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Home My WebLink About908 MACKENZIE PL - Building PermitsJob Address: Suite No Vicinity: Parcel Nunmber: Applicant Address: owner: 908 MACKENZIE PL 41805232 TEVIATA SULIAFU SCHWASSMANN,JACKTR Phone: 800-454-8955 Zip: Address 908 MACKENZIE PL Phone: COSTA MESA, CA Zip: 9262&2957 Contracior: FAST WATER HEATER COMPANY Address: 12601 132ND AV NE KIRKLAND WA WATER HEATER CHANGE-0UT ISSUE FEE BaCkOow irngation BaCkflow Preventer BathWb Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earihquake Valve Gas (7-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptore (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 80.00 E0.00 $0.00 $0.00 50.00 $O.OD $0.00 50.00 so.00 $0.00 so.00 $Q.00 50.00 $0.00 50.00 50.00 $0.00 2 Phone: 800454-8955 Zip: 98034 License: 877489 SCOPE OF PERMIT FEE SUMMARY AMT LaundryTub/Washer' $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 70 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Conned 80.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor � $0.00 Sink, kitchen $O.QO Sink, servlce/mop $0.00 Spa (pnvate) $0.00 Spa (public) $0.00 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 0524/2007 Issued: OS/242007 ISSUED BY: �Afi- -T� SumpPump Swimming Pool 7rap Primer Urinal Vacuum Brkr Bk9ow(1-4) Vacuum BrkrBkOow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater I venl Water Piping (Inst or Rep.) Water Re-pipe Water Service Water SoRener OTHER VIOIATION PLAN CHECK REINSPECTION AMT $0.00 so.00 $0.00 50.00 50.00 $0.00 50.00 S0.00 30.00 50.00 512.30 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES: 535.80 �N 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all appllcable handicap access requirements under Calilornia statutes and related regulations. (Ord. No. 92-28, § 1. 12-21-92) EXPIqATION: This permit shall automatically ezpire and become void it work is not commenced wlthin 1 BO tlays, or tl work is suspended or abandoned for a period of 180 days. � INSpECTIONS: In order for the work authorizetl under this permlt to be considered legal, such work must comply with all applicable codes, end all requlred inspectlona and tinel approval must be obtained. Failure to obtain inspections and final approval will result tn the expiration of thls pertnit. FOq INSPECTIONS CALI: (714) 7545626 c�o-aa �rvw� WORKERS'COMPENSAnON DECLARAnON: I hereby effirm untler penelry ot perjury one at t�e tollowing tlederetions: ❑ I heve end will maintaln e ceNiicate of consent to self-Insure for warkers' compensatian, es provided for by section 3700 of Ihe Lebor Code, tor ihe pertormance at the work tor whlc� thls permit Is issued. � I have arW will maintain woMers' compensatbn insurence, es raquired by sectlon 3700 of ye Letwr Code, br �he peAortnance of the xrork for whlch Nis permit Is Lssuetl. My workers' compensation Insurence carriar end polcy number are: I � _ �Certler: �--�� -Yl/IJ� PolicyNumber. __I ��o � lO�e� (Thls sectlon need not be wmpletetl i/ the pertnit Is veNed ef one hurMred dWlars (5100) or less.) � I certify thet in the peAormance of Ne work lor which this pertnit Is issueq I shall not employ any person in any manner so es to become sub�ect to ihe workers' compensation laws ol Calllomle, erW eg th I I sh � I b ome sub�eM ro the workers' cor9 pensallon provislons of Sectlon 3700 ot the Lebor Cotle, I s�ell farthwit� compty wlth Ihese proNsions.^ � / � Applicent SlpneNre: � � f � Dete: ''TI%�� l � WARNINO: FAILURE TO SECURE WOR S' COMPENSATION M I$ UNLAWFUL AND SHr1LL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES D CIVIL FlNES UP TOONE HUNDRED TNOUSAND DOLLARE (5100.00%, IN FDDfiION TO TME WST OF COMPENSAT70N, OAAWGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR COOE, IMEREST, AND ATTOqNEVS FEES. LICENSED CONTRACTORS DECLARATION: 1 hareby eHirm thet I em Iicensed under pwvisions I C�epter 9(commencing wlih Sacllory7900) ot Dlvision 3 of Iho euslness antl Profasslons Catle, end my license is In full forca end eHect. Lic. M � Ciess a G� S� —� Contrectols Slgneture: � Date: �!"Z��F / n,_� CONSTRUCTION LENDING AGENCV: ❑ I hereby ettirm t�et there Is a consiruction lending egenty lor the peAartnance ot ihe work tor which this permll is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentlers Adtlress: � Siqnature: OWNER-BUILDER DECLARATIONS: Date: I �ere6y eHirtn Ihet under penelry at perjury that I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business entl Prolessions Code: Any clry or counry which requires a pertnit to construct, elter, improve, tlemolish, or repair eny siructure, prlor to Its issuance, also requlres the epplicant br such pertnit m file e signed statemern Ihat he or she Is licensed pursuant ta Ihe provlsions of the Contrectors License Law (Chepter B(commencing wtlh Sectian 7000) of Dlvision 3 0l the Buslness end Prolesslons Code) or Ihat he or she is exempt therefrom end the besis tor Ihe alleged exemption. Any vloletion ol Sectlon 7031.5 by any applicant for e permit sublecta Ihe epplicent to e civil penalty of not more than flve hundretl dollars ($500�.): ❑ I, es ownar of the property, or my employees with wages es ihelr sole compensatlon, WILL DO THE WORK, and the siructure Is not Intentled or oMeretl tor ule (Sec. 7044, Business end Professions Cotle: Ttie Contractors LJcense Lew tloes not apply to an owner of pmparty who builds or Improves thereon, flntl who does such work himself or herself or through his w her own employees, provided that such improvemenis are not intendetl or oHerea for sale. If, however, Ihe building or imprwemem is sold within one year of completion, ihe owner-bullder will heve the Ourden of proving that he or she did not build or improve for purpose of sale.). � ❑ I, es owner oi the proDerty am E%CLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions CoOe: TTe coniractors LJcense Lew tloes not eppty to an awner ot propeny who bulltls or Improves ihereon, end who coniracis lor such projeci with a coniractor(s) license pursuant ta the CoNractws License Lews.). ❑ I em e:empt unCer sec. SigneWre: Owner ID varlfleA by ArlveYs license. ❑ Ves ❑ No Business end Professions Code for this reeson: Vedticatlan ai Ownership by (rype ol document, i.e. - properry tex bill or tleetl): DIVISION OF INDUSTRIAL SAFEfY PERMR CERTFICATON: Orivefs License No. Date: Fxpires: ❑ I hereby certity thet no excavatlon tive (5) or more feet in depih Into which e person is required to descend, wlll be mede in connectlon with work authorized by this permit, end I�eI no builtling siructure, scaHoltling, falsework, or demoli0on or dismantling thereol, will bo ^�ora Ihen Ihirty-six (38) feet high. (Chap. 32, Gry 2, Atl 2, Sec. 347, Tl�le 8, Cellfomia Atlminisirative Cotla). ❑ As ownor-Dulltler, I wlll not employ anyone to tlo work which woultl require e Oermit Irom ihe Division ol Intlustrial Sefary, es notetl ebove, unless such peraon hes e permit to do such work Irom Ihe tlivision. Signeturo: Dete: Divlslon ol Intlusirial Sefery Permit Number: CERTIFlCATE OF COMPLUWCE AND AUTHOfiIZATION OF ENTHY: I certity untler penalry of perjury thet I have read this epplication and state that the inlortnetion gNen is conect. I egree to comply with ell stete laws end ciry ordlnences releting to huilding constructlon, end authodze representatives ol the Clry ot Costa Mesa to enter upon the ebove•descdbed propeny tor inspection purposes. I egree not to acupy or allow occupency of any building euthorized by this permil until finel inspaction. GODE �, INSPECTIONTYPE 7878 Flzed System Final Fire Preventlon 1268 Pool Spe Final 200 Finel Re-Rool 201 FIneI BIacWRetaining Well 202 203 204 Final Fectary Fire Place Final Sign Final Demolitlon eeg u� / ,Date �?� D7 � CO�E 1 INSVECTION TYPE 206 Final Mechenlcel 20B Finel Plumbing 210 Finel Elecirlcel 212 Finel Fire Preveniion 220 Finel Planning Approval 222 Flnel Site 250 Finel BUIlding/Occupency eeg u�s October 7. 2009 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Jack Schwassmann Trust 908 MacKenzie Place Costa Mesa; CA 92626 PERMIT NUMBERS: P07-00369 PROJECT 908 MacKenzie PI., Costa Mesa, CA FOR: Water Heafer Our records indicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of the last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on October 19, 2009. Additional fees will be required to finalize expired permits. Requestinq an inspection - If you need to request an inspection, please call our Inspection Request Line at 714-754-5626. Requestinq an extension -If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-4871, beiween 8:00 a.m. and 4:30 p.m., and a staff member will assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter, Sjnc- � rel� il �Jwi.