HomeMy WebLinkAbout2792 BLUEBIRD CIR - Building PermitsCITY OF COSTA MESA
BDILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(�14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca:us
FOR INSPECTIONS CALL: (714) 754-5626 . .
PERMIT NUMBER�'P0�8-00155
PERMIT TYPE PLUM STATUS: ISSUED
APN: 13962109 DATE ISSUED: 0612612008
_ - - .. ISSUED BY: YH
•
JOB ADDRESS: 2792 BLUEBIRD"CI CM Suite/Umt
Vicinity: •. . - � � ` �.:. -� .-- ��.- . . , : ,.
SCOPE OF WORK: REMOVE/REPLACE GAS�WATER HEATER �
(SAME SIZE/LOCATION)
O NER: GAZDA, THEODORE E�TR w �, ,Address: -� 2792 BWEBIRD CIR :��';: '
PHONE: '- ' '�� City/State/Zip: .,' COSTA MESA CA �
AP L�: BRIDGES,`LIZ " � - ' Address: � � ��
PHONE: 800 454•8955 City/State/zZip:
;,. • -. '-". � :: �_. :: ;,
CONTRACTOR: FAST WATER HEATER COMPANY License No: _, 877489
Adtlress: 12601:132ND AV-NE ' � � _ " � � , � � � � PHONE: -� 800-454-8955 � .
City/State: KIRKLAND, WA --� . -; ZipCode: 98034 - - � . CELL: - '
.:-� .:�" , . : �....�.'.,,�...; ... ., .::: `,. ,;�,: ,,'...
ARCHITECT: -� :LicenseNo.--, -_ :�-PHONE:d��,�
ENGINEER: - - LicenseNo. "; PFIONE;�4'
. -.. ...� .- . � s �'� .
�
. ' : PLUMBING FERMIT FEE SUMMARY
PLAN'CH�ECK FEE; , ,. $0 00 ',=
PERMIT FEE „' $35.80 '
TOTAL FEES: $35.80
e�3 n?C
:a7
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § t, 12-21-92) . � �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable coGes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
C f i lNSPEC770N �YVE
1616 Fized System Final Fire Prevention
1288 Pool Spa Final
200 Final Re-Roof
201 Final0lock/ReWining Wall
20� Final Factory Fire Place
203 Final Sign
20p Final Demolition
�A1E IN LS CODEI INSPECTIONTYPE
206 Final Mechaniwl
208 Final Plumbing
2t0 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
25o Final Building/Occupancy
n� wmui
� �
WORKERS' COMPENSATION DECLARATION: �� � -
I hereby affrm under penalty o( perjury one of ihe following declarations: ,�
❑ I have and vnll maintain a certifca[e of consent to sel4lnsure°for workers'
compensation, as provided tor 6y section 3700 of the Labor Code, for the
peAormance of the work foi which this permit is issued.
� I have and will maintain workers' compensation insurance,�as required by
section 3700 ot the Labor Code, (or the peAormance of the work for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier 5 c.t�c E ��n r C9
(Th¢ sepbn neetl irot be comderetl d fhe ce�R is valuetl at one hundml tlollars (3f00) w less.)
Policy Number: �l lo \�O lQ O
� I certify that in lhe pertormance of the work for which Ihis permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the vrorkers' compensation provisions of Section 3700 0(
ihe Labor Code, I shall forihwi[h comply vnth these provisions. G
� �� ��.! C`�j ��n' t% C�
�—Applicanfs Signatur Da�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(3100,000), 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 untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( lhe Business and Professions Code, and
my license is in full force and eKect.
