HomeMy WebLinkAbout2905 JACARANDA AVE - Building PermitsPERMIT TYPE
CITY OF CO`STA M�SA
BYILDING DIYISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856
B_ROOF
FOR INSPECTIONS CALL: (714) 754•5626
PERMIT
• www.ci.costa-mesa.w.
NUMBE . B07-00787
STATUS: ISSUED
DATE ISSUED: 06119I2007
' ISSUED BY: SOK
JOB ADDRESS: 2905 JACARANDA AV CM _;; ''- Suite/Unit
Vicinity: ROOF Const„Type `�??; �=;._
SQ. FT: 2000 Valuation ; $5;600;00
t.
SCOPE OF WORK: -TEAR OFF�EXISTINGROOF.� INSTALL 2 LAYERS OF TITANIUM UDL 30�SYNTHETIC FELT, 2.5:12 PITCH, 30 YEAR
CERTAINTEED COMPOSITIOMSHINGLES, AND� -
REPAIR/REPLACE SHEATHWGAS'NEEDED.��20 SQUARES INCLUDES ATTACHED GARAGE
OWNER: CONTE, MARIO D �, $ ., • Address. -��. 2905 JACRANDA AVE ~Unit: ��.
PHONE: - � CitylState/Zip - COSTA MESA; CA � � . ' � �
APPLICANT: BRIAN ATKINS � Address: 23571"WHITEDOVE DR�' Unit:.��:
PHONE: 949-597-0'192., �" �,�-CitylState/zZip:�,'",LAKEFORESTCA-
CONTRACTOR: SOUTH COUNTY.ROOFING ��:. - -� � � ' License No.�� �� �737515 � �
Address: 23511 WHITEDOVE'DRUnit, `�c' � ,,. �- , .PHONEi �' �949-597-0192
... .
City/State�. LAKE F,OREST CA � = ZipCode. 92630 - , , _. . CELL: .. � '
� . � � ��,.
ARCHITECT: License No. . .: '. �FHONE:'�
ENGINEER: ` License No. �... ''���? :�� PHONE:�
'_ . . - �,.:-.:. _ .
t ��
FEE SUMMARY
Reroof PlanChecki n''$000����.,;� � � �� -
Reroof Permit Fee: $12'5�25 �� � ,
Reinspection Fee: � $0 00 , , _,_ ,� �
.. e,t."., . -<` :--
TOTAL FEES � $125.25 �'��V` - '
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 authonzed under this permil to be considered legal, such wo�k must comply with all applicable wdes, and all
required inspections and final approval must be obtained. Failure lo obtain inspections and flnal approval will result in the ezpiration of this permit.
COUE /. INSPEGTION TYPE
16t6 Fined System Final Fire Prevention
7266
200
201
202
203
Pool Spa Final
Final Re-Roof
Final Block/Relaining Wall -
Final Factory Fire Place
Final Sign
204 FinalOemolition
DRTE INTTALS
COOEN �x5vecnoNTrve
208 Final Mechanical
208 Final Plumbing
210 Final Electncal �
212 Pinal Pire Preventi0n
220 Final Planning Approval
222 Pinal Site
250 Final Building/Occupancy
� IN7ITIALS
WORKERS' COMPENSA710N DECLARATION: R,
I hereby affrm untler penalry of perjury one of Ihe M1,. .�g tleclarationsi
❑ I have and will maintain a certificate of consent to sel6lnsure:for workers'
compensation, as provided for by section 3700 of lhe Labor Cotle, for Ihe
p�erf�or nce of the vrork for which Ihis permil is issued. �
Cjd I have and will maintain workere' compensation insurance, as required by
s lec an 3700 of the Lahor Code, (w the peAormance of the wurk (or wtiich Ihis
pertnit is issued. My workers' compensation Insurance carrier and policy
number are: 1
Carrier:��w�� GuvVd1
L�(ihis section need no(f�be mmdetetl—tl1the perm� is v�alu,e/C� a�t one hunOred tlollars (S100J a less )
CPalicy Number:, - � l99%U I� 2���10
�"'
❑ I certify that in the peRormance 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 vrorkers' compensalion laws of Calitornia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the L bor e, I hall forthwith comply with these provisions
_9 �0
Applicant'sSiynaWre - ! �ate��
� � J
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
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, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pmfassions Code, and
my license is in full force and eRect. 2
Lic. # .— ✓ 5 � �—Class #' �'✓
��� G 7
Co roctor's Signawre oa�e �
��.��... ,
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrtn ihat there is a constmction lending agency for the
pedortnance of the work fa which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OW NER-BUILDER DECLARATIONS:
I hereby affrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5,
Business antl Professions Cotle: Any ciry or counry which requires a permit to
