HomeMy WebLinkAbout3413 MEADOW BROOK - Building Permitspia� �sa-sz�a • Fax (714) 754=4856 • www.��.costa-mesa.�y�MBING PERMIT
. , .
JobAddress: 3413 MEADOW BROOK
Suite No
Vicinity:
Parcel Nunmber: 93506060 ,
��
Applicant PAT JARVIS
Address: 30300 PUERTO VALLERTA
MENIFEE
Owner. WING LI
Address 3143 MEqDOW BROOK
CM,CA
9�'"
Phone:
` Zip:
aoo-�z�-osi��
92584
�� Phone:
Zip: 92627
Contractor: ALL STAR WATER HEATERS INC
Address: 30300PUERTO VALLERTA
MENIFEE
WATER ryEATER REPLACEMENT
Phone: 800-727-0977
'. Zip: 92584 .-
License: 812894 �
SCOPE OF PERMIT
7TFAIfl�DFIVE; WSTA MESA, CA 92626
� �Stalus: ISSUED
Applied: 11/02/2005
Issued: 11/022005
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ISSUED BY:�
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_. _ . FEE SUMMARY:
AMT Q7Y � , AMT," QT' AMT aN
ISSUE FEE $23.50 Laundry Tub / Washer $0.00 � 0 -� Sump Pump 50.00 0
Backflow irrigalion 50.00 0 Landscape Irrigation $0.00 0 Swimming Pool 50.00 0
Backflow Preventer 50.00 0 P-Trap $0.00 0 Trap Primer 50.00 0
Bathtub 50.00 0 ." 'Pressure Regulalor $0.00 0' Urinal $0.00 0
Clarifer Sy;tem 50.00 0 � Process Piping (per 10 fl) 50.00 0� Vacuum Brkr Bkflow(7-4) 50.00 0
Connect Qce,Soda,etc) $0.00 0 Receptors 50.00 0 Vacuum Brkr Bkilow(5+) 50.00 0
Dental Units $0.00 0 Septic Tank 50.00 0 Wash Basin 50.00 0
Dishwasher 50.OQ 0 Sewer Cap for Demo 50.00 0 Wash Basin Set 50.00 0
Drain, Floor $0.00 0 Sewer Connect 50.00 �0� Wasle and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Waler Closet (Toilel) $0.00 0
Drain,Roof .$O.OQ 0 Shower . 50.00 0 WaterHeater/vent 50.00 0
Drinking Fountain $O.OQ 0 Sink, bar � $0.00 0 Water Piping (Inst or Rep.) $0.00 0
Expansion Tank $O.Oq 0 Sink, commercial � $0.00 ., 0 Water Re-pipe 50.00 0
Gas Earthquake Valve �$0.00 0 Sink, Floor _ 30.00 0. Waler Service $0.00 0
Gas (1-4 outlets) - $0.00 0 . . Sink, kitchen $0.00 , '0 _ _ � : ',Water Soflener - $0.00 0
Gas (Over 4 oullets) 50.00 0 Sink, service/mop $0.00 0 OT}1ER $0.00
Gas Repipe 50.00 0 Spa (private) 50.00 0 VIOLATION � 50.00
Gas Service � $O.OQ 0 , Spa (public) $0.00 0 . - PLAN CHECK , " $0.00
Inlercepiors (Grease, Oil) 50.00 0 . - REINSPECTION 50.00 0
Interceptors (Sand Auto ) 50.00 , 0 . � �
TOTAL CALCULATED FEES: 523.50
NOTICE: The work authorized.by this�permit�shall comply�with ali applicable handicap access. requirements under Califomia statutes and related
regulations. (Ord: No. 92-28; § 1, 12•21•g2)
� EXBIRATION:� This pertnitshall aUtomatically expire�and become void i(work isnot.commenced�within� 180�days, orit work is suspended or. abandoned
� tora period of 1 BO�days.
, INSPECTIONS: In orderfor the work authodzed. underthis�De�itto� be considered legal, such work must compfy with ali applicab�e codes, and all
'� requlred9nspectiona�and���.Nna1 epprovalimusYbe�.obtained: FaiWre to�obtaiminspectians and�.finaLapprovaLwilLresulPin the:expiretion ofthis permit.
