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Home My WebLink About3206 OREGON AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us . 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3206 OREGON AV Suite No Vicinity: GARAGE Parcel Nunmber: 13909311 Applicant: Address: f/ // ' GLOVER, LORIE: - � � 2737 S.GRODDY ' i, - % i� ��' ��`. _ . 3ANTA ANA; CA � ,�� , . �i � ': � O\WLER?RICHARD H JR 3208 OREGON AVE � PLUMBING PERMIT : Phone: Zip: , (714) 241-1414: I � i 92704 � i �`/i;�/,��1.� �/�/ Phone: , ;- i ��% COSTA MESA, CA Zip . 92626 ,�,;',� �.�� j ,;� ; � , � . ��;��`l• ,/;�,'.- r�; �� • '��Contractor �COAST�ROOTER PLUMINGHEATING & AIR CONDITIONING�� ; ; � �, ,,,:, � , ; �: , _ � t -'% 'Address: '�2737-SCRODDY _'.� ; -� � � "� - _ � ��% �. . , �'�� j •�� .," _ Phone: Q14) 241-1414 � ' �� ;'SANTAANA, CA � ' Zip: 92704 � t_, � ` _f �� y %._ � . -' License. _ 529127 � � �1� �� fn1 ,v. -�. .^ v . -. - . . , ._� -- � �1 � Arch / Eng � �J I �1 . ,�.-�=t _ _ �..,%. _. � _ _ . _ .. � . _ 1_i. i � U, i'�Address:�l�l'� � � � � � _,.�-� � i ` i..� ` �. Phone. � - � � � � 'U` ��l l�'' " =_�z�P' __ _ t � + �. ,' � License: � ��i C � � � � .. �� '�' � (� �� : �V \ ✓ � � „ `<, ;. SCOPE OF PERMIT 1`WATER HEATER CHANGE-OUT. �� \� ti� ISSUE FEE� � BackFlow irrigation� Backflow Prevent\r� < Bathtub �1 Clarifer System �c� Connect Qce,Soda,etc)� Denial Units � Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (7-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) � ��: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 i{ uf_ ��.o'f�� 1 ' �� 0• � � n �: ti� C0� � �0 %� 0� � � 0 0 0 0 0 0 0 0 0 ,.. ;', "'FEE SUMMARY. `�': .... . � ,. � � '� _ � i AMTo �,qTY .` 'siLaundry Tuti / Washer ��c $0 00' ' 0��- � �,Landscape`IrngaUon � oF� $000 .0 �' �P-Trap rz� 1" � �� o o $0.00 � 0�o .� �PressureRegulator..). �� .$0.00 0-�/ '�Pro`ce`ss'Piping (per 10 ft)� _�$0.00 �0%% � Receptors _„ � -- - -�$0;00 -- �0 � '_,SepticTank - - - "$0.00 _ 0 ".,\� . Sewer Cap for Demo� ,- --��$0:00 ,-' 0 ��. \ -�., �.jSewerConnect ' � ' ; `$0�00 ,--0 -"J Sewer Private Line� � , � $O.OQ . - 0 � � - Shower -� . • '$0.00 . 0 �„-�'- ---. Sink; bar �, - $0.00�-- %�0' i� Sink; commeFcial�� __"�-�$0.00- �0 Sink, Floor ,$0.00 0 Sink, kitchen $0.00 0 Sink, service/mop $0.00 0 Spa (private) $0.00 0 Spa (public) $0.00 0 COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 01/23/2007 Issued: 01/23/2001 ISSUED BY: , -� � \ i ��. �\ �' �� . . �' i A � . , � � r V�� i�� : A� / �' � \_ @ �i A� � \f 1 � �� `�\\ r �� \ � �'��v ' � _ � '. ��\ � �, . . ' i � , _ ' � \,�1, _11 �...�'f '' !-� � �\ ' _'%,�i � �r--, �� l.i� �J I�' j�--- � ��/r 1`� % n� J�',�/ C-�- �i%t--� ��=�� i � "i /%�� `j ��AMT SumpPump `� D�$0.00 'Swimmmg Pool � $0.00 Trap PrirrSer/� �) fJ $0.00 Urinal/ � C/ � $0.00 Vacuum Brkr Bkfl,ow(7-4) $0.00 ,Vacuum BrkCBkFlow(5+) $0.00 �Wash Basin%� $0.00 Wash',82sin�Set $0.00 .Waste end Vent System $0.00 �Wa[e� Closet (Toileq $0.00 Water Heater / vent $12.30 Water Piping (Inst or Rep.) $0.00 Water Re-pipe $0.00 Water Service $0.00 Water Softener $0.00 OTHER $0.00 VIOLATION $0.00 PLAN CHECK $0.00 REINSPECTION $0.00 TOTAL CALCULATED FEES: 535.80 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 ot 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inepeetlons and final approval must ba obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2406-46 (B�W) WORKERS'COMPENSAnON DECLARAnON: I hereby effirm under penalry of perjury one of the tollowing tleclarations: „ � ❑ I heve end will mainiain a cediM1�a�e of consent to self-Insure for workers' compensation, es provided for by sedion 3700 of the Labor Code, tor ihe peAormance ot the work for which this permit is ISsued. [� I have end will meintain workers' compensation insurance, as requiretl by section 3700 oi the Labor Code, for t�e OeAortnance of the work tor which this permit is iuueG. My workers' wmpen tion Insurence cartler antl policy nu er ere: 1 Carrier. 1 ✓1 ��`L+'�� e !