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HomeMy WebLinkAbout2832 SHANTAR DR - Building Permits 41F 9 CITY OF COSTA MESA BUILDING DIVISION Y :-„' s, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 w—��-.-^_ t � �Iq� PERMIT +.,.o,it% B04-00732 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2832 SHANTAR DR Status: ISSUED Suite: Applied: 04/14/2004 Vicinity: Issued: 04/14/2004 Parcel Number: 13940301 Zoning: R1 R1 Applicant: JORDAN,RONI ISSUED BY: Address: 17611 WEBSTER ST Phone: (949)552-6289 IRVINE,CA Zip: 92614 Owner: MCLUCKEY,JOHN Address 2832 SHANTAR DR Phone: (714)444-0468 COSTA MESA,CA Zip: 92626-3539 ���Q� Contractor: BUILT ON THE ROCK CONSTRUCTION jj]]���((���'�_jj Address: 17611 WEBSTER ST .���.pp - Phone: (949)552-6289 fli►+� IRVINE,CA Zip: 92614 License: 528944 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD 80 SF FIRST FLOOR BATHROOM AND CLOSET TO LEFT SIDE OF HOUSE. FEE SUMMARY Plan Check: $99.61 Calc Valuation: $7,392.00 Permit: $153.25 Claim Valuation: $0.00 SMIP Res: $0.74 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $253.60 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 19-5 Left 5-9 Right 5-1 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 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 244646(6,00) O I ) DECLARATIONS ( WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 workeSsp1/rlpe tion Insur�a carrier and policy number are: / Cartier: 7 r tic 4' U l 0 Policy Number: - '�(/ C"1,L (This section need not be completed if the permit/s valued at one hundred dollars($100)or less.) O I certify that in the pert-. ma ce of the work for wbich t s permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o alt..mia,a••agree tha f I s uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comSig with these pr. '•ns. / /- /��D� Applicant Signature: ,/ c €N Date: ('(/� WARNING:FAILURE TO SECURE W•-':RS' SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTI S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100000),IN ••• ON 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 license•und-rprovislons of C :ohm 9(commencing with Section 7000)of Division 3 of the Busines d Professions Code,and my license Is in full forcet and ers ect.Lic.# r 4' Classat : # Contractors Signature: /MSS Date: Air � . . CONSTRUCTION LENDING A NCY: ❑ 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 slgned'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.Professlons,Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjectsthe applicant toe civil penaltyAof not more than five hundred dollars($500).): ❑ I,as owner of the property Ar1mylemployees 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 properly,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 em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 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: ❑ 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? 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 then 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 0 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 aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No (Section 65850.2 of the Califomia 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? 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 end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abo : . ribed property for in pection urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. wA a • Of Legal Owner(s) Date • And/er Authorized Applicant Date CODE# . �1•. s' DATE INITIALS COPE4 INSPECTIONTYPE BATE INTmAL8 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy T• CITY OF COSTA MESA 4 BUILDING DIVISION %f _ F J - DEVELOPMENT SERVICES DEPARTMENT PER NUMBER t;r O '.� PERMIT lika t M04-00182 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2832 SHANTAR DR Status: ISSUED Suite No Applied: 04/14/2004 Issued: 04/14/2004 Vicinity: • Parcel Number: 13940301 ISSUED BY: Applicant: JORDAN.RONI Address: 17611 WEBSTER ST Phone: (949)552-6289 IRVINE,CA Zip: 92614 Owner: MCLUCKEY,JOHN Address: 2832 SHANTAR DR Phone: 714-662-7699 COSTA MESA,CA Zip: 92626-3539 Contractor BUILT ON THE ROCK CONSTRUCTION Address: 17611 WEBSTER ST Phone: (949)552-6289 IRVINE,CA Zip: 92614 License:528944 • SCOPE OF PERMIT ADD 80SF CLOSET AND BATHROOM.REF B04-00732. 1 VENT FAN FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 - - Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 . Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 . -Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 • • 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(6/00) DECLARATIONS i1 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. 4 I have and will air In workers'compen tion insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My works tion I nce der and policy number ere: /��j� /S ' Carder: t Policy Number: 15-cfn U T (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the rfo ance of the work for w ich th' permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law of C ifomia, d agree that I sh Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ro ions. 7 /ay Applicant Signature: Date: //�T WARNING:FNLURE TO SECURE W ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ni EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU-ARE(S100.000),IN • rnON 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 li •.un•:r•r•vl.ions of Chapter 9(commencing with Section 7000)of Division 3 of the Business a1�Professions Code,and my license is in full force and effect.g Lic.e / • - Dlassate:# f Contractor's Signature: Lr�� _ _ Date:rt rp4 r,Ts PgAMf•� Y/. CONSTRUCTION LENDING •r NCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: I 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 end 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,end 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 en 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 Drivers 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)feel high.