HomeMy WebLinkAbout3429 TIMBER LAKE - Building PermitsCITY OF COSTA MESA
.
� ` BYILDING DIVISION
F�p 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
�•q��* g FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BX10-00037
PERMIT TYPE B MISC STATUS: ISSUED
APN: TPN01003 DATE ISSUED: 04/02/2010
Zoning: , ISSUED BY: ��
JOB ADDRESS: 3429 TIMBER LAKE CM :"_ -• - _ Suite/Unit:
Vicinity: COMMON AREA Primary Occ.��"., � 32 -. Const Type :??
SQ. FT: 424 .:.-�Valuation: r; � $20,000.00 r' �'
SCOPE OF WORK: ' -
REMOVAL AND REPLACEMENT� OF,AN EXISTING�FREESTANDING-GAZEBO AND�TRELLIS FOR "VILLAGE CREEK
TOWNHOMES". - . � � -
RECONSTRUCT A 274 SF FREE STANDINGGAZEBO AND A 150 SF FREE STANDING TRELLIS LOCATED IN THE COMMON
AREA. r�=. � ... ., �
NO ELECTRICAL INVOWED. r
OWNER: VILLAGE CREEK'ASSOCIAFION' Address:: Unit
City/State: � Zip Cotle: : " .: _ -
- _
Phone: '� : . . -. _�. � _- ., _ _ .
�,,. _ . ... - .
APPLICANT: TOMAS, FRED � ' � ' Address: � � . � Unit
City/State: , , Zip Code: ,
Phone: 949-718-0368
� '; �: , � �; �
CONTRACTOR: VINYL FENCE pEPOT - � - . - License No. 836988
Address: 14700 OXNARp ST ' � ' . . . � � . . .. Unit
City/State: VAN NUYS; CA � -
Zip Code: 91411�";. Phone .. 818335-2486� � � ', �,-� Cell:
ARCHITECT: AZIZI, MASUM M �' License No. �'C24129 �� --
Phone 949-718-0368 � . � "� - . �� ..-
ENGINEER: FARHAD AMNSNADI-ESI-FME � .. �" " � � License� No: " C36840 �
Phone 949-261-1181 ��:... .. - . : - ,: - . -,
FEE SUMMARY -' w
Building Plan Check: -��'._,. �� - . , - $208.81 � �� � � � "'
Building Permit: � � , $32125 �� �4' � - �
Electrical Permit: $0.00
SMIP Residential � � � ��- $2.00 ��� �
SMIP Commercial $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $533.06
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am lhru 7:00 pm. Satrudays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holitlays:
New Years Dav. Memorial Dav. Indeoendence Dav. labor Dav. Thanksoivino Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 bAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
�equired inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will resWt in the expiration of this permit.
CODE t. INSPECiION TYPE
1616 Fixed System Final Fire Prevention
126s Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Facrory Fire Place
203 Final Sign
204 Final Demolition
OATE IN7171RL5 LODEN INSPEC710NTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
UATE IN7111AL
Z d �
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalty of perjury one of the following declarations:
❑ I have antl will maintain a certi(cate of consent to self-Insure for vrorkers'
compensation, as provided for by section 3700 of Ihe Labor Code, (or Ihe
e ance of the work for which [his permit is i5sued.
I have and will maintain workers' compensation insurance, as required by
section 3700 0! lhe Labor Code, (or the peAortnance of [he work fw which this
pertnit is issued. My workers' compensatjpn Insurence carrier and policy
numberare: ��/���
Carrier.
(Tnissertonneetliatbewmd 1�oihesp�eimGisvalu/etl—atrn/e'��und!ietlC�llais(5100)wleu�
Policy Number. � � _J � �Y l.V ! O �
❑ I certi(y that in Ihe peAormance of Ihe work for which Ihis permit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe vrorkers' compensation laws of California, antl agree that if I shoultl
bewme subjec[ to lhe workers' compensation provisions of Section 3700 0(
Ihe Labor Code, I�h��h these provisi�i �'� `
� V
Applicant'S $ignaWre 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 DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE L480R CODE. IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions o( Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, antl
my license is in full force and e((ec
Lic. # � Class # � �� �\
, � �� �V
onlractor s SgnaWre �ate
CONSTRUCTION LENOING AGENCY:
❑ I hereby affrm tha[ ihere is a construclbn lentling agency for the
performance o( the v,ork for wfiich Ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affrm Ihal untler penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or the (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construc[, alter, impmve, demolish, or repair any structure, prior to its
issuance, also requires Ihe applicanl for such permit to file a signed statement
thal he or she is licensed pursuant to the provisions of the Contracrors
LicenSe Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business antl Professions Code) or Ihat he or she is exempt �herefmm and
the 6asis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry oi not more than
five hundred dollars (5500).):
❑ I, as owner o( the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oflered for sale (Sec. 7044, Business and Protessions Code: 7he Contractors
License Law does not apply �o an ovmer of property wh0 builds or improves
thereon, antl who does such work himself or herself or through his or her ovm
employees, provided that such impmvements are not intended or oHered for
sale. I(, however, the building or improvemen[ 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 tor 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 contractas License Law dces not apply to an owner of
property who builds or impmves thereon, and who contracts for such project with
a contrectw(s) license pursuan[ to the Contraclas license Laws.).
� I am exempt under sec.
Business and Professions Code for [his reason:
SignaWre Dale
305]-46(3/0])
Ovmer ID veri(ed by tlriver s iicense. ❑ Yes ❑ No ��� �.
Driver's License No. Expires: '
� �—
Verification of Ovmership by (type of tlocument, i.e. - property tax bill or'deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I heaby certify Ihat no excavation frve (5) or more feet in depth into wfiich a
person is required [o descend, will be made in connectan with vrork authorized
by this pertnit, and ihat no building strucNre, scaf/Wtling, falsework, or demolition
or dismantling Ihereof, vnll be more ihan thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which woultl
require a permit from Ihe Division of Industrial Safety, as notetl above, unless
such person has a permit to tlo such work from the division.
