HomeMy WebLinkAbout1771 NEW HAMPSHIRE DR - Building Permits •
CITY OF COSTA MESA
"' BUILDING DIVISION •
•
iANA1I 77 FAIR DRIVE,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: P07-00392
2 IOC) •
PERMIT TYPE PLUM .L3 STATUS: ISSUED
• 11 . - DATE ISSUED: 06/05/2007
DN't
6•- .; - =ISSUED BY: SOK •
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JOB ADDRESS: 1771 NEW HAMPSHIRE DR,CM Suite'/Unit
ViclnIty:
SCOPE OF WORK: REVISED 06/18/07 ADD,fWATER LINE LOCATED AT FRONT OF PROPERTY'FROM THE METER TO THE
HOUSE. .`
INSTALL 1 GAS LINE FOR FIRE'PIT..LOCATED AT REAR OF PROPERTY.
-=5 r _
OWNER: CASILLAS,JAMES T :,, t Address: 17711NEW HAMPSHIRE
PHONE: •Y City/State/Zip: COSTA MESA CA - ,
APPLICANT: CHRISTIAN-DEGROOTE ,,.Address: 1 WILLET.LN-
PHONE: 949458-9543 fs. , , „.. • City/State/zZip. -dAGUNA BEACH CA ' F ' •
CONTRACTOR: CALIFORNIA JUNGLE INC : License No.; `812808 ,
Address: 1 WILLED LN =, , _ ;-PHONE: . 949458-9543 ,
City/State: LAGUNA.BEACH,,CA ZlpCode' 92656 - - -' CELL:,. ' r;'
•
k.
PLUMBING PERMIT FEE SUM MARY ^ q:
PLAN CHECK FEE:
PERMIT FEE: $43.10
TOTAL FEES: $43.10 `
•
•
•
•
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE N. INSPECTION TYPE DATE INnnALs CODE INSPECTION TYPE DATE NIT
1616 Fixed System Final Fire Prevention206 Final Mechanical
1266 Pool Spa Final • 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining 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
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WORKERS'COMPENSATION DECLARATION: Owner I) fed by drive se. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the fa.,,..ing declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' •
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. . . , .
Cit have and will maintain workers'compensation insurance, as required by
Jsection 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
AioiCarrier: ?
/Q e� A 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
(This sea needrrol be completed(the permit is valued at one hundred dollars(Efee)orless)
2,Art 2,Sec.341,Title B,Califomia Administrative Code).
P`olicy.Number:_ 0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued,I shall not emplo any •erson in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' com• • sal laws o California,:•: .gree that if I should
become sub' t re "1-rs' c•:-•en i .visions of Section 3700 of
�1� Applicants Signature Date
the Lab•=Ct•/ "• with Al• ,��ftr���V e provisions.
i iL/A/� (7J_ 6 Division of Industrial Safety Permit Number:
/C s 5i• a//turreee - VVJL10ale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
�_'_
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license i in full force and effect. ' a registration form for acutely hazardous materials? 0 Yes 0 No
..Lic#_ Z • h•OO�'/r Class# l� (Section 25533 of the California Health and Safety Code, with some
-• ay,
exceptions, requires registration with the Costa Mesa Fire Department by
/ � each business which at any one time has on hand a quantity of acutely
r. Sin.u4j 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirn that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8If es";attachcertificateof compliance from the
employees, provided that such improvements are not intended or offered for ( 7' P appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer). ..
completion, the owner-builder will have the burden of proving that he or she -CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions. . '
❑ 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 Signature, Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF"COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. - the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occu• or -flow occupancy of any building
authorized by this permit until fin/.
Signature•-��1r.— •:v%rte
Signature Date ��� �/WS�
3057-46(3107)
=eerl !r•APO^. - %rDate .
