HomeMy WebLinkAbout175 TULIP LN - Building Permits CITY OF COSTA MESA
fac, BUILDING DIVISION
l 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
%TOM'? FOR INSPECTIONS CALL:(714)754-5626
PERMIT NUMBER: BC10-00171
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 04126/2010
ISSUED BY: BE
JOB ADDRESS: 175 TULIP LN CM Suite/Unit:
APN: 42613207 Zoning: , ,
Vicinity: INTERIOR OF HOME Primary Occ:
Const Type: SQ. FT: 0 Valuation: $9,900.00
SCOPE OF WORK: REPLACE TWO EXITING FAU UNITS AND ADD TWO AC UNITS,NEW DUCT WORK,5 RECESSED
LIGHTS,AND 5 SURFACE MOUTED LIGHT FIXTURES TO COMPLY WITH 2008 ENEGRY STANDARDS.
OWNER: MALI SOHANAKI AND ROYA SOHANAKI Address: 175 TULIP LN Unit:
Phone: 949-280-4422 City/State/Zip: COSTA MESA,CA
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APPLICANT: MALI SOHANAKI AND ROMA SOHANAKI Address: 175 TULIP LN Unit: :
Phone: 949-280-4422 City/State/zZip: COSTA MESA,CA
CONTRACTOR: License No.
Phone: Address: Unit:
Cell: City/State: Zippode
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ARCHITECT: License No. PHONE:
ENGINEER: License No: PHONE
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $0.00
Building Fees: $181.25
Electrical Fees: $34.50
Mechanical Fees: $67.20
Plumbing Fees: $0.00
SMIP Residential: $0.00
SMIP Commercial: $0.00 •
Bldg Std Admin Fund $1.00 •
TOTAL FEES: $283.95
**Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010- PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays:
New Years Day,Memorial Day,Independence Day,Labor Day,Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE N. INSPECTONTYPE DATE INI1TALS CODEC INSPECTION TYPE DATE INIMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 5-1a-ID 4' aro
201 Final Block/Retaining Wall 212 Final Fire Prevention J
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy .7 q�'/✓4 41.14151
x C •
WORKERS'COMPENSATION DECLARATION: - Owner ID verified by drivels license. 10Yes ❑No k
I hereby affirm under penalty of perjury one of the following declarations: Sc Driver's License No. $ & Expires: x]/27 /to
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property lax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,or demolition
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be competed dtne permit is valued at one hundred dollars($100)or less)
2,Art 2Sec.341,Title 8,Califomia Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicants Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑ No
Lic.# Class# _ (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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safely Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five h red dollars($500).): of the California Health and Safety Code).
I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
x compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
pp I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions •de for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purpo e . I agre- not/. occupy or Ilow occupant of any building
/ autho e y ermi r til fig. Inspectio
/\ / y 4 ` • ' .
J rV�/ 1____1/4747111.2_ a of Leg. weer s) •ate
Signature Date
3057-46(3/07)
And/or Authorized Applicant Date
Mandatory Measures _amary MF-1R
Residential - (Page 2 of 3)
Site Address: Enforcement Agency: Date:
• /75- TWO p t,✓ 9-2)5(6
§1500)4: Solar water-heating systems and/or collectors are certified by the Solar Rating and Certification Corporation.
/ Ducts and Fans Measures:
§150(m)1:All air-distribution system ducts and plenums installed,are sealed and insulated to meet:the requirements of CMC Sections 601,602,
11 603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or.
enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable
. requirements of UL 181,DE 181 A,or UL 181B or aerosol sealant that meets the requirements of UI.723. If mastic or tape is used to
seal openings greater than 1/4 inch,the combination of mastic arid either mesh or tape shall be used
§150(m)1: Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet metal,
duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts.
Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts.
§150(m)2D:Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape
is used in combination with mastic and draw bands.
§1 50(m)7: Exhaust fan systems have back draft or automatic dampers. •
§l50(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers.
§150(m)9:Insulation shall be protected from damage,including that due to sunlight,moisture,equipment maintenance;and-wind.Cellular foam
insulation shall be protected as above or painted-with a coating that is water retardant and provides shielding from solar radiation that
can cause degradation of the material.
§150(m)l0:Flexible ducts cannot have porous inner cores.
§150(o): All dwelling units shall meet the requirements of ANSI/ASHRAE Standard 62.2-2007 Ventilation and Acceptable Indoor Air Quality in .
Low-Rise Residential Buildings.Window operation is not a permissible method of providing the Whole Building Ventilation required in
' Section 4 of that Standard.
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Pool and Spa Heating Systems and Equipment Measures:
— §l§1 I4(a): Any pool or spa heating system shall be certified to have:a thermal efficiency that complies with the Appliance Efficiency Regulations;
an on-off switch mounted outside of the heater;a permanent weatherproof plate or card with operating instructions;and shall not use
- electric resistance heating or a pilot light.
§114(6)1: Any pool or spa heating equipment shall be installed with at least 36"of pipe between filter and heater,or dedicated suction and return
lines,or built-up connections for future solar heating "
§114(b)2: Outdoor pools or spas that have a heat pump or gas heater shall have a cover.
. §114043: Pools shall have directional inlets that adequately mix the pool water,and a time switch that will allow all pumps to be set or
programmed to run only during off-peak electric demand periods.
/// §150(p): Residential pool systems or equipment meet the pump sizing,flow rate,piping,filters,and valve requirements of§I 50(p).
Residential Lighting Measures:
§150(k)]: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in
Table 150-C and is not a low efficacy luminaire as specified by§150(k)2.
§150(k)3: The wattage of permanently installed luminaires shall be determined as specified by §130(d).
§I50(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall he electronic and shall have an output frequency no less than 20 kHz,
• §I50(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high
efficacy lamps meeting the minimum efficacies contained in Table 150-C and shall not contain a line-voltage socket or line-voltage
lamp holder; OR shall be rated to consume no more than five watts of power as determined by §130(d),and shall not contain a medium
screw-base socket.
§I50(k)6: Lighting integral to exhaust fans, in rooms other than kitchens,shall meet the applicable requirements of§150(k).
§I50(k)7: All switching devices and controls shall meet the requirements of§I50(k)7.
§150(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy.
EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 ft`or 100 watts for dwelling units larger than 2,500 ft2 may be exempt
from the 50%high efficacy requirement when:all low efficacy luminaires in the kitchen are controlled by a manual on occupant
sensor,dimmer,energy management system(EMCS),or a multi-scene programmable control system;and all permanently installed
luminaries in garages,laundry rooms,closets greater than 70 square feet,and utility rooms arc high efficacy and controlled by a
manual-on occupant sensor.
§150(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated
cabinet.
§150(k)l 0: Permanently installed luminaires in bathrooms,attached and detached garages,laundry rooms,closets and utility rooms shall he high
Uefficacy.