� Policy Number: �� 1 in � 3 �l� � (This section need not be comple etl / t�ermit is valuetl at one hundred dollars ($100) or /essJ ❑ I certity that in the performanCe of the work tor which Ihis pertnit is i�sued, I shall not employ any person in eny manner so es to bacome subject to the workers' wmpensation laws ol CaliforAia, and egree ihat ii I should Decome subject ro the workers' wmpensation provisions oi Sectlon 3700 of ihe Lebor Coda, I shall iorthwith comply with thesa provislons. npp�icantSignawre: �'�� oate: /'a3rO 1 WARNING: FAILUflE TO SECU�ERS' COMPENSATION COVERAGE IS UNUWNL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PE�LTIES AND GVIL PINES UP TOONE HUNDRED' hKKISAND OOLLARE (5100,000), IN ADD�TIqJ TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3/O60F THE LABOfl COOE, IMEREST, qND ATTORNEYS FEES. LICENSEU CONTRACTORS DECLARAT�ON: I hereby aHirm Ihat I am licensed u�tler rovisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Prolessions Cotla, and my license is in full torce antl etted. lic. x rSri �� 7 Class A �� (n Contredors SignaNre:� �— Dete: �— a 3^� � CONS7HUCTION LENDING AGENCV: ❑ I hereby atfirm that there is a constmction lending agency for t�e performance ot Ihe work for which this permit is issued (Sec. 3097, Civil Code). Lentler's Name: Lendefs Address: Signawre: Date: OWNER-BUILDER DECLARATIONS: I hereby effirm that under Denalry of per�ury Ihel I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing reason (Sec. 7031.5, Business end Prafessions Code: Any ciry or wunry which reqoires a pertnit to construct, alter, improve, demolish, or repair any siructure, pnor to its issuance, also requires tha applicant for such permit to tile a signed stetement that he o� she is licensed pursuant to Ihe provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) ot Divislon 3 of the Business and Professions Code) or that he or she is exempt theretrom end the basis for the alleged e:emption. Any violation ol Section 7031.5 by any applicent lor a permit subjects the epPlicant to e civil penelry of not more ihan tive hundred dollars ($500).): ❑ I, as owner oi ihe Droperty, ol my employees wi�h wagas es iheir sole compensation, WILL DO TME WORK, and the simcWre Is not intendetl or ottered for sale (Sec. 7044, Business and Pmtessi0�s Code: The Contractors License Law dces not apply to an owner of properry who builds or improves ihereon, and who dces such work himself or herselt or ihrough I+is or her own employees, provided ihat such improvements are not intendetl or oHered for snle. If, however, the builtling or improvement is sold wit�in one year of compla�ion, the ownea6uilder will have Ihe burden of proving that he or she did not �uiltl or impmve tor purpose of sale.�. ❑ I, as owner of lhe property, ar� E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to rqnsWc� �he projec� (Sec. 7044, Business and Pmtessions Code: Tha wNractors Llcense Law tloes not epply to an owner of property who builtls or improves thereon, antl who contrects for such project with e contrector(s) license pursuant to ihe Comractore License Laws.). ❑ 1 am exempt under sec. _ Signature: Owner ID verified by dnver's Iicense. ❑�'es ❑ No Business and Professions Code for this reason: Verificatlon oi Ownership by (typa oi tlocument, i.e. - proparry tax bill or deedJ: Driver's License No. Dale: Expires: DIVISION OF INDUSTRIAL SAFEYY PERMIT CERTIFICATION: ❑ I hereby certify that no excav0tion five (5) or more teel in depth into which a person is required to descend, will be made in connection with work authonzed 6y this permit, and that no building stNCWre, scaHolCing, falsework, or demolition or dismamling thereof, will be more than ihirry-six (3fi) feet high. (Chap. 3.2, Grp 2, Art 2, Sac. 34 i, Ttle 8, Cali}omia Adminis�re�ive Code). ❑ As owner-builtler, I will not employ enyone to do work which would require a permit from the Division of Industnal Safety, as noted above, unless such person hes e pertnit to da such work from Ide division. Signature: Date: Didsion oi IndusMal Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AIJT}fORIZATOROF EHTRY: I certity under penalty of perjury ihat I have reatl this applicetion and state that the information given is correct I agree to comply wlth ell Siate laws antl city ortlinances relating to builtling consWction, and authorize representatives of �he Ci�y of Costa Mesa to ente� upon �ha above-descnbed properry tor inspeG�ion purposes. I agree not to occupy or allow occupancy of any building authorized by �his permit until final inspection. raAFtegal Owner(s) Date � _ �^a ^� ^� f I ntl/Or Aut�orizatl Applicant a�— CO�E �. INSPECTIONTYPE 1616 Fized System Final Fire Prevention 1266 Pool Spe Finel , 200 Final Re-Foof 201 Final BIocWRetaining Wall 202 Final Factory Fire Placa 203 Final Sign 204 Final Demolition ' jl�j�' INT RL CWEt INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecincal 212 Final Fire Pravention 220 Final Planning Approval 222 FinalSite 250 Final BuilCing/Occupancy • �LO: � (714) 754-5273 • Fa�c (714) 754-4856 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: CITY OF COSTA MESA ' BUILDIN6 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT 3206 OREGON AV MATERBATHROOM 13909311 THORSON, CLIF Phone: r.' Zip: Owner: �"FOWCER, RICHARD H JR i ,,, Address /� '-3206 OREGON AVE � - _ i:i,-; �� . . / _ i �� COSTA MESA; CA- i` \ - - �:,� '� �. ��. Contractor. EARt'S PLUMBING INC , ' Address: 1526 NEWPORT BL COSTA MESA, CA Phone: Zip: 92626 Phone: (949)642-1756 Zip: 92627 ' License: 2� 7657 � MA�� SCOPE OF PERMIT -REMODEL EXISTING BATHROOM. 