HomeMy WebLinkAbout144 LISA LN - Building Permits : , 1f
u CITY OF COSTA MESA
4 BUILDING DIVISION
IF ., ..41 DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
k 111P111.4 PERMIT B06-00285
.tbkewernspee
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.BWLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 144 LISA LN Status: ISSUED
Suite: Applied: 02/21/2006
Vicinity: ROOF Issued: 02/21/2006
Primary Occ: R-1 Hotels/Apts/Res>10 Occ Type of Construction: V-N
Parcel Number: 43908120 Zoning:
Applicant: SANDOVAL, ISHMAEL
Address: 106 W.CANADA
Phone: 949-500-4370 ISSUED BY:
SAN CLEMENTE,CA Zip: 92672
Owner ARROWOOD, DANIEL F • ,y
Address %ORANGE COUNTY PROP MGNT• -
HUNTINGTON BEACH,CA Phone: "
PO BOX 2060 . , Zip: ,;-:92647-0060
Contractor: TTGCONSTRUCTION SERVICES INC` • '
Address: 1106 W.CANADA ,. .
Phone: 949-500-4370
SAN CLEMENTE,CA -
Zip: 92672. License: 771813 ,
Arch - Eng:
Address: Address:
Phone: - Phone:
Zip: License: - - ,License: ..
. SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL 1 LAYER 30#FELT,30 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE.SHEETING AS NEEDED.
33 SQUARES FOR,TRIPLEX.
F
FEE SUMMARY �; -
Plan Check rd - $0.00 / Calc Valuation '7'1 $11,760.00
Permit ;$209.25, .)1i .. .. • • r . Claim Valuation: $11,760.00
SMIP Res: $1.18
SMIP Corn: • $0.00 ,
.' Other :.J$0.00 . . .
Inspection: $0.00
;Total: -$ 210.43 .
PLANNING-& ZONING
SETBACKS '
MAIN STRUCTURE Front 0-0 .' .
. -- Rear, 0-0 '' •Left ,, 0-0 . . _ -Right 0-0
ACCESSORY N Front 0-0 • - -.Rear. —0-0 - -Left 0-0 Right 0-0
PARKING •EXistinq: 0 . Required: 0 Proposed.- 0-c/
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 this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections 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)754-5626
244848(8N0)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
'I'heve and will maintain Workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
a - My workers'co pensatlon Insurance carrier nd policy/number are: /
Fe-Cor,
« .-2 ' n•-. I in s:,re. .LG -r Polio Number.- -/C C S
I,Eemer r "i5 ,n.L / 1; y 1 �DD S
C �(7Dis section need not be completed"the permit is valued at one hundred dollars($100)or less.) - -
aceertify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
ompensatlon laws of California,and agree that if I shout come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro ' ions.�
-Applicant G.S-�P �F Date:. 2_ 2 2_ D 1�
def: 1' EF
TTHOUING:'FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER,TO CROANAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED
HWSAND DOLLARS(5100,020),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3704 OE THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby.affirmthel.l am.liceneed under prrisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Profession3,Code,and my license Is in full
iprce end ettecLUc,q. - j-jj1 SS
L�Date:`Class a ) 7 3 "7
Cori eC or nature: _ _ _ 'C Z Z 'L 0<
\..,.
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,altar,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or presnt or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes Ci-i No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Cale provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermil for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(II yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
B (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
9 <42, Si tura UnOwner(s) /2 D1'�ate 0
r AulKo�rizzeed Applicant / C'-Oete -..
LODE 6 INSPECTION TYPE ALE MAILS LODE! INSPECTION TYPEQAC. =MS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 4.-/P- S 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
: . City of Costa Mesa Building Division
PERMIT PROCESSING CENTER
i SUBMITTAL APPLICATION
Activity Number: Received By:
Project Address: (t('' L ) s ar ( n Suite/Unit:
Homeowner Association? ❑ YES (Approval letter from HOA required) ❑ NO
Existing Chain Link Fence? OYES 0 NO; OWNER OCCUPIED? OYES R"NO
OFFICE USE ONLY
SUBMITTAL TYPE:
❑ Building/Grading 0 Planning/Sign 0 Engineering ❑ Fire
❑ Plumb/Meth/Elect. 0 Other
Description of work to be performed: (please be specific) P.OM ro .e_xt SC,k ,. o AoQ SL..c k a__
-tS(-SC'C pig-lino o) Si-A-4-4;114 el s .. 5f-.elf 3O .7r- C(-7 -( A
C-o re.porit(-Ion S (,.r ,.CIL re){MC 511 Ste-v.v. e n(ar lorowr.. S(it.p c: /L
Sq. Footage: 3 rz' 00 Type of Const: Valuation: ( l -7 O
Occupancy Type: Occupant Load: Grading: Cut/Fill cubic yds.
