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HomeMy WebLinkAbout1424 SHAMROCK LN - Building Permits 41. b es. CITY OF COSTA MESA • rAs`w`F BUILDING DIVISION F;' �I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: BC10-00106 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: RES ALT DATE ISSUED: 03/11/2010 ISSUED BY: BE JOB ADDRESS: 1424 SHAMROCK LN CM - : Suite/Unit: APN: 41814303 - -Zoning:R1, , - - . Vicinity: INTERIOR OF HOME . - Primary Occ: Const Type: V-B SQ. FT: 0 Valuation: $9,500.00 • SCOPE OF WORK: REMODEL:MASTER BATH ,HALL BATH,KITCHEN,ADD NEW FR DOORS IN REAR DINING ROOM IN EXISTING OPENING. REMOVE NON-BEARING WALL IN DEN AND FRAME NEW WALL IN DEN. REPLACE WATER HEATER IN SAME LOCATION. DEMO 1/2.BATH. WORK INCLUDES ACCOCIATED ELECTRICAL,AND PLUMBING. 3 ELECTIRAL LIGHTING FIXTURES,4 RECEPTACLES,2 SWITCHES,REPALCE 2 BATHTUBS,KITCHEN SINK,AND DISHWASER.'• OWNER: GLEN SHELTON • Address: . - Unit: COSTA MESA, CA Phone: 714-864-1090 . .City/State/Zip: 1424 SHAMROCK LN • APPLICANT: GLEN SHELTON - . Address: - Unit: :COSTA MESA, CA Phone: 714-864-1090 City/State/zZip: 1424 SHAMROCK LN CONTRACTOR: License No. Phone: Address: Unit: Cell: - City/State: ZipCode ARCHITECT: License No. PHONE: ENGINEER: License No. - PHONE: • COMBINATION PERMIT FEE SUMMARY Building Plan Check: ' - $0.00 • Building Fees: $181.25 Electrical Fees: - $33.40 . Mechanical Fees: $0.00 Plumbing Fees: . $78.65 • - SMIP Residential: $0.95 - SMTP Commercial: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES: $295.25 **Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays: New Years Day,Memorial Day,Independence Day, Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE$. INSPECTION TYPE DATE minims CODE$ INSPECTION TYPE / DATE '/ INTTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 6-as—,e 4.7f ( Z 1266 Pool Spa Final 208 Final Plumbing ‘-kr-/6 ?�, yyy ( �,� 200 Final Re-Roof 210 Final Electrical 4-Ig / 10 ", fin 61e71 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 6 -/e1/71020 1011111. WORKERS'COMPENSATION DECLARATION: ®Owner ID verified by driver'sse. Yes 0 No �'ft_ �� I hereby affirm under penalty of perjury one of the following declarations: river's License No. c 311 93 3/! Expires/0 I r ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance, as required by • . 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,scaffdding,falsework,a demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed J the permit is valued at one hundred collars($100)or less) 2,Art 2Sec.341,Title B,Califomia Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applif2nt'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? 0 Yes 0 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? 0 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). O 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 0 No Lender's Address: (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. 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? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No plicant 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 fivcr5IPe 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 Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 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 sal . If, however, the building or improvement is sold within one year of control officer). mpletion, 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.).o information given above is correct. agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. i.9 0 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 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection .urroses. I agree n t occupy r allow occupancy of any building // / / / �hori e.xhi permit until ins ec n. O /1 id fti ,// `� �` /� �� d / D IliSignature of Legal Owner(s) Date Signature Date /]1157<6(3/0]) And/or Authorized Applicant Date &1(ev,, cln, il-Dy, (`7 ) )g /) 9 A1--' try) n z Extra room DECK / X XXX x 3 r uvall. Loco o, �/ - 'neW w�I( • • x 4c_ athez CMccs Ensth� • D I erfrlit) r K's bedroom W A< . 4Ta WAz t TO C&'7/C/ O X1)1/ Z4v7 cz5 (/ ,),c) cnLy 4 °lc. YXXX . 0 �z,�ey C B's bed room Kitchen1 im\ 11X12 10X13 Si .'� • • . OF B AIDING SAEF 'y CITY OF 006 zkx x x x x uxx - REVIEWEDFOX�E 01 ,r a Fra Lll•NCE 11 LPVingrnor& I Daae 3"/r/0 Den 13M)Odors and..:; .. nsMIST tx kept on this job at all time Ind aiaunlawful ro tions on same with ut written permission from b Divisional Burling n 11 X 12 and Selby,City of Costa Mesa. C' The slanging of this plan and specficatDrtSSIALL NOT be held to peri r to be an approval of the violation of any provisions of any Cif 01Costa Mesa Ordinanc and/or gods)law A • ra h dame ViiStafrWaY to Front porch Master bd ill '1. • City of Costa 911esa Build ng Division Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626 714-754-5273 / Fax 714-754-4856 OWNER BUILDER VERIFICATION Permit # Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit hw been submitted in your name lis g ursellftas the bu d9L%9 t..., property improvements specified at 1'1 P9 SJai'teockl LYL. r' ,c- tdic We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. /1 . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- ! ilder" building permit that erroneously implies that the property owner is providing his or her own labor and aterial personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeown 's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am are of the limits of my insurance coverage for injuries to workers on my property. . I I understand building permits are not required to be signed by property owners unless they are esponsisle for the construction and are not hiring a licensed Contractor to assume this responsibility. 2. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that ay protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his .r her name instead of my own. �11,7. I understand Contractors are required by law to be licensed and bonded in California and to list their c-nse nu bers on permits and contracts. . I understand if I employ or otherwise engage any persons, other than California licensed Contractors, d the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may e consi. red an "employer" under state and federal law. /kid:. I understand if I am considered an "employer" under state and federal law, I must register with the state d federal government, withhold payroll taxes, provide workers' compensation disability insurance, and ontribute t. nemployment compensation for each "employee." I also understand my failure to abide by these laws may - bject me to serious financial risk. /IA .. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family r;sidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed •' licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2 . I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable or any financial or personal injuries sustained by any subsequent owner(s) that result from any latent onstruction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractois' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about li nsed contractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand �/J<Hat I am the party legally and financially responsible for proposed construction activity at the following address: JJ 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will bide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the formation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verifica 'on acceptable to the agency is required to be presented when the permit is i s to verify the pro; • owner/' signature. Signature of property owner ,i%yis•L Y t/t- -! / Dater - /t • Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the.permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2 bF CITY OF COSTA MESA 4 BUILDING DIVISION FDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. PERMIT e r B03-02074 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ogSEEILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1424 SHAMROCK LN Status: ISSUED Suite: Applied: 12/02/2003 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 12/02/2003 Parcel Number: 41814303 Zoning: R1 R1 Applicant BURR, STEVE Address: 711 WEELO DR ISSUED BY: Phone: (949)548-2965 COSTA MESA, CA Zip: 92626 Owner: AMMANN, DANIEL S Address AMMANN,SUSAN T TR COSTA MESA,CA , Phone: 1424 SHAMROCK LN Zip: 92626 Contractor: BURR ROOFING Address: 711 WEELO DR Phone: (949)548-2965 COSTA MESA, CA Zip: 92626 License: 635586 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF SHAKE ROOF,RE-SHEATH WITH SOB,COVER WITH 30 YR TIMBERLINE SHINGLES. INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $11,000.00 Permit: $195.25 - Claim Valuation: $11,000.00 SMIP Res: $1.10 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $196.35 - 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 0r 0' PARKING Existinq: 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. 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 e 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. y workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) O 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 C 'forni and a t if I should become subject to the workers'compensation provisions of S tion 00 o�Labor Code,I shall forthwith comply with these pr - /! 