�ic. u� 1-1 `� �i qc� qass tt C 3 lD
��} � 11�.-vC9P lo ' ��0'On
JConVaTo'rs SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a construction lending agency for the
peAortnance of the xork for wfiich this permit is issued (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
SignaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 703L5,
Business and Professions Code: Any city or county which requires a permil to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signetl statement
that he or she is licensed pursuant to the provisions o( the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pro(essions Cotle) or [hat he or she is exempt therefrom and
[he basis for the alleged ezemption. Any violation of Sec�ion 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more Ihan
fve hundred dollars ($500).): '
❑ I, as owner o( the property, or my employees with vrages as their sole
compensation, WILL DO THE WORK, antl the structure is not intended or
oHered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
LiCenSe Law d0e5 not apply to an owner of property who builds or improves
�thereon; and who does such work himself or herself�or ihrough his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is soltl within one year of,
completion, the ownervbuilder will have the burdedofproving that he or she
did not build or improve.for purpose of sale.). . ,
❑ I, �as owner of ttie property, am EXCLUSIVELY CONTRACTING WITH�
LICENSED CON7RAC70R5 to conswct Ihe project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts for such projecl with
a contractw(s) license pursuant to Ihe Contractas License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3os�-as �sro��
Owner ID venfietl by driva� ., �icense. ❑ Yes ❑ No
Driver s License No. Expires:
� Verification of Ownership by (type of tlocument, i.e. - property tax bill or deed)i
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �_ �-
❑ I hereby certity that no excavalion frve (5) or more teel in depth into which a
person is required �o descend, will be made in connec�ion vri[h work authonzed
by this permil, and that no building structure, scaffdding, falsework, or demolition
or dismanlling thereof, will be more [han thidy-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noled above, unless
such person has a permi� lo do such work from the division.
AOW����'s SignaWre Da�e
Division of Industrial Safery Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to fle antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous malerial? ❑ Yes ❑ No
(Section 25505 of the California Health antl Safery Code requires, with some
exceplions, Ihat a Business Plan be filed with the Cosla Mesa Fire
Depariment by every business which has at any one time during a reportetl
year a quantity of hazardous materials equal to or greater than a weigh[ of
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at siandard temperature and pressure�.
2. Does or will Ihe applicant or presen� or fuWre builtling occupan[ need to file
a regis[ra[ion form for acutely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of the California Health and Safely Cotle, with some
exceptions, requires registration with lhe Cosla Mesa Fire Department by
each business which at any one time has on hand a quanlity of acutely
hazardous ma[erials equal to or grea[er Ihan a weight o( 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 preseM or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Healih and Safety Cotle provides [hat the
Costa Mesa Fire Department may require [he preparation, certifcation and
fling with ihe Fire Depahment of an RMPP by businesses which are required
to register acutely hazardous malerials with the Fire Department.
4. If an RMPP is presently required, has Sec[ion 25534 of Ihe Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicanl or present or future building occupant require for
the vrork which is �he subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air polWtion control distnct or agency? ❑ Yes ❑ No '
(Section 65850.2 of Ihe Califomia Govemment Cotle requires ihat [he requestetl
information be fumished on applications for non-residential building permits).
6. Will any part of the facility to be consiructed under lhis permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(It "yes", the facility must meet the requirement of Sections 25534 antl 42303
of the California Health antl Safety Code).
7. If a permit from the South Coast Air Quality Management Dislnct or other
air polWtion control district or agency is required for the work which is the
subject of this application, have all of Ihe disclosures prescribed by Califomia
Heallh antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (I('yes", attach certificate'of compliance from'the appropriate airpolWtion
control oKcer). .. . - . . . .
CERTIFICATE�OF COMPLIANCE l certify that under penaltybG perjury:the
infortnation given above is correcl. I�agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions. �
. 5ignaWre ' 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 constmction, antl authorize representatives of
ihe City of Costa Mesa lo enter upon the above-descnbed propeAy for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection. . . �
ure of Le I Owner(s) Da�e
.,, �9� � ' `a. lo ' O �
n�aro�nwno���ean e m oaie
BNLdNG: )%92 HLUEBIRD CI
Faawx: GAZDA, THEODORE E TR
ADONESS: � �yZ BLUEBIRD CIR
COSTA MESA,CA
�ar�. �uuxc �ooness
92626
uHr. �/ CITY OF COS'1'fi t�iESA - HUI1:�D1P1G L�ERNI:L'I.'
