HomeMy WebLinkAbout2940 MAUI PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.BWiLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job nddress: 2940 MAUI PL
Suite:
Vicinity: HOUSE AND GARAGE ROOF
Primary Occ: R3 Type of Construclion: V-N
Parcel Number: 13925214 Zoning: R1
Applicanl: MCCLAIN, KIM
Address: 12812 VALLEY VIEW ST
STE 33
GARDEN GROVE CA
Owner: THpMAS, THOMAS LLOYD TR
Address 2940 MAUfPL �
COSTA MESA, CA
Comractor. -MCCLAIN ROOFING INC
Address: 12812 VALLEY VIEW ST
STE 33
GARDEN GROVE CA
Zip: 928d5
Arch :
Address:
Phone:
Phone: 714-897-1780
Zip: 92845
Phone:
2ip: 92626-3612
Phone: 714-897-1780
License: 625013
Eng:
Address:
Status: ISSUED
Applied: OS/192006
Issued: OS/792006
ISSUED BY: �
Phone:
Zip: License: . License:
SCOPE OF PERMIT
T/O EXISTING ROOF MqTERIALS, INSTALL 2 LAYER S OF 22" ASTM FELT AND REROOF PROTEX SHAKE (ICBO ER 5492) FOR ATTACHED
HOUSE AND GARAGE, APPROX 3800SF. REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00
Permit: $223.25
SMIP Res: $1.30
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $224.55
PLANNING & ZONING
SETBACKS
ACCESSORY
PARKING
Front 0- 0
Front 0- 0
Exi_stino: 0
Calc Vaivation: 5�3,000.00
Claim Valuation: 5�3,000.00
Rear 0. 0 Lefl 0- 0 itigh� 0- 0
Rear 0- 0 Lefl 0- 0 Right 0• 0
Reauired: 0 Pr000sed: 0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Callfornia statutes and re�ated
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: This permit shall automatically expire and become void Ii work is not commenced wlthin 180 deys, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the'work authorized under ihis permit to be considered legal, such work mus� comply wNh all applicable codes, and all
requlred inapeetlone and flhal approval must be obtained. Failure to obtain inspections and final approval wlll resuft in the explration of Ihis permit.
FOR INSPEC710NS CALL: (714) 7545628
:aauan 1�✓w)
WORKERS' COMPENSATION DECLARATION: � � -
I hereby eflirm under penalry ot perjury one of th0 �ollowing tleclaratlons: '
❑ I heve enA will mainWin a certilicate ot conSent to setl-Insure lor workers' compensetion, as providatl tor by section 3700 at the Labor Catle, for Ihe peAormance of the
work lor w�ich this pertnit is issuetl.
�-1 heve erW wll malntain workers' compensat� ��wrance, as required by s¢ction 3700 0l Ihe LaDor Code, lor I�e.peAortnance ol the vrork tor which lhis pemtit is issuetl.
I>�- Miy worke s' wmpensation Insurance cerrie� and policy number are: `r� L
Carrier.�'��%Z ��iL4� " POIicyNumber: �� �✓%�j0' Z�,�%
7Th15 section need not be cwnpleted il !he pertnif 1s veNetl ef one Aundretl tlWlars ($100) or /ess.J
❑ I certity ihat in t�e pertortnance ol tha work �or which Ihis permil is Issuetl, I s�all not employ eny person in eny menner so as to become subject to ihe workers'
compensatlon laws of Calilomla, an0 egree lhet If I shoulC become suD�ecl to the workars' compensetlon provislons ai Section 3700 ai t�e Lebor Cotle, 1 s�ell torthwlN
comply with these provl5ion�� (� I
Appllcem�Signeture: �� �Deio: _5"ll��� p
W ARNINO:fAI WFE TO SECURE WORNERS' COMPENSFTION WVERAGE IS UNL1W FUL AND SHALL SUBIECT AN EMPLOVEP TO CRIMINAL PENALTIES PND GVIL FlNES UP TO ONE HUNDRED
THOUSAND OOLLARE (5100,000). IN ADDITION TO TME �T OF �0�.1PENSATION, DAhNGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CADE, IMEREST, ANO ATTORNEY'S FEES.
LICENSED CONTAACTORS DECLARATION:
I hereby aHirtn ihat I am IicenseA under provlsions oi Chaprer 9(commencing wil� Section 7000) ol Divlsion 3 ot the Business ang Professions Cotle, end my license is 7n tull
torca ana enea. uc. u i c ss a, C �f
CailrectofsSignature: �N( ��� Oale: .J nf7
CONSTRUCTION LENDING AGENCV:
❑ I hereby eHirm Ihat Ihere is a consimction le�ding egenty lor Iha Oedormence of ihe work tor which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lentlefs Neme: Lentlers Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eXirtn chet under penelry ot Oerjury that I em EXEMP7 FROM THE CONTRAC70RS LICENSE LAW lor �he lollowing reason (Sec. 7031.5, Business antl Protessions
Code: Any clry or counry which requires e permit to cnnswct, alter, improvo, demolish, or repair any strudure, prior to Its issuance, also requires the eppliwnt tor such permit
to flle e signetl slatement Net he or she Is Iicensetl pursuant to ihe provlslons ot Ihe Cantractors License Lew (C�apter 9(commencing with Sectlon 7000) ol Division 3 of Ihe
Business and Professions Coda) ar thet he or she is exempt therefrom antl Ne basis tor the allege0 e:emption. Any violatlon of Section 7031.5 Dy eny epplicant for e pertnit
sub�ecis the applicant to a civil penalry ol not more than tive huntlred dollars (SSW).):
❑ I, es awner af the property, or my employees with weges es their sole compansation, WILL DO THE WORK, entl the stmcture Is not Intendetl or oReretl for ule (Set.
7044, Business and Pmfessions CoOe: The Comractors Licensa law tloes noI epply m an ownor of propony who builds or impmves thereon, end who does such wo�k
himseit or herself or through his or her own employees, providetl that such Improvements are not intanded or oHeretl for sale. If, however, Ne builtling or improvemenl is
sold within one year of completion, the owneo-builder will have the burtlen of proving that he or she did not buiid or improve for puryoso of sale.). �
❑ I, es owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to con5trucl the project (SecJ044, Business end Professians
Code: The contractors License Law tloes n0� epply to an owner ol propeny who builds or impmves thereon, entl wha wntracts tor such praect with a wntractor(s)
license pursuant to the Contractors License Laws.).
❑ I em e�empt under sec.
