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Home My WebLink About2800 SHANTAR DR - Building Permits ,501 CITY OF COSTA MESA BUILDING DIVISION F i ,i vikee•Pr� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT / %% V B05-00732 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2800 SHANTAR DR Status: ISSUED Suite: Applied: 05/09/2005 Vicinity: ROOF Issued: 05/09/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 13940313. Zoning: R1 , Applicant: KAISER, MIKE - ISSUED BY: Address: 928 CHEYENNE ST - - Phone: (714)979-5314 COSTA MESA,CA"- - Zip: 92626 ' Owner: NGARMDEE;RUAMCHAI . . ' - Address ,2800 SHANTAR DR Phone: - COSTA MESA, CA- . Zip: 92626-3539 ,, ,, Contractor: KAISERROOFING ` Address: 928 CHEYENNE ST Phone: (714)979-5314 - - COSTA MESA,CA Zip: ' 92626 -License: 682897 - Arch : - • Eng: Address: - . . Address: • Phone: Phone: . Zip: ' License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF'30#FELT;30 YEAR•COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEATHING AS NEEDED.2,600 S.F. INCLUDES ATTACHED GARAGE. - ' . . - - . FEE SUMMARY Plan Check: $0.00 .- - - Calc Valuation: $5,800.00 Permit: $125.25 Claim Valuation: $5,800.00 SMIP Res: $0.58 SMIP Corn: $0.00 Other: $0.00 , - Inspection: $0.00 Total: • $125.83 PLANNING &ZONING , SETBACKS MAIN STRUCTURE Front 0-0 Rear ., 0-0 Left 0-0 Right 0-0 . ACCESSORY Front ' 0-0 Rear 0-0 Left 0-0 . . ' Right 0-0- PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 244646(6/00) WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the /work for which this permit is issued. ,r-� ' have and Will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' compensationInsurancecarder and policy number are- Carrier: Carrier: S�!�lr' &4 CW Policy Number. 6O/G-2S'- 1 y (This sect/on need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 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 Califomia, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Comply with these provisions.. Applicant Signature: /z✓ /'� Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chaplet 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license Is In full force and effect. Lib, n 6y,%,F2 7Class a Contractors Signature:AZ4�_ Data: $ _ �• O S CONSTRUCTION 4ENDING AGENCY: ❑ 1 hereby affirm that there i5 a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ahirtn that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK. and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such Project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt Under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ NO Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2. Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..e a plicant or resent or future building Occupant need to file registratii...... .ls? _ .................................................................................................................. .. .................... .......... ..... 2 Does or will the PP P 9 P registration at on lone for acutely hazardous materials. ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of Compressed gas at standard temperature and pressure). ................................................................._........................._................................................................................................................................................................................................................................................................................... 3 Dces or will th applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .........................................................................................................._....................................................................................................................................................................................................... ........................................... I.................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does Or will Ilia applicant orpresent Or future building occupant require for the work which is the subject of aJ Yes apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ es LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................................................................................................................................................................................................................................... 