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HomeMy WebLinkAbout1877 MAUI CIR - Building Permits CITY OF COSTA MESA • �\ y BUILDING DIVISION F.' u' 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. B07-01012 PERMIT TYPE B_ROOF2 STATUS: ISSUED DATE ISSUED: 11/0612007 ISSUED BY: , BJK JOB ADDRESS: 1877 MAUI CI CM , • Suite/Unit: - ' Vicinity: RESIDENCE AND ATTACHED.GARAGE , Squares: 5000 ' - Valuation:.. $16,000.00 SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING WOOD SHAKE,7/16",058, 1 LAYER 35# , FIBERGLASS,APPLY"40-YEAR COMP SHINGLES."PITCH 4:12 5000 SQ FT - OWNER: O'BRIEN,CONSTANCE Address: 1877 MAUI CIR Unit: PHONE: - • City/State/Zip: COSTA MESA,CA • APPLICANT: RICK MITTELSTADT • Address•. r.5571 SPRAGUE AV Unit : PHONE: 714-995-5072 ., I - City/State/Zip: CYPRESS,.CA ' CONTRACTOR: RICK•MITTELSTADT.ROOF - License No. 433862 Address: 5571 SPRAGUE•AVUnit: ' ' PHONE: 714-995-5072 City/State/Zip: CYPRESS,CA 90630 CELL: ARCHITECT: - License No. - - PHONE: ENGINEER: . - - License No. r PHONE:' • FEE SUMMARY Reroof Plan Check: $0.00 RePermit Fee: $265.25 . Reinspection ection Fee: `'$0.00 . ®� TOTAL FEES $265.25 - • . . , . .. .•. . .. . .. . • 3 . . . , . . . . . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODER. IN$PEC710N TYPE DATE IN7171ALS CODE0 INSPEC11ON TYPE DATE INnIIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 9 _/' �• 208 Final Plumbing 200 Final Re-Roof /L- 7 (ea ��— 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION Owner ID verified by drive. 0 Yes 0 No ' I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0, I have and will rtiaintain workers'compensation insurance,as required by 'section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized S-7-47-6 �I�A, n by this permit,and that no building structure,scaffolding,falsework,or demolition Carrieror dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This section need not be completed el the permit is valued at one hundred dollars($100)or less) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: /c<6 O,cUN - 0t% ❑ As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. 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 forthwith comply with these provisions. Applicants Signature Dale 7,_,,,-R ten?-71e- ` 1/- 6 -0-) Division of Industrial Safety Permit Number: �Alppl/iranl'slSoig�natuxre�aC../ pate HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. /� a registration form for acutely hazardous materials? 0 Yes ❑No # Lic. L ?3 S'Fi2 Class# 2)e 'S' (Section 25533 of the Califomia Health and Safety Code, with some n�7 // exceptions, requires registration with the Costa Mesa Fire Department by r..(h /1`d! 'C7�) each business which at any one time has on hand a quantity of acutely Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affum that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature pate t.,1 ' 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: ,'I: ;r : ',Y Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that.I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for-,the,following reason-( ec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish,:jor:repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance.also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapte-r;9(commencing with Section 7000)of Division 3 of the information be furnished on applications far non-residential building permits). Business and Professions'Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the Califomia Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes" attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control oKcer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and 0 I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec. 7044. Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a centractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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:reds ergs Dale Signature . Date ��/ry�/�/l /l 3057-46(3/07) L^4d/q AL(ppnEed Applicant DaO _v CITY OF COSTA MESA 4 - BUILDING DIVISION ioaes. 1. 1 ::..L DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0. • PERMIT B06-02121 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.B.W LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1877 MAUI CI Status: ISSUED Suite: Applied: 12/14/2006 Vicinity: SFD AND ATTACHED GARAGE Issued: 12/15/2006 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number 13941105 Zoning: R1 Applicant: O'BRIEN, CONSTANCE Address: 1877 MAUI CIR Phone: 714-545-3070 ISSUED BY: Yie COSTA MESA,CA Zip: 92626 Owner: O'BRIEN, CONSTANCE Address 1877 MAUI CIR Phone: COSTA MESA,CA, - Zip: 92626 Contractor: �q.",���� Address: VW �� Phone: Zip: License: EXP • Arch : Eng: iiiY/// Address: Address: DATE Phone: • Phone: • Zip: License: License: • SCOPE OF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING WOOD SHAKE ROOF,APPLY 1/2"CDX SHTG, 1 LAYER 308 FELT,APPLY 30-40 YEAR ASPHALT SHINGLES.PITCH 5:12 53 SQUARES FEE SUMMARY Plan Check: $0.00Calc Valuation: $12,000.00 Permit: $209.25 Claim Valuation: $12,000.00 SMIP Res: $1.20 SMIP Com: $0.00 Other $0.00 Inspection: $0.00 • • Total: $210.45 PLANNING &ZONING SETBACKS ' MAIN STRUCTURE Front '0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING , - Existinq:. 0 Required: 0 • Proposed: 0 • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 % 244646(ONO) . 1 4 DECLARATIONS i 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. ❑ I 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: Cartier: Policy Number: (This ction need not be completed if the permit.is valued at one hundred dollars($100)or less.) Ll 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 forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLARE($100,0110),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOS,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I 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.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: _ _ Date: 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 him elf or herself or through his or her.owremployees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is • d within one year o#completion,th& wnerjbuilder 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 apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuantto.the Contractors Liccense.Laws.). a n,r ❑ I am a �p tu�nae�ec. ��..�� Business and Professions Code for this reason: Signature:(�C'6'L .� 0 / A, ,Date: '/a --./..5--0 6 -Owner ID verified by drivers license. ,Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax 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,Califomia 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. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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 0 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 0 No (Section 25533 of the California Health and Safety Code,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 Califomia 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. . . .f ... 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Coodee 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,a,ppplication aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes U No (Section 65850.2 of the Califomia 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 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 It 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? 9 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. 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 p7 for i tion purposes.I agreoccupy or allow occupancy of any building authorized by this permit until final inspection. • y4(2 /a—/5 o6 Signature Of Legal Owner(s) 'Date /r And/Or Authorized Applicant Date CODE# INSPECTION TYPR PAU INTIAL$ CODE II INSPECTION TYPE DAM ' INTMALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • • 202 Final Factory Fire Place 220 Final Planning Approval • • 203 Final Sign 222 Final Site 204 Final Demolition '250 Final Building/Occupancy r • 21HAIn . CITY OF COSTA MESA y BUILDING DIVISION >•— : , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1114 • PERMIT 806-02122 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUhLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1877 MAUI CI Status: ISSUED Suite: Applied: 12/14/2006 Vicinity: 3 BATHROOMS Issued: 12/14/2006 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N EXP!BED Parcel Number: 13941105 Zoning: R1 Applicant: O'BRIEN, CONSTANCE I e Address: 1877 MAUI CIR DATE Phone: 714-545-3070 ISSUED BY: COSTA MESA,CA Zip: 92626 Owner: O'BRIEN, CONSTANCE Address 1877 MAUI CIR Phone: COSTA MESA,CA Zip: 92626 it/ Contractor 'OWNER-BUILDER- / Address: - r, Phone: • Zip: - - License: 000000 '`• -„""' Arch : Eng: ti Address: Address: Phone: Phone: Zip: License: - License: SCOPE OF PERMIT REMODEL 3 BATHROOMS IN AN EXISTING SINGLE-STORY SFD. FEE SUMMARY Plan Check: $0.00 - Calc Valuation: Sto,000.00 Permit: $181.25 7 . • . Claim Valuation: sto,000.00 SMIP Res: $1.