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Home My WebLink About2474 NAPOLI WAY - Building PermitsCITY OF COSTA MESA � BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT pia) �sa-sz�s • Fax pia) �sa-aess Job Address: 2474 NAPOLI WY Suite: Vicinity: Parcel Number: 43914144 Appliwnr. BERTLSHOFER, CAROL Atldress: 2474 NAPOLI WAY COSTA MESA, CA owner: BERTLSHOFER, CAROL Address 2474 NAPOLI WAY Contractor: Address: � Arch : Address: COSTA MESA, CA BUILDING PERMIT 2oning: Phone: 949-483-8732 Zip: 92627 Phone: 949-548-8732 Zip: 92627 Phone: License: , Eng: � • � � � Address: Phone: �tM1T NUMBEH 699-01496 " 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 09/16/1999 Issued: 12/21/7999 ISSUED BY: l /� Phone: Zip: ' License: License: SCOPE OF PERMIT ADD 99.5 SF TO AN EXISTING BEDROOM , REMODEL PART OF EXISTING BEDROOM FOR A BATHROOM, RELOCATE EXISTING INTERIOR WALLS. "PC FEES ARE NOT PAID YET." Plan Check: $190.61 Permit: $293.25 SMIP Res: $1.75 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $485.61 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 Rear 0- 0 Rear 0-0 FEESUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 517,464.50 so.00 NOTICE: Tha work authorized by this permit shall comply with all applicable handicap accass requiremenis under California statutas and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for e period ot 780 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 requlred Inapectlons end final approval must be ob�eined. Failure to obtain inspections and final approvel will result in the expiration ot this parmit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: • 1 hereby aNirtn under penalty of perjury one ot the following tleclarations: • ❑ I have end will maintain a certificate of consent to self-Insure for workers' compensation, as provitletl for by section 3700 of the Labor Code. for the pertormence of the work for which Ihis permi� i5155ued. ❑ I have ana will maintain workeB' compensation insurance, as requiretl by sectlon 3700 of the Lebor Code, lor the pedormence of Ihe work for which ihis pertnit is issuetl. My workers' compensation Insurence carrier and policy number are: Carrier: Policy Number: (rhis section need no( be completed il fhe permif is valued af one hundred dollars ($700) ar /essJ ❑ I certify that in ihe pertormance of ihe work for which ihis permit is issued, I shall not employ any person in eny manner so as to become subject to Ihe workers' compensation laws oi Calitornia, antl egree that if I should become subject to Ihe workers' compensation provisions ol Section 3700 of lhe Labor Cotle, I shell forthwith comply with these provisions. Applicant SigneWre: Date: WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVEF TO CFIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED TFIOUSAN� DOLLARE (5100.000�, �N A�DITION TO THE COST OF CAMPENSATIqJ, DAMAGES AS PROVIDED FOR IN SECTION 3lO60F THE L4BOR CODE, IMEREST. AND ATfORNEYS FEES. LICENSED CON7RAC70RS DECLARATION: I hereby aHirm �hat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Cotle, an� my license is In full force and eHecL Lic. N Glass # Comractor's Signature: Date: � CONS7RUCTION LENDING AGENCY: ❑ I hereby eflirm Ihet Ihere is a constmction lending egency for Ihe peAormance of Ihe woB for which this permit Is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signeture: Data: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnit to consiruct, alter, improve, demolish, or repeir any structure, prior to its issuance, also requlres the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provislons of the Contractors License Law (C�epter 9(commencing with Sectlon 7000) of Didsion 3 of the Business and Protessions Cotle) or that �e or she is exempt therefrom entl the basis for the alleged exemption. Any vloletion ot Section 7031.5 by any epplicant tor a permit subJects the applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner oi the property, or my employees with wages es their sole compensation, WILL DO TME WORK, antl the structure is not Intentletl or oNeretl for sale (Sec. 7044, eusiness end Pmfessions Code: The Comractors License Lew does not epply m an owner ol propeny w�o builtls or impmves �hereon, entl who does such work himself or herseN or through his or her own employees, provided iha� such impmvements are not intentled or oHered for sale. If, however, the huilding or improvement is sold within one yeer of completion, tha owner-builtler will have the burtlen of proving thet he or she did not build or impmve for purpose ol sale.). �I, as owner ot the property, em EXCLUSIVEIV CONTRACTING WITH LILENSED CONTRACTORS to consimct Ihe project (Sec. 7044, Business antl Professions Code: The coniractors License Law does not apply to en owner ol pmperty who 6uilds or impmves thereon, antl who contracis for such project with a contrac�or(5) licensa pursuanf to the Contractore License Laws.). Business entl Professions Cade for ihis reason: by driver's license. �Yas ❑ No Veritication of Ownership by (rype of documen�, i.e. - properry tax bill or DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no eacavation live (5) or more taet in depth Into which e person Is requiretl to descend, will be meda in connection with work authorizetl by this permit, end that no Duiltling swcture, scattolding, talsework, or demolition or tlisman0ing thereof, will �e more than thlrty-six (36) feet high. (C�ap. 32, Gry 2, Art 2, Sec. 347, Title e, Califomia Adminis�rative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit from the Division of Industrial Safety, as notetl ehove. unless such person has a permi� to do such work irom �he division. SignaWre: �ate: Division of Industnal Safery Pertnit Num6er. CERTIFICA7E OF COMPLJANCE AND AUTHORIZA710N OF ENTHV: I certity untler penalry ol perjury t�at I have read ihis epplica�ion antl stata that Ihe information given is correct. I agree to comply with all siate laws and city ordinances relating to building construction, and authoriza representatives of ihe City ol Costa Mesa to enter upon lhe above-describetl propeny f inspection puryoses. I agree not to occupy or ellow occupancy ol eny Ouiltling authorized by ihis pertnit until final inspection. /a- �-9 Sig � i Leg Owner(s Dat A u orized Applicant Date COOE t. INSPECTIONTYPE P9IE IMRIRLS 7616 Fixed System Final Fire Preventian 1266 Pool Spa Final 200 Final Re-Roof 2o1 Final BIocWRetaining wall 202 Finel Fectory Fire Place 203 Final Sign 204 Final Demolition 2d4Gd6 CODEY INSPECTIONTYPE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electrical 212 Final Fire Prevention 220 Finel Planning Approvel 222 Final Site 250 Final Building/Occupancy �g AL BACK BAY GARDENS ASSOCIATION September 1�, 1999 Caro1 B�rtlshofer 2474 Napoti Way Costa Mesa, CA 9?627 Dear Ms. Bertlshofer: The Back Bay Gazdens Board of Governots is pleased to inform you that it approved your recent Architectural Request pertainine to the following construction plans: extending the reaz section of your home into your patio azea. The approval is contin�ent on the following: the addition may not encroach upon the common azea. P:ease contact our o�ce, should you have relevant questions. Sincerely, �� cLro�[�--� oL.