HomeMy WebLinkAbout885 BEAR ST - Building PermitsUWIVCK STATE-WIDE Develo�rs� Eac. uAie. 4-28-76
JOB ADDRESS AAS a..o,. r,.vatr BUIIDING PERMIT N0. i,i �au
soi� VyG —
GAS
WATER
ROUGH PLUMBING
PROP. $WR. LINE Q HOUSE CON. ��
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH NEATING AND RIR CONDITIONING
TEMPONARV SERVICE 0Ii POLE
UNOERGROUND � POWER �
ROUGH WIFING
TRENCHES FORMS STEEL RE
FLOOF SVSTEM '
BONO BEAM n STEEL REINFORCE [
SHEATMING
FRAME ANO FLRSNING
LATHING - IN ��OUT �
PLASTER,BROWN COAT
STFUCTURAL, FINAL
HEATING. VENT.. REFRIG. ANO A.C.. FI
EZONE VALUE
�YPE p GROUf
SUBCONTRACTOR
� _ CITY OF COSTA MESA �
° BUILpING DIVISION //
� _ � DEVELOPMENT SERVICES DEPARTMENT M98-00185 ✓
�• PERMIT PERMIT NUMBER
��
(714) 754•5273 • Fax (714) 754-4856 MECHANICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suita No
Vicinity:
885 BEAR CREEK
ParcelNunmber: 93506080
Applicant: GREER, JASON
Address:
owner. PHILLIPS, ELIZABETH J
Address: %GRANT, ANTHONY J -
COSTA MESA,CA , '� -
885 BEAR CREEK
Contrector. PACIFIC AIR COMFORT
Address: 01327 S�LEWIS
ANAHEIM CA
ArehlEng:
Address:
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt Cooling/Heat
Inst I Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhausl
VAV BOx
Vent Fan I Single Dud
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < t0000dm
Air Handlers > 70000dm
Floor Furnace
Floor or Suspend Heater
Phone:
Zip:
SWtus: ISSUED �,(„�
Applied: 05122/1998
Issued: OS/22/7998
Phone:
Zip: 92626
• Phone: 937-1333 ��
Zip: � . 92807
_ License[500236
Phone:
Zip:
License:
SCOPE OF PERMIT , ",
INSTALLATION OF A HVAC UNIT AND ELEC.. MOTOR FOR THE UNIT.
$22.00
$13.25
$0.00
$0.00
$0.00
513.25
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
50.00
$0.00
Quantity
0
0
1
0
0.
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY �
Repair / All Absorbtion Unit
Repair / Alt Refngeration Unit
Ventillation System
Evaporative Cooler
Commercia l Incinerator
Domestic Incinerator '
Compressors / Absorption Systems
Upto3hp/t00kBTU
��3To15hp/500k�BTU .
15 To 30 hp I 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp I Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
-15 to 30 hp �
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Quantity
50.00 0
$0.00 0
so.00 0
50.00 0
E0.00 0
50.00 0
E0.00 0
80.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
$0.00
$0.00
$0.00
E48.50
EXPIRATION: This permit shall automaticalty expire and become void if work is not commenced withfn 180 days, or if work is suspended or abandoned
lor a period of 180 days.
INSPECTIONS: In order for the work authorized urWer this pertnit to ba considered legal, such work must comply with ell epplicable codes, and all
requlred inepeetlone end final epproval must be obtained. Failure to obtain Inspections and final epproval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545828
WORKERS' COMPENSA710N DEClARA710.,. "
I hereby eHirtn untler penalry oi peQury one of t�e following OedereUons:
❑ I heve entl wlll malntain e ceNficete of cansent to setl-Insure for workers' compensetlon, es provided far by sectlon 3700 of the Lebor Cotle, tor Me pedormence of ttie
vrork tor which Uis pertnll is issued.
p I heve erW will mainfeln workero' oorripensatim 4twrerke. aa required 6y sectirn 3700 of Ne LeUor Code. for the peAwmence ot tha work for whlch thLa pemtit Is Ls.wed.
My xrorkers' campensation Insurence certier end poliry number ere:
Certier: Policy Number.
(Th/s secNon need not be �npleted7! tlie permifls valued et me �untlred dollers ($100) or Iess.J
❑ I cenity that In Ihe pertarmance af tha work tor which ihis permlt Is issueA, 1 shell not employ any peraon In eny menner so es to hecome sub�ect to I�e workers'
compensetlon lews ol Cellfoml and e9ree thet i1 I should become sub�ect to Ihe workers' compensetion provislons ol Sectlon 3700 of Ipe Lebor CaAe, I s�ell lorthwlth
Comply wlth Ihese provisions. I �j �^7
Appllcem Signeture: .. l� Date: Y�� zZ / b
WARNINO:FNLURE REWIXiKERS'COMPENS4TONCOVEMQEISUNLAWFULPNDSMAl1SUBlECfANEMPLOVERTOCRIMIWLLPENALTIESANDCMLFlNESUPTOONEINNDHED
TTKK1ShND Dd.LARE 100.00�. IN ADDRION TO THE 00ST OF NAIPENSRTION, DAA1hGES AS PROJIDED FOH IN SEC(ION 3]OB OF THE L480R ODDE. IMEREST, AND ATTORNEYS FEES.
LICENSED COHTAACTORS DECLARATON:
1 hereby efllrtn Ihet I am Iicensed under provislans of Chapter 9(commendng wit� Sectlon 7000) of DNLalan 3 af the Business enE Professlons Cotla, entl my Iicense is in IuU
lorce end ettect. Llc. p Cleu p
Conlrectors Signature: y�. Date:� �� ZZ'
CONSTRUCTION LENDINO AGENCV:
❑ I hereby effirm t�et ihere Is e canslructian lentling egency for ihe pertortnente oi the work lor which thls pertnit is Issued. (Sec. 3097, qNl Cotlej.
