HomeMy WebLinkAbout207 PALMER ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 207 PALMER ST
Suite No
Vicinity: FAMILY ROOM
Parcel Number: 42533119
Status: ISSUED
Applied: 08/23/2005
Issued: 08/23/2005
Owner:
Address:
Contractor'.
Address:
3EORGE'ALFRED '
Ir F
"Phone.
'CA§ i : £ -Zip: 926273747
X
:.MISSIOM,VIEJO, CA
ata- x�•..?
F
ISSUE FEE
Inst FAU.<100 k BTU
Inst FAU''.>100 k BTU
Repair/Alt Cooling/Heat
Inst / Rep: Recess Wall Htr'I
Refng Sys <100 k BTU x
Refng Sys >;100'k BTUS
Gas Piping >°
Factory Fireplace
Hood w/Meth-Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers r
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
'.SCOPE OF PERMIT•;
FIREPLACE (MODEL ST42TVFL-IPI) IN FAMILY ROOM. FOR
.VED.
fri.: 4 4uf
1DE: LFACTORY FIREPLACE'x=Y 71
>w-
•
-$D 00 0
_
,
,FEE 5UMMAKY _,, -, `
` •'
, ..i
Quantity
,�
'�, ?, a
Quanti
50
0
.Repair/-AlbAbsorblion Unit
r $0,00
0
$0 00 -
0
•,
Repan /`Alt Refngerabon Unit '.
$0 00
0„ , F
-$,0 00
0 - -
- - - Vent0lation System " n e .°
$0.00
0
,.. $0.00 -.
0
•�
Evaporative Cooler - `-`^� ''
':$0.00
0 ,
s F-^$0.00
0
Commercial Incinerator .•
'--$000
0` .
_.
••;��+s0.00
0
Domestic.lncintor nz °
era '':'
k1o.00
`0`
',•,$0.00
0
Compressors /Absorption Systemss
-:'
.•;
,11.$0:00
0
Up to 3 hp/ 100 k BTU
"'^' $0.00
x$10.65
1
-=3-To 15 hp / 500 k BTU �5
1 $0.00",
o
',$0.00
0
,� '- -15 To 30 hp 11,000 k BTU #
`"$0 00
,' 0
-, $0.00
0
, _ - 30 To 50.hip 7,j .750 k BTU `4 h r•
$0.00
0
'`$0 00
0 '_
,
% •Over 50 tinp / Over 1 750 BTU ; '
$000
0
•
-$D 00 0
_
,
'.Boilers ,
�`
$0.00',0
Up to 3 hp
$0.00
0
- $0.00 0
- '-3 To 15 hp
` -
;x'' $0.00
0
v,'1$000 0
',-
-= Av X15 to 30 hp:<
$0.00
0
a - $0 00 0 ..,
- c ,1'30 to 50 hp
$0.00
0
" $0.00 0
- Ove 50 hp
-.
$0.00
0
$0 00 0„,;Other
Mechanical Fee
-
` $000 0 ``
` -
�? - . """Investig'ation Fee
_
$0.00
Plann CheckFee'
-”
$0.00
`Reinspection Fee u ,
$0.00
"`
,:: :•` a, TOTAL CALCULATED
FEES
$34.15
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 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 180 days. lam'
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codeVand all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: V1 4) 754-5626
[� Iwwt
DECLARATIONS C
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work tar which this permit is issued.
-�I
have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issuetl.
My workers'. meantion In�arance cam end policy number :
�r/� Cwnd2c'wn"%C�� Poucy,Numbar: =G9
(This sectlon need of a completed if Ne permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 o1 the Labor Code, I shall forthwith
comply with these rovi5ieac�
u L
pli�canl'Slgnature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER, CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION W06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license under provislon of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and eRect>Lic. # 'Class #
Contractor's Signature: —g
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that 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 the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered 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 does such work
himself or herself or through his or her Own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who bullds or improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this
permit, and that no building structure, scaffolding, faisework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
................._
.._.........._......._._.............. ....................... .............................................._....................................................... ............................................................................................................ ................_....._..................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Coda. with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely 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 standard temperature and 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 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
............_......._.................._..........._..........................................................._........._.___.._..............................................................................................__.......................................................
