HomeMy WebLinkAbout3139 SUMATRA PL - Building Permits 4Lo M 9 CITY OF COSTA MESA
BUILDING DIVISION
Y • r,,'h;.�r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. 1 t j. PERMIT E01-01073
; Lit
wrote-
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 3139 SUMATRA PL Status: ISSUED
Suite No Applied: 12/26/2001
Vicinity: BACK YARD Issued: 12/26/2001
Parcel Nunmber: 13915229
Applicant: LANE, MARK ISSUED BY:
Address: 3139 SUMATRA PL --• - ,
"!- - Phone: (714)556-4935 •
COSTA MESA;CA; ' Zip: 92626 /
Owner: ' LANE, MARK, . -
Address ' 3139 SUMATRA PL ' - , I -
, Phone: (714)556-4935
COSTA MESA/CA Zip: 92626
i
Contractor: OWNER-BUILDER •
' Address: �; j , -,
- • - - -Phone: -�
- Zip , ,
' License: 0 -
SCOPE OF PERMIT
REMOVE&REPLACE EXISTING'ELECTRICAL SERVICE WITH NEW 200 AMP SERVICE.
FEE SUMMARY
Quantity - a. _ Quantity
ISSUE FEE $23.50 Temp Dist System PLighting - $0.00 0
Temp-service.test $0.00 Busway/100 ft " $0.00 0
Res. a/c package . $0.00 Standing Section $0.00 0 ,
' New Res(1-2 units) . $0.00 0 Misc Electrical Equipment $0.00 0 -
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 70: , _ r
Pool/Spa , $0.00 0 up to 10 kva/kw $0.00 ",0 7
Lighting Fixts -, ,. • $0.00 0 up to 50 kva/kw $0.00 '//0
u
Recept Outlets 'v;.$0.00 0 -- p to 100 kva/kw $0.00/ 0
Switches - $000 0 over.,100.kva/kw--' _ $0.00 0
Non Res Appl \ $0.00 It '' 0:- . . Low Voltage Equipment'' - $0.00 0 "
Res Appl >,. �' $0.00 0 Low volt Wiring System/Ckt , "$0:00, , 0
Service to 200a- - - ' $30.50 -. ' --1 Misc/Conduit - $0.00 - 0
Service to 1000a' : , $0.00 0 > . Misc:Conductor $0.00 ' 0
Service over 1000a , $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 - 0 Circus(mech-ride or lights) ' • $0.00. 0
Motors to 10hp . $0.00 '0 Christmas Tree Stand - $0.00 0
Motors to 50hp $0.00 ' ' 0 ,, Fireworks Stand- ' " $0.00 " 0
Motors to 100hp $0.00 : 0 - Other ElectricalFee $0.00
Motors over 100hp $0.00- 0 . "
Communication drops $0.00 0_- Investigation Fee - $0.00
Sub panel to 200a $0.00 "-0 - Plan Check Fee, ' ' $0.00
Pole Light Pkg $0.00 0 Reinspection.Fee ", $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00
Intermed Pole $0.00 0
COMMENTS I SPECIAL CONDITIONS
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval Must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(WOO)
4 DECLARATIONS ` ) ;�)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(3100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
ya/ I,es owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt uncle c. Business and Professions Code for this reason:
Signature: 44 jtt (—Date: I ,6+•I _
'OwnerIDverified by drivers license. 0 Yes 0 No Diiver5 License No. Expires_ 69.6 -t
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisapplication aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes IJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for insp do rposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
21-
ne reOf.Le�Owner(s) - L_D
And/Or Authorized Applicant Date
Coos t INSPFCTION TYPE 2611. INTRIALS CODE( INSPECTION TYPE PAIS INMIIIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing .. /�y
200 Final Re-Roof 210 Final Electrical ( (J yam/
201 Final Block/Retaining Wall 212 Final Fire Prevention P
202 Final Factory Fire Place • 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
S, CITE'OF COSTA MESA '
4 ppeg BUILDING DIVISION
};j `1 DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
47 j> i I PERMIT
SbO•ewrfo•et B04-01496
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT .
Job Address: 3139 SUMATRA PL Status: ISSUED
Suite: Applied: 08/24/2004
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 08/24/2004
Parcel Number: 13915229 Zoning: R1 R1
Applicant: LANE, MARK JISSUED BY:
Address: 3139 SUMATRA PL - -
r Phone: (714)556-4935 -
COSTA MESA,-CA.: - Zip: 92626-2336
.
Owner: LANE,,MARK'J'. - • , . • ,-N
Address /3139 SUMATRA PL - - - - /`
• `/ �, - - - Phone: (714)556-0935; • r`'-
,. ,.COSTA MESA,CA _ Zip: 92626-2336 - - - p
:.�.
'' �•
Contractor OWNER-BUILDER �[)y���;
'Address: 0:
Phone: 0
- - Zip: . • License: 000000 -
Arch : - - _ Eng: ,', '-:
Address: _ Address:
• • - Phone: , Phone:
'Zip: , / License: License:
, [ . -, . SCOPE-OF PERMIT --,
• REROOF RESIDENCE AND ATTACHED GARAGE:170 EXISTING ROCK ROOF,,REPAIR/REPLACE SOLID SPACED SHTG,APPLY 3/8"OSB
OVER EXISTING SHTG, 1 LAYER 30#FELT,APPLY"30-YEAR DIMENSIONAL SHINGLES."25 SQUARES . /
PITCH 4:12 I ` -
- - - --- —FEE SUMMARY- - ' .
'Plan Check: $0.00 Calc Valuation: i - $2,500.00
, Permit: , $83.25 /7 Claim Valuation:,:,,.. . , $2,500.00
>SMIP Res: $0.50 ' -
SMIP,Com: ' `,$0.00
' ', Other: $0• .00 = ,. ;"'i
Inspection: $0.00 ,, r
�., n - • /'
Total: _ $83.75 ,,
\C; <i , .... ..k...:-..j\ --PLANNING &ZONING - <'
I 1
DECLARATIONS L) C ')
WORKERS'COMPENSATION DECLARATION: - '
I hereby affirm under penalty of perjury one of the following declarations: -
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed i/the permit Is valued at one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisi ns ^
Applicant Signature: ll Date: CL1S
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OWL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which-requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statenienpthathe 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.thet 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
sub'ects the applicant to a civil penalty.of not more-than five hundred dollars($500).):
u.�1 ev
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exemp�t tturi7der e . Business and Professions Code for this reason: q
Signature: '/4*{ ) Date: A req '9
Owner ID verified by driver's license. "❑Yes ❑No Driver's License No. ) Expires: _J'AM 12,,P0q,
Verification of Ownership by(type of tlocurttenC,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I 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 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No -
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_Bemit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described for ins ection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) ;1
, Date -
And/Or Authorized Applicant . Date
CODE/ INSPECTION TYPE PATE INTIT1ALS COPE JN$PECTION TYPE PATE Item Ls
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final - , ' 208 Final Plumbing
200 Final Re-Roof E7/ �'•
. _ �/ 210 Final Electrical
201 Final Block/Retaining Wall 4"� ! ' �e--- 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
OWNER __ SUMMAND T,ANA CO. DATE )i-2h-57 .
3iaq
JOB ADDRESS 1660 Sumatra Place • BUILDING PERMIT NO. #11892
GENERAL CONTRACTOR Owner B1dr• VALUE $ 11,142/1.00
LOT 65 BLOCK TRACT 2353 Res. w/att. gar.
