HomeMy WebLinkAbout1793 HAWAII CIR - Building PermitsMay 260 1972
Mr. John Oxford Y
1793 Hawaii Circle
Costa Mesa, California
Dear Sir:
A building permit has been ued to Blue Haven.Pools to
construct a private swimming -pool on your property.
In order thatyo pool will be a safe one and for the
purpose of advising you o our responsibility regarding the
requirements of the Costa Municipal Code, we refer you to
Section 8107, a.copy of which is attached.
This letteCC is directed to you in order that you will be
aware of our ordiil�cea and can make a complete safety check of
your pool area. \1�
Sincerely yours,
RICHARD HANHART
Building Safety Director
RH:dh
FIA v= Twininq Laboratories of =South
P.O. BOX n .3310 .lfoopgl WAY . LONG BEACH, CALIF. 90831 .12131 42G 3:55 (if 71 67b2186 1714I 828-6 4,32
BRANCH Ofn CES:
TESTING 151. o Na,h w.R.. s ... N9, D., *.I•�.9
Lnm A- C.",—.92703 92703 "55 R.d-d. A—. R.O OR. q
111.1 531 20.5 9 La,g E-ach C.6f. 90801 13131 6362196
June 29, 1972
Examination: SC72-3822
COMPRESSION TESTS ON GUNITE CYLINDERS
John R. Chambers
3443 Del Monte Drive, #3
Anaheim, California. 92804
PROJECT Swimming Pool for JOHN OXFORD
ADDRESS 1793 Hawaii Circle, Costa Mesa
SAMPLE FROM #1-iA Deep End: 12-2A Bond Beam: #3-3A Shallow End
ARCHITECT
Lester Paley b Assoc.
ENGINEER
- Same -
MIX
Gun Ite
DATE CAST
6-21-72
DATE TESTED
6-28-72
CONTRACTOR
Blue Haven Pools
SUBCONTRACTOR
Southern Counties Gunite Co.
SPECIFIED
STRENGTH 2,000 psi
SLUMP
6-28-72
CYLINDER NO. 1 2
COMPRESSION 7 -Day 7 -Day
TOTAL LOAD, LBS. 89,000 90,500
POUNDS PER SO. IN. 3,155 3,210
SIZE: 5-1/811 x 12-1/211 5-1/4" x 12-1/2"
COMPLIANCE 7 -Day test complies with specifications.
MADE BT DELIVERED BY
CYLINDERS, J. Chambers JC
DISTRIBUTION:
.---Costa-Mg.S,s Bldg. Dept.
John Oxford
Blue Haven Pools
So. Counties Gunite Co.
J. Chambers - 2
6-28-72
IA "HOLD"
3 2A "HOLD"'
3A "HOLD"
7 -Day
92,000
3,260
5-3/811 x 12-1/411
RECEIVED ON
6-22-72
BU101;T!G SAFETY DEPT.
JUN 3 01972
ALL REPORTS ARE SUBMITTED .S THE CONFIDENTIAL PROPERTY OF CLIENTS. AUTHORIZATION FOR PUOLICATION OF OUR REPORTS. CONCLUSIONS. OR EX
TRLCTS FROM OR RCGLPOING THEN IS RTSTRVEO PENDING OUR WRITTEN APPROVAL AS . MUTUAL PROTECTION TO CLIENTS. THE PUBLIC AND OURSELVES.
33012
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. DATE fj 12— —2e�12
LOT NO. 3S
ADDRESS _/,293
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he -she -they)
(was or were) advised that this tract has
not been given.final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
Lender
CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.aov
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC12-00391
PERMIT TYPE: B_COMBO
Sub Type: RES_ALT
STATUS: ISSUED
DATE ISSUED: 07/02/2012
ISSUED BY: RMD
JOB ADDRESS: 179Q HAWAII CI CM Suite/Unit:
APN: 13957213 Zoning:
Vicinity: REAR YARD Primary Occ:
Const Type: SQ. FT: 0 Valuation: $9,400.00
SCOPE OF WORK:DEMO AND BACKFILL AN EXISTING IN -GROUND POOL WITH UTILITIES CAP
OWNER: KING, JOHN R TR
Phone:
APPLICANT: SIMAT, GEORGE
Phone: 949-370-7200
CONTRACTOR: G N S CONSTRUCTION
Phone: 949-370-7200
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: 1776 HAWAII CIR Unit:
City/State/Zip: COSTA MESA, CA
Address: Unit::
City/State/Zip:
License No:486187
Address:P O BOX 141 Unit:
CitylState: BALBOA ISLAND, CAZipCode92662
License No.
