HomeMy WebLinkAbout390 17TH ST - Building Permits. ,.. - :,.,n_,�.Fti'o0(11299� *,��+129.30
- • ' 3472 I
COSTA MESA BUILDING•SAFETV DEPARTMENT
� P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 /
PP ICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RE EIV OSV DATERECEIVED DATEISSUED
BUILDING � D !�= JV /t - / - � '�O —
AODHESS [r•
OWNER EDU`IT FIi . STO ES /V�C. A.P.NO. I '—� � 3 P�p O�I
MAI� �' fl� ADORE S �% �, /.J�{�' �
Z ADDRESS �U u!� � S
dU CITY GD.S N EGE N��3 Z"/Z3 AC � LOT BLOCK
ZQ COKSTFUCTION
O� LENDER D tJr�/ V% �S
�
am
� n BRANCH A/ GH—%%OC1IN6 /'}., �
OWNE /�l' . S �
1 ADDflESS ( VALUE
'J a OR ENGINE R C L SSOG. NEL. � � $�Q �e
N p �j `
w� ADDRESS �iO - So UAI O C ./��7 Z�NE..( VPE ,�1\� GPOVP '��
a W 6cJ�Pn APPROVED [
W Z CONTRACTOR v BV DATE J� (�
J � ^- \
m Z /
J � ADDRESS n• \, `
w W TEL. ZONE NO.OF USE OF NE�G,�es• M�
Z= CITV - NO. � P�� BUILDING ` �
H
W � STATE CITV �'ARDS APPROVED VARDS APPROVED
y� LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING \
7 O (FROM C/L ST ET) �
SIZE NO.OF BLDGS. �
OF �OT NOW ON LOT / ONT FT. � � FT.
USE OF / � �'� l
E%ISTING BLOG. . �p7
F" SIZE OF NO OF
Z NEWBLDG. SO7C �ZS qOOMS STORIES I L SIDE T / FT.
a EXTERIOR WAL4 ROOF
V COVERING /1 AYO/�iQ C VERING �MP�lT�O REAR S FT. FT.
� USE OF BUI�DING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
S G �/ /�G E MAIN BLOGS. ACCESS. BLDGS.
O �(.C/ BLJJ C U � ap APPROVED
v~, G'OMm�,2ci L �R — 4j '7�.
Z
o srA�
v� hereby e�k�owiaaee thet I have reatl this application antl state EtOLD FOR SPECI aL RE� IP.L-hf- '
� thet the ebova information is correct entl apree to comply wtth �
� elt laws regulaiinp �uilCinB �onstruction, entl 1 zhall not employ �
� any parson in violation of ihe wOrkman's companmtion laws of
y tha State of California. � m
? i here0 certit that I am O SQ. FT. O
V y properlV licansed as a controctor under
the Staie ot Celifornia Business antl Professions Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNOER VALUATION IS FOR a
Chapter 9, antl Met such licenses A�e In tull force entl etfect, or 1 THE PVRPOSE OF ESTABLSHING A PERMIT FEE ON�V: ¢
am ezempt from the provisions of the Steie of Calitornia Businass
VALUATION
antl Professions Cotla, Divisi 3, Ghapter 9. �)� H
//q �� PERMITFEE S ,�7�+ ]
' Sipnature Qf� m
Permktee j� .L�—_ $��% PLAN /CNECK $ E
AuthoriztlApeni' �2v��� LL
TOTAL FEE
�� � � � 35529
COSTA MESA BUILDING-SAFETY DEPARTMENT
' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicant to Fill in Completely
PAIO
OCT —5�72c�is�,�� 180# �**��5.03
I FOR BUILDING PERMIT
OWNER � _ "S - A.P.NO. � �JS��i.% — _ —'
ADDRESS �� G �� �/y ' BUILDING � � �� � j "� S
ADDRESS � f /
Z 'Lf�
a U CITv ��
NOL Tj3� TRACT LOT BLOCK
Z
CANSTRUC?ION C W AD
O� LENOER +�l
a m ��
J � BRANCH '
J N OWNER
' ADDFESS � �/ ' VALUE U"7
J a OR EN IN ER /�� � � CK • . NEL. � D/VS $
U � `� ,r, �{� FIRE
w K ADDRESS (� Y/NI � � Z�NE VP� GFOUP �
a w � APPROVED
JO CONTRACTOR �j�i( � /p B�' I �/ DAT ^(v�
/9 /�/}ir ' \\
�J � ADDRE55 �� �f � /- /(It'�/
W W TE� ZONE NO.OF USE OF NEW \
Z F CITV �((((�/� � � NO. P�� BUILDING r
V
w� STATE CITY YARDSAPPROVED YARDSAPPROVED
j O LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING .`
SIZE r�o.OFeLOGS. (FROMC/LSTREET)
OF LOT NOW ON LOT FRONT FT. FT. ��
USE OF �
EXISTING BLDG. E FT
H SIZE OF NO. OF
Z NEWBLDG. :a00MS STORIES I.SIDE FT. FT. -
U EXTERIOR WALL ROOF
COVERING COVERING REAfl FT. FT.
� USE OF BU D N ANO OR TO 0E P R OFMED
DI5TANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
Q � VAR. � DATE
O C.U.P.# APPROVED
F APPROVED
y
Z
�
UI hereby acknowletlga thet I have reatl this applicetion antl stete O
= ihat t�e eCove informai�on is corract antl agree to comply with �
� ell laws reguleting builAing constructian, entl I shall not employ
F any permn in violaHon of the workman's compansation lews of
y Me State of Califomie. m
? 1 hereby certNy chat I�n p�operly Iicensed es a contractor under SQ. FT. o
the Stace of Californie Bus.,� s entl Protessions Cotle, Division 3,
Chapter 9, entl Mat such Iicaf.� THE AMOUNTSHOWN UNDER VALUATION IS FOF
rovisions`�are in full forca and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: �
and Prof st f�om Me p �Stata ot elit nia Buziness VALUATION p�) ¢
, p�oi:foo a, cA
v�9 � PERMR FEE 5 �� j
iC ��
SiO�atura of m
Permittee �
� t $ / O � PLAN CHECK $�� E
� ' ` �v-�J '
Authorizad AB t LL
TOTAL FEE $
�� � 355�0
COSTA MESA BUILDING-SAFETY OEI
' P.O. BOX 1200 COSTA MESA, CALIFOH
For Applicant to Fill in Complei
PAIC
OCT —5-7'cnsa�� 181# ���*�5.03
POR BUILDING PERMIT
BUILDING/ •�r � • " //�n�J — �j/% ' �� UJ -
ADDRESS
PER J 'JO
OWNER A.P. NO. _
� ��� BUiLD7NG `� � i
MAIL ADORESS
Z ADDRESS
a U CITV'��fl NOL�y3 JS� TRACT LOT BLOCK
Z Q CONSTFVCTION A �` W
ON LENDER � i ��� y
am
,� � BRANCH �� � , '
JN OWNER �L.�' � Q
ADORESS
VALUE
J Q AqCHITECT/ ♦ TEL 6/p �i $.
N OR ENGINEEfia -� / N �+�'Q �
V Q FIRE
w� ADDRESS Q L! ZONE T- PE GROUP �� (((���
a W CONTRACTOR S �%Q � 8V ROVED DATE -� Z �
W Z
J Q
m Z f
J � ADORESS L� ��
W w ZONE NO.OF USE OF NEW �
� = CITY � " NOL � . P�� BUI�DING \
ZH
w� STATE . CITV ��+RDSAPPROVED YAqDSAPPftOVED
N� LIC. NO. LIQ NO. MAIN BUILDING ACCESSORV BUILDING �
7O � (FROMGLSTREET) I
SIZE NO.OF BLDGS. �
OF LOT NOW ON LOT RONT FT. FT.
USE OF
E%ISTING BLDG. S E F. FT.
� S12E OF NO. OF
Z NEW B�DG. ROOMS STORIES L. SIDE FT. FT.
U EXTERIOR WALL ROOF
COVERING COVEFING REAR FT. FT.
USE OF B NG ANO ORK TO BE PER OflMED DISTANCE BET. BET. MAIN &
� \ MAIN BLDGS. ACCESS. BLDGS.
Q . VAR. # OATE
O C.U.P.�W qPPROVEO
F APPROVED
q) ST
Z
O ,�
UI hareby acknowledBe that I have reetl this appiication and stete
� that the a0ove intormation is corract and agree to comply with
� all laws reBuleting builtlinB constr�ctlon, and I shall not employ
� any person in violatibn of the workman's compensation lews of
(q tha State ot Californle, m
ZI haraby certity that I em properly Iicansetl as a contractor untlar SQ. FT. O
the State of Calltornia Buziness entl Profeszions Code, Oivision 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR
Chepter 9, antl that such Iicenses are in full forca antl eftact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: �
am exempt from t�e p�ovisions ot Na Stata of Ce4ifornie Bu5lness � ¢
VALUATION y
anA Professlons Cotla, Division 3, Chapter 9. / � r_� n
%%�� � PERMIT FEE $ �
Slgneture<f�r����lr� A- - _ m
Permlttee ��� Fi6�✓!l $��� PLAN CHECK $ o
��� ra"O
Auxhorizetl Age � � G.� LL
TOTAL FEE $ �,J
" � � 35531
COSTA MESA BUILDING-SAFETY DEPARTMENT
• P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
AP LI F
For Applicant to Fill in Complete/y REc
BUILDING � �W �
ADDRESS �
OWNER A.P. NO.
