HomeMy WebLinkAbout1855 ILLINOIS ST - Building Permits :II4,
S CITY OF COSTA MESA
4� ►9 BUILDING DIVISION
e• , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t PERMIT /(03-00580
*tbR„ o V
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us - 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1855 ILLINOIS ST Status: ISSUED
Suite No Applied: 06/30/2003
Vicinity: Issued: 06/30/2003
Parcel Nunmber: 13904204 rr//
Applicant: DIAMOND, MARY ISSUED BY: /-E /
Address: P 0 BOX 1855
COSTA MESA,CA Phone: 714-557-3118
COSTA MESA Zip: 92628-1855
Owner DIAMOND, D TR OF ILLINOIS
Address TRUST#890814 '
COSTA MESA,CA Phone:
�-
P O BOX 1855 Zip: 92628-1855 1 ''•, ,
4) '
r
Contractor OWNER BUILDER
O
Address: •
t Phone:
Zip:
License: 000000
SCOPE OF PERMIT
DEMOLISH EXISTING SWIMMING POOL.CAP UTILITIES.
. FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 . Temp Dist System/Lighting' $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $18.20 1
New Res(3+units) • $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 _ up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches 50.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 • 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 . 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp - • $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp , $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 . Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 -0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
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
2446-46(6/00)
A --oo 586
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
o 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.
❑ 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 Issued.
My workers'compens Ion In rance carrier en Icy number are:
Carrier: L V Policy Number:
(This section need not be completed if the permit I alued at one hundred dollars($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 to the workers'
compensation laws of California nd agree that If I should become subject to the workers'compensation provisions of Section yf the Labor Code,I shall forthwith
comply with these p�r�A�vis' s. �j�/� p
-Applicant Signature: ' /4 ,&t4Yl-(�JM�� �Ai-R-C-(,( Date: ✓l1 V�
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 DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR C00E,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 DMslon 3 of the Business and Professions Code,and my license is in full
force and effect.Uc.# Class#
Contractor's 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).
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'penalry of.no!more than five hundred dollars($500).):
o 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
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 doesnot apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑_-1 am axe r.t und= .e c Busi ass and Professions Code for this reason: ��/ `_p
, Signature:- II g AV. . (Alt. / a... -
Expires: :� �
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
o 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 B,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:
I 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? 0 Yes 0 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? 0 Yes ❑No
(Section 25533 of the Californiaa Health and ly hCode,with some exceptions,to or greater a eo the CostaoMesa Fire lumeofDepartment by each,business 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�r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
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 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subjeat of this.application a$ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LI 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 10001est 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 0 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.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
abov> crib ropy r for inspection pu os.I agree not to occupy or allow occupancy of any building authorized b this pe it until final inspection.
Signature Of Legalwner(s) ate
And/Or Authorized Applicant Date
BODE 1 INSPECTIONTYPE DAIS INTRIALS DODEE INSPECTION TYPE DAIS INTBIALS 1
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final • 208 Final Plumbing "
200 Final Re-Roof 210 Final Electrical 1 - • Nu
201 Final Block/Retaining Wall 212 Final Fire Prevention in <7, from
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
.
Ti„ _. '
'' _ CITY OF COSTA MESA
LiP.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
D:
2' DEVELOPMENT SERVICES DEPARTMENT
eft.
BUILDING DIVISION
COURTESY NOTICE OF PERMIT EXPIRATION
December 1, 2005
D Diamond Trust of Illinois
Trust #890814
PO Box 1855
Costa Mesa CA 92628-1855
PERMIT NUMBERS: B03-01103, E03-00580
FOR: Demolish Swimming Pool & Cap Utilities
PROJECT ADDRESS: 1855 Illinois St., Costa Mesa
Our records indicate the above listed permits were obtained for property improvements or
alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4
Expiration, permits are valid for 180 days from the date of such permit, or the date of your
last inspection for the project and additional fees will be required to finalize expired permits.
According to our records, the permits listed above have not had an inspection for a period
exceeding 180 days. If you have a signed inspection card indicating an inspection was
4 conducted within 180 days from the date of this letter, please contact this office so we may
correct our records.
If you need to request an inspection please call our Inspection Request Line at
714-754-5626. If you wish to request an extension, requests must be made in writing
addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances
and listing an estimated date of completion. If you do not have an approved final inspection,
your permits will expire on December 15, 2005.
If you have any questions, please contact the Building Division at 714-754-5273, between
8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of
records affecting your property is our goal and we appreciate your working with us to resolve
this matter.
Sincerely, •t
>lit dreti_,(.C 46 g e_ ,;&!:.(sq<LA)
Mary Jane Weidenkeller
Office Specialist II
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)7544856 • TDD(714)754-5244 • wvA+.ci.costa-mesa.ca.us
r
•
CITY OF COSTA MESA
4 BUILDING DIVISION
F iDEVELOP.MENT SERVICES DEPARTMENT PER NUMBER
PERMIT
- 1 • •• 603-01103
(714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1855 ILLINOIS ST Status: ISSUED
Suite: Applied: 06/30/2003
Vicinity: Issued: 06/30/2003
Parcel Number: 13904204 Zoning: II
Applicant: DIAMOND, MARY ISSUED BY:
Address: P O BOX 1855
COSTA MESA,CA Phone: 714-557-3118
COSTA MESA Zip: 92628-1855
Owner DIAMOND, D TR OF ILLINOIS V4 •
Address TRUST#890814 • i '
COSTA MESA,CA Phone: th•N• ,
P O BOX 1855 - Zip: 92628-1855 -
�r��
r
Contractor: ,
Address:
Phone:
Zip: License:
•
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: - License: License:
SCOPE OF PERMIT
DEMOLISH EXISTING SWIMMING POOL.CAP UTILITIES.
