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Home My WebLink About921 JASMINE CIR - Building Permits-: . (714) 754-5273 • Fax (�14) 75a-4e56 • www.ci.costa-mesa.ca.us 77 hA1H UHNt, GU51 A MtSA, GA'JZti2E PLUMBING PERMIT Job Address: 921 JASMINE CI Suite No Vicinity: FRONT YARD Parcel Nunmber; 41218306 Applicant: RADACK, FREDERICK Fddress: 3059 GIRD RD FAI.LBROOK, CA Owner: RADACK, FREDERICK W TR Atldress 3059 GIRD RD FALLBROOK, CA Contractoc OWNER-BUILDER Pddress: Arch / Eng : Address: Phone: (760) 728-0392 Zip: 92028 Phone: (760) 728-0392 Zip: 92028 Phone: Zip: License: 0 Phone: Zip: License: SCOPE OF PERMIT INSTALL LAWN SPRINKLER SYSTEM & BACKFLOW PREVENTER. � FEE SUMMARY ' ;� AMT QTY AMT ISSUE FEE . 523.50 � �" �' Laundry Tub / Washer� $0.00 Backflow irrigation 50.00 1 Landscape Irrigation $14.80 Backflow Preventea �`� :,$9:80�; � 0 ; P-Trap ; $0.00 Bathtub . , 50.00 , - 0., � �� o Pressure Regulator „ $0.00 Clarifer System � ;�$0.00�-�/ 0 ' Process Piping (per 10 ft)� $0.00 Connect Qce,Soda,etc) .50.00 0 � Receptors $0.00 Dental Units 50.00 0 ' Septic Tank $0.00 Dishwasher 50.00 0 � Sewer Cap for Demo $0.00 Drain, Roor $0.00 �� 0' ��•. Sewer Connect $0.00 Drain, Rainwater 50.00 " 0- �. , Sewer Private Line $0.00 Drain, Roof $0.00 0 �� :: Shower $0.00 Drinking Fountain 50.00 0 ' Sink, bar $0.00 Expansion Tank 50.00 0 Sink, commercial $0.00 Gas Ea«hquake Valve 50.00 0 Sink, Floor $0.00 Gas (1-4 outlets) 50.00 0 Sink, kitchen $0.00 Gas (Over a outlets) 50.00 0 Sink, service/mop $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 Gas Service 50.00 0 Spa (public) $0.00 Interceptors (Grease, Oiq 50.00 0 � Interceptors (Sand Auto ) $0.00 0 an 0 1 0 0 0 ` 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS ISSUED BY: Status: ISSUED Applied: 06/26/2001 Issued: O6/28/2007 . � Sump Pump � � Swimming Pool � �� -� Trap Prime�/� � i' �' Urinal : �' � i, j � - Vacuurti Brkr Bkflo�4(1=4) � � Vacuum Brkr BkFlovi(5+) � Wash Basin' � - Wash 8asin Set � Waste and Vent System Water Closet (ToileQ , Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 548.10 Qrv 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related I regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all � required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448-46(fl�00) WORKERS'COMPENSAnON DECLARATION: . � I hereby attirm under penalry ol perjury one of the following declarations: ❑ I have antl will maintain a certificate of consant to sel4lnsure for workers' compensation, es providetl Por by seaion 3700 of the Lebor Cotle, lor tha pedormance of ihe wark for which Ihis permit is issuetl. ❑ I have antl will maintain workers' compensatla� Insurance, es required by section 3700 0l the Labor Code, for the peAortnance ot ihe work for which Ihis pertnit is issued. My workars' compensation Insurance carne� end policy number ere: Carner. Policy Number. (This secfion need nat be complefed il (he permit is veluetl et one hundred dollars �$100) or less.) ❑ I certify that in the Oertormence of the work tor w�ich this pertnit is issuetl, I shall nol employ any pereon In eny manner so as to become subject to Ihe workers' compensation laws of Celifomia, entl egree that if I shoultl 6ecome sub�ect to the workers' compensetlon provislons of Saction 3700 ot the Labor Code, I shell forihwith comply with ihese provisions. Applicent Signeture: Date: WARNING: FAILURE TO SECURE WORKERS' COMPEN9ATIOtJ CAVEMGE IS UNL4WFUL AND SFULL SUBIECT AN EMPLOYER TO CRIMINAL PENAlT1E5 AND CIVIL FWES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000f, IN AODITION TO THE �T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby eHirtn ihat I am licensetl under pmvision5 of Chapter 9(commencing with Section 7000) ol Divislon 3 of lhe Business and Professions Code, an0 my licanse Is in full torce entl eNect, lic. # Class A Cantractor's SignaWre: Oete: CONSTRUCTION LENDING AGENCV: � ❑ I hereby aftirm that Ihere is a constmction le�ding egency for the pedormence of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle). . Lendafs Name: Lende/s Aatlress: ' Signature: Dete: OWNER-BUILDER DECLARATIONS: I here6y attirtn ihat untler penelty of perjury thet I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Professlons Cotle: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair eny stmcWre, prior to its issuance, elso requires ihe epplicant for such permit to tile e signed statement t�at he or she is Ilcensed pursuam b the proNsions of ihe Contrectors Llcense Lew (Chapter 9(commencing with Seclion 7000) oi Divislon 3 0l the Businass and Professions Cotle) or ihet he or she is exempt therefrom ena ihe basis Por ihe ellegetl ecemption. Any vialatlon o� Section 7031.5 by any eppllcant for a permit �s`ubjecis the epplicant to e civil penalty of not morB than five hundred dollers ($500).): 0 I, as owner ol the propeny, or my employee5 wi�h weges es their sole compensa�ion, WILL DO THE WORK, and the stmcture is nol intentled or oHeretl lor sale (Sec. ��--7044, Business and Professions Cotle: The Contrectors License Lew does not apO�Y �o an owner of property who builds or Improves thereon, antl who does such work himselt or herself or thmugh his or her own amployees, provided �het such improvements ere not Intendetl or oMered for sale. II, however, Ihe building or improvement is sold within one year of completion, ihe owner-builder will heva the burtlen of proving that he or she did no� build or improve for purpose of sale.). ❑ I, as owner oi the property, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to cOn5lrucl Ihe projett (Sec. 7044, 8usine55 and Professions Code: The contractors License Lew tloes no1 apply to an owner ol property who builtls or Improves thereon, entl who coniracts tor such project with e coniractor(s) license pursuant to �qe Coniractors Sicense Lawa�. L�� Business ana Professions Code for this reason: �OwneclDvenl(ed by tlmets license. ❑ Yes ❑ No �Dn"vers License No. Venfication of Ownership by (type of daument, i.U. - property tax 6ill or deed)� "—� DIVISION OF INDUSTRIAL SAFETY PERMR CHAnFIGATION: �Expires: � '---� � ❑ I hereby ceniy Ihat no ezcavation five (5) or more faet in tlepth into which e person is required m descend, will be made in cannection with work euthorized by Ihis permit, antl that no builtling siructure, swHolding, lelsework, or demolition or tlismantling ihereot, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 345, TUe 8, Califomia Adminislrative Cotle). ❑ As owner-builder, I will not employ anyone lo do work which would require e permit Irom the Division ol Indusirial Safery, as noted above, unless such person has e permi� to do such work trom the division. Signawre: Date: Division of Industnal Safely Permit Number: CERi1FlCATE OF COMPLIANCE Mj0 AUTHOR17ATON.OF EMRY: I certily untler Denalry ot perjury t�at I have read this eppliwtion and state Ihat Iha infortnation given is correct. I agree to comply with f✓stete laws end �I� � rdlnences relating to huilding consiruction, end authorize representetives of ihe Ciry of Cost Mesa to emer upon the above-descnbed D�aPe spection puryose eqree t to occup or allow occupancy of eny building euthodzed by ihis permit unti inel �ns� �n. 6 r��Y Signature Oi Legal Owner(s) ' Dat �-�—_/� AndlOr