HomeMy WebLinkAbout936 MACKENZIE PL - Building Permits. ,
n CITY OF COSTA MESA . , t,,,.
' ° BI/ILDING DIVISION ��'�
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DEVELOPMENT SERVICES DEPARTMENT
�� PERMIT PERMIT NUMBER
B98-01631 ✓
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 936 MACKENZIE PL
Suite:
Vicinity:
ParcelNunmber: 41805225
Applicant: LE, VINNY
Address:
j; :
Owner: HOANG,.VU'" � �
Address 936 MACKENZIE PL
�
/ ; \ ;
„� �
�� COSTA MESA,CA i � -
� "
Contractor:.' WEST ROOF,ING-CO
Address: 09812SUTHERLAND WAY
BUILDING PERMIT
Zoning: R1 R1
Ptione: � 774-541-5351
Zip:
. Phone: — . ,
- . " Zip: 92626 � .
Status: ISSUED
Applied: 09/14/1998
Issued: 09l14/1998
, .
, , . " � j � `.� .
' , � � Phone: � � , �
. � GARDEN�GROVE CA Zip��� 92844 ' � .
, � � License ; , 694940 , , .
Arch/Eng: : ��- � �-• � � �
Address:' � ' � , ; � �- . -
� . ' : �� , . 'Phone: _ _ - . . ,
' � / . � . . Zip: � . - . . �
� ' , � - License: . � � " ' � ,
' SCOPE OF PERMIT
� T/O EXIST SHAKE AND INST CLAY MAX TILE S.B�LB.ICB0�3523 ON SFR. - �
� FEE SUMMARY �, � � ,
Plan Check: $0.00 , . , _- -, --• .. � , - - Calc Valuation: ' Ss,000.00
Permit $149.75 _,_ - — r/'�' Claim Valuation: Es,000.00
SMIP Res: $0.90 � ,
SMIP Com: $0.00 - �
�.
Other: $0 00 = __. �
Inspection:
Total:
`$0.00
$150.65
SETBACKS
MAINSTRUCTURE Front 0-0. �
ACCESSORY Front 0-0
PARKING Existin : 0
NOTES:
�
Rear 0- 0
Rear 0- 0
Required: 0
PLANNING & ZONING
' � � Lek �0- 0
Left . 0- 0
Proposed: 0
�
Right 0-0� - � -�
Right 0- 0
EXPIRA710N: This permit shall automatically expire end become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In ordar for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell
required Inspeetione and finel approvel must be obtained. Failure to obtain inspactions antl final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545828
WORKEqS' COMPENSATON DECLARATION: .
I hereby ettirm under penalry of perjury one ot ihe following daclaretions:
❑ I have entl WIII meintein a cenificete of consent to self-Insure for workers' compensetlon, es provided tor by sedian 3700 0l lhe Lebor Cade, for ihe paAormence of Ihe
for whiGh this permit is issued.
I have entl vnll meimain workers' canpensetion insurance, es requireC by section 3700 of the Lebor Cada, for Ihe pertartnance of ihe work kr which ihis permit is issued.
M workers' com e`nsatlon urence certier and II number ere: �/j�{ -7r^� r ( /
Carrier:Y P J ��• � � Policy Number. `�V� � /" ' /// ! �% 7
/7his sectlon nsed nof be comD/efed il the oermit /5 veluetl ef one hundreE tlollars /31lxll or /w« 1 i�-
❑ I ceniry ihet �n the peAormence ot the work for which this pertnit is iuuetl, I shell not employ any person in any manner so es ta bewme sub�ect to the workers'
compensation laws of lifomia, entl egree thet if I s�ould become subject ro the workers' campensetlon Orovisions of Section 3700 of the Labor Cotle, I shell forthwith
com with these p visions. !�G�
icent Slgn 6: � Date: � ��— ( 6
WARNINQ: FAILU O SECU WORKERS' C01dPEN IIXJ COV E IS UNLAWFUL AND SHAl1 SUBJECf PN EMPLOVER TO CflIMINAL PENALTIES ANO GVIL FlNES UP TOONE HUNDRED
R&(E100,000),INADDITIIXJTOTHE PENSnTIIXJ,DAMAGESASPROVIDEDFOfiINSECfION3%OBOFTHELABORCODE,IMERE5i,ANDATTORNEVSFEES.