PERMIT NO: B 0£30499 PLAN CHECK NO: N
YICXRECT ON FNC��FEN: IIC. NO.:
IXCII OP ENG'S 1�OPE55: IINf:
coxm�crarsxuie ACTION FIRST ROOF CARE ( 714 ) 842-9122
cam�cToxswuur�c �4�2 SLATER AV
woqEu: EIUNTItdGTON BEACH CA ��,�.. 502900
92648 uxr:
LICENSEU CONfFACTOq4 DEC�ARATION: I hereby aARm unAer penelly d perjury thet I em licanaed uMs povieime d Cheqer 9
(cwnmenarq wnh Seclion 1000) d Demion 3 oi ihe Butineas enE Vroleaebns Coda, eM my licenm e in lull laca uM eHed.
c.No.:U64302 uc.cuss: C-39 c.No.: 502900 EXP: OS/97
'om I 1— I Ss -�j lo ���� �I�,J F� ��¢6. S�'✓GS ,
OWNER BUI�DEX DECLAFRTON: I Mreby e/fimi uMer penelly W parjury that I am exemq (mm iM COMretlm liroree law Ia IM
�� Idbw'eq raeson (�ion ]IXi1.5 &re'v�ma vd PMeasions Cotle: My c'ry a oounry v.fiiM �eyuirea a pmmil to mabwl, ellx. impove.
Eemd'eh, or repei eny sV�clure, prior �o in u�uance, elm requirae tM eppliraM tor eix� pemiil to fila e sgrieA HtlameM Mm M«ahe
ia licemeE W��1 to ihe povisions d Ne Comredon licenee Lew �Chepte� 9(�mendnp vril� Setlon )OOO) a a+eion 3 af �Ir
Buaineea arM %desaione Cade� a IMI he a ehe ia ezamq ihere/mm enE the beae fw Ne elleped ezemqian. My violelion W SeUion
]W 1.5 by eny epplirenl fa e parmA eubjeqe �he epplicent to e wil penelry ol �wt mors Ihen INe hundred dd4n �5500��.
� I, ea oxner ot ihe propeMy a my empbyeea wnh wagee m Ihert eda mmpansalion, xill do tM woA, end ihe enunuro m rw� inteMed
a oflered br aele (Saction'l0«, Buainessand Professiona Code: Tha Canireqon liceree LewEaea iwl xpplyto en owmrd propMy
who Wilds a inprovea iMreon, enE xfio doea auch xok Nmeall w henell a thraqh h's or her own ampbyw, povNad �hm ach
impwemenls era iwt inleMed a oHered Iw mle. M, however.IM WiHinB a'vnprovemmt u wld xnhin arY� d oomplation. the
owmr-WJdx xill heve tM buNen d provirp M w Me d'N ,wt Wild a impwe ta iM purpoae d aele).
� I. d oxner d Iha papaM. em utluaively mnireeiq xtlh lice�uetl wnlreclon to mnmua ihe pajae (Ssqion )OM. &uinss vd
Prdas�ans Code: The Contrepon Licanae Lew dom mi npply b en owmr d popeny who buitls a improrr thraon vd who
convecm 1« wdi pqaes v.ith e mMrodor(s) IicenmE W9� to tM CanVepne Liceme law).
� I em eaemq uMv Swlion: B. 8 P.C.. lor Uo imvon:
Dma: O.mer:
i eo nereM �r �n.i i�..a,e a.�d u�ersiene me �ea�+�e�d d cvaomie Heenn ene sme�r coee smion. zsws, zssaa, .ne
25534. enE ihPo I or eny fulure builtlinp oaupem xill / wdl nd (dreb one) naeE lo romply wih edd atme codec xM �M raQuiremmq for
apeimnlaoonniunbnormoEif�ratbnhaniMA'v ue-BTilyl.ranegemamDi�nd.RmidenlielcansUWioneppimtbmenexempfmmMae
provisiom.
ode: AON��:
WORKEN'S COMPEN31TIXi OKL�R�TION: I hereby aifirm uMer penMy d prjury pr d Na blbrA'p doderetiom:
❑ �n.rae�awameimewecenircm.amnemi��osen;raurer«.on�m:cwnw�emian.mawuwr«Mswia,a�ooame�ee«
Code. ln �he pMamence d IM wak la wNch t�b pemM ie iaued.
