HomeMy WebLinkAbout913 HELENA CIR - Building Permits�
�
� CITY OF C►OSTA MEScA
�SiNMFs9 BV1L�INV �/VI�7��N
F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714(754-527H • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
����o� FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC11-00034
PERMIT TYPE: B COMBO STATUS; ISSUED
Sub Type: POOLSPA DATE ISSUED; 0112612011
ISSUED BY: KJB
�os ao�ReS3: 943-HEL-ENA:CI_C �
APN: 41809202 Zoning: , ,
Vicinity:
Const Type:
SQ. FT: 0
Suite/Unit;
Primary Occ; .
Valuation: $30,000.00
SCOPE OF WORK: INGROUND 312 SF GUNITE POOL AND SPA. 400K BTU'HEATER, PLUMBING AND ELECTRICAL WORK. 1
ADD'L GAS OUTLET FOR BBQ. STANDARD PLAN # SW 100127
OWNER: B�CKMAN,STEVE
Phone:
APPLICANT: SCHWARZJIM
Phone: 714•241 •POOL
CONTRACTOR: SCHWARZ CUSTOM POOL
Phone: 714-241-POOL .
Cell:
ARCHITECT:
ENGINEER:
COMBINATION pERM1T FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund -
TOTAL FEES:
"Retef b fee receiMc fn. �II fonc mid inr nrnia[t
Address: 913 HELENA CIR
City/State/Zip: COSTA MESA, CA
Address: PO BOX 28437
City/State/zZip: SANTA ANA, CA
License No. 770413
Address: PO BOX 28437Unit:
City/State: SANTA ANA, CA
License No.
License No.
$287.46
$442.25
$73.00
$41.50
$114.50
$3.00
$0.00
$2.00
$963.71
Unit:
UniF. :
ZipCode 92799
PHONE:
PHONE:
MOURS FOR GONSTRUCTION ACTIVITY: EFFECTIVE 3/1812010 - PER CMMC Sec. 13-279
Monday thru Friday •7:00 am th�u 7:0o pm. Saturdays-9:00 am thru 6:00 pm. Prohibi[ed all hours - Sundays and the following Fedefal holidays:
New Years Day, Memorial DaY. Independence Day, Labor Day, Thankspivinp Dav and Christmas Dav
NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements under Califomia 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 aulhorized 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 fnal approval will result in the expiration of this permit.
,CODE X. INSPEGiION TViE
�1676 Fized SysfEm Finaf Fire Prevention
�1266 Pool Spa Final
200 Final Re-Rpof
'201 Final BlociciRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demoli�ion
pATE INTIilALS
V 7i�.Z�i"�� I,�p�__W/�
�_'<--
COOEp INSPECTIONTVPE
ZO6 FinalMechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Plannin9 Approval
222 FinalSite
250 Final Building/Occupancy
�RTE INTITIpLS
�
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty o( perjury one of the following declarations:
❑ I have antl will mainlain a certifcate of consent to self-Insure for workers'
compensation, as provided tor by section 3700 of the Labor Code, for Ihe
performance o( the vrork for which this permit is issuetl. t
❑ I have and will maintain wvrkers' compensation insurance, as required�by
5eclan 3700 ot the Labor Cotle, for the peAortnance of the work for which Ihis
permit is issuetl. My workers' compensation Insurance carrier antl policy
number are:
Carrier.
(inis seqpn neMnot be cwndeteC �the peim� rs valve0 af one nunered �Ilars (510�) a less.)
Policy Number:
�I certify that in the per(ormance 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 vrorkers' wmpensation laws of Cali(omia, and agree that if I should
become su6ject to the workers' compensation pmvisions of Section 3700 of
the Labor Coae, I sh I(orthwith compty a'th these provisions.
1 l � � �.
A ionl' SignaWre • �ate
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLP,RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed undei provisions ot Chap[er 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eftect.
Lic. # 1 `�_ Class # C-S�
. � � uQ�
Com ctw SignaWre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that Ihere is a construction lentling agency fw the
peAortnance o1 Ihe work (a wfiich Ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty ot perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 703L5,
Business and Pmfessions Cotle: Any city or county whith requires a permit to
construtt, alter, improve, demolish, or repair any slrucNre, prior to i[5
issuance, also requires Ihe applicanl (or such permit to file a signed statement
that he or she is licensed pursuant to [he provisions o( the Contractors
License Law (Chap[er 9(wmmencing with Section 7000) of Division 3 of the
Business and Professions Code) Or Iha� he or she is exempt therefrom antl
the basis for the alleged eaemption. Any violation of Section 7031.5 by any
applicant for a pertnil subjects Ihe applicanl to a civil penalry of not more than
fYe huntlred dollars ($500�.):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
o((ered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply lo an owner of property who builds or improves
thereon, and who does such vrork himself or herself or lhrough his or her own
employees, provided lhat such improvemeNs are nol intended or oftered for
sale. I(, 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 ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to wnswct the project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply ro an owner of
property who builds or improves Ihereon, antl who cont2ct5 for such project with
a contractor(s) license pursuant to the Contractas License Laws.�.
❑ I am exempt under sec.
Business and Professions Code for lhis reason:
Signalure Da�e
JOS]<6 �3I01)
Owner ID verifietl by tlrive icense. ❑ Yes ❑ No
Driver's License No. Expires:
Verifwtion of Ownership by (type of document, i.e. - property taz bill or tleed�:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certdy that no excavation frve (5) or more teet in deplh into wfiich a
person is required to descentl, will be made in connec�ion with v,ork authonzed
by [his pertnit, and Ihat no building sWcture, scaf(dding, falsework. or demolition
or dismantlinq mereof, will be more than thirty-siz (36) teet high. (Chap. 32, Grp
2, Art 2, Sea 341, Ttle B, Califomia Administ2tive Code).