Appliwnt's SignaWre Date
Division of Intlustrial Safely Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will �he applicant or present or fu[ure building occupanl neetl to fle antl
certity a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery 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 ot hazardous materials equal to or qreater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic leet of compressed gas
at standartl temperature and pressure).
2. Does or win the applicant or presem or future building occupant need to f le
a registration fortn for awtely hazartlous materials? ❑ Yes ❑ No
(Sec[ion 25533 of the California Health antl Safety Cotle, with some
exceptions, requires registration with ihe Cosla Mesa Fire Departmenl by
each business which at any one time has on hand a quantiry of acutely
hazardous matenals equal [o or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard
temperature and pressure).
3. Does or will ihe applicant or present or tuWre building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safery Code pmvides that the
Costa Mesa Fire DepaRment may require [he preparation, certifcation and
fling 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 Sec[ion 25534 of Ihe Cali(ornia
Health and Safery Code been fully complietl with? ❑ Yes ❑ No
5. Does or will lhe applicant or present or (uture buildinq occupan� require (or
the vrork which is the subject of this application a pertnit for such construction
or modification from the South Coast Air Quality Management District or fmm
any other air polWtion contml dislnct or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Cotle requires tha� �he requested
information be fumished on applications for non-residential building permits�.
6. Will any part of the faciliry to be consvucted untler this permit be within
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf'yes", lhe facility must meet the requirement of Seclions 25534 and 42303
of the Cali(omia Health and Safery Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control distnct or agency is requiretl 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 certifcate o( compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify ihat untler penalty o( perjury �he
in(ormation given above is correct I agree to comply wiih all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RY: 1
certi(y under penalty of perjury that I have read this application and state that
the infortnation qiven is correcL I agree to comply with all state laws antl city
ortlinances relaling to building construction, and authorize representatives of
the City of Costa Mesa to enler upon the above-describetl property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
SignaWre egalOwnar(s) Oaia
, �-a � �
/ AntllorAuthonzetl OPI¢ 1 Date
.�
n
�
�I
,�
PflOJECT ADOPESS: 3� 2 9 T IMB ER LAKE
owxensxame: VILLAGE CREEK H.O.A.
, nooeess: 3429 TIMBER LARE
COSTA ME:SA, CA 92626
553-1876
ABCHIENGINEEN:
AOOHESS:
HEG.NO.:
UNIT:
UNIT:
PEflMITTEE: P�;TERSON RC10F'ING ( 714 ) 979-7111
nooness: 3006 ENTERPRISE
COSTA MESA CA 92628 ,
LICENSEO LONTRACTOB OECLAPATION: I hereby aflirm �Aa� I am licensed unaer pmvisions of Chapler 9(commencing wi�h Section
7000) o� Division 3 0l Ihe Business and Prolessions CoOe, antl my license is in fu0 tarce antl e��eci.
CITYLIC.:� 5445 STFTELIC.:(jO%�7?Ai a�Cj�j
vii / / L �
Daie: Si namre: _�� f ��/�
WOPNE ' CO PENSRTION �ECIAflATION: I hereby a��irm t�a� I have a cetlilicalfoi con5eni �o self�insure or a cehi�icate ot Workers'
POLICY N0. n Psgrapcg. q y�rtilie� r�opy ��ereo� (SectiE%P. DATEab ��4 / 01 / 9 4
1V11J] J
COMPANY: STATE F'UND
❑ Cetlifietl copy is hereby lumished. � Ceni�ietl copy Ais A�iled wrth/�ye /ci�/y� wlding rvi/siry�
Oate: �/�Y/73 Applican�:/!{/•ril+✓' V �.0 �—
.-
E%EMPTION FROM WORREPS' COMPENSATION DECIABATION: (This section nee0 not b ampletetl if ihe permit is for one huntlretl ($1W) or less).
I cetliry �ha� in Ihe petlormance ot t�e work for which Ihis permi� is issued. I shall nol employ any person in any manner so as �o become
sublect la the Workeri' Compensa�ion Laws ol Califomia,
Da�e: Signalure:
NOTICE: I�, afler making this declaraiion. you should become subleci �o Ihe Wo�kers' ComDensation pmvisions ot �Ae La�or
Code, you must �atl�wiih comply wilh such pmvisions or �his permit s�all be Oeemetl �evoked.
CONSTflUCTION LENOING AGENCY: I hereby af�irm Ihal l�ere is a cons�mc�ion lentling agency lor Ihe pedormance of the work lor
wnich this permit is issueU (Sec�ion 3097. Crv. CI-
LENOEH:
RDOflESS:
OwNEP BUILDEN DECLNNR7ION: i here6y allirm ihat I am exempt imm ihe Coniracrors' S�ate License Law for the following reason
(Section 7�31.5 Business ana Pmfessional Catle: Any ciry of county which requires a permi� lo consimct, alter, improve, demolish, ar
repair any simcNre. Orior lo ils issuance. also requires t�e applicant for sucll permit to file a signeA statement ihat he/she is Iicense0
Oursuant �o �he pmvisions ol �he Coniraclars' S�a�e License Law �Chapter 9(commencing wi�� Sec�ion 70W) ol �ivision 3 ot ��e 9usiness
antl Pm�essions Co0¢� or Ihat he/she is exempl lherelmm and ihe basis �or Ihe ailegetl exemp�ion. Any violation ol Seciion 7031.5 by
any applicani br a permii sublecls Ihe aD0licant �o a civil penalry o� not more Ihan five hundretl tlollars (5500).
