U.' Dt_
(mss �+ APPROVED
CONTRACTOR 4.4.5-le pt- y-.-l..q-. C.� rt.,SC.. BY DATE C,
ADDRESS 32-) n: ?G/Ja.-/
TEL. E NO.OF USE OF NEW
^ / PLANS 2 BUILD
CITY(l}pt_ ,,,t� NO. J .� YYolL ( Li �(t�i
I�-,+ STATE / CITY YARDS APPROVED YARDS APPROVED
W LIC. NO. Zi-yc 77 LIC.NO. MAIN BUILD( G ACCESSORY BUILDING
SIZE NO.OF BLDGS. (FROM C/�LyST T)
W
OF LOT NOW ON LOT FRONT /p T. FT.
yUSE OF �h /''�
EXISTING BLDG. R.SIPF ,.6 FT.
LA /
(-1
Separate permits are required for L.SIDE / .� . FT.
G electric,plumbing and heating work. REAR . ,`
r . FT.
(W. USE OF BUILDING AND WORK TO BE PERFORM BET. BET.MAIN&
C Ate" Ana - is- ! 1 k MAIN BLOCS. ACCESS. BLDGS.
VAR.#ia; DATE
QC. U.P.#s APPROVED
.}.l C/s' G— Liv 4 SAY ROVEr/[/r/A. PDATF 5---2V--'77
IX
W
0 I hereby acknowledge that I have read this application and state tn
X that the above information Is correct and agree to comply with m
CH all laws regulating building construction, and I shall not employ
Z{� any person In violation of the workman's compensation laws of x
E
T. the State of California.
I hereby certify that I am properly licensed es a contractor under `^1
7s/ SO. FT. N
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:' i
ta
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E 3rc{/ or
and Professions Code iv anon 3,C r 9. v(j az, th
Signature of ..s/ PLAN CHECK E / so .s, ^
5/y� o
Permittee $ TAX 3 n
2
U
Authorized A TOTAL PAID 3 ,�f - CO
- Odd'. d:- rn�►G ��
37 J_ 1_3977
k -e�e,JG�l9�ht/ i;InR 6 19S1 ��
A MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING . _ BUILDING
ADDRESS SCro--.-..` c��.
.. .--6./ COSTA MESA. CALIFORNIAJFor Office Use Only
Investors Marine Inc. I RECEIPT NO. I A mud a
OWNER �1� {� gt�.�
1600 H. VQust- gnwa RHCHI BY DATE RECEIVED DATE ISSUED
MAIL //
ADDRESS / V I 6 1961
CITY Newport Beach E M6_1655 BUILDING ' /70
ADDRESS P e/�,J/./J i F
ARCHITECT Same TEL.
OR ENGINEER NO. o((J�O/_/ COSTA MESA. CALIFO IA ADDRESS
FI E
NE TYPE V GROUP t
CONTRACTOR Mesa Verde Builders,Inc. APPROVED
BY DATE
1653 Minorca Drive f,/��
ADDRESS ZONING .1 Z�
ZONE NO.OP UBEI OF NEW
CITY Costa Mesa Calif. I I PLANS �� BUILDING
STATE 181269 TEL. Ki 9-0395 A� �
LEGAL ---(�T` 2
LIC.NO.SIZE �^ NO. DESCRIPTION ` ‘0046 '� - 8 /
OF LOT S 1 X 1051 I NO. OF BLOGSO
NOW ON LOT A.P.NO.
USE OF YARDS EVES
EXITING BLDG, L APPROVED ALLOWED
SCENTERKOF HE STREHTM 451 REAR YARD 301 (CENTER NG ST.) y
FRONTc.5-FT. _ (�1 IN.
SIDE YARD I LEFT 91.411 I RIGHT 91 R.SIDE ( FT. C/-A-�` IN.
DESCRIPTION OF WORK Jr FT. IN.
L.SIDE
NEW I X II ALTERATION I II ADDITION I REAR ��}}• FT. /}-�� `IN.. -•
REPAIR I MOVING I I DEMOLISH I ByPROVEp'"p� DATEI —3FJ
BUILDING1600 S` Ft NO. OF 6 1 w
SIZE q' ROOMS STORIES
EXTERIOR I,L luinccog I ROCOVEROF ING S`Sh c o1Tlge
COVERINGS u
USE OF BUILDING AND WORK TO BE PERFORMED d j1 /47/p•
Single family residence and garage —
Model No. 620-D 8— Air/ p'
Attached garage 462 sq.r't.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT {HH A OVH ISCORRECT A D AD E8 TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH AU. CITS/ OR INANCES 0 STATE REGULATING
BUILDING CONSTRUQ�(fI N. / VALUATION
// ' L L � t�, I PERMIT FEE $ 3 7�- N
SIGNATURE OF 111 /7 �I
PERMITTEE //J G2 5S-47,at D
I $ PLAN CHECK $ / �J .J Q i
Z
AUTHORIZED AENT TOTAL FEE $ .-Sw.J 0
u