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Home My WebLink About869 LIARD PL - Building Permits� .. ,lob Adtlress: 869 LIARD PL Suite: Vicinity: HOUSE AND GARAGE ROOF Primary Occ: R2U1 Type of Construdion: V-N Parcel Number: 41806406 Zoning: Rl Appliwnt: AMANDA WOLDHUIS Adtlress: 1809 W ORANGETHORPE PARK ANAHEIM, CA Owner: HARRINGTON, J LANCE Address 869 LIARD PC " � � i ., , � COSTA MESA, CA, �� , � Contraaor: "; HOYT'ROOFS. � " Adtlress: - 1809 N ORANGETHORPE PK i: .. . .� �ANAHEIM,CA , � Zlp: 92801 . " � . Arch : , � � �", Address: ' � � Phone: • Zip: � . License: ' Phone: 714-773-1820 ZiP; 928�� ISSUED BY: Phone: Zip: 92626 �a s � �s^��'" �� '- Phone: 714-773-p1820 n, cr� License: 606111 Eng: Address: Status: ISSUED Applied: 12/15I2006 Issued: 12/15I2006 Phone: License: " SCOPE OF PERMIT TEAR OFF (E) ROOF MA"fERIALS, INSTALL 1 LAYER OF 30# FELT ON A 4:12 PITCHED ROOF, REROOF GAF GRAND CANYON LIFETIME ROOF MATERIA�S ON AN ATTACHED HOUSE AND GARAGE, APPROX 24 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: $0.00 $153.25 $0.80 $0.00 $0.00 $0.00 � , FEESUMMARY Calc Valuation: sa,000.00 Claim Valuation: sa,000.00 Total: $754.05 PLANNING 8 ZONING SETBACKS �� , MAIN STRUCTURE �Front � 0. 0 Rear � 0- 0 Left 0- 0 Right 0. 0 , —. . . ACCESSORY fmnt �,0.�0 - Rear 0.0 _ ; Left, 0-0 Right 0-0 PARKING � Ezistln : �' 0- �� Re uired: � 0 Pr000sed: o � �' �, . � � � . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements untlar California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become voitl if work is not commenced within 180 days, or il work is suspended or abandoned for a period of 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 Inapeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaasas �aroo7 WORKERS' COMPENSATION DECLARATION: I hereby etti� untler penalry of perjury one of Ihe following tleclarations: ❑ I heve antl will malntain a certifica�e ol consent to sel4lnsure �or workers' compensation, as Omvidetl for hy section 3700 of tM1e Lebor Code, for the pedormance of the watic tor which t�is permit is issued. ❑� I liave antl will maintain vrorkers' compensation insurance, az require0 hy section 3700 ot the La6or Cotle for the pertortnanca of the woAc for which ihis rtnit is iss ed notbe . pe u . enapolicynumberare: t�OO�� I ��n �alicy Number: � velued at one hundred dollars ($100) or less.) --- ❑ I certiry ihet in I�e pertormance oi Ihe work lor whic� this pertnit is issued, I shall not employ any person in any manner so as to become subject to Ihe workers' comp9nsatlon laws of Califomia, and egrae Ihat If I should Cecome subject to ihe workers' compenseilon provisions of Section 3700 oi the Labor Code, I shall torthwith comply with t�ese pr i'ons. • (� / ( � Applkant SiOnawce: ��..�i(.1�- Date�—" 1 G/ `� l� %� WARNINO:"FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUI M'D SHALL SUBIEGT AN EMPLOVER TO CRIMINAL PENAlT1E5 AND CIVIL FlNES UP TOOfJE HUNDRED THOUSAND OOLL4RE (E100,000�, IN AODITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 31060F THE LABOR CO�E, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereb �ettirm tha� I am license untler rQv`'siGns of Che ter 9 commencin with Section 7000 of Dlvislon 3 ot fhe Business�tl P9fe � ions Code, entl m license is in full force-end eHecL Lic �' �� 1 1 1 p 9 , `Cless N �� Y ConUactafsSignature�. �1�V'r �7 Date CONSTRUCTON LENDING AGENCY: ❑ I hereby eHirm that there is a construction lending egency lor ihe peAormance of iha work lor which this pertnit is issued. (Sec. 3097, Civil Code). Lendefs Nef�e: Lender's Adtlress: SigneWre: �ate: OWNER-BUILDER DEGLARATIONS: I hereby eMirm that untler penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business an0 Professions Code: Any city or counry which requires e permit to construGt, alter, improve, damolis�, or repair any simcture, prior to its issuance, also requires the epplicant for such permit to