....
....
.....
.............
.....
_...
..........
....
......
4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑No
..........._......._............................. _................................................................................__—___.................................................................................................._.................................I............................... .......... -............. ............................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication eggermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 6 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential
...8..W..ill .a..n..y...p.a..rt...o...f...t.h...e....f.a...c..i.l._ity.....t.o....b.._e...c..o...n...s_.................................................................................................................................................................building permits).
___................._...........................
.............................
tr..cte.
under this permit be within 1000 feet from the outer boundaries of a sic hcol? ❑ Yes ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade).
......................... ............................ _........................ _......... .._................. ................................................... ........................................................................................................... _.... _............ __.............................................................. I.....................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.............._........_........................ ..._...................................................................... _____.................................................................................................................................... ................................................................... ........... .._......... I.................
8 (II yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
' e Of Le at Ownar(s) Date
-=�=3-0�i-
�AncUOr.Authorizad.Applicant [Data`
:ODE E. INSPECTION TYPE 2AU LNTITIALS CODE11 INSPECTION TYPE g,ljF
1616 Fixed System Final Fire Prevention 206 Final Mechanical Z4
266 Pool Spa Final 208 Final Plumbing
00 Final Ra-Roof 210 Final Electrical
)1 Final Block/Retaining Wall 212 Final Fire Prevention
12 Final Factory Fire Place 220 Final Planning Approval
3 Final Sign 222 Final Site
4 Final Demolition 250 Final Building/Occupancy
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.�rfjMBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 207 PALMER ST
Suite No
Vicinity: FAMILY ROOM
Parcel Nunmber: 42533119
Applicant. ERIC WELLENKAMP
Address: 26722 ASHFORD
MISSION VIEJO, CA % ` ,..Zip . 92692 -
Owner: t31LLIVUA12(i
Address 207 PALMER ST
Address ^26722 ASHFC
Status: ISSUED
Applied: 08123/2005
Issued: 08/23/2005
ISSUED BY: P44L�l
License ';1634817
�£ _ `SCOPE OF PERMIT
>TANDARD FIREPLACE (MODEL ST-42TVFL-IPO IN FAMILY R
J I KUI 1 UMAL IIV vUly CU.
a.'
xA
Process Piping (per 10 ft)
wa
,0
tORG"LFRED'
$0.00
Conned (Iee,Soda etc) ::,
$000:
0"
Receptors
,;REF# M05-00476
,
Vacuum Brkr Bkflow(5+)
. $0.00
Dental Units ;' �d '�
$0 00 ,�;
WORK TOINCLUDE 1
GAS. OUTLETS)
$0.00
l
�s
$0.00
�• -Phone
$000 ` `:-0
!
Sewer Cap for Demo
Soot)
0
A "' "
- Zip. 926273747
, _
Drain, Floor-
'r '
---0 .;
Sewer Cdnnect
AMT -tom
"3sis �'.,
AMT
;'QTY
"+
ISSUE FEE
$2350 `-
Laundry Tub Washer
$000
_b a
+ Spm{
s'
' $o o10 � 0
_-
'�-landscape Imgatlon•
$0.00 ,;-
0
a '.
WEST
$0 00", o -
P -Trap
$0.00 `
0
-. Trap'
B tht b
$0 00 "`-0"
Pressure Regulator
$0.00
0
`a-• Unna
0
-Smk commercial -
$000 "-0"',
Water Re=pipe"
$0.00
Gas Earthquake Valve
Phone:
,714-504-5758
`.S nk Floor'`. �''�
$000 x:NO
�'
,Water Service
$0.00
Gas (1-4 outlets) -"-$615
•-� 1Smk
kitchen; ,-
$000' '70
CA
Zip'.
92692
Gas (Over 4 outlets)
' $0.00
.k ,
License ';1634817
�£ _ `SCOPE OF PERMIT
>TANDARD FIREPLACE (MODEL ST-42TVFL-IPO IN FAMILY R
v
AMT..;.
a u
Clarifier System
J I KUI 1 UMAL IIV vUly CU.