(Chap.3.2,Op 2,Art 2,Sec. 341,Title 8,Calitomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file 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 a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the Calitomia 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 Alr 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 prescnbed 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 •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-desc'•operly for inspection purpos. .I : 4n F 4aCITY OF COSTA MESA `, BUILDING DIVISION f tflt -Thr,'"__ ,I ! DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER t PERMIT e ' PO4-00263 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 2832 SHANTAR DR Status: ISSUED Suite No Applied: 04/14/2004 Issued: 04/14/2004 Vicinity: cz. /1 ���Parcel Nunmber: 13940301 ISSUED BY: ThsApplicant: JORDAN.RONI Address: 17611 WEBSTER ST Phone: (949)552-6289 IRVINE,CA Zip: 92614 Owner: MCLUCKEY,JOHN Address 2832 SHANTAR DR Phone: 714-662-7699 • COSTA MESA,CA Zip: 92626-3539 Contractor: BUILT ON THE ROCK CONSTRUCTION Address: 17611 WEBSTER ST Phone: (949)552-6289 IRVINE,CA Zip: 92614 License: 528944 Arch / Eng: . Address: Phone: Zip: License: SCOPE OF PERMIT ADD 80SF CLOSET AND BATHROOM.REF B04-00732. 1 SHOWER, 1 WASH BASIN 1 SEWER CONNECTION AND 1 TOILET. FEE SUMMARY AMT QTY AMT QTY - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $24.65 1 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 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)754-5626 2446-46(600) DECLARATIONS l I _� 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. XI have and will aintal orkers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My work pens n Ins ranee carrier and policy number are: /C� Carder: Policy Number: (This sect n need not be m feted if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the p orm nce of the work for w h thi permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws 1 Ca ornia,a agree that' I sh Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ovi ons. / Applicant Signature: /Date: T y'204' WARNING:FAILURE TO SECURE WO RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CAM PE AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOUARE(S1W,00o),IN MON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: //TT I hereby affirm that I am II ,• a• pder�tr.Visions of Chat er 9(commencing with Section 7000)of Division 3 of the Business6 ?i Professions Code,and my license is In full force and effect.Lic.a �.x��-77 .A - Class q //__ �y Contractor's Signature: / EMOInA Y r Date: CONSTRUCTION LENDING •7NCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom 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 then 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 end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this,application apernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California 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? 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 lcermit 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 ❑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 =. ee 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 ed property for inspection pu •oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i igiralpi % Legal Owner(s) Mr / Date Ait 1 nd/ar Authorized Applicant Date coo r Ti•. I DATE 1NTITIALS CODE r INSPECTION TYPE RAX INTtT1ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 0—j305— U 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 4`p5111b iCITY OF COSTA MESA pe BUILDING DIVISION . •.J 1. ir„. ,1 $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1 _Inlai PERMIT E04-00375 mese (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2832 SHANTAR DR Status: ISSUED • Suite No Applied: 04/14/2004 Vicinity: Issued: 04/14/2004 Parcel Nunmber: 13940301 Applicant: JORDAN.RONI ISSUED BY: Address: 17611 WEBSTER ST Phone: (949)552-6289 IRVINE,CA Zip: 92614 Owner: MCLUCKEY,JOHN Address 2832 SHANTAR DR 4" Phone: 714-662-7699 I1' COSTA MESA,CA Zip: 92626--35353 9 Contractor BUILT ON THE ROCK CONSTRUCTION Off' stga Address: 17611 WEBSTER ST Phone: (949)552-6289 IRVINE,CA Zip: 92614 License: 528944 SCOPE OF PERMIT ADD 80SF CLOSET AND BATHROOM.REF B04-00732. . 6 LIGHS,4 OUTLETS AND 3 SWITCHES. - FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $6.60 6 up to 50 kva/kw $0.00 0 Recept Outlets $4.40 4 up to 100 kva/kw $0.00 0 Switches $3.30 3 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 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 Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 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(6100) DECLARATIONS ( ) fl 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 III alntain w ers'co pensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My pensat n Insure carrier and policy number are: Icaaa Cartier: Policy Number: (This section need not be completed/t the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the ,:do :nce of the work for whit his permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la of C. ifo •a,and agree tt If I hould become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with rhes: ••ro '.i / /��� Applicant Signature: ��M Date: WARNING:FAILURE TO SECURE RS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C MINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000), DfON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F E LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lic}n-sed under/?rpiwsions of Chapter! (commencing with Section 7000)of Division 3 of the Busln nd Professions Code,and my license Is in full force and effect.Lic.If 5 • � . el)Y Tom" Class# Contractor's Signature: IS �I Date: Witt' 14' CONSTRUCTION LENDING AG W Y: ❑ I hereby affirm that there is; onstruction 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 penally 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 ihe.properry,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 oiAher 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„tfie 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: 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? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 It an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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 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: Dale: 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-de.. property for inspection pu ••ses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. a �Legal Owner(s) / Date r.� /. Iu Iliirnd/Or •uthorized Applicant Date CODE L , ' 'y=.'• s' DATE INTRIALS CODES INSPECTION TYPE PSIT. =Als 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy ,STp Lc CITY OF COSTA MESA - BUILDING DIVISION 12 Y •j r.,,�,' , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 St ! PERMIT J !' 11� E04-00650 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2832 SHANTAR DR Status: ISSUED Suite No Applied: 06/08/2004 Vicinity: Issued: 06/08/2004 Parcel Nunmber: 13940301 •. 