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HomeMy WebLinkAbout256 16TH PL - Building Permits l 1/4 4`oP' CITY OF COSTA MESA • - } BUILDING DIVISION PER T NUMBER F 1 DEVELOPMENT SERVICES DEPARTMENT k PERMIT a°. B99-01786 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 256 16TH PL Status: ISSUED Suite: Applied: 11/8/1999 Vicinity: UNIT A Issued: 11/8/1999 Parcel Number: 42522222 Zoning: Applicant: ZAZZARA, PETER ISSUED BY: Address: 1334 E JACARANDA AVE CA Phone: (800)469-2845 ORANGE Zip: 92867 Owner: ARROWOOD, DANIEL F Address 19800 MACARTHUR IRVINE,CA Phone: SUITE#1000 Zip: 92612 EXP p1±ZAZZARA CONSTRUCTION EX; O ' Address: 1334 E JACARANDA AVE CA Phone: (800)469-2845 DA'Z'E ORANGE Zip: 92867 License: 656781 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE(UNIT A).TEAR OFF EXISTING COMPOSITION SHINGLES WITH EXISTING SHEATHING TO REMAIN. INSTALL 1-LAYER OF 30#FELT UNDERLAYMENT&REROOF WITH 30 YEAR ASPHALT 3-TAB SHINGLES(10 SQ). FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,100.00 Permit: $41.80 Claim Valuation: s1,loo.00 • SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $42.30 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear' 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • 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 QECII4RATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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 have 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. My workers'compensation Insurance carrier and olicy number are: �L7q Carrier: fT/}T� �.pl\ Policy Number: I S 1 I ' 1 2 - I (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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 workers' compensation laws of California,and a ree that if I sh ,omasubject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi Applicant Signature: i 2'Date: ///277 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under. .visions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and ofessions Code,and my license is in full force and effect.Lic.# i Class# Contractor's Signature: Date: "7 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). Lender's 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,alter,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).): n I ❑ owner of the property,or ede: ees with wages is their sole compensation,WILL DOn rof WORK,and the structurer is not intended or offered for salecwork 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 property, 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 contractor(s) 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 ❑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,talsework,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 present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑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? ❑Yes ❑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 Code 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? ❑Yes ❑No ee_-_...._..work which ruor..mofan_ 5 Does or will the applicant present or future building occupant at y ohier for the work isi the t or of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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.-.... ... part. tyto....e. - sper... be . hn__.. toh... school? _..__.._ _.--....-_.., ......--.".. ............ 6 Will any of the facility to be constructed under this permit within 1000 feet from the outer boundaries of a scho0 Yes ❑No (If'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? ❑Yes ❑No B Mil"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,and 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. • m Date l�f And/ Authorized Applicant Date CODE I. INSPECTION TYPE LATE, INTRIAL$ CODE/ INSPECTION TYPE PATE INTITIAI5 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical - 1266 Pool Spa Final - 1-c--F-'L�- 208 Final Plumbing 200 Final Re-Roof t_44 r 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 2446-46 4>� CITY OF COSTA MESA ;r.��. • BUILDING DIVISION PERMIT NUMBER t' '-'!