HomeMy WebLinkAbout3326 FLORIDA CIR - Building Permits� • CITY OF COSTA MESA e "� i
BlIILDING DIVISION
77 FAIR ORIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax (7i4) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT TYPE B_ROOF2
APN: 13958201
JOB ADDRESS: 3326 FLORIDA CI CM
Vicinity: FLAT ROOF ONLY
Squares: 0 ., . - ,
PERMIT NUMBER: B09-00020
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
01/29/2009
RMD
$2,500.00
SCOPE OF WORK: PARTIAL REROOF. TEAR-OFF (E) ROOF MATERIALS, INSTALL HOT MOP ON FLAT ROOF ONLY (GAR4GE),
APPROX 7.5 SQUARES. _ , �.. . �
OWNER•
PHONE:
APPLICqNT:
PHONE:
MILLER, CHARLES M
AGUSTIN, VAZQUEZ �
949-812-2209 �
CON7RACTOR: PROFESSIONAL�ROOFiNG
Address: 17431 TEACHERS AVEUnit:
City/State/Zip: IRVINE, CA 92614
ARCHITECT:
ENGINEER: �
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$83.25
$0.00
$1.00 .
$84.25
Address: 3326 FLORIDA CIR
City/State/Zip: COSTAMESA,CA
Address: 17431 TEACHERS AVE
City/Stale/Zip: IRVINE, CA
License No.
License No.
PHONE:
License No. 9263T6
'949-612•2209
CELL:
PHONE:
PHONE:
Unit:
Unit:
NOTICE: The vrork authorized by this permit shall comply with all applicable handicap access requiremenLs under Califomia statutes and relatetl
regulatiqns. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRqTION: 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
requiretl inspections and final approval must be obtained. Failure to obtain inspec6ons and final approval will result in the expiration ot this permit.
COOE1. 1�svecnaxme � ��1171AL5 c� ixsvEc�vrrre p� innna�
7616 Fixed S}5tem Final Fir¢ PrevenUon 206 Final Mechanical
2006 Finell Re-Roof �� 2n1'o Final Electriwl
201 Final Blxk/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Plannirg Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WOR�ERS"COMPENSATION DECLARATIO� ,
I hereby aRrm under penalry ot perjury one ot theTlowing 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
peAormance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 0� the Labor Code, for the peAormance of the xork fw which this
pemiit is issuetl. My worke�s' compensation Insurance carrier and policy
number are: I
camer S-� c,( -�- � �` � �✓l CA'
(iNs sedion nBed rqi be cpnpleteC permq is vahm0 al are huMred doEars fSt00) a leu.)
Pol�umber 1 � � �� �,7 �J ` � �
❑ I certify that in Ihe p¢�ortnance of the work (or which this permit is
issued, I shall not employ any person in any manner so as to hecome subject
to the vrorkers' compensation laws of Califomia, and agree that if I shoultl
become subject to Ih erke ' ompensalion provisions of Section 3700 of
the Labor Code e ply with these provisions.G� n �r
- C-� � �� d—'T `� 1
I" 1' ig re �
i
WAR G: FAILU S URE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND � HALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FWES UP TO ONE HUNDRED THOUSAND DOLLAFtS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Divisi0n 3 of the Business and Professions Code, and
my license is in full force and effect.
� /� -� ��
1��-""�"_' Class# L_'� �7 �1
� .�5 ' ���—Q�J
��� �q�lure e'"^ �
CONSTRUCTI .AGENCY:
❑ I hereby affvm that there is a constructbn lending agency fa the
peAwmance of the work ta which tNs pertnil is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalry of perjury thal I am EXEMPT FROM 7ME
CONTRACTORS LICENSE UUN for the (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
wnslruct, alter, improve, demolish, or repair any sWCNre, prior lo ils
issuance. also requires the apDlicaN (or such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contraclors
License Law (Chapter 9(commencing vrith Section 7000) ot Division 3 0l the
Busine55 and Professions Code) or thal �e or she is exempt lherefrom antl
the basis for the alleged exemption. Any violalion of Section 7031.5 by any
applicant for a permil subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as ovmer of the pmperty, or my employees with wages as their sole
compensation, WILL DO TNE WORK, and the structure is not intended or
offered for sale (Sec. 7044, 6usiness and Professions Code: The Contractors
license Law does not apply ro an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, provitleC that suGh improvements are not intended or oflered for
sale. If, however, the building or improvemenl is sold within one year of
completioq the ovmer-builder will have the burden of proving that he or'she
did not build or improve for pu�pose of sale.).
❑ I, a5 owner Of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Pro(essbns Code: The contr2ctas License Law tices not apply to an ovmer of
property who builds or improv�s thereon, and who contracis for such projecl with
a contracta(s) license pursuanl to the Comractors License Laws.).
❑ I am exempt under sec.
Business and Professions Cotle for this reason:
SgnaWre
305]�46(3/09)
Ovmer ID verifed by driv, ._ense. ❑ Ves ❑ No t
��1 .
Driver s License No. Expires: �
Verification of Ownership by (type of tlocument, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '��
❑ I hereby certrfy IFiat no exwvation frve (5) or more feet in depth inio vfiich a
pereon is required to descentl, will be made in wnnection with wo11c autMrizetl
by this permit, and that no building structure, scaffdding, falsewnrk, or demolition
or dismantling thereof, will be more than thirty-su (36) feet high. (Chap. 32, Grp
2. M 2, Sec. 341, Title 8, Calitomia Adminislrative Code).
❑ As owner-buileer, I will nol employ anyone lo tlo work which woultl
require a pertnit from the Division of Industnal Safery, as notetl above. unless
such person has a permil lo do such work trom the division.
