HomeMy WebLinkAbout3256 NEBRASKA LN - Building Permits�
CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca,us
FOR INSPECTIONS CALL: (714) 754•5626
PERMIT TYPE
APN: 13906504
JOB ADDRESS:
Vicinity: CLOSET
SQ. FT: 0
MECH
3256 NEBRASKA LN CM
PERMIT NUMBER: M09-00091
STATUS: ISSUED
DATE ISSUED: 10I15I2009
ISSUED BY: BJK
Suite/Unit:
SCOPE OF WORK: FURNACE REPLACEMENT (90,000 BTU) IN THE CLOSET AT AN EXISTING SFD. 1 FAU < 100K BTU
OWNER:
PHONE:
APPLICANT:
PHONE:
RUSSI, JOHN C TR
ZAMORA,CARLOS
818-735-7876
CONTRACTOR: SERVICE CHAMPIONS
Address: 22971 SAVI RANCH PKWYUnit:
City/Sfate: YORBA LINDA, CA ZipCode: 92887
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: 538.30
PLAN CHECK FEE: $0.00
INVESTIGA710N FEE: $0.00
REINSPECTION FEE: 50.00
TOTAL F�ES: $38.30
Address: 3256 NEBRASKA LN Unit:
City/Slate/Zip: COSTA MESA, CA
Address: Unit:
CirylSlate/zZip:
License No. 799170
PHONE: 714-777•7777
CELL:
NOTICE: The work authorized by this permit shall wmply vrith all applicable handicap access requiremenls under California statutes and relatetl
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 ihe 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 fnal approval will result in the expiration of this permit.
oy oe � wsvecnoNTrve
1818 Fixed SyStem Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Blp�k/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
OPTE INiRIRL
COUEO INSPEL710NTYPE
206 Final Mechanical
208 Final Plumbing
210 Final ElectriCal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Sile
250 Final BuildingfOccupancy
ORjj IN7I7ULS
� "�—�
�
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalty ot perjury one of the following declarations:
❑ I have and will maintain a tertifcale of COnSent to 5e141n5ure for woBers'
compensation, as provitletl lor by seclion 3700 of the Labor Code, for Ihe
per(ormance of the work for which this pertnit is issued.
�� I have and will maintain workers' compensation insurance, as reQuiretl by
sectbn 3700 0l the Labor Code, for the peAortnance of the vrork fw which this
permit is issued. My vrorkers' compensation Insurance wrrier and policy
num6er are:
� Czrriec ��bl,
(iruss unnaed Dnam,�ndetetlsurepe�m]�,4fkrehxdatarenuntlreacbears(St00)aleu)
Policy-Number. L( 1���-1 `�s��
❑ I certify that in the peRormance af the work (or which this permit is
issuetl, I shall nol e oy person in any manner so as to becOme subject
to Ihe workers' c pensati n laws of Calilomia, and agree that if I should
become subject o Ihe mpensation provisions of Seclion 3700 0l
the Labor Code I shall wit� c ply with these provisions.
�In—• t�S�•�'
A nfs 9 e � wte ;•
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMNGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, INTEREST, AND
AITORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensetl un0er provisions o! Chapter 9(commencing
with Seclion 7000) of Division 3 of the Business and Professions Code, and
my license is in full force antl eHect. �,s�
� Cit. #> Class #�-� i�" w
(D��So�
Gon a's Sipnawre " �a�e
CONS7RUCTION LENDING AGENCY:
❑ I hereby aRum ihat there is a consWction lending agency for the
peAormance ol the v.oM la wfiich tNs pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
5�9^aNre
OWNER-BUILOER DECLARATIONS:
I hereby affirm Ihat under penalty of perjury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sea 7031.5,
Business and Protessions Cotle: Any ciry or counry which requires a permit to
construcl. alter, improve, demolish, or repair any sWCWre, prior to its
issuance, also requires Ihe apPlicaN for such permit to fle a signetl statemem
that he or she is licensed pursuant to the provisions of the Contractore
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business and Professions Code� or that he or she is exempt t�erefrom antl
the basis lor !he alleged exemption. Any viola�ion ol Section 7031.5 by any
applicanf for a permil subjects the applicant to a civil penalty o! not more Ihan
fve huntlretl dollars ($500�.):
❑ I, as owner of the property, or my employees with vrages as their sole
compensation, WILL DO 7HE WORK, antl the structure is not intentle0 or
oftered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such work himself or herself or Ihrough his or her ovm
employees, provitled lhat such improvements are not intendetl or offered tor
sale. II, however, the building or improvement is soltl vrithin one year ol
completion, the owner-builtler will have I�e burden of pmving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the propeny, am E%CLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business and
Professbns Code: The wntractars License Law dces not appty to an owner of
propeny who Duilds or improves Nereon, and who contracts fw such project with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for t�is reason:
Slpnalure
305]-a6(3/O))
.
