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Home My WebLink About926 HELENA CIR - Building PermitsCITY OF COSTA MESA i/� s. .. '` ' BUILpIN6 DIVISION `� > _ � ; � DEVELOPMENT SERVICES DEPARTMENT B98_0'I'130 � PERMIT PERMIT NUMBER .� � (714) 754-5273 • Fax (714) 754-4856 gUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 926 HELENA CI Suite: Vicinity: Parcel Nunmber: 41808149 Applicant: FORTH, DOYLE Address: owner: HUNTER, Address 1812 KINGL /� Status: ISSUED l Applied: O6/25/1998 Issued: 06/25/1998 Zoning: Phone: 714-556-7165 -' - -Zip';� _� " - --� r� f.- ' o:. r 4-r . -- /"�,ef! "== _. _. _ ;. . -- __ --;-`�; � :1TR'%', _—� , �-. -<;`�.�r %� �`-"', �� 1 1 ! �, '��% ,-�.`��'�`_'�� ,_ , i � � , �, � i� `� � �\ ��/ `,JPhone:L_. �:�� / �,�� l { , `- �Zip:=�92826- _ - . _� �> � ��\ �` \. .�-�-�-.�=c,.,, _+:5;-.'.' l ll Ll\ i ,�� \\ � /�% _' �c�?r.�'- . ,_..:.�.\�;:�� -�:s,, „��, (, % &-�MPANY '�;\�v / � � ✓ �� Ph Zip� 92626 �� .. \ ;�; i � i .. — ',' Phone� k' .�, � �I � � � � �.� � K , 1, �. , `�Licrye sle.� � �?_�...Y��k�e.�P'.�!"h�)i �'� //`�<�' !" SCOPE OF PERMIT �!;;; ;�3 . �- � �� ; T/O. EXIST AND RE �OF W/ 30 YR COMP. � �� %`J �II'hl � i7/r-oncr��.,s. _, . �'t^,r�;�fi�'r?.�r,�_F,�,�fr>;-�,c.z��t\ ACCESSORY PARKING NOTES: t = _ � �� 37.25 �,, r ��.fi,�,�,,..r-�, �� +__I: 0.80 , �.�� ` ] �..___' �J� ___ . �.�� . .� �.�� L � r, ��,1 � � ,. , i,� ,, / , . , ' �� !�-..:.Oti,!f�. ` �' ' i ' �- -i � Calc Valuation �` t$a o00 00 Claimed Valuation: ; 3a o00 00 . � � � .-. ; ) , � -�. � � ,�, ` �'_"'+i. 'i��l��r 'r� � v' �� –_` /`� � / _ f `/`/j '� �,� "./ /1' r, i �```I/ /IL �j� <. i�// I i/l� �� /�l% , �� \� ` �'PLANNING & ZONING ,�' ,a VA\l r }. �:>1/'(['�,rhla�l �3" .�,. � �ii i� � L� !` r �'��.�F�t� '��-�� . h d� .^..� G� �'- . ;��' ��` >> y �-��'\ �� ° � �ca � ` ( �i/ � "( nA E'Front 0-0�� Rear 0 0��.=,. Le8 0 0 �.; ,Right �0 0�'�% _ .. '; .��J �"�.�A1 :�' , � ; :� .t � _ ' �/ _ A,!;'' \ -� � / / Front 0 0� %� �� Rear 0 0�' ��Ceft ��0 0� '" Right - �0�0 /� � �� 'j1� . -'"' _ '_- ' , :/ ./� % Existin �'0_ �1Reauired . 0�-� , P.roposed �0 �� ' � = ; � � ��• L.' ", � , � I - � � , j , j�'.i �� ..._i , �, �, � , , s � _ ; i ,� � '�` '_ , ' �� ( / ` , .' . , -K[.r�l..J � ,_�`�.•��/., , ` G EXPIRATION: This perm0 shall automatically expire and become vold 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 the work authorized under this permit to be considered legal, such work must comply with all applicaDle codes, and all required Inepeetlone and Hnal approval must be obteined. Failure to obtain Inspections and final epproval will result in the expiration of this permi). FOR INSPECTIONS CALL: (714) 7545828 WORKERS' COMPENSATION DECLARA710N: ' . �, j � I hereby atfirm untler penalry of per�ury one of Ne following deGarations: �' ' ' ❑ 1 heve entl will meintein e wrtificate of consent to self-Insure for workers' compensatlon, es provided for by section 3700 af t�e Labor Cotle, for Ihe pertortnance of t�e ��, ��///''' work for which this permit Is issued. `� I have end will maintein workers' compensation insurence, es required by seciion 3700 af tha Labor Cotle, for Vie pertoimance of Me