1 ' /, A C. O Applicant: RONY JORDAN ISSUED BY: ' Address: Phone: 949-552-6289 . Zip: . Owner: �MCLUCKEY, JOHN AND KATHY . . . Address , 2832 SHANTAR DR _ �v Phone: (714)444-0468 " COSTA MESA,CA Zip: 92626-3539 Contractor BUILT ON THE ROCK CONSTRUCTION .. mn Address: 17611 WEBSTER STIS U -.Phone: (949)552-6289 - 0A . IRVINE,CA Zip: 92614 ' License: 528944 SCOPE OF PERMIT . LEGALIZE ELECTRICAL WORK ALREADY.DONE TO EXISTING S.F.D. ' . , ' ELECTRICAL TO.INCLUDE:70 LIGHT FIXTURES,31 OUTLETS,27 SWITCHES AND 1 SERVICE TO . 200 AMPS. FEE SUMMARY ; - - ' Quantity _ Quantity. ISSUE FEE $23.50 Temp Dist System 1 Lighting $0.00 0 , Temp service test '\` . $0.00 [ Busway/100 ft Resa/c package $0.00 -... '.Standing Section $0.00 -'0/ New Res(1-2 units)-' ' $0.00 0 , ...74',...74',/,',',,. ' Misc Electrical Equipment $0.00 ; 0 New Re's(3A-units) $0.00 0 - Transformers up to 1 kva/kw $0.00 , 0 Pool/Spa $0.00 . 0 - ' up to 10 kva/kw -.-- $0.00 A, 0 Lighting Fixts' , $58.50 , '-. 70 up to 50 kva/kw- $0.00 0 Recept Outlets , $30.03 31 up to 100 kva/kw $0.00 0 . Switches ' '$27.11 27 - - over 100 kva/kw - '$0.00 ' 0 . , Non Res Appl $0.00 0 _ . - ,Low Voltage Equipment - $0.00 :1, 0 / Res Appl v, - $0100 0 ': - Low Volt Wiring-Systern/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 ''.i0 Motors to 1hp $0.00 0 • ' Circus(mech ride'or lights) $0.00 0 Motors to 10hp $0.00 - 0 Christmas Tree Stand $0:00 0 Motors to 50hp $0.00 • 0 ' Fireworks Stand - $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee - - $0.00 , Motors over 100hp $0.00 0 - '- ` . . Communication drops $0.00 0 Investigation Fee $0.00 .P 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 suspendetl o bandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must compl • i gall applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will re-Air-the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS ( ) f l 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. M_Lheve 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'comTCE,(satf surence Wu/volley p�licy number are: _�� S — eri r:�= "j !/i •{'Y/VI N Policy Number. 7 ZIA N@Lseectlon need not be completed li the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the •:rform nce of '•work for which this p it is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law of Ca'omla :nd agree that if I houl ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thee. •r%••ns. /, cant Signature: I ( ` �ate:'-� V 4. vwARNINO FAILuR TO SECURE W 47 RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLQYERTO CRI NAL POIALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE($100,000),IN . ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF E LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I herebyatlifm.that.I.amjicer =d u de •rovisjpns of Chapter 9(co encing with Section 7000)of Division 3 of the Busine and Professions Code,and my license is in full 90-Grind effect.Llc..B. (Y I. Class_ Contctora Signature:--- ALIPPIPPaill . )41141115W----- " CONSTRUCTION LENDING AGENC ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom 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 ohe 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.). ' V1,"'if 1: r ❑ 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,doc s 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'vicense Laws.). ❑ I am exempt under sec. _ ` Business and Professions Code for this reason: Signature: '>n.-' Date: Owner ID verified by drivers license. 0 Yes 0 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: ❑ 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,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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). 8 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 : state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc''.• • perry for' spection purposes.I agre not to occupy or allow occupancy of any building authorized by this permit� unt/ilf❑ r_ final 1:1 I�.w Sig tura Of Le 1 Ow (s) lD d/V And1Oi Authorized Applicant _ - � // `:`1Daie COOS INSPECTION 'E DATE JNTRIALE CODE( INSPECTION TYPE PATE INIIDAUU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 'l Fa 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 • `os ; s9 tITYOFCOSTAM!SA ••X ��` CALIFORNIA 92626-1200 P.O.BOX 1200 � ,a. DEVELOPMENT SERVICES DEPARTMENT •July 16, 2001 Donna C. Ashley • 2832 Shantar Dr. Costa Mesa, CA 92626 RE: DEVELOPMENT REVIEW DR-01-01 2832 SHANTAR DRIVE, COSTA MESA Dear Ms. Ashley: The Development Review for the above-referenced project has been completed. The various City departments have recommended approval of the project based on • the following description and findings, and subject to the following conditions: DESCRIPTION • The applicant requests a Development Review to legalize an existing large family day care business for up to 14 children. The day care operates from the applicant's • single-family house. Various rooms on the first floor are used for the day care. Second floor is not used for the business. The backyard is used as the play area. • FINDINGS A. Approval of the development review will allow a use, density, and intensity that is in accordance with the general plan for the property. B. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. C. The project is exempt from Chapter XII, Article 3, Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. 77 FAIR DRIVE Building Division (714)754-5273 • Code Enforcement (714)754-5623 • Planning Division (714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • DR-01-01 July 16, 2001 Page 2 CONDITIONS OF APPROVAL • Ping. 1 . A copy of the conditions of approval must be kept on premises and presented to any authorized City official upon request. New business/property owners shall be notified of conditions of approval upon transfer of business or ownership of land. 2. This approval is for a large family day care for a maximum of 14 children. If at anytime, the day care provider decides to provide day care services for more than 14 children, the applicant shall apply for, and obtain approval of, a conditional use permit prior to the increase in enrollment. 