HomeMy WebLinkAbout3020 RED HILL AVE - Building PermitsCITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: Mll-00093
PERMIT TYPE MECH STATUS:
APN: 42708108 DATE ISSUED:
ISSUED BY:
JOB ADDRESS: 3020 RED HILL AV CM Suite/Unit:
Vicinity: ROOFTOP r
SQ. FT: 0
ISSUED
09/15/2011
MDM
SCOPE OF WORK: REMOVE EXISTING FAU, INSTALL NEW FAU, SAME SIZE, SAME WEIGHT, CURBIh
SAME, NO STRUCTURAL ALTERATIONS
PLAN CHECK FEE:
$0.00
OWNER: REDHILL-FISCHER BUSINESS
Address:
PARK Unit:NEWPORT BE/
PHONE:
City/State/Zip:
2 UPPER NEWPORT PLAZA
APPLICANT: TIM LEATHERBY'
Address:
Unit:
PHONE: 909-327.6431
City/State/zZfp:
Final Fire Prevention
CONTRACTOR: SORENSEN AIR
Address: 847 CARLSON DRIVEUnit:
City/State: BREA, CA ZipCode: 92821
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE:
$52.00
PLAN CHECK FEE:
$0.00
INVESTIGATION FEE:
$0.00
REINSPECTION FEE:
$0.00
TOTAL FEES: $52.00
License No. 585274
PHONE: (714) 719-1579
CELL:
11 ; THE
,.4
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
,required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE 9. INSPECTION TYPE DATE INPPALS CODE INSPECTION TYPE DATE INTMALS
1616
Fixed System Final Fire Prevention
206
Final Mechanical X 7•.29• �� ��
1266
Pool Spa Final
208
Final Plumbing
200
Final Re -Roof
210
Final Electrical
201
Final Block/Re.taining Wall
212
Final Fire Prevention
202
Final Factory Fire Place
220
Final Planning Approval
t,
203
Final Sign
222
Final Site
204
Final Demolition
250
Final Building/Occupancy
X
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2--1 have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: `
Carrier: eA o
(This sedan need nal be completed ifthe permit is valued a1 one hundred Collars (5100) or less)
Policy Number:
'0 1 certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwitp comply with these provisions.
nature
Applicant's SigDate
+ r
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND OWIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR jN SECTION 3706 OF THE LABOR CODE. INTEREST, AND
ATTORNEY'S FEES.
/- LICENSED CONTRACTORS DECLARATION:
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license`is in full force and effect.
Lic. u 5a a if -R O
/S-//
ontractor's Signature Date
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Address:
Signature
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not appy to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature Date
3057-46(3107)
Owner ID verified by driver s license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property lax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2. Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicant's Signature
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Cotle, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District of from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (if "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
X/ Signature Date
\CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature of Legal Owner(s) Date
And/or Authorized Arai Date
y
i
M
AgonEss op sunoDn: 3020 RED HILL �Av
GwxEasNAMeglDlowx:REDHILL—FISCHER -BUSINESS
ADDRm- 2 UPPERNEWPORT PLAZA DR
N.B.
752-2100
APPL. MAKING ADDRESS:
ARCI1tfECT 011 ENNfLNEE/h.
MICN.OR EN4'S ADDRESS:
UNIT:
UNIT:
cwrR*:TwsN -DONALD STEWART (909)371-3633
Ca T11WID1rs MNUNO 312 W 6TH ST
AwREss:CORONA CA ucao_ 406096
91720 UNIT:
LICENSED CONTRACTORS DECLARATION: I hmeby affirm under penelty of perjury that I sm Ioeraed under prwid«n of Chapter 9
(oemmondrM edh Section 70DO) of Oivoion S of Ne &ureas W Professions Code. end my Dose is in IW 1«a and effect.
CITY LIC. ND, XLIC.CLASS:C 10 uc.No.: 406096 EXP
/�//•
Dere: ( _/ ^ ( !/ Conneaor. 6/J
OWNER BUILDER DECLARATION: I hereby elfirm under peoslY of promy met 1 am attempt firm, IM C«Nrapon License law f« the
lolk w reason (Serbs 7051.5 Busher, end Professions Code: Any city «county Asan re uime a perms to crosmuct, Mer, improve,
'emolch, .,-P& any sevdun, prior to its Issuance, elso require the applimnl ler such lams Io fib a signed stm menl that he or she
licemed punumul to the prwit ons of this C«mect«s Lienee law (Chapter 9 (co nmenckq vdth Sefdorl 7000) d Ohmoon 5 of the
.usinee and Professions Code( or that he or she is exempt thanahgn end the Mab 1« the alteged exemption. My volalion d Section
7051.5 by any Vplirant for a permit subjects the Wplicenl to a civil pronely of not more then five hundred dollen (S D.
