HomeMy WebLinkAbout395 VICTORIA ST - Building Permitsi
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PPQIECTpUDHESB: �CjS C�ICTOf2IA ST uN�T: NONE
�nvHen�sxune:AIiARONIAN GARAPED
�►aooxess: 395 VIG1'ORiA ST. , .
* COaTA MESA '' '
�A
• � 92627 `
� RHCH/ENGINEEP: R�I'I-I� GAGOS�r1AN qE0.N0.:'� ' '
eooness: 1J1fS ORAD]GE' GROVE ' °N° NONE
GLF.NDALE ' CA,91205 ' . �
' PFflMITTEE: AIiARONIAN GAk2APED � ( 714 )'S48--S22'1
RDOflE33: jyS VICTORIA ST. � ��. NO,PQE
�COSTA MFSA . CA y262'J /
110ENSEO LONTMCTOB OEUAMTIOX: I �emby atlirm that I am OcenseC un0er pmNsions of ChaO�er�9 (commencinq wit� Section
7000) of Division 3 0l Ne Business anC Professions Code, anA my licensa is in full lorce uq ellect. �'
CITY L1C.: - STIITE LIC.: � . CLASS: ' i
, Data: � Sipnatum:'
NOBI(EHS' COMPEN8�t10N �ECUIUI�ION: I �ere6y aflirm t�at I �ave a cMiilute oi consent ro 5elf-Insum ar a certllicata ot WOBers'
;ompenution hxuance, ar � certiliea copy Nereoi (SettPon 3800, Lab. CL . ,
POl1CY NO.: E%P. O�TE: �
COMPRNY: ' '
❑ Certi/ieG capy Is �ereGy fumislie0. ❑ CartlfeG capy is IileA with IAe ciry BuilUi Oivislon, . - '
r /J
Date: � - 2' � - � y MDllwnt: ���' /'/i�� eJ/L/.</`-�
F%EMPTION FlIOM WOqKEq3' COMPEN5ITIOX OEWJUTION: (iltis ucUon neetl not he campletM II iha pertNt ¢ lor one �unOreC 15/00) a less�.
I certity Ihat in t�e petlormance ol Ihe work lor w�kh tNs DerMt I5 i55ue0, I s�all not emplq any person In any manner w az to Eemrtro
suEl�� �o IAe Workers' Compenution �aws oi Calitomla. � � }
Oate: � Sipnatum: �
NOTICE: If, aher maWnO ��u declaraGan, you ShouM�hecome suEject IoJ�e Warkers' Compenutlon provislons ot Ihe Labar
Cotle, you must IOMwit� mmpy with wch O�ovisims or tlus permit shall Oe OeemeG rawka0.
fANS7NUCTION 1FN01NU �CENCY: I �ereDy atlirm Itu( Ihem is e wnsVuctron lentlinp a0ency /or the pe�ormance ai Ne wod lor
wliic� t�6 Dermil ¢ iuue0 (�ction 3097. Civ. CI: ' . •
lENOEB: ' • • �
nooxess: . , .
OWNEN BUIIDEB OEUAIUITION: I �eahy attirtn tAai I am exempt Imm tha Contracmrs' State License Law Por ma tollovnnp reason
(Seciion 7031.5 Busness and Pmfessional COUe: My dry ot counry which requires a permN ta mnstruct, alter. imDrwe, Cemdish. or
rtDair any s[ructure, pnor to its issuanr», also requires tAe apDlicant lor such permit to file a siAneO statement tAat he/she Is IlunSeE
pursuam to tAe prwisions oi the Contaqors' Staro License Law (ChaDter 9(rommencinq wi0 Section 7000) al 0ivision 3 oi Ihe Business
an� Pmfessions Code) or t�al hrJshe is exempt t�erefrom aM t�e basis for the allepe0 exemD��on. My Nolation of Sectian 7031.5 6y
airy aDV����� �or a pertnit sublecis tAe applicant to a cihl penalry nf not more�than frve �undre0 7oltars (5500�.
I,�u owner of,t�e pmperry or my employees witA wapes as t�air soie compensation, vnll Ao the wod, anE the
❑ siructure ¢ iroi intenCeO ar ottert0 far sale (Section 7UGA, Bus�ness anE Professional Coae: T�e Contaciors' Sute License Law
Eoes not apON �o an owner oi a propeM �o WilUs or impmves t�ereon, and who does such wod himseltl�ersell or I�mupA
Ns ar �er own employea, D�+4� �� suc� imD�ments are not IntenOeC or oflere0 /ar sale. It, Mwever t�e DuiMinp or
ImD��ment a salE witkn one year ot compleVon. Ihe awner will haue t�e burUen oi provinq Ae/she 4i0 not �uilC or ImDrove
ror the purpase o� u�el.
I, az mmu ol Ure property. am eRUusiveN contacWO ��h �ensW contrapors ro wnstruct the Oroject (Section 7041, Bugness
❑ an0 Prafessions CaOe: The Cantractars SGte Licmu Law does not applY ro an owner ol properry wtw huJaS or improve5 Uereon
anC wtn cantracts far wc� D�1� � a antrottw�s) Ikense pursuant to the Cantractors' State Utenu Law). I am awara
tlut D��� ol ��eir Worker's Campensatlon inwranu shoNE be O�oviUeE to me. � '
� I am exempt unEer Section: �j p q q B. 8 P. C.