Signatura:
Owner ID veritietl Dy tlrivefs license. ❑ Yes ❑ No
eusiness and Pmlessions Cotle for this reason:
Venfication ol Ownership �y (type ol daumem, i e. - properry tax DIII or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERnFICATON:
Drivers License No.
Date:
Expires:
❑ I hareby cenity that no ezcevatlon Ilve (5) of more feet in tlep�h into which e person is required to descentl, wlll be made in connectlon with work euthonzetl by ihis
permit, entl �hat no builtling siructure, sceHo�ding, falsework, or tlemolition or dismantling thereol, will be more ihen thirty-six (36) teef high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltla e, Celilornia Atlministrative CoOe).
❑ As owner�builder, I will not employ enyone �o tlo work whic� would require a permil Irom Ihe Division ol Intlustriel Selety, es noteA ebove, unless auch person hes e
pertnit to tlo such work irom Ihe division.
Siqneture: Date:
Division of Intlusirial Safery Permil Num�or.
CERTIFICATE OF COMPLIANCE AND AUTHORWTON OF EN7AY: I certlly untler penelty of perjury that I heve reatl Ihis application end state thet the infortnation given is
correct. I egree to compy wilh ell siete laws end ��ry ardinances relating to builtling cons�ructlon, and authodze representa�ives at Ihe Clry ot Coste Mesa to emer upon the
above-desCribed properry tor inspection Duryoses� I agree rwt ro occupy or ellow occupancy of eny building authodzed by this pertnit unlil linel inspection.
COOE �. INSPECTIONTYPE '
1616 Fixetl System Final Fire Prevention
1288 Pool Spa Final
200 Finel R8-Root
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203 Finel Sign
204 Flnal Domolition
6-L�md 4c�
�
LODE I INSYECTION TYPE
206 Flnel Mochenicel
20B Flnel Plumbing
210 Finol Electdcel
212 Finnl Fire Prevention
220 Final Planning Approval
222 Finel Site
250 Final BuiltlingiOccupenc
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!IERNARD C. AUAMS'
C:VII ENG^::ca _ ]0183
12753 ftROG;iH7dgT (714) 636A29
f.ARf;EN G°CVF. CA 52660
POOL ?LAii� IiYC.
�06 t P� Soo
GITY OF LO^v 41fdJtS
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16CC.2 ZEDdJDo 42
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THESE DRAWINGS RS INSTRUMENTS OF SERVICE ME TME
7ROPEHT' OF THE ENGINEER ANO SHALL NOT BE REPRP
DUCED WITHWT iME CONSEM OF B. C. ADAMS.
lJOT� S •.
I 0+.1.. RJJr�IArJGs �iL �.ocM. OR UN GoOES.
Z WG17O �i.l Go�l'TpC.T Vl/I'T'F� ca¢[� TO 62
F2ESSJ¢.E "1'RIeA'STco OfG REW✓QOR
3 S{�p PC.OVI�ED WITH 'JKIMME�
q�wa sr¢���a ��000 Ps� yi" rtiac "t'
oz iz,me r5� '�/��" ,�
, iTvnei6e3� to i5�
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3!'�MMEE
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SECTION
� i��lll�'
CITY OF
AGP�Icant to flll In all
MESA 1 PERMIT NC
�N PERMIT G /:
Address 2 Q /
Arch/Eng. AVA: Y�� __ � License No.
Address �)����
_ _ �— � :r _ _ _
Addren
within heavy Eortler lines ana sign all a
TRACT NO. LOT
/ 3380 �
I hereby afOrm [�at I am Ilcense0 unOer provlslons of Charler 9(com-
mencing with settion 7000) of DlviSion 3 of the Business antl
P/ofasslons Cotle, antl my ���nse is In full Torw enC effact.
Ucense Cla a LI se o��
Date � ' Sl9nature
WORKE 5' C GPENSATION DE L ATION
I hereby affirm that 1 hava a��������e of consent to ultdnzure or a
certifirale of Workeri' Compansatlon Insurance, or a certi/letl copY
'•eof (Section 3800, Lab. C.��
y No. Company
.:ertified COpy is herlEy turr��shetl.
❑ CertlOeE copy is fileU with [he city BWltling Divislon.
EXEMiT10N FROM WORKERS' COMPENSATION DECI.ARATION
(ThiS 5¢cUon neetl not Ce cort�Pietetl if Ihe perTit ii for ona �untl/80
(EI00) or Iessl.
I cerbty that in the per(orTanu Of the wOrk fOr whicb Ihis permit is
issuatl, I snai� not emPioy any oerson in any manner so as to tecoma
subject to the Workers Compe�sation taws of Calltorn�a.
Data Signature
NOTICE: If atter making this Ueclaration, you shoultl bacoma subjo<t
to the Workers' Compensatlon provisions of the Labor Cotle, you must
to�thwith COTpIy with such proviSioni Oi 1h15 pe�mit shall be tl¢¢�fCtl
revoketl.
CONSTRUCTION LENDING AGENCV
� he�¢by aflirm that th¢re IS a con5tructlon lentling agGnGy for the per-
tormance of the work/lor wh{Ch thi5 pGrmit IS I55ueA (SettiOn 309]
Giv. CJ. I /
LenCer's Name �V��
L.eneer's Atltlras
OWNER BUILDER OECLARATION
I hereby affirm that I am exemD� from.the Contractor's Ucense L.aw for
Afly <I[y O! COU11ty WbICM1 lCqW!¢S d p¢fTl[ [O COOSIIIIC[� d1IC��
improve, tlemollsh o� repai� any st�uctu�¢, P/io� lo i[s IszuanGe, d150 ra-
quire5 the appliWnt for Such p¢�mit to file a Signetl statement that �C
is liGensetl pUrsuan[ ta [he pro��5ion5 of [h¢ ContrdCtor'S LicenSe Ldw
(Chapter 9(mmmencing witil Se<tion 7000) ot Dlvision 3 of [ne
�'ness an0 Professions CoAa) or that he Is exempt [herefrom and the
for the.dlle9¢tl exemptio�. A�Y �iolalion of SettiOn 7031.5 by
o. notmo e�than tiveep n�tlredbdolla�s (E500)icdnt to a clvll pen2lty
❑ I, as owner of the property, or my employees with wages as tnelr
sole compensation, will tlo the work, and the struc[ure is not intenaetl
or Off¢r¢tl tOr Shc¢. (5¢Ction 7044. Bu5ine55 antl Aofe551on5 Cotle: The
Contractor's License Law does not apply to an owner ot a prope�tY
who builtls or improves thereon, antl who tloes such work himselt or
through his own employees, Drovltletl thal such improvements are no[
in[entletl or offeretl for sale. If, however, the builtling or Improvement
is soltl within one year ot comp�etion, tne owner will have tM1e burtlen
of prOving h¢ tlitl not builtl a� Improve fo� lhe pu�pose of sdle).
