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HomeMy WebLinkAbout1430 SHAMROCK LN - Building Permits WEIDENKELLER, MARY JANE. S From: KENNERSON, SILVIA Sent: Thursday, October 04, 2007 12:15.PM To: WEIDENKELLER, MARY JANE Cc: CHIRAR, MOHCINE Subject: 1430 SHAMROCK LN Attachments: Picture (Metafile) Hi MaryJane, The property owner has withdrawn from the following permits: B06-00788, E06-01324, M06-00754 and P06-00947. I took care of the status in the system only. Thanks! Hi Mo, Please refund permit number PS06-00370, I didn't do anything to that in the system. Thanks! Silvia Kennerson Development Services Building Division City of Costa Mesa (714) 754-5652 Fax. 754-4856 S Ke ii nerson( c j costa-mesa Ca us Cost--—M sa •1 10/01/2007 17:09 FAX 714 545 4609 ROGER ROBINSON • 10-01-07 To: City of Costa Mesa Building Services From: Rob and Lisa Morgan 1430 Shamrock Lane Costa Mesa, CA 92626 714-540-2115 To Whom It May Concern: We will not be building the addition we had planned at the above address. Unfortunately, there has been a change in our financial situation. We are requesting a full refund. We would like to pick up a our plans from your office. Please note the following numbers: B0600788 P0L0o44 E0601324 M0600754 rPS0600370 bond Please do not hesitate to contact me if I have neglected to include any necessary information. Thank you for all of your help, Sincerely, eh. vitiut— Lisa Morgan i � CITY OF COSTA MESA 4@ BUILDING DIVISION y• I 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t• r w.i.•• I i PERMIT B06-00788 -"R•aaano'# (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cB4)ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1430 SHAMROCK LN Status: ISSUED Suite: Applied: 05/23/2006 Vicinity: Issued: 11/22/2006 Primary Occ: R3 Type of Construction: V-N Parcel Number 41814304 Zoning: R1 Applicant: MORGAN, ROBER+• Address: 1430 SHAMROCK LN Phone: 714-540-2115 ISSUED BY: COSTA MESA,CA Zip: , 92626 Owner: MORGAN,ROBERT& LISA ' Address 1430 SHAMROCK ' - - Phone: 714-540-2115 - . . - - COSTA MESA,CA. Zip: 92626 q VII•tie Contractor: OWNER-BUILDER t Address: y y da Zip: ''y License: 000000 .- Arch : Eng: _ ' Address: Address: rib, 7 Phone: : Phone: Zip: License: License:" SCOPE OF PERMIT ADD 508 SF AND INTERIOR REMODEL TO SFD.WORK TO INCLUDE:EXTENSION OF,KITCHEN,CONVERT(E)BEDRO ROOM INTC BATHROOM AND WALK-IN CLOSET AND.ADD MASTER BEDROOM W/FIREPLACE. lititt EXISTING 3 BEDROOM,2 BATHROOM SFD TO REMAIN THE SAME. _ - EXISTING BLDG: 1379 SQ FT - - - -- - - - � ikktk O GARAGE:414 SQ FT ADDITION:508 SQ FT • DRIVEWAY:396 SQ FT 0���' LOT COVERAGE:32"/ , • • FEE SUMMARY Plan Check: $450.29 Calc Valuation: $56,939.20 Permit: $692.75 Claim Valuation: $o.00 SMIP Res: $5.69 SMIP Com: $0.00 - - Other: $0.00 Inspection: $0.00 Total: $1,148.73 • . PLANNING &"ZONINGS SETBACKS ' MAIN STRUCTURE Front 22-0 Rear 40-0 Left 6-4 Right 5-6 • ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: -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) ' .- - l/ 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. .G/ 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 L WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: c ❑ 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 performan - oft -wo k for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' ..compensatiori laws of Cali a,a •a! roe that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith c.--coniplywiththeaaprwisi+ ( y«JLzzjob Appli ntSignature:----- i �A_ Dat -'m' ~ WARNING:FAILURE TO SECU-.7 WORKERS'es��yyIIIIPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P LTIES 0 CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1W,•. ,IN ADDITH E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR.TION: 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 It 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). 