work for wliic� this pertnit is issuetl. � My workera' comp ,� ytio�n I�n� a—n,c,e r end poll number ere: �j(� cf,� Carrier: �I GL/`1' � Poliry Number / %S �� ^ � (Thls secUon need not be completed i/ the permif is velued ef one hundred dollers ($100) oi less.J ❑ I certity ihat In tha peAortnance of Ihe woAc for which t�is permit is IssueQ I shell not employ any person in any manner so as to become subject to ihe workere' compensation laws ot Celilomia, entl e 4 that H Yhould become subject to ihe workers' wmpensation provisions oi Section 3700 of the Le6or Code, I shell lorthwlt� compty wIN ihese provlsions. � %� �/ Appllcent Signeture: Date: l �� f O WFRNINO: FAILURE TO SECURE WO ' O�MPENSATION COVERAGE IS UNLAW FUL AND SHALI SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE MUNDRED hqUSAND OOLLARE (5100,000),IN RIIXJ TO TME ODSi OF COMPENSATION, DAlMOES AS PROVIDED FOR IN SECfION 31W OF THE LABOR OODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS UECLARATON: I here6y elfirtn Ihat I am licereetl untler i� force end etfect. Lic. # Contradofs Signature: CONSTRUC710N LEND ❑ I hereby affirtn thet LenOefs Name: Signeture: 9(cammencing with Section 7000) of Divislon 3 oi the Busine.�end Professions Cotle, end my Iicense is in full Class k U �ate: n ' �—�'/ G is a construction lending egency for Ihe pertortnance of the work tar w�ich this permit is issued. (Sec. 3097, Civil Cotle). Lentler's Adtlress: Date: OWNER-BUILDER DECLARATIONS: I hereby eNirtn thet under penalTy ot per�ury thet I em EXEMGT FROM THE CONTRACTOfiS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires a pertnit to construd, alier, Improve, 7emolish, or repalr any siructura, prior to its Issuance, also requires the appllcant for such permit to 111e e slgneG stetement Ihat he a� she Is Ilcensetl pureuent to ihe provlslons ot the Contrectors License Law (Chepter 9(commencting with Section 7000) at Divlsion 3 oi the Business en0 Professions Code) or that he or she Is exempt therefrom end t�e basis for the alleged axemption. Any violation ot Section 7031.5 by any applicent for e pertnit sub�ecls Ne applicant to e dvll penalry ot not more �hen five hundred dollars ($500).�: ' ❑ I, es owner of the property, or my emDloyees with waBes as their sole compensatlon, WILL DO THE WORK, and the struqure Is not intended or oflered for sala (Sec. 7064, Business and Protessions Cotle: 7Te Contractors license Lew does not epply ta an owner ot properry who builds or improves t�ereon, and who tloes such work hlmseH or hersali or Ihrough his or her own employees, proNdetl Iha� such Improvements ere not intended or otlered tor sale. If, however, t�e bullEing or Improvement is soltl wit�in one year o1 comple0on, ihe avner-bullder will heve the burden of pmving Ihat ha or she did not bulltl or improve for purpose of sale.). ❑ I, as owner of tha property, am El(CLUSIVELY CONTRACTING WRM LICENSED CONTRACTORS to cons�ruct �he project (Sec. 7044, 8usiness and Professlons Coda: The wntrecrore LJcense Law tloes not epply to an owner of properry who bulltls or Improves therean, antl who contracts tor such pro�ect wR� e contrectoqs) Ilcense