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Home My WebLink About925 MACKENZIE PL - Building PermitsAVO��ant to fill in all spaces exceDi those wit�in �aavy Dortle� Iines anE sl9n all a00�o0/�ate Ceclarations. CI7Y OF COSTAj�QESa C ST UOCnTION PEf�MIT Project Address /�� u /Z� e IJ � ' 1/ Applicant'sMailina/A�ddreIss — G i 7 ' Owner's Name `��/�✓ Phone S� Address Arch/Eng. License No. Address Contrector's Nam� � Phone �99� � Addrea (mailingl � ' City License No � � 7.�7 5 LICENSED GONTRACTOR DECLARATION I hereby affirm [hat I am IicenSetl untler provislons ot Charter 9(commenclnq with section 7000) of Divlsion 3 of tne Business antl Professions Cotle, antl my Iicense is in (uy i antl effect. License CI s � �icen No. bDate Signature WORKERS',COMPENSATION DECLARATION \ � hcreby affirm that I have a certlficate of consent to selhlnsure or a certificate l Workers' Compansatlon Insurante, or a certlfietl cOpy (her¢Of (SeGtlon 10, Lab. )/�� /�� /] p'` �%/�/� �o7li,c,y No. ��W ��(/ �(d ^ V Company /�UVY Ia Cert'tietl coPY Is flle0 wHhrthehc'tY/�/�il �'vii i / Date� APPlicantiGb��'N ��i�� EXEM I N FROM W00.KER5' COMPENSATION DECLARATION (This 5ection neetl not be complete0 if the pe�mit is to� one huntlretl ($100) or less). I certi(y that ln the performance o1 the work for which this perm�t is Issuotl, I shall not employ any Oerson in any manne� so as to become SUDject to [he Workers' Comoensation Laws oi Calitomia. Date Si9nature 'NOTICE: If, atter making thiz tleclaration, you shoultl betome subject to the Worker5' COmp¢nSaliOn provisions af the Labo� Cotle, you must torlhwith tomply wilh such p�ovlsions or lhi5 permil shall be tlaemetl revoketl. CONSTRVCTION LENDING AGENCV I hereby attl�m [�a[ l�ere i5 a construction lentling agency for the p¢rformanG¢ of the work far which ihis permit is issuetl (Section 3097 Civ. CJ Lender's Name Lentler's AEtlress OWNER BUILDEH DECLHRATION I hereDy affirm that I am exempt irom the Contractor's Licenze Law for the following reason �Section 7031.5 Busine5s antl Professional Cotle: Any city or counly whiGh r¢qui�es a pe�mlt to ConSlrUct, alter, Improve, demoli5h or repal� any structure, prlor to its issuance, also requires the applicant (or such permlt to file a slqnetl slatement [hat he/sM1e is licensetl pursuant to the provi5ion5 ot [he Contraclor's License law (Chapter 9,(commencing witn Section ]000) of Division 3 of [he Buiiness antl Protessions Cotle) or tM1at be/she i5 exempl �refrom antl [he basls Po� the allegetl exemption. Any viOlation of Section 1.5 by any appllcant tor a pe�mit subject5 the applicant to a Clvil ,dlty o1 nol more than five huntlrea tlollari ($500). LJ I, as owner of lhe Property or my employees with wages as thel� sole compen5ation, will tlo the work, antl the structure is not intantletl or olieretl (or sale (Section 7044, Business anG Protezsional CoOe: The Contractor's License Law tloes not app1Y lo an owner of a property wno bulltls or improves [hereon, antl who tlocs such work M1imself/herself o� [h�ough his or her own employ¢e5, prOvitleO tnat SUCh iTP/ovements a�e not intentletl or o/feretl for SaIC. It, however, the bulltling o� improvement i5 soltl within one yea� ot com- pletlon, lne owner wlll M1ave th¢ burtlen Of proving he/she tliA nOt builtl o� im- p�ova for [he pu�po5¢ o/ sale). ❑ I, as owner of the property, am exclusively mntractinq with Iicensetl con- tractors to construct tna projec[ ($ection ]044, Buslness antl Profeislons Cotle: The Contractor's License Law tloes not apply to an owner of property who builtls or improves thereon, antl who contracts for such projects wlth a con- Vactor(5 llcensa pursuant�to tM1e ConVactor's License Law). I am aware that Oroof o� thelr WO�ker's Compenwtion insurance shoultl be p�oNtlltl to me. ❑ I am ezempt untler Sectlon B. 6 P. C. �or this reason Date Owner — 1 he�eby certify Ihat I have rea0 I infOrmation i5 correct. 1 agree lo co antl state laws relating to builtling � sentatives of tnis tlty to enter u inspec[lan p❑ aoseJ��//� � $ignature _�%�`_ �. LyLti DNvers' Llt nse o�55 � a��y9 __ TYPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p# DESCRIPTION OF WORK/USE OF BLDG. . S Main Building: E TVPEOFPERMIT GRAOING FOUNDATION STRVCTURAL T Front ❑ TENANT ❑ ELECTRIGAL Pl_VMBING ❑ MECHANICAL B Reaf ❑ OTHER A PRQIECT DESCRIPTION 5�. FT. oCCVPANCv C Right K Left CONSTRUCTION TVPE VALUATION $ $ 20NE GRADING CU. V�S. ACRES pin9. Ref. # Remarks: , Planning Notes: 3ar $ink 3ackflow Preveneer 3ackflow Irrigation 3athtubs �larifiers ' Jishwdsher Jrinking Fountains �loor Drains Floor Sinks 3as Service Outlets Interceptors Kitchen $ink