HomeMy WebLinkAbout3269 NEBRASKA LN - Building PermitsCITY OF COSTA MESA
BI/ILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.aov A�`
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M11-00109
PERMIT TYPE MECH
APN: 42251246
JOB ADDRESS: 3269 NEBRASKA LN CM
Vicinity: , - . .
SQ. FT: 0
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
1 011 412 01 1
MDM
SCOPE OF WORK: REMOVE/REpLACE 36K BTU FURANCE, SAME LOCATION
OWNER: HERBERT, KENNETH A Address: 3269 NEBRASKA LN Unit:
PHONE: � Ciry/State/Zip: COSTA MESA, CA
APPLICANT: CARLOS ZAMORA Address: Unit:
PHONE: 818-735-7876 ' - City/State/zZip:
CONTRACTOR: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWYUnit:
City/State: YORBA LINDA, Cq ZipCode: 92887
�:r
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MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
License No. 799170
PHONE: 714-777-7777
- CELL:
�"1-1��;'i0q
.�� r..��P?�t7�'i
NOTICE: The work authorized by thi5 permit shall comply with all applicable handicap access requirements under California statutes and related
, regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. ,
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approyai must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
�CODEt. INSPELPONTYPE ORT� INIITIALS COOEi INSPECTIONTYPE y DA� NTITIA
1616 Fixed System Final Fire Prevention 206 Final Mechanical �`'�'Z%' ��
. 1266 Pool Spa Final 208 Final Plumhing
200 Final Re-Roof 210 Rnal Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Faclory Fire Ptace 220 Final Planning Approval
'_ ';�.�ri�i
203 Final Sign 222 Final Site '�
204 Final Demolilion 250 Final Building/Occupanty
WORKERS' COMPENSATION DECLARA710N:
I hereby affrm under penalry of perjury one of the following declaralions:
❑ I have antl will maintain a certifiwte of consent ro self-Insure for workers'
compensation, as provitled (or Dy section 3700 of the Labor Code, for the
�erformance of the work for which this permit is issueC.
I have and will maintain workers' compensalion insurance, as required by
section 3700 of the Labor Code, for the peAormance of the work for which this
permit is issued. My workers' compensation Insurence carrier and policy
number are:�J
Carrier: //�D✓��'�9
(This s'ecfron need not be mmyeted �Meperm�( is valvetl a( ona �untlretl tlollars ($fOJ) orless.)
Policy Number. �.l% L✓J .%�JULG?'�'d y
❑ I cetlify that in the peAormance of the work for which this permii is
issued, I shall noi employ any person in any mannar so as to become subject
to the workers' compens c laws of Califomia, and agree that if I should �
become subject to the orkers compensation provisions of Section 3700 of
the Labor Code, I sh d f�vnth ompty with these provisions.
Ap iwm's Si ure Date
WARNING: FAIL O SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWPUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Cotle, and
my license is in full force and eftect.
�ic. u C�ass tt GZG
�D��
mracloY ignaWre Da1e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm that there is a construction lending agency for the
peAortnance of the work for which this permit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lendefs Address:
oace
OW NER-BUILDER DECLARATIONS:
I hereby aKrm lhat under penalty o( perjury Ihat I am EXEMPT FROM THE
CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7037.5,
Business and Pmfessions Code: Any ciry or counry w�ich requires a permil lo
consUuct, alter, improve, demolish, or repair any stmcWre, prior to its
issuance, also requires the applicant for such permit to file a signed statement
Ihat he or she is licensed pursuant to the provisions of the Conirac�ors
License Law (Chap�er 9(commencing with Section 7000) of Division 3 of ihe
Business and Professions Code) or that he or she is exempt therefmm antl
the basis for �he alleged exemp�ion. Any violation of Section 7031.5 by any
applicant for a permit subjecis ihe applicanl to a civil penalry of not more Ihan
(ve hundretl tlollars (5500)J:
❑ I, as owner of the property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and the structure is not intended or
oRered 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 tloes such work himsell or herself or t�rough his or her own
employees, provitletl that such improvements are not intended or offered for
sale. If, however, the building or improvemen� is sold within one year of
completion, the owner-builder will have lhe burtlen of proving that he or she
did no� build or improve for purpose ol sale.).
❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTFtACTORS to cons[ruct the project (Sec. 7044, Business and
Pmfessions Code: The contractors License Law tloes not appy to an ovmer of
property who builds or improves thereon, and who contracts for such project with
a contrector(s) license pursuant to the Coniraciors LiCense Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
sleoxw,e
305]<6 (3r0]�
Owner ID verified by tlriver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership Dy (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connec�ion with work authorized
by this pertnit, and that no building siructure, scaffoltling, falsework, or demoli�ion
or dismantling thereof, will be more lhan thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which would
require a permit from the Division of Industrial Safery, as noled above, unless
such person has a permit to do such work (rom the division.
Applirants SignaWre
�ivision of Indus�rial Safe�y Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the aDP�icant or preseni or fuNre building occupant neetl to file and
certity a 8usiness Plan for emergency response to release or threatened
release o( a hazardous ma�erial? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(ey Code requires, wiN some
exceptions, that a Business Plan be fled with �he Costa Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stanAarC temperature and pressure).
2. Does or will the applicant or present or future building occupant neetl to fle
a registration torm for acutery hazartlous matenals? ❑ Yes ❑ No
(Section 25533 0( lhe Calitomia Health antl Safery Code, vrith some
eaceptions, requires registration with the Costa Mesa Fire Department by
eaCh business whiCh at any one time �a5 on hantl a qUanliTy of aCulety
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feel of compressed gas at stantlard
tempereWre antl pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 2553a of the California Health antl Safery Cotle provitles that the
Costa Mesa Fire Department may require the preparation, certiFlcation and
filing with the Fire Department of an RMPP by businesses which are required
to register acutery hazardous malenals wilh ihe Fire Department.
4. I( an RMPP is presentry requiretl, has Section 25534 of the Califomia
Health and Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or tuiure builtling occupani r¢quirC (0�
the vrork which is the su6ject of this application a Oermit (or such constmction
or mo0ification from the South Coast Air Qualiry Management DisMcl or from
any other air pollution control tlistrict or a9ency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment CoOe requires that the requested
iNormation be fumishetl on applications for non-residential building permits).
6. Will any Dart of the facility to be constructed under this permit be within
1000 teet fmm the outer bountlaries of a school? ❑ Yes ❑ No
(If "yes', Ihe tacility mus� meet the requirement of Sec�ions 25534 antl 42303
of the Califomia Health and Safery Cotle).
7. If a permit fmm Ihe South Coast Air Dualiry Management District or other
air polWtion control dislrict or agency is requiretl for Ihe work which is the
subjecl of Ihis application, have all of the tlisclosures prescnbed by Califomia
Healih and Safery Cotle Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes', attach certifcate of compliance from the appmpriate air polWtion
contml officer).
CERTIFICATE OF COMPLIANCE: I certiy that untler penalry of perjury the
information given above is correcc I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
SiBnaWra Oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certiry under penalry of perjury that I have read this application and state ihat
the information given is correct. I agree to comply wit� all state laws and ciry
ordinances relaling to building construction, and authorize representatives of
the Ciry of Cosia Mesa lo enter upon the above-described properry for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Si wrao le , Owner�s) Daie
l0•I�ZeG
nNo� M1orizetl Np n� Dale
,
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� Cm�tracwr (lliicumenSatipii �Author's /ILespousiblc Desiguer'S'�llechu�atiuu Suuetucni) � . . .... .. � .
- � I cenify Ihai tliis Certificu�c of Complinnce ducwnema�ian is accurmc und complete.' � � . � � � .� �. �. . � �
, • I am eligiblc under Division 3�of Ihe Cnlifunua &usiness anJ_ I•roiessions Cade to uccepi responsibiliiy for Ihe desiym identnied�on [hie
� CeniScme of CompYlance. � � � � � ' � . � � � , . . ..
I cenify lhat t}le ener},�� teaturc.s nnd per(i�nnancc speciCicntions tur Uiq elesi�,n� idenlif�ul on this Cnrtif"maie of Canpiiance contonnlu �tlre -''-
� � requiremenls of7itle 24, Punx,l aiiA G of tlie Celiforni�i Cutic'of RegulaGmie. ' ' � ' ' � � . . � � . ,.. � . . .
The desi n features idemified.on ibis Certif�caie of Cum liance are consisteni w�th tlie mfunnaY ocumen�etl on o her.apph �
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compliance lorms,.worlshFelc,.calci0ationc,,pluns and specifications submitteA'tii�ti'ieenior eni epency (orupprqval witl� tli...pepnii .._ ...,
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2p0,'; ISaeidenliul Compliaiae Gorms Idurch'ZU)U
�v�vt��vt4t�YJ'n1L"lNV ?✓IiTL"/.uC,y.
