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Home My WebLink About367 LOURDES LN - Building Permits�oonEssoreawxc: 367 LOURDES ;LN a�ERa�+.�E�Faa�: SLAKTER CECILE �ooness: 367 LOU{tDES LN COSTA MESA,CA AFPL.AWjaM AUONE55: ANCXRECT OP FNtlNEFA: IR[N. ON ENO.'S100PES9: UNT: 92627 ue xo, VNi: carm�erarsx� ROSS 6 BARROWS INC. ( 714 ) 557-7440 Cprtq�CTOR4YNIlNG 260 E. ALTON AV �ooness: SANTA ANA CA uara.: 327802 92707 �r,,: LICENS MNRCTOflS DECLAN�TON: I Mreby alf m wMs pmely W prjvy Aw 1 un Icwed uMa pwviom d CMqer e (rom rwi�9 � h Seewn �0001 d Di.'v:n � d tM BuvMn ud Pealx�bm CoEe, eM mY Yoems u in IWl loree vM Mletl. c uc.r,o 020924 u�.o�5: C-39 uc.r,o.: 327802 EXP: 11/96 � a s ��,,,� ��-�, /QWIfE BUILDEN OECIANATION: 1 hmaby eHvm uMx qmly d pwjury tlw I un a�amp tmn Ihe Caqretlon Liume lew In iM imiew.�a �eeson (SeUion JW �.5 &aiwa� vM Rdemm+ COEa: A^Y ctY a mwY r.Aich n0u"vee e Derme lo ewmvuG. Mv. imMwa. bmdsR a npei vry at�uchne. pna b n eaueroe, e6o nywo �M eppGrant fa ach pmmtl to fib e epneE umemeru Rw he tt eM i��e w�� m ina yo� a e,. c�veaa. ��,. V. �cnea« e�oo�,�,�awro �n s.n�, �000� w o:+4� a a ine �uai�wss arq Prdeaiom Codel a rtw M a iw e aaemq theretran ud iM buu la Ihs eGeped vemqion. My vidmion d Seaion ]bJ1.5 by e�ry epplireni lar e permu eubpC� �he epplicaM �o a wi perody d nd moro �hen Ma hurdred do0an �5500�. � I. m owrcr M IM popany a my empb)eet wIn wapaa n Ihei We mmpanWun. v.tTdo tlq xqk, vd Iha tliucl�n Y nal inleMeE «dlaeE I« aeb (5ectian 10u. euv�en ard PrafaauonaCade: Tha Caurmm Lionae lew Eow nd apM'/lo en ownard propsny wAo ddde a in V�� Mrem. W Na Eo» �utl� wk h8naetl a MnM a W aN� hu a Mr awn+mP�Ww. 0� IIW wch impovemerva era ml'vueMed a atlaed la eW. tl, Mwwx, iM Grildinp ar inpvwnem o wN wilhin ar yeu d mmpbtion, ihs or.�.,�wadx .;e n... m. wm� a w�+a n. «.ne ma nu aaa «�w� �« m. wmos. a.wl. ❑ �. ea mmm d �n. wwem..m ..��N �n�.erq wn ron,w mno-.cm, ro canmw u» wqb (s.aion lou. ai.Mm. w Pm/emw Gode: The ConiMon licerw Lew Eom nd epM/ m en ox�w d PWMY Mn buiids w imP�+m �Mmm aM w1a cmi�ub la aMi pajeus wdh e mur+aa�a) fceroW pmun b IM CoNrerla� Limm� lav�. � I em exemp under Seetion: B. d P.C.. far Nb rsem: Oete: Ovrter. � eo nereW cwN �nu � em e..u. a ene wasmana we �am+oamaas a cauomie ween ane selnr coee swbm zssos. z55.v..nd xi53a. eM Uw 1 a mY N�vs briNuq moiP� M9l W nal (mcb one) nesd b camdY wN uii qns aoda� uN IM iM��aMs br apeimillwcmetruclionamoEifimlionhantM�r ue�enpananOiqriC.ROWmiWaonprutlioneppimoroenummplmmNeea a�. Dets: ADpfrsm: WONKEN'S COYiEN9�TON DECUN�TION: I MW/ elfom �adw prutly d pryvy w W Vw 1aEowirp Mdvelbro: ❑ I heva enE W memten e eenifwa d mwnt lo vetlareura tw r.oeksn' eompanWion, m pwidW la by 8wion �ro0 d iha LeEn eoae. b �ro o.rt«m.nu a o» woni eo, .I:w uw v� e wu.d. '� ino-,.�a�.u�m.:�..aiw.•�o�o�n,a,.�o...��a�.eMs.a�a�aodwi.m.coa..w�m.o«m��w,�.ain. work lor w1�rA Ni� n muM. W xvVen' comVM+�ian'v�sw�nc� mmr W D�Y �wmber me: c� FOUNDATION EXPIAES Pdc�jNumbx: ]_j-.