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Home My WebLink About401 19TH ST - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www,ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT lob nddress: 401 E 19TH ST Suite No Vicinity: Parcel Nunmber: 11734149 Applicant: SZABO, KEVIN ' � � � . � • Address: 2737 S CRODDY . � � ` STE-D �. " , � Phone: (714)241-1474 � ��' SANTA ANA, CA �� ; - Zip: 92704 � .� Owner: SPENCER,.MARK L ' �Address 401 E'19TH ST i � � COSTA MESA, CA Phone: Zip: 92627-2313 Status: ISSUED Applied: 02/14/2003 Issued: 02/14/2003 ISSUED BY: Contractor: COAST ROOTER PLUMBING HEATING & AIR CONDITIONING Address: 2737 S CRODDY ' � ' - ' " .. - �, . STE D , ` "_ Phone: (714)241-1414 � ` _ � � - , :< , SANTA ANA, CA , Zip: 92704 " � Arch / Eng : Address: ISSUE FEE Backflow irrigation � , BackFlow Preventer Bathtub Clarifer System Connect (Ice,Soda,etc) Dental UniLs Dishwasher Drain, Floor Drain, Rainwater Drein, Roof Dnnking Fountain Expansion Tank License: 529127 � -. . �� . � _ . �_ ��._ ".: . _ _ � • Phone: , .. . . . . i-;' - . . - Zip:. � " - _ _. .. -- - -- - - �- - - i�.� - - � � License: - - SCOPE OF PERMIT CHANGE-OUT OF A WATER HEATER IN AN EXISTING SFD. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. AMT 523.50 50.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 FEE SUMMARY ` ''':... aT.Y-_ -, ..� .� . AMT :�'�TY'.' _:. . . . . , : � � AMT Laundry Tub / Washer �$0.00 0 Sump Pump $0.00 �0��.' Landscape Irtigation � $0.00 0 :. Swimming Pool - $0.00 0��.' � P-Trap $0.00 0 Trep Primer $0.00 0 Pressure Regulator $0.00 0 ' Urinal $0.00 0 � Process Piping (per 10 ft) $0.00 0 Vacuum Brkr BkFlow(1-4) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 �0. : Septic Tank $0.00 ' �0 • Wash Basin ' $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 � � � Sewer Connect ' $0.00 - • 0 ' '- Waste�and Vent System $0.00 0,, - Sewer Private Line $0.00 0_ " Water Closet (Toilet) $0.00 0 - Shower $0.00. , 0�- Water Heater / vent $72.30 0 Sink, bar - �$0.00 �� 0" Water Piping (Insl or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 1 BO days. INSPECTIONS: In order for the work authorized under this permit fo be consideretl legal, such work must comply with all applicable codes, and all . required inapeetlons end final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaac�as (arool WORKERS' COMPENSATON DECLARATION: I hereby affrm under penelry ot perjury one ot the following declarations: - ❑ I have entl will melnlain e certifcate ol consent to selt-Insure for workers' compensetion, as providetl for by section 3700 ot Ihe Lebor Code, for t�e peAortnence ot the work ior w�ich this permit Is issued. � �I have end will meintain workers' compensetion insurance, as required by section 3700 of the Labor Code, for the peAormance ol the work for which this permit is luued. My workers' compensation Insurance ce�der antl policy number era: 1I n Z Cerrier. �� FU f�%� Policy Number. 1 KJ (�`J D� O� (Tiiis sectlon need nof be crompleted i! the permif is valuetl et one hundred dollars (8100) or less.) ❑ I certify Ihet in the pertormence ot tha work for which this pertnil is issued, I shell mt employ any pereon in eny manner so as to become subject to fhe workers' compensetlon laws CelHarnia nd egre that ii I should become subJect to the workers' compensetlon provisions ot Sectlon 3700 oi the Labor Coda, I ahell torthwith complywlihihese ovlsloqs. ApplicaniSigneture: �^�� oa�e: 2—r�f—o3 WARNING: FAILURE TO SE E �RKERS' COMPENSATIIXJ COVERAGE IS UNLAWFLL AND SHRLl5UB1ECT AN EMPLOYER TO CflIMINAL PENALTIES AND CML FlNES UP TOONE HUNDREO TYIOUSAND DOLLARE (5100.000�, IN ADDfTION TO TNE COST OF COMPENSATION, OAMAGES 0.S PROVI�ED FOR IN SECiION 3)O60F THE IABOH CODE, IfJrEFEST, PND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aXirm that I am Ilcensed under provisions of Chapter 9(co menGng with Seccion 7000) ot DiNsion 3 oi the Buslness and Professions Cotle, antl my license Is in full roma and ettect. uc. a 9 1 2�1 �/ � C�au t�. �( if� [ Coniractor's SlgneNre: t �ate: 2-1 �-l-O � CONSTRUC710N LENDING AGENCV: ❑ I hereby eMirtn Ihat there Is a wnstruction lentling agency tor the pedormanca of the work for w�ich Ihis pertnit is issued. (Sec. 3097, Civil Code). Lende/s Name: Lender'S Adtlress: Signature: Dete: OWNER-BUILDER DECLARATONS: I hereby aflirtn thet under penelry of perjury ihet I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business antl Professlans Code: Any ciry or counry w�ic� reQuires e permit to consiruct, elter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires ihe ep0licant tor such pertnit to file a signetl stetement t�et he or she is Ilcensetl pursuent to Ihe proNsions oi ihe