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $182.25 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear •0-0 Left 0-0. Right 0-0 ACCESSORY , Front 0-0 l Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 , Proposed:, 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6/00) . 1 ' DECLARATIONS 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. ❑ I 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: Policy Number: (This ction need not be completed if the permit is valued at one hundred dollars($100)or less.) 11 certify that in ire performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with theee pr visions. / Applicant Signature: eat-et ®/S^-r il.. Date: ) /g- /$`06 WARNING:FNLURE TO SECURE WORKERS'COMPENSATION COVEMOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND OOLIARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION Tice OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS&DECLARATIONI I. ri I hereby affirm that I am licensed under provisions'of Cheater 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.d Class N Contractors Signature: `1:r.ly 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,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end 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 old 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 apply 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 Ucense Laws.). ❑ I am exempt undo sec. . Business and Professions Code for this reason: Signature: r.x20/ (9f�l�[ Date: ?JR-'/4/-O to Owner ID verified by driver's license. rte(\Yes '❑No Driver's License No. Expires: . ‘ Verification of Ownership by(type of document,i.e.-property tax bill or deed): 40 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,faisework,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. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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? 0 Yes 0 No (Section 25505 of the Califomia 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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,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? 0 yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aPermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U No (Section 65850.2 of the California Govemment 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? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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? 0 Yes 0 No B (fries',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. Signature: Date: CERTIFICATE OF COMPUANCE 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 p fly for in ction purposes.I agr not to occupy or allow occupancy of any building authorized by this permit until final inspection. _ ,6e., OV /eg 51 ---e).‘Signature Of Legal Owner(s) - ' Date f And/Or Authorized Applicant Date OODE 0 INSPECTION TYPE PAIS 10QIALE CODEt INSPECTIONTYPE IATg MALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy CITY OF COSTA MESA 4 BUILDING DIVISION >•0 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4t4y * PERMIT PIC* E06-01479 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesats tLCTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1877 MAUI CI Status: ISSUED Suite No Applied: 12/14/2006 VicinLT KITCHEN AND BATHROOM Exp ' D Issued: 12/15/2006 Parcel Nunmber: 13941105 ',,,,,t, q i• - i k / 14. Applicant: O'BRIEN, CONSTANCE ' Address: 1877 MAUI CIR ISSUED BY: SA Phone: 714-545-3070 COSTA MESA,CA - Zip 92626 Owner: O'BRIEN;CONSTANCE Address44,spip 1877 MAUI CIR ' ��: - - Phone: COSTA MESA,CA; ' - . Zip: 92626 . . „ . . . ... Contractor: OWNER=BUILDER Address: _ .Phone:- Zip: License:000000 • . . . ,. . . . .. _ ... .. . , .. SCOPE OF PERMIT REMODEL KITCHEN AND BATHROOM IN AN EXISTING SINGLE-STORY SFD. 6 LIGHT FIXTURE(FAN/LIGHT),5 OUTLETS,5 SWITCHES,1 SERVICE TO 200A,1 MOTOR TO 1 . HP . , FEE SUMMARY Quantity - - -- . - Quantity ISSUE FEE $23.50 , Temp Dist System/Lighting $0.00 0 Temp service teat $0.00 Busway/100 ft $0.00 0 Res.a/c package '- $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 _ - 0 • - • ' Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 : 0 - . Transformers up to 1 kva/kw $0.00 0 Pool/Spa - $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $6.60 6 up to 50 kva/kw $0.00 . 0 Recept Outlets ' • • $5.50 5 up to 100 kva/kw $0.00 0 Switches - $5.50 5 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 _ Low Voltage Equipment $0.00 0 Res Appl $0.00 0 ' ' ' Low Volt Wiring System/Ckt $0.00 0 Service to 200a . $30.50 1 Misc.Conduit, $0.00 0 Service to 1000a - ',$0.00 0 - Misc.Conductr . $0.00 0 Service over 1000a \$0.00 , 0 '• - Circus(gen or ride) $0.00 0 , Motors to 1 hp .- $4.75 - 1 Circus(mech ride or lights) $0.00 0 Motors to 10hp , ' $0.00 . 0 Christmas Tree Stand $0.00 0 Motors to 50hp' $0.00 ' ` 0 _ Fireworks Stand $0:00 0 Motors to 100hp A, $0.00-. -'0_- " , Other Electrical Fee $0.00 Motors over 100hp ', - - $0.00' 0- - - ' Communication drops' , ', $0;00' - - , 0 . Investigation Fee $0.00 Sub panel to 200a $0.00� 0 Plan Check Fee $0.00 Pole Light Pkg ; '$0.00 0 , Reinspection Fee $0.00 Sign Circuits -N$0.00 - 0- ' ' Temp Pwr Pole $0.00 -,,_, 0 TOTAL CALCULATED FEES $76.35 Intermed Pole $0.00 \, -0- - , COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) \/ DECLARATIONS 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 sell-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. ❑ I 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: Policy Number: (Thissectionsection need not be completed it the permit is valued at one hundred dollars($100)or less.) SLY{I 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 forthwith comply with thesisns. / ��>Q ICApplicant Signature` Date: 1 47 —lb— —6‘", WARNING:FAILURE TO SECURE WORKERS'.COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: rtrt.,_ - I hereby affirm that I am licensed wider 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.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: 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 properly,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 old 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.). 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 apply 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•exe under s { Business and Professions Code for this reason: Signature:.'?._ /✓(C•11 �i ) C� Date: .7a—/5—D4 Owner ID verified by driver's license. ,Yes ❑No Drivers License Noz. Expires: ' Verification of Ownership by(type of document,i.e.-property tax 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. Signature: Date: 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 0 No (Section 25533 of the California Health and Safety Code,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 a2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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 California 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. 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 pp rty for I ction purposes.I agree t to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) ` , Date And/Or Authorized Applicant Date CODE♦ INSPECTION TYPE DATE INTRIAt.$ CODES INSPECTION TYPE AT INTIAL@ 1616 Fixed System Final Fire Prevention 206 Final Mechanical . 