❑ I, as owner of the properry, am exclusively conlracting with
IiCEnSed contraC[o�s to ConstN« the project (Section 7044, BuSin¢ss
antl Professions CoOe: The Con�/actor's LICenSe Ldw tlOes not apply to
an owner of property who bu�lds or imp�oves the�eon, antl who con-
tracts f�om such project5 wilp a ConVacto�(s) Ilcesnetl pursuant to
the Contracror's License Law).
❑ I am exempt untler Saction B. & P. C, for this
reason
Date " Owner
I h¢reby ce�tify [hat I have �eaU this appllcatlon anE zta[e [haf the above
information is cortett. I agre6 to comply wl[h all Uty antl cOuntY
orCinances antlyqt e laws re7�tin9 to�tonstruction ntl hereby authorize
representativeyo� this cjly t��enjpf uoon�e above mjntiope0
BLDG.NO.
TVPE OF C,�O/�$ TRUC�TIO�N
❑ NEW lD ADD L`I'I\LTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH `
❑ OTHER � � �
DESCRIPTION OF WORK A�� 2
/fVPE OF PERMIT
❑ GRADING ❑ FOUNDAT,��O,/N STRUCTURAL
❑ TENANT �ELECTRICAL L`�LUMBING �ECHAI
❑ OTHER / `
PROJECT DESCR�
SQ. FT. ��
OCCUPANCV CONSTRUCTIONTVPE y ,v
VALUATION �vZONE
GRADING CV. VDS. ACRES
PLUM61 NG
BATHTUBS
TOILETS
LAVATORIES !
KIT. SINKS
SER V ICE 51 NKS
FLOOR SINKS
ORINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOL
WATE{i SERV ICE
PLAN CHECK
SHOWERS !1
URINALS
DOUBLE LAVS
DISHWASHERS'
$VMPS ,�
FLOOR DRAINS
AITERHTION
GASSERVICE OVTLETS
WATER HEATERS BTU OUTPUT
SEWERCONNECTIONS
_AR TANK
LAR PIPING SYS.
ISSVE FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU_
ANDDVCTING 100,000+BTU_
REFRIGERATION 0-300,000 BTU_
SVSTEM 100,000+gTU_
BOILERS BTU
SVSTEM REPAIR,ALTERATION..
EXHAUSTSVSTEM MULTIPLE
Signature � - �a[e � I ISSVE FEE
Drivers' Licenze or 55 #
CMF 0865-46 White-Builtlin9: ��ary-Appli<ant; Pink-Ac<oun(ing: Goltlenrotl-Assessor
7610 10/29/81
`
A.P. �
ZONE
REAR VARD (TO P/L)
PKG. SPACE REQ. �—
STREET WIDTH �
ZONING APPROVED BY
SPECIAL CONDITIONS:
REF. �
ELECTRICAL PLAN CHECK
r GENERATOR p-1 KW_ 1-30 KW
TRANSFORMER
APPLIANCE 30-50KW_50+KW
. . MOTORS � 0�1 HP_3-30 MP
, (INC. SOLAR) 30-50 HP 50 + HP
� ` FIXTURES � OUTLETS
� r - _ GAS TUBE SIGNS
� , POLE LIGHTS
POLES METERED
PANELS MAIN
SERVICE
, /
ISSVE FEE
7 _ APPLICATION APPROVED BV
SW�TCHES
SUB
AMP
361.51 TL.'
E �
DATE
SUMMARV OF FEES '
BUIL�ING �
PERMIT E � SMIP E��
PLAN CHECK E �.�' PERMIT
t ISSUANCE 5
PLUMBING $
GRADING S
. PLAN GHECK § � �
ELECTRICAL S _j."_ S
PLANCHECK E MICROFILM E
MECHANICAL $—�r � TOTALFEE$
PLAN CHECK § - LESS AD-
� VANCE PC E
F FINALFEE S�`�/'�
'J + '
CONSTRUCTION AND PLqNNING � POOL & SPA �'. • � ���
APPROVALS Permit '�aG I57J Date Inspector APPROVALS Permit#• .. Date Inspector
1. Temporary Electrical Service qr Pole 43. Pool & Equipment Location ' �
Soil Pipe-Undrgrn 44. "Steel Reinforcement ' ' •
3. Electrical Conduit Utility-Unqrgrn -. � 45. Forms ��� �
4. Electrical Conduit-Undrgrn � 46. Electrical Bondin " '"� ' � -• � �
. tee em orce 47. Rough Plumbin & Pressure�7est '`�"• �' ' •
6. ElectricalUFERGrn - 48. APPROVALTOCOVER-GUNITE_� `���� ".- ' -
7. ootings � 3 � 5 49. Electrical Conduit-Undr rn
8. Foundation ' 50. Gas Pipe, ❑ Undr rn, Test
9: Water Pipe-Undrgm 51. `�Backwash Lines P-Tra �'� ndr rn ��s
10: StructuralFloorSYstem 52. APPROVALTODECK"`' '- • s�.� '�
� 11. , Property Sewer Line &.House Connection � � 53. Backwash & Rece tor•Final �
12. Street Sewer Connection � 54. Fleater & Vent-Final
� 13. Rough Plumbing �' ,j�_ °L - '
1�4. Rough Electric-Conduit - . �56. Electrical-Final
15. Rough Electric-Wiring - _$� 57. Solar System�Final - ' � •�
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure � � APPROVED FOR PLASTERING
18. Ducts, Ventilating f >3 -431
19. Gas Pipe-Rough &Test � � 60. POOL/SPA�SYSTEMS FINAL � •
20. Roof Framing � � � - - � � �
21. Roof Sheathin • ' ' ;2- � . ( ' •' � . � . ' . ,
22. Frameand Flashin ' - - -� NOTES: � • _
" 23. � Insulation -� ' - - -$,� � -� `� '
24. Lathin &Siding -7-8 �
25. Drywall Nailing _ _$� �
26. Plaster Brown Coat , , � '
27. Electrical Power Meter-Final •
28. Final'Electric � - �$1 .L. � -
29. Final Heating & Air Conditioning ' ' �
30. Final Gas Pipe-Test �
31. Final Plumbing a- 3- _� � - �
32. Water Service-Final ' � �
33. Gas Service-Final ' - �
. 34. Solar pomestic-Final •
3' Landsca e S rinklin S stem `' � '
36. Sound Attenuation '� � ' � ' �
� 37. Handicap Regulations �-- - � ` - � �
38. FINALSTRUCTURE&BUILDING � ',j_3_$� L', L', -
39. Special Requirements Completed �
40. Electric Release to Edison . • � � � - -
- 41 . Gas Releas= to Southem Calif�ornia Gas Co. - - "
42. CERTIFICATE OF OCCUPANCY � � �
� �� .No. Date _ . � .,��.. ��`•. .