consWct, alter, improve. demolish, or repair any sVucture, prior to ils
issuance, also requires the applicant for such permit to fle a signed statement
that he or she is licensed pursuant to the provisions o( lhe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or thal he or she is ezempt �here(rom and
the basis for the alleged exemption. Any violalion of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred tlollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensa[ion, WILL DO THE WORK, and the StrucNre is not intended or
oReretl for sale (Sec. 7044, Business and Professions Code: The Contrectors
License Law does not apply to an owner of property who builtls or improves
thereon, and,who does such vrork himself or herself or through his or her ovm
employees, provided ihat such improvements are not intended or offered for'
sale. If, however, the building or improvement is sold within one year of
completioq the owner-builder will have the burden of proving dhat he or�she
did not build or improve for purpose of sale.).
❑� I, as_ovmer of the property;�am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS lo constmct Ihe project (Sec. 7044, Business and
�Pmfessions Code: The contractors License Law dces noFapply to an ovmer of
property who builds or impmves thereon, and who contracts (or such project with
a contracta(s) license pursuam to the Contractas License Lavis.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre • . Dale
305]-O6(3/0])
Ovmer ID verifed by drive ;e. ❑ Yes ❑ No
Driver's License No. Expires:
�
Verifcation�of Ovmership by (type of document, i.e. - propeAy tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMI7 CERTIFICATION: �
❑ I hereby ceridy Ihat no excavation (rve (5) or more feet in depth into which a
person is required to tlescend, will be made in connection with vrork autFwrizetl
by this permit, antl Ihat no building stmcture, scaffdding, falsework, a demolition
or dismantling thereof, will be more than Ihirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administ2We Cotle).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit (mm the Division of Indusirial Safety, as no[ed above, unless
such person has a permit to do such work from Ihe division.
Appliwnfs SignaWre
Divisionnt IndusMal Safety Permit Number. _
HAZARDOUS MATERIAIS 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 Califomia Health and Safery Code requires, with some
exceptions, ihat a Business Plan be filed wi[h 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 o( 55 gallons, or 200 cubic feet ot compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant neetl to file
a registra[ion form for acutety hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Heal[h and Safety Code, with some
exceptions, requires regis[ra[ion with the Costa Mesa Fire DepaRment 6y
each business which al any one time has on hantl a quan[i[y o( 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 stantlard
temperature and pressure).
3. Does or will the applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Managemen[ and Prevention Program for acu[ely
hazardous ma[erials�? ❑ Yes ❑ No
(Section 25534 of the Califomia Heal[h and Safety Code provides that the
Costa Mesa Fire DepaAment may require the preparation, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire DepaRment.
4. If an RMPP is presently required, has Section 25534 0( [he Califomia
Health and Safety Code been fully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is lhe subject of this application a permit for such construction
or motlification from the South Coast Air Quality Managemen[ District or fmm
any other air polWtion con[rol tlisMct or agency? ❑ Ves ❑ No
(Secibn 65850.2 of the Cal'rfomia Govemment Code requires that the requested
infortnation be tumished on applications for non-resitlential building permits).