Owner/Tenant: 0' - pt.()p A"4 ^^ '+ m.e...t Phone No.: 1 (("( aLC o l 1 O 0
Address: ( G i '()L c,--01-).-,tc rcJ Suite/Unit: Z Z 3
City: (`-(' c.n j- t'n (+r^ 11,2---{ GC-. State: C-1 Zip:
_ S!-4MA. LL ✓ L
SAtnDoO.
Applicant/Agent: T�tL CD h SL (".r/'C ; 0 ^ S1<Phone No.: SYS � Y 0 MI
Address: /06 Ltd Cc .. £C. Suite/Unit: CDL#: 3 7 p2 /7
33
city: c - C (e-NI_L—vtk C—• state: C./S, Zip: 2 ,---7 2
Architect/Eng.: Reg. No.: • Phone No.:
Address: Suite/Unit:
City: /r State: Zip: �3
Contractor: r r & co,4r,,nc ' 5l
'D /c , I wb / !Phone No.: "J 'f (0 / 0 0
Address:/ O C-P7 ce 4 ...,pd �- Suite/Unit:
City: SA "` L( e-M2.v 4 e_ _ -- _- State:C/a Zip: / C -1 0—
State License No.: ?. (3 13 Class?) C31Expiration: & 3 I o-‘
Workman's Comp. Policy No.: (6�7 eS*--/7._ 2 ODS Expiration: ( o 6
Insurance Company: <f cr ¶( COAn pz—, S.sJi'., own (•,s ti(-A n G,__ -R..., f/
(SEE BACK FOR ITEMIZED ELECTRICAL, MECHANICAL AND PLUMBING)
_ ELECTRICAL,PERMIT
Qty. Description .fly. Description /. Description
ISSUE FEE Motors to 50 hp Transformers up to 100 kva/kw
Temp service test Motors to 100 hp Transformers over 100 kva/kw
Res. a/c package Motors over 100 hp Low Voltage Equipment
New Res (1-2 units) Communication drops Low Volt Wiring System/Ckt
New Res (3+ units) Sub panel to 200a Misc. Conduit
Pool/Spa Pole Light Pkg Misc. Conductor
Lighting Fixts Sign Circuits Circus (gen or ride)
Recept Outlets Temp Pwr Pole Circus (mech ride or lights)
Switches Intermed Pole Christmas Tree Stand
Non Res Appl Temp Dist System/Lighting Fireworks Stand
Res Appl Busway/100 ft Other Electrical Fee
Service to 200a Standing Section Investigation Fee
Service to 1000a Misc Electrical Equipment Plan Check Fee
Service over 1000a Transformers up 1 kva/kw Reinspection Fee
Motors to 1 hp Transformers up to 10 kva/kw
Motors to 10 hp Transformers up to 50 kva/kw
MECHANICAL PERMIT
Qty. Descripion Qty. Description Qty. Description
ISSUE FEE Smoke Dampers Compressors/Absorption Systems
Inst FAU < 100 k BTU Inst or Relocate Appl Vent Up to 3 hp/100 k BTU
Inst FAU > 100 k BTU Air Handlers < 10000 cfm 3 to 15 hp/500 k BTU
Repair/Alt Cooling/Heat Air Handlers > 10000 cfm 15 to 30 hp/1000 k BTU
Inst/Rep. Recess Wall Htr Floor Furnace 30 to 50 hp/1,750 k BTU
Refrig Sys < 100 k BTU Floor or Suspend Heater Over 50 hp/Over 1,750 BTU
Refrig Sys > 100 k BTU Repair/Alt Absorbtion Unit Boilers
Gas Piping Repair/Alt Refrigeration Unit Up to 3 hp
Factory Fireplace Ventilation System 3 to 15 hp
Hood w/Mech Exhaust Evaporative Cooler 15 to 30 hp
VAV Box Commercial Incinerator 30 to 50 hp
Vent Fan/Single Duct Domestic Incinerator Over 50 hp
Appliance Other Mechanical Fee
Fire Dampers Investigation Fee
Plan Check Fee
Reinspection Fee
PLUMBING PERMIT
Qty. Description Qty. Description Qty. Description
ISSUE FEE _ Laundry Tub/Washer Sump Pump
Backflow Irrigation Landscape Irrigation Swimming Pool
Backflow Preventer P-Trap Trap Primer
Bathtub Pressure Regulator Urinal
Clarifier System Process Piping (per 10 ft) Vacuum Brkr Bkflow (1-4)
Connect (Ice, Soda, etc.) Receptors Vacuum Brkr Bkflow (5+)
Dental Units _ Septic Tank Wash Basin
Dishwasher Sewer Cap for Demo Wash Basin Set
Drain, Floor Sewer Connect Waste and Vent System
Drain, Rainwater Sewer Private Line Water Closet(Toilet)
Drain, Roof Shower Water Heater/Vent
Drinking Fountain Sink, Bar Water Piping (Inst or Rep.)
