HomeMy WebLinkAbout3381 WIMBLEDON WAY - Building Permits(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: $3Hi WIMBLEDON WY
Suile:
Vicinity: HOUSE & GARAGE
Parce�Number: 41208305
npp�icent: SELL, RON
Address: 17072 ROSEBUD
YORBA LINDA , CA
Owner: HEWITT, MARKA
Address 3381 WIMBLEDON WAY
COSTA MESA, CA
Contractor: SELL ROOFING COMPANY
Address: 17072 ROSEBUD
YORBA LINDA , CA
Zip: 92686
Arch :
Address:
BUILDING PERMIT
Zoning:
Phone: (714)993-3328
Zip: 92686
Phone:
Zip: 92626
Phone: (714) 9933328
License: 323842
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 07/12/2000
Issued: 07/12/2000
Phone:
Zip: License: License: .
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (29 SQ). TEAR OFF EXISTING SHAKES &
RESHEATH WITH 1/2" OSB. INSTALL 2 LAYERS OF 30# FELT UNDERLAYMENT & REROOF WITH "EAGLELITE -
MALIBU" (ICBO #4660) 5.7 L6S.
Plan Check: $0.00
Permit: $167.25
SMIP Res: $0.89
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.14
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinn: o
NOTES:
Rear 0- 0
Rear 0- 0
Reouired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Righl 0- 0
Right 0- 0
sa,soo.00
$8,900.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not'commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and flnal approval must be obtained. Failure to obtain inspections and final approval will rasult in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
-�7
WORKERS' COMPENSATION DECLARATION:
I �ereby aHirm undar penalry oi perJury one ot the tollowing declarations:
❑ I have and will maintain a certlticate of consent to seli-Insure tor workers' compensation, as provitletl for by section 3700 of the Labor Code, for the pedormance of the
work for which ihis parmit is issued. �
� al h ve and wiil maintain workers' compensatio surance, as required by section 3700 of the Labor Code, tor ihe pedortnance of Ihe work for which this pertnit is issuad.
r�M workers' com nsura mer tl oli number ere: �� �� /
y
Y P P �Y �—� I G� S S 7
Carrier: �' P,olicy.Number.
need not be completed il the permit is velued af one hundred dollars ($100J or /ess.)
❑ I certify thet in the pertormance of the work for which this permit is issued, I shall not employ any parson in any manner so as to become subject to ihe workers'
compensation lews of Californi end agrea t t it I shoultl become subjact to Ihe workers' compensetion provisions ot Section 3700 of ihe Labor Cotle, I shall forihwith
comply with these provision ��
'ApplicenPSigneWre:. �AAn Dal` e:—� � '— � — � �
WFRNMGi PAILURE TO $ECURE WORKERS' COMPENSATION WVERAGE IS UNL4WFUL ANO SMALL SU&IECi AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSANO DOLLARE (Et00,OW), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIQY 3]W OF THE LABOR CADE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y attirm ihat.l.am licensetl unger provisions qf �h ter 9(commencing wilh Section 7000) of Division 3 of��e Business antl Profe ions de�and my license is in full
force antl eHecl.�Cicr#--� 5%,.�SC i' �/1 C�ass a / �—�(
CONSTRUCTION LENDING AGENCY:
❑ I hereby aMirm that ihere is a constmction landing agency for the performance of the work for which this permit is Issuad. (Sec. 3097, Civil Code).
, Lender s Name: Lentler's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm that under penalty of perlury ihat I am E%EMPT FROM THE CON7RACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a pertnit to constmct, alter, improve, demolish, or repair any stmcture, prior to Its issuance, also requires iha applicant for such permit
to file a signetl stetement ihat he or s�e is licensed pursuant to ihe provisions oi ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 oi t�e
Business and Professions Code) or t�ei he or she is exempt Iherefmm and the basis for the alleged exemption. Any violation of Seqlon 7031.5 6y any applicant for a permit
subjects the appliwnt to a civil penalry ol not more than tive huntlretl tlollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO Tt1E WORK, and the siructure is not intentletl or offeretl for sale (Sec.
7044, Business antl Protessions Code: The Contractors License Law does not apply to en owner oi property who builtls or improves thereon, and who does such work
himseli or herself or through his or her own employees, pmvided that such improvements are not intended or oHered for sale. If, however, ihe builtling or improvement is
soltl within one year of completion, lhe owner-builder will have the burden oi proving Ihat he or she did not build or improve for purpose of sale.).
❑ 1, as owner oi ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and Pmfessions
Code: The contractors License Lew does not appty to an owner of property who builds or improves thereon, and who coniracis for such prolect with a coniractor(s)
license pursuant to ihe Conirecbrs license Laws.).
❑ I am ezempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No.
Verification oi Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEfV PERMIT CERTIFICATION:
Expires:
❑ I hereby certify that no excavation five (5) or more teet in tlepth into which a person is required to tlescend, will be matle in connection with work authorized by this
permit, antl thet no buildin9 stmcture, scaHolding, talsework, or tlemolition or dismantling ihereoi, will he more than thirty-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, California Administretive Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safery, as noted above, unless such person has a
permit to tla such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
CER7IFICATE OF COMPLIANCE AND AU7HORIZA710N OF ENTRY: I cetlify under penalty of perjury that I have read ihis application and state ihat the intormation given is
correct I agree to comply with alt st aw and ciry o nances relating to huilding constmction, and authorize representatives of the Ciry of Costa Mesa to enter upon the
above-described pmDeny for insp ti p oses. I ag not o upy or allow occupancy of any building authorized by ihis permit until final inspection.