GROUP I & J - TYPE V ZONE R1 FIRE DISTRICT h918
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Footing Trench d.f.--1s' 7- r -
Foundation Forms and Grade to Garage/�
Rough Framing - 4--6 ":1
nG
Plumbing,Rough to Slab � (.yl-4< •2�,t4 ��G4 � ��� y—� -57 9a a 6
Plumbing, Rough Complete M6 S 6 /?-S.7
Temporary Pole *z o Y�
Wiring, Rough J - . ., U
1 _ ' & n r 4 tiLc_e 5-_ 13 -57 S/ 7� 3 `/
Heating, Rough n e 5 - -/I7-4.2 61.• Al (�r,n(.it)11.-1 6.-ff(- S-2 /o .,� 74 ,---
Heating,
Heating,Final Ot GS f,-. f-t ry
(,,Sewer, House Sewer,St. M//5 y-, c-7 L '44it. ,y�O.c�i.r` ,�- Ss7 f 7a-
Septic Tank or Cesspool �r 'L .[ iVS �j'
Lathing, In Out 6-44 2/- 2
Plastering te.frLa'`l /d
Plumbing,Final,Fixtures Completl1LGS *-p4 ri, _ ///�
Plumbing,Final Gas Test JS/h�Cs /a• *Li? \ �L, i p,�.., / .- Mr,
Wiring,Final 217 I.'-15a 7
Occupancy ,./T j•-Ay-a' C
FORM 210 3M 10.55
t: r+ 1st%r T,I „ '
- fcc,rt t,L' iYa..J
S;... , 4918 C!��.� �a-�,1cis 1 —S �)
FINANCE COSTA MESA BUILDING DEPARTMENT C DEPT.
P.O. BOX 317 CITY OF COSTA MESA
COSTA MESA, CALIFORNIA •
FOR APPLICANT TO FILL IN . APPLICATION FOR PERMIT
BUILDING "3T 3
ADDRESS ,T-1 Sums fro P1 Pee - BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. E@18�2
OWNER Summer].and Land Co. . P/ZZII.
RECEIVED BY DATE RECEIVEDMAIL
T IS
ADDRESS 112a So. Beverly �-c-, f_07.2 _j--7 APS fU ll57
TEL.Cre$ vt;.e�y\ BUILDING
CITY ',OS Arw 1 es, fl .1 i f_ NO. 1D- •h2d ADDRESS
ARCHITECT LIC.
OR ENGINEER will .1 . mc, NO. COSTA MESA, CALIFORNIA
IRE
ADDRESS112)1 .SO- PATTpr1 TT-too, 4TEpj e ZONE .
m.nerl and Land ZONE NO.OF TYPGROUP] CITY LIC f PLANS
CONTRAA�TOR^I Beverly-
NO.r��(- i IQ,5 7/
1124E So. Beverly TELGr'E'O�}yilel�� APPROVED ��vlll
ADDRESS Inc. unrrpl pe (;n. , NO. .T-1 t17h BY ' DATE
LEGALLOT t r r' CORRECTIONS
DESCRIPTION NO. 0.7 BLOCK TRACT2 3�3
A.P.NO.
SIZE ( nNO.OF BLDGS. ,
OF LOT ru Inn NOW ON LOT hone
USE OF •
.
EXISTING BLDG. Cr
SETBACK LINE FROM (�
CENTER OF STREET () lot I REAR YARD t -
SIDE YARD RIGHT C I LEFT 5 t
DESCRIPTION OF WORK
NEW X ALTERATION ADDITION
REPAIR ( MOVING DEMOLISH
BUILDING NO.OF
SIZE ] 31 6) ROOMS 6 STORIES 1
EXTERIOR WALL Stucco ROOF
COVERING R. Q-ir14 rim COVERING Pr,nb
USE OF NEW
BUILDING Single P am11 v fwn i 1 Ina
6-A C
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
•
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. VALUATION PERMIT FEE $ 28•00
SIGNATURE OF
PERMITTEE
n44 $O // �a r/ PLAN CHECK S 14.00
`R/F'L////J r� 7"
AUTHO EDA TOTAL FEE sL2.00 �BMr
OWNER SUMMI:,RLAND LAND CO. , DATE h-2)t-57
JOB ADDRESS 1.6,7.2 Sumatra Place BUILDING PERMIT NO. #L1895
, GENERAL CONTRACTOR Owner Bldr. VALUE $ 11,424.00
LOT 68 BLOCK TRACT 2353 RPS. w/att._gar.