Authodzed APp��CaM Date COUE L INSVECl10N7YPE 1616 Fixed System Final Fira Prevention 1266 Pool Spa Final 200 Fin01 Re-Roof 201 Finel Blak/Reteining Well 202 Final Factory Firo Place 203 Finel Sign 204 Final Demolition P�IE' INTRI�LS COOE 1 INSVECTION TYPE 206 Final Mechanical 208 Finel PlumDing 210 Finel Electricel 212 Finel Fire Prevention 220 Final Planning Approval 222 Finel Si�e 250 �FinalBuilding/Occupency P.aIE I[QIDdLfl V �' �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 9zszs JobAddress: 921 JASMINECI Suite: Vicinity: Parce�Number: 41218308 Applicane CHURCHILL, RICHARD Address: Ownec RADACK, FREDERICK W TR Address 3059 GIRD RD FALLBROOK,CA Contracror. CHURCHILL CONTRUCTION Address: 4425 FOREST GLEN RD CA ANAHEIM Zip: 92807 Arch : Address: Phone: Zoning: R1 R1 Phone: 760-723-7050 Zip: Phone: Zip: 92028 Phone: (714) 974-0456 License: 660990 Eng: Address: ISSUED BY: Status: ISSUED Applied: 10/09/2000 Issued: 10/09I2000 Phone: Zip: License: License: SCOPE OF PERMIT REMOVE SHAKE ROOF. INSTALL NEW SHEATHING. INSTALL 25 YR COMP SHINGLES. Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.51 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Totai: $125.76 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Lek 0- 0 Lek 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0- 0 ss,ioo.00 ss,ioo.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and relatetl regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pprmit shall automatically expire and become void it work is not commenced within 180 days, or it work is suspended or abandonetl for a period of 180 days. 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 flnal approval must be obtained. FaiWre to obtain inspec[ions and final approval will result in the expiration of this permit. �� FOR INSPECTIONS CALL: (714) 7545626 2d4&46 (6/00) WORKERS' f�OMPEN5A710N DECLARATION: � 1 here6y aflirm und6� penalty ot perjury one of tha following tleclerations: ❑ I have entl will melntein a certificete of consent to selFlnsure tor workers' compensation, as provided for by section 3700 of the Labor Cotle, to� the peAormance of Ihe work fOr whicn this permit is issuetl. ❑ I have erW will maintain workers' compensation Insurance, as required by section 3700 0l Ihe Lebor Code, for the performance of the work Por which this pertnit is issuetl. My workers' compensation Insurance carner and policy number are: Cerrier. Policy Number. (This secfion need na� be com0/eted il fhe permit is �alued ef one hundred dollaro ($700) or less.) ❑ I cartity that in ihe perfortnance ot the work to� which this pefmit is issued, I shall not employ any person in any manner so as to bacome subject to the workers' compensation lews ot Calilomia, and agree thel II I shoula becomo subject to the workers' rqmpensation provisions ot Saction 3700 of Ihe Lebor Code, I shall torthwit� camply wilh Ihese prOvi5ion5. Applicanl SlgnaNre; Date: WAFNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEfUGE IS UNL4WFUl AN� SHALL SUBJECT Ml EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TFKKISANO Dq1ARE 15100.0001. IN ADDITION TO THE COST OF CAMPENSATION, DAAIAGES AS PFiOVIDED FOR IN SECiION 3)Ofi OF THE LABOR CODE, INiFAEST, pND ATTORNEI"S FEES. LICENSEO CONTRACTORS DECLARATION: I hereby aXirm that I am licensetl under provislons ol Chapter 9(commencing with Section 700�) ot Division 3 ot tt�e Busioess and Protessions CotlO, and my license is in full farce antl eNecL Lic. M Class # Cantracmrs SignaW�e: Dete: CONS7RUCTON LENDING AGENCV: ❑ I hereby attirm ihat there is a consiruction lendinp agency lor the pedormance oi Ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lentlers Name: Lentlers Address: Signawre: Oate: OWNER•BUILDER OECLARAt10NS: I hereby aHirtn that Under penalty of perjury ihat I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the Following reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires a permit b consiruc6 elter, improve, demolish, or repair any stmcture, prior ro its issuance, also requires the applicant for such pertnit to fila e signetl siatemeni Ihat he or she Is Iicensetl pursuant Io the provisions ot Ihe Contrectors License Ww (Chapter 9(wmmencing with Section 7000) ot Divislon 3 ot the Business antl ProfeSsions Code) or that he or she is eaempt therefrom antl tha hesis for ihe elleqed exemption. Any violation oi Section 7031.5 by eny epplicanl tor a pertnit sublec�s the applicen< <o a civil penalty of not more ihan five huntlred doilars (5500J.): ❑ I, as owner ot the propeny, or my employees with wages as their sole compensation, WILL 00 7ME WORK, and ihe simcWre is not imantletl or oHeretl tor sale (Sec. 7044, Business and Professions Cotle: The Contrectors License Law does not apD�Y �o en owner ol properry who builds or improves Ihereon, and who does such work himself or her8etl or �hrough his or her own employees, provided �hat such impmvements ere not Intenaetl or oHered tor sale. If, however, ihe building or impmvement is sola within onp year of completion, the owner-builtler wiil heve ihe burden of proving thet ha or she did not builtl or improve for puryose oi sele.). ❑ I, as owner of the properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business entl Protessions Cotle: Tlie wn�recrors License Law Aoes not apply to en owner of properry who builds or improves thereon, antl who con[racis tor such projacl wl�h e coniractor(5) license pursuant to the Comractors license LawsJ. ❑ I em exempt untler sec. Signature: Business and Prolessions Code for Ihis reason: Owner ID venfied by drivers license. ❑ Ves ❑ No Drivers License No. Vedticetion ol Ownership by (rype oi document, i.e. • pmperty tea bill or tleetl): Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I here6y certify ihet no excavetion five (5) or more feet in depth into which a pe�son is required to descentl, will be made in conneaion with work authorized by Ihis permil, and that no building structure, scalloltling, falsework, or Oemoli�ion or dismantling thereof, wi�l be more �han ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, COlifomia Adminis[rative Cotle). ❑ As owner-builder, I will nat employ enyone to do work which would require a permit from the Divisian of Industnal Sefery, as noted above, unleu such person has a partnit to do such work From ihe division. Signeiure: Date: Division of Intlusinal Safety Permii Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I certify under penalry of perjury Ihat I have read this applica�ion antl state thai �he infortnation given is correct. I agree ro cOmpty with all state laws end ciry ordinances relating to 6uilding consWc�ion, antl euthonze representaiives ot I�e Ciry of Costa Mesa to enter upon Ihe above-described property for inspection purposes. I egree not to occupy or allow occupency ot any builtling authonzed by this pertnit until finel inspection. SignaWre Ot Legal Owneqs) Date AnNOr Authonzetl Applicant CODE A. INSPECl10NTrPE 1616 Fixetl Sys�em Final Fire Prevention 1266 Pool Spe Finel 200 Finel Ra-Rooi 201 Final8locWPetaining Well 202 Final Faciory Fire Place 203 Final Sign 204 Final Demolition �jF AL %�— LO-CU � CO�E{ NISPEC�ION�`fPE 206 Finel Mechanical 20B Final Plumbing 210 Finel Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Sita 250 Final Building/Occupency � •. t am_ . ✓ December 10� 1973 Ah�. Calvin 921 Jasmine Cr. Coeta M�ese� CA L .