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Home My WebLink About281 NASSAU RD - Building Permits(714) 754-5273 • Fa�c (714) 7543856 • www.ci.costa-mesa.c��fILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 281 NASSAU RD Suite: Vicinity: BATHROOM Primary Occ: R3 Parcel Number: 14144214 Applicant: LARA, GINO Address: 8727 SHANNON RIVER FOUNTAIN VALLEY, CA Owner: URRESTI, ANTONIO Address 281 NASSAU RD' ", COSTA MESA, CA ', Coniractw: LBN CONSTRUCT.ION Address; 8727 SHANNON RIVER Arch : Address: Zip: FOUNTAIN VALLEY, CA Zip: 92708 ' Type of Conslruction: V-N Zoning: Phone: License: , Phone: 714-408-6941 2ip: 92708 ISSUED BY: Phone: 714-914-2294 Zip: 92626' � . . . Phone: 714-408-6941 License: 835881 Eng: � Address: Slalus: ISSUED Applied: 07/10/2006 Issued: 07/10/2006 �� g �� pA� � � �. Phone: � License: � ' � . • SCOPE OF PERMIT MINOR REMOQEL OF SFD. WORK TO INCLUDE: REPLACEMENT OF CEMENT SHOWER PAN IN BATHROOM. . FEE SUMMARY Plan Check; $0.00 Calc Valuation: Permit; $69.25 �� Claim Valuation: SMIP Res; $0.50 SMIP Com; $0.00 ' Other, �0.00 ' Inspection; $0.00 " '_ � � ' _ . �" � � Total; $69.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front .0-0 PARKING Ezistin : o PLANNING & ZONING Rear ,0- 0- Lett .� 0- 0 Right 0- 0� i . Rear 0- 0 � Lett 0- 0�• � Right 0-.0. _ ,_ - i: Re uired: 0 Pr000sed: 0 -- ' 52,000.00 82,Ooo.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes antl related reguletians. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced wi�hin 180 days, or if work is suspe ded or abandoned for a period of 180 days, INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlona end flnel epproval musl be obtainad. Failura to obtain inspections end final approval will rasult in the expiration of this pertnit. FOR INSPECTIONS CpLL; (714) 754-5626 aawa caw� WORKERS'COMPENSAnON DECLARAnON: � ' I hereby effirtn under penalty ot perjury one oi ihe following declaratlons: ❑ I heve end will meintein a certilicate of consent to self-Insure lor workers' compensalion, es provided lor by section 3700 0l Ihe LeGor Code, tor lhe peAormance of lhe work for whith Ihis permi� i5 155uetl. ❑ I �ave end will maintain workers' crompensation insurence, as required by section 3700 ot the Lebor Cotla, for the peAormance of the work for which ihis pertnit I5 issuetl. 'My workers' compensatlon Insurance prner entl policy number are: Cerrier: Poliry NumDer. (Ihis s n{jn need nof be complefed ll fhe permit is valuetl af one hundred dollars ($100) or less.) / � eAi hat in t�e DeAormance 7,the work for hich this pertnit is Iuued, I s�all not employ any person in any manner so as to bewme subjea ro t�e workers' nsation laws ol Celito ', dntl egree. ii I should become sub�ect to the workers' compensation provisions oi Section 3700 oi tha Labor Code, I shall torthwith comply with these provision . Applicent Signeture: w Y. Date: %� �'� ` E' i� WARNING: FAILORE TO SECUPE 5' COMP SATIIXJ COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TIIOUSAND OOI.LARE (5100,000�, I RION TO THE COST OF COMPENSATION, DAMAGES PS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, INiEREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm that I em licensed under provisic force end eflect. Lia a �� ' .� fi�' Conirectofs Signature: CONS7RUC710N LENDING AGENCY: ❑ I hereby eflirtn that Ihere is a cons Lenders Neme: Signeture: OWNER-BUILDER DECLARATONS: 9(commencing with Section 7000) of Division 3 of ihe Business antl Professions Code, and my license is in full � Class a !