GROUP I & J TYPE V ZONE RI. FIRE DISTRICT 4921
PERMITS ISSUED
INSPECTIONS DATEiSUBCONTRACTOR DATE NUMBER
r
Footing Trench a-.4% 5.---p __d J
Foundation Forms and Grade to Garage _
Rough Framing -i 7
W C� (' p
Plumbing,Rough to Slab ^�{� �yG1 -,‘;‘..'11,1-1 ���. /'�� � �,JU71/�J - d ^S qa- )-1 d
Plumbing, Rough Complete ))\e5 4.2-0--57
Temporary Pole -f
Wiring, Rough I��""y"-7 Gp.. 2�/...)J . Tho. ,&06 1-,-1 -,17 Lig / 2
1 Heating,Rough /r1 S b^a0-S7 ,, i ,(.1,7„?.? q ' c`
Heating, Final kW-5 /2-17/-S`7 ��
';Sewer, House Sewer,St. 41mS $-2G,f ,/,-7 • �, n . , _ _ 3-5---.5-7 8'5 7 r ._
Septic Tank or Cesspool
Lathing, In Out t4fr` 4 I ,
� 7
Plastering ei, g 9 --/
Plumbing,Final,Fixtures Complete Mil c /1-H-.67
Plumbing, Final Gas Test Tr MHS /2-4-S-7 - ar yt e
Wiring, Final _ 7k at - — J _
Occupancy /MFS ,z-q-6-,
FORM 210 3M 10-55
Applicant to fill In all spaces within heavy border lines and sign all appropriate declarations.
- CITY-OF-COSTA MESA - " - -PERMIT NO:- • _ "TRACT NO. -LOT'NO." 'BLDG.NO. -- ---' -' ----/
CONSTRUCTION PERMIT 1 ao i :. 't
Project Address , .'_ VII t,t a:-_ C ,9536 12/15/81 • ,.17.75 )Tl.i
! .�'i.,,14,--„ A_.,,,,,, `S6 .?i TYPE OF C�O,NSTTRRU'CTION
Owner Sch P-� �i • -'- '- ' • ` Phbneygb i 0 NEW' Int DD ❑ ALTERATION' - - . _ . .
-Address3 -Surylk47e$• - -tsIA 72ala "..t...i.1 r❑'REPAIR' ❑ CONVERSION,❑DEMOLISH . . -_ - ._
Arch/En -- �� - ❑OTHER 1' ' I� ZONING REGULATIONS
9: .y -'_ _' _ ,- License No. • --.
DESCRIPTION OF WORK�i' _. �� ( 'p' ^s� - •- '
__. CO £bn\a+L r'- I ✓VG( - 'ZONE _- - " PLNG REF.,of -
ContraetOrhGf'tc _sh-i P - Phone:D ri - .7 . - - - - I- ---- . -BUILDING- - B ILDING -
_ TVPE OF PERMIT - - Fp 1�
Addres w YS•bm `4 � T I I I' • SETBACK DD L T. PROPERTYLINE
s�iZ��� D f (/V IlT31s'x - •/Q/Gl/•{fq^L'.`'IS-Pb'/, ❑,G RA04NG„ 0 FOUNDATION-❑'STRUCTURAL-- YARDL5EFFT
LICENSED-CONTRACTOR-DECLARATION - ._•''..' .:- Q TENANT ❑ ELECTRICAL❑PLUMBING -OMECHANICA RIGHT GH YARD - -• • - , - -,-• ( -
I hereby affirm that I am licensed under provisions of Charter 9 (corn- r -�L__ .
mencing-with' section-7000) of-Division- 3--of•-the-Business -and - I❑ OTHER- S _ - - - _ _ ..