Owner ID verifed bydrivers liceiise. ❑ Ves ❑ No
Dnver's License No. Expires:
Verifcation ol Ownership by (�ype of document, i.e. - properiy tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify �hat no excavation frve (S) or more leet in tlepih into wfiich a
person is required to descend, will be made in connectbn with v.ork authorized
by this pertnit, and that no building strucNre, sca(fdtling, false�wrk, or tlemWition
or dismanlling thereof, will be more than Ihirty-siz (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Title 8. Califomia Administ2tive Code�.
❑ As ovmer-builder, I will nol employ anyone ro do work which would
require a permit Irom the Division of Industrial Safety, as notetl above, unless
SUCh person has a permit to do such work from Ihe division.
APpIiG)nl's Sign2Wre
Division of Industnal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file anC
certify a Business Plan !or emergency response to release or threatened
release of a hazartlous matenal? ❑ Yes ❑ No
(Section 25505 ot the Calitomia Heallh antl Safety Code requires, with some
exceptions, Ihal a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reponed
year a quantiry of hazardous materials equal to or greater than a weight ot
500 pounds, or a volume of 55 gallons, or 200 cubic leet of compressed gas
at standar0 temperature antl pressure�.
2. Does or vnll the applicant or present or (uture building occupant neetl to file
a registration (orm for aculely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of 1he Califomia Health and Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hantl a quantiry of acutely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas al standard
lemperature and pressure).
3. Does or will the applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Health and Safery Code provitles t�at the
Costa Mesa Fire Department may require [he preparation, certifcation and
filing with Ihe Fire Department o( an RMPP by businesses which are requiretl
to register awtely hazardous materials vrith the Fire Depanment.
4. II an RMPP is presently require4 has Section 25534 of Ihe Calilomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicanl or presenl or fu[ure building occupant require for
the work which is lhe subjecl ot this application a permit for such wnstruction
or modifcation !rom Ihe South Coast Air Oualiry Management District or trom
any other air pollution control distncl or agency7 ❑ Yes ❑ No
(Secl'an 658502 0l lhe Califomia Govemment Cotle requires thal the requestetl
inlortnation 6e fumishetl on applications for ran-resiaential building permits).
6. Will any parl of the facility ro be constructetl under this permit be vnlhin
1000 leel from the outer boundarie5 of a sChool? � Yes ❑ No
(I( "yes". ihe facility must meet the requiremenl of Sections 25534 antl 42303
ol lhe California Health and Sa(ery Code).
7. I! a permil from the South Coast Air Qualiry Management District or other
air polWlion contml district or agency is required tor Ihe work which is the
subject of this application, have all o! the disclosures prescnbed by Califomia
Health and Salety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance from the apPropriate air polNtion
control otfcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is wrrect. I agree ro wmply vrith all state laws and
ciry ortlinances regarding Hazardous Materials and Emissions.
SipnaWre �ab
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cerlity untler penalry of perjury that I have read lhis application and SWte that
the information given is cortecL 1 agree to compty with all sWte laws and city
ordinances relating to building construction, and authonze representatives of
the Ciry ot Costa Mesa to enter upon the aboveEescribetl propeny for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by thi mit until final inspection.
Si naWreolL al neqs) Da�e
l .GE-.nc.
Ai /or Aul�o tl NOWipnl' -G Oa�C.
AVD�icant to fill in ali spaces exeept ihose within heavy Eortle� lines anE si9n all appropriate Gecla�alions, b�� I 2ia l i85 �,ap j
CITY OF cOSrn nnESA CONSTRUCTION PERMIT --
ProjectAddress � �.56 NFRRACKA I.N ,
Applicant's Mailing�Address -
Owner's Name RUSSI �P�p' e '
/:ddreu 3256 NEBRASKA LN. COSTA ML'�A
Arch/Eng. License No.
