HomeMy WebLinkAbout2298 WATERMAN WAY - Building Permits �,9 a Aft - CITY OF COSTA MESA
�, BUILDING DIVISION
I\f' `^•-'c`� ' DEVELOPMENT SERVICES DEPARTMENT
PERMIT P NUMBER \
^
4`°'^O^ 'E°``� P98-00906
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2298 WATERMAN WY Status: ISSUED
Suite No Applied: 12/16/1998
Issued: 12/16/1998
Vicinity:
Parcel Nunmber: 42604165
Applicant NOCK, RON
Address: 11612 KNOTT ST
Phone: 714 895-1246
GARDEN GROVE,CA Zip: 92841
Owner: INNERBICHLER, LEO J TR
Address 2298 WATERMAN WAY
Phone:
COSTA MESA,CA Zip: 92627
Contractor NOCK PLUMBING .
Address: 11612 KNOTT ST
Phone: 714 895-1246
GARDEN GROVE,CA Zip: 92841
License: 707775
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
WATER HEATER .
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap -$0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkftow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $11.00 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $33.00
COMMENTS/SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
far 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
DECLARATIONS
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.
L'.( 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 carrier and policy number are:
Carder: KC( t Or X. N a(t Policy Number: N W r�( Q/3 i'L
2
(This section need not be completed if the permit is valued et 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, ..I. 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. V L�
Applicant Signature: _ Date: r 2� /d �b
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 15 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,003),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 rovisj ps of Chapter-9(commencing with Section 7000)of Division 3 of the Business and Prodi ns Code,and my license is in full
force and effect.Uc.M p20.77 7 5 Class p G '2-
Contractor's Signature: Data: l Y/3' —�
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there fs a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's 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: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 a signed statement 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 civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,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. 0 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,end that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title a,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 or 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.ore 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 Califomia 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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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).
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 ❑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.
Sl..:tura OIL:.: Owner(s Date
And/Or Authorized Applicant Date
CODE L g15PFD/ONTYPE gAff INIALS COgE1 INSPECTIONTYPE DATE II�AL9
1616 Fixed SystemFinal Fire Prevention 206 Final Mechanical /
1266 PoolFinal 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 Anal Demolition 250 Final Building/Occupancy
2446-46
p PR`.O�JECTADORESS: 2298 WATERMAN WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: IB 064086
OWNER'S NAME: INNERBICHLER, LEO J
, ADDRESS: INNERBICHLER, MABEL D PERMIT NO: IB 064086 PLAN CHECK NO: N GOVT: N SUPP : Y
2298 WATERMAN WAY
COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: OTH STR PURPOSE: ALT
( 714 ) 645-3591
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REINSPECTION FEE PER INSPECTOR SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /M-1
PERMITTEE: CHAMPION ROOFS ( 213 ) 898-8600
ADDRESS: 3257 VERDUGO RD COMMENTS: REF: B63822
LOS ANGELES CA 90065 *+E*******a+ ***+E+L*RL*******+E+E**Rru****+E+E+P+E+r+tArRtat*El****+rkt*Etx*EEitaE***yE **ar***E **lt*+rRt+t+E
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONI NG REQUIREMENTS
70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: 0 4 2 7 2 5 STATE LIC.:4 2 9 4 8 1 cuts 3 9 �
-----; Date:9 'D /'9'\ Signature: � a GJ•-•:: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that lhave a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
Compensation 1pspayqqpp�yycpTt e�acopythereof(Section3800.Lab.f� LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
_ POLICY NO.: YWILLbtll EXP.DATE: 85/01 /94
• •COMPANY: GOLDEN EAGLES[ PARKING REQ• PROV: PARCEL: 42604165 ZNE: REF NO:
3 Certifiedieedcopy is hereby furnished. C)4 Certified copy is filed with the city Building Division. PLANNING
PLANNING N TES>
7 Date: 7--a I— 9, Applicant en ) (9e CP,a.. *************it****************************************************** **********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not he completed if the permit is for one hundred($I00)or less). DEVELOPMENT SERVICES REQUIREME
...
T S
I certify that in the performance al the work for which this permit is issued,I shall not employ any person in any manner so as to become 1'•
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY : DATE:
Date: Signature:
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. �JA
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• � /� ?
/{�) DATE; 2 1J
which this permit is issued(Section 3097,Civ.C). ************************************. {E*'2C4************************ * •
LENDER: ************************************************************************ *** **
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL- SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADINS
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 30 . 00 r / 1
repair any structure.prior to its issuance.also requires the applicant for such permit to tile a signed statement that he/she is licensed PLAN SM I P/NON-—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID a DUE \
I. as owner of the property or my employees with wages as their sale compensation. wit do the work, and the
00 , 00
❑ structure is not intended or offered for sate(SSection7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 30 . 00 0 . 00 0 . 00 30.00 30 , ' I ,
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through �„
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 30 . 00 OVER/SHORT: 00
imforptheepurpose of sale). one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 ' 00
•❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors)license pursuant to the Contractors'Slate License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST (TOTAL COST
Date: Owner: INS 1 BUILDING RE—INSPECTION FEE 30 . 00 30 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. ....Y
Date: Applicant: /I
.35
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
oldlnance3 and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. 01 00147360-0014760 TOT30.00
7 Date: 1r—C(' SignamQ
e: e �
1641,46 While—Building;Green—Corte Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
•
I�" • CONSTRUCTION AND PLANNING PL & SPA j moi,
S Permit m Dote Inspector Date inspector
i APPROVALS APPROVALS PennirV, --II
.1
I. Temporary Electrical Sarvice cr Pole.- I 52. Pool & Equ•pment Locat.on
j 2. So;' P pz•Uncirg-rd. -- y`' 53. Steel Rc,nfercement I
�,,.3..X71=G'.r•:a' Cor• t�(t.lit5'-Urdrgr rd-:"'_- J-- 54. Form-, -_ I --_- -______1
.•
1.:'Eleeer+cal ConCt.t•tJndrgrnd. ._. 55. Electrical Bonding j
I
-. ..7,..!.-,a1;4,..- 'Peinlorc re'u•1,j :yam. 56. Rough Plumbing & Pressure Test :. ,
_ ------ ---
'1'11:ralettarcaIUFF:R'G._nd_- - -4.‘“--1
57. APPROVAI- T0COVE R-GUNITE I y I
• '7=CogtPigs - " 58. Electrical Corduit-Urdrgrnd.
