HomeMy WebLinkAbout422 16TH PL - Building PermitsCITY OF COSTA MESA ` '
, � .: �va��N� ��v�s�oN
F� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
° FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BX07-00058
PERMIT TYPE B MISC STATUS: ISSUED
DATE ISSUED: 08/06/2007
ISSUED BY: CAC
JOB ADDRESS: 422 16TH PL CM, " � Suite/Unit:
Vicinity: ". Primery Occ: _ Const Type :??
SQ. FT: 0 � Valuation: ; $5,500.00 ;
" _
SCOPE OF WORK: NEW V1100D SIDING ICC 94116C AND NE1N: EXTERIOR 7 LIGHTS.
.;, o .. �
OWNER: KINGAARD, JANIS L' Address:: 422 E 16TH PL - Unit
City/State: COSTA MESA,.CA' Zip Code: 92627 .
Phone:
� ' . .
APPLICANT: KINGAARD,OBERT Rddress: 422 E 16TH PL Unit:
City/State: COSTA MESA, CA• , . Zip Code:: 92627��
Phone: 949-378-1824
CONTRACTOR: OWNER-BUILDER
Address:
City/State:
Zip Code:
ARCHITECT: ' .
Phone .
ENGINEER: ;
Phone � -
Building Plan Check:
Building Permit: -, �
Electrical Permit:
SMIP Residential
SMIP Commercial
$O.00TOTAL FEES
� License I�o. 00 � �
DA'� Unit:
Phone
= License No.
Cell:
' . ' License No. �������0�
FEE SUMMARY .
$o.00-_
$� 25.25.
$31.20
$o.00
$o.00 _
$'156.45
ALi.� EID
PER�s'
EXPIRES � ��
NOTICE: The work authorized by this permit shall comply with all appliwble handicap access requiremenLs under Cali(omia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES'180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and f nal approval will result in lhe expiration of this permit.
C� IN$PECTIONTYPE ORTE INTRIRLS CODEt IN$PECTIONTYPE DATE INRMLS
1818 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electnral
201 Final Block/Relaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demoliiion 250 Final Building/Occupancy
�NORKEKS' COMPENSATION DECLARATION:
I hereby aKrm under penalty o/ perjury orte of the �ollowing declaratio�
Q I have and will maintain a certifcate of consent to self-Insure for rkers'
compensa[ion, as provided for by section 3700 of the Labor Code, for e
pedormance of the work tor which this pertnit is issued. �
❑ I have and will maintain �wwrkers canpensation Msurance, as required by
section 3700 of the Labor Code, for the pertormance of the vrork fw which this
permit is issued. My workers' compensation Insurance carrier and policy
nUmber are:
Cartier.
(7hu sed.vn need �rof be wmplete0 �I Me oarmd ¢ relue0 al one hundred tlollars (5100) w IessJ
POlicy Number:
❑ I certify that in the pertormance of the work for which [his 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 i� I should
become subject to the workers' compensation provisions of Sec[ion 3700 of
the Labor Code, I shall forthwith comply vnth these provisions.
Applicant's SignaWre
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
P.7TORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aRirm that Pam licensed under provisions of Chapter 9(commencing
with Section �000) of Division 3 of the Business and Professions Code, and
my license is in full force �antl eRec[. 7�.�k =.
Lic. # ' �Y ��,�CI ss #
� � 7 flJ� f.
Conlracbr's SignaWre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that [here is a constmction lending agency for the
peAormance of the �+ork fa which this pertnit is issued. (Sec. 3097, Civil Code).
Lgnder's Name:
�ender's Address:
OWNER•BUILDER DECLARATIONS:
I hereby affirm that under penal[y of perjury that I am EXEMPT FROM THE
GONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Pro(essions Code: Any city or county which requires a permit to
cnnstruct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicanl for such permit ro fle a signed statement
[hat he or she is licensed pursuant [o Ihe provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business artd Pro(essions Code) or that he a 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 tlollars ($500).):
C] 1, as owner o/ the property or my employees with vrages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sea 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 herselt or thmugh his or her own
employees, provided that such improvements are not intentled or offered for
sale. If, however, the building or impmvement is sold within one year of
completion, Ihe owner-builder will have the burden of proving that he or she
did t build or improve for purpose of sale.). --
I, as owner o/ [he property, am EXCLUSIVELY CONiRAC71NG WITH
lIC NSED CONTRAC70RS to wnstruct the project (Sec. 7044, Business and
Protessions Code: The contrectas License Law tices not appry to an owner of
property who builds or improves thereon, and who contracts for such project with
a contracta(s) license pursuant to the Contractas License Laws.).
