The URL can be used to link to this page

Home My WebLink About1121 DANIELLE DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1121 DANIELLE DR Suite No Vicinity: Parcel Nunmber: 41207438 Applicant: KEVIN SZABO Address: 2737 S CRODDY STE D SANTA ANA, CA Owner: DE SOUZA, GERALD F TR Address 1121 DANIELLE DR COSTA MESA, CA Phone: (714)241-1414 Zip: 92704 Phone: Zip: 92626-16 Status: ISSUED Applied: 10/16/2003 Issued: 10/16/2003 ISSUED BY: Contractor: COAST ROOTER PLUMBING HEATING & AIR CON Address: 2737 S CRODDY SCOPE OF PERMIT STE D Phone: (714)241-1414 SANTA ANA, CA Zip: 92704 FEE SUMMARY License: 529127 Arch / Eng : Address: Phone: Zip: License: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2aae (6/00) C/O OF WATER HEATER. SCOPE OF PERMIT FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 - Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater / vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2aae (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ ybava 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 woIrk 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: I Carder: '_"%T7ACT—E fV73 A✓6 Policy Number: � O .O 3 (This section need not be completed i/ the permit is alued at one hundred dollars ($100) or less.) I certify that in theApedonte of th woror hich this permit is issued, shall not employ any person in any manner so as to become subject to the workers' compensation lawrnlaA`n gree h tit I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cade, I shall fonhwlth comply with these Applicant Signature: Date: V �� WARNING: FAILURE TO SE RE O ' COMP TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND D01-LARE ($100,000)1IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions o hapter 9 (corn oncing with Section 7000) of Division 3 of the Busind Professions Code, and my license is in full force and effect. Lic. # Class # (!resL'{�7 OZ Contractors Signature: Date: 1 C7 — 1 �_ p CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders 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 whicti 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).): ❑ 1, 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.). ❑ 1, 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: ' --� Date: Owner ID verified by drivers license. ❑ 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 6, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or prosnt 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 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 w111 the applicant or present or future building occupant require for the work which Is the subject of thisa plication a gpermit for such construction or modification from the South Coast Air Ouality Management District or from any other air pollution control district or agency? M Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................................................................................................................................................................................................................. 6 Will any pan of the facility to be constructed under this 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 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 distract or agency is required for the work which is the subject of this application, have allot the disclosures prescribed 6y California Health and Safety Code Section 42303 been made? ❑Yes ❑ No .................................................. .....ific................................................................................................11ut................trol............................................................................................... .................... ..................................... .......................................... 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspec ion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �—Signet a Of Legal Owners) Date _ to- And/Or Authorized Applicant Date CODE I. INSPECTION TYPE RBI& INITIALS CODES INSPECTION TYPE PATE INITTIAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ?E -1'1 _ 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesawILDING PERMIT 77 FAIH DHIVt, VUJ IA MtSA, UA tlZOZO SO FT. Job Address: 1121 DANIELLE DR Suite: Vicinity: RESIDENCE & ATTACHED GARAGE Parcel Number: 41207438 Zoning: R1 R1 Applicant: ROBERTS, CHRIS Address: 18193 MUIRWOOD CT Phone: (714) 557-6516 FOUNTAIN VALLEY, CA Zip: 92708 Owner: DESOUZA TRUST Address 1121 DANIELLE DR Issued: Phone: COSTA MESA, CA Zip: 92626 Contractor: ISLAND PACIFIC ROOFING Address: 18193 MUIRWOOD CT Arch Address: Phone: (714)557-6516 FOUNTAIN VALLEY, CA Zip: 92708 License: 631472 Phone: Eng: Address: ISSUED BY: Status: ISSUED Applied: 08/14/2000 Issued: 08/14/2000 Phone: Zip: License: License: SCOPE OF PERMIT REROOF: TIO WOOD SHAKES, INSTALL 1/2' PLYWOOD, 2 LAYERS 40# FELT, MONIER CEDAR -LITE (5.8 #). 