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall • _ 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy ,juL1m - CITY OF COSTA MESA BUILDING DIVISION >., t• _ .4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 :�r.i 1 4� PERMIT M06-00839 `*raagrio4A' (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1877 MAUI CI Status: ISSUED Suite No Applied: 12/14/2006 Issued: 12/15/2006 Vicinity: BATHROOM AND KITCHEN Parcel Number: 13941105 ISSUED BY: Applicant: O'BRIEN, CONSTANCE Address: 1877 MAUI CIR Phone: 714-545-3070 COSTA MESA,CA Zip: 92626 Owner: O'BRIEN,.CONSTANCEitio Address:, 1877MAUICIR _ Phone: COSTA MESA,CA, Zip: 92626 Contractor OWNER-BUILDER EVj P Address: jPhone:' AR / rrr Q Zip: 77e► License:000000 SCOPE OF PERMIT REMODEL KITCHEN AND BATHROOM IN AN EXISTING SINGLE-STORY SFD. 2 INST FAU<100K BTU, 1 HOOD W/MECH EXHAUST,3 VENT FANS/SINGLE DUCT FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 : _ Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $29.60 2 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100.k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 -0 ' -Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 ..0 - Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 •• 0 • Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $21.75 3 • Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp. $0.00 0 Smoke Dampers $0.00 0 , 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent -'$0.00 0' - - 15 to 30 hp $0.00 0 Air Handlers< 10000dm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00' 0 Over 50 hp $0.00 0 Floor Furnace . $0.00 '0 _ Other Mechanical Fee Floor or Suspend Heater Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 - - TOTAL CALCULATED FEES $85.50 \ -'COMMENTS/SPECIAL-CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related I regulations.(Ord.No.92-28,§1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 / --1 2446-46(6/00) (/ DECLARATIONS 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 Coda,for the performance of the work for which this permit Is Issued. ❑ I 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: Policy Number: (This section need not be completed/l the permit is valued at one hundred dollars($100)or less.) x!" 1 I 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 laof California,end agree tha if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the!?.r.vi-•., Applicant Signature: . I Date: / a',5 WARNING.FAILURE TO SECURE WORKERS'OON/PENSATION WYERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I 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 end effect.Lic.# I Class a1 Contractor's Signature: bate: I CONSTRUCTION LENDING AGENCY; ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: 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 end 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 Cf 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•oi her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is I,old within one year of completiori..the,owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). I ❑ I am exe t under, { ' Business and Professions Code for this reason: Signature: Ci1LL7 a Date /2 –/5'�4 Owner ID verified by drivers license. Yes 0 No Drivers License No. Expires:- Verification of Ownership by(type of documen,i.e.-property tax bill or deed): , DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live(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. Signature: Date: 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? 0 Yes 0 No (Section 25505 of the Califomia 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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a pllcaeon a2-Peroit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes u No (Section 65850.2 of the Califomia 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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 0 No B (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. 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 prop yY for inspec'on purposes.I agree of to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) : Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE INTRIALE 900E1 PNSPECTIONTYPE PATh ItDME45 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy CITY OF COSTA MESA tr., BUILDING DIVISION C,/'!..� F ( : ) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J PERMIT P06-01048 dP (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.WOMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1877 MAUI CI Status: ISSUED Suite No Applied: 12/14/2006 Issued: 12/15/2006 Vicinity: KITCHEN AND BATHROOM Parcel Nunmber: 13941105 ...... Applicant: O'BRIEN, CONSTANCE / Address: 1877 MAUI CIR ISSUED BY: r/ /"Phone: 714-545-3070 _ / COSTA MESA,CA Zip: 92626f 11Owner: O:BRIEN;CONSTANCE E DOE Address -1877 MAUI CIR - - " - , - Phone: COSTA MESA;CA - Zip: 92626 +: Contractor: OWNER=BUILDER ck- 'Address: , , Phone:- Zip: License: 000000 SCOPE OF PERMIT REMODEL-KITCHEN AND BATHROOM IN AN EXISTING SINGLE-STORY SFD. 1 BACKFLOW IRRIGATION,2 BATHTUBS, 1 GAS OUTLET(1-4),3 SHOWERS,1 KITCHEN SINK,5 WASH BASINS,3 WATER CLOSETS / ,_. __ . FEE SUMMARY AMT QTY AMT QTY AMT QTY 'ISSUE FEE • $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $9.80 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 1 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $19.60 2 - , Pressure Regulator. - $0.00- 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units .. $0.00 0 " Septic Tank . $0.00 0 Wash Basin $49.00 5 Dishwasher , $0.00 0 Sewer Cap for Demo $0.00 . 0 Wash Basin Set $0.00 0 Drain,Floor . $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater" $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $29.40 3 Drain,Roof - $0.00 0 Shower - $29.40 3 Water Heater/vent $0.00 0 Drinking Fountain $0.00. 0 Sink;bar $0.00 ` 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 \ 0 •Sink,commercial - $0.00 0 •-• - Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 . 0 L. " Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) . "$6.15 1,. Sink,kitchen . $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 : Sink,service/mop - • $0.00 0 .- OTHER $0.00 Gas Repipe -$0.00, , -0 Spa(private) $0.00 0 . . _VIOLATION $0.00 Gas Service $0.00 ,' 0- ='Spa(public) , - " ' $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) ,'$0.00, 0 - - - REINSPECTION $0.00 0 Interceptors(Sand Auto)N10.00 ,0', , , . - - , -�� _ - TOTAL CALCULATED FEES: $176.65 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 7 2446-46(6/00) DECLARATIONS 1 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. ❑ I 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: Policy Number: Fs section need not be completed If the permit Is valued at one hundred dollars($100)or less.) ;I certifythatin the performanceofthe work forwhich thispermitisissued, shall not employanypersonin anymanner soes to becomesubjecttotheworkers'compensation laws f California,end agree that it lc should becomq subject to the workerscompensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with rhes Isions. �/ Applicant Signature: (-Q L' 'Date: ) /2—fib —06 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($t00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I 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.4_ Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code). Lender's Name: ) ' Lender's Address: Signature: .,.:t ... •• f '-J Date: a u4 !i OWNER-BUILDER DECLARATIONS:274 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 apply 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 exeI under.5 '- Business and Professions Code for this reason: Signature: l' 0 Date: AZ— 15 —c Owner ID verified by drivers license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax 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. Signature: Date: 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? 0 Yes 0 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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,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 Califomia 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 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,Reermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ 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? 0 Yes 0 No (If"yes",the facility Must meet the requirement of Sections 25534 and 42303 of the California 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 prescnbed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No B (It"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. 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 Masa to enter upon the above-described p�roperty,r � for inspection��� �� �pu,rrposes.I agreeAot to occupy or allow occupancy of any building authorized by this permit until final inspection. 