HomeMy WebLinkAbout941 DAHLIA AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
BUILDING PERMIT
77 FAIR DRIVE, COSTA MESA, GA 92626
Job Address: 941 DAHLIA AV Status: ISSUED
Suite: Applied: 03/07/2005
Vicinily: REAR OF PROPERTY Issued: 03/07/2005
Parcel Number: 41218341 Zoning: R1 .R1 �
App�icanr. FRISCH AND SONS CONSTRUCTION ING —_ _ ISSUED BY: "
Address: 2546NORANGEHILLLN'�� �����"�`=��-`��=r���.-"
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��''�.�"�'"�- .Phone: 7,74-282-0643 � � ���
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ORANGE, CA�;i �.t--^' ,� Zip[ 92867 � � /� � � ' ��_ �.
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owner: PAREKH; NAVNIT M � � '—' � -� �� ' ' � � � �-��
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Address 9;1�DhHLIAAVE � .-�'/ .,r; - -��."� '�,-,:'�� -''�.� ' '= � ; � �-� �
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Contractor. � FRISCH�ANDSONSCONSTRUCTIONINC �\L,A ') ' ��.� �
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ACdress: 2ad6MARANGEHILLW ��'��\;,;,i �'��t`:,
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Phone:=�714-282-0643 ��� "�
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, Zip: 92867 � License �696810 ; . \� ,`�'� ' ' � `
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ABANDON EXISTING SWIMMING POOL � � � ' "�" ' � �� ''� p� I"� �i ��� ' ' � -� �� � �'�
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Plan Check:' '' 50.00
,, Permit:'. ' S8325
SMIP Res:, $0.50
SMIP Com: � �,' 50.00
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�` Other: '� � $0.00
In'spection: `, '�'`50.00
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SETBACK:
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ACCESSORI'
PARKING
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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 1 BO 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
I required inspectlons and finel approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiralion of this permit.
'� FOR INSPECTIONS CALL: (714) 7545626 . ,
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WO�S' COMPENSATION DECLARA710N: � '
I �ere aflirtn untler penalry of perjury one oi t�e Following declarations:
❑ I heve antl will malntain a certificate ot wnsent to self-Insure for workers' compensation, as provitletl tor by section 3700 ot the La6or Cotle, for the pertormance of the
work tor which Ihis permil is issuetl.
t have antl will maintain workero' wmpensation insurance, es requireC 6y section 3700 ot ihe Lebor Code, tor the performance of the work Por which this pertnit Is issued.
�� My work�° compansation Insurence arrier end policy num6er are:
'Carn'er:� 4��%�l� r . LPolic�yNu-m�ber: �a���7��
,(.Tlilssectlon need nat be cromp fed il the pryemit is elued f one hundred dollars ($100J or less.) � 6✓�
❑ I certity that in t
compensation h
comply with the
Applicent S�
WFPNING: FAILURE TO
THOUSAND DOLIARE (7
pedor I' nce f the �ork t r�� permit is issued, I shall not employ any person in any menner so as to become subjed b the workers'
: of li� mia ene agree I hould becoma subJect to the workers' compansatlon provisions oi Section 3700 of ihe Labor Code, I shell totlhwith
provsid . ^ ,� 6�
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W (ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVFATO CRIMINAL PENALTIES AND CIVI� FINES UP TO ONE HUNDRED
I,000), IN AODITION TO THE COST OF CAMPENSATION, DAM4GE$ AS PROVIDED FOR M SECfION 3]O6 OF THE LABOR CODE, IFf�EREST, AND ATTORNEPS FEES.
LICENSED CONTFACTOR DECLARA � ON:
I� by.aHum,thatl.am,lic s� -rtf r � oYi�io of Chapter 9(commencing with Section 7000) of Division 3 oi ihe.BusineJ/�rofessions Code, entl my license is in full
torce�and ettecL.LIa.A— l Class A�
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Contractocs�Signeture: __ - Date: �� `7 '
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CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that there is a constmction lending agency For ihe performance of the work for which ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
1 hereby eHirm �hal untler penalty of perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Protessions
Cotle: Any ciry or county which requires a permit to constmct, alter, improve, demolish, or repair eny structure, prior to its issuance, also requires the applicant tor such permit
ro file e signed statement that ha or she is Ilcensetl pursuant to ihe prodsions oi the Conirecbrs License Lew (Chapter 9(commencing with Sectlon 7000) ot Divislon 3 of the
Business and Professions Code) or thet he or she is exempt therefrom end the basis for ihe alleged exemption. Any violation of Section 7031.5 �y any applicant for a permit
subjects the epplicant to a civil penalty of not more ihan five huntlretl dollars ($500).):
❑ I, es owner of ihe property, or my employees with weges es their sole compensation, WILL DO TME WORK, and the siruclure is not iniended or o%aretl for sale (Sec.
7044, Business antl Professions Code: The Contractors License Law dces not apply to an owne� of properry w�o builds or improves ihereon, antl who does such work
himself or herself or through his or her own employaes, provided that such improvemenis are not intended or oHeretl for sale. If, however, ihe building or improvement is
sold within one year of completion, the owner-builder will have ihe burden of proving that he or she did not build or improve for purpose of sale.). �
❑ I, as owner oi the properry, am E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to Construct the project (Sec. 7044, Business antl Profes5ions
Cotle: The contractors Licanse Law tloes not apply to an ownar ot propeny who builds or improves thereon, entl who contracts tor such project with a contractor(s)
license pursuant to iha Contractors License Laws.).
❑ I em e:empt untler sec. Business antl Professions Code tor this reason:
Signeture: Date:
Owner ID venFied by drivers license. ❑ Ves ❑ No Driver's License No. Ezpires:
Verifiwtion of Ownership by (type of document, i.e. - propeny tau bill or tleatl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certi(y �ha� no excavation five (5) or more teet in depih into which a person is requlretl to descend, wiil be mede in connection wit� work authonzed by this
permit, and that no building simcture, scaHoltling, falsework, or demoli�ion or dismantling ihereof, will ba more ihan ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, 7tle B, Calitomla Adminisiretive Cotle). �
❑ As owner-builder, I will not employ enyone to do work which would reQuire a permit from Ihe Division of Indusirial Sefety, as notetl ebove, unless such parson has e
permit to do such work from ihe division.
Signature: Date:
Division of Industrial Safety Permit Number.
1 W ill ihe applicant or present or future building occupant nead ro file antl cenity e Business Plan for emergency response to release or Ihreatenatl release of a hazardous
material9 ❑ Ves ❑ No
(Section 25505 ot the Califomia Health antl Safety Code requires, with some ezceptions, that a Business Plan be tiletl with the Costa Mesa Fire Depatlmenl by every
business which has a� any one time dunng a reported year a quantity of hazardous materials equal to or greater ihan a weight of 500 pounds, or a volume of 55 qallons,
or 200 cu6ic feet ot compressed gas at standard temperature antl pressure).
2 Does or will the applicant or present or tuWre building occupant need to tile a registration fortn for acutely �azartlous materialsl ❑ Ves ❑ No � �
(Section 25533 of ihe Calitomia Health and Sefety Code, with some exceptlons, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hantl a quantiry of ecutely hazartlous meterials equal to or qreater then e weigM of 500 pountls, or a volume of 55 qallons, or 200 cubic feet of
compressetl gas at stendard tempereture and pressure).
