HomeMy WebLinkAbout3332 WYOMING CIR - Building Permits� Aoollcant to till in al1 sPaces exceVt tnose within heavY eoreer lines ana si9n all aoorooriate aeelarations.
CONSTRUCTION PERMIT PERMIT N. TRACT NO. LOT NO. UNIT NO.
.. rn MEsn
,- ProjectAddressZ C CR w y��7�'V�' G��
Applitant's Mailing d�ress �
Owner's Name G/>� L �/+�L r/�TK pnone z ��p`�
Address 333Z wro�,i�v� C//P. �C•/1,
Arch/Eng. License No.
Address L p
Contractor's Nam ��— a� 'vs✓�T/Phone 1 �
Addresslmailing) Z �% L/L/1-�- L.✓� , G%��'�
Ciry License No. D27SC�n �
LICENSED CONTRACTOR OECLARATION
I nereby a/(irm that I am licensetl under provisions of Cnarter 9(commencing
with sectlon �000) ot Division 3 of the Business antl Protessions Cotle, antl
my Iicense is in full torce antl eilect.
LJcense CIa55 '� Liceps� No. G�
Da�e J/- zy 7 s9 � -u ,1'f
WORKERS' COMPENSATION DECLA0.ATION
� h�ereby afiirm that I have a certificate of consent to self-insure or a certlficate
Workers' Compensation InsuranGe, or d certifletl copy [horeof ($ectlon
J0, Lab. CJ 1•' 2y63—000j /
Policy No. �— ✓�� O�� Company N�%/�'�W(�y H�LC
�Certi/ietl wpy is hereby /urnishetl. Nq
Certifietl co is f ed with [h0 ciry Buil q Divislon
oate //—Z �`{� nppucanc — . W A %�� /'��
EXEMGTION FROM WORKERS' COMPENSATION DECLFRATION
(Thi55ection neetl not be complete0 ii the permit is for On¢ huntlretl ($100) or
less).
I cerlify Ihat in the perfo�mance of the work tor whiGh this perm�t Is issuetl I
shall not employ any pe�son In any manne� 50 as to become subject to t�e
Wo�kers' Compensatian Laws of Callfornia.
Date Signaturc
NOTICE: I(, after making tnis tleclaration, you shoultl become subject to the
Workers' Compensation provlsions of Ihe LabOr Cotle, y0u muSt torfhwith
comply witM1 such provi5ion5 or this permit shall be tleematl revokea.
CONSTRUCTION LENDING HGENCV
I nereby aHirm that there is a ronstruction Ientlin9 a9ency for the pertormance
of the work for wh�ch this permi[ is issuetl (Secllon 3097 Civ. CJ
LRntler'S Name
Lentler's Atltlress
OWNER BUILDER OECLARATION
I hereby affirm that I. am exampt irom Ne Contractor's Llcense Law for the
following reason (Section 7031.5 Business antl Protessional Cotle: Any city or
county whiGh requires a permit [o <onstruct, alter, improvn, tlemolish o� r¢pair
any Structure, p�io� to it5 i55Uance, also require5 the appllcant tor such permit
f0 file a si9ned Statement lhat he/sM1e is licensetl pu�suant to the prOvisions ot
the Contractor's License Law (Chapter 9.(commenting wlth Sectlon 7000) of
Divislon 3 ot Ihe Business antl Professions Coda) or Ihdt hC/Shc is exempt
�refrom antl the basis for the alleqeC exemption. Any vlolatlon of Section
31.5 by any applicant tor a pe�mit Subjects [M1e aOPllcant to a civil
,tally of not more Ihan five huntltetl tlollars ($500).
L] I, as owner of the pwperty or my employees with wa9es as [hei� sole
compen5ation, will tlo tbe work, and [he SVuctur¢ IS n0� in[entletl or of/¢re0
for sale (Section ]044, Business antl PrOfessional Cotle: The Cont�acto�'S
License Law tloes not aoPty to an owner of a properry wno ouiltls or improves
thereOn, antl who tloes Su<h work nimselt/h¢rz¢If ot th�ougb h15 or h¢r own
emo�oYees, provitled that sucn imo�ovements are not intentletl or oiferetl tor
sale. If, nowevGr, the builtling o� Improvement is soltl wl[hin Onc yea� of com-
pletioq Ihe owner will bave thc burtlen ot provin9 he/she tlltl not builtl Or im-
prov! for [he purpose of sale).