6 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE 1N111AL$ COOS I INSPECTIONMg PA_E IN1111AL¢ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • r 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 77.\ Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA.ME6AS PERMIT NO. �p TRACT NO. LOT NO. BLDG.NO. . COMS'TR'UCTION PERMIT OCP- `9 9`7 ' -P373 22 Project Address i�'-n f't, U� C12GC-tf TYPE OF CONSTRUCtION Owner WILL/A/s -v- C7rA21rA 1 Phone S't/$3y7C 0 NEW L7 ADD El ALTERATION (,]mss ^ _ Address /g77 Hiu, L/(Lc t--a... 0 REPAIR 0 CONVERSION ❑DEMOLISH - Y '" 7729 6/15/82 aaF. IR 'T� Arch/Eng. U k/i S E CLt4rS License No. ti,Sli r ❑ OTHER \ '' 'r` ` A P / ZONIINGG REGULATIONS Address GG'' j - DESCRIPTION OF WORK Plfri* .a.1 4-DDrTO' 7._ t-✓I C4,�z 2T/7AJ ZONE R/ PLNG. REF.* • Contractor OWkJc2 - Phone " TYPE OF PERMIT -" BUILDINGTO BUILDING ,,,�� SETBACKpC/L ST //Q'•/C{/ PROPERTY LINE Address - - - - ,, 0 GRADING £YFOUNDATION Elf-STRUCTURAL STE-YARD O/! - - LICENSED CONTRACTOR DECLARATION 0 TENANT R7ELECTRICAL PLUMBING ❑MECHANICAL' SIDE YARD /9 /o•/ / I hereby affirm [hat I am licensed under provisions of Charter 9(corn- C • RIGHT '/ / mencing with section 7000) of Division 3 of the Business and 0 OTHER - - �� 0/ Professions Code, and my license is in full force and effect. . REAR YARD (TO P/L) . , PROJECT DJSCRIPTION " _ License Class License No. C, /,/per PKG.SPACE REQ. PROVIDED Date Signature - - _ SD. FT. m q• /� -�— STREET WIDTH PARK FEE$ WORKERS'COMPENSATION DECLARATION , OCCUPANCY •L ON TRUCTI N TYPE STREET,WIDTH ED BV/ tI DATE I hereby affirm that I have a certificate of consent to self-insure ora v i7 /00AZ_ certificate of Workers' Compensation Insurance, or a certified copy thereof(Section 3800, Lab.C.). - GRADING CU. YDS. ACRES SPECIAL CONDITIONS: 'icy No. Company . - - Certified copy is hereby furnished. - - REMARKS: - • L_I Certified copy Is filed with the city Building Division. . EXEMPTION FROM WORKERS' COMPENSATION DECLARATION . . .. . (This section need not be completed if the permit is for one hundred • ($100) or less). , I 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 PLUMBING PLAN CHECK - ELECTRICAL PLAN CHECK subject Soy Wo kers'Compensation Laws of California. - - uWELLINC, - GARAGE - �Date G•/ '0/e 4-Signature-Compensation, .,. - .7 V a_ BATHTUBS SHOWERS 50 FT. 60 SO FT 01,0 NOTICE. If a er making this declaration, you should become subject _TOILETS - URINALS GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must - TRANSFORMER forthwith comply•with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE • 10-50 KW - 50 + KW revoked. - - - - CONSTRUCTION LENDING AGENCY KIT.SINKS / DISHWASHERS ,3',©0 -MOTORS Al HP 1-10 HP . I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS - (INC.SOLAR) 50 HP 50-+ HP formahce•of the work for which,this permit is issued (Section 30971 - ' Liv. er's- a 5.CZ•, �; a - , FLOOR SINKS FLOOR DRAINS Fl C' •Aiii ,,ear-l- • S Ti, Lender's Name Lender's Address DRINKING FOUNTAINS • - GFS�� ti OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS P• ai � ` iw I hereby affirm that am exempt from the Contractor's-Professions License Law for � the following reason-count (Section 7031.5 Business and Professions(Code: SWIMMING POOL P TRAP - 1 /Pl'¢V5 Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure;-prior to its statement re- WATER SERVICE ALTERATION / ••2 00 • - ELS `I AIN isquiressthe pursuant for hesuchp permit to file a antra stare mectthat he � is licensed pursuant to the-provisions of the Contractor's License Law- GAS SERVICE OUTLETS • SEZ (Chapter 9 (commencing with Section 7000) of Division 3 of the - .-. • C ark \. r \: Business-and Pro4esd exeCode) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT^ - for the alleged exemption. Any violation of Section 7031.5 by • e applicant for a permit subjects the applicant to a civil penalty ' SEWER CONNECTIONS - • . at more than five hundred dollars ($500). _ _ LI I, as owner of the property, or my employees with wades as their SOLAR TANK COLLECTORS -" - ' '- • sole compensation, will do the work,and.the structure is not intended _ .. • _ OO or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE-- Contractor's License Law does not apply td ansuch owner himself ty or • APPLICATION'APPROVED BY (11,--. DATE6//e/8q who builds or improves thereon, and who does supe work himrelf or ISSUE FEE ' 00 J through hir own foremployees,sllf,provided that, such improvements are not intended or offered for sale, If, however, the building havea improvement MECHANICAL PLAN CHECK SUMMARY OF FEES • is ,.pr within one y¢nr of ppm pleb rov owner t will rpo the burden / p o,yf .proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU PERMIT BUILDING $ /2v •rO . SMIP $ 1. 26 t6-I, as owner of the property, am exclusively contracting with AND DUCTING -- ""' - - - licensed contractors to construct the project (Section 7044, Business 100,000+BTU PLAN CHECK $ PERMIT and-Professions Code:-The-Contractor's License Law does not apply to . • ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ ec tracts from such projects with a contractor(s) licesned pursuant to SYSTEM ' - ' - - - • •- GRADING $ ' the Contractor's License Law). 100,000 +BTU PLAN CHECK $ - - ❑ Lain-exempt under Section B.& P.C.for this BOILERS BTU $ ELECTRICAL $ reason '-- - - - PLAN CHECK $ - MICROFILM $ - Date VIVA Owner W l ie /-O1.51-0-----. SYSTEM REPAIR,ALTERATION bMECHANICAL $ TOTAL FEE$ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM ...MULTIPLE 'LESS AD- information is correct. I agree to comply with all city and county - - - "PLAN CHECK $ VANCE PC $_ ordinances and state laws relating to construction,and hereby authorize y' representatives of this city to enter upon the above mentioned ��SIQ property for/1 n�pbn.pur{ esi,• � �j�/G.� - FINAL FEE $ Signature 'ICs. 1�✓H / I ISSUE FEE CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor r . CONSTRUCTION AND PLANNING POOL&SPA ._v APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector ' g 1. Temporary Electrical Service or Pole - ` LJ/yJ57- 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 7�/�$'2 a$. 44. Steel Reinforcement • , 3. Electrical Conduit Utility'Undrgrn - % _ - 45. Forms 4. -Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn - 48. APPROVAL TO COVER-GUNITE 7. FootingsI Ke'Z.I�Qz. 49. Electrical Conduit-Undrgrn 8. Foundation . _ , SQF_ri, (o-'11 , _ 5 50. Gas Pipe, ❑Undrgrn,Test 9. Water Pipe-Undrgrn 51. , BackQvash Lines, P-Trap, ❑Undrqrn - - 10. Structural Floor System 52. ' APPROVAL TO DECK - 11. Property Sewer Line'& House Connection • 53. _Backwash & Receptor-Final .12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing '7//f/8,2 .47?�" 55. Plumbing System -Final , 14. Rough Electric-Conduit •56. Electrical-Final 15. Rough Electric-Wiring - 13--SL �,(/ 57. Solar System-Final 16. Rough Heating & Air Conditioning 68. Fencing &Access Approval 17. Ducts, in Structure / - 59. APPROVED FOR PLASTERING '18.- 'Ducts, Ventilating ' ' 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing / . 21. Roof Sheathing • .. 9,a•'9 Z• 1T>S - - / 22. Frame and Flashing - k..`tif b.,, h•� NOTES: 1.\/,.7-- S/741( ayz/� r---- ,--j,,‘,1, 4 0 U,, n 23. In • sulatio . ' 24. /Lathing,& Siding, - / /- - ! /,,1 25. ' Drywall Nailing' 7 •. i • - - ._- • 26.' Plaster Brown'Coat/ .. / ' - m - - 27, Electrical Power Meter-Final i' • - ' 28. 'Final Electric /• / /o%,/y5"-, e C 29. Final Heating & Air Conditioning'• ' - _ 30. Final Gas Pipe-Test _ 31. Final Plumbing /D2&-e3 _. �� - 32.- Water Service-Final - 33.• Gas Service-Final - 34. Solar Domestic-Final -35: Landscape Sprinkling-System.‘ - 36. Sound Attenuation __ • - . . 37. Handicap Regulations •: .''i").r,' td•*)ill 1C47.0 Jzt 'I - - 38. FINAL'STRUCT _l_RE- i BUILDING 39. Special Requirements Completed• • • 40. Electric Release to Edison • 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY - • • ' ' - NO - Date - • /-. _Al _/ r- Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. ff' I QF COST� :E„SA ' RMIT NO. TRACT NO. LOT NO. BLDG.NO. STRUtTION PERMIT (��i4 e93 �Z Applicant's Meiling(Address -,-------11 I~ ? {::.4"C -1\ TY OF CONSTRUCTION IJ NEW LI ADD U ALTERATION- U REPAIR __ - 09• .4 6I ���'0 1 5.011 TL - Prbject Address `�� r ' m�\-/\ �c� ' . . • U CONVERSION 0 DEMOLISH Irl OTHER • - I I t� DESCRIPTION OF WORK 1S J ( .O\/J(-'O$ �� t.P-;)K1-t.. k--.Sten(_ .ZONING REGULATIONS - Owner's Name !