� 07/O1/96 .ia actian mM na M rnnP'wb I tM I'a'm1 u br o» hv�CnE JN�n R�mi n Im.) ❑ i<.nn mm m u,. o.no�.z. a u. � i« .msn w c.mw v�.e, i wn �a •�r .m o«.m m.�n m.�,� A.+m ome .�q.a m ms w�we�,• �uo� e.,. d Cefdomu, W apn� YW 1 I�houk becpr� abptl to tM Morken' �o �wti.�� ww�.� �aysy.a�, a�ao a u. i.eo. coa.. i wu i��,m�, iro/..y�oW wn. e: � — S /�r Aoq'uN: iC./7X1Y.CI+�—� I Inp: HNun M��eun irortw�'rompwu�tlon rov�rry� l� unMHul, �rW �Nll �W/�rt �n �mploy�r ro cAmlirl p�n�ltlu �M slWl nrr� �q ro am MnW�tl NouunOOdhn fS1pq000A h MGdon ro M cut ol rompwwtbn a�p� �� poMhe br In Sxtlon J1G6 0l M� lebor CoO�. Intw4 �M �ttum�y'� Iw�. CON9TIIUCf10N LENDINO R6ENLY: I Mntr/ �rtn uMer peiutly d perjury IIW �Mn u a aonAeutlbn bMinp peney lor tM parlarmvm d iM xak lar whirh Rie pxmi u uawE (�� . G'r+. C). LENUER'S NIW E: � LOlUER'S �OOFESS: I cenEylMt I hme meE Nu epp4etion vd eW� tM Ns Wov�'udamNion u corted. I prs to canyy �.ith eA my eM ooumy pdiroriou eM elats kwe rMe�iq b butldi+p mvVuaion eM IweW eWariza repaw�tatiws d �he dryb emx �pon IM ebow-meNbned popeM ��M'�'"�'� NANCEE KILHOURNE /7 ^//^ Prva �A/_/1�'i��c�`-f�i ode:o2-,1� %�� Sqnm OxmtlAyaivlAppirsm�Catlraaa / L/ (5�51d6WP) Whna-BUYCvp85elary:GrseMWa;Cenery-Appfrau;Rnk-Rewnu�;dddanmd-N�eaw CITY OF COSTA MESA — BOILDING PERMIT PERM NO: B 0762)i PERMIT NO: H 076297 PLAN CHECK NO; N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STF� PURPOS£: OTH JOB DESCR�PTION : T/OFF 6 RE—ROOF SQ F'T1,: 1,200 CLAIM VAI;UE: 1,200.00 CALC—VALUE: 1,200.00 GAOUP OCC: U-1 / COMMENTS: X +r�c+r�r+�*+r�+t*****�r****r********�a*x *+t+�+�*****�r***+r��r�*�e***x�**+��x�*+r****��r**x *#�r�**�r*�r 2 O N I N GS ERTEBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN AEAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PAAKING REQ: PROV: PARCEL: 43914123 ZNE: REF NO: PLANNING NOTES> i 1E if 1k iE if 1f 1F 1E if iE 1Eif if 1E 1f 1E'Ih 1E 1f 1F if iE iE if i! 1k 1Flk1f if iF 1f If if If I! 1E 1E1k If IE if if If if if 1f 1F1f iE1E# iF if 1i if'If 1FiE1f if iE If 1E 1i 1f 1f 1E1f iE iE 1f 1i if iF aE if 1f iF D E V E L O P M E N T S E R V Z C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: HUILDING APPROVED BY : DATE: —{��j APPLICATION ISSUED BY: DATEs �-- ' � _ � " �F if MiF 1E IF IF if M 1E IE iF 1f 7E IE IFiF IE if 18 iE iF iE 1f 1f 1f 1E 1F1E 1E iE iE��K if LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGM£NT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES (GRADING PERMIT 29.00 .50 SMIP/NON—RES PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 29,50 0.00 0.00 29.50 29.50 .00 REVENUE DIVZSZON TOTALS--> COLLECTED: ^ 29,50 OVER/'SHOAT: •00 BLD29PM�T� PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT� GRADING PLAN—CHECK !f Ik 1F 1E IE1f 1f 1f 1F 1E 1F 1F 1F iF 1F 1F if 1F iF 1f 1k 1Fif 1k 1f 1f 1f 1k 1F 1f ik iF ik iE if 1E 1k 1k 1f iF 1! 