HomeMy WebLinkAbout3214 IDAHO PL - Building Permits�
��' CITY OF COSTA MESA
BYILDING DIYISION
�
77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-4856 �• www.ci.costa-mesa.w.us
FOR INSPECTIONS CALL: (714) 754-5626 . �
PERMIT NUMBER` E07-00783
PERMIT TYPE ELEC STATUS: ISSUED
DATE ISSUED: 09/07/2007
' ' ° � ' ; 'ISSUED BY: BJK
JOB ADDRESS: 3214 IDAHO PL CM SuitelUnrt
Vicinity: ti
SCOPE OF WORK: ADDITION OP�A SUB PANE�L UB��TO 200A AT AN EXISTING SFD�-NO OTHER�WORK AUTHORIZED WITH THIS PERMIT.
OWNER:
PHONE:
APPLICANT:
PHONE:
.., ,. r.-,: ,: .
FAUBIONFAMILYTftUST� � '-�Address: 32141DAHOPL=-Umt .n `--
714-434-1464 � �' �-: City/State/Zip: ; COSTA MESA CA ' �
FAUBION�; PAT � - � � Address. �:.:3214'IDAHO PL Unit: - -. �
714-434-1464 � �_� � � City/State/zZip: ��COSTA MESA,'CA ` -, ,
CONTRACTOR: OWNER-BUILDER :���- � � - � � - License No:`:-� 000000 �
Address: Unit:�:� F� �..: �7..PHONE.," -� �� � , ,�:_, , ..,... �.'. �-.. '�:
' � � Code ��� .CELL,�:
City/State: � .�, j,, _ :� .LP: ,. . � . :... .. . -: � .. � " �. _ -' =
�
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee. ' s ,: $0.00
Electrical Permit Fee: ;', $64 00
Reinspection Fee -'$0 00
TOTAL FEES - "- $54 00 ;
` .. .
,. ;
• .
'
, '� .
NO710E: 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: 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 wmply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and f nal approval will result in the expiration of this permit.
CO�E d. INSPEC710X TVPE
1616 Pixed System Final Fire Prevention
1266 Pool Spa Final . . -
200 FinalRe-Roof -
201 FinalBlocWRetaining�Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
ORTE INTITIRLS
COUEt INSPELl10NTYPE
206 Final Mechanic2l
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuildingi0ccupancy
�ATE ' IN7171AL5
� �
WORKERS'COM �NSATIONDECLARA�
I hereby affirm under penalty of perjury one o owing tleclara[ions: '�
❑ I have and will maintain a certifcate of consen[ [o sel(-Insure for vrorkers •
compensation, as provided tor by section 3700 of the Labor Cotle, for me
performance of the work (or which.this'permi[ is issued. �
❑ I have and will maintain wvrkers' compensation insurance,.as requiretl by
section 3700 0( the Labor Code, (or [he peRormance of the vrork �for'which this�
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carrier
(This sedqn neetl rrol be mmple(eC d the permd is valu¢d af One huntlretlWllars (Sf00) a less.)
Policy Number:
I certify that in ihe performance o( Ihe work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
hecome subject to the workers' compensation provisions of Section 3700 of
the Labyy Code, I shall forthvn[h comply with [hese provisi s.
/I/'�' 21��---- y 7 �7
Applicants SignaWre oa�e
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 DOLL4RS
($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 that I am licensed under pmvisions of Chapter 9(commencing
vnth Section 7000) of Division 3 of the Business and Professions Code, antl
my license is in full force antl eHect.
Lic. # Class #
Gontractor's SgnaWre Oale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrtn lhat Ihere is a construction lending agency for the
performance of the work for wfiich this pertnit is issued. (Sec. 3097, Civil Code).
L.ender's Name:
Lender's Atldress:
OWNER-BUILDER DECLARA710NS:
I hereby affrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Pro(essions Code: Any ciry or county which requires a permit to
construct, alter, improve, tlemolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
tha[ he or she is licensed pursuant lo ihe provisions of the Con[ractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of ihe
Business an0 Professions Code) or Ihat he or she is exempt [herefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of no[ more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and the strucWre is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or throu9h his or her own
employees, provided that such improvements are not intended or oRered for
sale. I�, however, lhe building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of provinq that he or she
did not build or improve for purpose of sale.).
� I, as owner of the �property, am EXCLUSNELY CONTRAC7ING WI7H
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Pro�essbns Code: The coniraclors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts for such project with
a contrectw�s) license pursuant to the Contrac[ors License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Cotle for ihis reason:
� � 9 ,�I
SIB�aWre � Dale �
305]-46�3I0]� '
r. +
Owner ID verified by tl nse. � Yes ❑ No
Driver'sLicenseNo` $�( Expires: ��
Verification of Ownership by (rype of tlocument, i.e. - propeny [ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in deplh into which a
person is required to descend, will be made in connection vnth vrork authonzetl
by this permit, and that no building structure, sca(rolding, falsevrork, or demolition
or dismantling thereof, will be more than thiAy-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 347, Title 8, Califomia Administrative Code).
❑ As owner-huiltler, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from [he division.