2008 Residential Compliance Forms August 2009
Mandatory Measures L. ._.nrnary - MF-IR
Residential (Page 3 of 3)
Site Address: Enforcement Agency: Date•
X75 TuC(p _
LI-Z6,70
EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by a manual-on
occupant sensor certified to comply with the applicable requirements of §119.
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EXCEPTION 2: Permanently installed low efficacy luminaires in closets less than 70 square feet are not required to be controlled by a
manual-on occupant sensor.
' §150(k)I l: Permanently installed luminaires located in rooms or areas other than in kitchens,bathrooms,garages,laundry rooms,closets,and utility
rooms shall•be high efficacy luimnaires.
EXCEPTION I:Permanently installed low efficacy luminaires shall be allowed provided they arc controlled by either a dimmer switch
that complies with the applicable requirethents of§I 19,or by a manual-on occupant sensor that complies with the
• applicable requirements of §1 19.
EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site is not required to comply
with§150(101l.
§150(k)12: Luminaires recessed into insulated ceilings-shall he listed for zero clearance insulation contact(IC)by Underwriters Laboratories or
other nationally recognized testing/rating laboratory;and have a label that certifies the lumiunaire is airtight with air leakage less then.
2.0 CFM at 75 Pascals when tested in accordance with ASTM E283;and be sealed with a gasket or caulk between the luminaire housing
and ceiling.
§150(k)13: Luminaires providing outdoor lighting,including lighting for private patios in low-rise residential buildings with four or more dwelling
. . units,entrances,balconies,and porches,which are permanently mounted to a residential building or to other buildings on the same lot
•shall be high efficacy. - •
EXCEPTIONI: Permanently installed outdoor low efficacy luminaires shall he allowed provided that they are controlled by a manual
on/off switch,a motion sensor not having an override or bypass switch that disables the motion sensor,and one of the
following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an
astronomical time clock not having an override or bypass switch that disables the astronomical time clock;OR an
energy management control system(EMCS)not having an override or bypass switch that allows the luminaire to be
always on
EXCEPTION 2: Outdoor luminaires used to comply with Exceptionl to§150(k)13 may be controlled by a temporary override switch
which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six
• hours.
EXCEPTION 3: Permanently installed luminaires in or around swimming pool,water features,or other location subject to Article 680 of
the California Electric Code need not be high efficacy luminaires.
§150(k)14: Internally illuminated address signs shall comply with Section 148;OR not contain a screw-base socket,and consume no more than five
watts of power as determined according to§130(d).
§150(k)15:Lighting for parking lots and carports with a total of for 8 or more vehicles per site shall comply with the applicable requirements in
Sections 130, 132, 134,and 147.Lighting for parking garages for 8 or more vehicles shall comply with the applicable requirements of
Sections 130, 131, 134,and 146
§150(k)16:Permanently installed lighting in the enclosed,non-dwelling spaces of low-rise residential buildings with four or more dwelling units
shall he high efficacy luminaires.
EXCEPTION: Permanently installed low efficacy luminaires shall he allowed provided that they are controlled by.an occupant sensor(s)
certified to comply with the applicable requirements of§I 19.
•
it
2008 Residential Compliance Forms August 2009
• (Simplified Prescriptive Certiii of Compliance: 2008 Residential HVAC 4r. ions CF-1R-ALT-HVAC
Climate Zones I and 3-7
i CZ- i
Site Address: Enforcement Agency: _ Date: Permit#:
l7S Tu�4� ,l,r 1 �(.Z2nc��e y z�l� .
Conditioned Duct insulatro
_ Equipment Type' _ List Minimum Efficiency? Floor Area requireme �p hemostat
❑Packaged Unit �j l !r' W'S!J
' „ .Furnace (/tFUE76/0 ❑COP Over40f •I,duc etback
P1erved by system added re Ia s n
o indoor Coil SEER!3 O HSPFSPF_ r 20sV 0 sf pncy>'iditio a pace lfl"oraheadrpresent must be
.Condensing Unit ❑EER 0 Resistance C. l�'R b (CZ 1, 3-5) i'utal(ed/
❑ Other Y
1. Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement envy f approval with the permit
application. /A
k Jame: M 4 ��� 777y4
JvTr 1 Signature:
Company:
Date: H
Address: 2 Gtjtt_c s u r5-\/t License:
City/State/Zip: /� \^ .Sc, 0 (', cda, 9265-6 Phone: et49') OSb-t.(y22-
2008 Residential Compliance Forms March 2010
(ENFORCEMENTAGENCY
CAN;Ct STOMIZE` UTHEETTERHEAD/SEAL)
•
2008 Building Energy Efficiency Standards Residential HVAC Alterations.
Climate Zones 1 and 3 through 7 CZ-6 c Gas77,rrF�sFz
BUSINESS AND PROFESSIONS CODE,SECTION 7110 •
Willful or deliberate disregard and violation of the building laws,including the California Building Code,and
local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board
working in conjunction with the local building department. This action may consist of fines up to$5,000 per
violation or suspension/revocation of a contractor's license.
WREN IS A PERMIT REQUIRED?
A written construction permit shall be obtained from the enforcement agency prior to the erection,construction,
reconstruction,installation,relocation,or alteration of any mechanical system,except as permitted in Appendix
Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include, but are not
limited to:
• New HVAC installation
• HVAC Changeout •
• Replacement of furnace,coil,FAU,or condenser
• Relocation of an existing HVAC unit
Adding or replacing more than 40ft ducting in unconditioned space
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part j REQUIREMENTS INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception:Wall &floor furnaces;room heaters).
2. Central air conditioners&heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. • .
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points)is required for all alterations. .
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
-• All joints and openings in the in the HVAC system must be sealed.
• Only UL 181,UL 181A,or UL 181B approved tapes or mastic shall be used to seal duct openings.
Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4ft. max for horizontal runs with no more than 2"
of sag between supports and 6 ft.max for vertical runs.
6. The CF-6R-MECB-04 must be completed and signed by the installing contractor. The Inspector will collect
this form and verify that the model numbers are the same as the installed equipment.
• I
. t
, ,, .....110..1.11b1.,^ City of Costa Mesa Building Division
Costa77 Fair Drive, Costa Mesa, CA 92626
Mesa 714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # 6C/0- 00/7/
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at .