� .�'.
ADP��cant to fi11 in all soaces witnin neavy bortler lines antl sign all apD�ep��ate aeclarations.
� GTY OF COSTA MESA PER IT NO. p TRACT NO: LOT NO.� BLDG. NO. � �(J(%3 I Y 15/82� B�OO T�.
CONSTRUCTION PERMIT � o�T 30�.7 -" � ' �
' Project Address (� . .. TVPE OF CONSTRUCTION � . � . � . ' .
Owne� � ' -' Phone ❑ NEW ❑ ADD - ❑ ALTERATION (�y� ' � ' ' - ` �
�� " 1
,Addrest ' ' � ❑ REPAIR ❑ COrvvERSIOfJ ❑�DEMOlISVi . ZONING REGULATIONS '
Arch/Eng. ' LiCense NO. ' ' � OTHER _ _ .
. DESCRIPTION OF WORK' A'P' �
Address - � - � �� ' � - ZONE � � PLNG. REF. �„
� Contractor /�j fG�[ Phon TVPE OF PERMIT �� � B � -� �� e�iLDWG �
�, SETBACK C ST. OP RTV LINE
�: Address - - ' � � , ,- ❑ GRADING ❑' FOUNDATION ❑ STRUCTURAL - �SID� VARO - - - �- - � ' '-
LICENSED CONTRAC OR-DECLARATION ❑ TENANT O ELECTRICAL ❑PLUMBING ❑MECHANICA �5 EDE VA �
, 1 hereby aftirm th:.t I am licensetl untler provisions o( Charter 9(com- • .�• � {iIGHT '
\rtiencing with sectlon' ]000) of �Divlsion' 3 0( tne Business antl ❑ OTHER �
Professions Cotle, antl my license is in full force antl etfect. pROJECT.DESCRIPTION REAR VARD (TO P/L)
� License Q sz ic nse o. 7�� � ,, PKG.SPACE RE�. � , PROVIDED �
� Date � $ignatu� ` ' � $Q• FT: ' ' � - --- ' � � 'STREET WIDTH PARK FEE $i. ,�,`�
WORKE 5' COMPENSATION'DECLARATION - � �� � OCCUPANCY!' CONST.RUCTION,T.YPE .
I hereby affirm that I have a certificate of consent to zelt-insure or a ' •-� � . 'ZONING APPROV ED BY ' DATE - .
cer[i(icate of Workers"ComOeosation InSurance, or a certifietl copy VAI.UATION ' 20NE _ �' �� ��
1' �o� (SectiOn 3800, Lab. C.j. GRA�ING CU. YDS. ACRES SPEdAL CONDITIONS:
� No.- " ' ComPanY - - .. . -' ' - � � -- . . .
L _artifietl coOY'is h¢r¢by fu�nishetl: - -- -- REMARKS: - � -' � � -_ _. _ _
❑ Certitietl copy is filetl with the city Building DivisiOn. � . '• '
,' � .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � - '� - - � � - � - - - ' - - . -
(This section neetl not be rompletad if.the permit is tar one M1untlretl _ -" _ , ' .. _ . . � ._ . _ . . _ '' ���c�`_ . '
(a100) OI IE55). ' '. '. ' ' �' ,' .
I certl(y-thaLin the performance.ot the_work for whiCh thls.pe�mit I5 �
issuetl, 1 shall mt employ any p¢rzon in any manner so as to betome PLUMBING- . -PLAN CHECK � �- � ELECTRICAL PLAN CHEGK �
subject toihe Workers' Compensation Laws ot Califomia. - .-- -.- _. _- . . _ _
Date - Si9nature BATHTUBS SHOWERS �
NOTICE: If after making this tleclaratlon, you shoultl betome subject' TOILETS� �� URINAl.S � �-� GENERATOR' - 01 KW �_1-10 KW � .� -
to th¢ WOrkCrS' COmpensation provi5ions of the Ldbor Cotle, you must � _ _. _ TRANSFORMER . _ �
lorthwltM1 comply with suth provisions o� this permit Thall be tleemetl LAVATORIES OOUBLE �AVS �APPLIANCE -10=50 KW_50 + KW -
revoketl.. .. '" ' "" '. .... .. . . .�,_ . .. " "_ _ �
CONSTRUCTION LENDING AGENCV � KIT. SINICS DISHWASFIERS � � I ""MOTORS"" ""- 0-1 FiP'_1=30 HP' '- �.
I her¢by aftirm tha[ there Is a const�ucti0n lentling agen<y for the per- SERVICE SINKS. . SUMPS "' ' +UN0. SOL-AR)- -10-50 HP_-50 + HP�- � - � -
formance of the w r for which this permit is iszuetl (Section 309] ' � �
Civ. C.). FLOOR SINKS FLOOR DRAlIVS � ' � FIXTURES �OUTLETS" SWITCHES' ' - "
Lentler's_Name � ' '
Lentler4 Atltlress DRINKING FOUNTAINS �i ' � ��� "' � �G'AS TUBE'SIGNS - '" - ' -- ' " - ' '
OWNER BULLDER DECLARATION "� � " - INTERCEPTORS CLARIFIERS POLE LIGHTS" - " - - ' '
I hereby a((i�m thal I am eaempt frotn the Cont�acto�'S Li[ense Law for �
the f611owing reason (Section �03175'Business'antl'Professlons Cotlei ' SWIMMING POOL PTRAP � � - ' ' ' " - � ' , -
... .. .. ._. . . � . � . ..
