HomeMy WebLinkAbout921 VAN NESS CT - Building PermitsPflOJECiR00flE55: 921 VAN NESS CT
OWNEP'SNAME: WALTZ KENNETH ROBERT TR
nooxess: 9zl V`AN NESS CT
COSTA MESA,CA 92626
AFLN/ENGINEEfl:
RO�flE55:
rexminee: BILT—WELL ROOFING
aooxess: 3310 VERDUGO
LOS ANGELES CA
LICENSEO CONTBRCTOB OECLABRTION: I hereby aliirm fhai I am li[enSeO un0er Om�
]0001 0l Oivision 3 0l the 9usiness antl Prolessions Cotle. antl my lirense is in full lon
cirv uc.: arare uc.: q 5 g 0 ` ss: _
�;`� �—�-91� �,��,.,,.a
UNIT:
flEG.NO.:
UNIT:
(714)75
�06�
ol ChaO�er 9 (com cii
effect.
WONKEPS' COMPENSPTION OFCLAFATION: I hereby allirm ��ai I have a cenifiCaie ol ConSeni Io
Compensalion Insurance. or a certdied copy inereol (5ection 3800, LaU. C�.
raucvNo.: W937102989 exr.oare: 07/31/99
COMPRNY: CAL COMP INS,
❑ Cenifiea copy is ne�eoy lumishea. Q cendiea copy is Iilee wim me �9a':::� �:::r
—3501
with $ecti0n
Workers'
E%EMPTION FNOM WOBNEXS' COMPENSPTION DECUMTION: (ihi5 5eclion nee0 noI be comDleleO il i �a huMrCd 15100) or 1e55�.
I retlily ihal in I�e perloimance ol Ihe work lor which this De�mii is i55ue4 I s�all no� employ any person in a r 5o as lo Uecome
5u0�ec1 to I�e Workers' ComDensalion Laws ai CalilorPia.
Oaie: Signalure:
NOTICE: II. alter making tAis tleclara�ion, you shoultl became suElecl to ihe Workers' ComDensation provisions ot ihe LaUar
Cotle. you must lonnwiln comply vAh such provisions ar �nis permil shall he Eeemed revakeU.
CONSTBUCTION LENOING RGENCY: I here�y affirm thal ihere is a cansimction leneing agency tar tAe peAormance al t�e wark lor
which I�is permil is i55uetl (Sec�ion 3097. Civ. C�.
�exoEx:
aooness:
OWNEB BUILOEfl OECLAflRTION: I here�y attirm iha� I am eKemD� ��om Ihe Conirac�ors' State License Law for ihe followinp reason
(Setlion 7031.5 Business antl Pwlessional Cotle: Any city o� counry w�ic� requires a Oermit �a cons�mct, al�er, improve, tlemolis�, or
' repair a�y slruclure. prwr lo its issuance. also repuire5 ��e applicant for such permit Io lile a signed s�a�emeni thal �e/she is licensed
pursuani Io Ne D�ovisions ol the Coniracmrs' S�ate License Law (Chapier 9(commencinp wi�h Seclion 7000� of Oivision 3 0l ��e Business
anE Proiessions Coae) or iAat ne/she is e�emo� �herefrom ane �he basis lor tne allepea exemDtian. Any violation of Section 7031.5 �y
any apPliwnt �or a permii suble��s �he applicant to a tivil penalty ot not mare I�an �ive AunAreA Dollaa (55f10�.
I, as owne� ol �he proDertY or my emploYees with wapes as meir mle comDensation, vrill ao Ine waM. antl Ihe
❑ strucmr¢ is noi intenaetl or oHereU lor sale (Sec�ion 70aa, Business aiM Pmlessional COAe: T�e Caneractari State Littnse law
eoes not apply lo an owner oi a DmDerty w�o Uuilas or impmves t�ereon, anE who Aoes sucA wark himself/Aerseli or t�muAA
his or her own ¢mploye¢5. pmviQeO �hai such �mpwuements are not inten0ea or oflereE tor sale. I�, howev¢r tAe Cuiltlinq or
impmvemenl is soltl wi��in one year ot compl6��on, lhe owner vnil have �he GurGen ol pmving he/s�e 4i0 nOt OuiIG Or impmve
lor Ihe purpose ol sal¢�.