�,v` Barbara J. Zwart Office Specialist II Fast Water Heater Company Building Division (714) 754-5273 • Code Enforcement p14) 754-5623 • Planning Division (714) 754-5245 FAX(714)754�4856 • TDDp14)754-5244 • www.ci.costa-mesa.ra.us (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 908 MACKENZIE PL Suite No Vicinity: Parcel Nunmber: 41805232 Applicant: NOCK, RON Address: 71612 KNOTT ST GARDEN GROVE, CA Owner: SCHWASSMANN, JACK W Address 908 MACKENZIE PL COSTA MESA, CA Contractor: NOCK PLUMBING Address: 11612 KNO7T ST Arch / Eng : Address: GARDEN GROVE, CA PLUMBING PERMIT Phone: (774)895-7246 Zip: 92841 Phone: Zip: 92626 Phone: (714)895-1246 Zip: 92841 �icense: 707775 Phone: Zip: License: SCOPE OF PERMIT INSTALL NEW WATER SOFTENER ISSUE FEE Backflow irrigation BackFlow Prevenier Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roo( Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 ouUets) Gas Repipe Gas Service Interceptore (Grease, Oil) Interceptors (Sand Auto ) AMT 523.50 $0.00 $0.00 $0.00 $0.00 30.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY AMT Laundry Tub / Washer 50.00 Landscape Irrigation � $0.00 P-Trap $0.00 � Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private line . $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 an 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS ISSUED BY: Status: ISSUED Applied: 06/04/2001 Issued: 06/04/2001 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 50.00 $0.00 $0.00 TOTAL CALCULATED FEES: E33.30 �TY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1247-92) 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred 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) 7545626 . 240648�N00� WORKERS' COMPENSATION DECLARATION: — I hereby affirm under penalty ol pe(ury ona of the following tlecleretions: ❑ I heve end,will maintein e certificete ol consent to self-Insure tor warkere' compensatlon, es provitled for by section 3700 of ihe Lebor Code, tor the padormance oi the ._._wo or which this permlt 14 �ssued. have end will meintain woMers' com ensatlon insurenca, as requlred by section 3700 of �he Labor Cotle, tor ihe pertormance of the work for which this permit is iuued. �'�My workers' compensation surenc carrier num a ��/�—�7 �/�/' Carrier:—"- � � � �� Policv Number; ��:J'Y /7 � 7' f-�� (This section "nb�d no!-be comp/ered i! Me peimit is veluetl �� ❑ I certily thet in tha pedormante ol tha wark tor whlch compensetion laws of C ' entl agrae ihet If I s�� compty with these proW ns. � or /ess.) I shflll no� employ any person in eny manner so es �0 6etOme subfBCt Io Ihp+�'orkere' �o the workere' compensation provisions of Sectlon 3700 of the}�bor Cqde, I shall forthwlth WMNINGi FAILURE ip SEq1RE WORKERS' �MPENSATION GUVEMGE IS UN OVER TO CRIMINAL PENALTIES AND CIVII�FlNES U TO dJE MUNDRED TYiOUSANDDOLURE�5100,OW),INMOfTIONTOTHECOSTOFWMPENSATIIXJ,OMMGE5A5PHOVIOEDFORINSECTION3%OBOFTHEIABORCODE,INiEREST,PNOAiT E1^SFEES. LICENSED CONiRACTORS DECLARATION: I �ereby affirm that I em Ilcensed un��° � m�q with Section 7000) of Division 3 0l the Business enC Prole ' ode, and my license Is In full lorce end ettecLfLic. q J —__. /�� Class a %__ G�� /� CONSTRUCTON LENDING AGENCY: ❑ I hereby aHirtn Ihat there is a consWction lending egency for the pertormance ol the work lor which Ihis pertnit is iuued. (Sec. 3097, Civil Code). Lentlafs Name: Lenders Adtlress: Signature: OWNER-BUILDER DECLAFiA710N5: Date: I heraby aHirtn Ihet under penelry a� perjury thet I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to construct, alter, impmve, demolish, or repair any sWCNre, prior to its issuance, also requires the applicant tor such pertnit to tile a signetl stetement �hat he or she is licensatl pursuant to the provisions ol the Contrectors License Law (Chepter 9(commencing with Sectlon 7000) of DlNslon 3 0l the Business entl Professions Cotle) or Ihat he or she is e:empt theretrom antl the Oasis for Ihe alleged e:emption. Any violetion oi Sectlon 7031.5 Cy eny epplicant for a permit subjects ihe epplicent to a civil panalty of not more Ihen five hundred dollars ($500).): ❑ I, es owner of the properry, or my employees with wages es their sole compensation, WILL DO TME WORK, end Ihe siructure Is not intendetl or ottered tor sele (Sec. 7044, Business end Professions Cotle: The Coniractors License Lew does not apply to an owner of property who builtls or improves theraon, and who does such work himself or herself or through his or her own employees, provided ihat such improvements ere not imentletl or ottered for sale. If, howaver, the building or improvement is soltl within one year oi completion, tha owner-builder will heve ihe 6urden of proving that ha or she did not builtl or improve for purpose of sale.). ❑ I, as owner ol the pmperty, am E%CLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to cOnstruct t�e pmject (Sec. 7044, Business and Professions Code: The contrectors License Lew tloes not epply to an owner of property who builtls or Improves thereon, entl who coniracts for such pro�ect with e coniractor(s) license pursuant to the Cont�actors Licensa Lawa�. ❑ I em exempt untler sec. Business and Professions Code for this reason: SignaW�e: Date: Owner ID verified by tlnver's licenbe. ❑ Yes ❑ No Drivers License No. Verificetion of Owners�ip Dy (type a� tlaumen�, i.e. - propeny tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Ezpires: ❑ I hareby cenity that no excavation tive (5) or more faet in depih into which e person is requiretl to tlescend, will be made In connection wlth work authorized by thi5 pertnit, and ihat no builtling struc�ure, scaltoltling, talsework, or demolition or tlismantling Ihereof, will 6e more �hen ihirty�six (36) feet high. (Chep. 32, Grp 2, Art 2. Sec. 341, Ttle B, Califomla Administretive Cade). ❑ As owner-builtler, I will not employ enyone to do work which would require a permit from the Division of Industnel Setery, es noted above, unless such person �es a permit to do such work Irom lhe divisian. Signature: Date: Division ol Industrial Safery Pertni� Number. CEBTIFICATE OF COMPLIANCE AND AUh10RIZATION OF ENTRY: I certity under penalty of perjury that I have read IhiS ep0lica�ion end slate Ihat the Informetion given is correct. I egree to comply with ell state laws and ciry ortlinances relating to builtling consiruction, and authorize representatives of Ne Ciry of Costa Mesa to enter upon ihe ebove-descnbed pro0erty for inspe��ion purposes. 1 egree not to occupy or allow occupancy of any 6uilding authonzed by this permit until f�el insDection. CODE I. INSGECTIONTYPE 1616 Fixetl System Finel Fire P�evention 1266 Pool Spa Final 200 Finel Re-Root 201 Finel Block/Retaining Well 202 203 204 Final Fectory Fire Place Final Sign Final Demalition Q�T, INTIilALS 4pDE� INSPECTIONTYPE 206 Pinal MeChanlCal 20B final Plumbing 270 Final Elettntal 212 Final Fire Prevantion 220 Final Planning Appro�al 222 250 Final Site Finel Building/Occupancy I�u1I.1�i PflOJECT�U0BE5S: GOB MACKEN7IE PL OWNEN'$NAME: SCHWASSM�NN ,iACK W nooxess: g08 MACK$NZiE PL COSTA MaSA,CA 92626 546-1749 RPLH/ENGINEFR: flEG.NO.: AODPESS: UNIT: UNIT: PEflMITTEE: CLAUDE MARRYAT'i ( 7i 4) 530-69:7 aooeess: 9531 WOODBURY AVENiIa GARDEN GROVE CA 92644 LILENSEO CONTRRCTON OEUABATION: I hereGy a��irm that I am licensetl unGer pmvisions OI CAaDte� 9 �commencing wit� Seciion 7000) oi Oirsion 3 0l I�e Business antl Prol@ssions Cotle. and my license is in tull �orce an� ellect. c�Tvuc.: 053737 srareuc.:qigq�-7 � cuss: �-3� �•�7'-� Oaie: �l%- � ' � �- Siqw�ure: �i��.L._ - lLeL� WOXNEBS' COMPENSAtION DEClAB11710N: I hereby aHirm Ihat I have a cenilicate ol consent to selbinsure cenificate oi Workers' Compensation Insurance. or a cetlilie0 copy thereoi 15ection 3800. Lab. C). POLICY NO.: E%P. UPTE: LOMPANY: ,� Cetlilie0 copy i5 �ereby fumis�etl. ❑ Certified copy is liled with ihe city BuildinA Oivision. �ale: ADplicanL EEEMPfION FflOM WOflNEflS' fAMPEN$IITION �ECLAflATION: (ihis sepion nEeO no� Ge completM il tAe perml is �a Me Aunartd (5100) or 1e51�. I[erlify �hat in Ihe pedormance ol Ihe work lo� w�ich �his permil is is ued I shall not employ any person in any manner so as to betome SuDjetl to I�e Workers' Compensation Laws ai Cali�amia. -ee!c�/i- Cl-'- �/ 1 Si9nature: �/�,�� /I/�.LL� NOTILE: II, ailer making Ihis Oeclaration, y0u shoNA be e uElect m lhe Workers' ComDensaiion pr ions o� l�e Labor Coae. y0u must IOrthwilA tomDly wit� Suth Omvisions or IN5 p¢rmi� 5twll be deem¢G rewked. CONSTflULTION LENOING RGENLY: I hereryy a�hrm I�at there is a consVuction lendinp agency �or Ihe pedormance of [�e wOrk �or whic� this permil is i5sued (Section 3097. Ci�. C). LENOEfl: ROOXESS: OWNEP 6UILOEN �ECURATION: I �ere�y aifirm �hat I am exempl Imm I�e ConVactor5' Slaie License Law �or l�e �ollovnng �eason (Seclion 7091.5 Business antl Pmlessional Cotle: Any ciry of county w�ich requires a permil Io conslmct, atleL improve, tlemolish, or reDair any simcture, prior to ils issuance. alxo re0uires t�e applicani for suc� permit lo lile a sipne0 stalement ihat he/she is licensed pursuan�lolhe provisions all0e Coniractors'State License Law�Chapter9(commencinp wilh $¢clion 7000�of0ivision 3 o�the Business an0 Protessions Code� or �hat �e/she is e�empt t�erefmm and the hasis lor Ihe alleged exemD�ion. Any violation ol Section 7031.5 Ey any applicanl lor a Dermil suCjetls tlle a00��Cant to a civil penalry ol not more itWn live AunUreO tlallars �5500). I, as owner ol tAe Dmpeny or my employees witn waqes as Iheir sole compensation, will do Ihe wofk, an0 lhe ❑ simclure is not imen0etl or olferea lor sale (Section 70a4, Business an0 Pmlessional Catle: T�e Coniractors' State License Law Uoes not apply to an owner o� a pmpe�y who builds o� impmves t�ereon, and wAo Aaes su[A work �ims¢IOhersel� or Ihmugh �i5 ar het own employees. pmviaeG [hai 5uth imprm¢menis a(e nOt in�endeE ar aflea0 �or syle. I7, however I�e bUilOing o� improvement is solU wilhin one year o1 compietion, ine owner will have ihe Ouraen of Dmving he/sne tlie not DuilU or improve lor ine ourpose o� sdlel. 