HomeMy WebLinkAbout1636 IOWA ST - Building Permits •
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CITY OF COSTA MESA
t con la 4,, BUILDING DIVISION
41M1a ��( 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
.1" a FOR INSPECTIONS CALL:(714)754-5626
PERMIT NUMBER: B09-00269
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: TPN980105 DATE ISSUED: 11/05/2009
ISSUED BY: RMD
•
JOB ADDRESS: 1636 IOWA ST CM Suite/Unit:
Vicinity: REROOF CONDO BLDG -
Squares: 2500 Valuation: $10,000.00
SCOPE OF WORK: REROOF 1636 IOWA CONDO BLDG:DO EXISTING B.U.R. REPLACE WITH BASE,MODIFIED,2-PLY AND ROCK.
25 SQUARES
OWNER: MASSEY, ROBERT TR Address: 24801 SAUCO Unit:
PHONE: City/State/Zip: MISSION VIEJO,CA
APPLICANT: PRICE, BOB Address: 17501 NORWOOD PARK PL Unit: :
PHONE: 714-573-0155 City/State/Zip: TUSTIN, CA
CONTRACTOR: PREMIER ROOFING AND BUILDING CO INC License No. 634404
Address: 17501 NORWOOD PARK PLUnit: PHONE: 714-573-0155
City/State/Zip: TUSTIN,CA 92780 CELL:
ARCHITECT: License No. •
PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $181.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $182.25
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE/. INSPECTION TYPE DATE INI1IALS CODED INSPECTION TYPE DATE INTIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof S/l'//o 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 _ _
sr
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WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive.„'cense. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the fallowing declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of Consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' comp nation 1999���urance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: / 4 person is required to descend,will be made in connection with work authorized
/.N—`n by this permit,and that no building structure,scaffolding,falsework,a demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm
(This seapn need rpt be completed I the peb s uv^^na
,ed at Onehundred (Ef
Npred Mears a less.) 2,Arta Sec.341,Title 6,California Administrative Code).
Policy Number: obey /'1/ d2��OU/
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performa• � •1 ; work for whic his permit is require a permit from the Division of Industrial Safely,as noted above,unless
issued, I shall not employ an -- ••• • • manner so o become subject such person has a permit to do such work from the division.
to the workers' comi3:- • /dornia agree that if I should
become subject 1• -•' •• er, ti ovisions of Section 3700 of Applicant's Signature Date
Adi
the Labor Cod - ortse provi/sions.
digirj ///G Division of Industrial Safety Permit Number:
Applicant's Sign ure Date/ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE To SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license ie,in full force 2d effect. a registration form for acutely hazardous materials? ❑Yes 0 No
iLi6.# _J7 0 G' -Cla - f t (Section 25533 of the California Health and Safety Code, with some
l� /i'i' 7/—‘---Of exceptions, requires registration with-the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
• va'f'2s"gn •e Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work fa which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Dale
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penally of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications fa non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8 (If'yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.), information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property.am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and _
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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 u ' n I inspection.
Sign L r Date
Signature Date / //— ,`e r
/
3057<8(3/W) Io�FA orzed Applicant - .... _ Daatb,
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 126, 11-1 DATE I (- 0 _ /
LOT NO. 0-9 2 Oh-LII /p ^_
ADDRESS /(C3 ( Q c ��CL de_etc. �/ Y`ce
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
he s e-they) was r ere) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
BY.
chi er
BY
Developer and/or orized
representative
BY
-Berate-
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33043
PALO
COSTA MESA BUILDING-SAFETY DEPARTMENT HAY -6-71CM5t00 229* k4 229.50
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEI EDB D_AT�R€CEI?) 3E IGgu 7
BUILDING % 4 R / J) 3 C 7-1 Iowa St. • ,G (`I ISSUED ADDRESS (f�✓(O r7/(I i l/
PERK C e^
OWNER Modular Technology, Inc. A.P. NO. . `�tII IFI S
MAILBUILDING// // $ Iowa Street
ADDRESSLil La 1104 E. 17th St. ADDRESS R/O
0-U CITY SantaAna TEL
547-9673 TRACT 6614 1 LOT 29 , BLOCK
ZQ CONSTRUCTION NEW ADD ALTER (REPAIR JMOVINn DFMOI ISH
Ow LENDER
fil
X
am
J 7 BRANCH
J N OWNER Mod lar Technology, Inc. -
Q w ADDRESS hN-J
OD m ARCHITECT TEL. USE - 5)131X. VALU$age,
Q OR ENGINEER Kermit Dorius,AIA. No. 675-1164 0 1\
U Q FIRE Cf
w ADDRESS 3111 2nd Ave., Corona Del Mar ZONE TYPE GROUP
tl W APPROVED
W Z CONTRACTOR Owner BY DATE
CO Z
J cc ADDRESS
1{"ADDRESS Same `7 `�'e f'n
W w TEL. ONE NO.OF USE OF NEWW
Z� CITY -_ NO. __ ���C P PLANS BUILDING
W O STATE CITY YARDS APPROVED YARDS A PROVED
up¢ LIC. NO. 252549 B-1 LIG. NO. 1690 MAIN BUILDING ACCESSORY BUILDING
DO (FROM C/LS REET)
SIZE -- NTNO.OF BLOCS.