Lavatories P—Trap Roof Drains Reinspection. Fee $15 Boiler Duct - Under Ground Duct - Sttuc W ral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting� ❑ o-� oo,000 sru o i oo;000 Reinspection Fee � $15 CMF 0865-46, rev. 10/B4 � White - Bulltling; Canary - Applicant; Pink - Ac<ounting; GOIGenrotl - Assessor Showers Service Sink � Sewer Cap Sewer Conneceion Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Wacer Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Fefrigeration System ❑a�oo,000sru ❑ioo,000 System Repair/Alteration Fire Dampers Registers IauB Fee FEES Aummatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixlures Device Boxes Outlets b4UY 12/�6/d5 Oo�'� �L Zone Accessory Building: Z " O N I N G R Parking Req./Provided E Q M T ' S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Garbage Dispoul Generator Oa5 KW �5-15 KW Meter LJup to 100 amps Merer ❑over100amps Sub Panel Motors O0.1 HP O t Y, - 8 Inc.Solar �9-15 HP 016-75+ Microwave Pole Light Range Sign ; Standing Sections Trash Compactor $ 3 ' � Reinspection Fee $15 Issue Fae FEES DEVEIOPMENT SERVICES REQUIREMENTS: 2oning Approved By Building Approved By I� AppIIC8tl0l1 IStuBd BV " $ 3 FEES $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �%� ISSUANCE S PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL, $ GRADING $ PLAN CHECK 50% $ MICROFILM $1 /, MECHANICAL $ TOTAL FEE $ �O v Pli1N CHECK 25% $ ' � � 'CONSTRUCTION AND PLANNING POOL ` CPA _ ^ APPROVALS Permit# - Date Inspector AppROVALS Pei��it# Date Inspector 1. Temporary Elect�ical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgmd. 55. Electrical Bonding - 5. Steel Reinforcement , 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE -7. Footings � 58. Elecirical 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 . 61. APPROVAL TO DECK 1�1. 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 ElecVical-Conduit . 66. Solar System-Final - 16. 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 FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT, 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structute 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.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical 27. Freme 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 � t � -1J-� �� 39. Water Service-Fin81 �� . , 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer " 43. Backflow Irrigation -� . � 44. Landscape Irrigation System ` , ; �, �r 45. Sound Attenuati0n - � . 46. Ha�dicap Regulauons - ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern Califomia Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' . . AGOlicant to fill in all spaces wit�In heavy OorEer Iinesan0 sign all aOV�opriate Eecta�a�lons. CITY OF COSTA MESA PERp� IT NO. TRACT NO. LOT NO. BIDG. NO. CONSTRUCTION PERMIT /�-,3(e �, S� \ � Address N/�� TYPE OF CONSTRUCTION Phe�el% /- t ❑ NEW ❑ ADD ❑ ALTERATION ��vr ❑REPAIR ❑CONVERSION ❑DEMOLISH LiCense NO. ❑ OTHER DESCRIPTION OF WORK � Addreu 7, � �. f � LICENSED CONTRACTOR DECLARATION I hereby aHirm tnat I am Ilcensea unCer provisions of Chartor 9(com- mencing wlth section 7000) of Diviilan 3 of lhe Business antl Rofesslons Cotle, antl my Iltense is in fu❑ force antl efte<t. LlCenseClasz �� -SF" U� Nq.:�� i � Date� �%'eZ 519nature)✓�A-s ,C �� _ WORKERS'COMPENSATION DECLARATION 1 hereby aftirm that I have a certifica[e of consent to self-Insure or a certififate o( Workers' Compensatlon Insuranca, or a terti(Ie0 <opy thEreof (SeCti n 3000, Lab. C.). PoIICY No.��``^n CampanY�'Q 1/rp �� /r ❑ Certlfietl copy is hereby (urnlshetl. ��Certitietl copy Is filetl with the city Bulltling Divislon. EXEMPTION FROM WORKERS' COMVENSATION OECLARATION, (This seGtion n<¢tl n0[ b! cOTpleteE It tbe pe�mlt is fo� one huntlre0l� (§IO�� OI 1255). � 1 certity that In Ihe per(OrmdnCe of thG wOrk fOr wnlGh this permit is � issuetl, i znaii not emPloy any pe�ion In d�y rtldnnG� to az to become Subj¢ct to tha Worker5 Comp<nsaUOn Laws of Callfornld. Date Si9natura NOTICE: It aftGr rtldking thiz tltGld�atlOn, yOu s�0ultl b¢Come subjlct to the Workers' Compensatlon provlslons of the Labor Cotle, you must forihwith comply wlth suth provi5ion5 or thls permii shall be tleemetl revoketl. _ CONSTRUCTION LENDING AGENCV I hBr¢by dtfirm thdt Ih¢r¢ IS d Co�StruCtlOn 1¢ntling aqGnGy (O� [he pe�- formance of the work for wnlch tnis permit IS ISsuetl (Sectlon 3097 Civ. CJ. Lender'S Name Lentler's Adtlress OWNER BUILDER DECLARATION 1 hereby aftirm that I am exempt from the Contracior's Llcense Law for the tollowinq reason (Se<tlon 7031.5 Business antl Professlons Cotle: Any city or county which requiras