........................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or tuture buildinq ocapant need to prepare an RMPP (Risk Mana9emeni and Prevention Program for acutely hazardous materials)7
❑ Yes ❑ No
(Section 25534 oi �he Calitornie Healih end Safery Code provides ihat the Costa Mesa Fire Depatlment may require Ihe preparation, certification antl �filing wiih �he Fire
Depanment ot an RMPP by businesses which are required to re9ister ecutely hazardous materials with tha Fire Depariment.
..................................................................................................................................................................................................................................................................................... ........................ ..................................................................
4 It an RMPP is presenNy required, has Saction 25534 of ihe Celifornia Healih end Safety Code been fully complied with7 ❑ Ves ❑ No
Does or wlll Ihe applicant or present or future builtling occupant requlre tor me worN wnicn is Ine suD�ecl ot mis a�pplicauon a ermrt ror sucn consiruaion or
irom the South Coast Air �uality Management District or from any other air pollution contwl tlisirict or egency? u Ves � No
(Section 658502 of the Califomia Government Code requires that lhe requested information 6e tumished on applications tor nomresitlential building permits).
.........................................................................._............................................................................................................................................................................................................................ . .....................................
Will any part of Ihe faciliry m be constmcted under this pertnit be within 1000 feet fmm the omer boundanes of a school7 ❑ Ves ❑ No
(If'yes", the facility must meet the requiremeni of Sactions 25534 and 42303 of ihe California Health entl Sate�y Cotle).
..................................................................................................................................................................................................................................................................................................................................................
tl a permit tmm the South Coest Air Quaiity Menagement Disirict or other air pollution control disidct or egency is �equired for the work which is the si
aoolication, have all of [he disclosures prescnbed 6y Calitomia Health end Safery Cotle Section 42303 been metle? ❑ Ves ❑ No
B Qt'yes", attach certiticate ot compliance irom the eppmpnate air pollution control otticer).
CERTIFICATE OF COMPLIANCE: I cenity that under penalry ol perjury �he intortnation given abova is correct. I agree to comply with all state laws and ciry ortlinances
regartling Hazardous Matenals and Emissions.
Signature: �ete:
CERTIFlCATE OF COMPLIANC D AIJTHORVATlO OF NTRY: I certity under penalry oi perjury that I have read this applica�ion and state that the intortnation given is
correct. I agree to comply with �I sta�e I e ciry tlin nc�s relating to builtling consimction, and euthorize representa�ives of the Ciry ot Costa Mesa to enter upon the
above-descri6ed property tor in p ction uryos . I a ee ot�o occupy or allow occupancy of eny building authonzed by this permit until final inspection.
COpE �. INSPECTIONTYPE " '
1616 Fixetl System Final Fire Preveniion
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202 Final Fectory Fira Place
203 Finel Sign
204 Final Demolition
(�i1g I A CODE� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
� i �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 941 DAHLIA AV
Suite No
Vicinity:
Status: ISSUED
Applied: 03/07/2005
Issued: 03/07/2005
Parce1 Nunmber: 4 i 218341
Applicanr. FRISCH AND SONS CONSTRUC710N INC-- - ISSUED Bv:
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Address: 25,6NORANGEHILL,LN"� ,�iG'- -���_��-�--.-_ ��=='`���--
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. / � �- � - �� Phone: 714-282-0643� �. . ,��.
Oi;ANG=; CA� _ -��_ 1 Zip �`-' 92867 � � /� � - _�
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Owner.' 'PAREKH; NAVNIT�M'�% - �' �`'`^� ti��� %� ` � ' ��
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Adc'ress ,', J�:1 DAHLIA AVE - j � �^ � � - �� � ' � � �
r`-: �i� Phone: �'\.� \ �� V - A��,�
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COSTA�NIESA;CA Zip: 92626-1709 � � �/ � �`
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Contrxtor. ` FR!SCH AND SONS CONSTRUCTION INC n -., t�}.��� ' "
� Address: 25•16N�ORANGEHILLLN ' '�� �` P.��� � �, ��� _ rti - � �\',��
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. . �',ORANGE, CA /' ��� � � ��ZIp�- -''92887 - : , ` - � . � ..
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. , -. , /' .,^" � - License:896810 - � -�;g �\,- . ---� ,,.
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,_; �_ , SCOPE OF:PERMIT - "� �,�.,; ,
- - . ' � 'AEIANDON EXISTING SN/INIMING POOL.^t - �„' � � jrr . � ��� �,
� � ELFCTF,ICAL TO-INCLUDE: CAP ELECTRICAL� � ' �^ ' ��cr7 � ��� v ,
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, , '� 'r,✓�FEE SUMMARY -�!% ;�',� ''
"- � QuantitY- ...._ _ � -� c' �' �'�"'z-- -' �F Quan6t
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� IS$UE FEE..� ' , 523.50 '�� Temp Dist'System / Lighdng � $0.00 0�
Temp service lest �� � 50.00 J Busway"%100tft�A ��,.. $0.00 0�
Res.a/cpackage �-;\��;. 50.00 ( Standing�Sectioo,r $0.00 0�
NewRes(1-2units)�, \\ti'� 50.00 � 0 MiscElectricafEquipment � �$0.00 y`0
New Res (3+'units) � '� � 50.00 ' 0 y•-y�`c�Tiansformers up to 1 kva/kw l�$0.00 �/0�
PooU Spa � � . � ��'a�';�S0.o0 � 0 �°� ° .P..�a �up to 10 kva/kw $0.00 � �o
\ a t'�i � c� �''x. 6 ..
Lighting Pizts, ,� A,A�50.00 ! 0 � �.r;it"r,��e � � � �up•to 50 kva/kw �$0.00
Recept Ouliets, � _ti 1 SCl 00 � 0 �j ti " � (� ° �� �.. :.... °up to 100 kva/kw-„ �$0.00
Switches '� . � �, SOOO�l � O�Q � '; ,�1 �'� ! " .over100�kva/kw'��$0.00
Non Res Appl, � i / 50.00� � � � 0-:, � � �� „ � ELow.Voltage Eqmpmenf -" �$0:00
Res Appl �� �� ��� i$0.00 �.. �'�;0 `�? <o �,� � _ _ o � Lovi Volt Wiring5ystem / Ckty'��/ $0.00
Service to 200a ���� C/j 50.00� �0��' ��'� ���rMisc. Conduit `��,,� $0.00
Service to 1000a � �'�� �„/50.00 � 0 �_��y�;�,��Misc,Conduc�o���'' �$0.00
Service over 1000a �� : ��, 50.00� � � �0�.. �� `�-`Circus':(�,gemor.ride) (� �$OAO
Motors to 1hp `� �;,,\SD�00, C. %/ 0�5� r� '�-"� -Circus�(mech ride oriights) \,'� r$0.00
Motors to �Ohp �```��50-00 '�-��-0`J �� /--� Christmas?re`e Stand \ V y$0.00
i
Motors to 50hp �'�50:00 0�, �f--1 J%� ��'�Flrewoiks�StanB� 1� $0:00
Motors lo t00hp 50:00� 0 ��-J� � i��OtheiEle�trical:Fee ��$6:75
Motors over 100hp 50.001`� ;Oj . ���� �" " �
Communication drops 50.00 �"'0.= U-=,� Investigalion�Fee%� $0.00
Sub panel l0 200a 50.00 0 ,.., �'�� PIan�Oheck.Fee $0.00
Pole Light Pkg ;0.00 0 �Reinspection Fee $0.00
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia 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 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPEC7IONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inapeetione 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
zrno-na �auu� � . , .