I. as owner ol Ihe pmpeny, am exclusively conRacting wit� licensea comractors lo constmct tAe prolect (Section 704<, Business
❑ antl Pmlessions COAe: 7he Conlractors' State U�anse Law tloes not aOPty to an owner ol pmDerty wAa builds or improves iherton
anU who contracis br 5uc� pmlecis wiih a co�«aclor�s�license pursuan�to Ne CONractors' Siafe Licens0 Law). I am awdre
I�al pmol ol Iheir WOBer's CamDensation insurance s�ouitl be provitletl to me.
� I am erempl unGer Soclion: B. R P. C,
lor Inis reason:
oate�. Owner.
i ao nertDy cendy �nai I am aware of and unaerstanA tne reQuirements al Calibmia Healtn anE Salery Code Sectians 25505. 25533, anA
255Y anC �Aal I or any IUWre Guildmg occupant wilVwill nol (cir[le one� neeE lo campty with saitl s�a�e cotles antl Ihe requir¢ment5lor a
Dermit �or con5lruciion or moddicalion trom Ihe Fu Ouah�y Managemenl OiSlricL Besideniial con5imclion apPlicaiions are e�emp� irom
IOCSC p�Ovi5i005.
Oale: FpP�icanl:
I �ereEy cenily Nai I pave read IhiS apDlitaiion and Slaie Ihdi I�e aGOve inlorma�i0n i5 C rrecL I agree to COmpty w h all Cily anE fAuniy
orainances aM sta�e laxs relatinq ia OuilGmg construction anG �ereGy autlrorrze rtD�esenta� es of this ciry to enter n the abm�e�mentime0
o�ooeny �o%rinspec�ion purposes. ,/
Dal / ^ /�i'`� SignaWrO�
od�ers Lhense or 5odai 5ecumy a�
16<I�46 While—Bmltling: Gieen—Cotle Enforcem¢�C Canery—Appl¢anl; PinF—Revenue: GolEenraE—Asses3p!
CITY OF COSTA MESA — BUILDING PERMIT
PEAMIT NO: B 067B03 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR
PERM NO: B 06780:1
GOVT: N SUPP: N
PURPOSE; OTH
JOB DESCRIPTION ; T/OFF 6 REROOF WITH COMP. 6 BUR IN BACK Sg FT; 1,100
CLAIM VALUE; 1,100.00 CALC—VALUE: 1,100.00 GROUP OCC: R-1 /M-1
COMMENTS: SMOKE DETECTORS ARE REQ�UIRED IN EVERY BEDROOM 6 HALLWAY
+ti��c-**�ti�*�r**�t**i�**�***f��titx�**�t**�* �t*��t**+t�t�tit***�tir�iti�*�t**�r+t+r�tfr#��r**fr�t*�u**i�;r**�tirit*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY B�ILDING ---------
FRNT; FT IN REAR: FT IN FANT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 41808399 ZNE: REF NO:
PLANNING NOTES>
>
�rir+r*x��rx���;r�rx ��it�rx ��r�*�u����� �r+�***�r+r*�r**�x��****+r#*���r��+tit��r��r�*�r�r#*�r*�+r*�r**it�r�r+r;r*
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N �T S
ZONING APPROVED BY DATE:
bUILDING APPAOC'ED BY ; DATE: "
APPLICATION ISSUED BY: DATE:
��������*�*�,�*�**��**� -�-,,��r �**,�����** � �Z ����-
�t****���*�***��*it*****�**�***��t*�****��*�;c�*�*���w****�3r�*****r*ia*�iF*iF�* -ie*it*i **
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLOMBING ELECTRIC MECFIANIC FIRE SMIP/RES GRADING
PERMIT 27.00 50
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT I55UE PLAN—CHECK
TOTALS----> 27.50 0.00 0.00
SMZP/NON—RES
TOTAL PAID DUE
27.50 27.50 ,00
REVENUE DIVZSION TOTALS--> COLLECTED: 27.50 OVEA/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
2�,�� ,S�
1Elf iE it iE if i! if i4 it i! iE 1E 1E fF if if iE iE iF f! iE iE iE if ik i! i(� IE 9ElE if iE if ie 1E iE iE fE i� iF if iE i!!f iE fE fE iF 1E M 1E iF i6 iE i! ik if if if iF 1f i(-1E k!f ?! iE iEYr if iM1 ## 1F �E 1E fF i!
