HomeMy WebLinkAbout3326 WYOMING CIR - Building PermitsC�
Aoplicant to fill in all soaces except tnose within heavy boraer lines antl sign all approvriate Oeciarations.
CIT`hOF COSTA MESA CONSTRUCTION PERMIT PERy411T NO. „ _ TRACT NO. LOT NO. UNIT NO.
Pro�ect ndd�ess 3326 WYON{ING C�'IFj('..C.E.
Applicant's Mailing Address �42. �QL$]j �-1�4'
Owner'sName ���( ��TNC'' (`TRV('TF Phone �+4�±^89.�6
Address �F'F'
Arch/Eng. License No.
Address
Contractor'sName NA}''•RTCAN H(�^4F. SFiA7TCR4hone g9�--�-2g�
Address (mailing) �q
City License No. l/ � ZZ� �
LICENSED CONTftHCTOR DECLARATION
I hereby aftirm that I am licensetl untler provisions of Charte� 9(commencing
with section ]000) ot Division 3 oi t Business antl Professions Code, antl
my license is in full force and effect.
ucense ctass icen 563146
Date_3—�5-89 5iqnature
WORKERS'COMPENSATION DECLARA ION
''�ereby affirm that I have a certificate of 5 t to self-insure or a certificate
Workers' Compensation Insurance, or a certifietl copy thereof (Section
J0, Lab. C. ���m
Policy No. 7 04675925 Company BUSH'�2N�.p�r�...+ �.5�.
�ertifietl mpy is hereby furnishetl. A(�' '�]�'
ertifietl mp is filetl with the city Builtlin9 DiviSion.
Date S—� 5—�9— APPlicant � ['j�„' i�%i(�T'',rj
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This settion neetl not be completetl it the permit is tor one huntlretl ($100) ar
less).
I certify that in tM1e performance of [he work far which this permR is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws ot California.
Date Signature
NOTICE: If, after making this decla�ation, you Shoultl became subject to the
Worke�s' Compensation provisions of the Labor Cotle, you must forthwith
comply with suth p�ovisions or this permit sM1all be tleemetl revoketl.
CONSTRUCTION LENDiNG AGENCV
I hereGy affirm that there is a mnsV uction lentling a9ency tor the performance
of the work tor which this permit i5 issuetl (Settion 30W Civ. C.)
Lentler's Name
LentleYs AOGress
OWNER BUIL�ER OECLARATION
I hereby attirm that i am exempt trom the ContractoYs License Law tor the
followin9 reason (Section ]031.5 Business antl Professional Code: `Any city or
counry wM1ich requires a permit to construct, alter, improve, tlemolish or repair
any stru�ture, prior to its issuance, also requi�es the applicant for such permit
to tile a signetl statement that he/she is licensetl pursuant to the provisions of
the Contractor's License Law (Chapter 9(commencing with Sectiom7,000) of
Division 3 of the Business antl Professions Cotle) or that he/she is exempt
=refrom antl the basis for Ihe allegetl'ezemption. Any violation ot Section
31.5 by any applicant tor a permit mbjects tM1e applicant to a civil
nalty'ot not more Ihan five hundretl tlollars ($500).
L� I,.as�owner of the property or my employees with waqes az their sole
compensation, will tlo the work, antl the structure is not intentletl or offeretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
Llcense Law does mt apply to an owner oi a property who builtls or improves
thereon, antl who does such work himself/herself or throuqh his or her own
employees, Provitletl that sucM1 improvements'are not intendetl or offeretl for
sale. If, howeveq tM1e building or improvement is soltl wlthin one year ot com-
pletion,-[he owner will have the burtlen of proving he/she tlitl not builtl or im-
erove for tne purpose of sale).
LJ I, as owner of the property, am ezclusively contracting with licensetl com
tractorsto mnstruct the project (Section ]044, Business antl Professions Cotle:
The ConVactor's License law tloes not apply to an owner of property who
builtls or improves thereon, and who contracts tor such projects with a con-
tractor(51 ucense pursuant to tM1e Contractor's License Law). I am aware that
proaf of their Worker's Compensation insurance should be provitletl to me.
