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HomeMy WebLinkAbout2821 SHANTAR DR - Building Permits CITY OF COSTA MESA • �5`pMF BUILDING DIVISION lltA Ft 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 -ewers. PERMIT NUMBER: BC09-00367 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: RES ALT DATE ISSUED: 12/29/2009 • ISSUED BY: RMD • JOB ADDRESS: 2821 SHANTAR DR CM • Suite/Unit: APN: 13940239 Zoning:R1, , • Vicinity: Primary Occ: Const Type: V-B SQ. FT: 1212 Valuation: $154,988.80 SCOPE OF WORK: 1212 SQ FT SINGLE STORY ADDITION. MAJOR INTERIOR REMODEL TO EXISTING RESIDENCE. 3 BEDROOMS, 2.5 BATHS W/DEN. ELECTRICAL: SERVICE UPGRADE TO 200 AMPS, 20 LIGHT FIXT,40 OUTLETS, 20 SWITCHES. PLUMBING: 2 BATH TUBS, 1 DISHWAWSHER, 2 GAS OUTLETS, 1 LAUNDRY/TUB WASHER, 2 SHOWERS, 1 BAR SINK, 1 KITCHEN SINK, 1 SERVICE SINK, 3 WASH BASINS, 3 TOILETS, RELOCATE WATER HEATER. MECHANICAL: 1 FAU, 1 HOOD/EXHAUST,2 VENT FANS TO SINGLE DUCT, 1 APPLIANCE VENT. OWNER: QUON, MARGARET A TR Address: 1108 DANIELLE DR Unit: Phone: City/State/Zip: COSTA MESA,CA APPLICANT: PAT CHERF Address: 949 AZELEADR • Unit: : Phone: 714-546-0318 City/State/zZip: COSTA MESA,CA CONTRACTOR: CHERF CONSTRUCTION License No. 362537 Phone: 714-546-0318 - Address: 949 AZELEA DRUnit: Cell: City/State: COSTA MESA,CA ZipCode 92626 ARCHITECT: License No. • PHONE: ENGINEER: MIKE HOUSHMAND License No.0042283 PHONE:949-752-1612 COMBINATION PERMIT FEE SUMMARY Building Plan Check: $846.14 • Building Fees: $1,301.75 • Electrical Fees: $134.60 Mechanical Fees: $74.30 Plumbing Fees: $196.25 SMIP Residential: $15.50 SMIP Commercial: • $0.00 Bldg Std Admin Fund $7.00 TOTAL FEES: $2,575.54 **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, CODE X. INSPECTION TYPE DATE IN1111ALS CODEX INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical �S 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 72/40 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver a license. ❑Yes 0 No I hereby affirm u11dbY 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 section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized C%T4 Carver V f P��7 P by this permit,and that no building structure,scaffolding.falsework,a demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This action need not be completed d the permit is valued at one hundred dollars($1md)orless.) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: p7 j — ©0 ©cat ri7ve� ❑ 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 stn.-of to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor C. h_ fo hwith comply with these provisions. ay n, 1rc7, /Q� Division of Industrial Safety Permit Number: Applicants Signatu- 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 El 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 ATTORNEYS 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 / �3 2 Class#- (i (Section 25533 of the California Health and Safety Code, with some Q. exceptions, requires registration with the Costa Mesa Fire Department by -1 6 ` each business which at any one time has on hand a quantity of acutely Contractor's si t 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,CMI Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ElYes ❑ 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 ❑ No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑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 Califomia 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 ❑ 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 ❑ 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. fiat of Legal Owner(s) ate • 'Signature Date t /* A 305746(3/07) _ And/or Amnonze'4 ni C. �oSt 12- 9-2009/C it ":P$" - i .jl :L•S"r NEWPORT-MESA UNIFIED SCHOOL DISTRICT N? 6955 • CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 611 �IA� To: ( ) City of Costa Mesa D�lstrict Receipt No. ( ) City of Newport Beach �� d ( ) County of Orange Plan C eck No.. Applicant: 90*- c, A n Address: g -Ig �C12/-QLa-- Pr. I C (1A44,°- G I.2U2 Telephone Number: I(`l ' Sf(-03/2 Tract/Parcel and Lot Number(s): 1, 0114023i Location of Project: o�qal c nan'rCur Pr Number of Square Feet of: 00 it Residential Space its- x $1.84 Total 36• Commercial and Industrial Space x $ .30 Total Commercial/Industrial Project is: (Check One) Warehouse _ Motel _ Preschool R & D _ Bank _ Auto Repair Movie Theater _ Neighborhood Shops _ Hospital Mini-storage RacquetiHealth _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _• Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed developme• may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. • • t By: usa p r: F+ t.',,Y� AWMor¢-• Re• 7; a " - r The above representation as to square footage is true. Applicant agrees at if it is later =mined that such representations, e'nos true, then this certificate shall automatically terminate and the appropriate City/County shall be notified. ap 4; I')'"v It Date: /Zkc/e99 +-.� ApXceM v ` n ,r I. • • CITY OF COSTA MESA ` 0601 ifts. BUILDING DIVISION FµSNESsr .�4 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 4% � PERMIT NUMBER: E09-00306 PERMIT TYPE ELEC STATUS: ISSUED APN: 13940239 DATE ISSUED: 12/22/2009 ISSUED BY: KJB JOB ADDRESS: 2821 SHANTAR DR CM Suite/Unit: . Vicinity: •• SCOPE OF WORK: TEMP POWER POLE FOR FUTURE CONSTRUCTION AT SITE. _ REF: BC09-00367 • OWNER: QUON, MARGARET A TR Address: 1108 DANIELLE DR Unit: PHONE: City/State/Zip: COSTA MESA, CA APPLICANT: CHERF, PAT Address: 949 AZELEA DR Unit: PHONE: 714-546-0318 City/State/zZip: COSTA MESA, CA CONTRACTOR: CHERF CONSTRUCTION License No. 362537 Address: 949 AZELEA DRUnit: PHONE: 714-546-0318 City/State: COSTA MESA,CA ZipCode: 92626 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. CODE S. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 1/67(0 201 Final Etlock/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 drivel s license. ❑Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 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 rformance of the work for which this permit is issued. • have and will maintain workers'compensation insurance,as required by s. ion 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized qt l by this permit,and that no building structure,scaffolding.falsework,or demolition Carrier: /�- —IWI v or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This seam need na compleeeted AThe 6rma�5/,)va'tectot a hundred dmars(51od/aless.) 