MAIL / BUILDING /,1
ADDRES (/ ADDRESS�,]
Z .
W W TEL. 7RACT
a U CITV O� NO.
Z Q CANSTRUCTION
O � LENDER F � S
am
J � BRANCH �v �/ F( /
J N I A �r OWNER
ADDRESS � ryy (rj
� a OR ENGINEEFl /C/� , MAG v TEL. .�/Q, S
��� iV
U �
wa S. / /7/i, l. FIRE
� ADDRESS ZONE
aw � APPROVED /
wO CONTRACTOR � S,L _ � BV �'
m Z k' S ��D �P,r ��
J � ADDflESS
PAIO
OfT-5-72cNs�,�� 162� �**�*5.03
FOR BUILDING PERMIT
W w ,/` �/ ZONE NO.OF
�_ (�6�N(/ ' NOLS'G�/�� PLANS
Z r arv
w� STATE CITV �'�+RDSAPPROVED
y Q LIC. NO. LIC. NO. MAIN BUILDING
_� SI2E NO.OFBLDGS. (FROMC/LSTREET)
OF LOT NOW ON LOT FROM FT.
USE OF
EXISTING BLDG. '
' I� SIZE OF NO. OF
Z NEW BLOG. ROOMS STORIES L. SIDE FT.
U EMEPIOR WALL ROOF
COVERING COVERING REAR FT.
� USE OF BUI ' D K TO.BE PEPFO ED DISTANCE BET.
� MAIN BLDGS.
� VAR. #
O C.U.P. �
� APPROVED
y
Z
�
UI hereby acknowletlpe thet I heve reatl this epplication antl state
� thet the above intormation is correct and aBree to comply with
� ell laws reguletlnB builtling eonstruction, entl I shell not employ
r eny person in vlolaHon of the workmen's compenmtlon lews of
y the Stata of Celitornie.
? I hareby certi(y that I em praperly Iicensetl es a contractor untler SQ. FT.
the Stai¢ of Calitornla Business entl Profeutons Catle, Division 3, THE AMOUNT SHO'
Chaptar 9, antl that such I(cansez are in tull force entl effect, or 1 TNE PURPO6E OF ES
em axampt from the provlsions ot tha Stem of Califomia Businecs VALUATION
entl ProfesQsion''s Code, Divislan 3, Chepter 9. �r1
Slpnature8 , / $���^p, V v
Pe�mittee - i � � - � � J ��
Authorized Apant'
C
LOT
USE OF NEW
BUILDING
BEf. MAIN &
TOTAL FEE
�V
�
m
O
VALUATION IS FOR � a
A PERMIT FEE ONLV: Q
� m
� `o
LL
Z .
aU
Z
2Q
Oy
am
��
J N
J Q
U Q
Z �
d W
WZ
J Q
m Z
J �
W w
O=
Z �-.
w �
N �
� �
� 35532
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFOHNIA 92626
For Applicant to Fill in Completely
BUILDING �j(rJ„ ��,c ��a r_ �n c+�
OWNER
MAIL
CITV ��/�
CpNSTRUCfION
BRANCH �
ADDRESS
ARCHITECT /
OR ENGINEERi
ADDRESS,
CONTflACTOR
ADORESS �
CITV ���(�
STATE
UQ NO.
512E
OF LOT
USE OF
EXISTING BLDG.
��.
T
TEL.
NO. �� �
CITV
LIC. NO.
�NO.OF LB�DGS.
NOW ON LOT
PA70 *�k��
QCT —5-72cN<r.00 183# 8.05
FOR BUILDING PERMIT
;!E r}�c� eo �� e is�u
y �l
A.P. NO.
BUILDING �
ADDRESS
TRACT
F�RE
ZONE
APPROVED
ZONE NO.OF
PLAN$
VARDS APPftOVED
VALUE "'v
S $
�GROUP
DATE �/ M
��
USE OF NEW �
BUIIDING
VAFDSAPPROVED `
ACCESSORV BUILDING
�
� SI2E OF NO. OF
QNEW BLDG. ROOMS STORIES L SIDE FT. F
U E%TERIOR WALL ROOf
COVERING COVERING REAR FT. � P
� VSE OF LDING AND WO K TO e PE FORMED DISTANCE BET. ' BET. MAIN &
MAIN BLDGS. ACCE55, BtD(iG
V � VAR. � DATE
O C.U.P.#5 APPROVED
~ . APPROVED
y
Z
p STATE
VI hereby ecknowlatlge [ha[ I hava reatl thi5 epplication antl stete `
� that the ebova informetian is correct enG aprea to comply with
� all laws �agulatinp b�ildin8 conrtruction, antl I shell not amploy � �
F any Derson in violaUon of Me workman's compensatlon lews of
(q Me State of Californla.
ZI hereby certify �hat 1 am prpperly Iicensatl as a contractor under S�, FT.
the State of Culitornie Businass entl Profes4ions Code, Dlvislan 3, THE AMOUNT SHOWN UNDER VALUA
Chapter 9, antl that such IicBnsas ere in full torca antl aftect, or I THE PURPOSE OF ESTABLISHING A PERMI
am axempt frpm the provisions at the State o( Celifornle Bus(ness �q�VATION
entl Professions Cotla, Dlvision 3, Chapier 9. � )
� PERMIT FEE $ L
SlOneture of
Permittee �/ �/- � � $�� PLAN CHECK $'—
Authorized Ape t v TOTAL FEE $�
m
d
0
FOR j
JLV: Q
`o
LL
' � � 35533
COSTA MESA BUILDING-SAFETY DEPARTMENT
' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant m Fill in Completely
BUILDING��/� ������ �� A%i�1/
ADDRESS /l
MAIL 9_
ADDRESS ��
CITV ���
CANSTRUCfION /�C
IENDER �/
BRANCN DLi (.✓
ADDRESS \ il
A�DRESS�J(
CONTRACTOR�
ADDRE55 �
CITV ��OW
STATE
LIC. NO.
SIZE
OF LOT
USE OF
EXISTING BLDG.
SIZE OF
VSE OF BUI
�,
NO. OF
POOMS
ROOF
COVERI
KTO BE
T_ I_�L1Z_3��
NO.
�///t�S
��E`�/773 vs 30
�
pTV
L10. NO.
NO.OF BLDGS.
NOW ON LOT
�7
PAiD
OCT —S'7��MSFOO 184� **�**5.03
4 pLIC TION FOR BUILDING PERMIT
I� V Dl)ATE R�cEIV;D DAaTE ISSUED Z
�l. �' �� y��
PERMIT NO.
NO.
DING �f �'/ /- ��
RESS� G
TRACT LOT BLOCK
A P
IER � �/ /
2 _ _ , VALUE JI. _ �
FIRE
20NE
APPROVED
ZONE INO.OF
PLAN$
VARDSAPPROVED
VAR.516
C.U.P.qW
APPROVED
DATE � ' [/ �\
E OF NEW �
LDING
VARDSAPPROVED �
CCESSORV BUILDING ' ' ,
�
BET. MAIN
ACCE55. BL
DATE
APPFOVED
1 hareby acknoWletlga thet I heve reatl this application and slate
thet the ebove informatian is corract and agree to comply with
all laws regulating builtlinp consttuction, antl I shall not employ
any person in violation of ihe workman's compensailon laws ot
Ma State of Cal7tornia. �
I heraby certify that I am properly licenutl as a contractor under SQ. FT. o
the State of Caljfornla Business antl Pfofessions CoAe, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
ChaOter 9, antl that such licenses are in fufl forca antl effact, or I THE PUftPOSE OF ESTABLfSHING A PEFMff FEE ONLV: m
am ezempt irom Me provizions of the State of C lifornia Bustneu ¢
antl Profassions Cotla, Division 3, Chapter j
VALUATION m
��7 ERMIT FEE $ � j
Signatura of /q) �5
Permittee �/� § U/ ) PLAN CHECK $ E
CJ ��) o
LL
Authorized A �t TOTAL FEE q
Pfl�CT ADOPE3S: 3�J O E 1 7 TH ST
S� owyensronMe: 30HNNY O'CONNER
aooness: 7 PO, bOX 1992
NEWPORT HEACH
CA, 92660
UNIT;
AflLN/ENGMEEP: HRETT MARCNI flEG.NO.: CiS2C��I
FDOflE55: 1 1 I 9 MAI N ST UNIT:
HUNTINGTON BEACH CA 92648
PEftMIREE: G C COS3STRUTION ( 310 ) 924-0801
ADOXE55: LE]SLO ESTELLA
CERRITOS CA 90701
IICENSE� CUNTMLTUfl OECL1BA710N: I �ereUY allirm itut I am Iicen5C0 un0er proHs�ons ol Chao�er 9(cammencinq wil� Seclion
7000� ol Division 3 0l the Business antl Pmiessions CoOe. an0 my licensrg in full larte antl e11ecL
ciTr uc.: srare uc.: 4 6 4 6 6 S .Cnas: H
Date�. I 2�� 7 Si9namre: �a �-G `�'�
WONNEBS' COMPENSRTION DfLlABA71DN: I �¢reby afli� i�ai I �ave a ceniticate of caisent to selLinsure o� a cert��icate o! Workers'
Comp¢nu�ion NsU� j o1 alc' �f y�y �ne�eo� (Sec�bn 3800. lae. CI.