AOP�icanl'S SignaWre Date
Division of Intlus�rial Sa(ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the appliwnt or preseM or future building occupant need to file and
certify a Business Plan tor emergency response to release or threalened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 oi [he Califomia Health and Sa(eiy Code requires, with some
exceptions, lha[ a Business Plan be filed with Ihe Gosta Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazartlous materials equal to or greater than a weight o(
500 pounds, or a volume o( 55 gallons, or 200 cubic feel o( compressetl gas
at standard temperature antl pressure).
2. Does or will the applicant or present or fulure building occupanl neetl to file
a registration form (or acutely hazardous materials? ❑ Yes ❑ No
(Sec[ion 25533 ot the Califomia Health and Sa(ety Code, with some
excep[ions, requires regisiration with the Costa Mesa Fire Department by
each business which at any one time has on hanG a quanlity o( acutely
hazartlous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons. or 200 cubic feet o( compressed gas at slandartl
temperaWre antl pressure).
3. Does or wdl the app�iwnt or preseni or future builtling occupanl need to
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous materials)7 ❑ Yes ❑ No
(Section 25534 of the California Health and Sa(ery Code provitles that l�e
Costa Mesa Fire DepaAment may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses whic� are requiretl
to register acutely hazardous materials with the Fire Deparlmem.
4. If an RMPP is presently required, has Section 25534 of the Cali�omia
Health and Safery Code been (ully complied wilh? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require for
lhe vrork which is the subject of this application a permit for such construction
or motlification from the South Coasl Air �ualiry Management District or fmm
any other air pollution control tlistncl or agency? ❑ Yes ❑ No
(Section 658502 0( the Califomia Govemment Code requi25 that the requestetl
infortnation be fumished on applications for non-residential Duilding permits).
6. Will any paR of Ihe facility lo be constructed under lhis permit be vrithin
1000 feet from the outer boundaries o( a school? � Yes ❑ No
(If'yes", the facility mUsl meet the requirement of Sections 25534 antl 42303
of the Calitomia Health and Safety Code).
7. If a pertnit �rom the South Coast Air �vality Management DisMcl or other
air pollution contml district or agency is required for the work which is the
subject of this application, have all ot ihe disclosures prescribed by California
Health and Satety Cotle Section 42303 been made? ❑ Ye5 ❑ No
8. (If'yes". altach certificale of compliance from the appropriate air pollution
control oKcer). � ' �
CERTIFICATE OF COMPLIANCE:'I cenify that under penalty oh perjury the
infortnation given above is wrrect I agree lo wmply with all state laws and
ciry ordinances regartlinq Hazardous Materials and Emission5. ���
SgnaWre Oate �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RV: I
certify under penalty of perjury that I have reatl this application and state Ihat
the•information given is wrtecl. I agree to comply with all state laws and ciry
ordinances relating to builtling consWction, 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 inspectioa .
5' at re � �+.+�eqs) Oate
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�oonEssovem�ova: �Jz6 FLORIDA CI uwT:
"E"s"'WEi`i°,o""MILLER, CHARLES M FLOOD: AE—i7
�oonEss:MILLER, LYN A
J326 FLORIDA CIR
S�T�,,,,,,,M�,��.CA 9262643A-7.466
IAIKNRECT OP FNOINFFA:
MCH.OP FNO.'S dWPE53:
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UM:
L0N"1ACi01fSN""EA PLUS ROOFING ( 714 ) 754-1000
GONfiIACTOR4N11Nq�1 �i Z 3% SLATER AV
"°°"ESsFOUNTAZN CTALLEY CA °BNDe 675241
92708 uxr:
tICENSEU COMPACTOFS DECLAXATION: I hereby ellim uMw penaly d pe�im/ iM� I em ficemed uMx pwiaone d Cheplm B
(wmmendiq xilh Saciim ]a00) d Div'vun 9 N Oro Buurro eM PMmaiana Code, uk mY ��» u in tuA brca vN alled.
cmuc.No.�60847 uc.cuss:� 39 uc.n 67� ;p O1/98
Dme: //y f T 7 Cavador.
OWNEP BUILDEP DECIARATiON: I hneby etNm unEer peiWy d pmjuy ihet I em exemp Imm tM Corurerlore licaiue law lor Ne
Idbwip reeeon (�� ��15 &nnaa+end Prdeesima Cade: AnV W o oowiy xfiirfi �apui�as e pe'mn to mnbuc1. eXs. improve.
demdeh, a npei erc/ struclure, pnor W u eaerca. e6o iepu'vm tte eppl"vau tor euUi parmG to fib e ep�d ntebmam thet ha m she
is �im�»a w9uem �o ine ao.d.lma a Y,a comreaon ti�.�ue law Ichaqer a(mmmena'ro wnn seaun �aao) d ot+wim a w �he
Bueirww vM Prdeaeau COCeI a thel M a fhe e uemq IhereM1dn eM tM bnfia la Me elbped uemp�ion. MY violalion d SaNun
]03t.5 by eny eppfceM la e parmil subpde the eppfwn to e tlHl penelry d na mora ihen Irve huMreE AoAen �5500�.
� I.eaownerdiMY�YormYamGbRea�.ihwegnmihsaalecomVe��.v.iIlEOYnwak.eMitneWcwnemlinieMed
«Weredl«eeblSecUon]oM.eutirosaend PrdmdueCode:TheCm�reaonli'auelawdomndaOdYtoenow�wa Wwam
who bu1Es ar inpwea Ow�eon, aM wla Aoes auM xarklimmtl a hmeel a Ifiraqh he n her own ampb�w, provideC tlie� euch
impovemenU ere mt iruenEed a dlemd lor seb, tl, lwwewr, iM buildinp a inpwameM u vatl wnhin me yeer d mmpblion. Ne
owmrbuiker xi0lieve ihe burden d pwi�p M a ehe did nd buiN or improva lor tM pu�pwe d mb).
