HomeMy WebLinkAbout3446 KINGS CT - Building PermitsCITY OF COSTA MESA
BUILDIN6 DIVISION
DEVELOPMENT SERVICES DEPARTMENT.
PERMIT
(714) 754-5273 • Fax (714) 754-4856
Job Address:
Suite No
Viciniry:
MECHANICAL PERMIT
3446 KINGS CT
ENCLOSED PLATFORM IN ATRIUM
Parcel Number: 41207402
Applicant: MARQUEZ, DAVE
Address: 10537 DALE AVE.
STANTON,CA �
Owner: BLOUNT, OLIN D.
Address: 3446 KINGS CT
COSTA MESA, CA
Contractor: DIAL ONE SONSHINE PLMB.
Address: 10537 DALE AVE.
STANTON,CA
Arch / Eng : . �
Address: "
Phone: (714)523-9219
Zip: 92626 �
Phone:
Zip: 92626
Phone: (714) 523-9219
Zip: 92626
License: 550716
Phone:
Zip:
License:
SCOPE OF PERMIT
REMOVE 8 REPLACE EXISTING FAU. - ,�,.
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >100 k BTU
Repair/Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
AirHandlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$14.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
PERMIT NUMBER
M00-00124
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercia l Incinerator
Domestic Incineretor
Compressors / Absorption Systems
Up to 3 hp / 700 k BTU
3 To 15 hp / 500 k BTU .
15 To 30 hp / 1,000 k BTU �'
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15 to 30 hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
investigztion Fee
Status: ISSUED
Applied: 03/27/2000
Issued: 03/27/2000
Quantity
$0.00 0 ,
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
So.00 0
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) ,
EXPIRATION: This permit shall automatically expire and become void if work is not�commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to ba considered legal, such work must comply with all applicable codes, and all
requlred Inapectlona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMVENSATION DECLARATION: �
I hereby attirtn untler penelry of perjury one ot the tollowing declarations:
❑ I have and will malntaln a certificate of conseni to self-Insure for workers' compensation, es provitletl tor by section 3700 of ihe Lebor Code, for Ihe pertormance of Ihe
work for which this permit is issued. .
� I have and will maintain workers' compensation insurance, as required by section 3700 of Ihe Lebor Code, tor Ihe peAormance of ihe work for which this permit is issuetl.
My workers' compensation Insurence carner end policy number ara: .
Carner. l 1 fV 1 T� i� �/a (�- I� ��' Policy Numbec n/W fi � � 7 9� c4 �^ C� �
(This sectian neetl not be complered i! fhe permit is valued at one hundred dollers ($ f 00) or less.)
❑ I certity ihet in the peAormance of the work tor which this pertnit is issued, I shall not employ any person in any manner so es to become sublect to the workers'
compensation laws of Celif rnia, end agree ihat ii I should become subject to ihe workers' compensation provisions of Sedion 3700 of ihe Labor Cotle, I shall fonhwith
comply with these rovisia
ApplicantSignaWre: .� � Date: 3' 2%— � O
WARNIN(3:FAILURETO REWORKERS'COMPENS ^CAVERAGEISUNLAWFULANDSHALLSIIBIECTPNEMPLOVEqTOCRIMINALPENALTIESPNOCIVILFlNESUPTOONEHUNDRED
iHOUSANODOLLARE($100, ),INADDITIONTOTHECI� FODMPENSATIIXJ,DMIAGESASPROVIOEDFORINSECTION3]O60FTHELA90RCODE,INTEREST,ANDATTORNEV'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Protessions Code, and my license is in tull
torce antl eHect. Lic. s S S ����o Class k� C LU —"� c., -!(�
ContraciofsSignature: ���y/ Date: 3 —2"J�O O
CONSTRUCTION LENDING AGENCV:
❑ I hereby attirm Ihat Ihere is a construction lendinq agency tor the peAormance of the work for which ihis permit is issuetl. (Sec. 3097, Civil Code).
Lentlers Name:
Signature: _
OWNER-BUILDER DECLARATIONS:
Lenders Atltlress:
Date:
I hereby aNirm Ihat untler penalty of perjury Ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reason (SecJ031.5, Business and Protessions
Code: Any ciry or county which requires a pertnit to wnsiruci, alter, improve, tlemolish, or repair any siructure, prior to i�s issuance, also requires Ihe applicant for such permit
to fila a signed statement that he or she is licansed pursuent to ihe provisions of the Comractors License Law (Chapter 9(commencing with Section 7000) of DiNsion 3 of the
Business and Pwtessions Code) or that he or she is exempt iheretmm and the basis for the allegetl exemption. Any violation of Section �031.5 by eny applicant for e permit
subjects the epplicant to e civll penalty oi noi more than five huntlretl tlollare ($500).):
❑ I, as owner oi the property, or my employees with weges as iheir sole compensation, WILL DO THE WORK, and the structure is not intentletl or otterad for sale (Sec.
7044, Business and Professions Cotle: Tha Contractors License Law tloes not apply to an owner of property who builds or improves thereon, and who tloes such work
himselt or herself or ihrough his or her own employees, provided that such improvemems are not intended or oRered for sale. If, however, tha builtling or improvement is
soltl within one year ot completion, ihe owner-builder will have Ihe burden ot proving ihat he or she did no� builtl or improve for purpose of sale.).
❑ I, as owner of the propeny, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct Ihe projact (Sec. 7044, Business antl Professions
Code: The con�rectors License Law tloes not epply to an owner of property who huilds or improves thereon, and who contrects for such proJeci with a contrector(s)
licensa pursuant to the Coniractors License Laws.).
