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Home My WebLink About1857 NEW JERSEY ST - Building PermitsP - r5A (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1857 NEW JERSEY ST Suite No Vicinity: HALLWAY CLOSET Parcel Number: 13910304 Applicant: LORETTA L PETERSEN TR -. .xs?�" t ` >` ISSUED BY: Address: 1857 NEW JERSEY ST-, %��- Phone: 714-241-7551`, Owner: Status: ISSUED .- Applied: 12/21/2006 Issued: 12/21/2006 COSTA•MESA, CA Zip: 92626 Quaritity),t .✓_" ll i::71%: �u �l1 .��1.�� Quantity• $23.50 - - - - - - L'ORETTA'L PETERSEN TR --'-- R---1857-NEW $0.00 0 $14.80 1 1857 NEWJERSEY ST ', $0.00 'o i Phone: 10 l i -.; $0.00=-0- COSTA MESA; CAS - Zip: 92626 _ _ $0.00 -"0-`-`'- -- ' -1 `Z -1 C_ v; -$0:00 _ 0 $0.00 -6- -- OWNER'BUILDER ',/� $0.00 -0 $0.00 0 ��.�. - , $0.00 0 Up to 3 hp /,100 k BTU `-� $0.00' : 0 $0.00 0 ' r Phone: 0 \ :' 15 To 30 hp / 1,000 k BTUj ; Zip: 0 " 'o $0.00 0^�,,' .,30 To 50 hp / 1,750 k BTU 'License:000000•, $0.00 0 , . , - 'Over 50 hp /Over 1,750 BTU, ��,; $0.00 , $0.00 0 oz� ! \ ? 'S( AN EXISTING FAU IN A SFO. 1 INST,FAU <.100K BTU -- NO OTHER WORK' AUTHORIZED WITH THIS PERMIT I i, ISSUE FEE Inst FAU <100k BTU Inst'FAU >100 k BTU�' , Repair/,Alt Cooling/He,at�i Inst /Rep. Recess Wall Htr Refng Sys <100 k BTU ' .. Refrig'Sys>100 k BTU,.,, Gas Piping-. Factory FireplaceA Hood w/Meth Exhaust VAV Box, Vent Fand.SingleDbct r,ppuance � A "7 \n\ Fire Dampers\� \\ Smoke Dampers 7 A Inst or Relocate Appl Vent Air Handlers <\10000cfm, V� Air Handlers> TOOOUdm V � Floor Furnace Floor or Suspend Heater MIT q �•;,` !� FEE SUMMARY f _ Quaritity),t .✓_" ll i::71%: �u �l1 .��1.�� Quantity• $23.50 - - - - - - - Repair /Aft Absorbtion Unit $0.00 0 $14.80 1 Repair/ Alt Refrigeration Unit ', $0.00 'o $0.00 0 _ �-� - r ,Ventilation System. $0.00 10 l i -.; $0.00=-0- - /.__.\ Evaporative Cooler, '- /,I' �.. $0.00 0 _ _ $0.00 -"0-`-`'- -- ' -1 `Z -1 C_ v; -$0:00 _ 0 $0.00 -6- -- �� ` � Domestic lnci6aral& _1 ',/� $0.00 -0 $0.00 0 Compressors / Absorption Systems' - , $0.00 0 Up to 3 hp /,100 k BTU `-� $0.00' : 0 $0.00 0 3 To -15 hp / 500 k BTU 'so 00 0 $0:00 0 15 To 30 hp / 1,000 k BTUj ; -/` "- $0.00 0 " 'o $0.00 0^�,,' .,30 To 50 hp / 1,750 k BTU $0.00 - $0.00 0 , . , - 'Over 50 hp /Over 1,750 BTU, ��,; $0.00 , $0.00 0 oz� Boilers' '0 ,$0.00 0 ,. $000 ' 0 r Up l0 3hp-T...-, _. 3To15hp' °' - $0.00 " $0.00;" " 0 0 x$0 00 0 .115 to 30 hp, . - - , $0.00 0 $0 0014 -$O 30 to 50 hp i -= -.� ' �i / $0.00 50 hp$0.00 0 0 o��.`Over ' $0 00 'o'- �� , Other Mechanical: Fee� %' $0.00 0� = -_ `' x � Investigation Fee (��-�� / / -V$0.00 -Plan Check Fee , I I", %!i' $0.00 ..Reinspection Feed%_ / $0.00 TOTAL CALCULATEDFEES $38.30 NOTICE: The.work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-29, § 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 the work 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 to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (6=) Ah DECLARATIONS WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and Will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued of one hundred dollars ($100) or less.) certify that in the pe dominance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should beco subject to the workers' compensation provisions of Section 3700 of th Labor Code, I shall forthwith _ c ese provision / Applicant Signatufe: Date: Z/ZI �L WARNING: FAILU O SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES A D CIVIL FINES UP TO ONE HUNDRED RE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (MEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LIC. # Class # Contractors Signature:Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement 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 the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner Of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, 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 did not build or improve lot purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). xempt and r Business and Professions Code for this reason: Signature: verified by d vers license. Yes ❑ No Drivers License No. Expires: ZL Venfication of Ownership by (type of document, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applliant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous me Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of 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 temperature and pressure). ................r.......................