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Home My WebLink About579 WENDY LN - Building PermitsCITY OF COSTA MESA . ost" F BUILD►NG DIV/SION F� . � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Paz p14) 754-4856 • w.wv.ci.costa-mesa.ca.us J � FOR INSPECTIONS CALL: (714) 754-5626 �r.o.mco`b PERMIT NUMBER: E09-00206 PERMIT TYPE ELEC STATUS: ISSUED APN: 42214303 DATE ISSUED: 08/1012009 ISSUED BY: BJK JOB ADDRESS: 579 WENDY LN CM Vicinity: Suite/Unit: SCOPE OF WORK: CHANGE-OUT OF AN EXISTING FAU AND AN A/C AT A CONDO UNIT. ELEC: 1 RES APPL OWNER: TROMBI, NANCY L PHONE: APPLICANT: YENULONIS, LAURA PHONE: 909-213-1640 Address: 579 WENDY LN Unit: City/State/Zip: COSTA MESA, CA Address: Unit: City/State/zZip: CONTRACTOR: ALLIED PLUMBING - HEATING - AIR CONDITIONING Address: 422 JENKS ClUnit: PHONE: 714•998-4300 City/State: CORONA, CA ZipCode: 92880 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $28.25 Reinspection Fee $0.00 TOTAL FEES $28.25 License No. 610780 CELL: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenls under California statutes and related regulations. (Ord. No. 92-28, § 1, 1&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 wmply 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. COOE I. INSPEQION TYPE 1618 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition UATE INiRIALS COOER INSPELPONTYPE 206 Final Mechanical 20B final Plumbing 210 Final Electnwl 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy OATE INTITIRLS WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certi(cate of consent to sel4lnsure for workers' compensation, as providetl (or by section 3700 of the Labor Code, for the performance of Ihe work for which Ihis permit is issued. C-7 I have antl will maintain wurkers' compensa[ion insurance, as required by ec[bn 3700 of [he Labor Code. for the peAortnance of the work (or which ihis pertnit is issued. My workers' compensation Insurance carrier and policy number are: I �\- ` Cartier� �A c,QX'CN (ThissecfionneednotDemmv�eled MepeimrtisvalueEaronehundredMllars(St00)aless.) PolfcyNumber.._�A'�(` -"�(p3\ S��LD3� O� R ❑ I certity tha[ in ihe peAormance of [he work for which this permil is issued, I shall no[ employ any person in any manner so as to become subject to the vrorkers' compensation laws ot Califomia, and agree that i/ I should become su6ject to Ihe vrorkers' compensation provisions of Sec�ion 3700 0( y�e Labor Cotle, I shall forthwith comply with these provisions. a.• i�-�o-oR Appliranl's SignaWre �ale WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNfAWFUL 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 DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pro(essions Code, and my license is in (ull (orce and effect. Lic.�#�-�O`��fSd ( Class#^ �.Z.O �.�(� � � M u (�Nv.x) �j^l� ��-1 Convactors Signature Oa�e -' CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that Ihere is a construclbn lending agency for the perfortnance of ihe work for which [his pertnit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Atltlress: Dale OWNER-BUILDER DECLARATIONS: I hereby aKrm Ihat under penalty of perjury lhat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pmfessions Code: Any city or county which requires a permit to constmcl, alter, improve, demolish, or repair any stmcture, pnor to its issuance, also requires the applican[ for such permit lo fle a signed s[atemenl Iha[ he or she is licensed pursuan[ ro the provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is eaempt Iherefrom and the basis (or Ihe allegetl exemption. Any viola[ion of Section 7031.5 by any applicant for a permi� subjects the applicant to a civil penally of not more ihan five hundred dollars ($500).): ❑ I, as ovmer of ihe properly, or my employees with wages as their sole compensation, WILL DO THE WORK, and the slrucWre is not intended or offered for sale (Sec. 7044, 8usiness 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 ihat such improvements are not intended or oRered for sale. If, however, the building or improvement is sold within one year of complelion, [he owner-builder will have the burden of provinq thal he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business and Pm(essions Code: 7he contractors License Law does not apply to an ovmer of property wfio builds or improves Ihereon, antl 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: ignaWre Date 305]-46 (3I0]) Owner ID verifetl by tlriver's license. O Yes ❑ No Driver's License No. Expires: Verifcation of Ownership by (rype of tlocument, i.e. - propeny tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavation (rve (5) or more feet in depth into which a person is requiretl lo descend, will be made in connec�bn with vrork authorizetl by this pertnit, and that no building strucWre, scaffdding, falsework, or demolition or dismantling thereof, will be more than thitly-six (36) leel high. (Chap. 3.2, Grp 2, M 2, Sec. 311, Ttle 8, Califomia Atlminist2tive Cotle). ❑ As owner-builder, I will not employ anyone [o do work which woultl require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit b do such work from the tlivision. nppiiwm's Signawre Da�e Division o( Indus[rial Safety Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or tuture building occupant need lo file and certify a Business Plan for emergency response lo release or Ihreatenetl release of a hazardous material? .