Professions Co.: and license is. in full force and,effect. il REAR YARD(TO P/L) „ `-
• Y. _ _ ___ - ".PROJECT DESCRIPTION- - - _
License as / `C `. � i ense NoiiS7�' • . -`- -'` _ '� • - PKG:SPACE RE , 'PROVIDED
Date U .- -Signature' -• _ __ _ _,. _.SQ,.F,T. _4 44`'1' J5 , - - D. /_ ,
-WORKERS'COMPENSATION-DECLARATION--. _ - • OCCUPANCY-=CONSTRUCTION TYPE STREET WIDTH • >„ PARK FEE$',�
I hereby affirm that I have a certificate of'consent to self insure or a VALUATION • ' - - ZONE ZONING APPROVED BV DATE '
tificate-of Workers' Compensation-Insurance,-or-a certified copy - -
reof(Section 80 Lap C.). ) i
(GRADING CV.YDS. •
tACRES SPECIAL CONDITIONS - 1
ICY N ,u�/3{4$-Yr' Company ✓'"-"`- _ .- .» _ ._ - - __ _ -
-
ertified.copy is,hereby furnished. _ ' 'REMARKS.• - _ _
+.__.. _. . . _ _ _ _- _ - _._t _ _ . ___ - __ _ ..-..,-
El
R
❑ Certified copy is filed with the city Building Division. ' - '
EXEMPTIONFROM WORKERS' COMPENSATION'DECLARATION ' ; - • '- '-' ' " -` -' -' ' . . - - - -- -- . .. -
(This section,need_not be completed if.the.permit is for one hundred
($100) or less)- . _-, __.._r _ _ _ . . _ __ - - _. _ - _
_1_certify that In the performance'of the work for which this permit Is
issued, I shall not employ any person iri any manner so s to'become -PLUMBING- - -`.r:' -PLAN CHECK"'" ' - - • -- - ELECTRICAL` r "PLAN CHECK '-
-subject to the Workers'Compensation Laws of,Ca ifornia • •
_ -" -
Date 1 Signature; - - � BATHTUBS - SHOWERS - SO FT Sm FT - ' - -
NOTICE; If after.making this declaration, you should become subject -TOILETS. .0- URINALS -- '-" - - - - GENERATOR-
. to the Workers"Compensation provisions of the Labor Code;you must - TRANSFORMER -
forthwith complylwith such provisions or this permit shall be deemed LAVATORIES DOUBLE'LAVS -• --- ' -- -APPLIANCE' .""'10-50'KW_50+KW - - -
.revoketl._ _-.. _ -. - - - `KIT.SINKS"- -` DISHWASHERS ` " -- MOTORS '- -
-
Cvoked. CTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS - - -" "' '- (INC.SOLAR)_.-lo_5o HPy-50+iHP- -
formance of the work for which this permit is issued (Section 3097 • - - -
Lender's
- _ _,- __- .._ .:-_ .__ _- - _ __ ___ _ .. _
Lender's Name FLOOR SINKS FLOOR DRAINS• - ' - • " ' '-1 -FIXTURES" " -OUTLETS/ SWITCHES ' - ' --.25
Lender's Address DRINKING FOUNTAINS- " --•--- ' „ ' - -4 "GAS TUBE SIGNS" ' -^ -' _ - - - - -- ^•
OWNER'BUILDER DECLARATION' ' - -`- - - ------
I hereby affirm that I am exempt from.the Contractor's License Law for INTERCEPTORS CLARIFIERS • -
'the^following-reason (Section 7031.5 Business and Professions Code:- -SWIMMING POOL' —P-TRAP -- - ' - - ' -- ' cUNN _ _ -_
SIULI ION _ _ - _ •
Any city or county which requires a permit to construct, alter, - POLES METERED _. .SUB -
improverdemolish or repair any structure, prior to Its issuance,also re-• -WATER'SERVICE—ALTERATION` ' -" - • "" ' - -PANELS - "MAIN ,'. ,SUB"" -- '- -
quires the api licant for such permit to file a signed statement that he - - - - - -
is-licensed-pursuant to the provisions-of the Contractor's License Law GAS SERVICE • OUTLETS .. -' - -SERVICE-
apter 9 (commencing with Section 7000) of Division 3 of the - - -' - -
mess and Professions-Code) or that he is exempt therefrom and the -•
WATER -
s for the alleged Permit sub Any eviolation of to-a-c 7031.5 by --- -•` ' - - ' a _
SERVICE-
Sapplicant for a-permit subjects the applicant-to"a•civil penalty -SEWER'CONNECTIONS' "- _"- --"- -' '- _ . .
