HomeMy WebLinkAbout1116 DANIELLE DR - Building PermitsIII
CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: Ell -00095
PERMIT TYPE ELEC STATUS: ISSUED
APN: 41207428 DATE ISSUED: 05/2412011
ISSUED BY: RMD
JOB ADDRESS: 1116 DANIELLE DR CM
Vicinity:
Suite/Unit:
SCOPE OF WORK: ELECTRICAL PERMIT TO UPGRADE SERVICE PANEL TO 200A.
NO OTHER ELECTRICAL WORK AUTHORIZED UNDER THIS PERMIT.
OWNER: SIMONIAN, SHARON Address: 1116 DANIELE DR Unit:
PHONE: 714-536-4271 City/State/Zip: COSTA MESA, CA
APPLICANT: FLYNN, RICHARD
PHONE: 714-545-4418
CONTRACTOR: FLYNN ELECTRIC
Address. 20632 GOSHAWK LN Unit:
City/Slate: HUNTINGTON BEACH,CA
CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee:
$0.00
Electrical Permit Fee:
$54.00
Reinspection Fee
$0.00
TOTAL FEES
$54.00
Address: Unit:
City/State/zZip:
License No. 514219
PHONE: 714-5364271
ZipCode: 92646
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work 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.
CODE k. INSPECTION TYPE DATE IN VIALS CODE# INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing X 2 �j/--
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
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 fbr 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 wor ers' compensation Insurance carrier and policy
number ar
Carrier:_ � 1i(, f
(THE section need notbe Wmpleleagtb penad, valuec, a tone hundreddollars nilw)orless)
P,`olicy.Number00012779 '7d0&)
❑ 1 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 1_4orrCode, jslgall forthwith comply with these provisio/Is. /
A050pant's Signature Date
WARNING: FAILURE TO SECURK WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am 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-# /7•L� cclas_s #, _/Q ,i'1//ML
G�
bit or's Si attire--" Date —
(/
CONSTRUCTION LENDING AGENCY:
❑ I hereby affimt that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Gvil Code).
Lender's 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, 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 contractors) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
signature
3057-4613(01)
Owner ID verified by driv. .,cense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - 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.
Applicant's 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 file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fled 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 feel 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? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ 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? ❑ 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? ❑ Yes ❑ 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.
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 stale laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
���Slg lure Legal Ownegs) Date
/�
i,Antllp ed pplicantt L e
CITY OF COSTA MESA
4,O�R"'FS,p BUILDING DIVISION
re 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
-�a,r„�.fi PERMIT NUMBER: BC11-00233
PERMITTYPE: B_COMBO STATUS: ISSUED
Sub Type: RES—ALT DATE ISSUED: 06//2�
I0/2011
ISSUED BY: "
JOB ADDRESS: 1116 DANIELLE DR CM
APN: 41207428 Zoning:, ,
Vicinity:
Const Type: V -B
SQ. FT: 0
Suite/Unit:
Primary Occ:
Valuation: $75,000.00
SCOPE OF WORK: ADD 25 SQ FT INTERIOR LOFT WHICH IS AN EXTENSION OF AN EXISTING 2ND FLOOR BEDROOM.
MAJOR KITCHEN REMODEL. NEW SHEAR WALLS. REMOVE EXISTING WINDOWS AND ADD NEW WINDOWS IN VARIOUS
LOCATIONS. REPLACE SIDING AND OTHER MISC WORK ASSOCIATED WITH REMODEL; MECH GAS PIPING FOR COOKTOP
RELOCATE, 1 KITCHEN
HOOD, 25 LIGHT FIXTS, 25 OUTLETS, 30 SWITCHES, 4 MOTOR, INSTA HOT, REWIRE KITCHEN, 1 DISHWASHER, GAS
OUTLETS (1-4), RELOCATE P -TRAP, RELOCATE KTICHEN SINK, WASTE AND VENT, WATER PIPE.
OWNER: SIMONIAN, SHARON
Phone: 714-545-0418
APPLICANT: POPPLER, PHILIP
Phone: 714-321-2021
Address: 1116 DANIELE DR
City/State/Zip: COSTA MESA, CA
Address:
City/Stale/zZip:
CONTRACTOR: PHILIP POPPLER CONSTRUCTION License No. 560248
Phone: 714.321.2021 Address: 2619 VIA CASCADITAUnit:
Cell: City/State: SAN CLEMENTE, CA
ARCHITECT:
ENGINEER: STEPEN WEBER
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
License No.