❑ Yes ❑ No (Section 25505 of the California Health and Safery Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every 6usiness which has at any one time dunng a reporled year a quantiry of hazartlous 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 standard temperature and pressure). 2. Does or will the applicanl or present or fuNre builtling occupaM need to file a registration form for awtely hazardous materials? '❑ Yes ❑ No (Section 25533 of Ihe Califomia Heallh and Safery Code, vnth some exceptions, requires registration with the Cosla Mesa Fire Depariment by each business which al any one time has on hand a quanlity of acutely hazardous malerials 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 femperaNre and pressure). 3. Does or vnll Ihe applicant or present or fuWre building occupant need to prepare an RMPP (Risk Management and Prevention Program (or aculely hazardous materials)? ❑ Yes ❑ No (Section 25534 0( the Califomia Health and Safery Code provides that the Costa Mesa Fire Department may require the preparation, certification antl fling with �he Fire Department of an RMPP by businesses which are required ro register acutely hazardous materials with the Fire Depatlment. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been (ully complied with? ❑ Yes ❑ No 5. Does or will the applicanl or present or future builtling occupanl require for the work which is the subject o( this application a permit for such construction or modifcation trom the South Coast Air �uality Management District or from any other air polWtion control district or agency? ❑ Yes ❑ No (Section 658502 ot the Cali(omia Govemment Code requires that Ihe requested information be (umished on applications fa noo-residential building permits). 6. Will any part o( the facility to be consVucted under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of Ihe Califomia Health and Satery Code). 7. If a permil from the South Coast Air Quality Management District or other air pollution control disMcl or agency is required for Ihe vrork which is the subject of this application, have all ot the disclosures prescribed by Cali(ornia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate of compliance from the appmpriate air polWtion control oKcer). CERTIFICATE OF COMPIIANCE: I ceAify that under penalty of perjury the in(ormation given above is correct I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penalty of perjury that I have read this application and state that Ihe information given is correct. I agree to comply with all state laws antl city ordinances relating to builtling construction, and authorize representatives of the City o( Costa Mesa to enter upon the above-tlescribed property for inspection purposes. I agree not to occupy or allow ocwpancy of any building authorized by this permit until fnal inspection. ' `SignaWreoi� alOwner�s) �ate v�Mt.�J 6Yr�lJo �� 8 -\O- C� , tllorAulM1or¢edApPli[ 1 Da�e � ' � 1 � � ' ' PLUMBING PERMIT ' • � - � lob Address: 579 WENDY LN Suite No Vicinity: GARAGE � Parcel Nunmber: 42214303 Applicant ELLIS, JOE Address: 3801 LENAWEE AVE CULVER qTY, CA Owner: TROMBI, NANCY L Address 579 WENDY LN COSTA MESA, CA Phone: (310)253-5229 Zip: 90232 Phone: 2ip: 92627 Contractor: ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU Address: 3801 LENAWEE AVE Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking FounWin Expansion Tank CUWER CITY, CA Phone: (3t0)253-5229 Zip: 90232 License: 679898 Phone: Zip: License: Status: ISSUED Applied: 03/15/2004 � . ' �Issued: 03/15/2004 �i , ISSUED BY: SCOPE OF PERMIT CHANGE-OUT OF AN EXISTING 40 GAL WATER HEATER IN AN EXISTING CONDO. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $O.oO QTY FEESUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 SepticTank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Sel Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe � �� ".`, ' �. J' AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 INOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related I regulations. (Ord. No. 92-28, § 1, 12-2b92) ' 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 epplicable codes, entl all requlred Inapectione and tinal epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. I FOR INSPECTIONS CALL: (714) 7545626 i 24/G08 (fl�00) WORKERS' COMPENSATION DECLARATION: I hereby aNirm untler penalty of perjury one oF the following declarations: ❑ I have antl will maintain a certificate of consent to self-Insure for workers' compensetion, es provided for by section 3700 of Ihe Lebor Code, tor the pertormence of the work for whiCh �hi5 permit is i5sued. � I have antl wlll maintain workers' compensation insurance, as required by section 3700 ot ihe Labor Code, for ihe performance of ihe work for which this pertnit is issuetl. M workers' com e ei' sur cer' end alic%�' �umber ere: / /'� Carrier:Y P�E�f��, ,�U�/� Policy Number �/�jC7 � L��C l� (Tl�is sectian need not be completed il fhe Oermif is valued et one hundred dollers ($100) ar less.) ❑ I catlity that in the performance of the wo c which tl's permit is issued, I shall not employ any parson in any manner so es to become su�ject to ihe workere' compensetion laws of Calif rf�a, and r it o'10 became subjea to the workers' compensation provisions of Section 3700 of Ihe Labor Code, I shall torthwith comply with these provis' �-( `/ � Applicent Signetura: <- Date: U � WA{iNING: FAILURE TO SECURE WORK ' C01dPEN5ATI0N OVERAGE IS UNLAWFUL AN� SHALL SU&IECT PN EMPIOVER TO CflIMINAI PENALTIES AND CML FWES UP TOONE HUN�RED THOUSPNDDOLLARE(E100,000),INAD� IONTOTryECOST CqAPENSATION,DAMAGESASPROVIDEDf-0RINSECilON3]WOFTHELABOPCODE,ItJrEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn ihat I am force and eflect. Llc. a_ Comractor's Slgnature: CONS7RUCTION LENDING AGENCV: (commencing with Section 7000) ot Divisian 3 af iha Bi '�1 Class x ..` / Date: _ Cotle, and my licensa is in full ❑ I hereby affirm that there is a construction lending agency tor the pedormance of the work tor which this permit is issued. (Sec. 3097, Civil Code). Lentlels Nama: Lender's Address: Signature: OWNER-BUILDER DECLARATONS: Date: I hereby ettirm ihat under penalry of perjury that I am EXEMPT FROM TME CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, BusineSs antl Proteuions Cotle: Any ciry or counry which requires a permit to consWct, elter, improve, tlemolish, or repair any slrucWre, pnor to its issuance, also requires the applicant for such permit to file a signed stetement Ihet he or she is Ilcensetl pursuent ro ihe provisions ot the Contractors License Lew (Chepter 9(commencing with Section 7000) ot Division 3 ot ihe Business entl Professions Cotle) or that he Or she is e:empt therafrom and the basis for t�e allegatl exemption. Any violation of Section 7031.5 by any applicant for e permit sub�ects the epplicant m a civil penalry of not more than five huntlred dollars ($500).): ❑ I, as owner o1 Ihe propeny, or my emplpyees with wages as Iheir sole compensetion, WILL DO THE WORK, antl tne siructure is not intentled or oHered tor sele (Sec. 7044, Business and Protessions Coda: The Contrectors License Law does not apply to an owner of property who builtls or improves thereon, and who does such work himseN or herselt or ihrough his or her own employees, provided ihat such improvements are not intended or offered for sele. If, however, ihe building or improvement is sold within one year of completion, tha ownerbuiltler will have Ihe burden ol proving that he or she tlitl not builtl or improve tor purpose oi sale.). ' ❑ I, as owner of the propeny, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, eusiness antl Professions Cotle: The contrectors License Law dogs not apply to en owner of property who builds or improves thereon, end who coniracts for such project with a contrector(s) license pursuant to ihe Coniractors Licpnse Lews.). ❑ I am e:empt untler sea Business ana Professions Code tor ihis reason: Siqnature: Oate: Owner ID verified by drivar's license. ❑ Ves ❑ No Drivers License No. Expires: Venfication of Ownership by (type of document, i.e. - propeny taz bill ar deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feet in deplh into which a person is requirad to descand, will be mede in connection with work authorized by this pertnit, and that no building strudure, scalloltling, falsework, or demolition or dismantling thereof, will 6a more than Ihirry-six (36) feet high. (Ghap. 32, Grp 2, Ah 2, Sec. 341, Tile B, Celifornia Admini5lrative Cope). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from ihe Division of Industrial Sefery, as noted above, unless such person has e permit to tlo such work fmm ihe division. Signeture: �ate: Division ot Indusirial Sefety Permit Number: CERTIFICATE OF COMPLIANCE AND AUT}IOfiIZATION OF ENTRY: I cenity under penalry ot perjury ihat I have read this epplication and state that iha information given is correct. I agree to comply with ell state laws and ciry ordinances relating to building conswction, antl authorize reD�esentatives ot ihe Ciry of Costa Mesa to enter upon ihe above-descri6etl property for inspection purposes. I agree not lo occupy or allow occupancy ol any building authonzed by this permit uniil final inspection. COpE �, INSPECTIONTYPE ' QAjE 1616 Fixed System Final Fira Preven�ion 1266 Pool Spe Final 200 Final Re-Roof 201 Finel BIocWRetaining Wall 202 Final Factory Fire Place 203 Finel Siqn 204 Finel Demolition � � — ��—a_ ,a Da e INTRULS ¢Q.Q�E INSPECTIONTYPE 206 Final Mechanicel 20B Pinal Plumbing 210 Finel Elecirical 212 220 Flnel Fire Prevention Finel Planning Approval 222 Final Site 250 FinalBuilding/Occupancy I)11�ISITYIr.1ka __ 3_3i _c�y IJIY s. ` • � � � � CITY OF COSTA MESA BYILDING DIV/SION 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Faz p74) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: M09-00066 PERMIT TYPE MECH APN: 42214303 JOB ADDRESS: 579 WENDY LN CM vicinity: SQ. FT: 0 STATUS: ISSUED DATE ISSUED: 08/10/2009 ISSUED BY: BJK Suite/Unit: SCOPE OF WORK: CHANGE-OUT OF AN EXISTING FAU AND AN A/C AT A CONDO UNIT. MECH: 1 FAU < t00K BTU, t CONDENSOR UP TO 3 HP/100K BTU OWNER: TROMBI, NANCY L . . Address: PHONE: � � � City/State/Zip: APPLICANT: YENULONIS, LAURA � Address:� PHONE: 909-213-1640 City/State/zZip: CONTRACTOR: ALLIED PLUMBING - HEATING - AIR CONDITIONING Address: 422 JENKS ClUnit: PHONE: 714-998d300 City/State: CORONA, CA ZipCode: 92880 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: � $53.00 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: � $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $53.00 579 WENDY LN Unit: COSTA MESA, CA Unit: License No. 610780 CELL: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulalions. (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 wmply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. L �Ep INSPECTIONTVPE DATE INTITIALS OOEp INSPECTIONTYPE — �ry I'p J L'l, INTI�1�uhi 1616 Fized System Final Fire Prevention 206 Final Mechanical � ff� �y p+c 1266 Pool Spa Final � 208 Final Plumbing 200 Final Re-Roof 210 Final Eleclncal 201 Final Block/Retaining Wall 212 Final Fire PreveNion 202 Final FaC�ory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolilion 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalry of perjury one of the following declarations: ❑ I have and will mainlain a certificate of consent to selFlnsure for workers' compensation, as provitled for by section 3700 of the Labor Code, for the � per(ormance of the work for which ihis permi� is issued. [� I have antl will maintain vrorkers' compensation insurance, as required 6y section 3700 of ihe Labor Code, (or the peAortnance of the vrork for which this permit is issued. My workers' compensation Insurance carrier and policy number are 1 _`— Carrier; l�\�.��. �(IDis sedan need nof be cromple(etl il 1 permrt is valuetl at one huntlred cbllars (5100) oNess.) Policy.Nu�er ��C �(Q`�1,S��IC�R ❑ I certify tha[ in the peAormance of the work /or which Ihis permi[ is issued, I shall not employ any person in any manner so as to become subject [o the workers' compensation laws of California, and agree that i! I should become subject to the workers' compensation provisions of Section 3700 of ih Labor Code, I shall oAhwith comply with [hese provisions. R-�O�CR npplican`,s SignaWre -�a�e WARNING: ILURE TO SECURE WORKERS' COMPENSATION COVER4GE 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 DECLARATION: I hereby aKrm lhat I am licensed under provisions of Chapter 9(commencing vrith Section 7000) of Division 3 of the Business antl Professions Code, antl my licenseIis in full force and effect. ry.�,� ic.�#_ Lp �� 8� Class.#. L.d'�-� Q�-��- Cft Gonlraclor'sSiBnaWre� .DaleY. CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a construction lending agency for the performance of the work fa which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Dale OWNER•BUILUER DECLARATIONS: I hereby affirm that under penally o( perjury Ihat I am EXEMPT PROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Cotle: Any city or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit to fle a signed stalement Iha� he or she is licensed pursuan[ to Ihe pmvisions of Ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Code) or that he or she is exemp[ theretrom and the basis for the alleged exemption. Any viola[ion of Section 7031.5 by any applicant for a permit subjects �he applicant to a civil penalty�of not more Ihan fve hundred dollars ($500).): � ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the strucNre 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 lhereon, and who does such vrork himself or herself or ihrough his or her own employees, pmvided that such improvements are not intended or oRered for sale. If, however, ihe building or improvement is sold within one year of completion, the owner-builder will have the burden of pmving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CON7RAC71NG WITH LICENSED CON7RACTORS ro construc[ the pmject (Sec. 7044, Business antl Pmfessions Code: The contractors License Law does not apply to an owner of pmperty who builds or improves thereon, and who contracts for such project with a contracta(s) license pursuant to ihe Contrac[ws License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SignaWre 305]-06 (3I0]� • � . .., . Owner ID verifed by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verifcation of Ownership by (rype of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ 1 hereby certity that no excavation five (5) or more feet in tlepth into which a person is requiretl to descend, will be made in connec[ion with work au�horized by this permit, antl that no building sWCNre, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, T�le 8, California Administrative Code). ❑ As owner-builder, I will nol employ anyone to do work which woultl require a permit (rom �he Division of Industrial Sa(ety, as noted above, unless such person has a permit to do such work trom ihe division. Applicanl's SignaWre Division of Induslnal Safety Permit Number _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will [he applicant or present or fuNre building occupant neetl to fle and certify a Business Plan (or emergency response to release or threa�ened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safery Cotle requires, with some exceptions, that a Business Plan be filed wi[h [he 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 (eet o( compressed gas at s[andard temperaNre and pressure). 2. Does or will the applicanl or present or fuW re building occupant neetl to file a registration form �or acutely hazardous ma[erials? ❑ Yes ❑ No (Sec[ion 25533 of Ihe Cali(omia Health and Safety Code, with some exceptions, requires regisiralion with the Cos[a Mesa Fire DepaAment by each business which at any one time has on hand a quantiry 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 tempereture and pressure). 3. Does or will the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management and Prevention Program (or acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of Ihe California Health and Safety Code provitles that the Cosia Mesa Fire DepaAment may require the preparation, certifcation and fling with the Fire Departmenl of an RMPP by businesses which are required [o register acutely hazardous materials with Ihe Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Calitornia Health and Safety Code been fully complied with? ❑ Yes ❑ No S. Does or will the applicant or present or future builtling occupant require for lhe work which is [he subject of this application a permit for such construction or modifcation from lhe South Coas[ Air Qualiry Management Dislrict or from any other air polWtion control districl or agency? ❑ Yes ❑ No (Secibn 658502 0! Ihe Califomia Govemment Code requires that Ihe requestetl information be fumished on applications (or non-residential building pertnits). 6. Will any part of [he facility to be construc[etl untler this permit be within 1000 feet (rom [he ou[er bountlaries o( a school? ❑ Yes ❑ No Qf "yes", the tacility must meet the requirement of Sections 25534 and 42303 of the Calitomia Health and Safery Cotle). 7. If a permit from the Soulh Coast Air �uality Management DisMcl or oiher air polWtion control district or agency is required for the vrork which is the subject ot this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach certificate of compliance from Ihe appropriate air polWtion control oKcer). CERTIFlCATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcL I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Oale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state Ihal the information given is correct. I agree to comply with all state laws and city ortlinances relating to building consWction, and authonze representatives o( the Ciry of Cos[a Mesa to enter upon lhe above-described property for inspeclion purposes. I agree not to occupy or allow occupancy of any building authorizetl by this permit until final inspection. SlgnaWreo(Le IOwner(s� Da�e ?%� -{`,.�„� -�1fJ-f� /or Aul�wiEeO AOP�� Oa�e - , , _ . . �,. , - ,; � , , �,. „�.. , - - i , s - �� . w ` ' ,� _ _ i� � ' - ' .� 4—�..