HomeMy WebLinkAbout2109 NATIONAL AVE - Building PermitsPERMIT TYPE
' � CITY OF COSTA MESA � �
BlIILDING DIVIS/ON
77 FAIR ORIV�, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626 ��
PERMIT NUMBER:YB07-00996
B_ROOF2
JOB ADDRESS: 2109 NATIONAL AV CM
Vicinity: REROOF RESIDENCE AND ATTCHED GARAGE
Squares: 0
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
10/26/2007
BJK
$4,000.00
SCOPE OF WORK: REROOF RESIDENCE WITH ATTACHED GARAGE: TIO EXISTING COMP ROOF, REPAIR/REPIACE SHGT, FELT PER
MFGR'S SPECS, APPLY "50.YEAR COMP SHINGLES" PITCH BETWEEN 2:12 AND LESS THAN 4:12 WILL
REQUIRE 2 LAYERS OF FELT; PROP OWNER ADVISED. PROP OWNER DID NOT KNOW SQ FT OF ROOF. '
OWNER: BUCKLEY,SCOTT
PHONE:
APPLICANT: BUCKLEY,SCOTT
PHONE: 949-212-3538
CONTRACTOR: OWNER-BUILDER
Address: Unit:
City/Slate/Zip:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
TOTALFEES
$0.00
$97.25
$0.00
$97.25
Address: 2109 NATIONAL AVE
Ciry/StatelZip: WSTA MESA, CA
Address: 2109 NATIONAL AVE
City/State/Zip: COSTA MESA, CA
License No.
License No.
0
PHONE:
License No. 000000
CELL:
PHONE:
PHONE:
I,J��. ;-•..
� .
�
Unit:
Unit:
NOTICE: The work authorized hy this permit shall comply wilh all applicable handicap access requirements under Califomia sWtutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRE$ 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the woAc authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure lo obtain inspections and final approval will result in the expiration of lhis permit.
CODEi. INSPECTIONTYPE DRTE IN� � INSPECTIONTYPE DRT INTITIALS
1616 Fixed System Final Fire Prevenlion 206 Final Mechanical
1266 Pool Spa Final E �,,' 208 Final Plumbing
200 FinalRe-Roof Z� O�� � 210 FinalElecirical
201 Final Blcek/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 22o Final Planning AOP�o�al
203 FinalSign 222 Fina15ite
204 Final Demoliti0n 250 Final Builtling/Occupancy
. �
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one o( Ihe following declarations:
❑ I have and will maintain a certificate ot consent to sel(-Insure for workers'
compensation, as providetl for by section 3700 of Ihe Labor Code, for the
pedormance of the vrork (or which Ihis permit is issued.
❑ I have antl will mainWin v.orkers' compensaibn insurance, as required by
section 3700 0! the Labor Cotle, fw the peAortnance of lhe aork for which lhis
permit is issued. My wnrkers' wmpensation Insurance wrrier antl policy
numberare:
Cartier.
(Tks sMion need not ce mnpefe0 d Ine pemv k rdh�e0 a� me �uM�ed tlnWa (E�001 �'kss.l
Policy Number:
�1'ceni(y that in t�e peAormance o1 the work lor which this permit is
issued, I shall not employ any person in any manner so as to betome 5ubjetl
to the vrorkers' wmpensation laws of Califomia, and agree Ihat if I should
become subject to the workers' compensation provisions o( Section 3700 of
the Labor Code, I shall forth th comply with these provisions.
�,f�/-�- _�� �o - a6 - o -�
Appliwm's Si0^aWre Dale
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAI
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADOITION TO THE CO5T OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn Ihat I am licen5ed under provision5 of Chapler 9(commencing
vnth Section 7000) of Division 3 of the Business and Professions Cotle, antl
my license is in full torce and eftect.