2000 NOTES: EXPIRED �l NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"646 (6/00) FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,800.00 Permit: $153.25 Claim Valuation: $7,800.00 SMIP Res: $0.78 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $154.03 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 - NOTES: EXPIRED �l NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"646 (6/00) I. WORKERS' COMPENSATION DECLARATION: I hQIe6y 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: /� �7 Carrier: %� .-rcf ti 2//V 7 (. h Policy Number: G/G 2'7 —V4V & (this section need ple(ed i(the permit is valued at one hundred dollars ($100) or less.) ❑I certify that in the performance of the r for which this permit is issued, shall not employ any person in any manner so as to become subject to the workers' compensation laws of C81forn11a, ag(ee Ihal if hould b Come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: v Data: /// WARNING: FAILURE TO SECURE W RB' COMP COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI P ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3/06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro ns 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. N Class x Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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: Lenders 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 no 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 pennit 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 lar such project with a comractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ 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: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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 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 o1 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 apartment 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 92plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................................... ... ................................................................................................................................... .................................... ........................................I .... ................. 6 Will an facility p ........................... ........ y pert of the facili 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 It 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 [I No .... ............................................................................................................................................................................................................................................................................................... .................. .......................... ............................. ............ . B (If'j�e5", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. Sr Legs w ) ! Of le 1 19 Kind/Or Aut !/( ate CODE t. INSPECTION TYPE DATE INITIALS COPE! INSPECTION TYPE pdjf, IINTITAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof "I'�0.'� �JJ�L 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 Applicant to fill in all spaces except those within heavy CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIZNO. TRACT NO. Project Address 1121 Danielle - Applicant's Mailing Address Owner's Name Glen T. Church Phone 751-4409 Address 1121 Danielle Arch/Eng. License No. Address Contractor's Name Culligan Water COnd Phone750-2233 Address (mailing) 4 MaQCheGt r City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fulls fg!ce and effect. 