��
Signeture Ot Legal Owner(s) .�y '�/ Z O O
/
COpE �, INSPECTIONTYYE
1616 Fizetl 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
2d46-66
�I& �NTITIRLS
� '� � ti�i�
CODEt INSPECTIONTYPE
206 Finai Mechanical
208 Final Piumbing
270 Final Electrical
272 Final Fire Pravention
220 Finat Planning Approval
222
250
Final Site
Final BuiltlingiOccupancy
[R�T INTRIALS
PflOJECiR00PESS: 3381 WIMBL'c:DON WY
awxEs•sxame: HERMANSON DAVID TR
nooness: 3381 WIMHf.EDON WAY
COSTA MESA,CA 92626
979-9680
aNCH/ENGINEEfl: NEG.NO.:
RDOflE55:
UNIT:
UNIT:
PEflMIREE: ES�THEP. HEAMANSON ( 714 ) 979-9680
anonEss: ;�381 WIMBLEDON WY
C.M. CA 92626
LILENSED CONTBRCTOP OEClAMT10N: I hereEy a��irm itui I am IicenseE unCer orovitions ol ChaD�er 9(commencinq wilh Section
7000) ol Omsion 3 0l 1�e Business an0 Pmlessions CaEe. anG my license is in fuA torce ana eHeci.
CITV LIt.: SiATE LIt.: CUSS:
yte: SqtuWre:
AflKEPS' COMPENSR710N OECLAMTION: I �ere0y aflirm that I IWve a certilitah of mhtent to self-insure or a certifiWte of Workers'
Comoensation Insurance, or a ttrafie0 cooY Inereaf (Section 7800. La�. C).
POLILY NO.: E%P. �RTE:
COMPANY:
❑ Ceniliea cooY is nereby tumishea. ❑ C¢nifieG copy is i�ed xiih �ne ciry Bu�l�mg Oivision.
�ale: AppGnnt:
E%EMPTION FNOM WOflKENS' COMPENSATION OECIAHRPON: (Iltis se[Wn nred r� be cand�� �� � Dbm� a �a a� hWidreO (5100) or less�.
I c¢rii�y Uwl in t�e Oedormantt al �he vmh �ar wTicO iNs permii is itsuea. I sha9 noi employ any person in any manner so a5 io become
5ub�eC1 lo I�e VJOtke�s' Campensation Laws Of Calilomia.
Da�e: Signawre:
NOTICE: II, aiter malting Uu5 deGaraiian. 7rou slimilJ 6ecome subject lo t�e Wo�ers CAmpensatmn pmvisions o� t�e Labor
CoOe. you musl fonhwi�A comply wilA suc� provi5ions ot Ifis perrtut Stull Ge GeemeO revaked.
CONSTBULTION LENOING pCENCY: I �ereGy aflirm I�at I�ere is a canstmction IenOing agem.y br ihe peAormance a� t�e work lor
w�ich Ihis permit is i53utE (5¢cli0n 3097. Civ. C�.
LENOEfl:
RODflE$$:
IOWNEfl BUILOEfl OELUPA710N: I hereby athrm that I am eeempt trom t�e Contraclori Slate license Law lor tlIe lallOwing reason
(Section 7031 5 Business an0 ProfesYOnal CaGe: My tiry of t0unty whic� repuuw a permit to fAnSiNct. alter. improve, tlemolish, ar
�eoair any simcmre. o�ioe to ns rssuance, also repuires �he apptiwnt lor sucn permit to f0e a AgneA statement tAat ArlsOe is Iicense0
. yursuam �o ihe provisions ol iAe Contracmri State License Law (C�aD�er 9(commencing vni� Section 7000) of Oivision 3 0l t�e Business
�' �a Mofesvans Codel ar that ne/sne is aemo� Uerelmm an0 tne Oasis tor ttre alteqeG exem0�ion. My vioWiian al Section 7031.5 by
��*'�,�.y apDlitan� for a permi� SUCIe«S lh¢ appliwn� �o d Civd pe(uliy Ot n0l mOr2 ihan live �unar04 EOAaR �5500).
*�.
' I, as ovme� oi me omveny ar rtry emVloyees wit� wages as their sole compenuuon, will do Ihe woA. an0 ��e
❑ s�mcwre is noi imentletl oi oltereu for sale (Section 70aa, Buvness anE Professional COGe: T�e Cantractars' State License Law
doe5 nal apO�Y lo an awner of a Oroperiy wiq Oui105 or impmves Ihereon, anE wli0 GoeS 5uc� wotlt �ims¢III�¢nel� or IllroupA
�i5 Or �¢r own ¢mployees. provbe0 I�ai suc� imprw¢ments are noi in�enE¢0 ar Ofl¢r¢E lor 5a1B. I�, Mwever llie huilCinO or
improvement is So�d within one year af camo�etiM, Ihe ovrner vNl tuve ihe ouraen ol provinp ne/511e EiE nol �ui10 or impmve
Im ine o��Vose ol sa�e).
I, as owner ol t�e D�operty. am exclu5iv¢Iy comraninp vni� IkenseA coniractws to mnsimct the prolect (Section 70aa, Business
� an� Pmh55i0n5 CoOe: The Conirat�ors' State License Law tices not aDPN �o an wmer ol Dropehy vrtio bmlas or imprmes t�emon
antl wno comrans loi wcn proiens vutn a contncmrlsl license pursuant to ihe Comracmrs' State license Lawl. I am aware
Ihat Omol ol I�eir Work¢r'S CamOeosdtion insurance shoultl be D�oNEe� �o me.
� I am exemD� untler SetliOn: B. 8 P. C.
lor Ihis reason: c / (
Oale: � l(=( / O+mer� . E57L."� �
I tlo nereby renity I�ai I am awaie ol anE unaers�ana �Ae requiremenis oi Cahiomia M alth�ery CaOe Seclions 25505, 25533, ana
25534 antl I�al I or any IWure Ouilding occupani vnlVwill noi (cucle one) nee0 lo compty vAt� saiC state coGts antl I�e requiremenls lar a
permil br[onsiruclion ar moGiliWlian UOmlhe AirOuaLiy Managemeni Dislricl. PeSNentulcansiruction aDPlica�ions are e�empi�mm
Ihese provisians.
