HomeMy WebLinkAbout1868 ELBA CIR - Building Permits •
�; 11 ' CITY OF COSTA MESA �: . ..ii,e ► BUILDING DIVISION
>4 ,.,,> `, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
tel / PERMIT
`om� P02-00572
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1868 ELBA CI Status: ISSUED
Suite No Applied: 09/06/2002
Issued: 09/06/2002
Vicinity: FRONT OF PROPERTY
Parcel Nunmber: 13942107 ISSUED BY:
Applicant: JOHNSON, RICHARD CHARLES
Address: 1868 ELBA CL
Phone: 714-545-2336
COSTA MESA,CA Zip: 92626
Owner: JOHNSON, ALDIS A TR
Address 1868 ELBA CIR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
Arch I Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
ON-SITE REPLACEMENT OF SEWER LINE WITH ABS PIPE WITH CLEAN OUT(FRONT OF S.F.D.).
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 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,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $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 $0.00 0 Wash Basin Set $0.00 0
Drain. Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $48.15
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21.92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
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
244848(6ro0)
DECLARATIONS :r
WORKERS'COMP NSATION 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,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(Thi action need not be completed if the permit Is valued at one hundred dollars($100)or less.)
�I certify that in the performance of the wo • ich this permit is i ued,I shall not employ any person In any manner so a o be a subject to the workers'
compensation laws of /� •mi: :nd ag -: :.t If I should,e•• ubject to the workers'compensation provisions of Se • n 37 I the Labor Code,I shall forthwith
comply with these pr•ri •n / ocpobrp
(ApplicantSignnture:-./ `.S _ . /4' . . da: e at2V-
WARNING:FAILURE • ECURE WORKERS'COMPENSATION✓• ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO IMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLIARE($100,000),IN ADDITION TO THE COST• COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.LJc.M Class a
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: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,es owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end 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.pursuent to the Contr tors License Laws.).
r),am.exempt un--"Fr seeBusiness and Professions Code for this reason:
S.agr_Laturet_ (
Expires:.- Arra
Verification of Ownership by(type of oc L i.e,-property tax bill or deed): Ar
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation live(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to tile 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 ❑ o ❑
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)?
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? 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 part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 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 at 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 • comet Ith al ,.e laws an ity o dinances relating to building construction,and authorize repro nt Ives of the City of Costa Mesa to enter upon the
above-desa>•:•pro. " for I ,,••ctionpu .I ee not occupy or allow occupancy of any building auth z�y IS permit final inspection.
!f+>Y
Si( gnature egal Owner(s). Date
And/ r Authorized Applicant Date
CODE I INSPECTION TYPE DM1 I$TTRAL$ CODE t INSPECTION TYPE PATE MUM
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing 9''&'0.7
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
•U 14$. CITY OF COSTA MESA .
4 OW BUILDING DIVISION
F 'OW- BUILDING
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
J
'r'r �
b#,, ,et P01-00398
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1868 ELBA CI Status: ISSUED
Suite No Applied: 07/06/2001
Issued: 07/06/2001
Vicinity: FRONT YARD OF SFD
Parcel Nunmber: 13942107 ISSUED BY: VA,:
ir
Applicant: JOHNSON, RICHARD
Address: 1868 ELBA CIR
Phone: 714-545-2336
COSTA MESA,CA Zip: 92626
Owner: JOHNSON, ALDIS A TR
. Address 1868 ELBA CIR
Phone:
COSTA MESA, CA Zip: 92626
10
Contractor: OWNER-BUILDER •
Address: �Yy U��
Phone:
9 /
Zip: 9
License: 0
Arch / Eng: - - - -
Address:
Phone:
- _ Zip; ,
License:
SCOPE OF PERMIT '
ON-SITE REPLACEMENT OF SEWER LINE WITH ABS PIPE WITH CLEAN-OUT.
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 17., ', $0.00', 0'::
DECLARATIONS
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,as required by section 3700 of the Labor hvfe,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I em 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.a Class#
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: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
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 Ucense Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors Lic: se Laws.).