1 LIGHT. 1 OUTLET & 1 SWITCH. PERMIT NUMBER �E99-00272 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/05/1999 Issued: 04/OS/1999 ISSUED BY: �� . �O �,a,, �2m��l - FEE SUMMARY � ISSUE FEE � Temp service test Res. a/c package New Res,(1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a. Service to 1000a Service over 1000a . Mators to 1 hp . Motors to 10hp , Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Cirwits Temp Pwr Pole Intermed Pole $22.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 $7.00 $1.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 1 1 1 0 0 0 0 0 0. 0 0 0 0 0 0 0, 0 0 0 7emp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor - Circus ( gen or ride) • Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 ' 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 525.00 COMMENTS / SPECIAL CONOITIONS NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia 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 oi 180 days. INSPECTIONS: In order for the work authorized under this permit to ba considered legal, such work must comply with all applicable codes, and all required Inapeetiona end tinal approval must be obtained. Failure to obtain inspactions and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 WORKERS' COMPENSATION DECLARATION: I hereby ettirm untler penelry of pe�ury one oi the fallowing declarations: ' � � ' ❑ I heve end will melntain a certiflcate of consent to sett-Insure for workers' compensetion, as provitletl for by section 3700 of �he Labor Code, for Ihe peAormance oi �he work for which this permit is issued. � I have and will maintain workers' compensatlon insurance, as required by seclion 3700 of the Lebor Code, for iha pertortnance of ihe work for which this pertnit is issued. My workers' compensetion Insuranca carrier end policy numher are: Carnec S�-q. f�-� �li/U6 � � � . Policy Number: I�� 3`� O I — O O (This sectlon neetl nof be completetl il the permit is velued et one hunCretl dollars (S100J or /ess.) � ❑ I certify that in the peAormance of ihe work for which this permit is issued, I shall not employ any person in any menner so as to becoma suDject to Ihe workere' compensation laws ot Califomia, antl egree ihat if I should become subject to the workers' compensetion provisions of Section 3700 oi ihe Lebor Code, I shall forthwith comply with ihese provisian�� Date: / / 9 9 Applicant SlgneNre: � � � WARNING:FAILURETOSECUREWORK RS'COMPENSATIONCOVERAGEISUNLAWFULANDSHALLSUBIEGTPNEMPLOVERTOCRIMINALPENALTESANDCIVILFINESUPTOONEHUNORED THOUSAND DOl1ARE (5100.0001. IN ADDRION TO THE COST OF COMPENSATION, DPhNGES 0.5 PROVI�ED FO{i IN SECiIIXJ 3]O60F THE LABOR CO�E, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm ihat I am licensed under provislons of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, and my license is in tull torce entl ettect. Lic. a :� �'7 6 S 7 Class s R- G I!-,i G �Zo , G.3(� Contractofs Signature: � Q �%� �-✓'-� oate: _ '>/�-. ; /q .!'i CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirtn Ihat there is a consWction lending agency for the pedortnanca of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Dete: OWNER-BUILDER DECLARATIONS: ' I hereby aHirm Ihat under penalry of perjury ihat I em EXEMPT FHOM THE CONTRACTORS LICENSE LAW tor Iha following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnit to construct, elter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires the applicant for such permit to file e signetl statement ihet he or she is licensed pursuent to the provlslons of �he Contractors License Lew (Cheptar 9(commencing wlth Sadlon 7000) of DiNsion 3 of ihe Business ana Professions Code) or that he or she is exempt Ihereirom antl ihe basis for the alleged exemption. Any violation of Section 7031.5 by eny epplicant for e permit sub�ects ihe epplirant to e civil penelry of nol more then fve hundretl tlallars (5500).): ❑ I, es owner of the property. or my employees with wages as their sole compensation, WILL DO THE WORK, end ihe structure is not intendetl or ottered for sale (Sec. 7044, Business antl Professions Code: The Contractors Licensa Law does not apply to an owner of properry who builds or improves Ihereon, antl who does such work himself or herself or Ihrough his or her own