HomeMy WebLinkAbout595 WENDY LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
,lobAddress: 595 WENDY LN
Suite:
Vicinity: KITCHEN AND GARAGE AT VILLA MAPLE CONDOS
Primary Occ: R-1 Hotels/Apts/Res >10 Occ Type of Construction: V-N
Parcel Number: 42214307 Zoning:
Applicant: DAYE, STEWARD
Address:
Owner: MC CALLISTER, BETTE
Address 595 WENDY LN
COSTA MESA, CA
Contractor: FINELINE FOUNDATION TO FINISH
Address: 9114 ADAMS AVE
Phone: 714-720-7060 CELL ISSUED BY:
Zip:
Phone:
Zip: 92627-5517
Phone: 714-536-9963
Slatus: ISSUED
Applied: OS/OB/2006
Issued: O6/OS/2006
� � ,
���. 1 I•
HUNTINGTON BEACH, CA
Zip: 926a6 License: 848833
Arch : Eng: HADID-TAMJED, HASSAN
Address: Address: 1564 W CRIS AV
Zip:
Phone:
License:
Phone: 714-883-4124
ANAHEIM, CA
92802 License: 54078
SCOPE OF PERMIT
INTERIOR KITCHEN REMODEL TO REMOVE A LOAD BEARING WALL IN THE EXISTING KITCHEN AND REPLACE WITH A BEAM AND REMOVE
AND INSTALL A BEAM IN THE GARAGE. .
Plan Check: $117.81
Permit: $181.25
SMIP Res: $1.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $300.06
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existin : 0
Rear 0-0
Rear 0- 0
Reauired: 0
FEE SUMMARY
Calc Valuation: Sio,000.00
Claim Valuation: S�o,000.00
PLANNING & ZONING
Left 0-0 Righl
Lefl 0-0 Right
Pr000sed: 0
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
tor 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 tinal approval will result in the expir�wn of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�
WORKERS'GOMPENSAnON DECIARATON: . �
I hereDy eflirm under penalry oi perjury orre oi the following tleclaretions:
❑ I have end will maintain a certificate ot consent to sell-Insure tor workers' compensation, es provitled tor by section 3700 0l the Labor Cotle, for the peAormance of the
work tor which �his pertnii is i5suetl.
❑ I have C�vill maintain worke ' ompens n insurance, as required by section 3700 of the LeDor Cotle, for Ihe pedormance of the work for which �his pertnit I5 issued.
""� � r�ca ansation I urance car r antl policy ber ere: ,�/�� L��
�Carriar"� '�� - Polic Number: � 7
i(T�SecNon need nof be cromple(ed i! fhe rmi val d e ne drg dollar (8100) or less.)
/
❑ I certity thet in the peAormance o a fo h' th' m�if is issu , I shall not employ eny person in eny menner so es to become sublect to the workers'
compen5atlon laws ot Cali�om' n e I uIC come e workers' tompensetion provisions o� Sec�ion 3700 of �he Labor Code, I shall torihwith
wmply with these provisio . �� �/���
Applicenb6tgrre�re: Da`� �
WARNINGCFAKURE TO SECURE WORKERS' CO!dPENSATI VERAGE IS UNLAWFUL AND SMALL SUBIEC� PN EMPLOVER TO CRIMINAL PENAL ES AND CIVIL FINES UP TOONE HUNDRED
TFIOIISPND OOLLARE (5100,000). IN ADOITION TO TME �JST OF COMPENSATION, DAMAGES AS PROVIDED F-0P IN SECTION 3]OB OF THE L4BOR CODE, IRfrEREST, FND ATTORNEV'S FEES.
LICENSED CONTRAC70RS DECLARApQ • / �/�J� /� /J
I hereDy aMirm ihat I am � �j' pi �e � kEhe r�y,(co encing with Section 7000) ol Division 3 of�the BusinesspQd Professions Cotle, end my license is in full
I�roe�antl'ettecLLic.A����% � � qas_s�.N� ,L/
contractofs sig ture: Dale:.- .� .� Bf0
�'sl' �
�
CONSTRUCTION LENDING AGENCY:
❑ I hereby aftirm that there is a construction lending agenty for lhe pedormance of Ihe work br which ihis pertnit is issuetl. (Sec. 3097, Civil Code).
Lendefs Name: Lentler's AAdress:
SignaWre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirm ihat untler penelty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Buslness end Professions
Cotle: Any ciry or counry which requires a permit to constmct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the appliwnt lor such pertnit
to file e signed statement ihat he or she is licensed pursuant to the provisions of �he Contractors License Lew (Chapter 9(commencing with Section 7000) oi Division 3 of the
Business end Pmfeuions Code) or that �e or she is exempt l�erefrom entl the basis for tha allegetl exemption. Any violetion ot Section 7031.5 Dy any applicant for a pertnit
suDjects Ihe ep0licaN to a civil panalry of not more ihan tive hundred dollars ($500)J:
❑ I, as owner of the properry, or my employees wi�h wages as their sole compensation, WILL DO THE WORK, antl Ihe structure Is not intended or oHeretl lor sala (Sec.
7044, 8usiness and Prolessions Code: The Conirac�ors License Law tices not apply to an owner of property who builds or improves Ihereon, and who tloes such work
himself or herseli or ihrough his or her own employees, provitletl t�at such impmvemen�s are not intended or oHered for sale. It, however, Ihe builtling or impmvemem is
sold within one yeer of completion, the owner-builder will have tha burden ot pmving that he or she did not build or improve for purpose of sale.�.
❑ I, a5 owner of the property, em E%CLUSIVELY LONTRACTING WITH LICENSED CONTRACTORS to consiruct Ihe project (Sec. 7044, Business entl Profe55ion5
Cotle: The contractors License Law tloes not ap01y to en owner ol property who builds or improves thereon, end who coniracis for such project with e coniractor(s)
license pursuant to ihe Contraaors License Wws.).
❑ I am e:empt under sec. Business and Prolessions Cotle for this reason:
Signawre: Date:
Owner ID venlietl 6y tlrivefs license. ❑ Yes ❑ No Dnvers License No. Ezpires:
Verification ol Ownership by (type of tlocument, i.e. - property taa bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby cenity ihat no excavetion five (5) or more feel in dapih into which a person is required to descend, will be metle in connection with work authodzetl by ihis
permit, and that no building slmcNre, scattoltling, falsework, or tlemolition or dismantlinq thereof, will be more then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, 7tle B, Calibmia Atlministrative Code).
❑ As ownervbuilder, I will not employ anyona to do work which would require a permit tmm Ihe Division of Intlustnel Setery, as noted above, unless suc� person hes e
pertnit lo do such work from �he tlivision.
Signature: Dale:
Division of Intlustnal Satety Permit Number:
HAZARDOUS MATEfiIALS AND EMISSIONS CERTIFICATION:
1 W ill the epplicant or present or future building wcupan� need lo file end certity a Business Plan lor emergenry response to release or threatened releese ot a hazardous
materiel? ❑ Yes ❑ No
(Section 25505 ot the Califomia Health and Safery Cotle requires, with some exceptions, ihat a Business Plan De filetl with the Costa Mesa Fire Depertment by every
businoss which has et any one time during a reported year a quantity of hazardous matenals equal to or qreater ihan a weight of 500 pountls, or a volume of 55 gallons,
or 200 cubic leet of compressetl gas at standard tempereture and pressure).
........................................................................................._.............................................................................................................................................................................................................................................................................................
2 Does or will the applicant or prosent or future building occupant need to tile a registration torm for acutely hazartlous malerials? ❑ Yes ❑ No
(Section 25533 of tha Celilornia Health and Safery Code, wlih some ezceptions, requires regislration with ihe Costa Mesa Fire Department by each husiness which at eny
one tima hes on hend e quantity ot acutely hazardous meterials equal to or greater then e weight of 500 pounas, or e volume oi 55 gellons, or 200 cubic teet of
compressed gas at stantlar0 temperature and pressure).
........................................................................................._.............................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupent need to prepare an RMPP (Risk Management end Prevention Program for acutely hezardous meterials)1
(Section 25534 of ihe Calilomia Healih and Safery Cotla pmvitles that the Costa Mesa Fire Department may require ihe preparation, cetlification and filing with the Fira
Depariment ot en RMPP by businesses which are requiretl to register awtely hazardous matenals with ihe Fire Depahmenl.
