HomeMy WebLinkAbout3330 SAN LEANDRO LN - Building Permits, . �
COSTA MESA BUILDING-SAFETY DEPARTMENT APP EATION FOR STRUCTURAL PERMIT �„
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � 5� T�1
RECEI PERMl7.. — 7�T° -'50504 � � ��
For AppGcant to Fill in Completely — Use Ink Only ���
BUILDING �') ��� .F�/v� A.P.NO. �O ��
ADDRESS
BUILDING � �
OWNER OR n �� /�� � ADDRE55
TENANT �
UNIT OR
ADORE 5 � CJ � �' ��N SPACE NO.
TR.NO. LOT BLK.
CITV �%� � NOL � � J�
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH • �.��/�
OWNER (fLiF�'
ADORESS -uSQ� VAWE /�-�
ARCN�TEC7 TEL. US ,,qtt 5 8✓V.
OR ENGINEER
ADDFESS ZONE TVPE GROUP
APPROVED
CONTRACTOFi /- �i � [/ BV DATE
ADORESS O 2 Sl ��[// I�
�//� TEL.
CITV � Ul NO.
F STATE ��"� ��rj �/ pTY APPROVEDSETBACKS
IIC. NO. � O � LIC. NO.
� 512E NO.OFBLDGS. (FROMC/LSTREET)
C. OF LOT NOW ON l0T ONT FT.
a USE OF
� EXISTING BLDG.
�
FSeparate permits are required for L. SIDE r.
� elec[ric, plumbing and heating work: REAR FT.
�,�. USE OF BUIIDING AND WORK TO BE PERFORMED PL,ANNING ACTION
� DATE
APPROVED
� APPROVED � ���
a 2 //
w
0 1 hareby acknowletlBa that I hava reatl thia epp�Icetion antl stnte �
(� that the ebove Information is correct end apree to eomply wlih
�. oll lews regulatinp buildinp construcNon, antl I shall not employ �
,� nny penon In v(olation of the workman's compenaation lews of
y, Ma Stete ot California. 0
3 I haraby cartify that I am prope�ly Iteensetl ea e contractor untler SQ. FT. rv
ihe Stata of California Busi eu entl Profavione Cotla, Divlelon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that suc een»s ere In full foree enC efiect, or I TNE PURPOSE OF ESTABLSMING A PERMR FEE ONLV: �
am exempt irom tha visions of the State ot nliforn e-&iainav VALUATION PERM�T FEE S ,�\
ontl Profoasiona Cotle; ion 3 Fap[er 9. / (/ v vyi
/J � PLAN CHECK S m
Slgnatura ot p � .�` m
0
Parmlttea � 5 �oO (��+ TAX 0 LL
or s .� �
AuthorizaG Agent Date TOTA� pqlD V
a S. S
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ay
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�1 c,1-� \ e, 1��. �..� l/ �' t � i= c1
'PLICATION FOR A BUILDING PEF T
Tract eiock �ot BUILDING PERMIT NO. Po mii No. m
Plumbing a
Atltl�ress 3 3 � �QM� � CQ.N�d 0 /`/ `/O � Pormll No. m
/� O J � a
C1051 � MechanlUl 6n
�� S(�p�( �/ PorTlt NO.
N
Ownar M�` ( DQ ryoe ot vroiect: ❑ Naw ❑ Alter ❑ AGtlINon �
,� ❑ Repalr ❑ Convert ❑ Damo ❑ O<cupancy Vmt.
naa.e:: 5 o S � T•GC 1� !.-'
CItY ZIP Phone A.P. SUP. Dist./
InSD. A/ea
Artnllecl/ Zone SPL Pmt. NO.
Dalgnor Llunu No.
Setbacks P/L Front C/L SL Streol WiOth
Atltlrou
Yar s Le t g ear
CItY ZIP PhonO
ave ro . e g . .
Enpinaer _ Llcense No.