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).): ' O 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.). At-15, owner of the roeproject j ' property,rty,am EXCLUSIVELY., doesntapply CONTRACTING an owner WITH LICENSEDwhCONTRACTORS tor constructn,and the rntrac(Sec.such Business and Professions %"Code:The contractor Ic-ase L. not to an owner of property who builds or improves thereon, who contracts for project with a contractor(s) license pursuant t• o rad; License La ❑ I am exempt un. -ec. ... .4 Business and Professions Code for this reason: / . /' +Signature:2`T"-•-,-i /ale ---. - - ! FFF 6 jExpi er`s:�-lo j!170 Verification of Ow =rship by(t•'ocument,i.e.-property tax bill or deed): - - LCC 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). ❑ 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,ore 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 a_Dermit 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? 0 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 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 : tate aws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property ford:, s•-ctio,•u ••ses.I agree not to occupy or allow occupancy of any building authorized by this pe mit unci final inspection. / I1a22DA Signaturri0:gal Owne s) • Date` And/Or A orized Applicant Date CODE 0 INSPECTION TYPE pATF, INTRIALS CODE N INSPECTION TYPE P_AM 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 Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 FinafPlanning Approval' • 203 Final Sign 222 ' • Final Site 204 Final Demolition - " - 250 Final Building/Occupancy - • 11-22-2006/11 ;03 :11 _ USER-01S 001-00166763 NEWPORT-MESA UNIFIED SCHOOL DISTRICT N 6324 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: ( v) City of Costa Mesa District Receipt No. ( ) City of Newport Beach ( ) County of Orange 706 Plan Check Novui Applicant: N i- vVaii Address: -so Uis C , Un a1L6TTelephone Number: 11"O %lb --a16-- Tract/Parcel ract/Parcel and Lot Number(s): .111%) 1436V Location of Project: HJ?)C) earn `.4 r Number of Square Feet of: Residential Space � 's x $1.84 Total Commercial and Industrial Space x S.30 Total Commercial/Industrial Project is: (Check One) _ Warehouse _ Motel _ Preschool _ R & D _ Bank _ Auto Repair _ Movie Theater _ Neighborhood Shops _ Hospital Mini-storage Racquet/Health _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Pemits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. By: AWgrized Reprew taWa The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true,then this certificatte/s�hall automatically terminate and the appropriate C. o my hall be notified. Date: 12-21t/6 Applicant p ' VF,, CITY OF COSTA MESA 4 BUILDING DIVISION ) .� ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �, IOWA PERMIT -"aiomnrm so E06-01324 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1430 SHAMROCK LN Status: ISSUED Suite No Applied: 11/22/2006 Vicinity: ADDITION Issued: 11/22/2006 Parcel Nunmber: 41814304 Applicant: MORGAN, ROBERT Address: 1430 SHAMROCK ISSUED BY Phone: 714-540-2115 COSTA MESA,CA Zip 92626 Owner: MORGAN, ROBERT AND LISA Address 1430 SHAMROCK . Phone: 714-540-2115 • COSTA MESA,CA Zip: 92626 • , 95, Contractor. OWNER-BUILDER kim - u '�° Address: E :�', Phone: „ pp Zip: R 5. 1''' T_. License:000000 i r SCOPE OF PERMIT 011/41 't ELECTRICAL PERMIT TO ADD 508 SF AND INTERIOR REMODEL TO SFD. - . ' REF#:B06-00788 WORK TO INCLUDE:5 LIGHT FIXTS, 18 OUTLETS,AND 6 SWITCHES, 1 SERVICE TO 200A. 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 Fists $5.50 5 up to 50 kva/kw $0.00 0 Recept Outlets $19.80 18 up to 100 kva/kw $0.00 0 Switches $6.60 6 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 0 Service over 1000a $0.00 0 Circus(gen or ride) ' - . $0.00 0 Motors to 1hp $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 $85.90 Intermed Pole $0.00 0 I NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califon 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. 