HomeMy WebLinkAbout843 17TH ST - Building PermitsFNS'C !�th STAE..°2' 84;
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11049 - 12-1-59 Gemo. Cnr�rye
� 110`'io - 12-1-59 Demo. 2es.
11051 - 12_1-59 De^o.�3es.
11052 - 12-1-59 iexo. ."zr e
11038 - 5_26-6o acc. w/ at�'s, g
11039 - 5-26-60 F.e�. :+! _;� �^
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36633 - �_ ' `'"r
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P24460 Water Servi.ce
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101.
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OWNER I�ON GreQarv - � DATE
.,... ..._..�_. ., ... .. . ._,. _. . .. .. . ����� ,
LOT Por tl09 TRACT
GAS
W ATEft
ROUGH PLUMBING
PROP. $WR. LINE
SPRINKLING SVST
MISCELLANEOUS
ROUGN HEATING AND AIR CONOITIONING
UNOERGROUND I I POWER
SHEATMING
COAT
SU6CONTRACTOR
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OWNER
908 AD
T
GAS
PROP.
MISCELLANEOUS
ROl1GH HEATING AND AIR CONOITIONING
iEMPORARY SERVlLE OR POLE
UNOERGROUND � POWER �
ROUGH WIq�NG
FLOOR S
BOND BE
SHEATHI
FRAME/
NG
PI "STER, BROWN COAT
:TURpL, FINAL
HtnfING, VENT., REFR�G. ANO A.C.
PLUMBING, FINAL AN
ELECTRIC FINAL
BUILOING, FINAL
DATE
SUBCONTRACTOR
OwNER LEON GREGORY M. DATE 11-30-59
JOB ADDRESS 843 West 17th Street BUILDING PERMIT N0. 11050
OYRl@ T'
V
-10 LOT TRACT FIRE ZONE DESCftIPTION OF WORK aCm01. t85.
Ir" �ECTIONS I DATE
SUBCONTRACTOR
OWNER LEON GREGORY M. DATE 11-30-59
JOB ADDRESS $�.ij West 17th Street BUILDING PERMIT NO. �.1��9
�FxFRnr, r.oNTencTox owner vnLUE s 101.00
-�.O LOT TRACT FIRE ZONE
ECTIONS I DATE
SUBCONTRACTOR
OwNER GARCIA JUAN DnTE ll-30-S9
JOB ADDRESS $�{3 '••�est 17th Street BUILDING PERMIT N0. uOSZ
GF.NF.RA7. CONTRACTOR OWt]ei` VALUE si rn_nn
70. 116-251-10 LOT TRACT FIRE ZONE DESCRIPTION OF WORK demo�. I'E
EC7iON5 DATE GROUP TYPE ZONE MZ
rground Soil U.G. Water —I SUBCONTRACTOR PERMITS ISSUED
oWNER GAPCIA, JUAN
ii-
JOB ADDRESS 843 West 17th Street BUILDING PERMIT NO. 11051
GENERAL CONTRACTOR otaner VALUE S 101.00
AP. No11C-2 -10 LOT TRACT FIRE ZONE DESCRIPTION OF WORK dem01• gax'.
1 EC7ioN5 DATE _I GROUP TYPE ZONE M1
L__erground Soil U.G. Water �_I SueCONTRACTOR PERMITS ISSUED
ie
coat
Form 410-3M-4-59
12-
GENERAI.CONTRACTOR B8 Coast Dlars. VALUE $ Y�7}1,W
AP. No.11fi-251-10 LOT T1tACT FIRE ZONE DESCAIPTION OF WORK S. W a , ST
��ecnONs L �(/ DATE I GROUP I& J TYPE ZONE �
r, _rground Soil/.�q/_� U.G. Water �.-� pERMITS ISSUED
_� —
�+�i_______ __ ��._ . _. _—I SUBCONTRACTOR I ..
d
OCCUPANCY
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Form 41�SM-17-59 5-B P
� 130'39
OWNER
AP. No. � ��,_9Sl —1 � LOT T1tACT FIRE ZONE
Iry�PECTIONS LN/ I DATE I GROUP T
SUBCONTRACTOR
OCCUPANCY
VALUE
Form 410—SM-11-59 5�B P "11038
aooxessaea�ar+o: 843 W 17TH ST
oamexsruYe�au�vrt LEON GREGORY
�u��+843 �/2 W 17TH ST
COSTA MESA,CA
�rr�. �uie+a �oo�ss
urcxrtecr on e+au+�n:
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uxr: 1 / z •
92627
uc xo.:
uNr:
caxm�cranw�: AMERICAN HOME IMPROVEMENT
cwm�crorcaWuiwo 10415 SLUSHER DR
woxEss: SANTA FE SP CA
90670
LICENSED COMNRCTOPS OECLAFATION: I MraEy N'rm uMer pendy d p' I
(mmnercLp xilh Senion ]000) a�� J d tlw Budnm eM Pmlaa'vu
(310)994-3400
ucxo.: 721379
_ uMr: 2
m oi Cheqm 9
Wetl.
CITY OF COSTA MESA - HUILDZNG PERMIT
PERMIT NO: H 087407
CONSTRUCTION TYPE: V-N
PLAN CH£CK NO:
PERMIT TYPE: STR
N
�9 0 �f
PERM NO: B 087407
GOVT: N SUPP: N
PURPOSE: OTH
JOB DESCRIPTION : CHANGEOUT OF 2C WINDOWS SQ FT; 1,000
CLAIM VALUE; 1,000.00 CALC-VALUE: 1,000.00 GROUP OCC: R-3 /
COMMENTS: NO CHANGRE IN SIZE.
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Z O N I N GS ERTEB�AUCIKRSE M E N T S
c.Ho.:068567 uc.cuss:g uc.w 1 EXP: 00/00 ------------ MAIN BUILDZNG ---�------- --------- ACCESSORY BUILDING ---------
����pd/ FRNT: FT IN REAR• FT IN FRNT• FT IN REAR• FT IN
om�: °antotlo° LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT ZN
OW R 9UIL�ER OECIAflATION: 1 Mmby elfirm uMer I em em p M1om tM CaNretlaa Licenee Lew la iM
wipreewn�$epbn'NJ15&»iwaaeMPNa55bn+GodlM ya �nKnp��e�a�o�ewn.ena.�wow, pp�KING REQ: PROV: PARCEL: 42410201 ZNE: REF NO:
Eemd"eh, a roper mry suuclure. p'wr io ua ewame, ebo rqui epplimM la mN lo Rb e �ipned nmamant tlul M a�he
�censad pum��eni �o the prowona d Me CoMreq«� Linn w Icnap« a �� '� �.nn s«a� �0001 a�m� � a me P LANN I NG NOT E S>
' n�rov eM Rdaabna Codel � tMt M n ehe u e�amq t and iM Oaae la the awamqion. Ivry vulmbn d Swbn �
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aollerdtorseblSeGan]OOi.BunrcnendProleeeion�Code:TheCamraqoisLi� roelewdmenotepptyloenormerWpope�ry X
wla Wih a inV�'a� Ihueon. rd Mq tloe� auM wak Nm�atl a henN n Rrwph he a Mr own M�pbAe�. P�+e IMI aM'.li
impovemema me nd intaMed a dlmeG la ede. tl, howewr, �M buuEirp a inprwemml4 edd wnhm ar ysv d compelion, iM Z ON I NG AP P RO V ED B it
�.,�..awa« .�n na�,. ine w�a.� a w«���o n. w.n. ea �,a waa «�mwo,+�« me wm�e a w.1. DAT E:
�I. m ownar M iM D�W�Y, em e�d�ehdY mmreUM xil� licamsd conirxlas ro m�mua tM G�9� (Setlion 10H. Busiroes vd
v�w..+�.c�:rn.c«u�ea.u�.ti.u.a«.�awara��+�.�aaw�v��w«.u�.m.�.a,w.+a HUILDING APPROVED BY : DATE: �
conVetls tor arh qo'pls rmh e mMratlar(e) feamW WnueM to IM CaMreOon Liwms lex�.
❑ i,,,,,,,,,,q�„a.,s«w,: e.ar.c..ro,um�..,�: APPLICATION ISSUED BY: DATE;
�**�e*�r**�*�*�**�x*�**� +�*��****�* **
o°'° Q"'�� LEGALI2ATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
� eo neAW cenM ind �.m ..m. a.ne u�deAmna m. na���eme a ceaomy Hedin ena smnr coe. seaion. zssos, zssa�..m
25531, erd NN I a eny Mun briMiiq omipant xill / wYl m� (acb aro) neeE lo campty wY� �aid nms mda enC tM rpuiremaMs br
eoermn/wcmeVuctionvmoEif�ronhaniM�iawTidiy �erepamemDinna.Raddxuielmnp'uaoneppfatianenazanqhanOwa bLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
Dme: AOWK��
W ONKER'S COMPEN9�TION OECL�NITION; I MraGy elfimi uMa panelly d pwjury ona d Ihs bllowl�q datlermon+:
� I hevs aM wll meintew e csWrwia W ooromt ro utliroura tar waken' canpruetbn, n po+kad la by 3aU'vi 3100 d iM leEa
CaCe, la tM p�ameMe of iM wak Ia which Mn pemin ie inueJ.
_[l in.w.�d.u�m�.Ana+•o�o«amo��w..�...or.a�,�.eMs.a�aroodm.�n«coae.m.m.c.���din.
7C' work la which ihie peimF n iwued. My warMere compeneetion inwrarice wr'w e�M pdiry number era:
c�..: EXPIRES
� voiKy N�me« ' 0 6/ O 1/ 9 8
�"ilseMionrrasdmlMcandNed/�MP�tubanhuMrWCd/en/310V/ ) —
�'� I cenly ihel in iM perlormenca d Ihe work la whkh I�Ie permN is i I rwl peiron in em� menner n u to
becmis wbjse to iM xwkme' rn�Wlm lers d Ce4lanie. rea �Iw d bevwin euEjw to tM xorken'
/\mmponution�ymy{� SeGion 3]00 M IM LeEor Code. I Mh M1 p! '�h ��a e provieime.
.el�a. 1 � � V"� � q�.
i
rnp: F�Nun ro ucun workwi rompeiv�tlon l� wN • ct w�olorw ro almlrW pwltlw uM
c/Hl Iln�� up b on� himtlrM MauunC tla/kn (Sf00, Itlon 1 M� ro�t ol co ��tbry Eamps� u proHtlM br In
S�etlon 9�G6 0l M� LeGor Latle, InfNsst. �nC etromry
CONSTqUCT10N LENDINO �OENCY: 1 hereby elfirtn u r penMy W perNrv �M1e� ihen is e eonn�uaion brdln0 a0ency M iM
peAameiwe d tM work M v.Tich �hc permY e eeued ( ion 3081. CM. C).
LENDEfl'S NNIE:
Lp1DEN'S �OOflE94:
I cMM �het I hew iaetl 1 " bn enA tlms thel Ne ebo+e iNamelion a conep. I N�� lo canWY wnh ell'+7 end courm/ aEirw�oe�
aMetelelexerelmi uilAiip etruqion}� eroby'�nhaiza�epmenlelrveed��iedlylosnlerupanlhseEove-menlionadqopariy
IainaGabnWr . . . _/ �___._—_
o�,: 3 —d-31I�
Whne-BuilE'vp b S y; Orem-Fk; Cenery-AppFrant; Pink-Rwenue; OoldenmC-Neeaeor
PERMIT 34.75 50
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 35.25 0,00 0.00 35.25 35.25 ,00
REVENUE DIVISZON TOTALS--> COLLECTED: 35.25 OVER/SHORT: ,00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
34,75 .50
iE iE if 1E iF i4 if iF if ik 1E 1f iE if iE iF iE iF iF if if fF iE 1E �1F 7E if iF if 1F iE iF iE 1F iE iE if �f 1F if 1k i4 3E iF �f iF iF iE iE �F if iE if if if 3F iE 1E iE iE ik IF iF if iF iE �f aE aE i�r 1E IF iE iF 3F iE 3f iF ik
I N D I V I D U A L F E E H 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 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 1,000.00
END OF FEES
����
�3-23-1998l03:16 Ati/t35.25
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CONSTRUCTIQN AND PLANNING � ��� �`'A
� APPROVAIS Permit # '- Date Inspector pppROVALS Permit # �ate Inspector
.�
i. Temporary Elearical Service or Pole 52. Pool & Equipmert Location ,� ,
2. Soii Pipe-Undrgrnd. �� 53. Steel Reinforcement J.
3. Electrical Conduit Ufility-Undrgrnd. � � 54. Forms . �
4. Electrical Conduit•U�drgrnd, • . 55. Electrical Banding _
_.5. Steel Reinforcemerit 56. Rough Plumbing & Pressure Test - -
_,6_ 'Electrical UPER Grnd. 57. APPROVAL TO COVER�GUNITE
'-7. f.00tings � �� . 58. Elecirical Conduit�Ondrgrnd. •
8. Foundation - � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgmd.:; , �� � 60. Backwash Lines, P;Trap, L� Undrgmd. �
10. Structural F�oor�SYstem . � 67. APPROVAL TO DECK -
11. Property Sewer Line & House Connection . 62. Backwash & Receptor�Final
�
12. Sewer Cap -, � - 63. Heater & Vent�Final � ,
13. Roof Orains �- � , 64. Plumbing SYstem • F.inal
14. Rough Plumbiny � � 65. Electrical-Final
75. Rou9h Electrical-Conduit � ' ' � ' 66. Solar System-Final ..
76. Rough EleMric'Wiring-� �' � �� . � 67. Fencing & Access Approval
� 17. Rough Wiring Sign ' ' . - 68. RPPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOI/SPA SYSTEMS FINAL
19. �Rough Heating &,Air Conditiooin� � � FIRE�DEPT.:REQUIREMENT
i. . ._
20.� Rough Factory Firepiace � _ _ , � ' � APPROVALS' ; Permit # ,
H .
