HomeMy WebLinkAbout410 BRIGHTON SPRINGS - Building Permits(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa��MBING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
410 BRIGHTON SPRINGS
Viciniry: GARAGE
Parcel Nunmber: 93786026
npp�icant: LITTLEFIELD, SCOTT
Address: 24707 SAN FERNANDO RD
SANTA CLARITA, CA
��g�� 1
�`�s, ,�,a
O��
Phone: 661-259-7131
Zip: 91321
Owner: KOLDINGER, MARJORIE STOVALL TR
Address %WILDES, DAVID H
COSTA MESA,CA , Phone:
410 BRIGHTON SPRINGS Zip: 95819-4146
Contrador: AFFORDABLE WATER HEATERS AND PLUMBING
Address: 24707 SAN FERNANDO RD
Phone: 661-259-7131
SANTA CLARITA, CA Zip: 91321
License: 627368
ISSUED BV:
Status: ISSUED
Applied: 05222006
Issued: 0522/2006
SCOPE OF PERMIT
CHANGE-OUT OF A 50.GALLON GAS WATER HEATER WITH SAME IN IN THE GARAGE OF A SFD.
1 WATER HEATER
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
AMT (
ISSUE FEE $23.50
BackOow irrigation 50.00
Backflow Preventer 50.00
Bathtub 50.00
Clarifier System $0.00
Connect (Ice,Soda,etc) 50.00
Dental Units $0.00
Dishwasher $0.00
Drain, Floor 50.00
Drein, Rainwater $0.00
Drein, Roof ;0.00 �
Drinking Fountain $0.00 i
Expansion Tank $0.00 i
Gas Earthquake Valve 50.00 �
Gas (1-4 ouUets) 50.00 i
Gas (Over 4 outlels) $0.00 i
Gas Repipe 50.00 i
Gas Service 50.00 i
Interceptors (Grease, Oiq 50.00 i
Interceptors (Sand Auto ) $0.00 I
FEE SUMMARY
� AMT gTY AMT �
LaundryTub/Washer 50.00 0 SumpPump $0.00 0
) Landscape Irrigation $0.00 0 Swimming Pool 50.00 0
1 P-Trep $0.00 0 Trap Primer 50.00 0
) Pressure Regulator $0.00 0 Urinal 50.00 0
) Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) 50.00 0
) Receptors $0.00 0 Vacuum Brkr Bkflow(5+) 50.00 0
) SepticTank $0.00 0 WashBasin 50.00 0
) Sewer Cap for Demo � $0.00 0 Wash Basin Set $0.00 0
) Sewer Conned $0.00 0 Wasle and Vent System $0.00 0
1 Sewer Private Line 50.00 0 Water Closet (foilet) 50.00 0
1 Shower $0.00 0 . WaterHeaterlvent $12.30 1
1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) 30.00 0
1 Sink, wmmercial $0.00 0 Water Re-pipe 50.00 0
1 Sink, Floor $0.00 0 Water Service 50.00 0
1 Sink, kitchen 50.00 0 Water Softener 50.00 0
I Sink, service/mop $0.00 0 OTHER 50.00
I Spa (private) $0.00 0 VIOLATION 50.00
I Spa (public) 50.00 0 PLAN CHECK 50.00
� REINSPECTION 50.00 0
COMMENTS / SPECIAL CONDITIONS
TOTAL CALCULATED FEES: E35.80
NO710E: The work authorized by this permit shall comply wlth all applicable handicap access requirements under Califomia statutes and related
regu18ti0nS. (Ord. No. 9248, § 1, 1241•92)
EXPIRATION: This permlt shall automatically expira and becoma voitl il work Is not commenced wlthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for tha work authorized under this permit to be considered legal, such work must comply with ell applicable codes, and all
required Inepeetlone and flnal epprovel must be obtained. Fallure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2a4&4B (8/00)
WORKERS'COMPENSATON DECLARAnON: �
I hereby eHirtn untler penelry of perjury one ol the lollowing tlecleretions: � ,
❑ I have end wlll meintein e ceniticete of consent to sell-Insure lor workers' compensetlon, es provltled lor Dy sectlon 3700 oi Ihe Lebor Code, iw Ihe peAortnence of the
�'ark tar whlch this pertnll is Issuetl.
�� I have end will meintain workers' compensetlon InSurenco, e5 requiretl by seclion 3700 0l the Lebor Cotle, br t�e peAortnance oi the work lor which this pertnit is issuetl.