"
Process Piping (per 10 ft)
$0.00 --
,0
Vacuum'Bilir Bkflow(1-4)77
$0.00
Conned (Iee,Soda etc) ::,
$000:
0"
Receptors
,;REF# M05-00476
,
Vacuum Brkr Bkflow(5+)
. $0.00
Dental Units ;' �d '�
$0 00 ,�;
WORK TOINCLUDE 1
GAS. OUTLETS)
$0.00
0
�s
$0.00
g
$000 ` `:-0
!
Sewer Cap for Demo
Soot)
0
Wash Basin Set :°:z
FEE SUMMARY
, _
Drain, Floor-
$0.00, •
---0 .;
Sewer Cdnnect
AMT -tom
"3sis �'.,
AMT
;'QTY
"+
ISSUE FEE
$2350 `-
Laundry Tub Washer
$000
_b a
+ Spm{
Backflow' irrigation
' $o o10 � 0
_-
'�-landscape Imgatlon•
$0.00 ,;-
0
'' - _--- Swim
Backflow Preventer
$0 00", o -
P -Trap
$0.00 `
0
-. Trap'
B tht b
$0 00 "`-0"
Pressure Regulator
$0.00
0
`a-• Unna
v
AMT..;.
a u
Clarifier System
` $0.00 ��-'.0
"
Process Piping (per 10 ft)
$0.00 --
,0
Vacuum'Bilir Bkflow(1-4)77
$0.00
Conned (Iee,Soda etc) ::,
$000:
0"
Receptors
$0.00
0
Vacuum Brkr Bkflow(5+)
. $0.00
Dental Units ;' �d '�
$0 00 ,�;
--0" "
Septic Tank„
$0.00
0
Wash Basin ;
$0.00
Dishwasher
$000 ` `:-0
!
Sewer Cap for Demo
Soot)
0
Wash Basin Set :°:z
$0,00
, _
Drain, Floor-
$0.00, •
---0 .;
Sewer Cdnnect
$0 00
0
Waste and Vent System ,�
,-$0.00
Drain, Rainwater
$000`
0 "'"
• Sewer Private Line $000 '"`.0
�3
,,,,,,,Water
Closet (Toilet)
$0.00
Drain, Roof
$0.00
0
'Shower ` '
$0 000_
Water Heater / vent `;,t
$0.00
Drinking Fountain
$0 00 °
0
Sink bar
$0'00
0
Water P. iping (Inst or Rep.)
$0.00
Expansion Tank,.,
$0.00",
0
-Smk commercial -
$000 "-0"',
Water Re=pipe"
$0.00
Gas Earthquake Valve
.:$000
0
`.S nk Floor'`. �''�
$000 x:NO
�'
,Water Service
$0.00
Gas (1-4 outlets) -"-$615
•-� 1Smk
kitchen; ,-
$000' '70
.Water Softener
$0.00
Gas (Over 4 outlets)
' $0.00
0,41 "
_ Sink, service/mop 4 -
$0.00
0
? OTHER.
$0.00
Gas Repipe
$0001,
0
. Spa (private)
$0.00„ '0
'VIOLATION"
$0.00
Gas Service
$0 00"
-0
,;:Spa,(pubhc)*- `
$0.00 ", ':0
3,+
PLANCHECK$0.00
Interceptors (Grease, Oil)
$0.00
",0 2
tea` F ' . � E`
s,,REINSPECTION
$0.00
Interceptors (Sand Auto )
$0.00
0
- „ ,
-
;
f
• -' TOTAL CALCULATED FEES:
$29.65
.;
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and
regulations. (Ord. No. 92-28, § 1, 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 at
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable code
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration Wf this r
FOR INSPECTIONS CALL: (714) 754-5626
244646 IBM)
QTY
0
0
0
0
0
0
0
0
0
0'
Oi
0
0
0
0
0
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
//_work for which this permit H issued.
(pJ= I have and will maintain workers' compensation insurance, as required by section 3700 o1 the Labor Code, for the performance of the work for who this permit is Issued.