❑ I, as ownet of the prOperty, am ex[luslvely contractlng with IlcenSetl Con-
tractors l6 con5truc[ the project (Sec[ion 7044, BuSiness antl Profe55ions COtle:
The Contractor's Licenze Law tloes not aoPN to an owner o/ prooerty who
builtls or improves thereon, antl who conlractz for such projecls with a con�
Vac�or(51 hcen5e pursuant to lhe Con[ractof's License ldw). I am awale [hat
prool o( lbei� Wotke�'S Compansatlon insurance zhoultl be provltleC to me.
❑ I am exempt untler Sec[ion B. b P. C. br this reason
Date
I hereby certity Nat I
information is wrrecL I
antl siate laws relaling 1
zentatives of this c ty
in5pection purp e
Signature
Drivers' License or 55 qF
_ Owner
nave rea
IT
tl this appliwtlon antl state that tne above
comply with all city antl county ortlinances
�q conSVuction, antl he�eby authOtize repre-
�upon ov �mentionatl Oroperty for
Date ��� L Y� �
�— _�
,� — 1/,300
TYPE OF CONSTRUCTION NEW ADD pALTERATIQN REPAIR
❑ CONVE17510N ❑ OEMOLISH � OTHER —L� E�dUF p� p,*
DESCRIPTIONO RK/U FBLDG
S Main Building:
E
TVPE OF PERMIT GRADING OUNDA ON STRUCTVRAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBIN ECHANICAL B Rear
❑ OTHER %�
C Ri9ht
PROJECT DESCRIPTION 54. FT oCCVaarlFv K
CONSTRUCTIONTYPE -� VALUATION$ L2ao�� g Left
ZONE GRADING CU.Y�S. ACRES p��9, Ref. �i-`
Remarks: �f ��OO F OV � wUO� S/i/A/rL��'— �`� � 30�' Planning Notes:
Bar Sink
Backflow Preventer
Backtlow Irrigation
Bathtubs
Clarifiers '
Dishwasher
Drinking Fountains
Floor Orains
Floor Sinks
G25 SCIVICC OIILICLS
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Duct - Under Ground
Duct - Svuctural
Duct - Ventilating
Exhaust System ❑ Multiple
FirepUFact. elc ICBO #
Heating System & Ducting
❑6100,000 BTU 0100,000
Reinspection Fee � S75
CMF 0865-46, �ev. 10/84 Whlte - Bulltlin9: Canary - qpplicant; Plnk - Accounting; Goltlenrotl - Assessor
ir✓-
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool wlSpa
Urinai
Water Closet
Water Heater
Water Service
Auto-Wash
Isue Fea
Hood or Type 1 ❑
Canopy Type I I ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
0201 II/24/B7
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction PoleSub. 0 50+KW
Cooking Unit Meter ❑up to 100 amps
Dishwasher Meter ❑over100amps
Dryers ❑Gas ❑Electric Sub Panel
Fan Motors � 0-1 HP � 1 h- 8
F.A.U. Inc.Solar �9-15 HP �16-15+
Fixtures Microwave
Device Boxes Pole Light
O ut lets Ran9e
Switches Sign
Garbage Disposal Standing Sections
Generator �0-5 KW �5-75 KW Trash Compactor
$ 3 I
� Rainspection Fee $15 Issua Fee
FEES
�T DEVELOPMENT SERVICES REQUIREMENTS:
2oning APPraved By
Building Approved By
Applintion Issuad By
$ 3
16,50 TL
Z
O
N
I
N
G
R
E
�
M
T
S
FEES
$ 3
SU RV OF FEES
BUILDING PERMIT $ . 00 SMIP $ �• s�
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% 3 ENERGY P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $ l�.S'o
MECHANICAL $ TOTAL FEE S
PLAN CHECK 25% $
,' CONSTRUf,TION AND PLANNING POOL & SPA I
� '� Date Inspector Date Inspector �
�APPROVALS �Permit# APPROVALS Permit# i
� h'
1. Temporary ElectricaliService 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 Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd� 57. APPROVALTO 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. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final � '