Any city or_ county whith requires, a permit to consVuct, alteq S 'POLES METERED SUB
improve, tlemolish or rep5ir any struc[ure, prior io"its issuance, also re- yyqTER SERV ICE � ALTERATION� �.V"j�� 1PANELS � MAIN - � SUB-' ..' '
quires the ap.licant fo[ such permit to file a signetl ztatement that he -' `
is licensetl pur3uant to lhe provisions of the Contractor's License Law GAS SERVICE OVTLETS '$ERVICE - - � AMP' _. �+
(Chapter 9(commencin9 with Section 7000) of Division 3 of the -
P,;;;ti.uiess antl Prdessions Cotle) or [hat he is'eBeinpt lherefrom antl'[h¢ yyqTER HEATERS BTU OVTPUT� �� "-" "' -' . "- "' '
��`Por the allegetl exemption. Any violation of Settion '/031.5 by
't'�Spplicant "for a pe�mit-subjec[5'the ap0�itant t0 -a clvil penalty SEWER CONNECTIONS � � � i - '- '-� - - �' � .
6\bt more than live huntlretl tlollars ($500).
. �
_ __"_ . .._._ """' ._..__ _.� . . _ � . - _. _. . ._' _ _"_ "
❑ I, as owner of the �property, or my employees with waqes as their SOLAR TANK COL'LECTORS �� -- ""� .'. _- —' -. _ - -, _ .
Sole compensatian,-will tlo.the work, antl the SSIpCI11IC.15 OOI IfItCfIG2G ' � _ � � - �
or oftered for sale. (Section ]044, Business antl Professlons Cotle: The SOLAR PIPING SVS. " � � ISSUE FEE� - -� "- - ""' ' '--� '- ' � ' �
ConVactor4 License Law-tloes not apply Io.an owner_ ot a _ . _ _ _ _ . . _. __ __ � �
p�operty 'APPLICATION'%�PPROVEOBY ' ' DATE
who builtls or improvez the�eon, antl who tloes such work himselt or ISSUE FEE '
�h�ou9h bis�own employees,-provitletl that such_improvements are m[ . � _ _ _ �__ _ _ _
intentletl or oiferetl for sale. If, howeveq the builtling or improvement MECHANICAL PLAN CHECK SUMMARV OF FEES, .l !
is soltl�within ona year ot.mmpletion,.the.owner will M1ave the,bu�tlen - � -- �
of proving he ditl not builtl or improve for the purpose of sale). -�6VICDING-' '' "-"- --� -" '-'-'- ' ---
� I'.'as owner of tlte property,- am'-exclusively"contracting� with HEATING SVSTEM Od00,000 BTV ; PERMIT . E '� �. !.-'SMIP(7: � $� •
ANDDUCTING�- ' - -�- -"' """ -' ""' -" � ' �
licensetl contractors lo construct the project (Section 7044, Business 100,000;+ gTU � �PLAN CHECK $ � BERMIT � '� ';
dntl'Professions Cotle: The Contracror'S'"Litense L:aw tloes'not apply to - - - - - - � - - ISSUANCE 5 - - -
dn owner of proper[y who builds or improves ther¢on, antl who cam qEFRIGERATION 0-300,000 BTU .PLVMBING E • '� .� ,�E
[ratts'from'sucn'prolects'with-a�contractor(s)� licesnetl pursuant to SVSTEM' -"" ' - - -" "- - - ' - - - - -- - - - � GRADING �'.E �
theConVactor'sLicenseLaw). 100,000:+gTU �PLANCHECK $ '' ' , ,
^'"_"_ "" '. _'_�_'" ' "_ __. . _ . . , ' � '
� 1 am exempt untler Section B. & P. C. for Nis �ELECTRICAL E -�.�_ �SL__ � � E�
BOILERS BTV �
ieason' - - - ' ' ' - ' ' - - - . . MICRORLM E
Date - Owner - - _ SVSTEMREPAIR,ALTERATION � PLHNCFIECK�E� _ .
� � � - - - - MECHFINICHL �$ TOTAL:FEE E �
1 hereby certifythat 1 have reatl Ihis appliCation.and state.that the.above. EXHAUST SYSTEM . MULTIPLE _ � �• ' ��• ' '��LESS AD- ' i
information is correcL 1 agree to comply with all city antl county , PLAN'CHECK $' VANCE PC 8, -�
or0inances an te laws r ati g to c nslruction, antl he�eby,autho�ize ' � ', �
represenla[iv o this iS e r the above menti netl � `
p�operty .fo� ins ctlon _ ' � '� o O
Si9nalu�e,_ Date 1 ' � � ' � FINAL FEE S Q� �
Drivers' License or 55 �
- "ISSUE FEE - ' -- ' - ' � - � -�- ^ - - -
CMF 0865-46 White-Builtling; Canary-Applicant; Pink�Accountin9: Goltlenrotl-Assessor
CONSTRUCTION AND PLqNNING � POOL & SPA ' - ' � _� , �
APPROVALS Permit # Z3Z Date Inspector qppROVALS Permit #�� ^" Date Inspector
1. Temporary Electrical Service or Pole �-�. ` 43. Pool & Equipment Location - - � -- ' �
2. Soil ipe-Undrgrn � 44. Steel Reinforcement -
. 3. Electrical Conduit Utility-Undrgrn 45. Forms '
4. _ Electrical Conduit-Undrgrn 46. Electrical Bonding - -
. tee em orce 47. Rough Plumbin� &'Pressure Test � � '
6. Electrical UFER Grn �' 48. APPROVACTO COVER-GUNITE• �- � � � '
7. Footings 49. Electrical Conduit-Undr rn � �� � �� -
8. _Foundation � ' 50. Gas Pipe, ❑ Undr rn, Test �
9._ Water Pipe,Undrgrn_ ' � 51. Backwash Lines P-Tra �� ' ndr m� � �
10. .StruciuralFloorSYstem , ._ -_' ..� 52. APPROVALTODECK�--- ` ` '"-�^""-"'"' ��-=�• ' �'
� 11. Property Sewer Line & House �Connection '� 53. Backwash & Rece tor-Final �
� 12.. _ Street Sewer Connection ' � � 54. . Heater & Vent-Final � � � �
13.. Rough Plumbing _ '- � - � -- � -- •
, 14. Rough Eleciric-Conduit - - � � - � _56. Elecuical-Final � � • -• �
15. Rough Electric-Wiring ' ^ ""' ' -- - - �- � 57.- Solar System-Final ' ' ' � -
16: �- Rough-Heating & Air Conditioning- - �� - � Fencing & Access Approval
. 17! Ducts� in.Structure . �'� i_ ' 9• APPROVED FOR PLASTER WG � '
18. Ducts, Ventilating � ' '
19. Gas Pipe-Rough &Test - ' ' � 60. POOL/SPA SYSTEMS FINAL - �
20. floof Framing - � - -- � � ' ' � �
21: Roof Sheathin � - -- - --�--. . . • , , . ., .� -, �
� 22. FrameandFlashin� � � � � NOTES: � " " ' � ' ' � ' �
23. Insulation - - - ` ' - ' ' �
24.- Lathing & Siding , i - - - . -- - -
' 25: Drywall Nailing ' ' � .. . . � ' ' � � � ` '
� 26. Plaster Brown Coat - ' ' ' ' � ' " � � ' �
, 27,_ Electrical Power. Meter-Final ' ' ..3.� 2 � ' � �
� 28! - Final Electric � ' ' � �
' 29. Final Heating & Air Conditioning. i. - '
� 30: _Final Gas Pipe-Test �
31_ _ Final Plumbing � ' - ' � ' " �
� 32' �Water Service-Final ' � � �• � � ' - ' ` "
33.: . Gas Service-Final � � - � '� ' • �
. 34. Solar pomestic-Final '� � ' ' �t�� "� -' � ' �
35. landsca e S rinklin S stem I � ' " ' �' �
36. Sound Attenuation • ' � �- � • '
' 37. Handicap Regulations . � � , + � �- - � - � �� - � '
38. FINALSTRUCTURE&BUI�,pING •� � � ' ' - - � ��
39. Special Requirements Completed - ' - "
40. Electric Release to Edison � � a - ' " - " � - ' - �
� 41. Gas Release to Southern California Gas Co. ' � � �
� 42. CERTIFICATE OF OCCUPANCY -
� , . . , ,
No.--- Date - - � ._� �- , � . � . .� !