Oaie'. Fpplicanl:
I here�y cer�ily Ihal I have ieatl I�is ap0licaiion and sla�e ihal Ihe above fnlormation is carr¢cL I agree �o cOmpty wit� all ciry ana counry
ortlmances and slate laws relating lo builemg consimtlion an0 �ere0y aui�or¢e 2preunlative5 oi Ihh ciry lo ¢nter upon the aDove�men�ionetl
o�apeny br msoeclion pur0oses. � /f `
L��
Date' e�-��� 91 Si9namrey _ 0��
oriver's L¢ense or Sociai Sewrity x:
164P46 White—Bmltling: Green—Gotle EniorcemenC Canary—ApplicanC Pmk—Revenue; GolQenroO—Assessar
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: EMP 051306 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE MEC PLU
JUB DESCRIPTION ; BUILD HABITAHLE SPACE ZNTO GARAGE
CLAIM VALUE: CALC—VALUE:
FERM NO: EMP 05130
GOVT: N SUPP; N
PURPOSE: CON
SQ FT;
GRUUP OCC: R-3 /
COMMENTS: RE: B51091 PRIMARY BLDG, PERMIT.
��*�r�x�+a*��r�rx r*�*��r***x*+r**x*�*�r�r�+e*+r**+r�rx+�**�***���x�***x+t**r.•*x�*x x+�rt+��r��xr.�*+�*�*
`L O N I N G R E Q U I R E M E N T S
ss•rBAcxs
------------ MAiN BUILDING ---------- --------- ACCESSORY HUILDING ---------
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 REO� PROV; PARCEL; 41208305 ZNE: REF NO;
PLANI3ING Nf3'I'ES>
i
x�*�*x**�**�v+�+�*��c�c��***+�*x***+t�a�**x���*���*x*�*��r*�x*��+�r*+t����**�*�**�*����*+��
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;
HUILDING APPROVED BY ; DATE;
APPLICATION ISSUnD BY: DATE: 3%
�FIF1EiFif3fiEif�ifiFifIF1F1EiF1EiF1F1f1f1f1F . . . : 1f�f�N�iF1±��IFiE?E�1FiF �IEiE
�+t+��r**+t+r�r�+t**��r�rx*�rr+��r***r**r��r�r�r�*+tx*x�*a���ri { itx+t*K��*�r+�x�+tit*�e���*w***ir+t**r.+tr�+t�r�r�!
LEGALIZATIUN;N F E E S U M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PiUMBING ELECTRIC MECHANIC FZRE SMIP/RES GRADING
PERMIT 8,00 12,75 9,OQ
25Y SOt 25t SMIP/NON—RES
YLAN
ISSUE FEE 3.00 15,00 15,00
BUILDING—DZV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 29.75 33.00 0.00 62,75 62.75 ,00
REVENUE DZV.ISION TOTALS--> COLLECTED: 62.75 OVER/SHORT: .00
BLDG PMT FLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
ii,00 zi,%s z4.00
iI' if iI +�' ic' iE ie if If if if if x ii ik if if iE if i�' 1f IE iE if iE Y iEiF ��f it iF iE iF iE if iF iF IE IE if If iE if iE M' iE K' 1f V 1a N' aF if IE ie iE If ie if if If )t it it iE iE X' N lE 1f iF Y i! i4 iF it IE ia
I N D I V 7 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
ELE 4 FIXTURES LIGHTING 1 ST 20 EA. ,'75 3,00
ELE 8 RECEPT/OGTLET 1 ST 20 EA, ,75 6.00
ELE 5 RECEPT/SWITCH 1 ST 20 EA. ,75 3.75
PLU 1 SHOWER 2,00 2,00
PLU 1 WASH BASZN 2,00 2 00 �
PI�U 1 WATER CLOSET (TOILET) 2,00 2,00
PLU 1 FLOOR DRAINS 2,00 2,00
MEC 1 REPAIR/ALT i-IEATING UNIT/SYS W/CNTLS 9.00 9,00
END OF FEES
�1 �J�u�i�'J:�—�i_Ji32'`:1� ' ' 7' �_ ,.
SHiEo pg•'i2���1 T�.; � : i'�:'.
CONSTRUCTION AND PLAM.,NJG `POOL & SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Oate Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms •'
4. Electrical Conduit-Undrgrnd. 55. Electrical 8onding
5. Steel Reintorcement 56. Rough Plumbing & 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. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Struttural Floor System 61. APPROVAL TO DECK � �
:
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .�;, ,
12. Sewer Cap . 63. Heater & Vent-Final �:
13. Foof Drains 64. Plumbing System - Final � �� �
14. Rough Plumbing 65. Electrical-Final � }
15. Rough Electrical�Conduit 66. Solar SYstem-Final - �
16. Rough Electric Wiring 67. Fencing & Access ApProval � �`
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING .'
18. Rough Electriwl�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.'Rough Factory Fireplace • � APPROVALS ' �Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe•Rough & Test . 72. Underground Flush -
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing . ' 74. Overhead Hydro
26. T•Bar Ceiling IStructural) & Monocoat 75. Dry Chemical '
27. Frame and Flashing 76. Dry Standpipe - �
28. Lathing & Siding � ' • 77. FIXED SYSTEM FINAL
29. Insulation �� . . , � 78. FIRE PREV. FINAL •
30. Drywall Nailing • . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final - • 80. �FOOD CERTIFICATE ISSUED
33. Final Electric ' " � �Notes:
34. Final Heating & Air Conditioning y � a1 �'�� '
35. Final Gas Pipe-Test .
i,
36. Hood or Canopy , _�� �: � -�
37. Final Factory Fireplace " :
38. Final Plumbing � � �/� �
39. Water Service-Final '. •
40. Gas Service�Final , " - � .
41. Solar pomestiaFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System . � ,
45. �Sound Atterivation � -
46. Handiwp Regulations � ' �
47. FINAL STRUCTURE & BUILDING �
'48. �FINAL PLANNING .