employees, proNtled Ihat such Improvements are not intended or otterad for sale. If, however, the builtling or improvement is soltl within one year of completion, ihe owner-builder will have ihe burtlen of proving that he or she did not build or improve tor purpose oF sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the proJect (Sec. 7074, Business end Professions Code: The coniractors License Law does not epply to an owner of pmperty who builtls or improves thereon, and who contrecis for such project with a contractor(s) license pursuant to the Contrectors License Lews.). ❑ I am eaempt under sec. Signeture: Owner ID verified by tlrivefs license. ❑ Yes ❑ No Business entl Professions Cotle tor this reason: Verification of Ownerehip by (rype af tlaument, i.e. - property tax bill or deed): Drivels License No. Da�e: Expires: DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICA710N: ❑ I hereby certlty ihat no e:cavation tive (5) or more taet in depth into which e person is required to descend, will be metle In connection wlih work authonzetl by ihis permit, entl that no builtling sirucNre, scaHoltling. felsework, or demolition or dismantling thereoi, will be more than thirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Adminisirative Code). ❑ As owner-hullCer, 1 will not employ enyone to do work which would require a permit irom the Division of Intlusirial Safary, as noted above, unless such person has a pertnit to do such work irom Ihe division. Signelure: Dete: Division of Intlustnal Safery Pertnit Number: CERTiFlCATE OF COMPLIANCE AND AIJT}10RIZATION OF ENTRY: I certify untler penalry of perJury that I have read ihis application antl state that the informetion given is correct. I egree to comply with all stete laws antl ciry ordinances relating to building construdion, and authorize representatives of ihe Ciry oi Costa Mesa to emer upon the above-Oescdbetl pmperry tor inspection purposes. I agree not to occupy or allow occupancy of any builtling euthodzed by this perm0 untll 8nal inspection. U�Si�atuJp Of�e�l Owner(s) ��/9 � Dete i� �� i�-+-,�— � An r Authorized Applicant � Date CODE t. INSPECTIONTYVE 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetalning Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demoli[ion , 2446A6 jl�, INfIfIRLS LOOEI �INSVECTIONTYPE ��206 FinelMechanical � 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Finel Planning Approvel . 222 Finel Site 250 Finel Building/Occupancy PAiE L� .�W,,_ �� •� i: �'��( (714)754-5273 • Fau(714)754-4856 CITY OF COSTA MESA " BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT JobAddress: 3206 OREGONAV Suite No Vicinity: MASTER BATHROOM Parcel Nunmber: 13909311 App�icant: THORSON, CLIF � , Address: �, , � ��;' � � owneri ' -FOWLER, RICHARD H JR' Addr`ess�� - 3206 OREGON AVE � - . ��. �COSTA MESA, CA Contractor: EARL'S PLUMBING INC Address: 1526 NEWPORT BL � COSTA MESA, CA � ArchlEng:, � Address:� - PLUMBING PERMIT Phone: Zip: Phone: Zip: 92626 Phone: (949)642-1756 Zip: 92627 License: 217657 Phone: Zip: License: PERMIT „/ P99-00212 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: APPLIED Applied: 04/05/1999 Issued: ISSUED BY: �� -` SCOPE OF PERMIT , REMODEL EXISTING MASTER BATHROOM. 1 SHOWER, 1 WASH BASIN & 1 WATEpR CLOSEj. ��V r.� i i / -e.�/N.a-% FEESUMMARY . .AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 BackFlow irrigation � $0.00 0� Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 BackFlow Preventer , $0.00 0 P-Trap � $0.00 0 Trap Primer $0.00 0 Bathtub � � $0.00 � 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System .- $0.00' 0, , Process Piping (per 10 ft) .$0.00 0 , Vacuum Brkr 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 $875 1 Dishwasher $0.00 0 . Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor �, $0.00 0 Sewer Connect $0.00 0 Waste and Vent Syslem $0.00 0 Drain, Rainwater � '., $0.00 0- Sewer Private Line � $0.00 0 Water Closet (Toilet) $8.75 1 Drain, Roof .�$0.00 0 �" Shower $8.75 1 WaterHeater/vent $0.00 0 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 Ga5 (14 outlet5) $0.00 0, Sink, kitchen $0.00 0 Wa[er 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) So.oO. � o VIOLATION $o.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: $48.25 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requiremenis under Califomia 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 requlred Inepectiona end tinel approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WO p."