My workers' compensatlan Insurence carder antl pollry numbar ere:
�Carrier.�-Th� �P�n11M � PolfcyNumber.� � �O(o7R�� �V �
/This sec(ion need nor be completed 1! Me penn/r /s valued er one nundred dollers (S t00) or /eu.)
❑ I certlty Ihat In the perfarmence t the work lor which Ihis pertnit is issued, I shall not employ any person in eny manner so es to become sub�ect to tha workers'
compensation laws ot Califom' , entl egree t�et tl I s�oultl become su6�ect to the workers' compensation provislons ot Sectlon 3700 ot the Lebor Code, I shall lorthwith
comply with these provisions.
�IkanYSignaiur0:. �ate:-� S' 3a' U b
WARNINO: FAIWRE TO SECUPE W KERS' COfdPENSATION COVEMOE IS UNIAWFUL AND SHALL SUBIEGT AN EMPLOVERTO CRIMINAL VENALTIES AND GVIL FlNE3 UP TOONE MUNDRED
TVIOUSANOpO�IARE(5100.000),I AODf�ONTOTHEODS�OFOOMPEN5AT10N,0AAMGESASPROVIOEDFORINSECfIIXJ3N80FTHEUBORCODE,INfEREST,ANDATTOfiNEYSFEES.
LICENSED CONTRACTORS DECLARATION:
I hereDy eHirm that I am Iicensed under provisions of C�apter 9(commencing with Sectlon 7000) ol Dlvision 3 of t�e eusiness end Pmfeulons Code, enA my license Is in ful�
rorce end enea. uc-x � �ai l'3�b g� C�ass a. G 3 b
^--`--'-_-�i__�...`._.- -- nT� n_._. c-]1_n�_
CONSTRUCTION LENDING AGENCV:
❑ I �ereby aHirm thet there is a conslruction lending epency br Iho DeAormenco of t�e work tor which this permit is iuuetl. (Soc. 3097, Civil Code).
Londers Name: Lenders Address:
Signature:
OWNER-BUILDER DECLARATONS:
Date:
I hereby eNirtn that untler penalry ol perjury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business end Protessions
Cade: Any ciry or county whic� requires e permit to consWct, elter, Improve, tlemolish, or repair eny strucWm, prior to its luuenco, also reQWres l�e ap011wnt for such permll
to lile e signed statement Ihat he or s�e Is licensetl pursuant to t�e prarisions al t�e Cantrecrors License Lew (C�epter 9(cammencing wil� Sectlon 7000) at DiWsion 3 ot the
Business end Prolessions Code) or ihai he or she is exempi Iherefrom end Ihe besis lor Ihe elleged ezemption. Any violation of SeCtion 7031.5 by eny apDlicant tOr a pertnit
subjects tha applicant to a civil penalry of not more then five hunOretl tlollars ($500).):
❑ I, as owner of tha properry, or my employees with weges as Iheir sde compensellon, WILL DO THE WORK, and the siructura I5 not intentletl or otlered tor sale (Sec.
7044, Business and Prolessions Code: The Coniractors License Law does not epply to an owner ol propeny who builds or improves theraon, antl w�o tloes such work
himselt or herseN or through his ar her own emplayees, provitletl Ihet such improvemenls ere not inlentletl or aHeretl tor sale. If, however, ihe building ar improvement is
sdd within one year ot completion, ihe owner-builder wiil have the burden of proving that he or s�e did not build or Improve tor purpose of sale.).
O �, as owner ol lhe prOperry. flm E%CLUSIVELY CONTRACTiNG WITM UCENSED CONTRACTORS to consWct the projacl (Sec. 7044, Business entl Protessions
Cotle: The contrectors License Lew does nol eppty to an owner ol property who builCs or Improves t�ereon, entl who contracts lor such pro�ect with e cantractor(5)
license pursuant to the Contractars License Lews�.
� I am exempt untler sec. Business and Pmlesslons Code for t�is reason:
Signature: Data:
Ownar ID verified by drivefs Ilcanse. ❑ Yes ❑ No Dnver s Licanse No. Expires:
Ventice�ion oi Ownership by (rype at documenL i.e. � property la�c blll or deeL):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certity �hat no axcavation tive (5) or more feel in depih Into w�ich e person is requiretl to tlescentl, wlll 6e matle in wnneciion with woM euthodzetl by t�is
pertnil, end that no building swdure, scattdtli�, falsework, or tlemolition or tlismantlinp thereal, will be more Ihan thirty-sla (36) teet high. (Chap. 32, Grp 2, A� 2, Sec.