168763 LJcensC Cl ss JJ Lice se No. Date J-� Signature NO R KERS' COMPENSATION DECLA TION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a Certified C py tho of(SS ction 3800, Lab. C.) // 7�� /s=ry /1�.3 !'0 Policy No. '64�(eGlnY7 Company t— eCertified copy is hereby furnished. Cer ifir �Q y is filed with the city, Build D'wis. Date- "� Applicant "en L7r EXEMPTION FROM WORKERS' COMPENrmn ATION DECLARATION (Thissection need not be completed if the p is for on¢ huntlred ($100) or less). I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so•as to become subject to the Workers' Compensation Laws of California. Date _Signature NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shan, be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of 'the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any ap Plicant for a permit subjects- the applicant to a Civil I(_enalty of not more than five hundred dollars ($500). LJ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code; The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of Com- ple[lof the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I. as owner of the property, am exclusively Contracting with licensed Con. tractors to construct the project(Section 7044. Business and Professions Code; The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who Contracts for such projects with a con. tractors) license pursuant to the Contractor's License Law). I am aware that proof o/ their Worker's Compensation insurance should be Provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state information is correct. I agree to comply with all city and cou and state laws relating to building Construction, and hereby a sentatives of this City to enter upon the above-mentioned inspection ��u,,,,rggggoses Signature Drivers' License r SS CMF 0865-46, rev. 4/84 that the above my ordinances uthoriae repre- property for .5-7-85 TYPE OF CONSTRUCTION LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF 8LDG. — and sign all appropriate declarations. ALTERATION LJ REPAIR TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY__ CONSTRUCTION TYPE VALUATIONS - ZONE— ALUATION$ZONE GRADINGCU.YDS. ACRES_ Remarks: _-s %vD FEES A.P. 1E S Main Building: E T Front B Rear A C Right K' S Left ring. Ref. # Planning Notes: 2765 5/10/85 Accessory Building: Zone 5,00. TL Z O N I N G R E Q M T S. Bar Sink Showers ' SUMMARY OF FEES ELECTRICAL FEES i Backflow Preventer - Service Sink Duct - Structural Automatic Washer Transformer ❑ 15-50 KW' Construction Pole Sub. 050+KW Backflow Irrigation Sewer Cap Duct -Ventilating Bathtubs Sewer Connection Exhaust System ❑ Multiple ❑ Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Firepl/Fact. Bit. ICBO # Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BTLl Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank PLAN CHECK 50% Fan Motors 110.1 HP 0 '/h - 8 Floor Drains Swimming Pool w/Spa MECHANICAL F.A.U. Inc.Solar 09-15 HP ❑16-15+ Floor Sinks - Urinal PLAN CHECK 25% Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Water Softener 2 00 Garbage Disposal, Standing Sections P -Trap Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 I I Issue Fee I $ 3 MECHANICAL FEES Boiler ' SUMMARY OF FEES Hood or Type 1 ❑ Canopy Type 11 C1 Duct - Under Ground Duct - Structural $ Refrigeration System ❑0-100,000BTU ❑100,000 Duct -Ventilating i-�-�-Q- Exhaust System ❑ Multiple ❑ $ . --km ISSUANCE System Repair/Alteration Firepl/Fact. Bit. ICBO # $ 'ENERGY P.C. $ Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BTLl $ GRADING $ PLAN CHECK 50% I Reinspection Fee I $15 I I Issue Fee White - Building; Canary - Applicant: Pink - Accounting: Goldenrod - Assessor $ 3 I Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By 1 Application Issued By $ 3 •. • ' SUMMARY OF FEES BUILDING PERMIT $ SMIP $ ' PLAN CHECK •' $ PERMIT i-�-�-Q- PLUMBING $ . --km ISSUANCE $ PLAN CHECK 25% $ 'ENERGY P.C. $ ELECTRICAL, $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ 5.00 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POvL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas OOil 25. Roof Sheathing _ 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation J 78. FIRE PREY. FINAL 30. Drywall Nailing r, HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric j Notes: 3' /y/dS e%Lf%(//2J. L.iO 34. Final Heating & Air Conditioning C 5 d?s No 6tyc qU,"0-.L•ri 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. mb n 1� / /-C� ALI!