FEE SUMMARY
Plan Check: $0.00 - Calc Valuation: $7,000.00
Permit: $139.25 Claim Valuation: $7,000.00
SMIP Res: $0.00
• SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.25
•
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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
2446-48 16/00)
• O3 r 61 / 03
WORKERS'COMPENSATION DECLARATION:
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 foryby section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,Sor the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
I (This se tion need not be completed If the permit is valued at one hundred dollars($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 to the workers'
compensation laws of California, d agree that If I should become subject to the workers'compensation provisions of Sec Ion 3700 of the Labor Code,I shall forthwith
comply with these•r• ishig. 1
Applicant Signature. � ( 4/1/`r/a.:( .�A:._ Date: (e 3O j OTh
.1/WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES D CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($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.t ic.II Class x
Contractors 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: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty.df.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 ortstie 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).):
�<
O 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
sol ithin 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.).
❑ l am ex.• • tir s r Business and Professions Code for this reason: __
Signature: D A At Ad AAA- A:5�./- . /. _ .�
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,end 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).
O 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? 0 Yes 0 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? 0 yes 0 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 of the California Health and Safety Cade been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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).
8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If'yes',the facility must meet the requirement of Sections 25534 end 42303 of the Califomia 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? 0 Yes 0 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.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- escrib propyty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by t s permit un 1 final inspection.
i“(,ezrAd24,41 , La "30
Signature Of eget Owners ) , Da
And/Or Authorized Applicant Date
gaff I INSPECIIONTYPF PATE (MAL* BODE. INSPECTION TYPE ERIE NEW
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 Signm 222 Final Site 'pi-'a'h-t-`�
204 Final Demolition 250 Final Building/Occupancy F7 C 7"r
T` / II
�� .. : � 4G , Vadast
Iiiirc* OWNER-BUILDER
VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830,,shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion and require the return of, an
owner-builder verification.
Attention Property Owner: )
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will be issued until this
verification is received.
XI. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. 0 Yes ❑ No
2. I (have/have not) signed an application for a building permit for
the proposed work.
3. I have contracted with the following person (firm)to provide the proposed construction:
Name COOsuN ‘R,A' DIldCo
Address c c-'j'c City
Phone ( ) 4 �" Contractor's Lic. No. Z 8 `iI i 5 L
/ 4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
• Name Address Phone Type of Work
1042-46 (REV.958)
•
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my personal
knowledge, in compliance with this State law.
Signed: // �/ 112,4n8 Date:
G , ,. M. D. T I Amcnlfl I R 51.4—l;
(Printed or Typed)
.D.L.#OR S.S.#
For more information call City of Costa Mesa Building Division at(714)754-5273.
142.46 (REV.998)
;7
�i CITY OF COSTA MESA
Y • P O ECX 1200 • 77 Fc'P DRIVE • CALIFoPNIA P262e.1200
•y 1 • '...��.o.-a..crrar watt ay.a-...._-.-:-.ea_sa.-.to:-==..,t .�
+� _ DEVELOPMENT SERVICES DEPARTMENT
BUILDING DIVISION
COURTESY NOTICE OF PERMIT EXPIRATION
December 1, 2005
D Diamond Trust of Illinois
Trust #890814
PO Box 1855
Costa Mesa CA 92628-1855
PERMIT NUMBERS: B03-01103, E03-00580
FOR: Demolish Swimming Pool & Cap Utilities
PROJECT ADDRESS: 1855 Illinois St., Costa Mesa
Our records indicate the above listed permits were obtained for property improvements or
alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4
Expiration, permits are valid for 180 days from the date of such permit, or the date of your
last inspection for the project and additional fees will be required to finalize expired permits.
According to our records, the permits listed above have not had an inspection for a period
exceeding 180 days. If you have a signed inspection card indicating an inspection was
conducted within 180 days from the date of this letter, please contact this office so we may
correct our records.
If you need to request an inspection please call our Inspection Request Line at
714-754-5626. If you wish to request an extension, requests must be made in writing
addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances
and listing an estimated date of completion. If you do not have an approved final inspection,
your permits will expire on December 15, 2005.
If you have any questions, please contact the Building Division at 714-754-5273, between
8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of
records affecting your property is our goal and we appreciate your working with us to resolve
this matter.
Sincerely,
Mary Jane Weidenkeller
Office Specialist II
Eu1ding Dwsion(714)754-5273 • Cooe Erlerce'nen:W4)754-5E23 • Planning Dr-e cn 714)T5 -:245
FAX(71(1)754-4856 • TDD(714)754-5244 • ,vim ci costa-mese Ca us
CITY OF COSTA MESA
BUILDING DIVISION
%l•hroarrcoA" DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
�. /s . PERMIT
%ro�� P03-00416
inse
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1855 ILLINOIS ST Status: ISSUED
Suite No Applied: 06/30/2003
Issued: 06/30/2003
Vicinity:
Parcel Nunmber: 13904204 ISSUED BY: let.,
Applicant: DIAMOND, MARY
Address: P 0 BOX 1855
COSTA MESA,CA Phone: 714-557-3118
COSTA MESA Zip: 92628-1855
Owner: DIAMOND, D TR OF ILLINOIS
Address TRUST#890814
COSTA MESA,CA Phone:
P 0 BOX 1855 Zip: 92628-1855
Contractor: OWNER BUILDER
Address:
Phone:
Zip:
License: 000000
Arch / Eng: •
Address: - - - - -
Phone:
• Zip: .
License: -
SCOPE OF PERMIT
DEMOLISH EXISTING SWIMMING POOL.CAP UTILITIES.
•
•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 10.00 0 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,et ). $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(54-) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher ,$0.00 0 Sewer Cap for Demo $9.80 1 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(Ins(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
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 fihal 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
2446-46(WOO)
NOiirditiC9
WORKERS'COMPENSATION DECLARATION:
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.