�ant�isreason: NOT REQ'D BY DSP CODES /Jn �� ;
2_ 2 f.� ,_ �' U �Owner: ���..+2�i�!% !-':�fi'ei'iv�'y
Date:
I tla hereby unily that I am awa2 0l anC unEemanG t�e repuirements ol Calitomia Hea h an0 Safety Cotle Sections 25505, 25533, an0 ,
25534 anE Wt I or arry fulure DWamp ottupant wiMNll �rot (drda me) nee0 to compty witn SaIE state caOes anE IM reyuiamenu lor a
permit lor construcnon ar motliliutlon Irom t0e Air Ouafiry ManaOement Olslnct. Hesidential consimctbn aDPlicatlons are e�empl iram
Iheu Drovisians.
oate: Applicanl:
I OerzCy ttrtity IAat I tuve rea0 t�k apDfi��on an0 state ttut t�e aDove information is corretl. I a0�ee to comDN ��h all city anJ cpmry
orainanca+na sme wrs mJatirp m mulainp caswctian ana nneM amhonxe rearesentacros o� ints c�ry �o mrer upon tna aoovammtiprcC
propeM �orinspttti0n purposeOs. / /J �% �J�- _'
Datt: 2 ' 2.0 •- / V 1 �'Onatua: C � "_ �/� /� �'t-� �"�
oriver's licenu or Saia� Secunry M: '
t6at�B Wl�ite-BUIM'uq; Green-CoOe Enlorcemem; Canary-ApplicanC Pink-Revenue; GolQenroO-�v¢asor
I�
� CI'1'Y OF C051'A MESA - BUILDING PEFtMT1' PBRM NU: G U4G'l0)
PtiRMIT NO: G 04618] . PLAN CfIECR NO: 01966-89 S GOVT: N SUI?F: id
CONSTROCTZUN 7'YPE: V-N '.•.'PrRM1T' TYPF.: ELE MEC PLO S'1'R P.URPbSL•': AUD �
J4D DESCRIPTION ' e ADU 2. BDRM5.6 BATIIS TO BXS"P SPD SQ FT'c �GSe ' "
CLAIM VALU�: , CALC'-VALUE: 99,192..60 GROUP OCC: R-3 �
COMMENTS: FERMIT INCI,UDE5 DINING RM. EX'tENSION. �- ��bg�
lEitlf�%iE1klFitlEiE�lfifiEiE�tifih!(ihiflflfjtiEitiElkffiflEifkiElElE9Eifff7f1E1fiEiEiEiliEiEif-i(�lfiE:M1E�lFK�Y#�i(�'rE9EiEi'�EiEiflt�lFi61f1cf(�1klkX�N-iti6�i � .
Z O N I N�.G R E F,� U I R E M E N T S
' ' S E T D A C IC S
_,_.----------- MATN BUILDING -�--------- ---------�- ACCESSORY'-HOi D `�NG ._.-------
FRNT: 20 fiT 7N�REAR: 57 FT 17. IN FRN'C: FT IN RrAR: -F1' IN
LEE'T: 5 fiT ItJ RGHT: 1?. F1' 6 TN LEF'I': FT IN RGIiT: FT IN
PARKTNG REO• 2 PItOt�: 2 PAACEI,: 41917202 ZNF.: R!_E' NO: DR897.5
PLANNING NC7TE:i> EX!'ANSIQN OE' AN EXISITNG SINGLE FAMILY HOME.
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' U. F. V E I, O P; M; £.N 1' .� S F_ R V�'i C G 5 R E Q 0 I R fi M E N' T S
"LONING- APPROVED HY� :�%+.•' -� __��j�IL.' DATE: Z-`Lo =�L
DO'ILDING APPROVED BY : �-.� DATF..: l__�
,APPLICATION ISSUED BSC F��e ' ' � ��rNI ' S� DATE: 2-'''�-
IE 3E it if k N� iE�t X- iE i(� K iE iE ie iE k aElE'vf i� it�i"F3F�7{iF±r iFiE� 3F�ifiF � 7F#3F7fiF7FiF�F7F7F�F'tF3F iFTeiF * �r ��-� �� x�+r ��1Fk � 1� I�F� x
**+��**x*�**r���e*�*#�ra��ii�r****�r*��x�*�*�r�*+�*�r�**+r+�x��e��+r��-*#�e+�****��#*���*�t***�r���en
LEGALI'LATION:N F E E S 0 M M A F. Y, STRUCTURAL SF.GMfiNT:Y
J . �
BLDG PMT PLUMBING ELECTRIC MECFIANjC . '. FIRE "'�. SMI�F./RL•'S GRADING
PERMIT 375.50 20.00 36 _$0 •, 9':0•0 �'' 3. Q2
� zs: _,:,-�;D��; ' ! 25Y .�; ShjIP/D16N-RES
PLAN 244 .OfS . - ' '� . • , - . •
TSSUE FEE 3.00 15.00 '�� 1,5�:00 � •
BUILDING-DIV-> PERMIT ISSUE PL'AN-CHECR ' TOTAL FA-ID •DUE
TOTALS-•--> 494.02 3�.00 244.08 • 721.10i •'721'.10 .UO
. . • .. � �. . i . ..
-RE��E�]UE DT.PISIUN TOTALS-�> GOLI�ECTEDc . A7�..02, OVEP.kSIIUR'C:f�, .00
HLDG PtdT FLUt-0IIIhIG EI,ECTRIC MECHANIC E'IRG .SMTP/TOT GRADINC PLAN CHECIC
375.50 2J.U0 51.50 •2�1.00 ';' � ' 7.02 .
3' •-� �
# df iE i: ## iE # iE ik )E 3E K# iF iE if ii �M-?k M k if if If # iE !E iE # 1E 3E #!k if fE ?f iE?F, iE if !E iE N il��lY it# itiE ik i!� if ik if iE iE M 3� fE9f� iE iE i! 1f ih 3[ IE Y, il- 7f 1E IF iE %�t !t �1! v
i.wDrvtr,oAL ti•�e :o.itknxno;wr�
'1'YPE QTY U E S C R T P 1' 7: U, N� -� � ' UP1IT COS7 ; , T01AL� COS1
�;�' ,
SFR 63F3 D{•]E-TYPG V WOOD FRAM�� : Q�'�D ' G 7.70 ' 47,'19"1..60
fiLE 7 FIXTURBS, LIG1iTTtdr, J S7' 2U. 'J F'A: '�, .; 5 � >.75
ET E 14 RGCEP'C/OUTLET 1 S7' 20 ' • F.A. :75 � ' J 0. 50
F.LE 7 RF.�BPT/.riL9T9'CIi 1 �c+'T 20 � EA. . tS �' S.25
ELE 1 SERVICES BELniI 6170 V p I�E1�OW d09 jp�P.� 9.J..50 ' 7t3.S0 n
t1EC 1 Ri"PAIR/P.LT ❑rAT'ING U1JTT/SYS PJ/.C�bj'j'T,S , 9.00 ' 'J.nU
f'LD i HATHT[lQ ' 2: 00 � � 6. U0
PLU ) I'lAall DP.Sitl � r 2. UU ' .� �,�l�
YLU 7 IdA1L'R CL(�.�'iGT (TOlI.ET) ` "• 2.00 fi.00
C'LU t WA7'ER FILA7'GR ll/OR VEAIT" ? 00 ' ?.00
END OC. rLE.S .:Bl 000544'i8-!1G05�`.'Yi� Y�'ty' .r?'..0'
`\� Q�v •,; . DATE: D2J:C/40 ) Ydii�: 15:,;5 .
