HomeMy WebLinkAbout3109 TAFT WAY - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PE T NO. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION��y� � PERMIT ///�.� 2052 12/23/87 5400 TL
Project Address Nog 7Q * U21( �//� �( r r 3` T— 9 P.
Applicant's Mailin �A`dddrr ssss o9I39 .4Q(.CL'aldYTr G/'��`[( TYPE OF CONSTRUCTION LI NEW 0 ADO U ALTERATION CJ REPAI R
Owner's Name �J(�/4 Phone 7��^CLQ`—Z
CI CONVERSION III DEMOLISH ❑ OTHER A.P.# Zone
rs�el DESCRIPTION OF WORK/USE OF BLDG.
Address "✓'l S Main Building: Accessory Building:
E Z
Arch/Eng. __ _ - License No. TYPE OF PERMIT LI GRADING ❑ 50T O
UNDATION 0STRUCTURAL Front
Address ❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANICAL A Rear N
❑ OTHER
Contractor's Nam- 11 .. i di /��I�d Phone���`'��`�Q�`/'`'�'1'!' C Right N
Address(mailing) 2�%yl9 �/li' V PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G
�0 � CONSTRUCTION TYPE VALUATIONS $
City License No. 73ZONE __ GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Cr ���/ T
with section ]000) of Division 3 of the Business and Professions Code, and RECEIVED
my license is in full fo • effect.
License Cl.ss -� i -n /./ t S
Date Lr Signature L1O'S/ I f�/.� PLUMBING FEES
WOR KE'S'COMPENSATIOND LARATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate _
1 of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 15-50 KW
3800, Lab.
Automatic Washer Transformer
Policy Np. /93�{�� Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
certified copy is hereby furnished.
Date ' 'e y5 filed with the city illi is n.n �/� Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date i Applicant ��i(
EXEMPTf OILFROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or
less). /
., O�
Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify 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 Drinking Fountains Solar Tank Fan • Motors❑0-1 HP 011/2-B
Workers' Compensation Laws of California. -•
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE:If,after making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY /'. Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097,Civ. C.) Interceptors Water Heater •
Lender's Name
Outlets Range
'
Lender's Address Kitchen Sink Water Service Switches -Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or —
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section-7000) of
Division 3 of the Business and Professions Code) or that he/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).
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee ' $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES .
License Law does not apply to an owner of a property who builds or improves _- _ —_ -
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0
pre the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Data
provovthe for the purpose of sale).
❑ I, as owner the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By_ _ ' Dat
tractors to construct the project (Section 7044,Business antl Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ COPERMIT
❑ I am exempt under Section 8.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ S- V ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BTU— GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to enter .on the above-mentioned property for )/,�,�)
inspection par. . /�� Da le MECHANICAL $ TOTAL FEE $ Sir°
Signature a Lim 0
Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AN 'PLANNING POOL &SPA
D
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APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
rr
1. 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 Gmdc.�. 57. APPROVAL TO COVERIGUNITE