WORKERS'COMPENSAnONDECLARAnON: �
I hereby eHirm under penalry of perjury one of ihe following declarations:
❑ I have end will malntain a cenificate o� consent to sel�-Insura for workers' compensation, es providetl br by section 3700 of the Lebor Code, br iha pedormance oi the
woAc for whiCh this pertnit is issuatl.
.D,rl�,have and will maintain workers' compensation insurance, as required by section 3700 of ihe Lehor Cotle, for ihe performance of Ihe work for which Ihis pertnit is issued.
�. My w� r' ompe sation In ance caf r and policy number ere: _ Q������
Carrier:,,�([] ��j� :` Policy.Number.
.(This section need nof b con eted il fhe permif 1 value et ane hundred dollers ($700) or /essJ
❑ I cetlity that in Ihe ped anc work r w i h t�is pertnit is issued, I shall not employ eny person in any menner so as to become subjed to the workers'
compensation laws oi for a, an agre Ih i I should 6ecome sublect to the workers' compensation provisions oi Sec[ion 3700 oi the Labor Code, I shall fotlhwith
comply with Ihese pro i ... __ .�7
Applicanl,SignaNre:-�-• (�+ Date:'-� � ' ! � O �
�� f ,,,
�WARNINGi FALLUREdO S UR OFKEFS' COMP NSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINQ PENAI.TIES AND CMl FINES UP TOONE HUNDRED
�TYqU$ANDDOILARE�E1 ,INADDITIONTOTHECOSTOFCOA/PENSATIIXJ,OAMAGESASPROVIDE�FORINSECTION310fiOFTHEIABORCADE.INiEREST,ANDATTORNEV'SFEES.
LICENSEDCONTRACTORS
I he�eby_attirm1hat i"am li ec�q!
(commencing with Section 7000) ot Division
q
Professians Code, end my license is in full
CONSTRUC710N LENDING AGENCV:
❑ I hereby attirm that t�ere is a conswction lending agency tor the pedormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lendels Adtlress:
Signature: Date:
OWNER-BUILDER DECLARA710NS:
I hereby aHirtn that under penalty of perjury ihat I am E%EMP7 FROM THE CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Businass end Protessions
CoCe: Any ciry or county which requires a permit to constmc6 alter, improve, tlemolis�, or repair any structure, pnor to its issuance, also requires ihe flpplicant for such pertnit
to tile a signed statement ihat he or she is licensed pursuent to Ihe provisions ot �he Coniractors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of the
Business antl Professions Code) or ihet he or she is exempt therefrom antl the basis for t�e allegetl enemption. Any violetion ot Section 7031.5 by any epplicent for a permit
subjects the eppliwnt to a civil penalry of not more than tive hundred dollars ($500).):
❑ I, as owner of iha property, or my employees with weges as their sole compensation, WILL DO THE WORK, antl ihe sWCWre is not imentletl or oflered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner ot property who builds or improves Ihereon, antl who does such work
himself or herseH or through his or her own employees, providetl that such improvements are not intendetl or ottered for sale. If, however, the building or improvement is
soltl within one year of completioq the owner�huiltler will have the burden of proving that he or she ditl not build or improve for purposa ot sale.). �
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the projed (Sec. 7044, Business and Professlons
Code: Tha comractors License Law does not apply to an owner of propeny who bullds or Improves thereon, end who comracts for such project with a conirector(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business end Professions Code for this reeson:
Signature: Date:
Owner ID venfie0 by dnvefs licen58. O Ye5 ❑ No Driver's License No. Expires:
Verificetion oi Ownership by (type of daument, i.e. - pmpeny taz bill or deed):
DIVISION OF INDUSTFiIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenify that no excavetion tive (5) or more fee� in depih into which e parson is required to descend, will be made in connection with work authorized by ihis
permii, and ihat no building sirucWre, scaHolding, falsework, or demolition or dismantling thereof, will be more than thirty-sis (36) feet high. (Ghap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Califomia Administrative Code). �
❑ As owner-builder, I will not employ anyone to do work which would require e pertnit from the DiNsion of Industnal Safety, as noted above, unless such person has e
permit to tlo such work irom the division.
Siqnature:
Division ot Industrial Safery Permit Number:
Date:
HAZARDOUS MA7ERIALS AND EMISSIONS CERTFICATON:
1 Will tha applicant or present or tuture building acupant need to file entl certity a Business Plan for emergency response b release or threatenetl releese of a hazartlous
matanal? ❑ Ves ❑ No
(Section 25505 of ihe California Heelih and Safery Code requires, with some e:cepiions, Ihat a Business Plan be tiletl with the Costa Mesa Fire Department by every
business which has at any one �ima during a repotled year a quant�ry ot 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 stantlartl temperature and pressure).
.......' _.... .. .........................................
................................................................................................................................................................................ .... ... . .. ... ............ ......................
2 Does or will ihe epplicant or present or fuNre buildinq occupant neeA to file a regislration form for acutely hazardous meterials. ❑ Yes ❑ No
(Section 25533 ot the California Health and Sefety Cotle, with some exceptlons, requires registratlon with the Costa Mesa Fire Depariment by each business which at any
one �ime has on hand e quantity of acutely hezardous materiels equal to or greeter than e weight of 500 pounds, or e volume of 55 gallons, or 200 cubic feet of
compressed gas at stentlartl tamperature and pressure).
........................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the appliwnt or Dresent or future builtling occupant need to prepare an RMPP (Risk ManagemeN end Prevention Program for acutely hazardous matenals)7
❑ Ves ❑ No
25534 ot the Califomia HeaHh and Satety Cotle provides that ihe Costa Mesa Fire Depariment may require the preparation, cetlification and filing with the Fire
snt ot en RMPP by 6usinesses which are requiretl to register ecutety hazardous matedals with the Fire Depariment.
Ii en RMPP is presently required, hes Section 25534 of the Calitomia Health entl Satary Goae oeen fully complletl wlth7 �„J Ves U No
..................................................................................................................................................................................................................................................................................................................................................
Does or will the applicant or present or tuture builtling occupant require for the work which is the subject of this a plication a permit tor such consiruction or
fmm the Souih Coast Air �uality Management District or irom any other alr poilution control dlstrict or egency? � Ves u No
(Section 658502 of the Califomia Govemment Code requires that ihe requested iniormation be furnished on applications tor non-residemial building permits),
............................................................................................................................................................................................................................................................................ ...................... .....................................
W ill any pan of the faciliry to be constmcted under this permit be within 1000 feet irom the outer boundaries of a schoot7 ❑ Yes ❑ No
(tl'yes", lhe faciliry must meet the requirement of Sections 25534 and 42303 ot the Califomia Heallh and Satety Code).
7 If
(II "yes", anach certifi
CERTIFICATE OP C
regartling Hazardous
Signature:
CERTIFlCATE OF
correct. I agree to
above-descnbed G
............................................................................................................................................................................................................
Nanagement Distnct or other air pollution control district or egency is required tor Ihe work
3tl bv Califomia Health entl Safety Code Section 42303 �een metle? ❑ Ves ❑ No
.IANCE: I certity ihal untler penalty of perjury ihe iniormation given above is correct. I agree to comply with all state laws and ciry ordinances
�ials and Emissions.