FOR!INSPECTIONS�.CALL': (Z14)'�75445626'•
zane-,slaaa)
WORKERS'COMPENSAnON DECLARAnON: ' - � �
1 �ereby aflirm under penaly oi perjury one ot the following tleclarations: ' "� •
❑ I have and will maintain a certilicete of consent to sell-Inwre tor workers' compensetion, es provided for by section 3700 oi the Labor Code, for the pertormence of ihe
woB tor whith ihis pertnit is issuBA.
have antl wlll maintain workers' compensatlon insuranca, as required by section 3700 of Iha Labor Cotle, for the pertortnance of the work for whic� this pertnil is IssueC.
y work�r ' c� orppe�saiion�suran ��rriar and policy number ere: �� •/� �/�
Carn . V jl«�� U/�/ olicy mber: 9
(T ' secfion need nof be cromp/e(ed i! fhe permit is velued af one hundred dollars ($f 00) or Iess.J
❑ I ce t in the pertormance oi ttie�workjnpW hich ihis perrnit is Issued, I shall not employ eny person in any menner so as to become subject to Ihe workars'
mpensat n laws oi Celitomie od egr 4 Kat if I shoultl become subject to tha worKa�S"bb 555aaa���t�ppp���aaa�ww555ions ol Secti 3700 of Ne Lebor Catle, I shell forthwit�
complywith heseproNsion �� ^���
plicent S' ure: a e: �
WA NING:FAILURETOSECURE O 2ER5'C PENSATIIXJCOVERAGEISUMAWFULANDSWILLSU&IECTANEMPLOVERTOCRIMI PENALTIESANDCMLFlNESUPTOONEHUNDPED
THOUSANDDOLIARE(5100,OOO,INAODITION OTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]OBOFTHEUBORCO�E,IfJrERE$T,ANDAITORNEY'$FEES.
LICENSED CONTRACTORS DECLARATION:
I ho het I em licery5�d�undefyrpyl5ipns of�hapter 9(commencing with SecUon 7000) al Divi ' t the Bi
or ec . Lic. p- )5 G�JS?�! �//n las #
C� ctoY igneture: ��/ � e; _
Code, entl my license is in tull
CONSTRUCTION LENDING AGENCV: �
❑ I hereby attirtn that there is a wnstruction lending egency lor iha pertormance ot the work lor which Ihis permit is issued. (Sec. 3097, Civil Code).
LentleYs Name: Lentler's Address:
SigneWre: _
Date:
OWNER-BUILDER DECLARATIONS:ly�", "'�
I hereby eMirtn that under penalry of perjury Ihet 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for tha tollowing reason (Sec. 7031.5, Business an0 Professions
Cotle: Any city or counry which requires e pertnit to wnsimct, elter, improve, demolish, or repair eny structure, pnor to its issuance, elso requires lhe epplicant tor such permit
to file e signetl statament t�et �e or she Is Ilc^e�d pursuam to the provisions of the Comrectors License Law (Chapter 9(commencing with Sectlon 7000) ol Divisian 3 of the
Bu5ine55 end Proteuion5 Code) ar Ihet'he, 8 a is enempt thereirom end Ihe basis br the alleged exemption. Any violation of Sedion 7031.5 by any epPlicant for e pertnil
sub�ects the applicani m a dvil penalry of not more ihan five hundred dollars (5500).):
❑ I, as owner of the properry, or my employees with wages es their sole compensetlon, WILL DO 7ME WORK, end the structure Is not intentlea or oflered tor sale (Sec.
7044, Business antl Professions Cotle: 7h Cq�iractors License Law does no� apD�Y �o an owner ol properry who builds or Improves thereon, and who tloes such work
himsell or hereelf or Ihrough �is or tieruwr�e m��p loyees, providetl that such improvemenis are not imentletl or oHereA for sale. If, however, the builtling or improvement is
sold within ona year ol complation, the�"ofvtb6r-B�u�itld�er will heve Ihe burden of proving ��at he or she did not build or improve for purpose of sale.). �
❑ I, as owner of Ihe propetly, em EXCLUSIVE�N. BONTRACTING WITH LICENSED CONTRACTORS to consiruct the projecl (Sac. 7044, Business and Protesslons
Cotle: TTe contractors License Law does not apply Io en owner ol property who bullds or impmves t�ereon, end who tomrecis lor suc� projact wii� a contreCtor(s)
license pursuant to ihe Contrectors License Laws.).
❑ I em exemp� under 50c.