1'j`/i -Applicant Signature: ( ` Date: 1 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.ri _ _ Class k ) (��2 Contractor's•Signature: S .. •�Date: 7 III -) CONSTRUCTION LENDING AGENCY: 1 J� ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • O 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 reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,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 ❑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 LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. -t-- gnature Of Legal Owner(s) Wy. ; to And/Or Authorized Applicant Date CODE t INSPECTION TYPE DATE 'INTITIALS CODE* INSPECTION TYPF PATE Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 9 �� 208 Final Plumbing 200 Final Re-Roof /`"p� tom" /� 3 "- 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 Applicant to fill In all spaces except those within heavy border lines and sigy all appropriate declarations. CITY OF COSTA MESA PER ITN l / TRACT NO. LOT NO. BLDG.NO. �''-O� ?/12P:_ - h��•��' Tl CONSTRUCTION PERMIT � �lo(� �f' st ' 1 .q4 F : u7 I ^1/'•9 r•. !11• 1u f1C, . Applicant's,Meiling A� r ss TYPE OF CONSTRUCTION: U NEW U ADDU ALTERATION U�REPAIR _ �_� ,�L Project Address Z✓ ' 0 CONVERSION ❑ DEMOLISH ❑'OTHER - -_ - Owners Name 4. f• r (Q n. Phone rGl0^ I - DESCRIPTION OF WORK ' ' - ' - - - L1 - - ZONING REGULATIONS Address 1 �n amt' -ty. r .. �-ry - - - -. - r°� • • TYPE OF PERMIT 0 GRADING .0 FOUNDATION U STRUCTURAL A.P.W ZONE • i Arch/Eng. - License No.' O•TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL' BUILDING - - _ .PLNG. REF.'# - • , ' qui-gore rn $T'• Address - ❑ OTHER TO BUILDING - ' // PROPERTY LINE• REAR YARD(TO P/L) Contractor's Name. O/ - • -Phone PROJECT DESCRIPTION SQ. FT. OCCUPANCY • - Address(mailing) CON ST RUCTION TYPE-_ - - VALUATION$ • LEFT SIDE YARD • RIGHT SIDE YARD • ZONE ' GRADING CU.YDS. ACRES • PKG.SPACE REQ. PROVIDED License No. __ - - - • ' LICENSED CONTRACTOR DECLARATION Remarks: STREET WIDTH PARK FEE$ I hereby affirm that f am licensed under provisions of Charter 9 (commencing _ , with section 7000) of Division 3 of the Business and Professions Code,and SPECIAL CONDITIONS: my license is in full force and effect. - ' • ' License Class License No. PLUMBING ' '-to Signature - Bar Sink Sewer Cap s ELECTRICAL RKERS'COMPENSATION DECLARATION Meter Clover 100 amps reby affirm that I have a Certificate of consent to self-insureBackflow Preventer - Sewer Connection or a certificate_ Automatic Washer . - - - - • - - - - -- of Workers' Compensation Insurance, or a certified copy thereof (Section - - '- • 3800, Lab. C.) • 1 B• ackflow Irrigation Solar Collectors- Construction •Pole Sub Panel Policy No. - Company ' Cooking Unit ' • Sub Pole B Certifled•copy is hereby furnished. Bathtubs . - Solar Piping Certified copy is filed with the city Building Division. Dishwasher Motdrs ❑0-1 HP ❑t -B Date Applicant - Clarifiers Solar Tank ' EXEMPTION,FROM WORKERS'COMPENSATION DECLARATION Dryers ❑Gas ❑Electric- - -Inc.Solar 09-15 HP 016-15+ (This section need not be completed if the permit Is for one hundred($100) or Dishwasher 1 Swimmin•g Pool w/Spa— ' • less). - - Fan I Microwave I certify that In the performance of the work for which this permit is Issued I ' Drinking Fountains Urinal - - shall not employ any person In any manner so as to become subject to the - - , ' I F.A.U. Pole. Light Workers' Compensation Laws of California. Floor Drains: Water Closet ' Date Signature • -- - - - Fixtures Range I NOTICE: If,after making this-declaration,you should become subject to the Floor Sinks - • : . Water Heater, . _ - . - _ _ ...- .. Workers' Compensation provisions of the Labor Code, you must forthwith. Device Boxes comply with such 'provisions"or this 'permit .shall be deemed revoked. Gas Service' Wer er Service -1 Sign 1 CONSTRUCTION LENDING AGENCY - 1hereby affirm that there is a Construction lending agency for the performance Outlets StandingSections - ' • 9 9 Y P ,Interceptors - t 3r of the 'work for which, this permit is''issued-(Section 3097 Civ. C.) 1 • Tres Compactor Lender's Name 4 - Kitchen Sink - • - �.•• Switchesr Lender's Address - • - - • - Garbage Disposal ' / �� 9 — OWNERIBUILDER DECLARATION -• '- -• I Lavatories • .' v ' I hereby affirm that I am exempt from the Contractor's License Law for the Generator ❑0-5 KW 05-15 KW following reason (Section 7031.5 Business and Professional Code: Any city or : P-Trap: 1 , county which requires a permit to construct,alter improve,demolish or repair .. ' - - Transformer ❑15-50 KW a v structure, prior to Its Issuance, also requires the-appiicant'for such permit Roof Drains - - n - • _ ?y9 a signed statement that he/she is licensed pursuant to the provisions of ' _ _ ' 050+KW' Reinspection Fee $15 • 4sntractor•s License Law(Chapter 9(commencing with Section 7000)of - Reins action Fee <•-• - • Jn 3-of the Business and-Professions Code) or that he/she is exempt . Showers p -$15 Meter ❑u to 100 amp$ us,;ufrom and the basis for the alleged exemption. Any violation of Section - - p p Issue Fee ' $ 3 7031.5 by, any applicant for a.permit subjects the applicant to a civil - 1/ — • enaity of not more than five hundred dollars($500). • ' Service Sink Issue Fee • $ 3 Zoning Approved By • Date I,.as owner of the,property or my employees with wages as their sole - - p p compensation will do the work,and the structure,is not intended or offered . ' ' ' MECHANICAL ' SO 7 ".