49. Electric Release to Edison .
50. Gas Release to Southern Calitornia Gas Co , . `
51. CERTIFICATE OF OCCUPANCY
No. Date
PflOJECTA0UHE5S: j3BS WIMBLEDON WY
awaex�sr+aMe: HERMANSON DAVID TR
nooecss: 3381 WIMB�EDON WAY
COSTA MESA,CA 92626
� 979-9680
AfltM/ENGINEEN: HEG.NO.:
ROONESS:
uxir:
UNiT:
PEPMITTEE: ESTHER HERMANSON ( 719 ) 979-9680
aooeess: 3381 WIMBLEDON WY
C.M. CA 92626
LICENSEO CONTBACTOB OECIAflAiION: I �er¢Oy alli�m Ina1 I am IicenSCO unCer provision5 0� C�apter 9(commencinp wiih Seclion
7000� ol Orv�son 3 ol I�e 9usiness and Pwtessions CqUe, an0 my bcense is in lull �orce and effec�.
GTY LIC.: STRiE LIC.: CIASS:
'�ta SiqnaWre:
RREPS' COMPENSRTION oECLAflAT10N: I hereEy allirm Ihat I have a cenifiWte of fAnsent to sell�insure ar a cenificate al workers'
,mpenSalion Insurance. or a certilietl copY �hereol �Setiion 3800. La�. C�.
POLICY NO.: E1(P. �ATE:
COMPFNY:
❑ Cenifiea coOY is ne2Ey fumis�ed. ❑ Cenili¢0 copy is IileO with the dry BUilOing Oiv¢ion.
Date: MW�um:
E%EMVfION fPOM WOPIfEN$' COM1IPENSITION OECLAMTION: (TI� SE[Im nttE nol Ge mmplt.eE it Ne pttnq 61a ane MmErM (5100) or 1e55�.
I cenily Ihat in ��e petlormance ol �he wark far wNcb It¢t pe�mii is issue�, I 51u0 noi emdoy a(ry persan in any manner so az to Oecame
su�l¢U to Ih¢ Workert fAm0en5ation Laws af Cali�oMa.
Oate: Siqnature:
NO710E: II. aller making I�is declaration, y0u shoulC hecome subjttl to tlle WoherS' Compensation pmvi5ions of the LaGor
Coae. you musl lonhwRh compty witn sucn pmvisions or Inis oermit snall be aeemed revoke0.
CONSTPUCTION LENOING AGENCY: I hereGy a��irm �hat I�er¢ i5 a[onStmcli0n I¢nEing agency lor t0e pedormance o� the work lor
whic� Ihis peimil is isSu¢E �Sec�iOn 31197. Civ. C�.
LENOEB:
AO�flE$$:
OWNEP BUILOEP �ECLAflR710N: I �eRGy atlirm Illat I am eeempl imm t�e fAntraclors' State License Law lo� I�e IOIIOwinq reason
�Section 703t 5 Buvneu and Prolesvanal CoEe: Any uty ol counry which repuuu a permit �o constmct, alier, imprme, Aemolish, or
ie0air any S�mcWre. Orio� lo ils issuance. also apuires l�e aDDlicanl lor suc� De�mil �o lile a signetl staiemen� ��a� �els�e Is Iicense0
pursuant �o Ine pwvisians oi iAe Coniratlors' State Licenu Law (Ctupter 9(wmmencinp wi�� Section 7W%ai Uivision 3 0l �Ae Business
-+G Pmle55ions COde) ar Ilal �e/she is exempt t�e�tlrom an0 t�e Oasis br I�e allepeE etemplion. My violation ol Sedion 7031.5 by
applicant lor a pe�mi� w01e��s ��e apD���nt to i civil p¢nal�y ol not more tlWn five �unEreA tlollars (55W).
I. as owner ol the pwpeny ar rtry emVbyea vnin wages as tneir sole compe�rsation, wJl Eo Ne wad. anE 1Ae
�❑ simcmre is noi intenCeA or ollered tor sale 15ec�an 70aa, Busineu anC Pmfessional Coee: The Contractars' State Liunse Law
Goes not appN io an avmer ol a D�oDeny wlro Ouilas ar im0�wes tAertan, anG who Aoes such work �imull/�ersell or ihrougA
Ais o� �er own employees. prmiGeG tlut sucll impmvements are no� intmGeG or oflereA lor ule. If, Inwever t�e builAinp or
impwv¢ment is soltl vnt�in one year 0� wmpl¢Iion. I�¢ owner will luve t�e burEen ol Omvinp �rlshe Ai0 no1 UuilU ar impmue
br Ihe Durpose a� sale�.
I, d5 OwpP� 0� t0¢ pr00erty, dm Prtlu9v¢Iy canVaclinp wiih Iicense0 contrac�ors �o conslmtl ��e pmlect (SectiOn 704a, Busines5
I� anC Pmlessions COGe: The Comracmrs Slaie Litense Law Eaes nol aODN �a an Owner ol prop¢tl9 w�o bmlEs or impmves t�ereon
' ana who contraclsio� suc� pmjecis witA a contracioqs�licenu Dursuant io ��e Coniractors' Slate License Lawl.l am aware
t�at D�ooi oi inelr woiker's Compensatian insunnce stloula Ee O�ovi0e4 to me.