pursuant ta the COMrectors License Laws.). ❑ 1 em exempt untler sec. Business and Protessions Code for this reason: Signature: Date: Owner ID verifed by drivefs license. ❑ Ves ❑ No Drivers License No. Veriflcetlon oi Ownerehip by (rype of tlxument, i.e. - properry tax bill or daed): DIVISION OF INDUSTRIAL SAFETY PERMfT CER7IFICATION: Expires: ❑ I hereby certity ihat no excavetlon tive (5) or more teet in depih imo which e person is required to descand, will be matle in connection with work euthodzed by this pertnit, end thet no bullding sWcture, swttol0ing, felsework, or demolitlon or dismantling thereof, will be more ihen ihirry-six (36) feet high. (Chep. 32, Grp 2, An 2, Sec. 341, Title 8, Celltomia AtlministretNe Cade). • ❑ As owner-bulltler, I wlll not employ enyone to tlo work which would require a pertnit from the Divlsion of Intlusirial Safery, as noted above, unleu such person hes e perml� to tlo such work from Ihe division. Signature: Date: Dlvlsion ot Indusirial Satery Pertnit NumDer: CERTIFlCATE OF COMPLIANCE AND AIJTMOROATION OF ENTHY: I certify under penalry of perjury that I heve read this application antl state thal the informetion given Is covect. I egree lo comply wit� ell state laws antl ciry orClnances relating to building consfruction, antl authorize representatives of the Ciry ot Costa Mesa to enter upon Ihe ebove-descnbed property for inspection purposes. I egree not lo ocCupy or ellow occupancy ot any building authonzed by ihis pertnit until tinal Inspeclion. IXSVECTIONTYPE 18 FIxeC System Final Fire Preventlon 1288 Pool Spe Final � 200 Flnel Re-Roof � 201 FIneI BIocWRetalning Wall 202 Finel Factory Fire Place 203 Final Slpn 204 Final Demolitlon ;...:�r;� �eg �� i�n '�� Z � Date FQyEl INSFECTION TYPE 206 Finel Mechanical 208 Final Plumbing � 210 Final Electncel 212 Final Fire Prevention 220 Final Plenning Approvel 222 Final Site 250 Final Buili �ff �� . 1� PFOJECT PUOflE55: (3 7(� H EI� ENA C I owNCR s name: D I E F�'ND AHL aooxEss: S AM£ .AS AROVE 714/556-4312' AflCN/ENGINEEfl: � PUOflESS: UNIT: Q flEG.NO.: UNIT: PEflMITTEE: NOCK PLUMBING ( 71 A) 895-1246 � aoosess:11610 SEABOARD CZR STANTON CA.90680 LICENSEO LONTPACTOB9ECLAflATION: I hereby aihrm Ihat I am licensetl untler pmvisions ol Chapter 9(commencing with Section ]000� ol �iNsion 3 af the Business an0 Pmfessions Code. antl my license is in �ull lorce antl eHecL � ciTvuc.:050386 ' sTareuc.:511971 ��SS C-36 Oate: _..�,�-��- �� SignaWre: . _ _ _ _ WOBREPS' COMPENSATION OECIABRiION: I hereby a�firm Ihai I ha cenificate of consent to seibinmre or a ceniticate of Workers' Compensation Insurance, or a certifiee copy ihereoi (Sectian 3000. Lab. C�. �nucrNo.:116799290 E%P.DFTE:O3IO1I91 MPANY: j TAT E Cetlilied topy i5 �¢reby lUmishetl. � Certitied cOpy is liled w t�)�he Ciiy BuilAing �ivision. Oaie: �. �U �O � �j� Applicam: �✓ �^1/1.� .� > � E7(EMPiIONFBUMWOPRENS'COMPENSATIONOECIABATION: (ThiSsectionneetlnOtb¢tompl¢Iedilthep¢rmi�i5 �ne�unerea$100orless. I cetlity Iha� in I�e petlormance oi ihe work for wAic� �his permi� is iSsueA. 