1. as owner ol ihe pmpeny, am exclugively contracting with licensea conlracmrs to constmct tAe pmlect (Section 7044, Busineu ❑ anG Pmlession5 CoG¢: i0e CanlraClors' Slate Lkenu Law Oces wt appty la an awnet al pmp¢rty wiro hmltl5 or imprweSlAereon anE w�o conVac�s lor suc� D�ojecls vnth a conlracior�s�license Oursuanl t0 I�e ConVac�ors' State License Law1.1 am aware ��al Omol ol t�eir Woder's Com0en5y(ion insurance shoulA be D�ovitleG to me. � I am exempt unGer Seciion: 9. 8 P. C. Ia� �hi5 rea5an: Date: Owner. I do her¢by cetlily I�al I am aware ol and untlerstand the reQuiremenis o� Calilomia Heal�� anU $alery Code Sections 25505, 25533, antl 2553< and ihat I or any IWure UuilGing occu0ant wiNwill not (cirGle one� neetl lo comply wilh sai0 slale codes and ihe repuiremenis for a permil lar consimclion or mo0ilica�ion imm �pe Air Oualiiy Managemeni Oislricl, qeSiUen�ial con5imction aDDlica�ions are exempi imm ihese provisions, Date: Applicant: I here�y cerlilytha� I have rea0 Ihis applica�i4n an0 51aie iha�ihe above information is correct.laB�e¢ io comply wi�h all city anC couniy ortlinance5antlstaielawsrela�ingtobuil4inpcnnsimctionanahereUyau��orizerepresenlative Il�iscilytoemeruponlheahove-meniionetl pwperiy lor inspec�ion Durposes. �/J� A ,`—,�'�/-�-J� .-a„r/D- r/- >>-- Signaiure —��(T"�� L�G��Y/'- -` IDd�er's L�cense or Socui Secunty r: 16<ba6 Whne-Bmltlino: Green-Cotle �nbrc¢menC Canary-Aoolitant: Pink-Ravenoe: GolCenroE-pssessor CITY OF' COSTA MESA — HUILDING PERM,IT PtRM NO: B 059931 PERMIT NO; B 059431 PLAN CHECK NO; N GOVT; N SUi�P; N CONSTRUCTION TYPE; V—N PEAMIT TYPE: STR FGRPOSE: OiH JOB DESCRIPTION : SHOWER PAN AND NEW WALL COVERINGS SQ r1'; 2,000 CLAIM VALUE: �,000,00 CALC—VALUE: 2,000,00 GAOUP OCC: R-3 / CO,NMENT5: SMORE DETECTOR RE�UIRED IN THE HOME iFihiE3fN-iE�lEihN�lFif-M�iFihiE3F�Fif#�1F3EiElEiElElElf ih�fiEiF1E*lFiti(if�flElt�l(�#iFiEX#ifk3Eif-ih#iF�f�lf##il�#Ifif�IFif#lki(3fiE1t3fiE3eiP3iifif�i�# 2 O N i N G R E Q[7 Y R E N, E N T S S E T B A C K S ----------- MAIN HUILDING ---------- --------- ACCESSORY BUIi,DINC --------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RGH'P; FT IN LEFT; F1' IN RGHT; rT 1N PARKING REQ• PROV; PARCEL; 41805232 ZNE; REF NO: PLANNING NtSTES> ' .�`. # i(� 3f iP 1f if• iE % K� it iE �1( il� ih iF 3E 7f iE ib iF il if� iE iF ##�i,fil(' 1E 1F �F if 3(� 1F Ik ih i(� lE k' ii� iE 7F #!E!F �E IF # 3E 1e 1f 1i # i( ?Fih i( if� !(� i( f! i(�?F }±f iF !E if'�k� #jb ii• lE iElE # iF if 1� E V E L O P M E N sT S E R V I C E S it E Q U S R E D: E N i1' S 20NING AF�PROVED BY 3. DATE; � BUILDING APPROVED BY : `� DATE; IO' '� Z APPLICATION I55UEU BY; +� DATE• 4� 0��a` #iM11E�fiFlEifiPfF#7fifi(�if3tiEiFif#�fiF# -%i[friy�,�r x%�YF�t�„ `�ftx#�. �.iriFit �lr1t ft±F k�](�it '<3fif3E#l6if�iFiFiFit.. fe k�1t RiE# �1t il� fk jf iE i(�iE iF ih-1Fi(� �If iF �F 7t iF it� iE iE �!t if # Y�?f !E i4SF 3E it iF # iE # iE ik ir .. "iF iF v. �k iE �f If if iF iE 3f M�±E iE 1F # 3E jf iE it # ie ih # 1E �6 f( ?4 k�IE iFiE 1E le k� # ie iF it �li ?E LEGALIZATION;N F E E S U�� M A R Y 5TRUCTi7RAL SEGN.EN7';Y BLDG PMT PLUMHING ELECTR'IC MECHANIC FIRE SMIP/Re:S GRADiNG PERMIT 45,00 • ,SO SMIP /1+tON—RES PLAN ISSOE FEE HUILDING—DIV—> PERMIT ISSUE PLA'N—CHECK T'OTAi. PAID DUE 'POTALS----> 45,50 0,00 0,00 45,`,0 45,50 ,00 REVENUE DlVISION TOTALS--> COLLECTED; 45,50 OVE�t/SHORT; 00 BLDG PMT PLCIN,BING ELECTRIC MECi�ANIC FIRE SMIP/TOT GRADING FLAN—CHECK 45,00 � � ,50 � M� 1f -N-#!f iE iE 1FiF if i(� �!4!t!E!k !f 1F )E �Ih iE iE# �%1F # 1E i4 #!f M�!(� if� 1F iE'x`iF'1(� itaE if� IE # if 3E ## ie !k ## if If If iE ik # i! il�lE 1F if iE IF 3F 3F iPlE iElf If iE 1E ii� if�% ie ih# 3 N D I V I D U A L_ F E E B R E A K D O W N TYPE �TY D E S C R I P'!' I O N; UNIT COST TOTAi, COS;' SFR 2000 ALTER BY VALUE RESTDEN7'IAL NOZONE 1.00 2,000.00 END'�OF F�ES . � CONSTRUCTION AND PLANNING P� '$ SPA � APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equ�pment Location 2. Soil Pipe�Undrgrnd. 53. Steei Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electricai Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Elect��cal UFEfl Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footin9s 58. Electrical Conduit�Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Floor System 67. APPROVAL TO DECK 1 i. Property Sewer Line & House Connection 62. Backwash & Receptor�Final 12. Sewer Cap 63. Heater & Vent-Final 73. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 75. Rough Electrical-Conduit 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPflOVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. flough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuctS, �n $tructure 70. Underground Hydro 22. Duct4. Ventilating 71. Product Piping �Gas ❑pil 23. Gas PiPe�Rough & Tesc 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding i 77, FIXED SYSTEM FINAL 29. Insulation �... � 78. FIRE PREV. FINAL 30. Drywall Nailing �_ZZ_ ��(,� � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION i 32. Elect��cal Power Meter�Final �� " 80. POOD CERTIFICATE ISSUED 33. Final Electric ' � Notes: /j 34. Final Heating & Air Conditioning '� ' �;M / �/ / '' S _ , / K �� / i_P✓� _tl�///_. J•��lL 35. Final Gas Pipe�Test � �� ' � 36. Hood or Canopy • ' � � 37. Final Factory Fireplace 38. Final Plumbing 39. Watet Service-Final 40. Gas Service�Final , 41. Solar pomesiic•Final � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape IrriGation System 45. Sound Attenuation 46. Hand�cap Regulations 47. FINAL STRUCTURE & BUILDING % .� �' '�� ' 48. FINAL PLANNING 49. Electtic Release to Edison 50. Gas Felease to Southern California Gas Co _ 51. CER7IFICATE OF OCCUPANCY No. Date Pfl0.1ELTRUGHESS: �jOE MACKENZIE PL OWNEP'SNAME: SCHWASJMAIVN JACR W nooaess: g08 MACKEN7,iE PL COSTA MESA,CA 92626 546-1749 pqLX/ENGINEEfl: NEG.NO.: PDOflE55: uxiT: UNIT: PEflMITTEE: CLAIIDE MARRYATT ( 714 ) 530-6917 auoxess: 9531 WUGDBURY AVENUE GARDEN GROVE CA 92644 LILENSEO CONTBRCTON OELUIIATION: I hereby attirm that I am licensetl unEer provitions o� Ctupter 9(commencing with $tt�ion 7000) ol UiNsfon 3 0l IAe Business antl Prolessions Co4e. antl my license is in NII lo¢e antl effect. urruc.:053737 STRTEUC.:4S842"] cass: f_36 /„ ,Jlye: /D—CI— �I�— Signature: (-q-� ��l/�Z7�-� WONI(E85'COMPENSRTIONDECUBF710N: IherebyaifirmtAatlhaveacenificareaiconsenttoseli-insure cenilicateofWarkers' CAmoensa�ian Insurante, ot a certiliea caDY ihereol (Section 3800. LaU. CI. POLICY NO.: E%P. ��TE: COMPANY: � Cerlilied t00Y is here�y �umishetl. ❑ Cenitie0 copy is fileG wicA IAe ci�y BuilOing Didsion. Oaie: Applican�: E%EMPlION FflOM WOPIIENS' fAMPENSRTION DEClAMT10N: (1A5 seciion nee0 not Ge compkteE i� Ne pemet is fa we hunErcd �f10U) or lea�. I certity thal in Ihe petlormance ol �he work lor whic� this permii is issu I s�all noi em0�oy any person in,any manner so as to become suDleci to Ihe Worker/s�' Cam/pe;nsatian Laws ot Catitomia. ��% (y' p� 11t;e: /n— `� � `r Zi Signalure: "�"� /l /��i� NOTICE: It. afler making Ihis tledaralion, yau shoultl be�su ec� Io ��e Workers' Compenulion p sions ol th¢ LaEor Cotle. you must lotlhvnl� compry vnt� such pwvisions or this permit shall he Eeemed revoke0. ' LONSTBUCTION LENDING RGENCY: I �ere�y allirm (ha� there is a[onSVuction lending agency �or tAe pe�ormance o� Ihe work for whicn this oermit is issued (Section 3097. Gv. C). LEN�EN: nooxcss: OWNEB BUIIDEfl OECIAMTION: I �ereGy aHirm Iha� I am exemD� ��om ihe Comracmrs' State License Law �or I�e fallowing reason (Seclian 7031.5 Business antl Pmlessional Cotle'. Any ciry ol counry which requires a permit to cansimct, alier, im0�a�e• Oemolis�, ar reDair any