file a signetl statement ihat he or s�e Is Ilcensed pursuent to the provisions of the Contrectors License Lew (Chapter 9(commencing with SecHon 7000) of Division 3 of the Business entl Professions Code) or that he or she is e:empt Iherefmm and ihe basis for the allegetl exemption. Any violation o� Section 7031,5 by any epplicant tor a parmit subjecis ihe applicant to e civil penalty of not more ihan five hundretl tlollars ($500).): ❑ I, as oW�er ol the properry, or my employees with wages as iheir sole compensation, WILL DO TME WORK, end the slructure is not intentletl or oRered for sale (Sec. 7p44, 9usiness and Professions Code: The Contractors License Law dces not apply to an owner of property who builds or improves thereon, antl who does such work himsetl or herself or t�rough his or �er own employees, provided tha� such improvements ere not i�tended or oHewtl for sale. �f, however, the huilding or improvement is soltl within one year of completion, the owner-builtler wlll have Ihe burtlen ot proving that he or she tlid not builtl or impmve lo� purpose of sale.). ❑ I, as owner of t�e properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The conirectors License Law does not eppty to an owner of pmpeny who builds or improves the�eon, and who contraci5 for such project with a contractoqs) license pursuant to ihe Coniractors License Laws.). ❑ I am avempt under sec. Signature: Owner ID ve��iatl by tlnver's license. ❑ Ves ❑ No BusinBu and Profession5 Code for Ihis reason: Verification a� �w�ership try (type of dxument, i.e. � pmperty tac bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Driver's License No. Date: Ezpires: ❑ I hereby �ertify ihat no ezcavation live (5) or more feel in tlep�h into which a person is required to dascend, will be made in connection with work amhorizetl by ihis permii, and ihat no building structure, scaHolding, falsework, or tlemolition or dismantling Ihereof, will be more Nan ihiny-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Titla 8, California Atlminisirative Code). ❑ As owner-builtler, I will not employ enyone to do worN which would require a permil imm �he Division of Indusinel Safety, es notetl ebove, unless such person has a permit to do such work Iwm Ihe division. Signature: Date: Division ol Intlustnal Safery Permit Numbar: CERTi1CATE OF COMPLIANCE AND AUTHORIZATtON OF ENTRY: I certiy under penatry ol peryury lhat 1 have reatl this applica4on af W state that the intortnation given is correct. I agr0e to compty with all state laws antl city ordinences relating to 6uiltling consiruction, and autho�ie representatives of the City of Gosta Mesa to enter upon the above�described property for inspection purposes. I agree not to occupy or allow occupancy ol any building authorizetl by this Dermit umil final inspection. ��V f LAM'LlU�9natureOf�e^g;10 qer(s'. )\.'�' '__.-Y.`u I �I' ��! � KJI l�,_AnNOr Authonze0 App� nl � - . � �oa�e — COOE �. �u��oeGTIONTYiE 16/6 Flxed System Final Fire Pre�enti0n 1266 200 Pool Spa Finel Final R8-Root 201 Fina� BIacWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition OATE INRIIALS /1/� / i/ �� LDDf� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 270 Final Electrical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy QQjE IM1ilAL5 I( ^ Jo#1540 Aop��ant to flll in all soaces exceo� those witnin heavy borOer lines antl sign all appropriate tleclarations. CITV OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. ProjectAddress 869 Liard Place ApplicanYs Mailin9 Address 2,$9_�—�%� a MB Yt.PI'14 _ Owner'sName _7�cZ71.C� Ha�'r.ing�'r+n PhoneS-56�i.�i0� Address � —8-6i_.1+13Yi�:.P1aCQ � ' - — Arch/Eng. � License No. - _ Address Contractor'snlamP AlY Manaqement Phone632-7S9O Addreulmailin9) Z890 Uld Martens Ciry license No. ___2,9.(�.�1,i � L'ICENSED CONTRACTOR DECLARATION I hereDy aHirm that I am Ilcoqsetl untler provisions of Charter 9(commencinq with Section 7000) a1 Divlsio� 3 of the Businesz antl Profe55iOns Cotle, antl my Iicense is in full`(orr�bna ettect. 