.............................................................................................................................................................................................................................................................................................................................................................................._.....
4 If en RMPP is presently reduire4 has Section 25534 0l Ihe Califomia Health antl Safery Code been fulry complied with7 ❑ Ves ❑ No
5 Doea ar will ihe epplitant or prasant or future builtling occupant reduire lar tha work which is the sublect ol Nis e plication a gertnit for such consWction or modiliwtlon
trom the South Coast Air �ualiry Management DisMct or Irom eny other air polWtion contml district or agency+ � Ves u No
(Sec�ion 658502 of the Calitomie Govemmen� Cotle requiros ihei the raques�etl inbrmation be Wmishetl on applications lor nomresidential builtling permits).
........................................................................................._................................................................. ....................................................................... ....................... .................................................................
6 Will any patl of Ihe feciliry to 6e conswcted under this permit be within 1000 teet irom the ou�er bountlaries oi a school7 ❑ Yes ❑ No
(tl "yes", tha tacility must meet the requirement oi Sections 25534 and 42303 of the California Health and Safety Code).
........................................................................................................................................................................................................................................................................................................................................................................................
7 If a pertnit Irom tha South Coest Air �uality Manegement District or other air pollution control tlistrict or egency is requiretl for the work which is the subled of Ihis
epPlicatioq heve ell of ihe dlsclosures prescribetl by Celifornie Healih and Safery Code Section 42303 been made7 ❑ Ves ❑ No
........................................................................................................................................................................................................................................................................................................................ . ...............................................................
8 Qf "yes", attach certificate oi compliance irom the appropriato eir pollution control oHicer).
CERTIFICA7E OF COMPLIANCE: I certity that under penalty of perjury the informalion given ebove is correci. I agree to comply with all state lews and city ordinences
ragarding Hezartlous Ma�erials and Emissions.
Signature: A Date:
CERTIFlCATE OF COMPLI AND
correct. I egraa to comply � stau
above-descnhetl prapert 50ect�
GOOE �. INSPECTIONTYPE
1616 Ficed System Final Fire Prevention
1266 Pool Spa Finel
200 Finel Re-Roof
201 Finel Block/Retelning Well
202 Final Factory Fiia Place
203 Final Sign
204 Finel Demoli�ion
V: I certily under penalry of perjury that I have reatl this application and state that ihe infortnation given is
es relating to building construaion, and authorize representatives of the City of Cosia Mesa to enter upon ihe
to occupy or allow acupancy of any 6uildinq authonzed by Ihis permil until final inspection.
Qpjf Illjjj�yk^� $�Qf�I INSPECTIONTYPE
206 Final Mechanical
208
210
212
220
222
250
Final Plumbing
Final EleCiriCal
Final Fire Prevention
Final Planning Approvel
Final Site
Final Building/Occupancy
PAI€ Irmn��S
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicank
Address:
Owner:
595 WENDY LN
KITCHEN
42214307
DAYE, STEWARD
9114 ADAMS AVE
HUNTINGTON BEACH, CA
MC CALLISTER, BETTE
Address 595 WENDY LN
COSTA MESA, CA
Phone: 714-536-9963
Zip 92646
Phone:
Zip:
Contreaor: FINELINE FOUNDATION TO FINISH
Address: 9114 ADAMS AVE
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recepl Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motoro to 10hp
Motors to SOhp
Motors l0 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Status: ISSUED
Applied: O6/08Y2006
Issued: O6/08/2006
ISSUED BY:
9z6z�_55,� EXp�.1�ED
OA'�
Phone: 714-536-9963
HUNTINGTON BEACH, CA Zip: 92646
License: 848833
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR AN INTERIOR KITCHEN REMODEL TO REMOVE A LOAD BEARING WALL IN
THE EXISTING KITCHEN AND REPLACE WITH A BEAM AND REMOVE AND INSTALL A BEAM IN THE
GARAGE.
REF#: 806-00685
WORK TO INCLUDE: 14 LIGHT FIXTS, 15 OUTLETS AND 5 SWITCHES.
$23.50
50.00
$0.00
$0.00
so.00
50.00
$15.40
$16.50
$5.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
Quantiry
0
0
0
14
15
5
0
0
0
0
0
0�
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Buswayll�Oft
Standing Section
Misc Eleclrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kvalkw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System ! Ckt
Misc. Conduit
Misa Conducto�
Cirws ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantiry
$0.00 0
$O.OU �
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
50.00 0
so.00 0
so.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E60.90
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92•28, § 1, 7247-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or it work is;u nded or abantloned
tor a period of 180 days. U
INSPECTIONS: I� order tor the work authorized under this permit to he co�sidered legal, such work must comply with all applicable codes, and ail
required inapectiona and Iinal approval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby eflirtn under penalty of perjury one ot t�e following declarations:
❑ 1 have antl will maintain a cenitiwte of consent to seli-Insure tor workers' compensation, es pmvitled br by section 3700 oi Iha Labor Cotle, lor t�e partormance ot the
work tor whi �is pertnii is issuetl.
❑ I have a will rr�Aintain �(iorkers' cwn nsation insur)nce, a�quired by sedion 3700 of Ihe Le6or Code, for ihe pertortnance of the work for which this pertnit is issuetl.
need nof be comp/efetl
❑ I cetlify that in the pertortnance ol ihe work for
compansalion laws ol Celifomia, end egree IN
com0ly with thes vi ' r}s. ,
�Plicent'inaliire: E
WARNINQ: FAILURE TO SEWRE WORKERS' fA PENSAI
TMOUSNND DOLL4FE (5100,OWf, IN NDDITION TO THE CO:
LICENSED CONTRAC70RS
I hereby aNirm that I am ly�y
are: /� %��� �
�.Y��:�"a7, ,J PolicY.Num6er.'_
ea ..n�,� u � r.,�� i
ph ot e loy any person in eny manner so as to 6ecome subject to Iha workers'
t e wo rs'tompensalion provislOns of Sgctipn 370p ot the LabOr Code, I sha0 torthwtlh
�Dete--� �/ /�P
AND SHALL SU&IECT AN EMPLOVER�TOCRI P ALTIES AND CIVIL FlNES UP TO ONE HUNDRED
;Fi+�S PROVIDED FOR IN SECTION 3]O60F THE LABOR CAOE, INTEREST, AND ATTORNEY'S FEES.
Section 7000) of Division 3 of Ihe Business �Professions Code, entl my license Is in full
CONSTRUC710N LENDING AGENCY:
❑ I hereby aHirtn ihat ihere is a construction lentling agency for ihe performance of the work for which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address:
II Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirtn that under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professlons
Code: Any ciry or counry which requires a permit to constmct, elter, impmve, tlemolish, or repair eny s�ructure, pnor to its issuance, also requires ihe eppliceN for such permit
to file a siBnetl statemeni ihat he or she Is licensetl pursuent to the pmvisions of the Contractors Ucensa Lew (Chapter 9(commencing with Section 7000) ot Division 3 oi the
Business end ProfeSsionS Code) or thel he or she is erempt therelrom and lhe basis for t�e elleged exemption. Any violation ol Section 7031.5 by eny epplicanl lor a permil
subjects lhe applicant to a civil penalry of not more then five hundred dollars (5500).):
❑ I, as owner of the propeny, or my employees with wages as lheir sole compensation, WILL DO THE WORK, entl the stmcNre is not intended or oNeretl lor sale (Sec.
7044, Business and Professions Code: The Contrectors License Law dces not apply to an owner of property who builds or improves ihereon, and who tloes such work
hlmself or hersetf or through his or her own employees, pmvitled ihat such impmvemenls are not intended or oflered tor sale. If, however, ihe builtling or improvement is
soltl wit�in one year of completion, iha owner-builtler will have the hurden of proving tha� he or she ditl not builtl or improve for purpose of sale.).