7. Footings , 58. Electrical Conduit-UndrgFM.
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 •
14. Rough Plumbing 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.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL •
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED Jr'
33. Final Electric Notes: '7:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace - •
38. Final Plumbing I-(Z-80 LCD •
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer - •
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
3i09 TAFT WAY
ADDRESS OF BUILDING: :t3 Df2•ri TA.rETfl my uMT: CITY OF COSTA MESA – BUILDING PERMIT
•
OWNERS NAME IF KNOWN:ASADA, YASUKO FLOOD : X 47 PERM NO: B 080382
ADDRESS: tOISHI ' S PROPERTY MGNT
750 AMANA ST #101 PERMIT NO: B 080382 PLAN CHECK NO: N GOVT: N SUPP : N
HONOLULU,HI 96814
tAPPL.MAILING ADDRESS: CONSTRUCTION TYPE: V–N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: uC.NO.: JOB DESCRIPTION : T/O WD SHING/RESHEATH1 /2"OSB, REROOF COMP SQ FT: 4 , 500
MCN.OR ENG'S ADDRESS: UMT:
CLAIM VALUE: 4 , 500 . 00 CALC–VALUE: 4 , 500 . 00 GROUP OCC : R-3 /U-1
CONTRACTORS/AME:DOO–RITE CONSTRUCTION ( 800 ) 525-7929
C ITRAcroRSMMIw032295 MISSION TRAIL COMMENTS: TEAR OFF WOOD SHINGLES,RESHEATH W/1 /2"OSB AND REROOFF/�W//30YR
AoORESS:LAKE ELSINOR CA men; 673031 ******************************************'x- -N******K-****+SK-xemopkL*FAty R
92530 on BLD 8 Z ONING REQUIREMENTS N.7
LICENSED CONTRACTORS DECLARATION:I hereby aftim under penaly a perjury that I am ' under provisions of Chapter 9 SETBACKS REQUIRED
/1Q U I R C D
(commencing with Section 7000)of Division 3 a the Business and Professions Cade,and my I' s i full force and effect. 1�•[L (s
CITY LIC.NO.: uc.Cuss:B MAO.: 67303 XP : MAIN BUILDING ACCESSORY BUILDING
�/ / i— FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
Done: I/– (! _9`� Donbmor. LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under pe pe' I am exempt from the Contractors License law In the
following reason(Section 7031,5 Business and Professions Code:Any city or comfy which requires a permit to ppratu d,alter.improve, PARKING REQ: P RO V: PARCEL : 14169310 Z N E: REF NO:
demolish,or repair any structure.prior to its issuance,also requires the applicant for such permit to fib a signed statement that he or she PLANNING N TES>
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of DH'ion 3 of the . .
Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My 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 PSSOOI). *******************************************************************************
o I,as ovmer of the propertY or my employees with wages es thei sole compensation.vAll do the work,a.nd the structure I not intended DEVELOPMENT SERVICES R EQU IR E M E N 'T S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owner el progeny
who bulds or improves thereon.and who does such work bmselt or herself or through ha or her own employees,provided that such :
improvements we not intended or offered forsale.I,however,the building of improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). -
❑ I,as owner of the property,am exdusivey nontrading with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of property who Wilds or improves hereon and who
contracts for such projects with a or(s)licensed pursuant to the ractas License Law). �/ T
❑ lamexempt under Section: B.&P.C.,for thtsreason: APPLICATION ISSUED BY: _ �1� ���– - - - DATE:
Date: °Me LEGALIZATION;N F E ES U M M , R Y STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534,and Meth any future building°cwp°ntwill/will not wile)need to complywlh said store cedes end the requirements kr BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modified/ion from theAir Quality Management District.Residential construction applications we exempt from these PERMIT 99 . 75 . 50
provisions.
Data Applicant: PLAN SMIP/NON RES
WORKER'S COMPENSATION DECLARATION:I hereby ell under penally d penury one of the following dedarnons: ISSUE FEE
o I have andwil maintain a certificate of consent to sea-insure for workers'compensation,as provided for by Region 3700 of the Labor BUILDING–DIV–> PERMIT ISSUE PLAN–CHECK TOTAL PAID DUE
Code,for the performance athe work for wkhthis pemaaissued. TOTALS----> 100 . 25 0 . 00 0 . 00 100. 25 100 . 25 . 00
❑ I have end will maintain waken'compensation insurance,as required by Section 3700 of the labor Code.for the performance el the •
work for which this permN is issued.My wonicem' insuranceaomp
ion ®crier and policy number are:
CartierREVENUE DIVISION TOTALS--> COLLECTED : __ 100. 25 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN–CHECK
(This section need not M completed if the pem<is for one hundred dollars(stool or bn.l 99 . 75 . 50
rw" ,PI certify tiled in the performance el the work for which this permit a issued,I shall no.em/- M.v'• in any manner 90 as to
become subject to the waken'compensation laws of Ceifornia,and agree that d I . subject to the workers' *******************************************************************************
compensations provisions of Section 3700 of the Labor Code.I shall fodhwi h campy I N D I V I D U A L- . F E E BREAKDOWN
— Dab: it—ly —/`i Applicant: — / / ':. ... , .