3. The development review herein approved shall be valid until revoked, but shall expire upon discontinuance of the activity authorized hereby for a period of 180 days or more. The development review may be referred to the Zoning Administrator for modification or revocation at any time if the conditions of approval have not been complied with, if the use is being operated in violation of applicable laws or ordinances, or if, in the opinion of the development services director or his designee, any of the findings upon which the approval was based are no longer applicable CODE REQUIREMENTS The following list of Federal, State, and local laws applicable to the project has been compiled by Staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1 . Approval of the development review is valid for one (1 ) year and will expire at the end of that period unless business license is obtained and business commences, or the applicant applies for and is granted an extension of time. 2. Signage advertising or identifying this business is prohibited. 3. The applicant shall comply with all applicable State regulations for large family day care homes. Bldg. 4. If new construction is proposed, Comply with the requirements of the • " Uniform Building Code as to design and construction. Fire 5. Comply with all applicable provisions of the California State Fire Marshal's ordinance. Upon receipt of this letter, DR-01 -01 has been approved, subject to the above- listed conditions. A copy of the conceptually-approved plan is enclosed. The decision will become final on July 23, 2001 , unless appealed by an affected party or a member of the Planning Commission or City Council. 4 DR-01-01 July 16, 2001 Page 3 If you have any questions regarding this letter or the project, please feel free to contact me at (714) 754-5136 between the hours of 1 p.m. to 5 p.m., Monday through Friday. Sincerely, NW �� WEND . SHIN Assistant Planner Attachments: Conceptually approved plans c: Engineering/Dev. Ser. Fire Protection Analyst Water District Building Division Ai FP ,,0111144a,, , CITY OF COSTA MESA / ,• `4 A BUILDING DIVISION :, DEVELOPMENT NUMBER DEVELOPMENT SERVICES DEPARTMENT "• PERMIT B99-01002 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2832 SHANTAR DR Status: ISSUED Suite: Applied: 06/29/1999 Vicinity: REAR OF HOUSE Issued: 02/18/2000 Parcel Number: 13940301 Zoning: R1 R1 Applicant: ASHLEY, DONNA C. ISSUED BY: Address: 2832 SHANTAR DR. Phone: (714)444-0468 COSTA MESA, CA Zip: 92626 Owner: ASHLEY, DONNA C. • Address 2832 SHANTAR DR • Phone: (714)444-0468 COSTA MESA, CA Zip: 92626 Contractor: OWNER-BUILDER Address: _ Phone: • Zip: License: 0 Arch : — Eng: Address: • - - - Address: • Phone: Phone: • • ' Zip: License: License: SCOPE OF PERMIT LEGALIZE EXISTING UNPERMITTED 140 SF DEN.ATTACHED TO REAR OF SINGLE FAMILY DWELLING. FEE SUMMARY Plan Check: • $121.71 Calc Valuation: $11,410.00 • Permit; ' $187.25 Claim Valuation: $11,410.00 SMIP Res: , $1.14 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: . $310.10 PLANNING.8, ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 32-0 Left 14-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 2" Required: 2 Proposed: 2 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 at DECLARATIONS : . ( . l ) • �" WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: t ❑ 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($100.000).IN ADDITION TO THE GUST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE.INTEREST,AND ATTORNEYS 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 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).): 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. if 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 7 Business and Professions Code for this reason: _ Signature: ill. a �_ Dete:i _-_r I - O ner ID verified by driver's license. ❑Yes 0 No D e slbicense Ni ' 1 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? ❑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? ❑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? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit 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 0 No (Section 65850.2 of the California Government Code requires that the requested information be fumished 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 ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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 co ly with all state laws and city ordinances ting to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe ro ny for inspection pure s.I agree not t ccupy or allow occupancy of any building authorized by this permit until final inspection. 6 2o, L�, In _ Do) _ 14 • O c 1 Si nature et el OvrneTQ(s):o--T',>�,� ill1a�— And/Or Authorized Applicant Date ;ODE a INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTRIALE 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final _ _ 208 Final Plumbing 200 Final Re-Roof _ _ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval _. 203 Final Sign 222 Final Site �� 204 Final Demolition - 250 Final Building/Occupan //t-//-o o 111)1 2446-a6 /l c.ir/'( ion 5- 0 jWiff//i \\\\\\\\v7 /A\\\\\"a///!////�\WIPM9 taldi I nalt&` I- Fidelity P 'nal Title - PLO i f RECORDING REOUESTE0 BY j RECORDING REQUESTEDCC� BY: ef AND W1H�NIRECOFlBERNek4Habid'o>i���UNLESS Recorded in the County of Orange, California C OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: I VIII II II II II GVIII VIII III I II II I III ILII III III ReCorder 29. 00 II smEeDonna sey ADDMS$f 2832 ShantarDr 19990802288 08:OOam 11/19/9 ci TE Costa Mesa, CA 92626 04 698458 07 28 IB12 - !m L J Q01 2 15 0.00 6,00 3.00 0.00 0.00 0.00 0.00 d118 Older No. Escrow No. 20.00 0.00 SPACE ABOVE THIS LINE FOR RECORDER'S USEI • DOCUMENTARY TRANSFER TAX $ CQ dim c PF U` XJ • Li computed on full value of property conveyed, or (rl,(CVZ 2t QUITCLAIM DEED ❑ computed on full value less value of liens and encumbrances remaining at the time of sale. Signature of Declarant or Agent Delermining Tax. firm Name N C) Kenneth W. Ashley . ))\ nunla lypa name al gunlonsl, the undersigned grantor(s), for a valuable consideration, receipt of which is hereby acknowledged, do_hereby remise, N. release and forever quitclaim tointerestCuc• Ashley A 100% interest in the following described real property in the City of Costa Mesa County of Orange , State of California: vCommonly Known as 2832 Shantar Dr. , Costa Mesa, Calif. 92626 Legal description NTR 4349 Blk Lot 1 UN • Assessor's parcel No, 139-403-01 ExecutedonJU'- a0 , 19 .99, at •Costa Mesa. CA / Icey and slate, 'l State of \ ,0-\ 1 1T * n( 0--) ; County of ( • a s On JUhQ_a� �� g 9 before me,7enn i-Frier m� �P! I Date Name and Title of Officer(e.g.,'Jane Doe.Notary Public') $ personally appeared V)5gnl Wat- vt1- Ash I- (, Name(s)of Signer(s) ' 31 9 personally known to sl i ❑ 91 croved to me on the basis of satisfactory evidence y (' A ^i` w Aur A n A to A A tiw to be the person whose name ubscribed to the s) ti r¢ JENNIFER MC DOWELL� lsi&re-s to ' �, COMM.