21. Ducts, in.Structure r - 70.-Under9round H.ydro
22.-Ducts, Ventitaiing.� � � S � �'' 7�, product Piping.0 Gas ❑ 0(1
i - -
23. Gas �Pipe-Rough & Test .,- �- ,, 'r ' `- �', r 72, Underground Fluih � _
24. Roof Framing •"• ' `- `� _•. 73�. Undergrnd. Storage Tank O Gas ❑ Oil
�
25. Roof,Sheathin " ;. � `Y - �
9 ;� � 74._�Overhead Nydro•-
26. T-Bar Ceiling (Structuraq & Monocoat ' . '"' 75. Ory Chemical ` ' � �
27. -Frame and �lashing " : . 76. Dry Staniipipe -; �� � , ,
28. Lathing & Siding - � _ -_ - -• � � i � � 77. FIXED SYSTEM �FINAL -
29. Insulation ' '" _ ' �� , �. 78. FIRE PREV�. FINAL ' .
30. Drywall Nailing ' � � ' - HEALTH DEPT. REQUIR�EMENT � �
, 31. Plaster Brown�Coat - , 79. FINAL INSPECTION � , . �
�� 32. Electrical Power Meter-Pinal � � 80: FOOD CEiiTiF1CATE ISSUED
� 33.=fina'LElectric' ; � _ � -� ' . Notes: y � : � �� ,
34. Final� Heatiog & Air Conditianing • , • � � "� _'� '�
35. Final Gas Pipe�Test - ' ' � � . : .. . _ ` !�
36. Hood or CanoPV � . ' � '
37. Final Factory Fireplace '�; ., � ��. �� -�
� 38. Finai Plumbing � _ �* � - �'
39. Water Service,Finai � - , ' - • � � . ', ; ,
= 40. Gas Service-Final ' .. - ' . � � � ._ -
� 41. Solar pomescicFinat � � � � � -
,. � ,
42. 8ackflow PrevenTer . . - � � , , �i _,'_
43. Backflow Irrigation '
44. .Landscape Irrigation System . � � -' ._ � � '
45. Sound Attenuation � � '' ' �' � - �°� � �
_ . .. , •-i: ..
46. Handicap�Regulations � . - � � `� -
47. FINAL STRUCTURE & BUIL�ING S y�0 - •
. 48. FINAL PLANNING • � :• . - . -
'49. Electric Retease to Edison � � " ' - . �. ' -
50. Gas Reiease to Southern Californla Gas Co - � �
51. CERTIFICATE OF OCCUPANCY
No. Date
�
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.B�WlLDING PERMIT 77 FAIF ORIVE, COSTA MESA, CA 92626
Job Address: 843 W 17TH ST
Suite:
Viciniry:
PrimaryOcc: U7
Parcel Number: 42410201
npplicant: CORRIE KATES
Address: �
Type of Consiruclion: V-N
Zoning:
ownec LEON, HOPE
Address 843 1/2 W 17TH ST� �
UNIT A
COSTA MESA, CA
Contracror: OLIVER MAHON ASPHALT INC
Address: 182 WELLS PLACE �
COSTA MESA, CA
� Zip: 92627.. ,
Phone: 714-434-9228
Z�p.
Phone:
Zip: 92627-4315
Phone: 714-548-6398
License: 524528
a
ISSUED BY:
�
Status: ISSUED
Applied: 05/16/2007
Issued: OS/142007
Arch : Eng: KUFf I JfVCVN � �
Address: � � Address: - . � -
Phone: " ' � . ' . � . Phone: 949-366-2180
�''�"
Zip:- . . � —Licen,se:"::1."' +. , . ��. �. , � \'�License: 44180 �.
' � SCOPE OF PERMIT
CONSTRUCT A 122 LF X 6' HIGH BLOCK WALL ON TOP OF A 2'-0" RETAINWG WALL. CONSTRUCT A 20'L.F. X 6' HIGH BLOCK WALL NORTH EN[
PERIMETER WALL: REPLACE EXISTING GATE WITH A NON-MOTORIZED SLIDING GATE. �
WALL MATERIAL TO BE TAN SPLIT.FACE BLOCK COLOR "SIENNA" OR.ORCO SLUMPSTONE BLOCK COLOR "LA PAZ" WITH A BRICK TRIM CAP
REP:PA-O6-63 � . .�. .�-. ��'�4 — '-' ' - . . . . _ � .
FEE SUMMARY ;`'
Plan Check: $90.51 � ,' l �'' — , Calc Valuation: $e,�oo.00
Permit: $139.25 _ _ Claim Valuation: $o.00
SMIP Res: $0.61
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total:. $230.37 �
. �e_v. �:,y.. ; -
SETBpCKS
MAIN STRUCTURE Front � 0- 0 - � Rear 0- 0
ACCESSORY Front �0-'0 Rear 0-0
'
PARKING Existina:� �� 0 ' � Reauired: ' -0
Left 0- 0
Ceft 0- 0 '
Prouosed: -�'0�,
Rlght , 0- 0, � .
Right ��0_ 0� �
' .
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulatlons. (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 abandonetl
for a period of 180 days.
IINSPECTIONS: In order for the work authorized under this permit to be considered legal. such work must comply with all applicable codes, and all
requlred InBpectlona end final approvel must be obtained. Failure to oblain inspections and final approval will result in the expiralion of this permit.
� FOR INSPECTIONS CALL: (714) 7545626 . -
zaansu �fnu�
WORKERS'COMPENSArONDECLARAnON:
I hereby aflirm under penalry ot perjury one of ihe following declarations:
❑ I have end will maintaln e certificate of wnsent �o self-Insure br workers' compensatlon, as provided for by section 3700 ot Ihe Lebor Cotle, for the pertormance of the
work for which Ihis pertnit is issuetl.
�I have and will maintain workers' compensation insurence, as required by section 3700 of ihe Lebor Code, for ihe pedortnance of the work far which this pertnit Is issued.
My wolers' compensation Insurence carner antl pollcy number ere: �
af one hundred dollars
P�y Numbar'ti 5� O E� G(s L d O tf� 77-.��n
❑, I certity Ihat in Ihe performence of the work for which Ihls permit is issued, I shall not employ any person in any manner so as to become subject �o Ihe workers'
compansetion lews of Celifomla, end agree at tl�ld become sub�ect to the workere' compensation provislons of Section 3700 of Ihe Lebor Cotle, I shall forthwith
comply with these provisions. "�
AppllceniSipnature:, ? oatai 7 SX//����
WMNINO:FAILURETOSECUPEWORKERS'COMP SATIONCOVEFiA0EI5UNLAWFULPNDSMALLSUBJECTANEMPLOVEFTOCRIMINALPENALTIESANDGVILFlNESUPTOONEHUNDHED
THOUSPND OOLLARE (5100.000). IN ADDITION TO� COST OF CAMPENSATION, DAAUGES AS PROVIDED WR IN SECTION 3]Ofi OF THE LABOq CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTOHS DECLARATION:
I hereby ettirm�that I am licensed under provlslons of Chapter 9(commencing with Section 7000) ot Division 3 o`f Ih�Business antl Professions Code, and my license Is in full
foae�entl eHed. Lic. # S .�Cless q G% L
ConlrectoKsSignature: Dete:;� 8�1�!/oZ
\ _—/ i
CONSTBUC710N LENDING AGENCY: (/
❑ I hereby aHirtn that thera is a consiruction lending agency tor Ihe pedormance of ihe work for which ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lender's Adtlress:
Signeture: _
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aNirtn ihat under penelry of peryury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires a permit to consWct, elter, improve, demolish, or repeir eny sirucWre, pnor to Its Issuance, also requires Ihe applicant for such pertnit
to file a signad statement thet he or she Is Iicensatl pursuent to the pmvisions oi the Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) ot Dlvlsion 3 af ihe
Busineu end Professlons Cotle) or ihet he or she is eaempt thereirom and the basis for the alleged exemption. Any violation of Section 7031.5 by eny epplicant for a pertnit
subjects Ihe epplicant to a civil penelty of not more than five hundred dollars ($500).):
❑ I, es owner oi the property, or my employaes with wages as their sole compensation, WILL DO THE WORK, end Ihe structure is not Intended or otteratl for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law dces not apply to an owner of property who builds or improves thereon, and who does such work
himself or hersetl or ihrough his or her own employees, providetl Ihat such improvements ere not Intendetl or oHered for sale. If, however, ihe building or improvament is
sold within one year of completion, ihe owner-builder will heve iha bwden of proving thet he or she did not build or improve for purpose ot sele.). '
❑ I, as owner of ihe property, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, Business and Professions
Cotle: The contractors License Lew tloes not apply to en owner ot property who bullds or impmves thereon, end w�o contracts for such prolecl with a contracror(s)
license pursuant to ihe Contractors License Lews.).
❑ I am exempt under sec. Busineu and Professions Cotle tor this reason:
SignaNre: Date:
Owner ID venfed by drivefs license. ❑ Yes ❑ No Dnvers License No. Ezpires:
Verification of Owners�ip Dy (rype ot document, I.e. - properry tex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I heraby certify thet no excavetion five (5) or more feet in depth into which a person is requlred to descend, wlll be made in conneclion with work euthonzed by this
permit, antl ihat no building siructure, scaHolding, falsework, or demolition or dismentling thereof, will be �core than �hirry-sia (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Atlministrative Cotle).
❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Indusinal Satety, es notad above, unless such person hes e
pertnit to do such work trom ihe division.
Signature: Date:
Division ot Indusirial Safery Pertnit Number:
CERTFlCATE OF COMPLIANCE AND AUfHORIZATION OF EMRY: I certify under penelty ot perjury ihat I have reatl this epplication antl state that the intortna�ion given is
correcL I agree to comply with ell stete laws and city ordinences relating to building construction, end authonze representatives oi ihe Ciry ol Costa Mesa to enter upon the
ebove-described property for Inspection purposes. I agree no� �o occupy or ellow occupency of any building authorized by Ihis permit until tinel inspection.
GOUE1, INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266
200
Pool Spa Final
Final Re-Roof
201 Finel Blxk/Reteining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
Q�¢, �MRIALS
ZS �
CODE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Preven�lon
220 Final Planning Approval
222 FinalSite
250 . Final euilding/Occupency
�
:' - �
� CITY OF COSTA MESA ,
e BUILDING DIVISION
f � DEVELOPMENT SERVICES DEPARTMENT
� �, _ ..' ;..,3: ;ro:.:,.
�� . PERMIT
(714) 754-5273 • Fax (714) 754-4856
Job Address: 843 W 17TH ST
Suite: B
Viciniry:
Parcel Nunmber: 42410201
Applicant: MARION, BARBARA
Address:
ownec LEON, GREGORY
Address 843 1/2 W 17TH ST "
COSTA MESA,CA
Contractor: MESA ROOFING
Address. 843 W 17TH � �
BUILDING PERMIT
Zoning:
Phone: 949-548-3012
' Zip: �
e
Phone: -949-646-9522
Zip: 92627 ' .
� 'v :
1
� � ' PERM BER ' �
698-01950 ✓
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 10/28/1998
Issued: 10/28/7998
- -. Phone: 949-5483012 � �,� � �
� . , � , COSTA MESA, CA , Zip: ` 92627 ' �
� " License:' S64151
Aroh / Eng : ' . . . 'i' . . � .
� "' i
, Address: , . " i _ _ ., , _
. . . . � . - -Phone: : . �
. . . . , � Zip. _ . ,
' � - License: � �
' SCOPE OF PERMIT ,
�_ " TEAR OFF ROCK ROOF INSTALL 40 YR COPM. SHINGLES OVER 2 LAYERS OF 15LB FE�T.
0
FEE SUMMARY ' �
Plan Check: ,$0.00 ___ � , Calc Valuation: S5,sao.00
Permit: $112.25 _ - -' _ . - - Claim Valuation: gs,sao.00
SMIP Res: $0.59 � ,! ' '
SMIP Com: $0.00
Other: $0.00 ,
Inspection: $0.00 -
Total: 5112.84 '
� � - � PLANNING & ZONING
SETBACKS � ". 'n� - - - �.
MAINSTRUCTURE�Front 0-0 � Rear .`0=0• . �� Left . 0-0 Right 0-0
ACCESSORY Front 0- 0 Rear 0- 0 . Lek 0- 0 Right 0- 0,
PARKING Existinq: � 0 Required: 0 Proposed: 0
NOTES: ` � � - -
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
tor a period oY180 days. .
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
�equired inspaetions and finel approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�Ecr.,aear�on
WORKERS' COMPENSATION DECLARATION: �
I hereby attirtn under penalty of perjury one oi ��e following declarations:
❑ I have end will maintein e cenificete of wnsent b self-Insure for workers' compensetion, as provided tor by section 3700 of iha LaDor Cotle, for iha performance of ihe
work for whiCh �hi5 petmit Is issued.
� I have end will maintain workers' compensetion insurance, as requiretl by section 3700 of ihe Lebor Code, tor Ihe peAortnance ot �he work for which Ihis pertnit is issued.
My wQ rk�ers' compensation Insura�(�ce cartier entl policy number are: ry,p
Camer: :7Fh�'P. �I1h(1 poiicyNumber: �� ��� YC�
(ThIs section need nof be completed i/ fhe permif is valued at one hundred dollars ($ f 00) or less.)
❑ I certiy thel in ihe performance of the work tor which this permit is issued, I shell not employ eny person in any manner so es to �ecome sublect to the workers'
compensetion laws of Celifornla, and egree ihet if I should become subject to the workers' compensation provisions oi Section 3700 of the Labor Cotla, I shell forthwith
comply with thes vision�` � �p_/� n
ApplicantSignaNre:���J �i� f�l�� Dete: ��'CYC7 �IC�
WARNING: FAILURE TO SECURE WORKERS' COMPEN$q7�pp� �pVERAGE IS UNLAW FUL FND SHPLL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDFED
THOUSAND OOLLARE (E100,000), IN ADDITIIXJ TO THE �pST OF COAIPENSATION, �AMAGES AS PROVIDED FOR IN SEGTION 37080F TME LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eNirm Ihat I em licensed unde provisions of Chapter 9(crommencing with Section 7000) ot Dlvlsion 3 of ihe Business and Profeuions Code, and my licensa is in full
force and eHea. Lic. u - Class a—�7--�
Conirector'sSignature: Q e� Date: 1(1'�
CONS7RUCTION LENDING AGENCY:
❑ I hereby eNrm Ihat there is e construction 16nding agency for ihe peAortnance ot the work tor which Ihis pertnit is issuetl. (Sec. 3097, CIWI Cotle).