15hall no� employ any person in any manner sa as �o become suble�� o �he Workers' CompenSalian Laws of Califomla. Date: Signa�ure: NOTICE: If, ailer making this declaralion. you s�oNa become suble�� to Ihe Workers' CamDensation D�ovisions of �he Lahor Cotle. you musl fonhwi�� comply wi�h suc� pmvisians or �hi5 permii 5hall he deeme0 revoke0. CONSTBUCTION LENOING pGENCY: I here�y allirm Ihal there is a cans�mctmn lentling agency �or. �he petlormance o� �he work �or which ihis permn is i=.5ue0 (Sec�ion 3097. Civ. C�. � LENOEfl: aooeess: OWNEF BWLDER OECIABpTIUN: I hereby afbrm Ihat I am exempt trom the Contractors' S�a�e License Law br the following reason (Seciion 703L5 Business antl Pmfessional Code: Any ciry of counly whic� requires a permii �o consbucl, atler, imD��e, tlemolish, or repau any Slmclure, prior lo i�s issuance. also requues Ihe applicant tor such permi� lo lile a signed s�a�ement �hat helshe i5 licensed pursuant Io Ihe pmvisions ol the Comracmrs Sta�e License Law (C�ap�er 9(commencing with Section 7W0) o� Division 3 of Ihe Business an0 Pmfessions Code) or Ihal ne/she is exempt Iherefmm ane Ihe basis lor tne allegee exemption. Any violation of Section 70.?1.5 �y any aOPlican� lor a Oermit sublecis the applican� ro a civil penalry of noDmore Ihan live �untlretl tlollars ($500). I. as owner oi Ihe pmpetly or my employ¢es wilh wages as �heir sole compensation, will tlo �he work, antl the ❑ stmcWre is nal imenaetl or oflered �or sale (Sectbn 704a. Business and Pm�essional Cotle: T�e Contracmrs' S�a�e License Law does nol appty lo an owner of a pmpetly who builds or impmves �hereon, antl wha tloes such work himsel�/�ersel� or Ihmugh / his or her own emDloyees, pmuitled Iha� such impmvemems are no� imenaetl or o��eretl tor sale. I�, however [he builAinA or ( improvement is soltl wi�hin one year o� campletion, ��e owner will have the burtlen af pmving he/she did not huilJ or impmve � lor ihe puroose ot salel. ❑� I, as awner oi the pmDeny, am exclusively coniracting with licensed conlracrors lo consimct ihe pmlect (Section 704d, Business antl Pm�essians Caae'. The Cantracbrs' State License Law tloes no� apply Io an owner o� pmpetly who builtls or impmves �hereon and who coniracis lor such projeds witn a conimctor(s) license Dursuant to ihe ConlractoB: State License Law)�.I am aware Ihai pmol of I�eir WOBeYs Compensali0n in5ufance Shou10 6e provided lo me. � � I am exempt under Sectinn: B. 8 P. C. br ihis reason: - Date: Ownec I do �ereby cendy �ha� I am aware ol ana untlers�and t�e requirements al Cali�ornia Healih antl Satery Code Sections 25505, 25533, antl 2553G and Ihat I ar any �Nure building occupani wiil/will not (CirCl¢ one) neeA Io cOmply wi�h Saitl S�ate cotles antl �he requiremen�s for a permit for consimction or ma0dication irom Ihe Air Oualiry Managemen� Dislrict PesiAential cons�mc�ion aDPlicaiions are exempi tmm Ih¢5¢ prOviSio05. �ate: AOP�icanl: I here�y cerlify Iha� I �ave read Ihis aDPlication antl s�ale Iha� Ihe above mbrmation is correcL I agree to compty wi�� all ciry and coun�y oreinanws and s�atelaw5relalingio builtling constmction antl hereby aN�orizerepresenta�ives otthis ciryto en pon�he above-men�ione0 P�aOerly.�orinspeciion p�ur0osQe5 paie- _`.D � �_! J � / .