�-O 3 for sale (Sec/ion 7044, Business and Professional Code: The Contractor's - - - Application Approved By • • Date �f D , License Law does not apply to'an owner of'a property who builds or improves Boiler ' • Refrigeration System ` Application Issued By 'm C, Date Fr/�s -rD 3 thereon, and who does:such work himself/herself or through his or her own ' I • - r - pP \ employees, provided that such Improvements are•not intended or offered for : ❑0-100,000BTU ❑100,000 BTU - sale. If, however,the building or improvement is sold within one year of com- Duct-Under Ground SUMMARY OF FEES elation, the owner will have the burden of proving he/she did not build or im- ' ' \ Qrove for the purpose of sale). Duct-Structural System Repair/Alteration -_ . BUILDING PERMIT- $ SMIP $ 125 I,as owner of the property,am exclusively contracting with licensed con- tractors to construct the project (Section 7044,Business and Professions Code: . •- Duct-Ventilating /. .- PLAN CHECK $ lO - PERMIT The Contractor's License Law,does not apply to an owner of property who - I PLUMBING $ %' ISSUANCE $ ' builds or.Improves.thereon,and who contracts for such projects with a con- Exhaust System ❑ Multiple❑ c_ I c/ tractor(s) license pursuant to the Contractor's IJcense Law). - - GRADING $ • PLAN CHECK $ $ 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG • - - 31 y� 1d /�-T.7j'7c. ELECTRICAL $ �� MICROFILM • $ • Date owner + - r Heating System&Ducting s r ' I hereby certify:that I:-have:'read this application and state that the above ❑0.100,000 BTU ❑100,0008T 'T - - 'PLAN CHECK $ : Lt Information Is correct. I agree to comply with all city and county ordinances - _ MECHANICAL $ • TOTAL•FEEI : $ and-state laws relating to building construction,and hereby authorize repre- - sentatives'of this cit I • ter upo a a•••ve-mentioned Jtroppp��erlyyy Hood or Type I 0 • Reinspection Fee. 15- LESS I ' k inspection igrIA 1 ' �/ n / •ateP '$ Signature /L., Accounting;Goldenrod-Assessor - - '- - 1 CONSTRUCTION AND PLANNING PO' SPA . \/\\\ Date -Inspector - - Date Inspector -APPROVALS ' Permit# APPROVALS . -mit# - 1. •Temporary Electrical Service or Pole • - 52. Pool & Equipment Location 26"$3 _1 op 2. Soil Pipe-Undrgrnd. - - 53. Steel Reinforcement 31 Electrical Conduit Utility-Undrgrnd. • 54. Forms - 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding p 5. Steel,Reinforcement - 56. Rough Plumbing& Pressure Test l .2447d p 6. Electrical UFER Grnd. _ • 57. APPROVALTO,ClOVER-GUNITE' 7. Footings - . 5� i-e ni�ec� Ctio uLti;l4 ei; di.��t7.0. , 8. 'Foundation _ 594 Ga;Pipe, 3 Undrgrnd.,Test • 1r--U-Y7 P 9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd. ' 10. Structural Floor System . 61. APPROVAL TO DECK 1- 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap _ 63. Heater & Vent-Final - - 13. Roof Drains .' 64. Plumbing System -Final 14. Rough Plumbing 65. Electrical-Final - 15. Rough Electrical-Conduit - 66. Solar System-Final - - --16. Rough Electric Wiring • - 67. Fencing &Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# • 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating , • 71. Product Piping 0 Gas 0 Oil . 23. Gas Pipe-Rough Si 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 (Structuralh& Monocoat • - 75. Dry Chemical '• 27. Frame and Flashing 76. Dry Standpipe • • • - 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - • - 78. FIRE PREY. FINAL 30. Drywall Nailing Notes: 1IYOTe 1:1‘ 1' 3 Need 1)qt y1, _ 31. Plaster Brown Coat Conflict Unger �• d#c KL Pxp0S94 e7Qb 32. Electrical Power Meter-Final W eut hey . Nett;td b y /O4One. A-/•. 33. Final Electric 1 - 34. Final Heating-& Air Conditioning ' 35. Final Gas Pipe-Test - 36. Hood or Canopy - • 37. Final Fadtory Fireplace - - • 38. Final Plumbing - 39. Water Service-Final . . - • 40. Gas Service-Final - 41. Solar Domeitic-Final - �- 42. Backflow Preventer 43. Backflow Irrigation - - • 44. Landscape Irrigation System ' 45. Sound Attenuation • - 46. Handicap Regulations. , • • 47. FINAL STRUCTURE & BUILDING i 48. Special Requirements Completed . - 49. Electric'Release to Edison ' . 50. Gas ReJVse to •Southern California Gas Co ‘ •r` Bi . CERTIFICATE OF OCCUPANCY - - _ ' • No II'."' Date _ Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. !F CO$TA MESA •_'�' • - IMMIT NO. TR••• -``•. LOT NO. BLDG.NO.. N ^i(.c/ / iR'�-'SaSONPERMIT , C7 - 700 .Z93 ss / • App font's Mailing Add ess'L - / .