IICENSED CONTRACTaRS DECLARATION:
I hereby ettirm thet I em licensed Pun"dar provlslons of Chapter 9(commencing with Section 7000) ot Divislon 3 oi the Business antl Professions Code, entl my license is in full
torce F. N�a6 Class N
ontrectar's SI neiur � -
� � � �„� D Date:
CONSTRUC710N LENDING AGENCY: !�
❑ I hereby eXirm that there is a wnsiruction lentling egency for the pertormance oi the work for which this pertnit is issued. (Sec. 3097, Glvil Code).
Lentlefs Neme: ._ Lentlefs Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby eHirtn Ihet untler penalry of perjury t�et I am EXEMPT FROM 7HE COMRACTORS LICENSE LAW lor Ihe following raason (Sec. 7031.5, Buslness end Professlons
Cotle: Any ciry oi c0unty which requires e permit to construct, alter, Improve, tlemolish, or repalr eny stmcture, prior to its issuance, elso requires the epplicent for such parmit
to ille e signetl stetament ihet he or she Is Ilcensed pursuem ro the proNsions of the Contrectore LJcense Lew (Chepter 9(commencing with Sectlon 7000) of Divislon 3 oi Ihe
Business and ProlBssions Code) or Ihat ha or she is exempt therefrom antl the basis for the elleged exemptlon. Any violetion of Section 7031.5 by eny applicent tor a parmit
subJects the eppllce�i to e civll penalry ot not more Ihan tive hundretl tlollars ($500).):
❑ I, es owner of Ihe Droperry, or my employees with wages as t�eir sole compensailon, WILL DO TME WORK, antl ihe structure Is not Intentletl or oMereC For sale (Sec.
7044, Bu5ine5s end ProFessions Cotle: The Contractors License Lew tloes not epply to en owner of prOperty wha builds or improves thereon, antl who does such work
himsell or �erself or Ihrough his ar her own employees, pravitled ihat such improvements are not Intended or oftered for sale. Ii, however, the building or improvement is
soltl within ona year of completion, ihe owner-builtler wlll have the burtlen of proving thet he or sha ditl not bulld or improve for purpose ol sflle.j.
❑ I, as owner a1 the D�aPertY• em EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS �o conslruct the D�alect (Sec. 7044, Busineu end Professions
Code: The contractors License Law does not apply to en owner oi properry who builtls or Improves t�ereon, and who contrects tor such pmject with a conirector(s)
Iicense pursuant to the Contractors License Lews.).
❑ I em exampt under sec. Business antl Professions Cotle for Ihis reason:
Signeture: Date:
Owner ID venfietl by tlnvers license. ❑ Yes ❑ No Dnvafs License No.
Verificetlon ol Ownorshlp by (rype of tlxument, I.e. - property taz blll or deed):
Expires:
DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATION:
❑ I hereby ceNty thet no excavetion tive (5) or more feet In depth Into which e person Is requlred to tlescenA, will be metle In connectlon wlth work euthorized by this
pertnit, entl thet no bullding strucWre, scaHoltling, telsework, or demolition or dismentling thereof, will be more than thirry-siz (36) feet hig�. (Chep. 3.2, Grp 2, Art 2, Sec.
341, lltle e, Cellfomia Administrative Code).
❑ As owner-bulltler, I will not employ anyone to do work which would requlre a pertnit irom iha Division of Industrial Setery, es noted ebove, unless such person hes e
pertnit to tlo suc� work trom ihe division.
