HomeMy WebLinkAbout590 GRAND HAVEN CIR - Building Permits(774) 754-5273 • Pax (714) 754-4856 • www.Ci.CoSta-meSa.Ce.US 77 FAIR DRNE, GOSTA MESA, GA 9Z626
BUILDING PERMIT
JobAddress: 590 GRAND HAVEN CI
Suite:
Viciniry:
Parcel Number: 41804112 • •
Applicant: SCOTT, JEREMY
Address: 2220 E ORANGEWOOD
ANAHEIM, CA
Owner: MORALES, JOAQUIN
Address 590 GRAND HAVEN CIR
COSTA MESA, CA
Convactor: WIN-DOR INC
Address: 2220 E ORANGEWOOD
ANAHEIM, CA
Zip: 92806
Arch :
Address:
Zoning: R1 R1
Phone: 714385-1202
Zip: 92806
Phone:
Zip: 92626-3104
Phone: 714385-1202
License: 545553
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 04/28/2004
Issued: 04/28/2004
Phane: Phone:
Zip: License: License:
SCOPE OF PERMIT
CHANGE-OUT OF 16 WINDOW AND 1 SLIDIN6 DOOR (LIKE FOR LIKE MEETING CURRENT CODE) IN AN EXISTING 2-STORY SFD.
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
, Plan Check: $0.00
Permit: $195.25
SMIP Res: $1.05
� SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $196.30
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existinq: 0
Rear 0- 0
Rear 0- 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
s�o,eoo.00
s�o,soo.00
NOTICE: The work authonzed by [his permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ortl. No. 92-28, § 1, 72-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or abantloned
for a period ot 180 days.
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicable cotles, and all
required inspeetlons and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2d46A6 (6I00)
WORKERS'COMPENSATON DECLARAnON:
I here�y aflirtn untler penalry of perjury one ot the following declaratlons:
❑ I heve end will mainlain e cenificate of consent to sell�lnsure br workare' crompenseHon, es provitletl tor by saction 3700 of the Labor Cotle, tor the pedormance ol Ihe
—/ work lar which this permit Is luuad.
�y' I �ave antl wlll malmafn workere' cronpensetion Insurence, es required by section 3700 of the Lebor Catle, for ihe pertortnance of the work for which this pertnit is Lswetl.
My workers' compensation Insurence carrier end policy number ere:
Cerner. Ai7O/iE0 Q4SK. -t6�C✓%G6S Policy Num�er. p2 5 Oooeo S 7-1
(Thls secfl need nof be complete0 i!!he permlr /s velued e( one huntlred dollers (y /00) or less.)
❑ I certify Ihet In ihe pOAormence ol iho woAc lor which IhiS pertnit Is issueQ I shell not employ eny person in eny mannor so as Io become subjetl Io tha worker5'
compensetion lews ot Calllomia, entl egree that II I shoultl become sub�ect to ihe warkers' compensation pmvislons oi Sectlon 3700 0l t�e Labor Cotle, I shall tort�with
comply with these pr vislons. /�—�
AppllcenlSigneWre: � ��r��/ Date: N.2fr..o4
WARNING: FAILUFE T CURE 5' COAIPENSAiION COVERAGE IS UNUWFUL AND SHALL SUBJECT AN EMPLOVER TO CFIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE (E100,000). IN AODfiION TO THE COST OF COMPENSATION, DAMAGES AS PPOVIOEO FOR IN SECTION 3�O60F iHE IABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHlrm the� I em
force entl eHect. lJc. u_
CONrecmr's SlgneNre:
ot Cheptor 9(wmmenGng with Sectlon 7000) of Divislon 3 of �he Busin ssI �nd Prolessions Coda, antl my license Is In full
Clessa �^'C -C1�7
Date: �I • 2 S. U�-1
CONSTRUCTION LENDING AGENCV:
❑ I hereby eflirm lhat Ihere is e canstruction lending egency for Ihe pedormance al the work tor whic� ihis pertnit is issuetl. (Sec. 3097, Civil Codej.