• 'slier - -'�' TYPE OF CONSTRUCTION L I NEW ADD U ALTERATION U REPAIR ' + Project Address /��"f s&4,* QQ ••• �• ❑ CONVERSION ❑ DEMOLISH 0 OTHER , , .s- (• DESCRIPTION OF WORK ROOM Alii Teo,/M,flail. -/•ftlropt. ' - Ice Owner's Name nil/C/ { SW-, e'nl Ccril,V Phone t�G-t('7 L cT'� - I -- - ZONING REGULATIONS O • G•iw FS.Address 5✓lAli TYPE OF PERMIT® GRADING FOUNDATION FS.STRUCTURAL A.P.O. 4/9- /4/3-03 'ZONE RI Arch/Eng.' License No. 0 TENANT / - ELECTRICAL fi PLUMBING IS MECHANICAL .PLNG.REF.IP BUILDING a R7r�Nn/7 Address - / ,,//�� pp ❑ OTHER TO BUILDING �1;��s,. ,' ecrwerr_rh r /nJGt A" 7S7-if to PROJECT DESCRIPTION SQ. FT. _ 23a OCCUPANCY -.S/MI-/ PROPERTY LINF/1r//yt�e I) REAR YARD(TO P/L) 29 Contractor's Name f t //q�t,�/tJf�ee Pghone A - 7_rlZ (_k0.iq/ C G`((d //fc CONSTRUCTION TVPF VALUATION$ •� reere 'LEFT SIDE YARD 62 et RIGHT SIDE YARDItr s��j// Address(mailing) 219 /•; License No. __13_ 3 0ZONE GRADING CU.YDS. ACRES PKG.SPACE REQ. A/,A PROVIDED N-A ., • LICENSED CONTRACTOR DECLARATION Remarks: _ , 4 STREET WIDTH �o n/ PARK FEE$ 'N-,, I.hereby affirm that I am licensed under provisions of Charter 9(commencing • with section 7000) of Division 3 of the Business and Professions Code,and SPECIAL CONDITIONS: ' • my license Is in full fore and affect. License Class �_I icens o, v PLUMBING • A - - CIL -iT Signature In a t A/* ' Bar Sink Sewer Cap ELECTRICAL • KERS'COMPENSATION DECLA TION - -- '• • ' - I eby affirm that I have a certificate of consent to self-Insure or a certificate Backflow Preventer - Sewer Connection _ Automatic Washer • Meter Dover 100 amps of Workers' Compensation Insurance, or a certified copy thereof (Section - - - - .'- - 3800, Lab. C.) I -- ti Construction Pole- Sub Panel • 22y-�T • • stir r-u#Q - Backflow irrigation Solar_Collectors Policy No. Company - - • - �, Cooking Unit Sub Pole 10 Certified copy Is hereby with the !• Bathtubs • Solar Piping ZOO - - 1I' Certified I flletl with city Building DivW1yon. yy// Dishwasher Motors ❑0-1 HP ❑,1 Y,$ Data 5---1-1-- li Applicant 8707e-- 11. r�/i%J'!!4' Clarifiers Solar Tank EXEMPTION.FROM WORKERS'COMP,ENSATION DECLARATION Dryer's ❑Gas DElectric Int.$018r ❑915 HP ❑16-15+ (This section need not be completed if the permit Is for one hundred ($100)or ' Dishwasher Swimming POO(w/Spa .� •i / ` Ie certify that In the performance of th• e'work for which this permit Is issued, I ' Drinking Fountains Urinal i Fan ;Microwave ' shall not employ any person In any manner so,as to become subject to the - - .F.A.U. Pole Light - - Workers' Compensation Laws of California.' Floor Drains' Water Closet f Date Signature • ' - - �, NOTICE:If,after making this declaration,you should become subject to the Floor Sinks 3 Fixtures Water Heater . Range 0.6o Workers' Compensation provisions of the Labor Code, you must forthwith _ Device Boxes comply with- such provisions or this permit shall be deemed revoked. - Gas Service 'Outlets Water Service . r^ Sign CONSTRUCTION LENDING AGENCY - Outlets J I hereby affirm that there is a construction lending agency for the performance Interceptors - .- .S Standing Sections / OO of the work for which NW permit -is 'issued (Section 3097 Civ. C3 Switches Lender's Name /f/t.4J Kitchen Sink - - i - 'Z 'Trash Compactor • 0 vs Lender's Address • Garbage Disposal OWNER BUILDER DECLARATION - ( Lavatories - .• 2� 9 P 1 hereby:affirm that I am exempt from the Contractor's License Law for the - P-Trap - - ' Generator ❑0.5 KW ❑5-15 KW - ' following reason (Section 7031.5 Business and Professional Code: Any city or •• - • county which requires a permit to construct,alter Improve,demolish-or repair — - - Transformer ❑15.50 KW • ��p P"'• structure, prior to its issuance,also requires the applicant for such permit. Roof Drains - - - - +^' - e a signec statement that he/she is licensed pursuant to the provisions of ' ontractor's License Law(Chapter 9(commencing with Section 7000)of - ❑5U+KW, Reinspection Fee I y� ion;3 of the Business and Professions Code) or that he//she-Islexem t Showers - • Reinspection Fee , _ therefrom and the basis for the alleged exemptio . Any violation'of Section - Meter Sup to 100 amps - Issue Fee. .$ 3 .7031.5 by, any applicant for a.permit subjects the'applicant to a civil , • i• $'3 6 anally of not more than five hundred dollars($500). , Service Sink Issue Fee Zoning Approved By Z�X�/ �/�� Date r/�+/ I;as owner of.the property or my employees with wages'as their Iola ' MECHANICAL compensation will do the work; and the structure Is not Intended or offered - ' a Application Approved By Date S,Z /y'y� . for sale'(Section 7044, Business and Professional Code: The Contractor's , / L/V ' License Law does not apply to an owner of a property who builds or Improves ' Boiler ' Refrigeration System <' Application Issued By thereon,-and who does such work himself/herself or through his or her own - - PP 'Date employees, provided that such improvements aremot intended or offered for , El BTU ❑100,000BTU - - • sale. If, I however, the building or improvement Is sold within one year of com- Duct-Under Ground I'- 1 • SUMMARY OF FEES • pletion, the owner'wlll have the burden of proving he/she did not build or Im- - /� TP $ I O� , gLpve for the purpose of sale). • - Duct-Structural System Repair/Alteration BUILDING PERMIT $ //Or CO ' U I,as owner of the property, am exclusively contracting with licensed con- I `�• 82 I tractors to construct the projectSection 7044,Business and Professions Code: - , Duct-Ventilating _ •_ •.. - - - ('• 7 PLAN CHECK $ PERMIT -The Contractor's License Law(does not apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple ❑ , `' r: - - PLUMBING $ •(. 