❑ I am exempt under sec.
6usiness antl Professions Code tor this reason:
� �
Sg aWre Dale
305]-0fi (3I01)
ise. Yes
hicense Na ' � ' E�res: �Y�/�"
wnership by (type of document, i.e. - ill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: `
❑ I herehy certify ihat no excavation frve (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorizetl
by this permit, and that no building stmcture, scaffdding, falsewvrk, or demolition
or tlismantlirn� thereof, wili be more than Mirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 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 Safery, as noteq above, unless
such person has a permit [o do such work fmm the division.
Appbcanfs SgnaWre
Division of Intlustrial Sa(ety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or tuture building occupant neetl [o file antl
certify a Business Plan for emergency response to release or lhreatened
release of a harardous matenal? ❑ Yes ❑ No
(Section 25505 of the California Heal[h and Safety Code requires, wi[h some
exceptions, that a Business Plan be Tled wi[h 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 o�
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperelure and pressure),
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutety hazardous materials? ❑ Yes ❑ No
(Section 25533 0( the California Health and Satety Cotle, with some
excep[ions, requires registration with the Costa Mesa Fire Department by
each business which al any one [ime has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pountls, 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 ocwpant need to
prepare an RMPP (Risk Management and Prevenlion Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health antl Satety Code provitles that the
Costa Mesa Fire Department may require the preparation, certifcalion antl
filing with the Fire DepaAment o( an RMPP by businesses which are requiretl
to register awtely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health antl Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future builtling occupant require (or
the work which is the subject of this application a permit for such construction
or modifcation from Ihe Sou[h Coast Air Oualiry Managemeot District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Cal"rfomia Govemment Code requires that the requestetl
infortnation be tumishetl on applications for rwn-resitlential building permits).
6. Will any part of the faciliry to be constructed under this permit be within
1000 /ee[ from the ou[er boundaries of a school? � Yes ❑ No
Qf "yes", the faciliry must meet the requirement o( Sections 25534 and 42303
of [he California Health antl Safety Cotle).
7. If a permit from the South Coast Air Quality Management District or otber
air polWtion control district or agency is required for the vrork 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 of compliance from the appropriate air pollution
control oKcer). ' �-
CERTIFICATE OF COMPLIANCE: I ceiti(y that under penalty of perjury the
information given above is covecL I agree to,comply with all state �laws and
city ordinances regarding Hazardous Materials antl Emissions. ,
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read Ihis application and state lhat
the information given is covecl I agree to comply with all state laws and city
ortlinances relating to building construction, and authorize representatives ot
the City a M a to enter upon the above-descnbed pmperty for
i i qs. I ree not to occupy or allow occupancy of any building
thorize h s r it u ti fjnal i ctio . �
R
Stg aturco(Le .0'vmeqs) Da�e
Andlor AUNonzea Ap0licanl
%K
_�
AIANDATORY MEASURES SUMMARY: RESIDENT[AL (Pa�ezof2) MF-1R
Spate Conditioning, N'ater Heating and Plumbing S}'stem Measures: (continued) E��o�co-
NA✓ p<ci ner ment
5. Insulation must M prntected Rnm Aama¢e. induAing �hnt due Ie wnlight, muiswre, ryuipment mainlenance, and �rind. ❑ ❑ �
6. Insulation fur chilled water p�ping and refrigerant suclion piping includes a vapor retardant or is enclmed entirely in � � ❑
c�nditioneds ce.
7. Solar wateo-hea[ine svstem�collectors are ttrtified bv the Solar Ratin¢ anA ('enilicatinn Cnqnrminn � ❑ �
� fi �50(m): DucLs and Fans
I. All ductc and plenums installed. sealed and inwlated to mee� the reyuirement o(�he CMC Sec�iuns (-0I, 602, 60}, 61W.605
and Standard 6-5-, wpplp-air and *ewm-air ducts and plenums are i�vsula�ed to a minimom instal{ed Ie�'el of R-0.'_ ur ernloxd
rntirely in condiiioned spatt. Openines shall be sealed with mactic. 4'y�e or other duc��closure rystem Ihal mttts Ihe applicable � � �
requirements of UL 18 L UL � B I A. or UL I81 B or aerosol sealanl that mec6 the rtyuiremenls of UL 7'3. If maqic or lape is
used to seal o nin� eater than 1/4 inch the wmbinadon of mactic and either mesh ur ta shull 6e useJ.
