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Home My WebLink About3209 VERMONT AVE - Building Permitsp'NF t`O . , � 0 a : � � °ot��et�' � . . � CITY OF COSTA MESA � . BUILDING D►VISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754•5626 � PERMIT NUMBER: B10-00107 PERMIT TYPE B_ROOF2 APN: 13910233 JOB ADDRESS: 3209 VERMONT AV CM Vicinity: ROOF . Squares: 2800 STATUS: DATEISSUED: ISSUED BY: Suite/Unit: Valuation: ISSUED 04/27/2010 RMD '� $8,870.00 SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL 1 LAYER OF 30# FELT ON A 4:12 PITCHED ROOF AMD REROOF WITH 30 YEqR COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE, APPROX 2800 SF. REPAIR AND REPLACE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. OWNER: HAUGN, TERRY Address: 3209 VERMONT AVE Unit: PHONE: 714-035-9445 � City/State/Zip: COSTA MESA, CA APPLICANT: MC FEGGAN, BILL PHONE: 714-997-9449 CONTRACTOR: FAIRWEATHER ROOFING INC Address: 1212 E ASH AVUnit: CirylState/Zip: FULLERTON, CA � 92831 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $16725 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 Address: City/State/Zip: License No. License No. PHONE:. ` ' License No. 770565� '. 714-997-9449 CELL: PHONE: . PHONE: Unit: AL FEES $168.25 � HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 311 812 0 1 0 • PER CMMC Sec. 13-279 Monday thru Friday - 7;00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal NeW Years Dav, Memorial Day, Independence Dav. Labor Dav, Thanksqivinq Dav and Christmas Dav NOTICE: The work a4thorized by this permit shall wmply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in ihe expiration of this permit. CODE Il. INSPECTION TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Finai BIak/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final �emolition OATE IN1111AL5 COOEp INSPELIIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy DATE INi1TIAt5 • WORKERS' COMPENSATION DECLARATION: I hereby aff�rm'untler penalry ot perjury one of Ihe following declarations: ❑ I have and will maintain a certifcate of consent to self-Insure for workers' compensation, as provided (or by section 3700 ot Ihe Labor Code, for the peAormance of the work for which this permit is issuetl. ❑ I have and will maintain v.orkers' compensation insurance, as requiretl by section 3700 of Ihe Labor Code, for the peAamance of the v.ork for which Ihis pertnit is issued. My workers' compensation Insurance carrier and policy number are: ! /"' / �net:s J �G �c,. /�•�cn A (This sectnn need rqt be�c1omde�etl �MeOerm� is vaWetl al one �untl�ed dollars (5100) w less.) �Pl�mber O H'7 � DO L9 / �(� ❑ I certify Ihat in the pertormance of Ihe work for which this permit is issued, I shall not employ any person in any manner so as lo become subject to the workers' compensation laws of Califomia, antl agree that if I shoultl become subject to the workers' compensation provisions of Seclion 3700 of [he La/b�or Cotl all forthwith comply with these provisions. .r/ -,,•!%i �i-27 /v —'—��App �CSSignaWre �--�Oa1a_-� WARNING: F�RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 0( �he Business and Pro(essions Code, and my license is in full force and eRect. ��.-�� ,� -3 5 /J �� ` � Z.%'�i/ b �'�C C�tf�'s�SignaWie' ate CONSTRUCTION LENDING AGENCV: ❑ I hereby atfvm that there is a conswctbn lending agency fw the peAormance o( lhe xork (or wfiich lhis pertnil is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Dale OW NER-BUILDER DECLARATIONS: I hereby aKrm lhat under penally of perjury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Professions Code: Any city or counry which requires a permit to construct, alter, improve, tlemolish, or repair any slrucWre, prior to its issuance, also requires the applicant for such permit to file a signed statement Ihat he or she is licensed pursuant to Ihe 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 exemp[ therefrom an0 the basis for the alleged exemption. Any viola[ion o( Section 7031.5 by any applicant (or a permit subjects lhe applicant to a civil penalry of not more ihan five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with waqes as Iheir sole wmpensation, WILL DO THE WORK, antl 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 vrork himself or herself or through his or her own employees, providea that such improvements are not intended or oRered for sale. I(, however, the building or improvement is sold within one year of completion, the owneo-builtler will have the burden of pmving that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer of the propeny, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to consWct the project (Sec. 7044, Business and Professbns Code: The cont2ctors license Law dces not apply to an ovmer of propetly who builds or improves thereon, and who cont2cts tor such projec[ with a contracta(s) license pursuant to the Coniractors License Laws.). ❑ I am exempt untler sec. Business and Professions Cotle for this reason: Signawre ]059-46(3I0]) , Ovmer ID verified by drive� � iicense. ❑ Yes ❑ No Driver's License No. Expires: Veri(cation of Ownership by (type ot document, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby ceAify that no excavation frve (5) or more fee[ in tlep[h inro which a person is required to descend, will be made in connection vnth wnrk authorized by this pertnit, antl that no building s[ructure, scaHdding, talsewoB, a demolition or dismantling thereot, will be more [han thirty-six (36) feet high (Chap. 32, Grp 2, M 2, Sec. 341, Ttle 8, California Administrative Code). ❑ As ovmer-builder, I will nol employ anyone to do vrork which vroultl require a permit from the Division of Industrial Safery, as noted a6ove, unless such person has a permit to do such work fmm Ihe division. SgnaWre � Dale Division of Industrial Safe[y 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 ma[erial? ❑ Yes ❑ No (Section 25505 of Ihe Califomia 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 dunng a reported year a quanlity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressetl gas at standard temperature and pressure). 2. Does or will Ihe applicant or present or fuWre building occupaN need to fle a regislralion form for aculely hazardous ma[erials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and SaFery Code, with some exceptions, requires registration with the Cosla Mesa Fire Department by each business which a� any one time has on hand a quanlity of acutely hazardous materials equal to or greater than a weiqht of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperawre 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 Ihe Calitornia Healih and Safery Code provides that [he Costa Mesa Fire Department may require the preparation, cenification antl fling with the Fire Department o( an RMPP by businesses which are required to register acutely hazardous materials with [he Fire Department. 4. If an RMPP is presently required, has Sec�ion 25534 0( lhe California Health and Safely Code been fully complied vrith? ❑ Ves ❑ No 5. Does or vrill Ihe apDlicant or present or fuWre buil0ing occupant require for the work which is the subject o( Ihis application a permit for such consUuction or modifcation fmm the Sou[h Coast Air Qualiry Management District or (rom any olher air pollution Control diSMC[ or agenCy? ❑ Ye5 ❑ No (Sectbn 658W2 of the Califomia Govemment Code requires that Ihe requestetl infortnation be fumished on applications for non-residential building permits). 6. Will any part of ihe facility to be constmcted untler lhis permi[ be within 1000 (eet from the outer boundaries of a school? ❑ Yes ❑ No (If'yes", the facility must meet the requirement of Sections 25534 and 42303 of Ihe Cali(omia Health and Sa(ery Cotle). 7. If a permit (rom the South Coast Air Quality Management District or other air pollution conirol distric[ or agency is required for Ihe work which is Ihe subject o( this application, have all of the disclosures prescribed by Califomia Healih and Safety Code Section 42303 been matle? ❑ Ves ❑ No 8. pt "yes", attach certifcate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the intormation given above is correct I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. SgnaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalty of perjury that I have read this application and state that the information given is correct. I agree to comply vnth all slate lavrs and city ordinances relating to building construction, and authorize representatives of ihe City of Costa Mesa to enter upon the above-descnbed propeRy for inspection purposes. I agree not to occupy or allow ocwpancy of any building authonzed by mis pertnit until final inspection. ��Sgn f Legal Ovmer�s) �ale `f-Z7 /b Antl/d� Aulhonzea Appl¢ant p31p� Yrascnptn�e �:ert� �ZL'.14(�CI111U� f� �[L'Pq! Projecl Nxme: TL' i" / Ceneral Iniormatiou su� nad� �ss: 320 Building "iypc'�Singlc Fnmily ❑ Multi �nmily Couditioned Cloor Area (CFA): Reti�d��a�a Thi.s (nrm i.c nn� tu Le u.sed /nr Nein[r Cortstructerl Gnibrcmnenl Agency: _ 1 D -DU e Ciimafl'LUne # M. e/� � Dnte: t�/� . cr_�a-A,.�� {Ya�e 1`oi'S)i � t: af Storics Cireie fhe 1�ronL Orien[ntion: �', P, S, W, ordegrees Projec� Type: ❑ AlteraLions � Hnvelope � Fencstrxtion`�{'Aoof' O HYAC Rep)acemen� ur Chenkc OW D Duct Replacement � U�ater Hea�er �ildine.s or dddifionx � Dtsulntinu Ynlues l•nr Opnq��c SurJncva� (Jnr Fw�rnig vse ibe A9ass uncl Furring Sn�ip.r Co��slrn�etion iable belm��1 Assembly Altcration ❑ Opening of' ll�.mied caviq' �done— Alternlions lGn� irrvoloe d�e apenirig �j//re fi�amed enviry' q(ri wn[l. ceiling, or flom-mus� in.stall !he mundc�lor'n n�ir�imvm �n.stidauo�v nnlve per {�750 /or 7he n4ered assem6lr. Fill in Co(vnm.s A—C ancl enier manda�m�p ii�stdation va(ue in Coltimvn H. ❑ Replucemenl of entire assemblp—Replaceme��l ofa�� e�viir ��nll, ceiling, orfloor'a,rsembl�� reqi�ires d�e instu]latio�v ofCou�pnr�erx� Pi�cknne-D ins�Jatio» valura' in TaGle 151-C Fi7/ i» Columns A—J. _ � ue Surface I3etails Ror u�e tun ud IS C Tug/ I Assembl}� Name I Matecial ID� orTvne� andSizeZ tioned ol'Mass W:dls see ll C Stand:u�d 'hicimess, Spacing, U- or Other� facmr� Construction Tnble below. r I �, I H I. �. .......II.. .. �..... Values From JA4 Table Fr�med Cantinuous JA4 Proposed JA4 Tnble Cavity Insulation Assembty Assembly Numbers R-value� R-Value' Cell Valueb U-feemr' Noie: For jm�red assemGlies, nttaunling fa� Con�inuoue' /nsulafion R-va[ue, see Pnge JA4-3 nnd E9tm(iw� 4-1. Gm� calcidaiing finred wa!!s use the Mass mid Fin�rin� Cmisbvciian �able be(o�r. l. Fa' Tng/ID indicu�e d�e ideiai/icaiion name tha� nmiches ihe building plans. 2. /ndicu�e the Assemblr Nnme or' rype: Roo(/Ceiling, Walls, Floors, S(abs', G�aw( Space, Doors and etc._Indicate [he Frane rype and Size: For N�ood, Me�ul, Metal Buildings, Nlass, enter 2s4, 2z6, nr etc.., see JA4 fw- odier possible f'ame ryye assemGlies. 3. En�er !he lhiduiess for muss in inches a� Syacino benveen f�arning members enter; 1 G'br 24 "OC; or O�her for al/ oUier assembl�� descripliwi such as Concrete SandivicB Pmie(, Spanilrel Pm�el, Logs, Straw Bale Pane( and ere.... . � 4. Dnsecl an the Climaie Zone; enter the SiandarA U factor fi�om Ta61e 751-B, C or D,for each d fjeren� assemLf�� Name m� type. 5. Enter 77�e Tablc raurnGer lhai closeh� rea�emGles� tl�e proposed osa�er��blt�. 6. L•n�er the 2-�,alue lhul i.v Geing insmlled in �he wall cavitv m� beiween d�c {'nnting; otherwise, enler "0„ 7. Ln�er the Canti�mnus ]ns�dn[ion R-vnlue%rlhe proposed assenrbl7q- nlhenvise, eir�er "0". eS. Li�ter [he rnui� a�vd calwr�n q(Ihe U faclor, valtie based on Coluo�n F Tuble Naar�6er and enter [he �issembl y U facior irv Cahmm J 9. T�1L P)'0/1lGSC(� f�d'S'ei)i��V �ifCiCfol', COltll]ll1 �/, ]]1tIS7 fIP Gt]1�u7 lu Or'!ee's' lhun !he Struu(nr'd U-rnc(or in Colunm E to coinpl��. � Furring Strips Construction Table for Mass W alls Only � A- B C D E F G H I .1 IC L M Proposed Pruperties of Mnsonr)' nud Cuncrete Adduil Interim� ur i'Lxterim�lnsulation 1A�nlls From Itefcrence in Fun�ing SpAce L'mn Refercncu Joinl A � iendix T:ddr.4.3.5. 4.].6. 4.3.7 Jainl A l�endix 9':�ble 4.3.13 .c y 1 W U U U � .1 �; n. ° � °' �' � °J, , , .. Assc�nbl�• �.. j o G.O F � o wl.'v m ,'"v Tlnal � �'u M:�ss Namc or JA4 Tahlc ..� ` v v� E q o '� ; R ` A Assembly TLickness� Type' Num6er' � 1O = w ° � a` % �. r = R�_ U-fac[or°'� Commenl I I I 2egirb�atioiiNinrther: ltegi.slrol+onlJu�e/Time: � HE/1S'Proi�ideir 200b'Resiclemial Compliance!•�orma� l�ugu.r� 2009 1'rescri�tive Certiticate of Comoliance: Residential CF-1R-ALT (PaRe 3 01': # #6!'Stories� ROOP'ING PRODUCTS (COOL ROOFS) §157(�12 � WLeu 1he nren nf ei'lerior roof.su�fnce 1n Gc repinced erceeds niore /hnn 50% nf /he e�isting rnof Areu, ar more 1{ime 1,//�0 fC, �vbicLever is less', We �aein rnnfing nrea iuus•1 reeet !he rnnfrug prnducl "Cnid Roof'requirements of§I52(bJIHi, 152(li)IHii, m� I52(b)IFliii. Clieck applicnble a[rernntive nr esreptio�i belou� if die rnnf a/�eration is eump� fi�on+ �he roofing produci "Conl Ronf" requirements. Note: lJuny one oflhe ul�ernalive,r or esceptian Geloir rs checked (he Rged Solur Rcflec�ance and Tlrermu( Enriltartce req:dvemeirts jor inofircg pi�oduc�s in ,�l l8(i) ure noi npplicnGfe Do nn� Ji(I mble befoe�. � ❑ Cool 2oofs Not Required in Climate Zones I-12, I4, and I( with a Low Sloped. �Less or 2:12 pitch. �ool Roofs Nol Itequired in Climate Zones 1 lhrough I ond 16 with a Stcep-Sloped Roofs (piroh grenter than 2:12) end product unil weight less 'klternatives tu §152(b)1Hi nnd §152(b)Hii, S[eep-slopc rooT (pi1cH > 2:12J ❑ Insulation with a thermal resistance ofat le�st O.SS hrR��°F/Bm or at least a 3/4 incii air-space is added ro tl�e roof deck over an attic; or ❑ Existing ducts in the attic are insulated nnd sealed uccording to §l51(�I�; or �❑ In climate zones 10, 12 and 13, with 1 ft� of free venulation �rea of atuc ventilation for every I50 4� of attic floor area, and � wl�ere at least 30 percent of the f}ee ventilation area is within 2 feet vertical distance of the roof ridge; or � Building has at least R30 ceiling insulation; or ❑ Building has radiant barzier in the attic meeting the reyuiremenis of § l51(�2; or ❑ Building has no Aucts in the attic; or ❑ In climate zones 10, 11, 13 and 14, R-3 or greatec roof deck insulation above vented attic. Ezceptiun to §152(b)1Hiii, Luw-slupe roof (pitclr <2:12) ❑ Building hes no dacts in the atlic. � ❑ Roofing area covered the by building integrated; photovoltaic panels and solar Ihermal panels are exempt from [he below Cool Roof criteria. rt have thermal mass over Ihe roof inembrane with at least 25 !b/ft is exempt from the below Cool Roof criteria. ;I is available, lhis compliance method cannot be used, use the Performance Approach to show compliance, otherwise, box below iFExem t from the.Roofin Products "Cool Roof' Re uirement: 2oof Slope Product Weight Product Aged Solar Thermat Numher� < 2:12 > 2:12 < 516/ft' > 516/fr2 Tvoe� Retlectance�'4 Emittance SRIS C ❑" o^ o^ ❑° ❑" The CR/iC Prnducl ID NinnLer cnn Le nbinine�!(�aru Ihe �uol /ino(Ra(ing Co�mci/'s liuled ProUucl Uirrc(ay al wrv�n.cnnlrnnis.m'n/nroducl.v/seurch.� Indicale Ihe l��pe ofproducl is being user!(or' Ihe roof Inp. i.e. single-pll� �'oof, �S�i,a�n��ol melnl raof, elc. lf the Aged Itefleclmice ia' nol avnilnLle in.lhe Cool Roof Rt�ling Cwnicil'.s Rpled Producl Direclwy Ihert use die /ni(iul Heflecionce vnlue fi�om tlie snn�e direcmrl' m�d ua'e �he egrvo�iorr (0.2+07(/linprm— 01J lo nLmio n cnlculo�ed aged voL�e. Where p is �he Ini�inl Solnr IteJlecmr¢e. � Check bn.�' i(Uie dged Refleclnnce is n calciduled vnlue nsing Ilte eyun(ion nGnve. � . Calcidnle !he Slil vaL�e bl' ��.sing Ihe ,SRI- WnrksheeYrtl hlln'//�nm�r enernv en en �/lille24/and enrer IHe resulling nnlue in tl�e Slil Co6unn nbnve nnd altucB ucopv tlie SRl- li�orlca�heel In Ihe CG-lX. i apply Liquicl Rield Applied Cuatings, the co�ting inust be upplied across the entirc roof surface and meet the dry mil tliickness or coverage commended by Ihe coatings manufacturer and meet minimum performnnce requirements listed in §I 18(i)4. Select [he sspplicable coating: Aluminum-PigmentedAsphall RoofCaa(ing �CJCemenbE3ased2oofCoating ILIOther RegLrtra�ioir N¢maLer: Regr.xbntron Da1e/Ttme: fIG2SProi�ider: 2006 Residenliul Compliunce Fornt,s - Augus� 2009 Prexcripf:ive Ct:rtificate n1�CumU��e: Residential CI�-112=Ai�T Resitle�ztinl Altcr�airnas (P��e. � ul� S� PL,jL•cl_1Van � Clinmtc Gunc r N nt�$tunies �/��T f��..�.ti 32oy vP.�-�o�� , � r— H�I:S VLkIFI CATION SUMMAP.]' %'he en(orcemen� ngei�er.shauld pnr syecinl nnen�inu io d�c HLItS iilensm-ee� speci/ied in U�is d�ecic(isi helrnr. A comyleted cmd signed CF-4R Favn Jor nll ihe nrene�ures specified shcdl be subneiued rn �h« birilding in.rpecror beja�e Jinul flpC( SeaI1Re cS:. 7�Ctitlllo HL/iS neri(iccnion fs rega�irecl�or /hi.r meosare ❑ l'�5 ❑ NO 1'CS:Iu Ciinmte Zmies ^_ tmd 9-I6, i(more tl�uu 4U Iinenrfeei olnew arreplecemcnl duats are ins�tdled In lwcaudilioued - space, [he ducls ure io be se,ile<I per ti I S2(b)IDii and [he newly insmlled ducts are �o be insula�ed pei § I51(1)1 U. ❑�XCP�PTIG�: Lxigting ducC systema thal ure extended, �vhicL are cuusfrucled, Insulatetl t�r xealed �vith �s6ustus. ❑ Y�S ❑ NO YES: ]n Climate "Lones 2 and )-IG, if the existin@ space-co�iditioning svstem (HVAC eyuipmem and ducting� is replaced, the ducts are to 6e sealed per G152(6)]Di, ❑ YES ❑ NO 7'LS: ln Climyte Zones P a�tl )-16, if the existiizg HVAC equipinent is repluced (including the replacemeni of t6e :nr handler, ou�door coudensing unii of a split system, cuohi�g or heEi[ing coil, or the fumuce heai exchznger� ehe ducts tn�e to be sealed per,�C752(b)lE. � ❑�aCI'�.7'TIOn': Duc� systems 8i�t are ducumented tu haee beeu previously sealed coufrmed tlu�uugli fiCRS � � �veritication in accbrdance �vitli pcucedures in the Rel'erence Residentinl Appeudiz P.A3. � ❑�XC�PTION: lluet s1�,steme witli less than 4U-linear feetin imcuntlitioned sp��ce.. � . ❑ EXCEPTIO�: Cxistin� duct svstems constrocted, insulated m� sealed �vith asbes[o5. R�f�Cleet'Ant ChflreE -$F711t S)�StOlil HERS veri/icnlion i.s reyuirecl,for Ihis measm'c. ❑ YiS ❑ NO YCS: lr. Climate Zones 2 and 5-15, when [he existing HVAC equipment is replaced (including the replacemen� of the air ha��dler, outdoor condensine unit of a splii system A/C or heat pwnp, cooling or Ireating coiL or the fumace heat exr.iianeeri a refrieeran[ charse measuremem shall be verii�ed oer $152(oIIF. Central Fan Intecrated (CFI) Ventilation Sl,'siem and Fan W att Dra�� The ven[ila[ion remiirements of F150(ol do not aooh� tn ezis[ine residential homes. DucYed Split Sys[ems - Air Condifioners and Aeat Pumps: Airflow HER;S rerijic❑iion is reguirerlJor thfs mea��urc. ❑ Y�S ❑ NO YGS: ln Climate Zones 1 U thmugh I5, when the existin� space-conditioning sysiem (HVAC equipment and ducein�) is - replaced. the airflow and fan watt draw shall 6e veri5ed ner � 1;2(b)1 Ci to meet the reauireinents df & I51(f17B. Documencation Au� 1 certiS�� that this Name. n .. •,, �z�z ❑nd Date: 5`-27 /b lf Applicable O CEH or � CEPE /�,,, //Gi-/si.�� L/�. 7GLr3 / I "' /—// /-777� r� inusible 13uilding Desiener's Declarntion Stntement . 1 am ellgible. underDlvision 3 ofthe Cali{omiEi Business and Professions Code �o occepi respousioiliq� lor the'ouilding design identiGed on this CertiScate of Compliancc. 7 cerlify tl�al the energy Ceotures and perYormuiice speciGenLions Yor tlie. building design identiLcd on Lhis Certificate of Compliance confornt tu the requirements of Titic 2q, P�ir�s 1 and G of lhe Calilbrniai Codc of Regula�ions: - . The buildmg denlgn fcatw'es idenliGed on lhls Certifmmc of Compll.�ncu tire consisteni wilh Uic informoiian provided tu documenl this buildina design on tfie other upplicable complianec lbnns, worLshcets, culculations, pltms antl speciGcaiions submumd io the enforcemeu� aeencv fur apP�'��'ul wlth thls 6uildinr� permii �ipplieulion. � _ N;�me Compiiny City/State/Zip-. Si��nauu�c: I)ale. License: I'hmie: l�ar tts�eisituice nr qttc�'tions regtu'ding ihe Lnerol' Sumdnrds, cont¢ci tlic L•nerbr I-In[line ar l-b'011-7i2-3300. ICegieartuion fJuni6cr Itegi.siraiiirmfimc/Time: bIERS' ('rni�ider: �nnr n.,..;.l..�,n.�l rnnn�linr�rv, Fnrm.c Aubue'1 ?OOl CITY OF COSTA MESA t ��p MFsy BY/LDING DIVIS/ON F�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us °�� FOR INSPECTIONS CALL: (714) 754-5826 PERMIT NUMBER: P09-00053 PERMIT TYPE PLUM APN: 13910233 JOB ADDRESS: 3209 VERMONT AV CM Vicinity: GARAGE STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 04/09/2009 RMD SCOPE OF WORK: PLUMBING PERMIT FOR WATER HEATER CHANGE OUT, SAME LOCATION GARAGE. OWNER: HAUGH, TERRY � - Address: 3209 VERMONT�AVE �- PHONE: � . . City/State/Zip: ' COSTA MESA, CA � . APPLICANT: KERCHER, ROBERT � � . - � � Address: PO BOX 1017 : , � PHONE: 714-530-2440 � - " City/State/zZip: GARDEN GROVE, CA CONTRACTOR: A-AMES PLUMBING HEATING Address: P O BOX 1017 �� City/State: GARDEN GROVE, CA � ZipCode:� 92842" License No. License. No. ARCHITECT: ENGINEER: License No. PHONE: CELL: 250307 (714�530-2440� PCUMBING FERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $35.80 TOTAL FEES: $35.80 PHONE: PHONE: NOTICE: The Work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. CODE %. INSPECTION TypE OATE INTITIr1L$ CODE / INSPECTION TYPE 0� INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �-/y -d9 __Q�[_ 200 Final Re-Roof 210 Final Electnwl 201 Final BIceWRelaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 final Sign 222 FinalSite 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby affrm untler penalry of perjury one of the follovnng declarations: ❑ I have and will maintain a certifcate of consen[ [o self-Insure for vrorkers' compensation, as provided for by section 3700 ot Ihe Labor Code, tor the peAormance of the work for which this permit is issued. ❑ I have and will maintain workers' compensa[ion insurance, as required by sectbn 3700 of Ihe Labor Code, (or the perfortnance of the vrork (or which this pertnit is issued. My workers' compensation Insurance carrier and policy number are:, I /' Carrierr. l/L° �5 y(�SJQ�cii1C2- l A�Mp�.V1lA (ThisrectionneedrrofDecumda�edllheperrri4isvaNetlatone� ntlretltld (Stoo)wless.) P licy ymne�: d�- �S�I"l�- 2Cb�oZ4'38 ❑ I certify that in �he peAormance of the work for which this permit is issued, I shall not employ any person in any manner so as [o become subjec[ to the workers' compensa �ryj laws ( Califomia, and agree [hat if I should become subje o e w (eis' pensation pmvisions o( Section 3700 of the Labor Co �, I all f with mply wi lhese provisio s. �c Uy �%�l d A liram's $ipndtweT/• CD�Ie' WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OP THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm lhat I am licensed under provisions of Chapter 9(commencinq vrith Section 7000) of Division 3 of Ihe Business and Professions Code, antl my license is in full force an0 effect. A �1 ./ .�c. # n%�7� �. C��.#. 1 T �1 � �� trp�jOLS ignaWre 1��9t2 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that Ihere is a consiruction lentling agency for the pedormance of lhe wnrk fa wfiich �his permit is issued. (Sec 3097, Civil Code). Lender's Name: Lender's Atltlress: Da�e OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty o( perjury that I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW fof lhe f011ovnng fea5on (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to constmcl, alter, improve, demolish, or repair any strucNre, prior ro its issuance, also requires the applicant br such permit to fle a signed statement that he or she is licensed pursuant to Ihe provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) o( Division 3 0( the Business and Pro(essions Code) or that he or she is exempt therefrom and the basis for lhe allegetl exemption. Any violation of Sec�ion 7037.5 by any applicant for a permit subjects the applican[ ro a civil penalty of not more than five hundretl dollars ($500).�: ❑ I, as owner of Ihe property, or my employees with vrages as iheir sole compensation, WILL DO THE WORK, antl the strucNre is not intentled or oftered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves lhereon, and who does such vrork himself or herself or through his or her own employees, providetl lhal such improvements are not intended or offered for sale. If, however, the building or improvemenl is sold wilhin one year of completion, ihe owner-builtler will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer ot Ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construc[ the project (Sec. 7044, Business and Professbns Cotle: The contractors License Law dces not apply to an ovmer of property who builds or impmves thereon, and vfio Gontracts for such prqect with a contractor(s) license pursuant to the Contreciors License Laws.). ❑ I am eaempt under sec. Business and Pro(essions Code (or Ihis reason: SignaWre Dale 305]-46�3/OJ) Owner ID verifed by driver's license. ❑ Ves ❑ No Dnver's License No. Expires: Venfication of Ovmership by (type of tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby ceAHy that no excavation frve (5) or more feet in tlepth into which a person is requiretl to descend, will be made in connection with work authonzed by Ihis permit, and that no builtlinq struclure, scaHoltling, falsewurk, a demoli�ion or dismantling thereof, will be more than thirty-six (36) feet high (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Adminis[rative Code). ❑ As ovmer-builder. I vrill not employ anyone to do vrork which would require a permit from Ihe Division o/ Industrial Safety, as notetl above, unless such person has a permil to do such vrork from the division. Appliwnl's SignaWre Date Division of Industrial Safery Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will the applicant or present or future building occupant neetl lo fle and certify a Business Plan for emergency response to release or threatenetl release of a hazartlous matenal? ❑ Yes ❑ No (Section 25505 ot the Califomia Health and Sa(ey Code requires, with some exceptions, that a Business Plan be filed vnth the Costa Mesa Fire Department by every business which has at any one time during a reported year a quan[ity of hazardous materials equal to or greater ihan a weighl of 500 pountls, or a volume o( 55 gallons, or 200 cubic (eet of compressed gas at standard temperature and pressure). 2. Does or will Ihe applicant or presenl or (uNre building occupant neetl [o file a registration form for awtely hazardous materials? ❑ Yes ❑ No (Sec[ion 25533 of lhe Califomia Healih and Safe[y Code, with some exceptions, requires registration wilh Ihe Costa M11esa Fire Departmen� by each business which at any one lime has on hantl a quantity of acutely hazardous matenals equal ro or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at standard tempera�ure and pressure). 3. Does or will Ihe applicant or present or fuNre building occupant need to prepare an RMPP (Risk Management and Prevention Program for awtely hazardous materials)? ❑ Yes ❑ No (Section 25534 of Ihe Calitornia Heallh and Safery Code provides that the Costa Mesa Fire Department may require the preparation, certifcation and filing with the Fire Department of an RMPP 6y businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Seclion 25534 ot the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No s. ooes or wiu the applicant or present or future builtlinq occupant require for lhe vrork which is the subject ot this application a permit for such consiruction or modi5cation from the South COast Air �uality Management Disirict or from any other air polNtion conlrol tlisMct or agency? ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemmen[ Code requires that the requesled information be fumished on applications fa non-resitlential 6uilding pertnits�. 6. Will any part of [he facility to be constructed under ihis permit be within 1000 feel from the outer boundanes o( a school? ❑ Yes ❑ No Qf yes", the facility must meet the requirement of Sections 25534 antl 42303 of the California Health antl Safery Code). 7. I( a permil fmm the South Coast Air �uality Management DisMc[ or other air pollution control district or agency is required for the vrork which is the subject of this application, have all of the disclosures prescribetl by California Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No 8. Qf'yes", attach certificate of compliance from Ihe appropriate air pollution control oKcer). CERTIRCATE OF COMPLIANCE: I certify that under penally of perjury the intormation given above is wrrecc I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signalure Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry ot perjury that I have reatl this application and state that the information given is correcL I agree ro comply vrith all state laws and ciry ordinances relating to building constmction, and authorize representatives of the City of Costa Mesa to enter upon the above-described propeny (or inspection purposes. I agree not lo occupy or allow occupancy of any builtling authorized by this permit until fnal inspection. S ur � L wner( Da i _ - ,r . ic.� O9 � Melc 'TulfibiizeG Ap Icanl d�4 (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: MECHANICAL PERMIT 3209 VERMONT AV HALLWAY Parcel Number: 13970233 Applicant: MORIEL, OSCAR Address: 9911 LARSON AVE GARDEN GROVE, CA Owner: HAUGH, TERRY Address: 3209 VERMONT AVE COSTA MESA, CA Contractor: A AMES PLUMBING, HEAT, AC Address: 9911 LARSON AVE ' GARDEN GROVE, CA Phone: 714-530-2440 Zip: 92644 Phone: Zip: 92626-2260 Phone: 714-530-2440 Zip: 92644 License: 250307 SCOPE OF PERMIT CHANGE-OUT OF A FAU IN AN EXISTING SFD. 1 INST FAU < t00K BTU � - NO OTHER WORK AUTHORIZED WITH TNIS PERMIT. `- , ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust . VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Fumace Floor or Suspentl Heater Quanlity 323.50 $14.80 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 . 0 $0.00 0 $0.00 0 $0.00 0 $0.00 " P $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 FEE SUMMARY Status: ISSUED Applied: 12/22/2004 Issued: 12/22/ 004 ISSUED BY: Repair / Alt Absor6tion Unit - Repair/AltRefrigerationUnit Ventillation System Evaporative Cooler Commercial I nci nerator Domestic Incinerator � � "�Compressors / Absomtion Svstems � Up'to 3,hp / 100 k BTU � 3To�156p%,500kBTU. � _.' 15 To 30 hp /�1,000 k BTU -- � 30 To 50 hp! 1,750 k BTU - Over 50 hp! Over 1,750,BTU , Bailers Upto3hp � � 3To15hp " � �" 15to30hp , ' 30 ta 50 hp � � � - - Over 50 hp � � - ` - Other Mechanical Pee � � Investigation Fee , , Plan Check Fee, ^ " , , Reinspection'Fee- � Quantiry $0.00 0 $0:00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 ' 0 � 50.00 0 $0.00 0 ' $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 , $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all app�icabie coaes, and all requlred inspeetlons and final epproval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 . 2446461N00) WORKERS'COMPENSAnON DECLARATON: I hereby eftirm under penelry oF perjury one oi the following declarations: ❑ I have and will maintain a cenificate of consem to seli�lnsure tor workers' compensation, es providetl tor by section 3700 of ihe Labor Code, br the peAortnence of the �work tor which ihis pertni� is issuetl. I have and will maintain workers' compensation insurance, es required by section 3700 of the Lebor Code, tor the perfortnanca of the work for which this pertnit is Issuetl. My workers' compensatlon Insuranca carnar and policy number ere: '/ Cartier: �7YA'�P. �AWI(1PMSG{�'IaY� ZV�SIIYCL:I��P. ��%F%�- PolityNumbBr:OOO�JS`t Z(717y (This section need not be co pleted i! Me permit is veluetl et one hundred dollars ($f 00) or /ess.J ❑ I certify that in the pedortnance ot Ihe work for which this permit is issuetl, I shall not employ any person in eny manner so as to Decome subject to the workers' compensatlon laws of Celifomle, entl agree that it I shoultl bacome subjecl to the workers' compensation pmvisions of Sectlon 3700 of the Lebor Cotle, I shall iorthwit� comply with these prov sions. l Applican�Slgnature: i�/� �% �� Date: �Z- L2�� WARNINp: FAILURE TO $ECURE WORKERS' COMPENSATION VERAGE IS UNUWFUL AND SHALL SUflIEC� Ml EMPLOYEfi TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED hKK15AND DOILAFE (5100,000). IN ADDITION TO THE WST OF fAMPENSATIqJ, DAMAGES AS PROVIDED FOP IN SECTION 31060F THE L4BOR CO�E, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm that I am licensed under provisions oi Chapter 9(wmmencing with Section 7000) oi Division 3 of Ihe Business end Protessions Code, end my license Is In full rorce and enect. Lic. a .�' � f7 class s C- 20 ;"C - 3 6 CantrectorsSigneture: �/ICG+n J � Dete: IZ'"L2-oy CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm that Ihere is a conswction lending agency for the pedormance of Ihe work tor which Ihis Dermit is issued. (Sec. 3097, Civil Cotle). Lenders Nama: Lentler's Atltlress: Signamre: Data: OWNER-BUILDER DECLARA710NS: I hereby eHirtn thet under penelry of perjury Ihat I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professlons COCe: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair any sWcture, prior to its issuanca, also requires the applicant for such pertnit to file e signed slatement that he or she Is licensed pursuant ro the pmvisions of the Contracbrs License Law (Chapter 9(commencing with Seclion 7000) oi Division 3 oi Ihe Business and Professions Code) or Ihat �e or she is exempt theretrom end the basis lor the alleged exemption. Any violation of Section 7031.5 by any epplicant for a pertnit subjecis ihe epplicant to a civil penalry of noI more Ihan five hundred dollars ($500).): ❑ I, as owner oi the property, or my employees with wages as ihalr sole compensetion, WILL DO THE WORK, and ihe structure Is not intended or oHeretl tor sale (Sec. 7044, Business and Professions Code: The Con�ractore License Law does not apply to an owner of property who builds or improves thereon, end who tloes such work himseH or herseH or through his or her own employees, provided that such improvemenis ere not imended or oHeretl br sale. It, however, the building or impmvement is sold within one year of comple�ion, tha owner-builder will have the burden of proving that he or she did not build or improve tor purpose ot sele.). � ❑ I, as owner oi the properry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sac. 7044, Business antl Professions CoCe: The wntractors License Ww does not epply to an owner of property who builtls or Improves t�ereon, ana who contracis for such project with e contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt untler sec. eusiness antl Professions Code tor this reason: Signature: Date: Owner ID verified by anver's license. Yes ❑ No DnveYs License No. Vedfication ot Ownership by (type of d meni, i.e. - property tau hill or tleetl): Expiras: �IVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no axcavetion flve (5) or more feet in depih into which a person is required to descend, will be made in connection wi�h work authonzed by ihis pertnit, and that no building structure, scaMolding, falsework, or demolition or tlismantling t�ereot, will be more than thirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttla 8, Califomia Administretive Cotle). � ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Industnal Safery, es noted ebove, unless such parson has e permit to da such work fram the division. Signature: Date: Division of Indusirial Safery Permit Number: CER7IFlCATE OF COMPLIANCE AND AUTHORIL4TON OF ENTAV: I certify under penalry of perjury ihat I have read this application end state thal the infortnation given is correct. I agree to comply with all slate laws end ciry ortlinances relating to building conswction, and authonze representatives of Ihe Ciry of Coste Mesa to enter upon Ihe above-describetl proparty tor inspection purposes. I agree nol to occupy ar allaw occupancy of any building authorizetl by this pertnit un�il tinal inspection. SignaturaOiLe alOwner(s) n Date /�iC� �:- �-u-� IL.-Zz.-O� AnNOr Authorized Applicanl Date � GOUE t. INSPECTIONTYVE i676 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Rool 201 Final BIaWRetaining Wall 202 Final Factory Fire Place 203 Final Siqn 204 Finel Demolition �_� um COOE 1 INSPECTION TYPE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electncal 212 Finel Fira Prevention 220 Final Planning Approval 222 Final Sita 250 Final Building/Occupancy Applicant to fill in aIl spaces except those within heavY borOer Ilnes ana CiTY oF COS7A MESA NSTRUCTIO .PERMIT Ptoject Address C Applicant's Mailing� d/d�ryy5s • ' C Owner's Name L��—^`/�I �O � Phone S 6 Address , � �-A�P. Arch/Eng. License No. Address � � � Contractor's Nam P one � Address (mailing) � � City License No. � ' . LICENSED CONTRACT00. DECLARATION - I hereby atfirm that I am licensetl untler provisions of Charte� 9(commencing with Section ]000) of Division 3 of the Business antl Professions Cotle, antl , my license is in full fq�,antl ettect. ''^ �� Licens /C�las5 �-t �% ��+�'Cen No ''L'O � Date ��,1�� 5'g t �� WORKEHS'COMPENSATION DECLA(1ATION � he�eby atfi�m that I have a certifi[ate ot mn5ent to Self-insu�e o� a certiticate Workers,.' GC,1o�mnpe'nsation� +I-n(/surance, or a certrified+� copy therreot (Section d00� Lab /�1 �U (lY �t 0 ComPanY LJY.1 �� /'(.( 4y� PolicY No. r ertitie0 copy is he�eby fu�nishetl. , /� i Cer ' ie�c is filetl witM1 the city u' i is �(/�-�� Da[e��_ Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (TM1is section neetl not be completetl if the pe�mit is fo� one huntlretl ($300) ar less). 1 certity [M1at in the perto�mance ot the wo�k to� which this perm�t i5 i55uetl, I shall not employ any pe�son in any manne� so as to become subjett to the Workers' Compensation LawS ot Califomia. Date $ignatuie NOTICE: H, after making thi5 tleUara[ion, you shoultl become subject to the Workers' Compensa[ion provisions ot the Labor Cotle, you must forthwith comO�Y wit� , such provisions o� thi5 Oermit shall be tleemetl rewketl. CONSTRUCTION LENDING AGENCV ,7� I hereby atfi�m lhat there is a const�uction lentling agency for the periormance of the work for which this permit is issuetl (Section 3093: Civ. CJ Lentler's Name Lentler's Adtlre55 - OWNER BUIL�EN �ECLARATION s � I hereby affirm that I am exempt from the ConVactor'S License'Law for the followin9 reason (Section 7031.5 �Business antl Professional Cotle:.Any city or county which'requires a permit to construct, alte�, imprave, tlemolish o� �epai� any SHucture, p�ior to Its issuance, also requires the applicant to�'such permit to file a signetl statement that he/she is licensetl pu�suant to the provisions of the Con[ractor's License Law (Chapter 9(commencing with Section �000) ot Division 3 of the Business antl Professions Cotle) or. that he/she is exempt '�erefrom antl the ba5i5 for the allegetl exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicanc to a civil �enalty of not more tnan five hundretl tlollars ($500). I, as owne� of the property or my employees with wages as their Sale compensation, will tlo the work, antl the sVucture is not intentletl or oiferetl for sale (Section 7044, Business antl Professional Gotle: The Contractor's License Law tloes not apply to an owner of a property who builtls or improves titereon, antl who tloes such work himselt/herself or tnrou9h his or her own employe¢5, provitletl tM1at such improvements are not intentletl o� of(e�etl tor sale. If, however, the builtling or improvement is soltl within one year oi com- pletion, the owner will have the burtlen ot proving he/she tlitl not buila or im- prOv! for the purpose of sale). ' ❑ I, as owner ot the property, am exclusivery contracting with licensetl con- tractoR to construct the project (Section ]044, Business antl Protessions COGe: Tne Contractor's License Law tloes not apply to an owner oi property who builtls or improves Ihereon, antl who mntracts for such projects with a con- t�aclov(sl Ocense pursuant to the Contracto�'s License Law�. I am aware that proof oi thei� Worker'S Compensation insurance shoultl be provitletl to me. ❑ 1 am exempt untler Section B. & P. C. tor this reason, Da[e I hereby certify tha information is correc and.state laws relatii senta[ives of tM1is�c� inspectlon pur .� Siqnature Drivers' License or 5: CMF 0865-46, rev. 30/84 Owner have reatl this application antl state tM1at tM1e above agree to com0ly with all city antl county ortlinances o builtling construction, antl hereby authorize repre- e te pon the above-mentionetl property for � Date_��_�� / — �� , �.�� y.� �, ��, �.�. � TVPE OF CONSTRUCTION ; LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — all apP.roOriate Eeclarations: UNIT NO. ALTERATION I�REPAIR A.P. � - S Main Building: ' i T.YPE OF PERMIT �GRADING FOUNDATION STRUCTURAL T front ❑ TENANT ❑ ELECTRICAL PLVMBING ❑ MECHANIGAL �8 Redr ❑ OTHER ' C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCV K, CONSTRUCTION TVPE - VAIUATION $ ' S Left � ZONE GRAOING CV. VDS. ACRES p�ng. Ref. # Remarks: � Planninp Notes: 3ar Sink 3ackflow Preventer 3ackflow Irrigation 3athtubs �larifiers �ishwasher � Jrinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct- Under Ground Duct - Sttuctural . Duct-Ventilating . Exhaust System ❑ Multiple ❑ FirepVFact Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 BT� Reinspection Pee � - $15 White - 8uilding; Canary - Applicant; Pink - Accountinq; Goltlemotl - Assesso� Showers Service Sink Sewer Cap Sewer Connection Solar Collectors - Solar Piping . Solar Tank Swimming Pool w/Spa Urinal Water Closet. Water Heater Water Service Auro-Wash Laundry Treys ' Issue Fae Hoodor Typel ❑ Canopy Typell,❑ Refrigeration Sys[em � ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers. Registers , Issue Fee ' FEES $ 3 FEES. $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures . Device Boxes Outlets Switches Garbage Disposal Generator �0-5 KW O5-' Zone Accessory Building: • Z , � O N I " N G ' R Parking Req./Provided � E Q M , T = g ELECTRICAL . . - , Transformer ❑ 15-50 KW � �❑ 50+KW . . Meter �up to 100 amps Meter ❑over100amps Suh Panel ' Motors OO-i� HP �1 %- 8 Inc Solar �9-15 HP 016-15+ Microwave ' ' Pole Light Range ' Standing Sections 5 KW Trash Compactor I Reinspection Fee I$15 I ' �uue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Aooliwtion luued Bv FEES i $ 3 SUMMARY OF FEES ' ' - . . BUICDING PERMIT $ � ' - SMIP ' . $ PLAN CHECK $ PERMIT � PLUMBING �$ � �/SSUANCE $ -- � � PLAN CHECK 25% $ ' ENERGY P.C. $ ELECTRICAL $ � GRADING $ � ' � PLAN CHECK . 50% $. MICROFILM $ � MECHANICAL $ TOTAL FEE $ "�' — . PLAN CHECK 25% $ DATE: Sb/17l8E TIi1E: OE:G7 . . .. _ . CONSTRUCTION AND'PLANNING . . . . .. POOL & SPA � � � Date Inspector Date Inspector AP�ROVALS� � Permit;# : APPROVALS Permit # , . � 1� Tempo}ary'ElectricBhService or Pole � 52. Pool & Equipment Location � • � ,�, . - ' 2. Soil Pipe-Undrgrnd: � 53. Steel Reinforcement' 3. Electrical Conduit Utility-Undrgrnd. , , 54. Forms - � � 4. Electriwl Conduit-Undrgrnd. � 55.' Electrical Bonding 4 � 5. Steel Reinforcement� �' , . � 56: Rough Plumbing & Pressure:Test ' 6. Electrical UFER Grnd. � ' . 57. •APPROVALTO COVER=GUNITE 7. Footings � , ' - - 58. Electrical Conduit-Undrgind. 8. Foundation . �-� '" � ' 59. Gas Pipe, � Undrgrnd., Test ' , �: - 9. Water Pipe-Undrgmd. .`' - • 60. �Backwash Lines; P-Trap, O�Undrgmd � 10. StructuraLFloorSystem � 61. APPROVALTODECK =' 11. Property Sewer Line & House Connection � � 62. Backwash & ReceptorFinal � . i 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. Raugh 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. Uniferground.Hydro � 22. Ducts, Ventilating ' 71. Product Piping � Gas ❑ Oil � � 23. Gas Pipe-Rough & Test � � 72. Underground Flush � � -24. Roof Framing ' 73. Undergrnd. Storage Tank O Gas ❑ 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 � v 31. Plaster Brown Coat - 79. FINAL WSPECTION � • 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED �� '�L 33. Final Electric , , � Notes: . i. .. . 34. Final Heating & Air Conditioning . ' ._ �.�✓� 35. Final Gas Pipe-Tesi _ , � � 36. Hood or Canopy . � 37'. Final Factory Fireplace � + a. 38. Final Plumbing - � �Z-jZ-�y (,�p " . - � . 39. Water Service-Final ' � � . ' 40. Gas Service-Final . � ' � � • ' -' C � 41. Solar pomestic-Final ' � � - -� � " 42. Backflow Preventer . � � - � ` 43. Backflow Irrigation - . - - � � � , . � ,� 44. ; Landscape Irrigation System � - , . " � - , 45. Sound Attenuation - - � � 46. liandicap Regulations ' � _ � . _ � 47. FINALSTRUCTURE&BUILDING � � ' ' ' � . , �, 48:.'Special Requirements Completed . - - - . . 49. Electric Release to Edison � � � � , -50.� Gas Release to� Southern Califomia Gas Co � - � � --- _ _ � .51: CERTIFICATE OF OCCUPANCY ,� � . ' � No. � Date _ � - � t � � Yl �� ' AVP��ant to (i11 in all spatts exceot tnose wilhin heavy eorOer Iines ana sign all aporopriale tleclarations. . CITY OF COSTA MESA CONSTRUCTION PERMIT �, P�"^�"o. �, � �, TRACT NO. LOT NO. • UNIT NU. ' . P�ojectAddress �209 Vermont ' ' � =Appiicant'sMailingAddiess ].0422 Trask Ave. � � Owner's Name 1.aI''SOiI Phone 545-4238 Address 3209 Vermont v . � ' �Arch/Eng. � License No.' ' Address ' ` � � - � � , Contractor'sNameA=Amec�'Plnm6ng-HeatinPphone 530-2440 � >Addresslmailingl��422 Trask Ave_ � ' � � � -Gty License Na. bbb4 � LICENSED CONTRACTOR DECLAR � ' � 1 hereby�affi�m lhat I�am licen untle� Otovisio ot harte (mmmencing 'witn section 70o0).ot Divisi �3 oi.the Busines a� e ns Cotle, and my license is in tull force an effe ��icense ciass -36 ��e 25 30% oace 1-f0-8�% Siyna k, WORKERS' COMPENSATION L'A ON ' '' ' ' �T 1 heieby atfirm that I have a tert icate � n5ent to�self-in5ure or a certificate � f Workers' Compensation Insurance, r� a certitietl cooY_tnereot (Section soo, �b. c.�978832 'blic 'y.tY . Policy No. C pan ' n`�J Certi/ietl copy i5 hereby furni5he . W LeertifleQ poP,Y�s file0 wAPPhca B i -� ' ,�^ '1 lU 6 I�� EXEMPTION FROM WORKERS' C PENSA DECLARATION (Thissection neetl not be'rompletetl i tne per is for one hundretl ($300) or ' less). � • , � ' I certi(y Ihat in the performance Of the work for which thls perm�t is issuetl, I' shall not employ any� person in any manner so as to become subject to the Workers• Compensation LawS of Californi5. ' • . . oate Signature . `NOTICE: 1t,afier makin9 this tleclaration, you,shoultl become subject to the Wo�ke�s' Compensation provi5ion5 of,the Labo� Cotle, you must forthwi[h � comply with such provisions •o� this permit shall be tleemed'. �evoketl. CONSTRUCTION LENDING AGENCV ' � ' ' � I hereby af9rm that [here i5'a const�uction'lentlin9�agency (or the pertormance of -the work,. tor which thi5� permit is issuetl ($ection 309] Civ. CJ Lentler'S Name � � � � ' Lentler's Atltlress � " � ' OWNER.BUILDER DECLARATION � � ' I M1ereby_affirrn that I am ezempt from tne Contractor's License Law for the - tollowing reason (Section ]031.5 Business antl Professional Cotle: Any dty o� wunty w�icb requires a peimit to const�uct, alter, improve, tlemolish or r2pair any struGture, prior to its i55uanCe, also requires the applicant for sucM1 pe�mit to tile a si9ned statement that he/she is Iicense0 pursuant to tne provisions o( � the Conbactor'S License-Law'(Chapte� 9(commenGing with Section ]000) ot .Division 3 ot tM1e BuSinesS antl P�otessions Cotle) or-that�M1e/she is ezempt -: herefrom antl the basis for the allegetl exemption. Any violation of'Section ��`�]31.5 .by�any,applicant (or a permit 5ubjeCtS the applitant .to, a civil ��`kenalty of not more than five hUndretl tlollars ($500j. � , . ❑,I, as owner of tM1e property or my employees with wages as their sole • wmpensation, will tlo tne work, antl the structure is not intentletl�or offeretl far sale ($ection ]044, Business,antl Professional Cotle: The Conirac[or's LicenSe Law tloes not apply to an owner of a p�operty who builtls or improves thereon, antl who does such work himself/M1erself or through� his or her own employees, provitled that such improvements are not intentletl or otfere0 for sale: If, however, ihe builtlin9 0� imD�ovement i55oltl wlthin one year of�com- pletion, the owne� will have the burtlen of provinq he/Sh¢ tlitl not builtl o� im- 1 � roveforthe purpose�of sale). I, as owne� of the property, am extlusively, contractinq witM1 licensetl con- Vactorst6 constr,uct the project�(Section ]044, BuSinesS antl Profe55ions Cotle: The Contractor's LicenSe Law tloesinot apply to an owner ot property, who ' builtls;or improves thereon, antl who'contracts for such projects witM1 a con+ _�"'o,`\�� 'l!I � - � " � TYPE OFCONSTRUCTION NEW � ADD . ALTERATION REPAIR = ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BCDG. � - � � TYPEOF�PERMIT - GRADING ❑FOVNDATION ❑STRUCTVRAL, "• ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAC � ❑ OTHER , P,ROJECT DESCRIPTION SQ. FT. OCCUPANCV CONST�RUCTION TVPE � VALUATION $ ZONE ' GRADINGCU.VDS. ACRES .Remarks: n.._i__.. r._..._ ..__.__. . ' � Car Sink 1 Backflow Preventer �- Backflow I'rrigation Bathtubs � � Clarifiers ' Dishwasher � • Drinking Fountains Floor Drains ' Floor Sinki - - GasService : Ou[lets ' Interceptors -� � Kitchen Sink - Lavatories' . � P—Trap , , Roof Drains � 'Reinspection' Fee. Boiler • , Duct ; Under-Grc Duct - S[ructural tractor(51 Imense pursuant.to the Contractor's License Law). I am aware that EXhdUSt SyStem ❑�Multipl¢ proof of [heir Worke�'s Compensation insurance ihoultl be provitletl to me. L7 1 am exempt unaer, Section ' e. &� P. C� tor this reason FirepVFact. 61t. ICBO # , Date � Owner � Heating System & Ducting � CMF 01 �,ertii at 1 have eatl th�i , pp ication antl state that the above -❑6100,000 BTU �100,OOOBI �' orrect: I aqre to c rfipl Sfi all ciry antl county ortlinancez s relati b iltlin co ltion, antl hereby authorize repre- - trtt to enter u i e b ve-mentionetl property ^tor ' , �, � • � 1 oense or � ' Reinspection Fee $15 rev. 10/84 White - guiltling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Showers ' ServiceSink - Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool �w Wd[2f CIOSEi .� Water Heater ,Water Service - Auto-Wash � . Laundry Trays � Issue Fee' - Hoodor Typel ❑ �Canopy Typell ❑ Refrigeration System . ❑0-100,OOOBTU ❑ti System Repair/Alterati Fire Dampers Registers ' Issue Fee 0 A.P. # S Main E T From B Rear A p Right K left S Ping. Ref. Planning I FEES . Automatic � Cooking Unit � Dishwasher Dryers ❑Gas ❑ Fan F.A.U. �;�� . Fixtures - Device Boxes 0385 I_/ I 6/87 _ � � , i• " Z< Accessory Building: ' � ! � i5�� . .. � � .., . . � � Parkirig 0 - 5.00 . TL . � .. •y. � Z O - N . ' N _ , G R . � M T S - { ELECTRICAL � ; .FEES Transformer ❑ 15-50�KW � Sub. �� SO+KW . Meter ❑up to 100 amps ' . , Meter ❑ovei100amps , � ' G V V O uLICtS' Switches Garbage Disposal . Generetor �65 KW ic Sub Panel Motors �0-1 HP 01 %- 8 Inc. Solar �9-15 HP 016-15+ Microwave- - ' ' -' Pole Light Range � ', Standing Sections 75 KW Trash Compactor, $•3 � ' Reinspection Fee $15 luue Fee FEES DEVELOPMENTSERVICESREQUIREMENTS: . � � 2onin9 Appraved By Building Approved By , / ^ Appliwtion Issued By- W � � $ 3 A $ 3 � ` 1 . ' SUMMARV OF FEES ' , BUILDING PERMIT $' � SMIP � $ PLAN CHECK, $ PERMIT ' � PLUMBING � $ � ISSUANCE $� PLAN CHECK 25% S � � ENERGV P.C. $ � ELECTRICAL . 5; GRADING $ PLAN CHECK � 50°� $� MICROFILM; $ MECHANICAL $ : TOTAL FEE , $', S.00 PLAN CHECK 25% $ i CONSTRUCTION AND.PLANNING � ' POO PA - - � -' ' ' - DaiA �Inspector � � - ,Date Inspector APPROVALS � Permit # - - - � APPROVALS' _ Permit # � 1. Temporary Electrical Service or Pole � .`�l � �: 52: Pool &�Equipment tocation • 2. Soil Pipe-Undrgrnd. . �J i�_ 53. Steel Reinforcement . ' � � 3. �Electrical Conduit Utility-Undrgrn� � ° ., ' � ' ' 54. Forms � , . � 4 �Electrical ConduittUndrgrnd. �� .55. Electrical Bonding - � , 5:�Steel Reinforcement - , . 56. � Rough Plumbing & Pressure Test. , 6.,ElectricalUFERGrrid. � � 57. APPROVACTOCOVER-GUNITE . - , ,- . 7. �Footings � . � , �58. -Electrical Conduit-Undrgrnd. 8. Foundation �' '. � . .- 59. Gas Pipe, O Undrgrnd., Test � � 9. Water Pipe-Undrgrnd. • m - � 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 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 i6. Rough Electric Wiring � , 67. Fencing & Access Approval , 17.,Rough Wiring Sign� 68. APPROVED FOR PLASTERING 1S. 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. Duc[s, in Structure < 70. Underground Hydro . . 22. Ducts, Ventilating � . 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test ' - 72. Underground Flush - � 24. Roof Framing . . � ' 73. Undergrnd. Storage Tank O Gas ❑ Oil ' � 25. floof Sheathing .' 74. Overhead Hydro � 26. .T-Bar Ceiling (Strucwral) & Monocoat � 75. Dry Chemical ' 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding � . 77. FIXED SYSTEM FINAL � 29. Insulation � 78. FIRE PFiEV. FINAL � ' 30. Drywall Nailing � �HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat � 79. FINAL INSPECTION - - 32. Elearical Power Meter-Final � 80. �FOOD CERTIF.ICATE ISSUED 33. Final Electric - ' ' " - 'Notes: ' . � - - � , � 34. Final Heating & Air Cpnditioning ' � � " - - � ' - - 35. Final Gas Pipe-Test � ' ' - � � � . 36. Hood or Canopy � . , • - � 37. Final Factory Fireplace � ' � _ ' 38. Final Plumbing r_ . 2-23' L.lEj7 -� . - -• 39. Water Service-Final'j � � ' _ 40. GasService-Final�:'� , � 41. Solar pomestic-Final � . 42. Backflow Preventer � ' � � � - , . . c 43. Backflow IrrigaUon � � . , � � i • . 44. ,Landscape Irrigation System � , , - 45. Sound Attenuation � ' ' - - i ` • • 46. Handicap Regulafions - - ' , -� 47. FINALSTRUCTURE&�BUILDING . ' • � � 48. Special Requirements Completed � , � - , ` . 49. Electrie Release to Edison � ' ' � � . .. . 50. Gas Release to Souther`n California Gas Co � , - � .. , 51. CERTIFICATE OF OCCUPANCY � ' � • � - � � � i No. �� Date� ' � � , ' � { - , oWNER Vermont Ave. Land Co., Inc. JOB ADDAESS � "mon Ave. GENERAL CONTRACTOR i�c� olegrove, Inc. AP: No. INSPEC710N5 OCCUPANCY > Form 210—SM-11-59 S-B P DATE SUBCONTRACTOR r�TE 6�21�� :,DING PERMIT NO. l2i%2 VALUE $ �1 1 3.IPTION OF WORK RBS.W att.Gaz'. PERMITS ISSUED ` i��. C09TA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C067A MEBA. CALIPORNIA For Applieanf fo' Fill In Complefely TYPE OR PRINT no�Re�s"s 2 Vermont Ave. COSTA MESA CALIFORNIA OWNER Vermont Avenue I.and Co. Inc. MAIL .__ .-. _�.. C. ■ARCHITECT GcT150T1 d' TEL. ■STATE _.�___ TEL. NO. OP BlDGB. FEE RECEIVED .� JUN 211969 � �� of cosT�A PMESA APPLICATION R PERMIT BUILDING For Office Use Only RECEIPT NO. /P�ER^MIT yNO. � l..1�F/ 7 RECEIVED 0Y �ATE PEC6IVED I DATE ISSUED � 6^ J_D-6�7 9rie� n� 9a�rt FIRE ZONE' APPROVED �ecw� COSTA MESA. CALIFORNIA YONING NO. OF � I USE OF � PLANS BUILDIN6 98iBACK LIH6 PROM lCENT6R LINC 8T.) cexTER OP BTIiCET � REAR YARD � FRONT SIDE YARD ILEFT � IRIGHT � R.SIDE DESCRIPTIOId OF WORK L.SIDE NEW I X II ALTERATION I II ADDITION I e�... � SRIOR WAL c aRING OF BUILDIN 1 H8H¢BY ACKNOWLEDGE TXAT � HAVE READ THIB APPLICATION AND BTAiE THAT THe A90VE i6 COqR2GT RND AGRE6 TO GOM- PLY WITH ALL CIT' OIiDINANCEB AND BI'ATE LAWB fl80UtATIN6 BUILDING CONBTRUCTION� � 61GNATURE OF �� -- PERMITfE AUTHORIZED AGENT Dike & C'O grove APPROVED � J � TME AMOUNT 6HOWN UNOER VALl1AilON IB FOR THC PUflPOBE OF EBTABLI9HING A PERNIT FEE ONLY. � S 16,101• � II1C• i PLAN CHEGK $ Zg•