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Home My WebLink About784 WESLEYAN BAY - Building Permits��i��r�: �� i �"'� L'::'� � � / � CITY OF COSTA MESA Bi/ILDING D/V/S/ON J 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.G.cosU-mesa.ca.us PERMIT TYPE MECH APN: 93768023 JOB ADDRESS: 784 WESLEYAN BAY CM vicinity: . " SQ FT: 0 ' CALL: (714) 754-5626 PERMIT NUMBER: M09-00061 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: FINALED 07/21 /2009 CAC SCOPE OF WORK: REPLACE AC CONDENSER AT THE SAME LOCATION WITH 24K BTU AND FAU 11 K BTU OWNER: PHONE: APPLICANT: PHbNE: MC CEVOY, RYAN MARKLEY GORDON 714-044-7243 CONTRACTOR: MECHANIC REFRIGIRATION COMPANY Adqress: 14770 FIRESTONE BLVDUnit: Ciry/State: LA MIRADA ZipCode; 90638 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: � . $53.10 PLqN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TQTAL FEES: $53,10 , Address: 784 WESLEYAN BAY # 23 Unit: City/State/Zfp: COSTA MESA, CA Address: 14770 FIRESTONE BLVD Unit: City/State/zZip: LA MIRADA License No. 697664 PHONE: 714-044-1243 CELL: NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia stalutes 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 musl comply with all applicable codes, antl all required inspectfons and Flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expi2tion of this permit. cooe . �xsaEcnox me peg INmu�s cooe t �NsvEcnoH rne �'T � 1616 Fixed $ystem Final Fire Prevention 206 Final Mechaniwl g t _ 1266 Pool SOa Final 200 Final Re-Roo! 201 Final8lacWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 208 210 Final Plumbing FinalElectrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Otcupanry WORKERS' COMPENSATION DECLARATION: , I hereby aKrm under penalty of perjury one of the following declarations: . ❑ I have and will maintain a certificate of consent to sel�-Insure for vrorkers' wmpensation. as provitletl for by section 3700 0( Ne Labor Coda, for the pertormance o1 the work for which this permit is issued. ' ❑ I have and will maintain wurkers' compensatbn insurance, as required by sec[ion 3700 of the Labor Cotle, for the peAormance of ihe v+ork for which ihis permit is issued. My workers' compensa�ion Insurance carner and policy number are: Cartier. (Thk serYon neetl rnM 6e mmdetetlllhe perm! is valuetl al me huntlree daNars (5100) wless ) Policy Number: ❑ I certiFy that in the pertormance of the work for which this permi[ is issued. I shall not employ any person in any manner so as to become subjecl [o ihe wo�kers' compensation laws of Califomia, and agree that if I should become subject to the workers' compensation provisions of Seclion 3700 0( the Labor Code, I shall forihwith comply with Ihese provisions. Applipnfs Signalure WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,OW), IN ADDITION TO THE COST OF COMPENSATION, DMAAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensetl under provisions o! Chapter 9(commencing wi[h Section 7000) of Division 3 of the Business and Professions Code, and my license is in tull torce and eRect. Lic. # Class # ConVatlor's SignaWre �ale CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn thal there is a conslruction lending agency for Ihe perfortnance ot the v.ork fa wfiich this pertnit is "ssued. (Sec. 3097, Civil Code). Lender's Name: Lender's Atltlress: Sig�Wre �a�e OW NER•BUILDER DECLARATIONS: I hereby aKrtn [hat unde� penalry o( pe�jury thal I am El(EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any city oi county which requires a permit to construct, aller, improve, tlemolish, or repair any sWCNre, prior to ils issuance, also requires �he applican� for such permit to file a signetl slatement t�at he or she is licensed pursuaM to the provisions ot Ihe Contractors License Law (Chapter 9(commencing wi�h Section 7000) of Division 3 of Ihe BuSiness and Professions Cotle) or that he or she is exempt Iherefrom and the 6asis for the alleged exemplion. Any violation o( Seclion 7031.5 by any applicant for a permit subjects �he applicaN [o a civil penalry ot not more Ihan flve hundred dollars ($500�.