HomeMy WebLinkAbout2865 STROMBOLI RD - Building Permits 4c � n . CITY OF COSTA MESA
y- 4,_A, BUILDING DIVISION PERMIT NUMBER
1..
1 ".""y' ' DEVELOPMENT SERVICES DEPARTMENT
. . PERMIT
' w.mm .. BO0-00469
•
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2865 STROMBOLI RD Status: ISSUED
Suite: Applied: 04/13/2000
Vicinity: Issued: 04/13/2000
Parcel Number: 13942124 Zoning: R1 R1
Applicant: FRENCH, LEONA I TR ISSUED BY: �/1'J�
Address: 2865 STROMBOLI RD v
Phone: 714-549-1880
COSTA MESA,CA Zip: 92626
•
Owner FRENCH, LEONA I TR
Address 2865 STROMBOLI RD
Phone:
COSTA MESA,CA - Zip: 92626
Contractor:
Address:
Phone: •
-
lt
Zip: _ License:
Arch : Eng:
Address: - - Address: -
Phone: Phone:
Zip: License: License: ,
SCOPE OF PERMIT
TEARR OFF AND REROOF WITH 28LBS BASE SHEET AND TORCH DOWN"PATIO COVER"
FEE SUMMARY
Plan Check: $0.00 . .-i Cals Valuation: i $1,500.00
Permit: $54.00 i Claim Valuation: $1,500.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $54.50
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
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
DECLARATIONS ("`
WQRKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: , 1
❑ 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 Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# _ _ _ _ Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed 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(5500).):
❑ 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.).
09 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:
`igna u�re3�.s-o.vw-au CDatgb Q P JLX k a a ro-�
Owner ID verified by driver's license. G❑,fas 0 No (DraVer'sticense'Non v Expires;_ 9— /2"a(It
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 Califomia 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 ❑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 0 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 ❑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 ermit 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 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? ❑Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). -
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection.
a) O.
re Ofte
signatugal.Owner(s) Date
And/Or Authorized Applicant Date
gags INSPECTION TINTMALS CODES INSPECTION TYPE QEF. INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 51. A2 06 ` .u-' 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
244646
•
*��'w CITY OF COSTA MESA
.a BUILDING DIVISION
t, I DEVELOPMENT SERVICES DEPARTMENT ,M98-00274
PERMIT V PERMIT NUMBER
P
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2865 STROMBOLI RD Status:' ISSUED
Suite No Applied: 06/25/1998
Issued: 06/25/1998
Vicinity:
Parcel Nunmber: 13942124
Applicant KITCHELL, KEN
Address:
Phone „..----r---, - _
ZI -
Owner FRENCH<LEONKI\-TR t `V. 1 , Ott li' 4 ���r��
Address: 2865 STROMBOLI•RD _ / /
frj'v/ ^ /1 ,_; i. i�L_,.--Lilt / ,, N
/ J/ \ �% /.---Phone :- -�.;'.\` /^..�
/COSTNMESA,,CA) ) < Zip: 92626 �� �( ��' \\N
Contractor:/ ANDRUS'PLUMBING & HEATING v`
Address: 855'G-.._,/ T �1
/'t7 Phone: 494-8096 �� �� � � .