9' 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 244641501/03) 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 it the permit is valued at one hundred dollars($100)or less.) , cit I certify that in the performance of the w• for w ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomi nd a• a tha f 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: U 7 b WARNING:FAILURE TO SECURE W RS'COM- ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1o0.000).IN DDITION TO -T 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.ff Class It 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of 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.). 9kI,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 Com':ct•rs License Laws. , ❑ I am exempt un c. Business and Professions Code for this reason: Signature: "� -_pate: (((7 Z(/)O'( / Owner ID verified by rivers lice• U •es ❑No Drivers License No. \ Expires: (O/2( Q8 Verification of Ownership by( .•document,i.e.-property tax bill or deed): 1 TTT 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? 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 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 Califomia 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 AN. 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 cowith : st.to laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described a for Ins'c •n purposes.I agree not to occupy or allow occupancy of any building authorized by thi permit until final inspection. ZZ /X, Sign= eOf Lega Owner(s) 111 Date An. a Authorized Applicant .. CODE. INSPECTION TYPE all INTITIALS CODE. INSPECTION TYPE PEE )NTRUL$ 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 t ' CITY OF COSTA MESA ,/ � BUILDING DIVISION 1. 1 ,.�,. � I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t>• fl • PERMIT M06-00754 %kowtow le (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1430 SHAMROCK LN Status: ISSUED • Suite No Applied: 11/22/2006 Issued: 11/22/2006 Vicinity: Parcel Number: 41814304 ISSUED BY: Applicant MORGAN, ROBERT Address: 1430 SHAMROCK Phone: 714-540-2115 COSTA MESA,CA Zip: 92626 • Owner: MORGAN,ROBERT& LISA Address: 1430 SHAMROCK Phone: 714-540-2115 U d0 COSTA MESA,CA Zip: 92626 ��.V..JJ Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 �y 1 Vit.f. SCOPE OF PERMIT 11711 P �.- 11 MECHANICAL PERMIT TO ADD 508 SF AND INTERIOR REMODEL ' F 3. REF#:B06-00788 DATE: i l/ WORK TO INCLUDE: 1 INST FAU<100 K BTU, 1 FACTORY FIREPLACE AND 1 VENT FAN/SINGLE DUCT. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 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 $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers 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< 10000dm $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 $56.20 COMMENTS I 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 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 2448413(WW00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end 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 It the permit is valued at one hundred dollars($100)or less) Eff� I certify that in the performance of the work f•r w 'ch 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, !reed at' I should become subject to the workers'compensation provisions of Semi n 3700/t,� of the Labor Code,I shall forthwith comply with these provisions. 22/ Applicant Signature: A J�, l- _ Date: tit WARNING:FAILURE TO SECURE WOR FS'COMPENSAT•, rCOVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADD ION TO THE••,•T•F COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. l 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.Lit.# Class 4 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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a chill 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.). 