I� I am exempt under Section�. B. 6 P. C.
Io� IhiS �Cd50n'. y� � � ��,, ` /
oaia �"'y��9� o«nef."""��'�ti
I ao nereby cenity iha11 am aware of and unEerstana ine reauiremenis ol Calilomia Nealih and Safety CAOe S¢ctions 25505, 25533, anU
2553d and I�a1 I or any Iuiure Ouilding acupdnt wiNwiA WI (tircle One) nECG Ia Compty wil� said state cotles and I�e Rpuiremenis br a
p¢rmii lo� [On5lmtlion or modilitdiion �mm Ilre Ai� Wlily ManaOemeni D'61rit�. He90en�ial rAnSVudiOn ap0liWii0n5 are eKempi Irom
I�ese provisions.
Oa�e: Ap0licant:
I �ere�y cenify ihat I �ave read lhis a00�icatmn anC s�ale I�ai ��e aEwe inlormaiion is correcL l agree to comply wit� all [ity antl county
orAma�es ana siale Wws relating ta �udaing conyrucuon an0 �e�e0y auttnrize representawes ot tNs aty to emer upan the ahove�mentioned
prop¢tlY �oi m50etiion purpo5e5 �/
Dale' c� - %n - �J � Signamre: �-i z�+-tnJ � �`•""''�—�"`
�rivefs Li�ense ar Social Securily >:
-� I6aLa6 WM1ite—BwlCmg: Green—CoOe Eniorcemen�: Canary—ApplicanC Pink—Revenue: GolQenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: H 05109
PERMIT NO: B 051091 PLAN CHECK NO; 00236-91 S GOVT: N SUPP; N
CONSTROCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOH DESCRIPTION : BUILD HABITABLE SPACE INTO GARAGE S(j FT: 215
CLAIM VALUE: 12,000.00 CALC—VALUE: 2,967.00 GROUP OCC: R-3 /
COMMENTS: BUZLD HABITABLE SPACE INTO GARAGE
�r**�r*****�***�c****�r*�r�r�r*******x�*+t+t*��r*�r***�r�r�+t*�e�***�r�r** �r�r*****�r**�*�+t�t*�t*** �**
Z O N I N GS ERTEB�AUCIKRSE M E N T 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
PARKZNG REQ• PROV: PARCEL: 41208305 ZNE; PDR— REF NO:
PLANNING NOTES> PROPSED INTERIOR MODIFICATION TO EXISTING DWELLING
**+t**�r*�r**�r**����*�*****�r�*+Er*��*****+Gr**�*�r**�**r*�**��**x�*��D***�B***�**r*+�*
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 Cp��. DATE: �_
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY• DATE: .�' 2 0
iflFifififiEifiElEif�fjflEk�f*iFififififlE ikaFlEifiElflfififiF ifiF
3f iE iF �lf ik iE �f iE iE if if 1F 1F 1F if if if if iF if if fF if �E �f �E �f �f 1F k if if iF M if if 1f �f±f if M iF If iF 1f 1E if iE if if k�t iE iE K if iF if iE If iE iF If iF if if iEik 3E'1E 3f 1F 3F if 1F if k If k
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54.00 ,SO
PLAN 35.10 SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 54.50 0.00 35.10 89,60 89,60 .00
REVENUE DIVISION TOTALS--> COLLECTED; 54.50 OVER/SHORT; 00
BLD54P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TO�T GRADING PLAN—CHECK
�f if IF iE ff if if IE if If !k k iF * 1E if M if M iF if iF iF 1ElE it 3f iE iF if If iF iE if 1t �f k k if if IF iF iF iF M k M If If if k 1E if if Mif if if iE if 3F k aF 1E if if iF M if k k k ik k iF if �k M 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 TOTFIL COST
SFR 215 DWE—INT. ALTER TYPE V—WOOD FR —GOOD 13.80 � 2,967.00
END OF FEES '
r
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:kTc. CJ_"_ _• �T:_ ; c•—�7
,:
, .-.
v
CONSTRUCTION AND PLAN� 1 'OOL & SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date In:pector
1. Temporary Electrital Service or Pote 52. Pool & Equipment Location
2. Soil Pipe-Undrg�nd._ 53. Steel Reinforcement
� 3.:Electrical Conduit Utility�Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
"�5.. Si�el Reinforcem€nt 56. Rough Plumbing & Pressure Test
• 6. Nectrical UFEfl�Gmd. 57. APPROVAL TO COVER�GUNITE ,:
'_ 7...Footings �' 58. Electrical ConduirUndrgmd. �-
8. Foundation S 59. Gas Pipe, O Undrgrnd., Test �
� 9''Water Pipe-Undrg�nd. 60. Backwash Lines, P�Trap, � Undrgrnd.
10. Structural Floor Svstem 61. APPROVAL TO DECK
11. P�operty Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap o 63. Heater & Vent•Final
13. Roof Drains T' 64. Plumbing System - Final
14. Rough PlumbiFig �� 65. Electrical�Final
15. Rough Electrical�Conduit 66. Solar System-Final
16. Rough Electrit�Wiring 67. Fencing & Access ApProval
17. Rough Wiring $ign 68. APPflOVED FOR PLASTERING
18. Rough Electric,al-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
' - ' . - ^r ❑'r C . .