❑ 1 am exemp[ untler Section 8. & P. C. tor this reason'
Date
I hereby certify '
intormatlon is r c'
and state laws e tir
5¢OIdiIV¢S Of
inspection p p s
Siqnature _
OriverY �icense or �5'
IF 0865-46,rev.10/84
Owner —
I have reatl tn$ a
I agree to corm6!v
to builtlina rbhst
'.tate that the above
tl county ortlinances
eby authorize rep�e-
ionetl praperTy for
D—a� rJ—�..�.—$4
TYPE OF CDNSTRIQCTION LJ NEW LJ ADD �ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BIDG.
TYPEOFPERMIT GRADING p❑q FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL LIPLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sc?. Fr. oCCUaANCv
CONSTRUCTION TYPE VALUATION $
ZONE GRAOINGCU.VDS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Backflow irrigation
Bathtubs
Clarifiers .
Dishwasher �
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof �rains
ReinspeMion Fee � $15
Boiler
Duct - Under Ground
Duct - Strucmrel
Duct- Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,000
Reinspection Fee � $75
White - Builtling; Canary - Applicant; Pink�- Acwunting; Goltlenrotl � Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration Sys[em
❑0-100,OOOBTU ❑100,000
SYstem Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
A.P. #
S Main Buildi
E
T Front
B Reat
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
E
Aummatic Washer
ConstructionPoleSub. �
Cookin9 Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures I
Device Boxes I
Outlets
Switches
Garbage Disposai
Generator DO-5 KW 05-15 KW
Reinspection Fee
FEES
�DEVELOPMENTSER
2oning Approved By—
Building Approved By
Aaalication Issued Bv_
$ 3
Zone
Accessory Building:.
Parking
ICAL
Transformer ❑�15-50KW
❑50+KW
Merer ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Momrs OO-1 HP �1 %- 8
IncSolar 09-15 HP �i6-75+
Microwave
Pole Light '
Range
Sign
Standing Sections
Trash Compactor
$15, � � Issue Fee
�
REQUIREMENTS:
SUMMARY OF FEES ,
BUILDING PEFMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ � ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL .$ � GRADING
PLANCHECK 50% $ MICROFILM
MECHANICAL $ �—, TOTALFEE
PLAN CHECK 25% $ .
aATE% 05/14!34 'i?�F:
$
FEE$
$ 3
Z
0
N
i
N
G
R
E
Q
M
T
S
CONSTRUCTION AND PLANNING . POOL & SPA �-
Date Inspector Date Inspector
APPROVALS Permit,# APPROVALS Permit#
i..Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgmd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER;GyUNITE
7. Footings , 58. Electrical Conduit-Undrgl:iiii.
8. Foundation q���:.- 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, � Undrgrnd. '
10. Structural Floor System 61. APPROVAL TO DECK t��`
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fihal
i_� �
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System � Final�+:.'�
14. Rough Plumbing � 65. Electrical-Final , �
15. Rough Electrical-Conduit 66. Solar SYstem-Final �
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. P,OOL/SPASYSTEMS 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 (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. F,IXED SYSTEM FINAL
29. Insulation 78. FfRE 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
3S. Final Plumbing �e� [,�p '
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final � .
42. Backflow Preventer
43..Backflow Irrigation .
44; -Landscape Irrigation System �
45. Sound Attenuation
46. Handicap.Regulations � �
47. FINALSTRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY . '
No. Date
I PflOJECT ROOFESS: 3 3 Z 6 WYOM I NG C I
OWNEN'S NRME: LEE GEORGE JR
AOOPESS: 33Z� WYOMING CIR
COSTA MESA,CA
l
.`
�
/ I
�
AXCNIFNGINEEfl: .