�"� �' wr,�,� a �,�.r-� � �' "� Cy- bia `" ,y �� "kSlr. �'� r � "°.. `a��""'" �J "� a 1�� .. r�}.,� °� . , . � r �..1 q, I '., ,.�`�T,,�� R .'.r �+--^{ ' . � '� � � �...r�tw' fi � .: � i3 �C �-"3" P $ '"� i �' '�`,. � � ? �" J � � , � } �' ti. � �`. ��.' '�b . � ,� x ' z � �j ' � �_ y .� � r , � � i- ��: v.a � � .�� . � ,� " � ��`�. �� i� � �� i �Yi j�µ ��/ �L � � � �� ' y � ' . U � �`.�,� Mµ .sa.�.�P" F- �� Ii � i � . .'vL � � 'v . � � i�� 1 � � 1 1 . ,._� ''. �' .�1 ��. •, ' c � �� C _ �� .:A rt''d- � ' � � :. ' . o"�"." 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Pfl0.1ECTR00NES$: S%9 WENDY LN OWNEP'S NRMF� TROMB I NANCY L nooAess: 579 WEfJDY LN COSTA MESA,CA AXCN/ENGINEEfl: 5 4 8— Z a 8 9 aooeess: uxiT: 92627 flEG.NO.: uxiT: PFflMITTEE: NOCK PLUMHING (714)895-1246 nooeess: 11610 SEABOARD CIR STANTON CA 90680 UCENSED CONTflACTOB DECLHflFTION: I hereby allirm Ihat I am nsetl untler pmvisions oi Chapter 9(comm R'ng with Sec�ion 7000) ol Division 3 of Ihe Business and Pmlessions Code, ana my ic nse is in lull lorce tl eifecl. ciTruc.:0��:51197 cusr C_ Uaie: Sipnalure:� . wOBREBS'COMPEN TION CIABATION: IhereUyaHilml�allhaveate�iliWleolrAnSen�i seu-msureoracertiliwteofwoMers' Comoenutron Inswance. w a cetlitie0 copY �nereol (Section 3800. La�. q. voucrno.: 116799290 E%P.�pTE: O3/OiI92 comraNr: STATE 1/^/I � Cerlitiea copy is �ereCy lµrnlsh=tl. � CertilieE [o�is liletl v/4q the tity BuilCinp 'sion. ' A m. �./ r i // . �aie: ApDlicant: v� ✓ E%EMPTIONFNOMWO REBS' OMPENSFTIONOECUNRTI :(Thiss ionneeGnot�etompleteUil epermitisbronehunErea�5100�oNess). I cerlily Iha� in I�e pedOrmance ol Ihe wotk fOr which Nis Oenn�� is i55ued. 15hall not employ any person in any manner 5o a5 f0 become subl�� o ihe Workers' Compensation Lavrs ol Cali�ornia. Date: Signalure: NO710E: II. atler making �his declaration, you shoultl Gewme subject to t�e Workers' Comcenution Drovisions ol the Labor CoEe. you mus� Io�hvni� comply wit� suc� proviSions or lhis permit s�all G¢ GB¢meG revoketl. CONSTfl11C710N LENOINC RGENCV: I �ere�y affirm that tHere is a conslNction len�inp aAenty for the petlormance ol Ne wark (or which Ihis permii is issuetl (Seclion 3097, Civ. C�. LENDEH: AUOPESS: OWNEfl BWlOEP OECNMTION: I hereby allirm Ihai I am exem0� ��om lhe Comractors' State License Law lor lhe following reason (Section 7031.5 Business an0 Pmlessional CoEe: Any city ol coun�y whith repuires a oermi� to consimd, alter, impmve. Oemolisn, or �e0air any simcwre. O�ior ta iis issuance, alm rtQuires ihe aDPlicant for such Dermii io file a signeA sutement Itwi �rJshe is licensed pursuanitothe pmvisions olt�e Coniractors'State License law(Cha0�er9�commencinq vnt� $¢ttion 7pp)of0ivision 9 oll�e Business anU Pmfessions COUq ar iAai he/s�e is eremD� iherelmm and the basis lor lhe alleAea exemption. Any violaiion al Seciion 7031.5 hy any a001icant lor a Oermit su�le��s ibe apD�icant to a civil ptlnalty of not more Ihan live hunOreO dollars (5500�. I, as owner of ihe D�openy or my employees ��h wages as tAeir sole comDensation, vnll Eo ihe work, and ihe ❑ simcwre is not intenCeG or oilerea lor sale (5¢cuon 704e. Busines5 anE Pro�es5ional Code: The Conlraci0rs' Sia�e license Law Eoes not ap01y to an owner ol a pwperly who bui105 or impmves lhereon, ana who does such vroM �imself/�ersel� of �hmugti his or �er own employees, O�oviOeG t�al such imprN'emenls are nol in�enOeA or oflered far Shce. If, �awever Ihe building or impmvemen� is soltl wiNin one year o� comple�ion. �he owner will �ave Ihe burtlen oi Dmving �e/she Aia nol huild or impmve lor �ne ouroose of salel. I, as owner oi the pmpeny, am e�clusively contracting with licensea comracmrs lo consimct the pwject (Section 7044, 0usiness ❑ an0 Prole59on5 fAtle: The Conlratlors' Siale Li[en58 �aw tice5 no� apDly Io an Own¢r a� pmpertywh0 EUiICs or imOrOves ��¢2on antl who conVac�s for suc� O�ojetls wi�� a Contratl0�ls) license pursuan� lo Ihe Conlractors' Stare License Law). I am aware Ihai proo� ol iheir Worker'S Compensation insurance shoultl be pwvitle0 �o me. � I am exempt under Section: 0. 8 P. C. lor Ihis reaSan: Oaie: Owner. I Oo hereGy cenity I�al I am aware ol anG unGerslan0 t�e repU��ements of Calilornu HealtA anE Satery CaEe Sections 25505, 25533, an0 � 25534 antl �hai I or any Imure �uiiaing occupam wiNwill not (Gircle one) nee0 to comDty vnih uiU state w0es anOlhe repuirements tor a permil lor cans�mction or moailica�ion �mm I�e Air Oualily Managemen� Oislrict. ResiOential constmction aDP�ica�ions are eeempt �mm Ihes¢ provi5ion5. Dale: Applicanl: I �ereby certilyihall haverea0�hi5 aODlita�ion and Slaie Ihal I�e abov¢ i m ation is correcL I agree lo comply wiih allci�y and counry orUinanresantlstatetavrsrela�ingtobuiltlingmnslmctionanahereEyau� r¢ reO�eSemaii�� s Ihisciryioenleruponl � Gove-mentione0 ', pm0e�y �or inspeci n DurO sei^. .