G'i1��,CI7STG��IIIZE IT�1Z'HLL':TTE'RF7EfL1L'/SL'x1L)
2(IOS P.,uilcling �nerg,y L�'f'fiicienc}� SCt�ndardh 32eSidenLial P3'VAC' A11:er�ttions
GIimai:e Zones 7 and 3 t:itrmt�Tli 7 �Z�-(� ��asr�,�iFs,�
SUSINL'�S�S ANI) PROP'CSSIONS COD�, SL�CTION 7CL0
U+illful or de4iberate disregard and violation nf the huildinp, laws. inr.luding ihe Caiiiornia Auil�ling Cudc, and
locnl pennit requiremwts constiwtes a cause for disciplin�rp action PI'Oill (I1C COI1ffllCt01'V SC�LL L,ICCIINf: B�el'(I
woc4dng in co���unetion witl� the �c�ca4 building departmettl. Thix uetion mal' r.onsisi oi fines up tu 115,U00 per �
violatian or .suspensi�mh�r.vocation of a contractor's license. � - -
I��II��' IS A ]'GIZMI"f' 1tL;()UII�D?
A written consiruction pennit shall br, obcainr.tl fi�om thc enforce,ment agr.nr.y prior to thr. erectirnt, constructicm,
rer.onstruction, installation,-relocation, or alteration of any mechenical syscem, excepl as permittetl iu �Appeudix
Chapter 1, Section I 12.2 of the 2007 Califnmia Mechanical Code. Projectc requiring permits include, 6ut ai�e not
Iimited ta: �
• IJew HVAC installation
• FNAC Ch�n�eoul
• Replacemeni of furnace, coil, PAU, or coiidenser .
• Relocation of an exieting HVFlC miil . . ,
� Ad�ding�or repi�cing more than 40fl ductinF ni unconditioned speer.
200R ATIILIiTNC: I;NL�RGS' �Ur1CT�N-Cy STANDAP.TSS (TiYla 24, PnrP fi) I2�OLIIIL��Ni�Ai�T4 I1JPI 1L:�
I. Heating equipment must have a minimum 78%AFUE (Exception: WaIFK floor nirnaces; room haaters).
2. Centtal air.conditioners & heat pumps.less thav6�,000 Btu/nr musl have a minimum li SEEK.
;. Newl}� installed or replaced ducts must have a minimum insulaeion value oT-IL-4.2: �
�q. Fl setbacl; typelhermostat (24 hr clocl: with four s°[ points) is required ior all alterations.
S. New or replacemem ducts must meet the mandatory requirements of Section 150(m!�. .
�« All .joints and openin�s in the in the ENAC system must 6e sealed.
� Only UL 1 S1, OL 1 S1A, or UL 1 R1B epproved tanes, o�� mastic shall be used to seal duct openings.
�� Connections of ine[als ducts and the. inner core o`fles ducts sUall b� mecnanically iastened. Flez ducts
mus� 6e connected using a metal sle=.veJcoupling.
• �i�>; ducts tnai are susoended must oe suoponed eve,-v 4ft. mar. ior iiorizontal nms with no more thao T'
oi sag oenueen suppons and 'o h. ma>: for venicai runs.
6. Tne Cr-oj.-NII�CD-04 musi be eompleted and si�necl by the installing confixetot. Tiie Inspector will coUeei
this iorrri and verify that the model numoers ar� the same as the instsdled equipment.
' t
� f
� . CITY OF COSTA MESA
BlIILDING DIVISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�vw ci.c sta•mesa.ca.
�. ` FOR INSPECTIONS CALL: (714) 754-5626
�� ��
PERMIT NUMBE B07-00775
PERMIT TYPE B_ROOF
JOB ADDRESS: 3269 NEBRASKA LN CM
Vicinity: HOUSE AND GARAGE
SQ. FT: 2800
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
ConstType:
Valuation:
ISSUED
06111 /2007
RMD
??
58,989.00
SCOPE OF WORK: TEAR OFF (E) ROOF MATERIALS, INSTALL A MINIMUM OF 2 LAYERS OF 15 # FELT ON A 3:12 PITCHED ROOF AND
REROOF WITH 30 YEAR COMP SHINGLES, APPROX 28
SQUARES ANO BUR ON APPROX 3 SQUARES OF FIAT ROOF, ATTAHCED HOUSE AND GARAGE. REPAIR AND REPLACE SHEATHING AS
NEEDED.
OWNER: HERBERT, KENNETH A
PHONE: CitylState2ip:
Address: 3269 NEBRASKA LN Unit:
COSTA MESA, CA
APPLICANT: MILLER, DAVID . - Address: 2870 CHIOS RD Unit:
PHONE: 949-631-1924 City/State/zZip: COSTA MESA, CA
CONTRACTOR: ORANGE COAST ROOFING License No. 434674
Address: 2870 CHIOS RDUnit: PHONE: 949-631-1924 - , .
Ciry/State: COSTA MESA, CA `� - 2ipCode: 92627 � CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
TOTALFEES
_ Lfcense No.
�icense No.
$o.00.
$167.25
$0.00
S� 67.25
PHONE:
PHONE:
�
NOTICE: The vrork authorized by this permit shall comply witli all applicable handicap access requirements under Caiifomia slatules and related
regulatlons. (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 work authorized under this permit to be considered legal, such work must compty with all applicable codes, and ai�
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit.
LOOE1, INSPECTIONME pT IN A �QUEt INSPECTIONTYVE p�jF� N l
1618 Fized Sygtem Final Fi2 Prevention 208 Final Mechanical
1288 Paol Spa Final � ' 208 Final Plumbing
200 Final Re-Root �� 210 Final Electrical
201 Final Blotk/ReWining Wall � 212 Final Fire Preve�lion
202 Final Fattory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final DemWition 250 Final Builtling/Occupancy
W6S2KER5' COMPENSATION DECLARATION:
I hereby aKrtn under penalty of perjury one of ihe W,�owing tleclarations:
❑ I have and will mainlain a certificate of wnsent to self-Insure (o��workers'
compensation, as provided for by section 3700 of Ihe Labor CoOe, for the
pedormance of the work for which this pertnit is issued.
❑ I have and vnll maintain v✓orkers' compensal'an insu2nce, as required by
sectbn 3700 of ihe Labor Code, tor the peAortnance f the vrork (or which this
pertnit is issued. My wnrkers' compe�tion In nce wrrier and policy
numher are: �� �
Carrier:l
(TnissMrn rroloemmplet[etl✓rhepemulisvaNetlatmehurrdietltlalars(Et00)aless)
Policy Number. � t1 � � �' �
���
❑ I certify that i the peAormance of the vrork for which this permit is
issued, hall not e ploy any person n any manner so as to become subject
to the rkers' co pens tion laws f Califomia, and agree Ihat it I should
beco subject t he rkers' c pensation provisions of Section 3700 of
the r Cotle, I all f rth 'th c ply with these pmvisions.
_r�
i nf551gnaWre —Da�e_
��_ _ �' '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm [hat I am licensed under provisions of Chapter 9(commencing
with Sectio 7000) �( Division 3 of the Business and Professions Code, and
my license s in t ce f L �^� �
Lic-#-- " � � Class"#
� - �'-
"�Gomi or'sS ure at�._
— �_ .
CONSTRUCTION LENDING AGENCY:
❑ I hereby affvm lhat there is a construcfpn lending agency fw the
per(ormance of Ihe v.ork ta which Ihis pertnit is issued (Sec. 3097, Civil Code).
Lentler's Name:
Lentler's Address:
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe (ollovring rea5on (SeC. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit ro
construcl, alter, improve, demolish, or repair any sWcture, pnor to its
issuance, also requires the applicant for such permit to fle a signed statement
Ihat he or she is licensetl pursuant to the provisions o! the Contracrors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 0! Ihe
Business and Professions Code) or Ihat he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects Ihe applicaN to a civil penalry of not mora than
fve hundred dollars ($500).�:
❑ I, as owner of 1he propeny, or my employees with wages as their sole
compensation, WILL DO 7HE WORK, and the structure is not intended or
ofleretl for sale (Sea 7044, Business and Professions Code: The Conlractors
�icense Law does not apply to an owner of property who builds or improves
Ihereon, and who does such work himself or herself or through his or her ovm
employees, provided that such improvements are not intentled or offered for
sale. If, hovrever, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of pmving�lhat he or she
did not build or improve for purpose of sale.�.
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl
Professbns Code: The contractors License Law dces not appty to an ovmer of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Cont2ctors License Laws.). �
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre
�OS]-66(3/0])
Owner ID verifed by driv nse. ❑ Yes �No '
Driver's License No. Expires:
• Venfcation of Ownership by (lype of document, i.e. - property tax bill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certify that no ezcavation frve (5) or more feet in depth inro wfiich a
person is required to descend, will be made in connection with work autMrized
by Ihis pertnit, antl that no building sirucNre, scaffdtling, falsewoB, ar demolition
or dismantling thereof, will be more than thirty-s& (36) feel high. (Chap. 32, Grp
2. Art 2, Sec. 341, Title 8, Califomia Atlminisl2tive Code).
❑ As owner-builder, I will not employ anyone to Oo work which woultl
require a permit from the Division of Industnal Satery, as noted above, unless
such person has a permit to do such vrork from the division.