�: ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe strucWre is not intended or oflered (or sale (Sec. 7044. Business and Pro(essions Code: The Contractors License Law does not apply to an ovmer ot property who builds or improves thereon, and who does such vrork himself or �erself or through his or her own employees, provided that such improvements are not intended or oflered for sale. If, however, the building or improvement is sold within one year of completion, the ovmer-builder will have the burden ot proving that�he or she did not build or improve for purpose ot sale�. ❑ I, as ovmer of the prbperty, am EXCLUSIVELV CON7RAC71NG WITH LICENSED CONTRACTORS to conswcl the project (Sec. 7044. Business and Professions Code: The wntractas License Law dces not apply to an amer of property who builds or improves thereon, and who cont2cis fw such prqect with a contractor(s) license pursuam to the Contractors License laws.). ❑ I am exempt under sec. Business antl Professions Code for Ihis reason: � S�gnawre oa�e 305]�46�3/Ol) Owner�ID verified by driver ,....,ense. ❑ Yes ❑ No � Dnver's Licanse No. Expires: Verification of Ownership by (rype of document, i.e. - propeny tax bill or deed): Oiyl N OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:' �° ( . certAy Ihat no excavation frve (5) or more feet in dep�h into which a perso descend, will be made in connecl'qn with work autMrized Dy [ e building sWcture, scaHdding, (alsework, a demolilion of antlin more than lhirty-Six (36) feel high. (Chap. 32, Grp 2. Art 2. Sec. , 8, li dminist2tive Code). ❑ As owner-bui �II n mploy anyone to do vrork which would require a permit from the � ot Industnal Safety, as noted above, unless such person has a permit lo o such work (rom Ihe division. Applicanl's SignaWre Date Division of IndusMal Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or tuture building occupant nee0 to (le antl certify a Business Plan for emergency response to release or ihreatened release ol a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions. that a Business Plan be filetl with the Costa Mesa Fire Department by every business which has at any one time during a reportetl year a quantity of hazardous ma[erials equal to or greater than a weighl of 500 pounds, or a volume ot 55 gallons, or 200 cubic leet of wmpressed gas at standartl lemperature antl pressurej. 2. Does or will Ihe applicant or present or fu[ure building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 0l me California Health and Safery Code, with some exceptions, requires registration with Ihe Costa Mesa Fire Department by each business which at any one time has on hand a quantiry o( acutely hazardous materials equal to or grealer than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressetl gas aI standard temperature and pressure). 3. Does or will the applicant or presem or fuNre building occupant need to prepare an RMPP (Risk Managemenl and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of Ihe Califomia Health and Safery Code provitles ihat the Costa Mesa Fire Department may require the prepara�ion, certification antl filing vrith Ihe Fire Depariment 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 l�e California Health and Safety Code been (ully complied with? ❑ Yes ❑ No 5. Does or will Ihe applican� or present or future building occupant require (or the v.ork which is the subject of this aOPlication a pertnit for such cons[ruction or modification from Ihe South Coast Air Qualiry ManagemeN District or from any other air polWtion control dis[rict or agency? ❑ Ves ❑ No (Seclbn 658502 of the Cali(omia Govemment Code requires lhat me requestetl information be fumished on applications for nomresidential builtling permits). 6. Will any part of the faciliry lo be constructed under this permit be within 1000 feet trom the outer boundaries of a school? ❑ Ves ❑ No (If'yes", the facility must mee[ the requiremenl of Seclions 25534 and 42303 o( lhe Cali(omia Health antl Safely Cotle). 7. If a permit trom the South Coast Air Quality Management Dislnct or other air polWlion control district or agency is required for the work which is Ihe subjecl of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf 'yes", attach certifiwte of compliance from the appropriate air �polWtion contml officer�. � � ' CERTIFICATE�OF COMPLIANCE: I certify lhal under penalty of perjury the infortnation qiyen above is correct. I agree to.wmply with all slate laws antl ci�y ordinances regartling Hazardous Materials and'Emissions. ' CERTIFICATE OF COMPLIANCE AND AUTHORIZATION-OF ENTRV: I certify under penalty of perjury Ihat I have read this application and state thal the in(ormalion given is correct I agree to comply with all state laws and city ordinances relating to building consWclion, and aWhorize representatives of Ihe Ciry of Costa Mesa lo enter upon the above-tlescribed pmperty for inspection purposes. I agree not to occupy or allow occupancy of any builainq authorized by this permit until final inspection. . Signature ol Legal Ovmer�s) MOIa Aul�onzeE AOPlitanl p N A�F � e o. "." � > � f �� , _ . '�r '� � CITY OF COSTA MESA � BlIILDING DIVISION � � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 754-0856 • vrNw.