iii
�'
/) LAGUNA..HILLS,CA Zip:a�si!!92651 �h \ �.� \�\\
�'� /r � License:/'249778 i i -zC - ���r ; - �A\
Arch IEng-: f i ---� ",, i t� i I i { Ani, S
/ /TT-
l f, 'r' �, 1
/ �Address.) � 1 t c 1 y�� 1 `� i � ' � � '
(}(/ �~ ./1.. ; r - .,may- I (
�I !( �. � / f �” )Phone. '- --6;;AY - /)1 '+.�� mss, I 11� � �` i� / i ,. 1/ _' til Zip `-- \ , i14j� � i rl,Ff�. ,{�/, ;.-.�°.- - License' --:.))/V7 \ { � 1
{11 l� ',/ t \ ,.7----, c�\ ' ''l�V' ',,
t 2 r' c - SCOPEOF.PERMIT-.== a'i , ' ( ' '.\ '
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i(4 �7 ItL_ 'R/R EXISTING FORCED HEATINO,UNIT IN GARAGE1i'i . 1 'v 'Jr;,L yam„ I
i iI t 9I �),� di aJil-bt Mull '‘ _
I 1f„PI FEE SUMMARY0. '1
\I \ 1 c— (\, s 1 Quantity�..�'f 6i' -..t:•,. C 1r<—,,,,• ---Quantity
4 IT.--- 'c,Zz., I
ISSUETEE \ `,'1/\.: 1, $22.00 r=� - _ `- - Repair/AR Absorbtiom Unit /', $0.00 0 lt1
Inst FAU' 100 k BTU ��,( $13 25 r - -- •--Repair/'AIt,Refrigeration Unit i� - / $0.00--'0 /
Inst FAU>100 k BTU \`\\if\ $0.00 Ventillation System L // $0 00� 0''t�'
Repair'/Alt Cooling/Haag`\'}\ $0.001 0 Evaporative Cooler -• �, '$0.00 0'1'
Inst/Rep'Recess Wall Kt? h $0.00 0 Commercial.Incinerator /2/,,, r$0 00 di,
/t
Refrig Sys<t00 k,BTU ' \\:16,\ $0.00 0 Domestic Incinerator � �,F$0.00/0'
Refrig Sys>100 k BTU $0.00 0 q,Compressors/Absorption Systems /7.,., V 7 //
Gas PipingV'J� \,-� V \ $0.00 0 �,p, Al ::,Up to 3 hp/100 k BTU /,%5,2 $0.00 /0
Factory Fireplace N, ��\$0 00 0 k tit t r - :3 To 15 hp/500 k BTU • /IC, /7 $0 00,/,/0
Hood w/Mech`Exhaust � ��$0 00 0 j"�'�A' d5 To 30 hp/1,000 k BTU i-�i ”. $0.00/ 0
VAV Box Vent Fan/SingleD`uct ,/,'� $0 0020 $.. l .`r� .,),N,c .Overo50 hp/Ove501 750 BTU�: ''\N $o.o0 0
Appliance v " - / ',/,:$0.09,:;;M:>•,:-:: �' ,'•-'l ',X: e- ZBoilers < 'a 3�./ .'/ V
Fire Dampers \ . ''' /,$0 00 0 -::•;- <-- r:!'`.•/' '` N .4Up to-3 hp�` " ,,,,-;,\V,,2,) //‘, $0.00 0
Smoke Dampers �
Inst or Relocate Appl Vent , - $0 00 0,^-.. _ —_15'to 30 hp _ \ --C. �;'�/ $0.00 0 •
Air Handlers< 10000cfm �$0.00 /0 ,..) r 30 to 50.hp, \ �',� � $0.00 0
Air Handlers> 10000cfm .,- $0.00 00V� rc y i --,i�r-Over 50,hp-1 A- ,, .----,-/„-' $0.00 0
Floor Furnace x'$0.00->0 -. ' - , -Other Mechanical"Fee--.7, '
Floor or Suspend Heater $0.00., -6,f---- _ -- ! - . \ . Investigation Fee " i„+.:'. - $0.00
'' C >:"- ^ .,.-.•: a 1..• ,PIan,Check Fee -1 $0.00
- - - -: =- Reinspection Fee $0.00
TOTAL CALCULATED FEES $35.25
COMMENTS/SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
fora 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 '
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: •
I hereby affirm under penalty of perjury one of the following declarations: • '
•
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carder and policy number are:
Carder: 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 p ormance of the work for which this perm j(is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of alifomia,gIy agfeel�/bat i I s /b//orF(�S(Ibject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
oomph/with the e pr Bions. '�"xll t)/lY6 -2s-- s
Appli�id3fgheture: n t < 6 [T�te:—
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS NLAW FUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,MD ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licen ed under p sions of C pt r co�J^ep i with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect. c. F A • 0 J/ //// Class A
Contra t�signature:{r<Tyn ti 1 Y pte: �1 —02,St q�+
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: - Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031,5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completIon,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property,-am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by 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,wit 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 Safely Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII 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).
12 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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 Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No
6 (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.1 agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property
�for
{sinspection purposes.I agreegrnot to occupy or allow occupancy of any building authorized by this
pemit untilpfinal inspection.