of not more than five hundred dollars ($500). _ -
❑1, d5 owner of the property, or my employees with wages as their SOLAR` ••AN- --- COCECTD '-) -' 7 -' --
' -
sole compensation,,will do the work, and the structure Is not Intended _ _L [ _ _ " ' _ ^• -
or offered for sale. (Section 7044, Business and Professions Code: The - 'S LAR PIPING $5._ _ it
Contractor's License Law does not apply_to an owner of a property
who builds or improves thereon, and who does such work himself or ' - ISSUE FEE .� i � - _
.through.his,own employees„provided that such improvements are not ' _ _ _ _ _ '_ _- -
intended or offered far sale. If, however, the building or Improvement- .\ ;\rt, •
\s, ! • SUMMARY OF FEES •
is soldwithinone year of completion, the owner will have the burden MECHANICAL PLAN�CH ECK -
of proving he did not build or improve for the purpose of:sale). HEATING SYSTEM 0-100,000 BTU '� ' -BUILDING-BUILDING-- • --'-- -- - -
-0-1, as -owner- of- the-property,• am exclusively-contracting with- _ _ - PERMIT $ - '�SMIP g
' _
licensed contractors - nthe s-Lice, (Section 7044, lyess 100,000 + gTU PLAN CHECK $ --PERMIT' `C_
and Professions Code:-The Contractor's-License Law does not apply-to MBI -- -�- - - - ISSUANCE- g'. t. _ - '
an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU • PLUMBING $ ��• -- +• f I h
-tracts- from-such projects with-a contractor(s) licesned pursuant to. -SYSTEM - GRA DING.,,,g '1• - Y
the Contractor's License Law), V 100,000+BTU PLAN CHECK $' '` , 1..• ,. ,,44 -
„I ❑-I am exempt'under Section` - -”" - = -' -B:& P'C:for'this --- -- - - 7'7J )
BOILERS .BTU ELECTRICAL $ / $
' MICROFILM
Y 'reason - SYSTEM REPAIR,ALTERATION PLAN C ECK $ $ I
-Date Owner t TOTAL FEE$'. • -
'MECHANICAL $ '- I \
1 hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE i t - LESS AD •
information id stateed I -agree to comply -with-all -city and county' -, PIAN CHECK -$- - - - VANCE PC $'_ -"'- -•-',
ordinances and laws r acing to construction,and hereby authorize'
representatives of his"o t enter upon' te above mentio ed'
property-for I e ti urp ses, _ _ .I I �y 7�
• - _ -•.n FINAL FEE $ �/- I
Signature / Date ��/lT I� • I• -- - -
Drivers• License or ssie. - • - - '- - ISSUE FEE ---- - •-•- - - ----_-- - —•- - -- - - _-. . ._ _ _ . ._ -
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
`__---_y
•
CONSTRUCTION AND PLANNG POOL&SPA. ' 1 , , ' 1' •.
• E"o2 � •Date Inspector r • - Date Inspector
APPROVALS ' Permit# 'APPROVALS '. . Permit# _ •• _ _
1. Temporary Electrical Service or Pole ), •,\" _ _Ali - . ; 43. Pool & Equipment Location - . ..___. . :. - -
2. Soil Pipe-Undrgrn t • - 4:y 44. Steel Reinforcement - • - - - - ,
3._ Electrical Conduit Utility-Undrgrn .- ,- . _ . . - 45.. Forms • - - - .-- - - -
A. Electrical Conduit-Undrgrn_ _ - _ _-_ ,_ _ _ 46. Electrical Bonding - - - - - - - -
I 5_ Steel_Reinforce 47. Rough Plumbing & Pressure Test •• - •
, ..6. Electrical UFER Grp . - 48. APPROVAL TO COVER-GUNITE' - t -- •- - - - •
7. -Footings - _ _ ` . 49. Electrical Conduit-Undrgrn
..8. - Foundation _ - _ . ..... 1 _ 50.. Gas Pipe, -❑Undrgrn,Test - •
. 9. .Water'.P.ipe-Undrgrn, . - __ _ - _ _I 51. Backwash Lines.P-Trap: ❑Undrgrn - " •- "' •'
- 10. .Structural Floor System. _ ___ .,.52. APPROVAL-TO DECK- - ..: " -
11. _Property Sewer Line & House Connection _. ` 1.7. _ . _ - _ ._ . A:. 53. Backwash & Receptor-Final r-' ' .