,
*y r
CITY OF COSTA MESA
•
r BUILDING DIVISION
A ,i1 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
144
11.154 FOR INSPECTIONS CALL: (714)754-5626
•
•
PERMIT NUMBER: P07-00392
PERMIT TYPE PLUM STATUS: ISSUED
....DATE ISSUED: 06/05/2007
- =L :ISSUED BY: SOK
I
JOB ADDRESS: 1771 NEW HAMPSHIRE DR_CM Smte%Unit
Vicinity:
SCOPE OF WORK: INSTALL`i1''GAS LINE FOR FIRE PIT LOCATED AT REAR OF PROPERTY.'
OWNER: CASILLAS, JAMES T1 1 " 4 Address: 111771 NEW HAMPSHIRE,
PHONE: ;' ;"r 17 I'=..`;'- .City/State/Zip COSTA MESA CA
APPLICANT: CHRISTIAN DEGROOTE Address: 1,WILLET.LN
PHONE: 949458-9549 City/State/zZip: LAGUNA BEACH CAt'-
CONTRACTOR: CALIFORNIA JUNGLE INC i ,. -�= License No
LE
Address: 1 WILT LN %{-� s ` '-� -PHONE .949458-95431 !'
ci
City/State: LAGUNA BEACH CAI ,ZlpCode 92656 � CELL. : � � --` -
o- a+ri
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PLUMBING PERMITTEE SUMMARY
PLAN CHECK FEE: $(1•00
PERMIT FEE:' $33.30 =
k
TOTAL FEES: $33.30 ">
s,1 7
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r
•
•
•
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODES. INSPECTION TYPE DATE INlnl S CODE I INSPEC'ON TYPE DATE INTITIALS.
1616 Fixed System Fie re Preven-on 206 Final Mech.;
1266 Pool Spa Final air '418 . .in..
200 Final Re-Roof / 'inal - trical
201 Final Block/Retaining Wa - l"airinal Fire P - ,-ntlon
202 Final Factory Fire Place r •. -anning Approval
203 Final Sign ' 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
1
WORKERS'COMPENSATION DECLARATION: Owner(iarifed by drive fse. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the R..._...ng declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
pe pe of the work for which this permit is issued. •
j 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensahop Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
num person is required to descend,will be made in connection with work authorized
(
number (%l' by this permit,and that no building structure,scaffolding,falsework,or demolition
C '—"� (Leor dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sedan need no!becompleletlagthe perm:u valued at one hundred cbnars($l00)orless.) 2 Art 2,Sec 341,Title 8.California Administrative Code).
Policy Number—J-4 QS i-1 3 g — �0 C57 .
( - ❑ As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work fir which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not -mploy an person i .ny man o as to become subject such person has a permit to do such work from the division.
to the work- ' compens on lawsJ�Califom': -nd agree that if I should
become t to the • •rkers' r pensatio' • ovisions of Section 3700 of
,,,••
•� Applicant's Signature Date
the La•% e,I l r: h ' r amply wi y -se provisions.
• 'h'_5_ O� Division of Industrial Safety Permit Number:
.plfq s5.� gWre^�*y,�,: fJ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. n a registration form for acutely hazardous materials? ❑Yes ❑No
Lic.# ti' co' A.O • lads.#-. C---" "7 (Section 25533 of the California Health and Safety Code, with some
/ //lI / lQ exceptions, requires registration with the Costa Mesa Fire Department by
.- - 6-5 each business which at any one time has on hand a quantity of acutely
c anlraetdrs enat,sza;; . Date - hazardous materials equal to or greater than a weight of 500 pounds, or a
L volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ElNo
(Section 25534 of the Califomia Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes El No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
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 information be furnished on applications for non-residential building permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes El No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she • CERTIFICATE OF COMPLIANCE:.1 certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
•
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of _• Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: • the City of Costa Mesa to en - upon the above-described property for
inspection purposes. I agree;. o occupy •• allow occupancy of any building
authorized by this per ...time!inspec •n.
•
i
Sign 4;007.rt!rr Date 7
Signature Date S
o
3057-46(3107)
---C. _—","744,----....0 -'
41: 4dlorAuf crnzed'Appfiranf-1-- - L Date " 'c`i±t•
OneeApplicantto fill in all spaces except those within heavy border lines and sign all appropriate declarations. �,
P IT NO. TRACT NO. LOT NO. UNIT NO.