/ 76 39. Water Service -Final t/ UA awle 40. Gas Service -Final r. s 41. Solar Domestic -Final 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' CITY OF COSTA MESA �` BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT J � - - PERMIT PERMIT NUMBER E98-01194 1- (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1121 DANIELLEDR Suite No Vicinity: Parcel Nunmber: 41207438 Applicant: GLEN CHURCH Address: Owner: CHURCH, GLEN T TR Address 1121 DANIELLE OR Contractor: Address: Phone: 714-751-4409 Zip: Phone: : COSTA MESA,CA Zip: 92626 Phone: Zip: License: SCOPE OF PERMIT legalize kitchen remodel, 4 fixtures, 4 outlets. no other work authorized by this permit. Status: ISSUED Applied: 11/13/1998 Issued: 11/13/1998 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 - Busway /100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kva/kw $0.00 0 Lighting Fixts $4.00 4 .................up to 50 kva/kw $0.00 0 Recept Outlets $4.00 4 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 1 Ohp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $8.00 Sub panel to 2003 $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $38.00 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 7 Ali WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' campensatlon 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: Comer: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars IS 100) or less.) ❑ 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 Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CMIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I 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 # Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby aBirn 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: Lenders 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 civ,l 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 awn employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt and Business and Professions Code for this reason: Signature: Owner ID verifiey rivers license. ❑ Yes ❑ No Driver's License No. Expires: Vellication of Ow rshlp 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 pernit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I WIII 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 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 app...licant ar 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). ........................................................................................................................................................................................................................................................................I........... 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 a2pa�plication eppertnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes LINO (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). ................................................................................................................................................................................................................................................................. Q 7 II a permit tram the South Coast AIr uality 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. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-deS=perty for innpgction purposes. I agree not to Occupy or allow occupanccyy of any building authorized by this permit until final inspection. 0 Signature Of Legal Owner(s) Data And/Or Authorized Applicant Date CODE 9. INSPECTION TYPE TATE INTITIA65 LODES INSPECTION TYPE Deg INTITA $ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical a3 e 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 244fi<6 t(� 6 CITY OF COSTA MESA ° BUILDING DIVISION F DEVELOPMENT SERVICES DEPARTMENT J •,� � PERMIT PERMIT NUMBER "tioom� P98-00851 ✓ (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1121 DANIELLEDR Suite No Vicinity: Parcel Nunmber: 41207438 Applicant: GLEN CHURCH Address: Owner: CHURCH, GLEN T TR Address 1121 DANIELLE DR Contractor: Address: Arch l Eng: Address: Phone: 714-751-4409 Zip: Phone: COSTA MESA,CA Zip: 92626 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT legalize kitchen remodel, 1 dishwasher, 1 kitchen sink. no other work authorized by this permit. QTY Status: ISSUED Applied: 11/13/1998 Issued: 11/13/1998 FEE SUMMARY AMT ISSUE FEE $22.00 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $8.75 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY Status: ISSUED Applied: 11/13/1998 Issued: 11/13/1998 FEE SUMMARY AMT QTY AMT QTY Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 R) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0,00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower • $0.00 0 Water Heater / vent $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $8.75 1 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $17.50 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $57.00 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 caller and polity number are: Cartier: Policy Number. (This section need nor be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOIIARE ($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. Uc. # Class # Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em 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 civ.] 