Signature: Date:
DiWsion of Intlustrial Selery Partnit Number:
CEHTIFlCATE OF COMPLIANCE AND AIJiT10RIZATON OF ENTAY: I certify under penelry ot Oerjury thei I heve read this application end 51ete that ihe infortnatian given is
correct. 1 egree to comply with all sWte laws and ciy ordinances relating to building consiruction, and euthorize representatives of Ihe Ciry of Coste Mesa to enter upon the
above-described prOperty for inspectlon purposes. I agree not to occupy or allow occupency of any building euthonzed by Ihis pertnit until final inspedion.
OI Legel
LQQE1, INSVECTIONTIYE
1616 Fixed Syst�m Final Fire Prevention
1286 Pool Spa F��al
200 Final Re-ROo�
20t Final Bbckl�etaining Wall
202 Finel Facto�Y Fire Plece
203 Finel Sign
204 Final Demalitlon
2448<B
�7.\i rini7.1R
I I %%
�- PA1�f- r�_
Date
yQpE,( INSPEC110NTYPE �¢ �$
206 Flnel Mechanical
20B
210
272
220
Finel Plumbinp
Final Electdcal
Finel Fi�e Prevendan
Flnal Plenning Approval
222 Final Sita
250 Finel Bullding/Occupancy
Appliwnt to fill In all spaces exeept t�osa withln �eavy borOer Iines antl sign all ap0�aoriate Ceclarations.
CITY OF COSTA MESA � + � ' , PER IT NO. ,TRACT NO. LOT NO, .BL . . �
CONSTRUCTION PERMIT � . ' �- S3 7 - � � ' � ' .
; Applicant's Mailing Address � - . ' "'� TYPE OF CONSTRUCTION ' NEW - ' ADD ALTERA710N REPAIR � . •
C � .��O�Z/ :� " . //�CT , ❑ CONVERSION ❑ DEMOLISH' ❑'OTHER
ProjettAddress - �- � -
OWn¢r 5 Neme ' �[, ,p hOne � . DESCRIPTION OF WORK� .
Addfeu '/ � F � � TVPEOF.PERMIT , GRADING FOUNDATION � STRUCTVRAL' � „ �A.P.qM -
A�Ch/En9. LiC¢n52 No. i❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL- ' � - '
' . PLNG.REF.qW
� Addrea � � � �rO7HER � � •' . � ' - ' ' � TO BULL�ING �
, CqntreCto�'s Nem ' hone 1 PROJECT DESCRIPTION SQ. FT. � � OCCUPANCV � P 7ERTV INE
- ' • CONSTRUCTIONTVPE ' VALUATION$ - LEFTSIDEYARD
, Addre53 (meifing) � Z�N$ � GRADING CU. VDS. ACRES ' PKG. SPACE REQt
� Licenie No: ' . '
� UCENSEO CONTRACTOR DECLARATION ' � Remarks: �: QVT �j . ��� Q � Na� STREET WIDTH �
I;hereby afflrm that bam Ilcensetl untler provisions o( Charter 9(commancing ,
wlth 5ection 7000) oT Dlvision 3 0! tha Business antl Profeisions Cotle, anC � �. __ , � � � . SF
my Ilcense Is in fulLforce antl'etiect. � ,
' Cicense Class License No. � PLUMBING � - �
. Date � - � ' Signature • � � � �
wORKERS' COMPENSATION DECLARATION � • - BecSiak ' ����P . � '
•reby afflrm that I nave a certificate of conunt to self-Insure or a ceitiflwte � gy�kflow Preventer _. - '. Sewer ConnEction � '_ . '
Norkers' Compensatlon Insurante,�or a certifletl'copy t�ereof (Saction �
_.,00, LaG. CJ � ; : i . , . , Backflow Irrigation ' - Solar Collectors � � ' ','� '
. POIi<Y No. � � � � CompdOY � . • � � ... - _ - ' .