❑ I, as owner of the pmperty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS ro construct the prolecl (Sec. 7044, eusiness end Professions
Cotle: T�e coniractors License Law does not apply to an owner of pmpeey who 6uilds or Improves thareon, and who contracts for such project with e contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. 8usiness and Professions Code tor Ihis reason:
Signature: Date:
Owner ID verifiad by drivefs license. ❑ Ves ❑ No Driver's License No. Expires:
Venfiwtion of Ownership by (type of documem, i.e. - propehy tax bill or deed):
DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: �
❑ I here6y cenih/ Ihat no axcavation five (5) or more feet in depth into which a person is required to descend, will be matle in connec�ion with work euthorizetl by Ihis
permit, and ihat no building siruc�ure, scaHolding, falsework, or tlemolition or tlismantling �hereof, will be more ihen ihitly-sin (36) fee� high. (Chep. 32, Grp 2, Ah 2, Sec.
341, Title 8, Califomia Administretiva Code).
❑ As owner-builder, I will no� employ enyone �o tlo work w�ich woultl require a permit from iha Division of Indusiriel Salety, as noted above, unless such person has a
permil to do such work from ihe divisian.
Signalure:
Division ot Indusinal Safery Permit Number:
Date:
ARDOUS MA7EfilALS AND EMISSIONS CERTIFICATION:
Will Ihe appliwnt or presem or future building occupant need to /ile and cenify a Business Plan br emergency response to release or ihreatenetl releese ot a hazerdous
meterial? � Yes ❑ No
(Section 25505 of the California Health and Safery Cotle reduires, with some ezceptions, t�at a Business Plan 6e tiled with the Cosla Mesa Fire Department hy every
business which has at any one time tlunng a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons.
or 200 cubic feet of compressed gas a� siantlard temperature and pressure).
.............................................................................__......................................................._....... ..................................................................................................... .............._....... ...................................................
Does or will ihe applicani or present or futura builtling occupant nee0 to file a regisiration lorm for ecutely hazardous materials7 ❑ Yes � No
(Section 25533 of the Califomia Heallh antl Sefery Cale, wilh some ezceptions, raquires registration with the Costa Mese Fire Department by each husiness which at eny
one time has on hand a quantiry of acutely �azardous meteriels equal to or greater ihen e weight of 500 pountls, or e volume oF 55 gellons, or 200 cubic teet of
compressetl qas et siandard temDere�ure entl pressure).
� uoes or win me appncam or presem or mmre �
❑ ves ❑ No
(Section 25534 of ihe California Health and S
Depertment of an RMPP by businesses which
........................................................................................._..................,
4 If en RMPP is presently required, has Section
occupant need to prepare an RMPP (Risk Manegement and
that ihe Costa Mesa Fire Deparlment may require �he preparation, certification and filing with Ihe Fire
ler ecuteW hazardous matedals with the Fire Depahment.
5 Does or will the applicani or present or tu�ure builtling occupant require br Ihe work whic� is ihe subject ol ihis a,�pplication a Permi� for such consiruction or motlification
Irom ihe Sou�h Coast Alr Oualiry Management DIStAct or irom eny other air pollu�ion contml tliSMct or egency? u Yes �J No
(Seclion 658502 0l ihe California Government Cotle reQuires Nel the requestetl infortna�ion be fumis0etl on aOPlicaiions for nomrasidential building permiis).
......................................................................................... _.............................................................................................................................................................................................................................................................................................
6 W ill eny part ol ihe �acility to be constructetl untlar Ihis parmit be within 1000 fee� from �he outer boundanes of a school? ❑ Ves ❑ No
(If "ye5", the faciliTy must meet lhe requiremeni ol SeC�ionS 25534 antl 42303 of ihe Calitornia HBalih antl Safety Cotle).
...._ ............................................................. .........._....................................................... .............................................................. ................................................................
7 If e pertnii from ihe Sou�h �CoaS� Air Oualiry Menegemen� Dis�nct or other air pollu�ion conirol dis�rici or egency is required for ihe work which is �he subjecl of �his
eppliwUon, have all ot the disclosures prescnbetl by Calltomie Healih and Safety Code Section 42303 been metla? ❑ Ves ❑ No
......................................................................................... _.............................................................................................................................................................................................................................................................................................
B (II'yes", atlach cetlificate of compliance trom ihe appmpnete air polWtion conirol otticer).
CER7IFICA7E OF COMPLIANCE: I cehify ihat untler penalty ot perjury the infortnation given above is wrrect. I egree to comply with all state laws antl ciry orainances
regarding Hazartlous Matenals antl Fmissions.
Signawre: ,U Da�e:
CERTFlCATE OF COMPL
correct. I egrea ro compry
above�desCribetl property 1
COOE 1, INSPECTIONTYPE
1fi16 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
ATION OF E K certify under penalty of perjury Ihat I have reatl ihis application antl state �hat t�e Information given is
ciry o in ces r ting to building consimction, end emhorize representetives of ihe Ciry of Costa Mesa to enler upon the
� ot to cupy or allow occupancy of any building authorizetl by this permit un�il final inspection.
F�
IMffIALS �Qy�� INSPECTIONttPE
206 Final MechaniWl
20B Final Plumbing
210 Final Electrical
212 Flnel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
Dl�g IHTITIALS
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us . 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 595 WENDYLN
Suite No
Vicinity: KITCHEN
Parcel Number: 42214307
Applicant:
Address:
Owner:
Address:
MECHANICAL PERMIT
ISSUED BY:
DAYE, STEWARD
9114 ADAMS AVE
HUNTINGTON BEACH, CA
MC CALLISTER, BETTE
595 WENDY LN .
COSTA MESA, CA
Phone: 714-536-9963
Zip: 92646
Phone:
Zip: 92627-5517
Contractor: FINELINE FOUNDATION TO FINISH
Address'. 91i4 ADAMS AVE
Phone: 714-536-9963
HUNTINGTON BEACH, CA Zip: 92646
License: 848833
Slatus: ISSUED
Applied: 06I08/2006
Issued: 06(08/2006
SCOPE OF PERMIT
MECHANICAL PERMIT FOR AN INTERIOR KITCHEN REMODEL TO REMOVE A LOAD BEARING WALL
IN THE EXISTING KITCHEN AND REPLACE WITH A BEAM AND REMOVE AND INSTALL A BEAM
IN THE GARAGE.
REF#: 806-00685
WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt CoolingMeat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Faclory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers � 10000cfm
AirHandlers> 10000cfm
Floor Fumace
Floor or Suspend Heater
523.50
$0.00
50.00
513.70
50.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$O.PO
$O.PO
$0.00
$0.00
$0.00
$0.00
Quantiry
0
0
1
0
0
0
0
0
0
0
0,
0
0
0,
0-
0
0
0
0
FEE SUMMARY
Repair I Alt Absorblion Unit
Repair / Alt Re(rigeration Unit
Ventillation System
Evaporative Cooler
Commercial Inci nerator
Domestic Incinerator
Comoressors / Absorolion Svstems
Upto3hp/t00kBTU
3 To 15 hp / 500 k BTU
15 To 30 hp I 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Imestigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
Quantiry
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
537.20
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, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wiihin 1 BO days, or if wor�uapended or abandoned
for a period ot 180 days.
INSPEC710NS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required inepeotiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
��r�,�w,
WORKERS' COMPENSATION OECLARATION:
I hereby aHirm under penalty of perjury one of ihe following declaretions:
❑ 1 heve entl will maintein a certificete ot consen self-Insure tor workers' compensation, es provided for by section 3700 0/ lhe Labor Code. lor Ihe pertormence ot the
work tor wNch�is pormit is issued.
❑ I Certify ihet in t�e pen
compensetion laws of
hKK1SlWD DOLLARE (5100,000�, IN ADDRION TO THE
as required by section 3700 of t�e Labor Cotle, For the pedormance ol the work for which ihis permit is issued.
�mb ra: �'� /��� ���
Policy Number. l
ne ndred dollars ($700) or less.) ��
rmit is issued, I shall not employ any person in any manner so as to 6eyome subject to ihe workars'
LYacome sub�e I lo Ihe workers' compensation provisions oi S tion 37/0p of the Lebor Cotle, I shall torthwith
7 � Date- �� /!�'�
AGE IS UNUWFUL M!D 5 SUBJECT Ml EMPLOYER TO CRIMI P T1ES AND GVIL FlNES UP TOONE HUNDRED
ENS/ ^ON, DAM4GES�P 01VIDED FOP IN SECTION 3lOfi OF THE LABOR CODE, IMEREST, AND FTTORNEI"S FEES.
