HomeMy WebLinkAbout2110 FEDERAL AVE - Building Permits 7iL'�c - CITY OF COSTA MESA
4 BUILDING DIVISION
}? •ale•�, PERMIT NUMBER
F t �....ia DEVELOPMENT SERVICES.DEPARTMENT
i�� PERMIT 1 Ph�_00855
(714)754-5273 • Fax'(714)754-4856 • www.ci.costa-mesa fy3MBING PERMIT 7TFAIR.DRIVE,COSTA MESA,__ CA 92626
Job Address: 2110 FEDERAL AV Status: ISSUED ,
Suite No Applied: 11/10/2005
• Issued: 11/10/2005
•
Vicinity: BATHROOM
Parcel Nunmber: 42245408
Applicant: GARY SEELBINDER
Address: 6 VIA FELICIA ISSUED Y:_
-` - Phone: 949-770-2913 v.
RANCHO SANTAMARGARITA , Zip: 92688 • '
. -1 ..
Owner: CANNON, STEVEN C ' , •
Address -PO BOX 30748 • -
• :; ,. Phone: r .
' • "TUCSON AZ, - Zip: 85751-0748
Contractor • SEELSBINDER PLUMBING
Address: 6 VIA FELICIA
Phone: 949-770-2913
'RANCHO SANTA-MARGARITA Zip:- 92688
License: 606458
' SCOPE OF PERMIT - • "
REPLACE BATHROOM FIXTURES: 1 P-TRAP, 1 SHOWER,1 WATER CLOSET.
•
•
FEE SUMMARY
AMT ' QTYAMT' •• -QTY i AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump - $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 -0-- Swimming Pool $0.00 0
Backflow Preventer $0.00 0 ' P:Trap $9.80 1' Trap Primer $0.00 0
Bathtub $0.00 0 / ' Pressure Regulator " - $0.00 0. •- . Urinal $0.00 0
Clarifiier'System • $0.00 0 - Process Piping(per 10 ft) -$0.00. 0' - Vacuum Brkr Bkflow(1-4) $0:00 0
Connect(Ice,Soda,etc) $0.00 0 • Receptors -„ - - $0.00 0- - Vacuum Brkr Bkflow(5+) - $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 ' Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect :$0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater • . $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $9.80 1
Drain,Roof $0.00 0 Shower _-. $9.80 1 Water Heater/veno $0.00 0
Drinking Fountain - $0.00 0 Sink,bar-.' $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00_, 0 • Water Re-pipe -$0.00 0
Gas Earthquake Valve $0.00 0 Sink;Floor ' - - ' $0.00., r:0 _ Water Service $0.00 0
Gas(1-4 outlets) • $0.00 ' 0 " -- Sink,kitchen - . $0.00 0.. .:I Water Softener $0.00 0
Gas(Over4 outlets) $0.00 ' IL.: - Sink,service/mop.. $0.00 0 i • '-OTHER . ' , $0.00
Gas Repipe $0.00 . 0 •- Spa(private) - 'i'. $0.00 . ii 0 ' - .---VIOLATION ' . $0.00
Gas Service $0.00 ' 0 .. Spa(public) ' $0.00 0 ' -=� ' --PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 - 0• - _ ' . REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00. • 0
TOTAL CALCULATED FEES: $52.90
. ' COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized:by this.permit:shall comply with:all applicable handicap-access requirements.under.Califomia'statutes and related
• regulations, (Ord.No.9272841,12,21792)
-EXPIRATION:•This:permit shall automatically:expire:and'become void if work isnot commenced within 180.days,.or if work is suspended or abandoned-
for
oned
for a period of 180'days.
' INSPECTIONS: In:order for:the:work'authorized.under.this.permit to.be:considered legal,ssuch work-must.compy es
with-all applicable cod , and all
• 'required Inspections and 1inal'approval.must,be.obtained:Failure,to.obtain Inspections'and.final::approval will result-in the expiration off fh�,permit.
• 'FOR-INSPECTIONS':CALL:'(714)75425626 �/
.2446-46 WOO)
DECLARATIONS (— ; (~t
WORKERS'COMPENSATION DECLARATION: ' ' '
I hereby affirm under penalty of perjury one of the following declarations: •-' - .