� � 3'j 'v Q i oate: 7-i:,-o C agency lor ihe pertormance of the work for which ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lantler's Adtlress: Date: I hereby affirm Ihat untler penelry ot perjury that I am EXEMPT FROM THE CONTpAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Busineu end Profeuions Cotle: Any ciry or wunry which requires e pertnit fo construct, elter, Improve, demolish, or repair any sWcture, prior to Its issuanca, also requires the applicaN br such permit to lile a signed stetement I�et he or she is Iicensed pursuem to Ihe pravisions oi the Comractors Llcense Lew (Chapter 8(cammencing with Section 7000j ot Division 3 of tha Business entl Protessions Cotle) or ihat he or she is exempt iherelrom end tha besis for the alleged e:emption. Any vloletion ol Section 7031.5 by any appliwnt for e permit sub�ects the epplicent to e civll penelry of not more than five huntlreC tlollers ($500).): ❑ I, es owner of ihe propehy, or my employees wlth wages as iheir sole compensailon, WILL DO THE WORK, antl �he siructure is not intended or oNeretl tor sele (Sec. 7044, Business antl Professions Cotle: The Contractors Liconse Law does not apply to en owner of propetly who bullds or Improves thereon, end who does such work himselt or herselt or through his or her own employees, providetl Ihat such improvements ere not in�ended or oflered tor sele. If, however, the building or improvement is soltl within one year of completion, the owner-builder will �eve the burden of Oroving that he or she tlid not build or improvo for purposa of sale.). ❑ I, es owner ot the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 704d, Business end Protessions Coae: The contrectors License Lew tloes not appy ro en owner of property who bulltls or Improves thereon, entl who contrects lor such pmject wl�h e contractor(s) license pursuam to tha Coniractors Ucense Laws.�. ❑ I em exempt under sec. Business antl Professions Code lor this reason: Signatura: Daie: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Venfication of Ownership by (type ot documeni, i.e. - property laz blll ar deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetlify ihat no excavation five (5) or more feet in depih into which a person Is requlred to descend, will be metle In connection with work authonze0 by Ihis permit, entl ihat no building structure, scaHolding, lalsework, or demolition or dismantling thereol, will be more than thirry-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle e, Califomia Atlministrative Cade). ❑ As owner-builder, I wiil not employ enyone to do work which woultl requira a permit imm ihe Division ol Intlustrial Safery, es notetl above, unless such person has e permit to do such work trom �he tlivision. Signature: Dete: Division of Industrial Sefery Permit Number: CERTIFlCA7E OP COMPLIANCE ANO AIJTHORIZA710N OF ENTRV: I cenily under penalry oi perjury that I have read this applicetion and state that the informaiion given is correct I egree to comply with ell siete laws and ciry ordinences relating to building constmction, and authodze representetives ot ihe Giry of Costa Mese to enter upon the ebove-described property for inspection purposes. I agree not to occupy or ellow occupancy oi eny builtling authonzed by t�is permit un�il final inspection. LOpE �. INSPECTONTYPE � 1616 Fiaed System F' el Fire Prevention 1266 Pool Spe Finel 200 Finel Re-Rool 201 FIneI BIocWRetaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolition PAIE It�Lfl �Date `Q1' O-L oate