6. Will any part of Ihe �acility to be consWcted untler this permit be within
1000 feet from the outer boundanes of a school? ❑ Yes ❑ No
(If 'yes", the faciliry must meet Ihe requirement o( Sections 25534 and 42303
of the California Health and Safety Code�.
7. If a permit from the South Coast Air �ualiry Management Distnct or other
air pollution coMrol dis[rict or agency is required for [he vrork which is the
subject of this application, have all of the tlisclosures prescribed by Califomia
Health antl Safety Cotle Seclion 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance from the appropriate air pollution
control offcer). ,
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury [he
information given above is coriect. f agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and-Emissions. �
SignaWre � Date _
CERTIFICATE OF COMPLIANCE AND� AUTHORIZATION OF ENTRY: I
certify untler 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
ortlinances relating to building construction, and authorize representatives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree nol to occupy or allow.occupancy of any building
authorized by this permit until fnal inspection.
i nal e o( Legal 0 ner(s) ate� �
(7 O
�Antllo� AulhonEeO Applit�an( Oate
_.:.. � _ _.
ADP���ant to fi11 in a11 spaces exeept those witnin heavY bortler Ilnes antl sign all aoo/oo��ate aeclarations.
C�TY� COSTA pESA CON TR UCTION PERMIT PEFj(v11T NO. ,„„ TRACT NO. LOT NO. UNIT NO. .
�oject Address �/� � � -����M��-% �-� -
Applicant's M!a�il[in.g��Address d �.0 Q�.
Owner's Name i1J��i��/ � rny'/�� � �P�`^ne -5-� � �`�
Addreu o�9/%.T /it!l�iJil�P��A/ � J%'7 .
Arch/Eng. License No.
Address
Contractor's Nam Phone
Address (mailingl
Ciry License No.
LICENSED CONTRACTOR DECLARATION
I hereby affi�m tnat I am IicenSetl untlar provisions o1 C�arter 9(commencing
with section 7000) of Divislon 3 of tha B si esz antl Professionz Code, antl
my licenze is in f W I force ana elfect.
License Qass LI ense No.
oate Signature
, -VORKERS'COMPENSATION DECLARATION
fiereby afti�m that I have a certititdte o( COnS¢n[ t0 Telf-in5ur! or a cerLiticat¢
�f Workers' Compensa[ion Insurance, or a certifietl cooY tnereof (Sectlon
3800, Lab. C.)
Policy No. Company
BCertitieC copy i5 her¢by fumishetl.
Certifietl copy is filetl with the city Builtlin9 Dlvision.
Date Appliwnt
E%EMPTION FROM WORKERS' COMPENSATION DECIARATION
(Tnis section nee0 not be completetl if [he permit Is for one huntlretl ($100) or
less).
I cerlify ihat in the pertormanGe Of the work tOr whlch this perm�t is Issuetl I
zhall not employ any person in any manner so as to become subj t to t�e
Workers'�Cp m e satio I�aws of Califor
_ Date '�`��—�3 Siqnature �� ��� �_�� ��
'NOTICE: If, after making tnis tleclaration, you 5houltl become zubject to the
Workers' Compensation provisions of the Labor Cotle, You must forthwi[n
compty wlth such prOvi5ion5 or�this pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby afti�m that there is a const�uctlon IenGing a9ency for the performance
of the work tor whicn tnis permit is issuad (Sectlon 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress , � �
OWNERBUILDEH OECLARATION
I hereby affirm that I am exempt from the ConVactor's License Law tor the
following reason (Section ]031.5 Business antl Professional Cotle: Any ciry or
counly whicM1 requires a pnrmit [o conStruCt, alte�, imp�ove, tlemolish o� �epair
any sVuclure, prior to Its Issuance, also requlres the applicant for such permit
to file a signetl sta[ement that h¢/slte is licensetl pu/suant [o lhe provisions of
'he Contractor'S License Law (Chapter 9,(Commoncing with SeGtlon 7000) o(-'
/ivision 3 of tne Business antl Protessions Cotle) or that he/5he is exempt
,nerefrom antl the basis tor [na allegetl exemption. Any violaHon ot Section
/031.5 by any applicant for a Permit 5ubject5 the applicant to a civil
�nalty of not more Uan five huntlretl tlollars (E500).