-7 : DEVELOPMENT SERVICES DEPARTMENT PERMIT Ill'ibimam°4* B99-01636 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 256 16TH PL Status: ISSUED Suite: Applied: 10/11/1999 Vicinity: LEFT SIDE OF BUILDING Issued: 10/11/1999 Parcel Number: 42522222 Zoning: __ ZAZZA Address: EJAC , ANDA AVEISSUED BY: Address: 1334 E JACARANDA A CA , Phone:' (800)469-2845 ' ORANGE /;" . , Zip: 92867 ' - - - - Owner ARROWOOD„DANIEL F Address 19800 MACARTHUR ” - IRVINE CA Phone: ` SUITE#1000 \ ` "- - - Zip: 92612 EXPIRE11 Contractoe'"/ZAZZARA CONSTRUCTION '/ L. Pt rfAddress: 'NI 334,EJACARANDA AVE '--DA �/ CA__y / Phone: (800)469-2846 \*N\'„,�� ,�, ,, /,..,/ /-. ORANGE-// .� . 1/ ,' Zip:' 92867.7 License:.. 656781 , 'Arch : - - : . : ' Eng: ', Address: Address: ' - Phone: .Phone: . �, ,1 • i .,) f - - - - N , '. ' N , r Zip: I v -'-, •License: - \a License: •� SCOPE OF PERMIT 106 SF ADDITION TO EXISTING TRIPLEX(UNIT A)FOR NEW BATHROOM&EXTENSION OF EXISTING BEDROOM. REMOVE AND FRAME IN EXISTING CLERESTORE WINDOW. 49%(3,168 SQ.FT.)OF OPEN SPACE PROVIDED AFTER EXPANSION OF BATH&BEDROOM. - ' FEE SUMMARY ' • ' Plan Check: $117.81 y Calc Valuation: $9,063.00 Permit: $181.25r ,' Claim Valuation: :- $s,o63:oo .SMIP'Res: $0.91 - - . SMIP Corn:. ' $0.00 _ Other: '. $0.00 . . Inspection:- '$0.00 ' -- • Total: $299 97� ��� ;�; , PLANNING'& ZONING i SETBACKS MAIN STRUCTURE:Front "36-0 Rear 71-0 .. Left - 11-0 Right 0-0 '� ACCESSORY Front 0-0 Rear 0-0 • Left 0-0 Right 0-9 • PARKING Existing: -0 - - Required: 0 2 ,, Proposed: 0' NOTES: - 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 0 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. )k I have 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. My workers'comper_naljori Insurance carder and policy number are: Carrier: /G Policy Number: (This section need not be completed It the permit is valued at one hundred dollars($100)or less.) • 0 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(SIOD.DDD),IN ADDIPON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensedj.n ider provisions of hapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a ,) j Class# Contractors Signature: ___// Date: /C. tjk. l' 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,CMI Code). Lender's Name: Lenders 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:My city.or 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 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 penally of not more than five hundred dollars($500).): ❑ I,as owner of the property,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 property, 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 contractor(s) 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 drivers license. ❑Yes 0 No Drivers 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 B,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 present 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 0 No (Section 25505 of the Califomla 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 0 No (Section 25534 of the California Health and Safety Code 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"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 8 (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,and 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. Si a ego And/Or Authorized Applicant Date 900E S INSPECTION TYPE PATE ` INTfTIAL$ SODER INSPECTION TYPE - USE INTITIAI 1816 Fixed System Final Fire Prevention • 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final1Re-Roof 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 2446-48 te �` CITY OF COSTA MESA y ® BUILDING DIVISION • PERMIT NUMBER 1.1 iCat ' DEVELOPMENT SERVICES DEPARTMENT ° " PERMIT • E99-00936 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • • ELECTRICAL PERMIT Job Address: 256 16TH PL Status: ISSUED Suite No Applied: 10/11/1999 Vicinity: ADDITION ON LEFT SIDE OF UNIT A Issued: 10/11/1999 Parcel Nunmber: 42522222 ISSUED BY: Applicant: ZAZZARA, PETER Address: 1334 E JACARANDA AVE . . ' ':r ` -' CA r c'. ' - Phone: (800)469-2845 - - ",-,"1.