HomeMy WebLinkAbout924 MACKENZIE PL - Building Permits/
CITY OF COSTA MESA i- .,�
�5`""'F= BlIILDING DIVISION
f
• 9 � 1
i ,.. �y� 77 FAIR DRIVE, COSTq MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� ` g FOR INSPECTIONS CALL: (714) 754-5626
'`�"'^�°'�' PERMIT NUMBER: M10-00124
PERMIT TYPE MECH
APN: 41805228
STATUS: ISSUED
DATE ISSUED: 11/17/2010
ISSUED BY: KJB
JOB ADDRESS: 924 MACKENZIE PL CM Suite/Unit:
Viciniry: '
SQ. FT: 0 .
SCOPE OF WORK: CHANGE OUT FURNACE AND AIR CONDITIONER.
OWNER: HADLAND, PAULINE Address: 924 MACKENZIE PL Unit:
PHONE: 949-279-6195 City/State/Zip: COSTA MESA, CA
APPLICANT: JENNIFER MORRIIL � Address: Unit:
PHONE: 774-282$178 Ciry/State/zZip:
CONTRACTOR: AIR CONCEPTS
Address: 801 S LAKEVIEWUnit; UNIT E
City/State: PLACENTIA, CA ZipCode: 92870
MECHANICAL PERMIT FE� SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
License No. 534722
PHONE: 714-282-8178
CELL:
NOTICE: The work authonzed by this p@rmit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODEi. INSPECTONTYPE OAiE INTITIFLS CODEN INSPECPONTYPE OATE INPPALS .i
1616 Fixed System Final Fire Prevention _ 206 Final Mechanicat Z' �� � � p N m (/�
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Elecirical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 � Final Demolition _ 250 Final euilding/OccuDancy
WORKERS' COMPENSATION DECLARATION�
I hereby aHirm underpenalry oRperjury one of the following declarations:�
❑ I have and will maintyin a certi(cate o( consent to self-Insure for vrorkers'
compensation, as provided for by section 3700 0( the Labor Code, for the
eAor ance of the work fOr which lhis permit is issued.
I have antl will maintain worke�s' compensation insurance, as required by
sec ion 3700 0( the Labor Cotle, (or the peAormance of the vrork for which this
permil is issued. My workers' compensation Insurance carrier and policy
number are�
. ;a A�a/�C.S,,. `thr��c��,c,e Gor�•P�i�—/
(IDrs 'nneedirot�q,{� mr�p�efetldMeperm�is�lvaluetlalonehvntlretlAWlarsS)00)orlessJ
Po i y Number: L"• ��� 11 S �1
❑ I certi(y tha[ in the peAormance of ihe work (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree Iha� if I should
become subject to the wqrkers' compensation provisions of Section 3700 of
the Labor Code, shall forthwith comply with these pmvis'ons.
�awe—"Y6�gnature I t
WARNING: FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER 70 CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION 70 THE COST OF COMPENSA710N, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm tha[ I am licensed under provisions of Chapter 9(commencing
vnth Section 7000) o( Division 3 0( the Business antl Pro(essions Code, and
my license is in full force and effect.
n�—� S' 2 N ��ti Glass# C' 1'6
�
�Co cops,,.ignatur �
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a construciion lending agency tor [he
peAormance of the work far which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atltlress:
Date
OW NER-BUILDER DECLqRpTIONS:
I hereby aKrm that under penalry of perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7031.5,
Business and Pmfessions Code: Any ciry or wunty which requires a permit b
construct, alter, improve, demolish, or repair any strucfure, prior to ils
issuance, also requires the applicanl (or such permit to file a signetl statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing vrith Sec[ion 7000) of Division 3 of the
Business antl Pro(ession5 Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Seclion 7031.5 by any
applican[ for a permit subjects the applican[ to a civil penalty ot no[ more than
fve hundred dollars ($500).):
❑ 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
of(ered 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 dces such work himsel/ or hersel( or through his or her ovm
employees, provided that such improvemenis are not intended or offered (or
sale. If, however, the building or improvement is sold within one year of
completion, the ownervbuilder will have the burden of proving that he or she
did not build or improve for purpose of sale.). �
❑ I, as owner of the propeny, am�EXCLUSIVELY CON7RACTING WI7H
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Cotle: The cont2ctas License Law does nol apply ro an owner of
property who builds or improves Ihereon, and who contracls for such project with
a contracta(s) license pur5uant to the Contractas License Laws.).
❑ I am exempt untler sec.
Business and Professiong Code for this reason:
305]-46 (3/W )
Owner ID verified by drie, .cense. ❑ Yes ❑ No
Oriver's License No. Expires:
Verifcation of Ownership by (type o( document, i.e. - propetly tax biil or deed):
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICA710N: �
❑ I hereby certrfy �hat no excavation (ive (5) or more feet in depth into which a
person is required to descend. will be made in connection with work authonzed
by lhis pertnit, and that no building strucWre, scaffolding, falsev.ork, ar demolition
or tlismantling thereof, will be more than thirry-six (36) (eet high. (Chap. 3.2. Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do vrork which vrould
require a permit from [he Division of Industrial Safety, as no�ed above, unless
such person has a permit �o do such work from lhe tlivision.
Apphcanfs SgnaWre Dale
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CER7IFICATION:
1. Will the applicant or present or (uWre builtling occupant neetl to file and
certify a Business Plan for emergency response to release or Ihreatened
release ot a haiardous material? ❑ Yes ❑ No
(Section 25505 0( the California Health and Safety Cotle requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
DepaAment by every business which has at any one time during a reportetl
year a quantiry of hazardous materials equal to or greater than a weigM of
500 pounds, or a volume of 55 gallons, or 200 cubic (eet o( compressed gas
at standard temperaWre and pressure).
2. Does or will the appliwnt or present or fuNre builtling occupant neetl [o fle
a registration fortn /or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 oi the Califomia Health and Safety Code, with some
exceptions, requires regisiraiion with the Costa Mesa Fire Depariment by
each business which at any one time has on hand a quanti�y of acutely
hazartlous materials equal lo or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of wmpressed gas at s[andard
�emperaWre and pressure).
3. Does or will the applicant or present or tuNre building occupant need to
prepare an RMPP (Risk Management and Preven�ion Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides iha[ Ihe
Costa Mesa Fire Department may require the preparation, certification and
fling with the Fire Department ot an RMPP by businesses which are requiretl
to reqister awtely hazardous materials with Ihe Fire Departmenl.