a permit to conStruCt, alter, improve, tlemolish or repalr any s[ructure, prlor to its issuance, also re- qulrez th¢ appllGan[ 10� such pe�ml[ to tlle a Signetl Statement that h¢ is licensetl pursuant to the provision5 of the Contrattor'S License Law (Chapter 9(commencing with Settlon 7000) ot Dlvision 3 ot the Business antl Professions Cotle) or [hat he 15 exempt tnerefrom antl the basls for tne allegetl exemption. Any violatlon of Section ]031.5 by any appliwnt for a perml[ subjects the applicani to a clvil penalty of not more tnan five nuntlretl tlollar5 (y500). ❑ I, as owner of lh¢ property, or my employees witn wa9e5 a5 Iheir sole compen5ation, will tlo lhe work, dntl the 5[ruCture I5 not intentletl or offeretl for sale. (Sectlon ]044, Business antl Rofessions Cotle: The Contractor's Licenze Law tloes not apply to an owner of a property wh0 builtls o� Improves [heteon, antl who does such work nimselt or thrOugh his Own employees, provitlotl that such improvamenti ar¢ not intGntled O/ Offe�e0 ta� Sale. If, howev¢r, thG bUlltling Or imp�ov¢ment is soltl wlinin one year of completion, the owner will have the burtlen ot p�oving he tlitl not builtl o� improve tor th¢ purpose of sale).� ❑ I, as owner of (he property, am exclu5ively ton[racting with licensetl contractori to canstruct lhe project (Section 7044, Businesz antl Professions Cotle: The Conlractor'S Llcense Law tloes not apply to an ownei ot properly who builtls o� Imp�oves lhe�eon, antl who con- tfatts frOm suGh prOjecis wltll a contldCtOr(5) IICGin¢tl pursuant to tM1e Cont�acto�'S License Law). ❑ I am exempt untler Sectlon 8. 6 P. C. for this reason Date Owner I hereby Certify that I have reatl this applicatian antl state tM1a[ the above information i5 cOrr¢ct. I agrea to comply wlth all city antl county o�tlinances antl state laws r¢Iating f0 COnstru<tlOn, antl h¢reby authOriie representative5 of th15 cl[y to enler upon the above mentionetl property fof �i ispectlon purppses. L_� Signatura F'1 "�� ! �� ^�^-^ Da[e � — 1' Drivers' License or 55 ,� �� " TYPE OF PERMIT ❑ GFADING ❑ FOUNDATJION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL 12WLUM8ING ❑MECNAI ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCVPANCY_CONSTRUCTION TVPE VALUATION ZONE GRADING CU. YDS. ACRES 0.EMARKS: PLUMBING PLANCHECK BATHTUBS TOILETS LA V ATO (31 ES KIT. SINKS SERV ICE SINKS FLOOR SINKS ORINKING FOUNTAINS INTERCEPTORS SWIMMING POOL WATER SERVICE GAS SERV ICE SHOWERS VRINAL$ DOUBLE �HVS DISHWASHERS SUMPS FLOOR �RAINS CLARIFIERS P TRAP ALTERATION OUTLETS BTU OUTPUT SEWERCONNECTIONS - SOLAR TANK COLLECTORS SOLAR PIPING SYS. ISSUE FEE MECHANICAL aLAN CHECK HEATING SVSTEM 0-300,000 BTU ANDDUCTING 100,000+BTU REFRIGEf3AT10N 0-300,000 BTU SYSTEM 100,000+6TU BOILERS BTU SVSTEM REPAIR,ALTERATION EXHAVST SVSTEM MULT�PLE ISSUE FEE CMF 0865-46 White-Bulltling; Canary-Applicant; Pink-Accountlng; Goltlenrotl-Assessor �'��.D� �7-p/ S� P A.P. 5 ZONE 6193 5/21/82 PEAR VARD (TO P/l) PKG, SPACE RE�. STREET WIDTH ZONING APPROVED BV SPECIAL CONDITIONS: ELECTRICAL PLNG. REF. � PROVIDE� PARK FEE PLAN CHECK GENERATOR O-1 KW_ 1-30 KW TRANSFORMER APPLIANCE 30-50KW_SO+KW MOTORS 0-1 HP_1-30 HP (INC. SOLAR) 10-50 HP 50 + HP FIXTURES OUTLETS SWITCHES GAS TUBE SIGNS POLE LIGHTS POLES METERED SUB PANELS MAIN SVB SERVICE AMP ISSUE FEE APPLICATION HPPROVED BV pATE SUMMARV OF FEES BUIIDING PERMIT S PLAN CHECK b� PLUMBING $ U� PLAN CHECK $ ELECTRICAL 5 PLAN CHECK $ MECHANICAI. S PLAN CHECK § G 5.00 T(� SMIP S PERMIT �s� ISSUANCE E 3' �`� GRADING E S MICROFILM E � ,, � TOTAL FEE $ � LE55 AD- VANCEPC $_ FINALFEE S h' � CONSTRUCTION qND PLANNI G ��_ POOL & SPA � "��iate Inspector � � Date Inspector APPROVALS Permit # 3 APPROVALS Permit # 1. Temporary Electrical $ervice or Pole 43. Pool & Equipment Location 2. Soil ipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding . tee ein orce 47. Rough Plumbin & Pressure Test 6. Electrical UFEF Grn 48. APPROVALTO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn 10. Structural Floor System 52. APPROVALTO DECK 11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 14. Rough Electric-Conduit �56. Electrical-Final 15. Rough Electric-Wirin 57. Solar System-Final 16. Rough Heating & Air Conditioning � encing & Access Approval 17. Ducts in Structure ' APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathin - 22. Frameand Flashin NOTES: 23. Insulation 24. lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating & Air �onditioning 30. Final Gas Pipe-Test 31. Final Plumbing 7�/ 32. Water Service-Final 33. Gas Service-Final 34. $olar pomestic-Final 35. Landsca e S rinklin S stem � 36. Sound Attenuation 37. Handicap Regulations � 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Compieted 40. Electric Release to �dison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date � 7 �""- ' ^� `� ` e.', '� y Applicant to fill in all ipacez exce0� lhose witnin �eavy portler Iines antl sign all a0V/oD/iate 0eclaralions. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT O. TRACT NO. LOT.NO. UNIT NU. - �SS'f0 4�7 `f � Project Address �� s i�Q�-' K�N 2-/ t Appiicant's Mailing Addre55 00 /W' (.t.�.2/IAfPIL 4 Q TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R Owner'S Name ��j'.q`� ��+ ("�� K� Phone t � CONVERSION ❑ DEMOLISH ❑ OT�E�R �� T�_ n/ Addreu �o`� %�%L'�G �1�/ `r-«' % S I—� y p DESCRIPTION OF WORK/US �O�F B♦ULDG. ?'T� S.L�I Arch/Eng. �icense No. �O/ �3 TYPE OF PERMIT GRADING " FOUNDATION STRUCTURAL Address �Z�'7'�-��,,. u-G� Q':u1w'+— �'/�.� � ❑ TENANT ❑ ELECTRICAL PLVMBING ❑ MECHANICAL Contracto N ��_�1 �An PhonBs`�l�'� � OTHER Addiess (mailingl � a CZ_� PROJECT DESCRIPTION 5�. F7. OCCUPANCv ' o' CityLiCenSeNo. U�J�S/ CONSTRVCTIONTVPE - � VALUATION$TG%i%� ZONE GRAOINGCU.VDS. � ACRES IIGENSED CONTRqCT00. DECLA0.A7�ON I hereby affirm that I am Ilcensetl untle� Provislons of Char[Gr 9(cOmmancin9 � with section 7000) of Division 3 ot th6 Business antl ProfeSslons Cotle, antl my license is In full tor na eftect. ' �; Y� � License Clas License No. Date �` �+Signature �� WORKERS' COMPENSATION DECLARATION � nereby atiirm that 1 have a certificate of consent to self-Insure or a certlficate workers' Compensation Insurance, Or a certifletl copy Nereoi (Section 00, lab. C.) � ,R A Policy No. m�� Corf�Pany �y�i �� Certifietl cooY �z hereby fumishea. Cerfi}f' �tl pyy5�ilgtl6wf�th [he city W+�+ � o. ate- 7�tS f3 pplicant EXEMPTION FROM WORKERS' COMPENSA ON DECLARATION (This sectlon neetl not be completetl if the Permit is for one huntlretl (5300) or lesz). I ce�Ufy thal In [he perto�manCe of tne Wo�k fo� wM1lch Ihis perT�t IS i55u¢tl I 5hali not employ any pCrSon In any ma��er so a5 to become sub)ect to t�e Workers' Compen5alion Laws of CaliforNa. Date Signature NOTICE: It, a/ter makln9 this tleclaration. You shoultl become subject to tha Wotkers' ComOensation p(ovi5ions o( tl�e L:abor Cotle, you must (Orthwith comply with such proviSiOns or thi5, Permit Shall ba tleome0 revoketl. CONSTRUCTION LENDING AGENCV I hereby affirm Ihat there is a consVuctio� lentling agency tor tha performance of the work ror which tnis pormit is issuetl (Section 309] Civ. C.) Lentler's Name Lentler'S AEtlre55 �OVJNER BUILUER DECLA0.ATION I hereby atfirm� [�at I am exemp[ from �he Contrac[or's License I..aw for the �..u....,...,. .e�<.... ice.e:.... vmi t a��..ezz antl Professional [otle: Anv Ntv or ��,?}�retrom antl tne basis tor tne allegea exemp�wn. rny vwiauun o� �ecuon .,.$�A1.5 by any applican[ tor a perm�t subjects the ap0licant to a civil °^'ialty of not more Ihan five huntlretl tlP�lars (5500). �� L� I, a5 ownet of tM1e p�operty o� my employees with wages as their sole mmpensation, will tlo,the wo�k, antl th¢ st�uctu�e I5 no[ intentletl o� ofteretl tor sale (Section 7044, Business antl P�otessional Cotle: The Contractor's License Law aoex not apDry to an awner ot a property who builtls or improves thereon, anG who tloes such work him5elf/herself or Ihrouqh his or hor own employee5, provitled lhat Such improveR�ents are not in[entletl Or offeretl for sale. If, however, the bulltling or improVement is soltl within ona year oi com- oletlon, tne owner wlll have the burtlen ot proving he/she tlitl not builtl or im- prove for the pwpose ot sale). ' ❑ I, as owner of the property, am exclusivety contracting with Iicensetl wn- tractors to consVuct ihe project (Section 7044, Business antl'Professlons Cotle: The Gontractor's License Law tloes no� apply to an owner ot property who builtls or improves.lhereon, antl who cOntract5 tor such prOjects with a con- t�actor(s I¢ense pursuant to the ContrA�to�'s Li[anse Law). I am aware fhat proof o� [heir Worker's Compensation insu�ance shoultl be prOvitletl to me. ❑ 1 dm exempl untler 5¢ction , B. & P. C. for IhiS r¢azon Remarks: ��_ {��s � . / Bar Sink - Backflow Preventer Backflow Irrigation rinking Fountains loor �rains. loor Sinks as Service _ Ouilets : Lavatories � P—Trap pooi Drai Reinspection Fee $15 8oiler Duct - Under Ground � �uct - Structural Ouct � Ventilating � Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Date Owner � Heating System & Ducti '� I hereby certlly i�a[ 1 have reatl [his dPP��ation antl stale that t�e above ❑O�70Q0� BTU 00 information is correc I agree to comply wiih all city antl county