Applmanl's SignaWre
Division o( Industrial Safety Permi[ NumDer. _
HAZARDOUS MATERIAIS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant need to file and
certify a 8usiness Plan for emergency response lo release or threatenetl
release o( a hazartlous material7 ❑ Ves ❑ No
(Section 25505 of the California Health and Sa(ety Cotle requires, with some
exceptions, that a Business Plan be filed wiID the Costa Mesa Fire
Department by every business which has at any one time tlunng a reported
year a quantity of hazardous matenals equal to or greater than a weight o!
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard IemperaNre and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration (orm for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health antl Safery Code, with some
exceptions, requires regislration with Ihe Costa Mesa Fire Department by
each business which at any one lime has on hand a quantiry of acutely
hazardous materials equal to or grea[er than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic (eet ot compressed gas at standard
temperature and pressure).
3. Does or will [he applicanl or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevention Program For acu[ety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code provides that the
Costa Mesa Fire Department may require the preparation, cerlification and
fling with Ihe Fire Department of an RMPP by businesses which are required
to regisler acutely hazartlous matenals with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safety Cotle been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or luture building occupant require �or
the vrork which is the subject of this application a permii for such construction
or motlificaiion from ihe Soulh Coast Air Quality Management DiSIricl or from
any other air pollution control distnct or agency? ❑ Yes ❑ No
(Sectbn 65850.2 ot the Califomia Govemment Cotle requires that Ihe requested
inlormation be fumishetl on applications for non-residential 6uilding permits).
6. Will any part of the facility to be constructed under �his permit be within
1000 (eet from Ihe outer boundaries of a school? ❑ Yes ❑ No
pf "yes", the facility must meel the requirement of Sections 25534 antl 42303
o! the Cali(ornia Health antl Safery Code).
7. I( a permii Irom �he SoWh Coast Air Quality Management Dislnct or other
air pollution control district or agency is required tor the work vfiich is the
subject of this application, have all of the disclosures prescribed by Calitomia
Health and Sa(ety Code Section 42303 been made? ❑ Ves ❑ No
8. Qt "yes", attach certificate of compliance (rom the appropriate air polNtion
control oKcer). . �
CERTIFICATE,OF COMPLIANCE: I certify that under,penalry of perjury the
information given above is cortect. I agree to comply�with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
Slgnalare Dale .
CERTIFICATE OF OMPLIANCE AND THORIZATION OF ENTRY: I
ceriify untl r penalt of p rjury that I hav r ad this appliration and sWte that
the infor tion giv is orrecc I agree comply vnth all state laws and ciry
ordinanc r tin to ilding onstru i, and authorize representatives of
the Cit f ost M a to nter u the above-described property for
inspec o . a ree o to y or allow occupancy ot any building
aWho thi e' un f al i tion. �
gnal e of gal er(s) Da�e
1� A A h 1 AOObcanl �—Dat,/ _O�
;
�oonasaem�a�: 3269 NEBRASKA LN ��
,wmerrsxryeiF�wavr+: HERBERT, KENNETH A FLOOD: X 37
� �� HERHERT, LINDA M
3269 NEBRASKA LN
COSTA MESA,CA 92626641-1858
IVPL.IW�1M�id00ME55:
NLMRELT OR F1M�NEFA:
MCX.OH EIM.'9 AOUIIESS:
/ I
!
uc xo:
UM:
caxm�crarsruu�: HRICK ARTISTRY ( 714 ) 841-5643
cwm�croirsuu�a+o 18357 ENTERPRISE LN
eooxess: HUNTINGTON HEACH CA uc.xo: 454722
92648 uxr:
LICENSED CONiPALTOFS DECL/�flATION: 1 hereby eflim uMx penely d perjury thet I em licemad uMm yo.viau ot GM1eqp s
(mmmendnp �Ih See�ion )000) W Oiviaun 3 d iM Busineu aN PMesdana Code, eeM my lieenee'v in lull bree ard Nlea.
cmuc.No.:057p530 uc.cuss: C 29 uc.No q54722 EXP: OS/97
Dme: I'!i"O • / � Comrearn�/
OWNEX BUILOEfl DEClAN1T10N: I hareby elfiim uMer peiWy W perjury �hel I em eaemq Ir iM Comrmae Limnsa lew lor ihe
IWbwn9 reawn (Seubn 1IXi1.5 Bwiima eM Prdwum COEe: �nY cYy a ooumy r,fiitl� re m e P�� lo mnWcl. Mer. impwa.
damdeh, w npei eny ewnure, p�ior a us 6weiwa. abo rapuiiea �M appicem Iw euch pe � to file e aprod e�etemant Nm M p ahe
ie licensed O�nuenl lo Ihe D��siona d Ma Conlredore license law �Chep�e� 9(comme tp wilh Sed'qn ]000) d Divopn 3 W Iha
usress eM Rdav"wiu CaEe� a �hei ht a Ma ie ezamq thaehan and �he beao /w t elbped xemqion. My violetun af SeUion
,nt.s W eiry eppiant iv e pxmn euqede �he eppirain io e tivil penely d rid mon i Me huiMreE Edlen �f500U.
�, I. as owner of iM propeM a my empbyeea v.ih wepea es thei ede mmpanmian, will do IM xn'k, eM IM sVucWre b iwt inleMed
or olfered fa sde (Saction ]OM. Biuirov eM Prolessima Code: TM1e CaNredon Licenae Lewtloan rwt eppy�oen ownxd propeity
wM WICe a inproves Iheimn, eM who doee cucli xaM NmwX or henetl or th�aph he a Mr own empb�eee, povidetl thm wM
impo+emmis are nd imvded at dlmetl lar eeb.'tl'Mweuw. IM WJliip a inqwemeM ie edd v.ilhin me Yeer d mmpl&un. tln
owner�WiNx xill heve tM buNen d pwi'p M or ehe dN rot buiW or impwa 1« iM WN�+a d seb).
� I, ea orma d tM propery. em udusirdy oonlrednp wM liceneed wnVeMae ro conWua the prqea (�� �. �+sinma erA
Proleauons Code: TM Canretlae Linnm law does ewi apply ia an owner d popeny xfio buitla a impovm tMeon aM wM
cmvecb M wM M9eea vmh e mnirepnlsl licensad Wnueni lo IM Conveaon lironse lewl.
� I em ezempt uMer SeMion: j"� B:'B�P.C., lor ihie reeaon:
ode: ow��.
I do hereby cenity Ihat I em ewere d erd uMemtend iha reyuiremenb oi CelAama HeeXh enE Selely CaEe Seclione 25505, 2553J, end
255�6. eM Met I a eny Mure WiWiiq mvpem will l will rM (aRb an) metl lo comqy wYh eeid awe oodee ard the requirementl br
epartnnl«miuuudianamodifmianhamiMAi e�y ampemeniD'ntiia.ReaiEeiMialmMvfioneGP�'vreenommqtmnihoe
provisiona.
Dete: ADW��
W OHKER'S COYPENSATION DECUfl�TION: 1 Mreby elfi�m uMm panelly a1 pajury aw M the Idbwi�q ded+rmim:
� I heve and xil meinten e cMXicate d mneenl lo eeX-imure la workaii companeelbn, m provided Iw by Semm 3)00 d tha lebor
eaee, �n �ne ronoimarw. a d�e woix �« whicn mle v�n n ivuea.
I�.l 1 heve aM wJ mvnteii v.wken' wmpe�uetion imuraMe. n m�uired by Seqim �100 d IM lebor Cade. br the perlarmenw at �he
7C woA la which Nis permn ia iaued. MY w«kers' mmpannelion insurar�ce'eriier eM pdiry number are:
c�r CAL COMP EXPIRES
Pd'ry Number 0 3/ 01 / 9 7
(This secfiw naed riw be cw�Ple�ed / Ne perm.f is br arro huMmd ddlera (StW) w bsa.j
� I ceniy Uut in IM perlom�enw d Rw work iw xfich thia paim� ia iaued. I dWl mt empby e�ry pemn in enY meniwr eo av to
becane wEjad m tM xarken' mmpansetion bwe d CeGbmie, aMpp ree ihel A I ehwM come wbjeu �o tM wa1Mn'
comVenaetion pvri+aa d Smion 3)00 d �ha lebor COLe. I Mell Yn'nh mmGA' xiN iMro Neb
/-��'� � .
Dete: A rani' I
Wam/ny: Falluis ro��curo woikwi eompe�uetlon rovaape / vnlewN{ entl Nvll albJecf an •' oyer ro alMrol peneMu aM
c/H/ flnes up ro a�e �untlrod flaurrd tivllen (5100,0001, In aetlltlon b Ms cwf ol comp�bM1 Oamepss as poNdW br In
9wUm 9)OS o/ Me Lebor COW, /nfxssf, �ntl eflorney'a /esx
CONSTFUCTION LENDINO AOENCY: I Mreby elfirm uMar peneMy d perjurv �I�m ihan' mnativaun brdi�p apaiwy br the
�IBf�OlIfILICB 0� 1118 NOh �Cf W�IIdI lh6 pBflll� Ie 681184 ($BCIUII' 9�. CiN. Ci.