F COSTA MESA CONSTR'U/CTION.P/ERMIT E/({ -3513
�Jc /7 A.P..# (zone
�,. rr leer Address 777 /1/Es't/(y�i/11'�tf'/i�E' - �r�� J./ a��-+� ' / I '� .. .
's. I _ '// /� S Main Building: , • Accessory Building: „
Applicant's MailingAddress /7;// ,tistLti /YL a .S J!F D�' TYPE OF CONSTRUCTION - LJ NEW ❑-,ADD H ALTERATION U REPAIR E - Z
e ?sy -tj(J.:n ❑*CONVERSION ❑-DEMOLISH ❑ OTHER - T Front - O
Owner's Name /�Q� ✓CYLt4Y Ai .SfMf-./# Phone, y1SC `DESCRIPTION OF We RK/VSE O� BLDG. B Rear - N
Address- - - r/ i ' . . , - /� .`ry. i •
_ . "A
'C Right - N
Arch/Eng.- License No. ' TYPE OF PERMIT : GRADING . FOUNDATION II STRUCTURAL - • - 1 K- G
Address • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left - -
❑ OTHER . R
Contractor's Name Phone Ping. Ref.# Parking Req./Provided E
FIT J4n�) OCCUPANCY
O
Address(mailing) - 0W JVF,'SZ" a' L • PROJECT DESCRIPTION SQ. V �- Planning Notes: - M
C O N ST RUCT IONTVPE - VALUATION$%/4 94 J -U-��
•City License No. TZONE GRADING CU.YDS. ACRES - - g
LICENSED CONTRACTOR DECLARATION - - _ - -___ __- -thereby affirm that-.1 am licensed under provisions of Chartei 9 (commencing Remarks: . .
with section 7000) of.Division 3 of the Business and Professions Code, and '
my license-is in full force and effect. ELECTRICAL , ' "FEES -
License Class License No. • . Automatic Washer Transformer 0 15-50KW
Date Signature PLUMBING I ,FEES -
WORKERS'COMPENSATIONDECLARATION Construction.Pole Sub. ❑ 50+KW - '
hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers •
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - Service Sink - Cooking Unit Meter Dup to 100 amps '
00, Lab.- C.) - ..- . - - - - -- - . . . - -
Policy No. Company Backflow Irrigation Sewer Cap • Dishwasher I Meter Dover 100'amps- '
Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certi- fied copy is flied with the city Building Division. Bathtubs Sewer Connection _ '
Date Applicant - - Fan Motors❑0-1.HP 01%-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIONClarifiers Solar Collectors r
-(This section need not be completed if the permit is for one hundred($100) or Dishwasher - F.A.U. • • Inc.Solar ❑9-15 HP ❑16-15+ - -
less). Solar Piping
I certify that in the performance of the work for which this permit• issued,I - Fixtures ' ^ '
shall-not employanyperson in anymanner so as to b ome s ' ct to the DrinkingFountains Microwave j;
Solar Tank' • X
Workers' p Pyyy U Laws of Califqs/�1 -
•
Date /i/ Signature (� f"`-* - 2 Device Boxes Pole Light( / 9 Floor Drains • Swimming Pool w/Spa 9
NOTIC f, ter making this declaration, you should become subject to the
Workers Compensation provisions of the'Labor Code, you must forthwith Floor Sinks' Urinal - _ ._ Outlets Range- „
comply -with such-provisions or this permit shall be deemed revoked. Switches - '
CONSTRUCTION' LENDING'AGENCY Sign
Gas Service Outlets Water Closet •
I hereby affirm that therewhiis a permit
it lending (Sec for the performance
of the work for which this permit is issued (Section, 3097 Civ. C_) Garbage Disposal Standing Sections ,
Lender's Name - Interceptors • Water Heater -
Lender's Address ' • r Kitchen Sink • 'Water Service _ - , Generator ❑0-5 KW ❑5-15 KW Trash Compactor• '