4 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 of 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 C• tractor. Lice -e Laws.).. ❑ I am exempt under s',. / Business and Professions Code for this reason: Signature: / A .ir xpire '���li Owner ID verified dri�s lic:nse. Irlf!sNo Driver's License No. Verification of Ownership by(type of d' u 'ent,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 ❑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,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia 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 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? 0 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 •mpli:Rce 3•m th7 appropriate air pollution control officer). CERTIFICATE •i •h',I•rANC-. =L...4.r•'Tn•i:u•- • •, information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardo ..... ':2.-- �QTi -- Signature: i� "��% Date: CERTIFICATE OF COMP •/NCE AND AfifIZATION 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 wi• - st ,e ld city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prop • .•r i -pec 4n•P•oses.I agree not to occupy or allow occupancy of any building authorized this per until final inspection. -i0 (//ZZ/0 6 /1 Sig - Of Lege •pplican) Date • d/• Authorized Applicant Date CODE, INSPECTION TYPE • DATE INTRIAL$ coDEE INSPECTION TYPE RATE !MALS 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 CITY OF COSTA MESA BUILDING DIVISION >:� � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. PERMIT IPA P06-00947 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.jjsMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1430 SHAMROCK LN Status: ISSUED Suite No Applied: 11/22/2006 Issued: 11/22/2006 Vicinity: Parcel Nunmber: 41814304 Applicant MORGAN, ROBERT ISSUED BY: 1 Address: 1430 SHAMROCK Phone: 714-540-2115 I T H COSTA MESA,CA Zip: 92626 Owner: MORGAN,ROBERT & LISA DATE: ( nC{ Q� Address 1430 SHAMROCK Phone: 714-540-2115 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: (.``J Phone: lilt JJll"" Zip: License: 000000 , . SCOPE OF PERMIT PLUMBING PERMIT TO ADD 508 SF AND INTERIOR REMODEL TO SFD. REF#:B06-00788 WORK TO INCLUDE: 1 BATHTUB,1 GAS(1-4 OUTLETS), 1 SHOWER,2 WASH BASINS,1 WASTE AND VENT SYST, 1 WATER CLOSET,1 WATER HEATER,.1 WATER REPIPE AND 1 KITCHEN SINK. 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 $9.80 1 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 $19.60 2 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 $9.80 1 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 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 Gas(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 - PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $120.35 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and,r ated 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. // crib/ INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appli_ le 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 Ohe 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: Cartier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) kI certify that in the performance theork �I r 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 Califor a, nd ,ere.t.at If I should become subject to the workers'compensation provisions of 1Sect/'yn 3700 f the Labor Code,I shall forthwith comply with these provisio �q� Applicant Signature: ti Date: SJN WARNING:FAILURE TO SECURE PIKERS'COMP' SA ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($10000).IN ADDITION T• E••'-T 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,end my license Is in full force and effect.Lia# Class k 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). 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 fora 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 Nzt 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.). Pl I,as owner of the properly,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License La. d•: 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 • tractor. U :nse Laws.). ❑ I am exempt under / Business and Professions Code for this reason: Signature: II/A..