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Home My WebLink About983 TRABUCO CIR - Building PermitsApplieant to ti11 in all spaces eacept those within heavy bortler lines ana sign all appropriate Oeclarations. .� R T NO. TRACT NO. LOT NO. UNIT NO. O 5 � YU Z Zone .� 2, cITYOFcoSTnMQESA 2CONSTRUCTIONPERMIT 3q. 87 5 Z O n.r.# ZZ Project Address ' L�J �P�J �� G�Q' � ' S' Main Building: Accessory Building: ' ApplicanYs Mailing Address � H3 �iA�CrO G� � TYPE OF CONSTRUCTION NEW �ADD ALTERATION- REPAIR E ^ Z Owner's Name �`�� PhonP�-^4�� ONVERSION ❑ DEMOLISH ❑ OTHER - T Front Ip DESCRIPTION OF WORJ�/USE OF BLDG.'� � I B Rear l N Addres5 Q�3 'i�2/Oi��I.��O GLQ.. (y.IQ' D�N IhG. 28'p�l lAi7i%L'i ' ' A � T I \ Arch/Eng.`7�CP�-i�+o ��,�%`C Lic nse No.l.r".fLQ� TVPE OF PERM - GRaoiNG ❑ FOuivoATION STRuc�'URAL j K Right� 5 j- G Address' ZG w�7� ip(.(A�(S.�E . ❑ TENANT�ELECTRIGAL ❑ PLUMBING ❑ MECHANICAI g� Left � JC � .. ' R ❑ -OTHER , Pln Ref. # � Parkin Re Contractor's Name Phone�03Z'�{T� � 9� g q./Provided E ^.��.2� �.; �dVp�b PRQIECT DESCRIPTION 5a. FT. [p�L ' oGCUPANCv 4 Address Imailing) ��p Planning Notes: Add S 1,�, y�yo.,..� S M 4' � 3� CONSTRUCTION TVPE�r� Il� VA�UATION $ 4 � Q% m 1 CityLicenSeNo. ZONE GRADINGCU.VDS. AC ER S�- �'�Tr✓1' W�n w T ' b a c! i o.n � s. LICENSED CONTRACTOR OECLARATION ��1 �v 5 ��` I hereby affirm that I arn licensetl untler p�ovi5ion5 of Charter 9(mmm¢nCing Remarks: a witM1 section ]000) ot Division 3 of the Business antl Professions Cotle, antl ' my Ilcense is in f 141 torce antl etiect. (� ELECTRICAL FEES License -C7I s� �3 I�\ 1 h LI se No. �� Date {�2�----• =;...,-;.,.-,, --. =� � ' H- PLUMBING - FEES Automatic Washer Transtormer ❑ 15-50 KW QWORKERS'COMPE ATIONDECLARATION � COnitlUctiOnP012Sub. � 5O+KW I hereby atfirm tM1at I �ave a certificate of consent to self-insure or a certiticate Bar Sink ShOwers - of Workers' Compensation Inmrance, or a certitied copy thereof (Section COOking Uni[ M¢t¢r ❑up LO 100 dmp5 3800, �5b. C. �h- . - Backflow Preventer Service Sink aoiicy No. � Ol�r�. Compa Backflow Irrigation Sewer Cap • � . Dishwasher Meter ❑over 100 amps `� Certifietl copy is hereby furnishe " ' - / DryCIS ❑C�dS ❑EIECl/ic Sub Pdf121 Certi ietl co " etl w�th the cit il in ision �M Bathtubs � Sewer Connection • � oate Applicant Clarifiers Solai Collectors.' �% Fan Motors �0-1 HP 01'/:-8 EXEMPTION--�RKERS' COMPENSATION DECLARATIO � (This section neetl no[ be completetl if the permit is Por one huntlretl ($100) � � F.A.U. Ina Sola� �9-15 HP 016�15+ iess). Dishv:ashe'r Solar Piping I certify tM1at in the performance ot the work for wM1ich this Oermft is issuetl, I� Fixtures Microwave ' shall not employ any person in any manner so as to become subject to the � Drinking Fountains Solar Tank � I1' Workers' Compensa[ion LawS of California: . . Date 5ignature floor Drains imming Pool w/Spa ` Device Boxes Pole Light ' NOTICE: If, afier making this tleclaration, you shoultl become subject to the ,¢ Outlets Range ^3 Workers' Compensation provisions of the Labor Cotle, you must forthwith FIoo�Sinks U�inal mmpry wi[h such p�ovisions or IhiS permit Shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV GasService OuU2t5 WatCfClOset $WitChES $iyn 1 hereby af(irm that (here•is a cons[�uction lentling a9ency fo� the pe�formanc¢ - ' of tne work for w6ich_this_ permit is issuetl (Section 309] Civ. G.) Garbage Disposal Standing Sections . Lentler's Name TL0�1� Interceptors Water.Heater � �entler's Atltlress Kitchen Sink � Water Service Generator �0-5 KW �5-15 KW Trash.Compacmr . OWNER BUILDER DECLARATION ' ' � i I hereby affirm lhat I am ezempf trom the ConVactor's License l.aw for the Lav2tofie5 AutO-WaSh �� tollowin9 reason (Section ]031.5 Business anG Protessional Cotle: Any city or �- county whicn requires a permit to wnstruct, alter, improve, tlemolish or repair' P-Trap Laundry Trays � any structu�e, prior [o its isSuance, also �equi�e5 the applicant to� Such pe/mit to file a signetl statement that he/she is licensetl pursuant to the provisions of Roof Drains roe Contraclor'S License Law (Cnao�er 9(commentlng with Section ]000) o( Division 3 of the Business antl Professions Cotle) or that ne/she is exempt Reinspection Fee $75 Issue Fee [herefrom antl the basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant fo� a permit subjects the aOP��ant to a civil - penalty oi not more than five hundretl tloliars (g500). DEVELOPMENT SERVICES REQUIREMENTS� ❑ I, as owner of ihe property or my employees with wages as their so�e Reinspection Fee $15 Issue Fee �' $ 3 Zp�ing Approved By r Dafe '2� 89 compensation, will tlo the work, antl the structu�e is not inlenEetl o� off¢retl for sale (Section 7044, eusiness antl Protessionat cotle: The Contracmr's MECHANICAL FEES '' Building Approved By Date License Law tloes not apply to an owner Of a property who builds or improves the/eon, an0 who tloes Such wo�k M1imself/herself or tM1rough his o� her own BOiI¢f � HOOd OI Type I ❑ %�PPlitetiOn ISSUBd By D3t em0loyee5, provitletl tM1at such improvements are not intentletl o� offeretl fo� saie. Ii, however, tne builtling or impwvement is soltl within one year of com- Canopy Type II ❑ SU MARV F pletion, tbe owne� will have the burtlen of pwving he/she tliG not builtl or im- DUct - Und¢f Ci�011nd ,�y� prove for the purpose oi saie). BUILDWG PERMIT $ 72 • BO SMIP $ • J V - ❑ I, as owner ot the property, am exclusively contracting witn licensetl corv Duct-Structural Refriger on System . pL'AN CHECK $ � •aa PERMIT trattors to cons[ruc[ the proj¢ct ($ection ]044, Business antl Professions Cotle: The Contracror's License law tloes mt apply m an owner oi property who Duct - Ventilating ��- 0,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $ builtls or improves thereon. antl who confracts Tor such oroiects with a con- - - . tractor(sl license pursuanc ro me Convactors License Law). I am aware that Exhaust System ❑ MWtiple ❑ ystem Repair/AI[eration . PLAN�CHECK .25% $ ENERGV P.C. $ proof ol tneir Worker's Compensation insurance shoultl be provitletl to me. ELECTRICAL $ �-�' DO GRADING $ ❑ I am exempt untler SecHon B. & P. C. tor this reason Firepl/Fact. Blt. IC80 # Fire Damper5 _ � PLANCHECK 50% $ MICROFILM $ � oate owner . Heating System & Ducting Registers � MECHANICAL $ � 0• � I nereby certiry that 1 have reatl this application antl state that the above ❑0700,000 BTU �100,0006T � � TOTAL FEE $ information is corre . I agree to comply with al ity antl county ordinances PLAN CHECK 25% $ antl state laws relati to builtling mnstructi , a tl hereby authorize reore- sentatives. o this cty o ente� on [ v mentionetl p�operty tor inspeCtio p o s.' ^� - -r 1��C�-'� �� af �'�`�IaCCZ �0(!Sr.vt.. r+...Z Y -"l�.Jt' Signature - Date D- On'+'f Drivars'.License or 55 � ' Reinspeaion Fee $75 Issue Fee $ 3 0 „ ry_ �:ire: n�r^;;us rinF: �.�-�., 0865-46, rev. 5/e8 Wnite - Builtling; Canary - Applicanh Pink - A¢ounting; Goltlenrotl - Assessor . . a�\',';�� .. ,. . .: CONSTRUCTION AND PLANNING h, . ; � POOL & SPA . ', I � APPROVALS , Permit # ' ' ' ' ' Dat � �• �I'nspector AppROVALS Permit # � Date Inspector �1. Temporary Electrical Service or Pole :�� 52. Pool & Equipment Location ^'� �� r ;n :n i � � 2._ Soil Pipe-Undfgrnd. �� r; �� - 53. Steel Reinforcement J � � r d 3. Electyical Contluit Utility-Undrgrnd�_, �^! 1.,,,� 54: Forms .-.�`� A1Electriql COnduit-Undrgrnd. ��. . ' 55. E�ectrical Bonding `�'� 5:JStee'IReinfotc�ement �} ' 56. Rough Plumbing & Pressure Test _; � s,&lec�rical^Pt�R�Grnd�- --� � � . 57. APPROVALTOCOVER-GUNITE �'l.:` �7C'Foot�ngs � j '��jf�_,_� (o -� �(Q 58. E{ectricalConduit-Undrgmd. " t� :` 8�_�F.qundation ^�� j�--' �- � n��1 59. Gas Pipe, O Undrgrnd., Test :�,� J , � : � -. �� . - �. r 9� WateY Pipe-Undr�nd. '�, 60. Backwash Lines, P-Trap, O Undrgmd. � - r � 10�Si uctu al Flobr System . (O� ��(:'� �� 61. APPROVAL TO DECK � 11.I Pioperty Sewei Line,& House OSr+neciion �� 62. Backwash & ReceptorFinal •'� f� , i .�� : ir <: i � '� .J 12:' Sewe� Cap�� _� , a � �� ' . � 63. Heater & Vent-Final :< 13. ROof�DrainS j� �;� �.�� {� (�� 64. Plumbing System - Final • �' 14. Rough Plumbing �. � �� -----�- 65. Electrical-Final A} 15. Rough Electrical=Conduit � 66. Solar System-Final 3_ ,�16I Rough Electric Wiring �G�7/ �,�y�Z 67. Fencing & Access Approval `17� Rough N/iring Sign 68. APPROVED FOR PLASTERING � 178�. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �j9 Rough Heati g& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace '•� APPROVALS Permit # :v ' n �2d•. Ducts, in Structure n` 70. Underground Hydro 22. Ducts, Ventilating �"' Cy 71. Product Piping O Gas ❑ Oil ' � 23' Gas Pipef Rough & Test ��N /72. Underground Flush �� 24. Roof Fiaming �� ,7_ i 73. Undergrnd.Storage Tank O Gas ❑ Oil �� 25. �Ftoof�Sheathing � �' tfj � 7� � 74. Overhead Hydro 26. T-Ba�lCeiling (Structural) &�Monocoat 7,5. Dry Chemical � , 27� Frame epd Flashing /' e 76. Dry Standpipe 28�. Lathing,8r$tiiing 'r � �e Z� .� 77. FIXEDSYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � `�. 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat=- �� • 79. FINAL INSPECTION � 32. Elect'rical Power�Merer-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 1:� � s c� Notes: l��Sv �:n wr,0'/ • 34. Final Heating & Air Conditioning � � �� rs� -� 35. Final Gas Pipe-Test ' � � 36. Hood or Canopy � , i.,. ; >-.� � L37. Final Factory Fireplace, � �38. Final Plurribing ` � ' 39. WaterSer,vice=Final ' . � ,i ; �i �40. Gas Seivice-Final ;� "� `� . , � �'41. Solar pomestic-Final.. ; �i.- �� i. �'42. BackflowPreventer-�._ � � n� c�,.%'� .., ;43. Backflow Irrigationr:� . _ • %' '' '� i � �% 7 n i, -4A: Landscape'I�rigation System ' (j�(.''� �� J/'� `�Q5. Sound At[enuation:� _.'� � �� );'% �46. Handicap Regulations �, � ' i� h 2 47. FINAL STRUCTURE & BUILDING % /G � i � 48. Special Requirements'Completed � _ . 49. Electric Release to Eiiison , � r��i� �50. Gas Release to Southern California Gas Co � . f�l�• • �n � � 51. CEFTIFICATE OF OCCUPANCY � � Gt i �� r;�`�:' r' 4) No. Date . (✓ i (^l : :..I/!/ �/1 (� V - v CI� OF CDSTA MESA GAIJ�ORNIA Y262E r.0. �O% 1200 FROM TME OFFICE OF TME DIRECTOR OF BUIlDINO SAFETV Project Address 9�3 j�'�}guCO C(RCLc COSTA MES:� Project Name Q.�ners Nan�e SG-l��i � (�f} j r D �'6 U i�.. ,I%OA1ALv L. 1-NkTC�-1 �/L amers Address 9ig3 7,�2,qguCO G2Ct-C, C'os�-A M�$4 ownezs Telephone �� 4� 5(1 F? 6 Z&i 9 ��t � so25s'� 0 City Use Chly I j)0�� G, /./�}-7��-f� as Owner, Csat-�as�or,-�Agent (strike out all except ore) do hereby attest that e�loyrrent of any person, or persons, is not anticigated at the time of seeking the above-referenced permit. Tn the.event that any person, or persons, are e�loyed under the prwisions of this permit, I shall imnediately cause a valid Certificate of Wor)miens Ca�ensation to be filed with the Costa Mesa Building Division. I agree to deferr3 at my avn cx�st, and to inrle�mify and hold harmless, the City, its officers, agents and/or a�loyees, fran and agairst, arry ard all liability, darrage, costs, lcsses, claims and expenses, hoascever caused, resultirg directly or indirectly fran, or oonnected with the i�rovesrent under this pernut. I further state that I have read and fully imderstand the implications arc3 rr sponsibilities of the above statements, and will crng�ly with all provisions of the Contractors State License Iaw found under the Business arrl Pcofessions Code, Division 3, C]�apter 9, of the State of California. 6-/?- 80 I�te (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 983 TRABUCO CI KITCHEN AND BATHROOM 42205212 Applicant: TERRY, ROY Address: 29291 KENSINGTON DR Owner: Address Contractor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1--2 units)� � New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl ' , Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Molors to SOhp Motors l0 100hp Motors over t00hp LAGUNA NIGUEL, CA GAMBLE; RODNEY L 983 TRABUCO CIR ' COSTA MESA, CA� COAST BUILDING CO 29291 KENSINGTON DR LAGUNA NIGUEL, CA � � e Phone: 949-510-2281 2ip 92677 Phone: Zip: 92627 � ,Pho"ne: 949-510-2281 Zip: 92677 , License: 660044 Status: ISSUED Applied: 04/OS/2005 Issued: 04/05/2005 ISSUED BV: SCOPE OF PERMIT . INTERIOR'120 SF KITCHEN.REMODEL IN AN EXISTING 2-STORY SFD. WORK70 INCLUDE REMOVING SOFFIT IN KITCHEN TO ELEVATE THE CEILING,-CHANGE-OUT OF FIXTURES'AND APPLIANCES.� WORK TO ALSO INCLUDE CHANGE-OUT OF FIXTURES IN THE EXISTING BATHROOMS. 10 LIGHT FIXTURES, 10 OUTLETS, 5 SWITCHES, 2 RES APPL - REF: BOS-00542 - . � � . $23.50 $0.00 $0.00 $0.00 50.00 $0.00 $11.00 $11.00 � $5.50 $0.00 $9.50 � �, , $0:00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantily 0 0 0 .�' . 10., . . 10 � , 5 p 2 0 ' 0 � 0 , 0 0 0 0 0 FEE SUMMARY Quantity Temp Dist System'/ Lighting $0.00 0� Busway /100 ft � $0.00 0 :� ' Standing Section � $0.00 � 0 �� - • � Misc Electncal Equipment $0.00 ' - 0 � . ' Transformers up to 1 kva/kw $0.00, �; ,� 0 ' � � ................up to 10_kva/kw _ ,_ $0.00 �/ 0 . � .................up to 50 k4a/kw �� '� � � $0.00 0 ' � .................up to 100 kva/kw `. $0.00 , � 0 .......:.:........over 100 kva/kw � "- $0.00 ', . 0- . Low Voltage Equipment .. � - $0:00 � 0 , Low Volt Winng�System./ Ckt ,� $0.00 � 0 ,, ' Misa Conduit- : � , � $0.00- . 0 . � Misc. Conductor . � , $0.00 - � 0 Circus ( gen or ride) �$0.00 - � 0 - Circus (mech ride or lights) .$0.00 0 , Christmas Tree Sfand � : $0.00 0 Pirework5 Stand . � $0.00 0 - - Other Electrical Fee " $0.00 s 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: 7his 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 requlred Inspections and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 �».o o�a,�„� WORKERS'COMPENSATON DECLARAnON: I hereby effirtn under penelry ot pe�ury one ot the tollowing decleretions: ❑ I heve end will meintein a certificete ot tonsent to sell-Insure lor warkers' compenselion, as provitletl for by section 3700 01 ihe Labor Cotle, for ihe pertormence of ihe work for which this pertnit is issued. �I have an0 will meintein workers' compensetion insurance, es requlred by section 3700 0l the Lebor Code, for the pedortnance of the work for which this pertnit is issuetl. My workars' campensation Insurence cerde� antl policy numher ere: Car+ier. STATE F'-JN� PoncyNumher IS4�77�I —2��i (This section need not be crompleted i! the permit is valued et one hundretl0ollers (S f 00) or less ) ❑ I certity that in the peAormence ot lhe work for which this pertnit is issuetl, I shell not employ any person in any manner so as to become sublect m the workers' compansation laws o� Califomie, end egree thai II I should 6ecome sub�ecl lo the workers' campensation provisions of Section 3700 oi the Lebor Code, I shell fotlhwllh comply with these pro � ions. r qppVicant 5gnatura: Oata: � L f� I��i / �J� WppNING: FAILURE TO SECURE WOflKERS' COAIPENS COVEPAdE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE HUNDREO THpUSAND DOILARE (5100,000), IN ApOfTION TO THE COST OF COMPENS/ TIqJ, DAMAOES / S PROVIDED FOP IN SEGTION 31O60F THE LABOR CODE,11.7EREST, AND ATTOANEYS FEES. LICENSED CONTRAC70RS OECLARATON: I hereby attirtn that I am licensetl untler pmdslans ot Chaptar 9(commencing with Saction 7000) ot Division 3 01 ihe Business antl Professions Cotle, and my license is in full force and ettect. Lic. k (n C�00 �l.