� Helen Aazdema, CCAM Managing Agent �VEBB Community Management, Inc. (300)498-1129 � FAX (949) 498-1295 — email: haardema@webbm�nt.com tl �� °� �� %i�ea.� �uu��y �fai�Co�s OWNER-BUILDER VERIFICATION A city or county, which is reyuired to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the retum of, an owner-builder verification. Attention Property Owner. An `owner-builder' building pemtit has been applied for in your name and bearing your signature. Please complete and re[urn this information in the emelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildine permit will be issued until this verification is received. 1. 1 personally plan ro provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No � I h v ave not) signed an application for a building permit for the proposed work. �'� I have contracted with thQe�following person (firm) to provide the proposed construction: Name �C � ,-« /rJ c��„�� Address ��7oi IV(ON !'ov�c� Q-#ni-a Ci[y CoS`�u n.ns� Phone �yy ) S l.S -�SO6 Convactor's Lic. No.s7��o� 4. I plan [o provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: . IVame Address City _ Phone ( ) Contractor's Lic. No. 5. I will provide some of Ihe work but I have contracted (hired) the following persons to provide the work indicated: Namc Address Phone Type of Work 10d2-A6 (REV.958) A 1 �L� M�9 . o. � • , _ F J .'a?,�� ia� �sa-s2�a • Fa: (�ia) �sa<ass Job Address: 2474 NAPOLI WY CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Suite No Vicinity: ADDITION @ REAR OF CONDO Parcel Nunmber: Applicant Address: Owner: 43914144 BERTLSHOFER,CAROL 2474 NAPOLI WAY COSTA MESA, CA BERTLSHOFER,CAROL Address 2474 NAPOLI WAY COSTA MESA, CA Contractor: OWNER-BUI LDER Address: ELECTRICAL PERMIT Phone: 949-548-8732 Zip: 92627 Phone: 949-548-8732 Zip: 92627 Phone: Zip: License: 0 ?RMIT NUMBER E00-00097 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 02/08/2000 Issued: 02/OB/2000 SCOPE OF PERMIT ELECTRICAL PERMIT FOR ADDITION & REMODEL OF EXISTING CONDOMINIUM. INSTALL 34 LIGHTS, 24 OUTLETS, 27 SWITCHES, 4 RES APPL, & 1-200 AMP ELECTRICAL SERVICE. REF: B99-01496 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixls Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $3022 $3012 325.11 $0.00 $19.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 � � 27 0 4 7 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System I Lighting Buswayl100ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Sland Other Electriwl Fee Investigation Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 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, 12-27-92) E%PIRATION: 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectiona end final approval must be obtained. Failure to obtain inspections and final approval will resufl in tha expiration of this permit. FOH INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: • I hereby attirm untler penelry of perjury one of the following declarations: • ❑ I have and will maintain a cenifica�e of consent to sell-Insure for workers' compense�ion, as pmvidetl for by section 3700 ot Ihe Labor Code, tor the pertormance of Ihe work for which this permi� is iuuetl. ❑ I �ave entl will maintain workers' compensa0on insurance. as required by section 3700 ot the Lehor Code, lor the peAormance oi Ne work lor which this permit is issuea. My workars' compensation Insurence carner and policy number are: Carrier: PoliCy Number: (7his secfion nee0 not be complefed il the permit is valued et one hundred dollars ($100) or Ie55J ❑ I certity that in the peAormance of ihe work for which this permit is issued, I shall not employ any person in eny menner so as to becoma subjecl to the workers' compansation laws ot Calitomia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith comply with these provisions. Applicem Signemre: Date: WARNING: FAILUPE TO SECUPE WORKERS' CQNPENSATION WVERPGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINA� PENNLTIES AND dVIL FINES UP TOONE HUNORED iF10USAND DOLLARE (5100,000), IN ADORION TO iHE WST OF CAMPENSATION, DAMAGES AS PRONDED FOR IN SECTIQV 3106 OF THE LABOR CODE, IMEREST, ANO ATTOflNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, end my license is in full force end atfect. Lic. N Class # ConiracbYs SignaWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that there is a consiruction lending agency for ihe peAortnance of ihe work for which ihis permit is issued. (Sec. 3097, CiNI Code). Lentler's Name: Lentlers Atltlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm that under penalry of perjury Ihat I am EXEMPT FFOM 7HE CONTRAC70RS LICENSE LAW for the following reason (SecJ031.5, Business antl Professions Cotle: Any ciry or counry which requires a pertnit b consWci, alter, improve, demolish, or repeir any stmcWre, prior to its issuance. also requires the applicant for such pertnit to file e signed statement ihat he or she is licensed pursuam to the pmvisions of Ihe Contraaors License Ww (Chapter 9(commencing with Sealon 7000) of Division 3 of the Business antl Protessions Cotle) or that he or she is ezempt Iherefrom and the basis for iha alleged ezemption. Any violation oi Section 7031.5 by any epplicant tor a pertnit sub�ecis the aOP�icant to a civil penalry of not more t�an live huntlretl tlollars (5500)J: ❑ I, as owner of Ihe propetly, or my employees with wages as lheir sole compensation, WILL DO THE WORK, and the swcture is not intenCetl or ottered for sale (Sec. 7044, Business and Pro/essions Cotle: The Contractors License Law dces not apply to an owner of property who Duiltls or improves thereon, antl who does such work himself or herself or thmugh his or her own employees, provided Ihat such improvemenis ere not intended or ofleretl for sale. If, however, Ihe building or improvement is sold within one yaer of completioq the owner-builder will heve ihe burden of proving �hat he or she did not build or improve for purpose of saleJ. —� � I. es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conshuct the project (Sec. 70a4, Business antl Professions —�Code: The contrectors License Law does not eppty to en owner of pmpeny who builds or improves thereon, antl who con�racts for such projact with a contractoqs) licen5e pursuant to the CONrector5 License Laws.). untlersec. Business antl Professions Cotle tor this reason: Date: by tlrivefs license. ❑ Yes Verification of Ownership by (type of document, i.e. i�Diivers Cicense No. �ex bill or deetlk y DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ 1 �ereby certify that no e:cavation five (5) or more feet In depth into which a parson Is required to descend, will be made in connection with work authorized by Ihis permit, and that no building sirucNre, scattolding, falsawork, or demolition or dismantling ihereot, will be more ihan thlrty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Califomia Atlmini5irative Cotle). ❑ As owner-builtler, I will not employ anyone to tlo work which would require a permit irom the Division of Industnal Safety, as notetl above, unless such person