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1100 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 1,100.00
END OF FEES
O1 001633�7-00163308 T O T 27.50
DATE: 07/01/94 TIHE: OE:S7
�
CONSTRUCTION AND PLANNING POOL .�A
APPROVAIS PermiT# Date inspector AppROVALS Permit# Date Inspector
1. Temporary Eleariwl Serviceor Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steei Reinforcement
3. E�ectrical Conduit Utility�Undrgrnd. 54. Forms
4. Electrical Condui.-Und�Srnd. 55. Electrical Bonding �
5. Steel Reinforcemen[ 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. 57. APPflOVAL TO COVER�GUNiTE
7. Footings 58. Electricai Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd.. Test
9. Water Pipe-Undrgmd. 60. Backwash Lines, P�Trap, O Undrgmd.
10. Structurai Floor System . 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Recep[or�Finat
12. Sewer Cap 63. Heater & Vent�Final
73. Roof Orains 64. Plumbing System � Final
i4. flough Plumbing 65. Electrical-Final
15. Rough Electricai�Conduit , 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access A�Proval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. flough Heating & Air Gonditioning F1RE DEPT. REQUIREMENT '
20. Rough Factory Fireplace APPROVALS Permit �
21. Ducts, in Strutture 70. Underground HVdro
22. Ducts, Ventilating 77. Product Piping �Gas OO�i
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergmd.StorageTank OGas ❑OiI
25. Roo` Sheathin9 7���--QY �f//�" 7q, Overhead Hydro
26. T-Bar Ce�ling (Structurai) & Monocoat 75. Drv Chemicat
27. Frame and Flashing 76. Dry Standpipe
28. La;hing & Siding 77. FIXED SYSTEAI FINAL
29. Insulation 78. FIftE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 7S. FINAL INSPECTION
32. Electricai ?ower MeterFinal 8Q. FOOD CERTIFICATE ISSUED � _
33. Final Eiectric IVotes:
34. Final Heating & Air Conditioning
35. Finai Gas Pipe�Test
/ -
36. Hood or Canopy ' �
37. Final Factorv Fireplace .
38. Final Piumbing
39. Water Service�Final
40. Gas Service-Final
41. Soiar pomestic-Final
42, Backflow Prevenier
43. Backflow Irrigation
44. Landscape Irriqation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUIIDiNG JQ �C��!/ 4��L
ri [
48. FiNALPLANNfNG '� -
49. Electric Release to Edison . ..
50. Gas Release to Southern Calitornia Gas Co •-�
51. CEflTIFICATE OF OGCUPANCY ,
No. Date
;��cT �:o. 10445 i�,��i•� September 3, 1980
? a: r:o, 104
ADDRrSS 921 Van Ness Court, Costa Mesa, CA 92626
Devclopm.ent Services ilep:irt.�en[
Plannin�, Division
City ot i:osta Mesa
77 r'air Drive
Costa I1esa, CA 92626
Attention: rir. Paul Dudlcy
Dear Ptz. Dudley:
Please be aware that the undersigned are aware [hat n certificate of occupancy
on the above referenced lot and unit is bcing requcs[ed prior to the entiie
tract and its streets �nd cor.vnon areas Ueing completed and accepted by the
City of Costa htesa.
BY���. �%.�-� -
�
�: o//&-n�vLLorra nnv/oti
E➢ l[�EPP.[iSLI�iTATIVE)
BY
RECEYV�n
S�P p4 198u
�PPLICATION FOR A BUILDING PF" 91T
� /, BUILDING PERMIT NO. Eiectr�ca� m
T�ac[ Q�y� Block Lot / O� P¢/mit No. �
Plumbing a
Bulitling �
� Atltlross ga� �Q� /�et�5 Ct. Permlt No. �p
�j / / Cross �� � I � Mechanieal C
Area ,�j�� ��lG/7U street Pormii No. �-
'm
G(lQ ��Z �� �
Owner �e� Typeof Project: ❑ New ❑ Alter faHtltlition
Atltlress qa� �Q� �ec�$ �' ❑ Repair ❑ Convert ❑ Demo ❑ Ocwpancy Pmt.
CItY (j�� /7C� TIP ��}ry�j Phone �a 3 A.P. SUP. Dist./
InSp. Area
Architect/ /�
Designer 6�/� � yG'S LicenSe No. Zone SPI. Pmt. NO.