00' ISSUANCE $ • I tractor(s) license pursuant to the Contractor's License Law). - • Q�' GRADING $ 0 I am exempt under Section ' ' B.& P.C.for this reason ' Firepl/Fact.Bit. ICBG# PLAN CHECK S. 2 ' . I - ELECTRICAL $ /0-ce $ • - ' Date Owner' l Heating System& Ducting I- hereby certify that I have rear('this application and state that the above ❑D-100,000 BTU ❑100,000 BTU - - - • PLAN CHECK $' �/ MICROFILM , $ information is correct. I agree to comply with all city and county ordinances r^—_ ! • OO - 41-.or( TOTAL FEE $• • and'state laws relating to building construction,and hereby authorize repro- Hood Or Type I 0 - MECHANICAL $ sentatives of this- city.to enter' pon he above-mentioned property for yP Reinspection F . PG PLAN CHECK $ 0ra) : LESS Inspection pure• - . J �/ S pq Canopy Type II ❑'/ ADVANCED PC I $ _ Signature • S ' ✓�/ Date 2-OJ' ' Drivers' License o S5# Applicant;Pink-Ace 'Goldenrod-Assessor r / JNSTRUCTION AND PLANNING I` • - _ .:PC4r SPA - - - -- - -_. ` ' 'i :Date Inspector • - - Inspector - 4 ROVALS Permit:# " _ :APPROVALS rermiY# ^ :.Ifi .emporary Electrical Service or Pole - ' ' , - . 52. Pool & Equipment Location : '' . tl } ._ ,. _ :Date ` 'Soil Pipe-Undrgrnd:: r - x , ' o' ' -:- ,53.' Steel Reinforcement .. y Electrical Condwt Utility Undrgrnd, 54. Forms c" ' Electrical Conduit-Undrgrnd`. t•? _ 55. Electrical Bonding' ` - • 5r, eel.Reinforcement "r I • " ., 56. Rough!Plumbing &Pressure-Test - - - '6: Electrical OFER Grnd. ' s • - �' n 457: APPROVAL TO•COVER-GUNITE• ' ' 7. Footings . , '' „ a = - - '• kr -458. •ElectricalConduit-Undrgrnd- i 8. Foundation _ ' ' ' .. ' 1 - ' ' '59. Gas Pipe, 0 Undrgrnd.,Test-. r • • 9. Water Pipe-Undrgrnd. ' ' _ - • , 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System ' _ - . - 61. APPROVAL TO,DECK - - 11. Property Sewer Line& House'Connection - •62. Backwash'&Receptor-Final - 12. Sewer Cap' ' I 4 I '' ' h - 63. 'Heater &Vent-Fir-al - 13. Roof•Drairfs 1 ' , 64. Plumbing'System =Final 'r - 14. Rough Plumbing' - 65. Electrical-Final' - - - - - ■ '15.-Rough Electrical=Conduit- _. '-r - - -- • 66:. Solar System-Final - ' . - ' - ' . ■■■ L ' 16:-Rough-Electric Wiring. I i_ ' 11 i-, !r 'pis-p' 67. Fencing&Accen Approval ' . - • -. , ` =FS • _ ' 17. Rough Wiring•Sign" , ' ' ,, ' 1 i - 68. APPROVED FOR PLASTERING • - 18.1-Rough Electrical-T Bel:Ceiling ': I 69. POOL/SPA SYSTEMS FINAL . • _' 19. Rough Heating & Air Conditioning �, I , ; ' . , 1, , 'FIRE DEPT REQUIREMENT • • • v 20 sRoughFactory Fireplace li I ; ; APPROVALS I Permit# ' _ 21. Ducts;in Structures• , ' . ' 70. Underground Hydro • . . - ,22.,Ducts,,Ventilating , I :. d, , ' 71; Product Piping ❑Gas 0Oil ' 23. Ges.Pipe-Rough&Test `- i j • ; 72. Underground Flush: -24::Roof Framing, 1 ' ' ',' • I ''_ ',,„ ',) : :; I • (; n, - ' 73. Undergrnd.Storage Tank'0 Gas 0 Oil I . 25. Roof Sheathin ' i, � 9 �� , J ' I{15 ;: ic _a-1 74. Overhead Hydro , 26. ,T-Bar Ceiling (Structural(,& Monocoat $ • 75-; Dry Chemical - E L 27. Frame and Flashing clic : . ' l 5 7-)S 2-s 76. Dry Standpipe • - . - • a 28. "Lahing & Siding i I I: i. I• �� 1 7-_2c, '77' FIXED SYSTEM FINAL - 29. Insulation 1 I •iy 1 . ,..77°K-1,3,:s 78. FIRE PREV. FINAL .. -30. "Drywall Nails !yyy i 1 D 5 7;al.tpNotes:' 5 (2 ) ern di ncl •..e9• is1 31. -Plaster Brown Coat} .Sr* "Na �(l93 1:112-tri •IO P ' re C91 a ;t o � -re-, e&il 7d e elk, j32.•Electriral!Power Meter-Final 1' • /O f 3 Lel • M..Ceso4fJ 0 i, :AR ! `- � 33. Final ;IElectric ' I ( - l.• 34. Final�ieating&iAirConditioning ' ' ,, - � /b%S�P'3 �, 35. Final Gas Pipe-Test) ' '' I _! . ' ,' I . - - , . - . . 36. Hood , • or Canopy', _ ! • ' - . ' 37- Final Factory Fireplace" - - 38. Final Plumbing ' - cl ' - -• 39. Water Service-Final;. ' ' ' I , 40. Gas Service-Final ; , I , , 41. Solar Domestic-Final _.r_ - - _ _ . .. 42. Backflow.Preventer. L' , j ' - • 'r3' r - t'• 43. Backflow Irrigation _ • . • I 44. Landscape Irrigation,System I - _ - ._ I, 45. Sound %Attenuation a , ' • . _ :. - - 46. Handicap Regulations: ' • I i • s_ •47. FINALSTRUCTUREt&•BUILDING l2•-213 - 48. Special Requirements Completed, i - , . - , 49. Electric Release:to Edison] ' - 1 - - - - '_ _ -. , - ' 50. Gas Release to Southern California Gas Co ' ' 51. CERTIFICATE OF OCCUPANCY - No ' '' - - ' Date • ' " I INSULATION CERTIFICATION I�ZY SGt AM/'Oc./Cfr "7y4 a .43_ 4.1 . - Number and Street /1S( City Coity Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF • Material Brand Name Thickness finches) Thermal Resistance IR Value) • _ EXTERIOR WALL/ -/� �, ,I Material _ /-r1.fl Brand Name WacNI - q