�ga lf9 I^J / to
And/Or Authodzez_pplica t r ate�
CODE I INSPECTION TYPF DATE SEALS Sggf INSPFCTInN TIFF DATE =ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical 16 fly PT
1266 - PooPSpa 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
2446-46
rr - - • - Applicant to-fill in.all spaces except those within heavy border-lines and-sign all-appropriate declarations. - . -_ . _ . _ _ - •
-
1CITY OFCOSTA M�ES7A,�7 ONSTR UCTION PERMIT PE T NO. j� : . TRACT NO. LOT NO. UNIT NO. I 351 0 ' 27'050 TL
oGCS&& S`Trorrl6oC y k1Y. • 0�37�(1 . • •
Project Address vv�,J - ' ' _
Applicant's Mailing Address a40 � Si • (4m eQTo f/ _ ,•7 TYPE OF CONSTRUCTION- ❑ NEW Li ADD U ALTERATION LJ:REPAI R - ^" ^ "• ��ArTL
r z�, '❑ CONVERSION ❑ DEMOLISH '❑ OT ' - i - .
Owner's Name dry �✓r4avC/1 ' J'9;V8'� A.P:# - Zone '
(ps �7Tb�n'16pCr �d nno SPhone DESCRIPTION OF WOR K/USE OF BLDG. e^�"�a _
Address ` TQ Ad e)4 _ : 1 S Main Building: , Accessory Building: -
Z
Arch/Eng. ^t- License N0. TYPE OF PERMIT ' `❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL • T Front• -- "
Address /J' eeopr'../ -Cor - - _❑ TENANT ❑ ELECTRICAL •❑ PLUMBING ❑ MECHANICAL BA Rear - ,_ ,- 'k N
Contractor's Name / _r. "_ S - j 37.15 - • OTHER • -
Address(maliingK41•196'" 5 CMM edit' Phan14Cq 7 . PROJECT DESCRIPTION Sqg./T. OCCUPANCY� C Right - - N
City License No. ���� • �' CONSTRUCTION TYPE e C.'S 77 VALUATION$ J/ °Oa S Left • _ , R j
ZONE GRADING CU.YDS. ' ACRES Ping. Ref. # i Parking Req./Provided • E
LICENSED CONTRACTOR•DECLARATION _ .. - • - - • Q
l'hereby affirm thatI am licensed under provisions of Charter 9.(commencing i Remarks: 1 I I 1 , Panning Notes: • _ M
with section 7000) of Division 3 of the Business and Professions Code, and • ' - ' ' ' T
my license-is in II f ce and effeC I - • - C
[- • S I
Licen e Class •- se N `� - ,
Date /ref C SignaturenkM .:..i- PLUMBING• ' ,• FEES f (a i '
•goRKERS' COMPENSATION DECLAR f'IO 1 1 '
Bar Sink . Showers 1 I ELECTRICAL FEES
ereby affirm that I have a certificate of consent to self-insure or a certificate • 1
'Workers' Compensation 'Insurance,-or a certified copy'thereof'(Section- -" -' !' -1 - - -- T - ,
..800, Lab. C-) ' 1 Backflow Preventer Service Sinkj Automatic Washer Transformer 0 15-50 KW
Policy No. • ' _ Company Backflow Irrigation . • Sewer Ca 1 i 0 50+KW 1 '
P Construction Pole Sub. .�
BCertified copy is hereby furnished. -
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Oup to 100 amps
EateXE • Applicant ' - - r . Solar Collectors . _ - . _- .Dishwasher .I . ':Meter- I
EXEMPTION FROM be cpm leteCOMPE NSATION DECLARATION - - - - • Clarifiers .f.. .__ -' - ...�_- ._ .. Dover 100 amps•i _--;- 1 -. - -.
