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Home My WebLink About2365 ORANGE AVE - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 2365 ORANGE AV Suite No Vicinity: Parcel Nunmber: 43926224 a a Status: ISSUED Applied: 08/25/2004 Issued: 08/25/2004 . . ISSUED BY: Applicant: VICTOR CAMPADONIA _ - " „ , - Address: � 1701 W 242ND ST ,.-� ". , � ' � -�.. "_ - � � - �. � . `'. � -� Phone: 310-530-8788 " � �ir%-�� LOMITA, CA":-' -' ' Zip: 90717 . , � � � ,� � _ . , , ' r • � ��, � " � / � " � j ��l � `� � / ii - � � � Owner�%�WEXELL, JULI i ' _ � � - - , �. � `- / `��\ , i � - . ,: Address, "-23650RANGE AVE%- . � . � i� ��, '-��`.�`� � ' Phone: . ' �� \ ' . � , COSTAMESA,-CA Zip: 92627-1505 � ��,� , �'� � '� � ' � � . - <�,' , � .� �Contractor. � VIC'S ELECTRIC � � � � �� ` � �' - �`.�'� Address: ' 1701 �W 242ND ST . � � _ � ' ` . _ - . � � � � �� , � . � � , , ' , � , , , �� Phone: 310-530-8788 � � . . ._ .. - � , � _ .. LOMITA, CA . Zip: 90717 � - . , � � / � , , - . . � , �� icense: 570018 ' �- , ' , � ' `�� ; ., . � , , , � � � ` - �� + �� SCOPEOFPERMIT,� " � � � � •, ' � . UPGRADE SERVICE TO 100 AMPS.._ % , ' . . _ , ' „ . .„ � �, ' lSSUEFEE��, ' - $23.50 �- Temp service test '. • $0.00 Res. a/c package � , $0.00 New Res_(1-2 unils)-� �, $�.00 New Res�(3+unils) ' $0.00 Pool /'Spa �� $0.00 Lighting Fixts � ' � �$0.00 Recept Outlets , , $0.00 Switches � $0.00 , Non Res Appl � $0.00 � Res Appl � ' $0.00 � Service to 200a . � �' � $30.50 Service to 1000a �`� � , " $0.00 ' Service over t000a A� � $0.00 Motors to 1 hp � � ' $0.00 Motors to 10hp ` $0.00 Motors to SOhp � . $0.00 , Motors to 100hp $0.00 ; Motorsovert00hp $0.00�� Communicatlon drops $0.00 � Sub panel to 200a $0.00 � Pole Light Pkg $0.00 � Sign Circuifs $0.00 , � - -FEE SUMMARY � � �i , . � Quantity " - .� -- "" � , � - � - - � � Quantity � � -_ - . ' � " � ` Temp Dist Systein / Llghting $0.00 0 ��. ; . � , ;; � Busway /100 R , $0.00 0 ; �� , � � ' Standing Section . $0.00 0'.:�,� , ' � � 0 Misc Electrioal Equipment $0.00 0;,',' , � 0 , Transformers up to 1 kva/kw �$0.00 y 0�' /� r-. 0 �� .:..... ....up to 10 kva/kw $0.00 i /i0 `�,� � i� �. , - '��' R� �.::., : .. . -' p . � ; �'^'�� ' ' ' .� uP to 50 kva/kw $0.00 r,.�f-'0 � � J, 0 . - .................up'to�100 kva/kw . $0,00�/.� p ,_ - . : . . .......: - , .' . . • -- 0 . "- � ,,. �� .....:............over�100kva/kw'-��:. �$0.00�� 0 L .' ' ; .� . 0 . . , low Voltage EquipmenL � �- - $0.00 , ., 0 - 0 - Lovi Volt Wiring System / Ckt ". "$O.00�j 0, '� _ �� 1 - - � � ` "Misc. Canduit � $0.00 �. � 0- �!� �� - 0 - � . � � > Misa Conductar. , ---' r' . $0 00, �� 0 `� / - 0� � � � , Circus ( gen or ride)�-�� : $0'.00'/ ,O;�t� ; � �0 ' � Circus (meah ride or lights) �� $0.00� ; i3O� ' " 0 �� . Christmas Tree Stand ��, � �� $0.00 � j0 . 0 � � 1 � � , . Fireworks Sland � ` �, ' $0:00 / 0 �0 � � Other ElectricaLFee � . $0.00" � ,-� �. 0- - - - - . Investlgation Fee� : %�""%� $0.00 0'��- ��- - . . -� PlanCheckFee'" � $0.00 0 ' ,- ----Reinspection Fee $0.00 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitornia 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 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONs: In order 1or the work aufhorized under this permit to be considered legal, such work must comply with all applicable codes, antl all requlred inepeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiralion of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaede le�oo� WORKERS' COMPENSATION