POLICV ND.: 1 � EXP. OATE; U 4/ O 1/ 9 4
comvaxr: STATE FUND
�] Ceni�ie0 copy is nereby Iumishea. d Certifiee c� k I' A Ihe dry B' I�Oiv'¢�iqn���
y /
Oale: � � � ��7 y PppliCant: !%%
E%EMPiION FPOM WOflIIEflS' COMPENSATION OECLAM7ION: (iNs Seelion n comDleteO il N¢ pmrot is Iw me M1undred �510p) or kss).
I ceN�y ihat in iM1e peAormance of ttM wOrk tor w�ip� Nis permit is issuetl. I snall nol emplay any person in any manner so as to become
su6leci �o t�e Warker5' Lomp¢nsaiion Laws ol CaGlamia.
Da�e: Siq�wiure:
NO710E: 11. alter makinA �M1is OecWration, you should become subjen to ihe Wohers' Compemation D�ovisions o7 the lahor
Cade. you must fonnwth compry vn7h sucn p�ovaian m tltis permif shaN De CeemeO revoked.
CONSTPUC710N LENDING �GENCY: I AereEy attirm t�al ibere is a consiruciion lenainq a9ency tor �he Dedorma�ce oi the work to�
which inis permi� is �ssue0l5eciion 3W7, Civ. C).
LENOEfl:
aooeess:
OWNEP BUILDEq OECUMTION: I �ereby allirm ilul I am exempt tmm tAe Contracmrs' Stafe License Law lor t�e lollowinp reason
(Seclion 7N7.5 9usine5s antl Pro�aui0nal CWe: Any city al counry w�icA repuires a Oe�mit to conslmci, alte�, impmve, tlemolisn, or
repair any slmcWre. odor m its iuuance. also requires Ra aD7���� �or wc� Oertmt ro iile a sipneC stafemeni ihat �els�e is Ilcense0
pursuanuo the pmvisions ol ine Comraaars' Siaie License Law (Clwpter 9(commencing wiM Settion 7000) oi Division 7 ot i�e Business
ana Professions COAe) o� tlwt he/sne a exempt inereirom an0 t�e ba5'a tor t�e atlepeE e�em0��on. Any violation oi Sectian IOJ7.5 6y
any aOPlicanl tor a Oermil 5ubletls l�e aD��icant lo a cidl p¢naliy 0� not mOre it0n irvC hun�i¢d dM�trs �E500).
I, aS owne� oi iire propehy o� my employees wit� waDes as tl�eit sole wmDe�sation, will tlo Ue wwk. antl llie
❑ amcW�e is �wt ink�¢4 w ollereA Iw u�e (Secewn 70a4. euvness ana Pmlesswnal CUUe: TAe Contractars' S�ate license Law
does na apWy tu an owner ol a pm0eny wlq ouiles or imo�oves tlrereon, ana wlio eoes sucn wo/k nimseltmenell or tnrouah
his o! �e� OWn ¢mpl0ye¢5. p�MiECU t6d� SUC� impfavCmenlS are n0i inl¢nECO Or Ofl¢red IOr ShcB. IL hoWever fhe buildinp or
imD�o�emenl is Soltl wilhin one year ol completion, tlre mmn will have th¢ bur0en ol pfoWnp AUs�e E�U not bui10 or im0�ove
, fo� me nurvose o� sale�.
I, at Onne� of ilm p�Op¢hy, am Eaclusivety tonUactrcq vn{� litensed conttacla5 t0 construct t�e D�alecl (SecliM T04E, Buainess
❑ a� Protesvan CaCe: TM Contractas' S�aie �iceme law aaa �ai appry w an ma�ar ol wacerty � Owldt a� impraves Iherean
ana w1w conVacls lor suU Ow�ecU wltM1 a canUactoq5l ��cense Oursuant �a I�e Cpntractors' Sia1e License Lawl. I am aware
lhet Otoul p� Iheu Warker'S Comp¢n5alqn irttur3nfR SImu1E Oe provi0ed Io me.
� 1 am exempl untler Seciion: B. 6 P. C.
lor Ihis reason:
Daic: Owner.
I Oo �e�e�' cenily itial I am aware ot aitC m1Ce�stand thC teQUirem¢rt6 W Calilomla Heatt� and $a1PAy fndC SCctions 25505, 25537, aaU
2553a a+W �nat I o� any Iutur¢ bwldi� awpaat wiwwill nol {tirUe one) need t� wmvM �� `+�ia swte cades antl ihe reQui�eme�ts Ior a
permit iw consvuctiw� ot modilication ham ipe Ai` �ua4ly Alanagement �iz�ricL NevGentul censvuc�ion apD�icalims are e.empt Irom
t�e5e O�oviSions.
Oa1e1 l�pti4anC
Ihereby certilythal Ihave read inis apolication anU slate Inal Ine a�oveinlormalionis carrect. Ia9Be to comply with all cily ana county
o�dinancesanGSiatelaxsreWiingiaboAEmgcons�mnlwi eby utlarirerepresemativesotittisarytaente�upont�¢aWve�mentione0
O�operlV IarinS�eciion purposes. � �J
Daie;� ���� Si9�tu�v-. �/ ' `f�-- —
oriver s L�mense or Sociai Secunty +:
t6ei.a6 WM1ne—BwlEing; Green—Cod¢ Enfo¢emenC Canary—Applicant: Pink—RevEnoe; GoloanroE—Assassoi
CITY OF COSTA MESA - BUILDIAJG PERMIT
PERMTT NO: B 065180
CONSTRUCTION TYPE: V-N
PLAN CHECK NO: 04239-93 L
PERMIT TYPE: STR
JOB DESCRIPTZON : INTERIOR ALTERATIONS & H.C. UPGAADE
CLAIM VALUE: 25,000.00 CALC-VALUE: '15,276:00
PERM NO:"�H ` 06518C
GOVT: N��SU ��l
\'PURPOS6: ALT
SQ FT: 25,A00
GRQUP OCC: B-2 !
COMMENTS: iVEW BANDIT BARRIER 6 VARIOU5 HANDICAP IMAROVEMEIJTS
�tir+rit****�tic��t�t�tic�+t��t-i�****�tie�tit*it�t****�t*�t-�t*+��r-�t***+t�it*�r.**+t�*�t***�r+r**�r*���r��r*�t+�r*�**+r*�
Z O N I N G R E Q II I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUT_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; 42502106'ZNE: C1 REF NO;
PLANNING NOTES> INTERIOR ALTERATION TO REMODEL EXISTZNG CUSTOMER SERYI�E,
> AREA AND TO PROVIDE HANDICAP ACCES5 FOR SCE PAYMENT�CENTER,
if if if �F iE 1E iF iE if iF ff 1E iE iE �E If !F iE df iE jf if iF if if if !E if �f 3E if iE if iF if if if iE iE iE iE if iE iE iE if jE �F 1E 3f 3E iE iE aE if 3F 3E iF if 1F 9F �F 9f iF ie iP iF 3E iF iF tF iE if �Y iF i� 1f iF af
D E V E L O P M£ N T S E R V I C E S R E Q 0 I R£ M E N T 3
ZONING APPROVED HY . �y �/a DATE: ,�t d� ��
BUILDING APPROVED HY : ��'��- DATE: �l' c} �j
APPLICATIpN ISSUED BY: • � DATE: (t-, Q3 j
�riFiFi4iEiFfEi43F11�iEiitEiElfiE1F3F3EiF3'r3t �x . . 3:�1FiFiF�FiF�FifiF?¢�3F . ��in3F
af�Ifil3E,jFiEififiFfEjFiEjfif�fifif�F3tififiFMiFiEiFiEiEiEiEiflFiEafMifdFif9Eif1fiE1fiF9f3EiE1f1F+f�Fififiti(�iFif3FificlficlFlE+f�lFifiFiFic ifiFicic#itjfic
LEGALIZATION:N r E S U M M A R�' STRUGTURAL � MENT:Y
.. ,
BLDG PD." ""..o1NG ELECTflIC 'M�CHANiC £IRE= � SMIP<RES � GRADING
PERMIT 258.5� • , • ^
g . ' " - �. SMIP'/MON�R�S
PLAN 16 .03 � �` , , 4� �31
ISSUE FEE ' .- • .
