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HomeMy WebLinkAbout1921 SWAN DR - Building Permits 1 POO 'T ADDRESS: UNIT: 4 • OWNER'S NAME: 1921 SWAN DR CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 06496L ADDRESS: MC INTOSH, BRUCE C MC INTOSH, NANCY J PERMIT NO; B 064964 PLAN CHECK NO: N GOVT: N SUPP; N 1921 SWAN DR COSTA MESA,CA 92626 CONSTRUCTION TYPE: 5-N PERMIT TYPE: SIR PURPOSE: ALT ARCH/ENGINEER: REG.ND.: ADDRESS: UNIT: SQ JOB DESCRIPTION T/OFF & REROOF W/LITEWEIGHT TILE FT; 11 , 800 PERMITTEE: CLAIM VALUE: 11 , 800 . 00 CALL-VALUE: 11, 800 . 00 GROUP OCC; R-3 /M-1 ADDRESS: PERFECT COVER ROOFING ( 714 ) 434-1566 3303 HARBOR BL D-5 COMMENTS : INSTALL LITEWEIGHT TILE ICBG# 4312, 507PSF COSTA MESA CA 92626 ############################################### *#***************************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E U I R E M E N T S 7000)0lDivision 3 of the Business and Professions Code,and m license is in full force and effect. S E T BQA C K S CITY 054055 STATE LIC.: 6 2 2 5 1 E— CLASS: �^ Dat / `) /3 Signature:_ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm t at l have a ce icate of consent o self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN POLICY NO.: 1263623-93 EXP.DATE: 07/01 /94 COMPANY: STATE FUND PARKING REQ PROV; PARCEL; 13948202 ZNE: REF NO: El Certified copy is hereby furnished. Q: Certified copy is f d 1th the city Buildi Divisio PLANNING NOTES> i Date: // /' f 3 Applicant ###############################################*###**##***#############**###### EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed' the permit is far one hundred($100)or less). DEVELOPMENT SERV ICES REQUIREMENTS 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. ZONING APPROVED BY • DATE: Date: Signature: NOTICE:It.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE; Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. o CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: l which this permit is issued(Section 3097.Civ.C). a. _ DATE; I 13 #********************* "yr.:,.x,c,. ****#***** ixiF :,;'RITC* LENDER: ###****##****#*#*#*#*#####*#*******##*##**#*************#********************** ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRESMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 13 5 . 0 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 1 , 18 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/ ON- R•ES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN , any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEEt. • f. I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAI��: DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 136 . 18 0 . 0 0 0 , 00 1 3 6 , 1 8 , 136 . 1T'. . 00 does nt apply to an owner of a properly 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 re-: improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 136 . 18 OVER/SHORT' • • 00 for the purpose of sale) BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADLIN PLAN CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 135 . 00 1 . 18 tr• C' ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon .. and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *,kN,*,**,W#***#,***##*#*****#*******#***##*##*****#***#**#*###****##*## #*4''1E******* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. {• d for this reason TYPE QTY DESCRIPTIO N UNIT COST • TOTAL COST Date Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 11800 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1f1 , 800 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES ty, permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from gt these provisions. Dale. Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county SMOKE DETECTOR ordinances and state laws relating to building construction and he''athorize represe to i s of this city to enter upon the above-mentioned _. property for inspe on purpo .. .. _ Da„: /// f j Signature: ` REQUIRED • 01 00150815-00150E76 TOT 136.1E Driver's License or octal Security A: I)q DA. , 11/17/93 TI)1r: 14:55 164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor w CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit Date Inspector 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, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 'I 12. Sewer Cap ! .� I _ 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 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil - • 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergmd.Storage Tank 0 Gas ❑Oil r 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical r:- 27. Frame and Flashing 76. Dry Standpipe H _C 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT { / 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning i , 35. Final Gas Pipe-Test g 36. Hood or Canopy • T 37. Final Factory Fireplace ' S 38. Final Plumbing •'t S+ 39. Water Service-Final 9 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System ff 45. Sound Attenuation .le. 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' i • 48. FINAL PLANNING - - - 49. Electric Release to Edison 4-4 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY -. No. Date PROJECT ADDRESS: 1921 SWAN DR 0N1T: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 064961 OWNER'S NAME: MC INTOSH, BRUCE C ADDRESS: MC INTOSH, NANCY J PERMIT NO: B 064964 PLAN CHECK NO: N GOVT: N SUPP: N 1921 SWAN DR COSTA MESA, CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: SIR PURPOSE: ALT ARCH/ENGINEER: REG.NO.:• JOB DESCRIPTION : T/OFF S REROOF W/LITEWEIGHT TILE SQ FT: 11 , 800 ' ADDRESS: UNIT: CLAIM VALUE: 11 , 800 .00 CALL—VALUE: 11, 800 . 00 GROUP OCC: R-3 /M-1 PERMITTEE: PERFECT COVER ROOFING ( 714 ) 434-1566 ADDRESS: 3303 HARBOR BL D-5 COMMENTS: INSTALL LITEWEIGHT TILE ICBO# 4312, 507PSF COSTA MESA CA 92626 +C**�E****B6******* --x-************�Ea6*TE**�E*�r*+r+6**>Eek **T6#****TE*********kk*****pf****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T S 7000)of Division 3 of the Business and Professions Code.and my license is in felt force and effect. SETBACKS CITY LIC.: 054055 STATE LIC.:622516 CLASS: B Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: thereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR• FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICYND.: 1263623-93 EXP.DATE: 07/01 /94 comgaaY: STATE FUND PARKING REQ: PROV: PARCEL : 13948202 ZNE: REF NO: ❑ Certified copy is hereby furnished. © Certified copy is filed with the city Building Division. PLANNING NOTES> , Date: Applicant: *************************************************************************i:***** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). D EV ELOP IW V T SERVICES R E Q U I R E M E N T S 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. ZONING APPP^T/E\/l�!"'k . _ DATE: Date: Syou shout V �. • NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING Pe DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION _S SUED BY: DATE which this permit is issued(Section 3097.Civ.C). ***********************-*********************************************Y#*#*#***** LENDER: **************************************************************************#**## ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT : Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter.improve,demolish.or PERMIT 135 . 00 1 . 18 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 Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation. wilt do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID �:, DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 136 . 18 0 , 00 0 . 00 13 6 . 18 136 . 18 . 00 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 completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 136 . 18 OVER/SHORT: . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 135 . 00 - 1 . 18 • // ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).I am aware *********************************************************************�EAf*#*#**** that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E B R E A K D O W N 9 I art exempt under Section: B.&P.C. or eisreason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFR 11800 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 411 , 800 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. I .. Date: Applicant: h I hereby artily that I have read this application and state that the above information is correct.I agree to comply with all city and county ,. ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above.mentioned / property lot inspection purposes. Date: Signature: Drivers License or Social Security N: 1641-46 White—Building;Green—Code EntorcemenC Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit Date Inspector 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. Stee• Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd 57. APPROVAL TO COVER-GUNITE - i 7. Footings. 58. Electrical CorJuit•Undtgrna. 8. Foundation 59. Gas Pipe, C; UrUrgrnd , Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, l J Undrgrnd. 10. Structural Floor System • 61. APPROVAL TO DECK 11. Property Sever Line & House Connection 62. Backwash & R capt_r Final 12. Sewer Cap 63. Heater & Vent_Fin;; 13. Roof Drains 64. Plumbing System • F-• .,I 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar Syster-,.F•.nal • 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-? Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Per rut ;> 21. Ducts,in Structure 70, Undergrounti Hyo n 22. Ducts, Ventilating 71. Product Piping I;Gas 3 Oil 23. Gas Pipe-Rough& Test 72. Undergro•..-^i F'uc.. 24. Roof Framing 73. Undergrnd.StorariL r.i.k :3 Gas 7,Oil 25. Roof Sheathing 74. Overhead Hydra 26. T-Bar Ceiling (Structural) & Monocoat 1,\--e 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lath:ng & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL _ II 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Mete--Final 80. FOOD CERTIF:CATE ISSUED 33, Final Electric Notes: 34. Final Heating &Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final l 40. Gas Service-Final 41. Solar Domestic-Final { 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation a 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING /2 g'q Gc_�_ C1�- _ L_ _/� ,( a- 48. FINAL PLANNING ! �"`� ��!'e 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • p�"� Twining w ininq Laboratories Of aoutuzei,2 Calif°Y,2Ga, J,2c. j'''rEL OZ P.O. 80% 47 • 3310 AIRPORT WAY . LONG BEACH, CALIF. 90801 . 1213) 426-3355 • (213) 636-2386 . 714) 828-6432 • BRANCH OFFICES TESTING 15140Nonh He.Re.S:,e., �y� wNon Des, cn..3...ieg Sella Ane Celilornre 92703 ,Y° 'e ' 2955 Redondo Ace.,P.O Bo.47 • 12141 531 2045 dj •3 .9/1 q Long Beac4,GLI 90501 (2131 635.2354 I It Mr October 26, 1972 Examination: SC72-6872 • COMPRESSION TESTS ON GUNITE CYLINDERS L. E. -Sprague 1411 Windemere Lane Tustin, California 92680 PROJECT Swimming Pool for WILLIAM MILLAR Job/ 107 Permit/ 35556 ADDRESS 1921 Swan Drive, Costa Mesa SAMPLE FROM Bond Beam, Shallow End, Deep end ARCHITECT CONTRACTOR • ENGINEER - SUBCONTRACTOR Gun i to SPECIFIED MIX STRENGTH 2,000 psi • DATE CAST 10-19-72 SLUMP DATE TESTED 10-26-62 10-26-72 10-26-72 ' 1A "HOLD" CYLINDER NO. I 2 3 2A "HOLD" 3A "HOLD" COMPRESSION 7-Day 7-Day 7-Day TOTAL LOAD, LBS. 131 ,00 128,000 126,000 • POUNDS PER SQ. IN. 4,460 • 4,530 4,457 SIZE: 6-1/8" x 12-1/4" 6" x 12-1/4" 6" x 12-1/4" COMPLIANCE 7-day test complies with specifications. MADE AV DELIVERED eV RECEIVED ON CYLINDERS L.E.Sprague LES 10-20-72 DIMINUTION: ' -L-) -4' 4) - I 3 a- Ces-ta-Mesa Bldg. Dept. L. E. Sprague - 4 .Li; ? 2 ALL REPORTS IRE SUBMITTED .5 THE CON,'IOEM1 TIAL PROPERTY OF CLIENTS. AUTNORITaT1011 fOP PUBLICATION OF OUR REPORTS. CONCLUSIONS. OR CRS TRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS. THE PUBLIC AND OURSELVES. 330-12 _ - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITY OF COSTA ME CONSTRUCTION PERMIT P T 9- TRACT NO. LOT NO. UNIT NO. �Qar 5u)CLf P T �� 6213 5%27/86 5.00 TL Project Address LI I l • Applicant's Mailing Addressy'' - /y ace TYPE OF CONSTRUCTION U NEW a ADD U ALTERATION CJ REPAIR Owner's Name 'Pin Phone (5 y`.'7c(Q ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A.P.# I Zone DESCRIPTION OF WORK/USE OF BLDG. Address 1 S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT U GRADING u�r-OUNDATION ❑ STRUCTURAL E Front p Address '',, �s��/ ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL A Rear -. N Contractor's Nam- / .III 15•hone �(c[/.� El OTHER Address(mailing) didnl' •///AVA .2f i PROJECT DESCRIPTION SQ. FT. OCCUPANCY . CK Right N City License No. \_Jf/135 _ CONSTRUCTION TYPE VALUATION$ 5 Left G ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks: Planning Notes: Q with section 7000) of Division 3 of the Business and Professions Code, and M my license is in f. I .r• and effect. ♦ a ) .��EI�-` '• p w T License _ / i 0 i..... iJ Ace _ lJ firs( 2 �J8h S Date Signature#ffegtr� /- PLUMBING I. Er"— • v WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers'Wein Insurance, or a certlilgggiggl copy thereof (Syction Backflow Preventer Service Sink 0 15.50 KW 3800, Lab. / `� 'e / ,t2', �2. ,� Automatic Washer Transformer Policy No. Company G(„�L(iI'i Backflow Irrigation Sewer Cap Construction Pole Sub. • 0 50+ KW ertfed cop Is hereby furnished. Certiio y is filen with the city. s�f s•- . ..h..., , ,g +I Ion. /i Date Applicant Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps /Y—�f EXEMPT ONE -FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter (Dover 100 amps (Jp (This section need not be completed If the permit is for one hundred($100) or less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel 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 Drinking Fountains Solar Tank FanMotors❑0-1 HP ❑1%-8 • Workers' Compensation Laws of California. _ Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9.15 HP 016-15+ 'NOTICE: If,alter making this declaration, you should become subject to the - N. Workers"Compensation provisions of the Labor Code, you must forthwith Floor Sinks • UrinalFixtures comply with such provisions or this permit shall be deemed revoked. _ Microwave \ CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet • Device Boxes I hereby'affirm that there is a construction lending agency for the performancePole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors / Water Healer a', - Outlets Lender's Name - ✓ Range Lender's Address Kitchen Sink Water Service • Switches OWNER BUILDER DECLARATION - • Sign , I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash 2 following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry '. .any structure, prior to Its issuance, also requires the applicant for such permit Trays y • Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains 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 applicant for a permit subjects the applicant to a civil - 'nenalty of not more than five hundred dollars($500). , I, as owner of the property or my employees with wages as their sole Reinspection Fee ' $15 Issue Fee • $ 3 compensation, will do the work,and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Reinspection Fee I $15 Issue Fee $ 3 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler • Hood or Type I ❑ sale. If, however, the building or Improvement is sold within one year of corn- - Canopy Type II 0 honing Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground •. prove for the purpose of sale). . Building Approved By Date p ❑ „as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ���� Date :5427/(!4 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 Duct-Ventilating 00-100,000 BTU 0100,000 BTU - SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- SUMMARY OF tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ System Repair/Alteration I BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ 601) PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers • PLUMBING $ ISSUANCE $ Date owner Heating System& Ducting Registers PLAN CHECK •25% $ _ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 0o-100,000 BTU 0100,000 BT - ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize PLAN CHECK 50% $ _ MICROFILM $ //�(//) repre- sentativesioof his to ent r on the above-mentionedoate_ prop V InspectionSo ate-C t.1 MECHANICAL $ TOTAL FEE $ _2,z Drivers' Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Drivers: License or SS# CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor • • CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector 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, 0 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 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 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 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: [.,pr-c.4e cED 34. Final Heating & Air Conditioning t ls.Jd7 C•94‘421.- 19-S AWL 20 VP4 IL C. 6, o 35. Final Gas Pipe-Test �`T 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing jw. 39. Water Service-Final 40. Gas Service-Final • 41. Solar Domestic-Final . 42. Backflow Preventer .•- 440 Rackflow Irrigation 44-.Landscape Irrigation System 453 Sound Attenuation 46�Handicap Regulations 4�.2FINAL STRUCTURE& BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co nr 51e;CERTI FICATE OF OCCUPANCY No.L Date OWNER MILLAR, William DATE 10/12/72 %kJOB ADDRESS 1921 Swan Dr. BUILDING PERMIT NO. 15556 GENERAL CONTRACTOR Sir Pools DESCRIPTION of WORK Pvt. Swim Pool a AP No. 139-482-02 LOT TRACT FIRE ZONE VALUE $ 2,167.00 INSPECTIONS Sinature Date GROUP J TYPE Ill ZONE R-1 Pool Location IPA d 4).1 Z SUBCONTRACTOR PERMITS ISSUED Date I Number I Signature Forms Main Drain • Steel Reinforce / Elec. Bond Electric Approval to Cover pie 540 - 1.A rieea IUi a 36.60"--- Underground 6. p/Underground Electric ,e/P /a(f•92 7 Gas Piping Test / Plumbing � Filtering System Lines e / Z'th Ynnoe-G/�" /U/'7/a. 6/zs, '� Backwash Lines and Recep. // .�re °'(r"'1G Z4vHeElectrical Final H-41- Heater ater and Vent Final 11"- 0 1,72- Filter System Final Backwash and Recep. Final Fencing Final AC416•r 35556 "° CCT 12-72-- 526* tt,t,t L00 3 4.65 I' trls. COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �f �}t}[/vscv rv� RE VEy7 Y DATE RE VED DAT ISSUE ABUILDING DDRESS 1921 = "'- ' Swan Dr. / ,0-,/ J 70-702-- Q PERMIT NO. _OWNER William Millar A.P.NO. 134-+4 "a- .0 MAIL BUILDING 1921 Swan Dr. Z _ADDRESS 1921 Swan Dr. ADDRESS C 10 U.I a U CITY Costa Mesa NOJ49-3915 TRACT 5289 LO2B BLOCK 1-Z - Z C CONSTRUCTION L171knOWn NEW ADO ALTER REPAIR MOVING DFMOLISH O 0) _LENDER ][ tL Y _JD BRANCH J - rnOWNER William Millar mJ _LLI ADDRESS VALUE J-03 Q _AORENGINET R. Tebault NQ5'32-6309 DB• Swimming Pool $2.16 .00 U N FIRE Z 0 _ADDRESa3O31 Prospect, Santa Ana ZONE TYPE GROUP 1L W APPROVED JO CONTRACTOR Sir Pools BY DATE CO Z .¢ _ADDRESS 1015 N. Parker W Li) ZONE( Na OF USE OF NEW 51.01104"Air&)G ZTE i_ CITY Orange N0138-0068 2 I PLANS a BUILDING Ra O t LLT° ^STATE CITY YARDS APPROVED YARDS APPROVED (/)CC LIC.NO. 230261 LIC.NO. 1516 MAIN BUILDING ACCESSORY BUILDING D O - (FROM C/L STREET) SIZE NO.OF BLOCS. c2�Q''� OF LOT NOW ON LOT FRONT FT. FT. I =.. USE OF r EXISTING BLDG. FL SIDE FT_ FT. (- SIZE OF NO.OF I ZZ -NEW BLDG. ROOMS STORIES L.SIDE FT. 16 FT. V EXTERIOR WALL ROOF _COVERING COVERING REAR FT. 6 FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& y - MAIN BLDGS. ACCESS.BLDGS. o DATE Pr. Swimming Pool C U.P.# APPROVED I-2 - —BAYPROVED I. 11 ilA DATE It)//�/7Z O i ST47,4 1.�) UI hereby acknowledge that I have read this application and state D that the above Information is correct and agree to comply with / cc ell laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of (n the State of California. ,q.k' m m Z I hereby certify that I am properly licensed as a contractor under SQ. FT. 2 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 4e Chapter 9,and that such licenses era in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a' am exempt from the provisions of the State California Business VALUATION and Professions Code, Divisi n 3,Chapter . 3 _ m PERMIT FEE $ N �,\ 0 Signature oi� / . / /J UV $ ..5.0 E Permlttee � '�`�-� $ / /17 ! / PLAN CHECK Authorized Agent 3 z{ 0 LL TOTAL FEE $ OWNER PEMRA SrrRUTVTI)RRS, fljC. DATE 2-4-66 JOB ADDRESS 1921 Swan Drive BUILDING PERMIT NO. 25198 GENERAL CONTRACTOR Same DESCRIPTION OF WORK Rea. w/att. garage AP No. LOT 28 TRACT 5491 FIRE ZONE VALUE $ 22,475.00 INSPECTIONS Sign u Date GROUP : TYPE ZONE ;-_ Spff SUBCONTRACTOR I PERMITS ISSUED Gas Date I Number I Signature Water •..anirer Plu.,.in_ Rough Plumbing—� Ae- crl" j JPS,., . . -/ . - Prop. Swr. Line rjI use Con. ilir :y --)r , ..:;rei jy • .tai/' - ebb p11 Sprinkling System Miscellaneous Rough Heating and Air Conditioning P4°5 3'2 Temporary Service or Pole T Underground 0 Power 0 Rough Wiring /7/415 g -L '6 HeatinPg�nd V3pt. Trenches IV �/i.oryrms ® Steel Reinf. ®_ /PS V/y/ ,C „ c .-,,',, (p�,�, Vs-hi /6-G6 d f47 Floor Systenlled / j//y/Ec Bond Beam p Steel Reinforce 0 Sheathing /OW 51/48/66 Frame and Flashing 'Rid s-//Gs Lathing— In Va, Out Q opt6 3%/3/66 Plaster, Brown Coat Structural, Final - Electric Heating, Vent., Refrig. and A.C., Final 1 �- , I Ai X11( 'dial', Ott - '.6- ce .fin Plumbing, Final and Gas Test L " .i-�77-' Electric,gFinal j'9 �� - --Building, Final .i f' Tr.Fi8 25198 9 of CITY OF casrA MESA r/998 COSTA-MESA BUILDING-SAFETY DEPARTMENTFEB 2 1966 P.O.Box 817 COSTA MESA.CALIFORNIA For Applicant to Fill In Completely A�L1iC49 iti -4 PERM TYPE OR PRINT m :Ir •• ,,r. For Office Use Only BUILDING 1921 Swan Drive ADDRESS - RECEIPT NO. ER 1 rvo. COSTA MESA, CALIFORNIA 2Sr�R RECpJVED SY DATE RECEIVED DATE 88U OWNER Pemba Subdividers, Inc. (��(CI /c2/74.6 FEB en x/66 BUILDING /(J 2/ �W / 1- - ADDRESS 2850 Mesa Verde Drive ADDRESS /GY -/��y I�n/J�llJ T ZONE TYPE ..72 GROUP (�/Y'�• FIRE CITY Costa Mesa, Calif.NEOS••49-0395 