Address
Cootra�ror'sName �1-AMES PLMBG.-HTC. phone 530-2440
nddresslmai�ingl _ 10422 TRASK AVE. GARDEN GROVE
City Licenu No. 754-SZ%$ �
LICENSED CONTRHCTOR DECLARA
I hereby a(firm lhat I am Ilcense Ee� 0/ovlsions of arter 9 com ci
with section 'l000) of DiviSio of the Bu5ine55 r ssion tle nd
my licenze is in full Ipr<¢�7ntl f L .L5 I
License Class � �� No.
Date�.�_ $i9natur
WORKERS' COMPENSATION CLARATIOJ
_�hereDy aftirm that 1 have a cert li ate of co� fe9 lo seli-insure or a certificate
�"` Workers' Compenution Insurance, or aKertHietl copy thereot (Section
.$'�i00, Lab. C.)
�vo�icv rvo. �84076419 comaany FREMONT
eCertifietl copy is hereby furnishetl.
ce�yr1�8ygys tiletl with the city Bu�iai��S����UMBING-HTG .
Date Applicant
EXEMVTION FROM WORKERS' COMPENSATION DECLARATION
(This sec[ion neetl not be com0letatl if the permit is tor one huntlretl ($100) or
less).
1 rertify thal in Ihe perlormance of tho wo�k fo� which this pe�m�l is iSsuetl I
shall not employ any pe�son in any mann¢r To as [o betome 5ubjeCt to [�e
Worke�s' Compensation Laws ot CalifOrnia.
Date Signature �
'NOTICE: If, after making this tleclaratlon, you shoWd become subject ro the
Workers' Comp¢nsation provisions ot the tdbo� Cotle, you musl torthwith
comply with such p�ovisions o� this permlt shall be tl¢emetl revoketl.
CONSTRUCTION LENDING AGENCV ' � �
1 be�eby affirm that there is a con5truttiOn lentlin9 agency tor the. pe�fo�mance
of the wark for which this perml[ is issuetl (Section 309� Civ. CJ
lRntler's Name
Lentler'S Atltlress
OWNERBUILDEH DECLARHTION '
I hereby aitirm that I am exempt irom the Conlractor's Llcensa Law for the
�ollowin9 reason (Section ]031.5 Buslness antl Professlonal Cotle: Any city or
counry wnich requires a permlt to wnstruct, alter, improve, tlemolisn or repair
any sVucture, prior to i[s issuance, also requlres the applicant for such permit
to file a signetl statement thdt ha/she Is IicenSetl pu�suant to the provisions of
the Contractor's License Law (Chapler 9(commencing with Section 7000) ot'
Division 3 of the Bu5ine55 antl Profes5�On5 Coae) or that he/She is exempt
'hmefrom antl the ba5is fo� tha a11G9etl exemption. Any violation o/ Section
i031.5 by. any applicant for a Permlt subjects Ute aOPlicant to a clvil
penalty of no[ more than tive huntlretl tlollars (5500).
Ll I, as owner ot lhe propmty or my employces with wages as their sole
com0ensation, will tlo tlte work, antl the structure is no[ intentletl or offeretl
for Sale (Section 7044, BuSiness antl Protessional Cotle: The ConGactor'z
License Law does not apDly to an owner ot a property who builtls or improves
thereon, antl who tloes Such wOrk hlm5¢If/he�seli or th�ough nis o� her own
employees, provltl¢tl ihdt suGh ImpwvCmenls are not intentletl Or oiferetl tOr
sale. If, however, lhe bulltling or improvemen[ is soltl wiNin one year of com-
pletion, Ihe owner will have the burtlen Of proving he/She tlitl not builtl or Im-
p�ova for Ihe DutDose oi Sale).
❑ I, a5 owne� of the O�operty, am extlusively cont�acting with Iicensed con-
t�actors to consV u<t Ne project (5¢Ction 7044, Busine5s antl Profession5 Cotle:
The Contrattor'S License Law aoes nOt appty t0 an owner ot property who
builtls or imv�oves thereon, antl who contracts br such projects witn a con-
hactor(s) license pursuani�to tne Contracior's License Law). I am aware that
proof ot their Worker'S Compensation in5urance ihoultl be provitletl to me.