I, a owner of the properly or my sevoyese wlh wegas as invest sols compmemon. sill do the vvodc, And Na stnMum is; no, intended
to offered for safe (Section 7044, Business end Professions Code: The Contractors License Lew doe not ep*to m own«d prtpeM
who beside or improes thereon. mrd este does such wok Nmseff or herself «duorgh her m her, own employees. «goad they such
imprwmnelas se ms intended or Merest for cels. it, however, the building «knpmmrnrM is sold wlhin ons yese of mmplelon. the
owror-builder will have the burden of proving he or she did rel Mild or imprae for the purpose of els).
1, u oxeye d the properly. sm esdusrvaly conmessiq with le ereed mnvadars m comnuct tlu proleC (Section 7044. Business; and
Proses a Code: The Contractors License law does not apply m sn . d propend who builds or im«ea IMnm and who
oommuse or smh projects "m a comrad e(.) licensed imsuem to IM Cwhassos liars Law).
I am exempt under Section: B. A P.C., for this ressm:
Dme: Owner:
I do hereby coaly dd I se aware of and urdaneuud the mquimmerym of Ca mnie Ileekh and Beefy Code Sessions 85505.15550, and
15.SSs, end dor I or my haus W ldoq omgent still /wit not (ends am) need W comply with said state codes and th.g101emme he
a pemm to donemoton te recd'didalim from [he mupmtwp Comes. ResoWiel a«dnefim appimtoe en esampt from dms
provieWa.
Date: Applicam:
WORKER'S COMPENSATION DECLARATION: I hereby elfin. under ppMy d perjury ora of Ne fcDOwhq de Nandi s:
0 I Mva and ail moisten..W". d aoroml io seff4 sm fur w«kans oompenelon, a provlded f« by Section 0700 d 144 Lab«
code. l« Ihs pedomdma d the emelt he which this panni Is isund.
I hew end wits theinter a ht Issued.
My emion insumme, a rpuired by Section 5 and
othe Lebon Coda. b the pedormema d the
who 1« eAidn tlds pwdt u Iseuod. MY workers' compensmon vuamanme owner end policy number ere:
Corder:
Policy Number.
61session rood nor os, corm�let�O s the permit u b are hundred dole. (.stool «be./
1 coaly thin in Ne ped0rmama of the work for which this peneh to issued. I ehdl rho employ an, person In Any memmr so m to
become wbject to the ewka.' oompenediion Is d Ctr!o s, pre that s I should becomes s to the wwkars'
compensation pmdeiom d Section 57W d the labor Code. I shdl/fye�/MAS,^�"h c *with t
Waming: FeNurs 0 swum.*m" eonLpweltym covmege Is unlemNl, aMahell s ]Pot on smployw to c 1W.1 pmsld. end
c/rll firms w m ore hundred thouserM dols. (1100,000A to A00/11en to the cwt o/ oemoxwtoM damages a prerldM or In
Section 0705 of m. LMor Cods, Intens 1, and amont.0 I.
CONSTRUCTION LENDiNG AGENCY: I Mnaby affins under Penalty of peifey that Inde, ls e coauudum Wiling party W Ne
pedarmmnm of IM wok for wfiidt th. Perms M Issuod (Section 5097, Civ. C).