License No.
$0.00
$181.25
$41.70
$0.00
$43.10
$0.94
$0.00
$1.00
$267.99
PHONE:
PHONE:
'Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday -7:00 am thru 7:00 pm. Saturdays. 9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Day, Memorial Day Independence Day Labor Day Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE f. IxsvrcnoN TYPE Q&U INMAL LOPE! IxsnCnoN lrae DATE INTMAL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy Zirr/
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 is issued.
❑ 1 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 issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
cTrWscUion need nor eee mmpletwddtlre pened a valued at are rdretl ars(s100)w lass)
PficylNumber:
❑ 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 of
the Labor Cod I shall forthwith comply with these provisions. J
G 2—
"
/
lieant'a signalure "; -�Y bale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS 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 in full force and effect.
Lic. .-- Class S
maaofs signature Date."'
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:
Lender's Address:
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, 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 vdth 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 appy to an owner of
property who builds or improves thereon, and who contracts for such project with
a contmctods) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3057<6 (3ro7)
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License 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 6, 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.
Applicant's Signature
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).
2. Does or will the applicant or present or future building occupant need to file
a registration farm for acutely hazardous materials? ❑ Yes ❑ 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).
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
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes', the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
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
8. (If -yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I.certity 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.
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 lam 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.
si Legal Owner(s) bate
Armor ized Apprmnt .._" rbete�1,
(714) 754-5273 • Fax (714) 754-4856 • www.c"cosla-mesa fIA-DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1793 HAWAII Cl
Suite:
Vicinity: ROOF
Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V -N
Parcel Number: 13957218 Zoning:
Applicant: LEMUS, RAFAEL
Address: 2016 WALLACE AVE
UNIT B Phone: 949-642-7057
COSTA MESA, CA Zip: 92627
Owner: ANDREWS, CHARLES H
Address 1793 HAWAII CIR
Phone:
COSTA MESA, CA Zip: 92626
Contractor: LEMUS ROOFING
Address: 2016 WALLACE AVE
UNIT B Phone: 949-642-7057
COSTA MESA, CA
Zip: 92627 License: 826813
ISSUED BY:
Status: ISSUED
Applied: 03115/2006
Issued: 03/152006
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 3011 FELT, 30 YEAR GAF COMPOSITION SHINGLES AND REPAIR/REPLACE SHEETING AS
NEEDED. 16.5 SQUARES.
Plan Check:
$0.00
Permit:
$125.25
SMIP Res:
$0.56
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $125.81
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
FEE SUMMARY
PLANNING & ZONING
Rear 0-0 Left 0-0
Rear 0-0 Left 0-0
Required: 0 Proposed: 0
Calc Valuation: $5,600.00
Claim Valuation: $5,600.00
Right 0-0
Right 0-0
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.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATION DECLARATION: 1
I hereby affirm under penalty of perjury one of the following declarations: -
❑ I 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 is issued.
A 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 issued.
-My workeem. compe atton Insurance carder and policy number are:
"Carder: la m- V0y—" PolicyNumber:
-(71iis section need not be com� pie permit is valued at one hundred dollars (3100) 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 sh uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these prow�'s,'re�ns. j !\
Applicant Signature: 1 � (J`r� ' rK, L (--Det': t —y C_
_WARNING.^FAILURE TO SECURE WORKERS' COMPENSATION COV RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDCML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license �iG�da,`�provision f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prof sire Code, and my license is in full
tome end;etleCL.LIC..q LIJ�J l n rClbC_S
/Contractors Signature: Lf�zf iiA dJ1r- -- Date:
r�_--- r
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).
Lender's Name: Lender's 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, 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).):
❑ 1, 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 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 driver's license. ❑ Yes ❑ No Driver's License 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, fal5ework, 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, 1 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? Q 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 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).
........................ ....................................... _ ....... _... ... _............... ................................................_..._.........................................._'_.................................__......._.............................-."_................................_................._............
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
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.............................................................................................................................................................................-........................................................................................................ ............................................................................................