My workers' mpen ation I surance carne( end policy n�}mb�r are:
Cerier 1-17/�fOrJ�i�-� �-/ncdt��l. 7,,t; Policy N^umber.%� ft 42 .3 4 Lf
S(ThH'seWon neearrfaf be completed if fhe permit is valued atone hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation lawsit )Weenie -grid agr If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these ovisions. /)
Applicant.Slgy tire. -Date:
WARNING.r FAILURE TO SECURE WORKS WMPENSAPON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED
THOUSAND DOUARE (5100000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Was OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby.affirrthat:Tam licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 o1 the Business en Professions Code, and my license is in full
C
an
force.and 'eNect. LIc. It A 4is / 7
1C tractoes.Sign reDate: ---7 a -n ;-
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, eller, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 o1 the
Business and Professlons Code) or that 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 the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered 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 does such work
himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors Ucense Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers Ucense No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 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 connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.........._..........._............................................................................. __.................................... _............................................ .......................... ....................... .............................. _........................ _................................... __........_..................__......
Does or will the applicant or present or future building occupant need to fila a registration form for acutely hazardous materials? ❑Ves ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely 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 standard temperature and pressure).
....................._........................................_....................................._..................................................................................._...._.............................._......................................_._....................................._............................._...................._......
Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.............................__.............................__........................................__.._........................._....................................................................................................................._...... .......................................... ................. _...........................
.....
If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
......_........._..............................an't.._.._p'.r'as'e"..............................iIdIIn'g...........__....._......................................................................__...............................p"ll"........._.......................................................cti*..no'._.............................
Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication appe.rnit /or such constmction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Ves LJ No
'Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
................_......._.................................._.............._.....................................__.................................0.0..........................................._...............................s..........................._._..........................
...............
...........
..............................
VIII any pan of the facility to be constmctetl untler this permit be within t0001eet from the outer boundaries of a school? ❑Ves ❑ No
1 -yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
....... _.......... _.......................... _............. ......................................................... "....................................................... _..... __.................................. __............................................ .__............................... __........................... __.......................
a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
iphcation, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been made? ❑ Ves ❑ No
..................................._............................... ............. _....__......................................... ..................._.._.._.._._................................................... ..................... ..__._._.................._..............................................._.....................................
yes", attach certificate of compliance from the appropriate air pollution control officer).
:RTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
larding Hazardous Materials and Emissions.
nature: Date:
:ATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that I have read this application and state that the information given is
agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
scribed property for inspection purposes. I agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection.
>o ure Of Legal Owner(s) p. Date
�(�d/Or.Authorized�Applicanl"�" `fDale,
�PELTON TYPE g,,¢ INTITI CODES INSPECTION TYPE P9IE I[iTRALS
ed System Final Fire Prevention 206 Final Mechanical
11 Spa Final 208 Final Plumbing Z y%
N Re -Roof 210 Final Electrical
I BlocWRataining Well 212 Final Fire Prevention
Factory Fire Place 220 Final Planning Approval
Sign 222 Final Site
Demolition 250 Final Building/Occupancy
C�
7
i
PROJECT ADDRESS: 207 PALMER ST�� UNIT:
P.
OWNER'S NAME: BILLIOUX, ALICE T
ADDRESS: 207 PALMER ST
COSTA MESA,CA 91.627
646-2805
ARCHIENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: KEMNITZ A/C 6 HEATING (714)453-8500
ADDRESS: 188 TECHNOLOGY C
IRVINE CA 92718
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code and my license is 1n full force and effect.
CITY STATE16958'74 CLAM C-20/E,XXPP-
Date:.. /qqSignature:`-�,�—�� �J,
WORKERS' COMPENSATID I hereby affirm that l have a certificate of consent to sell -insure ora certificate of Workers'
Compensation 11s11ag�oQ 1t ��4thereof (Section 3800. Lab. 02/01/015
POLICY NO.: STATE FUND EXP. DATE:
COMPANY: ...�,,((
el Certified copy/ is hereby furnished. L" f Certified Copyis filed with the Ci Building Division.