has a permit to do such work fmm Ihe divLsion. Signeture: Date: Division of Industrial Safery Permit Number CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I cenity under penalry of perjury that I have reatl ihis applica�ion and state that the infortnation given is correct. I agree to comply with ell state laws and ciry ordinances relating to building consiruction, and authorize representatives of ihe Ciry ol Costa Mesa to emer upon ihe above�tlescribetl property br �in,s,pec�tion pur�Xfpses. I egree not to occupy or allow occupancy ol any building authorizetl by this permit until final inspection. �V`----� �--TI �vZ=S�O O � SignaNre Of Legal O Yner(s)� Date And/Or Authorized Applicam Da�e COpE L INSPECTIONTYPE p0¢, INTITIALS 1616 Fized System Final Fire Prevention 1266 200 201 202 203 Pool Spa Final Final Re-Roof Final Block/Retaining Wall Final Pactory Pire Place Final Sign 204 Final Demalition 2a48-a6 CQOEt INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevemion 220 Final Planning Approval 222 Final Site 250 Final Building/Oaupancy �� i �� INiiTIRLS � �� °� �� %� S'uu�C�uz y �iuiQl4c� OWNER-BUILDER VERIFICATION A city or county, which is reyuired to give notice pursuant to Sec[ion 19830, shall attach [o such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'ownervbuilder' building permit has been applied for in your name and bearing your signa[ure. Please complete and return this informatian in the envelope provided at your earliest opportunity ro avoid unnecessary delay in processing and issuing your building permit. No buildin� permit will be issued until this verification is received. 1. 1 personally plan [o provide the major labor and materials for conswction of [he proposed property improvement. � Yes ❑ No 2. I av ave not) � signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed conswction: Namc . J Address /�'��n� (ZoV�ct City �OS %%1CSq Phone (9q� ) �i �.5 ` �{�9!'1 Contractor's l.ic. No. S ��IDaZ —C 4. I plan to provide portions of the work, but 1 have hired the following person ro coordinate, supervise and provide the major work: Namc Address City Phone ( ) Contractor's Lic. No. 5. 1 will provide some of the work but 1 have contracted (hired) the following persons to provide [he work indicated: Name Address Phone Type of Work GQ,n�u�`N2 NdC. !-Boo-ZU3-aSa� J/¢C, �oazas 1AEv. B�es1 � r t�,�'� MF q ''� � CITY OF COSTA MESA � ' BU/LDING DIVISION � � DEVELOPMENT SERVICES DEPARTMENT � ' PERMIT x�+� "o p�a� �sa-s2�s • Fax (714) 754-4856 Job Address: Suite No Vicinity: 2474 NAPOLI WY ADDITION @ REAR OF CONDO Parcel Nunmber: 43914744 Applicant: BERTLSHOFER, CAROL Address: 2474 NAPOLI WAY COSTA MESA, CA - Owner: BERTLSHOFER, CAROL Address 2474 NAPOII WAY COSTA MESA, CA Contrecror: O WN ER-BU I LDER Address: Arch / Eng : Address: PLUMBING PERMIT Phone: 949-548-8732 Zip: 92627 Phone: 949-548-8732 Zip: 92627 Phone: Zip: License: 0 Phone: Zip: License: . .- � PE 1 IT NUMBER P00-00077 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 02/08/2000 Issued: 02/08I2000 ISSUED BY: SCOPE OF PERMIT PLUMBING PERMIT FOR ADDITION @ REMODEL OF EXISTING CONDOMINIUM. INSTALL 2 TUBS, 1 CLARIFIER, 1 DISHWASHER, 4 GAS OUTLETS, 1 GAS REPIPE, 1 WASHER, 9 P-TRAPS, 2 SHOWERS, 1 BAR SWK, 1 KITCHEN SINK, 7 PRIVATE SPA, 1 WASH BASIN, 1 WASTE 8 VENT SYTEM, 2 WATER CLOSETS, 1 WATER HEATER, 7 WATER REPIPE, & 1 WATER SOFTENER. REF: B99-01496 ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof AMT $23.50 $0.00 $0.00 $79.60 $44.25 $0.00 $0.00 $9.80 $0.00 So.ao $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $9.80 0 Landscape Irrigation $0.00 0 P-Trap $88.20 2 Pressure Regulator $0.00 1 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 1 SewerCapforDemo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $19.60 QTY 1 0 9 0 0 0 0 0 D 0 2 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-0) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $9.80 $19.60 $12.30 QTY 0 0 0 0 0 0 1 0 1 2 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 ihe work authonzed under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: � I hereby aHirtn untler penalry of perjury one ot t�e following declarations: � ❑ I have and will maintain e certificate ot consent to seli-Insure for workers' compensation, as provided for by section 3700 ot Ihe Lebor Cotle, for the pertormance of the work tor which Ihis permi� is i5suad. ❑ I have and will maintain workers' compensation insurance, as required by sedion 3700 ot Iha Labor Code, for the pedortnance oi ihe work for which ihis pertnit is issued. My workers' compensation Insurence wrrier entl policy numher are: Carrier. Policy Number. (This section need not 6e completed il the permif is valued et one hundretl dollars ($100) or /ess.) ❑ I certity that in the pertormence of Ihe work for which ihis permit is issuetl, I shall not employ any person in any manner so as to become subject to the workers' compensation lews of Califomia, end agree ihet il l should become subject to ihe workers' compensetion provisions of Section 3700 of ihe La6or Code, I shan forthwith camply with these provisions. Appiicam Signature: Date: WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL $UflIEC� AN EMPLOYER TO CRIMINAL PENAlTIES AND GVIL FWES UP TO ONE HUN�REO iFIOUSPND OOLLARE �5100.000I, IN ADDITION TO THE COST OF COMPENSATION, DAh1AGES AS PROVIDED FOR IN SECTION 3'lOfi OF THE LABOP fAOE, IMEREST. AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm that I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force antl eHect. Lic. a Class p Contrectofs Siqnature: Da�e: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that t�ere Is a construction lentling agency for ihe peAortnance of the work for which this permil is issuea. (Sec. 3097, Civil Code). Lender's Name: Lentler's Atltlress: SignaNre: Data: OWNER-BUILDER DECLARATIONS: I hereby aMirtn that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which requires a permit to consWct, alter, improve, demolish, or repair any strucWre, pnor to its issuence, also requires the applicaN tor such pertnit to tile e signetl stetement ihat he or s�e is licensed pursuani to ihe provisions of the Contraciors License Law (Chapter 9(commencing wlth Section 7000) of Division 3 of the Business antl Protessions Cotle) or that he or she is exempt iherefrom and the basis tor Ihe alleged exemption. Any violaiion of Sec�ion 7031.5 by eny epplicant lor a permi� subjecis Ihe applicant to a civil penalry ol not more than five huntlretl dollars ($500).): ❑ I, as owner of Ihe propeny, or my employees with wa9es as their sole compensation, WILL DO THE WORK, and the simcture is not intended or oNeretl for sale (Sec. 704d, Business end Professions Code: iTe Contractors License Law does not apply to an owner of property who builtls or improves ihereon, antl who does such work himseli or herself or �hrough his or her own employeas, provided ihat such improvemenis are not intended or ottered lor sele. If, however, the builtling or improvemem is sold within one year of completion, Iha owner-builder will have the hurden of proving that he or she tlid not build or improve for