1klf 1f 1F1f 1F 1E 1FiE 1t111f If 7f iE 1f if 1f �1k IFlF 1f 9f IE # 1E iE 1flt # 1k1F 1tlF1k 1f 1E iE I N D I V Z D U A L F E E B R E A K D O W N TYPE QTY D E 5 C R I P T I O N UNIT COST TOTAL COST a SFR 1200 AEROOF HY VALUE RESIDENTIAL NOZONE 1.00 1,200100 END OF FEES 01 Q0149888—QQ199889 T C+"P g9,iij OATE: 02/03/95 t2t4E: 14:46 :367 LOURDI:S LN BACK BAY GARDENS HOA 350-B RIVIERA ST, C.M. �fltNIENGINEEfl: �OOHESB: uHiT� NEO.NO.: ' UNIT: ' PEflMITTEE: WESTERN ROOFING CO ( 714 ) fi93-4377 nooness: �q g i RONALD DR A H. 0. CA 92547 11tEN5E0 COMTMQOB OECLAMTION: I �ere0y aflirm Nat I am IicenseA unOer provisio� of CAapter 9(wmmendng witA Sectian 7000) al DHision 3 of t�e Business an0 Professions Cotle, an0 my license is in full farce anE etlect. � cm uc.: U 3 0'I 7 0 $TpTE 11C.:O �� cu oace: \2�-1g- �' q �Si9natua '`="�^� ��5'4l C�`4.�� WOpKEP3' COMPENS�710N �ECLAMTION: I �ereby attirm Nat I have a cerli/icate ol consent m 5e14insure or a certificate of Workers' Compensation Insurance, or a cenified co0 thereot (Section 3800, La�. C). Poucr Ho.: 2 A 5- 73 9 U N I T� 6 4 IXP. O�TE: O I/ O 1��.� I � cornvnxr: STATL' ' r] Cehifie0 copy is herehy fumishe0. � Cenifie is hle0 wfth ih it wldinp D' ision. uate:`� \X �-1 WPVlicant��n��n _ �/ EXEMPfION FBOM WONKEBS' fAMPENSlITION DECUM710N: (IM1is uction nee0 not �e comDleteO il Ihe parmll is tor one hunOretl (5100) or less). I ceniry Iha� in the p¢tlormance 01 ��e work lor which this permit is issueU, I shall not employ any per5on in any manner 5o as �0 6ecome su�ject to tAe Workers' Compensation Laws ol Califomia. ' Oate: • SiAnaNa: - � � NOTICE: Ii, atler makinp iAls �eclaration, you s�oultl Oecome suhlect la t�e Workers' Compensatlon proNsions of the Lahor CoOe, you musi IonAwit� comply vnt� suc� O�a��ons or tNs permit shall Oe GeemeJ revakeU. CONSTHULTION 1FN01NG �GENCY: I Irereby attirm tlut ihere ¢ a conttructbn knUinp apency lor the petlormance of t�e wod for which I�is permit i5 i55ued (Seclion 3097, Civ. C�. lENOEfl: ' aooeess: OWNER BUILOER DECUILITION: I hereDy attirm that I am exempt from tAe Coniractors' Slate License Law far Iha followinp reasan (Section 76315 Busineu antl Prolestional CaOe: My dry of counry whic� requires a permit ro wnstmct, atter, imOrme, Aemolan, or repair airy stmctum. D�or to ils issuance, aLSo repuires t�e applicant for sucli permit to file a siqneE statement that �rJs�e is IicenSeE pursuant to ihe OmNsians af t�a Contractors' SWIe License Law (Chap�er 9(cammenunp xitA Seciion 7000) of OM5i0n 3 a� ��e Business an0 Professions CoOe) ar that he/she is,exempt tAerefmm and ihe Dasis for tAe alle9e0 exemplion. Any violation of Section 7D37.5 6y any apDlicant lor a Dermit suGjects the aOUlkant Io a ciNl penalry of not more tlun five �unOretl dollars (f500�. � 1, az wmer oi t�a Droperry or my employees with wapes u Neir sole comDensatlon, vnll do t�a work, anU [he ❑ simctureis notintenEeU oroneraelorsale�Sedion 7064.Business anA ProfessionalCada: TAe Contractors Stata License Law Oaes not apDly to an owner ol a pmperty who builtls or improves ihereon, anA w�o does such work himsell/herself or.thmupA his or �er owmem0loyees, pmvitleC thzt such imDrovements are not IntenAeO or offere0 lor ule. If, Mwever ihe Euildinp or improvemeni