❑ I am exemp rise ' �/ :usiness and Professions Code for this reason:
Signature: "" / _. - = Date: 04/
Owner ID erified by drivers license, I//❑- 0 No Drivers License No. Expires:
Verification of Ownership by(type of adcul eht'i.arj-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT.CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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 ❑No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP is presently required,has Section 25534 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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government 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 ❑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? 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-descri•••prope or inspec'••purposes.I agree not cupy or allow occupancy of any building authorized by t per until final inspection.
, '9/
(s) 6 �
signature Of Le wnerner(s) Date
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE PEE INTRIALS CODE INSPECTION TYPE PATE INTRIALS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root _ 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy
•
PflOIEii ADDRESS: 1868 ELBA CI UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05639:
OWNER'S NAME: JOHNSON ALD I S A TR
ADDRESS:
1868 ELBA CIR PERMIT NO: B 056393 PLAN CHECK NO: 00746-92 L GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: 545-2336 REG.NO.: JOB DESCRIPTION : CITY STD BLOCK WALL 6 ' 120LN FT. SQFT; 120
ADDRESS: UNIT:
CLAIM VALUE: 5, 000 . 00 CALL-VALUE: 2, 400 . 00 GROUP OCC: R-3 /
PERMITTEE: ALDIS JOHNSON ( 714 ) 545-2336
ADDRESS: 1868 ELBA CI COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
COSTA MESA CA 92626 ********4*****************>E#x*********x *****yi**u• **** :*+ter*SCM Ya E.xLQT41 :Fxx*
LICENSED CONTRACTOR DECLARATION: I hereby aflirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS MAY BE REQUIRED
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN R EAR; FT IN FRNT: FT IN REAR : FT IN
Compensation Insurance,or a certified copy thereof(Section 38w.Lab.C). LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV; PARCEL; 13942107 ZNE; R1 REF NO;
7 Certified copy is hereby furnished. .❑,Certified•bbpy is lited with the city Building Division. PLANNING NOTES> CONSTRUCT 120 ' LONG 6 ' HIGH SLUMPSTONE BLOCK WALL ALONG
> SIDE PROPERTY LINE ABUTTING MESA VERDE DRIVE,
Date: •"' Applicant• ' ******************************iE**********i6!E**WM***********i4*************?e******.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (this section need not be completed if the perp is for one hundred 15100)or less). DEVELOPMENT SERVICES REQUIREMENA S
I certify that in the performance of the work for which this permit is issued,I shall not employ any pe n in any manner so as to become
subject to the Workers'Compensation Laws.of California. _ / ZONING APPROVED BY DATE;
e: I-- 1-7 5 /7 et Signature: Z ,
NOTICE:If.after making this declarati ri.you should become subject to the Work 'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: I, _
Code.you must forthwith comply withsuch provisions or this permit shall be deemed revoked. �,,,M ,��
CONSTRUCTION LENDING AGENCY: I hereby affirm IBM there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: // (,,/// DATE• a!/.Z-r,A#'2
which this permit is issued(Section 3097:Civ.C). ; * *iv
' ***** **************** *r***h.****•-****'*rE**********N********if*****-14 • krc**
LENDER: � ******************%************************************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING EL ECTAIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 5 4 . 0 0 5 0'A
repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM IP/NON tR ES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 35 . 10 .
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE i
x
I, as owner al the properly or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV-> PERMIT ISSUE ISLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or altered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 54 , 50 0 . 00 35 . 10 89 . 60 89 , 60 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through ,
his or her own employees.provided that such improvements are not intended or offered for sale. II,however the building or I
improvement is sold within one year of completion,the owner will have the burden oI proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 89 . 60 OVER/SHORT: 00
for the purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 • 50 - 35. 10
❑ and Professions Code: The Contractors State License Law does not apply to an owner of property who builds or improves thereon
and who contracts lor such projects with acontractor(s)license pursuant to the Contractors'State License Law).I am aware *.*.*.*:*.*.**..x.*.**************************iF**********N•********7e***********3(**********
that proof of their Worker's Compensation insurance should be provided to me.