Lentlefs Neme: Lendefs Atltlress:
Signeture: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby efllrtn thet under penelry of per�ury Ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the tollawing reeson (Sec. 7031.5, Buslness entl Professions
Catle: Any ciry or counry which requlres e pertnit to construd, elter, Imprwe, Aemdish, or repeir eny structure, prlor to i�s Issuance, also requires the eppllcant lor such permit
to flle e signetl statemeM Ihet he or she is Ilcensetl pursuent lo ihe provlsions of the Contrectors LJcense Lew (Chepter 9(commencing w0h SecUon 7000) ot DlNslon 3 of the
Business end Professions Cotle) or t�at he or she is exempt Iheretrom and Ihe basis for the elleged esemption. Any vloletlon ol Section 7031.5 by any epplicant lor e pertnit
sub�ects Ihe eppliwnt to e clvll penalry o1 not more Man five hundred dallers ($500).):
❑ I, es owner of the properry, or my employees with weges es Iheir sde wmpenutlon, WILL DO TT1E WORK, end the siructure Is not interbed or oftere0 for sele (Sec.
7044, Business entl Professlons Catle: The Coniradars License Lew tloes nat appty to en awner o1 properry who bullds or imprwes Nereon, and who tloas such wwk
himseli or herself or through his or her own employees, provitletl that suU improvements are not Intendetl or otteretl for sele. If, �owever, the bulltling or Improvement Is
sold within one year oi completion, Ne owner-builder will have tfie hurden ot proving ihat he or she tlid not buila or improve for purpose af sale.).
❑ 1, es owner ai Ihe property, em EXCLUSIVELY CONTRACTING WfTH LICENSED CONfRACTOR3 lo construd Ne project (Sec. 7044, Business and Professions
Code: The conirac[ors License Lew does not apDN �o en owner ot properry who builtls or Impmves iherean, end who wntreds for such prqecl wlih e conirector(s)
Iicensa pursuant to the Contraclors License Laws.).
❑ I am exempt untler sec. Buslness anC Professions COOa for this reeson:
SigneWre: Date:
Owner ID verified by drivels license. ❑ Yes ❑ No Drivels License No.
Verlflcation af Ownership by (ry0e oi Aocument, i.e. - propery lex bill ar deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CEHTIFICATON:
Eapires:
❑ I hereby ceNty iha� no excavetlon tive (5) or more teel in depth into whiU e persan Ls reqWretl ro tlescentl, wi11 be matla In connecUon wlth work euVroAzetl �y this
pertnit, end Ihat no bulltling sWcture, scaHdding, taLvewoAc, or tlemditbn or dLsmantling Uereof, will be more lhen Ihlrty-slx (36) feet high. (Chep. 32. Grp 2, An 2, Sec.
341, 71t1e e, Calltamle AdminlsVeWe Coae).
❑ As owner-bulltler, I wlll not emp�oy flnyone to do work whicli would require e pertnit Irom Ne Dlvislon of Industriel Seiery, es notetl ebove, unless suU person has e
permil to do wch work irom t�e tlivision.
Sipneture: Dete:
DlWsion of Intlusidal Sefety Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTAV: I certity under penalry ot perjury thet I heva reatl this eppllcation and state that the Intortnatlon given is
correct. I egree to comply with all siete laws and Gty ordlnances releting to building construction, end euthorize representetive9 of Ihe Ciry ot Coste Mese to enter upon the
ebove-describetl properry for inspectlon purposes. I epree not to occupy ar ellow occupency ot eny buildinp euthorized by Ihis permlt until �inal InspeIXim.
COOE 1. INSPECTIONTYVE
1816 Fxetl System Finel Fire Prevenlion
1288 Pool Spa Final
200 Finel Re-Foo1
201 Finel BIocWRetelning Well
202 Finel FeCtory Flre Plece
203 FInalSipn
204 Flnel Demolltlon
2Me�e
� S-zz ''�
��$ yQpfj MSVECTONTYPE
208 Flnel Mechenlcal
20B Final Plumbing �.
210 Final Electdcal
212
220
222
250
Final Flre�Preventlon
Flnel Plenninp Approvel
Final Site
Flnal BuilAing/OccuDency
/.11 [I'11111IR
• � � \ l
AOPficant to /i�l in all spaces except those wtihin neavy eoraer Iinos antl slgn all aooroo��ate aeclarations.
CITY OF COSTA MpESA OCONS�RUC�TIOjV�PERMIT. - PERM17 NO. TRACT NO. LOT NO. UNIT NO.
Project Address g(7 S+�L�.a! i EI7� 5
Applicant's Mailin(y�Lq ddress � e��'
Owner's Name J` eJ� Phone
Addreu -da'^p- . ..
Arch/Eng. Licerise No.
Address
Contractor's Nam ��n ,,,���yyy�����I��� V`^` � hone �
Addreu (mailing) � � �
City License Na 473�
LICENSED CONTRACTOR DECLARATION
I-nereby�aHirm Ihat I am Iicensetl untler provisions of Cnarter 9(commencin9
with sec[lon 7000) of Division 3 ot the Business antl Protessions Coae, antl
my Iicense is in full �oryr�anG etfect. /��U�..�'
-W�ORKERS' COMVENSATION DECLARATION - �
I hereUy atfi�m that I �ave a certificate ot <On5¢n[ to selhinsu�e o� a certlficale
of Workers'- Compen55tiOn Insu�ance, o� a cer'fietl cOP thereo/ (Section_
3800, Lab. C.) c�
cy No. � +�'��� � ComDany
�Certi(ietl copy is he�eby fur�iShGC.