#1179237 n within instrumentand a knowiedged to me that T she/they s , r-Pat NOTARYPUBLIC-CALIFORNIA executed the same it i ier/thele a thorized capacity(�s), st \_a '!jt My Comm. GRANGE 10.2002 TY C.11 executed and that by ist er/thelr-signature( on the instrument the (a J ,r -mnr ry v v ry ry v l person(s)'or the entity upon behalf of which the person(s)- 9 acted, executed the instrument. al 9 I WITNESS my hand and official seal. $ $ CI t - .._. _,.0 $ , 0 I 91 • IVSignature of Nolary Public ',91 DEC-19-2000 03:41 MI P 01 ee\T`� CITY OF COSTA MESA,BUILDING SAFETY acv POST IN CONSPICUOUS PLACE ON THE JOB NOTICE Schedule inspection one workday In advance.To schedule inspections. call(714)754.5626. Provide the following information: 1)Permit number,2)Job address.3)Inspection item number.4)Day and date you need the inspection. wrung raw-.253Z._‘NA-1.4-7-Ar44 DR . emir Are-44-LEY . D01.4 IIA C - Watneemu.:8614 01004 EndanPNn...:ee12.(7111ZE3 Canna: tiaikiF P • ,111 nep. IltehaA lPaint.: HntNp Pemee: aC eatJom 1_EC-+hi-I2e s7C1ern Nat, iryc VP4 ume: pa S. 40 tti Dail a'r9D)T10N _ eN Plan aCh. m :&lam* 2. 10.00 mAtiVet.bt sale 0L /At00evSe NEw .00 !.LIER sap Sas MSS PERMITS EXPIRE 160 DAYS(5 MONTHS)FROM ISSUE OR LAST INSPECTION CONS I AUCs ION APPROVAL 5 - • ti.. STRUCTURAL �..��/// our i*c an.- POOL 8 SPA Ow .uppor 4 Footings6 Slab_ i(.'/OO lig' 94 Pool B Equipment Location ._ 96 Sled Reinforcement _-- 12 Roo19Maming- - . . 100 Electrical Bonding.. 14 T-BarCeaing-Strucural 102 Rough Plumb A Pressure Test - 16 Exterior Shear Pard 104 Approval to Cover•0urt% 18 Frame 8 Flashing /1 ml. /00 A 106 Elec Conduit-Underground • 20 Lathing&Siding ��"/ 108 Gas Nee/Underground Test — 22 isolation 110 Backwasn Lines,P-Trap, 24 Drywall Waling Underground , 26 Raster Brown Coat 112 Approval to Deck 30 Pie•Grout 116 Pool Plumbing System•Final 33 CisabWd Access 118 Pod Electrical•Final __-_ 122 Fencing 8 Access Approval ELECTRICAL __ _ 124 Approval for Plastering - 38 Elec Conduit•Underground . _ ___T126 Peones Systems•Final 44 Ro gh Elec-Wrong - - . _ 48 Elec T-Bar Cetng 50 Dec Power FinalRough•r a - AR u -A ••_VAL 1810 Overhd hydro/0/0nd Rgh PLU MNG 8 MOM= Dry Chemical 52 Sofa Pipe-Underground 1814 Dry Standpipe 54 Water Pipe•Underground 1616 Final-F'ued System 62 Rau Plu 64 Rough Mechanical 66 Rough-Factory Frplace Call(71)754462Bfor the loitering: pee ba e* • 72 Gas Pipe-Rough Test - •-_ 200 Fvml Re-Rod 90 Gas ripe Test-Final 201 Final Block/Retaining Wall 92 Water Service-Final 203 Fast Sign 204 Fna1 Demolition 206 Mal Mechanical how- 208 Feral Plumbing ,,,...{{{ }}} 210 Final Electrical !//�,7 0) 41 wiz-I\QD ea)e_ E•/�"/7✓ d►�12IFin151ePreveti(orWr/irg: '/ ow .. . l " � �( � / 12 Final Fite Prevention 2 LeLir(sc) io. r /(/ Can f714)754-5335 roe marol10WUI9 - -- -m Spots �! 214 final Transponaben sous.--. /A/ 'C _ x-Hz''wi an m97545871 for the sdladng: m spas 2161 Fin*Engineering Approve .Sec-F l.•.•a /Blle;1e Can(719 7544307 to the teaming: ' ms smpapr� 2181 Final GMSC Appraal 190 i_ epoa v� A W.e r% C (719754.5245 Iw t eroubMn¢ 220 - x.- Final Planning Approval ��,(�.. - et.._. A- 444(1 �p tall 14 754-6826 to thetdawi a s . -. 222 POW Site -aa�arty. /efC. 250 Fal Buk •.Occu y/ddcre, _-- . -;/>--AAs 1 7% 45ece �4,66e e BROWN, RICK A. From: LAMM, DONALD Sent: Monday, December 18, 2000 5:54 PM To: BROWN, RICK A. Cc: PETROS, EDWARD Subject: RE: 2832 Shantar Rick: I told reporter Stan Kabalo from the CM Breeze that he needed to quit calling so many people; i.e., Sandi, me, now whoever? So, I provided him Eddie's telephone number and said call only him on the outcome of the Building inspection. So, your choice, either wait for Stan to call between 3:30 p.m. and 4:30p.m. today, or you c- • - - : • - as Building Official and close this case. Either way is fine with me. His number s 714 240-6398. That"' Don' Original Message From: BROWN,RICK A. Sent: Monday,December 18,2000 3:20 PM To: LAMM,DONALD;VALANTINE,PERRY Cc: PETROS, EDWARD Subject: 2832 Shantar Ed Petros has just returned from a site visit to this home. The permits were finaled on the owners job card. I have provided you each a copy of the permit. I have instructed Ed to update sierra and our file copies. The owner does have a furnace that is functional. She chooses to use space heaters instead of the furnace. Code requires that a residence have heating sufficient to maintain 70 degrees at 3 feet above the floor. In this case we have an owner preference for one form of heat over another. As far as asbestos, there is no evidence of active construction at the residence. Asbestos, if present, is not hazardous unless it becomes friable(airborne). The is no requirement to abate asbestos from a residence unless you are remodeling that area which contains asbestos. Please let me know if you need anything else regarding this matter. Rick • • 1 1wk - CITY OF COSTA MESA }49 �, BUILDING DIVISION f, .,., . , /PERMIT NUMBER -�� : DEVELOPMENT SERVICES DEPARTMENT // 74. g0411* PERMIT E00-00128 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2832 SHANTAR DR Status: ISSUED Suite No Applied: 02/18/2000 Vicinity: DEN ADDITION @ REAR OF HOUSE Issued: 02/18/2000 Parcel Nunmber: 13940301 ISSUED BY: Applicant: ASHLEY, DONNA C. Address: 2832 SHANTAR DR Phone: (714)444-0468 COSTA MESA, CA Zip: 92626 Owner: ",'ASHLEY, DONNA C. Address 2832 SHANTAR DR ' Phone: (714)444-0468 , COSTA MESA, CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 • SCOPE OF PERMIT ELECTRICAL PERMIT FOR DEN ADDITION TO SINGLE FAMILY RESIDENCE. INSTALL 1 LIGHT,4 OUTLETS, &1 SWITCH. REF: B99-01002 - , - FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System Lighting $0.00 0 Temp service test $0.00 Busway/100 ft I $0.00 0 Res.a/c package $0.00 - Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $1.10 1 up to 50 kva/kw $0.00 0 Recept Outlets $4.40 4 up to 100 kva/kw $0.00 0 Switches $1.10 1 _ over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 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 • -/ \ 1 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(S100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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 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 s .jects,ihe applicant to a civil penalty of not more than five hundred dollars(5500).): . tII:,, 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 sate(Sec. !