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Home My WebLink About422 WALNUT PL - Building PermitsAPPLICATION FOR A BUILDING PERMIT ��-{'Z �j aiock j-( �r� h 2 2, BUILDING PERMIT NO. Ei°`ni"i 7�a�� V �/ Lot Permlt No. Builtlln9 / � () !1 W �� U'"Y � / . /� P¢rmi'No. Atltlrezs �� L�C.-. t ` _( D �/� \1 ArraC'OS'Cv� MCS✓�. _,�_ �� vC • Pormlt�No! Owner •�.1� ��FrGI�-! Typeo/Roject ❑New ❑Alter ❑Atltlitlon .. Atltlress � 22 y�7(..,j'vv T L. ❑ Repalr ❑ Convert ❑ Oemo ❑ Occupancy Pmt. CItY cos-r�- H��s Z�P �62? PhoneG' y�'.�I> A.P. $up. Dist./ Insp. Area Architect/ Zone Spl. PTt. No. Designar LicenS¢ NO. Setback5 P/L Front C/L SL Street Witlth AGtlress Vartls Left g ear ��y Zip Phone ave rol. e 9 . . �„ En9ineer license No. C ark ng Spates Requ rG rov e overe n Atltlfe55 m Slruct No, of No. of m ��y Zip Phone Height Storles Famlly Y Park Faes Yez Fee IICENS60 C�NTRAGTOR'S DECLARATION m I hereby affirm thei � am licensetl under provisions of Chapter 9 RequiraE No C.T. 0.ecelpt L (commencing wi[h yection 7000 ot Divisian 3 ot the Buainess antl Zoning Approvetl By: Date �. Protmzinns Cotle, and mV ��censo Is in tull force antl etfecH. � Licenso Cla� License Number > Date Conttector Misc. E Atltlrass PropoSetl Use j� City nntl Zip �hone of Strutture « CONSTpUCTION LENDING AGENCV � I horaby nf}irm tha[ there is n construction lentling apency for [ha d parforrnance of the work tor which this permit is iss�atl (Sec. 3097, OCC. Type Cotle ` Clv. CJ. dass Const. Vear y Lontlor's Name _ USE/OCCUPANCV SIZE S�: FT. � Lender's Atltl�ass J OWNER-BUILDER DECLARATION y 1. I horoby etiirm that � am axompt from the Canttactor's Liconse Law 1O tor tha following �ea4o�: � ❑ I, as owner of th9 proper[y, or my employee5 with weqes as their 2. solo compnnsetio�, w�� do Iho work, antl Iha shucture is not �t„ Intontletl or oftere� tor sele. � �I, es ownar oi tho property, am ezclusively contractinq with 3' licensetl tontracrors to cOnrtruc[ [he project. a' ❑ I a x t under Sec. e&�Cito. tRi reason 4� = a Oet� � 0 pwner QV1 1...� �Q-� �� E WORKERS'COMPENSATIO LA TION 7otal Valuatlon � I hereby aHirm x�a� � heve a cer[ifiw[e of comm�t ro self.insure, Encroachment Permit Requlretl ❑ Ve5 ❑ No or a cor[ificate ot Workers' Compensation Inswance, or o certifietl C copy thereot. Gratlin9 PmL GraCin9 � Policy No Company ROQuiraC ❑ Ves ❑ No Pmt. No. a ❑ Cortified copy is hereby f�rnished. a ❑ Cortifiotl copy is filetl with OronBe Covnry, EMA. Rough Gratling Q , Approvetl by: Date Dd[B PPPlicant CEF7IFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (T�is saction neetl noi bo cOmpletatl it permit is tor $100 or less). I certify that in the perfo�mence of Ne work for which this parmi[ is issued, 1 hell not emP�oy any per m any anner o as to become subjor t� orkers' Compan io Laws alifo PERMIT FEES Det ( APPlitan[ ' - NOTIC T APPUCANT: If, at[er a' g i Ce� ifi te ot SVuctural S Plan Check 5 Exemption, you shou�tl become subject to the Wo/keri Compensetion provisians of tha Labor Cotla, you must forxhwith comply with suchi Electrical SPecial prOvisions or fhis permit sholl �e tleemetl revoketl.. $ Invest. E I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE �NFORMATION IS CORRECT. I AGREE TO P�umbinq E COMPLV WITH AlL COVNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- Mecnanital E ORI FEPRESENTATIVES OF THIS COUNTV TO ENTEF UPON T BpVE EN7� NED PpOPERTV FOR INSPE TI/ON PUR- qa-Gratle /� 1�7i1 Inspectlon g a �� Pra-Gratle P¢rmit ure of A li nr A n pata Rec. No. E Isim S Print Applicant's/Age�Y Name K All spacn within this box must be completed m process Pian issuance . Check By: ADP�ovetl: CMY UJJS-40 (tlU-1b1 �ev. o/av m c n � � a a m ia CITY OF COSTA MESA CAlJFORNIA 92826 P.O. BOX 1200 FROM TME OFFICE OF TME DIRECTOR OF BUILDINO SAFETV Project Address _` 22 "`� � L N�� L Project Name owners t�ame `�D hl ` 1� l—� �-11:-� owners Address LI" 2� W✓.� L j�l U T I'� Raners Telephone (� �f �j ' �J � � � _ Petmit # r� .�� ZYPe ✓ City Use Only I /GO N �I EfFEQY as owner�tror,.-�errt (strike out all except one) do hereby attest that e�nployment of any person, or persons, is not anticipated at the time of seeking the above-referenced permit. In the event that any person, or persons, are e�loyed �nder the prwisions of this pennit, I shall imrediately cause a valid Certificate of Worlanens Co�ensation to be filed with the Costa Mesa Building Division. I agree to defend at my cx,m �st, arcl to indemnify and hold harmless, the City, its officers, agents and/or eng�loyees, fran and against, arry and all liability, damage, costs, losses, claims and expenses, hc�rscever caused, resulting directly or indirectly fran, or connected with the improveirent under this permit. Z further state that I have tead arrl fully imderstand the implications and re- spoasibilities of the above statesrents, and will crniply with all provisions of the Contractors State License Iaw found under the Business and Professions Code, Division 3, Chapter 9, of the State of California. f u ��rF�2 � Print Name �U� � � Signature cmF m77-as � 1�= 8 O Ik3te owNER gpN JF.FFERY DATE 8/15/80 JOB ADDRE55 422 Walnut Place BUILDING PERMIT N0. 50514 C,FNFRAI [ONTRACTOR (L.mar-hni �APY DES[RIPTION oi WORK oom i 1on sm� W�TER ROUGH PLUMBING PROP. $WR. LINE I-I HOUSE CON. MISCELLANEOUS �a� ROUGH ME�TING ANO A�A ROUGN WIRING TRENCHES FORMS STEELI �-:LOOR SVSTEM ��(�_, uBOND BERM [, STE� REINFORCE t0 SMEATHING y FRAME RNO FL�SXING %j LRTHING - IN n OUT n n C STRUCTUR4L, FIN � HEATING. VENT., (}� PLUMBING, FIN4L ELECTRIC, FINAL BllIL01N�, FINAL _._..... �...1. _.. � � ...... SUBCONTRACTOR � !api u�ia7tlU 60�50 �� COSTA MESA BUILDING-SAFETY DEPARTMENT � APPLI TION FOR STRUCTURAL PERMIT P.O.BOX1200 COSTAMESA,CALIFORNIA92626 RECE V PERMIT SO S For Applicant to Fill in Comple[ely — Use Ink Only ADORESS �I2Z w��'v U 1 �� A P N� Z ' �� T�ENANT R ' i �_ 1 ��-I�� J ADDRE55 �Z� IV ADDRE S � L� W �TL, v U 1 UNIT OR (� , SPACE NO. CITY i(,J��/'} �—(L%�� No`�G46•513Q � , LOT � BLK. EW AOD LTER REPAIR MOVING �EMOLISH CONSTFUCTION �/ LENDER BflANCH �� OWNER ADDRESS �' V UE �f ARCHITECT TEL. USE �. ♦ S� J� OR ENGINEER N P� ADDRE55 � 20NE TVPE � GROVP � APPROVE � /S' �� CONTRACTOR BV DATE ( ADORESS TEL. CITV NO. STATE CITV AFVROVEDSETBACKS LIC. NO. LIC. NO. SIZE �� NO.OF BLDCS. (FROM C/L STREET) OF LOT 2• �• � g• NOW ON LOT FFO EXI5TINGBLDG. C�SL � �� L � � FT. Separate permits are required for L SIDE vr. electric, plumbing and heating work: �/� REAR FT. USE OF BUIIOING AND WORK TO BE PERFORMED PLANNING ACTION � In - DATE CTW PPPROVED .�Ro� � • -/J �d I �ereby acknowledpe that I have read this application antl stata that the above intormatton is cofrect anE agrae to comply with all laws regulatin8 builtlln8 consVuction, entl I shell not employ any person in violetian of the workman's compensation laws of the State of California. � hereby cettify that I am properlY licenud as a contrector untler SQ. FT. the State of Californie Business antl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, antl that such licenses are in full forca en0 effect, or I THE PURPp$E OF ESTABLISHING A PERMR FE ONLV: am ezempt from the provlslons of tha Stata of Calitornia Business antl Professions C e, Division 3, Chapter 9. VALUATION PERMIT FEE S D� QQ / �f PLAN CHECK $ 2O �O Signature o /— `QO TAX $ D .S Permlttee $ �V V or � Authorizetl Agent Date TOTA� PAID S b. s