ROONE55:
UNIT:
92626
HEG.NO.:
UNIT:
PENMITTEE:GREGG THOMAS ROOFING (714)841-2290
aooness: 15212 XAVIER CIR
WESTMINSTER CA 92688
LICENSEO CONTBRCTOP OECNNATION: I �ere7Y allirm �hal I am Iicense0 un0er D�ovisions o� Chapler 9(coromencinp wilA Seclion
7000) ol Uivision 3 al ihe Business anA Professians Cotle. antl cense is in lull lorce antl effecl.
cirr uc.: 0 2 6 STRTE LIC.: S O 4 S�I S cu�ss:
Oaie: SignaNre: — � _ _ . _
WONNEflS' MPEN TION DECUIBATION: I �¢�ebY aflirm ��a� I hav¢ a[erlilitaie o nse I �o SelbinsUte oi a cetliliWie 01 WOrkets'
CAmpenSalion Insurance. or a tendied coDY �hereof (�ction 3800. Lab. CI.
roucvNo.:1305719-92 E%P.DATE: IIIOSI9
COMPANY: STATE FUND
❑ Cemhed copY is ereEy turnis�eE. � Ce�ifie0 copy is file vnth the ci�y 9uilEing bviSion.
�aie: � Applicani:
E%EMP710N FflOM WOHHEPS'COMPENSATION OECIARpTION: (Thi55 , on neetl nolbe mplte0illhe permili5lm on¢ AunOretl�$100�aNe55).
I ceriily iha� in ihe peAormance al ��e work lor wAich Ihis permit is issuetl. I s0all no� pl y any Derson in any manner so as lo become
subject to Ihe Warkers Campensalion LawG of Calilomia.
Oate: Signaiure:
NOTICE: If, atter making ihis Geclaration. yo0 S�ouIJ 6emme SuDleci la Ihe Workers' Campensa�ion provi5�ons ol the la�Or
Cqtle. yau mus� �atl�vnN compty wil� suc� Orovivons or Ihis Oermit stull Oe tleeme0 revakeE.
CONSTPUC7ION LENOING AGENCY: I neteGy aUirm Inat there is a consimction IenainA aAenC/ lor ihe petlormance ol ihe work for
wAich I�is Oermit is i5sue0 (Setlion 3097, Civ. CI�
LENOEH:
AOONESS:
OWNEfl BUIlOER OECLFflATION: I here0y afhrrn Ihat I am exempl imm t�e Comractors' S�ale License Law for �he following reason
(Seclion 7031.5 Business antl Pmfessional Cotle'. Any ci�y of counly wllich requifes a De�mi� lo cons�ruc�, alter, improve, tlemolish, or
repair any simcWre, prior m its issuance, also re4uires ihe applicant br suc� permit to lile a signetl staiemem ihat helshe is Iicense0
pursuam io the provisians of �he Coniracmrs' Staie �icense Law (ChaD�e� 9lcommencing with Seclion 7000) of Division 3 0l �he Business
anC Prolessions Cotle� or I�at he/s�e is exem0� Ne�e��am and the Easis lor I�e alleQetl exempiion. Any violalion ol Seciion 7031.5 6y
any applicani �or a Oermii su6lects ihe ap0licanl lo a civil penalry o� not mare Ihan live huntlred dallars (5500�.
❑ I, as owner oi ihe Oropeny or my employees with wages as iheir sole comDensation. will do Ihe work, anU the
stmtWre is not imended or oifereU lor sale (Sectian 7044, Business anG Pmlessional Code: TAe Comracmrs' Slaie License Law
tloe5 noi ap01y �o an owner o� a D�ope�y who bui105 Or impmves Ihereon, antl who tloes SUt� woB himSelllher5ell or Ihrough
his or her own employees. pmvitleC IM1aI such impmvemenls are nol inlenAed or offeretl lor sale. II, however Ihe builtlmp or
improvement is saltl within ane year ol cJmplelion. �he owner will have Ihe hurden ol proving �e/s�e Oid nol �uild or impwve
lor ihe purpose of sale�.