LENDER'S NAME:
LENDER'S ADDRESS:
1 cenilythat 1 hove mad Oda 40icadon end more lines Ne eW,re sto esum o canes. I agree to comply efth Mary and county ord'vdm
end We ism misting to Wldim construction and hereby admr o, Rpeeeramive of Iles dry o amu upon the ebarcnantioead Proporty
for imp%aaiongnsrpposee DONALD STEWART
4 lr_/ Does:
Sure d ApenVAppkmn tract«
(51514 .wP) WhisAdldiq A Betery: Gmsr�: Ceney_Appicent: Pink-Rmanue: Gddaood-Naevor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: E 086715 PLAN CHECK'NO: N
CONSTRUCTION TYPE: PERMIT TYPE: ELE
JOB DESCRIPTION NEW SERVICE, MISC ELECT WORK
CLAIM VALUE: CALC—VALUE:
COMMENTS: NO BUILDING PERMIT ON FILE, NO OTHER WORK AU
Z O N I N G R E Q U I R E M E N
S E T B A C K S
E7
PERM NO: E 086715
GOVT: N SUPP: N
PURPOSE: ALT
SQ FT:
GROUP OCL hwQ /
S
------------ MAIN BUILDING ----------
F E=E,'i S U M M
---------
ACCE O
'
FRNT: FT IN REAR:
FT IN
FRNT:
FT I
LEFT: FT IN RGHT:
FT IN
LEFT:
FT
PARKING REQ: PROV:
PARCEL:
42708418
ZNE:
PLANNING NOTES>
50%
SMIP/NON—RES'
>
iF dE dE di iE ilk iE df dF SE tf dF lE dE iE iE**lE dE dF iP iE ib iE ih dE i(dE SE if*iE if jiE)E ik if dE iE 9E �k )E iF iE iE 9E iE dE
iE *i6 iE iE 3E -)F 1t
D E V E L O P M E N T
S ,E R V I
C E S R
E Q U I
ZONING APPROVED BY
•� �'
BUILDING—DIV—>
PERMIT ISSUE PLAN—CHECK
BUILDING APPROVED BY =
APPLICATION ISSUED BY-
i! dE iF dh iE dE iE df sE * * dE lE sE * * * iE dF lF 1E ifiFis�'isiFi
BY THIS PERM
!lT11VV---------
FT IN
FT IN
REF NO:
iF if iF dE 1! sE iF iE iE * dE * * dE iE 3(-iE is sE iE
�t E M E N T S
I DATE: r
DATE: /
DATE:
if if if if iF iFif if 3E �E
LEGALIZATION:N
F E=E,'i S U M M
A R Y STRUCTURAL
SEGMENT:N
l
.�u
BLDG
PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/RES
GRADING
PERMIT
157.25
*
50%
SMIP/NON—RES'
PLAN
ISSUE FEE
22.00
BUILDING—DIV—>
PERMIT ISSUE PLAN—CHECK
TOTAL PAID
:'DUE
TOTALS ---- >
157.25 22.00 0.00
179.25 179.25
1x.00
REVENUE DIVISION TOTALS--> COLLECTED:
179.25 OVER/SHORT:
.00
BLDG PMT
PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING
PLAN—CHECK
179.25
•,i
it lE iE if it 1f )E ii iE 1E iE dE * iE iE
sE s(-* * iE * ih sF %iE Sf iE tk iE ie iF ih ff iE * sF * sf sE tE iE * iE iE 3E
* iE sE if iF sE 3E iE 9E iE ik Ik i(-iE ih iE iE sE iE iE iE �E iP iE
dE if it dE i(!f sE 1E iE dF
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
ELE 1
SERVICES BELOW 600 V & BELOW
201 AMP 27.25
27.25
ELE 2
MISC APPARATUS NOT LISTED REQ
PERMIT 16.25
32.50
ELE 3
MISC CONDUCTOR NOT LISTED REQ
PERMIT 16.25
48.75
ELE 3
MISC CONDUIT NOT LISTED REQ
PERMIT 16.25
48.75
END OF FEES
81-23-1998/88:59 8N/S179.25
RCPT8:81-8818612
PERNIT:686715
- :.,
CONSTRUCTION AND PLANNING
APPROVALS Permit # Date
-
Inspector
POOH - SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
r
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
-
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement -
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
-
58. Electrical Conduit-Undrgrnd,
i
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final '
13. Roof Drains
64, Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 00il
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
_
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown.Coat.
7 FINAL INSPECTION
32. Electrical Power Meter -Final
2e
80. FOOD CERTIFICATE ISSUED
otes:
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
.
36.' Hood or Canopy
-
37. Final Factory Fireplace
38. Final Plumbing -
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic-Fi 1`
42. Backflow Preventer 1
43, Backflow Irrigation
44. Landscape Irrigation System rl
45. Sound Attenuation r
a r
ly
46. Handicap Re' dations
47. FINAL STRUCTURE&BUILDING
48. FINAL. PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
COSTA MESA BUILDING—SAFETY DEPARTMEN1 r "ails
P.O. BOX 1200
Costa Mesa, Coliforms
ALL'
ML 25-76P—;�:Q078G5 u�•� �'�Z3.�0
ELECTRICIAN DUANE ELECTRIC INC
TRACT NO. MIN) RECD BY
LOT NO.
DATE ISSUED
BUILDING USE
ADDRESS 2740 F SPRING STREET
Cm LONG BEACH; CA TEL. NO.
