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HomeMy WebLinkAbout1417 SHAMROCK LN - Building Permits CITY OF COSTA MESA • BUILDING DIVISION • 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 1111041 FOR INSPECTIONS CALL:(714)754.5626 %so° °'4PERMIT NUMBER: P07-00539 7.7:stigf.19 PERMIT TYPE PaM4K STATUS: ISSUED 9 DATE ISSUED: 10/12/2007 ISSUED BY: SOK • JOB ADDRESS: 1417 SHAM M Suite/Unit: Vicinity: SCOPE OF WORK: REPLACE BATHTUB;SHOWER AND 2 WATER CLOSET DRAINS:REPLACE,WASTE AND VENT FOR S.F.D. OWNER: OTTO, CHRI ... : ., . STOPHER V t- ;.=Address':, X1417 SHAMROCKLN- • �_, PHONE: (714)549-9486 City/State/Zip:' - COSTA MESA,CA' ' APPLICANT: OTTO,CHRISTOPHER V y;_- ' Address: 1417SHAMROCKLN PHONE: -(714)549.9486: City/State/zZip: COSTA MESA,CA.' • - CONTRACTOR: OWNER-BUILDER " ' License No. 000000 Address: - - PHONE: City/State: •• ZipCode: • CELL: - - EXTEN ION A PLUMBING PERMIT FEE,SUMMARY ALIO V Ej D PLAN CHECK FEE: $0 00„ TER PERMIT FEE: $72.50 • TOTAL FEES: $72.50 ` EXPIRES � 4 • • • 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. CODE S. INSPECTION TYPE DATE INTITIALS CODE A INSPECTION TYPE DATE INIIIIALS 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 WORKERS'COMPENSATION DECLARATION: Owner ID�y driver's a. &les 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. (Expires: -2—/y d -/,.Z ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-(property tai 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 section 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 ❑ 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 by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier • or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This section need not be completed ifthe permit is valued at one hundred dollars($100)or less) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would O 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 sgnawre Date the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: 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 ❑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. a registration form for acutely hazardous materials? ❑Yes ❑ No Lic.# Class# (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 Contractor's Signature Date 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 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)? 0 Yes IPNo (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? ❑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? ❑Yes ❑No 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 (Section 65850.2 of the California Government Code requires that the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). 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 0 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? ❑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 city ordinances regarding Hazardous Materials and Emissions. [❑ 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 Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ 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 authori by this permit unyy/l�;inal inspection. -i —#,�s_ /o.:--/ -2 S na ure of Le er s �7 Dale n a ure J Date J Sl-Ce'r3/o7J • I And/or Authorized Applicant Date it . fir; Q. c-_o��-2_vs- P �1 �° 7—ay — a;. ,, •P % c.4.- r i,.) T E Q- ._%�.ep_-r 1 ! -% A es-r_o_F ?o--/-v .5 o j v_N,L}_L_6_7C6 — A c-zr n- /,✓_i- G cr" 777:1- /l2a_d_-a_g-- 11f lNre---- ��G_v_,✓Q...c.c1=/ /_trrai<—/_-Irk L�x_T_2 _a- 11 ii 11 tri _//.-`/J ii/aP-i.J 4 __E- 1 - _- i_i_z_^4_6-_,,e...n a / /2-174- :21/ ls_g fr_z_T_/_u..-i — - %.)-/-779—...) e9 -61-2-457204--s-- -- r -/ag-^)/4 /eLeei 7Ci. /-°--C4-4..-- WiCr r #1 1 — - /yi_ .5Ze_9_7_L-7-2-o_o/c_---G=am-- --- -ji — — — - GvsTi+_ I >- �Ltr. -- - - - 4__— -- — — — — - yic - 6 a-6- --------- — I — i' 0/ 55 9--- 9yef_G-- - -- - li - --- -- - --- --- - • CITY OF COSTA MESA• 4 BUILDING DIVISION . •j•,,,�' \ DEVELOPNIENT-SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT - - PO4-00695 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1417 SHAMROCK LN Status: ISSUED Suite No Applied: 10/18/2004 Issued: 10/18/2004 Vicinity: Parcel Nunmber: 41814122 ISSUED BY: Applicant: OTTO, CHRISTOPHER V Address: 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626-2635 Owner: OTTO, CHRISTOPHER V Address 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626-2635 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng: Address: - - ' Phone: Zip: - • License: SCOPE OF PERMIT REPAIR WATER SERVICE 10/25/04 REVISED: REPAIR/REPLACE PRIVATE SEWER LINE. 