4. If an RMPP is presenlly required, has Section 25534 of �he California
Health and Satety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or future building occupant require for
the work which is the subject of this application a permil for such constmclion
or modification fmm the South Coast Air �uality Management District or (rom
any olher air polWtion control disVict or agency? ❑ Yes ❑ No
(Section 658502 of the Calitomia Govemment Code requires that the requested
in(ortnation be fumished on applications fa non-residential building pertnits).
6. Will any part of Ihe facility to be constructed untler Ihis permit be within
1000 fee[ (rom the outer bountlaries of a school? ❑ Yes ❑ No
Qf "yes", the facility must meei Ihe requirement of Sec�ions 25534 and 42303
o( the Cali(ornia Heallh and Safery Code).
7. If a permi[ fmm the South Coast Air �uality Management District or other
air polWtion control district or agency is required for the vrork which is the
subject o( this application, have all of the disclosures prescnbetl by Califomia
Health and Safery Code Seclion 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certi�cate of compliance from the appropriate air pollution
control oKcer). '
CERTIFICATE OF COMPLIANCE: I certify ihat under penalry of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaNre �ate
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building construc[ion, and authorize representatives of
the City of Costa Mesa to enter upon the a6ove-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
� i naWre of Legal Owner�s) ale 'l
I� V
Ofo-' _1I14JFe�A"p��f nP a�_—
Certit'icr' �f Compliance: 2008 Residential HPAC Al
Zones ] and 3 - 7
�
ew fiw �+n..
Fumace ❑ AFUE
lndoorCoil ❑SEEA
Condensing Unit O EER _
Agei+cy:
Conditioned � Duct
!ions CF-IR-ALT-HYAC
Penuit p:
❑ COP Over 40 f f duc Setback
Served by system addedf re�n
❑HSPF s{ nc �iditio e pace �f'�a�alreadvprerexcnwsrbe
❑ Resistance �6 (CZ [, 9-5) �usralledJ
]. Equipmen� Type: Choose ihe equipment being inatalled; if more than one system, use another CF-1 R-A1,T-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFLiE, 7.7HSPF for rypical residen�ial systems. �
Contractor (Documentation Author's JRespousible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentaGon is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code ro accept responsibility for the design identified on this
Certificate of Compiiance.
• I sertif�� ihat Ihe energy feat�tes and pedottnance specifications for the design identified on this Certificate of Compliance conform to the
requirements otTitle 24, Parts 1 and 6 of the Califomia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applica6le
complianee forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
S
,-
�
LO
-L
200d' ftesidentia( Compliance Fo+ms � Mm�ch 2010
(EIVRORCEMENT AGENCl'
CAN� G ,..,TOMIZE ' N�ITH LETTEIt7-IEM/SEAL)
2008 Building Energy Efficiency Standards Residential H'VAC Alterations �
� Climate Zones ] and 3 through 7 �Z—�j c Gaf�/�'r'IPShi
BUSINESS AND PROFESSIONS CODE. SECTION 7110 .
Willful or deliberate disregard and violation of the building laws, including the Califomia Building Code, and
local pennit requirements constitutes a cause for disciplinaq� action from the Co�hactors State License Board �
working in conjunction witli�the local building depattment. This action may consist of fines up to $5,000 per '
violation or suspension/revocation of a contractor's license.
WHEN IS A F�RMIT REOUIREU? -
A wri[[en construction permit shall be obtained from the enforcement agency prior to Ihe erection, construction,
reconstruction, instatlation, relocation, or alteration of any mechanical sys[em, except as permitted in Appendix
Chapter 1, Section 112.2 of the 2007 CaGfomia Mechanical Code. Projects requving permits include, but are not
limited ro:
• New HVAC installation
• HVAC Changeout
• Replacemeni of fumace, coil, FAU, or condenser �
+ Relocation of an existing HVAC unit
+ Adding or replacing more than 40ft ducting in unconditioned space
20UA AUII.DING ENERGI EFFICIENCP STANDARDS lTitle 1A. Part 6) REOLIIREMENTS INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wa11 & floor furnaces; room heaters).
2. Central air conditioners 8;. heat pumps less than 65,000 BtuThr musc have a udnimum 13 SEER.
3. Newly installed or replaced ducts mus[ have a minimum insulation value of R-4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandarory requirements of Section 150(m):
�• All joints and open'ings in the in the HV AC system must be sealed.
+ Only UL 181, UL 1 S lA, or UL I81B approved tapes or mastic shall be used to seal duct openings.
�• Connections of inetals duc[s and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4fr. max for horizontal runs with no more than 2"
of sag betv+een supports and 6 ft. maz for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspecror will collect
this form and verify that the model numbers are the same as the installed equipment.
.-V
�
�
.
�b
J
�m' of Coata Mese Pianning Div.
Subject to g�{��� p�bn Regs,
�y Revislon must be approved.
Re uired pri f to Bufldin Final:
OYES ❑ Zpning Inspeclion
�VES �NO Traflic/ park Fee
By�-.�oa�e: lI �G�/a
��zor�-1n A-� vxri�`
C2E��c.�crM- �z�� J�}c- �N
�'2 � ��- � KE�-r S � � P�-
a
CITY OF COSTA MESA
4 ��pMFq BI/ILDING DIVISION
��� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • viv+w.ci.cosu-mesa.ca.us
���� FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: E10-00274
PERMIT TYP� ELEC
APN: 41805228
JOB ADDRESS: 924 MACKENZIE PL CM
Viciniry:
STATUS: ISSUED
DATE ISSUED: 11/1712010
ISSUED BY: KJB
Suite/Unit:
SCOPE OF WORK: CHANGE OUT FURNACE AND AIR CONDITIONER. MISC ELECTRICAL FOR CONDENSOR.