BUILDING-DIV-> PERA ` ISSUE P�,AN-CHECR ,,.. TOTAL � PRII3'� • DUE
TOTALS----> 263. 1 0.00 168.03 431,.�4 ` 4_31i�84'l 'r ,00
REVENUE DIVISION TOTAL'--> COLLEETED:� .263.81� OVERGSHORT:��� t 00
HLDG PMT PLUMBIN� ELECTRIC MECHANIE ' FIRE SM�P/TOT '6RA�JYNG.PE,'AN-CHECK
258.50 ,, • •\5. 31 . . ;.',
�r***+r+t+t+r*+�**�r�r******r*** ***�f*+t+�+r*+e+r�tC*}r�+t+��*+t**ir**ff***-M-*�.**+t'*�r�t�t�**+rx��#�:i+r+��r��+�*
I N D 2 V I D U A L fF' E E $�R`£,A K, ff'Q •Wi,N - '_ ,
� �
TYPE QTY D E S C R I P T I�O% / .• -. UNIT.COST . TOTAL COST
SFC 400 EQU-ALT COMM. AIR COND f�' -AVER �-- .69� .' ".' 276.00
SFC 25000 ALTER HY VALUE G6MMERCIAL- NOZONE� -_� 1.,00 r, 25,000.00
END OE' .F�EES ,
, -�9.: DD1
• 'JATE:
. �� -
� 1 .: ,��-
. a - J�.
/, i�
.�
5i'/13-001`li2%+ YCAT 26�.�i
i�f�3ls�3���iIttE: i1:U�
� � CONS7RUCTION AND PIANNtNG '
�� �APPRQVALS Permit��,
�
ii. TemOorary Elecvical Service or Po7e .
.
Z, $p;t Pipr-Unar�rnd.
3. EieCtrical Condu��t Ut�hty•Undrgrntl.
4. Electncai �Condu�bUnd�gmd.
5. Stecl Remfa.c�men�
�� Eiectrlc�i L'FER G�r.d.
7. foot�ngt
9, fountlat�on
9. N�atcr Pipe-Undrgr�d,
, 1C. Structural F�oor Systen
, 7 7. P�operty 5=.�.r Line & Hc�..sc'� Connettion
12. Sewar Cap
13. Roof prains
14. Rough Plumbing �
15 Rouqh Electrical-Contlult
�76. floughE�ectric4Viring
17. Rough Wiring Sign
18, Rou�h Electrical-T Bar Ceibn9
19. Rough Heati^g & Air CondiUoning
20. ?o��h Fdttory Fireplace
21-Ducr,?n Structure
2i. D�ctS, V2n[il8tir.g
� 2$. Gas ?ipa�Rou�h & Test
24. Roof Framing
25. Root Shcathing
26. T�Bar Ceiiing (Struccurall & S.�onoeoat
27. Framc and Fiash�ng
28. lath�np & Siding
29. I�sulauon
30. Dryr.ail Naih�o
31. Pla;ter Ero�•rn Coat
32. Electnc�i Poa;cr M1^ete�-Final
33. 'rinal Elcctr.c
34. �=ina! Nzating & A�• Con�:tiod,rtg
35. Final Gas Pipe�Test
3&. Noad or Canopy
37. Finai Facmry F�reptace
38. Finai Ptum6ing
39. Water Seraice�Final
40. Gas Sermce�Finat
4t. S�lar pomestic•Final
42. 8ackflow reventer
43. Backftow irngation
44, landswp (rriqation Svstem
45. Sound Attenuation
ndicap Regu�ations �
47. F NAL STRUCTUFE & BUfLDI�iG
48. FINALPLANNING
49. Electric Reiease to Edison
50. Gas Release to $outhern Catitornia Gas
Date
ROO SPA
Date Inspedor AppROVALS Permii �r`
52. Pool & Equipment Location
53. Steel fle�nforcemeM �
54. Forms
55. Electrical6ondmg
56. Rough Plumhing & Pressure Test
57. APPRUVIIL TO COVER�GU��TE
56. Electrical ConduirUndrgrntl.
59. Gas P�pe, 0 UndrgrnA., Test
� 60. Backwash l.inEs, P�Trap, O Undrgrnd.
� 67. APPROVALTODECK
67.. Baekwash & ReceptorFinal
63. Heater & Vent•Final
64. Plumbing System � Final
65. Elecvical-Finzl
66. Solar System•Final
67. Fenpinq & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEf.:SFINAL
FIREDEPT,REQUIREMENT
APPRQVALS Permit i�=
70. Underground Hydro
71. Product Pipin9 C Gns 7 Oii
' 72. Under9�ound Flush `
73. Undergrnd. Storage Tank O Gas � 0��
_ 74. Ovenc�ad Hydro
75. Dry G�emlcal
2
Date � Inspector
76.)br tandpipe �
7J.{ FlXED �,YSI�Ft�6 FINAL �
78, FIRE P�EV. FINAL ��l`__ 1�
� HEALTH DEPT. REDUIRE�.;EP:T
79. FINA INSPECTION ` _ _�_
�0. FOOD CENTIFlCA7E ISSUED /� � � _
Notes: ���„y�.t.,, 4� �y�i�Is�7�
r CJ
/�R� z-� a -Y4 //%
��
2-Lz-? 4,
0
_1
�—I
PflQIECTA00NE55: 3JO E 17TH ST uxiT:
owxen s xarne: JOHNNY O' CONNER
aooREss: 7 p0. BOX 19�2 ,.
NEWPORT BEACH '
CA, 92660 .. '
AHCNIENCINEEN: BR ETT MARCH I sec.xo.: C 1 5 2 6 7
nooxess: 1 1 1 9 MAI N ST uxrt:
HUNTZNGTON BEACH CA 92648
PEflMITTEE: G C CONSTRUTION ( 310 ) 924-0801
nooness: 15510 ESTELLA
CERRITOS CA 90701
LICENSEO CONTflACTOP DECIANATION: 1 �ereRy allirm t�ab l am Iicense0 un0er pmvisions oi C�apler 9(commencinp wit� Senion
7000) ol �rvision 3 al Ihe Business antl Pmlessions Code, an ¢ se is in lull �orce a lect.
cirr uc.: sTnre uc.: 4 6 4 6 6 cuss:
�ate: / �� � � Signature: _ -
WOflKEBS'COMPENSATIONDECLABpTION: I�ert� uirminatlhaveaccye1 i¢atealconsenttaseu�insureoracertiliwleofwarkers'
CompensaGon �su� j ej of a�cGriiliey jpy Ihereot (Sec�iEXPDRTEao V 4� O 1 I 9 9
POLICY NO.: �
comvaNr: STATE FUND�+,
❑ Cenilied coDY is here0y lurnis�etl. l•J Cenified co0 s hle vnih t�¢yil uiltlinA Div ion.
i
oa�e: C 2- 3—�l� ncoa�a �� z-- �� is����-
E%EMPTION FflOM WOBHEBS' fAMPENSRTION OECLl�NRiION: (T�is section neeA nol Ue com0leteG i� th¢ permit is lor one hmMreO (51 W) or IeSs�.
I certily �ha� in ��e Dedormance ol Ihe work far w�ich �his permii is issuetl. I shall not employ any Dersan in any manner w as lo �ecome
5u�leci la Ihe Workets'�Comp¢n5ation Laws o� Calitomia.
Date: '� SignaNre:
NOTILE: 11. ai�er making t�is aeclaration, yrou s�oula Gecome suElect to t�e Workers ComOensatiomprovisions of t�e LaDor
Code. you mus(lonhwnh compty wit� suc� pmvisions ar �his permit s�all Ge Oeemea revoke0. �/}
CONSTBUCTION LENOING RGENLY: I �ereby allirm thal ��ere i5 a conitmclion lending agency lor �Ih¢.DeAormance ol t�e work for
which I�is permit is issued (Section 3097. Civ. C�. �
LENDEfl:
AODNESS:
OWNEB BWLDEN DECLABRTION: I hereby aflirm i�at I am eKempl imm the Conirac�ors' State License Law lar t�e following reason
(Section 7031.5 Business and Pro�essional Code: Any ci�y ol tounry which repuires a permit �o conslmci, alier, impmve. Oemolish, ar
reDair any simcmre. prior ta its iuuance, alw reQuires the aODlicant lor suc� permii io lite a siAneO slatemeni that h¢/5Ae is licensed
pursuanilol�e O�ovi5�on5 ollhe CAn�ratlors'Slaie License Law(Clupter 9(commencinq with $eCiion 7000�a�Divivon 3 ol�he Business
an0 Pmlessions Code) or that ne/she is eremD� iherefmm an� Ne basis for ine allepee e�emption. My violation ol Seclion 7031.5 by
any aDPlicanl for a Dermit suble��s ihe applicant to a civil Denally of not more t�an live AunEr¢E Uallars (ESOIq.