I, as ownerollhe Oroper�y, am exclusively con�rac�ing wi��license0 coniracbrsto cans�mcti�e pmlecl �Section 7044, Business
❑ antl Pmfessions Cotle: The Coniraclors' S�a�e License Law Uoes no� apply to an owner ol property who builds or impmves �Aereon
antl who contracts �or such pmlecis wilh a contrac�or�s) license pursuanl to Ihe Con�ractors' State Lic¢nse Law�. I am aware
ihat pmol al their Warker's Compensation insurance ShoWd �e pwvitletl lo me.
� I am ecempt unaer Sec�ion: B. 8 P. C.
for I�is reason'
Date: Umer.
I Oo �eieGy ceNty Ihal I am aware of antl untler5i9na the repuirements ol Calibmia Healt� anC $afety CoEe Sections 25505, 25533, an0
2553a anU Inat I or any fuWre Duilding occupdN will/will not (circle one) neetl lo comply wi1� saiU staie coAes and Ihe requiremen�s �or a
permit for conslmction or modilica�ion Irom I�e Pir Oualily Management Oistrict. flesi0ential WnStNclion applicalions are exempl �rom
IhQSC Pf0V1510115.
Da�e: Aov�icant:
1 hereEy cetlity iha� I have read IAis applicalion and sla�e thal bove iniarmalion is carrect. I agree m campty wilh all cily anJ caumy
o�dinances an0 sia�elavrs relalingio Ouiltling consWction an ereby utlror¢erepre5enlativeSOlthiSuryioenter uponl�e a0we�mentioneE
pm0ehy far ir peclia purposes.
Oale: Sigtlaiure:
Driver's Lic . se or Social Sewrny +:
16eba6 WMe—Builtling: Grean—Coao Enlor�emem: Canary—ApplicanL Pmk—Revenue: GOIEenrod—Assessor
CITY OF COSTA MESA — HUILDING PERMIT
PERMIT NO: B 064052 PLAN CHECK NO: N
PERM NO; B 064052
GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIpTION : REROOF WITH FIBERGLASS SHINGLES SQ FT: 3,700
CLAIM VALUE: 3,700.00 CALC—VALUE; 3,700.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTORS RE�UIRED 91 UBC, REROOF 2500SF R�7i��'C�1��'}�,4��t—y
�r*�tr+tir�tirir*�t�r**�t�rxit*+t�t�t�r�t�r�ef�* frfrit+t*itfr�r��+tkitit*+rr+t*�fir**rrw*wir !t .#.ii ii$�ti� �F+�
Z O N I N G R E(j U I R E M E N T S '
S fi 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: 13961114 ZNE: REF NO:
PLANNING N2S'PES>
i
1f M k k M �t M �f �E!!!F!t 1f 1k k 41F if 1f ff It 1E 1Elf iE if if ft fF M M 1E k 1E 1E 1E if it 1E M M 1f M M 1h �F ff k%!f 1E %1f M k M!f M 1flF 1f ik 1k M 1E 1f !F M 1f 1f iF if M!f 1f �F if 1f 1f
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 BY : DATE:
APPLICATION ISSUED HY: DATE:
kMifkffMMitilkMiflflflFNiFiEitlfiflE Mk1EiFiE1f1liEif% 1E
*iEiflfiFiFM1lfFMMiEf!ltlfkMMiFMifiEiEiElFiflf%1FMffiflEffff1E1f1fiflflFitlfMMlEiF%ikiEKIf1EMMMMMif1EM1flfIfMMlf%iFMMiFifffiEfflfiflf
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 63,00 ' ,50
' SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL % PAID DUE
TOTALS----> 63.50 0.00 0.00 63.50 � 63.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHORT: .00
HLD63P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT� GRADING PLAN—CHECK
ftffifMiEfflf%ifiklkklfiliElEftlffflfM3EifififlFlFifMiflfikMifikiElEifMitMkMMMfElfMlEkiflfMMlfiflFlElF9EK1E%MMMMIEMIFIl7F1flfiffklflflF
I N D I V I D U A L F E E H 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
SFR 3700 REROOF HY VALUE RESIDENTIAL NOZONE •Ik00 3,700.00
END OF EEES
�� l/ � " �
c:.' a ��� E 1993 �
CITY F C�STA MESA
�� �� t .
