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Home My WebLink About774 WESLEYAN BAY - Building Permitsf � i CITY OF COSTA MESA ��pMfs'q BI/ILDING D/VISION F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us ° � FOR INSPECTIONS CALL: (714) 754-5626 �'��"°'�� PERMIT NUMBER: M09-00064 PERMIT TYPE MECH APN: 93768018 JOB ADDRESS: 774 WESLEYAN BAY CM Vicinity: CONDO BALCONY SQ. FT: 0 STATUS: ISSUED DATE ISSUED: 08/05I2009 ISSUED BY: BJK Suite/Unit: SCOPE OF WORK: ADDITION OF 1 HEAT PUMP (2.5 TONS) AND 1 AIR HANDLER TO AN EXISTING CONDO UNIT OWNER: PHONE: APPLICANT: PHONE: SCHIRNER, TAWNYA MARIE JACOBY, ERIC 818-735-7876 CONTRACTOR: ADD AIRE INC. - Address: 834 W PRODUCTION PLUnit: City/State: NEWPORT BEACH, CA ZipCode: 92663 � MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $48.95 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 . REINSPECTION FEE: $0.00 TOTAL FEES: $48.95 Address: 774 WESLEYAN BAY Unit: City/State/Zip: COSTA MESA, CA Address: Unit: City/State/zZip: License No. 906705 PHONE: 714•997-2969 CELL: NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requiremenls under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applirable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval wiil result in the expiration of this permit. LOOEY. INSPELTIONTYPE �AIE INTITIALS CODEN INSPEG710NTYPE ORTE IN7I71pL$ lLr �i _ 1616 Fixed System Final Fire Prevention 206 Final Mechanical _S��v r i r.a» ) /_.—�w�� / 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Eiectriwl 201 Final BIocWRetainin9 Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Finai Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuiltlinglOccupancy ti WORKERS' COMPENSATION DECLARA710N: I hereby aKrm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certifcate of consenl [o self-Insure (or workers' cOmpensation, as provitled for by seclion 3700 of ine Labor Code, tor Ihe �p?rfor nce of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by seclan 3700 of the Labor Code, for Ihe peAormance of Ihe work for which Ihis pertnil is issued. My vrorkers' compensation Insurance carrier and policy number are� / Carrier`��i G .�G(l (Thrs sectun neM i/ro�f �eWmpleletl i/the pertnJ is valuetl af one huntlred tlollars (5100) w IessJ Policy�Number /-Y � Z 7 / Z--� �� --- ❑ I certily that in the peAormance of ihe work for which this permi[ is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject ro the workers' compensation provisions of Section 3700 of �he Labor C�e�ie1, 'allal forthwith comply with these provisio 9t ) (/Z.�-✓ j"�D — AOPlican)'s ignaWre �ate� / WARNING FAILUR O SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR4TION: I hereby affrm that I am licensed untler provisions o( Chapter 9(commencing vrith.Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect. � lic: #-z Class # Z"� � 4'/��°� Comraclor's5ign e Date,� CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm thal there is a construction lending agency for the peAortnance of the mork for which this permit is issued. (Sec. 3097, Civil Code�. �ender's Name: lender's Address: SignaWre Date OWNER-BUILOER DECLARATIONS: I hereby aKrm that under penalty oi perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for lhe follovring reason (Sec. 7031.5, 6usiness antl Pmfessions CoOe: Any city or counry which requires a permit to constmct, alter, improve, demolish, or repair any stmcWre, prior to its issuance, also requires the applicant for such permit to fle a signed statement ihat he or She is licensed pursuant [o lhe provisions of the Contractors license Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe 6usiness and Professions Code) or that he or she is exempt therefrom and �he basis (or the allegetl exemption. Any violation of Seclion 7031.5 by any applicant (or a pertnit subjecls the applican[ to a civil penalry of not more than Tve huntlred dollars (5500�.