�] in..o.�ew��md,.an�n•oomv����,reno....�a��.dMs«abnarooameimn.coe..i«mero�«meMawm.
wak lor whi fi Mis parmil ie baued. My wvkzn' i umbar ue�
✓
PERM NO: B 0?�0499
GOVT: N SUPP: IJ
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: UTH
JOH DESCRIPTION : T/OFF 6 REROOF W/HARUISHAKE 4.OPSF SQ FT: 10,425
CLAIM VALUE: 70,425.00 CALC-VALUE: 10,425.00 GROUP OCC: R-3 /U-1
COMMEN'1'S; ICHO# 29'792 �
iE aE iE iF iE M lE �K� # N lE 3C K N� �N K- X� %�IE jE �E �E �E iE iE 3E iE iE if 3F iE iE iE 9E-%iE iE iE iE if if iE iE iE iE aE �IE iE # 3F lE 7E',E 3f IE If iE IE iF iE iE i( �� �E 3E iE �IF i4 i! i6 �X� iE if iE if iF iE iE iF
Z O N I N G R E Q U I R E M E N T S
5 E T B A C K S
---------- MAIN BUILDING --------- ------ — - ACCESSORY BUILDLNG ---------
PRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGH'f: FT IN
PARKING kEQ: PROV; PARCEL: 13962109 ZNE: REF NO:
PLANNING NOTES.> �
- :� .
fE �E iE fF If 1E 1E iE iElE 3E 1! �IE i('3(-'K-1f 1E �IE jFlE'� 3E-%1E iE �1E iE'lE 1ElE �lE iF �lE iElE iE �IE �If �1E iF ik 1f �(-�IE iE iF �1E 3E'1E �)f 3ElE iE iE 1E iE if iE jE �E fF iE 1F if iE 1E ff� iE 1f- IE IE 3E �E fE # 1E iF if
D E V E.�L O P M E N T S E R V I C E S R E Q U I R E M E N,�T S
ZONING APPROVED BY DATE: '
BUILDING APPROVED BY : DATE: �
APPLICATION ISSUED BY; //►��� DATE:
*****x�****�t****��-�c****�'iF7F��F'iF3F3F'fF'�F'�iF�3F'�3F3F�1b�FiFFF�Fi�*'iFiF'�iF7FiF3FiF�f3FiFi�ir**i�***�-x� , � �r�
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL EGM NT;Y
BLDG PMT PLC7MBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 174,75 1.04
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-UI��-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 175,79 0,00 0.00 175.79 175,79 .00
s t�°�L�'iYF�ii l`�"`�'Pi�c EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 175.79 OVER/SHORT: 00
c��� 09/O1/97 BLL�G PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
� �� Pdky Numbec
rmr: s«r� ��a �a ae �d�=e e rn. o.,,�x m ro. � n��a,.e ew�.lsioal o. r�,.l ' 17 4. 7 5 1. 0 4
I cenity thm in �M pMortnence d tM work lor whch Ihia perm� ia ieeued, I elull nd employ eiry penon in eny menner eo av lo '
anewbl�totMxo�kera'compenaetionlexadCddanie.arMepreaNelXlahouMbacaneeuawmthawkeis' iEiEiEK"1EiE'1ElE#�EiE-lEiEiFiElEiEiEiE�hiEiEif#iFiEjflEif#1E#1EiE#�##�IffE1E1ElEiEiEiEiEiElE1E3(-#1EiEiE�(-iflFlEiFiE#�EaE�F1EfE�f1EiF�E1FjEfEf(-iF##if
mp��i��y�y d s<a� a�oo m me �m« coaa. i.ndi mnma�h �m,n� ..nh m� n �, I N D I V I D U A L F' E E B R E A K D O W N
od l�� I$-"� l� a,a�,��lC'�r'ioni 1'1'P_S'( � i��rG��JGS.
` Wemlip:Fallunroaseunworten'romperustlanrovs�epel�unbwNl,aM�hlliub/�efanw�nployMtoerlMmlprWtlanM TYPE QTY D E S C R 1 P T I O N UNIT COST TOTAL COST
nvn nnu w ro om n�narw rno�,.rd dwlen fsfao,00aA �n ew�rwn ro m. eo.t or ronps�wrwn esm.w u proMtled ro. m
S�ctlon 9)05 0l tlro Le4orCotls, Inbrsaf, antl ercomsya lsu. $ FR
CONSTIiUCTON LENOINO ROENCY: I hereby eifi�m urMer penely d pmjury tlal lhere e a adutiutlion WMi�p eqanry br tha
perlamerca ot �M xork IIX xfiicM1 Ih'v Germi u esred (Sadqn 3081. CN. CI.