OWNER BUILDER DECLARATION . ' -
I hereby affirm that I •am exempt from the Contractor's License Law for he • Lavatories - - • Auto-Wash- '
following reason (Section'7031.5 Business and Professional Code: Any city or - - '
county which requires a permit to construct,alter,improve,demolish or repair P-Trap . - . Laundry Trays - - - '
any structure, prior to:its issuance, also requires the applicant for such permit - -
to file a signed statement that he/she is licensed pursuant to the provisions of Roof •
Drains • - • - '
the Contractor's License Law (Chapter 9_'(commencing with Section 7000)of - - - ' -. - '
:Tiivision 3-of the Business and Professions Code) or that he/she is exempt - ' _- •
Reinspection Fee I $15 Issue Fee $ 3
; •refrom-and the basis for the alleged exemption. Any violation of Section , " . — -- -
`"731:5'by any applicant for a permit subjects the applicant to a civil
:�•enalty of not more than five hundred dollars ($500). - - - ' . I DEVELOPMENT.SERVICES REQUIREMENTS: •
I; as owner of the property a Reinspection Fee . $151 " Issue Fee .$ 3 Zoning Approved By Date '
- npeasaaiorr, will do the work,and the structure is not intended or-offered
-
'for sale ow(Section e Business and f aProfessionalprCode: The Conma roves MECHANICAL FEES Building Approved By ' Date= / :__
Licen Lpw does not apply to owner ora props or who builds or improves - -
Ihed e.yid who tloes work himself/herself or through his or her own - Application Issued By Dat
erne! ees, provided that such improvements are not intended or offered for, Boiler - Hood or Type I. ❑ •
sale. If, however, the building orimprovement is sold within one year of com- - , Canopy' Type II 0 - SUMMARY OF,FEES
prove , the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground -
prove for the purpose of sale). BUILDING PERMIT $ ....2C."(C.• SMTP $' ‘S-0❑ I, as owner of tI he property, am exclusively contracting with licensed con-. Duct-Structural ' Refrigeration System , , .. PLAN CHECK $ PERMIT•
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 Duct-Ventilating •- _ _ ❑R-100,000 BTU.❑100,0001BTU _ _ PLUMBING $ • ISSUANCE $.
builds or Improves thereon:and who lac tracts ice se oro reefs with a con- - " ' _ ENERGY P.C. $
tractor(s)their pursuant to me Contractor's License Law). l am aware that Exhaust System 0 Multiple 0 System Repair/Alteration •• ' I • PLAN CHECK 25% $ i
proof of their Worker's Compensation insurance should be provided to me. It ELECTRICAL $ • ,GRADING $
•
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers
I g / PLAN CHECK 50% $ MICROFILM $
Date • Owner il'^�''� nom++-%dA • Heating System& Ducting: Registers �(—
�'� - MECHANICAL $ - TOTAL FEE $ `IS•S�
I hereby ver have-read this a P Plication-antl state that the above 00-100,000 BTU 0100,000BT
Information is correct. I agree ty with all city and county ordinances PLAN CHECK 25% $
and state laws relating to buildinging construction, and hereby authorize repro- 1
Inspection
of this city to est upon t above-mentioned property f
Inspectionp •• -5. C, //�p(y' :
Signature ' _ Aga '-_ �., Date ��//J J i .
