HomeMy WebLinkAbout1050 WESTWARD LN - Building Permits .
CITY OF COSTA MESA
la BUILDING DIVISION
, DEVELOPMENT SERVICES DEPARTMENT
1. 1
` PE IT NUMBER
� PERMIT B05-01575 '
%Iowa
*44
(714)754-5273m'c • Fax(714)754-4856 • www.ci.costa-mesa.cgt9ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1050 WESTWARD LN Status: ISSUED
Suite: Applied: 09/12/2005
Vicinity: COND BLDG 1050 THRU 1058 WESTWARD LN Issued: 09/12/2005
Primary Occ: R-1 Hotels/Apts/Res>10 Occ Type of Construction: V-N
Parcel Number: TPN99015 Zoning:
Applicant: SELL, RON - ' /
Address: 18032 LEMON
- Phone: (714)528-1758 ISSUED BY: /�
YORBA LINDA,CA Zip: 92686
Owner WESTBLUFF VILLAGE HOA
Address MIKE BERRY - -
COSTA MESA,CA- Phone:
1024 SEA BLUFF DR Zip: 92626
Contractor -SELL ROOFING COMPANY
Address:- 18032 LEMON
Phone: (714)528-1758
YORBA LINDA,CA
Zip: 92686 License: 323842
Arch : ... Eng: _. .-.
•
Address: Address:
Phone: Phone:
Zip: License: License: .
SCOPE OF PERMIT •
'REROOF WESTBLUFF CONDO COMPLEX BLDGS 1050 THRU 1058 WESTWARD LN:REROOF OVER 1 LAYER OF TORCH RUBBER SMOOTH Wll
ROCK B.U.R. -
32SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,900.00
Permit: $139.25 Claim Valuation: $6,900.00
SMIP Res: $0.69 -
SMIP Corn: . $0.00 -
Other: $0.00 •
Inspection: $0.00 -
Total: $139.94
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 - Rear 0-0 . Left 0-0 -Right 0-0 -
ACCESSORY Front 0-0 Rear 0-0 - Left 0-0 •Right 0-0 •
PARKING Existing: 0 Required: 0 Proposed: ' 0.
•
ft
A .
NOTICE: The work authorized by this permit shall,comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
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
2448-48(8/00) -
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
I have and will maintain workers'compensatio 'nsurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers' u epee card rid policy number are: / 7/
/� ry�tn Policy Number: ! O� b �S
(This section need not be completed it the pe it is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,an ree that i should become subject to the workers'compensation provisions of Section 3700 of t Labor e,I shall forthwith
comply with these provisions. — /9 /7 G C
rApplicaant Signetiire: a/L Date: 9
`WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CI L FINES UP TO ONE HUNDRED
THOUSAND OOLLARE($l00,000),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 licensed_unde provisions of�hapter 9(commencing with Section 7000)of Division 3 of the Business and Professio Code,and my license Is in full
force and effect.Lic.-N 7/- ', .// G / Class j
Contractor's-Signature: 2�. ,-a4 " Date:/–'sy /Z�O
•
CONSTRUCTION LENDING AGENCY:
•
❑ I hereby affirm that there is 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).):
O 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.). •
El 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,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O 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? ❑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,or a 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 California 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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aRermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L-I No
(Section 65850.2 of the California Govemment 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 0 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 Manage • -Ijif!istrict 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 byGllffo=;Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If'yes",attach certificate of compliance from the apPropfi: :-';I .ollution control officer).