I, as owner of the property or my emoloyees with wa9es as their sole
mmpen5ation, will tlo Ihe wo�k, antl tlte struc[u/e I5 not Inlentletl o� ofteretl
for sale (Section 7044, Business antl Protessional Cotle: The ConlractoYz
License Law tloes not apply to an owner of a property who builtls or imoroves
thereon, anC who tloes SucM1 work hlm5elt/he�seli or tnrOu9h his or ner own
employee5, pfovitletl lhal suCh Improvement5 are not Intentletl or ofteretl to!
Sale. It, howeveq the builtling or improvement Is Soltl within One yea� of com-
� D�etion, tne owner will have the burtlen Of O�oving h¢/She tlitl nol builtl or im-
prov0 for [he Ou�Oose ot Salc).
❑ I, as owner oi the prop¢rty, am exclusivery contractin9 with Iicensed con-
tractors to con5truct the prolect (Seclion 7044, Bu5ine55 antl Profession5 COtle:
The Contractor's Licanse Law tloes not apply to an owner ot pmperty who
builtls or imp�ovCS LM1e�e00� dOtl wh0 contracts tor Suth pmject5 with a wn-
tractor(51 license pursuant to lhe ConlraGtOr'S Ucense Law). 1 am aware that
proof o( Iheir Worker'S Compensatlon Insutance shoultl be prOvitletl to me.
❑ I am exempt untler Sectlon B. 6 P. C. for lhis reason
XDate - — Owner •
I hereby certify that I have reaa this appiicatlon antl state that the above
information �5 cortect. I agree to ComO�Y �+��h au city antl county ortllnances
antl state lawi relatin9 to bvilUing construcllon, antl hereDy authorize repre-
sentatives oi this city to enter•upon thq, aoove-mentionetl property for
inspection o�lA�se� CJ // ,�. � /, ��
�� Signature y'�Q- < <-��- Date�
Drivers' License 55 � � �/«*-�+���
TYPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION LJ REPAIR
, ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
' � -
TYPE OF PERMIT GRADING FOUNDATION ST UCT AL �
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ -OTHER
PRQIECT DESCRIPTION Sq. F �_oCCU�NCV _
CONSTRUCTIONTVPE �ALUATION �
GRADING CU. VDS.
Rema�ks:
Sink
Preventer
Irri9ation
rinkin9 Fountains
loor Drains
loor Sinks
as Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspec[ion Fee � $75
Boiler
Duct - Under Ground
Duct - Structural
Duct � Ventilating ,
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heatin9 System & Ducting �
❑0.700,000 BTU 0100,000
Reinspection Fee � $15
CMF 0865-46, rev. 10/B4 Wni[e - Builtling; Canary - Applicant; Pink - Accountin9: Goltlenrotl - Asussor
Showers
Service Sink
SewerCap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash .
Laundry Trays
Issue Fee
Hood or Type I ❑
Canopy Type II ❑
Refrigeration System
❑6100,OOOBTU ❑700,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
EES
$ 3
FEES
E3
A.P: #t
5 Main Build
E
T Front
8 Rear
A
C Ri9ht
K Left
$
Ping. Ref. #
� � '13u9 k/17/�5
- Zone
� Accessory Building:
, Parking fleq./Provided
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Oryers ❑Gas ❑Electric
Fan
F.A.U.