- - - - - - - - - � - - - - - ._� _ _ _, � ' - -
ApPllcant lo fill in all
�� CITCOF COSTA MESA � �aEa{ry� T�N,c
CONSTRUCTION FERMIT � /'oGi
Address
License No.
�WYii—I��.L/�=-:_ •rb.."!S!.�
witltin heavy Oo�tler lines anO sign all appropriate tleclaratlonf
TRACT NO. LOT NO. BLDG. NO.
� - 3380 2�
TVPE OF CONSTRUCTION� �
� ❑ NEW. ❑ AOD ❑ ALTERATION
-' -O REPAIR ❑.CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
;
_.,•
`� 1',����-����-�A�2'3 "12/22/BI 5.00 ;TL
' H �� �" '. ' • . ' - . . , .
, i�� '� , - � � . .
rnone JZ TVPE OF PERMIT i
AddfC55 . O GRADWG ❑ FOUNDAT�IO/ry ❑ STRUCTVRAL -
LICENSED CONTRACTOR DECLARATION • ❑ TENANT ❑.ELECTRICAL �OPLUMBING ❑MECHANICAI
) 1 hereby a(flrm that 1 am Iicensetl under provislons of Cbartar 9(com- • .
N mancing with section ]000)' of'-Divislon 3'of the-'Buslness antl ��OTHER
�a Professions Cotle, itl my Ilcense is in full torce tl efiect. ppOJECT DESCRIPTION
Lit¢nsBCl 5 - �I 5 N 2� �: ,� '
\ Date��' Si9nature' ' SQ.FT. � - -
'WOHK RS' OMPENSATION �ECLARATION OCCUPANCV_CONSTRUCTION TVPE
� I hereby_atfirm tha[ I �ave a certificate of consent to self-in5ure or a VAIVATION • � ZONE
ce�tltiUl¢ of WO�ke�s' CompenSatiOn Insu�ance, o� a Certifietl copy , - �
"+ereof (Sectlon 3800, Lab. C.j. GRADING CU. VDS. ACRES
Ity NO. COTPany �
: Certlfietl copy Is hereby lurnishetl. • �- � - � � ' REMARKS: ' - � --
❑ Certilled copy is fil¢a witn the city Builtling Divi5lon.
EXEMVTION FROM WORKERS'-COMPENSATION DECLARATION � ' � � " � -
(This seclion neetl �not be comple[e0 if the Oermii I5 for one huntlretl . _.
SE100) or less�. •
certi(y lhat in lha�performanc¢ o4the work fo� which thi5 pe�mit IS
issuetl, I shall not emPloy any person in any manner so as to become PLUMBING" �. � PLAN CHEGK
SubjG<t to fhe Wo/kers Compensatlon LawS of California. - .
Date Signalure� BATHTUBS SHOWERS
NOTICE: It alter making thls tlecla�ation, you ShOuld becomG'SUDjecl -TOILETS " VRINAL$
to the Workers' Compenzation provi5ions ot [he IaEor Catle, you mus[ � .
brthwith compty with sucb provisions or this permit shall be tleemetl LAVATORIES DOVBIE LAVS
� revoketl. - - � - - - - - - .
CONSTRUCTION LENOING AGENCV KIT.SINKS DISHVJASHERS
I hereby afflrm tbat there 15 a constru<tion lentling aqency for the Oer- SERVICE SINKS � SUMPS
formance,of_ the work fy► hicy� h this permit is issuetl (Section 309]
� Civ. C.). ��� Y_ FLOOR SINKS F�OOR DRAINS
Lentler'S, Name �� ���N••��� _
Lentler'S Atltlress DRINKING FOLINTAINS •
OWNER BUILOER OECLARATION�- -� � INTERCEPTORS CLARIFIERS
I nereby affirm tha[ I am exempt from t�e Conlractor's License I..aw tor
the following reason (SectiOn 7037.5 Busines5 antl PrOf¢s5lons Code: SWIMMING POOL P�TRAP -
Any city or munty which requires a permit to construcq alter,
improve, Oemolish or repair any structure, prior [o its issuance, also re-' yyATER SERVICE ALTERATION
pulres ttle ap4���nt to� such pe�mrt to tile a siqnetl statement that he
i5 Iltensetl pursuanl to tfie proWsions of [he Contracfor's License Law GAS SERVICE OUTLETS
�Cbapter 9(commencing with Sectlon 7000) of OivlSion 3 of the —
'usiness antl Profesnons Cotle) or that he is exempt [herefrom andthe yyATER HEATEftS � BTU OVTPUT� �
%'�xyi5 fo� the alle9¢tl_exemplion. Any violation ot Section ]031.5 by
;�.;� appltcant'for a permit sub�ects the applicanf to a�civil penalty- SEWERCONNECTIONS �
_� not more than five huntlretl tlollars (5500). ��
❑ I, as owner ot Ihe property, or my employees with wages as their SOLAR TANK COILE,CT'ORSti � -- _, �
Sole Compen5ation, will tlo the-wo�k, anC Ihe SVucture is not intentletl
or o/t¢r¢tl fOr wl¢. ($ection ]044, BuSin¢55 antl Pi'ofe55ion5 Cotle: Th¢ $Ol_AR PIPING $Y5. � �
�Contractor's License Law tloes not appry to an owner of a properiy . .