Ceriifigtl copy is fileU wN� the ciry B�1Q in9 Divizion
Oate ( �(� APO���dnt ////
E%EMPTION FROM WORKERS'.COMPENSATION DECLARATIO
(Tbis section neetl mt be completetl If the permit is for one huntlretl (EI00) or
less).
1 certify that in Ihe Oe�formdnce o! the wo�k (or whith thi5 pqmR i5ls5ueQ I
snau nn[ emoiov anv oerzon in anv manner so as to bamT� subiect lo tha
worker �mo�en�j tlon ldws o( Califor . /
Dale �%�!�,�_519nature �
NOTICE: H, after making tnis tleUaratfon, you sboWtl bacome s'¢ to the
Workars' Compensation provisions ot the Labor Cotla, you mus or[hwith
tompty witM1 sucn provisions or [hls parmlt 5ha11 be tleemetl revoketl.
CONSTRUCTION'LENDING�AGENCV
I hereDy aHlrm tnat lh<re iz a construction lantling dguncy iOr Iha performdnce
of tha work (or wnicn,cN��ermit is Issuatl (Sectlon 309] Civ. C.)
L�ntler's Name � � �
Lentler'S AOtl�e55
OWNER BUILDER D CL RATION- �
I harCby affirm thdt I am ezempt irom thn ConlrattOr'S License Law for Ine
following reason (Section 7031.5 BuSiness antl Protusslonal Cotle: Any city or
ounly which reqWres a permit to construct, altar, Improva, aemolisn or. repair
�y slructura, prior to its issuanca, also requiras the applicant for such pormit
,.o fiio a� signetl statamont that he/sho is Ilcensad pursuant to Ue provislons of
the Contractor'S License Law (Chapler.9 (COmmencing wlth Soctlon 7000) ot
"Division 3 oi the Business antl ProtesSions Coeo) or thal hp/Sitc Is exampt
therefrom antl the basi5 for tho allegetl oxemptlon. Any violatlon of Se<tlon
7031.5 by any apP��Gant for a p¢rTil sub)etti tho applicant tO.a civll
�enalty o( not more than five huntlretl tlollars (E500). -
I, as owner of iho property or my employces with wa9es as thelr 5010
tompensation, will tlo lha work, antl [ha structure is not intantletl or offeretl
for sale (Settlon 7044, Businass antl Prole551ona1 CoUa Tho Con[ractor'S
U<Cnse l.aw tloe5 nol apply [O an ownCr 01 a proparty who bulltls or Improves
tnereon, antl who tloes such work himscll/nersalt or throu9n his on c�r own
employecs, proWaetl tnat such imptovaments aro not In[entlotl or ofieretl for
selu. If, noweveq tha builtlln9 cr Improvoment is soltl wi[�in ono yoar of com-
pletion, Iho owne� wlll havn thc burtlan ol O�ovin9 hC/s�e tlitl nOl builtl or IT-
��ova far Ihe Ourposo of SdIC�.
1, asowne� of�the prop¢rty, am excluslvery <onlractlng with Ilcan50tl cOn-
[raclars to conztrucl Ihn proJec[ (SeCtiOn 7044, BuSiness an0 P�oteSsiOns Cotla: •
Tho Conlractor's LitenSe L�w does nOt dpP1Y to.dn Owne! OI ploporty wh0
builtls or Improves Ihareon, antl who conlydGts lo� such projecl5 with a com
bacror(s Iicense pursuant'to tbe�Contractor's �icense Law). I am awara lhat
prOOf O� Iheir WOrker's Compansation InsuranG¢ zhoultl ba prOvitlatl to me.
❑ 1 am exemo� untler Section—/-/'�— B. & P. C. for this reason
///�U. '
Date
Si9nature %v
Drivers' License or 55 �
owner
ve reatl
a
tate that the abova
tl tounty ortlinante5
fby authOrize r¢p�e-
IOnetl p�ope�ty ta�
Date�
(J I i0�� '
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR -
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,.�6
DESCRIPTION OF WORK/USE OF BLDG. �
� S Main 8uilding:
E
TVPEOFPERMIT GRADIN FOUNDATION STRVCTURAL �' T Ffon[
❑ TENANT ❑ ELECTRICAI. PLUMBING ❑ MEGHANICAL A Reer
i �
Q OTHER
PRQIEC7DESCRIPTION S�.F7. OCCVPANCv C Right
K Leh
CONSTRVCTIONTYPE VALUATIONS S
ZONE GRADING CU. VDS. ACRES Ping. Re(.'/�
Remarks: _ , Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtuhs
Clarifiers
Dishvrasher '
Drinking Fountains
Floor Drains �
Floor Sinks' �
Gas Service Outlets
Interceptors � - '
Kitchen Sink -
Lavatories � „ •
P-Trap
Roof Dreins -
Reinspection Fea � $15
Duci � Under Ground
Duct - Structural
Ouct - Ventilating • .
ExhaustSyscem � MWtiple
Firepl/Fact. Blt. ICBO,$
Heating System & Ducting
�0.100,000 BTU � 100,000
Reinspaction Fee � $75
CMF 0865-46, �ev. 4/84 W�ite - Builtling; Canary - Applicanl: Pink - Accoun[in9; Goltlenrotl - ASsesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
$olar Collectors .