Drivers' License or 55 9f Fee $15; Issue Fee , $ 3r
•• I , _ D1 000147Q4 O17D14705 : TOT' ?5.a1J
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 09/19/88 TIME: 11:44
.CONSTRUCTION AND PLANNING POC SPA
APPROVALS Permit# Date Inspector APPROVALS Permit#, Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Locaiion ,
2. Soil Pipe-Undrgrnd. •
53. Steel Reinforcement •
3.,Electrical Conduit Utility-Undrgrnd. I :. 54. Forms •
4.;Electrical Conduit-Undrgrnd. 55. Electrical Bonding - •
5. Steel1HReinforcemerit 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE m
7. Footings 58. Electrical Conduit-Undrgrnd. •
8: Foundation _ - 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. i - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System , - • 61. APPROVAL TO DECK
11. Property Sewer Line& House Connection -• 62. Backwash & Receptor-inal
.12. Sewer Cap 63. Heater & Vent-Final L
13:-Roof Drains 64. Plumbing System - Firfal
14. Rough Plumbing 65. Electrical-Final f
15. Rough Electrical-Conduit 66. Solar System-Final •
46: Rough Electric Wiring 67. Fencing & Access Approval
C
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING -
OB. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
191. 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 0 Gas. 0 Oil
•
23.'Gas Pipe:Rough & Test • 72. Underground Flush
24. Roof Framing '9 . , 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing . I 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 . t HEALTH DEPT. REQUIREMENT
•31. Plaster Bfown Coat ' 79. FINAL INSPECTION
•
32. Electrical Power Meter-Final • •80. FOOD CERTIFICATE ISSUED ,
,
33. Final Electric i Notes: • - •
- 34. Final Heating&-Air Conditioning • -
. 35. Final Gas Pipe-Test
36. Hood or Canopy '
37. Final Factory Fireplace - . '
38. Final Plumbing
39. Water Service-Final _
40. Gas Service-Final 1 '
41. Solar Domestic-Final - ,
42. Backflow Preventer 3.
43. Backflow Irrigation - (w
44. Landscape Irrigation System . ij
-
45.-Sound Attenuation
46. Handicap Regulations •-
• 47. FINAL STRUCTURE & BUILDING r r !J •
48. Snecial Requirements Completed - 7 ,
49. Electric Release to Edison , .i
50. Gas Release to Southern California Gas Co .- •`
51. 'CERTIFICATE OF OCCUPANCY - ,/� '' iv
Nor - Date T- ,t
CITY OF COSTA MESA '•
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
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 'ownerbuilder'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 the major labor and materials for construction of the proposed
pro improvement. Yes 0 No
2. (have ve not) ;7i314--c— signed an application for a building permit for the
proposed work.
3. I have contracted with thefollowing person (firm) to provide the proposed construction:
Name \(/\
Address 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 ( ) Contractor's Lie. Nn •
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
A
I hereby affirm that I have received a copy of the information set forth In Section 19830 of the
State of California Health and Safety Code and have completed the above information to the best of my
personal knowlle�e77dge, compliance wi this State 1
Signed::211:4•°,14Ay��'/ Date: ?/l7/)
Name: 1412 Aio/ 0. m '%i
(Printed or Typed)
C.D.L. 4 or S.S. .
754-5273
CMF 104246
CITY OF COSTA MESA REQUEST FOR OCCUPANCY n
TRACT NO. 9 DATE ( 2- y' - 2(,
LOT NO, C?
ADDRES'S_J 21_42L ..rhe (
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
QA . -572-erj 6;71 chaser
_AMENUmafflair
Developer and or :uthr'ed
re. esentative
‘ZiAr Faf"Fa I
Lender
4I CITY OF COSTA MESA
BUILDING DIVISION
t ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
ti I
0 � PERMIT
4 ,a, /P01-00325
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1771 NEW HAMPSHIRE DR Status: ISSUED
Suite No Applied: 06/04/2001
Issued: 06/04/2001
Vicinity: WATER HEATER
Parcel Nunmber: 13957308 ISSUED BY:
Applicant: NOCK, RON
Address: 11612 KNOTT ST
Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
Owner: CASILLAS, JAMES &THERESA
Address 1771 NEW HAMPSHIRE
Phone:
COSTA MESA,CA Zip: 92626
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST
Phone: (714)895-1246 - -
GARDEN GROVE,CA Zip: 92841
License: 707775
Arch / Eng : - - �.
Address:
- Phone:
•
-- - -- - -ZIP: - -- - - ,2 ,
License: -
SCOPE OF PERMIT '.