341, Tttla B, Celilomia Atlministretive Cade).
❑ As owneabulltler, I will not employ enyone to tlo work which woultl require e pertnit trom t�e Division of Industdel Sefety, es notod ebove, unless such person haq e
permit lo tlo such work Irom tha tlivision.
Signalure: Date:
Division ol Intlustnal Safety Pertnit Numbor:
cooe �. ixsvecnoNnve
1816 Fixetl System Finel Fire Prevention
1266 Pool Spa Final
200 Finel Re�Rool
201 FIneI BIocWRetalning Well
202
203
204
Final Factory Fire Place
Final Sign
Finel Damolllion
�
�$ �QQ[a INSPECTIONiYVE
206 Finel Mochanicel
20B Finel Plumbing
210 Finel Eloclrical
212
220
Flnel Flra Prevontlon
Finel Planninq Appraval
222 Finel Slle
250 Final Building/Oaupency
PAgi I[�LS
�
�
��
Pfl0.1ELT�DOflESS: �}lO BRIGHTON SPRINGS
owNen•s xame: STOVALL CLYDE E
aooecss: ROHL LbUIS M
410 �RIGHTON SPRINGS
COSTA MESA,CA 92626
727-9090
RfltHIENGINEEfl: flEG.NO.:
RODPE55:
UNIT:
UNIT:
PEflMITTEE: CRANK BROS ROOFING CO ( 714 ) 548-5569
aooeess: 126 COMMERCIAL WAY
COSTA MESA CA 92627
LICENSEO CONTflACTOB UECIAflATION: I �¢r¢Ey allir mat I am Iicense0 unAer omvisions ol omr 9 Icommencine wiiA Section
70001 0l Orv;sion 3 0l ihe Business antl Protessions Co e. anA my license is in iWl lorce a ec
ciTv u 00 9 3 sTnTe uc.:4 0 8 6 c�ass:
�ate: — SiAnaWre: — — —
WOBI(EBS' LOMPENSRTION OFLNNA710N: I �er rm t�at I �ave a cenifiwre ot consent ta sel4insure or a certilicate af Wo�ers
Comoensatian 7�s�y,nce. ��cenilie� �py m I ction 3800, LaG. G)1 / O 1/ 9 3
POLICY NO.: � E%P. 0►TE: U
coMraNr: STATE FUNDM
❑ /Cen�if�ieE copy is hereLy IumisAeU. YJ Certilietl co vmh e ciry BuilAinA ��sion.
DateCL_�!��z APDIic���(/���J�e�"' `,
'�, EEEMPTIONFNOMWOPHEBS'fAMPENSATION�ECIAMTION: QhissectianneeAnatbecamDleteOilUece�mitisfaronehunOreA�$10�)orless).
I I cetlity ��al in the peAormance ol Ihe work lor which ihis permii is i55ue0. I s�all no� employ any person in any manner so as lo betome
subleci Io I�e Workers' Compensatian Laws al Calitomia.
Da�e: SiAnaiure:
NOTICE: II. after making ihis aectaralion. yau shoultl become sublect to tAe Worker5' ComDe�Sa�ion prOvisions of Ihe La�or
Cotle. you must IorthwilA compty wii� sucA pmvisions or ��is permit sha0 Ge Ceemea revoke0.
CONSTPUCTION LENOING RGENCY: I here�y allirm t0a� Ihere is a conslmction lentling aAency for Ihe pedormance ol Ih¢ work �or
which Ihis permit is issuetl (Seclion 3W7. Civ. C).
LFNOEfl:
nooeess:
OWNEfl BUILDEfl OECUflFTION: I �ereby afiirm thal I am e�empt imm the Comracmrs' Stale License Law for lhe lollowinp reason
(Section 7031.5 Business antl Pmiessional Cotle: Any city of county which reQuires a De�mit to conslmct, alter, impmve, demolish, or
re0air any simcmre. Drior ta its issuance. also requires t�e applicant br such Oe�mit to file a sipned stalement that �elshe is Iicense0
pursuam �o Ne O�ovisions a� ��e Coniracmrs' State License Law (C�ap�er 9(commencinp vn�h Section 7000) ol Division 3 0� IAe BuSiness
an0 Pmleisions Cotle) or I�al �e/ihe is ¢xempi I�ere�rOm antl Ne Oa5i51or Ihe allegea exemD�iOn. Any violaiion a� S¢t�ion 70315 �y
any aDPlicant lor a Dermit su0lects Ne applicant to a civil penalty of nol more tAan five hunOreO Oollars (5500�.