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 $24.65 1 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.) $9.80 1 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 fora 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)7545626 2448-46(6/00) DECLARATIONS 1 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: is section need not be completed it the permit is valued at one hundred dollars($100)or less.) ( I certifythat 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' L= r.. ')compensation laws of Califomia,a agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. ay,` �j �-• ,/ � 1APPlicaRLS ro: • N�� �Dete 3 (/ c� ' � Y' WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPEOVER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.tic.# Class# Contractors Signature: Date: 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: 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.). • ❑ 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.). _ _0..-_I.am.exempt sec. - Business and Professions Code for this reason: 1ISig afore:"�_ ---.4e-/S (7l(J / ( biter /0 —ar „9-n4 -OwrrerID'verifted by driver's license. Yes 0 No rDrt3br5 LlCense,No. ., Ejj re_-s" 0 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,Grp 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? 0 Yes 0 No (Section 25505 of the Califomia 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? ❑Yes ❑No (Section 25533 of the Califomia 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes L-I 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? ❑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 ❑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-descc j d property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 42,s /0 -' jl-- 7)-0 4— /-SIf Legal Owne_(s)t= Date And/Or Authorized Applicant Date ODE I INSPECTION TYPE PATE - INRBALE POE INSPECTION TYPE • DATE IdTIDSLE 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 if 4 CITY OF COSTA MESA• 40Fifkit, .; ea"' ., BUILDING DIVISION !dr i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t I J PERMIT PO4-00695 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1417 SHAMROCK LN Status: ISSUED Suite No Applied: 10/18/2004 Issued: 10/18/2004 Vicinity: ISSUED BY: Parcel Nunmber: 41814122 Applicant: OTTO, CHRISTOPHER V Address: 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626-2635 • Owner: OTTO, CHRISTOPHER V Address 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626-2635 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng: - • Address: - - - Phone: . Zip: • - License: _ SCOPE OF PERMIT REPAIR WATER SERVICE • 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.) $9.80 1 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 • 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 • 2446-48 WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: r. 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • _ (E 9�I.pertity that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' Ig O' —ccoompensation laws of Califomi nd agree that if I should become subject to the workers'compensation provisions of Section 37 0 of the La or Code,I shall forthwith comply with these provislo / n App icanti$Igneiure: --,.- j( C^� Date:- ` 4 . Y WARMNG:FAILURE E TO SECURE WORKERS'COMPENSATION COV GE IS UNLAWFUL AND SHALL SUBJECT AN MPLOYER TO CRIMINAL P ALTIES ' CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SE Ot�3706OFTHE R WOE,I REST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: 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). 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 Cr 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).): ❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORN,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.). ' ❑ 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.). 0`. l a I exempt u ec. Business and Professions Code for this reason: _ /0 -/ P �! (� vie?? �(r��-S h.��/!��/✓"y hate: , L/ �¢ I Owner ID verilie y driver's license. ep y s ❑No Orlveys Li-'„ cense No.•` / - �'E pins'. �� / #—0 7 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,Grp 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? 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 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? lYes LJ No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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? 