HomeMy WebLinkAbout1451 SHAMROCK LN - Building Permits I ti R
CITY OF COSTA MESA
A e% BUILDING DIVISION
f ���a 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: BC09-00063
PERMIT TYPE: B_COMBO STATUS: FINALED
Sub Type: RES ALT DATE ISSUED: 03/31/2009
ISSUED BY: RMD
JOB ADDRESS: 1451 SHAMROCK LN CM Suite/Unit:
APN: 41814115 Zoning:R1, ,
Vicinity: • Primary Occ: R-3
Const Type: V-B SQ. FT: 150 Valuation: $35,860.00
SCOPE OF WORK: ADD 150 SQ FT TO OFFICE AND BATH AREA. REMODEL KITCHEN AND MASTER BATHROOM. ELEC: 34
LIGHT FIXTS, 10 OUTLETS, 12 SWITCHES, 1 SVC PANEL TO 200A; PLUMBING:2 BATH TUBS, 1 DISHWASHER, 2 SHOWERS, 1
KITCHEN SINK, 2 WATER CLOSETS, 5 WASH BASINS; MECH: 2 VENT FAN.
8/18/09: SUPPLEMENTAL PERMIT TO ADD ITEMS NOT ADDRESSED PREVIOUSLY. ELEC: 1 RES NC PKG; PLUMBING: 1 GAS
OUTLET(1-4); MECH: 1 REPAIR/ALT COOL/HEAT, 1 NC UNIT
OWNER: MC CORMICK,THOMAS R Address: 1451 SHAMROCK LN Unit:
Phone: City/State/Zip: COSTA MESA,CA
APPLICANT: CHRISTIANO,STEVE Address: Unit: :
Phone: 949-294-5387 City/State/zZip:
CONTRACTOR: CHRISTIANO CONSTRUCTION License No. 848745
Phone: 949-294-5387 Address: 336 COSTA MESA STREETUnit:
Cell: City/State: COSTA MESA,CA ZipCode 92627
ARCHITECT: LA ROCHE ARCHITECTURE INC License No.0-13756 PHONE:949-642-7126
ENGINEER: OG ENGINEERING License No.0040730 • PHONE:562-644-0909
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $326.85
Building Fees: $502.85
Electrical Fees: . $164.92
Mechanical Fees: $78.85
Plumbing Fees: $157.05
SMIP Residential: $3.59
SMIP Commercial: $0.00
Bldg Std Admin Fund $2.00
TOTAL FEES: $1,236.11
--Refer to fee receipts for all fees paid for project
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.
CODER. INSPECTION TYPE PATE INTITIALS CODE* INSPECTION TYPE DATE IN1111ALS
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
r��
204 Final Demolition 250 Final Building/Occupancy �1J
I. 4 t
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. Yes 0 No /a
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(typ 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.
O 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed tr the pontiff is valued at one hundred dollars(5100)or less.)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
0 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
Applicants Signature Date
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 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 0 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 Dale 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)? ❑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 Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 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? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia 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
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 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 ❑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
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a 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 no occupy or allow occupancy of any building
authorized by this permit until inspection.
2 Q - 18 -49 Signature of Legal' wner(s) -Dale
3057-4613/07)
And/or Authorized Applicant Dale
1 -
_`._, City of Costa .Wlesa Budding Division
Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION i
Permit # 1 9 , t✓yC 6 3
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your rpe listing yourself s the bui er of the
property improvements specified at
We are providing you with an Owner-Builder Acknowleddment 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-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material 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
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
I-ilk 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
J A4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
7 I 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
a6. I understand if I am considered an "employer" under state and federal law, I must register with the state
nd federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
—Le- 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
.�, lit 1 I ., =% I
r"` 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
-1..L( 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
es" 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed con�$t{{uction activk at the following address:
f°fJ7 \Peri c/ ck i . CQs%.4 /7Er �9• 72624
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
•
f K 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information 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 verification acceptable to the agency is required to be
presented when the permit is issued to verify the property owner's signature.
Signature of property owner / /2 ---xL7Date: d-(8- O 9
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
CITY OF COSTA MESA
E °w!"'Fs'q BUILDING DIVISION
r4'_� 'fli , 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
i. FOR INSPECTIONS CALL: (714)754-5626
1`'4aeovmv"'.
PERMIT NUMBER: BC09-00063
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 03/31/2009
ISSUED BY: RMD
JOB ADDRESS: 1451 SHAMROCK LN CM - Suite/Unit:
APN: 41814115Zoning:R1,
Vicinity: Primary Occ: R-3. -
Const Type: V-B SQ. FT: 150 Valuation: $35,860.00
SCOPE OF WORK: ADD 150 SQ FT TO OFFICE AND BATH AREA. REMODEL KITCHEN AND MASTER BATHROOM WITH 34
LIGHT FIXTS, 10 OUTLETS,42-SWITCHES, 1 SVC PANEL TO 200A, 2 BATH TUBS, 1 DISHWASHER; 2 SHOWERS, 1 KITCHEN
SINK, 2 WATER CLOSETS,5 WASH BAINS, 2 VENT FAN. , , -
OWNER: MC CORMICK,THOMAS R , Address: 1451 SHAMROCK LN Unit:
Phone: City/State/Zip: - COSTA MESA,CA
APPLICANT: CHRISTIANO,STEVE ' Address: Unit: :
Phone: 949-294-5387 City/State/zZip:
CONTRACTOR: CHRISTIANO CONSTRUCTION License No. 848745
Phone: 949-294-5387 Address: 336 COSTA MESA STREETUnit: "
Cell: City/State: COSTA MESA,CA ZipCode 92627
ARCHITECT: LA ROCHE ARCHITECTURE INC1 License No.0-13756 PHONE:949-642-7126
ENGINEER: OG ENGINEERING License No.0040730 PHONE:562-644-0909
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: - - $326.85- "
Building Fees: $502:85
Electrical Fees: $110.42
Mechanical Fees: $38.00 " -
Plumbing Fees: - $150.90 ,
SMIP Residential: $3.59
SMIP Commercial: • $0.00 , .
Bldg Std Admin Fund $2.00 , . ,. ,..
TOTAL FEES: $1,134.61 -
**Refer to fee receipts for all fees paid for project
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.
CODES. INSPECTION TYPE DATE INTITIALS CODE INSPECTION TYPE DATE INITIALS
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 a
204 Final Demolition 250 Final Building/Occupancy 6—1&-'7 &31-----
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver a license. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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 ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Gm
(This section need not be completed Oho permit is valued at one hundred dollars($100)or less.)
2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
N-1 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
the Labor C de,I shall forthwith comply with these provisions. Applicant's Signature Date
ii
2�3 /U I Division of Industrial Safety Permit Number:
Appli anrs'Slgnature �ILip te.JHAZARDOUS 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 is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No
i#�G �7 VS CCW#� 8 (Section 25533 of the California Health and Safety Code, with some
qq exceptions, requires registration with the Costa Mesa Fire Department by
—[j -+�,:a�. 3/�I 09 each business which at any one time has on hand a quantity of acutely
'Cbntra t&nidnature" )ale 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 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 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 Califomia 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 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 ❑ No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signereof Legal Owners) Dale
Signature Date
7{_c__,,
to 3t�d�(
9
30 -46(3l0)) C./` da'
bnAuth5iideli Applicant
CITY OF COSTA MESA
4 04 BUILDING DIVISION
>1- 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
,Oj�'ownm�
PERMIT NUMBER: E09-00078
PERMIT TYPE ELEC STATUS: ISSUED
APN: 41814115 DATE ISSUED: 04/01/2009
ISSUED BY: BJK
JOB ADDRESS: 1451 A SHAMROCK LN CM Suite/Unit: A
Vicinity:
SCOPE OF WORK: TEMPORARY POWER POLE IN CONJUNCTION WITH A FUTURE ADDITION TO A SFD.