; eCertifleC copy is hereDy furnlstieC, - � j , ' � � BaThtubs � � � � Sol3r Piping � �
Cert(fietl copy is filetl with the city Builtling Division. �
I � ' Clarifiers
% Date ' Applicant � ; � ' ' SOlar T2nk (
��EXEMPTION�FROMWORKERS'COMPENSATIONDECLARATION � , DiShweshef j . SwlmmingPOOIW/Spe � '
'(Thissectlon neetl nat De complaterl if the permit is tor.one huntlretl (E300)prJ � —
. les5).� ' � ' • i t ' : , ; � .
- I certtty �that In the performznce of tne work for whic thiz perm�i is Issuea I D�inking FOuntains U�inal � .
� shall noY employ any person in any er ss as becdme subject. to t�e f � - �
7 Worker ompe sa ws ot Ca or a. < � � .�loor Dreins' : Water Closet � �
Date � /�Signatur ' - . .
� NOTICE: If, after making this tleclar on, you shoultl.bacome subjec[ So.tne Flao� Sinks � _ _ Water HeateS �
� Workers'. CompensaHom provislon f[he Labor Cotla,-you must for[hwith ''
comply with such proWzlons 'this.permit shall be tleematl� revoketl: � Gas$ervice OuHets Wate�,Service � ,
CONSTRUCTION�LENDING GENCV - '
I hereDy afflrm ihat there iz.a'construction lentling agency for Ihe performance . Intercept0�5 . .
ot the wbrk for wnich„this permil I5 Issuetl (Section 3097 Civ. CJ �� -
Lenaers Name � - � Kitchen.Sink
LBntler'S AaCre55, ' ' -�' - •
OWNER BUILDER DECLARATION - • � ��etOfiCS '
. � .
- ' . � �' . . : . . , , .
I hereGy allirm that I am axempt irom the,Contractor's License Law !or the • p_Tran� '• �' �'
t�e
'rom antl tha Da5i5 for [ha alleqetl examptlon. Any, Nolatlon of,5ectlon �
5 by, any appllcant for a permit sub�ects t�e�appliwnt to, a clvil
fy ot not more than five huntlre0 tlollars (g500). •�
'as �owner of the O�operty or my employeas with wages as their sola
ansaHon will tl0 tha work, antl tha Stru<tur0 it nOt Intentled or off¢reC
�le: (Saction 7044, BuSiness antl Professional Cotle: Tha Contractor'S
se Law Coes nol apply to an owner of a property who bulitls or Improves �
fn„antl wlto'Coei.Such work himself/�erself or lhrou9b his or har own
Iyees, plovltl¢tl thdt SUCh IrtlP�ovBm¢nt5 ar8 not Int¢Otletl Of Offeletl fOf
}, �owever, tho builtlln9 or improvement Is soltl within one year ot com-
n, the owner�wlll have the buraen of Oroving �o/she tlitl no[ bulltl or im- �
.for the purpose of sale)'. ' + , '
as owner of the property, am ezclusively contracting.with Ilcensetl con-
�!5 t0 COnstfuct the ploject ($Ccfl_on 7044, Bu51ne55 antl PlofeSSioOS Cotle:
nntractnr's License �aw daez noc aoolv To zn owrier of orobertv who "
U I am exempt untler,SeCi�on�-
lJ w
Date � nwnr..
I h¢rebvi certltv�lhab I�hare reat
upon
rev,
in-antl
citY a
antl h�
Roof Dreins � � �
Showers � �y � ' �
Service Sink . � '. �
i: , ,. � �
Boiler � � n �
Duct-UnderGround �
Duct-Strucmral , � �
t
. Reinspection Fee $15
Isue Fee ' $ 3
iANICAL , '
Refrigeration System �
1
00-100,OOOBTU ❑100,OOOBTU �
. �
System Repair/Alteretion ,
:ts w�th a con- : Exhaust System LJ MWtiple LJ .
for this reason � FirepVFact. BIL ICBO'� 1
Heating�.System & Ducting { �
hat the above - 00.100,OOO�BTU �100,OOOBT� � _
nty ortlinances � � • �
�thorize repre- Hood o� T e I ❑'
-prooerty tor �P .