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
/051. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
/)j/} 4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
(t5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
taii6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
Aiki.7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
�8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
of r any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
fi9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
evenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
M10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
I I am the party legally and financially responsible for proposed construction activity at the following address:
;.: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
aside by all applicable laws and requirements that govern Owner-Builders as well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or of er verification acceptable to the agency is required to be
presented when the permit is is/�ed t rify t-.rot rty owner's signature. y
k aft Signature of property owner C •
/10, , ._, Date: �( /21:77/0
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature: Date:
3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2
This Documen s electronically recorded by
Law, ., Title Company B
'RECORDING REQUESTED BY: Recorded in Official Records, Orange County
Tom Daly, Clerk-Recorder
yatwtrs (/1". e
WHEN RECORDED MAIL TO: II IIIIIIII IIIIIIIIIIIIIIIIIII VIII II II IIIIIIIIIII 129.00
2010000190365 04:28pm 04/22/10
Mi•
Sohanaki .93 401 Got 2
2 Endless Vista 0.00 0.00 20.00 0.00 3.00 0.00 0.00 0.00
Aliso Viejo, CA 92656
:>0100P-15 SPACE ABOVE THIS LINE FOR RECORDER'S USE
APN: 426-332-07 GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S):
DOCUMENTARY TRANSFER TAX is $NONE CITY TAX is $NONE
computed on the full value of the property conveyed, or •
computed on full value less value of liens or encumbrances remaining at the time of sale,
Realty not sold
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
M. Ali Sohanaki and Roya Sohanaki, Husband and Wife as Joint Tenants
hereby GRANT(S) to
M. Ali Sohanaki and Roya Sohanaki, Husband and Wife as Community Property with Right of Survivorship
the following described real property in the City of Costa Mesa, County of Orange , State of California:
As shown in Exhibit "A" attached hereto and made a part hereof, and commonly known as
175 Tulip Lane, Costa Mesa, CA 92627
Dated:
}
STATE OF CALIFORNIA }ss ^,
COUNTY OF V Y7 e, } M.Ali anaki
On 14-17ri j 19. 7o° before me .
H '[� _ oya�ia aki
N.L . tb142017"4'/ Notary Public,
personally appeared QL jA. S6 itaI-ftat ; L
VVI . I41 ; Soluu a r;
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and off ial seal.
Signature 7,I j .6.4)1e171,0_
—
"This document filed for record by ;:nr.<, H.L.BUTCHER
,
Lawyers Tttleasan oasv9
• � .• • enn
accommodatIon•only. lt'hasnot j !,NotaryPublic•Californn
ni
' -been examined is'to Its•execution ' :a C, „ty� •
or,as to Its effect'upon the Vie" tiComrftECm Ms a,•.2.2013-' -
z r
.
s Applicant to-fill in all spaces except those within heavy border lines and sign all appropriate declarations. • r - .- - -
• CITY OF COSTA MESA •
• P MIT NO. TRA(•"-'r NOI'` ;LOT NO. BLDG.NO. I - i •
• .CONSTRUCTION PERMIT - i284 7 I -- 9154 4/23/84 = 29.3 PL
•
Project Address' k "' ' ' - - TYPE OF CONSTRUCTION ElNEW H ADD L ALTERATION ❑ REPAIR - t
Applicant's MailingAddress( lanlie+i•/+�trM �- ' • - ❑ CONVERSION '❑ DEMO I Ill OTHE- ' A.P.# 41.6-
��, I /� , (Zone r
Owner's Name •'/I ' G : a.•`• A. . .Phone-5711rt'Ong ' DESCRIPTIO OF WORK s�fn � 1�t ' _ 1
- r - -r at Pi...) ' 7Rv711✓/4' - - • S Main wilding: Accessory Building:. 2
Address J - . - (� r - - E - 0 '
TYPE OF P RMIT U GRADING- OUNDATI ON TRUCTU RAL T. Front ". N
•
Afch/Eng. - License No. . • C.TENANT ❑'ELECTRICAL r PLUMBING ❑,MECHANICAL •
- • I B _ ,
❑ OTHER - A• Rear :' N
Address - _ - j -
l. C Right - i G
(�- Contractor's Nam _ 'f- 'hone
-� PROJECT DESCRIPTION SQ. FT. TION OCCUPANCY'/'s 74.
,
"\O Address'mailing) lc '0 4-2.) . Abp• 4 tiJR . sA CON ST RUCTION TYPE •• • VALUATION$ .q5�. •$: Left R
I ZONE GRADING CU.YDS. ACRES •
O
City License No. ' a .X 7 / F Ping. Ref. •# . Park.Fees $ lJ
LICENSED CONTRACTOR DECLARATION , • Remarks: Parking Req./Providedsf - - . 1
hereby.affirm that I'am'licensetl under provisions of Charter,9 (commencing
YU with section 7000) of Division 3 of the Business and Professions Code, and • Use of Building: L • E
my license Is In full forcend effect.
License Cass License N. - , . - PLUMBING FEES Planning Notes: � at-e 4j 1� ,.y .p ,( M
Date -! Signature ,,ice, _ •- - - _- _r`-' "`- _""r" [rLl�' �P a A ! E
• Bar Sink Showers fa-c��_p� tj �,`wA. N
-"ORKERS'COMPENSATION DEC • RATION . ' /
ereby affirm that L have a.certlflc. e of consent to self-insure or a certificate'• Backf low Provence( f - Service Sink -"- .4 '- '- - > "- -- -"
Workers' Compensation Insurance, or.,a certified copy thereof (Section - - - . - '
.300, Lab. C. �r J Si / I I Backflow Irrigation Sewer Cap ELECTRICAL t FEES
Policy No. ��3' '-`�� 1 COm Pant Q`"P to /' - • -
pW�certified copy is hereby furnished. •-1 . Bathtubs Sewer Connection . Automatic Washer Transformer 0 15-50 KW
LJ certified
d o y f ed with the city Bull g Division. n ❑ 50+KW •
Date `1•-4' `i Applicant • .P%l,IUs emu
4. Clarifiers t -
Solar Collectors Construction Pole Sub. „ - - ..
EXEM PTION'FROM WORKERS:'.COMPENSATION DECLARATION • , Dishwasher Solar Piping ' Cooking Unit Meter ❑dp to 100 amps' S
(This section need not be completed If the permit is for one hundred ($100) or -
Iceless)rtlfy'that in the performance of the work for which this permit is issued, ' Drinking Fountains 'Solar Tank • Dishwasher Meter Odver 100 amps-
shall not employ any person In any manner so.as to become subject to the •r .
Workers' Compensation Laws of California. - Floor Drains ' • Swimming Pool w/Spa Dryers ❑Gas ,❑Electric Sub Panel '
Date • Signature •
-
' NOTICE:If„after making this declaration,y ,you should become subject to the ; Floor-Sinks - -- ' Urinal ' ' - ' - - Fan- ' Motors❑0-1 HP ❑'n4 8 '--
Workers' Compensation provisions of the Labor Code, you must forthwith ' - - -
comply with such ,provisions- or,this-`permit shall be deemed revoked. Gas Service . Outlets- Water'Closet, F.A.U. + Inc.Solar ❑9-15 HP ❑16-15+i, •
CONSTRUCTION,LENDING AGENCY r - • .