AEtlress
Setbacks P/L Front C/L St. Street Wldth
YarCs Lett R 9 ear
CitY Zip Phone �
, ave ol. e 9 . .
« Engineer LicOnse No.
� Park ng SPaces equ re rovi e overe
a Atltlresz
m CItY Zip Phone Struct No. of No. ot
Helght Storles Famlly
� LICENSED CONTRACTOR'S DECLARATION Park Faes ves Fee
°p ReqWreC No C.T. Receipt
m I heroby attirm that I am licansad u�der provisions of Chepter 9
_ (commencing with Section '/000 of Division 3 of the Businxss antl Zoning Approvetl BY: Date
v. Professions Cotle, and my licensa is in tury force and effecc).
7� License Cles Lltense Number
T Date_____Conttactor Misc.
E Atltlress Proposetl Use
of Structure
�'y City anA 7_ip Phone
N CONSTRUCTION LENDING AGENCV
� 1 hereby effirm that there is a conshUction lending aBency for the
a porformance ot tha work for which this pormit is issuetl (Soc. 3097, �cc. TYpa Cotle
' Civ. C.1. C1a55 Const. Year
y Lender's Name USE/OCCUPANCY S12E SQ. FT.
� Lantler's Adtlress
� OWNER-BUILDER DECLARATION
� I hareby affirm Shet I am exempt from the Conhactor's License Law 1�
q for the following reeson:
� � I, as awner af the proparty, or my amployeas with wages as their 2.
wia compensetion, will Co the work, antl tha structura is not
= intentleA or offared for sale.
3 ❑ I, as uwner of th¢ proporty, am ezclusively conbacting with 3�
licansed contrectors to conshvct the p�qact.
r ❑ I am exempt vntler Ser.. , yg�pC tor this reewn 4'
v
;� Dat Owner
E WORKERS' COMPENSATION DECLARATION Tota� valuation
� I heroby nffirm that 1 have a certificate of consent to self-insure, Encroachment Pe�mit ReQulretl ❑ Ves ❑ No
« or a certificata of Worker5' COmpBn58tiOn IOSVIdOCB, O! d C¢ISIf12d
G cOpy Ihereof. Gratling Pmt G�ading
� Policy No Company Requi�etl ❑ Ves ❑ No Pm[. No.
�R ❑ Certified copy is hareby iurnishetl. Rough Gratlln9 v
Q❑ Certitiotl topy is filetl with Oran9e County, EMA. qpproved by: Oale tD
DaYe Applicant 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSqTIONINSURANCE Z
(This section need not be completed if permit is for $100 or less): C
I certify thnt in the performunce oi ffie work for which this permit is 3
issuetl, 1 shall not employ any person i� any manner so as to become m
subject to tne Workers' ComuanseNon La�ys of California. PERMIT FEES
Deta Applicant
NOTICE TO APPLlCANT: It, attar making this Certificate of Structural $ Plan Check $
Evemption, you should becoma subjett io the Workeri Compensation
provisians ot the Labor Cotle, you mu5t forthwith comply with s�ch Electriral y S�ecial s
provisions or this permit shxll ba deemetl revoketl. Invest.
1 CERTIFV THAT I HAVE READ THI$ qppLICATION AND STATE
THAT THE ABOVE INFOFPAATION IS CORRECT. I AGREE TO P�umbing 8
COMPLV WITH ALL COUNTV ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBV AUTH- Mecnanlcal S
ORIZE REPqESENTATI VES OF THIS COUNTV TO ENTER UPON
THE A M NTIO�D PROPER7V FOR INSPECTION PUR- Pre-Gratle
POSES Inspection E
�� '6 �� Pra-GraOe Permit
�Si nature of Applicant or Agent L D`ate Rea No. $ Issue $
i�ilE /� Gr%G/�z� �.Ce� /e/n���
Print ApplicanYs/AgenYs e
All s aces within this 6ox must he com letad to rocea P�an Issuance
P P P Check By: ApprOvetl:
i,mr UJSD�40 (CV�L6f rev. o�av
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COSTA MESA BUILDING-SAFETY DEPARTMENT
2447 II/p6/BO � �•23.00
APPLICATION FOR'STRUCTURAL PERMI F
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 '
RECEIVE Y PERMIT 7�j0 5 0 9 4 9
For Applican[ to Fill in Completely — Use Ink Only � i��
BUILDING C�aI �� N�SS �• A.P• NO. �"
ADORESS
BVILDING
OWNEROR /� // i_/��� ADDRE55 �LM
TENANT KE/) �� U/
UNIT OR
MA1 LI NG ��/ SPACE NO.