LenCer's Namo: Lendefs Address:
Signeture:
OWNER-BUILDER DECLARATIONS:
Date:
I here6y eflirtn t�et untler penalry ot periury t�at I em E%EMPT FROM THE CONTRACTOHS LICENSE LAW for the following reason (Sec. 7031.5, Business enC Professions
Cotle: Any city or wunry which requires e permit to canstruct, elter, improve, demolish, or repair any swcture, prior to iis issuance, also requires Ihe applicant for such pertnit
to file a signed statement that he or she is licensed pursuent ro the pmvisions of Ihe Coniractors License Lew (CheD�er 9(crommencing with Section 7000) ot DiWslon 3 oi the
Business entl Pmfe55ions Code) or ihet he or she is a:empt therelrom antl the basis for the elleged exemption. Any violation of Section 7031.5 by any applicant tor e pertnit
sub�ects the epplicant to a Gvil penalry at not more than live huntlre0 dollars (5500).):
❑ I, as owner oi the properry, or my employees wit� waqes es their sde compensetion, WILL DO THE WORK, antl the structure is not intended or otteretl for sele (Sec.
7044, Business and Professions Code: The Conirectors License Law does not appty to an owner oi proDeny who builtls or improves thereon, antl who dces such work
himself or herself or Nroug� his or her avn emplqrees, provideC l�at suU improvements ere not intendetl or oHered br sale. If, however, the buiiding or imprwement is
sold within one year ol completion, the owner-builder will have the burtlen ol proving thet he or she did not build or improve tor purpose ot ule.).
❑ I, as owner ol �he property, am E%CLUSIVELY CONTRACTING WITH LILENSED CONTRACTORS �o construct Ihe project (Sec. 7044, Business and Professions
Code: The contractare License Law Aoes noi appy to en owner ol property who Ouiltls ar impmves thereon, antl w�o contracts for such projec� with a contrector(s)
license pursuant to the Comrenws Ucensa Laws.).
❑ I am exempt untler sec. _
SiqnaWre:
Owner ID verlllad by tlriveYs license.
Vedticatlon of Ownerehip by (type of
Business end Professions Cotle for this reason:
Ves ❑ No Drivefs license No.
m, i.e. - property tax DIII ar tleetl):
Date:
Eapires:
DIVISION OF IN�USTRIAL SAFETY PERMR CERTFICATION:
❑ I hereby certlty ihat no exwvation tive (5) or more feel In depih into which e person is required to tlescend, will be matla in connection with woM authorizetl by this
perml�, antl ihat no building structure, scafloldinq, falsework, or tlemWition or dismantling lhereol, will he more than thirty-six (36) faet high. (Chap. 32. Grp 2, An 2, Sec.
341, Title e, Celllornia AdminlstretNe Coda).
❑ As owner-builder, I will not employ enyone to tlo work which would reduire e permit Irom Ihe Divislon of Industnel Sefery, es notetl aDove, unless such person has e
permit lo do such work Imm Ihe divisian.
Signature: Dete:
Division ol Industrial Seloty Permit Numhor:
CEHTIFlCATE OF GOMPLIANCE AND Alfi}10FiOATON OF ENiAV: I certify under penalry ot perjury that I have read this application and state t�at the infortnation qiven I5
correcL I egree ro com0y with ell state laws entl Ury ordinances relaling to building consWction, entl authorize representatives ot the Ciry ot Costa Mesa to enter upon the
ebove-de5cnbetl property for inspeCtion purposes. I egree not to acupy or allaw occupency ol eny building authonzed 6y t�is permi� until finel inspection.