Lic. # Class #
Coniratlor's SignaWre
CONSTRUCTION LENDING AGENCY:
� I hereby affum Ihat lhere is a construction lending agency fw the
pertortnance ot the work for wfiich this pertnit is issued. �Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
l�J'�•
SignaWre r ` � 0�2�e;�;^�
:,j ' r a � !' j
OWNER•BUILDER DECLARATIONS: �nr � •
I hereby aKrm_that under perialry�oFperyury�that I am�EXEMPT FROM THE
CONTRACTORS UCENSE L'AW,tor Ihe following reason (Sec. 703t5,
Business and�'Professions Code: Any city or county which requires a permil to
construct, alier,�improve, demolish, or repair any strucWre, pnor to its
issuance, also requires the applicant for sucn permit �o file a signed statement
thal he or she is licensed pursuaN to the provisions of Ihe Conlractors
License Law (Chapter 9(wmmencing with Section 7000) of Division 3 of the
Business and Prolessions CoOe) or thaf he or she is exempt therefrom anC
the basis for the alleged eaemption. Any violation of Section 7031.5 by any
applicant for a pertnit subjects the applicant to a civil penalry of not more t�an
five hun etl tlollars ($500).):
' I, as owner of the property, or my employees with xages as their sole
compensation, WILL DO THE WORK, and the structure is not intenCed or
offered for sale (Sec. 7044, Business and Protessions Cotle: The Contractors
Licensa Law does not apply to an ovmer of property who builds or improves
Ihereon, antl who tloes such vrork himsell or herself or throuqh his or her own
amployees, providetl that such improvements are not intended or offered for
sale. If, however, l�e building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving Ihat he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer o( lha property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to wnswct Ihe project (Sec. 7044, Business antl
Pro(essbns Code: The contractors License Law dces not appty to an wmer of
property who builds or improves Ihereon, and wno conlracts tor such projecl with
a cmt2ctoqs) license pursuant to the Cont2ctor5 LiGenSe Laws.).
❑ 1 am ezempt under sec.
Business antl Professions Code (or this reason:
�%�/� �o-a�-v �
� 9gnalure . Dale
]OS)<6(10])
Owner ID venfed �y dnv�e. �Yes ❑ No ' •
Driver's License No. �]� Expires: I�� ' � S
Venfication of Ownership by (typa of tlocument, i.e. - property tax hill or deetl):
OIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavatbn frve (5) w mpe feet m tlepth into which a
person is required to descend, vrill be matle in connection vrith work authorized
hy this peimit, ana that no builtling sWcture. scaHdtling, falsework, or tlemolition
or tlismantling Ihereof, will be more Ihan [hirty-sa (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, CalitomialWminist2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a Dertnil from the Division of Industrial Safery, as noted above, unless
such person has a permit to do suc� work from Ihe division.
Appliwnfs Sipnalure Dale
Division of Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or preseM or fuNre building occupant neatl ro file and
certify a Business Plan for emergency response ro release or threatened
release ol a hazardous malerial? ❑ Yes ❑ No
(Seclion 25505 of the California Health and Safery Code requires, with some
exceptions, that a Business Plan be (led with Ne Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity ot hazardous matenals equal ro or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressea gas
at standard tempereNre and pressure).
2. Does or vrill the applicant or present or luWre builtling occupant need to file
a registration form tor acutety hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Heal[h and Safety Code, vnlh some
exceptions, requires registration wim the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of awtely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
tempereture and pressure).
3. Does or will the applicant or present or tuture building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program !or acutely
hazartlous malenals)? ❑ Yes ❑ No
(Section 25534 0( the Califomia Health and Satery CoOe provides lhat the
Costa Mesa Fire Department may require the preparation, certificatlon antl
fling vrith Ihe Fire Department of an RMPP by businesses vTich are requireC
[o register acutely hazardous matedals vrith the Fire Department.
4. If an RMPP is presently required, has Section 25534 0( the Califomia
Health anC Salely Cotle been fully complied with? ❑ Yes ❑ No
5. Does or vrill the applicant or present or fuNre building occupant require tor
tha work which is the subjecl of this application a permil (or such Construction
or modificalion from Ihe Soulh Coast Air Qualily Management Distnct or /rom
any other air pollulion contml district or agenry7 ❑ Ves ❑ No
(Sectbn 65850.2 of Ihe Califomia Govemment Cotle requires that the reduested
in(ortnation be fumished on application5 fa rroo-re5idential builtling pertnits).