❑ I, as owner al the pmpeny or my employees with wages as iheir sole compensation, will Oo Ihe woB, and ihe
stmcWre is not intentletl or aflered �or sale (Seclion 7044. Business an0 Pmtessional Code: The Conlractors' $tate license Law
Aoes nol ap01y to an owner of a propeny who �uiltls or impmves thereon, and who does such work himsell/herself or through
his or her own employees, proviAetl tha� suc� improuemems are not intended or ofleretl �or sale. tl, Aowever Ihe building or
impravemem is sold wi�hin one year ol rompletion, the owner will have the burtlen oi pmving �e/s�e Oitl nol build or impmve
for Ihe purpose ol sale�.
I, as owner ol Ihe pmperty, am exclusivety contracting wiih licensetl con�rac�ors �a con5�mci Ihe pmlec� (Section 7044, Business
❑ and Pmfessions Coee: The Caniraclors' S�a�e License Law does no� applY �o an awner o� pmperty who builds or impmves �hereon
and who canirac�s �or such pmle��s wi�� a conVaclor(s) license pursuan� to the Conlractors' Stale �icense �aw�.l am aware
Iha� pmoi of Iheir Warker's Compensation insurance shaultl be pwvide0 to me.
� I am eKempt under Sec�ion: B. 8 P. C.
lor ihis reason:
Oate'. �wner
I Oo �ereby certify Ihal I am aware ol antl untlers�and Ihe requiremems o� Calibmia Heal�� antl Safery Cotle Seclions 25505, 25533, antl
2553d antl Ihai I or any Iuiure buil0ing occupant will/will nol �circle one) need to comply wi�h said siale codes antl Ihe requiremen�s �or a
permil lor cons�mction ar modilicalion irom Ihe Nir Oualiry Managemen� DiSlricL fiesidential consimc�ion applications are ezempt Irom
Ihese provisions.
Dale'. Applicant
I here�y cetlify Iha� I have reatl Ihis apPlication and 5�aie I�al lhe above inlormaiion is correcL I agree la compty wiih a0 ciry and caunty
orainancesantlslatelawsrelalingiobuiltlingconslmc�ionantlnerebyauth ¢erepresen�alivesollhisci�ytoen�erupont�eabove-men�ioned
pm0eny lar inspetlian purpases. /�
Oate: ' � Signalure� ,///� A / �
i
Drivefs L¢ense or Social Securitv n:
i64Fa6 W�ne—Builtling; Green—CaEe Enbrcemem: Canary—Applicam: Pmk—Revenue; Goltlenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT FERM NO; H 063959
PERMIT NO: B 063959 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF SHEATH REROOF W/COMP SHINGLES SQ FT: 2,000
CLAIM VALUE: 2,000.00 CALC—VALUE: 2,000.00 GROUP OCC: R-1 /
COMMENTS; SMOKE DETECTORS RE�UIRED AS PER UBC 1991
�r**�r��r�r��r��r��*�r*�x�*��rx���*** �r�e**�r�r*�r�r*�x#�******�**�+�*****�x��e�r*�***.��*+�***�r*�* ,
Z O N I N G R E Q U 2 R E M E N T S % i.'^??�
S E T$ A � K S �g�(E DETEC�t�Rx
------------ MAIN BUILDZNG ---------- --------- ACCES�ORY �UILQT
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR:'�
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; � IN
PARRING RE • PROV: PARCEL: 00000000 ZNE; REF NO:
PLANNING N TES> ,
_ �y+'.
i •
*�r*******��t*�***�t*�r�t*+r�r�r�r�r*��t*+�* ****�*�� ***�*�*���r******* ���x �e**�r***� **.x ***�r�r�*
D E V E-;'L O P M E N T S E R V I C E S R E Q U I R E M E N„T S
ZONING APPROVED; BY DATE; ','
v �. ;
BUILDING APPROVED BY : DA�',E: r
APPLICATION ISSUED BY; IYATE•
**�r�r*�t�*�x�r*�r�e**�r�t*�r�r�r�������F'���'�� �'������������r�r�t�t+r**�** �, r l +t�
if iE if ik iF if �lf 3f �1E iE if iE if �lE if iE if if iE iE if if iE if if iE iE �1E 1E �IE iE if iE ik #if if 1E 1E i! iE if iF iF iFiFlElf iE if fE if iE if if if if iF iF1! iE if iE iE iE �lE iE 1E iE �lE i(� * iF iE'1F iE iE iE iE
LEGALIZATION:N F E E S U M M A R Y STR[]CTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SMIP/RES ' GRADING
PERMIT 95,00 .50
', SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 95,50 0.00 0.00 45.50 95.50 ; ,00.,
REVENUE DIVISION TOTALS--> COLLECTED; 45,50 OVER/SHORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/TOT GRADING PLAN—CHECK
45.00 .50
iE iE if iE iE iE if if iE if �f if ik iE iE �E if iE iE 1E iE iF iE iE k 1E iE if iE iE it iE iE if iF 1E iE 1F f! if iE 1Elf iE fE iE iE iE iE if 3E ik 1f if 3E if iE 1tr if iE iE if iE if iP if iE iF iE lF fE iF it 1t 1F * 1f af af
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R Z P T Z O N UNIT COST TOTAL COST