OWNER: HADLAND, PAULINE
PHONE: 949-27&6195
APPLICANT: JENNIFER MORRILL
PHONE: 7y4-2B2$178
CONTRACTOR: AIR CONCEPTS
Address: 801 S LAKEVIEWUnit: UNIT E
City/Stale: PLACENTIA, CA ZipCode: 92870
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspeclion Fee $0.00
TOTAL FEES $54.00
Address: 924 MACKENZIE PL Unit:
City/Slate2ip: COSTA MESA, CA
Address: Unit:
City/Slate/zZip:
License No. 534722
PHONE: 714-282-8178
CEIL:
NOTICE: The work auNorized by this permit shall comply with all applicable hantlicap access requirements under California sfatutes 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 (or the vrork authorized under this permit to be considered legal, such work musl comply vrith all applicable codes, and all
required inspections and final approval must be obfained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE/. INSPEC➢ONTYpE UA7E INTRIALS CO�E� INSGECPONTYPE D� IN7fIIALS
1876 Fixed SyStem Final Fire Prevention 206 Final AAechaniCal
1266 Pool Spa Final 208 Final Plumbing --�
200 Final Re-Roof 210 Final ElectriCyl � �� �� ��V��'
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Oemolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of the (ollovdng declarations:
❑ I have and will maintain a certificate o( wnseN to selbinsure lor vrorkers'
compensation, as providetl for Dy section 3700 0( Ihe labor CoCe, for the
perlo ance of the work for which Ihis permit is issuetl.
I have and will maintain workers' compensation insurance, as requiretl by
s tbn 3700 of the Labor Code, fa the peAortnance of Ihe v.ork (or which lhis
permit i5 is5ued. My workers' compensation Insurance carder and policy
number a e:
Carrier. ��`4.�\C,4`+ � b. $'Hfi.v��.Q C°�Q�,h—f
(inisseamnaetlndce`,cvmpetetlslnepermaisvdlueUaimenware00nw� f5�00)aleu)
Policy Number: �.•\ LQ�S �L't
❑ I certify thal in the pedortnance ol the work (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of Califomia, and agrea thal if I shoultl
become subject �o lhe vrorkers' wmpensa[ion provisions ot Section 3700 of
Ihe Labor Code. I shall forthwith wmply with these provisi ns.
�e�,.5,�,�p��,5� i � — — �
-Y�'_" _" ture
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUT AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLP.RS
($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 aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 ot the Business antl Professions Code, and
my license is in full (orce and eftect.
�:s� S� �(�1 VL , �er��x, C,l-6�7 T
�'«'1�t1�/�%.� �V
m-_'—
CONSTRUCTION LENDING AGENCY:
❑ I hereby aRum that there is a consWction lentling agency fw the
peAormance of the work for which this permit is issuetl. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
SiB^aWre Date
OWNER•BUILDER DECLARATIONS:
I hereDy affirm Ihat under penalty o( perjury that I am El(EMPT FROM THE
CONTRACTORS LICENSE LAW for the followin9 reason (Sac. 7031.5,
Business and Professions Code: Any city or couniy which requires a permit to
construcl, alter, improve, aemolisn, or repair any sWCNre, prior to its
issuance, also requires the apDlicant !or such pertnit to file a signe0 stalemenl
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(wmmencing with Section 7000) of Division 3 of ihe
Business antl Pro(essions Code) or that he or she is ezempt there(rom ana
the basis lor the alleged exemption. Any violation of Section 7031.5 by any
applicanl tor a permit subjecis the applicant ro a civil penalry of not more than
five hundred dollars (3500).):
❑ I, as owner ot the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl the struclure is not inlended or
oftared tor sale (Sec. 7044, Business and Prolessions Code: Tha Contractors
License Law does nol apply to an ovmer ot pmpeny who builds or improves
thereon, and who does such work himsell or herself or through his or her own
employees, provided that such improvements are not intended or ofleretl for
sale. If, however, the building or improvement is sold within one year of
completion, Ihe ovmer-builtler vrill have the burden of proving that he or she
did not build or improve for purpose of sale.�.
❑ I, as ovmer o( lhe propeAy, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conswct lhe project (Sec. 7044, Business and
Professions Code: The wntractors License Law dce5 nOt apply to en O�mOf o(
propeAy who builds or improves thereon, and v.fio wnt2cts fw such prqect with
a cmtracta(s) license pursuant to the Contractors License LawsJ.
❑ I am exempl under sec.
Business and Professions Code for ihis reason:
Owner ID venfied by driv� .cense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (rype of document, i.e. - pmperty tax bill or tleetl):
DIVISION OF INDUS7RIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby certi(y that no excava�ion fve (5) or more leet in depth into which a
person is required �o descend, vrill be made in connection with work authorized
by this pertnit, and that no building strucWre, scat(ddinq, lalse�wrk, a tlemWilion
or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Trtle 8, Califomia Atlminislrative Cotle).
❑ As ovmer-builder, 1 will not employ anyone to tlo work which would
require a permil lrom the Division of Industrial Sa(ely, as noled above, unless
such person has a permit to do such work Irom the division.
APd�����s $ipnature Da�e
Division of Induslrial Sa(ety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre builtling occupant need to file antl
certify a Business Plan !or emergency response to release or threatened
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the California Health antl Salery Cotle requires, with some
exceptions, that a Business Plan be fled wilh the Costa Mesa Fire
Department by every business which has at any one lime dunng a reported
year a quantity of hazardous material5 equal to or greater than a weight of
500 pounOs, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standard temperaNre antl pressure).
2. Does or will the applicaM or present or fuNre building occupant need to file
a registration (ortn for aculely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Cali(omia Health and Safery Code. with some
exceptions, requires registralion vrith the CosW Mesa Pire Department by
each business which at any one lime has on hantl a quantiry of acutety
hazardous matenals equal to or greater lhan a weight oi 500 pounds. or a
volume of 55 gallons, or 200 wbic teet o! compressed gas at stantlartl
temperature antl pressure).
3. Does or vrill Ihe appliwnt or present or (uture building occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Califomia Health and Sa(ety Cotle D�ovitles Ihat lhe
Costa Mesa Fire Department may require the preparation, certification and
fling with the Fire Depatlment of an RMPP by businesses which are required
to register acutely hazardous malerials with Ihe Fire Departmenl.
4. If an RMPP is presently repuire0, has Section 25534 of Ihe Calilomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. DOes or will the applicanl or present or future building occupant require lor
Ihe work which is Ihe subjatt of Ihis appliCalion a peRflit fOf SUCh COOSINUiOn
or modification fmm the South Coast Air Quality Management Distric� or (rom
any other air pollution control dislrict or agency'! ❑ Yes ❑ No
(Seclion fi58502 of the Cali(omia Govemment Code repuires that the requestetl
infortnation be fumished on appliwtions ta ranresideniial building pertnits).