6 Will . an............................................................................................ y part of the facility to be censlmcted under this permit be within 1000 feat tram the outer bountlaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..................................._.................................................................................................................................................................................................................................................................................................................................... .................. 7 a a Permit from the South Coast Air Quality Management District or other air pollution control district n agency is required for N work which is the subject of this aDPlicatlon, have all of the disclosures prescribed by California Health and Safety Coda Section 42303 been medal ❑Yes ❑ No B (If yes', attach certificate of cempliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date. CERTIFICATE OF COMPLJANCE AND AUTHORIZATION OF ENTRY: I Certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / $jgualure Of Legal Owner(s) ,Dat And/Or Authorized Applicant 'Dale LODE s INSpLgD011Pi 9M WRTt LS CODE WW%CTWNTYPE INT71AL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roof�' 2-d 210 Final Electrical 201 Final BIOCWRetaining Well 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2800 SHANTARDR Suite: Vicinity: PATIO COVER ATTACHED TO REAR OF HOUSE Parcel Number: 13940313 Zoning: R1 R1 Applicant: IACINO, ROBERTA SMTP Res: $0.50 Address: 2800 SHANTAR DR Other: $0.00 Inspection: $0.00 Phone: (714)557-6829 COSTA MESA, CA Zip: 92626 Owner: IACINO, ROBERTA Address 2800 SHANTAR DR Phone: (714) 557-6829 COSTA MESA, CA Zip: 92626 Contractor: OWNER -BUILDER Address: Phone: Zip: License: 0 Arch : Address: Eng: Address: ISSUED BY: Status: ISSUED Applied: 01/31/2001 Issued: 02/01/2001 Phone: Phone: Zip: License: License: SCOPE OF PERMIT LEGALIZE EXISTING 189 SQ. FT. PATIO COVER ATTACHED TO REAR OF EXISTING SINGLE FAMILY HOME. Total: $160.96 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 27- 8 Rear 36-0 Left 10-0 Right 15-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 2 Required: 2 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2406-46(6,00) FEE SUMMARY Plan Check: $63.21 Calc Valuation: $3,046.66 Permit: $97.25 Claim Valuation: $0.00 SMTP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $160.96 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 27- 8 Rear 36-0 Left 10-0 Right 15-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 2 Required: 2 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2406-46(6,00) DECLARATIONS WORKERS' COMPENSATION DECLARATION:EL I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the perfomlance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certity that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED MR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. Lic. N Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500).): ,tr 1, 'owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt unger ec. Business and Professions Code for this reason: (Signature; — ��.�.%�-^— (,Date:.—�I - Owner ID verified by drivers license. ❑ Yes ❑ No Dmets.Li xmss Nor-- � (Expires_: O Verification of Ownership by (type of document, i.e. - property tax bill or deed): zy DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby car ity that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code), ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......................................................_............._......_................utu-...................................a-nt...................file..................rati.o. IT........................ute-......................................._....................................................................................................... 2 Does or will the applicant or present or future builtling occupant need to file a registration forth far acutely hazartlous meteriels7 ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceGtions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................. ................ ......... .................................... .................._...-..__....................................................................... _............................................... .............................................................. .... .................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...._...........................................