Fixcures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator DO-5 KW 05�'
Fee
ELECTRICAL
Transformer ❑ 75-50�KW
❑ 50+ KW
Meter ❑up to 100 amps�
Meter ❑over100amps�
Sub Panel
Motors �0.1 HP � 1 h- 8
Inc. Solar �9-15 HP ��16-15+
Microwave '
Pole Light
Range
; Standing Sections
5 KW Trash Compacror
$15 luue Fee
15.GG TL
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
$
DEVELOPMENT SERVICES REQUIREMENTS:
2onine Approved By Date
Building Approved By Date
Appliption Issued By Dat ��
� SUMMARV OF FEES
BUILDING PERMIT ' $ �S � -ri/7 SMIP' $ `S�
PI.AN CHECK , $ PERMIT .
PLUMBING �S ISSUANCE $
PLAN CHECK 25% .$ ENERGV P.C. $
ELECTRICAL ,$ GRADING $
PLAN CHECK 50% .$ MICROFILM $ ,/_ ��
MECHANICAL $ TOTAL FEE $ �
PLAN CHECK 25% $ �
`. �ONSTRUCTION AND PLANNING PO� : & S°A
' PPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspectnr
� i. Temporary Elect�ical Service or Pole 52. Pool�& Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -
3. Electrical Conduit Utility�Undrgmd. 54. Forms � -
.4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
-6. Electrical UFER Grnd. 57. APPROVALTO COVER�GUNITE
7. Footings � - . 58. Electrical Conduit-Undrgrnd.
B. Foundation � 59: Gas Pipe; � Undrgrnd., Test
�9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
•10. Structural Floor System 61. APPROVAL.TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Elec[rical-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 8ar Ceiling - 69. POOL/SPA SYSTEMS FINAL
19. �Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough FactorY Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Undergraund Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test ' 72. Uadergrou�d Flush
24. Roof Framing , 73. Undergrnd. Storege Tank � Gas ❑ Oil .
' 25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
�� 27. Frame and FlBshing 76. Dry Standpipe
� 28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailin9 HEALTH DEPT. REQUIREMENT.
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes:
34. Final Heating & Air Conditioning � ' ,
35. Final Gas Pipe-Test
36. Hood or CanaPY
37. Final Factory Fireplace �
38. Final Plumbing �
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestio-Final � .
42. Backflow Preventer
43. Backflow Irrigation ., � ' •
44. Landscape Irrigation SVstem
45. Sound Attenuation ' '
46. Handicap Regulations , � � �
47. FINAL STRUCTURE & BUILDING G+N � .
48. Special Requirements Completed •
49. Electric Release to Edison � , - � ''
"50. Gas Release to Southem California Gas Co • ,
51. CERTIFICATE OF OCCUPANCY _ .
' N�: Date ' -
C /(�^ \ i
F. !.1 i�.1 tJ:.
��' ��'��a�: ��lv d3'�:,��`.,�' ���C�.�'.'�liuu+;�SiC���t;?�j c�� �cuE.�leva ��Ci�c.r_iq �i�c.
: '
� c� � �, �•� e ^ �i---
�� ��� I7 ��\� L 7.0. 3v)' u] . 3i10 ?J?.PO.; WAY .:OP1G ccP.Gi. ChUF. 4C5'vl .�i131 '.Z�-�'-=i . �?!iJ 676�23Ei . �i15� 8:8.64J2
_I L, �n• .;. �.. o.� ces:
=.;._-�:��.s�:S
1'ESiI`G �s�..cn.�o„��,,,�.._.,... --:::..-:._; �:o-c.�...:�� ,;.,�._ �
� S,�:n-e.Ce!. ..a);.1 fi.ai�r�. ?.C.so..;
' i r.-� :}�
111�1 d:l ]J�. � :� . Lc-p BmcM1, Gelll. 9ce01 �1U� We�zlee
���-�':�:.�-
August 2, 197G Examination: 76-4b83
GUNI'lE
COMPRESSION TESTS O?d �.Cdd'a',�£'[F CYLINDERS �
Bob �:encersoe
17817 San Raiael
Fcuntair. Valiey, Galifornia 90708 ����
�ROJECT SWI?�'.h1ING POOL
ADDRc55 ?90i Jacaranda Avenue, Costa `tesa, California
SAMPLE FROM ��3 fro.*=i Deep Ead on Bond IIeai�, :'fl from Shallow end on floor,
,',f.i fro� SPA
AF:XITECT
E401NEER
B. C. Ad�s
t,hlX
DATE CA57
DATE TESTcD
CYLINDER NO.
