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HomeMy WebLinkAbout273 19TH ST - Building Permits r e CITY OF COSTA MESA , /tS�1r BUILDING DIVISION _ i y., �"', 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. s 'I %�� ..L I 0.4 FOR INSPECTIONS CALL:(714)754-5626 ^bean 04. • PERMIT NUMBER P08-00153 PERMIT TYPE PLUM STATUS: ISSUED APN: 11721417 , ;,, ..DATE ISSUED: 06119/2008 '11'7-ISSUED BY: YH Y t ` JOB ADDRESS: 273 E 19TH;ST;CM '' Suite/Unit !� Vicinity: a, SCOPE OF WORK: REPLACE GAS LINErFROM METER TO HOUSE. 'hI 441 r r� / i.:' I OWNER: ILTIS, BARBARA I,. Address i 273 E 19TH Sr: PHONE: WI /e „ CIty/State/Zip .- COSTA^MESA CA •,.,., APPLICANT: TAITE,GREG ;, c' t 1' .,,:_;. 1:••.,9.1__ Address - :' 718 UTICAiAVENUE PHONE: 714-960-1474 City/State/zZlp: zHUNTINGTON BEACH, CA ,r,_ CONTRACTOR: CLEARLINE PL UMBING SOLUTIONS License No.' 890970' = <53 Address: 718 UTICA AVENUE • I `-° .' _: . " :` PHONE:' 714-960-1474 i City/State: HUNTINGTON BEACH CA ' ZipCode:, 92648 - CELL: ARCHITECT: ENGINEER: I License No. PHONE: ) A: Pi:UMBINGPERMIT. IEE:'SUMMARY,"' ' PLAN'CHECK FEET;f , , $0 00 PERMIT F,EE :w i I ..$332.301' TOTAL FEES $33.30 .. • 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. CODE#. INSPECTION TYPE PATE INTIPALS CODEC INSPECTIONTYPI; DATE IN111IA`L�`5��r�",J- 1616 FixedlSystem Fin Final Fire Prevention 206 Final Mechanicalmbi � �� V 1266 Pool Spa Final 208 Final Plumbing pi 4_ b 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 drivt -Ise. ❑Yes ❑ No I hereby affirm under penalty of perjury one of the IL__..mg declarations: - Driver's License No. Expires: 0 I have and will maintain a certificate of consent to self-Insuredor 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. . • • - •' r' . (❑il 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation I surance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: •/� ` person is required to descend,will be made in connection with work authorized i / `-'Y�In cf -; 1/� by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: UQboVa___llliiiCCC J 1Jl t or dismantling thereof,will be more than thirty-six(36)feet high.(Chap. 3.2,Grp (This seaie need rbtmin puna is af�pe hundred dollars(btoo)aless) 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). Policy Number. CIL Le`tel- /\ ❑ As owner-builder, I will not employ anyone to do work which would O 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's signature Date the Labor C.•e,I sh-_forthwith comply with these provisions. fall,-..-2-1-r - 6 - l 1 9 _o- Division of Industrial Safety Permit Number: 9 Vs Signa Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: %.__,41. Will the applicant or present or future building occupant need to file and WARNING: FA ••E TO SECURE WORKERS'COMPENSATION COVERAGE 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? 0 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: ull force 4and effect. / a registration form for acutely hazardous materials? 0 Yes 0 No Lic..#-t- (S 10 (7 9/^)Class# C.- (Section 25533 of the California Health and Safety Code, with some >_-- • exceptions, requires registration with the Costa Mesa Fire Department by ,o, - �- -b --)9-06 each business which at any one time has on hand a quantity of acutely �ranlignature - Date hazardous materials equal to or greater than a weight of 500 pounds, or a v 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 California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 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 Duality 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 Califomia 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? ❑Yes 0 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). O 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 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 certifyithat 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. 1 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 until final inspection. . . Si..- ' • '• • ner(s) Date. Signature . 3057-46(3107) L~ /9 _O/��A 6 than ..Applicant rDate PROJECT ADDRESS: 273 E 19TH ST • UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: MP 048050 OWNER'S NAME: FRED ARNOLD - ADDRESS: 273 E 19TH ST PERMIT NO: MP 048050 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA .. . CA 92627 CONSTRUCTION TYPE; 5—N PERMIT TYPE: MEC PLU • PURPOSE: ADD ARCH/ENGINEER: ( 714 ) 642-9435 REO.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REPLACE PLUMBING & MECH SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 / PERMITTEE: FRED ARNOLD ( 714 ) 642-9435 ADDRESS: 273 E 19TH ST COMMENTS: REFER TO #BE47680 COSTA MESA CA 92627 **yr***>F*->F>E****** *****>E***>E****x >E>F+r********>E* **+rut-********* ***>t********aa«****x- UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS • 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY UC.: STATE UC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING laKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT . IN FRNT: FT IN REAR: FT IN tpensation Insurance,ora certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN I ...MY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL : 11721417 ZNE: REF NO: 'l.Certified copy is hereby furnished. D Certified copy is tiled with the city Building Division. PLANNING NOTES> • „ate: . Applicant: -' *******************************************************************:BE*********** EXEMPTION FROM WORKERS'COMPENSATION OECLARMION: (This section need not be conpleU. I the is for one hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M E :N .T S . I certify That in the pe.•rmance• the work for which this permit is is •.,' hall .t,mpl•. any 7 iii any manner so.--• •. ome subject to the Work s',,,imp' on aws of California. ' r� jn1 / ( ZONING APPROVED BY DATE: Date: '`� Signature: '� /// NOTICE:I after ma- g this declaration,you shout ,• e subject to t lir iro.rn .ton provisions of he L._.. BUILDING APPROVED BY : DATE: ` . Code,you must fort with comply with such provisions or this permit shall be.•emed revoked. !, //; CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the'penormance of the work for APPLICATION ISSUED BY : which this permit is issued(Section 3097,Civ.C). ***********?F**************************it**it1**********************iE* . ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N • l : 0 OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SKIP/REST," GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,improve,demolish,or PERMIT 1 4 . 0 0 9 , 0 0 y1' repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed / G pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business - 25% 25% SHIP/MON-LR E S and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN • ••applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). - ISSUE FEE 3 . 00 15 . 00 --L1 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV--> PERMIT ISSUE PLAN—CHECK TOTAL PAIDT DUE structure is not intended or offered for sate(Section 7041.Business and Professional Code: The Contractors State License Law TOTALS————> 23 . 00 18 . 00 0 . 00 4 1 . 0 0 41 . 0014° . 00 - does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through -, -I •his or her own employees,provided that such improvements are not intended or offered for sate.If,however the building or7 t4,, n.--+improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or Improve REVENUE DIVISION TOTALS--> COLLECTED : 41 . 00 OVER/SHORT: •, 1 ,....o • forme purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING LAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business • 17 .00 24 . 00I ❑ •and Professions Coda: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contactors'State License Law).l am aware *********************************************************el-************-********?t that proof of their Worker's Compensation insurance should be provided to me. / s.x INDIVIDUAL F E E BREAKDOWN E I am exempt under Section:B P 7 0 4 4 B.A P.C. n for this r n: �AjJ� WORK BY OWN( — /( TYPE QTY D E S C R I -P T I O N UNIT COST 1, TOTAL COST • Date: 7 A' . V Owmc �. ��,/ {-/ and PLU 1 BATHTUB 2 . 00 ' 2 . 00 • Ido hereby I to am aware of and understand the requirements of California Health. O Salary Code Sections 25505, FLU 1 DISHWASHER Gh 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 2 . 0 0 2 . 00 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from PLU 1 SHOWER 2 . 00 ' )• 2 . 00 these provisions. PLU 1 SINK, KITCHEN 2 . 00 2 .00 PLU 1 WATER CLOSET (TOILET) 2 , 00 2 , 00 Date: Applicant: PLU 1 WATER HEATER AND/OR VENT 2 . 00. 2 • 00 I hereby certify that I have read this application and state that the above information'. ..rrect.I agree to comply with all city and county /PLU 1 GAS SERVICE 2 . 00 2 . 00 Ordinances and stat laws relating tobuilding construction and hereby a vss . , : to enter upon the above-mentioned MEC 1 INST/RELOC RECESSED WALL HEATER 9 . 00 9 . 00 property for ins.• ion pu...