Lendefs Name: Lender's AGdress:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
I hereby affirtn Ihat under penalry of perjury thet I em EXEMPT FHOM THE CONTRACTOHS LICENSE LAW for the following reason (Sec. 7037.5, Busineu end Protessions
Cotle: Any ciry or counry which requlres e Dertnit to construd, alter, Improve, demolish, or repelr any siructura, prior to its issuance, also requiras the applicant for such p9rmit
to file e signed statement Ihat he or she is licensed pursuant to ihe provisions of ihe Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Professions Cotle) or thet �e o� she is exempt iherefrom and Ihe basis tor the alleged exemp�ion. Any violetion of Sedion 7031.5 by eny eppliceni tor a pertnit
sub�ecLs the epplicant ta e civd penelty of not more than five hundred dollars ($500).):
❑ 1, as owner of t�e properly, or my employees with wages as thelr sole compensatlon, WILL DO T1E WORK, and ihe structure Is not intanded or offered for sale (Sec.
7044, Business and Professions Code: The Conirectors License Lew does not apply to an ownar ot property who builds or improves thereon, antl who does such work
himseli or herself or ihrough hIs or her own employees, provided that such Improvemenis ere not intentletl or oHeretl for sale. If, however, the building or improvement Is
sold withln one year of wmpletlon, ihe ownar-builder will have ihe Durden oi proving that he or she did not build or improve for purpase of sale.).
❑ I, es owner oi the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the praject (Sec. 7044, Business end Prafessions
Code: The conirec�ors License Law does hot epply �o an owner of property who builds or improves Ihereon, end who contrects for such project wlth e contractor(s)
license pursuant to Ihe Contractors License Lews.).
❑ 1 am exempt under sec.
Signature:
Owner ID verified by dnver's license. ❑ Yes . ❑ No
Business and Professions Gode tor ihis reason:
VerHication af Ownership 6y (rype of document, i.e. - properry tex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CEpTIFICATON:
Dnvefs License No.
Date:
Ezpires:
❑ I hereby certiy ihat no excevetion five (5) or mora feet in Aep�� into w�ich e person is requiretl to descenq wlll he matle in connectlon with wark euthonzed by this
permit, antl Ihet no building atrucNre, sceHplding,lalsework, or demoli�ion or dismentling ihereof, will be more then Ihirry-six (36) feat high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomia Adminisiretive CoOe).
❑ As owner-builder, I will not employ anyone to tlo work which would require a pertnit from the Dlvlsion of Industnel Satery, as noted above, unless such person has a
pertnit to do such work irom the tlivision.
Signature: Data:
Division of Industrlel Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTFiORIZpTON OF ENTRV: I certity under penalty of perjury ihat I have reed this application end state that ihe infortnation given is
corred. I agree to comply with all state laws antl ciry ordinances relating to building consWction, end authonze representatives of the City of Costa Mese to enter upon the
above-described property for inspection purpo5eg, I agree not lo occupy or allow occupency ot any building euthonzed by this permit until fnal inspedion.
re Of Legel pwner(s)
��)'U2�'�C/�Q `���/I)'YI1 %/')-�-4�
AnNOr Authonzed Applicant Da e
CODE I INSPECTONTYiE
1616 Fixed System Final Fire Prevention
126fi
200
Pool Spa Final
Final Re-Roof
201 - Final B1ocwRetaining Well
202 Final Fectory Fire Place
203 Final Sign
204 Finel Demolition
2A66 db
�.1 Jul:
_���� /�
GQQE1 INSVECTIONTYPE
206 Finel Mechanicel
200 Finel Plumbing
210 Finel Eledncal
272 Final Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final Builtling/Occupancy
PAiE It�ALS
/
T
/
wonasaea�naa: 84J W 17TH ST
o�n'sn+�E�c�LEON, GREGORY
�o�u:U4J 1/2 W 17TH ST
COSTA MESA,CA 92627
646-9522
APPL. IWl810 ADMIE53:
41CNRECTOfl F1FiNEEN:
uara_
°�'T' ,l �l� CITY OF COSTA MESP — DUILDIhJC PERMIT
`v
PERMIT NO; B Oti2340 PLAN CHECK NO; N
CONSTRUCTION TYPE: V—N PERMIT TYpE: STR
UM:
ca+rn�crarsru�:AMERICAN HOME IMPROVEMENT (310)994-3400
coxm�cToxs�uwa10415 SLUSHER DR
,�oonessSANTA FE SP CA uar+o: 721379
90670 uxr: 2
110EN3ED COMR�CTOXS DECLApAT10N: I hereby ertim wds pe�Wy d pmjwy Nm I liaued wds prwieiau d Cheqx 9
(mmm«�q wan S�ction �aoo) d Diubn o al Me Budnm eM GNm4uu Co . uM 'oenn u m M bica �d allw.
wrruc.no.p68567 uacuss:g uaNa: 1 9 �XP: 10/97
Dye: � CaNreaw:
OWNEN 9UI DEP ECLAflATION: 1 heiaby dRrm untler pe' I em mmq hom ihe COMrepan Liorive lew la IM
Iqbxi�B ieewn (9atlion ]IXf1.5 &uim� rd Rdmdao .♦ n ' �eV� e Ve^^'s to ooraWcl. a0er. inpave.
bmdeh.a�epeiarry�mctum.p'nbb'vauen».aborap eypCrint pw�mAlofibeq�riedaWenq�utlutMvahs
0 m
� 4oemed puwW b Ihe pw�ora d U+ Ca4recu* M jCheqs B( mendip weh Setlion )000) tl D'webn 9 d Ih
uavwv mW Prdenam Codel a Iha M a aM e eaanp � uM �M bema Ihs sOepeE eaanqion. /nY violelion d Swion
/W1.5 by enY aDW�I la e per�l wEjeUe �M eppliranl �o � p0ealy d nol mqs �hen frve huMreA AdW �5500�).
� I.avow�wrdiMpW�YamYamVbl�wiAwepe+miheisobmmV��ion.willAolMwwk.eedOreLucNiewm�'vXeMed
a o%med la ede (SecUon )Oi1, Buuroea enC Proleesiona CaAe: The Conireqon L'aenee lewdoes rwl epply�oen ownor ol popoity
wlp blid9 p ItIMO"d IhNM. dM'win dCL081lCh wCIN IY11FN p helaN p 4VCW�11b d 11[I Own BTp09l�. P'p'�L� I11N PICA
improvemenie are rot imeMed a Waad lor ade, tl, however. tM buiNieq a inqwanaN o wid wuhin ms yeer d mmplelion. IM
o.,b.a�ae« .au nwa m. dod«� d o��w ne « m,e au oa nmu «�mwa+i« in. wwm• a.ds�.
❑ �. m m�n.r a ine wW�v. � exd�uiwN oom.mna �.an fmn.w cantrxtae m cmarue ina woi� Iseaion �ou. eusinss a�e
Pmi»anu Coda: The Caufetlm liceros law� Aom na evdY n en owner d P�Y Wc buffi a impwr Owaon end vAn
eoni�eele la wN papae wiN e oomrmor(e) Ibaued pueuap �o IM Coeaemae Liwue lawl.
qi�..�a ��a., s«,�: e. a r.c.. r« w. �:
pme: ormer:
I� hereby caN1y Ihel I em ewara d end uManWM Ms requiiemeMe d Cd'/orttie Heellh vd Selery Coda $wbm 25505, 255�, aM
�553,. aed tl�el I a enY Mua EUJC'vp mo�OW. will / vA m� (meM ane) �wetl to eomNY wIh oid uma mEm xN �Ir rpwemw tar
SM�elaaaumcYanormoEificmionham�MAr ue�y e�pmqNOiurie.RmidevoloautMioneGV�'�iauenasemqhanNma
nowom.
Dele: Apqicam:
WOpKEN'S COMPEHSRTION DKLPR�TION: I henEy eifinn umler penely d paijury ms W iM blbrring Mderetione:
� IhaneMwilmeiMen�cenEiraleWmiwntoseCimunbrwarkerimmpenWion,npwidedtabySWbnJ]OOdtMLMcr
cm.. �« in. p.no�.��e a in..wx i«..i:u, m� �mm n m.�.e.
�� n.r. ena wa meune:,.oikei.• wmv�o� i�w,�anw, o r.c�aA M swbn mo a e,e Lenu. coa.. w ue w�amenm a 11r
wak la which Mu Ge� u usueC. MY wakae' mmGM�ion imurerca wrier and Vdic/ wmber ars:
c.m..: NATInNAL UNION EXPIRES
Pw�r+�,�, Wf'iR�S�aR 06/O1/97
,�w ,.a� �ee �a w�d�oa � rn. o�e e ro. �» n�,b.ed eodd. ls�ool o. w..)
�] I ceXJy iha in �ha pMamence d Ihe wark la wAch lhia permX b iwad, I I�NI iwl y eiry pereon in eny menmr vo r lo
pecpro wbjee to iM workme' canpenWion lewa d CalJomis. eM s tlm' I houtl became aCjsq to the wukr�'
comps ronq� voro N SaUion 9100 d tM Lebar COAe. I e1Wl lon 1 comp ' � �qwlaioro.
I o.,a: Y�/Yr� •ow�:
Wam/ip: F�Ilun b ucuro wikr�'ror�ow�tlon corerp� 1 ahll ui I�n wlploy�r ro WmIM pwWtlr mE
NNI 11ro� �y ro wr� ��rOrW fhouuN Odl�n (S1n0.OGOJ, n b tlh of ro xuetbn, AemsW �� proHWE br In
Sstlon 3MJ ol IM la6o/ Co4, InMpL Nd �ttomsy� I
CONSTAUCTION LENDINO AGENCT: I Mreby elfi�m u �alry d per'puy Ihtl �Mre ' e mnelrutlion Imtli�q epencry br Ns
perlpmeiwe d �hs wpk br wh'xi� Ih'e W�1 u ue�»d (Setl �D8]. C'x. C).
LENOEP'S NIWE
LENOEH'3 ADOqE34:
1 cenity tM1m I hen nad Ne eppf � eM etms Ihm the ebv.e iNammion e cansl. I e�pae tocmiply �%� e0 �Yy end awmyoMuunow
vM c�PoB kw8 �dNTO �O buikM CMOh1�CIfN1 uA Mfl�Y eNhOtR! Aplptpn�ati'/Bs d IhOOIY IO aMM IIV� Ih! BbOVl.TBI1�LYIBj pOpMy
w, m.vae;o� oww�+.
GEO E TINEZ
PnM Neme
/% ow: �
�%—%`"°"� °"'"dro.wnow�,�c«n�u«
wnne-e�m:a s sdar: c��ie: cenw-�oa�m: q�k�..�.ow: ode��oe-n,.�.o,
PERM PdO; B 082340
GOVT: N SUPP; N
PURPOSE: UTH
JOH DESCRIPTION : CHANGEOUT OF 4 WINDOWS WOOD TO VINYL SQ FT: 2,000
CLAIM VALUE; 2,000.00 CALC-VALUE: 2,000.00 GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED WORK IS FOR 8J2-1/2 W 17TH
�**��*�*�e���*�**��*****�*+��***x*+�*�****�x�***+�***���*******+�**�**�***�***�*�*�*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
----- --�---- MAZN BUZLDING ---------- --------- ACCESSORY BUILDING - --------
FRN'f: ['T IN REAR: FT IN FI2NT; FT IN REAR: FT IN
LEFT: E'T SN RGFiT: FT IN LEFT: FT IN RGHT: FT LN
PARKING REQ• PROV: PARCEL; 4241020i ZNE: REF NO:
PLANNING NdTES>
i
!E 1E 1E �)E 1F ik 1f 1F �f fE f(-iF 1F'lE �lE -0E 1E 1E IE iF iE iElElE iE iF Ik 1E 1E iE'lk 1F 1E 1f 1E 1E iF'lE 1E iE fE if 1E 9I� If 1E )f iE 1f �IE iE if 1E 1E fE if # 1flE 3E �ElE 1ElE 3' #f 1E f41f if �IF 1E iE iFlf if IE �lE if
D E V E L O P M E N T S E R V I C E S R E c,� U I R E M$ N T S
ZONING APPROVED BY
BUILDING APPROVED BY
APPLICATION ISSUED B
�*��*��***x�****x***+�
LEGALIZATION:N
BLDG PMT
PERMZI' 62.25
3
F E E S U M M A R Y
PLUMBZNG ELECTRIC MECHANIC FIRE
LAN
SSUE FEE
UZLDING—DIV—> PERMZT ISSUE PLAN—CFfECK TOTAL
OTALS----> 62,75 0.00 0.00 62.75
DATE;
DATE;
DATE; � 4
iE k df if dE 1f iE iE 1Ei���'iF� iE
STRUCTURAL SEGMENT;Y
SMIP/RES GRADING
.5�
SMIP/NON-RES
PAID DUE
62.75 ,00
E DIVISION TOTALS--> COLLECTED; 62.75 OVER/SHORT; ,UO
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
62.25 .50
if if if 1E 1F �f fF 1E fE 1E 1E iF �E iE fE k if !f 3E fE jE jE iElF 1E iE 1E �IF fF iE if IE iE iE 1F IE ff iE 3k if k 1E k 1E 1E iE IE �k k 1f if If 1E 1f !E!E 1E 1E 1E iE 1E 1E iE fE iE iE iE iE ff iE 1t 3E if �E �f if iE if
I N D I V I D U A L F E E B R E A K D O W N
YPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
FR 2000 ALTER HY VALUE RESIDENTZAL NOZONE 1,00 2,U00,00
END OF FEES
EXPIRE�p
DATE 1 `� �' l-I"' �
04-97-1997/11:25 AM/f62.75
RCPTq:01-8004443
PERMITe082340
CONSTRUCTION AND PLANNING � POOI 'A
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
- 1. Temporary Electrical Service or Pole - - 52. Pool & Equipment Location .