Z, Building caviiies, support plaiform5 for air ha�lers, and plenums de�ined or constmcled with malerials other ehan
sealed sheet me�al. duc� board or �esibl< duct shall not be used for conveping condi�ioned air. Building cavi�ies and � � �
support pla[forms may contain ducls. Duc6 installed in ca�ilies and suppon plat(orms shall not M compressed to cause
reduc�ions in lhe cross-sec[ional area o(Ihe ducts.
3. loints and seams al duct sVstems and their componenl5 shall nol lx sealed wilh clolh back rubber adhesive duc� tapes � � �
unkss such ta is uxd in wmbinaliun �aith mastic and draw hnnds.
6. Echaus ian svstcros havc back aratt or aummabc dampers. � � �
5. Gravity vemilating systems serving cunditioned spare have either amoma�ic or readily accessible, manually opera�ed � � �
dam rs
6. Protection of Insulatiun. Insulalion>hall be prolected (rom damaee, including thal due to sunlighl, moisiurt, Cyuipmenl
main�rnance, and wfnd. Cellular foam insula�ion shall be proiected as above or paimed wilh a coating �hat is w'aler � � �
re�:irdam and rmides shieldine from solar radialion that can cause deemdalion o(Ihe malerial.
7. flesible ducts cannot have pnrous inner cores. � � �
� � Ilt Poo{ and Spa Heating Systems and Equipmenf.
L A lhermal elTciency �hat complies wi�h the Appliance Et7m¢ncy Regulaliuns. on-olTswilch mouNed outside of the � � ❑
heaier, weaiher roofo ratin inslmetions. nn electric resis�ance heaiin and no ib� li �ht.
2. Syslem �s installed with:
a. al least 36" of pipe belween �ilter and heamr �itt (uWm s'olur heaung � � �
b. cnver for omdnor pools nr outdonr spas � � �
3 Vcwl system has directional inle[s and a cireulatinn pump time swiich. � � �
p � ISt Gas tired Pan-npe central 1'umaces. pool healers, spa healers or household ca�Aing applianccs have no cnnlinuously ❑ ❑ ❑
Hurnine ilutliehL IEsce tinn'. Nnn-elecvical emkine a liances wi�h ilo� < Ii0 Biu�hr�
§IISIi�: CoolRoofmate:ialmcctsspcciticdcritcria � � �
Residential Lighting Measures:
$ I>�(kll: HIGH EPFICACY LUMINAIRES OTHER ThIAN OUTDOOR HID' cantainunh� high ctllcary lumps ati
�rullined in TuMr I50-C and do no� coneain a medium s<rew base sceket 1 f:24/E2b�. Ballast 1'nr lamps I i w�apti or ¢rea�rr � � �
a�e elecironic and have an out ut fie uencv no less than 20 kllz
�IiO�kII�.HIGHEFiIC.4CYLUMINAIRES-OU7'DWRIIID:containonlrhighe0lcacvlamps:�soudinedinl'aMe � � �
I��-C luminaire has (anon� installed H�D ballan
� � i0�k�?: Permanend� installed luminaira m kitchens shall be high etlicaq� luminaires. Up to >0 pe¢ent o(the wallaee, us
d���'�mined in § UO (c), n(ptrtnanemh' installed luminaires in kitchens may be in luminaims lhut �rc not high e�i�iwq' ❑ ❑ ❑
I uminaires, provided thai [heu luminaires are controlled by s�ci�ches separate fmm Ihose controlling the high efticaty
1 uminairu.
g � i0�k�3: Permanendr installed luminaices in balhrooms. gamees, laundry reroms ulilin' ruoms shull be high e0icacy
Iuminaires.OR arc contmlled bc an occupam senmr�s) cenilied lo complp wiih Section 119�d) Ihai does nollum on � � �
�utomaticallv or have an alwaes on o tion.
§ �iO�kW: Permanemlv insialled luminaires located other than in kitchens. bathrinms, garages. laundrc rnoms, and utilin'
r�ms shall tre high elticacy �uminaires (e�cept doseLs less than 70fl' �: OR are comrolled by a dimmer s�vimh OR are � � ❑
�untroUed by aa occupant sensor that c�mplies w ith Seccioa 114�4� that does �t wm on automat�cally m have an always
pn n lian.