•s. / �, �� ��� END OF FEES Or Date: I' Signature: Driver's Li 'rise or ial Security N: \ �� 01 00064745 00064746 TOT 41.00 164146 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor 77 DATE: 07/09/90 TIME: 11:12 r CONSTRUCTION AND PLANNt, )01. PA • APPROVALS Permit# Date • Inspector APPROVALS -Permit # Date Inspector r 1. Temporary Electrical Service or Pole - -i 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement f"/ / 3. Electrical Conduit Utility-Undrgrnd. - 'T 54. Forms _ t' 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. j / / 8. Foundationr /r 59. Gas Pipe, 0 Undrgrnd.,Test . - 9. Water Pipe-Undrgrnd. ! 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System i � 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection - ,', 62. Backwash & Receptor-Final • . 12. Sewer Cap -' " 63. Heater & Vent-Final Z • 13. Roof Drains / 64. Plumbing System - Final 14. Rough Plumbing Ei//plt - t4C9 65. Electrical-Final i 15. Rough Electrical-Conduit 3 66. Solar System-Final • 16. Rough Electric Wiring a f'` 67. Fencing & Access Approval ,/ ".� • 17. Rough Wiring Sign - - .'/" r 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 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 412.5-fro 9 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co I 51. CERTIFICATE OF OCCUPANCY No. Date 1 PROJECT ADDRESS: 273 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 048051 OWNER'S NAME: FRED ARNOLD ADDRESS: 273 E 19TH ST PERMIT NO: E 048051 PLAN CHECK NO: N GOVT : N SUPP : Y COSTA MESA ' CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: ADD (714 ) 642-9435 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ADD ELECT WORK TO PERMIT 4BE47680 SQ FT: ADDRESS: UNIT: • CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 / PERMITTEE: FRED ARNOLD ( 714 ) 642-9435 ADDRESS: 273 E 19TH ST COMMENTS : REFER TO $BE47680 COSTA MESA CA 92627 ********>E+Era*****>E*x******************Nx*****+ ***>f********le**********>E*+E***xat*** UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7090)of Division 3 of the Business and Professions Code.and my license is in WI force and effect. SETBACK S CITY sec.: STATE sec.: CLASS: • rale: Signature: MAIN BUILDING ACCESSORY BUILDING RKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sen-insure or a certificate of Workers' FRIT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN .hpensation Insurance,ora certified copy thereof(Section 3804 Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POUCY ND.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 11721417 ZNE: REF NO: -I, Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > oats: Applicant: ***********************************eE******************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Itis section .-.not.:.• - I be;• ' is M one hundred($100)• less). DEVELOPMENT SERVICES R EQUIREMENT S I certify that in the•• Orman• of the work for which the permits', if sha n. emm n in any manner • -come _ - - Date:ttoth:W �Co�� .tion LamolCalilomu. / / ( ZONING APPROVED BY DATE: Date: 41., Signatu NDTIC : f,atter •. g this declaration,you show. •... • -subj- tot :W. .rs'Co pensalion provisions• •e Labor BUILDING APPROVED BY : DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: - • DATE: .--•�Ls • which this permit is issued(Section 3097,Civ.C). ********************** ********..**,7 1 R0 ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E S:U.,M M A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby 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: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 12 • 0:0 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed r < pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business r 5 01 g,j SMIP/NON—RES 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 . •applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). I SS UE FEE -4 . :0.'*. ' 1, as owner ti the propend or my employees with wages as their sole compensation, well do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN;CHECK TOTAL PAID DUE L7 structure Is not Intended or offered for sale(Section 704A,Business and Professional Code: The Contractors'State Ucense Law TOTALS————> 12 . 00 4 . 50 0 . 00 16 . 50 16 . 50 . 00 does not apply to an owner of a propend 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 Improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or Improve REVENUE DIVISION TOTALS--> COLLECTED • 16 . 50 OVER/SHORT: 00 for the purpose of sale). 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 16 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or Improves thereon •, and and who contracts for such projects vith a coniractorts)license pursuant to the Contractors'State License Law).l am aware **********************************.*i**************.*******.******,*.*.+**.*.*,*,*,*.*******, that proof of their Worker's Compensation insurance ce should be provided to me. r ® am exempt under Satan:B .7044 B.8 P.C. INDIVIDUAL • F E E B R E A K D O W N forihisreasm RR K BY OWNER / TYPE QTY D E S C R I P T I O N ,. UNIT COST TOTAL COST Dale: K9 c Owner: Zi 'err i��//_ i r � ELE 6 FIXTURES LIGHTING : 1 ST 20 EA. . 75 4 . 50 • Idohereby ndthatcertify that am . -.ofand understand the requirements ofeed,orris Heltha• .lett ••eSaions25 •• . d ELE 10 RECEPT/OUTLET / 1.• ST 20 EA. . 75 7 . 50 25534 and that I or any future building occupant w01M01 not(circle one)need to comply with said state codes and the requirem- • or a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from END'O F FEES these provisions. Dale: Applicant: ..-. %A ' I hereby certify that!have read the application and state that the Information .correct.I agree to comply with all city and county , ordinances and state . •relating •• .... •aramxaion. ,.herelf� ; ///yy/ f this city fowler ..j... :mentioned ,• • . . propend for irepectlo' pu...r - or -••i///"/ -. ' r' Date: /1J r• ` Driver's Lice or Soc'+ Security A: 0100064747-00064747 TOT 16.50 1641-46 white—Building;Green—Code Canary—Applicant Canary—Applire Pink—Revenue:Goldenrod—Assessor DATE: 07/04/90 TIME: 11.12 CONSTRUCTION AND PLANN,.....; /OO1 PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector / , • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 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 • ..'� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System • ' - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final12. Sewer Cap 63. Heater & Vent-Final " • 13, Roof Drains •' , 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 1 16. Rough Electric Wiring S-10--Y1)self ' - 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 j0 r itte.i I� Notes: � ,/1 34. Final Heating & Air Conditioning • 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 273 E 19TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 048052 OWNER'S NAME: FRED ARNOLD ADDRESS: 273 E 19TH ST PERMIT NO: B 048052 PLAN CHECK NO: N GOVT : N SUPP : N . COSTA MESA • CA 92627 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH ARCH?ENDIREER: ( 714 ) 642 9435 REO.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REROOF 500SF W/COMPOSTION SHINGLES SQ FT: 1 , 200 i CLAIM VALUE: • 1 , 200 . 00 CALL-VALUE: 1 , 200 . 00 GROUP OCC : . R-3 / • CPERMITTEE: FR ED ARNOLD ( 714 ) 642-9435 ADDRESS: 273 E 19TH ST COMMENTS : X COSTA MESA CA 92627 ******************************************************** e� LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON INC REQUIREMENT I V 1©t fETQ R 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. R CITY CM: STATE M.:: CLASS: SETBACKS REQUIRED fl 6s! G Date: Signature: MAIN BUILDING ACCESSORY BUILDING WKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure ora certificate of Workers' FRNT: FT IN REAR: • F T IN FRN T: FT IN REAR: FT IN .npensation Insurance,or a certified copy thereof`Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: • FT IN IPOLICY NO.: EXP.DATE: COMPANY: PARKING REQ:_ PROV: PARCEL : 11721417 ZNE: REF NO: • r3 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > gate: Applicant: ************-**3e:fE******************************************************* ******** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This secti•i eed not be compl{ted if the permit Is for one hundred($100)or less). DEVEL OPMENT SERVICES R E Q U I R E M E N t1' S I certify that int perform nee of the work for which this permit' u I sit. not employ.• ••rson In any mann• so a o become ' subject to the alters' mpensationjLOM of California. —. /ZONING APPROVED' by A Date: 7 9 o \ Signature: employ I DATE: .r NO :IL a making this declaration,you should b!me subject to the 'orkers'Compensation provision of Labor BUILDING APPROVED BY : DATE: "1.7 Code,you must forthwith comply with such provisions or tiffs permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: µ,A- DATE:which this permit is issued(Section 3097.Civ.C). *****************************************':-'F;r*I ekcIF *3F'*9F*3F********** ''�F'*'** UNDER: ******************************************************************************* • ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y . OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR',IC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 29 . 