2. Soil Pipe-Undrgmd. , . 53. Steel Reinforcemenc
3. Electrical Conduit Utility�Undrgrnd.. , 54. Forms � .
4. Electricai ConduibUndrgrnd. � • 55. Electrical Bontling ', "
5. Stee� Reinforcement � 56. Rough Plumbing & Pressure Test
6. Elettrical UfER Grnd. . 57. APPROVALTO COVER�GUNITE
7. Foocings . � 58. Electrical Cqntluit�Undrgrnd; -
8. Foundation � �� , 59. Gas Pipe, O Undrgmd., Tesx �
9. SNater Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor Sysiem 61. APPROVAL TO DECK �. -
i t. Property Sewer Line & House Connectio� 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent•Final ''
13. Roof Drains 64. Plumbing System - Final
74. fiough Piumbing 65. Electrical-Finai �
15. Rou9h Electrica�-Conduit � g6. SoVar SYstem-Final� � �
16. Rou9h Electric Wirin9 67. Fencing & Access ApProval -�
17. Rough Wiring Sign . � 6$. APPROVED POR PLASTER WG �
78. Rough Electriwl•T Bar Ceiling 69. POOUSPA SY57EMS FINAL .
19. Rough Heating & Air Conditioning � . . FIRE �EPT. 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 & Tesi . �_ � 72. Underground Flush � �
24. Roof F�aming � � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing � . 74, Overhead Hydro
26. T•Bar Ceifing (Structuraf� & Monocoat � 75, pry Chemical -
27. Frame and Plashing � 76. Dry Standpipe '
28. Lathing & Siding 77. FIXED SYSTEM�FINAL
29. Insulation . 78, FIRE PREV. FINAL
30. Dryvaall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Pinal - 80. FOOD CERTIF�CATE ISSUED
33. Pina� Etectric � Notes: -° �
34. Final Heating & Air'Conditioning . � ' '
35. Fina� Gas Pipe-Test � ' � �
36. Hood or Canopy ' .
37. Fina� Factory F(replace
�
38. Pinal Plumbing . . . .
39. Wate� Service�Final , •�
40. Gas Service-Pinal -
41. Solar pomesticFinal
42. Backflow Preven[er � � � _ �
43. Backflow Irrigation
44. Landscape Irrigation System � .
45. Sound Attenuation �
46. HandicaP Regu�ations � . � �
47. FINAL STRUCTURE & BUILDING -.. � '
48. FINAL PLANNING
49. Elecrric Release to Edison - �
50. Gas Release to Southern California Gas Co _' •
51. CERTIFICATE OF OCCUPANCY
No Date
Applicant to f111 in all sDaces except those within heavy Eortler Ilnes ana sign all approo��ate eeciarations.
`s�Y OF COSrn MESA C NSTRUC PERMIT
��ject Address
� Applicanl's Mailin Address �
�Owner's Name Phon ���
J Address
Arch/Eng - License No.
. Address � , .
Contractor's Nem Phone �
Address (mailing) .
City License No. /��P ����p-�
IICENSED CONTRACTOR DECLARATION
I he�eby affi�m that I am liconsetl untler provision5 of Char[er 9(commencing
wi[h Sectlon ]000) ot DIvi5lon 3 ot the Bu5lness antl Prot<ssions Cotle, antl
my Iicense is in full force antl effect. •
License Class � License No.
Date 519nature
WORKERS'COMPENSATION DECLARATION
I hereby affirm tnat I have a certificate of consent to sel(-Insure or a certificate
• Workers' Compensation Inzurance, or a certifietl copy ther¢ot (SettiOn
00, Lab. C.)
olicy No. Comoany
8 Certiiietl copy is nereby furnishee.
Certifietl copy is filetl with the tity Builtling Divlsion.
Date ApP���ant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be comple[etl If the permit Is for one huntlretl ($300) or
Iess).
I car[i(y tha[ in ihe pe�fo�mance o7lbe wo�k (or whicM1 [his pe�m�t is iSSuetl 1
<nau not emolov anv oerson in anv manner so as to b,ecome subject to t{�e
NOTICE: Vf,.ifti
WOrkets' Comp�
comply witn s
CONSTRUCTI[
I nereby atfirm t
of [he work'
lxntler's Name
txnaer•z Atlares
OWNER BUIL[
I hereby aHirm
following reaso
coun[y which r
any structure, �
, to fiie a siqnetl
G,�-,I
L2W5
provisions or. t111s permit sllall oe aeemea. revoNea.
LENDING AGENCV ' � -
[here'is a constructlon lending agency for the periormance
whicb this pormf[ is issuetl (Section 3097 'Civ. G.)
DECLARATION t
I am exempt (rom the Conlractor's
�<tion 7031.5 Business antl Professbr
'es a permit to construcq.alter, impro
to its issuance, also �equire5 [he appl
�ment thr[ he/she is licensetl our5udn
the
or
�31.5 by any applicant for a permit subjects the applicant to a civil
palty of not more than five hunCretl tlollars (5500).
, a5 owner of tne propOrty �b y +�pl yee_r�_�y9ei.d�rlHei�'-SQte-
wi11 tlo the work, ana the structvre is not intentletl or o(teretl
for sale (Section 7044, Buiiness antl Professional Cotle: The Contractor's
License law tloes no[ apply to an owner of a property who builtls or improves
thereon, antl who aoes such work nlmselt/berseli or throu9h his or her own
emplOyees, p�ovitletl that such imprOv¢ment5 are nOt Intentletl Or otte�etl for
Sala. If, howeve�, the builtling or Imp�ovement is soltl within ona year of com-
pletloq the owner wilf havG [he burtlen of provin9 h¢/she tlitl not builtl o� Im-
�rove for the purpose of sale). �
�J I, as owner of the prop¢rry, am exclusivery contracting with IlcenSetl con-
Vactorstd construct the project (Section 7044, Business antl Professions Cotle:
The ContractoYs'License law does not apply,to an owner of property who
builtls or impwves thereon, an0 who cont�acts tor suth prOjects with a con-
fractor(sl license'pursuant to [he Contractor's Ucense Law). I am aware�tnat�
prooi o( their Worker'S Gompensdtlon insutance ShOultl be provltletl fo me.
❑ I am exempt untler Section ,B. 6 P. C. fo� thls �eason
have
TYPE OF CONSTRUCTION U NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER.,
PROJECT DESCRIPTION 5a. F7. � OCCUPnrvcv
CONSTRUCTION'TYPE VALUATION $
GRADINGCV.VDS. ACRES_
Remarki:
Bar Sink
Backflow Preventer
Backflow Irriga[ion
Irinking Fountains
loor-Drains '
loor Sinks
Ias�Service - ' Outlets
ncerceptors �
:itchen Sink -- — -
avatories � �
'—Trap �• . '
ioof Drains � �
• 1
Reinspection� Fee $15
Boiler
Dutt- Under Ground
Duct - Structural .
Duct - Ventilating
Exhaust System � Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ o-i oo,000 sru O i oo,000 er
antl state laws relabng to oWlamg consVuctvOn, ana nereoy autnorae repre- - -
sentatives of this tity to e er up Me above-mentionetl p�-Perty. tor .
inSp¢Ctlqq Ou ses. ' � �
Siqnaturb'� �l • ��_ Da[e� � .
Drivers' License _ Reinspection Fee
CMF 0865-46, rev. SO/84 White - Builtling; Canary - Applitant; Pink - Accounting: Goltlanrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors.
Solar Piping � -
SolarTank �
Swimming Pool w/Spa� � .
Urinal
Water Closet � . �
t
Water Heater . '
Water Service.• - � � � - � -
Auro-Wash . � '
laue Fee
Hood or Typel ❑ .
Canopy Typell ❑
Refrigeration Sys[em
❑aioo,00asTu Oioo,000
System Fepair/Alteration
Fire Oampers
Registers .
$ 3
FEE
Issue Fea • � � $ 3
�
A.P. #
S Main Building:
E
T Front
B Rear
A
C Right
g Left
Ping. Ref. dk
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher �
Dryers ❑Gas ❑Elec'
Fan
F.A.U. '
Fixtures ' �
Device Bozes
Outlets � �
Switche5 , - -'
Garbage Dispoul
Genereror �0.5 KW C
8933 7%07/B6�m
Zona
Building:
5.00 Tl
• r . . . .
. , .ELECTRICAL FEES
TransfOrmer ❑ 15-50 KW
� 50+KW
Merer ❑up to 700 amps � .
� Meter ❑over100amps '
�c . Sub Panel �
Motors�61 HP�ih-8 .
� InaSolar �9-15 HP'�i6-15+
Microwave� �
Pole Light, �
� Range
' Standing Sections
5 KW Trash Compactor
. I Reinspection Fee �$15 ' ' laue Fee
.DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
� ' SUMMARV OF FEES
BUILDING PERMIT $ ' SMIP . $
PLAN CHECK $ PERMIT
PWMBING S � ISSUANCE �S _
PLAN CHECK 25% $ . ENERGV P.C. $
ELECTRICAL $- � GRADING! $
PLAN CHECK 'S0°,6 $.• ' ' ' MICFOFILM $ � �
MECHANICAL $ , TOTALFEE $ `Si�
PLAN CHECK •-25% $ � '
� ``I
CONSTRUCTION AND PLANNING , POOI & SPA -
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Insp�c�r
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms :�
i
4. Electrical Conduit-Undrgrnd. 55. Electrical Bo�ding �'
r,
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE •
:h
IJ
7. Footings 58. Elearical Conduit-Undrgrnd. o
8. Foundation � 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � 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. Fough 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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory fireplace APPROVALS Permit # -
21. Ducts, in Structure 70. Underground Hydro
22. Ducis, Ventilating � 77. Product Piping OGas ❑Oil �
23. Gas Pipe-Rough & Test . � � � 72. Underground Flush
24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 7A. 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 �.�' � di` G
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 Regulations
47. FINAL STRUCTURE & BUILDING � ._
48. Special Requirements.Completed '
49. Electrie Release to Edison
50. Gas Release to Southem California Gas Co � ,
51. CERTIFICATE OF OCCUPANCY
. �
No. Date _ _ 5�
Ai
CI7Y oF COSTA nnESA CONSTRUC�IO ��RMIT ,
Project Address �1
Appiicant's Mailing ddress
Owner's Name � �/P�-�� �� Phone �
Address � � �� `" � ' �' -
Arch/Eng. License No. �
Address -
Contracmr's Nam Phone .
Address Imailing) �
City License No.
LICENSED CONTRACTOR DECIARATION • �
I her¢by a(fi�m that I am licensetl untlet.Drovislons ot Chdrter 9(Commencin9
with Section 7000) Of Division 3 of the Business antl Profes5ion5 Cotle, antl
my license is In Itµl� c antl effect. � Z, .-p
License Clas �- ' e N �
�Date - 99�ature -
WORKERS' COMPENSATION DECLARATION
` I hereDy attirm lM1at 1 have a certiticate of conseni to selt-insure or a certiflcate
��� ` Workers' Compen5ation Insu�ance, o� a certifi¢tl co y thereof (Section
� ��. `�°. �q/9�3�f-R.7
� .olicy No: ' Company �
1 rtifietl copy is hereby furnisheii. ' �
` Dateeffjfie o�yj$ �Iletl with the city��IdMf�1�y� gn.�/// //•.1 / i'
ef5 Q / APPlicant �.��{ f ,�,/.%////�."-`�
EXEMPTION FROM WOFKERS' COMPENSATION DECLARATION
(This section neetl nat be completetl if the permit is for one huntlretl ($100) or
less).
I certity that In the perio�mance oi tne work �tor which Ihis perm�t is issuea, 1
shall not employ any pe�son in any manner so as to become subject to the
Workers' Compensation Laws ot California. , •
Date � Si9nature
� NOTICE: Ii, atter�makingrthis'tleclarallon, you shoultl become-subject to the-
� Worke�s' Compensation provisions-ot the LabOr Cotle, you mu5t Por[hwith
� comply with sucb D�ovi5ion5 0� thi5 permit shall .be tleemea revoketl.
CONSTRUCTION LENDING AGENCV �
I hereby aftirm that there is a construction lentling agency /or-the performance
of the work �tor which this permit is issued. (Section: 309� Civ. C.)
Lentler's Name �
LentleYs Aatlress �
OWNER BUILpER dECLARATION �
I hereby affirm that I am exempt from the Contractor's License Law Ifor the
following rea5on ($ection' ]031.5 Bu5ine55 antl Professional Cotle: Any City o�
county which �equir¢s a permit to Construct, alter,�imp/ove, tlemolish or �epai�
any structure, prior to its issuance, also requires the applicant for zuch'permit
to file a signetl statement thdt he/she is licensetl pu�suant to th¢ provisions ot
tM1e Contraclor'S Li<en5e Law (Chapter 9(commencing with Section ]000) o(
Division. 3 of tlie'Business antl-Professions'Cotlejor that'ite/sM1e is exempt
„�y��erefrom antl the basis for the alleqetl'exemption. Any violation of Section
,. 31�.5 by any apD���ant for a permit subjec[s the aOP���ant to a civil
' '-'"ndlty ot not more'than five huntlretl tlollars,(5500). �
';J I, a5 ownei ot the'property or my employees witlt wages a5 their sole
� compensation, will do the work, antl the sGuc[ure is not intentletl or ofteretl
for, sale (Section" ]044', Business antl Grofessional Cotle: The Contractor's
' License law tloes no[ appty to an owner of a p�operty who builtls o� im0�ove5
' thereon, antl who tloes such work.nimselt/herself or tnrougn nls or her own
employees, provitletl thai such imp�oJ¢ments are not Intentletl or offeretl fo�
sdle. It, however, the builtling or imp�ovement is soltl within one yea� of com-
pletlon„the owner. will have the burtlen of p�oving he/She tlitl not builtl or im-
p�ove tor the.purpose of sale). ; '
❑ I, as owner ot tne property, am exclusively contracting wifh licensetl con-
tractorsto con5truct (tte project (Section��044, Busine55 antl Prote55ions Cotle:
� The Contracto�'s.Llcense Law tloes not apply to an owner ot Property who
builtls or improves thereon, antl who•contracts for such projects with a mn-
Vactor(sI license pursuant to tM1e Cont�actor's License Law). I am aware [hat
. proof of their Worker's Compensation inw�ance shoultl be providetl to me.