CODE� INSPECTIONTYGE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Preventlon • 220 Final Planning Approval 222 Final Site 250 Final Building�Occupency PEg ItIIIIJ9L5 �O (714) 754-5273 • Fa�c (714)>54-4856 • www.ci.costa-mesa.PLUMBING PERMIT n FAIF DRIVE, COSTA MESA, CA 92626 ,lob Address: 281 NASSAU RD Suite No Vicinity: BATHROOM Parcel Nunmber: '141y4214 Appliwnt: LARA, GINO Address: 8727 SHANNON RIVER FOUNTAIN VALLEY, CA Owner: URRESTI, ANTONIO Address 281 NASSAU RD � CO5TA MESA, CA - , Contractor. LBN CONSTRUCTION Address: 6727 SHANNON RIVER FOUNTAIN VALLEY,CA Phone: 714-408-6941 Zip: 92708 Phone: 774-914-2294 Zip: 92626 Phone:�� 714-408-6941 Zip:, .92708 License: � B35B87 , � Status: ISSUED Applied: 07/102006 Issued: 07/10/2006 ISSUED BY: � �� - , . _ � ' . •� � , � � SCOPE OF PERMIT MINOR REMODEL OF SFD. WORK TO INCLUDE: REPLACEMENT OF CEMENT SHOWER PAN IN BATHROOM ' ANp 7 WATER HEATER. . REF#:BO6-01132 WORKTO INCLUDE: 1 SHOWERAND�1 WATER�HEATER. r ISSUE FEE Back(low irrigalion BackOow Preventer Bathiub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drein, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Aulo ) AMT $23.50 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00' $0.00 $0.00 50.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 QTY 0 0 ' 0 0 0" 0 0 0 0 0 0 , - -_ 0 0 0' 0 0 0 0 0 FEE SUMMARY AMT LaundryTub/Washer., .50.00 �Landscape�lrrigation � �50.00 P-Trap 50.00� Pressure Regulator $0.00 Process Piping (per 10 k) -'S0.00 Receptors � $0.00 SeplicTank �50.00 Sewer Cap for. Demo - � $0.00 Sewer Connecl •- � . $0.00 Sewer Private Line $0.00, Shower 59.80 Sink, bar � $Q00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen . $0.00 Sink, service/mop 50.00 Spa (private) . . $0.00 Spa (public) $0.00 Qn 0 , 0 0 0 0 0 0 0 0 0 .1 O 0 0 0 0 0 0 � „ SumpPump Swimming Pool � Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bktlow(5+) Wash Basin � Wash Basin Set� � Waste and Vent System , Water Closel (Toilel) Water Heater / vent . Water Piping pnst oi Rep j Water Re-pipe WaterService - � WaterSoflener . OTHER � : VIOLATION ' ; � PLAN CHECK i � REINSPECTION AMT .50.00 50.00 30.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 � TOTAL CALCULATED FEES: 545,60 COMMENTS / SPECIAL CONDITIONS QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, ¢ 1, 1241-92) / EXPIRATION: This permit shall automaticalty expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order lor the work aulhorized undei this pertnit to be considered Iegai, such xrork must comply with all applicab� codes, and ali requlred inapeetlona end final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (71q) 7545628 �.ssz�:vr,cn� WORKEFiS' COMPENSATION DECLARATION: I hereby aflirm under penelty of Derjury one oi the followinq declaretions: , ❑ I have end will meinlain e certificate of consent to self�lnsure for workers' compensatlon, es provitletl for by sectlon 3700 of ihe Labor Code, for the peAormance of the work for which Ihis pertnit Is issuetl. . ❑ I have and wlll maintain workers' compensation insurence, es required by secNon 3700 of the Lebor Cotle, br the pedormance of ihe work tor which Ihis permit is Issued. My workers' compensatlon Insurance cerder end pollcy number are: Carner: (This secfion need not be can0�eted il fhe permit is u �cenity.that in the performance ot�tJ�e work for _ compensation laws of Callbmi �Bntl egrae tha comply wit ihese provisions. / AppliCant Sl�ture: ``````/// .... � � WARNING.