- '27- 1 _ • ORANGE / (-- Vii. Zip: 92867 - - '�� Owner ,ARROWOOD DANIEL-F -/ Address -49600 MACARTHUR -, - _ •� / n./ / / - \'7 _ -'\ \,:-• _ A N "1"' IRVINE CA - Phone: c /,i./ /SUITE#1000 ;/ Zip: 92612 = %;i N_2,/7. EXPIRE /pi/ to DBTFv,ciNZ i Contractor:/ ZAZZARA CONSTRUCTION /- ',Address: , 1334-E/JACARANDA AVE 'S _ Phone} (800)469-2845 - _ ' - ORANGE . ' Zip:,_ 92867 . - ' -, - - .License: 656781 - 1 • ' •f, %t i . ' �v -:� _ SCOPE OF PERMIT 7 ELECTRICAL PERMIT FOR ADDITION TO EXISTING TRI-PLEX"UNIT A". INSTALL 2-LIGHT r ' FIXTURES, 3-OUTLETS, &12 SWITCHES. / - _ _ _ REF: B99-01636 - . ..a i_ ^ _ .... - - - i ,• • �' ,• v ' '`„FEE SUMMARY'`L� x ; til,,, • `. Quantity _ / - Quantity , , ISSUE FEE ' $23.50 Temp Dist,System/Lighting $0.00 0 i Temp'service test. $0.00 Busway/100 ftr - $0.00 0/, ' ..- 'Res. a/c package `•• $0.00 :-/ Standing Section'• $0.00 0"' - New Res(1-2-units)". $0.00 0 -- - . Misc ElectricaFEquipment 1 $0.00 ..0 - ,. New Res(3+units) $0.00 0 r'Transformers up to 1 kva/kw . $0.00 - 0, Pool/Spa $0.00 ' ' .0 up to 10 kva/kw '$0.00 0 Lighting•Fixts ' " \\\$2.20 2 r' /up to 50 kva/kw $0.00 - 0 „`j • Recept Outlets '\$3:30 �� ' Switches •'-.AV 'vT4 $2:20,, 2 ' .i : ovef'100 kva/kw _ --$0.00/ 0 ' Non Res Appl y; $0.00: -.o`'-'` Low Voltage Equipment,'.. :$0.00 , N 0 Res Appl � , /�' $0 00: ',•\,,,,d. . ' - , Low Volt Wiring System/Ckt /$0.00 -- 0- /� Service to 200a ,,�`, -/ , $0.00 � 0'. . - -Misc:-Conduit , - $0.00 '0 , / Service to 1000a v,•. •'� $0.00 .-0'=""" -, Misc Conductor $0.00-. 0 � ' ' Service over 1000a ',\\‘1..-"' '"$0.00 , 0 ti Circus(gen or ride) $0.00 / 0- Motors to 1 hp • -$0.00 0 Circus(roach ride or lights) Motors to 10hp Christmas Tree Stand - $0.00/-/ 0 Motors to 50hp '- $0.00_ -. 0 -Fireworks Stand . $0.00 - 0 Motors to 100hp $0.00 Cr-- . -,, .Other Electrical Fee /,$0.00 • Motors over 100hp $0.00' v : t0._ - Communication drops $0.00 1.0 7 ' „ Investigation Fee,,- ; $0.00 . Sub panel to 200a 50.00 0 - - Plan Check Fee $0.00 Pole Light Pkg $0.00 0 - •Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $31.20 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: , •i • . 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 have 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. My workers'compensation Insurance carrier and policy number are: e''...---r7771,974/ Carrier: �K�7 Policy Number: ',974 (This section need not.be completed if the permit Is valued et one hundred dollars($100)or less.) ❑ 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business an rofessions Code,and my license is in full force and effect,Lic.# Class# v ' Contractor's Signature: 67:008C- Contractor's Date: e�(J CONSTRUCTION LENDING AGENCY: 0 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). Lender's 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,alter,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 property,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 oythrough'Ihis 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 property, 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 properly who builds or improves thereon, and who contracts for such project with a contractor(s) 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 present 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 0 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 end pressure). ----6Oes o.—.._. ._.an._Or present__..._re .-_ _d..._ 3 Does sr will the Npplicant or present or future building occupant need to prepare an RMPP(Risk-Management antl Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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). — -- " he- acil-__-_____-t-r ....._n.__tis__.emit.be_._._hn..1.0_._f. t.from.t_e..__teboudariesof._schoo?__..--- e._._.......... ..............._------'----"__-.....------......--..... . 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑No (If'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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (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,and 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. nature f Legal And/Or Authorized Authorized Applicant Date CODE 6' INSPECTION TYPE - QdTF.' • 1NIRIAL$ CODE1 "INSPECTION TYPE PATE INTRIAL$ 1616 Fixed System Final Fire Prevention • 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 2446-46 . ._. 