` Desr Afr. Ce].vin: �� A building permlt Las been issued to Sunset Poola to constnict a privste se mml.ng pool on your property. In order thet your r+ill be a saYe one and for the purpose of advieina you of ur recponsibility regarding the requirements of the Coata Mesa Munlcip¢1 Code, we refer you to Sectiott 81 a copy oY rrhich ia attached. �is lette s directed to you in order that you will be avure of our ohi ces end can c�nke u comp2ete safety check of your pool azea. RH:bh sincerely yours, RICBAiiD HANHpRT Director of Building SeFety H. '. LAWMASTER � CO, INC. i940 MAIN STREET — STANTON, CALIFORNIA 73CM5-1066G-002 ,- 828-8040 XXX Field Data on Test Specimens Core Concrete Gunite Grout/Mortar projecT Ralph Calvin Pool • Permit No ��"� Project Location 921 Jasmine Circle, Costa Mesa Contrador Sunset Pools Architect Location in Structure Paol Engineer Date Moulded 12/12/73 No of Specimens 6 Slump Specimens Marked' � Specified Strengih at ZB days ZO�� P.5.1. Mix Designation 1:4 Age to be tested �_days 28 �ays �ay's days READY MIX PLANT Jabsite AGGREGATE SOURCE Weaiher Condition Good • 1 Yd. CemenT Monolith TYPe I/II Cement, Ibs. Admix None Sand Specimens made by Enter rise Gunite #4 Data by Gail Haker #3 Delivered by #2 Date Delivered # REMARKS: Water, Gals. Lab. No, fI Oate of iest Specimen Dimensions Area Ultimate Load Lbs, per sq. in. H/D Corrected FORM M - O15 73 - 3709 72/19 6.�9 X 12.5 29.13 73,50❑ 2523 73 - 3710 7 Day TesT 12/19 5.89 X 12.5 27.25 71,000 2606 _Yd. Batch �UllQll�G SAFETY p � C 2 11973 73-3711 73-371 73-3713 73-3714 7 Day Test Dav T.est 12/19 .OS X 12.5 28.75 91.500 3193 Nat re ,,...-„' .,� r d �,�/ CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT N0. � � IAT N0. / � ' ADDRES S-Y� .�-� DATE �� The developer o£ the above entitled tract.desires to aell the above set forth lot prior to the time that the tract has been completed and its streete accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he-glxe-t-lxey-}�(was �*+ - ��,��,.o advised that this tract has not been given final inspection nor has it been accepted by the City of Coata Mesa as having coanplied with the conditions ot approval which were imposed by the City at the time the final tract map was approved. The City asstunes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to'indemnify and hold the City hazmlese from any claim resulting in damage or peraonal injury to'the undersigned by reason of the aforemenCioned uncompleted condition. ; ; _ � , .�_ . , i� , . R E G E I:'.�V:FE'Dr:;:. �� CITY.OF C��L�. �`1ESA,.,..:: ,'i' ; �: ?' ' . � �. ,. :', :',i ...;., ,., .. JlIN .i� -�.7{, ;' �I��J'I�J�.•�.� .. r . . � � . . '. �' .' '' . � ' 1.ij�,:,,;,' �: :, . 7i8�9iIDi�ll�12i1�2�3i,4i�;i6,,; � . � , ' � ;, , , , : $Y � l � � Purcha r BY �%%�a �� /,��y'i�v — Developer and or authorized representacive SY �G'Cv /,c/%�.�u�,�• Lender OWNER CALYIN, Ralph DATE u-27-73 V ^'NERAL CO No.4l?—1 ll INSPEC710N5 � Pooi Location .� Forms _ Main Drain _ Steel Reinforce Elec. Bond _ Approval to Cover Underground Electric � Gas Pipinq Test Filtering System Lines � Backwash Lines and Recep. Electrical Final ' er and Vent Final �. Fiiter System Final Backwash and Recep. Final Fencing Final Date .Zo. r•s�n��u[a VAL SUBCONTRACTOR E Plumbing 3 `-'� n � ` '� /"�� vnv 27-73PA'`001019Y ��39.5Q CNY COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 P TION FOR BUILDING PERMIT For Applicant to Fill in Completely REC IV V DAT BU�LDING � B � ADDRESS � A.P. NO. � OWNER � MAIL BUILDING ADDRESS �10DRE55 Z . / W W � TEL TRACT d U CITV NO. ZZ Q CONSiRVCTION W AD A O � LENDER d m J � BRANCH " � OWNE � AODRE55 m Q ARCHITECT /, TEL � S� � -� OR ENGINEER N U Q � FIRE - W CL ADDRESS � + 20NE T d w •APPPO V E D J O CONTRACTOR 'BY ' � m Z .