WATER HEATER CHANGEOUT
•
FEE'SUMMARY .'j,' •
AMT QTY .. ' -_ AMT_ QTY ;v- • AMT QTY
ISSUE FEE • $23.50 , Laundry Tub/Washer $0.00 0"., `' ",Sump Pump - $0.00 0
Backflow irrigation.y " $0.00 �0 �_ Landscape Irrigation " / $0.00 .0 ,Swimming Pool $0.00 0
Backflow Preventer < $0.00'� 0 P-Trap - $0.00 < 0 'iTrap Pruner, /C, $0.00 0
•Bathtub Pressure Regulator - c - $0.00 0 % Urinal= "v , ' $0.00 0
Clarifier System "$0.00'' 0 - Process Piping(per,10 ft) • $0:00 0'' ' VacuumBrkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) '$0.00' 0 • , • Receptors $0.00 - 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 - 0 . Wash Basin . / $0.00 0
Dishwasher $0.00 0 • Sewer Cap for Demo $0.00 ".0 Washbasin Set $0.00 0
Drain, Floor $0.00 . 0' ' Sewer Connect $0.00 "0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 ' -0 Sewer Private Line " $0.00 - 0 -Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 . Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 -- Sink,bar $0.00" 0' Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial " : $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
COMMENTS/SPECIAL CONDITIONS
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 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
2446-46(6/00)
DECLARATIONS '
f 1 (1)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: -
❑ Ih ve 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
ork for which this permit is issued.
Lhave 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.
Lr My workers'comp.-ns n Insu rice cgr�acgnd icy numb _ ��� - ` � To ,
Cartier:; LAY moi% Policy Number.//✓/ J
G -(This section neeC not be completed if the permit is valued at one hundred dollars($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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Lab Code,I shall forthwith
comply with these provisions. / _(
'Applicant Signature:-SECURE (D�<e�-` 0
�/5/ F/�
WARNING:FAILURE TO WORKE- .• LL PENS-•-'COVERAGE IS UNLAW AND SHASUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVIL FINES P TO ONE HUNDRED
THOUSAND rvx I ARE(5100,000),IN ADD • TO THE COST OF COMPENSATION,D• •GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed •- •C"r.si••. of •-• - •(.• mencing with Section 7000)of Division 3 of.the.Business and rot s ode,and my license Is in full
force end effect..Uc..a, — ' _ L'Ctass'N"Y -
Co`Vectors'S ---..- =� C.Dete:•^' _ A=
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the••• r • r this•ermit 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 properly,or my employees with wages as their sole compensation,WILL DO THE WORK,end 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 for 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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I 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,fatsework,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 Cale).
❑ 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 applicant 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
material? 0 Yes 0 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).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomla 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 ❑No
(Section 25534 of the Califomia 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 an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If'yes",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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign. . •f Le.al Ow = / / ,Yate•
(And/Or'Authorized'APPiicant^ `/�� LK;//�'m. —
COPE 1 INSPECTION TYPg RAM INTIMLS CODE t INSPECTION TYPE OATS INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical J
1266 Pool Spa Final 208 Final Plumbing //S[O/
aZI
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Walt 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
OWNER APOLLO DEVELOPMENT DATE 1-22-70
JOB ADDRESS 1771 New Hampshire. Drive BUII "'`IG PERMIT NO. 31305
GENERAL CONTRACTOR Same DESCRIPTION of WORK & ence W/Attached Garage
AP No. - LOT 57 I r ACT 6694 FIRE ZONE . VALUt $26,470.00
INSPECTIONS Sir ure a GROUP I 6. J TYPE V ZONE R1
SOIL z. zee'c PERMITS ISSUED
Y� SUBCONTRACTOR
GAS / . .r •J4 � Date Number I Signature
WATER _ 4 .•� / • _/// P m.in• /� �,
44V t
PROP'ROUG.SWR• .LINE MOUSE CON. Y4 /� ``t7-22 //� ,„If ��i-e" . ,. -742L- -07/C<L7�il 04d)
SPRINKLING SYSTEM T 1 _`GAP /44i�72 fa4.i,#
MISCELLANEOUS 7 / Y'
ROUGH HEATING AND AIR CONDITIONING /4 (�.fo-70 JJJJ
TEMPORARY SERVICE OR POLE [T'�
UNDERGROUND ❑ POWER El �/
ROUGH WIRING /v�/I� V 1 Heafin• and Vent.
TRENCHES FORMS STEEL REINF. 0 erne
0 ., ' i _ art./ -„/.. .J.?