Coniractors License Law (Chepter 8(commencing with Sectlon 7000) of DlWsion 3 ot ihe Business and Professions Code) or that he or she is eaempt therefrom entl the hasis tar Ihe alleged e:empUon. My Nolatlon ot Seclion 7031.5 by eny applicant for e permit subjects the epplicant ro e cNil penalry of not more than live �undred tldlers (5500)J: ❑ I, es owner of t�e properry, or my emplayees with weges es �helr sola compensatlon, WILL DO THE WORK, anC Ihe sWcture is not intentletl or oNeretl for sflle (Sec. 7044, Business antl Professions Coda: The Contractors License Lew does not apply to an owner of pmperry who builds or impmves thereon, and who does such work himsetl or herself or throug� his or her own employees, provided ihat such improvements are not intendad or oHered for sale. If, howaver, the building or improvement Is sold within one yeer oi completion, the owner-builder will have the Eurden of proving that he ar she did not 6uild or improve tor purpose ot sele.). ' ❑ I, es owner ot t�e property, em E%CLUSIVELV COMRACTING WITH LICENSED CONTRACTORS to con5irutt the prol�� (SBC. 7044, Business end Protessions Code: 7Te comractors Licensa Lew tloes not apply to en owner of propeny who builds or impmves thereon, end who coNracts br such pmject with a comrecior(s) license pursuent to tha Contrectors License Laws.). ❑ I em evempt under sec. Business and Professions Code tor �his reason: Signature: Date: Owner ID veriliBd Dy tlnvers license. ❑ Yes ❑ No Drivers License No. Venfication ol Ownership by (type of documant, i.e. - propeny taa blll or deed�: OIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N: Ezpires: ❑ I hereby certiry ihat no excavation five (5) or more feet In depih into which a person is required to descend, will he made in connection with work euthorizad by ihis permit, and thet no builtling swclure, scaflolding, falsework, or tlemolition or tlismantling ihereol, will ba more than thirry-siz (36) teet high. (Ghap. 32, Grp 2, An 2, Sec. 341, Title 8, Callfomia Adminisirative GoOe). . ❑ As owner-builder, I will not employ anyona to do work which would require a permit from ihe DiWslon of Industnel Sefety, es noted above, unless such person hes e pertnit to do such work from the division. SignaNre: Date: Division of Industriel Setary Permit Number: CERTIFlCATE OF COMPLIANCE AND AU7HORIZATION OF ENiAY: I certily under penalry of perjury Ihat I have reatl ihis epplication and state t�at Ihe infortnetion given is correct. I agree to comply wlih ell state lews end ciry ordlnences relating to builtling cons�ruction, antl euthonze representatives oi ihe City of Costa Mesa to enter upon Ihe ebove-descnbed properry lor insDection purposes. I agree not fo occupy or ellow occupancy of any builtling euthorized by this permit until final inspectian. COOE 1. INSPECTION TYPE 7616 Fized System Final Fire Prevention 1268 Pool Spa Final 200 Finel Re-Roof 201 FIneI BIocWReteining Wall 202 FinBl Fettory Fire Plece 203 Finel Slgn 20d Final Demolition ' ' 2_ I at `D im Qd¢. ��$ �Q�FI INSVECTIONTYPE � 206 Finel Mechanical 20B Final Plumbing 210 Final Elecirical 212 Final Flre Preventlon � 220 Final Planning Approvel 222 Flnal Site - - 250 Finel Building�Occupancy �g � Pfl0.1ECT R��XE55: Q O S E 19 TH ST OWNEN'SNAME: ERICKSON, KENNETH ROY noneess: ERICKSON LINDA S 401 E 19�'H ST COSTA MESA,CA 92627 6'15-3886 qq�H/ENGINEEfl: qEG.NO.: aooaess: UNIT: UNIT: � PEflMITTEE: CRANK BROTHERS ROOFING ( 714 ) 548-5569 AODflE55: SZG COMMERCIAL WAY C.M. CA 92627 LICENSED CONTpALTON OECIABpT10N: I �ereby afiirm tAat I am Iicen5e0 untler pmvisions ol ChaO�er 9(commencing with Section 7000� ol Oivisim 3 of ��e Business an0 Pmlessions COGe, arM my license is m lull force and etlec�. cinuc.:005993 STATELIL.tQ�S6%% �s�� oaie: -S' ' Z � / �iqnaWre: _ W08NE8S' COMPENSRTION OEClABA710N: I �ereDy allirm that I �ave a cenilicate ot conseni to set4insure or a cenilicaie o� Canoensaiion �sy,��q, q� qc�nJieE copy t�ereol (Setlion 3800, La6. �1. PoIItY NO.: � L L 1 E%P. Un7E: S I O S I9 Z ; coma�xr: STATE FUND , ] Cendiea coOY 5 nere�y lumisned. � nilietl copy is hle0 the c/ny� udaing ///DivJJJisionn. /� / Dale:�� - %S ppplicanl: `--�^'��V Lli� � EXEMPfION FNOM t40HNENS' fAMPENSRTtON DECIAMTION: (Thz secUon ne� iwt be completeG if tM perml is Iw one IwnEreU (5/00) a less�. I cenily thdt in t�e p¢Aarmance of Ne work lar whicn IttiS Dermil i5I5Suetl, I Shall not employ any persOn in any manner So d5 to befAme Su0�tt1 Io I�e Warker5' fAmOensaUon LawS 01 CaliiOrnu. Date: SipnaWre: � NO71LE: If, aM1er making t�is aMaration, you s�oulU hecome suEl�� a ��e Workers' Compenution provisions at t�e Labar LOOe. you mu9 tonRxilll compty vrit� suc� pmvi9ons or IMs Dermit SAall Ge