n Thickness (inches) J �L Thermal Resistance IR Value) if • CEILING Bus or Blanket TVDe___AIL Brand Name �.,J-lr( Ci.r i•g'! Thickness (inches) 6 Thermal Resistance IR Value) � €/ Loose Fill Type Brand Name Minimum Thickness(inches) Number of bags Weight per bag lb Area Covered (h7) Thermal Resistance (R Value) FLOOR, ELEVATED Material Brand Name Thickness(inches) Thermal Resistance (R Value) FLOOR,SLAB M Material 'Brand Name Thickness(inches) Thermal Resistance IR Value) Width (inches) _ FOUNDATION WALL Material Brand Name Thickness finches) - Thermal Resistance IR Value) DECLARATION I hereby cenify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 74 of the California Admiristratkve Code). General Contractor (Builder) License/ Numuer /T_J3 Signature and Title Date Sub Contractor (Insulation Applicator) License Number - Signature and Title -- Date Figure 4 -1 Example of a compliance cenilicate 4-9 UY/Ntl( LLLLi aea. 1.11.- .('.LLLur UAIC JOB ADDRESS 1424 Shamrock Lane BUILDING PERMIT NO. 49530 GENERAL CONTRACTOR Blue Ribbon Blds DESCRIPTION of WORK Rn Add AP No. 141-012-05 LOT 28 TRACT 2432 FIRE ZONE VALUES 24,000.00 INSPECTIONS Signature Date TYPE VN GROUP I ZONE R1 SOIL (5..+ jit{-eel, SUBCONTRACTOR PERMITS ISSUED GAS Date Number I Signature WATER p Plumbing ROUGH PLUMBING^ 1/2". l 1/53(1 ")/84.1.1..6",/,-67,,K---, i-,ai--0 '1'/5a7 . *'- PROP. / PROP. SWR. LINE n HOUSE CON. ` SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CONDITIONING (r". .3..'17---‘64 V TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER Elkin e.e,3-4'a//��.` ROUGH WIRING ._L. 4-2-ciP Hegtin d Vent. -/ TRENCHES fl FORMS GrF- STEEL REINF. Li £S .--g,.et, 6t�. c. ?-6 ku in% FLOOR SYSTEM "-� BONO BEAM n STEEL REINFORCE n ��+ SHEATHING Roo 4- F(on/y i% K.J'Ic ip FRAME A FLASHI; ff 0 I 3-f -, r' LATHING " I Til ?" fl t %••[� `,,� PLASTER, BROWN COAT E, u'-i7 STRUCTURAL, FINAL S?3- Electric HEATING. VENT„ REFRIG. AND A.C.. FINAL O . _J Q� 4gY" it'lgLrm '_Oj/ F 7 AsMo /� PLUMBING, FINAL AND GAS TEST %�•�+ 3 ELECTRIC, FINAL Cj -6i 3./60 BUILDING, FINAL ST23$a corn Al orni im rMmMTC c3, e5 £th es A. aSc—C^•.s:n.., -a s -a a 19 r c .s cOat/a-d rI S IAte., >S 4-. ,.2 sx.e44e . COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR7STRUCaTUIZ�1nL PERMIT 63.68 TL P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 EIVED BY PERMIT *rp 4953 - For Applicant to Fill in Completely— Use Ink Only Iv BUILDING�y24S//A MAOc< LAI, A.P.NO. — — 6' S--- OWNER ADDRESS TEN NT I-I eC.(?/9L.. MCLAR-(IN �� TENANT }`/TF- • tafiral OR MAILING SPACCE NNO. ADDRESS A V F SPA . ` ,,f ret �+ /� �am ALK. CITY GOc 4 r "LVZ]A- NO. NEW ADD y LTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER qt/�,.( BRANCH OWNER MC CftR /Ir/U 2c ADDRESS ,t r� �� / ) ^ "IN- USE A old VALUE 0` U• OA RENH GINEER LARRY y1/ LT/RO NOL . r - �' J_�L ADDRESS Ism f3C.us fit RD c-1'N.iii 0. A TYPf��/GROUP CONTRACTOR at O(- RISSn' �,1 BY LL1 - DATE.2/ 4, O ADDRESS /l�/,�1 VI KR1tL- 1 CITY OiCSANc-,g- No.TELgq 1- y t STATE 1 CITY APPROVED SETBACKS LIC. NO. 2-;aS1B LIC.NO.67605. SIZE NO.OF BLDGS. I (FROM CIL STREET) ) �,,/ &x2 L OF LOT NOW ON LOT FRONT... Ct f 5x41 (/t! c /t Q USE OF / /7 FEXISTING P- -SBLDG. n RIDE FT e Separate permits are required for L.SIDE El ri G electric,plumbing and heating work. REAR —SFr USE OF BUILDING S/�A�NDD WORK TO�BrE.,PERFORMED '/ PLANNING ACTION DATE '•� .• fIF�i�-�I�LS )'./(r//>•/Jv 1 ��.QR F�I1 ,O)/��/RrTI(T APPROVED >..� &JD ISI ('loon bio t APP-OVED / < DAT -9���° I mA-Anor a O I hereby ac owledg9 that I have read this application and state e' lig that the above Information is correct and agree to comply with C L all laws regulating building construction, and I shall not employ S Z any person in violation of the workman's compensation laws of o Lai 5 the State of California. m • I hereby certify that I am properly licensed as a contractor under SO. FT. N D the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEg ONLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE and Professions Code,Division 3,Chapter 9. S /Q .Q Signature of —t 04. Orb PLAN CHECK E Q D 2 Permittee .(&11/11 CN irleae `� /•Zs / Q LL L or '2'( - TAX a !ad U Authorized Agent Date TOTAL PAID S • OWNER BAGGER, C.V. DATE 5-5-59 JOB ADDRESS 142h Shamrock Lane BUILDING PERMIT NO. 9199 GENERAL CONTRACTOR Pulsifer VALUE $174.00 AP. Noll3-262-05 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block Wall INSPECTIONS DATE I GROUP TYPE ZONE Rl Underground Soil U.C. Water PERMITS ISSUED Underground Gas — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing _ Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Healing, Final Plumbing Fixtures Final Gas Test • Construction Pole Underground Power Rough Wiring Trenches C— Forms Steell GIT/, S� Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing Lathing, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures,_gmal�9 Building, FinalY<c,t OCCUPANCY Form 210-3M-4-59 _._ 9199 . Vie '\I L• \j If 0199 \Rtes+ Cpl y59 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 317 COSTA MESA, CALIFORNIA 1No� E DEPT. G�STA top /' )S Ci FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT S v 1I TYPE O/RJ PRINT BUILDING BUILDING /1z-i ` (� ,M1 ADDRESS yjJ,(,J/I'/v[ FOR COSTA/ MESA, CALIFORNIA��� . OFFICE USE ONLY OWNER {� �/t,/�( • RECEIPT NO. I _/PERMIT NO. 22 MAIL ,/�1,J A / - ■ EIVED BY I O TE REQEIVED7 I .OATE ISSYEDEJ ADDRESS /Y.G T -124''I/j.0'(� po / `J I / .