2,Art 2Sec.341,Title B,California Administrative Code). Policy Number: �C3 / ""o" — " " " 70 ❑ As owner-builder, I will not employ anyone to do work which would O 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 - - — the Lab.v.r,..e.I shal hwith co •ly with these provisi ns. ,1 Applicant's Signature Date ♦�r �A_ /_ ' V 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 00.3,-/ 1 7(JI//22 exceptions, requires registration with the Costa Mesa Fire Department by kf�dLJ \\�� each business which at any one time has on hand a quantity of acutely Contractor's- re 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 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 Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If'yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for 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 O 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 Cit of Costa Mesa to enter upon the above-described property for inspecks I a.ree not to occupy or allow occupancy of any building out is p- ntil al inspection. '..l�J� _sac �.► ASlgna t.egm o mg-) Date Signature Date rte_((, /a/d07 J 3057-46(3101) And/or Authonzed ' 'pecant Dat il ; 'z ,psi Ws CITY OF COSTA MESA BUILDING DIVISION > • .,,a DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER f 1 .'^•" I 4 PERMIT IN 0,0 601-01923 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2821 SHANTAR DR Status: ISSUED Suite: Applied: 12/06/2001 Vicinity: HOUSE&GARAGE Issued: 12/06/2001 Parcel Number: 13940239 Zoning: R1 R1 Applicant: JOSEPH W GOBSTER ISSUED BY: Address: 1067 CHEYENNE .c : '. _ • 'Phone: (714)540-0147 ; — COSTA MESA,-CA• . - • • Zip: 92626 Owner QUON,'MARGARET A TR ' Address /1108-DANIELLE DR, . = / _ ' - Phone: ' ,COSTA MESA,CA . Zip: 92626 \ ,A Contractor: ' JOSEPHW'GOBSTER Address: 1067 CHEYENNE . ' " - - Phone: (714)540-0147 / - - COSTA MESA, CA Zip: 92626- License:` 362397 - •_ - Arch : - - ,_ - Eng: ../�:' .. Address: - - Address: -- • "N ,i n Phone: ' N , ,-;> \ Phone: - N ', i . -Zip: . , / . License: -\ License: - c ' \ ' • - „Th .SCOPE OF PERMIT_.-_. _. , N -' REROOF EXISTING SINGLE FAMILY RESIDENCE_ &GARAGE(27 SQ).TEAR O_FF EXISTING ROOFING, RESHEATH WITH • 1/2"OSB, &REROOF WITH 30 YEAR GAF SHINGLES. ' ' FEE SUMMARY ' Plan Check: $0.00 ' _ - - - - - - - - - . Calc Valuation: $5,425.00 Permit: $125.25 Claim Valuation: „ ,, $5,425.00 SMIP Res: $0.54 'SMIP Corn: $0.00 — Other: •,$0.00 , Inspection:,' $0.00 - - / Total: ? , i'. , //1 v '_- . - - 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=,o% %' PARKING Existing: 0,- - Required: , 0 Proposed: 0 - NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within.180 days,or if work is suspended or abandoned for a period of 180 days. - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446443(&0O) . ` r„ DECLARATIONS ( ) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - . ❑ I have and will rgaintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. . ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) Ij41. 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 oomph/with these pr . . 5. -App)_ cart Slgnatur •� . -V r Date: /z —6 - C}' "WARNING:FAILU URE RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),I ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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 Professi s Code,and my license Is in full force and effect.Lic.N L Class N G� 7 WI L CContraDtDrs Signature{ =iJJisz/ e� (Date: _ / Z — G - ry 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).): ❑ 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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this replication 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 Yes 0 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.1 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i Si•natur�Qf Legal,cRer( Date lir.101.