❑ As owner-builder, I vrill not employ anyone Io do work which would
require a permit from the Division o� lntlustrial Safe[y, as noted above, unless
such person has a permit to tlo such vrork from Ihe division.
ApplicanCs Signalure
Division o( IndusMal 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? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions. that a Business Plan be filetl vnth lhe Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantiry of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at standard temperature antl pressure).
2. Does or will the applicani or present or (uWre 6uilding occupant need 10 (le
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safery Code, vrith some
exceptions, requires registration wim the Costa Mesa Fire Department hy
each business which at any one time has on hand a quantity o( acutely
hazardous materials equal to or greater than a vreight of 500 pounds, or a
volume ot 55 gallons, or 200 cubic teet of compressetl gas a1 standard
temperature and pressure).
3. Does or will the applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acWely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Cotle pmvides that the
Costa Mesa Fire Department may require the preparation, certifcation and
filing wi[h the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with [he Fire Depariment.
4. If an RMPP is presen[ly required, has Section 25534 of Ihe California
Health and Safety Cotle been fully complietl with? ❑ Yes ❑ No
5. Does or wiu me applicant or present or tuNre building occupant require (or
the work which is the subject of [his application a permil for such conslruction
or modification from [he South COast Air Quality Management DisMct or from
any other air pollution control distnct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that ihe requested
information be (umi5hetl on appliwtions (a non-resitlential builtling permits).
6. Will any part of the facility to be constmcted under Ihis permit be within
1000 feet fiom the outer boundaries of a school? ❑ Yes ❑ No
(If yes", the faciliry must meet [he requiremen[ of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. I( a permi[ (rom the South Coas[ Air Quality Management Districl or other
air polNtion control district or agency is required tor the work which is the
subject of this application, have all of the tlisclosures prescnbed by Cali�omia
Heallh and Safely Code Section 42303 been matle? ❑ Yes ❑ No
8. (If'yes", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPUANCE: I certify that under penalty o( perjury the
information given above is corzect. I agiee to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi�y under penalty of perjury that I have read this application and state that
the information given is correcl I aqree to comply vrith all siate laws and ciry
ortlinances relating to builtling consWction, and authorize representatives of
the City o( Costa Mesa to enter upon ihe ahove-described property (or
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by Ihis permit until final inspection.
Signalure ot L Owner�s) �a�e
_�, i 24 � I f
� An � Pul orrzetl A0�6�dn1 � ` Ddte
(7/4) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job nddress: 913 HELENA CI
Suite:
Vicinity: ROOF
Parcel Number: 41809202
Applicant JOHNSON, SCOTT
Address: 13672 ONKAYA
IRVINE, CA
Owner: BECKMAN, STEVE
Address 913 HELENq CIR
COSTA MESA, CA
Convacmr: POPA ROOFING INC.
Address: 13572 ONKAYA
IRVINE, CA
Zip: 92720
Arch :
Address:
Phone:
Zoning:
Phone: (714)776-6294
Zip: 92720
Phone:
Zip: 92626
Phone: (714)778-6294
License: 675902
Eng:
Address:
Status: ISSUED
Applied: 08/14/2002
Issued: 08/14/2002
. • i�j
Phone:
Zip: License: License:
� SCOPE OF PERMIT
TEAR OFF EXISTING RqOF. ADD 1/2" SHEATHING, 30# FELT, 30 YR, ELK COMPOSITION SHINGLES. 1500 S.F.
INCLUDES ATTACHED GAR,4GE. �
Plan Check: $0.00
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existin : p
NOTES:
Rear 0-0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
left 0- o
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right . 0- 0
$3,000.00
$3,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1B0 days, or if work is suspended or abandoned
for a period of 1B0 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 inspeetlona and final approVal must be obtainetl. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754�5626
zaases �aroo�
WORKERS'COMPENSAnON DECLARAnON: �' � �
I hereby ettirm under penalry of Derjury one of the following declaretions:
❑ I have and wlll maintein a cenificate ot consent to self-Insure for workers' compansation, es provitled for by section 3700 ot the LaDor Cotle, for ihe pertormence of the
� rk for which this Dertni� IS issuetl.
�il'heve anC will maintaln workers' compensation insurance, as reduired by section 3700 of Ne Lebw Cotle, for the pertortnance ot ihe work tor which t�is pertnit is issuetl.
My wo�rk+errs' compensatlon Insuran�ce�cfa�rder antl policy number are: �7/�� � Q y�
Carrier.—c� i�� 7����V !/ Poh'� umber. �
(This�secNon need nof be tnmp eted i/ Ne permit /s ve/uetl af one hundred tlallars ($100) or less.)
❑ I certity that in Ihe pertortnance oi the work lor which ihis pertnit is issued, I shall not employ eny person in eny mflnner so es to become subject to t�a workers'
compensetion lewa oi Californle end aqree lhat ii I should becoma sub�ect to the workers' compensation provisions ot Seciion 700 of the Wbor Coda, I shall forthwith
comply with these provisions � C�/a�
�icen`t Signature: � Date: � �
WAqNING FAILURE TO SECURE WORKER OOMPENSATON GUVEMGE IS UNIAWFUL PND SHPLL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES r1ND CIVI� FlNES UP TO qJE MUNDRED
TiK)USPND DOLfARE (5100,000), IN ADDfTION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECiION �W OF THE IABOR CODE, INrEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
of Chapter 9(commencing with Section 7000) of Division 3 of�lhe:8usjiess and Protessions Cotle, and my license is In full
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirm Ihet Ihere is e consWction lending egency for ihe peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lenders Name: Lenders Atltlress:
Signature:
Date:
OWNER•BUILDER DECLARATIONS:
I hereby aHirtn that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professlons
Cotla: Any ciry or wunry which requires a permit to construct, alter, improve, tlemolish, or repair any sWcture, pnor to its issuance, elso requires Ihe applicant for such permit
to file e signed stetement Ihat he or she Is Iicensed pursuant to the O�ovisions ot the Contrecmrs License Lew (Ghapter 9(commendng with Section 7000) of DlWsion 3 of ihe
Business end Professions Cotle) or that he or she is ezempt theretrom and the basis for ihe allegetl exemption. Any violation of Section 7037.5 by eny epplicant tor e pertnit
sub�ects the epplicent to a civil penalry ot not more than five hundred tlollars ($500).):
❑ I, as owner of t�e property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the sWCWre Is not intentletl or ottered for sale (Sec.