- --z- 7--
i ----4
r -ff<;FD'.,--�ut:nn - 59. Gas P.pu, C Undierrd., Test I .
P-0J-730atLP, Pipe•Undrgrrd. 60. Back.-.ash Lines, P-Trao, -' Urdrarrd i
10. Sti.ctura' =luor System 61. APPROVAL TO DECK -
11.. Prope ty Sc..?; Li-.ti& He-,.ase Connection 62. Bae:cr,ash & Receptor-Final
1 12. SeirLer Cap t 63. Heater & Vent-Final
13. Root Drains ., 64. Plumbing System • Final _i
14, Roder Plumbing 65. Electrical-Final C
• 15 Rough Electrical-Conduit 66. Solar System•Final
i 1G. Rough Electrid-Viiring -------_-� 67. Fencing & Access APpro:al -�- _-- - -
17. R .ip i; •nnq S.gn. 68. APPROVED FOR PLASTFRI',IG i
o }-
I 18 Roo
ugElcctripl-T Bar Ceding ' 69. POOL/SPA SYSTE'2S FINAL y
19 Rui.y'n Nen ,rg& Air Coi.ditioning FIRE DEPT. REQUIRLNIEN"i
. - ..4 :I_.41--2.-4. -I: - ':,^- a: r + �_
23: 7a:,q.-. barter,; e,:a: APPRQ Vt1-1.9:-- -Par,`'i�t -''- --�
�.'�_-' " T"- - ---�.
21;_;Docs`. ig S'7c�. -,. -+1 -...., `70. Underw-cone Hyde •Y 1
I22 DU-Crib, zn1; t�rSg'' i - _• ' _jj _+, T . 1 71. Produgt•Ptping tlfjds :;,011 _--_-1
232.G"CP IpC H oygh & fest i - - • t.1 r. .= T R ,. 72. Undo-yr on•r-1 Flu•;' F 1
--tr- -;fy- -cr«;n 4- 1/ - • __...>_.-„:„_t_____•,,._____
--- 7
24..•Rouf Ftt.ming _ '-i' • •• - - •• "- " 73?T Undergrrid• .Stor'1-Tin's4 'Gac @I'
25 ROM. Shaathirg - `.f..u_4!j'_� .4-g= 74:,Overhead HYdrrr,' -�- - -
26cT 5a- Cc nn, $;1l.Cturui &�"fcrrrcoat _ _�..,._,•. - 1- _ __ _4--_ -_.
�- 75- my L. cm.ni _ -
1 2l-,F.a-re eni Flesltticj ,.i,s: fS�-.. S�- 76Y dry Sia^e pe C' .- YS I L -
.28. Lea• ng-& S'e,rg . -arx t: 5 •• •
tt ••_} 777' FIXED 5'� TE?°;cINA1: -" � 7
--
"20. Insu,,.11on , T ii l I -r ; 7F• FIRE PREY. FINAL , r,
T 30. Dryw„TNail,ng + +EALT2t:DEP1t.REQL+9RIIMENT
;31. PlasterPrownCoat : T 70"'?FINAL. I fjECT(ON - '•
1 e i -t i. ♦ i c __ i-1 *_-.-y-t --�T} .� -
- •
�32r'Electrical PC;;er Mete'r•F:na; j 2. e 1'.80.14F00D CERTIF:r'A1 E I UED
's-3. •FilM' Lirtrl4 d 0 N ?s: I. 7 1
n_34-,Final HEaLtHj& Air Condlti0rxn+~ I h t I r •_ L
11 ❑ - . - a:_ )- - 1 { F - __- _ - __ _ -__--1
CI
,3a IFi3a' Cis Rik-Tes� ,. t -L l*x T _ • - � � --- Y- - --- - --- - --- '
- 1 -- ':
I •3G Hccr1 of•Carlopy . _ t, ' a 4 it- r•c' . -
t 1 :� I .1 �, -1
137 .... .F.....y Fuedlace-. (+ _. * _ -.__-.___ - ,
1.738. Find' Plu rnb ng r _ ____ r- y .______- -- - __
L- . .' it � �- .
1._•39. 1Ya1i1r Sf,:vlru Fi Rai' -_ * . -- -
n * i„
1,140. Gas`. ervicr' Final . -- •r'•.1 n; 1,7. pLi_�. Y
1%41. Solar DomcsuoFinal' 1-1
_ _-
42.uBackflon Presenter (.: - j -may - - - - -- ,
43. Backflow Irrigatio+ r -
- .