ADDRE55 9a ��n NGSS �^ •
/j � TR.N . LOT � BLK.
CITV �-e�i /� 9a�n NOL Op"I�j"a
NEW ADO AI.TER REPA R MOVING �EMOLISH
LENSTRUCTION /� /G ( _ � � /
! �3Q �
BRANCH /
OWNER Q,�.� �R.(
ADDRESS � � ✓ VALUE '1
ARGHITECT TE � USE � � O✓G E a%•�'
OFi ENGINEER
��`,
ADORESS ZONE TVP v GROUP
CONTRACTOR O((JqQ/' U� APPROVED
�� PJ BV DATE Il G�
ADD
TEL.
CITV NO.
STATE APPROVEDSETBACKS
LIC. NO. IIC. .
SIZE NO.OF BLDCS. (FROM C/L STFEET)
OF LOT ' NOW ON LOT RONT
USE OF / . �
EXISTINGBLDG. /lame. Cdnc��m:n�u.n � "
♦ � .
Separate permits are required for L. SIDE Fr:
electric, plumbing and heating work.
REAR T.
VSE OF BUILDING AND WORK TO BE PERFORMED P�,p,NNINC. ACTION
p / �^•_ DATE
e � / 4ci d �-tll/G/` AFFROVED
APPROVED I_r
"CD
I hereby ecknowlatlge that I heve reatl this appliceNon antl stete
that the above informet(on is correct and eB�ee to eomply wlth
all laws regulating b�ildinB construction, antl I shall not amploy
any person in violatlon of the workman's compensation laws of
the S[a[e af Califomie. �,SOO' �-
I hereby cerilfy that I am properly Iicensetl es a contrector untler S�. FT.
the Staie ot Californla Business end P�otazsions Code, Division 3, THE AMOUNT SHOWN UNDER VALVATION IS FOR
Chaptar 9, and ihat such Ilcanaes ara in tull force entl effect, ar I THE �URPOSE OF ESTABLISHING A PERMIT FEE ONLY:
em eaempt from tha provisions ot the State of Celifornla Buslnezs
end Profe551on e, Dlv\lsion 3, Chepnr 9. VALUATION PERMIT FEE $ �S ��
� ' �/� �� PLAN CHECK 5 �C:i
SiBnetora o `
Permlttee p S /� �d �� TAX E �} cJ�
Authorizatl Agant Date �%��0� TOTAL PAID a 23 . a a
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OWNER y�,TZ, I�I R.
JOB ADDRE55 92]. Van Ness Court
GENERAI CONTRACTOR p�l r-b �i 1 Pr
A' '�� 418-083-49 LOT 1 TRACT
II :cTloNs Si �oru
SOIL
GAS
W �TER
ROOGH PLUMBING
PROP. $WR. LINE � HOUSE CON.
SPAINKLING SYSTEM
MISCELLRNEOUS
ROUGH MERTING �ND �IP �ONDITIONING
TEMPOR�RV SERVICE OR POLE
UNDERGROUND � POWER �
AOUGN WIRING
THENCHES FORMS STEEI REIHF. A�%
� FLOOR
v BOND 6
UsNEPrI
N FRAME
� L�THIN
,� PL�STI
5�
VD FLASNING
- IN n
UI —
C ME .�G. VENT.. REP
�PLUMBING, FINAL AN
W ELECTRIC, FINAI
nuunir�r. viuu
DATE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ [o Fill in Comple[ely — Use Ink Only
flU1LO1NG
ADDRESS
OWNER Biddle Development, Inc.
nooRess 3848 Campus Dr. Suite 116
Newport Beach, CA re6l+0-550'
CITV NO.
CONSTRUCTION
LENDER N/A
BpANCH
ADDRE55
ARCHITECT TEL.
OR ENGINEEIiT.a(�d �P� cP�G]nndHrd NO.
ADOREs�80 Newport Center Dr. NB
CONTRACTOR g;ddle Development Inc.
ADOREss848 Campus Dr. Suite 116
TEL.
cirv Newport Beach, CA No.540-550
�?c No.g 286614 LICYNO.