§ I!OIkU: Luminaircs �hat are recessed fnlo insulated ceilings are approved (or mro clemm�ce insulaiion cover QC) and are � � ❑
cmified aini ht to ASTM E283 and labeled az air tieht (ATI �� less ihan 2A CFM at 75 Pascals.
§ Ii0lklb: Luminaires providing outdoor lighiing and permanently moumed to a residential building or to other buildings on
(k same Irn shall be high e�Fcac}' luminafres (no[ includine liehiine around sw�imming pools/wamr I'ealures or other ❑ � ❑
Anicle 6801ocaiions� OR are controlled bc occupant szn>ors ��ith inteeral phom comrol ccrtiGed m comply u'i�h Seainn
1191d1.
� Ii0(k)7: Lighiing (or parAing luts for 8 or more vehicles shall have liehting Ihat complies w'iih Sec. 130, 13'_, and 147. ❑ ❑ ❑
�.iehiine for arkineearaees for 8 or more vehicles shall hare Iiehiin¢ Ihai wm lics �+iih Sec. 130. I JI, and Wti.
51 �U(k)8: Permanendy insialled ligh�ing in ihe enclosed. non-dwellin@ spaces o(b�.-rise residential 6uildings with (our or
purc dwellin¢ units shall be high tFlicu�� lumineires OR arc cnntrolled by occupani xnsoRs) ceni�ied �e compl}' a'ilh � � �
S:ction I19�d).
Resi,lential Conrp/iunce Forn�s � Aprif 2005
JUL-18-2008 08�38 RM TKO INTERNATIONAL LLC 9496454153 P. 1
. .
Ed Petros
RE: Permit tt8X07-00058
ED,
I am requesting a 30 day extension to 8/18/OS for this permit due to the fact that I was in an automob(le
accident and have been recovering from surgery and require thls time to have items completed.
If you have any questions I can be reached at 949 378-1824
Robert Kingaard
422 16`" Place
Costa Mesa
Fax # g49 645-4153
J
�. _ J
Applicant to fill In all spaces exee0< l�ose within heavr �orCer lines antl sign a11 apvroD/�ate tleclarations.
el7v OF COSTA MESa CONST�UCTION PERMIT
� " b-2% \b P�a�.�
.' Prol�ct Addiess
Applicant's Mailinp.qddress' SAMi -yp '
Owner's Name t�{1�J.bt�� "f dQ� 1S ��N-Phone �S'���
Address �M�" �
Arch/Eng. ' Licen;e'RItS� \ �
Address — �
Contractor's Nam � Phone \
Address (mailinq) /'�
City License No. —�`
IICENSED CONTRACTOR �DECLARATION
I M1eteby a(tiim that I am licensed untle� proviSlons of Charter 9(commencing
wifh Section ]000) of DiviSion 3 0! the Bu5ine55 antl P� essions Cotla, antl
my license is in full force antl effect. :
License Class Licens �
Date �Signature
WORKERS' COMPENSATION DECLARATION '
I hereby atfirm that I nave a certiticate ot mnsent to self-insure or a certlticate
nf Workers' Compensalion Insurance, or a certltietl copy thereof ,(Section
�00. Lab. C.) . .. •
�licy No. � Company �
Certifietl copy is hereby furnishetl.
�Certifietl copy is tiletl with the city Builtlin9 Division. '
Date - - � Applicznt ' '
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tltis section neetl not be com0letetl if the permit is�/o� one huntlretl ($300) o� -
less).
I certlfy� that in tne performance oi the work for whlcn this perm�t is issuetl, I
shall not employ any person in any ma so as t become subject to the
Wo�k¢r5' Co pensati n Laws of Calito
.Oa[e - Si9natureX � �.hL�
'NO C: If, after makin9 this tleclafation, you shoultl become subject to the
Workers' Compensation provisions of the Labo� Cotle, you must fortnwith
comply with such provisians or this pe�mit� shall be tleemetl revOk¢tl.
CONSTRUCTION LENDING AGENCV
I her¢byaffirm that there is a constructiomlentling agency for the per(ormance �
ot the •work tor whicM1- this permit is issuetl (Section 30W Civ. CJ
Lentler's Name .