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 r 5 0 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 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 • .1, y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 7,' I, as owner of the property or my em loyees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I LJ structure is not intended or offered for sale(Sect=7044 Business and Professional Code: The Contractors'State License Law TOTALS----> 29 . 50 0 . 00 ) 0 . 00 29 . 50 29 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himseff/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or n. 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 TOTALS TOTALS--> C OL L ECTT/ED : 29 . 50 OVER/SHORT: 0 0 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as corner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 29 . 00 • 50 ❑ '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 *,*************,***********************,*,f4**********,**,****.********.*****,*,**,*******,* that proof of their Worker's Compensation Insurance should be provided to me. I am exempt under section:B P 7044 B.a P.C. INDIVIDUAL ' yF E E BREAKDOWN for this reason: AL' WORK BY 0WNE• % ( TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: �Q I ow ; SFR 1200 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 1 , 200 . 00 7 S .ILL I do hereby certify at I am are of and understand the requirements of California Health and Safety Code Sections 2 25533.and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with :id stat•codes and the req ements for a permit for const don or modification from the Air Quality Mane ger•• '•stric '• 'dent co• ' on applications are exempt from these provision / if_ Date: CcApplicanl: A _.� — •i MI I hereby ertify th I have read this application and state tha the above information is•••ed.I agree to comply wi all city and county /" ordinances and state Laws relating to building construction and hereby autho• •re•resentat s of •'+ M to enter upon ".bove-mentioned property for inspe ion pur ses. • //,�/ '' • Date: Signature:'r S' 1 c, A, fir Driver's License or ial Security x: ' 01 00064748-00064749 TOT 29.50 1841<e White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor DATE: 07/09/90 TIME: 11:13 • CONSTRUCTION AND PLANN,,.S .'00L PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location . %. 2. Soil Pipe-Undrgrnd. - y " 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 ConduitUndrgrnd. 8. Foundation 59. Gas Pipe, 0•Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. ! ' • ` /, 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains r 64. Plumbing System - Final • = y 14. Rough Plumbing - 65. Electrical-Final . 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval . i 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Be; 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 fio-Qo 4tq/9 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 /p^.2a - to- C'K� ` . +tt. 35. Final Gas Pipe-Test C < "c &cv41 36. Hood or Canopy - - 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 l54.2‘...* (ib' 48. FINAL PLANNING 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 273 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B .048302 OWNER'S NAME: FRED ARNOLD ADDRESS: 273 E 19TH ST PERMIT NO: B 048302 PLAN CHECK NO: 05014-90 S GOVT : N SUPP : N t COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: OTH (714 ) 642-9435 .ARCH/ENGINEER: REG.NO.: JOB ,DESCRIPTION : INSTALL SKYLIGHT • SQ FT : 500 ADDRESS: UNIT: CLAIM VALUE: 500 . 00 CALC—VALUE: 500. 00 GROUP OCC : R-3 / • PERMITTEE: FRED ARNOLD ( 714 ) 642-9435 ADDRESS: 273 E 19TH ST COMMENTS : INSTALL SKYLIGHT ICB0#3933 COSTA MESA CA 92627 ********>E>ElF*********xrF**************> x+Ex******* ***aE***R*-rEar*>F* ****:r********->E** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of DMsion 3 of the Business and Professions Code,and my ncense is in full force and effect. SETBACKS ' CITY UC.: STATE LW.: CUSS: Signature: MAIN BUILDING ACCESSORY BUILDING • . FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: • FT IN (ENS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: .FT IN RGHT: FT IN peneation Insurance,or a certified copy thereof(Section 3800,Lab.C). POLICY COMPANY:NO.: EXP.DATE: PARKING REQ: PROV: PARCEL : 11721417 ZNE: R1 REF NO: -CO Certified copy is hereby furnished, ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> NO PLANNING APPROVAL NEEDED AS PER CP • ate: Applicant: D EVE L O T.... Mfr E N T SERVICES R E Q U IR EH E N .T: S EXEMPTION FROM WORKERS'COMPENSATION DELL MTION: (This section need not be co.plated if die punt is for one hundred($100)or less). I certify that in the p ormance 'the work for which this permit is .•, s II not: ploy.ny person in any manner so as to become T Subject•t�ome Wo ars'Com Non Laws of Calfomia. ZONING APPROVED BY .t f . : DATE: Date: 2 9� (Signature: - ' � s �L/.� BUILDING APPROVED BY Nom .If,after m ng this declaratioh,you should become subject to the kers'Compensation provisio s of the Labor u • DATE Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ";'� r CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BIt • • DATE: (..� r which this permit is issued(Section 3097,Cho. *.*"*.*.***.x.'*'k'**''6*'E.*.N''•e.M' ''�'**"N.*.*.**'***.*'.R'*.R'*****.*.N'*'•t"'F*' •• ?E*********? 1E3F'TF�.Q LENDER: ***********************************iF*********************************9 *3E******* ADDRESS: LEGALIZATION : N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG �PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 5 . 00 . 50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed -----+ SM I P/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 9 . 75 (j -tee Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE 'DPlicant lora permit subjects the applicant roacMl penalty of not more than five hundred dollars($503). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 15 . 50 0 . 00 "` 9 . 75 25 . 25 25 . 25 . 00 (] structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors State License Law (1 3 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 unprovements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS——> COLDECTED: 25 . 25 OVER/SHORT; 00 improvement is sold within one year of completion.the owner win have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MPCHAN IC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 15 , 00 (t . 50 9 . 75 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: The Contractors'State License Law(toes not apply to anowoer of property who(Rath or improves thereon ***eE************'i.'***********?F*************ie**************?t;***a(-***************** and who contracts for such projects yth a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compens:tion insurance should be provided to me. I N D I V I D U A 1,.,, FEE BREAKDOWN I am exempt under Section:B P 7 0 4 4 B.B P,C. • for this rea ALL WORK BY O,NEA. TYPE QTY D E S C R I P T I O1 N UNIT COST TOTAL COST Data:_ 1 24 15re2 ! Owner 'I "irilther SFR 500ALTER BY VALUE RESSIDENTIAL NOZONE 1 . 00 500 . 00 I do hereby certify that I aware of and understand the requirements of California Health and Safety Code Sections 25506. '5533,and END OF FEES 25534 end that I or any future building occupant will/will not(circle one)need to comp with said state codes and the require ents for a 5' permit for construction or modifi tion from the-AV-Day Ma. ; •ant Di rict.Re?.ential construction applications are exem a from these Provisions. ' Date: - 0 ��i� Applicant: a r{, I hereby cern that I ha read this application and state that the above information is correct.I agree to comply with. .ty and county -t ordinances and state laws relating to building constnlction and hereby. .. .'..:re.rase •;-of this dry to enter upon the above- . ed . T h• .:1 property for' inspe��tioon puurrpose �T __ . Ct0. Date: 2 iZ-1 / V (signature: / / zr Driver's License or Soclarsecudry 0: 1 01 00066206-000662008 TOT 25.25 \ 1641.46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor DATE: 07/26/90 TIME a 13:55 V • ' 1 CONSTRUCTION AND PLAN, .i '001 PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement j- , 3. Electrical Conduit Utility•Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test i - 9. Water Pipe-Undrgrnd. - 1 •i' 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System �' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains 64. Plumbing System- Final - 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring • 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING; / - ,o . 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 g/0.q0 (W,1 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: //1 ZC-e9c. - JL ! a( cit 34. Final Heating & Air Conditioning l�" 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace . 38. Final Plumbing 39. Water Service-Final 1 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 * 644(- 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No Date PROJECT ADDRESS: 273 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 048549 OWNER'S NAME: FRED ARNOLD ADDRESS: 273 E 19TH ST PERMIT NO: B 048549 PLAN CHECK NO: N GOVT : N SUPP : N COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ADD (714 ) 642-9435 ARCH/ENGINEER: REO.NO.: JOB DESCRIPTION : REPAIR TERMITE DAMAGE SQ FT: 8, 000 ADDRESS: UNIT: CLAIM VALUE: 8, 000 . 