6. Will any part of the facility to be wnstructetl un0er Ihis permil be vnthin
1000 feet Irom the outer boundaries of a schooll ❑ Ves ❑ No
(I( yes'. the lacility must meet tha requirement of Sections 25534 and 42303
ol the Calilomia Heallh antl Safety Code).
7. If a permit Irom Ihe South Coasl Air Ouality Management Distrid or other
air pollution coNrol tlistric� or agency is requiretl for Ihe wvrk which is the
subject of Ihis application, have all of Ihe disclosures prescribed Dy Califomia
Healch antl Salety Code Seclion 42303 been made7 � Yes ❑ No
8. (If'yes", attach certificate of compliance from the appropriate air pollution
control offcer�.
CERTIFICATE OF COMPLIANCE: I certify that un0er penalry ol perjury the
information given above is correct. I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury Ihat I have read this application and state that
the information given is correcl. I agree to comply wilh all state laws and city
ordinances relaling lo building construction, and authorize represenWtives of
the City of Costa Mesa ro enter upon the aboveEescnbed pmperty tor
inspection purposes. I agree not to occupy or allow occupancy of any builtling
auth '�Ihi pertnil unC m�ection.
/D—��—O'�
SlgnaWreolLegalOwner(s) Dale
AnElor AutFonEeO APOlicant Da�e
L'i�y a� G''aa,ta yY,e�a �'u�%�'dus� Diui�iac�
OWNER-BUILDER
�'"'�'�" VERIFICATION
��-���+��7�
Address: ��� / YV /g'�i�B /� �"/ / 1 ✓� Permit #: �d 7—fb /1� / /
A city or county, which is required 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 remm of, an owner-
builder veri fication. ,
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and'bearing your signature.
Please complete and retum this infonnation in the envelope provided at your earliest opportuniry to avoid
unnecessary delay in processing and issuing your building pemtit. No buildin¢ permit will be issued untii this
verification is received.
1. I personally plan to provi the ntajor labor and materials for construction of the proposed
property improvement. Yes ❑ No
Z. (have ave not) signed an application Cor a buiiding pertnit tor
t e proposed work.
3. I have contracted with the following person (firm) ro provide the proposed construction:
Name
Address
Phone ( )
City _
Contractor's Lic. No.
4. 1 plan to provide portions of the work, but 1 have hired the following person to coordinate,
supervise and provide the major work:
Name
Address _
Phone ( )
City _
Contractor's Lic. No.
5. I will provide sonte of the work but 1 havc convacted (hired) [he following persons to
provide the work indicated:
Name
10a2-46 (Rev.11/04)
Address
Phone T��pe of �Vork
r .. ,
� CITY OF COSTA MESA
B!/ILDING D/VIS/ON
PERMIT TYPE
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.cosla-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-56,26
PERMIT NUMBER. E07-00879
ELEC STATUS: ISSUED
DATE ISSUED: 1 012 612 0 0 7
ISSUED BY: BJK
JOB ADDRESS: 2109 NATIONAL AV CM
Vicinity: METER ON RIGHT SIDE OF SFD
Suite/Unit:
SCOPE OF WORK: CHANGE-OUT AND RELOCATION OF AN ELEC SVS TO 200A SVS AT AN EXISTING SFD. METER TO BE RELOCATED
TO THE RIGHT SID� OF THE RESIDENCE. �
OWNER: BUCKLEY, SCOTT
PHONE:
APPLICANT: BUCKLEY, SCOTT
PHONE: 949-212-3538
CONTRACTOR: OWNER-BUILDER
Address: Unit: PHONE:
City/State: ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
Address: 2709NATIONALAVE Unit:
City/State/Zip: COSTA MESA, CA
Address: 2109 NATIONAL AVE Unit:
CitylState/zZip: COSTA MESA, CA
License No. 000000
CELL'
�
�
Ip
�
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. N0. 92-28, § 7, 12-21-92)
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work aufhonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and (nal approval must be obtained. Failure to obtain inspections and (nal approval will result in the expiraUon of lhis permit.