�. .i.� Expires: (01K//0 K Verification of Ownership by(type of ment,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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Calitomia 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 end 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,hes Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or preser1;i•OT future building occupant require for the work which Is the subject of this a plicadon 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? U 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 con„tructed 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 Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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 COMPLI' AN• A . •RIZATION 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 comp) ith .I s - e la s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope fo s,�o�• rposes.I agree not to occupy or allow occupancy of any building authorized bithi permit un' final inspection. G / Sig•. ur.Of Legal Owner(s) 22 Date A d/•r Authorized Applicant Date CODE• IN$EECTION TYPE PATE 1NTmALE COOP INSPECTION TYPE PATE INTIBAL6 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 b CITY OF COSTA MESA - • BUILDING DIVISION • Ftµ ,/ • 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER B07-00895 PERMIT TYPE B_ROOF2 STATUS: ISSUED DATE ISSUED: 08/14/2007 ISSUED BY: RMD JOB ADDRESS: 1430 SHAMROCK LN CM Suite/Unit: Vicinity: HOUSE AND GARAGE ROOF Const Type: ?? SQ. FT: 2700 Valuation: $0.00 SCOPE OF WORK: TEAR OFF(E)ROOF MATERIALS, INSTALL A MINIMUM OF 1 LAYER OF 30#FELT ON A 4:12 PITCHED ROOF ON AN ATTACHED HOUSE AND GARAGE,APPROX 27 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. OWNER: MORGAN, ROBERT AND LISA. Address: 1430 SHAMROCK Unit: PHONE: 714-540-2115 City/State/Zip: COSTA MESA,CA APPLICANT: HOWARD,AUSTRALIA Address: 2737 S CRODDY WAY Unit: PHONE: 714.641-1440 City/State/zZip: ,SANTA ANA,CA CONTRACTOR: DKAM ROOFING License No. 841611 Address: 2737 S CRODDY WAYUnit: PHONE: 714-641-1440 • City/State: SANTA ANA,CA ZipCode: 92704 CELL: • ARCHITECT: License No. - PHONE: ENGINEER: License No. PHONE: FEE SUMMARY , Reroof Plan Check: $0.00 Reroof Permit Fee: $181.25 Reinspection Fee: $0.00 TOTAL FEES $181.25 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE r, INSPECTION TYPE DATE INTIMAL$ CODE/ INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final n � 208 Final Plumbing D' 200 Final Re-Roof (17— ? ,Z-' '11 210 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver .Ise. ❑Yes ❑ No - I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ 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. 42' 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 s-kOV-C T- __`(A 1 by this permit,and that no building structure,scaffdding,falsework,or demolition Carries '�'�/` or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp (This secti ,need not bbeecompleted rtthe permit is valued at one hundred dollars(Stao)orless.) 2,Art 2,Sec.341,Title 8,California Administrative Code). Polx icY Number. \ USO 4.—+ Z ❑ 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...yyye 'rs' compensation provisions of Section 3700 of Applicant's Signature Dale the Labor Code,I 'th comply with these provisions. rp_ ©� --1 t{U T Division of Industrial Safety Permit Number: Applipnfs Signature" Dale/ 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 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 isisin full force and effect. a registration form for acutely hazardous materials? 0 Yes El No cCic-#--O L.'\`' r~Class'#. 