Date:
��E AND AU7HORI ON EMAY: I certity untler penalry of perjury that I have read Ihis application antl sta�e Ihat the information given is
all state laws end ity or n nces relating to building consimction, and authorize representaiives of Ihe Ciry ot Costa Mese to enter upon the
specti�rpose . I ag ,�iot to occupy or allow occupancy of any building euthonzed 6y this permit until final inspection.
40pE �.' INSPECTONTYPE � '
1616 Fixed System Final Fire Preven�ion
1286 ' Pool Spa Pinal '
200 Final Re-Roof
201 Final Block/Retaining Well - �
202 Finel Factory Fire Place
203 Final Sign
204 Final �emolition
�RTE
N I SOOE♦ INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing-
270 Final Electrical
� 212 Final Flre Prevention
� 220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
Q9IE It�69
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' t:; _ , , ALAN,J ilESSUP, P E`., :`
� `- '� � ",; : ' Consulting Geotechnical Engineer '
, �Registered Professional Engmeer� n'�'" , ��'; , - �.. 24432,Silver Spu� Lane -
, California "' � . '� • Laguna Niguef,.CA 92677, .
'S' ' ' . � ; ;': Phone/Fax (949).448-9650 � , -
r. "�,. . .. .
- ` ` , .
' ' - . ' � , ' ';
� �: -Frisch & Sons, Inc. ti , . �,� March 1 l 2005 - �
: 2546 N. Orange Hill Road. .. � ,.' My Project No. 03.1431 ,
, . � ., : .
" � " "Orange, �Califo'rnia 92867 / ;
� Attention: .' ' Mr. David W. Frisch �. ,
« ".' '. Sutiject ; Compaction.Test�n� for.:Swimming'-Pool' Abandonment �Backfill, at�941 Dahl�a :.. ' ,."
° ; , Ayenue (Parekh), CostajMesa, Califorma � � � `. .
• � _ .. .., . ' . .
' Gentlemen:' , ` • , t'� � . .. . ,
_..'t , ' . _ � . t . ' ' ' -
, As per your reque'st;�'a'field den'sity test�.(ASTM D-293,7.) was'taken for the_subject:swimming'pool .��
� abandonmenf bacld�ll (+/- 4 to;7 feet deep);,in the rear yard of the'subject site. • Tf is understood.that
�.�-, .-. two: (2), 3' by 3',,drain holes were cut in tfie shell bottom; and that the coping was remov.ed to a depth :.'
_ , of 12" below, grade,.prior.to_placinggrariular`bacldil,matenal in 8 to ] 2-inch lifts,and compacting it-. r'.~ ;,
"„-by wheel rolGng with a Bobcat loader and`by,a hand-operated Wacker Tamper. .A maximuin�density �. ''
and optimum moisture test (ASTM D=155'� was�perfoimed on'the,backfill material,. in the la6oratory .
., When comparing t}ie laboratory and field tests, a relative compaction,of.93:7 percent resulted The, -
'_ :. test results and�a partial site plan (prepared,from plan provided 6y,addressee) �of the rear-yard :are •,
� . pr`esented per'the'attached Table I � - � ,� . . . .
� . The opporturury to be"of contuiued service�is smcerely appreaated.: If you have any,questions; please '
contact me at (949) 448 9650 . '_` ,
, �. . - � - � ', � -� � � Q,OPESSIO,�, ' . . : . . . . .
. ', �oQ a y dEssqe�_. .
Res pectfull y subm�tted; Q � m
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� � id0.�439, m� •
� 6 , ��p; 8-30•05 � 9 . , ' • :
Alan J. e up, P. .. *. ;. � u , ' ;
', reotechni�a! E�i�iieer,:GE 43� s%�cF�bHN��P��� , ` .
� Givil Engineer, RCE °18431 . 9jFor. cA=���P. �• • . �
,, , ' . ; , .
� Attachment: .� Table'I;:Test Results & Location �i , - -��
,, . _ .
` ` Dismbution: (3)�Addressee - ' �' � _ �AJJ/03-t431, 73 -. �
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Summary of Field Density Tests
� �� ��
Test � Dry Dens. Soil Rel. Comp.
DATE No. LOCAT[ON PCF Moist., °/a Type %
3/ra/vs JT-6 Gy ��e ,�.�/w O S //r8 / /¢. I 1" 93. %
�/ 4� Siy'n i1Tos 17 iV2 pP �/� O/ �f.S�^ .� :
� 7%�Tsj %�1 "l�B� ��'B� ti�i S�ic�e' 9i^ CiP
l��r* ,laS �: /aG.o �c � �v sy� .,�s ?�-/s �
�
ALAN J. JESSUP, P. E.
Consulting Geotechnical Engineer
Project No.03•/43/ Date i 05
�
PflOJECT AODflESS: c3 4 S DAHL IA AV '
owxcnsxame: pAREKH, NA��NIT M
nooeess: pAREKH SAROJ N
941 DA{iLIA AVE
�. COSTA MESA,CA 92626
��ppCHIENGINEEH:
� AODflE55:
UNIT:
FLOOD; AH-38
flFG.NO.:
UNIT:
PEFMITTEE: NAVNIT PAREKH ( 719 ) 540-6297
aooness: g q 1 DAHL IA AV
C.M. CA 92�26
4CENSED CONTFRCTOfl OECLAflATION: I hereby allirm t�at I am licensetl untler provisions ot hapter 9(cammencing with Seqion
7000� ai Div,sion 3 0l the Business and Pmfessions Cotle. and my license is in full lorce an0 effecL
cirr uc.: sTaTe uc.: cu�ss: EXP :
qie: SignaNre:
NOFNEP$' COMPENSATION UECIAflATION: I Oereby afiirm �hal I �ave a tertiliCa�e o� conSen� to Self-insure or a certifiCaie ol Workers'
�:ompensation Insurance. or a certtlietl copY �hereaf (Section 3800, Lab. CI.
POLICY NO.: E%P. URTE:
COMPANY:
❑ Cenified coDY �s �ereby fumis�etl. ❑ Certilietl copy is filed with the city Buibing Oivision.
oate: PpDlicant:
E%EMPTIONFBOMWOPNEHS'fAMVENSATIONOECLABATION: Qhissecl etlnol�ecomple�edi�thepe�mi�i5faronehuntlretl�510D)Orless�.
I cerlily ��al in the pedormance ol �tle work for which t�is permil is iss e4 shall no� employ any De�son in any manner so as Io become
Subleci �a IM1e Workers Com0en5a�ion Laws of Calitomia. ��
Da�e: 9_2� Signalure:
NOTICE: 11. al�er making ��is eclaration, you shoultl become 5u61eci Ae Wo't � Compen5aiion pmvisions o� �he LahOr
Code. you must fotlhwiih comply wiih such provisions ar this permit shall be tleRjlp revaketl.
CONSTflUC7lON LENOINc RCENCY: 1 nereby ailirm inat iheB is a consimction lending aAency tor the pedormance ol ihe work for
w�icn Ihis permil is issued (Sectian 3W7. Civ C). '
LENOEfl:
AOUHE55:
OWNEfl BUILUEfl OECLABATION: I �ereCy a�firm Iha� I am exempt �mm the Contrac�ors' State License Law �or IAe following reason
(Seclion 7031.5 Busines5 ana Pm�essional Cotle: Any ciry ol coun�y which requires a permii �o cons�mc�, al�er, impmve, tlemoliSA, or
repair any 5�mciure. Orior to i�s issuance. also requires ��e ap0lican� �or such pe�mit �o �ile a signetl s�aiemenl tha� he/s�e is licensetl
pursuanuo ��e pwvisions o� I�e Comraaors' S�a1e License Law (C�ap�er 9 �commencing wiih Sec�ion 7000� of Oivision 3 of Ihe Business
antl Professions Cotle) orinat ne/sne is exempitherefrom and the basis torlhe allegetl exemption. Any violation of Section 7031.5 by
any apDlican� lor a permi� 5u01e��5 ��e applicanl �o a civil penalry oi noi more ihan live hundred Doltars (5500).