00 CALC—VALUE: 8, 000 . 00 GROUP OCC : R-3 / ' PERMmEE: FRED ARNOLD ( 714 ) 642-9435 ADDRESS: 273 E 19TH ST COMMENTS : REFER TO #B47680 COSTA MESA CA 92627 *********************at*****arx*******+r*+eat***lr*******************er*************** LICENSED CONTRACTOR DECLARATION: hereby affirm that I am licensed under provisions fChpter 9(commencing with Section ZONING REQUIREMENTSQDand Professions Code, fers Cc is in SETBACK T B A C K S CITY UC.: STATE UC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING YORKERS'COMPENSATIONDECLARATION: I hereby affirm that)have a certificate of consent toseuasure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN ,ompensation Insurance,ora certified copy thereof`Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN I POLICY EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL : 11721417 ZNE: REF NO: ❑ Certified opy Is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> Date:3 / Applicant: *********************************************************************!F''********* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This •' reed not be completed the per it H or one Modred(5700)or less). D E V E L O P M E N T S E R V I C E S R E Q U Z R E M E N �•, S Icertity that in the perform ce of the work for which this per employ yDe, rot any r+,ter So as tO•�'O 9 subject to the orke Co penTsation Laws of Cali /� �i/`�j� ZONING APPROVED BY DATE: (. . Date: {�i n (Sonaue: �L : BILDING APPROVED BY : NOTICE.II,after king this declaration,you s become subject to the Workers Compensation provisions of the Labor — DATE: /a Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: ATE: _— I ,_ which this permit u issued(Section 3O97.Civ.C). **************************************** * *****************D****** ** * ** ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT :Y OWNER BUILDER DECLARATION: I herebyaffirm that I am exempt from the Contractors'State License Law for thefollowing reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Cade: My city o1 county which requires a permit to ca struct.alter,improve,demolish,or PERMIT 99 . 00 —• 5 6 repair any structure,prior to Its issuance.also requires the applicant for such permit to file a signed statement that he/she Is licensed n) pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business P LAN S M I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ) •ny applicant for a permit subjects the applicant to a dull penalty of not more than five hundred dollars(1500). ISSUE FEE .1 ' as owner of the properly or my a ogees with wages as their sole compensation, call do the won. and the BUILDING—DIV—> PERMIT ISSUE PLAN=CHECK TOTAL PAID DUE I ❑ structure is not Intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 99'. 56 0 . 00 0 . 0 0 99 . 56 99 . 56 . 00 does not apply to an osner of a property who builds or improves thereon,and who does such work himself/herself or through ,a his or her own employees.provided that such Improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS TOTALS--> COLLECTED: 99 . 56 OVER/SHORT• ,00 improvement U sold witNn one year of completion,the owner will have the burden of proving he/she did not build or Improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusivelycontracting with licensed contractors to construct the project(Section 7044.Business 99 • 00 I . 56 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who s Law).Ia thereon • ******************************************************************************* and who contracts for such projects with a eLice contractor(s)license pursuant to the Contractors'State License I am aware that proof of their Worker's Compensation insurance should be provided to me, INDIVIDUAL - I F E E BREAKDOWN I amexempt under Sectio BP7O44 B.&P.P.C.C. , fonthe. • A WORK BY 0 C7y�� eQTYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: / �� SFR 8000ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 8, 000 . 00 I do hereby••nil)?that I, aware of and understand the readn•••.+is of California Health and Safety Code Sections 25505,25533, rte END t 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 constr ion or modification from theAir ualty Management District.Residential construction applications are exempt from these provisions ' Date: Z / Applicant: a • .>• I hereby c rtify that I have r.'this application and state that the above information is correct.I agree to comply with all city and county • orOinances and s to laws relng to building construction and hereby mire repos toe er upon the above-mentioned property for in ection Pu ses. 1 'of / S' Date: / —/)0 ( Sig . re: f�/i I .4 Driver's License , Social Security it 01 00067493-00067494 T CE T 99.54 DATE: OE/14/9O TIME: 11:43 1641-48 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldemad—Assessor CONSTRUCTION AND PLANNING • POOL L. SPA APPROVALS Permit _ Date Inspector APPROVALS. Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing • 65. Electrical-Final • 15. Rough Electrical-Conduit - 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 O 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 'j&-2$._q0 _ [-z.S'ce`ne dist G� 35. Final Gas Pipe-Test • _ tL� 36. Hood or Canopy - • 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 `0-ZL1p 6E44 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY No Date 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BE 047680 LD • ST PERMIT NO: BE 047680 PLAN CHECK NO: 04373-90 S GOVT: N SUPP : N _9TH ESA 7 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE STR PURPOSE: ADD 2-9935REG.NO.: JOB DESCRIPTION : 40SF LIVING ROOM ADDITION SQ FT: 40 UNIT: CLAIM VALUE: CALCVALUE: 2, 760 . 00 GROUP OCC : R-3 / NOLD _ ( 714 ) 642-9435 19TH ST • COMMENTS: SMOKE DETECTOR(S ) REQUIRED IN HOME. COSTA MESA 'CA 92627 *******************************it+rrt***cit***yr*****srsr+rif***+r<**********dr***ar********* LICENSED CONTRACTOR DECLARATION: I hereby affirm that lain licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY UC.: STATE UC.: .' CLASS: Ne" Signature: MAIN BUILDING ACCESSORY BUILDING RKERS'COMPENSATION DECLARATION: I hereby affirm that l`haveaceNfiate of consent to self-insure oraceNliate of Workers' FRNT: 30 FT IN REAR: FT IN FRNT: FT IN REAR: FT IN ,mpensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHTn FT IN LEFT: FT IN RGHT: • FT IN IPOUCY NO.: EXP.DATE: ' COMPANY: PARKING REQ: PROV: PARCEL: 11721417 ZNE: R1 REF NO: 17 Certified copy is hereby famished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> 40 SF ADDITION TO AN EXISTING SFR. date: Applicant' , EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(3100)or less). D E V E L O P M; E _N T SERVICES R E Q U I R E M E N f�' •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 • gni/ • subject to the Workers'Compensation Laws of California. , , ZONING APPROVED BY -:- --.577 C DATE: C;.:5-,Er—to '-ss.-,96Date NOTICE:U,after making this deciaratiod,you Signature: should became subject to the Workers'Compensation provisiond of the Labor BUILDING APPROV£D BY? %I 7G R�"/jJ(/" DATE: to O �o Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. - L�`�.^, CONSTRUCTION LENDING AGENCY: I hereby affirm that there H a construction lending agency for the performance MIN work for APPLICATION ISSUED B Y: e DATE: v i. /p which this permit Is issued(Section 3097,Civ.C). _ *********************** * * *�1E** *** ** ' - **** *********************9F*O* LENDER: • *******ek************************************* *********************ie********** ' ADDRESS: LEGALIZATION:N F E E S U M M • R Y 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: .Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 . 00 13 /.50 5 0 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 O'8 L." 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 35 . 10 G� 'ltd Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by • y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S.500). ISSUE FEE 15 :00 t-t . owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLANLCHECK lc) TOTAL PAID DUE Istructure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State Ucense Law TOTALS—— > 68 . 00 1 5 . O O ..- 35 . 10 1 18 . 10 118 . 10 0 0 ❑ Idoes 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.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED : r118 . 10 OVER/SHORT: . 00 improvement¢coltiveWn one year of completion,the owner will have the burden of proving ne/sne did not build or Improve fororthe purpose of sale). 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 54 . 00 28 • 50 50 35 . 10 ❑ and Professions Code: The Contractors'State License Law does not apply loan owner of property who GWds or improves thereon and who contracts for such projects qth a contractor(s)license pursuant to the Contractors State License Law).l am aware ***'**********'**'****'****'*j(************.****'* NNN' ****'71N******'le*********'*'**'N'-1 **-**** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL "%F E E ," B R E A K D O W N - pg I am exempt under Section:8P7044 B.