7044, Business and Professions Code: The CoNrectors License Law tloes not apply �o an owner of pmperty who builds or impwves Ihereon, and w�o dces such work
himself or herself or through hls or her own employees, providetl ihat such improvemenis ere not Intended or offered for sale. If, however, the builtlinp or Improvement is
sold within one year of comD�etion, the owner-builder will have Ihe 6urden oi proving ihat he or she did not build or improve for Ourpose of sale.).
❑ I, as owner oi the property, em EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to con5lrutt ihe project (Sec. 7044, Business entl Profes51on5
Code: The conirectors Llcense Law does not apply to en owner of property who builds or improves thereon, end who comracts tor such project wiih e comractor(s)
license pursuant to the Contractors License Laws.).
❑ I em e:empt untler sec.
SiqnaWre:
Owner ID veritied by tlrivefs license. ❑ Ves ❑ No
Business and Professions Code for this reason:
Vedilcetion ot Ownership by (type ot tlocument, i.e. - pmperry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Drivefs License No.
Da�e:
Expires:
❑ I hereby certify that no excavetion flve (5) or more teet in depth into which a person is required to descend, will be mede in wnnection with work authonzed by this
permit, and that no building siruMure, scattolding, talsework, or tlemolition or dismaniling thereoi, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Ttle 8, Celifomia AOministrative Code).
❑ As owneabuilder, I will not employ anyone to do work which would requlre e permit from t�e Division of Industnal Safery, as noted ebove, unless such person hes e
pertnit lo do such work Irom the tlivision.
Signature: Date:
Division of Industrial Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMRY: I certify under penalry of perjury that I have read ihis application and state tha� the information given is
correct. I egree to comply wilh ell state laws and ciry ortlinances relating to building consWctlon, end euthonze representatives oi the Ciry of Coste Mesa to enter upon the
ebove-descnbed pmperty tor inspection purposes. I agree not to occupy or allow occupency of any building authorized by this permit until final inspection.
CODE 1. INSPECTIONTYVE
1618 Flxetl System Final Fire Preventian
1268 Pool Spa Final
200 Final Re-Roo1
201 Final Blak/Retaining Well
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
�. 1 IJIIIL\F
/ � �
CO�EI INSVECTONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning ADProval
222 Final Site
250 Final Builtling/Occupflncy
��i `��L
(;Date �
�g ��
,
January 28, 2003
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CAIIFORNIA 92628-1200
DEVELOPMENTSERVICESDEPARTMENT
Steve Beckman
913 Helena Cir.
Costa Mesa, CA 92626
BUILDING DIVISION
NOTICE OF PERMIT EXPIRATION
PERMIT NUMBER (S): B02-01270
FOR: Re-roof
PROJECT ADDRESS: 913 Helena Cir., Costa Mesa
Our records indicate the above listed permit(s) were obtained for property improvements
or alterations at the above address. Per the 1997 Uniform Buiiding Code, Section
106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the
date of your last inspection for the project and additional fees may be required to finalize
expired permits.
According to our records, the permit(s) listed above have not had an inspection for a
period exceeding 180 days. If you have a signed inspection card indicating an
inspection was conducted within 180 days from the date of this letter, please contact this
office so we may correct our records.
A time extension may be granted if you intend to commence work and complete the
project. Requests must be made in writing addressed to Ed Petros, Chief of Inspection,
at the above address, detailing circumstances and listing an estimated date of
completion. If you need to request an inspection please call our Inspection Request Line
at 714.754.5626. If you do not contact this office within 10 days, your permits will expire
on February 12, 2003.
If you have any questions, please contact the Building Division at 714-754-5273,
between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The
accuracy of records affecting your property is our goal and we appreciate your working
with us to resolve this matter.
Sincerely,
���/
U
Mary Jane Weidenkeller
Office Specialist II
cc: Popa Roofing Inc.
13672 Onkaya
Irvine, CA 92720
BuilEing Division (774) 754-5273 • Cotle Enforcement (714) 754-5623 • Plenning DNision (714) 754-5245
FAX (71d) 754�d856 • TDO (714) 754-5244 • www.G.rnste-mesa.w.us
Property Profile Page 1 of 1
`
Property Profile
� 2003 DataQuick Inlormalion Systems
This informalion is compilcd fmm public Aocumcnts and is m� guaranteed.