I. as owner ol the property or my ¢mployees with wages as Iheir sole compensa�ion, will Oa �Ae work, and �he
i� s�mqure is n0i inten0etl ar olleretl IOr Sale (5¢ciion 7044, Business and Pwtessional Code: The ConVaC�ors' $tate Lit¢nse Law
tloes noi apply �o an owner oi a pm0erty who 6uiltl5 or impmves Ihereon, antl who tloes such work himsel�/he�sell ar t�wugh
his or hei own employees. pmvideA thal such impwvemems are noi inten0etl or otleretl for sale. Ii, Aowever ihe builtling or
impmvement is soltl within one year ot comple�ion, �he owner will have Ihe burden of proving he/she tlid no� huild o� impmve
for ihe purpose o� sale).
I, as owner oi �he properlY. am exclusively contracting wi�h licensetl contractors �o wnstmcl the D�olec� 45ec�ion 7044, Business
❑ antl Pmiessions Code: The Canlractors' State License Law does not apDry to an owner oi pmperry wAa bwltls or improves Ihereon
.and who cantracis for suc� pmlec�s wiih a conVactm�s�license pursuani �o �he Contraclors' S�ate Litense Law�. I am aware
�hai D�ooi of Iheir Worker's ComDenSaiion insurante 5houla he pmvidetl �o me. L
� I am ezemD� unAer $ection'. 8. 8 P. G /
tor Ihis rea5on', ` �' � /
% �1�
Oate: _._� � �� Owner
�
I tlo nereby cenify tnat I am aware ol antl untlersland the requirements of Califomia Healih n0 afety o Sections 25505, 25533, antl
, 25534 antl ��al I ar any lulure builtling occupanl will/will no� (tircle one) need [o comply wi�h tl slale c an0 �he requiremen�s for a
. permil br consiruc�ian or motlilicaiion fmm �he Air Oualily Management �isVic�. HesiAen�ial consimction plications are exemp� Iwm
I ihese pmvi5i0ns.
Date: Applicanl:
I here0y cerlity ihat I have reatl Ihis application antl sta�e Iha� IOe above
ortlmanws antl slatelawsrelalinglo building consimction antl hereby auth
pmoerly Ior inspeclion pur�s�s�
Date'. � Signaiure:
oriver's License ar Sociai Securiry a.' �
is carrect. I agree to comply wiih all city and coun�y
n�aiives olihis ci�Y�o enter upanthe above-men�ionetl
Green—Code Enlorcement: Canary—Nppllcanl; Pink—Fevanue; Goldenmtl—Assessor
CITY OF,COSTA MESA — HUZLDING PERMIT 'PERM NO: B� 06898°
PERMIT NO; H 068985 _ PLAN CHECK NO: . N , GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION ; T/OFF SHEATH 6 REROOF W/COMP SHINGLES SQ FT; q,500 �+`
CLAIM VALUE: 4,500.00 CALC—VALUE: 4,500,00 GROUP OCC; R-3 lM-1 ��.Y
COMMENTS; SMOKE DETECTOAS'REC�DIRED PER 91UBC, REROOF 3100SF RESIDENCE
**x*���r�r�r*x��r*�r+r��******x*x* ***��*x*�r**x�*�r*�r*��t��r*+�*�r yy�j �r . ry-
Z O N I N GS ERTEHQAUCjKRSE M E N��Vf�� ��'�TOR. ;
p _
------------ MAIN HUILDIN� ---------- --------- ACCESSORY b�iLZ I�v �-----�
FRNT; FT IN REAR; FT IN FRNT; FT IN REAA; FT IN
LEFT; FT IN RGHT; FT IN LEFT; . FT IN RGHT: FT IN
PARKING REQ; PROV; PARCEL; 41218341 ZNE; REF NO; ,
FLANNING NOTES'> ry . -
�
�r+�x���r+r�t-i�**�c-�r�r*�'�t�r***�r�**�r�r**�-**�*�rx��rx�**+�+�**x�*�**�**��**�r�r��r�ru�**+�-�**�r+�*:*�r*��r*�r�r�*
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 � '
/l. �.
ZONING APPROVED.BY DATE; �'
BUILDING APPROVED BY ; ' DATE: -"%` G
APFLICATION ISw�'UED BY• DATE•(,T ��✓ `�'I
** ft it it-� it ir fr i� f� it �t �At ir fr �E �r iE �t f�%� iF �F iF iF iFiF �r3F��r�r3F'� �r'�r'iF�F���FiF,�r+FTFTF'fFiFir *�-fe ir ir i� ir �t *� ��* i�
it iE it # if ik iF iE iE iE it iF it iE i:-iE iE if !E if iE it if it iF iE it iE �iE iE iE iE fElE ## iE ft iE it iF iE 1E i! iF iE iE iE'k iE ik k�E iE±f iE if iE iE i!� iF if iE iE iE 1E iE iE iE iE it iF iM1 if �lE if 3E �1E it
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y "
BLDG PMT PLUMBSNG ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72.00 ,50
' � SMIP/NON—RES
PLAN •
ISSUE FEE �
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72,50 0,00 0.00 72,50 72,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 72.50 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
%2,�� ' ,rJ� �
iE jE fE it �E iE i! iE 1E ff iElE tE it ic iE iF iE if �E iE dE iE iElE iF iF ft if 9E iE if iE iE iE if iE it iE it 1E iE it iP iE iE iE iE iE if iE if it it iE iE 1E iE if # iE 3E iE iE if i6 if iE iE if iE!E iE fE if iE iE �t iF
I N D I V I D U A L F E E B R E A K D O W N
TYPE
SFR
QTY D E S C R I P T I O N.
4500 REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
n.
UNIT COST TOTAL COST
1.�� 4�5��,��
32 OQ16o?7o-OO1b3279 T C�T i7.5D
DRTE: 09/23/94 TII^E: 11:OE
/
P
<
CONSTR:;; TION AND P.Lar�rvtNG�� � . • JOL & SPA
APrROVALS Permit # Date inspecto� ,4PpROVALS Permit � Date inspeczor
L"TemporaryElectrlcat Service or Pole ��i � 52. Pool & Equipmen2 locatian . 4-
2. Soi� Pipe-Undrgmd. � � 53. Steei Reinforcement ,. '
�
3. Electrical Condvrt Utility-Undrgrnd. - 54. Forms ' � � �
i
4. Electrical Conduit�Undrg:nd. - 55. E�ectrical 6onding� � • - I
- �
�5. S[ee! Reinforcemem " - 56. Rough Plumbing & Pressure Test �
,6, Electrital UFER Gmd. - - 57. APPROVAL TO COVER�Gt)NITE : �
'7. F.00tinns � . 58. Electrical Conduit�Undrgrnd.