0 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: 1 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 w th ell state laws and city ordinances relating to building construction,and authorize representatives of the ity of Costa Mesa to enter upon the i above-described props .o inspection purposes.I gree not to occupy or allow occupancy of any building authorized by this permit u/n/' final insp ction. CSignature OfLe al wner(s) - /0 4---------) And/Or yam" / And/Or Authorized Applicant Date i CODE I INSPECTION TYPE PATE INTRIALS COOEk INSPECTION TYPE RATE IHTmALS • • 1616 Fixed System Final Fire Prevention 206 Final Mechani 1266 Pool Spa FiI 208 Fetal Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall Final Fire Prevention 202 Final Factory Fire Place . 220 Final P an - ••• •vel 203 Final Sign -, 222 Final Site 204 Final Demolition ' —7I NV250' Final Building/Occupancy 41I AI 9 CITY OF COSTA MESA 4 BUILDING DIVISION •K-•., , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER rm . PERMIT 1.141 - 401-00574 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1417 SHAMROCK LN Status: ISSUED Suite: Applied: 04/26/2001 Vicinity: Issued: 04/26/2001 Parcel Number: 41814122 Zoning: R1 R1 ��1�j� Applicant: ISSUED BY: . V -.- Address:Address: Phone: Zip: Owner OTTO, CHRISTOPHER Address 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: • License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REPLACE EXISTING 22'X 16'PATIO COVER WITH NEW ONE AT THE BACK OF THE HOUSE AND REPLACE EXISITNG MASONRY FIREPLACE WITH NEW FIREPLACE/CHIMNEY IN THE LIVING ROOM.UL LISTED(UL)MH9245/ICBO#2578. FIREPLACE SPECS WILL BE ON-SITE FOR INSPECTION. FEE SUMMARY Plan Check: $90.51 Calc Valuation: $6,824.24 Permit: . $139.25 Claim Valuation: $0.00 SMIP Res: $0.68 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $230.44 i i PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 15-0 Left 9-0 Right 11-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right '0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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 , ( 1 ) fl 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 end will maintain workers'compensation insurance,as required by%c';'n 3749 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This se 'on need not be completed if the 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 agree that H I should become subject to the workers'compensation provisions of Section of the Labor Code,I shall forthwith comply with these p isions. p�+/' Applicant Signeture. /c `)//O Date: / r WARNING:FAILURE T CURE WORKERS'COMPEN TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OIL 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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 end Professions Code)or;ttiat 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 it more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees witti 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.). ❑ 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am axe oder sec. //� Business and Professions Code for this reason: // Signature: ;iC ( 1//U Date: 0 Owner ID veen ed by driver's license. 0 Yes 0 No Drivers 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,Grp 2,Art 2,Sec. 345,Title B,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? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 ❑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? ❑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? Yes U 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? ❑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(Duality 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? 0 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 yyand city ordinances relating to building construction,and authorize representatives of he City of Costa Mesa to enter upon the above-descri /`7r"rrooppperty for inspection pu o es.I agree not to occupy or allow occupancy of any building authorized by this pgrm it final inspection Sign Of LLega Owner(s) (! i/DDal'tf1/', And/Or Authorized Applicant Date ODE I, INSPECTION TYPE DM' INTITIALS CODE! INSPECTION TYPE PAIS INTRIALS 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 Wail 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final en 222 Final Site e��-R2 204 Final Demolition - 250 Final Building/Occupancy ,• 44. p4"MF CITY OF COSTA MESA IL BUILDING DIVISION Ff DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT 4; BOO-01185 EDeb (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesatLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1417 SHAMROCK LN Status: ISSUED