14. Rough Plumbing 65. Electrical-Final
15. Rou9h Electrical-Conduit 66. Solar System-Final
16. Rough Elearic Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .
79. 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 O Gas ❑ Oil . �
23. Gas Pipe-Rough & Test 72. Underground Flush . � �
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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. FIXED SYSTEM FINAL . :
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �. � i:
31. Plaster Brown Coat 79. FINAL INSPECTION , r '
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 - � '
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. FINAL STRUCTURE & BUILDING Z,y-b'� � . , '
48,. Special Requirements Completed � '
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,
No Date
AOG�icanl to fill in all ip:
CITY OF COSTA MESA - PS�n�ir rvq�
CONSTRUCTION PERMIT j �
Project Address d
�333 � �/nm�iv�
. Owner/`' .�.0 .0 /Il s9� � . �� Ph°�
'Addrea ��.�.'L l��/JiYli�n)�'i /
, ArchlEng. �"Lice se NTo.
withln heavy bortler lines antl sign all aoo�aariata aeclarations.
� TRqCT Np, LOT NO.- Bl_DG. NO. "'
TVPE OF CONSTRUCTION �
❑ NEW " ❑ ADD ❑ ALTERATION
❑REPAIR ❑CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
w"""""' J fNC' / fi'C �;-� .v �,GCY�eP�rnoneX.37 / v TVPE OF PERMIT' .
, Addre � � - �
/ �! � O� � .Cl�� ❑ GftADING � O FOUNDA� ❑ STRUCTURAL
iLICENSED GONTRACTOR'DECLA TION ❑ TENANT ❑ ELECTRICAL' GLUMBING ❑MECHAI
�1 h¢reby aT(Irm thtt 1 am Ilcensetl un er provisions of Chartor 9(com- , ,,
inentlng wflh sectlon 7000) ot,Dlvision 3'of [he Businoss antl ���OTHER '
Professlons Code, 'antl my cense Is In full forte ntl aR c � pROJECT DESCRIP.TION .
License CUInnss- �,',�—` �� L' se No:������, � �
Date� SI9naWre ' � �� %�t-�'�� -' ,54. FT. � . . _
WORKERS' COMPENSATION DECLARATION • - OCCUPANCV_CONSTRUCTION TYPE
I hereby af/irm Iha[ 1 have a c¢rtlflcat¢ ot consent to sclf-insure or a VAWATION 20NE
'certi(I�ate of Workerz•'Compensatlon In rance, or/� certlfletl copy� .
thereof (Sec[�800 b. CJ. �G (/ �^� .GRADING CU. VDS. AGRES �
:c�No: ComPanY '��A
�k *`�ertlfietl Copy�is hereCy fumishetl. - - - - REMARKS:- ' - - ' - - . .
'a.'ertHlltl Copy 6 filetl wi[h [hB Uty Bulitling DiviSiOn.
EXEMPTION FROM WORKERS' COMPENSATION DECLARP.TION � - '�
(This Settion neetl noLba ComplaleC if Ihe pe�mit IS �o� One huntlretl . _._ �
(E300) or less). ; .. '. "
1-certiry that In lbe performance of th¢ work_fot whiGh thiS.permlt I5
Iss�etl, 1 Shall nOt GmplOy any per5on In any mdnne� So as to become PLUMBING PLAN CHECK - ��
subject to the Workers' Compensation laws of California. . . _ ____
Date Signature - B/{THTUBS SHOWERS
�NOTIGE: If after making this tlecl5ratlon, you shoultl become subject -TOILETS � •-URINALS ��' '
.to [h¢ Work¢rs' CompenSatloO p�ovl5lons of the Labo� Cotle, you must
tOr(hwilh comply wlth such provl51on5 or this perTit shdll b0 tl¢emetl LAVATORIES DO � -- '
�evoketl: � - � � � -- -- - .- �
�CONSTRUCTION LENDING AGENCV � ICII'. SINKS �ISHWASHERS -"
'I h¢reby af(irm that there Is a con5tructlon lentlin9 aqenGy tor the per SERV ICE SINKS ; ,.StlRAP9----�"�� ��. ` �
formance of t_he work for which this permit is issued (Section 309] -
Civ. C.). .. � FLOOR SINKS FLOOR DRAINS '�
'L.enAer's NamC,
,Lentler's Atltlrgs}''''•` � ^ - � � ��+ �� - '• < _ ` � DRINKING FOUNTP.INS � - � � � �- - � '
OWNER BUILDER DECLARAT�ONT-A^ ^^^ : f ^ ^^ , � ^ - �NTERCEPTORS CLARIFIERS � C
me wuowing.reason �xcoon iwi.a eus�ness ana vro�essions Cooe:- SWIMMING POOL PTRAV �
Any ciry or county which reaWres a permit to COnSVucl, alter,
improve, tlemolish or repair any structure, Orior to its ittuance, also re-' ypq-�ER SERVICE ALTERAYIOP
quire5 t�e ap�lit'ant to� such pe�mit to tile a si9�etl 5[at¢m¢nt thdt he
is Iicensetl pursuant lo the pwvisions of'the ContractorY Ucense Law GAS SERV ICE OUTLETS
(Chapter 9(commencing with Section �000) of Dlvision 3 of the _
Business antl Professions Cotl¢) or that he is exempt therefrom ana the y�qTER HEATERS BTU OVTPVT
{�r-��� for tbe allegetl exem0��on. Any violation of Settion ]031.5 by
���,.ppplicant for a permit sublects the applicant to a'civil penalty SEWER CONNECTIONS "
?': rt more ihan live huntlretl tlollars ($500).