Is solE within ane year of completion, the owner will have t�e �urden ot pmdnp �e/s�e EiU nat Uuild or improva lor Ine puryose of salel. ' ' I, as owner oi Ihe proDerty, am axclusively coniractinA with licensed coniractors to consimct tAe D�olect (Section 7044, Business ❑ anG Prolessions Cade: The Conlraciors' State License Law Oces �wt apDN �o an ovmer ot properry wAo hml0s or improves thereon anA wno wntracts lor sucA Dmjecis vritn a wntractor�s) license Oursuam ro t�e Contractars' State licensa Law). 1 am aware that D�� ot Iheir Workei 5 ComDensa[ion insuance slroultl be OronEeO to me. � I am exempt under Satilon: B. 8 P. C. lor l�¢ reason: Date: Owner. I Ga �ereby anity ttwt 1 am aware of anG unAerstantl lhe reQuiremenl5 oi Califomu HeaII� an0 Safery CoOe Secli0n5 25505, 25533, an0 2557a aM ttut I or any Imum Ouikinp occupam wilUwill not (cirde one) neeE to wmDN �+�� tl sbte coGes ana Ne repuirements lor a permit for conslmciion or rtqGifipiion fmm t�e Nr Oualiry Manapement District. NesidenGal consiruction appliatrons are exempt imm ��ESE DfON510115. ' , Date: Applifant: I �¢re6y certiry tAal I have aaE lhis appliution anA state ihat t�e a0ave inbrmation ¢ correct. I aA�� o comDty wit� all ciry anE counry or0inances anG statelawsrelalinpto DuiltlinqwnsW ' n anE hereEyaNMrize reD�esentativu allAis ciryto en�er upani�e abave-memioneE DroOeM �or inspectron Ourponsu. / Date\,l� � 'b ' 4+ "\ 1 SiAna[ a �–A� °` � � Duver's License or Social Secunry x: 1fi41J6 W�iro—BuilEinp; Green—COEe Enb¢ement Cenery—Aoolicam: Pink—Revanue; GOIEenrod—Assesmr CITY OP COSTA MESA - BU'ILllING PERMIT ' PERM DIO:. B 045430 .� PERMIT' NO: B 045430 „ PLAN CHECK NO: N GUVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH JOD DESCRIPTION : REROOP W/40LB FELT 6 EIOT MOP SQ FT: 4,00 CLAIM VALUE: 400.00 CALC-VALUE:. 400.00 GHOUP OCC: M-1 / COMMENTS: �*****�+r�r**�******�**�r*�**�**� *t�x�r+�� **+�*�**�*�r**�r*�***��x�*+�**�**:rt��***�t��**� Z O N I N G R E Q U I R E M E N T S ' S E T B A C K S ------------- MAIN BUILUING ---------^ --------- ACC�SSORY BIIIL.DING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT TN LEFT': FT ' IN RGFiT: FT TN `LGFTt FT IN RGFIT: FT IN - PARKING REQ: • PROV: PARCEL: 93914125 ZNE: ' REF NO: ' PLANNING NOTE�> � , , > if iE 3F jFlE �f ff 3f 3f if !f 1F if k M iE if iE iF iE iE * 1E 3E iF �1F 3F 3E 9E jE IE fE iF )E iF iE iE iE ft # iE fF it i(� �f i! iF it iE iE iF iE iE iE 3(� if i! iE iE iE iE 3E if ik �F �� 3E iE iE jE if iE 3E iE it it �f % D F: V E L O P M E N T S E R V I C E S R'E Q U I R F M E N T S ZONING APPROVED,';DY _. DATE: HOILDING APPROj�L•D BY : _ DATE: p,. APPLICATION ISSUED BY: � ' DATE:�� ^� � �l if iF if IE �f iF iE if iE iE 4�E if iE 3f if iE iE �E iE IE!