The URL can be used to link to this page

Home My WebLink About3265 IOWA ST - Building Permits� � !� � . ' � � . { ` f (714) 754-5273' • Fax (714) 754=4856 • www.ci.costa•mesa.�y�DING PERMIT 77 FAIR�DRIVE; COSTA MESA, CA 92626 Job Address: 3265 IOWA ST Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 13904316 Zoning: Applicant: ZACH, DARON Address: 326510WA ST COSTA MESA, CA - :� "� Owner: ZACH, DARON & TINA Address 3265 IOWA ST COSTA MESA, CA . ' Convactor: O W N E R-B U I L D E R Address: 2ip: Arch : Address: . ' Phone: Phone: 714-444-7469 Zip: 926262004 Phone: 2ip: 926262004 Phone: License: 000000 Eng: Address: ISSUED BY: Status: ISSUED Applied: 05/24/2005 Issued: OS/24/2005 Phone: Zip: License: License: : SCOBEAF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING ASPHALT SHINGLES, REPAIR/REPLACE SHTG AS NEEDED, 2 LAYERS 30# FELT. APPLY "30-YEAR ASPHALT SHINGLES " 31 SQUARES FEE SUMMARY Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Caic Valuation: Sa,000.00 Claim Valuation: Sa,000.00 Total: 597.75 „ - PLANNING & ZONING � � . ' , SETBACKS � MAIN STRUCTURE Front 0- 0. Rear 0- 0 Left �- 0- 0 Right 0- 0 � ACCESSORY Front 0- 0 Rear 0- 0 Left 0- 0 - Right 0- 0 PARKING Existing: 0 Re uired: 0 Proposed: 0 NO710E: The work authorized.by this:permit shall compty.with�all applicable-�handicap access.requirements underCalifomia:statutes�and related :.regulations: (Ord. No. 92-28; §�t, 12-21-92) EXPIRATION: This permit shall automaticallge�cpire and.become.void.if work isnot commenced within�180 days; or if work (ssuspended'or abandonetl . for a-period of 180.days: INSPECTIONSi In�orderfortheswork�authorized:under this:permit.to�be:consideredAegal, sueh•work musYcompy with all applicable codes, and all � requlred.inspeettons and final approval must be obtained: Failureto�obtain�inspeclions��and final approval will resulfin �he expiration�ol this permit. FOR INS�ECTIONS CALC: (714)�754=5626' zaa+e (aroo) WORKERS'COMPENSAnON DECLARArON: � ' I hereby affirm under penalry ol perjury one oi the following deGarations: � ' � ❑ I �ave entl will melntain e certilicate at consent to setl-Insure for workers' compensation, es proWtlad for by section 3700 of the Labor Code, br ihe pertormance ol the work tor which this permit is issuetl. � - � 1 have entl will maintain workers' campansation insurance, as requiretl by secGon 3700 al Ne LeOor Cotle, lor the pertortnance ot ihe work for which Nis pemtit is iswed. My workers' compensa�ion Insurance carner and policy numbar are: Carrier. Policy Number. (This section nsed not be cromplefetl i! (he permif is valued at one huntlred tlallers (5/00) or less.) �� I certity t�et in the performence of the work lor which this perinit is issuetl, I shall not employ eny person in any manner so as to become subject to the workers' compensation laws of Califomla, and egree at it I shoultl bacome su6ject to ihe workers' compensation proNslons ol Section 3700 of the Labor Code, I s�ell forthwlth comply with these provisi s. ApVI'�can�;6ippawra: Date�+ �7�� — WARNING: FAILURE TO SECURE WORKEPS' PE ATIdJ COVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES ANO CIVIL PINES UP TOONE HUNDRED iHOUSAND00LLARE�S100,000),INAD�ITION CASTOFCOMPENSATION,DAMAGESASPFOVIDEDFORINSECTION3)O60FTHElABOFCAOE,INTEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I em licensed under provisions of Chapter 9(commencing with Section 7000) ot Divlsion 3 of the Business and Profeuions Code, antl my license Is in lull farca end eHecL Lic. N Cless k