Expansion Tank Sink, Commercial Water Re-pipe
Gas Earthquake Valve Sink, Floor Water Service
Gas (1-4 outlets) Sink, Kitchen Water Softener
Gas (Over 4 outlets) _ Sink, Service/Mop OTHER
Gas Repipe Spa (Private) VIOLATION
Gas Service Spa (Public) PLAN CHECK
Interceptors (Grease, Oil) REINSPECTION
Interceptors (Sand, Auto)
2546-46 (rev.4/04)
ADDRESS OF BUILDING 144 LISA LN , `, 01n` A CITY OF COSTA MESA - BUILDING PERMIT
0WNEWSNAl1EIFlaoxe:MARTING, RICHARD APERM NO: P 082247
"mtss: 2173 VISTA ENTRADA .. ,
NEWPORT BEACH,CA 92660 t12- PERMIT NO: P 082247 PLAN CHECK NO: N GOVT: N SUPP : N
251-8012 L
APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE; PLU PURPOSE: REP
ARCHITECT OR MINER: H. C. HANSON ANO-, 53027 JOB DESCRIPTION : SUBSIDENCE SLAB REPAIR DUE TO BROKEN PIP SQ FT:
APCN.OPENO.'SADDPESS: 17371 IRVINE BL uNT 120
TUSTIN CA 92680 CLAIM VALUE: CALC-VALUE: GROUP OCC : R-1 /
CONWIIACTORSNAME:JOHNS PLUMBING & HEATING ( 213 ) 661-9105
cONTRACTORSMNNNG 1840 HYPERION AV COMMENTS : REF: B-81117
ADDRESS: L.A. CA uc.NO.: 387623 ********u***uxx** -x-x-Stxx*SEI *****Dt*St**** (-*x*atu**SE*DE**M-***u**** -*it*x*x**** -*******
90027 UMT: ZONING REQUIREMENTS
LIC CONTRACTORS DECLARATION:I hereby rim under penSy of perjury ilei I am loaned under provisions d Chapter 9 SETBACKS
with Section 7000)of B aiOn 3 of Me Business LIC.CLASS: C 39dPu Professions Code,and my 387621icense 3 is nfull force and EXP eN� MAIN BUILDING ACCESSORY BUILDING
7 ( 7 cob..«: b 1� a�cc .i FRNT: FT IN REAR; FT IN FRNT: FT IN REAR : FT IN
/�%// LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
BUILDER DECLARATION:I hereby Ann under penal c%rluIT thin I am exempt from the Contractors License Law 1«the I
^.wig reason(Sedlen7031.5Busnees and Professions Code:AAAfifinyOty«oounty which requires a permit toomrenuct alter. PARKING REQ: PROV; PARCEL: 43908120 ZNE: REF NO:
'wnolrepass any or reparty structure.prior bas issuance.also requires the applicant for such permit to file a signed statement that he on she
tensed pursuant WM.provisions of the Contractors License Law(Chapter 9(commenmg with Section 7000)of Division 3 d the P LAN N I NG NOTES>
aim=es Prdeaiw Coded or that he or end is exempt therafmrn and the basis dor the alleged exemption.My violation of Section >
7031.5 by any applicant for a penin subjects the applicant to a WA penally of not more than five hundred Bogen(5500)). ****************************************************WWW W.W.W.*********************
❑ I.as ownerdrhoprwenyamy emPlme°s with wages as their sole compensation.MD do the work.end the not intended DEVELOPMENT SERVICES R E U I R E M E N T S
or offered ler sale(Carrion70u.Business and PMessionsCode:The Contractors License Law dose not apply to an owner of property Q
who betide or improves thereon.and who does such work himself or hand on through his or her own employees.provided that such
improvements we net herded a oflered lesele.1,however,the building«inprvennent is sold within we Yee"c«nplstion.the ZONING APPROVED BYDATE:
ownerbuilder will have the burden d proving he or she did not build or improve for the purpose d Sale).
o I,as owner of the'helicons.am estlrmrely contraci a wily lammed contractors to construct the project(Section 7044.Business and
profswipes Cider Titre Contractors license law mea not apply to an awnera progeny who builds alnwmer thereon and who BUILDING APPROVED BY ; DATE: li ^
contracts ler wdi Irojeds with a c«grador(s)licensed pursuant to the Contractors License Law).'' / M _ �� 1
❑ Iamemend under Section: B.AP.C.,for tsreason: Cs APPLICATION ISSUED BY: 1 / N �— DATE:
*****************************************yyyKKM.......44x___*
DmB1 Ov°° LEGALIZATION:N F E E SUMMARY STRUCTURAL S 'ME T:N
I do hereby caddy that I am aware of and understand the requirements of Caliomia Health and Safety Code Sections 25505,25533,and •- i. Z
•
25.534•and that I or any future building occupant will t wit not(ace one)need to comply with said state codes end the requirements for
a pemdfaamtmctlen ancddrelion horn thAiawTdy anegeent District.Residential amallWiana l iamaewnd lmndwe BLDG PMT PLUMBING ELECTRIC .�, MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 70 , 00 L ;. 7r' r
Date, Applicant: 25R SMIP/NON RES
PLAN ./1i
WORKER'S COMPENSATION DECLARATION:I hereby a/finn under penalty d perjury ons of the Iollowing daderati«i:
ISSUE FEE 22 , 00 ,�_
❑ have and MI mantas acendcata of consent lo sellinsurelr worker compensation.asprwided for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK 1-TOTAL PAID DUE
ca.,for the performance dthe work for which this permit leissued.