❑ I am eaem0� under sec.
Signeiure:
Owner ID verified by drivef5liCen58. ❑ V85 ❑ No
Business antl Professions Code tor ihis reason:
Venfication ot Ownership by (type of daument, i.e. - properry tas bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Drivefs LicenSe No.
Date:
Expires:
❑ I hereby cenity that no eacavation five (5) or more feet In depth into which a person Is required to descend, will be mada in connection with work euihorizetl by ihis
permit, and that no building siructure, scattolding, falsework, or demolition or dismantling thereot, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Califomia Atlminisirative Cotle).
❑ As ownar-builtler, I will not employ anyona to tlo work which would require a permit Irom the Division of Intlustrial Safery, as notetl above, unless such person has a
permit to tlo such work trom Ihe tlivision.
Signawre: Date:
Division of lndustdal Satery Pertnil Number.
CERTIFICATE OF COMPIJANCE AND AUTHORIZ4TION OF ENTAV: I certify under penalty oi perjury Ihat I have read this application and state that the iniortnation given is
correct. 1 agree to wmply with all state laws and ciry ordinances relating to Duilding conslruction, entl authorize representatives of the Ciry oi Costa Mesa to enter upon the
ebove-tlescnDetl propeny for Inspection purposes. I agree not to occupy or allow occupancy of any bullding euthonzed by this pertnit until tinal inspection.
CODE �. INSPECTIONTYPE
1618 Flzed System Flnal Fire Prevention
1266
200
201
Paol Spa Final
Final Re-Roof
Final BIocWRetaining Well
202 Final Fectary Fire Place
203 Final Sign
204 Final Demolition
2a46-a8
INTffIatS
CODEt INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
2i2 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
3-
�
• y��'.
r e:�:: � -
�; `
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT.
PERMIT
(714)754-5273 • Fax(714)754-4856
Job Address:
Suite No
Vicinity:
PLUMBING PERMIT
3446 KINGS CT
ENCLOSED PLATFORM IN ATRIUM
Parcel Nunmber: 47207402
npp�icant: MARQUEZ, DAVE
Address: 10537 DALE AVE.
STANTON,CA
Owner: BLOUNT, OLIN D
Address 3446 KINGS CT
COSTA MESA, CA
Contractor: DIAL ONE SONSHINE PLMB.
Address: 10537 DALE AVE.
Arch / Eng :
Address:
ISSUE FEE
BackFlow irrigation �
BackFlow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units �
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas EaRhquake Valve
Gas (1-4 outlets) �
Gas (Over 4 outlets)
STANTON,CA
Phone: p14) 523-9219.
Zip: 92626
Phone:
Zip: 92626
Phone: (714)523-9219
Zip: 92626
License: 550716
Phone:
Zip:
License:
SCOPE OF PERMIT
REMOVE & REPLACE EXISTING WATER HEATER.
AMT
$23.50
$0.00
$0.00�
$0.00
$0.00.
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 Landscape Irrigation $0.00
0 P-Trap $0.00
0 Pressure Regulator $0.00
0 Process Piping (per 70 fl) �$0.00
0 Receptors $0.00
0 Septic Tank � $0.00
0 Sewer Cap for Demo $0.00
0 Sewer Connect $0.00
0 Sewer Private Line $0.00
0 Shower $0.00
0 Sink, bar $0.00
0 Sink, commercial So.00
0 Sink, Floor $0.00
0 Sink, kitchen $0.00
0 Sink, service/mop $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PERMIT NUMBER
P00-00147
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 03/27/2000
Issued: 03/27/2000
ISSUED BY:
SumpPump
Swimming Pool �
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
water Service
Water Softener
OTHER
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$12.30
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92) , _
EXPIRA710N: This permit shall automatically expire and become void if work is no4commenced within 1B0 days, or if work is suspended or abandoned
for a period o( 180 days. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapecllons and final approval must be obtained. Failure to obtain inspections and final approval will resul� in �he expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION: �'
I here6y eftirtn untler penelty of perjury one ol the following tleclaretions:
❑ I heve an� wlll malntain a certificate oi consent to selt-Insure for workers' compensation, as provitletl for by section 3700 of ihe Labor Cotle, for the peAormance ot the
work for which this Dermit Is issued.
� I have ena will maintain workers' compansation insurence, as required by section 3700 of the Labor Code, tor Ihe peAormance of the work for which this permit is issuetl.
My workers' compensation Insurance carrier antl Dolicy number are: .
cemer: v w i rr�-n On � � F( L Policy Number: U i.v la 1 I? 9 G j- (,-G j
(This section need nat be rnmpleted i! he permif is velued et one hundred dollers ($100) or /ess.)
❑ I certity lhet in ihe peAormance of the work for which this permit is issuetl, I shell not employ any person in any mflnner so es to become subject to Ihe workers'
compensetion laws o Califomia, and agree that if I should becrome subject to ihe workers' compensetion provisions of Section 3700 of ihe Labor Cotle, I shall forthwit�
comply with Ihese pr isions.