purpose ot sale.). � I as owner ol Ne pmperty, am EJ(CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construd the project (Sec. 7044, Business antl Professions —Gotle: The contractors License Lew does not apply to an owner of property who builtls or improves thereon, entl who contrects for such prolect with e contractor(s) license pursuant to ihe Contrectors License Lews.). o� •0_.I em exemot under sec. �_ Business and Professions Code for �his reason: �— O�� . by driver's license. ❑ Ves � � No Venfication of Ownership by (type of document, i.e. - property taa bill or DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehiry that no ezcavation five (5) or more fee� In tlepth into which a person is requiretl ro descend, will be mede in connection with work authorized by this permit, antl Ihat no builtling structure, scaflolding, falsework, or tlemolition or dismantling thereol, will be more then ihiny-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, Califarnia Adminisireiive Cotle). ❑ As ownar-builder, I will nol employ anyone to tlo work which would require a permit from the Division of Industrial Safery, as noted above, unless such person has a permit to tlo such work irom ihe tlivision. Signature: Date: Division of Indusirial Sate�y Permii Number: CERTFICA7E OF COMPLIANCE AND AUiHORiZA710N OF ENTRV: I certify under penalty of perjury ihat I have read this application end state ihat the information given is correcL I agree to comply with all state laws and ciry ordinances relating m building consiruction, and euthoriza representatives of �he Ciry of Costa Mesa to enter upon �he above-tlescribed property for inspection pu es. I agree nai to occupy or allow occupancy of any building authonzed Dy this permit until final inspection. �� _, _�=��a 6�alureOf'Legal�Owner(s)`-- � Date ? _l AndlOr Authorized Applicant Date COpE �, INSPELTIONTYPE � INTRI L 1676 Fixed System Final Fire Prevention 7266 200 201 202 203 Pool Spa Final Final Re-Roof Final BIocWFetaining Wall Final Fectory Fire Plece Final Sign 204 Final Demolition 2646 a8 COOE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elechical 212 Final fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupency jIR�T INTRIRL . • • � CITY OF COSTA MESA BI/ILDING DIV►SION DEVELOPMENT SERVICES DEPARTMENT PERMIT �»a) �sa-s2�a • Fax (»a� �sa-aess PLUMBING PERMIT Job Address: 2474 NAPOLI WY Suite No Vicinity: Parcel Nunmber: 43914144 Applicant: CAROL BERTLSHOFER PERMIT NUMBER � P0o-ooz26 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 05/04/2000 Issued: 05/04/2000 g� Gas (t-4 outlets) - Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) $0.00 $0.00 $0.00 $0.00 50.00 $0.00 Sink, kitchen Sink, service/mop Spa (private) Spa (public) $0.00 $0.00 $0.00 $0.00 COMMENTS / SPECIAL CONDITIONS Water Softener 50.00 OTHER $0.00 VIOLATION $0.00 PLAN CHECK $0.00 REINSPECTION 549.50 TOTAL CALCULATED FEES: E56.75 1 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 automa�ically expire and become void if work is nobcommenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under Ihis pertnit to be considered legal, such work must comply with all applicable codes, and all requlred Inapections antl flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: ' I hereby eHirtn unaer Denalry of perjury one ol the lallowing decleretians: � ❑ I heve end wlll maintain e certificate of consent to setl-Insure for workers' compensetion, as providetl for by sectlon 3700 of the Lebor Cotle, lor the peAortnanca ot Ihe work for which this pertnit is issued. ❑ I have entl will meintain woMers' compensation insurance, as requiretl by section 3700 of the Labor Code, for �he performance of ihe work lor whlch ihis pertnit is issued. My wOrkers' compensetion Insurance cerrier end pollcy number are: . Carrier: Policy Number: (Thls setf/on need no! be comp/e�ed il the permit is valued af one hunUred dollars ($100J or less.) ❑ I certify t�et In ihe peAormance ot tha work for which this Dermit is issued, I shall not employ eny person in any manner so es to become subject to the workers' compensation laws oi CalifO�nia, antl egree that If I shoultl become subject to the workers' compensation pmvisions of Section 3700 of the Lebor Coda, I s�all fonhwith wmply wilh these provisions. Applicant Signature: Daie: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEPAGE IS UNLAWFUL AND SHALl5U61EGT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNORED TFKKISPND OOLLARE (5100,000), IN ADDITION TO TME C0.ST OF GOMPENSATIIXJ, DAMAGES PS PROVIDED FOR IN SECiIIXJ 37060F THE LABOq CO�E, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby afli�m Ihel I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 af the Business and Professlons Code, entl my license is in full lOfCe Bntl eRed. LIC. M Class N ContractoYs Signature: Date: CONSTRUCTON LENDING AGENCY: ❑ I hereby aflirtn that there is a�nsiruction lending agency tor !he peAortnanca of the work lor which �his pertnit is issueU. (Sec. 3097, Civil CoOe). Lentlefs Name: Lentlers Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby effirm that untler penalry of perjury that I em E%EMPT FROM THE CON7RACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit to construct, alter, improve, damolish, or repair any slrucWre, Pnor to its issuance, also requires the applicani tor sucB pertnit to tile e signeC statement thet he or she Is Iicensed pursuant to the provisions of the Contrac�ors License Lew (Chapter 9(commencing wlth Section 7000) oi Division 3 ot the Business ana Professions Coda) or that he or she Is eaempt i�ereirom and ihe basis tor t�e elleged exemption. Any violation of Section 7031.5 by eny epplicent for a permit suh�ecis ihe eppllcant to e civil penalty of not more then five hundretl tloilars ($500).): ❑ I, as owner of the property, or my employees with weges as iheir sole compensation, WILL DO THE WORK, and ihe struaure is not Intended or oHered for sale (Sec. 704a, Business end Protes5ions Cotle: The Coniractors License Law tloes not apply to an ownar ol propeny who builtls or improves Ihereon, antl who does such work himsalt or hereelf or ihrough his or her own amployees, provided t�at such improvemanis ere not intended or oflered for sele. tl, however, ihe builtling or improvement is sold within one year of completion, ihe owner-bulltler wlll heve iha burtlen of proving Ihet he or sha did not build or improve for purpose ot sele.). ❑ I, as owner ot Ihe property. am EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to cronstruct the project (Sec. 7044, Business and Professions CoGe: The contractors License Law does not epply to an owner ot pmpeny who builtls or impmves thereon, and who conirects tor suc� project with a contractor(s) license pursuant to ihe ConVactoro LJcense Laws.). ❑ I am exempt untler se . Business antl Professions Code tor this re�: Signeture: � Date: S- y- o U Owner ID verifietl by arivers license. ❑ Yes ❑ No Driver's License No. � Expires: 9- eZ��-03 Venfication of Ownership by (rype ot dacument, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certity that no e:c2�ation five (5) or more feet In