TOTALS 70 . 00 22 . 00 -/0 . 00 92 , 00 92 . 00 . 00
3p
I have and soil maintain workers'compensation insurance,as required by Section 3700 d the Labor Code,for Ihe performance of the _i _
work for which this permit s sued.My waken'compensation Insurance carver and policy number are: 1✓ i
Carrier COMP EXPIRES REVENUE DIVISION TOTALS--> COLLECTED.: ;
nr: (' 92c00 OVER/SHORT: . 00
Policy Number: (;471111418 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
is Section need not be competedI the permit is for one hundred dollars($0001 or lest.) 92 . 00v - _
I eerily thin in the performance d the work lar which Ihie permit b issued.I shall nal employ any person in any manner°o as to t
became subject 10 the workers'compensation Laws of Caldada. and agree that t I should became subject to the netters' **W.**.*********************.*.***.*******1E**'!f******.***lE****************************
pensatioqn provisions of SSection 3700 d the Labor Code.I shalllt tpthwith comply w-ith/Nose pr viysioons. i/ I N D I V I D U A L,- F E E `'B R• E A K D O W N
orn
1 Dat.: ?`'7 t -9 )/ Apptnanr: {//l�•rit. L% // .y�/�./ ..
ova Iffy:FaMun dosecure warkeri compsrwfion covmpsb NwM,,,and sheu are/ect err smpygwrrooemIn.Ip emu and TYPE QTY D E S C R I P T IO -N1
/ UNIT COST TOTAL COST
d fines up to one hundred thousand dollars($104000),In e Won to the cost of compensation damages es provided for In - "Z, •'+` ,
salon ams of the Labor Code,interest,and attorney'fees. PLU 1. BATHTUB - 8 . 75 8 . 75
\CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there s a constmdion lending agency ler the PLU '1. SHOWER 1 t - t , 8 . 75 8 . 15
pedormancedthe work/awfdchths permit isisued(Sedia,3on,Cit.C). PLU 1 SINK, KITCHEN Q ' 8 . 75 8 . 75
LENDER'S NAME: PLU 2 WAST{ BASIN �. 8 • 75 17 . 50
LENDER'S ADDRESS: PLU 2 WATER CLOSET (TOILET') y ''
8 . 75 17 . 50
I certify 11110 l have read this 0000a11onad state lhNibs above information sconed.l agree to empty with an CO aMoounty ordinances PLU 1 WATER RE-PIPE -- ,`t ' 8 . 75 8 . 75
sealing• stele laws to building construction and hereby authorize representatives of this dly to enter upon the above-mentioned doper/ 'o END FEES
for wptWgnlrapaaee / F 03-31-1997/10:34 AM/f92.00
]OLIN ❑ROI4Nf
PI �, 1 RCPT0:01-0804154
// ( -- '3 - - 9 } PERMIT:082247
Date:
Signature of Ower/Agonal .. . O -A 1.
(5151.46.WP) W de-Buhdag&Safety:Green-Fie. nary-Appicent:Pink-Revenue:Goldenrod-Assessor
•
...CONSTRUCTION AND PLANNING POO( WA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole -----\._
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. •( -7-k 53, Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. l`� 54. Forms -
4. Electrical Contluit-Undrgrnd, - . 55. Electrical Bonding
"5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical LIFER-Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8, Foundation 59. Gas Pipe,0 Undrgrnd.,Test
•
9. Water Pipe-Undrgrnd. • 60: Backwash Lines, P-Trap, 0 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
I14)RoughPlumbingr9_a..t, $�� 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
'17. Rough Wiring Sign • - - - 68. APPROVED FOR PLASTERING
18. Rough Electrical-t Bar Ceiling 69. 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 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24, Roof Framing 73. Undergrnd.StorageTank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydra
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 PREY. FINAL
30. Drywall Nailing 4. . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final - " 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: r