LENDER'S NRME:
LENDEH'S ADDPES3:
1 cerlily Ihet I heva read �hia epplcetion enE slele t�el ihe ebove infomation ia corted. I epree to comON �h ell My enA muMy oNinenoea
eM atete leMs releling lo WiMinp cn^sirvnion erd hereby eu�harixe roqeaentetivee W thia nyto enter upon the ebova-mentbred properry
�°' 1o8pedqo °�`OOeB° DOR I S WADA �
q ura d 6xiw qenU
(515M18.WP) _ W�ne-BuiMnp 8 Selely:
e
Dma: �
Pink-Ravenue: addanm�Aneeewr
10425 REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
1.00 10,425.00
O1 QQ21943a-00219431 T Q T
DATE: fl/lE/9S TIME: 15:2?
i
� CONSTRUCTION AND PLANNi�._r ,
APPROVALS Permit # '�
t. Temporary EI¢ctrical Service or Pole
2, Soil Pipe�Undrgrnd. ' �
3. Electrical Conduit Utifity�Undrgrnd.
4. Electrical Concluit�Undrgrnd�.
5. Steei Reinforcement
6. Electricai UFER Grnd. '
7. Footings
8. Foundation
9. Water Pipe�Undrgmd. � � -�
10. Structuwi Fioor System �
11. Property Sewer Line & House Connection
12. Sewer Cap ' _
73. Roof Drains
74. Rough Piumbing
15. Rough Electrical-Conduit ,
16. Rough Electric Wiring �
7�. Rough 4Viring Si9n
78. Rough Electrical-T Bar Ceiling '
19. Rough Heating &.Air Conditioning .
20. Rough Factory Fireplace
21. Ducts, in Strueture .
22. Ducts, Ventilating
23. Gas Pipe-Rough & Tesc
24. Roof Framing
25. Roof Sheathing /�
26. T�Bar Celfing (Struct�ral) & Monocoat
2Z Frame and Fiashing _
28. Lathing & Sid�ng
29. Intulation
30. D; ywall Nailing
37. Plaster Brown Coat .
32. Electrical Power MeterFinai
33. Finai Electric
34. Final Neating & Air Condi:ioning
35. Final Gas Pipe�Test
36. Hood or CanoPY
37. Final Factory Fireplaee
38. Pinal Plumbing
39. 1�Vater Service-Final
40. Gas Service�Final
41. Solar pomesucFinal
42. Backflow Preventer
43. 8ackfiow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING `
48. FINAL PLANNING
0.9. Etectric Release to Edison
50. Gas Release to Southem Catifornia Gas Q
Date
., � �
inspector
� � POOL $ SPA/: 1 .
APPROVRLS Permit # � Dare Inspector
, ��-
52. Pool & Equipment Location
53. Steei fleinforcement '
50.. Fosms _ '
55. Electricai 8onding � �
56. Rough Plumbing & Pressure Test '
57. APPROVAITOCOVER•GUNITE
58. Electricai Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
61. APPRQVALTO�,DECK �
62. Backwash & Receptor�Final
63. Heater & Vent-Final
64. Plumbing System � Final _
65. ElectricabFinal �
�66. Solar Sy,tcm-Final �
67. Fencing�.& Access AnProvai
68. APPROVED FOR-PLASTERING
69. PpOI,'SPA SYSTEMS FINRL
FIRE DEPT. REQUIREPo7EN?
APPROVAIS Permit # �
70. Underground Hydro
J1. ProductPipingOGas �Oil
72. U�derground Flush
73. Undergrnd. Storage Tank O Gas O OiI
74. Overhead Hydro
75. Dsy Cnemtcat
76. Dry S,andpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMEN7
79. FINAL INSPECTION I
-}_�
80. FOOD CERTIFICATE ISSUED �
-i_
Notes:
"',
A
Date ( � I �_�
/
CITY OF COSTA MGSA REQUEST FOR OCCUPANCY
TRACT N0. O 7•��8
LOT N0.
ADDR�SS 2792- �c.+i'B�ZJ C//rG's.F
DATE � ��� y
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she he (was o were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa A1esa
as havinp compli.ed with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liahility for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersip,ned agrees to indemnify and hold the City '�armless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted conditic
BY
gY �UCfYJc-.9 � /Ia1 ��i��
Develoner and/or autho zed
representative
BX G .. �',t . /�L`i0472.�iG.�/G f'f ��'��
Lender
E'
Laboratosies �,j ���,«<�i:��,� ��,<<f�,�,.�.�, �,��.