Lender's AOtlress
OWNERBUILDER �ECLARATION- ' � � �
I hereby aitirm that 1 am exempt trom the ConVactor's License Law (or the
following reason (Section 7031.5 Business antl Profes5ional Cotle: Any city or
county which requires a permit to construct, alter, imorove, demolish or repair
any structure, prior to �its issuance, a1m requires the applicant tor such permit
to file a signetl statement lhat he/she is licensetl pursuant to the provisions ot
the Contractor'slLicense Law (Chapter 9(commencing with Section J000) oi
' Division 3 of the Busine55 antl P�ote55ion5 Cotl¢) o� that he/she is exempt
theretrom and the basiz tor the allegetl exemption. Any violation of Section
�31.5 by any applicant for a permii subjects' the applicant to a civll
ialty of not more than (rve huntlretl dollars (§500).
. I, as owner of the property or myemployees with wages as their sole
compensation, will do the work, antl the struciure is not intentletl or offeretl
tOr sale (Section ]044, Business antl Prot¢ssional Cotle: The Contractor'S
License Law tloes'not apply to.an owner ot a property who builtls or improves
thereon, antl, who tloes such work himselt/herselt�or through his or her own
employ ¢es, provitletl tnat Such improvements are not intentletl o� offe�etl (or
sale. If,.howevet, tM1e Euiltlin9 0� improvement I55oltl within one yea� ot com-
D�etio the owner will M1ave the buraen of proving�he/she tlitl not builtl or im-
p� forthe purpose of 5ale). •'
I, as owner of the Droperty, am exclusively contracting with licensetl con-
tractors to mnstruct the project (Section 7044, Business and Protessions Cotle: �
The Contractor's ,Litense Law tloes not apply to an,owner of property who
builtls or improves tM1ereon, antlawho cont�acts fo� such projects witlt a con-
tractoi(S) license pursuant to the ConVactor's License Law). I am aware that
proot of their Wo�ker'S Compens�a('/��o-�n/�/ryIfu�ance zhoultl be provitl¢tl to me.
❑ I am ezempt untle� $eclion—'�TI B. & P. C. to� lhis reason
Date /�c/�"-a/� Owner /� 'aiv `wi�^^'�^' 'r
I hereby certity that I have reatl this application antl state that the above
information is mrrecL I a9ree to compty with all cRy antl wunty ortlinances
antl-state laws relating to builtling construction, antl hereby authorize repre-
sent5tives or� city tA enter upon tne aoove-mentionea property tor
'� �� Z� 2 �y
TYPE OF CONSTRUCTION rvEw
❑ CONVERSION- � DEMOLISH G
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT LJGRADING LJFOUNDATION lJSTRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
� OTHER
PROJECTDESCRIPTION Sa.F�7/�'., ��1� oCCUaA Cv_
•.CONSTRUCTIONTVPE �/ u VALUASION$ ��E
20NE GRADINGCU.VDS. ACRES_
Remarki: �_ � , �r--� � �('j� LA�
tiJ 1 IIQ �
PU
Sink (
<flow Preventer . . �
<flow Irrigation
1tub5 ' �
ifiers
I WdSh¢f
iking Fountains �
>r Drains
GasService ��Outlets
In[erceptors
Kitchen Sink ' -
Lavatories -_
P-Trap
Roof Dreins
Showers '
Service Sink . .
$ewer Cap .
Sewer�Connection �
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Wacer Closet _
Water Heater
Water Service
Auto-Wash
laundry Trays
�
, ...
FEES
Reinspaction Fee' � $15I I Issue Fea . I $ 3 I
MECHANICAL FEES
Boiler
Duct - Under Ground
Duct � Strucmral
Duct - Ventilating
Exhaust System Multiple
FirepVFacc Blc ICBO #
Heating System & Ducting
❑ ai oo,000 sTu � i oo,000
ISignature K�'kV/ Y�^/�'� [�r�"�J Date/�J�- �a -u -•
Orivers' License or 55 � � Reinspection Fee
CMF'0865-46, rev. 30/84 White - Building; CSnary - Applicant; Pink - Accounting; Goltlenrotl - A55¢SSor
$15
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System �
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Pire Dampers �
Registers
Issue Fee � $ 3
. # �
S Main Building: E
E �
T Front2�
A Rear �
C Right
gLeft � -
Ping. Fef. #
Planning Notes: �
Automatic Washer
Construction Pole Sub.