Salar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Watef Closet
Water Heater
Weter Service
� laue Fea
Hood or Type I O
Canopy Type 11 ❑
Refrigeration System
❑0.100,000 BTU ❑ 100,000 BT
System Repair/Alteration
Iswe Fee
FEES
$ 3
S 3
Automatic Washer '
Construction BoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
O utiets
Switches, �
Gnrbage Disposal
Generator O0.5 KW C
5
5624 �/14/85
• Zone
Acceuory Buildin9:
Parking Heq./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter lJup to 100 amps ,
Meter �over 100 amps
Sub Panel
Motors �0.1 HP O 1 h- 8
Inc.Solar 09-15 HP �16�15+
Microwave - �
Pole Light
Range
Standing Sections
Trash Compactor
6.Q0 T�
FEES
I Reinspeaion fee ' I $15 I � Issue Fee � $ 3
DEVELOPMENT SERVICES REQUIREMENTS: �
2oning Approved By Date � �
Buildine APP�oved By Date
Appliption Issued By � Dat�
Z
O
N
I
N
G
R
E
Q
M
T
S.
SUMMARV OF FEES
BUILDINGPERMIT $ SMIP $
PLAN CHECK S � ' PERMIT �
PLUMBING $ .�"J ��-Y� ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING S
PIAN CHECK 50% $ �MICROFILM S �'/��
MECHANICAL $ TOTALFEE § _��
PI.AN CHECK 25% $
CONSTRUCTION AND PLANNINo " �:' . OL & SPA
APPROVALS Permit # Da4e Inspector p�ppROVALS Permit # Date Inspector
1. Temporery Electrical Service or Pole . % 52. Pool & Equipment Location
2. Soi� Pipe-Undrgrnd. � � a � � } �� 53. Steel Reinforcemen[
3. Electrical,Conduit Utility-Undrgrnd. � ' 54. Forms . i�
4. Electrical Conduit-Undr9rnd. - � 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. -'
6.'Foundation • . r 59. Gas Pipe, O Undrgmd., Test ��
9.`Water Pipe-Undrgrnd .� 60. Backwash Lines, P•Trap, O Undrgrnd.
10. Structural Floor System � �'• 61. APPROVAL TO DECK
�• i t. 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. Rougli 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 Struc[ure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72.`l'Jnderground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing � 74. Overhead HYdro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing , 76. Dry Standpipe
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
, 29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nai�ing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION ; �
32. Electrical Power Meter-Final 80. FOOD CERTIF,ICATE 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 5 Z/�� �/f
39. Water Service-Final ' � -
40. Gas Service-Final � � .
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Jrrigation - , , _ ' ,
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed ' �
49. Electric Release to Edison -�
50. Gas Release to Southern California Gas Co . � . �
51. CERTIFICATE OF OCCUPANCY
No Date �
CITY OF COSTA MESA
BUILDING DIVISION ��
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
E98-004d7
PERMIT NUMBER
(714) 754-5273 • Fax (7.14) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Jab Address: 885 BEAR CREEK
Suite No
Viciniry:
Parcel Nunmber: 93506080
Applicant: GREER, JASON
Address:
Status: ISSUED
Applied: 05/22/1998 ��
Issued: 0522/1998
Phone:
. Zip . - ' - - .
Owner: PHILLIPS, ECIZABETH J � � � � -
Address %GRANT; ANTHONY J�., � _ _� � � '- ' �� � , � - � �
COSTA MESA,CA � � � � Phone:- _�_-_ ' ' ' � '�' _�
�885 BEAR CREEK ' . • �' Zip: � 92626 : `�, �._ � � � �� ��-����'�
. - ' --_ . A �, �� �.�
._'.. , _ � . , - -,�� �
- ' V V, :' '�,'�.' .
Contrector: PACIFIC AIR.COMFORT "� � ` � ���� �
' \•'��,--.� ., " � ���
Address:" 01327 S CEWIS � �� � .
.� �_ �
' - � . , . Phone:�i937-1333 � ; ;,, ,� / �
. ANAHEIM CA Zip: ��92807 � � �
�
� ; License:�500236 ' " � �
. . . . . _ � _ .. .
" ' �„i . .... � ' .. . _. - ' '�
_ " �. _ - ' � . . \
� �� � `� SCOPE OF PERMIT� � � ' � �
� INSTALLATION OF A HVAC UNIT AND ELEC. MOTOR FOR THE UNIT. ' � �
l, . . , . , . .�
ISSUE FEE
Temp service test
Res. alc package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighling Fixts
�Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 7000a
Motors l0 1hp _
Molors to 10hp
Motors to SOhp
Motors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
$22.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$425
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
- FEE-SUMMARY
Quantity . � , - � , ' ' � -
� �
� �� _ � �Temp Dist System I Cighting
Busway /700 ft ' ,
� � Standing Seclion' �
0 -_ - Misc ElectricafEquipment ' �
- =0 - � � - � Transformers u to t kva/k �
0
0
0
0
0
0
0
0
0 '
�
�0 - ,
-0 , " '. .
0 `
0
�0 -
0 '
0 ..
0
0
0
p� w .
-- .............�...up to�10 kva/kw
...........:.. yup to 50 kva/kw
.............:...up to 100 kva/kw
.........."'::...over100 kva/kw
Low Voltage Equipment
(� Low Volt Wirinq System / Ckt
� ' �-Misc.Conduit
' � � � Misa Condudo�
- � . Circus ( gen or ride),
'��Circus�(mech ride or lights) . ,
� � -�Chrislmas.TreeStand . �
� Fireworks Stand . ' .
� � ' Other Electrics6Fee . '
Investigation Fee .
- Plan Check Fee
Reinspection Fee ,
, „ � ��
Quanlity � ,'
$0.00 0 : - � '
$0.00 0 .
$0.00 0 .