Signe�ure:
Busine55 and Professions Cotle for t�is reeson:
Date:
Owner ID varilied by dnvefs license. ❑ Ves ^[�J;fsq� DnverS License No. Expires:
Voriticaiion ot Ownership by (type ol dwument, i.e`i p p rty taz 6111 or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby cenify that no excavetlon five (5) or more feet In dapih into which a pereon is require0 to descend, will be made in connection with work euthodzed by this
permi6 end that no builtling stmctura, scatfoltlinq, falsework, or demolition or dismantling thereot, will ba more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, TiUe 8, Califomla Administrative Code).
❑ As owner-builder, I will not employ enyone to tlo work whic� would require a permit trom the Division ol Intlusiriel Sefary, es noted above, unless such person hes a
pertnit ta da such work fram Ihe division.
Signature: Date:
Division of Indusirial Sefety Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORIZA710N OF ENTAV: I certify under penalty ol perjury that I have read thls application antl state that the intortnation given is
correct. I agrea lo comply with ell state laws and ciry orUinances relating to building consiruction, and authonze representatives ot the Ciry of Casta Mesa to enter upon Ihe
ebova-described property for inspection purposes. I agree not to occupy or allow occupency of eny building authorized by Ihis permit until final inspection.
COUE �.
1616
1268
200
INSPECTO�(TYPE ' ' � - pAIE ` ' INTRIALS
Fixetl System Final Fire Prevention
Pool Spa Final
Final Re-Roof � - �
201 Final BIacWRetaining Well
202 - Final Factory Fire Place ''
203
204
Final Sign
Final Demolition
COUE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 � Final Elecirical
212 Final Fire Prevention
220 �� - Final Planning Appmval ��
222 FinalSite
250 FinalBuilAing/Occupancy �
!. i ,�w. .,
`S7(1'`V�1 �'
PflOJECTA00NESS: j4I3 MEADOW BROOK
OWNEfl'SNAME: V.T.LI�AGE CREER HOMEOWNERS
nooxess: ASSOCIATION
3429 TIMBER LAKE
CM VA 92626
UNIT:
pflCN/ENGINEEH: CHESTER CARVILLE nec.xo.: C18305
AOONE55: '] 9'z 'l p,RMOUR Jr T UNIT:
S,D, CA 92111
PEflMITTEE: FIHOENZX ENTERPRISES INC. ( 213 ) 690-9559
aooness: qll COMERCIAL WAY
I.A HABRA CA 90631
LILENSED CONTBACTOP OECLAflFTION: I �ereDy affirm thai I am licensetl untler is ns ChaD�er 9(commencing wit� Seciion
7000� ol Orvision 3 01 the 6usiness and Pmlessions Cotle. antl my license is in lor a Ifecl.
ci�ruc.: 5 g s re ic.:376639 � —/�
�ate: —���� SignaWre: _ . _ L — —
WOPNERS' COMPENSATION UECLRNATION: I hereCy affirm ihat I hav a cenilicate of c. ent m sell-insure or a ce ate of Workers'
I Compensalion Insurance or a cetlifie0 co pY Ihereol (Section 3800. La�. CI.
=oucr eo.: W7 0 0 3 5 4 E%P. ORTE: O% I O 1
coMraxr: CA COMP & FIRE
� CeNhe capy is nereby lumishe�. ❑ Cenitiea copy is liletl wilh � uilding - sion
Oate:_ _(/� AOPlicanf.
E%EMPi10� OM W� ENSP RTION OECLAflATION: (T�is sedion neetl not be complele0 if �he permil is lor one hm rea �E7001 ar less�.
I cenily Ihal in the oedormance of ihe work for wnich Ihis permil is issuea. I shall no� employ any perSon in any manner 5o as to become
su�ject lo I�e Workeri' Compensatian Laws al Calilomia.
Daie: Signature:
NOTItE: I( afler making t�is declaration, you shoWE Gecome sublect to t�e Warker5' ComOensation pmvisions ol I�e tabOr
Caae. you must fonnwiN comply wiin such p�Ovisions or ihis oermit shall ee deemed reroke0.
CONSTflULTION LENOING RGENLY: I hereEy af6rm �Iwt I�ere is a cons�mclion IenOing agenry �o� Ihe performan[e ol the work tor
whit� t�is Oermn is i=sueE (Seclion 3W7. Civ. C�.