43929 Ucens Cla�} Lic e No. ate � `� Signatpre /ORKERS' COMPENSATION DECLARATION 1 hereby aHirm lhat 1 nave a certiticate of conseM to selt-Insure or a certi(Icate , ot Workers' Compensa[ion Iqsurance, or a certitietl coOY thereof (Sectlon 3800, Lab��C C2-216996—� INA ' � Policy No. Co pany � �erti(iaG copy Is hewby furnishetl. tif%} co is tlletl wltM1 the cit Builtli Division. Da[e�—L�—�4 Applicant�lY iianaqement EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (ThisSection neeG not be cOmp�etetl ii the permit is for'one huntlretl ($100j or less). I carti(y Ihat in tM1e Oe�formaqce 01 the work for which tbis perm�t is issuetl, I snall not employ any person in any manner so as to become subjett to [he Workers'.Compensation Laws ot California. Date Si9hature NOTICE: It, after making this tleclaratlon, you shoultl bewme subject to the Workers' COmpensatlon provi5iOn5 of the Labor Cotle, you must forthwith como�Y �+�� such vrovisions or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 her¢by afiirm that there is a Gonstruction'lentling agency for t�e pertarmance ot Ih¢ wotk for whicb t�is permit is issuetl (Section .309] Civ. C.) lcn0er's Name Lentler's ACtlress � OWNER BUIIOER DECLARqTION� � I hereby altlrm Ihat 1 am ¢xempt �rom the Contracto�'S License Law for the following �ea5on ($ecUon 7031.5 Bu5ine55 antl Pmtessional Cotle: Aqy city or munly whlch require5 a perrqit to conSt�uCl, alteq imprOve, demoli5h or �epair -!'_„ny structure, prlor to Itz issUance, also requires the applicant for such permit � 0 1lle a signetl slatement lha( he/5M1e IS licensetl pursuant to the provi5ion5 of �'=�"he Contractor's License Law (Chapter 9(commencing with Section )000) of �"bivision 3 Ot the BuSiness antl Protessions Cotl¢) o� tttat h¢/She is exemp[ therelrom anC ihe baSiz fo� (he allegetl exemption. Any violation of Sectlon 7031.5 by any applicant lor a permit subjecis the applicant to a civll �enalty of not more lhan tive huntlretl tlollars (y500). I, as owner of [he OropErty or my employe¢5 with wage5 as thei� sole coTpensation, will Co the wO�k, antl the sVuctu�e is'not intentleC O�off¢r¢tl � iOf Sd�2 ($EC1100 ]044, B115{p¢55 dOd Professional Cotle: The C011fl3CI0I'S LicenSe �Ldw tloes not apply tp en owner oi a property who builtls or improves theraon, antl who Eoos such work hlmself/herself o� throu9M1 his o� her own employees, provltleE lhat such improvements are not intenaetl or olterea for sale. If, howeve�, th¢ builtlln pr improvernent is soltl�within one year of Com- pletion, [he ownc/ wlll have �he bu�tlen ot proving he/slte tlitl nOt bulltl o� Im- �, �ove Por tlte purpose of sale), LI I, as own¢r of tM1e property, am exclusivery contractin9 with IicenSetl COn- � Vactorsto construct thC pvoje�t (Section ]044, Business antl Prote55ion5 Cotle: ' The Contrattor's License Law tloes mt apply to an owner ot property who builtls or Improves thereon, antl who contracts for such projects with a con- eractor(s1 Ilcense pursuant'to'tne�Contractor's License Law). I am aware tnat proot ol [heir Worker'S Compen5ation insu�ance shoultl be p�ovltletl to Te. ❑ l am exempt untler Section B. & P. C. for this reason Date OWn¢r 1 I hereby certify tnat 1 have reaa thls application antl state lhat the above information Is correcL I a9ree to comply with'all Nty antl county ortlinancez antl state laws relating to builtling constructlon, antl hereby authorize repre- 5¢ntdtives Of thi5 city to enie� upOn the abov¢-mentionetl 0/operty fo� inspection Pur�ses. �� 6-22-84 � Si9nature te �1 � �� ' � o!�, TYPE OFCONSTRUCTION LJ NEW ADD ALTERATION� REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING LI FOUNDATION LJ STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING � MECHANICAL ' ❑ OTHEf3 ' PROJECT DESCRIPTION S�.FT. oCCUPnNCv_ CONSTRUCTION TVPE VALUATION 5 ZONE GRADING CU. VOS. ACRES_ Remarks: nk Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service ' .Outlets Interceptors Kitchen Sink ' Lavatories P—Trap Roof Drains Reinspection Fee � $15 Duct - Undei Ground ' Duct - Sttuctural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Pact BIL ICBO # Heating System & Ducting 1 a� oo,000 eTu O i oo,000 Drivers' LI<ense or SS � I I Reinspec[ion Fee I $15 CMF 0865-46, rev. 4/84 White - Builtlin9: Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal � Water Goset � Water Heater Water Service Isue Fee FEES $ 3 A.P. � S Main Building: E T Front A Rear C Ri9ht ' K Lefx S Ping. Ref. # Planning Notes: 3649 7/d9/84 Zone Accessory Building: ' Parking Req./Provided ' ELECTRICAL � Auromatic Washer t- - � - Canstruciion Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures. Device Boxes � . Outlets • Switches Garbage Disposal Generator 00.5 KW �5-15 KW ❑ 15-50 KW � 50+KW Meter ❑up to 100 amps , Meter ❑over100amps Sub Panel Motors �41 HP �1 %- 8 Inc.Solar �9�15 HP 016-15+ Microwave Pole l.i9ht Range Standing Sections Tresh Compactor Rei�spection Fee $15 �Ssue Fee IANICAL . FEES DEVELOPMENT SERVICES REQUIREMENTS: Hoodor Typel ❑ Canopy Type I I ❑ Zoning Approved By ' . _ _ Building Approvad By _ Refrigeration System ❑0.100,000 BTU ❑100,000 BTU System Repair/Alteration Issue Fee � $ 3 I 4. 5!7 FEES 0 $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ��UANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL ��IYSn �e TOTAL FEE $ � PLANCHECK 25% $ ,�jj ;�,j. C� Z O N I N G R E � M T S. CONSTRUCTION AND PLANNINV iL & SPA � APPROVALS Permit # Date Inspector p�ppROVALS Permit # � Date Inspector i. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. � 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � 5. Steel�Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings . 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. _" 60. Backwash Lines, P-Trap, O Undrgrnd. 70. Structural Floor System . 61. APPROVA� 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 . 74. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit , 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18: Rough Electrical-T Bar Ceiling ' � 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22.�Ducts, Ventilating - 71. Product Piping OGas. OOiI 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 GERTIFICATE ISSUED 33. Final Electric Notes: Giy�d'S L� f+92 0. L�� 34. Final Heating & Air Conditioning a/� �?3- L�j� . 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 • - � I 43. Backflow Irrigation , . . � ' 44. .Landscape Irrigation System � � . 45. Sound Attenuation � , 46. Handicap Regulations ' , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed . 49. Electric Release to� Edison , 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY � - No. Date " No. - WILLIAMS INSULATION COMPANY OF CALIFORNIA 1207 E. Hunter Ave., Santa Ana, California 92705 (714) 547-5148 THERMAL INSULAT�ON CERTIFICATION 7HIS IS TO CERTIFV THAT INSULATtON HAS BEEN INS7ALLED IN CONFORMAM1ICE WIT CURRENT ENERGV REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24 STAT OF CALIFORNIA, IN THE BUILDING LOCATED AT: ' Name: Lot No. �, Tract No. ��'�� Block No. Street �� L�('.�� City EXTERIOR WALLS: Mfg. �}�%'� :� ��+�: �^'�; Thickness/Type Cei I i ngs: Batts: Mfg. �T�L;:: :;�]I'.3L4 ; Thickness/Type Blown In: Mfg. Thickness/Type c— Ft. Covered s: Mrg. Other Mfg. No. of Bags Used Thickness/Type Thickness/Type General Contractor California Contractors License No. Williams Insulation Co. of California California Contractors License No. 267522 � T ri `_ � Si9namre JOB COPV-WHITE GENERALCONTRACTOR-VELLOW J39 R— � Value •� R— j�� Value ��i R— Value R— Value R— Value f:Z Date Date -_'rn._7�, F �C1C. BUILDING DEPARTMENT-PINK FILE COPV-GOLD f' �! '7 r:'. � ' COSTA MESA BUILDING-SAFETY DEPARTMENT P.o. BOX 1200 COS7A MESA. CALIFORNIA 92626 r3355 2! I'�'i�� . It3�!Q I�CKi�il 3356 00�0447436 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVEDBV DATERECEIVED DATEISSUED BUI�DING ADDRE55 `N�cO��r � PEflMIT NO. OWNER Fole CORStiUCt.lOIl CA. IL1C. A.P. NO. [u� MAIL BUILDING �/'� ADDfiESS 2101 E. Fou�'tr� St. , #ZOO �+DDRESS ��1 CITV .Sd11�1 �iild No`.' S43-947 TRACT 1�5�..3 LOT 2% BLOCK CANSTRUCTION N W ADD A TER R P LENDEq X BRANCH O W N E R Ebley Construction i..'O. � II1C . ADDRESS VALUE ORENGINEEa Hales-Langston NE`� 547-0862 SE $ y FIIiE ADDRESS 777 `S• �� St..� tt�.OS; Orange 20NE TVPE GROUP Qdf1P�Y' DeV21O /+PPROVED CONTFACTOR � PPP-r BV DATE ADDRESS 'S� TEL. ZONE NO.OF USE OF NEW CITV S�� NO. P�� BUILOING p W /h STATE 5'� CITV �'ARDSAPPROVED VAflOSAPPROVED LIC.NO. LIC.NO. MAINBUILDING ACCESSORVBVILDING SIZE NOAFBLOCS. (FFOMClLSi�E�7) ^� ) j� OP LOT NOW ON LOT 7U � �� ' Q FONT FT. T, VSE OF I EXISTING BLDG. N A � FT. O F, � Separate permits are required for � si E � FT. O FT. electric, plumbing and heating work. 1 REAR FT.O FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BEf, MAIN & MAIN BLDGS. ACCE�. BLOGS. Developeaent of 41 single-famil cu.P.� APPROVED detached residence units. �R E — � &-79 1 heraby acknowledga thet I Have reed this application antl stete � that the above Information is corract antl aprea to comply with � all laws reBulatln8 builtlln8 conrtrucNon, antl I shall not employ yOLD F � OR SP ' eny person In vlolation of che workman's compensation laws of EC� �p o Me Staie ot Californla. • Z GOO SQ. FT. `° I hereby canify that I em proparly Iicensatl as e contractor under 1i{ tha Swte of California BusinesS entl Profauions Cotle, Dlvizion 3, THE AMOUNT SHpWN UNDER VALUATION IS FOR m CM1ep[er 9, ontl Met such IicanSes era In tull farce end effeci, Or 1 THE PURPpSE OF ESTABLISHING A PERMIT FEE ON�V: � am exempt from the provisions of tha Smte ot California Busineu VALUATION PERMIT FEE § `� antl Proteulons Cotle, Divislon 3, Ch teF 9, m 8� ��Q PLAN CHECK S m Sle�ature aS�� Permlttee� $,��Q TAX $ � �-u AuthorizatlABent TOTALPAID $ Q• ` COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. HOX 1200 COSTA MESA. CALIFORNIA 92626 �� 6761' �, 676�, :6761, 3[27/Z9 3%27/I9_ .. 00004G74 36 2!i9.00 TV "2G9■OOCKTq _ 'IA.-._" �n APPLICATION FOR STRUCTURAL PERMIT For Applican[ to Fill in Comple[ely — Use Ink Only RECEIVED BV DATE RECEIVED DATE ISSUED BUILDING ADDRESS PERMIT NO. OWNER A.P. NO. MA I L BUI LDING ADDRESS ADORESS g TEL. TRACT lOT L BLOCK CITV NO. CONSTRUCiION W ADD P LENDER BRANCH OWNER ' ADDRESS VALUE ARCHITECT TEL. S $ OF ENGINEER FIRE ADDRESS 20NE TVPE GflOUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO.OF USE OF NEW CITV NO. P�� BVILOING STATE CITV . �'/>RDSAPPROVED VARDSAPPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING SI2E NO.OF BLDGS (FROM C/LSTREET) OF LOT NOW ON LOT ROM FT. FT. USE OF EXISTING BLDG. FT Separate permits are required for L. SIDE FT. FT. eteMriq plumbing and heating work. FEAF FT, FT. USE OF BUILDING AND WORK TO BE PERFORMED OISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLOGS. VAR.# R4TE C.U.F,�% APPRpVED APPROVED I hareby ecknowledBe that I �eva reatl ihia eppllceNon anC stete '^ n Mat the abava In/ormetion ia correei and eprea So comply wIM m el� laws roBulatinB EuilCinp conrtructlon, entl I shall not ampioy � any person In vfolailon of Me workmen's compensation laws of m Me Stete of Celifornia. I hereby canify that I am proparly Iicansatl as a contractor untler SQ. FT. w the Stete of Ca�ifornla Busineu antl Profeuions Cotle, Division 3, THE AMOUNT SHOWN UNDEfl VALUATION IS FOfi m Chaptar 9, antl <het such 1(cenaes are In full fofce antl effBct, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: em exempt from the provisions of the State of Callfornie Buslnev a VALVATION PERMIT FEE E 2 antl Professions Cotle, D(vizion 3, Cheptar . 777((( J� � PLAN CNECK $ "� Sle�etura of � Petmlttee $ TAX E LL F U AuthoAzed Agant TOTAL PAID S �