LENOEN'S NMIE
LFNOER'S ADDRE55:
I canM thet I heve rteE I�b applcetion eM elele thm the ebova intormmbn n mrtea. I epree lo compty xilh ell dly vd ooumy aNiruirae
enE slete lewe relmnp b buikinp wnsNwion end hereby eu�lwrae repreaenietivea d ihu vry to emer upon Ihe ebave-mantioned pmpeM
�«��P'tl�0�`0�"' TERRY CONNOLLY
�
Dete: y�_'_T_
(5151<fi.WP) Whno-AuiNrp 8 Selery; OreemFle: Cenery-Appiranl: Rnk-Ravenue; Gokanro�bsmw
CITY OF COSTA MESA — BUILDING PERMIT
PEAM NO; B 081234
PERMIT NO; B 081234 PLAN CHECK NO: 00217-97 S GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : 80LF CITY STANDARD BLOCK WALL SQ FT: 80
CLAIM VALUE: 1,600.00 CALC—VALUE: 1,600.00 GROUP OCC: R-3 /
COMMENTS: CITY STANDARD BLOCK WALL
�rx �r*�r��r*�x***�e**xx�r**��r***�+r�r�r��r*�r*�r***�*�*�r��r���******�x�**��*x��*�*�*��r����**�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: 25 FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: S FT IN
PARKING REQ: PROV: PARCEL: 13906413 ZNE: R1 REF NO:
PLANNING NOTES> 80 LF OF 6' HIGH BLOCK WALL ON LEFT SIDE PROPERTY LINE OF EX
> S.F. RESIDENCE, i
1E iF IF 1E 1F 1f 1f 1E 1f 1E 1E 1f 1E ik iE if if Ib ik if iE ik iF1E k ik iF iF k iE 1E k iF ib ib ik iF 1f if 1E 1f !F 1t 1E fE 1t 1E if IE �E iE 1ElE if fF 1k fE ik iE 1E 1E fE 1E iE k 1E 1FlE_1E iE iE iE iE 1f �E iE 1f dE iF
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 S
ZONING APPROVED BY CC/'� DATE; ,.•� �1r
BUILDING APPROVED BY :
ION ISSUED BY
LEGALIZATION:N
BLDG PMT
PERMIT 51.25
PLAN 33.31
ISSUE FEE
F E E S U M M A R Y
l�1! tl S I:i �. [a� � 1l?I�i! �l;f �[��'u ��I�1: i:\. i[�l
DATE: �l�
DATE: il�^
�+F�r**�x �x�����+�*��*��t�at*it
STRUCTURAL' SEGMENT:Y
FIRE SMIP/RES� GRADING
� 50
�, SMIP/NON—RES
i
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL . PAID DUE
TOTALS----> 51.75 0.00 33.31 85.06 •_� 85.06 .00
REVENOE DIVISION TOTALS--> COLLECTED: 85.06 OVER�/SHORT: .00
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
51.25 .50� 33.31
1E 1! 1trlF 1E Ik 1k 1f 1E 1f 1E 1E 1k iF iE ff iE 1f !F 1E M it iE iE 1F 1E 1E 1E iF if 1E k 1k 1F iF ff 1ElE IE 1E k!E 1E 1F IElElF if iE 1ElF 1k iklf ft iE 1k if fE fk ff 1f 1E 1E 1E 1E 1E iE ff 1E fE iE iE iElFlf 1F iF ik
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFA 80 RES—CONCRETE BLOCK WALL / FT
END OF FEES
20�.00 1,600.00
�l .
/'' �`+
' /;
i Y .'81-28-1997/82:52 PM/f85.66
� RCPTq:01-00@�764
P�RMIT:081234
� -
� CONSTRUCTION AND PLANNING POQL S a
APPROVALS Permit #� Date Inspector qppROVALS Permit # Date inspector
t. Temporery Electricai Service or Pole 52. Pooi & Epuipment location �
2. Soil pipe•Undrgrnd. �. � � 53. Steel fleinforcement �
'3. Electrical Conduit'Uf;lity�Undrgrnd. 54. Forms � ' - "
;= 4. Electricai Conduit,[t�drgrnd. 55. Electrical Bonding -
' S[ Steel ReinforeementS `-ZZ-R, %,(,y� 56. flough Plumbing & Prassure Test
�6
�� 6."�Electrical UFER_Grnd. " � 5�. APPROVALTOCOVER�GUNITE� � �
-7-.- aotings Z c � ,: I�Z-O-� /W� 58. Electrical ConduitUUndrgrnd. '
� / 6� �
-• L. ., '
�;�8-r fqUnclation _ 59. Gas Pipe, O Und�grnd., Test �
,�9- Wafer Pipe�Undrgrnd:,t 60. Backwash Lines; P_-Trap, O Undrgrnd.
10. St�ucturai Floor$yste'm � 61. APPROVALTE�SDECK �•
71. Property Sewer �ine & House nnection � S2. Back�vash & Receptor-Finai
12. Sewer Cap , �� - 63. Heater & Vent�Final �
73. Roof Drains � "'
64. Plumb�ng System - Final
'74. Rough Plumbing - 65. Electrical-Final ' "
.t5. Rough Electrica'i'Conduit '�'� . �
66. Solar SYstem�Pinal
16. Rough ElectricLl'iring 67. Fencing & Access-Approvai
17. Rough Wiring Sign '' � 68. APPROVED FOf;"PLASTERING
.18. Roo�h Electrical•T Bar Ceiling , 69. POOLISPA SYSTEM5 FINAL � �
- 79. Rough Neating & Air Conditioning - FIRE DEPT. REQUIREMENT
20. Rough P'actorY Fireplace -�, "-. x r� p ��.r ;. APPROVAL�S�'� Permit #* �^J'
- •��
2L �8uc'ts, in_Structur.e." '': �= ; '7 �'- � � ' �"f ~ '• . .
_ . � .. �c .. r� ,-,�, ` 70.�Undergrol�nd Nydro _.
22. Ducts,Ventilating�..: �� � _-�":- 71. ProdJ�t�iping'f7'Gas OOiI
23.'Gas 9ipe�f?oyqh & TEst ��. x�. � e, -` � 72, UndergreUnd F,�'ush '' �'
24. -Roof.-Framing' ��, _�_ ' .,: � A c� � _ 73'. Underyri�d� Stc�ra e Tank� O Gas ❑'Oil
�..
25. Roof Sheathing � � `= 7�" � - 74: Ovy_rhead HydioF' ' `
v� � �. 7 � ...1. r
26. 7'-Ba� Ceiling (Struct�ral) & Monocoat .r _ -� r 79'. Dry Chemical � . s
27.��Framea�dFlashing'_ _ _ T''_ � r�x 76�.�Dry`$tanc�pjpe'�^-'�``�' . '' �
�.
„28. �athingBeSlding�r,ri ��� � ^ -� •• �� 7B', FIXED-SYSTEM'.FINAi '
<�
' 29. Insulation ' F_,� ' ��" " - .;;_ "-�`' r 7$. FIRE PREV. FIt�IAL � ti � =
� 30. Drywall Nailiog "_ � ��� - +�� �� � �;: �NEALTt� DEP.T:-REQUIREMENT
�} �� I j �,�,.. 7�J'. FINALi1�SPECTION `- � A.
31. Piaster Brown.Coat', �. _�„�., � r�
� 32.�Electrirz.kPower tJjeierFina! " '� i;,-� ! ! i': 80; FOOD CERT�FICATE 16SUE0 G
i ��
33.'�FinAI Elearic� ��' � ' - ` � f ' r� �' Nbtes: °' -'� •
iP ,I 1 �X ^'f 1'�j
34. Eina[�Heating'& Air'Conditioning; ' �� � { ', c ;j :� : � = r�r
:�
35.-F.inai•Ga's-Pipe-Test ` � a' � � �* '�' �� 7`-� �` �`' �'�%
'' r H I :`: C-� % � r
. 36. Hood or.�anoPY + � `'. . c ;: ,-, 'y ! - ' ' -
� 37. Final�Factory Fireptace _ � "' -' t "' � �r � �� : "
• �-, o.: x i�
. . � _ `' Y. . T i
� 38.:Fina( Piumbing , � n; � •. .. .. . r r� r + 7� .
� 39. ?h'ater Service-Final •� � � ! , " ^'� --
i � S J �
.. 40. Gas Service-Final ' _ _ . � ` � - � �
- - r: <_;,. a
' 41..Solar Oomestic�Finzl '� •� • Ci � •- - l� �- �
�' _ _ " '
42. �Backtiow Preventer" -' tt - " � - :
. , r� � ir �.. ,
43. Backfiowlrrigation.. � �'r ,.._ , -� 'Z�-.3-q�,-�� �� -�-� ��"'_ ��
l 'c�rv_!