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 appy to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt a ec. Business and Professions Code for this reason: Signature: � / Expires:Tt Verification of 0iWarship by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, wlll be made in connection with work authorized by this permit, and that no building structure, scaffolding, ialsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to rile 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 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). .....................................................................................................p,an.............................................(Ris.......................................enti.......rogr...............utel.......................aterials ? 3 Does or will the applicant or present or future builtling occupant need to prepare an RMPP (Risk Management end 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 plication apo mit 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 65650.2 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 pernit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No fit'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................... 7 If apermit from the South Coast Air Quality Management District or other air pollution control district or agency Is reqGuired for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been made? ❑Vas [I No ............. ............................................................................................................................................................................................................ attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to c9�nply 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 pr ¢arty for inspectio urposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / i Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE J INSPECTION TYPE PAIS INTIRALS CODE INSPECTION TYPE BATE ISL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 2046 46 (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 1121 DANIELLEDR Suite No Vicinity: Parcel Nunmber: 41207438 Applicant: GLEN CHURCH Address: Owner: CHURCH, GLEN T TR Address: 1121 DANIELLE OR Contractor: Address: Arch/Eng: Address: MECHANICAL PERMIT Phone: 714-751-4409 Zip: Phone: COSTA MESA,CA Zip: 92626 Phone: Zip: License: Phone: Zip: License: . , PERMIT NUMBER M98-00528 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 11/13/1998 Issued: 11/13/1998 EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 A SCOPE OF PERMIT legalize fau/a/c unit replacement. no other work authorized by this permit. FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Repair / Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $13.25 Repair / Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $13.25 1 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping $0.00 0 Up to 3 hp/ 1001k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp / 500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $26.50 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $75.00 EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 A a WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed i/ the permit is valued at one hundred dollars ($100) or less.) ❑ 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 Labor Code, I shall forthwith comply with these provisions. Applicant Signature: . Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W 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. Uc. a Class q Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this pernit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders 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 civ,l 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 Cade: 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.). ❑ 1 am exempt and ac. Business and Professions Code for this reason: Signature: _ T Date: OwnerID ver fia ✓ rivers license. ❑ Yes O No Drivers Ucense No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, TIt1e B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to 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 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 Daes or will the applicant or present or future building occupant need to file a registration forth 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 hes 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 Uoes 