Fpplicanfs Signalure
Division of Industnal Safery Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or NWre builtling occupant need to file antl
certify a Business Plan for emergency response to ralease or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, wi[h some
exceptions, that a Business Plan be filetl with the Costa Mesa Fire
Department by every business which has a� any one lime tlunng a reportetl
year a quanlity of hazardous materials equal to or greater ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applican[ or present or future building occupant need lo file
a regis[ration form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the California Heallh and Safety Cotle, wilh some
exceptions, requires regis[2tion with �he Costa Mesa Fire Department by
each business which a[ any one time has on hand a quantity of aculely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feel of compressed gas at standard
temperature and pressure). �
3. Does or will the applican[ or present or fu[ure building occupanl need to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Sa(ety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire DepartmeM o( an RMPP by 6usinesses which are required
[o register acu[ely hazardous materials wi[h �he Fire Deparlment.
4. If an RMPP is presently required, has Section 25534 of the California
Heal[h and Safety Cotle been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
lhe vrork which is the subject of this applica[ion a permit (or such conslruction
or modifcation tmm the South Coas[ Air Quality Management District or (rom
any other air pollution control district or agency4 ❑ Ves ❑ No
(Sec['ron 658502 of [he Califomia Govemment Code requires [hat the requested
infortnation be fumished on applications ta non-residential building permits).
6. Will any part of the facility to be constmcted under this permit be within
1000 feet from Ihe outer boundaries of a school? ❑ Ves ❑ No
Qt'yes", Ihe faciliry must meet the requirement of Sections 25534 antl 42303
of Ihe California Health and Safety Code).
7. If a pertnit from the South Coast Air Quality Management Dislrict or other
air polWtion contml district or agency is required for lhe work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
8. (It'yes", attach certificate of compliance from 1he appropriate air polWtion
conirol oKcer�. , _
CERTIFICATE OF COMPLIANCE: I certi(y Ihat under penalry of perjury lhe
information given above is cortect I agree [o comply with all stale laws antl
ciry ordinances regarding Hazardous Materials and Emissions. �
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury [hat I have read this application and sta[e Ihat
the information given is correcL I agree to comply with all state laws and cily
ordinances relating to building construction, and authonze representatives of
the City of Cos[a-Mesa to enter upon the above-descnbed property for
inspection rposes. I agree not to occupy or allow occupancy of any huilding
authoriz `y�per it until faal inspection. ��ja �
����
SignaWreofLegalOwner(s) Da�e
Antllor AutM1onzetl AOGlicant
, .
; .. �
_ �
L'c't.cy °� L''-oa,�a %'Zeda v�iu;�'duuy Diuio�a�
OWNER-BUILDER
y�4°"" �� � VERIFICATION
�D 7-00 7�z
Address: ��1 / Permit #: ( ��
A city or coun�y, which is required to give notice pursuant to Section 1983Q shall attach to such noticc, and, as
a condition precedent to issuing a building pemiit, require the completion and require the retum of, �n o��ner-
builder verification.
Attention Property Owner.
An 'owner-builder' building pem�it has been applied for in your name and bearing your signatum.
Please complete and retum this infonnation in the emelope provided at your earliest opportunity �o a�•oid
unnecessary delay in processing mid issuing your building pemiiL No buildine pemiit �vill be issued u»til this
verification is received.
I. 1 persanaily plan to provide the m �or labor and materials for construction of the proposed
property impro�•ement. ❑ Yes� No
2. (have/h •e not) siened an application for a building pemiit for
h osed �vork.
�1 ha�•e contracted with the following person (firni) to provide the propused construction:
I�ame r n �-/ TCvh- l' �E��r; ��! ,� �
Address 07 �)a,� 3} L H City ��.s �F%ti 9L7b1-:5 25
Phone ( 7/ �h 6 7 5- �`! S� Contractor's Lic. No. �� � b 4��
4. 1 plan to provide portions of the ��•ork, but I have hired the following person to coordinate,
supervise and provide Ihe major work:
Name
Address
Phone (
City —
Coi�Vactor's Lic. No.
5. 1 wi!! proride some of the ti�ork but 1 have conirac�ed (hired) thc follo�vine persons �o
provide Ihe work indicated:
Namc Addmss Phone Tcpe af ��'ork
10d2-<6 (Rev. 11I041
� • 1 � ' ' R
� CITY Of COSTA MESA ,
.
BIIILDING pIV/SION
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(�14) 754-5273 • Fax (714) 754-4856 �• www.ci.wsta-mesa.ca.us
�. FOR INSPECTIONS CALL: (714) 754•5626
�m�
PERMIT NUMBER. E07-00782
PERMIT TYPE ELEC
JOB ADDRESS: 3214 IDAHO PL CM
Vicinity: SVS AT RIGHT-REAR SFD
STATUS:
DATE ISSUED:
" ISSUED BY:
- • Suite/Unit:
SCOPE OF WORK: CHANGE-OUT OF AN ELEC SERVICE IN AN EXISTING SFD. 1 SVS TO 200A
NO OTHER WORK AUTHORI2ED WITH THIS PERMIT. -
OWNER: FAUBIONFAMILYTRUST
PHONE: 714-434-1464
APPLICANT: FAUBION, PAT
PHONE: 714-034-1464
CONTRACTO R: OW N ER-BUILDER
Address: Unit:
CirylState:
PHONE:
ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
ISSUED
09107/2007
BJK
-Address: 3214 IDAHO PL Unit:
Cily/Stale/Zip: COSTA MESA, CA
Address: 3214 IDAHO PL Unit:
Ciry/State/zZip: �COSTA MESA, CA
License No. 000000
CELL:
� ; ' � ��
,
�;�, a. - .