OWNER: MC CORMICK,THOMAS R Address: 1451 SHAMROCK LN Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: CHRISTIANO,STEVE Address: 336 COSTA MESA STREET Unit:
PHONE: 949-294-5387 City/State/zZip: COSTA MESA,CA
CONTRACTOR: CHRISTIANO CONSTRUCTION License No. 848745
Address: 336 COSTA MESA STREETUnit: PHONE: 949-294-5387
City/State: COSTA MESA,CA ZipCode: 92627 CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $47.00
Reinspection Fee $0.00
•
TOTAL FEES $47.00
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.
OODEP INSPECTION TYPE QpF INTTnALS CODEX INSPECTION TYPE DATE INIIIIALS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final - 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical201 Final Block/Retaining Wall _ 212 Final Fire Prevention �\
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver s license. ❑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.
❑ I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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 ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will he made in connection with work authorized
by this permit,and that no building structure,scaffolding,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 it me pend is valued at one hundred dollars($700)or less)
2,Art 2Sec.341,Title 8,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
J 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
sed, 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 gpplttanl's Signature Date
the Labor Code,I shall rthwith comply with these provisions.
4 �-4 . . i "II 16 q Division of Industrial Safety Permit Number:
applicants Sign.ure Date ;, HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No
Licr.#:s 19 F?a f Class# (Section 25533 of the California Health and Safety Code, with some
/J 00 � exceptions, requires registration with the Costa Mesa Fire Department by
.-�� ( '. ✓1_,. ...% ��II I a4 each business which at any one time has on hand a quantity of acutely
Contractor's Signature !ale 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
Lenders Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No
I hereby affirm that under penally 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 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? 0 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 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 ❑ No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to Construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature of Le I Owner(s) Dale
Signature Date
,,� 1 yl/eq
And/Or005]-6613/W) Anor Authorized Applicant"— Date 1
•
•
CITY OF COSTA MESA
ola , BUILDING DIVISION
>• m !•I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
t ^`
, - FOR INSPECTIONS CALL: (714)754-5626
n
PERMIT NUMBER: B09-00062
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 41814115 DATE ISSUED: 04/27/2009
ISSUED BY: KJB
JOB ADDRESS: 1451 SHAMROCK LN CM Suite/Unit:
Vicinity:
Squares: 2800 Valuation: $6,793.00
•
SCOPE OF WORK: TEAR OFF COMP ROOF.REPAIR/REPLACE SHEATHING AS NECESSARY.COVER WITH CALSS A 30 YEAR COMP
SHINGLES. INCLUDES ATTACHED GARAGE. ROOF PITCH IS 4:12
OWNER: MC CORMICK,THOMAS R Address: 1451 SHAMROCK LN Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: HARTLEY, LARRY Address: 8941 MINT AVENUE Unit: :
PHONE: 714-847-7663 City/State/Zip: WESTMINSTER,CA - yry9_00062
CONTRACTOR: CALIFORNIA ROOF LIFE CO INC License No. 509623
Address: 8941 MINT AVENUEUnit: PHONE: 714-847-7663
City/State/Zip: WESTMINSTER, CA 92683 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $139.25
o YEA fl r:0M1:
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
Unit:
TOTAL FEES $140.25
Unit:
• .11 S-00062
1
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28, § 1, 12-21-92)
EXPIRATION: 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 INnn�I. CODE/ INSPECTION TYPE RATE Sf ,INPT1ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �/ , /��, 208 Final Plumbing
200 Final Re-Roof f"1/ / /V_I 210 Final Electrical
201 Final Block/Retaining Wall �'T 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval !ii:i
203 Final Sign 222 Final Site - ;Si)
1204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: . Owner ID verified by driv s license. ❑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
p9rf2panice of the work for which this permit is issued.
t�cI 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
/ by this permit,and that no building structure,scaffdding,falsework,or demolition
Carr C u.7M „.1 by
dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This section eed not be completed if the permit is valued at one hundred dollars($100)or less) 2 Art 2Sec.341,Title 8,California Administrative Code).
PolityIddtnb'Br.
- -- 0 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 work- s' compensation laws of California, and agree that if I should
become s�ect to the workers' c. pensation provisions of Section 3700 of Applicant's Signature Date
the, aisi ode, I shal fort • '. ply • h these provis ons
J Division of Industrial Safety Permit Number:
/ _ -):--
A... ,-.Coat e VP--IL" HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAI URE 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. '7 q a registration form for acutely hazardous materials? 0 Yes 0 No
�rcC#7 0 9h Z 3 Cf855#4 — ) 1 (Section 25533 of the California Health and Safety Code, with some
�f// exceptions, requires registration with the Costa Mesa Fire Department by
each 2��nq each business which at any one time has on hand a quantity of acutely
rcorxr aws�gnet�e �'Dal� 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 Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 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 Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished 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
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
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
ignature o/(�� al ehs) D le
Signature Date // ��z7/(
3057-46(3/07) A!u`to iz 11
IhonzetlApPtcant Date
CITY OF COSTA MESA
o • MF •
BUILDING DIVISION
Fk , 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cd.us
pirFOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: BX09-00190
PERMIT TYPE B_MISC STATUS: ISSUED
APN: 41814115 DATE ISSUED: 09/11/2009
Zoning: R1, ISSUED BY: BJK
JOB ADDRESS: 1451 SHAMROCK LN CM Suite/Unit:
Vicinity: PATIO COVER Primary Occ: 32 Const Type :??
SQ. FT: 210 Valuation: $3,385.20
SCOPE OF WORK:
DEMOLITION OF THE EXISTING ALUMINUM PATIO COVER AND CONSTRUCT A NEW 210 SF ATTACHED PATIO COVER, PER
CITY STANDARDS,AT THE REAR OF AN EXISTING SFD.
OWNER: MC CORMICK,THOMAS R Address:: 1451 SHAMROCK LN Unit
City/State: COSTA MESA, CA Zip Code: 92626
Phone:
APPLICANT: MC CORMICK, LOUANNE Address: 1451 SHAMROCK LN Unit:
City/State: COSTA MESA,CA Zip Code: 92626
Phone: 949-463-0977
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: Unit:
City/State:
Zip Code: Phone Cell:
ARCHITECT: License No.
Phone
ENGINEER: License No.
Phone
FEE SUMMARY
Building Plan Check: $63.21
Building Permit: $97.25
Electrical Permit: $0.00
SMIP Residential $0.00
SMIP Commercial $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $161.46
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 TYPED)A�T IN1ITIAL4 CODE* INSPECTION TYPE DATE INIITIA4
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 # TR V
I .
•
11.WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivere. Yes ❑No ,t�
I hereby affirm under penalty of perjury one of the following declarations: Dr veer's.License No. Expires: -/f k—C7
0 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure.scaffdding,falsework,a demolition
Carder: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed d the permit is valued at one hundred dollars(StOO)orless)
2,Art 2,Sec.341,Title 8,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:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 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
Contractors Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia 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? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for •
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
IDI, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa . to enter upon the above-described propegy for
inspe .r rpose�. 'e not o oc upy or allow occupa cy o any building
au this ../42I'fine in t.-ction.
&.a Ai..4/ . ..
a- .A� u��
��� 1 � _ Signature of.Lega • r(s)- sa'�
"CC]]
Signaty$ ciao
(3I07) U And/or Authorized Applicant Date
/ ; .
•
nillt C (-----ra , . • c
— -- -- — -- I 65.38' + ---7
5 v --
.... ,
co
.. 0u.)0"e.5 --- - 0)
• / -2/
,a•.,z•
Auumary
n - A I /1 Building
/ CY a
If 1
/ �, III '1��t1 ,l�,I:G
DIVISION
ITY Fch ui 1) nnl:sA
('O{)1': CI)N1PLlA1E ua
REVIEWED OR _1 7
l X `l �Q Date i''BY
_
ee 'ob at al tines and _ ' _
lAbOM �
• '. •wimea�a" ionlromtlteg'witbnd:1I -,)
q1 / , , o
dna i h �"
//
andSdsiY.Thesisidtl� SHAL NOT
s1 Mesa P• ,,:: I�.