•
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater, L - Fixtures ;Microwave
of the work !or which this permit Is issued .(Section 3097 civ. C.) _ ' - - _ - '
Lender's Name Kitchen Sink - Water Service ' • ' , Device Boxes Pole Light
Lender's Address Lavatories, - '
OWNER BUILDER DECLARATION . , , Outlets ' , Range
I hereby,affirm that I am exempt from the Contractor's'License Law for the - '
followinreason (Section'7031:5-Business and Professional,Code: Any city or P-Trap • - - Switches , Sign ' •
county which requires a permit to construct,alter,improve,demolish or repair - -
.any structure, prior to its issuance, also requires the applicant for such permit ' Roof Drains - - Garbage Disposal Standing Sections -
to file a signed statement that he/she Is licensed pursuant to the provisions of _ _
the Contractor's-License Law,(Chapter 9(commencing with Section 7000)of Generator ❑0-5 KW ❑5-15 KW Trash Com actor
'vision 3 of the Business and Professions Code)-or that he/she is exempt ' . P
irefrom-and the basis for the alleged exemption. Any violation of Section _ .
.31.5 by' any applicant for a permit:subjects the applicant to a civil Reinspection Fee
enalty of not more than five hundred dollars($500). pe .$25 Issue Fee $ 3
LII, as,owner of the property or my employees with wager as their sole MECHANICAL Reinspection Fee $25 Issue Fee • $ 3
compensation will do the work,and the structure is not intended or offered ' FEES -
for sale (Section 7044, Business and Professional Coder TheContractor's PUBLIC SERVICES RE I' MEN '
License Law does not apply to an owner of a property who builds or improves ' Boiler '' Hood or Type I ❑ �� �
thereon, and who does such work himself/herself or through his or her own ' - - Zoning Approved By Date 2-3 SI • .
employees, provided that such improvements are not intended or offered for Canopy Type IL 0 I
If, Duct-Under Ground r
sale. I however, the building or improvement is sold within one year of com- Building Approved By Date
elation,the ownerwl11 have the burden of proving he/she did not build or Im- 9C-s12-3--
Drove for the purpose of sale). • Duct-Structural Refrigeration System Application Issued By ' Date
•
LJ I, as owner of the property,am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU _
tractors to construct the project (Section 7044,Business and Professions Code: . . Duct-Ventilating -� -_ SUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who BUILDING PERMIT �$ / 7.50 SMTP $ co
d
builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple ❑. System Repair/Alteration ' • • - -
•
tractor(s) license pursuant to the.Contractor's License Law). PLAN CHECK •' $ //•3 7 - PERMIT
0'1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING: $ SSUANCE $ •
Date Owner Heating System&Ducting
PLAN CHECK 25% $ ENERGY P.C. $
i herebyacertify ect I have readto- amply itand state that the above 004 00,000 BTU 0100,000 BTI - -� -. - GRADING $
information t correct. I agree this-application
with all clay and countythat ordinances I I ELECTRICAL $
and state laws relating to building construction,-and hereby authorize repro- , PLAN CHECK 50% $ MICROFILM $
sentatives of t is cI to enter upon the above-mentioned property for t Q(� St ,
Inspection pure s q MECHANICAL $ TOTAL FEE '$ •+C / r
Signature ' p--...0-.r n+,�_ Date _.2±g-� •
Reinspection Fee $25 .-Issue Fee $ 3 PLAN CHECK 25% $ -
Drivers',LIcensq r.SS l - _ - - - '
CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - , . -
r - POOL ?A .c.
? ^CONSTRUCTION AND PLANNING - , ; _ - r= - ' - -'
Date . Inspector ` ' Date's Inspector
APPROVALS Permit'# _ - APPROVALS, 'Permit# - 5 -
1.t 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. - .• = r 55.- Electrical Bonding •- - - - ,• ,,
5. Steel Reinforcement iso/ £ _ 56. •Rough Plumbing & Pressure Test ;?,; '
6.• Electrical LIFER Grnd. ' 1 ( . r ' ' 57, APPROVAL'TO COVER-GUNITE' y _ - -.
7. Footings - - • , t/ArbyA 58. Electrical Conduit_Undrgrnd. • _
8. Foundation, - ' - - 59. Gas Pipe, O Undrgrnd., Test; • , -a
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. Eledtrical-Final ' - "
15. Rough Electrical-Conduit i- - -- - - - - 66. Solar System-Final - _ . ' - " - "
t _
-16. Rough Electric Wiring - - 67.. Fencing & Access Approval ' - " ; __• '
17. Rough Wiring Sign • , 68.. APPROVED FOR PLASTERING ' " I c '
1&. Roa
ugh Electricl -T Bar Ceiling 69.' POOL/SPA SYSTEMS FINAL '.
19.,Rough Heating & Air Conditioning e ' FIRE DEPT.,REQUIREMENT , " • - - • • '
20.' Rough Factory Fireplace . APPROVALS' Permit # ' r '
21. Ducts, in Structure , . ' 70. Underground Hydroi i_ ` 1
22. Ducts, Ventilating 71. Product Piping O Gas. 0 Oil •_ A, '
'P3. Gas Pipe-Rough &Test ,P 4 1 72., Underground Flush • •- . I i I ;
74. Roof Framing - ..4 t i 173. Undergrnd.Storage Tank Gas O Oil - - • '
•
25. Roof Sheathing 714.1 Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 4 0 ' -. 75.' Dry Chemical , i :
27. Frame and Flashing' •' • ! 1 ` 76.j Dry Standpipe -
28. Lathing& Siding ^ ] . , , ,77: FIXED SYSTEM FINAL ` i '
_29.. Insulation i ' 178: FIRE PREY. FINAL ., �= r 1 i
_30. Drywall Nailing . ' HEALTH DEPT. REQUIREMENT ! ;
•
AM:MESSOF BUILDING: 175 TULIP LN r LMT' i CITY OF COSTA MESA — BUILDING PERMIT
NEEIFMIOW": GODFREY, BONNIE D `-
OWWSN"MPERM NO: B 076156
ADDRESS: 175 TULIP LN
COSTA MESA CA 92627 L PERMIT NO: B 076156 PLAN CHECK NO: N GOVT: N SUPP : N
( 714 )723-455
APPL.MAIUNO ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
•
ARC"NECT ORENOMEER: UC NO.: JOB DESCRIPTION : APPLY 20YR COMPO SHINGLES O/EXIST ROOF SQ FT: . 1 , 187
ARCH.OR DIR.'S ADORESS: UMT:
CLAIM VALUE: 1, 187. 00 CALC—VALUE: 1, 187. 00 GROUP OCC : R-3 /U-1
CONTRACTORS NAME: CRANK BROTHERS ROOFING CO ( 714 ) 548-5569
CONTRACTOWS MAILP 126 COMMERCIAL WY COMMENTS : REROOF OVER ONE EXISTING LAYER OF COMPO ROOFING
ADDRESS: COSTA MESA CA utNO.: 408677 +F*******+F+E*+ ESE*SH******+tiE*dE*******atiE3E*at-iFat*It St*SE*iESE*+r• -tt**SF**;'Eek*********x-*SE**aF**+E*+t
92627 UMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
CITY LIC.NO.: 0 0 5 9 9 3 LIC.CLASS: C 39 uO 4�0�J'(\}6�77 EXP: 06 /96 MAIN BUILDING ACCESSORY BUILDING
Date: /— 7--5=94, Contracto fv--s�e05 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I ant exempt from the Contractors License Law for the
following reason(Section 7031.5 Business and Pmfenions Cade:Any city or county whim requires a penult to construct.alter.improve, PARKING REQ: PRO V: PARCEL: 42613207 Z N E: REF NO: ,
lemoleh,or repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she r,+
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of DNeion 3 of the PLANNING NOTES> ,
usinem and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exempeion.Any vi nation Of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001). *******************************************************************************
❑ oree � ae doessinso �Cotriwill eooaure n�mr° 'd DEVELOPMENT SERVICES R E Q U I R E M E N T Soffemd for am(Section 7i �anPressions CdeThe Contractors License not dapyytoanOwner dp oprly
who budde or improves thereon,and who does such work Nmeel or herself or through he or her own employees,provided that such
improvements we not intended or offered for sale.If,however.the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE: '+
ownereuilder will have the burden of proving he or she did not build or improve for IM purpose of sale).