lel lam exempt under Section:BP7044 B.BP.C. INDIVIDU A.,, F E £ BREAKDOWN '
for this reason:
ALL WORK BY OWNER TYPE QTY DESCRIPTIO S CR ! PTIO N' UNIT COST /
G �",.z 4 T
OTAL COST
--Tam nn- )---e. 9' Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 120 RES-CONCRETE BLOCK�+,WALL / F1', 20 . 00 2, 4 00 , U 0
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END:-OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. '
;•v• % l
Dale: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county 4,
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned -n
properly for inspection purposes. re-----,
- _ _.-t ^1�( /Z tet' J7 'aICY-''r- _1 2' /�t7 ' 7 Signature: C C� LF:T�. 0.!";, • a, . , _.
Driver's License or Social Security p:
164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor ,
•
CONSTRUCTION AND PLANNING j POOL .PA i 1
ve APPROVALS Permit# Date 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 Y-(2�_ 6261- 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. ` (�L 57. APPROVAL TO COVER-GUNITE
7. Footings ft/7-ga- 1w4 58. Electrical Conduit-Undrgrnd.
8. Foundation / 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O 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. FOOD CERTIFICATE ISSUED
33. Final Electric - Notes: tin_ QZ_ e (G_ 4 +t
34. Final Heating& Air Conditioning b/c.4 a.
35. Final Gas Pipe-Test �'� _; r��
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE &BUILDING 7-y013,4 � _tee Gam.'<
48. FINAL PLANNING (
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
f�J
.s � kr J
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4 ____. , ,� � _ ,...._ 0�
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4...H
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i &ii 3 CRY OF COSTA
z` o T • / PLANNING DEPTESA
r� a _ o z LL LANSING TO non
gym C li Owe (-• t u) i
TYPICAL 611 CONCRETE BLOCK FENCE
Cement Coping Optional -- p�S GENERAL- NOTES
Channel Block With 1-3/80 r U. '� NIMBI
Horizontal Top of all
Fences e�l ' MORTAR; One Part Plastic Cement, and
Three Parts Sand
MI GROUT: One Port Cement Three and
For Fences 5'or Less itl�: s One Half Parts 4and
Vert. Bars 3/8"55 at 4' -0"O.C. i�Bi o
r
COPING: One Part Cement, Three
For Fences Higher Than 5' ! LL . WellPortSand
Vert. Bars 3/8"0 at 32" O.C. IItl77��, U .
w — --- .- -__ - CONCRETE: Well Mixed 1:2-1/2: 3-1/2
a x Max. of 7- I/2 Gallons of
Fill Cells Solid With Grout IF > z IL' Water Per Sack of Cement
!LJ .!IU ill
Reinforcing Steel Shall ( f IIIIGROUT MAY BE POURED FROM THE TOP
Conform to Sec.A-15-39 Ell OF THE FENCE IN CELLS WHERE STEEL
• u o OCCURS.
A.S.T.M. �I1 �' CELLS AND AREAS OF HORIZONTAL REIN-
I w n _ FORCEMENT SHALL BE CLEAR,CLEAN P.
All Steel to be Lapped pe LL FREE OF ALL MORTAR DEBRIS,ETC.
24"or to Code �� U
NATURAL GRADE Iii !
4ty.);, c>,,VAY/h. ,: vill---
• />`/ R
• w
P:�� Iv p L
' TWO 3/8"¢BARS —al .e • ' I e • . s
CONTINUOUS TOP
&BOTTOM 1---WIDTH •
• TO 16 0 C. MAX. •
SEE CHART .• .� .