(-3�if 3f �i� �3(�FiF�i(-r!f if af if fb if it iE fE7��:�'iF iE iE if i6 jf iF iF iE iE if k k iE dtlE lE k iE jtlf ff !F k!E iE !E 3E !E iE if ib if # iE if iE 1f 3E iE iE it k iE iE * if k IE �E 3E iE �E iE jE jE 3F iE iE iE# 3l-iE jE i6 iFiE k iE if %iE if if it iE ik �' iE iE iE LEGALIZATION:A1 F E E S U M M A R Y S.T�UCTURAL SF.GMENT:Y , 6T,UG PMT PLUM➢ING ELECTRIC MECHANIC FIRE SMIP/REY3 GRADIDIG PEAMIT 15.00 ' .SO . � SMIP/NpN; ItES PLP.N -� rssuc r•Ee � � BOILDIt•IG--UIC�-> FERMIT TSSUE PLAN-CHECK TOTAL PA2D ' DUE TOTALS---> � 15.,50 0.00 0.00 15.50 15..'SO y„� , � .OU RLVENUE UIViSION 'POTALS-->' COLL�CTED: 15.50 OVER/SHUk`t.Ti� '• .00 . BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADTNG;•PLAN-CHECh � 15�.00 : ' - 5� -. �:i iE iE it iF 1f 1E iE!(� h iE iE i6 iE if iE iE k fE if 3f iP iE iE iE k iE �E iFlf jE iE �E iF iF iF it fE k if i` it k 1E iE iElt iE �E iE 1E it iE iE iE if iE 3E!E iE �E i61f �t it it iE iE iF iF 3E iE �! # iF if iE ik dE iE I N D I V 2 D U A L P E E II R E A R D O W N .� ' � TYPE QTY D G S C R I P T T O N UNIT COST T01'AL COST SPR 400 REROOF DY VALUE RESIDENIAI, NOZONE 1.00 } 400;:00 _ ' END OF FEES , , - '• � . _ � EXPIRED Incomplete Inspections S i. :i Uate � _�� Sig — f � r -�I�„�q� Oi OD044944-00049944 T QT .50 6ATE: 12/1E/89. TINE: 13:02 �DUPL%C�t'YE F`.�CEIPT� 0! UD049943-00049943 T 4 Y 15.00 DATE: 12/18/89 TIME: 13:02 � � CONSTRUCTION AND PLANNING�� r��iDPROVALS Permit # � . Temporary Electrical Service or Pole� 2. $oil Pipe-Und�grnd. 3. Electrical Conduit Utility�Undrgrnd. 4. Electrical Conduit�Undrgrnd. 5. Steel Reinforesment 6. Electrical UFER Grnd. -7.: Footings . 8. Foundation 9. Water Pipe-Undr9rnd. 10. Structural Floor System � 11. Property Sewe� Line & House Connection 13. Foof Drains 14. Rough Plumbing " 15. Rough Electrical-Conduit 16. Rough Electric Wiring 17. Rough Wiring 5ign 18. Rough Electricsl-T Bar Ceiling 19. Rough Hea[ing�& Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure� 22. Ducts, Ventilating 23. Gas Pipe�Rough & Test � 24. Roof Framing 25. Roof Sheathing 26. T�Bar Ceiling (Scructural) & Monocoat 27. Frame and FlaShing � 28. Lathing & Sidin9 29. Insulation 30. Drywall Nailing , 37. Plaster Brown Coat� 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test. . . 36. Hood or CanopY � 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service�Final 40. Gas Service-Final 41. Solar pomestie-Final 42. Backflow Preventer 43. Backflow IrrigBtion 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap RegUlations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Elearic fielease to �Edison 50. Gas Release to Southern California Gas Co 51. CERTIPICATEOFOCCUPANCY Date Date Inspector � � POOI 'PA APPROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPflOVALTOCOVER�GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P�Trap, O Undrgrnd. 67. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access ApProval 68. APPROVED FOR PLASTERING 69. POOI/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # " � 70. Underground Hydro 71. Product Piping � Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL . 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date � Inspector i� � 0 �J \ 1. � ADD��ant to fill in all soaces exttpt those within neavy border Iines antl si9n all aoorovriale tleclaratians. CITY OF COSTA MESHA CONST UCT.ION PERMIT PE T NO_ _ _ TRACT NO. LOT NO. UNIT NO. Project Add ess ��' / �i 1� � .