❑ I,as owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business and
Professions Code:The Contractors License Law does not apply to an owner of properly ono builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contrador(s)licensed pursuant to the Contractors License Law).
El I am exempt under Section: B.a P.C.,for this reason: APPLICATION ISSUED BY: ` t ^L * E 4:4;117:1 :
tt DATE: ( 'ZS`. 6
Date: Owner ************************** **** * ib*** * **** *************** **
LEGALIZATION:N F E E S U M Y STRUCTURAL SEGMENT:Y
I do hereby certify than I am aware of end understand the requirements of California Health and Safely Code Sections 25505,25533,and
25534,tfodthatlerionany r modure fuitiongomtheAOusThMnd(circleamut District.
Residential
lfhsaldonapodesand requirements these
fm BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
2534,permitforthat I r anormodibctliinhoccuhanl sae/wi of ce one)
nee toeioemW with construction codeioan the exempt ruireme tsfr
provisions. PERMIT 29 . 0050
Date: Applicant: SMIP/NON —RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN
ElI have and will maintain a certificate o consent to sef-insure ler workers compenwbn,as provided for by Section 3700 o the Labor ISSUE FEE
Code,for the performance or the work for which this permit isissued. BUILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
ElIhewand will maintain wmkemcompensation insurance.as required bySection 3700oOwLabborCode,orthe pedonnanceothe TOTALS > 29 . 50 0 . 00 0 . 00 29 . 50 29 . 50 . 00
work for which this permit Is Issued.My workers'compensation insurance cornier and policy number are:
Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 29 . 50 OVER/SHORT: . 00
Policy Number: 7R5-96TTNTT00224 01 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
this section need not be completed y the panel is for OM hundred dollars($ION or lees.) 29 . 00 . 50
❑ I cerfy that in the pedonnance of the work for which this pe( s issued,I that not employ any person in any manner eo as to
become subject to the workers'compensation lawn of C. .,and agree that ' coo become sublecl to the workers' *******************************************************************************
compensation provisions of Section 3700 of the labor Code I forthwith t
Data: Apda.n• i ,,
�— 2 --
s7C INDIVIDUAL F E E BREAKDOWN
Warning:Failure to secure workers'compensation Is unlawful,and shell subject en employer to criminal wattles and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollen(34:,, ) In addition to the cost of compensation damson es provided for in
Section 3725 at Me labor cod.!menet,ands • eye/su. SFR 1187 ALTER BY VALUE RESIDENTIAL NOZONE ( 1 . 00 1 , 187 . 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'tenni is issued(Section 3097,Cb.C).
LENDER'S NAME:
•
LENDER'S ADDRESS:
i
I certify that I have read this application and stele that the above information is coned.I agree to Co.'.1 with all city and county ordinances -
and state laws relating to building construction and hereby authorize representatives of this: .r upon the above-mentioned property I • .
for inspection purposes.
MURPHYO' BRIEN 01 C'�1Cl /T5/c.,5
4{,1'1e?-_'31SoSih&' '. :?'2 ;,fin
vnr Print Name / DATE; V(f•=�i/':�r ili,�2 ���
Date:
Signature dPww/AgenUA••' - --a r
�51de.WP) White-Building A Safety:Green-File;Canary-Appicant:Pink-Revenue;Goldenrod-Assessor ,
., I
CONSTRUCTION AND PLANNING - POOL _ .,PA •
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location t
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .
1.3- Electrical Condtiit Utility-Undrgrnd. 54. Forms -
'4. Electrical Conduit-ilndrgrnd. - , 55. Electrical Bonding _
.,-.5".--„Steel Reinforcement. 56. Rough Plumbing & Pressure Test ,
6;"Electrical UF ER G_md. 57. APPROVAL TO COVER-GUNITE _
' 7-,Footings - 58. Electrical Conduit-Undrgrnd. / • <I
' •
- 8 Foundation - . - 59. Gas Pipe, 0 Undrgrnd., Test
-9. Water Pipe-Undrgrnd. _. 1 p 60. Backwash Lines;P-Trap, D'Urdrgrnd.
10. Structural Floor System -:r 61. APPROVAL70DECK 171
11. Property Sewer;Fine & House•`Connection62. Backwash & Receptor-Finpf , 2
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System~Final V
14. Rough Plumbing- 65. Electrical-Final -
15. Rough Electrical:Conduit . 66. Solar System-Final.
16. Rough Electric Wiring 67. Fencing & Accels-Approval
17. Rough Wiring Sign 68. APPROVED FIPt PLASTERING-
18. Rough Electrical:f Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ., FIRE DEPT. REQUIREMENT
20. Rough Factory Fi�6p'lace - - r,t. - ;APPROVACS;:r, Permit # -
21. Ducts, in Stru-ciuri"� 70. 'L'lnder9round Hydro X
22. Ducts, Ventilating-_-. -• - - -r ; 71. Produc_tPiping O-Gas OOil
23. Gas Pipe-Rough & Test , '+_ * r 72. Underground F,fiisH: "1r
24. Roof-Frariiing - 11; - ±• . 733 Undergrnd.StoraggJankvD Gas 0 Oil
25. Roof Sheathing •` v - 'r 74: Overhead Hydro' ,
26. 12Bar'Celling (Structpral) & Moit Coat ` 75:.dry Chemical •-_-_-17- ''' -I -
27. Frame andiFlashing, 76. Dry Starfptpe ac - 11
_28. Lathing&Siding �.' 1 _ _ - ' 7. FIXED SY.STEM,CFINAL . •• :
29. Insulation •• 7$, FIRE PREV. EtpAL , ' t:
.-
,-
30. Drywall Nailing t- ' _ x .... _ ,HEALTH DEPT.REQUIREMENT
4 , - :
31. Plaster Brown:Coat-r ' 79. FINAL INSPECTION '
32. electrical;P.owzr Meter.-Final C. - : 80:; FOOD CERTIFICATE ISSUED r
33. F-final EleQVict _ i Notes: '.T. .-. "1T
If c
--34. FinaleHeading& Air-Conditioning1; t. - - : '. a. _.