`FAILURE TO SECURE WOy�rtt,nS' CAMPEN�SA�T[ TTIOUSANDDOILARE(510p,000),INi ITIONTOTHEtMS LICENSED CON7RACTORS DECLARATION: I hereby aHirtn �hat I am licen5ed under proNsionS ol '�'---, _„-. ...__.._ c:. � :,,, c • Policy Number: s ($f00J orless.) I shall not employ any person in any menner so as to 6ecome suhject to Ihe workers' to Ihe workers' compensation provisions oi Sectlon 3700 of the Lebor Cotle, I shall forthwith �.�� e':"�_�' / � � Q6. COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOYER40CAIMINQ PENAI.TIES AND CIVIL FlNES UP TO ONE HUNDRED ° CAMPENSATION, DMMOES AS PROVIDED FOR IN SECTIIXJ 3]Ofi OF THE LABOR CADE, INTEREST, AND ATTORNEV'S FEES. 9(commencing with Section 7000) of Oivision 3 of.lhe�Business and Professions Cotle, end my license is in full ��— `ciass.x� R 3� Y"s � i� I// n�m:-- 7—i.,�Ul-� CONS7RUC7ION LENDING AGENCV: [� ❑ I hereby alfirm that there is a construction lending agency tor the pertormance of ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lenders Neme: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby atfirtn Ihet untler Denelry of perjury that I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which repuires e permit to wnstruct, elter, improve, demolish, or repflir eny sirucWre, prior to its issuance, also requires tha appiiwnt for such permit to fle e signed statement Ihet he or she IS Ikensetl pursuent to Ihe pmvlslons ot ihe Contrectors Ucense Lew (Chapler 9(commencing with Sectlon 7000) of Divislon 3 of the Business end Professions Code) or Ihet he or she Is e:empt therefrom end Ihe basis lor the elleped exemption. Any Wolation oF Section 7037.5 Dy any applicant for a permit subjacts Ihe epplicant ta e civil penalty ol not more lhen five hundred dollars ($500).): ❑ I, as owner ot the properry, or my employees with weges as their sole compensation, WILL DO THE WORK, antl the sWCWre is not Intendetl or oNered tor sele (Sec. 7044, Business and Professlons Coda: The Gontractors LJcense Law does not apDly to an owner of propeny who builtls or improves thereon, and who does such work himsalt or hersetl or Ihrough �is or her own employees, pmvidetl thet such impmvements ere not intended or oflered tor sale. If, however, the building or improvement is sold within one year oi completion, tha owner-builder will heve Iha burden ot pmving that ha or she ditl not huild or impmve for purpose ot sale.). ❑ I, as owner of the properry, em EXCLUSIVELV CONTRACTINC WITH LICENSED CONTRACTORS to construct t�e O�oject (Sec. 7044, Business antl Protessions Code: The contractors Litense Lew does not epply to an owner ol propeny who builtls or Improves t�ereon, and who contracls tor such projec� wlth a contrector(s) licensa pursuant to ihe Contracbrs License Lews.�. ❑ I am exempt untler sec. Business and Pwfessions Code for this reason: Signature: Date: Owner ID veniietl by drivers license. ❑ Ves ❑ No Orivels License No. Ezpires: Verificetian of Ownership by (rype oi tlaument, i.e. - properry taz bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I �ereby certify ihat no excevation live (5) or more feet in depth Into whic� e person is required to tlescend, will be made In connection with work authorized by this pertnit, end ihat no builtling structure, scaXolding, lalsework, or demoli�ion or tlismantling thereof, will De more �han ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, Celifornia Adminisiretive Code). ❑ As owner-builder, I will not employ enyone to do work which would requira e pertnit from the Division ol Intlustrial Sefery, es noted above, unless such person hes e permit to do such work from tha division. Signature: Data: Divislon oi Industriel Salery Permit Num�ec CER7IFlCATE OF COMPLIANCE AND AUTHORVATON OF ENfRY: I certily under penalry of perjury that I have read this flp0��on and state that the intortnation given is correct. I egree to comply wlih all state lews end clry ordlnences relating to bulltling consiruction, end euthonze representatives of t�e Ciry of Costa Mesa to enter u0on ihe ebove-described properry lor insgeciion purposes. I egree not to accupy or ellov.