Suite: Applied: 08/03/2000 Vicinity: HOUSE&ATTACHED GARAGE Issued: 08/03/2000 Parcel Number: 41814122 Zoning: R1 R1 Applicant: OTTO, CHRISTOPHER Address: 1417 SHAMROCK LN ISSUED BY:• Tl Phone: (714)549-9486 COSTA MESA,CA Zip: 92626 Owner: OTTO, CHRISTOPHER Address 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(20 SQ).TEAR OFF EXISTING SHINGLES& REPLACE SHEATHING AS NEEDED. INSTALL 1 LAYER OF 40#FELT UNDERLAYMENT&REROOF WITH 40 YEAR COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 • SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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(6/001 ,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'compensation Insurance carrier and policy number are: Career: Policy Number: (This section need not be completed it the 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 agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOU_ARE($100,000),IN ADDRICN 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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.q Class x Contractor's Signature: Date: 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). 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).): C 0 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.). ❑ 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 and sec. Business and Professions Code for this reason: _Signature:_ --e/4/Z/4 _ Date: E--?—rrurrc Owner ID verified by drivers license. 0 Yes 0 No Driver's License ' _ 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(38)feet high.(Chap.3.2,Grp 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? 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 wilt 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 a ermit 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 Calitomia 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes ❑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 prope or inspection purposes.I agre of to occupy or allow occupancy of any building authorized by this permit until final inspection. a-3 - SignaturaObLdgaF94.'r of r(s)— —__ __ V t �7 And/Or Authorized Applicant Date CODE f INSPECTION TYPE PATE MALE CODEC INSPECmON TYPE Phil 2111BMLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final208 Final Plumbing 200 Final Re-Roof /-?^ "02- 6-41-9--- 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 • 4`, ,r• 9 CITY OF COSTA MESA BUILDING DIVISION • 5 i ,r : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER tPERMIT J 11114111 • Y PO2-00742 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1417 SHAMROCK LN Status: ISSUED Suite No Applied: 12/16/2002 Issued: 12/16/2002 Vicinity: Parcel Nunmber: 41814122 ISSUED BY: Applicant: ROBERT DEPOT° • Address: 05457 CRENSHAW BL Phone: 800-554-5858 LOS ANGELES CA Zip: 90043 Owner: OTTO, CHRISTOPHER V Address 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626-2635 • Contractor: ADEE PLUMBING & HEATING Address: 05457 CRENSHAW BL • Phone: 800-554-5858 LOS ANGELES CA Zip: 90043 License: 240186 • Arch / Eng: Address: Phone: Zip:- License: • SCOPE OF PERMIT • PLUMBING TO INCLUDE: 1 WATER RE-PIPE. • 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 $9.80 1 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 • 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)754-5628 2446-46(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. 'iDhave 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 work a''ccom. sari Insur a vier and Y number are: cCarier: .l'"- ( fP -). CPoNcyNOmbe? Iiipa9q6"7/� --© I (This section need not be complet a permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the p rmance o he 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 f Califomi ea that If uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these rovisio . C -A ppUcant'Signature:-7 Q Gosh? ./ ? /it, - 0 o` 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 ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: Lherebyaffirmthet4.am.lic- ed .• - ". • -••Lind: " _.:.ter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full Cforce and effect.Lic.0 -- V cZ a 1Clasa�p C-o c- (_„ #1 C' - GongacforsDate: a j(0 - 0a- L — _ 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). 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.It,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.). ❑ 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: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers 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,Grp 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? 