HomeMy WebLinkAbout171 VIRGINIA PL - Building Permits • 3
•
CITY OF COSTA MESA'
4 BUILDING DIVISION
> , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
f t —.sa
PERMIT
/BB005-02204
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.&1113LDING PERMIT- . . 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 171 VIRGINIA PL Status: ISSUED
Suite: A Applied: 12/05/2005
Vicinity: - Issued: 12/05/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 42606105 Zoning:
Applicant: MIKE ROGERS
Address: --'
Phone: 949-548-1645 ISSUED BY:
Zip:
Owner: HARVEY, STEPHEN-
Address 171 VIRGINIA PL �" A%s,
- - •
COSTA MESA,CA Zip: 92627
" ,
R � 1P
Contractor PETRONEL'LA R �OOFING . --,-
Address: 2626 NEWPORT BL • ;; s
Phone: 949-548-1645•
.:� �• 'c
COSTA MESA,CA
Zip° 926271`x' License: 460707
Arch Eng:
Address: Address:
Phone: •- •
Phone:
Zip r License: �' - . .._
RUcense:�°'
�itf` x� ar %
Vii- ' - -t
SCOPE OF PERMIT �_ • 14
T/OFF AND REROF 900SF W/COMP SHINGLES <* [{ ,-�-�
.._. F.EE SUMMARY ,
Plan Check r$0 00 Calc Valuation $1,200:00
Permit $44 85 F ; Claim Valuation $1 zooms
H.SMIP Res: $0:50 1,/4
SMIP Com x$0 00
Other �,$0 00 0
Inspection -' $0 00
Total: ;
? k PLANNING&ZONING
SETBACKS
MAIN STRUCTURE Font 0-0 %Rear, 0 0 ��LeN 0�0 _ Right 0-0 t� 427/
ACCESSORY Front 0 0 n Ream 0 0 - ; Left - - Right ..�.0 �
V * • " i„ ^' tEta, . ‘`°2i, i � . :< =
PARKING '•Existing. 0 • $5"`• ¢w..,. ..
i2
:
ry 3
•
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1,12-21-92) '
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00) . ••y 1414
d
DECLARATIONS C ) T'j
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: • -
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($1(2‘less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AN B SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GWL TINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury.that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Anylcity of county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a slghedStatement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions•Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a ci'il penalty'of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to en owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release Cr threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant / Date
ODE INSPECTION TYPE PAIS EIIIDAUS CODE( INSPECTION TYPE PALE tNT AI&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof ( 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition . 250 Final Building/Occupancy
i
' CITY OF COSTA MESA S
BUILDING DIVISION
Yt •�`�r. sI DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT. • — BOS-02203
Sqtrownso se t
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BthLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 171 VIRGINIA PL Status: ISSUED
Suite: B Applied: 12/05/2005
Vicinity: Issued: 12/05/2005
• Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 42606105 Zoning:-. ".-—-. "
Applicant: MIKE ROGERS . .
Address: . -
Phone: 949-548-1645 ISSUED BY: r'S
Zip:
Owner: HARVEY, STEPHEN M; ! ' .2.','4.2:"i:,
Address 171 VIRGINIA PLw� 4• '• ,m �,'
Phone:,---.4 --,1' •-..+ _ .^ ,
COSTA MESA`,CA � Zip 92627"! -t2.
Contractor PETRONELLA ROOFING ,..,.--:.-• • $ . '
Address 2626 NEWPORT BL q. -°=-" '�
"' < � fr ,. Phone: 949-548164
COSTA MESA,CA d.
Zip: 92627 ,-,-4%,e- License: 460707 -:
Arch ,• Eng: ,, ,
Address 'a 3 'T cAddress '7..W.,3;,---
°e Phone - Phone
""' SCOPE OF PERMIT
T/OFF AND REROOF 2200SF W/COMP SHINGLES. a ;>j t
FEE SUMMARY ., 44 A-,
Plan Check $0 00 Calc Valuate n ,, $s 000.00 .
Permit $125.25 `" ' Claim Valuation s $6,000.00
SMIPRes `- $0.60 - , - %, j j.
SMIP Com %$0 00 „ '
Other: 149.06 r • ay
Inspection: 1$0 00 ,,,1,4 ,,,p.,- ra=x ffi < ; : ' t , d--
Total $12585 ',m ,4 g�:, , =y
PLANNING &ZONING :, '
SETBACKS : ‘-‘..i., ;r c4941.-,'4,, --- O� - 4,4.•
MAIN STRUCTURE Front 0-,;,9- , Rear 0 0 Left 0 0 Right 0 0 e
ACCESSORY ." •, Frontes 0 0 ,° , Rear 0 0-- `, L'eft 0-0 ? •,. Right 0-0:, 4-:
PARKING Existinq 4 0 Required ,0 Proposed�zT,0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
bra period of 180 days. - -
INSPECTIONS: In order for the work authorized under this permit to-be-con. Sr' 59 r'$ `Iuyul,,,.A.h .a,krinust complywith-all-applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646(&OO)
DECLC'RAT%ONS
WORKERS'COMPENSATION DECLARATION:
I hereby affiml under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'corn❑enation Insur/anCe carder and policy number are:
Carrier 7� _! ' nom Policy Number: egeC naf —
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provviiy' ns. �J
Applicant Signature: d S/W" %ti{✓ Date: /2).6. r/i 4--
WARMNG:FAILURE TO SECURE WORKERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENS D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,030),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Sectio 000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.0 0 o _ Class R C— 3 a
Contractor's Signature: _SrS1=raial — " Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I herebyiffirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:.Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commendng with Section 7000)of Division 3 of the
Business and Professions Code)or Ihathe or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of 7iot more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this gppplication aggermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health end Safely Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all stale laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
A A /An
Of r s) /e�oS Date
L///�'v`L An r Authorized
zed Applicant Uate
rims r INSPECDON TYPE PdIE INTITML¢ CODE INSPECTION TYPE PAIS ItlrLE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ,, 208 Final Plumbing
200 Final Re-Roof t 2 s v 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. ' _
' CITY OF COSTA MESA MIT NO. TRACT NO. LOT NO. •r BLDG.NO.. 1 . '
'CONSTRUCTION PERMIT , • •
_PE '- $ 73r�y "
Applicant's Mailing Address -I' • ' �a I ' • - TYPE OF CONSTRUCTION L I NEW L I ADD; LJ'ALTERATION LI"REPAIR . - - . ''. ' ,
i CI'CONVERSION ❑ DEMOLISH CI OTHER ,q7•/A -q/ I K/n� - 5.U::" TL .
Project Address `. •�. --s - - -
/ .. /7g DESCRIPTION OF WORK 'ZONING REGULATIONS
Owner's Name -•%i Phone4��•lG Y _ - ,
Address; • / -�ril • - ' TYPE•OF PERMIT: '❑ GRADINGr-❑ FOUNDATION ❑ STRUCTURAL A.P.# - OZONE ! - •. '
Arch/Eng:- - ` , - - ' ' ' - License NO.: • ' i -❑ TENANT ❑ ELECTRICAL_ Ik PLUMBING ❑ MECHANICAL ' • ' _ PLNG.REF-#. ' ' �, - BUILDING' - i - •1
Address - ° Q OTHER ' i •' • ` - TO BUILDING 'eFT en-ranch,rn Cr' '
- - - • - REAR YARD (TO P/L) ' '
Contractor's Nam /I. , la ,O /' •ho`n`e PROJECT DESCRIPTION SQ FT -.r OCCUPANCY •
PROPERTY LINE
Address(mailing) D' • .0 ' ' With, 'v ' CONSTRUCTION TYPE - - VALUATION$- LEFT SIDE YARD RIGHT SIDE YARD
•� •� ! I / ZONE ` GRADING CO.YDS.
+ACRES PKG.SPACE REQ. PROVIDED _
License No. -
• LICENSED CONTRACTOR DECLARATION , Remarks: • _ ! - STREET WIDTH ;PARK FEES I
thereby affirm that-I am licensed under provisions of Charter 9(commencing . ' ' _
• with section 7000)•of Division 3 of the BusIness-and Professions Code and . It n ' n ^i/7-XL ` SPECIAL CONDITIONS: -
my_license is in f for¢0 ntl aired. I • ' ',hook. NLLI/'l 1 I yil (/(J r �-'
license CI ss Licep;eQN�O� , PLUMBING ! i
x ;,p Signature • M • Bar Sink Sewer Cap I ELECTRICAL t I , !
',KERS'COMPENSATION DECLARATION , ' • , - ` I-
\ '^+`eeby affirm that I have a.certificate of consent to self-Injure o'ca certificate'.+ - - Automatic,Washef `Meta[_❑over. 100 amps ::-., .. •
I
s -.''Workers' Compensation Insurance,t or a certified co y thereof (Section ' •r Backflow Preventer 'SBwe!Connection: ; - -r' --
3800, Lab- C)1Ale P Construction Pole'1 Sub Panel:
Policy No. 2 3"7�7�1' ' ' L� , Backflow •Irrigation f -, Solar Collectors _
Company - ' •
\v - I Cooking Unit 'Sun Pole '
c _Certified copy Is hereby furnished. . ; Solar Piping ._ L- 1
Bathtubs
I Certifle copp filed with the city Bull g DI islgfi. I ' Dishwasher „• 'Motors DO 1 HP D1 b-B i ' j
: Date ty'(• Applicant ti r /U/p/t%`� Clarifiers Solar Tank ,
EXEMPTIONjFROM WORKERS'COMPENSATION DECLARATION 1 • , y Dryers ❑Gas DEleetric' • inc.Solari D9-15 HP 016-15+
Dishwasher i SwimmingPool w/Spa V ' (This section need not be completed if the permit Is for one hundred($100)or 1 P _ s
1 less)'. i s ; I , - Fan 1 • K: ;Microwave 1 - i 1
I certify:that In the performance of the work for which this permit is Issued,I ' Drinking Fountains . Urinal I , ) - :
shall not employ any person In any manner so as to become subject to te _ - 1 f 1 1. '
F.A.U. Pole'Li ht i • 1
Workers',Compensation'Laws of California,! 4 • , Floor Drains l i I Water Closet } I I ' -' f
Date ' ' Signature t ' vl •
g s •
• NOTICE!If,after making this declaration,-you should.become subject to the - Fldor Sinks -- 1/ Water Heater --.... - _ . �,. _ Ftxthres )- ,.Range.,., ♦-_.) �_
I Workers'; Compensation provisions,of the Labor, Code,.you must-forthwith - /- - ' -,. t - i
I comply .withi such 'provisions -or.this),permit ,-shall be :deemed) revoked,, 4 1 v Gas Service + ,Outlets1 . 'Water Service y. ' - `-r 1 Device Boxes ! 'Sign, , ; -
• CONSTRUCTIONILENDING •AGENCY- , ' i ! ' '- , ;
Outlets
I hereby affirm that there Is alconstruction lensing agency for the performance. ! Interceptors - t) , J I ,• , , Standing Sections I 1 i•
• of the work for which•this;permit^is ,Issuetl '(Section 30971 Civ. C.)` i - -
' Lender's; Name= I • ' - ' - . r 1 1 Kitctien'Sink, •.`1 - ¢ -- Switches' - 'Trash Compactor i I ;
Lender's Address - 1 Y' -C 1 " t - • - -- - - i• .
OWNE R•BUILDER DECLARATION':1 '. L Lavatories j , , -. r - :o - I ' i • ; •
Garbage Disposal � � ! 1
I hereby affirm that I am-exemptifrom the Contractor's.License Law for the ' _ • Generator, DO-5 KW O5-15 KW , i '
following reason'(Sectiont 7031.5 Business and Professional tone: Any city or- , ' . P.—Trap, '' j 1 ' -1 n . 1 , .,e j .- I ',' j 1
•
county which.requires a permit to'construct,alter improve;demolish or;repair t 1 ,
Prequiresapplicantpermit ' Roof Drains ' - Transformer D15-50 KW
ry structure, statement to its issuance, also d the for such .i !-
+le a signed that he/she is licensed pursuant to the-provisions of. - 1 ' D50+KW
�"'ontractor's License Law,(Chapter 9(commencing with'Section 7000)of ' • • •• •- 9 1 I Reinspeetlon.Fee $15' }
z^+&fro 3 of the Business and Professions ption or that he/she is exempt i Showers i T Reinspection Fee_ f .$15 - ;
f 'b':2from-and the basis for the alleged exemption. Any.violation of Section 1 _ Meter Dup to 100,amps ', i , Issue, Fee 1 , .3 3
;=U31:5 by:,any applicant for:a I permit-subjects the applicant to a'.civil -• 1 - - _. - _ '
malty of not,more than five huntlretl dollars($500). ; i 1 ; Service Sink I - j L Issue Fee", ' $ 3 + i •I
- I,-as owner of.the; .I ' - i { Zoning Approved By • •Date ' -
property orimy employees with as their"srle . - ,
compensation will70 the work,and the structure•is not intendedC or offered -,� - - - - { t- MECHANICAL' • I , Application Approved By • i 'Dare +
j'for sale.(Sec/Ion 7044', Business aria Professional.Code:'The.Contractor's e - { { •
I
Lq/! /�� '
License Law does not apply to.an owner of a property who builds or improves i Boileri ' 1 Refrigeration System ,/ I, I
thereon,lana who does'such work himself/herself or through his or her own - , Application Issued By �(6N Date
•employees, provided that such improvements areinot Intended or offered for . - 1 - - ❑0-100,000 BTU ❑100,000 BTU , - - I.
i sale. If, however, the building or.improvement Is sola within oneyear'of cam- i Duct=UnderGround , I I.SUMMARY OF FEES j- i , '
,prove f, the caner:will have the burden of proving he/she did not build or Im- ' I i , , $
• eLove for the purpose oflsaler'. 1 , , ; , Duct-Structural I i. System Repair/Alteration { • ,BUI LDING PERMIT $; 1 SMTP 1 $ ' . I,
I,
LJ I, as o.con of the property, se exclusively urine contracting with llicensetl con- • - 1 i.�_�
.tractors tract trust t License
oject (Section 7044,Business and Professperty ode:.t Duct-Ventilating_-� • , _ .1....1_,,_ ` - 'PLAN CHECK. $' I PERMIT I ��-7� �'
.The Contractor's License Law does not apply to an owner of property who - e - ' -' t `� ,
i bullas or Improves thereon,and who contracts for such projects with a con- I. Exhaust.System 0 Multiple D� 'PLUMBING $ (J Q-y t ISSUANCE - ) $ , 1 ,
tractors) license pursuant to the Contractor's License Law)! ' PLAN CHECK: I " GRADING • ,. $.I I { ,
D' am exempt under Section B.&P.-C,for this reason , Fliepl/Fact.Bit. ICBG# i I $,
I - I' 1 1 i , i - • ELECTRICAL' t $- ' • r ; ' $ I i
• Date 1 ' ' Owner; i ' ' ' I- i 1 Heating System& Ducting • i • I - l ' MICROFILM - $ ' ;
: I•hereby. certify-that'Irhave-read-this'application-an'd state that the above DO.100,000,BTU D160,000BTU- i ' - - 'PLAN CHECK I $ ,
Information is correct. i agree to comply with all city and county ordinances I 1 i
•� - TOTAL;FEE $ 1_ 1
and,state laws relating to building construction,:and hereby authorize repre- '' ,, I - •ME CHANICAL • $ _ , L , 1
sentatives of:this 'cit Ito enter'upon the above-mentioned roperty for Hood Of Type I_ . DI '
y' ' p I Canopy Type II D, •'l` i Reinspection Fee 1 $15 PLAN CHECK' $ ) . l LESS I
inspection purD i // p 1 ADVANCED PC $
1 Signature /N'.P.f /,. �/' Date �� — 1 -
Drivers' license or SS#
E 1 ! • - I FINAL FEE $ 1 j
CMF 0865-46 rev.12/82 White-Building;Canary•Applicant;Plnk-Accounting;Goldenrod-Assessor
L' OCDNSTR UCTION,AND;PI N� J NG�' t 2 cI , _ l• °' t9, Ep POw ''SPA ^ - kms: ' 9,,,:_:;1:.'1A. 171:2„Lar ', a
;-- C, v ' c c _ t O-_ - - o Date inspector - "APPROVALS Permrt,# " ' Date Inspector •; o
.• 'APPROVALS : t J, t# r _ - - E
'6 'tremporary•Electrical Service o_`rEPole i, r� _, I. 52, Fo'dl &`•Equipment Location.-'1,_'iti <;c r7 ' i i '� • ' • o
• t _ r
2l :Soil Pipe-Undrgrnd o g, E.C. 153.-Steel Reinfordemerit tr, c =a; , a , f•k,,°^
3: Electrical Conduit Utility-Undrgrnd! ! NT y _ ---: .yc I, 154a -) - ;,M-- 9, .t 1- :', ,:` °- - .. _ - I a .i 1
:447 4: Electrical Conduit-Undrgrnd J - I L. ° !,!..1., =B c;_• 1 155:: Electrical Bonding'--3- 4s.:1-,,,;';,72....,,-.; ^ 1` ^^- ,
5 Steel Reinforcement•• I .r; ^ ' I 'Do `, ; r: 'X56 Rough Plumbing&
binPressure.Test r .- ^'� • 1. -
' •
I.
6: Electrical UFER Grnd' ! u ; ! 2 n `'•, °_ . ,•57"APFROV.AL'TO;COVER-GUNITE; ,• '''..:-_s ; ; I ''?:'",•!;-' '
7. ,Footin s ! I ' .. I -` c� <.' r c ' l'58'• Electrical Conduit-Undrornil - �.' 1 1 i ^ -• I •;, ll
8• Foundation i ' • 1 • o '7 c - - - r ' -. ,. 1 ,
c s, y._ i •;j59• . Gas Pipe; Undrgrnd:,Test,-rr.= .I I i` _ ••1 •
9. Water Pi a-Undr rnd. 1 , i T , 1 '� Lin.e-'P-Tra 1;66...B. -- I ;`=51 1 i
I p 9 , - L - X60..Backwash,Lines,, 'p, 9 L t <
10. Structural Floor System , t r c 1 1 ^- ; !Al. APPIROVAL TO,DECK _:''T 1;
11• Property Sewer Line& House`Connection; - •- ' •''" - - V - ! • '
P I . I , 1 t , 62• Backwash &- FinalFinal - 5 •;
12. Sewei Cap 1 I .� o" w a 63• Heater&,Vent-Final •' , _„y = - ; .r c
11 RoofiDrains I I j 1 11 i ! o 1-- '64 Plumbing Systerti•; Final•`_' A i I
I , 1 I -. 1,
• 14. Rough Plumbing , 1 :c ! " -1 165. ElectricalFinal` - '' - - `-
p-
i`Y5`-,,Rough-Electrical- T.I--ii ii - '-r---T -667 SolarSyitee-m-Final-1- - ;- +__7--" -- 1-- -T-"
< ,- a �� { I } I 1 ! , : I ,1 , I 1 I 1
.; ;y?16. (Rough-Ele uric Wir�ngr i r I 11 ' i` ,i m-'---' ' = 1 :,,. i s '167..}.Fenc ing&rAccess'Approval1; ; i u '.. i _ . : 1 • „ a 2
- 1` f -
ri i;17:SI . RoughaWinngSig"n s•_ <• , . ` - I i : 1 ; I c I r-;,:•-7. I c 1' •1 - II 68.; APPROVED FOR,PLASTERING I 1 , • i
18 'Rough Electlrical--T;Ba7 Ceiling I 11 I c i : j I I :I : i `. i. !69•I FOOUSFA SYSTEM.S:FINAL 1 , 1 II. I, j I IL. ,i !tit!
' 19• �Rough,Heating&,Air•Conditioning st '; a n : 1 I ` , I FIRE DEPT. REQUIREMENT I I ' . I
•� '! ft 7 '. f 1 11 , - 1 0 , 1 _ t I i i i • I ! '.- { -' , .•,
20. 1, ,• , .-, ._.ry Fireplace , 1 - t, I; 1 ! � ' I I 1 APPROVALS. I Permit;.# '! , ' I e i.11.1
Z j 21• 'Dudts;fin Structure-J ' 1 I I1 I I I I ' i 70.;.Underground Hydro ' i i i 1 ' �' ' '
C , , -
r I;22. (Ducts, Ven ilafing n 1 I is i( I I ; i 1 ! 1 171•I Product Piping O Gas D Oil I _ I 1
„( Y- r• r ,� a �. -;'-'1-- __'_._.� ._ _172TUnderground Flushp _ _, , _.• _ .,_ _
,23. Gas:Plpe-Rough &Test I . • 1 3 l i _,.n , , i
'jjo24• [Roof Frarning ' i I n : i 41:1E;Fits I '_I 1!=c ! 1 3 1 „I' 173.! Undergrdd•StorageT.ank•-OGas;DOil ' I •• �
o. 4 25. 1Roof Sheat ing . I 1 I 1 Ii:> 1l` 1 , I j! � I i l I ;I • i74., Overhead Hydro I _ I '. I I i
r: .'26• IT Br aCeiling (Structural)& Monocoat'4 I =.1 2::::- ._. I' i j l ,. 75.i Dry Chemical t t ' ! ' I i I
•
��t27. 1Fr,anieand:F•lashing{ II ' tl• 11 1 .1 '; I 1 ' '- ' I 76• Dry Standpipe ' ', , • ' ' ' I ``
I rt I ' I I i.l I I t 1 1. I r.
131.,28• •'L'ath.ing&Siding, : o I 1 II it• ' i I i ' `• 1 , i 177.1 FIXED SYSTEMFINAL :j 1 , i . I , I I , -u t
Ir 29.Cinsulatiori .r- _ a r + I I: a I I i l i I . i . 178' FIRE PREY. FINAL • : I I ; ! m I
=. 'Dry
30• wal) Nailing ° ` i I I it I
'I I i I I
3 I - I INotes:i 1 I I . I, ' -. • • i 'I i I I
y I e r , ,1 ,l I 1,' 1,
F_ 1 I S._�- _ . __. , H---t
1__ .� ._ i-..--7
_ _. _. _ _
c I. 31- Plastar Brown Coat I I i .< ; 1 ! t I j I .I . I .. 1 ^'
' ,.32. 'Electrical'Power Meter-Final I i. II I ; I i i i 1 I I ' r • f ' L.`• -
- 1, ,__ _�- ,_ I
33. final Electric 1I '{ li I ' I !
` 34• Final Heating &:Air, Conditioning a I ! I ! ' i , IW I ' •;
45587 f 77
,i--i "LG ZOSTER MESA
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• APPLICA ON FOR STRUCTURAL! PERM
For Applicant to Fill in Completely —Use Ink Only
/. ��� ,, �" ,,f a RECEIVED BY DATE RECEIVED DATE1SSU:0BUILDING ( „
ADDRESS t74 "–izen a I c t / i M A fit. liT int i gr e1y
OWNER f1/L s $ mei) S 'Gild (4Atz.V5' y A.P.NO./9 j• -•
MAIL / BUILDING •
,� uS p ADDRESS /�/ fir 0",
ADDRESS 1i�/ 1-- 45 /-[} (�
,r NO.
TEL.
CITY TRACT /LOT BLOCK
C Us7/Ly (l7f/�
CONSTRUCTION NEW SOD ALTER REP•IR MOVING DEMOL6H
LENDER Ulf1C_
BRANCH --- A /
•
^' ^'
OWNER V i • J
ADDRESS
all S
ARCHITECT TEL. ._ . ff. •n' � ' w
OR ENGINEER — NO
ADDRESS -- ZONET E or GROUPgL / !�
CONTRACTOR Y� 4/���� APPROVEDEC DATE `V t,7l
ADDRESS '---'
TEL kin�J NO.OF�-r USE OF NEW 4r'
PLANS G. BUILDING �e��
CITY +- NO. L
,w STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. -"" LIC.NO. MAIN BUILDING ACCESSORY BUILDING
w SIZE "NO OF BLDGS
d (FROM CIL STREET) ,�' �,�/OF LOT G(J;I/ )( r3 . 7 NOW ON LOT OVid FRONT 2 0 FT, t 4920 f FT.
Q USE OF / �p
,f/1 EXISTING BLDG. 9t1 Z.L.LL AJ e R SIDE 0: Fr FT.
rA
(–I
Separate permits are required for L.SIDE : co FT. FT.
C electric,plumbing and heating work. REAR I.3 FT. FT.
USEOF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
/ �• MAIN BLOCS. •7 • ACCESS.BLOCS. �/ ^7
-Re
pi,,q•LiAlv6 ._ (n;JYt dcra N Tt4t YLIn C.U.P.. G'/B)23 APPROVED�Ai f I7t 7
�'" ! APPROVE Pe DATE �v "3^ 7/�
a HOLD FOR SPECIAL REQUIREMENTS
La
0 I hereby acknowledge that I have read this application and state
n
p( that the above Information is correct and agree to comply with m
O• all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of 0
the State of California. ��j�� 111
I hereby certify that I am properly licensed as a contractor under /` SO.FT. 4'/LC/ Na
the State of Cantor;:a Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter exempt frdmh suchen are n
f rh nt tll•'Caliandnco anef effect,
Busor I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: u•
amf VALUATION PERMIT FEE a
and Professions ( •e,Division Ch ter \
PLAN CHECK 3
Signature of 1/ sD '114-1
Permittee $74 / TAX $
/ /�
Authorized ' .:nt / / TOTAL PAID S 7
4SS7� _•,s 0. 5 10%03/78, -
I6,9x00. TL
COSTA MESA BUILDING- AFETY DEPARTMENT - 6225 10/03/78 v 169.000KTQ
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626-° °° 6225 —0004445587 I A
AP IC TI N FOR STRUCTURAL PERMIT'
For Applicant to Fill in Completely —Use Ink Only REc I e DATE RECEIVED
'ADBUIDRESS / "iCE' //¢ • I •/LDING 'VE tiF 'ERMIT NO.
OWNER A.P. NO.
BUILDING a /4 �
ADDRESS -
MAIL ADDRESS (/
•
TEL. TRACT` LOT BLOCK
CITY•
NO. IM
NDER �I , • s . u,CONSTRUCTION -,
.`�--__
BRANCH ��r�L –"��.
OWNER TEt4 ,g&_.-.-
ADDRESS •—
ARCHITECT TEL.
OR ENGINEER NO.
FIRE
ADDRESS ZONE PE GROUP
j��� ahi. APPROVE ////_
CONTRACTOR �'I/ 111 QQQ BY DATE
ADDRESS
" TEL
yang l it, ZONE NO.OF USE OF NEW
CITY /V/f Aht, PLANS BUILDING
F_
STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLISS.S.
C/L STREET)
Cs OF LOT I NOW ON LOT FRONT FT. FT.
Q USE OF
c& EXISTING BLDG. R.SIDE FT. FT.
col
FSeparate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
Q 1 REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS. BLDGS.
° VAR.# DATE
r1 O.U.P.# APPROVED
Q –
, APPROVED
>. _By –DATE
..1
0 I hereby acknowledge that I have read this application and state '^
--
a that the above Information is correct and agree to comply with
M. all laws regulating building construction, and I shall not employ ro
Z any person In violation of the workman's compensation laws of
.WW the State of California. -
I hereby certify that I am properly licensed as a contractor under SQ. FT., w
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMITF O LV:
am exempt from the provisions of the State of California Business / es
VALUATION PER FEE s / c
antl Professions Code,Division 3,Chapter 9. v+
LAN CHECK $ o
Signature of
Permittee $ TAX $ u.
Authorized Agent TOTAL PAID $
3665 I P""
n 1g:r ;:,::.;:3,:. 0
1 V i i5 73 ,: C . 4 .
COSTA MESA BUILDING-SAFETY DEPARTMENT
i. P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
. APPLICATION FOR BUILDING PERMIT
For A/p�plica/ntt to Fill in Completely/ / �J ,/
/� U/r'�o/N/. 1 z RECEIVEp18Y DGA�T"/57-73 S _B .
E ISSUED
BUILDING /�7 //OI— d
ADDRESS
/� J A.P.NO./yf O8'� /L, PERMIT NO.
OWNER Cr/ti9 W/�/if/'�17.5 _ 7
MAIL BUILDING / e f v/rG//v/rt /74 .
ADDRESS Sy.n e ADDRESS
z Luis; TE . �/ ,yi //
CL U CITY NOL y5-.:1. TRACTd 6 7 s LOT 0" ' BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMf11 ISH vn
O m LENDER Oti.K.,,O l `/
O.
J •
ttt�D111 BRANCH /W-OW /r� / yNERC /9 , / ms
ADDRESS
J QSVALUE
>Q
TEL?'y USE /nay/Su./.s y00 /pr/V $ J07aARCHITECT DOfrMOR ENGINEER NO. $2"-2!
WG /^ / /J FIRE
CC ADDRESS s71/ /'(9,r i7/ I iJ gut._ ZONE tPcGROUP3
d Uri
APPROVE
y1y��/
W Z CONTRACTOR f4-C19-KQ POO/S •� BY Vvl DATL� —r�73
Jcc ADDRESS 99.,2__flus /-/ - Jr.
W wTEL. or 17 ZONE n NO:OF USE OF NEW (���
0 2 K� PLANS BUILDING
Zi— CITY clry , EL "now* NO. n9-0/27 . ..am li00<
w-0 STATE CITY YARDS APPROVED YARDS APPROVED
m 2 LIC. NO. 233 VD 3 LIC. NO. MAIN BUILDING ACCESSORY BUILDING
JO SIZE NO.OF BLDGS. (FROMC/L STREET)
OF LOT I NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. )CCS R SIDE FT.
I— SIZE OF • C ' NO.OF •
ZZ NEW BLDG. S/) ROOMS STORIES L.SIDE FT. ..51-7T.
U EXTERIOR WALL ROOF '
COVERING COVERING REAR FT. /6 FT.
USE OF.BUILDING AND WORKJO BE PERFQRMED DISTANCE BET. BET.MAIN&
V/N Ji _rc.V f m Toe( fN/ I) MAIN BLDGS. ACCESS.BLDGS.
Q / VAR.# . DATE
Q C.U.P,# APPROVED
I— - APPROVED PG
N RY �� DATE r— /5--1-2.1
Z
O strip
C~.1 I hereby acknowledge that 1 have read this application and state
that the above information is correct and agree to comply with �
CC all laws regulating building construction, and I shall not employ rg[?
I•" any person in violation of the workman's compensation laws of
N the State of California. TAX m
Z c
I hereby certify that I am properly licensed as a contractor under SO. FT. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of the State of California Business Cr
VALUATION -
and Professions Code, Division 3,Chapter 9. !11'20
PERMIT FEE $ {�
I J
/l 6-0 in
Signature of I/_ /� ��./ PIAN CHECK $ 73. E
Permittee (, PP"� $J /) (/`
Authorized Agent ji
11-e) LL
TOTAL FEE //
t\t- OWNER
WILLIAMS, CRAIG a -15-73
JOB ADDRESS 171 Virginia Yl. BUi�UING PERMIT N0.
GENERAL CONTRACTOR Secard Pools DESCRIPTION of WORT •swim tool
AP NonLOT TRACT FIRE ZONE . VALUE $ 8,072.00
INSPECTIONS r/��SSiiggnaature Date GROUP J TYPE TIT ZONE R.2
\ Pool Location - '1.073 SUBCONTRACTOR PERMITS ISSUED
Date Number Signature
Forms
Main Drain •
' Steel Reinforce
Elec. Bond • ' < Electrice� �7
Approval to Cover ills 5134-73 / //Geettdeab-----/5-7Y 9a 7,
Underground Electric /Jr y-/.?-73
Gas Piping Test ((l�� Plumbing p
Filtering System Lines i � 6-41.2i1 .O_etAe��arn_ �•> 75 3/art
Backwash Lines and Recep. Pg 6i2.Z3' /7 .Aivlea.,../ 7--3-7g d 74L
Electrical Final
7775
Heater and Vent Final _
Filter System Final
Backwash and Recep. Final
CITY DI .TA MESA
PARK FEES
-Fee Payment Receipt N° 406
6
A �/ pQ/i
Project Address /7/ 644_5CM+.✓ / ,t, SCJ
A.P.Number /if 12 2 a q Park Area
Building Permit Number4 r,`j P
Owner's Name S,I-✓r
Mailing Address /.7/ /./r • • .l�.. y'1 a'• in
FEE: Single amity ' Number of Units
2-Bedrooms or Less - @ $ 702.70 =
3-Bedrooms @ 983.13 =
4-Bedrooms @ 1,260.33 =
5-Bedrooms+ @ 1,476.32 =
Multiple Family **
Bachelor or Studio @ 386.81
1-Bedroom @ 467.38 =
2-Bedroom @ 718.80 -
3-Bedrooms+ _� @ 1,135.66 / /,3,Sa6
p
/60 Total Fee *** /1 66
Planning Department Approval Date .�V' 3 '7O By CI�CJie -•
Applicant's Signature t�Qlh(7 ,.,G X11 JJ?A.
* City Ordinance 72-44 '(/City Ordinance 72-45 *** CIL t solution 77.89
CMF 0174-32 Rev.7/77 white—Planning;Canary—Planning;Plnk—Finance;Goldenrod—Applicant DOMnl II11 J