HomeMy WebLinkAbout1062 WESTWARD LN - Building Permits 4--4... ;., CITY OF COSTA MESA ,
►w iric4 BUILDING DIVISION
r '�""� ' DEVELOPMENT SERVICES DEPARTMENT F98-00531 .
irePERMIT PERMIT NUMBER
-
(714)754-52773 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1060 WESTWARD LN Status: ISSUE
Suite No Applied: 06/09/1998 V
Vicinity: Issued: 06/09/1998
Parcel Nunmber: 93523016
Applicant: KATHER, SCOTT
Address:
Phone:
Zip
Owner: VON TIESENHAUSEN,
Address ENGELBRECHT
8280 CAMPANA OR Phone:
VON TIESENHAUSEN,LINDA L Zip:89117
Contractor: AQUALINE POOL SERVICE
Address: PO BOX 9694
Phone: 714-742-9597
FOUNTAIN VALLEY CA Zip: 92728
License:515862
SCOPE OF PERMIT
STATE HEALTH AND SAFETY CODE SECTION 116049.1 PUBLIC POOL GFCI INSPECTION.
FEE SUMMARY •
Quantity Quantity
ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 _ Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
•Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $1.00 1 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
'Motors to 1hp $0.00 0 Circus(meth ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00 - .
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $23.00
Intermed Pole $0.00 0
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
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
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. .
❑ 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 carter and policy number are:
Carder: Policy Number.
(This section need not be completed if the permit is valued at 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 Califomi ,end agree that if I sh uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
��` qqq
comply with these provisions y ( ,i .-- C
y' Applicant Signature: Date: l---4 5
WARNING:FAILURE TO SECU WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($103,0t0),IN ADDmON 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 un e� • ons of Chapter 9(commencing with Section 7000)of Division 3 of the Business/end Professions Code,and my license is In full
force and effect.Lia.q (O Class q l i/
L Contractor's Signature: ! 71
Date: ---2.-- 5
CONSTRUCTION LENDING AGENCY: v
❑ 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).):
❑ 1,as owner of the 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 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 end 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. ❑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).
❑ 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 ❑No
(Section 25505 of the Califomia Health and Safely 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 Califomia 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Depanment.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be fumished 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? ❑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 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 (II'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 COMPUANCE 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 properly for
inspectioninpurposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
p /� ,F l�,�Slg OI Legal Owner(s) • 6 _ S_*at9."
7 y And/Or Authorized Applicant / lDat}e(
1/ CODE L INSPECTX)NTYPE DATE =ALS ODE INSPECTION TYPF ME =ALB
1616 Fixed System Final Fire Prevention 206 Final Mechanical ilia.
1266 Fool Spa Final 208 Final Electrca {{ n
200 Final Re-Roof 210 Final Electrical l O(/(�7 B
•
201 Final BIocidRetaining 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
2446-46
IIIIIIIIIIIIII
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
A MESA . •
' PERMIT NO. , ' I ' TRACT NO. • I LOT NO. BLDG.NO. I , , - ' S2(_.-III/- �/•~ r ' S. n
CO ION PERMIT - �j // - _ u 1 , �¢ ' 0 •,
1te 1 ,� '(' (O1 - / ' - Irq I L LI) i , 5) . 1 i= I ' I !o .: c+ _ - Io 1 .l ' ro . F- I - a I I
Project Address • a .60 . rf _ . L ' 7 TYPE OFCONSTRUCTION" 1 CU NEW--Lyy❑^^ADD U�f•LTERAT;1p`�.N7U'REPAIR-t - ' - - ' - - - 1 - - - - - - , �
Applicant's Mailing Address,4
- - • ❑ CONVERSION _❑ DEMOLISH IIB 0THERr. Q((JIrc O'\ - I A:p:,�y, • - t • -' I I j Zone_ ' a ILL
Owner's Name' O!(-1'f H0&C.0 --e4ione - DESCRIPTION-Op wOR/�G� �w^�AJ�%�r j- hi / '! S. Main Building: -- - -Accessory`Building:- - ZZ 1