• occuDancy ol any building authorized by this pertnit until final inspection. GODE t. ifi16 Fixed System Final Fire Prevention 12fi6 Pool Spe Final 200 Final Re-Rool 201 FIna181acWRetaining Well 202 Final Factory Fire Place 203 Finel Slgn 204 Final Demolition Q� �Q �QQ�( INSPECTIONTYFE 206 Final Mechanical 208 Final Plumbing 270 Final Elec�ncal 212 Final Pire Prevention 220 Final Planning ADProval 222 FinalSite 250 Final euilding/Occupancy Date ']—/U�-U (a , PdIF II�LS (714) 754-5273 • Farz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber. Applicant Address: Owner: Address Conlractor. Address: ISSUE FEE Temp service lest Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighling Fizls Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to 1hp Motors to 10hp Motors to 50hp Motore l0 100hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circui�s Temp Pwr Pole Intermed Pole 281 NASSAU RD GARAGE 14144214 LARA, GINO 8727 SHANNON RIVER FOUNTAIN VqLLEY, CA URRESTI, ANTONIO 281 NASSAU RD ' COSTA MESA, CA . LBN CONSTRUCTION 8727 SHANNON RIVER FOUNTAIN VqLLEY.CA Phone: 714-408-6941 Zip 92708. . Phone: 714-9'14-2294 2ip:_ 92626 .- Phone: 714-408-6941 Zip: 92708 License: 835881 ISSUED BY: S�atus: I SS U E D Applied: 07/t0Y2006 Issued: 07/70/2006 SCOPE OF PERMIT MINOR REMODEL OF SFD. WORK TO INCLUDE: REPLACEMENT OF SHOWER PAN, 1.WATER HEATER AND ELECTRICAL WORK IN GARAGE. � ' WORK TO INCLUDE: 4 LIGHT FIXTS AND 1 SWITCH. $23.50 $0.00 50.00 $0.00 $0.00 $0.00 54.40 50.00 51.10 50.00 50.00 50.00 $0.00 50.00 $0.00 50.00 $0.00 SO.Op 50.00 50.00 $D.Op 50.00 S0.00 $0.00 $0.00 Quantity FEESUMMARY `•. Temp Dist Syslem / Lighting Busway /100 ft ` ' Standing Seclioq "" � - - Misc Electrical Equipment -. Transformers up to 1 kvalkw ................up to 10 kva/kw .................up to 50 kva/kw .................up l0 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment -- '��Low Volt Wiring Syslem I Ckt . Misc. Conduil Misc. Conductor� Cirws ( gen or ride) . � Circus (mech ride or ligYits)" Christmas Tree Stand � � Fireworks Stand Olher Electrical Fee Investigation Fee , . , Plan Check Fee , , Reinspection Fee � . Quantily t $0.00 0 50.00 0 50.00 0 $0.00 0 , 30.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 50.00 0 50.00 -0 , 50.00 "" 0 so.00 o . so.00 0 $0.00 0 50.00 , 0 50.00 ' 0 so.oa , $0.00. $0.00 $0.00 TOTAL CALCULATED FEES $29.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The vrork authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 12-21�92) �/ EXPIRATION: This pertnit shali autometicaliy expire and become void if vrork is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In ortler for the work authorized under this permit to be eonsidered legal, such work must compy with all appi�cable codes, end all requlred Inapeetlone and finel epproval must ba obtaineC. Failure to oDtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7546626 w.'-�...