LENOEfl:
noonEss:
OWNEfl BUILUEfl OELLANATION: I hereby a�lirm Ihal I am eM¢mp� �mm IA2 Conlraciors' Siate License Law lor ihe lollowinp reason
�Seclion 7031.5 Business ana Pmfessional Cade: Pny cily ot counry which requires a permil �a cons�mc�, aller, improv¢, Eemolish, or
�e0air any StmcWre. Orior �o its issuan[e, also re0uire5 �he applicani lor such permii to lile a signea stalement IAai �eJshe i5licen5e0
Dursuanl lo t�e pmvisions of Ihe Coniraclors' SIa1e License Law (ChaD�e� 9lwmmenting wi10 Seciwn 7000) ol Uivision J o� Ihe BuSiness
anU Pmlessions CoOe� or that �e/s�e is eKempt iherefmm antl t�e Oasis for the alleA� exemption. Any violalion ol Settion 7031.5 by
any aODli[ani lor a De��� 5ubjeci5 Itle aDUliWn� to a civil penalry o� nul more �han five huntlred EWIaR (f500�.
I, as owner of �ne pmperty or my employees with wages as their Sole wmpensdtion, will Aa the woA, anU the
7 svucwre is nat inten0etl or oilerea lor sale (Section 70aa, Business anA Prolessional Cotle: TAe Comractors' State Licenu Law
tloes not appty to an owner of a ompeny who 6uilOs ar impmves Ihereon, an0 who aoes sucll xrork Aimsell/hetsell or Inrough
his or her own employees. D�oviOea t�ai suc� impmvements are no� in�entle0 ar oflereG �or sale. II. however lhe builaing or
im0�ovement is sold within one year ol comO�eGon. ihe owner will �ave I�e �urtlen ol pmving Ae/she OiA nal �ui10 or improve
br ��e Ourpose o� sale�.
I, as owner oi ��e D�operty, am e�cWsively conlrac�ing wilh licensed comractors m conslmc� Ihe O�ole��,Seclion 7UAa, Business
❑ ana Pmlessions CoDe' The Conlraciors' Siate License Law dces nol ap01y lo an ovmer o� pmpetly w�o buAEs or imDmves t�ereon
antl wlw coniraqs �or Sut� pmle��s wil� a conitac�oqs) liCense Dursuanl Io ihe Contracfars' Slale Licenie Law�. I am aware
Ihat pmof of Iheir Worker'S Compensalion inmrance shoNd be prwi0ed io me.
� I am e+empt un0er Section: B. 8 P. C.
lor l�is reasan: ,
Daie: Owner.
I eo nere�y cenity that i am aware ol anC unaerstanU �he repuiremems al Calilomia Heallh an0 Salety Coae Sections 25505. 25533, ana
25534 and Ihat I o� any IUWre huilding occuDanl wilVwill no� �circle one) neetl to comply witM1 saiA state co�es ana Ihe reQuiremenls br a
permit lo� constmction or moadicaiion Imm Ihe Fu Ouably Management Distric�. FesiOeniial constmc�ion apDlica�ions are e�empt iram
I�ese pmvisions. ,
Date: Ppplicani:
I �ereby ceriily Ihal I have reatl �his applicaiion antl s�a�e Ihal ��e a�ove i� rma� .n is cor . I aqree Io coi �y all ciiy antl count
orainancnaMs�atelawsielatingmDuilCingconsvuaionan4�e�eEyau . rze�.,�resenta� oitN urytoo u thea0ove�me '.e0
pmoeny la� mspe^m�n/�p^ wfff���%%/•jff
Da�e: �/ ��j�/ Signalure:
Driver's License or Soci�Securny n:
t6<bn6 W�ile—Building: Green—CoOe EnlorcamenL Canary—AppliwnC Pink—Revenue: Golaenro0—Assossor
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: B 050595
PERMIT NO; B 050595 PLAN CHECK NO; 00116-91 A GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: REP
JOB DESCRIPTION : REPAIR SETTLEMENT DAMAGE SQ FT: 143
CLAIM VALUE: 14,300,00 CALC—VALUE: 14,300,00 GROUP OCC: R-3 /
COMMENTS: BUILDING SETTLEMENT REPAIR/FOUNDATION
�r�r�*****x�*�r***�r�***�**�*�*****��*�rx****�rx��+��***�r��**���****�**x�***�r****�*�**��
Z O N I N G R E Q U I R E M E N T S
_ S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDZNG ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING RE • PROV; PARCEL: 93506124 ZNE: R2 REF NO;
PLANNING N 'I'ES> FOUNDATION REPAIR.