LICENSED CON7RACTORS DECLAFATION:
I hereDy aNirm Ihat I am li d o isi of e ci wit ecti 7000) ol Division 3 of�ihe.Business tl Pmfessions Cotle, end my license is in tull
face�e� aHactrCfc: a— � Class N�
ContracloCs:Slgnature: % D ta B_ �`` ' B
� i
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirm �hat there is a conslmction lending agency for ihe pedormance of the work lor which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lender's Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aMirm lhat undar penalry oi perjury Ihat I am EXEMVT FROM TME CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business ena Professions
Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, elso requires the epplicam tor such pertnit
to Fila a signetl statement that he or she is licensad pursuant to the provisions ol Ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) ol Division 3 of Ihe
Business end Professions Code) or ihat he or she is exempt therefrom antl the basis lor the alleged exemption. Any violetion ol Section 7031.5 by eny epplicant for a pertnit
sublects �he applicant to a civil penalry ot not more than tive hundred dollars (5500).):
❑ I, as owner ot the properry, or my employees with wages as their sola compensatlon, WILL DO T1E WORK, and the swciure is not intentletl or otteretl for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law dces no� ep01y to an owner ot property who builds or improves Iheraon, end who tloes such work
himself or herselt or Ihwugh his or her own employees, provided ihat such impmvemen(s are not intended or oHered for sale. If, however, the building or impmvemenl is
sold within one year oi completion, Ihe ownervbuiltler will have the burden of proving that he or she did not �uild or improve lor puryose ol sale.).
❑ I, as ownar of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 70aa, Business and Proleuions
Code: The contretlor5 License Law does nol apply m an owner ol property w�o builtls or improves ihereoq antl who contracis lor such pmjeci with a tonlractor(s)
license pursuant to the Contracmrs License Laws.).
❑ I am ezempt untler sec. Business and Prolessions Code for this reason:
Signature: Date:
Owner ID verilied by driver5license. ❑ Yes ❑ No Driver's License N0. Expires:
Verificetion of Ownership by (type of document, i.e. - property tar bill or daetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cehify thai no ezcavation five (5) or more feat in tlepth into which e person is required to descend, will be made in connec�ion wlih work authorized by this
permit, and that no building siructure, scaHolding, falsework, or demolition or tlismantling ihereof, will be more �han thirty-six (36) leet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomla Admini5trativ8 Code).
❑ As owner-builder, I will no� employ enyone to do work which woultl require e permit from Ihe Division of Indus�rial Safety, as noted ebove, unless such person has e
permit to do such wark from Ihe division.
Signature: Data:
Division of Industrial Satety Pertnit Number:
W ill Ihe applicant or present or future builtling occupant neetl to file end certity e Business Plan lor emergency response to release or Ihreatenetl release of a hazartlous
matenel? ❑ Yes ❑ No
(Section 25505 of ihe Celifornia Heaith and Safety Code raquires, with some exceptions, �ha� a Business Plan be filed with Ihe Costa Mesa Fire Department by every
business which has at any one time during a reponad year a quamity of hazardous materials equal to or greater ihan a weight o1500 pounds, or a volume oi 55 gallons,
uoes or win me appucam or presenc or mwre ounaing occupam neea m nie e regisvauon iorm ior acutery nazaroous matenais t U res LJ No
(Seciion 25533 0l the Celifornia Healt� antl Safaty Cotle, with some axceptions, requiras registration with the Cos�a Mesa Fire Depanment hy each business which at any
one time has on hentl e quantiry of acutety hazardous materials equai to or greeter then e waigM of 500 pounds, or e volume oi 55 gallons, or 200 cubic feet of
compressed gas et standertl tempereture and pressure).
..............................................................................................................................................................................................................................................................................................................................................................................
Does or will ihe applican� or present or fuWre building occupant nead to prepare an RMPP (Risk Management end Prevemion Program for acu�ely hazardous materials)?
❑ Ves ❑ No
(Section 25534 ot the California Haalth and Safety Code provides Ihat ihe Costa Mesa Fire Depanment may require Ihe preparation, cehification and filing with the Fire
Departmant ol an RMPP by businesses which are required to regisler acutely hazardous matenals with the Fire Department.
.......................................................................................................................................................................................................................................................................................................................................................................................
4 tl en RMPP is presently required, has Section 25534 of ihe Calilornia Heelth entl Safery Code been fully complied with? ❑ Ves ❑ No
........................................................................................................................................................................................................................................................................................................................._.............................................................
5 Does or will �ha epplitant or present or tuWre building occupant roquira for �he work which is ihe sublect of ihis e pliwtion a germi� br such cons�ruaion or motlitication
Irom ihe Sou�h Coesi Air �uality Management Districl or imm any oiher eir pollution control tlisirict or agenc� � Yes u No
(Section 650502 0l the Calitomia Govemment CoOe requires thel lhe requestetl intortnation be tumished on applications tor nomresitlantial builtling permits).
......................... .......................................................................................................................................................................... ..... .............................................................................................................. ..............................................................
6 Will eny part ot ihe faciliry to be constructed under �his permit he wllhin 1000 feei from �he outer boundanes of e school7 ❑ Ves ❑ No
Qf yes", the facility must meet the requirement of Sections 2553a and 42303 0l ihe Calitomia Health and Safery Code).
......................................................................................................................................................................................................................................................................................................................... _.............................................................
7 If e permit from ihe South Coast Air Oualiry Management DisMcl or other air pollution contml distnd or egency is required lor the work w�ich is the subjact of this
applicallon, have ell ol Ihe disdasures prescnbetl by Califomia Heelt� antl Salery Cotle Section d2303 bsen made7 ❑ Ves ❑ No
............................._.............................._............................__......................................................_..............................._................................................................................................................................_......._.............................................._....
B (II yes", etlach cetliticate oi compliance from the appropriate eir pollution contml oHicer).
COMPLIANCE: I certify that untler penalry ol perjury ihe inlormation given above is correct. I agree to comply with all stete laws and ciry ordinances
is Materials antl Emissions.
Signature:
CERTIFICATE OF COMPLIANCE AND
correct I agree to camply wilh ell sten
ebave-describetl propertyforinspecyp)
COOE �. INSPEC110NTYPE
1676 Fiaed System Finel Fire Prevention
1266 Pool Spa Final
. i...
200 FinalRe-Rool `�
207 FIneI BIocWRalaining Wall
202 Final Fecrory Fire Plate
203
204
Flnal Sign
Final Demolition
p�TE
Date:
ti}4 under penalry of perjury lhat I have read ihis application antl s�ate t�et the information given is
6 Duilding construction, and authonze representatives of Ihe Ciry of Costa Mesa to enter upon the
ellow occupancy of any building authorizad by ihis permit un�il final inspec�ion.
INiRIALS C�DF_! INSPELTIONflPE
206 Final Mechanical ���
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesaP. LUMBING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 595 WENDYLN
Suite No
Vicinity: KITCHEN
Parcel Nunmber: 42214307
Applicant: DAYE, STEWARD
Address: 9114 ADAMS AVE
HUNTINGTON BEACH, CA
owner: MC CALLISTER, BETTE
Address 595 WENDY LN -
COSTA MESA, CA -
Phone: 714-536-9963
Zip: 92646
Phone:
Zip: 92627-5517
Contracror. FINELWE FOUNDATION TO FINISH
Address: 9114 ADAMS AVE
Phone: 714-536-9963
HUNTINGTON BEACH, CA Zip: 92646
License: 848833
ISSUED BY:
Status: ISSUED
Applied: 06/OBl2006
Issued: O6/OB/2006
SCOPE OF PERMIT
P4UMBING PERMIT FOR AN INTERIOR KITCHEN REMODEL TO REMOVE A LOAD BEARING WALL IN THE
EXISTING KITCHEN AND REPLACE WITH A BEAM AND REMOVE AND INSTALL A BEAM IN THE
GARAGE.
REF#:BO6-00685
WORK TO INCLUDE; 1 KITCHEN SINK.