I, as owner of ihe Oroperty or my employees with wages as Iheir sole compensalion, will tlo t�e work, anU t�e
❑ simcmre is not imen0etl ar ollereA lar sale 15ecUan 7044, Business and Pmiessianal CoOe: The Cantractors' State License Law
aoes no� apply la an owner ol a O�oDeny w�o Uuiltls orim0�oves �hereon, ana who Does 5ut� work �imi¢II/herull orlAmupA
�is or �er own em0loyees, providea Nai such impmvemems are not intentle0 ar atlere0lor sale. If, however t�e Duilaing or
improvement is sola wit�in one year ol completion, the owner will have t�e 6urAen of proving �e/she tli0 not GuiIG or imD�a�e
br Ihe purpose of sale�.
I, as owner of ihe pmDerty, am e�clusively contracting wilh licensetl coniractors to conslmcl lhe prolect (Section 7044, Busineu
❑ antl Prole55i0n5 Code: ihe ConlfaCtors' Sla�e License Law tloes no� appty Io an owner oi pmpehy w�a bwltls or imp�oves thereon
antl wM10 [onVads lor SUC� D�OjetiS wilh a tontratbr(5) litense pursuant t0 Ihe Canbatlors' Slaie LiCenSe Law). I am awaf¢
Ihat pmol ol IAeir Worker'S Compen5aiion insurance 5hou10 Ce pmvidetl �o me.
� I am erempl unaer Section: B. 8 P. C.
IOI IhIS fCd500:
oate: ownec
I Qo hereby cenily Ihat I am aware ol anE underslana IAe requiremenls ol Calibmia Heal�� an0 Sale�y Code $ections 25505, 25539, antl
2553A ane Ihai I or any lulure builUing ocapant will/will nol (circle ane) need to comply with saia slate codes anA the reduiremenls for a
permil lor consimction or moUilicalion irom �he Air ualily ManaAemenl �istrict. flesitlential constmction applications are exempt hom
Ihese vmvisions.
Date'. AOOlicanC.
I her¢by terlily I�al I �ave r¢aa Ihis applitation antl Slale
ortlinances anC slate laws relaling to DWltlmg constmclion:
pmpe Or inspe lyq purpases.
C
DaI � � Signalure:
Driver s �icense oi Socia� Security x:
— '�-
C Canory—Applicanl; Pmk—Favonuo: GOIEenmtl—Assessor
e
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; B 058664 PLAN CHECK NO: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR
SOB DESCRIPTION ; TEAR OFF, REROOF 619SF/W4 PLY BUILT UP
PERM NO: B 05866
GOVT; N SUPP; N
PURPOSE; ALT
SQ FT: 1,817
CLAIM VALUE; 1,817.00 CALC—VALUE: 1,817,00 GROUP OCC: R-3 /
COMMENTS• REROOF RESIDENCE W/BUILT—UP ROOFING ����
�t+tx �rx�r�t+r*�t�t�r�r�tx��r�r�e***�*�r*�r*r�r*�e�r�r�r*�t+r �r�t�t+t*+r��r����r�r�r***�r
Z O N I N GS ERTEBQAUCIKRSE M E N T��
------------ MAIN BUILDING ---------- --------- ACCES�pgy, �ISI G��� � ---
FRNT; FT IN REAR; FT IN FRNT: FT —7Ff REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PAAKING REQ• PROV; PARCEL; 42435111 ZNE; REF NO;
PLANNING Nt31'ES>
i
�t*�r**+e�r**��*�e*�t�t*+r**�t�t�r�t�t�r�t�rx��e�r�r�r��ex��,e�r*+t+t*�**�t**�r�r+t,r�r,r�r�r*«�t*�e**��r�r****�t+��t***�r�t
D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E N T 5
20NING APPROVED BY DATE;
BUILDING APPROVED BY ; DATE;
�.n . � . .