�CeHS' C�MPENSATION DECLARATION: . � � I heibby aRirtn untler penalry ot perjury one of the tollowing declarations: � � ❑ I have end will main[ain a certiticate oi consent to self-Insure for workers' compensation, as provided.for by section 3700 of the Labor Cotle, tor Ihe pertormance of the work for which ihis pertnit is issued. �' ) I have enC will maintain workars' compensation insurance, es requiretl by section 3700 of Na Labor Code, tor the peAormance oF Ihe work For which this pertnit is issuetl. My workers' compensetion Inwrance carrier and policy number ere: Cflrrier. Si—Ya-'I^v TUN D Policy Number. ��'� 3 5 lJ �� G (Th/s section need nof be wmp/eted /l Ihe permit is velued ef one hundrea tlollars ($100) or less.) ❑ I certify that In the peAortnance of t�e work tor which this permit is issueQ I shall not employ eny person in any menner so es lo become subjact b the workers' compensation lews of Celifomle, antl agree Ihat if I should 6ecome subject to the workere' compensation provisions of Sectlon 3700 of Ihe Lebor Code, I shall forthwilh complywi�hthese�D�or,si ns �n /S/ y Applicant Slgnature: �� -�""�— Date: � 9 WARNING: FAILURE TO SECURE W RKERS' CAMPENSATION COVEPAGc IS UNLAWFUL AND $MALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HIINDRED ilqUSPND DOLLARE (E100.0001. IN ADDfiIIXJ TO THE WST OF COIAPENSATION, DPANGES PS PROVIDED FOfl IN SECrION 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CON7RACTORS DECLARATION: I hereby attirm Ihat I em licensed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business antl Professions Cotle, end my Ilcense is in full force and etted. Lic. a �/ 7 db S% Class x;8, C%G . C� c y f 3 G Gontractofs Signature: d/� �'%� Date: �/r y��gy CONSTRUC710N LENDING AGENCV: ❑ I hereby aHirm that ihere is a consiruction lending agency tor the pertormance ot the work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lender's Atldress: Signature: Date: OWNER-BUILUER DECLARA710NS: I hereby alfirtn that untler penelry of perjury that I am EXEMPT FROM TXE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires a pertnit to construct, elter, improve, demolish, or repeir any structure, pnor ro its issuance, also requires Ihe epplicant tor such permlt to tile a signetl statemeN that he or she is licensed pursuant to ihe provisions of the Contractors License Law (Chapter 9(commencing with Sedion 7000) of Division 3 of the eusiness and Protassions Coda) or ihat he or s�e is eaempt Iherefrom antl the basis for the allegetl azemptlon. Any vlolation ot Section 7031.5 by any applicem for e permit sub�ects tha applicant to a civil Denelry of not more lhan five hundretl dollars ($500).): ❑ I, es owner of the property, or my employees with weges as Iheir sole compensation, WILL DO THE WORK, entl ihe structure Is not intended or oftared for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not eOP�Y �a an owner of property who builds or improves thereon, entl who does such work himsell or herselt or ihrough his or her own employees, provided that such improvements are not intentled or otteretl for sale. If, however, ihe building or improvement is sold wiihin one year ot completion, ihe owner-builder will have Ihe Durtlen oi proving that he or she did not 6uild or improve tor purpase ot sale.). ❑ 1, as owner of Ihe propeny, am E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to consiruct ihe proJect (Sec. 7044, Business entl Professions Code: The coniractors License Ww does nat appty to an owner of properry who builds or improves Iherean, and who conirecis for such projact with a contrector(s) license pursuant to the Contractore License Lews.). ❑ I am eaempt under sec. Business and Professions Cotle for i�is reason: Signature: Date: Ownar ID verlfietl by dnvels license. ❑ Ves ❑ Na Drivers License No. Ezpires: Verification of Ownership by (rype ot document, i.e. - property taz bill or deed): DIVISION OF INDUSTHIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavation five (5) or more feet In depth into which a person Is required to descenq will be metle in connection with work authorized by this permit, end that no bulltling structura, scettolding, falsework, or demoliilon or dismantling thereof, will 6e more then Ihirty-six (38) feet hlgh. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Celitomia Adminlsirative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from Ihe Divislon of Industriel Safery, es noted ebove, unless such person hes a pertnit to do Suth work irom Ihe division. Signature: Date: Division ot Industrial Satary Pertnit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTRY: I certify under penalty of perjury ihat I heve read ihis application end state that ihe information given is wrrect. I agree ro comply with all state laws end ciry ortlinances relating to building consWction, and authorize representatives of ihe Ciry oi Casta Mesa m enter upon ihe above-described property tor insDection purposes. I agree not to occupy or allow occupancy of any building euthonzed by this pertnit until final inspection. i ature Of Legal Owner(s) Date ��./ ��---- �/5,%� s AnNOr Authonzed Applicant � Date � COOE I, INSVECTIONTYPE 1616 Fixetl System Final Fire Preveniion 1266 Pool Spa Final 200 Finel Re-Foof 201 Finel BIocWRetaining Wall 202 Finel Fectory Fire Plece : 203 Finel Sign 204 Final Demoli�ion . ,,, 2406-69 URTE INTRIALS COpE� INSPECTIONTY7E 206 Final MBchanical 208 210 212 220 222 250 Final Plumbing Final Electrical Final Fire Prevention Final Planning lwprovel Final Slie Final Buildiny0aupancy, Q�, INTffIRLS � �i PFOJECTNDOHESS: 3'zOG OREGON .a.V OWNEH'SNAME:FOWLER, RICHARD H JR ' FDDHESS:FOWLER, MARIAN P � 3206 OREGON AVE COSTA MESA,CA 92626 ANCH/ENGINEEF: PUDNESS: _ UNIT: NEG.NO.: UNIT: PEPMITTEE:GRAHAM BROTHERS ('714)546-1653 aooness: 295?. CENTURY COSTA MESA CA 92626 UCENSEO CONTPqCTON OECLABATION: I here6y aifirm �hal I am licensed untler pmvisions ol ChaD�er 9(commencing wilh Seciion 7000) ol Diwsion 9 al �he Business an0 Pmiessions Code. antl my license is in fult loree and ellecL ' crtvuc.:0 59 3 q+sr.a�reuc.�qg6y�,,5./��/� cuss�:C-1,20`1 Oaie'. � 1 `/ Signature:�+ 5L--� � WOBNEBS' COMPENSpTION OECLABATION: I �ereby aflirm I�al I have a ceriifica�e of consenl �o self-insure or a cehihcate of Workers' Compensation insurance, or a ceritlietl co y thereoi Section 3800. Lab C ;aoucrNo.:WC71610302�1601�1 E%P.ORTE:O�IOII9j �:'COMPRNY:LIBERTY MUTUAL ❑ Cetlifietl copy i �ereby lumished. g] Certified rs hle ilh �he ciry Buildmg D� i�on./� Date: ApDlicam��`� ��1./�— E%EMPTION FflOM WONRERS' COMPENSATION OECLAPpTION: (This setlion n¢e0 nat be tompl¢tetl iflhe Dermii is for one hundre0 (SiW) oN¢55�. I cetlify I�ai in the pedormance o� ihe work �ar which this permi� is issuetl. I s�all no� employ any persan in any manner so as lo �ecome sublec� Io Ihe WOBers' Compensalion Laws oi Califomia. Oate: Signaiure: NOTICE: IL a�ter makmg �his tleclaration, you shauld become sublec� ta the Workeri' Compensalion pmvisions oi the Labor Cotle. you must foMwith comply wii� 5uc� D�ovision5 or Ihis Dermi� s�all 6e 0¢emetl revoketl. CONSTPUCTION LENOING NGENCY: I hereby afiirm Ihai there is a cons�mction lending agency for [he pedormance oi the work for which Ihis permii a issued (Section 3097. Civ. C�. LENDEH: ADUXESS: OWNEX BUILOEB OECLANATION: Ihereby a�hrm ��all am exemptimm the CanlracbrY Staie License Law lor�he �ollowing rea5on (Seqion 7031.5 Business ana Professional CODe: Any city of county w�ich reQuires a permi� ta canstmci, aller, improve, demolish, or repair any stmcWre. priar to its issuance. also repuires I�e applicant �or such Dermit �o file a signetl staiement tha� he/she is licenre� pur5uani m �Ae Dmvisions af Ine COmratmrs Slaie License Law (Chapl¢r 9(tommenting wilh Sec�ion 7000) oi Oivision 3 Of ��e Business and Professions Coee� ar ihal he/she is exempt ihere�rom antl �he basis �or the alleged exempiion. Any viola�ion ot Seclion 7031.5 by any aOPI¢ant br a Oermil sublec�s the ap0licant to a civil penal�y o� noi more Ihan five huntlre0 Oollars (E500). I. as owner o� �he pmperly ar my employees with wages as Iheir sole compensation, will tlo the wark. and I�e 7 Slmcture is na� in�enCed or oifere0lor sale (Seclion 70a4, Business an0 Pmlessionat Code'. The ConVactors' Stale License Law does not applY �o an owner ol a pmperty who bui105 or improves �hereon, antl w�o tloes such work himseli/herseli or lhmugh �is or her own employees. pmvitletl thal such impmvements are no� in�entletl or oflered lor sale. Ii. �owever ��e Ouilaing or impmvement is soltl within one year o� comple�ion, �he owner will have �he �urtlen o� pmving helshe did no� build or improve for the purpose o� sale). I, as owner ol ihe pmperty, am exclusively conVacting wi�h licensed conVaciors to constmc� ��e pmlec� (Section 7044, Business ❑ and Pmie55ion5 COde: The ConVattors' S�a�e LitenSe Law tloes no� appty �o an Owner Of OrODehy who �UilOs or impmves �here0n antl w�o Canlratis for Such pmletls wif� a CoNrat�Or�s) litense pUrsUanl lo the Conlraciors' S�ale Litense Law�. I am aware Ihat proo� o� Iheir Worker's Compensatian insurance shoulU be providetl to me. � 1 am eeempl untler Section: 8. 