'�44. Landscape Ircigation.System--= - �;=, �.,- - _ '-� _ . ,_� _:, * _ ' � �/ _ _ /
P��(!'�
'�5. So�nd Attenuatiorr• �-" - _ !- `^" ' ' '�' � '
- - - - _
46. Handicap Regylazions - • �' ���. 3 � - �. ��- :;
47. -FINAI STRUCTURE & BULCDWG ' Y . �� •�
- - - ;Z-Z�Y'j ��-~ �
48.`.FINALPLANNING' _ _ . ;� -
:49. Elecfrie Release to Edison . r; � - ''
r: .r .• ,% - �. o
-50. _Gas Release m Southern Caiifornla Gas Co '' y � -- . � � " - -.
b1. CER?IFICATE OF OCCUPANCY' , w ; ;; - � ,. - - -
No. Date
sI!' ; ! , I'
, ._ . ,
,
i�i • � . . � � �
��C.�,�J �r ?�S
.3�-��' N��>Q�s�a ��
� �.� �y��'�, f�
�� �r�
DIVISION OF BUILDING S�
CITY OF COSTA MESA
APP3tOVED
This so� ot plans and sDeciticalions MUST be kept on'
�nd it ic nnlawltA to maice any chan�ss or alteration on s
pertnission trom thc Division o! Building an ery, i
The stamping ot this plan and specificaUons SHhLI NO
or to be an apC�oval of the violation ot any provisionsR
Mesa Ord'+nance anNo� State Ww. ft� 1-�; �F
71 es -. ; znd 7ermit/. �ti�" xpire by IlmRalion and bec
tF ±�, i�p ��%/�f c,nmenced and mamtained a
1` It id �uavs ol issee ice.
c
� �'(`t,
s iob at an
ne withc;tt �
'Ca�s1B `Me?
� n�m
any City ot
ne null and
ve per UB(
r,
�,
3357 Ente�prise Lmze
Huntington Beach, Ctilifornia 92648
Offl1 (714) 84I-5643
Faxti (7l4)842-9276
Co�ztractors Lice�zse#i 454722
f/G��=��' '� �� .
3 �r��' ,�� c.��.�'>> �� ��- ,�,
CDC� ��f�r7
�
s. / p �`.r• � 1
��G /�
8� � �- 6' i�
��'� �.���
CITY Or COSTA MESA
PLFlNNING DIV.
SU8IECT TO BLDG. DEPT.
BY C.N'p _DATE�
�I / /�/(.��Z. (i./��
` f� �
ADDITIONS, DEL[TiOidS, C.. CD� RECTIOMS SHALL
BE APPROVED BY THE "rLAidiiIP1G DNISION
Cement Coping Ootional -�
Channel Block With 1�3/8�
Horizontal Top of all
Fences
For Fences 5' or Less
Vert. Bara 3/8"� at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/8"� at 32" O.C. "
Fill Celis Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall
Conform ta Sec.A-15-39
A.S.T.M.
All Steel to be Lapped
24" o� to Code
NATURALGFADE
TWO 3/8"¢ BARS �
CONTINUOUS 70P
& BOTTOM
.HOR7Z.STEEL MUST BE TIED IN
PLACE AT TIME OF TRENCH
INSPECTION.
TYPICAL
� Z
a
i�
W O
U F-
z
W M
�
i
�'o -
d 'p N
u n — —
a
u �_
a
D I Q
6�� CONCRETE BLOCK FENCE
—WIDTH " ��{..,�
SEE CHART I
BELOW �
�. Ie .
� . ; Q.
� .. ♦
FOOTING REQUI
♦
� ♦.. . e .
eae§ �en �ad
p P� P� Ifnu
GENERAL- NOTES
MORTAR: p�e pa�t Plostic Cement, and
Three Ports Sond
GROUT; One Part Cement Three and
One Half Ports S�and
COPING: One Part Cement, Three
Parts Sond
CONCftETE: Well Mixed 1:2-I/2;3-I/2
Max. of 7- 1/2 Galtons o?
YVotflr Per Sack of Cement
GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLS AND AREASOF HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN &
FREE OF ALL MORTAR DEBRIS, ETC.
DE?TH OF E4RTHTCOTH
1/3 ihiE HEIGTH OF FENCE
'a�ut.�ssl �;� ^' � nol my;cn (Pi
paauawwo� �ou si :; :. :.0 u� SCA'L
dq a�idxa ;IeU` tia^.�a prc ::r 1 asa41
nue ao uoi{eiou ay�;c i.nm,Ge ve aq oti io
suageayiaads pue ue�d siy� yo 6uid�:n,js aU1
W I D T H .. .... . I 4" .......... I��11°" �noyun� awes uo uogeia��e iq �:weya Aue evew oi in�v,e�un si ii 1:2�
T H I C K N E S S...... I 0��. .. , I 0���c qq siyj uo 1daH eq j,gpg� aunUea�i�etls Due sue�d �o �as ���
DEPTH OF EARTHTOOTH .. 24'�.... 2S`-- .
���----���-- . 18i�
SPACING OF EARTHTOOTH. . 12' . . . . . . . . . . 14� . . . _ __. 16�_._._ 16�
City of Costa Mesa, California
Building Department ._
. : ' . .• . -. .. R-EVN.�cD NOK b2
VS3W tl1S0� �O All�
1i.L�3b'S `JMQ'IIflfl 30 rIOISIAIQ
I/2"= I'
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SURVE ~OF LOT LINE
MAY E REQUIRED
�
SURVEY OF LOT LINE pARTY WALL AGREEMENT
MAY BE REQUIRED .
THIS AGREEMENT, made and entered into this �Q �� day of
�U�� , by and between���/,t%✓1if� �/r''�e/
hereinafter referred to as "LANDOWNER;' and �1 �'�i2/_-h`���1�!.Q
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between
of Adjoining Properties)
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
� y6 ����
in Book �_ , Page of Miscellaneous Maps, in the office of the County Recorder
�„CG,�siu,� f% %,
of said County. The party wall shall be permitted to encroach _L2r_�1 ��/-�%% <.,/n�
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LAN OWNER
�
- -� �� - - —
Signa ure)
�/���9 /�CI� 6_�c %
Name (Typed or Printed)
ADJACENT PF�OPERTY OWNER
I`
(sig ure) — — — .
�o�a �l���at�
Name (Typed or Printed)
�a�9 ��,�is,�� ��ti� ��� ��as� ��.
(Addiess) (Address)
�90W6
NOTARIZATION RE�UIRED
CALIFORNIA ALL•PURPI _ � ACKNOWLEDGMENT
State of ���� ��/�ti� s3-
County of c�ic=��n/GF_
On �7i0,�/S�� ��before me, _
onre
personaily appeared il�c1(�t�-�
NAME. TITLE OF OFFICER - E.G.. "JAHE OOE. N6TP
�h
�- �/—Ik'vz �//(/C�- /
NAME(S) OF SIGNERIS)
No. 59W
C'personally known to me - OR - L�proved to me or the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their
gg`K�rq signature(s) on the instrument the person(s),
� ������� � or the entity upon behalf of which the
� �c�
� ���� person(s} acted, executed the instrument.
WITNE my hand and official seal.
SIGNATURE OF NOTARY
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
(raudulent reattachment o( this form.
CAPACITY CLAIMED BY SIGNER
INDIVIDUAL
❑ CORPORATE OFFICER
❑ PAFTNER(S) ❑ LIMITED
❑ GENERAL
❑ ATTORNEY-IN-FACT
❑ TAUS7EE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER: _
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR EMITY(IES)
DESCRIPTION OF ATTACHED DOCUMENT
p�n, c�-�, ��z��--�
TI LE OR TYPE OF DOCUMENT
NUMBER OF PAGES
�/z�/�2
� DATE OF DOCUMENT
�l�/v�
SIGNER(S) OTHER THAN NAMED ABOVE
�
m1993 NATIONAL NOTARY ASSOCIATION • 8236 Remmet Ave., P.O. Boz 7184 • Canoga Park, CA 91309-7tBa
�
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H. ✓. LAWMASTER & CO._ INC. 7�cMs-62ev-ao2
7940 MAlN STREE7 — 57AN70N, CALIFORNIA
828-8040
XXX
Field Data on Test Specimens Core Concrete Gunite__Grout; AAortar_ _.
Project H. Steveneon Pool Permit No.���.
Projecr - — — -
L«ation 7269 Nebraska, Costa Mesa
Contractor Anthony Pools Architect
Location in Shudure Engineer
Daip Moulded 4/26/77 No of SFecimens 6
Slump Specimens AAarked
Specified Strengih at JB days 2IlIl�P.S.I. Mix Designation
Ag@ to be tesied�days�_days _days_ days
READY MIX PLANT AGGREGATE SOURCE
Weather Condition 1 Yd.
Cernent Type Cement, Ibs.
Admix Sand
Specimens made by i-.`4
� _ Marin
Data by ;:3
Dclivered by �-'2
Date Delivered #
REMARKS: Water, Gais. I
Laka. No.
Date of iest
Sp�cimen Dimensions
Area
Ultimate Load
Lbs, per sq. in.
H/b Corrected
F O R I+� t.; - O 15
-J '/ /
FOR IABORATORY I
I7i624 7t625
7 Day Test 7 Day Test
4.371
RCE#6207
4
'7626 71627
� Day 1'est
X 1
.9�
� � c� 2 �._.,–,--
---Yd. ftatch
150 ske
40 tone
71628 ,71629_
, Day Test_
'� � 4
April 19, 1971
Ttr. H. Stevenson
3269 NebxBska Iane
Coste MeGa� California
Dear Sir;
A butlding permit has been issued to thony Pools to construct
a private swimming pool on your propertjr.