$0.00 0 � �
$0.00 0
$0.00 0' � � , �
$0.00 0 - .- ' •
$0.00 ,0� � '
$0.00 �,0- ` �,
$0.00 � 0
$0.00�. � ��, � 0 , . �
so.00; o
$0.00 ' 0
$0.00 0
$0.00 0
$0.00��� 0 "
$0.00 ', 0 � ��
$0.00 �
$0.00
$0.00
$0.00
' TOTAL' CALCULATED FEES 526.25
; , .�
COMMENTS / SPECIAL CONDITIONS
EXPIRATION: This permit'shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 100 days. � �
INSPECTIONS: In ortler for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetions and final epproval must be obtained. Failure to obtain inspections antl final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545826
WORKERS' COMPENSATION DECLARATION:
i hereby a%rtn undar penalty oi perjury one af the tdlowing tleGarations:
❑ I heve flnd will meintain e certificate of consent ta selt-Insure tar workers' compensation, es provitled far by section 3700 of the Lebor Code, far ihe peAortnence of ihe
work for whlch this permit is issued.
❑ I have eM will maintein workers' oompensetion Insurence, as required by seciion 3700 of Ure Lebor Code, for �he performance of ihe work tw which this pertnit is iswed.
My workers' compensaUon Insurance cerrier and policy number ere:
Cartier. PWicy Number.
(This sec6'on need not be comp/etetl U fhe permit /5 valueC et one hundretl tlollers ($100) or /ess.)
❑ I certiy that In the pertortnance of t�e work for which ihis pertnit is issued, 1 shall not employ any person in eny manner so es to become subject to the workero'
compansatlon laws of Celito���yyyeee antlpppggg ree �hat H I shoultl become sub�ect to tha workers' compensetlon provislons o1 Section 3700 of ihe Lebor Cotle, I shall forthwith
comply wiM these provisian� , � C �7 Q/y'
Applicant Signature: ��'l r'J�J Date:.�7 ��`� / U
WARNING: FAIWRE RJ SEp1RE WORI�RS' COMCENSATION COVEMGE IS UNLAWRIL AND SMALL SUBJECT AtJ EMPLOVER O CRIMINAL PENALTIES M'D CML FlNES UP TO ONE NUNDRED
TlqUSAND OOLLARE ($100.000). IN ADDITION TO T7{E COSi OF COMPENSATON, DAM4GE5 AS PROVIDED FOR IN SECfION 3706 OF THE UBOR CODE, INTEREST, ANO ATTORNEY u FEES. �
LICENSED CONTRACTORS OECLARA710N:
I �ereby a�rm that I am licensed under provlgions of Chapter 9(commencing with Section 7000) ol Division 3 of the Business antl Profeuions Code, end my license is in tull
force and etfad. Lia a � �� Class x
Contractors SigneNre: s-, —\- h''"'—� Date:�o '
CONSTRUCTION LENDING AGENCV:
❑ I hereby aifirtn that there is a construclipn lending agency for ihe performance oi Ne work for which Mis pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Neme: Lenders Address:
Signature:
Date:
OWNER-BUILDER DECLARATION3:
I hereby aNirtn Ihat under Denelry of perjury ihet I em EICEMP7 FROM 7ME CONTRACTORS LICENSE LAW tor ihe fdlowing reazon (Sec. 7037.5, Business end Professlons
Cotle: My ciry or counry which requires a permit to wnstruct, atler, improve, demolis�, or repair eny siructure, pdor to Its issuence, fllso requires Ihe epplicent for suU permit
to fle e signed stetement that he or s�e is licgnsetl pursuent to the provisions of the Coniractors License Lew (Chapter 9(commencing with Sectlon 7000) o} Division 3 of ihe
Business and Pmfessions Code) or that ha or she Is exempt therefrom end the basis tor the elleged exemption. My Nolation M Sectlon 7031.5 by any eppliwnt tor e pertnit
subjecls the applicant to e c'rvil penalry oF not more Ihan five hundred dollars ($500).):
❑ I, as owner ot Ihe pro0erty, or my employees with wages as their sola compensation, WILL DO THE WORK, and the structure is not intendetl or oHeretl for sale (Sec.
7044, Business and Professions Cotle: The Contradors License Lew does not epply to an owner o1 property who builds or improves thereon, and who does suU woAc
hlmself or herself or through his or her own employaes, proWtletl thet such imprwements ere not intended or atlered far sale. If, however, Ihe 6ulltling or Improvement is
sald witNn one year of completlon, the owner-builder will have ihe burden of proving ihet he ar she tlitl not builC ar improve for puryose of sale.).
❑ 1, as owner ot the properry, am EXCLUSIVELV CONTRACTINC WITH UCENSED COMFiACTORS to consWct t�e project (Sec. 7066, Business and Professions
Code: The contrectors License Lew tloes not epply ta an owner of propeM1y who bulltls or Improves Ihereon, ena who comrects for such pro�ed wlth a contrector(s)
license pursuant to the Contradors Ucense Lews.).
❑ I am exempt under sec. Business and Protessions Code for ihis reason:
SigneNre: � Date:
Owner ID verifietl by drivers license. ❑ Ves ❑ No Dnvefs License No.
Ve�cation of Ownership by (type of tlocument, i.e. - properry tu DIII or tleeC):
DNISION OF INDUSTRIAL SAFETY PERMR CERTIFlCATION:
E:pires:
❑ I hereby certNy that no excavatlon tive (5) or more feat in depih Inta which a persan Is required to descentl, will be mada In connectlon with work authoAzed by ihis
permit, antl Net no Duilding structure, s�Xoltling, falsewark, or demolition or di5mantling thereof, will be mora lhan Nirty-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec.
341, Ttle 8, Celifomia Administrative COde).
❑ As owner-builder, I will not employ anyone to Co work which would requlre e pertnit trom the Dhrision of InCusinal Safery, as notetl above, unless suc� person hes a
pertnit to do such wark from ihe Oivislon.