_8. Foundation � - � 59. Gas Pipe, O Undrymd., Test
9. Water Pipe-Undr9md. ' • _ � 60. Backwash Lines, P�Trap, C; Unciryrnd. �
70. Structural Floor Svstem 67. APPROVALTO DECK-
11. Properb Sewer Line & House Connection � 62. Backwash &-Recep.or�Final
12. Sewer Cap . - 63. Heaxer & Vent-Finai -
73. Roof Drains . � . � . 64. Plumbing Sys;em - Final '
74. Rough Plumbing- - - 65. ElectricabFinal � i'� - �
i5. Rough Electrica6Conduit i 66. Solar SyStem�Final - '
� 16., Rough Elec2ric Wiring . 67.'Fencing & Access Approval
77., Rough Wiring Sign � � � 68. APPROVED FOR PLASTERING '
18. Rough Electrical-T Bar Cei�ing 69. POOL;SPA-SYS?EMS PINAL
19:' Rough'Neating-& Ak Condit5or.ing " " - FIRE DEPT. REQUIREMENT '
20. Rough factory Fi�eplace •�'� APPROVALS �. Permit #
21. Ducts; in Structure' , , : . , " � _ 70. Underground Hyciro �
22. Ducts, yentiiating ' - - 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . � , . ' 72. Underground Fiusi� .
24. Roof Framing � � � '� - � �73. Undergmd. Storage Tank G Gas � OiI'
25. Roof Sheathing � • �_�Q�QLr � 74. Overhead Hydro '
26. T�Bar�Ceiling (Structural) & Monocoat '� 75.'DrV Chemical . - �
27. Frame and Plashing �, , � ,� ; 76. Dry Standpibe � _ �
28. Lathing &,Siding ' • , , . •• �• 77. F;XED SYSTEM FINAL
�
29. Insulation � � �� ' ' � . � � , , 78. FlRE PREV. PINAL .
30, Drywall Naiiing . � � - . HEA�TH DEPT. REQUIREMENT
I
31. Piaster Bro��n Coat: . � � '� 79. FINAL INSPECTION - `� - �
, i i' --- , , .
32. Elzctricai Powir MeterFinal !� 80. F00� CERTIFICATE ISSUED
( 33. Finai Electric � � , � � Notes: . r.
i
34. Final Heating & Air Conditioning � �, " �. � - -
i�
35. F(nal Gas Pipe�Test � � I � -
; {
36. Hood�or Canopy ��� ' � , � i , �
37. Final'FBctory FirePiace . . : . ' f ��. � ?1 �
38. Final Plumbing - , � "r ' - ' , .
39. Water Service�Final� � ; � ��
�
40. Gas Service-Final ' ' . . � i �
47. Solar pomesticFinal . - i � ^
42. Beckfiow PreFenter: �'�,�j ' ' � .� � . . _ ';`
43. Backf�ow Irrigation ..a. _ . - - � �
.�
�a -
44'. �andscape Irrigation-�ysie�"' � � - _ - , - - � .
45. Sound Atienuation �; � ; ;�,}_� : � - r . �, . . � i
46. Handicap Regulations,? w-: ' � � � •- � . :
47�. FINAL S7RUCTURE�& 3,�t�LDING � �� c� �w� "- - - �
46. FINAL PLANNING i;�I }! i �"� I _v �' � . '. �
i �.
49. Electric Release to E� ffon'� ��� ' '
t
50�. Gas Release to South`err�t California Gas Co � �� " -. � �.
r
51. CERTIFICATE OF QCCUPANCY , _ , , •
No. Dace
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
�-._ :- ..
.;
Permit No. � ��� �>>
Property Address �� � �f��/L 7 /4 i�'"�� _ _
Owner NA-1//1��% 0�%• � .S/¢/e�.T /v• /����%��
Contractor
State Contractor License Number Classification
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building
Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
� I further certify that I am the owner of the property. (Owner-Builder permittee only).
❑ I further certify that I am:
❑ Owner of sole proprietorship company
❑ Fuil partner of the company
❑ Limited partner of the company
❑ Offi�er of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make
this certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance. �
Received by Building Division
By:
� Z 4
Initial Data '
0990.a6 White-Buildinq Div.; Canary-Con�rec�or, Pink-0wner
Company or Corporete Name '
Q�l ��L�G�.4 �i/C— G�S7/9�/7Cd/tL
naa�ass ci4-- �/Z6
_ �
' n ure � Date
!l � . f � C
Printed or typed name
% y/ �J� �� Building
Address
f +[2nrc-�:i /Gp2yvaoM Oc,mer
_ v�-p.,C. �6.tDtiai Contractor
���, �aQ- Address
Permit Date
�/S.S�Number � 23 Issued
CITY OF COSTA MESA
DEPARTMENT
OF
BUILDING SAFETY
Registered Deputy Building Inspector
Certificate of Compliance
Date of this Certificate
To the Director of Building Safety:
I hereby certify that the following portions of work on the buildings
at the above address which required continuous inspection and which I was
�mployed to inspect, were inspected by me and comply with the provisions
of the Suilding Code applicable thereto.
1) Concrete
3) Welding 5) Special Cases
2) Masonry . � 4) Reinforced Gypsum
5wimming Pool Size %y X� r% Gunite�_Hand P
Sacks Cement / 3 8 Tons of Sand 3
Approximate % of water in aggregate %�p
.
This report covers war[c completed during wee[c ending� 75'
r_ _TvT� � �I�, % �i%/ -�
♦ / � /
i
Name � �l�i
Addreas 3/ n G�. oCt�� �Gd�—
Laboratory �/ • Telephone �/3� yz5= d�S'i
Form BU 6
AP�t :. � ��1�
' �1��6 '
., ,
• ;�I�',d�' ,�y,
Ap'ril"10,'1978
����
f M
'i:`t�<: l
� �vir°sniau� ��bor�t�siss �f s ue�� ea�:���, �,�.
o.0.-BOX N. 7710 AIRPORT wAY . tONG BEACM, CAUF. 90801 ..�tll� �76d]55 . �2U) 676�1786 . �7N� 82B-6a77
. . . e�wr+cw orricEs: � "- � '
isu.orva�Ht.o«s��... - :r`ia,a«..��..wn..
5����.W.G6faM�1l101 ^��. k•TS111�deiJeAw_�.O.la.�)
, .V��1 OI.}Ui r` ��r +- lei�V M�cA. GtIC �q01 ISUI O1.LU
. . \r�I• • - . . .
' •�wN�n�non: 7$-llb�i
` GUNITE
.COMPRESSIONTESTSON�ECVLINDERS '
Jack Hubbard
3106 Oatram Avenue
Long Beach, California 90808'
rRo�ecr SWIMMING POOL - DAVID KORMAN
nooRess 941 Dahlia St., Costa Mesa, California
SAMPLE FROM Shallow end., deep end, bond beam
•aeH�r¢et, �ontnwcrort
Regal Pools
[XOIN88R �YBCONTRIICTOR
B: C. Adame Enterprise Gunite
- SPECIiIfi D'
MIX . (�.'1 CO 1 � . STRENGTH
DATE CAST
DATE TESTED
CYLINDER NO.
COMPRESSION
TO�TAL LOAD, LH9.
POUND$ PEi7 SO. IN.
COMPLIANCE
4/3/78
4/10/78
1
SLUMP
4/10/78
2
4/10%78
3
7 days 7 days 7 days
76,000 71,000 106,000
2,690 2,510 3,750
7 dey average: 2,984
7 day teste comply vith epecifications.
M�D[ B•
CVLINDERS Odie
ourwiourmn:
Jack Hubbard - 3
Cos[a Mesa Bldg. Dept.