1 ❑ I am exempt untler Section B. & P. C.'for this reason
'Dat¢ �� Owner - �
I h¢reby certify that I have reatl thi5 application antl State tM1af the above
intormation is correct. I agree to comply with all city antl county ortlinances
antl state laws relating to builtlin9 construction, and hereby autnorize repre-
zentatives of this city to en er u on the above-mentioned property for
cant to till in all spaces except t�ose within heavy Oortler lines anE si9n all aDDropriale Oeclarations.__
PERNyY� �:� , TRACT NO. �LOT NO.; UNIT N6. ` � � � �
i� � �
?VPEOFCONSTRUCTION NEW. liDD ALTERATON REPAIR,
❑ CONV,ERSION ❑ DEMOLISH ❑ OTHER . . _ ,_ , A.p. �! :_ ' �
� DESCRIPTION OF WORK/USE OF BIDG.
� � S Main Building: �
TYPEOFPERMIT ' GRAOING OUNOATION STRUCTVRAL � T Ffont . I
� TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear
' � OTHER . � .. . %� ..
�P.ROJECT DESCRIPTION 5Q. FT. � ocCUPANCv � C Right'
.. K �eft �. ,
CONSTRUCTION TVPE VALUATION $ $ '
� ZONE GRADING CU.YDS. ACRES � P�nJ. R2f. # ' '
Remarks: ,� ' ' � ' Planning Notes:
: . � i •
3ar Sink � � '' , � �
3ackflow Preventer
3ackflow Irrigation "
3athtubs' �
�larifiers ' -
�ishwasher' � ' �
�rinking Fountains�
Floor Drains ' ;
Floor Sinks
.�i25$2NIC2 �Ol1t1Ei5
Interceptors ' �
Kitchen Sink - - �
Lavatories ' ,
P-Trap
Roof Orains ' .
Showers
Sewer Cap
Sewer Connection .
Solar Collectors
Solar Piping �
Solar Tank,
Swimming Po01 w/Spa
Urinal �
Water Closet
Water Heater
Water Service � �
Auto�Wash '
)
Heinspectian �Pee , . $15 _ , Isue Fee
Boiler
Duct - Under Graund
Duct - Structural
Duct-Ventilating � '
Exhaust System ❑ Multiple ❑
Firepl/Pact: elt. ICBO #
Heating System & Ducting '
❑ o-i oo,000 aTu O i oo,00a sn
P
inspection pp os ' � n
Signature �/ / / Date ��.�
Fee
CMF 0865-46, rev. 30/84 WM1ite - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor
FEES
0
Auromatic Washer
Construction PoleSub.
Cooking Unit� • �
Dishwasher �
Dryers ❑Gas ❑Electric
Fan '
F.A.U.
Device Boxes .
Outlets
- ' Switch¢s -, ' --
1 � Garbage Disposal .
Generator �0-5 KW 05-15
� > �.
Hoodor Typel� ❑ �
Canopy �Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBTU
System Repair/Alteration . "
Fire Dampers : i � ' �
Registers '
3980 3/I3/87
!
. . . '. . 2one
Accessory Building:
I
S
_ � i
.�:' , . >
' � � Parking Req./Provided
�
ELECTRICAL' � . ., �
Transformer ❑ 15-50 KW
❑50+KW -
� Meter 0'up to 100 amps '
• Meter ❑Dver 100 amps
, Sub,Panel � j �
5a00 TL
1
Z
O
N
I
N
G
R
E
Q
M
, T
S
Motors �0.1 HP 07 h- 8
Inc.Solar 09-15 HP �16-15+
Microwave � � i `
Pole Light �
Range '
Sign .. . " ' ' ' -
Standing Sections ' i �
Trash Compacror �
$� E
Reinspection Fee $15� Issue Fee
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
� Zoning APProved By -
Building Approved By '
Application laued Bv
$15 � Issue Fae; � , � ' $ �3
$ 3
�
. � � - SUMMARV OF FEES •
BUILDING PERMIT $ ' SMIP � � _ $ �
. PLAN CHECK $' PERMIT
. PLUMBI�NG � $ �' ISSUANCE � $ ��
� PLAN CHECK 25%, $ ENERGY P.C. $�
" ELECTRICAL . � $ GRADING $
- PLAN�CHECK -50%� $ � -MICROFILM $ ' �
MECHANICAL $ TOTAL FEE , $ �� �
' P�AN CHECK ' 25% $ " ' � _ ' t
CONSTRUCTION AND PLANNING POOL & SPA. . � �
APPROVALS Permit# Date Inspector qpPROVALS Permit# �� Date Inspector
1. Temporar.y/Electric8l Service or 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 59. Gas Pipe, O Undrgrnd., Test � ,
9. Water Pipe:Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd: '
10. Structural Floor System 61. APPROVAL TO DECK .
i t. Property Sewer Line & House Connection 62. Backwash,& Receptor-Final .
12. Sewer Cap � 63. Heater & Vent-Final �
�13. Roof Drains 64. Plumhing 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 Elearical-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 (5tructural) & 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 GasPipe-Test � �
/ a
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. Handirap Regulations - , � . �
47. FINALSTRUCTURE&BUILDING � �
48.�SpecialRequirementsCompleted- � ' � ,
49. Electric Release to Edison
;:.
�50. Gas Release to Southern California Gas Co ' � J°
51. CERTIFICATE OF OCCUPANCY �
No, Date _ � �
Applicant to fill in all spa<es wilhin naavy bortler tines antl sign a1l aoP�epriatc eaelaratlons.
CITY OF COSTA MESA' � aEgj�41T O.^� TRACT NO. LOT NO. BLDG. NO. � � � �' ' �- " ' '
CONSTRUCTIONPERMIT N y '•3175• 3/I'2/Bc� ' 6.00 TL
Projett Address � �� TYPE OF CONSTRUCTION • ' . �
owner rho�e�y -Q �? ❑ NEW . � ADD ❑ ALTERATION _�}
AddrCss � ` ' - �REPAIR ❑CONVERSION ODEMOUSH
�� �.
ArthlEng. - � Litense No.s��� ❑ OTHER , A P � ZONING REGULATIONS
DESCRIPTION OF WORK
AddfMS ' . 20NE �PLNG.REFL.p� r
Contracmr � ��` Phone 7 TVPE OF PERMIT' ,� .SEreAC T ���P��RTVNLINE ��
Addfe55 l. � � -� - � � . _ � � ❑ GRA�ING ❑ FOUNDAT,I�OyN � O STRVCTURAL�- 510 YHRD
�GGENSED CONTRACTOR DECLA ATION �'� � ❑TENANT ❑EL'ECTRICAC J�7PLVMBING OMECHANICA L5Ep '•
I h¢reby d/tirm th:.t I dT IiG¢ns<G Untltr provlsions of Gharter 9(com• � -� � � R�iGH7 !
�mencin9 wlln' sactlon 7000) ot Olvislon 3 of tne' Buslness antl ❑'OTHER - ' •� • - ' �
Vrofosslons Cotle antl my Iiceose is in tult force antl e ett. . . � RElaR YARD (TO P/L) ,. �
. � . - - . �. a PROJECT�DESCRIPTION . - _ _ __ _- _ . . . . . i
'Lltense Class License No. .�� . r � i � PKG. SPACE REO. PROV IDED
��ate 3'�- �! < r':e I_ _ s '. ' ' .5�. FT: -' . . '_ _ ' ' ' _ �.
�WORKERS' COMPENSATION�DECLARATION � � OCCUPANCY_CONSTRVCTION TYPE � STREET WIDTH �� PARK FEE S
�VACVATION �- ZONE `Z�NINGAPPkOVEDBY .DATE � �
I hareby afflrm that 1 have a<ertiflwte of consent to selhinsure�or�a . ''s ,!
jcertlfica[e of Workers"Campensation Insuranta, or a certi(Ied copy . - . ---
therBof ($e tio 8Q0 Lab. C.). � GRADING CV. YDS. � ACRES SPECIAL CONDITIONS: �• �
� �PolicY No.� Cl�`9 {o (1 ComPanY . . . _ . _ - ` - - • _ " _' ' _ _ _ " ' ..
��CertifieE copy IS hlrGEy furnishetl. - pEMARKS: � _ _ ' - _ �
Clrtlfietl cOpy Is fil<tl wlt� the city Builtling DivisiOn.
EXEMPTION FROM WORKERS' COMPENSATION DECILARATION � - ^ � "��- " � -
(ThiS 5¢CtiOn neetl OOt.bG COmple[¢tl H..the Defmit i5 far onG hunCrttl __ _ _ . __, _ . . _ __ . __ - . _ � � ._ _ _ ' . _� ._ _ - ' _
(5700) or less). ' � '� ' •�
I.Certify that in the perfarmanm.of the work (or which lhis pe�m(t I5 _ __ �
issuetl, I znall not emPloy any person in any manner so as to.become PLUMBING'��% , ;PLAN CHECK �� �'ELECTRICAL �� PLAN CHECK- +
subjecl ro th¢ WOrkers CompensatlOn laws.ot Ulitornia... .. ' _
Da[e � � Si9nature BATHTUBS SHOWERS � l �� � � • L
NOTICE: If after making thiz tlecl5ration, you shoultl become-subject 'TOILETS � -, y 'URINALS' �-V -��� "GENERATOR'-" 0-1 KW_1=30�KW �� j, �
to the Workers' Compensation provisions of Iha Labor Cotle, you must , -_ ____ TRANSFORMER _ _ _� �
fort�with compq with suth proWilons or this permit shall be tleemetl �VATORIES DOUBLE LAVS � � �,APP�IANCE 30-50 KW_50-+ KW, '- ' r..' �'
�evoketl. .�_ _.. . _ ' - - • - - -' ' � �. -KIT.SINKS � � DISViWA5HER5` � - �MOTORS -- - " �^ " '
CONSTRVCTION LENDING'AGENCV 0-1 hiP_]-30 HP_� '''
�I hereby atlirm tba[ thera I5 a construction Ientling agency tor Ue perv ,�-.• ^ � ; - � � �� (INQ SOLAR)^ - 30-50 HP'_'50 t:HP - ' � + , ~ '
formance ot the work tor whic� thls permit is 155uetl �Se<Uon 3097 SERVICESINKS '- '�SUMPS � ��� � ;
Clv: C:). " " . � - - -- � � � �FLOOR SINKS FLOOR DRAINS 'FIXTVRES�- � OUTLETS - SWITCHES �,� �
�Centler's Name
�Lontler•SAtltlress � DRINKINGFOUfJTAINS ,i � �{ GASTUBESICNS- �-� � ' �.j � - "
OWNER BUILDER DECLARATION .' ' " -' ' -- - - ' � � INTERCEPTORS CLARIFIERS POLE�LIGHTS � ` � � - -- —� - - - � �
I hereby aHirm thal 1 am axampt from tha Contractor'S License Law for �: �.. '1 �' �
the'lollowing�reason (Soctlon 7031.5-Buiiness antl'Profeszlonz'COUo: SWIMMWG POOL� 'PTRAP ' "" ' '- ' ' ' ' ' " '_
Any dty or county which reqWres a permi[ to construct, alter, POLES METERED iSVB��
Improve, tlomollsh'or repalr any strutture,- prior to Its issuance, aiso re- yyqTER SERVICE �� ALTERATION -� - ' PANELS �� �MAIN - SUB'„�i �
qulros the aP,.11wnt for such Oermit to tile a signe0 statement thal ho _�
is'Iicensetl-pursuant to the orovislons of tne Contractor's License Law �GAS SERVICE OUTLETS� SERVICE " � ' " - '- - ' - "AMP - _ - - ,
(CM1aptar 9(commencing with Section ]000) ol Dlviilon 3 0l tho �' -
6usine55 antl-Ro/e55ions Cotle) or'tnat �e'I5 exompCtherefrom antl tbe yyqTER HEATERS' - BTU OUTPVT � 3 � O - ' - � - - ' ' ' ' • ' ' �
' basis tor che all¢getl exemptlon. Any violation ol Sectlon 7031.5 by _ _ _ . _--�-�" �' _ •
any'applitant lor"a permit zuDjects tne'apo��wM'to a<Ivil'penatty - SEVJER CONNECTIONS
ot nol mora than Iivo huntlretl tlollars (E500). '�� ,�
� I, as owner oi Ne property, ar my employees wilh�wagez as tlielr ' SOLAR TANK ' COLLECTORS {- \� -
501¢�COTPenSdtion,.wl11 tlo lhe w0lk,.anE [hC Stfuc[ufe IS OOt If1l¢OtltO _ T'
or oHerotl �or.sdla (SecUon ]044, Buziness antl Rofe55lons Cotle: T�o SOLAR PIPING SVS. - ISSUE FEE � --'� � �� -
Conlractor's LI<ense Law tloez m[ applY to.an. owner of a property_ ,APVLICATION APPROVED BY'
wbo builds or Improws thereon, dntl wh0 Eoes sUth work hITSCIi Or ISSUE FEE ' 3 Q �, • - DATE'-
throu9h his Own emplDyees, provitletl.[hdt such_Improvements aro not 1 ' �
Intentletl or otferotl far sale. 11, howeveq the builtling or ImOrovement MECHANICAL PLAN CHECK 1
IS Soltl wilhin.Ona year OI COmplelion, th¢.Own¢� will hava lhC bUrtltn SUMMARV OF'FEES, �. �_ , • _ I
o/ proving ho tlitl not buIIE or improve tor the purpose oi sale). ,BVILDtNG'
HEATING SVSTEM_0-100,000 BTU .PERMIT S �'�SMIP..' , 'E��'' ' ' �
❑'I; as owner �of the property,-am-exclusivaly-conlractin9 �'��h qryD DUCTING- - - - -� � - - - "" -- - - -" �
Iicensetl concraclors to consVuct the project (Section 7044, Business 100.000�rBTU IPLAN CHECK S : PERMIT• '
antl' R'Ofe551on5 COde: Tlte Contractor'S Litense�ldw Ooat Oot epply'to - � � �-- ISSUANCE' S,-� �
an owner of property who builtls or Improves thereon, antl who <on- REFRIGERATION Od00,000�BTU �PLUMBING S� ;�' .11' , H ,'� i I
tracts-from�such projectz with-a-mntractor(s) IlcCined�pursuant-to- SVSTEM ' - "' ' -' " " ' ' � -' '-' - - - - � -- -GRADING- E �- - '
t�e Contrattor'S'LI<ense Caw). 100,000+BTU .P�AN CHECK § "� ' „ ' � \�. , �'
❑ I am ezampt under Soctlon �- � B. d P. C. far ttiis BOILERS BTV . • � s •
� ELECTRICAL E
reason - - ' ' - .- - _- �. MICROFILM.S ,
�� SVSTEMREPAIR,ALTERATION �;PLp.N'[HECK S-
Date - � �- - Owner - �- - - . _ .. _..TO.TAL FEE E �
I hereby terti/y Ihat I have reatl tM1iS aOG���tiDn antl 5tate tM1at the abovc � EXHAUST SVSTEM MULTIPLE A MECHANICAL_ S� , .