ConirectoYs Signature: Date: � CONSTRUCTION LENDING AGENCY: �❑ 1 hereby aflirm ihel I�ere is e consiruction lending agency for ihe pedormance of t�e work tor which this permit is issued. (Sec. 3097, Civil Cotle). ��. Lendefs Nama: Lentlefs AOdress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby atlirtn that under penalry ot perjury thet I am EXEMPT FROM THE CONT(7ACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Busineu flntl Professions Codo: Any Clry or counly whiCh raquires e parmit lo construct, eltar, improve, demolish, or repair eny sVucture, pnor �o its issuanca, also requires �he eppliCan� ior such pertnit m file e signetl stetement that he or she is licensetl pursuant to Ihe provisions oi the Comractors License Lew (Chepter 9(cammendng with Section 7000) of DlNsion 3 of ihe Business and Prolessions Code) or lha� he or she is exempt Iherefrwn end the besis tor the elleged exemption. Any violation of Section 7031.5 by eny epplican� for e pertnit suDjects Ihe applicent to e civil penalry of not more than five �untlred tlollars ($500).): �� as owner of the property, or my employees with wages es t�elr sole compansatlon, WILL DO THE WORK, end ihe slructure is not intended or oMeretl for sale (Sec. 7044, Business end Pmfessions Code: The Contractors License Law dces nol apply to en owner ol pmperiy who builtls or improves ihereon, antl who does such work himself or hersetf or through his or her own employees, provided lhat such improvemenis ere not Intantlatl or oHered far sale. It, �owever, t�e builtling or improvement Is soltl within one year ot completion, the owner-6uiltler will have the hurtlen of proving that �e or she did nol build or improve tor purpose of sale.). � ❑ I, as owner of Ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct t�e projea (Sec. 7044, Business and Pwfessions Code: The contracbrs License Law does not epply to an owner of property who bullds or improves thereon, end who contracis lor such prolect wit� a contrector(s) license pursuant to Ihe Comrectors License Lews.). ❑ I em exeqipt untler Business end Prolessions Code lor �his reeson: ` wnor ID venfied by tldvef�t%ensa. �Ves ❑ No D'ver�r'sfoe�Se.No^ �� Ex`piras� ./�/,//OK Verificetion of Ownership by (type of tlocument, i.e. � pmperty tez bill or deed): ''± DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity that no e:cavetion five (5) or more teet in tlepth into which e person Is requiretl to tlescenQ will 6e matle in connection with work euihonxed by Ihis pertnit, and that no building siructure, scaflolding, talsework, or demolition or dismantling thereol, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 347, Title B, Calilornia AAministrative Cotle). ❑ As owner-bullder. I will not employ enyone to tlo work which would require a permil Irom ihe Division ol Indusirial Salety, es noted above, unless such pereon �es e pertnit ro do such work from the division. Signature: Data: Division of Industrial Selery Permit Number: CERTIFICATE OF COMPIIANCE AND AU1110RIZATION OF ENiFY: I certity under penalty of perjury Ihat I have reatl Ihis application and sia�e that the infortnalion given is correct. I egree to comply with ell state laws and ciry ordinances relating to building consiruction, antl euthonze representatives of Ihe City of Costa Mesa to enter upon iha above-descnbetl propeny for � pection p es. I a ree not to occupy or allow occupancy of any building authorized by Ihis permit until final inspectio 4"�35C o �s�' ignaNreOf galOwner(s��_ _ Lle' . : � And/Or Authorized Applicant Data COOE �. INSVECl10NTYPE ' ' 1616 Fixetl System Final Fire Prevemion 1286 Pool Spe Finel 200 Finel Re-Rool ' 207 Finel BIocWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition Dpre li�fi' . ♦ ir1�JiI.I .