OF LOT 72 x 110 I NOW ON LOT � FRO ��17V FT. FT.
USE OF -- _H.SLOE /'/
EXISTING BLDG. f/��/FT. FT.
NO. OF
SIZENEW OBL 2094 S.F. ROOMS 10 STORIES 2 L.SIDE /'/ FT. FT.
2 NEW BLDG.
Ct EXTERIOR INN& SLnCCO- ROOF /
a COVERING 1Red• Shake SCOVERING Built-Up REAR (('FT. FT.
..J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a /,� MAIN BLDGS. ACCESS.BLDGS.
O. C
DATE
Construct residential with VACURP#9G3S-7d APPROVED 11-40 7O
zAPPROVED garages @front of lot. IthL DATF 5---S - 7
o Q/14.1 //3C-
C~.1 I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
D
all laws regulating building construction, and I shall not employ HOLD FOR SPECIAL REQUIREMENTS
any person in violation of the workman's compensation laws of
H the State of California. (f[113 .2: m
do 0
I hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER SUUATION IS FOR s
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: Q
am exempt from the pr isionf of the State of California Business
and Professions Cod inion 3,Chapte VALUATION /3-5 r (^i„ N
PERMIT FEE S D
Signature of /7/ m
Permittee ars" Et $ PLAN CHECKS '/G• E
o
++�� � LL
Authorized Agent ` Ol ��• TOTAL FEE $ z7Fil�
N.
`PRWE614Ess: 1636 IOWA ST UNIT: ABCD CITY OF COSTA MESA — BUILDING PERMIT. PERM NO: B 048067
Q.WNER'S NAME' FRANCISA WANDEN
• ADDRESS: MESA VERDA ASSOC . PERMIT NO: B 048067 PLAN CHECK NO: N GOVT: N SUPP : N
7400 CENTER ASSOC. •
#205, HUNTINGTON BEACH CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: 71 4/5 5 7—9 9 7 5 REO.NO.: •
ADDRESS: UNIT: JOB DESCRIPTION : REROOF SQ FT:" 3, 500 .
PERMITTEE: CLAIM VALUE: 3, 500 . 00 CALL—VALUE: 3,500 . 00 GROUP OCC: ' R�3 /
ADDRESS: PETERSON ROOFING ( 714 ) 720-0812 •
2816 PCH COMMENTS : SMOKE DETECTOR REQUIRED
CORONA DEL MAR CA 92625 *********-x-ea**aaea*sax-oaea*aa*-N-toe*ea*->E**x*atateF**at***x->Fee*itea*ar*at*eerter+granite+t*at*+t***->E*eaac-aa*->F*aa*#
❑CENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETH ACK S
CITY lid': 045445 STATE UC.:468553 ve cuss: C-39 •
Date:Z^C 0' IT c Signature: � Cie""`.._ MAIN BUILDING ACCESSORY BUILDING
I 'IRKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of nsent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: ' FT IN
tpensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT , IN '
,UCY No.: 10 21 3 5 5 EXP.DATE: 04 /01 /91
COMPANY' STATE PARKING REQ: PROV: PARCEL : 00000000 ZNE: REF NO:
❑ Certified copy is hereby furnished. (4 Certified copy is filed with the city Building Division. ` PLANNING NOTES>
��_� >
Date: Z_y O . 't0 ApMicant: C7 /��` ********************************************************************ja**********
EKEMPThON FROM WORKERS'COMPENSATION DECLARATION: (This section need not be comp! d the permit is for one hundred(5100)or less). DEV EL OPMEN T SERVICES R E Q U I R E M E N T S •
'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. ZONING APPROVED BY DAT E
Date: Signature: -
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: 7-Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. ''7/767.9e)
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY : n DATE:
which this permit is issued(Section 3097,Civ.C). ***************************************iF�[�+R*iF7F iF iF3F iF iF iF?F3F7F;F**********'iFiFg-F.it******
LENDER: ******************************************************************************* _
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My dry of county which requires a permit to construct,alter,improve,demolish.or PERMIT 61. 00 5 0
repair any structure,prior to its issuance,also requires the applicant for such permit to the a signed statement that he/she Is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