� �Applicant's Mailin Addre'ssl �/ .0�. °� p Owner'sName ��/��(NKfP � Phonel2� '�1G Address –�3.7�yP' ArchlEng. License No. Address Contractor's Nam Phone � Address (ma'I'ng) t�l f City Licensa No, —�i �n-� UCENSED CONTRACTOR OECLARATION I hereby a/tirm l�at I am licensetl untle� p�ovislons of ChdrtCr 9(commencing with section 7000) oi �Ivislon 3 ot the Bu5ine55 anC VrOtesslons Cotle, antl my license is in tul g�antl eilect. �� License C ass � Li ze No Date Si9nature WORKE 5' MPENSATION DECLARATION I hereby aHirm that I nave a certi/icate ol consent to selt-insure or a certificate �' Workers' Compensation Insurance, or a certifiea copy thereo( (Section 10, Lab. C /�^� �/ iicy No. �/y n� Company S�I�L� �'r'��— �erti'ietl COPR'S f letlbwlthr(henc ty B n�!�/ sio oate Applicant �iv v(, �� EXEM TIO F M W00.KER5' COMPENSATION DECLARATION (This section neetl m[ be completetl it Ih! pe�ml[ is for one huntlr¢tl ($100) or less). 1 certity lhal in the perlormance oi lha wOrk to� which Ibis Oe�mi( is i55uetl, I shall not emoloy any person in any manner so as to betome subject to the WO�ke�s' Compen5ation LawS Of CalifOmia. Date Slgnature NOTICE: If, aRer making this tle<laratlon, you shoultl become subject to the Workers' Compensation provi5ion5 ot lhe Labor Cotle, you must iorcnwt�n comply wi[h such provi5ions or [nis Oermit 5hall be tleemetl'revoketl. CONSTRUCTION LENDING AGENCV - I hereby a(flrm Ihat there is a mnstructlon lentlin9 agency for the performance oi tM1e wOrk for whiCh this pmml[ is Issuetl (SeCtlOn 3097 Civ. CJ �'. Lentler's Name � �entler's Atltlress OWNER BUILDER DECIARATION 1 hereby af/irm Lhat I am ezempf trom the Contracror's License Law for the /ollowing reason (Section 7031.5 BuSiness antl Professional Cotle: Any city or counly whlch �equires a pe�mit f0 const�utt, alt¢t, Improv¢, tl¢molish or repal� any structure, prior to its issuance, also requires the applicant for suth permit lo file a signetl statement that he/she i5 licensetl pur5udnl t0 [tte p�ovisions of [he ConVactor's Licenze Law (Chapter 9(commenclnq wl[h Section 7000) o! Division 3 of the Business antl Professions Cotle) or that he/she is ezempt t�'•=hom antl tne basis (or tho allegetl exemp[ion. Any vlolation of Section .5 by any applicant Por a permit sublects the applicant to a civil ty of not more than five huntlretl tlollars (E500�. L, i, as owner of the property or my employees with wages as their sole compenSatiOn, will tlo the work, antl tne struG[ure i5 not IntenGetl or offeretl for sale (Section ]044, Business antl Professional Cotle: The Contractor's License Law tloes nol apply [o an owne� ot a prope�ty wh0 bullAs o� improves Ihereon, antl wbo tloe5 Sucn work Itlmselt/h¢rself or through his or her own emplOyees, provitletl that such improvements are nOt Intentletl or offetetl (o� sale. If, however, the bulltling or improvement is soltl withln one year of com- plelion, the owner