___. buildin....occu ant need to file ......'..... ......................................... ...............................will...............................................................................................terii .... .................-. .......... ..... 2 Does or will the applicant o present o futureg p e e registration form for acutely hazardous materials. ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). ...................................................................-.................................._........-....................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes [3 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..... .................. ......................................................................................................................................................................................................................................................... 4 If en RMPP is present) required, has Section 25534 of the California Health and Safe Code been full complied with? Y q N Y D []Yes ❑ No 5 Does or will inn applicant or present or future building occupant require for the work which is the subject c a this plication aPPertnil for such construction or modification from the South Coast Air Duality Management Distract or from any other air pollution control district or agency? � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .....................................................................................................................................................................................................................................................................................-..... 6 W III an art of the facili to be constructed under this Permit be within 1000 feet from the outer boundaries of a school? y p ry, P ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................ ............................... ...................................................................................................................................... ... ................ ........... ............................................................. -............................. .-.................... ...................... ... ............ 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..................... erti...........................................-m--............p-r-o-p-......................11ut................trol..................................................._..................................................................................._........................................_............... 8 attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -describe propinsp n purpose . I agree not to occupy or allow occupancy of any building authorized by this permit until final inspec n. / Signature Of Legal Owners Date Ari Authorized Applicant Date CODE 11, INSPECTION E DATE INITIALS CODE( INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 2 L e zs(c 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Hoof 210 Final Electrical 201 Final BlocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 1 f OWNER -BUILDER t� VERIFICATION Address: J 7/� Permit #: /"`6 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 return 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 return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide them 1� labor and materials for construction of the proposed property improvement. ❑ Yes j� No 2. (have ave not) \ signed an application for a building permit for t roposed work. �3 I have contracted with the following person (fine) to providehee proposed construction: Name t. o6432�- 4 1 Address Ile� City . Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone (SP� 3 11; Contractor's Lic. No.G.26 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042-06 (Rev. 11104) Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF-COSTA.MESA_.CONSTRUCTION PERMIT RJnject Address11857, New Jersey Applicant's Mailing Address 4 Owner', Name Harvey Peterson Phone 557-7361 Address 1857 New Terrey—Costa Mesa 92626 Arch/Eng. License No. Address _ Contractor's Nam ,pRO —P )RMANCF, INC. Phone 779-6868 Address (mailing) 4r;72 F Ric nshowCr.