I and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN ,
my applicant for a permit subjects the applicant to a civil penalty at not more than five hundred dollars($500). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL • PAID DUE
J structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors State License Law TOTALS————> 63 . 50 0 . 00 0 . 00 - 63 . 50 . 63 . 50 , '. 00
does not apply to an owner of a proper),wlo.butds or improves thereon,and who does such work himself/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 wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTAL S——> COLLECTED : 63 . 50 OVER/SHORT: . 00
forthepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 5 D i
❑ •and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon '
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me.• IND IV IDUAL F E E BR E AK DOWN
❑ I am exempt under Section: B.E.P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 3500 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 3, 500 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wiNxill not(circle one)need to comply with said state codes and the requirements for a
permt for construction or modification from theiri7 Oualty Management District.Residential construction apptcations are exempt from
. these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information B correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby ut orae representatives of this city to enter upon the above-mentioned
property for inspection purposes. •
/_
Dater -C 0 a 4 fw Signature: `"�••' -.",
k\Ck. • .
1.07
Driver's License or Social Security A:
1641-46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;GoldenrodDATS:: O7/I1D/SO TIME: SO:D
—Assessor 0100064838-00064339 Tc�3 83.SD
OAt13
CONSTRUCTION AND PLANNI,.., JOL & SPA
' _ APPROVALS Permit# • Date Inspector APPROVALS Permit# Date Inspector
l
�f 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. r - 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 58. Electrical Conduit-Undrgrnd.
8. Foundation - - 59. Gas Pipe, 0 Undrgrnd.,Test r.vi
9. Water Pipe-Undrgrnd. • 60. -Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House,ConnectionI 62. Backwash & Receptor-Final 1
12. Sewer Cap � '� 63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing i 65. Electrical-Final
15. Rough Electrical-Conduit t •
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 Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 `t]
37. Final Factory Fireplace
38. Final Plumbing -
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer •
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 4/
48. FINAL PLANNING '(/ - f� �•/f
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co t •
51. CERTIFICATE OF OCCUPANCY . .
Na. Date
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. t46/G/C
b 3 — DATE /2 - �- 7
IAT NO. 2‹,737
ADDRESS l tC /8' La 44/ CA--,
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets.
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-they) (was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason '
of the aforementioned uncompleted condition.
BY741-2Qi✓i d Jc (C-CSO
Purchaser
E,l MESP
SAL
F CONGDE1/4 vT Developer
epresentativeo
40k\ Pan./or autrized
G\
1911 PM BY
��G E 2),3,k`516 Lender
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CITY OF COSTA MESA
`,t tHA'E,p BUILDING DIVISION
'I$ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
Ln‘
- FOR(NSPEC&NS CALL:(714)754-5626
'°° ° PERMIT NUMBER: M11-00073
PERMIT TYPE MECH STATUS: ISSUED
APN: 93207015 DATE ISSUED: 06/15/2011
ISSUED BY: KJB.
JOB ADDRESS: -7636 IOWAST'CM Suite/Unit: C
Vicinity:
SQ. FT: 0
SCOPE OF WORK: FAU CHANGE OUT. 70K BTU. SAME LOCATION.