who bulltls or improves th¢reon, antl who tloes such work himself or ISSUE FEE
lh�ough his own ¢mployees,�p�ovitletl that such imProvlmen[s ar¢ not
intendetl m offered tor sale. It, nowever, the builtling or improvement MECHANICAL PIAN CHECK
is�soltl within one year of completion, the owner_will have the burden
ot p�oving he tlitl not builtl o� improve for the purpose of sale). HEATING SYSTEM 0-]00,000 BTU
❑ I, as owner-of '[he 'property, am ezclusively contra<ting with AND DVCTING '- --
Iicensetl contrattors to conSVucl th¢ Project (Section 7044, Business 100,000+8TU
and Professions"COtle: The COn(rd[tor's Llcenz¢ I:aw tloes not apply to "
an owner of property who builtls or improves thereon, antl who mn- REFRIGERATION 0-100,000 BTU
t�acls'f�Om sU[h"profects'wlth a Contracto�(5) IlCesneE' OurspanYto SYSTEM- -' ' '
Ihe Contrac[or's Ucense Law). 100,000 + BTV
❑ I am exempt un0er Sec[ion � � B. 8 P. C. for this BOI LERS BTU
reason' ' ' —"
Date - - Owner - - - SYSTEMREPAIR.A�TERATION
I hereby certifythaLl have reatl this application antl state that Ihe above EXHAUST SVSTEM MULTIPLE
- Informalion 15 cm�ect. I a9ree [o comply with all city antl county
.o�0inances an � ate laws elating to onst ��ction, antl.hCreby autM1O�iie
representativ f ip95 it/D� t [er qon the above� r/r� ntlonI ptl
.property fo i s ¢cllc (I/ _ _ _ /�/ / . . .
Signature � V Da[e
Drivers' Licenseor SS � '- ISSVE FEE
� CMF 0865-46 White-Builtling; Canary-Applicanh Pink-Accountlng; Goltlenrotl-Assessor
� ��� ZONINGREGULATI(
A.P. if"u ��_ _. __
ZONE (�I � � . PLNG. REF.
REAR VARD (TO P/l)
PKG. SPACE REQ.
STREET WIDTH
ZONING APPROVED BV
iPECIAL CONDITIONS:
ELECTRICAL
PRpVIDED
� .. PARK FEE S
DATE
PLAN CHECK .
GENERATOR 0-1 KW_1-10 KW '
TRANSFORMER
APPLIANCE -10-SOKW_SO+KW ' �
MOTOR$ �� 0-1 HP_1-30 FiP
(INC. SOLAR) 30-50 HP 50 t HP'
FI%TURES � OUTLETS SWITCHES
"GAS TUBE SIGNS '
POLELIGHTS �� � '.
PANELS � MAIN . SVB - �
ISSUE FEE I - I
qPPLICATION APPROVEp BV ' ' DATE
SUMMARV OF FEES •
BUIIDING " ' _ .
PERMIT $ SMIP - 3
PLAN CHECK § � PERMIT �
- ISSUANCE S
PLUMBING E � GRADING S-��
PLAN CHECK .§ �' � � � ,
ELECTRICAL E §
PLANCHECK E � " - MICROFILM S _
MECHANICAL y - TOTAL FEE S' �
PLAN CHECK 'E � �-ESS AO � ' .
VANCEPC b_
� - . . FINAL FEE y `-'
CONSTRUCTION AND PLANNIN ...� - �. � ,, :��' POOL & SPA �
APPROVALS ' � - � ' Permit # '�' ..�Jo Date Inspector qppROVALS Permit #�^ � ' Date � Inspector
1. Temporary Electrical Service or Pole� 43. Pool & Equipment Location -- -� ��
Soil ipe-Undrgrn ' 44. Steel Reinforcement - '� �
3. Electrical Conduit Utility-Undrgrn 45. Forms � '•�•`� '
4. Electrical �onduit-Undrgrn 46. Electrical Bonding -� = � �>�:• ��. -„_ �._ _`
tee ein orce � 47, Rough Plumbin & Preswie'Test �"-'^ � :•��. �-
6. Electrical UFER Gm 48. APPROVALTO COVER-GUNITE- --�"�`-' J,= �'=
7. Footings ' - 49. Electrical Conduit-Undr rn
8. Foundation � 50. Gas Pipe, ❑ Undr rn, Test • �
9. Water Pipe-Undrgrn '- 51. Backwash Lines P-l}a �"�� nd m � -� `
10. Structural Floor System 52. APPROVALTO DECk� �"'�'"'�'�- '�'''" "� ' ' ' • �' ��' �`
11. Property'Sewer Line & House Connection 53. Backwash & Rece tor-Final � '
12.. Street Sewer Connection • � • 54. Heater & Vent-Final
13. Rough Plumbing =
14. Rough Electric-Conduit - • � 56: Electrical-Final
15. Fough Electric-Wiring �- - 57. Solar System-Final
16. Rough Heating & Air Conditioning � encing & Access Approval .
17. Ducts, in Structure � APPROVED FOR PLASTERING
18. Ducts, Ventilating - �
19. Gas Pipe-Rough & Test . 60. POOL/SPA SYSTEMS F INAL
20. Roof Framing • � �
21. Roof Sheathin
22. Frame and Flashing NOTES: �,
23. Insulation
24. Lathing & Siding �
25. Drywall Nailing
26. Plaster Brown Coat � ' �
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning _ �
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final ' �
33. Gas Service-Final � �
34. Solar pomestic-Final
35. Landsca S rinklin S stem
36. Sound Attenuation -
37. Handicap Regulations - -
38. FINAL STRUCTURE & BUI LDING
39. Special Requirements Completed '
40. Electric Release to Edison
47. Gas Release to Southem Cafifornia Gas Co.� -
42. CERTIFICATE OF OCCUPANCY
� , �. ,
No- Date � , . .
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,
�WNER TfiOMAS
�JOB ADDHESS
S" Gk:NCRAL COi
DATE 5-22=64
BUILDING PERMIT NO.- 21
vnr.vE s 2i.6q�.00
SUBCONTRACTOR
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CbSTA MESA BUILDINGSAFEfN DEPARTMENT
P. O. 90X 91] CO9TA MC9A. CALIFORNIA
For Applicanf fo Fill /n Completely
OR PRINT
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COSTA MESA, CAL FORNIA
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DESCRIPTION OF WORK
BUILDIN6P 5 71f
SIZE 7 7 �
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COVERING
USE OF BUILDINO ANC
OF
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MAY 5 1984
FINANCE OEPT.