SFR 2000 REROOF BY VALUE RESIDENTIAL N020NE 1,00 2,000.00
END OF FEES
J1 001458;?2-170�4b8`3 TnT
C�+TE: 09/1d/93 iI(iE: i.0:45
4ti.aC
CONSTRUCTION AND PLANNING
APPROVALS Permit # � Date
t. Temporary Elecvical Service or Pole
2. Sod Pipe-Undrgmd. , -
3. Electrical Co�duii Utility�Undrgrnd.
4. Electricai Conduit-tfndrgrr.d.
5. Stezl ReintorcemCnt
6. Electrical UPER Gmd.
7. Footings �
8. Foundation �
9. Water Pipe-Undrgmd.
10. Structural Floor System '
11. Property Sewer line & House C6�rreclion'�,
12. Sewer Cap - '
73. Roof Drains
14. Rough Plumbing
75. Rough Elecviwl-Conduit
76. RoughElectriGWiring
77. Rough Wiring Sign
18. Rough Electricai-T Bar Ceilin9
19. Rough Hea2ing & Air Conditioning
20. Rou9h FbctoXy Fir2P�ace
21•. Ducts, io Struccure � •
22. Ouas, Ventiiating � �
� �
23. Gas Pipo•Rqugh & Test � � •
24. Roof Framing � ' " '
25. Roof Sheathing � �
26. T�Bar Ceiling 1Structural} & Mpnocoat
27. Frame and Flashing .
28. Lathing 6� Sitling , '
29. Insulation ••
' 30. Drywall Nailing
31. Piaster $rown CoaF � �
32. Electrical Power MeterFinal'
. �r
. 33. Final Electric - � ,
r
34. Finai Heating & Ai� Conditioning .
, 35: Final Gas Pi(ie-Test . .�
36. Haod or Canopy � �
37. Final Factory Firep�ace ' �
38. Pina� Plumbing '
� 39. 1'Vater Service-Firial
40. Gas Service-Final
41. Solar pomestic-Final '
42. Backflow Preventef �
43. BackEiow Irrigation
44. Landscape Irrigation Sys;'Em •
r_-�-
45. Sound Attes�,uarioP '�'� . �
46. Handicap Reg�lations • �
_ �i1?� �
47. FIf�jAL STRUCTURE j:n1 ._ ING 'j
/�-
48. FINAL PLANNING � `� �
49. Eiectric Release to EdisOrr" '�"
50. Gas. Release to $outherr! fz � nia Gas Co
51. CERTIFICATE OF OCCJE�CY
POOL ,PA
Inspector APPflOVAIS Permit #
- 52. Pool & Equipment Location
53. Steel Reinforceme�t
54. Forms
55. Elec[rical Bondin9
56.� Rough Plum6ing & Pressure Tesi
57. APPROVAI TO COVER�GUMTE
58. Electricai Conduit�Undrgrnd.
� 59. Gas Pipe, L� Undrgrnd., Test
60. Backwash lines, P-Trap, 0 U�d:grnd.
61. APPROV�� TO DECK
62. Backwash & Receptor-Final
� 63. Heater & Vent-Finai
64. -Plumbing System - Final
65. Electrical-Final '
66. Soiar System�Final
67. Fencing & Access AnProval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
� APPROVAL$ ;�'Perinit#�,
' � •70. Under9round Hydro
,' .'71. Product Piping �Gas ❑ Oil
_ 72. Undergrountl FVush� � �
� �-„73. Undergrnd. Storage Tank � Gas ❑ 0��
�y(.(i� 74. Overhead Hydro -
' 75. Dry Chemical -
. � 76. Dry Standpipe • �
" ' � ' 77.. FIXED SYSTEM FWAL . . ,
j I�� 78:�FIREPREV.FINAL
I HEA�THDEPT.REQUIREMEN7
I i 79. �FINAL INSPECTION �
�� �. 80. FOOD CERTIFICvaTE �SSUED
� � Notes: � �, � .
u
:
Date � Inspector
0
0
� ,
. . ���� 2�QF
-�,2�'`� � �'02
TESTING
La�or������� of �ou�� ea�fo�ta, �,�. �
P.O. BOY �? . 3J10 NRPORT WnY . IONG 9E.�CH, CqLIF. 90601 .(213� 426J355 . �713) 636-i386 . �7N) B28�M32
B9nNU+ OLFlCFS:
6�bDNorr6Nnov5v.✓ � NonDnr��cll.�bnlna
$anle An<. CeE(o���e 01)O] 0.0. Boa �]
�I�� S1i4C�5 ������
� 2�\ i�, ��, } . Lonq &ac6, QIiL VO801 �]Il� e�e�nce
��4L,` -
Februaty 23, 1977 V�
, Examinafion: 77-800
GUNITE
COMPRESSION T'cSTS ON XW1Y4R�E CYIINDERS
Jack Hubbard
3106 Ostrom Avenue
Long Beach, California 90808
PROJECT
ADDRE55
SAMPLE FROM
ARCNITECT
EHOINEER
H. M. Hansen
MIX
DATE CAST
DATE TESTED
CYLINDER NO.
COMPRESSION
TOiAL IOAD, LBS.
POUNDS PER SQ. IN.
COMPUANCE
CYLINDFRS
SWIMMING POOL - CONLMERCIAL, STATCWIDE DEVELOPMENT C0. �
3429 Timberlake, Costa Mesa, California
Shallow end, deep end, bond beam ���I� I
4.2 to 1
2/16/77
2/23/77
1
7 days
62,000
Y,19S
CONTRACTOR
California Poois
SU6tONTRRCIOR
Enterprise Gunite
SPECIFIED
STRENGTH
SWMP
2/23/77
2
7 days
63,000
2, 2.iu
7 day tests comply with specifications
IMpF 6Y
Cruz
DISTRI�UTION:
Jack Hubbard - 3
Costa Mesa Bldg. Dept.
DEIIVFNED !Y
Hubbard
2,000
2/23/77
3
7 days
64,000
Z,Zo:
RECEIVEO ON
2/17/77
REC�IpED
�EB 2 8 19i/
•Ll RE�ORT9 1NE 6VqyITTLD �� TM[ CONflO[NTIA� �I�OI'CI1TY O� CLI[N1�. 1VTHORI2/�110N FOR PVlIICATION OF OUM PL�011TS.TOACILSIONS. ON [Z. `
T11�CT{ {I�OM OR N[G.�qO1MG 7NEM IS PCS[NV[D PCMOIMG OVN WI�ITTCM /��IROY.�L �! A MUTVwL YROT[CTION TO CIICNT/, TM[ pVOIIC AND OUN![lV[B.