L.�"i, as owner of the property, or my employees with wages as thelr SOLAR TANK �� �' COLLECTOR:
sole�Compensation,�will Go lho-work, antl the.struc[ure I5 not IntCntletl -
or offeretl for sale. (Section ]044, Business antl Professlons Code: The SOLAR PIPING SVS. ' �
COM�actor's-License law�tloes not apply to-an ownGr-of.a pro0erty . .,
wh0 bulltl5 or Improves theraon,'and who Goes such work hlmsGlf or ISSUE FEE �
tbrou9h his�Own employee5, provitled tnat such improvements are nol
Intentletl or o//eretl for sale. I/, however, the builtling or Improvement MECHANICAL � ��PLAN CHECK
is soltl within ono year. oi completlon,.the owner_will havo the burtlen
of O�ovin9 h¢ tlitl no[ builtl or improve tor [he purpose ol sale). HEATING SVSTEM 0-100,000 BTU_
0 I, 'as owner ot -the property, am exclusively contracting with� qND DVCTING -'— " '- "
IicenSetl cOntraGtors to construct [he prajeC[ (SeC[ion �044, Busln¢55 100,000+BTU_
and Profesilons-COtl¢: The Contractor's License Law tloes nOt apply to'
an owner of property wno builas or imOroves thereon, antl wno con- REFRIGERATION 0-100,000 8TV _
tra2ts'from'suc�'Dro�ects'witn a contractor(s) licesnetl-pursuant [o -SVSTEM " - -'
the Contractor's Ucense Law). 300,000�+ BTU _
❑ I am exempl untle� $ectlon B. & P. C. fm [his
BOILERS BTU
reason ' ' ' ' ' ' -
Date - - Owner -- SVSTEMREPAIR,ALTERATION
I hereby.certify.tnat I have reatl thiz application.antl.state that the above EXHAUST SVSTEM MULTIPLE
Intormation is wrrect. 1 a9r to comply wi[h all city antl county
o10inances afltl-f e IawS re �n to.constructio antl tlelC�y du[horil2
re^resentajivesmol�inis ^y^^.`Q`entel\upon i� abovr�mentlonetl . ,
m nartv Im � .-i .
519nature \ Y�^-Z—: „_' �`iv--e�f�Date� � _'I_"
Drlvers' Li<ense ar 55 � � ��-- � �SSUE FEE' '
CMF 08G5-J6 White-8uiltling; Canary-Applicant; Pink-Accounting; Goltlenrotl-Assessor
� ' �
A.P. �
ZONE
SETBAC T.
IO VARD
E
�A i gIDE VA
RIGHT
� REAR VARD (TO I
'PKG.SPACE RE�.
8017 9/21/82 5.00 TL
ZONING APPROVED B
�SPECIAL CONDITIONS:
ELECTRICAL
NG REGULATIONS
PLNTGp. RUEF. � -
FROPE�RTVNL NE
PROVIDED - �
.PARK FEE S ,
Y DATE
. . � .
, t � , .