Z
if iF if jF if iF if if k �f iFlf 1t 1EiE iE iF iE iE if �F 1f Ik iF �FlE�k k!F k it it if if k iF k if kiF ikik iE itlf M!f iE k if if �F 1E if iF if if if 1f if fE if iE it 1f IE iE iE 1E 1f k iE k iE df if 1flk k
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES.' GRADING
PERMIT 43.00 ,SOf
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID � DUE
TOTALS----> 43,50 0,00 0.00 43,50 43.50 , ,00
REVENUE DIVISION TOTALS--> COLLECTED: 43.50 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING ELAN—CHECK
93.00 ,50 �
iF 1f 3f 1F IE it 1E k iE �f if if it iF 1E if !t iF it itif if if iflf iflE 1F if !F iF i! 1f iE if if if fk iF fF �F ik fE fl� M k �E iE �f IE it iEif 1f iF k itlFif 1k iE 1E fE iF iE iE 1ElF 1E iFlF iF iF If if if if If �F
I N D I V I D U A L F E E H R E A K D O W N '�
TYPE QTY D E S C R I P T I O N UNIT COST �.TOTAL COST
SFR 1817 REROOF BY VALUE RESIDENTIAL N020NE 1,00 •%• 1,817.00
END OF FEES
r„
�
Ir
tY ,
I'
A�•1�
U:t. �'. _r' • •.._ ". !.
t- �
CONSTRUCTION ANDPLANNING POO. .SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date In:pector
1. Temporary Electrical Ser�ice or Pole 52. Pooi & Equipment Location
2. Soil Pipe•Undrgrnd. �� ' 53. Steel Reinforcement
� 3.�ectr�icalCondait�ltili[y-Undrgrnd�.: 54. Forms
.- �
:'�4. Etactrrcal Condart.lJndrgmd. � 55. Electrical Bonding
r' S,-St�e�; Reinforce'm�M' - 56. Rough Plumbing & Pressure Test -
;,6. Electrfcal UFER'firad. . 57. APPROVAL TO COVER�GUNITE �
`_,Z:FOopngs ' . 58. Electrical Conduit-Undrgrnd. -
"�. Foundation �, � 59. Gas Pipe, O Undrgrnd., Test =
^ 9. Water Pipe-Undig;nd. 60. Backwash Lines, P�Trap, O Undrgmd.
�i0. Siiuctural FloorSystem . � 61. APPROVALTO DECK
l t. Property Sewer Line & House Con�eciion 62. Backwash & Receptor-final
12. SeJ,r.er Cap � ; � 63. Heater & Vent•Final
13. Roof Orains L � � 64. Plumbing System - Final
14. Rough Piumbing ' 65. Electrical-Finai
15. Rough Electrical�Conduit 66. Solar SYstem•Final
16. Rough Electric yJiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTER�NG
18. Rough Electric$1�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- , '- ' :J
20.-ftough �zctoRy F.� eplace t.r: � � ;�, _ , !APPROVAIS � �Permit # ' .,- '
x
21.''pucts, in StructureY �`.-, y; � . " �� 70. Undergraitnd Hydro
22. Du�'fs, Ventitating � :� ; ' ''� -71. Produc[Piping O Cu�s O'OJ
i '4 . ' _
23. Gas Pipe�Rough $�?est � ;. , ' . ,. , , i• 7y, Underground FIJsh; . . .
24. � RoDf Freming � � r� � '' - - �73. • Undergrnd. Storage Td�k O Gas O Oti
25. Roqf Sheathing . s ' . � � _ - �7q, Qverhead j-lydro. .
26�T-6ar Ceiling (Structuraq & Monocoat . 75:'4�Y Chemjcal . -
27,iFrame and Flashihq. � ' � � 76. Dry Standpipe �- . ' � �
�-28. Latbing & Siding� : : ! i .: . * 77,' FIXED SYSTEM F,dNAL '
'29. Insulatief � . "` " . � ".'. : 78 FIRE PREV. FINAL � • �
�30. Drywall•Nalling - � � � HEALTH�DEPT: REQUIREJNENT
' 31. Plasrer Brow� Coat � . . � � z _79.^FINAL INSP_�CTI(�N '
-32. flectrica� Power MeteCF�nal �«.80.� FOOD CERTIFICATE ISSUED
33.finalElectric � ' . � � , Notes: �
�34,'Fina1 Hegtinq& AirConditioning, • - I . , � � , .