❑ I have and will maintain workers'compensation insurance, required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My comp workers' sat n surance carr d umber are:
arrier: Policy Number:
This section need n e completed if the p reit is lued at one hundred dollars($100)or less.)
I certify that in the performance of the rk 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 Sectio 9 3700 of t e Labor Code,I shall forthwith
comply with these j�jsion�s//�I /'/I � / Q 7
Applicant Signature: •s !'// z A(/���/H-!? i A//./.vt.�,/A Date: /// uL
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALT1ES D CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($106,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.$ Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
O 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: 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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O 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 ithin 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.).
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.).
.0 I am exe •.t und• sea . Business and Professions Code for this reason:
Signature: ' U L . /vim/J 7S/. . - ,
Expire-.
Verification of Ownership by(type of documen,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: •
O 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,Califomia Administrative Code).
O 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? 0 Yes 0 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 0 No
(Section 25533 of the Califomia 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 of the California Health and Safety Code been fully complied with? 0 Yes 0 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 ❑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 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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.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- e crib pr..:rty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until fi I inspection.
Signature Of Legal Owner(s) ate
And/Or Authorized Applicant Date
CODE r INSPECTION TYPE GAIL INTmALS CODE. INSPECTION TYPE RATE INTI1IALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical ,,�G��1
1266 Pool Spa Final 208 Final Plumbing '7 /O`J3 `J]C
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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
ICITY OF COSTA MESA Q RUCTION PERMIT 1 PERMIT�N 6 9 g TRACT NO. LOT NO. UNIT NO.
'� A.P.# I Zone
Project Address �'7 �/L //��•/�'LS -/ - t �l� S Main Building: Accessory Building:
Applicant's Mailing Addre IRS T Yii/'Yo,CL�,- TYPE OF CONSTRUCTION Li NEW U ADD IJ ALTERATION L7s REPAIR E •Front Z
}� - (/634116,
3 .q//6, ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • T O
Owner's Name (3 i FT�>.�.-�• Phone///(O 04 DESCRIPTION OF WORK/USE OF BLDG. I A •Rear N
Address / ie5 J l/I/WO f'Ss 1
U STRUCTURAL I C Right N
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING�OUNDATIOry � K G
Address ,/ ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL S Left
/9"-AYr7eb Pl8 /HT Phones3 'ays ❑ OTHER Ping. Ref.# Parking Req./Provided R
Contractor's Name E
q ,-r PROJECT DESCRIPTION SQ. FT. OCCUPANCY 0
Address(mailing) /n 7� ! /'n-Sk U'¢-- (�' - Planning Notes: M
``/',�\/Ls •( *y CONSTRUCTION TYPE GRADING CU.- VALUATION
A$C RES $,
City License No. FACTO ,l O•"'
LICENSED CONTRACTOR DECLARATION RECEIVED DEC 2 7 1939
I hereby affirm that I am licensed under " as of Charter 9(commencing Remarks: �/-7�5•H..//,Q / /I �'rae� I,l,� '��.��•
with section 7000) of Division 3 o e Busines and Pro essLi• s Code, and �lD, i t- Q
qmy license is in full •rce .n• effec . / ✓� /1. / •• _• •`}' ELECTRICAL - FEES
sc License Class v Lice „•• VtYlJC..g AQUI/ ss..nJ
\v` Date 'AV Signature �r%�%� - - PLUMBING V I FEES Automatic Washer Transformer ❑ 15-50 KW
'•'ORKERS'COM•ENSATION DECLARA •N Bar Sink Showers 'Construction Pole Sub. ❑ 50+ KW
ireby affirm that I have a certificate of onsent to self-Insure or a certificate
N.
Workers' Compensation Insurance. or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps
—.400, Laby� Backflow Preventer Service Sink
L� Policy No./ 11419_4067/34160,11) ompany i��r0 _a. Backflow Irrigation Sewer Cap _li Dishwasher Meter ❑over 100 amps
I 8 Certified copy is hereby furnisher. - /� Dryers ❑Gas ❑Electric Sub Panel
—
Certified copAis/-fs(led with the c[ •r•in ' Bathtubs Sewer Connection
Date MP �O _ / 1 ' Applica �S, �I��✓ Clarifiers Solar Collectors Fan
Motors❑0.1 HP ❑i'h-8
il
EXEMPTION FROM WORKERS'COMPENS• 0 •N DEC ARATION
(This section need not be completed if the pet- it is for one hundred ($100) or Dishwasher Solar Piping F.A.U. (n0.Solar ❑9-15 HP ❑16-15+
less).