deemetl revok¢C. CONSTqULTION LENOING pGENCY: I �ere0y affirm ihat i�ere is a consimction tentling agency for the De�o�mance af t�e work lar wnicn Iha ce�� n issuea �Sectqn 3D37. Gv. CI. LENUEN: RODNESS: OWNEB BUILOEB DECLAMTION: I hereGy affirm thai I am eaempt fmm t�e Contractors' State Lkense Law Por ihe fo0ovring reason (S¢ctpn 703f.5 Buvness and Professianal COGe: Any ciry ol county wtticn rtpuires a permil ta constmct, alter, impmve, Cemd'ah, or re0au any strucmre. prior ro its issuance. alm repuires t0e apD�iwnt lor such pe�mit to lile a signed statement ihat hrJshe is Ikensed oursuant to tAe pmviUws al ihe Contracmrs' State Licenu law �C�aD�er 9(cammencing with Section 7000) ol �ivisian 3 of ihe Business ana Prote55ionS Code) or tlui ne/sne is evempt Ihertimm anJ Ine ba9s for Ihe allege0 exemption. Any violation al Section 7037.5 by any aDGlicanifor a Oerrtnt suejeps Ihe aoo��ant to a tivil penalry of not more t�an five huntlre0 tloliars (5500). I. as ovmer ol t�e propeny or rtry employees wit� vraqes as iheir sole compensation, will Uo ihe xrork, anG the ❑ 5lrunure i5 n0t inl¢ntle0 Or olterM lor sale (Secmn 70a4, BUvness antl Pmlessional Code: TAe Contratmrs' State License Law Goes not apply �o an owner al a pmperly wM builGs ar imD�oves Ihereon, anJ who do¢5 5uc� wnrk himsel�/�er5el� or INouq� �is or �er own emD�%'ees. OmviC¢4 Ihai such improvements are noi intended or o��ered lor sale. It, �owev¢r Ihe Euiltling Or ' im0�wemenl is 5a10 wilAin One year 0� comple�ion, I�e owner wi0 have �he Curaen ol pmving he/s�e die na� Ouild or improve r lor ��e ourpase ol ule�. I. as owner al I�e propeny, am exGusively conlraclNg with IicenseG comraclors �o constmci the pmiect (Sectian 70aa, Busineu ❑ anU Pmtessims CoGe: T�e Canvactors' Siaie License Law aces not appy to an owner af DmDeM who huilJs or impmves thereon arM wiq coniracls lar sucn o�oiecis witA a comracmqs) license pursuant Io ihe Conlracmrs' S�ate License Law�. I am aware Ilui pr0ot ol iheir Wwker'S ComDensalian insurante SAouIG G¢ prwiGetl �0 me. � I am wempi un0er Senian: B. d P. C. IOf IIIK !¢aSOn: Daie: � Pwner. I Oo AereUy amly flut I am aware Of an0 un0u5lanE Ne r¢puiremenls af Calitomia Heal�h anA Salery Coa! SEnionS 255115, 25533, aM 2553< anG I�al I or any fuWre DuilCing otcupant vnlVvnll nol �circle one) need lo ComDly wilh said state catles antl Ihe rcQui�emenis lor a Oermil �or conslroclion ar mo�ilicalwn Irom ihe Ai�uality Manadeineni OrsVicl. FeSiUenlial con5lmcti0n appliwtions are Ex¢mpi �mm I�ESE O�Ovi5i0�5. �ale: plicanl: I h¢r¢Eq utliiylllal I�ave reatllAiS aDO��tali �antl Siale Ihallhe a�ove inl0rmali0n i5 COrreci.l a0r¢e �0 CamDly wI111ailtlly an0 COun�y orUinancesan�siaieWwsre�atinptobuil0inp onstmciionana�erebyam�onxere senta�ivesalthisutytoenterupont�eabove�mentian p�OpCtly 10� in50M�i0n OwpO5C5 O Dale: sf Z� � � Signalure: Orive�'S License Or iai security r: 16a La6 K'bi�o—Beiltling: Grean—COCo Enbr<om¢nl; Cenarv—ApPlicam: Pink—Fovanuo: GolCanroE—Assessor CITY OF COSTA MESA — BUILDZNG PERMIT PERMIT NO: B 052131 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: STR PERM NO: B 052131 GOVT: N SUPP: _N PURPOSE: ALT JOB DESCRZPTION : REROOF 2700SF RESID 6 GARAGE SQ FT: 10,421 CLAIM VALUE: 10,921.00 CALC—VALUE: 10,421.00 GROUP OCC: R-3 /M-1. COMMENTS: REPLACE ROOF W/CLASS "A" HARDISHAKES f`c�i�i[$ LIC� B� �r�***+r*�****�x�*�c**x*�*�r*+t�t****�*******+t��t*******�c**x�r+�** Z O N I N G R E Q U I R E M E N T t � sETSAcxs ��UI � ----------- MAIN BUILDING ---------- --------- ACCESSORY �I�LDING� ��-----.� FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN �PARKING REQ• . PROV: PARCEL: 11734149 ZNE: REF NO: PLANNING NO'I'ES> i �*****�*�t*******+t*�*�t***�r+r****�r�t**r+t�r********�***�*�t*�r�r**�r**x**�+r�r�t********+t�r** D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S 20NING APPROVED BY DATE: HUILDZNG APPROVED BY : DATE: APPLICATION ISSUED BY• �c— DATE; �� S iF if M If iF iE iE �E if iE �F if iF if Ih �E iF iF 1f if iE if7FTfTf7i"iE7FiF7f �Pr'7f"R"iFif7F'iFiF7F7FTF7FiF7F 7'�"iF'iF3F'iF'iF'iF'iF'3F7FiF k iF I(� iF if iE iF iF iF �E it if iF iF if if iF IE iF k �F If �f if rt iF 3E iF iF 16 fE IFif iE IE k IE If 14 if iF iE if if iF iF �lE �E IF if iE if iF ff iF:f if if if if iF af iF iE iF if iM iF iF IF �F aF iE iE iE iE iE if iF iE iF if iF iE if if 1E )F iE iE LEGALIZATION:N F E E 5 U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 126.00 1.04 SMIP/NON—RES PLAN .. ISSUE FEE HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID - DUE TOTALS----> 127.04 0,00 0,00 127.04 127.04 .00 REVENUE DIVISION TOTALS--> COLLECTED: 127.09 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECAANIC FZRE SMIP/TOT GRADING PLAN—CHECK 126.00 1,04 if iF iF if 1f iE if iF iF ik if if if iE if 1E k iF if if iE if iE iF K k ik if iE if iF if iF k if if if 1E IF k iE k M af iE M �f iF IE k 1f i! ff iF iE if 1F if iE IF if k 1F iE iF aF aE iE iF al�f 1F iF IF iE 3f 1F�E iE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 10421 REROOF HY VALUE RESZDENIAL NOZONE 1.00 10,921.00 END OF FEES V 01 UJ037;7a—GGD�77G4 T'Te� ,.?7 f�•; PRif: 05�2Qi92 TFhF.: S2;C4 CONSTRUCTI3N ANDPLANNING PO� .SPA APPRO�Fs1LS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electriwl Service or Pole _ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' ' � 53. Steel Reinforcement 3. Electrical Conduit Utility�Undrgrnd. 