-?P�[�'�l • Phone•��-3��� C - �/' Address .` C �� • • • TYPE OF PERMIT�I�U GRADING�U FOUNDATION LTJ STRUCTURAL _ A.P.IP ZONE - Arch/Eng. A An'�r^S License No. 0 TENANT ty'tLEGTRICAL LJ PLUMBING ll--11 � �j p LYMECHANICAL BUILDING I \' C-f\1GV C�S� E 1Z_• S J - - ` ❑'OTHER - - PLNG.REF. G _ S . Address - - TO BUILDING PTwerr rn ST r[�__ REAR YARD(TO P/L) Contractors Name •-t �-�+k� `�e0( � • Phone��Tl��. PROJECT DESCRIPTION SQ.F7. .00CUPANCY - PROPERTY LINE r .�^ Y - - LEFT SIDE YARD RIGHT SiDE YARD Address(mailing) r1 nick-1d, Lok- CZ.Fl `S I CON ST RUCTION TYPE VALUATIONS (�/ftp - - LiCenseNO. _�_ L�� l RJ ' ZONE _ •1 ' GRADING ICU.VOS. ACRES PKG.SPACE REQ. PROVIDED "' LICENSED CONTRACTOR DECLARATION • Remarks: Y ;KC �' t-4� . STREET WIDTH ;PARK FEE$ t hereby affirm that I am licensed under provisions of,Charter 9 (commencing (\ -JF �s '•V • with section 7000) of Division 3 of the Business and Professions Code,and ( ' \ SPECIAL CONDITIONS: , _ ° - my license-is In full force and effect. - ' • - t License Class .-..� _ tr Dw-No • rt s�� PLUMBING • `. Date '2Z-- Signature GH(�J • ORKERS'COMPENSATION DECLARATION ~ ' Bar Sink Se Wer Cap ELECTRICAL Iereby affirm.that.l hive a Certificate of consent to self4nsure or a certificate. - - _ - Automatic.Washer. _ Meter Dover 100 amps• of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer-- SBWer Connection' - t°1 :00, Lab. C. e� Construction Pole Sub Panel N Polity No. S 2C--- D2' Company A, t-Va-� Backflow •Irrigation Solar Collectors_ ' Bathtubs I I Solar Pi in • Cooking Unit , • Sub Pole • c. ifled copy is hereby with thehed. ' P 9 , SI ert fled obmis filed with the city BWIdfrirdivlsll-n ,. • - Da e -22-b.) Applicant • ..n....-Fti • �`'�� Clarifiers Solar Tank Dishwasher 'Motors ❑0-1 HP ❑1'h$ EXEMPTION FROM WORKERS'COrAPEN ATION DECLAR TIO TION ' • Dishwasher Swimming Pool w/Spa - Dryers OGas ❑Electric ' • - ' • (This section need not be completed If the permit Is for one hundred($100)or - _ yInc.SOlar•09-15 HP ❑15-15+ less). Fan.. Microwave i • • I certlfy'that In the performance of the work for which this permit Is issued I , Drinking Fountains Urinal • shall.not employ any person In any manner so as to become subject.to the - . - • - i - - -- F.A.U. Pole Light Workers' Compensation Laws of California. , Floor Drains ' Water Closet' I Date' Signature • - - • NOTICE:if,after making thisdeclaratlon,you-should-become subject to the ' - FTOor Sinks , • ' - - - • - Water Heater, - • I - - _, Fixtures -_ Range . . ._ - 1 _ :Y Workers' Compensation provisions of the Labor, Code, you must forthwith - • comply with' such provisions-or this .permit ,shall be'deemed revoked: • Gas Service ' Outlets ' Water Service Device Boxes Sign ' • CONSTRUCTION-LENDINGAGENCV - _ , I hereby affirm that there Is a-construction lending agericy.for the performance. - - . , Outlets Sections ' ) I of the work for which,this permit is issued .(Section 3087 Civ. C.), Interceptors r • , _ , Standing Lender's Nathe - - - • . ' Kitchen Sink• . ! r. t Switches Trash Compactor - LenCer's Address - = - -• - P _ - - Garbage Disposal• - ' • OWNER BUILDER DECLARATION' - 1 ;, ' • i- j Lavatories ' 0 p ' I Hereby;affirm that I am exempt from the Contractor's License Law for the' - p_Tra - Generator 00-5 KW 05-15 KW I ' following reason (Section 7031:5 Business and Professional Code: Any city or • _ P ' - - __ ' county which requires a permit to construct,alter,Improve,demolishir . , - - 1 Transformer 015.50 KW permit Reef'Drains • - _ file a signed statement'that he/she Is licensed pursuant to the provisions of / 050+KW: Reinspection Fee ' • Contractor's License Law(Chapter 9(commencing with Section 7000)of • . , . / §75' ' ision 3 of the Business and Professions Code) or that he/she is exempt I Showers Reinspection Fee $15 - refrom-and the-Oasis for the alleged exemption. Any violation of Section ' - •• \ _�� Meter ❑up to 100 amps Issue Fee: ' '$ 3 7031.5 by.tany applicant fora'permit subjects the applicant to a- civil - - . I _ • --bat; LIenaity of not more than Tivehundred dollars($500)'. ' - I Service.Sink I _ . Issue Fee $ 3 Zoning Approved By • I, as owner of the property or.my employees,with wages as their sole t - - I ' , compensation will do the work,and'the structure Is not intended or offered I ' , , , MECHANICAL ' for sale.•(Set/ion 7044, Business and'Professional.Cotler'The Contractor's ( - Application Approved ey Data License Law does not apply tolan owner of a property'.who builds or improves . ' Boiler • . Refrigeration System • ' thereon, and who doeslsuch-work himself/herself or through his or her own ' Application Issued By ' Ij ' '� Date ' employees, provided that such Improvements are not Intended or offered for 00.100,000 BTU ❑100,000 BTU' sale, If, however,the building or improvement is Sold within one year.of com- Duct-Under Ground I : SUMMARY OF FEES 1 . pletlon,the owner,will have the burden of proving he/she did not build or im- rove for the purpose of sale). I . , Duct-Structural System Repair/Alteration •BUILDING PERMIT $ ' SMTP - - $ 1 I, as owner of the property, alit exclusively contracting-with licensed con- ,1 1 ' tractorsto.construct the-project (Section 7044,Business and Professions Code: ' , Duct-Ventilating „I. _, .. _ -j _ , - -PLAN CHECK. S. l� PERMIT ' The Contractor's License Law does not apply to an owner of property who - - /5:00 ISSUANCE • $ I builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0: PLUMBING $' tractor(s) license pursuant to the Contractor's License Law). - • GRADING $ 0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact:'BI t. lCBG# • t PLAN CHECK • $ ' Date •'t - Owner - ' • t g' yDucting ; ELECTRICAL - S Heatin S stem& $ - ' $'• 1 - _ '.PLAN CHECK $ • MICROFILM I•hereby:certify that Ii have read this application and state-that the above-• - 00-100,000 BTU 0100,000 BTLI • Information Is correct. I agree to comply with all city and county ordinances ) I I 1 I ' TOTAL,FEE. , $ I and state laws rel to building construction,and hereby authorize repre- . Hood or T e I •❑. MECHANICAL $ , 1 , sentatives of s cl - to neer,q••• e above-mentioned property for ,Type Reinspection Fee• $15 ' LESS I ' Inspection rp s: 4�, /' / y7 Canopy Type II 0'' PLAN CHECK $ , Signature p-' f`- 'o- Date IC 2 V- - ADVANCED PC $ Drivers' Llcen or'SS • • Registers t Issue Fee = $ 3 ' FINAL FEE ' $ (Sdi' , CMF 0865-46 rev,12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor ,;CONSTRUCTION AND;PLANNING ', p " - ; t I ` = - _' "' POC SPA -- _ - -.- , r(�' VV. , - .Date 'Inspector ,, Date Inspector APPROVALS Ber'mit;# : "I 'APPROVALS Permit# --'• ii., Temporary Electrical Service drrPole •' - t ii.' - -'52- Pool &Equipment Location 4 - . - _=.21 Soil Pipe-Un ,'drgrnd - AL- i s _ -:53? Steel Reinforcement - - 3. Llectrical Conduit Utility-Undrgrnd. . s . 1._ - .-54.,..:- 54 Forms - - - . LElectrical Conduit-Undrgrnd'. ->" ! ' C '' s c F' : ,'55 Electrical Bonding ", - - , 5: Seel,Reinforcement - - ' ? Pi ; 5d C, . -"56.- Rough Plumbing& Pressure Test ' 6 Electrical OF ER Grnd.I `. ' • -,- it o, .. • ` ,57 APPROVAL TO'COVER-GUNITE 7- footings , ' , �- 'y ; a r - . r ; -. 58'" Electrical Conduit-Undrarnd- 8. Foundation , ; 1 j i G; Y ,`.'_ 59. Gas Pipe, D'Undrgrnd:,Test _ - - 9. Water Pipe-Un-d . t � -' 1 _• - "I -60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Stiuctural Floor System ' - ; i . ii 61. APPROVAL"TO::DECK , 11- Property Sewer Line&House Connection - , • '- : ' 62. Backwash'&-Receptor-Final?. ' -. ' 12, Sewer Cap 1 ' '• v '63. Heater &-Vent-Final - - 13. Roof,Drains - 1 _ - - - - _ •- "64. Plumbing,System - Final �� 14. Rough Plumbing. l ` ,) - 65. Electrical-Final - - - ' t5-.Rough-Electrical-Conduit'- - --' . -j -T-1' -1-- i -i_ -. i '"66.'Solar System-Final - - - - , re r 16' Rough-Electric Wiring.:,- i 2 ; ;I " q 367. Fencing&T-Access Approval - . -" - 17. Rough Wiri g'Sign ' r. I I;_ ! _ - 68. APPROVED FOR PLASTERING ' . -: 18 Rough Electrical I Ba? Ceiling II ; j ; i X69.. POOL/SPA SYSTEMS FINAL ',,2I-%- C! o` 7. 19. ;Rough•Heating&IAir Conditioning j `; - ' FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace; t: j: j l ' APPROVALS- ! Patina# . _ . 21 ;Ducts;in Structure �� " I I - I ii it i I I i 90., Underground Hydro n `22. 