(•iJ] WORKERS' COMPENSATION DECLARA710N: I �ereby aHirm under penelry ot per�ury one ol the tollowing tleclarations: ❑ I hava entl will maintain e cerliHcate of consent m self-Insure br workers' compensation, as provided for by section 3700 ot the Lebor Coae, for ihe pertormance ot ihe work tor which this permit is Issued. ❑ I heve en0 will maintain workere' compensation insurance, as requiretl by section 3700 of Ihe Lebor Cotle, for the Derfortnance of t�e work for which this pertnit is issued. My workers' compensatlon Insurance carrier enA policy number ere: Gerrie� Policy Number: (Th�s/ s�/ection need not be comp/eted i/!he permit is velued a( one huntlred dWlers ($100) or Ieu.J �/ q cenify that in the pedortnance ot he work for which this permit is issued, I shall not employ eny person in any manner so es ro become suhject to the workers' compansatian laws af Califami an gre9y�t If Lshould become sub�ect to the workers' compensatlon proNsions of Sectlon 3700 ot the Labor Code, I shell forthwith comply with ih85e provisions � j I ApplicanlSigneture: . _ .� f' � .�—� Date: _.._ ..._. WARNING: FAILURE TO SECURE THOUSAND DOLLARE ($100.OD0). LICENSEO CONTRACTORS DECLARATON: I hereby ettirm Ihat I am licensetl under pro ' io force end eflecL Lic. # ___-__[-=e� !� Contreclofs Slgneture: CONSTRUCTION LENDING � ❑ I hereby aKrm that thare Lendefs Name: SignaWre: COVERAGE IS UN(AWFUL AND SHFLL SUflIECT AN EM%.OVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED ' COMPENSATION, DAMAGES AS PROVIDED WR IN SECTIpJ 310fi OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. of CheO�er 9(commencing with Section 7000) oi Division 3 ot the Business antl Professions Code, end my license is in full Class a -%— �"" ^� � 3� cY k I %j i�- Date: '7— i o-�^• L wnstruction lentlinq egenty for the peAortnance of the work for which this pertnit is issued. (Sac. 3097, Civil Code). Lander's Address: Date: OWNER•BUILDER DECLARATIONS: I hereby eHirtn that under penalry ol perjury that I em E7(EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, eusiness end Pmfessions Cotle: Any ciry or county which reQuires e permit to consiruct, elter, improve, tlemolish, or repair any struc�ura, prior to its issuance, elso requires the applicanl lor such permil to lile e signed siatement Ihet he or she is licensed pursuant ta ihe provlsions ol lhe Conirectors License Lew (Chepter 9(wmmendng with Sedlon 7000) ot Division 3 ot tha Business and Pmtessions Cotle) ar t�et he or sha Is exempt therefmm and Ihe besis for the allegetl exemption. Any violation oi Section 7031.5 by eny epplicaM for e pertnit subjects tha epplicant to e clvll penalry ot not more ihan live hundred dollars ($500).): ❑ I, as owner oi 1he property, or my employees with wages es their sole compensation, WILL DO THE WORK, and the siructure Is nol intended or oHeretl for sale (Sec. 7044, Business antl Professions Code: The Coniractors License Lew does not apply to an owner of property who huiltls or improves thereon, and who does such work himseli or herseli or ihrough his or her own employees, provided ihat such improvemenis are not intentletl or oHered lor sala. It, however, ihe building or improvement is sold wilhin one yeer of completioq the ownervbuilder will have ihe burden of proving that he or she did not buiitl or improve lor purpose of sale.). ❑ I, es owner of the propetly, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS b constmct the project (Sec. 7044, Business end Professlons Coda: The conirattOrS Utense Lew doe5 noi apply Io en owner of property who bullds or Improves Ihereon, and who contrecis for such pro�ect with e contractor(s) license