1.n 3 (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by e�(L'+,o1- each business which at any one time has on hand a quantity of acutely ConVactor's ignatureI Lyate• i 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 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Oare 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 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 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 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? 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 control officer). 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 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 El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Dale 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 purposes. I agree not to occupy or allow occupancy of any building authorized by this pe it until final inspection. / s.n.l/II egal Owner(s) Dale Signature Dale ^// .1/ a 81 4 07 3057-4613/07) iinsar Authorized AppfnntDate_ \ \ OWNER Coll Pet. MP SA tririlnany DATE L-18-56 JOB ADDRESS 1)430 Shamrock Lane BUILDING PERMIT NO. 2788 GENERAL CONTRACTOR The Hale Co VALUE $10,248.00 LOT ?9 BLOCK _ _ TRACT 2432 Sin_ - C - Gh..•UP T L ,i TYPE V ZONE R1 FIRE DISTRICT 2817 • PERMITS ISSUED INSPECTIONS V �' i/,-/y T D E55.- SUBCONTRACTOR DATE NUMBER !aCI✓a,�C Footing Trench ✓�D�L`V irCi- Foundation Forms and Grade to Gara e Rough Framing 7 3 O 6 h to e �/..- c�J� f2-,, Plumbing,Rough Plumbing,Rough Complete-44p �/y/C el: �„ 7/ 4j 6--rc 476' CJ Temporary Pole / Wiring, Rough 7'2f!Z .a i pGQ_ 7 /9'.S4 C; 45.2....1 -_... Heating,Rough / Heating,Final -46.-6.01,..„140 / •-.0 • 3 3 6 / ---- ,h,hewer, �- ewer, House afir Sewer,St. 3kir QA�t-,. / 4 ).._C7, ,$-6 -- ' ./ 1.2-0 � •P, � ,-� Lathing, In,\ Out)r g F Bring ,0,,` F AY V;f P,_..lbing,Final,Fixtures Complete / /`r% An >evoe Plumbing,Final Gas Test S is- / J ' �ir `In� Wiring,Final nqetri �5 Occupancy N1 II-lh,/ FORM 210 3M 10.553 Costa Mesa Building Department 28ItPPLICATION FOR PERMIT - 16 111 EAST 20th "WEET B 1/ L D I N G 1 COSTA MESA, C{ ORNIA FOR OFFICE USE ONLY TOR APPLICANT TO FILL IN Receipt No. I Permit No. Building Address 1430 Shamrock Lane o7 73 7 Costa Mesa, California Received by Date Rec'd. /L Date Issued Nearest {iatson Avenue ��g�� T /��� Cross St Building Address Owner College Mesa Company Mail Costa Mesa, California Address 8002 Central Avenue Nearest Tel. Cross St. City Garden Grove No, LE 9-2158 Zone i,/ I No.of I Type crow, n6� Architect or Lie. Plans Engineer Davis & Quigley No. C-1790 Approved U Sy Date Address A3 Halm. Cove Plaza,Palos Verde: CORRECTIONS it Contractor The Hale Company Noy Lie. 3422 Address 8002 Central Avenue,Garden Grove Legal De cr ption I Not 29 I Block j Tract 2432 (Attach Metes and Bounds) Size of Lot 63 x 135 I No.of Now. on Bldotgs. LNone ---'s \Th vv-__-,. Use of INo.of INo.of `1rr� /1 \\ ) 11SL �1 m Existing Bldg. Families Rooms / ,_� ,._-_, ,. 2 Setback Line from Rear Yard QQi _(1 '� -/ Center of Street 52' Side Yard 5Eii -___-_,1 V- D DESCRIPTION OF WORK ApH 1 b waS r New I .- I Alteration I I Addition I Repair I I Moving I I Demolish I t n 'r Building No.of /111 V! vv,-,vv,-,Li 6 . Size 1181 Rooms 5 Stories 1 Exterior Wall I Roof Covering Stucco I Covering Shake APPROVALS Use of New Building ainele family dwel line with FoForms,Materials, tion Inspector Date attarhed 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 Signature of THE HALEC0MP(�,Y�' Permittee Plaster, int Authorized Agt. Plaster,Ext Valuatl o LARDNER Permit Fee $ )4° ' Masonry Reinforced Plan Check $ / 1 ' $ /v) vt/i , Bond Beam Total Fee $ )9' FINAL L ,cram 9116 c.RP 2M 6-55 • .. • C. d _ J o n ` o D ` COSTO • Street 1 . PLOT PLAN Show location and distances from property line and between buildings. r ' VWNCK MARRON, JAMES UAIt 10-16-68 JOB ADDRESS 1430 Shamrock Lane BUILDING PERMIT NO. 29252 GENERAL CONTRACTOR Babi and Smith DESCRIPTION of WORK Add. Family Room and 'Utility a AP o. 141-012-06 LOT 29 TRACT21(.32 FIRE ZONE VALUE $ 5,062.00 I >�iCTIONS Signature Date GROUP I :. TYPE V ZONE R—1 si. it fp, /4-7-5C:( PERMITS 155. ED GAS • L,(; 'iv l0--vTGiY ac- SUBCONTRACTOR -7 —Cr Date INumber I Signature 9 Plumb' g • • �. V ROUGH PLUMBING S ,---7-4: 4, -f-91 J /Q-%,_..Q d c /3$J PROP. SWR. LINE HOUSE CON. J /Q i ,[^T SPRINKLING SYSTEM )fr 4.14")%i L .6 �✓ /(�` MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING /14-745/1-7 t.P" TEMPORARY SERVICE OR POLE UNDERGROUND I] POWER ❑ ROUGH WIRING //7j' �//t-44- �9 eating an tent. TRENCHES ® FORMS El STEEL REINF. [ai enii- /c-.2-7-676 471 e• 10-711-dg fr-ki9/- FLOOR SYSTEM VW (Fi-)2.