CERTIFICATE OF COMPLIANCE:I ceiti yithat under penalty 0 perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emission% �'.`�
%
Signature: R= - z Date:
If
CERTIFICATE OF COMP.LIANCE 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 agreeliiis ?�AYY-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*or inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signator Legal O (s) ate r
And/ Authorized Applicant (Da e'
CODE I INSPECTION TYPE PAIS INTmALS CODE. INSPECTION TYPE PATE INTTfULS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final �1 �/ p�,.�ant' 208 Final Plumbing
200 Final Re-Roof /[�`-/`O7 '�`� 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 Final Demolition 250 Final Building/Occupancy
PROJECT ADDRESS: 1050 WESTWARD LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06677C
OWNER'S NAME: WESTBLUFF HOMEOWNERS
7 ..A01TRESS: 7400 CENTER AV PERMIT NO: B 066770 PLAN CHECK NO: N GOVT; N SUPP : N
4 - HUNTINGTON BEACH
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: OTH
ARCM/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF ,REROOF W/TORCH ON BUILT—UP ROOF SQ FT: 7, 150
ADDRESS: UNIT:
CLAIM VALUE: 7, 150 , 00 CALC—VALUE; 7, 150 . 00 GROUP OCC: R-1 /
PERMITTEE EVERGREEN ROOFING ( 714 ) 529-7427
ADDRESS: 1175 ORANGEWOOD DR COMMENTS ; SMOKE DETECTORS REQUIRED PER 91 UBC REROOF 3800SF-5 UNIT APARTME
alp CA 92621 ************�t+F****x*****s¢eE**4 sE*******+EE¢ sESE*x4ts6*x**+ ****s¢*******+Eras**ss*sEe6**xarsr*
LICENSED C r R'.TED TION: I hereby affirm that I am licensed under provisions of Chapter 9(co ncing with Section ZONING REQUIR EMENTS
7000)of Div. •'18 a BJJJJJdssssssnrrrrrRRkRkkss and Professions Code.and my license is in lull force an feet. SETBACK S
CITY LIC.: 15-3-4"37 STATE LIC.: 615531 CLASS: C3
// Date:— Y Signature:- 1f,. _ MAIN BUILDING ACCESSORY BUILDING
`. WORKERS'COMPENSATION D CLARATION: I hereby fir that)have a certili to of consent to self-ins a or a certificate of workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
^ompensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
1 .erDLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV; PARCEL: 93523025 ZNE: REF NO;
3 Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING NOT ES>
>
Date'. Applicant. *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section.•ed eel be completed if th••ermit is for one hundred 13100)or less). DEVELOPMENT SERVICES R E U I R E M E N T S
I certify that in the performance of the work for which this permit is 15 I shall not employ a pe.0 in any manner so as to become p� ��//rr
subject to the Workers Compensation Laws of California. —ZZONING APPROVED BY SO okE DETECj fi DATE;
qy'/ z
Date: 11---/A—// Signature: I BUILDING APPROVED BY �,��
NOTICE:y:II.alter making this declaration,wiyou should become subjectmibe •ervoked.Compensation provisions of the Labor : I►M� DATE
Code.you mLstDINGwAG comply with provisionsmthat
a this permit shalldeemed'al
revoked. nn
U •
CONSTRUCTION LENDING AGE ere•y affirm that there is a c '�n lending agency for the performance of the work for APPLICATION ISSUED H Y; `' DATE•
which this permit is issu•• • lion 9097.Civ.C). *********************4**********************44 ****************4** * * **
LEND '. *******************************************************************************
ADD - 5: ADDRESS INCLUDES LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y
1050-1058 WESTWARD WY
OWNER BUIL• R DECLARA ON: I hereby affirm that l am exempt from the • actors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and• . • sional Code: Any city of county whi • •uires a permit to construct,alter,improve,demolish,or PERMIT 99 . 00
repair any structure.prior to its issua ' • 's ires Ih• -:. or such permit to file a signed statement that he/she is licensed7 2
pursuant to the provisions of the Contractors'State License Law(Chapter 9)commencing with Section 7000)of Division 3 of the Business PLAN 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I, as owner of the property or my employees with wages as Meir sole Compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—--—> 99 . 72 0 , 00 0 . 00 99 , 72 99 . 72 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himselt/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.U.however the building or REVENUE DIVISION TOTALS--> COLLECTED: 99 . 72 OVER/SHORT: . 00
. - improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
forte purpose of sale). 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 99 . 00
72
❑ 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 rare **********************************************************************4********
that proof of their Worker's Compensation insurance should be provided to me. I IND I V IDUAL F E E BREAKDOWN
•
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCR IP T ION UNIT COST TOTAL COST
Date: Owner: SFR 7150 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 7, 150 , 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 will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Ouality 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 agree to comply with all city and county
ordinances and state laws relating to building construction and hereby ouch ' representative this ci to enter upon the a e.mentioned
property for inspection purposes.