�J "/j ��\ / 4// TEL. .SocO B ILDING CITY NO a. ADDRESS ARt CT LIC. OR . NEER NO. COSTA MESA. CALIFORNIA ADDRESS ftrateFIRE ZONE type (_-/ group �/ n STATE 9 p/5J APPROVED • v CONTRACTOR9/{/'� /j�/jj/J LTO.NO./,J(<y, ; BY DATE ADDRESS !}' f�' or 4004ioJ17q� ZONING LEGAL I LOT // C I �J 2. ZONE NO.OF USE OF NEW DESCRIPTION NO. �[.p---'TT BLOCK s- I / (PLAIN SS ,/�}'�.BUILOING Ct'c, �A.P.NO. II 3--' . . /1 a-- oV BYPROVED(�� .F (V/ If (�/�-�!9D�TE SV ISJ -S7 SIZE '� ,/ NO.OF BLOCS. '- YARDS EVES OF LOT 9I /' CP I NOW ON LOT REQUIRED ALLOWED USE OFy]. _ (CENTER LINE ST.) EXISTING BLDG. 0 az...-Z/ • ' FRONT cc-Orr. IN. SETBACK LINE FROM �^ ,h if CENTER OF STREET ` ' 01C REAR YARD {/ R.SIDE i•- ••.- FT. .-41.-IN..IN. SIDE YARD LEFT (, it I RICHT •-- L.SIDE Ft O IN. DESCRIPTION OF WORK /ALTERATION REAR FT. 0 IN. NE‘, I ✓ ALTERATION I ADDITION REPAIR . I I MOVING I DEMOLISH I BUILDING NO.OF SIZE ROOMS STORIES EXTERIOR WALL 'ROOF COVERING COVERING USE /NJ o USE OF BUT'% C Rg/c,c-O' JRO/! y"... -2 �X 3 X /02 ' 4/71/454 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ^ / � ///Jf� VALUATION Oki � > SIGNATURE OF rf� PERMIT FEE $ /Oki PERMITTEE '� �� s /,9 ! $ PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE $ / C—V OWNER Cnl1eg_ Mesa Company DATE 4-18-56 JOB ADDRESS 1112)1 Shamrock Lane - BUILDING PERMIT NO. 2787 GENERAL CONTRACTOR The Hale Company VALUE $ 10,880.00 LOT 28 BLOCK TRACT 21132 Single Res. w/att gar GROUP I Fc J TYPE V ZONE Rh FIRE DISTRICT 2816 INSPECTIONS (#144:24:0. )44/yr0 9' /' ,. b- �DiTE�J SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench Foundation Forms and Grade to Gar e Rough Framing S/i L_S --% _ /- Plumbing,Rough tSBlab ��`} r- �` / /� Nit Plumbing,Rough Complete'/.r 7!— 7/LS//�6. rj .7.6.esi /( , �, jeryt, 4e"1-6 •rc, y(' !6 Temporary Pole eeii J /' _ Wiring, Rough )•J5'•tz 2 .tri). 7-/9- Ja (9/ P/ -- Heating, Rough Heating, Final ;,/ //14 /?._af-i 3 d 2 --- ..- newer, flower, House,LSewer,St. :3 �1�Cj - . -...- -5%2-..)re, c/0 Cr '-- .6clatic....Tan4reeh-C.ossposal 6024.24.. Lathing, InX Out) y � Plumbing, Ci- � q-/3- `4 �� Plumbing,Final,Fixtures Complete f1/JQ 4 _�� L' /� Plumbing,Final Gas Test /S ni /ii����y.7 1 '�/�'�•%� Wiring,Final q0 ///f-ct Occupancy „Q(t( 7/-/4.hY FORM 310 3M 10.35 sta Mesa Building Department ET281_6 APPLICATION APPLICATION FOR PERMIT voy 7 , Ill EAST'COSTA MESA,CALIFOERNIA �vQ n BUILDING 1 FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. qPermit No. Building I c 7 p Address 1424 Shamrock Lane 7 �R�ec/e�ivSd'by Date Reed.\d.L1 Date Xisssued Costa Mesa, California I -�rsZ. /u �� Nearest // �� - Cross St. Watson Avenue Building Address Owner College Mesa Company Costa Mesa, California Mall Address 8002 Central Avenue Nearest Tel. S Gross St City Garden Grove No. Le 9-215 zt1 one e I) I No.of I Type .V/ Group()/�)- Architect or Lic. Ny Plans rJ Engineer Davis & Quigley No. C-1790 Approved (/ by Date .cess 43 Malaga Cove Plaza,Palos Verdes CORRECTIONS contractor The Hale CompanyCityoLk No. 3422 Address 8002 Central Ave. , Garden Grove Legal I Lot Description No. 28 I Block I Tract2432 (Attach Metes and Bounds) _ No.of Bldgs. Size of Lot 60'x 130 I Now on Lot None I iii !)lA' l! , r1� Use of I No.of I No.of tIi ‘`Pi--\ &A I i H 33 Existing Bldg. Families Rooms J' Setback Line from Rear Yard 40' Center of Street 50' Side Yard 6' APR j 8 1q5S DESCRIPTION OF WORK r New I x I Alteration I I Addition I n T/ pi- nn^4.., VIII VI /y i/Uctn lit.,-. Repair I I Moving I I Demolish I - Ilding No.of 1260 Rooms • 6 Stories 1 ..erior WallI I Roof Covering Stucco Covering Shake APPROVALS Use of New Inspector Date Building Single family dwelling with Forms,Materials, attached garage_ Under-PinninBoltsg Frame: Fir,e Stops, Br I hereby acknowledge that I have read this Application Foundation Locat ion and state that the above is correct and agree to comply Lath. Int - with all City Ordinances and State Laws regulating building construction. Lath.Extacing Signature of THE HALE COMPANY - Permittee � �� Plaster, Int ` Authorized Aet. ` tiA-Mi. Plaster,Ext. SILVIA LARINER Valuation Permit Fee $ • Masonry Reinforced /v o S 0 Plan Check$ i 3 ' Bond Beam $ ) d Total Fee $ 37. FINAL Comm 206 S-aP 111 e-55 Y C a J c ' • J ws a •n �I•rf.P0EE54rn r¢ ;,•..::-39.r0 Street • PLOT PLAN Show location and distances from property line and between buildings.