Properry Clearacteristics
Dedrooms: 3
[3athrooms: 2.0
Total Rooms: 7
Zoning:
Heating/Cooling:
Sale & Loan Information
"Cransfer Date: 10-18-1995
Transfer Value: $215,000
First Loan Amt $171,000
Loan Type:
Primary Owner: BECKMAN,STEVE
Secondary Owner:
Nlail Address: 913 HELENA CIR
COSTA MESA, CA 92626
Site Address: 913 HELENA CIR
COSTA MESA, CA 92626
'Celephone Number:
APN: 418-092-02
Reference APN:
Census Tract: 639.031
Housing Tract Number: 9383
Lot Number: 6
Page Grid Old: 27-F3
Page Crid New: 859-05
Legal Description: N TR 9383 LOT 6
Subdivision:
Year Built 1976 Square Feet: 1,660
Garage: Lot Size: 6,004 sq ft/ 0. l4 acres
Fireplace: Number of Units: 1
Poo]/View: Use Code: Single Family Residence
Seller. Document: 00004624G6
__._ _. _....._. __ .
CosdSq Feet $129.52 Titic Co.: Southland Tifle
Lendec Bayview M[g
Interest Rate Type: F
Assessed & Trc� Information
Assessed Value: $213,660
Land Value: $111,595
Improvement Value: $102,065
Percent Improvement: 47.77
Tax Amount: $2,432
Tax Status: wrrent
Last Trans W/O$: �
Last Trans W/O$ Doc:
Homeow�er Exemptioo:
Tax Rate Area: 15013
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ApPliqnt to }ill In all spaess exeept tl; wlthin heavY borGer Iines anE si9n all approoriate Geclantions.
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� ' 20N� GRADING CU.VDS. 'ACRFe ' ' PKG.SPACE�REQ. " � � PROVIDED , ' � -
Li nx No. - ' � �
LI NSED CONTRAGTOR DEC �ON ' pemarks: ' � ` ' , � ' � , �STREET WIDTH ' � t � . 'PqRK FEE S ' ' �
I'hereb . censetl untler Provlslons of C� -
wlt� de<tlon 7000) of Dlvizlo�f the BuSiness fq(ysslons Cotl antl ' t - - � ; . � � SVECIAL CONOITIONS: � � ' ' 4 �-� �� �
my IICen58 IS in full f0lca antl ef f.d - '
17cense CI � �� � ' nu No. - ' PLUMBING ' � � . � � � - � y �
Date � - SlgnaWre � " ��� . '
� WORKENS'COMPENSATIONDECLARATION . - � Be�Sil�k � � SewelCep ' • ELECTRICAL �
heroby atilrin Mat 1 �ave a CBrHflwte oi �on5ent to� If-Insure or a certlfiCate � - - . i � Automatic Washer. . _ ' � Me[er Qover 10� amps ,. '.. �. �
�f Workers' compensation Insurance, or a certifia coo�Y/ thereoi (Sectlon B�kflouv Preventer - , Sevuer Cqnnection .
3800, Lab. C.) c, /� -� � -- �- , - ConstructionPole . �SubPanel .
� � �// � Backflow Irrigation � Solar Collectors � . . ?
Policy No. ���/�// ComDan `�'"�-�� ' - � � � � " - Cooking Unit � � 1 Sub Pole : " '
❑-Ce�t7fleA Copy IStlareby turnlsheG. / B3thtU65 � ' , $Olef Piping � ' i .
❑�Eerilf� g�y Is fI1e0 with the <ity Bu��tling izb� �� . � Dishwasher . MotOrs �O•7 HP ❑1 h$ `
. Data ' � �% AOP��cant � ��- ' Clarifiers � . � Sotar Tank .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � / Drye�s ❑Gas ❑Electric .. ?IncSOlar 0945 HP �i6'15+
(Thissection.neetl not be comD�etetl if th6 Permit is for one huntlratl (5700) or ` Dishwashe� Swimming Po01 w/Spa -
iess) : � ; ! '� , , , . Fan � � -Microwave � � '
. I certlfy that In the pertormance ot the Work for which [his Derm�t is ISsueC I Dfinking Fountains U�in21 � .
ihall not amploy any person In any ma�nar so,as ta become su0�ect to tf�e - - - - , F.A.U. . � � � ,Po�e'Light - � �
� Workers' Comoensatlon Laws oi California. . Floor Drains. � Water Clout'
Date � �ignature ' ' ,' ' . Fiatu�¢5 � ' ..i_
NOTICE: If,'aftef makln9 thls Aeclaratloq: You'snouldbetome subject to the : FIoaI Slnks �- - Wat2f Heeter � �- - -- Renge. .. . _. .
Workers' Compensation provislons.of tne Labor COUe, you muit forthwith ' ' � � � �
comply �wiih' such ,provisions or this,'Dermit shall be �Aeemetl revoketl.. � , � � Device Box25 � Si n ' �
. Gas Service� Outlets . Water Service , 9
CONSTRUCTION'IENDING AGENCV ' f � Outlets ' � �
I hareby attirm that there I5 a�,ton5tructioP IenCin9 agen<y�for the�parformance� � , Interceptors �� . � ' . � Standing Sections - ... �
of the �work tar . which.. SNi� pe�mtt -is issuetl :(Sectlon 30B� qv: C:) �� . -
Lenaer•s. Nzma-- � � - Kitchen Sink� � . . � � - Switches ' ' Trash Compactor i
' LenGer's AOtlress � � `� � f ' � . ' _ -- Gartia9eDisposal � � � �
OWNER BUILDER OECLARATION' L9�2tOri25'�. : . ' .