will have the burtlen of prOving he/Sh¢ tlitl not builtl or iT- prOve tor tbe purpose of sale�. � I, as owner of the property, am exclusively contratting wtth Iicensetl con- tractors to cons[ruc[ [he Oroject (Section ]044, Business and Professions Cotle: The Contractor's LicenSe Law tloes not apply to an owner ot property who builtls or improves the�eon. antl wno confracts for SUGh oroieGts wlth a con- traclor(51 Lcense pursuant to me COM�actot'S LiGens¢ Law). I dm aware [ha[ prooi o( [heir Worker'S Componsation insuranCe snoultl be proviCetl to me. ❑ 1 am exempt untler Section B. & P. C. for this reason Date Signdture _�� Orivers' �icense or 0865-46, rev. 5/8 _ Owner I have reatl IhiS applicatia I agree to comply wi[h all I �O bullding con5i�uctlon, / [o enter upon th¢ dbo � [ ] state that tne above ana county orainances iereby authorize repre- :ntlOnetl pro0er(y to� TYPE OF CONSTRUCTION LI NEW L.J ADD LJ ALTERATION f�J REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING L�FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL Lf PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION S�.FT. oCCUVANCv CONSTRUCTION TVPE VALUATION $ ZONE GRADING CU. VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow IrrigatiOn Bathtubs Clarifiers rinking Fountains loor Drains loor Sinks as Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under GrOund Duct - StrUctural Duct - Ventilating Exhaust System ❑ Multiple Firepl%Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU �100,000 Reinspection Fee � $15 White - Bulltling; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor ShoWers Service Sink Sewer (;ap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Tra'ys Issue Fee Hood or Type I ❑ Canopy Typell ❑ Refrigeretion Sys[em ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers laue Fee A.P. �i`- S Main Buildi E T Front B Rear A C Right K Lefc s Ping. Ref. # Planning Notes: FEES Automatic Washer Construc[ion Pole Sub. Cooking Unit Dishwasher . ' Dryers ❑Gas �Elec Fan . F.A.U. Fixtures Device Boxes Outl¢ts $WitChQS Garbage Dispoul Generetor �0-5 KW C Zone Building: Parking Req.IProvided ELECTRICAL Transformer ❑ 15-SOKW ❑ 50 * K W Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors �0-1 HP O1 Yh - 8 InaSolar 09-15 HP �i6-15+ Microwave � Pole Light Range I I Standing Sections 5 KW I � Trash Compacror Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: ZoninB APProved By FEES Building APProved By $ 3 O N I N G R E Q M T S. FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP q PLAN CHECK $ � PERMIT PLUMBING $ ��DISSUANCE $ � PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ �/�� MECHANICAL S TOTALFEE $ _–",� PLAN CHECK 25% $ n1 r- r.�r :?'—�Q`a:fi�i:l 1.`a_. �.i'�iC.� 4��(��!,/ 14111�: !rl\ IY .. . � . . . . . , . . . . . �.'. . ... `. .. ±'i . � \,��, 1 CONSTRUCTION AND PL�ANNING � POOL ➢- cpq ;APPROVALS Permii# Date Inspector AppROVALS Pe�....c# Date Inspector 1. Temporary Electrical Service or Pole' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ,. , 53. Steel Reinforcement "� 3: Electrical ConduiLUtility-Undrgmd. 