ortlinances antl state laws �el N g to builtlin9 mnst�uction, antl hereby authotlie repre- zentatives of c ci o enter upon ��e above-mentionetl property tor insp¢ctian pur Sey o ' Signature l°�k ' Data � O � Driverz• License or 55 � Reinspeetian CMF 086946, rev. ]0/84 White - Builtlin9: Ganary - Applicant; Pink - Accounting; Goltlenrotl - Assessc Fee � $15 0 Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimmi Pool w/Spa �N/2L¢f CIOSCI � Water Heater Water Service . Auro-Wash WundryTrays ' Isue Fee �ANICAL Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-700,000 8 100,000 BTU Sy Repair/Alteretion Fire Dampers Flegisters Issue Fae FEES � A.P. # ,�'%� Z S Main Building: TFront. C ARear � C Right K S Left i Pln9. Ref. # Planning Notes: < Auromatic Washer " ConstructionPoleSub. � Cooking Unit _ Dishwasher Dryers ❑Gas �Electtic Fan F.A.U. Fixtures Device eoxes Outlets . Swiahes . . _ Garbage Disposal � 4020 9/29/86 � I Zone Accessory Building: � Parking Req./Provided � ELECTRICAL - ' Transformer ❑ 15-50 KW ❑ 50+KW Generemr �6 W �5-15 KW $ 3 I � Rainspection Fee FEES �� DEVELOPMENTSER � Zoning Approved 8y_ Building Approved By �APPliptian luued By_ $ 3 $15 Meter LJup to 100 amp� Meter �over 100 amps Sub Panel / / Motors 61HPO1:4-8 Inc olar �9-15 HP �16�15+ Pole Light Range Sign Standing Sections Trash Compactor luue Fee 46.70 1�1,' FEES $ 3 Z O N I N G R E Q M T S SUMMARV OF FEES - BUILDINGPERMIT' $ %��•Op SM�p ' - $ . ,�O PLAN�CHECK , $ �R.ab pERM1T � PLUMB�NG � . S ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $. ELECTRICAL ' $ GRADING 5 PLAN CHECK 50% $ MICROFILM $ / ' MECHANICAL $ TOTAL FEE $ CO t%G PLAN CHECK 25% $ • CONSTRUCTION AND PLANNING POOL & SPA � APPROVALS Permit# Date Inspector AppROVALS Permit# Date� Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � • 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. � 54. Forms � � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings � -�,b �- 58. Electrical Conduit-Undrgmd. 8. Foundation . 59. Gas Pipe, O Undrgrnd.,-Test 9. Water Pipe-Undrgrnd. - , � 60. Backwash Lines, P-Trap; � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK' 1 i. 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 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL . 19. Rough Heacing & Air Conditioning FIRE DEPT. REQUIREMENT • 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil�' 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing ' 73. Undergrnd. Storage 7ank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Fr,a{ne and Flashing 76. Dry Standpipe -� 28. LathiAg & 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. Electriral Power Meter-Final y 80. FOOD CERTIFICATE ISSUED � • . 33. Final Elec4ric Notes: ' 34. Final Heating & Air Conditioning ' � 35. Final Gas Pi�pe-Test 36. Hood or Canopy � 37. Final Factory Fireplace ! � 3S. Final Plumbing � . '6 ' �, 39. Water Service-Final , � - ' � � 40. Gas Service-Final ' � ' ' 41. Solar pomestic-Final , � � 42. Backflow Preventer . � � � � � 43. Backflow Irrigation • '. • � , . 44. Landscape Irrigation Sysrem '. - . � , r. 45. Sound Attenuation ' • 46. Handicap Regulations . , � - . � • , � � 47. FINALSTRUCTURE&BUILDING • • � ' ' � 48rSpecial Requirements Completed �:�/•,.�� s , , • � - 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co � , 51. CERTIFICATE OF OCCUPANCY No. Date 3 AUDITING COpY, nO�RE/: V ` I� L_ GFO55 NAME GENERAL ORDER TO THE CONTRACTOR SFqRS, ROEBUCK AND r'7. �IFOIFFEFENT� , , . L� FE NO. ZIP COOE � PHONE STNI STNTE ZIP . � 5 �i'[vi �� .��-P�... � o L[1 ' �2v R To �c.: - a SALESPEFSONTOCHECK � pqEPAPPTION � PLUMBING �Q SHEETMETAL � WPLL-FLOOF-GEILING9 FE�UIFED NCTIVI➢ES NND . ❑�CLEAN UP. � NON-INSTALLED SPECIFY ON PROPOSNL � Q C/•RPENTPY � � ELECTRICAL 'O CONCPETE � DECORATING ` � COSiOMER AGfiEES '� SPEqFICATIONS � - ' - ' .....••�� ......•. ....�._...��. .......� ....... ......� •.•��•,. ••.�...� .....�� ......� ��.r •�. .......� ....... ...�• ....... `•` •...� ........ ........ .j � ........ .�...... ..... I........ ...��.. :::: :: ::�3��;� ��' : .: .:/.��Ii14j�'f%f:��'�: :.. ' �:.. ':'' �� .. �.. ' `' `:-....... �::�:-• . :..:_..: '......... '..... r :..:... 'J�H� : .. � ..... �., .... .. . . .. .. . -......... ....,. .... .�.. ......-t .... ..... : ' �: . . : .': : . . . : : : : �� • �� .� :b�:sf.l: : : :': : : : . : : ' : . . . '7-`' : : : : : . • , . ' ' *. . . : : ` � {":�. � �: ��'? �:��:''P` �:�:c� Ir . : ' : : . . . : r— . . . : . . . � . . . .. .... „� ... :. " .... .'.... .:..., .......�I..T .:...... ..:....' - ... : f .i- :4 •':::: ��;�;�� : .. ::::::: •:•; f:. �.::' . : : . ti '"'. '� �: :'.