pursuant to the Contrectors License Lews.). ❑ I am exempt under sec. Business end Pralessions Catle for �his reason: SlgneNre: Date: Owner ID verified by drivers license. ❑ Yes ❑ Na Oriver'S Litense N0. Verificetion of Ownership by (rype of documem, i.e. - properry tax bill or tleetl): Expire5: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehify ihat no axcavation five (5) or more feet in dapih into which a person Is required to descend, will be metle in connection with work euthonzed by this permit, and ihat no building simdure, scaffolding, talsework, or demolition or dismantling ihereoi, wlll be more than �hirty-six (36) leet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, TUe 8, Califomia AOministretive Code). ❑ As ownar-builder, I will not employ anyone Io tlo work which would requlre e pertnit trom the DlWsion oi Industnel Sefery, as noted above, unless such person hes a pertnit Io do SUCh work Irom lhe division. SignaWre: Date: Division of Industrial Salery Partnit Number: CERi1FlCATE OF COMPLIANCE AND AUfHORIZA710N OF ENTRY: I certiy under penalry of perjury t�et I have read this eppliwtion antl state Ihet the Information given is correcL I agree to comply with all sta�e laws entl ciry ortlinances relating to builtling consiruction, end authodze represematives ol the Ciry of Coste Mesa to enter upon the ebove-described properry tor inspection purposes. I egree not to a:cuDY or allow occupency of any building authonzed by this permii until fnal insDection. COOEI, IXSPECTIONTYPE 1616 Fixed System FIn41 Fire Preveniion 1266 Pool Spe Finel 200 Final Re-Rool 201 Final BIaWReteining Wall 202 Final Factory Fira Place 203 Final Sign 204 Final Demolition ws u�e CODEI MSPECTIONiYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 Finel Planning Approval 222 Final Site 250 � Finfll Building/Occupancy Da�e c- J 1�7.11�Ii1111%�[�j � � �, f!.*, -0WNER Rntgpr� T]Pv_ Cn_ DATE 8-29-58.. " - JOB ADDRESS 2$T NeS58U Rd. � � BUILDING PERMIT NO. 735�T . GENERAL CONTRACTOR Dike & COleAT'OVe. InC. VALQE S 13,919•00 ' � AP. INSPECTIONS coa[ Final Gas Test DESCRIPI'ION OF WORK � DATE I SUBCONTRACTOR PERMITSISSUED NUMBER a � �+ yy �� , Vt. COSTA MESA BUILDING DEPARTMENT P.O. Box 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL, IN ivaaaau noau COSTA MESA. CALIFORNIA MAIL AODRESSLy�,� E CITY �/OSYE.'. 7T.. Calif. ARCHITECT C � YY OR ENGINEER� Qbrook AOORE55 Garden lit'�Qe LEGAL LOT 1'] oescaiariorv No. J A.P. NO. s'ZE 60 z l00 OF LOT BLOCK LIC. NO. CITV LIC. NO. ITRACTtii7�y rvo.or a�ocs �,ow o� �o, none E%ISTING BLOG. SETBI�CK LINE FROM � cerv'rea oF SiReEi 5O� REAR VARD SIDE YARD RIGHT �� LEFT ]_';� DESCRIPTION OF WORK NEW p ALTERATION ADDITION REPAIR MOVING [ l DEMOLISH SIZELDING �LC B f't ROOMS �J STORIES VJ EXTERIOR WALL ROOF rnvrrzivr. StUCCO COVERING Ci0ffi�• D1Rg1@ S27ll11.4 QwC.IJ1Il with attached garage. t� � �I� L.'�% b Y�� IL ,. AUG 27 1958 F1�,!",�'CE �EPT. . ' �r�r-.� . ,. APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY aeceivr rvo. I �,ylO'iY d e'ei`i A PECEIVEO BY DITE RECEIVED � Df�TE ISSIII � y6� AUG 2 9 BUILfJING ADDRE55 COSTA MESA. CALIFORNIA FIRE ZONE 20NE1� � P�sNS TYPE �/ GROU4 t/ i APPROVEO C BY OATE I HEREBT ACI(NOWLEDGE THPT I NAVE FE4O TMIS AppLICATION ANO STATE THFT THE ABOVE IS CO IiECT FNO AGREE TO COMPLY WITM <LL CITY OflOINANCES FNO $TF �NS REGULI�TING BUILpING CONSTRVC� norv. VFLUATION SIGNATURE OF PERMITTEE �� $13,919-00 AUTHORIZED AGENT UUi..ke & Colegrove, �C• CORRECTIONS PERMIT FEE S3'zL�OO PLAN CHEGK $1V�Vv . TOTAL FEE $y.�� e.