I certify that in the performance of the work for which this permit is Issued I Fixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:If,after making this declaration,you should become subject to the Outlets Range
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal -
comply with such provisions or this permit shall be deemed revoked. I
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign
- 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. C.) Interceptors '� Water Heater 2 ft' ' Garbage Disposal Standing Sections
Lender's Name inn
Lender's Address Kitchen Sink Water Service Generator ❑0-5 KW ❑5-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to Construct,alter,Improve,demolish or repair P-Trap Laundry Trays
any structure, prior to Its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains '
'-ie Contractor's License Law(Chapter 9(commencing with Section 7000)of
rision 3 of the Business and Professions Code) or that he/she Is exempt Reinspection Fee $15 Issue Fee $ 3
,refrom and the basis for the alleged exemption. Any violation of Section
' a31.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
$ 3
❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee Zoning Approved By
compensation, will do the work,and the structure is not intended or offered Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES' Building Approved By Data /
License Law does not apply to an owner of a property who builds or improves 1 /1 I r(,
es
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ Application Issued By a DateI
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ SUMMARY OF FEES
pletion, the owner will have the burden of proving ne/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I,t as owner of the property,rojectSe exclusively contracting ing Pion licensedioncon- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT !y ���
tractors to constructLi the project d 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or improves thereon.and who contracts for such projects with a con- '
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof
proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. (CBO# Fire Dampers PLAN CHECK 50% $ MICROFILM $
-
Date Pner Heating System& Ducting Registers • MECHANICAL $ �C"(}/
I hereby certif hat I have ead this ap• c. on and state that the above ❑0.100,000 BTU ❑1oo,000BT TOTAL FEE $ s
information Is orrect. I agre to co •• all city and county ordinances PLAN CHECK 25% $
and state la relatin. uilding on tion, and hereby authorize repre-
sentatives • this ci t0 enter p he .•ave-mentioned • oP =qfT�
-
Inspection •ur.••G a y -
Signature -air Drivers' License or SS - //
DATE: 01/11/90 TINE:- 12:19 •
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING PO SPA
, APPROVALS Permit - Date I Inspector
APPROVALS Permit 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..Electdcal LIFER Grnd. 1 57. APPROVAL TO COVER-GUNITE •
):7. Footings. IP 58. Electrical Conduit-Undrgrnd. • ,,,•./
8."Foundation ` 59. Gas Pipe, 0 Undrgrnd., Test hi 1
9. Water Pipe-Undrgrnd. " 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System ' / 61. APPROVAL TO DECK r
11. Property Sewer Line & House-Connection ,
:. .. •, h• e --, - 62. Backwash & Receptor-Final "
•
12. Sewer.Cap 'r' - _ 63. Heater & Vent-Final '�
4..13. Roof Drains - S,' 64. Plumbing System - Final ' .�
y
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
'I,&. 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-8/ Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding ' 77. FIXED SYSTEM FINAL
29. Insulation - 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ,. 79. FINAL INSPECTION
32./Electrical Power Meter-Final 80. $(11)0D CERTIFICATE ISSUED
33. Final Electric Notes:' S730/qo DA Onf man m_t£rtf63401oo
34. Final Heating & Air Conditioning 41( rytro pf1zrnt'rrc.,ceir2AES A-s c2_ za.s
35. Final Gas Pipe-Test URC 'L E O
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final • 1:
42. Backflow Preventer - -.;
43. Backflow Irrigation �" j
t
44. Landscape Irrigation System . 1 7...
- /
45. Sound Attenuation i
46. Handicap Regulations
z i
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
27
51. CERTIFICATE OF OCCUPANCY 4
c^
No. Date
' MAIN OFF1LE :4
BRANCH OFFICE
1535 WEST GAYLORD ST.- F O BO% 9oES 1514.D NORTH HARPER ST.
LONG BEACH ID, CALIFORNIA • SANTA ANA. CALIFORNIA
HEMLOCK 5-7493A
JEFFERSON 1.20450<S t ,
SPRUCE 5 20E11 JEFFERSON 1.2046
I Twinin .• Laboratories of sou fiEttz Calf f olnia, gnc.
Inspection and resting Engineers Soil Foundation•Analysis' • Chemical Analysis
IMay 24, 1961
GUNITE
REPORT OF =CM TEST CYLINDER
Examination No. SC61-2859
Project 'ELWOOD COX RESIDENCE
1855 Illinois Ave. , Costa Mesa, Calif.
Sample from Gunite Swimming Pool
Architect
Contractor Peter Pan Pool Co.
Mix
Water, gal. 'sk. cement
Size 6 x 12* 6 1/8 x 11 7/8
Date cast 4-26-61
Date tested 5-3-61 5-24-61
Cylinder No. 1 2
COMPRESSION TEST 7 Days 28 Days
Total load to destruction, lbs. 71,000 90,500
Pounds per square inch 2,510 3,071 1 -
4�v
Cylinder made by Gunite Crew ✓ 'l O Ej 04)
0IL \ b - � * o
Cylinder delivered by Al Bemmer t 'P8 % tt� �
Cylinder received on 4-27-61 CO . OIk .%a
a
Mt
•
cc: Elwood Cox % 8ba - �u
Costa Mesa Bldg. Dept. .J !� ,r
SA Lab
e‘aci 70
ALL REPORTS ARE SCBM1TTE17 AS THE CONFIDENTIAL PROPERTY OF CLIENTS, AUTHORIZATION FOR PUBLICATION OF OUR REPORTS, CONCLUSIONS, OR R .
TRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTIOM TO CLIENTS, THE PUBLIC ANO OURSELVES.
Applicant to fill in all spaces except those wi �In y border lines and sign all appropriate declarations. --
CITY OF COSTA MESA r _ • RMILIIO. TRACT NO. .. LOT NO. BLDG.NO.