License No.40001
$532.19
$818.75
$146.05
$50.95
$88.45
$7.50
$0.00
$3.00
$1,646.89
Unit:
Unit: :
ZipCode 92672
PHONE:
PHONE:909-736-0844
'Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13.279
Monday thou Friday -7:00 am thou 7:00 pm. Saturdays -9:00 am thou 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Day, Memorial Day Independence Day Labor Day Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work 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.
CODE p. INSPECTION TYPE DATE IIMMALS CODE N INSPECnON TYPE DAA INTITALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical X 1 /-/ -/ / H
1266 Pool Spa Final 208 Final Plumbing N II- / // E 0
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 �/ �T�
204 Final Demolition 250 Final Building/Occupancy 1)- -i- pL r-1
WORKERS' COMPENSATION DECLARATIONt.
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:
(Tors setlion need not he mope ear Arhe permd,is valuetl atm hurrtlretl tlo0ars (5100)wleu)
Policy Number:
certify that in the performance of the work for which this permit is
Issu , 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
ab e, 7 fo with c mply with these provisi ns.
/ !
A picam's Sighliulfe 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 DOLLARS
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am 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. # Class # r ^
W
ontra r ignature to
❑ 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)
Lender's Name:
Lender's Address:
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, as owner of the properly, 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 License Laws-).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature
3057-46(3107)
Owner ID verified by drive. - .,cense. ❑ Yes ❑ No
Driver's License No.
Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed): r
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.
Applicant's 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 file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, voth 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? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? []Yes ❑ 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? ❑ 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? ❑ Yes ❑ 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.
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-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
^�ol L71 0O erun ate
���And�thonxed Appi� Date
R. I _. Deputy Inspections, 1, (949) 291-3912
Fax(949)481-5866
�} Ty' -L -k 002.33 www.deputyinspector.com
t)t.6�»Iet-le:Dr
Email: rpaquette4@cox.net
1903 Via Pimpollo
San Clemente, CA 92673
REGISTERED I
INSPECTOR'S
REPORT OF:
❑ REINFORCED CONCRETE
❑ REINFORCED STEEL
[-IPOSTTENSION CONCRETE
❑ REINFORCED MASONRY
❑ STRUCT. STEEL WELDING
F1 EPDXY
❑ FINAL REPORT
❑ BOLTING ❑ OTHER
JOB NAME
Simonian
BLDG. PERMIT.
BC11-00233
CITYOF PERMIT
Costa Mesa
JOB ADDRESS
1116 Danielle
CONTRACTOR
Poppler Construction
ARCHITECT
Brian Oslin Design and Drafting
SUB CONTRACTOR
Poppler Construction
ENGINEER
Steven Weber
LAB TESTING SAMPLES
Observed
cleaningn
for bolts at existina' shear wall. Location he
south kit hen wall for 2 5/8"x12" RFB bolts with 8" embedment.
Sim son epoxy ICC ESR 2508 was used as per amwoved Olans.
All work
was found to comply with the aDproved
plans and specifications 8 applicable building codes.
Note det
ii 21S-8 calls for 1/2" bolts.Contracto LiDarade to 5/8" HDU2 .
I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY
ABILITY, 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS.
MATERIAL INFORMATION: CONCRETE❑ GROUT® MORTAR❑ WELDER CERT.