OJO'13 �' �� 1 .
� 2
2 s�
=W�� ��:
—�,_�'� ,�� °�
TESTING
�J
L�bo�a�orae� �f sO4�� ea�f��ta, ��.
7.0. BO%� �7 . J710 /JRPpRT �WAV . LONG BEnCH, CnUF. 90801 . �2I3� �t6J755 . �213� 636-2386 .(7'14� 828�6173
- BRANC� OFHCES:
isu.oNonnH.,o..s�,..� - uo.o.� ..r.��,., �
. . s..i, n... c.r.�o,�,. vno� � '•., v.o. eo. u�r
- . piq s�i.xas • a � �, t Lon9 &�cF, �Jil. O0001 �lq� e�e.o�ee
� � �,��>��n/1\ r . .
February 23, 1977 ' �'`�� ,
• , Examinafion: 77-801
6UNITE
COMPRESSION TESTS ON }4D1f[QRESE CYIINDERS
Jack Hubbard
�� 3106 Ostrom Avenue
I_ Long Beach; California 90808 ,
,
! PROJECT SWIMMING POOL - THERAPY SPA - STATEWIDE DEVELOPMENT C0.
ADDRESS 3429 Timberlake, Costa Mesa, California
SAMPLE FROM
ARCNITECT
�
I EHOINEER ' '
j H. M. Hansen
�
� MIX
DATE CAST
I DA7E TESTED
CYLINDER NO.
' COMPRESSION
� TOTAL IOAD, LBS.
I
POUNDS PER'SQ. IN
Floor and bond beam
4.2 to 1
2/16/77
2/23/77
7 days
61,000
2,160
CONiRACTOR
Califernia Pools
fUECONTRRCTOR
Enterprise Gunite
SPECIFIED
STRENGTH
SLUMP
2/23/77
5
7 days
62,000
z,iys
COMPLIANCE �\ day tests comply with specificationa.
' AUDE GT DEUVERED pY RFCfIVEO ON
CYLINDERS Cruz Hubbard 2/17/77
oisTRieunoa:
Jack Hubbard - 3
Costa Mesa,Hldg. Dept.
RECEIVED
FEB 2 8 1977
�/� ,
•LL�I�[�OPTB �RC E�llY�1T[O .�9 TNC CON�IOCNT1.�l �i10r[�ITY O� CLICNTl. /�U�MOPI2AT�OM I01� IUOIIC.�TIOM O( OUN 1�[/OI�T6. CO� ION6, ON [[�
TI�1C�� II�OM �R I�f.G.�RDIN6 1M[M 16 R[SCAVCD rCND�M6 OUR WMI�TfLN 1pPROV�L A9 /� YVTV/�L PROTCCIION TO CLIEMT�. TM( rVOIIC �MO OVI�fCLVCb.
1
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43753
COSTA MESA BUtLDING-SAFETY DEPARTMENT
P.O. BOX 1200 � COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING %/L h /ii �,�� 2 ,y����
ADORESS ��7 L�I /JC1/
OWNER
MAIL
TEL.
CITV NO.
BRANCH
ADDRESS
ARCHITECT TE�.
ADORESS
CONTRACTOR c�/�Tviv lOE� �� /
ADDFESS �. ,���(,/'
TEL. I
CITV ��2�� NO� —�
STATE CITV
LIC. NO. 2��7i�_i IC. NO.
_f
SI2E ' INO.OFBLDGS.
OF l0T NOW ON LOT
USE OF
EXISTING eLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILOING AND WO:iK TO BE PERFORMED
ry r, - -�?AIG L :R;h'fv " � �'
�R--..�-�,r:�,.,..00 1�6,�. �1;.1�
FORSTRUCTURALPERMIT
TRACT J
N W. ADD ALT R P
OWNER
E
FIRE
ZONE T PE
APPROVED
BV
NO. OF
PLANS
VARDS APPROVED
MAIN BUILDING
DISiANCE BET
X
AWE �
$
.JI�� GROUP �
DATE ` �;JD�2,
USE OF W J
BUILDI D.�iD' y/L
V PPROVED
AC SSORV 6UILDING
BET. MAIN &
� hereby acknowletlge that I have read this applicetion antl steta '^
thac ihe abova Information is corract and aB�ea to comply wiM �
m
all laws regulating bulltling consttuctlon, and I shall noi employ
i
any person In violatlon of the workman's compensation lews of m
the StaSe of Californle. '
1 hereby certify that I am propatly Ilcansetl as a conttactor under SQ. FT. N
ihe State ai Callfornia Business antl Protessions Cotla, Divfsion 3, THE AMOUNTSHOWN UNDEF VAlUAT10N IS FOR m
Chaptar 9, antl that such licensas are in full force entl effect, or I THE PURPpSE OF ESTABIISHING A PEfiMIT FEE ONLV: �
em exempt from the provlsions o� tha StaSe of California Business VALUATION PERMIT FEE $ a
antl Protesslons Cotle, Division 3„Chapter 9,/� � � —�� m
m
��G�� �-✓ PLAN CHECK $ � , �� o
Signature of /��,�} LL
Permlttee � $ U���� TAX $ g
„ , � u
AuchorizatlAeant � ' � , ,. ` TOTAIPAID $ //3 ��/
� .. !'Fl.rir . ' .
� OWNER
�� J�R AC
�- e
�.