NO710E: The work authorizetl by this 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 authorized 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 final approval will result in the expiration of this permit.
CODE/, ixsvEcnoNnre p� i� L4PE� lx3pecnoxrrre � p� ixmu�s
7816 FixtW Sys�em Final Fire Prevention ZOB Firal MeUanical
1286 Pool Spa final ' 208 Final Plumbing ��
200 Final Re-Rool 210 Final Electncal
201 Final Block/Retaining Wall 2/2 Final Fire Prevention
202 Final Factory Fire Place . 220 Final Planning Approval
203 Final Sign 222 Final Site -
204 Final Demolition _ 250 Final BuilEing�Occupancy �
r .. �
WORKERS' COMPENSA710N DECLARAT�
I hereby a(frtn untler Denalry of peryury one o owing tleclarations:
❑ I have anC vnll main�ain a cerlifiwte o( wnsent to sel4lnsure for vrorkers'
compensation, as provitle0 for by section 3700 ot the Labor Code, for the
peAormance of the work lor which this pertnit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of ihe Labor Code, for the peAormance of the v.ork for vmich Ihis
permit is issued. My workers' compensalion Insurance carner and policy
number are:
Carrie[
(IDis seclqn neatl nd �a mmdetetlA(he peimAk valuetl at one �urWiCtl tlpNars (5100) wless )
Policy Number:
�.�? I certify that in the pedormance of the work (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe workers' compensalion laws of Califomia, and agree that i! I should
become su � cl to the wvrkers' compensation pmvisions of Section 3700 of
the Labor de, I shall f iwith compty with these provisi ns.
9 ���%
Apdinnt s Sipnawre Oa�e
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDRION TO THE CAST OF CAMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions of Chapter 9(wmmencing
wilh Section 7000) of Division 3 of t�e Business and Prolessions Code, antl
my license is in full force and effect.
Lic. # Class #
Comrac�or's SipnaWre
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn lhat there is a consln�ction lentling agency for the
peAwmance o( the work for wfiich thds pertnit is 5sued. �Sec. 3097, Civil Code).
Lender's Name:
Lenders Address:
SignaWre �ale
OW NER-BUILDER DECLARATIONS:
I hereby a(frm that under penalty ol perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ne following reason (Sec. 7031.5.
Business and Professions Cotle: Any city or wunty which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ihe applicant lor such permil to file a signetl Slatement
lhal ha or she is licen5ed pursuant to the provisions o( the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pro1e55ion5 Cotle) or lhal he or 5h8 i5 exempl lhBrelrom and
the hasis for the alleged exemption. Any violation of Section 7031.5 by any
applicant lor a permit subjects the applicant Io a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with waqes as their sole
compensation, WILL DO THE WORK, antl the strucWre is not intended or
ot(ered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes not apply to an owner o( property who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, provided that such improvements are not iniended or offeretl for
sale. If, hovrever, the builtlinq or improvement is sold within one year of
complation, Ihe owner•�uilder vrill have the burden of provinq that.he or she
did not build or improve for purpose of sale.).
� I, as owner of the propeAy. am EXCLUSIVELY CON7RACTING WI7H
LICENSED CONTRACTORS to conSWct the project (Sec. 7044, Business and
Professbns Code: The contractas License Law dces not apply to an rnmer of
property who builOs or improves thereon, antl who contracis for such project wilh
a canlracla(s) licen5e pursuant ro the Cont2ctors License Laws.).
❑ I am exempt under sec.
Business and Protessions Code for this reason:
�/Y� L�^�`- °�/ 7�0 7
SignaWre Da�e
� . i
Owner ID verifletl by dri se. � Yes � No �
Dnver's License No. ' F�cpires: �%
Verification of Ownership by (type of document, i.e. - property lax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: .
❑ I hereby certily Ihat no excavation frve (5) w more leet in tlepth into wfiich a
person is required to descend, vnll be made in connection with v.ork authorized
by Ihis permit, and that no builtling structure, scaHdding, falsework, p demolition
or dismantling Ihereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp
2. Ari 2. Sec. 341, Ttle 8, Califomia Administ2tive CoOe).
❑ As ovmer-builder, I will not employ anyone to do work which woulC
require a permit from the Division of IntlusMal Safety, as noted above, unless
such person has a permit to tlo such work trom the tlivision.
ApPlicanl's SgnaWm
Division of Intlustrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or (uNre builtling occupam nee0 to file antl
certi(y a Business Plan (or emergency response to releasa or threateneC
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health antl Safery Cotle requires, with some
exceptions, that a Business Plan be filed wiih the Costa Mesa Fire
Depanmenl by every business which has at any one time tlunng a reportetl
year a Quantiry of �azardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas
at standartl temperaNre and pressure).
2. Does or will the appliwnt or present or future building occupant need to file
a registration form tor acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 0/ the Califomia Health ana Safery Cotle, with some
exceptions, requires registration with the Costa Mesa Fire Oepartment by
each business which at any one time has on hand a quantity o! acutely
hazardous materials equal to or greater than a weight o( 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
tempereWre and pressure�.
3. Does or wiu (he applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevention Program lor acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provitles that Ihe
Costa Mesa Fire Department may require the preparation, certifcalion antl
filing with t�e Fire Department of an RMPP by businesses whiU are required
ro register acutely hazardous materials with the Fire DepartmeN.