� I. ea oww d IM pWaM. em udmM' mmredM xtl� Iwnsad contrecbn ro cansm�tl Ne pM� (Swion )OU. &n'uws anE
Vrdeatime Gode: The CaNratlae lianae lew Eou nd app�y b en o�nar d popony x1n builde u impovn tlronan end wlw
<mvecn M pM popdn wuh e mNraqa�e) Iceruad punueru Io tM Cauroum Limme Lew).
� I em ezemq uMer SecYion: 8. 8 P.C., br Niu �mmn:
Dete: �
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2559a. aM tlw I a e�ry Mure buikirq amqaM vnll / wil rwi (rirtla orw) � to compFy wY� eek aete catlm end ihe �epuimmente 1«
apmN�lorowWctiona�mEJreiionhwniM�i u�Tlly.%repememDmriq.ReaidWolonmiueuneppiratianeranvemplram�heae
ywisiona.
Dob: AGG���
WOFKEN'S COMPENSATION DECL�PATION: I MeWy eRvm udr pr�My d prjuy ar d the b0ow'vq Eeduelom:
� I heva eM vnl meinleF e r.Mil'Ws d mruenl to �ellirourt M xqken' mnpmWion. n prwidad la by Stlion �100 d Iha laba
Code, iw �he parlameMe o/ Ue work la wNc� Nia pwmX'v ivued.
❑ I hew W hil me'vuan wMw�' mmW�uetion'vwuence. m ipu'veE Dy Satlion 9]00 d IM Lebor Cods. b tM pa�lormenoe d iM
�( wak la xfiidi tlJw OM^� h mued. MY �wrMen' mmP��bn'uvwencs far's W VdkY number ue:
te�,�..: �rmr r.nc�n EXP7RES
Pa"" ""'""°' 01 / O 1/ 9 8
i(mh seabn ne.a nw w canWe�ee � rn. w�x u ro`. m,. un ,nd e t or'b�e.)
� I cMM �� in iM perlamenw d tte wark Ip whN ihu prmu u ivaetl. I Netl ary pnaon In ury mems w m lo
becoms wbpd to �M xakma' mnpmvtion k�n d CdAmJa. epese E I k E�W to IM waMeis'
compenaelion �� vb/�� .S�eaien �100 d tM labor COEe. I 4u01 xilh com �
Dma�.�'�J�- �VW:�am: ' �
Weminp: FeNun ro�xun workxi rorrywu�tlon caverp� l� un/nM�l, uM �IWI wb/�cf �n xnplqw ro MMnsl pm�ltlu an0
nHi nnes up ro m. ni..�e�.e rnauune edr.n (t�alaooA M wrouo� ro tM rost ol romp�nu�bM1 e�mepu u provle�d ror In
SxHan 9�5 0l Ms l�borCaJ�. /nM1rs�4 �� ��msY'i /ra
CONSTNUCTION LENDINO �OENCY: I Mreby efNm uMs peneYY d perjirty �hm �hxe u e mrmiueion bndinp epxwy M �M1e
poAameMe d iM xork br wnich ih'v M�Y b ewH (Smion �09). G'v. CI.
�ENOEP'S NMIE:
LENUEH'S �U�HESS:
I�anM �nm i nce reed iw e?vr�im m�d mae inm me mow w�n�, e�nsa. i ro� �o WmvN wnn eu ar ene coumr oww�m.
eM etete kwe relaiiq �o driNep omurwim aM Mraby eWarce �epreaeNetnea W thu cty b emer upon tM ebova�mer�tioneE pmpery
taimpea purpwes.
Sf�t�j MALONE
P'
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S � ure d OxnadApeN�ROPirant/Cmireda
(5151de.WP) While-Buildip 8 Selery; GraemFle; Cviaiy-Appirent; Rnk-Revenue: GokenmE-0.aeeawr
CITY OF COSTA t•tESA — BUILDITdG PERMIT
PERMIT' NO: B 082331. PLAN CHECK N0: N
CONSTRUCTION TYPE: V—id PERMIT TYPE: STR
PERM NO: B OlS�JJI
GOVT: N SUPP: P!
PURFOSE: UTH
JOB DESCRIPTZON : T/O SHEATH 6 REROOF W/LT TILE ICBOIi4660 SQ FT: 6,236
CLAIM VALOE: 6,236.00 CALC—VALUE: 6,2J6.00 GROUP UCC; R-3 /U-1
COMMENT'S: REROOF 2334SF RESIDENCE WTILE S.SPSF MAX WT, SMOKE UET RE�QUIRED
**�**�r*���***�t�+�*�**�****�*****x**x�*+�xxx�*���r****�*�x*�r�*�*�*�***** �*�
ZON ING REQUIREMEN���K�nETEG�'��
S E T B A C K S �('�
------- ----- MAIN BUILDING ---------- --------- ACCESSORY���iGiJ-----,
FRNT: FT IM REAR: FT IN FRNT: FT IN AR: FT �IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ; - PROV: PARCEL: 13958201 2NE: REF NO:
PLANNING NOTES>
1
�E�EiEiE�EiEiEiE3FfEiE�Eif3EfE�FfEiEffiEfEiE kiF1ElkikiEiE3fiElEfFiEfEiEiEIElE1EfElEfElEfEiE�EjElF�EiEifiElE1E1ElEfEiEiElElfiElF3k�F3FfEdEiF1EfElFiEfElEiE1ElF
D E L� E,.I. O P M E N T S E R V I C E S R E Q U I R E M E N'I' S
• '/
ZONING APPROVED—BY DATE: `�
i i
BUILDING APPRUVED BY : DATE;
APPLICATION ISS.UEG BY: � DATE: �s�C1�
fE 1f if 1f 7F if * iE 1f-1E if !! !E iE iE 1E 1F 1ElE 1k')t if 3F7F3F'i�itiF3F� TFiF �F iFiFiFiF�F3F�f3f3f�F�fiF3F�F �F3F�F3FiF3F�1E 1f 1E IE If 1! fF fE fE 1E 3F3F !6 fk
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 124.75
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 125.37 0,00 0.00
FIRE SMIP/RES GRADING
.62
SMIP/NON—RES
TOTAL PAID DUE
125.37 125.37 .00
DIVISION TOTALS--> COLLECTED; 125,37 OVEA/SHORT: ,00
LDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
124 . "75 , 62
iE af iE iE iE iE k� iE iE if 1f !f k� 1E fE iF 3k iE iF if� i41k ik 1f� ik if 1f IF 1f !f N 1k i! fF 1f iF fk iE �F iE fE iE 1F iklflf IE �E iE iE iElE 1F #!f !E 1E iF },: iE fE �E ik iE iF �lE 1f iklE fE iE iE
I N D I V I D U A L F E E H R E A K D O W N
QTY D E S C R]: P T I O N UNIT COST TOTAL COST