C ark ng SPates equ re rov a overe
� Atltlrass
m Clty Zlp Phone SVuct No.of Na.o/
Haight Storles Family
� LICENSED CONTRACTOR'S DECLARATION aark Faes Vos Fee
A Requiratl No C.T. 0.acelpt
m I hareby affirm that 1 am licensatl untler provisions of Cheptar 9
L (commencinB wich Saction 7000 of Division 3 of zhn Business entl Zoning Approvetl By: Data
Profesaions Cotl , antl my license ia in full forte antl ftact). �
3 Licenso Clas Licenze Number
> Data — J Conttactor Miic.
E naa.e:: ` d�Z- arocosea use
jy Cityand ZiD 7hone�%�^�� 7( of Structure
� CONSTRUCTION LENDING AGENCV
� I heraby affirm that there is a consvuction tentling aBency lor the
?� performance ot the work for which this permit is Vssuatl (Sac. 3097, Otc. Type Cotle
' Civ. CJ. Class Const. Vear
C Lentler's Name �� USE/OCCUPANCY S12E SU. FT.
Lentler's Atltlre.•
'� OWNER-BUILOER D CLARATION
� I haraby eftirm tha[ I am axempt from [he Conhactor's Licenae Lew 1�
� for the following reason:
� ❑ 1, es ownar of tho proparty, or my amployen with wagas ea t�air 2.
aolo componsotiOn, will tlo the work, entl xhe snuc[ure is not
�t„ intantlatl or offa�ed tor sale.
� ❑ 1, as ownar of t�a prop¢rty, am axclusively coniractinp with 3�
Iicensatl eonvacton ro consvuct the proleet.
.d„ ❑ I nm oxompt undor Sec. , B&PC for thia .eeaon 4�
m
a Dem Ownar
E WORKERS' COMPENSATION DECLARATION 7otal valuation
� I hareby affirm thet 1 hava e certifiwm of coment to wl�-Inawe, Encroachmant Pormlt ReqWretl ❑ Vas ❑ No
or n certificato ot Workers' Componsetion Insurence, or o certifiotl
C copy thareof. `/ Gratlin9 PmQ G�atli09
8 �IcyNo.L��B-���ofnpany����s RlQW�Gtl ❑Ves ❑Na PmLNo.
�a Certifletl copy is heraby furnishaE. Roug� Gratling S
Qa ❑ Certi(ietl cUpy b liletl with O e C nty, MA. m
AOprovetl by: Ddto
OnteF"/� Applican 3
� CERTIFICA XEMPTIO
FROM WORKERS'COMPENSATIONINSURANCE Z
(This wttion neetl not be completaC if Darmii Is for $100 or IasaL �
I cartify Ihet in fAe performence of ffie work fOr which Ihis pormit if Q
Isaued, 1 shull not amploy any person In eny menner ao oa m become ry
sublect co che Worke�s' Compensation Lewsof Calitornia. PERMIT FEES
Detn APPlicant
NOTiCE TO APPLICANT: If, after makinp this Cxtificete of Structural E Plan Chack E
Examption, you should b¢come subject to the Workxi Compansetion
provisions ot the Lebor CoAe, you must for2hwith comply wich suc� ElettriWl SVecial
provisions or thiz permlt shall be tleemeA rawkatl. E Invest. s
I CERTIFV THAT I HAVE REAO THIS APPLICATION AND STATE p�umDin9 S
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMI'LV WITH ALL COUNTY ORDINANCES AND STATE LAWS
' FELATING TO BVILDING CONSTRVCTION, ANO HEREBV AUTH- Methanical S
ORI2E PEPRESENTATIVES OF THIS COVNTV TO ENTER UPON
THE ABOVE MENTIONEO PROPERTV FOR INSPECiION PUR- pre-Gratle
POSES. Inspection E
SI neturu o( A . Pre-Gratle Permit
g pplicant or qgent Date • Rec. No. a Issue E
Print ApOlicanYs/Agen['s Nama
All spnees within this box murt be tompleted ta praeea Plan Issuance
Cneck BY: ApprOveC:
CMF 0335-a6 (BU48) rev. 6/80