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 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 en 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 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 LI 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? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). 7 II 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? 0 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 end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc • . operty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. tura Of Legal Owner(s) Date And/Or Authorized Applicant _ rOate--____ CODE 1 INSPECTION TYPE all RETRIAL$ CODE( (NSPECT10N TYPE RASE II1MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing )-ay-03 171V 200 Final Re-Roof 210 Final Electrical 201 Final BIocWRetaining 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 s�M CITY OF COSTA MESA 4L BUILDING DIVISION }:l,,, ..4 DEVELOPMENT SERVICES DEPARTMENT PERM UMBER v. 114111 I PERMIT MO1-00230 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1417 SHAMROCK LN Status: ISSUED Suite No Applied: 04/26/2001 Issued: 04/26/2001 Vicinity: Parcel Number: 41814122 ISSUED BY: Applicant: OTTO, CHRISTOPHER Address: 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626 Owner: OTTO, CHRISTOPHER Address: 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: License: SCOPE OF PERMIT MECHANICAL FOR ICBG FIREPLACE. REF:B01-00574. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 , Inst FAU <100 k BTU $0.00 0 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 $10.65 1 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 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 i Fire Dampers ' - $0.00- 0 Up to 3 hp -$0.00 0 Smoke Dampers - $0.00 0 3 To 15 hp $0.00 0 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 $34.15 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 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: hiss Ion need not be completed/f the permit is valued at one hundred dollars($100)or loss.) 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.end agree that If I should become subject to the workers'compensation provisions of Section 370 of the Labor Code,1 shall forthwith comply with these provision /n�O Applicant Signature: �/S (6-Y/0 Dete: a� WARNING:FAILURE TO SCOUR WORKERS'COMPENSATIERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND C IL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR it)SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.if Class a Contractor's Signature: Date: 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that'under penalty of penury 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(5500).): ❑ 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.). ❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sac.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 exemp r sec. Business and Professions Code for this reason: / /�- / 'Signature: ��tfri— Date: / / 21 / 0 Owner ID verified by driver's license. 0 Yes ❑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 feel 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,fatsework,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). ❑ 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 lime 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? ❑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 L-I 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 ❑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? 0 Yes ❑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-des ' d property for inspection purpo e .I agree not to occupy or allow occupancy of any building authorized by thi it until final i pection. 4/�s CTr �CO � Signa ure f Lege Owner(s) Da And/Or Authorized Applicant Date you 1 INSPECTION TYPE VATS' INTmALS CODE it INSPECTION TYPE 1 328.1E INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1' O- a. tljl 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 (#7-Do> CITY OF COSTA MESABUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT / PERMIT NUMBER PERMIT ✓ E01-00481 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1417 SHAMROCK LN Status: ISSUED Suite No Applied: 06/11/2001 Vicinity: Issued: 06/11/2001 Parcel Nunmber: 41814122 - Applicant: OTTO, CHRISTOPHER ISSUED BY: S Address: Phone: 714-549-9486 Zip: Owner: OTTO, CHRISTOPHER Address 1417 SHAMROCK LN Phone: (714)549-9486 COSTA MESA,CA Zip: 92626 Contractor: : . Address: Phone: Zip: License: SCOPE OF PERMIT ELECTRICAL SERVICE UPGRADE. FEE SUMMARY ,' Quantity Quantity . ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 . Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw _ $0.00 - 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 - 0 Low Voltage Equipment $0.00 0 �' Res Appl . $0.00 . 0 Low Volt Wiring System/Ckt $0.00 0 , Service to 200a ` - $30.50 - 1 -. Misc.Conduit $0.00' "0 / / Service to 1000a ` - $0.00 -0 Misc.Conductor - $0.00 v 0 / Service over 1000a $0.00 , 0 Circus(gen or ride) • $0.00 1:1' . Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp , . $0.00 0 Christmas Tree Stand $0.00 0" Motors to 50hp $0.00- 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00' Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 Intermed Pole $0.00 0 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) DECLA?ATI9NS , t:46 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the 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 agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: 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 ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: 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: 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 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.It,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.). O I am exempt under sec. ' Business and Professions Code for this rea Signature: v` 0 � Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. res: 6'—/f a7+ Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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,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 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? ❑yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 15 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? ❑Yes ❑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? 0 Yes ❑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-descr' property for inspection pup .I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Cis � �� - , Signature Lega wner(s) ate And/Or Authorized Applicant Date CODE# INSPECTION TYPE QALE INTRIALS CODES INSPECTION TYPE PATE INTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing I 4er, 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 [PROJECT 1417 SHAMROCK LN UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; BEP 048819 OWNER'S NAME: OTTO ADDRESS: SAME PERMIT NO: BEP 048819 PLAN CHECK NO: 05421-90 S GOVT: N SUPP: N CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PLU SIR PURPOSE: NEW • 549-9486 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE UTILITY ROOM SQ FT: 100 ADDRESS: UNIT: CLAIM VALUE: 1 , 000 . 00 • CALC-VALUE: 1 , 730 . 00 GROUP OCC : R-3 / PERMITTEE: OTTO ( 714 ) 549-9486 ADDRESS: CM417 SHAMROCK CA 92626COMMENTS; LEGALIZE 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 force and effect. SETBACK S CITY LIC.: STATE UC.: CUSS: MAIN BUILDING ACCESSORY BUILDING Date: Signature: FRNT: FT IN REAR: FT IN FRNT: 15 FT 6 IN REAR: 42 FT IN IRKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: 55 FT IN RGHT: 5 FT 6 IN ,npensation Insurance,or a certified copy thereof(Section 3800,Lab.C). POLICY NO.: EXP.DATE: PARKING REQ: PROV: PARCEL : 41814122 ZNE: R1 REF NO: COMPANY: PLANNING NOTES> PERMIT TO LEGALIZE EXISTING ACCESORY STRUCTURE ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. > (UTILITY BLDG. ) . • Date: Applicant: D E V E L O"P 'M E N T SERVICES REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). . _{C I certify that in the performance of the work for which this permit is issued.I shall not employ any pe on in any manner so as to become ZONING APPROVED B Y d �� q subject to the Workers'Compensation Laws of California. •— DATE: G�3 / O Date: a"' 3u — a/ U Signature: /1Q IS $UILDING APPROVED BY ]L� e DATE: c't 3090 NOTICE:If,after making this declaration,you should become'subject to the Workers'Compensation provisions of the Labor - Code,you must forthwith comply with such provisions orthis permit shall be deemed revoked. —wwwinlilliNIIIIIMMIIIMIIIIM. II_ II—APPLICATION ISSUED $Y; 1 �L" ay CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ***************ISSUED**.B**-_*E-, _s rs,�,� ****DA(�DATE : *AVE* which this permit issued(Section 3097.Civ.C). ******************************** ***** ************************************* UNDER: ADDRESS: LEGALIZATION:Y F E E S - M M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRI 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 82 . 