'Ducts,-Ventilating ' ,, I II P j I ! '71. Product Piping ❑Gas ❑Oil ':23-;Gas Pipe-Rough & Testi , " , c 1 , a ' I 72., Underground Flush' ' c 1 • . " 24, ,Roof Framing • , 2, I ! -, 1 j e Hz, - T. • i 03.' Undergrnd-Storage Tank OGas ❑Oil 25- Roof Sheathing I I, t 1.; I I I - j • _ - 74.' Overhead Hydro 26. T-Bir Ceiling (Structural),& Monocoat's - I ' I ' - , 1 75. Dry Chemical• - , r27. !Frame and Flashing ' i I ( ; • 1 • , ' X76.• , Dry Standpipe , _ 1 28.'''Lathing& Siding j ! it I I I I I ! !77. FIXED SYSTEM FINAL , __ 29. ;Insulation ? I "I ! I i; i I 1 78. FIRE PREV. FINAL • - ,230. Drywall Nailing ; :' j, li j i ' ! 'Notes: ' _ , 31- Plaster Brown Coat I 1 II I , - i I- -I I • I ' _ _ { 32. ,Electrical;Power Matadi-41'a] I II I ,I I - ' ! ' j ' ' , 33.7;Final Electric _ j^ ; I' I i • i ' 1 ' 34. Final Heating &lAir Conditioning ; e' . • -, 35. Final Gas,Pi pe=Testi 1, i I o j 7 I . - 36. Hood or Canopy'- . 1' I I r _ - 37, Final Factory Fireplace- - j Vj I i, j .. : '. 38. Final Plumbing 1 , 1 I si G' ; ' ' , 1 r • 39. Water Service-Final, I ' I ' • _ 1 , , ' - 40. Gas Service-Final I ' . i I. I I , i I ' i 1 - 41. Solar Domestic-Final 1 I !_ _. I ._ - - - 42. Backflow;Preventer; , j I ".r,i 1_ 1 I _ 43. Backflow Irrigation =I I I I r.2(•- 1.` ,r9 ?.; ' 1 : I - r ' ' U.. , , a 44. Landscape Irrigation;SI ystem -i, I 1 ; I_ 1 _ , - 45. Sound:%Attenuation ;is;5' j : I 1 li (` I I' ': t I 1 ; ' ' - - •' 46. Handicap Regulations I I ;; • hPi. r I. _ Applicant t_o/ill In all spaces except those within heavy_border lines and sign all appropriate declarations. - CIT'r`OF CQJTA MESA, - r P IT O. pp' / T(�,ACCT NO. L0 2• , BLDG.NO. _ 4. 'CONSTRUCTION PERMIT -(S/5� 44 9s. , 5794 3/16/8 Applicant's Meiling AddressN' TYPE OF CONSTRUCTION- NEW U ADD LI ALTERATION ❑ REPAIR Project Address /A �RU-r e,�' • - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - '" - - . DESCRIPTION OF WORK ' 5 /.7/J-(/•//111 CT, 'PO I -I-- Sf4 Owner's Name --"8/ Z-- 'r•J �,e/E/v - Phone' d--ATO - _q pp - �-� ZONING REGULATIONS Address �r8�7 H4�r G/F•' • TYPE OF PERMIT GRADING ❑ OUNDATION Lei STRUCTURAL A.P.gW j 41. 1—ZONE f-- - Arch/Eng. W,C', .404/es. ' License No. -�/(`,�I' 9 �I ❑ TENANT L`7 ELECTRICAL PLUMBING ❑ MECHANICAL PLNG.REF.* _ �/� . -BUILDING - /P 7,r3 U,61r4-1at:a-i'' 6A GA- UI-. ❑ OTHER \�� s dr Tg4Cr r(s dm Address �� � /� BUILDING s`.L\ REAR YARD(TO P/L)-' �S1 'Li 7i'z-' o Sao-/635 PROJECT DESCRIPTION SQ. FT. - oCCUPA PROPERTY LINE �n Contractor's Name / �f PhoneIy/C�y - • LEFT SIDE YARD �` jyj � ' Address(mailing) //79/ Los-,ems - �" , CONSTRUCTION TYPF VALUATION$ i�- 000 1 ,p/'`s{+/� RIGHT SIDE YARD 9 Ri 7.S o I ZONE GRADING CV.YDS. ACRES ?KG.SPACE REger PROVIDED License No. __ LICENSED CONTRACTOR DECLARATION Remarks: ' • STREET WIDTH PARK FEE$ I hereby.affirm that I am licensed under provisions of Charter 9 (commencing !- with section 7000) Of Division 3 of the Business and Professions Code,and . SPECIAL CONDITIONS: VJ ' • my license Is in culy forte and effect. . Ucense Class C'S3 • License No. 3 F7SSz6 PLUMBING • - I ' _ M ' oate .1-/D-£f3 Signature a a .i - ' !OR KERS'COMPENSATION DECLARATION 7 Bar Sink • Sewer Cap ELECTRICAL , .herebyaffirm that.I have a certificate of consent to self-Insure or a certificate • • - - Automatic Washer _ Meter Dover 100 amps . . ( of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Sewer Connection; (�, 3800, Lab. C. Construction Pole Sub Panel `V S2 fob A'e-p.7 $/A7 - S Backflow Irrigation Soler Collectors • ' Policy No. 6i• Company (L. I - CookingUnit Sub Pole N Certified copy Is hereby furnished. Bathtubs . . • . Solar Piping • rtifi co y Is o with the city.@ul d ng Bion. _ ) • Dishwasher 'Motors 00-1 HP 01%-.8 I Date ��' � Applicant �,'-A- / Clarifiers Solar Tank EXEMPTION FROM WORKERS'COMPENSATION DEC RATION • Dryers ❑Gas ❑Electric • 'Ina Solar 09-15 HP 016-15+ (Thissection need not be completed if the permit Is for one hundred($100)or Dishwasher • Swimming Pool w/Spa . Icerltify that in the performance of the work for which this permit is Issued I - Drinking Fountains • : Urinal ' , Fan Microwave shall not employ any person in any manner so as to become subject.to the - F.A.U . Pole Light ' Workers' Compensation Laws of California.' - Floor Drains Water Closet• , • • . Date Signature . Fixtures• NOTICE:If,after making this declaration,you-should become subject to the ' Floor Sinks - - • Water Heater - Range. _ - Workers' Compensation provisions of the Labor Code, you must forthwith . . comply with such provisions or'this permit shall be deemed revoked. Gas Service Outlets Water Service . • Device Boxes Sign , CONSTRUCTION LENDING AGENCY Outlets I hereby affirm that there is a construction lending agency for the performance Interceptors S 1 �..— ' 'Standing Sections ' •' of the work for which lois permit is issued (Section 3097 Clv. C.) - - Lender's Name- \......N-.....aL I Kitchen Sink ' Switches Trash Compactor ' LenOWNer'sER AdBUILDER - Lavatories Garbage Disposal Pone S� q,0 OWNER BUILDER DECLA0.ATION - / / I hereby affirrrl that I am exempt from the Contractor's License Law for the P-,Trap - Generator 00-5 KW ❑5-15 KW following reason (Section 7031.5 Business and Professional Code: Any city or p , county which requires a permit to construct,alter,Improve,demolish or repair - Transformer ❑15-50 KW • I ' any structure;prior to Its Issuance, also requires te applicant for such permit Roof Drains' - ' • 1,.,y,file a signed statement that he/she Is licensed pursuant to the provisions of 05U+KW - i -Contractor's license Law(Chapter 9(commencing with Section 7000)of Reinspection Fee • .flk75)ision 3 of the Business'and Professions.Code) or that he/she is exempt ' - Showers -- Reinspection Fee �$1i` s erefrom and the basis for the alleged exemption,-Any violation of Section - Meter Opp to 100 amps -Issue Fee $ 3 :7031.5 by any applicant for-.a permit-subjects the applicant to a. civil , • - eenalty of not more than five hundred dollars($500): • e-: Service Sink 7, ' I Issue Fee. - i . $ 3 -- - - �/i I , ,`� L I,'as owner of the i property or 'my employees with wages as their solo Zoning Approved By Date compensation will do the work, and'the structure-Is not intended or offered :t MECHANICAL - I ' ' ' for sale'(Section 7044, Business'and Professional Code: The Contractor's _ _ - Application Approved By O� Date - /���ap > License Law does not apply to an owner of a property who builds or improves Boiler : ' - . Refrigeration System - Application Issued By - `L AW4 .a thereon, and who does such work himself/herself or through his or her own ' - ' - pP Date • employees, provided that such improvements are not intended or offered for - - - ❑0-100,000 BTU ❑100,000 BTU ' sale, If, however, the building or Improvement Is sold within one year of com- . Duct-Under Ground ' SUMMARY OF FEES - • pletlon,the owner'will have the burden of proving he/she did not build or Im- ' Q� LIrove for the purpose of sale). • Duct-Structural S• ystem Repair/Alteration •,BUILDING PERMIT $ Z S_ SMIP V tt I,as owner of the property, am exclusively contracting with licensed con- . - $ tractors to construct the Drolecl-(Section 7044,Business and Professions Code: .. Duct-Ventilating . , ' ._ . _, - . - - PLAN CHECK $ t. /2 PERMIT • i The Contractor's License Law does not apply to an owner of property who ' 9 ' builds or Improves thereon,and who contracts for such projects with a con- . Exhaust System ❑ Multiple 0 , , PLUMBING $ 7 .DO ISSUANCE ' $ tractor(s) license pursuant to the Contractor's License Law). ,. - - GRADING $ ❑ I • am exempt under Section ' - . ' 'B.&-P.C.for this reason ' 'Firepl/Fact.'BIt. ICBO# • $'PLAN CHECK I $ , Date Owner. •'! Heating System& Ducting i ELECTRICAL $ /2, tO PLAN CHECK $ : MICROFILM $ • I-hereby.certify that I'have read this application and state that the above 00-100,000 BTU 0100,000 BTL - Information Is correct. I agree to comply with all city;and county ordinances ' TOTAL FEE' $ • and state laws relating to building construction,and hereby authorize repro- Hood orMECHANICAL $ I ; sentatives of anis'city to enter upon the above-mentioned property for Type., I ❑ Reinspection Fee' $15 l • y i LESS ' _ PLAN CHECK' ADVANCED PC $ Inspection purpos a Canopy Type II 0 $� , Signature Date�•�0•�� ) ' / Si‘rivers' Ucense or SS 9p . - ' Registers - Issue Fee $ 3 FINAL FEE: $ •�7`�'. rp CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor 1 U . . •,_ i,?CONSTRUCTION AND"PLANNI G - <_ " PO iSPA _ . fr �j' <Date, ;Inspector _ Date Inspector APPROVALS „ Permit# �/4� - APPROVALS Permit.