54. Forms ,,• 4. Electrical ConduiY-Undrgrnd. ' �� 55. Electrical Bonding � 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test 6. Electrical UFER �Grnd. 57. APPROVAL TO COVER-GUNITE ' - 7�. Footin9s . 58. Electrical Conduit-Undrgrnd. - B.-Foundation . 59. Gas Pipe, O Undrgrnd., Test �• 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P�Trap, O Undrgrnd. "' 1.0. 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 Plum6ing 65. Electrical-Final �< 75. Rough Electriwl-Conduit � 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electricai-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Facto.ry Fireplace ' � : � 'APPROVALS. � 'Permit # ' '� � 21."Ducts, in Structur',e. .. .. - ., � .70. Underground Hydro • � 22. Ducts, Ventilating • � _ � � � �77. Product Piping OGas ❑Oil 23. Gas Pipe�Rough & Test ' -� 72, Underground Flush-. ' �.� 24. Roof Framing � � �� 73.''Undergrnd'StorageTank �Gas ❑Oil - 25. Roof Sheathin - � . � ' - ' ' 9 . . . 74,, Overhead �Hydro a 26. T-Bar Ceiling (Structurall & Monocoat �� _ 75. Dry Chemical • - ' 27: Frame and F.lashing' '-. i _ 76: Dry Standpipe '�� ., ' � 28. Lathing & Siding. � . • - • � 77.: FIXED SYSI'EM FINAL' ' - 29. Insulation � ' � � � . 78; �FIRE PREV. FINAL �- � � �30. Drywall Nailing HEALTH�DEPT. REQUIREMENT 31. Plaster Brown Coat� , ,� ' � n ,.79; FINAL INSPECTION ' ' ' . � �32. Electrical Power Mecer-Final - I �80: FOOD CERTIFICATE ISSUED � _ 33. Final Electric � . _ ' ' � � I Notes: � �. - 1: ,. ,� . � . . - -. - . -34. Final Heating & Air Conditioning, , � � !. '` ` . � ' 35. Final Gas Pipe-TesY �� ' � . � � • ' 1 - � . 36. Hood or Canopy'• - _. .- - ' � ` , � 37. Final Factory Fireplace . • ' " ' - � • -38. Final Plumbing � ' � ( � ,. . . � , . 39. Water Service�Final � - � ' � ' . 40. Gas Service•Final . ,. , ;� - __ � , ' � �41. Solar pomesticFinal � � • � . - . i ,, 42.- Backflow Preventer " " - i � � _ 43. Backflow Irrigation � ' �44. Landscape Irrigation System• : `. , � � ' � _' 7 . .. • .� 45. Sound Attenuation • � • ' •- . � ; - . _46. Handicap Regulations - ' ' ' , - " . 47.-FINALSTRUCTURE&BUILDING �_3.%�2 �'�j,(�.�-. � ,�� e � �� w� 48. PINAL PLANNING ` i i �, ,� ; _ ; 49.. Elearic Release to Edison � i � �i; - 50. Gas Release to Southern California Gas Cn i � ' " ' 51. CERTIFICATE OF OCCUPANCY , _ , No. Date ' � Aoo�icant to fill in all spaces exceot thoze witnin heavy Dortler Iines ane si9n a1i aooroD��ate eeclarations. CrITY+ OF cOS7A MESa CON �TRI�CT�N PERMIT ,/ro7ect Address �0 � % �+ � ApP�kant's Mailinq ddress � / � � � % �' Owner's Nam//e �--` / Spll Phone7L2�.,�"� Address s�0 / � � � �'01 � Arch/Eng. License No. Address Cohtractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DEC ARATION I hereby altirm that I am license untler prOvi510n5 0/ ChartOr 9(commGOCing with seclion 7000) ot Divislon 3 of the Business antl Protessions Coae, antl my licp�se Is In full tOrta antl O1t¢cl. License Class LicenSo No. Date_ Signaturo WORI(ERS' COMPENSATIOH DECLARATION 1 hereby af/irm lhat I havo a cerlilicate of consent to sulf-Insura Or a C¢rtlfitat¢ ,Workerz' Componzation Inzurance, or a certlfietl copy tnereo( (Sectlon D0, Lab. C.) olicy No. ' ' Comoany BCertiiietl <opy ii �creby �urnlsnetl. CertiRetl copy is filetl with the <ity Bulltlin9 Dlvision. �a[e Applicant E%EMpT10N FROM WORKEHS• COMVEf�ISATION UECLARATION (Tltis s¢clion neetl nol be COmpbt¢tl i/ [h¢ perrrylt I5 tOr On0 huntlretl ($300) or less). 