P.O. BOR a� . 3310 P.IPPO°T �:'A`, . LON6 BEAGFI CALIF. 90d01 .,713� 416 -i]5- , L13� 6lb-IJtlb . I/�qi e[r h<dL
' 9Fn::6, Or.CES.
isi.:n_..,. ,.s�,a,.. ...,. n��,u.,.,.��.�r���,��
Se, ah.a C .a%�Gl { V�� ]oSSRed n:P.� PC Bc.n
'n�15?i 1P5 � �t� �� ... .,o � C� 1 SC5Li I��li ele.t3?e
�C�: ,
September 21� 1976 Examination:
COMPRESSION TE5T5 ON �UNITE CYLINDERS
h1r. Errol F. Heesch
i2<)21 Aspenaood Lane
Garden Grove, California 92640
PROJECT P�ol for MR. & �iRS. GAZDA
ADDRESS �'792 gluebird Cirele, Costa Mesa
SAMPLE FROM GU!71t@ SW].R![illrlg POOl
♦RCMILECL
ENGiHFEv
Mix
DATE CAST
DATE TES'ED
CYLINDER NO.
COMPRESSION
TOTAL IOAD, L85.
POUNDS NER 50. IN
SIZE:
COMPLIANCE
CYLINDER:
CONIRAQOR '
Aquar�� Pool Company
SUBCON14nC10N
Grove� Gunite Co.
SPECIFIED
4-i/2 - 1 STRENGTH
�-1u-7� ' CYLINDER SIZE
9-21-76 9-21-76
1 11
7-Day ']-Day
86,000 56,500
3,040 2,00a
6" X 12" 6" X 12't
7-day test complies with speci.fications.
MADE er OFtrvFNfD Bv
— — � H8P_SP.12
oisTuieurioN
E. F. Heesch - 2
Grove Gunite Co.
� ��^ta hiesa Bldg. Dept.
SC76-3349
2,000 psi
9-21-76
IV "HOLD"
111 V "HQLD"
VI '�HOLD"
7-Day
74,000
2,510
6-1/B" x 13"
AECErvFO OH
9-15-76
� / �
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i
c � 33850
COSTA MESA BUILDING-SAFETY DEPARTMENT
V.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
�` ' 7 For Applicant to Fi!l in Completely �� ,Q
��nv�2;�P',='�QO 59z.� u;:*�Oi;:C
�.�.
APPLICATION FOR BUILDING PERMIT
RECEWED BV DATE RECEIVED nerv iccni
BVILDIN� ^ �
AODRES$ �
OWNER A.P. NO.
MAI l BUILDING
Z . / ,�(/
ADDRES' ADDRESS y
W W TEL. –�� TFACT (� a�
a U CITV 0 NO.
ZZ �
Q CONSTRUCTION EW ADD P
O N LENDER
am
J � BRANCH
J � OWNER
m J A�DRESS -
J Q ARCHITECT TEL c SE � �
N OR ENGWEEFi – - N. O�J S
V Q FIRE
W� ADDRES$ � S ZONE TV�
aw
APPROVED
W Z CONTRA�TOR BV
J Q
0] Z . .
J � ADDRES$ 5 O
DATE
W w ZO E NO.OF USE OF NEWX�J:
�= CITV NO�. O� — P�� � BUILDING �����
H
W� STATE CITV �'ARDSAPPROVED VAROSAPPR VED
y� �IC. NO. � Z LIC. NO.�j Q MAIN BUI�DING ACCESSORY BUILDI
� O (FROM Gl ST,R'EET)
S12E � NO.OF BLDI'�S.
OF LOT ,5 � 'L NOW ON LOT D FROM FT.
USE OF
EXISTING BLDG. 51 E F.
Z NEW BLDG, ���� �' ROOMS �! STORIES Z L. SIDE � FT.
U EXTERIOR WAL� ROOF • � v
COVERING COVERING REAR 0 FT. �
J USE OF BUI DING AND WORK TO BE PERF ME DISTANCE BET.
a
a nnaw e�ocs.
Q VAR. �i`
O GU.P. #
� APPROVED
N
z
�
F- HOLD FOR SPEC
U I hereby acknowledge thac I have reatl ffiis application and state
� that ihe above information is correct and agree to comply with •
� all laws ryyulating builtling construction, antl I shall not employ .
F„ any person in violation ot the workman's compensation laws of
y the Stare of Calitomia.