20.:Ro"u�gh Facto�y Fiieplace "�, X1 + S � .APPR'„O,VALS.�-Permit # � '
21. Duiis, in Structu€e� i�•• ��� - - O �a -:� J0. Unde grlou�dHydro x
22. Ducts, Ventilating, - �_ _ � ? �'� :�f77, product',Piping O'�Gas O'Oil
� . . ... • n • - J � . I�i � ,
23:-Ga;.Pipe�Rough&�?est ,;y.S • ,. - ,ry . ,, -72. Underg�ound Flush,- y ' ,
24. Roof Ftaming 'v � �. �� �, F L� ' � > ` �735�'�Undergmd'Storage�Tank4OGas ❑Oil
25. Roo Sheathin '.`.� �� •' :` . e�7 �. ::�r . - �- - _ :�
f 9 = � v • � _ �� � �:y. • -74.=0verhead Hydro, x
26.� T-Ber Ce�ling (Stcuaturap &�Monocoatc'• - � � � - ln�+ ?- 75YDry Chem'ical � � - _
27.� Frame a d Flashiii, _ %��� 'j' ' ` r, �: -,+� , r �,r•
{? � 9, ;� . y �•., ,. 76. Dry Standpipe `. r - ,.
� 28. Wthing&Siding'.• •- .�?,t .��� ,n.;7 • • ��a �' 77. FIXEDSY�TEM;F�INAV �
''29. Insula[iOn � � .. . " , •.t [v � •
. . i. � ,: � 78>iFIRE PREV. FINAL ��
��30. Drywall Nailing �L+ � �� � � "� m HEALTH�DEPT: REQUIRENIENT
31. Plaster Binwn Coat; � � ,.,� r �.y � ` �, ,79.'FINAL INS�P.ECTI6.N ' `� "� r
� ' -80.�FOOD CERTIFICATE ISSUED
32. Electriwl Power Meteo-Final �: . . ' �� 4 �
.33.';:Pin�l Electric -"� ,.i '`� r� � "Noies: _ 'z �� - '.,.�
� ' ,J �
`�34.'Finai Heating'& Air.Conditioning; � j7 � , �� .. �:, � ,���: . c � --
.T
35.�Final Ga's Pipe-Tes`t° " _ ( � � , � '^ � " ' � _
II� '-r+ �.i
.i36.� Hood or CanoPY.w ; �� n - i: � - % ., -. , .,. . - ��
�r � r'
^37:-Pinal Factory FirePlace ' '��z' �'`- �.y` .� � {��.c. y � � �P `�.�
i � i_� GX' f t`'• :C .�.�.il
��38 _Final Plumbing i .� � .• .. � . �.,. � � t� y. ` � _
:39: WatEr S.e2r.vice�Final. - - .�,1 + � ' M a ^ . ., S -
T 7'A Q'. d
-_40`�Gas Ser'vlce-Final , r �rir.� � � �.� i- j. � ",�� .�: - �
�
391 r Solar pomestirFinal � ^• � � ? � : � ; " ��� � � '*
:� j � � w �,. T � �
42.�Backflow Preventer' - �: _ - � ( �' - , �
43. Backflow Irrly'ation' � �� _ '• ' � � �� � � ` ' _
� a . . �• i � •..
'44. LandscapelrrigationSystem,,�,= ���' ,: - - } i �� , , -
45...Sound Atterivation �^:- �� : - - - 'v � y �
� ':, � - 1
46.,Handicap Regulations ' �� � - ��� �� � - ` � �
_ . ti m
47. FINAL STRUCTURE & BULLDING y.((.f� � -:�`� ���` Oa,_ �
48. FINAL PLANNING � '� -� � ; � �; ^ ',' i:: ,y : , �
- t.
49.�Eleciric Release to Edison ' l� . r ^ � ��
� h^ n �. 1 ' a � G
50. Gas�Release to Southern California Gas Co : � I f� ,. �. �. a�, • ''
'S1. CERTIFICATE OF�OCCUPANCY , ' ,. , ' i;;,�. . . ;�� ,,
No. Date
I, � Applicant to fill in all spaces except those wit�in heavy EorOer lines anC si9n all a0Gro0��ate tleclarations. B23I I 2/04/ 66 . g,ary
i C7TY OF COSTA MESA C NSTRU TION PERMIT PERMIT �� TRACT NO. LOT NO. UNI7 N0. • � , :
�A
Project Address � � ' ' , �,
ApplicanYs Mailing Addreyss�� ' - TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R � �
Owne�'SName �_L.y����%� ' ' Phone� � CONVERSION ❑ DEMOLISH ❑ OTHER qp # ' . � ' _ Zane_ ' '
�y �q DESCRIPTION OF WORK/USE OF eLDG.
Address � �y'-�A�'(p � S Main6uilding: AccessoryBuilding:
Arch/Eng. License No. TVPE OF PERMIT cRADIrvG OUNDATION ❑ S7RUC7URAL T Front ' ' �
Add�¢55 ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear � N
Contractol'SName _PhOne _ � OTHER A I
� PROJECT DESCRIPTION 5c1. Fr. oCCUaANCv K Right G
Addresslmailing) � ' Left '
�/� � CONSTRUCTIONTVPE VALUATION$ g
CityLicenseNo �/�/� l ZONE GRADINGCU.YOS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref. � ' {_' �Parking Req./Provided E
I hereby affi�m that I am licensetl untler provisions o( Charter 9(commencing Remarks: ' � Planning Notes: ' � M
with section ]000) o( Division 3 of the Businezs antl Professions Cotle, antl ' �
my license is in t y jyr e antl ettect. � - � ' - T
Licens lys� • • 'c s N.'�DUS,P Z- ' S
� Date " ( ' � Si9�ature � �� 6�`� � PLUMBING FEES ��
� WORKERS' COMPENSATION DECLF. ATION Baf Sink � ShOwefS ELECTRICAL . FEES
�' hereby affirm tha[ I have a Certi(i[ate of consent to self-insuve or a certifiCat¢ -
+:'.'"'" Worker5' Compen5ation Insurance, or a certi(ietl cOpy thereot (Section • -
Backflow Preventer Service Sink
i'�?*300, �ab. c '/� i /�%� o ' Automatic Washer Trensformer ❑ 15-50 KW
� Polic No. ������ / � Com an '/�" �l -���.Lr � � �
v P v Backflow irri ation
-r -.� —,7—�— 9 Sewer Cap - Construction Pole Suh. ❑ 50+ KW
�ertifietl copy Is hereby fumishetl. . - . ' -
Cer i'eq y is '1 tl with the city ' di�' Is �//�� Bathtubs Sewer Connection Cooking Unit' . Meter ❑up to 100 amps '
Date Applicant l/� � � -
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers - . $olar COIICctO�s � ' Di5hwd5h¢f MEt¢� �Ov¢f 100 amps
(This section neetl not be completetl if the Oermlt is for one huntlretl ($100) or - '
Iess). Dishwdsher Solar Piping ' Dryers ❑Gas ❑Electric Sub Panel
I certify inat in lite Oetformance of the wo�k fo� which thi5 pe�mk is issuetl, I - �
zhall not employ any person in any manner so as to bemme subject to the Drinkinq Foun�ains Solar Tank Fan � ' � '
Warkers' Compensation Laws O! Califomia.