# • " ' ;t- Temporary Electrical Service or::Pole I, . 52.: Pool & Equipment Location .'fop 4_-(t{RS _ " 2: 'Soil Pipe-Undrgrnd: : : ,, -. _53. Steel Reinforcement- ' l I 3:•Electrical-Conduit Utility Undrgrnd < 54: Forms : - - _ _ ..- ' .(. '3 4: Electrical Conduit Undrgrnd. _ • < - 55.' Electrical Bonding ` . 8, Steel'Reinforcement I P (.1 - 1 ; pj - `1 - 56. Rough Plumbing & Pressure Test . �r3 r C� < r ` 6: Electrical OF ER Grnd.• ' ;` ; r c : ✓� . - 57. APPROVAL TO COVER-GUNITE ,,. 1101 7. Footings • - eR .58. Electrical Conduit-Undrnrnd. . ; Tt . • 8. Foundation '� 59. Gas Pipe,-0 Undrgrnd ,Test - Ike, 1-egl-g3 I i I j 9. Water Pipe-Undrgrnd. 't ' 60. Backwash Lines,P-Tratp, ❑ Undr rnd. x ' 10. Structural Floor System ' 61. APPROVAL TODECK - .;y,•�.�a, G_p : _ 11. Property Sewer Line & House Connection' • 62. Backwash & Receptor-Final . ' '11.44A1 . r�D ' I _ 12. Sewer Cap , < :.' - 1 _ ;=63. Heater &-Vent-Final 13. Roof'Drains ' i '; I _ 64. Plumbing System - Final - - t 14. Rough Plurnbiog •- I - - • "65. Electrical-Final - '- i-R - oughElectrical-Conduit'i --- T ---_, - r . i- - T-' '- . v-15 • • ! ! �- -_66.. Solar System-Final � - - ' -16.,Rough:Electric Wiring . ` 1, : • ,• ,,i'� ,- - ., 671 Fencing& Access:Approval" - - - - 17. Rough"Wiring;Sig'n;' ' - r (d 68. APPROVED FOR PLASTERING , 7 3 ,C, a 18:l,Rough•Electrical-T.Bar Ceiling. It !I t I ' .7- 69.. POOL/SPA SYSTEMS FINAL " • 7'Q1,%1 Ce- , 1,9? Rough Heating& Air Conditioning ,. I " I I FIRE DEPT. REQUIREMENT a 20. Rough Factory Fireplace' �I 14 j APPROVALS: Permit# " 21. 'Ducts,:in Structure' i 70.' Underground Hydro • ::22. Ducts, Ventilating i . ; 71. Product Piping O Gas 0 Oil F 1,,23. Gas:Pipe-Rough & Test i !,,,- , -7 - -, ' I 72.' Underground Flush I 1 24.tRoof Framing-, I I . . I , !r. - 73. Undergrnd.Storage Tank ❑Gas ❑Oil. . 25.:.ii) Sheathing . i _ l i'" i• ,, I• Q i r :t . • 74. Overhead Hydro - -26. T-Bar Ceiling (Structural),& Monocoat' i ` �; ' ` ! ! a , 75. Dry Chemical ,• • ' 27. Frame and Flashing : n1 • 1 i 76. Dry Standpipe 28. iLathing& Siding' • I ii ` . i : ' X77. FIXED SYSTEM FINAL . ` ,, 29. ,Insulation `, -.7. C 1 � I ) 178. FIRE PREV. FINAL - - �_30. Drywall Nailing •�[' • i I ` Notes: 1 I 1 I I . . I I I - ( " "31. iPlaster Brown Coat ,“ ' I li !i ` Y32. ,Electrical Power Meter-Final ' 1 ! I ; 1 I ,_ , ' H :I ! , j 33, 'Final Electric 1 i, ! I I , • 1 34. Final Heating &'Air Conditioning !I 1 ' - ' 35. Final Gas•Pipe-Test - ' - I'• ' • ' 1 - - - 36. C.'.-' - ' - ' I ' I. i . I ! ' 1 . i Pt 37. Final Factory Fireplace , I - I • 1 ' - 38. Final Plumbing - ' ' ^I ! - - ' 39. Water Service-Final ' i ' 40. Gas Service-Final : ' . ' - z 41. Solar Domestic-Final l .,., - i - _ _ , . . t-. A' ' 42. Backflow'Preventer; I - I I I '•f1 7 43. Backflow{IrrigationI. . I`. I I ' . ;• ' I • 44. Landscape Irrigation System ; ' I ! - - , '+ ' • - • 45. Sound!Attenuation ; . ; ' _ • i' 46. Handicap.Regulations . I :I I' - I Y 47. FINAL, STRUCTURE & BUILDING :' i.; I ! ' ! , 1 48. Special Requirements Completed1 I • II . . ,,r, 49. Electric Release'to Edison , 1 . .I _ . ._�_. . - - 50. Gas Release to Southern California Gas Co i 1 ! - 51. CERTIFICATE OF OCCUPANCY . ! „ • No Date I ' ' �: DOWNER CLEGG. M. S. DATE 12-13-67 ' JOB ADDRESS 1877 Maui [ Hr is BUILDING PERMIT NO. 27899 GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Residence W/Att. Garage -AP No. 139-411-05 LOT 22 TRACT Ljg3 FIRE ZONE VALUE $ 30.959.00 IN" 'CTIONS 5j'gnat�ure Dote GROUP I & J TYPE V ZONE R-1 SL / S 412---2-6"7"' PERMITS ISSUED GAS �q/ ll`� ��y'� SUBCONTRACTOR �`� N 60 Dote Number Signature WATER Plumbin. ROUGH PLUMBING 1 'Inferdi ` {/79Jj�l a-25.-� 570 PROP. SWR. LINE HOUSE CON. rye -f-S"2-"2.94, 0W/ /an/.0-{/- _ t/ 7�I SPRINKLING SYSTEM u /��o'/ �/ Q// MISCELLANEOUS / �1'�,�' ! y ROUGH HEATING AND AIR CONDITIONING I3 -G[t TEMPORARY SERVICE OR POLE ISA,f$ /2o. UNDERGROUND 0 POWER ❑ 1p ROUGH WIRING ry� /ti z. IS ba �H/e�e iiin�q�and "JVpenntt..,� ��J TRENCHES �] FORMS rJ STEEL REINF. Q La /t -39-&7 1/ilii # T? M7/ IJ'ifl 11 � FLOOR SYSTEM al- i y CTR �y BOND BEAM n STEEL REINFORCE f ",n{l FRAMESHEAT ING R AND FLASHING "fes y✓ .../6j ..`9 LATHING - IN XI OUT ! 2_247*�' PLASTER. BROWN COAT / 3! Lj STRUCTURAL, FINAL �" .,�,+ Ele tr. / ,�/n Hf a, VENT., REFRIG. AND A.C., FINAL// y�2 Thr it/ !4'-2Q.L a0 /L+-C�e PLS. ..ING, FINAL AND GAS TEST �js JS ...Jr Ja -lj 2,Qoa.Zy/ ELECTRIC. FINAL �!" !o C:S! !! BUILDING, FINAL /Y 4;-1,5- r ' 27899 PAtB *** DEC —7-67070M 333* 139.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING / c'7 7 `� , ' , i G_ For Office Use Only ADDRESS / �"*�`( RECEIPT NO. PER IT N MCOSTA /MESA,,/C/ALIFO/RNIA —�7-6;7+ &79Y'. OWNER ///•S. CIES 4! a . R[C[1,V[D HY D/2- `G ED7 DAT[I 7 BUILDING Oja7 ( 22 /o/(/��/ _ MAIL �/D ��fj /�/(,rf'f- ADDRESS //f / ( J�/G2.C�.L C�/[.GCei ADDRESS /Vx//. // /t�.,/c��}��/ 94-,-- TEL Fj 7J FIRE 4 n CITY /DC7-C4'czr %cli-e NO. one/.. ZONE •. TYPE �// GROUP. --J2 APPROVES Y''N-©/ice ARCHITECT TEL. BY DAT! OR ENGINEER NO. ZONING ADDRESS ,�rr;; �/� ZOry� I PLANSNO.OF USE or raw BUILDING, / /4 �.I A' CONTRACTOR 6eG�ten- 'A` �J. IR ADDRESS DESCRIPTION G4 p/!�/ R ' `k C93 • A.P.NO. /3 / �7// d CITY NOTE: NO HAVE OVERHANG SHALL BE LESS THAN STATE "1 w.8 9 cp.- NO 90'TO 81D!a REAR P.L LIC.NO.OLS/ 7 VES SIZE 7P'K /is/ I J 'ellNOW4NLAT ALLOWED (U.B.C.REQUIREMENT) OF LOT /•l �� K 0 YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. J� - (FROM C/L STREET) CENTER OF SETBACK I STREETNE FROM cJ�C� REAR YARD ✓�--I FRONT PT. FT. (/' I SIDE YARDI LEFT ) v RIGHT v R.SIDE eoFT. FT. DESCRIPTION OF WORK 4.SID' 7 rr. (p // FT. NEW X i ALTERATION_ ADDITION REAR .acarr. PT. DISTANCE BET. BET.MAIN& REPAIR _ MQVIIINQ _QEMOLIBH MAIN FILMIC ACCESS.BLDGS. BUILDINGNO.OF .* DATE Z23'2 y�V��-IT ROOMS C CSTORI,E'S/ / C.UU�.pP.# ,['�� APPROVED EXTERIOR COVERING F- 4(16,40 GC�L I COVERING Ju/I'�"� BY�,//,3e,/y2_ / ) DATE /�—�— 6/ USE OF BU I LOINS AND WORK TO BE PERFORMED � ! 0' . //a GE (A//fy7 4.4a1e • nor.r, ri_-7, r^-•.T. t. RtYxITnr%......-e• 9 ___d/V eo.me; . 9 aY� 1 I HEREBY ACKNOWLEDGE THAT I HAVE D THIS APPLICATION THE OUNT SHOWN UNDER VA DATION IS FOR THE AND STATE THAT THE ABOVE IS CORR AND AGREE TO COM. PYRFOS[ OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AN TAT -LAWS REGULATING VALUATION BUILDING CONSTRUCTION. / � ^J IA SIGNATURE OF / lLPERMIT FEH $ "] p PERMITTEE /%� 9/J / G is J �/ iLAN CHECK S 734„75::0 1 AUTHORIZED AGENT . TOTAL FEE $/ 39 J a `r"""" O 'BRUiN, 3111 MnIL 3-22-// JOB ADDRESS 1877 Maui Circle BUILDING PERMIT NO. 43704 GENERAL CONTRACTOR David G. 1-Iartke DESCRIPTION of WORK Add Bedroom APNo. 139-411-05 LOT 22 TRACT 4593 FIRE ZONE VALUES 10,000.00 . IN :TIONS Signature Dat TYPE V GROUP I ZONE R-7 sOl_ PERMITS ISSUED GAS SUBCONTRACTOR Date I Number 1 _ Signature WATER 1.-k". 3-3)-71 � �J lam ng ROUGH PLUMBING 44t.A4i- p-f 17 7 -1- PROP: SWR. LINE 0 HOUSE CON. Q SPRINKLING SYSTEM MISCELLANEOUSr �jnl,,t • i2• ') ROUGH HEATING AND AIR CONDITIONING • TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER 0 ROUGH WIRING C. t-1.\-7) Heating and Vent. Ai-f]� TRENCHES [I FORMS n STEEL REINF. U.7. G - 6144-/44-4 3QG6.) r4)C, 4-!3-11 I.32e,� — FLOOR SYSTEM 7 343' BOND BEAM [i 'STEEL REINFORCE 0 SHEATHING ./-11' "/-G-77 FRAME AND FLASHING -C 4-1.\.,"”LATHING - IN .4 OUT 7 t. - • • '';',?..L...!-a....".-.4 __� PLASTER, BROWN COAT - ft i 4-T Z+ _ STP"^T UR AL. FINAL p � �� �e U' �/ HE 3. VENT., REFRIG. AND A.C., FINAL J4 � ,$- / �JJ d T£ ,�/-1I")) -J-�O SO PLUMBING, FINAL AND GAS TEST R (�.o 7 GRBNAM IJ.04s.) .itte- *-/3-71 '#aiLb ELECTRIC, FINAL R L 5-S-72 BUILDING, FINAL RC. 5-Tj-71 43704 :n ?2-77� -0(71?72 ) *wt "A'S 0.70 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to'Fill in Completely=Use'Ink'Only - . • -s RE/C�/jljV,�$�D BY DATE'RECEI E BUILDING y�{j-�/y7 � •_ V/ o' -161-7? DATE ISSUED ADDRESS f -.c! / /.�/r/s/;' .5-22,97 OWNER S L L C cNO/37.--W/a—C,/ T N O. �� �� A.P. MAIL �j �J p BUILDI / ADDRESS /��A / 7 42/9.(J t 0/u- - ADDRESSeat 6r • CITU 0:27n /1(�d3 • , NO.TETRAC O t BLOCK CONSTRUCTION' NEW ADD: ALTFR REPAIR MOVING OFMOLISH LENDER. . A • ` �.` - )- ) V. BRANCH �- - 0.0.0. (1521;51<). /( OWNER, ILL E • y( \; \AODRESS, .