ZI hereby certify that I am properly licensetl as a contractor untler � . FT.
Me Stare ot Calitomia 8asiness antl Professions Code, Divisicn 3, HE AMOUNT SHOWN
Chapter 9, antl that such licenses e in full torce antl affect, or 1 THE PURPpSE OF ESTAE
am exempt tro the pr sions t t State ot C itornia Business VALUATION
and Protessio .ode, i ision , C pter 9. PE
Signature of , A A !. D , / ///
Permittee . !/t � �/,� $'/�r�� P�
/'T
Authori -A ¢nt �
BET. MAIN
ACCESS. BL
DATE
! b
0
ALUATION IS FOR �
A PERMIT FEE ONLY: m
¢
/.3 �� �
_ $ �� ]
K $ �� E
OU LL
8 TOTAL FEE $ pCD� �'
��OWNER ��nA T� DATE 7-22-76
JOB ADDRESS 2792 Blue Bird Circle BUILDING PERMIT N0. 42342 -
GENERAL CONTRACTOR Aquatic Pools DESCRIPTIONofWORK Pvt.Swim Pool w/spa
i1P No139-621-09 LOT TRACT FIRE ZONE VALUE $5,500.00
- ---.._ . _.,.._ rrT _,..... n ,
INSPECTIONS
Pool Location
Forms _
Main Drain _
Steel Reinforce
---�Elec. Bond —
Approvai 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
Fencing Final
Siana��re
SUBCONTRACTOR
Electric
Plumbing
7•a?-
� �
: '
a234a
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. eOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
AODRESS �7�Z /J([�(� �y//p C%/�
OWNER �j� . �. �,��
MAIL
ADDRESS Z �� � U� �//C� CJ�
/� TEL. �j
CITV ! l�/JYl /�.r>w NO. /S^/Ai
BRANCH
ADORESS
Fnio .,4.5C
1U1.2?-7�cTiws,��?_��57ao- �o-^,t�c
APPL1CATfON POR STRUCTURAL PERMIT
FEC �DATEPECEIVED T U
���
A.P. NO. i- �Q(l !U P '
ADIDRIE 5 i��. �/C��' �R C//,L
TRACT �.i LOT B�OCK
N W ADD AL R P
_ w � �...— ' .' .�__�
/� FIRE �
ADDRESS � ' i� (/ /jf, �Q� ZONE TVPE ROUP
APPROVED
CONTRACTOR J /(' �t BV DATE �
ADDRESS � y/['� " 6' �
,TEL ZaNE NO.OF. USE OF NEW j r
CITV ' 7 NO.� o6y� PLANS� BUILDING.=,b�� '
F STATE CITV �'AflDSAPPROVED VARDSAPPRO'
UC. NO. �- � 6�� �IC. NO. MAIN BUILDING � ACCESSORY BUI
� 512E NO.OFBLIX3S. (FROMC/LSTREET�
�+ OF LOT NOW ON LOT FRONT FT.
a USE OF GJ'
,.�. EXISTING BLDG. SI FT
.N. �
� - Separate� permits are required for �. sioe Fr.
A electric, plumbing and heating work. REAR FT.
� E U DI AP1D W RK TO BE 7ERFORMED DISTANCE BET. BET. MAIN &
Q MAIN BLD(wS. ACCESS. 9!�
aS/� /� C URP # APPROVED
i
� APP:iOVED �6{ j" ' / '
} vv�+ I
�
a
w
� I hereby acknowledBe thet I have reatl this application and siate
�
y� that the abova information is correct antl apree to comply wiih
� all laws reBulatinB building construction, antl I shall not employ
z any parson in violation of the workman's compensation'laws of
� the State of California.
3 I hereby certify that I am properly Iicensetl as a contractor untler SQ. FT.
tha State of Celifornie Business and Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALU
Chapter 9, end that such licenses are in full force antl effect, or I THE PURPOSE OF ESTABIISHING A VERP
am exempt from the provlsions ot he S te of Cal'fornia eusiness VALUATION
and Protessions Code, Dlvision 3 ha r 9. PERMIT FEE $
� PLAN CHECK $
Signaiura ot
Permlttee � � - ��Z� $ ��40 TAX $
Authorizetl ABent TOTAL PAID $
n
m
u'
m
N
IS FOR m
ONLV:
e
�0 �
m
Qi7 m
V �
50 4
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