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued. -
,0-,-I.have'and.wW:maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
,;.‘--Myworkejs'co pensatlo Insurance�crarrri and policy number are: 7 �7 (gy p—��J
,Carie-•=�_ fry/!7� : - P.SII NbmberrOO `-C /7 S C�co,-
*i(Th1s section need not be completed if the permit is valued at one hundred dollars($100)or less.) .rr-'---"'
❑ I certify that in the pedormance'of the work for • ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation la,2. .,California,arid agree th bd I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
complywith thes.••visions. , / _ •
CfApplicantSignature /A ata/.1�� IL/i Date---,,,././-7° - d� a
`` "WARNING:FAILURE TO SECURE 0*KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($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 affirm that I am lice ed under provisions of Ch:•ter 9(commencing with Section 7000)of Division1 3 of t-.�eBusin s and Pr essio s Cogs,and m Ii n e is in full
force and.effed-Licrkr-,, / A Class,q.` `-3 v
Conntrectofs.5lgnaturA•...•;A . ✓ k P t/ . _ - 1 --- rDa e: il' /l> —�cS' .,
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
-
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom 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 not more:than 've hundred dollars($500).):
❑ I,as owner of the property,or my employees w ges as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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 contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
O As owner-builder, 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 the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than 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 applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. agree no to occupy or allow occupancy of any building authorized by this permit until final inspection.
SignnOf i:•. Owner.' Date
741/2.14
7 ._^ hodzed'Applicanit :Dated/-w •-d C
CODE 0 INSPECTIONTYPE ' "' PAM' NTMIAL$ - 'CODE. INSPECTIONTYPF - - BTW$
1616 ` Fixed System Final Fire Prevention.. ' . - _. • 206 Final Mechanical ' __�'
1266 Pool Spa Final 208 Final Plumbing ID-Act-6.5 R- \A
•
200 ' Final Re-Roof ' 210 Final Electrical
•
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place - • 220 Final Planning Approval - ,
203 Final Sign - 222 Final Site
204 Final Demolition 250 Final Building/Occupancy -
CITY OF COSTA MESA
4 BUILDING DIVISION?
r-% y r we.... i 4 DEVELOPMENT SERVICES DEPARTMENT: PERMI1 NUMBER
f ..,
k j • PERMIT B05-02033
itb*Po.aroo IP
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaB,WLDING PERMIT 77•FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2110 FEDERAL AV Status: ISSUED
Suite: Applied: 11/10/2005
Vicinity: BATHROOM Issued: 11/10/2005
Primary Occ: R3 Type of Construction: V-N
Parcel Number 42245408 Zoning:
Applicant: GARY SEELBINDER
Address: 6 VIA FELICIA A _
Phone:. 949-770-2913 ISSUED BY: �/V�rp
RANCHO SANTA MARGARITA . Zip: 92688
Owner: CANNON, STEVEN C
Address PO BOX 30748 • '
Phone:
TUCSON,AZ . Zip: . 85751-0748 -
Contractor SEELSBINDER PLUMBING
Address: 6 VIA FELICIA -
Phone: 949-770-2913 -
RANCHO SANTA MARGARITA i+
Zip: 92688 License: 606458
Arch : Eng:ViliW'
Address: . . • • Address:
Phone: - • Phone:
•
' Zip: _ - License: - • License:
SCOPE OF PERMIT
TEAR OUT AND REPLACE GREENBOARD AND PLASTER FOR 1 WALL IN BATHROOM,INSTALL A NEO FIBERGLASS PAN FOR SHOWER.
FEE SUMMARY. -
Plan Check: $0.00 Calc Valuation: $6,000.00
Permit: $125.25 Claim Valuation: $6,000.00
SMIP Res: $0.60
SMIP Com: $0.00
Other $0.00 .
Inspection: $0.00
Total: $125.85 -
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 •. Required: - 0 Proposed: , 0 ' ' -
NOTICE: The work.authorized.by this permit shall-comply with afl applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12721-92)
EXPIRATION: This permit shall automatically expire,and become void If work is not commenced within 180 days,or it work is suspended or abandoned
for a period.of 180 days.
.INSPECTIONS: In order-for the work authorized.under this.permit tote considered.legal, such work must comply with all appy le codes, and all
:required Inspections and final approval must be.obtained.Failure to obtain inspectionsand final approval will result in the expiration of this permit.
.FOR-INSPECTIONS•CALL• (714)754.5626i
2446-48(6/00)
WORKERS'COMPENSATION DECLARATION: ' '
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
j3-1 have antl will maintain ti workers'compensation on Insu once,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued.
C Myworkers' n ati uraTncye Carrie !icy number are: "7'7O Z ^) /VC_Z0d--_
{ Carrier i� / ' "Policy Numbec G•'
1 -Mils-action nee f e mp/eted i the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance'of the work for of h this permit is issued;I shall not employ any person in any manner so as to become'Subject to the workers'
compensation law f alifornia,and agree that should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thes r isions.-pop /
-WARNING:
FAILURE T URE .f p Date.