62�6 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 6,236.00
END OF FEES
B4—A4-1997/83:56 PM/f125.37
RGPiN:81-0084425
PERMIT_082331
,
i
� CON57RUCTION AND PLANNING � POOI a SPA �
APPROVALS Permit # Date Inspec2or qppROVALS Pennit # Date Inspector
7. Temporary Electrical Service or Pble � 52. Pool & Equipment Location
'2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utifiry-Undrgred. 54. Forms ��
4, Electrical ConduiFUndrqrnd. 55. Electrical Bonding . .� ,
5. Steel Reinforeement 56. Rough Plumbing & Pressure Test I
6. Etectrical UPER Grnd. � 51. APPROVAL TO COVER�GUNITE .�
7, Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrg�nd., Test � ��
9. Water Pipe-Undrgmd. ' 60. Backwash Lines, P-Trap, � Undrgmd. �'
10. Structural Floor System 61. APPROVA� TO DECK "'
17. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63, Heater & Vent•Final
13. Roof Drains 64. Piumbing System � Final �
14. Rough Plumbing . 65. Electrical-Final
15. Aough Electcica6Cq�duit 66. So1ar System�Fina1 - � .•
16. Rough Electric Wiring 67. Fencing & Access Approvai' � .
17. Rough Wiring Sign 68. APPROVED FOR P�ASTER� NG
18. Rough Electrical�T Bar Ceiling _ � 69. POOLISPA SYSTEMS F�NAL
79. Rough Heating & Air Conditioning fIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Dvcts, Ventilating 71. Product Pipiny O Gas ❑ Oii
23. Gas Pipe-Rough & Test 72. Underground Flush
20.. Roof Framing � 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing � 2 2. �'T ��� 74. Overhead Hydro
26. T-6ar Ceiling �Strucwrali & Monocoac 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe '
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PflEV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Elecirical Power Meter�Finai 60. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heaiing & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. YVater Service-Final
40. Gas Service-Pinal -
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow irrigation
44. Landscape Irrigation System
45. Sound Attenuaiion
46. Handicap Regutacions
47. FINAL STRUCTURE & BUILDING ({�c �R? �
48. FINAL PLANNING
49. Elearic Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
\PPLICATION FOR A BUILDING PL IIT
BUILDING P IT NO. Electr�w� ao
Tra<t Block Lot Permit No. C
, 1�/� / Plumbing n
aaa:es: 33 �..e i d C� /ii'U i Permit No. �
CroSs I , Ma<haniwl G
Ar¢a �S. �e Street ' � Permit No. �
Owner T� �Q Typa of,Pro)ecL ❑ Nnw ❑ Alter ❑ tltlilion �
V
Atltlress 3 3a (� �C'� c���y �/�l�t ❑ Repalr ❑ Convert ❑ Oemo ❑ Occu ancy Pmt.
cnvCUSrAi7zSA Z1p I1v2G rno�e�yc/s:/8�/ A.P. $uP.DISt./
Insp. Area
A�chlleCl/ Zone Spl. Pmt. No.
Oasi9ner Licenu No.
Se[backs P/ Fronl C/L SL $be¢t Witlth
ACtlress
VarGs Le g ear
CItY ZiP Phone
ave o�. a 9 . .
Englneer LJcense No.
,� rk ng Spaces equ rov a overe
p, Atltlreii
m Gt Zip Phone Stru<t N of No.oi
y Heig�t $t rie5 Famlly
� LICENSED CONTRACTOR'S DECLARATION Park Fees Ves Fee
m I haroby etiirm that I am licansed under provisions of Chepxer 9 Requlretl No C.T. Recelpt
L (commencing with Section 7000 ot Oivision 3 of the Businass antl Zo���9 q�Provetl By: Data
ProtessVons Code, and my license is in tufl force antl effec2l.
3 licansa Clas licansa Numb¢r
T Data Conhacror_ Mist.
E Atltlress Proposetl Use
of Structure
jy City ontl Zip Phone
N CONS7RUCTION LENDING AGENCV
� I horeGy effirm [hat thore is a construction lentling egency for the
a performance of the work fo� which t�is parmit is issueA (Sec. 3097, O<c. Type Cotle
' Civ, CJ. Class Const. vear
y Lender's Name USE/OCCUPANCV SI2E SQ. FT.
5 �e�eo: 9 naa.ao:
'� OWNER-BUILDER DECLARATIQN
y 1.
I he�eby aftirm thet I am ezempt trom the Contrattor's License Lew
� fqr the following reawn:
� � 1, es owner of the proporty, or my amployees wi[h wages as their 2.
� sOlo compensxtion, will tlo the work, antl tho snuctura is not
t intentletl or offaretl �or sale.
�' 3.
i❑ 1, as owner ot thn property, am excluaively con[racting with
liconsed contret[ors to conrtruct the projact.
d ❑ I am examp unAor $oc. B&PC or this reawn 4�
°' �' �, X.ta�
a Dat ��� Owner-- o�.N
E WORKERS' COMPENSATION DECLAqATION Total Valuation
� I heraby nffirm that 1 hava a certificete ot consant to self-insure, Encroachmant P¢rmit Requira ❑ Vas No
or e corxi/icace o� Workeri Compensation Insurence, or a certifiatl
C topy Mereot, G�atling Pmt. Gratlin9
� Policy No Company Required ❑ Ves ❑ o Pmt. No.