DECLARA710N: I heraby effirm untler penalry of perjury one ot t�e following declarations: ❑ I heve ana will maintein e cenificate of consent to selt-Insure far workers' compensation, as provided br by section 3700 of Ihe Lebor Cotle, for t�e OeAarmance of the work for which ihis permit Is iuued. ❑ I have antl will maintain workers' compensatlon insu2nce, es raquiretl by section 3700 of Ihe Lebor Cotle, for Ihe perfortnance of the work for which this pertnit is issuetl. My workers' compensation Insurence wrtler and policy number are: Cerrier: Policy Number: (lhis secfion need nof be completed i/ the permiNs va/ue0 et ane hundred dWlars ($100) or /ess.) ��lcertity Ihet in t�e pertortnence oi the work tor which this pertnit is Issued, I shall not employ eny parson in eny mannar so es to become sub�ect b the workers' compensatlon lawg of Callfomla, end egree Ihat It I should bewme sub�ect to Iha warkers' compansation proNsions of Section 3700 ot the Lebor Code, I shell forthwith comply with these pravi ions. Applieam�Slpnalure;�— ��'i- -�� -�Dete:•. ".. �',�Z �—U�/ fs�t+�:.; .. �� "WAHNIN(!c'FAILURE TO SEWRE WORKERS' COfdPEN � TION ODVERA�E IS UNUWRIL AND SHALL SUflIECT rW EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TFIOUSAND OOl1ARE (5100,000). IN ADDITION TO THE WST OF COMPENSATION, DAMAGES PS PROVIDED FOR IN $ECTIIXJ 3]OB OF THE LABOR CODE, IMEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby eHirm that I am licensed untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business antl CONSTRUCTION LENDING AGENCY: ❑ I hereGy eHirm that there is e consiruction lending agency for the performance of ihe work tor w�ich ihls permit is issued. (Sec. 3097, Civil Code). Lentlefa Neme: Lenders Address: Signeture: OWNER-BUILDER DEGLAHATIONS: Date: license Is in full I hereby eflirtn Ihat under penalry of perjury that I flm EXEMPT FROM 7HE CON7RAC70RS LICENSE LAW tor the tollowing reason (Sec. 7031.5, eusineu antl Professions Cotle: Any city or county which requires e Oermit to construct, alter, impmve, tlemolish, or repair any sirucNre, pnor to its issuance, also raqulres Iha epplicant for such permit to tile a signeC statement that he or she is licensed pursuant to Ihe proNsions of the Conirecrors License Lew (Chepter 9(cammenGng wlth Sectlon 7000) of DlNslon 3 of the Business end Professions Coda) or that he or she is e:empt therefrom end the basis tor the alleged e:emption. Any violation oi Sectlon 7037.5 by any epplicant tor e pertnit sub�ects ihe epplicant la e civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner oi the properry, or my employees with wages as their sole compensatlon, WILL DO 7ME WORK, end the siructure is not Intentletl or otteretl for sale (Sec. 7044, eusiness and Prolessions Cotle: The Contractars License Lew daes not apply to an owner of property who builds or improves thereon, and who does such work hlmsetl or herself or Ihrou9h his or her awn employees, provided ihet such imOrovements are nat intendatl or oNered for sale. It, however, ihe building or improvement is sold wit�in one year of completion, ihe owner-builtler will have the burtlen of proving ihat he or she did not build or improve for purpose oi sale.). ' ❑ I, as ownar ot ihe pro08rry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct Ihe project (SBc. 704d, Business end Profession9 Code: The wntractors License Law does not apply to an owner oi propeny who builds or impmves thereon, antl who coniracts