�: ❑ I, as owner of lhe property, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or Offered for sale (Sec. 7044, Business and Professions Code: The Contrecrors License Law does not apply to an owner of property who builds or improves thereon, and who does such vrork himsel( or herself or through his or her ovm employees, provided that such improvements are not intended or oHered for Sale. If, however, the building or improvement is sold within one year of Completion, the owner-builder will have the burtlen of proving that he or she tlid not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH UCENSED CONTR4CTORS to construct the project (Sec. 7044, Business and Professbns Code: The contrdctors License Law does not apply to an owner of property who builds or improves Ihereon, and who contracts for such project wilh a contractor(s) license pursuaN to the Contractas License Laws.). ❑ I am exempt under sec. 6usiness and Professions Code for this reason: r� - � Owner ID verifetl by tlrivers license. ❑ Yes � No Dnver's License No. Expires: Verification o( Ownership by (rype of document, i.e. - properry [ax bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certify that no excavation frve (5) or more feet in depth into which a person is requiretl to descend, will be made in connection wi[h vrork authoriZed by this permiL antl that no building strucWre, scaHdtling, falsewnrk, p demolition or dismantling ihereof, will be more than thiny-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I wiil not employ anyone to do work which would require a permit from the Division o/ Industrial Satety, as notetl above, unless such person has a permit to do such work from Ihe division. Applicam's SlgnaWre Division of Industrial Safety Permit Numbec _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or fuWre building occupant need lo file and certify a Business Plan !or emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Calilomia Health antl Safety Code requires, wilh some exceptions, that a Business Plan be filed with Ihe Costa Mesa Fire Department by every business which has at any one time during a reportetl year a quantity of hazardous malerials equal �o or greater than a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or wiV the applicanl or present or future building occupant need to fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceplions, requires registration wi�h [he Costa Mesa Fire Department by each business which at any one time has on hand a quantity o( awtely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas at stantlartl temperature and pressure). 3. Does or will Ihe appliCan� or present or fWure building oCcupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safery Code provides that the Costa Mesa fire Depanment may require the preparation, certification and fling with the Fire Department of an RMPP by businesses which are required to register acutety hazardous materials with the Fire Department. 4. If an RMPP is presently requiretl, has Section 25534 of the California Health and Sa(ety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future builtling occupant require for the work whicb is lhe subjecl of Ihis application a permit for such construction or modifcation from the South Coast Air Quality Management District or (rom any other air polWtion control distnct or agency? ❑ Yes ❑ No (Section 658502 of Ihe Califomia Govemment Code requires Ihat ihe requested information be fumished on application5 fa non-residential building permits). 6. Will any part of Ihe faciliry [o be cons[rucietl under this permit 6e wi�hin 1000 feet from the outer 6ountlaries oi a school? ❑ Ves ❑ No Q('yes". Ihe facility musl meet Ihe requirement oF Seclions 25534 and 42303 o( the Califomia Health and Sa(ery Code). 7. If a permit from the South Coast Air Qualiry Management Disirict or other air pollution control district or agency is required for Ihe work which is Ihe su6ject o( this application, have all of the tliscbsures prescribetl by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach certificate of compliance from the appropnate air pollution wntrol officer). CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury the intormation given above is correcL I agree to comply with all state laws and cfty ortlinances regarding Hazartlous Matenals and Emissions. Signature Dale CERTIFICA7E OF COMPLIANCE AND AU7HORIZA710N OF EN7RY: 1 certify under penalty of perjury that I have read this application and slate that the inlormation given is correct I agree to comply vnth all state laws and city ordinances relating to building construclion, and authonze representatives of the Ciry of Costa Mesa to enter upon the above-described property for inspection purposes. 