I heraby'affirm'Shat I am axemptffrom thaiContractor's LI<ense Law forthe • p_T a � Gen¢r0t0� �0-5 KW �545KW f � �
tollowing reason>(Sectlon']031�.5 BusineSs antl ProfeSsional;Cotle: Any Nty or' P � -� "" �.� -
: county wNch requires a permit to conz[ruct, alter Improve, tlemolish�or. repair ' _ - � . T�ansfo�m¢r ' �
�'any structure, prlor to its�issuance,'also Yequires t�e appllcanEtor such permit � Roof Drains. � , � .� n � ' ' � ❑15-50 KW • . � ) . .
to file a signetl statement [hat he/she is Ilcensetl pursuant to the�provisions of - - �- ' '_ '' � � ❑5U+ KW � . 'Rein Mion Fee
,Contractor's�Licensa Law�(Chapter,9 lmmmencing with Section ]000) of - � - , � , $15' ; ,
lon 3�rof tne Business� antl Protessi0�5 Cotla)- or that he/she' is axempt � E ShOWe�s .. - �� . Reinspection Fea � $15 '
�(rom antl the ba5ii !or the�allegeC �xempUon. Any violation'of�5ection . �� . , ' ' Meter ❑up to 100�ampi ' ��yqua.Fee' ' ! ' $ �3 I �
.r} ki:5 Ey;any apPlicant Tor^a-permit=subJects.the apD����t to a civll ' ' - . I ._ � � ' ' _. _ . ._ - .
fZKalt ai not more than iive nuntlretl tlo�lars $500 %< I Service Smk v : Issue Pee %' � 3 i 1 ,
�- Y ( ): I � 1 . Zonin9 MPravad By Date �
Ll 1`�as Iowner of� the �property or my empioyaes with wages as their sole :. '
; compensation wlll tlo the work, antl t�e:structure� is not Intentlatl ar offeretl . � �� � MECHANICAC � . � ' ' � ,- , ' �
tor sale Secfion 7044; Business!.antl;Profe55ional Cotle:'The'Contrattor's ApplicationApprovedBy � ate ,
' Licenze Law tloes not apply to an owner of a property who builtls or Improves �, gOileC ; , REfrigE�atiOn System , , ' � { � �� � � n ��� �
thereon, dnG who tloes suth'wb�k hiro581f/h¢rSBlf o� th�oU9h hi5 or he� own � � `< •� � APpliCdtl00ISSUBd By � etB �
1�employees, proviaed that such improvements are;not Intentletl or offeretl tor , �^ ❑0-100;OOOBTU ❑100,OOOBTU �
; ule. If, however, t�e builtling or improvement Is solG witnin one'year of com- Dutt ='Under.Ground- , . � i. : ' : ' f ' SUMMARV OF FEES i � �
. pletion, the owner'wlll have [he burtlen pi proving he/she tlitl not builtl or Im- � . .- . . ' . I � �� j � .
-�rovalorthepurposaoT�sale). �. � '. ; , I � : Duct-Struttural SystemRepair/Alteratiori � jBUILDINGPERMIT $ ' SMIP � ' � $'
� LJ I, as owner of the property, am ex<IUslvely contra2ting�!with,,licensetl com ! , . - � i � �
; tractorsSo construct the�project (Saction 7064, Business antl,Professions.Cotle: ., � Duct - VenUlatin9,,,.��_ _,. I ....� __ _ .t _ _�_..__I.,.. ; � PLAN CHECK� ' $t • � ' PERMIT � i • .
� The Contractor's L'icensa Law does not apply to an owner ot property who � ' . . � ' ; � �
- builtls or improves thereon, antl who coPTracts for such'projects with a con- ! �� E%haurt Syst2m ❑ MWtipIE ❑ ' ' � , �PLUMBING $ i ��. � ISSUANCE ' �. $'
� tractor(s) Ilcense'pursuant to the Contractor's License Law). . � � - �- � � : � I � � � '
' 0 I,am exempt untlar Se<tion ` B. & P, C.:for th(s reason � i Firepl/Fatt.81t. ICBO # � ' , i PLAN CHECK'_ F $ ' 1 GRAO�NG , ,. $` �
. . • . . . . � � �ELECTHICAL $ ' a ' ' $ l . � f
' Date � • � � Owner � ' � ' - � • Heating System & Ducting • • `y j j� � � ' MICflOFILM '� $
I-hereEy �eertify�that�l�hare reaA this•aPol�catlon antl�ztate that the above-,-- ' ❑a100,000-BTU �100,OOOBT — � �� - PLAN CHECK; ' $� � - . , � �
� information is corre<t. I agree to comply with all Uty antl county ortllnances � i . ' � % ! ' � ' � TOTALiFEE� ;$
antl•ita[e laws ralat to butltlin conSVucbon,�antl hereby authorize re re- � , 'MECHANICAL $ � � , �
.sentativei of'Mis Ut t 'ter9u on the aboue-mentlonetl pro ert for � � Hoodor � � . ,
{ �
p Y Type I ❑ � peinspeMion Fee � 515 p�qN CHECK�. $ � qDVANCED PC �$� �
In50ectlon ourpo5es: Y� p + • � CenO � .T e II ❑' . . • � .
1 Si9riature . l _ D� ��' � , • � 1 i . . . � . , � � a
'. Registers . Issue Pee . S 3
� Orivers' License or 55 I � ti � '� FINAL FEE � �$�� 6 v� ,
, . . . . � , i . .
' ' ' _
CMF 0865-46 rev, 12/82 White - Bulltlin9: r- Appllca nk - Accountin9: Goltlenrotl - Assessor � _"
, . .. .__. r_. ` -'._.^ ' :� t- P00� PA >°}r -''-:r 'L t.�; - •=
�? �CONSTFIUCTION�AND:PGANNING � •• � C� �.�=; �c.> _r? ;` 1 e: . - �� . ', c: !. � � i
r- O � � ' r s � � � r_ , `Date'� � �Inspector ;.ApPROVALS� 'Beimir# � Data Inspector� � �•
. �'APPROVALS ,,, Permit'#= � - - r
..fV1= �v �NY�:C �10 i�i -o. . so... ?