depth into which a person Is requlretl to descend, will be matle in connection with work authorized by this permit, antl ihat no building simcNre, sceHol0ing, telsework, or demolition or tlisman�ling thereof, will be more than ihirry-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Title B, Calitornia Administretive Code). ❑ As owner-builder, I will not employ anyone to tlo work whlch woultl requira a pertnit Irom the Division oi Indusirial Safary, es notetl above, unlass such person has a permii Io do such work fram the division. Signeture: Date: Division oi Industrial Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORQATON OF ENTRY: 1 certify under penelry of perjury that I have read this application entl state Met the informa�ion given is correct. I agree to comply with all state laws end ciry ordinances relating to building construction, and euthonze represen�atives of the Ciry of Cwta Mesa to enter upon the ebove-descdbetl pwperty for i�sp6��ion puryoses. I agree not to occupy or allow occupancy ot eny buliding euthorized by this pertnit until Ilnal inspection. �v J� �. � = s� u n Signa�ure Of Lagel Owne s) Date AnNOr Au�honzed Applican� Date COOE �. INSGECTIONTVPE 1676 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Fina1 BIocWRetaining Wa�� 202 Final Fectory Fire Placa 203 Final Sign 204 Final Demolition zme�ae QOjfi INT CODEY INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Appro�el 222 Final Sita 250 Final Building/Oaupancy onre �NTRIALS From: [] �. � ❑ ❑ Finance Building Safety Planning Public Services Leisure Services Other CtTY OF COSTA MESA REFUND REQUEST FORM Vendor#: Permit#: hhrr��•�,r,IF i i l�"�-f��f',2Z(�� Amount: $ ( I � ".-= Date: >• 1�{ 'C)� Department Signature Account Fund OrgaNzation Program ProjecVGrani Amount 7 Name and address of applicank '�/{ n�. ��/��-�5�7�0 %_�'%( a��v �l/�.,pd�,� w'�u C°�s�`� /4/�-s� C�r . 9� G� 7 Pno�e: 9 %9- �-/�3- � 36 3 , ApplicanYs Signature REASON FOR REFUND: =/9-c Date �J �Iti'�l t� I S� 1:��1^l i N u-�'J �C Jc • �`� /�-1��C_1'1-u> Cl'�t�i� o r` i� �C��=� r� � S!=c`>>� Ri�F� .(Zr-_N CL- . i4'I:-21 MV/ ONLINE (714)754-5273 • Fax(714)754-4856 CITY OF COSTA MESA � ' ' • BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 2474 NAPOLI WY Suite No Vicinity: ADDITION @ REAR OF CONDO Parcel Number: 43914744 Applicant: BERTLSHOFER, CAROL Address: 2474 NAPOLI WAY COSTA MESA, CA owner: BERTLSHOFER, CAROL Address: 2474 NAPOLI WAY COSTA MESA, CA Contractor: OWN ER-BU I LDE R Address: Arch / Eng : Address: MECHANICAL PERMIT Phone: 949-548-8732 Zip: 92627 Phone: 949-548-8732 Zip: 92627 Phone: Zip: License: 0 Phone: 2ip: License: NUMBER M00-00066 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: SCOPE OF PERMIT MECHANICAL PERMIT FOR ADDITION 8 REMODEL OF EXISTING CONDOMINIUM. INSTALL 1-FAU, i HOOD WITH MECH EXHAUST, 2 VENT FANS, 4 APPLIANCES, 1 COMPRESSOR UP TO 3 HP. REF: 699-01496 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys �100 k BTU Refrig Sys�>700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent $23.50 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.65 $0.00 $14.50 $42.60 $0.00 $0.00 $0.00 Quantity 1 0 0 0 0 0 0 0 1 0 2 4 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / All Refrigeration Unit Ventillation System Evaporative Cooler Commercia l I ncine rator Domestic Incinerator Compressors / Absorption Systems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp / 7,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp i5to30hp Status: ISSUED Applied: 02/08/2000 Issued: 02/08/2000 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $14.70 1 $0.00 0 $0.00 0 NOTICE: The work authorized by ihis 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 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be consitlered legal, such work must comply with all applicable codes, and all required inspectfons and final approval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , WORKERS' COMPENSATION DECLARATION: • , I hereby aHirm under penalry of perjury one oi ihe tollowing declarations: ' '' • � ❑ I have antl will malntain a certificate ot consent to self-Insure fo� workers' compensation, as provitletl for by section 3700 of the Labor Cotle, for tha peAormance of the wo�k tor which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as reQuired by section 3700 of the la6or Code, tor the pedormance ot the work for which this permit is issuetl. My workers' compensation Insurance c�rner and policy number are: Carrier: Policy Number: (fhis section need not be completetl il the permit is valued at one hundred dollars ($700) or less.) ❑ I certity that in Ihe pertormance oi the work (or which this permit is issueQ I shall not employ any person in any manner so as to becoma su6ject to ihe workers' compensation laws of Califomia, and agree that if I shoultl become sublect to the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNL4WFUL AND SHALL SUBJEGT PN EMPLOYER TO CRIMINAL PENALTIES ANO qVIL FMES UP TO ONE MUNDRED THOUSPN� DOLLARE (5100,000). IN ADDITION TO THE WST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]Ofi OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION; �'� I hereby attirm ihat I am licensetl under pmvisions of Chapter 9(commencing with Section 7000) of Division 3 oi ihe Business and Professions Cotle, and my license is in full I �Iforce antl eflect. Lic. k Class q I Coniractofs SignaWre: Da�e: � CONSTRUCTION LENDING AGENCY: ' ❑ I hereby aHirtn that there is a conSWction lentling agency for ihe pertortnance of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirm �hat untler penalty ot perjury �ha� I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Protessions Code: Any city or county which requires a permit to constmct, alter, impmve, demolish, or repair any stmcture, prior to its issuance, also requires ihe applicant for such permit to file a signed statement that he or she is licgnsed pursuant to ihe provisions ot ihe Coniractors License Lew (Chapter 9(commencing with Section 7000) of Divlsion 3 of the Business and Professions Code) or that he or she is exempt iherefrom antl the basis tor the alleged ezemption. Any violation of Section 7031.5 by any applicant for a permit subjecis the applicaN to a civil penalty of not more than tive hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl the structure is not intendad or oNeretl for sale (Sec. 7044. Business and Professions Cotle: The Comractors License Law tloes not apply to an owner ot property who builds or improves thereon, and who does such work himself or herself or ihmugh his or her Own employees, providetl Ihat such improvements are not intended or ottered for Sale. If, however, ihe building or improvement is sold.within one year of completion, Ihe pwner-6uilder will have ihe burden of proving that he or she did not builtl or improve for purpose ot saie.). � I, as owner oi the property, am E%CLUSNELV CONTRACTING WITH LICENSED CONTRACTORS to construct the pmjact (Sec. 7044, Business and Professions �Code`: The comractors Licanse Law dqes not apply to an owner ot propeny who buiids or improves Ihereon, antl who contracts for such