FLOOR SYSTEM rneJ,� ra • -7 _ f
BOND BEAM n STEEL REINFORCE n
SHEATHING 'r , I% 3-j/-7O
FRAME AND FLASHING .r .e�' 4•r1-r0
LATHING — IN ® OUT ® • yt f•-7-70
PLASTER, BROWN COAT f`Z1.7C
-,. ..: _1 in
' HEATINr� NREFRIG. AND A.C., FINAL / @7?'/`" , `,�r AL
�, *�p- 7Q O77
r BING, INAL AND GAS TEST I,-IV 60,? 2.7i,-) //
ELECTRIC, FINAL /����.�(� (fr t/./0
BUILDING, FINAL ,a4 111.2 Ho
31305 r/9 t 7 c e—
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN26-70�n5F,O0 747* ***141.00
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEI D DA E R EIVED DATE ISSUED
BUILDING �7 �/ /J /� "—/c 7(.� 7 )
ADDRESS / ,/ / / �i-p y r'L e.04• /—g-2--/`
PERMIT IV ISJb
OWNER Apollo Development orp. A.P. NO PER'S"-
v
MAIL BUILDING
Z
7././../-.04-43-04.42:„...19 ADDRESS 1104 E. 17th Street - ADDRESS/97/
L.
-U CITY Santa Ana nNi, 547-9673 TRACT 6694 LOT 57 BLOCK
CONSTRUCTION NEW ADD ALTER (REPAIR MOVING OEMOI ISH
N LENDER U. S. National Bank
- X
0. m
_10 BRANCH •Main Office
—IN OWNER Apollo Development Corp.
a ill ADDRESS 190 S. Broadway, San Diego .
m•CO ARCHITECT TEL. USE Dwelling vALu$ 16,000 III
-I Q OR ENGINEER Kermit Dot ius NO. 675-116 ,,[
V FIRE
f7 J
w ll: ADDRESS 3111 2nd Ave., Corona Del Mar ZONE TYPE GROUP"
p_W
APPROVED
J Z CONTRACTOR Apollo Development Corp. BY DATE
Ca
Z
nQ• ADDRESS 1104 E. 17th Street tq• (0
LU WZ E NO.OF USE OF NEW
O = CITY Santa Ana NO.
_ 547-9673 I PLANS BUILDING torn•
F Z
W0• STATE CITY YARDS APPROVED YARDS APPROVED
y it LIC. NO. 252549 LIC. NO. 1690 MAIN BUILDING ACCESSORY BUILDING
0O I FROM C/LST ET)
SIZE ONO.OF BLOCS.
F LOT 49 x 99
NOW ON LOT --
FRONT 3 FT. FT.
USE OF (0
EXISTING BLDG. —�— R SIPE l FT. FT.
I— SIZE OF 1770 S.F. NO. 1
Z0FT. FT.
Z NEW BLDG. ROOMS 7
STORIES L.SIDE
COVERING WALL
Pl< EXTERIOR Per
ans ans ROOFCOVERING Shingle
REAR ''/ FT. FT.
—I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1 MAIN BLDGS. ACCESS. BLDGS.
0
Construct new dwelling with cU.P.# �5-b $ APDAPROVED ___,.).0._
— _68>
o
Nattached garage. ROVED Lt/L./ _PATE (t�/j6/ ,
a (U� 4/1/11 ( .
I hereby acknowledge that I have read this application and state HOLD FOR SPEC'IAL E
V that the above information is correct and agree to comply with st REQUIREMENTS
CCall laws regulating building construction, and I shall not employ
F„ any person in violation of the workman's compensation laws of
the State of California. v co
z/ 72 I hereby certify that I am properly licensed as a contractor under SO. FT. �Y,yJ vJ p
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN✓ UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of the State of California Business l[
VALUATION
-and Professions Code, Division 3,Chapter 9. 9i O C ce
ire PERMIT FEE $ l N
Signature of P - )) ^7 it {�/y m
Permittee -✓N / � $ oS� y PLAN CHECK $ / /�vU E
/
Li!Authorized Agent a
TOTAL FEE $ // D