6. Will any paN of Ihe faciliry to De wnstructed under [hi5 permit be within
1000 feet (rom the outer boundaries of a schooll ❑ Yes ❑ No
(If "yes", Ihe facility musl meet the requirement of Sections 25534 and 4230J
of the Califomia Health and Salety Cale�.
7. II a permil from the South Coast Air �uality Management Di5[ritt or olher
air pollution control dislricl or agency is required lor the work which is tha
subject of this applicatioq have all of the disclosures prescnbed by Califomia
Health and Safely Code Section 42303 been made? ❑ Yes � No
8. Q!'yes", attach certificate of compliance from the appropriate air polNtion
control oKter).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL I aqree to comply with all state laws and
city ordinances regarding Hazartlous Matenals and Emissions.
Sgnawre oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I have reatl this application and state that
the in(ortnation given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, antl aulhorize representatives of
the City ot Costa Mesa to enter upon the aboveEescribetl pmperty tor
inspection purposes. I agree not to occupy or allow occupancy ot any building
authorized by lhis permit uniil final inspection.
Si9nawreolLegalOwner(s) �a�e
Signature ��e �w�����1 II �/ �—/ U
905]a6(3ro)) d�
I�AE._' . �1t32E nl (� e 1
%
�onntssaFeaiowo: yL MHC:lSL
an,enswuieiriuiowx: MASCIALE, M
,�� 929 M�CKENZ
CGSTA MESA,
�vri. �uiwc �ooxEm
u�cxrtccr on Fxa+�+:
�,,,, CITY OF CGSTA MEsia - BUILLING FERMI'I
FLOVU: X 97
9262b PERMIT NO: M 0845b7 PL.�N CHECIi NO: N
CONSTRUCTZON TYPE: V-N PERMIT TYPE: MEC
ue w,
YKN.OP FNGY 100NE54: UNf:
�orr�u,ars,u� CRYSTAL AIFt (714)534-2593
������ 11801 MAC STREET
GARDEN GROVE CA 655036
"°°�au 9 2 b 41 "` "°" u�r:
LICEN4ED COMN�CfONS OEC4fl�TI0N: I Ir�eby eflim uMa puWy d prpvy Ihtl I em f�wueA ivder pa"voro d CNqs e
(mmmaia�q x8�S�pm7 000ytl 0ivuion J d Ne &qq�wq Pralawro Cal4.mE .Grn� e in md eRaa.
cm io.: V/`�'LVVb uacuss: L—L� uallo.: b�7�l.ib . VJ/98
,: "�� cnnma«: �� �.c..
WN BNL�ER UEC4R�TON: I MnW dNm uMa Denery d pr'�aY IM I am memp hom iM Caa�eum tioem� lew la IM
ise�m (SW ian RII.S &eiws W Pmlmtians Gode: �m M' G OwvLY �1sA iapiva e Ve�� lo mvbiG. Wer. inPM.
�mde�. w �pv mry �tncu�e. pna b b'vawnca. ebo iapiiriruu iM eppfireN la wrA pmN b fle a ri�ed qtlwroe9 Nm Ir a eM
ficmwd pmuW to �M prvm'vu d tM CMreqm lioenaa lew jChepr B(mrvnsvq Wh SWion lOW) d Oxsion 3 rf tlr
nu�mms eM Pf Wniam Codsl a i1W M a tlw u uemq Ihsdmn uW �M bem foe Ma ^A^G^d avenPion. /�nY vioM�un W Setlion
]0]1.5 by mry epp6me� la � pdm! vLNC� Ilr eppl'cW lo e dil pauEy d ml mon Nen 1'iro haWeA GoCen �Sv00p.
� I.mormerd�MP�Da�Yam/emdWee+xf�wape+esiheiedemmW��.�wTEotheMakeMUe�bueiueaend'waded
a dlered br �ele (Seeum ]at.8umr� eM PmlmvmsCods: The Camreaaa l"meua lewdoa �a ePW to en awrora piapmly
who puWa u inpivn� �Iwaon. rd Ww dae+vurl� wak Nmroll a MnM a INaqh M1e a Iw wm empb/os. pwided tAm vuch
impwemmu ero nol'vewded a aflnN Iv eeb. tl. Mwevm. IM bnidinp a inqwananl u edd wilhw oro yar d mmpk�ion. Ne
owner-0uTCar wA heva rte W�den A G�'�0 M a�he d'd m� Wad a imPa+la �M POW�e d We).
❑ �... o.m. e m. o�w�r..m.mm.+r ow,aunv .'vn �iwmea w�v.da. ro� n. maw (s«,o� �a.. 9�.m... d,e
w
Pmlauian Code: TM Cwureem Licmr !ew don nal eWM b en oMner d V�D�Y vAn dild� a MPa'n Re'aon eM who
convem la adi v� n4n e mureuMe) �ksn.ed wnuw �o �I» cavbfm liuira Lerl.
� I am uemq uMs Section: B. 8 P.C.. br Nw iae�m:
' ov.: o.�.c
i m n.,�nv �«wr um i.m e.�w a w we«.wd u» naw��u d cdio�w wem, .oe sear coe. sw�. zs.ws. zssu..m
255�. md thet I a eny Mun driNuq oovpun. wlll / wll rwl (dreb aw) rieetl to oomNY wYM1 Wd qns eodn md iM nO��aM� br
epwmNlamntwionamodifmiontramlMA� u�iy enepemsMDipntl.RaYderuWaoMMioneppirtlbroxesemqtmnlhne
w�.
ome: �voi�om:
WOHKEP'S COYVEN411TON DECLAN�TION: I �xNy elfirm unEar p�nMy d pajivy ans d Me b0owi�p deds�mioro:
� lhmaeMwilmeuYen�c«W'rsadmwntm�WyrounMwakan'mmpaiunbn.uP'�blaWSwian3]OOdtMleba
coe.. �« n. o«io�wm. d m..w ia w:u� inn o�a m s.�.e.
❑ in.,�.�ew�m,�.a+w,•�o����,.�,re�.a.r.c���.anrsw�aroowme�cae..ameo��em.
waF la xAirA Nu D�N u ouM. My wvMen' comPsnealbn imurencs wrier mN D�Y �mbar ae:
c.m«:
Pa6ry MvnEr.