7
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
20NING APPROVED BY ;� �� DATE: cl i.S'�I
BUILDING APPROVED BY : w�L DATE: ' (
APPLICATION ISSUED BY: DATE; �
if iF M)F iE if iE 3f 1E iF 7F iF jE 1F 3E !E if iE iE iF if iF iF iE ff 3E 3E 1F iF iF fF �F��F'iF�FiE if
iEiPjEiFif-1EfFlEitlfMiP�FifiEiFiEifiEiFifjFjFiPlfikkififM :iflFiElFif3hiEiFiE�lfjEfFiFiFiEiE�FlkifiEiEiE3fifiE3Eif1E3EjFiEiF1E3E�f1E�1EiEiEiE
LEGALIZATION:N F E E U M M A R Y STRUCTURAL' SEGMENT:Y
BLDG PMT FLUMBING ELECT IC MECHANIC FIRE SMIP/RES GRADTNG
PERMIT 162.00 ' 1,00
SMZF/NON—RES
PLAN 26.33
ISSUE FEE
HUILDING—DIV—> PERMZT ZSSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 163.00 0.00 26,33 189.33 189.33 .00
REVENUE DIVISION TOTALS--> COLLECTED; 189,33 OVER/SHORT; .00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
162.00 1.00 26.33
1f !E k 1F 1Elf iF iEiE iE fF iE iE iE M IE I!-iE k%If iE if if iE IF IE M 1f k if iF ff iF if if iE if 16iE 1f ff IF IE iE iF 3f iE f!� �f 3E iE IF if if iFlFlE )k jf iE �E if iE if 1E iF 1E if 3f if IE �f �F ** 3f iE if
I N D I V Z D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N I]NIT COST TOTAL COST
SFR 143 STRUCTURAL BY VALUE PER g100,00
END OF fiEES
100,00 14,300.00
nI ����l�70�'4��7��av ti 1_i�r '%'l.S�
L�H�E� OL%�3/41 TIME� 17���5
CONSTRUCTION ANO PLANNING � ` $ SP'0'
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
�
1. Temporary Electrical Servi�or Pole ;,� 52. Pool & Equipment Location
i
2. Soil Pipe�Undrgmd. �•t , �_ 53. Steel Reinforcement _
3.'Electrical Conduit Utility-Undrgrnd. � 54. Forms �'�.
4. Electrical Condui[-Und�9�n�%` r 55. Electrical Bonding '�
- 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test •
_ 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. EleMrical Conduit-Undrgrnd.
8. Foundation • -' ' 59. Gas Pipe, O Undrgrnd., Test j�
9. Water Pipe-Undr9rnd. ,r � J� 60. Backwash Lines, P-Trap, � Undrgrnd. �' ��
10. Structural Ploor System ,�� !���; 61. APPROVAL TO DECK -•
11. Property Sewer Line & HoufenConnection %�� 62. Backwash & Receptor-Final • �'
12. Sewer Cap , � ��' � � ,. � '� 63. Heater & Vent-Final .;
13. Roof Drains ` �' � � 64. Plumbing System - Final '"�
14. Rough Plumbing /!'� � �' 65. Electrical-Final • i
15. RoughElectrical-Condui3• �n f �� 66. SolarSystem-Final � j�
16. Rough Electric Wiring � ��� 67. Fencing & Access ApProval �
17. Rough Wiring Sign � � 68. APPROVED FOR PLASTERING �
18. Rough Electrical�T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Coriditioning ' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace '• � ' APPROVALS' -Permit # i
21. Ducts, in Structure • . � -- �70. Underground.Hydro
22. Ducts, Ventilating. • � "71, Product Pipin9 O Gas ❑ Oil
23. Gas Pipe-Rough & Test . . . 72, Underground Flush •. �
24. Roof Framing " '- - �73. Undergrnd. Storage Tank � Gas ❑ Oil
25. floof Sheathing � '. � . ; . '7q, �Overhead Hydro �
26. T�Bar Cei�ing (Structu�al) & Monocoat ' 75. Ory Gtiemical �
27. Frame and Flashing. . . 76. Dry Standpipe � . �
28. Lathing & Siding • ` � 77, FIXED SYSTEM FINAL^
29. Insulation . ' • I I � 78,,FIRE PREV. FINAL
30. Drywall Nailing • I � � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � i �. � 79. FINAL INSPECTION �-
32. Electriwl Power MeterFinal � � . !� 80. FOOD CERTIFICATE ISSUED �
33. Final Eleciric � � j: ' Notes: �' �
�34. Final Heating & Air Conditioning � ' , f� � / �
�� � 1/ / w � ii "