project with a contractoqs) license pursuant to the Contrectors License Laws.). �} p� ❑ I am eaempl under sec. „ Business and Professions Code for this reason: _ —oC � O— �� verified by driver's license. ❑ Yes Venfication of Ownership by (type of tlocumen�, i.e. - pfopeny tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby cehify that no excavation tive (5) or more feet in tlepih into which a person is required to descend, will be matle in connection with work authorizetl 6y ihis permit, and that no Duiltling simcture, staffoldinq, falsework, or demoli�ion or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, T�le e, Calitornia Adminis�ra�ive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Intlustrial Safety, as noted above, unless such person has a permit to do such work 6om ihe tlivision. Signature: Dare: Division o� Indusirial Safery Permi� Numbar. CER7IFICATE OF COMPLIANCE AND AU7HORIZA710N OF EN7RY: I cenity under penalty of perjury �ha� I have read this application and state �hat the intormation given is correct. I agree to comply with all state aws and ciry ordinances relating to building consimction, and authorize representatives of the City of Costa Mesa to enter upon the ebove-described property for inspection urposes. I agree not to ocwpy or allow occupancy ot any building authorized by this permit umil final inspection. � sL_ i P4�.�i _ o?- $-rJ O SLnature Of Legal Owner(s) � �a�e And/Or Authorized Applicant Date COpEN. INSPECTIONTVPE �1Rj[ INTRIALS 1616 Fiaed System Final Fire Prevention 1266 200 Pool Spa Final Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion 2aa6>6 CODE� INSPECTIONTVPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy � I ITIAL ��a) �sa-sz�s • Fax (�ia� �sa-aess CITY OF COSTA MESA . ,_ , . BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT, PERMIT Job Address: 2474 NAPOLI WY Suite No Viciniry: Parcel Number: 43914144 Applicant: Address: Owner: CAROLBERTLSHOFER BERTLSHOFER, Address: 2474 NAPOLI WAY Contracror: Address: Arch / Eng : Address: COSTA MESA, CA ` � REINPSECTION FEE ISSUE FEE Inst FAU <700 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Re�rig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV 8ox Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Hantllers > 10000cfm FloorFurnace Floor or Suspend Heater 25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 50.00 MECHANICAL PERMIT Zip: 949-548-8732 92627 Phone: Zip: Licen � PERMIT NUMBER 77 FAIR DRIVE, COS�A45fESA', t.9P9 Status: ISSUED Applied: 05/04/2000 Issued: 05/04/2000 ISSUED BY: . � � � ne: / ///^�\' \ \ Zip: nse: : \ �� Repair / Alt Absorblion Unit 0 Repair I Alt Refrigeralion Unit 0 Ventillation System Evaporative Cooler 0 Commercial Incinerator 0 Domestic Incinerator 0 Compressors / Absorption Systems 0 Up to 3 hp / 100 k BTU 0 3To15hp/SOOkBTU 0 15 To 30 hp / 1,000 k BTU , 0 30 To 50 hp / 1,750 k BTU 0 Over 50 hp I Over 1,750 BTU 0 Boilers 0 Upto3hp 0 3To15hp 0 15 to 30 hp 0� 30 to 50 hp 0 Over 50 hp 0 Other Mechanica� Fee 0 Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 50.00 $49.50 556.75 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, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is no4commenced 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 requlred Inepectlone antl flnal approvel must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754•5626 WORKERS'COMPENSAnON DECLApANON:�� ' I herehy aHirm untler penalry oi per�ury one oF the following tlecleretlons: . . � � � I have end will maiNain a certificate of consent to self-Insure for workers' compensetion, as provided for by sectlon 3700 oi Ihe Labor Code, tor ihe peAormance of Ihe work lor which Ihis pertnit Is is5ued. ❑ I have and will maintain workers' compensatlon in5urance, as reqWretl by sectlon 3700 01 �he Labor Code, tor the performance of the work for which this pertni� is issued. My workers' compensetion Insurence cartier and policy number ere: . Carriar. Policy NumDer. (This section need not be comp/eted!! the permit is valued et one huntlretl tlollars ($100J or less.) ❑ 1 certity that in the peAormance of Ihe work tor which Ihis pertnit is issued, I shall not employ any person in eny manner so as to become subjecl lo the workers' compensetion laws ot Celifomia, end egree ihat il I should become subject to the workers' compensation pmvislons of Section 3700 of tha Lebor Code, I shall torthwiN comply with thase provisions. Applicanl Signeture: Date: WARNING: FAILURE TO SECURE WORKER$' COMPENSATIIXJ COVERAGE I$ UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND pVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAFE (5100,000), IN ADDRIIXJ TO THE C0.ST OF COlAPENSATION, DMMGES AS PROVIDED FOR IN SEGTION 31W OF THE LABOR (X�E, IMEfiEST, AND ATTORNEVS FEES. LICENSED CON7RAC70RS DECLARATION: I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of Ihe Business and Professions Code, and my license is In full torce entl eflect Lic. M Class N Contrectors Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I �ereby aHirtn that lhere is a construction lending agency for Ihe peAormance ol the work for which this pertnil Is issued. (Sec. 3097, Civil Code). Lenders Neme: Lentlefs Address: Signeture: Daie: OWNER•BUILDEfi DECLARATIONS: I hereby aHirm that under penelty of perjury Ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business end Professions Code: Any ciry or county which requires e permit to conSWct, alter, improve, demolish, or repair eny stmcture, prior �o its issuance, also requires Ihe epplicant for such permlt to tile e signed stetement Ihe� he or she is licensed pursuant to Ihe provisions of the Contractors Llcense Law (Chapter 9(commencing with Sectlon 7000) oi Division 3 ot Ihe Business and Professions Cotle) or thet he or she is exempt therefrom end ihe basis for the elleged exemption. Any vlolation of Section 7031.5 by eny applicant tor a permit sub�ects the epplicant to e clvll penalry of not more ihan fiva hundred dollars (5500)J: ❑ I, as owner of Ihe property, or my employees with weges as their sole cnmpen5ailon, WILL DO THE WORK, end the structure i5 not inlentlatl ar ottered for 5ale (Sec. 7044, Business antl Professions Code: The Conirectors License Law dces noi epply to an owner of property w�o builds or improves thereon, antl who does such wark himself or herself or Ihrough �is or her owd employees, pmvidetl that such improvemenis ere not in�ended or oflered tor sale. If, however, the building or impmvement is sold within one year of completion, the ownar�6uilder will have ihe burtlen of provinq the� he or sha ditl not builtl or Improve for purpose oi sela.). ❑ I, as owner of �he property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contrectors License Lew tloes not epply to en owner of properry w�o builds or improves thereon, end who contrects for suU project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt untler secl Signeture: � �� Owner ID veniied by drivels license. � Yes , No eusiness entl Professions Cotle for ihis Venfication of Ownership by (rype of document, i.e. - properry tax bill or dead): Dnvers License No. Date: Expires: DIVISION