HOQIZ.STEEL MUST BE TIED IN BELOW a DE PTH OF EARTHTCOTH
PLACE AT TIME OF TRENCHI 1/3 THE HEIGTH OF FENCE .
c
INSPECTION. u L j I I BLOW BOTTOM OF FOOTING. •
• 1-°'-I o' 2..�� SCALE: I/2" = I'
- FOOTING REQUIREMENTS CHART
WALL HEIGHT 6 • 5 4 3'
• WIDTH 14" 14" 12" . . . . . . . . 12"
THICKNESS . . . . . . . .10" 10" 8 " . 8 "
DEPTH OF EARTHTOOTH . . . 24" . . . . . . .20" . . . . 16" . . . . . . . 12"
SPACING OF EARTHTOOTH. . 12' 14' . . . 16'. . . . 16'
City of Costa Mesa, California
Building Department .
�o NoV. NC.
INSPECTION & TESTING E N G I N E...5 //4. RESEARCH R ENVIRONMENTAL TESTING
CHEMICAL 8 PHYSICAL ANALYSIS
CORROSION ENGINEERING 8 ANALYSIS
PO. 80, 16036 • 3310 Airport Way TwinlaQ Laboratories 1514-D N orth Harper Street
Long Beach, Calif. 90806 �I — Santa Ana, California 9]703
(213) 426-3355 • (213) 636-2386 • (7141 828-6432 ie" _ X7141 531-2M5
Since 1898
July 6, 1967 Examination: SC67-3008
GUNITE
COMPRESSION TESTS ON CONIMME CYLINDERS
Jos. M. Henley
1973 Newport Blvd.
Costa Mesa, California 92627
PROJECT 22 x 39 SWIM POOL FOR DR. A. JOHNSON
ADDRESS )868 Elba Circle, CostaMesa
SAMPLE FROM 2 #1- Center line bottom - 2112 side wall at skimmer
241s bond beam deep end
ARCHITECT CONTRACTOR
Tibor Ginter Royal Pools
ENGINEER SUBCONTRACTOR
Tibor Ginter Enterprise Gunite
SPECIFIED
MIX -1 STRENGTH 2,000 psi
DATE CAST 6-30-67 SLUMP
DATE TESTED 7-5-67 7-5-67 7-5-67
---HOLDS-
CYLINDER NO. 1 2 3 1A,1B, IC
SIZE: 5 7/811 x 12 3/811 611 x 12/11 5 7/8" x 12 3/8"
COMPRESSION 5-Day 5-Day 5-Day
TOTAL LOAD, LBS. 28,50o 60,000 35,000
POUNDS PER SO. IN. 1 ,051 2, 122 1 ,290
COMPLIANCE //49"/F `
MADE BY DELIVERED BY RECEIVED ON
•
CYLINDERS Jose M. Henley Jos. M. Henley R E e1I7V E D
BUILDING SAFETY DEPT.
DISTRIBUTION:
Jos, M. Henley JUL 7_ 1967
Enterprise Gunite - AM PM
..Cc Mesa Bldg„ Dept.
Royal Pools- 8702 Garden Grove-G.G. 71819110111112111213141516
i
•LL REPORTS APE SUBMITTED AS THE CONFIDENTIAL PROPERTY Or CLIENTS AUTHORIZATION FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS. OR ES.
TPACTS FROM OP RFGAPOING THEM IS RESERVED PENOINC. OL R W PI'TFN AnPRO"!AL A$ A MUTUAL PROTECTION TO CLIENTS.THE PUBLIC AND OURSELVES.
•1.112
�ti % CITY OF COSTA MESA
�t ♦.ewft. . I`' CALIFORNIA P.O. BOX 1MM1200
FROM THE OFFICE OF THE PLANNING DEPARTMENT
November 9, 1967
Dr. A. Johnson
1868 Elba Circle
Costa Mesa, California
Dear Pool Owner:
The Costa Mesa Planning Department has been notified of the completion of
your swimming pool,
So that your pool will be a safe one and for the purpose of advising
you of your responsibility regarding the requirements of the Costa Mesa
Municipal Code, we quote Section 9298,9:
1, No swimming pool shall be constructed closer than five (5)
feet to any property lines, measured from water line of pool,
2. No swimming pool shall be constructed under any electric power
lines or on any electric power easement,
30 No swimming pool shall be constructed unless the yard surrounding
such pool is completely enclosed by a fence six (6) feet in height
and has a self-closing and locking type gate or gates,
This courtesy letter is directed to you so that you will be aware of
our ordinances and can make a complete safety check of your pool area.