� INSPEC
� soi�
� GRS
STATEWIDE DEVELOPNtENT COMPAi�Y
54-01 LOT 8858 TR
ROUGM PLl1MqING
GROC. SWR. LINE Q NOUSE CO
SPRINKLING SVSTEM
MISCELLANEOUS
RO(IGH HEATlNG ANO AIF CON01
TEMPOR�RV SERVICE OR POLE
UNDERGROUNp � POWER [
ROUGH wIHING
TRENCMES FORMS 5
F�OOR SVST�M
BONO BEAM n STEEL REIN
SHEATMING
iRAME ANO FLASHING
I 'NG - IN n OUT �f
cP, BROWN COP.T
S1nJCTURA�, FINAL
HEATING, VENT.. REFRIG. ANO
PLUMBING. �INAL RNO GAS TE',
ELECTRIC, FINAL
BUILOING, FINRL
DATE
SUBCONTRAC70R
4-5-77
�
� OWNER �lt
\�' �pa ADDRESS
RAL G01
., .. .o.
�INSPEC
soi�
ROUGH PLUMBING
PROP. SWR. LINE
ROUGN HEqTING ANO AIR CONOITIONING
UNOERGROUND �J POWER
ROUGN WIAING
FLOOR
REI
SXEATMIN�
FRAME r1ND FLRSHING
� YG - IN n
HEATING, VENT., REFRIC
PlUM81NC. FINAL AND G
ELECTRIC, FINAL
BUILOING, FINFL
SUBCONTRACTOR
. 4! . � .. ' ' {.
Fr .
43752
COSTA MESA BUILDING-SAFETY DEPARTMENT
. P,O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant [o Fill in Completely — Use Ink Only
OWNER �
•MAIL
ADDRESS
CITVi !
BRANCH
ADDRESS
ARCHITECT
OR ENG W EEt
ADDRESS
C
TEL.
PAiO
:P�-S-,�c„s.ao ���;� i<�-;�59.9C
A IC TION FOR
FE E E BV DATE
I•
��
A.P. NO��� ��f�—
BUILDING
ADDRES
TRACT
NEW ADD ALT R
OWNER
5 1
FIRE
ZONE V
APPROVED
PERMIT
�
E ISSUED
_ � /
DATE . �A�c7U �
ADDRESS j(e/ / '
�j TEL.(� i� NO.OF USE OF NE �'
CITV %O O N�'O�G' P�-'4N5 BUILDING
� STATE CITY � �'AROSAPPFOVED VARDSAPPROVED
� LIC. NO. � LIC. NO. MAIN BUILDING ACCESSORV BUILDI
{� SIZE NO.OF BLDG�. (FROM GL STREET)
C+ OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
,.�.i EXIS7ING BLOG. I E - FT.
�
FS¢parate permits are required for � �. sioE FT. FT.
� electric, plumbing and heating work. REAR FT. FT.
W USE OF BUILDING AND WORK TO BE PERFORMED
F DISfANCE BET. BET.•MAIN &
Q ' MAIN BLDGS. ACCESS. BLDGS.
�
`� OG L E ALI,S C VRP. ' � APPROVED � '
a
7 APPROV �'
r v—
a d LIA1
w
0 I hereby acKnowletlge ffiat I have reatl this appllcation antl state `
p: that the abo�e Informetion is corract and agree to comply with
a all laws regulating build(ng conrtruction, entl I shall not employ .
�Z any person in violation of the workman's compensation laws of -
� ihe Staie of Californie. � Q
3 I heteby certify that I am properly licenutl es a contractor untlar � `. FT.
tha State of Californie Businass antl Profssstons Code, Division 3, THE AMOUNT SHOWN UNDEq VALUATION IS
Cnapter 9, antl that such licenses are in full torca antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE OP
am exempt flom tha provisions of the Stece of Calffornia Business VALUATION �" O�
and Professions Cotle, Dlvlsion 3, Chspter 9. �,,.�n , PERMIT FEE $
� Sienature of .� �AT�A� ���ar� Qp PLAN CHECK s 4•
Permlttee � � `�OO'� TAX $ �
v J � •
A�thorizetlPBent TOTALPAID S S�i (�
n
m
>
m
J
m
e
a
N
m
LL
�
u
�
� OWN E R
�10R ADI
� R/
�. . o.
� INSPEC'
� SOIL
G�5
WRTER
ROIIGH PL
PROP. SW
SPRINKLIi
MISCELL/
NOUGH HE
STATEWIDE DEVELOPMENT COMPANY
AIR CON�ITIONING
UNOERGROUNO (� POWEF U
ROUGN WIq�NG
TRENCHES fORMS STEELI
FLOOR SYSTEM
BONO BEr1M n STEEL pEINFORCE
SHEATHING
FRAME ANb FLASMING
1 YG -- IN n OUT [,
-'A. BROWN COFT
SInaCTURAL, FINAI
HEPTIHG, VENT., REFRIG. AND A.C., �
PLUMBING, FiNP.L �N� WS TEST ❑
ELECTRIC, FINAL
BUILOING, FINRL
FIRE ZONE VALUE E14
SUBCONTRACTOR
� - � � . y"_4y::5,.: —_
43762 �
COSTA MESA BUILDING-SAFETY DEPARTMENT
� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Appl�cant to Fill in Completely — Use Ink Only
BUILOING (.� y (�j �! , � _ � _ _
C
OWNER �i(�(�fn/�l,I:�L ,C�%Gf�[
�ADORESS �����.�(}=�'+�/�+-
/♦ � _. TEL.
CITV ��Q/%y) O�n NO.
BRANCH
ADDRESS
ARCHITECT TEL.
R
BUII�ING
ADDRES:
FIFiE
ZONE
APPROVED
CONTRACTDR J�G��f'L� 'r—� BV
ADDfiE55
TEL. . Z O.OF
CITV NO. P��
IIC. NO. p� �} �7 ((/ CITV YAROS APPFOVED
LIQ NO. MAI�
SI2E NO.OF BLDGS. (FROM C/
OF LOT � NOW ON LOT RONT
USE OF
EXISTING BLbG. SI E
Separate perrtrits are required for _ �. sioE
electric, plumbing and heating work.