CITY Of C0.StA MESA
APPLICATION FOR PERMR
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For Oiiice Use Only
R[C[IR NO. � pHRMIT NO. /
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I HEREBY ACKNOWLEDOB TXAT 1 NAVB R6AD TNIB APPLICATION TIE AMOUNT BX !
AND 6TATE THAT THE .�BOVE 19 COqqECi ANO AORH6 TO COM� PURPOSE OP 88TAp
PLY WITH nLL CITY OR�INAHCfi9 ANO BTATB LAWB P80ULATINO yqLUAT10N
BUILDINO CONBTH ION. .�q�
SIGNATUREO �(�,�Jl % �
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Date
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COSTA MESA BUlLDINCrSAFETY DEPARTMEM JUN 3 1966
P.O. BOX 1200 COSTA MESA� CALIFORNIA 92E20 -
urvnerc �OMAS� OMAS
'JOB ADDRESS Zq4p Mau1 P
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AP No. 139-252-14 l-OT 2
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9
GAS --
W ATER
ROUGH PLUMBING
PROP. SWR. LINE Q MOUSE C�N. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONDITIONING
TEMPORARV SERVICE OR POLE
UNDEfiGR0UN0 � POWER ❑
ROUGN WIRING
TRENCHES � FORMS � STEEL RE
FLOOR SYSTEM
BON� BEAM [� STEEL REINFORCE [
SHEATHING
FRAME AN� FLASHING
LATHING — IN OIIT IiF�
DATE 5_19-6�
BUILDING PERMIT
�CRIP710N of WORK Enclose Pe
E ZONE VALUEE �_inn.
SUBCONTRACTOR
STRUCTURAL, FINAL I 1e r'
M VG, VENT., REFRIG. ANtl A.C., FINAL �
FINA
FINAL
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COS7A MESA, CALIFORNIA 92626
FarApplicanttoFillinCompletely APPLICATIONFORBUILDINGPERMIT
/y� FEC I V D V DATE RECEIVED OATE ISSU
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SIZE � / NO.OF BLOCS. (FROM C/ ST T)
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USE OF / f t
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UI horeby acknowlatlBe that I have reatl this appllceNon antl state
� thet the abo�a informecion ia correcc antl aBrae to comply wlt�
� all lews requlntinp builEinp consttucNon, entl I ihell not employ
� any parmn �� ��olaUon oi tha workmen'e companfallon lawe af
y tha Stata of Calitomia.
? I horaby ce/tity that I em proparly IICan�etl af a conbactor untlar Sp. FT.
Ne Stero of Cnlifarnle Buflnass entl Profeasions Cotle, Dlvision 3, THE AMOUNT SHOWN
Chapter 9, e�tl thet sucn Iicanms are In fuil force entl aftact, or I THE PURPOSE OF FSTAB
am exempt irom the provisions of tha Smto of CelHornla Bualneas VALUATION
antl Professlons Cotla, Dlvislon 3, C�eptor 9.
� � PE
Sipnaturo of //�y"{� ^.,�_ � ^
Permittao ' " ��/"'"`-" $ �/4' �� PL
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UWNtK �OMAS. THOMAS L.
JOB ADDRESS 29� Maui Place
.� GENERAL CONTRACTOR pwner-Buidler
AP No. -2 2-, 4 LOT 2$ TRACT
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PROP. SWR. LINE � HOUSE CON. �
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UNDERGROUNO
ROUGH WIRING
BONO BEAM
SHEATHING
� POWER Lf
FORMS � STEEL REINF.
STEEL REINFORCE ❑
FRAME AND FLASHING
LATHING - IN n Ol1T
PLASTER, 6ROWN COAT
STRUCTURAL, FINAL
H' 'G, VENT., REFRIG.
DATE
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
A)l -8-69°�A-SA00 580 0****�+5.00
For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
RECE VED BV DATE ECEIV�D DATE ISSUEj1�
BUILDING C � � _ �!
ADDRESS \. '
-�y ` _ � � � _ / P RMI �
OWNER � �+.P. NO. .J
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ADDRIE S �"� � O I�'' G.�UiI. �
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CITY G NO.
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OWNER fi L
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OR ENGINEER N .
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ADORESS 20NE TVPE GROUP �l
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CONTFACTOq �}{�!WQ,N � , (' BV (_� DATE /
ADDRESS ��i�.l.-•-�.0 2.S R '�(•L
TEL. Z E NO.OF USE OF NEW
CITV G NO. � P�� 1/ BUILOING
STATE CITV �'ARDSAPPROVED VARDSAPPROVED
LI0. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILOING
SIZE t � NO.OF eLD(.�5. , (FROM GL STREET) ��
OF LOT O x � NOW ON LOT QY�� RONT FT. FT.
USE OF
EXISTING BLDG. �.,� I E FT. ��
SIZE OF - NO. OF �.f
NEWBLDG. � ROOMS STOFIES L.SIDE FT. v FT.
EXTERIOR WALL ROOF
COVERING COVEFING REAR FT. FT.
USE O UIL ING AND W RK TO BE PE FORM€D • DISTANCE BET. BEf. MAIN &
G MAIN BLOGS. ACCE55. BLIX9S.
�.{/�� ^ � VAR.� DATE
L\ I�Z O F I.v ��) � hf C.U.P. # APPRpVED ��//
� ' APPROVED � Ij
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I hereby acknowledge that � have reatl this application antl staie
that the above information is correct and agree to comply wiih
all laws regulatinB builtling �onstruction, and I shall not employ
any person in vlolatian of the workman's compensation laws of
' ffie S[are ot California.
I hereby certify that I am properly licensetl as a coniractor untler SQ. FT.
the State of California Busi�ess antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chaprer 9, antl that su� h licenses are in full torce and effect, or 1 THE PURPOSE OF ESTABLISHING A PEFMR FEE ONLV:
am exampt from Me rovis(ons of the State ot Cali omia Business VALUATION
antl ProfessionsCotle Division 3, Chapter 9. �S'�
\ PERMIT FEE $ �/
Si8^ature of 1 ^
Permittee ' C�-���° '�/�V"'� 5� ij�-n � PLAN CHECK $ -�
�/ ��
Authorized Agent � �)
TOTAL FEE $ i./%�U