—Anaheim 92807 City License No. 4002 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �ICense Class C 20 Kens¢ e 8/4/8oA Signature R KERS' COMPENSATION DECLARATION .ereby affirm that I have a certificate of consent to self -insure or a Certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. BWC605891 Company highland ertified copy is hereby furnished. //�1 Certified copy is filed with the city Building Divisloi4�, AL.((/ Dae Applicant ( FGRMTviv_n_at.^va ! EXEMPTION R M WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lander's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's LicenseLaw for the following reason (Section 7031.5 Business and Professional Code,: Any city or county which requires a permit to construct, alter, improve, demolish or repair i" ,y structure, prior to its issuance; also requires the applicant for such permit ^7y,',file a signed statement that he/she is licensed pursuant to the provisions of Contractor's -License law (Chapter 9 (commencing with Section 7000) of SrJi Sion 3 of the Business and Professions Code) or that he/she is exempt "therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil pena lt_y of not more than five hundred dollars ($500). ❑ I, asaowner of the property or my employees with wages as their sole co mpensation,'wif l do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon,_and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of COM- pletion, the owner will have the burden of proving he/she did not bulla or im- prove efor the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a. con- tractor(, license pursuant to the Contractor's License Law). I am aware that proof of their Worker'$ Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason » Zone Accessory Building: Z ' O N IN G R Parking Req. Q El M T S PLUMBING FEES Bar Sink Showers TYPE OF CONSTRUCTION LJ NEW ADO LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # S Main Building: TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL ElTENANT VJ ELECTRICAL ,❑ PLUMBING 5D MECHANICAL ❑ OTHER E T B A Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE •VALUATION $ ZONE GRADING CU.YDS. ACRES C K $ Ping. Right Left Ref. # Remarks: Planning Notes: » Zone Accessory Building: Z ' O N IN G R Parking Req. Q El M T S PLUMBING FEES Bar Sink Showers $15 Issue Fee - ELECTRICAL FEES Backflow Preventer Service Sink - - Date Date Date Automatic Washer ' Transformer ❑ 15-50 KW 11 50+KW Construction Pole Sub. - _ Backflow Irrigation Sewer Cap Bathtubs - Sewer Connection BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Cooking Unit Meter ❑up to 100 amps ' Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric - Sub Panel _ Drinking Fountains Solar Tank Fan Motors E10-1 HP❑11A-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP 016-151 Floor Sinks ` Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range - Kitchen Sink Water Service Switches Sign - Lavatories Auto -Wash Garbage Disposal - Standing Sections RP -Trap Laundry,Trays Generator 110-5 KW 05-15 KW Trash Compactor Roof Drains - I , Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating. .- Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Date Owner 1 . Heating System & Ducting I hereby certify that I have read this application and state that the above I($0-100,000 BTU ❑l 00,000 BT! information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives o his city to enter upon the above-mentioned property for inspection ur os S. Signature CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 0O -10m000 BTU ❑100,000 System Repair/Alteration Fire Dampers - Registers Issue Fee Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS; Zoning Approved By Building Approved By Application Issued By - Date Date Date 0 BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ ,/ ryMICROFI LM- $ $ "01�1%oZY "TOTAL FEE $ A7 0 $ • . DATE:VO�%IblSEy TIi�E: 15:55 • $ 3 CONSTRUCTION ANWPLANNING APPROVALS1 Permi t# i 4 Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1..Temporary Electrical ,S&r ice 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 r 56. Rough Plumbing & Pressure Test 6.' Electrical UFER Grnd. 57. APPROVALTO COVER -GUN ITE 7'�Foctings lr :. 58. Electrical Conduit-Undrgrnd, 8.foundation _ �- 59. Gas Pipe, 0 Undrgrnd., Test 9:�jWater Pipe-Undrgrnd: 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System _ - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final .1u 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. 