COUE /. INSPECIION TYPE
1818 Fixed System Final Fire Prevention
12B8 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRe�ining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Dertaiitipn
�T_E IN7Ii1RL5
CODE� INSPECTIONME DFif
208 Final Mechanical
208 Final Plumbing
210 Final Electrical� /� �
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Fina( BuilOing/Octupanty
NI TI71RL5
J
i .. i
WORKERS' COMPENSATION DECLARATIO
I hereby aKrtn under penalty of perjury one of the following declaretions:
❑ I have antl will mainlain a ceAi(cate ol consent to self-Insure lor vrorkers'
compensation, as provided for by section 3700 0( the Labor Cotle, for Ihe
peAormance of the v✓ork for which [his permit is issued.
❑ I have and will maintain workers' compensatbn insurence, as required by
sectbn 3700 of the Labor Code, for the peAormance of tha v.ork lor which this
permit is issued. My workers' compensation Insurence carner and policy
number are:
Carrier:
(�lus seem need nd ea wnplefM I t/re permf k vahrea at me ninMied aalarslS �001 abu )
POl�ity Number:
[�J" I certify that in Ihe peAormante of the work for which this permil is
issuetl, I Shall not employ any person in any manner so as to become suEject
to the workers' compensalion laws of Califomia, and agree t�at if I should
become subject to the workers' compensation provisions of Seclion 3700 of
the La o� I shall fort 'th comply with these provisions.
ib-aG- 0 7
nw��o�rs siOM,mre�-- oa�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNORED THOUSAND DOLIP,RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensetl under provisions of Chapter 9(wmmencinq
with Seclion 7000) of Division 3 of the Business and Professions Code. and
my license is in full lorce antl eflect.
Lic. JF Class #
ContrettOr's SignaWre Date
CONSTRUCTION LENDING AGENCV:
❑ I hereby affmm that Ihere is a construction lending agency fa the
peAortnance of the �wrk fa v.tiich this pertnit is issued. (Sec. 3097, Civil Code�.
y
Lender's Name: � • ��,
/ f = � � {'
Lender's Address: `�,�{ r :��, r�:',
,. : � ti `� �';' `r�� - � %• � '
i .-�,
Slgnamre y-� Z�u, �•'; Dale
. � �.� , `
OWNER-BU�LDER:DECLARATIONS: '" �
I hereDy affrm that'untler penalry o( peryury Nat 1 am EXEMPT FROM THE
CONTRACTORS UCENSE LAW (or the (ollowing reason (Sec. 7037.5,
Business and Protessions Cotle: My ciry or wunry which requires a permit to
wnstruct, alter, improve, tlemolish, or repair any struclure, priar to its
issuance, also requires the applicant for such permit to file a signeA statemeM
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of tha
Business and Prolessions Code) or that he or she is exempt therefrom and
the hasis lor Ihe alleged exemption. Any violalion of Section 7031.5 Dy any
applicant (or a permit subjects the applicant to a civil penalry o( not more than
five hun red d011ar5 ($500).):
I, as ovmer ol the property, or my employees wilh wages as their sole
compensation, WILL DO TME WORK, and Ihe structure is not intended or
oReretl for sale (Sec. 7044, Businass and Professions Code: The Contractors
License Law does nol apply to an owner of property who builds or improves
lhereon, and who Ooes such work himself or herself or Ihrou9h his or her ovm
employees, provided lhal such improvements are not intended or oKered for
sale. II, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
di0 not builtl or improva tor purpose of sale.).
❑ I, as ovmer of the Droperry. am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conswct the project (Sec. 7044, Business antl
Professbns Cotle: The contractas License Law dces rwt apply to an ovmer of
pmperty who builds or impmves t�ereon, antl who contracts fa such project with
a cantractor(s) license pursuant to the ConUactors License laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
� , /o-�G -O'7
Signawre Date
305Pd6�Y0])
i .. �
Owner ID verified by dn/ e. �L'es ❑ No
Driver'S License No. ��� Expires: /- 7-o �
Venfcation of Ovmership by (type of documenl, i.e. - pmperty tax bill or tleed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certi(y that no excavation (rve (5) or more feet in depth into vfiich a
person is requiretl to tlescend, will be made in connection with v.ork authorizetl
by this pertnit, and that no building struclure, scaHdding, falsevqrk, p tlemolitbn
or dismantling thereof, vrill be more than thiAy-s� (36) feet high. (Chap. 32, Grp
2, M 2, Set. 341, Title B, Cali(omia Atlminislrative Code).