-QP "EE BOND BEAM ii l STEEL REINFORCE fl SHEATHING i,:#7 d- 0-ii�b6- FRAME AND FLASHING /nye/ /'-'2_6K LATHING — IN ✓n( OUT AI ,pQi,y��L 9-45--6,ey PLASTER, BROWN COAT /V/!c4 F1-9-L8-- �,y Electric cy j/ HTo 'TG RV ENT., REGRIG. AND A.C., FNAL / 7�G /\L�c./_�yAL. FINAL �'e/I'f^d J 11-12-a8 �1rz`1o/.j I PLUMBING, FINAL AND GAS TEST p /O.' I-1012 1-1012 11 /� ELECTRIC, FINAL /// 4/.2 U'b BUILDING, FINAL n7� /-18,-‘7 cor,-ia orn,,,onArNTC 2925 COSTA MESA BUILDING-SAFETY DEPARTMENT OCT 16-68F—"12 P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 CRSAOO 808* +Nrh*31 5 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING For Office Use Only ADDRESS Iif30 5I„gMROt-k LANL RECEIPT NO. y�fyJT NO. COSTA MESA. CALIFORNIA q. 1j� gorvZDATE gg'��',/ /111Z.a'MIZS. R[c[v D � /� /(�1_(O� `OJ f(o–(o2� OWNER 3AmE 5 MARRoN �� BUILDING MAILRESS i`f,/ ADD30 s ll 19 rn,e o c k /A/✓E_ ADDRESSFIRE TEL ZONE TYPE ✓ GROUP — CITY GosrA MEsy NO. // APPROVED ^7I� T TE/4:44j4--A--676� ARCHITECT TEL BY 7 4A OR ENGINEER NO. 1 ZONING // ADDRESS pGL ((}},, [t�) ��//,, ION[ I HO.OF U9[OP NRW II Cl:,CONTRACTOR hl// 8 2 0- (SMITH 62- ' PLANS (� BUILDING �„I,J.), to LEGALLot / r/? act 3 �1 ADDRESS .52.0 iL(S TI AI AJ ell Ke_. / DESCRIPTION /\ .l J- CITY Newpooicr 6f/9C4 A.P.NO. 141 - O/. - 0 (:- 59a- 207C LIC./510 p TEL. 5Y a- ZOIC NONOTE: NO RAVE V ROVE PLOVERHANG SHALL BE LESS THAN LIC.NO. ) /$ I 73Z,/ y NQ. CI'465 -/1- g OFLOT .3x /3`i.6- - ✓T.J / NOW ON I EAVES SU.B.C.REQUIREMENT/- - USE OF YARDS APPROVED YARDS APPROVED EXISTING BLDG. ' I n c/ L✓ie. 1,9 nn Res Idehc</ MAIN BUILDING ACCESSORY BUILDING f j (FROM C/L ETRE ) ., / SETBACK LINE PROM r / c[ ``/ FRONT JCS{ FT. CENTER OF STREET J Z REAR YARD / �•J ^^� 7 SIDE YARDI LEFT 6 , // I RIGHT N./( R.SIDE dOFT. ±- FT. DESCRIPTION OF WORK L.SIDE 26 FT. 'f' FT. NEW x REAR Liu. PT. t Fr. ALTERATION ADDITION DISTANCE BIT. BET.MAIN Q MAIN BLDGS, ACCESS.BLDGS. REPAIR _MOVING peMOL19H BUILDING L[ NO.OF VAR.46 DATE SIZE T I'7" ROOMS SLTORIES i C.U.P..fi APPROVEDErrEivirmjjj COVERINGWALL STVcc0 COVERING s4ihv/ES :;PROVED (Up/ rt /0 /16 4g USE OF nu ILDI NG AND WORK TO BE PERFORMED 1 /V' V/ a Add I'19,+1,/-y jr o o t. ti- o9 gretiry Rao t.2 To 3 Ex•sr'N4 5try y/E 'T191"I/ty Judd/int /CJ SG.FT. ,'k et / o I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IB FOR THE j AND STATE THAT THE ABOVE IS CGRRECT.AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. 211 PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 01D BUILDING CONSTRUCTION. / / ,7(.____ SIGNATURE OF PERMIT FEE $ PERMITTEE -�� /O/ L, 0 as c, 04'; PLAN CHECK S AUTHORIZED AGENT / a`5-0 .� TOTAL FEE $ OWNER 1iANtllj1E, 1,6018DATE A-13-5& JOB ADDRESS 1430 Shamrock Bane BUILDING PERMIT NO. 69117 GENERAL CONTRACTOR �.,fn,., 3..d Clonstr !'o VALUE $ 52.00 AP. No. 113-262) )6 TRACT FIRE ZONE DESCRIPTION OF WORK Ai ',t„-,1 GROUP TYPE ZONE PLAN NO. 6947 I 'ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel rr Floor System Steel Reinforce Chimney Re-Rod mid% Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil W/G Pipe Test — Tap Out Furnace Gas Vents Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbin. Fixtures Final 14.',Gas Test rt on 'ole Underground Power Rough Wiring Fixtures, Final -OCCUPANCY 6947 Form 210-5M-1-57 `_ C - STA MESA BUILDING ''APARTMENT I 6'. ¶7 P. O. BOX 317 COSTA MESA CALIFORNIA - r r -`` C _ �((Ll EI�VED FOR APPLICANT T• FILL IN• / C.L. OF STREET---- 19 /S�BUILDING A DRESS 0 --2/•- /-a.