00 400 21 0 ,50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 25% 5 % SMIP/NON-RES pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 53 . 30 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 3 . 0 15,00 1y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE I� I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 107 . 50 18 . 00 26 . 65 152 . 15 152 . 15,-- . 00 LJ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors State 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 employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 125 . 50 OVER/SHORT: '' - - 00 improvement is sold within 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 for the purpose of sale). 82 . 00 7 . 00 36 . 00 . 50 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business • ❑ and Professions Code: The Contractors'State License Law does not apply to an miler of Property who builds or improves thereon .********************************dE***************#**##****#***##-1E####3E#it dF###it### and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).I am aware �{ that proof of their Worker's Compensation insurance should be provided to me. IND I VIDUAL F E E BREAKDOWN CJ I am exempt under Section:B P 704 4 B./3 P.C. for this reason: ALL WORK BY OWNERTYPE QTY DESCR IP T ION UNIT COST • TOTAL COST K. / o/% Date: �! —; e/ ' `1U Owner. ' S SFR 100 RES-LAUNDRY RM. APT COMPLX TYPE V-N � 17 . 30 1 , 730 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and EL E 2 FIXTURES, LIGHTING 1 ST 20 EA. . 75 1 . 5B 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 EL E 2 R EC EP T/OUTLET1 ST 20 EA. . 75 1 . 50 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from EL E 2 R EC EP T/SWITCH ''' 1 ST 20 EA. . 7 5 1 . 50 these provisions. ELE 2 RES APPLIANCE NOT OVER3 . 00 6 . 00 Date' Applicant PLU 1 LAUNDRY TUB OR WASHER E X P I R �etcllona 2 . 00 2 . 00 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 EN 'Tpt@�t�T-Q ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned fn� property forinspectionpurposes. �( v\ ' J J SIg �=� •••.J Date:. b —.3C)- 9U Signature: C.�' � 2S C� t � IT� Date Ddver's License or Sodal Security x: / 705 8 01 30068702-00058 O 1 in. _: \ n tl 1 U nn 1641-46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor t r: /30/90 TilE: 10:433 i CONSTRUCTION AND PLANN,,.,t3 POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole52. Pool & Equipment Location „/ 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '1. 3. Electrical Conduit Utility-Undrgrnd. 54. Forms r 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • V 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • • 6. Electrical UFER-Grnd. 57. APPROVAL TO COVER-GUNITE, 7. Footings58. Electrical Conduit-Undrgrnd. 8. Foundation sits-- ' ,B/ 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. I r1 60. Backwash Lines, P-Trap, 0 Undrgrnd. ,t 10. Structural Floor System 61. APPROVAL TO DECK 7l /--- 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final " ,i 1 12. Sewer Cap Ild' i 63. Heater & Vent-Final 13. Roof Drains . ✓ 64. Plumbing System - Final -r 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final „ - 1 16. Rough Electric Wiring 67. Fencing & Access Approval 3'. 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 ID 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 i f f FZ 441f 76. Dry Standpipe 28. Lathing & Siding _ 77. FIXED SYSTEM FINAL - - 29. Insulation - i r 78.• FIRE PREV. FINAL ' 30. Drywall Nailing • ` jj I` - . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 1 79. FINAL INSPECTION • 32. Electrical Power Meter-Final ! i I 80. FOOD CERTIFICATE ISSUED • 33. Final Electric �, ; (- - Notes: " 34-: Final Heating& Air Conditioning - �/ ,I Ii, I - ' • 35. Final Gas Pipe-Test / i / 1 36. Hood or Canopy I ek ;� /r' : � _ , 37. Final Factory Fireplace - •' ' II 38.'.Final Plumbing . 39. Water Service-Final • I , 40. Gas Service-Anal {, " 41. Solar Domestic-Final • - • 42. Backflow Preventer 43. Backflow Irrigation 1 l 1 44. Landscape Irrigation System EXPIRED . 