tODE �. INSVECTONTYPE PEIE Pi�1LLS
1616 Fized System Final Fira Preventlon
12fi6
200
201
202
203
Pool Spe Final
Final Re•Rool
Flnel BIaWReteining Wall
Final Faciory Fire Place
Finel Sign
204 Final Demolilion
COOE 1 INSPECTION TYPE
206 Finel Mechanical
200 Flnal Plumbing
210 Finel Elet�riCel
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Daie
2 8'• � �/
Date
QdIE II�L4
�
PflOJEtT RDONESS: S 9$ GRAND HAV EN C I
OWNEH'S NAME: DUKART KENNETH J
nooness: 598 GRb.ND FIAVEN CIR
COSTA MESA.CA 92626
AflCHIENCINEEB:
AUDHESS:
flEG.NO.:
UNIT:
UNIT:
PEflMITTEE: VILLA CONSTROCTION ( 719 ) 554-4950
PDONESS: 1qnp3(S��S`}� E(U'�C(L�ID�' AV � q9 a 10
UCENSEO CONTNACTOROfC �lAplTION: The�reby`a rm ttwl I am licensed untler pi6vi5i6n5Z��Ap�r 9 kammencing wiih Seclion
7000) ol �rvision 3 0l I�e Business anG Pmlessions COGe, an0 my license is in Iu0 �orce anA �tect.
CITY LIC.: STATE LIL.: CLA55:
�05676�,� 616869 B
I Da�e: G=_[<}. Signamre:
� �—
I WOflNEHS' COMPENSATION �ECLABATION: I hereby allirm ��at I have a c iwi I consem m selt�insure or a erti' te o� Workers'
� Compensalion Insurance, or a cerUhetl copy Ihereol �Seclion 3800. �a�. C�.
POIICY NO.: E%P. URTE:
COMPANY:
� Cenilie0 coOY �s AereUy lurnishee. ❑ Cenilietl copy is tiled xi�� the city Building Divisian.
Uate'. Npplicanl:
ESEMPTIONFPOMWOPREBS'qIMPENSATIONOEQABRTION: (ihisSecUonneeano�bemmpl¢Iediliheper i�isforone�un�red�5100�orless
I tetlily Ihdi in Ih¢ p¢tlOfmdnt¢ 01Ihe wafk �Or whiCh thi5 p2rmp i iSSU¢tl. I sllail n0i em010y dny pEf in any man�f 50 d5 �0 b e
subjecl Io ihe WorkerY Compen5aiion Laws ol Calilornu. ��
Daie: — V � SignaWr¢:
NOTICE: I�, atter makin �his declara�ion. you should �ecome 5ublec o e cers' Compensa�ion pmvisi o� the bor
COOe. you musi fotlhwilh tomply vriih Suth D�avisions or tlti5 permi I � G�med revOkeU.
WNSTFUC7ION LENOING AGENCY: I here�y allirm Inal there is a constmclion IenOing agency lor ihe pedormance ol Ihe work lor
w�ich ihls Dermu ls issuea (Seciion 3097. Gv. C�.
LENOEfl:
aooaess:
OwNEP BIIILDEP OECLANATION: I Aere6y allirm ttut I am erem0� ��om the Camracmrs' Staie License Law lor tne followinA �eason
(Semion 7031,5 Business ana Pmlessional COde: Any city of coun�y w�ich repuires a Dermi� �o constmci, alier, impmve, demolish, or
r¢pair any Stm[ture. D��o� Io its issuance. also repuir¢S�he applitani tar 5ut� permi� to �il¢ a 5igne0 Slalemenl �ha� he/She is IicenSed
pursuani io i�e O�ovisions ol tne Comracmrs' Sta�e License Law (Chapter 9(commencing wil� Section 7000) oi Oivision 3 0l tAe Business
antl Pmlessions COAe� or I�al �e/sne is exempi Iherefmm ana ihe Dasis lar ��e alleqeG exemption. Any Wolatian ol SeGtion 70.37.5 by
any applican� for a permit su01eci5 Ihe apPlicant Io a civil penalry oi not more ihan �ive hunUretl Oollars (5500�.