&P.C. for this reason: ALL WORK BY OWNE' TYPE QTY DESCRIPTIO NI , 4) UNIT COST TOTAL COST Date: fo g^ e 0 a Of%• A'red, «wSFR 40 DWE—TYPE V—WOOD FRAME / ! ' —GOOD 69 . 00 2 , 760 . 00 I do hereby certify that I am aware of and understand the requirements of alifornia Health and Safety Code Sections 25505,25533,and ELE 4 FIXTURES LIGHTING 1', S T 20': EA. . 75 3 . 00 25534 and that I or any future building occupant wilWAll not(circle one)need to comply with said state codes and the requirements for a ELE 10 RECEPT/OUTLET 1` ST 20 ' EA. . 75 7 . 50 permit for construction or modification from the Air uality Management District.Residential construction applications are exempt from ELE 4 RECEPT/SWITCH . 1 ST 2 0"' EA. . 75 3 . 00 these provisions. END-OF FEES Date: Applicant: , I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ' , r 'I ordinances and state laws relating to building construction and :• authorize representatives of this'• to enter upon the above-mentioned • property �' for inspection purposes. r. Date: 6 ' O f 4, Sig a urea i/ .. •, Driver's License or Social Security x: 434301 00062747-00062750 TOT 118.±0 DATE: 06/08/90 TIME: 11:11 1.... 1041-48 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor fAND PLAN. ... POOL PA Date Inspector Date InspectorPermit # APPROVALS Permit # _tI ;. Electrical Service or Pole 52. Pool & Equipment Location -Undrgrnd. 53. Steel Reinforcement Conduit,Utility-Undrgrnd. 54. Forms - Conduit-Undrgrnd. 55. Electrical Bonding �111111111' teel Reinforcement- 7-6'.20 &kill 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 7.-6-rtope CSV" 58. Electrical Conduit-Undrgrnd. 8. Foundation 94 //''rep 7-`J1 _but, 59. Gas Pipe, 0 Undrgrnd.,Test - 9. Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System' • _ 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • i 12. Sewer Cap 63. Heater & Vent-Final • , 13. Roof Drains - 64. Plumbing System -Final _ • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit ^,�OQ", 66. Solar System-Final • • .16. Rough Electric Wiring (oho COY 67. Fencing & Access Approval . • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL r 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 COil 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-Bat Ceiling (Structural) &'Monocoat , 75, DChemical • 27. Frame and Flashing. /,j�� 76. Dry Standpipe 28. Lathing& Siding; Y-1,7-10 &CV.Dl-- 77.- FIXED SYSTEM FINAL 29. Insulation • ' q_/ 4e605147,78. FIRE PREV. FINAL 30. Drywall Nailing ' �/Z17Q,, j HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coit - Y79. FINAL INSPECTION. 32. Electrical Power Meter-Final / 80.. FOOD CERTIFICATE ISSUED J -33.• Final Electric ; - )0 1 r t>!-'• Notes: 34.. Final Heating:& Air Conditioning / > 35. Final Gas Pipe-Test. . . ,'. _ 36. Hood or Canopy • .. - - 37. Final Factory Fireplace .`O ZC. -' 5' n •��� • 38. Final Plumbing -. - aGt� 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 ipa ...e aw141-- - 48. FINAL PLANNING : ,' 49. Electric Release to Edison .. . _ , • 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY - No. Date 1 ..,_../ ,a Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA ME2E�SA CONSTRUCTIO P RMIT PERMIT NO. ' 'TRACT NO. LOT NO. UNIT NO. A P Sly Zona Project Address 73 04-sr- / - 6 394 89 Li '' ( ` TYPE OF CONSTRUCTION LINEWADD LI ALTERATION X REPAIR S Main Building: Accessory Building: Applicant's Maili Address E Z ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T Front O Owner's Name -r khan�,y Phone _ ~ DESCRIP ION OF WORK/ E OF B DG. • A Rear N Address Ciiii . , 4- a Arch/Eng. License No. TYPE OF PERMIT IlG•'ADING FOUNDATION U STRUCTURAL C Right N Address ` r (, c ❑ TENANT K ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ Left G Jb$"� tJ'TWP3 phone9t 1-l�53 ❑ OTHER E Contractor's Name pr 4 Pl ng. Ref.# Parking Req./Provided E �+ PROJECT DESCRIPTION 5 FT. OCCUPANCY •f 1 ..7 Q Address(mailing) 12/ `- i'6 cm ' j Planning Notes: M 4,16 //_ 1O 7 CONSTRUCTION TYPE VALUATION$ City License No. Y rG T ZONE GRADING CU.YDS. ACRES S, LICENSED CONTRACTOR DECLARATION 1 f I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: a , : 1` l� with section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. //�� ELECTRICAL FEES License lass - C // 'cense No..___ Se Date Signature' ..�Y�l PLUMBING I FEES Automatic Washer Transformer 0 15.50 KW WORKERS' OMPENSATION D2C,O.A RATION Construction Pole Sub. 0 50+KW I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers �// lorkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit �1 Meter VJup to 100 amps �7 b0 . i, Lab. C.) F Policy No. - Company Backflow Irrigation Sewer Cap Dishwasher Meter [Dover 100 amps P 6 Certified copy Is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection Z yyoo Date Applicant - Fan Motors ❑O-1 HP 01X-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors 1 (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping • F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ - less) • I certify that in the performance of the work for which this permit is Issued I Fixtures Microwave shall not employ any person in any mance so o become subject to the Drinking Fountains Solar Tank • .- - DorkersLQgrs}pr{,]�pn Laws of Californ' Device Boxes Pole Light Dale Y 7N O 1 Signature Floor Drains Swimming Pool w/Spa - 9 NOTICE. If,aft r making this declaratio you should become subject to the Outlets Range Workers' Compensation provisions of t Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions Or this permit. shall be deemed revoked. • CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction lending agency for the performance — of the work for which this permit is issued (Section 3097 CIV. C.) Interceptors „Z.-Cater Heater Garbage Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Ie Water Service Generator 00-5 KW 05.15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash . following reason (Section 7031.5 Business and Professional Code: Any city or • county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays • any structure, prior to its issuance, also requires the applicant for such permit • to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000)of f'u'sion 3 of the Business and professions Code) or that he/she is exempt Reinspection Fee J $15 Issue Fee $fD0 sfrom and the basis for the alleged exemption. Any violation of Section . 5 by any applicant for a permit subjects the applicant to a civil - - alty of not more than five hundred dollars($500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS: b I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee Zoning Approved By Date compensation, will do the work,and the structure is not Intended or offered __ • for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES Building Approved By Date License Law does not apply to an ownor of a property who builds or improves © - thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ Application Issued By Dat, employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUM ARV OF ES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground grove for the purpose of sale). BUILDING PERMIT $ SMIP $ LJ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigerate -System PLAN CHECK tractors to construct the project (Section 7044,Business and Professions Code: $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑ 0,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or Improves thereon. and who contracts for such oroeects with a con- ENERGY P.C. $ tractors) license pursuant to the Contractors License Law). I am aware that Exhaust System 0 Multiple System Repair/Alteration PLAN CHECK 25% $ proof of their Worker's Compensation Insurance should be provided to me: ELECTRICAL $ 7�-. 00 GRADING $ _ 0 lam exempt under Section B.S. P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers GICRONILM $ - PLAN CHECK 50% $ Date Owner Heating System&Ducting Registers - MECHANICAL $ 00I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL TOTAL FEE $ 7¢' Information Is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relatin to building construction, and hereby authorize repre- sentatives of this ci t et upon the above-mentioned pr�p�ert/yy��}OL inspection purpo a Date �' v 01 OD0388?7-00038827 TOT 4,123 Signature Reinspection Fee $15 Issue Fee $ 3 DATE; 07/20/89 7jnEf 13139 0865-46,rev. 5/88 White - Building; Canary - Applicant: Pink -Accounting:Goldenrod - Assessor • CONSTRUCTION AND PLANNING POOI SPA ' f APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pale y. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. .) 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. h 54. Forms • 4:-Electjical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel-Reinforcement • 56. Rough Plumbing & Pressure Test � ;g 6!Electrical UFER.Grnd., U 57. APPROVAL TO COVER-GUNITE 7)r'Footings '1 , �., �- 58. Electrical Conduit-Undrgrnd. t-4 • 8. Foundation l� I 59. Gas Pipe, 0 Undrgrnd., Test 9.Water Pipe-Undrgrnd. ,.%A 60. Backwash Lines,'P-Trap, 0 Undrgrnd. 19h Structural Floor System • 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap A. - r 63. Heater & Vent-Final 13. Roof Drains ,; 64. Plumbing System - Final 14. Rough Plumbing.. 65. Electrical-Final 15. RoughElectrical-Conduit 66. Solar System-Final (1'6. 