�-1 Class x Contramor'sSignaturei �Z-.��i/1 i Dete: �{ CONSTAUC710N LENDING AGENCY: ❑ I hereby altirm that there is a construction lenaing agency Por tha perlormanca ot Ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lender'S Name: Sigr�eture: _ OWNER•BUILDER DECLARAT10N5: Lender's Address: Deie: I he�eby aHirtn ihat untler penalry ot perjury ihat I em E%EMPT FROM 7HE CONTRACTORS IICENSE LAW for the lollowing reason (Sec. 7031.5, eusiness antl Protessions �e: Any city or County whiCh requires e permit to con5�ruct, al�er, impwva, demolish, or repeif eny simcture, prior to its issuance, also requires the appliCan� for such permit to fi�e a signed statament thet he or she Is Iicense0 pursuent ta �he provlsions of �he Contrectore License Lew (Chapter 9(commencing with Section 7000) of Division 3 af the Business antl Professions Code) or thet he or she is eaempl theretrom end the basis for the allegetl exemption. Any violation o� Section 7031.5 by any apDlicant for a permit subjecis Ihe epplicant to e dvil penalty ot not more then tiva hundrad dollers ($500).): ❑ I, as owner of the property, Or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl Ihe structure is not intentled or oHered for sale (Sec. 7044, Business antl Professions Code: The Contracrors License Law does not apDly lo an owner of properry who builtls o� improves theraon, an0 who does such work himseN or herseN or ihrough his or her own amployees, provitletl that such improvements are not intended or otteretl for sale. If, however, the huilding or improvement is sold within o�e year ot completion, ihe owner-builtler will heve the burden of proving t�at he or she did not build or imD�o�e for purpose o� sale.). ❑ I, es owner oi the properry, em EXCLUSIVELV CONTRACTNG WITM LICENSED CONTFACTORS to consimct the prolect (Sec. 704a, Business and Professions Cotle: The contrector5 License Lew tloes not epply to en owner ol pmDeny who bWlds or improves �hereon, and who coNrads lor such prolect with a coniractor(s) license pursuant to ��e Contractor5 LiCense Lews.). ❑ I em exempi untler sec. Signature: p�yper ID venfiatl by tlrivers license. Ves Vedfcauon of Owners�ip by (typa ot tlocument, i.e. Business and Prolessions Code �or this reason: ❑ No Drivers License No. property tax bill or deetl): DIV�SION OF INDUSTRIAL SAFETY PERMR CEfiTIFICATION: Date: Expires: ❑ I hereby certify Iha[ no excavation five (5) or more feat in depih into which e person is raquired to tlescend, will be matle in connection with work authonzed by this pertnit, antl that no buildi�g sVucture, scaHolding, talsework, or demWition or dismantling thereof, will be more than thirry-siz (3fi) feet high. (Chap. 32, Grp 2, An 2, Sec. 3a1, Title 8, Califomia Administretive CoOe). ❑ A5 owner-builder, I will not employ anyone to tlo work which would require e pertnit trom the Division o� Intlustnal Safety, as notetl above. unless such person has a pertnit to da such work tmm the divisian. Signature: Dare: Division ot Indusinal Salety Pertnil Number: CEflnFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I certity untler penelty ol perjury ihat 1 have read Ihis application and slate ihal ihe information given is corfacC 1 eg�ae to wmply with all state laws end city ordinences relating to 6ullding cons�mction, and auNodze representalives of Ue City ol Costa Mesa to enter upon the ebo�e-described propeny tor inspection purposes. I egree not to occupy or allow xcupency ol eny building eutnorized by this parmit until linal inspection. Synaiure Ot gal Owneqs) �/ S/ � ate �f 6 A�6� Auttwrizetl Apphcant � ' Date �pf,1, INSPECTIOXTYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Root 201 Finel BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 2p4 Final Demolition PAIE INTITIALS GOpEr INSPECTIONTYPE 206 Finel MecheNCal 20a Flnal Plumhing 210 Final Electricel 212 Final Fira Prevenlion 220 Final Planning Approval 222 Final Sile 250 Finel BuildinyOccupancy PAIE ItIIQ1SL5 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 983 TRABUC�C� Suite No Vicinity: KITCHEN AND BATHROOMS Parcel Number: 42205212 Applicant TERRY, ROY Address: 29291 KENSINGTON DR ,LAGUNA NIGUEL, CA Ownec GAMBLE, RODNEY L Address: . 983 TRABUCO CIR COSTA MESA, CA Contractor: C0,4ST BUILDING CO Address: 29291 KENSINGTON DR LAGUNA NIGUEL, CA MECHANICAL PERMIT Phone: 949-510-2281� Zip: 92677 Phone: Zip: 92627 Phone: 949-510-2281 Zip: 92677 License: 660044 Status: ISSUED Applied: 04/OS/2005 Issued: 04/05/2005 � , . ISSUED BY: SCOPE OF PERMIT INTERIOR 120 SF KITCHEN REMODEL IN P.N EXISTING 2-STORY SFD. WORK TO INCLUDE REMOVING SOFFIT IN KITCHEN�TO ELEVATE THECEILING,.CHANGE-OUT OF FIXTURES AND APPLIANCES. WORK TO ALSO INCL'UDE CHANGE-OUT OF FIXTURES IN THE EXISTING BATHROOMS. - 1 REPAIR/ALT COOLING/HEAT, t HOOD W/MECH EXHAUST � REF:BOS-00542 - � FEESUMMARY 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 Furnace i Quantity $23.50 $0.00 0 $0.00 0 $13.70 1 $0.00 0 $0.00 0 �, e$0.00 ' - 0 - � � $0.00 . 0 $0.00 0 "$10.65 �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 Repair! Alt Absorbtion Unit Repair / Alt Refrigeration Unit , � -� �"- Ventillation System � � � ' Evapo(ative Cooler , � , CommerciaPincinerator , ' Domestic Incinerator -.-., , , " � Compressors / Abso'rption Systems � Upto3hp/t00kBTU �- 3To15hp/SOOkBTU ' 15 To 30 hp / 1,000 k BTU „ , -� 30 To 50 hp / 1,750 k BTU ' � Over 50 hp / Over 1,750 BTU �� Boilers , � . ' , Upto3hp � , � 3To15hp 15to30hp. �� ' 30 to 50 hp . � . ". � Over 50'hp: ' " Other Mechanical Fee Quantity $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 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and itnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. . FOR INSPECTIONS CALL: (714) 7545626 I zaauaet�l - WORKERS'COMDENSArON DECLARATON: I Pereby eKrtn under penelty ot perjury one of the tollowin9 decleratlons: ❑ I heve end will meintein e certificete of consent to self-Insure for workers' compenselion, es providad for 6y section 3700 of the Lohor Code, tor the pertortnance of Ihe work tor which ihis permit is issued. _[�; I heve and will maintain workers' compensetion insurence, es requiretl by section 3700 01 Ihe Labor Code, lor the pertormance of the work Por which this pertnil is issuetl. ..r My worke can nsation Insurance carder end policy num6er ere�. caMe�: ��/`�'� t"`-� N Y� Palicy Number (�� % �� 6�'I (7his sectlon neetl nof be complete0 it the permif is velued et one hundred dollars ($ f o0) or less ) [j I certity Ihat in the pertortoance of the work for which this permit is i35ued, I shall not employ eny per5on in any manner so as to bacome sub�ed m Iha workare' compansation lews ot Calitomia, end e9rae Ihet if I should become sub�ect b the workers' compensation pro�isions oi Section 3700 of the Lebor Code, I shall lorthwith comply with ihese pmvisons. �/ � qpplicani 5ignamre: Dete: '[� � � � WARNING: FAILUFE TO SECURE WORHERS' CIX.IPENSAj1 COVEFiAOE IS UNLAWFUL FND SHALL SUBIECt NN EMPLOVEP 70 CRIMIPIAL GE ALTIES AND qVll FlNES UP TO qJE HUNDRED h1(H15ANDDOLURE(5100,OD0),INFDDITIONTOTME 6 OFCAMPENSAtION,DAMAGESASPROVIOEDFORINSECT10N3]O60FTHELABORCODE,INtEFEST,ANDATTOHNEV'$FEES. LICENSED CONTRACTORS DECLARATION: I qereby affirtn iBat I am licensed/u�nder pro�sions ol Chaptar 9(commencing with Saction 7000) ot Division 3 0l ihe Busina5s antl Professions Code, and my license is in full force and eftect. Lic. a i �1p � O�i y Cless e C�irector's Signawre: � � �, � �ate�. 1 � A� CONSTRUCTION LENDING AGENCY: (] I hereby aHirtn ihat lhere is a cronstruc�ion lending agency tor the pertormance ol the work for which this permit is issued. (Sec. 3097, Civil Cotla). LOnders Name: Lender's Add�ess'. Signature: OM/NER-BUILDER DELLARATIONS: Date: I pereby aHlrm that under penafty of perjory lhat 1 am EXEMPT FROM THE CONTAACTORS LiCENSE LAW for Ma tollowing reason (Sec. 703i.5, Business antl Proiessions C�e: Any ciry or Counry which requires a pertni� to consWCl, elter, improve, tlemolish, or repair eny simcWre, prior lo iis is5uance, also requires ihe applicant for such pertnit to file e 5ignetl sietement that he or she is licensed pursueni to Ihe provlslons of Ihe Conirectors License Law (Chepter 9(commencing with Section 7000) o� Division 3 ot ihe B�siness an� Plotessions Code) or that he or 5he is ezempt theralrom and tha hasis for I�e alleged exem0��on. Any violation of Section 7037.5 by any applicant for a pe�nit sVbl�s the applicent to a civil penelry of not more than tive hundretl tlollars ($500).): d I, es owner ol the property, or my employaes with weges es Iheir sole compensetion, WILL DO TME WORK, and the structure is not intentla0 or offerad for sale (Sec. 7044, Business an0 Profeuions Code: The Contracbrs Licensa Law tloes noI apply to en owner of property who builtls or impmves thereon, antl who Oces such work himsetl or �erself or thmugh his or her own employaes, pmvidetl that such impmvements are not intendad or o%eretl for sale. Ii, however, the building or improvement is soltl wit0in one year ot comple�ion, t�e ownervbuilder will heve �he burden oi proving that he or she did not build or improve �or purposa oi sale.�. d I, es owner of the OropeM. am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS ro consWct the project (Sec. 7044, Business and Professions Code: TTe cnntractors License Lew does noI epply to an owner of proparty who builtls or Impro�es thereon, antl who coNracts for such Oroject with a contracror(s) licensa pursuent to ihe Gontractors License Lsws.). ❑ I am exemp� untler sec. _ Si9�ature: pwner ID venfied Dy drivefs liGense. Venticetion ot Ownarship by {typa ot Business and Pmfessions Code br this reason: Yes ❑ No i.e. - pmperty laz bill or tlaetl)'. DnveYs License No. Date: Expires: DI�ISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hera�y cenify that no azcavation tive (5) or more tee� in dep�h into which a person is required to descend, will be matle in connection with work authonzed by ihis pertnit, and ihat no building sirucWre, scaftolding, falsework, or demolition or tlismantling Iheieot, will 6e more than thirry-siz (36� teet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title 8. Califomla Atlminisirative Code). � A5 ownerv0uiltler, I will not employ enyone to do work which woultl require a permit irom ihe Division of Industnal Sefery, as noted above, unless such person has a pertnit ta do such work from the division. Signature: Date: Di�sion of Industrial Safery Permit NumDer: CEFiTIflCATE OF COMPLIANCE AND AUTHORRATION OF ENTRV: I cenity under penelty ot perjury Ihat I have reatl t�ls epplication antl state lnat ihe informafion qive� �s co�rect. I agree �o comply witn all state laws antl city ordinences rela�ing !o bullaing consimc�ion, end authorize representatives ot the Clry of Casta Mesa to emer upon ihe above-descnbetl p�operty lor inspection puryoses. I agree not to occupy or allow occupency of any builtling eulhorized by Ihis permit umil linal inspection. COUE I, INSVECTIONTYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final pp0 Finel Re-Root 201 Finel BIxWRetaining Wall 2tl2 Final Factory Fire Place 203 FinalSign 204 Final DBmolilion AOPlitant PAiF INTITI�LS COOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Fi�al Elacttical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finaleuiltling/Occupency Date I !Y! �-YP�� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 983 TRABUC� C� Suite No Vicinity: KITCHEN AND BATHROOMS Parcel Nunmber: 422052�2 Applicant: TERRY, ROY Address: 29291 KENSINGTON DR LAGUNA NIGUEL, CA Owner:� GAMBLE;.RODNEYL' Address , 983 TRABUCO CIR COSTA MESA, CA Contractor. COAST BUILDING CO Address: 29291 KENSINGTON DR. ISSUE FEE BackFlow irrigation . BackFlow Preventer � Bathtub Clarifier System Connect pce,Soda,etc) Den[al Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Founiain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) LAGUNA NIGUEL, CA PLUMBING PERMIT Phone: 949-510-2281 Zip: 92677 . . Phone: Zip: .,92627 Phone: 949-510-2281 Zip: 92677 License: 660044 Status: ISSUED Applied: 04/05/2005 Issued: 04/05/2005 ISSUED BY: ' SCOPE OF PERMIT INTERIOR 120 SF KITCHEN REMODEL IN AN EXISTING 2-STORY SFD. WORK TO INCLUDE REMOVING SOFFIT IN KITCHEN TO ELEVATE�7HE CEILING, CHANGE-OUT OF FIXTURES AND APPLIANCES: WORK TO ALSO INCLUDE CHANGE-OUT OF FIXTURES AND FIBERGLASS UNITS IN THE EXISTIIVG BATHROOMS. - - � ' - � 2 BATHTUBS, 2 SHOWERS, 1 KITCHEN�SINK, 2 WASH BASWS, 2 WATER CLOSETS, 1 ' � WATER PIPING QNST OR REP) , � REF: B05-00542 � � FEE SUMMARY �� AMT QTY „ . " " .. AMT QTY " - $23.50 Laundry Tub / Washer $0.00. �.: 0 Sump Pump" " ' $0.00� � 0 Landscape Irrigation . � $0.00 ..':0 . Swimming�Pool ' . $0.00 0 �� - " � .- P-Trap - $0.00 � 0 -� � ' .�� Trap Primer . , $19.60 �' �2 , - PressureRegulator $0.00 0 Urinal .- - �$0:00 0: Process Piping (per 10 k) $0:00 0, -- Vacuum Brkr BkFlow(1-0), . ��$0.00� , 0 , � `Receptors- $0.00 0 _ �, VacuumBrkrBkFlow(5+) � $0.00 , 0 �. SepticTank $0.00 0 _ -WashBasin � � � ,$0.00 0 � - _ � Sewer Cap for Demo $0.00 0 � _ Wash Basin,Set , � $0.00 � 0; _ Sewer Connect � $0.00 0 � WAste and Vent System �$0.00 0 Sewer Privafe Line $0.00 - 0 ' Water Closet (Toilet) $0.00 ' 0 Shower � $t9.60 2 WaterHeater/vent $0.00 ' 0 _., Sink, bar , $0.00 � 0 �, Waler Piping pnst or Rep.) $0.00 0- Sink, commercial � $0.00 0 � Water Re-pipe $0.00 0 �� Sink,Floor . $0.00,",A � � WaterService $0.00 0 Sink, kitchen � � -$9.80 1� Water Softener AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 $0.00 $0.00 $19.60 $0.00 $9.80 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 2 0 0 2 0 1 0 0 0 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void it work is not commenced within 780 days, or if woik is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for lhe work authorizad 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 ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 266636 (8�00) WORKERS'COMPENSAnON DECLARATON: I hereby efrirm under penelty ot perjury one of Ihe (ollowing tleclaretions: d I have end will meintein e certificete of consent to seN-Insure for workers' compensation, es provitled lor by seciion 3700 oi ihe Labor Cotla, for the pertortnance ot ihe work tor which Ihis permit is issuetl. �DI,? I heve and will maintain woAcers' cnmpensation Insurence, as required by section 3700 ot ihe Labor Code, Por the pedormance ot the work �or which this pertnit is issuetl. T My worke�s' c me7p-eyn�s�ation Insurence cerder end pollcy number era: CBmer: � + �Tl= �J� Policy Number. � �R V 7� � — �0 � (7his secNon need not be crompleted i! the permit is value0 af ane huntlred dollars ($100) ar less.) ❑ I cetlily ihat in the pedortnence ot Ihe work for which this pertnit is issued, I shall not employ any person in eny manner so as to becrome sublect to the worknrs' compensation laws ol Cfllifomia, and egree that il I should become sub�ect to ihe workers' compe�sflUoa qroWsions ot Sactioa 37W of the La6o� Code, 1 shaU forthwllh comply with these provisions. �} qpplicaniSignaWre: _�L�r� � Date: 9=1_I� �J � WARNING: FAIWRE TO SECVPE H'ORKERS' COMFENSAII VERAQE IS UNL4WFlIL ANO SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENA�TIES AND pVIL FlNES UP TOONE HUNDRED 7}IOUSAND DOLURE (5100,000�, IN ADDITION TO THE COST OF �MPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 3lW OF THE LABOR CODE, IMEFEST, AND ATTORNEY'S FEES. LICENSED CONTAACTORS DECIARATON: I Pereby afrirm ihat I am licensed under provisions of Chapler 9(commencing with Seclion 7000) ol Division 3 of the B �orce antl effect Lia u 3 Class M Contractor s Signature: ��✓ �— Dete: _ CONSTRUCTION LENDING AGENLV: Code, and my licen5e is in full [J I here6y affirtn that Ihere is a construction lending agency for the pedormanca ol the work for which this permit is issuetl. (Sec. 309J, Givil Cotle). ��ntler s Name: Lentler's Address: Sig�ature: OV✓MER•BUILDER DECIARATONS: Da�e: I pereby attirm t�et untler penalry of perjury Ihet I em E%EMPT FROM TME CONTRACTORS LICENSE LAW b� ihe following reason (Sec. 7031.5, Business antl Professions Cpde: Any ciry or counry w�ic� requires e pertnit to construct, elter, imOrova, tlemolish, or repair eny simcture, prior to its issuance, also requiras the applicant lor such pertnil �e tile e signad statement Ihel ha or she is Ilcensed pursuant Io the provislons of t�e Contrectors Licanse Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe gpsiness entl Professions Code) or that he or she is exempt theretrom entl the basis lor the allegad ezemption. Any violetion of Section 7031.5 by any applicent for a pertnit sUblects the applicant to a d�i penalty oi not more then live �undretl dollars ($500).): ❑ I, es owner of Ihe properry, or my employees with wages es iheir sole compensation, WILL DO 7HE WORK, antl the siructura is not intentletl or otferetl lor sale (Sec. �044, Busi�ess and Pro�essions CoOe: The Contrectors License Law does not appry co an owner of OropaM who builtls or improves thereon, antl who tloes such work �imself or herselt or through his or he� own employees, pmvidetl Ihat such improvements ere not intendetl or oflaretl for sale. N, howe�er, the builtling or impmvemeM is sold within one yeer of complation, the owner-builtler will have Ihe burden of proving t�at ha or she tlid not builtl or improve tor purpose ot sala.). � I, as owne� oi Ihe propehy, am E%CLUSIVELY CONTRACTING WITH LICENSEO CONTRACTORS to cons�ruci the project (Sec. 7044, 6usiness antl Protessions Code: The contrectors Licanse Lew tloes not apply to en owner ot properiy who builtls or improvas thereon, and who contracis ior such projact with a contractor(5) license pursuani to ihe Cantractors License Lews.). ❑ I am ezempt untler sec. Business antl Professions Code tor Ihis reason: $ignaNre: Dale: pwner ID venfietl by tltiver's license. Ves ❑ No Drivefs License No. Venfcation of Ownership by (type of documem, i.e. - property ta: biil o� deea): Expires: DI��SION OF INDUSTAIAL SAFE7Y PERMIT CERTFIGA710N: d I hereby certity ihat no excavation tive (5) or more feet in tlepth into which a person is requiretl to desce�, wi0 be matle �n connection with wodc authorize� by this pertnit, antl that no buil0ing siructure, sceHoltling, falsework, or Oemolition or dismantling ihereoi, will be more than ihirty-six (36) feet high. (Chap. 32, Gry 2, An 2. Sec. 347, Ttle 8, Calitomia Atlministretive Code). � As owner�builtler, I will not employ anyone to do work which would require a permit from Ihe Division of Intlustnal Safety, as notetl above. unless such person has a pertnit to do such work fwm ihe division. Signature� Date: Di�sion of Industnal Satery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHOHVA710N OF ENTRV: I cenify under penalty o� perjury �het I heve read this epplication and stala lhat ihe information qiven is �qrtect. 1 agree to comply with ell stale laws afW ciry ord�nances relatia9 lo builtling constmclion, and authorize rep�esen4atives ot the City ot Costa Mesa to enter upon t�e aW�e-described pmpeny for inspection purposes. I agree not to occupy or ellow occupancy of any building authorized by Ihis permit until linal inspection. ^ Si`gn.�ure Ot Le al Owner(s) �l�v — An0/Or Auihorizetl Appli CQOE 1, INSPEC710NTVPE 1616 Fixed Sysrem Final Fire Prevention 7266 Pool SOa Final 200 Finel Re-Rool 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Flnel Sign 2tl4 Final Demolition Q� INTITIALS SOpE � INSPECTION TYPE 20fi final Mechenical 200 Final Plumhing 210 Finel Eleclrical 212 Finel Flre Prevenlion 220 Flnal Planning Approva� 222 Final Sile 250 Finel Building/OCCupency 2:1IE I[iiIDs:: (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.r��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 983 TRABUCO CI Suite: Vicinity: KITCHEN AND BATHROOMS Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 42205212 . Zoning: Applicant: TERRY, ROY Address: 29291 KENSINGTON DR LAGUNA NIGUEL, CA Owner: GAMBLE; RODNEY L " Address 983 TRABUCO CIR � � - � � ; � �.. � . , � -, C09TA MESA; CA- -' - - - Contractoc COAST BUILDING CO Address: 29291 KENSINGTON DR � LAGUNA'NIGUEL, CA ISSUED BY: Phone: 949-510-2281 2ip: 92677 � . i Status: ISSUED Applied: 04/05/2005 Issued:," 04/05/2005 Phone: � � � - ` , - � . Zip: 92827 �' � , - � . Phone: 949-510-2281 - . - - ' _ Zip: 92677- �' . "License: 660044 , Arch : � � � . , , � Eng: . s, Address: � . � �� Address: - � Phone: Phone: Zip: � . License: License: � SCOPE OF PERMIT INTERIOR 120 SF KITCHEN REMODEL IIJ'AN'EXISTING 2-STORY SFD. WORK TO INCLUDE REMOVING SOFFIT IN KITCHEN TO ELEVATE THE CEILING, CHAN6E-OUT OF FIXTURES AND APPLIANCES. WORK TO�ALSO INCLUDE'CHANGE-OUT OF FIXTURES AND FIBERGLASS UNITS IN THE EXISTING _ - BATHROOMS. ' . � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $18125 $0.99 $0.00 $0.00 $0:00 $182.24�` "' ' Calc Valuation: Claim Valuation: . j PLANNING & ZONING SETBACKS �, , � � � � MAIN STRUCTURE Front 0- 0 ' Rear 0- 0 Left 0- 0. Right 0- 0�- ACCESSORY Front 0- 0 Rear 0- 0 Left 0- 0 � Right ;' 0- 0� PARKING Existing: 0 Required: 0 Proposed: 0. � $9.887.00 $9,887.00 NO710E: The work authorizad by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days. or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetions and final approval must be obtained. Faiiure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7sa5e26 n,d.o,aw, WORKERS'COMPENSATUN DEC�ARATON: � I hare6y eKrtn under penelry of perjury one of Ihe following declerations: ❑ 1 hava end will maintein e cehificate of consent to self-Insure tor workers' campensetlon, es provided for by section 3700 af the Le6or Code, tor the pertormence of the work for which this pertnit is issued. �1 have end will maintain workers' compensetion insurence, es requlretl 6y sectlon 3700 oi the labor Code, for ihe pertortnance of the work for which this pertnit is issuetl. -' My workers' compensetion Insurence cerder end policy number ere: Certier. ��/�"T� �✓`-fY% PolicyNumber: �qU%%U `Z+��i (This secflon need not be completed i! fBe permit is veWeO el one hundred dollers ($100) or less.) p I certity that in the peAortnance of the work br which Ihis permit Is issued, I shell not employ any person in any man�er so as to become subject ro the worknrs' compensation laws oi Calitomia, and egree Ihat �� I should become subject to Ihe workers' compensefion provisions of Saction 3700 f the Labor Cotle, I shell forthwlih comply with these pm�sions. � / � q ppplicant Signeture: - Date: . � V � r-- WARNING: FAILURE TO SECUPE WORKERS' WMPENSATIIXJ CO RAO 5 UNL4WFUL AND SHALL SUBIECT AN EMPLOVER TO CFIMINAL PENAITI S AND CIVIL FlNES UP TOONE NUNDPED TTqUSpNpppLIARE(5100,000),INADDITIONTOTFIECOSTOF SATION,DFMr1GE5A5PROVIpEDFORINSECTION�O60FTHELA60FCODE,INTEREST,ANDATTORNEY'SFEES. LICENSED CON7RACTORS DECLARATION: � hereby aHirtn ihat I am �prCe and eHeCL Lia k�_ �)OnirBCbrS Signature: Ghapler 9(commencing with Section 7000) ol Division 3 of �he Business and Profes5ions Code, and my Ilcense is in full Class u _�� _� oa�e:: ti/ �/6� CONSTRUCTON LENDING AGENCY: p I hereby attirm that there is a consWction lentling agency lor tha pedormance of ihe work lor which this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lander's Adtlress: 5ignature: Dete: OWNER-BUILDER DECIARATIONS: � hereby affirtn ihat untler penalry ol perjury that I am EXEMPT FROM TNE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Gode: Any ciry or counry whicn repuires e permit to consWct, elter. improve, demolish, or repeir eny stmcture, prior 10 its issuance, also requires the applicant for such pertnit to file a signed stetement that he or 5he is licensetl pursuent to 1he proNslons ol the Contrectors License Law (CheD�er 9(commencing with Settlon 7000) at �Ivision 3 of the 0usiness entl Protessions Cotla) or thet �e or she is exempt iheratrom antl ihe Dasis tor iha eltaged examption. Any +riolation M Sedion T031.5 try any applicaM Sor a pertnit subjects ihe e001icant to a civil penalry o� not more than tive hundretl tlollars ($500).): p I, as owner ot Ihe properry. or my employaes with weges as lneir sole compenselion, WILL DO 7ME WORK, antl Ihe structure is not intended or otterea for sale (Sec. 7044, Business and Professions Cotle: The Contrac�ors License Law tloes not apply to an owner of ptopeny who builtls or improves ihereon, and who does such work himself or herselt or through his or her own employees, provided that such improvements ere not intended or oNeretl for sale. tl, however, the builEing or improvement is sWtl wi1Mn one year of completioq the owner-builtler witl hsve the burtlen ot provirg that he a she did fwt builtl a improve tor purpose of safe.�. [] I, es owner ol ihe property. am EXCLUSNELV CONTRACTNG WITH LICENSED CONTRACTORS lo construct the prolact (Sec. 7044, Business and Pmfessions Cotle: The contractors LicenSe Lew does not epply m en owner ot propetly who 6uiltls of Impmves ihereon, antl who contrects for suc� pmject with a contrector(s) license pursuani b �he Contrectors License Laws.). p I am exempt under sec. BuSiness antl Professions Code lor ihis reason: yignature: Daie: Qwner ID venfietl by dnver5liCenSe. Ve5 ❑ No Drivef5 License No. Venlication ol Ownership by (type of d umen , i.e. - pro0erty tax bill or deetl): Expires: DIVISION OF INDUSTAIAL SAFETV PERMIT CERTFICA710N: [] I �ereby certity ihat no excavetion five (5) or more feet in depih into which a person is required to descenq will be made in connection with work au[honzed by this pertnit, antl that no 6Uilding s�ructure, scaHolOing, falsework, or demolition or tlismantling ihereof, will be more than thirty-six (36) feet high. (Ghap. 3.2, Gry 2, Art 2, Sec. 341, Ttle 8, Calitomia Atlministrative Code). p As owner-builder, I will not employ anyone to do work which woultl require e pertnit from the Division of IndusMal Safery, as notetl aDove, unless such person has a pertnit m do suc� work from ihe tlivision. 5ignature: Date: pivision of Intlustrial Safery Permit Number: GERT1flCA1E OF GOMPLIANCE /WD AIffMORIZ4TON OF ENTRY: I coeity under penalry ot perjury that I have reatl ihis application antl state Inat the information given is �orrect. I agree to comply wit� ell state laws end clry ordinances rela�ing to bullaing conslmction, entl euthorize representatives of Me City of Costa Mesa to enter upon tha above-tlescribetl property tor inspactioa purposes. I egree not to occupy or allow occupancy of eny building aulhorizetl Oy this permit until lioal inspection. ��nature 01 Legel Owne�(s) � I� I �ale And/or Authorized ' ant �� — Data ' LOpE �. INSPECTIONTYPE 1616 Fi:eO System Final Pire Prevention �266 Pool SOa Final p00 Final Fe-Roof 201 Pinal Blwk/Retaining Well 202 final Fadory Fire Place p03 Final Sign p04 Finel Demoli�ion DATE IN7IILLfl �Q� INSPECTIONTYPE 206 Final Mechenical 208 210 212 220 F�nal Plnmbing Finel Electrical Final Fire Prevention Final Planning Approval 222 Finel Site 250 Finel BuildinglOccupancy �E u{1Q�� • __ K�-(GH �N REr�c�dE� @ 983 TRP�E��CA GIR�, Cos-rA M�st�, G�, °I2/ 2� :- ;o dNER: ROD:-Gi�rl QL�_. _ �°C83.. ?i2tig�e;0 GI e� - �CDST.A M rcSP. � GA �12to2'7 � zf�_9.-.-:5_`i8=_'723(0.: -- - Go P.ST �U I 1.01 N G� C..d• 24251 KEuSiNGroµ �e, �r�c,JN �. NI�,�EL, c.A 92�77 -P_H�q49-5ia_-2Z8� �5�►� ��,004�'t �� ST �I R� �S `� TY� �I �"� n(E� II "�F` III � -�EF�cz�� =:-f��Nlo E -' ' _ � soF�iTS � �- � u� -D/GJC.� - � tY� i �!; � �i- -- - — ; ��Ec-E.ssE�� - ! I C R A'fE ��.�`�� yG� � LI�i-1'f5� T`(�. SI�1LC�.Fi. c�(.u� , - \ =-K1"rLHgN ; _ ; ��) Nl - � �� -- _. N� � ,' �. ^ . RAE15� Q�i� �\'.I:u �� ' '.s�► ✓�� F (E � , ,_�,;�;�. nR.EMO✓E E'7�IS'(� ' r�_P�.� I N. �5 � Go � N'fPJ7-S. �(ZcMOdE SoF�I'�S _.. _ S��K�-l�lo Q�C L.I S� ri N c�__.. ._. ��Nst�� N�1�1 C; t�6 � N E Ts c� ��►T'�zs E�=P_:e�l �N�ES � C s��'�� .oc P� - -- _. �i:N�_ - 'ri0 N �s-� ��z- tl (7/4) 754-5273 • Fax (714) 754-4856 • www.ci.cosfa-mesa.ca.us BUILDING PERMIT JobAddress: 9$3 TRABUCOCI Suite: Vicinity: ROOF Parcel Number; 42205212 nppiicanC SHULMAN, JOE Address: 7721 ETNA CL HUNINGTON BEACH, CA Owner GAMBLE, RODNEY L Address 983 TRABUCO CIR COSTA MESA, CA Contractor: SHULMAN ROOFING Address: 7721 ETNA CL Arch : Address: Zip: HUNINGTON BEACH, CA Zip; g2648 Phone: License: - 77 FAIR DFIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 03/01/2005 Issued: 03/01/2005 Zoning: / ISSUED BY: �� h� Phone: (714)536-5116 Zip: 92648 Phone: 949-548-7236 Zip: 92627 Phone: (714)536-5116 License: 690617 SGVYt Ut TEAR OFF EXISTING WOOD SHAKE ROOF, RESHEATH WITH 7/16" OSB, 50 YEAR GAF SHINGIES 22 SQ). Plan Check: Permit SMIP Res: SMIP Com: Other: Inspection: $o.00 $139.25 $0.69 $0.00 $0.00 $0.00 Total: $139.94 SETBACKS MAIN S� T�RE Front 0- 0 ACC_ES��RY Front 0-0 pARKING Existin : � Rear 0- 0 Rear 0- 0 Ftequired: 0 Eng: Address: Phone: License: 1 LAYER OF 30# FELT UNDERLAYMENT, & REROOF WITH FEESUMMARY r ..-.r PLANNING & ZONING Left. 0- 0 ` Left .- 0-0 ., , Pro osed: �U ��- ' Calc Valuation: $s,aeo.00 Claim Valuation: Ss,a5o.00 " Right Right 0-0 ' %'� 0-0� ' ;E: The work authorized by thls permit shall comply with all applicable handicap access requirements under California statutes ana reiaieo tions. (Ord. No. 92-28, § �. �2"Z�"9z� pTION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or ebandoned �riod of 180 days. TIONS: In order for the wof�kV ��must be obta nedSFailure�to obtaln napect ons aand f n I pp o al will � sult in'the expPatwnbof th�s permi d a ` Inapeetlons and tinal app �ECTIONS CALL: (714) 754i626 WORKERS' COMPENSATION DECLARATION: I �ereby ettirm under penalry of perjury one ot the tollowing declarations: . ❑ I heve and will malntain a cetliticate oF consent b selt-Insure tor workers' compensation, es provided br 6y section 3700 of the Labor Code, for ihe peAortnance of the work tor which this pertnit is Issuetl. �� I have and will maintain workers' compensetion insurence, as requiretl Dy seciion 3700 oi tha Labor Cotle, tor t�a peAormance of Me work tor whlch [his permit is Issuetl. My worke�rs' C1om ensatioo Insµranc carder antl policy number ere: �j '/ Carrier. �}r��y, �i�1..� � Policy Number. 17� N� �/'tSO 7 (Thls section need not be camp/eted it the permit is valuetl et one hundred dollars (5100) ar less.) � I certify t�at in the perto� ence of the work for hich Ihis permit is issued, I shell not employ any person in any manner so as to become subject to the woAcers' compensation laws oi �31'rfomia, and egree if I s�ould become sub�ed to t�e workers' compensation provislons oi Sectlon 3700 of the Labor Code, I shell forihwi�h complY wi[h th se p isions. Applicanl5lgnatu� Dale: � % l�C� WARNING: FAILURE TO URE WORKERS' COMPENSAiION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNORED THIXISPND DOIURE ( 00,000), IN ADDITION TO THE COST OF COMPENSAiIIXJ, OAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CADE, INTEREST, AND ATTORNEV'S FEES. LICENSED CON7RACTORS OECLARATION: I hereDy aHirtn that I am licensed unf�e�r�pr,Qvisiqns of Chapter 9(commencing with Section 7000) of Division 3 of the Business�d r essions Code, and my license is in full force anC eHect. Lic. k �O`�//)�O, � Class N� Contrectors Signeture: Date: '�J'/ ' �} CONSTRUCTION LENDING AGENCY: ❑ I herehy aHirm Ihat there is a conslruction lending agency tor ihe pedortnance ot the work for which Ihis permit is issued. (Sec. 3097, Civil Coda). LentleYs Name: Lentler's Adtlress: Signature: Date: OWNER-BUILDER DECLARA710NS: I hereby aHirtn ihat under penalry ot perjury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit m construct, alter, improve, tlemolish, or repair any stmcture, pnor to its issuance, also requires ihe epP��nt tor such pertnit to file a signetl statement that he or she Is licensetl pursuant ta the pmvisions ot ihe Contrectors License Lew (Chapter 9(commencing with Saction 7000) of Division 3 oi the Business and Professions Gode) or that he or she is ezempt tharefrom and the besis tor the alleged ezemption. Any violetion oi Section 7031.5 by eny applicant tor e pertnit subjects the ap0licent to a civil penalty oi not more ihan five hundred tlollars ($500).): ❑ I, as owner of the properry, or my employees with weges as iheir sole compensation, WILL DO 7ME WORK, and the structura is not intanded or oflered tor sale (Sec. 7044, Business and Pmfessions Code: The Contractors License Law does not apply ro an owner ot propery who 6uilds or improves thereon, and who does such work himself or herseN or ihrough his or her own employees, provided that such improvements are not intended or otteretl for sale. If, however, ihe building or improvement is soltl within one year ot completioq the owner-builder will have the burtlen of proving that he or sha did not build or impmve tor purpose ot sale.). � ❑ 1, as owner ot the property, am E%CLUSNELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe projea (Sec. 7044, Business antl Prolessions Cotle: Tha contwclors License Lew tloes not applY to an owner of propeny who builds or improves thereon, end who contrads tor such project with e contractoqs) license pursuant to the Contractors Licanse lews.). ❑ I am ezempt under sec. Business antl Professions Code for Ihis reason: Signa�ure: Dale: Owner ID verified by drivefs license. ❑ Ves ❑ No Dfiver's License No. Ezpires: Veritication ol Ov.nership by (type ot tlocument, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby ceniry that no excavetion five (5) or more feet in depth into which a person is required to descBnd, will be made in connection with work euthonzed by this permit, and ihat no building sWcture, scattolding, talsework, or demolition or dismantling thereof, will ba more �hen �hirty-sIx (36) feat high. (Chap. 32, Gry 2, AA 2, SBC. 341, Titla 8, Califomia Adminisirative Code). , � As owner-builder, I will not employ anyone to do work which would require e pertnit irom ihe Division of Indus�rial Safety, es �ofBd 9bOve, UnIBSS SUCh person hes 9 permit to da such work irom the division. Signature: Date: �ivision of Intlustnal Safery Permit Number: Will Ihe applicant or presem or Iuwre building occupam need to file and cetlily a Business Plen Por emergency response lo reiease or threetened release of a hazardous materiell ❑ Yes ❑ No (Section 25505 of ihe Calitomia Health and Safery Cotle requires, with some exceptions, ihat a Business Plan be filed with ihe Costa Mesa Fire Dapahment by every business which has at any one Ume tlunng a reported year a quan6ty o( hazardous matenals equal to or greater then a weight ot 500 pounds, or a volume of 55 allons . or 200, cubic feet, of,compressed gas.at, standard tempereNre.and, pressure) :......................._..............................................-......................................................... Does or wtll the applicam or present or future building occupant neetl b tile e regisiration fortn tor acutely hazardous materia151 (Section 25533 of the Califomia Health antl Safery Cotle, with some exce tions, requires reqisiretlon with iha Costa Mesa Fire Dep❑atlment by e❑ach husiness which at en one time has on hand a quantiry of ecutely hazardous metenals equaPto or greater ihan e welght of 500 pountls, or e volume ot 55 gallons, or 200 cubic fee Y compressetl ges at stentlartl tempereture and pressure). .. . .. ... ..... .... ............. ...... Does or will the applicant or present or future building occupant need to prepere an RMPP'lqic4�i,.i�;;��'___:'e-�-: c--�-�-�� ................_ � of ❑ Yes ❑ No vymm �of 2CUt81 h ........................................ ec ion 5534 of the Califomia Healih antl Safary Code provides ihat ihe Costa Mesa Fire Depatlment may require ihe preparatioq certificafi � a�ertlous eteri Department of an RMPP by businesses which are required to register aately hazardous meterials with the Fire Department. g wlth thelF � ..............................................._.........,....................................._................................._...... ntl filin It an RMPP is presently reQuiretl, has Section 25534 of ihe Califomie�Health entl Safery Code baen fully com ��lie�� e . ....................._........................._............................................._......................................._................._................_.........................._......................................._.. Does or wiu the epplicant or present or future building xwpant require Por ihe work which is Ihe sub�ect of his aw, from the South Coest Air �ualiry Management District or tmm any other air pollution conirol tlistnct or agency7 � (Section 658502 of the Califomia Governmem Code requires �hat the requestetl Informaiion be furnishatl on appiice ..................................._................_........................._......................._._................_................................................_........................................_............................ Will any part of the facility to be constmctatl untler this permit ba within 1000 feet from the outer bountlaries of a sch (Ii "yes", the faciiity must meet the requirement of Sections 25534 antl 42303 ot the Califomia Haalth and Safety Coc . ....... ...... . ... If a permit from the South Coast �Air �pualiry �Management �Disinct or �ojher �eir pollution �conhol tllstn ��""�' epplicatlon, have all oi Ihe disclosures prescn6etl by Calitomia Health antl Safery Cotle Section 42303 been made7 .............................................. ct or agency Qt'yes", attach cenificate of comPliance from the�nnor�.,��Te'�i:'::7:11�::�__..__..r....:....::r ..................._........._.....__... CERTIFICATE OF C regartling Hazardous Signawre: CERnFicerc ne rn.m� i..�..� . LJ Yes . ...................................... ❑ No . ........... ................ .......... . ... . .... . on a Permit for such construCtion or LJ No tor non-residential building permits). .... .................................. ................................... � Yes � No .......................... ......... .. ........................................ leSred for ihe work which is the Su ❑ No . __...._._...,...��. _._..... ..................... ........................... . . certity �hat untler penelty of perjury the information qiven above is correct. I agree to comply with au state lews antl ciry ordinances Emissions. oa�e: wrrecL I agree to comply with all state laws antl city ordinances rela�ing t I building �onstruct onB�a d ehuthonzeeepr senitef �es oftthe City otf CoSta, Mesa to enter upon r ebove-descnbed properry for inspection puryoses. I agree no� to occupy or allow ocapancy of any builtling authorized by this permit until (inal inspection. — .,a ,� GODE � 1616 1266 200 207 202 203 204 INSPEf Fixetl System Final Fire Prevention Pool Spa Final Final Re-Roof Final BIocWRetaining Wall Final Factory Fire Place Final Sign Finai Damolition - u�mrac� 7 �/� os�1e COOE;1 INSPECTION TYVc 206 Final Mechanical ZOe Final Plumbing 2�0 Final Electticel Z1Z Final Fire Prevention zz0 Final Planning Approval 222 250 Final SifB Final BuildinglOccupancy � �' iuWNER DpNAI,p L, F;ATC[IEg DATE 6 17 80 � JOB ADDRESS Tr uco C1rc1e BUILDING PERMIT N0. 50255 AP No. 422-052-12 LOT 10 TRACT 9592 FIRE ZONE SUBCONTRACTOR GAS WATER ROUGX PLume�NG PROP. SWR. IINE r, HOUSE Ci SPRINKLING SVSTEM MISCELLANEOUS ROUGH HERTING r1ND AIR COND W UNDERGROUN�� POWER � � ROUGH WIRING .� TRENCHES FORMS STEEL FLOOR SVSTEM .� 80N� BEAM �� STEEL REINFORO SXEATHING � FqqME RNO FLASNING � LATHING — IN r� OUT n a o �.�o oo„w� �,,,. VENT._ REFRIG. �NO �.C.. F PLIIMBING, FINAL AN� GAS TEST ELECTRIC. FINAL BUILOING, FINFL -y SPFf1AL REOI)IREMENTS � ' iS ■ F � W W Q .N. y x H Q [id F Q A ..i ¢ > r .� x � a O � a z � .T� 3 �+ ' l COSTA MESA BUILD '>AFETY DEPARTMENT , P.O. 60X 1200 COSI. :SA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUIIDINQ () p3 ,.�ydn�� /� `� ADDRESS JO / �W Vs OWNEROR /7D��u� L. �9r/!�-Rm'I� TENANT �/ ADDRE 5 983��Tr7uCO G/�CLG CITV 4F/�� /•�rY�A. - NOL �/ CONSTRVGi�ON BpANCH � ADDflESS ARCHITECT TEL. AODRESS ADDRESS � TEL. CI7Y NO. STATE . CITV LIC. NO. LIC. NO. SIZE NO.OF BLDGS. OF LOT NOW ON LOT VSE OF Separate permits are required for electric, plumbing and heating work: OF BUILDING AND WOiiK TO BE PEFFOR� !` fr�.�C ft. S'� I hereby acknowlatlge that I have read this applicetion antl stata tl�at the above intnrmation is correct antl agree to comA�Y with all laws reg�lating builtling consttucilon, and I shall not employ any Darwn i� violation of the workman's compensation laws of tha Staie of California. I hereby certify that I am properly licensed as a contrector unde� the State oT California Business antl Professions Code. Division 3, Chapter 9, and that uch licenses are In full force antl effect, or I am exempt from a p ovisions of tha Stata of California Business entl Profess�ons otle, ivision 3, Chapter 9. SiBnatura oi Pe�mittee or A /� GO Authorizetl Agent Date .�� 0 1257 6/17/80 10.50 TL APPLICA V FOR STRUCTURAL PERMI7' RECEIVED PERI�T��—(.�a� !)�a ]o�� A.P.NO. ��IiZ. �OS� '�� BUILDING ��w�lICO G(�. ADD RE55 .yy]�� UNIT OR SPACE NO. Tfj.fyjy„ � LOT ,�� BLK. NEW I ADD ^ALTER �REPAIR IMOVINGIDEMOLI OWNER ZONE —� APPROVED VALUE i �. S f EV^� `� GROUP /`.' DATE �/ %�i ND 2�fM_ 0 t�1'/..ST"/.J �e �J � �/ REAR �7 FT.O PLANNINGACTION � ��_�� O DATE / AGPROVED (p / % � C ; m �� SQ. FT. �-- a THE AMOUNT SHOWN UNDER VALUATION IS fOF m THE PUFPOSE OF E5TABLISHING A PERMIT FEE ONLV: � VALUATION PERMIT FEE $ a O ` N m ^ PLAN CHECK $ �� "� Y � $ LL � � � TAX $ � � SC� � U TOTALPAID $ /7. C ! F �d 4 Q � � CC F � W F Q ❑ � a > } � a w a � �i G. z{� 3 � TA MESA B� G-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � For Applicant [o Fill in Completety — Use Ink Only � BUI�DING � S L.ir,R'e, fl �� ADDRESS E�/�}-�Jt�•L Cif-� OWNEfi tT•H. Gregory � ADDRE55 3187 '�G�� Airway Ave. - c�Tv Costa Mesa, No.`751-385 BRANCH Jack Hester r�� ADDRESS ADDRESS 3187 ��Cr�� Airwa,y AVe• c�TY Costa Mesa No�51-3840 �� No. 285-9s1 ��No. 008179 SI2E NO.OF BLDGS. OF LOT 35oosq. ft. averag NOW ON LOT � USE OF EXI5TING BLDG. Separate permits are required for elec[ric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFOFiMED Single Family Res. F'A`u u.�tF -£�-77�.ns�,O� SCS:r ft�� 3ZL;.5 i APPLICATION FOR STRUCTURAL PERMIT RECEIVEDBV DATERECEIVED nnTowcimn BUILDING AODRE55 xxl I I I I OWNER J.H. Gregory �sE Res W Gar �'+��§ 36,600. FIRE ZONE TVPE V GROUP I�^J APPflOVED gy DATE ZON NO.OF; USE OF N � .�%� PLAN$ � BUILOING � �� VARDSAPPROVED VARDSAPPqOVED MAIN BUILDING ACCESSORV BUILDING E FT.�/ FT. L. SIDE �J FT. � � FT. � REAR 0 FT.� FT. DI5TANCE BET. BET. MAIN & MAIN BLOGS. ACCESS. BLOGS. ,�^ CUflP##/��irlS�'�� APPFOVEOI 1'��r�"�/i I hereby acknowletlge that I have reatl Mis application antl state —_�—� --' ' --- �^ n thai the ebove information is correct antl agree�io comply with � ell laws reguleting building construction, and I shall not employ any person In violation of the workman's compensatlon laws of '1 ' � the State of Califarnle. 1'-Y'-YZ SQ. FT. J—�67 Sq. ft. N I hereb certif that I am � y y properly Ilcensetl as a contractor undar the Stata of Californie Business and Profe fons Cotle, Division 3, THE AMOUNT SHOWN UNDEfi VALUATION IS FOR m Chapter 9, antl that such licanses are in t 1 force and affect, or 1 THE PURP�E OF ESTABLISHING A PERMIT FEE ON � am exem fro tha provisia of S te of Cellfornia Businass Q VALVATION PERMIT FEE $ and Pro ssions ode, Oivisio 3, p r 9. � in n � � - ' PLAN CHECK $ J ^� 0 Slgnature LL Permittee _ 3 36, 660. �� TAx $ � Auffioriz A - u TOTALPAID