�� � ..
� f
� "-a
�ONSTiRUCTION AND PLANNING FOOL & SPA
PROVALS Permit# Date Inspector qpPROVALS Permit# Date Inspector
1. Teaporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. 3u/� �,�i 53. Steel Rein(orcement , �
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. Q 57. APPROVAL TO COVER�GUNITE� � -
7. Footings SC/���-- ' O,� 58. Etectrical Conduit�Undrgrnd. '
i
6: Foundation 4 - 59. Gas Pipe, O Undrgrod., Test _ '
9. Wa[er Pipe-Undrgrnd. , 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural floor System � Q 61. APPROVAL TO DECK " .
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final -
12. Sewer Cap _ 63. Heater & Vent-Pinal '
73. Roof Drains . � 64. Piumbing SYstem • Final
14. RoughPlumbing S���O� vj ��� 65. Electrical-Final � �. I
75. Ro�gh Electrirai-Conduit , 66. Solar System-Final ' � ,
16 Rough Electric Wiring � 67. Fencing & Access ApP�oval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • '
18. Rough Electrical-T Bar Ceiling � 69. POOUSPA 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, ProduciP.iping OGas �Oil
23. Gas Pipe�Rough & Test , , 7Z, Underground Flush
24. Roof Framing _ _ " �73. Undergrnd.SrorageTank OGas ❑Oil
25. Roof Sheathing - y ���: ' , - 74. Oberhead Hydro ,
26. T-Bar Ceiling (Structural) & Moriocoat � " 75. -Dry Chemiwl
27. Frame and Flashing 76. Dry Standpipe � .
28. Lathing &�5i�ing� '.g �� .� 6� 0 77. FIXED SYSTEM FINAL
29. Insulation • y 78. FIRE PREV. FINCQL .
30. Drywall Nailing ' ' _ . - �p(,� � . HEALTH DEP7. REQUIREMENT - ��'
- 31. Plaster Brown Coet - �p,. p 6�,.i� �� 79. FINAL INSPECTION . _- .` ��.' -
32. Elecirical Power Meter-Final _ ` 80:' FOOD CERTIFICATE ISSUED `��'
� 33. Final Electric : - - � � Notes: ? Z2v � � � ��� �y�� _
34. Final Heating & Air Conditioning , 11 7 L;� t,�� 3 $d .5�/B�C.� PD f�t�ldf- U�/7T'� �rO -
'35. Pinal Gas Pipe-Test � � '�� (��D - � " m'G= • ��
36. Hood or Canopy � .
37. Final Factory Fireplace � � ' . ..: �� �- � �, �,
38. Final Plumbing -� - � � �. � 1 e '
39. Water Service�Fi,n`,ai _ � _ � �� _ y -
40. Gas Service-Final� ��-� � ' • � - 1�
�
41. Solar pomestic�Final
�ZSL. `.w w. �/
42. Backflow Preventer
43. Backfiow Irrigation
/�'r� a .a-� ,ri s -
44. Landscape Irripation SYstem �
45. Sound Attenuation .s � -
�E .t1 �Qin l �Q
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING� /7 .0 y� � ��j �•
48. FINALPLANNING r s' �an = i v� . 1
49. Elearic Release to Edison f,�
. r �`
�) �tq� .E 6 Lt✓!r+'
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
C, IFICATE OF COlfPLIANCE
PAY![ENT OF SCAOOL FACILITY FEES �'
:— -- _ -�---y=�:
� 7/ �
NEfiPORT-lIESA UNIFIED SCHOOL DISTRICT
Developer/Applicant: �'��'¢PE.l7 /f-/��¢,Qp�r//��/
�•
naaress: 39S'. ✓� � To,e »- S i, cos �'� .�iEf'�- .�. 9�s2�
Telephone Number: �71�/J S�/��Z Z3
Tract/Parcel and Lot Number(s):
Location of Project: 3��, ll/�TO�Y/h�• �� •�-' �/'f'l •
Number of Square Feet of y� , �/
Residential Space �4 �� x$1.50 Total' �S/• Od
Number of Square Feet of
Commercial and
Industrial Space
Commercial/Industrial Project is:
Mini-storage
Movie Theater
Racquet/Health
Warehouses
Heavy Industrial
Regional Shops
Light Industrial
x $0.25
(Check One)
Total
Motel
Bank
Neighborhood Shops
R & D
Hotel
Medical Office
Office Park
Preschool
Auto Repair
_ Hospital
_ Large Office
Office Bldg.
Restaurant
Fast Food
The provisions of Government Code Section 53080 are not applicable.
This certifies that the above-named Developer/Applicant has paid school
fTcility fees in compliance with Government Code Sections 53080 and
65995.
Checks are to be made payable to Newport-Mesa Unified School District.
tsusiness `Man'ager
Newport-Mesa Unified School District
The above representation as to square footage is true. Developer/
ppplicant agrees that if it is later determined that such representa-
tions are not true then this certificate shall automatically terminate
and the appropriate City/County shall be notified.