�Ais x«.;u, med m e. mnplNeC l m.Ca^�+e n, n,. nune,ee eomi. Riaol w wo.J
LJ 1�N � n� V^�� a Ilr wwk la xfich Inie pe�mtl u iatueE. I Wp nd pnpb� vry prson n vry menne� w 2v Io
e.cane w4m �o �ne xwte..• oomw�� bw. a celi�orttie. .ne m+e ma L �.haWa n«cn» .mi.a �o �n. .orken�
canpwubn ion d Seam �iW d �M lebor Cods. l 1 ' h mmpf� � Uoe p'm6oro.
,: -�c`�"—s ,��:
c
s : F�Bun ro weun nvik�ri compw�tlon rowrep� Is unNMW, uM Nvll un/ct m rrployr ro erhNml prWtlu uN
I 11nu ip ro aw �vdrb ttcuaW LWI�n lS�Oq000A a�� ro IM cml ol ccu�prrutlw� Wnap� u provlbJ fw In
S�etlm 9106 0l IM IaEor CacY, Imwa4 ���m�Y'� ��
CONSili11C110N LENpNO �DENCY: I Iwaby dfirm uMw pmetly d pai�vy Nel tMn u e mMMbn laidvq epr�.y 1or tM
y.,tomi.no, a i�..on m..Arie� Uie o.m� e uasa (s.am ]oo'!. u,. c).
LENOEF1'S N�11E:
LENUER'S AOURE59:
I CMM �MI I I1F! 1!O'� NU WG��� W tlY! �IW IMlEWG pllqllb11011 O COIIMY.I VM �O WIII[�P MA N W Yld fMY OIdM11LM
eM etms kw� mlat�q m duM�q mmuwion ad Mr�bY aUMrixa rsp�owuetiw tl tli� aoYn wa upan IM eEwfmaNiwwd PWab
'°"'�petl10"0"`D°'°' RALPH BELL
�,: �l"�-97
(St51-a6.WP) '�e-�1d,q 8 Se1My; Omen-Fb: Canuy-AppireN: Pink�lowwe:OaldenmJ-A+xaor
JOH DE5CRIPTION ; ADL� A/C s kEPLACE F,A.U.
CLAIM VALUE:
CAL�-VALUE:
PERM NO: M 08456:
GGVT: N 5UPP: N
PURPGsE: GrH
S(� FT:
GROUP OCC: R-3 /
COMMENTS: X
ii ic iE iF iE �lf iF+F iF iF ik iF ii ie ie �F iF #� i(� ik if �f 1f 3'r i!� 1i iF ie if 3i ii ir ii iE ii if 3i ii j'r iF iF iE if iF ii iF ih if if if 4 i� if iE iF iF if ie iF ii if w ie iE iF ic if di * iF �r rrt iR w w w if ie ii
Z O N Z N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT ZN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT ZN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 418G5228 ZNE: REF NO:
PLANNING NOTES>
i
it if if'r. iE if+E 1i iE ii iF iE iE iE i'r �1e ie i� iE i't 3E ie ie if ii ir x�1F �k if iE ii ik i� ii iE iR iE 9i ii iF iE iE if iF if iE i(� if ii if iE ii it iE iE if iE 3E iE if iE if if iE iF iF if if iF ii it if se ii �1i iE if !e
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 5
ZUNING APPROVEL bY . DATE:
f•li���1�1��1�I� L'3�:ir��/7iYf:l`I
APPLICATION ISSUED HY• f �"�-
ifif�iieititiFifiEiFifiFiEiEiF3iiFikifiFi6iFiF'ri�ii�%�F%�iciFiFiFiE�iac£iFx"'� ie'�ir
LEGALIZATION:N F E E S U M M A k Y
bLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 2b.50
25Y
PLAN
ISSUE FEE 22.00
BUILDING-DIV-> PERMIT ISsUE PLAN-CHECK
TOTALS----> 26.50 22.UG 0.00
FIkE
TOTAL
48.50
DATE:
_�?jl�
UATE:
iFiiii+fiEicieiE�i iFi'+exsefc.exiFii
STRUCTURAL aEGMENT:AI
SMIF/RBS GRAUING
SMIP/NVN-RES
48A50 U00
REVENUE DIVISION TOTALS--> COLLECTED: 48.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIkE SMIP/TOT GRALING PLAN-CHECH
98.5�
'K' JC:'R 1!!E jt JE'.l�"R x lC'R �E jt'� * 9I' ]E l!'R 9E'h ]t!t x jt 1t'�t'T'k 1! lE lE �E F �E *'k 9t lt'R lF ]E'%E'!E 1E'If i�'k �' � jF �! �"1! lE �� 1t 1t l! � lI' 9E 1C'JE F lF 9� 9I"R 9t lF!t 1F �E 1� 14'
Z N D I V I D U A L F E E B k E A K U O W N
TYPE QTY U E S C R I P T I O N UNIT COSI' TOTAL CuST
MEC 1 INST FURC-AZR/GRAV FORN <= l0U A BTU 13.25 13.25
MEC 1 REFkIGEkAl'ZON SYSTEM <= 100 K bTU/H 13.25 13.25
ENL OF FEES
EXPI ED �
lnComplete ' nspections
at �� '��' � s�& . _` •
63-�5-199NC2:17 Pn/546.5a
PERP7YT�:T084563
CONSTRUCTION AND PLANNING � POG SPA .
APPROVALS Permit # Date lnspector AppROVALS Permit # Date {nspector
�, Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Sceet Reinforcemenc
3. Electrical Gonduit UtilitY-Undrg�nd. 54. Forms
4, Electrical Conduit�Undrgmd. 55. Electrical Bonding
5. Steel Reintorcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7, Footings 58. EVectricat ConduirUndrgrnd.
g, Foundation 59. Gas PiPe, � Undrgrnd., Test
9. Water PiDe•Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. '
10. Structural Floor Svstem ' 61. APPROVAL TO DECK
71. Property Sewer line & House Connection 62. Backwash & Receptor•Final
72. Sewer Cap 63. Heater & Vent•Finat
13. Roof Orains 64. Plumbinp System - Final
14, Rough Plum6ing 65. Etectrical-Final
15. Rough Eiectrical-Conduit 66. Solar System•Final
16. Rough Electric Wiring 67. Fencing & Access ApAroval
17, ftough Wiring Sign ' 68. APPROVED FOR PLASiEA1NG
1$, Rough Electrical-T Bar Ceilin9 69. POOL/SFA SYSTEfaiS FINAL
19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Struaure 70. Underground HYdro