4. I! an RMPP is presently required, has Section 25534 of the Calitomia
Health and Salety Code been fully complietl with7 ❑ Yes ❑ No
5. Does or will Ihe applicant or present or future building occupant require for
lhe HOAc which is the subject ol lhis appliwtion a permit for such conslruction
or motlification Irom the South Coast Air Qualiry Management District or from
any olher air pollution conlrol disMct or agency? ❑ Ye5 ❑ No
(Seclbn 65850.2 of Ihe Calilomia Govemment Cotle requires Ihat Ihe requeSteG
infortnation be fumished on applications for rao-residential buildifg pertnits).
6. Will any part of tha facility to be constructeC under this permil be within
1000 feet !rom Ihe outer bountlaries ol a schooll ❑ Yes ❑ No
(If yes", the lacility must meet the requirement of Sections 25534 antl 42303
of Ihe Calilomia Health and Sa(ery Code).
7. If a permit from the South Coast Air Qualily Management Districl or other
air pollution coNrol district or agency is required for the work wliich is tha
subject ol this application, have all o! the disclosures prescribed by Califomia
Health and Sa�ety Code Section 42303 been madel ❑ Yes ❑ No,
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correcL I agree to wmply with all state laws and
city ordinances.regartling Hazardous Matenals and Emissions.
SignnWrc Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application antl state Ihat
the inlormation given is correcL I agree to comply with all state Wws and city
ortlinances relaling to building construction, and authonze representatives ol
the City of Costa Mesa to enter upon the above-described pmperty for
inspection p rposes. I agree not to occupy or allrnv occupancy ot any builtling
autnonz� this pp,rmit unti� ��a� i�spe�6on. �% �/G�
li✓ �// y.� ��
�urealLegalOwner(s) Date
3051�66(3/O)) qnC/orAut�onz¢OApp�WN Date
/ . . �
v Q-� / �l/VK.(�(IN �,//(�QG% � ���
� V �
OWNER-BUILDER
�'"'"� VERIFICATION
�0 7-00 7�z
Address: �1 T Permit #: ( ��
A city or county, which is rcquired ro give notice pursuant to Section 19830, shall attach ro such notice, and, as
a condition precedent to issuing a building pemiit, require the completion and require the retum of, an owner-
builder verification.
Attention Property Owner: \
An `owner-builder' building pemiit has been applied for in your name and bearing your signature.
Please complete and retum this inforniation in the emelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building pemiit. No buildin�perniit will be issued un[il this
verification is received.
1. I personally plan to provide the m jor labor and materials for constn�ction of the proposed
property improvement. ❑ Yes� No
2. (have/h e not) signed an application for a building pertnit for
osed work.
�3� I have convacted with the following person (fimi) ro provide the proposed constniction:
C� Name Y n/-✓ �Gv�- l%i�G�r; �-� �r+-�
Address P9 ���� 33 L y City� y,s �%%ti 9Z7b/-33 29
Phone ('Jl"h 67 �'- � `f5 � Contractor's Lic. No. �� ? � ���
4. I plan to provide portions of the work, but 1 have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City _
Phone ( ) Contractor's Lic. No.
5. 1 will provide some of the work but 1 have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Nork
t042-06 (Rev.tt/04)
��
�
�
June 18, 1970
Mr. R. R. Hodson
3214 Idaho P�ace
Costa Mesa, California
�
Dear Sir:
� A building permit has been i ed to Sir Pools to con-
struct a private swimming pool on your property.
In orde�r that you ool will be a safe one and Por the
purpose of advising you your�responsibility regarding the
requirements of the Costa sa Municipal Code, we rePer you
to Section 8107, a copy of which is attached.
This lett is directed to
be aware of our inances and
check oP your pool rea.
RH:dh
you in order that you will
can make a complete safety
Sincerely youra,
RICHARD HANHART
Building Safety Director
i1N5vECilON 6 iESi1NG ENGINEE0.5
CMEMICnL 6 Ppy51C�1 �N�LY515
RADIOGRAVNY Y.p/.y GAMMA R�T
i.0. �e. �) • ll�o �i�o.,� w,�
Le.p ��.aF, C.Iff. G0101
pul �xsuss • pul e�anu • I��•� �n.e�3i
S�nc. 1896
NFSEANCM 1 ENVI�ONUENTwI TESTIN6
C04ROSIOH EN6INEENIN6 \ ANALT515
ULTRASONIC 4A6NETIC 1 �ENEI4�NT
1611.0 N�r1A H�.p�. 51r���
5��1• A��. C�I1(�r�i• 13)0]
pi�� �v.nx
Examination: SC70-4036
COMPRESS�ON TESTS ON GUNITE CYLINDERS
L. E. Sprague
2133 Miramar Drive
Balboa, California 92661
PROJECT
ADDkE55
SAMpLE FROM
All[HITECT
FNOIMEER
MIX
DATE CAST
DATE TESTED
CYIINDER NO.
COMPRESSION
TOTqI IOAD, LBS.
POUNDS PER SQ. IN
R. R. HODSON
3214 Idaho, Costa Mesa
i7c�ap end - Shallow end - Bond beam
CONT�IICTOR
Sir Pools
sueconra�cro�
Grove Gunite
SPECIFIED
Gunite STRENGTH
7-3-70
7-10-70
7
7-Day
93�000
3•156
7•10-70
9 .