Date: t/li6lQV Applicant: / I _e_-CSJ'iT,3
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be Completed if the permit is for one hundred ($100) or less).
I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become
subject In the WorkersCompensation Laws of California.
Date: Signature:
NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shall be deemed ranked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
Which this permit is issued (Section 3097, Civ. Q.
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that helshe is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (1500).
I, as owner of the property or my empVloyees With wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered lot sale (5ection 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself thersell or through
his or her own employees. provided that such improvements are not intended or offered for sate. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I. as owner of the propeny. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑
and Professions Code: The Contractors' State License Law does not apply to an Owner of property who builds or improves thereon
and who contracts lar such projects with a Contractorls) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Dam'.
I do hereby certify that 1 a
25534 and that I or any tut
permit lar construction or
these provisions.
Owner:
m aware Of and understand the requirements of California Health and Safely Code Sections 25505, 25533, and
ore building Occupant wiNwill not (circle one) need to comply with said stale codes and the requirements for a
modification from the Air Oualily Management District. Residential construction applications are exempt from
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct. I agree to Comply with all city and county
ordinances and state laws relating to building constructwn and hereby authorize representatives of this city to enter upon the above-mentioned
property tar inspection purposes. ',�f.—�A
Date: 11-1L6 Signature: ` e
Driver 5 License or Social Security e:
164146 White—Building; Green—Oode EnfercemenC Canary—Appiicano rinK—HevenUe, uomenroa—nssessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: M 06994
PERMIT NO: M 069940 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH
JOB DESCRIPTION ; FAU CHANGE -OUT SQ FT:
CLAIM VALUE: CALL -VALUE; GROUP OCC: /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------
MAIN
BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT;
FT IN
REAR,
FT IN
FRNT;
FT
IN REAR; FT IN
LEFT:
FT IN
P,GHT;
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING
REQ:
PROV;
PARCEL:
42533119
ZNE;
REF NO;
PLANNING
NOTES>
D
E XT E L O
P M E N
T S E P, V I
C E S
R E Q
U I R E M E N T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE; Lt"(o_= iflu(—
M#+l if if######{E##iE fF tf i(•Y-###M#1E###Ma'##if if#if*41e#lf ix#k1e###Y##iF#iF##############at #ie +t## y###
LEGALIZATION;N F E E S U M M A P, Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 9,00
25% SMIP/NON-RES
PLAN
ISSUE FEE 15,00
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 9,00 15,00 0,00 24,00 24,00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
24.00
#iE'y<if lf{f if jf'�'N#1F#####✓')F###')!'#{fY{(.#f#MSF####')f if �f if �'###if ii iF if#if MSF##'Ir'######if #iF F####Y#ir-i114##4iF#
I N D I V I D U A L F E E B 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
MEC 1 INST FORC-AIR/GRAY FURN <= 100 K BTU 9.00 9,00
END OF FEES )
V/
03 00171807-00171807 TOT 24,+90
DATE: 11i16/94 TTf1E: 10:04
DL�0. 7T.s� T IT
DAT' i ET»
CONSTRUCTION AND PLANNING
APPROVALS Permits Date
Inspector
POO! PA
APPROVALS Permit ?k
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
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, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61, APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
1
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64, Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -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
19. Rough Heating & Air Cood;tioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit
20, Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 000
23. Gas Pipe -Rough & Test
72. Underground Flush
24, Roof Framing
73, Undergrnd. Storage Tank El Gas ❑ Oil
25. Roof Sheathina
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. -Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL _
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT, REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
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 Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47, FINAL STRUCTURE & BUILDING
_
48. FINAL PLANNING
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
July'8, IC
' Ms. Alice' Billioux .._
_ 207 Palmer Street
-
Costa Me'sa,` California 92627
" Dear Madam:
A building permit has'been issued
to.-,Petty Pool_s':to construct•a
.
private,swimming pool witha on
.your property.- •,
' In order-that yodr pool will Ne
safe one and for the purpose of
advisirig'you of your.responsibility regarding the-requirements-of ,
the Costa _Mesa Municipal Code;' we
yod to Section 8107, a`copy
of which is attac
_refer
This Letter. is directe• to you,'in
oider'that you wii=1-•be-aware of
' our ordinances. and can make a complete_safety.check'of your pool
area.