s�mc�ure. prior to its issuance. also repuires the aDDlicanl lor such permit ro �ile a signe0 s�a�ement thai he/s�e is licensed pursuanl m Ue pmvisions ol Ihe ConVacmrs' S[a1e Litense Law �C�apter 9(commencing with Senian 7000) of Division 3 0l ��e Business antl Pmtessions CoOe) ar �hai �e/she is ecempt Ihere�rom and the basis br �he alleged exemD�ion. Nny violaiion ol Sec�ion 7031.5 by any apDlicant lor a permit su6ject5 �he applicani Io a civil Denat�y o� no� mOre Ilwn five �unOreA tlollars �5500�. I, as owner of the propehy or my em0loyees with wages as their sole fAmpensation, will Eo I�e wodc, antl ihe ❑ simclure is not imendea or oHered lor sale (Section 704a, Business an0 Prolessional CaAe: The Coniracrors' State �icense Law Uoes noi apply �o an owner o� a D�opehy who Ovilds or impmves ��ereon, antl who tloe5 such wo�k hims¢IUhersell or Ihmugh his ar her own employees. O�ovided thai such imprmemenis are not intentletl or oflereG for ule. Ii. Oowever ihe buildinq or impmvement is soltl wi��in one year at com0le�ion, the owner vnll have lhe burden ot prnving he/she di0 no� 6uild or impmve lor ine purpo5e af Salel. I, as owner a� the pmperiy. am eeclusively conVacting wilh licensetl conlraciors �o wnsimct I�e prole�� (,��ian 704d, 9usine55 ❑ and PmfeSSqns Gode: The ConVactars Siate License Law tices not appty to an owner of pmpetly who Omlds or improves t�ereon ana wllo c�niracis lor such pmlecis with a coniractor�s) license pursuant to tlle Canlractari' State License Law�. I am aWare tha� pmol af ��ei� Worker'S Compensa�ion insurance 5houltl be pmvitled lo me. � I am eeemp� un0er Seciion: 0. 8 P. C. �or ihis reason: Da�e: O�vner. I tlo nere0y cenily t�at I am aware ol antl untlersiand I�e requiremems o� Cahlamia HeaI�A and Safery Cotle Sections 25505, 25533, an0 2553a and ��ai I or any fu�ure �uil0ing occu0ant will/will nat (circle one) neetl to comply with saia state codes anA �Ae requirement5lor a perma lor cons�mction or motlification imm Ihe Art Ouainy Managemem Oisvict. Fesitlemial constmetion ap0lications are e�empi iwm Ihese O�a�isans. Oale'. Fppbcanl: I hereby cetlity I�at I have read �his application anA s�ate Ihat Ihe a�ove in�ormation is correcl. I agree to campty wiih atl [ity antl coun�y ortlinancesantlsla�elawsrelatingloDwltlingcons�mnionan0�erebx aulhorizerepreseman sof�hiscity�oemerupontheaUove�menlionetl pmDetly lor inspec�ion purposes A{�I, ' . ��//��////�� -0ate: l �— � — � � Signalure: /� ��P ��/�W�/.� Driver's Lirense oi Saiai Security N: U 164L46 White—Builamp', Green—Cotle EniorcemenL Canarv—AoohcanL Plnk—Revenue'. Goldenroe—Assauor CITY OF COS3A MESA — BUILDING PERMIT PERM NO; P 059433 PERMI'C NO: P 059433 PLAN CHECK NO; N GOV:; N SOPP; N� CONSTRUCTION iYPE; V—N PERMIT TYPE; PLU PURPOSE; OTH JOB DESCRIFTION ; SHOWER PAN AND NEW WALL COVERINGS SQ Fi'; CLASM VALUE: 2,OU0.00 CALC-VALUE: GROUP OCC: R-3 / COMMENTS: REF; B59431 K �%� # �1E �1E �%� �lE �X JF # if df i( �%�% % % X �( � iE�k�%�% M� #!F il k �%� )( k� M % �%•k iE%�X �k i! iE if 3f �lkjE lE �1 IF % �lf k iF �li- % M� �l( # # iE ik �* iE �N N �% �If �% % k k �� if if iF k �k �� 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 BIIILDING ---------- --------- ACCESSORY BUILDZUG --------- FRNT; F1' IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN PARKING RE4• PROV; PARCEL: 41805232 LNE; REF NO: PLANNING Nt51'ES> � X�fEi('it�1Fi4N'##i('#iE##fE1EffH�iE#k#iEiEifK-ifiFiElE#if##iEiE#iEM�if##itiFiFlE#3fjfMdEif'IF#iF3fiflElE#iPH'i41EiE�7fiE)!'�EiEiE3f###iEfEM< D E V E L O P M E N T S E R V I C E Sr R E� U I R E M E N T S 'LONING APPROVED BY : DATE; BUILDING APPROVED BY � DATE: /^ ///��' APPLICATION ZSSUED BY: ' �' DATE: j/� �(J ��,,/// M�1E1flf3F#ff1F�E141EiFfEiEifikM�ifffiEiflfft �iF �i'x�it �Rxffx ft JeiF ..�%�1t#iENdfiF#iFiEiEif3r ��'r -�}r#� if*IFiF-1EiE-%i4�%i(�!f!ElEiE�F#ifiEfk�l'iFihiE�fflf#�7fiF1E1E1FiFIfiF)klfiF3f7(��1E1f1Fih34�F 'd1Fif1(�1! �fflElfiEihitiE%fEiElFikii•jf�iFli�3ElElEik}lEiEiE?FiF3F LEGALIZATION;N F E E S U M M A k� STRUCTURAL SEGMENT;N BI�DG PMT PLUMBING ELECTR7C MECHANIC F1RE SMIP/RES GRADING PERMIT 21,00 25II SMIP/IvON—RES PLAN ISSUE FEE 20,00 HUILDING—DIV—> PERMIT ZSSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 21.U0 20,00 0,00 41,00 91.00 ,00 REVENUE DIVISION TOTAI,S--> COLLECTED; 41.00 OVER/SiiORT; .00 BLDG PMT PLUMBING ELECI'RIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHnCK 41,�� #% fE jF i4 �l� if IF k�N� if ik i(� # iE � 3k iE lf �f # i!� i! 3f iF %� #!t i! !f k# 3t N� 3E if� if iE ih i(- %�li� iF �lf iE if� iE ii� iE iE 1E �It 1f if ?F ik iE 9f * 1! if ih 3'r id if # 1(� iE iF IF R iE>: !f 3(� iE % iE ik I N D I V I D U A L F E E B R E A K D O W N TYPE Q'!'Y D E S C R I P T I 0 N UNIT COST TU;AL COST PLU 1 SHUWER 7,00 7,00 PLU i WASH BASIN '1,00 %,00 PLU 1 WATER CLOSET (`fOILET) 7,00 7,00 END OF FEES � i � , CON5TRUCTION AND PLAN ING . PG & SPA � APPROVA�S Permit # Date inspector AppROVALS Perinit # Date Inspector i. Temporary Electrical Service or Pofe 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement 3. Electt�cal Conduit Urility-Undrgmd. - 54. Forms 4. ElecUical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbin9 & Pressure Test 6. Elect��ca� UFER Grnd. 57. APPROVAL TO COVER-GUNITE . 7. Footings 58. EleMrical Conduit•Undrgrnd. 8. Foundation 59. Ga: PiQe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, t7 Undrgrnd. 10. Structural Floor System 61. APPROVAI TO DECK 11. Prope�ty Sewer Line & House Connection 62. Backwash & Receptor�Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem - Final 14. Rough Plumbing rol3�4z �.� 65. Electrical�Final 15. Rough Electrical•Condu�t 66. Solar System•Final 16. Rough Electric Wiring 67. Fencing & Access ApP�oval 77. Rough Wiring Sign 68. APPROVED FOR PLASTER�NG 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 27. Ducts, in Structure 70. Underground Hydro 22. Duct4, Ventilatin9 71. Product Pipin� OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding �'•� 77. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINAL i 30. DryWall Nailing � � -�;-^ HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat '' 79. FINAL INSPECTION 32. Elect��cal Power Meter�Final ! ' 80. FOOD CERTIFICATE ISSUED 33. Finai Electric � �'� Notes: 34. Final Heating & Air Conditioning . 35. Final Gas Pipe�Test ;- � 36. Nood or Canopy ' � "� 37. Pinal Factory Fireplace ' � 38. Final P�umbing (/ j}( (�() � 39. Water Service�Final � � 40. Gas Service-Final ; \ `, 41. Solar pomestic-Final 42. Backflow Preventer i '� 43. Backflow Irrigation 44. Landscape Irriqation SYstem 45. Sound Attenuation 46. HandiwP Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING , � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co � 51. CER7IFICATE OF OCCUPANCY �. No. Date PNOJECT RODflE55: 9 Q� ,NACKEN Z I E �T. OWNEfl'S NAME: SCHWASSMANN JACR W aooAess: g08 �KACKEN'L�fi PL COSTA MESA,CA 926?.6 546-1749 FflCHIENGINEEfl: aoos[ss: flEG.NO.: UNIT: uxiT: PEHMITTEE: CLAUDE MARRYAT'I' ( 714 ) 530-6917 aooeEss: 953I WOObBURY AVL•:N[JE GARDEN GROVE CA 97.644 UCENSEO CONTPpGTON UECIANATION: I hereEy allirm that I am licensed under provisions oi Chapter 9(commencing with Section 70b0� of OiNsion 3 of ihe Business ana Pmlessions Cotle, an� my license is in full torce and eilecl. cirr uc.: 0 5 3% 3 7 STRTE LIC.: 4 1 8 4 —z$x , ,, cuss �"/�, -Oate: ��%'�'� �� Signaiure' �1'�N� /�-�� WOBKEHS' COMPENSpT10N �ECU1flATI0N: I hereby rm tha� I have a cenificate oi consenl �o sel4i 5 or a ceriificate o� Worke�s' Compensation Insurance, or a certitietl copy Ihereo� (Sec�ion 3800, Lab. C�. POLILY NO.: EXP. OATE: COMPRNY: ] Cenilie0 coOY is hereDy �umished. ❑ Certilie0 wpy is �iletl vnlA lhe ciry Builtling Division. Date: PODlicant E%EMPTION fBOM WOANEflS'COMPENSATION OECIAflATI�N: (ihissec�ion neetl na�becomple�e0i�the permitis�orone huntlretl�$100)orless�. I cetlify ��at in the pedormance of the wark �ar which lhis permit i issuetl, I shall not employ any person in any manne� so as �o become 5u�leci �o Ihe W/o�rkerY Compensatian Laws ol Calilomia. �Da1e: ��'_/ ' g'�— Signature: � -L�/� ��LL!?A�� NOTICE: Ii. after making Ihis declara�ion, you shoultl become 5u61eci �o �he Workers Compensation � isions oi Ihe Labor Code. you musi fortAwith compty with suc� D�ovisions or this Dermit shall be Oeemed revoked. CONSTFUCTION LEN�ING AGENCY: I hereby alfirm Iha� Ihere is a conslmc�ian len�ing agency lor Ihe pedarmance o� Ihe work for w�ich Ihis permi� is issued (Section 3W7. Civ. C�. LENDEP: � FODNE55: OWNEP BWLOEP DELIANRTION: I �ere�y allirm Ihat I am exempt imm �he Contrac�ors' S�aie License Law tor Ihe following reason (Seclion 703L5 Business antl PmfesSionai Cotle: Any ciry of counly which requires a permit to construci, al�¢�, impwve, tlemolish, or repair any simcture, prior to i�s issuance, also requires �he