�a ❑ Cartifiatl copy iz heraby furnishod. Rough Gratling �
Q❑ Cortitiatl copy is tilatl with Orange County, EMA, qpproyetl by: te A
Date Applicant 3
CERTIFICATE OF EXEMP710N —
FROM WORKERS'COMPENSA710NINSURANCE Z
�This saction neetl not be <omploted it permi[ is (or $100 or less�. �
I tertify t�at in tha porformance of tha work tor which this permit is �
iszuetl, 1 shall not employ any person in any mannar so as to become �p
sub�oct to the Workers' Compansation Laws ot California. PERMIT FEE$
Data Applicant
NOTICE TO APP�ICAhT: If, after making this Certificate o( Struttulal S Plan Citeck 5
Exemptlon, you zhould become eubject to the Worke�i Compensation
rovisions of tha Labar Wtla, SPetial
p you must tonhwiih comply with such Electriwl E 1nve51 E
provisions or thie permit zhall bo tleometl revoketl.
I CEFTIFV THAT I HAVE READ THIS APPLICATION AND STATE
TNAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO %umbing S
COMPLV WITH AlL COUNTV ORDINANCES AND STATE LAWS
RELATING TO BVILDING CONSTRVCTION, AND HEREBY AUTH- Mec�an' 1 E
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
TME ABOVE MENTIONEO PROPERTY FOR INSPECTION PUR- Re- atle
PO �n �1 Ins ction s
� J �On / . / lYC(X // — / �/� �� pr -Graae Permit
�gnatare of Ap ¢ t or qgent Date S E
,/ ec. No. Issue
'Y�P�FN L • IIIP/l!
Print ApplicenYa/AgenYs Nem¢
Plan Iisuance
All spaces within this box must be completed to process Check By: aporovetl:
CMF 0335-46 (BU-28) rev. 6/80
CITY OF' COSTA MESA R�QUEST EOR OCCUPANCY
TRAC'P NO, ��93 DATE //-lif�-�S %
LOT N0. (� `
ADDRESS ('2/y�
C_� �� ''/ -
The developer of the above entitled tract desires to sell the
above set forth lot prior to the time that the tract has been
completed and its streets accepted by the City of Costa Mesa
The undersiqned, by executing this agr.eement, acknowledges
that (�-they) (�c'r- were) advised
that this tract has not been given final inspection nor has
it been accepted by the City of Costa Mesa as having complied
with the conditions of approval which were imposed by the city
at the time the final tract map was approved.
The city assumes no liability for the enfoecement of the conditions
necessary for approval other than those conditions protected by
s urety bond,
The undersigned agrees to indemnify and hold the city hasmless
fYom any claim zesulting in damage or personal injury to the
undersigned by reason of the aforementioned�un�ompleted co�dtition.
Developer "anRT/o3'-�uthor ized
representat�I�ve
BY
,f der
C.IY DF C�STA MESA
CAUFORNIA D2826 P.O. BOX 1200
FROM THE OFFICE OF THE D�RECTOR OF BUILDIN6 SAFETV
Project Address 33a �, �Lo z„�,o �i2 c/� , os�,o /L�s 9
Project Name
Oanexs Name
S pR
J. LL. I�QQ � - XfP�wu, (,. /i%PA �
amers Address 3.3a � I��oe i!a C`�/C C��
O.mers Telephone ��'!,� S-- /� � /
� � i
.- � � _,��
City Use Qily
Z -�-e Jek (, YJ�c� / as Owner, co. + *�.-, n t(strike out all
except one} do hereby attest that �loyment of any person, or persons, is not
anticipated at the time of seeking the above-referenced permit. In the event that
any person, or persons, are employed under the pravisions of this pennit, I shall
imrediately cause a valid Certificate of Worlanens Cort�ensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my cx,m mst, and to indemnify and hold hannless, the City,
its officers, agents and/or ertg�loyees, fran and against, arry and all liability,
damage, costs, losses, claims and expenses, haascever caused, resulting directly
or indirectly fran, or connected with the improv�nent under this pernut.
I further state that I have iead and fully i.mderstand the implications and rr
sponsibilities of the above statelnents, and will ccmply with all provisions of the
Contractors State Licer�se Iaw found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
�P IPN L• �C�R �
Print Name
�c-Q� oC � �QP i/- /S/- �G
Signaturn ` Date
CMF 0777-46
�
rnor�crnooi��ss: 3326 FLORIDA CI
dwxensxn%ie: NEAL, J W
nonness: NEAL, HELEN L
3326 FLORIDA CIR
COSTA MESA,CA
545-1881
AflCHIENGINEEfl:
ROONE55:
UNIT:
92626
XEG.NO.:
UNIT:
PER"uTTEE: ADVANTAGE ROOFING ( 714 ) 877-0242
aoosess: 125 BRYANT ST
BLOOMINGTON CA 92316
LILENSED CONTflRtTOB OECUM710N: I Irzreoy allirm VWt I am Iken5e0 unaer 0«�s ol CtWpter 91�mmencinA ��� Section
7000) ol Drvision � ol ine Business an0 Pmle55ion5 CaOe. antl rtry licenu is in lull �o¢e ana e11ec1
cirr uc.: 5 S 2 3 3 sT�re uc.: g 9 q 1 c s.