tor such pro�ect with a contractor(s) . license pursuam to the Contractors License Lews.). ❑ I em exempt under sec. Business and Professions Code for this reason: SignaNre: Data: Owner ID venfied by drivefs license. ❑ Yes ❑ No Drivers License No. Expires: Vedficetion of Ownewhip by (typa af daument, I.e. - property tax bill or tleea): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICA710N: ❑ I hereby certify t�at no excevatlon tive (5) or more teet in depth into which a person is requiretl to descend, will be mada in connection with work authorized by �his permit, end ihat no builtling siructure, scaffolding, talsework, or demolition or dismantling thereof, will be more ihan thirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title B, Celifomia Adminisiretive Coda). ❑ As owner-huilder, I will not employ anyone to do work which would require a permit from Ihe Division of Industrial Satery, as noted ebove, unless such person hes e pertnit to do such work irom the division. SignaNre: Date: Divislon oi Industrial Satary Permit Number. CERTIFlCATE OF COMPLIANCE AND AUT}IORVATON OF EMRV: I certi(y under penalry of perjury that I have read this application and state ihat the intortnation given is correct. I agree Io comply with ell state laws end ciry orClnances relating to builtling construction, and authorize representatives of the Clty ot Costa Mesa to enter upon ihe ebove-descnbed pmperty for i ctlon purpos s. I egree not to occupy or allow occupancy of any building euthonzed by this Dermit until tinel inspection. 1 !/1 � � a �-�j��_- /�/ _ Sign re Of Legal Owner(s) Date � COOE I. INSFECfION TYPE 1616 Fi:eC Sysiem Final Flre Prevention 1288 Pool Spa Final 200 Final Re-Roo� 201 Finel Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Flnal Demolition PAL � R COOE! INSPECTONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval � G_S ��CJ<( '�jDate � QAIE It�EL3 � ¢ I� 222 Final Site 250 Final Building/Occupancy . .. ADP��ant to fill in a11 soaees exceot those wit CiTY oF COSTA MES C NNSTRUCTION PER/�MMIT�, - PmjL•�,Address �� „ v'„/' . !Applicant'SMailin dress ��' Owner's Name Pho^-SS -JOI � Address � if/'-�-O-2CL/! �,� .�ii Arch/Eng. License No. ' Address � ry I Contractor's Nam pM10 G 1+ Address (mailing� G ' C /YYI. ' I City 6icense No. - LICENSED GONTRNCTOR DECLARATION ' 1 hereby.aftirm tnat 1 am�licensetl untler provisions of Cnarter'9 (commencin9 with sec[ion ]000) of Division 3 ot the Business antl Protessions Cotle, antl my license is in ❑j o/ce antl e tecL � //�� Licen e CI l�/� -�� a .� License No.�Q�[ / Oate �%i'� .�i - 5'9 [ �S ��/-L.G�/..� 'NORKERS'COMPENSATION DECLARATION � hereby attirm that I M1ave a certificate of mnsent to elf-insure or a<ertificate f- Workers' Compensatiom Insurance, or a cer i(i - copy thereof (Section. 3800, Lab. C.)�+n /_pnZ/ , Policy No. �T �� I T lo Company ertifietl copy is hereby�isnetl. � ertJ'�ietl copy iletl wi the city il ' ion. ate�//-�.f'�� APPlicant i EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl if the permit is tov, one huntlretl ($100) or less). I certify that in the pertormance of the wo�k fo� which this p¢rm�t i5 i55uetl, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Si9nature NOTICE: If, alter making this tleClaration, you shoultl become subject to the Workers' Compen5ation �provisions ot the Labor Cotle, you-must forthwith comply 'with such -provisions o� this pe�mit shall be tleemetl revoketl. CONSTRVCTION LENDING AGENCV� - ' ' � 