,.ism Gd of I osta Mesa antb'aalg' ,
of the*Coo d mat :no become null void I lie „ 'a \A;
inrca wd shd-- e.:. 105.5 . . 180 days d'`.: ' //
? �� .,, -‘45
--/..:
RF G ;
Seo 'lammu�
/
rp.� ��F ,;illb l�Illllll�11il��l I 1111111111H�
l �IIl' II �,�I
--- —� il1 Ol11111
EXISTING DRIVEWAY i �II"'HIIdIL II ,ao•
c
1 }
' \ , ---`-g ,/1 E.ut ng
jw�vlge.y I
i auilding
r 1451
SHAMROCK LANE ' Fes\\ APPROVED _i"1. 4
CpSl A- nAe 5 C,� \ \CITY OF COSTA MESA.
ICI PLANNING DIVISION..------ r 19.54
(.0. cp $t BIFCT TO BLI) EPT REO.
SITE PLAN NO '6C• DDMONS, DELETIONS,
0 ' C•RUCTIONS SHALL BB •
Prui ' ' PK• : )`11 ' PLANNMO DIY..
North
Eusling landsmpe - I
" • r� 'ATE: b 4 APPROVE
OTY(1�'C1�STw MFS
-" - - VInr..gW1510
— SUpIT i iO pLDG.pfPl
PAPo COt/t-/t- O� 7 DNS FF'
Syr° 007 9a
m--
2_
2_ -
41771c- 2x6 L,•dgc�
11111.1.11- 4111.11,111S1111r r11r71:
24' P°s
DIVISION OF BUILDING SAFETYL- -~'—"P f CTYP)
CITY OF COSTA MESA
REVIEWED FOR CODE COMPLIANCE
Monet of pians and specifications MUST be kept on this job at Mimes and it is wdawtd b
mazer/doges or alterations on same without written pem»n nonlife Division of Wei
and Setey,City of Costa Mesa.
Thestowing ofthis plan and spedficadonsSNAIL NOT beheed topato!tobeanap ravS
of the violation of any provisions of any City of Costa Mesa Ordinance as State law.
These pians and peS shall expire by limitation and become nus and void if t e budding a
rhohkism emerged and ratiteiwdoctets per CSC Set MSS din 110dap ofleant
..,t t•lY
Oi\' cij Of C 5 t COM? IAKCE
D �bua�t,ito
VVE Gate
N..,. ing
�� ns1 al Bina �a+t an hll '°t
:Amy •-�etha,.— popetees.
this sc' ‘ " << e. (OW
Tpq itteh ,L LOC intvgiti tie issiire
t�estaim'"9'` ;,•ovts°-^� ^ ;:,,,�,re•a^'' S� 16S.9w44.mt96
et the vtotato n`�"' �,�i=.,+e i Gil,
r
c
Rafter Header
Header(s) /Rafter(s)
-•II■—IIII . _—
•
I�-u_ DETAIL OPTIONS
-M— Check the ones that apply:
■—■— Lattice Cover:
Ing NI Ili OA�ESMNAMMIMEr / I OD OE OF
SolidC❑overOC ❑D❑ E ❑F
IN MS/
•—a
—M—
• .Mil
NoSoWorSIVVYS
•—Wi w
•�III1 i
aM-INS. . - . . . . . - .J.'/•INI% Post
EXTERIOR WALL OF HOUSE Anchor Post
Lattice Cover Solid Floor Cover Roof Covering
6'min
26 Ga. Roof Sheathing • Footing
FRAMING PLAN •Flashingg • Depth
Lattice \
Roofing
12" Sheathing J PAD FOOTING A
Lattice — 1= 1-0 .1 750#max
Iperpost Post
I� lc _ 6'min
Rafter .2 Header _ Rafter
Joist Hanger 4, Joist Hanger
Ledger Post Ledger sue
e
b SLAB FOOTING B
io i--
I
Slab r `O io Slab--\ 2% 2x6 Min 2x Joist
e _ Slope 1eF=JainElExisting, a Anchors
0 Footing to Drain wan 8 2'-0• e'-o•
Lattice Solid Roof roof
Cover Cover Max Max Span
SECTIONS
EAVE CONNECTION C
- CONSTRUCTION MATERIALS 1r2'x 6• Joist
Lag Screws
SPECIFY LUMBER: ( DF 0 Redwood 0 Hemfir ®16•o.c.
SPECIFY GRADE: 0 No. 1 Joist
CONCRETE: 2500 psi min. @ 28 days waisting Hanger
CONNECTIONS: ICBG approved or equal Ledger
1. Roof covering: Slope: :12 WALL CONNECTION D
2. Roof sheathing: - Maximum spans: c_attice
lattice: Q x 2 O.c.: 2x2-6'; 2x3-8';2x4- 10' 11} Bolts
solid: "CCX plywood or " lumber: 1"-2' - 8"; 2"-8'-0" Rafter
3. Rafters: x o.c. 0 Single 0 Double Summr Post
@ " 9 �I `-support Post
4. Header:7(p x G) 0 Single 0 Double Y Beyond
5. Ledger; Z x 6 (2x min) RAFTER/HEADER E
6. Fascia: x (2x6 min) -
7. Post: 4 x 4. (4x4 min) Raise 1"min above slab surface Roof Sheathing
or Lattice
8. Footing: (p r•x_(;i 12"x12"min for up to 66 sf tributary area; 18"x18"min for 67-150 sf tributary area Rafter
" depth (Expansive Soil Zone ) Framing -��
Anchor ri
9. Slab 41r "thick (Expansive Soil Zone ) Each Block/A
10. Connections: a. Joist to Ledger -Metal joist hanger Header— 2 X Blocking
b. Joist to Header -Solid blocking with framing anchor Post column Cap
c. Doubled joist or header to post -(2) 1/2"dia. thru bolts w/washers JOIST/HEADER F
d. Joist to Fascia - Metal framing anchors each side
(min. capacity =0.5"joist span'joist spacing' 15)
e. Header to Post -Column Cap
_ f. Post to Slab or Footing - Metal Anchor/Post Base
g. Roof Sheathing -8 d @ 6"o.c. Edges and 12"o.c. Field
11
27346 back
1997 UBC
Cit ofCosta !Mesa Out.frling Division
77 Fair Drive, Costa Mesa, CA 92626
Costa Mesa 714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit# 'Adp / !C�
10
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at l451. S(I1A-v“WL.zz Z. a4.ufCos-+• tM.e5A--
We are providing you with an Owner-Builder Acknowledgment and Informati6n 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.
/QWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
pp
RECTIONS: 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-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material 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
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
..a 2. I understand building permits are not required to be signed by property owners unless they are
./t responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
`'17,may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
oi' her name instead of my own.
i I understand Contractors are required by law to be licensed and bonded in California and to list their
�° icense numbers on permits and contracts.
�, -. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
6 and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
b considered an "employer" under state and federal law.
'S. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
I. s may subject me to serious financial risk.
1 . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by 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
o any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
Olstruction defects in the workmanship or materials.
/ •. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
•evenue 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
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
(ELI:v.4
I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
hat I am the party legally and financially responsible for proposed construction activity at the following address:
I agree th. , .s the party legally and financially responsible for this proposed construction activity, I will
bi.- by all a•: cable laws and requirements that govern Owner-Builders as well as employers.
2. 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 verification acceptable to the agency is required to be
presented when the permit is is ed to verify tjproperty gwner's signature.