�FOa�e: .�� �-�9 �— i . . — _ _ _ _
I WONI(EBS' COMPENSRTION OEClAM110N: I AereGy affu t I have a cenih consenl tosel4inwre or a ceniliwte of Workers'
ComDenSation Insutance. or a cenifietl py Inertof (�tqn 3800, Lae.
roucrxo.:PWC 18025� exr.o�Te: 1/10/93
comraNr: GOLDEN EAGLE
� LenilieA coDY is here6y lumis� ❑ ceroom wor �s nea w�m me a .am �'de �
oaie: 2 �
E%EMPTION FIIOM WOflNEflS' COMPENSRPON OEQAMTION: eNm nreG n mpkW iI Ne ppmt i51a dM INMrM (5100) oi 1u5�.
I certily Ihal in the periormant¢ of (�e woM Iot w�it� �his perrtut ¢$SueE. I 51w11 not employ any p¢rson in airy manner so a5 �o became
su�l�� �o t�e Workers' Compertutim Laws ol CaGlamu.
Oa1e: 9gnaiure:
NOTICE: II, alter making tNs Oeclaration, you stioultl 6ecome SUGI�� �o t�e Workeri Compenution Omvisions of tAe Labor
COOe. y0u mu5� IOfili'MII1 fAmply wiill wtll 0«5 ot Ih6 p¢rmi SINA CE UEtmEE rCwOk2G.
CONSTBUCiION LENUING pGENCY: 1 �ere0y aifirm Nat ihem is a constructim lenamp agenry la� Ne ceMormance ol ihe xroM1 lor
w�ic� I�is p¢rmi� is i55u¢G (Sttiion 3097, Gv. C�.
LFNOFfl:
ADOXE55:
OWNEB BUILOEB oECIAMTION: I here0y atlirm tAa� I am e.empUmm i�e Contractwi State lice�¢e law br the followin0 �eamn
�Seclion 7031.5 8usiness an0 Pmlessional CoOe: Any nry ol county w�ic� repuires a permit to cansimcl, alter, impmve, Oemolish, or
', re0air any 9ruciure. pnar to i6 issuanu. aLso rEpuirts l�e aOWk:ni �w wU permil ta lile a 5i0ne0 slatemeni IAai �tls�e is Iicense0
pur5uanl to I�e proviSi0n5 al lhe COntratlors' Sla�e License Law (CnaD�er 9(commencinq vn�� Stttian 7000) of Uivision 3 0l I�e Busine5s
antl Pro�esvons Cotle) or tnat hNs�e is e+empt t�erefrom an0 t�e Dasis br t�e apepe0 e.emption. My �iolatian al Section 7037.5 Ey
any aD7liCanl lOr a p¢rmii Su�jetis l�e appliwni lo a civil penalry 0� noi rtpre ihan liv¢ hunUreO OOtlars �5500).
I, as owner of tAe pmperlY a� mY em Iqtts vrith wapes as I�eir sole compensation, wiA Eo the work, antl Ihe
O stmcmre is nol imenOeE or alhreU Iw ule (��wn 70aa. Buvneu an0 Prolessional COAe: Tne Comraciors' State liunse Law
Ooes noi appty ta an ovmer ol a Omoeny who Ouilas or imDrwes ihereon, a(M wM Jaes suc� xrork himself/nersell or tnmup�
his or �er Own employe¢5, prmdUeA ltw� SUCh imprOv¢menls are nol inlenEeO Or ofl¢r¢d lor sale. II, �owever �he bulldlnq ar
impmvem¢ni a saltl mihin on0 year ol completion, IIM owner vrill �ave I�e burOen 01 prOvinO ��5�e OiU nul Oui10 or improv0
lor Ihe purvose ol salel.
I, as owner o� t�e D�oOe� , am exttusively contrac�inp vnt� lit¢nSCU comraclors lo conslmci I�e pmleci �Sec�ion 7044, Businass
❑ an0 Prolesvqrs COGe: T�e Coniractws' Suie License Law Ooes iro� appty ro an owner al pmcehy � �uiltls or imD�oves Ihereon
ana wno conlracis lor suc� pmjeds wit� a comrac�or(s�license Oursuanito IAe Comractors' Slate License law�, I am aware
Ihai D�o01 Oi lheii Work¢i5 Compensalion in5urante S�oulO Ue O�oNEeG IO me.
� I am exempi under Sec�ion: B. 8 P. C.
lor I�is reason:
Da�e: Owner.
I Qo nereUy cenily �nat I am aware a1 antl uneerstana Ihe reQuirements al Calilomia Healln ana Safety COAe Section5 P5505, 25597, ana
2553a ana ihat I or any INure builaing occuDant will/will nol (circle one) neea ta comvly with sai0 slate coaes antl iha reQuiremenls lor a
peimil Ior wnSlmtiion or modili[alion Irom I�e Air OUalily ManaAemenl DiSViCI. fleLOential tOnSlmtiiun apptiwlions are exempi �mm
ihese provisions.