�: � j �� . . : j.� � : 'i : . x� to tt,1�J? : : . : : : . " : : : : : : : : : : . . . . . : : . . . :� : : : : • ' : : : : : : : : : : ; : �'.`�'�,: .� '�'�'S" : : : : : : �E S3�fi's.,:c:-: ' : . : : : : :..5 � Z�,i�CSf:I' M;,�t:�rt o�Y ( . . . : : : . .�. . . . ._ . . �.� �-�-. . . . . . . . . . . . �T II. : ),.L'�.Id% . J,�i�. • �dJ•.. .��.�,: ��::... ....:: .....:. .::..:: �:�.:::: .:::::: :::::::: ApprOz, complation tla[e � . , ::.., � unGerstend t�at this is only an INSTALLATION CLERK -.Enter below on File and Installer's Copies: Contractor's Charge � �� Work $pecifietl Above. • � - - � NOTE TO CONTRACTOR: SEND BILL FOR THIS WORK TO: SEARS, ROEBUCK AND CO. — (REErav) (Permi� No � . �co�o-.�mn - ' (natlmee , W ba contacte0 priar to Mis Eata ICliy� �S�eie� (Zip Cooe� � �Clty� �Steie� �Zio Caoe� 4774-111 5/85 . . • ! . s . . . • i ♦ 1 . � 1 1 . .. . . To Contractor: � . . " ti ' • � - - ' — � - j�heyusto�mer named on the reverse side„wishes you to proceed with the installation at the specified addiess, of. materials specified on the reverse side and/or;on attached sketch or specification sheeL By the acceptance of this order you agree to protect and.��demnify said cusiomer and Sears, Roetiuck and Co., from all,claims or.demands on account of injury to persons or property occu�ring during or as a result of said installation: You are responsible for payment of all contributions and taxes due under and for ail requirements of Federal and State Sociat Security and Income Tax laws with respeci to any payrotls incurred in performance of the work herein specified. These provisions do not in anyway amend or modif� any other agreement that you may have with Sears, Roebuck and Co, On completion of the job, you agree to obtain the customer's signature on the Letter of Satisfaction below, and execute the Waiver oi Lien, submitting both to Sears, Roeduck and Co., along with your invoice. . .... . .. . . . ... . .-� ._. ., ' WAIVER OF t1EN , � ' ' ' ' (TO BE SIGNED BY CONTRACTOR) - � � , • To Whom It May Concern: - • - - � � � , I, the undersigned Contractor, having been employed by the customer whose name appears on ' � the reverse side, do herebvi certifv that the work referred to on the reverse side has been comoleted " to the customer's satisfaction. In consideration of the receipt of one dollar and other good and valuable consideration, I hereby acknowledge receipt of PAYMENT IN FULL, and hereby waive and relinquish all liens and all rights and claims of liens which I, the undersigned, now have or may • hereafter have for labor or material furnished. I, the undersigned, certify that all the work performed and materials furnished,,if any, by any other party or parties upon the o�derof the undersigned, has been fuily paid for. Further,'I the unde'rsigned, agree to cause the prompt release of any mechanic's lien which�may be filed against the premises referred to on the reverse side by any subcontractor, �laborer, mechanic or material supplier claiming the right to file such a lien through work related to this contract. I further agree to hoid harmless and indemnify the customer whose name appears on the reverse side and/or Sears, Roebuck and Co., from and against aii costs and expenses arising • from or by reason of such lien or the release or discharge oLsuch liens. Signed and delivered this, . . , _, day of s�e�em�e o� 19 _ , CERTIFICATION OF COMPLETION , . : � . , � '. ' � (TO BE SIGNED BY CUSTOMER) ' . � �. . _ TO: SEARS, ROEBUCK AND CO. . . . . . . ' _ . . . _ . The installation of ordered by me has been completed satisfactorily. _. _.. NO710E TO CUS70MEfl: DO NOT SIGN THIS STATEMENT UNTIL THE INSTALLATION IS SATISFACTORILY COMPLETED. Date customer's ��: ■n 15. (.dL - � H f_..� '�• H 1 1 "r' ; . � F' ; iir,Pi. h10hi _. r;5 F ;.. H _ .;` F ` �'�• ^` r��or; i�_�'�...5 �F' j = _ •.� iC�i '=-��ii?, = – ai"'1',_ i�'��="r._�.1;lf�'_"_.' �..a.,Y.� Fiii;T::�;�= 1 jl.j, `i. r,r�.`i, " ic',._:'��- I J�_�r.r�� `#. ' - c,_ � ' =�. =' '. i' I i'� :l r� 1,5 5,5 � 31. 5 61, 5Co �,�5 � � �o,ao = I18o (�;z w.t. i't.sr _�� P5F C: 7o to 8v mP�. s��o.fl. t_��2� �.5 d,= 4.�� 5_ 0 4 � �13 5 -4,7� 0 2.2 IN3 . � S I'.� i �b, 71�9.•zSn�Z��.2=38�¢1 �o• . ��;� �•3�= 3�� , �_,�s,� o� �.�`� S =�OU 1, 5 G�5 5 �G�3 3 � �� .43 �7� r �=r� � uiiv , _ �� ELEC7�ICAL.LINE �LE€�R«��'�r RtQ1.I1RE�JIEIViS . F IN -ACCORCANCE WITH STAT � SF,TETY REGULATION5, IF ' � CONSTRUCiIflNREQUiR��WO��ERS,EQUIPMENT,CRANES �: , �: OR HOISTING DEVICES TO BE i� PROXIt,AITY OF OVERHEAD � 7IPE cn►oe 'E' A.9.T.1S. A-SJ, rzrc c 1'. ELECTRtC'kL• LINES, OR UNDERi:ftOUND ELECTRIC ox a, on �.r.t. sv�unian S� canoc a. niu• inux rir� sruwcza �s.