�_ Signaiure: � ' Driver's License or Social Sewriry d; �� . 164t�G6 White-9wlaing: Green—Gotle Eniorcemenf. Canary—ApplicanL Pink—Revenue: Goltlenrotl—Assessor CITY OF COSTA ME5A — BUILDING PERMIT PERM . , PERMIT NO: P 049644 'PLAN CHECK NO: N GOVT: N . CONSTRUCTION TYPE: PERMIT TYPE: FT,U PURPOSE: OTH ' JOB DESCRIPTION : WYaTER HEATER REPLACEMENT SQ FT: CLAZM VALUE: CALC—VAL'JE: GAOUP OCC: / COMMENTS: NO STRUCTURAL WORK HEING DONE *'* �*+��t *�*****�t*�*** �� **�t**x��x �t**�r*x��t**�t*�t**i��t�t��t��t�ta�****� �t**�***�t*�* �� * ��r r��r** Z O N I N G R E Q U I R E M E N T S S E T B A C� K 5 ------------ MAIN PUILDING -------- --------- ACCESSORY BUILDING --------- FkA1T: FT IN REAR: FT IN FRNTi FT Z1V REAk: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT ZN PARKING REQ: P.40V: PARCEL: 13919219 ZNE: REF NO: PLANNING NOTES> ) _ 3f i! iF iE iE �F iF iE if ik iE iE jE aE �E i@ if jf iF jE k;E 3f if if iF iF if iE af �E �f �k if iE �f jf iE if ik i! iE iF iE �� if ��i(� ?E if 1E 3F ik iF 3F iE k-0f H� iE 3E 1E iE if if k�3(� %'h 7E �H� �IE 3E jE 1f ib jE �iE jE D E V E L O P M E N T S E R V I�C � S�• R.E Q U I R E M E N T S ZONING APPROVED BY " DATF.: bUILDING APPROVED BY : " DATE: � APPLICATION ISSUED BY: DATE• f +�***��****�r*�*****��e �**�**�u��'�* iE j41f jE �t aE ik �F ff i! iE iF 1! iE iF 1E it iF if 1f 9E if jf 1E 1k iE af iE if iF iF iE it if 9k 1F if if iE if iE �E if 3E i! if iE dE 1t if iE iE if 1F if i4 iE �f iE iE jf if iF iE %% �)f Jf M�Jf iE iE ii �1f iF fE 1E �E LEGALIZATION:N F E E S U�M M A R Y STRUCTURAL SEGMEDIT:N BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/RE; GRADING PERMIT 2.00 25� SMIP/NON—RES PLAN ISSUE FEE 3,00 " � BUILDZNG—DIV—> PERMZT ISSUE. PLAN—CHECR TOTAL' � PA.ID DUE TOTALS--->- 2.00 3.00 0,00 � 5.00 5.00 '.OU , AEVENUE DIVISION TOTALS--> . COLLECTED: 5.00 OVER/SHORT: 00 BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/'fOT GRADING PLAN—CHECK 5.�� ' 3f if !E ff if !f if if if iE iE jE -0E if iE iE iE if if i4 iE iElE iE iE iE iE iElE 1E !E iE iF jf iE iE 1E iE 1E �E iE iE 1E i! �� f 7E k if �k if if �E if if iE �k iE 1E if 3F?f iE jE if ?E % lE X� If iE �>f 9f ii ii i� jF ii I N D I V I D U A L F E E B R E A K D O W N. TYPE QTY D E S C R I P T i O,N UNIT COST 1'OTAL COST PLU 1 WATER HEATER AND/OR VENT 2.00 2.00 END OF FEES W 0 01 Gi10?3:23—D4�73123 Tt�T S,OU DF.Tc: i0�31{4U i IC{E: i�: iCl t CONSTRUCTION ANDPLANNING APPROVALS Permit # � � . 1. Temporary Electrical Ser�ice oi Pole . 2. Soil Pipe-Undrgmd. , . .. � 3..Electrical Conduit Utility-Undrgrnd. � 4. Electrical Conduit-Undrgmd." � �5: Steel Reinforcement `6:'Electricai UFER Grnd. � 7. Footingi , 8. Foundation 9. Water Pipe-Undrgrnd. ' 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Dralns 74. Rough Plumbing- , 15. Rough Electrical-Conduit 16. Rough Electric Wiring 77. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Heatinq & Air CAnditioning 2�.: Rough Factory Fireplace � '� '` � � 21. Ducts, in Structure • _ � 22. Dutts, Ventilating � 23. Gas Pipe-Rough & Test 24. Roof Framing, . '" �'.,. 