Cooking Unit
FFJ�9 J�.1<'�� J
�
.�
\
. � ' i
Zone' Q —
Accessory euilding:
Parking Req./Provided
� . +
J
ELECTRICAL , ,
- Transformer �'15-50 KW
❑ 50+1(W
Dryers LJGas IefElectric
Fan
F.A.U. .
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW �5-15 KW
Reinspection Fee $15
DEVELOPMENT'SERVICES REQUIR
Zoning Approved By���(��.�
Building Approved By �
APplltBtiOf1 ISSUBd BY
Metef ❑up to 100 amp5`
Meter ❑over 100 amps
Sub Panel ' i
Motors �0-1 HP 01 h.- 8
Ina Solar 09-15 HP �16
Microwave� - �
Pole light � ••
Range
Sign
; Standing Sections � �
Trash Compacmr
Fee �
�
EES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
$
� SUMMARY��Qppp EES ''��
BUILDING PERMIT . $ �I �o� SMIP � $ 4'ZD
� PLAN.CHECK $ PEFMIT
ISSUANCE! $
PLUMBING $ i
PLAN CHECK 25% $ 'Z ENERGV P.C., $
ELECTRICAL $ eZ-Zi GRADING� $
PLAN CHECK 50% $ % I.! MICROFILM"� $ C�
MECHANICAL ' $ � �� TOTALFEE'" $ 1 �e��
PLAN CHECK .25% $ Z � � ,
' :1. ... . . ,
� � CONSTRUCTION AND PLANNING
' � � .��APPROVALS Permit#
' �- 1. Temporary Electrical Service or Pole
` 2. Soil Pipe-Undrgrnd.
- 3. Electrical Conduit Utility-Undrgrnd.
_ 4. Electrical Conduit-Undrgrnd. �
5. Steel Reinforcement .
.•
6. Electrical UFER Grnd. �'
7. Footings
, 8. Foundation -
9. Water Pipe-Undrgrnd.
� 10. Structural Floor System �
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
• 15: Rough Electrical-Conduit -
16: Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling •
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace �
21. DuCts, in Structure_
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test -
24. Roof Framing �
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27,�. Frame and Flashing�,�1�'"'� •
28. Lathing &�Siding
29. Insulation'
30. Drywall Nailing '
31. Plaster Brown Coat �
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test -
36. Hooci�or Canopy �
;'� .
, � +,
37. Final'Factory, Firep]ace
,_.
38. Final.Plumbing ' �{- �
39. Water Service-Final ✓ " �-
_ �--;i
40. Gas'Ser;'vice=Firial % � '
_, ,
41. Sol�r pomesticFinal '
42. Backflow Prevenier - ��
43. Backflow Irrigation `,� .
44..LandscapelrrigationSystem�``i .
45. Sound Attenuation � .
46. Handicap Regulations
� 47. FINAL STRUCTURE & BUVLDING
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas'Release to Southern California Gas Co
Date
POO L 'A
Inspectar �AppROVALS Permit#
� 52. Pool & Equipment Location
53. Steel�Reinforcement
54. Forms � �
, 55. Electriral Bonding
56. �Rough Plumbing & Pressure Test
� 57..APPROVALTOCOVER�GUNITE
58. Electrical Conduit-Undrgrnd.
' 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undrgrnd.
' 61. APPROVAL TO DECK
62. Backwash & Receptor-Final
. , 63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
-66. Solar System�Final
� �
(� 67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. ProductPipingOGas ❑Oil
' 72...Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
z 74. Overhead Hydro
75. Dry Chemical
�5 76. Dry Standpipe
�.y 77. FIXED SYSTEM FINAL �
�� 78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
•y O
30
Date �Inspector
�
�i. �.�n i irii.rvi � vr vi.�.vrr.��.. �
_. `
No � Date " � -
��°�'Y OF COSTA MES��. �
w►u�oRNu azesa �.o. �ox tsoo
IROM TME OffICE OR TiE DEVELOPMENT SHRVICES OE7ARTMENT/ ��� �` �
. BUILDING SAFEfV DIVISION %
��/- �Z 9 Z
CERTIFIED MAIL
COMPLIANCE OR OCCUPANCY INSPECTION REPORT
Subjec[ Address _ Z"Z �� `
�Date Rec'd. _ �
Moi/ Repor ctton Norrer to: ` / Wp�
Applinnt ��� ` IN�RRn� TelePhone(1�1�T��1`
Address �ZZ ��� ���"'" ����`� ��a ZipCode��2
Owner'sName(Rint) �JA`fy�S `�'�'N �\N(cA(at�-O
`\� �Owner's Address 2 �`' 2ip Code �2
Owner's Signature � Date � 19 ^�T
"�� (/��+��-�-�l.E�� � `j�-� �-- Recorded by�.