�on r.�.i. "s FACILITIES; CALL SOl;THERN CALIFORNIA EDISON COMPANY x. �cc so�s �BI[1LD OR pUHC}tLD. 5 • ). -00IL TPL-SIND� �ILiET�AND, CUTLI SAND� F�`-y,��IATELY-!x�%'8��02� � �� AND CLtTLT GRAYLL OR AOCC. .. �• T�2IHF2.00D P.�,I. CONCRETL, APPROVED of Costa Mesa Building Depf. _' __i,__� . iHESE PiAN; MUST BE ON J08 AT AI.L TIAAES MAKE NO CHANGES WITHOUT PRIOR APPROVAB QE D�[. iTNE ISSUFNCE OR GRANTING OF A PERMIT OR,APPR04AC �f PtA�IS FND SFECIFICATIONS SHALL NOT BE �CBNSTRUED Fd0 BE p PERMIT FCR, OR AN APPROYAL Of. ANY VIOLA710N QF AN1f Of 7HE PR04'ISIC�S OF THIS CODE. NO P�RMIT. PRE� SilA11NG TO GIVE AUTHORItY TO VIOLATE OR CFNCEC THE 9:°OVISIONS OF THIS CODE SHALL BE VALIC, EXCEPT IK SO FARASTHEWORK OR USEWHICM ITAUTHORIZES IS LAWEUL' THE ISSUMlCE OF A P�RMIi BASED UPON PLRNS AND �� SAEI.YFlCATIONS SHALL N07 PREVENT THE BWLDIVG OFFICIAL' . Fl�td THERfAFTER REQUIRIfIC THE CORRECTIOP7 0` FRROiiS ` iN SAID PLANS AND $PECIFICAT10;i3 CR FRR�f PflfVENihVG � BUIIDIMG OPERA710NS dEING CARRIED GN THEREUNDFR WHFli � IN V�O1A710N Of THIS COUE OR OP ANY O7HFR OR�JI1d�b UE THE C�IY. j �/� c�j �S r. l/.fL .c . 7 S �� . 35 n= i z�3 ��s s �° _�� Z, d L,n� s P= l%77, S DE;i4N L/� - , 1�= 6 ' b_2,.��r,4r� =3.5 dT.a,� ,d� 53z ,�=r,�G dr>.�.�� $TRUCiURAL APPROVAL ONLY1� SEPARAtE PERMITS ARE P,E�UIRED Q FOR ELEGTRICAL, PIIMBING. HEA7ING, IJ:NT!Erl.Tlt�f RND ' RffRiGERAT18U �PJQRk: ! � .�. �.`� ; ��r� :•��$ ;=._,�aSS� , 7h9S idU�!8Ei'• �i:;S7 �:Ct;Od1fPA':Y t°.'�,: il'i::i!��'�l!ie �[il��G..�� iOF. E�Uii'Jlw.u: ,NR�::i "ERf.9i�!i �R:'TO 3E � FKr?lC'.'Et7.4Y: Si)R,":c�; Ti9ki if;' `'ir�SE OF � � GkL'F�RIVIK.r,I`dlSiit;Oi�!i;�':Sir'�iALSAfETY ; BE COR'$UL7E�7.�FOFl i�CDIT10NA� '.:i;EDUFflEGtEtJTS. � � ' _' ( �J 0 r� a ro � 1� ;t ao.ai.� � lJ.i ��- S�G Y�1FG DW6 '3 3�T1� 7' E �/ "c' L R.DJU_ST/YI E,�-/7 N II 5�2 � o.�. �Ez,�815 1 ��i= �✓.��^P p;:j) � � =�!I =_- < < � I �----c��f r��r � c,-. -� , II�c—F— ij c� v. r�. L` _.� Z'� + t (�= 4300o Ps�) I' I ' 4----- '�pno �> l Cv r/G .�iz( �,� � �� s. ALL 7TRULNFLlL SiEEL A.9.T.Ii. A-jG MINI- M1K fIEI11 SSRLNCTN J6,000 p,g,I, ' '" 6. FAB$1CA?ION. EAEC?ION AND PAjNiINC OF S7EUCNML S7EEL SHALL CONF0�7f 70 U.B,�; � STAJrDtR� NO. 27-2_67, 7• �'�=tIIING VILL BE PERFORY.ED BY CER7IFIED ' Y[[DEftS VICOC7. 7H£ SUPERV7SION OF A SPCCIAL jNIPL'CiOR Od'jN TH2: SHOP OF Ah APPeoCEh reORIGTOC. 8. A CCftTIj'ICA?C OF FAEAICATI071 FeOH T6E SNOP PEAFOaY,1HG 7tlE t'EIDING OP. A RE- PORT FRD1f TYl. SPECUL INSP£C70R Y05T Ef TUPJ�IStSD TO 1�;= Jo3 IFSPECT03 p91GA 70 FfUn]I:L �P7AOVpL. �?. rurr.iatcin o� pusrlc �.67E�IAL ]N SICS YILL'CO;S7LT RI7H TY:E U.5.C. �7d1:- DR?,D NO Sz_x_Se A1:D secTior, bzoz jr�. ]0. ]D�FTIFTII:G NUY5=p AI:D 4'EIG11T OF SIC:7 i'1L` B_ PUINLT PLICED. 0;: EX7Eellpg SVd!'ACE OF SIGh 9DDY AS CU7LIhCD I1: SECSI0:7 6202 )I). 11. ?pDV1D: 72YPo:.aP.Y' PEOf�T'RIAN PP.OiE[ TSOY AS OUTLIV:D 7:: C'NPTEfl 44. .lZ. AL' S7EEL j/16' TY.IC< AND U1�0.,d CUST L GL7AKIZD. SJ. V�=I£= ALL CO::OITIO\5 � ---,�n NG . ��c . (op ro---�� _� �� S � 6`r DEPTh� �� G' G " oR �2'-6'�5Q �4' 2 I�.S v1'L �oo �r- ��r peEssurzE Se�; ,�N 1—e N �A s�ro�l . . ---_----.— —•-- ---- ..__'�—_ . 1 �/ II � �.�j� Z..=1 �ie,� . . -7 . CU5T01.4 HOl.iES SERNARD C. ADAMS �� 8��«< ��(�L-P'.P.Pr�c�.,�- GE 10183 ` umz �rwcu v�aKw�v R '..1.. S9RFF, ..r,i...t. t�uo �Mn< pIy 676-029< �EARS Ar,-�TENN.A . �ax �.�.sy r rnw�am a k.w: ra +.� . . . �. �nm � r� u�a� w wat �n K nn�o wim �nwn �a m+tn r 0. G ADAMIi "�;;� <_' PL�lNS NDID WtTN00Y� .�':':. � ` � ' :.. tNK SIGNATURE � - _ �. : ; : . .�. . . ' ' � -. ' . r. .. _ M�O.S• F � ��y 3 ��: ..,...b. :.. .. . . „ ,+ . Pl' . �W ATER ROUGH PL PROP. SW M ROUGH HEPtING AN� RIR CONDITIONING UNDERGROUNO �J POWER U ROUGN WIRING TRENCHES F00.M5 STEEL REINF. FLOOR SVSTEM BONO-BEAM � STEEL REINFORCE (—J SHEATNING LATNING — IN �. f ( GlnSTEF.BROWN COnT HER' VENT.. REFRIG. AND A.C.. FINAL BUIL�ING, FINAL SUBCONTRACTOR Plum6ina r� 2 . aU H Z ZQ O c~i> am J � J � Q W (O J J Q U � Za w� aW J Q m Z J � ww 0 = Z � W � N � 70 F Z Q U J a a Q 0 H N Z O H U � � H N Z 39515 � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Campletely AD'DRESS c erv e �c OWNER ��'J / ADDRESS �' P Z /�C� CITV ( �/ICTd ///�✓%. /ID/ NOLSY//�� BRANCH f Ni1�J /e/ ADDRESS�QX �JCO]�J Q P/ { �. /' ARLHITECT TEL. OR ENGINEER NO ADORE55 CONTRACTOR /n��,�/J/�jfJ'� • AODRES$ TEL. GITY NO. STATE �j CIT V LIC. NO. f /�Jr LIC. NO. SI2E �(.�Q, �� \ NO.OF BLDCS. OF l0T �+CA! /J.Vr- � NOW ON l0T USE OF �T�U E+ �i � EXI5TING BIOG. COVeQi '� SIZEOF �(` NO.OF NEW BLDG. o� 7 FOOMS STORIE: EMERIOR WALL POOF COVERING COVERING USEOF BVILDING AND WORK TO BE PEflFOFMED PPI� y ��;',�` �D.F! 17-75�,,;� 00 535�• � 1 Z. AP LIC TION FOR BUILDING PERMIT F E E OATE ECEIVE D TE ISSUED / � /F/ � � I � � j//� �r^_ �( P qM1T NO. A.P. N0.