/
`WARNING:FAILURE T URE WO COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN A DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 7708.OFTHE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereb affirm that I am II ensed under provisions of Che. :r 9(commencing with Section 7000)of Division 3_of.the.Busine .,nd Pr. :ss- s Code .nd lic:n-e 'n
-force a 'effect.Lk.# / jCI�+ — a / •
,Contrac b4sSi tura•rs/n i(/ _ D> : i
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
A..
OWNER-BUILDER DECLARATIONS:
1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom 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 not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure 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 work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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 contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e..property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, 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 the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than 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 applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes 8 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
B (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatur,Oi":'rte ner(s) Date
tidial-ha-67 ApplicaplA rDate,
CODE/ -INSPECTION TYPE ' ' ' QATF RiTIDAU CODE1 INSPECTION TYPE - PAIE ItIIIDAIE
1616 ' Fixed System Final Fire Prevention 206 Final Mechanical;
1266 Pool Spa Final 208 Final Plumbing
200 ' Final Re-Roof ' • 210 Final Electrical ,
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval -
203 Final Sign 222 Final Site •
204 Final Demolition 250 Final Building/Occupancy ' 110'062 “1414'\
N CITY OF COSTA MESA
4�, 9 BUILDING DIVISION
> .' , DEVELOPMENT SERVICES DEPARTMENT PE NUMBER
4 ' PERMIT
'1+.,,„nndb P06-00398
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2110 FEDERAL AV Status: ISSUED
Suite No Applied: 05/25/2006
Issued: 05/25/2006
Vicinity:
Parcel Nunmber: 42245408 ,,
Applicant: SEELSBINDER, GARY ISSUED BY: '
Address: 6 VIA FELICIA
Phone: 949-770-2913
RANCHO SANTA MARGARITA,CA Zip: 92688
Owner: CANNON, STEVEN C
Address . PO BOX 30748
Phone: .
TUCSON,AZ Zip: 85751-0748
Contractor: SEELSBINDER PLUMBING
Address: .6 VIA FELICIA
Phone: 949-770-2913
RANCHO SANTA MARGARITA,CA Zip: 92688
License: 606458
SCOPE OF PERMIT
REPAIR BROKEN SEWER LINE.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 .0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0, Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) . $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor . $0.00 0 Sewer Conned $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet(Toilet) $0.00 0
Drain,Roof _ $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 . 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 , Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 , 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 . -,Spa(private)" $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 • PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 . 0
TOTAL CALCULATED FEES: $48.15
-
COMMENTS I SPECIAL CONDITIONS
•
•
NOTICE: The work authorized 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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if 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)754-5626
2448-46(8/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
•
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
❑'�l.have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. r
.,, M\vorkers'your ensation Insurance carrier and policy number ere: / ��
C
.=er: `F '1 � APO • Polis Number �( (� �(� J
-'-section'need not e completed A the_permit is valubd at one hundred dollars MOO)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation la of alifomia,and agree that if I hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with rhes I io_ n�."
Appllqent Signature: vLL j- �,Qit� rgej5--�-2- 5--49 6 •
WARNINGSFAILURETO SECURE WO RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP OYEP4O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN A ITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
.berebyaffirm.tha.l.amlicens/etl-underyrovisjons of�cihhapter 9(commencing with Section 7000)of Division 3.o41he•Businesssand Pr es�iens Coge,and my license Is In full
10 ceranE effect-Lic.a-�3t�,,C0O� Y.�/i /Ape... `( -- .. l0 r
nlrect0irsrSignature: -?'I L4l ct�� +!Date: i.
d 1T
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom 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 not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or 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 work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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 contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ l am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, 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 e
permit to do such work from the division.