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE MECH APN: 93768023 JOB ADDRESS: 784 WESLEYAN BAY CM Vicinity: SQ. FT: 0 PERMIT NUMBER: M09-00061 STATUS: ISSUED DATE ISSUED: 07/21/2009 ISSUED BY: CAC Suite/Unit: SCOPE OF WORK: REPLACE AC CONDENSER AT THE SAME LOCATION W ITH 24K BTU AND FAU 11 K BTU OWNER: PHONE: APPLICANT: PHONE: MC CEVOY, RYAN MARKLEY GORDON 714-044-1243 CONTRACTOR: MECHANIC REFRIGIRATION COMPANY Address: 14770 FIRESTONE BLVDUnit: City/State: LA MIRADA 2ipCode: 90638 c- MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $53.10 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: 50.00 �f TOTAL FEES: $53.10 4" m Address: 784 WESLEYAN BAY # 23 Unit: City/State/Zip: WSTA MESA, CA Address: 14770 FIRESTONE BLVD Unit: Ciry/State/zZip: LA MIRADA License No. 697664 PHONE: 7'14-044-1243 CELL: , -;`�1061 � n n r) r .� t. � .. i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § t, 12-27-92) . t.. �.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 wnsidered 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. O�E� INSPECiIONTYPE DRTE IN7IilALS C�DE� INSPECTIONTYPE ; UATE INTRIALS 1616 Fixed System Final Fire Prevention 208 Final Mechanic2l 1266 Pool Spa Pinal 208 Final Plumbing 200 Final Re-Roof 210 Final Eleciriwl 20'I Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMP@NSA710N DECLARATIO• I hereby affrm�der pqnalty ot perjury one of the (ollowing declarations: ❑ I have and vnll maintain a certificale of consent to sel6lnsure for vrorkers' compensation, as provitled for by section 3700 of the Labor Code, for lhe peAormance of the work for which this permi[ is issued. I have and will maintain vrorkers' compensation insurence, as required by s tbn 3700 of the �abor Code, for the pedortnance of the vrork !or which this permit is issued. My workers' compensation Insurance carrier antl policy C %�1� ��.FA`l�!> ��.�vf/ � �� (Tnrs sedion eed �pl0e mmWeted rt tne permn is valued at on ntlretl lars (Ei w IessJ �� , e�: �--„C�� z S 2-%Y � 0 I cetli(y that in the peAortnance of the vrork for which this permit is issued, I shall not employ any person in any manner so as ro become subject to Ihe workers' compensation laws of California, antl agree that if I s�ould become subject [o the workers' compensation pmvisions of Section 3700 of the La or Code, hall forthwith omply with these provisi s. Ap f{' re D WARNING FAILUR� TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADD1710N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LP,BOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRqCTORS DECLARATION: 1 hereby aKrm that I am licensed untler provisio�s of Chapter 9(commencing with Seclion 7000) ot Division 3 0! lhe Business antl Professions Code, and ��se is in full force and effect. vr ,6 � � C'-2a a raryor s SgnaWre CONS7RUCTION LENDING AGENCY: ❑ I hereby affum that there is a consWction lending agency for the perfortnance of the �+.ork for which this permit is issued. (Sec. 3097. Civil Code). Lenders Name: Lentler's Address: $ignaWre OW NER-BUILDER DECLARATIONS: I here�y aKrm that under penalry ol perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or the (ollovring reason (Sec. 7031.5, Busine5s antl Professions Code: Any city or county which requires a permit to constmct, alter, improve, demolish, or repair any stmcWre, prior to its issuance, also requires the applicanl 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 Nat he or she is exempt therefrom antl Ihe basis for �he alleged exemption. Any violation of Seclion 7031.5 by any applicant (or a permit subjects Ihe applicant to a civil penalry of not more than five hundred tlollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the strucWre is not inlended or offered for sale (Sec. 7044, Business and Professions Code: The Contrectors License Law tloes not apply to an owner of property who builds or improves thereon, and who does such work himsel( or herself or through his or her ovm employees, provided that such improvements are not intended or oRered tor sale. If, however. Ihe building or improvement is sold within one year of completion, the ovmer-builtler will have the burtlen 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 CONTRqCTORS to constmc[ Ihe project (Sec. 7044, Business and Professbns Code: 7he contractors License Law dces not apply to an ovmer of property who builtls or improves [hereon, antl who conl2cts for such prqect with a contractor�s) IicenSe pursuant lothe Conlractors License Laws.