1 agree not to occupy or aUow occupancy ol any building authorized by this permit until final inspection. S aWreofL Owneqs) Ddle � SignaWre Date ' �/; /� " 305]-a6(3ro]� �� 'J AqOlor ulp I tl Applitdnl „ 031e 1 ,, r ��oPo-s�l� C o��`�� v� � O F � g W ��£�j �UM P//�C (�NIT gs�� oti � . .. . '. ..y- APPRO` Cll'Y OF COSTA PLANNING D1V SUCi1F.CT TO BLDG. '. NOTr. nDD1TIONS,. OR c'uItRECT[ONS APPROVL'D BY THE PI � �_�_... . ED , ESA ION :PT. REG. L�TIONS, 'ALL 8E -. JNINC DIV �,1. , ! "'-� r. � 7y � C SL�'�/�N �'`{� :.. . � PENTRt'DGE COVE HOMEOWNER'S ASSOCIATI"ON Professianally Maxaged by Opamum Property Managemenr, 7na (CMF) A CEftTIFIED MANAGE,IIBNT FIRM 77731 Irvine Boulevard, Suire 212, 7ustin CA 92780 O�ce: (714) 508-9070/Fa,r: (714f 6h5-3000 www.optimumpm.com J,ily 1, zooa Q�RI5TOPHER GATES 774 �/ESLEYAN BAY COSTA 11�SA, Ct192626-2986 •• � P>r�,tp� 774 WESLEYAN BAY R� A�dntaumulRe�Ct --AirCm,e(itiw�r Dear Homeoaver(s): The Board of Directois reviewed }�our architectural application, received in our office on 06/ 16/09 for: Cenuzl Air Co❑ditioning Uoi[. Your applicarion �tas been �pproved as subinitted This modificaaom m�st be complered wichin 90 da}s; failure co comply may result in you being required to resubmit your application. All wnrk and funu� upkeep is to be done at yow expense and shall be performed at a time and in a a�anner to m��m;�e interference and inconvenience to odier liomeowners. You shall assume all l;ab�liry and will be responsiblc for all damage and/or injurychat mav resulc fmm performance of this work When the work is completed, please cotn�lete che aaached °No[ice of Completion" form and renun io Optimum Propeity Management, Inc. (CZvIF). L�pon Receipt of the Norice of Compleuon, the .4rehicecttual Commiccee w�ill be no�ified thac dze above rcferenced modifica�ion has been completed and is ready for ;n�pection. . Fwchermore, you are responsible for complying with all applicable fedecal, stace and local laws, codes and t�gulations and requiremenu in conuecriou with this work and s6a11 obtain any necessary go�einmencal permics and approval for rhe work Tbe Boarci of Direceon, iu agent and che Commic[ee have no responsibilitq aric6 respect to such compliance and the Board of Direccors or i[s designated commitcee's approval of this requesc shall aor 6e unden[ood as making of any represencarion or w�arranty thac the plans, specificacions or vrork complywith anylaw, eode, regtilation or govemmenral requiremeni. Should ye�u have any fuxcher quescions, please do noc hesitate to concact the tuidersigned at (714)508-9070 E7ec: 250. At rhe D'ucqkion of the�oard of D'uecco�s ASSOQATION By. $ykp e Jebbia '. Co unityAssociacionNlanager sJ/�z EnGlosure cc: Board of Direcrois // CITY OF COSTA MESA �o�`""'F=Q BIIILDING DIVIS/ON it�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us � FOR INSPECTIONS CALL: (714) 754-5626 4yro„�m e�` PERMIT NUMBER: E09-00201 PERMIT TYPH ELEC APN: 93768018 JOB ADDRESS: 774 WESLEYAN BAY CM Vicinity: CONDO BALCONY STATUS: ISSUED DATE ISSUED: 0810512009 ISSUED BY: BJK Suite/Unit: SCOPE OF WORK: ADDITION OF 1 HEAT PUMP (2.5 TONS) AND 1 AIR HANDLER TO AN EXISTING CONDO UNIT. ELEC: E�UIPMENT HOOK-UP OWNER: SCHIRNER, TAWNYA MARIE PHONE: APPLICANT: JACOBY, ERIC PHONE: 818-735-7876 CONTRACTOR; ADD AIRE INC. Address: 834 W PRODUCTION PI.Unit: City/State: NEWPORT BEACH, CA ZipCode: 92663 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $78.00 Reinspection Fee $0.00 TOTAL FEES $78.00 Address: 774 WESLEYAN BAY Unit: City/State/Zip: COSTA MESA, CA Address: Unit: Ciry/State/zZip: License No. 906705 PHONE: 714-997•2969 CELL: NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statules and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in [he expiretion of this permit. CO�Et. INSPECTIONTYpE DRTE IN1111R1 CO�Et INSPECTIONME p�TE INTITIRLS 1fi16 Fixed System Final Fire Prevention 206 Final Mechani�al 1266 Pool Spa Final 208 Final Plumbing n 200 FinalRe-Roof 210 FinalElectncal S�%��/U ��L� 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factoy Fire Piace 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildingiOccupancy WORKERS' COMpENSATION DECLARATION: I hereby aHirtn under penally o( perjury one of the follovring declaralions: ❑ I have and will maintain a certifcate o( consent to sel4lnsure for vrorkers' wmpensation, as provided for by section 3700 of the Labor Cotle, lor the pedo�r`` ance of tha work (or which this pertnit is issued. �,°[[� I have and wlll maimain workers' compensation insurance, as required by section 3700 of the Labor Ccde, !or the perfwmance