•
Signature: Date:
Division of Industrial Safety Permit Number:
•
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than 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 applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes 0 N
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
_� __ occupant
require
_._
5 Does or will the icAlt or(Duality
ar n building o oat yefor the work which is the subject this application a Nmit for such construction or modification
from the South Coast Alt Oaaliry Management District or from any other air pollution control district or agency? Yes IJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
._ _ ___.t........._. .— _._ -_.........__..._
6 Will any part of the facility to be constructed under this permit ie within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is •
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
gnature Of I Ow r( — ��^, ateC-0
'A -i nd/Or Authorized Applicant _- LF#Date; • _y Y
CODE! III$?ECRONTYPE P 11 15 CODE! INSPECTION TYPE DATE Its
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 5.2 -3 é r)KT
• 200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 ,Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition .. . , 250 ,Final Building/Occupancy
110RESS OF BUILDING: 2110 FEDERAL AV UHT: CITY OF COSTA MESA — BUILDING PERMIT
owNExSNANEIFte4ow"' CANNON, STEVEN C PERM NO: B 074517
ADDRESS' CANNON, SUSAN S
2110 FEDERAL AVE PERMIT NO: B 074517 PLAN CHECK NO: N GOVT: N SUPP : N
:OSTA MESA, CA 92627645-4923
APPL.SWUNG ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENtlNEER: UC.NO.: JOB DESCRIPTION : T/OFF & REROOF W/COMP . SHINGLES SQ FT: 2, 700
ARCH.OR ENG.'S ADDRESS: UNT:
CLAIM VALUE: 2, 700 . 00 CALC—VALUE: 2, 700 . 00 GROUP OCC : R-3 /M-1
CONTRACTORSNAME: A-1 ALL AMERICAN ROOFING ( 714 ) 546-7663
CONTRACTORS MMUNG 5024 KATELLA AV COMMENTS: SMOKE DETECTORS REQUIRED PER 91 UBC
ADDRESS: LOS ALAMITOS CA LIC.NO.: 693307 ******+E** -*******************K-***x************ ******+H+E*it-**********************
90720 UHT: 15D Z ON ING R EQUI R EMEN TS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am tensed under provisions of Chapter S SETB ACK S
(commencing with Section 7000)of Division 3 of the Business end Professions Code,and my Iioense is in full force and effect.
Ic.NO.: 065182 LIC.CLASS: C-39 UC.N 6 330]/ EXP : 06/96 MAIN BUILDING ACCESSORY BUILDING
/ FRN1': FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
e, -i/�9� Contractor: AG.��/
at1� LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
NER BUILDER DECLARATION:I hereby affirm under penaky of perjury that I exempt from the Contractors License Law for the •
following reason(Section 7031.5 Business and Professions Code:Any city or count which requires a permit to construct,after,improve. PARKING REQ: 'r P RO V: PARCEL : 42245408 Z N E: REF N O•
demolish,or repai any structure,per to ns bsuenco.aeo requires Iha applicanl for euch permil to fib a eigned etatemenl Ihel he m aha
\licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Di,eion 3 of the PLANNING NOTES> .
Arsine's and Professions Cada)or that he or she is exempt therefrom end the basis for the alleged exemption.My violation of Section �>{
7031.5 by any applicant for apermtsubjeds the applicant to a civil penalty d not more than five hundred dollars IMOD. **************it*db*************df RE***dE***dE***************************************
o I.as owner of the properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended D E V E ` L OP MENT SERV ICES R E Q U I R E M E N T $
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owner of property i Q
who builds or improves thereon,and who does such work himself or boreal or through he or her own employees.provided that such
improvements are cot intended or offered for sale,ft,however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
owner buiker will have the burden d proving he or she did not build or improve for the purpose of sale). •
❑ I,as owner of the properly.em exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
Professions Coda:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contrador(s)licensed pursuant to the Contractors License Law). •
❑ Iamexempt under Section: B.8 P.C.,for this reason; APPLICATION ISSUED BY: DATE: 11._x7
Date: Owner: ********************** • kir, y'*n ********4* 4*****
I do hereby certifythat I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y
25ep aAthnft«aM1ylmurewiUirgomttheAiivayl not MaanageentDi) 0.Resompycoatsaid emap ions eeremptfromtefor
se BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
2534, In mat Icer an mmnddgatiinhomlpant 11 I wIM ceone)n need tocomply
wonarud state
cedes
the requirements
provisions. PERMIT 54 . 00 . 50
Date: Applicant: SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedereliane: ISS U
❑ I have and will mmaintaina certificate of consent toeef'insure for nt
wvers'compensation.as provided for by Section 3700 of the Labor ISSFEE
w
Cada.for theporta/manceof the work fowNchthis permiisissued.