In order that your pool 11 be a safa on and for the purpose of
advising you of your responsib ity regarding.the requirements of the
Costa Mesa Municipal.Cale� we re. r you to Section 8107, a copy of
which is attached. �
This letter i irected to you in order that you will be aware of
our ordinances and'c make a complete safety check of your pool area.
, Sincerely yours,
RICHARD HANHART
Buildin� SaPety Director
L.J
January 15, 1971
Mr. H. Stevenaon ��
3269 Nebraska Lane
Coata Mesa, California
Dear Sir:
On December 21, 1970,�lfling permit was issued
to Anthony Pools to construct a p ate swi�ing pool on your
property.
In order that ur pool will be a safe one and i'or
the purpose of advising of your reaponsibility regarding
the requirements of the Co Mesa Municipal Code, we refer
you to Section 8107, a.copy of wriich ie attached.
This 1 er is directed to you in order that you
will be aware of�r ordinances and can make a complete
saPety check of yo�,pool area.
RH:dh
enc.
Sincerely yours,
RICHARD HANHART
Building Safety Director
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SOL-NEATER SWIMtdING POOL HEATING. `
SYSTE6IS. �
�T .�vfi�?2i L ai �
BGIH: APPftOVED BY: DRAWN EY ���;�:.J �
OATE: REVI9ED
I
lOS ANGELES CITY APPROVAI� RR3991
CAlIfORNIA CONTRACTORS IIC. 339280
n.wn ��unrnovvo.�oca�.�ac.r.�.i�mir�eo[.00r
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� '//��pn'�,l �'�y(,�
BY ��" �.(��- .._"____DATE����.--`
THESE PLANS 5T BE ON JOB AT ALL TIMES
MAKE NO CHANGES WI7HOU7 PRIOR APPROVAL
OF DEPT.
THE ISSUANCE OR GRANTING OF A PERMIT OR �PPROVAL
OF pLA6�5 Ai�D $PECIFICRTIONS SHALL NOT 8E CONSTRUED
TO BE A PER;,;IT FOR. OR aN APPRO:�AL OF, ANY VIOLHTION
OF ANY 0� �: PflOV1510NS OF iHIS CO�E. N� PERMIT PRE�
SUMING TO GNE AUiHORITY TO VIOLATE Oft CANCEL THE
PROVIS10145 OF TH�S CODE SHALL BE VALIC. EXCEPi IN SO
FAR AS THE WORK OR USE WHICH IT AUTNORIZES IS IAWFUI.
THE ISSUANCE �F A PERMIT BASEO UPON PIANS AND
:PECIFICAiIOR: SHALL NOT YRcVENT THE BUILDIN, OFFICIpL
'GOhI THEREAFi R REQUIRING THE CORRECTION OF ERRORS
IIV $q10 PLANS A,IU SPECIFICATIONS OR FROM PREVENTING
blI1LDING UPERATIb45 UE�NG CPRRIED ON 7NEREUNDER WHEN
IN VIDL.�lT10N OF THIS CODE OR OF ANY OTHEP. OROINANCE
pF 7HE CIN.
OWNER STEVENSON H.
J�" ADDRESS 32EJ�r�
� cRAL CONTRACTOR Anthor
� aP No. 139-0 -13 LOT
�INSPECTIONS
soa ;,(/
GAS' ��—
WATER
ROUGM PLl1MBING ' ��
PROP. SWR. IINE Q HOU CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING ANO Alq CONDITIONING
TEMPORARV SERVICE OR P LE
UNDERGROUN� � PO
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF.
FLOOR SVSTErnM�-
BONO BEAM�pu -cTEFy,.AE!liFpRC[�
SHEATHING
FRa�nE ANO FLASHING
L IG — IN � OUT n
PL...,fE0., BROWN COAT
STRUCTURAL, FINAL
HENTING, VENT., REFRIG. ANO A.C., FINAL
PLUM9ING, FINAL AND GAS TEST I—I
DATE 12-21-
BUILDING PERMI
FIRE ZONE VALUE $ 2 tS00.00
GROUP J TYPF III
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. 60X 7200 COSTA MESA. CALIFORNIA 92626
4-71cMSA00 719 v*u�**9.00
APPLICATION FOR BUILDING PERMIT
For Applican[ ro fill in Comple[ely
Q/��� REC IV D BV DATE R CEIVED D'A/TE ISSUED^�
ADDRESS ���✓ / N� V'VT�Ki� L/Tryt �—% � ? —� "'/�
�I 3 �l — � PERMITNO
OWNER ��µK STCVt.h�SOM A�P�NO. Y�
MAIL BUILDING �/ / C � �
ADDRESS 3 z 6 NE1��(�'SK/4 LA AI� /aDDRE55 �p( (Q /�
GTV GOSIA Mt_SA NO`aSYOS(p/J TRACT , r]q LOT O BLOCK
CANSTRUCTIO W ADD A P
IENDER
BRANCH ��O NE
OWNER � � �
ADDRESS VA�VE
ARCHITECT TEL. USE � 5 ����
OR ENGINEER N .
FIRE �—
ADDRESS ZONE TVPE GROUP
^^ -1 APPROVED
CONTRACTOR 'I`O DE�LV Cmn�$T2��Tio�J B�' DATE
ADDRESS �33 �� �LOWE.� y%
ZO NO.OF USE OF NEW
CITY s — N/} No`.sy3�7yy / P��� BUILDING
STATE CITY VARDSAPPROVED VARDSAPPROVED
LIC. NO. �p�j 1 S LIC. NO. MAIN BUILOING ACCESSORV BUILDING
SIZE �1.�., �7 I� � � NO.OF BLOGS. (FROM GL STREET)
OF LOT � �', S» NOW ON LOT FROM FT. FT.
USE OF � /
EXISTINGBLDG. ES1f�Y'JJCE Fl-�/R' �= S T. FT. �
SIZE OF NO.OF
NEWB�DG. ROOMS STORIES L.SIDE FT. F�—
EXTERIOR WALL ROOF 11
COVERING COVERING REAR FT. FT. �
USE OF BUILDING AND WORK TO BE PERFORME% j/ � OISTANCE BET. BEf. MAIN &
LO G�C W LL EA�CC �/� T MAIN BLOGS, ACCE55. BLOGS.
1Q7� �(OC T p VO'R.# DATE
OlC 'A l� �%F�—C.. C.U.P.# APPROVED
6 T�L e� U n 0.� APPROVED
K/�
�' �eonteBE' E
I hereby acknowletlge that I have raeG this appliwtion antl sta[e
thet the above informa�ion is correct and agree [o comply wich
nll lows �egulatlnB builtling construction, antl I shall not amploy
o�Y Oerson in violation of che workman's compensation laws of
[he S[ate ot Califomia.
I hereby certify ffiet I am properlY ��censetl as a conttector under SQ. FT.
the Stote ot California Business entl Prota ' Cotle, DivlSicn 3. THE AMOUNT SHOWN UNDEF VA�VATION IS FOR
Chapter 9, and thet suc� licenses are I ull ta ce and affact, ar I THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONLV:
nm exempt from tho ' ns of th S[ate Ca r la Business VALUATION
ond Profezsions C e, Di '' n 3, C pter Q'(/
PERMIT FEE $
Sip^ature L �
Parmitte �"� PL.P.N CHECK $
Authorizetl Agant TOTAL FEE $ �
OWNER �A
'J�^ ADDRESS
l :RAL CON
AP Na. 139—�
INSPECTIONS
SOIL
GRS
W�TER
AOUGM PLUMB�NG
�PROP. SWA. LINE
,� SPNINKLING SYSTEM
MISCELLANEOUS
�AOUGH MERTING RNO RIR C0�
�TEMPOF/A� SERVICE OR POL
W UNOERGROUNU �I POWER
p ROUGN W�RiNG
� TRENCHES FORMS
N FLOOR SYSTEM
� BON� 6E�M � STEEL RE
� SMERTH�NG
N FRAME ANO F�nSHING
y L; G— in (� our �
�P�. �R. BROWN CO�i
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OPLUMBING. FIN4� �NO W$ T
(j.i EIECTR��. FINaL
BWLOING, FIN�L
IONING
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DATE
IRE ZONE VALUE
TVPE GROUI
SUBCONTRACTOR
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COSTA MESA BUILDINGSA�=,y"=7 DEPARTMENT
• P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING 3�G��JE�3r�rsi��7 Z�
AD�RESS
T� NANT�R/AL(J/�dVGC- L� `.I7/J2 /Z
rauuncn>�J—�(/ LtJi/O/Y/ J� �
CITY�S� � � ��� NO
WfYSTFUCTION • e � . _/"
BRANCN
TEL.
ADORE55
CONTRACTOR
ADDRESS
TEL.
CITV NO.
STATE CITV
LIC. NO. I.IC. NO.
SIZE NO.OF BLOGS.