SUPPLIER: MIX NO.: ADMIX: SAMPLES CAST:
SPEC. P.S.I.: TYPE: SLUMP: YDS. PLACED:
AIR -TEMP: CONC TEMP: MIXING TIME:
DATE 1 START 1 STOP 1 REG. HOURS! O.T. HOURS
06/21/11 12:00 PM 6
AA Wv&tma bmedm a mnimum dl harm.nd.4 hmo -/tier mnhnam, in mdddm my hm da
mlmdma pmt men hem 0be m Bhmr minimum Atlba mem offb. dmrydlhn hiphem b/dmb of
mMe1, u "V.1 mllndiml mmand Mkmry Im AAmmmod dmds.06 u*o b. $A.W Im
06/21/11 1100030-49
DATE OF REPORT REGISTER NUMBER
JU04-22-2011 03:29P M M:BRIAN OSI.TN DESIGN 7149621300
JLN-22-2011 15:23 FROM:PDPPLE NSTRUCTION 949-361-1637
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MAVC APP
Cap/ -M crry 8 00�v1ta'
2619 Vm Cascadha • San Clemente • CA 92672 0 Phonr 714941.2021 • Fax_ 949-36L 1687 • Uc..*560249
Fire Incident # � (0 i t�
Police Incident #
RELEASE OF PROPERTY AFTER EMERGENCY INCIDENT
The Costa Mesa Fire Department, in the interest of the safety and welfare of the
assumed control of the property located at
The necessity for assuming control of the property was because of l )r� 41P,
Pursuant to the conditions contained herein, as of line) /
and is to be under the control and the responsibility of /) ///r'f"Y)
is the owner l`�IIJQ, owner's representative ( ), tenant ( ).
STA MESA FIRE DEPARTMENT
P.O. BOX 1200
COSTA MESA, CA 92628-1200
(714)754-5106
at I -150.a (time) /- c 13�L' (date),
rte), the subject property is released to
/` / (name), who
YOU ARE HEREBY PLACED ON NOTICE OF THE FOLLOWING CONDITIONS (Check applicable conditions):
( ) A rekindle or an additional fire from a hot spot is possible. The Fire Department recommends that a fire watch, with a
means to extinguish hot spots, should be posted for 24 hours. - / fi r ; , �, C. t (�
�Q The following utilities: electricity A, gas X), water ( ), serving the property have been shut off. It is advisable to
/ contact the appropriate utility company before restoring the service.
( ) The structure may have been weakened by the incident. Until a structural survey can be made, it is advisable to keep all
unnecessary people out of and away from the building.
( ) Buildings that cannot be locked or secured by normal means must be secured by alternative means. Barricades and/or
fencing are required to prevent unauthorized entry. It may be necessary to provide a security guard.
( ) Rebuilding and/or repairing the damage will require permits (e.g., building, electrical, etc.) from the City of Costa Mesa's
Development Services Department, Building Safety Division. They may be contacted Monday through Friday between
the hours of 8:00 a.m. and 5:00 p.m. by calling (714) 754-5273.
The Costa Mesa Fire Department and the Costa Mesa Police Department retain the right to re-enter the property at
reasonable hoofs, should their investigation of this incident require such re-entry.
The conditions listed above are not all inclusive. They are intended as guidelines for the City's Fire Department in exercising their
discretion in providing emergency assistance advice.
Information concerning a copy of the report for this incident can be obtained by calling the Fire Department Business Office at (714)
754-5106, Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m.
You may be entitled to a reassessment and subsequent reduction of your property tax as a result of this incident. For further
information contact the Orange County Assessor's Office at (714) 834-2727, Monday through Friday, between the hours of 8:00 a.m.
and 4:45 p.m.
The OWNER, OWNER'S REPRESENTATIVE, and/or TENANT shall protect, defend, indemnify and hold harmless CITY and its
elected and appointed boards, officers, and employees from any an all claims, liabilities, expenses, or damages of any nature,
including attorney fees, for injury to or death of any person, and for injury to any property, including consequential damages of any
nature resulting therefrom, arising out of or in any way connected with the negligent performance of this Release by act or omission,
by or on behalf of OWNER, OWNER'S REPRESENTATIVE, and/or TENANT, or resulting from any violation by OWNER,
OWNER'S REPRESENTATIVE, and/or TENANT of any statute, law, regulation, or other legal requirement
N --
I.,
Owner Q�) Owner's Representative (�(._..)�
Costa Mesa Fire Department
Signed:
Officer in Charge
292344 While- Fire AOministration, Yell-owner/Owner's Reyesentativenenant. Rnk- Development Servces Bolding Safety
Date: I — i Time: i
Assignment: I
CI _ OF COSTA MESA REQUEST FOB OCCL_.NCY
TRACT NO. OM L L DATE 3-
LOT N0. 50
ADDRESS I l l (O
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 (ie -she -they)
(was ox-4zesa)
uurTcl) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
J
BY
Ln er
l` gne,�Udit�S
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS /// 0ANIEr t/rly/FJS
OWNER
MAIL
ADDRESS 508 29th Street
DATE ISSUED
CITY Newport Beach,CA
TTEL'675-4910
CONSTRUCTION
LENDER
� //TRACT
L.