7-Day
90,0�0
3.465
SIZc:
J-10-]0
11
]-Ddy
97�500
3.450
2,000 ps1
�i7 6-t/6�� x 12�y��
il9 5-3/4�' x 12 z�
q11 6" x 12��
8�'HOLD" 10"HOL�" 12"HOLD"
COMPLIANCE 7-Day test complies with specifications.
uUp( �Y OEIIVE�ED �Y lECFIVEO ON
CYLINDERS �• E. Sprague L, E. Spraguc 7=6-70
��C�I\1�D
BUILDING SAFETY DEPT.
DIfTRI►UTION:
sir Pools JUL 13 1970
ID15 North Parker, Orange 92667
L. E� Sprague - 2 •ti�� PI�
Costa Mosa Bldg. Oept. i�9i9�h1,ll,12,1�2'��',�,�'��
e
�
• w[e0o�5 �oE 5..l��l�[O �5 Tr�( COMfID(NTI�L VMOI[qTY Of <LIEN15. �ViMOAIl�iION lOI� YVOLIC�TION Oi OVP PFVOYTS. COMClU610Mf OM C�
\P�Cii �4�� fl4 w[f.�nO�'�G ir�(u �5 ALSInJlO I[NO�NG OUF WRIttCN I.VPPOV/.L �S � NUTU�L PROTECTIOM TO CIICMTS. �NE PJll1C .�NO OVNfCLV[1
3J0 )
........ ..� ..... .., ....... ...
p JOB AC
V GENER
�AP No.
�INSPEC
501 L
GNS
W ATER
PROP. SwR. LINE Q HOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH HEPTING RND RIR GONOITIONING
TEMPORARY SEPVICE OR VOLE
UN�ERGROUN� � POWER �
ROUGM WIRING
TRENCHES FORM$ STEEL REINF
F�OOH SYSTEM
BONO BEnM STEEL pEINFORCE
SMEATNING
FRAME AN� FLFSHING
LRTHIHG — IN � OUY ❑
PLASTER. BROWN COAT
STRUCTURFL, FINRI
MEATING, VENT., REPRIG. /ND A.C., FINI.L
PLUMBING, FIN4L ANO G�5 TEST �/j/�']
P�T
' ELECTRIC, FINAL
BUILOING, FIN�L
iui o. u[;
�RACT FIR
VNIC � � ��
_.o�e icen
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant ro fi!l in Completely
BUILDING
ADDFESS Z � � -Z. �C7 Ci •
�
OWNER .� N � Ii •
MAIL
Z ADDRESS ,'i ry 'i �C �
W W TEL. �j
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aW
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� w TEL.
ZF CITY �d5 .,,r� i r,o. /7��'�
w � STATE CITY
�� LIC. NO. Zj �. LIC. NO.�
7 � SIZE NO.OF BLDGS.
OF LOT NOW ON LOT �
VSE OF
EXISTING BLOG.
F"' SIZE OF NO. OF
Z NEW BLDG. ROOMS If STOFIES �
U EMERIOR WALL ROOF
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VI haraby acknowletlpe that I heve read Nis epplicetion antl state
� thet the obove information is corract and apree to comply with
� all laws regulating builtling construction, antl I shall no� amplay-
� any parson in violation o� [ho workmon's compensatiOn lows Of
y the Stete of Celifornie.
ZI hereby certify [hot I am prOperly licensatl es a tontrector un0or-
Ne Stnta of California B s ontl Profaulons Cotle, Divis(cn 3,
Chaptar 9, antl [hat sucM lican s are In fuli ntl atfect, or I
am esampt trom tl e provisions �o[ f C ornia Buslness
antl Protessions Cnc� , ivli% , Ch ptar 9. ////n///� �
Slpnatare of ,{�`�,. //G `
Perminae ��!
Au[horizetl Age t
R
L P.1 I � ` {`. �
`'FR -7-7 � ��,�0 759 +�Z7.5�
FOR BUILDING PERMIT
SE RECEIVED DATE ISSUI
2- 7 _
A.P.NO. /�`%�(itYi�-
BUILDING .'�.�
ADORESS h C.. / �
)fy€ NO.OF
e PLANS
VARDSAPPROVED
MAIN BUI�DING i
ROM GL STREET) y
VAR. #
THE AMOU�
TNE PURPO6f
VALUATION
$
/`'�(4
d
DATE I � � �
USE OF NEW
BUILDIN � a /
YAFDSAPPROVED
BET. MAIN &
ACCESS. BlU
DATE
APPROVED
R
TOTAI FEE $
� m
0
ON IS FOR �
FEE ONLY: m
,�) ¢
(7 �+ m
N
7
� E
� �
/ LL
!
UwNtK HODSON, R. R. DATE 6-17-70
JOB ADDRESS 3214 Idaho Place BUILDING PERMIT N0. a�a�o
TRACT 3F?5 FI
GAS
W NTER
ROWH PLUMBING � �,u
PROP. SWR. LINE HOUSE N.