� 7� (�tial
Compliance Inspection No. CMB No.
Site Location
At your request, inspection was made at the aboveteferenced address
and the Code violations shown on the reverse side were observed.
Vou will be required to correct the violations listed within fifteen (15) days after receipt of this letter. Failure
to comply :r'tFin tha oilor.ed time wiil iesutt �n a coinplaint investigacion being initiated tor compliance of the
Codes.
If you need assistance, please contact the approDriate Inspec[ors listed beloW:
Structurel
EleMrinl
Plumbing/Mechanical
Very truly yours, �
Name
Title
a: Inspectors
Roperty Owner
CMF 3035�6, r�r. 9/83
WhIb91E9.: 4naryOw�m; PInkCNrlul
77 FAIR ORIVE (714) 754-5273
(754- 1
(754- �
(�54- l
NOTE: SEE REVERSE SIDE
�
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I�LL_L_LJ CITY OF COSTA MESA FIRE DEPARTM� '
INCIDENT REPORT
X. HEADING (Page 11)
BQ�
-9/�7
.1 nGiOent � No: i}ii i}': . -.".
<::::�3 a:� <�:�
Del Atl0 Corr
IT 1 ❑ 2❑ 3❑
one
Test
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2 `
3
.�
5
A. INFORMATION (Page 13) �
Fire DeOt. ID ExDasure No. •'•}'x±me'.':: i: i: ii:MD:'�:� ,(�( _ ay�,:• :::Y,lLr.!,'D2 o�oppt�Y DIsVC�ty Out of JurisEiction
1 3 0 0 2 0 <::�; :j::::: :; :d'<i� .�i :J< �z• �< ..:: ..: F� I C�cekif Ves ❑ 1
6. PROPERTV CLASSIFICATION (Page 15)[ � C. PROPER7Y TVPE IPage41)
Cotle.•:.�:.}::T De�of;InclCentii??i}}iii}}; i: i: iif�}: �: Pr�e�]2�� ost 71 �D�oPertriMa+N9ement: -iii?i?:{4}iii7?:-:{�}:v?:�i}::: i?i:?"r'::.:_i::}<::y.: 1
1 /� ' '
:•�v-/.•'•1:�:� �%�J/j/v.7::}:i:i}iiY.::G:•:4i}ii: .1 2 7Pet1i:3�5i2te:;:4:GouiHy�:•5'Clty.{�6:D1[lrict,:;7:ForeiBn:'BOtner::
Cotle: �'•;'•;;orcpertY:Clanification(Gomplei)? :::.::::::::: :::}<:;::;: .;:;:;::(:;:; .•0..:�5t <t0ie;�BYI1Eiiry;oi:VMIe1l.{V,[upeitY_TYPe;:: ::'��u0Oin9"':.•f
2 ' �..'L�' '.' .111. .. .G:!-. � ..;�.... .a .:::•:•:{.:•>:•i:�:•:�::•:•': �:'::::� ..` : � . . ::�� .j .. •�".�OGG�i7 A .0 �:: a: torl s.Z 2
3 Cotl '� .'-�:Praperry.ClasiMicStion(InCivitlual
1':,::.: •::.•.;;:: • ::::::::::::::: ructure, Bu n9 or e ie e. onz rue on YPe .
:.-..:
,.:};.;: : .. :...... . .. ••. • • n FIoOr - Fire R 3
::= 'ui' c' ' =���E' .A� � i� .YFAR-�iPe.. ::�: � rvi com o Ni co s nic co e; ve: i+a
D. EXTENT OF DAMAGE (Paee 45� _ _ E. LOCATION & CAUSE (Paee 491
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F. AREA, MATERIALS & SMOKE SPREAD (Page 63)