prBUILDING DIC > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
InkIhave and will maimain workers'compensation insurance,as required by Section 3700 d the labor Code,for the performance of the TOTALS----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00
ork for whits this permit is issued.My workers'compensation insurance cardand d polity number are:
1 Carrier: T.7AFRTV WI
Policy
EXPIRES REVENUE DIVISION TOTALS COLLECTED : 54 . 50 OVER/SHORT : . 0 .0
Pdiychamber: M C1111aq 4.'77r1r11 ti 04 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
,section need nor be completed I the permit is for one hundred dollars($fool or len.) 54 . 00 . 50
❑ I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to
become subject to the workers'compensation laws of California,and agree that E I should become bed to the workers' *******************************************************************************
m
compensation provisions d ion 3700 of the Labor Code.I shall hwnh ply wit I I N D I V I D U A L F E E B R E A K D O W N
7 Dere: /P-'i/-7 Applicant: .. /Y,{�
ming:Failure to secure workers'compensation coverage Is unlawful,an a Il subject an employer to trim(penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($100000),In adWlton tom ost of compensation,damages as provided for In
Section 37osolthe LaborCode,Interest,and ad �
orneynea. SFR 2700 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 700 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the pane is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I centy Mai I have read this application and nate that the above information is correct.I agree to comply with all dry and county ordinances
and state laws relating to building construction and hereby authorize representatives of this city to enter upon the ebove'menloned property
for inspection purposes.
ANDY MARSHALL
91 00191£15-30191816 TOT 54.0
4 Print ^,� DATE: 1G/tii55 Ti95: 10 10
/!/ /%%
Dale
Signature of Owner/Agent/Applicant/Co tat
(5151.40,W P) White-Buidig&Safety:Gran-Fle:Canary-APpicant:Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING / POOL 'PA
APPROVALS Permit# Date Inspector APPROVALS 9 Permit# �f Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, ❑ Undrgrnd.,Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-I Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas ❑Oil
25. Roof Sheathing k/y-q5- 6C/4 74. Overhead Hydro
26. T-Bar Ceiling (Structural{ & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32, Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
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 Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& GUILDINGb- 6U;u
48. FINAL PLANNING c D 4T
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
ORANGE COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT
636 North BUILDING
' • SANTA ANA,
CALIFORNIA
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
RECEIPT NO. P��ERRR MIT NO.
BUILDING , 5/C �r f
ADDRESS 2110 Ped P.rA1 l/� / /
SCHOOL DIST. RECEIVED BY DA E OF APPL. DATE ISSUED
OR TOWN /
NEAREST V -'13--.0 VVV G 'j54,--D
CROSS ST. Vi rtnri a St.-
O
u. BUILDING 2 // D �' "�vl' 0
z
OWNER OSAGE BONES, INC. ADDRESS �
MAIL 9363 WILSHIRE BLVD SCHOOL DIST.
£ e
ADDRESS OR TOWN L-�/fQ/(/�
BEVERLY HILLS TEL. CR.5436
CITY NO. NEAREST
CROSS ST.
ARCHITECT OR TEL 1,p(1 ZONE NO. OF TYPE I GROUP
ENGINEER(,A IN R MCKE RRACHER NOSY• 648et 41 / I PLANS I .� ' / 4_S
ADDRESS 2110 E. WALNUT ST. , PASADENA SETBACK LINE/e8O�kMi CENTER OF ST. 5
,1 /1 REAR YARD G'1 L. } SIDE YARD 16. .. 1
CONTRACTOR NEWPORT VISTA CO NO.LR. 5Y ■ APPROVED
1(R,^1l RVL� BY DATE
ADDRESS 9363 WILSHIRE BLVD., BEV. Ls CORRECTIONS
LEGAL I 72 I BLOCK 1 713
DESCRIPTION LOT NO.
(ATTACH METES & BOUNDS) _
TRACT
SIZE OF LOT 68.01010 I NOW ON LOT 0
USE OF I NO. OF I NO. OF
EXISTING BLDG. FAMILIES ROOMS
DESCRIPTION OF WORK
I X I ALTERATION I I ADDITION I 0
NEW a
/ p O
REPAIR I I MOVING I I DEMOLISH I I !! y
BUILDING2I0 sc.FT. NOO. OF / 1
-` I'
SIZE / ROOMS O STORIES (`f713'-
WALL ROOF COMPO
COVERING STUCCO I COVERING $HI NGLES
USE OF NEW
BUILDING RESIDENCE 4' dit Gfi„A `�e�
V
APPROVALS
FOUNDATION: LOCATION INSPECTOR4, DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS, L� I �/
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING A i
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS.
BRACING. BOLTS ...9..441-R -3'JI
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
LATH. INT. ,� fJ7/��
I
SIGNATURE OF NEWPORT V CO. LATH. EXT. ('l / `/
PERMITTEF y
AUTHORIZED AG f �Lt� ,r� /JI I� /�
PLASTER. INT. f�2ftj ?-2,--A:2
` PLASTER. EXT. A:-C4 :/ •FiP P•4 r,�..f
$ 5902.00 P- D. $ MASONRY REINFORCED l
FEE /4/4-
BOND
E BEAM
VALUATIONU ' //) —2 I
FEE FINAL -et/3 j` ',yd
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