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Connect pce,Soda,etc)
Dental Unils
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptor5 (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 R) $0.00
Receptors $0.00
Septic Tank $0.00
SewerCapforDemo $0.00
SewerConnect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor 50.00
Sink, kitchen 59.80
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
COMMENTS / SPECIAL CONDITIONS
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr BkBow(5+)
Wash Basin
Wash Basin Set
Wasfe and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
333.30
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 7, 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. /�'
!l
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
raqulred inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244E681fi�00�
WORKERS'COMPENSAnON DECLARAnON:
I hereby aNirm under penalry of pe�ury one of ihe following tleclarations:
❑ I have and will maintain a cenificate of consent to self-Insure for workers' compensation, es provided for by section 3700 oi the Labor Code, for ihe pertortnance of the
work for whic� permi� i5 i55uetl. / �
❑ I certity that in the peAormance of
compensation laws of Galifornia, i
DOLL4FE (5100,000�, IN A�DITION TO THE COST
LICENSEDCONTflACTORS
S, as repuired by section 3700 of Ihe Labor Code, for the partortnance of Ihe work for which ihis permit is issued.
number are: /������
Policy�N. umber: �
hundr dolla $ 0)or/ess.) � j —�
s pe i iss , I all no� employ any person in any manner so as �o become subject �o �he workers'
ild je e worker :compensation provisions of Secti 37 0 ot t Labor Code, I shail torthwith
Date� �/7J 6`C/
�
� S UNLAWFULlWD SHA L SU&IECT AN EMPLOYEHTO CRIMINQ NALj� 5 ANO CIVIL FWES UP TO ONE HUN�RED
tPENSATydJJ, DAMAGES �VIDED FOR IN SECTION 3)O60F THE LABOR COGE, IMEREST, AND ATTORNEY'S FEES.
I hereb attirm that I am li c o a er co en h Section 7000 of Division 3 ot the Business a mfes �ons C e, and m license is in full
Y � � 9 ) I y
(orce ena effecL Lic. N �i LClass.�� ��7 �.
C�ntrflctor's�5lgnature3 � Date� /
/
_ i
CONSTRUCTION LENDING AGENCV:
❑ I hereby aflirm ihat there is a constmcfion lending agency for ihe performance of ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
SignaWre:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby attirm ihat under penalty of perjury that I am EXEMPT FROM 7ME CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, eusiness antl Professions
Cotle: Any ciy or county which requires a permit to construc�, alter, improve, tlemolish, or repair any strucWre, prior to its issuance, also requires the applicant tor such pertnit
to File a signed statement ihat he or sha is licensed pursuan� to lhe provisions ot ihe CoNrectors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 ot the
Business end Pmfessions Code) or thet he or she is exem0� therefmm and the basis tor the allegetl ecemption. Any violation ot Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of noc more than tive hundred dollars (5500).):
❑ I, as owner of ihe properry, or my employees with wages as iheir sole compensation, WILL DO 7ME WORK, and the stmcWre is not intended or oHered 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 ihrough his or her own employees, providetl that such improvements ere not intended or ottaretl for sale. N, however, the building or improvament is
sold within one year of completion, the owner-builder will have tha burden ot proving that he or she did not build or improve for purpose of sale.).
❑ I, es owner oi the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consimct the prqect (SecJ044, Business antl Professions
Cotle: The contractors License Lew does no� apply to an owner of property who builtls or Improves ihereon, and who con�rac�s for such pmject wi�h a contractor(s)
license pursuan� to the Contractors License Laws.).
❑ I am ezempt under sec. Business and Professions Code br ihis reason:
Signature: Date:
Owner ID verified by dnver's license. ❑ Ves ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - propeny taz bill or daetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlify ihat no excavation five (5) or more feet in depth imo which a person is required to descend, will be made in connedion with work auihodzed by ihis
permit, and that no builtling simcWre, scafloltling, falsework, or demolition or dismantling ihereof, will 6e more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title e, Calitornia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Indusirial Safery. as noted above, unless such person has a
permit to do such work imm the division.
Signature: Date:
Division ot Indusirial Safery Permit Num6er:
COOE I, INSPECTIONTY7E If�AL IMRIRLS �QpFy,, INSPECTIONTYPE j1�jF INiRAL
1616 Fixetl System Final Fire Prevention 206 Final Mechanical � Q�
1266 Pool Spa Final 208 Final Plumbing �(� �
200 Final Fe-Roof ,
201 Final BIaWRetaining Wail
202
203
204
Final Factory Fire Place
Final Sign
Final Demolition
210 Final Elecirical
212 Final Fire Preven�ion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�
.
l
�op�a%�� 595 WENDY LN
o�xsx.�E�F�x*+:HUNTINGTON WEST PROP.
�� 591 WENDY LN
COSTA MESA,CA 92627
�rvi. Wmmo �oo�sx
urcxrt�cr on exrnivn:
MCX.Ofl ENd'S A�ONE54:
uc xo.:
uNr: (L�P,> CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: B 087396 PLAN CHECK NO: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR
JOB DESCRIPTION : REROOF OVER EXIST. 1 LAYER COMP. WITH
UNT:
coxm�crarsx,ua: JD JONES ROOF CRAFTER ( 714 ) 826-9822
caim�croRs�u�wo 8941 WALICER ST
,�oo�ss CYPRESS CA uc.ra.: 435996
90630 unr:
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��o�o wvn s«i� �000) w u�o� a a� a,.o,� m,e vAee.,�. coe.. d,e mr uowe m m nm ro� m,e enea.
�rtruc.No.:029223 uc.cuss:C39 43 99 EXP: 09/98
e: � �'�� Comrm .
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a licemed W�� �o iM yowiau d iM Ca4reqon limrue lew �Cheplr 9(mmmendnp vm� Seaion ]UW) W D'wuion 3 d ib
duai�ren eM Prdeesone Codel a Ihm M« Me e exemq iherelmn end tM bnL I« iM elbpeE memqion. Nry vidmion a SWion
')W t.5 Dy e�ry oppliwx la e permn aubp�ta �M epplicen� �o e avil penelry d nd maa then 1'va hu�dred ddlen �550011.
� 1, m ovmer ol the prapeny ar my empbyeee wIh wepea m Iheir wle mmpeneelion, will do iM woM, eM Hn nrunun u rw� in�endad
w oHerad lor eeb (Seclion ]Oad, Buainesa erd PMeasionaCab: Tha Gonlraqore Licenee Lew Eoee rwl epply�o en ownerd propary
who Wtlde w inpovae �hareon. enE Ww doee nuch wark Ivmaelt a henep a ihrap� hu or har own emdoY�s. M�� �� euch
imprvminems ers mi ImudeE a Werad /« eeb. M, howaver, ihe Wikirq or inqoverneM is eold wnhin ma ymr d oompinion, the
owror-0uitiv xill M1eve IM burden M ywinp he a eM did �W WiM or improva la tM WN�+a d vb�.
� I. n ornrr d iM papeiry. em a<dnn'W mmreeM MVh fmuad cavrMas ro mmtrW Ns P9� (Sad'vn �u. &w'viw� and
PMeasbru COEe: TM CaNracae liro'ue lew Eoes nal WN/ b em m��er d PWMY Ma bWlds a inww� thaaon uN who
mnteaM b vxf� projxa wuh e wmrmoHe) Icaved Wnuem b IM Contratlas L'aerua Lew�.
� I em eaemq wNer Seciion: B. 8 P.C.. br Nb neson:
Dme: Ow�x:
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a�.
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WOPKEP'S COMVEN9�TION DECL�RATION: I Mreby alfi�m uMer pe�M1y d prjury me N IM Idlowiiq dacWviom:
� IheveaMxilmeinlenacenRratadmneemtoeatl�murobrworken'wmpamelon,npwidaEforbySetlian�]OOdlheLebor
Code. la IM pa�iwmence d IM wah la wlvth I�ia peimil ia usuad.
_ fl � n.w.iw wi� maim.�..ak.n� wmv.�a, ���+.�. %+�w��red M s.ain, aroo a u» lee« coea. �« me w�«�ww. d m.