' Address' - ' ' - TYPE OF PERMIT' U GRADING=LI FOUNDATION' ❑"STRUC RAL c- T Front' - _ _ _ - - •• • 'r' N
Arch/Eng. License No. _ - _ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING' ❑ MECHANICAL I • B Rear e - _ _ - _ • - 1 I
Address . ' .❑ OTHER 1 _ _ ! - I I : , ' a A •
- - _ - - N
?Idi
Right - . , _ c c G
Contractor's NormC •^'�, �• I 'hone" 'Q PROJECT DESCRIPTION, SQ: FT.; 2pDD ' 'OCCUPANCY ' 1 . _S' CONSTRUCTION TV PE ' ' I VALUATION$ '�0�1c Left, IAddreicenss se ing) VW/ �p� ZONE I 1' I G9ADINGCU,VDS ACRES - t- I � QZQCJ94/ - • -: , 9: Ref. # Park:Fees $I 1 p c Ir ll
City License No. - I 1 1 - 1 1 o
LICENSED CONTRACTOR DECLARATION , l 1 i Remarks 1 - 1 . 1 1 1 I I I r l I I i ' Parking Req,/Provided I , 1 I F i I I , I F- I U I' 1
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code,and I I _ I 1 I I I 1 , Use of Building' I , 1 I -1 I Y !c R
my license is in f Il forte and effect. ' 1 I - I _ - • - _ - - E
License Cass G--3'-/ - t-. TI- cense fj1�•;'��'�''27 2.9 Z- 1 1 PLUMBING - ; 11 FEES Planning Notes: I I 1 1 1 ;> E
Date / ^!y 7 Signature 1'(frig ' , ' Ia
'IORKERS'COMPENSATION DECLARATION Bar Sink l ' Show¢rs 1 - - I i I N
1 :. I I I• 1 1 • 1 1 i '3 1 S I
hereby affirm that I have a certificate of consent to self-insure or a certificate - Backflow Prey' 1 _ ' __j ,_ Service Sink_ ! i , ! i I 1
of Workers' Compensation Insurance, or a certified cop thereof- Sect on--' - -- - -- - - --' -- -- — I
3800, Lab. qo I 1 I
cT� S-/IS- r z 7 . .74, I Backflow Irrigation I , Sewer Cap I I ; i I ELECTRICAL I I I I , FEES
Policy No. S./ , Company -�/� G (irU _ - l
1fy certified copy is hereby furnished. 1 I 1 1 ' Bathtubs I � I I I Sewer Connection I I Automatic Washer I i 1. I (Transformer E 15150 KW
Itl Certified copy is filed with the city Building Division. I , 1 - I I
Date Applicant I I I Clarifiers I I I ! Solar Collectors 1 I I Construction Pole Sub I I I I 0SG+KW I
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION---1- -I- ' Dishwasher • 1 Solar Pi in 1 1— i '-' ,-- '�' "I"—'- -`
(This section need not be completed if the permit is for one hundred ($100) or 1 I 1 P 9~ Cooking Unit , Metes❑up tdt100 amps --1,---1-
Iecertify'that.in the performance Of the work for which this permit islssueh I ! Drinking Fountains I I I Solar Tdnk I I I I I - Dishwasher I ! I .Meter Dover 100 amps I i I
shall not employ any person In any manner so as to become subject to the -
Workers'.Compensation,Laws of California. I I I I Floor Drains) I I 1 I Swimming Pool w/Spa I I Dryers ❑Gas i ❑Electric I 1 'Sub Panell I I I I I I I
p I
Date • Signature '
NOTICE: fatter making this declaration,you should become subject to the I I Floor Sinks I 1 I Urinal I I I I -_I. _ Fani I -.4. 1 I
Workers' Compensation provisions of,the Labor_ Code, you must forthwith T "- -- ---1_-" - _ _ _Fan!- Motors DOr1_HP 01'6;8 4
comply with such provisions or this permit'shall be l deemed revoked: p I Gas Service' I 'Outlets: ,` I L- (Water Closet) ✓ I v I 'eC I I nC I w _, , F,A{U. I I I . 1 I Incf .Solari❑9-15 HP ❑1,6-15+ I
CONSTRUCTION'LENDING AGENCY: • I - ' `/' 1 lJ ' ? I ti _ a
1 hereby affirm that there is a construction lending agency for the performance I ` Interceptors' & I 1 .r I . _t!'loter,Heater �, , - I ' i ,._ , f Fixtures ' 1
of the ,work for which this permit is issued (Section 3097- Civ. 'CJ' • 1 _ 1 - _ I I I I I fMiCrowave ( I I I I
Lender's Name. 1 • - ' 1 m 1 - I I _ Cf:,' ..
I _ 1 ! kitchen'Sink! T , I S I j _Water Service > �,. w I I ' Device I ! I IPoleiLight : I : I I
Lender's Address - - 14- I
OWNER BUILDER DECLARATION I _ I ' 'La,a`ories; I Q -, p I to n • - <1 I ! 11 i 1 - I • 1 ' O 1. 1 ' I 1 I I I 1 1 I
1 -. . I C i : _ Outlets 1 I ;Range
I hereby affirm that I am'exempt from the CdProfe or's License I:aW f-or the - - -
following reason (Section 7031.5 Business and Professional C de:•Any city or ' . P-Tiap1 r I - 1 . ? I _. ^ I t I -- 1 0. I T , T -' IT Switches 1 I 1 !Sign' I I 1 ' I '
county which requires a permit to construct,alter,improve,demolish;Oprepair 1
any structure, prior to itsdssuanee, also requires the applitantfor such permit I Roof.Draiiisl m I ' I I " = i -' I ° I ; - I • i �( • .-. : • " Garbage Disposal ' - I I Standing Sections
to file a signed statement that he/she is licensed pursuant to the provisions of 1 - - - ' 1 I I I