- /1)44,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 i l 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, em 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 pursu nt to the Contractors License Laws.). ❑�lam.exempt nder sec. Business and Professions Cale for this reason: yignature: 1 - . .. .0 • • Verification of Ownership by(type of document,i.e.-property tax bill or dee -4, ) 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 thispppplication 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 L-I No (Section 65850.2 of the Califomia Government Code requires that the requested information be fumished 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 ❑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 ❑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 AUTHO- •TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree t comply with all state laws . d city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe property for a ion purpo es.I agree not to occupy or allow occupancy of any building authorized by bry�this permit until final inspection. a 1 ' s'/' _ f,c - / ? 0 -I.natt aOfLegal Owner(s) -= Date `s- And/Or Authorized Applicant Date CODE 4 INSPFCTION TYPE OAI )NTnpLS CODE! INSPECTION TYPE DATE INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing JJ(( 200 Final Re-Roof 210 Final Electrical lJ/ 7/ 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 2446-46 City of Costa Mesa MEASURE "G" EXEMPTION • Plan Check # 115-89s Exemption # 89-305 Permit # Case # Address: 2832 Shantar Unit: Applicant: Rudy Galouio FACTS: P Residential I I Commercial/Industrial ❑ Other Existing Lot ❑ Not Part of Larger Project Project Description: Legalization of existing 12'x18' family room at rear of a single family residence No. of Dwelling Units one Gross Floor Area NA Square Feet F.A.R. NA Estimated Traffic Generation: NA Avg. Trips/day FINDINGS: The above described project is exempt from compliance with Measure "G" for the following reasons: ❑ 1. Project is a commercial/industrial development which meets all of the following criteria: gross floor area is equal to or less than 10,000 square feet or has an average daily trip generation of less than 130 daily trips, has buildable floor area ratio of less than 0.5, on an existing lot, and is not part of a larger project. n 2. Project is a residential project of four dwellings or less on an existing lot. Pi 3. Project is residential construction that does not increase the number of permanent housing units on the parcel where the construction takes place, such as remodeling or rebuilding of an existing house. ❑ 4. Project is commercial/industrial construction that does not increase the footprint or square footage or change the use on the parcel where the construction takes place, such as remodel- ing or rebuilding an existing structure. IT 5. Project is a public benefit facility, which is defined as public libraries, public administration facilities, public parks, public utilities, and religious facilities. n 6. Project is a facility serving the health and safety of the people, which is defined as hospitals, police, fire and safety facilities, and schools. Exemption ratified by: • Planning Commission Date March 13, 1989 City Council Date nollim 1648-30 ' I Z G Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 70' )C 'oO r c'`'"305 • PERMIT NO. TRACT NO. LOT NO. , UNIT NO. • CIT:�OF COSTA MESA♦11CONSTRUCTIONDPERMIT I Ifs 913 CO ¢3 _ A.P.# 39 Ckj 3 _p I Zone g ( Project-Address 2 CJ 3 5 f� /V TAE\ PR q 77 R l�]] p S Main Building: Accessory Building: , Applicant's Meiling Address / J S s 11714 U 0 R TYPE OF CONSTRUCTION U NEW ADD U ALTERATION U REPAI R -.--" hj/OO�p' ❑ CONVERSION ❑�7 DEMOLISH ❑ OTHER ' T Front 0 tit,.`Jr � O Owne.'s""Name -n ONrYN /4- .S��� �j/ phone7P// ] l / D D SCRIPTI N GLF RK/USED BLDG. A Rear 31 / Cth Er N Address 7 �2 SJ/A K TA le PIC -me. • C Right ILC( Srr N Arch/Eng. License No. TYPE OF RMIT GRADING FOUNDATION ❑ STRUCTURAL K G Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL i S. Left ZZ / ja❑ OTHER Ping. Ref.# Parking Req./ProvidedContractor's Name Phone r� • -90 ( 6 PROJECT DESCRIPTION SO. F7. �I L0�4 d TIONOCCUPANCYL(.2--3 ' inonto Notes: �� X '� r'Address Imailin 1v VALUATION$ &W [i-] g I rjCONST RUCTION TYPE 1 // � /�City License No. ZONE GRADING CU.YDS. ACRES f•3n t6 (Corn -(eks+)V1o5) �— 0.tl Z.Q�f !0LICENSED CONTRACTOR DECLARATION //�� DC /f - 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: (tD�" 4- pts Ft I.o1 \ ar� ..... -j�# ' 1 with section 7000) of Division 3 of the Business and Professions Cone, and hiss '��^ my license is in full force and effect. pL 11.– IL - —89 5 s Date Signature ELECTRICAL FEES License Class License No. PLUMBING "i1 FEES Automatic Washer Transformer 0 15-50 KW ;, — • WORKERS'COMPENSATION DECLARATION , Construction Pole Sub. 0 50+KW ' hereby affirm that I have a certificate of consent to self-insure ora certificate Bar Sink Showers • Yorkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps 0, Lab. C.) .-. • "s Iicy No. Company Backflow Irrigation Sewer Ca 'e,. Dishwasher Meter Dover 100 amps Cap.. _ El Certified copy is hereby furnished.-' !' Dryers ❑Gas ❑Electric Sub Panel • certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant Fan Motors❑0-1 HP ❑19a-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not b¢completed if the permit is for one hundred ($100)or F.A.U. Inc.Solar ❑9-15 HP 016-15+ less). Dishwasher Solar Piping ,� I certify that in the performance of the work for which this permit Is Issued I - shall not employ any person in any m. ner so as become subject to the Drinking Fountains $Ola(Tank • '' • FI%tures Microwave Workers' Co ens La sof Cali -1!`7 /,�� / Device Boxes Date __-�,FZA-- iignatur OF tear ` Floor Drains Swimming,Pool w/Spa Pole Light 1 ' NOTICE: If aft g m king this decl �1fj1' ion�,'y0'u"_should become subject to the - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal • Outlets Range • t. comply with such provisions or this permit shall be deemed revoked. f Switches CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign 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. C.) Interceptors - Water Heater Garbage Disposal Standing Sections Lender's Name Generator ❑0.5 KW ❑5-15 KW Trash'Compactor Lender's Address Kitchen Sink Water Service OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' Auto-Wash n following reason (Section 7031.5 Business and Professional Code: Any city or - county which requires a permit to construct,alter,improve,demolish or repair P-Trap • Laundry Trays - 1 �- any stru ign, prior to its issuance, also requires the applicant for such permit' __ signed file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapters(commencing with Section 7000)of - -"vision 3.of the Business and Professions Code) or that he/she is exempt - Reinspection Fee I $15 Issue Fee • $ 3 •efrom and the basis for the alleged exemption. Any violation of Section 1.5 by( any applicant for a- permit subjects the-applicant to a civil - DEVELOPMENT SERVICES REQUIREM Nj$��r, .alty'of not more than five hundred dollars($500). 