-....................... ................................................................ _................................................................................................................... .................... ............................ .................................................... _.......... _........... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ........................................_........_........___.........._................._........................................................................................................................................_..........................._.................._..............................................................-............................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .._........_.........._........_........_................................................................................................................................................................_........................................................................................................................................................................... fi Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................. ............... ..... ..... ........................... ......._...... ....................................... ..................... ................;.................................................................... .............. _.... ........_. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...8........_(..I.f...y_e..s...'.., ._a.t.t..a..c.._h .c..erti.f.i.c._a..t..e....o...f._c..o...m....p..l.i.a...n...c..e....f.rom .te...a..p...p..r..o...p...r.i.a...t.e....a...lr*p.o..l..lut..i.o..n..c...o...n..trol..off....e...r.)... __...... .............. .......... ............._........... ..... .... .............................................. ......................................................... .. CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described props y I action purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature -Of Uegaf Owner(s)- - (Date J x And/Or Authorized Applicant Date CODE 0. INSPECTION TYPE gLII INTMAS@ CODE It INSPECTION TYPE jNTMALy 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 Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 2G4 Final Demolition 250 Final Building/Occupancy 112 C'1- Y OF C:DSTA skiEsA 'li --. iji�c"ill �,i6 SF c'40=L�II;ii iB P.(GiS}11S )0'J+Ia�!i:ir•"•i c:id!I Lq unITM1 5Fml?''Atoirt':((��:`:./£f��F'ff��iT`dyS2'"diiiD;l Sh'M., F31111'.::. Poo Ar' R®�D CITY 0 COSTA MESA PLANNING DIV. SUBJECT TO BLDG. DEPT. REG. BY !/LGv _DATE P6ECT ADDRESS: 2800 SHANTAR DR UNIT: OWNER'SNAME: R.A. IACINO ,ADDRESS: SAME 1 . ARCH/ENGINEER: 557-6829 - REG.NO.: ADDRESS: UNIT: PERMITTEE: R. A. IACINO (714)557-6829 ADDRESS: 2800 SAME CM CA•92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that) am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date. Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a climbed copy thereof (Section 3800, Lab. Q. POLICY NO.: EXP. DATE: ^OMPANY: ' Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This secOon need not be completed B the permit is for one hundred ($100) or less). I certify that" 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 Workers' Compensation Lpaws of California. Dale: —7-140 =_LD Signature: _ NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions 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 which.this permit is issued (Section 3097, Civ. Q. LENDER: ADDRESS: it OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason, (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/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 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 ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (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 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). - I, as owner of the property, am exclusively contracOng with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law dines not apply to an owner of proDeM who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' SState License Law). I am aware that proof of their•Worker's Compensation insurance should be provided to me. I am exempt under Section: B P 7 0 4 4 B. 8 P. s. for this reason: ALL WORK BY OWNER Date: 7 —/ Og6 —' Owner: I do hereby certify that I am aware of and understand the requirements