1 TE00158745- 8746 TETT
Date: U / L 0
,y Signature: DA : 04/11/001594 TIISE: 14:44 99.72
Driver's License or Social Security a:
1641,46 While—Building:Groep—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CJJSTRUCTION AND PLANNIN:/-- PO 4 SPA
APPROVALS Permit Date Inspector APPROVALS Permit # Date Inspector
Temporary Electrical Service or Pole • 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
,.. 3.'Electrical Conduit Utility•Undtgrnd. • 54. Forms
4. Electrical Conduit-Undrgrnd.' .'55. Electrical Bonding •
• 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -
.'5..Electrical UFER6rnd. 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. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace - APPROVALS Permit#
21.,Duct's, in Structure . . -: - _;" . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24."Roof Framing .. 73. Undergrnd.Storage Tank 0 Gas Oil
r
25. Roof Sheathing 74. Overhead Hydro r r
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27.-Frame and Flashing- 76. try Standpipe
28. Lathing & Siding -I • .• - 77. FIXED SYSTEMIFINAL '
:'29. Insulatidn ; 787 FIRE PREY. FINAL
t30. Drywall Nailing + ! I HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final , 80. 'FOOD CERTIFICATE ISSUED L
33. Final Electric Notes: f� Lt, B,s Ari-2, 9//111 f%i,
�z
34. Final Heating & Air Conditioning.
-
35. Final Gas Pipe-Test P�f 544; ale-- q-C('- ?eG - G��
-36. Hood or Canopy .. , tel
37. Final Factory Fireplace ..
________
38. Final Plumbing Ty- : -
.
39. Water Service-Final c.a. . '
:•r -r
40. Gas Service-Final - `•`
41. Solar Domestic-Final ' -
42. Backflow Preventer �.'-
43. Backflow Irrigation . -
.44. Landscape Irrigation System , - r - ,
45. Sound Attenuation. -- . '
46. Handicap Regulations ..
47. FINAL STRUCTURE & BUILDING .S /51_2 6,,,6se -
48. FINAL PLANNING - .
49. Electric Release to;Edison .
50. Gas Release to Southern California Gas Co - ' • . .
51. CERTIFICATE OF OCCUPANCY
No. Date
PPP./ r ..
%R 442689 AFP ?n-7f�F:�00 405' *; ' 757.30
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For ApplicanJr,'to Eill in Complete) Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING V /
ADDRESS}'`7 jam"' li�` •��'�-� ' r.
OWNERS/4n%'n/ ,1 Iq/L/) ///,r/t/l A.P. NO. �t I �,s R
® 9gde _t `1 igto ADIDRESSI� 7s/•-Z� �•V-p �.L7ft� 0Lk
MAIL /�
ADDRESS r/ k EL rif
CITY ®/,//l//.GQ,T/�0/, NO.(s/�Iy" 7/Z TRACT LOT BLOCK
CONSTRUCTIO NEW ADD ALTER RFPSIR MOVING Dftv1D1ASH
LENDER
BRANCH
-
OWNER / 2rNoFE2/ 4oQ •
iNa.O
ADDRESS VALUE
ARCHY at„„,/,‘,4L. US v UNrf[ $
OR ENGINEER
S.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR By DATE
ADDRESS ZONE INO.OF USE OF NEW
TEL. PLANS BUILDING
CITY NO.
F STATE , y3 CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE " td , I NO.OF BLDGS. (FROM C/L STREET)
C. OF LOT G(/C� • NOW ON LOT FRONT FT. FT.
Q USE OF
y EXISTING BLDG. B.SIDE FT. FT.
h
(-•
Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
O REAR FT. FT.
ILI
[..• USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& • '
Q .2.C/4161.
MAIN BLOCS. ACCESS BLDGS.