CC RUCTION PERMIT. j m 2t3 , _ 3
•
Project Address /57C—i— - y N/S ‘5,4"6.Jam ' TYPE OF CONSTRUCTION' NEW ADO LJ ALTERATION UREPAIR 9132 •/1123IRL l7-C'O IL
Applicant's Mailin• Address ./9— ' —Ztiar dr .&' .1. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# /3 q--/ 04 a- 0 9' Zone R
' i.� Phone S f DESCRIPTION OF WORK
Owner's Name - S Main Building: Accessory Building: Z
Address /1- Atii/S f`P1 E — / 0
TYPE OF PERMIT ❑ GRADING U FOUNDATION U STRUCTURAL T Front lo hood .P N
Arch/Eng. •�- License NO&S770 3 ❑ TENANT, ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICALB Rear 4 " 1
Address '— ❑ OTHER A N
_ir Y:.- •J - A. , _•...i C Right / G
Contractor's Na nmol' � ---114•••dr!' wmater u•"n•i. f PROJECT DESCRIPTION SQ. FT. _ OCCUPANCY
go fl' —".�h 1%-a10:1•7 —'-'sa- ••' C 0 N ST RU CT I ON TYPE VALUATION$ t—:,s o,-a l $ Left T' if fares/ R
Address lmailirtgl S' , .. •' �—C92—«-IL- d E
City License No. -in ri j' ONE GRADING CU.YDS. ACRES Ping. Ref.# 1 Park.Fees $ Q
LICENSED CONTRACTOR DECLARATIONU
Remarks: ��Cr "22 3 — ��S` Parking Req./Provided I
I hereby affirm that I am licensed under provisions of Charter 9(commencing
with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: ��� E
my license is In fu I fo e �� 6 � ��� _ —
' License Class t License N PLUMBING FEES Planning Notes: yt E
q-lo-�+- 3' N,I ^'F/C�IS G�/t,e G rf ESQ LL-t,D .�L'r-•� M
ate Signature Bar Sink Showers /�'cj9 /W�•,a-- N
IRKERS'COMPENSATION DECLARATION T
.:ereby affirm that I have a certificate of consent to self-Insure or a certificate Backflow Preventer Service Sink S
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL • FEES
Policy No. Company
Certified copy Is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50 KW
Certified copy Is filed with the city Building Division. 0 50+ KW
Date Applicant Clarifiers . Solar Collectors Construction Pole Sub.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher
(This section need not be completed if the permit is for one hundred($100)or Solar Piping Cooking Unit Meter ❑up to 100 amps
less). DrinkingFountains
I certify that in the performance of the work for which this permit is Issued Solar Tank Dishwasher Meter Dover 100 amps
shall not employ any person In any manner so as to become subject�tp the
Workers Oefnpensatlon Laws Signature Calliorpha 2 y,_y� //�' Floor Drains Swimming Pool w/$pa Dryers ❑Gas ❑Electric Sub Panel
Wor npe ws Cal C.( 2221-Ai-Al I/ - ,�`
NOTIC f,1after making this declaration,you should become sub ect to the Floor Sinks Urinal • Fan Motors 00-1 HP Llfl`h-8 •
Workers' Compensation provisions of the Labor Code, you must forthwith.
comply with such provisions•or this permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. Inc.Solar ❑9-15 HP 016-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance interceptors Water Heater Fixtures Microwave
of the work for which this permit Is issued (Section 3097 Civ. C.) •
Lender's Name Kitchen Sink Water Service Device Boxes Pole Light
Lender's Address ies
OWNER BUILDER Lavatories 5f 4 r7 4,1/y - .3 OD Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the P—Trap /
following reason (Section 7031.5-Business and Professional Code: Any city or Switches Sign
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 Roof Drains Garbage Disposal Standing Sections
's;file a signed statement that he/she is licensed pursuant to the provisions of . '
ICJ Contractor's License Law(Chapter 9(commencing withSection7000)of
vision 3 of the Business and Professions Code) or that he/she is exempt . • Generator 00-5 KW ❑5-15 KW Trash Compactor
'Therefrom and the basis for the alleged exemption. Any violation of Section • - I
7031.5 by any applicant for a permit subjects the applicant to a civil Reinspection Fee I $25 Issue Fee $ 3 ��
LIenaity of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole MECHANICAL • Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work, and the structure is not Intended or offered - FEES
for sale (Secion 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES R UI EMENTSn:
License Law does not apply to an owner of a property who builds or Improves Boiler Hood or Type I 0 � _ KJ"Y�' _ i — �_��/
thereon, and who does such work himself/herself or through his or her own Zoning Approved By Date /
employees, provided that such Improvements are not Intended or offered for Canopy Type II 0
sale. If, however,the building or Improvement Is sold within one year of com- Duct-Under Ground • ' Building Approved By - Date _ -
pletlon, the owner will have the burden of proving he/she did not build or im- '
move for for the purpose of sale). Duct-Structural Refrigeration System Application Issued By Date
LJ I, as owner of the property,am exclusively contracting with licensed con- ❑0-100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES
The Contractor's License.Law does not apply to an owner of property,who . , �'
builds or Improves thereon, and who contracts for such projects;with a con--- Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
tractor(s) license pursuant to the.Contractor's License Law). - PLAN CHECK $ 'o PERMIT
0 Yam exempt p Section B.& P.C.for this reason ' Firepl/Fact.BIt. ICBG# ISSUANCE •'$
Oma/ �7 PLUMBING $ ( CO
Date - Owner( /.,.tAit1 Pi /' G�G.e-e•I� Heating System&Due ' g . •�5 • ENERGY P.C. $
That
PLAN CHECK 25% $
I herb certify that. have read this application and state hat the above - 00-100,000 TU 00,000BTL GRADING $
information Is correct. I agree to comply with all city and county,ordenances P-25. p/�7 QTtL S Dt3 ELECTRICAL ,$ 12-•C_n ,
and state laws relating to building construction, and hereby authorize repro- • • / PLAN CHECK 50% •
$ 9. SO MICROFILM $
Inspection
of this city to enter upon-the a.. :-mentioned pr�eFty for / •
inspection p •oses. _K - MECHANICAL $ p,.00 TOTAL 32-..5(—)
Signature • - �. /�/ . Date TOTAL FEE $
Drivers' License or SS — _ Reinspection Fee I $25 Issue Fee $ 3 Y PLAN CHECK 25% $ ( ,Zb
•
CMF 0865-46 rev.12/83 White-Building; Canary-Applicant;Pink•Accounting;Goldenrod-Assessor
1
CONSTRUCTION AND PLANNING PO :SPA
Date Inspector - Date Inspector
_- ^ PROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 5-3 bw -<,(' p3
_2. Soil Pipe-.Undrgrnd. 53.. Steel Reinforcement - -_ _ - _ - - - • .