�. ❑ I am exempt under sec. Business and Protessions Code for this reason: � • i Ovmer ID venfied by dri license. ❑ Yes � No � Driver's license No. Expires: Verification of Ovmership by (type of document, i.e. - property [az Dill or tleetl�: DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby certHy that no exravation �ive (5) or more teet in depth into which a person is requiretl to tlescend, vrill be made in connectbn with work authorized by Ihis pertnit, antl that no building sWCWre, scaffdding, falsework, or demolition or dismanlling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Code�. ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit from the Division o( Industnal Safety, as noted above, unless such person has a permil lo tlo such work from the division. Applitanfs Signature Date Division o( Industrial Satety Permit Mumbec _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant need to fle and certify a Business Plan for emergency response to release or Ihreatened release of a hazardous material? ❑ Yes � No (Section 25505 of the Califomia Health and Safety Code requires, wiih some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume oi 55 gallons, or 200 cubic feet of compressetl gas at standard tempera[ure and pressure). 2. Does or will the applicant or present or fuWre building occupant need lo file a registration form for acutely hazardous matenals? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Sa(ery Code, with some exception5. requires registration with the Cosla Mesa Fire Department by each business vfiich at any one time has on hand a quantiry o( awtely hazardous materials equal to or greater than a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standartl temperature antl pressure). 3. Does or will the applicant or present or fuNre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous malerials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that Ihe Costa Mesa Fire Department may require [he preparation, certifcation and fling with Ihe Fire Department of an RMPP by businesses which are required lo register acutely hazardous materials with the Fire Department. 4. I( an RMPP is presently required, has Section 25534 of Ihe Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or fuWre building occupant require for the work which is the subject of this application a pertnil (or such wnstruction or modifcation from the South Coasl Air �uality Managemenl District or from any other air pollution contml disirict or agency? ❑ Ves ❑ No (Section 658502 0( Ihe Califomia Govemment Code requires that the requestetl infortnation De fumished on applications for noo-resitlential builtling permits). 6. Will any part of the (acility to be consWcted under this permit be within 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No Q('yes", the faciliry must meet tha requirement of Seclions 25534 and 42303 of the CalifOrnia Heallh and Sa(ely Code). 7. If a permit from the Swth Coast Air Quality Management DisMct or other air pollWion control disMct or agency is required for the work which is the subject of this application, have all ol the disclosures prescnbetl by Cali(ornia Health and Safery Code Section 42303 been matle? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance fmm the appropriate air pollotion con[ml oKcer�. CERTIFICATE OF COMPLIANCE: I certify ihat under penalty ot perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Matenals and Emissions. Signamre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RY: 1 certify under penalty o� perjury that I have read this application and state that the information given is correcL I agree to comply with all state laws and city ordinances relating to builtling constmction, and authorize representatives of the Ciry of Costa Mesa to enter upon the above-described property for inspection purposes. I agree nol to occupy or allow occupancy of any building authorized by this permit until fnal inspection. Si am o(legai s� � Daie Signalure Da�e 305]-a6�J/0]� Analo�i, ¢an� t¢ :. Neighbor 2 r_ • �� C.