COMPRESSION
TOTAL IOAD,'IBS.
POUPIDS PcR SQ. IN.
COMPIIANCE
3.�
7-26-76
8-2-76
1
7 Days
79,000
2,i95
CONiRACTOR '
BI:�C' t�001S
SUBCCNiiACTOR
Gur.�te tinlimited
� SPECIFIED
SSR:NGTH
SLUMP
8-2-i6
3'
7. Da}'s
76,000
2,690
7-Day tests comply with specificatioas.
auoe ar
CYLINpERS � Lew
DiS:RIbVTION: J
Bob Hcaderson - 2
Cesta ,tesa Buildin� Dept.
DElIVE4ED�0C
Bob Fie.^.de:son
2,000
8-2-76
S
7 Days
73,000
2,580
RECEIVEO ON
7-27-76
�tl{LDlP"G. ���=�,�Y DEP�'.
•�l q[o0�1T5 wRE SVOMIiT�D �5 iN� CO�'fIvC4:1�I, 1`qCI�CRTV O! CLICN'S. �V:�ORI]wi10Y fOR 1`VOIICATION Of�OVM >EPOP . CONC��.
9R4R5 �RO�' Oa p�GARCu�f Ti�Cu �•. aE5[VVC^ PCNp�N. OUR wYiCiEn nr'nBO�'�: �5 e MVi'JnL PnOiCC'IOH i0 CUENTS. TME PUptK wf/O OVFS[�VC4.
��; 33C92 � .
OWNER CONTE, M.
JOB ADDRESS 2905 Sacaranda Ave
GENERAL CONTRACTOR Rargp Pnn'
AP No. 139-284-28 LOT
��INSPECTIONS
0 Pool Location �
�� C,......
� ain Drain
Steel Reinforce
Elec. Bond _
Approval to Cover _
Underground Electric.
Gas Piping Test _
Filtering System Lines
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final
Filter System Final
Backwash and Recep. Final
Q.� ��C'�•�
DATE 7_7_76
BUI JG PERMIT N0.
SUBCONTRACTOR
E lectr ic
Plumbing
�'��1�
- 42248
� COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use !nk Only
F
C
W
6.
a
y
h
S
F
G
u�
h'
Q
�
J
Q
�
�
�.1
C
v�
a
O
�
a
Z
{r]
S
3
OWNER '
MAIL
AODRESS L
CITV
CONSTRUCTION
LENDER
BflANCH
ADDRESS
ARCHITECT
NO.
L.
pa��
�,�� -7-76�,.-�0 49fi':� t:;�::::S�.�C
APPLICATION FOR STRUCI'URAL PERMIT
A.P. NO(•
BVILDING
AOORESS
OWNEfi
"CXY�I�) I
q� d' ✓Rr,.9Q.�r��—
71��T LOTI `/'� BLOCK
ADDRESS � l' � �U �'i-�rLU'P�/`M/✓'^"� `�%J ZONE TVPE
� APPROVED
CONTRACTOR BY
ADDFESS /�/ CC�--n/
TE . / / Z E NO.OF US
CITY N j G I b � PLAN$ � BU
LIC. NO. O v� LICyNO. vMAIDN BUILOING P
512E NO.OF BLDGS. / (FROM C/ STREET) .