Sincerely yours,
William L. Dunn
Director of Planning
18257 COSTA
wi f;' 17„...?-3
F'PwFc iQ4B� Mrt--a.--
,.nacosT, .-. n .
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT vanilla rA *** r^
�� g B�IZbfNfaY�s, .4 r lVV
BUILDING
ADDRESS COSTA MESA. CALIFORNIA For Office Use Only
C r_ `� I RECEIPT NO. f P+8257
OWNER 4/11W/L5LJT^L.'�r.-Y+.rr/-r �J25
MAIL / y RECEI ED BY DATE RECHEIVED DATE ISSUED
ADDRESS
�n/- qr W o,2 c.i- li ` /i—/c/---Fc ;..,v 2 S 1962
CITY L�-t`T9y� ///�- o N07e7 37 ADDRESS
APrHITECT r/," TEL.y� COSTA MESA. CALIFORNIA
C VTECT R.L cF ,f.AZTF/79/0•41NO/A ;jam%/
ADDRESS 9773- 4272-L/N ��//77j FIRE /� _ 0
S442,439
/ 949 ZONE TYPE v GROUP O
CONTRACTOR�Y�J //��C�l;�!"`M,�-T G/��/�j�,. ABY PPROVED DATE I
ADDRESS �/ c---29 /////Yle[i/J-- 4: ZONING ,� I'';a4L'
�/!La Z q NO.OF USE OF NE ' I
CITY -i'T_ e- rl ( I PLANS .�I BUILDING 1I/I P %
STATE �J�y TEL. LEGAL Il /},(/ ../� [�/w 111
LIC��j /�3� NO. - / 5O���� DESCRIPTION /// //L- J L� /
SIZE
OF LOT .q-i X /CD No. OF BLOGB.
NOW ON LOT A.P.NO.
USE OF �_ YARDS EVES
EXISTING BLDG. ' APPROVED ALLOWED
SETBACK LINE FROM / c'�/ )/ (CENTER LINE ST.) (�
CENTER OF STREET C'S CJ REAR YARI>U Q FRONT 57 FT. 1- IN.
SIDE YARD I LEFT /U / I RIGHT /U - R.SIDE / D FT. IN.
DESCRIPTION OF WORKFT./ c7 v-N s_—
L.SIDE
t I i II ALTERATION I II ADDITION I REAR 5 (]FT. r IN.
REPAIR I II MOVING NO. OF /I/I DEMOLISH I APPROVED r , '1Zf f') DATEJ� / —/9 -6 y
SIZE BUILDING �s^y ROOMS / STORIES •"''''''.
`V /`- '�li •" 1 I
EXTERIOR WALLC / ROOF r''��"� �/
COVERING LI/F' " O COVERINGcY/%Y4Ce- '
USE OF BUILDING AND WORK TO BE PERFORMED
/aA o) ^ G7P157Q'p_ SQn 1) r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN U R VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLIB IND A PERMIT FEE ONLY.
PLY WITH ALL CITY ORD?IANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION 73-___
SIGNATURE OF /� / PERMIT FEE $
PERM ITTEF - ( ! j���' 7L,7- N
( � $013 V PLAN CHECK $ 37 Soi
AUTHORIZED AGENT/74e-e--4/Seetea r o
TOTAL FEE $ /42-ca y
22042 FEE RECEIVED I
COSTA MESA BUILDING-SAFETY DEPARTMENT APR 2 7 1964 (/
P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPT. i
For Applicant to Fill In Completely O'Lo1GO$TAC*E5LRMIT
TYPE OR PRINT BUILDING
84 �L n For Office Use Only
BUILDING I 2 q IQC.i ADDRESS IJ 1...