•
34. Final Heating,& Air Conditioning
E,iDAra)i__j ror -a-v r k 5tthetiot
35. Final Gas Pipe-Test .. • / stye
- 36. Hood or Canopy 4- 4. ,c`
v1i nD 1 c-1 , T} =r"ts . C
37. Final Factory Fireplace _ - -
e Final Plumbing £? n -T' (le- - /- a OUGH PLUMB. ") -______6i17
39. Water Service-Final , - 4-7 30cp i s-_ ,ga of_:40. Gas Service-Final I ( (�,'1 U/A ����22 --
5g2.. t'7 J'rlVfl L Z
41. Solar Domestic-Final -
42. Backflow Preventer
43. Backflow Irrigation : .
44. Landscape Irrigation System • •
-
45. Sound Attenuation
46. Handicap Regulations - - ' -
47. FINAL STRUCTURE& BUILDING Y
48. FINAL PLANNING' ..
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co i
51. CERTIFICATE OF OCCUPANCY
No. Date
ADDRESS OFBWL903) 144 LISA LN °Ni' CITY OF COSTA MESA - BUILDING PERMIT
csmur°UAMEIF"+owwMARTING RICHARD A PERM NO: B 081117
, AODREss. 2173 VISTA ENTRADA
NEWPORT BEACH,CA
251-8012 92660 PERMIT NO: B 081117 PLAN CHECK NO: 05170-96 L GOVT: N SUPP : N
APPL.WINO ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STA PURPOSE; REP
ARCRDECTORENGINEER: H.C. HANSON LlCND.: 53027 JOB DESCRIPTION : SUBSIDENCE SLAB REPAIR DUE TO BROKEN PIP SQ FT: 30, 000
ARCILDRENa'SADORESS: 17371 IRVINE BL DIT: 120
TUSTIN CA 92680 CLAIM VALUE: 30, 000 . 00 CALC-VALUE: 30, 000 . 00 GROUP OCC : et-i i
CONTRACTORS NAME KENCO CONST INC ( 818 ) 507-6900
CONMPACTORSMMLg1G 1505 GARDENA COMMENTS : TRIPLEX REPAIR DUE TO BROKEN PIPE DAMAGE, REPAIR STRUCT AS NEEDED
ADOREss:GLENDALE CA uC.NO.: 271916 AtBEAFxiF***4*****x**********FRSE**Ar** Fr*+t*FEitx*xBRAE****FErtiE*xx***RRx***Frx*ARxiF*****iEFtrt+r**
91309 DLT ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penal)/of perjury that I am rimmed under provisions of Chador 9 SETBACKS
(oommendng with Section 7000)of Division 3 d the Business and Professions Code,and my license is in full face end egad.
CRYLIC'NO.:024890 055' B 'a: 271916 EXP: 00/00 MAIN BUILDING ACCESSORY BUILDING
���.� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: /' /6�q7 coaad« LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby drum under Penal/of perjury that 1 am esanp from the Conned=License Law lot the
following reason((Section 70315 Business and Professions Cede:Any cey a toady which ngdres a permit to oonawd.after.improve. PARKING REQ• PRO V• PARCEL: 43908120 Z NE: R 2-M REF NO
demolish,or repel any structure.pie to es issuance.anis requires the apofcard for arch permit to fle a signed statement that he a she
e licensed pursuant m the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 d the PLANNING NOTES> REPAIR EXISTING FOUNDATION DAMAGED THROUGH SUBSIDENCE.
Business and Professions Code]or that he a the is exempt therefrom and the basis fa the alleged exemption.My violation of Section >
7031.5 by any applicant for a permitsubRcts the poplin-sof Yoedvd penalty drot more thanfue hundred dollars MOOD. *******************************************************************************
❑ I,ascomer ofthepropedyormyemployeeswithwagesasMeisolemnpensation.udothe work,amthe structure is not intended DEVELOPMENT SERVICES R E U I R E M E N T S
or Owed for sale(Section 7044.Business and Prolesdply ons Code:The Contractors License Law does not aploan owneo Proven), Q
who bolds a Improves thereon,and who does such work himself or horse,a though his or her own employees,provided that such
improvements we net intended or°tiered for sale.If,however.the building a inprwemea is sod within one Year°f completion.the ZONING APPROVED BY ; —r GAsi Pc3GU . DATE: I -10-97
owner-builder vii have the burden of paving he or she did not build or improve for purpose rpose d sale).
❑ I,as owner of the properly,an exclusivelycontracting with licensed contractors to construct the purled(Section 7044.Business and I r �
Professions Coda:The Cwd
r. a.Lip«ne Law does nes appy m e d an owrproperty whoWith Ori improves thereon and who BUILDING -APPROVED BY : 5C'1'� DATE:/^I-• t0-%n
7
contracts for such projects with a wneradons)fceiiaed pursuant to the Contractors License Law). / /�./ r is
❑ I an exempt under Section: B.&P.C..krfra reason: APPLICATION ISSUED BY: *L*/ DATE: I 9
*+r**********x********************************* * ************************* ***
mat. LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I ern aware of and understand the requirements of California Heath and Safety Code Sections 25505,25533,and
25534.and lhatl«onor buildingoccupanttheA,win?wanes(dmlearo)treeemwmpyw.nedddd.aodesanemefrm thfor
ese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
2534.andmat construction«moeibrmonhoccuhaAr�iiIwi ahglale°ii need
tosiomly mmadion°pcedeian t ever=requirements
provisions. PERMIT 394 . 75 3 . 00
Date: Applicea: SM I P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury reed the following declarations: PLAN 256 . 59
❑ Ihave and wilmaintain auNmd
foeoonsenttoselfinsreforwan .n
workers' Section ISSUE FEE .
Cede,for performance ispamale.,ued. BUILDING DIV > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
jj ve
Ih° and wilmdntanworkers'canpamatow
nirenoe.asrequkedbySedion370ofthe Labor Code.for the performance othe TOTALS-- -> 397. 75 0 .00 256 . 59 654 . 34 654 . 34 00
work for which this permit is issued.My workers'compensaton'amurance carrier a l policy number ere:
Carrie: )JAFF�TY MUTUAL EXPIRES REVENUE DIVISION TOTALS--> COLLECTED; 397. 75 OVER/SHORT: 00
Poky Number: WC77166109 6 04/01/97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This sedan need nes be completed a the permit b for one hundred doers rstm)or lest) 394 . 75' 3 .00
❑ I certify that in the performance of the work fa which this permit is bayed,I shall 1101 employ any person in any mane so as to
compensation
bacon*
the workers'tnmdeers'°co pcf°tihe Labor hoe el Codec donolbflolwnh'°pr°°COM if I should oanpy wen(nosepbeoomeone.sullied To to wonk°n' *******************************************************************************
"
I N D I V I D U A L .F E E B R E A K D O W N
Date: /-/°--cr.? APPI�d: e
Warning:Failure to secure worth'eorrtoerteaaon Coverage le oolawfu.god snail meteor en employer to cdrdnelaanm°a and TYPE QTY DESCRIPTION , UNIT COST TOTAL COST
civil linos up to one hundred thousand dollars($f04000),In sedldon to Urs coal of compensation,d°nnsgss es Provided ter In
SKtlon azae of the labor Cods,Inre..L end afromey'•hsa. SFR 30000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 30, 000 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097,CN.C).
LENDER'S NAMEn li
LENDER'S ADDRESS: P
.a
I certify that I have read this application and date thatinformation b coned.I agree to comply with all oily and county ordinances
and stale laws relating to building construction and hereby=both.)representatives d this cyto enter upon the aboe-mentbned property
for inspection purposes. JAN 1 0 1997
2M"{�A"RY MC CONNELL
Print Name X �f Signature wn
oadAgerunppf�rmd
conda Date: "e7-77 CITY OF COSTA MESA
•
(5151-48.WP) White-Building&Safely;Green-Rte:Canary-Appicant:Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POO SPA
(lPPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
- r _
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
L1- _L. - r.: U. �..
c3rElectricalConthtft-4kdity-Undrgfnd. 54. Forms
51gctrical CQprdtttuadrgrnd. 55. Electrical Bonding
;:- Steel Reir orcement- 56. Rough Plumbing & Pressure Test r
' ✓- _ -t r.
" .¢', ,lectrica`Ii EFnd. -/ 57. APPROVAL TOCOVER-GUNITE c
,;,•:::7. - " �' 4/S7 58. Electrical CondiNUndrgrnd. -
,Fbundatioil? : M 59. Gas Pipe, 0 U iirgrnd„Test err_ .:
R.`Water Pipe-Undrgrnd. p 60. Backwash Linesa.P-Trap, 0 Undrgrnd.
a
10. Structural Floor System 61. APPROVAL T(ZD€CK
Ki
11. PropertyPrSewer Line.& House-Connection 62. Backwash & R6eaptor -Final
12. wer Cap `
Se - 63. Heater& Vent-F�-ittal
13. Roof Drains ,`',.•_, 64. Plumbing System - Final ,
14. Rough Plumbing. :•! 65. Electrical-Final
se
15. Rough Electrical Conduit 66. Solar System-Fiinal •
16. Rough Electric Wiring a 67. Fencing& Access Approval
17. Rough Wirinlg Stjn o 68. APPROVED FFTPLASTERING
18. Rough Electrica5T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FthE QEPT•-,REQUIFIEMElj cti
20. Rough Facto Fiw�lace " S< 7. r 'K APPijOV¢LS PAimit #
Oucts,ini truaturelK •• .. =+= x -'s: G ,-.v. rs F_ v
21,
�. � <,•:. v -. „x r 70.�lndergiound F dro
22. ucp:, VeQtiloin y . � Q C ,z . 71. ProdFSpingrEtas W Oil ,.,
s _
23. 'Gas Pipe•RoUh& Test nS T m tL O z 1- 72. Undergriild Pttrh3.' o
C.
24. RooFFrarming" `F - * ti r,; = 761 Undergrntl.Sto yf;7ank':❑Gas ❑Bil
- - + .. .- 're. e: 0 ale 2 - •.
25. Roof-Sh®thing c, V V 1: 7 cu t 74?cOvdhft,ead Hydei '•
26.°F'-Bad CeiiiP9 (Strucrall & Mnso`coat iTi T. 0 ill* 7jjry.,. hegfical r,•� w,
27. Fra me and Flashi, a =.z;a: a ^7
n9 -r.. 7 Crr.T > �a 76. Dry StanT pipe��,� r r c
; 28. LathingSiigng -K '4 HSF• -x z "I "I " 7Z'; FIXED`,rS`RSTEINA .: n to
29. Insulatia r r _ S `' n (ix U L
7A FIRE PREV. FL ;1 > tr,
30. Drywall tilailirfg fi.itg H xx•. ^ I I i' s ~n,FtvEAL15I DEP"Tf•.pE&)IFYEMENT
31. Plaster Browne Coat x S • :rtr S tr * ? 79. FINAL CNSPECT-ION r m
'
32. nElectricakPovver Me(,erTF•Unal ' `; "' i a. 8Ff FOOD CERTIP3CATE It Ss )E¢, x
` U L 4 r[ ��p� ,/-/ y___yR -
S_ 33. .Einal:Elertricf �! art. G : K I �.: NStes_3�2 7/,_;�OfJ4il�I i/� .,O l/
��LL 1i
i 34. •Fina7-Heatind& Air CopelltioriingS :F > I rt 147:e7 SO
: .Gx e/
35. ig,,inal Gas:Pipe:Tesh,: C _ E. : arc p•-,
4 • .1 . ..n f:L . I.-
r. 36. Hood'or&anopy T. T L=`- a C. 1 I.1 S % rpJ C-
37. F.inilFai<10rY Fireplace ,: - .1.-.,...- rx 'V r
38. _FinaYPl4,,bi29 "'"` ` S "" x s C
39. Vete? SexvIce_Fina1 x : `r r - , - r I .* > .p `;`•• -" S
• 40. Gas Servrce-FTal •- rr - SFt * _ , I* 04. %tv x
• 41.Solar Do-Mesuc•F 5 ;n - * " i it Y u e > „ j.�� fM"
42. Backflow.'Prev_enterr .., •Z 'ix Us.r 7F• • •' t- V/
r- .. , n ry ;-...-1 t 'a: rr v r ::i C 'r' T- ...T �..
43. Backflov7lrr.gatio0r >S' Z` r- K n ‘4..t-. J �+ ; c 0
._ F 'P.0 r F n1 t - ,-� f
44. Landscape Irrigati6ri Systemr ? rc w n S r CK 3 f: v r� Gc - S f- � -
- -- w e- r•- x 2. H c. i. . r. 714. 1., . A I. `^
1t5. Sound Attenuatibnp .. e x -- c- C' _ C; . �-.n
_ Q
46. Handicap•flegulatitns ,....1. ' S ��-1 Ci G. Jr
67. PINAL STRUCTURE & BUILDING /S.,(f7 ! i/ '!o' g s
_ r
48. FINAL RLANNINg1 - L. r .v I h: �! a F 5,......./
t f t C x
49. lec.?ric Release tai tlison r
i ti‘7: rrx
rt ..; r rd
-50. Gas'Release to Southern California Gas Co
x - F
61. CERTIFICATE OF OCCUPANCY 5 •• .. -
No. Date
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ma MI BRIAN A. ROBINSON & ASSOCIATES, INC.
ENGINEERS&GEOLOGISTS - P.O.BOX 3328,VAN NUYS,CALIFORNIA 91407 I8IB17828282 1
FIELD OBSERVATION MEM •
DATES 2Ao /9/ WORK ORDER
NO .
JOB ADDRESS /1/11/ Z' S4 '4rP • r-)41 f
OBSERVATIONS
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ENGINEERS&GEOLOGISTS - PO BOX 3326.VAN NUYS,CALIFORNIA 91407 IEIE17628282
• FIELD OBSERVATION. MEMO
DATE 3//97 WORK ORDER NO .
JOB ADDRESS / 79/-�7, P
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ENGINEERS&GEOLOGISTS PO.BOX 3329 VAN NUYS.CALIFORNIA 91407 181917E128292
FIELD OBSERVATION MEMO
DATE 3/5 4/ WORK . ORDER NO .
JOB ADDRESS 974 // « /
OBSERVATIONS .
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ENGINEERS 8.GEOLOGISTS PO.BOX 3.928,VAN NUYS.CALIFORNIA 91407 18181782-8282
FIELD OBSERVATION MEMO
DATE 3/ 7C-if 7 W 0-RAC— ORDER NO ,
/ ��JOB ADDRESS l v1S5 /--° 44 os1r /SSG
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ENGINEERS&GEOLOGISTS PO BOX TRB•VAN NUYS.CALIFORNIA 91497 181817828292
FIELD OBSERVATION MEMO
DATE 3/ 75-11/ WORK ORDER NO .