OF LOT NOW ON LOT
USE OF /� � �p���
EXISTING BLDG. �: 1�.Li�(�/fj�n/-- (J✓�" L�
�p �
Separate perm are rAquired for
electric, plumbing and heating work.
USE OF BVIIDING AND WOFK TO BE PERFORMED
DISTANCE 8ET
MAIN BLDGS.
VAR. �W
C.U.P. W+
I hareby ecknowlatlpe thet I hava reatl Mif apPllcatlon end stata
thnt t�e ebova Informption Ie corroct ontl oproo to comply wlth
all laws re0ulatlnp bulltlinB conrtructlon, antl I a�oll not employ
ony person In vloleilo� of Me workmen's compenmNon laws ot
No State of Calilornio.
I hemby cartity MeI I nm properly Ilconwtl as e conAecror undar
i�e Stero of Califarnla Busineu entl Profeuions Code, Olvislon 3, THE AMO
Chepter 9, antl that suCh 1(censes ere In full force end effect, or I THE PURM
om exempt tram Ma o�ovisions of the Stete of Celifornia B�sinacs V ALUATION
and Professions Co , tl�����on 3, Cha�r�
Slpnature of
Pormittae � 5 / � �
Authorizotl AOent
VALUE
DATE / � / �-
APPROVED
)i
/
BEf. MAIN &
�
n
m
i
m
m
FT. N
f SHOWN UNDEfl VALUATION IS FOR m
OF ESTABLISHING A PEFMR FEE ONLY: �
PERMIT FEE E a
N
m
PLAN CHECK E �, Qb ^'
0
/ �O LL
TAX E f
U
TOTALPAID S
' Z���9
C�STA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA• CALIFORNIA
FOR APPI/CANT TO F/LL /N COMPLETELY
TYPE OR PRINT
noo e�s"s 29�5 Jacaranda Avenue
COSTA MESA, CALIFORNIA
OWNER Adams Acres Inc.
ADDRESS '+-�9 E• 17th StI
c�rr Costa Mesa TNO. �O�S%
nw�w�ra�nEucco C32'ISOLI 8c u�n
0
LEGAL ILOT �1./]
DESCFIPTION NO. '�� �
A.P. NO.
512E �j'z X qg I ruo. ov e�ocs
OF LOT NOW ON LOT
USE OF �
EXISTING BLDG.
6ETvqGH LINE FROM bOj REAR YARD
CENTER OP BTRECT
SIOE YARD LEFi' b� RIGHT 6�
DESCRIPTION OF WORK
BUILDING 145� ROOMS
SIZE
EXTERIOR WA��uCCO IROOF
COVERING COVERI
attacnea garage.
I HEREBY ACNNOWLEDGC TN�T 1 XAVE HEAD THI6 ePP4CATION
M1ND 6T�TE TNM1T TNC ABOVE IB CORFELT AND AGREE TO COM-
PLY WITH ALL CITY OPOIN/�NCE6 ANO STwT �W9 REGULATING
BUILOIN6 CONSTHl1�N.
SIGNATURE OF ��
PERMIITEE
AUTHORIZEO AGENT Dilce & Cole�rove yi1C
vmi
' .' ��j�'7 f959 ..._
-��,ia,-�.,r ,--.�j
�1� . , .. . .. ..
APPLICATION FOR PERMIT
BUILDING
�oR afficF usF oHcy
t REC�IVEO I^11p�T�C
I cr Nuu i
COSTA MESA. CALIFORNIA
APPROVED
ZONING
ZONE� I I PLANB 2 I BUELDINOEW V V
_ �Y�
APPROVED
BY C DATE � I�
REAR
TH! ANOUNT 6HOWN UNOER VALU�TION 18 FOfl THE
PURPOBE OF EST/�BLI9HINO I. pERMIT FEE ONLY.
VALVATION
14,552.0o PERMIT FEE $ 34��
g PLAN CHECK $ 1( �OO
TOTAL FEE $ 5�•