I. as owner of ��e pmperty or my empIoyeeS vnih waAes as I�eir Sole compen5atian, will tlo the work, an0 the
❑ sVucWre is no� imenOea or ottereA for sale �Section 70aa. Business an0 Pwfessional COEe: The Cantractors' State Licenu Law
aoe5 noi apply Io an Own¢r o� a prOp¢rly wh0 �uiltls Or impmv¢5 I�ereOn, an0 who tl0e5 5ut� wark �imsel�/Aerult o! �Amuq�
�is or �er own em0�oyees. O�ovitle0 Ihai such impmvemenls are not inlenEetl or ofie�e0 lo� sale. Ii. M1owever ��e builGing or
impmvemen� is SOIG wil0in ane year al com0�eiion, i�e owner vnll have I�e �uraen ol DmNnq hUshe Oi0 not buila Or improv2
for ine ourpose ol sdlel.
I. as owner of ihe propeny, am e�cWsivelp coniractinp wilh Iicense0 coniracbrs lo consimct Ihe O�olect (Section 7044, Business
I❑ antl Pmtessirns Cotle: ihe ConiractOrs' Siate License Law Gces not apDly to an owner of pmpeny wAo builds or imprwes Ihereon
ana wno contracts tor sucn o�ajects min a commctorls) license pursuant to ine Contratlars' State License Law�. I am aware
I�al proa� of t�eir Workei 5 Compen5aiion insurante 5�ou14 be DronOeJ l0 me.
� I am eKempt unaer Setlian: B. 8 P. C.
br ihis reason:
Oate: Ownec
I do �ere�y certily Ihai I am aware ol anG unGerslana Ihe repuirem¢n�s o� Calilomia Heal�� ana Salety Catle Seciions 25505, 25533, an0
25534 ane Iha� I or any �uiure �uil0ing atupanl will/vnll no� (ci¢le one) nee0 i0 compty vnih saitl Siale COCes antl lhe reQuir¢menf5 �or a
Oe�mi� lor consimc�ion or modilicalion Imm I�e Air Oualiiy Managemeni Di51ncL FeSiAenlial conSlNc�ion apD�ications are ¢Kempt Iwm
these pmvisions.
Oaie: FOV�i[anL
1 hereby c¢r�ity��atl�avereatl�his application antl state Ihal the a intormationis carrecL I apreeio comply wit� allcity anE counry
ortlinancesanOSlalelawsrelalingiobutldingconsimnionanaher aut r¢erepresemativesol ' irytoenteruponi�ea0ave�mentionetl
pmperly for inspectmn purpases.
�ate: � Signalure:
or��er's �hense oi Socia� Securiiy a:
164t-<6 Whne—Buildmg; Green—Cotle Enlorcement; Canary—Applicanl; Pink—Revenue: GOICanroC—Assassor
�' 1
CITY OF COSTA MESA - BOILDING ?ERMIT PERM NO; P 06518�
PERMIT NO: P 065182 PLAN CHECK NOE N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-N PERMZT TYPE; PLU PURPOSE: ALT
JOB DESCRIPTION : INTERIOR ALTERATIONS 6 H.C. UPGRADE SQ FT:
CLAIM VALUE; CALC-VALUE: � GROUP OCC; B-2 /
COMMENTS: REF : H-65180
*****-x�*�r+�+t�+�ir*�r*�r****i�+r+��r***�-�r�r**�t#*****�***�t+t� ***r****�*�r****ac**�r**�t*+�+�********
Z O N I N G R E Q U I RjE M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- -----�--- ACCESSORY BUILDING ---------
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: PRO��: PARCEL: 42502106 ZNE: REF NO:
PLANNING NOTES> 4
>
***�*,��*�*,«*�+�x�**��*���***���**����**���*����+��***+�****��****��*�*�**�*******
D E V E L O P M E N T S E R V I C E S,= R E Q U I R E M E N T S
ZONING APPROVED BY ' DATE:
1 '
BUILDZNG APPROVED HY : i: DATE: G
r � /�
APPLICATION ISSUED BY; ',"I DATE: � v J
9f9E�E1filiEiFiF�EjEiEifififlEiE�fjfiEiflEi4 +c . �c . . {Fj4�IRiFiEiF9f#FiFif�x ���r'iFlE3E
3f�FiEif3FitiEitiEl4ifiEiEiEiEjElFiEkiEiFiEiFikaf%x� ...cifiEiEaFaEikiFiEiE#ffiEifiFjEiF-)Fi;iFitiE3EiE3fjfjfifjEiFifiEiEaEiEiFiFjf3E1Fj.9F�%iF aEif�EiE
LEGALZZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
✓� =-
BLDG , r PLUMHING ELECTRIC� MECHANIC FIRE SMIP/RES GRADING
PEAMZT 21.00 -
ZS' �� "� SMIP/NON-RES
PLAN' �
ISSUE FEE _�,00 "'�
BUILDING-DIV-> ' PER ISSUE PLAN-CH'ECK TOTAL PAID DUE
TOTALS----> 21.10 20.00 0.00 41.00 41.00 .00
AEVENUE DIVISZON TOTA1;--> COLLEC.TED: 41.00 OVER/SHORT: .00
HLDG PMT PLUMBIN ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
4i,oi l .
L �
ifififiEiE1f1E1tifiEifitifiFiE3ElfiElfifitifiF ik�EiEjEififif�kiEiEiEifiEiiifiE3EiFiFiEiE1EiE9clfif�Eff3cjfiEiEif9fiFiFiEifMilifjEi43FafiFi6ifiEiFiEiFiEiE9f
, I N D I V I D. U A L �FrE E B R E A K D O W N
TYPE QTY D E S C R I P T I O IJ, - UNIT COST TOTAL COST
J '
PLU 1 WATER CLOSET (TOILET)� 7.00 7.00
PLU 1 SEWER CAP / DEMOLITION,'^ EACH 7,00 7.00
PLU 1 SINKS, COMMERCIAL OR INPUSTRIAL 7,00 7,00
END OE; FEES
,� .
, . 'l
'
S
t;t 001`?712-001��1712 �t7T L1.00
DATE: I?J03/9s TIME� 11:03
CONSTRUCTION AND PLANNING �
APPROVALS Permit #
1. Temporary Electrical Service or Pole
2, Soil Pipe-Undrgrnd. �
3. Electrical Conduit Utility�Undrgmd.
4. Electrical Conduit�Undrgrnd.
5. Steel Rcinforcement
6. Electncs! UFER Gmd.
7. �f ootmgs
8. Foundat�on
9.'vVater Pipe-Undrgrnd.
10. Svi�.turel Floor System
17, Prr�perty Snwer Lme & House Connection
i
12. SeCver Cap
73. Root Drain:
14. Rough Ptumbing
15. Rough Elecirical•Conduit
16. fiough Electric Wiring
77. Rough Wiring Sign
18. Rough Elect.ical-T Bar Ceiling
19. Ro�gh Heating 8i Air CondiUOning
20. Rougi� Factory Fireplace '
21. Ducts, in Siructure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
Y5. Roof Sheathing
26. T•Bcr Cciling IStructurall & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insuiat�on
30. Drywall Nailing
31. Plaster Bravn Coat
32. Electrical Power MeterPinai
33. Final Eleciric
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Canopy
37. F��.� __..._.. �..� 'ace
��1_
38. Final Plumbing
,,.,. ..�.�� aervice-Final
40. Gas Service�Final
41. Solar pomesticFinal
42. Backflow Preventer
43. Beckflow Irrigation
44. Landscape Irripation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNiNG
49. Elearic Release to Edison
50. Gas Release to Southern California Gas
Date
Date
POOL 2 A
Inspector APPROVAIS Permit #
52. Pool & Equipment Location
/ 53. Steel Reinforcement
.f�--.
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER�GUnITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. BackH�ash Lines, P-Trap, O Undrgrnd.
61. APPROVAI TO DECK
� 62. Back�vas4 & Recepto�-F��ai
63. Heater & Vent-Fi�ai
64. Plumbing System - Finai
� X/,�f�. 65. Electricai-Final
a��
66. Solar System•Final
67. Fe�cing $� Access ApProval
68. APPROVED FOR PLASTEflING
69. POOUSPASYSTEP,1SFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
77. Produci Piping O Gaz ❑ Oil
72. Underground Flush
73. Undergmd. Storage Tank �7 Gas ', Oil
7A. Overhead Hydro
�. Ory Chemical
47. FIXED `tj4'STEh4, tNA�
�
78. FIRE fiEV. FINAL�
' HEALTH DEPT. REQUIRENIENT
79. FINAL INSPECTION _I
80. FOOD CERTIFICATE IS�.iED
�
Notes:
Date � inspector
�
i /
I�
PflOJECTADOHESS: jjO E 17TH JCT
OWNEN'S NAME: SOHNNY O' CONNER
aonaess: � p0. BOX 1942
NEWPORT BEACII
CA, 92660
UNIT:
AflCHIENGINEEN: BRETT MARCHI flEC.NO.: C1��67
ADDPESS: I i I S MAIN ST
HUNTINGTON BEACH CA 92648
PEflmiTTEE: TICKNOR ELECTRIC ( 719 ) 639-7911
aooeess: 625 W KATELLA 34
ORANGE CA 92667
LICENSE� CONTHRCTOfl DECIABAiION: I �ereby a��irm Ih am li nseU under pmvisions ol C�apier 9(commencing wi�h Section
7000) ol Div�sion 3 0l Ihe Business antl Pmfessions Cotle. nA my li[ is in �ull lorce antl efiact.
ciTruc].:Pr �32�/ 9 srnTeuc.:37799 5' C10
Daie: _p�.J�. ` SignaNre: _ . _
WOBKENS�COM ENSATION DECLAflATION: I here6y a� Ihat l e a cenificate oI consent �o sell�insure or a cenificate of Workers'
ComOensation Insurance. or a cerlilieA coOY ��ereol (Section . Lab. C�.