- = - • _ __ __ PROP. LINE FII`ANCE BEFIT. owner_ I dda� - A' 'r /Oo4q be i- 10 FT. FOR 60 FT. STREET—FP52 FT. 61Fl;27 CITY OF Q05 A tItESA Mail Address / I � I I`50 FT STREET 1 Q� J� �'��� �"O2n�,c�C �� City L v''�-ai -a-l. Ph. No.er/ SCI?/_ II Contractor r Ph. NNo. ) 7/ pD Address a G ✓/LW,..e y`^ u6 I I 50 FTI IF FRONT City Lic. No. C.R State Lic. No. /?d`25 OF PROP. /� 150 FT_ w fx Size of Lotg�X iaq AP No. /2 3- c/�- 0 w A \ ,_.• Setbacks: C/L Street /3V/'f. Rear .`3 y� — ¢ J rc v_ Side Yard - Right �� Lef u~i r—___ ___a. 0 Type of Fence 4�� .6.c+� c�> 8ai-4-4dt LL NALLEY QR PROP. LINE r 0 v ne 1 a S� 1 0. 33' d J I -..:- . ¢ \ --1 I hereby acknowledge that I have read this application and state Ord- (..i _ that the above is correct and agree to comply with all City Ord- N_rp `____ i w w finances and State Laws regulating building construction U ft—du F p ° 2 • Signature / / ' ® Le 0 o 0 10 I of Permittee �/ i/d Y Oz • "I �'� �: U ;, m FT I Agent �S // /f/ LO ¢ o 37 6 IN. fj 7 a" ua j a I • FOR OFFICE USE O LY FT. z 40 La • N Na FT I // / / -- /A permit No. I 0 -41 60 FT ST d by Date eceiv d ate Issued I I t / ‘- 73 --.\ ? I50 FT. ST. I F I /� b /3 1 i 1— _ �iPROP. LINE 4' I — _ _ - - - � VA ATON .Lj i-- -- - - Permit Fee $ 0 in - / $ Jr Z i Plan Check $ �— C.L. OF STREET—, I 2 TOTAL FEE $ 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 S. , • - • • •N‘? C C • Cti • A • .-cVe5*tvI ckl% • C.° • • . \\. 4.% - ' \"" S. . . . - • OWNER MARRON., J.W. DATE 5-5-59 JOB ADDRESS 11130 Shamrock Lane BUILDING PERMIT NO. 9198 GENERAL CONTRACTOR Ptl4s if er VALUE 5 183.00 AP. No.113-282-oo LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block Wall INSPECTIONS DATE I GROUP TYPE ZONE R 1 -rground Soil U.G. Water PERMITS ISSUED L rground Gas — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test _ Construction Pole Underground Power Rough Wiring Trenches (_ Forms Steel L 4t6 -G'JL/ Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing I ig, In Out F. .er, brown coat Plumbing Fixtures, Final Electric Fixtures F;y,l Ar�,a� Building, Final -near /�. %�,���e OCCUPANCY / -teff _ Form 210-3M-4-59 9198 9198 ?EE RE "ciVED COSTA MESA BUILDING-SAFETY DEPARTMENT Fr1A(5 1959 P.O.BOX 317 COSTA MESA, CALIFORNIA FINANCE DEPT. • CITY OF A MA fOR APPLICANT TO TILL IN COMPLETELY APPLICATIIONOFST OR PERMIT TYPE` ORPRINT BUILDING. j I `l AD ADDRESS i/ /i`/J^" L^ ^), 11Lk / / //-4e46 g/COSTA MESA, CALIFORNIA fOR OffICE USE ONLY A / I RECEIPT NO. I PId0 OWNER YC/ V/C/ J'�./�j/J MAIL /A� ��lN`'T RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS l O _ �J-1--"P f `C s-- I c!- \"i� ////��J ,�//,/,/.,,// �/f TEL./' �J BUILDING CITY /.ecai .... ,L.4 NO.C{',3J✓,/ ADDRESS ARCHITECT LIG. COSTA MESA, CALIFORNIA OR ENGINEER NO. / ADDRESS �G, FIRE ZONE type gY'OUjJ \ +IV �w/-/ STATE y /A7CONTRACTOR [.i LIC.NO.�j COT/ APPROVED ./BY DATE ADDRESS O ZONING LEGAL I LOT /J, I 21 J. ZONE A/�/ NO.OF USE OF NEW (I DESCRIPTION !NO. �( / BLOCK 6 II TRACT I, ; IPLANS 1 I BUILDING C-�. / A 1 A.P.NO. //3 re b BPPRO/VED s Q/ V^ / DATE 3-3.---Lill/ BY R/ l�-rn .J SIZE i ]" / / NOW ON LOTF BLOCS. REQUIRED / (! EVES ALLOWED OF LOT 3 i... P USE OFp (CENTER LINE ST.) EXISTING BLDG. If..CO - FRONT- UFT. 71 IN. SETBACK LINE FROM 1 'y/- i CENTER OF STREET J D I REAR YARD D R.SIDE FT. D IN. I --� 11 SIDE YARD LEFT I RIGHT SCJ L.SIDE FT. IN. DESCRIPTION OF WORK NEW I ///. REAR FT. O IN. ' ALTERATION II ADDITION I REPAIR I II MOVING ] II DEMOLISH I BUILDING NO.OF SIZE ROOMS STORIES EXTERIOR WALL ROOF COVERING I COVERING USE OF BUILDI G A D WORK TO/� E PERFOR ED : "x S' x,/-57 -gy,77;r1 . - 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 L WS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OFat. / ./ PERMIT FEE $ ,51_0 PERMITTEE ,�y Sp /`' o-4PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE $ /