HomeMy WebLinkAbout3109 JEFFERSON AVE - Building Permits,� ,
4.
� CITY OF COSTA MESA " ` " ' ' ' '� �"" ''
, . .. ,
BUILDING DIVISION
P FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesasa.us �. � : _�_
, FOR INSPECTIONS CALL: (714) 754-5626 . � ' , .. - . � -� �.
PERMIT NUMBER: M08-00097. _
PERMIT TYPE MECH
APN: 14165232
JOB ADDRESS: 3109 JEF
Vicinity:
SQ. FT: 0
SCOPE OF WORK: MECHANIGAL9
RELOCATE AND REPLACE.AN (E) F.
OWNER: BAUERMEISTER;•KIRKP,
PHONE: 714-032-1989
APPLICANT: BAUERMEISTER KIRK=P
PHONE: 714-432-1989 _
CONTRACTOR: OW NER-BUILDER
Address: Umt:;�s %
Ciry/State. ..
MECHANICAL PE
MECH ITEM FEE: �
PLAN CHECK FEE:
INVESTIGATION FEE:
�REINSPECTION�PEE:
��� y'��y
. STATUS:
TE ISSUED:
ISSUED BY:
Suit
O-INSTALL A NEW A/C UNIT < 100 K-E
K BTU. REF#: C08-1502 AND E08-002i
E ,,,,. , " � .�Address ? 3109
"� City/State/zZip: CO
- Licen
c.
$53.10
„ $p0 00
4 ",�pVO �� i 2`.;.� t
$ YO 00
r"
TOTAL FEES: $53.10 �
:i� �� �
„� r
0
\
ISSUED
06/30/2008 �••.�;�
RMD
, ' .y "';.
'
y'
;ATED=AT SIDE YARD AND � � -
n.,E .
ON AVE;.,Un�it: �
CA �.; . � ; �'; � , . . . . � �
ONAVEE�Unif�-,, . . . � � ��
CA �.:q � . . , ..
�0000 ";'
: H._
S:r ♦
�4r .
�t
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Calitornia statules and related
regulations. (Ord. No. 92-28, § 1, 72-27-92) . - � .� � , � � ' � , � - ': -
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . , _ ,.. � �� . ;
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply�with all applirable codes( and all
required inspections anii final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
.r
CO�Et' INSPECiIOXTYVE � OpTE INIIlIALS CO�EA INSPECTIONTYPE � _ �� U4TE . Mnn,us
1616 _ Fixed System Final Fire Prevention ' . 206 Pinal MechanicaP � � , �a
1266 Pool Spa Final � ' 208 Final Plumbing _ ' � � " - ' /�� � �
200 Final Re-Rwf . - 210 Final Eledrical � � � - -r �i � � �
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 ' fi 250 � Final Building�Occupancy - ' -
� �
WORKERS' COMPENSATION DECLARATION• ' � �' .
I nereby aKrtn untler penalty of perjury one of the following declarations.�. �
❑ I have and vnll main�in a certifcate o! consent to self-1nsu�e !or workers'
compensation, as provitletl for by section 3700 of the Labor Code, for the
pertormance of the work (or which ihis�permit is issued` �
❑ I have and will maintain workers' compensation insurance, as requiretl�by
section 3700 of the Labor Coda, for the performance of lhe v,�rk for which this
pertnit is issuetl. My wa�kers' compensation Insurance carrier and policy
number are:
Cartier.
(T�is sed.on neetl rrol �e cOmpeletl i/fl�e pemrAis valuetl at rne nunOretl Mllars (5100) a less )
Policy Number:
�g*I•certify [hat in the peRormance of [he work for which Ihis permi[ is
is ued, I shall no[ employ any person in any manner so as lo become subject
to the vrorkers' compensa[ion laws of Califomia, antl agree thal if I should
become subject [o the kers' c nsation pmvisions o( Section 3700 of
ihe Labor �, I s rdfl o with ply with these provi� n$.�D�
�_ �
ApplitanfsSig aMre "�y��"=0a�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS
PROVIDED FOR IN SECYION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm tha[ I am licensed under provisions of Chapter 9(commencing
with Section 7000) o( Div�sion 3 0l the Business and Professions Code, and
my license is in full force and effect.
Lic. # Class #
Conireclor's SignaWre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a constmctbn lending agency for the
peRormance of the v.ork fof wliich this pertnit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereDy aKrm that under penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW !or the following reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit lo
construct, alter, improve, demolish, oi repair any structure, pnor to its
issuance, also requires the applicaM for such permit lo Ne a signed statement
tha[ he or she is licensed pursuant to the provisions of the Contrectors
License Law (Chapter 9(Gommencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or [hat he or she is exemp[ there(rom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applican[ to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as ovmer of the ploperty, or my employees wilh wages as [heir sole
compensation, WILL DO THE WORK, and the structure is not intended or
oflered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not app�y to an owner of property who builds or improves
thereon; and who does suGh vrork himself or herself or Ihrough his or her own
employees, provided that such Improvements are not Intended or offered ior
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builtler will have the burden of proving thaGhe or she� �
did,not build or improve fof purpose of sale.)..
��, as oJmerof the pfoperty, am EXCLUSIVELY CONTRACTWG WITH
`' ENSED CONTRACTORS to construct the project (Sec. 7044. Business and
Pro essions Code: The contractors License Law dces not apply to an owner of
pmperty who builds or improves the2on, antl who contracts for such project vrith
a cartracta(s) license pursuant to the Contractors License Lavrs.�.
❑ I am exempt under sec.
Business and Professions Code for this reason:
� � �ai��
t
� �Si9na�ure/ . . •Da�e_.�
305]-06 (3/0])
� ,
'' Ovmer.ID verified by dri.,v/El'S}I�,ense. ❑ Yes ❑ No �
.Drivar's�License�No. � ���� �Expire_ s�: �zC�!3
� [, -���: ��_�+
� Venfication of Ownership by (type o! tlocumen[, i.e. - property lax bill or deedj:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .��-
❑ I hereby certAy that no excavation (rve (5) or more feet in depth into which a
person is required to descend, vrill be made in connectbn wilh work au[horized
by Ihis permil, antl that no building s�rucNre, sca(ldd�ng, falsework, or demolition
or tlismantling thereoF, vrill be more Ihan thirty-six (36) (eel hlgh (Chap. 32, Grp
2, Art 2, Sec. 347, Ttle 8, Califomia Administrative CAde).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit (rom the Division of Industrial Sa(ety, as noted above, unless
such person has a permit to do such work from the division.
ApPliwnfs SignaWre
Division o( Industnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or fuWre building occupan[ need to file and
certify a Business Plan for emergency response lo release or threatened
release oF a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Heal[h and Safery Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has a[ any one time tluring a reported
year a quantiry o( hazartlous materials equal to or greater ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
al standard temperaWre and pressure).
2. Does or will Ihe applicant or present or future building occupant need to file
a registration form /or awtely haza�dous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which a[ any one time has on hand a quanti[y of acWely
hazardous materials equal lo or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
temperature and pressure). �
3. Does or will the applicant or present or fulure building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe California Health and Safety Cotle provides [hat [he
Costa Mesa Fire DepaRment may require ihe preparation, certifcation and
fling wilh Ihe Fire Deparlment of an RMPP by businesses which are requirea
to register awtely hazardous materials wilh lhe Fire Departmenl .
4. If an RMPP is presently required, has Seclion 25534 of the California
. Health and Safety Cotle been fully complietl with? ❑ Yes ❑ No ,
5. Does or will Ihe applicant or present or (uture building occupant require for
the work which is Ihe suDject of Ihis application a permit for such construction
or modification from [he South Coast Air Quality Managemenl DisVict or fwm
any other air polWlion control district or agency? ❑ Yes ❑ No
(Section 658502 of the Calitomia Govemment Code requires that the requested
in(ortnation be fumished on applica�ions fa non-residential building pertni[s).
6. Will any part of the facility to be constmcted untler this permit be within
1000 feet from ihe outer bountlaries of a school? .❑ Yes ❑ No
Qf "yes", the facility must meet the requiremen[ of Sections 25534 and 42303
of the California Heal[h and Safety Cotle).
7. If a pertni� from the South Coast Air Quality Management DisMct or other
air polNtion conirol district or agency is required for Ihe vrork which is the
subjecl of this application, have all of the disclosures prescribed by California
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
'B. (It "yes", attach ceAificate of�compliance f}omlhe app�opriafe air pollution
coritrol officer). � � .. . . . � .., � �. ,
CERTIFICATEOF COMPCIANCE: I�certify'thaCunder�penalty of perjury.the
information given above is cortect. I agree,to,comply with all state laws and
, city ordinances iegarding Hazardous_ Materials and�Emissions. ' �
SignaWre ' Oale �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF� ENTRY: I
certify under penalty of perjury that I have read this applicalion and state Ihal
the intormation given is correct. I agree to comply with all state laws and city
ortlinances rela[ing ro building cons[ruction, and authorize�representatives o(
Ihe City of Costa Mesa to enter upon Ihe above-descnbed property for
inspection purpoj es-. I agre ot [o o� n�.y or allow occupancy of any builtling
authorize b liis eQnit � fln Nfis ectio . �
G�p�� '
SignaWreo! egalOvmeqs) Dal. e_
��_��
� �J
MplorAW�orize4Applicant Dale
eddress:
�
�� a� L� �� S'uiE'd.�y �u<idiac�
OWNEit—��IILD�R
VERIFICe�T10N
Permit #:
A ciry or county, which is required [o give notice pursuant to Section 1983Q shall attach to such notice, and, a's "
a condition precedent to issuing a building pemlit, require the completion and require the retum of, an owner-
builder venfication.
Attention Property Owner:
An `owner-builder' building perniit has been applied forin'your name and bearing your signature: = .
Please complete and retum this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building pennit. No building pennit will be issued until this
verification is received. �
�1,� 1 personally plan to provide the major labor and materials for construction of the proposed
property improvement. ❑ Yes � No .
�2'�'1 (have/have not) �//I ��% signed an application for a building permit for
the proposed work.
-� I have contracted with the following person (finn) to provide the proposed constniction:
Name ./.4`/yl� �yVi�
Address
Phone ( )
City _
Contractor's Lic. No.
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 _
Pho�e ( )
City _
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
i
1042-06 (Rev.t1103)
Address
Phone T}'pe of Work
0
:� �f^F/=iz S �•i/
� . :
�-(iNi��c ��;
> // j
�� i ���, � ���
--������''��
CITY OF CO� �,� �1ESA
PLANNING ; ���'I�ION
��'DJECT TO BI ! �! �. I)IiPI'. REG.
' �TE: ADDITI�'�ti, UI:LET►ONS,
' �It CURREC'I Ic>NS SHALL DE
nr;��tOVED BY 1 uL' PLANNING DIV.
BY:� n:�Tf?. � �G �
5 UT�>r i,T /-� L l�-I_%f%lf�c-
%` v/L S U t/i(�7 />cii�-(�vi C j
- �� CITY OF COSTA MESA •
' BUILDING D/VISION ` � ; ' ,
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 -• ww.J.ci.costa-mesa.ca.us , � ��
FOR INSPECTIONS CALL: (714) 754-5626 , � � .
PERMIT TYPE ELEC
APN: 14165232
JOB ADDRESS: 3109 JE
Vicinity:
SCOPE OF WORK: ELEI
ASSOCIATED ELECTRICAL.
OWNER: BAUE
PHONE: 714-4�.
APPLICANT: BAUE
PHONE: 714-0
CONTRACTOR C
Address: l
City/State: �
Electrical Plan Check
Electrical Permit Fee:
Reinspection Fee
TOTAL FEES
Zg,�� _.
��Y.��°ti .
.'� v., �_wi
'F� _,�,,.- ;CM t . _��.
, � ,, _ =
.,{a� s ._ ..n; __ —
L'� � C71�1 f� i� 1�11�� �-3 � c� X�%II�Z�j'��3
STATUS:
DATEISSUED:
ISSUED BY:
'"i ,-.,c: j ��.."''*�5"`�t'� :....
'�Suite/Unif:'�.
�. �,,i.'-,-'�'a," '_
._ �.� ...:.
��`- �-: a� �;.� • `�.
PANELTO
ISSUED
0613012008 • . ,
RMD " "
b .. �
>TALL A NEW AIC UNIT WITH THE
" ��4';;?;. � . • .. � �
�`�� �°u�'}, ?� �: J� .
,tC� c - ' �v:,i; : ; ,'^ -' �
= -��Address 3109 JEFFERSON AVE .0
u '''�"'' �Cjt /State2i COSTA��MESA CA : "
_ r?-t� .Y P.�_.'s' . �.
6AND DENISE�^�"�� Address �'�3109 JEFFERSON'AVE'��Unit:��
?""+'=� .�"�';`+ City/S[ate/zZip: COSTA MESA;`CA'�� '- � ii 'i�;
,.� .- , . :�ri " . '� �; ��� � �
R � S r���- �� r• ,. �License No: 000000' �� i -
�„'� PHONE p ' .. �. �, � �
�, e ZIpCOdO v , CELL �'� } J� + �'�`� �' �,
o J ^r ,:.
?� t�,��{r _ u. �:. r 5'Ja''=r�i r.'� *il�i ,":' 1�'+.
.U� _ ' f � �._ < <.(�� — t
�-.�,, .., L`— . . , '..'� f i J�;/f . .
' �S7
ES • ,F � � �:�
— ,
�� $O OO ' �`;- ���* � f� J�
�
- ���$i�085� 1'��'a��F`ti�'-w�,'���2i+': ��J'. ���F' "
- @ .,i . , 2. a �. . . -�7 � � ,
: f� `'�V� �Q � � .i 4 / F ,��<:�. "%�4 � S -.
Q
,r .,$108'.50 t =�_ •.
'�� F ;,,,' � �:,. �_� ,� � ,1'.
'`�c\y L( • -f`+u. l' 4.�.. . . ,Y't: � .
�xj.� �J�� � y.Y.x. �� .-. A .:lY✓,.� ..
� )5 � f��
" t-�'-�.�, �'� � �'ury.4t `t� "�r �I ,`:'� ��s �'M �''� � s`FJ�"r� . . . . . ,
i .w
���'�:-=.;.t r;.... � . d'i_ � t„ r':� , � .
- .��y -G'c :": .- .
. -•+(.•� t:-�a.,.. �f J � �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia�statutes and relaled
regulations. (Ord. No. 92-28, § 1, 12-21-92) � � � � ' � "
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. ��� . �, � ,
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure lo obtain inspectlons and final approval will result in.the expiration of this permit. �
400Et, iNsvecnoxTvre . np�t n� � cooe� INSVEClIONTYVE . �-. 1� . NITITIRLS
1B1fi Fixed System Final Fire Prevention ..� 206 Final Mechanical , -� -��� .
1288 Pool Spa Final 208 Final Plumbing �'"�� �
200 Final Re-Roof 210 Final Electrical . � �
201 Final BlocklRe�aining Wall 212 Final Fire Prevention �� �
202 Final Faclory Fire Place 220 Final Planning Approval
203 � Fina15ign 222 Final Site
20C Pinal Dertrolition 250 Final Building/Occupancy ' '
WORKERS'COMPENSATIONDECLARATION: ��.
I �ereby affirtn under penalty oi perjury one of the following declarations_ ,,
❑ I have and will maintain a cenificate of consent to self-Insure for workers'
compensation, as provided (or by section 3700 of the Labor Code, for the
peAormance of the vrork for vfiicfi this permit is issued. � �
❑ I have and will maintain workers' compensation insurance, as requiretl tiy
section 3700 of the Labor Code, for the peRormance of the work for which this
pertnit is issued. My workers' compensation Insurance carner and policy
number are:
Carrier.
(This sedwr neM irot �e mmpetedslfm permrt is vaNed af ine nuntlietl tldlars (Ef 00) w less �
Policy Number:
j1rFyI��I �rtify that in Ihe pedortnance of the work tor which this permit is
i's3ued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of California, and agree that it I should
become subject to the workers' conp� nsation provisions of Seclion 3700 of
lhe Labor C de, al � thwi[ pfy with these provision
��30%
/ `A 4 ignaWre Da�r e�
L'
WAF2NING FAILURE TO SECURE WORKERS' COMPENSATION COVERP,GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am Iicense0 un0er provisions o( Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Code, and
my license is in full force and eHect.
Lic. # Class #
Conl2clar's Signature
CONSTRUCTION LENDING AGENCY:
� I hereby aHtrm lhat there is a constructbn lending agency for the
performance o( the v.ork for v.fiich this pertnit is issued. (Sec. 3097, Gvil Cotle).
Lender's Name:
Lender's Adtlress:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby affvm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any cily or county which requires a permil to
conslruct, alter, improve, tlemolish, or repair any sWclure, prior to its
issuance, also requires the applicant tor such pertnit to file a signed statement
that he or she is licensed pursuant lo lhe provisions of ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or tha� he or she is exempt Ihere(rom antl
the basis for the alleged exemption. Any violation of Section 7037.5 by any
applicaN for a permit subjects the applicaN lo a civil penally oF nol more Ihan
fve hundretl dollars ($500�.):
❑ I, as owner of ihe properry, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oflered for sale (Sec. 7044, Business and Pro/essions Code: The CoNractors
License Law dces not apply to an owner of property who builds or improves
Ihereon, and who does such vrork himself or herself or Ihrough his or her ovm
employees, provided that such improvements are nol intended or oBered for
sale. If, however, the builtling or improvement is sold wilhin one year of
completioq the owner-builtler will have ihe burden o! proving that he�or she
did not build or improve for purpose of sale.). .. . . ..
�'l,�y.��I, as ovmer of the prbpeny, am EXCLUSIVEGY CONTRAC7ING WI7H
�LICENSED CONTRACTORS lo consWct the project (Sec. 7044, Business antl
Pro(essbns Code: The contractors license Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracis for.such prqect with
a coniracta(s) license pursuant to the Contraclors License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for��is reason: .
� . �
� �ipfawre- � - �Date�'
aos�-as pro��
O�mer ID verified by Ari�ve/.
�pires:r .71LU�✓
v— ..
Verification of Ownership by (type of documenl, i.e. - property taz bill or deed):
�DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .�; '
❑ I hereby cert'rfy that no excavalion frve (5) w more feet in deplh into v.t�ich a
person is required to descend, will be made in connectbn with work authorized
6y lhis pertnil, and tha� no building slnicture, scaHdding, falsev+ork, p demolition
or dismantling ihereof, will be more Ihan Ihirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Cali(omia Administrative Code�.
❑ As owner-builder, I will not employ anyone to do work which would
require a permit fmm the Division of Industnal Safety, as noted above, unless
such person has a permit to tlo such vrork from the division.
ApWiwnPs Signawre
Division of Industrial Safety Permit Num6er. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applirant or present or future building occupant neetl to fle and
cenify a Business Plan for emergency response lo release or threatened
release of a hazartlous material? ❑ Yes � No
(Seclion 25505 0! the Calilomia Health antl Safety Code requires, wilh some
exceptions, thal a Business Plan be filed vnth the Costa Mesa Fire
Department by every business which has at any one lime tlunng a reportetl
year a quantity ot hazardous materials equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet o( compressed gas
at slandard tempera�ure and pressure).
2. Does or will the applicant or present or fuWre 6uilding occupant need to fle
a regis�ration torm for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
exceptions, requires registralion vrith Ihe Costa Mesa Fire Depariment by
each business which al any one time has on hand a quantity of acutely
hazardous matenals equal ro or greater ihan a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at slandard
temperaWre and pressure).
3. Does or will the applicant or present or fuNre building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardoUS malerials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Heallh antl Safety Code pmvides that the
Costa Mesa Fire Department may require the preparatioq certification antl
filing vriN the Fire Depatlment of an RMPP by businesses which are required
lo register acutely hazardous materials with lhe Fire Department.
4. If an RMPP is presentty required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes � No
5. Does or will the applicant or present or fuNre building occupant require (or
Ihe work which is the subjecl of this application a permit for such construction
or modification (rom Ihe SoWh Coast Air Quality Managemenl Dislrict or from
any other air polWtion contml district or agency? ❑ Yes ❑ No
(Sectbn 65850.2 0! lhe Califomia Govemmen� Code requires that Ihe requeslea
informalion be fumishetl on applications for non-residential building pertnits).
6. Will any part of lhe faciliry ro be constructetl under lhis pertnit be vrithin
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
(If'yes". the facility mus[ meet Ihe requiremenl of Sections 25534 and 42303
Of the Cali(Ornia Heallh and Sa(ety.Code).
7. If a permit fmm the Soulh Coast Air Quality Managemenl Dislrict or other
air pollWion.control district or agency is required for the work which is t�e
subject of this application, have all of the disclosures prescnbed by Califomia
Health and Sa(ety Code Seclion 42303 been made? ❑ Yes ❑ No
8. (If yes", siWch certificate of compliance from the approprizte aii pollution
control oKcer). - � . � � � .
CERTIFICATE OF COMPCIANCE: I certify thal under penalty oLperytiry-the
infortnation given. above is cortect. I agree to comply with all,state laws and
city ordinances regarding Hazardous Malenals antl Emissions. ' ''
SignaWre Oa�e - � '
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION �OF ENTRY:� I
cenity untler penalty of perjury Ihat I have read this application and state lhat
the infortnation given is correcL I agree to comply with all sta�e laws and �ciry
ordinances relating.to building construction, and authorize representatives of
the City o( CosW Mesa to enteryR�q lhe above-descnbetl property (or
inspection purp ses. agre� not �occy py or allow occupancy of any building
authorize is �f htil al � peclioa . �� 7O /_
O ���
6iyuwreN.LegalOVnerts)i Daie
v �_�
Ana/or AWnonzeG AOW��nI Dale
CITY O�F COST� 1VIES� � � �
CALIFORNIA - P. O.. BOX 317 �
FROM THE OFFICE OF THE DIRECTOR OF PLANNING
�,>.: .
.Car1 ,Ha.tm�
'3109. J�t'ferson Street
� Ccst� Mesa, California
Dear Pool Owner: . •
FeUru�ry 17, 1966
The Costa Mesa Planning Department has been notiPied of the completion
_ oP your �s�ti�ing �pool: .
So that your pool ti*ill be:a saYe one and Yor the purpose oY advising
you oY your,responsibility regarding�the requirements oY the Costa Mesa
Municipal Code� we quote'Section�.9298•,9: • ,
. �, , �' . .
1t. No stiti�ing poo13 sha11�'be constructed 'closer than iive (5�
Peet to any propeity lines, measured.Prom water;line oY pool.
� • 2. No s?�ri�ing pool shall be constructed iinder any electric power -
lines or on any electric power easement..
3. ,No swi�ing pool shall be constructed unless the;yard
surrounding such pool is completely enclosed by a.fence
� six (6) Yeet in height and have a self-closing and
locking type gate or gates.
This courtesy letter is directed to you so that you �rill be aware oY �
-our ordinanqes:and can make a complete safety check oY„your pool area. _
Sincerely yours,
vviC�:��'
. William L. Dunn
� , Mrector oP Planning
!
a
1
�,:
�,
�, .
' r1 �;�
��
H. ✓. LAWMASTER 8 CO., INC.
7940 MAIN STREET — STANTON, CALIFORNIA 65CM5-02BAZZL-002
828-8040
Field Data on Test Specimens Core Concrete '�un�ile Grout/Mortar
P�ole�t CaYl Hamm . Permit No. ���
Project
L«ation 3109 Jefferson Costa Mesa, Calif,
Contractor AnthOny Pools Architect
Location in Structure Bond Heam Engineer T, Larsen
Date Moulded 7/16/65 No of Specimens 1 2 3
Slump Specimens Marked 1_ 4 ��2
�Specified-Sirengifi �at - ze - days 2IlQp_,_P.S.I. � � Mix Designation �
Age to be tested_7 days_2fl—days days days
READY MIX PLANT ��b Mix AGGREGATE SOURCE Bic�
Weather Condition 1 Yd.
Cement p�a p te Type I Cement, Ibs.
Admix None Sand
Specimens made by W �etter �4
Data by Charles Cam �3
Delivered by n2
Date Delivered #
REMARKS: Water, Gals.
Lab. No.
Date of Test
Specimen Dimensions
Area
Ultimate Load
Lbs. per sq. in,
H/D Corrected
7088
Dav Test
/23
6X72
28.2744
000
440
TORY USE
7489
av Test
�, e,.. T�',�. ,. , _
Test
:
—Yd. eatch
130 sks
32 tons
Test
, � , � �j�.
,
7jM . ,� r �
^` 1 �� ! �. y� i' x` �t
�. �7t � j .n .:.�t� J,.,J,::�s�
af ��'` 4y��. .P. /�;
Sf� A�T�S! � iL G�'�;
,? .y � +
��yr?(,Y'��„...�!� 4�A; iYi
(�`.'.�Y.. � .
ir
' .7 ;;;'; .,'; `�,:,;, ,,
'^C'.' �%,
' •h�",.: �..�,
i;:i.! t� :•;�
'�. $�. <•rr:
- , %: �j�� .�J�{
��, y:;,� �.
L�� ,'a��.v '. '• . � •;
�!� �y;+,1 , � p
,;, �,'
, ��vc_. . . . .
{ � PfO:YF���L.�i _ .
.�Srd=� jni"jiir+i�4Y��x "�!`,�"1.
+'�i�? =iic t�. �' v`>.:r;�.
� •+,�;f;�.�'"' l'. :t.
, +- ; . i, ,+,., , ;
: rt:,:
: �' =x��.`y.F,��-.. ,S!i
�+�.�P .��r�T:,�. !��,Y,2':�.�.[.�
{,, fi. ;°
,j��iP?`• . iil;t �yF��,t;�.*i'�
p����' �'1��.,�:thg�d,.�`'4
��:rlt :i:;k:� ,`��'• " '.
�r'��s, ; �,.,. ..�:i1r'`ff�`'A
t� �L � -
i:;�'� 'ii'•,Uti�$�.����`,�i�
i. � :,; •s
jh��' . . _.'i'. Gf� '�q
1'# �'?��.`.�•:
; i y: ?�{Zh.�ti , ' a�,
?h�Ru'`� . y��a.j'...7
.--��iS• _: '� r��a�'�i�
, <,� ;�-F,.
'�..x. . .. . . .:� .,
�/0�9,� E'�i LX5o+ti�✓cguilding .
, Addreas� .
�03 WA(.I�KS �ner' ,
Vt/�5iJE `�vo�--5 Contractor
�j/9x��'rl ��iV/a Address
Permit Date
�y a Number ^"� is�ueu'
c7 � %/ Yu a'
{ `
CITY OF COS2A MESp
�EPARTMF.�IT
OF
BUILDINC SAFF:TI'
'��o� C�'' `N�C.�
Regis[ered Deputy Ruiic� insyector
Certiflcaee of Compllance
DaCe of this.Certlflcate
� ' �//- l S'-5-�
To the Director of Uuilding Safecy: .
I hereby certlfy that [he fo11ow1nR portions of work on the�buildings
at the above address whlch zequlzed con[inuous inspec[lon and whlch I vas .
employed to Snspece, were inspected by me and�comply with the provisions
�of the Building Code appllcable thereto. . ,
�) Concre[e �.,.�._ 3) � Welding • .5) Special Cases
2) Masonry i �� 4) Reinforced Cypsum
Smtmmi�-�ool Size � x 9� Gunice �� Han� t'ack
� . v.� �.
Sacks Cement 3(� ' ions of Sand _ : �
Approxlmate :G of watez Sn aggzega[e . 5%n _ • � �
This repott covers work completed during week ending -�oto� "�
� ��-.� �..�� � .
� � REGIS'IF. 'D U BUILDINC INSPECTOR
,��. „_;,.. ;,, . . ���,��w�s.�.�2.
..,;•� •°
?�•.. , �:�.t: � l,J�.v� Name 2 L c
���< ,rr ;�.� .4::�';t� . p . .
'�.� , , �, i, �11%, - ��'� Addresa /zD J .piZ�
i, .
z�ii:�� ,.., ' �ar �, , ..� .
�. . : , ,,
;�;�/4 ��� ,�,i,`'4 � Leboratory W�nJt-NG � Telephone �]7/��`���' �
':�,r� ���., � ���
�
�� rv; , : � ;:ti,�. . Fo[m BU 6 CQ/?.�9 tiGt � `
'�i�1.�4' , . . .
" 1 � .
���V � .1.. "•.�.� � '
�, � � ,.
. ;�, � :r;,;�,� , . � ��
, . , �>. : �:, _ _ l..j�'
r�w��. r'. '.�:��� � + � I i
, <<. .. .. 1 .2� i . .
�� , .
�ti r:� ' ;•''�.�•1 . _ � :_. :.... ..._... ., .
:�; 7�tj .�r `�t � .. �3)�'.:, r..';_S'y',`'�
�, YiI� ... i-� . -- 1 j: � p ?
�� �� , t 1 � r } v � •.i' ti
��1� � ' r . Y � � I
, r ' t'� , ���', . . . �/f S �
f �', � i ,� .r,��,
C ✓.'
,� �. . � � . . r�
, ,, . �,. , �
ry��:i � ' ' ' :i
J ' ..�' `t� � . � t "4',. ,�" . .i',�:`r.�i.C:
,
7,P'Yr; i, i f °r
.j'dii��� t��
�§!J L
:z '1 'I�V
::� ,� �.:
� . �x; •• .
� .�L � i.
1�r.7'1'%FS�' lfi�
r
a
a
2� �'s
�r�W�'`� �-02 Twininq Laboratorie� ��f =�J11��=,t ��<<��_,_�, ���= ..
�
7310 onnn.: `n'n�. r Ma,�,nq cnn,..,� P 0 60. s] , ton�: 6..,r.n �� 9Ge01 �? 131 �2o-3J55 / Rt 3i 636�2386 / I7I a� 820�6�37 ..
TESTING 4q_ryl� O��iCf IS��.D'mvn �.�.� S:r•�� � S,n.. -n. C<"]03 ���-� Sa; _O�S
December 2, 1980
Ez�minNion: SC80-6699
COMPRESSION iESTS ON GUNITE CYLINDERS
Mr. Errol F. Heesch
12921 Aspenwood Lane
Garden Grove, California 92640
PRolECT BOB WALT�;RS RESIDENCE
o,00RE55 3109 Jefferson Avenue, Costa Mesa
SAMPLE FNOM GUnite Spa
iUCMI1fCt
fN01Nf[II
MIX
DATE CAST
DATE TESTED
SPECIMEN NO.
4} to 1
11-18-80
11-28-80
1
COMPRESSION 10-Day
TOTAI IOAD, 165. 57 � 500
POUNDS PER SO. IN. 2�035
GOMYLIANCE
SPECIMENS
SIUMP
cown�ao�
Lake�ide Pnol�
SWCONi��Ci011
S & A Gunite
SPECIFIED
STRENGTH
SIZE
2 & 3 "HELD IN PIELD"
IO-Day test complies with specifications.
ww �r
Don
DlSi�l\UtION:
E. F. Heesch - 2
�-Ge.sta Mesa B.D./Chuck Conner
DELIVF�FD �Y
Heesch
2,OOOpsi
6" x 12"
•f
• :J✓
`' ^ � g 1Q8Q
■fCf1VfD ON
11-25-80
1Jeale Zuidema
•.i •���n+�s .o� .,,e..�.ree .s i..� eo+.io�..r�.; .+o.�.a�. o� eiie•�.s .�n..o.i�.no.� .ow Poeiie.non o• ooe �rro+rs. �or.uosio�s, o� u.
r�.�es �.0� oa �re.no�4e rre. �s 4FSEov�o P�.o��e o�o wni+riv .�ano:.i..s . �oiu.i e=ontr�or. io eue.n *�� .o�ue .•o ou•�ures
i3o i�
u
1 vrvivc�a -�--•� �
�t JOB ADDRESS
GENERAL CONTRACTO
.9 AP No. 1 1— 5_'.
\' I" 'ECTI(
5.
DATE l—i7'�l
SUBCONTRACTOR
24 � g � . � � CITY OF C�STA MESA
�.COS�'A MESA BUILDING-SAFEfY DEPARTMENT � • MAY 19 �965
V. O. BOX 919 C09TA ME9A, CALIFORNIA - �
�. For Appficant� fo £ilI In Complefefy � . APPLt AiIO�R,�E��
� � TYPE �OR PRINT � .. � ' BUIL OL� .
eui�oino ' - ' ' For�ce Use Only � � �
AODRE55 / �IJ � �FFE' Q So .c�
116C81I1' NO. PERMI NO.
. COSTA MESA,, CALIFORNIA - � �
. R[C6 sr o �, �a�, �q .
OWNER ' /J'f
MAIL . . . .. BUILDINO � '
ADDRE53 /YJ E � � ADDRfi88
. . P,IRH � . '
� TEL. ' ZONB � �TYP GROUP ,
CITV ' NO. , ' .
ARGHITECT . �2 SO� NO. 3a�� gyPROVED DATE _� /,-J
OP -'•GINEER .
/ - ZONINCi .
ao....Es8d / �.eE�>B " io �/ no.ov Y960PNEW
vuxe <� eu��o�rva
CONTRACTOR /(/ N ✓ O � S /� �
//�j LEO/�L � � � r
ADDRE53 J LJ / '� E YON6� DEBCRIPTION �1
A. P. NO. � ��� . �
� CITY � . � ` � . ,
y ^ 'NOTH: NOEAVEOVERHAN68HALLBELESBTHAN
LIG.rNO. I �d�/ NO.� ���% � � �O"T091DE8REARP.L.
'EAVEB
OFLOT X��1� I No.oPeLnae. A�LOWED fU.B.G.REQUIREMENTI ,
NOW On LOT
. VAROSAPPROVED YAR�SAPPROVEO.
USEOF '� MAIN BUILDING ' ACCESSORY BUILDIN6
E%ISTINGBLOG, E S� �f �
(FROMGLSTREET) �. �
BETBACKLINEFROM ���� /� � � � � FRONT Fi�. � � 'FT. �
CENTER Op 6TREET ' REAA YAAD
1'
• i.. R. s�oe � Fr. � F-r.
81DEYARD L@p7 �� � ' "R16HT ' .
pESCRIPTION OF WORK �. s�oe Fr. r�. �
Nr -� MOVINO IONI_ AOOITION �REAR � Ff. � Ff. '. .
DISTANCE BET. BET. MAIN @
REPAIR DEMOLIBM MAIN BLDGS. ACGE55. BLD69. '
BUILDINO �NO.OF ' � ' Vp'R.00" DATE ,
SIZE ROOMB., 8fOR1E9 C.U.P. APPROVEO - '
EXTERIORWALL ROOF" ' APPROV[
COVERING I COVERINO BY ATE S .~�
USE OF B DINO AND WORK TO BE PE emeo f{OLD FOR SPECIA REQUIfiEMENTS �
� �
. . n
- 6C. Ff. � � � .
I HHqEBY ACKNO�yLEO08 THhT I HI1V8 PEAD THIB APPLIGTION TH8 �MOUNT BHOWN UNOBP VALUATION IB FOq TMe g
ANO BTATH TMAT 8 ABOVE 19 CORRECf AN TO COM. PURP088 OP BBTABLIBXINO A PBRMIT FEE ONLY. p
v�r W�TN wLL {y ORDIN�NGB9 ANO BTAT W6 N IILATINO yqLUAT10N, ' , n m� m,
em�niNa co aTquciion. ' � � PERMIT FEE $ _( �
PERMI7TE �F '• � �G �./f � � m- .
. . $// OO v� C CI �� 0
� � e�� � 3 � �
AUTMORIZED AGENT
TOTAL FEE
AP.No.'141-652-32 L(
i =CTIONS
Pool Location
' Forms
Main Drain
Steel Reinforce
Elec. Bond
. %>Phroval to Cover
Underground Electric _
y� Gas Piping Test-
� Filtering System Lines _
�p Backwash Lines and Recep.
'-�{ Electrical Final
Heater and Vent Final _
a F - System Final
Ba.;Kwash anG Recep. Final
Fencing Final
�.�
BUILDI
RIPTION of WORK' pv�..