. _12._Street Sewer Connection __._ _ .._ '_. -- - - . - - -54. Heater:&Vent-Final . - ' - ' -
- 13.,_Rough Plumbing, _ _ _ - -. - - ___ _ - - -' Fig Phlmhina System :Final ' - . T . ' ._' - .' t '
14. Rough Electric-Conduit - - -- - --- - - - - -56. Electrical-Final - - . • .
15. Rough Electric-Wiring - . - . . - - .. - . -- - - 57. Solar System-Final . . .. . . ,
16. Rough Heating&Air Conditioning ._ __-. __ - -. - - _ - .58.- .Fencing & Access Approval .t _ .
-1.7.- Ducts, in Structure . . _. - - . _ " _ 69. .APPROVED FOR PLASTERING , ; - - •
-18. - Ducts, Ventilating• a.. _ ._ _ - _- - ,. _ _ �_ .'_. _ _ _ _ _ ._- . ,
19. Gas-Pipe-Rough &Test - :;. -. :L 1.. _ __._ ._ ____ 60: __POOL/SPA SYSTEMS'FINAL r
21. Roof Sheathing. - i - �. .' 'E �_ �-- ,{}� - . .
-22. Frameand Flashing- - - -- - - -= --'1 - - - =NOTES --= FF+ cxs-'1'��"e - ,.�:.7•s��. .r.•- ••J. ;
. ,. .-
23. -- Insulation- _- - - -!- - ' - _ --. - j -- - - - - -- -- _
24. - Lathing &Siding . .._ .-. __. .. -. '. ._ • - . _ - . - -- i`l. . - _.
.25. . Drywall Nailing " ,
26. Plaster Brown Coat : - . . . . _ _ _- I -. . . ._ - .. . _ 1 ,
27.- Electrical Power Meter-Final _ - �. ' .. _ ' , . •
28. -Final Electric - - - - - _, .. ....._. .. . _ . - __ =; ;
• -29. --Final Heating& Air Conditioning _. -__- --4_ _.- . - _ ' _ -: . _ ' - - - $. - - •- ;
- -30. . Final Gas Pipe-Test - _ - _ . .- . . _ . . _-. . . . _ _ _ -
- • 31_ Final.Plumbing - _ _ .. _
32. - Water Service-Final - . - _ .. _ .. _ - _ ' ' - . '
33. Gas Service-Final. - . - . _ •
• 34. Solar Domestic-Final •,t. .•_ '//j9.fj ��J4 . ,
35. Landscape Sprinkling System '
•
36. Sound Attenuation - , _
• 37. Handicap Regulations - l" I _ _ . . - _
38. FINAL STRUCTURE-& BUILDING • - . . , .
39. Special Requirements Completed •`- •- " • , - - - - - ' , .
40. Electric Release to Edison - -- ' ' • - - - - -
41. Gas Release to Southern California Ges Co. ' • - - ,- '
- 42. CERTIFICATE OF OCCUPANCY _i_ ._ __ . " . u •
- -
No. - - Date • - - - - - , -
I ^2.453
� PAID. 799* .****52.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
p5� 9 REC IVED B DATE RECEIVED D TE ISSUED
ADDRESSBUILDING / J / I i I / . /�.r ,l1 ..--.24,... /I /,_ZD�D
r` p _ +� PERMIT NO.