ARCHITECT Tg} APPROVED DATE OR ENGINEER Kaltenbach NO7'47-8046 BY 1823 E. 17th St. Sant aAna ZONING /� ADDRESS /(L ZONE USX OF NEWfi(PILI e_/ I PLANS z I BUILDING,/ CONTRACTOR Pemba Subdividers, Inc. �,<CHH DeECRlLEGAL mon J o/1 S VV J. ADDRESS 2850 Mesa Verde Drive C0 O 4,'A LJ (f CITY Costa Mesa, Calif. A.P.NO. —13— NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE .187318 TEL 549-0395 30'70 SIDR&REAR P.L. EAVES SIZE OF LOT 70 x 100 I No.of BLOCS. O ALLOWED (U.B.C.REQUIREMENT) Now ON LOT YARDS APPROVED YARDS APPROVED USE OF Single Family Residence MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. with attachcd gar acc - (FROM Cl�.�6'fREETY SETBACK LINE FROM FRONT p7L/FFT. k,C) `N FT. CENTER OF STREET 47 REAR YARD 29. 5 O I SIDE YARD LEFT 8 10 I RIGHT .3 R.SIDE (pp,3FT. FT. DESCRIPTION OF WORK L.SIDE /9 FT. FT. i NEW ALTERATION _ ADDITION REAR /�FT. FT. DISTANCE BET. BET.MAIN S MAIN SLOGS. ACCESS.BLOCS. REPAIR MEWING DEMOLISH VAR.# DATE BUILDING NO.OF SIZE 1753 ROOMS 1 ) •- __ 1 C.U.P. ; APPROVED EXTERIOR WALLS tuccd ROOF APPROVEI 21 I6 COVERING "� COVERING shakes BY 0DATE I�✓ USE OF BUILDING AND WORK TO BE PERFORMED /l-,{IVA1�L/ /6 7/SO. o' N 64.FT. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. E O PLY WITH ALL CITY ORDINAN S AND STATE LAWS REGULATING to BUILDING CONSTRUCTION. VALUATION " 474... // PERMIT FEE 72 N PERMITTEE SIGNATURE OF �'fT��/J 111 I ✓ ^^// 7 'J $ co ; $ �.2,4/ PLAN CHECK $ 3 '� Q AUTHORIZED AGE TOTAL FEE $ /DIS' u e COSTA MESA BUILDING—SAFETY DEPARTMENTPAID 22 d*** *6.00 • P. O. BOX 1200 � 1 N `k 72391 e 90421 Costa Mesa, California r i PERMIT �i PLUMBING PERMIT APPLICATION TRACT NO. RECD. 11 CONTRACTOR General Installation LOT NO. I =T BUILDING USE Address 6558 West Blvd. City L• A. 90043 Zip Code Building 1921 Swan Dr. Address State License No. 151839 Class. C36 ownerSeott Davenport O G w Mail City License No. Tel. No. 753-2541 Mail Same > S I- Q NUMBER TYPE OF FIXTURE OR ITEM FEE Same „...-4• 'I� ` _b l 957-8063 _o Bathtub City • - - Tel.No. J Laundry Tub or Tray I hereby acknowledgef[hat>1 hz"ve read this application and 4 Automatic Washing Machine state that the above,is coirecl and agree to comply with all City Ordinances andlStateaws regulating plumbing. Shower I certify,�tha l pons a 'Ls the above valid State of California classi- Sink, Bar fication orrl am"the legal owner of the residential property de- 2 Sink, Kitchen scribed above. w Wash Basin(Lavatory) ('certify that I have obtained a permit from the State Division of 0- Water Closet(Toilet) ,� it , Industrial Safety for excavations,other than swimming pools,five C' feet deep or deeper and into which a person is required to descend. S Drinking Fountains -+ J 1\111a. Floor Drains `1U .1; Signature of / �/ . s '/e- -/• Permitee Le • (. ' Z Interceptors 'i'. ‘L,„" ill Receptors ar Y INSPECTJON RECORD _ r ,j Sinks,Commercial or linlatilalr Y F Sinks, Floor -,-R il. \t S . S. r 77 N` II U Sinks,Service PQ, \1f" 2 Swimming Pool-- / CC LSI , Urinals%) d ' Dishwasher S Garage Disposal D Water Softener O 1 _Water Heater and Vent 3 00 Gas System. ..Outlets... cn Roof Drains APPROVALS to _Water Piping Alteration INSPECTOR DATE Backflow Preventer U/G Soil I Lawn Sprinklers(Res or Non-Res) U/G Water Property Sewer... Feet Services—Water D Gas ❑ House Sewer Connection Rough Plumbing _Cesspool,Septic Tank Sprinkler System Sewer Cap Gas Miscellaneous Property Sewer ' Pool Receptor Filter System Sub-Total 1 Pool Heater Reinspection Fee 00 Miscellaneous Processing Fee Is- Final Gas TOTAL FEE 00 Plumbing Final ACM________F 12. — 77 Utility Co. Notified /(1 �\ CMF 0450-46 BLDG. PERMIT NO /// y—,