The URL can be used to link to this page

Home My WebLink About932 MACKENZIE PL - Building Permits(7�14) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa��DING PERMI JobAddress: 932 MACKENZIE PL � Suite: • Vicinity: REAR SFD Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 41805226 Zoning: R1 Applicant: PETER SHAMBROOK Address: 932 MACKENZIE PL COSTA MESA, CA Phone: 775-556-1248 Zip: 92626 Owner: SHAMBROOK, PETER AND PATRICIA L Address 932 MACKENZIE PL COSTA MESA, CA Contracror: OW N ER-BUILDER Address: Phone: Zip: 92626 Phone: 77 FAIR DRIVE, COSTA MESA, CA 92626 � � Status: ISSUED Applied: 12Y21/2005 Issued: 12282005 . ISSUED BY: Zip: License: 000000 Arch : TONY MASSARO Eng: Address: 3100 AIRWAY AV Address: C.M,CA Phone: 714-556-8299 Phone: SUITE 114 Zip: 92626 License: C24376 License: SCOPE OF PERMIT CONSTRUCT 408 SF SOLID PATIO COVER AT THE REAR OF AN EXISTING SFD. Plan Check: $90.51 Permit: $139.25 SMIP Res: $0.66 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $230.42 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Fronl 0-0 PARKING Existina: o Rear 0-0 Rear 0- 0 Reouired: 0 FEE SUMMARY Calc Valuation: ss,s�e.se Claim Valuation: So.00 PLANNING & ZONING Left 0-0 Right Lek 0-0 Right Pr000sed: 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 7, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all requlred Inspectiona and Iinel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permit. FOR INSPECTIONS CALL: (714) 754-5626 cano-ro �aw� WOqKERS' COMPENSAnON DECUWATON: - I hereby aNirtn un0er penalry of perjury me ot Ne following tledaratiwu: �\ ❑ I have Antl will meintain e certificete of consent to sell�lnsure fa workers' compensation, as provitled for by section 3700 0l the Lebor Cotle, tor Ne peAortnence af �he work fo� w�ith Ihis pertnit i5 issued. ❑ I heva gnd will meintain workers' compensatlon insurance, as requiretl by sectlan 3700 of Ne Lsbor Cotle, tor Ihe perfortnence of the work for whicti this pertN� 4s issugA, My worke�s compensatbn Insu�e�e came� a� poliry numher are: Carrier. Policy Number: (Tfris sec0on �eed nof be mnpleted il Ihe pemtit is valued et one nuntlretl tld/ers (5700) or less.) comply ol ihe work tor whiCh Ihis �pntl agree thaj il I shoul� is issued, I shall not employ any person in eny menner so ns to 6ocome subject to the workers' ne sub�ect to the workers' compensatian provisions of SacHon 3700 0l ihe Lebor Cotle, I shall fort�with �LYlIL.I�� VdL"�t'�� ete: .. �'�. 2� • Q ii WORKEP$' COMPENSATION CpVERAOE IS UNIAWFUL rWD SHALL SUflIECT AN EMPCOVERTO�CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNpqED IN A�OITI�N TO T}4E CqST pF OOMPENSATIIXJ, DAIMGES AS PROVIDED FOR IN SECTION �TCB pF THE LADOR CApE, �KTERESi, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARA710N: I horeby aHirm that I em Ilcensed under provisions ol C�eptor B(commencing with Section 7000) of Dlvision 3 0l the Business antl Prolessions Cotle, and my license is In tull . force antl effe��. Lic. s Class a Contrecbrs S�gnaWre: Dete: CONSTRUCY�ON LENDING AGENLY: ❑ I hereby aflirm that there is a construction lentling egency tor the pertormance ot lhe work for which this pormit is issued. (Sec. 3097, Civil Code). Lentler'S Neme: Lender's Atltlr05s: �. SignaNre: Dete: OWNER-BUILOER DECLARATIONS: I hereby eMlrrr� Ihei under penelry of perjury Ihel I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code�. Any city or counry which requires a permit to conshuct, aller, Improve, tlertrolish, or repair eny stmcturo, pdor to its issuance, also raquires the appiicani fo� such parmit to tile e signed ste�ement thet he or she is licensed pursuant to the proWsions ol the Contractore License Lew (Ghepter 9(commencing wlth Section 7000) of Oidsion 3 of tha Business and P�ofesslons Code) or that he or sha is exempt therelrwn enC the besis tor the allegetl ezemption. Any vloletion of Section 7031.5 by any applicant for a permit subjects the apPlicent to e civii penalty of no� more ihan five huntlretl dollars ($500)J: I,as owner of ihe pwpeny, or my employees wilh wages es �helr sole compensation, WIIL DO 7HE WORK, entl ihe simcWre Is not Intended or oHered lor sale (Sec. �7044, BVsiness end Professions Code: The Conirectors Licenso Law aoes not apply to an owner ot property who builds or improvos ihereon, and who tloes such work himsell o� herself or through his or her own employees, prwitletl that such imprrnemems are not Imentled or oMeretl for salo. II, �owever, ihe building or improvemem is soltl within one year ot wmpletion, the owneo-builder will have the Eurden of proNng ihat he or she did not builtl or improve lor purpose oi sale.). � ❑ I, as ow�er ot the property, am E%CLUSIVELV CONTRACTINC WITH LICENSE� WNTRACTORS ro construct the pmject (Sec. 7044, Business antl Pmfessions Cotle: Tpe coniractors License Lew does not apply to en owner of property w�o builds or impmves thereon, antl who coNracis for such project with a contractor(s) _litense�v�rs�ant to the Contraaors License Wwy1. Business antl Professions Code for Ihis reason: licen5e. ❑ Ye5 ❑ No Vedlication ot Owners�ip by (ryye ol tlocument, i.e. - pmperty tax hlll or DIVISION OF INDUSTRIAL SAFETV PERMR CERTiFICA710N: ❑ I hereby cenily thet no excavation five (5) or more teet in depih In�o which e pereon is required to aescend, will be made In connection with woM authodzed by �hls permit, and ihal no building strucwre, scaffolding, lelsework, or demolition or tlismantlinq �hereof, will 6e more then thirty-six (38) teei hiph. (Chap. 32, Grp 2. An 2, Sec. 341, Ttl6 B. Celifomie Atlministrative Code). ❑ As owner�bullaer, I will not employ anyone to tlo work which woultl require e permit from the Divislon ol Indusidal Satety, ns notetl above, unless such person hes e permi� to do such work from Ihe divisian. SigneWre: Da�o: Division of Intl�s�rial Safety Permi� Number. CER71FlCA7E PF COMPLIANCE ANU AUTMORVJITON OF ENTRV: I certiy untler penalry of perjury Ihat I have reatl this application end stata that the informaiion given is correct to with all state � ws antl ciry ordinences relating to building construction, and authonze reprasentetives ot tho Ciry ol Costa Mesa to emer upon the ove-d prope for inspection es. I ree not to xcupy or ellow occupancy of any building authohzod by lhls pertnit until tinal inspection. �A�/_l --�_ IZ�ZS,CF,. rSgna� gal Owner(s)_ _ _ � Date - � AnNOr Authodzed Applicant Date CODE �. INSVECTWNT'PE 1818 Fixetl System Final Fire PrevenGon 1266 POoI SPa Final 200 Flnal Fe-Rool 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 204 Final 5ign Final Demolition PAIE II�ElS COUE 1 INSPECiION TYPE 206 Final Mechanical 20B Flnal Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Plenning Appraval 222 Final Site 250 Final Bulitling/OccuDenry PAIE 1�L$ � � .. �� °� L?oQta ��%Qa �'uiE� Diuiaio�a OWNER-BUILDER VERIFICATION Address: I �Z I"��L � �"'�"T• ��mit#: A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the rewm of, an owner- builder vcrification. A[tention Property Owner: An `owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and retum this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building pemiit. No buildine �ermit will be issued until this verificatiun is received. 1. I personally plan to provide the major labor and materials for constcuction of the proposed property improvement. � Yes ❑ No 2. [(have/have not) �4�. signed an application for a building peani[ for the proposed work. 3. [ have contracted with the following person (firtn) to provide the proposed construction: Name Address _ Phone ( ) City _ Contracror's Lic. No. 4. 1 plan to provide portions of the work, but 1 have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone ( ) City — Contractor's Lic. No. 5. I will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: Name 10a2<6 (ftev.ltroa) Address Phone T}�pe of N'ork � 5ar� c�. �orton Specia! Inspection Services 6232 Kiowa Road • Westminster, CA 92683 Joint Certified ICBO Reinforced Concrete ACI Conerete Field Tech l.iccn�e HU528(3 Insund S DAILY REPORT TVPE OF ❑ Reinforcetl concrete ❑ Structural INSPECTION ❑ PostTensioned Concrete ❑ Gunite REQUIRED ❑ Reintorcetl Masonry ❑ Shot crete Ph 7I4-895-1344 Fax 714-899-5684 Mobile 714-309-7304 Gmai Cgnkiowa@verizon.ne� Epoxy Other Job Address Q �.f �/ •_ Gry /� /L�%/-�/ /fl=�✓9 / (- � (_..lS %f' /'✓%/- 5 /� Job Name Pertnit No Issued By Sr/�r.�� /'.cu�/c h'a��73s"" �. � . Type o� SWtture �% Architecl � I1YL.i..oi � Matenal Descn tion (type, g�ada, soume) En ineer P � l ��.�i 9 ,/� �� /I/h ��.��-1.,, Contrector y . r �? , . ., � -.. i � 2 /_ ,/�,J y , , Cf� /"�; �, 5 i�' . „ 7� • ;� ._ inspecto^(s) Name �� / J/j A/� � 7�JA Subcontrector 7/ // / / TESTS PERFORMED TVPE OF SAMPLE SLUMP �UANTRY IN SET ADDITIONAL REMARKS ON SAMPLES INSPECTION SUMMARY -LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, EfC. INCLUDES INFORMATION ABOUT - AMOUNTS OF MATEFIAL PLACED OR WORK PEFFORMED, NUMBER, TYPE 8 IDENT. NO'S OF TEST SAMPLES TAKEN: STRUCT, CONNECTIONS (WELD MADE H.L BOLTS TORQUED) CHECKED; ETC. ..✓s /is--�-7..,E% %�/1i� ,�� . /'/�i771 F y1._ ei % ,-lii f�.i�i5 . _ /'.i � 1.,�._, /J.-� /�- �A� ��/.� �S �%/ � i/ /� . f.. /I �� %<: . L9�1� / �! '/. / . � GLi �� /-...h._ /%ni ,7 % il,iu.. „ /,4 4. .�'.��,. `�.-T � ? r= �-,..t„ ;n �� , ,�/ d, �/ ,-, �� ,>.., � �Y <. Y,I/ r�., ,,. - %�, . ,. ✓ / C(1NTINI IFfI (1N NFYT PGCC f'i OdCC � !lL � �/ \ ✓. / � /�� / �/ � SIGNATURE OF REGISTEflED INSPECTOR L c� �50614 7�?G/ -/-/ `7 _Z �G-� �' <<- � $PECIALN NO AGENLV TIME IN � TIME OVT � REG. HOURS I 0.7. HOURS I SAMPLES All inspec�ions basetl on a minimum ol 4 hours aM over 4 hours - 8 hour minimum. / ApprweE M'! /. / "Ii /�% , % ,/ Prqect $upemtenGent WHITE • CITY'S COPV, CANARY - ACCOUNTING COPV, PINK - INSPECTOR'S COPY (714) 754-5273 • Fax (774) 754-4856 • �wiw.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suile No Vicinity: Parcel Nunmber: ApplicanC Address: Owner: Address Contractor. Address: ISSUE FEE Temp service test Res. alc package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fi�ts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors l0 10hp Motors lo SOhp Motors l0 100hp Motors over 100hp Communiwtion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 932 MACKENZIE PL 41805226 SHAMBROOK, PETER AND PATRICIA L 932 MACKENZIE PL Phone: 714-556-1248 COSTA MESA, CA Zip 92626 SHAMBROOK, PETER AND PATRICIA L 932 MACKENZIE PL Phone: COSTA MESA. CA Zip: 92626 OWNER-BUILDER Phone: Zip: License: 000000 SCOPE OF PERMIT UPGR4DE SERVICE PANEL TO 200A (SAME LOCATION) FOR SFD. 523.50 $0.00 50.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 830.50 50.00 50.00 50.0� 50.00 $0.00 50.00 50.00 50.00 80.00 50.00 50.00 50.00 50.00 Quantity FEE SUMMARY Temp Dist Syslem / Lighting Busway /100 R Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring Syslem / Ckt MisC. Conduit Misc. Conduclor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Slatus: ISSUED Applietl: 04/032006 Issued: 04I03/2006 ISSUED BY: � Quaniity $0.00 ' 0 50.00 0 $�.00 � $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 30.00 0 so.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 50.00 S0.00 50.00 TOTAL CALCULATED FEES 554.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related regulations. (Ord. No. 92-28, § 7, 1241-92) EXPIRATION: 7his permit shall automatically expire and become void if work is not commenced within 1 BO days, or il work is suspended or abandoned for a penod oi 780 days. INSPECTIONS: In order for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, end all requlretl Inapectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 75A-S626 .�. ., �,.,,,,, WORKERS'COMPENSAnON DECLARATON: _� • 1 �ereDy ettirtn under penalry of perjury one oi tha tollowing Ceclarations: ' ❑ I heve and will main�ein a certificata ot consent to self-Insure for workers' compensation, as provided tor by section 3700 ot the Lebor Cotle, for tha pertormanca of the work for which this permi� is issuetl. ❑ I have and will mainlain workers' compensation insurence, as required by section 3700 0l the Labor Cotle, br Iha pertortnanca of ihe work ta which this pertnit is issued. My workars' compensation Insurance wrtier antl polity number ere: Cerrier. Policy Number. (This secfion need nat be complefed i! Ne permif is valued et ane hundred dollers ($f 00) or less.J ��I.certify ihai in the pedormance ot �he work br which thls permit is issue4 I shall not employ eny person in any manner so es to become suDject to ihe workers' compensetion lews ot C Illomi 0 egrae tha if I should ecome sub�ect to the workers' compensatlon provisions ot Sectlon 3700 of Ihe Labor Code, I shall lorthwith comply with th�J �� wPi��rsia�a,a�a: �'�. � ��` 4. 3. D(o WARMNO:'FAILURE TO6ECLAE WORKERS' COMPENSATION OOVEMGE IS UNLAWFUL rWD SIULL SUBJECT PN EMP�OVER TO CRIMINAL PENALTIES M1D dVIL FlNES UP TOONE HUNORED THOUSAND OOILARE (5f 00,000)� IN NDdTION TO THE CQST OF COM�ENSATION, DAMAGES nS PitOVIDEO WR IN SECTION 3]OB OF THE UBOR COOE. INTEREST, ANO ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aHirm lhat I am licensetl untler provisions of Chapter 9(commencing with Sec�ion 7000) ol DiNsion 3 0l lhe Buslness end Protessions Code, and my license Is in tull torce and eflecl Lic. » Class a Contrector's Signatura: Date: CONSTRUCTION LENDING AGENCY: ❑ I hareby eHirm that Ihere is a construciion lentling agency br ihe Dedortnanca ol Ihe work tor which ihis Oa�mit is issuetl. (Sec. 3097, Civil Coda). Lontler's Name: Lentler's Address: SigneWre: Date: OWNER-BUILDER DECLAAATIONS: I hereby elfirtn that under Penelty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor Ihe following reeson (Sec. 7031.5, Business entl Professions Cotle: Any ciry or couniy W�ich requires e pertnit to construct, elter, impmve, tlemolish, or repair any swcWre, prior to its issuance, elso requires the appliwnt br such pertnit ro lile a signetl siatement ��al he or she Is licensed pursuant to the provisians ot the Contractors License Law (Chapier 9(commencing with Section 7000) ot Division 3 01 the Business end Pmfeuions Cotle) or that he or she is e:empt therefmm and the basis br the alleged exemption. Any violation ot Section 7031.5 by any applicant for a pertnit subjecis Ihe eppliwnt to 8 civil penalty of not more than fiva hundred dWlars (5500)J: �il; as owner of �he property, or my employees with wages as their sole compensation, WILL DO THE WORK, end the structure Is not intended or otfere0 for sele (Sec. 7044, Business an0 Pmfessions Coda: The Contracbrs License Law does no� apply to an owner of pmpeny who builds or improves Ihereon, and who does such work himself or herself or ihrough his or her own employees, provided ihat suc� impmvements are not intandetl or otterad for sale. If, however, the building or improvement is sold within one year of completion, the owneo-6uiltler wiil have the burtlen of pwving that he or she did not buiid or improve for Durpose of saleJ. ❑ I, as owner of lhe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct tha projact (Sec. 70aa, Business antl Pmfessions Code: The contracro�s Ucense Law tloes not appty Io an owner ot pmperty who builtls or impmves thereon, and who contrects tor such projeq with a contractor(s) license pursuant to the Coniraciors License Lews.j. �� ID v�rifie V drive� s licensa. ❑ No Business and Professions Code for this reeson: °Dete:- Dm�_rs License No. �' � � - - "= Fxpires:-� . / 7. O� Verilicetion of Ownership py (�ype of document, i.e. - property taz bill or deed): � DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby cehify ihat �o excavetion five (5) ar more feat in depih into which a porson is required lo Oescend, will be matle in connaction wi�h work euthorized by lhis pertnit, antl that no builtling siructure, scaffolding, lalsewo�k, or tlemolilion or dismantling Ihereot, will be more than ihirty-siz (36) feet hig�. (C�ap. 3.2, Grp 2, An 2, Sec. 341, Tule B, Califomia Administretive Cotle). ❑ As owner-huilCer, I will not employ anyane to tlo work which would require e permit from Ihe Divislon of Industnel Sefety, es notetl ebove, unless such person has a permit lo do such wOrk �rom t�e tlivision. SigneWre: Dele: Division of Indus�rial Salety Permit Number: CERTIFICATE OF COMPUANCE AND AUTliORVA710N OF ENTAV: I certify untler penalry of perjury that I have read ihis epplication an0 state ihat Iha Intortnation qiven is correct. I egr e �o c� iply wlih ell st te laws and city ortlinances relating to huiltling construc�ion, and outhorize representatives ol Ue City of Costa Mesa to enter upon ihe e ove� pr rty �or inspe puryose . I agreo not to �upy or ellow occupancy of any builtling authorized hy this permil until finel inspection. �F.3_D(o T -Signature Of.Lepal�Owner(s)--- J f Date -_. _ 1 AnNOr Authorizetl Applicant Date CO�E �. INSPECTONTYPE �6ie Fiaed System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Finel BIocWReleiMng Wall 202 203 Final Feciory Flre P�ete Final Sign 204 Finel DemWltion Q� INfffIALS 40DE� INSPECTIONTYVE 206 Flnel Methanical 208 Final Plumbing 210 Flnol Electrical 212 Final Fire Prevantion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency QdIF i�. 1t�1L5 C� °� C''°�ta �zleda �uiE'du� Diuidia� OWNER-BUILDER VERI FI CATI ON �r% �_ C�(l�'�+ i"� � Permit #: A city or county, which is �equired to give notice pursuant to Section ] 983Q shall at[ach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the retum of, an ownerv builder verification. Attention PropeRy Owner. An 'ownervbuilder' building pemiit has been applied for in your name and bearing your signature. Please complete and retum this infomiation in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building pennit. No buildine permit will be issued until this verification is received. l. 1 personally plan ro provide the major labor and materials for construction of the proposed property improvement. � Yes ❑ A'o 2.�1 (have/have not) i-h4'��Z �� signed an application for a building pertnit Tor the proposed Wark. � 3. I have contracted with the following person (firm) ro provide the proposed construction: Name Address Phone ( Ciry _ Contractar's Lic. No. 4. 1 plan ro provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone ( ) City _ Contractor's Lic No. 5. 1 will provide some of the work but I have contracted (hired) the following perso��s to provide the work indicated: Name 10C2d6 (Rev. N�OC) Address Phone Type of Nork AVI CITV OE GOST ��y'�SA CONSTFiiJCTIQN PERMIT I ProjectAddress ac enzie ace � Applicant's Mailin9 Address 932 Mackenzie Place • Gwner's�Name James C. Hd1VC1^SOn ohon�51 -959�i � ndd�ess 932 Mackenzie P1ace Arch/Eng:. R_.i _ Knl nci� i p� " Licenu No. 1%$1� � 'Addreu. �n hnv ��57 -(',nIDIIlPCCP ��R22 Contractor'sNama�I7Y.klClriy POOl� `Phone��$ /•�� , Address Imailing) � O bOX 2ii�ii - C'nmmarra� �0022 I City Licanse IVo. � � I I LICENSED CONTRACTOR OECL RATION 1 her¢by attirm thd[ I am lic¢ns � itlG� p slons of Charter D(commencing \ � wltn section 7000) of Divislo 3 f th gyp ss antl Pro ns Cotle, antl �J my license Is in fulLto{Cqan t . ��1� 179 bLicense Class �' �'� License No. Date � �—��—�� Si atvre S 'vpRKERS' COMPENSA ON DEC R ION \ ereEy affirm that I have a certifica e consent to self-Insure or a certificate Workers' Compensation Insuran , or a certifietl copy thareof (Section � Po��Y No°2�1�5-00-053867' comaa�vWausau Underwriters' �Certitietl copy Is hereby fumishetl. , InC. Certlti�,�coqy4is tiletl with tne city 9ullppgrDiOvpion Date H ZS Applicant H L y Pools EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be com0�etetl if the permit is fo� one huntlr¢tl (5300) or less) I<ertify that in the performance of [he work for whicn this perm�t iz izsuetl I zhall� not employ any p¢rson In any manner so•as to becOme subject to t�e Workers' Compensation Lzws of Californla. , Datn - Signature NOTICE: If,'after making this tleclara[lon, you shoultl become subject to the ' Wo�kere' ComPenSatlon p�ovislons of the Labo� Cotle, you must forthwith comply with suc� pwvisions,or Ihls �permit,shall ,be Ceemetl revoketl. CONSTRVCTION LENDING AGENCY ' I nereby affirm thal there is a cons[ructlon lentling agency tor Ihe performance of t�e work for whichhthis permlt is IssueE (SecHon 309� Ciw CJ Lentler•s Name CHS Lentler's Atltlrass� OWNER BUIIDER DECLARATION � � I hereby affi�m that I am ¢xempt f�om the Cont�acto�'S.Lic¢n5e L.11p1 tor the a si9netl ztatement that he/sne Is Iicen ntracror's Llcense Law (Chapter 9 (mrt n 3 of the Business antl Professions om antl the basis for the allegetl exen by any applicant for a permit su � ot not more than tive hundretl tlollars u I, as owner ol compensa[ion, will for sale (Section �icense Law tloes theteon. ana wM10 �ove �o�ine pu�pase I. as owner oi the I am exert�pt such permlf rovisionz ot n 7000) of : is exempt i o/ Section to a civil �, pro0ecty o� my employees wi[b wag85 d5 their Sole the wOrk, dntl the structure,i5 not Intentletl Of otf¢r¢tl 6, Business antl Prolessional Cotle: The Contractor's ipply to an owner of a property who builtls or improves s such work himself/herself or tnrou9h hls or her own iat such improvements are not inten0etl or offeretl tor �uiltlin9 or improvament is soltl within one year of com- have the burtlon of proving he/she tlI0 not builtl or im- �f sale). ��operty, am eXclusively tontracting wi[h li<¢nsetl con- e prOject ($ec[ion 7044, Business antl Prof¢islons Cotle: 158 LdW does not appry to an owner of property who veon, antl who contracts tor such vrojects with a wn- ant to the Contractor'S License Law). Section � , 8. &�P. C. (or lhiireason Date �� owner I M1e�ebY cetflfV� that I have rea Drivers' License 6r 5 statn thai the above itl county ortlinances eby authorize repre- �.lonotl property tor �Date 4-1 1 -R4 to flu'in'an'spaees'excepl those wit�in S�C �' �t% 4b�/� TVPE OF CONSTHUCTION NE ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORK si9n all approp�iate tlecla�ations. � ADD LJ ALTERATION LJ REPAIR OTHER TVPE OF PERMIT LI GRAOINC� �� L'{I FOUNDATION LJ STRVCTVRAL ❑ TENANT � ELECTRICAL �q PLVMBING Cj/� MECHANICAL , � �OTHER 6F7iR1—^p66�ri5-�8 PROJECT DESCRIPTION SQ. FT. �n oCCUaANCy�_ CONSTRUCTION TVPE guni YP VALUATION S L• � 00 ZONE GRADING CU. VDS. ACRES�— Remarks: 8ar Sink Backflow Preventer Backflow ir(,gation � Bathtubs �rinking Fountains =1oor Drains =1oor Sinks �as Service Outlets � Interceptors� Kitchen Sink ' � Lavatories - . . �—Trap Roof Drains Reinspection Fea $25 Duct- UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑o-i oo,aoo aru O� oo,00a er Reinspection Fee � $25 1� CMF 0865-46 rev. 7/83 White - Builtling; Ganary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping ` Solar Tank Swimmin9 Pool w/Spa Urinal Water Closet Water Heater � Water Service Isue Fee Hood or Typel ❑ Canopy Type II ❑ 0 Refrigeration Sys[em ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Issue Fee FEES $ 3 ES $ 3 A.P. # � + Q � � 5 Main Building:, T'Front ' B -Rear � A � Ri9ht K Left S Ping. Ref. # Parking Req./Provided ' Use of Building: Planning Notes: 8999 4/19/B4 Zone AcceSsory Building: �- _� �. �.� � �i ( I 3Qi,-� i' Park.Fees $ ELECTRICAL • Automatic Washer Trensformer ❑ 15�50 KW Construction Pole Sub. � i � 50 + KW Cooki�g Unit ' � Meter �up to 700 amps Dishwasher , Meter ❑over 100amps Dryers OGas ❑Electric � Sub Panel � Fan � Motors00.1HP�1'/:-8 ' F.A.U. Inc. Solar 09-15 HP 016-75+ Fixtures Microwave Device Boxes ' 'Pole Light � , Outlets Switches Garbage Dispoul ' Generetor �0-5 KW �5-15 KW Sign Standing Sections Trash Compactor �J4o78 � FEES O N I N G R E I R E N E N T Reinspection Fea $25 �ssue Fee $ 3 � PUBLICSERVICESREQUIREMENTS: 2oning Approved By Date . Application Approved By Date Appliwtion Issuad By �'✓ � Dat � " SUMMARV OF FEES BUILDING PERMIT $ � SMIP $ � PLAN CHECK $ � PERMIT PLUMBING $ iD ISSUANCE $ PLAN CHECK $ /S ENERGY P.C. $ ' ELECTRICAL $ O GRADING $ i , PLAN CHECK $ . D d MICROFILM $ - MECHANICAL $ TOTAL FEE $ �� PLAN CHECK $ � �� s COFVSTRUCTION AND PLANNING 4 APPROVALS Permit # : 1, eTemporary Electrical Service or Pole 1 � �'1. Soil Pipe-Undrgrnd. � 'r -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. Structurai Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing 75. Rough Electrical-Conduit 76. Rough Electric Wiring 77. 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 '5. Roof Sheathing 6. T-Bar Ceiling (Structural) & Monocoat 7. Frame and Flashing 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. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final 40. Gas�SerJice-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation. 46. Handicap Regulations , 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California GasCo Date Date POQ SPA Inspector qppROVALS Permit# 52. Pool & Equipment Location � 53..Steei Reinforcement 54. Forms 55. Electrical Bonding � 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE �. 58. Electrical Conduit-Undrgrnd. ' 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap,�lndrgrnd. �` 61. APPROVAL TO DECK (o 62. Backwash & Receptor-Final 7 63. Heater & Vent-Final 64. Plumbing System - Final 65.- Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 7 69. POOL/SPASYSTEMSFINAL � FIRE DEPT. REQUIREMENT � APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil - 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Ory Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: n . A .. _ . . � . , , . _ . _ _ . Date �Inspector C LT 6unite (� Post=.Tensioned Concrete ( ) REPORT OF INSPECTION ON Masonry ( L)s �� F�i�epro,qfing ( ) ` Concrete ( c)iTY a'� ��Re`i;rifor,cing Steel O '' gU1L�iNG u.•r...... � � BIIL T0: Address: v"YNER: 1�.� PROJECT: v Qy,u,w�,,,. ��.w(..� �j:.��dQ� R�eNo �% � ✓ Address: q.�� /yLp.L/�n,,,n�Q, �� Permit No.�. .E/aBJ� Awela E�-t� �'�l�jD � Contractor: , (rg.Ax�,� Address: Address: � � vY�Gcx-E-d-c.��i �2 ' __ Engineer: �. �,, %�,y.�-�(� � � Subcontractor: �'��„Q��,k� �• /� (Gunite)�� , Address: �P.2J�,t.� /cep�• � Masonry or �,��: , �%r . � n � o� Concrete) " Inspector: ,r��p, Nl Address: �cwt�� /.3-ta-t� i6�'� 81p .R Nix Used: 1{•l,*e-► a13��XS�(cBgAi Slump, inches: �ort : �� ,�cx�t"` ct��,�� Designed Strength, PSI : �OOm T�e following inspection was performed in acc�rdance with the approved drawings: Cu.Yds. No. of DATES Placed Cyis• Remarks 5� � 6. �a-H�L- 5� �.uv ,�.,�.�- /9'0 .ab� Copies of Reports to: (Indicate which Bldg. Dept. 6 furnish address of any not listed) Applicant to fill in all spaces except tnase within neavy bortler lines anC sign all apvropriate tleclarations. Ci7Y pF cOSTA MEsa, CONSTRUCTION PERMIT n Project Address �� 3-Z- I��-G X�NZ i� !�L ApplicanYsMailingAddress � �Z /�1/Yt•L/�/IiG �� Owner'sName �JAMII;� � NAL✓IP91�hone ��,�29' Address �3�� 7 �� • Arch/Eng. �•� k n Z n b z/ 4. / License No. �Addreu �� /�/ h 2.'Z 2.SS��- Ca.v� ms.pc� 9/yJ1 Contracmr's Name �pL Phone2��' �%�%i Addresslmailingl.J�% �2X- -Z � � M�-d°'..C�9�2 42 Ciry License No. LICENSED CONTRACTOR DECLARATION I here0y affirm that I am Iicensetl untler provislons of Charter 9(commenUnq with sectlon ]000) of Division ot the u' ess antl Protessions Cotle, antl my license is in full rc tl ef e G License Class Licen No.�/(f.,I�� y Date �.3% ��-s Sign�' re WORKERS' COMPENSATION OEGLARATION iereby aifirm tha[ 1 have a<ertificate ot consent to self-Insure or a cerUficate ; Workers' ComOensation Insurance, or a certifietl copy thereo/ (Sectlon 3800, Lab. C.) � /A [/SAU �'��d�./ Policy t�o. Z�.('f/�n-�r39�JCompany �7� BCertifietl ropy is hereby fumishetl. �n'� Certifie copy is file with the city Bu)�lain9 �DI islon. ,�j Da[e APplicantT„_NT�D/7{ 6�A0�5'. EXEMPT N FROM WORKERS' COMPENSATION DECLARATION (This section neetl nal be cOmpleletl if the permit is �or one huntlretl (EI00) or less). I ce�tify that In [he perfOrmance oi the work to� which this pe�m�t is i55uetl 1 shall not employ any persOn in any manne� so as lo become Subject [o t�e Worker5' Compensdlion Laws of Califomia. Date Signature NOTICE: It, aiter making tnis tleclatation, you Shoultl becOme subject to the Workers' Compen5ation Orovisions ot the Labor Cotle, you must forthwith mmpty ,wi[h such provisions o� this permit zhall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I nereby a/flrm tM1at the�e is a construction lentling agency fo� the performance of [he wark for wM1lc� jhi� permit is issuetl (Sec[ion 309] Civ. CJ Lentler'S Name �-1.t`f Lentler's AtltlresS OWNER BUILDER DECLARATION� I M1ereGy aftirm that I am exempl from the Contractor's LicenSe Law for tne /ollowing reason (Seclion 7031.5 Business antl Professional Code: Any city or county whith repuires a petmi[ fo const�utf, alte�, improve, tlemolish o� repai� any strutture, OrlOr to Its i55uance, also requires the applicant for SUGh pe�mit to file a signetl statement Ihat M1e/she is licensetl pursuant to the provisions of �he Contrac[or's LicenSe Law (Chapter 9(mmmenang with Settion 7000) of �vision 3 of tbe BuSinesS antl Professions Cotle) o� thal h¢/ihe is exempt erefrom antl the Dasis for Ihe allegetl exemption. Any violaLon of Sec[ion .031.5 by any appliCant for a permlt subjetts the applicant f0 a civil �enalty o1 not more tnan five huntlretl tlollars (5500). 1, as own¢r ol the prop¢rty o� my employees with wage5 as [hei� sol¢ compensatlon, will tlo the wotk, antl the SVucture is nol intentletl o� otteretl 10! Sd�C ($CCII00 �044, Busine55 d�d PIO{CSSIOOdI CoCe: The COlISfdCI0f�5 liG¢nze Law tloes not apply [o an owner Ot a property who builtls o� improves ihereon, antl who tloes such work himseli/herseli or through his or her own em0�oyee5, provitletl iltat such improvemen[5 are no[ Intentletl o� ofteretl f0� sale. If, however, the builtlin9 cr improvemen( is soltl wlthin one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not Duiltl or im- �rove for tbe purpOse ot sale). I, as owne� of th¢ P�oOerty, am exGlusively con[�acting with IiCensetl con- Vactorsto construci the prolect (Section 7044, Businass antl Professlons Code: The Contractor's License Law does not aOPly to an owner of property who builtls or impwves thereon, antl who conVacts for such projects with a<on- . tractor(s1 license pursuant [o [he Contraclor's License Law). I am aware tha[ � proot o1 their WOrker'S Compensation insurance shoultl be provltl¢tl to me. '❑ I am exem0� untler Sec[ion B. & P. C. tor lhis reason Date — I �ereby infOrmati antl state SQl1(dIIVCS inspe<[lon Signature Drivers' L CMF 086$j owner certify that I have reatl this application on is cortecL 1 agree to comD�Y '�'��h all t laws�tin9 to bui�ing�tru�� o( Is dty to en er t above TVPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: E TVPE OF PERMIT GRADING FouNDarlorv STRUCTUR.aL T Pront � ❑ TENANT ❑ EIECTRICAI. ❑ PLUMBING ❑ MECHANICAL A Rear ❑ OTHER PROJECT DESCRIPTION Sp. FT. OCCUPANCV C Right - K Left CONST0.UCTION'TVPE VALUATION$ $ ZON[ GRADING CU. VDS. ACRES P�ng. Ref. # Remarks: � ,�1 � Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Dreins Floor Sinks . Gas Service Outlets InterceptOrs Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee � $15 Duct - Under Ground Duct - Structural Duct - Vencilating Exhaust System � Multiple ❑ Firepl/Fact.8lt. ICBO # Heating System & Ducting ❑0�100,000 BTU �100,0006T 55 � �J-�- I I ReinsOection Fae I $15 rev.4/84 Whi[e-Buildin9:Canary-Appliwnh,Pink-Accounting;Goltlenrotl-Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors $olar Piping Solar Tank Swimming Pool w/Spa Urinal Warer Closet Water Heater Water Service Iuue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑o-ioo,000eru ❑ioo,oao System Repair/Alteration Issue Fae FEES $ 3 $ 3 Automatic Wesher Construciior Pole $ub. Cooking Unit � ishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets SWILCIICS Garbage Dispoul Generator �0-5 KW C 2one Accessory Building: Parking ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter Dup to 100 amps Meter �over100amps 5-15 KW Sub Panel Morors �41 HP � 1 X- 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light • Range Si9n Standing Sections Trash Compacmr IReinspection fea '$15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved 6y Appliwtion Issued BV � � FEES $ 3 Z O N I N G R E Q M T S. P� SUMMARV OF FEES BUILDING PEFMIT`�Sr"�� . SMIP $ PLAN CHECK $ v��lJ�� PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAI $ TOTALFEE $ 15� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING PO( . SPA ,APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector 7. Temporary Electrical Service or Pole -52. Pool & Equipment Location 2. Soil Pipe-,Undrgrnd. • � 53. Steel Reinforcement �3. Elecirical Conduit Utility-Undrgmd. 54. Forms ' 4. Electrical�Conduit-Undrgrnd. 55. Electrical Bonding . 5. Steel Reinforcement ' � 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE ; 7. Footings. � 58. Electrical Conduit�Undrgrnd. 8. Foundation �� 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd ,. . 60. Backwash Lines, P-Trap, � Undrgmd. � . 10. Structural Floor SVstem� 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 72. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � � ' 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final � 15. Rough Electriral-Conduit " 66. Solar System-Final �i'6: Rough Electric Wiring � 67. Fencing & Access Approval 77. Rough'Wiring Sign � � . 68. APPROVED FOR PLASTERING 78.. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air C',onditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating - 77. Product Piping � Gas ❑ 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. D�ywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Cqat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 7� �j Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test . � 36. Hood or Canopy � ' 37. Final Faaory Fireplace � 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer - 43. Backflow Irrigation � . . 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regul�tions � 47. FINAL STRUC7URE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ;�' 50. Gas Release to $outhern California Gas Co , . 57. CERTIFICATE OF OCCUPANCY • No. Date ��'��Jq'�-h Twininq L�b�ratorie� �1�,�� e�f��, �� . �"+'�� a�io aroo.e w+r i �+.nino naaw c.o, eo: sv i �ooa e.,�n, cn aoew i cz�3� azsa�ss i �zia� s�e-z�es i piq exeauz TESnNG BRANCM OFFICE� 1314-D Nortn Suun Slr�l/ S�nta Ma, CA 92703 /(731) 55426�3 � IXAMINATION NO. $4-%�12 COMPRESSION TESTS ON GUNITE TEST CYLINDERS Jack Hubbard 3106 Ostrom Avenue Long Beach, California 90808 PFOJECT ADORE55 ARCHITECT ENGINEER R. J. Kalodziej SAMPLE FROM MIX DATE CAST DATETESTED SPECiMEN N0. COMPRESS�ON TOTAL LOAD L85. POUNDS PER S�. IN. AR EA. 50. IN. COMPLIANCE SPECIMENS DISTRIBUTION Jack Hubbard - 3 Building Dept./ 932 Mackenzie Place Costa ?tesa, California CONTRACTOR Anthony Pools SUBCONTRACTOR Dtc Bee Gunite Company Deep Center Floor, Shallow End, Bond Beam 4.0 to 1 5/31/84 6/7/84 1 7 Days 75,000 2,650 28.27 SPECIFIED STFENGTH SLUMP SPECIMEN SIZE 6/7/84 2 7 Days 96,000 3,400 2,000 fi X 12 6/7/84 3 7 Days 71,000 2,510 7 Day tests comply with specifications. M40E Bv: DEUVENED BV: RECEIVED ON: ilorrell Hubbard 6/1/84 �.,� �.�; -�- y�� -1 d CLL pE�ORiS �NE SVBMiTTED OS TNE CONi�DEMTm� cROOERT O� CIiEHiS •UT�O4iZe*�ON i0A �UBUCO��ON O� OUA REOORTS COMCLUSiOMS OA ErtR1�T5 fPOM OF REG�ADIN(� TNEM IS FESEAVEO �END�NG OUA WPITTEH GDOqOV<L �5 0 MUIUOL �pOiEC110N TO CIIENi$ TME �UBL�C >HD OUASELVES 1 � City of Costa Mesa — Planning Division SUBCONTRACTOR LIST �� t1��N P.O. Box 1200, Costa Mesa, CA 92626 Builder Anthony OPools Address P• 0. Box 22252 Commerce phone 268-4877 JobSite 932 Mackenzie Place - CM Date 4-19-84 Permit # BPL-12816 Valuation $16,500.00 SUSPFNSF �ATF FOR PARTIAL LIST DUE: 5-16-34 ASPHALT CABINETS CARPETS CARPENTRY CEMENT CONT. CEMENT TRANSIT CLASSIFIED SPEC. DOORS (GARAGE) DRAPERIES DRY WALL ELECTRICAL ELEVATOR EXCAVATION FENCING FIRE EXTINGUISHER FLOORING/DECKING FORMICA FOUNDATIONS GLAZING HEATING INSULATION LANDSCAPING LATHING LINOLEUM/ASPHALT TILE/GLJNITE MASONRY PAINTING PLASTERING PLUMBING POOL REFRIGERATION ROOFING SANDBLASTING SEWER SHEET METAL SHOWER DOOR SOLAR SPRINKLERS STEEL REINFORC. STEEL STRUCT. STUCCO TRUSSES/GLU-LAMS TV ANTENNAS WALL COVERINGS WEATHER STRIPPING OTHER SPECIALTY CMP �]0140 rev./2/82' SUBCONTRACTOR� I ADDRESS I IPHONE __ _ — . . —__ _ . . _ r . __ _. c� p c:� hl , L i� CITY OF COSTA MESA DEVELOPMENTSERVICESDEPARTMENT PLANMNG DIVISION OWNER BUILDER CERT[FICATE OF EXEMPTION I am fully aware of the responsibilities as owner builder. The persons named below are my employees and I agree to withhold the following required deductions: Federal and State Income Taxes, Social Security payments, and Workmen's Compensation Insurance Premiums. My employer's number is . Further, I hold no objec[ion to a copy of this certificate being forwarded to any governmental agency upon their request for same. Employee's Name Address Social Security No. Under penalty of perjury, I declaze that the above statement is true and correct to the best of my knowledge and belief. Signature Address Date CITY OF COSTA MESA DEVELOPMENT SERVICES DEPARTMENT P. O. Box 1200 Costa Mesa, California 92628-1200 Date: Auri 1 19. 1984 To: Anthonv Pools P. 0. Box 22252 Commerce, CA 90022 Re: Subcontractors List af8Sf-J98 CC8A-8dS oo.00�,ar8 We note that you have recently been issued a City of Costa Mesa Building Permit to do construction or home improvements at 932 Mackenzie Place - Costa Mesa . [� The Building Permit indicates that you are the General Contractor, Our Municipal Code re- quires ihat all subcontractors working on your job purchase a City business license. We are requesting that you complete the enclosed Subcontractors List and return it to the Planning Division. It is your responsibility to see that all subcontractors purchase a City business license prior to your request for final inspection. Final inspections will not be given until all subcontractors are licensed. ❑ The Building Permit indicates you are the Owner/Builder. If you are acting as the General Contractor, our Municipal Code requires that all subcontractors working on your job purchase a City business license. Please complete the enclosed Subcontractors List and return it to the Planning Division. It is your responsibility to see that all subcontractors purchase a City business license prior to your request for final inspection. Final inspections will not be given until all subcontractors are licensed. ❑ The Building Permit indicates that you are the Owner/Builder. If you are acting as Owner/ Builder, please complete the Certificate of Exemption which is on the reverse side of the Subcontractors List and return it to the Planning Division. It is your responsibility to see that all subcontractors purchase a City business license prior to your request for final inspection. Final inspections will not be given until all subcontractors are licensed. ❑ Noi al! Subcontractors at the job site have obtained City busirress licenses, therefore, as of , the Building Division will no longer respond to your requests for inspections. This is the only reminder you will receive from this office. Should you have any questions in this maiter, please do not hesitate to call the undersigned ai 754-5623. Thank you for your early response. Sincerely, Nancy unge, C e Enforcem t CMF 1115-30 Whlta-Atldressee; Canary-2ntl Notica Atltlressee; Pink-Flle -osiGa mcsa . ��9 COSTA MESA BUILDING-SAFETY DEPARTMEM �' P.O. BOX 72pp - pOSTA MESA, CALIFORNIA 9T6i6 For Applkont ro Fill In Completefy TYPE OR PRINT BUILDING ADDRHBD 9 2 MaCkenZie Place COSTp ME9A. CALIFORNIA nwuao U_ .i_ FIItHY1Cl�_ I� ARCHITEGT Front St. 901 Liard Place. Costa e Lewis H. Schmi.d 29�t0-A Randolph Ave. ta Mesa. CaLif. srze ii�i�GG�I-' OF LOT US8 OR EXISTINO BLOO. cere�eec una iRor �Escwvno� oF wowc OR �U iPle 1 1 H8R6BY ACKHOWI,[pps }HAT 1 MI�V[ IICAD iNl� APPLIGTION AN� BTATB TXAT il{6 AOOVL 1� CORR6R�AND 110Rt[ TO COM• PLY WITM �LL CITY OROIIUNCO AND �TATi LAWO R60UL11TIM0 YUILOtNO CONBiRUtt10N. SICNATURB OP PERMITf6G ��^ K� ��`--�^. tis= 1a_. AUTNORIZ[D AO[M �EB �7'(7PAIDOO 721� �**+r �Nsn 99.00 APPLICATION FOR PERMR BUILDINa for Offlce Ux Only YARD� MPROVHD MAIN BIIILDIN6 e�arwnee eer MAIN BLDOi. VAR. }C ZONING � uaa or H�w euao�na eNw�� ee �ese THwn (U.B.C.REQUIPHMENTI YARDSAPPROVHD ACGEG80RY BUILDIN6 esr. i ACCE DATE TN6 AMOUMT 6NOWN YNO6R ttlPPOO[ O! iBTAG�IBNIXO VALUATION PERN .��.�y- TOTA �/-1—W G w � � � 0 ie �ow n1e � r88 ONLY. 5 I � 3— w �y-