3. Electrical Conduit Utility-Undrgrnd. 54.'Forms . _ _ _-- ___
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' , 5- -'-y j21/a • -
5. Steel'Reinforcement ( .56. Rough Plumbing & Pressure Test S-3 -Y7 41,
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE _ - - • -
O. Footings 58. Electrical Conduit-Undrgrnd.' $_3-y ' .4 0
8. Foundation ` 59Inas Spe,fi�lrtgr Test (.7 N•
5-_3 444 2 fb
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd:o_-- - -_ ..�.-
10. Structural Floor System 61. APPROVAL TO DECK .5-3.8y .4j p .
I 11. Property Seiner Line & House Connection 62. Backwash & Receptor-Final - - -
12. Sewer Cap ' ' - 63. Heater & Vent-Final 3/lr6)o LCD
13. RoofiDrains' . 64. Plumbing System - Final. - spefss,6 CG/)
14. Rough':Plumbing 65. Electrical-Final • 3`f o'f- .-(-)r7
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 Hr�( GCID .
19. Rough Heating-& Air Conditioning FIRE DEPT. REQUIREMENT - 111 . , '
20. Rough Factory Fireplace APPROVALS Permit# - - '
21.t Ducts, in Structure 70. Underground Hydro, • - '
22: ts, Ventilating 71. Product Piping 0 Gas 0 Oil
' 2_� ',?as Pipe-Rough & Test 72. Underground Flush
12 Roof Framing 73.. Undergrnd.Storage Tank 0 Gas.'❑Oil
25. Roof Sheathing 74. Overhead'Hydro - _
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27( Frame and Flashing 76. Dry Standpipe '
28. Lathing & Siding 77. FIXED'SYSTEM FINAL
29. Insulation 78. FIRE PREY. 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 pr Canopy - ., .
37. FinalFactory.Fireplace - . - . -
38. Final Plumbing .. ,. -
39. Water Service-Final
40. Gas Service-Final ''
41. Solar.Domestic-Final
42. Backflow Preventer .
43. Backflow Irrigation, • •
44. Landscape.IrrigationSystem •
45. Sound Attenuation _
46. Handicap Regulations-- - -
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed '-
49. Electric Release to Edison - - - . .
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY -
\ No. Date - - I __
1.111"rir .
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TIO� EN7.>'.
POOL AND SPA REQUIREMENTS
The following information shall be required in a clear and legible manner. All information shall
be complete or pre-site inspection will not be made. Information shall be on plans or cover sheet.
Two sets of plans showing all of the following with measurements shown from property lines,
buildings and patio covers.
1. Name, address, phone number of owner.
2. Name, address, phone number, type of license of any contractors or subcontractors.
3. Pool and/or spa location.
4. Equipment location.
5. Gas and electrical meter locations.
6. Overhead service lines and serving pole location.
7. Type of gas and electrical conduits to be used.
8. Size of main electrical service (if less than 100 AMP, service is probably inadequate and will
have to be upgraded to minimum City requirements).
9. Rating (horsepower, voltage, amps) of all electrical equipment.
10. BTU rating of gas heater.
11. Distance and size of gas line.
• 12. All electrical outlets within 15 ft. of pool/spa.
13. Capacity of spa (spas only).
14. Handrails, ladders, slides and diving boards (if any).
15. Location and details of solar panels (if any).
16. Location of doors and windows within 5 ft. of pool/spa.
17. The type of construction - gunite, poured concrete, prefabricated fibreglas or other.
18. The pool dimensions, including the depth and adequate cross-sections drawn to scale.
19. Computations, stress diagrams and other data sufficient to show the correctness of
plans; including reinforcing steel schedule and details.
20. A statement by the applicant concerning the anticipated nature of the soil under and
around the pool structure (expansive, moderately expansive, non-expansive. (A soils
report may be required by Building Division prior to permit issuance).
21. The Engineers wet ink signature is required on pool plans and calculations.
22. All semi-private pools and spas shall conform to California Administrative Code Title
24 handicapped requirements (hotels, motels, recreation areas for lease to public or
publically funded projects).
23. Where a permanently installed pool is constructed, at least one 120 volt receptacle shall
be installed a minimum of 10 feet and not more than 15 feet from the inside wall of the
pool and shall be protected by a ground fault circuit interrupter.
24. Indoor installation of spas and hot tubs, receptacles shall not be closer than five (5)
feet to spa/tub.
25. Receptacles located within twenty (20) feet of a spa or hot tub shall be G.F.C.I.
26. Receptacles for spa/hot tub motors shall be G.F.C.I. protected.
CMF 1039-46 (OVER) Gas liQ(j1
U 1)UU [I
GENERAL REQUIREMENTS /
1. If capacity is 750 gal. or more, backwash and P-Trap shall be installed.
2. All P-Traps shall tie in at lower terminus of house drain.
3. If permanent fill line is not installed, nearest hose bib shall have an anti-syphon valve.
4. All PVC shall be 18 inches underground.
5. PVC gas lines shall be tested at 60 P.S.I.
6. Pressure test required on entire system (35 P.S.I. air test or water fill) prior to back fill.
TYPICAL SETBACK REQUIREMENTS
Equipment: 4 ft. from property line
4 ft. from doors/windows
4 ft. from attic vents
18 inches from house/garage
Pool/Spa: 5 ft. from property line
5 ft. from structures
Notes: 1. Fiberglass type spas may be located 3 ft. from property lines and/or structures
with prior written approval of jurisdiction.
2. Overhead Edison drops shall be a minimum of 10 ft. horizontally or 18 ft.
vertically from water line and 16 ft. vertically from diving board or platform
and shall be triplex service cable.
3. It shall be unlawful for any person to install, remove, alter, repair or replace
any plumbing, gas or drainage piping or any fixture, swimming pool heater or
treating equipment in a building or premises without first obtaining a permit
to do such work from the City Building Division.