D a t e: G� (i �—_/ � L�i��l��-r�/Tl-����/-v`--
Deve oper/Applicant
U�/% '/�f��..��%� ����� O�/�is�•
v
PxOJECf RODHESS: j 9 S V I CTOR I A ST °NR� NONE
owx[x�sx�be: AHARONIAN GARAPED
"°o"Ess: 395 VICTORIA ST.
COSTA MESA
� CA
92627
�ecxrtxciNeex: RAFFI GAGOSSIAN flE0.N0.: �
ROOflESS: 13SB ORANGE GROVE uxiT: NONE
% GLENDALE CA 91205
�"�"�E' AHARONZAN GARAPED ( 714 ) 548-5223
aonxess: 395 VICTORIA ST. NONE
COSTA MESA CA 92627
ucexsco eoxrx�eron oeeuiuriox: i nereoy amun, w� � an, ucemea ume pro�ns oi cnap,er s Icommma�o ��n secuo�
7000) of Oivision 3 ot the Buvness anG Vrafessiotls Catle. aM my licensa ¢ in IW lorce aM ella1.
cm uc.: sT�h uc.: cuss:
�: Siqnature:
1(ERS' COMPENSATION OECIAMTION: I �ero attirm Wt I law a artilicate ol co�ttent ro ul4iisum or a cetllfiwte ol Workers'
.ip¢nsa�ion InSuranca, ar a ceniliEE copy IAer20� S¢CYon 3800, LdD. C�.
POUCY NO.: E%P. �ATE:
COMP►NY:
❑ Certifie0 capy k here6y Iumulie0. ❑ Cert�iM copy is NeE wt� Na tiry Bulldinp P�rislon. �
Date: AppGcant
IXFMPf10N fAOM WOPKFHE' COMPFNSATON OFCUfl�7�ON: (fA'a satim mN not Oe mnplete7 if tice pemit is ta me �unde0 (f700� a kx�.
I certity tlut in Ne pertormaMe ol Ne xrork tor wAi[n Ihfs ce�� a IsweE. I shall mt empby ersan in any manner w az to Cecome
suCject ro the Warkers' Compe�a� L ol Ca�tmYa. � �� �
Dare: ^�8 � S'rynamre: .Z�70 ��'V�/
NOTICE: Ii, alter maltln0 «s GeUaration, you sMuIE come wEj ro �Ae Workers CompensaGon prmdslons o� Iha LaEor �
CaAe, you must lanhvnt� mmply wiN such p�wivons w ih¢ permi� StaA Ee EttmeO rewke0.
CONSTNIICTION LENOINC �GENCY: I �ereGy alltrm Wt Nere is a comVuctlan IeMinO a0enry lor tAe peAormance of ehe vrork lor
wAich lAis permitis issuea (Senion 3097, Civ. C).
LENOEP:
RODflE88:
OWNEN BUILDEO DEClAMT10N: I AereEy allirm Ital I arn eaempt hom Ne ConVactors State Lice�e Law for tM totlowinp reason
(Section 7031.5 BuSiness anE Prateuional CaOe: MY ab ol munry wltich repWres a permil to cw5truct, atier, improve, 0emolis�, ar
repair airy Siructure, D� a ns Isswxe. also ro0u�rcs be app�cant Im wU pemdl to fib a si�eE slatemml Ilut Ml51ie I51zen5eE
pursuant ro Ihe Drovivons af I�e Cantrectars' State l��ense Law (CMpter 9(commencinp wiN Section 7000) ol Oivision 3 of IM Business
N Pmlasiore Code) or wt Mlstp La e:empt Nuelrom aM be Oass lor W aAepW aemptbn. My vioWtan ol Section 763t.5 ey
aDDliwm lor a permii subl�u t�e aDDli[ant t0 a civil penalry ol not mort Itun IWe �uMreO tlalWrs (5500).
I, as ovmer ol iM DroPaM or my ertro�W�es vnt� wapes az I�air wla wmpensa[ion, wlll Uo IAe work, antl Ihe
W
❑ StmtWfB IS fl0i YIICOElE Of ONEfOE IIX S:IB (SecWn 7041. &wness arM Pmfessbnal CoEe: TAe Contnctars' State License Law
does noi apply to an owner of a Droparry w�o OWIOs or imD�oves Ihereon, an0 who Uoes such �vark �im5elf/�ersalt or t�mupA
his or her awn employees, DmWUed Itwt s��� �mprwemenis am not Intentle0 or olfereE for ule. II, Aowever t�a builtlinp or
improvement is solC witNn one year ol com0�e6on, Ue owner will have t�e burEen oi provinp ndshe Oid not �uil0 or Impmve
lor the Durposa of ule�.
1, as owner of the D�operry am ecGuslveN W�Uactinp wit� Iicensa0 conVactors to construct Iha D�olecl (Sectlon 701a, Businass
❑ arq Profettim5 WEe: iha ConVatloR' Sute LkmSe law Eaa noI appy Io an mmer oi Droperry whu NJds or Improves Uereon
anA wlw wntncis lor wc� projecis xilA e wnVapoqs) Gcerrse pursuant to tAe Controctors' Sute License Lew). I am aware
Na� pfml al ticeit WIXkei s CompertSalron �w�:� stqW De WM�7tE IO m!.
� I am eumpt mMer Sectlan: '] 0 4 q B. 8 P. C.
rormisreason: NOT REQ'D BY 6P CO ES
oate: � ^ � Umer.
I Oo MreEq urtiy I�aI I am awam ol anE uMersia04 Na repuiremems oi CalitomW d atih and Salery CoEe $ectlorrs 25505, 25533, and
25534 anA tAat I ar any fuWre EuilElnp occupant willMill not (cude ane) neeU to compty vntA sai0 sUta cotlw antl Ihe mpuirements for a
permil lor construclbn m moCiliptlon Imm I�e Nl Uualiry Manapemenl Oislncl. FevOential cansiruction aDP���lon5 am exampl Irom
�hESO 0� � 1005.