8 P. C. �Of IhiS I¢d50f1: �ate: Owner. I tla hereby ceriily tha� I am aware ol and untlerstana �he requirements ol Califomia Health antl Safery Cotle Sections 25505, 25533, and 25534 and Ihai I or any Iuiure bullding occupanl willlwill not (circle ane) need Io comply wiih saitl s�a�e codes antl Ihe reQulrements �or a permi� lor consimction or modilica�ion iwm �he Air �uali�y Management DisVict. Fesiden�ial canstmction aOPlica�ion5 are exemp� imm Ihese pmvisions. Date: ppp�icant: I hereby cer�ity iha� I have read ihis application and slaie Iha� I�e above in�orma�ion is rorrecL I agree �o comply wi�h all ciry and caunty ortlinances antl sta�elawsrelalinglo Guiltling conslmc�ion an0 her aulhorizerepresenlatives o�this city/�'o�enteruponihe aDove-men�ioned prOpetly lo� In5peclY n purpo5e5. , !/ -- Daie: � � • � Signalur Diiver s License or Social Security a: � � �16<1�46 White—Bmltling; Green—Cotle EnlorcemenC Canary—ApplicanC Pink—Revenue: Goltlenrotl—Assessor � CI'PY OF COSTA MESA — HOILDING PERMIT PERM NO: M 06113R PERMIT NO: M 061138 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: OTH JOB DESCRIPTION ; FORCED AIR UNIT CHANGE OUT SQ F'P: CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 / COMMENTS: CHANGE OUT ONLY. NO OTHER PERMIT RE�UZRED, ******+t**�r��*x�*****��**�*x*�*�**�*****�r****� �a��x+r*��*��rx*�*+�-xx��*x****xx�**** Z O N I N GS EkTEH�AUCIRRSE M E N T S ------------ MAIN BUILDING ------ -- -------- ACCESSORY HUILDZNG --------- FRNT: FT ZN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN ];EFT: FT IN RGHT; FT YN PARKING REQ • PROV; PARCEL: 13909311 ZNE; REF NO; PLANNING N�3I'ES> � k iF iF iF rt iE iE iE 3f -0f if iF �lE if %it k iE �f iE iF if 1E if if� iF lE �lf jE �E-k 3E �lE * iEiE 3ElE if if �)E if i(� iE iE-%iE iE 1E �)t �E iE # iE iE it iE iE iF iE iE if if 3E iE �6 3(� 3Fif� if lk 3f ih �lF 3E �IE IE �7F 3E D E V E L O P M E N T S E R'V I C E S R E Q U I R E M E N T S ZONING APPROVED BY , '"?� DATE; BUILDING APPROVED BY ; � DATE: APPLICATION ISSIIED BY; � ' �� DATE• 2-.2 iEit�EiEitit�itiEiEifiEikil��fEx-iEititiFftiEiEiFiFiF$��3 iFF �F'#iFiFiFinFifiF iF7F fr�FiF�FiFitiEit3ti1�3Eic�iFiEx� 3Ei� lkif3Eif3fiFlEaFiEiEiElkikiEikiE3EiF1kfElEiEk3flf�F�E3E3f�EiF3E3fififififlfifif3EiF3fiFiE %1EjEiE�Eif3EiF3E1Ei(�aE3EiFiEiElE�fiFiFii�iFiEif3EiFibiplf-1EiEjE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMEN'C;N PERMIT BLDG PMT PLUMBING ELECTRIC MECH9Noo FIRE SMIP/RES GRI�DING �15Y SMIP/NON—RES PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTALS----> 9.00 15.00 0.00 REVENUE DIVZSION TOTALS--> COLLECTED; HLDG PMT PLUMBING ELECTRIC MECHANIC 24_00 15,�� TOTAL PAID DUE 24.00 24.00 .00 24,00 OVER/SHORT: ,00 FIRE SMIP/TOT GRADING PLAN—CHECK iE iElE !F k!t if iE 1E'lf % lf If iE if iE it ik 1E 1E iE �lElE iE if iE1E 1E �1F if 3E iE if iE 1E �lE 1t iE-1F iE iF 1E 1E �7E ik if k�7F IE iE # iE if� �lE if iE if iE 1E If iF 1f )E iE iE iE if �lf lE iE lE iE �1(� if'IF 3F iE iF iE I N D Z V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 INST' FORC—AIR/GRAV FURN <= 100 R BTU 9,00 9.00 END OF FEES �• 4.. _,•S. ". i i�'' i� ' • _�� f- `.y ' � � . CONSTRUCTION AND PLANN G- - - \� •� �& SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector t. Temporary Electricat Service or Pole , - 52. .• oi & Equipment LocaUon '; 2. Soil Pipe-Undrgmd. _ ! - . 53. Steel Reinforcement '� •�- " •r . 3. Electrical Conduit Utitity�Undrgmd. 54. Forms , 4. Electrical Conduit-Undrgmd.� � 55. Electrical Bonding ?� 5. Steel Reinforcemenc 5fi. Rough Plumbing & Pressure Tesc . 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Pootin9s . , 58. Etectriral Canduit�Undrgrnd. r �. S. Foundation � • "� 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe�Undrgmd. � - � 60. Backwash Lines, P-Trap, O Undrgrnd. � - 10. Struaural Floor SYstem � � 67. APPROVALTO DECK �t ' 7 i, Property Sewer Lirie & House�Connection � 62. Back�vash & Receptor-Finai � 12. Sewer Cap 63. Heater & Vent-Final � � 13. Roof Drains `,; 6A. Ptumbing System � Final ' � 14. Rough Plumbing 65. Electrical-Pinal � 15. Rough ElectricaLConduit � 66. Solar System-Fina( � 1 76. Rough Elattric Wiring 67. Fencing & Access APProval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING ( 18. Rough Electrical-T Bar Cei7ing 69. POOL/SPA SYSTEMS FINAL I 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMHNT � " � 20. Rough Factory F,ireplace APPROVALS Permit #` � 21. Ducts, in Structure 70. ,Under9round Hydro � 22. Duci,s, Ventifating . � 77. Product Piping OGas ❑pil 23. Gas Pipe�flough & 7est • 72. Underground Rush � i 24. Roof Framing ...73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74, Overhead Hydro 26. T�Bar Ceiiing iStructurap & Monocoat , , 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe " 28. l..athing & Siding � . 