Signeture: Date:
Division of Intlustrial Safery Pertnil Number:
CERTIFlCATE OF COMPLUWCE AND AllTHOflQATiON OF EMRY: I cerlity under penalty of perjury that I have read this application antl state that ihe infortnatlon given is
cortecL I agree ro comply with all stete laws and ciry ordinances relating to builtling construction, end authorize representetives of the Ciry ot Costa Mesa to enter upon ihe
abovadescribed property for Inspeclion puryvses. I egree not to occuDY or allow occupancy ot any building authorized by this perm% until final inspeclion.
Si naNre Legal Owneqs) � ate
/�c� �'Z�.
, And/Or AuNohied Applicant / — Date
CppE I. IN�ECTIOXTYPE ps¢ �lLS
�616 Fzed System Finel Flre Preventlon
7266
200
207
202
203
204
2466d6
Pool Spe Final
Flnel Re-Roof
Finel BIocWHetaining Wall
Finel Fectory Flre Place
Final Sign
Final Demolition
y9p�( INSPECTIONTYPE
206 Fnel Mechenicel
200 Finel Plumbing
210 Final Electrical
212 Final Fre PrevenGon
220 Final Plenning Approval
222 Finel Site
250 Final Building/Occupanc
�
�{ �
I��
0
Pfl0.1ECT p0UXE5S: 8$ S b EAR CREEK
owxexsxnmE: VILLAGE CREEK HOMEOWNEftS
nooxess: ASSOCIATION
3429 TIMBER LAKE
CM VA 92626
UNIT:
APCH/ENGINEEB: CHt.STER CARVILLE flEG.N0.:C1S3OS
aooxess: 7922 ARMOUR ST uNir:
S.D. CA 92111
PEflMITTEE: PHOENIX ENTERPRISES INC. ( 213 ) 690-9559
aooness: 411 COMERCIAL WAY
LA HABRA CA 90631
LICENSEO GONTflPCTOP DECLABATION: I h¢reDy a�lirm Iha� I am liCens in0er provision5 0l Chapl¢r 9(CommenCinA wilA $¢tlion
7000� ol OiviSion 3 0l Ine Busineis antl Pml¢ssions CuJe, antl my lic e in I lorce antl efl
cirruc./:A. �5(y!J1� 7��/yp�BCsr, qreuc.:376639 /� � ��
oa�e: —a=l=�—(—�— Signamre'. _ 'G (/[�—
WOFREHS' COMPENSATION UECIAflRTION: I here�y a�lirm al I have a certAica e al cansenl to sell-insure or a ce eicaie ol Warkers'
comoensation ��cb e� �cdrtilieU copY �hereol �Section 3800, LaD. LI., � O I/ 9 S
Poucv wo.: CA COMP 6 F I RE E%P. DATE: ��
�OMPFNY:
Cenifietl coDY �s h/e/reby Wmi hetl ❑ Cenifiea copy is �ile e ci� uil0ing OiNsion.
�� `i ` � 'if/'
Oa�e: applicant
E%EMPTION FBOM WOBKEflS' fAMPENS11TI0N OEClAPR710N: (This seclion nee0 noi Oe cample�e� if Ihe permt is iw u�MreO (5100) or less�.
I ceriity Ihal in ihe pedormance ol the work lor which Ihis permi� is issued I s�all no� employ any person in any manner so as to become
Subleci �o ihe Workers' Compensa�ion Laws of Calilornla.
Oa�e: Signalure'. -
NOTICE: 11. atter making IhiS Eetlara�ion, yoU S�oultl Oe[Ome SubleCt �o Ne WOrkers' fAmp¢n5aiion O�a��5ion5 0� �Ae LabOr
CaGe. you must fanhwth comply witA suc� provisions or t11i5 permit shall 6e deemetl revokea.
CONSTNIICTION 1EN01NG AGENCY: I here0y allirm I�ai Ihere is a conslmction IenAmg agency br ��e petlarmance oi the work for
whicA ihis permn is issue0 �Section 3W7. Civ. C�.
LENOEN:
aoosess:
OwNEP BUILOEN OECLAMTION: I nere�y illirm ihdl I am eMempl Imm ihe CAniractor5' State L'Kense Law for Ihe following reason
(Section 7Q31.5 Business anC Prolessional CoOe: Any city oi coumy which requires a De�mil ta consimct. alter, im0�ove, demolish, or
repair any simc�ure, Oriw Ia iis issuance, also requires Ihe applicanl lor suc� permit ta lile a siA�� slatemen� t�at �e/she is licensed
pursuanl lo Ihe pmvi5ions al lhe Conlraqors' Slate License law �Chapier 9(commencing vnih $eclion 7000) of Division 3 ol i�e Business
antl PmleSsionS COtle) or Ihai he/she i5 ¢�empi �h¢refmm an0 Ne �asi5lor �he alleged BremO�ion. Any Wolaiion Of Seciion 7031.5 �y
any applicanl for a permil subjecis ihe apV,licant lo a ciuil penalty of nat more tAan live tlunAreO Ooilars (3500).
I, as awner ol ine pm0eny or my employees with wages as tneir sole compenution, wiil ao ihe work, and Ihe
❑ stmciure is na� imen0etl or oileretl lor sale (Section 7044, Business antl Pm�essional Cotle: T�e Cantractors' S�ate License Law
tloes not apD�Y lo an awner ol a O�opetly who �uilds or impmves lhereon, antl who tloes suU1 work himsel(/herself or thmugh
�� his or her awn emDloyee5. pmvitle0 Iha� such impmvemenis are noi in�en�etl or offered Por 5ale. II. �owev¢r �he builtling or
impmvement a sold vnihin one year oi completion, the owner will Aave Ihe burtlen ot pmving he/she did not 6uiltl ar impmve
' Ior Ine ourpose ol salel.