POLICY NO.: W S Z 3 H S Z O S E%P. OATE: O S� O S� 9 S
cornraxr: PACIFIC NATIONA
� � Cenilietl coDY is hereby lumishetl. � Certtlietl ca is file0 IAe ciry Builtlinq Uivision.
Date: u ApplicanC .
�
EXEMPTI FflOM lOPNEHS' COMPENSATION UECLAPA710 � is secuon neeU not be romplete0 il ihe perrml is for one hmMreO (5100) ar len�.
I cerlify Ihai in Ihe pedormance o� t�e work for which t�is permit is issued, I shall no� employ any person in any manner 3o as to Uecome
suUlecl to lhe Woikers' Compen5aiion Laws ol Calitornia. -
Date: S�gnawre:
NOTICE: I�. aliet making I�is aeClamlion, y0u shoNU b¢wme suDle�� �o lhe Wark¢rs' CompenSatiOn pmvi5ion5 of �he Labor
Cotle. you must lonhwil� com0ly wiih sucn D�ovisions or �his permi� shall 6e deemetl revokatl. .
CONSiNUC710N LENOING RGENCY: I nereby atfirm �nat inere is a cons�mction leneing agency lor the peAormance'ot tAe vrork for
wnicn Ihis permit is i<suetl (Seclion 3P37. Civ. C�. '
LENOEfl: �
AODflESS:
OWNEB 9UILOEB DECLANRTION: I Aere�y aifirm ihatlam exemptlmm lhe Caniractors' State License lawlortAe tollowinp reason
�Sec�ion 7031.5 Business ana Pm�essianal Code: Any city o� county which requires a Dermit Io conSlmci, alier, improve, tlemolish, or
repaii any s�mclure, pnor �o ils issuance. also requires �he apPlicant for suc� permil Io �ile a sipnetl Slatemeni IAai he/s�e is licensetl
Dursuant Io Ine O�ovisions of �ne Comracmrs' Sta�e License Law (Chapter 9(commencinp vn�� Seclion 7000) of �ivision 3 of �he Business
an0 Prolessions Cotle) or t�ai he/s�e is e+emp� I�erelmm antl lhe hasis �or lhe all¢ged exemption. Any violation of $ection 7031.5 by
any apP�icantlor a p¢rmi� 5ubjeci5 ihe appliWnl Io a civil penaliy of not mor¢ IAan live hunOreO Eollars (5500�.
I, as owner oi ihe pm0eny or my employees with waAes as iheir sole compensation, wiil do t�e work. anC ihe
I❑ stmcwre is not intenEeO or ofierea for sale (Secnon 70a4. Business anC Profeuional Coae: T�e Conlractors' Siate License Law
Ooes nol aODly to an owner af a property who hWltls or impmves t�ereon, anA who does suc� work him5ell/Aersel� or �hmuA�
�is o� �er wm em0�oyees, pmNtled I�at such impwvemenis are no� intenGeG or oifereA far ule. If, Iqwever the builtling or
imorovemeni is soltl vnlnin one year of complelion, the owner will have the buraen of D�aNnp he/sne eia not 6uilA or imDrove
lor ihe purpose of sale�.
I, as awner o� I�e D�operiy, am exclusively coniractinA ��� IicenseC comractors lo constmcuAe Omject (Section 7094, Business
❑ antl Pmleuions Code: T�e Contractor5' State License Law does nol apply to an owner ol pmceny who 6mIQt ar imD�aves ihefeon
and wM10 conVacls lor such prole«5 vnlA a conirac�oq5�license OurSuanito Ihe ConVaciors' Staie License Law�. I am aware
Ihal pmol ol �heir Worker'S Compen5aiion insurance SAONA be providetl Io me.
� I am ehemD� untler Seciion: 9. 8 P. C.
lor �his reason:
CITY OF COSTA MESA — BUILDING pERMIT PERM NO: E 06610G
PERMIT NO: E 066105 PLAN CHECK NO; A] GOVT: N SUPP: N
CONSTAUCTION TYPE; V—N PERMIT TYPE: ELE PURPOSE: ALT
JOB DESCRIPTION : ZNTERIOR ALTERATIONS & H.C. UPGRADE SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 /
COMMENTS: REF ; H-65180, EXTRA ELECT WOAK MORE THAN PERMITTED HY #E65182
***��r***x�**�r��tx��r***x*+e*�r�r*x�***�r�r�r�t*****�x-�*******�r****�r*****+�**�t*�r**�r�r�r+�*******�-
Z O N I N G R E Q U I R E M E N T S
s E T a a c x s
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN AGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ; PROV; PARCEL: 42502106 ZNE: REF NO:
PLANNING NOTES>
i ��
i� 1E iE fE iE if !f 1E 1F 1! iE 1f if i! iE k� 1E �E iE if iE �E if if ik if iE iE 1F 1f 1E if if iE iE iF 3E iE 1E iE iF if !F iF if ik if M ff 1E �F 3E iE 1f 1Elf if 1E -0f 1f iE {f 1f iFlf iE jf iF if iE iE if if if iE 1f if iE iE
D E V E L O P M E N T S• E�/�R V' Z C E S R E Q U I R E M E N T S
ZONING APPROVED BY _ __ L�ATE:
� ;��� � �Z �i rQf� �.•jSt1�_� �� ��i�
APPLICATION ISSUED BY;
iE it it ik 1t if iE it i4 iF jt k it if if iE!! M� i4 if iF fE��
�! iF 1E iE if 1f 1E iE fE if if iE ik k it 1F if iE if 1F iE if �f if iE iF iE iE 1F
LEGALIZATION:N
BLDG PMT MBING
PERMIT
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT
TOTALS----> 20,75
REVENUE DIVISION TOTALS—
BLDG PMT PLUMBING
f! iE iE 1f 1f'1F 1f ik i! i4 it ff iE iF 1E fE iE 1E if if� iE if it iF 1E iE k
I N D I V I
TYPE QTY
oaie: �"'"e0 EL E
I Oo here�y cenify I�at I am aware ol antl untlers�antl Ihe requiremems al California Health and Sa�ery Co4e Sec�ions 25505, 25533, and EL E
2557a and �hai I or any tmure Cuiiaing occupanl wilVwill noi (ciale one) neetl to compty wA� saitl staie coaes and ihe requiremenis lor a I EL E
permit lor cons�mction or motldication Imm me Air Ouahly Managemem Disirict. NesiOemial consimclian aoolications are eeemD� �mm EL E
I�ese pmvisions.
Oate: ApPlicanl:
I �er¢�y cetlJy I�ai I �ave read Ihis aDPlicalion anJ stat
orCinaMes and sla�e laws relaling lo Uuiltlmg cons�mction
piopetly forinspectivn purposes.
Oaie: Sipna�ure
Driver's License oi Social Securily a:
inlormatian is correti. I agr¢e to tampty wilh all city and Counry
arize represenwtives of �his ciry lo enter upon i�e a6ove-mentione0
1641�a6 Whne—�mltling�, Green—Cotle Enlorcemenl; Canary—Applicam; Pink—Revenue; GalCenmtl—Assessor
9
3
1
1
' DATE:
�����' DATE: Z I 1 I�l�
iF�3�3'3F�f�i� '�'iF3E3F�+F�F'iF�F'ir***��ri��f*i� +r*
���� !F fElf !E fF 1t 1E it if iE iE jE i! iE if �E �E 3E it iF 1f iE iE �E 1f iE if %1E fE iE i! if iE �f iE iF iE iE 7E iE jf if iF
E E S"U M M A R Y STRUCTURAL SEGMENT:N
ELECTRIC MECHANIC FIRE SMIP/RES GRADING
20.75
_ 503 SMIP/NON—RES
/ 15.00
5UE PLAN—CHECH TOTAL PAID DUE
.00 0,00 35.75 35.75 ,00
COLLECTED; 35.75 OVER/SHORT: 00
TRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
5.75
M if if iflf 1F i! 1E 1E 1E k 1E 1E iE if 1f 1k 1E fE if iklf iE 1E iE 1F 1E if if ff if 1f if 1E 1k 1f 1E?E #E!t if if iE jE iF 1E iE 1f ff 7f 7E
� U A L F E E B R E A K D O W N
D E S C R I P T I O N
FIXTURES LIGHTING 1 ST 20
RECEPT/O�]TLET 1 ST 20
RECEPT/SWITCH 1 ST 20
SUB—PANEL
END OF FEES
UNIT COST TOTAL COST
EA, .75 6,75
EA, .75 2,25
EA. .75 .75
11.00 11,00
ai notssbi�-aoiss6n -raT ss.�s
DATE: 02/17/94 TINE: 14:33
CONSTRUCTION AN� PLANIVING POOI PA
APPROVALS Permit �`. Date Inspector APPROVALS Permit #� _ Dace Inspector
1. Temporary Electncal Service or Pole . 52. Pool & Equipment Location "
2. Soi� Pipe�Undrgrnd. 53. Steei Reinforcement
3. Electrical Conduit Utility-U�drgrnd. 54. Forms
4. Electrical Conduit•Undrgrnd. 55. E�ectrical Bonding
5. Steel Rei�forceme�c 56. ftough Plumbing & Pressure 7esi
6. Electricai UFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8, Foundation � '� 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgmd. � � 60. Backwash Lines, P�Trap, � Undrgmd.