-
-Sincerely yours, -
RICHARD HANHART
'
Building Safety Director -
RH,:cb
2sA
&01 -
TESTING
July 7, 1975
Laboratories Lf--S�«t&Vz 6,C&fO21L1a) &C.
P.O. BOX 47 3310 AIRPORT WAY . LON6 BEACH. CALIF. 90601. 12131 4zb-33SS . FIJI 6363186 . 1/141 BZB-64J2
3RANCr- OFFICES:
1511. DN.,IF F.a'par $Tree' Na. Des u[ive ies'i+g
$mre Ane, CelOore�e RPO3 G"':
m5Redc,doA,-PO.I
'I 511.2CK AT " ' Lo-, e-,, Cel 10801 12131 6k 23E6
Examination: SC75-3051
COMPRESSION TESTS ON CUNITE CYLINDERS
Mr. Errol E. Heesch
12921 Aspenwood Lane
Garden Grove,. California 92640 // /
PROJECT ALICE BILLIOUX - SWIMMING POOL 'J— I4ff
ADDRESS 207 Palmer St., Costa Mesa, Calif.
SAMPLE FROM Gunite swimming pool
ARCHITECT CONTRACTOR
Petty Pools
ENGINEER SUBCONTRACTOR
Clint Jackson - 8unite
SPECIFIED
MIX 4.5 to I STRENGTH
DATE CAST 6/28/75 CYLINDER SIZE
DATE TESTED 7/5/75 7/5/75
CYLINDER NO. 1 2
COMPRESSION 7 -Days 7 -Days
TOTAL LOAD, LBS. 62,300 94;500
POUNDS PER SO, IN. 2,745 3,486
SIZE: 5-3/8"x12.5" 5-7/8"x12-1/8"
COMPLIANCE 7 -Day tests comply with specifications.
MADE BY DELIVERED BY
CYLINDERS Clint Heesch
DISTRIBUTION:
E.F. Heesch - 2 BUILDING SAFELY WT.
City of Costa Mesa
Clint Jackson JUL 111975
123 E. 140th St., L.A. 90061
2,000 psi
47
0
I
7/5/75
3 4 "HOLD"
5 "HOLD"
7 -Days 6 "HOLD"
55,000
2,020
5-7/811x12-1/4"
RECEIVED ON
6/30/75
F .I I IY:,.: :,u0.'f.u,. O< <, 1,r5 .L,nOc1,.:, I .. .. el I C.) On 0' 0Vu >[nO a.S CO VCLus i OI na 1Ll .
.G1. 1 '.Is. -,I. =11 11, . .= '.n. a - T,C:mv :o cL1¢.;s r..c PveuC : . ou=sFLVFs
L OWNER BILLIOUX, Alice
`{
JOB ADDRESS 207 pe
GENERAL CONTRACTOR
No. 317-141-15 LI
'ECTIONS
Pool Location
Forms
Main Drain
Steel Reinforce
Elec. Bond
Approval to Cover
Underground Electric
Gas Piping Test
Filtering System Lines
Backwash Lines and Recep.
Electrical Final
r' -er and Vent Final
System Final
Backwash and Recep. Final
Street
DATE 6-24-75
BUILDING PERMIT NO.
TRACT FIRE ZONE VALUE
Si nat.re I Date GROUP J TYPE
R\ -C. 6 -Z5 -7S SUBCONTRACTOR
Electric
Plumbing
/f
11
4 1703 nPA zl 7F:N�f
r,OO*51;.50
COSTA MESA13UILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FX STRUCTURAL PERMIT
Fn. A...Ji... ♦ .- Gili :n /`n.....leleln IT.- I..L ll..l.. /\
s
n
REC V
E
TE D E SS E
BUILDING ��//����
Zx:) PA�A� SI.
r
ADDRESS
r PERMITNO.
OWNER A/CC iLL/Oc/
A.P. NO.