applicant lor such permi� �o �ile a signetl s�a�ement that he/she is licensed pursuam �o the pmvisions ol ��e Contractors' S�ale License Law (ChaO�er 9(commencing with Sec�ion 7000) o� Division 3 0l �he Business antl Pmfessians Code) or Ihai he/she is exempl thereimm and Ihe Aasis �or the alleged ezemplion. Any viola�ion o� Section 7031.5 by any applicant �or a Dermit subjects ��e applicant Io a civil penalry o� noi more than five huntlre0 tlollars ($500�. I. as owner ol the pmperty or my employees with wages as their sole compensation, will do �Ae work, and ihe ❑ slmcWre is nol iNenOed or olfere0lor sale (Section 7044. Business an0 Pmfessional CoOe: T�e Contrac�ors' Siate License Law Ooes noi apPN �o an owner ol a D�aDeM1y w�o builtls orimD�oves Ihereon, antl who Joes such work himseli/hersell or ihmugh his or her Dwn employees, pmviUeO Ihal 5uth impmvemenis are no� in�¢ndetl ar ofl¢red �ar 5ale. I�, howevef ��e OUiltling or improvement is soltl within one year ol completion, ihe owner will have the buraen of pmving he/she Oid no� buil0 or improve �or the purpose ol sale). I, as owner of �he pmperty, am exclusively conUac�ing with licensed contradors �o consimd �he pwle�� (Sec�ion 7044, Business ❑ antl Professions Coae: The Contrac�ors' Sla�e License Law tloes noi appty to an owner oi Ompertywho builes or impmves Ihereon and who comratls �or such Oroleds with a contractor(5) license pursuant m Ihe Contractors' Slaie License law). I am aware that pmoi ol their Worker's Compensation insurance shoul0 be pwvitletl to me. � I am exempl unUer Seciion: 8. 8 P. C. for �hi5 reasOn: Oate: Ownec I tlo hereby cenify �nat I am aware of anU unaerstand �he requiremenis of Cah�omia Health ana Sa�ery Cotle Sec�ions 25505. 25533, antl 25534 and lhal I or any IUWre builtling occuDanl willlwill not (circle one� nee0 �o comply wi�� said s�a�e cotles antl ��e requirements �or a p¢rmil for constmclmn or motliliw�ion �mm Ihe Air Ouali�y Management DiSVict. Fe5i0ential cons�mc�ion apDlicalions are exemp� from I�WC pf0Vi5i0f15. Date: ADDlicant: I here6y certify Ihal I have reatl Ihis apphcation and s�aie tha� the a�ove in�arma�ion is correcL I agree ta comply wilh all ciry antl counry oreinances antl stalelawsrelalingto building canslmction antl he by aulhoriterepresentaiives ol�his ciry�a enterupanihe above�mentionetl pmper�y �o� inspeC�iDn purpOses. 9ale'. �� % �� Signature: ' � Oriver's License or 5ocial 5earity xr � � �6AL46 While—Bwlding', Green—Code Enbrcement; Canary—ApplicanL Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING Pc�MIT FcRN NO: E 0�9432 PERMTT NO: E 059432 FLAN CHF,CK NO; N GOVT: N SUFP: N CONSTRUCTION 7'YPE; V—N PERMiT TYPE; ELE PURYOSE; OTH JOH DESCRIFTIU\ ; SHOWER PAN AND NEW WAa,L COVERINGS SQ FT: CLAZM VALUE: 2,OU0.00 CALC—VALiJE: GROUP OCC; R-3 / COMMENT'S: REF: B59�31 �IF N-�lE iE #�lE 9F�lE �M� X IE X� �)FiE 3E iE 9t # iE �)E IF �1EdF lE iE if i(� 1F iF �k �IF �Y df %� iF�%�If jF jE iE �k �](� dE # JE �% �%dE �A �K 9(-if if �%�7E 1E l( �( %9F 1(� ii �X� �/E iE 9E �k 3f JF �% �%iE �k if� if �N If f# Z O N T N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING --- ------ -------=— ACCESSOkY BUTLDING ------ FRNT: FT IN REAR; FT IN FRNT: fiT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN R�HT; FT IN PARKING REO• FftOV; PARCEL; 41805232 ZNE; REF NU; PLANNING NGTES> > � ik iF iFlF If if iF lE ik lk %� 3E if fE iE iF 3F iE iE ff 3f iE iE iE # K� fE iF it ### if if.iF 3f it iE iE je i(� # if iE% iFiF iFlE if if if� if iF 3k iE ## 3f # 14 #%�k ii� 3i-iF i(� iE # 1E 3f t. iE 3F iE �1'r% ih D E V E L O P K E N T S F,�.•,R V I C E S R E Q i3 I R E M E N T S � ZONING APPROVED BY :� DATE; BUILDING APPROVED HY ; : DATE; !/; APPLlCATION ISSGED BY; �'"- DATE; �� c�a�**�***�***�*�*�r�u**�«. .. �� . . z . ,� _ .�. �xxx�x��+�**� �- �� )E iF �lf �%iF�7E iE �E 36 iF #�3f �k 3F �e i!� iF IE ie'.E IE 3E dtlt 3k H� if af 3h jt ik iF �lE if.¢h,�lE �F �1F �1h it ie �f iE iE �1F 3f iE x,. : if �iElf ik if �lf iF iE lE iE 3f 1E iE iF it iE if ie #h it if ii� 3F iF if 3E �1E if 3f LEGALT7A'PZON;N F E$" S U M M A R Y STRUCTURAL SEGMENT;h BLDG F+MT PLUMBING ELECTRIC MECHANIC FIRE SMIPlRES GRADING PERMIT 3,"/S 50� SMIPINUN—RES PLA[3 ISSUE rEc 15.00 HUILllING—llIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DU6 TOTALS----> 3,75 15,00 0,00 18,75 18,75 ,00 REVENUE DIVISIUN TOTALS--> COLLECTED: 18,75 OVER/SHOkT; ,00 BLDG PMT I�LUMHING EI,ECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECH 18,75 iE iE iF iE �lE iF �](� jk lf # iE i(� iE iE 1E ih i(-iFlF �F iE iF �1�F ii ii� �iE �lf # iF i(�-lE if *# iF �)t 3f * iF it� Jc �lE �1F if iE it-iE �E �(� fE iE iFdP IE iE iF#� 9E �: iF iE K� �)f 3E dt �if 3E ie fh if 1E 3E � if iE �lE jf iE �K� I N D T V Z D U A L F E E 5 R E A K D 0 W N TYPE QTY D E 5 C R I P T I O N UNIT COST TOTAL (_OST ELE 1 FIXTUkE5, LIGHTING 1 ST 20 EA, 7� 7S ELE 1 MOTOk/POWR APPARATUS 0,0 — 1,0 HP 3,00 3,00 END OF FEES nAT�I . .L`r :'=�j~ _. . � . _ .. CONSTRUCTION ANOPLANNING� POC .SPA _ APPROVALS Permit# Date Inspector qppROVALS Permit# Daie Inspector 7..Temporary Electricai Service or Pote �52. Pool & Equipment l.ocation 2. Soil Pipe-Undrgrnd. 53. $teel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical COnduit-Undrgrnd. 55. EIOCtriC21 Bonding 5. Steel Reinforcement 56. Rou9h P(umbing & Pressure Test 6. Electrical UFER Gmd. 57. APPROVAL TO COVEB-GUNITE 7. Footings . 58. Etectrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. LVater Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgmd. 70. Structural Floor System 67. APPROVAI TO DECK 71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 72. Sewer Cap 63. Heater�& Vent�Final 13. floof Drains 64. Plumbing System � Final 14. Rough Piumbing - � 65. Electrical�Final 15. Rough Electrical•Conduit 66. Solar SYstem-Final i G. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T E3ar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducis.in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Under9rnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding � i 77, FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL 30. Drywail Nailing � i HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � j � 79. FINAL INSPECTION 32. Electrical Power Meter-Final ; � ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric �Q (3-+��, Q�Notes: 34. Final Hea[ing & Air Conditioning � �" ' i � 35. Finai Gas Pipe-Test � . � 36. Hood oi Canopy . 37. Final Factory Fireplace '` _ 38. Finat Plumbing � 39. Water Service-Final . � . 40. Gas Service-Final 47. Solar pomestic-Finai 42. Backflow Preventer � . 43. Backfiow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING _.-. 48. FINAL PLANNING 49, Electric Release to Edison ��- 50. Gas Release to Souihem California Gas Co ;�--'I 51. CERTIFICATE OF OCCUPANCY No. Date � -- • Applicant to /ill in all spaces exeept those within neavy eoraer lines ane sign all appropriate aeclarations. CITY OF+OSTA S CONSTRUCTION BERMIT ., _ PERMIT NO. TRACT NO. LOT NO. � UNIT N6. M�c � z�-' �3� Z � i:13 , . Project Address - � Applicant's Mailiny Address Z7 7 ,� N � rn�1 ,�b. Owner'siName - ��'H �arr� �� Phone�-�� 1-�� Address � ' � Arch/Eng. License No. Address Contrecror's Name �� A" Phone 5�3- � nt�lrv�� .��.V�t�`G Atldresslmailin9) �,,, — Ciry'License No. " � ' 2 LICENSED CONTRACTOR DECLARA 1 hereby atfirm [hat I am licensetl untler provisions ot Charier,9 (commencing with section 7000) oi Dlvision 3 of tne Bus'ness antl Professions Cotle, antl my license Is in full force n %� Q� Lice Class � w, o. ✓� ` � Date�� Signature YOHKERS'COMPENSATION DECLARA ION I hereby affirm that I have a certificate of consent to sel6i ure or a certificate of Workers' Compensa[ion Insurance, or a certifletl copy_thereof (Section 3800, l.ab.�Cj.y� /i I��-�/�� l � ^ Policy No. �+�� r7(/rol.mpan y — �Vr� Q Certifie ca y is hereby furnishetl. ' ' �e 'letl with [he ci[y n. Date Applicant E%EMPTI N-FROM WORKERS' COMPENSATION DECLH TION (Thissection neetl not be compleletl if the p¢rmit i5 tor one h reG ($300) or 1e55). 