SPRINKLING SVSTEM
MISCELLANEOUS �
ROUGH HEATING AN� Alft CON01 IONING
TEMPORARY SERVICE Oft POLE
UN�ERGROUNO POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF. �
FLOOR SVSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AN� FLASHING
LATMING - IN n OUT n
PLASTER,BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST �
ELECTRIC, FINAL
6UILOING, FINAL
SUBCONTRACTOR
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COSTAMESABUILDINGSAFETYDEPARTMENT lUtJ17-70�y5pOOi873�`� tr***39.CC
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
ForApplicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
RECEI DATE REC IVED DATE ISSUED
no�oa°es"s 21� Idaho P1. � �C'� �7 �-J���7I���
OWNER ��R• Hodson A.P.NO. ��—UJ" ��D P 7(/
MA�L l] ADIDRIE s 214 fdaho PZ•
ADDRESS 21� Idaho f 1• [
CITY Costa Mesa N��6-7066 TRACT3625 LOTJO BLOCK
CONSTpVCTION W A D
LENDER jSn�'CmWYl X
BRANCH
OWNER A�A• Hodson
AODRESS
sePr. Swimmin Pool"'s 096.50
ORENGINE RTgbAUlt TE �3z-518o
N
FIRE
ADOFESS 1 � 1 Pros ect Ave Santa A �ONE TVPE GROUP
CONTRACTOR SST POOZS ByPROVED ' DATE ` — �
ADDFtESS 101 N. Parker,
CITV Orange NO`.538-0068 ZON� ( P����C BUILDING EW `
STATE CITV VARDSAPPROVED VAROSAPPROVED
IIC. NO. 'Z Q �1 LIC. NO.'LQ ]_ MAIN BVIL�ING ACCESSOFV BUILDING
SI2E NO.OF BLOGS. (FROM C/L STREET)
OF LOT O NOW ON LOT FRONT FT FT.
USE OF
EXISTING BLDG. S E T T
512E OF 6 NO. OF Q�
NEWBlOG.OZ�L ROOMS STORIES L.SIDE FT. FT.
EXTERIOR WALL AOOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLIX9S.
VAR. #` DATE
PT'. SwimIlling POOl c.u.a.� APPROVED
APPROVED i / O
4•
I hereby acknowledBe Mat I have reotl this application entl itate
[hnt the abOva informa[ion i3 correct antl egree io comply wiffi .
ell Inws r¢Bulating builtlinB comttucNon, entl I shell not amploy
uny person in violation ot tha workmen's compensa[ion lews of
tho Stato ot CalifUrnla. m
I hereby certity tPet I em properly Iicenaetl as a contractor untlar SQ. FT. o
the State of CalitOrnie B�ainoss entl PrOfessions Coda, DivisiGn 3, THE AMOUNT SHOWN UNDER VALU/+TION IS FOR
Chepter 9, antl th9i such Iicanms ere In f�ll force antl ef}e[t, or 1 THE PURPOSE OF ESTABLISMING A PERMIT FEE ONLV:
m
om oxompx fram she provisions of tha State ot Ca�i rnie eusinosa �
VALVATION '7/
antl Professions Cvde, ivis. n 7 Chapter 9. GERMIT FEE 5 tYlO / � � �
POBmlttae�( 5�' OgGj � PLANCHECK 5 /✓ D O E
/ o
LL
Authorizetl ABant TOTAL FEE 5 i d 6
�OWNER RODSON, R.
�ti JOB ADDRE55 �11� I
ROUGM PLUMBING
PROP. $WR. LINE n HOUSE CON.
UN�ERGROUNO I� POWER
TRENCHES �f FORMS � STEEL REINF.
FLOOR SYSTEM
FRAME AND FLASHING
�
PLASTER, 6ROWN COAT
BUILOING. FINAL
DATE
BUILDING PE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
paln
�fAY 20-6S�MSA001141� ��**34.50
P.O.BOX1200 COSTAMESA,CALIFORNIA92626
For Applicant to Fill in Comp/etely APP��CATION FOR BUILDING PERMIT
RECE�I/V 8V DATE FECE/IVED DATE ISSUED
BUILDING p� C.� � /� S -( S��'-�
AODRESS bL-
�. � Iv ` - _ P MIT O.
OWNER A.P. NO.
MAIL BUILDING
ADDRESS ��I � ADDRESS �.�
CITV �% � Q_ m e � NOL�J JIO /OG TRACT � LO BLOCK
CONSTRUCTION W A A P
LENDER
�
BRANCM
OWNER
ADDRESS ,h � • VALUE e r///D
ARCHITECT TEL. S �Cf� i^ao s � 70
OR ENGINEER
FIRE
A�DRESS 20NE TVPE GiiOUP
APPROVED !
CONTRACTOR - • C+" BV DATE � �(�
ADDRESS
TEL. ZONE NO.OF USE OF NEW i
CITV NO.
PLANS BUILDING
STATE CITV �'AROSAPPROVED VARDSAPPROVED
�IC.NO. LIC.NO. MAINBVILDING ACCESSORVBUILDING
SI2E NO.OFBLDGS. (FROM /LSTR ET)
OF LOT NOW ON LOT Rp FT.
USE OF
EXISTING BLDG. 5 FT FT
S12E OF NO. OF
NEW BLOG. ROOMS STORIES L. $IDE FT. FT.
EXTERIOR WALL ROOF
COVERING COVEflING REAR T. FT.
USE OF BUIIDI G ND WORK TO 8 ERF RMED DI5TANCE BET. BET. MAIN &
�i � i MAIN BLDGS. ACCE55. BLDGS.