'i � � 77. FIXED SYSTEM+ FINA�' 29. Insu�ation � � � 78. FIRE PREV. FINAL 30. Drywall Nailing � '� HEALTH DEPT. REQUIREMENT I 37. Plaster Brown Coat � � ! 79. P�NAL INSPECTION 32. Electrical Power Meter-Final � �,�� 80, FOOD CERTIFICATE ISSUED , 33. Final Electric � � �� •�� Notes: � 34. Finai Heating & Air Conditioning �6�tt� L'�,�jj' , � � 35. Pinal Gas Pipe�Test j ,I � , i � ', � 36. Hood or Canopy ' � `}, :.. - 37. Finai Factory Fireplace � ?� � ' � 38. Final Plumbing ' �'• � � � � � :� ' 39. Water Service-Finat . I � '� 40. Gas Service-Final . � � - 47. Solar pomescicPinal .' � � i - 42. Backflow Prevenier � � 43. Backflow Irrigation 44. Landscape Irrigation System � - - 45. Sound A[tenuation , . 46. Handicap Regulations . . r � 47. �FINAL STRUCTURE & BUILDING i ' � i r 48. FINAL PLANN�NG I,' I 49. Electric Release xo Edison �'"-� - i_ � i 50. Gas Release to SDuthem California Gas Co � i�' �� 51. CERTIPICATE OF OCCUPANCY � • ' No. Date �. "; 1 ��5:� ' COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 9f7 C08TA MEHA. CALIRORNIA For Applicani fo Fill In Complefely TYPE OR PRINT AooRe�ss 3206 Oregon Avenue COSTA MESA CALIFORNIA , OWNER �erst Development Co. ADDRESS 1533 Baker Sti• ' �,,,. Costa Mesa, Cali£. No: KI 911; ARCHITECf Carlson�Middlebro �. Garden Grove� Calif. aR Dike & Colegrove, Inc. 1533 B�er St. . Costa Mesa, Calif. 167293 NEo`: KI 9-1151 7D x 89 � W�w��.,a�r� 86TBACK UNE PROM �1. .� ..� �Z' �I%� ILEFT 1�1 I RIGHT 7� DESCRIPTION OF WORK I x II „r�oer,�N I II a��,r,�., EXTERIOR WALL ROOF COVERING `��CC� COVERING T�OOC� USE OF BUILOING AND WORK TO BE PERFORMED �' �, � b b. �'.r. �,,` , . � �JAN i � �� FINAP!CE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use iiECE1PT NO. BY COSTA MESA. CALIFORNIA FIRE APPROVED ZONING ZO I NO. OF � I UBE OF NQ4S � - f PLANS eUILDING �;��o„�, „ Lot 2, Tr. 3403 ' �", (CENTER LINB BTJ 1 Single £amily residence with attached garage. Plan 21B. 1 HEREBY ACNNOWLEDGE THAT 1 MAVE RP.A� THIB APPLIGTION AND BTATE THAT TXE ABOVE 19 CORRECT AND AGREE TO CON- PLY W�iH ALL CITY ORUINANCE9 ANO BTATE lAW9 REGUTATING BUILDIN6 CONBTpUGT1�0/NJ/� SIGNATURE OF `-'�/" � PERMITTEF / �-/ �i"'-'"' ■ AUTNORIZE� AGENi APPROVED l.. V' dl BY W L- l:� IBBUHD THE AMOUNT 6XOWN UNDER VALIIATION IB FOR TH6 PURPO6E OF EBTABLI9HING A PERMIT F6E ONLY. VALUATION L PERM17 FEE $ 3V�1 S y��1O�• pLpN CHECK $ ��• F tt 4 ' . �-. : � _ 3715 !. ,� PA10 , �, ��,Y : -jl,,, i0-73Ct15,00 653� $.50 Z d U Z Z a O v~i am J � J N Q W ¢] J m J Q U N Z a W � d W J Q m Z J � W W O= Z F W � N � � � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely REC V BV DATE RECEIVED D E SSUE eui�oiNc 3�Olo 62%=GON f�-U� � ��%/C'- ,3 � %Q-7� ADDRESS �/� + q 1 ..PEq T NO. . OWNER/C/G�fF'%ZD FOL!%�G�.`'C A.P.NO.I��OI�``� .2 IV I � MAIL ' BUILDING / ADOREqSS �"��v� ADDRE55 �O(p O�F�O�� I�E C_pS'%�- ��,5'/� NpL'J9S-�/8 ' TRACT� r�� LOT � BLOCK CITV CANSTRUCiION W ADD A R P LENDER �� BflANCH � � ' OWNER C G'Y ADDRESS �� .�� _.�/' VALV$ SOQO� ARCHITECT � TEL. SE Cil/Y OR ENGINEEfi N � FIRE .ADDFESS 20NE T PE GROU CONTPACTOR LJW � Vj�p��Z APPROVED �/0�7 8V DAT L ! ADDRESS TEL. Z�Ny`�rj NO.OF'J USE OF NEW O^PEN CITY NO. I_ `. P�`� �� BUILDING%i D C'� STATE CITV �'ARDSAPPROVED VARDSAPPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING SI2E � / NO.OF BLDGS. (FROM C/L STFEET) ��;� Of lOT 7O X� � O NOW ON LOT � RONT FT. T(/ FT. USE OF / EXISTINGBLDG. �J�ML SNG�(F Fi1Mi.�}' F. 2'S!FT. SIZE OF NO. OF NEW BLDG. ROOMS STORIES L.SIDE FT. D� FT. EXTERIOR WALL ROOF u COVERING COVERING REAR FT. I T� FT. VS OF BUILDING AND WOFK TO BE PERFORMED OISTANCE BET. BET. MAIN & �/f T•t� s?t2�F N� l.�.9-L .0 MAIN BLDGS. ACCESS. BLDGS. CO� FI�%Z�(pNY� �j�ISI��CY VAR.� DATE C.U.P.� APPROVED Fl.00,t� l,�i T-c�o7i�UG� S,z,F/Q�x�4� �Ra�Eol'ctJj�, �-/0-73 I hereby acknowledge that I have reatl this applicaiion and state `SrATE that the above information is correct and agree to comply wiffi all laws regulating building consvuction, antl I shall not employ � any person in violation o1 ffie workman's compensstion laws of the�State ot California. � I hereby certify that I am properly licenzetl as a coniractor untler � O SQ. FT. ' T'� the State ot Calitomia 8usiness antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF Chapter 9, antl that such licenses are In f�ll force and ettect, or I THE PURPOSE OF ESTABLISHING H PERMIT FEE OrvLv: am ezempt irom ttie provisions ot ffie 5[ata ot Califomi Business VALUATION � O antl Professions Cncie, Di is' n 3, Chapter 9. $ �— PERMIT FEE Si0^ature ot � � — Permittee $ � QQ . PLAN CHECK $ - Auffiorizetl Agent � �•—� TOTAL'FEE $