Daie: ApDlicanl:
I hereby cer�ity i�at I �ave read ��is applica�ion anU s�a�e I�ai I�e a0ove inbrmalion
ortlmances antl slalelawsreWlinglo0uiltling consimction anC �¢reGy autAor¢ere0�e51
pmper�y lOr in eciion p rpases. �
Oa�e'. � � �
oriver's �icense ar Socia� Secwiry x: /
wit� allci�y and
1641�46 `Nbite-6uiltlinpl Green—Co�a Enlorcemenl: Canarv—Apoliwnl: Pink—Revenue: GolOenro4—Assxssor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 05583
PERMIT NO: B 055834 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : T/OFF REROOF W/ BUILT UP SQ FT: 1,163
CLAIM VALUE: 1,163,00 CALC—VALUE: 1,163.00 GROUP OCC; R-3 /
COMMENTS: T/OFF REROOF W/BUILT UP
iE iE �IE�� if if �1E iE �lF iF �lE iE If df �lf if 3EiE if if iE iF 1f if if if �iF if iEaE-lE if iE iE if iE i( �7Fif �lf dE iE iE iE iE JF�iE1E �JE if if �1F �)F if if �Jk iE iF if if if iF �� �)f iF�k �lE �1F iF �� ie if iF �1F�lEif iE iF �)f
Z O N I N G R E Q U I R E M E N T S
sEZHr,cxs
------------ MAIN HUILDZNG ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 13958201 ZNE: REF NO;
PLANNZNG NiSTES>
>
�***��*��*�*�*****�r***�r**�r*****�**+�**+�* �****�r����r********�*******�+�*�******�*
D E V E L O P M E N T S E R V 1�C E S R E Q U I R E M E N�T S
. �
ZONING APPROVED BY ,
HUILDING APPROUED BY :
APPLICATION ISSUED
k iF ih 1E �E iFif �F iF iE �FjF ik 3E if �
iF iF iF iE iE iE iE iE 3F if iElE if iE iE
LEGALI7.ATION:N
BLDG PMT PLUMBING
PERMIT 29.00
F E E
DATE:
DATE:
DATE: ��T/��,'��
iEi(�iEifiEifl£iEiFiE r IF�E
�E iE if iF �E k�1F if if if N ik if k �E �lE iE if 1E iE iF if ib jF iE IE iF ff �E iE�1F ik iF iF iE iF iE iE �E iE
U M M A R Y STRUCTURAL SEGMENT:Y
IC MECHANIC FIRE SMIP/RES GRADING
50
PI.AN SM I P /iVON—RES "�
7SSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 29.50 0.00 0.00 29.50 29.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 29.50 OVER/SHORT; ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECH
29.00 .50
3f if �k 3f Ik K iF if �f iE if iF iE iE iE iF if ik fE if iE 1F i! 3E iE iF i! iF i! 3E iE if iF iE 1E iF ik i! M iE 1E if 1E IElE iF 1E If ik if �1E k iE iE if iF if � if if k iE iE iE Ik if iF if iE it iE 1E if iF'if 3E 3E �F *
I N D I V I D U A L F E E B R E A R D O W N
TYPE QTY D E S C R I P T I O N
SFR 1163 REROOF HY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
1,00 1,163,00
"I .�C.�c 4; i' i ;[a. '; -• �
Ct'.= ��,'_./i_+'��;.� .. .._,_-
CONSTRUCTION AND PLANN�NG POOL . dPA
" APPROVALS Permit # Date fnspeclor qPPROVALS Permit # Date Inspecto.
1, Temporary Electrical Servicc�.or Pole . . 52. Pool & Equipment Location �
-� .
2. Soil Pipe�Undrqmd. _- ' 53. Steef ReinSorcement -
3. Electrlwl Conduit Utility-Undrgrnd. 54. Forms '
4. Elettricai Conduit-Undrgrnd. 55. Electritai Bonding
_ 5. Steel Reintorcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
: 7, Footings 58. Etectricat ConduibUndrgrnd.
8. Foundation • � 59. Gas Pipe, O Undrgrnd., Tes[ .
9. Waier Pipe-Undrgmd. ' 60. Backwash Lines, P�Trap, Q Undrgrnd.
10. Structural floor System � 61. APPROVA� TO OECK
11. Property Sewer Line & Hnuse'Connectipn 62. Backwash & R¢ceptor�Final
i
12. Sewer Cap 63. Heater & Venc•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 Anproval
17, Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Fough Heating & Air Conditioning FIRE DEPT. FEQUIREMENT
20. Rough Factory Fireplace '� T ' �APPROVAL$ Permit #
21,vDuMs, in,Structure .. � 70. Underground Hydro
22. Ducts, Ventilating • �71. Product Pipi�g �Gas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. � Roof Framing . 73. Undergrnd. Storage Tank Q Gas ❑ Oil
25. Aoof Sheathing l.,L(-R �Wd( 74, Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27, Frame and Flashing 76. Dry Standpipe
28. Lathing & S�ding 77. FIXED SYSTEM FINAL
� 29. lnsulation � 78. FIRE PREV. FINAL
30. DrywallNailing HEALTHDEPT.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. Pinal Gas Pipe-Test , � '
36. Hood or Canopy �
37,"Final Factory Firepiace � ' �
38. Final Plumbing _ -
39. Water Service�Final
40. Gas Service•Final
�.47, Solar pomestirFinal
42. Backflow Preventer ' �
43. Backflow Irrigation � �
44. Landscape Irripation SYsrem � " -
45. Sound Attenuation
'46. HandicapReyulations -
47, FINAL STRUCTURE & BUILDING / 27� �(,v�
! � �(�
48. FINALPLANNING
49. Electric Release to Edison �Z _C/z- G'4�/�e ����
/ !T
'50. Gas Release to Southern California Gas Co � � ��
51. CERTIFICATEOFOCCUPANCY
No. Date
P^ Vo. LOT 6 TRACT
1 ECTIONS Si n tu
soi�
GAS
WATER
ROUGH PLUMBING
PROP. $WR. LINE lISE CON.
SPRtNKLING SVSTEM
MISCELLANEOUS
ROUGM HEATING ANO AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UN�ERGROUN� � POWER � �
ROUGH WIRING
TRENCHES FOftMS STEEL REINF.
F�OOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME NNO FLASHI
LATHING - IN OUT ��L-G
PLASTER, BROWN COAT
'CTURAL, FINAL
i ING, VENT., REFRIG. AND A.C., FIN
6UILOING, FINAL
SPECIAL REQUIR
EM ENTS
BUI
FIRE ZONE VALUE
GROUP I & J TYPE
SUBCONTRACTOR
PI,.m6:.... i _
- � � s-4 � 30 87
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 926T6
For Applicant to Fill in Completety
BUILDING � :17) � � --�-4% /�
ADORES$ 'L.�,�7.0 [.�11�
OWNEF H8TID08 �V. CO.