1 certify that in t�e performance ot lhe work for whith thli perm4 is issuetl I shall not mploy any person in any manner s as to beW mo zub�ect o t�e WOrke� �pei i n laws Of Callt� / Oate v S�gnature� �i�-t� 9 NOTIC : If, at e� R� kin9 thi5 tlCClar�On, y0U shOultl becOme subject t0 the WOrkeYs' Compensdtion prOvisions of [he Labor COUe, y0u mus[ forthwi[h comply with su<h provizions or tniz permit snall be tleemetl revoketl. CON57RUCTION LENDING AGENCV ' 1 hereby aHlrm that there is a construction Ientling agency tor lhe perlormance Of [hB work tor which lhis Oermlt is issuetl (Sectlon 3097 Civ. CJ Lentler's Name Lenaet's ACtlresz OWNgR BUILDEq DECLARATION I hereby altirm Lhat I am exempt from the ConVactor's �Icense Law for the following reason ($ection �031.5 Business antl Professional Cotle: Any city or coun[y V,.hicb requires a permit to construct, al[eq ImProve, tlemolish or repair any structure, prlor to iti izsuance, also requires the aOP��ant for suth permit �efrom antl the basis !or the allegetl exemOtion. Any vlolation ot Section LS by any applicant tor a permit su�jects the appli<ant [o a Nvil alty of not more than five huntlretl tlollars (5500). L�I, ds owner o1 the prODGrty I oemphnatien, will tlo the work, antl the structure is not intenaeC or o ere (or sdle �(Section ]044, Bus(ne55 anC Professional CoOo: The Contractor'S Licen=¢ �w tloes not apo�Y �a an owner oi a property who bulltls or Improves thereqn, ana who tloes such work himSeH/herself or throu9h hls or her own employees, O�ovitletl that such Improvements ara nol Intentlatl or otferetl tor sale. II, howeve�, the �ulltling or improvement Is soltl withln on0 yea� of com- pletion, the ownar will nave the burtlen of proving he/she tlitl not builtl or im- �rove for the purpose o1 sale). LJ I, as owner ol the property, am exclusively tootractln9 wlth II<ensetl con- tracto�s to construct lha project (Section 7044, Businoss antl Pro(esslons Cotle: The Contractor'S Ucense Law does not apply ro an owner ot proper[y who builtls o! improve3 tber¢on, antl who tontlaCtS 1or SUCh �rolOcls wlth a r.on- tractor(z1 I�cense pursuam ro �na Convactor�s License Law). i am awaro that proof of their WOrker'S Compensation Insu�dnce ShOultl bu p�ovitletl [o ! ❑ I aM exempt nder Section� g. &iC. fo�this reas�n U� / Date O I heretivi certify that I have reatl t s aoolita on ari state tnat the annvx enter or G d"� V �' . � . � . I TYDE OF CONSTRUCTION NEW ADD ALTERATION REGAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - DESCRIPTION OF WORK/USE OF BLDG.� ' , TYP^E OF PERMIT GRNOING IJ FOUNDATION LJ STRUCTURAL iJ TENANT J ELECTRICAL ❑ PLVMBING ❑ MEGHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. F7. OCCUaaNCv CONSTRUCTION TVPF VALUATION $ ZONE GRADING CU. VDS. ACRES Remarks: � -- ` _2Cy(—�g � Bar Sink Back(low Preventer Back(low Irrigation Bathtuhs Claritiers ' Dishvrasher Orinking Fountains Floor OrainS Floor Sinks � Gas Service Outleis Interceptors Kitchen Sink Lavatories Roof Reinspaction Fee 515 eoiier Duct - Under Ground Duct - Structural Duct - Ventilating ExhaustSystem ❑ MWtiple Firepl/Fact. Blt. ICBO � Heating System & Ducting ❑6100,000 BTU O 100,000 Reinspection Fee � S15 0865-46, rev. 5/BB White - Builtling: Canary - Applltant; Plnk - Atcounting; Goltlenrotl - Assa55or NG Servite Sink Sewer (:eP Sewer Connection Solar Collectors $olar Piping Solar Tank � Suvimming Pool w/Spa Urinal Water Closet Water Heater Water Service. Auto-Wesh IsSue fee Hobd or Typel ❑ Canopy Typ¢ I I ❑ A.P. #'+ � S Main Buildi E T Front B Rear ` A C Ri9ht K g Left Ping, Ref. # Plannino Notes: FEES P.utomatic Washer Construction Pole Sub. � Cooking Unit � . Oishwasher ' Dryers �Gas ❑Elec f� Fan F.A,U. - Fixtures Device 8oxes Refrigeration System 00-100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Ree�sius Issue Fae zon, Accessory Building:� Parking Req./Provided ELECTRICAI Transformer ❑ 15�50 KW ' O SO+KW Meter �up to 100 amps Meter ❑over 100 amps Sub Panel Motors O0.1 HP O1 h- 8 " Inc. Solar �9-15 HP �16�15+ Microwave • ' Pole Light Range Switches Sign Garbage Disposal Standing Sections Generator �0-5 KW �5-15 KW Trash Compactor Reinspection Fee $15 Isuk � 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning APProved 8y FEES Building Approved 8y � Auolitation laued Bv $ 3 N I N G R E Q M T S. FEES $ SUMMARV OF FEES BUILDING PEFMIT $ SMIP S PLAN CHECK $ PEHMIT PIUMBING g ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ �� GFADING $ PLANCHECK 50% $ MICROFILM $ /� �/'� MECHANICAL $ TOTAL FEE $ �`' ,.� PLAN CHECK 25% $ - �� -^��r�i:_ _ J.+' r.. � ��i.^.'/�i U �: . ! �IE: �'./i��39 'iIi1E: i2:'..- CONSTRUCTION AND PLANNING v �� ; POOL & SPA \� APPROUALS Permit# �' ,'�ate Inspector_ APPROUALS Permit# Date Inspeclr 1. Tempo,r,�y Electrical Service o� Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgmd. �,'� 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 �� -S 59. Gas Pipe, O Undrgmd., 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 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 Struc[ure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 Me[er-Final 80. FOOD CERT�FICATE ISSUED � - 33. Final Electric Notes: � ' 34. Final Heating & Air Conditioning �� j 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing - t 39. Water Service-Final � � . 