r' ��1: � empor`FaryrElectrical Sk rvice or�Pole" N ''' � _ o ; � . 52� "Pool & Equipmenf Location • _ - - � � r F _ � `� � o. � � y
� - -
�
h :� Soil PiPe-Undrgmd` - i F {�;. . .� c; j - � o `r �_ ' - i ��53 'Steel.Reinforcement ` ` ; `-= �r � ' ` � � `�
� �3! Elect�ical Conduit Utilitv UnAigrnd t � s; : - - �, ` 0 54 � Form4 � � o '' ' t ' ' ' `, , � ` � - ''` ' �
L m i.... i• � i. J x o� �- ' c� i a. �-
^�� A' Electrical Conduit=Undr �nd� � � � i "' ` - ' ' � ' ' o `' � � 55�� Electrical Bondin � " , ? -a=- � � � � - , � :`• s
��:ri a i � � �9 C, � ... - ;�- 9� ' - _<
♦ A I , ^ 1 1 CLr � J 1: : � ��,7.�•s ^-� ` S.. . ... ' t •' � ' r,C� I�% _ . 1 C
5:�Steel�Relnforcement��� _ ��i9L�^;'�, � �_ - � ;,o � _ � �56.� RougFiPlumbing:&�Pressure'Test:� _
6: �E�ect�ical UFER Grnd. � ` _ � r � �; ^ � 4 - ' �� : ,57"' APP,ROVAL TO;COVER-GUNITE� � ¢ " � ?
� ,
` ri:
7. Fontings ' I ( � I • '�� ? ` �,' a' ` ;'� 3 � ' .:58� Electrical Conduit'Undrom�l. - ` ': � ' '�� •.� .
I 1 ! .�'Ii L^ �._
8,: Foundation _ �' � � j �' � _ � : ; � " �_ �59. Gas�Pipe :❑ Undrgr`nd Test�� ' ' � � _ � �•'; � t
i -i -
9. 1Nater PipeiUndrgrnd. y��._ ' � �N �'60. Backwash Lines,�P.-Trap,�O Undrgrnd ' ^ ' � - � �:
' 70. Structural Flo`or System ? ��::�' o � ! ;; ' � 3,' r61. APPROVAL'TO�DECK '� �- � ; ' ,y��-. -�
it. Pro ert� Sewer Line"&�House�Conriection. - .' 'r � '" � � � --.� � � ^ . ` °� �
� P � Y � � _ c . � . i � 62. Backwash & Receptor Final. _ : �j � "
12. Sewei Cap � � ' �� � ; � c ��,'. i . . � [= ' F ` ,'63. Heater & Vent Finil _ . _ � _ � ���� ' � '
13. Roof�Drains � .� .; ��`�,�;; ; •c .;� i '64. Plumbjng�SYstem,-F.inal= � �: '�a P � �� � �
' �; ' '
- n.�- � � I .�
�, 14. Rough Plumbing � � � � _i: �:: �';'•�r �� �`- . � - � � 65. Electrical-Finel'' - � - •� � ` � • •
�
_ ^15":'Rougfi'Electrical=Conduir'�"'-.� �"'{ �r""'--� -r`f ,- -66TSolai�Sysiem-Final"i --�''" "-`�-`� ��"T- � '+ '-" -
i a. m '
. ' !;16. Rough; Electric Wir.in9: ,, 1 r � � {,>�" i 1 � I `."rF �-.':= `. - -'67.; Fencin�&�Aceess;A� ro'val; -:"� �. �' :.��""` �
o q`s �'. I.�� � ..r � n I t i: o � r :e �- 9 PP � � - � � � s
� �,17. �Rough WirPng Sign� � � i ^ � �� : � , � � : i � i � � 68 { APPROVED FOR°PLASTERING 1 �
^1 P � n c - 1 i� f . i � . . ' ` � � � - � . . . . , - . � .o � t, 1 � � •
. ry q 18. 1Rough ElectricaLT,Ba�, Ceiling� }. � � _ i :) �', t I ,69.' POOUSPA SVSTEMS FINAL , ' ` > � �-
� � 19. �R�ugho eating & Air�Conditioning }� ' ' j � � i i ��f • i :FIRE DEPT.�REQUIREMENT� ' �' + ' � � _ .r�
� �� � � � � . , . , . _ '.
�� 20. �RougFgFacto'ry", Firepiace� � � II �j ( ' � � � ' - � , i ' ' c' %r � . '
;, �f � .: n� i r. • : .� � _. > � � � � I ' , APPROVALSI i Peimit # 1 I .
21. D'ucts,:in Stiucture . i �- � � ' � � � ' ' -
'- �� _H � i , �. � u � � � � ;� � 1 i ,.� ' ;70.• Unde{ground HYdro �� � � � � .
�!22: �Ducts, Ventilating ^' i n � ( �' �' � I i � �� � 71.� Product Piping O Gas ❑ Oil , ' � , '
� ^P23. �GAs Pipe-Rough & Test ? � ! ��� ;� j j � { �` � �� j2 � Undeiground Flush � ' ' � � . �
. , ; :_ Y � � ' � ;VI�- � y �� � t � t i � ; . '.:. i { .
d�=24.�RobfFram�g. t , ;') � �;,���,�,�^? i<3 ' �Z3.�Undergmd.StorageTankO�Gas❑,Oill � . �
' � � �. r � �, ' �: 1 i � S ; � I � . � ° - t ' ' ' ' ' ! - "'.1 1 � ! '
� R 25. Roof Sheathing 74.� Overhead H dro -4 �� .
nn _.q r:. i �.. � r 1 � A��.,.1 fr' ��..i� Y � �
� �i � o:, � � i . - p '� . I , ' ' � '. � � � o - � : � , - � � �. . I
: �-26. tT_Bar Ceiling (Structurap'. & MonocoaY� ��, � � A„ ';- i , q t' Z5.� Dr�y Chemical _. i
r � i r. -�i . �
w r�27. `Frameand Flashing j I � � �i ' .; .' . � . � - ' . � { � ' ..' - � � � � �
- n i c � � 1 � �� ' �� �� 1� I i �� � I i i76.� Dry StandPiPe r: P r.. � t �' '
? � 28.. �Lathing & Siding' � � � � � i� ii � ' i � Y � ; � i77.f F.IXED SYSTEM�F�INAL ^� _ - ,. � � �
,� ��9�Insulation � S � q " R i " I I: � i+ I ! { �I ' i � i 78.� FIRE PREV. FINAL ' . " � � j j ' ; �
-� g�30. Drywall,Nailin`g �^ i"� � 'i 1� 1 I 1 1 �� � � INotes:� � � � i � , ri J � � j:
6_.�� . � � _ -: , , .