_,.., � i �/ 7. Cenop T� e II ❑•
♦o 0
i J Registers , ,
Pink - Accounting; GOIGenrotl - Aisessor � � - � —
'
Reinspection Fee 515
laue Fee $ 3
Automatic
�9i;4 �/ i G/ :.�
I
�t
lUhATIONS - �
. REAR VARD (TO P/U .. •
RIGHTSIDEYARD ' � �
� ' � PROVIDED , .
, PARK FEE $ � � �
�
' - ELECTRICAL . '
Meter ❑over 100 amps �
iwasher �
^rs ��Gas � �Electric -
ures
ice Bozes ' .
Sub Pole � � • ! ;
Motors DO-1 HP ❑1h$ � i
inc.Solar 09-15HP �i6-15+ � � •
Microwave ' �
Pole Light � '
Range
ing Sections
Compactor
Generator 00-5 KW 0545 KW , ,
Transformer 015�50KW �
❑5U i KW �, peinspection Fee ' S15 �
Meter ❑up to 100 amps Issue Fea' .'$ 3
2oning APProved By ' � ate � ��� � � (� �
Applintion Approved By ' ete Jkl . "
r �
Application Iaued By � � Date
, � � � SUMMARV OF FEES � ' �
BUILDING PERMIT $� � SMIP ! � S . ,
PLAN CHECK � $, ' : PERMIT ' ,
,PLUMBING � � $ ' � ISSUANCE � ; $
,PLAN CHECK � $' . � GRADING : � $ � µ ,
�ELECTRICAI . $ 3'-Z�• . � ' � ' $ �
PLAN CHECK� �� $ ' . MICROFILM ,; $ �
MECHANICAL $ � TOTAL FEE $
.PLAN CHECKi ; $ � � � �ESS • .
• : ADVANCED PC � $
, ; � , � . . 3,,�0
' � � � FINAL FEE $ :
0
a
'• �CONSTRUCTION AND PLAN,[VING � � -- ' - � ��� �A �
- APPROVALS . Permit#� "Date Inspector qppROVALS Permit# Date Inspettor
•1. Temporary Electrical Service or Pole " 52. Pooi & Equipment Lowtion
2'. ,Soil Pipe-Undrgrnd. � - 53. Steel Reinforcement . ,
3�. Electrical Conduit Utilitv-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. � � ' 55. Electrical Bonding �
5. Steel�Reinforcement . . 56. Rough Plumbing & Pressure Test . .
6. Electrical UFER Grnd. . . 57. APPROVALTOCOVER-GUNITE
7. Footings 58. Electrical ('qnduit-Undror�.1.
6. Foundation . 59. Gas Pipe, O Undrgrnd., Test
9. -Wa'ter Pipe�Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK •
11. Property Sewer Line & House Connectio� 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-Coriduit - - � 66. Solar System-Final -
d 6. Rough. Electric Wiring . �� g�4 d3 � . Fencing & Acceis ADProval � " .
17. Rough.Wiring Sign. . . , 6$, qPPROVED FOR PLASTERING
78.'Rough Elecirical-T 8ar Ceiling 69. POOUSPA SYSTEMS PINAL
79.-Rough Heating & Air Conditioning -. FIRE DEPT. REQUIREMENT
20.•Rough'Facto�yFireplace � , APPROVALS . Pa�mit#
21. Ducts; in Structure� , � 70. Underground Hydro
22. Ducts,.Ventila,ting- � � �71. ProductPipingOGas ❑Oil
23. Gas Pipe-Rough & Test , , ' 72. Underground Flush
24. Roof Framing � � 73. Undergrnd. Storage Tank �O Gas ❑ Oii
25. Roof Sheathin9 '� _ 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 Notes: � �
31: � Plaster Brown Coat .