40. Gas Service-Final � i -41: Solar pomesticFinal . � � � 42. Backflow Preventer � ' � '43. Backflo'w Irrigation � ' � ' ! 44. "Landscapelrrigation System ' • � 45. Sound Attenuation - 46�. Handicap Regulations � 47. FINAL STRUCTURE & BUiLDING 48. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co " 51. CERTIFICATE OF OCCUPANCY � No. Date , m ADP��ant lo fill in all spaces except Ih05< within �eavY Dortler lines anE sign all apOropriate Eeclarations. CITY OF COST�A) MESA ONS .U�(%�TI(��'pT' PE1�j MIT,�pJ PERMIT�Q_,,, „ TFACT NO. LOT NO. UNIT NO. A P# Project AddressY'0 � � � ��pjT� `b15 / .l(� /` I �i�C._ Applicant'sMailin Address 0 � /9 ST 7"-/ Owner's Name ✓ O /'� honN�j��kt Address �a l � �'`1 � e� l 7Z �n Z� Arch/Eng. s /''"" ' License No. Address Contractor's Name Phone Address (mai7ingl City License No. LICENSED CONTRACTOR DECLARATION I hereby�atfitm that I am licensetl untler provislon5 O( Charte� 9(mmm¢ncinq witn section ]000) of Dlyjsion 3 oi tho Bu51ne55 antl ProfeSSions Cotle, antl my license is in full force antl etfect. � License C�ass License No. Date Signature WORKEFS'COMPENSAT�ON DECLARATION i nereGy aifirm that I have a certlficate ot consent to self-ins�re or a certificate .Workers' Compensatioh Insurdnce, Or a Certifletl COpy thereof (5¢Ction ]0, Lab. C.) . rolicy No. Company eCertitietl copy is hereby }umishetl. Certifietl copy is (iled With the dty Builtling Division. Date Applicant EXEMGTION FROM WOqKERS' COMPENSATION DECLARATION (Thissection neetl not be compleletl if Ihe p¢rmit ii for on! huntlreE ($100) or less). 1 certity tltal in the Oe�fo�mance o� lne wo�k fo� whicn this pe�mit I5 issuetl, I shall not employ any pe�;on In any manner So as to betome subj¢ct to the Workers' Compensation Laws ol California. Oate Si9nature NOTICE: It, atter making thi5 tleClaration, you Shoultl b¢COT< subject to the Workers' Compenzalion provisions ot the Labor Cotle, yoU must forthwith comply wi�h such p�ovi;ions or tM1is pe�Tlt Sltall be tleemeE �evoketl. CONSTRUCTION LENDING AGENCV 1 hereby aflirm that there is a<onstruc[ion lentling agency for t�e Oerformance of the work for which this permlt is issuetl (Sectlon 3097 Civ. C.) �Pntl¢r's Name Lentler's Atltlress OWNER BUILDER DECLARATION I hereby alfirm lhat I am exemo� f�om tne Contractor•s Llcense l.aw (or the lollowin9 reason (Section 7031.5 Buziness and ProfeSsional Cotle: Any city or county whith r¢qui�es a permit t0 cOnst�uct, alt¢r, ITp�ove, tlemoli5h o� �epair any sVucture, prlor to it5 i55uanc¢, also �eqWr¢5 the apP�icap( fOr such Oermit to tile a siqnetl statement [ha[ ne/she is IlcenSetl puisuant to lhe provisions of the Contractor'S License Lyw (Chap[er 9_(commencin9 witb Section �000) of Division 3 ot the Busine=s antl Profesvons Cotle) or tha[ he/she is exempl , -efrom and the basis for the allegetl exemption. Any violation of Section LS by any applicant for a permit subjects [he a0Plicant to a civil _.a)ty of not more [nan five huntlretl tlollars (5500). LY, as owner of the property or my employees with wages as their sola compensation, will tlo the wprk, antl the ztructure Is not intentletl or ofteretl for sale (Section 7044, �usiness antl P�ofessional Cotle: T�e Contractor's License Law tloes not apply to an owner of a property who bWlrls or improves thereon, antl who Ooes sUch work himself/herself or through his or her own employee5, provitletl [hat such Improv¢ments are not intentlea or offeretl to� sale. If, however, the builtling or improvement is sold wlthin one year ot com- pletion, the owner will na�e the burden of proving he/she tliE not builA or im- prove for the purpose of sdle). ❑ I, as owner ot tM1e Oroperty, am excluslvely tontracting with licensetl con- tractors to construct the project (Setiion 7044, Business antl Professlons Cotle: The Contractor's License ��y aoes not apply to an owner o/ property wM10 builtls ar improves lhereqn. antl wM10 conl�acts for Such oroi¢ct5 with a con- tractor�s) license pursuant to �ne ConVactor's LicenS¢ Law�. I am aware tha[ proot of their Worker's tompensation inmrance shoultl be o�o�iaea to me, ❑ I am ex¢mpt untle� Seclion B. & P, C. tor Nis reason Date • � I he� y ce ify hat In(ormation is mrrect ana state laws relatin sentatives of this ci1 InspeCtion oses. Signdtur��j Drivers' Licenze or 55 0865-46. rev. 5/88 eYeatl t�is applicaj7on apA�state that the above :e lo comply wi[M1 all Ci➢Y aptl county ortlinances uiltlin9 constructlon, arC]�freby authorize re0re- enter yqon the above-mentioneG qrope/ty tor TYPE OF CONSTRUCTION LJ NEW U ADD lJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT GRADING FOUNDATION - STRUCTV RAL ❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sa.F7. oCCUaANCV CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee Under Ground Shawers Service Sink Sewer Cap Sewer Connection Solar �Col lectors Solar Piping Solar Tank � Swimming Pool w/Spa Urinal Wa[er Closet Water Heater Water Service Auto-Wash W undry Tra'ys $15 laue Fee � $ 3 MECHANICAL FEES Hood or Type� ❑ Canopy Typell ❑ Duct � Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑P700,000 BTU 0100,000 Reinspection Fee � $15 '/�'hite - Builtling: Canary - Applicant Pink - Accountin9; Gol�enrotl - AsseSsor Refrigeration System ❑aioo,000aTu Oioo,000eru Sysrem Repair/Alteretion Fire Dampers Regislers laue Fee � $ 3 S Main Building: E T FrOn[ A Rear C Right S . Left Ping. Ref. # Planninq Notes: Automatic Washer Construction Pole Su Cooking Uni[ Dishwasher Dryers ❑Gas ❑E6 Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 KW Fee Zona Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up [0 100 amps Meter ❑over 100amps Sub Panal Motors O0.1 HP � 7 Y, - B Inc.Solar �9�15 HP �76-15* Microwave Pole Light Si9n Standing Sections 5-15 KW Trash Compactor $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By BuildinB APP�a"ed By Aoolicetion luued Bv SUMMARV OF FEES BUILDING PEFMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ��UANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ � � GRADING PLANCHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ O N 1 N G R E Q M T S. FEES 01 [Jpp34�1(jb-R003910f� �8"!;1'¶' y�. �� uere.. o> tliyY �'Zflice l�� p CONSTRUCTION AND PLANNING POOL 'PA APPROVALS Permit# Date Inspector qppROVALS Permit�# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' , � 2.� Soil Pipe-Undrgrnd. 53. Steel Reinforcement � � t a 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . 4.,Electrical ConduirUndrgmd. 55. Electrical Bonding "' � 5. Steel .Reinforcement 56. Rough Plum6ing & Pressure Test �� 6. �Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings, 58. Electrical Conduit-Undrgrnd. � '� � 8. Foundation 59. Gas Pipe, � Undrgrnd., Test ` � r,� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. � . .� 10: Structurel 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 ri 14. Rougli Plumbing 65. Electrical-Final '� 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 1.7. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. 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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ 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 pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation ' 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulaiions • 47. FINALSTRUCTURE&BUILDING , 48. Special Requirements Completed 49. Electric Release to Edison ., . 50. Gas Release to Southern California Gas Co ' '' i 51. CERTIFICATE OF OCCUPANCY , No. Date ' � ' � . � �- '� -�� 3453L '�' _5.7iPaieOO 153tr �,�,ta113.�0 rry5 'COSTA MESA BUILDINGSAFETY DEPAHTMENT : - � P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626 APPLICATION FOR BUIIDING PERMIT For Applicant to Fill in Comp/etely R C IV BV DATE flECEIVED DA/T.E ISSUED ADIDRESS O f� i S� N �/ 7� �+' y/ 7 y / L �, PERMIT p10 OWNER � V COHS�IJG`ltl+� �. A.P. O. I17� 3YI 'I��" MAIL _� ADIDR1E S�O E, /% 5T, Z ADDRESS 7i�0 D Ie 47 a U CITV C q Me$Q NOL TRACT LOT B�OCK F- Z ZQ CONSTRUCTION CL � �Dl�� D P ON I.ENDEF I ��t�IID f0 a m J � BRANCH J � OWNER m J ADDRE55 VAWE m ARCHITECT TEL. S $ J a R ENGINEER � Q N 7^ U N FIRE w� ADORESS Z S� v O� L ZONE YPE GROUP � aw W Z y- APPROVE � JO CONTRACTOR �,�%4„�.,�, COtiilNG �/ Cu BV � DATE p] Z . /� J� 4ODFESS QQ ^l' P4J �Y f ` ` W W , S', ZONE�.�(, NO.OF USE OF NE Z� CI� Y Qw pr ' P0.c N�� i 2'-'��5�� I` PtANS �- BUILDING L7�.,.L. � w � STATE ['�� CITV � YqRDS APPFOVED �'ARDS APPROV � y¢ LIQ NO. -� z So$ L LIC. NO.SS �S�/� MAW BUILDING ACCESSORY BVILDING � O (FROM GL STREET) � SIZE O NO.OF BlDGS. ��- OF LOT NOW ON �OT ROfYT FT. � I J/ Fi. USE OF ^ Q � �• E%ISTINGBIDG, r F �� / � SIZE OF L NO. OF Z NEW BLOG. IJ L F• ROOMS STORIES L SIDE � FT. FT. a EXTERIOR WAL� ROOF ( • V COV RING e[G COVERING SA��- I� � FEA � fT. FT. �- = USE B ILDING AND WOqK T BE PERFORM DI5TANCE BET. BET. MAIN & a i.;� MAIN BLDGS. ACCE$$. BLOGS. a Q VAR, qy. DATE O C.U.P.�W% . APPROVED S-IS'7Y r APPROVED N ' O STATF�l ~ f hereby atknowfedge Me[ I hava read fhis applicefion antl state �/ � thot tha above into�maiion is co�rect antl agree to comply with dPa � � oll laws re8�latin8 builtlin8 construttion, entl I shall not employ r ony parson In violotion of tho workmnn's compansaHon laws ot T� y [he Stete of Cnlitarnio. m z /S SJSQ. F7. �'LQ o I heraby certity thet 1 am proparly Iicensetl as a contrector under the Stere of CelifOrnia Buslness antl Pratess7ons Code, D7visicn 3, THE AMOVNTSHOWN UNOEft VALVATION IS FOR � Chopro� 9, nntl rhot wch licensas are (n tull force aftect, ar I 7HE PURPOSE OF ESTABLISNING A PERMIT FEE ONLV: m om ezampt irom tba provi ns of the Steca of C ifo nla Business VAI,UATION ¢ antl PratessiOn otla, DivisiOn , Chopmr 9. m PERMIT FEE $ c' � SiBnatura ot // �/ Q m Permkme � $�2/ yoO PLAN CHECK $ E / 6 Authorizatl Ape LL TOTAL FEE $ , - 36216 � T ' COSTA MESA BUILDING-SAFETY DEPARTMENT ' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING JI^' n �a}�l �.