��. Oa�e: � ` Sipnamre: _ �� orivers ��cense or Soci s��av �: i6nFa6 WOue—BmlOing: Green—CoOe Eniorcamenl; Ce�ary—AppAcanl; Pink—Revenue; Goltlenrod—Assessor CITY OF COSTA MESA — HUILDING PERMIT PERM NO; P 05552 PERMIT NO; P 055528 PLAN CHECK NO; N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE; PLU PURPOSE: OTH JOB DESCRIPTZON : CHANGE OUT WATER HEATER SQ FT; CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 / COMMENTS• SMOKE DETECTOR RE�UIRED IN THE HONE *�r�t�t�t*�e�r�t�t*�t�t�r�r�r�r�t�r�e�e*�t�t�t�t�t �t�r�r*�r�r*�r��t*�t�r�t�e�r�r�e�e��**�t�t*�rr��e�r�e�t*�t*��e�t*�t�r*�e*�e�t�*�e�r Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING RE�• PROV; PARCEL; 42214303 ZNE; REF NO: PLANNING N 1'ES> > �r��e�r��e�r**��r**�rr+e�r*�r*�r�e�e�r�rr*�r��e�r*�e*�r�r�r�+e��+r�e�r�r�e�r**��e�r�r�r**�r�e�e�e�+t�r**�r*�r+r*�r�r*�r**�r�e* D E V E L O P M E N T S E R V I C E S� R E Q U I R E M E N T S 20NING APPROVED BY ' DATE; BUILDING APPROVED HY : DATE: APPLICATION ISSUED BY; ` '' DATE; �—�� if �F if if iF iF if iF iF if 3F M �f iF k�f if if if �f iF k�{Fi k 3f 1f �f iFiF �f iF 3f 1F�iFiFiF M if�F3tafkltiFitiFif�fififitkkifkMiFitiflfitiflfkiFikifikkMiEkklk3F�FkMitififiFlfk�fiFifiFiFifififkMMiFkitiFkitifikiF�f�tMiFklE3fifkkk�f LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUM�Ioo ELECTRIC MECHANIC FIRE SMIP/RES GRADING �15t SMIP/NON—RES PLAN ISSUE FEE 3,00 HUILDING—DIV—? PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 2,00 3,00 0,00 5,00 5,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 5.00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/TOT GRADING PLAN—CHECR 5.�� kkMlfMlfafifik!lit1ElEMMkkiFif�FiFifkifit�tMiFitiFkMMik�fifillkkiFiEiFkiflfififltififififklfMMM�FifiF3FiFiFlfik�FkiFlk�FiFiFiFk3fiFiFkiE I N D I V I D U A L F E E B R E A K D O W N TYPE (jTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR VENT 2,00 2,00 END OF FEES :r tl, -�' - �.i,r: C�.2C:;;--;� : _" - CONSTRUCTION AND PLANNING POOL 'A . APPROVALS Permit # Date Inspeetor APPROVALS Permit # Date Inspector 1. Temporary Elec[rical Servite or Pole 52. Pool & Equipment Location <. Soil Pipe-Und�grnd. •'-�S �-� 53. Steel Reinforcement .;3:�[2ctnGal ConduttZlt��lity�ll'ndcgrnd,;,'�� 54. Forms 4.'H19ttrical Conduit�Undrgrndc --' � 55. Electriwl Bonding ' r ,i.,5 "3t�g1 R�P,inforcement� � 56. Rough Plumbing & Pressure Test -; ElEctricalUFER�Qnd. �� 57. APPROVALTOCOVER�GUNITE i _7.''F iotings y'� � 58. Electrical Conduit-Undrgrnd. ' B� Foundation ` 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrg4d. .- i 60. Backwash Lines, P�Trap, O Undrgrnd. '' ?0. Structural Floor System � 61. APPROVAL TO DECK 11. Property Sewer Line & Hopse Connection � 62. Backwash & Receptor�Finat 12. Seu"ver Cap 1 - 1 63. Heater & Vent•Final 13. Roof Drains �c 64. Plumbing System • Final 14. Rough Plumbirfg ' . . 65. E�ectrical-Fina� 15. Rough Electrical.Conduit 66. Solar System-Final 16. Rou9h Elearic?FViring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrica�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - _ _ - -.�.- � ^ 20. �Rough Factor�y Fi2eplace � x t� �i'- _ � : � � ;APPROYALS'% = Perqiit # � �' i � x 1 :�.r • 1 - -f ' o ^ 7, �.'.': '� ♦ 21.�DuctS, inStrycturg y ... '� � y � -;.� a`i0. ndergrwpd jHYdfo • 22. Ducis. �Ceotitating:o �.=5 S � =' ' 7. ProductPiRing 0'Gas OOiI 23. Gas Pipe,�tough &'%st { S �, �,.: '. y y,� i� 7z. Underground Flush"- . `_` 24. �Roo� Framing� z: � .-�- � R : C` : �+ � '�3.°Undergmd'Storage-Tank O Gas ❑ Qtl• v •�r '� �i' t �. 25. Roof Sheathin r' ^ � . .r, " �-'- " • - . �� , ;, 9 ,�: r ,- 74.�OverheadHydro- r 26. T-Ban Ceilin9 1Structuraq & 6lonocoat �� o _ Y'r + 75.=Dry Chemical •� �- _ _ .-i., 27.��Frame and Flashi 9' `r t �� 76.' br Stan i e �T ' S �T' !�. � _.a:,� ��. v Y dP e . u� s 28. Lathjng� Siding +� �:�`� i• . 5" • �• �-� � 77.7FIXED SYS7EM��FIPFAL` � r . '29. Insulatiorh .�'w , S.^••• - • �" i � � � 78;�FIRE PREV'FII�A,LI x ^ .r :n � .. +30. Drywali,.[Vailing .�,; " �; " ' �x �' r•y�u. HEAlTH.OEPT�REQUtREMENT • 31. Plaster 87own,Coa�; � �:r_:. I � �y; *,�79.'f't�JAIiN$PECTICIN x - '-� 2.-Electriw3PowQr Me�ecZfinal i +' . ,; � _ �> . r$0. ,FOOD CERTIFICATE ISSUED � 33. FinaT7, Ele'ctrict ' ,. . '. ; " , I " •Not�s: r. j;, y •l L34.��Fina! He@iing & Air,Conditionicig-; : ' � � �,, v ,y- ,� %'y �6 � �,;= 35. Final�GalPiPZ-Te�$' '_ ° ' ' _-'� g .- - ," .' ^ "; _ e, $ . � �. t , C;' A , . � n t �:; I i � t �n� , .f m ,36. Hood or�CanoPY �s�+ �7 i r - ^ �k :. �. F + .. - � 37..Finai'Factory Firepf5c2' � r �. t i. I h. � g z r , 4 "38. Finai.Plumhing �� • , i . .