X— woM tn vr�itli I�u ixm� is'veueE. My wakeea' wmG�+vion imurence urtiet and DdKY mimbar ae:
c.mer. STATE FT7ND EXPIRES
Pa�v n�mn« - � ' O 1/ 0]. / 9 3
(ihie eection nesd na W mndered I Ns 0�! b ror`me IwiMistl Gd Riool a bu.l
❑ I mnh � in Ns peAortnenca d IM wak br wfiih thu psrmil u uaueE. I Nell m� ampby erry pemn in ury maruiw vo n to
becane wbjetl to iM xwkne' canpen+etion levn d Ce41�. erd yree Ihel A I�hquk Dacome eubjW to tM �ken'
b ucun woiks�'rompwYatlon covsip� I I, �n/ilWl utl/ct �n wrylo�w ro alMrol p�Wtle �ntl
Mn n,nend tAoua+M eadl�n (sf�4o0oA n ro tln cmr ol rnlrowa�tbn � u provm1e ror In
CONSTfi11C110N LENOINO �OENCY: I MreEy ��m under pendry d perjury tMt Ihen u e oonn�utlion bMirp epency lar Ne
perlamence ol lhs �wM la wfiich ihw permY i� ewaE (Setlion �08], CN. C�.
LENDER'S NAYE:
LENOEH'S ADDHE53:
I cMiy ihet I heve rud ihia eppliraiion enE peb �liei tM ebwa iM«mNbn u oorietl. I eqrta b canply wilh ell ary enE coumY �inencee
eiM eiete le�w mlelinp lo builEvp conYruqion end Mroby aNMrixe repreunteinas d �hu ory to aMer upon tM ebave�mentioned propmly
iwinnpwion Wrpaeas.
JENNIFER HAUSER
�ry�
p CG
� om,: "� �' r o
J we w o0
Wnns6uddiq 8 SefMY: arer�FJa: Cenery-Appirenl: RnkJiwanus:Oddavo�Ava»w
�
PERM NO; B 087396
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT: 2,090
CLAIM VALUE: 2,090,00 CALC-VALUE: 2,090.00 GROUP OCC: R-1 /
COMMENTS: 1 LAYER OF COMP.
at�**at*atat����x �xit*ititatatatatat�arjtatatatx�*itititxx�+titiE��t�tat��t�*atjtjtarit�ar+t�+tit�f�e�atjt�at*x�it*x*iFat+t+�*�
Z O N I N G R E Q U I R E M E N T 5
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT ZN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ: PROV: PARCEL: 42214307 ZNE: REF NO:
PLANNING NOTES> _
' ..
1E iE iE iE iE 1E 1E 1Elf 3f !f iE iE 7FlE it iF 1E 1F iE i! 3E iF iE 1E if iF itlt 1E iE iE �E iE iE 1E iE 1E 1E ik iF iF iF iE iE if iE �E 1E 3E if iE iE 1klf itlt 1k iElE iE �1E 1E dE iF iE 3E iE iElF it 3k i! 3k 1k 4 if iE if
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
ZONING APPROVED BY DATE: '"
BUILDING APPROVED HY : DATE: ��
APPLICATION ISSUED BY: DATE: � �(�
iEiElEiEiEiE�E�E�EiElEiElEiEifitifiEitiFlFit IFkMiFikiEiE�Eif�E IEiF
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL S GMEN :Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMZP/RES GRADING
PERMIT 74.75 ,50
_ SMZP/NON-RES
PLAN
ISSUE FEE "'
BUILDING-DIV-> PERMIT ISSUE PLAN-�CHECK TOTAL PAID DUE
TOTALS----> 75.25 0.00 -, 0.00 75.25 75,25 .00
+ ./
REVENUE DIVISION TOTALS--> COLLECT�ED: 75.25 OVER/SHORT: ,00
HLL��qPMs PLUMBINr ELErTRir MECHANIr FIAE SMIP/To�T GRADING PLAN-CHECK
if 1f iE iE iF iF ik iE iF iE �E 1F iE iE iE if �f if if if if iF iE if iF if �E iE �E fE �E iE 1E 1E ik ik If IElf iE 1E 1E 3f iE fE iF if iF iE if if iF iF iP �41E 1F if iF jF iF 1f it iF iE 3E �1E iE �F iE ik if if #} iF if if 1E iF
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O Ns UNIT COST TOTAL COST
. ;
SFR 2090 REROOF HY VALUE RESIDENTIAL NOZONE 1.00 2,090.00
END OF FEES
03-20-1998/01:48 Pfl/f75.25
RCRTq:01-��21189
F'EkMIT:08?396
CONSTRUCTION AND PLANNWG - POOL a SPA
APPROVALS Permit # Date Inspector pppROVALS Permit # Date inspector
i. Temporary Electrical Service.or Pole 52. Pooi & Equipment l.ocation
2. Soil Pipe•Undrgrnd. 53. S[eel Reinforcement �
3. Electrical Conduit_Utility-Undrgrnd. 54. Forms
- 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � �'
.- 5. Steel Reinforcement � 56. Fiough Plum6ing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings `' 58. Electrical Conduit�Undrgrnd.
� 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Wa[er Pipe�Undrgrnd. �. 60, Backwash Lines, P-Trap, L� Undrgrnd.
10. Structural FloorSYstem " 61. APPftOVALTO DECK .
11. Property Sewer Line-& House Connection 62. Backwash & Receptor�FinaP
12. Sewer Cap ' � � 63. Heater & Vent�Final , �
13. Roof Drains 64. Plumbing SYstem • Finai
14. Rough Plumbing 65. Electrical�Final
15. Rough Electrical-Conduit �� 66. Solar System-Final
16. Rough Electric Wiring . 67. Fencing & Access ApProval
77. Rough Wiring Sign �. 68. APPROVED FOfl PLASTERING �
16. flough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & A'u Conditiorung � •� , ' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace -: -" y - + �` •• qPpROVALS. Permit#�-
21. Ducts, in Structura - •� �, �. ��- 70.: Underground Hydro �
22. DucFs, Ventila"ting' � � � �i - ' 71. Product Piping �Gas ❑Oil •
23. Gas Pipe�l#ou9h & Test . ' �� ' 7Z. Underground Flush � �
24. Roof Framing _ � � � - 73: Underymd. StorAge Tank O Gas ❑ Oil
25. Roaf Sheathing � , r 74. �Overhead Hydro
26. T•Bar Ceiling (Structurall & Moaocoat , '` 75.-Ory Chemiwl ' ,
27. Frame and Flaihing "' � ' 76. Dry Standpipe - •. � "
� 28. Lathing & Siding , !�� - , ' 77, FIXED SYSTEM FINAL'
29. Insulation � � _ . � 7�i FIRE PREV. FINA� �
30. Drywall Nailing - -' � ' " • HEALTH DEPT. REQUIFEMENT
� 31. Plaster Brown Coat � � i �� 79. F�NAI INSPECTION .
� 32. Electrical Power Meter�Final � 80. FOOD CERTIFICATE ISSUED ��
. 33. Finai Electric - _ _ � Notes: - � . .
34. Finat Heatinq& Air Conditioning � , � ...�?,�Q�� �� „'� �`, _
� vn r -
35. F,inal Gas PipA�Test - ,. , '� ,; " , , , �
36. Hood�or Canopy � , � " ��
. 37. Final Factory Fireplace ' . � „
� 38. Final Plumbing � � ' _ � �
39. Water Service•Final ' �
40. Gas Service-Final '" � - � � . - '
41. Solar pomesticFinal � . ; ; � -
42. Backflow Preventer . , .
43. Backflow Irrigation - • ,
44. landscape IrriAation System . . � . , . ` �
45. Sound Attenuation' " � " �� ' - '
, � .