44 `, -401 CITY OF COSTA MESA }4a ���� BUILDING DIVISION c PERMIT NUMBER 1.1 `�""4 !1 DEVELOPMENT SERVICES DEPARTMENT ° � PERMIT E99-00989 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 256 16TH PL Status: .ISSUED Suite No Applied: 10/22/1999 Vicinity: KITCHEN AREA Issued: 10/22/1999 Parcel Nunmber: 42522222 1.272 ISSUED BY: Applicant: ARROWOOD, DANIEL F Address: 19800 MACARTHUR IRVINE,CA Phone: (949)263-9513 SUITE#1000 Zip: 92612 Owner: ARROWOOD, DANIEL F Address 19800CAARTHUR IRVINE, EXPI . D IRVINE,,CA Phone: SUITE#1000 Zip: 92612 • DATE.. /3 O liar Contractor: O N,H/U 48Di L.SY� Address: Phone: Zip: License: SCOPE OF PERMIT SUPPLEMENTAL ELECTRICAL PERMIT.5 LIGHTS,2 OUTLETS&5 SWITCHES. REF:B99-01636 E99-00936. FEE SUMMARY Quantity Quantity ISSUE FEE $7.25 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $5.50 5 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 Switches $5.50 5 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $20.45 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 • is Y DECLARATIONS v- WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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 have 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. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed If the pemrit Is valued at one hundred dollars($100)or less.) ❑ 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDRON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in lull force and effect.Lic.0 Class a Contractors Signature: Date: 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). Lender's Name: Lenders 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,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signedstetemenl that he oFshe,lslicensed 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.thathe 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 appltcanl to evdvilrpenalt9 Of not more than five hundred dollars(5500).): ❑ I,as owner of the property,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 CON ACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The con •rs License Law does not apply t n owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license purs ontractor 'cense Laws.). ❑ I am exempt u f Business and Professions Code for this reason: �U/Z�/ny? gneID Date: -( Owner ID verified by driver's license. 0 Yes 0 No Drivers 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 present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 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 Code 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 Califomia Health and Safety Cafe 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 aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? ❑Yes 0 No (If 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? ❑Yes 0 No 8 (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: A CERTIFICA • COMPLIANCE AND AUTHORIZATION O -Y:I certify under penalty of perjury that I have read this application and state that the information given is correct. I .gree to • ply with all sD : laws and city ordin- es relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d.scribe •r Insp' t• purposes.I agree to occupy or allow occupancy of any building authorized by this/Lyn! until I inspection. Signature Of Legal Owner(s) // Date9 And/Or Authorized Applicant Date CODE INSPECTION TYPE PATE INIII119 CODE* INSPECTION TYPE PALE INTRIALE 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof _ 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 2446-46 `oM CITY OF COSTA MESA Q A ��, CALIFORNIA 9262&1200 P.O.BOX 1200 `Q4• li 1 d' DEVELOPMENT SERVICES DEPARTMENT 4/28/00 Daniel F. Arrowood 256 16th Place #A Costa Mesa, CA 92628 Dear Mr. Arrowood: This letter serves to confirm our discussion and agreement on the telephone regarding your existing electrical service at the above referenced address. As stated, we are in agreement with you that your existing electrical service is sufficient to handle the demands of your residence including any increased load • from your current project. Please be aware, however, that any future improvements that increase the demand upon the existing service shall be cause for a service upgrade. Thank you for this opportunity to be of service to you. Should you have any questions or need additional service, please feel free to contact me Monday through Friday between the hours of 8:00 AM and 5:00 PM at 714.754.5277. If I am unavailable, you may also contact Burt Morgan during the same business hours at 714.754.5615. Sincerely, OS Fett1/4_,N.