Applicani Signature: Date: 3- 2%� CJV
WARNINO: FAILURE TO SECU E WORKERS' COMPENSATIO GE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNORED
TFIOUSANDDOIJ.ARE($100,0OO�,INADDITIONTOTHECOST NSATION,DMMGESASPROVIDEDWRINSECilON31060FTHEL4BORCODE,IMEREST,ANDATTORNEI^SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, antl my license is in full
force antl eMecL Lia a `-7 7(o Class x Lc. -'S (, -! L
Contractors Signature: �j�, oate: _ _ '3-,�'7 -0 6
CONSTRUCTION LENDING AGENCV: `t�
❑ I hereby aHirtn ihat ihere is a constructian lending agency for ihe pedormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name:
Signawre: _
OWNER•BUILDER DECLARA710NS:
Lendefs Address:
Date:
I hereby aflirtn thet under penalry ot perjury ihat I am E%EMPT PROM THE CONTRACTORS LICENSE LAW tor t�e following reason (Sac. 7031.5, Business and Pmfessions
Coae: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any siruciure, pnor to its issuance, also requires ihe epplicant for such permit
to flle a signetl stetement thai he or she is licensed pursuant ro the provisions ot the Coniractors License Lew (Chepter 9(commencing with Sedion 7000) of Division 3 of Ihe
Business and Proteuions Code) or that ha or she is eaempt therefrom antl the basis tor t�e allegeC exemption. Any violation oi Section 7031.5 by any epplicant tor a permit
sub�ects the applicant to a civil penalry of not mora than five hundred dollars ($500).):
❑ I, es owner of Ihe property. or my employees with wages as their sole compensation, WILL DO THE WORK, end iha structure is noI iniended or oHeretl tor sale (Sec.
70a4, Business antl Protessions Cotle: The Contractors License Law does not apply to an owner of propeny who builds or improves thereon, end who does such work
himself or herseN or Ihrough his or her own employees, provided that such improvemenis are not intended or oHeretl for sala. If, however, the builtling or improvement is
sold within ona year of compleUon, the owner-builtler will have the burden of proving that he or sha did not builtl or improve tor purpose of sale.).
❑ I, as owner ol the properry. am E%CLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS b construct ihe prqect (Sec. 7044, Businass and Professions
Code: 7Te contradors License Lew tloes not epPly to an owner of property who builds or improves Ihereon, and who contrects for such project with a contrector(s)
license pursuant to Me Contractors License Laws.).
❑ I am e:empt untler sec.
SigneWre:
Owner ID venfietl by drivefs license. ❑ Yes ❑ No
Business end Professions Cotle for this reason:
Venfication of Ownership by (rype of tlocument, i.e. - properry tax bill or tleetl):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
Drivefs License No.
Date:
Expires:
❑ I hereby certily thal no excavation five (5) or more feet in tlepth into which a person is reQuired to descend, will be made in connection with work euthorizetl by this
permit, end Ihat no building s�ructure, scaffolding, talsework, or demoli�ion or tlismantling thereof, will be mora ihan thirry-six (36) feei �igh. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Califomia Administretive Code).
❑ As owne�-builtler, I will not employ enyone to do work which would require a permit from the Division ot Industnal Safery, as noted above, unlass such person has e
perml� to tlo such work from the division.
Signature: Date:
Division of Industrial Safety Pertnit Number:
CER'TIFICATE OF COMPLIANCE AND AlfTT10RIZA710N OF ENTRY: I ceNify under penalry of perjury that I hava read ihis application and state �hat ihe information given is
correci. I agree to comply with all state laws and ciry ordinances relating ro building consiruction, and authonze representatives ot ihe Ciry of Costa Mesa to enter upon the
e6ove�tlescnbed propeny for inspection purposes. I agree not to occupY or allow occupancy of any building authonzetl by this permit until tinal inspection.
CODE �. INSPECTIONTYPE
16�6 Fixed System Finel Flre Prevention
726fi Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203 Flnal Sign
204 Final Demolition
24d646
3-27VoU
Date
Q�jf, I�iJ��$ �OQ� INSPECTIONTYGE
206 Final Mechanical
20B Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
W
� %LI i ' �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 3446 KINGSCT
Suite:
Vicinity: ROOF
Parcel Number: 41207402
Applicanr. SELL, RON
Address: 18032 LEMON
YORBA LINDA , CA
Owner: BLOUNT, MARGARET E TR
Address 3446 KINGS CT
COSTA MESA, CA
Contractor: SELL ROOFING COMPANY
Address: 18032 LEMON
YORBA LINDA , CA
Zip: 92686
Arch :
Address:
Zoning: R1 R1
Phone: (714)528-1758
Zip: 92686
Phone:
Zip: 926261657
Phone: (714)528-7758
License: 323842
Eng:
Address:
Status: ISSUED
Applied: 09/24/2002
Issued: 09/24/2002
ISSUED BY: �
Phone: Phone: -
� Zip: License: � License: -
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL EAGLE LITE TILE, ICBO #4660, 5.7 LBS, 2500 S.F. INCLUDES ATTACHED GARAGE
Plan Check: $0.00
Permit: $16725
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 Existinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
Left 0- 0
Proposed: , 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right �� 0- 0
$8,900.00
sa,soo.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 it work is suspended or abandoned
� for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required inspectlona and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaae�ae (wao�
WORKERS'COMPENSAnON DECLARArON: � ��
I hereby afflrm untler penalty o1 perjury one ot the follov.ing declaretions:
❑ � have and will maintain a ceNficate of wnsent to self-Insure for workere' compensation, as provided tor by section 3700 oi the Lebor Cotla, for the peAormance of the
work for which ihis pertnit is issuetl.
�j I have antl will maintain workerg' compensatian insurence, as r ire0 by section 3700 of the Labor Code, tor Ne perfortnance of the work for which this pertnit is issuetl.
My workers' compensatio Insurenc rrler e Icy num re:
ca�ae-�^��Tf� r�..r�:, /O�o � s�.S—��
(Th/s section need nof be completed il fhe Oerm/f is velued et one hunared tlollare ($100) or less.)