I _., n, _ is
4.-____i;44. Landscape ti4atic n SYstc rgt r r1 ti- T. - ...
k. ---
45. Sound Attniivatiorl
h46..Handicag Rtyulatiq`ns ,! " .-A G
47.F INAL STRUCTURE & BLtCLDING it - �i t.--• . e 4-- 4.. (c- -��-#_
'48 'FINAL PLANNINGq ;', 1. - I k : i - --
-.49. •Electric Release to.Edison • ; 4 't I
>r . t •
--
f�50. Gas Relecse tp Southern Califurnte Gas Co . _ _, -;
•
'-x-51. CERTIFICATE OF OCCUP4IGCY •
'� ry
(No. Date - -----_\
t
', _a4ECTADDREss: 2298 WATERMAN WY um CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 063822
OWNERSNAME: INNERBICHLER, LEO 'J
ADDRESS: INNERBICHLER MABEL D PERMIT NO: B 22 PLAN CHECK NO: N GOVT: N SUPP : N
PURPOSE: ALT
2298 WATERMAN WAY
COSTA MESA CA 92627 CONSTRUCTION TYPE:06385-N PERMIT TYPE: STR
( 714 )645-391
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T/O SHAKES,RESHEATH 1 /2"CDX APPLY COMPO SQ FT: 6, 400
ADDRESS: UNIT:
CLAIM VALUE: 6,400 . 00 CALC-VALUE: 6, 400. 00 GROUP OCC: R-3 /M-1
PERMITTEE: CHAMPION ROOFS ( 213 )898-8600
ADDRESS: 3257 VERDUGO RD COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDTION OF THE UBC
LOS ANGELES CA 90065 **************************** **************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
70001 of Division 3 0l the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITYLIC.: 042725 STATELID.:429481 Cuss: C39
C/ �' __-4--J� • C�• MAIN BUILDING ACCESSORY BUILDING
Date:—/ � ` -� Signature: T FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation4.1e pf y rXrjOnp copy thereof(Section 3800,Lab.G15/01/9 4
POLICY NO.: YWI.LLCO yL EXP.DATE: 11
• COMPANY: PARKING EAGLE PARKING REQ• PROV: PARCEL: 42604165 ZNE: REF NO:
J Certified copy is hereby furnished. I Certified copy is filed with the city Budding Division. PLANNING NOTES>
Date: y—'3 'C/ Applicant ` ' '" 9 ''-- c ? ..---*********************************************************** * ********
D E V EI'L O P M E N T SERVICES R EQ U I R E M E N'1I' S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1(0)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 becomeI .)
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature: BUILDING APPROVED BY
NOTICE:0.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor . d (/�/��/] DATE:
Code,you must lonnGh NCY: with such provisions or this permit shall be deemriding d fd. �. )'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: jiff DATE.: • .3
which this permit is issued(Section 3097.CH.C). ************************* **** ** ** * *** ******************* } **
UNDER: **************4******************************* ****************4****1F*********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANICFIRE% SMLP./RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 90 . 00 . 64'1
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed —;
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN SM Ip/NON=RES
and Professions Cede)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE e r t7
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL /
PAID' DUE
❑ 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 oe offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 90, 64 0 . 00 0 . 00 90. 64 90,,64' ' . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himsell/herself or through 7i0,
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 90 . 64 OVER/SHORT:,�, 00
improvement
erfslun one year of c0mpletion,the owner will have the burden of proving he/she did not build or improve
forthepurpose eoae) BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/TOT GRADS NG PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
90 . 00 . 6 4:- ' ';
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon .- '
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ******************************************************************9F************
that proof of their worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN' -
❑ I am exempt under Section: B.8 P.C. •
tor this reason: TYPE QTY DESCRIPTIO N •
UNIT COST i TOTAL COST
Date: Owner: SFR 6400 REROOF BY VALUE RESIDENTIAL NOZONE P.00 , 6, 400 . 00
I do hereby cenity that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will nm circle one)need to comply with said state codes and the requirements for a r'1
permit for construction or modification Nom the Air(Malay Management District.Residential construction applications are exempt from
these provisions.
1 T ih
Date: Applicant:
4
I hereby certify That I have read this application and state that the above information is correct.I agree to comply with at city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this thy to enter upon the above.mentianed
property for inspection purposes.