! ~ POOL lA �
i CONSTRUCTION AND PLANNfNG
APPROVALS Permit�, Dute Inspector pppROVALS Permit'� D�te Inspector I
I
� - - - - ------i
1, Tempor.:ry Eieancal Serv�eqrPol��� _r 52. Poo� d� Equipmznt locat�on -: j
� z;�Sod PiFe-Undrgrnd„ '' � �`�,.`; . 53. Steel Remforcement '
�f�.'-•"��-�7' �--"ti."-.-�=7-� : ,T- I ____-_ , i
�,;�i���n3r.!r,al Cond��i'.��ity•U�drgrr.tk� I 54. Forms �
���! �1G{.n- .-. t. n. r.� � � I .
I'O�}.�E'ectr c�! C�^dir4=:�iJrgr�-d.�'�� J __� � 55. Electrica! Bnnu ng � �
rr•�.Fy�- _ . _ -;- ----T ��"
i y,•�-S. y N ? r��f a- c r^ e r e� >; I�. Ro� gh Plurcb'n 9 6i P.eso�:e Tesi I � t�
;9a:-�� " �s- - - - r-�
%=�.�r;��c: :;FEr^�.,Q.}:,�d. � -I_ ' 5/. APPHOVAL TO C: \'�R GU\ITE � j _
� .��. . a _ - -
�"5_ _ _ '1 : .. ... • I
�� 7,"i-ty�uDnas �� 58. ElectriCal CondU-�bUrdi�mtl.
-�-•.�t---"'F� _ -_-
8.,�ou^.tldt�on 0--+ 59. Gas Pipe, iJ Undrqrnd., 7eri •� .
_?�__ r'� � -;-
�J. H�ater P�pe-Unc�_grnd. '� }" � 60. Bae:cwash Lines, P�Trup, -' Undrgrrd. � •- I
i 10. S'ructurel Fbo'i�System ' '-' � 1� 61. APPROVAL TO DECK -t - i
1 L Pr�pe!;y Sevrer lin�& Hou<q�Conrx2tion � 62. Back�•�ash & aecz;rm�F���i � �
- I �
, l�we� Cap . - =� 63. Heater & Vent-Final I
F- - . - .}' -- - --
, !3. RoofDrains � 64. PlumbingSystem F�nal
r---- _ . -�----
14. fio::gh ?lumbirin - � G5. Eluctrica6Final '
i '
r15 Flc � Flcc!ricz4�Corttlwt 6u. So�a� SfStzm-F��•, - �-���- i i
la". Ro�9n �iearic�iyiring I 67. Fcnc�ng & A�c.s� Aan�o.31 �-J
1 i Rocgh \1��nng �gn 68, APpqQVEC FQR PLASTERI,IG �.
�
1 R R�u h E�ectri �T $ar Ceilin c n� ?
9 �5� 9 69. POOLI�PASYSTE„SF'NAL I
° Rou�h Heating & A�r CondiLoning FIRE DEPT. REUUIREMEiVT �
_�... : � .'1 x. � �' -� -, r.. ., � . � �. � i ,. ._ J i- s-�- a � �l '�
�%.•vPOJy�• �jG:Of4 F��:BC2 � u,*; �at, M _ j ^z ��I�IPPFiC�,Vl��:��Pcri��t �.r�_�- i
_..r_ . � . - , f __-' ' s = -'�-^7--���T-:.. - _ _� .
e!rt)�:Fi,:..7itrm;tu[O! � .... �S ' " ) .-+�`Jnd¢r9..O.r+�.[��P,Hlti7�n } � i
1'l r. � ...c - . _ - _y i
�2. �IIC�`�rva}!lilf'd.2�f1� l ; :�r ( li_��L��_. _'1' tP � '� ' i
� . :�i: �.J � li v �.• i-��F :t G`J 1. ProUuc'rrPj`{Jipg � IG�+ � .:Oil �
23'�� ' � f__C' . F-`- .