(This section need not be completed if the permit:is for oneihundred ($100) or , - ,
less). • 1 Dishwasher ' . . Solar Piping - - Dryers ❑Gas ❑Electric I Sub Panel --
I certify that in the performance'o •• work for whi• is ::rmit is issued, 1
shall not employ any person in my m.•ne . . 0 •••• - subject to the Drinking Fountains Solar Tank • I • Fan' 1 Motors 00.1 HP 01 c t 8 '
Workers;Co_mpen 7}ion Laws of •er •r : air - •
Date 4C_..a - erg,- Signatt r. —!1 '. ;ie. - - Floor Drains: i Swimming Pool w/Spat ' F,q',U, Ina Solar 09-15 HP 016-15+
NOTICE:If,after making this des-lara in, y• ou be�•me subject to the - _ - _ _ _t • _ -
Workers' Compensation provisions of the !.:or Code,-you"must'forthwith - Flodr Sinks Urinal. , -' e I i •
I Fixtures 1 , 1 Microwave
comply with such provisions.or this roe it, shall be deemed revoked: ' ' '
CONSTRUCTION' LENDING AGENCY • t Gas Service 'Outlets' Water Closet Device Boxes • Pole Light
I hereby affirm that there is a construction lending agency for the performance - '
of the .work for which this permit s:issued .(Section 3097 Civ. C.) - -
Lender's Name - - - S Interceptors• r Water Heater Outlets Range
Lender's Address - • - ' - Kitchen Sink , - •• i ••• -Water Service ' Switches Sign • I I
•
OWNER BUILDER DECLARATION - - ,
I hereby affirm that I am exempt from the Contractor's License-Law for the I Lavatories i -Auto-Wash , Garbage Disposal ' i "• Standing'Sections ' 1
following reason (Section 7031.5 Business and Professional Code:.Any city or ' - •
. . -
county which requires a permit to construct, resalter,-improve,demolish or-repair P-Traci. - ' 1- - ,.Laundi' Trays ' '
.any structure, prior to,its.issuanee, also requires.the applicant for such permit - P - y y ' Generator 00.5 KW 05-15 KW 'Trash Compactor
Jo file a signed statement that he/she is licensed pursuant to the provisions of - - - i -
c•he Contractor's License Law(Chapter'9'.(commencing with Section 7000) of Roof-Drains - .. '
(vision 3 of the Business and Professions Code) or that he/she is exempt - i - - . I
erefrom and the basis for the alleged exemption. Any. violation of Section - - , i _ I , j ,
031:5 by any applicant for d permit subjects the..applicant'to 'a civil • �. •' - - •
•
penalty of not more than five hundred dollars ($500).- - i ' ' . . '$' I ,
0 I, as owner of the property Or.my employees with wages as their sole i Reinspection-Fee • ' I $15 c ' Issue Fee - 3
compensation, will do the work,and the structure is not intended or offered Reinspection Fee , '! $15 Issue Fee i 1 ' $ 3 '
for sale (Section'7044, Business and Professional Code: The Contractor's • ' , - MECHANICAL FEES -- - --• - - - - . •- . -
License Law.does not apply to an owner-of a property who builds or improves - - • - I
thereon; and who does such work-himself/herself-or'through his or her own - - DEVELOPMENT SERVICES REQUIREMENTS: ,
employees, provided that such improvements are not.intended or offered for Boiler ' 1 ' 1 . Hood or Type I 0 : - i
sale. If,. improvementyear ' Zoning Approved By Date
however, the building or enofproving is s he/shthin one of Com- , Canopy• Type II 0 I _ 1 ;
prove n,'t he owner will have the burden of he/she did not build or,im- Duct-Under Ground ' • ,• Building Approved By j Date
prove for the purpose of sale). , - I • I •
I
0 Lias owner of the property,em exclusively contracting with licensed con- Duct-Structural I Refrigeration System ' Application Issued By Date •
tractors to construct the project (Section 7044,Business and Professions Code: ,
The Contractor's License Law does-not apply-to an owner property who Duct-Ventilating- - - - ' 00-100,000.BTU•0100,000 BTU - •-- .SUMMARY OF FEE$ '
builds or improves thereon,and•who contracts for such projects with a con-. OFA
FEES
license pursuant to the Contractor's License Law). I am aware that • ' BUILDING PERMIT $ % T �• '- SMTP $ s Sb
( 1 I Exhaust System 0 Multiple ❑ System Repair/Alteration 1
proof of their Worker's Compensation insurance should be provided to' me. _ j PLAN CHECK 1 ' $ I PERMIT •1 , I '
Dai am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers 1 I I 'ISSUANCE $ - i
i i PLUMBING $ •' i '
Date Owner - - Heating System&Ducting . Registers • • ENE RGVP.C. $ _
I hereby certify that-I nave redo this x i PLAN CHECK 25%: $
pplicatill and state that the ati ces ❑0.100,000 BTU 0100,000 BTL - 1 GRADING ; $ '_
information is correct.,) agree to comply with all city and county ordinances ' 1 •
I ELECTRICAL $ - ,
ate I. • relating o buil. •g : [ruction, vand e-menreby authorize repre- • I i • 1 PLAN,CHECK 150%1 $ MICROFILM • $ ' j
tentative �jy�` ' •j• e er pan the above-mentioned property for I i `
inspection // , /i ' I ' MECHANICAL $ i TOTAL FEE I $ 1.27 co I
Signature V _ 1 Oate7 I
• _ i I Reinspection Fee x$15: } Issue Fee $ 3 PLAN CHECK 25%' $ •
Drivers' License or •_ - _ - ` /
CMF 0865-46,rev. 10/84 White - building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor V/
''' POO SPA
CONSTRUCTION AND PLANNING Date Inspector - Date Inspector. _
APPROVALS Permit# APPROVALS Permit# "
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - •
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement •
3. Electrical Conduit Utility:Undrgrnd. • 54. Forms .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement- • 56. Rough Plumbing & Pressure Test -
-
6. Electrical UFER.Grnd. • 57. APPROVAL TO COVER-GUNITE •
. 7. Footings . • t . 58. Electrical Conduit-Undrgrnd. •
8. Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. - "
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap .63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough"Plumbing - 65. Electrical-Final - -
-
15. Rough Electrical-Conduit 66. Solar System-Final -
16: Rough Electric Wiring 67. Fencing &Access Approval - -
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING -
18. Rough Electrical-T Bar'Ceiling 69. POOL/SPA SYSTEMS FINAL _'
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro .
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil , •
•
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil -
25. Roof-Sheathing . ' • 74. Overhead Hydro '
•
26. T-Bar Ceiling (Structural).& Monocoat _ 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe . •
28. Lathing & Siding " 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing ' " HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION - - .
32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: .
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test . •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing '
39. Water Service-Final
40. Gas Service-Final -
41. Solar Domestic-Final
42. Backflow Preventer - - ,
43. Backflow Irrigation - .
_J 44. Landscape Irrigation System
45. Sound Attenuation -
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING 5-_5-50 .
48. Special.Requirements Completed - -
49. Electric Release to Edison .- - -
50. Gas Release to Southern California Gas Co
' 51. CERTIFICATE OF OCCUPANCY _ _ - •
Na. ! Date - - -
`r 25640 .
•
("STA MESA BUILDING-SAFETY DEPARTMENT I CITY OF GS i A MESA
P.O.BOX 917 COSTA MESA.CALIFORNIA ��pp�p qq QQIp�
For Applicant to Fill In Completely APPLICAIRO BF9R'PERM
TYPE OR PRINT - BUILDING
For tart
BUILDING 12 il / SnipM n.O�
ADORES$ "LEl'X7 Snip Cbto
... . .........—eft PO NO.
COSTA MESA, CALIFORNIA
• ' /� y�`\ .p RBC yitoe,--BY O�AfTfr)�CEIVEp 14 D _z�G!
OWNER NDRN Ti 1V 'FOX' LL// ( ----L' �V
MAIL p.��^ _ BUILDING
ADDRESS �� aY W$ 681_,1' ADDRESS.
FIRE
CITY\ /� .�S/�O3 4 MGrt TEL.
NO. ZONE • TYPEn�IGROUP
ATp
ARCHITECT .... r
TEL. APPROVED BY
OF (NEER NO.
r ZONING
ADL..�sa �.�,U-✓
20N OF
/\ A MES �" •v 9-COI
�� I NO.OF PLANE >,...1I BUILDING
NE I
CONTRACTOR \��A�•�.�••�iF- / �` �� %
+�wM `/� LEGALt it
ADDRESS not, C�u DESCRIPTION / / l
CITY PJLoi A . 1 1 1 e- A.P.NO. / 9 - 1 a / -A y .
Q �` NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE 30-
JJ v - TE1 D to 90"TO SIDE @REAR P.L.
SIZE C3 . e4 7, Is •6SI _ EAVES • 1
No.OFBLDGS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT U/^,us- A.( l6/�j� NOW ON LOT
USE OF J .U' f+C.�B+� � YARDS APPROVED YARDSAPPROVED
BUILDING BLDG. V W�+��' NN MAIN BUILDING. ACCESSORY BUILDING
C/L STREET) (�
SETBACK LINE FROM FRONT I T/ x/
��" ��I 4 FT.
CENTER OF STREET REAR YARD f.� /
SIDE YARD I..LEFT RIGHT R.SIDE �/ A FT. L FT.
- DESCRIPTION OF WORK L.SIDE 2FT. FT.
NI _I ALTERATION ADDITION REAR / /FT. FT.