-e-
RECEIPT NO. PERMIT NO'/
COSTA MESA. CALIFORNIA -
n( ^ { RECEI DY DATE RECEIVED. DA E Bey/`e�D //
OWNER r` !--`. e )[1zIV Sn� //'-C� -2 ,-4-Y1 p((�� 1�f�Pj�l/`�1L�r17
MAIL G // f /J /� ADDRESS 1 g (O� Ft, Bn C I'LL-lII
ADDRESS 1 VKj EL-t./] Pilo C .p" .
FIRE
TEL. ZONE TYPE GROUP
CITY Cos\ NA5.c, p. NO
ARCHITECT TEL..
APPROVED ��I/ DATE!/�/��/�
BY K�f,
rn ENGINEER ---'--------• NO.
• ZONING I a
.._-MESS I NE
`/i I PLANENO.OP �BUUSEILOOIFNO G A� P
a
CONTRACTORL-l1AiT'b d/1C+Ai/1Ie11@
.' ' 2771 J? JUN 12-67PAI�OO 704* ****22.50
cnsa
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING ' a f C C` On For Office Use Only
e
ADDRESS
RECEIPT NO. cr1.1 NO.
COSTA MESA. CALIFORNIA .,
1`((��,J /�J of V[ SY D rE RECEIVED / p/,yT�ISSUED/
OWNER •w 1' o - 1 [!� `/d -17 V'�2- b7
BUILDING
MAIL ADDRESS
ADDRESS �p�(
!� )'v TEL FIRE
CITY NO. ZONE 1 TNyrr— GROUP
APPROVED J,� •-.y
ARCHITECT �� TEL BY' Y. - DATE C V l�•
_ ?NGINER�} NO. �� /
py a o ZONING ( 4 �///�1//I1
ATlORESt o '. I �
ZONE NO.OF USE OF NEW
�' { , • PLANS '� BUILDING
CONTRACTOR tat"-Q (x__ ( /in /U'ADDRESS aDESCRIPTION
A.P.NO. / ,] O
CITY R1 ( ` OVERHANGY ! - /
1 STATE 1 2 \ 701-:c.)
60L^ 10�U j a 16 Sr TO SIDE a REAR P. SHALL BE LESS THAN
LIC.N _t 7 "4 \.:/—-4 \ l
VES
SIZE 4Q, 5 177 A RO .7�I No.OPSLDGS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT )( ) .7 NOW ON LOT YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(PROM C/L STREET) E Lei
SETBACK LINE PROM FRONT PT. Fr.
CENTER Op STREET REAR YARD
SIDE YARD I LEFT I RIGHT N.SIDE PT, �hFT.
DESCRIPTION OF WORK L.SIDE PT. ,rj/
'1 7F[/T. /
M ALTERATION ADDITION REAR PT, l .)- FT. b
DISTANCE BET. BET.MAIN a
MAIN BLDOB. ACCESS.SLOGS.
REPAIR !MOVING DEMOLISH
BUILDIN •YjT/j NO.OF VAR.* DATE
SIZE �O U ROOMS STORIES C.V.P.# APPROVED
EXTERIOR WALL ROOF APPROVED (/ C?6'�1 / ,
COVERING I COVERING •r �G'✓1/✓" /,I A //7 ��/� /
USED Ul )LAMS WORK TO BE PERFORMED
2 7 HOLD. FOR SPECIAL QUIRE ENTS
SQ.FT. X
I HEREBY ACKNOWLEDGE THAT.; HA • D THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IE FOR THE C
AND STATE THA ..■ ABOVE,IS CO AND AGREE To COM. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH A an •-DINANCO TE LAWS REGULATING VALUATION
BUILDING C•NSTR 'N.
PERMIT FEE S Arid.° co
C
PERMITTE - ^0 /f
AIt• f `5O'•' PLAN CHECK 8 7 W
AUTHORIZED AG •;ly dug., ' / / Y - /J -T *Lc
5
TOTAL PEEO�o�'