32. Electrical Power Mete�-Final
33. Final Electric ' g'/G " (,�/p
34. Final Heating & AirConditioning . � � -�
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 pomesticFinal � _ _ , . ' �
42. Backflow Preventer ' � ., . � _
43. Backflow Irrigation � .
44. Landscape Irrigation System
45. Souni7 Attenuation � � �
46. Handicap Regulations ' � ,
47. FINAL STRUCTURE & BUILDING � �
48. Special Requirements Completed � '�
49. Electric'Release to Edison -�- ' "
50. Gas Release to�Southern California Gas Co "
51. CERTIFICATE OF OCCUPANCY . •
No � Date "
C1_ Y OF COSTA MES�_
CAUFORNIA Y2628 P.O. BOX 1200
FAOM TNE OFFICE OF TME DEVELOOMENT SERVICES DEVAqTMENT/
BUILDING SAFETY DIVISION
f
- . CERTIFIED MAIL
COMPLIANCE OR OCCUPANCV INSPECTION REPOHT .
.... — ---�.
Subjen A ress _ 936 Mac Kmzie Place Date Rec'd. 712�/83
Mail Repo r Correetion Notice to:
Appli�ant �1� � ' � felephone (114�� 751-7198 �
Address 925 24acFCenzie Place Zip Code 9z626
Date 7/22/63
Compliance Inspection No. 78649 CMB No. 505
Site Location 936 Mac KenZie P1aCe
At your request, inspection was made at the above-referenced address on Jilly 21, 1983
and the Code violations shown on the reverse side were observed.
You will be required to correct the violations listed within fifteen (15) days after receipt of this letter. Failure
to comply within the allotted time will result in a complaint investigation being initiated for compliance of the
Codes.
If you need assistance, please contact the appropriate Inspectors listed below:
Struaura� �allace Gloud �754. 5293 �
Electrical (754- )
Plumbing/Mechanical (75q� �
Very truly yours,
1/v� ��
Name
Title
cc: Inspectors
Property Owner
77 FAIR DRIVE (714) 754�5273
CMF ]035-66 While•Bltlq.; Canary-Clerical
NOTE: SEE REVERSE SIDE
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Cc/.� ��-�
� 26���
, COSTA MESA BUILDING-SAFETY DEPARTMENr
P.O. BOX 1P00 - COSTA MESA, CALIFORNIA Y1l16
For Appl7canf fo Fill In Completoly
TYPE OR PRINT
nooaesc° 936 A�ackenzieFlace
COSTA ME3A, CALIFORNIA
S_ Hanrvr.k no�"
FEB 17-67PAio00 720� **** L
�„SA 9 ..50
APPLICATION FOR PERMR
BUILDINfi
FOr Offlca Uf0 Only
11[C[II� NO. PlPMIT NO.
jt�i���
�r unaec rv� wn eueo" y
� �-/�-% -/�./7
ZONIN(i
AD�RE68 � d P�3C Costa Mesa
i0 NO.OP UY[O!N[W �
� ILAI1) lUILOIMO
GONTRAGTOR Lewis R, Schmid /]
uoAL . � / � �
wo R6II! 294�-A Raixlolph Ave. cucn�mon �
cirr C� ta Mesa Calif • A. �'• NO.
H0T6: NO[AV[OVLRHANOBMALL98L888THAN
ucTno. 231i399 THL 54ao96o ao• ro e�o� e nun a. �.
oFior 60 x 9 . x 111.(f "no''w°�HLDO1' 0 �ioweo (U.B.C.REGVIRBMENTI
YARDDMPROVHD YARDSAPPROVfiD
I1SE OP MAIN BUILDINO AGGEYSORY BUILDINO
E%ISTI N6 BLDO. ; pROM C/L 9TR6[T )
iETpACK LIX[ �ROY
ceniew or s�rw�ii SO� RBAR YARD 1• 1 � ��HT FT. PT.