BRANCH
G
ADDRESS
NOW ON LOT
ARCHITECT Frank Spangler_
OR ENGINEER
TE L.673 _0952
ADDRESS 2240 Newport Blvd.
Newport Bch
CONTRACTOR Oumnpr
EXISTING BLDG.
'10II 10-77P0.[NS1Dt00 560* *** 109.78
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY DATE RECEIVED
A.P, NO.
DATE ISSUED
BUILDING
ADDRESS
I l (�/ CL—LC a Irl LLE
9866 LOT 50 BLOCK
� //TRACT
L.
(FROM L$
L
G
OF LOT A rox 60' x 80'
NOW ON LOT
OWNERProperties
Q
S
VALUE
S 61
TEL. P� /
CITY NO. EMLJDL
F STATE CITY YARDS APPROVED
USE OF���I�t—�L��
BUILDING UTA j]
YARDS YARDS APPROVED
ACCESSORY BUILDING
I BET. MAIN &
ACCESS. BLD
17 DATE
APPROVED I
96
L>r
0w
LIC. NO. LIC. NO.
MAIN Bt
W
SIZE
NO.OF BLOCS.
(FROM L$
L
G
OF LOT A rox 60' x 80'
NOW ON LOT
ONi
Q
USE OF
am exempt from the provisions of the State of California Business
end Professions Cod (Division 3, Chapter 9.
.�.
EXISTING BLDG.
S
to
Signature o
Pormltte
G
FSeparate
permits are required for
L SIDE
Authorized Agont�
electric, plumbing and heating work.
G
REAR
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BE'
MAIN BLOCS.
nQ
VAR. �'+xx
QC.U.P.
tY•'L�i'
yhouse
Plan # 3
SPR
a
a
w
USE OF���I�t—�L��
BUILDING UTA j]
YARDS YARDS APPROVED
ACCESSORY BUILDING
I BET. MAIN &
ACCESS. BLD
17 DATE
APPROVED I
96
L>r
0w
1 hereby acknowledge that I h V read this a lication and state
that the above information is c Tract and agree to comply with
all laws regulating building construction, and I shall not employ
HOLD FOP'. EPEC
IAL l��t..;irl1li::3Y.C1N I n
m
IZ
any person In violation of the Workmen's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and affect, or 1
m
2295m
SQ. FT, n
THE AMOUNT SHOWN UNDER VALUATION IS FOR m_
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
end Professions Cod (Division 3, Chapter 9.
VALUATION
'O
PERMIT FEE E a
m
m
PLAN CHECK E ^
0
Signature o
Pormltte
S61,100.
g'
TAX s 2 u
TOTAL PAID $
Authorized Agont�
C:
e���
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
SA
TC-9-77Cf'900 505 0* `1211.00
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY
I DATE RECEIVED
DATE ISSUED
BUILDING /
ADDRESS
r /
PERMIT NO.
OWNER !�/(/�/
A.P. NO.
MAIL
ADDRESS
BUILDING / t
ADDRESS
TEL.
CITY NO.
TRACT LOT BLOCK
CONSTRUCTION
W
ADD ALTER
REPAIR
LENDER
BRANCH
OWNER
ADDRESS
VALUE e
S $ "
ARCHITECT - TEL.
OR ENGINEER N 0.
FIRE
ADDRESS
ZONE TYPE GROUP
APPROVED
CONTRACTOR s
By DATE
ADDRESS
TEL.
CITY NO.
ZONE
NO. OF
PLANS
USE OF NEW
BUILDING
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO. OF BLDGS.
(FROM C/L STREET)
OF LOT NOW ON LOT
FRONT FT.
FT.
USE OF
EXISTING BLDG,
SIDE FT.
FT
Separate permits are required for
L. SIDE FT.
FT.
REAR FT.
FT.
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN SLOGS.
ACCESS SLOGS.
VAR. sib
DATE
C.U.P.sle
APPROVED
6z
APPROVED
By
DAIE
I hereby acknowledge that i have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in Violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
SO. T.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
and Professions Code (vision 3, Chapter 9.
VALUATION
PERMIT FEE $
PLAN CHECK $
Signature O
Perm nee --f�7
$� �
TAX $
Authorized Agent —�
TOTAL PAID $