I, as owner al ihe pm0eny or rtry employees vnlh wages a5 I�eir sole com0ensation, will Go IM1e work, antl Ihe
❑ slmcture is not imenOeA or otteree br sale (Section 70a4. 9us�ness ana Pmlessional Cotle: T�e Coniractors' State License Law
aoes no� apDly to an owner of a D�oDeny wha ouilas ar imDmves ihereon, ana wlio Oaes sucn work himself/nersell or tnmugh
�is or her own emplayees, D�oviUetl t�ai suc� improvemenis are not inlenC¢d or o�lered lor sale. tl, however �he building or
improvemenl is so�G wit�in one year of com0letioq ihe owner will �ave t�e burEen of pmvinA �e/she Aid not builtl or impmve
, for Ihe purpose af sale).
I. as owner o� ��e pmperip. am exclusively comrac�ing wilh Iicensea contractors lo conslmci ��e pmle�� (Sec�ion 7044, Business
❑ antl Pmlessions Cotle: The Camraclors' State Lkense Law Qoes not aDDN to an owner ol pmpeM •ho builtls or impmves ihereon
and who conlracis lor such pmjetls wil� a contraclor(5)licen5e pursuant �o �he Conlractor5' Siale License Law�. I am aware
Iha� pmol o� t�eir Workefs Compensation insurance s�aultl 6e pmviDeA Io me.
� I am exemD� untler Sec�ion: B. 8 P. C.
lor Inis reason:
�aie: Owne[
I tlo �ereby cenily I�a� 1 am aware o� anC unCersland ihe repuirements al Calilomia Healltl antl Safery Coae Seciions 25505, 25533, and
25534 antlihal I or any luture �uiltling occuDantwilVwill nol(circle one�neetl�o comply with sai0 5ta�e cotles antl�he iepuiremenis lor a
permil lor conslmciion or modili�a�ion imm I�e Air Ouahty ManaAemenl Di9fici. flesiden�ial consimciion aOD�ita�ions are evempl Iwm
�hese pmvisions.
Date: Applicani:
I hereby cerliry I�ai I have reaA Ihis applicalion antl sia�e iha� Ihe a�ove inbrmaiion is correci. I agr e lo comply with all ciry an0 counry
orAmanceSanOslatelavrsreW�ingloOuilUingcros�mclbnanOhereWauilqr¢er¢pre5eniativ¢soltha memeruDo I�eaOove-mentionetl
propetly Iarinspeciian p/ur�posei
�ate: bo � `7 — �I� SignaNre: ��
Driver'S License or Social Securiry x:
i6�1-46 Wlnte—Builtling'. Green—Cotle EniorcemenL Canary—AOp�icanl; Pink—Revenue: 6oldenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 064303 PLAN CHECK NO: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR
JOB DESCRIPTION ; REROOF W/COMPO OVER ONE EXISTING COMPO
PERM NO; H 06a�0.