�7%Q •J (J�L 7 BUIIDWG IYIAC �G/(J P� ADDRESS U . 9„'jE,�' TRACT�J'(Q LOT(� BLOCK � W A OWNE �/��/ F � ��' � —�VAWE Q�6'a� � ' $ FIRE I I / ' i/ T 20�� NO.OF USE OF NEN PLAN$ BUILDINGGE VARDSAPPROVED YAPDSA MAIN BUILDING ACCESSOR (FROM C�T T � ROM — �% /� /i S � �] /� L. SIDE / F. -.L � /� REAR � FT DISTANCE BET. BET. MAIN & MAIN BLDCS. ACC6S5. BLD VAR.# DATE C.V.P.� n APPROVED APPROVED G 1 l 41 � I i I hereby acknowletlea that I have reatl this application entl rtata Nat che above informa�ion 7s correct and apree to comply with all laws repulating building consYruction, entl I shall not amploy any person In violatlon of tha workman's compensatlon laws ot tha Stete of Californie. a G S I herBby ca�tily that 1 em p�oparlV Iicansetl as e cont�ectar untler the State of Californie Business a�tl Profeszions Code, Divisicn 3, THE M�l Chapter 9, antl that such licanses ere In tull torce end etfect, or I THE PURPO am exempi irom tha provisions of the State of California Business VALUATION antl Professions Cotla, Divislon 3, Chapter 9. SIB^ature of / _ �y(, Permlttae $ v(J (f Authorizetl Apen � v a�po T. d SHOWfJ UN�ER VAlUAT10N IS FOR ' IF ESTABLISHING A PERMR FEE ONLV: Q � � N PERMIT FEE $ ] m PL4N CHECK $ E � � `O LL TOTAL FEE $ :J 2 25432 � COSTA MESA BUILDING-SAFEiY DEPARTMENT � � P.O. BOX 1200 � GOSTA ME$A. GALIFORNIA 92EY6 For Applicant fo Flll In Complero/y TYPE OR PR�NT ADDRE'SS 92$ 1�ackenzie Place COSTA ME3A, CqLIFORNIA 1355 Front Street ■ SfA7H C�TY Of C{�ST�1 M� MpR 23 1966 I'PPlIGA�1�R�E�J � BUILDIN<i For Office Use Only nacs�rr rvo. �.�n� L� 11[C�IV[ �Y -M R[C V[D WT[1881I8D � .-,�r y�� MHH a z isss BUILDINO ADORE88 /� (� ZON! TYPH �j GROUP-�/-� `L APPROV[D !Y DATB ZONINCi - i0 HO.O� UitOIN[W rueu o2 euuoma � uoiu. / D[�CRIMI�OM � / A. P. NO. �— fiOTl: NO UV6 OV iRHANO SHALL OE LE88 THAN YARDDAPPROVHD YARDBAPPROVED USE OP MAIN BUILDIN6 ACCES60RY BUILDIN6 EXISfINO BLDO. �(RROM G/L R6[T iETlACK LIX6II10N FRONT . R�. cenien OP tnt[[T � RBAR YA D � SIOH YARD I L[F1' � RIQHT t R. YIDL � FT. FT. DESCRIPTION O� WORK �.IIi � R*. F*• ' !, I XBRRBY ACKNOWL[D06 TNAT 1 NI�V4 RGD TXIB APPL�CATION AND BTAT6 TXAT TN8 AlOV6 1� COqR6CT�AND AO 6 TO COM• PLY WITN ALL CITY OHDINANCU AND {TAT{ IAWY R YIJITINO euaoinaconsrnurnon._ . /, AGlNT � VAR. �F esr. i ACGH DATB a w � % a ec. Rr. !o � �X a THH AMOUNT BNOWN UNOBR VALUATON 19 POR TH6 j rYRP096 OP YTI�BLIlHINO A PBRMIT P66 ONLY. A VALUATION Q � - � . PERMIT FEE p �� (7^ � s `" TOTAL FEE $ � / ` . � 3b52� � COSTA MESA BUILDING-SAFETY DEPARTME P.O. BOX 1200 COSTA MESA, CALIFORNIA 9262� :� For Applicant to Fill in Completety BUIIDING / G ADDRESS ( (� 1 OWNER MAIL /� Z ADDRESS �'� W W TEL. a U CITV � �/e , a NO. ZZ ' Q OONST CT10N O� IENOER D�'G am J � BRANCH J N m J ADDRESS J m ARCHITECT TEL. a OR ENGINEEfl N U N Q W ¢ ADDRE55 d W J O CONTRACTOR % � � m Z J � ADDRESS D � / w w �= E L. � CITV � (� . C .e O. w 0 STATE pTV N¢ LIC. NO. LIC. NO. 7 � /'�( ' � NO. OF BLDGS. OF LOT '} // /� J A T I NOW ON LOT c z_ rato � :�:. k;: � ' R 7 7'�... ��,1355'� 2�. 0 I ATION FOR BUILDING PERMIT BV D_!f'TE RECEIVED D TE ISSUI , .r � � r ��i4�7 — �1� PEflMJ3{`70 BUI�DING � ADDPESS , TRACl7� OWNER i ff FIRE ZONE APPROV ZON J NO.OF_ PLANS VARDS APPqOVED F" SIZE OF NO. OF Z NEW B�DG. ROOMS STORIES L. SIDE U EXTERIOR WALL ROOF //7� COVERING COVERING REAR [/ J USE OF BU4LDING�ND WORK O BE PE FOR ED DISTANCE BET a ) . C�. MAINBLDGS. a Q / / // G VAR. iW O � /Y C9 C.V.P.qW F /�J� ( APPROVED y iV .� Z O VI hereby acknowletlge tha[ I have reatl this application entl state � that th¢ above informntion is correct antl agree to comp�y wit� � alt lews regulating builtlinp construetion, entl 1 zhall no[ employ r uny pa�son in violation ot the workmen's compensa[ion lews of y tha S[ate of Califomia. zI hereby certify that I am properly licensetl es a convactor untler S the State ot Calitornia Businass antl Protessions Cotle, Divisicn 3, THE AMOI Chuptar 9, antl ihat such Iicenze5 ere in full fotce antl effect, or 1 THE PURPC am exempt from ilia provisions of the Stare of Californla Business VAIUATION antl Professions Cncie, DlviSion 3, Chapter 9. Slpneiure of � �/ !/7�� Permittee / $/� Authorizatl Agent �J v �A �/ f VALUE ��V g DATE N"� % 7 VSE OF NEW �7�C�[ BUILDING �� VARDSAPPROVE� ACCESSORV BUILDI BET. MAIN & AOCESS, BLDi DATE APPROVED I�� m � FT. o �SHOWN UNDER VALVATION IS FOR � OF ESTABLISHING A PERMIT FEE,O�,..N�L)Y: Q �i m w PEPMIT FEE $ j � ,�J m PLAN CHECK $ E � `o LL TOTAI FEE 5