7 � - --�-
_. _---
°o !r31.'�Plaster �Brown Coet I � � � I �� b � f I - I i � � , i 1 1 � � ' - -, �- � - � F � - �
`� �� � � � . � i . , � � I ,f � � , � ' ' � � � ; , j ( � . � i I . . {
�
,� ti�32.�ElectricalPowerMeter';Final � � �- � ( � j i , � � I � I �� ; �
; & 33: YFinal Electric i � �:.,�i_,j I��.,� � � ' � � I � . � ' � � � � r � } � �
���
34. Final Heatin� &�Air Conditionin � '� � ' � 1 � M! ' ' � �~� - � �
9 9 ' ' i . i -i.
A �1 "Irs.�'nl�c Ir-1 =� � t �� 1 � 1 � i ( c ��.
� � �vt .i." � �,:. ;n' ' u - ��� p. �r r -n
35. Final�GasiPi e'-�7est� � � '? (� ' _ . • < - � i z !'_ - � �� k � � � � i ,�.
�i i. -P Ic.¢F� Fmt el (� j. i'., - e�- c -
36. HoodorCano��.iH?�":''. i �I :I . -. _ � �; � 1. ,_^;�` �� : � �; , - . :. : _ _
n 1 r ` � !1.
9 Ii IP�IF ��m -1r� I� I_ ���_�._� � � �: �c � �� ' � .i �f ' - ' '
�• 'n_, - i ¢ r b � � o � .-� � - . : � � � n . .. � -
37. Finai �actory Firep�lacer,. � =� o� 1 '' �� I' 1� t . i I i I � ��_.l- ' .� �D'' • „. `' `. - -
,_ s
38. Final Plu�mbing � Ti ! � � uj 'i 1 5�//�'' , �%O I i � i � i � "' ' � ' N
t
39. Water Service-Final� � I. f � � , I � , 4 � • " �
u � � i . � � t + � .-. � -
� N�1 I 1 �. 1 I i: " � ,>
40. Gas Seivice-Final � � � � p I , : .. , � , � , � � j n: � � I � , � ' �, , � i , �
A�� 1, � 11 � � f � i
. . � � . . I I i I ' ' • ' : ' i - ' .
41. Solar pomesticFinal � I � � � I j_ � � „ __ , . �' �> � -� ' ! ,
. n � ' � i i 1! �^ T"�.'� -r-1"-.._ -}' -t" ' 1 _%!
42. Backflow�Preveriter� z� � � ' ,�jm � � � . � � � -� --��-� ,i_--'- ` • . .. .: i � �
ti r.: ... i � .�-- - --{- k - --+- - - , .
1 � � _ wi• � �„�' ,, . _ � ' Y ' :o � ' �' , - , �
43. Backflow Iriigation ��� � ,�, � - , , � , � ��'
•, i..0 !ri� { 1 � iF.. �_ 1.• ;{.., .r.�
• � l�• � NIG U t � C " ' � �
44. Landsca'pe Irr.i9ation�SYstem ! { r,�.- " . i ,° j ; ; � : I � s i : � i � , . ;� -- ,- -
1._ �v i _ Iir � . f 1 : s I ' � ` � (o �
C.
+� I-'� �1}'p RI I . � � �r '�; � ` � �i 31 -1 " f . Ir:.. ,. ) � _ -' �' ri % Y�
45. Sound�Attenuation z „ I � � � <. � � .y ,_ � ; � ! , �. �- _ 4 � '• � _
�n���.:� i. -�m,
=i � � � � c � ' � i i � : � � .. q' :n ii.
M1 0.'i i �-- i n � p ,' 1 t I f T -J
46. Handir�.aplRegulations' � i w ',: � I': � i � � ' ; � ! '' �' , „ ' ^,
47.� FINA� STRUCTURE & BUILDI�NG i� " � { � � � 4 � � i � � { I W � '.� � .
❑ � i 1 i � n 1' i �'� �-•�' i i t,- ' �il
48. SPecia� Requiremerits ComPleted� � � t � i�- I �' � � ( I , � � � `" ,� � � �.� �.. : •o c� . . .
��i i i i i i 1 ( 1 I. i i i':
49. Elec[ric Releaseito Edis`on � I � � � � .*�.- .�.- � _�.L • � .� R ._! --�--; - � � ' .• I ' I ,: • j � J � ' .
t- i T- '�- ' � 1 i i f
i n ti � � � � , � � i � ( , , t � � i f ' ..� ' ;i , , -
50. Gas Release to Southem Califomia Gas Co � i •, � '' '
n n � � � � � s 1 � ' i i 1 1 1� "� �� � � i
51. CERTIFICAfEOFIOCCUPANCY ;. ! � ! ' ". � i •� � ' ' �
i. -� - �'-- -r-"}- , �"�'- i '-'�-� , � � ! .