I. as owner of the pwpeny, am exclusivety coniracting with Iicense0 contracmrs io consimet ihe prole�� (Section 7044, Business
❑ ana Pmlessbns CoOe: The Contratbrs' Staie License Law Ooes not apply Io an owner of pmpehY � builOs or improves �hereon
antl who mNratlsfor suc� pwletls with a coniractor(s) license pursuanl to ihe Contractors' Slate License Law�.l am aware
that pmol ol �heir Worker'S Compensation insurance SAouIA be proviaetl f0 me.
� I am evempl untler S¢tlion: B. 8 P. C.
lor Ihis reason:
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 050645
PERMIT NO: B 050645 PLAN CHECK NO: 00065-91 A GOVT: N SUPP: N
CONSTRUCTION TYPE: V--N PERMIT TYPE: STR PURPOSE:.REP
JOH DESCRIPTION ; REFAIR SETTLEMENT DAMAGE SQ FT; 1q3,
CLAIM VALUE: 14,300,00 CALC—VALUE: 1A,300,00 GROUP OCC: R-3 /
COMMENTS: BUILDING SETTLEMENT REFAIFt/FOUNDATION �
**�r*�***�r�r��**�*��**���*�r��*��*�*�+t*�*��r**�*�����x**��ux�**�eu*�*��*+�*�*x��u���rrt+�*
2 O N I N G R E Q U I R E M E N T S
sETSAcxs
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
E'RNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARI(ING REQ• PROV; PARCEL: 93506129 ZNE: R2 REF NO:
PLANNING NiSTES> FOUNDATION REPAIR,
i
iE dE if if iE 3F iE �E iE iE iE if iE jF if� iF if fE iE �E IE aE iE iF iF IF IE jE if 3f i(� if iE 3f if 363F �lf iF iF�IE 3E iF If IE it lE iF IF �f iF iE if iF ik if # fE 1E iE iE lE iE if 3f N� iE if 1E if IE ik �F IE 3F %iF � iE
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; O I l, S`7 /
i'
BUILDING APPROVED BY : �.. i�-p�� DATE: �
APPLZCATION ISSUED HY; DATE: I,•�
IFifMlfifiFiflFjfifiElE�lFififiblflFifififif - iE�6iE�1FiE1E3f-1FlE3F��iF3F3f
If�iEfEif�lEiEiF�F�E1EifdFif�lflfiElEiflfKifMiE3F3EifIflFif�fifiEiElf � af�E E1EiPklFiEifiE�E1E�EiFlflflFifiElf�fMiE4iEif1F3EiEiE1E�f1EiE1f3f1EifiEi6iF�f1E
LEGALIZATION:N F E E U M M A R Y STRUCTURAli SEGMENT:Y
E
HLDG �MT PLUMBING ELECT TC MECHANIC FIRE SMIP/RES GRADING
PERMIT 162..00 " 1.00
SMIP/NON—RES
PLAN 26.33
ISSUE FEE � '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID DUE
TOTALS----> 163.00 0.00 26.33 189.33 189.33 ,00
REVENUE DIVISZON TOTALS--> COLLECTED; 189,33 OVER/SHORT; ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC' FIRE SMIP/TOT GRADING PLAN-•CHECI{
162.00 . 1.00 26.33
1E iE if 1f If� i(� IE iF iE )f iE ff !E iE 3k * iE 1F iF 3Elf 1E iE 1F if f(• fE iF ff IF if ik �k if if )E ik 3f fF if if iE IE iF iF if iE K� � if �(� K� It �F IE 1E 7F�E iE �E if 3E 1F # 3F if if iE if if 1E iF IF 3E M iP 3E !E iF
Z N D I V I D U A L F,E E B �R E A K D O W N
���J�
Daie: owner. SFR
i tlo nereby cenily �na� i am aware af anA understana the requiremems ot Caiifomia Healih antl Safery Coae Semions 25505. 25533. anA
2553a antl thal I or any lulure Euiltling occupanl wilVwill nol (circle one) neeC to compry wilh uid 51aie cotles antl the requiremen�s �or a
permit fo� conslmclion or rtwEilicalion imm Ihe Nir Oualily Management Oislrict. Fesitl¢n�ial conslmclion ap0licalion5 are eeempi Imm
these o�odsians.
Oa�e: POPlicani:
I �erehy tErlily �Aai I �ave read lhis appliCa�iOn and S�ale Ihal Ihe a�ove' Iq atio correcl. I agree 1 .. py wit� ali cily and c ry
ordmances antl stalelawsrelaling�o Uuiltlinp conslmction and hereby a b re re nlativeSo�lAis LiP eru ni�e aEove� IioneO
pro0etly far insf�el'ion, rpos¢5 �
Oa�e: �� � �V � Signature'. �
od�er's ucense or sociai secunty n:
1fiaLa6 Wbne—Builtling; Green—Cotle Enlarcement�. Canary—ApOhcant: Pink—Revenue: Goltlenroa—Assessar
QTY
143
I ���.Y�1:� � il lf ���.I
STRUCTURAL BY VALUE PER "g 100.00
END OF FEES
UNZT COST
100.00
TOTAL COST
14,300,00
O1 QOPl°E33-GD678E3; r�� �' 18q.3o
DP,7E: 031;:3l91 TIt7E: 0.4:1?