- \'- . '"� ‘ V t `VALUE S ARCHITECT \ TEL. S_ i/II D (`-/Irk $ OR ENGINEER NO. - FIRE ADDRESS, - ' %• -) _ \ ZONE TY•.E GROUP APPROVED', CONTRACTOR --Vniieff.0 6. • tt7r<e BY - A• 5 I . /' DATE � 2 72 1/4-ADDRESS X23! agies0 A)• I 0. . , -1) . /,fi."/yJ{/'J^ �J9 � A NO.*W & 2- ZD/ NO.OF U$E,OF NE ''' CITY 72 r//A` ' PLANS 7 BUILDING a 110-014-7-2-7 STATE --) `77�� -CITY•', 5• LIC. NO.. ,YARDS APPROVED . YARDS APPROVED / /7 LIC.NO. 1' MAIN BUILDING.) ACC SSO BUILDING Lc] SIZE NO.OF BLDGS. (FROM C/L STREET) 0.. OF LOT NOW ON LOT FRONT . , r FT. • Q USE OF • 'S / 1.:- /' .�. EXISTING BLDG.BLDG... Razg(LIleitC-C R•SIDE ‘ tip FT, k ' •• F Separate permits are required for L.SIDE IF/ FT. FT. electric,plumbing and heating work.. `,� - {'al REAR L+..� FT. \ - .':.FT.. . [.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& CMAIN BLOCS.- ACCESS. BLOCS. /�/n/ VAR.# DATE ♦ \ ..a �'/ �i• �EO ��(AC-/(IL_ "L1 D 'C.V.P.qjE• iC�� APPROVED �S.�/J 'r �W'� _BY R DATF��7 ��./ 7 C.• `'- - �•� ' ' • • ' , '1 J �/ / • 0 I hereby acknowledge that I have read'this application and state e I,ca _/ AO p / C that tho above Information Is correct and agree to comply with !f�'T' /11 e m all laws regulating building construction, and I shall not employ 4 C. ' Z any person In violation of'the workman's compensation laws of r sr', "ooze"ref� W the State of California. / 2 I hereby..certify that I am properly licensed as a contractor under y �)SO. FT. y N tho,State of.California Business and,Professions Code,plvision 3, THE'AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9,and that such licenses are In full force and effect,or I • THE'PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: u am exempt from th. •rovisions of the State of California Business �t o VALUATION PERMIT FEE $ 5z and Professions C•• s ivision 3, haps 9. m q O ' PLAN CHECK S /� et-i., m Signature of /JI Os� (((///..` �.y/J LL Permittee • ! Y $ l a TAX $ 20 U Authorized Agent TOTAL PAID $ O 0 b . •. . v % - . . , . - - .. •. . , 2 5 I4P, / a Yr And t- 53(57/ 4 ait . 57 to,age. e.frit ..; Z--$:\S-Jivi4 K Ac, c lair = ele_102 - ...- • M. . 7y , ___ Ity,(2.4..z.)(-077 • low-cov Cec4 0 a ,1 I let-Cy f ' . • Alnitte..7e4 • -7/Ct*r Lae ck A2d-nz-e--70 G1/2-14 ir -rit ( . rye?extrAill a 2/,a-n ey--a-cp ) •-h-cla, aldr- ott jire-/La / 2‘ dr_ c-cifoie-n ez-vt-r., --__ ..te-fic---tet-e•ce./ .. I . 1 .ifia-n. 75 .% ecni 4' 7 M 4 7-r • .. , .. . • is , . JOB ADDRESS 1877 Maui Circle!' BUILDING PERMIT N0. 439 GENERAL CONTRACTOR Irvine Pools DESCRIPTION of WORK Pvt.Srrim Pool tirf�a AP No. 139-411-05 LOT 22 TRACT 493 F12 IRE ZONE VALUE $ 5 75of'00 I' 'ECTIONS $ignatare Dare GROUP III TYPE J ZONE R-1 PERMITS ISSUED P . Location - SUBCONTRACTOR Dare _� Numb!. I Signature Forms 4 Main Drain Il•Steel Reinforce I Elec. Bond Electric�J ® �,y Approval to Cover 1-aCticen2 1 Fi`r 4 6=3-7 7 5a Dsdl Underground Electric Gas Piping Test Plumbing - • AA.Filtering System Lines L / S-2-77 y/ 1,09 Backwash Lines and Recep. • Electrical Final Heater and Vent Final Fi'tor System Final L Nash and Recep. Final Fencing Final Approval for Finish (Pre /0—e-V.'" 77 • 1 1 • ' 43912 -w _1-77p..-400 13z ;: 51 . c COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only PP INION FOR STRUCTURAL PERMIT R gN DATE RECEIVED DATE SUFE BUILDING 1877 Maui Circle 5' --/ ADDRESS i'l 01.5 .l OWNER O'Brien &Mt, A.P. NO./S9-4//-- VJ PERMIT NO. MAILBUILDING ADDRESS 1877 Maui Circle ADDRESS 1877 Maui Circle TEL. TRACT/kg-1LOT BLOCK MTY Costa Mesa NO. 545-3070 ,'-� CONSTRUCTION X NEW ADD`ALTER 1 REPAIR (MOVING DEMOLISH LENDER BRANCH WNER O'Brien)0 • ADDRESS <- ,�Y` ARCHITECT TEL. USE.,K�r�(//,_ a • ,UE 57,0 OR ENGINEER J.P. Anderson No. 546-8581 / 4500 Campus, Newport Beach FIRE �� DATE �(� ADDRESS ZONE GROUP APPROVED/J/4/4E CONTRACTOR Irvine Pools BV � S �ADDRESS 4301 Brich St. Z E NO.OF /'t USE OF NEW CITY EestaxMeaa Nww.ort Beacil 557-102 t PLANS _! BUILD( S^ t�� ti Z STATE y-1640 CITY YARDS APPROVED YARDDSA�PPROV_ c� LIC.NO. 281951 LIC. NO.reig. MAIN BUILDING ACCESSORY B ILDING � It SIZE Pool 575 SQ.FT. I NO.OF BLOCS. (FROM Gil_STREET) 571WL US NOW ON LOT FRONT FT. a OF USE OF Ci).. EXISTING BLDG. R.SIDE FT. Fx- Separate permits are required for L.SIDE FT. r-P*Ci electric,plumbing and heating work. REAR FT. e\. 11.1 I.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0 MAIN BLDGS. ACCESS.BLDG& � /� _� construction of pool & spa VAR.# DATE c.u.P.gbL. APP ED� V APPROVE .rl _11Ye�e `AT \ 2� 14 I hereby acknowledge that I have read this application and state \.` V / N a! that the above information is correct and agree to comply with — m Cin all laws regulating building construction, and I shall not employ /°� / Z any person in violation of the workman's compensation laws of p _\G' Q x the State of California. r ,(f, V 7• . �] � w I hereby certify that I am propefly licensed as a contractor under - the State of California Business and Professions Code, Division 3, THEA UNT SHOWN UNDE ALUATION IS FOR m Chapter 9, and that such licenses are In full force end effect,or I THE PUR E OF EST�LBL A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION rW`rE- and Professions /Code,JVDivision 3,Chapter 9. (cog' LU IT FEE $ ea- m Signatu /�%/�s�S�es's�'�`�'� �`"`' $ 5-757)7(�) Oc TAX CHECK S 2 Permitt J (J / LL Authorized Agent TOTAL PAID E C5f, 5--0 UWNtN O BF'N�RfBILL UAIt:. 5-.071f JOB ADDRESS In( Maui Circle BUILDING PERMIT NO. 45639 KGENERAL CONTRACTOR -P al DESCRIPTION of WORK Pvt. Swim Pew/spa _ qAP ' . LOT a TRACT 4593 FIRE ZONE VALUE $ 10,000. . .CTIONS iSignature Date GROUP J TYPE nZONE $1 Pool Location SUBCONTRACTOR PERMITS ISSUED Dote r Number j Sinnature orms Main Drain Steel Reinforce Electric I Elec. Bond Cover ?beta DH��-I , 3 A-703429 Approvalto Underground Electric Gas Piping Test ••.ing rila i 0 i Filtering System Lines • a11 .�, • /96 3' Q� ; '} Backwash Lines and Recep. i r r Electrical Final /l Heater and Vent Final D! F System Final 7-alact� r C' - . Backwash and Recep. Final ' s� tA -� • Fencing Final �:_: I a€39 COSTA MESA BUILDING-SAFETY DEPARTMENT 7154 3/10/73 75o70 TL P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 7'I Fp R/ I fl/77 75a 70G(TQ APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only /i nit , ,u& .s-: I II /, Q REV,/BY D1.6.../!I 3—Jo— g BUILDING /`/ / ///Cs ��/ 9Jf 8�71fJ( • OWNER rx 4e/c/ /,�.�t /G/�e//�CJ A.P. NO. 37- eii -0 '4c..111. - BUIADDRESS I() /7 a ('/C ADDRESSDEG /® � 1/yj/y t, �N (/��!/Wt+ • CITY �; te TENO1.S�S3a7o TRACT 457 '31 LOTZZ BLOCK CONSTRUCTION /'iypNEW App ALTER REPAIR MOVING DFMOLH LENDER / //4��//IIYYg LS BRANCH — OWNER �� 0{Se LQif/ ADDRESS i /Ll ARCHITECT i TEL ' / S' ,/ • I„/ Wig/ idle 0 'I i OR ENGINEER .I G A' �a f/. s • t s' t•IV i,Q253 ,,c .t*,,4Cx?5r Oa. FIRE ADDRESS ZONE YPE GROUP APPROV' • 4 / CONTRACTOR �� Ant( BY / // DAT �. / � a ADDRESS *3' (.5-7700/fr {ye USE OF //^,tet,(, CITY ��,yg NoTE`1179 a/4 ZONE / I P - BUILDING NEW J�v'r , - F STATE CITY YARDS APPROVED YARDS APPROVE LIC.NO. ,;78,65,4"..3 LIC.NO. MAIN BUILDING ACCESSORY BUILDING SIZE / NO.OF BLDG& (FROM C/L ST'EET)S. OF LOT g9 �/09-6 . NOW ON LOT j -ONT FT' tom_y4 A FT. a USE OF /J���q�y y/ cis EXISTING BLDG. /!"437L1v R.SIDE /2frS- / - ' FT. ca FSeparate permits are required for L,SIDE / FT. FT. electric,plumbing and heating work. Ci REAR FT. ` FT. I.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET.MAIN& C MAIN BLDG$. • ESS BLDGS. - -�� ) C.U.P.# DATE iin �fnfiLta / 4/1 VAR.',,, ' °� APPROVED } / APPROV tl/IA/rte. • • 15�r :777,.;.=-..„ 7--\ cm ch o ' � � I hereby acknowlatlge that I have reatl this epplleetion and state C'. that the above Information Is correct and agree to comply with 1• t , V �' all laws regulating building construction, and I shall not employ ] Q'-./C? n /” 't Z any person in violation of the workman's compensation laws of ./J 1'> "'-...t ( s M the State of California. /♦ ` , �. v I hereby certify that I am properly licensed as a contractor under SD.FT. — s- N the State of California Business end Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATI• IS si a) Chapter 9, and that such licenses are In full circa and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the Sty Cell/ornla Business VALUATION PERMIT FEE $ 5^�J end Professions Cod Division 3,Chapt- 9. S ��.a'✓D (i /�,� PLAN CHECK 3 g4•o o Signature of /n/v v v r— Permittee ^ !.f�� $ /r> TAX 3 f a I / /`f u Authorized,�.Beni TOTAL PAID 3 78,7,9