No �� ' � � Date � � i i � t � ; � . ' ' , , �� ' � _ .. . �
� ��.> .,!.�.✓ ...t_ _._...� _ ' ' __1... .L_ ��- - � _- ._�.=. - - - _ - -
OWNER gUCCOLA co. '
�JOB ADDRESS 913 xelena Ci
\f"'ERAL CONTRACTOR h�.mPr/
� o. 418-091-01 LOT 6
aINSPECTIONS
soi�
�GAS
�W�TER � Ti� �% �i�•i
�22 ROUGM GLUMBING
PROP. SWR. LINE [] HOUSE CON.
SPqINKLING SVSTEM
MISCELLANEOUS
� ROlIGH NE4TING r1N� AIR CONOITIONINC
TEMPOR�RY SERVICE OR POLE
UNOERGROUNO � POWEF �
NOUGM wIFING
� TRENCMES FORMS STEEL REINF.
fL00H SVSTEM
BOND BEAM [� �STEEL REINFORCE ❑
SMEATHING
FqqME AND FLASMING
�pTMING - IN �r�`-6UT
ER, BROWN CORT
S -TURAL. FINAL
HERTING, VENT., REFRIG. RNO A.t., FIN�L
P�UMBING. FINRL ANO GAS TEST n
TRACT 9383 FIRE
DATE _1 � _
11111��]L`[H�37LIii
SUBCONTRACTOR
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' COSTA MESA BUILD�NG-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fill inTCompletely — Use Ink Only
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OWNER
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CONSTRUCTION
LENDER
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BRANCH i
ADDRESS
ADORESS ,-'(`
CONTRACTOR
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ADDRESS L
CITV
STATE I �
LIC. NO.
SIZE
OF LOT'
USE OF
TEL. TRA(
NO.�O �
W �ADC
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OWNER
TEL./,j�P,OIC SE
NO lV yy
_� ' (�� B 1 YIRE
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APPROVED
TEL.
NO.
GTY
LIC. NO.
NO. OF BLDGS.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
Pi.' G ,
.�r��y�v'?(:ini�.�,����.1�'b �'x�:����.i�i
�ORSTRUCTURALPERMIT
E I NO.OF �
PLAN$
VARDS APPROVED.
MAIN BUIIDING
IOM GL 5 ET
7NT FT.
. � r-, n
VAR. #
C.U.P.�
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0
DATE I I �
USE OF NEW �
BUILDIN
VAROS APPqOVED
BEf. MAIN &
I hareby aeknowletlBe that I hava �ead this eppltcation antl atate '^
ihat ihe above fnformation is correct antl aprae io eomply wlth �
m
all laws �eBuletlnB builtl(nB construetlon, antl I shall not employ
any peraon in violation of the workman's compensation laws of �
Me Stata of Californfa. Lw► -
I hetaby cartify that I am ptope�ly Ilcansetl es a eantractor untler SQ. FT. �' ✓ w
the Stato of Californle Busineas end Protesslona Cotle, Divislon 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR m
Chapiar 9, antl that suc� lice sas nre in tull forca antl atfect, or I THE PURPOSE OF ESTABIISHING A PERMIT FEE ONLV: �
am axempt from t prov la�ic of the State of Celifornie eusinass d
VALUATION PERMIT FEE $
and P�ofessionz Co , Di io � 3, Chapter 9. � �n
�J � PLAN CHECK $ O "�
Sipnature of � �/� �' • �
Permlttea � � S ' / TAX E �
Authorizatl 0 < TOTALPAID $
�
�3530 II/26/80 72.6D TL
_._, _ _. _..
% COSTA MESA BUILDINGSAFETY DEPARTMENT APP ATION�FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 i �
�f REC ED PERMIT
For Applicant to Fill in Completely — Use [nk Only N� 510 8 9
. BUILDING A.P. NO. �
ADDRESS
BUILDING/� /
OWNER OR ADDRE55 �/J � �
TENANT
UNIT OR
MAILING � � SPACENO.
ADDRE55
T LO BLK.
� ^ M TEL�����G
CIT J � I V[Juf`� NO. 1 �
� . , NEW i ADD ALTER REPAIR MOVING DEMOLISH
BRANCH I' / v I
OWNE
ADDRES USE��� � VALUES �� `
ARCHITECT } � TEL �� ��
OR ENGINEER
ADDRESS^�vI LX LWYYW)lRJ /lt%lJ� ZONE TVPE GROUP
APPROVED
CONTRACT ^� BV DATE
ADDRES I / �
CITY ��(f,�(/�� NOL 5��`�
F STATE , // CITY %�PPROVEDSETB
� LIC. NO. �y ( � LIC. NO. y�
SIZE NO.OF BLDGS. (FROM C/L T ET `�
� CW. OF LOT NOW ON LOT qONT r F.
a USE OF � L�
'� EXISiING BLDG. �
� 1 !�
� Separate permits are required for �. s� E FT.
� electric, plumbing and heating work. REAR FL `/
� USE OF BUIIDING AND WORK TO BE PERFORMED PIJiNNIN ACTION
G �'•
j DATE
a APPROVED
7 APPROVED /
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� I hereby acknowletlge that I have reatl this application antl state �
[� ihat tha ebove information is correct end agrea to comply with
4. ell laws regulating building construction, and I shall not employ , �
z any person in violation of the workman's compensallon laws of d
� She State of California. '
SQ. FT. �
3 I hereby certify ffiat I am properly licensed as a contractor untler �
the State of California Business antl Professions Cotle, Division 3, THE AMOUNTSHOWN UNDER VALVATION IS FOR m
Chapter 9, antl that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from the provisions of th� Stete of Celifornia Business `'
VALUATION PERMITFEE $
antl Professi s o ivision 3, Ch pter 9. "7 .� m
Signatura ot `�/— P�AN CHECK S a�,�. �— o
Permittee � $ �5�^ TAX $ � U
or I
Authorizetl Agent Date �� �a-�P TOTAL PAID 5
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