OWNER: SASS, RICHARD HTR Address: 3121 BROKEN ARROW ST Unit:
PHONE: City/State/Zip: NORCO,CA
APPLICANT: RODLER,WAYNE Address: 4751 ARROW HIGHWAY Unit:
PHONE: 909-354-1250 City/State/zZip: MONTCLAIR,CA
CONTRACTOR: QUALITY CONSERVATION SERVICES INC License No. 757471
Address: 4751 ARROW HIGHWAYUnit: PHONE: 909-445-0450
City/State: MONTCLAIR,CA ZipCode: 91763 CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00 •
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODEC. INSPECTION TYPE DATE INDTALS CODEC INSPECTION TYPE -DATE C INTMALS
(,
1616 Fixed System Final Fire Prevention 206 Final Mechanical V I�1—f I ci tfr z
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
•
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive._.,cense. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 t -
section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is i ue . rk compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number ar H✓I person is mquand to descend,owill t made in conning,fol with worka authorizedm
Carrier: C� by this permit,and that no building structure,scaffolding,falsework,a demolition
ferias torn not d erne e a warn ndretl donors(stool wtess.) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
Y °7 '1) Ur-CC
°i4 2.Art 2,Sec.341,Title 8,California Administrative Code).
Polic Number: /7 / 5� /�
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued. I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the w, rkers' compensation laws of California, and agree that if I should
become subject tot workers' compensation provisi s of Son700 of
Appl¢ant's signature Date
the Lab r Co I forthwith comply with these pr ' ionS�
( Division of Industrial Safety Permit Number:
Apphca Signature Date" HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file
my license is inlull7 e ap(d�e((ect. 7 a registration form for acutely hazardous materials? 0 Yes ❑No
Lia# 7-2 /�(yl / Class# (Section 25533 of the California Health and Safety Code, with some
eta / exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
ont. •�.na. - - Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: - Health and Safety Code been fully complied with? 0 Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If yes".the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
\ Signaler t ingot Owner s)
Signature Date
3057.46(3/07) t onzed Applicant Date
•
,PROJECT ADDRESS: 1636 IOWA ST UNIT: D CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 049195
OWNER'S NAME: JONATHAN S, MASSEY -
• ADORESS: SAME AS ABOVE PERMIT NO: P 049195 PLAN CHECK NO: N GOVT: N SUPP: N
' CONSTRUCTION TYPE; PERMIT TYPE: PLU PURPOSE: OTH
714/966-0681
' ARCNIENGINEER: REG.NO.: JOB DESCRIPTION : WATER HEATER REPLACEMENT SQ FT:
ADDRESS: UNIT:
• CLAIM VALUE: CALC—VALUE; GROUP OCC: /
PERMITTEE: GENERAL ' INSTALLATION (714 ) 753-2541
ADDRESS: 6558 WEST BLVD. COMMENTS: **
LOS ANGELES CA 90043 ************it********** r****r*****************:er**+ESE*EE E+r*******it**+r+r*********r*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of C .s - 9(commencing with Section Z O N I N GS EREQUIREMENTS7000)of Division 3 of the Business and Professions Code,and my license is in full force and e•
cm tic.: 0 6 3 STATE uc.:1518 39 C 36 � � J
Date: AIf SA dx Signature: / �/ ' MAIN BUILDING ACCESSORY BUILDING
��y��gRNERS' 0 PEN Tl DECLARATION: Iherepy attirmt tl vee nificate ofa to self-insure ora certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
?�...cJpensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
.d""Wim xD.: 6969-0004 EAP.DATE: 04 /01/91
COMPANY: NMIC PARKING RE}npq PROV: PARCEL: 00000000 ZNE: REF NO:
❑ Certified copy I hereb furnished. ® Certified copy i t h ivy altl' s PLANNING NOTES>
Date: 9/ ApPlicant: *******************************************ik*** *******************************
EAEMPRON Wo COMPENSATION DECLARATION: (Iles section need not be co the permits to one hundred(S1e0)or less). DEVELOPMENT S E R V I C E S R E Q U I R E M E N T S
I certify that in the performance of the work for which this permit is issued,I shall not-'ploy any person in any manner so as to become
subject to the Workers Compensation Laws of California. ZONING APPROVED BY .-
DATE:
Date: Signature: i
NOTICE:II,after mating this declaration,you should become subject to the Workers Compensation provisions of the Labor BUILDING APPROVED BY : - DATE:
Code,U you must foNG G I ithhe such provisions r this permit shall bedeemed revoked.f $)
CONSTRUCTION LENDING AGENCY: 17, CM.affirm that there is a construction lending agency for the performance of the work for *APPLICATION** ISSUED BY: DATE: f
whim this permit is issued(Section 3097,Civ.C). ********************** ************ ***
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contactors'State License Law for the fofov.lng reason . BLDG PMT • PLUMB INNGG ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 .00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 252 SMIP/NON—RES .