4 If an RMPP Is presently
required, has Section 25534 o.. the California Health and Safety Code been fully complied with? ❑Yes ❑ No
5 Does or will Nle applicantsAiror present or future building occupant require for the work ontch is the subject c this a plication app,ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency! � Yes LJ No
(Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits).
......................................_..................................................................................................-............__......................................................................................................._...._....................................-..................................................................._.
8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ NO
(If "yes", the .facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
....
.............................................................................................................................................................................................................................................................................................................................................
.............
7 a permit from the South Coast Air Quality Management District or other air pollution control district agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Coda Section 42303 been
made? ❑Ves ❑ No
B (If '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 stale 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.
I lure Of Leg I Owner(s) Dale-o
�i 3 -lS
Or Authorized Applicant _ . Date
CODE I. INSPECTIC PE Dig IMmALS CODE INSPECTION TYPE AT IMMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fite Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us T7 FAIR DRIVE, COSTA MESA, GA 92626
PLUMBING PERMIT
.lob Address: 1793 HAWAII CI Status: ISSUED
Suite No Applied: 07/13/2001
Issued: 07/13/2001
Vicinity: FRONT OF SFD
Parcel Nunmber: 13957218 ISSUED BY:
Applicant: FRASER, RICK
Address: 10172 VALLEY FORGE
Phone: 800-675-8621
HUNTINGTON BEACH, CA Zip: 92646
Owner: ANDREWS, CHARLES H
Address 1793 HAWAII CIR
Phone:
COSTA MESA, CA Zip: 92626
Contractor: R B FRASER
Address: 10172 VALLEY FORGE
Arch / Eng :
Address:
Phone: 800-675-8621
HUNTINGTON BEACH, CA Zip: 92646
License: 581307
Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING PERMIT FOR GAS LINE FOR AN EXISTING POOL HEATER.
1 GAS OUTLET (1-4).
'
FEE SUMMARY
AMT
QTY
AMT
QTY
AMT
QTY
ISSUE FEE
$23.50
Laundry Tub / Washer
$0.00
0
Sump Pump -.
$0.00
0
Backflow irrigation
$0.00
0' '�
„ Landscape Irrigation
$0.00
0 "
_
Swimming Pool
$0.00
0
Backflow Preventer
$0.001
"O_
P -Trap
$0.00
0 °_ %
, Trap Primer '
$0.00
0
Bathtub
$0.00'
0
Pressure Regulator
$0.00
0
Urinal
$0.00
0
Clarifier System
$0.00
0
Process Piping (per 10 ft)
$0.00
0
Vacuum Brkr Bkflow(1-4)
$0.00
0
Connect (Ice,Soda,etc)
$0,00
0
Receptors
$0.00
0 �,
Vacuum Brkr Bkflow(5+)
$0.00
0
Dental Units
$0.00
0
Septic Tank
$0.00
10
Wash Basin
$0.00
0
Dishwasher
$0.00
0
Sewer Cap for Demo
$0.00
0
Wash Basin Set
$0.00
0
Drain, Floor
$0.00
0
Sewer Connect
$0.00
0
Waste and Vent System
$0.00
0
Drain, Rainwater
$0,00
0
Sewer Private Line
$0.00
0 - .
Water Closet (Toilet)
$0.00
0
Drain, Roof
$0.00
0
Shower -
,$0.00
'0
Water Heater/vent
$0.00
0
Drinking Fountain
$0,00
0
Sink, bar
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
Expansion Tank
$0.00
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
Gas Earthquake Valve
$0.00
0
Sink, Floor
$0.00
0
Water Service
$0.00
0
Gas (1-4 outlets)
$6.15
1
Sink, kitchen
$0.00
0
Water Softener
$0.00
0
Gas (Over 4 outlets)
$0.00
0
Sink, service/mop
$0.00
0
OTHER
$0.00
Gas Repipe
$0,00
0
Spa (private)
$0.00
0
VIOLATION
$0.00
Gas Service
$0,00
0
Spa (public)
$0.00
0
PLAN CHECK
$0.00
Interceptors (Grease, Oil)
$0.00
0
REINSPECTION
$0.00
0
Interceptors (Sand Auto )
$0.00
0
TOTAL CALCULATED FEES:
$29.65
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.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
P""6 terool
DECLARATIONS rf
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 penult Is Issued.