OF INDUSTRIAI SAFETV PERMIT CER7IFICATION: ❑ I hereby certity ihat no excaveilon five (5) or more feet in tlapth Into which e person is requlretl to tlescend, wlll be matle in connection with work authonzetl by this permil, end tha� no Ouiltling stmcture, scaflolding, falsewoM, or tlemolition or dismantling �hereof, will be more than ihirry-six (36) feet �igh. (Chep. 32, Grp 2, Art 2, Sec. 347, lltle 8, Califomie Administretive Cotle). ❑ As owner�Duiltler, I will not employ anyone to do work which woultl require e parmit irom the Division of Indusirial Sefety, es notetl ahove, unless such person has a permit to do such work Irom the tlivision. Slgnature: Date: Division of Indusirial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIffHORIZATON OF EMRY: I certify under penalry of perjury ihat I have reatl this application end stata that the infortnation given is correct I agree to comply with ell state laws and ciry ordlnances rela�ing to buil0ing consWction, entl authonza representatives ot the Ciry oi Costa Mesa to enter upon ihe aDove-tlescnbetl property tor�nspaction purposes. I egree not to occupy or allow occupancy ot eny building authonzed by this permit until final Inspection. �' �—��--� � Signature Ot legal Owner /� Date � � / ,� y v u And/Or Authorized Applicent � Date 4pDE t. INSPECTIONTYPE 1676 Fixetl System Finel Fire PreveNion 1266 Poal Spa Final 200 Finel Re-Root 20/ FInaI BIocWRetelning Wall 202 Final Fectary Fire Placa 203 Final Sign 204 Final Demolitian 26abd6 0 irrtma�s CODEt ixsvecnoxnve 206 Final MBChanicel 20B Final Plumbing 210 Final Eleciricel 212 Final Fire Prevention 220 Final Planning Appraval 222 Final Site 250 Final euiltling/Occupancy B9IE Ixmiais From: ■ � ■ ■ ■ ■ Finance Building Safety Planning Public Services Leisure Services Other CITY OF COSTA MESA REFUND REQUEST FORM Vendor#: Permit#: hi�rn�--�•;r;1Fi i t�"':f'�-rf.2Z4� Amount: $ � � � '� C, . Date: '�• I�i "O(, Department Signature Account Fund Organization Program ProjecUGrant Amount I Name and address of applicant �G':./.� n� v��/! /�- S��o ��'/( a��v ti�Adi,� ��u C ��S��t ��5� ��t . s.� � � � Phone: 9 y/�— y�.3— � 36� � S=/9-o v Applicanfs Signature Date REASON FOR REFUND: l��N1\ t i I S:� l��cl� i N ,�J-�'J-�C'J�• Si=z= /i-l�l�C �L—i� Cl`��i� S; r rZ�C�� r� i S i=E%r: J2i-F; ,�'.i=N �_L— . 2q:.;� MI! ONLINE Applicant to fill in all spaces ezcept tnase within heavY bortler lines ana sign all appropriate tleclarations. CI7YOP.COSTAMESA CONS�RUCTIpNPERMIT •Project Address ApplicanYs Mailing A ress � ' Owner's Name �C Phon Address Arch/Eng. � License No. Address Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR D CLARHTION 1 hereby afti�m that 1 am licensetl untle� provision5 of Charter 9(comm¢ncing wi[h section �000) of Division 3 of the Bu5ine55 antl Prote55lon5 Cotle, antl my license is in tull ntl eff¢c[. License a ce No. Date / Si9nature WORKE 5' COMPENSNTION DECLARATION � � hereby affirm that 1 have a certi(icate of consent to self-insure or a certiticate Workers' Compensation Insurance, Or a certifie co y thereof (Secti n 00, Lab. C. 1 pp �y//� /� /jP Policy No. -��r/p� ComPanY � -p� / t/V/ (lzl� ertifietl copy is M1ereby urnizhetl. a Cer �f'e (ile0 with the city B 1ng '�n�, � Date Applicant EXEMPT 9 FROM WORKERS' COMPENSATION DECLARFTION (This sect�on neetl not be completetl if the permit Is for one huntlretl (g100) or IE55�. 1 certify lhat in tne performance of the work for which tM1is perm�t is issuetl I shall not employ any pe�son in any manner so as to become subject,to t{�e Workers' Compensation Laws ot Califomia. , Oale Signature NOTICE: If,after makin9 this tleclaration, you shoultl become subiect to the workers' Compensation provisions ot the Labor Cotle, you must fortnwitn mmply wi[h such provisions or tbis permit shall be tleemea revoketl. CONSTRUCTION LENDING AGENCV .'� I hereby affirm that the�e is a construction lentling agency for the Per(ormanC¢ of the work for which this permit is issuetl (Section 3097 !Civ. CJ Lentler's Name Lentler's Atltlress ' OWNER BUILpER DECLARATION I her¢by atfirm [hat I am exempt from the Contractor'S License Law for Ihe followinq reason (Section 7031.5 Business antl Professional Cotle: Any ciry or county wnicM1 requires a permit to cOnst�uct, alter, improve, tl2molizh o� repai� any 5Vu[ture, prior to Its issuance, also reqW�es the applicant for such permif to file a si9netl statement that he/she is Iicensed pursuant to the provisions ot the Contracror's License Law (Chapter 9(commencin9 with Section 7000) of Division 3 ot the Business antl Profe55ion5 Cotle) Or that he/She I5 exempt ��efrom�and lhe basis to� t0e allegetl exemptlon. Any viotation of SectiOn 31.5 by any applicant for a permit subjects the applicant to a civil nalty of mt more than five huntlred tlollars ($500�. L� I, as owner of the propevty or my employces with wages as their sole compensation, will �o tne work, ana the structure is not intentletl or offeretl for sale (Section �046, Business antl Professional Cotle: The Contractor'S License Law tloes not apply to an owner ot a pwperry wM10 bulltls or �mp�oves tpereon, antl who aoes sucn work himsolf/nerseli or tnrough his or her own employees, provitletl that such improvements are not Intentletl o� offe�etl tor sale. If, howeve�, IM1e builtling or improvement is Soltl within one year ot com- pletion, the owner will have the burtlen Of proving he/she tlitl not build or im- �rOve tor the purpose ot sale�. I, as owner of tM1e property, am exclusively contracting with Ilcensetl con- tractor5 to tonstruct the project (Section �044, Business antl Professionz Cotle: The Contractor's license Law tloes not apply to an ownerot prope�ty who builtls or Improves thereon, antl who contracts for such proje<ts with a con- ' tractor(s) ucense purwant to the Contractor's License Law). I am aware that � proof of their Worker's Compensation insurance shoultl be provltletl to me. ❑ I am exempt untler Section B. & P, C. for this reason Da[e � I hereby certify tha' information is correc' antl state Iaws relatir sentatives of �s ci in5peclion p e5 Signature Drivers•�Lirense or 5' 7F 0865-46,rev.10/84 _' Owner I have reatl lhis application antl state that the above I agree to comply wrth all city antl county ortllnances to buiitlin9 mnstruction, antl hereby authorize repre- to ¢n[er ypon the above-rrlentionetl property for _ 3�/37 _._- - __ ..,.,...... TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER AP # DESCRIPTION OF WOFK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING ❑�FOUNDATION ❑ STRUCTUftAL T Front ❑ TENANT ❑ ELECTRICAL PIYPLUMBING ❑ MEGHANICAL � B Rear ❑ OTHER A PROJECT DESCRIPTION 5cd. FT. oCCVaArvCv � C Right � CONSTRUCTIONTYPE VALUATION$ ' g Left ZONE GRADING CU. VDS. ACRES Pln�. R2F. # Remarks: ' �� ' Planning Notes: Bar Sink Backflow Preventer Backflow Irriga[ion Drinking Fountains Floor Orains Floor Sinks . GasService Ouclets InterCeptor5 ' Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee � $75 Boiler Duct-UnderGround Duct - Siructural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepVFacL 61t. ICBO # � Heating System & Ducting ❑ ai oo,000 aru � i oo,000 er Reinspection Fee � $75 White - - Accountinq; Goltlenrotl - ASsesSor Showers Service Sink Sewef Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service - Auio-Wash � Laundrv Travs , Issue Fee Hood or TYPeI ❑ Canopy Type I I I] Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration � Fire Dampers . Aegisters � � . Issue Fae FEES $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher - Dryers ❑Gas ❑Electric Zone ' Accesmry Building: Req./Provided - o sr.00 ELECTRICAL ' Transformer ❑ 75-50 KW ❑ 50+KW Fan F.A.U. Fixtures Device Boxes Outlets Switches' � � Garbage Disposal Generator �0�5 KW 05-15 KW Meter LJup to 100 amps Meter pover 100 amps Sub Panel Motars �O-1 HP 01'f. - 8 InaSolar �9-15 HP �16-75+ Microwave � Pole Light Fiange Standing Sections Trash Compactor I Reinspection Fea f$15 ' ' Issut DEVELOPMENT SERVICES REQUIREMENTS: Zonin9 APProv¢d By Building Approved By App�ication Issued By FEES $ 3 Z O N I N G R E � M T S SUMMARV OF FEES BUILDING PERMIT $ SMIP � � $ PLAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ � PLAN CHECK 25% $ ENERGV P.C. $� ELECTRICAL $ GRADWG $ PLAN CHECK 50% $ MICROFI�M $ MECHANICAL $ TOTALFEE $ � � PLAN CHECK 25% $ ' � 7� Y TC�`f `a.3U CONSTRUCTION AND PLANNING POOL & SPA � APPROVALS Permit.# Date Inspector qppROVALS Permit# Date Inspector 1. �Temporary Elecirical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �; � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ��; , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. ElectricalUFERGrnd. - 57.'APPROVALTOCOVER-GUNITE ' 7. Footings ,. 58. Electrical Conduit-Undrgrnd«- 8. Foundatiori� °�,_. 59. Gas Pipe, O Undrgmd., Tes�^� 9. Water Pipe`L�ndrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. A ..r 10. Structural Floor System , 61. APPROVAL TO DECK L> 11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal � � 12. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains . 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final . 75. Rough Electrical-Conduit 66. Solar System-Final 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 Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts,in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil , 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil r 25. Roof Sheathing • 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . 27: Frame and Flashing . 76. Dry Standpipe � � 28. Lathing & Siding � 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL } 30. DrYWall Nailing HEALTH DEPT. REQUIREMENT •� 31. Plaster Brown Coat 79. FINAL INSPECTION '_ 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ` 33. Final Electric Notes: 7�16..�19 (�'f�"(,p/Lp .(,,.L{7 ' 34. Final Heating & Air Conditioning . 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � '7�fi/d7Y L�/% ' 39. Water Service-Final � 40. Gas Service-Final � . 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System - 45. Sound Attenuation . 46. Handicap Regulations � 47. FINAL STRUCTURE & BUI LDING ' ' 48. Special Requirements Completed -- _ 49. Electric Release to Edison - � � 50. Gas Release to Southem California Gas Co � � 57. CERTIFICATE�OF OCCUPANCY . No. Date • DOYLE & JOB ADDRFSS GENERAL COl DATE E- �_'IRE ZONE U'CHIPTION OF WORK DATE IGROUP I&J TYPE V ZON SUBCONTRACTOR . (` L � ! �E�;� COSTA MESA BUILDING-SAFEfY DEPARTMENT P.O. BO%91] C09TA M88A, CALIFORNIA for Appliconf fo Fill In Complately TYPE OR pRINT B�,�o,na � h 4— ADORE59 \ CQSTA MESA, CALI ORNIA r �, e � � T :Hfl Q 1 ��Op �CJ/ 1 'OR Sa I� � -f�cr h, v �'avn e� �1 /'.:yj��B�I NO ..i � �s i FEE RECEIVED �ux s :issa FINANCE DEPT. CI�PFQ�C.C�F� �F�ERMR BUILDING For Office Use Only � R{C61'T NO. pl n 61V6D�Y w �L LDINO � ✓ � DR68S O� FIRB ��jap ZONE APPROVHO �. Z.l'f er NO. OI GLD06. 68TeACK LINB PNOM �7� � CENTEH OF BTREqT " - REAR SID6YARD L6FT I RIGHT DESCRIPTION OF WORK 1z nq I r+o. or� / �ur+ LeO.�L DBGCRIIf�ON � � A. P. NO. � NOTE: NOEAVEOVBRlV 90' TO SIDE B REAR P. EAVES ALLO W EO YAR�SAPPROVEO MAIN BUILDING BUILDIN� � � NO.OF VAR'# SIZE Y"""��-��'� ROOMS � 6T RIHS / C. U. P.$F EXTERIORWA� I ROOF Sµ�N6L£ APPR COVERING U<<-° COVERINO BY USE OF BUILD�N6 ANDWORK 70 BE PfiRFORMfi eJ�dehcc W� G t b'aY' �!� 3 � is` y ea. �, I H8R8BY �CKNbWLeO08 TH�T I H�V6 HCAD THIB APPI,�GiION THe �MOUNT Bly •NO BTATB THAT TH8 ADOV[ IB CORRCCT /�NO AORHt TO COM� PUPP088 OP YB PLY WiTH wLL GiTv OqO1NANCHB At1O BT�T[ UWO PiOYLATIHO ypLUATION � BUILOINO CONBTpUCTION. P RMnITTE80R . . `� �. P• � , `p �w.,��',^ w $ �� yos . � � AUTHORIZHDAGHNT ��. //NNI uae 6HALL BE LE95 THAN <U.B.C.R2QUIREMENTI YARDSAPPROVED AGCESSORY BUILDING BET. MAIN ACCE55. B DATE APPROVEC owre '� � � r ry 0 VALUATION �B POfl TXH ;' A PEHMIT FHH ONLY. � 0 IT FEE S S�� J 0 CHECK $ � / � ; 0 `v LL _ PEE g OWNER gAgpFITCK, J. DATE 1��19-76 JOB ADDRESS 2474� Napoli Wav BUILDING PERMIT N0. q3nfis WORK SUBCONTRACTOR ` W �TER :� ROUGH PLUMBING PROP. SWR. LINE � HOUSE CON. �SPRINKLING SVSTEM MISCELLANEOUS � ROUGH NEr1TING ANO �Iq CONOIiIONIN TEMPOPIAV SERVICE OR POLE UNOERGROUN� � POWER � FOUGX WIRING TRENCHES FORMS STEELI FLOOR SYSTEM BONO BEAM � 'STEEL REINFORCE SHEATHING FqAME �NO FLRSNING LRTNING - IN n OUT [� PL�STER, BROWN COAT i+ " Q (��/ - �/OGI; � '. 1n."F.� n�.qj.i • ..... `.Sl COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 APPL►CATION FOR STRUCII3RAL PERM[T For Applicant to Fill in Comple[ely — Use Ink Only REc iv av DATE RECE o BVILDING y A� �j '�/ �/ � DATEIS UED ADDRESS � ! /�AiOLI (�VA/ p �/ //� " � OWNER ✓ /l�Gf��'✓�(i7\ A.P.NO.-/3l�I ��'/y P MAIL BUIIDING ay7y /{�/�pOLI (�jLf � ADDPESS S��'E ADDRESS CITV NOL TqAC,3y33 LOT y/ BLOCK CpNSfRVCTION � �'�' A A P LENDER BRANCH � OWNE ADDPE55 VALUE AFCNITECT 7EL. SE S OR ENGINEER FIRE ADDflESS ZONE T PE GROVP CE%'/TEKn L�NE �� APPROVED CONYFl.4CTOR BY DATE � � ADDRESS/ 7 z /R Nq p Q-' TEL. ZOry'(� NO.OF USE OF NEW /O CITY �iW/IYb No.B33BB33 ^�Z PLAN$ Z BUILDING 4�� L C No. 2.6s96 .f LICVNO. yMAIDN U LDING ACCE SOPV BUILDING SIZE NO.OF BLDGS. (FROM GL STREEY) OF I.OT NOW ON �OT RONT FT. USE OF 7 �- EXISTING BLDG. 5 F. /` FT Separate permits are required for L SIDE FT. �/ FT. electric, plumbing and heating work. �� REAR FT. ��FT� USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLOGS. ACCESS. BLDGS. /� VAR,# DATE /v T%4 :�E%Z C.U.P.%W APPROVED APPROVED /(..� 9 ��7 C ( I hareby acknowlatlpe tha[ I have reatl thia epplicntlon antl state that tho ebova Informetlon Is correct and aprae to comply with ell laws regulattnp buildinp conctruction, antl I 6hali not employ ony panon In vlolaiion of tha workman's compenaatlon lowe ot tho Stete of CelHornle. I herepY cerNfy t�et I am properly Iicensetl as a contractor untler SQ. FT. tho Stato of Calitomla Buainau antl Proteafom Cotla, DWhion S, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chopter 9, and the[ such Iicen�es nra In tull forco ond aitact, or I THE PURPOSE OF ESTABLISHING A PEflMiT FEE LV: em oxampx from Me provialons of the Scate of Calitornla Businass VALUATION PERMIT FEE § � end Professlons Co/tle), Divislon 3, C�apter Slpnatura of /��_ / �Dv �)' /� PLAN CHECK § P¢�mlttea IfT �fi� i�� 5�(/"� TAX S AuNo/Iza�an� TOTALPAID § 6'