Signature of property owner GVC��j --3 ICat .1- Date: d I II HclOCDT ,
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
PROJECT ADDRESS: 1451 SHAMROCK LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06741`_
OWNER'S NAME: MC CORMICK, TOM R
ADDRESS: 1451 SHAMROCK IN PERMIT NO; B 067415 PLAN CHECK NO; 01956-94 L GOVT: N SUPP; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ADD
ARCH/ENGjNEEA: G.C. G. DESIGN/771-3665 REG.NO.: CO JOB DESCRIPTION : ADD 198SF BATHROOM & CLOSET TO EXIST BDM SQ FT; 198
ADDRESS: 19119 COUNTRY HOLLOW UNIT:
ORANGE CA 92669 CLAIM VALUE: 12, 000 . 00 CALC—VALUE: 14 , 652 . 00 GROUP OCC : R-3 /
PERMITTEE: BOURKE CONSTRUCTION ( 714 )979-4345
ADDRESS: 2973 HARBOR BL 341 COMMENTS : ADD TO EXISTING BEDROOM
C .M. CA 92626 ********ar******************+r********* *m.****aF*************;e****star*iE***+F********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S
r`llc.: 053255 STATELIC.: 603923 CLASS: $
•Date C , 5 'i Signature: �✓ h MAIN BUILDING ACCESSORY BUILDING
KERS'COMPENSAnoN DECLARATION: (hereby affirm than haveacendicate of consent to sail-insure oracertificate of workers' FRNT: FT IN REAR: FT IN FRNT ; FT IN REAR: FT IN
Compensation lnsnnance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT : FT IN RGHT: FT IN
POLICY EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 41814115 INE; R1 REF NO 7 Certified copy is hereby furnished. I: Certified copy is sled with the city Building Division. PLANNING NC)T ES> 198 SQ. FT. ADDITION OF BEDROOM AND BATHROOM TO SFR
>
Gale: Ci Applicant: *********************fP**#************************+F**********************af******
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: Ochs section need rot be completed if the permit is for one hundred(5100)or less). D E V E L O P M E N T- S E R V I C E S P. E Q U I R E M E N T �yyy'
I cenify that in the pertormance of the work for which this permit is issued.I shall not employ any person in any manner so as to become ,, I/' 6 /I I r)�
m the/War etrrs'Compensation Laws of California. '(/ ZONING APPROVED BY . . , \ DATE; I 1
Si
1 7 y Signature: � �_1� (,^
NOTIC :If,alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED B Y -t-14 DATE: 61 1�
Code. oil must forthwith comply with such provisions or this permit shall be deemed revoked. • n 1111
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction fending agency for the performance of the work for APPLICATION ISSUED B Y: V Y DATE: /Vy///� Y
F.--
which this permit is issued(Section 3097.Civ.C). ************************************* * * **************iF************iF-N- i�rt 4 **
LENDER: **************************•*****************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC. FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 162 . 00 1 . 47
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed •
pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7003)of Division 3 of the Business PLAN 105 . 30 SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant mr a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, wino do the woo. and the BUILDING—DIV—> PERMIT ISSUE PLAN•-CHECK OTAL• PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 163 . 47 0 . 00 105 . 3 0 2 8 . 77 268 . 77 . 00
does not apply to an owner of a property wino builds or improves thereon,and who does such work himsell/hersell or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED • '268 . 7 OVER/SHORT: • 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC F RE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the protect(Section 7044,Business 162 . 0 0 1 . 47 10 5 . 3 0
❑ and Professions Code: The Contractors'State License Law does not appy to an owner of properly who builds or Improves thereon r
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ****************************************************)F*aA************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E' E B R E 'A K D O W N
❑ I am exempt under Section: B.6 P.C.
lox this reason: TYPE QTY DESCRIPTIO N • , UNIT COST TOTAL COST
•
.I Date: Owner: SFR 198 DWE—TYPE V—WOOD FRAME —GOOD • 74 , 00 14 , 652 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and END OF FEES
25534 and that I or any future budding occupant MINI!not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from
fl these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with an city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned .
property for in whop pechopurposes.
/J 2� 0100161449-00161451 TOT 268.77
cal _ b I R.
1 Signature: " W `
Driver's License or Social Security.: DATE: 06/01/94 TIME: 10:25
r
1641-46 White—BuilOing;Green—Code EOlortement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING
POO_ 1 SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement to9--iq /� 56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. (A'ti84-4t 64,40 57. APPROVAL TO COVER-GUNITE
7. Footings ce-taceq 60.)44,- 58. Electrical Conduit•Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor Systemy_g4 611.41-- 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 1
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 & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0011
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �\
27. Frame and Flashing 7_({_4 y 6 cts_ 76. Dry Standpipe
28. Lathing& Siding
71/2-T q 44.6‘ 77. FIXED SYSTEM FINAL
29. Insulation 7-14-€2 Ci 6te.44. 78. FIRE PREY. FINAL
30. Drywall Nailing 7 IIL�..LtCf6 � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat WW 6641-- 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning 7_ o-q( 8�
35. Final Gas Pipe-Test _L 'f " �-4
36. Hood Or Canopy 7/�_ q C1._ /`let. me- 3
37. Final Factory Fireplace
!a -/rm
38. Final Plumbing
39. Water Service-Final le-27 41/1 /'_ _ / / Ee
40. Gas Service-Final a`( tripf,/G_ its `Seri/ /GG#-
41. Solar Domestic-Final (_ ^a-�
(?
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
•
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING b h Ggcy bcat
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date
•
City of Costa Mesa
California 92628-1200 P.O.Box 1200
Insulation Certificate L/
Permit Number 6 ` I
IH Si 5ilex nnA°LK LA •
C :sN /hejy •
Number and Street City
D✓f4Apt,
County Subdivision Lot Number
• Description of Installation
ROOF D g— 3
Material Brand Name �`ti V ' f/ C
Thickness (inches) Thermal Resistance (A-Value)
EXTERIOR WALL k
Material R_ / 3Brand Name_j .S 3v
Brand <
Thickness (inches) 5' '/ z- Thermal Resistance (R-Value)
CEILING
Batt or Blanket Type Brand Name /V'C t yr I R
Thickness (inches) Thermal Resistance (R-Value)
Loose Fill Type Brand Name
Contractor's minimum installed weight/ft2 lb. Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value)
RAISED FLOOR n ✓ . ./
An tic
Material , 19 Brand Name
Thickness (inches) y 1/2. Thermal Resistance (R-Value)
SLAB FLOOR
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Adminstrative Code.
81/4., nye- C- sr Q 403523
General Contractor(Builder) License Number
Signature and Title Date
Sub-Contractor(Insulation Installer) License Number
Signature and Title Date
1907-46
PROJECT ADDRESS: 1451 SHAMROCK LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 067416
OWNER'S NAME: MC CORMICK, TOM R
ADDRESS: 1451 SHAMROCK LN PERMIT NO; E 067416 PLAN CHECK NO: N GOVT : N SUPP : N
COSTA MESA,CA 92626
CONSTRUCTION TYPE ; PERMIT TYPE: ELE PURPOSE: ADD
ARCH/ENGINEER: G.C .G . DESIGN/771-3665 REG.NO.: CO JOB DESCRIPTION : ADD 198SF BATHROOM & CLOSET TO EXIST BDM SQ FT:
ADDRESS: 19119 COUNTRY HOLLOW UNIT:
ORANGE CA 92669 CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
PERMITTEE: BOURKE CONSTRUCTION ( 714 ) 979-4345
ADDRESS: 2973 HARBOR BL 341 COMMENTS : REF: B-67415
C .M. CA 92626 *W**;c**************ac4**** ****-$F************+ex**yF+ **** -*aE+FBF***ir-ar- -**yF*aF*****acaF->EkP
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACK S
Ic.: 0 5 3 5 5 STATE LIC.:603923 ss: 1 /�
Date: 9 Signature: - G), 4_, (/1_ MAIN BUILDING ACCESSORY BUILDING
Wo ERs'COMP xsanox DECLARATION: hereby arum that I have a certificate of consent to self-insure or a certificate of Workers' FRN T: FT IN REAR: FT IN FRNT: FT IN REAR: FT I N
LEFT: FT IN RGHT ; FT I N LEFT: FT IN RGHT: FT IN
sensation Insurance,or a certified copy thereof(Section 3800.Lab.C).
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ; PROV; PARCEL : 41814115 ZNE: REF NO:
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division, PLANNING NOTES>
>
Date: Applicant: DEVELOPMENT S E' R V I C E S R E U I R E M E N T S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1W)or less). Q
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
Heel to thep VyOrkers',Compensalion Laws of California. II ZONING APPROVED BY : DATE:
(I. 6 J / Gl y signature: n' /� BUILDING APPROVED BY _
OTICE: after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE:
' Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. r
INSTRUCTION LENDING AGENCY: I hereby affirm that(here is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: '� yl�`
which this permit is issued(Section 3097,Civ.C). ***********************************,,**.v*��r**111FFF***********iE************ h 4'"'7777 at*
LENDER: **********************************,*********************************************
ADDRESS: LEGALIZATION:N F E E ' SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 6 • 7 5
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5()% SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Cade)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as Meir sole compensation, will do the work, and the TOTALS----> 6 . 75 15 . 00 0 . 00 21 . 75 21 . 75 . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through •
his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 21 . 75 OVER/SHORT: 00
improvement is sold within one year of completion.the owner wit have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 21 • 7 5 .