Gi
Q c r/G' V` . /bki �`�kg6c 5 C URP# DATE
APPROVED
APPROVED
—ELY DATE
..1 a II
a
(� f0 Ts TU � 1 -1- C
O figi
I hereby acknowledge that I have read this application and state 3 AN i� •1'J-z 1 ,7o Ss-9 i70T- �I
CC that the above information is correct and agree to comply with 1
4• all laws regulating building construction, and I shall not employ
i
Z any person in violation of the workmen's compensation laws of l� U /+� 4
Sthe State of California. (9 q 9 SQ. FT. 55?-- 0IS/ C570 11
tmv ' O
I hereby certify that I am properly licensed - e contractor under
the State of fo is Business and Profe ons Co•e, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o
Chapter , and s licenses are In f: force :nd effect,o I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt fr h rovlsions t�/S : e of C. If• la Bus r:ss v A
J- up
VALUATION PERMIT FEE E
and Professio o DI Sion Ch/p / m as
Signature o / - Ma
PLAN CHECK E2� D In
Permittee / $ !�,(/ a TAX E //i 2� U.
Authorized Agent ` 7 U
TOTAL PAID E Z$` 0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
AI
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Complete! — Use nk nI}' RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING 0 ,
ADDRESS • y/,''.,.,// J� / [/(/_ 2
✓ . . na(s SU /A. C7� �" �(��' PERMIT NO.
OWNER n
MAIL /J BUILDING
ADDRESS C eta vi..._� AI / ADDRESS /La _ _ . _as tar _ r
� 61 A Z
CITY //// �y� a// _A' NOL. ,��� TRACT • ��j�'LffCK
CONSTRUCTION ���� NEW ADD ALTER REPAIR OV C/ • I GUSH
LENDER on& / CLQ- •
BRANCH \57.10./., //�///)�1 ^ /
/,.s OWNER Trr
ADDRESS "0/7.._- L/� ,J /J I , VALUE
ARCHITECTENGINE /lam �) TQQ�C7 f S $
OR EHC�� -/�� // ( N �/�,{7 I�,//' /�frJ
FIRE
ADDRESS
�(r/S/L�'Seig err_./6 Cc ZONE TYPE / GROUP j. 7
,�,�ts'�'�I� APPROVED
CONTRACTOR (,�CenSee.. �+' BY DATE
ADDRESS '�'f/ �.(y�
TEL. NS �UILDING E /
CITY NO. OF ��/Wj�'
F STATE pp CITY YARDS APPROVED YARDS APPROV D //
LIC. NO.e�ACeY LIC.NO. MAIN BUILDING ACCESSORY BUI DI
04 SIZE !!// NO.OF BLDGS /� (FROM C/LAASET)
fi OF LOTS NOW ON LOT l.J FRONT a, FT. FT.
Q
USE O F ,s.��
EXISTING BLDG. R.SIDE '/QT e FT.
ER
Separate in are rred for L.SIDE 4Fr. 6 FT.
electric,plumbing and heating work. REAR """)�!I4 FT.
[W.i USE OF By1ILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
✓t / /] i MAIN SLOGS. ACCESS BLDGS.
DATE
Q 2' �Ls�V••'sr / / 0 �1 CUP. 7h—t 3APPROVEt2.� I / —7
.'.l fit /t— —B_YROVEL.I C/Rp�DATE 1 -2,/-7-7
W !� TOLD FOR SPECIAL REQUIREMENTS
QI hereby acknowledge that I have read this application and state n
EC that the above information is correct and agree to comply with
m
R. ell laws regulating building construction, and I shall not employ al
Z any person In violation of the workman's compensation laws of
I
the State of California. /s' 4
I hereby certify that I am properly licensed as a contractor under ail, SO. FT. ���` • 9,a r
the State of Califor . Business and Professions Code, Division 3, TMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, an• tha/suc licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
to
am exe .• o .visions of h.State of C• ifornie Business a
VALUATION PERMIT FEE E
and Pr• .-sIo s •.d• •Ivisi• 3,.' •ter 9. m
• PLAN CHECK E m
Signature of o
Permittee 11 I $ TAX E u.
f
U
Authorized Agent TOTAL PAID $