STATE LICENSE NO. 2 2 117 5 CLASS.C-10
BUILDING 0AO /'J
ADDRESS L K
CITU LICENSE NO. AfjRF
NO.
ITEM
EACH
FEES
COSTA MESA, CALIFORNIA
Dwelling, Sq. Ff.
$
NEAREST
CROSS ST. fl V
Garage, Sq. Ft.
�r w
OWNER �GlLll4f4'
First 20 Outlets, each
MAIL
ADDRESS p/'G 1 '
Outlets, Additional
CITY TEL NO.
First 20 Fixtures, each
I HEREBY`ACKNOWIEDGE THAT I HAVE READ THIS APPLI.
unoN AND,, THAT THE ABOVE I$ CORRECT AND AGREE
TOACOMPLY)WITH ALL CITY ORDINANCES AND STATE LAWS REG.
.ULATING ELECTRICAL WIRING.
1\\ �-I CERTIFY THAT I POSSESS THE ABOVE VALID STATE OF
CALIFORNIA CLASSIFICATION OR 1 AM THE LEGAL OWNER OF
THE SINGLE FAMILY RESIDENTIAL PROPERTY DESCRIBED ABOVE.
'
Signature of
PERMITTEE s'
Fixtures, Additional
Dryer
...�
Fan
—�
q
,A e
Hooter
,R
Oven, Domestic
�'C
NO.
ITEM
EACH
FEES
1
Pole, Construction
`U
Sign 6 1 Trans.
2.00
Range, Domestic(
Transformers
KW
Misc �(
Generators
KW
Motors (See Schedule)
3
!a- HP
2
HP
Sub -Total Fees
I
S HIP
APPROVALS
/Meters,
aa. A
d 1pD
INSPECTOR DATE
TEMP. POLE
Permit Fee
3
00
UNDERGROUND CONDUIT
ROUGHSub-Total
Fees
FIXTURES
POWER
UTILITY CO. NOTIFIED
Total Fees
23
FINAL
CMF 0313-46, rev. 7p5 For items not listed refer to Fee SchedbJe BLDG. PERMIT NO. /Yom/
1111s—
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0
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0
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2
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COSTA MESA BUILDINa—SAFETY DEPARTMENT
P.O. BOX 1200
Costa Mesa, Callfomla
Rig.,11111imTRACT
ELECTRICIAN lAfC—
NO.
LOT NO.
RECD BY
�Et6XRrrte e/
DATE ISSUED
ADDRESS.Q c /'F.�%.f�
BUILDING USE
CITU L041'6 dj5-40 f TEL. (o
STATE LICENSE NO. J_//7 CLASS. CO
BUILDING 240go
ADDRESS / L%
CITY LICENSE NO.
NO.
ITEM
EACH
HU
COSTA MESA, CALIFORNIA
Dwelling, Sq. Ft.
$
NEAREST
CROSS Si.
Garage, Sq. Ft.
OWNER
I
first 20 Outlets, each
,
l
MAIL
ADDRESS
Outlets, Additional
CITY �q���� TEL. NO,
first 20 Fistures, oath
I HERB KNOWLEDGE THAT 1 HAVE READ THIS APPLI.
CATION _,DjLtATF THAT THE ABOVE IS CORRECT AND AGREE
TpA0MPL)F,%A1TH ALL CITY ORDINANCES AND STATE LAWS REG-
VLLATING ELECTRICAL WIRING.
yl CERTIFY THAT 1 POSSESS THE ABOVE VALID STATE OF
,CALIFORNIA CLASSIFICATION OR I AM THE LEGAL OWNER OF
THE SINGLE FAMILY RESIDENTIAL PROPERTY DESCRIBED ABOVE.
Signature of (�J�/
PE0.M11TEE 4 '-'*/
fixtures, Additional
Dryer
Fon
q
Heater
�
Oven, Domestic
NO.
ITEM
EACH
FEET
Pole, Construction
Sign & I Trans.
2.00
Ronge, Dome rc
Transformers
KW
Mi$C.
GeMrators
KW
2
//��
Motors (Sae SchedvI4/ .
HP
HP
Sub -Total Fees
HP
APPROVALS
Motors, sa.
"INSPECTOE I DATE
TEMP. POLE
Permit Fee
3
00
UNDERGROUND CONDUIT
ROUGH
Sub -Total Fees
FIXTURES
POWER
Total Fees
UTILITY CO. NOTIFIED _
FINAL J I�r �j t/7
CMF 0313-46, re V. 7/75
For items not listed refer to Fee Schedule BLDG. PERMIT NO.