:.�a.Rough & ;est � ;q�- :� p; C' -Q ;��: s .-�2. Undergro�d FI��'S'�-� ' :� � r
. _ ,,� � ... �- a ,�., � r� :��_
�4 "�Aot� Frvtnin5' � t . �- F � ••`' �� �• `� �" s 'x =]3 �_}Jnder rna.: Stor��i'�`•' k `�,.,' Gas �7 � �
.� Q'i n; g ri C: H% d 9 ii �. Mi�
' 25. Roi?k Sheething �, { - v e ' _i ^ �`i+ k 74. :CT�+erhead HvdroO � �I
- t - --�-C'- -`L -- _ � _ _ _!
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i 9 n�. 4PgFoat 4: ;.'* i5.�%il' C�iert}i�.al _ , �
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51. CFPf-YIFICATEOFOCCUPANCY . � �+ C :'� � ` . ' -
\o. '� Date
J
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0. �j Fj / 5 �
r,�m Nn_ % %
DATE �-'-'/��-� /
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in namage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
BY :/��
Developer and/oxrla�'khdrized
representative ��
BY
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rrov -�,-7�SA0�'��a* *�* 159.75
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicant to Fil/ in Completely APPLICATION FOR BUILDING PERMIT
RECEI D'� D(aT,E�� I�n DATE ISSUED
BUILDING � /Q V
ADDRESS �g�
PE�M�l�. '1 !
OWNER Modular Technology, II1C. A•P•NO.
MAIL BUIIDING
aooaess 1104 E. 17th St. nooAess3326 Wyoming Circle
CITY S3T1T.$ �?T13 No`' S�+7-9673 TRACT 6(, LOT Q BLOCK
�Noea��oNU.S. National Bank W
X
BRANCH Main Office
nooRess 1 0 S. Broadway San Diego �WNER Modular Technolo Inc.
VALUE
ARCHITECT TE 1. s Residence � ��
ORENGINEER Kermit Dorius � —1164
FIRE
ADDRESS r n Del Mar ZONE TYPE GROU
APPROVED
CONTRACTOF OFA12P BV DATE
Same
ADDRESS
TEL. �ON NO.OF USE OF �. / i
CITV `S�e NO. P��� BUILDING
L C No. 252549 °;��No. 1690 vMAIDN B ILDINGD ACCE SORV BUOILODING
SI2E NO.OF BLDGS. (FROM C/L STFEETI)
OF LOT 5 X Z�LO NOW ON LOT -- R M d FT s" � Fr.
USE OF � �T.
EXISTING BLDG.
NEW BLOG. Z1OO Sf ROOMS 2 O
9 STORIES L SIDE FT. FT.
EXTERIOR WALL ROOF
COVEFING COVERING W I11T1 12 REAR FT. FT.
USE OF BUILD�NG AND WORK TO BE PERFORMED OISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLOGS.
VAR.# DATE
Construct new residence with attaehed c.u.a.,w �— �-(fl APPfiOVED 6
e araRoveo � a _ Q
LD FOR SPEC AL "'irn
I hareby acknowletlBe [he[ I have raatl thla epplication entl stata �
that tha abOve Informatian ia corract a�a ee�oo to comply with
ell laws repulaclnB builtlinp consttuction, enA I shall not employ
any person in viOlatiOn of [ho wotkmen's componsallon lewa Oi
the State ot Calitomta. r
I hereby cartify Mat I am properly Ileansatl aa e eontractor untler � O� SQ. FT. �l O
[he S[ate ot CalifOrnie Business entl ProlessiOne Cotla, Dlvlsicn 3, THE AMOUNT SHOWN UNDEfi VALUATION IS FOR
Chaptar 9, antl that c� 1711censes nre In full force antl effact, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV:
em eaempt from t��ovislons of xhe te of CelNmnie Businacz VALUATION
antlProfessionaC Diviflon (C pt /D� � Q
/J�j PERMIT FEE 5
Sip^eture of � "
Permlttee 5 3//6y PL.AN CMECK S �
Authorizetl ABent /�� 7�
TOTAI, FEE $ i