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she s exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by i
any applicant for a permit subjects the applicant to a civil perm*of not more than five hundred dollars(3500). ISSUE FEE 3,00 .
I, as owner of the properly or my employees with wages as their sole compensation,'wit do the work. and the BUILDING—DIV—> PERMIT . ISSUE PLAN—CHECK TOTAL PAID DUE
" , structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contactors'Sate License Law TOTALS————> 2 . 00 3.00 0 . 00 5 .00 • 5.00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through ,
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or ,REVENUE DIVISION TOTALS——> COLLECTED• 5 .00 OVER/SHORT• •
0 0 '
for the purpose of sale).
Improvement Is sold within one year of completion,the owner will have the burden of proving he/she did not build or Improve_ BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business • S. O O
•
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who.contacts for such projects cath a contractor(s)license pursuant to the Contactors State License Law).l am aware *******************************************************************************
that proof of their Worker's Compenettlon Insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY D E S C R I 'P T I O N UNIT COST TOTAL COST
Date: Owner: PLU 1 WATER HEATER AND/OR VENT 2 .00 2 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a •
permit for construction or modification from theAi�ality Management District.Residential construction applications are exempt from ppp''''''{{}���
these provisions. •.f_ \ �. n 'at,-
Cate: - Applicant: S 6Y�a_:...i
AA t
I hereby certify that I have read this application and state that the above information is••rect.lag ell to comply with all city and county q.;! I µOCT
I
ordinances and state on u' to DuiW'��simction and here, autho" .tives of ill', to enter upon the above-mentioned _..9 C5 1990 1
property for inspectionOeu•i.i ' u'
Date: ignature: i /� ,/�'
Driver's License or .ial Security if: CITY OF COSTA MESA
-" •..Ow—Revenue;Goldenrod—Assessor
.
CONSTRUCTION AND PLANNII._ - . JOL & SPA
• APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
0
1. Temporary Electrical Service or Poles 52. Pool & Equipment Location
o ad
4 M
.2;.Soil ftjpe-Undrgrndri ;goyn 53. Steel Reinforcement
r,faC
. lectrftal Con rF;t9ility-Undrgrncg 54. Forms
J.
0 .s.Electr,t�eal Conca ttdrgrnd. c 55. Electrical Bonding
0S., teel 0 Reinforcem x 56. Rough Plumbing & Pressure Test w
-„_
aco
wIElect cal UFE,A`Cdibd. 57. APPROVAL TO COVER-GUNITE 0.)
:1; > G
E- ti+footings Qti 2 ci 58. Electrical Conduit-Undrgrnd. r-
G
g. Foundation ';'e. 59. Gas Pipe, 0 Undrgrnd., Test .
.JJ F j
`4. Water Pipe-Undtgrnd.Th . O 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural FIod7System •
61. APPROVAL TO DECK
11. Property Sewer LinirC& House Conrw.Ftion 62. Backwash & Receptor-Final
12. Sewer Cap o' `e c' 63. Heater & Vent-Final
o •
U
13. Roof Drains - a - 64. Plumbing System - Final
14. Rough Plumbir`2 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough ElectrioANiring 67. Fencing & Access Approval
0
17. Rough Wiring 3iin 68. APPROVED FOR PLASTERING
•m
18. Rough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL
19,atlollgh Vivi?? & r Conditlo9jo9 .•.•c., * ci us <* * "7 r,,FI gr. RREQUIRgMENS, r- '
t" v Or 1.1 ‘t. 1/4:,C
* C .7 '..4 ; t•1 m '7tU:70 m * > '7
20.5iot�h l ctoay Fguplace I SmT tcV * S H m* * r PPRCCVALBj171rrt rit # * !?.^.
' '�
s ni H T ' a.H M * H '1 '-1* * k' S ' D i< M * ''i
21.au5f?,i Str&ctu * I •• •• 'i.', , * S O '-r* * "470. ~der roOi jHy ro *
,,, * I * CJ H n* * H 9
.� v -or 1 .1S' * X S* * ...2 r'S •j4.
22.�u4ts, ' nti1 ting)* I T•CJ * 0 K CF* x e571. Produc1P3ng Ups DOil
'o tr' -
23.'Gas8Dip jiorph k1rest I mS * t+7 v' ;IC, O* * '"72. Under roR{3 FI""R 'lc* r-
* I F rr OIs * Li s* * O 9 d gs �.