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 en 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 gppllcatlon apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency?Yes O 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 pan of the facility Io be constructed under this 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 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 distinct or agency is reqquired 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 ❑Vas ❑ No ................................................................................................................................................................................................................................................................ 6 (If yes , attach certificate of compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to mply 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-tlescribed p o e y for inspecti n purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ./- // /i 3/9J - Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I. INSPECTION TYPE OAIE VICTIM L$ CODE INSPECTION TYPEDATE 111i[RALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical Z� iti 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocklRetaining 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 2446-46 17F11Ji P.fi( _(Building rAj Address C h Owner Zi V/4/ , PmL Contractor 4"101 tA1i�G14 ST' /J. B, Address Permit Date LI!LL'i q_Number j 1 L19 Issued t6- CITY OF COSTA MESA DEPARTMENT OF BUILDING SAFETY M A X S*Pf- Registered Deputy Building Inspector Certificate of Compliance /V\ V '-V (mak \ Date f this Cer €irate la/ iU/1q 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 employed to inspect, were inspected by me and comply with the provisions of the Building Code applicable thereto. 1) Concrete 3) Welding 5) Special Cases 2) Masonry 4)inforced Gypsum Swimming Pool Size GuniteHand Pack Sacks Cement y. —t Tons of Sand M0 �. Approximate % of water in aggregate 1511/6 This report covers work completed during week ending Ja 1411 7 Ct 4 REMARKS: SJ-PeL.� REGIS4�,EP YUP B H•YNG INSPECTOR to C7L. PQ^ n S `jail lit) I" � Pool a3y q Name �r Address F'0. /3ox 3<! s�/ i//P"*A) Laboratory i—U�la�l�� Telephone gql 5a3� V Form BU 6 �2=�� F�oi Twining Laboratories of 3370 Algm.l lYar / Maphnq AaUress o 0 So- 47 /long Bc•nc n. CA 00801 112131 4263355 1 12131 6362386 / 171 a1 828-6432 TESTING 89ANCH OF LICE 4514 D Norm •.nmr• S:•=.•: Seola Ann. CA 92703 17141 531:045 January 8, 1980 Examination: SC79-7334 COMPRESSION TESTS ON GUNITE CYLINDERS Max Sitter P.O. Box 3454 Fullerton, California 92631 PROJECT SWIMMING POOL ADDRESS 1121 Danielle, Costa Mesa SAMPLE FROM Shallow end and main drain ARCNItECT Irvine Pools ENOINEFR J. P. Anderson Mix 4.2 - 1 DATE CAST DATE TESTED CYLINDER NO. COMPRESSION TOTAL LOAD, LBS. POUNDS PER 50. IN, COMPLIANCE 12-14-79 12-24-79 1 10 -Day 30,000 1,060 CONIRA]top Irvine Pools SUSCON1RAClOe Pacific Coast Gunite Co. SPECIFIED STRENGTH 2 000 psi CYLINDER SIZE 1-4-80 2 21 -Day 100,000 3,535 21 -Day test complies with specifications. MADE RV CYLINDERS Sam DISTRIRUTION Max Sitter - 3 Costa Mesa Bldg. Dept. .. �.. � . -� s .... 1. .. ..• cry .. � •I. DELIVERED By Sitter 1 611 x 1211 RECEIVED ON 12-17-79 RE0ErQEfl MAN a4 196i L- a ?wininq Laboratories of sOutGtn &6-/O nia, -qnc. "® 9910 Airppn Way / Moiling Address P.O. 00x 47 /loop Beetn, CA 00007 112131426-3355 / (2131 630-238a /(714( 828-6431 TESTING 9A MCH OFFICE: 1514.0 Nor1n K.,W 51,n1 / Dorm Ans. CA 07703 117141531-7045 FIELD DATA FOR CONCRETE TEST CYLINDERS Charge to max ax 577Y t PROJECT Address Architect -rPVINP Pcx)L,� Contractor Sayl>,i PooLS Concrete Engineer J , P. Contractor PqLI-�,•L GzAcl• (-,U/u!k SAMPLED FROM Location in Structure �`�) 5�g1�ju _ua.�fy)A+J 12w;o (al Mix Used Spec. Strength, P.S.I. ;�qoo Date Cast l01 — jy-ice Slump -g- Number of Cyls. Cast (C, Date Tested CYLINDER NOS. COMPRESSION 7 Days Total Load, Lbs. Lbs. per Sq.in. Area Sq. In. 28 Day Average: 28 Days 28 Days Cui;i•LiARCE 2'o Day tests comply (does not comply) with specifications. REMARKS Cylinders: Made by Delivered by Copies to: (Please furnish addresses) Received on Our Identification 7 Days 28 Days 28 Days "Hold" • 4 nAOJ 1P lie Q/Z Building Address ( h Owner -tlbx)I,,,p Ped5 Contractor Had 0()(\1gf Ihp Address Permit Date 41SNumber Issued CITY OF COSTA MESA DEPARTMENT OF BUILDING SAFETY `/ \ Iv Re istere& Depu y Bu ng Inspector Certificate of Compliance /9- jq. ?9 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 employed to inspect, were inspected by me and comply with the provisions of the Building Code applicable thereto. 