� _�� COOEt INSGECTONTYPE ' �- 206 Final Mechanical 20B Final Plum6ing 210 Final Electrical 212 220 222 250 Flnal Fire Prevention Final Planning Approval Final Site Final Building/Occupency . . . . PAIE It�EL$ r , � . ._ ; C'',it�y o� C,'oa.ta ��eda �u,%��uuy Du�idio�s OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuan[ to Section 19A30, shall attach to such notice, and, as a condition precedent to issuing a building permit, reyuire the completion and require the remm of, an owner-builder verifica[ion. Attentio� Property Owner. An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please comple[e and re[um this inforznalion in the envelope provided al your eadiest opportuniry lo xvoid unnecessary delay in processing and issuing your building pcnnit. No buildine permit will be�issued until this verification is received. I. I personally plan to provide the major labor and ma[erials for cons[ruction of lhe proposed property improvement. �' Yes ❑ No 2. I(have/have no[) �� signed an application for a building permit fur thc proposed work. 3. I have cuntraded with the fullowing persun (firm) [o provide the proposed consWcdon: Namc Addrecs City Phone ( ) Contractur's Lic. No. 4. t plan to provide portions of the work, but I havc hired the following person to coordinate, supervise and pruvide the major work: ' N�mc Addrecs City Phone ( ) Contractor's Lic No. 5. I will provide some of the work but 1 iiave contrac[ed (hired) the following persons ro pro��ide the work indicate�d: Name Address Phone Type of Work IM2-a6 (REV_9/98) - , , - . . , . . . , I hereby affirtn that I have received a copy of the information set forth in Section 19830 of the Sta[e of Califomia Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with [his Sta[e law. Signed: � vi'l � Name: ��2cN �/dC f� (PrintW orTyped) C.D.L. # / Date: J a y �� For more information call City of Costa Mesa Building Division at (714) 754-5273. 101216 (REV. &98) BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION December 1, 2005 Daron & Tina Zach 3265 lowa St Costa Mesa CA 92628-2004 PERMIT NUMBERS: BOS-00824 FOR: Re-roof PROJECT ADDRESS: 3265 lowa St., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building 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 will be required to finalize expired permits. According to our records, the permits 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, piease contact this office so we may correct our.�ecords. If you need to request an inspection please call our Inspection Request Line at 714-754-5626. If you wish to request an extension, 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 do not have an approved final inspection, your permits will expire on December 15, 2005. 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, Mary Jane Weidenkelier Office Specialist II Job Address: 3265 IOWA $T Suite: Vicinily RESIDENCE AND ATTACHED GARAGE Pnmary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 13904316 Zoning: Applicant ZACH, DARON Atldress: 326510WA ST Phane: 714-444-1469 COSTA MESA, CA Zip: 92626-2004 Owner: ZACH, DARON & TINA Address 326510WA ST Phone: COSTA MESA, CA 2ip: 92626-2004 Convactor: OW N ER-BU I LDE R Address: Zip: Arch : Address: Zip: ISSUED BV: Phone. License: OOOOOO.C' � ` < .��t S y•4e Eng-,' i' ,� �; .� AddressS�t t ,-.; �:': Phone: - t.. .+.. icense: • �,.•-''-�� ;. •, ' � l !,. . : crrinc rir nvo��r .(L � / REROOF RESIDENCE AND ATTACHED,GARAGE��T/O EXISTMi FELT, APPLY "30-YEAR ASPHALT SHINGLES" 31 SQUARES ��' /'` 3 — Plan Check:;; `$0.00 ' lPermit; .� $97.25 . . .. SMIP Res'.: : .' $0.50 �_', � ' SMIP.Com:.::.`� �:$0:00 ' �a,}', � - -- yl ; ' Other.. ., . $0 00 ..;.: �- . Inspection 4;: /$0.00 " // „ ;,;';;'. � . J Total: 597.75 '- . . / r'. . � i ! � *:; , ' .��.._.% PL�AI SETBACKS �•': ;'�Y , . _�MAINSTRUCTURE'Fronl� 0-0. � �,,�Reac.:0-0 �' ' � i - . t,,.'..n'.' �i v� . . . ACCESSORV -' Front 0- 0 '�s ;Rear - 0- 0 ; 1:r;; J ,� ' � .PARKING '� . ExijsGna: o .I �� Reaui' ied: o . ` i. ! , ,x. . � �.i- ��; .,: . ..� � �,. , .� ��l,,i.: � , j+; dMARY � - ; � Left 0- 0 Left 0- 0 Pr000sed: 0 Status: FINALED Applied: 05/24/2005 Issued: OS/24/2005 �. .:�. �. , ,�� - ` . , •f ; t\ \ V } ' T .J P\hone:'_�. . y I IMl1CP' ' �i � SHTG AS 2 LAYERS 30# r � .. ; Calc Valuation: !- • . ,�I$a,000.00 Claim Valuation: ! �= 3a,000.00 Right 0- 0 Righl 0- 0 NOTICE: The work authorized by this permil shall comply with all applicable handicap access requiremen�s under Calilomia staNtes antl rala�ed regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire antl become voitl if work is not commenced within 180 tlays, or if work is suspendetl or abandoned lor a period of 180 tlays. INSPECTIONS: In order for ihe work authorizad under this permit to be considered legal, such work must comply with a11 applicable codas, and all requlred inspectlona and final epproval must be oblained. Failure to obtain inspeclions and linal approval will result in the expira�ion Ot this permil. FOR INSPECTIONS CALL: (714) 75Y56P6 YO�O (dW� WORKERS' COMPENSATION DEGIARATION: �w —a I bereby atti�m untler penalry ot peryury ono ol me tollowing declaretions: ❑ I �ave aqtl will maintain a tertitita�e of consent to sell-Insure tor workers' componsalion, es pmvitlatl lur by soclinn 3700 ol Iho Lebrn CWo, lOr Ine petformance of I�a worM lor w�icn V�is pe�mil is issuetl. . ❑ I nava anA will mainlJ�� 'arkBrS' CompOnSalion in5uranGe, as rBquiretl by SeCI�On 3700011ho Ldbor COtle, lof IIIO OCMOtmanCe Ot Ihe wOrk tor whiCh I�is pannii i5 iSSUed. My woners'tompensation Insmancn wrrmr an0 pobcy numoer are: Carner: Policy NumG�r. (7ros secmm neu� not be GanP�ofntl il �ne perrtm ia valuud a� onu nuntlrxd dWlars (fl00f or less ) ❑ I Cerlify IIt9i in IttB pOrtOrmanco ol Iho worM lor whi[h IpiS pormil is issued, 1 shall no� employ any par5on in any manner s0 as to Decomo 5u0jecl to Ihe workers' compensation Iews J� Calitomia, antl egino Ihal tl I snoultl oecome sub�ect to tne workers' CompensaliOn provisions o� SeC1iOn 3700 o� Iho La�or Cale, I sliall lonhwilb comply witn meso provisions. Appl¢anl Si9nalw�: Dulu: W�FNiNG� P�ILl1RE TO SECUAE WORNFRS' COn�PENSATip, COVEaAGE IS UrvUwFUL M1D SN/�115U61ECT MI EMPLOVEF TO CRiMINAL PENAl.TIES u�D GVIL FINES UP 10 UNE HUNDPED THUUSrWD WLLARE �SIOO,UMII.IN AOOIiION TO iNE COST OF COMPENSATIpJ, OAM4GE5 AS PROVIOED FOR IN SECTIpJ J]C60F iME LABOF GOOE, INiEREST, M1D ATTOHNEV'S FEES. LICENSED CONTRACTORS DECLARATIUN: I I I Oaroby aflirm Iha� I am lirensr.tl unner pmvisions ol Chapter 9(commencing wit� Seclion 7000) ol Division'3 0l Ihe dusine::s antl Pmfessioru Cotle, entl my litense is in tull brce antl enecL Lic. � Class � i � Comreclur's Signawrn: Uate: •! � � ! CONSTRUCTION LENDING ACENCY: � , . ` I � � � 1 ❑ I hereuy anirm tnal �nere is a consimcoon lending agency lor the penormance ol tne work tor wnich Inia permit is isswfd. (SOc. 3087, Civit Cotlo). Lender's Nama: Lenaer's Atltlress: % ' 1 � � � Signawr�; � ' � �� Oale; � � ��i \ l OWNER-BUILDER DECL4NATIONS: I hurooy atlum Inal untler penatly ot perjury Ihul I am EIEMPT FROM THE CONTRACTOI Cafe: Any ciiy or counly which requires e pormit �o [onslruCt, elter, impmve, tlemWisn, or Io tile a s�gnBtl stelnment I�nl no or ann is licensetl pursuant lo Ine prpN5IOf1! OI �ne Conir Busmess ana Pwtesaions Cotle) or mat ne or sne is e.empt tnerefrom end Ne 6asis for t wo�ecls Ine a07h[ant to a tivil penalty ol not more Ihan Ine �untlre0 dtllarc (5500).j: ❑ I, as owner ot the proPeny, or my employees wiih wages es MWr wls cortpensa�ion, 70a4, Businuss antl Protessions Coae: 1 ne Comractors licerqa taw tlaee rqt eOPly M1imsall or �arselt or IllrouJ� his or her Own employBeS,�PfWIdBC Ulat lOLfl htlpl0vem sold wunin ono year of completion, tne owner�builtler wlll have iha burCen W proving ❑ I, as owner nf ine proPeny. am EXCWSIVELV CONTRAC7ING WITIi LICENSED C Coae: The comrano�s License Law ooes no1 apply ip en owner of Droperlywhp build iicense pursuanl lo Ine Conv&cton Lksnse Laws.) � - ! � I ❑ I am e.ompt untlar soc. � � �� Business en0 PraleSsions Signalure: % . � ; � . � !` . ' � � � Ownor ID veneatl oy tlnver/'a'IWenea: ,� � Yea� d�No � ' Drivete Lics VerAi[auon uf Ownership py (type ol,tlowment, i.e. � pr�openy tax �ill or tleetlJ� I DIVISION OF INDUSTRIA� $AFETY PEqM1T CERTIFICATION: f � i ' 1 ❑ I norahy coniry iMt no aKtavation live (5) or mora IeN N doplh inlo wAkh a person oormiL ana ihui no b��9 stmaure, scaflolAinq, felaewoik, or demNitim or tlisma 34 i, liuo B, CaldoinW Atlminisvauve Cotlo�. I; , � /'�% 1 'i d � As ownor-Ouiltler, LN�X not employ enyona la tlo wurk wlri0h woultl �ulre e pen permit lo tlo 5u011 r0�k trom Ne tlrvislon. � , I,� ` � �_� :� � � Sipnature: -� � �� : / Divisfon ol Indusitial'SefeB' Permit Numbar.' � � `' / _ � ' I ' 9 LICENS LAE W ta Iha (ullowing ieamn (9ec. 7031.5, Businoss and Protessions yair any'svuclure,.prip,to tls issuance, deo reQtiiros �ne appl¢ant br sucn parmit Yors Utense Luw (C�apler 9(commentinp wIN Seclian 7000� a� Uivision 3 ot Ine � ellBpeE evomption. Any violauon ol SaCtwn 7031.5 Dy any applic&nl �or a permit �� VI�L DOiTHE WONK, ena tne stmcw�a b nol in1l rMatl or otteretl tor sale (Set. � a� NYMf 01 prapm�y�who builtls or �mOrovBs Ihereon, antl wno tloes such work lI5 8f8 !qi IfltBlldBd OI OflefBd luf SLIB. II, hOWBVB�. if18 builtlln9 Or impfavtlRlBOi IS et tre or Yie tliA noabuiltl or impmve tor'puryoee ol sale.�. i i �NTIiACTOR9 io�tonstmci ma pmjncl (Sec. 70M, Business antl Pmtessions a h�pl0ve! tl�eieon, entl wpo conlr;�[I5 fMluch projett with a coniractor(5) � ' �o0e tor Mis roason� � � Ualo: '" iNo._ �. . ♦. .—. ERpires: tlosconQ will bn matlo in connection with work authorizntl by ihis will be more ihan Ihuty�sir �36) loel high. �C�ap. 9,2, Grp 2, Art 2, Snc. Ihe Div�sion ol IntluStriN 3ntaly, as notad above, unless such porson has a Date: MAZARDOUS MATERIALS AND EMISSIONS CERTIFICATtON: i - I Will Iho appliwnt p p�a�t o�luturOOUAding occupant need to lile antl tenity a Business Plan br emergancy response lo �alensa or Ihreatenetl releese ol a haierGous malenal? ❑ Yes � • '� � . , �Secuon 25505 01 Ne CalAomie Heetl�,entl Satery Cotle requiras, wit0 some exceptions. ihet e Business Plan be Id�atl wit� ihe Costa Mesa Fire Depanmeni by evory busmoss wnicn ha� a� �y a+e 6ma tlixing a mponcu yeer a quamny ol hazardous matenals equal to or g�eaiur man n wcighi ol S00 pounas, or a voWrne ol 55 gallons, n� 200 CubiC ICCI 01 CORW�9349C as el slantlartl tem0erawre ana pressure). .................................,.....�..._...._� ......................................................................................_............__.._...._.................................._........................_..__....... . ... _.............__............................... . . ....._.__... 2 DOev or will Ine app6CBnt Or p�OSanfor IUW re builtling occupani need to lile e �egislrati0n �orm lor ticulaly hafaNuus maional57 ❑ Yes ❑ No ISecbon 255J3 M tna Ca6lwrria Healih antl Salety Code, with some e.ceptirns, �equires registraiion wii� ino Cosia Mesa Fire DeOanment by eacn businass wnicn e� uny unn urrie has un naiid.a.Wani�iy ol acuieiy hazamous matenals equal m or grealer Ihan a woiglii ol SfM {rounUs, or n volumo ot 55 gallons, or 290 cubic inel ot compiesseo gus ul stanaam tempereWre and pressure�. ._ ............................_........_............................................................._........................__..__......"_""'__"_'....._....._....__....._.._._............................_......................__......._".._....._......__..............__........................................... 9 Ooas or will ltie upolicanl or prosonl or IUN�o �uiltling oCcupani neetl to pre0a�e an RMPP (Risk Managmnanl antl Pievention PtaJram lor aculoly hazartlous malerials)? ❑ ��L`S ❑ IIU Bnction 2553a ot the Caidomia Meelin and Safety Code provitles Nat me Costa Mosa Fire Depanmenl may roquiro t�e propa�ation, ceriifiwtion antl tiiing wiih Iho Fire Depanmem ol an RMPP by busmesses wnicb are requuetl m wgis�er acutely �azartlous malanols wiih tho Firo Doparonem. ........._ ................. _................................................................,.......,............................................._.................................................................................................................. .._...._........... ......._.__...............................__...........__ n u an IUdPP �v pr�snniry rnqunetl, nas Seciion 25534 0l Ihe Cahtornia Heal�h antl Sately Cotle Daon lully compbed wnh7 ❑ Yes ❑ No ........................................................._...........,...................................,,......................_......._............................................................................,....................................................................................................................................................... 5 Uons or will me uppliGam or pmsunl or IuWre builtling oc[upani repuire tor t�e work which is t�e sublecl ot Riis applia�lion a,permii lor sucn connmc�ion or moniliwuon Imm �be Sou�li Coast A�� Uuahty Managemont Dislnct or trom any othar air pollu�iom m�lrol tlisintl nr ugancy? J ��+ LJ No ISectmn 65Bti0.2 0l Ine Cahbmia Govemmem Cotlo requires mat tne reQues�etl mlormaiion be Wmis�ed on ap0litalions lor nomresitlentinl ouiltling permits). _ ........................... ......._. ..............._................................. ......... ...,........................................................................................... ..................................... ........................ . ......:............_............................................... f W AI uny pert oi V�n Iaw�Ory m be consimctetl un�er I�is permil bo wii�in 1000 lea� Irom Ihe ouixr �ountlaries ol a SChOu�'? ❑ �ns ❑ No 111'yus". Ihe �ar.iby musi meoi ihe reqwrement of Sections 25534 antl 42303 ot Ihe Calilomia Heatlh anU Salely Cotle). ................_...._......................... ......................._............._...................._...... ..................................._...._............................_......_..........................._...._ _.................._...._......._......................_......... 7 il a pamiii iium Inn Soum Coasl Air Ouab�y Managemenl Disiricl or olher ai� pollution convol districi or eyuncy is reqWrea lor Ihn work whicA is Iha sublect ol this nyul¢auun, navu ell o� �nn tlisclosure5 prxscnbea by Calitornia Health antl Safery Cotlo Seciion dp3U3 been ma�e? [] Ves ❑ No ......... .......... ................_...................................._......................_............._............;............,......................................................................................................................................._................................................................_...............,........ 9 (11 yos", ullacn curidiGule ot comU��anCo hom Ihe approp�iale eir pollution roMml oflicar). CERI'IPICA7 [ OF COMPLIANCE: I conity Ifial untler penaliy of perjury IOB inlorma�ion given e6ove is rorreCL I agrae to comply wi�h all slale laws and city omina�cos regurwng Hezartlous Mamnals and Emissiuns. Signa W re: Ualo: CERTFICATE OF COMPUANCE AND AU7HORRATON OF ENiRV: I cenity untler penally ol porjury Ihat I have ruatl Ihis appliwlion antl siate i�ai t�o inlormation given is mrrea. i agree Io eomply wiln all state laws entl cny ortlinanees relating to ouiltling consimnion, anA auinoriex ruprnsemairvos ot ine Cny ol Cos1a Mesa to entar upon ihe ebove�tlescn�etl propony tor inspection purposes. I egree not to occupy or allow occupancy ol eny buildmg authorizatl by i�is pormit until linal inspociion. Ltlgal Owneqs) AnNOr Aut�or¢etl Appliwnt iODE � INSPECTIOHTYVj 1676 Fue63yttemFln��Fh9PCe� r i.. '. 72E6 Paai S(ie qneL� � ': � 2�0.' FlnNReRool �.� '`� ' _- 1 201. ' i Fk181 BIocIJRetaining W all i('nr > -�l . 202 ?� Fkml Pgaory Fuo P� a ` `� '"�: 203 \ ' I5) u. • �.., i '. };,�d 2Da `Fh410artwMdm '�{1 t'_J� D�TE INTRIAL � . 06— � '. , 1 I's -z . ,ti� �'- . : s.�n:L ._ , ti �.�.'� CODE � INSYEp10N TYPt 20BT�FNW M4BC11�n�Ni 20B -finat P �wnmlrg I. .. - I 210 -F'melElectrical 2 t 2'.•�. Floel FM Prav I. � .. �' � ��.i.S! . �F." � 220 �FInalPlei+ning 27t�:. FfnalSite f J ' ✓' I 250 - Flnel Builtllna/I �l Tin nuis � �•--�-� i'--^— � ` ti/ 'i�'-� ' f . �_ �� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. 60X 917 C06TA M68A. CAL�FORNIA For Applicanf fo Fill In Complefely TYPE OR PRINT aoo e�s"s 3265 Iowa St. , COSTA MESA CALIFORNIA � MAIL SOlI SC TEL. TEL. Ll 8-1159 NO. ' No. oF BLDOB. FIRE ZONE APPROVED ZONB � L60AL �� S /L-Ee t � .- APPLICATION FOR PERMIT BUILDING For Office Use Only rsece�wr no. epj71T NO. ,i �Y�lf � .er 1 nwra aece�vxo .�I owre �ssuso COSTA MESA. ZONING NO. OR U86 OP N6W PLAN9 n B1111DIN0 . IP1NSiAE TM SO� REAR VARD �1� F O�eRLIN6 ei.> RD I LEFT � I RIGHT S� q SIDE DESCRIPTION OF WORK __ WALL NO. OF 1 HllilBY ACKNOWLEDGE THAT 1 XAV6 IiEAD TXIB MPLIGTION THE AMOUNT BXOWN UNOHP VALUATION IB POR TN[ AND BTATe THAT TN8 A60VE 18 COPPECT AND AGREE TO COM- pUfiP09G OP eBT�BLI8HIN0 A PHqMIT F6E ONLY. PLY WITH ALL CIiY OFpINANCEB ANC HTAT¢ LAW9 HEDULATINO au1tAIN0 CONBTRUCTION. VALUATION SIGNATURE OF �/ PERMIT FEE $ �6. PERMI7TE T� S l�j�]_�].• PLAN CHECK $ 18 AUTHORIZED AGENT Dike & Colegrove� .u1C• TOTAL FEE 54•