Motors OO-1 HP O7K- B
Date 5iqnature Floor Drains Swimmin9 Pool w/Spa F.A.U. '
NOTICE: If, after makln9 tnis Oeclaration, you shoultl become subject ro the �nc.Solar 09-15 HP 016-75+ .
Wo�kers' ComOensation p�ovisions ot the Ldbor COtle, you must forthwitn FI00! Si0k5 ' �
comply with suth p�Ovisions o� this pe�mit shall be tleemetl revoketl. Urinal � Fixtures Microwav¢ i
CONSTRUCTION LENDING AGENCV ' ' GasSefviCe Outlets WaterCloset DeviceBoxes �
I hereGy affirm that [here i5 a conshuction lentling agency fo� the performanc¢ Pole Light . .
of the work for which this permit is Issuetl (Section 3097-•Civ. CJ' Intereeptors Water Heater � Outlets
Lentler's Name � Range '
Lentler's Aatlress Kitchen Sink -.- . Water Service ' Switches � - Si n � '
OWNE0. BUILOEH bECLARATION 9 '
1 nereby affirm that I am exempt from the Contractor's License Law tor the Lavatories . Auto-Wash Garba e Dis osal
following reason (Section 7031.5 Business antl Professional Cotle: Any ci[y or 9 P Standing SCetions
counry whicn requires a permit to construct, alfer, improve, demolish or repalr P-Trap � Laundry Trays � Generator 0�-5.KW �5�15 KW �
any structure, prior to its issuance, alm requires tne applicant tor such permit Tresh Compacto�
to (ile a si9netl statement that he/she is licensetl oursuant to the provisionz ot Roof Drains ' � -
the ConVactor'S License ldw (Chapter 9(commenCing with Settion 7000) o( �
'Division 3 of tM1e Business antl Protessions Cotle) or that he/she is exempt - -- - �� � - -
there(rom antl the basis for the allegetl exemption. Any vialation of Sectlon , �
�'031.5 by any applicant for a permit subjects the, applicant to a civil
��enalty of not more than five huntlretl tlollars ($500). - � , '
LJ I, as owner ot [he property o� my employee5 with wages as thel� sole ReinSpeMiOn'FBe $15 ISSUe Fee $ 3
rompensation, will tlo the work, antl the structure Is mt intentled or otteretl Reinspection Fee $15 Issue Fee $ 3
' for sale (Section'�044, eusiness antl Professional Cotle: The ConVactor's � , ' MECHANICAL FEES -
License'Law Ooes not apply to an owner of a prope�ty who builtls or improves .
thereon, antl who tloes such work himself/herselt or througn his or he� own goiler HoOd or T DEVELOPMENT SERVICES REQUIREMENTS: . '-
employees, provitletl [hat such improvemen[s are not intentletl or offe�etl fo� Ype I ❑
sale. It, howeve�, the builtling ot imp�ovement is soltl within one yea� of com- CanOpy 'TypE I I ❑ Z���^9 %�PProved By �ate _
pleiion, tne owner will nave tne burtlen of proving he/she tlitl not builtl or im- Duct - Under Ground � Building Approved By Date�„�ti
�ove far the purpo5e oi Sale).
I, az owner ot the property, am exclusively contractin9 with licensetl con- Duct -Structural Refrigeration System Application Issued By Dat�
tractors to construct the project (Section ]044, Business antl Protessions Cotle: '
The Contractor's License Law tloes not apply to an owner ot properry wno Duct - Ventilating � ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES -
, builtls o� improves the�eon, antl who cont�acts fo� Such projects with a con- .
tractor(sl imense pursuant m tne Contractor's Liwnse Law). I am aware tnat Exhaust System ❑ MWtiple ❑ System Repair/Alteration BUILDWG PEFMIT $ - SMIP
$
proot of their Worker's Compensation insurance shoultl be provitletl to me. PLAN CHECK _$ PERMIT - �
❑ I am exempt untler Section - � e. & P. C. tor this reason Firepl/Fact. Blt. ICBO # Fire Dampers PLUMBING $� �SSUANCE �$ ,
Date Owner Heating System & Ducting � Registers - pLAN CHECK 25% $ ENERGV P.C. $
I hereby certiiy that I have reatl this application antl state ihat the above ❑0-100,000 BTU �100,OOOBT GRADING $
information is mrrecL I a9ree to comply with all city antl county ortlinances �ELECTRICAL $
antl state laws relating to builtling construction, antl hereby aumorize repre- MICROFILM
sentatives of t�is cit to ent upon� the above-mentionetl property tor PLAN CHECK 50% $ $
inspection p os / / 1 MECHANICAL $ \
Siqnature �(/` Date��CL��rp Reinspectian Fee $15 Issue Fee $ 3 PLAN CHECK 25% $" ' TOTAL FEE .$�
Drivers' License or 55 �
CMF�0865-46, rev. 10/B4 Whit¢ - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - A55e55or
\ _ _.