1 DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLDGS.
BUILDING NO.OF VAR.# DATE
SIZE ROOMS STORIES C.U.P.# (/l///////J ,'-APPfPRnOVED /''
EXTERIOR WALL I ROOF COVERING APPROVED C/1/✓Y' C%(��TE/ q_ V/_(
COVERING I�/ /
USE 2.Z BUILDING AND WORK TO?EPERFORMED
/
.�`TUHf` /l0-V�VFT`SC CZ-. %7-, /1\/e J . N
I SO.FT. o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. - PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. PERMIT FEE $ 1c - a
SIGNATURE OP ^/ ( O
PERMITTEE '��A MMt., Ana f)i //00 r 02
S
S; cc
AUTHORIZED AGENTA 1A
E
TOTAL FEE $
uwive'n FAtillS;r_. BURMAN Mtn 14-•••d0••00
kJOB ADDRESS 2865 Stromboli Road BUILDING PERMIT NO. 25640
ENERAL CONTRACTOR Costa Mesa Lumber DESCRIPTION OF WORKPatio COVer
AP No.149-421-24 LOT
TRACT FIRE ZONE VALUE $ 1,000.00
NSPECTIONS Signature Date GROUP J TYPE V ZONE R-1
SoilPERMITS ISSUED
Gas
SUBCONTRACTOR
IDate I Number Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con. 0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power O
Rough Wiring Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing _
Frame and Flashing _
Lathing—In 0 Out 0
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric,Final
Building, Final /kW I,/h,VC5
3'6 w;r,: 6'76ff
!/ , r`,..,„...ci, 1
18240
.. ._ . . .
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA COS
:1V23-61rFli#L,rD c7612 *it*11'250
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ARSr J 65I DM ha,/
R
//./COSTA MESA. CALIFORNIA For Office Use Only
/h( ,n_,-/ -�_� / I RECEIPT NO. PERMIT [! (^
OWNER �•Y/'/'jd]Il/`J .LJ�. L/.f'r}-n."/� - /(J/'Y)elC/JI
JJJ ///yyy��� Vic
! /
MAIL /%<�$ ////jy��� 1� /y RECEI D BY .DATE REC/gG� D V DATE ISSUED
ADDRESS/(JL)✓ /„ �G Vic I )/-/7-4-
/� /7E5'
/v�JrJ,/,/, ��yy // 0.i. . n COLO
CITY l✓.6 s rA2 , 'E L1 L A-Ctr No. 70396 BUILDING
-CT / - ADDRESS
ORAR/ EER C K' +-7E...-y/ i'Y Nom./71".33(.� COSTA MESA. CALIFORNIA
ADDRESS fj/�'% G Gyp , - /Y"N�. FIRE '/ �/,�/� ��
/' ZONE TYPE I GROUP l�..Y/l /
CONTRACTOR c5 -,7.43 � C,0N • Cor APPROVED
BY DATE
ADDRESS /1C3 /yl//v�CAL ZONING , �--
[n �{/ A ^_ ZONE NO.OF USE OP NEW d�/^^:�' '
CITY e&s TW- /�p',c-5 CA-r_/� PLANS 2 I BUILDING /�y////��
LIE TEL. LEGAL
C.TNO. /77 .3 NO. ,13 f/- 3 9r DESCRIPTION /r91t7 7 01/J•1/V'
OF LOT O X O0
I NO. OP,BLOTS. 1i1 4,7
NOW ON LOT A.P.NO. wV✓�
USE OF .--- YARDS EVES
EXISTING BLDG. /� APPROVED ALLOWED
SETBACK LINE PROM < V REAR YARD JJ' FRONT
/CENR LINE ST.) b FT. IN. `,
CENTER STREETPRO V t/ e/
SIDE YARD I LEFT. /V ` I RIGHT / , R.SIDE 7 FT. . IN.
DESCRIPTION OF WORK L.SIDE % LFT. IN.
NE I >CIALTERATION I IIADDITION 1 REAR 1(2, FT. IN.
REPAIR 1 II MOVING I II DEMOLISH ,L,/ ABYPPROVED (// L I ) l' /,�/
SBZLDING 2_2.)C ROOMS STORIES / L�11 I ���� 7 Y
EXTERIOR WALLS _ I ROOF a:/,le
COVERING "--+f}I ROOF
/Tr
USE OF BUILDING AND WORK TO BE PERFORMED
.[ytU FL c_L/V CP . Y77L,,/ _23C
•
aft 4, cid _-d1- 07.257 `d - re i0'
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ANCES AND STAT WS REGULATING
BUILDING CONSTRU VALUATION y.��
SIGNATURE OFJ --"mss PERMIT FEE S /
PERMITTEE /) '7 �j N
( C C' / / �^Q! $�3, 9607 PLAN CHECK $ /tel ��
AUTHORIZED AGENT /�'�/�W/i' 7 �a ¢
® ,. TOTAL FEE S //O�i u
,.----
------
/4f-