❑ I certity that in ihe pertortnance of �he work tor which this pertnit is issued, I shall not employ eny person in any manner so as to become subject to the workers'
compensetlon laws of Celitornla, rae that It I sh uld hecome SuDjact Io ihe workers' compensalion provisions of Section 3700 oi lhe Lebot Cotle, I shall fotlhwith
comply with these provisions. ' /
APGJ-�—SiOnature: �� .CDate:� � ! �i �
WAPNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAOE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYEfi TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED
TVqUSANO DOLLARE (E100,000). IN ADDITIIXJ TO THE COST OF COMPENS4TION, �AMAGES AS PFOVIDED FOR M SECTION 31080F THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby_affltID.(he( I em licensed under provisic
with Section 7000) of Division 3 of ihe Business anA Protesslons�� and my license is In full
Glass.q (� _
7— �o�re.-�. /n — ?� / — o Z
CONSTRUCTION LENDING AGENCY:
❑ I �ereby aHirtn that there is a consiruction IenOinp agency tor Ihe peAormance of tha work tor which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lenders Name:
Signature: _
OWNER•BUILDER DECLARATIONS:
LentleYs AtlCress:
Dete:
I hereby etfirtn Ihat under penelry ot perjury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires e pertnit lo construct, elter, improve, tlemolish, or repair eny siructure, prior to its Issuance, elso requires �he epplicant for such pertnit
to flle e signeC stetemem thet he or she Is Iicensetl pursuant to ihe provisions ot t�e Conirectors License Lew (Chapter 9(commencing with Sectian 7000) oi Divlsion 3 of the
Business end Pmfessions Code) or Ihet he or she is exempt therefrom end the basis tor the elleged ezempiion. Any vidation of Sectlon 7031.5 by eny applicant tor a permit
sub�ects the applicent to e civll penalry o1 not more then five hundred dollars ($500)J:
❑ I, es owner of the property, or my employees with wages es their sole compensation, WILL DO THE WORK, end Iha structure Is not intentled or oMered tor sale (Sec.
7044, Business and Professions Code: The Comracrors License law dces not appty to an owner ot properry who builds or improves thereon, flntl who does such work
himself ar herself or throuqh his or her own emplayees, provided that such Impmvemenis are nat Intended ar oflered lar sale. Ii, however, t�e building or Improvement is
sold within one year ol completion, the owner-builder will have the burden of proving ihat he or she did not build or improve for puryose of sele.).
❑ I, as owner Of lhe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruct the prqect (Sec. 7044, Business and Protessions
Cotle: The comractors lJcense Law tloes not appty to en owner of property who bullds or impmves thereon, and who coniracts for such proJect wiih a contrector(s)
license purSuenl to the ConVaCtor9 LiCeM159 LewS.).
❑ I em e:empt untler sec. eusiness antl Protessions Code for this reason:
SlgnaNre: Date:
Owner ID venfietl by tlrivefs license. ❑ Ve9 ❑ NO Driver's License No. Expires:
Verification of Ownership by (type ol tlocument, i.e. - properry taz bill or tlaed):
DIVISION OF INDUS7RIAL SAFETV PERMR CERTIFICATION:
❑ I hereby certity that no excavation �ive (5) or more feet in depth into which e person is raquired to descend, will be made in connection with work euthorized by t�is
pertnit, and Ihat no builtling strucWre, sceHolding, talsework, or demolition or tlismantling ihareof, will be more ihan thirry-six (36) teet �iqh. (C�ap. 32, Grp 2, Art 2, Sec.
341, Tltle B, Celitomla ACministrative Coda).
❑ As owner-builder, I will not employ anyone to do work which would require a permi� trom ihe Division of Industnal Safery, es noted ebove, unless such person has e
permit to tlo such work fmm the division.
Signatura: Date:
Division of Indusinal Selery Parmit Number.
CEHTIFlCATE OF COMPLIANCE AND AUfH08VATON OF ENTAY: I certiy under penalty of perjury that I have reatl ihis application and state that the intortnation given is
correct I agree to comply wlt� ell stete laws end ciry ordinances relating to building consiruction, and authonze representatives of t�e Clry of Costa Mesa to enler upon the
ebove-tlescnbed property for inspection purposes. I agree not to occupy or allow occupancy ot any building authonzed by this permi� until final inspection.
COUE I. INSPECTIONTYPE
1616 FixeO System Final Fire Preventlon
1266 Pool Spa Final
200 Flnel He-Roof
201 FInaI BIocWReteining Well
202 Final Fectory Fire Placa
203 Final Sign
204 Final Demolition
�g ��
�'v` �
� -Z°�-0 Z
c:��aia:- . —,
GO�E � INSPECTION TYGE
206 Final Mechanical
208 Final Plumbing
210 Final ElecMcal
272 Final Fire Prevention
220 Final Planning ADProval
222 Final Site
250 FinalBuiltling/Occupancy
�g �
PB0.IECTADUflE55: 3446 KINGS CT �'�� � ' ux�T:"�- �� '� � �� � � CITY OF COSTA MESA - BU�ILDING PERMi1' PERM NOd P�, 045568.
OWNEB'SNRME:BTOUNT . . . . . . . ' � ` � ' ' , 5• • ' � � . y , ' ) . !
nooxess: SAME �. ' ' ' PERMIT NO: 'P 04556� PLAN CHECK NO: ' N GOVT': 'N SUPP: N.
� . , • • " . '= ' _ . CONSTRUCTION TYPE: . "� PERMIT-TYPE: PLU � PURPOSE': NEW. �
714)966-1'733 . . , ' , :• , .