of Cali ornia Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant willtwill not (circle one) need to comply with said state codes and the requirements for a permit lot construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby eartify 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 allthonze reprise tatives of this city to enter upon the above-mentioned property for inspection ., 1purposes .Date: 742/S —.470 Signature: Driver's License or Social Security x: 184148 White—Building; Green—Code Enforcement; Canary—ApplicanC Pink—Revenue; Goldenrod—Assessor ITY OF COSTA MESA -'BUILDING PERMIT PERM NO -;B/1 048068 PERMIT NO: B 0,48068 PLAN CHECK NO: N GOVT: -N SUPP: N CONSTRUCTION TYPE: V -N PERMIT"TYPE: STR P,URPOS'E.: ALT JOB DESCRIPTION _: T/OFF REROOF W/CLASS C SHAKES SQ FT: 4,100 1 CLAIM.VALUE: .4,100.00 CALC-VALUE: 4',100.00 GROUP OCC: R-3 1'r COMMENTS; TEAR OFF/ REROOF W/ CLASS C SHINGLES Z 0 N I N G* R E Q U I'R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING-------- FRNT. FT IN REAR: FT IN FRNT:, FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT. FT IN ' PARKING REQ: PROV: PARCEL: 13940313 ZNE: REF NO: PLANNING NOTES> > D E V E L O P M E N T S E R V I C E S R E Q U I;R E M E N T S ZONING APPROVED BY z DATE:' X7 BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE: o7.7 l0 LEGALIZATION:N F E E S T_ M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/•RES GRADING PERMIT 72.00 50 SMIP/NON-RES PLAN ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID 'DUE TOTALS ---- > 72.50 0.00 0.00 72.50 72.50 •00 REVENUE DIVISION TOTALS--> COLLECTED: 72,50 OVER/SHORT: 0'0 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-C$ECK 72.00 .50 I N D I'V I D U A L7, F E E B R E A K D O W N n TYPE QTY D E S C R I P T I OrN UNIT COST TOTAL COST SFR 4100 REROOF BY VALUE RES.IDENIAL NOZONE 1.00 4,100,00 END OF FEES .1 01 00064£47-00064848 TOT 72,50 DATE: 07/10/90 TIME: 10:36 i CONSTRUCTION AND PLANNING - Date APPROVALS Permit # _ f1 ,Inspector POC SPA .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 r 5. Steel Reinforcement L - 56. Rough -Plumbing & Pressure Test - 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59.. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - ! • d 60. ._Backwash Lines, P -Trap, 0 Undrgrnd. • %/t 10. Structural Floor System 61. APPROVAL TO DECK. r+ .'-••�" 11. Property Sewer Line &House Connection 62. -Backwash & ,Receptor -Final r , 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64.-, Plumbing System - Final _ 14. Rough Plumbing . - - 65. Electrical -Final r 15. Rough Electrical -Conduit - 66. Solar System -Final ' 16. Rough Electric Wiring_ 67. Fencing & AccessApproval 17. Rough Wiring Sign 68. APPROVED FOR.PLASTERING 18. Rough Electrical -T Bar Ceiling - 69.*POOL/SPA SYSTEMS'FMAL 19. Rough Heating & Air Conditioning• FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑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 :;',j 78. FIRE PREV. FINAL 30. Drywall Nailing i,/ HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric }' Notes: 97 34. Final Heating & Air Conditioning ' V t 35. Final Gas Pipe -Test r r 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 . FINAL STRUCTURE & BUILDING p.7/ (r% 48. FINAL PLANNING !a 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date CITY OF COSTA MESA BUILDING DIVISION ROOF COVERING CERTIFICATION Property Owner Contractor State Contractor License Number Permit No. Classification I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the manufacturer. I further certify that I am the owner of the property. (Owner -Builder permittee only). ❑ 1 further certify that I am: ❑ Owner of sole proprietorship company ❑ Full partner of the company ❑ Limited partner of the company ❑ Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Received by Building Division RV. 099046 White -Building Div.; Canag-Cordractor; Pink -Owner Company or Corporate Name Address / 7-/0- 9v it E�i nature Date %�-1t, li4ci�vn Printed or typed name OWNER PACESETTER WEST JOINT VENTURE DATE 3-22-63.. JOB ADDRESS PAnn ChAntar nl ive BUILDING PERMIT NO.190S4 GENERAL CONTRACTOR Andros Land COIDUa.11Y VALUE $ 26,262.00 AP No. LUT B THAUF 4340 FIRE ZONE DESCRIPTION ON' wOHK res aLL gar I*-- ECTIONS Signature DATE GROUP I&J TYPE V ZONE R1 E — SUBCONTRACTOR PERMITS ISSUED Gas DATE NUMBER RoWater9 ugh Com. efrig. ❑ Air ond. ❑ Rough Heating,,,/ _Z[ -,�� = _ y�'1•i(= \ tr'� Rough Plumbing Miscellaneous Prop. Swr. Line House Con. p'St. Swr. (j -11f, Sprinkling System Construction Pole Underground ❑ Power ❑ _ Rough Wiring Trenches 5.