REAR
USE OF BUILOING AND WORK TO BE PERFORMED DISTANCE
���+��-5-7�vnro{1� 148�-= ie�e:119.8"c
cM::
FORSTRUCTURALPERMIT
�jL/,n� / l, �/I�/L/O:�S H�.JTJ A%'ROVED / ,
��.r.rw ��
� � (v O f -/o '� G
I hereby acknowletlga that I hava reatl this applicaiion antl state .
that the abave Informetlon is correct antl ag�ee to comply with
all laws regulatfng buildinB �ons<ruction, antl I shell not employ
any person in vlolation of the workman's compensation laws of
the Stata ot Celitornla. � �
I hereby cartify that I am prope�ly Ilcansetl as a contractor untlar . FT.
tha State of Californle Business entl Profassions Code, Division 3, THE AMOUNT SH
cnepner 9, end nnai sucn licenaez are in full force and effect, or I THE PURPOSE OF I
am exampt from the p�ovlsions ot theState-ot Califor ia B�siness VALUATION
and Protessions Co a Division 3, Chaptar 9�./�/'���j
Slpnatuin.��'� /`�� /� j //�O
Permlttee $ 7/Jt/
_
Auihorizad qgent ��� `
BLOCK
DATE � �0�
USE OF NEW'S.(/GZ
BUILDING� �� �! „
v��
YAft05 APPROVEO
ACCESSORV BUILDI
BET. MAIN &
ACCESS. BLIX'�S.
DATE
APPROVED —
t� �—�i
` � I
n
m
i
m
� N
!N UNDER VALVATION IS FOR m
ABIISHING A PERMI FEE ONLY; e
PERMIT FEE 5 .�� p
n
� m
PLAN CHECK $ "�
TAX $ LL
.oz. �
TOTALPAID $
\ "' " J1H1pW1LG LGVbLVYl"1GLV1 ' """- IL�L_!9—
�JOB ApDRESS 3429 Timberlake BUILDING PERMIT N0 '43118_
n'1 `-RAL CONTRACTOR Califox'[lia Pools. Inc._DESCRIPTION oF WORK Semi—Pvt Sna.;
0
" Pool Location .
�Forms —
Main Drain
Steel Reinforce
Elec. Bond _
Approval to Cover
Underground Electric _
Gas Piping Test �
Filtering SYstem Lines _
Backwash Lines and Recep.
Electrir,al Final
�r and Vent Final�_
Filter $ystem final
Backwash and Recep. Final
Fencing Final
Ar.nrn„�I'S..r Finich
FIRE ZONE VALUE
GROUP J 7YPE
% SUB�ONTRACTOR
RC � �•s5-i7
Electric
Plumbing
r
. r 4�1I?�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completel� — Use�k Only
..----•-r
BUILDING 7 dlfA P/.�r�i , r Ei i'
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OWNERyC/(�(�(J �
MAIL �,// /
ADDFESS 7(O
CITY �jqy�
CONSTRU�
LENDEF �
BRANCH
ADDRESS
AFCHITECT LJ
OH ENGINEER / :� - ��
ADDRESS ��� (p ,
CONTRACTOR (_ �(.
ADORESS��D �G
CITV /1
STATE
LIC. NO.
SIZE
OF LOT
USE OF
USE OF
TEL.
�x,U
;SC -2-i6�„-; Oi� 905�+ *�a�*33.SQ
APPLICATION FOR STRUCTURAL PERMIT
E�1 V�LjJ BV D/y�` �EIyF�1 pq� �� �VE�
�� �1 �o� %G „r
FIRE
, L . 20NE
q APPROVED
�3�i�s CL RV
TEL. v'�
NO.�CJ—Gl7 C'.
CITV
LIC.NO. GJ 3
INO. OF BLr S.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
YAPDS
MAIN
IOM C/I
D4STANCE BEf.
MAIN BLDGS.
VAR. �
C.V.P.iW
NO. OF
PLAPLS
VAIUE
11 �
ED
� FT.
� / ��
FT.
BET. MAIN &
ACCESS. BLIX'.S.
DATE
Z'.
I heraDy acknowletlge that I have reatl this application and stete � �
thet the ebova Informatlon is correct antl agrea to comply wlih �
m
ell lawz regulating buiidin8 construetlon, antl I shell not amploy ' �
ony pe�son in vlolation ot the workman's compansation laws of ' m
the State of Californle.
� hereby certify that I am properly Iicensstl as a conttactor untlar SQ. FT. N
the State of California Businesa antl Protessions Code, Divtsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and t�at such iicenaes are in f�ll torca and atfact, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ON�V:
am exempt from the prov(sions of the State of Calitornia Business 'O
VALUATION PERMIT FEE S a
antl Professlons Code, Dlvtsion 3, Chapter 9. � J�
/// n m
SIB^etura of (� � • i"�� �L( :,. / . . �/ � � �� PLAN CHECK $ a
Pa�mittee //�L(<<�f`� � J LcTirs.[�� g 'rAx g �`
� D �
V
Authofized Agant , TOTAL PAID $
J1H1GW1UG UL`VbLVY1LMLV1 ' —�1�G-�%d—
JOB ApDRE55 3429 Timberlake BUILDING PERMI7 N0.
� SRALCONTRACTOR California Poolc Tnr_ DESCRIPTIONofWORK Semi-Pvt. Swl
���+ oTiI�L11�T6 L0� TRACT FIRE ZONE VALUE $6,500.00
]'t'lNSPECTlONS Si nature Da�e GROUP =:'J_.: TYPE I I Z
�POoI Location R� Z'I�'� SUBCONTRACTOR PER
Datc _I
�Forms '
Main Drain
Steel Reinforce
� Elec. Bond Electric
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines —
Backwash Lines and Recep.
Electrical Final
er and Vent Final
F�iier System Final
Backwash and Recep. Final
Fencing Final
Plumbing "
�
F�+
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� 43117
COSTA MESA BUILPING-SAFETY DEPARTMENT
P.O. BOX 1200 C05TA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING`2��� - ,' �
ADDRESS L
OWNE(iyd�/ G(i�-L!� //wWGCQfy�j/�i
MAII /.jn � . !w_ � A O/ i �_ . . _ . .