46. Fiandicap �Regulations . . �
� 47. FINP:L STRUCTURE & BUILOING � ��,��� �� , �
48. FINALPLANNING -
49. Electric Release to Ed(son • �' •
50. Gas Release to Southem California Gas Co + �'-�� . -
51. CERTIFICATE OF OCCUPANCY
No. Date
■
PflOJECT AODHE55: S S S WENDY LN � t'"
awxeASName: BATTLES, JULIE A
nooness: 595 WENDY LN J�1.0 CJ�'F'—!7
COSTA MESA,CA 92627
RflCNIENGINEEP:
FODNESS:
flEG.NO.:
UNIT:
UNIT:
PEHMIT�EE: NOCK PLUMBING (719 1895-1246
aooness: 11610 SEABOARD CIR
STANTON CA 90660
LICENSEO CONiflRCTOfl DECLARATION: I here�y a��irm ihal I am licensed untler pmvisions of Chapter 9(commencing wiih Seciion
7000� af �iNsion 9 0l I�e Business antl Pmfessions Catle. antl license is in Nllforce antl eflec�.
cirr uc.: 0 0 3 8 STRTE LIC.: S S 1 9� cuss: g�
� � SignaNre- _ ' - ��
S' COMPENSp ION �E UIXATION: I hereby a at I hT�e a cetlilica�e o eni �o seA�insure or a certiticate o� Workers'
ompensalion Insurance or a cer�ified copy thereo� (Section 3800, la�. C�.
roucvxo.: 1167992-94 EXP.OAiE: Oj/OL/9S
comvnxv: S TATE
❑ Centlied co y is �e�eby fumishetl. � Cenitied copy i 1ii wilh t�e city Buildin ivision.
e 1 qpplicanl' _
EMPTIONfPOMWOPREBS'COMPfN5ATI0NOEClABATION: (T�i55ec�ionnee0no�becompletcAtl�hepermi�is�oronehuntl�eU�3100�orless�.
I cetlify �hal in �he petlormanre oi ihe wark �ar whlc� �his permil is is5uea. I SAall no� employ any person in any manner so as �o become
subjectlo ��e Workers' Compensa�ion Laws oi Calibmia.
Daie: SignaWre:
NOTICE: Ii. alter making IniS tleclamtion, you shoultl become sublec� �o the WoBers' Campensa�ion pmvisions of Ihe Labar
Coee, you must lotlhwilh compty wilh such pmvisions or �his pe�mit shall be tleemetl revoketl.
CONSTPUCTION LENUING FGENCY: I hereby affirm �hat �here is 0 conSVuction lentling agency �or Ihe performance oi ��e work for
which ihis permit is issuetl (Sectlon 3097, Clv. C).
LENDEB:
ADUHESS:
OWNEB BOILOEH OECIABATION: I hereby atfirm t�at I am exempl �mm �he ConVactors' State License Law �or the �ollovnng reason
�Section 7031.5 Business anU Pmfessional Code: Any city ol touniy w�ich requires a Oe�mi� to construc6 alter, improve. Oemolish, or
repair any s�mcWre. prior lo ils issuance. also requires ��e applican� �or such permit �o file a 5igne0 Slalemeni Iha� he/she is licensed
Oursuanl lo ihe pmvisions oi I�e Coniraclors' State License Law (Chapter 9(commencing wrt� Sec�ian 7000) ol �ivision 3 oi ihe Business
antl Pmiession5 Catle) or Ihai he/she is evemp� �herefmm anU the Uasis lor I�e alleged exem0�ion. Any viola�ion ol Seciion 7031.5 6y
any applicantlor a Dermii SuDleclS Ihe applicant to a civil penalry o� no� more than �ive hundretl dollars (5500).
, as awner of Ihe property or my emplayees with wdges as their sole compensation, will tlo ��e work, an0 the
❑ structure is noi inten0etl or ofleretl 1or sale (Section 704a, Busness antl Pmiessional Code: ihe Contractors' State License Law
tloes nol apply lo an owner ot a property who 6uile5 or imploves �hereon, and w�o Ooes such work himself/herself of �hmugh
his or �er own emDloyees, pmvide0 ihat such improvemenis are not intended or offereU for sale. If, however ihe huilding or
improvement is solU within one year of completion. Ihe owner will have Ihe bur0en ot pmving he/she tlid not build or impmve
for ihe puroose ol sale�.
I. as owner ol ihe propehy. am exclusively conirac�mg wi�� liGensetl conVactors to con5truci Ihe projecl (Sec�ion 7044, Business
❑ antl Pmlessions Code: The fAnlraciors' Siate License Law UOes no� aDDly �o an owner ol O�operty wha builOs or improves �hereon
antl who coniracis for such pmjects with a coniractoqs�lictnse Dursuant�o ihe Coniracbri State License Law),I am aware
�hai prool ol Iheir Worker's Compensation insurance shoultl be OmviOed to me.
� I am exempl under Seclion: 8. 8 P. C.
lor ihis reason:
Oale: �wnec
I tlo hereby cenify Ihal I am aware ol and untlerstand Ihe reQuiremen�s of Cali�amia,Heal�h and Safery Cotle Sec�ions 25505, 25533, and
25534 antl ihat I or any future 6uildtng oaupant will/wlll naI (circle otle) need Io comply wlt� saltl s�a�e cotles antl Ihe raQulrements for a
permit for consimclion or modiflca�ion Imm �he Nlr Ouallly Managemani �islrie�. Ae570ential cons�mctlon appllta0on5 are exemp� irom
ihese pmvisions.
�a�e: Ap0licanL
1 hereby <etlily �hai I �ave rea0lhis applicaiion ana Slaie Ihai Ihe abo�e in�ormaiion is correcl I agree lo comply wilh all ciry an0 counry
ortlinancesantlstaielawsrelatinglobuildingcanstmc�mnantl ebyaV�hon 5enia�ivesoilhiscily�oenlerupon�heabove�men�ionetl
pm0e��y lor insp¢ lion 0�P^oses. �j
Oat� r f SignaWre /
uriver s �icense or soaai s�turny n:
i64va6 WMie—Bmltlmg�, Green—Cooe Enlorcemenl', Canary-�Applicanl; Pmk—Reven�e: Goltlenrotl—Assessor
CITY OF CQSTA MESA — BUILDING PERMIT
PERMIT NO: P 066281 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU
PERM NO: P 066281
GOVT; N SUPP: N
PURPOSE: OTH
JOB DESCRIPTION ; INSTALL WATER HEATER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORI( AUTAORIZED HY THIS PERMIT
*�r�**+t**�r***�x**�**�+�**+�**�**�**�c*********��****�*�r*��*�t*+�*x**+��*�***�******+�**
Z O N I N G R E Q[l 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 REQ• PROV; PARCEL: 13944406 ZNE: REF NO;
PLANNING NOTES>
>
ik dE it 1! 1f iE if iE if fE 1:1E if 1F iE if if %it if if iP if 1f fE jE!! k if iE 3f iE ih ik iE if �f iF M ik iE iE if iE IE iFif if it jF?E iE aE iE 3E �E K fE iE iE i41f If iF if iP i! iF iE 94 �f jE Y-iF �7F iF iF iE iF
D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY . DATE:
HUILDING APPROVED BY : � DATE:
APPLICATION ISSUED BY: �� ��I DATE: ��,���L(
ieitit***jEiEiEiEia�Eit*ititiE%ifiE�t�t it ie aE it iF*jE+ri:**irleieiE� .*i'��**"��cv-
if if iE iE iE jE if it ik if iE iE iF it iE 1E 1F if M iF if if if k iE iElF it if if iE iE if jf if iF it iE iE iE iE 9E jc ik jf * iE iF iF iFiF iP iE iE 1E if iE 1f iE i! iF iF if 1E if if if ik iE iE 3E 3F 3E jE iE 9f if if ik
LEGALIZATION:N F E E S;U M M A.R Y STRUCTURAL SEGMENT;N
HLDG PMT PLUMBING ELECTRIG- MECHANIC FIRE SMIP/RES GRADING
PERMZT 7,00 • '
258 � SMIP/NON—RES
PLAN • '
ISSUE FEE 20.00 "
BUILDING—DIV—> PERMIT ZSSUE PLAN—CHECIC
TOTALS----> 7.00 20,00 -� 0.00
REC'ENUE DIC�ISION TOTALS--> COLLEC.TED: '
BLDG PMT PLUMBING ELECTRIC MECHANIC.