10. Structura� Floor System 67. APPROVAL TO DECK
11. Property Sewer Line & House Connectio� 62. Baekwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent�Final
73. Roof Drains 64. Plumbing System � Fina�
14. Rough Plumbing . 5. Electrical�Final
15. Rouyh Elecvical-Condurt � 66. lar SYstam•Final
16. '�ough Electric Wiring 2/�(`y � 67. FE icing & Access APProvai
17. Rough Wiring Sign 68. PROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOLJSPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
27. Duas, in Structure J0. Under9round Hydro
22. Oucts, Ventilating 77. Product Piping �Gas ❑Oii
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storaye Tank O Gas O Oil
25. floof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structural} & h4onocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding '� f� ED SYSTEM FINAL
29. Insulation 7�. FIRE PRE , NAL
30, Dryovall Nailing �IEALTH D�Pi REQUIREMENT
37. Plaster Brown Coat '4 FINAL�`�NSPECTION �
32. Electrical Power A9eterFinal � ��80. FOI. CERTIFICATE ISSUED
33 � inal Eleciric �� � ��� Notes: �
.s4. final Heatin9 & Air Conditioniny
35. Final Gas Pipe-Test
36. Hood or Canopy V
37. Final Faciory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gaz Service�Final
41. Solar pomestic-Final
42. Backflow Preventer �-��
43. 8ackflow Irrigation � ��
44. Landscape Irrigation System '
45. Sound Aitenuation --
46. Handicap Regulations „',-'
47. FINAL STRUCTURE & BUIIDING �
48. FINAL PIANNING .
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co '
51. CERTIPICATE OP OCCUPANCY
No. Date
�
.�
Pfl0.1EtT AODflE55: 3 9 O E 17 TH $T UNIT: �
OWNEfl'S NAME: �TOHNNY O' CONNER
nooxcss: 7 PO. BOX 1942 •
NEWPORT BEACH
CA, 92660 •
� AflCHIENGINEER: HRETT MARCHI REG.NO.: CLS2r+7
nooeess: 1 1 1 9 MAI N S T `, uxrt:
fiUNTINGTON BEACH CA 92648 ._
PEHMITTEE: G C CONSTRUTION ( 310 ) 929-0801
ADDNE55: ZEISLO ESTELLA
CERRITOS CA 90701
LICENSEO CONTBACTOB UECIABATION: I here�y aifirm Ihal I am licensea un0er Dmvisions at Chapter 9(commen[ing with Seclion
7000� of Division 3 0� �he Business an0 Professions COUe, antl iense is in iull lorce antl eifeci.
ci.r uc.: nTe uc.: 9 6 4 6 6` cu�� - �
Oa�e: � � Signamre� _. ��– �
WONNE ' COMPENSATION OECIANATION: I hereby allirm Inai I have a cenilica�e ol consenl m selt�insure or a certiliwi¢ af WoBeri
CamDensation �nsWance, a a mied wav mereoi (Section 7eoo. �ab. C�.� � � 1� 9 9
POLICY NO.: 1 V J J/ I�-7 J E%P. ORTE:
comraNr: STATE FUND --
] Certifiea copy is hereby IumisheA. '� CenifieA copy ' file witA t�e city B'' nsion.
� / 2-�,--rj� � �
Date: ApplicanP r� Y �
E%EMPTION FBOM WONRENS' COMPENSATION OECIANRTI :(i�is secUon neM not be comDleteO il �he permt is lor one hun4re0 (5f00) or IeSs).
� I ceriily that in t�e peilormance ol I�e work br w�ich I�is permi� is iSsueG. I shall noi employ any person in any manner w as lo Eecome
su�ie�� �o tne warkers' Comoensalion laws ol Califomia. .
Oate: Signamre:
NOTICE: II. a�ter making this tleclaration. you s�oultl Gecome 5u�leci Io Ih¢ Workers' Compensa�ion pmvisions OF�he LaDor '
CoOe. you musl lonhwitn comply wilh such Wovisions or ihis permit sAall �e �eemetl revoketl. �•
CONSTBOCTION LENOING AGENCY: I here0y aflirm t�at t�ere is a tonSimciion IenOinA agency lOr ihe p¢darmante Oi Ihe woB �or
wnich Ihis permii is issued (Section 3W7, Civ. C). � r��
LENUEfl: •" 1 '
aoueess:
OWNEB BUILDEB DECIANRTION: I hereby af�irm t�at 1 am ¢aemp� �mm t�e Conlrac�ors' Slate License Law�or ihe lollowing reasan
(Seclion 7031.5 Business and Fmlessional COUe: Fny ciry ol couniy which requires a De�mi� Io conslmc�, alter, improve; demolish, or
repair any stmclure. prior to iis issuance. also re0uires Ihe applicani lor suc� permit Ia lile a signed slatement thaC�tJshe is licensetl ,
Oursuant �o I�e O�ovisions o� ihe Conlractors' $tate LicenSe Law (Chapier 9(commencinp wt� Seclion 7000) ol Oivision 3 0l Ihe Busineu
anC Pmlessions Coae) or �hal he/5Ae is exempl t�erelmm anOlhe basis lor Ihe allegea exemption. Any violation oi Sec�ian 7031.5 Ey
any applicant for a O¢�mii subjec�s Ihe applican� to a civil penalry o� noi more ��an five �unEretl dollars (5500�.
I. as owner o� ihe D�operty or my employees wit� wages as ��eir sale compensation, will tlo Ne work, and I�e
❑ stmcmre is noi intenUeO o� offere0lor sale (Seclion 70a4, Busmess an0 Professional COJe: TAe Coniractors' S�ate License Law
tloe5 n01 apply to an ownel Oi a O�operty who builas or impmv¢SlM1ereon. antl who Oo¢s Suth work himSelV�ersell ar �hmuq�
his ot her own employees. Dmvided Ihat suc� impmvemenls are not inten0e0 or afleretl lor Sale. II, however ttle builtling or
improvemem is SOIE wilM1in one year ol compleiion, t�e ownei vnll have Ihe �uraen ol proving he/s�e dia nol hui10 or impmve
. lor Ihe purpose ai sale�.
I, as owner ot Ihe D�operty, am exclusivery conlraciing wi�� licensea conVactors m constmci IAe pmle�� l5ection 7044, Business
❑ an0 Pmlesvons CaAe: T�e Contractors' $lale Licenu Law Oces nol aDPN la an owner ol pmperry wtw bml0s or imprwes t�erean
and wno coniratls lor sucn D�oieds min a conVaclar(sllicense pursuanl to ine fAniraztars' State License Law),I am aware
Iha� pmol o� Iheir Workefs Compensa�ian insurance s�aultl �e pmviUeO to me.
� I am eeemp� un0er Section: B. 8 P. C.
ior mis reason:
Daie: Owner.
I do here0y cerlily ��at I am aware ol and unaerstantl Ine requiremen�s o� Cali�omia HeaIN antl Safety Cotle Seciions 255P5, 25533, antl
25534 antl ��at I or any fuiure builaing occu0anl will/will not �circle one) nee0lo comply wi�� said staie cotles antl Ihe reQuirements �or a
permit loi conslmclion or modilicaiion imm I�e Air Ouali�y Managemen� OiSlrici. PeSiGentul constm[Iion aDD�icaiions ar¢ exempt Imm
Inese provisians.