fL
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Pprmit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility�Undrgrnd. 54. Forms
4. E(ectrical Conduit-Undrgrnd. 55. Electrical Bonding �%
:r:
..�
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER G�JNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �
8. Foundation 59. Gas Pipe, O Undrgrnd., Test �-
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK ��;j
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Firia�j
12. Sewer Cap � - 63. Heater & Vent-Final ^�
13. Roof Drains . 64. Plumbing System - Final �
74. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rougfi Wiring Sign 68. APPROVED FOR PLASTERING �
18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _ .
21. Ducts,in Structure 70. Underground Hydro ,
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush .
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. FrameandFlashing 76. DryStandpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation 78, FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditioning , .
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 6•Y-87 LEI�
39. Water Service-Final � '
40. Gas Service-Final �
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation '
44. Landscape Irrigation System
45. Sound Attenuatibn '
46. Handicap Regulations ' �
47. FINALSTRUCTURE&BUILDING -
48. Special Requirements Completed � -
49. Electrie Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date _�_ r°n- ' � '
. ' F_i -
o-�
�
s
TRACT N0. �D� 7 �
LC7P NO.
CITY Or C�TA
RD�UFST FUR OCQIPANCY
n�Te: ,6? /9—�1.
Rhe developer of the above entitled tract desires to sell the above set forth
lot prior to the tune that the tract has been com�leted and its streets
accepted t� the City of Costa Mesa.
By execvting this agreement, the undersigned acknoaledges that he/she/they
was/were advised that this tract has not been given final inspection nor has
it been accepted b� the City of Costa N,esa as having co�lied with the conditions
of approval which were i�ed b� the City at the time.the Final Tract Map was
approved.
The City assimies no liability for the enforcement of the conditions necessary
for approval other than th�e conditions protected b� surety bond.
The undersigned agrees to inde�nnify and hold the City harmless from any claim
resulting in dam�ge or personal injury to the undersigned b,� reason of the
aforementioned unoortpleted condition(s � ����
BY �[ _/��Zw��J�o/ � / L4.. __ /�--i -
� ':. J L I tV � �
C��� nC �' : . -��.
�
(
DEC � G 1979
PIN
'iiSi9i��ll���1j��`��4�5i6
!
4%19
.�•
authorized presentative
BY
(Signature of r)1V. H. HARVEY
HOhtE SAVINGS AND LOAN A CIATION
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIfORNIA 92626
For Applicant to Fill in Completely - Use Ink Only
BUILDING Tract 10277 I.ot 32
ADDRESS �
OWNER MCLain Develooment Co.
MAIL 1470 Jamboree ROdC�
ADDRESS
cirv Newport Beach No�'640-6800
BRANCH
ADDRESS
ARCNITECY _ . . ,__ _ .. TEL.
CONTRACTOR McLain Development Co.
ADDRESS 1470 Jamboree Road
TEL.
ciTv Newport Beach r+o. 690-6800
L C. NO. Z�3H%S LICyNO.
OF LOT 4S X IIO NOWON�O S
USE OF
E%ISTING BLPC.
Separate pemtits are requ'ued (or
electric, plumbing and heating work.
UILDING AND WORK TO BE PERFOFMED
Single family residence,
New House
I heraby ack�owletlpe thet I heve read thia epplicetion antl state
ihat the abo�e Information is corract entl eprea to comply wIM
an iaw� reeula:ina oumm�e conn.�eoion, aoa i shall not employ
any perwn In �ioleTlon of the workmen'a compansation lews of
Me Stata of CalHornla.
1 �araby cart�fY thet 1 am properly Iiconaed aa a eonnaetor untlar
No Stnte of Califarnle eusines� antl Profaalona Cotle, Dlvislon 3,
Chepter 9, entl that sueh licenses are in full forco entl effeet, or I
nm exempt f/om the provislons o( the Smta of Colllornia Businass
end ProfesslO�a Cotle, DlviElon 3, C�epter 9�
Slpnot�re of � �� L� � � � ' /
Permittee �Q� ��� ��''��
1
Authorizatl Ap6nt/
`�3HOj 2 2jL79 i_ 357'.6�2GKT�
�+- 38D1' 0000447502 " '�A' - '-�
APPLICATION FOR STRUCTURAL PERMIT
RE I BY/ DATE RECEIVED nnrc wcimn
A.P. NO. �I�—Qp �'
BUILDING �3 ¢/
AODRESS O
TRACT � IiZ%�J
�
NE NO.OF
R-rn D P�^^�
vAROS APPqOV ED
MAIN BUILDING
iOM C/L STREE7)
�NT .ZSFT. O
CIlIF S CT O
PERMIT NO.
LOT 32 I BLOCK
USE OF NEW
BUILDING /QE S
YARDSAPPROVED
ACCESSORV BUILDIN
DISTANCE BET. BET. MAIN
MAIN BLDGS. ACCE§ BI
CURP,ysZE'/O"3y APPROVEO
APPROVED
HOLD FOR SP CIAL R
TMEAMOUNTS
THE PURPOSE OF
VALVATION
$ �3 20D_
n
— m
House 2352 m
Garage 678 „
✓N UNDER VALUATION IS FOF m
'ABLISHING A GERMR FEE ONLV: �
PERMIT FEE 5 � e
PLAN CHECK E ! � s� o
TAX 5 � �Z LL
E
u
TOTALPAID E'� �