54. Forms , 4.-Elec[rical Conduit-Undrgrnd. 55. Electrical Bonding 5.� Steel.Reinforcement 56. Rough Plumbing & Pressure Test , 6.. Electrical UFER'Grnd. � 57. APPROVAL TO COVER-GUNITE 9'. Footings � �, � 58. Electrical Conduit-Undrgrnd. , 8. Foundation ; � 59. Gas Pipe, O Undrgmd., Test ' 9.. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. . 10. Structural Floor System � 61. APPROVAL TO DECK 1 i. Property Sewer Line & House Co�nection 62. Backwash & Receptor-Final 12. Sewer Cap ' - 63. Heater & Vent-Final ' 13. Roof �Drains . 64. Plumbing System - Final � 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval `�77,. Rough Wiring Sign 68. APPROVED FOR PLASTERING �. i �y8: Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT i` �20i Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Foof Framing 73. Undergrnd.StorageTank �Gas ❑011 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurap & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � ��( (,� 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomestic-Final ;-� 42. BackflowPreventer '��' .!' v Y'� 43. Backflow Irrigation - �" , r ll • 44. Landscape Irrigation System ,'.� " , _. 45. Sound Attenuation �� 46. Handicap Regulations "' 47. FINALSTRUCTURE'&6UILDING � 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ! :�• 51. CERTIFICATE OF OCCUPANCY .� - No. Date " JOB ADDRESS : Shields IT" `&CTIONS 5 co.,Inc. DATE 6-3-� �v.Co.,Inc. vaLUE � 16,790.00 ,� FIRE ZONE DESCRIPTION OF WORK RES.W a.tt. DATE IGROUP I&J TYPE V ZONE R-2 SUBCONTitACTOR COSTA MESA BUILDINGSAFETY DEPARTMENT P.O. BOX 91] COBTA M68A. CALIPOHNIN For Applicant fo Fill In Completely TypE OR PRINT ILDIN6 �B �"/ .n /1 �. DRES3 (7 ( IILy � COSTA MESA. CALIFORNIA ess O / Ja •// r/ R N L- P� C, i � ITECT / ' � G %a r, '.GINEER �/G� / E59 � a fl !�/�J't CCc, RACTOR `] O� N� � �d� LICTNO.IS� ��-/J % NO�� 02� OFLOT ��%'^ ��•u V / NO.OPBLOOS. NOW ON IAT �� IISE OF EXISTING BLDG. '��'� 82THACK LIN6 FROM � ^ / CENTER OP eTREET G�1 • J� REAR YARD �� SID6YARDI LEFf I RIQHT DESCRIPTION OF WORK °°33 y )R WAL� NG BUILDif; Ca h d� 3z - G I HEREBY ALNNOWLEppB TXAT I X�Ve READ TIIIB �PPLIC�TION •NO BTATE THAT iHH ABOVE 19 COqRlCT ANO AORHH TO COM. PLY WITH ALL CITY OtjDINANCBB ANC BTATi LAWB RHODUTINO Bl11LO�N0 CONeTqURION. I� � AUTHORIZED FEE RECEIVED ./ JU N 3 1963 � FINANCE DEPT. APPLICATIOKI' FORFP�� MESA BUILDING FOI Oiil[B U58 Only 11CCH1'TNO. PH� ��,"P2 r oere rtacarv o o�re iseueo S-a9-�3 JUN 3 1963 �� 7 ,�.s-��,e�� ''.�-� ZONING , NO.OF UB80RNH P�une BUILDIN � � AL CPIIlION �3 %ra� 3�Y3� �.NO.� fE: NO EAVE OVERHANO BHALL BE LE88 THAN ' TO SIDE 3 REAR P. L, 'ES .OWED (U. B. C. REQIIIREMENTI YARDSAPPROVE� YARDSAPPROVED MAIN BUIL�ING ACCESSORY BUILDING REAR O I DISTANCE BET MAIN BLDG3. VAR. 3C /.�•r� so. F TH8 AMOUNT 81 PURPOSfi OF E VALUATION �6 ,�o � �y $ BET.I AGCE DATE � �.a� � 0 VALUATION 18 FOH TNE F A PERMIT PEE ONLY. Q /� 0 IT FEE $ � � � h��/ m CHECK S o / � ¢ 0 /� , l LL �� _PEE $ fJ/