the Contractor's License Law(Chapter 9(commencing with Section-7000)of V i i -- ' - -i C i j I - I t: ' I Generator ❑65 KW 05-15 KW 1
Division 3 of the'Bsifor
and Professions Code) or that ha/she is exempt I a i ' ( CC I h- I m F I J I .. I Iv y I I 1 I a ! a, I _ 1 - I t7 Trash Compactor I I I I
,therefrom and the basis forlhe allegedperm exemption. Any.vlolation_of Section I n I-_ I I I I n 1 " I_ I I I I I I I I I I I I l
'7031:5 by„any'applicant for a• permit subjects$500).;the-applicant- to a civil -' f i
' enalty of not more than five hundred dollars mob). -_ I c • I I =Reirtspection_Feei 1 $25I I I Issue Fees I i=• S l3 l
:U as.owner of the property or, my employees-with wages as Mei? sole Reinspection Fee 1 I I $25 !Issue. Feel I I I I I $ 3
compensation will do the work,and the structure is not intended or offered I I ; j r I z- i m I I I i -MECHANICAL 1 I -'1 1 I r FEES
for sale (Section 7044, Business and Professional Code:. The Contractor's ' I
License Law does not apply to an owner of a property who builds or improves ' ' rt
= 1 I I c[ _r PUBLICISERVICES REQUIREMENTS: 1 I I 1
Boiler - I m I I I Hood or Type I I ❑ -
thereon,and who does such work himself/herself or through his or her own I
rt '�1 Zoning Approved By 1 I i 1 I Deta
employees, provided that such Improvements are not intended or offeretllfor I Canopy I Type II 0 ta i , O
sale. If, however, the building or Improvement is sold within one year.of com- 1 Duct j Under,Ground I I 1 I I I I J - Applination Alpproved By 1 I 1 I 1 Data 1 I 1
plelion, the owner will have the burden of proving he/she did not build or Im- - 1 1 1 I II
s!_rove'for the purpose of sale). 1 ' ( Duct-Structural t 1 I I Refrigeration System 1 ; L= I I Applimtion Issued lBy I 1 �),/1�/ 1 1 I Dete 2/71.,c78‘2 1
U I,as owner of the property, am exclusively contracting with licensed con- - - 1 1 I m !
tractors to construct the project (Section 7044, Business and Professions Code: 1 Duct-Ventilating 1 I I I X0.100,000 BTU ❑100,000 BTU I 1 -SUMMARY OF FEES I I I I I 1 I
The Contractor's License Law does-not apply to an owner of•property who- ' _ _ I ( A O D 1
builds or improves thereon,and who contracts for such projects with a con- I Exhaust System 0 Multiple ❑ System Re air/Alteration i' BUILDING PERMIT $ d`-V SMIP $ -`5 I
tractor(s) license pursuant to the Contractor's License Law), I I - yp• ' P 1 I F' PLAN CHECK ( $ I ! 1 ' PERMIT I
❑Ilam exempt under Section B.&P.C.for this reason 1 Firepl/Fact.Blt. ICBOj# I I 1 1 1 I I I PLUMBING' I $ 1 ! ` ! :ISSUANCE I $ I 1 `
Date owner I 1 Heating System&Ducting I : I I I : 1 •
I I _ • PLAN CHECK $ I 1 ENERGY P.C. I $ ! ! I
I hereby certify that I have read this application and state that the above ❑0100000 BTU ❑loo,000BTL ! ! 1 1 �: l
Information is correct. I agree to comply with all city and county ordinances --' '-T" -T'--'i 'T-n' — '—"'� • 1--f---1 I - I ELECTRICAL• $ I GRADING $
Ill 1
and state laws relating to b iltling constroand'hereby authorize repro- 1 PLAN CHECK I $ I MICROFILM ! $ •
sentatives of this city nt u e above-mentioned property for' ! ' I I I I I I I I I I 1 • 1 MECHANICAL I $ ' TOTAL FEE $ I4`r sr2
inspection la^fposes. I
Signature vti� I Date /i/(f CJ •v 1 1 1 I • I I 1 1 1 1
drivers' License or,55 9k ' , i I I I Reinspection Fee I I$251 I I Issue Fee I I I $ 3 ' PLAN CHECK I I $ - 1 I I I I I I
CMF 0665-46'revr7/83-1-' White:'Building;Canary-Appllcant;'Pink'1Accounting;'Goidenrod"-1Assessor--- --1---1 _L_.L-_'__ 1__1J_--I---1--1__.1 I ' ' L___._�.;_,-y.,__I--_ '-__- (--L.--L--....L.- I r -1_-
CONSTRUCTION AND PLANN ING" , _ '• • • - t ' " " ' ',1- L &: -
o, r1-'`. .
-Date' 'Inspector - - - ' - Date Inspector
APPROVALS; ;Permit# 4 - - - ,,:,,i.,...APPROVALS...-:. Permit#" - _
.,Temporary Electrical Service or Pole ; • , ; ' id •' 52.-Pool &,EquipmeritLocation; . '
:, Soils Pipe-Undrgrnd. , .. 1 if - c ';53 1 Steel Reinforcement o -
-li
:3.: Electrical Conduit Utility1Undrgrnd 1 ' .1 :',...t, I ::, a , "54.- Forms,i r , .-.
• .4. Electrical Conduit-Undrgrnd. , :p , - '55.»ElectricalBonding . •
-5. Steel Reinforcement • - t c r - ' •`• =- - -56. 99
Rou h.Plumbin :&Pressure Test-
- w-+!..,r.�.-, r -tom-•-n4-.:.-,-art rte--- ,.- r:-.--..--r--- •_.-yam_...