Oale: Ap0litanl:
I �ereby cerlily ihat I have rea0 i�i5 applicalion antl s�ate Ilwt t�¢ aLove inlormation is corre[L I agree lo campty wii� atl ciry anA couniy
artlinante5an051alelavSrelalinglobuiltlmgton5lmtlionanA�er¢ nzerepresenta�ivesolt�isarytoenterupont�eabove-mentionea
piopetly for inspection purposesQ. r %//�
I� Dale: ��/ ` Siynalure:._���/����/Y� R'i'--�—
oriver's license ar Sociai Sewriiy x:
I6db46 Whito-6uilding; Gieen—Cotiv Enlorcemenl: Canary—Appbcn^L Pink—Revenue; GolOenme—Assessor
� - ---=_� -
CITY OF COSTFS'�MESA — BUILDING PERMIT PERM NO; E 065181
PERMIT NO: E 065181 PLAN�CHECK NO: N GOVT: N SUPP: N
CONSTRUCTZON TYPE: V—N �PERMIT TYPE: ELE PURPOSE: ALT
JOB DESCRIPTION• : INTERIOR ALTERATION5�6 H.C. UPGRADE SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 /
COMMENTS: REF : B-65180 '
it iE iE iE 3E iE at �c iE iE iE �)f iP iE �M iE if �1R iM iE i4 iE if iE jE iF iE �If iE �1E �It iE �)F it1i: iE 3f 1E �E ih iF if if ic if it iE iE K if �7E 3E iE iF if af a: it� dc ic fF #�F+t # x>F 9c ac {f x� ic if �Y it iF 3F if �F
Z O N I N G R E Q U I R E M E N T 5
S E T B A C K S _
------------ MAZN BUILDING -------,'--- --------- ACCESSORY HUILDING ---------
FRNT; FT ZN 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: 42502106 ZNE: REF NO:
PLANNING NOTES> .
> �, '1
**������,�,�*,«�,«��,«*,�*�*,«*��,«*�,��,�*�*,��,«**��**��*�**����,�*,�,��*�«***,�*���**,�*��*��*
D E V E L O P M E N T S• F,�jR !V I C E S R E Q U I R E M E N T S
i, �
ZONING APPROVED BY
BOILDING APPAOVED BY : !
APPLICATION ISSUED HY: �
***�r*****it�tiEitit****�r*it�tiF'iF"iF'iF'�F';F ',
iE i! it 9! it if if iE iE iE iE iE iE i! if iE 14 if if iE iE if 9t iE 9F 1E if if iE if it if iE iF,�NF �M
LEGALIZATION:N F E �if�`:
BLDG PMT PL� "�BIN� � — ..�
PERMIT / �
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT
TOTALS----> 3.75
REVENUE DIVISION TOTALS-->
BLDG PMT PLUMBING EL
DATE;
DATE: r
�.��������������°*���*����/,�Y�
1f if 1f af ifiE if if �k iE if IF 1F if if �E ikaEiE if if jE M if if iE if if if iF iE 1f �f M�f if if if if �E iP if
S U M M A R Y STRUCTURAL SEGMENT:N
?C MECHANIC FIRE SMIP/RES GRADING
,�.50x
-l5.00
SSUE I�T "l—CIIECK
5.�^ ; 0.00
COLliECTED:
TRIC MECHANZC
18.75 _
SMIP/NON—RES
TOTAL PAID DUE
18.75 18.75 .00
18.75 OVER/SHORT: 00
FIRE SMIP/TOT GRADING PLAN—CHECK
�EitiflEiEit�EfEiFiEiFiEilkiEiE�kiEiEiEiEilititiEifiE� ifiFifiEif* iEififlf�fiEitjflEiffEtEifiEiEaE3E1EiEiljFifiticlfitiFlEifltifififitiEiEititlt%jfiP3fif
I N D I V I. U A_T, 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
ELE 3 FIXTURES, LIGHTING 1 ST 20 EA, ,75 2,25
ELE 1 RECEPT/OLITLET � 1 ST 20 EA. .75 .75
ELE 1 RECEPT/SWITCH 1 ST 20 EA. ,75 .75
END OF FEES
.�
O1 00251717-0�151715 TC�T 13J5
DATE: i?iC'sf93 T?I7E: '_1:D4
_
CONSTFUCTION ANO PI,ANNtNG
APPROVALS Permit-�r
i. Temporary Electriral Service qr Pole
2. Soil Pipe-Undr9md. . �
3. Electrical Conduit Ut�hty•Uridrgmd.
4. Electrical Conduit�Undrgind.
5. Steel Reinforcement
6. Elettrical UFER Grnd.
7. Footings �
8. Foundation
9. Water Pipe-Undrgrnd.
10. Struct�ral Floor Svstem �
i t, Property Sev.�er Line & House Connection
12. Sewer Cap '
13. Roof Orains
14. Rough Plumbing
7� � ��qh EVeci.'Ca�-Conduit .
16. Rough EIo' .riG Wiring �
il. Rough 4Viring Sign
18. Rough Electrita�-T Bar CeiDng
19. Rough Heating & Air Conditioning
26. Rough Factory Fireptace
21. Ductt, in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Siructurall & Monocoat
27. Frame and Flashing
28. tathing & Sidi�g
29. Insulation _
30. Orywall Nailing
37. Plaster Bro�vn Coat
� Electncal ?ower Mete�-F�nal
,3. F nal Electric �
� Final Heating & Air Contlitioning
35. Final Gas Pipe-Test
36. Hood or CanopY
37. Final Faaory Fireplace
38. Final Plumbing
39. LVater Service�Final
40. Gas Service-Final
41. Solar pomestic-Finai
42. Backflow Preventer
43. Hackflow irrigation
44. Landswpe Irripation System
45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
Date
�
POC SPA
Inspector qppROVALS Permit #
52. Pool & Equipment location
53. Steel Reinforcement
54. Fo•ms
55. Elec2rical8onding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNiTE
58. Eloctrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgmd., Test
60. Backwash Lines, P�Trap, L Undrgrnd.
67. APPROVAL TO DECK
62. Backwash & RecepturFir�al
63. Heater & Vent-Final
64. 'lumbing System � Final
65. Etectrical-Final
66. .'�lar System-Finui
�� 67. F:ncing & Access ApProval
F'. APPROVED FOR PLASTEflING
69. POOL/SPASYSTEMSFlNAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product P�ping :7 Gas � Oil
72. Underground Flusl+
73. Undergrnd. Stora9e Tank O Gas ❑ 0�1
74. Overhead Hydro
75. Dry Chemicai
76. Dry Standpipe
77. FIXED SYSTEM FINAL
7��.EpREV. FINAL
NEPR.Tii DEPT. REQUIREMENT
F�NAL
ICATEiSSUED
Date � Inspector
i
�
t
�
-� .� 35658
COSTq MESA BUILDING-SAFETY DEPARTMENT
•• P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
FvrApplicant ro Fi//in Completely
BUILDING � O ,� / 7�/ C• ry�.
ADDRES$ ��/
� E � uirr- A
OWNER G P
ADDRESS T� ��/ R / �
2 .
W W TEL./,, /
a U CITV Q ST J�Sf�, NO'(�/�y:
Z
conrsrRucnorv �?.�. AG . Q�
O N LENDER
J � BRANCH /� T� S �
J � /�
�� ADDRESS Li O� � l� S
ARCHIT�CT TEL.
� Q OR ENGI EER q� N
U N �
wa Ll/ r
Q AODRESS
aw C
JO CONTRACTOR a ` ! I�F.�.ZS/�%�C
wQ ADDRESS 3 C/(/CJ /{7 L.�T /
W TEL.
Z� CITV QS'�� �Q NO.
W � STATE '_ CITY
y� LIC. NO. t� LIC. NO.
� � SIZE� l NO.OF BlOGS.
OF LOT � Q �{ �CJ � NOW ON LOT
USE OF <
EXISTING BL�G. G�Gi �-ITJ C V�
���� C; �C�� �� i?,1`�„� i
!
r�o�+ 07 ��;� �'�
ADDRESS
OWN
FIRE
20NE
20N NO.OF
�'-L P�,� �
VARDS APPqOVED
MAIN BUILOING
(FROM C/L STFEET)
USE OF NE
BUILDING �
VARDS
BLOCK
��
Z NEW BLDG, «C U � �ROOMS `� STORIES l. SIDE v_ FT.
a EXTERIOp WALL FOOF
V COVERING !I COVERING R FT. FT.
J USE OF �UIIDING AND WOFK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
t VAR.# DATE
� �p -�-r��.� p c.u.P.# awaovEo
y. � � ^ ,P ' APPROVE ��
�
z
0 ST
UI hereby acknowled8e that I have reatl this aDP���ation and state
� that the above informetion iz correct antl apree io comply with
� ell laws repulating builtlinB co^struction, antl I shell not amplOy �
F any persq� in violaUon ot Ma workman's compensatlon laws ot
[he State of Celifom(a. m
y �-- W
Z1 hereby cerNfy inat I em proparly licensatl as a contrector under SQ. FT. o
Me State ot California Business antl Professions Cotle, Dlvisicn 3, THE AMOUNTSHOWN UNDER VAIVATION IS FOR
C�apter 9, antl that such licenses ere in tull forca antl effxt, or 1 THE PUFPOSE OF ESTABL6HING A PEFMR FEE ONLY: Q
am ezemOt from Me provisions of the State of Celifornla Buslness VALUATION
antl Professions Cotle, Division 3, Chapter 9. � � r
PERMR FEE $ ]
SiB�ature o � m
Parmittee �� A _ --�• $ ��Q PLpN CHECK $ �-- E
U �� �
LL
Autho�izqd Apent TOTAL FEE S