HomeMy WebLinkAbout2689 SANTA ANA AVE - Building Permits \ ♦ . F 1
CITY OF COSTA MESA
4 BUILDING DIVISION
°tna �, PERMIT NUMBER
f I „_------: DEVELOPMENT SERVICES DEPARTMENT •
PERMIT
.15111 B06-00086
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.JLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2689 SANTA ANA AV Status: ISSUED
Suite: Applied: 01/19/2006
Vicinity: Issued: 01/19/2006
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 43920215 Zoning:
Applicant: GORINA, JOSE V/
Address: 10395 SLUSHER DR •
Phone: 800-807-9889 ISSUED BY:
SANTA FE SPRINGS,CA Zip: 90670
Owner: BEDELL, DAVID
Address 2689 SANTA ANA AVE '
' - - Phone: �1
COSTA MESA,CA Zip: 92627-4638 F.
Contractor SEARS HOME IMPROVEMENT PRODUCTS INC DATE It,
Address:' 10395 SLUSHER DR
Phone: 800-807-9889
SANTA FE SPRINGS,CA
Zip: 90670- License: 721379
Arch : Eng:
Address: . •
Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CHANGE-OUT OF 4 WINDOWS(SAME SIZE)IN AN EXISTING SINGLE-STORY SFD.
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3200.00
Permit: $97.25 Claim Valuation: - $3,200.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Totati $97.75
. PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 _ -Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: -0 , •
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
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 this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
24413.48(WOO)
DECLARATIONS 6 ° 0
- G 6 e
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penally of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
Qd
�have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Idled.
My workers'compensation Insurance carrier and policy number are:
Carrier - 400 Policy L LR.C."?-( ( <'7OGZ7
(T17s section need not be completed ll the permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall forthwith
comply with these provisions.
Apt>Ikx!:Sipneture: 01,--L.-- Darer I I Id, /O s
WARNING:FAILURE TO SE R WORKERS PENSATION COVERAGE IS UNLAWFUL AND SHASUBJECT AN EMPLO
LL YER70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOUARE(5100 ).IN ADDRI 0 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic..a 13701 Class b
Conctods.SignaDate: iI
d, D C.
b
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant to such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). -
❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivels license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feel in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder. I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any.
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature end pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑NO
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes Ul No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will anyfacilitypermit _ _—_....___—..... _.._
part of the fac0i to be constructed under this be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
..._........__ South _.._ w_
7 Iia permit from the South Coast Air Management District or other air pollution control district3 or is required—for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
of compliance
fro.thea_p _. _.._ _ _..
8 (If yes',attach certificate of compliance Irom the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: _ Date:
CERTIFICATE OF COMPLiANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
SInature Of al Owner(s) Date
(,rg`b.�� t,�—' II19I 0(,,DO�tl/Ol,Autno z tl Applicant ,r0a,
gen I INSPECTION TYP(, ME MAO cOPSk tNSPECRON TYPE RAIL MALI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
•
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall - 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site ,
204 Final Demolition 250 Final Building/Occupancy L 2. "pi I
04" F r CITY OF COSTA MESA ,'� •
�. ° BUILDING DIVISION
y:r�,taartem• , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
tvI Jr% t PERMIT
+1!"� L.,,,,4304-02133
• '4anasm�
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2689 SANTA ANA AV Status: ISSUED
Suite: Applied: 12/20/2004
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 12/20/2004
Parcel Number: 43920215 Zoning:
Applicant: KUHN, SPENCER ISSUED BY: �I
Address: 63 VIA PICO AV
STE 433 Phone: (949)366-6597
SAN CLEMENTE,CA Zip: 92672
Owner: BEDELL, DAVID
Address 2689 SANTA ANA AVE
Phone:
COSTA MESA,CA Zip: 92627-4638
Contractor: OZONE ROOFING
Address: 63 VIA PICO AV
STE 433 Phone:. (949)366-6597
SAN CLEMENTE,CA
Zip: 92672 License: • 758431
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF RESIDENCE AND ATTACHED:T/O EXISTING COMP ROOF, REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER 30#FELT,APPLY 30-
YEAR DIMENSIONAL COMP SHINGLES.23.20 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,429.00
Permit: $167.25 Claim Valuation: $8,429.00
SMIP Res: $0.84
SMIP Corn: $0.00 -
Other: $0.00 •
Inspection: $0.00 -
Total: $168.09
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left -0-0 Right0-0 ,
ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right- 0-0.,
PARKING Existing: -6 _ Required: 0 Proposed: - 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
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 this permit to be considered legal, such work must comply with all applicable codes, and all
required 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)754-5626
2446.46(1/00)
DECLARATIONS ' •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
;+I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers' m ensat�loo-n lnsur ce carrier and policy number are; ,
Carrier: ��el'l.Q T- f Policy Number: i 7 3 31¶1 -leaf
(This section need not be completed it the permit is valved et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any porson In any manner so as to become subject to the workers'
Compensation laws of California.and agree that II I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell fdrthwith
Comply with these provisi
Applicant Signature: Date: {71 7.416
WARNING:FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN m AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5106.0(0),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Profe§ssions Code,and my license Is In lull
force end effect.Lie.a . -T g 3 1 Class a. C 034 ail
Contractors Signature: Date: ,2/ e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code).