6.' Electrical LIFER Grnd. _ C. - , `._ -> ;- 515AP.PROVALTO COVER G- UNITE -
7.IFootings , ' ! I1 `•' ; ¢;, - S _ ;-?'' ;' :',58.'ElectricalConduit=Undrgrnd,, _
8.i Foundation I _ '" - - -'- 59."Gas Pipe; 0 Undrg:iid.;.Test.2 _.
9.•Water Pipe-Undrgrnd. - _ • '60..Backwash Lines;.P- .rad, 0 Undrgrnd, _ - •
10.1Structural,FloorSystem .t: ` •- - +- 7 "61.-APPROVAL TODECK '
,
MI Property Sewer Line & House Connection Y.; ,', '62.:Backwashi&'Rece`pto_r-Final° •
12.1 Sewer Capi i ' 63.4ter & Vent;Final - - -
n - •
13.1 Roof Drains _ . F:64. Plumbing System - Final
r 14: Rough Plumbing : ' ' - 1 "` 65.^Electrical-Eirial:7'f'= _
15. Rough Electrical-Conduit -,- 1 r-- 1 "
, -;-----r--, 1-, 66.-Solas System=Final , '" - � ' ' •
16.' Rough Electric Wiring - ' 'z.... 11-,1.-;+; r - -• - •
tl '1..-,,,,•;-,( - T-• . r_-) f 67" -:Fencing&-Access:APp�oval -
17. Rough Wiling Sign .„ i It^ I _ I : 51 : : .ISH : I : 68 -APPROVEDtFORPLASTERING. ,
18. Rough Electrical-T,Bar Ceiling 11 i! l :-- ' I I I•_ I " I 169 POOL/SPAt SYSTEMS FINAL' .
19." Rough Heating &Air'Coriditionii g '" t -, I � ; � ` I I I I FIRE DEPT!. REQUIREMENT
20. Rough Factory Fireplace,
1 . 1 ` ,. ' (APPROVALS i Permit# '
21. Ducts;in Structure - ) , , 70. Underground Hydro '
' :22. Ducts; Ventilating I i1 ii ! I I : 1 I 1 71. Product,Piping 0Gas' :0 oil
23: Gas Pipe-Rough & estt T • :r ! r I I i 1 72; gro
Underund Flush ,,i r
2C Roof Framing - 1 11.-11.- I ' I r i ' r:3 ! -,1 73...Undergrnd.Storage Tank,.0 Gas 0:Oi1
25, Roof Sheathing . ' ' _ _ • , 74. •Overhead Hydro
26: T-Bar Ceiling-(Structural) & Moriocoat ' : :1 t : ! I.'. i ' 7S.'Ory Chemical ' -
27. Frame and,Flashing • i , i ! 1 ''I ' ' i - 176. Dry`Standpipe i ,,. 11 ' -
28. :Lathing & Siding . , II 11 � I j I I 1 j ' j ; 7Z,- FIXEDjSVSTEM FINAL ., ',. • • '
29. 'Insulation - i , 1 I ! ' 1, 78. FIRE PREV. FINAL ,
' 30. Drywall Nailing I , ' i 1 ' ; j HEALTH DEPT, REQUIREMENT
r - -
31r Plaster Brown Coat I 1 I ; I i ' 79. I INAL,INSPECTION ' •,
32: Electrical Power Meter-Filnall 1 ! I I I I i 1 8d. FOOD CERTIFICATE ISSUED _'A mac,
33; Final Electric. .- -ry-- I . -I- -I I ! ' Notes: lr/�r7B'3 I /n.[' -.vs�a/�A= t1;
t 34. FinallHeating'&Air Coriditioning ' I. ' 1 ' 1 '
I , p ....821/
35. Final Gas PilpeTest t I - !z. : .i 1 '` ! EI - 1 'i - 1-'1 >Ei i .. 1 I ! i ` _ r .
36. HoodorCanopy 1 - i r. 1 I i Itl '+ I -' i :. � 2 ', ' l-` S:j ; t ` - `-
i I -I. , •
37. Final Factory Fireplace 1 i I I ! , ( ( 1 -
38. Final Plumbing! i ! i i I i ! ` , vi ,,I , I I I ' ' ' n' 1 - ' i '. u.
• 39. Water Service-Final : I '
t t i i I � I + I I " 1 i i
40. Gas Service-Final 1 ' 1 ' ,' ! 4 + ; i I i i ' I i I .
41. SolarrDdmestic Final , I I ' j I t I ! ' I 1 ' i ._
r 1 I . ; ! I 1 I t i . i •
42. Backflow Preventer �_.
43. Backflow Irrigation I - t i 1 1 r `, : " 1 ' 1.. 1 ' ' 1' I i :' 1 - t I •
44. ,Landscape Irrigation System I, I I I ' ! - I ' 1 .' r i ' cal 1
• 45. Sound Attenuation , i I 1 ' i ! 1 I _ , i `' i.n I I I t - '
46. Handicap Regulations. ; I ' i I . 1 ; I- I ", ( i !
47, FINAL STRUCTURE& BUILDING ! I' I I ; I !; i 1 , i ' -
48. Special RequirementsiComplete1 I I ' I 1 I i • I I I i 11 i I I
t
, 'I'
49. ElectrielRelease to Edison I I -i_---1_--I--- i - - I-*--'�- ii _i -11---:-;
,. ;
50. Gas Release-to Southern California Gas Co I I + ` -
51: CERTIFICATE.OF,000UPANCY 1,. J . '_. I i i ! i I ' t _' '
No. - •
` .,.- l c Date.. . '.-•. .'- v .i_. -. LLI I ,._ 1 - .