Odie: AypliW��:
I Aereby certity that I lwve rw0 ttus appliw6on antl state Wt Uro a6ove inlormatian k conect. 1 aprea ro wmpy wiin au ciry an0 counry
wGmantes ar10 s�ate Wws fNalYq Io Wbuip :�b hereR/:���! reW�vwe501 Ns cey lo emer upoll N8 above�mdlllMed
prapeM for in5pecibn puryoses.
y 1
Date: �— Z8 ^ ('� wture:� � �/���
�river's Licenu or Saual Securiry ,r:
18d1-60 W�i�e--BuilCirg; GreerCotle Enlorcament; Canary—ApWicent: Pink—Revenue; GdEanroC—Aasesior
CITY OF COSTA MESA — BUILDING PERMIT PERM N0: M 047955
PERMIT NO: M 097955 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE; V—N PERMIT TYPE: MEC PURPOSE: ADD
J06 DESCRIPTION ; ZNSTALL A PREFAH FIRE PLACE SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: REFER TO #G46183
*x�*x��tir*�t**+t�xx��t�r**�t�t**x�*i�*�titf�*�tx�*x��t�r*x�*+t�*x�***±r+rir+ti��tit*�tir#***�tir*�t?rx��t***�*�r�e��rit�t�t
Z O N I N G R E Q U I R E M E N T S
S E T H 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 ZN RGHT: FT IN
PARKING REQ: PROV: PARCEL; 91917202 ZNE: REF NO:
PLANNING NOTES>
>
�r�r*x**�r*�*��+�**�*x�*�+r�*��+��r**x�r*��+�*�ic�e�r��**�r��r�*�r�**��***�rx��***+��**�**�*+�**�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 DATE:
BUI-LDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE: a/,
� �r *+t �rt �t �t * �t �t * * x� * * * * �t * �t i� �t iFiF�F'iF�f3F3F�iFiF±F3F�FiFiF�F iFiF�r� �FiF�FiF3F�F'�iF iF * * �t �t i� �t * * � *�it�r�* x�
it jE if if iF iF if 1E iE iE jf iE it iF iE jE it if 1E 3E 7E %jF iE if if iE if if 1f iE iE ik if if it %�f if iE if if iE iF ik iE if if if if if %iE if iF �1! if it iE iE iE iP 1E ik �f �E rt 1E if if iF jF 9E iE iE iE iE if iE
LEGALIZATION:N F E E S U M M A R Y STRUCTOAAL SEGMENT:N
BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/RES GRADING
PERMIT 6.50
pL N 25t SMIP/NON—RES
IS�UE FEE 4,50
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 6.50 4.50 0.00 11.00 11.00 .00
REVENUE DIVISZON TOTALS--> COLLECTED: 11.00 OVER/SHORT; .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECS<
11,�0
if if fE jE if 3t i! if ik if if iE it it iE �fk i! ik ik if iE # 1F if ik if iE it i! if iE it iE if 1F ik ik ik if iE iE if iE iE iE if 1F 1E if if iF iE iE k iE iF it iF iE it it iE 1f if it if� iF k iE iE if iE iF if iE iE if jf-i(-
Z N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
lbE�i�l
D E S C R I P T I O N
FACTORY FIREPLACE
END OF FEES
UNIT COST TOTAL COST
6,�0 6.50
71 OOQ64212—OOQ64212 'T!�T I1.0�
OATE: Ob/2819p TIi9E: id:?2
CONS?RUCTiON AND PLAh. d POOL & SPA
APPROVALS Permit# Date Inspector Date Inspector
.> APPROVALS Permit# _ '� -
1. Temporary Electriwl Service or Pole 52. Pool & Equipment Location �� '
2. Soil Pipe-Undrgrnd. 53. S[eel Reinforcemen[ '
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�GUNITE
7. Foo[ings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
/
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final .
14. Rough Plumbing 65. Electrical�Final j
75. Rough Eleccriwl-Conduii 66. Solar SYstem-Final ,
16. Rough Electric Wiring , 67. Fencing & Access App�oval
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. Rouqh 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. 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. 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:
c
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy ,
37. Final Factory Fireplace �lcy� (,{�n
38. Final Plumbing
39. Water Service-Final
40. Gas Service�Final
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation -
44. landscape Irripation System
45. Sound Attenuation
46. Handicap Regulacions
47. FINAL STRUCTURE & BUILDING �
48. FINAL PLANNING
49. Elearic Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Pfl0.1EGT%oOflESS: 39S VICTORIA ST °NR' NONE
' uwxex•sx�Me: AHARONIAN GARAPED
�ooxess: 395 VICTORIA ST.
' COSTA MESA
'� CA
� RflCNIENUINEEN: 9 z 6 z 7 HEO.NO.:
�ooness: RAFFI GAGOS3IAN � uxrt:
i 1318 ORANGE GROVE NONE
PEpMmEE: GLENDALE CA 91205
�ooness: �ARONIAN GARAPED ( 714 ) 548-5223
395 VICTORIA ST. NONE
COSTA MESA CA 92627
LICENSED CONTflIICTOfl OECUMTION: I hereby aflirm that I am licensetl untler pmvision5 of Chapter 9(commancinp wl�h Section
7000) of Oivision 3 of the Business an0 Prolessions Code, anE my license is in tull lorce anE effecl.
ciTr uc.: srnTe uc.: cuss:
�ate: SiAnaNre:
INY,ENS' COMPEN&1TION OECUMTION: I hereby aflirm Ihat I have a ceNfiwte ol consent to setf-insure ar a cMi/iwte ol Workers'
�mpensation Insurance, or a certilie0 copy t�ereoi (Section 380U, La�. C).
PoL1CY NO.: FXP. O�TE:
COMPANY:
❑ Certifie0 caDY is hereUy /umis�eA. ❑ Cetlitie0 coDY is filed vnt� Ne ciry BuilEinO �ivision.
Date: pppiicani:
E%EMPfION FBOM V10NIIEN3' COMPEN311TIOX DECUMTION: (1Ais se�tion neeA not be camDletetl if Ne permit is for one hunOreO (5100) a less).