MAIL `-
PAfAiot
BUILDING
ADD�RES�Sp.p7B
_
L lLYC
ADDRESS ZO M.
TEL./' /
p p�
CITY f NO. F7Y6 Z/AS
TR��CTs'
Ls BLOCK
CONSTRUCTION
EW ADD AREPAIR
LENDER
x
BRANCH
n
OWNER f-/ CE
�7
bl"IeUX
ADDRESS
VALUE
ARCHITECT TEL.
US
$LQ
OR ENGINEER N
FIRE
ADDRESS
ZONE
T P GROUP
ByPROV EO
DAT
CONTRACTOR l�t.t/�L'/2/(�r�t7cC.
ADDRESS
TEL.
ZONENO. OF
USE OF NEW
CITY NO.
PLANS
BUILDING
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZEI NO. OF'LOGS.
-r
(FROM C/L STREET)
q'
- /Y NOW ON LOT v
OF LOT _ 60 X /7-7
RONT
FT.
USE OF ,`_
EXISTING BLDG. -i-.HDUSF
1 /,FT. lJ
FT.
Separate permits are required for
L. SIDE FT.
FT.
electric, plumbing and heating work.
REAR
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN er
MAIN BLOGS.
ACCESS. BLDGS.
��At/L
VAR.*
DATE
/Aa0 IfWD 77cu)
C.U.P.#
APPROVED
APPROVE
By
4V,ZA —1
ClATE �
I hereby acknowledge that I have read this application and ,state
'
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
1 hereby certify that 1 am properly licensed as a contractor under
SO. FT.
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT F ONLY:
from the provisions of the State of California Business
Mexempt
and Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT PEE $
PLAN CHECK $ oO
Signature of / // `
/1�
_
Permittee /! / J�\l
$ /Y///J_ 0
TAX $
y�//
Authorized Agent/
TOTAL PAID $
Z
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am
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COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
****
Ira 211-75PAIR04293-x 43.50
91
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC IV D BY
DATE CEIVED
— —
DATE ISSUED
—� S
BUILDING
207 Palmer Street
ADDRESS
PER IT O.
OWNER l i
BUILDINnuxG
MAIL
ADDRESS 2O Palmer Street
ADDRESS 20 Palmer Street
TEL.
Pde WPflSt�CTeights
CITY COS MP.. NO.
TR LOT BLOCK
CONSTRUCTION
W
ADD
AL
P
X
LENDER l: i.
BRANCH
OWNER Alice Billioux
ADDRESS
VALUE 1�
S 4480.
ARCHITECT TEL.
OR ENGINEER No.
FIRP.
ADDRESS 1 4.N B S A R
ZONE V E GROUP
.(3W
APPROVED
K40U
CONTRACTOR Petty Pools
BY DAT
ADDRESS 9951 Brier Lane
TEL
ZON
NO. OF/ -1
PLA
USE OF NEW
BUILDI
CITY Santa Ana NO 38 96
/
STATE CITY
YARDS APPROVED
YARDS APPROV
p
LIC. NO. lG1 18 LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO.OF BLDGS.
(FROM C/L STREET)
/
OF LOT NOW ON LOT
FRONT FT.
T. C• ,7'
USE OF
EXISTING BLDG. Res Gar
R. SIDE FT.
FT
SIZE OF NO. OF
/
.L—
NEWBLDG. ROOMS STORIES
L. SIDE FT.
EXTERIOR WALL
ROOF
y
COVERING
COVERING
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS. BLDGS.
VAR.#
DATE
C.U.P.#
APPROVED
APPROVED
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
0
all laws regulating building construction, and 1 shall not employ
any person in violation of the workman's compensation laws of
t
'�
the State of California.
I hereby certify that I am properly licensed as a contractor under
SQ. FT.
the State of California Business and Professions Cod., Division 3,
ITA AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full farce and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION
and Professions Cr,ue, Division 3, Chapter 9.
PERMIT FEE $ (/'Z
Signature of _
(
Permittee µ µ- v�
PLAN CHECK $ r OZJ
Authorized Agent,� y_
��"C.l
TOTAL FEE $ r
91