8106 YARD I LRRT 6� RIOXT 1� R. il�[ Ft. FT.
DESCRIPiION OF WORK . oin �7 rr. rr.
X T[RATI N ADDITI N RGR I' �PT. Fr.
DIYTAHC[ BR. BHT. MAIN Q
REPAIR IN gM � MAIN BLC • ACCESD.BLD68.
BUILDING ,1� NO OP L V�•� OAT6
SIZE 1µ18 9f ROOMB v pl �- C.U.P. APPROVED
EXTERIORWALL WOOd- ROOr Shake-Shingle APPROV[D �_/ _
COVERINO COVlRINO 01 DATQ
U8H OF �UILDIMY AND WORK TO B6 PQRPORM[D a
in le Famil Ihvellin �Yith Attached ^+
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1 HERBBY ACRNOWLE006 TXAT 1 XAV6 RHAD TXI/ APPL�GTION T116 1�MOUHT 6N0 NDHq VALUATON 1! IOR TN6 j
AND BTATB TXAT TH8 IIGOVQ 1� CORR6R�AND 110R88 TO COM. �UPPoG6 OI t9TI� LI8NIN0 A PCPM�T P4 ONLY. 3
PLY WITN ALL CITY OROIIIANCO AND RI1T{ IAWt HiOYIATINO y/LLUATION �� q5 �
au1LOINo CONeTRYRIOx. PERMIT FE8 S (//✓ -�
8IGNATURE OP -/ E
PERMITTH /��� yf /� , w
� �
AUTH011IZiD AO[NT � O
TOTALFEE �S
38367
COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to F��� in Completely
BUILDING 7
ADDRE55 / i
�
OWNE�� D�I���C�
MAIL
ADDF
CITV
BRANCH
ADDRESS
ARCHITECT
OR ENGINEER
ADDRESS
CONTRACTOR
ADDRESS / //
STATE ��
LIC. NO.
SIZE
OF LOT
VSE OF �
EXI5TING BLDG.
SIZE OF
NEW BLOG. I� X L
EXTERIOR WALI
COVERING
USE OF�IJILOIfgG
R
NO. OF
TEL.
NO.
,E� 6Z�
NO.
CITV
LIC. NO.�Z
�
INO. OF BLDGS.
NOW ON LOT
A.P. NO. �'/Y
BUIIDING �
ADDRESS
TRACT
OWNER
FIRE
ZONE
APPROVED
Pnl�
�,;iY-P,-7���u�.�� 3�g�� ft:�::�:�.5�
TION FOR BUILDING PERMIT
_ D
NO. OF
PLANS '
VAROS APPROVED
�O FT
VAR. �W
i
USE OF N W
BUILDIN
YAROS APPR
ACCESSORV 8
BET. MAIN &
ACCF�. BLD
DATE
APPROVED
I haraby acknowletlBe that I hava r¢otl thif applica2ion antl steta
that Me ebovo Informetion is colract antl aBrea to comply wit�
ell laws reg�loUnB buildinB �onattucUon, and I sha�l not employ
any person in vlolation ot the workman'a compensation lawf of
Me State of Cellfornia. ���-/
I hereby cartily thet 1 em properlV Iiconsetl es e eonnector untler S�. FT. Q
ihe Steto of Calitornie Business e�tl Profaulona Code, Divialcn 3, THE AMOVNT SNOWN UNDER V
Chapter 9, anE tAet such licenses ara in full force end atfact, or I THE PURPOSE OF ESTABLISHING A
am exempt (rom [�B provlsiOnsot t�e $te[e of Celltomia Business VALUATION
antl Profassions Cotle, Division 3, Ghepmr 9 �
PERMR FEE
Signeture of /
Permittee $ //�� PLAN CMECK
t!/
Authorizetl Apant TOTAL FEE
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