'w,p3RESS Of WILDING: 1062 WESTWARD LN UNT: CITY OF COSTA MESA — BUILDING PERMIT
j avNEntumI mmftWESTBLUFF HOMEOWNERS
ADmm 7400 CENTER AV PERM NO: B 072683
HUNTINGTON BEACH PERMIT NO: B 072683 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: 5—N \ PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF ,REROOF W/TORCH—ON BUILT—UP ROOF SQ FT: •
5, 500 •
ARCH.OR ENG.'S ADDRESS: WE:
CLAIM VALUE: 5, 500 . 00 CALL—VP E• 5, 500 . 00 GROUP OCC: R-1 / k
COMNACIDRBNIME:EVERGREEN ROOFING ( 714 ) 529-7427 \ — �l ++, �
•
CONfRACTORSMING 1175 ORANGEWOOD DR COMMENTS: REROOF UNITS 1062-106,8 \ */
ADDRES&BREA CA ucNo: 679865 *********************4A(4**-**jf.*******4r• *********************Rr** ***************
92621 ZONING N G REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I em lice er provisions of Chapter 9 ' SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Cod m en s i ull force effect.
mAo.:060741 uc.ams:C39 m.No.: 861ken
EXP 1 MAIN BUILDING ACCESSORY BUILDING
rode: 6 —� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
—95--- Contractor: ""--- LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
wER BUILDER DECLARATION:u:Ihereby
and
Coe:Af ny
Ind Iyrsexemgtreat a theContractorstmmLicenseLaw mprthe PARKING REQ: PROV: PARCEL: 93523017 ZNE: REF NO:
owing NER reason(Radion ARATI BN:I her end f frm undesr Code:Afy erj «county a which rat firm t e Con ra torL e,alter.wfor ve,the
molah,or repair any structure,prior to as issuance,also requires the applicant for such permit to file a signed d°lement That he or she PLANNING NOTES>
is licensed pursuant to the provisions of the Contractors License Law(Cheraw 9(commenting 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.My violation of Section >.
7031.5 by any applicantal for a permit subjects the applicant to a civil penally of nmore Man fee hundred dollars 155001). *******************************************************************************
IDI.as owner tithe popery«my employees with wages as their sole compensation,will do the work,end the stnnclure'e not intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not appy to en owner of properly
who bolds or improves thereon,end who does such work Iimset or herself or through ha or her own employees,provided that such
improvements are nor intended or offered for sale.If,however,the building or improvement is sold within one year of completion.the ZONING APPROVED BY DATE:
ownercudder will have the burden of proving he or she did nal build or improve for the purpose Of sale).
❑ I,as owner of the properly,am exclusNely contracting with licensed contractors to constract the project(Section 7044,Business end BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner or property who builds or improves thereon and who
contracts for such prams with a contractor(s)licensed pusuenl to the Contractors License Law).
❑ lam exempt under Section: B.IS P.C..for this reason: APPLICATION ISSUED BY: � DATE: n
*************************************** *********************** * **4?***
Date: °w"«: LEGALIZATION:N F E E SUMMARY STRUCTURAL SE MENT:Y
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.PACs,,end
25534,and Mat I or any tenure Wilding occupant will/wf1 not(alma one)need to comply*eh said date tides end IM requirements for
a permit for construction or modification fromtheAi anagemenl Diss.Residential cansmdion eppicmins are exempt lmm these
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 81 . 00 . 55
•
Date: Applicant: SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby dorm under penally of perjury one of the following declarations: ISSUE FEE
❑ !have and will maintain acetivateoccnsenitoseeirsurefor warkswio
'cornpern,aprSection BUILDING—DIV—> PERMIT ISSUE PLANrCHECK TOTAL PAID DUE
Code.for the performance
of the work for which this permit is Sued. TOTALS----> 81 . 55 0 . 00 0 . 00 81 . 55 81 . 55 . 00
❑ I have and Wil maintain workers'compensation insurance,as required by Section 3700 of Me Labor Code,for the performance of the
work d«which Maparrier: e.kywokasmnpennd«inara earer adpdkynOmbeee: REVENUE DIVISION TOTALS--> COLLECTED: 81 . 55 OVER/SHORT: . 00
Carrier:
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed y the pane is for one hundred dollars MOO/or less.) 81 .00 . 55
I cox*that in the performance of the work for which this prima a issued,I snap employany manner so as to '
become subjm Io the workers'compensation laws o California. ark ep H 1 wpm ID the wakes' *****************************************************************************
pensar n provisions of Section 3700 of the Labor code.I shall forth ply with gra.