of tbe vmrk fa which this permit is issuetl. My workers' compensalion Insurance carrier and policy number are: �% ///1 Carrler. _(//ii � J� �Z�O (Th�c secfion need nW pp cnrtrdeted d tne permn is value0 af we huMied doNars (5100) wlessJ Policy Number: �� G,` � , �.._ Y �—� ❑ I certify lhat in Ihe peRormance of [he work (or which this permit is issuetl, I shall not employ any person in any manner so as to become subject to Ihe workers' compensation laws of Califomia, antl agree that if I should become subjecl to Ihe workers' compensation provisions of Section 3700 of lhe Labor Code, I Sh II fo with compy vnth Mese provisions. �Y� / ApPli�nfr 9nawre � e' � �� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5700,000). �N ADqITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm tha� I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in /ulI (orce and eRecl. i Cic. # i� ��%U ` c�ass u- �� c% � — �'/s%� Comracmr's Sig wre - Da�e �� CONSTRUCTION LEND G AGENCY: ❑ I hereby aHirm that there is a construction lentling agency for the per(ormance of ihe work lor wfiich fhis pertni[ i5's5ued. (Set. 3097, Civil Code). Lender's Name: lender's Atltlress: Slgnawre Dale OWNER-BUILDEk DECLARATIONS: I hereby affirm lhg( under penalty of perjury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pro(essions Code: Any ciry or counry which requires a permit to conswct, alter, improve, demolis�, or repair any structure, prior m its issuance, also requires the applicant (or such permit to file a signed statement that he or she ig licensed purSuaN to the provisions ot the Contracrors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pm(essions Code) or that he or she is ezempl therefmm and the basis (or Ihe alleged exemption. Any violation o( Seclion 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than fve huntlred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and Ihe swcture is not intended or ofteretl for sale (Sec. 7044, Business antl Pmfessions Code: 7Ae Contractors License Law doeg not apply to an owner of property vfio builds or improves thereon, and who does such vrork himself or herself or through his or her own employees, provitletl that such improvements are not intendetl or offered for sale. If, however, the building or improvement is sold within one year of completioq the owner-builder will have the burden of proving that he or she did not build or impmve for purpose ot sale.). ❑ I, as owner oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRpCTORS to construct lhe prqect (Sec. 7044, Business and Professions Cotle: The contractors License Law dces not apply to an ovmer of property who builds or improves thereon, and who contracts for such projec[ with a cmtracta(s) license pursuant to the Contractors License laws.�. ❑ I am exempt under sec. Business and Professions Code for this reason: SiqnaWre Date 305]-66I3/0]) Owner ID verifietl by tlriver's license. ❑ Ves ❑ No Driver's License No. Expires: Verification of Ownership by (rype of tlocument, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: ❑ I hereby ceAify that no excavation 6ve (5) or more feet in depth into wfiich a person is required to descen4 will be matle in connection with work authonzed by this pertnit, and that no building stmcWre, scaffdding, falsevrork, a demolition or tlismantling thereof, will be more than �hirty-six (36) (eet high. (Chap. 3.2, Gry 2, M 2, Sec. 341, Ttle 8. Califomia Administrative Cotle). ❑ As owner-builder, I vrill not employ anyone to do work which would require a permit from the Division of Industrial Safe[y, as noted above, unless such person has a permil lo do such vrork from lhe tlivision. Applicanfs Si9nalure Division ot Industrial Safery Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neetl b file and certi(y a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 oi the Califomia Health and Sa(ety Code requires, wilh some exceplions, lhat a Business Plan be filed vrith the Costa Mesa Fire Department by every business which has at any one time Ounng a reported year a quantity of hazartlous materials equal ro or greater lhan a weight of 500 pounds, or a voNme of 55 gallons, or 200 cubic feet of compressed gas at s�andard lemperature and pressure). 