-.,.„._..... Rick Brown, CBO Building Official 77 FAIR DRIVE Building Division (714)754-5273 • Code Enforcement (714)754-5623 • Planning Division (714)754-5245 FAX(714)754-4656 • TDD(714)754-5244 0 256 th Daniel F. Arrowood Costa M sla,CAA92627 RECEIVED CITY OF COSTA MESA 'We estc nwwisinw February 11, 2000 Ptt3 14 2000 Mr. Rick Brown Building Official City of Costa Mesa W L CBox 1200 Costa Mesa, CA 92628 RE: 256 16th Place #A Dear Mr. Brown: I am sending this letter as follow-up to our conversation regarding the above- referenced address. As requested by the City of Costa Mesa, I have received the attached bid to upgrade my electrical panel to 100 amps. As you can see, the estimated cost is $4,950, which is nearly a third of the $18,000 total cost to remodel my residence. The additional electrical work presents an economic hardship and I would like to request that the City reconsider its request or offer a more cost-effective solution. I look forward to hearing from you. erely, eAttb)li Daniel F. Arrowood y__ cAti- FWAt - pwtr€ /2 L.19 x,`-00 20 • Electric Company • • • • Electric Company 7-e " , (7ie7,) Sage / 2 9 2558 w. Harriet Ln Anaheim CA 92804 • Job adress 296 16th place Costa Mesa qz el 7 Job description and the total cost as follows 1 Complete service up grade , instalation 400 Amp, 220 v. Single phase meter box,with a new surface mount,4 meter base with riser or mast. price include one 100 Amp two pole breaker for unit A and for unit B, C and the House provide 40Amp each. 2.Main service is provide 200 Amp,so rccomand 3/OT111-IN wire.but the box capacity is 400Amp for future need. 3.proper grounding to main planting line and ground rod , 4. Sub panel:provide 100Amp, 220 v. Single phase Load center distribution panel up to 16 poles of breakers. 5.Providc 100 Amp,220 v, Branch circuit for hook up to 100 Amp sub pane] . run 1"EMT conduit on surface of back wall,run rigid conduit on top of roof and coduit inside.run wire gage#4 price include parts and labor. Price include all connection and termination price does not include permit and Inspection price does not include any repair to the interior or exterior wall ,cieling. • Total price for this job : 4950.00$ I hope 1 receive your aprval as soon es possible to do the job Thank you 1 3 � CITY OF COSTA MESA �._-_ t `;r ►,r BUILDING DIVISION / r ""Cal ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER `/ PERMIT P99-00571 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 256 16TH PL Status: ISSUED Suite No Applied: 10/11/1999 Issued: 10/11/1999 Vicinity: ADDITION TO LEFT SIDE OF UNIT A • Parcel Nunmber: 42522222 ISSUED BY: Applicant: ZAZZARA, PETER • Address: 1334 E JACARANDA AVE': " CA =,�' -, Phone: (800)469-2845 ORANGE1'" / C . Zip: 92867 Owner.(ARR WOOD DANIELF Address//19800 MACARTHUR�_ 7, N .7 L //:// IRVINE DA//;; Phone: - i �� i„�� SUITE 87000,, Zip: 92612 '- N ' `77--/N77. ,',"cam/ .7 : 7-,\ , /2 / Conr: tracto : ZAZZARA CONSTRUCTION = , " Address:' .1334E JACARANDA AVE �CA �P6one:- (800)-469-2845 , ORANGE ' • i 'Zip: 92867 • 0' �, /1r. _ i License: 656781-- -L. // • i . t ' (Arch/Eng:.� A • - Address: • Phone: - - - / - - ,. Zip: . . .-. . _ - . - , - License: v•. 'SCOPE OF.PERMIT r ' ' - N . 'PLUMBING PERMIT.FOR ADDITION TO EXISTING TRI-PLEX'""UNIT A".INSTALL 1-FLOOR DRAIN, 1-SEWER CONNECT, 1-SHOWER, 1-WATER CLOSET,AND 1-WATER PIPING. / ' REF: 899-01636' _ ' FEESUMMARY - ,AMT QTY - • • -•AMT QTY "AMT QTY ISSUE FEE',, $23:50 'N Laundry Tub/.Washer ,, ' $0.00 0 Sump Pump - $0:00 0 Backflow irrigation L $0.00V�;0 - - --Landscape Irrigation.:, ; $0.00-' 0'1 ' ' Swimming Pool , $0.00 0 Backflow Preventer $0.00 z0y- ;ji`P-Trap '$0.00 0 , '.Trap Primer , /" $0.00 0 Bathtub Ni•,V /50.00 N0;,",, -" ,Pressure Regulator ' $0.00 ‘0 Urinal ' $0.00 0 Clarifier System,7.7 , N $0.00 , 0 -\Process Piping(per 10 ft)' $0.00 0 -_ - - Vacuum Brkr Bkflow(1-4)' $0.00 0 Connect(Ice,Soda,etc)) $0.00- ; 0. ' ' Receptors . $0.00 0 Vacuum 8th Bkflow(5+) $0.00 0 Dental Units ..