OHLWYNtO BY
Hubbard
'�EZ-'ErpE�
Ap� 1 '; '� _. �
R8C61V6O ON
4/5/78
�
♦ L F�Ow�i �• u ��T�O �\ tw� COwilDtxT��l � • CIItNI\. AVfM01�111rION 101� �Y��ICA�ION O u l�O�f�. CONCIU\�OM{. O
♦u���a � ynrn nw �cp�w1]�r�G tw[Y 1� I�f\fAv�O �tw011�6 OV 1�16A ���AO��I �� � Y •1�0�[CfIOA t0 Cll<n��. Tr1f �u���t �FY n�w��lv�t.
ER KORMAN� DAVID DATE 2-16-76
SUBGONTRACTOR
W RTER
OUGM GLUMBING
PROP. $WR. LINE Q HOUSE CDN.
SPRINKLING SYSTEM
��dISCELLRNE0U5 A
ROUGH MERTING ANO R CON01 IOM�N�
TEMPOR�FY SERVICE OR POLE '
UNOERGROUND � POWER �
ROUGM WIRING
TRENCMES FORMS STEEL p
FLOOR SYSTEM
BONO BEAM � STEEL REINFORCE
SXEATHING
FR�ME ANO FLr15MING
LATHING - IN n OUT
PLASTER. BROWN COAT
STRUCTURqL, FINAL
HERTING, VENT., REFRIG. AND �.C.. F
PLUMBING. FINRL ANO GRS TEST n
. �5519 .
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in �Completely-- Use Ink Only
ADOfiESS . %YI '�A��L�A ��• '
OWNEF �• �/"nI �iQ✓/� �GQ/LN/A7%
ADORE55 � r /'/�ANCi.9 /SVC•
R
BUI�DING
ADDRESS
CITV. CpI7� /�'iCIA. � ' ' � NO`Jf4••• �� T
CANSiRUCTION A� / ' W '
LENDER- �S?-%�l V -GC�O�%��rlOnl .
BRANCH J/�I%9 /}✓A ' ' ' � . -
• OWNER
ADORESS � � � -
ARCHITECT M��rlo��'crr . Na3'3y9s�iL SE �
OR ENGINEEIi
' AODRESS //8.r/ .G�}cTu� f�� ._ CG. - FIRE
� . CONTRACTOR C/4L N f � - �
ADDRE 0,�..C�JTV�G ,�T•.
��T� DR�G� . - ; No�SS'/ 9/G
- � STATE q p� . �CITV
� �IQ NO: � �,[ �� �p .%� LIC. NO..
a OF LOT (pD'G �' � OD' NOW ON LOT� I
� . USE OF ' �C„ � G' . .
,�
EXISTING'BLDG. C/L
F� • , ��Separate pernuts aze requited for � � '
� � � electric, plumbing and heating �work. .
(.Wy U$� OF.BSIILDING ANO WORK TO'BE PFRFORMED
Qn Li�JKLC O /T/�.J ✓!G S
-� l3teldoo . • .
a .
7
r ..
a
: �
.w
APPROVED
59Z8 2/I6/78
FORSTRUCTURALPERMIT
DATE RECEIVEO pqy-E�5�=3
1 /
54,50 TL
tiv��,. �o, m��--.�
^ /� VALU$ /-��i..�!
i��v �. J ��� O
� -'T PE GFOUP
r
� �ATE
NO.OF USE OF N '
PWNS BUILDING '
'ROVED� VAFDSAPPROVED
LDING � ACCESSORV BUILDING
fi ET)
r
6:Z -i FT.
. . 4
DISTANCE BET. � ' BET. MAIN & '
MAIN BLDC$. " /1CCE$$. BLDGS.
VAR. �I`- . ' . DATE .
C.U.P.=,y�/1� � ' APPROVED �
APPROVEUi /��/ L� // '
�r-�� ` ��
,, �- 1 hereby acknowledga that I have reatl this application and stete '' , � .
(x that tha above fnformation is correct and.agree to comply�wiih
�+ all laws rogulatinp �building consttucNon, antl 1 shall ndt amploy �� ,
z any person in vlolation of the workman's compensation laws of � -
. � , the'State ot Californie. � - � .� ��., � � .
. 3 I hereby certtfy that I. am propeYly Iicensed es a contractot under , � n' FT'
• the State of California Business antl Protesslons Coda, Division 3, THE AMOUNTSHOWN UNDER VALUP
Chaptar 9, and that such 1lcenses ere In full force entl effect, or I THE PURPOSE OF FSTABLISHING A PERM
nm axempt from ihe provislons of tha Stata ot Callfornia Businass VALUATION � PERMIT FEE
.and Professions Cotla, Divislon 3, ChaPter 9. T , ' a�
///jjj r _ � . LAN CHECK � $ -
Signature O£ �%�.(...�
� Permlttee _ � ` S � � / � TAX , E
� �Authorized ABent � ' ' ' ' ' TOTAL PAID E i
n
m
i
:
m .
7 -
m
d '
a
N
m
M
0
LL
U.
ENERAL CONTRACTOR � E�JGpI, PppI,S DES
P No. Al2-1S3-1+1 LOT bp TRACT 7718 FIR
ISPECTIONS Sfannm.e�a��
Pool Location '
�orms
1 ain Drain
Steel Reinforce
��� Elec. Bond--
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines _
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final _
Filter System Final
Backwash and Recep. Final
Fencing Final
Approval for Finish _
BUILDING PERMIT•N0.
�%i� 1 : • • -
�
■�
1�������
� �� � �.ri.%��
���
��
r
y-lo=1�l 7aa. .1,�� —:1,G yo, a,5/o, 9, /so� �/,
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7da. � ys��, s, ; _
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,
.. , � •,.,�r.. ^� - +,
,..,:
i►�, , ' ' ��J��� � . ' ' 6285 2/23%78 . . 48050 TC
� � ��COSTA MESA BUILDING-SAFETY DEPARTMENT �- � ' • � . � �
, P.O. BOX 1200 COSTA MESA, CALIFORNIA 82626 � � �
CA ION FOR STRUCTURAL PERMIT
For Applicant to FID in Completely�,— Use Ink Only �RE i E v DATE RECE�VED '
� BUIL�ING � d . . _ � ^DAT�EJIS^�SUED
ADDRESS �/����� O��/` J^
A I.Z-I P O
OWNER �y(f�I Ji O�M%%� - .. A.P. NO.
' MAIL BUILDING /� ,
.. ADDRESS' I /¢ �Jf}� /�� - ' ADDRESS ' �%/G�jy .
CITV [,��fJ �'j/es/¢. � � NOL,�'j6�.�a% TRACT / , . �LOT/ BLOCK
' . ODNSTRUC�ION . � ' . . � • A
LENDER'. ' ' � '
� BRANCH �� , OWNER I �e A
' ADOFESS � . . � . % � . . VALUE i/1t� ,
ARCHITECT ' ' - ' '. TEL. � -. �USE ��= �5�� - $ d���0 �
e . a � , �����.�� .
, CONTRACTOfi BV DATE
� ADDRESS ��.y (S �/U�� •I��� ” - .