25. Roof•Sheathing � . - 26.:T-Bar Ceiling �Structural) &�Monocoat 27. Frame and Flashing. . � 28. Lathing'&Siding ' , ;� � 29. Insulation � • �'30. Drywall Nailing ' � 31. Plaster Brown.Coat Mr 32: Elec[rical.PowerMeter�Final� • 33.. Final Electric � - � 34. Final Heating & Air Conditionirig .35. Final Gas Pipe-Test-� � ' 36. Hood or Canopy , " ' 37..Final Factory Fireplace -. , �. - � 38. Final Plumbing �- �' � 39. Water Service-Final, ; ; � 40. Gas Service-Final - " 41. Solar pomesticFinal .. � 42. Backflow Preventer 43. Backflow Irrigation, ,' � 44. Landscape Irrigation SYstem'� ' • 45..Sound Attenuation �. 46. Handicap Regulations 47: FINAL STRUCTUfiE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Q pate �_ - - ' � PC � SPA � Date Inspector ppPROVALS Permit # � "52. Pool & Equipment Location � 53. Steel Reinforcement 54. Forms - 55. Electriwl Bonding 56. Rough Plumbing & Pressure Test � 57. APPROVAL TO COVER�GUNITE 58. E�ectrical Conduit•Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P�Trap, � Undrgrnd. ' 61. APPROVAL TO DECK '_ ' 62. Backwash & Receptor�Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical�Final �. 66. Solar System�Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTEftING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT ., . , " ' _ , . � APPRO�VACS, Permit # � � . � '.� � 70. Undergrvund?Hydro , ,� ,�-; " . . . • � , . � . .�77. Product.Piping O Gas ❑ Oil � �' �„ '� '� � 72. UndergroundFlush- ` � �. i ��J3. Lndergrnd. Storage Tank � Gas ❑ Oil ' '- �� ' 74. .Overhead Hydro � , , � �, �� , 75�DryChemical � - . , _' �� '� • • ' + 76. Dry Standpipe � " ' � �i �� : 77:�,FIXED SYSTEM FINALi . , . � 784FIRE PREV. FINAL '' ' '• , ' t' ' ' ' ;HEALTH DEPTr REQUIREMENT ' � �f �. �79. FINAL�INSPECTION i, '' � �; � �`80.";FOOD CERTIFICATE ISSUED , . � ,i Notes: -'•' - _ � � :_ v . ' � n . � � _ ' h x • � .r . � k, , , . . � , . .r . � i � � � � . i, + � . .� . ,i . . , > �� . � � � i•, � � . ( i i � � . i i - • , - .-.i " , . _ . , ••f; r , .� . . ` � i . � � i„ � �y I . : � � _ ,i Date Inspector � 0 OWNER SUCCOLA C0. Circle o. 41A—O81-40 LOT c�s I3 ROUGH SPRINKLING SVSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CONDIT TEMPORARY SERVICE OR POLE UNDERGROUND � POWER C ROUGH WIRING REINF. BOND BEAM U �STE SHE�THING FRAME ANO PLASNING LATHING — IN' I � 'TER, BROWN CO�T :TURAL, FINAL SUBCONTRACTOR e' : F'1: 0 ••� l� Ts�� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 For Applicant to Fill in C plet y— Use Ink nly' BVILDING%J�/ _ __ OWNER MA�L ADDRESS CITV t � CANSTRVCTION LENDER L BRANCH � � ADORESS F � L a �.�. y F G .d Q 7 } ..1 C v� a � a o. Z Lil S 3 TEL. ADDRESS � , �L, 1 1 (l � I ( \ IV � CONTRACTOR „ r �a ADDRESS f� �� I �� TEL. CITV NO. STATE � // �� . CITV LIC. NO. 7 IIC. NO. SIZE NO.OF BLDGS. OF LOT .