\ VAR.# DATE
C.U.P.#'� APPROVED
� APFROVED
I hare0y acknowlatlBa that I have read this application entl rtata ��:� �
that tho ebove intormation iz corract antl apree to comply wlth
ell laws rap�locinp buildinB �onstruction, antl I shall not amploy
eny parson in vlolation of the workman's compenaation lawf ot
the Srota ol Celltornle. �
I horeby cartify thet I nm proparly licensetl ea a eonttecror untler /�O SQ. FT. � i
the Stato of Cali(ornia Busineis antl Profeulons Code, Dlvisicn 3, THE AMOVNT SHOWN UNDER VALUATION IS FOR
Chapter 9, entl Nat such licansas ere In �ull force and Biiect, or I THE PUFPOSE OF FSTABLISHING A PERMIT FEE ONLY: �
am oxompt from tha provisions o( the State of Cellfornlo 8usines!
antl Profosslons Cotla, DlvlsiOn 3, Chaptar 9. VAIUATION 2 g' O O
� ,/ Oa PERMIT FEE 5 � '.
Sipnaturo of�^�/ /. / �' t-�/ /� /�� J-t ' S� C //' / f PLAN CHECK $ ��� s O ��
Pormltmo � � ..1�. � , r , L ,
��7� ' d � (O
Autharizatl Apant �
TOTAL FEE $ ' S G
AP No. 1 -084-04 LOT 6 TRACT
INSPECTIONS Si nat�
soi�
GAS
WATER
ROUGM PLUMqING
GROP. SwR. LINE � HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEpUS
POUGH HEATING AN� AIR CONOITIONING
TEMPORARV SERVICE OR POLE
UNDERGROUND � POWER �
ROUGH WIRING
TRENCHES FORMS � STEEI REINF. �
FLOOR SVST�M
BONO BEAM STEEL REINFORCE
SHEATHING
FRAME ANO FLASHING
LATHING - IN OUT
PLASTEF, BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AN� GAS TFST �
ELECTRIC, FINAL
_...._..._ �..._. .,A7i—
DATE
SUBCONTRACTOR
19�:7L1�I
'... �. "• 298�8 iiAli 26-G4crisa00 655 o***,r*5.0�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
ForApplican[toFillinCompletely qECE1VEDBV DATERECEIVED
I� D TE ISSUED
BUILDING - �7/ �/Q�
ADORESS I L �Ci Q oG(I GO/
OWNER � A.P. NO. � � QO ' P O
MAIL ADIDRE 5 3�- I J /DA�o L�
Z ADDRESS ' C
�-U CITV NO` TRACT �cS LOT BLOCK
ZZ
Q CONSTRUCTION NEW ADD P
O � LENDER �
d m
J � BRANCH
J N OWNER
m J ADDRE55 VALUE
m ARCHITECT TEL. SE S
J a OR ENGINEER N
U � FIRE � �-)"
wa 20NE TVPE GROUP �•�
� A�DRE55
4- W APPROVED
W Z CONTRACTOR (� hJ N. � BV DATE
J Q
m z
J � A�ORE$$ a
W w TEL. �ON NO.OF USE OF
Z� CITV ,N NO. OI(� I — PLANS BUILOIN�
w � STATE CITV �'ARDS APPROVED VAR�SAPPROVED
y� LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
� O (FROM GL ST�)
SIZE � 1 NO.OF BLDC.S.
OF LOT �[ � NOW ON LOT � FRONT FT.
USE OF
EXI5TING BLDG. S O T FT
F' SIZE OF 1 NO.OF �Je-
Z NEW BLDG. � X IO ROOMS STORIES L. SID FT FT.
U EMEPIOR WALL ROOF �.
COVERING COVERING REAR FT. FT.
J USE OF BUIL�ING ANO WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
a MAIN B�DGS. ACCE55. BLDCS.
a
Q ' VAR.aW DATE
O L � �� _ C.U.P.# APPROVED
� APPROVEO /
N
z
0
VI heraby acknowledge Net I hava read this application and stete
� that the abova information is corract entl agrea to comply with \
� all laws regulating builtling consvuction, antl I shell not employ
F any person in violation of She workman's compensation lews oi
y the State of California. m
�
z1 heroby certify that I em properly licensetl as a contractor untler S�. FT. o
the Stete of California Business entl Professions Cotle, Divisicn 3, THE AMOUNT SHpWN UNDER VALUATION IS FOR �
Chapter 9, antl chet such licensos ere in full torce antl etfec[, or I THE PURP�E OF ESTABLISHING A PERMIT FEE ONLV : Q
am exempt trom the provisions of the State ot California Businass VALUATION
antl Profassions C e, DiviSion 3, Chapter 9. W
�.��'�L�/�C��'K'u'l/ �' �f -V� PERMIT FEE $ �
J
Signature of � m
Perminae 5�' O �� PLAN CHECK 5 "'�' E
0
Autharizetl Agent �y,.� LL
TOTAL FEE §�. (/ V
OWNER R. FIpDSON DATE S�Zg�gp
JOB ADDRE55 3214 Idaho Pl. BUILDING PERMIT N0. 50146
AP No. 139-084-04 LOT TRACT FIRE ZONE VALUI
INSPECTIONS Si nat��e Date TVPE GROU
soi� SUBCONTRACTOR
ATER
)UGM PL
'RINKLING SYSTEM
ISCELLRNEOUS
)UGH NEATING ANO AIR CONOITIONING
OERGROI/ND �J POWER Lf
UGM WIRING
ENCNES FORMS STEEL REINF.