J. MISCELLANEOUS (Page 109�
1 No.lnjurc FirHi9hter o. Deaths� No. Injure Civilians No. Deat s
Z SMF Form GO-1 SUGmitteE tor eaen Eeat� �Nur R-�/
repulrinq �ospitalizatlon (Chec x tf Ves) LI
L. VEHICLE/FIREPREVENTABLE (PaBe117)
Slate License No. Make or Name
1 I I I I I i I i I � I I I I I I I I I I
2 Fire PrevepW Ele Cy InsDection Dat La�l Inip.
Ves Ll No
N. CAUSALAGENT (Paget27)
1 Cotle;;•}::::'::f''..>:':CiuuYAaent:�7�:.{�};};{{:;.Mite�:!FemSlei�UOR�ipyin:
9o1:D I'0:1'�iVK1NvuJ�/:. : sq.:_:::,:;:;;� :i::::�:i:<�::IRI: o::�:
2 �� LJ /.�e�'2 �:' 'LJ 3 .:1��94 '40$OS �C1r�66 � ,� n�o' O �:
{_) �
COMPANYMEMBERS: F�ANT/ND
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K. RESCUE (Page 115)
� TYVe U L� L 1
ParametllcsAv Ilable TimeArriveC RezponseDista�ee 2
❑Ves �No � �. O
M. RESPONDING UNITS IPaBe 719)
Reporting Officer CMF 0030-44 (FD 16) rev. 9/83
i
2
3
a
5
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F
SKETCH LOCATION OT' FIRE BUILDING(S) AND APPARAT1�c: •'
i ' i� d! L/ /_. �' � i i a i_ 1� �� i/ G� i a /
�
/Nbbcv�D iv�r,f��io�E,1�uD FirPE. dy0.3 �A/D/4 SiNGIEsUPf�YFRD/N//S�L�PANi�SE C�iRNEiPOF /(o�P�� AnU
/9USo . �y03 /97TAP.�ED F/iYE {i//TJ���`PRE-�'e�'�'�rrATrpc.�l/NE ANO �ir /h.4N/FO[D UNE. �/13 JE�uRED T%iE
� , i
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i.L %!:I i I %�� / ♦/�I �/ � f I� I I
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/ � � / � / / � / 'i i I/ / �� / , i /
•
i I_ J �' �i.• � / � / i ♦ • �
29246
COSTA MESA BUILDINCrSAFETY DEPARTMEN!
V.O. BO% 1200 GOSTA MESA, GALIFORNIA Y26t0
For App►Fcan! ro Fip In Completaly
TYPE OR PRINT
JREiBD `( (/(/ � *R C.L
COSTA MESA. CAIIFORNIA
nic o
NeR Newport Balboa Savings & Loan
�� 3366 Via Lido w°o� e'sc°
xeaas
� New ort Beach Ho 6733130 =oNa
_HiTeerBurtor��mberger re�408833 av�Rovio
HI use
PAIO * ***
�cT 76-6�00 910 120Js
APPIICATION FOR PERMR
BUILDIN3
IOr OfiJce Use Only
n[c[IIT NO. •
iECl1 NO.
4501 Birch New ort Beach �ox� No.o' zONINGo,„� es. w
� n Fabre Gonstruction Corp. _ .ux. ew�omo
uw�
i 4501 BirCh Str2et o�acnimox
Newport Beach A.P.NO. - -
= 146423 Ng�• 540 8833 �O'rTO81D[ARBARRHL 08MALLOHL[88THAN
QAVEB
�}2S 83' x 60' Mo.oI�LDo�. ALIOW[D (U.�.G.R[GUIRHMHNT',
now e�
YAROOMPROVHD YARDSAPPROVHD
_. __ MAIN BUILOINO AGCEL80RY BUILDINO
DESCRIPTION OR WORK
1928
j stucc
� oisrwHci ea7. . etr. i
DRMOL{BM MAIN BLD ACC[
vw�+.# V-40-68 owTs
� 'sr 111[ 1-lIZ C.V.P. APPR
shake �?P����� ��' � .
uc6 OF �UILD111Y AND WORK TO GQ P[RPORM[D
Famil dwelling w/attached garage
Pian 2C p � � -
1 NHplBY ACKNOWL6006 TMAY 1 NA R�AD iNl� AP�LIG O
ANO BT�TB TXAT iN6gAO�OV6 (� COt�RpRtRT�JANO WA0�1,16[ TO COI
BUILDINOCONsiA OOIIG'FI x. Y/ �/ u//�iOYIATIM
� AUTHORI2[DAO[NT
TX[ wMOUM eN
�YRPOOH OI t!
VALUATION
s��?bj�'/7
'iAT6 � v - � v �
a
�
�
3'°� / ° �
0
vw�u�noH ie ron n�s �
A P¢ptllT I6B ONLY.
y�r� LO
1T F8H !/ D/� O p
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