Warning:Failure to secure workers'compensationcow. nbwtu(a •shall srdlact an employer to edMrtel patterns and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil floes up to one hundred thousand dollars fSTOD,r c• in add/tion to tib cost of compawtbn.Smells s provided for In
Section 3706 of the Labor Cods,Interest,and attorney's lees. SFR 4500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 500 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of pejay that there is a°onstnaion lending agency for the END OF FEES
performance of the work for which this perms ls issued(Section 3097,Cit C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have mad this application and d that the above information is correct.I agree to comply with all city and count'ordinances
and state laws relating to building consVudi nd her. 'aul •ea representatives of this city to enter upon the above-mentioned property
fa irsPection purPonee.1 F..SS E G C�F a� 01 00218873-00218874 TOT 100.25
DATE: 11/08/95 TIME: 12:25
e,. .. P
Done: /1-4''?6
'slur o Ombr/AgenUAppFranVC°ntrada
(51St-46.WP) Whine-BuiM'vg&Safety;GreemFk:Canary-Applrant;Pink-Revenue:Goldenrod-Assessor
,71111
•
CONSI RUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
• 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ,1
' 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, 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
14. Rough Plumbing , - 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.Storage Tank ❑Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation • 78. FIRE PREV. FINAL
30. Drywall Nailing - - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: (/[
34. Final Heating& Air Conditioning - i�y/96 C. C r V
35. Final Gas Pipe-Test 111 V{�
36. Hood or Canopy
37. Final Factory Fireplace -
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING $4vv
48. FINAL PLANNING -
49. Electric Release to•Edison -
50. Gas Release to Southern California Gas Go
51. CERTIFICATE OF OCCUPANCY
No Date
ACORD .
CERTIFICATE OF LIABILITY1NSURANCE DATE., . . ... ... BUILD-2 07/13/96
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Arthur J. Gallagher & Co.• - SD HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 609006 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Diego CA 92160 COMPANIES AFFORDING COVERAGE
Robert W. Haukom COMPANY
Phone No. 619-591-1900 Fax N0.
A Argonaut Insurance Company
INSURED COMPANY
B
COMPANY
Builders Staff Corporation C
160 Chesterfield $9 COMPANY
Cardiff CA 92007 D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE.INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION I LIMITS
LTR DATE IMM/DD/YYI DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE
COMMERCIAL GENERAL LIABILITY PRODUCTS•COMPIOP AGG
CLAIMS MADE L✓OCCUR 1 PERSONAL 8 ADV INJURY j 1
OWNER'S&CONTRACTOR'S PROT I EACH OCCURRENCE
FIRE DAMAGE(Any one fIr.l 1
MED EXP(Any on.Person! 1
AUTOMOBILE LIABILITY I
COMBINED SINGLE LIMIT
ANY AUTO ; 1
ALL OWNED AUTOS I BODILY INJURY I 1
_ SCHEDULED AUTOS (Por canon/
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (PE!occident)
PROPERTY DAMAGE 1
WAGE LIABILITY I AUTO ONLY•EA ACCIDENT •
ANY AUTO OTHER THAN AUTO ONLY:
• EACH ACCIDENT 1
.
AGGREGATE 1
EXCESS LIABILITY i I EACH OCCURRENCE iI
t_ UMBRELLA FORM i AGGREGATE ; 1
I OTHER THAN UMBRELLA FORM I I 1
WORKERS COMPENSATION AND i X I Y LIMI TH.
TORY T
TORY AT
EMPLOYERS'LIABILITY EL EACH ACCIDENT 41,000,000
A I THE PROPRIETOR/ n INCL 121570115494 01/01/96 01/01/97 EL DISEASE.POLICY LIMIT 11,000,000
•PARTNERS/EXECUTIVE I--I
I OFFICERS ARE: I I EXCL' EL DISEASE.EA EMPLOYEE 111,000,000
OTHER I I
•
,HoommoRRMISawalawanaiwwwwwwwwwwwwwInal.
wwsoultmeamitaisaitar
(CONTRACTOR
DA OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL REMS DOO-RITE CONSTRUCTION LIC M673031 EFF 5/9/96
°ONLY EMPLOYEES OF'BUILDERS STAFF CORPORATION WORKING ON CONSTRUCTI:'c
NT; ,y_ ;.
LOCATIONS ARE INSURED UNDER EVIDENCE OF COVERAGE PROVIDED" j��I
PY
CERTIFICATE HOLDER • CANCELLATION
CONSTO4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIE LEFT.
Contractors State License BUT FAILURE TO MAIL SUCH NOTICE EMAIL IMPOSE NO OBLIGATION OR LLBILTY
Board
P 0 Box 26000 OF ANY RIND UPON THE COMPANY.ITS AGENTS OR REBENTATIVES. •
Sacramento CA 95826 WT "EPPK7NTAT a (-7 /
R b ff`Ha kE m `�'I eC� .¢ C'
ACORD 26•S (1/96) • . " . O ACORD CORPORATION 185'
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State of California
C01151.1111 11: CONTRACTORS STATE LICENSE BOARD '
Mein ACTIVE LICENSE '!W
Liana
Nnhm b 1 30 3 i EnuM i I1 U
"" 1000 — RITE CONSTRUCT 1011 •
•
•
• ciasocatimpl
EapiraS Oats 06/ S0 /9'd 44
2e37R FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN -1, 7 1984
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEP1. dr,J
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS 3109 Taft Way
RECEIPT NO. 2 I ll'JJJJ FF%7 NO.
COSTA MESA, CALIFORNIA nig
RECtIyHp BY DATEHC,EIVRD , DATE ISSUED
OWNER Northgate Homes (/(� /---7 -- .6y-9J/ JAN 1 6 1964
MAIL BUILDING
ADDRESS15939 Las Flares ADDRESSFIRE
[/I�
TEL. ZONE TYPE JT am- GROUPQV A
CITY Fountain Valley NO. 5316792 ✓
TECT /�
APPROVED
ORntaARCHin ValC. Hiller No' DATE
KE52007 BY
LAZONING
ADDRESS Anaheim (ma
—§ f ___/ IPNO.NOS YIaUUSEILODg�C i
,
CONTRACTaQn ser Const. Inc.
LEGA` /a—�'/ //(
Vett ; ,)1S �'
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ADDRESS 1593�]9 Las Flores DESCRIPTION
CITY Fountain Valley A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC..TNO. 215049 NO' 5316792 30"TO SIDEe REAR P.L.
EAVES
SIZE I NO.OF BLDG°. ALLOWED (U.B.C.REQUIREMENT)
OF LOT 97x102O
NOW ON LOT YARDS APPROVED YARDS APPROVED
USE OF 00 MAIN BUILDING., ACCESSORY BUILDING
EXISTING BLDG. -
(RONT0F
SETBACK LINE FROM FRONT •
8FT.OFT.
CENTER OF STREET 501 REAR YARD 28
SIDE YARD I LEFT 10 I RIGHT 5 R.SIDE CPT. Fr.
7
DESCRIPTION OF WORK L.SIDE / / Fr. Fr.
NEW X ALTERATION _'ADDITION REAR 4-ST. FT.
DISTANCE BET. BET.MAIN B
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDOS.
VAR.# DATE
BUILDING NO.OF SIZE 1747 ROOMS STORIES 2 C.U.P.# \ APPROV D y_ 6 v
EXTERIOR Way ROOF AP,FRO IF '.\11 /�� /
COVERING S bUCCo I COVERING shi le B �t`.YJI/\/VI/q l DATE
USE OF BUILDING AND WORK TO BE PERFORMED •�/ )` ' i,
single fam. res . w. att. $ fr ) V
2/ 6 / SQ.FT.J 9-2o4' J N
B
1 HEREBY ACKN. . •. AVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE T. 'T TH A. IS •RRECT AND AGREE TO PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH A CITY ES D STATE LAWS REGULATINGi
BUILDING C•NSTRU- VALUATION CO n
SIGNATOR • ' PERMIT FEE $ 72
PERMITTEE e $72 00 AO corc
AUTHORIZED AGENT �" " ��� oo b.
• TOTAL FEE $/o 8