OOR SVSTEM
NO BERM �J STEEL REINFORCE ❑
EATMING
AME ANO FLASMING
iMING - IN n Ol1T n
HEATING. VENT., REFRIG. RNO R.C., FINAL
PLUMBING. FINR� ANO GRS TEST �
ELECTRiC, FINAL
BUILOING, FINAL
F
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W
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F
COSTA MESA BUILDING-SAFETY DEPARTMENT pPPLICATION FOR.STRUCTURAL PERMIT
' P.O.BOX1200 COSTAMESA,CALIFORNIA92626 luii ❑/eoiou 5_�
REC€�VEp_BY PERMIT t��
For AppGcant to Fill in Completely — Use Ink Only A� !� �`�
BUILDING 3a� � D/� A.P. NO. '3 � �
ADORESS 7
BUILDING
OWNER OR AOORE55 G •
TENANT
VNIT OR
MAILING $PACE NO.
ADDRE55
TR.NO. I.OT BLK.
TE .
CITV NO.
NEW ADD ALTER REPAIR MOVING DEMOl15H
CONSTRUCTION
LENDER
BRANCH
OWNER
ADDflESS VALVE
ARCHITECT TEL. VSE E
OR ENGINEER
ADORESS ZONE TVPE GROUP
APPROVED
CONTRACTOR BV OATE
ADDRE55 /
T G
CITY � N � �
APPROVEDSETBACKS
LIC. NO. ���'-3 LICYNOp�I�QO'3
SI2E NO.OF BLDGS. (FROM C/L STREET)
OF LOT ^ /� NOW ON LOT / qOM FT.
USE OF N 2 � , // „.
EXISTING BIDG. /�_,�LC�OL..Y/Y) F ,
Separa[e permits are required for L SIDE FT.
electric, plumbing and heating work.
PEAR FT.
USE OF BUIIDING AND WORK TO BE PERFORMED PLqfVNING ACTION
yq�y � DATE
(/ (J �ROVED
APPROVED
I hereby ecknowled0a that I hava reatl this applicetion antl state �
that the above informetion is correct anG aBrea to comply with
all laws regulatlnB builtling construction; and I shall not employ
any penon In violation of Ne workman's compenution lews of �.
Me State of Calitornia. -
I hereby certify that I em prope�ly Iicensed as a eonirector untler SQ. FT. �
the Stata of Celitornia Business antl Profassions Cotla, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR i
Chapter 9, entl Nat such licenses ere In full force antl affact, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempt from Me provisions ot the Stnte of California Business VALVATION
antl Profass(Ons Co , D(vision 3, Chap PERMIT FEE E
' O� PLANCHECK S �
Signature of i
Parmittee 5 TAX S
or i
Authofizetl Agant Dato TOTAL PAID E
� TL
�OT 5b - TRACT 3bz5
.. � " � 1�.�:5�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEHA. CALIFOiWIA
For Appllcanf fo Fill In Complefely
TYPE OR PRINT
BUILDING ?2�� IDAHO PLACE
ADDRESS .J
COSTA MESA CALIFORNIA
owNER KENKOL COtS TRUCTION CO.
mp�L �555 P�ACENTIA AVENUE
ADDRE65
arr NEwPORT BEACH No`MI O'32f
K•W• KOLL
NEWPORT BEACH
�7 NOI"II V-}cc�
' QQ I NO. OP lLpQB.
USE OF
EXISTING BLDG
BeTBAGK LIN! PNtlM 5O �
CeMeR aP BTxeeT REAR YARD
SIDE YARD ILEFT � IRIGHT �
DE5CRIPTION OF WORK
81ZE�ING � 5g55F NO. OF 6 �
ROOMS STORIE6
E7CTERIORWAL� IROOF WOOD SHINGLES
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
SINGLE-FAMILY RESIDENCE AND ATTACHED
GARAGE PIAN 3-C
BUI�DING
ZONE
�
LCGAL
�`` FE� RECEIVED
.��`�. s-ia-� �,
FINANCE DEPT.
CiTY OF COSTA MESA
APP�ICATION FOR PERMIT
- euaci�t�� ,.
For Office Use Only
MECE�PT NO. n PPRNII:NO.�'
�ATE 189UEO
CASTA MESA,. CALIFORNIA
ZONING
Ho. oF use or
PLAN9 •� -OUILDIp
YARDS
APPROVED
(C6NTER LINe 9TJ
AePPROVED /�/
S;
� �.
I HER88Y ACKNOW�3D08 iHAT 1 HAVE READ TH18 MPLIGTION
AND 9TATE TXAT TX8 ABOV6 IB CORHEGT AND A6REH TO COM- TNe AMOUM BHOWN UNDER VqLU�T�ON IB POR TH¢
PURP09E OP EBTABL�BHINO A PERMIT FEE ONLY.
PLY WITH ALL CITY OR�INANCEB ANO eTAlE LAWB p80ULATNO
Bu�tD�No coNeTRurn VALUATION /
SIGNANRE OF PERMIT FEE $ �(� �
PERMITTE / '" p J e
n (1 _ �_2�\_ S �(�j vOJ' � PLAN CHECK $ �� r
( �/�/vl
AUTHORIZED A ENT � S � O
TOTAL FEE 4
ht
�..;
: