HomeMy WebLinkAbout960 AZALEA DR - Building PermitsWORKERS' COMPENSATION DECLARATION: ' .
I hereby eHirm under penalty of per�ury one af the following tleclaretia�s:
❑ I have entl wlll meintain e certificate of consent to self-Insure tor workers' compensation, es provitled for by section 3700 of the Labor Code, for tha perlormence of Ihe
work for which this permit Is Issued. '
� I have and wlll maintain workers' compensation Insurance, as required by section 3700 of the Labor Cotle, for the peAormance of the work for which this permit Is issue0.
My wo ers' coAmpe�n jetion Insu(ance cerrier and policy number are: v D
Cemer. ir'I' �\"��^n A(lA PolicyNumber. ���� � ��d A Q�
(This secti n.n 8r�be completed'il e perm Is valued af one huntlred dollers ($f 00) or less.) .
❑ I certity ihat In the performance of the work tor which ihis permit Is issued, I shall not employ any person in any manner so as to become subject to ihe workers'
compensation laws ot Calitornie, and agree that if I should become subject to ihe workers' compensetion provisions ot ectlon 3700 of the Lflbor Cotle, I shell forihwith
comply with these provisions. 1 _�,l
Applicant Signature�: �p �" Date: f.i0-�'•� �
WARNING: FAILUB@-705ECURE WORKERS' fAMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOVER TO CRIMINAL PENALTIES AN� CIVIL FINES UP TOONE HUNDflED
THOUSAND DOLLARE ($100,000), IN ADDITIIXJ TO THE CQST OF CAMPENSATION, OPNAGES AS PR�VIDED FOfi IN SECTION �7080F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm that I am licensed unde provislons of Chap[er 9(commencing with Section 7000) of Division 3 of ihe Busineu end Professions Code, end my license is in full
force and eHecL Lic. # o���iii Cless q
Conirector.sSignature: � Dete: ��n��
CONSTRUC710N LENDING AGENCY: �
❑ I hereby aftirm that there is a construction lending agency for the pedormence of the work tor which lhis permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lender's Atldress: �
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm ihat under penalry of perjury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Cotle: Any city or county which requires a permit to construd, alter, improve, tlemolish, or repair eny structure, prior to IGs Issuance, also requires ihe epplicant for such permit
to file e signed stetement thet he or sha Is licensad pursuant to ihe provlsions of the Contractors License Law (Chapter 9(commencing with Saction 7000) of Divislon 3 of the
Businass and Protessions Code) or that he o� she is exempt iherefrom and ihe basis for ihe alleged exemption. Any violetion of Section 7037.5 by eny epplicant for a permit
subjecis ihe applicant to e civil penalty of not more ihan five huntlred dollars ($500).):
❑ I, as owner of ihe property, or my employees with wegas as their sole compensation, WILL DO THE WORK, and the stmcNre is not intended or oHered for sale (Sec.
7044, Business end Professions Code: The Contractars License Law does not apply to en owner of properry who 6uilds or improves thereon, and who tloes such work
himself or harself or through his or her own employees, provided that such Improvements ere not intended or ofleretl for sale. If, however, tha building or improvement is
sold within one year of complelion, ihe owner-bulitler will heve the burden ot proving that he or she ditl not bulltl or Improve tor purpose of sale.).
❑ I, as awner of the property, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS ta wnstNct ihe proJecl (Sec. 7044, Business end Professions
Code: The contrectors License Law does not apply to an owner of property who 6ullds or improves Ihereon, entl who coNreds for such projeq wiih a contractor(s)
license pursuant to the Contractors License Lews.).
❑ I am exempt under sac. Business entl Protessions Code for ihis reeson:
SlgnaNre: Date: '
Owner ID venfietl by tlriver's license. ❑ Yes ❑ No Driver's License No. Ezpires:
Verification of Ownership by (type of document, I.e. - proparty tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � .
❑ I he�eby certify thet no ezcavation five (5) or more feet In tlepth into which a person Is requlretl to tlescentl, will be made in connection with work authorized by this
permit, and that no building strudure, scaftoltling, falsework, or tlemolition or dismantling thereoi, will be more than thirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Celifomia Administretive Code).
❑ As owner-builder, I will not employ anyone lo tlo wofu whlch would requira a permit from the Division of Intlusiriel Sefery, as noted above, unless such person has a
permit to do such work irom the division.
Signature:
Division of Indusirial Sefery Permit Number:
8
Dete:
ARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
Will the applicant or present or future building occupant neetl to tile and certify e Business Plan for emergency response to release or threatened release of a hazartlous
materiel? ❑ Yes ❑ No
(Section 25505 of the California Healih and Safety Code requires, with some exceptions, that a Business Plan be filed with tha Costa Mesa Fire Department by every
business which has at any one time during e reportetl year a quantiry of hazardous materiels equal to or greater than e welght of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressetl gas at standard temperature antl pressure).
....._...._...._ ..__.._...,. _. ._'__" _._...'.—_ ._._._... ' ....... .. ................... . ..... . .. . . ,
Does or will the epplicant or present or tuWre 6uilding occupant need lo file a wg�stretion torm for acutely haiardous matenals? ❑ Ves ❑ No
(Section 25533 of the Calitornie Health end Safery Coda, with some exceptions, requires registretion with the Costa Mesa Fire Department by each businass which at any
one time has on hend e quantity of acutely he�rdous materials equal to or greeter then e welght of 500 pounds, or a valume of 55 gallons, or 200 cubic feet of
compreued ges at standard tempereture and pressure).
..__�_'__..__'__'�__.__.._--.__......_.—_.._.__....._......__.._._...._'.."_....___—.._ —'___..___
Does or will the epplicant or presenl or future building occupant need to prepare an RMPP (Risk Menagement end Prevention Program for acutety hazardous materials)9
❑ Yes ❑ No
(Section 25534 of the Celifomia Healih and Safaty Code provides ihet the Costa Mesa Fire Depariment may require �he preparatlon, certlfication and filing with the Fire
Department of an RMPP by businesses which are required to regisier acutely hazerdous meterials with ihe Fire Depaltment.
Does or will iha applicant or presen� or fu�ure builtling occupent require tor the work whic� is the subject of this a plication e permit for such construction or motlificatlon
from ihe South Coest Air Quality Menagement DlsMct or from eny other elr pollu�bn control distdct or agency7 � Yes u No
(Section 658502 of ihe Calitornie Government Code requires iha� ihe requested information be fumished on applications for non-residentlel bullding pertnits).
W ill any part ot the faciliry to be constructed untler this permit be within 1000 feet from the outer bountlarles of e school? ❑ Yes ❑ No
Qt "yes", the fxlltry musi meet tha raquirement of Sec[ions 25534 and 42303 ot the CalNornia Health antl Sefery Code).
If a permit fmm the South Coast Alr Quality Managemen� District or o�her alr polWtlon conirol district or egency is required for the work which is Ihe su6ject of this
application, have all of the disclosures prescnbed by Califomle Heelih antl Safery Cotle Sectlon 42303 been made7 ❑ Ves ❑ No
.__..._.__...______..—..___._.—..__._____...._._'__"'_'_�_—.___.--._
(If'yes", atlach certiticale of compliance irom the appropriate air pollution control otticer).
CERTIFICATE OF COMPLIANCE: I certify ihat under penalry of perjury the infortnation given aCove is correct. I agree to comply with all state laws entl ciry ortlinences
regarding Hazartlous Materials entl Emissions.
Signeture: Dare:
CEFTFICATE OF COMPLIANCE AND AUfHORIZATON OP ENTRY: I cenity under penelty of perJury ihat I have read this applicetion and state ihet the intormation given is
correct I egree to comply with all state laws and ciry ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa ro enter upon the
above-desc�lbed property for inspection purpases. I egree not to occupy or allow occupancy af any building au�horized by Ihls pertnit untll final inspection.
—_' �rtat`�_ gal Owner(s) (O �P etX9
��/ r
�AnNOr Authorized AppliCent Data
CODE t. INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
' 200 Final Re-Roof
201 Final BIocWReteining Wall
202 Finel Fectory Fire Place
203 Final Sign
204 Final Demolltion
244636
PA7E
�
JyjQf04¢ �t INSGECTIONTYPE
206 Finel Mechenical
208 Final Plumbing
270 Final Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Slte
250 Finel BuildinglOccupancy
PffiE INfITIALS
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PflOJECT ROOXESS: j( O A2ALEA Dft
OWNEX'S NAME: KEMPER OTAMAR A J
i nooxess: g60 AZ}:LEA DR
COSTA MESA,CA 92626
557-1977
FflCN/ENGINEEH: HEG.NO.:
ROUflE55:
UNIT:
UNIT:
PEPMITTEE: BRENT QWENS ROOFING ( 714 ) 835-1005
aooxess: g 4 2 6 MAR I ON WAY
SANTA ANA CA 92706
LICENSED CONTRFC70B �ECLABIITION: I �ereby affirm ihat I am licensetl un0er provisions ot C�apter 9(commencing with Section
7000� of �ivision 3 of I�e 9usiness antl Professions Cotle, an0 my license is in fullforce antl enec�.
cmuc.: 03�J 53 srareuc.:6004Q.2J�SS: 3f�p/�9
Oa[e: �b �Z �y SignaNre: "�� �)/"�~�_
WOflHEHS' COMPENSRTION OECLAflATION: I hereby af�irm tha� I have a cehificate ot consen� m sel4insure or a certi�icate o� Warkers'
ComDensation Insurance. ar a certitied caOY ihereof (Section 3800, LaO. C).
roucvno.: 0682522-92 EIIP.DRIE: OZ�OSI93
comraxr: STATE FUNA
7 Cenifietl copy is here6y fumishe0. � Certifietl copy is filetl with the ciry /Bu�ilAing Oivision.
�ate: Q Applicant: �/� � �� -!( ��
E%EMPTION f OM WONI(EPS' COMPENSRTION �ECLAMTION: (itas sectian nee0 nol be campkte0 ii ihe permit is for ane hunOretl (5100) or less).
I ceriity �hat in Ihe periormance oi Ihe work tor which Ihis permit is issued. I s�all not employ any person in any manner so as lo become
5u6jecl lo �he Workers' Compensation Laws of Califomia.
Oate: SignaWre:
NO710E: If, after making ihis tleclaration, you shoulA become su0iect to ihe Workers' Campensation pwvisions of the LaOor
Cotle. you must forthwith comply wi[� such pmvisions or f�is permit s�all be tleemetl revoketl.
CONSTPUCTION LEN�ING AGENCY: I �ere6y attirm ihat ihere is a construction lentling aAency for the pedarmance oi Ne wark for
j which Ihis permii is issue0 �Section 3097. Civ. C).
LENDEfl:
aooeess: TEAR—OFF SHAKE/REROOF
W/TILE
� OWNEB BUILUEN UECLABRTION: I herehy afiirm ihat I am exempt from the Contractors' Sta[e License Law lar [he following reason
(Sec�ion 7031.5 Busine55 and Pm/e55ional COtle: Any city ol counry whith require5 a permit �o tOnStmCt, ai�¢r, impmv¢, demoli5h, or
repair any siNcture. priar to its issuance. alsa requires Ihe apD�icant for such permit to file a signed statemen� �hat he/she is licensetl
pursuan� �o ��e pmvisions ol �he Contractors' Sta�e license Law (Chapier 9(commencing wi[h Section 7000� of Oivision 3 ot �he Business
anE Pmfessions Cotle� arthai he/she is exempttAeretram antl ihe basis Por t�e allegetl exemption. Any violalion of Sec[ion 7031.5 by
any aDDlican�for a permit su6lecis Ihe aDPlicant to a civil penalty ot not more ihan live huntlred tlollars (5500�.
I, as owner of t�e pmpeny or my employees wi[II waAes as Itieir sole compensation, will do t�e wafk, antl the
❑ simcNre is not intentled or ofieretl for sale (Section 70Ed. Business antl Pmtessional CoOe: The Coniracrors' State License Law
Ooes not aOP�Y io an owner oi a property who builds or impmves ihereon, an0 who does such wark �imseli/herself or thmugA
his or her own employees, pmvitletl ihat such imD�ovements are nat intentletl or offeretl far sale. I(, hawever the 6uil0inA or
improvement is soltl within one year ol completion. the owner will �ave t�e burtlen of DmvinA he/sAe Oitl not 6uiltl or improve
forlhe purpose of sale).
I,as owneroi�he prope�y,am exclusively contracting wi�h licensed cantractors m conswctthe pmlec[(Section 7044, Business
❑ and Pmfessions Cotle: The Coniracmrs' State License Law tloes no� apply ro an owner of pmperty who huilEs or impmves Ihereon
antl w�o coniracts for suc� projec�s with a coniractor(s) license pursuant lo the Cantraciors' Staie License Law�. I am aware
Ihai Dmof ot Iheir Worker's Compensation insurance shoultl be pwvi0e0 ro me.
� I am exempt untler Section: B. 8 P. C.
br lhis reason:
Da�e: Owner.
1 tlo hereby cerlify Iha� I am aware o� ane untlerstantl t�e requir¢ments o� Calilomia Heat�h antl $afety CoOe Sec�ions 25505, 25533, an0
2553a antl ihat 1 or any luture 6uiltling occupant will/will not (circle one) nee0 to comDly with saiA s[aie codes and the requiremenls tor a
permi� �or cons�mclian or modi�ica�ion imm �he Air Oualiry Managemeni Dis�rict Resideniial consVuction applications are exemp[ irom
ihese provisions.
Oate: Ppplicam:
i here�y cetlity �hat I have reatl this appliwtion antl staie thai the above information is correcL I agree �o comply wi�h all ci�y antl counry
ortlinancesanas�atelawsrelalingloOuiltlingconslrociianantlherebyauthorizere sen�aiivesoi�hisci�yloen[eruponlhea6ove-mentionetl
pmDehy lar inSDetlion punrposes. ///�
Oa�e: O Iz 7Z Signalure: ��n r/�
Driver's License or Social Security M:
1641-46 While—Builtlinq: Green—Cotle EnlorcemenL Canary—Aoolican�: Pink—Ravenue: Goltlenraa—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERN, NO; B 059452
PERMZT NO: B 059452 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE; ALT
JOB DESCRIPTION ; SHEATH 6 REROOF 31005'F RESID 6 GAR W/TIL SQ FT: 10,230
CLAIM VALUE; 10,230.00 CALC—VALIIE; 10,230.00 GROUP OCC: R-3 /M-1
COMMENTS• REROOF W/PIONEER TILE ICBO#3748 6.9PSF
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Z O N I N G R E Q U I R E M E N T����
5 E T B A C K S ��(� R
------------ MAIN BUILDZNG ---------- --------- ACCESSORY B�{.7��i�` I"-� �
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; � FT IN
LEFT: FT IN RGHT: rT IN LEFT; FT IN RGT-IT; rT IN
PARKING RE • PROV: PAkCEL: 41217111 ZNE; REF NO:
PLANNING N TES->
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N%T' S
�
20NING APPROVED BY DATE; '+
BUILDING APPROVED BY : DATE:
APPLICATION IS'SUED HY; DATE; 1� 2—
lE�EiEiEiEiE�ElEiEiEiEiEjEi(-iFiEififiFdEiE�EiFiFi'F�iF3FiF3Fi-FiFiFi�iF3F�F3FiF3Fv� if3f iFi��Fii7F��iFiF�FiEiEifiE3F3EiFiPiE�)(� lEif
iE if iE if iE-1f if df if ik 1E-)E ik �E iE jE3kiE ik �E iEiE iE 3E if 9E iE 3E �E jE iE iE if if 3f iE iE iFiF iE �E if if iF ik iE iE 3E iFiF iE�F �f iEiE iE iEiEiF iE iE itiF iF �E-lE �t iE iG �EiF 3E iE iF 3FiF iE iEiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT FLUMBING ELECTRIC MECHANIC FIRE SMIPIRES;� GRADING
PERMIT 126,00 1,02;
PI � SMIP /NON=.RES
ISSUE FEE �-
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 127,02 0.00 0.00 127,02 127,02 ,� .00
AEVENUE DIVISION TOTALS--> COLLECTED: 127,02 OVER/SHORT• ��'�i 00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADZNGi1�LAN—CHECI{
126.00 1,02
�lE iE 1E �1F 1E iE iE fE �Jf if iF iF iE ih iE it 1E iE iE iE iF iE iE if �E iF iE iE �1F iE iE iE iE 1E iF iF �lE iE 3E �lE �1ElF * iF ik iF iE iE iF iE iE iE iE iF iElF iF if iE�E if �Ih iE �lE 1E iE iE �1E �F iE,if iF iE iE iE 3E 3E # iE
I N D I V I D U A L F E E B R E A K D O W N �'�
TYPE QTY D E S C R I P T I O N UNIT COST ��'OTAI, COST
SFR 10230 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 '�10,230,00
END OF FEES r
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V. ��C�..' ' ._' '_' ' ' _
, _
uCONSTRUCTION AND PLANNING � POO . SPA .
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service ot Pole 52. -Pool & Equipment Location .
2, Sail Pipe�Undrgind. • 53. Steel Reinforcement _ .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressur.e Test
6. Electrical UFEfi Gmd. , 57. APPROVAL TO COVER-GUNITE
7, Footings 58. Electrical Conduit•Undrgr�d.
8. Foundation . , 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgmd. , � 60. Backwash Lines, P-Trap, O Undrgmd. �
10. Structural Floor System 61. APPROVA� TQ DECK -
11. Property Sewer Line & House Connection ' 62. Backwash & Receptor�Final
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Orains ' � 64. P�umbing System - Final �
14. Rough Plumbin9 ' � 65. Electrical�Final
15. Rough Electrical�Conduit 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval
1�. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling , 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
n; .
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure i • � 70. Underground Hyelro �
22. Ducts, Ventilatin9 -��' 71. Product Piping �Gas OOiI
23. Ga: Pipe�Rough & Test ' , ' . ` 72, Underground Flush .
24. Roof Framing � � 73. Undergmd.StorageTank �Gas ❑Oil
25. Roof Sheathing ' .�� _G,Z �P 74, Overhead Hydro
26. T�Bar Ceiling (Structurall & Monocoat , 75. Dry Chemical
27. Frame and Flashing , 76. Dry Standpipe
28. Lathing & Siding i � 77. FIXED SYSTEM FINAL
29. Insulation � 78, FIRE PREV. FINAL
30. Drywall Nailing i HEAI.TH DEPT.�REQUIREMENT
31. Plaster Brown Coat ' � 79. FINAL INSP.ECTION
32. Electrical Power Meter Final� � 80. FOOD CERTIFICATE ISSUED
�
33. Final, Electric ' I � � Notes:
34. Final Heating & Air Conditioning I I ,
i
35. Final Gas Pipe-Test . � '
36. Hood or Canopy . , , � �� �
37. Final Factory Firep�ace �, �
38. Final Plum6ing I I I
i I
39. Water Service-Final I � �
40. Gas Service-final . I I
41. Solar pomesticFinal � ' ;
42. Backflow Preventer i � �
43. Backflow Irrigation �
44. Landscape Irrigation System .
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING � Zl�y G�,., �� �-���GC_
48. FINAL PLANNING , �' ' j
49; Electric Releaie to Edison ��
� �
50. Gas Release to Southem California Gas Co � l'�
51. CERTIPICATE OP OCCUPANCY �
No. Date
OWNER KII�PER, OHI�7AR AND CLEO
JOB ADDRE55 960 Azalea Dr.
GENERAL CONTRACTOR Ber�e_Pools
P" No. 472-1 1-11 LOT TRi
ECTIONS Si
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 _
r System Final
Backwash and Recep. Final
RE
DATE �-�5'74
BUILDING PERMIT N0.
17_1�
�L°- SUBCONTRACTOR
Electric
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x � •
.�m,y Plumbing
.� 3b90�
' / COSTA MESA BUILDING-SAFETY DEI
301 A P•O. BOX 1200 COSTA MESA, CALIFOR
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For Applicant to fill in
BUILDING ��/ � ,/� ,
OWNER IARWIN SOUTHAktN CALIFORNIA, INC.
AooaEss 16255 Ventura Blvd.
TEL.
ciTv F.nrinn_ Calif_ No. qRFi-RR90
BFANCH j
ADDFESS F
AflCHITECT
ADDRESS 9100 Wilshire Blvd., B.H.
CONTRACTOfl LARWIN SOUTHERN CALIFORNIA,
AODRESS 16255 Ventura Blvd.
cirv Encino, Calif. No 986-8890
L C rivo.191311 LICVNO. B_1
OF LOT 6O X�.00 I NOW ON LO � Q
USE OF
EXI5TING BLDG.
SIZE OF 1(�87 Sf NO. OF 1
NEW BLDG. ROOMS STORIES
EXTERIOR WALL ROOF
COVERING StllCCO COVERING WOOd shingl
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledga thet I have reatl this application antl state
that tha above informetion is carrect and aB�ea to comply with
ell laws re9ulatin9 building consbuction, and I shall not employ
eny pe�son in violetion of the wo�kman's compensation laws of
the State of California.
I he�eby ce�tify thet I am properly licensetl as a contractor under
the Stata ot Calitornia Business antl� Professions Code, Divisicn 3,
Chapter 9, antl thac sueh licenses are in full forca antl affect, or I
am exampt from tf�e provisions of the State of California Business
antl Professions Cnue, D/ivi]sion 3, Chapter 9.
Sipnature o���/�C'��•`�s.�^`
Permittee 6�� + n. n04mC
Authorizetl Ageni
Paco
1UL -5-73��a5C,OQ 274� **tr 173.40
APPLICATION FOR BUILDING PERMIT
A.P. NO.
BUILDING (
ADDRESS
�
TRACT
FIflE
ED
BLOCK
DATE /+L �
\"� FLANSZ I BUILDING E /
_��
VAflOSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDIN
BET. BET. MAIN &
35. ACCESS. BLU
DATE
APPROVED
HOLD FOR SPECIA REQUfREI�i �
W
b
� 54. FT. �O C
THE AMOUNT SHOWN UNDEfl VALUATION IS FOR �
THE PURPO6E OF ESTABIISHING A PERMIT FEE ONLV: ¢
VALUATIO ��) 1 � r-(f �
I/V PE M FEE $ � �
3 � / �
ry 0
$ ''� P�CHEC� � E
/ � o`
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TOTAL FEE $
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F(� i5-74�.�5:00 71?_� 39.`�0
COSTA MESA BUILDING-SAFETY DEPARiMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
R EI E BV DATE RECEIVED DATE ISSUED
BUILDING �bG (�,Zq1�p �n a' .y ` S �
ADORESS 1�1
OWNER �w"�� $�-'•FO �e �,E� A.P. NO. TIZ—I � l PFrR/IT N.70.
�
ADOflESS SITiM1 BUILDING ^��
' ADDRESS �� �Z�\�CA .
e�'�} M�SA• NQ���S�-�q7 TRACT yy1 LOT�O BLOCK
CITV
CON5TRUCTION W �+ 0 A P
LENDER
BRANCH /�.����
OWNER �s�rt�K�Pa�. �M ��
ADORESS
L E
ARCHITECT ��p.� TEL: .� " S $ �
OR ENGINEER 1VSkti �• (� �5�� N �ia0� �.++
ADDRE55 ":J�S ��,� �'�i_ FIRE
`�. � 6� ZONE PE GROUP
CONTRAC70R �t� rC OO S ByPROVE DATE � S�
ADDflESS ���� \:��� �1�+F •
t_ A Z� NO.OF USE.�F N
CITV N��� O�T �Cn• NOL �1,��� PLANS � BUILDING �OQ (.�
L C NO. a q.� LICVNO. J� CJ� YMA NSBUI LDING ACCESSORV BU�ILDING
SIZE NO.OF BLDGS. (FROM C/L STREET) /''% ��p/
OF LOT NOW ON LOT FRONT FT. /� FT. �L •
USE OF
EXISfING BLDG. . S FT.
SIZE OF NO. OF
NEW BLDG. ROOMS STORIES l. SIDE FT. S FT. ��
E%TER10R WALL ROOF
COVERING COVERING FEAR FT. FT.�
USE OF BU�LDING AND WORK TO BE PEflFORMED DI57ANCE BET. BEf. MAIN &
MAIN BLOGS. ACCE55, BLOGS.
� VAR, a{-` DATE
� • � WW`� �Q' C.U.P.# APPROVED
� APPROVED J ��y
. �
P�� .\
�
I hereby acknowlatlge that I have reatl this application antl state �
that the above information is correct antl aBree to comply wlth •
all laws ragulating builtling construction, entl I shell not employ P� /
eny person in vlolation of the workman's compensation laws of "�
the State of California. � !"
I hereby certify that I am p�oPerly licensetl as a conSractor untler SQ, FT.
the State oi Calitornia Business and Protassions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl the[ such licenses are in full force and atfact, or I THE PURVOSE OF ESTABLISHING A PERMIT FEE ONLV:
am ezempt trom tlia provisions of the State af California Buslness VALUATION /
antl Professions Co�ie, Division 3, Chapter 9. PERMIT FEE $ d
SiBnatura pf ry� O/ /, �/�( ,�(� � aa
Permfttea �'�� ���� ��, ���« $ ��� PLAN CHECK $ �
Authorizetl Agent TOTAL FEE $
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April S� 1974
�
Mr. Ottmar Kemper . �
960 Asalea Drive ,
Coata rieaa� California 92626 �
Dear. Sira • .
A building permit has bee iasued to•Berge Poola to.construct
a psivate swismning pool o our property.
In order that your.pool will b a safa one and for tha putpoae
of adviaing�you of your reaponef�bility regarding the requfse-
menta of the CoatB �aa Municipal Code� we refer you to Section
8107� a copy of ch ie attached.
Thls letter ia disect to you in order that you will be awase
of our ordinancea end can meke a completa safety cheek of your
pool area.
Sincerely yours,
RICNARU HANHAAT
Suilding Safety Dizactor.
RHtcb,
a
r
, . � �� z�q .
�,��" `�fo Twini�q Labor�tories �f .s�,��t�tz,t c«��foZ,t«z, �,L�.
��� � P.O. BOX a] . 3710 AiRPORT WAY . LONG AEP.CH, CALIF. 90801 . Izl3� 4Yo-3355 . �213� h36�2386 . �711� 828-6432
B0.nrvC� O:�ICES:
TESTING isi..ouo�.nNe.ca.s„a No�ofi �.er��,�y
5=�:en�,Cei�'..•�evx�m "�. •� 1v55Rmo�aon....PO.Bo���
�]Iq 5ll YO�S �� i, 1�' �ang Bvech, Colll. 90001 �213� 6362186
.' ��y_.`
March l, 1974
' Examination: SC]4-�j28
COMPRESSION TESTS ON GUNITE CYLINDERS
Mr. Er�ol F. tieesth
12921 Aspenwood Lane
Garden Crove, Californla 926�0
PROIECT Swimming Pool for OTHMlIR KEMPER
ADDRESS 960 Azalea Drive, Costa Mese
SAMPLE fROM
ARCHIIFCi ,.
ENGINFiY
MIX
DATE CAST;.... �
DATE TESTF6
Gunite Swiming Pool
4-i/2 t0 1
2-21-74
2-28-74
f.011iPACiOF
Berge Pools
SUBCONLRdCfOR
Grove Gunite
SVECIFlED
STRFNGi'H
CYLINUER SIZE
2-28-74
CYIINDER NO. . � � �
COMPRESSION ]-Dey J-Dey
TOTAI IOAD, 185. Ij)�000 I30,000
voun+os PER so. iN. 4,445 4,412
SIZE OF CYLINDERS: 6-1/8" x 12-1/2" 6-1/8" x 12-1/4"
CO MPLIANCE 7-Day test complies with spectfications.
MADE BY
CYLINDERS
msraieunow.
E, F,Neesch - 2
Costa Mesa Building Dept.
DFUVFAfG BV
Heesch
2,000 psi
z-28-74
III IV,V,VI"HOLDS"
7-Day
127.500
4,330
F-1/8" x 12-1/2"
RKE�VED OH
2-22-74
�UILDING �AFETY DEPY.
!�„�,;; � y974
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,
TRACT N0. I ��
TAT N0, � O
v
�.
CITY dF COSTA MESA REQUEST FOR OCCUPn,.CY
DATE 2 • I �' �
The developer of the above entitled tract desires to se12 the above aet
forth lot prior to tha time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The unde signed, by executing this agreement, acknowledges that
i ,
�'he�ke-they) (s�a�Qr were)� advised that' this tract has
not been give na inapection 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 haxmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted conditior
@
REGE(VED
CITY OF COSTA MESA
P�NNING DfPT.
DEC 2 � 1973
Af� e�y
'�, � � 9, tl��: � 3.x���,4, 5� 6
�
By
� ��._.-.,-/--
BY �� C-�< <� �/�--ll�>yl�t� �
Developer and/or auchorized
representacive
�.% �
BY .i'7�ut/�i� ,�/.i ,�cti
L nder ;