4., Clarification or additional information may be obtained by telephone :
75415230-or-754-5234, between 8:00 a.m. and 8:30 a.m., or 4:00 p.m. to •
5:00 p.m. - L_ 51Dl7
J
OWNER COX, ELWOOD AUG :l 1) 1961 DATE 3-21-61
JOB ADDRESS 1655 Illinois Ave. BUILDING PERMIT NO.114113
GENERAL CONTRACTOR Peter Pan Pools] Inc. VALUE $2,800.00
AP.No. LOT 63 TRACT 3648 FIRE ZONE DESCRIPTION OF WORK Pvt.Swim Pool
1 -`: zCTIONS DATE I GROUP TYPE ZONE RI
L*?, ;'"*ground Soil Th14 U.G. Water Li—A3-4 r PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing, .,4 r 'FtM 4-.) ? '/ ( 51)—�e. w..i 07,a, 3 --z"--coI �/? ','t
Miscellaneous /` G
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test
Construction Pole p�
Underground Power 'F' '4 , -A-G 1 Y
Rough Wiring i-_I"l Y—9-6/ 4.2.01te-.— A1-..24--...z4-4/ 141 Fe2.V
1
Trenches Forms SteelN7M u_A C
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
SF-,thing
e and Flashing
-1,.-sing, In Out
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final ,^' ytt.
A ,1 Z
Building, Final r+ >;a
OCCUPANCY
Form 210-5M-11-59 5-B P 114113
'9/et' 1' entrteal"
vett, .
t'4E it LCti:VPFjj
..... 61AR 211561
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA id1ESA
For 'Applicant fo Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINTBUILDING
•ADD /QSTYLT/l/ Var 4 /
COSTA MESA. CALIFORNIA For Office Use Only
/ / RECEIPT NO. PERMIT/t10.
OWNER .F7142001 _ / i/
MAIL �jrN/S A RECEIV BY O.2" RE,'�j11� DD ISSUED
ADDRESS/PA-Cr/ /j r /C`� I .J -,:,"-0'A D7 3.(-(f,
CITY ( . Q�G'Q /7/ecGL, • NELa�/c"53G/� ADDESS
_' G
ARCHITECT / /'r` TNoELMv`
li
OR ENGINEER O SCOSTA MESA. CALIFORNIA
o %Z/7y
ADDRESS #.2V / 5 Ats"/677�5' FIRE ✓��/'�'^1•'/�'C
T / ZONE TYAPE GR P
CONTRACTOR n/C A� /IL.{C .�/� BYPROVED i IJDATE 3j u/4)
ADDRESS/6443 pieevs/'ve Gip/(40 CZ/�IING
// ZON NO.
OF USE OF NEW
CITY Co 1/4." - /3 hi I I PLANS BUILDING
<b, �'
LIC.NO. �J '} r/J 7r/(/TO LEGAL 'T 6 re'? " D
8 ATE /7��.G3 NO. �''�YOTr .7" Z L
DescRlPnon //II
SIZE //Y �j /� NO. OF BLOCS. // y
OF LOT 7 //co NOW ON LOT / A.P.NO. A�� a�(-�(—'O
USE OFp /- YARDS EVES
EXISTING BLDG, /2a1Jf/L1/ C S/ 6 - C - APPROVED ALLOWED
SETBACK UNE PROM �s (CENTER LINE ST.)
CENTER OF STREET REAR TARO FRONT
tFT. /' IN.
/ I /
SIDE YARD I LEFT S RIGHT .ZS R.SIDE FT. IN.
DESCRIPTION OF WORK D,/�1
NEW I ,/Ips L.SIDE `f FT. W.
I ]1 ALTERATION I III ADDITION I REAR 4 FT. IN.
REPAIR I II MOVING I A DEMOLISH I utit
BPTPROVEOL III/) DAT 3 _ar'v
BUILDING NO. OF
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF •
COVERING COVERING
USE OF BUILDING AND WORK 0 BE PERFORMED
¶W/Mde Z.
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PLY WITH ALL CITY O INANCEB AND ST TE • REGU TING PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
BUILDING CONETR I VALUATION
SIGNATURE OF :04V n LM PERMIT FEE $ /2r
PERM ITTEF /, , � / 02 ,/ pG' �{/ .�' _,
/A//gI Ap, $ O �( PLAN CHECK $ 'w P^-
AUTHORIZED AGENT{{{{YY'"'��V��V TOTAL FEE $ •/ B
4
o - 0t _ f-. 7-- 6 - 6 /
\.,,.
r
!/Lr,6-�61'1-'ft cs_5 ///a-, /IJ , :1-zcc
;14 eta-,
/07 acti--7i217- ' - '/ 4<,7( , ��
Jz��elk-cr .-52z
/-
7 - 6/ — 2/cA
UM" !r. Lin 11-4-bti
JOB ADDRESS 1855 7JJ5nois Avenue BUILDING PERMIT NO. 29316
'--AP
CONTRACTOR Mc Rachern eamnany DESCRIPTION of WORK Repair Fire Damage
SAP No.1 3Q-04?-014. LOT 61 TRACT Q64.8 FIRE ZONE VALUE S 600,00
IN"^c.CTIONS Signature Date GROUP I & J TYPE V ZONE R-1
h`- SUBCONTRACTOR PERMITS ISSUED
Gn_
Date I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑ r� G
ROUGH WIRING Pie t' Heating and Vent.
TRENCHES 9 FORMS 9 STEEL REINF. ❑
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING — IN n OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL Ic dC 9�y����� //yy
HF'-'NG, VENT., REFRIG. AND A.C., FINAL i./4.v1///{(/tp- /L�c,t'LW4/ .4t 7/7f.
P NG, FINAL AND GAS TEST n �/ y /
ELG..i RIC, FINAL /, l'7Y-
BUILDING, FINAL /r/C /-211.4,
SPECIAL REQUIREMENTS
7_9' ' 6
-4-6sg00 061 0*****5.00
COSTA MESA BUILDINL,-.SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92020 .