�: noccc �`i i OWNER J MA1 L Z ADDRE55 a U Cirv -� ~ Z CONSTRUCTIC Za O N LENDER am J � BRANCH J � m J ADDRESS J m ARCHITECT a OR ENGINEER U N Q W � ADDRESS d W W Z CONTRACTO J 0 m Z w� AODRE55 � Q W Z F : CITY �. w � ' STATE � Q, LI4 NO. '.� � � SI2E OF LOT VSE OF . EXISTING BLO PRID ;:dR 13-73��,-�.�0 y4'l_<< ,a�-:af:,<5.�0 APPLICATION FOR BUILDING PERMIT RECEIVED BV DATE RECEIVED nnTe we��.. A.P. NO. I BUILDING AODRESS y TEL. iO4Io— ��Y NO. � �� W A D OWNER TEL. �1�.3— SE �)/L`'O/i/ No. 301Z. �j /,��`� %/�'} �. FIRE �/ICc�Ih RSIULOTb�'Jd ZONE � APPROVE . TEL. 3.�1� � "'o. d/4 3 CITV 110. NO. INO. O LBF�OGS. NOW ON I.OT 20NE ' NO.OF PLAf�LS VARDS APPROVED MAIN BUIIDING (FROM C/L STFEET) VALUE S oi d � ^'M\ �GFOUP � • \ USE OF NEW �� BUIIDING VAROSAPPROVED �. SIZE OF NO.OF � � ] Z ' NEW BLDG. ROOMS STOFIES L. SIDE FT. J Q FT. _ v� EMERIORWALL ROOF � � � COVEFiING COVERING REAR FT. Ci✓ FT. J. USE OF BUILDING AND WORK TO BE PERFOFMED DISTANCE BET. BET. MAIN & a MAIN BLOGS. ACCFSS. BLOGS. a Q / � / � � VAR.# DATE C.V.P.# qPPROVED Q� r � a � APPROVE ' � � �/ fq �' � Z O j ~ I hereby acknowletlBe that I have reatl [hit applica[ion antl stete �'(P' � � that the abov0 ��tormation is correct antl eg�ee ro comply with �- all laws ree��^e builtling construc[ion, a�tl I shall not amploy ' F eny persan in ��olaUon of the workman's compensation laws of N Me State of Califomie. �_�l � W z1 hereby certify Ihat I am properly licensed as a canvacSor untler / $Q. FT. O the State of Califomte Busineu antl Protassions Code, Divisicn 3, THE AMOVNT SHOWN UNDER VALVATION IS FOR � Chaptar 9, end ihat suth licenses are in ful� force entl aftatt, or I THE PUFPo6E OF ESTABLISMING A PERMIT FEE ONLV: ° am ezampt tr�m the provisiOns of Ihe State of Calltornia Business � antl Protessions Cotla, Divislon 3, Chapter 9. VAIVATION D � PERMIT FEE $ � J Sienature ot � m Permittee �(Q� � $�� O-� PLAN CHECK $ E � o Auffiorizetl Atleni �� LL TOTAI FEE �C' .�= ` 34747 —�`'y ;;�5�� `1�3c� ' . . . • Q�`��9 �� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTq MESA, CAUFORNIA 92626 C,r, qY 19 �972 � P ICATI N FOR'BUILDING PERMIT ForApplicant Co fill in Completely R��Ec iv o sv DATE REC�YED DATE I65UED ADIDRESS O ��/ R S� "- ` _22� �� 7 OWNER / A.P. NOIIi' '� I�O'I� O�Y"3� PERM N/�� < / . �o . y� `�� MAIL � BUILDING � y ✓/�''vy �� Z AODRESS �. O U P��SOiaJ Lt• AD�RESS O� L• (% /� THACT SQT LO�TyYs BLOCK d U CITV (_.OS P � Qy' No`s�/6 03 O~ z CONSTFUCTION ` �( W AD A N LENDER ✓ �. Sa.J/.: 1' 9LOpq/ am J � BRANCH COLOW ��e G�� + /� �N � - �pUST Lp. a w ADDRESS OWNER 0] J ��O VALU$ � e� m ARCHITECT /�Q /a` NEL. �� S LTUi�t J � OR NGINEER �PS /( L{ U Q 20NE TVPE GROUP� � a w ADDRESS ` L S�. N.(J � j � `O. ByPROVE IC DAT�-Z'Z J O CONTRACTOR `(,a.. �y [ �J � ADDRESS �OO � v W p� f \ w W TE� ZONE� I NO.OF USE OF NEW A Z� pTV ��,�/QOr- ��. NO.�p LI) l� PLANS "' B LDING t n ��2 � STATE CITV 1'ARDSAPPROV D A OVED jw g—I 2�j. g 4' � MAlN BUILDI A CESSORY BUIIDING O LIC. NO. UC. NO. SI2E �OO "/3 NO.OFBLDGS. / (F MC/LSTRE I OF LOT JC NOW ON LOT q0 FT. USE OF EXISTING BLDG. 0✓ F FT. H SIZE OF Z NO.OF Z NEW BLDG. ��_J ROOMS STORIES L. SIOE FT. F. a EXTERIOR WALL �+ ROOF % � V COVERING V�«� COVERING �SN�'� n REAR FT. FT. —� VSE OF BUtLDING ANO WORK TO BE PERFORM OISTANCE ET. BEf. MAIN a MAIN BL ACCEa. B DGS. a Q VAR. �F _DATE O C.U.P. APPROV D � � ,o,�Ro o L S z� �� N Z O STATE VI hetaby ecknOwlatlBe [ha[ I hova reatl this aDPlication antl state � Mat the abova Intormation is correct antl eBrea co camply with � ull lews roBulatlnp builtlinp eonsttuetlon, onG I chall noi employ � � any person in viole[lon of t�e warkman's compenm[Ion lews of m y Ma Stata ol Cnlifornia. � ZI �oraby tartlfy Mnt 1 em p�OporlV ��enmtl ae e conbacto� untle� SQ. FT. O tha Smte of California Business and Profassionc Cotla, Divisicn 3, 7HE AMOUNT SHOWN UNDER VALUATION IS FOR � Chapter 9, and that sueh lica�s¢s are in full force anC effact, ar I ll-IE PVRPOSE OF ESTABLISHING A PERMIT FEE ONLV: m em axempi irom Me provisi s of the State of Calitornia Business ¢ VALVATION �p N entl PrOfasslons Cotl Divi 3, Cheptar 9. PERMIT FEE $ � Sip^atura ot .� m � m Permlttae $ ""1/""fi / ��0 PLAN CHECK $ E �'�-�� Authorl tl pent � � � LL -I TOTAL FEE $