'�PLANCHEGK"E' 1L'ESSAD- . _ _ �
� inbrmation is correcL I�a9ree-lo comply witti 511 tity antl <ounty ��- VANCEPC b_
or�inances antl state laws relatin9 to conSVuction, anC hereby authorize i (� i'•. •, , .� . �� � �i �
repre5enldtiv¢5 of thi5 <ity to enler`upon Ihe above m¢ntion¢tl �. '�`Q'�'1�1 �3'�
prop¢rty fQ� In5l[qCllpn. OU�Do5e5. _ _ _ _ � �� � 1 ' ` \ „ FINAL FEE 5 �
519nature "`- YG V'nno
����� � ISSUE FEE � -� ^ - - - -
CMF 0865-46 W�ite-Bulltling; Gnary-Applicant; Pink-Accountln9: Goltlenrotl-Asussor
� �
CONSTRUCTION AND PLANNING ?OOL & SPA� � � �
Q v�(��� Date Inspector - �- - Date .Inspector
APPROVALS . Permit # L�1.LL APPROVALS � Permit #
1. Temporary Electrical Service or Pole �� 43. Pool & Equipment Location� - -- - -- -
Soil ipe-Undrgrn � � • ' � 44. �Steel Reinforcement • - --
3. Electrical Conduit Utility-Undrgrn 45. Foims �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding . --- �
. tee em orce- . 47. Rou h Plumbin & Pressure Test
6. Electrical UFER Grn ' � ' 48.' APPROVALTO COVER-GUNITE -- -- �
i 7. Footings - " �49. Electrical �Conduit-Undr m � • - �
8. _ Foundation - - 50. Gas Pipe, � Undr m Test � � -
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra •-�' ndr rn ' - - '
' 10. Structural Floor System 52. APPROVALTO DECK' ' " ' '- " -- • •
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final � �
12. Street Sewer Connection � _ 54. Heater & Vent-Final ��
. 13. Rough Plumbing � � = - � - - - � � - � �
14. Rough Elec[ric•Conduit � - - - • � - - �56- Electrical-Final - � �
15: 'Rough Electric-Wiring ' " - " - - � - 57.- Solar System-Final -"' ' ' • ' ' � - ' '
� 16. - .Rough Heating & Air Conditioning . • - encing & Access Approval �
� 17.. Ducts, in Structure - • APPROVED FOR PLASTERING ' - �
• 18. Ducts, Ventilating . � _ _ - - � ' _ _ _
19: Gas Pipe-Rough & Test � . 60. POOUSPA SYSTEMS FINAL � . ,� � �
20.. Roof Framing' - - - � ' . ' - '" , , ',
, 21! Roof-Sheathiri� - --- -- - ' , -- - - . . ' ..... . ,
22: Frame"And�Flashin ' - - NOTES:�� ' � .. � ' � ' ' � .
23. Insulation ' ' ' � � � '
24. - lathing.& Siding � � ' � -
� 25. Drywall Nailing . _ � � - �' �
26: Plaster Brown Coat � � � - " `
� 27. _Electrical Power MeterFinal - � !! - - � � � � -
_ 28.-_Final Electric.. . ' � � - ' - � � ' "' - "
29::_ F.inal�Heating &.Air Conditioning . ^ ' � ' - • � • � - - "� '
30. FinabGas Pipe-Test__ ' � � ; .
31. Final Plumbing � ' � ' � ' '
i 32. Water Service-Finai _ ' ' � - � � '
33. Gas Service-Final _-- � � � �
� 34. Solar pomestic•Final ' � � ' � ' ' ' � '
� 35. Landsca eS rinklin S stem �� - � � ' ' � �
36. �Sound Attenuation � ' " � - � - - •
' 37. Handicap Regulations - � •�� . ' � � • � - --
38. FINALSTRUCTURE&BUI�DING ' - �
: 39. Special Requiremen[s Completed � - ' �' � -'
; 40. Electric Release,to Edison ' � � � � -- � ' '
; 41 . Gas Release to Southern California Gas Co. � � -
; 42. CERTIFICATE OF OCCUPANCY ' � . � �
No Date
•oonessaew�oua: 843 W 17TH ST
wn+Ea9r,�Ei�w�a�*+: LEON GREGORY
noo�sa $43 f/2 W 17TH ST
COSTA MESA,CA 92627
AYPL.1WIlN0 ADDflESA
�xcxrtecT on �on�a: uc. w.:
IiPCN.ON FN0:41�WPE59:
uNr:
uxr:
1/2
COMHACTOP'EWIYE NOCK PLUMHING (714)895-1246
ca+rx�croas�uwa 11610 SEABOARD CIR
aooness STANTON CA uo.�+o, 511971
90680 uxr:
LICENSED CONTRACfOH4 OECL�fl�TIOM: I lwaby dlim wNx psWy W prpuy Nm I em ficemse uieer pmie'vu c1 CM1eqx e
(mmmmdnV �wh Fenion )OOD) d Orv'sun � d Me &onav aM Vmhaedu Cada. W my 4wns e in hA laq eM ellod.
cmuc.No.:050386 uc.cuss: C-36 uc.No.: 11971 EXP: 02/96
om, 41a1 � � ��� �� P��Ma,,�
OWNEN BUILOER DECIAP�TON: I hweby eRum wdar prWy d per'�vy ihtl I am wmq Imn tAe WMrafm Licenee tew /a iM
Idbw+q newn (SW ian ]OJ�.5 &uiw� eM Pnda�dw Coda: Ml Uy a mwY wlJd� nGwm s G�a to mn+trw. eEs. "unpa+.
Mmd'o�, a rapai erry euucture. p'w b b eaenw, eho reQino tM appimN /a arh pemiil to fJe e eipned atmemenl Nm M or ehe
ucamse w�wv io ms a� a m. cacrenas �s te. Ich.qs s I��a wn saau, r000l d oHecn a w �ro
�dnaa vd Prdsabn CoCel a Ihet Ae a eM e ezemq therMmn erd �M buo ta tlr eOeYb ezemqun. MY vuletbn d Setlbn
)0]t.5 by eiry appku�M I« e pemm ubj�m iM eppfcmtl to a dH px�eEy of no� moea Run fiva MvW�ed do0us �5500D.
❑ �.e,awnera�newownra�m�oMe+•.Anwapu.�u.:.wmmv�..amm..M..nea,e.wT,eaem'vnadoe
a c/laad br seb (Saction ]Du.Busn�v W Prds*aim+f:ode: Ths CaNredon Licane lawAw no1 WdYto en oxnerd papeity
wAo EuiAa a inpow� ihaeon. end wtn Am� �urh r.ak Inn�eE a MnN a rtvaqh he a her am amWvJ�. pa'� tlw wch
impwa�nmu ero nd iNaded a aflsaE la ub. tl. hmnw. iM bWE'vq a inP��w u edd wuhm ar Yar M mnWaun. tM
ow�wrLu3dx w�l heve tM buken d pwinp M a ehe d"d m� ddd p impwa ta tlro pvpova d We�.
� I. n o�wwr d �M pWMY. em umrdnly murrinY wdA Gwnwd oontreclan b mmua Ns p9b (Ssaion IOM. &ninma eM
.vm«.�, coe.: Tn. comma, u�.. i.., m.. �u .car a.� a.,.� a ww.nr w,o aaa. «:�w« in«.� .oe w,o
contrecb Irc wN prqoqs wA e mmrtlor��) ficanwE pmueM lo IM Carcrma� liosue la�.
� I em axemq undm SMoi: B. 8 P.C.. br thb imm:
Deie: Olnw:
1 do MrebY ��h IIW I em ewva W eM �vMrsWM Na nmeeamatla M CeRmtle IIseG� eM SNmY COEe Sseidn 25503. 2553J. ud
25SN. eM Na I a eny Mun MOYmO � wiA / wY na (ertY ar) nsed b oamNY wih uid ptla wda� mM �M raCw�mb tar
eW�tammmxtionamodSmionhomtM�i w�ty mopsneqD'etntl.RaedwWmuuueioneGP�ioroene*emqlmmtMu
aa;.�..
om.: �,�:
WONKER'S COMPENS�TION UECLAN�TON: I hsraby dlvm udr pviWy d pMjuy ons d Ns Idbwinp laie'etnro:
� I hevs xM wJ meinten a nrNiui� d aoma�t io Wrnwes br warkai oomG�mmion. n Mwkod la M Saaim 9)OO W �M laEa
c«y,ror m. o.nomwK. a m..at �a .Aicn me v� e ww.
pirhe...nd wu munen.wr. mmoM.mon vuverc.. m nwtr.d W S«aim alao a m. Laar Coe.. w �ns oNa�• a�n.
wM la xliicM1 Uw M�e u u�uA. MY waFen' oomVerue�ion inw��nu mrtbr W W�Y �umbx en:
c.m«: STATE EXPIRES
r,r� rh,me.r — 0 3/ 18 / 9 6
hu pciM rraM na N candwb! IMV�I 'u b aw hwdiM doEen �5�001 a 40./
� I oenh � in iM pMm�unce tl tM waM br r+h4h Ihb psme h e�usA. I�Ae! nq rnploy vry prcn in ury mevwr m m �o
becane wbjeq io �M MMen' oompuuYian kw� d Gefdamie. raa Nu Y 1 Nwk Eeconr wbjrf to iM nwMn'
canqnwion pmv M SWian Y)00 d tM leEa CaM. l wmdY'� �� p�.
ov.: BI � �'�.r �.: _ _ � � ��---�
Wem/np: F�N�n b ucun noMwi mmpwwtlon rov�ip� l� un4wM, urtl �IWI u!/s ur �rrpleyw ro MmYrl pmdtlu uW
elvll nrw� �p ro om nurdrvdWusW Cull�n lttOq000A N�Ifbn ro fM cmt ol romp.rw(bn �yP� y pro�b ror In
9�ctlon.t106 0l N� Ltloi Cob. Infwf. nM �Romry�s fw�.
CON9TIiUCTION LENDINO AOENCY: 1 Mnby elfirtn uMar pe�aly d pmlNrv �� �� 4 a con�rwon brdi�q epericy la Ne
penamema d m. wak �« wn�a me pam� b's.,.d (s«abn 3D8). cM. c1.
LENOER'9 NMIE
LENDEW9 �OCHE9S:
1 eanilY �he� I Mva raaC Nu Wd'rNbn ud ama ihet Ne eEav'udomW ian o eanad.l e{pes b mnM/ wM1� W�y eeM muM' adinenw�
OIIQ tltl! �GNI IlIGIi1010 b11ibI1� CMfV Wlql Glb �Nflbj OII�ClSG IlPIlbN6(VO� C� ��Ib OA' b OMN up.l' 111hG G�1Wl�TG11�pMd pIO�IBR/
la impedion pur �ou�.
xoN Nocx
M��, gl� 1 z�
� o�:
sb�v�reaox,ie,roenunvof �reev
(5151�16 WP) W�Ae-BuiNnp 6 Salery:OnemFb; Cenvy-AppiraM; Rnk-Ravenw: GdEenra�As.vaew
CITY OF COSTA MESA — BUILDZNG PERMIT
PERM NO: P 073552
PERMIT NO: P 073552 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : WATER HEATER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
�rx�**� **�r**+r�r������x��*���+r*�+r**x�**+��r�r�r+�+�rt**�+r*��r**x � *���**x��r*�r*�r**�r�r*�****��+�+��x�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
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: 42410201 ZNE: REF NO:
PLANNING NOTES>
>
1E if iE if iElf iE if iF if if iE iE if fE if 1k iE If iE if if iF if if iflf iE if if if iE iF if iE 1E if iE 1f iE 1E 1E IE IE 1E IE 1E k�1E IE 1E 1E iE 41f 1i 1E iE iE iE iE 1E 1E 1E iE 1E �E 1E 1E iE 1E iF iF iE 1E iF if If !E
D E V E L O P M E N T S E R V I C E S L R E Q U I R E M E N T S
ZONING APPROVED BY ��� DATE:
BUILDING APPROVED BY ; ,�l DATE:
APPLICATION ISSUED BY: '•:•'�/ DATE: j^�
IEifiEififiElFiE1FIfMiElEifiElEififlElfikif ifiEiEiflFlkiElEiFiE 1FIF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT
%,00
252
SMIP/NON—RES
PLAN
ISSUE FEE 20.00 �
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 7.00 20,00 �i 0.00 27.00 27.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT; .00
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
2 % , 0 �
1E 1E 1F 1! 1E iF IF 1E 1E 1E 1E 1E IE i! 1E 1E 1E 1E 1E iF 1F 1E iE 1E iF 1E 1k 1E iE 1E Ik 1k If 1E 1k'i! M 1E 1E if 41k 1E 1E iE 16 if 16If IE 1E 7! 1F iE 1E 1E 1E IE 1i iE 1E fE IE if IE IPlE 1F i61E 1f iE IE iE 1E 1f IE iE iF
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
PLU 1 WATER HEATER AND/OR-VENT 7.00 7,00
END OF FEES
OL �OIS�i71'O��YiJS%Y ��� � �....