❑ 1 have and will maintain workers' compensatlon Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued,
My workers' compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed i/ the permit is valued atone hundred dollars ($100) or less.)
..El, - ,l certify thethe pe o neevtt ork for which this permit is issued. I shall not employ any person In any manner so as to become subject to the workers'
compensat n laws I I' omia, and reg that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with hese r isl
Applicant Signature. Date:
WARNING: FAILURE TO SECURE WORKERS' MPEN ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P94ALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (S100.0DO). IN ADOMON TO THE DOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm tha�1 am Ilcen d undeyp wslon f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect.I ��. e � Class N
Contractors Slgnatoa.- Date: I
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 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, 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 fora permit
subjects the applicant to a civil penalty of net 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 Cade: 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.).
❑ 1, 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 builds or Improves thereon, and who contracts for such project with a contractor(s)
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 driver's license. ❑ Yes ❑ No Drivers License 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 feel 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).
............................................................................................................................................................................................................................................... ............................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? as ❑ 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).
.._................._....................._........................................................................................ _........................... _........................... _.............................. _............................................ _........................ ..... _........................................... .................
_........
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 Masa 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.
.._.................._...........................__..........................................................................._._........................__..........................._._......................_._.............................................. ......................._..........................-..............._.......................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? [I Yes ❑No
..........................................................._......................................................................... ......................................... _............................................................................. -... ................ ...... ....... ........._.................
...___.
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
.............................. ........................... ............................................................................................................................................... ....................................................... ............ I ................................... I.... ..............................._....................... ._.......
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? [I Yes ❑ No
(11 "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
......................................................................................................................._...................................................... ................................................................. .................................. ............................................
..........
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
...........................................................................................................................................................................................................................................................................................................................................................................................
8 (If '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. 1 agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Data:
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
abovgdHs hoed property f inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
f/ Signature OI Legal Owner(s) 1 Dat
And/Or Authorized Applicant Date
CODE I, INSPECTION TYPE lIfTrTIALS CODE INSPE"014 TYPE DATE INTMAL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
UWNtN APOLLO DEVELOPMENT uAIt 1-22-70
JOB ADDRESS 1793 Hawaii Circle BUILDING PERMIT NO. 3130
nC\ICn 11 rnIroAl-rnn .. MCCIDIOTIn AI_twnDV - .. —1... . _
AP No. LOT 35 TRACT 6694 FIRE ZONE VALUE$26-470-00
INSPECTIONS
Si no ure Date
GROUP
TYPE
v ZONE
SOIL
-76
SUBCONTRACTOR
PERMITS ISSUED
GAS
Date Number Si nature
WATER
.PIU bi
ROUGH PLUMBING I
h{ .
PROP. SWR. LINE HOUSE CON.
I
- i -
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
- O
TEMPORARY SERVICE OR POLE
- V
UNDERGROUND POWER 11
'� 0
ROUGH WIRING
Heating ancl
Vent
TRENCHES q FORMS & STEEL REINF.
FLOOR SYSTEM'
BOND BEAM STEEL REINFORCE
SHEATHING
]-Zj-%
FRAME AND FLASHINGy .70
:klro
LATHING — IN OUT
-I '1
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FIN A
O
_
- -7117 Q
PLUMBING, FINAL AND GAS TEST
�^
ELECTRIC, FINAL
BUILDING, FINAL
Z
ww
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Z
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J D
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Q
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11 3* 1?
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
n
/,>/,fyjI 26,,Lcf � 0 742* ***141-00
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEI D V
CAT E R' EIVED
pgT'U
BUILDING
ADDRESS /
PERk'jI
OWNER Apollo Develo ant Corp.
A.P. NO.
I
MAIL
BUILOING SS
ADORE
ADORESS
CITY Santa Ana NO.547-9673
TRACT 6694
LOT 35 BLOCK
CONSTRUCTION U. S. National Bank
W
A
A
P
LENDER
X
BRANCH Main Office
OWNER A olio Development Cor .