I cMiry t�al in Ihe pertormanc¢ ol the vrork for wNc� Ihis permit is issueG, I slwll fwi employ any person in any manner w as lo Oecome
suCIK� ro tM Warkers' Compensation Laws of Calilomia.
Oa�e: ' Siqna�ure:
N O T I C E: I f, a ttu m a l dng i N s tl e daration, you s t au l d h e c ame su 6j e c t ta t he Wa r kers' C ompensa t ian Drovisians a f t �e L a 6 or
CoOe, you must lart�wi[h wmpty wrth SucA prmidons or iNs permR staA be OremeU rewkeC.
CONSTBUCTION LENOIN611GENCY: I hereby aflirm that IDere is a constmction IenEinp a0ency for the Dedormance a6the work tor
wNcn Itus Dermii is issueE (�1ion 3097. Gv. Q. .
lENOEN: "
ROOBEBE: " -
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 047596
PERMZT NO: E 047596 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION ; ELECAPPARATUS/REWIRE 6 CHANGE OUT SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /
COMMENTS; RE; G46183 PRIMARY BLDG, PERMIT.
�r��e��r�r**�r�r�e�r�r*�r�r�*�r�r�r�r�rx��rx�r�r�rx�rr*�r*�rx�r***�r*x�r�r�r**�r*��e�r�r��r*x*�r�r�e��r�r���r�*�r�r�r�*�r�r*
2 O N I N G R E Q 0 I R E M E N T S
sETSAcxs
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN AEAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ • PROV; PARCEL; 91917202 2NE: REF NO:
PLANNING NZSTES>
> � f
�F 3f 1f iF if if ik if ik ik ik i! ik 1f !f !E ik ik 1flk 1E if !k if k ik 1F 1f 1f if ik it iF iF.iF �! iE if 7k if !t if !f !k!!!k!f if ik it iklf if ik k!t if iFlt iE ik if i!!E if iF iF 1! if !t iF it it iE iF itlf it if
D E V E L O P M E N T S E A V I C E S R E{j U I R E M E N T,S
20NING APPROVED BY — DATE:
HUILDING APPROVED BY : DATE:
APPLICATION ISSUED HY: • DATE: 6—�
3F�i�3F%iFiC�i�!?i?�j?i?�i?�i4i?eieiFi?�3FiF�>i�.iT#+.��lFi4ilci?i=iFiFiFi.iEi414#FiF fiE#E .iFifi if �F��ififMiElFiEiFififlf %kiE iF IFiFiEiE
iii��iii��!%����iF1i�����1Yiti���i�i!����#�ik�'if�!������f���F ��i����F��iiifiFi3Fx�cxiEiE��i4i�if�f�fifiFi4ifi4ififif
�;��,+��,• f¢�fi f(�f7. (y P' �� S U M M A R Y STRUCTURAL SEGMENT: N
OWNENBUILOEHOECUMTION: I�erehyaffirmthatlamexempthomlAeCont2ctars StateLicensaLawtwlMioOovnnO��� BLDG PMT PLUMBING ELECTAIC MECHANIC FIRE SMIP/RES GRADING
(Sectian 7031.5 Business anE Pmlessional CoJe: My dry of counry whic� reQuires a Dermn to conswct. alter, imprwa, Cemolis0. ar p ERM I T 3 7. 2 S
repair any stmcture, prior ro its issuance, ako repuiru t�e apD�irant for sucA permit to file a si0ne0 sqtement ihat �dshe is IicenseE
pursuant ro tne pmvisions at Ine ConVactors SUte License Law (CAapter 9(commencinp witn Section 7000) ot Oivision 3 of Ne Business rJ � t SM I P/ NON—R E S
+nA Professions CoGe) or Itut MJshe is exem0� therefrom anOlAe 6aUs far Ihe aDepeO exempUon. My vioWUon ol Sectlan 7031.5 Oy PLAN
y apDlicant for a Dermit subjects Ne apDliant to a civil Denalry oi not mare ttun iNe AuntlreO Oollars (5500). 1 S S U E F EE 1 5, 0 0 •
i u owner ol ttm pmperty ar my em�wyees witn vraoes as ttceir so�a campensation, nin ao ma wone. ana ma HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ stmnure is no� inrendea aroneree ror sa�e (Section 761d. Business an0 Professional Catle: T�e Cantaclors' SUte Lianse Law TOTAL S--- —> 3 7. 2 5 1 5. 0 0 0. 0 � 5 2. 2 5 $ i. 2 S . 0 0
tloes wt appty �o an owner ot a DroDerty wAo Euilds or impmves tA¢reon, anJ who Eaes suc� wark �imull/hersell or IArouOh
�is w her own employee5. Dravitled IM[ sucA improv¢menis are nol intenEeE or atterBE tar sale. II, Mwemr Ne OUAdinp or
imprnvement is so10 wiWn one year oi campletlon, Ne owner will nave Ne Eurtlen ol vrovin9 AUSAe diE irot EuilA ar ImD�we R E V EN U E D I V I S I ON TOTAL S--> COL L ECT ED : $ Z. i S OV ER / S HORT ; . � �
for t�e Durpose ol sale�.
I, az owner oi Ne D�aDeM. am exclusNeN conlraNnq with IicenseE contractars ta cansWct Ne prol� (�on 7044, Business
❑ anO Pr0lesvms CaOe: The Cantnctors �tate license Law Eces mt appry ro an wmer al Draperry wtp hutltls or unprwes Uiereon
an0 who wntracis for SucA pmjecls vnN a cantactoqs) license Dursuant to ihe Contactori Stale Licertu Law). I am awam
Ihal pmof al their Workar's Compensalian insurance sMulA Ee proviUeO to me. '
� I am ezempt un0er SecGon: 7 0 q q B. 8 P. C.
ronnisressan: NOT REQ'D BY B&P COD
Date: � � �" � � Owner: �
I Ao AereEy ceniry that I am aware of and unEerstana tne re0uirement5 of Cahfomia
25534 an0 t�at I or any future Guil0ing occuDant wilVwill nat (circle ane) nee0 to comp
permit tor constmction or mo0if¢atian irom the Nr Qualiry ManaOement Disiric�
mese nmvisians.