OF lOT � 7C' �� NOW ON LOT
EXISfiNGBLDG. /�{�S/D�/�t�
Separate permits are required for
electric, plumbing and heating work:
USE O�BUILDING AND WORK TO BE PEFFORMED
I heraby acknowledpe that I have reatl this epplication and stete
ihat the ebove intormation is cor�ect and apree to comply with
all laws reBuleting builtling construction, entl I shall not employ
any person in violation of tha warkman's comp¢nsation laws of
the State of California.
I hereby certify ihat I am prooerly licansatl as e contractor undar
t�e State of California Businass antl Ptofessions Cotle, Division 3,
Chapter 9, and that such licanses ere in full force and effect, or 1
am exampt trom the provisions ot ihe State ifornia Buslnass
entl Profeszions Cotla, ivision 3, Cha
Sig^a
Pe� ttee
or O �, ��
Aut ' etl Ageni Date
^421 10/02/80 5.50
APPLICATION E� oTRUCTURAL PERMIT . �
A.P. NO. I
BUILDINCa
ADDRE55
UNIT OR
SPACE NO.
�
[�J
NEW I ADD IALTER IREPAIR �MOVI
C•�1d
APPROVED
APPROVEDSETBACKS
PLANNING ACTION
APPROVED
THE AMOUNT S
THE PURPOSE OF
VALVATION
�
VALUE
E
DATE
onre
APPROVED
VN UNDER VALUATION IS FOR
�ABLISHING A PERMIT FEE ONLV:
PERMIT FEE E � O
PLAN CHECK $
TAX S ��
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._KAL CONTRACTOR Solar Research System:; Ut5(.KII' IIUN ot IIUKR SolaT
No. 7 3g_064-1 3 LOT TRACT FIRE ZONE VALUE S
LINE � I HOUSE CON.
SPRI
ROIIGH
UNOERGROUNO � POWER
ROUGH WIp�NG
FLOOR SVSTEM
BONO BE�M (, STEEL REINFOF
SHEATHING
FR" � ANO FL�SHING
LA �- IN � Ol1T ❑
PLASTER. BROWN COAT
STRUCTUqq�,FIN�L
ME�TING, VENT., REfNIG. �NO A.0
PLUMBING. FINRL ANO GFS TEST I
FINU
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COSTA MESA BUILDING-SA� _� Y DEPARTMENT
; P.0.6{1X1200 COSTAMESA,CALIFORNIA92626
For Applicant to Eill in Completely — Use Ink Only
BVILDING 3 a 6��� �/
ADDRESS
OWNER OR � ¢ �`�/+ y�^
TENANT [ty���((�
MA1 LI NG
ADD R E55
/� TEL. r�1 ��
CITV l_�. NO. T) 1
BRANCH
ADDRESS
AFCHITECT
ADDRESS
CONTRACTOR �'D �l�n � aC�/PG�I� �
ADDRESS 3�v I /f' 2D� LLi/ r-�
TEL. I,
CITV C. �� NO. f �r)'
STATE CITV
LIC. NO. LIC. NO.
SI2E NO.OF BLOGi.
OF LOT NOW ON LOT
USE OF
EXI5fING BLOG.
Separate permi[s are required for
electriq plumbing and heating work.
USE OF BUILOING AND WORK TO BE PERFORpQED
I hareby acknowletl8e that I heve read this application antl state
Mai tha ebove IntormeNon is corract antl agrea to comply wiih
all laws reguletln8 builtling conrtruction, and I zhell not employ
eny person in violation ot Me workman'a compensation laws of
ihe State of Celifornla.
I hereby certify chat I am properly licansetl as a conttactor under
the State of Californla Business entl Profassions Cotle, Division 3,
Chapter 9, and thai such licenses are In full force enA effect, or I
am ezempt from the provlsions of Me State ai Calltornia Business
and Profezsions Cotle Division 3, Chepiar 9. ,}
Signature of /
Permittee �r�
or !
Authorizetl Ag Date
6619 4j�2/jg 10.50 TC
APPLICAT[ON F�.. STRUCTURAL PERMIT
RECEIVEDBV PERMIT r� ry
� � f i � � ? ` q
A.P. NO. � J, �{//p �
BVILDING ^ y � i� / �
AODRESSS �LJ /�u
VNIT OR
SPACE NO.
T O� 2 LOT � BLN
NEW ADD LTER REPAIR MOVING DEMOLI:
OWNE
US � Oa ALUEE D4L
20NE TVP GROUP
APPROVED �r
gy DATE �'�
APPROVED SETBACKS
PLANNING ACTION
DATE
APPROVED
— /2 �
m
>
m
m
SQ. FT. �`+
7
THE AMOUNTSHOWN UNDER VALVATION IS FOR m
THE PURPOSE OF ESTABLISNING A PERMIT FEE ONLV: �
VALUATION PERMIT FEE E � N
�y � m
O� PLAIV GHECK § ^
0
/bDo LL
$ TAX E �
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TOTALPAID S n GT
JOBADDRE
P" 9RAL (
A .o. 139
INSPECT101
soi� —
GNS
(-) W/TER
d ROUGH PLUMB
��'� b—lb—/O
BUILDING PERMIT N0.
LOT _ TRACT FIREZONE_ VALUEb500.0
SUBCONTRACTOR
NOUSE CON.
OU6H HEATING NND q�q �ONOITIONING
UNOERGROUNO �J POWER
ROUGH WIRING
TRENCHES FORMS
FLOOR SYSiEM
BONO BEAM � STEEL RE
SHEATHING
FRAME ANO FLASNING
LATUING — IN [�
P' [R, 9ROWN COq
HERTING. VENT.. RERRIG. RNO A.C.. F
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADIDRESS �Zfp / IVE/'l,��Q%��/�// L/��E
OWNEF L/4/�KE�C E Li �—!/(/2/L�c..%
i�
MAIL iJ^si/3 i/�n.-,_ _.i. /� _i�
TEL.
CITV
BRANCH —��
ADDRESS �—
ARCHITECT TEL.
CONTRACTOR (J��(/��J(�{� •
ADDRESS
TEL.
CITV NO.
STATE CITY
LIC. NO. LIC. NO.
SIZE 6 / / NO.OF BLOGS.
OF LOT p S X I�D NOW ON LOT
USEOF 2ES/,(��.�yG� �t� /
EXI5TING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUIIDING AND WOFK TO BE PERFORMEO
I hareby acknowletlga ihat I have reatl this applicetion antl state
that the above Information is corract antl agrae to comply with
ell laws regulatin0 builtling construciion, and 1 shall not employ
any person in vlolatlon of the workman's compensation laws of
the State of Calitornia.
1 hereby certify that 1 em properly licensed as a eoniractor under
the Siate ot Cellfornle Business and Professlons Code, Oivision 3,
Chaptar 9, and thot sueh Iicensas ere in tull force end effect, or I
am ezampt from the pro�isions of the Stete of Califprnia Business
antl Protessions Cotlfe Division 3, Chaptar 9.
SIB�ature p�y '
Permltte� ���
Authoriz tl Agant
�a,
ur: i�-�F���:O��s��r: ,:::.:: �:,:5.50
APPLICATION FOR STRUCTURAL PERMIT
ELEIY�D BV qATE RECEl1[ED nnro icc�irn
A.P. NO. 1// (/lr � 1 J� �'R' Yd
BUILDING �'j �J/� �1�wL1� �
ADDRESS �/( (y / -r�c��
TRACT %�Z LOT � BLOCK
ED
VALUE
DATE �O^�I/Jr
20NE %i f IPLANS '/iI BUILOING
r �
YAROS APPROV ED
MAIN BUILDING
�ISfANCE BET. BET. MAIN
MAIN BLDGS. ACCE�. 8L
VAR.qW DATE
V
N
n
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3 50. FT. N
THE AMOUNTSHOWN UNDER VALUATION IS FOR m
THE PURP6SE OF ESTABLISHING A PERMIT FEE ONLY: �
VALUATION PERMIT FEE $ �OQ N
�— PLAN CHECK $ ��— ^�
s �j 0 4 �
TAK $ !� v LL
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TOTALPAID E � Q
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OWNER STEVINSON� H.
r ADDRESS 9 e
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L_..ICDAi ('lIAITDA('Tl�D
WATER f
ROUGH PLUMBING
PROP. SWR. LINE � �U�SE CON. �
SPRINKLIN— G S�iCS C'Y�/�
MISCELLANEOUS v�— �
ROUGH HEATING ANO AIR CONDITIONING
TEMPORARY SERVICE OR POLE
IINDERGROUND POWEft QiJ
ROUGH WIftING �.
TRENCHES � FORMS � STEEL RE
FLOOR SVSTEM
BOND BEAM �i STEEL REINFORCE(�
SHEATHING
f = ANO FLASHING
L .iNG - IN �J OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFFIG. l- Ns.C.