For Applicant to FIJI In Completely APPLICATION FOR PERMIT
TYPE O PRINT BUILDING
wDNG/gS.S /i�ol� For Office Use
Only
RECEIPT NO. I.EltMIT NO.
COSTA MESA. CALIFORNIA 3/
/� �Q,(� RIC writ■ CA ns77 /�jj[/IB [D
OWNER l'i - (C)(/x/ylaiLLD15 I� '��'� G G
AMAILDDRESS��S`v ///won
`p ADDR /V A"114
f / wV l U c _ //��
,�pp C t1 �/ TBLLJ �J FIRE
ZONE TYP GROUP O
CITY C_ O�IN �lC ST NO. )/.f� /
ARCHITECT TEL !
APPROVED 0 DATE //
OR ENGINEER NO.
ONING
ADDRESS
_ /^✓ ZONEI NO.Or Uf[Or MEW 12t rjA-IR-
/e 4..� PLAN[ -_ BUILDING /
CONTRACTORS/64;4"%Can/ —2 I
/J ^D `�/ DESCRIPTIONLESCR 1.-0 T- Cod i rad Alq 3448
ADDRESS r? 9
L`/T✓ �/T'/A IdDESCRIPTION
I
CITY keTa �1'S/L/T-re-..l� A.P.NO. n9 — 042 _ 4
ATE �' 7 •
NOTE, NO EAVE OVERHANG SHALL BE LESS THAN
LIC..NO. /7.5
S 7o 7 NOL a. G —G VT 6. 3O'TO SIDE&REAR p.L.
EAVES
SIZE I NO.OF BLDGE. ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
c _ YARDS APPROVED YARDS APPROVED
USE OFD. q /�'�G MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. C !CC
(FROM C/L STREET)G\
SETBACK LINE FROM FRONT
CENTER OF STREET REAR YARD 15.e.i
4i
R.
v
SIDE LEFT I RIGHT //\y SIDE .41 PT.
_
DESCRIPTION OF WORK L SIDE PT.V Pr.
NEW ALTERATION ADDITION / REAR FT. FT.
DISTANCE BET. BET.MAIN ft
REPAIR ..4K- MOVING DEMOLISH MAIN BLOOB. ACCESS.BLOCS.
BUILDING NO.OP VAR.SI DATE
SIZE ROOMS STORIES C.U.P.# APPROVED /�1�
EXTERIORWALL. I ROOF COVERING S FROY[ �C��` DATE II-4—toR
COVERING
USE }BUILDING AND WORK TO BE PERFORMED IL
Drfrrr/At 6,e 1
GO.FT.
I HERESY ACKNOWLEDGE THAT NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION 1[ FOR THE C
AND STATE THAT T)il ATOP CORRE ND TO COM. PURPOSE OF ESTABLISHING A PERMIT FEZ ONLY.
PLY WITH ALL
Az
ORDI AN2-4-/i
S R[OYMTNO
BUILDING CONSTR
VALUATIONSIGNATURE P . PERMIT FEB SPBRMITT81• - " //��J ocs E
T. s L/Yn`„'� ' PLAN CHECK S ` w
i;
AUTHORIZED AGENTC—
$
TOTAL FEEJ
/
g��,._ � _E RECEI�t�
I,
COSTA MESA BUILDING-SAFETY DEPARTMENT Jr, 5Ay1h , j
P. O. BOX 917 COSTA MESA. CALIFORNIA
FINANCE DEPT.
• For Applicant to Fill In Completely APPLICATION ' R4ERmiTA MESA
TYPE OR PRINT
BUILDING r BUILDING
ADDRESS 1855 Illinois St•
COSTA MESA. CALIFORNIA For Office Use Only
I RECEIPT NO. I PERMIT blld
OWNER VertgOrit Avenue Land Co., In,
AMAIL DDRESS /119 E. 17th St. TEL y Recel I DAT^/viD�� �DAMTpy1D7}yg)
ILDING
CITY Cogta Mesa NOL181159 ADDRESS
ARCHITECT Carlson & TEL. COSTA MESA. CALIFORNIA
OR ENGINEER -"iddlcbrook NO. /
FIRE //�/ ,,
ADDRESS Garden GDOVP ZONE TYPE GROU � 1! /
CONTRACTOR Dike & Colegrove, Inc. APPROVED J
BY DATE
ADDRESS 41.9 E. 17th Sts ZONING
CITY Costa Mesa ZONH I NO.NS2 I USE LDING w/atl..L�m.
R-1 w/ att_Rar•
STATE TEL. T= LEGAL
LIC.NO. 167293 NO. ILL. 8-1]59 DESCRIPTION Lot 63, Tr. 364.8
SIZE NO. OF BLDGS.
OF LOT 601 X 1001 NOW ON LOT none A.P.NO. none
USE OF YARDS EVES
EXISTING BLDG. None — APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.)
CENTER OF STREET 551 REAR YARD 251 FRONT 5-0 FT. IN.
SIDE YARD I LEFT 71 I RIGHT 71 R.SIDE 7 FT. IN.
DESCRIPTION OF WORK (7
L.SIDE FT. IN.
NEW I X II ALTERATION I II ADDITION I REAR ,Q 5 FT. IN.
REPAIR I D MOVING I II DEMOLISH I APBYPROVED W. L. D. DATE 5-13-60
SIZE G3b5 s9• ft.ROOMS NO. OF 6 STORIES 1
(Ill
SIZE 1 —
EXTERIOR WALL ROOF la
COVERING Stucco I COVERING Camp. & Rif
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence with
attached ggraee. Plan 10A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTIO . VALUATION
SIGNATURE OF „ PERMIT FEE $ 3/1.,
PERM ITTEP m_
$ 14,179• PLAN CHECK $ 17. e` •
AUTHORIZED AGENT Dike Colegrove, Inc.
TOTAL FEE $ 51e 0