Oate: ADPlicanC �
I here�y cetliry IAat I �ave reaG t�is applitation anA state that the a�ave
orAinancas anE state laws relatinp to builtlinq consirucGon anE �ereby aN�
pmDerty lor ins0ecHtion purpocses.
Daie: C�' T� L � SipnaWre: �
Driver's license or Sociai Securiry x:
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
si,2s
iE ik if if it if iF ik if if if if k it iF iE if ik it ik iE iE it iE iF 1k iF it iE iE if iE 1t �t if 1k it iE it it iE it it i! 3! if iF k iE iF ik if it it if iE �t it it iF M iF iE if if if iE if if if it if iE iE if it if iF 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
'— ELE
COEe Settior4 25505. 2553J, ane EL E
� cotles an0 lhe raquirements tor a
Tbn appliwtlons ara exempt Irom EL E
i ELE
� _ ELE
apree to comply witn atl dry an0 counry
iscdyro enteruponthe aEove-mentione0
18d1d8 WM�e—Builtllip; Grean—CoEe Enlorcement; Canary—Applicem: Pink—Fevenue; GolCenroE—Aveaaor
9 FIXTURES, LIGHTING 1 ST 20 EA.
15 RECEPT/OUTLET 1 ST 20 EA.
7 RECEPT/SWITCH 1 ST 20 EA.
1 RES APPLIANCE NOT OVER 1.0 HP
1 SUB—PANEL
END OF FEES
,75 1i.25
,75 5.25
3.00 3.00
11.00 11.00
�I 0006236?-040623b2 ��.�T 52.2"a
DATE: O6/04/90 TIt1E: 15:22
�
� COP�TRUCTION AND PLAN�_ ...i _ lOOL & SPA .
Ap➢ROVALS Permit # � Date Inspector qppROVALS Permit # Date Inspector
"1. Temporary Electrical Service or Pole 52. Pool & Equipmen[ Location
2. Soil Pipe-Undrgrnd. 53. Steel Reintorcement � ��
3i'Electrical'Condult Utility-Undrgrnd. 54. Forms .
4. Electrical Conduit�Undrgrnd. 55. Electriwl Bonding
5. �Steel Reinforcement � 56. Rough Plumbing & Pressure Test �
_6. ElectricafUFER Grnd. 57. APPROVAL TO COVER�GUNITE
-�7, Footings � ' - � 58. Electrical ConduibUndrgrnd. ,
'8. Foundation= ' 59. Gas Pipe, O Undrgrnd., Test
1 9. Water Pipe-Und�grnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Strucwrel Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
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 , Fencing & Access ApP�oval
17. Rough Wiring Sigm 68. APPROVED FOR PLASTERING
-18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
-_ � : , � ' � t: -
20.,Rough Factory Fireplace ' - � - , • � APPROVALS;- Permit# , , �
21.�Ducts,in Structure � �� - � . 70. Underground.Hydro -
22. Ducts, VAntilating -- _ � ,'71, Product Piping � Gas ❑ Oil
23. Gas:Pipe�Rough & �Test � - � �72. Underground Flush- -
24. "Roof. Framing� ' � . .� 73. Undergmd'Stora�e;Tank O Gas ❑ Oil '
25. Roof:Sheathing � - � � - - - �74. Overhead Hydro -
26.-�-Bar Ceiling (StrGctural) & Monocoat - ". 75. Dry Chemical ; � ' ' ' � •
27.'Frame and Flashing; � � . - �� • , . 76. Dry Standpipe � � � �
�?8. Lathing&Siding�, • , - - ' "� , 77."pIXEDSYSTEM-.FINAL � ...
29. Insulatio ' . . + �� � - : 78. FIRE PREV. FINAL _ �
30. Drywall Nailing �- � � ' y �' " HEALTH'DEPT. REQUIREM�NT �
31. Plaster BrowmCozt �: - �� '��t , ' -7g, FINAL INSPECTION . - ' � , �
� 32.'Electrical,Power Meter�Final ' � '80. :FOOD CERTIFICATE ISSUED '
-33.-PinaLElectric � �- 8 Nofes: � - '�� � _ , .
34..Final.Heating & Air Conditioning� - � . � _ � • �
35..Final'GasPipe:Te'st� , �� - ' � �_ , ' �
_36.�Hood or CanoPY • .... • - . . � � � _ � '
37.'F,inal.Factory Fireplace �. .. . � �. � � -
38. Final•Plumbing � ' _ ` .- -� -�
�39. Water Service�Final . ' ! ' , '
.40. Gas Service-Final . , . �' • . , " - - � •
41. Solar pomestioFinal .. '� . ` �, ' -
42. Backflow Preventer - � • � � �
43. Backflow Irrigation. - ' . , . . � �
.44. Landscape Irrigation System • - � � - '' - - ' � • �
� - . .. ... _ _.
45.:Sound Attenuation - � � `- � -' ' '
. . r ,
�46. Handicap�Regulations � � ' . :: • ' � '
47. FINAL STRUCTURE & BUILDING . _ - ,� � ' _ ,
48. FINAI.PLANNING - yG`. •,
49. Elect�ic Release to Edison , fi�-
. 50. Gas Release to Southem California Gas Co ' - • � ' ' � • � �
51. CERTIFICATE OF OCCUPANCY = � �
No. Date
Costa Mesa Building Department APPLEpCATION FOR PERMP� I
^ � COSTA MESA, CALIFORNIA �' ��7�7 D U I L D,l N G .
�
Jr
C.
a`
( r'°�'�
I-
��9
1
+! e '
Street
• >
,� _
' . �
.r�c ' d i ' . . - :
' • '-
� � - '--- ' �. . ' -. ' - - - —
-. PLOT PLAN - - ,.. ;_'. - _ - =;. -
,.•--��<
Show Iocation distafiEes from � 1 � _ �� , , ' C '�
�� . -
rIi ' �w'-a.? .
propert3 I�ne a� �etween buildings. , „ . . , , �
�� �� .' 2'} f . - � .. r: , . '` _ I _ ` ' . � '��
�}
5.= - r .:1 � _ , � � i
' .,� 'i �� ., .' '._ .. . '
..r _ h
- - .�o gou carry �7o�xi�i�is•<<;,��:�enau�ion ; �'., • •
Znsuranae.i�ft �'.��Y`�s � PIo �
I am a�are af Provisi.on 3700 0: the State _
' Labor Code nnich i•equire3 cver;� e�ployer • `
to be 74us'w^ed a34i.nst liabill�y ior
workman'� cc:�veasation.
�igned:
.. �n:
45ii2 �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applficant to Fill in Completely — Use Ink Only
BU�LDING '� ,^ {�
A�DRESS ��S VIL�C_.I.� ��
OWNER KLN M\I�G`4
qODRESS ��S �)IL��>I-:'
TEL
CIYV �f}��'A• . f �� NO.�'O.
gqANCN �
A�DRE55
TEL.
R
rato ., tr,�,t:�
_ ,- , •nvza_-7�cMSA00i23���� . 57.74
TRACT
FOR STRUCfURAL PERMIT
FIRE
ADDRESS ZONE
S�LI� APPROVED
CONTRACTOR BY
ADDRESS
TE L. NO. OF
CIYV NO. P��'
.�+ STATE CITV �AROSAPPROVE
IIC. NO. �—� �IC. NO. MAIN BUILDINC
� SIZE NO.OF BLDCS. (FROM C/L STF3EET)
�. OF LOT � ,j NOW ON LOT � ONT FT.
a USE OF ' �
� EX4STING BLDG. S — �L�I �L�
y �
FSeparate permits are required for � sio vr.
0 electric, plumbing and heating work. REA — Fr.
(.W. USE OF BUILDING P.ND WORK TO 8E PERFORMED OISTANCE BEf.
QQ \ MAIN BLOGS.
^ ` VAR. qW
a-�S� �C- C.U.P.
} J (� ( ' u11 i � nvaaov
.�
a
�
� I �e�eby eeknowletlpe thei I have reatl ihis applicetion antl rte2e
pQ that the ahove (nfo�metlon la correct anG agree to comply wlth
� ell lews regulaSinB bulltllnp conct�ueSion, antl I shall not employ HOLD FOR SF
�Z any Person In violatlon of Me workman's compensetion lews of
� Ma Smte of Californle.
3 1 hereby certify that I am proparly Il�ansatl as a coniroctor untler SQ. FT.
Me SSeta of California Buain anE Profeuions Cotle, Dlvislon 3, THE AMOUNT SH�
ChePiar 9, end that sueh II naaf full foree and affect, or 1 THE PURP06E OF E
am exampi from Ma Gro oi Stat California Business VALUATION
antl P�ofeulons Cotla i on 3, p r
Sipnatura of ` �
\ Permirtae $ ,� fl ��
�s
Authorizatl Ag nt �j
B
DATE 7 �
USE OF NEW
BUILDING
BEf. MAIN &
ACCFSS. BLD
DATE
:CI4L REQ�;�;�;'
- D
VN VNDEP VALUATION
'ABLISHING A PERMR FEE
PERMIT FEE S
�PLAN CHECK { C
TAX S
TOTA�PAID E �
i
0
.__._ . ��� /�-
COSTAMESABUILDWG-SAFETYDEPARTMENT H{57 3128178� I12oI
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
!
APPLICATION FOR STRUCI'URAL PERMIT
For Applican[ to Fill in Completely — Use Ink Only qECEI V EO eV D RECEIVED
BUILDING /' D,�TE�SUED/_7
AD�RESS ' 'S /
PERMIT NO.
OWNER p`•P• N�.
MAIL BUILDING �
ADDRE55 P.DDRESS
TEL. TfiACT LOT BLOCK
CITV NO.
CONSTRUCTION W �+
LENDER
BRANCFS
OWNER
ADDRESS VALVE
ARCHITECT TEL. $
OR ENGINEEfl N
FIRE
ADORESS 20NE TYPE GROUP
APPROVED
CONTRACTOH � BY DATE
ADDRESS
TE� ZONE NO.�F 4SE OF NEW
CITV NO.
PLAPLS BUILDING
STATE CITV �'ARDSAPPflOVED VARDSAPPROVED
LIC. NO. IIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLDGS. (FFOM C/L STREET)
OF LOT NOW ON LOT ROfYT FT. FT.
USE OF
EXISfING BLDG. FT
Separate permits are required for L. SIDE FT. FT.
electcic, plumbing and heating woTk.
REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED D4STANCE BET. BET. MAIN &
MAIN BLDGS. ACC65. BLOGS.
VAR.qW DATE
C.U.P.�W APPROVED
APPROVED
� heraby acknowledge ihex I have reatl this apDlicatton and rente
{hat the abova informeilon Is corract antl aprea to comply with
all lowa regubilnB �uilding conrtructlon, antl 1 s�all not employ
A�V Derson In violation of the workmen's compensation laws of
�e Stata of Californie.
� hareby ceRify that 1 am properly Ilcensetl as a conttector unde� . SQ. FT.
fhe Sute of Celifornia Businesa and Profeatona Cotla, Division 3, THE AMOUNT SHO�^1N UNDER VALUATION IS FOfi
Ghaptar 9, entl thet such Iicenaea ere in full force and aflect, or I THE PURP06E OF ESTABLISHING A VERMIT FEE ONLV:
em axempt from Me provisionz of the Smta of Calitorn(a Businesz VALUATION PERMIT FEE E ,��
antl Professions Cotla, Dlviaion 3, Chapter 9.
PLANCHECK S
$ipnetura of '
Pe�mfttee S TAX E
Authorizetl Apent TOTAL PAID E �