_RBCN/ENGINEEH:; � � BEG.NO.: r " JOB DESCRIPTION : REPLACC WATEA HTR . , � � � ��SQ FT: • � . . �
nooeess: � ; . . uxR: , , . . , �
' � ` �CLAIM .VALUE:' � "1,500.00 CALC-VALUE'c� . � " GROUP pCC: R=3. '/
PEflMITfEE: GEORGE HRAZIL � ' - � � ( 714 ) 541-0917 . � - ' : .. . , � . . . , ' � � . - , ,
, nooeess: 3022. N; HESPERIAN WY 101 COMMENTS": �'REPLACE 40 GP.L WTRt HTA � ' �
.'`iANTA ANA � CA 92706 ; -� �*��r�*;*��x�*�**�*��*�r+r�r�***�***x�*�ri��***a��r�r*+�����****r*�r�**�r*ar�r****+t*��r*****,*i�+�*�r � ,
110ENSED CONTMCTOB DECUMTION: I hereby affrm that I am licensetl un0er'provisions oi ChaO�er 9(commencinA with Sectiun • � �. �� ' �'L O N 2; N G R E Q U I R E M. E N T S � � � �
7WU) oi Division 3 ot ihe'eusiness xna Pw ions Cotle, and my license is in full force anA elfect. ' � . � - � �$ E, T H A C K S' � � - � �
cinuc.:(�� 2991 -;tareuc.:q�{z4 cuss:C-36 ' ; ; ' . , - _ �"�
oate: /- 1 �-G siqnamre X� ` ' ;------r---- MAIN BUILDING ---------- • --------- �ACCESSORY'•BUILDING --------- �
WOBKEBS'COMPENSRTIONOEClAMT10N: I�e[�irmthatlhaveaiertificate_ofconse�imseu-insureoraceniticateo�Workers' FRNT: � RT IN REAR: .' FT IN FRNT: FT � IN REAR; � FT IN �
ComDensation Insurance, or a cenifietl coov th "oi (Section 3800, Lab. C�. � LEFT :, FT . LN RGHT : '� FT IN LEFT ; � FT . IN RGHT : -' F'P ' IT1 �'
roucvNo.;WCO297893 EXP.ORTE: OSIO`/91 ' � • �
�Mrnxr:UNITED PACIFIC ' ; , PARKING RE(j: PROV: PARCEI,: 14195311 ZNE: REF NO: . ��
Cetlifea copy,is hereDy fumisnee.' ��Certitied ooQy is flea with the ciry Builoing Uivisian. �, PL�N ING � NOTES >
/' c� \\ —��---•�_�_' . ' . ' . . � _ . . � � '� . � .
Oate: / "" �" —�/ i� APDlicant: /"�\\ —� . 1FififikifkifiEiEklfMiEiEiEiFikifiFlfiFitititiFikikiEiEiE�ItlElkiEfEiEilkiFitlEkit4iElfiElEiEifiFiEkiFkkitifitlEiFifiEiEifititifiFiFi(�il��EiEitiliEiFiE • .
E%EMRION FHOM WOHKEIIS' COMffN&1TION OECIAfl/rT10N: (This ucvon nced nolVbe Wm ete0 if Ine permit is lor one nuriOreA (E100) ar kss). ; - � ; 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' �
I cehity ihat in Ihe peAormance ot the wurk for whic� tAis permit is issueA, I 5ha11 noi emp any per5on in any manner sa as la become � ' � ' • . . , . � - .
sueiectmmeWorkers'Compensation.LawsatCalimrni5�--�__�__ . , ' ' ZONING' APPROVED BY ' _ ��,� � AATE; ;
Oa�e: ' � - SipnaWa: , : . . . _ . � i _ . . .� •. . .. . .._ . � . . _ � .. . . . � ' -- ;. . - -. . . .
NOTICE: u, atter making this declaraGon, you snoultl necoma subject m me� Workers' Campensation provisions o1 Ine LaOor BU I LD I NG . APPRO�/EU BY � . r--�=_._._� �' � D ATE : ,
CoOe, you mustfonAwtth comply with such D�aJisions arihis permit shall 6e deeme0 revake0. : � - � - � � �
CONSTBUCTION LENOINO �GENCY: I hereby aflirm that IDere is a ton5tmction lending apency lor the pertOrmance af the work lor AP PL I CAT ION I SS UED' B Y: � - -�' � ' � DATE : O• D��
whiththisDermi�isiuuetll5ection3W7.Civ.C). � ' � . . *�X,.lfif.N.iEif.lFififiliEM.iE3fifN,lk�F�Etf,l(,3FiF- � .. _ ' ., , .iflkM,i4iFi(,K,K,.K,iF �D
_ . . p �HESS: - ... � ... . . . ._ � ._. ' , _i iFiEiEifiklFifiEiEiEiEiEiElEiEffiFiE�lEiEiE1FlEiklElEiEiklEiEiFiEiElklEiFiE1�iF�ikiflF itiliElEiEkifiEiEiEiFIF1E1EfEiFiEltil3Eifik�ElEiliElFiEikiEiEiFiEiFIF'iE .
, „ , • , • LEGALIZATION:N ' " •- 1'F ,'E, E" � S i7 � M A"A'Y,' ! - "STRUCTI7RAL 'SEGMENTFN ;
OWNEB BW�UEB OELlAH�1710N: I �ereby aflirm that I am exempt irom Ihe Contraclars State License Law for Ihe followinA �eason '' ' BLDG PMT PLUMB ING � ELECTR IC ECHAN IC � FIRE ' SMIP /RES �� GRAD ING �
(Section 7031.5 Business ana Pmfessionai Coae: �My ciry of counry which requires a permit to constmct; atter, impmve, aemolish, o� � p ERM I T! - � � . - '2 , 0 0 f� ' � • � ' '
repair any stmcNre, D�o� �o its issuance, also reQuires t�e aOD�icant lor such permit to file a signeJ statement Ihat �elshe is Iicense0 � � • . -, , � � � � �
pursuant ta the O�ovisions at the Contrectors' State License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business � -' � � 2 S Y • ' , SM I P/ NON -R E S .
and Pmfessions CoOe) or t�at he/she is exempt therefrom an� ihe buis tar tAe alleAea exemption.'Hny vialation aPSection 7031.5 Oy .- PI,AN � . ` _� �� � , . • , � � , , �.
any aODlicant for a permit su61eit5 the aDPlicant ta a ciNl penalry o� not more t�an five hunareA dollars.(5500). jSSUE FEE ' : • �; 3, OO � � � �
' i as owner oi'tne pmDeM or�my employees witn wages as�ineir sole compensation, will ao ihe work, anA ine . HUILDING—DIV--> � PERMIT ISSUE : PLAN—CHECK TOTAL . � PAID , � DUE
❑ stmctura is not intenAea or oneretl tor sale (Secnon 7044, Business ann Professional Coae: The Contacrors' State License Law ,' TOTAL S---> i, � 0 J. �, � ' 0, Q 0 ' S, 0 0 � 5, 0 0 ` , ,�� 0� j
Cces not appry ro an owner af a DroOertY wha builOs or impmves thereon, an0 who Ooes such woM himseltlhersetl or ihmuAh � . .�,'- .�. , , ' ' . " . . ' 4
�is or �er ovm emDloyees, pmviAed that such improvemems are not intendetl or offere0 for sale. II, however the buildinp ar � ' ' ' -
Impmvpment i5 sola within on¢ yea� o� completion, the owner will have Ihe Gurtlen ot proving �e/she Uitl nol build ot improve RE V ENUE D I V�I S ION TUTALS--> ' COLLECTEO : 5. � � (iV ER / SHORT : • � ���
mrteepurooseotsa�e). . ^ , BLDG PMT PLUMHI'NG ELECTRIC MECHANIC FIRE SMIP/'TOT GRADING PLAN-CHECK
' ' I, az owner o� t�e D�oOerty, am exclusively contractinA with Iicenie0 contractars to constmct the Droject (Sectian 709A, Business S,.O O� , . , .� • " -
❑' and Pm/essions Cotle: The Contractors' Sfate License Law Uces not apDy ro an owner of property who hml0s ar imD�aves Ihe2on � � ' � � ' � ' ' � '
anawhoconiracistorsuchprole��swithaconiractor(5)Iicensepursuantro�theContractors'�StateLicenseLaw�!lamavrore ,�IEiFihifit{kiEaE{EiE1FiE{FiEi(�IEiliEiEiliFlElFiElFiEiEaE�EiF1lifiliF3EiEikiF{t***�.�-{�..�.{E{t{EiE3EilikiFiE{Ei!{t�EfEfEi61l3E{E**{p**{�..K.**�Eit�1E3Ejp
ihat proo� o� Nei� Worker'S Campens `iUn insurance ShoulE be proviEeE �o m¢. �' � . , j N D I' V I D U A L: F E E, B R E A K� D O W N. � � � ' , �
� I am exempt unaer Section: , B. 8 P. C. � . � � ,
mrm�sreason, , TYPE : QTY D E S C R I. P T I O N : UNIT COST TOTAL COST
�
, i
Oa�e: ownec PLU Q WATER HEATER AND/OR VENT 2.00 2.00 i
I Oo hereUy certiry t�at I am aware of antl un0erstand I�e reQuiremenis ol Calitomia Healt� ana Safery Cotle Sections 25505, 25533, antl ' � ' END OF FEES �
25534 antl t�at I or any future buil0ing occu0ant will/wiil not (circle one� neeA m comDty with said state codes and ihe requirements for a ..� .. . . � _. _ � ' i
permi� for consimc[ian or moAification imm t�e Nr Qualiry Management �isirict Resitlen�ial constmtlion applications are exempt from � ' ' . , . ' , �
these Drovisions. , . ' _ . . � � . . � . . • , • ' . e .
Date: � Fpplicant: � � ' - - . - � �
I hereby certiry ihat I have �ea0 this apDlication an0 state tAat ihe ahove intormation is correct. I agree to comDly wdh all ciry and counry � . , � ' + • ' �
ofdinantes antl sta[e Wws relatinq to buildinp tonstmc�iun and hereby autlwrize repreSenWilves ol INS ciry t0 enter,upon Ihe above-men�i0netl . . • ' � � '.
4
properry /orinspectian Duryoses� � � . . � � � , . ' � ; � , ,
Date: �' 2 �� , Signature: � - � ' � ' ' � ' � � � � �
i
01 UOOS�E39-OQ05QE39 70T . , S.OQ
od�e�suc:e�seorsocia�secu�ryx: ���'�� OAtE� 01/02/90 TI11E: Ia:56 '
1801-46 W�ite—Builtlina; Green—Cotle Enlorcament: Canarv—ApplicanC Pink—Revenue: GOldenroE—Assessdr � � � � . _ . . _ ' . . . _ � . . . �. . .. � .. _ .
CONSTRUCTION AND PLANNING " - . P< & SPA • . '. , ; ,
APPROVALS Permit# Date Inspector pppROVALS Permit# Date Inspector
� 1. Temporary Electrical Service or Pole�> ' 52.� Pool & Equipment Location
nt
2.� Soil P.ipe-Undrg�nd._ - , �" . "� ,- 53. Steel Reinforcement -- •
��3-Electrical Cond"uit=0fility-Undrgrndrn - 54. Forms - � - ,
r. �,
' 4. Electriial ConduitlUndr9rnd. �, "' � y- _ 55. Electrical Bonding , � '
� 5. Steel Reinforcemenr -+i: � � . 56. Rougfi�Plumbing & Pressure Test � c�
� -
�� 6. Elect'rical UFE�R'frnd. ''. �-�.; • 57. APPROVAL TO COVER-GUNITE `l
; 7. Footings Y�� - . 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 3ystem � .' . 61. APPROVAL�TO DECK.
11. Property Sewer Ling;& House Conrjection - 62. Backwash & ReceptonFinal - �
12. Sewer Cap c. • � c% ' 63. Heater & Vent�Final �
cn
13. Roof Dreins " o .• 64. Plumbing System - Final
14. Rough Plumbirg � _ � 65. Electrical-Finai
e.
15. Rough Electri�t-Conduit . . 66.. Solar SYsterri-Final ,
16. Rough ElectriF�/iring � � 67. Pencing & Access ApProval . �
17. Rough Wiring�ign, . �' 68.'APP.ROVED FOR PLASTERING �
18. Rough Electrical-T Bar Ceiling " 69._POOUSPA SYSTEMS FINAL
19. RougFi Heating & Air Conditioning� V y, � ��� � �,,,FIRE QEPT. REQUIREMENT
.� n ,x - :a �, cx�: c
20:yRoiryh Facto�.y Fa'replace "rr'.' �,� � S H -';; ` �APPR'OVALS;,:,�Pefl.it# r � _
21.�DucCs, inStructu?Ser ', > N R :� i�; w�X ?70. Underg�o'o,nd, H�ro �
�'� J ' ' .v � L..:[ � S 'Ga' # . ,_' -U
22..-0uCts, �entitating;r { �. ..� _r, � ,� ;_,M � T77, ProductP.iping O�6as Q:OiI
23. �Gas-Pipe-Ro�h & iest :i= �� '! �C � 0�;� � �72, Undergrotind FIGsh' � `
� 1 L T Y' �"'�'� (l'f i K C T). C :K
24��Roaf Fr�'ming "* • �".` - �x - G - � �x m - V -�. r .,
� y� ;-.; �* � :-,�- ,i: ..73r,Undergrn8. Storagg�Tank;O Gas ❑ Oil
25. Roof Sl�athing �M �; � � +� � � C' ' � ,�++� :r 7q �'Overhead Hydro-�', �`
m - r a: H ^.x , ^C e
� N 7 � C•^.a.' X G' - 4' � _% ,S
26� T-8Qi Ceiling (Stru�tural) &'Mo'necoat �,� j; ., r f 75.rDry Chemical c.- z �
27:�Freme and FWshing- :, t; � � � >+ � A r� 76. Dry Stan�pipe "�"„ V U �� � � ,'7
�28y Lathing:$ Siding�� "' ��:_ � r� �; 5*' 77h FIXED SY�TEMFI{JAL� �� ��� -
� 29. Insulation �' _� v ;� J• x,c, � :;� � 76iFIRE PREV. FIN�',L x= C` �
,..,
�'30. Drywall_Nailing �:�' r. �� i. � x Soiv c:AEALTH`-,DEP�: REQUIREaVIENT
�.i37. Plaster Bio�r/rl C6at> S � � I a� �� r79.� FiNAL IDTSRECTION _
r..n
- • r -i r �: � - ;f : ] � I }t' X .n �=. r. �`.;
y.32�Electrical Pawer IrVle�ieh-Einal; � � � �* x 80.:FOOD CERTIFIGATE IS�UED,.,., �
_ • x 4� -. . � ,: r :�, .,- ., . '
�33:5�Finei E�ectric „ : x ` ! �:r K �Notes: "' '=^ *'". 'v ^ .
1 I f N' 1!� ."} Y 1 C
�134�Fina�"1 Heatiny& AifC_QriditioningS 1 �� � � j�� ' G � �'' 'K _. ^`-
� .`.. -, C :. r. ,r. 7 � x �� 'J t F. <C �-'K ; 7
35r,Final Gas Pipe-Test!; rj:y : �r r.; � , � :� : � � �o �;;- g ' �.. �=-
�x36`Hootl or Canopy y J.` _�-, •.-' .x n j � � �x x_ � Clo > rr
c' v 'y. :'1 � �' 6 K• ! � --Fx Y• ^C y; " .��
� lT� - .J -� : v, � -- -�
�-37..-Final Factory Fireplace � : FY� s �x + � * � Y c-
�38. Fina� Plumbing ' ! x ; � � y; �
, � .� (' (Y 9'oi LEOti: R r
+: r ~
"39. Water Service�Finalr g . � a: � � j �; r � � n�� � � �
-'40. GasService�Pinal �- G:�'T = �,r,,., j ' ix � pn.: c;a x�
- Y, (i =. 4 i: 'K I FY, 'Y ' i_ • J t Y Q
• c i ; •• � �r i sc F -,s .i.
,=41. Solar pomesticFinal'- r; � � � ,� Y� � �c �^ �
�_ r� ��'. c. c :
42. Backflow Preventer� � �� z I ! �� r � 7c- �+� � �
r r� n�:, T r * a: �� mr * :•�
�
43. Backflow trngationF ;cs` t� - x i U �^ ,r. `� c-� . �
_ .,. ._ _ ; r,
:�44�l.andscape 17tiqatio5i Systern��`��� `-� ��`'• +„ b 7* x r3 N yC� y c n: ...
z . c, •.• 1'• �� Q M� �K • £ E S c-
. . r; : i-±:z c-� i= x r V r x� �-•-� r, � � � .r.
`'45 jSound Attenuatioq: • •• ,. �,; ;.y -�* :� -, c� ¢ � ��d .c "
C46.•Handicap Regulations �-+ C * J > * `� '' �� = " � �_�
v- x^. i I-.b: 'i: tT: Cl ^ i'
_47=FINALSTRt1CTU�tE&.BUILDING " � � `Y' ��' �' ; •
# :. � I •; �% Y: i C' ?,
y-
48�FINALPLANNIN6 "-'�' r � ' +'F k "' ;T � -'
'# 1 ii: �: � ^? C.
=ag:"�ieccric Release to:�dison i � � �� i�'''. ; a �� ,� ' �'
i50�GaeRelease to Southem Califorrtia Gas Co ' : I i�' K- ^ '�� : +° O '
s c.- k. �A:x S �C C� x :� O
=51. CERTIFICATE OF{OCCUPANCY * * � �- •�4 ^ ��
r+�-
No. Date
berg as
anket Insulation
The contractor named below certifies that the Owens-Corning Fiberglas
Blanket Insulation used carries the NAHB Research Foundation, Inc. label
for assured thermal performance and that the Blanket insulation is in-
stalled in conformance with current energy conservation regulations,
California Administrative Code, Title 25, State of California, in the building
located at: /
i /%/i^ /�. , , �, � ( � �; ` J,1C%
Stieet � �ot Number
/' IJ
Tract Number
f �rior Walls —
(,..,;ns-Corning Fiberglas Blanket Insulation �/ __ %�__
Thickness R-Value
Ceilings , ,, ��
�Owens-Corning Fiberglas Blanket Insulation_ i _ _
'� � Thickness R-Value
� �
U, •��
"` 'Floors
� a Owens-Corning Fiberglas B�anket Insulation
.. Thickness R-Value
Foundation Walis
General
Manufacturer Type Thickness R-Value
License No.
By -� � Title -- Date — _ _
ISlgnalure) / / �, J� /_ �
Insulatio ntractor_����-!��- % ��"�' ���� �j-�'��LicenSeNo._»�/'C,�
BY-- �-�2�"_--Title iJ• � Date �`��.',�'1
1519 amre)
Homeowner Copy (White)
State Copy (Yellow)
Builder Copy (Pink)
Pu� No. 16�BL6995-P LI�M10 in U.S.A., July 19>9
OWENS-COHNING FIBERGLAS CORP.
InSulation Operating Division
Fiberglas Tower, Toletlo, Ohio 43659
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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
ADIDRESS 3446 Kings Court
OWNER OR
TENANT Wimbledon �iSSOC.
ADDRE55 1470 Jamboree Rd
c�-rv Newport Beach No�640-680
LENDER�ON Imperial Savings & Loan
BRANCH Pasadena
ADDRESS 61 S. Lake Ave.
ARCHITECT .. TEL
,. .. ('nrhin/Vamafn�i ridQ_7l9
ADDRESS 17992 Mitchell So.,Irvine
CONTRACTOR MCLain Dev. Co.
ADDRESS l�i�%� Jamboree RCI
TEL.
c�rv Newport Beach No.640-68
�ic No. 273875 �ic�No. 18873
SIZE NO.OF BLDGS.
OF LOT NOW ON LOT O
USE OF
EXISiING BLDG.
Separate permits are required for
electric, plumbing and heating work:
USE OF BUILDING ANO WORK TO BE PERFORMED
PRD - New construction
Single-family �dwelling
I hereby acknowled8e that I have reetl this application antl stata
that the above information is correct and egree to comply with
all laws reBulating builtling construction, antl I shell not amploy
any parson In �violation of ffie workman's compensation laws of
the Stata of California.
I he�eby certity that I em pro0erly Iicensetl as e eoniractor untlar
tha State of California Business and Professions Cotla, Division 3,
Chapter 9, and that such licenses are in full forca antl affect, or I
am exempt from the provisions of tha State of California Business
and Professions Cotla, Division 3, C-pter 9.
Signature of ,.
Permittee
or � -1
n�cnor�:aa c.ee�t Date "'�
APPLICATION Fb�°CRI�I��U��L PERMI'F32.35 TI:�
RECEIVED�' PERMIT _ __ ' t _ _ '. '.
A.P. NO.�IZr—r1�'� U 1 � ','�
ADIDRE55 3446 Kings Court
UNIT OR
SPACE NO. 3Q-
TR.NO. 1.0T
NEW ADD ALTER REPAIR MOVING
X
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use PRD VALU �
APPROVED
APPROVEDSETBACKS
(FROM�.:.^!7) j
PLANNING ACTION
DATE � �20
DATE
�QLD FOR SPECIAL
�d � ! SQ. FT.
THE AMOUNT 51
THE PURPOSE OF
VALUATION
§ .���3�°
r.
4N UNDER VALUATION IS FOR
-ABLISHING A PERMIT FEE ONLV:
PERMIT FEE $ aa /
PLAN CHECK $
TAX $ � �
TOTAL PAID $'.�{�_ �
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