Date: Y - 7 - 9') signature:` '\ G'C— Cais 01 00146350-001'46351 1-1-1-r 90.64
Driver's License or Social Security 0:
DATE: 09/03/93 TIME: i1:53
1641.46 White-Ruddmg:Green-Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
ONSTRUCTION AND PLANNING 1
Pl & SPA
i� APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
i I
1. Temporary Electrical Service or Polo 52. Pool & Equipment Location j
2. So I Pipc-Undrgrnd. • r' 53. Steel Reinforcement
3 F'cctrvc,l Condu-t Uttitv•Undrgrn9, . 54. Forms I •
4. ElpLtrical Coni utt•U-d-gref. I 55. Electrical Bond'ng
5. Steel RrInforcemcnt 56. Rough Plumb rg 8! Prcr:urc T:st I
6. Rs-orrice! OF ER Grrd 57. APPROVAL 10 COVER-GUNITE -t
. 7. Footings 58. Eiectrical Conault•U urgrna. I
B. Foundation 59. Gas P.pe, C Undrernd , Test i •i
9. Water Pipe•Ucdrgrrd._ 60. Backwash Line,,P_rap,_Lr..dr '.:d j __ +
10. Structural Floc- System 61. APPROVAL TO DE CK II
11. Prooirty So•.ler Lin., & Hous(' Connection £2. 33Ccs.o311 & Recd, 1-1 f' i T. ---1--J-- -
12. Scorer Cep 63. Heater & Vert-fF. a'
13. Root Mums
I • 64. Plumbing Systrm F n:I
-
--__ 65. FlectricahFirai _ _-
14. Roar, m
P,ub n: - --}- - � -_
15 Rough E.actncdi-Cond,.t 66. Solar System-Fin.. f
h E!ectnc\'!vin _
16. Rau
g 9 r 57. Fencing & Access A,:pro••,I
17. Rough W17rnrg Sign 1 l 68 APPROVED FOR ?LASTERIX3
tt I
18. Rough Elecb,Cal T Bar Ceding69. POOL/SPA SYSTc'.'S FINAL
IV -t
19. Ruuyh 4a,.tng & A•r Cordrt.on�ng FIRE DEPT. HEOUI9'ii?EidT 1
20.,Rongh Factory flrcp•ace ' ! 't ' ' I APPROVr3,_$ -'^•rite'. •.__ T •---I
21. OoCe, m Sbuciu 70. Und,:rg:G{ tMF,L u
22. D . tlr t:h , .171 Pronuc4-.htipJl-rI . j,--. -'D
r � .
-1
- - _ -1I -4--
i
2j. Ga P_;_ R,.,r L 'CA I 72. Lino : rp6.n1 F" 16y .
.l_-it u$- 1 _ -,. _.N- . v , -.;_-..---4-__
24 Re,, Premm-rn ' , I r t S 7:. ^d, nr7� sr-r.;1. _ I.
--_
r
G. s - - - -
25. Roof Shcatmn? ---. qzz -116eti�1 '#. Os :rcaed•li•;:"e H
2E T.Btr Celina ,St, ,' E ____ pat Chclm ca
27.. Frumt..rd FIsr'y.y - { " , , i�76. Dry Sten' rp^ . . I
-
+- - t r.--t-,- -��_�._ -
.28. Lath:rg & Sa+.�1 r3 7 -. . T-'. L_ 177.: FIXED SYSTEr: FIE,AL
•
• 29. In;ulats:n i I 78 FIRE PREY. FNAU }i
30. Dry±•.a1 \ ^--- •_----- I HEALTH DEPT. REGUIRF.I.;E --. _ ._
•
31. P its `$3';.p Cost --t- j 7 . F •,AL In1SI' t T' 1
3?--East ca' P : s "'curt .t�-rr --- i- -1
�80. FCIODaR , r '01.'r S:rrl .
i.
34. Fra R•ct n;, 8 .'ur l:7 .= t on,nq . • -I i f - - -
35. F,i al G ., Flp. -T, -c .. .. I r •
4.
36. Haid Caropy . ,I . , � c
I -- --t - - -- --- - - - --- - - -. .
37. F.r it F,RorV F✓vu. t&c. - I -_ -__---- --_---- ---- ----- - --
38. Final PIurt b rg . I�1
_�
39. _ ,
1.1.rater Beivic_-FN O '
ce-Fmei
40. Gas Ser,. --- • - -
----- ^ --
41. Solar Cnm.e-to m_! _ L-J+-- __ -. __.L____ - _ _- --_ ,
42. B:.c..!iu:: Pre.tntrr �- 4---li-H
- _ -- ----- ---43. Bucicflor: Irri utbn 9 �`�=1 -23--sr-¢. -w� ����44. L.,rdfc. . k:.q,:t•IrY SYHc:•' .- L.(!�.45. Sound Attensissia- - -- J�-/'�� _r/� e/7745_/41519P,,((,,''``yyJ_g
46. Handicap Rc9u'.tior /J!'�t/�O G,���O/'/ � Z __ /`' _ .
47. FINAL ST'UCTURE & BUILDING )(-3-a3 1 6w4.
- - • co4 _ -,�_
® .,�c�t4
48. FINAL PLANNING _j I
49. Eleefric Release to Edison 1 • --- -
50. Gas Peleise to Southern C.ufortua Gas a I
51. CERTIFICATE O.' G.:CUPAiCCY rr - -- -- -
No. - .-- I I I -- --
-- --- - - --- -�I - - ---- - - - -- --- --
Applicant to fill in all spaces except thoswih
ein heavy border lines and sign all appropriate declarations.
PERMI NO. TRACT NO. LOT NO. UNIT NO. 9( 76 2/II/36
CITY OF,COSTA IVES C N / CTION PERMIT �� " .
aa�� t�r ' rrn�n toy �aa7o4
Project Address y r y . �J1' i
Applicant's Mailing Address ( / (-- A en I TYPE OF CONSTRUCTION ❑ NEW Li ADD Li ALTERATION CJ REPAIR
,,��ia /� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone
Owner's Name �'p�{{����11 ve ,✓ •� • Phone��.LV,:LZ-J� DESCRIPTION OF WORK/USE OF BLDG.
Address On Intl S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION LJ STRUCTURAL E Front 0
Address �)/ � T/� ❑ TENANT ❑ ELECTRICAL 7 PLUMBING ❑ MECHANICAL B Rear N
Contractor's Nam• N���/y./�J��LH#IS ' Ph. e Re I ❑ OTHER A
Address(mailing) I ilIX� I i L a PROJECT DESCRIPTION SQ. FT. OCCUPANCY C -Right G
/ CON STRUCTION TYPE VALUATIONS $ Left
City License No. ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: QM
with section 7000) of Division 3 of the Business and Professions Code,and Eg 3 f�EG
my license is in .I • ce and effect. I\IG� f T
License .las 1 i • 0 MIRECD' S
Date At I Signature £PJi2W� . • AZ1t� PLUMBING FEES
'ORKERS'COMPENSATION DECLARATION Bar Sink Showers
iereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink -
Automatic Washer Transformer 0 15-50 KW
Pole Lab. C- -'�•//_fRi -0
Policy No. L(„� (U O L/ Company _ Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
Certified copy is hereby furnished.
/CertifiedF9 p led with the city .1d. •• I ./ �q.� , Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date /-t / Applicant !Al vCih
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued,I
shall not employ any person in any ornmanner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'h-8
Workers' Compensation Laws of California. —
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE:If,after making this declaration, you should become subject to the _ Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such previsions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet
I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors i Water Heater (( Outlets
Lender's Name a 00 Range
Lender's Address Kitchen Sink Water Service - Switches Sign
OWNER BUILDER DECLARATION
-
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal ;Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair p-Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
he Contractor's License Law (Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
.nerefrom 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 not more than five hundred dollars (8500).
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not Intended or offered - ' Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type 11 ❑ Zoning Approved By nate
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground •
prove for the purpose of sale). Building Approved By Date pry/
CII, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By (6) nate c '/e?t
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU
builds or Improves thereon, and who contracts for such projects with a con- SUMMARY OF FEES
tractor(s) license pursuant'to the Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $
proof of their Worker's Compensation Insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration
0 I am exempt under Section - PLAN CHECK $ PERMIT B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBING $ APO ISSUANCE $
. PLAN CHECK 25% $ ENERGY P.C. $ _ - -
Date Owner Heating System& Ducting Registers
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000BTL GRADING $
information Is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre-
sentatives of this cit to enter upon the above-mentioned property for sl
inspection ourvv es / -g 4 • 0 )
Signature /_ ,A A . �� .:• Date I'I MECHANICAL $ TOTAL FEE $ �/
Drivers' License or SS# - 91 Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
SSINSISCMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor '
CONSTRUCTION AND PLANNING P( & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
3. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
'3. Electrical Conduit Utility-Undrgrnd.' 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
" 12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19..Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: I 2.6-56 LCF1 Ca'ZO•
34. Final Heating& Air Conditioning 12 -2$- t.
CAttgi, ars etc. Zn.3 upc c.E3
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
. 38. Final Plumbing • i-
i
39. Water Service-Final
40. Gas Service-Final
•
41. Solar Domestic-Final
42. Backf low Preventer %7
43. Backflow Irrigation
44. Landscape Irrigation System:,
45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY-OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. •BLDG.NO. Y'J�,S 7�2BIO� 20e(1! 11
CON'eTRUCTION PERMIT 5hE_ 444Ctel
Project Address1'.2 � 'E�m�y )//
y" � V TYPE OF CONSTRUCTION 1,
Owner o Jtiygft? eq/g4Jfl Phon S7 ❑ NEW 0 ADD 0 ALTERATION )
Addres.5-2,29pi UlATf,a n.gnt tilAv 0 REPAIR 0 CONVERSION ['DEMOLISH
ZONING REGULATIONS
Arch/Eng. License No41, Qs.e 0 OTHER �J
Address DESCRIPTION OF WORK .49:17 4477//7//71
,01 Ado contractor) ZONE PLNG. REF.y•
,'a I. TYPE OF PERMIT • LDI NG
Address -.f ell 0 GRADING FOUNDATION 0 STRUCTURAL- $IDEE YARD
LICENSED CONTRACTOR DECLARATION 0 TENANT ELECTRICAL OPLUMBING •f-J,1WEECCHANICA LSIDE YARD
1 hereby affirm that I am licensed under provisions of Charter 9lcom- RIGHT
mencing with section 7000) of Division 3.of the Business and 0 OTHER
Professions Code, and my license Is In full form pd a fel REAR YARD(TO P/L)
License Class �g—e ^-`-'^^nze o
.1 PROJECT DESCRIPTION PKG.SPACE REQ. • PROVIDED
Date 7-I/—r' Signature r% tln.(f./i SQ.FT. _
WORKERS'COMPENSATION DECLARATION OCCUPANCY—CONSTRUCTION TYPE STREET WIDTH PARK FEE$
I hereby affirm that I have a certificate of consent to self-Insure or a VALUATION ZONE ZONING APPROVED BY DATE
certificate of Workers' Compensation Insurance, or a certified copy
thereof(SecctfiJon 3k0A0,}a',C�.�f 1��/C GRADING CU.YDS. ACRES SPECIAL CONDITIONS:
Policy NO.L(/X/d// /��riiQbmPany /�T/�fd77� �/
-
Certlfietl copy is hereby furnished. REMARKS:
Certified copy Is filed with the city Building Division.
EMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred
($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 PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK
subject to the Workers Compensation Laws of California. - UW ELLING GARAGE
BATHTUBS SHOWERS
Date Signature _ • SQ FT
NOTICE: If rs'er making tion provisions
you shouldabor become subjectmTOILETS URINALS ■, GENERATOR 0-1 KW_1-10 KW
to the Workers' Compensationwith pvisio sns the Labor Code,you must TRANSFORMER
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW_SO+KW
revoked.
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP__1_1-10 HP �1 is]
I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50 + HP o�CC/
formance of the work for which this permit is Issued (Section 3097
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES
Lender's Name
Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby affirm that I am exempt from the Contractor's License Law for
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP wrvSI KULI ION
Any city or county which requires a permit to construct, alter, POLES METERED SUB
improve,demolish or repair any structure, prior to its Issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB
quires the applicant for such permit to file a signed statement that he
is licensed pursuant to the provisions of the Contractor's License Law GASSERVICE OUTLETS SERVICE AMP
(Chapter 9 (commencing with Section 7000) of Division 3 of the -
Business and Professions Code) or that he IS exempt therefrom and the WATER HEATERS BTU OUTPUT
basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
of not more than live hundred dollars ($500).
0 I, as owner of the property, Or my employees with wages as their SOLAR TANK COLLECTORS
sole compensation, will do the work,and the structure is not intended
or offered for sale. (Section 7044, Business and Professions Code:The SOLAR PIPING SYS. ISSUE FEE
Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who does such work himself or ISSUE FEE APPLICATION APPROVED BY DATE
through his own employees, provided that such improvements are not '
intended or offered for sale. If, however, the building or improvement MECHANICAL PLANCHECK
is sold within ono year of completion,the owner will have the burden SUMMARY OF FEES
of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU X91 BUILDING
❑ I, as owner of the property, am exclusively contracting with AND DUCTING P.
PERMIT S SMIP E
licensed contractors to construct the project (Section 7044, Business 100,000 +BTU •
PLAN CHECK $ PERMIT
and Professions Code: The Contractor's License Law does not apply to ISSUANCE E
an owner of property who builds or improves( thereon,and who con- G
REFRIGERATION 0-100,000 BTUJO0 PLUMBING S GRADING E
tracts from such protects with a contractor(s)
licesned pursuant t0 SYS
the Contractor's License Law). 100,000+BTU Id PLAN CHECK $
El !�I am exempt under Section B.& P.C.for this BOILERS', BTU/OD /, ELECTRICAL E Ear-u' E
reason MICROFILM E
SYSTEM REPAIR,ALTERATION PLAN CHECK S
Date Owner MECHANICAL S s2srli2101 /5--TOTAL FEE.$
IShereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE LESS AD-
Information is correct. I agree to comply with all city and county PLAN CHECK S VANCE PC S
ordinances and state laws relating to construction,and hereb authorize
r-presentativer of this this city t enter� upon the abov mentioned/ - //�✓f
5 natruY { /I/ /GAJ pa �V O� _ FINAL FEE J!t/T/D
•rivers' License or SS aF ISSUE FEE ME
CMF 0865.46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor c 2_>61
•
CONSTRUCTION AND PLANNING POOL&SPA ! ''
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspe�Qor
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil Pipe-Undrgrn - 44. Steel Reinforcement •
T. Electrical Conduit Utility-Undrgrn 45, Forms
4. Electrical Conduit-Undrgrn 46, Electrical Bonding
5. Steel-Reinforce - . 47. Rough Plumbing& Pressure'Test
6. Electrical UFER Grn 48. APPROVAL TO COVERGUNITE
7. Footings 49. Electrical Conduit-Undrgfn
8. Foundation 50. Gas Pipe, ❑Undrgrn,tTest
9. Water Pipe-Undrgrn 51. Backwash Lines,P-Trap. ❑Undrqrn
10. Structural Floor System 52, 'APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final
_ 12. Street Sewer Connection 54. Heater & Vent-Final
3. Rough Plumbing _ 55. Plumbing System -Final
14. Rough Electric-Conduit :56, Electrical-Final •
15. Rough Electric-Wiring - • - 57. Solar System-Final
16. Rough Heating &Air Conditioning 58. Fencing & Access Approval
17. Ducts, in Structure - 59. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathing NOTES:
22. Frame and Flashing.
23. Insulation et
24, Lathing & Siding kToe
25. Drywall Nailing J c (o-o'(ce( �'s r Q ie., a.a( No pj c.,....+
26. Plaster Brown Coat 0r-at. . .o g-(d-4'/
27. Electrical Power Meter-Final
28. Final Electric - - 7, +/J"f <�C,O / )/5/,y y Lk-Fr C+4@ . C..T.D
29. Final Heating & Air Conditioning 1�.a arm/
.0. Final Gas Pipe-Test l�
31. Final Plumbing _
32. Water Service-Final
33. Gas Service-Final.
34. Solar Domestic-Final
35. Landscape Sprinkling System •
36. Sound Attenuation
37. Handicap Regulations •
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co. -.