GOVT: N SUPP: N
PURPOSE: ALT
SQ FT; 1,850
CLAIM VALUE; 1,850.00 CALC—VALUE: 1,850.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTORS RE�UIRED PER THE 1991 EDITION OF TAE UBC
* k jf iE iE 1f !f 1f 1E !f if iE 1E !f !E if iti! 1k k �f iE k if k k!f !f if if iE ih if if 1E 4 if if ikik k if if iE 3f ffiflf !E 1f fkif if 1! iE 1f if if !f 1f 1E fFff if jf !f 1f ik fE 1f if 1EiE k�F 1FiE ft
Z O N I N GS ERTEBQAUCIKRSE M E N T S�+pA/—l1��� 'nUi,l�_' E'`���.� =lJh
J ��� � V
------------ MAIN BUZLDING ---------- --------- ACCESSORY BUI]��lHfi��--
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING RE�• PROV; PARCEL: 41804110 ZNE: REF NO:
PLANNING N TES> �:'
> �
*�*�**��***�*�r**�x�*�r***�r�e**�r*****��r�**�rx �r�r�r��*�**�r*�r*�rx *�*�+�**�rx �+r*�*� �*******
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
ZONING APPROVED HY ,
HUILDING APPROVED BY ;
APPLICATION ISSUED BY• `� v�
if iF iE if if 1E jf * if iE iE iE 3E iE fE if 1f iE iE 9F iF a6 �F
�it**��******itit�e**x**�*�r*���r�*+�**+��r*�ft�rr**�****i ��
LEGALIZATION:N F E E S U M M A R Y
HLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 43,00
PLAN
ISSUE FEE
_ DATE:
_ DATE:
DATE: /O
�iFiFiFifiEiEiEiFiFlFif lfif
iflt ik k iE iE iE iE K if fE i! iF iF 3f ff ff iF if iE if fF iF iE 1f iE
. STRUCTURAL SEGMENT:Y
FZRE SMIP/RES GRADING
� . SQy
SMIP/NON—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 43.50 0,00 0,00 43.50 43.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 43.50 OVER/SHORT: ` .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING�PLAN—CAECK
43.00 ,50
it if i! if if if i! iF fE fE If k iE 1E 1F iE ff fE ft if �E i! i! if N if it ik 1t if 1! fk 1t 1f i! 1E fE 1E ff iE ih iE if if 1E 1f iF it 1f if if ik it 1f it if 1F �f if fE �f if if if i! iF if 1E if 1F M if iF it iF if iE 3f iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFA . 1850 REROOF BY VALUE RESIDENTIAL NOZONE �1.00 •' 1,850,00
END OF FEES
01 D�14S2S7—OD�432`8 T��T ;3.SD
RATE: 19/0:lS3 TI7E: 14:37
,
CONSTRUCTION AND PLANNING ��� 'PA
ApPROVALS Permit# Date Inspector APPROVAIS Permit# Date inspector
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe�Undrgrnd. 53. Steel Rei�forcement
3. Electrical Conduit Uti7iry�Undrgrnd. 54. Porms
4. Electrical Conduit-Undrgrnd. 55. Electric0l Bonding
5.'$teel Reinforcement 56. Rough Plumbing & Pressure Test
6. ElapVical UfER Grnd. 57. APPROVAL TO COVER�GUNITE
7. foptings � 58. Electrical Conduit�Undrgrnd.
-8.�_�'oundation 59. Gas Pipe, O Undrgrnd., Test
9: Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, � Undrgrnd.