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 7 70. Underground Hydro ' 22. Ducts:Ventilating - 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe7,Rough & Test 72. Underground Flush 24. Roof Frraming 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 ` FINAL INSPECTION 32. Electrical Power%leter-Final /�y// / Q :cc FOOD CERTIFICATE ISSUED 33. Final Electric / 14lll _lir Notes: ' 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 4 41. Solar Domestic-Final •� 42. Backflow Preventer .; rt-'- 43. Backflow Irrigation } 44. Landscape Irrigation System ; 45. Sound Attenuation 46. Handicap Regulations •� 47. FINAL STRUCTURE & BUILDING L 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ID /. 51. CERTIFICATE OF OCCUPANCY No. Date t. ,i - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . orliatm'6 ((( p RMyF�(�� TRACT NO. LOT NO. UNIT NO. city OF COSTA MESA FONST CTION PERMIT I r,� 0//k{'yy'J? A.P.# Zone Project Address Z.73 /2 n /. ' l dJ rN • mss' �I�t F-� 11 "\ l�/�-�J • ! S Main Building: Accessory Building: Applicant's Mailing Aggress /4 V' le, /2 / L- „// TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION%REPAIR _ / ❑ CONVERSION ❑ DEMOLISH ❑ OTH R T Front I0 Address Name M��G e0 �yUL/ PhoneQl �� a RIPTIO(V,4F i RJC/dl$�OF,: DG. A 1�` alp – I B Rear N r , / / f'i /lei C/�G / 4 .f� . C Right N Arch/Eng. License No. TYPE OF PERMIT I■ GRADING ■ FOUNDATION E STRUCTURAL K – G Address ❑ TENANT 0 ELECTRICAL ❑ PLUMBING 0 MECHANICAL $ - Left — p �!� ) /, .lc�fOTHER r�� [' • E Contractor's Name���� /7U�L�C'ePhone(///� 7�� / > yPing. Ref.Sf`- _ _ Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. i OCCU PgN1CYhG� Planning Notes: M Address(mailing) CONSTRUCTION TYPE VALUATION CCa,9YY��''�%-i - - — - - -- - -- - • , T City License No. ZONE GRADING CU.YDS. ACREG S. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / ,i / , • with section 7000) of Division 3 of the Business and Professions Code, and L ilr in 1- Te!Gi/iar • moi.! ., -� my license is in full force and effect. �r�� r tie- S C 45 017-970--5, ELECTRICAL FEES License Class License No. u� sw" Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATION - Bar Sink • Showers Construction Pole Sub. 0 50+ KW 1 hereby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Sectionking Unit Backflow Preventer Service Sink Meter Dug tO 100 amps 0, Lab. C.) ••• Meter Dover 100 amps .icy No. Company Backf low Irrigation Sewer Cap B — Certified copy is hereby furnished. • ■ ■ Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date ApplicantFan EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Motors 0-1 HP 1%-B (This section need not be completed if the permit Is for one hundred ($100) or ' less). Dishwasher Solar Piping Inc.Solar ❑9- ' ■16-15+ I certifythat in the ertor ws of the work wFt)ch t permit Is IS ue g pFixtures shall nt amp y a arson in any m Gr oIY/aea to me subj a Drinking Fountains Solar Tank Mic • ..ye • Workers' o n ws of Calif • Pole Light Date Si not r¢ Floor Drains Swimmin Pool w/Spa 9 NOTICE: I ,aft r moo g this dee on, you s u ecome subject 'the • Range Compensation provisions of the Labor Code, you must forthwith Floor Sinks' Urinal Comply with such provisions or this permit shall be deemed revoked. • _ CONSTRUCTION LENDING AGENCY Gas Service Outlets / Water Closet Z Switches Sign 1 hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Gdfbdga Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Water Service Generator 5 KW ❑5-15 KW Trash Compactor - OWNER BUILDER DECLARATION rj 1 hereby affirm that I am exempt from the Contractor's License Law for the / Lavatories - Auto-Wash G.� — r following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,Improve,demolish or repair P–Trap Laundry Trays ' any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of • Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3 •'-^refrom and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil illy of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: p..I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • Zoning Approved By compensation, will do the work, and the structure is not intended or offered nate for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL 1 FEES Building Approved By Date License law 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 Hood or Type I ❑ Application Issued By C Date employees, provided that such improvements are not Intended or offered for Boiler sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type II 0 dMMAR OF FEES . .. \ pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground BUILDING PERMIT $ ri7 SMIP J prove for the purpose of sale). $ s ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK _ PERMIT y tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU • •'1,000 BTU 7 ISSUANCE-' builds or improves thereon. and who contracts for Such oro leets with a con- PLUMBING $ $ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 Syst-•• 'epair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $ ❑ 1 am ex. pt nder Section ' - . P.C.fort . r on Firepl/Fact.Blt. ICBO dk Fire Dampers MICROFILM $ a / PLAN CHECK 50% $ Date �Ire''.' Ow �/_//�_ Heating System& Duc - Registers MECHANICAL $ TOTAL FEE $ l�J / •o I here, c•rtify that I have read Is applic. o .nd state that th .:.•e 00-100,000 B a 100,000 ST • _ PLAN CHECK 25% Information is correct. I agree to comply with all city and county ordinances $ and state laws rela 'ng to builds 9 cor truction, and her• author ze rpre- sentatives of t Icy t• i t he above–•• oned pr••ert for Inspection pu .-• • / ////i' Da :/ a) DriverSignats' ` Reinspection Fee $15 Issue Fee $ 3 01 00041690-00041692 TOT h1�5p DN vers' License or SS /= PATE: 09/01/B9 T/Mr: 14:29 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink •Accounting; Goldenrod - Assessor • _ r^-= CONSTRUCTION AND PLANNING POOL 'A Date Ins ector APPROVALS Permit# p APPROVALS Permit# Date Inspector 4 1. Temporary Electrical Service or Pole it,, 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �e" 53. Steel Reinforcement r /, 3, ric Electal Conduit Utility-Undrgrnd. -''.5i. 54. Forms '�! .-1 • 4 ,Elecfrical Condciit-Undrgrnd. e• 55. Electrical Bonding / ,� 5.;Steel,Reinforcement 56. Rough Plumbing & Pressure Test y/; 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE ea - ,7c"Foot ngs � ., 58. Electrical Conduit-Undrgrnd. `l �/ '.•.r, .r,.• 8.,.Foundation - 59. Gas Pipe, O Undrgrnd., Test • • ',./1R 9..Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, 0 Undrgrnd. •- / A for Structural Floor System 61. APPROVAL TO DECK - r .4, is , 11.,Property Sewer Line & House Connection : ' 62• . Backwash & Receptor-Final . „ r,r, 12. Sewer Cap -i 63. Heater & Vent-Final ,7 __-111.. A '.. :�'. 1 //.4 13. Roof'Drains 'S lin 64. Plumbing System - Final / • "v /:1. 14. Rough Plumbing" 65. Electrical-Final - VIAr 15. Rou h Electrical-Conduit 4r,r g r 66. Solar System-Final '16: Rough Electric.Wiring -� 67. Fencingng& Access Approval 0 1.,17. Rough,Wiring Sign �'I 68. APPROVED FOR PLASTERING .; • X .8: Rough Electrical-T Bar Ceiliri I / - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • P RMIT NO. T e, LILTERATION CrUNIT NO. I / CITYCI�COSTA zM�Sg, cp, _L}s _:-_ 5EiMiT ` j 16 LEDS1-� �— A.P.# U? fy �� � Zone li S `�� r roject Address S Main Building: Accessory Building: TYPE OF CONSTRUCTIONW U ADD U REPAIR Applicant's Mailing Address / y+19 0 ft/EA/64 ° /_77—?jib/ ❑ CONVERSION ❑ DEMOLISH 0 OTHER T Front �7 /// Owner's Name /" `/'v^N F� PhonfJ G T7.1 BA Q I Ac e J N �,A m� DESCRIPN OkWORr�aOF B GG.. V Rear 01 Address (,Q TYPE OF PERMIT LI GRADING FOUNDATION STRUCTURAL I I C Right 2 Q/ N Arch/Eng. License No. K G Address //// p < _ ❑ TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL $ Left "It Z / R Contractor's Name otgiv e/� cfrepErC Phone 5:4 me- O 'OTHER Ping. Ref.# Parking Req,/Provided E CCCCCC PROJECT DESCRIPTION SO. FT. OCCUPANCY O Address(mailing) //yy! --/o+� Planning Notes: �s 6j 4--) 4 y4.�fp (�� M CONSTRUCTION TYPE VALUATION$ TJ [ �� V_Ckx N f T City License No. ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:8x8 P.h n with section 7000) of Division 3 of the Business and Professions Code, and (tuna, my license is in full force and effect. _ T'�� � n 1 i ELECTRICAL FEES License Class License No. ce1Ot1-1r— PC-1-8.12 LDl RCD 1tV l Date Signature PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATIONBar Sink Showers Construction Pole Sub. ❑ 50+KW I hereby affirm that I have a certificate of consent to self4nsure or a certificate Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps • 0, Lab. C.) ...iicy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Cover 100 amps-- 8 Certified copy Is hereby furnished. Dryers ❑Gess ❑EI¢CtrIC Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant Fan EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Motors 001 HP 03%-B (This section need not be completed if the permit is for one hundred ($100)or less). Dishwasher Solar Piping F.A.U. Inc.Solar 09.15 HP 016-15+ I certify that In the erformance of the wor for whr h this rmit is issued - shall not a toy a person in any m3Je�r O be a subject Drinking Fountains Solar Tank Fixtures Microwave .,- Date f'� Siwaf Calif( ' Date Signature, J Floor Drains Swimming Pool w/Spa Device Boxes Pole Light • NOTICE: f,aft making this declaration,you shou b ome subject to the Outlets Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet Switches Sign i hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. CJInterceptors Water Heater Garbage Disposal Standing Sections Lender's Name Generator ❑0-5 KW 0545 KW Trash Compactor Lender's Address Kitchen Sink Water Service OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License.Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Treys any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt Reinspection Fee ! $15 Issue Fee $ 3 -refrom and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil arty of not more than five hundred dollars($500). $ 3 DEVELOPMENT SERVICES R��..O.I.UIMEfjl�6 ��^^''�� Reinspection Fee rG \ (� . 1ml3��Q co I. n owner of the work, my employeesctwith Intens r f sole Pe I $15 Issue Fee Zoning Approved By - Date / s t theandooffered sale (Section 7044, Business and Professionalpr pen Code: The Contractor's MECHANICAL FEES Building Approved By Date License Law does not apply to an owner of a property who builds or Improves _. . ___— --_ _ - ----- --. t O�� thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 Application Issued By S� Date el employees, ever,provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 $U• M�py�F FEES prove , the owner will have the burden of proving he/She Old not build or Im- Duct-Under Ground "W— s�rote for the purpose of sale). BUILDING PERMIT $ SMIP $ 5° U I, as owner of the property,am exclusively contractingwith licensed con- Duct-Structural Refrigeration System r tractors to construct the project (Section 7044,Business anA. g y Professions Code: _ PLAN CHECK $ 4f PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or Improves thereon. and who contracts for such orolects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ r of of their Worker's Compensation i surance should be provided to me. GRADING $ I am exempt under Section ex B &P.C.fort reason Fire Blt, [CBO# Fire Dampers ELECTRICAL $ / // /5y / PLAN CHECK 50% $ MICROFILM $ Date n ✓ Own _Aft, -^� _ Heating System& Ducting Registers MECHANICAL $ I hereby certif that I have read this application and state that the above 00100,000 BTU 0100,000BTL TOTAL FEE $ ' ' information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ 3 t7.fTS and state laws relating to building construction,and hereby authorize repro- Sentat[ves of flit cit t enter n the a v ant ioned pro rty f inspectiignatuon p s.i/q DI QQQ44i,�4—� Signature W � - Accounting; Goldenrod - Assessor -1 7 CONSTRUCTION AND PLANNING POOL 'PA 'APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector .v1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3.;Electrical Conduit Utility-Undrgrnd. 1: 54. Forms l • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6.: Electi:ical UF ER Grnd. 57. APPROVAL TO COVER•GUNITE / ' 7.1 Footings 58. Electrical Conduit-Undrgrnd. • , • 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test -' - - 9. Water Pipe-Undrgrnd. ' . 60. Backwash Lines,P-Trap, 0 Undrgrnd. / ' • 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection f 62. Backwash & Receptor-Final a 12. Sewer Cap 63. Heater & Vent-Final / • 13. RoofDrains / 64. Plumbing System - Final • 14: Rough Plumbing' 65. Electrical-Final , 15. Rough Electrical-Conduit 66. Solar System-Final •16. Rough Electric Wiring • 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-I Bar Ceiling • l 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough-Factory Fireplace 4 ' APPROVALS Permit# 21. Ducts, in Structure ' �'1 70. Underground Hydro 22. Ducts, Ventilating 4. .751 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing F i 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 i,; ' 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 37. Final Factory Fireplace 38. Final Plumbing :39. Water Service-Final I .. - 40. Gas Service-Final ' ) 41. Solar Domestic-Final :I' 42. Backflow Preventer I 43. Backflow Irrigation ' t 44. .Landscape Irrigation System ./ 45. Sound Attenuation 46. Handicap Regulations LL,�.{/�_ 47. FINAL STRUCTURE & BUILDING b/�/W 48. Special Requirements Completed / ( . 49. Electric Release to Edison - .0 50.`Gas Release to Southern California Gas Co t 4.1 51. CERTIFICATE OF OCCUPANCY (•" -( No.: Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. + ^ PERMIT NO. TR NO LOTN UNITN ''� _� Ic,1_'� CPiY OF-COSTA MEA CNNST R ,T /ON PT,- s7 1 s . t� I �/ A.P.# 1 zone I Project Address 27 3 /z L r _ S/r O Lf/ 5 S Main Building: Accessory Building: Applicant's Mailing Address TYPE OF CONSTRUCTION NEW ADD ALTERATION U REPAIR Front I F lJ /JOG is ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • T 4 FcYC 11� O Owner's Name l2e t re L- Phone z 9tf DESCRIPTION OF WORK/USE OF BLDG. I B Rear J - N Address 521'nes+ o v.� A ' I C Right 3s.l N Arch/Eng. License No. _ TYPE OF PERMIT GRADING II FOUNDATION M STRUCTURAL K t '. G Address El TENANT ❑ ELECTRICAL ❑ PLUMBING El MECHANICAL S • Left R D�A/e/f• /<,OE�_ (�� ❑ OTHER I Ping. Ref.t Parking Req./Provided E Contractor's Nam�,T hone PROJECT DESCRIPTION SQ. FT. OCCUPAN Y I 0 Address(mailing) (Cs�/ wJ Planning Notes: CID�J�ft.L—F y rC� l [OL{� M CONSTRUCTION TYPE VALUATION$ 7f Lj7 de. T City License No. ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Q , Q nolo G�cL _ • with section 7000) of Division 3 of the Business and Professions Code, and (Jr 0 r n ��KV 1 c—en 1U \``oe- --_�, • my license is in full force and effect. SNO C.a r et cTD( F--;CELECTRICAL FEES • License Class License No. date Signature PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATION Construction Pole Sub. 0 50+ KW 1 hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink ShOw¢!3 Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps 0, Lab. C.) - volley No. Company _.. Backflow Irrigation Sewer Cap Dishwasher Meter Cover 100 amps, 8 Certified copy Is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel L' Certified copy is filed with the city Building Division. Bathtubs Sewer Connection ) Date Applicant Fan EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Motors 00-1 HP 01:5-8 (This section need not be completed if the permit is for one hundred ($100) orDishwasher Solar Piping F.A.U, Inc.Solar ❑9.15 HP 016-15+ less). I certify that in the performance of the work for wh h this permit is issued, Fixtures .ter shall not emp y an 'person in any m.• er so as o bee• , subject-i,+ a Drinking Fountains Solar Tank Microwave Workers' ws of Calif. ni. r Device Boxes .a Date idada. shouldthis become subject to the e Outlets Ran — Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9 comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Generator ❑0-5 KW❑5-15 KW Trash Compactor Lender's Address Kitchen Sink Water Service p OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3 1'-�;lefrom and the basis for the alleged exemption. Any violation of Section "1;1.5 by any applicant for a permit subjects the applicant to a civil a I, as owner of the property or my employees witn wages as their sole Reinspection Fee I $15 Issue Fee `ialty of not more than five hundred dollars($500). $ 3 DEVELOPMENT SERVICES RE EM/F— "ii` / (0--i3-�y compensation, will do the work, and the structure is not intended or offered Zoning Approved By C Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By License Law does not apply to an owner of a property who builds or improves _ Date / /� fps thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 Application Issued By Tr - — Date bar (3 O 1 employees, provided that such improvements are not intended or offered for . • sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 SUMM• OF FEES pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). • BUILDING PERMIT $ ? T SMIP $• •'S0 o I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK T .tractorsto construct the project (Section 7044,Business and Professions Code: $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct- Ventilating ' 00.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon. and who contracts for such oroiects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ I ofp their Worker's Com . •n • 5 nce should be provided to me. yam exempt under ction int B P.C.fort 's r•.son Firepl/Fact.Bit. ICBG dk Fire Dampers ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ Date Owner — �i/t�..•4 Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ I hereby c rtify ha I have tea• • appli ation and state that the above 00-100,000 BTU 0100,000 BT Information is correct. I agr a to comply with all city and county ordinances PLAN CHECK 25% $ 3�', y= and state laws relating to 'Aiding construction, a d hereby authorize repre sentatives of this y to en upon the ab -mentioned prop rty .r inspection Pur - /3 • -- Signature Dat /i Drivers' License or SS* -Accounting; Goldenrod -Assessor CATE: 10/13/39 TINE: j5:11.. � .. CONSTRUCTION AND PLANNING POOI WA • y APPROVALS Permit# Date Inspector APPROVALS Permit#- Date Inspector i 1. Temporary Electrical Service or Pole ...