OWNER t. [�}i1. ��{ /�V A.P.NO. .3/ .//�/• a"'-c ''
MAIL
RMI j�^.L'I/n//�
ADDRESS / // ./t1..��%�/Vl�.��v�tu r / NG
ADDBUILRESS 3! 9 Pel
a U CITY [�? £j[��(.-(,l/ , NOLJ 71 7401 TRACT. 3C LOT& C BLOCK
ZZ Q NEW ADD ALTER REPAIR MOVING OFMOI H
LENSTRUCTION S"l!r-7�3b+ IS
O N LENDER / V
.j m
J 7 BRANCH Ii`l\
JN OWNER! 1g _L' s_,
CO J ADDRESS / VALUE '
_I<
m ARCHITECT v�� TEL. USE $
OR ENGINEER NO. "
V tn FIRE
W B_ ADDRESS ,/�'�J/� ZONE /I --
TYPE GROUP
Ilw APPROVED ' �et��. ATE//_" I r%20
W Z CONTRACTOR BY rid
J Q
mZ �,, n
J x ADDRESS /v"d'-IL of P '
W W ZOf ( IND.OF USE OF NE�QLa-.-x-�7%Y
O= CITY NOL PLANS-j� BUILDI ,t
Z1- 1 ,y�� Ll !•nq—
W-0 STATE CITY YARDS APPROVED /C x4 r.ytsu MMHef � ��QQ��
j O LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUI DFfPG- ..
SIZEAl �` rr /� /� NO.OF BLDGS. IFROM C/L STREET)
OF LOT O y r(r (! I NOW ON LOT J• f FRONT �FT. FT.
USE OF
'` t l
EXISTING BLDG. a,SIDE _ FT.
�� ( L) NO OF
F' SIZE OF i.
Z NEW BLDG L/ ROOMSSTORIES
STaE REARSIDE
/ 2 FT. a r/�i��ty�.
Q EXTERIOR WA LW a JWJyyH(KH V F
V COVERING
J USE OF BUILDING AND O TO BE PERFORMED DISTANCE BET. BET.MAIN&
O. MAIN BLDGS. ACCESS.BLDGS.
a
4c r N c u P5.. E'LL&.7O APPRDATOVED //.47:7[7;
0
CI) _ AAPPYfyj} . IQ r DATE_//- 2-70
OI hereby acknowledge that I have read this application and state �(�yH
n that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ .
CC
F any person in violation of the workman's compensation laws of
N the State of California. /^ to
/f O
I hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of California Business CC
VALUATION
and Professions Code, Division 3 Chapter 9. �"
PERMIT FEE $ `�� 3
��t JJJ��t/ 7
Signature of /�� 4`N �J et
Permittee / / r $��,,,_ PLAN CHECK $ / /r S O E
o
•Authorized Agen / u.
TOTAL FEE $ /
OWNER JOHNSON, K. J. DATE 11-20-70
I'JOB ADDRESS 3139 Sumatra Place BUILDING PERMIT NO. 321483
GENERAL CONTRACTOR owner-bldr. DESCRIPTION of WORK legalize family room _
I-AP No.139-152-29 LOT TRACT FIRE ZONE . VALUE $ 6,500.00
c‘INSPECTIONS Signature Date GROUP I TYPE V ZONE R1
\ SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUBE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND n POWER ❑
ROUGH WIRING /IA /1-,-41-70 Heating and Vent.
TRENCHES LI FORMS • STEEL REINF. n
FLOOR SYSTEM .
BOND BEAM n STEEL REINFORCE L] . •
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n _
PLASTER, BROWN COAT
STRUCTURAL, FINAL Ele�pt�i�Q/ �
HEATING, VENT., REFRIG. AND A.C^., FINAL Q rv-'r-'C/ /1"4"70. .j/t 7J ' Y
PLUMBING. FINAL AND GAB TEST t J
ELECTRIC, FINAL �Z2a ' v '
BUILDING, FINAL --