PLAN CHECK ' -� -I
,GENERATOR - ' p_j KW_1-lO�KW _
.TRANSFORMER
APPCIANCE` � � 30-50 KW'_50'+ KW _
,MOTORS " ' Q-1 HP_1-30 FIP _
�(INGSOLAR) 30-SO�HPy50-+HP _
.FIXTURES OUTLETS SWITCHES
GHS TVBE SIGNS ' -
� E '
r
� :�. �
- - i
�POLELIGHTS � - ' '
POLES METERED SUB� �
"PFNELS MAIN SUB . '.
SERVICE -� ' - AMP �
�' ' ' '_ '— "___'_ .-. . a
_ _ _
' ISSUE FEE'- ' - - - " ' - '
APPLICATIONP.PPROVED-BY -- - - - DATE -- -
SUMMARYOFFEES � , I
, BUILDING � " ' ' -
�PERMIT ' S ��'-•SMIP r,§'� �, ".y
PLAN CHECK E ...PERMIT ^' - � y�� �
�PLUMBING S�'. �SSUANCE.EL__
GRADING ' E-
�PIANCHECK .S _ ' - � ., �` �
, ELECTRICAL S - , b
;PLAN'CHECK $ MICROFILM'S _ _
. MECHANICAL 5-' - �-� 'TOTAL FEE 5. �
'PLAN'CHECK § - - - LESSAD-
VANCEPC E_
. . , �I ; . •
�. �
_ FINAL FEE b .
CONSTRUCTION AND PLANNING 0 � POOL & SPA � '�
APPROVALS Permit # �'i G Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole , 43. Pool & Equipment Location � �- �
2. Soil ipe-Undrgrn � 44. Steel Reinforcement - � � �
_3. Electrical Conduit Utility-Undrgrn 45. Forms � '
4. Electrical Conduit=Undrgrn 46. Electrical Bonding
tee ein orce , 47. Rou h plumbin & Pressure Test
6: Electrical UFER Grn 48: APPROVALTO COVER-GUNITE �-
7. Footings " 49. Electrical Conduit-Undr rn
8. Foundation . 50. Gas Pipe, ❑ Undr rn, Test • �
9. Watec Fipe-Undrgm 51. Backwash Lines P-Tra 0 ndr rn ' ' -
10. Structural Floor System - 52. APPROVAL TO DECK � ' ' � -
11. Property Sewer Line & House Connection' 53. Backwash & Rece tor-Fina6 � � � �
'._12. Street Sewer Connection ' �' 54. Heater & Vent-Finaf -
. 73. Rough Plumbing_ � - - - - v - - � ' • �
14. Rough ElectricConduit -- 56. Electrical-Final •
� 15. Rough Electric-Wiring " � - 57. Solar SVstem-Final -�
76.' - Rough Heating & Air Conditioning encing & Access Approval
17. Ducts in Structure .. � � � 59. APPROVED FOR PLASTERING �
18. Ducts, Ventilating . 1 ' - ,
19. Gas Pipe•Rough &Test- -' - � 60. POOUSPA SYSTEMS FINAL � � .
20. Roof Framing- - - �' -"'�- � � �
21. Roof Sheathin - ' ' � • . .
Z2_ Frame and Flashfn •' NOTES: '
23. Insulation �
24. lathin & Siding - �' O -
25. Orywall Nailing ' � ' � �
26. Plaster Brown Coat ' ' � �
' 27. Electrical. Power Meter-Final. . ' .i _ ' ' �
28. Final Electric � � �
29. Final Heating & Air Conditioning � �
30. Final Gas Pipe-Test - '
- 37. Final Plumbing - ' �
; 32. Water Service-Final ' �
33.- Gas Service-Final � � '
� 34. Solar pomesticFinal ' � ' - � '�' -
� 35. Landsca e S rinklin S stem � - �' �� ' � ' � ' ' '
36: ,Sound Attenuation • ' � ` � - '
� 37. Handicap_ Regulations' � � �
38. FINALSTRUCTURE&BUILDING � � �-
39. Special Requiremenis Completed � � � - � - -
� 40. Electric Release to Edison "
41. Gas Release to Southern California Gas Co. � �
42. CERTIFICATE OF OCCUPANCY •
�
No. Date - � .. .
-
_ � . '.
5
. c�C�rY or co. �r�� rv�s� x��ti_ ��r rou O�CUP21nCY
��c�r ro,_��� ' .