1) Concrete 3) Welding 5) Special Cases 2) Masonry 4) Reinforced Gypsum Swimming Pool Size Gunite' Hand Pack Sacks Cement Zi'a- ( Tons of Sand 3b Approximate % of water in aggregate This report covers work completed during week ending REMARKS: STeeL� p, L,SNS n �C As:�lti s S7ecC CLegr��, c� REGISTERED -DEPUTY BUILDING INSPECTOR '/ YL ��b�rLS YLeSLLiS Name f 1 M 1 /4 )( S/iiFz Address RO. AC,( ?NSLd r'ulle-Auu Laboratory, -7-y or) Iu (� Telephone CjCf I -SJ-"-SI Form BU 6 20 Zs A Twininq Laboratories f c5o,tfEV2 earifo=nza, -Y,=. 3310 Airport Way / Mailing Address PO Be, 47 ' tong Beach. C4 90801 / (2131426-3355 / (2131 6362386 / (714) 828-6432 1,� TESTING 9BANCH OFFICE 1514.0 troch-ta.ne, Sl,eo; Sane Ara. CA 92703 r 1)141 531-2045 W� AT January 8, 1980 Examination: SC79-7334 COMPRESSION TESTS ON GUNITE CYLINDERS Max Sitter P.O. Box 3454 Fullerton, California 92631 PROJECT SWIMMING POOL ADDRESS 1121 Danielle, Costa Mesa SAMPLE FROM Shallow end and main drain ARCHITECT CONTRACTOR Irvine Pools Irvine Pools ENGINEER SUB CONTR A C I OR J. P. Anderson Pacific Coast Gunite Co. SPECIFIED mix 4.2 - 1 STRENGTH 2,000 psi DATE CAST 12-14-79 CYLINDER SIZE 611 x 121' DATE TESTED 12-24-79 1-4-80 CYLINDER NO. 1 2 COMPRESSION 10 -Day 21 -Day i TOTAL LOAD, LBS. 30,000 E 100,000 POUNDS PER SO. IN. 1,060 3,535 COMPLIANCE 21 -Day test complies with specifications. MADE BY CYLINDERS Sam DISTRIBUTION. Max Sitter - 3 Costa Mesa Bldg. Dept. DELIVERED BY Sitter RECEIVED ON 12-17-79 .-s ... ¢ ,nw ,.x,II IT _.I o, I ou'L'Ir ,. . I ..1 V., e..I no ov r? v:F CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. LOT NO. 7 , ADDRESS 11,�� DATE / 56 -ow 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 -they) /••ii:.� (was or were) W4 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. representative (—Lender � 2O 2s �2=�� "�oi Twining Laboratories of SouEi1= cac�fo=,=�1 g,_c• 3710 AnpnrE lVav / Madm� Addles PO Bo. 47/ LmTp Peach, CA 90801 / 1213) 420"3355 / 1213) 6382386 / (71 J) 828-6432 TESTING 9RANCH OFFICE Santa An9 CA 9270? � OtaT 53: 2045 Examination: SC79-7334 POUNDS PER SO. IN, 1,060 COMPLIANCE MADE BY DELIVERED EY RECEIVED ON CYLINDERS Sam Sitter 12-17-79 DISTRIBUTION Max Sitter - 3 Costa Mesa Bldg. Dept. • <y ,]�._9..•C. • un[F .e TS rfi rar..,5�0^.♦ (.w 1. COMPRESSION TESTS ON GUNITE CYLINDERS Max Sitter P.O. Box 3454 Fullerton,.California 92631 PROJECT SWIMMING POOL ADDRESS 1121 Danielle, Costa Mesa SAMPLE FROM Shallow end and main drain ARCHITECT CONTR A' !0. Irvine Pools Irvine Pools ENGINEER SUSCONTR A C TOR �. P. Anderson Pacific Coast Gunite Co, SPECIFIED MIX 4.2 - 1 STRENGTH 2,000 psi DATE CAST 12-14-79 CYLINDER SIZE 611 X 1211 DATE TESTED 12-24-79 , CYLINDER NO. 1 COMPRESSION 10 -Day TOTAL LOAD, LBS. 30,000 POUNDS PER SO. IN, 1,060 COMPLIANCE MADE BY DELIVERED EY RECEIVED ON CYLINDERS Sam Sitter 12-17-79 DISTRIBUTION Max Sitter - 3 Costa Mesa Bldg. Dept. • <y ,]�._9..•C. • un[F .e TS rfi rar..,5�0^.♦ (.w 1. N«ALL« No. Pool Location Forms Main 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 T DATE SUBCONTRACTOR -ffmwj MIN l; _F I' -l - NO. 49198 V --spa-_ - r COSTAP.QOXE1200 BUILDING-SAFETY MESAFCALI CALIFORNIA 9 626 DEPARTMENT APPL ATION F9R�S�XI� 5��y"y PERMIT zr. 50 For Applicant to Fill] in Completely — Use Ink Only REC V PERMIT N° 4919 ADILDINGDRESS A.P. NO. BUILDING ADDRESS ` OWNER OR /> /J // TENANT UNIT OR SPACE NO. MAILING`j n^ i ADDRESS ✓ "1 TR.NO. LOT BILK. TEL. J//_ CITY G NO /'((�(/ NEW ADDlALTER IREPAIR IMOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESSS USE ,K4 f ALVE§ L ARCHITECT TEL. OR ENGINEER NO ZONE VPE GROUP ADDRESS CONTRACTOR (/ APPROVED DATE By ADDRESSTEL CITY _ No_j57 /II STATE CITY LIC. NO. LIC. NO. APPROVED SETBACKS SIZE LOT NO.OF BLOGS NOW ON L07FRONT (FROM C/L STREET) "/OF FT. USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. C� L SIDE FT. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APPROV��%/. BY DATF oC 4 7 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 the State of California Busin and Professions Code, Division 3, Chapter 9, andthat such I' n s are In full force and effect, Or I em exempt from the or o s of the State of California Business antl Professions do, is n 3, Chapter 9. Signature of Permittee u �� SQ. FT. THE AMOUNT: SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT F E NLV: VALUATION ` / ^ $ 2 O PERMIT FEE § s 80 PLAN CHECK § , O� TAX E or Author' Ag t Data TOTAL PAID E Q LEM TL 45J45 • �' COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 '40V 10-77PAIACHSAOO 591* ***122.64 1.6 s APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY I DATE RECEIVED DATE ISSUED BUILDING 7% / IE ADDRESS (i1 G OWNER Properties West Development Co °• P MAIL ADDRESS 508 29th Street BUILDING 7 E ADDRESS CITY Newport Beach, CA No`'675-4910 TRACT LOT BLOCK CONSTRUCTION NEW LENDER BRANCH OWNER P ernes West De e o en C ADDRESS Res. Atd. Gar. VALUE 73,400. S § OR ENGINE ARCHITECT Frank Spangler TEL.673-0952 FIRE ZONE YPE GRO P.