35. Final Gas�Pipe-Test - ' . /��� ' ���
36. Hood or Canopy . - ' � • • - . � �
37. Final Pactory Fireplace . • _ � ' � _ '
. , -
38. Final Plumbing � • � ->
39. Water Service=Final' i j� , _ "
r
40. Gas Service-Flnal . . � �� -
47. Solar pomestic�Final t - '
' � f
42. Backflow Preventer , , � � , .
43. Backflow Irrigation ` _
44. Landscape Irrigation SYstem . - �.
'45. Sound Attenuation� � ' - � '
� 46. Handicap Regulations . � _
47. FINAL STRUCTURE & BUILDING ^/,r.q 1 �
48. FINAL PLANNING. • �
49. Electric Release to Edison � � ,
i
50. Gas Release to Southern California Gas Co ; ��
57. CERTIFICATE OF OCCUPANCY . . •
No. Date
OWNER
JOB ADDRE:
F RA C
A. .o�
INSPECTION
SOIL
GAS
W PTE0. I�,
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ROUGH PLlIM91
PROP. SWft. LI
SPRINKLING 5`
MISCELLANE01
ROUGH HEATIN
TEMPORARY 51
11N�ERGFOUND
ROUGH WIRING
TRENCHES
FLOOR SVS A
BOND BERM [
SHEATHING
FRAME AN� FL
LAT"'NG — IN
P R, Bft0
AIR CONDITIONING
OR POLE
POWER I—I
% ouT
COPT
HEATING, VENT.� qEFFIG. AND A.
PLUM6ING. FINAL AND GAS TEST
Inc. DATE
BIIIL�ING. FINA4 _ �
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
foi Applicant to Fill in Completely
nooREssqq73 MeadOw Brook
OWNER State-Wide Developers, Inc.
ADDPESS946� 6rindlay
CITV Cypress,m N�L �
826-4
CONSTRUCTION
BRANCH
AqCHITECT TEI,
«u+K�.,��R i cLrhach/�ulasYi No. 556-661
Aooaess »848 SkyPark Blvd Irvine
CONTRACTOR State-Wide Developers, INc.
AooREss9461 Grindlay
ciTv Cypress No`.826-4550
�Ic No. 224710 LICVNO.
oF ior 12.093 aCM25 NOW ON �OT� 0
USE OF
EXISTING BLDG.
EXTERIOR WALL YadSLEi� I ROOF Shake
COVEfiING I.I,...J COVERING
USE OF BUILDI D WORK TO BE PEflFOFlMED
New construction-Condominiums
I herebV eeknowletlpa thet I hava reatl this epplicatlon end state
<fiac tha above informatlon is correct anci epree to compty wiih
ell laws repulotlnB builtlinB �onrtrualon, antl I 6hell not employ
any person In vl0letion of the workmen'f cOmpansptlon lews Of
ihe Siate of Celifornie.
1 herebV carHfy Mut 1 am pmperlY �Icanmtl as a conuector unAar
tho State of Celifornio Business entl Professiona Code, Dlvlsicn 3,
Chapte� 9, entl thet such licensas ere in full force ontl affect, or I
am exomp[ trom the provlsions of the Steto of CelHornia Buslnacs
antl Profosalona Cotlo, Olvislon 3, Chapwr 9.
_state-lJide DeveloAerq nc.
ParmltTee \/ �—`'� '"
Au[�ollzetlApent Vice President
'IAY13-?6�p��:�� 768� '�'`=Z2�.0�
APPLICATION FOR BUILDING PERMIT
RECEIVED BV DATE RECEIVED nnTo iccu
A.P. NO. / QO -1
ADDRESS �Y�3
TRACT Rd-
OWNER��(
U E�
FIRE
zoNe
APPROVED
BY
20NE
�zcP
VARDS API
MAIN BUI
(FROM C/L$1,
OI
VALUE
DATE
NO.OF I USE OF NEW
PlANS � BUILOING
DISTANCE BET.
MA7N BIDGS.
VAR. qW q `
G.U.P.q�(i� —
APPROVED
HOLD FOR S'
THEAMOUNTS
THE PURPO6E Of
VALVATION
� 00°y
BET. MAIN &
R VA
i
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IS FOR '
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