$0.00 o, - ' Septic Tank - , - -$0.00 0 ' „Wash Basin / $0.00 0 Dishwasher \A$0.00`-, 0/ Sewer Cap for Demo $0.00 0 - 'Wash Basin.Set." $0.00 0 Drain, Floor '$9.80 1 ' ;Sewer Connect $24.65 1 Waste and Vent System $0.00 0 Drain, Rainwater $0.007 0 - ' Sewer Private Line $0.00 0 Water Closet(Toilet) $9.80 1 Drain,Root $0.00 - 0 Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 '0_ Sink, bar , .$0.00 0 Water Piping(Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 . ' Sink,commercial $0.00 0 / Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 . Sink, Floor $0.00' 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) - $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $87.35 COMMENTS I SPECIAL CONDITIONS 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 6 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: , , ❑ 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. JJ— I have 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. My work s'compensation Insurance carrie nd policy number are: —, �} Carrier: J( 'PI&1�� Policy Number: [CJI ` '7� / — I I (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) • O 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions ., Applicant Signature: // Date: w�i / WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,003),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provi n of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# - Class It ft Contractor's Signature: .----- Date: /Ulm/tr 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). Lender's 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,alter,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 property,or my employees with wages as their sole compensation,WILL DO THE WORK,end 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 property, 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, end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end 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: O 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,Gm 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 present 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 0 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? ❑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 0N (Section 25534 of the California Health and Safety Code 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 a plication appermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? lU 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 0 No (If"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 8 (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,and 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. Slgy IOwner /�t�eC�/9 And/Or Authorized Applica /� atD"e CODE J. INSPECTION TYPE ' f1U REELS CODE 4 INSPECTION TYPE DATE ATRIAL@ 1616 Fixed System Final Fire Prevention 206 Final Mechanical '� / 1266 Pool Spa Final 208 Final Plumbing 19-'7-99 111V 200 Final Re-Roof . 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 2446-46 • , C MF CITY OF COSTA MESA °v� BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT P99-00603 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 256 16TH PL Status: ISSUED Suite No Applied: 10/25/1999 Issued: 10/25/1999 Vicinity: UNITA 1��� ��-,,,,,,,,,rrr���,,,,,, Parcel Nunmber: 42522222 ISSUED BY: / "r'Y"'- o Applicant: ARROWOOD, DANIEL F Address: 19800 MACARTHUR IRVINE,CA Phone: (949)650-6090 SUITE#1000 Zip: 92612 Owner: ARROWOOD, DANIEL F Address 19800 MACARTHUR IRVINE,CA Phone: (949)650-6090 SUITE#1000 - Zip: 92612 Contractor: OC___ Address: Phone: Zip: License: Arch l Eng: Address: Phone: Zip: License: SCOPE OF PERMIT SUPPLEMENTAL PLUMBING PERMIT FOR GAS REPIPE&REPLACEMENT OF FIVE GAS OUTLETS FOR EXISTING TRIPLEX(UNIT A). REF: 899-01636& P99-00571 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $7.25 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System - $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line . $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $1.10 1 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $24.30 COMMENTS/SPECIAL CONDITIONS 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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 have 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. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND OOLLARE(SICO.000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.0 Class a Contractors Signature: Date: 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). Lender's Name: Lenders 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 Cod :Any city or 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 to 1'e 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 B Iness 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 s jects the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,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 property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors icense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the ontractors License Laws.). ❑ I am exempt s . Business and Professions Code for this reason: , �y ` Signature: Date: /�/G / Owner ID verified by rivers license. Yes 0 No Driver's License No. Expires: S7 /170 Verification of Ownership by(type of ocument,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,faisework,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 present 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 0 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 Califomia 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 Califomia Health and Safety Code 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 a_permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the Califomia 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 0 No (If"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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No . ...-.._f. 8 (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: CERTIFICOF COMPLIANCE AND AUTHORIZATiON OF E Y. certify under penalty of perjury that I have read this application and state that the information given is correct.es.aa y,with all - a laws and city ordinance r ting to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descrl pro rtler purposes.I agree not to upy or allow occupancy of any building authorized by thlS/perms until fl aliInspection. ot Zs Signature Of�el Owner(s) �Date And/Or Authorized Applicant Date ;ODE 4 INSPECTION TYPE PEE INTMALs CODE! INSPECTION TYPE PAIL IMfTIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing I -7-97 200 Final Re-Roof 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 2446-46 OM at COSTA MESA BUILDING DEPARTMENT ciNNOE cDEPT COSTA MESA. CALIFORNIA 0„.,. FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDI ADDRESS 256 - 16th Place, A, B, C BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO, P_ER NO., OWNER Santa Ana Patio Homes, Inc, (6% 7�c% . MAIL DATE RECEIVED ATE ISSUED 1555 Placentia ADDRESS1/45---)1i .s--��-s-� CITY Newport Beach. Cal. TNO. MI 6-322/ ILDING RECEIVED BY DDRESS ARCHITECT same LIC. OR F 'NEER No. COSTA MESA. CALIFORNIA FIRE ADDRESS� jT7J(]. same/ ZONE cJ tRMerAoll Const. Co. ND' 1217 ZONE NO.NSF TYPje E GROUP CITY LIC �� NO-O TEL APPR///OVE' ADDRESS same NO. same BY p,,,�[ DATE 5/4-4 LEGAL V GOR ELTI N DESCRIPTION NOT 20 BLOCK TRACT 2996 .fi"#" P j rr', ”. i n A.P.NO. }�'�Y V A / SIZEFNO.OF BL OT PR IQ fl TTI il $h };; OF LOT 102.5 x 125 NOW LOT 0 :ry1Tpi tt I! N ��{i'id FS ,. USE OF aid /� I. LL% L EXISTING BLDG. : ; SETBACK LINE FROM �- I, ?IN -Y-- -Pei .241 CENTER OF STREET 4612" REAR YARD15 to C "" ✓' cf y�C 34 ' VAR. No.l�� DaTc'n t_ ` ``_� SIDE YARD RIGHT 8 LEFT r fl I At-PROVE�� /�V / I DESCRIPTION OF WORK NEW % ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING NO.OF SIZE 3123 ROOMS 16 STORIES 2 EXTERIOR WALL ROOF COVERING St1SOCO COVERING hot-mop USE OF NEW BUILDING Triplex residence and att. garage. / Plan 4-A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY W!TH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION SIGNATURE PERMIT FEE $ • .0 PERMITTEE $ 26,378.00 PLAN CHECK $ 23.00 AUTHORIZED AGENT 1 TOTAL FEE 5 69.00 "aMF