Lenders Name: - Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct.alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ I em exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of doc ment,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demditlon or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 goes or wit the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
L]Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Californiaia Health and Safety Code been fully complied with? 0 Yespp0 No
._........_.._..—�___ 'rysent 9Poagency? LJ ' _._
5 Does or wo the applicant u lily Ma Or Management
building occupant at any other
for the work controlntch district the or of this a Yesestion a eNnit fOr such construction or modification
from the South Coast Air Quality Mena ement District or from other air pollution or No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (It yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLiANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I'have read this application and state that the information given S
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
1/Atiliiignatufray7.p)t Legal Owner(s) /Z/ Date
eV
And/ Authorized plcant Dale
CODES INSPECTION TYPE Ori¢, i11ImEL5 CODE! IN$PECRON TYPE PATE MALI
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
_/'2 _
200 Final Re-Roof -2 tel
el c(!"� 210 Final Electrical _
201 Final Block/Retalning Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
•
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
COUNTY OF ORANGE - .pplication for Building Permit (L,. (_ Sr
WILDING DEPT. Permit No / /
636 No.Broadway AND FOR A
Santo California
Phone:KI2-6211Certificate of Use and Occupancy
Date /1 —d O ---s-7--"-
17-%
�S--
,; 7 , �ti
I. OWNER'S NAME�S �! �� �//,)„P/HQ del
Q
MAILING DRE /Ur�O ` -a-� -�Y CITLY 4a Ger 07_d�
Name • �ni — Name .(- .
#7$
(Architect or Engineer) / `-�'/' r to
Address C./
at
/�/fes,/ �/v�p�/ -
City ..S- '' � City &'! M'c- � �- ,
State State / / 3/47 ����%/_2/
tic. No Phone Lic. N 1 t? 4z/ P de
PROPOSED USE- ./�� ��-117"� . l •• r /� '� r
2. JOB LOCATION 6 QG.1/'9 // „...„. 4- aa- 'dam `/ `f -" /✓' Y
(House No.)' (Name of Street) (Town or School District)
NAME OF AND DIRECTIOIJ.,FROI N9RESTe99SS STREET
3. LEGAL DESCRIPTION: Lot..._........ 0 Block Tract 3 7 `
(Metes and Bounds Description—Use reverse side of form)
4. CORNER LOT ( ) yyINTERIOR LOT ( A) THROUGH LOT ( ) SLOPE OF LOT ( )
5. SIZE OF BLDG 33 C•SI tz AREA:-/.PV a SIZE OF LOT •J5..4 1/ v AREA: lis
6. HEIGHT OF BLDG - / C7 CEILING HEIGHT• o GNO. OF STORIES
/ Ci.Iy
7. NO. FAMILIES / Size
ro�f,Smallest
_Bredro�om ' 4Size of Kiteh / �1
8. EXTERIOR WALL CONSTRUCTION;1 ✓�� �^ • INTERIOR WALL COVERIN "�
(Frame, Stucco, Et n _ (Plaster-Drywall, Etc.)
ROOFING COVERING Q'- ---r4" f ., ^ �'�"/"
9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH
Thi_
10. SETBACKS: Front Yard From Center Line of Street SO •
�/ G
Nearest Side Yard Rear Yard...:/..17 -4 Distance in Feet Between Bldgs, on Same Lot.
(Property Line) (Property Line)
. 11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
12. (a) Footing: Width Depth in Ground Width of Wall
(b) Size of Studs / .Spacing... . ..e Material of Floor
(c) Size of Floor Joists- ( S acing "CC
•
(d) Size of Rafters ` Spacing "CC
' 13. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal $ 1 . _tea o --
14, I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK_WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFOR IA APPLI BL ' ERETO.
r
Signed• � AL.-,Plans Filed•
/r /-z Qr L 79/ ner
By•
Authorized Agent)
• FOR DEPARTMENTAL USE ONLY
FEES: ! H iityNG BY
Bldg. Permit $ 241r"'V nn)� . .s /r GROUP APPLICATION.. .. HEALTH
.. l
Plan Check • $ Ti PE VZONING V FIRE
Total swerfill DIST. e//� PLANS AND MARSHAL
Receipt No. - 7 Dace. M� L/
P / SPEC'S STATE..._
Paid to - - f 5 ./(.. - SHEET NO .1 -
Date •
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