1 I certify lha[ In the pe�fo�mance of the wo�k to� which thi5 perm�t is i55uetl, I- SM1alPnol employ any pe�son in any mann¢r So as to bemme subject to tne Workers' Compensation Laws oi Califomia. ' Date Signa[ure �NOTICE: It, afle� making this tleclaration, you Shoultl bemme subject to the Workers' ComOensation provi5ion5 Of th¢ Labor Cotle, you must to�thwith . comply with such provisions or this oermit snall. be tleemetl revoketl. CONSTRUCTION LENDING AGENCV. ' ' 1 hereby affirm Ihat there is a mnstNction lending agenty for the pertormance of the work tor whicn this permil is issuetl (Section 3097 Civ. CJ Lentler's Name LenUer's�Atltlress � ' ' �� OWNE0. BUILDEN �ECLARATIOfi � I hereby afiirm that I am exempt from Ihe Contractor's License Law for the tollowing redson (SectiOn 7031.5 BuSiness antl Pro(e55ional CoOe: Any tity or [ounty which �equires a permit to const�uct, alter, improve, tlemolish or repair any structure, prior to i[s. issuance,'also requires the applicant for such permit to fiie a signetl statement tnat he/She is Ilcensed purzuant to tM1e provisions of the Contractor'S License Law (Cnapter 9(Commencing with Section7000) o( Division 3 of the Busine55 antl Piofes5iOn5 Cotle) o� that he/She is ezempt the�etrom antl the� ba5i5 f0/ [he alle9etl exemption. Any.violation of Section 7031.5 by,any applicant Por a permit subject5 the-applican[ to a civil , eEpalty o( not more than five huntlretl tlollar5 ($500). � ' LJ I„as owner of tbe.property or.my 2mployees with wa9es as their sole compensation, wilbtlo the wo�k, antl [he st�uctu�e i5 not intentletl or otf¢retl i+, nowever, tne owioing or n, the owner'will have the I tor Ihe purpose of sale). as owne� of the p�operty, a �Rto construct th¢ project (: ]onVactor's License I.aw tl i or"improves thereon, antl t�actor(5} litense pu�suant�to the praot c ❑ I am Date _ untler antl -state laws relaUn t sentatives of this cit inspection purpose . Signature ' Prote55ional Cotle: The Cont�acto� 5�, er of a properry who builtls or improves ' nself/he�self or Ihrougn hi5 or h¢r own ements are not intentletl or offeretl for ovement is soPo within one year,ot wm- n of p�ovin9 he/she tlitl not builtl o� im- clusivery contracting'with licensetl con- m]044, BuSiness antl Professions Cotle: ot apply So an owner ot property who contracts for such O�ojects'wifh a con- �.ractor's License Law). I am aware that n in5uranc¢ shoultl be provitletl to me. 8. & P. C. for this reason • ow�e, ve reatl�this application antl staie Nat the above r to comply with all city antl county ortlinances uiltlinq Lpf6tluctlon. antl herebY authorjie IeOfe- 0 OF ADD LJ ALTERATION. LJ REGAIR LJ CONVERSION LJ DEMOLISH iU OT R SCRIPTION Ok W K/ SE O B DG. � �X �j UI2_`�i �' D'f �.2Gf� R FS�,�-�� TYPEOFPERMIT � GRADI—NG � FOUNDATION �STRUCTURAL • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . ❑ OTHER = PROJECT DESCRIPTION� SQ. FT. �'�1 00 OCCUPANC 7�[� C O N ST RUCTI ON TV PE �V ALUATI O N$��S ZONE � GRADINGCU.VDS. ACRES Remarks: Sink Preventer I rriga2ioo Clarifiers Dishwasher ' Drinking Fountains Floor Drains� ' Floor Sinks Gas Service' Intercepmrs Kitchen Sink Lavamries ' / PLUMBING ' $hOWEfs ' ServiceSink Sewer Cap Sewer Connection Solar Collectors Solar Pipin S immin9 Pool w/Spa - Urinal Outlets Water Closet Water Heater - Water Service Auto-Wash Roof Dr ns '� Reinspection Fee ' $15 Duct - UntlenGrountl Duct-Strucmral ' Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO # Heating System & Ducting Daioo;000,eTu ,oao Drivers' License or 55 � � I I�nspec[ion Fee CMF 0865-46, rev. 10/B4 White - Building; Canary - Applicant; Pink - qccounting; Goltlenrotl - Assessor A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: ; � 1519 z/Ik/C7 Zone Accessory Building: ' i � Parkin9 Req./Provided FEES Automatic Washer Construction Pole Sub. Cooking Uni[ �Dishwasher , _ Dryers ❑Gas ❑Electric Fan F.A.U. � ' Fixtures� .-� Device Boxes Outlets Switches Garbage Disp I Issue Fee ' $ 3 iANICAL FEES Hood or - Type I � ❑ Canopy Type I I ❑ RefrigerationSystem �� ❑0.100,000 B 100,OOO.BTU . Syste epair/Altefation Fire Dampers Registers I $15 I I Issue Fee I $ 3 ELECTRICAL Transformer ❑ 15�50 KW � � ❑ 50+KW Meter ❑up to 700 a s ' Meter ❑over 10 mps. . Sub Panel KW �5-15 KW ' Rainspectian Fae $15 DEVELOPMENTSERVICESREQUI 2oning Approved By Building Approved By Application Issued By . =5,c�• T� 'FEES 0 Motor 0-1 HP LJih-8 � I .Solar 09-75 HP �16-15+ Microwave � � Pole Light `�i5' ' Range u) Sign �� ; Stending Sections � Tiash Compactor ' i -� �Ti 1 'luue Fce7� ' , $ 3 Z O N I N G R E Q M T S ' SUMMARV OF FEES � BUILDINGPERMIT $� 7.q• DO SMIP•�-- � $� �•S� PLAN CHECK �$ PERMIT � � PLUMBING �$ ISSUANCE �$ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL � $ ' GRADING $ PI:AN CHECK 50% $ � MICROFILM .$ • MECHANICAL $ � TOTAL FEE $_ Z�I � SL� PLAN CHECK 25% $ � CONSTRUCTION AND PLANNING •� POOL & S°A �APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector ( � t, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement �3. Elect�ical Conduit Utility�Undrgmd. 54. Forms ,.� 4. Electncal ConduibUndrgrnd. - _ 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6.. Elect�ical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. S.�Foundation . 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trep, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. �Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap ' � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem - Final 14. Rough Plumbing 65. Electrical-Final , 15. Rough Electrical-Conduit 66. Solar SYstem-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval 77. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 1$. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS , Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating _ 71. Product Piping O Gas ❑ Oil 23. Gas PiPe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro -26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Freme arid Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywa�l Nailing HEALTH DEPT. REQUIREMENT 31. Plastei Brown Coat 79. FINAL INSPECTION 32. Electrical Powe� MeterFinal 8�. 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. Backflow Preventer � � 43. Backflow Irrigation Incomplete Inspectwns 44. .Landscape Irrigation System � 45. Sound Attenuation - _ � 46. HandicaP Regulatio�s . - �_ 47. FINAL STRUCTURE & BUILDING . ' 48. Special Requirements Completed 49. Electrie Release to Edison � '- � 50. Gas Relea4e to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - � No, ' ' Date noyessaremianc: 908 MACK�NZIE PL uNr: CITY OE COSTA MESA - BUILDING PERMIT an'NEasNu�E�Faam+: SCHWkSSMANN, SACK W FLOOD: X. 47 �ooness 9pg MPCKENZIE PL COSTA MESA,CA 92626 PERMIT NO: P 07449.1 PLAN CHECK NO: N APVL.MNl1NGA0DRE54: C�C�['�;TRUCTIOh] TYPE: l�-Di PERMIT TYPE: PLU �RCNRECT OR ENtlNFER: RLX.Ofl F.NG.'S AUDPESS: LIG NO.: UNT: CONIHACTqfSNAME: DP FLUMBING 6 INSTAL. (714)9�1-9977 coNm�crorcsuuuxc 2?.0 N. CRESCENT WAY �ooxEss: ANAHEIM CA uc.rw: 563793 92801 uxr: M LICENSED COMFRCTOPS DECLAflATION: I hereby ell'vm under Po�aAY m Da�ury Ihat I em Ikensed under proviaiona of Chepter 9 (wmmendng vmh Senion J000) d Divisbn 3 N the Buaineas entl Profeasiom Code, arM my license is in hll force e�W eiled. a uar+o.: uacuss: C36 ��'�93 EXP: /9ate: '� � commaoc � A1 �lm �� OW P BUILUEN DECLAFRTION: I hareby elfirm uMer penely W perlury �hat I em erzempt Irom ihe ConVeUaa License Lew for IM VI iig raeson (Seclion ]031.5 Bueinesa arM Professions Code: Rny c1y a munry which requiree e peimA b cauVuct, eNer, impove, of h, ar repai eny s�mnure, pda lo ils esuence, also raQuiree ihe appli anl for auch paimd lo file e aiB�� ement thm he m ehe e liceneed punuent m the povisiona M Ihe Conlreclon License Lew �Chepter 9(commer�dip wuh Seaun )000) d Diraion 3 N the Busiireas enE PrMessbns Code� or �hal he ar ahe ia axamp therehom end tM besis ta IM ellepeE exemption. Any voletun ot Sectun ]031.5 by any epplicem lor a permn subjeds ihe epplicaM to a civil panelry o/ na mwe then Me hundred dollera �5500��. ❑ I,esownaro/thepropenyarmyempbyeasvMhwegeaesiheieolemmpenselion:xilldolhevroA.endihestruc1urebnMintendeE imo�menls are rrot imeMed a WIereE for aele. rc, M1aweveq the buiMinp w inprovemenl i5 sotl wilhin one yeaz W mmplelbn, ihe owner-buiker �II have tM1e buNen M provinp he or sM EiE �wl builE a improve Iw ihe Ourpoae d aele�. � I. ea owner d iM proqily. am udueiveFy cantrenin9 �h li�naed comruYon �o canatrud Ihe prqed (Sedion )044. Businma enE Pmieasiona COEa: The Contractas Licenae Lew doea rwt eppy to en owner d propeM �o buike or imqovm ihmeon aM who convacia for such prol�s ��h e mnVeclm�a) IienseE pursuenl to ihe ConVedus Licenae lew). ❑ 1 em axampt untlar Section: B. 8 P.C., br ihia reeson: o�a�. o.,�e.: i ao ne.any �an�y mm i� e.