- Forms Steel Reinf. 2r� Floor System Bond Beam ❑ Steel Reinforce. ❑ ' Sheathing / ,, Frame and Flashing. ?"d' Lathing —'In Eg ly Out (a- Pla-[-q brown coat R ❑ Air Cond. ❑ Final H, o, Final Plumbing Fixtures, Final' - - Final Gas Test _ i Electric Fixtures, Final Building, Final OCCUPANCY FORM OU4 • 5M - 7.61 4 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA, CALIFORNIA For Applicant to Fill In Comple ly .:�2�TYPE OR PR NT BUILDING 00 I'�1 ADDRESS /L1�li COSTA MESA, CALIFORNIA FEE RECEIVED MAO ,2 2 1963 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RECEIPT NO. I PEAMIT NO CITY .[.-Qe�� TEL. s`F NO. FIRE ZONE / TYPE {' THAT THE AB IB COFRECT AND AOR PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. p AP--'ITECT O ;INEER J TEL. 7a' �' NO. APPROVED BY ¢ AN O K 5l ADDRESS (/O / 4 / �'2 ZONING ZO / NO. OR PLANE USE BUIL n n O n TEL LIC, NO NO. S —03 .i SIZE NO. Op BLDGB. O OF LOT Y� l� �* NOW On LOT USE OF 0 DESCRIPTION OF WORK ■ BU YARDS APPROVED MAIN BUILDING DATE ISSUED SHALL BE LESS THAN (U. S. C. REQUIREMENT) YARDSAPPROVED ACCESSORY BUILDING VAR. # I DATE dna ezlz e-I�J�A �/97SO.FT. O CKNOWLEDGE THAT 1 HAVE READ THIS THE AMOUNT SHOWN UNDER VALUATION IS FOR THE THAT THE AB IB COFRECT AND AOR PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. p LL CITY ORDPNAN 8B ANO STATE LA LAUTHORIZED ALUATION qijONSTRUCTION. (lXJPERMIT FEEj E OF ¢ AN O K 5l ED AGENT (/O / 4 / �'2 TOTAL FEE $ y� `V OWNER 2B ADDRESS NERAL COI No 139-3,E Temp. Tag #223 SAMAR DEVELOPMENT CO. DATE AUG BUILDING PERMIT NO. VALUE $ 200• FIRE ZONE 3 DESCRIPTION OF WORK Teml 3 1960 Signature DATE GROUP - TYPE - ZONE tel r _INSPECTIONS SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Water Rough Com. Refrig. ❑ Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line ❑ House Con. ❑ St. Swr. ❑ Sprinkling System Construction Pole Underground ❑ Power.,❑ Rough Wiring Trenches �p Forms ❑ Steel Reim. ❑ Floor System Bond Beam ❑ Steel Reinforce ❑ Sheathing Frame and Flashing Lathing — In ❑ Out ❑ Plaster, brown coat Re` ❑ Air Con. ❑ Final H Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building,Final // yr 4 OCCUPANCY Form 1. CITY OF COSTA MESA 22763 Building Safety Department Application for permit for the fabrication and erection of classified signs. Location Building Site Address Z8®O �i-�1a1siT�Q ~ Tag No.� 4 Type of Sign ❑ Elec. ;Stion-Elec. Name of Leasee SAM04QD-i=\1�\ rhPM �(�.� ��=— Phone Contractor (=&.��-F] . State License No. -2 0-2 1 L Address zi 1Z il.s ST City Phone Ar,' 'ect or ineer State License No. Address City Description: Tract Sign ❑ Appurtenant and Incidental Advertising Sign Off-site Advertising Copy Sign Phone Roof Sign Gas Tube, Elec. Sign Sec. 1.37, 1.44 Two copies of plans and specifications shall be submitted with application for permit for each sign. Plot on plan sheets proposed location of sign and locations of all other signs at site. Minimum size sheets SHALL be 18" x 24" and non -erasable. If between property line and established setback line, owner is to sign written agreement with the City. Sionature of Property Owner Date The undersigned hereby agrees to fabricate and erect the advertising structure within the intent and meaning and in strict accordance with the provisions of Ordinance 63-13, Ordinance 344, the Electrical Ordinance of the City of Costa Mesa, and all amendments thereto. ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICANT. ALL FOOTING, FRAMING, ELECTRICAL AND FINAL INSPECTIONS SHALL BE CALLED. Signature of ---------�- Permittee Authorized AgentccO . Recd. by FORM BU-30-iM4/63 The amount shown under Valuation is for the purpose of establishinq a permit fee only VALUATION Permit Fee $ fl� �3_ $ �Do, Date Plan Check$ 3 -- Total Fee $ FEE RECEIVED AUG 3 1964 FINANCE DEPT. CM OF COSTA MESD FOR OFFICE USE ONLY Date Issued 6; XP e r m i t Na Fire Zone—Type Group QQ�� Approved by >7 DateV� PLANNING DEPARTMENT % Zone 1 —1 A. P. No. !3 Bldg.Site Address ?_80a Legal OwnerpW411K 6:zt_V'Or Address /25;>'S a,/�j�%� City Area of Sign: ft. •— in. X /Z -ft. in. Required Bldg. Setback to Center line of Street Location of Sian: Behind Bldg. Setback Line _ Between Property Line and K�Bldg. Setback Line {gent "�'�- Right Feet _ Feet . Left 49,110 Feet _ Projection!'/off a Feet _ Ground Clearance & Feet_ C. U. P. C. Date Approved Clearance Chap, VIII, Art. 5. Section 8504 (b) 4ilL/�/ NgQu Planning Staff) Signature (Dept. of Pub914 Works Date:`-" `3