1 hereby affl�m tM1at the�e is a�const�uction lentling agency for the pe�formance of tne �work for which- thiv permit is issued (Section 3097 Civ. C.) Lenaer's Name � ' Lentler'i Atltlress ' " - � OWNERBUILDERDECIARATION�-� � ' I hereby atfirm that 1 am exempt trom the Cont�actor'S L'icen5e Law fOr the tollowin9 reason (Secilon 7031.5 Business antl Protessional Cotle: Any ci[y or county wnich �equires a petmit to const�uc[, alter,�improve, tlemolish o� �epai� �any structwe�, prlor to �it5-i55uance, also requires the aOP��ant (or such permi[ ' tn fi�e. r sion d statement tnat he/she is lirensetl oursuant to the orovisions o( nvision 3 or me� tlusiness ana rroressions wae) or mac ne�sne is exemp� herefrom antl the basis tonthe allegetl exemptian. Any violation of Section , l031.5 �by. any applicant for a permit subjects ttle�apP��cant lo a civil �enalty ot not more than five huntlretl tlollars ($500).: � LJ I;�aS owner ot the property ov my employee5 with wages a5 their sole compensation, will tlo the work, antl Me structure is not intentletl or offeretl for sale (Section 7044, Business antl P.rofessional Cotle: The Contractor'S License Law,tloe5 not appty to en owner Of a property who builtls or improves [hereon, antl who tloes suth wo�k himselt/berself or tNough tiis or her own employees, provitletl that su[h improvements are not intentletl o� ofte�etl tor sale. If,�however, the builtling cr improvement is sottl�within one year oi com- pletloq the owner will have the bu�tlen Of proving�he/she tlitl not builtl o� im- �ove fo� the purpo5e of sale). ' Ll I, asowner ot the property, am exclusively contracting with licensetl con- , t�acto�s to construct the p�oject (Section ]044, Busine55 dntl P�otes5ions Cotle: The Coniracto�'S -License .Law tloe5 mt apply to an owner of •property who . buiias or improves thereon, antl who contracts for such projects with a con- trattor(s} litense purouant to the Cont�acto�'s Litense LawJ, I am aware that O�oof of tM1ei� WorkeYs Compensation insu�ance shoultl be proviCed fo me. ❑,I am exempt untler Section B. & P. C. for tM1is reason Date � ' Owner, ' - I hereby �certity thaC I have ieatl this application antl state [hat [be above Intormation a m�rect. �I agr¢e to comOty wrth all city antl county 0/tlinances antl state laws�relating to uiltlinq construction antl hereby authorize repre- sentatives of' is' ity enter upon the above-mentionetl �roperty for bortler lines antl si9n all appro0riate tleclara[ions. LOT NO. UNIT NO. � TVPE OFCONSTRUCTION LJ NEW � ADD- ALTERATION REPAIR �"�' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Ap �, .DESCRIPTION OF WORK/USE OF BLDG. � / S Main 6 TVPE OF PERMIT ❑ GRAOING �OUNDATION STRUCTURAI. �' T Front �� TENANT ❑ E�ECTRICAL PLVM ING ❑ MECHANICAL B Rear lO �OTHER � (�`%�✓L �'r �72 !�! GC= A PROJECT DESCRIPTION 54. FL- OCCuaaNCV " �C Right K Left �CONSTRUCTION TVPE VALUATION $ S ZONE � GRADING CU. VDS. ACRES ping. Ref.9 Remarks: . ' . � f Bar Sink . � Backflow Preventer Backflow Irrigation • Bathtubs � � � � . Clarifiers - � Dishwasher ' Drinking Fountains . . � Floor Dreins . Floor Sinks - [ GasServic-_ •Outiets� - Kicchen Sink ' Lavatories � � P-Trap Roof Drains - • � Reinspaction Fee $15 Boiler Duct-UnderGround � Duct-Structural � ' Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepVFact. BIt. ICBO # � Heating System & Ducting ❑a100,000 BTU 0100,000BT inspettion oy �j�� 'Signa[ure /'� Date�Q�✓ ��' ' pginspection Fee Drivers' Li<ense