22. Duas, Veniitating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rouqh & Test 72. Undeiground Flush
24. Roo( Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical
z7. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTECI FINAL
29. Ins�lation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. RE�UIREMENT
31. Plaster 8rown Coat 79. FINAL INSPECTION
32. Electrical Power kleter�Final 80. FOOD CERTiF�CATE ISSUED
33. Final Eiectric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test ��
36. Hood or Canopy . �i
37. Final Factorv Fireplace ..
38. Final Plumbing J
39. Water Service-Final
40. Gas Service-Final
47. Solar pomestic-Final
42, Backflow Preventer
43. Backflow Irrigation
44, Landscape Irripatiort SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. PINALPLANNING . -
4g. Eleccric Retease to Edison "
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
;
AOP�kant to fill in all spaces except t�ose within heavy �orGer Iin¢s antl sign all appropriata Oeclaralians.
CITV OF COSTA MESA CONSTRUCTION PE�MIT
, . �—Project Address �
Applicant's Mailing Addres �,�
Owner's Name _� .�QL.n-�—^P . p.n.�„a 557- G✓�Ll
Address
Arch/Eng. �icense No.
Address
Contractor's Namen �hone �%
Address�ma'I' g) �'�/'j3� � � �
Cicy License No. [L� 3
LICENSED CONTRACTOR DECLARATION
I hereby atfi�m that I am licensetl untle� provislon5 ot Char[e� 9(commencing
witM1 section ]000) Ot Division 3 of the Buslness antl Profeszionz Cotle, and
my license is in tull c antl etfect.
�License la _ 'c s .
Dale Si9nature
WORKERS' COMPENSHTION DECLARATION
' � nereby a(firm Ihat I have a certificate of consent to self-insure or a certificate
� ' Workers' Compensatian Insurance, o� a certif,i.ejtl� c,�o�py �t.h-�er�eo,f,, (�SJection
� PQOOY No. iq�Q��{`� Company c'�71KAL l7iL��
�r6fietl copy is hereby furnishetl.
r i 'e�=y�i�tiletl wiin [he city/gutydi 'yifipry� �i
Date (� Applicant bFb l�L
EXEMPTION FROM WORKERS' COMGENSATION DECLARATION
(This seclion neetl no[ be complet¢tl if the permlt is fo� one huntl�etl ($300) o�
Iess).
I Certify that In the Performance Ot th¢ work to� which thls pe�mi( is issuetl, I
shall nol employ any person in any manner So as [o becom¢ subject to the
Workers' Compensalion l.aws ot Calitornia.
Date Signature
NOTICE: I(, after makin9 this tleclaratlon, you shoula become subject to the
Workers' Compensation Orovislons of the lzbor Cotle, you must fortnwith
comply witM1 sucn p�ovisions or th15 permit Shall be tleemetl revok¢tl.
CONSTRUCTION LENDING AGENCV
I hereby affi�m that Ihere is a conStruc[ion lentling agency (o� the Oe�formance
ot tne work for which thiz permit Is issuetl (Section 309] Civ. CJ
Lentler's Name
Lentler's Atltlress
OWNERBUILDER UECLARATION
I hereGy affirm that 1 am exampt trom Ihe Contractor's License Law for tne
following reason (SecHon 7031.5 Business antl ProfeSsional Cotle: Any ciry or
counly wbich requi�es a permit to const�uct, alt¢r, imp�ove, tlemolish or rCpair
any structure, prbr lo its issuance, also r¢qWres Iite applicant tor Such pe�mit
to file a signetl slatemenl that he/she iz Iicense� pur5uant tOlh¢ Provision5 of
tne Convactor's License Law (Chapter 9(commencin9 �+'��h Sectlon �000) ot
Division 3 of the Busine55 antl Professions Cotle) or lha[ he/sbe-is exempt
��ere(rOm antl the ba5i5 tor lhe allege0 exemption. Any viola[ion o/ SeCtiOn
131.5 by any applican[ fo� a permil subjects Ihe applicant to a clvll
<ndlty ot not more than tive huntlretl tlollars (E500�.
❑ I, as owner of the property o� my employees wiOt wages ai their solo
comoensation, will tlo the work, antl Ihe siructure is not intenaetl or offeretl
for sale (Section ]044, Busine55 antl Professional Code: The Con[ractor's
LicenSe law tloes not apply to an ownet of a proplrty who builtls o� Imp�ove5
lhereon, antl who tloes Such work himseli/hersefl o� [nrough his or her own
employees, provltletl that such imorovements are noc intendetl or ofleretl for
sale. It, howeveq the builtling or improvement is so10 witnin one year of com-
pletion, lhe owner wlll have lM1e burCen of provin9 �e/she ditl not builtl or im-
�rove tor [he purpose of sale).
I, as owner of [he property, am exUusively contracting with licensetl com
l�actors to const�uct the projeGt (Seclion ]044, BuSiness antl Profe55ions Cotle:
The ConVactor's License Law does mt apply lo an ow0er of 0/operty wM10
builtls ov improves lhereon, antl who con[rac[s tor such projec[5 wilh a com
lraclor(sl I¢ense pursuanl to the Contracror's LicenSe Law). I am aware Ihat
proof of Iheir Worker's Compen5ation insurance shoultl be provltletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner _
I hereby certity that I have reatl th
information is wrrecL I agree to con
ana state laws relatin9 to building ct
sentatives o( this city ro enter p
inSpeCtion p s
Signature � �
Drivers' License or 55 �
above
nances
tep�e-
[v for
f'3 � Ss 9 I I I
TYPE OFCONSTRUCTION NEW ADD ALTERATION
❑ CONVERSION' ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
OFPERMIT LJ GRAOING LIfOVNDATION LI STRUCTURAL
TENANT ❑ ELECTRICAL C9'PLUMBING ❑ MECHANICAL
PROJECZDESCRIPTION 5q. FT. oCCUPArvCV
CON STRUCTION TVPE VALUATION 5_
20NE GRADINGGU.VDS. ACRES_
Remarks>' -
Bar Sink
Backflow Preventer
Backflow Irrigation
Drinking Fountains
Flbor Dreins
Flaor Sinks
Gas Service Outlets
I n terceprors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
fleinspection Fee � $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust Syscem ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,000
Reinspec[ion Fee � $15
--
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Appli<ant; Pink - Atcounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Hearer
Water Service
Auto-Wash
Laundry Trays
�sue Fee
Hood or Typel ❑
Canopy Type I I ❑
Retrigeration System
❑o-ioo,000aTu ❑ioo,000
System Repair/Alteraeion
Fire Dampers
Registers
luue Fee
R
FEES
A.P. qW
S Main Building:
E
T Front
e Rear
A
C Right'
K Left
$
Ping. Ref. #
Planning Notes:
8383 10/27/87
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer ' Transformer ❑� 15-50 KW
Construciion Pole Sub. � ❑ 50 + KW �
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Bozes
Outlets
Switches
Garhage Disposal
Generetor �0�5 KW �5�15 KW
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panel
Motors � 0-1 H P � 1%- 8
Inc. Solar 09�15 HP 016-15+
Microwave
Pole Light
Sign
Standing Sections
Trash Compactor
$ 3 I
�- Reinspection Fee $15 luue Fee
FEES
�DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Building Approved By _/�����
Appliwtion ISSUBd By_I ll/
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ � PERMIT
PLUMBING � $ � -�•V v ISSUANCE
PLAN CHECK 25% $ ENERGY P.C.
ELECTRICAL $ GRADING
PLANCHECK 50% $ MICROFILM
MECHANICAL S TOTALFEE
PLAN CHECK 25% $
5,00 Tl
2
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
5
S
S
S �
S �
CONSTRUCTION AND PLANNING POOL & SPA
c-� Date Inspector - -" � Date Inspector
AP.PROVALS Permrc�# APPROVALS Permit#
1
1�tTemporary Electrical,Service or Pole 52. Pool & Equipment Location"''
l
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement ���
3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms �� .
4. E�ectrical Conduit-Undrgrnd. 55. Electrical Bonding C� -
5. Steel Reinforcement 56. Rough Plumbing & Pressure��2st �-�
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GIJNITE
�,:
7. Footings �. 58. Electrical Conduit-Undrgrn8.: ,
8. Foundatiop - 59. Gas Pipe, O Undrgrnd., Tes� : •
9. Water Pipe�Undrgmd. 60. Backwash Lines, P-Trap, O Undrgmd. ,
70. Structural Floor Syjtem 61. APPROVAL TO DECK �
71. Property Sewer Line.& �House Connection � 62. Backwash & ReceptorPinal
12. Sewer Cap 63. Heater & Vent-Final ,
73. Roof Dreins 64. Plumbing Syscem - Final �
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrica6Conduit 66. Solar SYstem-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval -
17. Rough Wiring Sign � ��' �- � 68. APPROVED FOR PLASTERING '
18. Rough Electriral-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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ 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 :'�i ,
31. Plaster Brown Coat 79. FINAL WSPECTION �'-.'
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED .
33. Final Electric Notes: �.((�88 ��r G�a L.�.D �'^
34. Final Heating & Air Conditioning ?��,� (qn�� � �e ZG13� GF� �,�f.� , ...•. _
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 pomesticFinal . , ,
42. Backflow Preventer - � � '
43. Backflow Irrigation ' . . � r
44. Landscape Irrigation System : .
45. Sound Attenuation � � • �
46. Handicap Regulations • . ' . ,
47. FINAL STRUCTURE & BUILDING - . , � � ' .
48. Special Requirements Completed � � - '
. �
49. Electric Release to Edison ' , � � �
50. Gas Release to Southem California Gas Co � . - . �
51. CERTIFICATE OF OCCUPANCY - -
No. Date �
rt�y 13, 1970
Mr. William L. Palmblade
924 MacKenzie Place �;`
Costa Mesa, California `\
Dear Sir: y
On May 11, 1970, you too ut a permit to conatruct a
private awimming pool on your pr y.
In order that your pool will be a safe one and Por the
� purpose oP advising you of your reeponsibility regarding the
requirements oP the Cos Mesa Municipal Code, we refer you
to Section 8107, a copy o which ia attached.
This letter is directe to you in order that you will
be aware of our ordinancee and can make a complete safety
check of your po area.
Sincerely yours,
RICHARD HANHART
Suiiding Safety Director
RHsdh
INSPECiION 6 iFS71NG EN61NEERS
CHEMICA� 8 VHYSICwI ANALY515
0.�DIOGRwPHY %.RnY G�MMw RAY
P.O. Be. �] � I110 A4rpe.e w.y
lonq BucA. C�IiL 90lOi
�7u1 �xa»ss • �iu� eaatve • piq eie�wn
June 2, 1970
Since IB98
RESEARCH 8 ENVIqONMENi�I iEStING
CORqp510N ENGINEERING 8 ♦N�LY515
ULiRA50NIC MAGNEIIC 8 VENETq�NT
I51�.0 Ner�h H�rp�r $li���
$�nl� .1n�. C�liferni� 93J0]
pi.� sv�xas
Examination: SG70-3065
COMPRESSION TESTS ON GUNITE CYIINDERS
l.aVirence Spragua
2�33 Miramar Dr1vo
Balboa, Callforni� 92661
PR0IECT NM. L. PAIMBLADE
ADDRE55 92<+ Mackenzio, �09L� NB3a
SAMPLE FROM :: shcllow ond/ 2 deep end/ 2 bond beam
ARCNITECT
ENOINEFN
MIX
DATE CAST
DATE TESTED
CYLINDER NO.
COMPRESSION
TOTAI LOAD, LBS.
POUNDS PER SQ. IN.
COMPLIANCE
CYLINDERS
Gunita
5-?5-7C
6-2-70
I
7-Oay
I�1,SOD
4�12j
GONiRACipR
Aloha Pools
SUECONI9A�f00.
SPECIFIED
STRENGTH
SIZE:
6 -2 -70
3
; -Day
i06�000
3,597
7-day test cort�iios withspecifications.
Maoe er
L.E.Sprague
msraieunor+:
L. E. Spra,ue - 2
Dean Beaur.wnt
P,o.aox 57�, rusctR gz66o
Costa M�sa Bid;.�Dopt.
���a�
2,000 p5i
ql � 6-1/8" x 12��
li3'� 6_��g�� x 12-3/�+��
q4: 6-3/8�� x 12-3/�►"
6 -2 -70
5 2 "HOLO"
4 ��Ho�o'�
7-Oay 6 'WOLD"
93,000
z,314
DE4VEME0 pY '� � �E � I V E D
-Sarxi- BU�I.DI�''a-70FETY DEPT.
�uN 3 1970
aM PM
; �c^,i9,1�,ISiL �i2i3i4�5t8
�
� �F
�/�� ��Y/ ^�_/ � •!�'q � � //
9,�.i ,t'� +-r`--"'�.,�c„='"�s..- _
�
�LL REVOAIS �PC SVB�Ii:ED �5 iMC COM1f10EMil�l VYOOCNTI O� CLICHT$ U}MONi}�iIOM i'O�/��UBLIC�TIOH O� OUP PEPONTS. CONCLVSIONS. OR Ei�
iN�CTS 1'FOM 04 RCL�YO�'�G iMEv IS 4CSF9Vt0 P[NOIHG OVA WAIi'IM1 �nnMpv�L �] � MU`V�l Y��OtlCfION l0 CIIEMiS. TMG V�/BLIC �ND OVNSELVES.
J30 i2
� � 2�E��'1
' f .�
COSTA MESA BUILDING-SAFETY DEPARTMENf
P.O. BOX 1200 � GOSTA MESA, CALIFORNIA D26Y6
Fer Appficanf fo Fill In Completely
TYPE OR PRINT
ADDRES8 92G Mackenzie Place
COSTA MESA, CALIFORNIA
OWNER U. S. Financial
ADDR85t 1 Front St•
e�n San Die o �alif, no' 23Lt-7
YITECT re�. 546-5
NGINEBR A. S. Henrsck NO.
wcroR Lewis R. Sc%�mid
as 29L�0-A Rancki�h Ave.
Costa Mesa, Calif.
� 6RE
ti� �S � R@AR YMO
�� 5 � � R�a� 5 �
DESCRIPiION OR WORK
� US80R
L
I HER6BY ACKNOWL6D06 TNAT � MAVi RGD TMIB APPLICAT�ON
AND BT/�T8 THAT TX8 ABW6 If CORRRCI' AND AOR86 TO COM•
PLY WITH ALL CITY ORDINAXGO AND RATf tAWY R[�YLATINO
BUILDINO CONeiRYG�10N.
SIGNATURE OP n
PERMI7T@E �^- /�`^ �+�0.i o� _ � �
AUTHORIZiD AGQNT
PAIO
FEB 17-67cMs�,00 723� *::t���'99.00
APPLICATION FOR PERMR
BUILDIN(i
FO� �1c6 {�fe �ll�
ZONING
no.or uoa
�uH� �' ew�
�.eoN.
�. Ho. -�'_
�6: NO iAVE OViRHANO SHALL �E L68S THAN
' TO SIUt a RBAR P. L
�E8
_OW[D SV.B.C.RECUIREMENT]
YARDB/1PPROVED YARDSAPPROVHD
MAIN BUILDIN6 ACCESSORY BUILOINO
DIRANC� BiT.
MAIN BLDOf.
VAR.�
�✓ �/ `� 80. Ff.
THH AMOUXT BNOWI
PUpPoeB OP 68iA1
VALUATION
:���Sy-
�
DATE
' � - ��
a
W
�
�
�6 FOP TH6 �
FE6 ONLY.
�
�� �
,�3— w
7�I -
�,
.� �i
i
� COSTA MESA BUIL N-SA TY DEPARTMENT
P.O. BOX 1i00 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUI�DING /)✓1 !/ �// i _ U _ _ . /� .
Z .
a cWj
� Z
z F
ON
am
J7
J N
6'
[
J Q
UN
Z a
W �
aw
WZ
J Q
m Z
J �
W w
O
ZH
W �
N ¢
� �
F
z
Q
U
4
�
F
�
z
0
F
U
�
�
H'
N
z
OWNEfi LU�/LI .C. O�Q�Ml�l7��
MA I L /. �� //
ADORESS Q%.� /�� /`GIyl��J^I
TE
CITY ���- � ��.�� NC
COn1STiiUCiION �
LENDER
BRANCH
ADDRESS
ARCHITECT �{J , IS/ / TE
OR ENGINEER lK/�dbi Qbrr,,.w���. Nc
n _ .. .
ADOFESS [�$
CONTRACTOR
ADDRESS ^
GTV
STATE
LIC. NO.
SIZE
OF LOT
USE OF
EXISfING BLpG.
512E OF
NEW BLDG.
EXTERIOft WALI
NO.
CITV
LIG. NO.
NO.OF BLDGS.
NOW ON LOT
NO. OF
ROOM$
ROOF
COVERING
K TO BE PERFO
0
I hereby acknowletlBe thot I have reetl this application entl state
that the abova intormation is correct antl eprae to comply wiM
all laws ragulatintl builtlinp conaVuction, entl I shall noi employ
eny person in vlolation of the workman's compensation lawi of
t�o State ot CelifO���a.
I heroby certity [Pat I em proparly Iicenaetl es a cont�acror untler
Me State ot CalifOrnia Business antl Profawlons Cotle, Dlvisicn 3,
Chapter 9, antl thnt such licenms are In full force entl efiect, or 1
am exempt (rom the provisions o( the Stete of Cellfornia Business
nntl Professlons Cotlo, Division 3, Cheptar 9.
slenatura of � D OD�f�.'.�t /
Permlttea �n'+ !4G
Authorizetl Agant �/�
�iAY 12-70P�'�00 424# ****34.5Q
CMSA
APPLICATION FOR BUILDING PERMIT
R
BUI�DING
ADDRESS
OWNER
FIRE
20NE
APPROVED
N r NO.OF
Fl-CNS o
VARDSAPPROVED
MAIN BUILDING
DISTANCEI
MAIN BLDC
VAR. #
C.U.P.�
APPFOVED
THE AMOVNT 51
THE PURPC6E OF
VALUAT�ON
B
�DATE� Jl/
VSE OF NE
BUILDING � `
YARDS APPflOVED
ACCESSORV BUILDING
BEf. MAIN &
b
0
VALVATION IS FOR ^
A PERMIT FEE ONLV: �
¢
� �-a m
o $ ]
K 5
� `�'sJ e
�� � a
$ LL