�a a e�e uneeB�e�a ine reyu��ama m cmeomia Heenn ena sarary coae seuions zssos, zssa3. ene 25534, eM that I w any fulure builCirq acapenl will / will nW (cirob one) med to comply weh aeid atme cadec end tha requirementa lor epertnniamnavuctionormodificelionhan�haAir u�0-Tyl�epementDimnd.Reeidemielcanatiuqoneppliceliwuereazamptimmlheea provisions. oete: Aoo�beM: W OFKEN'S COMPENSATION OECLAFRTION: I hereby eifirm uMer penelly W perjury oiu IN Ihe lollovnrq dedvmona: ❑ I heva entl wi1 meinten e cenEcme d mnxm to aetl�insure lor worken' cwnpanae�ion, es provked fw by Sedion 3]00 0/ Ihe Lebw Coda, lor tha pa�lormence oi ihe woA fw which Ihis pe�mX ie iseued. Q I heve e�M vnl mainivn woMere mmpameiion inaurence, ee requirad by Seclim 3'!00 N ihe Lebor CoEe. M Ihe pe�lormenca d IM n WOfII IOf Vr}IICII �M1I9 FIBfT111919HUB'J. MY WIXI{BR canpanaation insurence rartier eM poliry number ere�. c�a�: FARMERS EXPIRES POIcYNumber: �1f11(1' 944h47 02/01/96 (mis secfion naeG irof be complNed d the peim�t h/or are hurrdreC EWlers (5100) or bxa.) i�n�y m� �� m, �no�a�� a ma woM ro� .nwn m�a � 1 ie ieaued, I ehall �rot employ eiry pereon in eny mennm eo ea m a<om< s�ni<a m me .on�.a wmoao��o� iews m c o � a� m� n i ano�m n�oma wnim m me �nan• mpenaetion •rovisi i of $eUion �)0o N the Lebor Code, sh fo hx�l�*�i�h thoae provi�ioru. ` �� ., oete: Aoo��em: al W� Iny: F�lluro ro ieevro worken' comparueHon rovenps b unbw/ul, �ntl �Mll aub/eeNn �mp/oya ro ctlm/rol psvMu an0 I flmI up ro one hwtl�wi tMuulM Colbrs (5100,OOOA �� atltllXon ro M� ro�l o/ comperwtbn, tlenx�p� �� proHtlstl bi In ectlm J]O6 0l tlis LMor Code, Intsrost, entl ettomsy'� Isu. CONSTFUCTION LENDINO AOENCI: I hereby elfrtn uMer penalry d per'ryry ihat t�ero ia e mnat�uaion bndinp epenry lar iha p0l�OT1811CB O��hB WJf�t�O! W�I�If111h6�IBfRilll9 98Uld�$BL1U11 303)�CiN.Ci�. LENOEP'S NAME: LENUEF'S RUUflE3S: I canity thet I heve reed thia applicmian end altle ihel �ha ebove iniormation is corteU. I epree to mmpty wilh ell ciy end wunry ordine�wm enE stete lews mleling lo builEirp conetmdion eM heraby eu�hor¢e repreaentativea Mihu aiy b an�er upon iM ebove-menloned pmpeM brinapection vurpoaee. � � PATRICIA PADILLA (5151-�6.WP) Deta: � 1-�-� Pink-Fevenue: Goldenrod-baeoor JUB UESCRIPTION : WATER SOFTENER AND WATER HEATER LLAIM VALUE: CALC-VALUE: PERM NO; P 074411 GOVT: N SUPF': N PURPOSE: GTfi SQ FT: GROUF OCC: R-1 / COMMENTS: X ��***�*�*�*��**�*��**********��**�r*�**********�x***�*�**�****�*��******�**+�*� 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 BUILDING ---------- --------- ACCESSC�RY BUILUING --------- FRNT; FT IN REP.R: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN F.GHT: FT IN PARKING REC�: PROV: PARCEL: 91305232 ZNE: REF NO: PLANNIIJG NOTES> i iE iE 9E �1E �IF iF iE if iE iE iF dF iE 1E 3E #F iE iE iE iE �F jE iE iE iE dE-%9E * iE �1E �IE if �E iF iE iE 9f �E iE �F if * 3E 9E df !F iElE 1F i4 iE dt #�'c dE 9F iE � iE iE iE iP iE dE iE �)E �E jE iE iE �f' dE'1E iE iE 1E iE iE D E V E L O P M E N T S E R V I C£ S R E Q U I R E M E N T 5 ZONING APPRC�VEi� BY DATE: BUILDING APPkOVEU BY : DATE: APPLICATION ISSUED BY: � DATE: � v'3 —� � iFdElEifiEiEifiElEiE3EiEjEdE3EiFiEiElEiFiEdE yr'rfiF ,9E�f9EdE1E3EiEiE3EiF3F-�' E�i�'fEiE LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N SLDG PMT PLUMBING ELECTRIC MECHArIIC FIRE SMIP/RES GRADING PERMIT 14.00 259 PLAN ISSUE FEE 20.00 BUILDING-UIV-> PERMIT ISSUE PLAN-CHECK TOTALS----> 14.00 20.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 34.U0 SMIP/NON-RES TOTAL PAIU DUE 34.00 34.00 ,00 34,00 OVER/SHOkT: 00 FIRE SMIP/TOT GRALING PLAN-CHECK 9E dF iE 3E if iE dE if�lE 3F if dE 9E dE # if if jE'1F 9f 9f �%dE df jF df-iE �If iE 1E 3E'7F 3E 3E iE �)E �E IF �IE �E aF 3E 3E iF-%� iE if jE iE if �)f jE i69Elf iE if # if iF jE iE 1E �7f �1E �7E �E �E -)E 3E jE if 1E dE IE �7E')E �1E 3E I N D I V I 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 PLU 1 WATER AEATER AND/OR VENT 7,00 7.00 PLU 1 WATER SOFTENER 7.00 7.00 END GF FEES / � ✓ 7.;,� A..v t�+,� � ��Y"�' � � i �j� Oi C�3391�'•4-i;Q147�7°° B`E�� :>4.UG �(�' -.�� " � �JAT"c: lU. �i,i�Y` 7?M£; t!1a','+,? � _,� CONSTRUCTION ANOPLANNING PO. .�SPA • ti APPROVA�S Parmit# -- Date inspestor APPROVALS Permit#--� Date Inspectar � t. Temporary Electricai 5ervice or Pole 52. Pooi & Equipmenx Location � � • 2. Soii Pipe-Undrgrnd. 53. Steel Reinforcemen; � � 3. Electrical Cond�it Utiiity-Undrgrnd. � 54. Forms 4. Electrical Conduit-Undrgrnd. _ 55. Eieciricai Hondiny • ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6, Electrica( llFER Grnd. 57. APpROVALTO COVER�GUNiTE � ti 7. Footinqs 58. Electrcal Conduit�Undrgrnd. 8. Foundaiion 59. Gas Pipe, G Unclrgrnd., Test i 9. Waier Pipe�Undrgrnd. � 60. Backwash Lines, P�Trap,-f� Ur�drgmd.- ' 7Q. Strurtural Floor SYstem � fii. APPRQVA� TO DECK i t. Property Sewer Line & House Connection $2. 8ackwash & Receptor-FinaV ' j 12. Sewer Cap � B3. Heater & Vent-Fina! � ' i3. Roof Dra+ns 64. Piumbinq System -Finai 14. Rough Plumbing 65. Electrical-Final , . 15. Rough Elecirical-Condui; 66. Soiar SYstem-Final 76. ftough Eiectric Wiring $7. Fencinr� & Access Approvai _� 77. Rough W�riag Sign � 68. APPROVED FOR PLAS7ERING -'-_..... ...__.--_-: 18. Rough ElectricebT Bar Ceiling 69. POO�/SPA SYSTEMS F WAl 19. Rougn Neating & A�r Cnndi:ioning RftE DEPT. RHQUtRER9ENT 2Q. Rough F2clory Firep!ace APPROVALS Permit # 1 27. Qucts, in Structure 70. Underground Hydro . i 22. Ducts, Vsntilat(ng 71. Product Pipi�3y G' Gas � OiI ? 23. Gas Pipe-Rough & Test 72. Underground �lush - yj, 24. Roof Framing 73. Undergrnd.5tarage7ank �:�Gas '�4i4 � � 25. Roof Sheaihing 74. Ovefiead Hv�ro � �� ` � 26. T-Bar Ceiling {Strueturali & Monocoat 75. Dry Chemicai 3�'"� �'� i 27. Frame and Flaehing 76. Dry Standpipe ' � �28. Lathing i� Siding 77. FIXED SYSTEttr" �lNAL � 29. Insulazion 78, FIRE PREV. FINAL T� 30. D:ywall Nailing � MEALTN DEP7. FEQUIREMENT � � 31. Piaster Brown Coat 79. FINAL 1N5PECTION � � 32. Electrical Potiver lleter-Finai 80. FOOD CERTt?�lCATE ISSUED � 33. Pinai Electric � Notes; { 3-0. Finai Neating & Air Conditior.ing � 35. Final Gas P�Pe-Test •-� 36. Hood or CanoPY - -'-` ��- ... : --- -- - 37. Finai Faciory Firepiace 38. Fina7 Plumbing _� �---^"..v---� 39. UVater Service-Finai 40. Gas Service-Finai At. Solar Oomesfic-Final � �A2. Backfiow Preventer �43. Backflow Irrigation 44. Landscape irrigafion System , � 45. Sound Attanuation 46. Handicap Regulaiions � -t 47. FINA� STRUCTURE & BUILDING 48. FINAIPLANNiNG _ 49. Eiectrlc Re4ease zo Edison � J 50. Gas ftelease to Sauthern California Gas Cn r; 51.�CEFYIFICATE OF 6CCUPANCY �-� ' ( Na. Date , � �' � ) s v � Aoo�icant to fill in all spaces except those witM1in neavy borGer lines ana zign all avPropriate aeclarations. CITY�OF COSTA ME A CON TRUCTION PER �T PERMIT ^'� -- TRACT NO. _ LOT NO. UNIT NO. ProjectAddress �a� RG ,YIZi f ��Q{< Applicant's Mailing Ad fess � [Lr �� Owner's Name � �L �u)G�SS Me�� Phone Address � � �- Arch/Eng. A ��n ; License No. Address � �!s��o,�., Contractor's Name �/','�/ Phone f7�pY-� AdAresSlmailing) �Ce�(-4(,Jl �� `2 ' City Licensa No Di�S" - � LICENSED CONTRACTOR DECLARATION 1 hereDy atfirm lhat I am licensetl untler provislons ot Charte� 9(commenCing with section 7000) of Division 3 oi the Business antl Protessions Cotle, antl my license is in f II torce antl ettect. d- License Class Lice se No Date /�'4_�T�Q y Signature WORKERS'COMPENSATION DECLARATION' hereby aftirm [hat 1 have a certiticate of consent to self-insure or a cer[ificate .f Workers' Com/p1enzition Insurance, or a certif'etl� mp thereof (Section. 3800, Lab. QYT�S�17�O� Company POIICy No. ' �Certifietl mpy i5 hereby furnishetl. � � � Certitied mpy i5 fileG with the city Byjltli Divis' � i ate JZ�c�'�Y Applican�*�� * EXEMPTION FROM WORKERS' CDMPENSATI N DECLARA ION (Thissectlon neetl no[ be completetl if the permit i5 for one huntlretl ($100) or less). 1 c¢rtlfy �that in the performance of the wo�k for which this perm�t is issuetl, I' shall not employ any person in any manner so as to bec e syr6y�ct to the Workers' mp� n� ��Y&n. Laws ot Califor� �� . � �ate ��^,�3�/ Signature /` NOTICE: If, after making this tleclara�ion, you shoultl become su ject to the Workers' Compensation provisions of Ihe Labor Cotle, you must Porthwitn comply with such O�ovisions or thi5 permit shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV � I hereby affirm [M1aLthere is a construction lentlinq agency for the Oerformance of (he work ,for which t ermit is issuetl (Section 3097 Civ. CJ LenOer's Name L¢ntler'S AEtlre55 - ' � ._ OWNER BUILDER DECL RATION - ' ` ' I hereby aftirm that I am ezempt tram the ConVactor'S L'icense Law (or the following reason (Section 7031.5� Business antl Professional Cotle: Any city or .,.��„�., �.,n��n ..,��.a. a.,a.�.,a ro cnnztruct_ alter. imorove. tlemolisfi or reDair, fo�tile a siqned statement that he/she is licensetl pursuant to the provisions oi .('he Contractor's'License Law (Cnapter 9(commennng with Section 7000) of� I„=��9ivision 3 of Ihe Business antl Profe55ion5 Cotle) o� that he/she is exempt .`'herefrom antl the basis tor the allegetl ex¢mption. Any violation ot SectiOn 7033.5 by any applicant for a permit subject5 [he ap0licant'to a civll �enalty ot not more than five huntlretl tlollars (550�).