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 APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 11Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0Oil 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 Brawn Coat 79. FINAL INSPECTION U- 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric -Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy ; l 37. Final Factory Fireplace Ir -38. Final Plumbing - b 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic-Finalit 42. Backflow Preventer - 43. Backflow Irrigation j 44: Landscape Irrigation Systemf' 45: Sound Attenuation 46. Handicap Regulations 47: FINAL STRUCTURE & BUILDING 48: Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co i 51. CERTIFICATE OF OCCUPANCY I No. Date �r 11_\ -1 -�_ Utt INCK rziGaavnp narvey H. O. LoreLLa L. VAIC G 1J JOB ADDRESS 1857 New Jersey Street BUILDING PERMIT N0. 43518 GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK patio Cover AP No. 139-103-04 LOT 102 TRACT 3648 FIRE _ ZONE VALUE S IN SP ECTIONS Signature Data TYPE V GROUP T ZONE pl SOIL SUBCONTRACTOR GAS Date Number Si nature WATER Plumbin ROUGH PLUMBING PROP. SWR. LINE [] HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING' TEMPORARY SERVICE OR POLE UNDERGROUND POWER 0 ROUGH WIRING Heatina and Vent. TRENCHES Vj FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT PLASTER, BROWN COAT STRUCTURAL, FINAL HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC. FINAL BUILDING. FINAL torr ul - wmulwcM cu rs a i� 43518 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS 1857 /t%Iew ,./�t�/er/se Sf1- OWNER Llry • t-A�(vGj,:`. sem• dersen MAIL ADDRESS G, Q. TEL. �( CITY 8- NO. CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT �� •.. ,.:.•I„' _ ...y °-_TEL.-,....;�. OR ENGINEER N . ADDRESS . . •�.•;., .. a, ::d t.\..i', �a CONTRACTOR , 'SB L. •!s �.'t J '� �. ADDRESS ~\`•SY'y5'.'`e. ��, `',1� µ,,3 TEL CITY NO:. •,l`, STATE . CITY LIC. NO. .,:;� _ _ r LIC, NO...'� SIZE 1 NO.OF BLOCS. OF LOT �; Lr._`'q�. •�,�. NOW ON LOT_s USE OF EXISTING BLDG.. -�I; : ": `• - -- Separate*peerrmits are required for, `. •,: electric_, plumbing and heatingwork.V .` USE OF BUILDING AND WORKTO BE PERFORMED— v � I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that 1 am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or 1 am exempt from the rovisions of the State of California Business and Professions ode Division 3, C ter 9. Signet u a of Perm 1tt, Authorized Agent Kfi,357,11 r.4gAQ, 8-.9'- a._C FOR STRUCTURAL PERMIT RTE RiCEIVDD TE ISSUE[ ///l1 2 - A.P. NO BUILDING ADDRESS TR -FIRE t/ ...ZONE i =TY E-. .GROUP+^ APPROVED J^. BV'.'• a..� , �. I+DATE 21 11�,^ NO. OF s USE OF N WW ; h< PLANS . +BUI [-DIN YARDS APPROVED + VA SAPPROVED ., '.MAIN BUI LDIN ACCESSORY BUILDINC (FROM C/L_S R 4- FT- Q, FT:+s 1E^- _/+,FT... Vii_ `L FT-,' INCE BET\ BET. MAIN & BLOGS..'.'. ,\ ACCESS. BLDGS..., #, / ✓i , :DATE mss. . TOTALPAID S N n m i m SO. FT. r THE AMOUNT SHOWN UNDER VALUATIO IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT N Y: VALUATION PERMIT FEE $ 0, v n m PLAN CHECK $ ^1 o S^ 0 S4 s/�/ TAX $ LL f U TOTALPAID S •. . .1249'7 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT ■ BUILDING COSTA MESA. CALIFORNIA �kT10N1irFt&PrV�_PTZWM#KAPPLIC BUILDING For Office Use Only m k 0 RECEIPT NO. 1=97 oggylrp7rt'es OWNER New York Avenue. Prue, Inc 1e6�'`�J' II MAIL ADDRESS 9 9'P 17th St• RECSXFr DA1T RECEIVED DATE ISSUED /`1- /� i�0 ill 1 1 1960 TE BUILDING CITY Costa Mega ADDRESS ARCHITECT Carlson & TEL. COSTA MESA. CALIFORNIA OR ENGINEER P(• NO. Garden Grove FIRE -t ADDRESS ZONE TYPE GROU � CONTRACTOR Dike & Cole rove TnC APPROVED DATE ADDRESS /a,E17th St ZONING ZONE y� NO. OF USE OP N ,�. CITY Co.-;ta Mesa /L� PLANS SU NO LIC.STATNO. 167293 NO. Li. 6-1159 DESCRIPTION Lot 102 Tr 6 SIZE - NO. OF BLDGe. OF LOT 6 X NOW ON LOT non A. P. NO /"1 USE OFYARDS EVES EXISTING BLDG. none APPROVED ALLOWED SETBACK LINE FROM 01 221 (CENTER LINE ST.) CENTER OF STREET REAR YARD FRONT FT. IN. SIDE YARD I LEFT 81 RIGHT 71 R. SIDE '7 FT. IN. DESCRIPTION OF WORK17 L. SIDE IN. NEW I II ALTERATION I I ADDITION I REAR /FT. '2 -FT. v FT. IN. REPAIR MOVING DEMOLISH APPROVED / L/ GATE BUILDING NO. OF SIZE os ROOM6 6 STORIES EXTERIOR WALL ROOF 1 COVERING s t, I I.0 a 0 COVERING CnM USE OF BUILDING AND WORK TO BE PERFORMED Single family reside t o a 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY. WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRUCTION. SIGNATURE OF _PERMIT FEE S 35. PLAN CHECK s 17.50 PERMITTE s 15,045, - AUTHORIZED AGENT Dike & 4olegrove, Inc. 5250 TOTAL FEE m k 0