� C c'�v.� %� �' � c �ih.e2 � -J Level 1 - - — �^ . �=� •. �� Kitchen � 117 Mstr Bath � 5 cfm Hall � 168 cfm A1' l�(��'F i; . , �.�;,,�.,. .us.�.. „� �� i�,,.;�� .i��ti �I !tli (�I I�l Rl I Mstr��7�1�m�(i. ' �;Ii '�I�I)'I'I(�v� I�I I lillu\� ' �� • !<RI ('ll( ItiS :tili:\Ll, lili :��•�.�<�,� �. „ � ��l�. i�l AKNING U V. l31'._C�� —i�1II.: Liv � 235 cfm Ba�ctm 78 Bed � 62 dm lei Nzvrcev.� tr� aM �e , i � Job #: 3088 Engineered Comfort Perfortned by Markley Gordon for: ScAneiCer, lisa 784 Wesleyan Bay Santa Ma, CA Coste Mesa, CA 92626 phane: 714744-1243 Fax: 714-20Q0115 Phone:7143i�1514 engcomfort.com engineeredcomfort(opca.rt.com Neigbor 1 Scale: 1 : 91 Page 2 RIgMSuile� UnWersal 7.1.09 RSU09t53 2009JuL17 72:45:14 :umen5 and SetlingaN F � W a a � y s F G W F r � � � � a a Z �] � 3 � C�STA MESA B�`I�G-SAFETS V• DEPART� N� OG� � 1/O ON FOR�'fR13��i. PERMIT 25 976' D P.O. BOX 1200 :A MESA, CALIFORNIA 92626 For Applicant to Fill in Completely - Use Ink Only R eV P�I37� N� � ADDflE55 6,�Z A. . NO. L�"I -Qq I�-1 ��'� �Z �Z� BU�LDING le �C�Ira 6 T� NANT�R ADDRE55 UI M.D. Janes Co. Inc. �� MAIL�NG UNIT OR c.00REss Z950 Airwa Ave. D-9 SPACENO. TR.f`�obb� LOT BLK. TEI. ` CITV Costa Mesa No. 979-3376 __ _ NEW ADD LTER IREPAIR MOVING DEMOLISM BRANCM ARCNITECT CONYA�+CTOR TEL. TEL. � CITV e NO. STATE CITV LIC. NO. e IIC. NO. e SIZE NO.OF BLOGS. OF LOT 550 � X 334 � NOW ON LOT USE OF EXISf�NG BLDG. N�A Separate permits are req�ired for electric, plumbing and heating work. USE�OF�VILD�NG�AND WORKTO BE PEfiFORMED I heredY acknowledBe that I hava reatl this application and state that tne above informaiion is correci antl egree to wmply wich all laws regulating building consnuction, entl I shell not employ any person in violation of the workman's compensaiion laws of Me Stzte of Calitornia. I herebY certity that I am properly licensetl as a contractor under the State of California Businass antl Professions Code, Division 3, Chap[0r 9, anE thet cuch licanses ere in full tmce antl afteci, m I am exemOt from th provisions oi the State of Celitornia Business antl Professions Co�, Div�pv� 3 Chapter 9. SignatUre ot /� /�- Permittee or a�mort:ecne __�ie R�17�7Q C OWNER VALUE USE E �� 2 ZONE J TVPE V GF APPROVED av DA7E APPROVEDSETBACKS REAFi FT. PLANNING ACTION � �' �!' C DATE �L� � I � r� N'PROVED Z�� A�Rov�,,,, P. ' /� _ � �_ � � m �' � � i �u � �� m SQ. FT. N � ` THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLSHING A PERMIT FEE ONLY: � �`� VALUATION PERMIT FEE E q 7� N m p PLHNCHECK S �� j o S�SI.� iLID.CP,� TAX E � ��.%, f u TOTA�PAID $7,'_�/f�% /" � COSTA MESA B��"JINGSAFETY DEPARTME � Z F � W L Q y H S F G � F a G J Q 7 } ..1 C W a 0 � a Z [iJ 'S' 3 ... _._� �C./!//%=i !�.::�."��_ ;i APPL.. ATTON FOR STRUCTURAL PERMIT .._..,,....___ _,.,,.r....__f,._.._.._.......____„ RECEIVEDBV PERMIT � For Applicant to Fill in Completely — Use Ink Only BUILDING�� 7 A.P. NO. ADDRE55 G. BUILDING OWNER OR ' I ADDRE55 TENANT MAIL�N VNIT OR ADDRE SPACE NO. TR.NO. LOT BLK. TEL CITV NO. CONST CTION N� ADD LTER REPAIR MOVING DEMOLISH LENDE BRANCH OWNER ADDRE55 VALUE ARCHITECT TEL. USE E OR ENGINEER N ADDFESS ZON TYPE GROUP A7P � �//i O C�NTRACTOR BY OATE i' � ADDRESS TEL. CITV NO. STATE CITV AVPROVEDSETBACKS ' LIC. NO. LIC. NO. SIZE NO.OF BLDGS. �FROM C/L STREET) OF LOT NOW ON LOT qpf.J{ FT. USE OF EXIS�ING BLiXi. F . Separa[e permits are required for �. sioe Fr. electric, plumbing and heating woik. REAR Fr. USE OF BUI�DING AND WORK TO BE PEFFORMED PLANNING ACTION DATE APPflOVED APPROVED 1 hereby acknowled8e that 1 have reatl this application antl stato � that tha above information is correct and apree to comply with all laws reBulating builtlin8 consttuction, entl I shall not employ � any Darson in violation of tha workman's compensation laws of � Ma State ot Califomla. m I herebv �ertify xhat I am properlV licensetl as a conbactor under SQ. FT. � tne State oi Caiifor la eusiness and vrotessions CoOe, Oivizion 3, THE AMOUNT SHOWN UNDEfi VALUATION IS FOR m Chapter 9, antl ih such licenses ere in f�ll force anC etfect, or 1 THE PURP�E OF ESTABL75HIhG A FERMIT FEE ONLv: � am exempt }rom e Orovi ons ot ihe State ef Calitornia Business / e VALUATION PERMIT FEE 4 (�•OD and Professions ' 'on 3, Chapter 9. � m Signaiure o GLHN CHECK E `^ 0 Permlttee 5 i TAX S � or L u AUNorizetl nt Date TOTALPAID E/ ,