LOT n0. �C"� '
ADDRESS _>� }� U �C/V�.y� �
lJ
D.?�TE � -1 Z - % �.
Tli� developer oi the above entiiled tract desir.es to se1.L the
�i}���ve sei; iorth lot �rior tu the time tliat tlie kraci: has been
completed and it.s str.eets accepted by the City uf Costa Nesa .
The undersiniied, by executing thi.s agreemnnt, arkno���ledges
L-i:at (he-she-they) � (was or wereZ_______� advised
t}�a� this tract has not been given final inspection nor has
it• been accepted by the City oi Costa Masa as havi.ng compli.ed
with tlie conclitions oi �pproval wllich were imposed by the city
ait the ti.rae ihe final traci: map �aas approved.
The city asswn�s no liabi.lity for the enioscement of the conditions
r.��cessary for appr.oval other than those conditions protectecl by
s urety bond.
T}::� undersigneci agrees to indemniiy and hold the city hacmless
from any claim resuJ.ting in damage or personal injury to the
uhc�Prsi.gned by reason of the.aforemen{:ioned uncompleted condition..
se
Developer andl f��ihoriz�ci
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P_o_ RnX 72no COSTG MESA. CALIFORNIA 92626
��ov -�0�"-,6o t 3 i�** � 1 Z9.00
� APPLICATION FOR BUILDING PERMIT
For Applicanf to Fill in Completely
RECE Y D TE REC IVED DATE ISSUED
eUILDING �Q�����Q
ADDRESS 2 W omin Circle
PEFiM1T NO.
OWNER Modular Technology II1C. P..P.NO. '17t���i
MAIL 6UILDING
ADDfiESS 1�-04 E. 17tY1 S'I�.. ADDRESS 3332 Wyoming Circle
cirv Santa Ana nTio�47-9673 TRACT 6695 LOTJ� BLOCK
CONSTRUCTION W ADD F P
LEN�ER U.S. Natioi1al Bank
X
BRANCH Main Branc11
ADDRESS 190 S. Broadway, San Diego OWNER Modular Technolo y Inc.
VALUE
A(iCHITECT Kermit Dorius TEL 6'T5-116 SE Residence g 13p2��
OR ENGINEER NO.
FIRE ,✓
ADDRESS 3111 2nd Ave. Corona D21 M3T ZONE TVPE GROUP 0
APPROVED
CONTRACTOR Owner BV DATE
Same �-
ADDFESS �
TEL. ZO E NO.OF USE OF M W(,��
5217]e ryp, PLANS BUILDING
CITV
STATE CITV �'AROSAPPROVED VAqDSAP OVED
���. No. 2525�+9 ���. No. 1690 MAIN BUILDING ACCESSORV BUILOING
SI2E NO.OP BLIX'iS. (FROM GL TREET),(J
OF LOT X 1 NOW ON �OT _ FRONT DFT. i FT.
USE OF
EXISTING BLDG. -- 51 E O FT. f FT.
SIZE OF 158L�, g f' NO. OF '7 1 -7"
NEWBLOG. RtlOMS STOFIES L.SIDE �FT. FT.
EXTERIOR WA�Y, Plans RooF Wood Shin le
COVERING COVERING g FEAR rFT. FT.
USE OF BUILDING AND WORK YO BE PERFOFMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCFSS. BLDGS.
VAR 3F` DATE /_
Construct new residence with attache c.u.P.#y o�s`%� APPROVED�—�V
aT e. .4PPROVED / � ���
�IOLD FOR SPEC L RC UIRENiEN?'�
I hereby acknowletlge that I have reatl this application antl state
that the above intormation is corlect antl agree to comply with
all laws regulating building constrUction, antl I shall not employ
any pe�son in violation ot the workman's compensation laws ot
the State of Calitomia. (��
I hereby certity that 1 am properlV ��censetl as a conttactor under � SQ. PT.
the State of California 9u ' ess and Protessions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALVATION IS FOfi
Chapter 9, and thet such li enses a�e ' full r e anC eftect, or 1 THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLY:
am enempt trom the p�o sions of t St alifornia Business
antl Protessions Code vision 3 C�P< B. VALUATION Q
� PERMIT FEE $ lJ � ��
Signature ot '
Permittee $ �3l D PLAN CHECK $ ��vd
Authorizetl Agant TOTAI FEE $ �/ / ��