• `' �/Z�/y i G��. . � � . �n .39. Watet Service-Final �� ` � (�r + . h �'�'� .: i :� +>. + "40. Gas Service�Final y � � � ' x� . r' ._[ t' r i � �r ' 'v .Y _ ^ � •.1 >41. Solar pomesticFinal > t�� • � _ � i �'� `� t r . ^ i ♦ 42. �Backflow Preventer' �, ` � �;� � � "� ' _ � � ' ' J • 43. Batkflow IrrigBtion� =� i -�• � ' � - ' � ��v 44. Landscape ir�fgatio� S stem~��'K ' '� r � ��' � @ Y - n,� r " �n iL .4.'. t 'i G ,.� ., . . -. ' . _ '45..Sound Attenuation• � - •� • - .- �� -' . �:� i. �� '�, ,r. � �46. �Handicap,"Regulatioqs � '-'_ � .� . .. . , ` • • • : ` •. • .. � F 1. 5 . � s �47. FINAL STRUCTURE & BUtLDING J � �� ' '� +' � .. � � � : � e 48.•FINAL PLANNING' � �''` '' ,. , rr ' " '' ' - Er . �r r « �¢9. Elec['r(c Re�ease to dison � . ' :� : . ; �� i� r .� � � f k ,50..Gas Release to Southern Califofnia,Gas Co ' ; � ��, ' , �� r y -' 1. CERTIFICATEOFQCCUPA, C , ; _ ,� '; :r , ' - No. Date F � W M a � w+ � F _, -= ,.a 45822 .-�-- � . COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 9225 4/14/78 106084 TL 9225 G/14/78 106oB4CKTQ APPLICATION FOR STRUCTURAL PERMIT � A For Applicant to Fill in Completely — Use Ink Only n.._,�.,_ RECEIVED BV DATE RECEIVED DATE ISSUED BUILDING Maple M�Cdc ADDRESS �y OWNER �ohn R. Davies t41 S�ii A'P' ND' ' _ PE��[ "' U MAIL BU�LDING Maple A1VL. ADDRESS P. 0. Box 155 .�.DDRESS TEL. TftAC LOT � BLOCK cirv San N�� 751-993 CONSTRUCTION - W A �+ LENOER X BRANCH OWNER ADDRESS ARCHITECT TEL. S Single family UI17tVALU$ OR ENGINEER ADDRESS 447 E.17th St.- Costa Mesa ZONE TVPE GROUP APPROVED CONTRACTOR eV DATE ADDflESS TEL. ZONE d NO.OF �7 USE OF NE CITV Santa Ana No. 751-9930 /�� P�+� [�, BUILDING STATE CITY �'ARDSAPPROVED VARDSAPPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUIIDING SIZE NO.OFBLOGS. (FROMGISTRE T) - OF LOT NOW ON LOT ONT FT. USE OF EXI5TING BLOG. SI FT Separate permits are required for L. SIDE Fr.6 p Fr. electric, plumbing and heating work. REAR FT. VSE OF BUILDING AND WORK TO 8E PERFORMED A DISTANCE BET. BEf. MAIN & �'� MAIN BLDGS. ACCEffi, BLDGS. Single family townhouse with 2 car up'A'# �?��5'� o^rE C.U.P.� APPqpVED '�%� � Y,a e AW'ROVED •'�' I hereby acknowledpe that I hava read thls application and state that tha abova informatton is correet and agree io comply with . all faws reBulacinp buildinp construction, and I shell not employ any person in violatlon of the workman's compensation laws of the State of Celifornla. ��/'7J� I hereby certify ffiat I am D�operly licensetl as e contractor under /�`� � 54 FL �� tho Staie of Callfarnle Business and Profassions Coda, Divlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR C�apter 9, antl ihat such licensas ara In full forca and effect, or I THE PURPOSE OF FSTABLISHING A PERMIT FEE ONLV: am exempt from thn pravlsions of the Staie of Callfo�nia Businecs V ALUATION PERMIT FEE S end Professions Cotl/e, Divi haptar 9. � Pe9mltte0��L / � �� OD �� PLAN CHECK § D „�.� � $ TAX S � � Auihorizetl ApenY / TOTAL PAID 5 � � g n m i m � m e� N m M O ^ LL ;y �iv �: %��-�- COSTA MESA BUILDING-SAFETY DEPARTMENT P o_ ROX 7200 COSTA MESA. CALIfORNIA 92626 r7��t,6 .- -_ �_..., : _M 160.00 TU For Applicant to Fill in Completely — Use Ink Only APPLICATION FOR STRUCTURAL PERMIT RECEIVEDBY OA��.�CEI EISSUED O BUILDING �. " -' i � ADDRESS PERMIT NO, OWNEF �— A.P. NO. MAIL BUILDING � ADDRESS ADDRESS TEL. TRACT LOT BLOCK qTV NO. CONSTRVCTION W ADD ALTER P 1 LENDER BRANCH OWNER � AODRESS VALUE ARCHITECT TEL. $ OR ENGINEER N FIRE ADDRESS ZONE TVPE GROUP APPqOVED CONTRACTOR BV DATE ADDRESS TEL. ZONE NO.OF USE OF NEW CITV NO. PLANS BUILDING STATE CITY YARDSAPPROVED YARDSAPPROVED LIC. NO. LIC. NO. MAIN 6UILD�NG ACCESSORV BUILDING SIZE NO.OFBLDCS. (FROMC(LSTREET) OF LOT NOW ON LOT PRONT FT. FT. USE OF E%ISTING BLDG. FT. FT Separate permits are required for L SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFOFMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCEffi, BLOGS. VAR.# DATE C.U.P.# /1P7RpVED APPROVED I �ereby acknowladga that I have reatl this applieation and state '^ n thai the above information Is corract and aB�ee to eomply with m all laws re8ulating builtlin8 conscruction, and I shall not employ � any person in vitl�ation of the workman's compensation laws of the Stata of Californla. `= m I hereby certify that I am properly licensetl as a canirector under SQ. FT. �v the State of California Business entl Professlons Coda, Division 3, THE AMOUNT SHOWN UN�ER VALUATION IS FOR m Chapte� 9, and ihat such licensas ere in fu�l foree and ¢ffect, or I THE PVRP06E OF ESTABLiSHING A PERMR FEE ONLV: � am enempt from the provisions of the State oT Celitornia Bustness VALUATION PERMIT FEE S p antl Professions COtle, Divtsion 3, Chapter 9. m PLAN CHECK E �� ^� Stpnature of � Permlttee $ TAX E �� LL f U Authorixed ABent TOTAL PAID E � TL � 1