❑ and PrhoCcointra sdfo TheContractors'
projectswithState elawdoesrsutpo hCtfproperty aicensor improvesIathereon ***********************************;*******•************* ***********************
and who contractsnCo for hh with a contractor(s)LiensLwlicensenot pursuantly to the erContractors'Stateh builds or
am aware
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BR E AK DOWN
D I am exempt under Section. B.8 P.C. •
•
for this reason: TYPE QTY D E S C R I P T I O, N UNIT COST TOTAL COST
Date: Owner: ELE 4 FIXTURES, LIGHTING ' 1 ST 20 EA. . 75 3 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and 4. ,4',; 4^" ,'i//Qjr' S}gyp—}' �" %14 0.
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a 1 L -i 1 — � 2 . 25
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from = ',E — :-Li'l:E r r e//�9'T,I:-..24-
permit ST 2D EA. . 75 1 • 50
these provisions. END OF FEES
Date: Applicant: f
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
. ipe for/ ins ction purposes.
/bar b /l c `i Signature: i 4-4 01 00161448-00161448 TOT 21.75
Iriver's License or Social Security DATE: 06/01/94 TIME: 10%24
t64i-46 white—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
1
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 1 60. Backwash Lines, P-Trap, C Undrgrnd.
10. Structural Floor System 61, APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63, Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit "6. Solar System-Final
16. Rough Electric Wiring J
1�9/� / 167. encing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceding 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 1 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION j�
32. Electrical Power Meter-Final �t FOOD CERTIFICATE ISSUED
33. Final Electric Q l7�7 Motes:7._6_Q2/__ ei
34. Final Heating& Air Conditioning VV 7 /
6j-/Z-7V OJf<e�s (GC��(u�i / c
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .-
51. CERTIFICATE OF OCCUPANCY
No. Date
W1951 SHAMROCK LN �� UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NOc F 067917
4PROJECTADDRESS:
OWNER'S NAME; •
MC CORM ICK, OM R
ADDRESS: 1451 SHAMROCK' LN" PERMIT NO: P 067417 PLAN CHECK NO: N GOVT: N SUET : N
COSTA MESA, CA 92626
-••<ti—..,,:,.....`....,, a-`_ \ �� CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ADD
•
ARCH/ENGINEER: G,C ,G, DESIGN/771-3665 REG.NO.: CO JOB. DESCRIPTION : ADD 198SF BATHROOM & CLOSET TO EXIST BDM SQ FT:
ADDRESS: 19119 COUNTRY HOLLOW UNIT:
ORANGE CA 92669 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: BOURKE CONSTRUCTION ( 714 ) 979-4345
ADDRESS: 2973 HARBOR BL 341 COMMENTS : REF: B-67415
C.M, CA 92626 x************xx*x********vtxx*TE#x#iE> *****x****ae+ **********x*********************
•
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z 0 N I N G REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S E T B A C K S
ITY C.: Cts'/25,5cuss:STATE((�? / // y y �
Dat A -/ r MAIN BUILDING ACCESSORY BUILDING
Signature:
, FRNT: FT IN REAR; FT IN FRNT : FT IN REAR: FT IN
RKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a cerlificateof Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C).
POLICY NO.: EXP. DATE:
COMPANY: PARKING REQ; PROV: PARCEL: 41814115 ZNE: REF NO;
3 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
> •
**iE*********if.**************if:*********14******w:***#***ii-**************************
Date: Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). 16 E V.' S L OP M F N T SFR V I C E S • REQUIREMENTS
I c-x ify 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
-Wale to theWor ers' i m?ensation Laws of California. n ZONING APPROVED BY DATE:
Dale. 6 1 Signature: Bit h A
BUILDING APPROVED BY
I TICE:If.after making this declaration,you should become subject to the Workers'Compensatiog.provisions of the Labor - DATE
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ((7� ' � -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the wont for APPLICATION ISSUED B Y; \ • I DATE: _if
�LhT`
which this permit is issued(Section 3O97.Civ.C). *'****************************1Ex******x **************x*iF*********** 3F x* **
LENDER: *****************if*************************************************************
ADDRESS: LEGALIZATION: N - F E E S U M M- A R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE SM I P/RES GRAD I NG
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 50,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25%
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70110)of Division 3 of the Business PLAN •
SM I P/A70N—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE 20 . 00 - - •-
I. as owner of the properlyor myemployees wits wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK • TOTAL PAID DUE
ep TOTALS—---> 50 . 00 20 , 00 0 , 00 70 . 00 70 , 00 , 00
❑ structureonot intended n or offered p for properly
(Sectionb7044,i Business and oandi whl Coes The Cork hdprs'State e Lior hr Law
does not apply to an owner of a proDertY who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTAL S--> COLLECTED : • 70. 00 OVER/SHORT: . 00
improvementois nsold lt.within one year of completion.the owner will have the burden of proving he/she did not build or improve
forene
the of
d BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
•
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 70 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *************************************'It*****************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
tor this reason: TYPE QTY DESCR IP T I O N , , UNIT COST TOTAL COST
t
Date: Owner: � PLU 1 BATHTUB 7 . 00 7 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 2 WASH BASIN 7 . 00 14 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a FLU 1 WATER CLOSET ( TOILET) 7 . 00 00
permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from 7 . 00
mese provisions. PLU 1 SEWER, BUILDING / TRAILER 15 . 00 15 . 00
PLU 1 INSTALL/REPAIR WATER PIPING EQUIP . 7 . 00 7 . 00
Date: Applicant: END OF FEES
I hereby certify that I have read This application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
•
property for inspe tion urposes.
�J • 0100162447-00161447 TOT 70.00
Dale F flsignature; Y' DATE: 06/01/94 TIME: 10:23
ori s License or Social Security a: .
1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
COIOTRUCTION AND PLANNING POt. Si SPA
APPOIOVALS Permit Date Inspector APPROVALS Permit Date Inspector
-1
1. Ten$orary Electrical Service or Pole 52. Pool & Equipment Location
c
2. Soil;Pipe-Undrgrnd. 53. Steel Reinforcement
3. Elecirical Conduit Utility-Undrgrnd. 54. Forms
4. Elec}cal Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel 'Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd,
8. Foun,i7tion • 59. Gas Pipe, C Undrgrnd., Test
9 Water Pipe-" .,:.,.. 4. pees_ ��-Z�- J 60. Backwash Lines, P•Trap, C Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing T"l/.4 a 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& Test
9 72. Underground Hush
24. Roof Framing 73, Undergrnd.Storage Tank 0 Gas C Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28, Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 4. Z3 _ ry :
34. Final Heating & Air Conditioning c_2.41•10-7" n Y _
Jr `e„
35. Final Gas Pipe-Test _ 4Y' ou_V
36. Hood or Canopy � �
37. Final Factory FireplaceL
t -
38. Final Plumbing „fr A4f r&r r--A .-J#-GC ?
39. Water Service-Final .�`Lr�L n 7 ���
40. Gas Service-Final ! '
41. Solar Domestic-Final
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
vMIMI% 1AJJAl'vvl v&J3 UVan U . DAT111 C 1 V(
JOB ADDRESS 1451 Shamrock Lane BUILDING PERMIT NO. 26628
GENERAL CONTRACTOR owner DESCRIPTION OF WOE garage slab rpl.
AP No. 141-012-16 LOT TRACT FIRE ZONE VALUE $ 325.00
INSPECTIONS Signature Date GROUP J TYPE I ZONE Rl
Soil PERMITS ISSUED
Gas SUBCONTRACTOR Date { Number { Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground Power 0
Rough Wiring Heating and Vent.