CONSTRUCTION AND PLANNING � F, �L & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
��
1. Temporary Electrical Service or Pole, �� � 52. Pool & Equipmen[ Location
2. Soil Pipe�Undrgrnd. �--2 .� 53. Steel Reinforcement ��
3. �Electrical�Conduit Utility�Undrqrnd. ' � 54. Forms
4. Electrical Conduit-Undrqmd.- � 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. Founda[ion � J- f�'� 59. Gas Pipe, � Undrgrnd., Test �-
.. .y
9. Wa[er Pipe�Undrgrnd. �ff �"� 60. Backwash Lines, P�Trap, O Undrgrnd. �`�,
10. Structural Floor System ��% ����� 67. APPROVAL TO DECK " �
11. Property Sewer Line & 1-IoySe Connec4ion �, 62. Backwash & Receptor�Final �' �.,
12. Sewer Cap ' � , �+ 63. Heater & Vent-Final �1
73. Roof Drains �j�\' �; 64. Plumbing SYstem - Final �-
14. Rough Plumbing 1 � '
.� � � 65. Electrical-Final ja �, A
15. Rough Electrical•Conduit � � � � � �%�
/' �� 66. Solar System-Final �
16. Rough Electric�Wiring �� 67. Fencing & Access ApProval ,
17. Rough Wiring Sign 68. APPROVED FOR PLASTEFING
18. Rough E�ectrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.� Rough Factory Fireplace '� • APPROVALS �' •Permit #
i
21. Ducts, in Structure; .. � ��70. Underground Hydro
22. Ducts, Ventilating �- _ _ � -77. Product Piping OGas ❑Oil
23. Gas Pipe+Rough & Test , , � .� 7z, Underground Flush� �
24. Roof Framing � � ; � 73.�Undergrnd.StorageTank�OGas ❑Oil �
25. Roof Sheathing ' � - _ .� 7q' Overhead Hydro. �
26. T-Bar Ceiling (Structural) & Monocoat': _ 75: Dry Chemical '
27. Frame and Flashing • . - � . 76. bry Standpipe � ",� �_ ' � �
28. Lathing & Siding - � � � 77. FIXED SYSTEM FINAL �
29. Insulation `, . ' . � I � �; 7$, FIRE PREV. FINAL �
30. Drywall Nailing ( �- - HEALTH�DEPT. REQUIREMENT
31. Plaster Brown CoaY , � � 79. FINAL INSP,ECTION '
32. Electricat Power Meter-Final . 80. F000 CERTIFICATE ISSUED -
33. Final Electric � . � � � I ��' � Notes: � � �
,34. Final Heating & Air.Condi[ioning ( I . . �
•
35. Final Gas Pipe-Test , � ( � � � � " '
36. Hood or'Canopy _ .� i f�
37. Final Factorv Fireplace, �' ` � � �: '
i
38. Final Piumbing ; . ��, , � � � � � I � .: . .
39. WaYer Service-Final� � • � �
� •
40. Gas Service-Final . , , . I .
� 41. Solar pomestic•Final � . �� �
- 42.�BackflowPreventer, _ , � � I' � � '
43. Backflow Irrigation • • � '
44. Landscape Irrigation SYstem � , � - �
45.-Sound Attenuation � '� �
46: Handicap Regulations � , ..
47. FINALSTRUCTURE&BUILDING i �
48. FINAL PLANNING � _ �i G ' �� . • �
49. Electric Release to Edison � ; � � •
- 50._ Gas Release to Southem Califomia Gas Co . I �. • -
51. CERTIFICATE OF.00CUPANCY � � , • . •
No Date '
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
Far Applicant ro Fil1 in Completely
Ao�oREs"s885 Bear Creek
OWNER State-Wide Develooers. Inc.
cirv l,yF
CONSTRVCTION
No.`' 826-4550
BRANCH
ADDRESS
ARCHITEGT T
CONTRACTOR StHtQ�W�dB oevelopers. inc.
AooREss9461 Grindlav
No`'826-4550
CITY Cypress
uc No. 224710 uc�No.
SI2E NO.OF BLDGS.
OFLOT �p.093 acres NOWONLOT p
USE OF
EXISTING BLDG.
SIZE OF NO. OF
NEWBLOG. ROOMS 5T0�1�ES
EMERIOFiWALL��a�ter ROOF
COVERING (�p COVERING Shake
USE OF BUILDING AND WOFK TO BE PERFORMEO
1 Residence w/att
PR � U �, {::: �: �
1tAY 13-7G�,;—S�00 6II0 Z3R.2
APPLICATION FOR BUILDING PERMIT
RECEIVED BV DATE RECEIVED �oTF issu
BUI
AD
n
FIRE
ZONE
APPROVED
¢2ca P° °s z
VARDS APPROV ED
MAIN BUILDING
10M C/� STREET)
DISTANCE BET
MAIN BLDGS.
VAR. alE
C.U.G. �
APPROVED /�
I hereby acknowled8e thet I heva reatl t�is epplication anA sSate
that tha above intorma[Ion ia correct entl aprea to camply wl[h
all lews reBulaHnp builtling connruttian, entl � s�ell not amploy
any parson in v(olation of tha workman's compansation laws of
Me Sroie of California. o
I heraby certify that I em properly IicenwC as a contracior untlar ��oo SQ. F'
Me State of Californie Business antl Protession6 Cotla, Divisicn 3, THE �1MOUNT:
Chapter 9, antl that sueh licanms are in fult forca anE efixt, or I THE PURVOSE O
em ezempt trom Me pro�isio�s of tha Siate of Callfornia Business
VALUATI N�v
entl 7rofessions Cotle, Dlvislon 3, Chepter 9.
State-Wade Develope s nc. .3�%,0 ---
Sipnature o
Permlttee �
AuthorizBtlApent Vice President
'/J/�+
DATE
E
V
BET. MAIN &
a
J-645 ;
!N UNDER VALUATION IS FOR �
ABLISHING A PERMIT FEE ONLV: Q
m
PERMIT FEE $ � � �
�
PLAN CMECK $ � SD E
`o
� 'd� a�0 LL
TOTAL FEE $ /