• � lU�`- / a —6-01 d/Or Authorized Applicant LDate_ CODE II INSPECTION TYPE PATE If{ All CODEC INSPECTION TYPE DEE MOW 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof /2-'2-6-67( 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 • OWNER PACESETTER WEST JOINT VENTURE DATE OCT 2 3 1962 JOB ADDRESS 2821 Shantar DC. BUILDING PERMIT NO.17219 GENERAL CONTRACTOR Andros Land Co. VALUE $ 15,681.00 AP No. 139-402-39 LOT 87 TRACT 43219 • FIRE ZONE DESCRIPTION OF WORK Res.Watt.gar. INSPECTIONS Signature DATE I GROUP I&J TYPE V ZONE R-1 Soul PERMITS ISSUED Gas ���R W0-0„--SUBCONTRACTOR DATE NUMBER V r I. LLC /9I✓Q h ,n Com. Refrig. 0 Air Cond. 0 Rough Heating -� _ ...,_74,_ A /2 -27-6:?. /c 92-,Z, - ",u Rough Plumbing L. 1t ,` .i / c7,I ,• //-/-G J' ;-- 7V/, .,p Miscellaneous M' Prop.Swr.Line (Mouse Con. QSt.Swr. D t "CJ©f+_2 71_03 PLUME CQ]NTR NO 32 7 Y c '- Sprinkling System !148'43 Construction Pole / Underground 0 Power 0 Rough Wiring fr/7/2 /-3-L3 ///,LY-C 71o1��isei/r�F /2-/7-/.a. Trenches 0 Forms 0 Steel Reinf. ❑1^x-111 /t"?_--6 t Floor System 741,1 /�---/''r1.33 Bond Beam 0 Steel Reinforce 0 Sheathing - Frame and Flashing (-i X63 Lathing — In h Out P �,. -44 --cam Plaster, brown coat r-- wl .\-1?-4-:_2> Refrig. 0 Air Cond. 0 Final Heating, Final -61-71 ./8_G� Pt •mbGa Fixtures, Final 3�� 1 Gas Test /h� 4: 7 Ei...,aic Fixtures, Final .J /WI-, -./7-CZ Building, Final 5N Y-7/'%/J, OCCUPANCY `* FORM 6114.5M - 761 1(9j9 I7939 FEE iE'CcaVED COSTA MESA BUILDING-SAFETY DEPARTMENT pOgCT(1 11962 P. O. BOX SIT COSTA MESA. CALIFORNIA . FhNAi C€ DEFT. QTY For Applicant to Fill In Completely O ofF �R ISA PPP Y APPLICATION FOR PERMIT • TYPE OR PRINT - BUILDING 2C'74 **.MAVIIIrK BUILDING ADDRESS COSTA ��jMESA. /'CALIFORNIA /� (�/ For.Office Use Only !/RIMJ�T�,1jUQ oweat' �j / / . /{�1�/-`57-JJJ / t'a7VF-GJ . I RECEIPT NO. I I Tip�}. MAIL / cs , /NV RECEIV Y I OATS R91 � yE/ I1H1E`".IBaul`P362 ADDRESSES ww A /// ��j� � a FATS e/IX 51 G. J CITY Good- - /l2 � NOIV 1.09 )ADDREISS 20 0� / �/GR/NSi(/ ARCHITECT �,/ /� �j,TEL. COSTA MESA. CALIFORNIA OR ENGINEER �I, y]rF�/(�/�/ft-// NO. FIRE ADDRESS /,�V�f�-{/� -yG,T��4/ //� ZONE TYPE / GROUP 4 vir CONTRACTOR /.44/OK-(J4'w 444. D 4 * APPROVED DATE (((/// ADDRESS /6 ) 44'42a - ZONING' zone I NO.OF I USE OF NEW--C,1 S A. CITY /�. ele9 ��``// PLANS 2 �J BUILDING }^ STATE .�� / f G c TEL. let L V 7 �• `'17 5 9 LIC.NO. L NO. fs LEGAL �j x /{ DESCRIPTION Q �/ p • �f SIZE OF LOT /£lj X I p O I NOWONLOT A.P.NO. 13 / -� / O 1 - 3 7 USE OF tt� ��E��G./� EXISTING BLDG. YARDS EVES .yl G APPROVED �,/ ALLOWED CENTER SETBACKOPNSTREET E M �//i REAR YARD r FRONT 4// LINE ST.)_/`/ FT. — IN. SIDE YARD I LEFT . • I RIGHTlc. R.SIDE ✓ ^ FT. —. IN. DESCRIPTION OF WORK L.SIDE t..5I FT. IN. NEW I Al ALTERATION I II ADDITION I REAR 1- v FT. .� ryIN. REPAIR • I II MOVING II DEMOLISH BYPROVEDz /Iq�{ DATE 7/`9��• . BUILDING NO. of !*,-�A/✓ 9'� SIZE 1SD0 ROOMS �P STORIES/ EXTERIOR W /,y� ROOF 6 /irat..�+' COVERING u`.R-(J COVERING II�T l�� OF BUILDING AND WOR TOO El PERF R/MED /.f �f t.:). Li /� IAA- a t -'S 3 A 1T sr p:1 - .1/4 5L 'd6 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUA N IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- . PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PY WITALL CITY ORDINANCES ANP STAT LAWS RSG TING BLmLOWGH CON �eee/TTi�11oN.//A /f ^ VALUATION / 0-0 SIGNATURECJ/ �j. PERMIT FEE $ Sl• PERMITTEE �_KKG��-- Wit. /S-+ D S n �//'//�� OA $ J O / PLAN CHECK $ en •r° i' AUTHORIZED AG Y ' ~` X TOTAL FEE $ 76 . .4-0 0