• 52. Pool & Equipment Location '4.1 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3:•Electrical Condui[ Utility-Undrgrnd. ,-1 54. Forms ' t--' ' Electrical Conduit-Undrgrnd. •/ 4 55. Electrical Bonding ./ i 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFE&Grnd. 57. APPROVAL TO COVER-GUNITE 1'i .! .;.• : 7. Footings ` 58. Electrical Conduit-Undrgrnd. ;' f ' 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ., f(" 9:Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. / ; 1 10'Structural Floor'System 61. APPROVAL TO DECK 11;.' Property Sewer Line& House Connection -i. ; 62. Backwash & Receptor-Final - ' 12' Sew&Cap ;; 63. Heater & Vent-Final Al ' 13. Roof.Drains /'ry 64. Plumbing System - Final /s-. �,n 14. Rough Plumbing'- _ 65. Electrical-Final AI 15. Rough'Electrical-Conduit 66. Solar System-Final .- .16. Rodgh Electric Wiring ,. 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling 1 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Condi{ibning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace "? k, APPROVALS Permit# i..! . 21. Ducts,in'Structure 7 'J 70. Underground Hydro 22. Ducts,Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe'Rough & Test 72. Underground Flush 24. Roof Framing 1 V 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing •t 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 v 78. FIRE PREV. FINAL 30. Drywall Nailing i}; 7 - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coatt'1 t1,(I 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 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final ' 40. Gas Service-Final - ✓' 41. Solar Domestic-Final (it 42. Backflow Preventer FI a I. / -. 43. Backflow Irrigation . I (-/ :17 + 1 44. Landscape Irrigation System .l 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE& BUI LDI NG p ® o # 48. Special Requirements Completed II'"`'' 49. Electric Release to Edison . ,!. 50. Gas Release to Southern California Gas Co ,,,i II , ' 51) CERTIFICATE OF OCCUPANCY ';: J No& Date \_. N -r"--N U r, N 8321 t1 155 'Lin COSTA MESA BUILDING DEPARTMENT FINAPIC P.O. BOX 317 • ppE��COSMMDEPT.p �p. COSTA MESA, CALIFORNIA CITY OF +Q INGSA .FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING cc, 1 (/SLC& tM BUILDING ADDRESS3 / _� COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY /,•� E\t RECEIPT NO. MANAti . OWNER az ` v(� MAIL i/l.l� /� I'� RECEIVED BY DATE RECEIVE,PG DATE ISSUED ADDRESS- 2 / S y_ I® � S ' , ca�Z -4 a I C2 -CI //� �. `O Il TEL. BUILDING CITY l r. 6 , ��1�� �!j` NO. ADDRESS ' OR ENGINEER '/' {'y_' LIC. COSTA MESA. CALIFORNIA OR ENGINEER NO. FIRE ADDRESS ZONE ZONE NO.LOF TYPE GROUP , ����....y�� CITY LIC. PLANS r_, CONTRACTOR T. NO. VVVV �/�w���'�����—���_ /12\ 'TEL. APPROVED / �y 2/-/J•Lf. 7 ADDRESS NO. BY - �'// ', DATE --•1 'C LEGAL OT / (j /J C� ,CORRECTIONS DESCRIPTION NNO. 5/ BLOCK , / TR T� (Y� A.P. NO. /1 7.-. i,. /4/—/ 7 \. 1 SIZE (l f O.OE SLOGS. �If(�`'� I . OF LOT 6 D i 7 y� I.J 0.0 OW ON LOT- A I'R' ...:'it 1 1 , EXISTING BLDG.USE OF . CITY OF STA rY�E�-°. I 1,F.11+/ �5 PLIANN V UCPJ. CENTERR KOF LINE REAR YARD �V SUBJECT TO DG. DEPT. REG. SIDE YARD RIGHT 6 ' LEFT- 1S / irf r�,. DESCRIPTION OF WORK BY_W 0 DATE s7 • PLAN 'NCH �..r7 NEW ALTERATION I ADDITION REPAIR MOVING DEMOLISH BUILDING NO.OF /I SIZE RMS it/STORIES _J y / EXTERIOR WALL ROOF COVERING COVERING USE OF NEW BUILDING e•-•-.) , (/[JAI ) !�� � w� /^. E `�•� The Amount shown under valuation is for the I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND purpose of establishin STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL g a permit fee only. CITY ORDINANCES AND S LAWS REGULATING BUILDING CONSTRUC. • TION. VALUATION X.Zt.- J- 4_,e,SIGNATURE OF PERMITTEE ,tC �4-0PERMIT FEE $ / — 53-6 , PLAN CHECK $ • "nfr AUTHORIZED AGENT TOTAL FEE $ .�O • .t, " 7307 COSTA 6 ct ***,-06.00 COSTA MESA BUILDING DEPARTMENT nuczo52PDNESA It P.O.BOX 317 COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUDRESS .3 Si-LDING ..f7n- /77-1 CBUILDING AD COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY p-� '/� �- RECEIPT NO. PERMIT NO. OWNER ///'f�//(��J L REF / -/� . . ;22 DATE MAIL �7 ! _ �L� /x/` RECEIVEDy �, BY mDATEI�RECEIVVEDD ISSUED ADDRESS,...,/ l3 E. „.c}.. //C. S/ FM /`^] e-(96--Se .R- a.°..4 CITYC. o,; J� /lhy��. TEL. NO. AB DDRESS (Jf /, /9T� JT ARCHITECTENGINEER C.LIC. ARCOSTA MESA. CALIFORNIA N / FIRE ADDRESS �/ n _ ZONE .if CITYY LLI G. C+'C ZD NO.OE PLANS TYPE GROUP CONTRACTOR NO. (` If ADDRES / If- -t. AP 1 +A,�Flynn...). DATEd --exc. J c_ \\\\VVV��^»' LEGAL LOT t� CORRECTIONS DESCRIPTION NO. BLOCK BLOCK1 7 TRACT A.P.NO. 1/ / _ .2 /1/^ / / P{{y$ D CIN\ SIZE �./� NO.OF BLOGS. • APPR q`®v !/ .\ OF LOT o) (I[ )30Laid NOW ON LOT a 33 D1111��� llll USE OF J 1��� F /•� p /I GS. STA MESA EXISTING BLDG. !7C �"vT' CITYrOF r• SETBACK LINE PROM • FL.,:-',NN 4C DEPT. CENTER OF STREET /Si $e a4SRD 0 c ' SUBJECT TO G. DEFT. REG. 3 i SIDE YARD RIGHT LEFT S `,' [� DESCRIPTION OF WORK BY Nd � DAIt2-421)--"D I PLAN T:.CH7 NEW _ I ALTERATION II ADDITION REPAIR Nry MOVING X DEMOLISH BUILDING NO.OF / SIZE /ig,/ L ROOMS STORIES a EXTERIOR WALL ROOF COVERING A� COVERING • USE OF NEW& BUILDING lei i Cleo BC 5/EI4crF4 ! I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. I VALUATION PERMIT FEE SIGNATURE OFT / YCC /v Q PERMITTEE j - vn/ PLAN CHECK S AUTHORIZED AGENT yl �/J .. TOTAL FEE $ '-.. `SMF 12456 1 t E o E�l 6 t( L.0 COSTA MESA BUILDING-SAFETY DEPARTMENT JUL 5 - 1960 P. O. BOX 517 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF For Applicant to Fill In Completely APPLICATION FOR PERMIT BUILDING�1 TYPE ORPRINTBUILDING ADDRESS'/�7 3 E IJ 'a ST gOE% aQ ��COSS^^TAA MESA.. CALIFORNIA For Office Use Only OWNER #44 /i R I [!T 11411-11 ccc� I RECEIPT NO. I IL•44rERt. T�lIO� MAIL 2 9. I C 3 4 BR G : RECEI D RED IVED DATE ISSUED TAODRESS / vu ,A y, ne " may "/1 0i--0o 7/a1., //�o CITY Co .S%t9 ty —$n NO.L\ I- 7Z672s ADDLRESS -/ e, C/ / 9/4/ at- ARCHITECT TEL COSTA MESA. CALIFORNIA OR HIT ENGINEER NO. 1,CA ADDRESS FIRE ' �nj /nJ ZONE TYPE �I GROUP ///112 CONTRACTOR ES u%NE 1,CII LOQ 11 BYPROVED (11/ DATE // 71$/1 r1 ADDRESS ZO INC (flz Z ( I/ NO.OF US F NEW AY/ CITY I ._ y' PLM19 ILDING ��/VVV--- r jj \ STATE TEL. LEGAL II / /�yl /3 f�'{/ 71 if -7j LIC.NO. / NO. DESCRIPTION Lot ( U t/'I 1 1 '` -1 `/ SIZE y^ -QI t }{ a NO. OP,BLDGB. I / OF LOT .7 •71' t�V w 0 (J NOW ON LOT /s A.P.NO. // 7-- "R i L-1- - /7 USE OF �ji EXISTING BLDG. ((' eu SE y 4 Q R N s t YARDSROVED ALLOWED SETBACK LINE FROMISO C� (CENTER LINE ST.) /�J� ,y • CENTER OF STREET REAR YARD I FRONT .`J V FT. ( //L , IN. SIDE YARD I LEFT 1 C fit I RIGHT .c F7 R.SIDE ajii- •--7 1 N. DESCRIPTION OF WORKL. /// FT. 7Jn IN. v II ADDITION I// REAR SIDE 4j NEW I IIALTERATION �) [ REPAIR I MOVING I DEMOLISH APPROVED r ./ 1 DATE /--S l7V BUILDING NO. OF U SIZE ROOMS STORIES I . EXTERIOR WALL '/h OOF COVERING' COVERING I/¢9 PRt 1 .$711/241.6 USE OF BUILDING AND WORK TO BE PERFORMED N(f%FIF_ RS H0PTE. 2 8EDRooN - r1- DDITIbM I HEREBY ACKNOWLEDGE THAT I HAVE READ TH18 APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND ST TE REGU TING BUILDING CONSTRUCTION. �T VALUATION 4/0 SIGNAITUR OF e✓L' " � '� PERMIT FEE $ �'> N PER M /p/LS N $ / �" PLAN CHECK $ /5"-- ✓r— `K AUTHORIZED AGENT 'L / v •— fi B TOTAL FEE $ n FEE RELEIVW �. 15670 / , , OcI X71951 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. *L P. O.,BOX 817 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant fo Fill In Completely APPLICATION FOR PERMIT ,.. TYPE OR PRINT BUILDING BUILDING , E /7 • ADDRESS COSTA MESA. CALIFORNIA For Office Use Only H _., ['•� -' M G" I RECEIPT NO.ILLI y I %6RMIT• 7 G OWNER JJJ (/O MAIL',I. ' /�7 r / 7s . RECEIVED sr DATE RECEIVED DATE ISSUED / / ADDRESS a / 3 £ /9�• �l tar.. I )o nil— I [`/D / /-�4, CITY G O IS! /7 .II E J NO. .BUIL7 0 IG 2:73 (. 10: ,)fi, -_ ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER I14J✓L.4.-- NO. FIRE --}}yy ADDRESS ZONE TYPE :{L GROUP CONTRACTOR GJ K/ Fr APPRO //�� Q BY DATE/L/ ;:"!p/ ADDRESS ZONING ,04,a-ew'' 20N61 I PI BUILDING OF NEW [y�� CITY sk PLANSEL. ��_ O.O USEONO �j �X,I� `�\` LIC.NO. ' IC gni ng ATE TNO. DESCR i g ' , HI I T p �7$ Q ' IC' DESCRIPTION !� '(� \` OF NO. OF BLOCS. "1 y7 ./� / 7 ` OF LOT 0 D I NOW ON LOT �G•. A.P.NO. r USE OF I . el— I'ar_yr S •F,,,f (,4 YARDS EVES EXISTING BLDG ' APPROVED ALLOWED P SETBACK LINE FROM (CENTER LINE HT.) r CENTER of STREET l7 S - REAR YARD CO FRONT /c- FT. •AG , IN. i L SIDE YARD I LEFT _.."2 I RIGHT V R.SIDE ,�y1/�[FT. /� 'I"N`. DESCRIPTION OF WORK L.SIDE (µt , 6Ft-tije, �.��Eyq.1. NEW I II ALTERATION I II ADDITION I REAR /0 FT. r7// CJ IN. REPAIR I 1 MOVING I II DEMOLISH I ByPROVED//I .T/ Pt-21/ /6 -7/ BUILDING v2b}C•y b NO. OF (�(/ 00 ` Pt SIZE ROOMS STORIES EXTERIORWAµ T C" VI COVE call,40 1 COVERING O /'�' COVERING ..••• USE OF BUILDING AND WORK TO BE PERFOR' Mgp�� (�I /�� J - Car Cetc G P �yop I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION oh --Ent_ ,:k. 3'-. PERMIT FEE SIGNATURE OFi $ • PERMITTEE _ 'j'-°1-‘J' - LI 0i AUTHORIZED AGENT /.Y �� $ I/ 'nO • PLAN CHECK 5 y, on = E )A . _ TOTAL FEE $ 0