Date 6 S J`-� _ Applicant:GinINDIVIDUAL •F E E BREAKDOWN
1 Imp:Fel/unmsecure wokers compensation oeage/sunawal,end en.nswprane a/ayeropemnalPararo«ane TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
civil lines unto one hundred thousand dollars(5100,000),In addidon to the cost of compensation,damages as provided for In
•
Section 3106of Me Labor Code,intemt,and attorneys lees. SFR 5500 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 5, 500 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction lending agency for the END , OF FEES
performance of the work for which the pemhi is issued(Section 3097.Ce.Cr,
LENDER'SNAMEAADDRESS INCLUDES -
LENDER'S aDORESsx EXP RE SMOKE DETECTOR
I and
slate
that I have read this application and state that the above authorize
information is coned.I agree totcomply with all city and county ordinances
and sspe bws relating to building construction and hereby edhor¢e rapreaenlativss d this dry to enter upon Ina ebwe-mmbrred property
for inspection purposes. ypct/7C7{-_-
DATE/6 ,9 REQUIRE9Ps :: of 0:183/95 ).hr =f1 'C ;:i0w Date: 6—J—5�- DATE: caro:. cirri:
Signature of e• er/Agent/APNcan Sc ., f.
(5151-46.WP) White-Building A Safely;Green-File:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor A
ICONSTRUCTION AND PLANNING P: & SPA I
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
Eq-3. Electrical Concruit-1 tility-Undrgrnd. 54. Forms
1
F• r.Electrical Condui Undrgrnd. 55. Electrical Bonding
. : 5_CSteel ReinforceTe'nt 56. Rough Plumbing & Pressure Test
e_ -
i t" Electrical UFER t rnd. 57. APPROVAL TO COVER-GUNITE -1 ,
:^ 7.footings ^,.- 58. Electrical Conduit-Undrgrnd. ,'
- 8'.`foundation
'� -
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Uncjig_nd. " 60. Backwash Lines, P-Trap, 0 Undrgrnd. _ {
.-THIO. Structural Floor System 61. APPROVAL TO DECK • •
11. Property Sewer Line& House Connection 62. Backwash & Receptor-FJrial
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing _ - 65. Electrical-Final
15. Rough Electrical-Conduit 'J 66. Solar System-Final
16. Rough Electric Wiririg • - 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,.REOUIREMENT
20.Though Factory Fireplace - = ` I-' APP.tOVALS::. Permit #
21. Ducts, in Structure • " - - ` • 701 Underg ound Hydro r
22.•Ducts, Ventilating ` - . -- ' " ; - r
9,:.. •
,�, 71. Product',Piping L7-Gas OOiI _qqq
23. Gas-Pipe-Rough & Test - - - - 72. UndergFound Flush(„ 1 F~ c • I
24.•RooP Framin " _
9 - . tom 73. Undergrnd.Stolige Tank 0 Gas nil •
25. Roof•Sheathing •,,- _. r 74r Overhead HYdp9-, ' -
26.;T-Bar Ceiling (Structural) & MErio'coat '.', 7F. -Dry Chemical l..,_-~, . - .- -
27.,Frame and Flashing. �^ - "?' 76. Dry Sta�ridpipa; Y '
C' - - - - .
28. Lathing;& Siding "; `: �''_1'. - •' ' '_ 77„ FIXEd_SI,STnEM'FINAL:- ,
29. Insulation • - .7 ; 78. FIRE PREV. FINAL - '>'
r' 30. Drywall;Nailing ' - _ :'NEA LTH DEI T. REQUIREMENT
.
31. Plaster Blown Coat. : - .r 79. FINAL:INSPECTION - ^
32.EgIectricaTPower McEer:Final -. 2 a • Sp. FOOD CERTIFICATE ISkkUED c:
- 33:.Final.Electric - '. Notes:44/ Cr'TV, - .1T'
34.l Final Heating& Air Conditioning=• r /
�1 al pi-;:r._. •etc� -
35.,Fina Gas_iPipe-Test - • u ^ �;,,��/ - t?. 5
36. Hood or`Canopy - . _ t- .
-- 37. Final.Factory Fireplace;- - , ,
38. Final Plumbing • _ ' - ¢ _
. - -_ r.e -
39. Water Service-Final; n `- t• - r
-
40. Gas Service-Final - - -. 1
1. 41. Solar Do'mestic-Final ` _ - •i �.,; _
42. Backflow Preventer' I c -F- • `: t`
_
• ... Y- m n• Y ,_.,
43. Backflow Irrigation, ;-' ' 1 1. :-...1-• •'
:44. Landscape Irrigation System''nt: Ir '' •' - -' O- ^ -. i_ :.r,,, e
'45.:Sound Attenitatio * -- - - * = r_ 1
'46.rHfandicap Regulations - 4' . * x c - Ov +:
7. - .. L ( .f qr I('
47."7EINAL STRUCTURE & BUILDINGF, • - Mc `-` = c -
48.;FINALPLANNING'r it. 4 F •
-49.rEleeTric1Relea"se to Edison ' * f T -, ,7
-50.•Gas••Release to Southern California Gas Co - - n Yi,
-)
51. CERTIFICATE OF-OCCUPANCY - . :? : -
No Date
/I
_: 42688 rr 0-7. -Yt°On 904` -=257.30
c• 7 r,—
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
�J APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink 16A y) RECEIVED BY DATE RECEIVED DATE ISSUED
® BUILDING y/v- d... /, /
ADDRESS ,I,!✓ /y,�_ ` f7.I
A.P.NO. . PEWI t. o
OWNER .6�r. 6CC l '7
MAIL yI.r/ p ADDRESS/Viz BUILDINO `.1-.9-1.-$ (itiativ�( 4-)
ADDRESS . '/P Com- /fA/7'
pw TEL. TRACT LOT BLOCK
CITYA ./L Nl �I0, 7
CONSTRU ON ___"` "l NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH /���s te '
OWNER Al2/r10FrR/HOU MO
ADDRESS
ARCHITECT ���w✓7JJJ�
/"1 TEL mysii (CYV Do VLII .rs VALUE
OR ENGINEER
FIRE '�\�( 1_ k
ADDRESS ZONE TYPE �r-� GROUq
APPROVED
CONTRACTOR (::)), t BY DATE
ADDRESS ZONE NO.OF USE OF NEW
TEL.