� TEL. NO.OF USE OF NEW
cirv i?%J/f/4' �/y/i4-� ' .�i�o-io�.S33��2 . rws� euu.ouac
H STATE - • ' . GTV � �'ARDSAPPROVED 'YAR0.SAPPROVED
�• i' LIC. NO. ' 7j v r " GC. NO � MAIN BUILOING � ACCESSORV BUILDINO
W � 512E ' � • NO.O: BLDGS (FROM C(ySTREET)
� d . OF LOT NOW ON LAT � FT. ' '
a � USE OF . .. , . ' . ' �
- �' .y.. EXISTNG BLDG. � � ..
. � ' ' � �. � . � . .
Separate permits are required for � s T FT.
electric, plumbing and heating work. �
� REAR. FT. � - FT.
USE OF BUILDING AND WORK TO BE PERFORMED OISTANCE B BET. MAIN &
C Ci � ' • . ' MAIN BLOGS. � ACCESS. BLOGS. . .
, . a .r . ' 'VAR.Me . DATE . .
M
/ . Qjf/ I.V � � C.U.P.� /��� �APPqpVED� .
� . � ' ' AP? N�-l.lJ �
�
0,,,�.i - . . . � ' . . -
W ' _
0 I h�reEy ecknowletlpe that I heva raaA Mia eppllcation end ateta � - � � �
�' mat me ebovs fnformeilon la eolrect and epree to comply wlffi m
ell laws requletlnp DuilEin9 <onatruccion, antl I ahall not �mploy . , �.�
. ' Z. any penon In violetlon af the-workman's compantatlon lewa of. ' "- : m
� � Me'State of Celifomle. �' � �
3 1 heraby cartify that 1 am Droperly Iicanfetl af e contractot under ��SQ. FT. a
-. Ma Stece of Cellfornia Bminen end Profasslona Catle, Dlvialan 3, THE-AMOUNT SHO UNDER VALUATION IS FOR m
' Chepter 9; entl-that auch:lieenm� are.in full fmce antl aHxt; or I h1E VURPOSE OF ABLASHING�A VERMIT FEE ONLV: �
am exemp< fram the provlfion� of the State of Californla Businep VALUATION ' pERM1T FEE i �
. and Professlons Code, Dlvision 3, Chapta� 9. '' -. �,(� �'
� ' p - a� PLANCHECK� S ' �' ^
SlOndture o}����� �/���� ' . , � �']�., � . - . � � .
Vermli[eel�//:C.Gk6f�iC%L�^�— � $ � o o TAX .' 3 �
. � V
AuihOfiZed Apent ' � ' ' . - ' . TOTAL PAID 3
..... ::, ,..,... �.. . ..
,' 60 .. .. . . .. • ^„ " _
� . � . 35C��';a � . �+oc is-�2��5POO�oo9�� *-��142.85
� � �� COSTA MESA BUILDING-SAFETY'DEPARTMENT�� � � � ' -
' SOLCR P,O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �� � - � -
� . � � . � . � PPLICATION� FOR BUILDING PERMIT � . �
�. . Fo�ApplicanLto�Fillin Completely � � R EIV D V ,DATE FECEIVED D E ISS ED �
-�/- �� � /�' 7 .
no�oaess Dahlia Avenue ✓
- - ' PERNH7 6. '
. '.OWNER Larwin'�Southern California`,.�Inc. A'P'NO. •/� � . �S�U � �
� . ..MAIL .. : . .. � ' _, ' BVILDING _/ `i'/; .t %' :. n �. . i. �
ADDRESS " '�6255 � � } p,' ' �+DDRESS. �y���c_ _
Z . .« :. r _ . � /' � .
d U GTY • Ei1CIf1O� CQII�Oif11C1 �NOL��b—pH]O - �TRACT ' [ � � f� LOT � BLOCK �
.� Z. . � . . . :
' oN � LENDER�ION Lar�yin'Southern Californid, ��jC. �EW ADD Al R P -
�� eaaNCN' 16255 Ventura Boulevar'd b'' ., 4
, J N . . . . .. . OWNER . ,.,If��/U � � C T �
m J ADORE55� E�1CIIl0 CC�II�OrIIIQ� �'' ' � � ' VALVE �/�� J/
J m ARCHITECT �' � .TEI.� �? SE -�� ' � $ /fJ y�� ' '
a OR ENGINEER '.N .
UN
w�,CL �ADOFESS 9�100.Wilehire, Blvd. Bev.�HIII$ ZONE_" _ TY.PE� GFOUP �� .
�-�W . •' ^ • APPRO ED � .
w z coNraacroR La in $outhern alif nid eY '.DATE' — =� `
-� O . .. � .- .
m�._ aooaess 16255 Ventura B' + ;'�f `: ' �U
w w" ' -' - ' TEL. e ZONE , NO.OF, USE OF NEW /N F
z� cirv Encino�Califomia NO.9H6'OH�%O P�� BUILDING(�(� y�
O STATE - � � ' � � CITV - '�'ARDSAPPROVED' w�`' VAFDSAPPROVE� `/'\
y�. LI0. NO. ��%�3� �, � � �IC. NO. B�� MAIN BUILDING : ACCESSORY BUILDING
' �O - � (FROM�GLSTREET) � � "
�SIZE " " NO.OF BLDGS. , "i � . �
� OF LOT. , (�1 1 O ' ' NOW ON LOY � Q � FROfYT �S� FT. FT.
USE OF � . . . . ' - • . � .
' E%ISTING BLDG.�� " ' '- � ' E � � F ' FT.
�' H. SIZE OF. NO. OF '- Y � -
' -Z�- NEWBLDG.'174'O -" ROOMS �� STORIES1. �.SIOE S—FT. .� FT. '.
�. V COVERINGP.LL StUQCO'�� COVOERINGWOW Shlll I85 REAR ��'S . FT. . �
J. VSE OFBUIIDING AND WORK TO BE PERFOFMED DISTANCE BET.- �� BET. MAIN &
a '. •. � � . .• , MAIN BLDGS. ' � ACCESS. BLDGS. . .
a-
Q - � � �. . VAF. # . DATE .
O. . C.U.P.aW APPftOVED . �
. F � , , � , , APPROVED '7/u/�i -
N '
O. -' .. . . , . . ' . .
�, V I heretiy,acknowled9e�mat I hive'read.this appliwtion and;tate -HOLD FOR SPECIAL R QU REME �S. �
� that ffie above intormation is correct �antl agree to comply with �
� all.laws regulating�builHing mnsttuction,'antl I shall not employ � j�/� �
.. F any person.in violation ot the workmads compansation laws ot •
y ' ffie State ot Calitornia. _ .: , , >• ' � �
. �' ' ' . "' � io
- , z I hereby.certify that I am prop¢rly licensed as a contractor under SQ: FT. ' o
the'S[ate ot Califomia gusinassantl Professions Cotle, Divisicn3, �� TH .AMOUNTSHOWN UNDER VAWATION�IS�FOR '
� .Chapter 9,�and ffiat such licenses are in full force antl' effect, or I- THEPURPOSE OF ESTABLISHING A PERMIT FEE ONIY: � m
' �� -am exempt from the O+ovisions oi the State ot California'Business - � - ¢- '
VACUATION . , ` . . m;..,
. . antl Professions Cotle,-Oivision 3, Chapter 9. ' � � �� � � ' � ' N .
. - . ' -PERMIT FEE: 5 � -
SiBnature of � �- � . Dwone � ��`7.J/�/ (7y,/ � � '. ': ..<� - � .- m ..
'. Pe�mittee ���. $ V�+'./ � PLAN CHECK $. E
. r �. O , i
• „ Auffiorizetl Agant " - ' LL �
. � � TOTAL FEE , 5 '