� J � ADDRE$$ �_ � TEL.. _�� ZONE / PLANS � Z � CITY NO: ( w O STATE CITV �'AFlOS APPROVEO y� �IQ NO. LIC. NO. -�a MAIN BUILDING _� SIZE NO.OF BLO('aS. (FROM C/L STREET) OF LOT NOW ON LOT RONT FT. VSE OF EXI5TING BLDG. F SIZE OF NO. OF Z NEW BLOG. FOOMS STOfilES L. SIDE FT. UEXTERIOR WALL ROOF , COVERING COVERING REAR FT. USE OFbBUI�DING AND WORJC TO BE �EFFORMED DISTANCE BET. 4 MAIN BLDGS. Q VAR. # O C.U.P.a{'+ � APPROV � N Z O VI heraby acknowlatlga [hat I have reatl this application antl state � that the above informetion is correct antl agree io comply with � ell laws regulatinB builtlin8 �onsttuction, antl I shall not employ F any person in violetion of the workman's compensation laws of y the State of Celifornie. ZI hereby cerilfy that I em properly licenutl as a contractor untler SQ. FT. [he State of Califomia Businesz antl Profezsions Cotle, Divisicn 3, THE AMOVNT SHO� Chapte• 9, antl [ha[ soch licansas ara in full force antl eHect, or 1 THE PVRP�E OF E5 am exempt from Uie provisionz ot the State ot Calitornia Business VALUATION antl Professions Cncia, Division 3, Chapter 9. Sie�eture of� �--,�� '� � � � Perminee �/Y1 4 _ $ / Authorizetl ABent USE OF NEw�"jf/ � BUILDING SlL)//ii I YARDSAPPROVED ACCESSORV BUILDI � �� DATE APPROVED 'li_ 'y m T�^�` � 0 JATION IS FOR � 2MIT FEE ONLV: m ¢ lm N �'U ] m � `o LL 93 � 351I� COSTA MESA BUILpING-SAFETY DEPARTMENT P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING � 7 / Z . ww aU F- Z Z F O tn am ¢ . m J •m J Q UN Z a w� aW WZ J Q m Z J � W w � ZH W � �O F z Q �. a Q Q H N Z O F- U � � �"' N z OWNER MAIL c�rv Encino, Calif. No.-gg6=889 CONSTRUCTION LENDER Larwin Southern Calif. eaaNCH 16255 Ventura iBlvld. aooaess Encinq, Calif. AFCHITECT � . _ _ TEL...... . . � aooaEss y1UU wiJ�shire, Beverly H111 CONTFACTOFi Larwln SOutheYn Calif. ADORES516255 Ventura Blvd. c�TY Encino, Calif. NoJ86=8890 LIC. No. 191311 LICYNO. B_1 512E NO.OF BLDGS. OF LOT ](� X 1�3 NOW ON LOT Q USE OF EXISTING B�DG. SIZE OF NO. OF NEW BLDG. Z3S�F ROOMS STOFIES 2 COVERINGALL `St'U�`C COVERINGWd. SYIIRCJI2 USE OF BVI�DING AND WpRK TO BE PERFORMED Construct sincile'f RECEI A.P. NO. BUILDING AD�RESS NUP�S'7iPAIOOO�O�iP'�`' *��71.ZU cnsn 1TION FOR BUILDING PERMIT Y DATE RECEIVED DA E ISS I i` �- PEIiMI^NO l0T l� I BLOCK FIRE ZONE TVPE GROUP APPR D BV DATE � 2 ZONE ,� ' NO.OF USE OF NEW �J[(� 'LG fY4 1/�'-' / PIAN$ BUILDWG , 1 . ��/ E I�llii VAR�SAPPROVED VARDSA PROVE� MAIN BUILDING ACCESSOfiV BUILDING (FROMC/LSTREET) , , VAR.# c.u.v. ;� I hereby acknowledae ihat I nave reaa tnis application antl staxe F.j�LD FOR $ that [he above intormatio� is correct antl agree to comply with all Iaws regulating builtlin9 construction, and I shall not employ any person in violation ot the workman's compensation laws of ffie Stare of Galifornia. 1 hereby certify [hat I am p�op¢rly licensetl az a contractor under SQ' the State ot California eusiness antl Professions Cotle, Divisicn 3, THE AMOUN' Chapter 9, antl that such licenses are in full force antl affect, or I THE PURPC6E am ezempt from the provigions ot the Siate ot Calitornia Business VALUATION antl Professions Code, Divis�on 3, Chapter 9. Signatur¢ of Permittee 1 �t,� D. DOWi1S $ ��///� (4�% Auffiorized Agent & DATE APPftOVED � T. D o SHOWN VNDER VA�VATION IS FOR IF ESiABLISHING A PERMIT FEE ONLV: m ¢ ,�3� m PERMIT FEE $ � J m PLAN CHECK $ � E '= LL TOTAL FEE $