❑ I am exemp[ untler Section _ B. & P. C. tor this rea5on
Date
that the above
mtv orainances
Drivers' icense or 55 �
CMF 0865-46, rev. 30/84 White - Builtling; Canary - Ap0lica t; Pink
TYPE OF CONSTRUCTION L.� NEW LI ADD LI ALTERATION LI REPqIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ FOUNDATION IJ STRUCTURAL
❑ 7ENANT ❑ ELECTRICAL ❑ PIVMBING ❑ MECHANICAL
❑ OTHER
PRQIECT DESCRIPTION SQ. FT. � OCCUPANCV—
CONSTRUCTION TVPE VAIVATION $
ZONE GRADINGCU.VDS. ACRES_
Remarks:
Sink
Preventer
I rrigation
Drinking Fountains
Floor Drains �
Floor Sinks '
Gas Service
Interceptors
Kitchen Sink -
Lavarories
P-Trap �
Roof Dreins
OUtI¢Ls
Service Sink -
Sewer Cap
Sewer Connection
Solar C011ecmrs .
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auw�Wash
Wundry Trays
Reinspection Fee $15 , laue Fee $ 3
. - MECHANICAL FEES
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FirepUFact. Blt. ICBO #
Heating System & Ducting �
❑ 0.100,000 BTU � 100,000 BTi
Reinspec[ion Fee
GOltlenlotl - A5525501
$15
HOod or Type I ❑
CanoPV TVPe II ❑
Re(rigeration Sys[em
04100,OOOBTU ❑100,000
System RepaidAlteretion
Fire Dampers
Registers
Ifsua Fee � $ 3
A.P. # -
S Main Buildi
E
T Front
B Rear
A
C Ri9ht
K Left
$
Pin9. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit -
Dishwasher
Dryers ❑Gas �Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Swi[ches
Garbage Dispoul
Generator 00.5 KW �
Fee
Zona
Parking Req./Provided
ELECTRICAL � '
Transformer � 15-50 KW
❑ So + Kw
Meter ❑up to 700 amps
Meter ❑over 100 amps ,
$ub Panel
Motors �U7 HP � 1'h - 8
Inc.Solar 09�15 HP 016�15+
Microwave �
Pole Light
Range
! Standing Sections
5 KW Trash Compactor
$15 Issue Fee
FEES
S3
DEVELOPMEN7SERVICESREQUIREMENTS: �
Zoning Approved 8y Date
8uilding Approved By ��}�,(� Date
Application Issuad By yy-�N Date Z-�'$s
SUMMARV OF FEES
BUILDING PERMIT $ SMIP � $
PLAN CHECK $ PERMIT • �&
PLUMBING S•� �' ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $�
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE , $ S.00
PLAN CHECK ZS% $ ' �
Z
O
N
I
N
G
R
E
Q
M
T
S
= CONSTRUCTION AND PCANNING - � POOL ,.. S°A .
APPROVALS � Permit�# Date� Inspector AppROVALS Permit# Date Insp>r,rnr
� 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
,,
. � �
�2. Soil Pipe-Undrgrnd. � � •0 53. Steel Reinforcement �
�3. Electrical Conduit UtilitY-Undrgrnd. - � 54. Forms ' ,
� i i
'4..Electrical Conduit-Undrgrnd. � 55. Electrical Bonding .
5. Steel Reinforcement - - 56. Rough Plumbing & Pressure Test
\6. .Electrical UFER Grnd. • 57. APPROVALTO COVER�GUNITE �
,7..Footings � . 58. ElectricalConduibUndrgmd.
��
8. Foundation . 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. � .. 60. Backwash Lines, P-Trap, O Undrgrnd. ,'
10. Structural Floor System . , � 61. APPROVAL TO DECK
�,11. Property Sewer Line & House Connection � , ' 62. Backwash & Receptor-Final
� �12. Sewer Cap . -� � � • 63. Heater & Vent-Final � � '
73. Roof Drains � 64. Plumbing System - Final -
�
14. Rough Plumbing 65. Electrical-Final
�
15. Rough Electriral-Conduit � � 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79.,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 (Structura0 & Monocoat 75. Dry Chemiral '
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding �77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. �Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICA7E ISSUED
33. Final Electric N�tes:
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace . �
38. Final Plumbing ' � � �(„�� �
39. Water Service-Final .
40. Gas Service-Final � - "
41. Solar pomestic-Final �
42. Backflow Preventer ' � �
43. Backflow Irrigation � -�
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 Southern California Gas'Co , . �
51. CERTIFICATEOFOCCUPANCY . .__ _ .
Nn. � Date ' , , ' ,
�
j
IIr. John Russi
3256 Nebrneka Place
Coeta l�esa, Californie
Dear Sir:
, March 31, 1972
. �
9�626 �
A building permit has been isaued to /wthoi{y Pools to conetruct
a private ewia�lag pool a�roperty.
In ar8er thaL your pool bo a eafe one and for the purpose
oP advising you o2 your responsibility regerding the requirements of
the Coste Mese Municipal Code, we refer you to Section 8107, a copy
of which is atta d.
Thia letter ie cted to you in orQer that yrou vill be axare
of our ordinancee end an meke the cort�lete safety check oP yrour
poal area. •
RH:eb
Eac. 1
3lncerely youre�
RICHARD HAHHART
Buil.ding Sefety Director
' H. ' LA�'o"�IA�STER 8. CO., �9C. ' . :'
( 72CMS-7B5Z-002.,
,, �� 7940 MAIN STREET — STANTON. CAUFORNIA . ;; ��:,�.
� 828-8040 . � "
XXX . .
Field Data on Test Specimens . Core Concre�P Gunite Grout/Mortar .�
Project Swim Pool John Russi � Permit No- -
Project
Lxation 3256 Ne6raska Place, Coste Mesa
Contractor Anthnny Pools Architect
Location in Strudure Engineer
Date Moulded 4/26/72 No of Spe�;mens
Slump Specimens IAarkad'
6
S�ci`iacl Sirength at �� days _��4—P.S.I. Mix Designa'ion
Age to be tested 7 days 26 _days_.___day's days
READY MIX PLANT AGGRE(�ATE SOURCE
Weather Condition 1 Yd.
Cement Monolith Type I�II Cement, Ibs.
Admix Sand
Specimens made by #4
Data by Jack Hubbard #3 �
Delivered by #2
Date Delivered # �
REMP.RKS: Water, Gals.
Lab. No.
Date of Test
Specimen Dimensions
Area
Ultimate Load
Lbs. per sq. in.
H/D Corrected
FORM M - 015
� FOR LABORATORY USE ONLY
72 - 917 72 - 910 72-919
7 Day Test 7 Day Test 7 D�
5/3 5/3 5/3
R
City Of'�
_Yd. Batch �
4D tons
72-42a1 72-921 72 - 922
Test � Da Test
5.81 X 12.25❑ 6.13 X 12 5.89X12.2
26.52 29.51 27.25
64,�00 100,�00 61 000
2,413 3,389 2239,
� � �fi tT'Y-DEt T.
rrAY � �3�z
tests required
RCEit6207 lUZ-C..L.tc:..,�'(. �p_•`w`^ ..
.�++��� �.• vvv VMIL .!-�� I'-'
JOB ADDRESS e ras a . BUILDiNG PERMIT N0. 34488
�ENERAL' CONTRACTOR Anthoryy A.s DESCRIPTION of WORK P Scuim Pool
iSP No. 139- 5- LOT TRACT FIRE ZONE VALUt $ 2,400.00
SUBCONTRACTOR
ROUGM PLUMBING
PIiOP. SwR. LINE � HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOIIS
ROUGH HEATING AN� AIR CON�ITIONING
TEMPORARV SEFVICE OR POLE
UNOERGROUN� � POWER � , /Lc'J�
ROUGH WIRING
TRENCHES FORMS p STEEL REINF
FLOOR SVSTEM
BOND BEAM � STEEL REINFORCE �]
SHEATHING
FRAME AND FLASHING
LATHING — IN n OUT ❑
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING. VENT., REFRIG. ANO A.C., FINAL
PLUM9ING, FINAL AN� GAS TEST
ELECTRIC, FINAL
BIIILOING, FINAL
SPECIAL REQUIREMENTS
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COSTA MESA BUILDING-SAFETY DEPARTMENT
� P.O. BOX t200 COSTA MESA. C4LIFORNIA 92626
PAID
f�R �4-7?rns::��1142� �*��34.67
APPLICATION FOR BUILDING PERMIT
For Applicant to Fi!l in Compleiely qECEI V ED B �ATE RE EIVED
DATE ISSUE�D/
AD'DRESS 3256 NEBR.ASKA PL ^� ^ �^Z� /
� ( PERMIT NO.