42. CERTIFICATE OF OCCUPANCY
No Date
PROJECT ADDRESS: 2298 WATERMAN WY L T UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 066273
OWNER'S NAME: INNERBICHLER, LEO J J 1
ADDRESS: 2298 WATERMAN WAY PERMIT NO: P 066273 PLAN CHECK NO: N GOVT: N SUPP ; N
COSTA MESA, CA 92627
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT: SQ
JOB DESCRIPTION INSTALL WATER HEATER FT;
PERMITTEE: NOCK PLUMBING CLAIM VALUE; CALL—VALUE; GROUP OCC; R-3 /
ADDRESS: (714 ) 8 9 5—12 4 6
11610 SEABOARD CIR COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
STANTON CA90680 ****************+6+tf **********+E***F6y6* -yF**+F**+ys6**** Fie*yF*********y6**************56*
LICENSED CONTRACTOR 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 m nse is in full force and effect, Z ONING REQUIREMENTS
Cn 1c.: 0c038 - STATE LIC" 511971 cuss: C-3t SETBACKS
am _le signature:_ _MAIN BUILDING ACCESSORY BUILDING
ORKERS•COMPENSATION OEcCLAARATION: I hereby affirm that I have a certificate of consen o self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FR NT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section MOO, Lab.Cl. LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
POLICYNO.: 1167992-94 EXP.DATE: 03/01 /95
COMPANY: STATE PARKING REQ• PROV: PARCEL : 42604165 INE; REF NO:
❑ tried copy is ereby f rmsned. ERCertified coot ith the city Build' Division. PLANNING NOTES>
D Applicant: ******************************************************************************* •
EXEMPTION FROM WORKERS'COMPEN TION DECLARATION: (This section need not be completed if the permit is for one hundred Ir i •.. D E VELOP MEN T SERV I C E S- REQUIREMENTS
I certify That in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY
•Date: _ Signature: • DATE;
NOTICE:II.atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY
Code.you must forthwith comply with such provisions or INs permit shall be deemed revoked. DATE:
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY;
DATE• —1 �
• —y
which this permit is issued(Section 3097.Civ.C). **PLIC******ISSUE**************
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7 , 00
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5.% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of•Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars(5500). ISSUE FEE 20 . 00
I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 7 . 00 20 . 00 0 , 00 27. 00 27 . 00 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sate.II,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED : 27. 00 OVER/SHORT: . 00
for the purpose of sate). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK -.
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 27 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).l am aware **********+E**************************{F*****************************************
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN
tor this reason TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 , 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a END OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Dale: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state I ws relating to building construction and he•i authorize r.. ••.lives of this city to enter upon the above.menfioned
p edy for inspect' n purees s.
ar �� /CA, Signatur�- _ - �� 01 DATE:103/07/ 0154 672 09:42, 27.00
Driver's License or Social Securil�
164146 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrrd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final -• 80. FOOD CERTIFICATE ISSUED
33. Final Electric `l Notes:
34. Final Heating& Air Conditioning •
c c7
-1
35. Final Gas Pipe-Test X ,•; :} LL G 1N i 'moi 1.15Zi
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing ' t-- r -
39. Water Service-Final l
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
•
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co _
51. CERTIFICATE OF OCCUPANCY -
No. Date •
JOWNER Hanley, Andrew DATE 11-76
OB ADDRESS 2298 Waterman Way BUILDING PERMIT N0. 41409
+++-�NGGGGGGGF"6RAL CONTRACTOR Owner DESCRIPTION of WORK Stnrp ,e Shed
E 1. 118-203-64 LOT TRACT FIRE ZONE VALE¢ 250 00
.• INSPECTIONS Signature Dote TYPE V OUP J ZONE H1
SOIL _
SUBCONTRA OR PERMITS ISSUED{
GAS Date I Number 1 Signature
WATER Plumbing •
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. 0
SPRINKLING SYSTEM (----'
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING . _
TEMPORARY SERVICE OR POLE -
UNDERGROUND LI POWER 0
ROUGH WIRING Heating and Vent. .
TRENCHES fl FORMS 0 STEEL REINF. 0
FLOOR SYSTEM '
BOND BEAM n STEEL REINFORCE n '
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
P 'ER. BROWN COAT
S .TURAL, FINAL Electric
HEATING. VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n_
ELECTRIC, FINAL
BUILDING FINAL _ � ' e'X
•
. 180I9
COSTA MESA BUILDING-SAFETY DEPARTMENT- n /I�0 � �� riL� at�LLB
62
P. O. BOX 917 COSTA MESA. CALIFORNIA? �_'e.-7" 'yU Fg�gg2
For Applicant to Fill In Completely �� +nln�IrR nFp E
PP P Y APPLICATION FOR' PERMIT
TYPE OR PRINT • C{lY OF LUSIH MESA
BUILDING ZZ? £.I BUILDING
ADDRESS
CO TA MESA. CAL FORNIA/ Qy For Office Use Only
OWNER
/ `�'/ry
[l fr$- I/f/ L;�✓✓• _ RECEIPT NO. / (/MLI/lx D/
OWNER 535 y/�
MAIL
ADDRESS "�/�/////(_ / RECEIVE DAJB�R�=yCg(1/�`�/1'�D %DATE ISSUED62
C �/ / / TN L. ( BUILDING
ADD ESS %19U V//i.l^i u-•oma'/�-'/V�JI/� LGi �J�a
CITY V JL(f(�/j/
ARCHITECT �7E1 � COSTA MESA. CALIFORNIA (,//
OR ENGINEER NO.
ADDRESS FIRE _ //A
- ZONE TYPE GROUT' r
CONTRACTOR W• APPROVED
BY DATE
ADDRESS S4.-C _ ZONING /1' '
ZONE•,, I NO.OF I use or NEW S/^ ?d.n/kV
CITY - /(2 PUNS 2 BUILDING W/
•
STATE �2 G Jq0/TEL. LEGAL �/ p
LIC.NO. V D O /�C NO. DESCRIPTION Le1-/O '/" 4/701 7
SIZE SOS. An.X 5-b d S" X NWo, OF eas. A
/ 44--.- h
OF LOT Q • LJ • 3sEL
DGS I NOON LOT V A.P.NO.
USE OF ` YARDS EVES
_EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM // !I 5---- ie (CANTERLINE ST.)p w 4 2 3 L../CENTER OP STREET �i (Q REAR YARD FRONT _CO '-�L� FT. SIN.
/
SIDE YARD LEFT iU / y
RIGHT 33 S R.SIDE 6 FT. IN.
DESCRIPTION OF WORK L.SIDE ..C. FT. IN.
NEW I� II ALTERATION I II ADDITION I REAR 33 FT. L.(-- IN.
REPAIR I II MOVING I II 7DEMOLISH I APPROVED /n DATE /%l/61
BUILDING /4/70 NO. OF / 1tY N,cD�
SIZE H-yf( ROOMS STORIES
EXTERIOR WAL ROOF //'' ''
COVERING I COVERING W
USE OF BUILDING AND WORK TO BE PERF RM D
../ sips • / - /S. of e / re
I HEREBY ACKNOWLEDGE THAT I HAVE RA THIS APPIJCATION elf
THE AMOUNT SHOWN ODER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORM AND AGREE•TO COM-
PLY WITH ALL CITY 0 NANCEB T8 LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRU VALUATION p^.{[/
SIGNATURE OF ,`/� PERMIT FEE $-'7
PERMITTEE j"� /�!{Y� - e
$ / PLAN CHECK $ 2 7ri_
AUTHORIZED AGENT / re
E
- TOTAL FEE $ 2
^ `-^ Hanle Mari- n and Andrew URIC 3..11.••/(3
• OB ADDRESS 2298 Waterman Way BUILDING PERMIT NO. 41409
NERAL CONTRACTOR Owner DESCRIPTION of WORK Storage Shed
A x. 118-203-64 LOT 10 TRACT 4787 FIRE ZONE VALUES 250.00
IN_. dCTIONS Signature Date ',TYPE V GROUP J ZONE R1
-.SOIL P RMITS ISSUED
,GAS SUBCONTRACTOR
WATER Date Number Signature
Plumbing
ROUGH PLUMBING
ROP. SWR. LINE CI HOUSE CON. fl
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER n
ROUGH WIRING Heating and Vent.
TRENCHES ❑ FORMS fl STEEL REINF. 0
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLACTER, BROWN COAT
S URAL, FINAL Electric
HE...NO, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC. FINAL �,/�
BUILDING. FINAL •-.144 1.-L-77
41409 i4AR 11-76 o0 505* ****1 0.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
•For Applicant to Fill in Completely— Use Ink Only P•IC ION FOR STRUCTURAL PERMIT
Roe I A Y D• ER E r Dc. E sidS �/���
BUILDINGoZai91 att.�CL� ' nr� — i Js / i
ADDRESS « 7!!Gl/u' C/' V � ��//
P -
OWNE' rl�// Aed ' L ' A.P. NO. %�,. 03-� ' dli
ADDRESS.( 9241'&//1111/Id BUILDING ��JJ '/, ,C, ,
//,yam �//f, ¢ ,(�( ADDRESS�r`0 '^' y1l nnan (�
CITY (0576' //Ztoct. NOL�J��orrJB�� TR ACTy7 ' %I LOT !92, BLOCK
CONSTRUCTION NEW I AAD ALTER REPAIR MOVING DFMOI ISH
LENOER X I
BRANCH
OWNEF / H k• / nu ^'
LYJ/A
/
ADDRESS ALOE
ARCHITECT TEL. USE 5aJee
OR ENGINEER NO.
FIRE
ADDRESS ZONE TV E GROUP
CONTRACTOR OWvwz — 6/.cid•
APPROVED ���t}- /QDAA7TEE ai Z�
ADDRESS 761 r//�/�'y v��
TEL. Z l pLo / BUILDING�USE OF ,� r Skied
CITY OF ?�
o-F. STATE CITY YARDS APPROVED YARDS APPRO D
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET/
04 So. OIF LOTNOWZE OF
•LOT FRQNT At; FTS ii FT.
Q USE OFcol /
EXISTING BLDG. 19. .',F SIOF 1. FT,
Fr/J �i
Separate permits are required for L.SIDE 47�5/C�'�` r 4 S� FT.
O electric,plumbing and heating work. REAR .1-yT` FT.
14 USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN&
0 \/ MAIN BLOCS. ACCESS. BLDG&
VAR.46 DATE
a ,,e)
,O C.U.P.gy APPROVED
} fd_sea&
✓ (/ Arita �B.V ROVED C,DR PotE.S-1/—7,6
w
IX
W
40 I hereby acknowledge that I have read this application and state n
X that the above information is correct and agree to comply with m
4• all laws regulating building construction, and I shall not employ
Z any parson in violation of the workman's compensation laws of
,44 the State of California. m
I herepy certify that I am properly licensed as a contractor under 4 SO. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN ER V ATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABL P MIT FEE ONLY: to
am exempt from the provisions of the State of California Business
VALUATIONPE � a
1 FEE S
and Professio s Code,Division 3,C apter . !!! �� m
iste PLAN CHECK $ 5 en
o
0
Signature Of '//y/�/'
Permittee $ ate(/ TAX $ u.2
U
Authorized Agent TOTAL PAID SI 6 7