• � I, a5 owne� ot the pro0erty or my employees with wages as thei� sole coenpensation, will tlo tM1e work, antl ihe Structure is not intentletl or offeretl tOr sale (Seclion 7044, Business antl Profe55ional Cotle: The Contractor'S License Law tloes not apply to an owner ot a property who builtls or imOroves thereon, antl wno tloes such work himselt/herself or through his or her own employees, provitletl that such improvemenis ar¢ not intentletl or offeretl fo� wle. If, however, the builtling cr improvement Is soltl within one year of com- pletioq [he owner will have the burtlen of proving he/she tlitl not builtl or iT- �ove for the purpose of sale). ' I, as owner of the property, am exclusively contracting with licensetl con- t�actOrs to construct [he p�oject (Section 7044, Busine55 antl Protessions Cotle: The ContraGtor's License Law tloes no[ apply to an owne� of property who builtls or improves tM1ereon, antl who contracts for such projects with a con- tractor(51 license pursuant�to the Contractor's License Law). I am aware that p�oof of their Wo�ke�'s Compensation insurance Should be provided to me. ❑.1 am exempt untler Section B. & P. C. for this reason Date Owner I her¢by certify that I M1ave �eatl this appli tion antl state that the abOve iniormation is mrrect. 1 agree to comply wi[I� all clty antl county ortlinances antl.state laws relating to builtli consV pfion, antl reby autho�ize �e0/e- s¢ntative5 Of IhiS city t en � upon (e abov ntionetl roperty fOr inspection Purposes. ']� Signature Date Ol Driver5' Licenze or 5 TYPE OF CONSTRUCTION LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — TVPE OF PERMIT LJ GRADIM . ❑ TENANT ❑ ELECTRICAL ❑ OTHER " PROJECT DESCRIPTION 5Q. FT._ ALTERATION LJ REPAIR - FOUNDATION LJSTRVCTURAL - LUMBING ❑MECHANICAL. CONSTRUCTION TVPE VALUATION $ � ZONE GRADINGCU.VDS. _AC Remarks: Bar Sink ' Backftow Preventer Backflow Irrigation Bathtubs Drinking Fountains Floor Drains' FloorSinks - GasService Outlets Interceptors� - Kitchen Sink Lavamries; � ' � P-Trap '. Roof,Drains ' . � Reinspection .Fee PLUMBING Showers ServiceSink` - ' Sewer Cap �. � Sewer Connection � Solar Collectors Solar Piping � � Solar Tank � Swimming Pool w/Spa Urinal � Wdt2f CIOSES • Water Heater Water Service � $15 Istue Fee Boiler Duct - Under Ground � � Duct - $trucmrel Duct - Ventilating Enhaust System ❑ Multiple ❑ Firepl/Fact: elt. ICBO # Heating System & Ducting ❑ai oo,000 eru o i oo,000 er Reinspection Fee I $15 GMF 0865�46, rev. 4/84 White - Builtling; Cana�y - Applicant; Pink -Accounting; Goltlenrotl -Assessor Hoodor Typel ❑ Canopy Type I I ❑ FEES Refrigeretion System ❑0-100,OOOBTU ❑100,000 System Repair/Alteretion , Issue Fee � $ 3 A.P. qW S Main Building: E T Frorit 8 Rear A ' C Right K Left � " S Ping. Ref. # . 4013 /�/13/�� Zone � Accessory Building: , • i013 I 2/ I 3/B4at � . ,y 1 ` Parking Req./Provided . �. ' ELECTRICAL Automatic Washer- --� Transformer � 15-50 KW CanstructionPoleSub. � ❑SO+KW Cooking Unit, -� � Meter ❑up to 100amps Dishwasher � . Meter ❑over100amps, Dryers OGas DElectric Suh Panel � Fan Motors �61 HP �1'/:-8 F.A.U. ' Inc. Solar �9-15 HP 016-75+ Fixtures - ' � Microwave � Device Boxes Pole Light Outlets Range Swi tches � Sign Garbage Disposal ' $tanding Sections Generator DO-5 KW �5-15 KW Trash Compacror � � �.Q� i �LL��` FEES Z o. N I N G R E Q M T S. I Reinspection Fee I$15 I ' Issue Fee I $ 3 I DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Date Buildin8 APP�oved By Date Application luuad By Dat ( 2 SUMMARV OF FEES BUILDING PERMIT $ SMIP � $ PLAN CHECK $ PERMIT PLUMBING $ OO ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ ' GRADING $ . PLANCHECK 50% $ MICROFILM $ �',� MECHANICAL � $ TOTAL FEE . $ ��_� PLAN CHECK 25% $ ' CONSTRUCTION AND PLANNING `• PO. .� SPA � `APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole, � _ 52. Pool & Equipment Location � :� 2. Soil Pipe;Undrgrnd. - �� 53. Steel Reinfo�cement � 3. ElectricalConduit;Utility-Undrgrnii. , � .� 54. Forms . 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding ' .� ' 5. Steel Reinforcement � � , 56. Rough Plumbing & Pressure Test �' � 6. Electrical UFER�Grnd. 57. APPROVALTO COVER-GUNITE � . 7. Footings � � .�� 58. Electrical Conduit-Undrgrnii. 8. Foundation " �� '� �� 59. Gas Pipe, O Undrgrnd., Test � . 9. Water Pipe-Undrgrnd. ' .�� . �� 60. Backwash Lines, P-Trap, O Undrgmd. 10. Structural Floor System �'(� •. �. 61. APPROVALTO DECK - 11.'PropertY Sewer Line & House Connection . 62. Backwash & Receptor-Final 12. Sewer Cap , � ' . 63. Heater & Vent-Final . 13. Roof Drains �, ' 64. Plumbing System - Final 14. Rough Plumbing' . � 65. Electrical-Final 15. Rough Electrical-Conduit '- 66. Solar System-Final - i 6. Rough Electric Wiring ' 67. Fencing & Access Approval 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING � 18..Rough Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FIN,4L � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. ,Ducts, Ventilating 71. Product Piping � Gas ❑ Oil . 23. Gas Pipe-Rough & Test � � , 72. "Underground Flush " - 24. Roof Framing � ; 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ' ' 76. -Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation . . 78. FIRE PREV. FINAL 30. Drywall Nailing . , . ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' � •79. FINAL INSPECTION � 32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating &.Air Conditioning , 35. Final Gas Pipe-Test � . � . 36. Hood or Canopy . � 37. Final Factory Fireplace 38. Final Plumbing , y �'" (� 39. Water-Service-Final � 40. Gas Service-Final , � 41. Solar pomesticFinal - � � 42. Backflow Preventer - � 43. Backflow.lrrigation . ,. ;.� � � . . . 44. �Landscape Irrigation System . 45. Sound Attenuation � - � 46. Handicap Regulations . 47. FINALSTRUCTURE&BUILDING � 48. Special Requirements Completed 49. Electrie Release to Edison � � . � 50. Gas Release to Southern California Gas Co � � 57. CERTIFICATE OF OCCUPANCY • No. Date `� 27525 � :� . COSTA MESA BUILDING-SAFETY DEPARTMEM P.O. BOX 71W COSTA MESA, CALIFORNIA Y26T6 For Applicant fo FIII In Compleroly TYPE OR PRINT B°"°�"' 0 e z i e Pl � woonesn COSTA MESA. CALIFORNIA ' \. oS'1 i� \\\ �.gti r+o.SYO- .iITECT T6L • � -b1-�11 lb! no. M.F.'i'J=+-1 In... / J / ,./ I No.o.n.cw. � /6TSACR LIX[ II10M DFSCRIPTION OE WORK /q � ^ I NO.OP oC �( ROOMB WALL ROOP �1 XEpHOY ACKHOWL6D0{ TryAT 1 MAVt pHAD THIY MPLICATION AND BTATQ TH�T TN6 AOOV6 It CORR6CT AND I10q6[ TO COM. VLY WITH �LL CITY ORDIIUNCU AND YTAT[ LI1WY R[OYLIITINO BUILDINO CONBTRU4TION. � AUTHORIZiD AOQNT ento � t:...: SEP -7-67cnsr,00 137 c'�,; :: 5• C APPLICATION FOR PERMR BUILDING For Off(ee Use Only e�cc�rteo. �i em�oiNo 4 ZONING � �:a o. 198U6/D %�{7 o� ��.no� f/.r.t 5k - T/�CL�Uco7� A. P. NO. � NOTl: NO[AVQOV[RMANO6HALL�BLH88TNAN 'JO' TO 8108 S RiAR P. L. awvea ALLOW[D IU..B.G.REGUIRHMHNTI YAROBAPPROVHD VARD8APPROVBD MAIN BUILDINO AGCHLHORY BUILDINO vwn.# DATE � � � � � � �. �. � 0 TX6 AMOUXT lNOWN UM06p VALUI�TON 19 FOP Ti6 j IURP098 OI 60TABL19NIN0 A PBpMIT I88 ONLY. ,3� VALUATION .ti PERMIT FHH � � s�7� � �- ��°. TOTAL FF8 $ ✓ E or rG SUBCONTRACTOR '�'- ~ �� FEB 17-67PaIo00 727+� *x**99.00 crisa COSTA MESA BUILDING-SAfETY DEPARTMEPfT P.O. BOX 7200 � COSTA MESA� CALIFORNIA 9t646 Far ApplTcanT fo Fill In Compleroly APPLICATION POR PERMR TYPE OR PRINT BUILDIN(3 eui�iNo Por OHIm Use Only ADDRESY 08 Macke ie P1aCe �.«�.rra. ��+,. r COSTA ME3A. CALIFORNIA '��'" � T�D�°7 R[C IV[D�T -M'RN i1V6D yAT�I 8UHD owNeR II. S. FinanCial 03 � euao�Na L Q �/'�% ' ADDR896 1355 Front St• ADDRE68 �// ///�� TEL ZON! TYP! � OROUP � � San Diego, Calif. No_ 2311-791 A ITECT TEL BYPrt�vC� DATE ORENGINEBR i�. .S. Henrvck No. 546-561 ADDRE88 Ol Liard Place Costa Mesa ZONING Zpp{ HO.O� YYLORM[W �(J �C �un� emtolno CONTRACTOR Lewis R, Sckmid ��,� . -5/� �� 5 AD R880 2944-A Randolph Ave. DUC111rt1oN ��T. r,osta �iesa, Calif• AP.NO. N0T6: NO [AVH OV[RHANO SHALL BE LE88 THAN LIC.TNO. � � NHL ao�6o 80'TO81D[eRBARP.L [ lAV68 OFLOT UO X ZOO ry0W �h��' Q ALLOW[D �LL..B.C.REQUIREMENT). YARODAPPROVHD YAROSAPPROVED U6EOF MAINBUILDINO ACCEDSORYBUILGIN6 EXISTIN6 BLDO. ^ �(FROM RH[T) . YCfCACK L�N[ IROM I1 G9 � 5Q FRONT FT. FT. ceniee op cne[R "� � R[AR YMD SIDB YARD I U[FT J� RI6HT �� R. DID6 �1 FT, F7'. DESCRIPTION OF 1NORK �. ai J rr. rr. NEW $' T[RATI N ADDITI N Ru"" ��' �� DIIITANC[![T. BBT. MAIN Q MAIN BLD f ACCEHf.BLD68. REPAIR IN 6M Ll8 BUILOIN6 r[ NO OR V�•# DATB 81ZE 17UO Sf ROOMH 6 pl 1 C. U. P. APPROVBD EXTERIOR WA WO�� ROOr '� n� e MPROV[D /} / COVERIN6 n`faster COVERINO Ol' owre Ll�� f0 U8H OF �UILDIl�GAXD WORK TO B6 P[RFORM[D a Sin le Famil Dwellin With Attached ?� GaraPe $ ,Lor � .Q�L� 5Go �.�. �3� � 1 HCRlBY ACKNOWL6D06 T11AT i NAV6 q6AO TX�B MPLIWTIOM THR AYOUHT 9M0 UNOBN VALUI�TION �9 FOR TH8 j AND fiTATB THAT TH6 AGOVC Ii CORR[Gi�AND AORHf TO COY• �UMPo88 OP �BTAGLIBXINO A PEPMIT PHB ONLY. 3 PLY WITH ALL CITY OpDINANCtl AND YTAT[ LAWY R[OYLI�TINO yALUATIOH // f � CUILDINO CONBTAUCI'ION. SIGNATUREOP g ^ / ` � PERMIT FEE S u� �( PERMIITE O( � j�5 .�3 — w AUTNORIZ6D ADSNT TOTALFEE ��