CITY NO. PLANS BUILDING
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO.2Z Beta 3 LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLDGS. (FROM C/L STREET)
L OF LOT NOW ON LOT FRONT FT. FT.
-2 USE OF
EXISTING BLDG. R,SIDE FT. FT,
Li)
2 Separate permits are required for L.SIDE FT. FT.
F.
electric,plumbing and heating work,
Ca REAR FT. FT.
I'
F. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
-2 MAIN BLDGS. ACCFFS BLDGS.
/ //` VAR.# DATE
Q L ihi. r--- C.U.P.# APPROVED
7 !`""J+J -- APPROVED
,r.1 —6Y SATE
w I4}.
a.
" �T q3 Pet( 15�1$
I hereby acknowledge that I have read this application and state ✓1 ti I,� I:- it'll°
Cd that the above information Is correct and agree to comply with 7
0., all laws regulating building construction, and I shell not employ
Z any person in violation of the workman's compensation laws of 2
the Stets of California. cos() 2 ('''7, ,r�yI, '
I hereby certify that I am properly licensed as a contractor under �� 7V . FT. �— I )91NI. 59 •a U
Chapters California su Business and inullProfessions Code,end Divieffect, 3, THE AMOUNT SHOWN UNDER VALUATION S FOR y�p
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
klip
am exempt from the provisions of the State of California Business e
VALUATION PERMIT FEE $
and Professions Code,Division 3,Chap r 9, m
PLAN CHECK $ L!// p3
Signature o /fl/coo • o
Permittee $ (v TAX $ //I /J� 5
Day/ U
Author@ed Agent ` TOTAL PAID $257,
Q
1
I.
4 67 .2?' Par„
b1a31-77�;,-.Q01317 11***378:5
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING/v fa 2 V--6 7 E�J"W tJ l d
ADDRESS/ i
� ,�sr
mew PERMIT NO.
OWNER At ns �t1/Mit r A.P.NO. / .', �jl/�' Q min
I
MAIL BUILDING
ADDRESS/UGO2' 414- s.�7 sW ° t,ii
ADDRESS
TEL.
CITY NO. TRACT I LOT BLOCK
CONSTRUCTION NEW ADD ALTER I REPAIR [MOVING DFMOLISH
LENDER `\\J/\/
BRANCH ` �f
OWNER fr
ADDRESS (/ VALUE
ARCHITECT TEL. DISE '/ atit _ $
OR ENGINEER NO. -
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
CITY NO.
PLANS BUILDING
F• STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLOCS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
EXISTING BLDG. R $IDE _FL FT,
h
9 Separate permits are required for L.SIDE FT. FT.
F.
electric, plumbing and heating work.
C REAR FT. FT. 111111
R7 USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN \'
<Q MAIN BLOCS. ACCESS.BLOO CS.
VAR.* DATE
..1 C.U.P. APPROVED
Q
7 APPROVED
>. _BV DATE
EL
EL
ILI.
I hereby acknowledge that I have read this application end state
In
t.
CC that the above information Is correct and agree to comply with
m
0. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of m
= the State of California.
I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR a
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: -
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 37 f 5-71' o
and Professions Code,Division 3,Chapter 9. fir
tn
PLAN CHECK $ to
Signature of O
Permittee S........„....-.-2-- TAX $ LL C
D
Authorized Agent t TOTAL PAID $
37X,
'Au as
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
4 APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use In Only
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING
ADDRESS v'f�/ Li,
, 'q c el�/ sl//y/^4��A
/ // (tOa—a, o? PERMIT NO.
OWNS- .res- �4�s� A. .NO.
MAIL. AB ILDING 7Ol r{7 li
ADDRES� APES / �/ ADDRESS (J�(� LAI.