27.00
TOTAL PAID DUE
27.00 27.00 .00
27.00 OC�ER/SAC�RT: ,00
FZRE SMIP/TOT GRADING PLAN—CHECK
k iE iF iE 1h 1t iE iE 41E 1E iE iE k iF iE iE iE iF iF iE iP iE iF iE iE iF jE %iE if 1f if if iP if if iE if i! iF fE if if iE if 1E iE iE iE 1f iflf 1E if if ff if if %if if iP if iF iF af iE * ff iE iF jF iE iF K iF #F iF
I N D I V I D U A L•"F E-E B R E A K D O W N
TYPE QTY D E S C R I P T I O N� � UNIT COST TOTAL COST
PLU 1 WATER AEATER AND/OR C�ENT ' 7,00 7.00
END OF FEES�
� i i
�,\ /
.- �� ', �'� O1 OO1S6691-00156691 T�] T 27.00
..� �.� _.. DATE: 03l07/94 TI1fE: 09:51
CONSTRUCTiOIV AND PLAPINING � POOL'& SPA
APPROVALS Permit # Date Inspector APpROVALS Permit # Date Inspector
i. Temporary Eiectrical Service or Pole • 52. Pooi & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. E�ectrical Conduie Utility�Undrgrnd. � 54. Forms
4. Electrical Conduit•Undrgmd. 55. Electrical Bonding
5. Steei Reinforcement 56. Rough Piumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE �
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas PiPe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, RTrap. L� Undrgrad.
10. Structural Ploor System 61. APPROVAL TO DECK j
71. Property Sewer Line & House Connection 62. Sackwash & Receptor,Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Draint 64. Piumbing SYstem - Final
14. Rough Plumbing 65. Eiectrical-Finat
75. Rough ElectricaV-Conduit . 66. Sotar System-Final
16. Rough Electric Vdiring 6�. Fencing & Access ApProval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING I
18. Rough Electrica!-T Bar Ceilin9 69. POOLISPA SYSTEMS FINAL �
79. Rough Heatirg & Air Conditioning PtftE DEPT. REQUIREMENT '
i
20. Rough Facmry Firepiace APPRQVALS Permit # �
21. DuMs, in Structure 70. Under9round Hydro
� 22. Duas, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush '
24. fioof Framing 73. Undergrnd. Storaye Tank � Gas ❑ Qii
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Celling (Structuraq & Monocoat 75. Dry Chemicai
27. Frame and Flashin9 76. Dry Standpipe
i
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �
31. Plaster Brotvn Coat 79. FINAL INSPECTION i
i
32. Electrical Potver Meter-Final 80. FOOP CER7IFICATE ISSUED I
33. Final Electric Notes: _�
34. Final Heatin & Air Conditionin � �y#�
9 9 J -l� ��- �' �-�t�`r=`-�`-"� - = - - I
35. Final Gas Pipe�Test ' -22-�'(- k G�
36. Hood or CanopY . 2c,YtUv'sz� �F�tc.n 2:-�d �
37. Final Factory FirePiace a�"'� �'rzf'G'-n^�[ --'�'-�`¢�7 -�
/�2dG� '�p '12s���.4G(�'O_lJ��. _ _ _�
38. Final Plumbing fb'uL ,C`�� Y-� Grf ���=�y �-
-4T �P=-
39. Water Service�Final
40. Gas Service-Finai
At. Solar pomestic-Final �
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation �
46. Handicap Regulations � �
47. FINAL STRUCTURE & SUILDING � �
48. FINAL PLANNING _ .
49. Electric Release ta Edison "
50. Gas Reiease to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. Date
. �582�
�F COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX1200 COSTAMESA,CALIFORNIA92626
9229 4/I4/78 106084 T�
9229 4/14/7B 106o84CKT0
9229 00004458 p6 lA
APPLICATION FOR STRUCI'URAL PERMIT
For Applicant to Fill in Completely — Usc Ink Only
RECEIVEDBV DA'�CE� OATEISSVED
ADORESS �'}'�" Mt7 � e A�iiFie �G.
P
OWNER A.P. NO. _ '
MAIL - � BVILDING �''` /
ADDRESS P. 0. Box 15584 ADDRE55 Ma � e�1Tpf-4d's'i t
TEL. TRACT � LOT BLOCK
c�rv Santa Ana No. 751-993
CONSTRURION
LENDER
BRANCH
OWNER
A DDF ESS yALUE
ARCNITECT re�. Sin le famil UIi7L § �
OR ENGINEE
FIpE
ADDRESS 447 E. 17Eh St. - Cesta Mesa ZONE TVPE GROUP
APPqOVED
CONTRACTOR BV DATE
ADDRESS »20 E. Garry Ave./ Ste 118
TEL. Z�NE NO.OP USE OF NEW
CITV NO.
Q � PLANS � BUIIDING
STATE CITY �AROSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUIlO1NG ACCESSORY BUILOING
SIZE NO.OF BLOGS. (FROM GL STREET) '
OF LOT 'Z1 X�j4 NOW ON LOT O FT.
USE OF
EXI5TING BLDG. p7
Separate permi[s are requ'ued for L SID F FT.
electric, plumbing and heating work.
REAR FT.
USE OF BUI�DING AND WOFlK TO BE PERFORMED � DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLOGS.
C VRP.SW �G '/B J APPROVED �'� 7�
garage APPROVE Q ' G'�'?g
I heraby ncknowladpa t�et I heva �aetl Mls eOP���atlon enC rtete
Thet t�e ebove Infolmetion Is cOfrott and ep�ee to tomply wiffi
ell lew� re0ulatln0 bulldinp conrtruction, antl I s�ell not amploy
any Darson in violetlon af Ma workman's compan�etion lew� 01
ffie Stata of Californla. O �/'� �/ �
I hareby cartity t�at I am properly Ilcenwtl a� a eonttacto� under ,
S�.PT. �� �r
the Smto of Calltornia BusinP�s entl Profeolons Coda, Dlvialon 3, THE AMOUNT SMOWN UNDEH VALUATION IS FOR
Chapter 9, antl that wc� Ilce�ses are In full forca entl eHxt, or 1 THE PURPOSE OF E5TABLISHING A PERMR FEE ONLV:
em axempi irom the provialo�� oi eStata of Callfornia Bueinau VALUATION PERMIT FEE 3
enC Profecsione Cotla, Dlvielon 3, hep 9.
Sipnetureof ///��' � PLANCHECK { � �04�
Parmlttae � • � $� L.�d TAX 3 �
.l
AuthorizatlApent �` TOTALPAID 3 �
N
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COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
� 7112 6%27/y8 160.00 TL+
APPLICATtON FOR STRUCTURAL PERMIT
For Applicant ta Fill in Completely — Use Ink Only
RECEIVEO BV DPTERECEIVEO DATE 4SSUED
BUILDING
ADORESS
PERMIT NO.
OWNER A.P. NO.
MAIL BVIL�7NG
ADDRESS �+DDRESS
TEL. TRACT LOT BLOCK
CITV NO.
CANSTRUCTION W A � P
LENDER
BRANCH �
OWNER
ADOFESS VAIUE
ARCHITECT TEL. � $
OR ENGINEER
FIRE
ADDRESS ZONE TYPE GROUP
APPqOVED
CONTRACTOR BV DATE
ADDIiESS
TEL. ZONE NO.OF USE OF NEW
CITV NO.
PlAPLS BUIlO1NG
STATE CITY �'ARDSAPPROVED VARDSAPPROVED
IIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUIL�ING
SIZE NO.OF BLDGS. (FilOM C/L STREET)
OF lOT NOW ON LOT OM FT. FT.
USE OF
EXISiING BLOG. F7
Separa[e permi[s are required for � s�o FT. FT.
electric, plumbing and heating work.
REAR FT. FT.
USE OF BUIIDING AND WORK TO BE PERFORMED DISTANCE BET. BEf. MAIN &
MAIN BLDGS. ACCE�. BLDCS.
VAq.aW OATE
C.U.7.g�+ PPPROVED
APPROVED
I hareby ecknowletlpa thet I have reaC this application antl rtate
that the above informetlon is correct and agrae to com0ly with
all laws ragulatinB buildinp constr�ction, end I shall not amploy
any perwn in vlolatlon o1 Me workman's compenseilon laws of
the State of Californle.
I heraby cenify that I am proDerly Iicensetl as a conbactor untler SQ. FT.
tha State of Californla Buslnass end Protassions Cotla, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOfl
Chapter 9, antl Mat such Ilcenses ere in tuli for<e antl affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am axempt from the provlsions of the Staie of Calffornia 8usineu VALUATION PERMIT FEE E
end Profassions Code, Divislon 3, Chapter 9.
SIO�eture af P�N CHECK E ��
Parmlttee S TAX S _,�
Authorized ABent TOTAL 7AID E �