1! O U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3' ' Zoning Approved By ' Date 2 compensation, will do the work,and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date '� License Law does not apply to an owner of a property who builds or Improves A. /� p thereon, and who•does such work himself/herself or through his or her own Application Issued By / • Date 3� v�� / employees, provided that such improvements are not intended or offered for Boiler - Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ t7ry SIWIMARV Ot7 OF FEES (,p' ,�.t pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground 1 It. Refrigeration System prove for the purpose of sale). - BUrLI INA RE R(v11T SMIP 't5�" I1 0 I,'as owner of the property,am exclusively contracting with licensed con- Duct-Structural PD.DpLAN CHECK $ SZ��• PERMIT tractors to construct the project (Section 7044,Business and Professions Code: -r• The Contractor's License Law does not apply to an owner of property who. Duct-Ventilating 00-100,000 BTU ❑100,000 BTUPLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such oro sects with a con- - tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration _ PLAN CHECK 25% $ _ _ ! ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ _ GRADING $ ❑ I am exempt under Section - B.& P.C.for this reason Fire I/Fact.Bit. ICBO# Fire Dampers PLAN CHECK 50% $ / . p - Rte.MICROFILM $ •�� Date _mo o Owner rt / Heating System& Ducting Registers • MECHANICAL 1 ��8L I ftereby certify that I have reads a Iication and state that the above ❑o-100,000 BTU 0100,000 BTL - $ i •TOTAL FEE $ Information Is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of this ci to enter upo the above-mentionedpro erty for Inspection purpose ��T�� Signature p•W�s/ Dat e_ ' Drivers' License o 55# Reinspection Fee $15 Issue Fee $ 3 o s. . ACCOUNT 4: 1174021702 0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor 01 0001 001 0002,494-00029496 f ?/70/OO nI Pit Timm no ')t .�. •\4. -r.-e•-�...�. -. T,r•. .--.'..w ....+..v a . .sem.. . CONSTRUCTION AND PLANNING POOI PA Date Inspectorbate -Inspector 1" - APPROVALS Permit# - - APPROVALS Permit# • 1. Temporary Electrical Service or Pole 52. Pool & Equipment.)_ocation 2. Soil Pip -Undrgrnd. . . 53. Steel Reinforcement ` ' r 3. Electrical Conduit Utility-Undrgrnd. - ` 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • ,.5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • . 6. ;Electrical UFER Grnd' 57. APPROVAL TO COVER-GUNITE L. ( 7. :Footing s 4 58. Electrical Conduit-Undrgrnd. -f " 8.'Foundation - �/ ,, 59. Gas Pipe, 0 Undrgrnd., Test . I' 9;Water Pipe-Undrgrnd. • 4 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '- 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final ' 14. Rough Plumbing , 65. Electrical-Final - •, • 15. Rough Electrical-Conduit 66. Solar System-Final 1:6. Rough Electric Wiring - 67. Fencing & Access Approval 17'. Rough Wiring Sign 68. APPROVED FOR PLASTERING /Ir} t8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL %9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '20. Rough Factory Fireplace _y„ - APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test •• 72. Underground Flush 7.24. Roof Framing 511 73. Undergrnd.Storage Tank•DGas OOiI ti-_1 • 25. Roof Sheathing 1. S 74. Overhead Hydro - 26- T-Bar Ceiling (Structural) & Monocoat I{/ /yf/yy/� 75. Dry Chemical ' 27: Frame and Flashing „ • % /��i/R7 76. Dry Standpipe ' 28. Lathing & Siding r -/Y 9' 77. FIXED SYSTEM FINAL 29. Insulation ..- 78. FIRE PREV. FINAL 30: Drywall NailingH- HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat IC) 79. FINAL INSPECTION 32. Electrical Power Meter`Final-' 80. FOOD CERTIFICATErrISSUED '33. Final Electric •-t • 4_',;' ` Notes: (o/41 t7- - c).4 , 34. Final Heating & Air Conditioning i r c /� 35. Final Gas Pipe-Test ',- V! 'v r 36. Hood or Canopy 37. Final Factory Fireplace , i • 38. Final Plumbing - 39. Water Service-Final • 40. Gas Service-Final k ,'; 1 _-_• 41. Solar Domestic-Final . n “1.1 42. Backflow Preventer-' 'r 'fit. - 43. Backflow Irrigation' _ r i 44. Landscape Irrigation System c4.i 44 __ /l. it� 1.-n - ' 45. Sound Attenuation • l� 46. Han'yiicap Regulations• r 47. FINAL STRUCTURE& BUILDING , 48. Special Requirements Completed l / ' 49. Electric Release to Edison , i _Uj ' 1'750. Gas Release to Southern California Gas Co 7 51. CERTIFICATE OF OCCUPANCY /s rr' -fn! No. Date . . LIMITED STATEMENT .iF RESPONSIBILITY Bldg. Permit # TO WHOM IT MAY CONCERN: This Permit # a �� �N cria rN c Street Address AP Number 1, \)0 NI M A AS\-1. r / , as Owner in Title of the above referenced property, do hereby authorize: Name Telephone No. 2/ S 717%to e(Y//J�i� `Street Address O1! "r-imaig cS ate Zip to obtain permits in my behalf, as owner/builder, for r0 0 B �j 1��1 i o 12 N2 C. (Y) . C0.. 926Q S at the above referenced property. Should any person become an empinyva engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be-filed with.the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. nt N ASy 1, r Printed Name / Date PA) 1 n �C -51 Signature • 0779-46,rev.6/67 CERTIFICATE OF COMPLIANCe. PAYMENT OF SCHOOL FACILITY FEES °��9� . NEWPORT-MESA UNIFIED SCHOOL DISTRICT • / adily/ Developer/Applicant : lc ( 7-- Address : 2 3 ) i 4% , 'L. f� (s C � . l ei'� 924 Telephone Number : 0/ (053/ 67 "7 ( 'T 44 Tract/Parcel and Lot Number (s) : Location of Project : 04.-794 ( Number of Square Feet of Residential Space .F3471'e7 x $1 . 50 Total c570e Number of Square Feet of Commercial and Industrial Space x $0 . 25 Total Commercial/Industrial Project is : (Check One) Mini-storage Motel Preschool Movie Theater Bank Auto Repair Racquet/Health Neighborhood Shops Hospital Warehouses R & D Large Office Heavy Industrial Hotel Office Bldg . Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food The provisions of Government Code Section 53080 are not applicable. This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995 . e Checks are to be made payable to Newport-Mesa Unified School District . Bness Manager Newport-Mesa Unified School District The above representation as to square footage is true . Developer/ Applicant agrees that if it is later determined that such representa- tions are not true then this certificate shall automatically terminate and the appropriate` City/County shall be notified . Date : 2 j CPA)-11 L� . / lo he /Applicant ye u d y 6-H4 tt t.i o OWNER GATZKE, HERBERT"K. DATE NOV 7 1963 JOB ADDRESS 2832 .5hantar Dr. BUILDING PERMIT NO. 20963 GENERAL CONTRACTOR Owner-Builder VALUE $ 924.00 AP No. LOT 1 TRACT 14399 FIRE ZONE 3 DESCRIPTION OF WORK Add PatioToRes. • I 'CTIONS Signature DATE GROUP d TYPE V ZONE Rl St_ PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Com. Refrig. ❑ Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous _ Prop. Swr. Line O House Con. 0 St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power ❑ Rough Wiring Trenches U- Forms K1- Steel Reinf. 0 'F,4,7 >,Z •//-4;; Floor System Bond Beam 0 Steel Reinforce ❑ _ Sheathing Frame and Flashing al* Lathing—In Out 0 P' ''r, brown coat E . ❑ Air Con. ❑ Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final �}- Building, Final ea_ �,A' t 0J —;1. I _ OCCUPANCY i Form BU4-5M-3-63--S-13 P 20965 • 20963 I FEE RECEIVED NOV. 7 1963.. COSTA MESA BUILDING-SAFETY DEPARTMENT . P.O.BOX 517 COSTA MESA.CALIFORNIA FINANCE DEPT. . ' CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING )/ ' 1 �p For Office Use Only ADDRESS .>z 83.R `J/7/7N I / ) IL_ Lf ' RECEIPT NO. SGjyy¢({gw COSTA MESA, CALIFORNIA ��� ///III C/.IlJl lldl!MIVf J �j�] K / / ' / RET„,, /ITT R EG a. DATE ISSUED6 OWNER EtrgUt��� C/AF7_frt VfT / / //r✓1 77 3 MAIL (`�( �7"��. I�-yy 1, ,BUILD ADDRESS g 3 1 �l tfri i//f2 .IJ IZ ADOR q/1 n,� �/ p� FIRE CITY L 03779 ma-3 No.SVO-7/II ZONE TYPE OU APPROVED ARCHITECT NEL. „ BY DATE W OR ENGINEER O AlN Z�� NO. IylNftl/p / ` ZONING ADDRESS . i . Z^yr�•,v► I NO.OF .I I USE OF NEW /I`V� 1 I PLANS vl BUILDING U CONTRACTOR o tug✓; r 80,_DC- /Z Il 1 .//--,(//'� DESCRIPTION L__e Y 1/ : / Fes, 11. ADDRESS ` %�7YIt (_ //// CITY A.P.NO. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL. -. . 50"TO SIDE @ REAR P.L. LIC.NO. NO. EAVES SIZE 7the IAO I NONLOT OF BLOT / NOWALLOWED (U.B.C.REQUIREMENT) OF YARDS APPROVED YARDS APPROVED U%ISTSEOING F BLDGeItJ`ID ED C` MAIN BUILD IN ACCESSORY BUILDING E . L�,. (FROM C/L STR !� L/ SETBACK LINE FROM �/ REAR YARD FRONT '` r l'-� FT. ' CENTER OF STREET a D /// SIDE YARD I LEFT LJ I RIGHT S , R.SIDE )7 FT. FT. DESCRIPTION OF WORK L.SIDE .I n FT. Fr. NEW ALTERATION _ ADDITION x REAR FT. FT. II -DISTANCE BET. BET.MAIN @ REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING (6/ �X� NO.OF / VAR.# / DATE SIZE 6 V i3 ` ROOMS — STORIES / C.U.P.# _APPROVED EXTERIOR WALL I ROOF kf��i `% APPROVED// // 1 ATE //r 9rt3 COVERING COVERING . d . IV'/SAV/// (�`/./A (( USE OF,BUILDING AND WORK TO BE PERFORMED ' y�I 7/9�a �O r .— VVV / /..jf- .�D�-� N SQ.FT. CLGL (G�KZL 7. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER ALUATION IS FOR THE F AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORD MINCES AND ST TE LAWS R' •ULXONG VALUATION / m BUILDING CONBTRUCTJ� f / PERMIT FEE S `42 SIGNATURE OF '+ I S PERMITTEE - ///]]]��f �� $ /// , LA CHECK0 AUTHORIZED AGENT , / 0 i' E ‘. TOTAL FEE 1 OWNER PACESEr�,R WEST JOINT VENTURE DATE � '2 tHF JOB ADDRESS 2832 Shantar Dr. BUILDING PERMIT NO. 17900 GENERAL CONTRACTOR Andros Land Co. \ VALUE $20,112.00 AP No. 139-1+03-01 . LOT 1 TRACt3119 FIRE ZONE DESCRIPTION OF WORKRES.w/att.gar. -TSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R-1 1 yuc // "' PERMITS ISSUED SUBCONTRACTOR Was P AT /..2.-W- ,.% DATE NUMBER I Water j. W 4A-W-G 5i - , Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating J- i y` 1.2-.27-4,:z. ___,/e go Rough Plumbing - f� 'a�eai7 . 'i ,,. i ,'-'-e a sq_4_ 7 Miscellaneous / Prop.Swr.Line a-House Con. [}St.Swr. ❑ e_./( // u_1;, t ( -k A_„-,C. t , , - /1/10i142... /r`I 4 5--s5 _ _-yo Sprinkling System .z ,P I Construction Pole / i�^'�' Underground 0 Power,_r] �/' �'��ti��J Rough Wiring - r /2-754'7 'l 4,1'< c. '/” Z2:17 6.•:- Trenches ❑ Forms ❑ Steel Reinf. ❑ J'L1_ /J-(- 7 r Floor System ,f114_1L-1,3t.is Bond Beam ❑ Steel Reinforce 0 . Sheathing F.174 j234..- _ Frame and Flashing ,�. / j-4 -4.1Lathing — In 0 Out i cy J N[1 J i 1-114 j / P�Qster, brown coat / P1 '2,..•-r, _411 / g. U Air Cond. 0 Final ' .ing, Final F-Pe1?-7760, _ - PlumbinFixtures, Final // �,� g / 5- // . / "//' —,m---7- -!:•:.Final Gas Test i, Electric Fixtures, Final ,/G ` �' �i 1Cr Building, Final 3 Y- /-f -3 - OCCUPANCY FORM BU4-5M -,7.61 1acx,n I 17500 FEE RECEIVED CC4TA MESA BUILDING-SAFETY DEPARTMENTOCT 1 1962 P. O. BOX S17 COSTA MESA. CALIFORNIA \t/ yy'F�yIINANCE DEPT. For Applicant to Fill In Completely APPLICATIOMFOR PERMITA MESA TYPE OR PRINT BUILDING AIDLRDEISNG // O2�2_ G li/i��12 •ez- COSTA MESA. CALIFORNIA// __ )T ��-���/.T� For Office Use Only MIT NO. OWNERAis/2+7?ZR {�u.a7 Jr-/E,/V/it/v7_,--e• I RECEIPT NO. I //PER7OO MAIL I �� /�/i�, n /�' RECEI ED BY DASE g FAI �/I IASS l4F�2 ADDRESS ��A /I ,nIYI�/ �7 EA"Y yp (^/ C/ LIp/' �{IA,y// .ift ,( �(%er,O4 �v(F.64 NO. ADDRESTEL. S �O Xf-LC u srr'.` Oly[/ CITY / / ARCHITECT /../��( / / TEL. / COSTA MESA. CALIFORNIA OR ENGINEER ^L�f/bl/,I��g C.1/ NO. ��// y/ ADDRESSEE//✓. FIRE ZONE TYPEV GROUP Imo- I CONTRACTOR A/v171Zo9 L4NO Z0 . I APPROVED G 2 ,}/ �1 A BY DATE ADDRESS /64 ) /VF//VIIet4 ZONING �p ZON l NO.OP2 USE OF NEWS n 7+y)rev CITY • / I PLANS BUILDING/oXL //,�����I��- STATE t�7 /G 6- TEL �D 34���� LEGAL �/ / LIC.NO. ` NO. DESCRIPTION l-iitL'/ Q SIZE w�J^ NO. OP SLOGS. l./ / OF LOT / / '( �©6 NOW ON LOT A.P.NO. /a ' — 41O 3 — 0 / USE OF rA�' YARDS EVES EXISTING BLDG. G /T �� APPROVED ALLOWED NSETBACK LINA FROM / ,4t ... (CENTER LINE ST.) _ CEHTER of S BEET �� REAR YARD"/% FRONT FT. IN. SIDE YARD I LEFT40I RIGHT R.SIDE FT. IN. DESCRIPTION OF WORK L.SIDE ,J FT. IN. NEW I XII ALTERATION I I ADDITION REAR % -S FT. ---- IN. REPAIR I II MOVING I DEMOLISH 7---- EXTERIOR �- BYF'ROVED_ //I�Q DATE"1/41-942--- B ZE BUILDING Iqh�„&.-71 NO. OF ROOMS ` STORIES WnAT D� COVERING WA�j�II/e, I COVERING *71/ 76 USE O BUILD N AND WARK TO BE PERFOR, ED I bI a ' i. adr L.• � - ifesnJe21;, � /8701 '' d✓ - Co 6 fl I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATIO IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH AL . ITY ORD] NOES AND ST. E LAWS REGULATING BUILDING • S -uGTIG./ / VALUATION // FO SIGNAT n .:P' / PERMIT FEE S �b.' PERMI (�� / -� r o-O �O / $ o?O� //07, PLAN CHECK 5 3 3. E AUTHORIZED A /N r ✓a` / ' . .. /._ ,. � - TOTAL FEE 5 99 •�°'