Trenches 0 Forms:0 Steel Reinf. 0 I
Floor System o 6, . r' ,7/1/67
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing—In 0 Out 0
Plaster, Brown Coat
Structural, Final �Jj/d 7 Electric
Heating, Vent., Refrig. and A.C., Final ^7
Plumbing, Final and Gas Test 0
Electric, Final
Building, Final
rte. I UICHSAVI .. "
% 2C628 FEB
-167cnsaCl 019R�*^* �^3•CC
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA E2626
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
P/1/ / / N For Office Use Only//� I/�(/'�5
ADDREISS SJjakn rote ` i/ RWEIR NO. PER
COSTA MESA. CALIFORNIA
I /,/,7/ .jr/.,•, `/ RECEI !Y �2DAT*R[ IVED D*E 1g1U[D
OWNER J 4 L . ILCfa,lfl(/T'�/S ) A`/ /t g7 a/� /G.
�/ 1 BUILDING
D
AD5/RESS / / ch ami rO t IC L 41 ADDRESS
FIRE�`/ //�� TE4 // ZONE Ai /A >GROUP
Sr
STY CDSV U- //QS cc, No..S/7{�gYC� �1 /'
ARCHITECT TEL BYPROVED DATE T.T. ( t 7
OR ENGINEER NO. ZONING X044'
ADDRESS U/ r� m [ NO.of BUE orDI No rp q
/Y I� / I PLANT O I BUILDINOd e„„ 1P'
CONTRACTORlift — JJ�� /1 2IJ(�i7 •7�/•2
_ ADDRESS
DESCRIPTION
(��)�l// /J 1- iG� /L/Y` X
A.P.NO. ( "/ ( --0 /.Z —/,
CITY
NOTE: NO[AVE OVERHANG SHALL BE LESS THAN
STATE TEL. EO'TO SIDE a REAR P.L
LIC.NO. NO,
SIZE I NO.OF sLDGS./ VES
ALLOWED (U.B.C.REQUIREMENT) _
OF LOT NOW QN LOT
USE OR r YARDS APPROVED YARDS APPROVED
EXISTING BLDG. MAIN BUILDI ACCESSORY BUILDING
(FROM D/L SYR )
SETBACK LINE FROM FRONT FT.
CENTER OF STREET REAR YARD
SIDE YARD LEFT I RIGHT R.SIDE FT.
DESCRIPTION OF WORK L.SIDE FT. FT.
REAR FT. FT.
NEW TERATI N_ ADDITION
DISTANCE BET BET.MAIN&
MAIN BLD S ACCESS.BLDOB.
REPAIR MOVING DEMOLISH
VAR.AC DATE
BUILDING NO.OF
SIZE _ROOMS STORIES C.U.P. APPROVED
EXTERIOR WALL ROOF APPROVE
COVERING I COVERING SY _ DATE '.2 I/6i 7
USE OF BUILDERS AND WORK TO BE PERFORMED M
H
C.64494 slab 5 a My f. Goo v
et
re/Mpkt slab perch -PAY BQ.Fr.
I HEREBY ACKNOWLEDGE TN T I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COAL PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. T31
PLY WITH ALL CITY ORDJNAN EB AND STAT[. �- R[WLA„.O VALUATION B�
BUILDING CONSTRUCTIO J /J e //
X// ' PERMIT FEE 5SIGNqq
PERMAITTEF TURE OF eV . . /••. gi•
S �2� PLAN CHECK S (ti
/
AUTHORIZED A.�NT o
..._. TOTAL FEE S
• V WIN Zit PWLLL
Vl@1V� D. .ATP: 4- CO—r3
3�JOB ADDRESS 1451 Shamrock Lane BUILDING PERMIT NO. 26972
S GENERAL CONTRACTOR COntinental net.Co. DESCRIPTION OF WORK lockwall
Al' No. 141012-16 LOT 1...-LCT FIRE ZONE VALt„s $ 250.00
INSPECTIONS I Signature Date GROUP J TYPE III ZONE R-1
SoilI PERMITS ISSUED
Gas SUBCONTRACTOR Date
Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.0 _
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches i® Forms 0 Steel Reinf. 2. ,} 6 el-y 7_67
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing—In 0 Out 0
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final ,
Building, Final en
_ ; ' 26972APR 26-67C1.i,F001328 -'a***^*3.00
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA P2626
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 1451 Shamrock Lane For Office Use Only
ADDRESS
RECEIPT NO, 2Plw r/e2
COSTA MESA, CALIFORNIA �p-�T/� /W �/�nl�`���i�y
REC V[D SY / EC<IYYi G.7 ISSUED
OWNER B. Maldonado _ /t/Y/ of
MAIL 1451Shamrock Lane BUILDING -47
ADDRESS ADDRESS
FIRE
CITYCita ii4sa 74,L. 545-1702 ZONE TYPE/72: GROUP ,
APPROVED
ARCHITECT TEL BY DATE
OR ENGINEER NO. ZONING /1/f
ADDRESS SON No.OP UEE OF NEW�J�
PLANS BUILDING �(//
CONTRACTOR Continental Const. Co. /
V"
1640 South Minnie Street DESCRIPTION 02l 0,(X942-
ADDRESS /,� .q
CITY Santa Ana A.P.NO. /59--D/%2 �I[/
Q
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC..NO. 202487 NQ 5475868 SO'TO SIDE S REAR P.L
VES
SIZE I NO.OF SLOGS. ALLLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF Dwelling MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
-(FROM C/L STREET)
SETBACK LINE FROM FRON - Fr.
CENTER OF STREET REAR YARD
BIDE YARDI LEFT I RIGHT R.SIDEr------ FT.
DESCRIPTION OF WORK L.SIDE PT. Fr.
fee
/
NEW X ALTERATION ADDITION REAR RT. PT. i
DISTANCE SET. BET.MAIN S
MAIN BLDOS, ACCESS.BLOCS.
REPAIR MOVING DEMOLISH
BUILDING NO.OF VAR.# DATE
SIZE ROOMS STORIES C.U.P.# / / APPROVED/,
EXTERIOR WALLROOF - APPROVED//�,�� '�/ �6-
COVERING I COVERING BY ({� DATE /
USE OF BUILDIns AND WORK TOE PERFORMED 0.
8 course plus trim 4" garden wall H
65 1/f
1
SQ.PT. 22
O
1 HEREBY THAT TLEDOE TN T 1 HAVE READ TRIG AFPLIGTIO. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE ALL CI THE IB AND STATS LAWS
AGREE TO COM• PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. i1S
PLY WITH CITY ROMANCES AND STATE LREGULATING
BUILDING CON ON. VALUATIONLO
PERMIT FEE 5 '�
SIGNATURE OF �� ��—
PfiRMITTEP (PSC
�� e.
' s PLAN CHECK S
AUTHORIZED AGENT
TOTAL FEE 5
OWNER College Mesa .Company ' DATE 4-18-fi6.
JOB ADDRESS 11151 Shaittrocl. ane eUILDING PERMIT NO, 2772
GENERAL CONTRACTOR The Hale Co VALUE $ 11,280.00
LOT 13 BLOCK TRACT 21132 Single Res. w/att gar
GROUP I & J TYPE V ZONE FIRE DISTRICT 2801
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER
Footing Trench ,-ie S '
Foundation Forms ani Gra. to Garage j.. -67
Rough Framing ii •�- 7—/ 9 ' Sia c✓a1'
Plumbing,Rough to Sta. ^
Plumbing, Rough CompIet q44'S JJet7 ��G/,..,/ (7-JG ,!-G 474, .rc —
Temporary Pole V "/_�'
Wiring, Rough 1/113 rt. an.,..�,.d fit- . d -.ab-S/o ay-ga —
Heating,Rough
Heating,Finally AQ 1- /W, , - , - f 3 3 V —
Sewer, House,y.e„( Sewer,St. - $9 , go, 2. 5=3,1-Ai (f 4 g•-
Lathing, lnX Out WC 7- 9.�.a
/ 1
Plastering _ ',ZS
y ";
\
Plumbing,Final,Fixtures Complete,jJ Cde d`)-,5-- 11
Plumbing,Final Gas Test /5-464 4 (7/ /O-3a,3G `p�CGi!` S
' 4,_ ' ei�7J
Wiring,Final /o` 'ft
Occupancy [Pete /0--26-b
FORM 110 3M 10 i3
•N. sta Mesa Building Department Q APPLICATION FOR PERMIT
111 EAST 20th STREET
-' COSTA MESA, CALIFORNIA 2801BUILD 1 N G1
• FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN 1 Receipt No. Permit No.
Building I 77-2—i
Address ,- u . • , ,
Costa Mesa, California Fyiveby I Date Rec'd. Date Issued
Nearest WatsonAvenue 4'/g' i� ci/, k''5�
Cross St. Building
Address
Owner College Mesa Company Costa Mesa, California
Mail • ,
Address 8002 Central Avenue Nearest
Tel. ' Cross St.
City Garden Grove No. LE 9-2158 :<' Zone /J,/• I No.of I Type 1/ Groupe`jf
Architect or Lic. • F 't' Plans 4 •-Y Y—If
Engineer Davis & Quigley No. C-1790 Approved //l
by Date
Address 43 Malaga Cove Plaza,Palos Verdes CORRECTIONS
Contractor The Hale Company Nlo. Lie. 3422
Address 8002 Central Ave. , Garden Grove _
Legal Lot I - �� '� An
Description I No. l3 I Block Tract 2432 .\ , s/�F, , „ , n
(Attach Metes and Bounds) ` `ti 4t `[��j_15
No.ooBldgs. 1 I0,Cb O
Size of Lot 81 x 102 I Now on Lot None -.,
ExistingUBldg. I Families I Rooms �• t` p
Setback Line from Rear Yard 40' _....o p r.CQ A
Center of Street 501 Side Yard 81 nt 1�w'ro tVi^"' y
DESCRIPTION OF WORK Ct �- U r
•
New I x l Alteration I I Addition I
Repair I I Moving I I Demolish I
Building No.of
Size 1310 Rooms 6 Stories 1 -
Exterior Wall Roof —
Covering Stucco I Covering Shake APPROVALS
Use of New
Building Single family dwelling with . Foundation Location Inspector Date
Forms,Materials,
attached garage. Under-Pinning
Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply _ Lath. Int
with all City Ordinances and State Laws regulating ..
building construction. = Lath. Ext.
Signature of THE HALE COMpre%
Permittee : Plaster,Int
Authorized AgtQIN—at Plaster,Ext.
SILVIA LARDNER
Valuation Permit Fee $ Masonry Reinforced
Plan Check $ 1 Ile'
$ 1 /) ygrU , Total Bond Beam
Fee 5 y>". FINAL
FORM 204 S-nP 2M R-55
•
•
•
0
c 0
J c_
C.
O.
O ❑ �a 9
•
1 .F'�Z f?tilpU11E'£A r7� '" 'f�i��C..6Q
•
•
• Street
PLOT PLAN
Show location and distances from
property line and between buildings.
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA - i J PERMIT NO. TRACT NO. LOT NO. BLDG.NO.
CONSTRUCTION PERMIT c Jv - 13 00 2 9833 5/03/84 5.0C TL
Project Address ' 'ri h'An e- ,La__& TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR I
Applicant's Mailing Address /.r33 L<J 471d a,ofzi ❑ CONVERSION ❑ DEMOLISH '❑ OTHER A.P.# I Zone
�J0A/A /� /.J Sy 9- 5'4 DESCRIPTION OF WORK
Owner's Name /` Phone t ' - S Main Building: '
Accessory Building: Z
Address SA 47 F. TYPE OF PERMIT U.GRADING FOUNDATION U STRUCTURAL T Front N
Arch/Eng, License No. 0 TENANT 0 ELECTRICAL PLUMBING 0 MECHANICAL B Rear N
Address �/ ❑ 'OTHER • ,
O/Ya/l* P/6i L.de Phone-J7,'3V9d PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G
Contractor's Name // / K •
Addresslmailing) /el3a ' kJ ``- /4/AA//J A.t./4 A,,m CONSTRUCTION TYPE VALUATION$ S Left R
E
'-93 0 ZONE GRADING CU.YDS. ACRES Ping. Ref.# Park.Fees $ Q
City License No. Ge - .- U
LICENSED CONTRACTOR DECLARATION • - Remarks: Parking Req./Provided
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 • Use of Building: E j
my license is in full force and effect. _
License Cass 9` a./76.J 7 PLUMBING - FEES Planning Notes: M
'J / �' �• License/4//7—.7,5,..„
esN _
Date 7-L^ -ri-� signature/ /Y-I-Q-•s� /^`/ �'�9./ +� N
Bar Sink Showers
WORKERS'COMPENSATION DECLARATION - T
hereby1affirm that I have a certificate of consent to self-insure or a certificate - Backflow Preventer ' • Service Sink• - rl.. _ .. S
,f Workers' Compensation Insurance, or a certified copy thereof (Section
\ 3800, Lab. C.y)� '/ ,'n' Backflow Irrigation Sewer Cap i .- ELECTRICAL • FEES
Policy No. k'�FTV Company5 '94(/P YC 'Z•tl_5 •
•
'• ertifl ed copy is hereby furnished. Bathtubs Sewer Connection' Automatic Washer. . 'Transformer 0 15-50 KW
ertif)ed 6opy s fllyd with the city Bgllding Divi ion - - ,
Date Lf'L+ -4-Lit Applica nt�/�/N -L /. /j-t+,r -+J Clarifiers • Solar Collectors __ _ Construction Pole,Sub. 0 50+ KW
EXEMPTION FROM WORKERS'COMPENSATION DEC ARATION • Dishwasher Solar Piping - - -
(This section need not be completed if the permit is for one hundred ($100)or - Cooking Unit Meter ❑up to 100,amps
less). I '
I certify that in the performance of the work for which this permit is issued, I Drinking Fountains Solar Tank Dishwasher Meter Dover 100 imps
shall not employ any person in any manner so as to become subject to the '
Workers' Compensation Laws of California. l Floor Drains, Swimming Pool w/Spa Dryers ❑Gas DElectric Sub Panel
Date Signature _ _� -
NOTICE: If,after making this declaration,you should become sMotors 00-1 HP_❑1K-B
,subject to the Floor Sinks _ - Urinal - Fan - _
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions.or this permit shall be'deemed revoked. • - Gas Service Outlets 'Water Closet - F.A.U. Inc.Solar 09-15 HP ❑16-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance Interceptors - Water HeaterFixtures •
of the 'work for which this permit Is issued (Section 3097 Civ. C.)• a Microwave
Lender's NameKitchen Sink Water Service . • Device Boxes Pole Light • ,
Lender's Address Lavatories
OWNER BUILDER DECLARATION ' - • Outlets Range
•
I hereby affirm that I am exempt from the Cdntractor•s License Law for the I -
following reason (Section 7031,5 Business and Professional Code: Any city or P-Trap Switches •
Sign ,
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 Roof Drains - • - Garbage Disposal _ Standing.Sections
to file a signed statement that he/she is licensed pursuant to the provisions of
-
`<he Contractor's License Law(Chapter 9(commencing with Section 7000) of - Generator ❑0-5 KW❑615 KW 'Trash Compactor
c-v3vision 3 of the Business and Professions Code) or that he/she is exempt p •
erefrom and the basis for the alleged exemption. Any,violation of Section ' - - - '
X7031.5 by any applicant for a permit subjects the •applicant to a civil Reinspection Fee I $25 Issue Fee $ 3 '
enalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole MECHANICAL Reinspection Fee $25 Issue Fee. ' $ 3
compensation will do the work, and the.structure is not intended or offered - ' • FEES
for sale (Section 7044, Business and Professional Code: The Contractor's t PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to en owner of a property who'builds or improves Boiler ' ' Hood or Type I 0
thereon, and who•does such work himself/herself or through his or her ownZoning Approved By Date
employees, provided that such Improvements are not intended or offered for Canopy Type II ❑ •
Duct-Under Ground
sale. If, however, the have
building or Improvement is sold within one year,of im- - Application Approved By />�� �// •
Date
pletion,the owner will have the burden of proving he/she did not build or im- Duct-Structural Refrigeration S stern •
Application Issued B /i //" y nate C/?/g'
LIrove for the purpose of sale). 9 Y Pp Y
I, as owner of the property,am exclusively contracting'with licensed con- ' ❑0-100,000 BTU ❑10Q000 BTU
tractors to construct the project(Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES '
-The Contractor's License Law does not apply to an owner of property who • I '
builds or Improves thereon, and who contracts for such projects with a con- • Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT . $ •
- SMIP $
tractor(s) license pursuant to the Contractor's License Law). - - PLAN CHECK ' $ s- PERMIT -❑ I am exempt under Section , B.& P.C.for this reason Firepl/Fact.Bit. ICBO,# ' PLUMBING $ SSUA NCE $
Date Owner , Heating System&Ducting • •• ENERGY P.C. $
PLAN CHECK $
hereby certify that I nave read this application and state,that the above I ❑4100,000 BTU 0100,000 BTL— _ ELECTRICAL $ • GRADING $
Information is correct. I agree to comply with all city and county ordinances '
and-state laws relating to building construction,and hereby authorize repre- PLAN CHECK $ MICROFILM $
5entatives of this'city to enter upon the bove-mentioned,p/ropertycfor' / .
inspection Pu pos9�' a ' Date Y'-6 -+ Y -
/l (/ t,.c�--0` MECHANICAL $ TOTAL FEE $
Signature ��
Drivers' License or'SS YF Reinspection Fee '$25 Issue Fee • $ 3 PLAN CHECK $ I '
\
CMF 0865-46 rev. 7/83 White-Buildingi Canary-Applicant;Pink?Accounting;Goldenrod-Assessor .- - - ' ' - - - t
CONSTRUCTION AND PLANNING •
POC _SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
- 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement • - 56. Rough Plumbing & Pressure Test
6. ElectricalUFERGrnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
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 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 O Gas 0 Oil
• 23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
• 28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation •
- 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning •
35. Final Gas Pipe-Test - •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing .7//9/y'Y Le
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final • .
42. Backflow Preventer • ..-
43.
43. Backflow Irrigation
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING ••
48. Special Requirements Completed
•
49. Electric Release to Edison - -
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY
No. ' Date
PROJECT ADDRESS: 1451 SHAMROCK LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 052789
OWNER'S NAME: TOM MCCORMICK
ADDRESS: 1451 SHAMROCK LN PERMIT NO: B 052789 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: DEM
549-7373
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : RESTORE LIVING SPACE TO GARAGE SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 1 , 000 . 00 CALC—VALUE: 1, 000. 00 GROUP OCC: R-3 /
' PERMITTEE: TOM MCCORMICK ( 714 ) 549-7373
ADDRESS: 1451 SHAMROCK LN COMMENTS: X
C.M. CA 92627 ***********+ESE+LSE*SLStSF****St* ****Sr*******SF********sl***Sr**SE*****SE****+E****SF****+E***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Dam: Signature,• MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800, Lab.C)_ LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
r POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ• PROV: PARCEL: 41814115 ZNE: REF NO:
1 Cernified copy is hereby furnished. ElCertified copy is filed with the city Building Division. PLANNING NUTES>
>
Dale: Applicant: *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($10o)or less), DEVELOPMENT SERVICES R E Q U I R E M E N 'T' S
I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: I r�
Date: Signature:
NOTICE:II,alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:" r /
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE; %7-7211t
which this permit is issued(Section 3097.Civ.C). ****************************************** * *********************W * * *
LENDER: ******************************************************************'****lE********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTUR`KL' SEGMENT:Y
;•T ' .
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RE$ GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 25 . 00
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN . 50
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE
n I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 25. 50 0 .00 0. 00 25. 50 25 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
ahis 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 vnll have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 25. 50 OVER/SHORT: 00
for the purpose ot sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 25.00 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware / **********************************************************************.*********
Inas proof of their Worker's Compensation insurance shoo be provided to me. fi /// INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: D.8 P C.
mrlmsreason: �� /
O"„ TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: �'(r—Cr( •
Owner. !`
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and NO FEES WERE SELECTED FOR THIS PERMIT
25534 and that I or any future building occupant wiluwill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt Irom .
these provisions.
Date: plicant:
I hereby certify that I have read this applicati and state that the above information is correct.I agree to comply with all city and coun ordinances and state laws relating to building sbuction and hereby authorize representatives of this city to enter upon the above•mention dproperty fo'r inspectti(i��on purposes. c��/ nDale. I'(P1 ( Signature: /G-_ AG. 1u'�C `1 \t\i‘ri'Ve
''1 Li:::,,,,,,,..V.L'y�y: _'. ,_r., .Driver's License or Social Security �`•ri• (.7..i.: r r,e. i. .`+
1641-46 White—Budding:Green—code Enforcement:Canary—Applicant:Pink—Revenuo:Goldenrod—Assessor
IT
As
CONSTRUCTION AND PLANNING POOiPA
APPROVALS Permit# _ Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.. 53. Steel Reinforcement
3.'.Electrical Conduititgility-Undrgrnd. 54. Forms
4. Electrical Condult-Undrgrnd. 55. Electrical Bonding
5. SteelReinforcement 56. Rough Plumbing & Pressure Test
''6;'.Ele'ctrical OF ER.Grnd. 57. APPROVAL TO COVER-GUNITE -'
-.,,•Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test -
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 63. Heater & Vent-Final
13. Roof Drains i 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 Electridal-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace : ' ' l 1 ; '< 'APPROVALS'• .Permit# _ ^
21. Ducts, irr-Structu-r2; .. S
u X� , - •a :a. 1 ,
5 ; 70. Undergroujid_H ,
22. Ducts, Ventttating a ' 71. Product'PiPing 0Ges C'Oil
23.-Gas Pipe``-Rough nest ;. , :, - - , 72. Underground Flush;_ s, •
C
24.sRoof Framing - . - 7- C j , . ,73:-Undergrntl:Storage--Tank 0 Gas.-0 Oil
25. Roof Sfteathing `. 1 ' - , , '74,-Qyerhead Hydro - `l _
26. T-Bar Ceiling (Structural) &•hlonocoat 75-'Dry Chemical -
27.'Frame and Flashing' ' ' - �; 76. Dry Standpipe - `
'-28.0 Lathing& Siding _'rlr_ s - .. 77.7 FIXED SYSTEM.FINAL, _
29. Insulation ;' - -• , 1 -, ;.. 78„ FIRE PREY. FINAL .
=30. Drywall Nailing - HEALTH DEPT/REQUIREMENT
r ,
.31. Plaster Brown Coat I f 79`FINAL INSPECTION -
32.-Electrical Pov✓er Meter,-Final •i (, R r$0,-FOOD CERTIFICATE ISSUED i
33�Final Electric I� ' ' No{es; ->
,
-r34.• Final Heating& Air Conditioning;. •- . 3' is . , Q - -
35. Final Gas Pipe-Test' _ • f< _ _ •" - -
36. Hogd or-Canopy . ; _ 3: - - _
37.-Final Factory Fireplatc_ ' ' r- : '• -
x
-38. Final Plumbing , •• y . a -,
.:39. Water Service-Final ': L. :-
'
40. Gas Service-Final ; „, t ' t,, ; _ - •-
-41. Solar Domestic-Final c. r
, 'r1 :4-.
' r t I' __
42. Backflow Preventer n; • �;, ; : ' . ;
43. Backf low Irrigation. r s • '
f l .t -L ,
'•44. Landscape Irrigation System,1,;, i,- . it ,,:, c �. . r xi n s
45__Sound Attenuation l' ' = lc
_.
. ., �'
X
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING J / �A I , c
• •
48. FINAL PLANNING[ ; r_` /• / -'i ..T. p -
49.-Electric Release to Edison , i
I I • cl
50. Gas Release to Southern California Gas Co ,. 1 j N •
51. CERTIFICATE OF:000UPANCY -
No. Date