MAIL . . _ "_'" __ '
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cirv Santa Ana
CONSTRUCTION
LENDER United
BRANCH 190 BrOad
ADDRESS Sfl27 DSBfz�
ARCHITECT _
E
CONTRACTOR QyJj�Bi
ADDRESS
CITV
STATE
���. No. 25256p
SIZE
OF LOT lOO X �
USE OF
EXISTING BLOG.
NEW BLDG. 177� �
EMERIOR WALL
COVERING 8tucc
USE OF BUILDING AND �
No` 547-�04
ates National Bank
Avenue
alifornia
rvo`' 675-116
t HviY. Corona D M
TEL.
NO.
CITV
LIC. NO.
NO.OF BLDGS.
NOW ON LOT Q
NO. OF 1
ROOMS 7 STORIES
COV�ERING COIDF10W02'd
00
K TO BE PERFOFMED
PAiU
nr�2�.,-F���,—,�OO�zsi� *�*�137.25
APPLICATION FOR BUILDING PERMIT
RECEN BV DATE RECEIVE DATE ISSU�
/%� y�=�-� .r_i-U
ADDR
�
20 E�� T�'PE L� GROUPS�d
APPROVED
gy DATE
ZO NO.OF USE OF NEW
/ PLAN$ y BUILDING
VARDSAPPROVED YAROSAPPROVED
MAIN BUILDING ACCESSORY BUI�DING
(FROM G4ST_R�ET)
!/.�1 /� �L�
DISTANCE BET. BET. MAIN &
MAIN BLOGS. ACCESS. BLIX'¢.
VAR.#�' qppROVED �'
c.u.P.# V -� �-G $
I hereby acknowletlBa that I have �eatl this application antl sta[e HOLD FOR SP
that the ebove information is correct antl agree to comply with
all laws regulating buildinB construction, and I shall not employ
eny person in violetlo� of the workman's compenmiion laws of
the State ot Californie. Y � J
I hereby cerHfy ffie[ I am properly lirensetl as e conhector under � SQ. FT.
the State of California Business antl Professions Cotle, Divisicn 3, THE AMOUNT SH01
Chepter 9, antl xhac su�h licenses ere in full torce entl affact, or I THE PURPOSE OF ES
am exempt from the provisi99oqgns ot the State ot California Business VALUATION
antl Protessions Coytl ��� 3, � p[er 9.
SIB^atura oi � , �
Parmittea �� -�---�--- $a�, 3ia -
AuMorized Agent
b
O
VALUATION IS FOR �
A PERMIT FEE ONLV: Q
E $ I. �o �
]
m
�.K g 5, '7� E
o`
i. � � ! LL
a
�OWNER GIBB, Gary DATE 6-6-78
OB ADDRE55
�
W NTER
ROUGN PLUMBING
�PROP. SWR. LINE
� SPFINKI IN6 SYST
MISCELL�NEOUS
ROUGH MEai1NG wN0 RIR C�N�ITIDN�NG
M
STE
BONO BEPM I I STEEL REINFORCE I I
SNERTMING
FRnME eN0 FlASHING
LATHING — IN rl OI1T n
P' TER, BROWN C05T
.TUR4L, FIN4l
MEATING. VENT., REFFIG. AND r1.Cr.�. FINAL
PLUMBING. FINnL ANO GR$ TEST I J
ELECTRIC FINnL
P1111 �11AIf. Ciu AI
�ui�ouve rtrcmi i
FIRE ZONE VALUE
TVPE � GROUf
SUBCONTRACTOR
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�� COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant ro Fill in Completely — Use Ink Only
ADIDRESS %-� ��• �t'��
OWNER y /��
MAI L ? /� /cG
ADDRESS J�� I-I�� ,
CITV
G'nS'� dI�SA No
BRANCM
ADDFESS
AHCMITECT TEL.
REC
� ' BUILDING
ADDiiESS
ADDRESS �/�
CONTRACTOR C�GI�. ��/�NO�-fc S
ADDRESS (I� NLO/GA
CITV /[��V/� V(rj NO. S��-D
�� L C NO. �-�.QNTQ-�f7�� UCVNO.IV' IC
{y 512E N0. OF BLOGS
0. OF LOT �i '3 X NOW ON LOT �
� USE OF � S7 �
EXISTiNG BLDG.
H
FSepara[e permits are required for
� electric, plumbing a�d heating work.
(.�.� USE OF BUILDING AND.WOFK TO BE PERFORMED
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0 I �ereby ecknOwletlp0 the� � heva �aetl this apP��eetion antl steta
a that tha ebove Informetion �� eorract antl apree to eomply with
d ell laws repuletlnp builtlinp constructlon, entl I shall not amploy
Z eny parwn In vlolation of the workman's compansallon laws of
� the Steta ot Californie.
3 I hereby cartify that I am p�oparly Iicensetl as a conttactor untlar
the Stata of Callfornla Busineu antl Profassiona Code, Dlvlsion 3,
Chapter 9, and Net suc� Iioenaes era in full force end eflact, or I
em exempt from Me provlslons of tha Stata of Californla B�aineq
antl Professlonne Codo, Divisl0� 3,,C/Jhaptar 9.
Sipnature af //='� /I� 'I " �-�ij
Permlttea _b
/
Authorizetl Agant
.. ..._ . ..' G _S '�
�G� �PERMITNO.
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APPROVED IAA A� �
sv "IIl// DATI
�'l
20NE NO.OP USE OF N
VlAP6'� BUILDING
VARDSAPPqOVEO VARD�
MAIN BUILDING ACCESS
DISTANCE BET
MAIN BLOCS.
VAR. �
C.U.P. �
THE AMOUNT SI
THE PURPO6E OF
VALUATION
/� �
$ %�
(
BET. MAIN &
ACCFSS BLd
Q4TE
S�
VN UNDER VALUATI
'ABLISMING A PERMR
PERMIT FEE S
PLAN CHECK S
TAX f
TOTALPAID E
0
._r,.;
5.50 TL'
5. 60CI(%D!
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