2. Does or will the applicant or present or fuWre building occupant need to fte a regisVa�ion form for aculely hazardous materials4 ❑ Yes ❑ No (Section 25533 of [he Califomia Health antl Sa/ety Cotle, vrith some exceptions, requires registration with Ihe Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous matenals equal to or grealer than a weight ot 500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas at slantlartl temperature and pressure). 3. Does or will the applicant or present or fuWre building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous malerials�? ❑ Yes ❑ No (Section 25534 0! the Califomia Health and Safery Code provides thal the Costa Mesa Fire Department may require the preparalion, certifcation and filing with ihe Fire Department of an RMPP by businesses which are required to register acutely hazardous ma[erials vnth the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health antl Safety Code been fully complied with7 ❑ Yes ❑ No 5. Does or will the applicant or present orluWre building occupaN require for Ihe work which is the subject of lhis application a pertnit for suc� wnstruction or modification from the South Coast Air Qualiry Management Disirict or from any other air pollucion control districl or agency7 ❑ Yes ❑ No (Section 65850.2 of the Califomia Govemment Cotle requires that the requested infortnation be (umi5hetl on applications !or nornresidential 6uiltlinq permits). 6. Will any part of the faciliry to be consiructed under [his permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf "yes", the faciliry must meet the requirement o( Sections 25534 and 42303 of the Califomia Heal[h antl Safery Code). 7. If a permit from the South Coasl Air Qualily Management District or ot�er air polWtion contml tlistrict or agency is required for the vrork which is the subject o! this application, have all of the disclosures presaibed by Catifomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", atiach certifcate of compliance from the appropriate air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the information given above is correcL I agree to comply with all state laws and city ordinances regarding Hazardous Materials antl Emissions. Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty ot perjury thal I have read this application antl slate lhat the infortnation given is mrtecl. I agree b comply with all stale lavrs and city ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa to enter upon the above-describetl propeny for inspeclion purposes. I agree not to occupy or allow occupancy o( any building authorizetl by this permit until fnal inspection. S aWr LegalOwncr�s) Dale I /� h.�, l .+ie�i w.0 S An0/orAulM1Mz2d cent Dale_ a l 1 / F � a ¢ � y � m F G W F a c � a > r .� x � a � �i a Z W 'y. 3 Q ? 75F�/4�2/��yryd��i81 e�j/�,s2��y';;s��8jco 6z� H NItN i %8 %�� /�. 7'7 �,rr-�, i COSTA MESA BUILDINGSAFETY DEPA T T� �Ap�L,ICr�T10N FOR STRUCf7�UIEe�L PERMIT �'•� I T� PA. BOX 1200 COSTA MESA, CALIFORNIA 92626 R�CFjVEj% 8V PF�RMIT Q ' For Applicant to Fill in Completely — Use Ink Only BUILDING nooaess Tract 10626f �r��/, �/ TENANT�R M.D. Janes Co., Inc. ADDRE55 2950 Airway Ave., D-9 TEL. CITY Costa Mesa No. 979-3376 CANSTRUCTION LENDER NOt selected BRANCH N/A ADDRESS ADDRESS CONTRACTOfi ADDRES$ UNIT OR SPACE NO. � USE - F�� 3 ZONE APPaOVED TEL. CITV A N�� e STATE - CITV LIC. NO. e IIC. NO. A OIF LOT 550 � x 334' NOW ON l0 S e USE OF EXISTING BLDG. N/A Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WOPK TO BE PERFORMED I M1ereby acknowletlBe that 1 have reatl this epplication and ttate that the ebove information is correct anA aBree to comply with ell laws regulaiing builtling consiruction, end I shall not employ any person in violation of the workmsn's compensation laws ot tha Stata of California. I he�eby certify ihat I am p�operly licensetl as a tonttactor untler i�e State ot California Business and Protessions Code, Division 3, Chapter 9, antl that such licenses are in tull forca antl ettect, or I am exempi t�om the �ovisions of the $tate of Calito�nia Bysiness and Professions Cotl Divisi rp3, Chapier 9. / SiBnature of `-'�� Permittee or 8/17/79 Authorizad ABent te 0 APPROVEDSETBACKS GL PLANNING ACTION _ 7�%0�%� / J / 1 \ - � —_ !B l?J' �/O.//d' n.� ✓ G�� ~ BLK. REVAIR MOVING �EMOLISI �- VALUE E E V �a��,P �-�.T �-J�� , _ �cs_, THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PVRP�E OF ESTABLISMING A PERMIT FEE ONLV: VALUATtON PERMIT FEE 5 PLAN CHECK y Sd � � s �O � /�gp. c1�'' rnx a TOTALPAID EI i7 Q� � .. f� . \ m `�� N `\ 7 m ��, e a � m o fJ1