�aT�: e��o���s r7r;e; ia:,s
CONSTRUCTION AND PLANNING POOL ,PA
APPROVALS Permit�k Date Inspector qppROVALS Permit# Date inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . 53. Steei Reinforcement �
���Electrical Condul't�Ui+iity-Und'rgrnd. 54. Forms
�=Q.yF,�lectricalCondult'-�l7ridrgrnd. 55. EfectricalBonding
_ �,�5..: $�eel ReinforcemenC- 56. Rough Plumbing & Pressure Test -�
"6��lectrical UFER�nd. 57. APPROVAL TO COVER�GUNITE
��
-,�7,,� Footings .-,� , 58. Elettrical Conduit-Undrgrnd. � `
'� &� Foundation � a� �+ 59. Gas Pipe, O Undrgrnd., Test
9.. Water Pi e�Undr r �
P 9�� -� 60. Backwash Lines, �-Trap, � U�drgrnd.
10. Struttural Floor Svstem ' 67. APPROVAL TO �ECK � �
1 i. P'ropertY Sewer line.& House;Connection 62. Backwash & Receptor-Final �
12. $ewer Cap ` � 63. Heater & Ven[-Final �
13. Roof Drains _, , 64. Plumbing System - Final ,�
14. Rough Plumbing-� ?� ' 65, Electrical-Final
15. Rough ElectriwkCortduit =" ' � 66. Solar System-F,i.nal �
16. Rough Electric Wiring _ 67. Fencing & AccCss Approval
� 17. Rough Wiring Sigh - 68. APPROVED FQ�R PIASTERING
18. Rough Electrica�.`i Bar Ceiling 69. POOL/SPA SYS'P€MS FINAL
19. Rouy,h Heating & Air Conditioning ,,, FIRE DEPT.AEQUIF�EMENT
: a f* "" k '. ] O' x .i �_, t-� t
r-. ♦ � ' y. -. . -� , _
20. �ough Ftcto,y Fi�qtace ���;; �'� t � ; _,�. � qpP�VR6S�::. Permit # y =
21. �Ou ,ctrz,in�truEiurli* . '.. .. �S k � y �r � 70.�1ndergrbGr�i1 Npdro "
.,
22. DucCa; V tilaiin �' . �' _ . '' a:� ` I '
@� 9.ti�• z' C< C,� � R- 71. ProduCt�iping C}6as Gl Oil
23. Gas Ripe-Rough & Test � ?- ?7 � � .'^ +� �: 72, Undergrtr�4d F.ILsh *
24.'Roof-Framin . �-` � -' •.` ' 7 � ^ �` � `' "'T '
-, 9 . �; ♦ � cC .-ix • 7�7 Undergmd.St�,aggTank,OGas ❑Oil
25. Roof�6he3thing 'T � • '� �� k '"J :r ��%+ 7d:; Overhead HydrYt 1 `
_ „ � • -
26. ,T•Ba'7�Ceiling (Strun�Ural) & Mopocoat : � y py 7� Dry Chetpical ,-,; .� - �
27. frame aad Flashirig�c =x � x;^ :+ x* 76. Dry Star�pipeF�% ` �r
-... �a �, : .,
' 28. Lathing & Siding �� �' .=� � Y ,�, f "� �',a 7� fIXEDSYSTF,b1'F`iNAk - , x
29. Insulatioo �R S •• r � � � 7' FIRE`PREV. F.IJ$QL ,� � ••?
' 30. Drywall aiting F"t ' s ; ' T.�;� _-,H ALT,�I,DEP .REQUI EMENT
�. x � ... � - .§ T g
r
31. Plaster Bmwn Coac �=: i r r ' � ;� 79. FINAL lMSPECTION F~ a
-r � t-� K ^
: 32. �lectrical Po�vGr f5lei�r-Final �'t' � � ��' 8f� FOOD CEfiTIFICATE IS�UECL, -
� .. .. , ..
: 33. ��naf�Electric� � ti ^n Y � � - ' Notes: T -' -
- - - • _ . _ , . �j_ZZ`!_� ��,c?,�Z_�
' 34. �Final-�ieating=& Ai�,�opditioniny= ��� " y - � - _ . --
- : i fi � C �
35. Final Gas Pipe.Tesl; * 1 Y � ~ , rSt _ '. .,.� _ - » - �
T' . T
_ 36. Hood'or Canopv ^•'� =� ^ � r,. _ �, v. � i , r s' C.o - ;-
> �� < x ,-�l ?' �. 4� z_
.37. EinaLFactorv Fir�place�,�; ''- � • � � x � :c -
_, ,,. ;
38. Final:�lumbin �* T�' ` � r + '"
B -. ;� ;�. o � � r., �
- : � . . �. . . �
" 39. Watei Service�Final E� � . X ' i KR : .
n �
-40. GasService-Pinal � r ' ' °� � �-' .�_ '
`r,_ - r � _ . i .
y 41. Solar �omestic-Final; � - � : " , : c _ _ -
� R,
42. Backflow Preventer � � ;' " • ' T _ - «' _
43. Backflow Irrigacion � 1, >'�- i.; s.. �� _
44. Landscape Irripatio�System= � _ .� " ' • - . ' ' � , - - '
a <' r�r ' y
�35. Sound AFren,�dation � . .. - : ,. � �� -, ; ' .� . • � +
46. �Handicap�Regulations -� '- � � - '� -
a k '-
47. FINAL STRU�TUF�E & BUILDING * F. -. ' -� � _
48. F1Nli� PLANNING" • ° t � ''
.. - a C� �•
49. EIeM[jc Release to �ii5on . ,� � . �< = � . .
'� -
50. Gas Release to SoutHem Califomf�,Gas Co � `, ` " -' � �
r < � � � :i
51. CER�IFICATEOFOCCUPANCY �
No. Date
� ; B_��3�
�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. GALIFORNIA
fOR APPI/CANT TO F/LL /N COMPIETELY
TYPE OR PRINT
BUILDING � -
ADDRESS
COSTA MESA. CALIFORNIA
I �uIA
ADDRESS 6 r
LEGAL I LOT (��.(�� j I
OESCRIPTION NO, r� < BLOCK
�
A.P. NO. i-^' .� �
OF LOT ✓ X �`� `� /
USE OF
EXISTING BLDG.
SETOAGN LINE FHOM
CENT6R OF STREET
SIDE YARD ILEFT �, I
DESCRIPTION OF
�
NO.OF BL�GB. '
REAR
GEf RECEIVED �
-� � � - 3�' - ��
API���E��R PERMIT
! ��Ti ���O�b� '
��
fOR OFF/CE USE ONLY
I AECEIPf NO. I .PERMIT
COSTA MESA. CALIFORNlA
FIRE �
ZONE TYPE GROUP '
APPROVED y
BY DATE �
z6i� ' �
Z N6� I NO.OF USE OF NEW [�(iL
•�%/✓1t IPLANB �! _I BUILOIN04 nI1 ` �
// / f' u/N
APPROVED `�..�. � ! DATE ��F '-�d-
BV /�'
YARDS �VES �
REQUIRED ALLOWED
(CENTEH LINE STJ �^ �''
FRONT �JJFT. IN.
�L.
G I II DEMOLISH
NO. OF
ROOMS ^ STORIE
ROOF / l� � _ .0
0
_J FT.
'v �
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
pND 6TATE THAT THE ABOVE IS COXRECT /�ND IIGNEE TO COM- THE AMOIINT BHOWN UN�ER VALUATION'IS FON THE'
PLY WITH ALL CITY OFDIN/�NCES ANO STATE LAWS REGULATING PUNPO6E OF ESTABLIBHING A PERMIT FEE ONLY.
6UILDING CONSTRUCTION. • VALUATION
�. � �
SIGNATURE OF ��/�� PERMIT FEE S-
PERMITTEE a � �
$ ���/ PLAN CHECK S `� �
AUTHORIZED AGENT �� TOTAL FEE 8� �
I � .
,' 1��3�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPL/CANT TO f/ll /N COMP[ETfIY
� TYPE OR PRINT
BUILDING �
ADDRE55 / �
COSTA MESA. CALIFORNIA
t
'ARCHITEQ // � LIC.
OR ENGINEER �/ NO.
��
LEGAL ILOT ,` L I �,�Y
OESCRIPTION NO. v BLOCK IT CT
A.P.NO. �',/ `/�/O
$IZE � /���( � I NO.OP BLDGB, /1
OF LOT �/ (/ NOW ON LOT V
USE OF
EXISTING BLDG.
SETBACK LINE FROM
cENT[n OF sTaEEr REAR YARD
SIDE YARD ILEFT IRIGHT
DESCRIPTION OF WORK
NO.OF
I HEHEBY ACKNOWLEDGE THAT I HAVE NEAD THIB APPL�CATION
AND STATE THAT THE ABOVE I6 CORRELT ANO AGflEE TO COM-
PLY WITH ALl CITY OpDINANCEB ANp $TATE LAWS FEOULATINp
BUILDINO CONSTHU ION.
� �
SIGNATURE � ���
PERMITTEE
AUTHORIZED AGENT
FE�E RECE��ED
yCINANCE DEPT.
APPL,IF.�'�P��¢pF�I� RM IT
,'�� BUILDING
fOR OFF/CE USE ONLY
I RECEIPT NO. I PERMIT
COSTA MESA, CALIFORNIA
FIRE �/
ZONE TYPE �- GROUP r
APPROVED / y 2 �
9Y DATFJ �
ZONING
20NE l NO.OR �,I IIBE OF NEW
�iy. � PlAN3 / I BUILDIN0IJ, �
� ii 9"� �r.[�.c ,r-
APPROVED �'�
9Y 1 � . ,,,III��� DATE � �I ^ O
YARDS /�f �
REpUIRED VA LOWED
(CENTER LINE 9T.) � �1 /
THE wMOUNT SHOWN 11NOEH VwLUATION �8 FOR TNE
PURPpSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION µ(
PERMIT FEE $ " �
g , C� 3 J � PLAN CHECK $�a /
V �/ TOTAL FEE $ '� �
' _ � �� ��:9
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPUCANT TO f/LL /N COMP[ETELY
TYPE OR PRINT
AODRE55 /1 Y �� GCI. I / �_p
COSTA MESA. CALIFORNIA
MAIL '
ADORE55
ITEQ � / LIC.
AODRESS
LEGAL I LOT �O p I I��
OESCNIPTION NO. / BLOCK TRAC'
A.P. NO. J I �' S/ V
SIZE /7� ji �R�}�' nO.ove�oas.
USE OF
EXISTING BLDG.
SETBACN LINE FPOM
CENTER OF STflEE! REAR YAF
SIDE YARD ILEFT IRIGHT
� DESCRIPTION OF WORK
NEW I II ALTERATION I II ADDITI�
WALL
�
NO.OF
1 HEREBY ACKNOWLEDGE THAT i MAVE HEAO TH19 APPLIGATION
AND STATE THAT THE ABOVE IS CORFER AND A6PEE TO COM-
PLY WITX M1lL CITY OHDIN/�NCES AND STATE LM1WB RE6UL/�TINO
BUILOING CONSTRO � N. %
/
SIGNATURE OF «Qy��
PERMITTEE
AUTHORIZED AGENT
REAR
6=EE RECriVED
//� 3o-S�' � �
FINANCE DEPT.
'4�u �M l�'TI.�STAFIPPL�APERMIT
BUILDING
fOR OFF/Cf USf ON[Y
HECEIPT NO. � PEflMIT NO.
BY
COSTA MESA, CALIFORNIA
TYPE GROUP
ZONING
NO.OP USE OF NEW1^
PLANB .G BUILDIN6 // 1�
p / .LL
I. 1' �// � DATE �/'�
�
aw
0
THH AMOUNT BHOWN UNOER VALUATION 18 FOR THE
POHp08E OF ESTABLIBHING • PERMIT FHH -ONLY.
VALUATION � —
PERMIT FEE S
/a/ — —
$ PLAN CHECK $
TOTAL FEE S � `—
- � 1���0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 GOSTA MESA. CALIFORNIA
fOR APPUCANT TO f/LC /N COMPLETfIY
TYPE OR PR�NT
COSTA MESA, GALIFORNIA
IS i�
USE OF
EXISTING BLDG.
SHTBACN LINE PNOM
CENTER OF BTFEET
SIDE Y�
i BUILDING
0
TEL.
Y7 IBLOGK �TRACT
_ �. ('� � U
^� NO. OF BLDG9.
1 O// NOW ON LOT I
DESCRIPTION OF WORK
NO. OF
. ROOM4
� OOF
VER
AND W TO E
I HEFE9Y M1CKNOWLEDGE TXAT I HAVE RGD THIS APPLICAT�ON
AND BTFTC THqT THE ABOVE IS CORNEQ ANO AGFEE TO COM•
PLY WITH AlL CITY OqOINANCE6 ANO �ATE GAWS REGULATIN6
BUIL�IN6-CONSTFJU��T�DN.
SIGNATURE OFi( / e i. _� . J ,JI^.�. �
� AUTHORIZED AGENT
�
�=EE RECEIVED
!r-3o -S`� Vti
FIIVANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
foR officF vsF oHcy
D/.TE IBqSUEO
�� a l fi i.