35. Final Gas-Pipe;Test.: - • -, =1 c. Cr-' i_.-
n
-36. Hood•or CCanopy r0'" - 1_. -. -- T C'r *
:ri "3111
37. Final.Factory Fireplace • - - - - * r- - + Ci
• 38. Final Plumbing Y -
r 1t, r. S c: _
-39. Wate( Service-Finat 2 ;. 4• =
40. Gas Service-Final • 1 ,' E•c.)
_ 41. Solar Domestic-Final, - - 111111 //. p
42. Backflow Preventer ,• _ ', _� (:i 2- [`-"7G �S-.O7-7[4 ,., ,i&so4 .
43. Backflow Irrigation /,.g
44. Landscape Irrigation'System : •• - n •; r
45. Sound Attenuation- " . -- p, c- L ,y - 1--"-
46. Handicap Regulations ••• •
47. FrNQ•L STRUCTURE& BUILDING 2- -
&- q/� it +,, - _ -
L 11
n
48. FINAL PLANNING ' ._,
49. Electric Release to Edison .;, '
-
50. Gas Release to•Southern California Gas Co ' -. i" ' '
_. T1� :1 -
51. CERTIFICATE OF OCCUPANCY '
No. Date
\V
I STRUCTURAL APPROVAL ONLY i ' V-
j SEPARa�TE PERMITS AREa 0�
FOR ELECTRICAL, . U; R'NG,REQUIRED 1
I I .n .a `0
AT11. '(::;•t,i.?T,"!0 AND
REFRIGERATION }VCRI(
{1 Permit # 677 Z 42 a:42
THIS NUMfsi'.?i i,M�,SI .,.,_I n
LU:)P!?ANY
^` ALL INSPECIIO:;' REQUESTS Ci,
P 7° OS0E����
1.4NN7 iaif.
FO,: E_tilth,,;. �,H; s�D�Fcr TO B�G SEPT.
I BE Ei i°LO;:ED. :;< E I `.. "DNS ARE HE BY(� �G' oFvt REG
f SI TE S'T THAT THE /c-ci.,
OF '' q DIVISION Of I • Dim os aci SATE .=4/ >
FL•; ': G NSULTED I �MNINp a3
... .,. .i".OUi E F.NTS.J FOR /" ..
b. VI
I
V
' 17S
I c
RESIDENCE RESIDENCE RESIDENCE RESIDENCE
lb
I--
ti l
la
W W
W
ti
u F
ia
At _ . S It1
P;(11-474° —1"4`.x — vn n':ru�vn IC' app
1444,ww-NV 0
— ICC+. STREET LE
/ 7 sr- Tom-(,/0 1 K,vY
•TYPICAL 611 CONCRETE BLOCK FENCE
•
aCement CopingOptional --_ r� �— GENERAL- NOTES
Channel BlockWith1-3/8 -) �d �,'�,_� �I
0 Horizontal Top of all 1��' Y
Fences MORTAR: One Part Plastic Cement, and
Three Parts Sand
For Fences 5'or Less 'I�-,� GROUT : One Part Cement Three and
One Half Parts Stand
Vert. Bars 3/8" Oat 4' -0"O.C. o COPING:
Ir _ One Part Cement, Three
II_ I- .1111 Parts Sand
For Fences Higher Than 5' CONCRETE: Well Mixed 1:2-1/2 . 3-1/2
Vert. Bars 3/8" Oat 32" O.C.ill
Y w
Icc 1111
;ID
Max. of 7 I/2 Gallons ct
Fill Cells Solid With Grout `> Z Water Per Sack of Cement
Where Steel Occurs >1
a- ` ! GROUT MAY BE POURED FROM THE TOP
Reinforcing Steel.Shall P tD `
Conform to Sec.A-15-39 — w OH r --- -� - .._--� OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
A.S.T.M. CELLS AND AREAS OF HORIZONTAL REIN-
All Steel to be Lapped ' w �'I�-,� FORCEMENT SHALL BE CLEAR,CLEAN&
PP '�_� FREE OF ALL MORTAR DEBRIS,ETC.
IS"or to Code
ilNATURAL GRADE BONDS SHALL BE PROVIDED BY LAYING
"' "f:1'9p't9 " II _ '�' BLOCKS IN STRETCHER COURSES SO THAT
,' -O �b - I �O - • O VERTICAL JOINTS ALTERNATE IN EACH
--.:'' ....-;.0.--.�‘ .°• •°. o �_ o ' n w COURSE.
TWO3/8"OBARS
CONTINUOUS TOP II .II
& BOTTOM -1•.--1 . - 1.-....--WIDTH TO 16' 0.C. MAX. __
SEE`: e BELOWC CHART � . p..
I DEPTH OF EARTHTCOTH
-i-' ( e I e 1/3 THE HEIGTH OF FENCE
Lj .o . rLOW BOTTOM OF FOOTING.
• e' 3• ,
•
1o' 10" jZ„__JT • SCALE: 1/2" : I'
FOOTING REQUIREMENTS CHART
WALL HEIGHT 6 '. . 5' 4' 3'
WIDTH ' 14" 14" 12" 12"
THICKNESS - IO" 10" 8 " 8 "
DEPTH OF EARTHTOOTH . . 24" 20" 16" . 12"
SPACING OF EARTHTOOTH. . 12' 14' 16' 16'
OWNERS NAME:
City of Costa Mesa, California JOB PERMITDORESS.NUMBER:
. Building Department SIGNATURE: • •
_ 4 „r. .
COyTpI STY 0, ' C STA MES.-
4akD 4ACto CALIFORNIA 92626 P.O. BOX 1200
FI I.I
V• .1
•6 FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY •
Project Address ' Permit #
Project Name '- i !�" Type
Owners Name
Owners Address f 7 1 �2ei� City Use Only
Owners Telephone -
I as Owner, Contractor, Agent (strike out all
except one) do hereby attest that employment of any person, or persons, is not
anticipated at the time of seeking the above-referenced permit. In the event that
any person, or persons, are employed under the provisions of this permit, I shall
immediately cause a valid Certificate of Workmens Compensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my own cost, and to indemnify and hold harmless, the City,
its officers, agents and/or employees, from and against, any and all liability,
damage, costs, losses, claims and expenses, howsoever caused, resulting directly
or indirectly from, or connected with the improvement under this permit.
I further state that I have read and fully understand the implications and re-
sponsibilities of the above statements, and will caiply with all provisions of the
Contractors State License Law found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
7' on4Ar 26eT/c7/c Co
Print Name
2atu214/4"-e--1—°-214/4"-e--1—°- /D- a e moo.
r(72 Date
CMF 0777-46
INSULATION CERTIFICATION
•
—17 r 77, L A ( n TttI PCIT a elLo 1
Number anti Street City County✓
'1 Subdivision Lor Number
DESCRIPTION OF INSTALLATION
ROOF
•
Material al I' 7Brand Name0 p �a df1Y�/v •
Thickness (inches) Thermal Resistance (R Value)
EXTERIOR WALL o
Material _ '\ I I Brand Name Q LA"-er✓S Ccirrity,,j
h
• Thickness (inches) Thermal Resistance IR Value)
CEILING •
�j C/
Bast at Blanket Type C 1 / Brand Name PO ss GN c C- d e'es/t1 •
Thickness (inches) Thermal Resistance IR Value)
Loose Fill Type Brand Name
Minimum Thickness (inches) Number of bags Weight per bag lb
Area Covered(h2) Thermal Resistance IR Value) •
• FLOOR, ELEVATED
Material Brand Name
Thickness (inches) Thermal Resistance(R Value)
FLOOR,SLAB
Material - `Brand Name
Thickness (inches) Thermal Resistance (A Value)
Width (inches) -
FOUNDATION WALL '
Material Brand Name
Thickness (inches) Therrr.al Resistance IA Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with the
current regulations setting Energy Conservatun Standards for new residential buildings (located in Title 24 or the
California Administrative Code),
`� i
4 i1 td - Ht-/ 100,1., yT 36 7g95-
�,.�yGeene all Coonnteraaccct/or (Builder) LiCenns�e Nurnue.
waiFr
//aria aa Title / 0 te�
!e' _ I
Sub Contractor (Insulation ApOGUIpI) License hamper
— i
Srpnature and Title Date
Figure a .t Example al.&compliance certificate
4-9
>PPLICATION FOR A BUILDING P' 'IT
BUILDING PERMIT NO. Electrical CO
Tract Block Lot Permit No. C
Building �-. Plumbing G
Address / 7� /(J E ' LAN ` S Q n1% Permit No.
Cross J C/ / Mechanical 0.
Area ,6rgf7"col; MASA Street 0�AN9 C Permit No.
co
Owner /11/1✓✓y Ni/ / Type of Project: ❑ New ❑ Alter Atltlition
1 ❑ Repair ❑ Convert ❑Demo ❑ Occupancy Pmt.
Address / / U L/,n
1} ,n7�t .? ,/ y o �Q Sup.Dist./
City Goy.in 4/1Ej4 Zip [26Z7Phone rye-S-1_761Z Insp.Area
•
Architect/ //
Designer JLJ,Ct/ I1 t License No. Zone SPI.Pmt.No.
•
Setbacks P/L Front C/L St. Street Width
Address
Yards Left Right Rear
City Zip Phone
Eave Proj. Lett Hight F.P.
Engineer License No.
C Parking Spaces Required Provide Covered
0Address
m City Zip Phone Struct No.of No.of
Height Stories Family
U LICENSED CONTRACTOR'S DECLARATION Park Fees U Yes - Fee
m Required LJ No C.T. Receipt
m I hereby affirm that I am licensed under provisions of Chapter 9
L (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date
Professions Code,anttny license is in full force and effect). q 9
Licens$%lass_ /J Li e Number
> Date " Z 7/SOContractor d/'.H Misc.
E a Address I 7S7✓La P 7 Proposed Use
jy City and Zip C ojTA me 4 Z 6 z_7 Phone cif B—LI T$g of Structure
CONSTRUCTION LENDING AGENCY
�, I hereby affirm that there is a construction lending agency for the
TypeCode
9. performance of the work for which this permit is issued (Sec. 3097, OCC. Cons Year
Civ. C.). Class Const. Year
y Lender's Name USE/OCCUPANCY SIZE SQ.FT.
C Lender's Address _
OWNER-BUILDER DECLARATION
A. I hereby affirm that I am exempt from the Contractor's License Law 1.
al for the following reason:
❑ I, as owner of the property, or my employees with wages as their 2.
sole compensation, will do the work, and the structure is not
.0 intended or offered for sale.
a 3.
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project.
�.r 0 I am exempt under Sec. , B&PC for this reason 4.
d
a Date Owner
E WORKERS'COMPENSATION DECLARATION Total Valuation
3 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required ❑ Yes ❑ No
•, or a certificate of Workers' Compensation Insurance, or a certified
e copy thereof. C/ Grading Pmt. Grading
Policy NoCT Y6-z,<��m�any IVa NOorI' T Wr5 Required ❑Yes ❑No Pmt. No.
.a 0 Certified copy is hereby furnished. / Rough Grading
0 git Certified copy is filed with Orange County, EMS, '//
g/Z7/e0 A '�✓L/ Approved by: Date
Date pplica nt
CERTIFICATE OF EXE TI
ION
FROM WORKERS'COMPENSATION INSURANCE Z
(This section need not he completed if permit is for $100 or less). C
I certify that in the performance of the work for which this permit is 9
issued, I shall not employ any person in any manner so as to become crm
subject to the Workers'Compensation Laws of California. PERMIT FEES
-
Date Applicant I
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with suchElectrical Special
provisions or this permit shall he deemed revoked. $ Invest. $
/ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $
/ COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-Grade
POS - / E /27,7,/e:D Inspection $
•l! 4/tea f// V V Pre-Grade Permit
Signature of •'pplicant or Agent Dae Rec.No. $ Issue $
-.� /171 ras Ro/Sso8I
rint Ap¢licant's/Agent's Name n
Clan 1/ Issuance
All spaces within this box must be completed to process Cneck BY: (//1;/'✓X� Approved:
CMF 0335-46(BU-28)rev.6/80
OWNER 1'WEN'1'.E'1'H CEN'TUEX HUME'S, 1NCUEYVf<AT'EU DATE June 0, Lye°
IJOB ADDRESS 175 Tulip Lan' ^UILDING PERMIT NO. 24241
GENERAL CONTRACTOR 20tI mtury Homes DESCRIPTION OF W Res Watt Garage
�AP No. 118-075-18 LOT TRACT FIRE ZONE 3 VALUE $ 17,552.00
INSPECTIONS I Signature Date- GROUP I & J TYPE V ZONE R 2
a• Soil - A/ /I rL _ PERMITS ISSUED
Gas 7g1� SUBCONTRACTOR I Date I Number I Signature
T.Water �_/ 74?" Plumbing
5 Rough Plumbing ' AW MOPMAIL.,,S l T�� -
Prop. Swr. Line 0 House Con. d arl /JZI�'i ILl._W/�1.%i,,,,. 7_,n2 �1Xi
Sprinkling System •
Miscellaneous
Rough
""- t
RoughhHeating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0 _
Rough Wiring iii, 016- S Heating and Vent.
� LaiTrenches iForms� Steel Reinf, 0 I OWC/.c44 IS i f l H 0 Ts, 7/I 510c r
Floor System JJ
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing e"`/���y„et
a-Ts.
Lathing —In G ® I}3 Out r1V 14-14f
Plaster, Brown Coat /T4 p"%r
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final 5'i f f,.g�Q�(Y}g(,��(,C}3) I (I . 'Z/2/(05 �if•An i a .
Plumbing, Final and Gas Testa �,T Pt/Of/1� •,jt7"_�7�-,"`�,.•�
Electric, Final it-15.6.5
Building, Final 'um), �
- V1-7-h5--. _ _ Dinning Dept. .
2424 I CITY Of' USN MESA
COSTA MESA BUILDING-SAFETY DEPARTMENT JUN 2 1965
P.O.BOX 917 COSTA MESA,CALIFORNIA
For Applicant to Fill In Completely APPLIVI�-F;I' ®MIT
TYPE OR PRINT
For Office Use Only
BUILDING ' /7 T Q L
ADDRESS N// f�Q H RECEIPT NO. PERMIT NO%
COSTA MESA; CALIFORNIA /' /pfi/IL:
�6 • / c/J{(�//24
t 11 . / REC81V� to Al ! ( .I Y ' / (0 5
OWNER E MEUEOV
`jd a 6AJ} a1ty k0.1lff nue ) /�n /7 yI
MAIL l V i`i ( / //�'r\ ADDRESS 1 7✓L y.l 1� lotwa.
FIRE ADDRESS O T 1 G Y"
CITY to S T 1 E1 NO .s-75.4'- rj ZO E 3 TYPEt`7 GROUP ` T
ARCHITECT �'` STEL. 5
OWN •
ER IM //_7Y 6
OR ENGINEER L-eaLI I", NO. b lio -7o // Y'� O
•
ADDRESS p�
I1 4 ( 4t t4 S7 Tas7,J ZONING
ZO NO.OF DEE OP NEW St. �J,0./`AST
!f /. //��LG _ 2 I PLANE Z BUILDING J 6y.{. �`
CONTRACTOR 9.-(5-1- ` et.,I L/'`�- 14,5 k£! The / y �� .y , t,
�7 1 ' L r, LEGAL !i✓ 4* 2.92 /�'!{.•�O/ /r/T r4
ADDRESS--}- 1 d I `t l C 'Y��1 •
DESCRIPTION q I f�
CITY
l US 7(E) ' - A.P.NO. �/3 r U/s--/`�
: NO EAVE
STATE / r7 TEL. 90'T TO SIDE Et REAR P.L OVERHANG SHALL BE LESS THAN
LIC.NO. �L' -04/46i / Na R. g ova a
�lrA K / EAVES
OFLOT J+ V Sy I NOW ONLOGB ALLOWED W. REQUIREMENT)
1 pp / ,G L �1 LL .s YARDS APPROVED YARDS APPROVED
EXISTINGUSE TF BLDG. S to(o LC K f CY CdC�! MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET) / � �
SETBACK LINE FROM FRONT /SFT 'Cr "
. `t �4 -g-FT.
CENTER OF STREET - - REAR YARD . - -
SIDE YARD LEFT - - ' I RIGHT R.SIDES FT. FT.
prir
DESCRIPTION OF WORK ' L.SIDE Q FT. —
FT.
NEW .• `� ALTERATION _ ADDITION REAR' a FT. FT.
Lit
—, DISTANCE BET. BET.MAIN D
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLOCS.
BUILDINGI RLvR''l C44-gr,QO.OF VAR.# DATE •
SIZE ',� Vii B ROOMS (B ,1 STORIES I _ C.U.P.# APPROVED
EXTERIOR WALLS ITJf co ROOF . • lie CI< APPROVED ��
COVERING I COVERING BY �q.,� DATE /�
USE OF BUILDING AND WORK TO BE PERFORMED HOLD.FOR CIAL REQUIREMENTS
QEC'IDesite (pr7 el • S `q ( )
HTTAeNeD (e12A(ot F !/ `7/T o
_L�GD'S SD.FT. V('f
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER.VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION - cc m
BUILDING CONSTRUCTION. N
SIGNATURE OF • � ��L� PERMIT FEE $
PERMITTEE �'�A.11?C-l�Ar, +�'Ti.A11w .AjO X
x17125n L K 2 src
AUTHORIZED AGENT �'/ e
i TOTAL FEE $ 6
P,
4.
• 49: F t
l COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIO PIR@CIi1A.PERMI'll 74_.29 TL,
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ' .
RECEIVED�B`� PERMIT N° . 50589
For Applicant to Fill in Completely —Use Ink Only v ✓` +
BUILDING A.P. NO.
4264n7
ADDRESS ��_S nTi`c'��p .ane, C .M'
TENANT R /t/nKQi -f' rly/l ADDRESS IIs -T,�If'p 14�t,c-
TENANT p!f _( , ,i-/�
MAILING //�� // UNIT OR
ADDRESS / 75 7&L/R hQfled
S/=P�-sAyCE-'✓N'O'.
p� TEL. �[Q '/ c H6(C.l LO . 272-
CITY .BLK.
606144Mesa NOS"/(J'7�0 NEW ADD _ALTER REPAIR I MOVING DEMOLISH
CONSTRUCTION i—' It
LENDER
BRANCH ,s
OWNER 714 Hey.
rJt\` 14, ) I
ADDRESS USE e� r�I ,[,., ry/ VALUE �/'
ARCHITECT TEL. fr�'4 Slay et
cid
$25 �6/
OR ENGINEER NO.
ADDRESS ZONE /2-1. ¶TYP /VGROUP /Q—r?
r,, // APPROVED /'.
CONTRACTOR J4/// y-/ ^y//La („vQ/�s7 BYt�—`//� }'(/��{-v{Q DATE �_2"�_fj(�
ADDRESS /75 1le/�/ U ne, ' V6
CITY l ,l ,Wsa / 81
NTO. ""r
E' STATE CITY APPROVED SETBACKS
LIC. NO. LIC.NO.
SIZE NO.OF BLDGS. (FROM C/1_STRE/ET)
W
L OF LOT NOW ON LOT FRONT Q.OFT.
USE OF ,..,
EXISTING BLDG. R SID Z FT.O
J
Separate permits are required for -
• L.SIDE -pT. //
electric,plumbing and heating work: /
O - REAR FT.D
USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q _
0
..d 2MC4 f.j_/ti YELLICI . • DATE
APPROVED
' _AP ROVE.T ��'�l"��r' SATE �-L��T./
)'•
..1
Ci
W
EXL • I hereby acknowledge that I have read this application and state o'
that the above information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
Wi, the State of California. 7/ LI � `l6 /` —
SQ. FT. N
I hereby certify that I am properly licensed as a contractor under / N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR al
Chapter 9, and that such licenses ere in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of California Business I
VALUATION PERMIT FEE $ 85: re
and Professions Code, Division 3,Chapter 9.
w
m
PLAN CHECK $ "I
Signature of /'/� _ S .5 o
Permittee G �j • 27/ 7-' TAX $ �', �7 Q LL
or • 8/ 2. 7 / U6 $ /� / / U
Authorized Agent Date ` TOTAL PAID $ f 2F