�` ADDRESS 2240 Newport Blvd. Newport Bch CONTRACTOR Owner APPROVED BV DATE ADDRESS TEL. CITY NO. O NO, PLANS/ USE OF BUILDING kW 6A STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS (FROM C Iya�TREET) OF LOT NOW ON LOT (� FT FT. USE OF �^ EXISTING BLDG. R. SIDE 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 8, MAIN BLDGS. ACCESS BLDGSZ Construct single family 4 bedroom C ARP* APPROVED If 70d r7 Ouse APPR I hereby acknowledge that 1 have rejeAhis applica on and state that the above Information is correct and agree to comply with _ PnIrN r^n rn!PI I nr^I ssn'!sarMT. all laws regulating building construction, and 1 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. FT. 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 exam pt from the pro Mons of the State of California Business antl Profassions Cod/a, islon 3, Chapter 9. VALUATION PERMIT FEE § PLAN CHECK § 117.50 Signature o / J/� Permittee .z,�_/I'll/� § 73,400. TAX s 5.14 Authorized Agent ,.Ggff TOTAL PAID § 1.6 s Sdo CQSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only LDING A DIDRESS TEL. NO. OWNER O MAIL L/ 4 ADDRESS LOT BLOCK W TEL. CITY NO. CONSTRUCTION BRANCH ARCHITECT OR ENGINEER TEL. NO. ADDRESS A.P. NO. u�nL CONTRACTOR I�1Z 014 L/ 4 ADDRESS TEL. CITY NO. I" STATE CITY LIC. NO. LC. NO. W SIZE NO. OF BLDGS. 0. OF LOT NOW ON LOT a USE OF 4 EXISTING BLDG. h FSeparate permits are required for to electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED a q a i' C W 0 1 hereby acknowledge that I have read this application and state IX that the above Information Is correct and agree to comply with L1w all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of the State of California. 3 1 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 effect, or I am exempt from the Provisions of the State of California Business and Professions Code, vision 3, Ch 3, Signature ^ �J ��/A�/ Permittee ""`! Authorized ABant ,EC—9-77Ths 00 525 d= -_,- x 235.00 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY DATE ritutivtj DATE ISSUED A.P. NO. PERMIT NO. BUILDING t ADDRESS TRACT LOT BLOCK W ADD 1ALTER I REPAIR OWNER VE S V E S t4 FIRE ZONE TYPE GROUP APPROVED BY DATE ZONE NO. OF PLANS USE OF NEW BUILDING YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING (FROM C/L STREET) FRONT FT. FT. R. SIDE FT. FT. L. SIDE FT. FT. REAR FT. FT. DISTANCE BET. MAIN BLOCS. BET. MAIN & ACCESS. BLDGS. VAR.* C.U.P.4% DATE APPROVED APPROVED RY DATE SQ.FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION $ PERMIT FEE S PLAN CHECK $ TAX $ TOTALPAID S Ea L Cj COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR -STRUCTURAL PERMIT O P n RAY 19nA COSTA MFSA CAI IFn RNIA 99R9Ti • J 17`1 1 `-1 lur r 1 r -50 For Applicant to Fill in Completely — Use Ink Only REC PERMIT A1'0 4§446 1�1 BUILDING ��-j�IELLE D ADDRESS A.P. NO.4-(2---(0-71 —*3Z B VILDI NG //Z/ s ADDRESS C`1 TENANT OWNEROR Lc/• /•1 � r G" lr UNIT OR SPACE NO. j-� ^ MAILINGADDRESS ,I oZ `/Au IL`•`L•LE 0)� - TR.E. NA� / LOT Y/ `�7 (9 TV SLK. CITYCOSTA MFSA NOL NEW I ADD JALTER IREPAIR MOVING DEMOLISH CONSTRUCTION LENDER ON� BRANCH OWNER ADDRESS VALUE USE Q $ ARCHITECT OR ENGINEER`AIJDSG` �fINC.NO. �q(0 �[i ZONE 1 TYPE • GROUP ADDRESS �� S, O1�N L CONTRACTOR �.i�' ADDRESS/1 S L)KAp6E J �' APPROVED BY DATE L LA TEL. s� CITY 0 F NO. p STATE CITY LIC. NO. 3 ;Z4- LIC. NO. APPROVED SETBACKS SIZE OF LOT NO. OF SLOGS. NOW ON LOT 'FRONT (FROM USE OF C EXISTING BLDG. (,.� Cff Separate permits are required for electric, plumbing and heating work: L. SIDE FT. ) PEAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION aT� CoV E DATE APPROVED APPROVED/ a• DATE ` 1 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. 1 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 effect, or I em exempt from the provisions of the State of California Business and Professions code, Division 3, C ter 9. Signature of' Permittee _ SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION S / r V /W PERMIT FEE E PLAN CHECK E TAX E O or Authorized Agent Data TOTAL PAID E TL