CITY
BRANCH
ADDRESS
ARCHITECT
AODRESS �/p� �(J �u � o�(�L'G>'Y.�-:�' �KCijJ .�,
CONTRACTOF (���,«p�-R� r/j'�7 �
AOORESS//�� �G�'LC�/1't�t^�/F[.C.U.
^� � TEL.
CITV ✓JCI...L[,v :(i' NO.
STATE CITV
LIC. NO. ��(J � , LIC. NO.
SIZE �"'� <• �j.1 NO.OF BLDGS.
OF LOT ���Q ���+/M � NOW ON LOT
�' .
USEOF_"'_ Dd.J-� rrrr".//'A�
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WOfiK TO BE PERFORMED
� ��
I hereby acknowletlge that � hava raad this applicaHon and stace
ffiat ffie above InformatioM Is corract and apree to comply with
ell laws regulatlnB buildln8 conctructlon, and I shall not employ
any person in violation of <he workman's compensation laws of
the State of Californio. ,
I hereby certify that I am properly licensed as a contrector untler
the Staie of Califo�nla Busi�ass anE Professions Code, Division 3,
Chapter 9, entl thot sucA licensas are in /ull torca antl affaci, or I
am exemp[ from tha provis�ons ot the State of California 8usiness
antl Professions Codo, Divisfon 3, Chapter 9.
SlBnatura of �6/(J�
Permlttae �/� /✓
Authoriaetl Agent
Nn;u
�1:f; —?-7b�����;.�}� i0t�;: t�a�e(��.�Q
APPLICATION FOR STRUCTURAL PERMIT
RE I � BV D E REC D �qT IS�E
� — P
A.P. NO.
BUILDING
ADDRESS �
TRACT LOT BLOCK
W A D A T P
OWNER •
5 � AW$
FIRE
20NE TV GROUP
APPROVED /1
BV DATE L ��
Z NO.OF USE OF NEW
�P PLAfS BUILDING
VAROSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESS RY BUILDING �
(FROMGLSTREET) � ��„`, y
F ONT FT. FT. �
DISTANCE BET.
MAIN BLDGS.
VAR. #
C.U.P. #
MAIN &
n
m
i
_ �
SQ.FT. N
THE AMOUNTSHOWN UNDER VALVATION IS FOR m
THE PURPOSE OF ESTABLISHING A PERMIY EE ONLV: �
VALUATION PE(3MIT FEE $ P
N
m
PLAN CIiECK $ '^
/ ��-Q o
g /� �� � TAX $ LL
�7i� V
TOTALPAID $
" STATF.WTTIF. TIFVFT.CIPMF'NT� TNC /—lb—/b
JOB ADDRESS 3429 Timber Lake BUILDING PERMIT N0. 42293
o. LOT
ln..r'ECTIONS
soi�
G r15
WATER � ff..
�OUGH PLUMBING �
PROP. SWR. LINE I� HOUSE CON.
MISCELLANEOUS
ROUGM MEATING ANO AIR CONDITIONING
•TEMPORARY SERVICE OR POLE
UNOERGROUN� � POWEF �
ROUGH WIRING
TRENCHES! FOHMS STEEL REINF.
FLOOR SV ES�T M
FRAME ANO FLASMING
LATHING — IN (
ER.BROWN COAT
HE4TING, VENT., REFRIG. ANO A.C., FINAL
PLUMBING, FINFL ANO GAS T ST -i-i
ELECTRIC, FINAL
BWLOING, FINAL
SPECIAL REQIIIREMENTS � �, �� r,
17_1�11:
SUBCONTRACTOR
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. COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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For Applicant to FiII in Completely — Use Ink Only
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Separate permits are required for
electric, plumbing and heating work.
U14DING AND WORK TO BE PERFORMED -
i111.jh'7f+PAIDOOi�7ci�'�' C.�v�.�i0
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AP�C�TIfOIY FOR STRUCTURAL PERMIT
RE�D _ OATE RECEIVE� r.�r� ��oi i�.�
A.P. NO.�
BUILOING
ADDRES:
TR
FIRE
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APPROVEI
B�
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�ARDS
MAIN
(FROM C/t
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NO.OF �j' USE OF NE�
PLANS `. BUILDING
'PROVED YARDSAPPROVED
iILDING ACCESSORV BUILDING
R. SIDE � FT FT.
i /J� �
l. SIDE FT.i FT.
REAR � FT. FT.
DISfANCE BET. � BET. MAIN &
MAIN BLOGS. ACCESS. BIOGS.
VAfi. aF` j,� DATE
C.U.P.qW2E ��,-� �� APPROVEO/�
APPROVEQ�/, ��/ . � � '/ J.-
1 he�eby acknowledge that I have reatl this application and state '^'
Mat the above information is �correct end apre¢ to wmply wiffi �
m
all laws regulating building consttuction, antl I shall not emplay . �
eny DersOn irl vialation o? the workmen'S compensation laws ot ' d
the Siate of Califarnia. . q/ / .:
' SQ. FT. � J (/ m
I hereby certify ffiat I am properly Iicansed as a contractor untle� ^�
tha Staie of Galifornia Business end Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF m
Cnapter 9, and that such Ilcanses ere In tUll force antl effect, or I THE PURPOSE OF ESTABI.ISHING A PERMIT FEE ONLY: �
am exempt fVom tha provisions ot the StaTa of'C litornia lness VALUATION ` PERMIT FEE a
antl Professions C d Divi on 3, Cye ter 9. $ M
PLAN CHECK $ ^�
SIO�atura of c �
Permlttee $ � � J� TAX $
Z LL/
Authorized A9ent �
TOTALPAID E