�� I NOW ON LOT USE OF y... _r� EXISTING BLOG �/ E! � Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PEfiFOFMED I heraby acknowledge that I ha�e reatl this applicetion and state ihat the above information is correct and agrea to comply with all laws reguleting builtling con6Yruction, and I shall not employ any parson In violation af the workmen's compensation laws ot the Stata of Californla. ' 1 hereby certify that I am properly Iicansed az a conttacror untler the State of California Business antl Protess(ons Cotla, DiNsion 3, Chapier 9, antl that such I(cen � �� full fO�ce and effe[t, of 1 am exempt from the p vi5io t e Steie of California Business and Professions Code; visio 3 pter 9. SlBnature ot � Permlttaa % Authorizetl Aae t ,rr�i� � ?f]��ir,G,,d;�i�1'12f�: +;,:=��LJ;� 4;5 APPLICATION FOR STRUCTURAL PERMIT ECEIVEO BV DFlTERECEIVED DA IS6VE➢ BUILDING ADDF3Fji; 0 DATE // � � NO.OF VSE OF N W -� PLANS BUILDIN � YARDSAPPROVED VARDSAPPROVED MAIN BUILDING ACCESSORV BUILDI IOM C/L Tfi T � 7NT FT, T. � il FT. FT. >IDE I � FT. FT. I Afi F FT. iANCE BET. BET, MAIN & VAR. # � N n � 'm 54. FT. �' rv THE AMOUNTSHOWN UNDER VALUATION IS FOR m THE PURP�E OF ESTABLISHING A PERMIT FEE ON�V: VALUATION �/� PERMIT FEE 5 O� � �0((��0� O(/ PLAN CHECK $ w/1 LL� �a ,�� . ; �•r. $ TAX $ �� ' TOTALPAID $ � �s .—. SPRINRLING SYSTEM MISCELL�NEOUS ROl1GM HEaTING AND �IR CON TEMPORnRV SERVICE OA POL UN�EAGROUNO � POWER ROUGN WIRING TRENCMES � J FORMS FLOOR SYSTEM BONO BE4'n � STEEL FE SHERTMING FRRME AND FLASMING LNTHING — IN L'i OUT � PV'TER. BAOWN CORT 5' URGL, FINOL ELECTRIC, FIHRL BOIL�ING, fIN4L ING DATE SUBCONTRACTOR /Yi@7� r ��O / //�'�` /7Cd�� f � .(9� /a/9/? � I /� ' � �f?��iu�0 . -COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUII.DING ' ADORESS V C OWNER y�'t'Q✓� MAIL A. . . . . .. � TEL(f 'y�' CITV rCls'�/�} �'ieSH NO. Q�� CANSTRUCTION BRANCH ADDFESS ARCHITECT TEL. CONTRACTOR L�, �y�,�er ADORESS � �v C A y� TE L. ��j/ CITV COS'I'/+ PSH NO. .1 I F STATE CITY i LIC. NO. � -(� 44 NO. �� I {ay,j SIZE NO.OF BIDGS. G� OF LOT NOW ON LOT ¢ USE OF .�.., EXISTING BLDG. � FSeparate permits are required for � electric, plumbing and heating work. W USE OF BVILDING AND WORK TO BE PERFORMED = a,� il in _ /G1 X � � 7 } ..l C W 4 � � 0. z W 'y" 3 F� � 6220 10/03'/78 5 50 TU h__ . ... ._ ._ _.. APPLICATION FOR STRUCTURAL PERMIT ftECEIVEO eV �ATE ftECEIVED DATE IS ED �h � �� A.P. NO. BUILDIN ADDfiE55 LOT �i I B OWNE K(/V VALUE SE • 5 FIRE ZONE �TVPE GROUP APPROVED gy DATE ZON NO.OF USE OF NEW d '� PlA BUILDING ARDSAPPROVED V DSAPPROVED MAIN BUILDI dG AC ESSORV BVILDIN (FROM GL � T) FRONT FT. 1 5 E FT FT. �� L. SIDE FT. _ �� / w W BET. � BET. MAIN & VAR. # C.U.P. # I hereby acknowletlge that I have read t�is application antl state Shat the abovo information is correct antl agree to comply with all laws regulating builtling const�uction, antl I shall not employ any Oerson in violation ot the workman's compensation laws of the State ot California. / I hereby certify that I am properly licensed as a contractor unCer SQ. FT. the State of California Business antl Protassions Cotle, Divisian 3, 7H AMOUNT SHOWN UNDER VALU. Chapter 9, antl that such licenses are in full force and effect, o� I THE PURPOSE OF ESTABlISHING A PERD am ezempt from the provisions ot the State ot Calitornia Business VA�UATION and Protessions Cotle, Division 3, Chapter 9. PERMIT FEE $ 1 O� PLAN CHECK $ Signaiure o� /. � . _ _ . �. / '�00� Permittee AH//XiW V I (F_�— � TAX $ Authorizetl Agent TOTAL PAI� § n m v' m N )N IS FOF m EE ONLV: � ►.00 " ui ro `— ro 0 LL � v � -U • D