JOB ADDRESS 't ` /�D • CoCA '
OBSERVATIONS
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Sandy Pringle & Associal , - •
STRUCTURAL INSPECTION CONSULTANTS
PO Box 840, Hermosa Beach, CA 90254-0840 ••
OFFICE (310) 798-6868 FAX (310) 376-5294
REGISTERED SPECIAL/DEPUTY INSPECTOR CERTIFICATE OF COMPLIANCE
/( � Yr7797 BUILDING DEP T TL /"l ' 1� ) 117 Project Date Project Name /;:'`5 cr ,--nate I W ob Phone
Project Address1 yS�4 � aSTA- E04
Owner's Name 1 c'S7 {t) Phone #'s
Address
General Contractor C Phone
Address -II fJ Fax
Site Contact �I,Q Vltk Beeper
Sub-Contractor v Phone
Address
/y Fax _
Engineering Firm 1'' Ih /, Phone 7/ L}• Z3 00
-13
Address/737i RIVV1; it . g1:71(7-0 he n49268b Fax (56,svce
Name in Seal Contact
Architectural Firm Phone
Address Fax
Name in Seal Contact
TYP F INSPECTION: Reinforced Concrete, Gunite, Prestress, _Grading, Framing
A'Rebar, Hi-Tension Bolts, Anchors, Structural Masonry, Welding, Other
To the Building Official: Buildinginspector. nt o..5
I hereby certify that the following portions of the work at the above address which required Special/Deputy Inspection
and for which I was employed to inspect, were inspected by me and comply with the applicable provisions of the Building
Codes and the approved drawings:
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Inspector (Sign) /!” // / airGr Date 3
HOURS: Mon, Tues, Wed, Thurs, Fri, Sat, Sun
Verified By: (Print & Sign)
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ENGINEERS S GEOLOGISTS PO BOX 3329,VAN NUYS,CALIFORNIA 91407 I8ISIm2-82E2 •
FIELD OBSERVATION MEMO
DATE L/ L f � WORK ORDER NO .
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ENGINEERS&GEOLOGISTS P.O.BOX 3328,VAN NUYS,CALIFORNIA 91407 IDtOP828282
FIELDOBSERVATI ® N. . MEMO
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DATE v/ i /I 7 /yV WORK ORDER NO .
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FIELD OBSERVATION MEMO
DATE t./ / /17
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ENGINEERS&GEOLOGISTS PO.BOX 3328,VAN NUYS.CALIFORNIA 91407 18181782-8282
FIELD OBSERVATION MEMO -
DATE / / /? 7 WORK ORDER NO .
JOB ADDRESS I " 7..--- /4ti (0"e- ` —C,'7`' ` 1115``
OBSERVATIONS
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Sandy Pringle & Assoc 'es,
STRUCTURAL INSPECTION CONSULTANTS
PO Box 840, Hermosa Beach, CA 90254-0840
OFFICE (310) 798-6868 FAX (310) 376-5294
REGISTERED SPECIAL/DEPUTY INSPECTOR CERTIFICATE OF COMPLIANCE
BUILDING DEPARTMENT C' .s« Ace* Project Date Ape,c 7, 1 Fig
Project Name FOLn a.t,,., ?c- +,t. Job Phone
Project Address 1 '4c4 L's#- LAVcc" Coo'7+ Mtg4
Owner's Name Phone #'s
Address
General Contractor Firc..pout, cc usi 2ocT,,,, Phone
Address Fax
Site Contact Beeper
Sub-Contractor Phone
Address Fax
Engineering Firm ht.c..-/. c c.tett,— Phone 7iµ) 573- 007_5
Address / 73 7 Iu,ur 3414 N,90 Rus 74-) Fax 7i4) 573- teSs-
Name in Seal • Contact
Architectural Firm Phone
Address Fax
Name in Seal Contact
TYPE OF INSPECTION: Reinforced Concrete, Gunite, Prestress, Grading, _Framing
Rebar, Hi-Tension Bolts, Anchors, Structural Masonry, Welding, Other
To the Building Official: Buildinglnspector:
I hereby certify that the following portions of the work at the above address which required Special/Deputy Inspection
and for which I was employed to inspect, were inspected by me and comply with the applicable provisions of the Building
Codes and the approved
��dr" //�Jovi:
drawings:
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PRIOR io ,iusi.rc..L R%in,i tftf2 ZNoCc 'Azp71 D.09..-,c?-r I
?Mori ty (?./m-n.Je,
Inspector (Print) License: 4%a 460 Type: Se: _
Inspector (Sign) Date V-7-97
HOURS: on, Wed, Thurs, Fri, Sat, Sun
Verified By: (Print & Sign
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
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For Applicant to Fill in Completely P CyTION FOR BUILDING PERMIT
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the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
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am exempt from the provisions of the State of California Business
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• "L AT •N FOR BUILDING PERMIT
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VI hereby acknowledge that I have read this application and state
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CC all laws regulating building construction, and I shall not employ
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I hereby certify that I am properly licensed as a contractor under,: SQ. FT. a
the State of California Business and Professions Code, Division 3,: THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: P
ric
am exempt from ti e provisions of the State of California Business
VALUATION
and Professions Criue,Division 3,Chapter 9. /66
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PERMIT FEE $ / N
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Signature ofm
Permittee $ PLAN CHECK $ E
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