ADDRESS 190 S. Broadway,San Die O
VALUE
s Dwelling - $16 000
ARCHITECT TEL
TN
OR ENGINEER Kermit DOr1llS DL-675-116
ADDRESS 3111 2nd Ave.,Corona Del Mar
ZONE TYPE GROUP-/�
A ollo Development CorpPPROVED
CONTRACTOR P P P•
BY DATE
ADDRESS 1104 E. 17th Street
TEL
ZOI./�C
NO. OF USE OF NE
CITY Santa Ana NO. 547-9673
`
PLANS BUILDING
STATECITY
YARDS APPROVED YARDS APPR ED
LIC. NO. 252549 LIC. NO. 1690
MAIN BUILDING ACCESSORY BUILDING
SIZE 56 97 NO. OF BLDC.S.1
(FROM C/L ST ET)
X
OF LOT NOW ON LOT
FRONT FT. FT.
USE OF
EXISTING BLDG. --
FT.
SIZE OF NO.OF
1770 S.F. 7 1
R'
/.SIDE
NEW BLDG. ROOMS STORIES
FT. FT.
EXTERIOR WALL er
Plans
ROOF
Shin le
COVERING
COVERING
REAR 10 FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
Construct new dwelling with
C URPDATE
.. 3W—�,5--�j APPROVED S —i'O—
nt-t-nCbpri garage
APPROVED D�TE 16
I hereby acknowledge that I have read this application and .tate
OLD FOR SPE IAL REQUIREMENTS
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
SO. FT3 13.
the State of California.
I hereby certify that I em properly licensed as a contractor under
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force 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 Co tl Division 3, Chapt r 9.
7
4,0
PERMIT FEE
�
Signature of D/
�)^/
Permittee +�nYA - rdL
5�Zi 7 /d
��
PLAN CHECK $ ao
Authorized Agent
TOTAL FEE $
OWNER OXFORD. John DATE 5-25-72
JOB ADDRESS 1793 Hawaii Circle BUILDING PERMIT NO. 34772
3AP No. 139-572-18 LOT TRACT FIRE ZONE VALUE $ 6.000.00
INSPECTIONS
Signature
I Date
GROUP I
TYPE
ZONE
solL
SUBCONTRACTOR
PERMITS ISSUED
Gas r-
Date Number I Signet
WATER
P u
bin
/
ROUGH PLUMBING
r L'�
PROP. SWR. LINE ❑ NOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
A • 7
ROUGH HEATING AND AIR CONOrtIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER ❑
.��
r �'1,
ROUGH WIRING
Heating
and Vent.
TRENCHES FORMS LA STEEL REINF.�-
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT Fj
PLASTER, BROWN COAT
IF
STRUCTURAL, FINAL
HEATING. VENT., REFRIG. AND A.C., FINAL
_
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
1 -
BUILDING, FINAL17-7Z-7Z
.�1 34772
• COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING/--?,, /.
OWNER
MAIL .
TEL.
NO.
CONSTRUCTION
LENDER
BRANCH
ADDRESS --
ARCHITECT I %J TEL.
ADDRESS
CONTRAC/TO
ADDRESIS 1C
STATE
�j
CITY
LIC. NO .�
LIC. NO.
SIZE
D
NO. OF BLDGS.
OF LOT
NOW ON LOT
USE OF
VAR. #
EXISTING BLDG.
DATE
SIZE OF NO. OF
C.U.P.#
WALL
801165*
APPLICATION FOR BUILDING PERMIT
RECEIVEO
BY
��a qE�n A/T I"S '
BUILDING
ADORES!
N NO. OF
PLANS
YARDS APPROVED
MAIN BUILDING
BLOCK
DATE'S
USE OF Nq
BUILDING 1 n
USE
YARDS APPROVED
ACCESSORY BUILDING
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN & l
any person in violation of the workman's compensation laws of
MAIN BLOW.
ACCESS. BLOW. S
VAR. #
m
m
DATE
SQ. FT.
� _
C.U.P.#
the State of California Business and Professions Code, Division 3,
APPROVED
'm
iPi Q r11
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
Da TF S -1
I hereby acknowledge that 1 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.
m
m
1 herebycertify that I am
V properly licensed as a contractor under
SQ. FT.
� _
o
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
'm
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Ch pt r 9.
m
VALUATION
P
PERMIT FEE $ ,
N
/
PLAN CHECK $
Sig
Peln/
/
E
o
Authorized Agent Ovj.-
TOTAL FEE $