COSTA MESA. CALIFORNIA
APPROVED
BY
ZONING
NO.OF U86 OF NEW
PLANB /) BUILDIN6
(CENTEP
��
THE IIMOUNT BHOWN UNDER VALUATION IB FOH THE
PURP08E OF E9TABL19NING • PEHMIT FEH ONLY.
VALUATION o( _
PERMIT FEE $ di
S y
�" � I PLAN GHECK S
TOTAL FEE $ o'" �
. , 11�5�
COS7A MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 917 GOSTA MESA. CALIFORNIA
fOR APPUCANT TO F/CL /N COMPLETfLY
TYPE OR PRINT
BUILDING v/i� y. /• / ) �,
ADDRE55 Q � (�lJ /
COSTA MESA, CALIFORNIA
� MAIL
1�1[M
� I_l.l.l:]Y-Y-'3
0 LEGAL
A.P. NO. i V
OF LOT /lJ � X 30n' I No. oF etOG4.
NOW ON LOT
USE OF
EXISTING BLDG.
BETB�CK LINE FHOM
�LEFT IRIGHT
DESCRIP710N OF WORK
REPAIR I IIMOV�rvG
BUILDING � NO.OF
SIZE O �• ROOME
E%TEftIOR W IROOF
COVERING, COVER
USE OF BUILDING AND WORK TO I
1 HEflEBY ACKNOWLEOGE TMAT I HAVE FEAD THIS APPLICATION
•ND 6TATE TMAT THE ABOVE IS COHPECT AND AGREE TO COM-
PLY WITH ALL CITY ORDIN/�NCE9 RND STRTE LAWS REGULATINO
BUILUING CONBTRUCTION. q� �
SIGNATURE OF �UA�L�, /h�0�/L^« /
PERM ITTEE—�. '
6=EE �ECEiVED
FINAhCE DEPT.
APPLIC�.61iTl�fy;(��QF2 n�EhiMIT
BUILDlNG
FOR OFF/CE USE OHLY
BUILDING
ADDRESS
COSTA MESA. CALIFORNIA
FIRE
ZONING
ZON6 NO. OP UBE OP NEWA
'�Y�/� � I PLANB/� BUILDINO /�/D/
—411 ll lX
APPROVED l 1
BV �/ ✓ � ��jj �DATE �I��
YARDS EILK� S
REQUIRED ALLOWED
ICENTEH LINE 6T.�
�
THE M1MOUNT BHOWN �INOER VALUATION �8 FOP THE
PURPoSE OF ESTABLI6NING A PERMIT FEE ONLY.
VALUATION q _
PERMIT FEE $ ty'
I %I / PLAN GHECK S �
s �,
TOTAL FEE $ p�
, • t� .. . ��11'��
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
FOR APPUCANT TO f/LL /N COMPLETfLY
TYPE OR PRINT
'AftGHITECT
OR ENGINEER
LEGAL
OEBCR
A. P. N
COSTA MESA. CALIFORNIA
�
USE OF
EXISTING BLDG.
SETB/�CK LINE FROM
STATE
IC. NO.
� /O
I NO.OF BLD08.
DESCRIPTION OF WORK
WALL
1 HEflEBV ACKNOWL8D06 THAT � HAVE REAO THIB APPLICATION
/�NO BTATE THAT TH8 �DOVE I6 CORH6CT AND A6fl6E TO COM�
PLY WITH ALL CITY OPOINANCEB AND BTATE LAWB REOULATINO
BUILDINO CON6T LTIDN. /n/�
SIGNATURE OF � _ _ __ NOA_w i .. .
� AUTHORIZED AGENT
�EE RECEiUED
//-3� _s��
FINAIVCE DEPT. v L.
,.�r,. „� ,,.,..-
APPLI CATION:�FQRAPERM IT
BUILDING
FOR OfF/Cf USE ONCY
HECEIPI NO. PEAMIT
'1�Q9i
�yga� Y DATE R¢C61VHD 'J O TE 18:
�l //-.�b-S71 /�.?G
COSTA MESA, CALIFORNIA
APPROVED
ZONING
NO.OF � UBE OF NEW
GL�NB �BOILDIN6
APPROVED
TXE AMOUNT BHOWN UNO¢R VALUATION 18 FOR THE
1 PUHP08E OF EBTABLIBMINO A PERMIT FEE ONLY.
VALUATION q —
j PERMIT FEE $ o�
$ / �/ PLAN CHECK S -�
TOTAL FEE S � �
3b632
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant ro Fill in Completely
BUIIDING /i� 7� 1 /�l�— S•� �
ADORESS N J
OWNER
MAIL
ADDFE'.
CITV I
BRANCH
AODRESS
CONTRACTOR �[•
ADDRESS 3�.�� �
GTV ! O� 5 �f f.
L C N O. � I?� y��
SI2E
OF LOT
VSE OF
E%ISTING BLOG.
SIZE OF
EMERIOR WALL I AOOF
COVERING COVERI
USE OF BUIIDING AND WOFK TO BE
TEL.
NO
'f !
a o rf rr
NOL 71J �2.
CITV //; a
LIC. NO. 1.
NO.OF BLDGS.
NOW ON LOT
STOR I ES
iG
'ERFORMED
�
„a,r iu-��P;ro�O so��, .;,:�:Z'�.50
n�<•
APPLICATION FOR BUILDING PERMIT
EIVED BV DATE RECEIVEp �eT� iccw
BUI LDING '
ADDRES$
OWNER
FIRE
ZONE
APPROVED
ZONE
VARDS API
MAIN BUI
OISTANCE I
MAIN BLOG
VAR. �
C.U.P. #
APPROVED
OF USE OF NEW r' �"
NS .� BUILDING �
VED VAqDS APPROVED
BET. MAIN &
ACCESS, BLD
DATE
6 nj
I hereby acknowlndBe that I hevo reatl this applieetion antl state - i"
thet che nbova �nformation h wrrect entl nBrno to comply with
all laws raBuiating builtllnB consvucNon, antl I shell not amploy �
any person In violation of tha workman's compansation laws ot
m
t�e Smta of Colifomla. �
I heraby certtfy ihot I am properly Iicensetl as e contraetor under� 5�. FT. o
[he S[eta ol Colifornta Businass ontl Profassionf Cotle, Oivisicn 3, � THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chap[ar 9, antl thet such licenses ara in tull force end affxt, or I� THE PURPOSE OF ESTABLISMING A PERMR FEE ONLV: Q
am azempt tror� �Fe provislons of tha S[ete of Colltomia Business VALUATION _ 60
entl Profasslons Cnue, Divia 3, Chapter 9. °�
PERMIT FEE $ �
/J �
SIB�ature of //� ' �lI � � m
Permittae /(� Nf.�W $/ SO U P�AN CNECK $ E
� o
LL
Authorizatl ABe�t TOTAL FEE S
• • � 3b633
� COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING
ADDRESS � %� — G
OWNER P dY BON
MAII'nc �d/s ,P.
z .
ww
a c�
Z
Z a
O t~ii
am
J �
J N
Q W
\.0] J
• 0]
J Q
U a
Z�
aw
W Z
J Q
m Z
J �
W w
0
ZF
w�
70
F
z
Q
U
J
a
a
Q
�
F
y
Z
O
F-
U
�
�
H
N
Z
CITY � Q�
CONSfRUCTiON
BRANCH
ADDRESS
ADDFESS
CONTRACTOR
ADDRESS ����
CITY `O// S �
STATE �
LIF. NO. �3�
a
512 E
OF LOT
USE OF
EXISTING BLDG.
SIZE OF
WAIL
�: �
NO.
TEI.
CITV �}
LIC. NO. �J (J
INO.OF LB�DGS
NOW ON LOT
NO. OF
ROOMS STOi
ROOF '
COVERING
ND WORK TO BE PERFORMED
R
I
.,,Y 1�-73�,.�•0(1 799'. ��:�a-..j5."Q
APPLICATION FOR 6UILDING PERMIT
- ST•
DATE
20N�' IP��� I BUILDING EW
VARDSAPPROVED VAFDSAf
DLSfANCE BET
MAIN BLOGS.
V AR. qW
C.UP. sW
a.vaaoveo i ,
BET. MAIN &
ACCESS. BLD
DATE
S �/�-
I horeby aeknowlatlga Mat I heve raotl this epplication and siete�
[hot tha ebove information is correct and nprea to comply with
oll lows reBulating builtling construc[ion, entl I shall not employ' � �
any person in violation of the workman's compensation laws of
the Stato of Celitomle. °�
e
I hereby certity that I am properly Iicansetl as a conttactor untler` 5�. FT, o
che S(ute af Califarnie Business and Professions Cotla, Divisicn 3,- TME AMOUNT SHOWN UNDER VALUATION IS FOR �
Cheptar 9, antl thac such licenses era in f�ll forca entl effect, or i� THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV: Q
am exampt irom tt•e provisions ot the Stata of Celifornia B�sinass VALUATION ��J)
antl Professlons Cnue, Divisio ha tar 9, m
PERMR FEE 5 �. V V �
J
SIB^atura of 1� m
P¢rmlttee /� o/ 4� � PLAN CHECK $ E
�' � `o
AuMorixed Agant LL
TOTAL FEE $
� CO UILDING E�T.'G� �
636 No. Broadway
Santa Ana� California
Phone: KI 2-62t1 "
Application for Building Permit
AND FOR A �
Certificate of Use and Occupancy
Permit No�_�� �`�--'—
���777 Date���:c..G� -f--%-/f----�f��'-----------
� � r � �
OWNER'S NAME---C�-a.-.-.- �1-icL� S�i-4v- -. PHONE:----------------------
MAILILVG ADDRESS--tW � --Y3. -�r ---0 �yJ�------�ifT--�------- --------- CITY _.C.__�..CI.i..__/�2,_�.X.Q�...�
Name ._._-
Address ._
Ciry -'-'----
State
Lic. No. ___
(Archiceco or Engineer)
---------- -`----`------._...----"-r--_ ;
--- -- - -- ------------ ------------
--------- Phone .----_.-----------
Name._'---��•�'_vvl.%'e-'�-P<1..�.�7-:_------'----------_'-----' ---
(Conoraaor)
nJJ_......— ' ' •
Ciry ----_
$tate
Lia No.
PROPOSED USE: ---- - ' ' ------ Jio �.r1G*,-- �0 r--- �' jf1 ✓ � � ��-- -- � l�✓'2�I!_ve•A �
r
` � - ------ - V ,
---
1v„�/� ry - ' .T.O i �J i
OB LOCATIOH...4...���..---------------��=I-�--``�-��"'�---..:--------�----------���---`--'f-�/'- �- - ------ .
,{+� ' (House No.) Q (Name of Str�)iz 6 � (Town or School District) ��c.
3 LEGAL DESCRIPTION: Loc __q)_�_.�. � G_�__ _.______._BIocCC�____' _.__._.._ _._.Tract�'2��j'1xR9�lIQ�
�- - - � ----- -- -
(Metes und Bounde Destription—Use reseree si e oE form
4. CORNER I,OT ( ) INTERIOR LOT (�) THROUGH LOT ( ) SLOPE OF LOT ( )
5. SIZE OF BLDG.: �.�.x..�_�___ AREA:_..------ --------------...__.SIZE OF LOT: sc..3./�--�-Q..P__ AREA: ---� -- -�-- ---- ...
6. HEIGHT OF BLDG.:__---_--_--_----------__-----_-CEILING HEIGHT:.-.__-__-..-_----.--__---_----IVO. OF STORIES_J���_-
7. NO. FAMTLIES
�
9.
..Size of Smallest Bedroom:
Size of Kitchen:
EXTERIOR WALL CONSTRUCTION:._._._____ ____...__________________ INTERIOR WALL COVERING ..._______
(Frame, Stucto, Etc.) q (� Qfj— (Plaacer-Drywall, Em.)
SEi'$ACK$: Front Yard irom Center Liae.oE Strte[.._._�n_� _✓._.____:?'-__'_.____._-.-.___________.________________..
I�earest Side Yard(4�% �ear Yard._�7 t"...__.Distance in Fee[ Between Bldgs. on Same Lot ._��.__�.___``
� S.sMO��ta,, \ -
1U. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. '1 I��^`
11. For (a) Footing': Width _---_-__'__-_-__-'-'---__ Depth in Ground.-_'_-___-...--'--___---Wirith oP Wal� .-'_--�.\'�"_'_/_
Accessory ��
Bldgs. and b Size of Studs: ----'------- --------- --S acin ---'- -------'-_"CC Mamrial of Floor .- ----"_ C� ..-'-------
Similar ( ) ----p g-----'------- - -- .
$trucmres: �
(c) Size of Flopr ]oists: --------...-`-- '------'---.Spacing ---._-"'------.---'------ � CC' , .
(d) Size of Rafters:._....
]2. VALUATION OF"PROPGSED
in¢ and sewa¢e disvosal $.__._.____.
all
"._._.Spacing --
"CC
electzital wiring, heatinq, {iie sprinklets, paino-
'�+ d c�i � c� Y�' c�'i ,�o a c'�i �� . .
LCi ,��I ER��' £�t"�I�Y T�t�`i' ES OF MY K EDGE AND BELIE� THE INFORMATION IN
��-'�IIS �P�I��."��+8`I I�GQ AND� A CONSTRUCTIO[V WORK WILL CONFORM TO ALL
•'�h�WStO�, �I#���.CQ�V'gYA F RANG D THE STATE OF CALIFORNIA APPLICABLE THERETO.
�..: ..^ �.m-LCQo`o=" '
t, �++ O'�" O N �.N N♦
E.3 c_ �_ o.oy!^ n . �y/'//��-}�� i�)
O�1'. e) 'a o ai v�i ap.� e o` Signed:------ -- -- ----'----.�vr-V'S'LY+f_"`�'+,`-----�-------------`-------
� CV .� .+
� CL u N 1'� y� 0.7 � 4.. �'n (Owner)
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5M-9-50
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CORRECTIONS ENGINEER
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