S I Z E I NO. OF BLDCaS. _
OF LOT NOW ON LOT
USEOF residential
EXISfING B�DG.
electric, plumbing and heating work.
USE OF BUILOING AND WORK TO BE PERFORMED
itnit dk 104 (D) 1740sq.ft.
105 (C) 1603
a`SL,�c�. �,/3�i/79 , 251.00 T�L•
a-�;. -
A -
APPLICATION FOR STRUCTURAL PERMIT
ECEIVEDBY DATEflECEIVED nnTcieciicn
�(} � �`�c y.a� PERMIT NO.
R2i—L�
g 2 2, qa 3 L�., ,tJ� ss �
TflACT
ED
�� y� PLANS
VARDS APPROVED
DISTANCE BET
MAIN BlDGS.
VAR. �I` �
C.UR. 3Y`
HOLD
I hereby acknowledge that I have reatl this aOP���atian antl state
that the above Information Is correct antl agree io comply with
all laws regulating building conztruction, and 1 shell not employ
eny porson in violation o4 ihe workman's compensation laws of
the State ot California. �
I hereby certify that I em prop¢rly licensetl as a contractor untler
tha State ot CalHornia Business and Prot Cotle, Divlsion 3, THE AMO
Chaptar 9, and that such licenses ar t for<e ontl effect. or I THE PUFP(
am exempt Srom tfie provisfons ete ot Ce1NOrnia Buslness VALUATION
antl Protessions Co Divisio aPter 9.
Signatur L L/
Pe�m $ / �
Agent
i
USE OF NEW �(.(�ti
BUILDING ("��
YAR�S �+PPROV E�
BET. MAIN &
�
m
� t �
• C N y J
VN UNDER VALUATION IS FOF m �
'ABLISHING A PEPMIT FEE ONLV: e
PERM�T FEE S d� I
�
m ^
PLAN CHECK $ 0� o fY u i
LL „
TAX S � � I
U /l
TOTAIPAID $ ''T
' �
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�"
5505 4/10/79 369.50 T�
COSTA MESA BUILDINGSAFETY DEPARTMENT APPLICATION FOR STRUCTURA�L PERMIT .
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For Applican[ to Fill in Completely — Use [nk Only �
BUI LDING A,P, NO.
ADDRESS
• BVILDING
OWNER OR , + ADDRE55
TENANT
UNIT OR
MAI LI NG SPACE NO.
ADDRE55 3848 Cam us Suite 116
TR.NO. LOT BLK.
TEI.
CITV N2W or[ Beach CA No. 540-5505 NEW ADD ALTER REPAIR MOVING DEMO�ISH
CONSTRUCTION
LENDER
BRANCH
OWNER
AODRESS VALUE
ARCHITECT TEL. USE S
OR ENGINEER N
ADDRESS ZONE TVPE GROUP
APPROVED
CONTRACTOR Biddle Develo ment�:��� BV DATE
ADORESS
TEL.
CITV NO.
STATE CITV APPROVEDSETBACKS
IIC. NO. IIC. NO.
SIZE NO.OF BLDGS. (FROM GLSTREET)
OF LOT NOW ON LOT ONT FT.
USE OF
EXISTING BLDG. T
Separate permits are required for � si Fr.
electric, plumbing and heating work.
flEAR FT.
USE OF BUILDING ANP WORK TO BE PERFORMED PLqNNING ACTIOIV
DATE
APPROVED
Permit — Tract 10445 �R�VED
I hereby acknowledge tpet I have reatl tNs eppl)cation antl stata 'i
thet the above intormarion is corract entl a8rea to comply wit�
all laws ragulating builtlf�g constructlon, and I shall not employ
any person in violation of the workman's compensation lews of
Me State of California.
I hareby certity that I am Properly licensed as a conttactor untler SQ. FT.
the Stata of California Business and Professions Cotle, Division 3, THE AMOUNT SNOWN UNDEF VALUATION IS FOR
Chapter 9, and that such �� s are 1 ca antl effeci, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempi from the isio of t Steie o alifornia Businecs
VAIUATION PERMIT FEE E
antl Protessions Cotl , i+� 3, aptar i
$ignat�re of PLAN CHECK E
Permittee $ TAX S
or
Authoriied Agent Date TOTAL PAID E 6g