❑ As owner-builder, I vnll not employ anyone to Ao work which vrould
require a permit lrom the Division of Induslrial Safety, as noted above, unless
such person has a pertnit to tlo suc� work Irom Ihe division.
Apvliranfs SB��ure Qale
Division of Intlustrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or presenl or fuWre huilding occupant neeG to file and
certify a Business Plan for emergency response to release or Ihreatened
release ol a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Salery Cotle requires, with some
exceptions, that a Business Plan be filed vrith che Costa Mesa Fire
Department Dy every business which has at any one lime Curing a reportetl
year a quantiry of hazardous materials equal to or qreater than a weight of
500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas
at stantlard temperature and pressure).
2. Does or vnll the applicant or presenl or future builtling occupant need to file
a registration fortn for acutety hazartlous marerials? ❑ Yes ❑ No
(Section 25533 ot the Calilomia Healt� and Safety Cotle, with some
exceptions, requires regisiration with the Costa Mesa Fire Department by
each business whic� at any one time has on hantl a quantiry ot acutely
hazardous matenals equal to or greater Ihan a weigM of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicanl or present or future building occupant need to
prepare an RMPP (Risk Managemenl antl Prevention Program for acutely
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 of the Calitomia Health and Salety Cotle provides tha[ the
Costa Mesa Fire Department may require Ihe preparation, certifcation and
filing with the Fire Depahment of an RMPP by businesses which are requireC
lo register acutely hazardous materials with lhe Fire Department.
4. I( an RMPP is presently required, has Seclion 25534 of the Cali(omia
Health and Sa(ety Code been fully complied wilh? ❑ Yes ❑ No
5. DoeS or will [he applitant or present or (uture Duilding occupaN require (or
the work which is the subject of this application a permit for such wnsWction
or motlifcation trom the South Coasl Air Qualiry Management District or from
any other air pollution control distnct or agency7 ❑ Yes ❑ No
(Section 658502 of the Calilomia Govemment Code requires that the requesteE
infwmalion he fumished on appliwtions lor noo-resitlential Duildirg pertnits).
6. Will any part of ihe lacility to be construcletl under this pertnit be wiNin
1000 leel (rom the outer boundaries o( a school7 ❑ Ves ❑ No
Qf yes", the faciliry must meel the requirement ol Seclions 25534 and 42303
of the Califomia Health and Sa(ery Cotle).
7. If a permit from the South Coast Air Qualiry Management District or other
air polWtion control district or agency is required lor the v.ork which is the
subjecl of this application, have all of the disclosures prescribed by Califomia
Health an0 Safety Code Section 42303 been made7 ❑ Yes ❑ No
8. Qf "yes". attach cenifcate of compliance from the appropriate air polWtion
control oKcer). . .
CERTIFICATE OF COMPLIANCE: I certify that under penalry o( perjury the
inlormation given above is correcL I agree to comply with all state laws and
city ordinances regartling Hazardous Matenals and Emissions.
Signalure Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury thal I have read this appliwtion and sfate Ihat
the information given is cortecL I agree to comply vrith all sWte laws and city
ordinances relating to building wnstruction, and authonze representalives o(
the qry of Costa Mesa to enter upon Ihe above-tlescnbetl pmperry tor
inspection purposes. I agree not to occupy or allow occupancy of any buildinq
authoriz� ermit til final inspe ti . / O Q
�- -a�- >
��na ure o! Legal Owner(s) Date
AnClor Authorrze0 AppLcant Date
Z
. .. , -., . , . I . ,
OWNER-BUILDER
�'""� VERIFICATION
�� ����
n I�7/ . �Q -� 7
Address: ���� ! YV f%" � B /f �/ / 1 ✓� Permit #: �d 7—�b � / �
A city or counry, w�hich is required 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 remm of, an owner-
builder verification. ,
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and retum this infortnation in the em�elope provided at your earliest opportunity to a�•oid
unnecessary delay in processing and issuing your building permit. No buildine oemiit w�ill be issued until this
verification is received.
l. 1 personally plan to provi the major labor and marerials for conswction of the proposed
praperty improvement. Yes ❑ I�'o
2. (have ave not) signed an application for a building permit for
t e proposed w�ork.
3. I have contracted with the following persun (firm) to provide the proposed conswction:
Name
Address
Phone(
City —
Contractor'S Lic. No.
4. I plan to pro��ide portions of the work, but 1 have hired the follo���ing person to coordinate,
supenise and pro��ide the major work:
\ame
Address
Phone(
Ciry _
Contractor's Lic. No.
f will provide some of the work but I have convacted (hired) the foliowing persons to
provide the �eork indicated:
Name Address Phone T��peo(1Vork
10a2�a6 (Rev.11�0a)
ORANGE COUNTY BUILDING DEPARTMENT
636 karth B.- �way
� SANTA ANA, �. �RNIA � .
' FOR APPLICANT TO FILL IN
NEAREST
caoss sr. Oak Sr _
owNER PIIERLO iiOMESi INf.
MAIL 9363 WILSHIRE a��o.
ADDRE55
EVERIY IILS TEL.CR. 5 3
QTY NO.
ARCHITEG �T OR LIC.
ENGINEEI�,AIN Ra Mf.KERRAf.HFA NO.
AODRESSZ��O E. WA�NUT ST.� PASADENA
CONTRACTORNEVPORT VISTA CO.NO.�J�""�
ADORE559363 w��S��Re BIVD.� BEV.HILIS
LEGAL LOT p
DESCRIPTION I NO. U BLOGK I' TRACT ���
(ATTACH METES B BOUNDSI
SIZE OF LOT��•ZO X � �� I NOW ON LOTS O
USE OF I NO. OF I NO. OF
E%ISTING 6LDG. F�wl��[5 ROOMS
SETBACK LINE FROM: REAR YAR
CENTER OF STREET S!)ft _ sioe YARD 6 t 6�
DESCRIPTION OF WORK
NEW I x I HLTERATION I I qOD1TION I
Pla
EXTERIOR WALL
COVERING S
USE OF NEW
BUIIDING �_
�za:ax-y
I HEREBY ACKNOWLEOGp THAT 1 HAVE READ THIS
APPLICATION AND�STATE TrypT THE ABOVE IS CORRECT
ANO AGREE TO COMPLV WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING BVILDING CONSTRUCTION.
sice eruaeoFNEMPORT VISTAif�U.
AUTHORIZEO AGg'+ ' ( r ' f�
VALUATION s �83o'OQ
�
APPLICATION FOR PERMIT �
• �` ��'��
FOR OFFICE USE ONLY
- RECEIPT NO. PERMIT NO.
8337- j o�,�
RECE�VED BV DATE REC'D. DATE 1651aED
� 9 —� � 3 �j 3 �j
BUILDING q I O O �.%��
ADDRE55 ry, � � �
SCHOOL �IST. ��'T�' �
OR TOWN /
NEAREST /i .
PERMIT FEE $/��f MASOf
PLRN CHECK 5 I�
BOND
TOTAL
FEE � FINAL
PLANS I ••• I � J
�._��-a -
CORRECTIONS
APPROV.
0
A
�
Z
D
r
z
J
u
'O
a
I �
. � �
STREET
PLOT PLAN
�, Show location and distances from
property line and between buildings.
I. . _. C. . _ n' .
_ ' _ " . ,. '" � r �.
. , '�
' .J' � �._SI'.:'. t : _ •
�, .•'/ ..'f:_ l. �
- � . .. , �J_ I . . ," '
_. _ .��.. . � . . .'I-.
--- � ..._ ., � �.T � �1 . ��_.
. ' � . _ ,. . .. : �. .—.. _ .'./� i
,__ L..Y' Y 7.1'..". 1 1'
� � .
��I X.. •"
..—.' � � - ,
f .- . _ � f.
.,,-. �
_ ... i�. _.,_ , .
J _ _ . . . . " _. .. . I . � .
i f. r
. . _ _ ... � __' �\ � � .
. . . . ._ . i _'�— _ ""' _ _
�s