TEL
CITY /�JG I a A _L ` NO... ' o• TRACETE1tfftR
5: Pe .,-.jjJJJ...000 CK
LENSrRUCT10N �/ f� NEW ADD MOVIN/VD LISH
LENDER �J /��� \ /
BRANCH r/(4/Al� X
��V777 ' J/e wAt9
�}�J OWNER
ADDRESS /�^ //�,�/�/v"/ VALUE
ARCHITECT / -�" -moi/' N 7� T FIRE , Piet) $ _,
OR ENGINEER V %nGfi�[ �• yyJJ
Pr
ADDRESS �C Vsree.( ZONE TYPE GROU 7r
APPROVED
CONTRACTOR a/C BY DATE ,//
ADDRESS Zol7a pt /+NO.OF� USE OF NSW/4 �i
TEL. n(/a/(/ iJJ/*j POS BUILDING .11/
CITY NO. ^'t
F STATE CITY YARDS APPROVED YARDS OVED
LIC. NO.ZC,ft'E 3 LIC.NO. MAIN BUIL.INC ACC ESSO BUILDING
ia SIZE Y �at NO.OF BLDGS. (FROM C/ S LEE7)
a OF LOTS 1 �/ NOW ON LOT d sorer., /,/ FT. FT.
USE OFcn /// "�/j
EXISTING BLDG. R.SIDE 02 /FT FT.
LQL
FS Separate permits are required for L.SIDE F1Y/�/
FT.
electric,plumbing and heating work. /
Laid REAR 49Thel-
FT.
1.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
-2 !` 4 MAIN BLLDDGS.` ACCESS BLOCS.
.71
�J Q/1 CV URP 'iI-Z�,�PPROVED5---17-7 /.
/r/ APPROVE�/// /� G � �
C f HOLD�OR SPECT T lEQ&EM NTS
IQ
0 I hereby acknowledge that I have read this application and state N
r-
C that the above Information Is correct and agree to comply with
9. all laws regulating building construction, and I shell not employ m
Z any person In violation of the workman's compensation laws of F.
ill= the State of California. N/ /, OD
— /� n k m
I hereby certify that I am properly licensed as- contractor under /�J� SO. FT. J (!j• /lvl�I'�!/ N
the State of Califon B sin s and Prof-silo s Code, Division 3, TH LL((AMOUNT SHOWN UNDER VALUATION 1S FOR m
Chapter 9, and t uc li nses er in ull ••rce : d effect,or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt fr th vi ons of he •tate -f Ca •rnia Business ta
and Platen) ns Co , v �:� m
VALUATION PERMIT FEE S v
u
PLAN CHECK E r^2
Signature ofo
Permittee , $ TAX S
f
U
Authorized Agent TOTAL PAID S
c
tile
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Cgtnp etely — se Ink Only
t�7 )i RECEIVED BYJJ DATE RECEIVED DATE ISSUED
BUILDING '/j',(_./(j/ i
ADDRESS
111:-;.64
/S�p6 [�/���c PERMIT NO.
OWNEiti /�} fJ��s�
MAIL BUILDING �" �" L .
ADDR ESSc ,rz c444, ADDRESS I Ota 0.112 .64:24
eel
CITY �4/�‘er Net, rl ryes TRACT Ga O`�CbY✓`��7R/��) a K
CONSTRUCTION j4/
,jV„/ EW ADD ALTER REPAIR MO D(EE I ISH
LENDER �/JK3 X /�,t�'p"
BRANCHr/JGiC6� _ / / s/'D
s� �J
OWNER
ADDRESS /� f�/j/1, / VAL E
ARCHITECT (i! • N �`LJ1_�J/�r US O-- $
OR ENGINES v CO�rC //C�J
ADDRESS ��!4' , e ,f FIRE
C.CJ `� //J �iJ1/�``/� ZONE TYPE TGROUP�
�v//888��"""/nAn ' ��E�'f APPROVED lar
/
CONTRACTOR l/'CK/� ��ii�✓✓ BY DATE /yam
ADDRESS INNy��� NO.OF USE OF N�y,/��' (/Ty/ /
TEL. �// PLANS BUILDING s�'�
CITY NO. ,7C.M.L
F-: STATECITY YARDS APPROVED YARDS APPR dili
LIC. NO2Z3 LIC.NO. MAIN BUILD! G
(FROM MST ACCESSORY LDING
W - —
SIZE t — NO.OF BLDGS.
a OF LOT itNOW ON LOT U FRONT T. FT.
Q USE OF
( EXISTING BLDG. R.SIDE sP/1 171-. 6 FT.
rn
FS Separate permits are required for L.SIDE T FT.
electric,plumbing and heating work.
D _REAR T. FT.
tri,
(W,,, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QQ MAIN BLOCS. ACCESS.BLDGS.
C.U.P. ATE
Q (/ C.UP,q ��A'� 7-7c.
A APPROVEDfl (y ATE/��77
...1
OLD FOR SPECIAL REQUIREMENTS
A.
I hereby acknowledge that I have read this application and state a
Ce that the above Information Is correct and agree to comply with --
0. all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws ofy o
the State of California. , (E �41 2 I n9y
I hereby certify the I am properly Ilcen-'d as a contractor under
the State of Calif la =usiness and Prot-scions Code, Division 3, TH AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9t •• licenses are7i ull f• ce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
em exempt fr• '�t : • ovisions • the -tate • Californl: Business a
end Profassio•- ••a e, ision h;• .r 9 VALUATION PERMIT FEE $
PLAN CHECK $ o
Signature • U.
Permittee .� $ TAX $
V r U
Authorized Agent TOTAL PAID $