ZONE VALUE
JUP V TYPE
SUBCONTRACTOR
ng
s
i —i
RMIT NO
/
■
COSTA MESA BUILDING-SAFETY DEPARTMENT
� P.O. 80X 1200 COSTq MESA, CALIFORNIA 92626
' For Applicant [o Fill in Completely — Use Ink Only
BUILDING I p 1� GN y,
AODRESS t �J
OWNER OR �AL Q S
TENANT• •
ADORE55 !/ . �V b� 9v,
CITV � � Np � s {aL
CONSTRUCTION it _ .
BRANCH
ADDRESS
�
L.
ADORESS /'// / �/�/ '�f�7
CONTRACTOR ` �.�j �C//
ADDiiESS �% // '(�{/
TEL.
CITY NO.
F STATE G CITV
c' UC. NO. � � LIC. NO.
{y SIZE NO.OF BLDGS.
�. OF LOT NOW ON LOT
a USE OF
'� EXISTING BLDG.
y
FSeparate permits are required for
� electric, plumbing and heating work:
�.W., VSE OF BUI IN AND WORK TO BE PERFORMEO
Q
1
i
�
i'
�
�
m
a
2582 II/10/80 54.50 TU
APPLICATION FOR STRUC'fURAL PERMIT ' ' ��
..��.,�so.. ore..i�r - -- - - _ —
A.P. NO.
UNIT OR
SPACE NO.
Tft.NQG� LOT ?�
(� �
NEW ADD ALTER REPAIR
ROVE
APPROVEDSETBACKS
�
PLANNING ACTION
0 I hereby ecknowletlga that I heve reetl this epplication antl stnte
(� that the above informetion ig carrect and agree to comply wlih
a all iaws regulatin8 building cOnatruction, antl I shall not amploy
Z any person in vlolation of the workman's compensation laws ot
� � tha State of Calitornia.
3 I hereby certify thai l em properly Iicansatl as a contractor under SQ'
tha Stata of California Busine� a�tl Professions Cotl , Dlvision 3, THE AMOUN
Chaptar 9, antl ffiet suc� n are In fvll force affocq or 1 THE PVRPO6E
em azampt frOm Ma pr0 I Of Ihe Smt C t rnia BuSlnBzs
antl Professians Cotla, DI i o 3, Chapter 9
VALUATION
Sipneturo of � / /�
Permittee 5 � O( /O
o� � ;�; � v
Authorized Agant Datu
VALUE
�ATE
APPROVED
%� _
P
n
i
V
m
FT, n
TSHOWN UNDER VALUATION IS FOR m
OF E5TABLISHING A PEfiMiT FEE ONLY: �
PERMIT FEE S v
n
PLAN CHECK E o
TAX E f
�
TOTALPAID S /�_L�1
. �
. i
; � � ; i s��s
COSTA MESA BUILDING-SAFETY DEPARTMENT
' P..O. BOX 917 COHTA MEBA. CALIFORNIA
F.o� Applleanf fo Fill In Complefely
i � TYPE OR PRINT �
Ao RE's"8 70 e e�r.aon A✓enue
COSTA MESA. CALIFORNIA
A MAIL
� 61ZE
� SfiT6�CN LINH PRO�t
TEL.
NO.
TEL.
NO. OP GLD68.
DESCRIPTION OF WORK
NE• I X IIALTERATION I' IIADDITIOD
REPAIR I IIMOVING , I IIDEMOLISI
BBUZIELDING � .j x /, NO. OF
G Y ROOM6 STORI
EXTERIOR WALLf j�CCOI COOVERI Gn'�OLL �
�GJOVE�E.DRING ='�• V�( I$ $ Fj
76/-2m UIL,pI'w ANOI/21�Q('h_PdFnQ/!2i
Y(
FE RECEIVED
• f E8 1 y 1963
FINANCE DEPL
CI i ti. UF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
R8C81PT NO. PE I N/�p1
�/`/
!Y OATH NECCIVHD �ATE 198UEO
� � rcd 1 u I963� fC� 1 n �ys3
COSTA MESA. CALIFORNIA
FIRE
ZONE
APPROVED
.ve ZONING
zo �r� I NO. OP I UBE OP NHW Sij9 �dm�Pry
�� PLANB z BUILDINO W/q� 9qy
LHGAL Lez- � �,e y6o 8
DH9CRIPTION
A. P. NO.
YARDS EVES �
_ APPROVED ALLOWED
�(C6NTCR LIN! BTJ ��
FRONT � D FT. IN.
R. SIDE �! FT. IN.
L. SIDE SY FT. IN.
IRFAR � � FT � �wi
1
� . � / �O --� — CO(� (o
I HEREBY ACKNOWLCOGH TXAT 1 HAVB RBAD TNIB APPLJGTION }X6 �MOUNT 9XOWN UN�BR VI
AND BTATE THAT TH8 ABOV6 I8 COHR6CT �ND AORBH TO COM- pUPP068 OP 88TABLiBHIN� �
PLY WITH ALL CITY OR�INANC89 AND 8TAT8 LAW9 RHO TINO
BUILDINO CONB ON. VAI.UATION
SIGNATURE O PERMIT I
PERMITTE
S �l � 0 �j�� P�arv cr
AUTHORIZED AGEN " �C ��
TOTAL F
1 9 3G
i- �e � �Q.
M T P6H ONLY.
8 ?� �
$ �o s� a
i
/� p
6
0