C •• * * t Fr ••t-' * > U r * * S w FC/ fi
24. Roos Raining * S mt ** r n* * k73.`1Xlndergrnd Stortit fank'pGas OOil
[. Y nm >m
25.ORo�,'P Shi'ething * H v 'r: `7 O m S* * 74.�verhead HydroSp.
* H H 444:
m U mils* o• J + r-+ Li
26.�-Bamr Ceiling (Strur,�ural) &l�leyigcoat * 0 > O* * 753Dry CheryCt;al FO * 6
* r = x 'k. F K O Y x s rr '-
27.Cframe Flashing: OGcC * Cr >' in* * Fav * m
r: ri HCT0 t^ * Y* x 76. Dry Stant lYie ,Q F„ * n;
8. Lathin 4 Siding * v: 'Gd5 x * r .•* * ci J LJ *
) 9 * OtCF O * ••I ••I t* * 77.'7FIXED SNSTEIW f�1AA L* H C'I Z
29. InsuIatigo * S * * 78ff �REP EV. FI I �msj * > x F
T * * * H •U •H rn * H H �•1
30. Drywall` failing * H I * F I * Soni 0tRALTF{-OEPT*REQUIRB(JIENT
1 t * t- * --(7`.1>a, rnpj . F x n rw
931. Plaster fibwi Coat* s II t-.F * * m'79. FINAL Irpgm*. * F•
* N
2.T€Iectric4Po7er Maer Ecifial I * * [*+80.yOOD CERTIFICATE IS%IdIEDH •.il
9 4'f': r v '}S *
�i3. in r EI ttrie * Cl I I `_ * I I * No{?s: `3 '7m * 1 0 trm
m , .1rT ,..,1_, * G * r CS m n * S
'-+ I * * * F S t 1.[. * ... -v .,4.=Fin He ting�t Air*C4rft3itionir�QS m * > I ,* * FI F-C * Rj
;.•, - ' '7 t '*4 n ^ TIS * m "O
I35CFinal GdE Pipe-Test* 0 •• * H ' St * O mo OH I HIT
.tI�_j '- m x cr * I * m • --n * m
S' � * .^� i -:n O * n * E Y no * r -
6. o O nopy * n I Gm O * I * m x * m tri
I' . , rs r = * t? 4-S n
`37.FinchFactory Firepl9ceX I FF 0 * I i* * S -n 4 •-
n * cc I •• •• O **,�N * < C
SiB. Fin�Plumbing * RjN i o ` ��/9d 4°4 x PC I- 1 c * w
e 1 a n - r-
�' 9. Water Service-Final* Z I * m I tx * >i ai *
# �: x t* x F * m
X10. Gas Service-Final VII Qmm 5 * Cl r
Url• 0 I
* CFF m * I OS * 4
41. Solar Domestic-Final Cl * m -30 e * x O _
( S c-, N * ^') H 0/ * $ '42. Backflow Pr enter* N * I I o` :^ x ' H
its * Ci OHH * H * * m mO * F
43. Backflow Irrigation* >1 * PC * * N - 4 CI '
rT: 7Jmr .� * m O 0 O* * CO CU SIJ * mQ J
R4.rLandsca e Irrigatio'6SystemO<. (:j x d ,¢ cc* ** O S f OG * S I-
U
�J 't' Hr.. . t•' • Z F I • [ +• A"i• . tT`l: ""'G �-
45.�Oand Attermatiort* ^ • * m Cl m* * F C a' K • E-0 *
[ F ^ * t .. qv x re .. .. ..* * a -- .- HO ••H *
46. Har-i icad'Re4Olatio s r'
S * S I 0 * C * O 00 S
1 *
c47. IriFL STRUCTURE & BUI` DING * F I /# * Cu J n *I O
n .,, .- * , mm
48. IN�L PLANNING* I F * N I t • ?K * m m * F
,� I 4: l ,'� * CJ 0 ti; S a K
.1c m. yy s.m tE `C
9. Electric Release to 6�dison ; * I I" 't* r: r, •n *
s- * ' Itx .• c 0.:.. * n LA
•
` 0.tasETelease to Sou ern Calif'o "" *Gas Co I i- r* * I--' H O • Om * v
F I � * (/* * .. S 00 0 * c
r „ :?O - •* • r,°51. CER�IFICATEOFIOCCUPANCY '
No. _ Date