45. Sound Attenuation incomplete Inspections 46. Handicap Regulations //cj) i?Atn Z(�C, g St 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 0 OWNER H. S. McDonough DATE 8—d-58 JOB ADDRESS 1417 Shamrock Lane BUILDING PERMIT NO. 7270 GENERAL CONTRACTOR Owner-Builder VALUE $ 225,00 . A3RV3-15 LOT 6 TRACT 7632 FIRE ZONE DESCRIPTION OF WORK Wood Fence GROUP TYPE ZONE PLAN NO. INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System - imi Steel Reinforce Chimney Re-Rod ail Bond Beam ; Frame and Flashing — Lathing, In Out Plaster, brown coat Underground soil L . /G Pipe Test —�A g`I' Top Out 10-34: 0 COSTA MESA 4. PBUIO. BLDINGOX 7 DEPARTMENT I 7� e0 I ✓�E ,CEI QED COSTA MESA CALIFORNIA E Ippl FOR APPLICANT Tg 01. EIN�EPT. C.L. OF STREET---- BUILDING �J'{� r �f f �gT•q `1E�" BUILDING ADDR APPA // __ ______--12_99L LINE _ ----;-N Owner '97 � / �' 1_,_ / r _10 FT. FOR 60 FT. STREET— 12 FT. TUT FOR i Mail Address / / / 50 FT STREET � - j--- City e 2 �/`' Ph. No. A/ 5-- 1.5- 4 Contractor©�N P tC— Ph. No. Is t u Address CITY �F COST t MESA 50 IIF FRON[ City Lic. No. State Lic. No. _ Pi,A '^:INGS DEPT, OF PROP. E. � �?-1 150 FT SUBJECT O SLUG. DEPT. REG. W Size of Lot ye"X /as A)/iero?f 3� o to m AP No. cc t- I- r-S' w t F' Setbacks: C/L Street -_./0 f' Rear - • w BY / if . DAT Z ` Co rc PLAN TE,°i' Side Yard - Right — 0— Left —O — m F — J S 0 0 r---- a. O Type of Fen af u. ALLEY OR PROP. LINE\ 0 c.52� J m F:---Z -, I' I hereby ackn wledge that I have read this application and state 7L 1 IVI that the above is correct and agree to comply with all City Ord- Ntp inances and State Laws regulating building construction. V 1 t-- Signature (\ 10 of Permittee / e /YID/ UFT' Agent fi 37 s IN. FOR OFFICE USE ONLY Ft Q I 40 Z ' �}_ FT 1 I Permit No. o >"i 1 I X2t0 m 60 FT ST. Receiveen�di^by Date Received DateQIssued p 50 F�G ST. I F i r E. f "\ ' 8- a- g8 V- 6 - S O ailli . _—.CPROP. LINE _- - �`- - i tt I VALUATION Permit Fee $ ea N I $ a a S OD Plan Check $ k C) C.L. OF STREET— I I T TOTAL FEE $ d& ' C) v MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES --- --- . MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS OWNER Onll.Q• ; Masa"Company DATE 4-18-56 - JOB ADDRESS 3)117 Shamrock"Lane BUILDING PERMIT NO. 2765 GENERAL CONTRACTOR The Hale CO VALUE $ 10,960.00 LOT 6 BLOCK TRACT 2132 Single Res. w/att gar GROUP I & J TYPE V ZONE R11 FIRE DISTRICT 2791 PERMITS ISSUED INSPECTIONS • DATE SUBCONTRACTOR p DATE NUMBER Footing Trench .0.C J� - I Foundation Forms apitade W Garj e 5--.../4,,s7-4 _ Rough Framing 46 7 - a--y,, Plumbing,Rough to Slab ,6� Plumbing,Rough Complete-7a - - - - .29..'31 2,,,,/ ,ya G(-.z- . ra 4' / 4/r -- Temporary Pole �"� Wiring,Rough mcc_-y-9; �Ja cc � .wrt, gitc, 6-0.S4' 4 a '1 eAA -- Heating, Heating,Rough ,J �/ Heating,Final x6AY.t,-,-.i Air, e -,7,-1-1 3 3 3 c f' t'Sewer, House,4 e/ Sewer,St. 3/ O/E/ &6-:147/ f-22,(7 ctq- 3 — �t .�eg *i—a ., Lathing, Inl. OutX g""-&5 7-SQ J. Plastering g-44 I2 -' Plumbing,Final,Fixtures Complete..& /0( (p,/k-04 Alir Plumbing,Final Gas Test /el% 017 de p-/ -31 ' a /O, ! MJK Wiring,Final _ '"/; /0-/y-IC. Occupancy ACo /0y4,-31 FORM 210 3M 10-55 Ceta Mesa Building Department i y APPLICATION FOR PERMIT 111 EAST 20th STREET e COSTA MESA, CALIFORNIA 2/94 BUILDING 1 USFOR APPLICANT TO FILL IN FOR OFFICE No. ONLY Receipt No. Permit No. Building _a 76 s' Address 1417 Shamrock Lane Costa Mesa, California R by I `D/ate Reed. I Dat essued Nearest Watson Avenue f` 7 �py� `,TL Jli��'� Cross St. Building Address Owner College Mesa Company Costa Mesa, California Mail Address 8002 Central Avenue Nearest Tel. Cross St. City Garden Grove No. LE 9-2158 Zone ea, No.of I Type v Group y Architect or Lic. 'Y" Plans Engineer Davis & Quigley No. C-1790 Approved / by Date Address 43 Malaga Cove Plaza, Palos Verde CORRECTIONS City Lio. j tractor The Hale Comnarly No. 3422 Address 8002 Central Avenue, Garden Grove Legal I Lot I Description I No. 6 1 Block 1 Tract 2432 (Attach Metes and Bounds) f----n-'31 ^-�.-_ NN J f I'J ' Size of Lot 69 x 114 I Now o.of on BlLot gNone Use of No.of No.of i p i 707 I Existing Bldg. I Families Rooms 6 Setback Line from Rear Yard 36' r -' 1-1 _ Center of Street 50' Side Yard 8' rti n 8 14,6 y DESCRIPTION OF WORK r New I X I Alteration I I Addition I CI!? O -r QT1l MESARepair I I Moving I I Demolish I �J jl tj Building No.of Size 1270 Rooms 6 Stories 1 Fwterior Wall I Roof ering Stucco I Covering Rock APPROVALS .•df New Foundation Location Inspector Date Building Single family dwelling with Forms,Materials, p attached garage. Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building construction. Lath.Ext. ISignature of THE HALE COMP.91Y..1 Permittee ``l plaster, Int.Authorized Agt. l(�1a Plaster,Ext. SILVIA LARDNER Valuation Permit Fee $ Masonry Reinforced $ Jb 4�O• Plan Check$ / �' Bond Beam Total 1 !� Fee $ J / • FINAL vnnne nu F-RP 2M e_55 • N C N o a ° 3 1 p.5GPQus-r"Q3rc *..;- 39.C1 • • Street PLOT PLAN Show location and distances from • • . property line and between buildings • • I4 •g V •. ,