PLUMBING. FINAL AN �Jv�yy��'7�
ELECTRIC, FINAI
DATE 4-16-71
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COSTA 1MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APH 16-77PA7000 803� ****3�.50
CpSA
APPLICATION FOR BUILDING PERMIT
Fo� Applicant ro Fill in Completely
RECEIVEDBY D,/AT flEC VED D TEI /s_UE
BVILDING 3269 NLBRASKA �?�i �%�� % ��V��/
ADDRESS
PEflM1T NO
OWNER S A.P. NO. — 3
MAIL BVILDING '�6 NEBRASKA LANE
ADDRESS ADDRESS 3 9
TEL. TRACT LOT BLOCK
CITV NO,
CANSTRUGTION Cash W P
LENDEfi
7IX:
BRANCH
OWNER
ADDRESS
ARCHITECT TE 5 Si-rimmin OOIVALU� � OO�OO
ORENGINEER James Harder N �P3221�
FIRE
ADDRESS ZONE TVPE � ROUP
APPROVED
CONTRACTOP Anthony Pools BY DATE
ADDRE555871 Firestone Bl�%d.
ZON NO.OF USE OF NEW
CITV South Gate NOLSp3221O P�� BUILDING
STATE CITY VARDSAPPROVED VARDSAPPROVED
���. No. 1901'79 LIC. NO. MAIN BUIL�ING ACCESSORY BUILDVNG
SI2E NO.OF BLDGS. (FROM C/LSTREET)
OF LOT NOW ON LOT FROfYT FT. FT
USE OF
E%ISTINGBLDG?�e$. (�+C garage SI T � FT
SIZE OF NO. OF
NEW BLDG. :a00MS STORIES L. SIDE FT. FT.
EXTERIOR WAL� ROOF
COVERING COVERING REAR FT. FT.
VSE OF BUILOING AN� WOPK TO BE PERFORMED DISiANCE BET. BET. MAIN &
MAIN BlOGS. ACCESS. BLDGS,
private serim �70�1 1n rear CURp � APPqOVED
f Ci v q {� i 7.I o �ROVED �
I heraby acknowledpe Mei 1 �eve reatl this applicetion entl stete
that the ebove information is cOrrect antl agree to comply wiih
ell laws ragulatinB builtllnB co^atruction, antl I shall not employ
any person in vlolation of Me workman's compensetion lews of
tha Sta[e of Califomla.
I hefaby terNfy that I em proParly Iitonsetl as e contrncxor untler S�. FT.
tho Smte of California Busines+ antl Profauions Cotla, Dlvlsicn 3, THE AMOUNT SHOWN UNOER VALUATION IS FOFi
C�epter 9, antl [1 �ch Iicenees are In full co antl effxt, or I THE PURPpSE OF ESTABLISHING A PERMR FEE ONLV:
am axampt fr the prbvlslona o/ the St of Ilfornla Busine54 VALUATION �L(�
and Profassi s COda, DIvi510n 3, Chep �
PERMIT FEE 5
Sipnntura f SI%
Parmlttoa 5 .Zpoo.00 PLAN CHECK $ /
V �
Authorizetl ABe�t � /�
TOTAL FEE S 9
��
'�`, OWNER �
ADDRE;
� �cNERAL O
\t' AP No. 139
y INSPECTION
� soi�
V GAS
� � WATER
ROUGH PIUMBI
ROUGH
UN�ERGROUNO
ROUGH WIf21NG
CEVF:NSON, Pinky
—�9 Nebraska Lane
VTRACTOR Modern Const
-13 LOT TI
5
' Q HOUSE CON. �
TEM
r1ND AIR CONDITIONING
VICE OR POLE
] POwER �
FORMS n STEEL REINF. n U�
FLOOF SYSTEM
BOND BEAM STE
SHEATNING
� E ANO FLqSHING
L. .ING - IN �
PLASTER, BROWN COAT
STRIICTURAL. FINA�
HEATING, VENT
PLUMBING.FIN
DATE
BUILI
FIRE ZONE VALUE
GROUP J TYPE
SUBCONTRACTOR
4-14-
PERMIT
�
- t '��.ri�iQ
� ••COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BU I L D I NG /� �� (� n\.. n.. _� i I . 1_._
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OWNER
MAI l
TEL.
CITV NO.
BRANCH
A�DRES
. eaams TEL.
ADDRESS
CONTRACTOR Anthony Pools
ADDRESS J�/1 Firestone B1V�•
CITY South Gate NOLSA3[
LIC. No. 190179 LICYNO.
SIZE NO.OF BLDGS.
OF LOT I NOW ON LOT
VSE OF
EXISTING BLDG. Se$'�dP.ISCe and g�ra�g�:
SIZE OF — Y NO. OF
NEW BLDG. O ROOMS STORIE:
EXTERIOR WALL ROOF
COVEFING COVEFING
USE OF BUILD NG ANO ORK TO E PERFORMED
priva�e sw�m poo� in rear
oi single family dwelling
I hereby acknowledge [hat I have reatl [his application and sta[e
that tha abova information is cot�ect antl eg�ae to comply with
all laws regulating builtlinp consiruction, and I shall not employ
any person in violation o( the workmen's compensation laws of
the Stace ot Calitomia.
I hereby cerxify ffiat I am properly licensetl as a contrector untler
Ne Stata of California B�siness and Profassiona Code, Divisicn 3,
Chepter 9, entl that such licenms are in fWl farce antl etfect, or I
am exempt trom the provl5ion5 af the Stete ot Califomla Buslnass
nntl Protessions Co(ya,/, Division 3, Cha t 9.
slennw.e oe /1 / �� �—Liti�
Permlttee � p�C'� � l/7I��
Authorized Agent
PA16
DEC21-70c�isa00 878+* ���*34.50
APPLICATION FOR BUILDING PERMIT
FECEI ED BV OAT RE EIVED DATE ISSUE
� ' /'� �� � —
PERMI
A.P. NO. ���
BUILDING ���q ��E��,��� ���
ADDRESS
1/a�TRACT LOT R BLOCK
OWNER r7, ��(/',�)�L
„�� swim pdol
FIRE
ZONE
APPROVED
N NO.OF
,� PLANS
VAflDS APPROVED
VAR. qlt
C.U.P. #
APPROVED
VAIVE � ��D.
s �
�
� GROUP
7ATE /L'� I O �
V
USE OF NE
BUII.DING �
VARDSAPPROVED
ACCESSORV BUILDING
/ [' FT. �
n I
DATE
APPROVED
a
THE AMOVNTSHOWN UNDER VALUATION IS FO
TME PVFPOSE OF ESTABLISHING A PERMIT FEE ONL�
VALUATION
PERMIT FEE $ `�
7)O j�
$ � �• PLAN CHECK $ /I'J O
%
TOTAL FEE
b
O
�
¢
m
N
7
m
E
LL
Lor 8 •
TR �:J2L �
' :� 1����.
COSrA MESA BUILDING-SAFETY DEPARTMENT
'P. O. BOX 917 GOBTA ME6A. CALIFORNIA
For Applitanf fo Fill In Complefely
TYPE OR PRINT
BUILDING
wooRE65 2F) NEBRASKA LANE
CO5TA MESA. CALIFORNIA
L
BEACH
� ARGH
�oMi 6-
TEL.
FEE f,�CEiVED
(�- OCT 241960
FINANCE DEPT.
APPLICATIO�ITfiO�Fp�I� MESA
BUILDING
For Office Use Only
neceirr Ho. a �� ��
1
41YED BY I OATB.RECEIVED .I DATE �BSl1ED
FIRE
ZONE
APPftOVED
COSTA MESA.
ADDRE� I ZONING
Clry �vEW ZOy��� I PLAN9 2 I Bl11LDIN0�1/ a,'tt
A /
IHOAL
LIC. NO. p NO. - DEBCRIPTION IAt 8 Tract `2'2
SIZE NO. OF BLDOB. O
OF LOT . ZX�OO JRREG. How oN �or p, p, NO. IIOTle
USE OF YARDS EVES
EX16fING BLDG APPROVED ALLOWED
BHT9ACK LINE IflON r�o I q0 � R6NTER LINH BTJ /�
CHNTBR oP 6TNEHT J REAR YARD � FRONT 'J �' FT.
�
SIDE YARD I LEFT �/ RIGHT � R. SIDE FT. ����'"��
DESCRIPTION OF WORK ___ i _
APPROVED
EXTERIOR WAu ROOF a��(
COVERING STUCCO COVER NG
USE OF BUILDING <.ND WORK T(} BE PERFORMED
PLAN 7-C
1 HBRHBY ACKNOW48CaE TIAT 1 XAVE PeAD THIB APPllGT10N TXC ANOUM BHOWN UNDEP VALUATION IB FOR TX¢
AND BTATE TXAT THQ ABOVB IB CORliECT AND AGREE TO COM- pUFPOBE OP lBTABLI9HING A PERMIT FEE ONLY.
PLY VlITH hLL CITY ORDINANG[8 AT6 WB P£pUtATNG
Bu1tnlNo coNern �oN. VALUATION �
SIGNATURE OP { j `� `[ PERMIT FEE 8 —
PERMITfE � /y�v
S /���J / / PLAN CHECK S ! O i
AUTHORIZED AGHNT s�
TOTAL FEE
F
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