OWNER O A.P.N . � �O�S� `C
M A I L BUI LDING
ADDRESS S'�' ADDRESS `Z 6 NEBRA.SKLA P�
CITY NOL TRACT 37µ LOT lo BLOCK
CONSiRUCi�ON cash �'�' P.DD P
LENOER
7C7C
BRANCH
WNER I� JOHN RUSSI
ADDRESS
VALUE
ARCHITEC7 TEL S SDTlIlS pOOl §
OR ENGINE R P� N C �'l
FIRE
ADDRESS F' ZONE TVPE GROUP
CONTRACTpq Anthony Pools ByPROVED � DATE� � %%
ADDFE55 5871 Firestone Blvd.
ZON NO.OF USEOFNEW ,Sti//wM/N1C
CITV South Gate NOLSp3LG1U � I P�� 2 BUILDING OJ`
LIC. No. 19o1'7g IICyNO. vMA NSBUILDING ACCESDSORVPBUILDING
SIZE • ' NO.OF BLOGS. (FROM GLSTREE7) /
OF LOT NOW ON l0T FRONT FT. b FT.
USE OF residence ciRCl 3 ^ ^
EXI5TING BIOG. g rage FT. d�lJ FT
SIZE OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE FT. FT.
EXTERIOR WqLL ROOF ��
COVERING COVERING REAR FT. � FT.
VSE OF BU�LDING AND WORK TO BE PERFORMED pISTANCE BET, gE7'. MAIN & � IJ
p •1'I MAIN BLOGS. ACCESS. BLDGS. ��
VAR.� DATE
of single famil do�ellin c.u.P.�w APPROVED
APPROVED � 2
1 hereby acknowletlga [hat I have reatl this appllcation and stere STAjE
the[ the abOve information is correct antl aBree to comply wi[h
all laws regUleting b�ilding construction, antl I Shell not employ
eny perwn �n violation at the workman's comp¢nsation laws of �
the S[exe of Califomia.
m
I here�y cer2ify [hat I am properly licensetl as a conttactor untler SQ. FT, o
che State ot California Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UND ATION IS FOR �
Chapter 9, antl that su<h licenses are in tull torce and effect, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLY: m
am exempt from,the provisions ot the 52are of Califomia Businan �
antl Profezsio�s Cotle, Division 3, Chapter 9. VALUATION m
{ PEFMIT FEE S �• ��� c'
� 2�0.� , � �
Sie^atura ot m
Parmittee 7 �"� $ P�AN CHECK $ E
/ J� `o
Au[horizetl A9ent /�� �'.��J g_�.�'1;./ l/ �� �✓ LL
TOTAL FEE 5
LoT 16 ,
TRj�722 �
� �V� M�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 91] C08TA MEBA. CALIFORNIA
For Applieanf fo Fill In Compleiely
TYPE OR PRINT �
BUILDING 32-r�6 NEBRASKA LANE
ADDRESS
COSTA MESA. CALIFORNIA
owNER K& E DEVELOPMENT COL�INC.
MAIL
TEL.
I.S.�ZE .,T 6OX � OO 1 R R EG I uo�orue�oos. Q
BET6ACK LIN! FROM O f 'Z �
ee'rrEw op srneer 5 REAR YAR
/ 1
SIDE YARD I LEFT �5 I RIGHi S
DESCRIPTION OF WORK
WORK TO BE PERFORMED
PLAN 2-BR
1 HER6BY ACKNOWLBDGH THAT 1 XAV6 RBAD TH18 APPIJWTION
AND BTATE THAT TNQ ABOVH I6 CORRHR AND AGREB TO COM-
PLY WITM ALl Cl y��� CHB AN�'�IAiH y{W9 REpUTATIN6
BUILDIN� CONBTR � � � //
� AUTHORIZED AGENT
FEE RECEIVED
�,��- OCT 241960
FINANCE DEPT.
CITY OF COSiA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO. PlRMIT NO.
o�re iesuEo
ILDING
COSTA MESA, CALIFORNIA
APPROVED
ZONING
NO. OF I UBE OP NEW y
Pl.AN9 2 BU�LDING W/ Slit
L80AL
YARDS
APPROVED
IC6NT[R LINH 8T.1
EVES
TMB AMOUNT 9HOWN UNOEP VALUATION �8 FOR THE
PURPOBH OF EBTABLIBXING A PEPMIT pEE ONLY.
V UA710N /`
/� ��/ PERMIT FEE $ i�(j�/—'
S I PLAN CHECK $ IO '�
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