or � CMF 0865-46, rev.4/84 White - Builtling; Canary -Applicant; Pink -Accounting; Goltlenrotl -Assessor $15 u Showers � � -Service Sink - ' Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal WdI2f C10522 Water Heater Water Service � Issue Fea, ,I FEES � � E OCT 15 1985 Automatic Washer- Construction Pole Sub. Cooking Uni[ � Disfiwasher � ' Dryers ❑Gas ❑Electric , FA.U. ' � �,,) Fixtures - - � Z �// Device Boxes - O ut lets Switches -� � Garba9e Dispoul Generator �0-5 KW 05-15 KW �� , � p �� ' Zone j Accessory Building: � i � � � , • Parking Req./Provided � . 1 ICAL Transformer ❑�15-50KW ❑ 50+KW Meter ❑up to 100 amps � Meter ❑over.100amps Sub Panel Motars�0-1 HP�1'h-8 Inc.Solar �9-15 HP 016-15+ Microwave - - Pole Light - Range Si9n � Standing Sections Trash Compactor , IANICAL FEES Reinspection Fee $75 Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: � Hood or Type I ❑ + 1 Zoning Approved By Canopy Type II ❑' , ' 8uilding Approved By 4efrioeration System � Application laued By - ❑0-700,OOOBTU ❑100,000 System Repair/Alteretion Issue Fee , � $ 3 Z _'O N I 7 �. ry � G • R � ` E _ Q' { ' M T . S. FEES i � $ 3 � SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN'CHECK $ PERMIT PLUMBING ' $ � S DO ISSUANCE $ , PLAN CHECK � 25% $—� ENERGV P.C. $' ELECTRICAL ' ' $ GRADING , $ PLANCHECK 50°/ $ � � MICROFILM . $ � w� � MECHANICAL $ -TOTAL FEE $ _SiW6Y PLAN CHECK . 25% $ _ CONSTRUCTION AND PLANNING , � , :POG. .. SPA . . - . - . A�PpROVqLS Permit # Date Inspector qppROVALS. Permit # Date �Inspector 7: Temporary Electrical Service or Pole 52. Pool.& Equipment Location • r �2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement. . . , � - ' 3. Electrical Conduit Utility-Undrgrnd. � , . 54. Forms � � � - . ' 4. Electrical Conduit-Undrgmd. _ 55. Electrical Bonding � - � 5. Steel Reinforcement � - , 56.. Rough Plumbing & Pressure Test - � � -6. Electrical UFER Gmd. �.� � �- 57. APPROVA�L TO COVER-GUNITE ' 7. Footings � � . � . 58.� Electrical Conduit-Undrgrnd. ' � ' � 8. Foundation ' � � 59._ Gas Pipe, O Undrgrnd., Test • 9. Water Pipe-Undrgrnd. � . .. -60.� Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System ' . � 61. APPROVAL TO DECK �- . - 17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final � 12. Sewer Cap ' ,� 63. Heater & Vent-Final 13. Roof Drains � � 64. Plumbing System - Final � � 74. Rough plumbing 65. Electrical-Final ' � 15. Rough Electrical-Conduit � 66., Solar System-Final ' �- -- 16..Rough Electiic Wiring - � 67. Fencing & Access Approval � � - � 17. Rough Wiring Sign • �� 68. APPROVED FOR PLASTERING � . 18. :Rough Elearical-T Bar Ceiling �, � ' 69. POO VSPA SYSTEMS FINAL . � 19. �Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace , APPROVALS Permit # 21. Ducts, in Structure � � 70. Underground Hydro . 22. Ducts, Ventilating � 71, Product Piping � Gas ❑ Oil . 23. Gas Pipe-Rough & Test � � . � 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil ' 25. Roof Sheathing �. 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical . . � 27. Frame and Flashing 76. Dry Standpipe . � 28. Lathing & Siding� 77. FIXED SYSTEM FINAL � 29. Insulation � 78. FIRE PREV. FINAL - 30. Drywall Nailing �HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electriral Power Meter-Finai ' - 80. FOOD CERTIFICATE ISSUED 33. Final Electric � �Notes: � � 34. Final Heating & Air Conditioning , ' . , 35. Finai Gas Pipe-Test �0 �s/�/S L�� .