35.,Final Gas Pipe-TeSt - ' � _ ' ` ' �
36, �HoOd oaCanopY� u • . �� .-- � � :'
37.-Final Faaory Fireplace.. ' ` � I �� .. . �
38. Final Pl�unbing , . � � , � !'
�39. Water Service=Final . ' � I • ' �
i
,.AO. Gas Service-Final - , ; ' _ - � . � �
.-41. Solar pomesiicPinal i � � I ' '�
, -•
42. BackfloW Preventer - . ' � ,, � j j - � _
43. Backflow irrigation'' j � � z ' - . ,
�
44. Landscape Irripation System, =,� „ � . _ • . ._ ^i ' • .. "
-45.Sound Attenuation • � - ` - ' � -t � �
�46: Handicap Regulations �_ . � r - .-
47. "FINAL STRUCTUR� & 8U6:LDING :�-9 �'�� . �, � /i � B `C ,� /'
/ � (O
46.-FINALPLANNING ' � •�� �� , '
'49. Electric Release to Edison � if - - -
J
`50. Gas,Release to Sout`hem Califomia Gas Co � � -. -
51. CERTIFICATE OF,OCCUPANCY , . �
No. Oate
OWNERM. D. JANES G0, INC. DATE '� `� ��
JOB ADDRESS 410 Briahton Spri ngs BUILDING PERMIT N0.
AP No. LOT Z6 TRACT 10 2 FIRE ZONE � VALUI
INSPECTIONS Signature Dore TVPE GROU
SOIL
__" T�I �V oLVI� 11{%�l l V 1(
ING
�
NIR CONOITIONING
UNDERGROUNO � I POWER
FOUGM wIRING
FLOOR SVSTEM
BONO BEr1M (J SiEEL REINFORCE
SHEaTNING
FFRME <NO F�RSMING
PL�STER. BROWN C04T
NE�TING. VENT., R
PWMAING. FIN1L
� �¢ 4pp�p�/pci� �G� O�i iU �� ;I
' O
� 5 26 7/!0/7S �7 15.84 T�, '
COSTA MESA BUILDINGSAFETY DEPARTMENT APPLICATION:FOR S'iRUCTURAL PERNII� � ��
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
RECEI V ED 8Y
For Applicant to Fill in Completely — Use Ink Only
BUIIOING A.P. NO. �,�
AODRE55
BUII.DING
OWNER OR � D. Janes CO . IllC . ADORE55 �
TENANT �
M411LING UNIT OR
, ADDRE55 2950 Airwa,y Ave ., D-9 SPACE NO.
T9 .Np
c�rv Costa Mesa 92626 No�979-337 / a-
NEW ADD
CANSTRUCTION N/A
� Fninca
BRANCH `y
ADDRESS y�
AqCHITECT Sam l�T
OR ENGINEER P
nooAess 17922 Sky
CONTRACTOR Owner
ADORESS
CITY
STATE
UG, NO.
SIZE Zrre
OFlOT g•
USE OF
i/Ilg No`54
Park, Irvine
TEL.
NO.
CITV
LIC. NO.
� IVrO OF E
Separate permits are required for
electric, plumbing and heating work.
VSE OF BUILDING AN� WORK TO BE PERFORP
-i�3- l 9
i � .
L '�
LO7 ��/r BLK.
ALTER REPAIR MOVING DEMOLISH .
APPROVED
gy DATE
APPROVEDSETBACKS .
� (FROMC/LSTREET)
ROM FT.
FT.
L. SI E FT.
PEAR � FT.
PIANNING ACTION
�� /a �S �ROVED ���
�R�i sn`'- �/ 15'-
cir�r cr^ c^..__.._ ?_�,_ -...;�iTo
I hereby acknowledge thai I have ree0 this application and atate
thai tha above informaiion is correct entl ayrae io comply wiih
a!1 laws regulatirtg builtlinB connruction, antl 1 shall not employ
any Oerson in violatian of tha workman's compensation lews of
Me Scate ot Californ're.
1 hereby tertity fbat I am propeqy qcensetl ds a conVactor untler
the State of California Businax, antl Prafessions Cotle, Division 3,
Chapter 9, and that such licenses ara in tull force antl ettact, or I
am ezempt frorr� ihe provtsions Of the Stete Ot Callfornie Business
antl Profeszionz otle, yizian 3, Chapter 9.
Signatura of
Permlttee
ar /�
Authorizetl . nt Date
THE AMOUNT SHOWN UNDER VALUATION
THE PVRP�E OF ESTABLISHING A PERMIT FEE
VALVATION PERMIT FEE 5�
PLANCHECK S�Y,j
s �17, 7i )L� TAx s(S. �
TOTAL PAID S �// ,
P
�
u'
m
N
7
R m
� e
e
m
m
0
�
F
u