- 36. Hood qr Canopy � � ' � - 37. Final Factory Fireplace . ' . � � 38. Final Plumbing - • / - � L£n � � 39. Water Service-Final, , � � , ' 40.,Gas Service-Final 47. Solar pomestic-Final ' • 42. Backflow Preventer • � � � � 43. Backflow Irrigation ., _ ,. � � 44�. Landscape Irrigation System � . ' . 45. Sound Aitenuation ' . ' 46. Handicap Regulations ' � 47. FINA�STRUCTURE&BUILDING � � � ' 48. Special Requirements Completed ' � • 49. Electric Release�to Edison � � • � 50. Gas Release to Southern California Gas Co ' � „� ' 51. CERTIFICATE OF OCCUPANCY . ' No. _Date • � - � ' � � ' ANGE,COUNTY BUILDING DEPARTMEN•. _•., �' APPLICATIOtd FOR PERMIT . � 636 Norfh Broudway SANTA ANA, CALIFORNIA _ ...___.��, ��- �-�� --- � FOR APPLICANT TO FILL IN $�'' ' �---FOR.OFFICE USE.ONLY— _ `/ � I- RECEIPT NO. PERMIT:NO. BUILDING�'1�/ S �/�C��NGC � I• � ADDRESS L (p . �- z��FsS l/,s�6 SCHOOL DIT,, �I. _`^ - � ^ � .y _� i, � OR TOWN (�7 ` L�/�r"' l�• RECEIVED BY DATE REG' . �ATE ISSI�ED �Ro555�. ,: . — � �1 C'i%�Lv S�i.) /S3 .57%�� OWNER � �/�L- ��c�� (�� BUILDING � n � S N�i ��I ADDRE55 /C. MA�� ' � � ? _ �� SCHOOL DIST. _ _ 'YJ- ADDRE55 OR TOWN l9�ZiC_c'v.� CIT�""��S " (�� NO. .��v.ii' NEAREST i / /% / � . CRO55 ST.; (/�/ Q�/\ . ' ARCHITECT OR %' 1, LIC Z NO OF �TV E I GROUP ' ENGINEER �(„�-� _/��y NO. � ZC7 � I PLANS I y� A�DRE55� ) �W' �'�M � LFi.� � / L _ I�Y/ T� APPROVED' S�� ` 7 LIC. BYI Y .� CONTRACTOR �G(�-7(_�E r NO. � � CORRECTIONS nooaess , LEGAL LOT � ! JESCRIPTION I NO. BLOCK ITRACT � � � i _ _ _� (ATTACH METES & BOlJND51 � � USE OF NO. OF NO. OF E%ISTING BLDG. Fwvi�ies ROOMS SET9AGK LINE FROM: G: !i� / REAR YARO CENTER OF STREET ✓ V SIDE YARD ��L � DESCRIPTION OF WORK vFw I •LTF_RATION ( I qpp�T10N I E%TERIOR GOVERING USE OF NEW BUILDING / 1 HEREBY AGKNOWLEOGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORREGT AND AGREE TO COMPLY WITH ALL COUNTV ORDINANCES AN� STATE LAWS REGULATING BUILDING CONSTRUCTION. SIG ERM`1TfE �I� � � `G KCI�� V. �qq� `AUTHORIZED AGT. uv a `"" � �y � � ^ PERMIT FEE S � VALUATION S X V U PLAN CHECK $ I� '�i'1(1 e'� fl A TOTAL FEE —7�± S SM 9-JO-09� � - BOND FINAL APPROVALS .3 S- � 0 A � Z D r �NGE COUNTY BUILDING DEPARTMENT 636 North Broodway SANTA ANA, CALIFORNIA FOR APPLICANT TO FILL IN� ,� BUILOING�� / i i�1^ � /> � �� ADDRE55 (p �J /�/-1 O✓ � SCHOOL DIST �/�J ORTOWN C �v[�Q NEAFEST CROSS ST. G � OWNER�. /�C�-�' ��/`VI/� MAIL / /� �•� / � � , �� . AODRE55 tf _ CITY C�.g ��j ' NOL�'� �-Zri ARCHITECT OR LIC. �/' ENGINEER ' �. �GE��NO. C-`7 2�} ADDpE55�L(f �,� PN� L�1•� �j[//•�//T• CONTRACTOR ��/!/�%�/��NO. AOORE55 LEGAL LOT ]ESCRIPTION I NO. BLOCK ITRACT (ATTACH METES & BOUND51 S7, 3S X/3S ryOW ON LOTS/V�� SIZE OF LOT USE OF NO. OF NO. OF EXISTING BLDG. Fekiues I ROOMS SETBACK LINE�FISGM� REAR YARD . OENTlIrCF STREET SIDE YARO / 1�.3�� DESCRIPTION OF WORK �. USE OF N BUILOING APPLICATION FOR PERMIT . __� . �'�' • � �' •�•� _'_ _'_ ` r _FOR_OFFICE.USE ONLY 1�: RECEIPT NO. PERMIT;NO. '' �� 5�:8 � [NED�BY OAPE REC'D. DATE ISSbED / I� � S/L S L /s- �,N�� 36s , ESS : OL DIST. �� , _ � ! . ( i VV � � NO.OF TYPE � PLANS I t ' L : � CORRECTIONS I HEREBV ACKNOWLEDGE THAT 1 HAVE READ THIS FORMS, APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-P AND AGREE TO GOMPLY WITH ALL COUNTY OROINANCES FRAME: FIRE AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING LATH. INT. SIGNATURE OE'F�j �L^ CI�Lx-,Gf�d(�lv LATH. EXT. PERMITTE l�L+'� t �� / I� . _ PLASTFR.INl S6THORIZED AGT.� VALUATION S � � D i � SM PERMIT FEE $ � PLAN CHECK $ � �E'EA�S�� S "' : �