I 70. Structural Ploor System 61. APPROVAL TO DECK
i t. Property Sewer Line & Hoase Co�nection 62. Backwash & Receptor•Final
i
12. Sewer Cap , 63. Heater & Vent-Final
13. Roof Dreins � 64. Plumbing System - Final
14. Rough Plumbin0 65. Electrical-Final
15. Rough Electrical-Condurt 66. So�ar System-Final
� i6. Rough Electric Wiring 67. Fencin� & Access Approval
17. Rough Wirin9 Siyn 68. APPROVED FOfl PLASTERING
18. Rough Electrical-T Bar Czil�ng 69. PO4L/SPA SYSTEM1AS FtNAL
79. Rough Neating & Air Cond�tioning FIftE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Perrhit #
21. nucts, in Structure . - 70. Underground HYdro
22. Ducts, Ventitating � - 71. Product Pipin9 �Gas OOiI
23. Gas Pipe-Rough & 7est - � 72. Under�round Flush.-
24, Roof Framing " - � 73. Undergrnd. Storage Tank � Gas ❑ Oii
25. Roof Sheathing 74. Overhead Hydro � '
26. T•Bar Ceiling IStructural) & Monocoat 75. pry Chemical '' �
27. Frame and Flashin8 . � • 76. Dry Standpipe �•
28. Lathing & Sidtng 77. FIXED SYSTEM'FINAL
29. Insulation ' � �' 78.�FIREPREV.FINAW
30. Drywall Naiting ' - HEALTH DEPT. REQUtREPlIENT
31. Plaster Brown Coat, � 79. FINAL INSPECTION �
32. Electrical Power MeterFinai - 80. FOOD CERTI�ICATE ISSUED
33. Einal Electric �� ' . . Notes: � �
34. Final Heeting & Air Conditioning � � ' ' � • -
35. FinatGasPipe-Test � i; _ . ' .
36. Hoo� or Canopy . . � � . ' • �
37. Final Factory Fireplace . .' � " �
38. Final� Plumbing �
39. Water Service-Final' , �
�40. Gas Service•Final , . , . � . �,
41. Solar pomesticFinai " � `
42. Backflow Preventer ' ���.! p 7- p�' � �.� ¢ ���
✓ �17
43. Backflow Irrigation ; � . - ,
44. Landscape Irrigation Sysigm � - � . �
4b. Sound Atienuation - • ' '
46. Handicap Regulations ' .
47. FINAL STRUCTURE & BUILDING !0 Ot�? G Gfi+ti�" S h-g� �� d�.- ����
m
48. FINAL PLANNING "� .
49. Elettric Release to Edison • �_
�50. Gas Retease to Southern CalifOrnia Gas Co �
6`i. CERTIFICATE OF OCCUPANCY
No. � Dats
ADDlicant to fill in all so��es ezcev� those within neavy bortler Ilnes ana sign all aoorovriate aeclarations.
Ci7a! oF COSTA MESA CONSTR U TION PER IT, ' "' "' ""'— "'" ""' "-' -- -' "'•" '""
. Pro}Bct'A'ddress �,�� G"�ff�v0- 'AdE�Y �,eEL� C J12�{ �G P� �
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
AppliCant'S1Uailin AdtlfC ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's N�my �/'� �,(� �� Phonef�'s7 DESCRIPTION OF WORK/USE OF BIDG.
,Adtlreu Y `��J� �v� /��'�'�
Arch/Eng. License No.
Address �-p
Contractor's Name ���G� Phone
Address (mailingl
Ciry License No.
LICENSED CONTRHC70R DECLARATION
I hereDy allirm that I am licensetl untler provi�slOf harter 9(commencinq
with ucllon ]000) of Division 3 of Ihe BuSi e jn ofessions Cotle, antl
my Iicense is in full forc¢ antl effect. �
License Class Llcei1se o.
Dale Si9nature
WORKERS' COMPENSqTION DECLARATION
I h¢reby afflrm that I h8ve a certificdte of consent t0 seli-insure or a C¢rtilicale
N Workors' Compensztion Inzurance, or a cerHtietl mpy thereot (Sectlon
3800, Lab. C.) ' ,.
POlicy No. Company
8 Certiiletl copy is nereby'turnisnetl� �/
Certlflatlpooy'�fi�.",�u�i�^�^^�'�dl �'� isia � /^
E%EMPTION FROM WOHKERS' CO PENSATION DECLARATION
(This sectlon neetl not be completetl i e permit is tor one huntlretl (5300) or
lezs). -
I certity [hat in the peYto�manca Of wOr \� ttich �5 p¢rm�l is I55uetl, I
shall not mploy y ppSson in an an s as t ecome subject [o h¢
Worke z'l�� e if Laws of Calii rni . .
Date "� $i9nature �
NOTI E: It, a1 r aking thiz aeclar io , You shoultl become subje<t to tne
Workers' Com ensatioh� provisions l�e Labor Goae, you must fortbwith
comply witn w�h provisions or Is permlt snall be tl¢emetl revoked.
CONSTRVCTION LENDING AGE CV
I her¢by aillrm that there is a construction lenaln9 agency for tne periormance
o( thu work for which Ihis permit is issuetl (Sectian 309] Civ. C.)
Lentler's Name �
LenOer's AtlOresz
OWNER BUILDER U�CLAR%1TION
I hereby affirm that I am exemp[ from the ConVactor•s License Law for M�
Iwunty which requires a pe�mit lo construct, alter, Improve, tl¢moiis� or �e0a
any structure, ptlo� to Its issuanGe, al5o reqWreS [he applicant for Such permi
[o file a zionetl statemenl Ihat he/shc is IicenSetl pursuant to th¢ provislons O
fh¢re/rom antl the baSis fo� the allegetl ¢zGmp[ion. Hny vioidimn or xcuon
]031.5 by any applican[ (or a permlt subjett5 the'applicant t0 a civil
�enalty of not more tnan five huntlretl tlollari (E500).
�I, a5 owner ot th¢ property Or my ¢mployees with wages as their sola
comp¢nsation, will Co the work, antl lhe structure is not intentletl or olleretl
for sale (Section ]04q, Business antl Profeszional Cotle: The ConVattOr's
LicenSe l.aw tlo¢5 not app1Y to an owner ot a prope�ry who builtls or improves
thereon, antl who tlo&s such work himself/nerzeli or throu9h his or her own
employecs, provitlea tnat such improvements are not inientlea or oHeretl for
sale. If, howev¢r, tne builCing cr Improvement is soltl within one year of com-
pletion,.ihe owner wiry have the burtlan of proving he/she tli0 not builtl or im-
��ove fo� lhe purpose ot Sale).
I, a3 ownet of [be property, am axclu5ively Cont�acting with Iicen5e0 con-
tractors to construct tA¢ project (Seclion 7044, Business antl Professlons Cotle:
The Conlractor•s LicOnse Law does not apPIY to an owner of Oroperry who
builtls or Improves lhereon, antl who conVacts �o� such projectz witb a con-
tractor(51 license Ounpant [o the ConlractOr's LicenSe Lawj. I am awara that
proot o( Iheir Worker'S Compensatlon Insu�anta shoultl be 0/ovitl¢tl to me.
❑ I am Czempl untler 5¢�tion B. 6 P. G. �or thi5 reason
Date Owner
1 have reatl this appliwtlon antl state that the above
I agree t comply with all city antl county ortlinan<es
to buii ng constructlon, antl hereby au[horize req re-
' to e�� upon th¢ dbqve-TentiOnetl PrqpertyQ_o�
TVPE OP PERMIT LJ GRADING LJ FOUNDATION VJ STRVCTURAL
❑ TENANT ❑ ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PRWECT DESCRIPTION So. Fr. 3� pCCUaarv�c�v'—,.��
CON STRUCTION TYPE VAWATION $ _ryL_
ZONE GI7ADINGCV.YDS. ACRES—
Remarks:
$ink
Preventer
Irrigation
Drinking Fountains
Floor Orains
Floor Sinks
Gas Service Outlets
Interceprors; �
Kitchen Sink
lavatories
P-Trap
Roof Orains
Reinspection Fee � $15
Boiler ;
Duct-UnderGround
Duct - Struc[urel
Duct - Ventilating
ExhaustSyscem ❑ MWtiple
Firepl/FacL BIL ICBO #
Heating System & Ducting
❑6100,000 BTU �100,000
�.v����..�� v�� ...,� . .��`-�4'Y r�✓i�L Date ��nLf7��5
Signalui
Drivers' � cense or 55 � � �� Reinspection Fee
CMF 0065-46, rev.4/84 White - Builtlin9; Canary -Applicant: Pink - Accounting; Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection-
Solar Collectors
Solar Pipin9
Solar Tank .'
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater �
Water Service
laue Fee
Hoodor Typel ❑
CanOpy Type I I ❑
System
BTU ❑100,OOOBT
laue Fee
$ 3
$ 3
A.P. #
5 Main Building:
E
T Front
B Fear
A
C fiight
K Left
S
Ping. Ref. #
Planning Notes: �B//
Automatic Washer
Construction Pole Suh.
Cooking Unit
Disfiwasher
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$W I IChCS
Garbage Disposal
Generator �65 KW C
" 6212 I/2�/B5
Zone
Accessory
ELECTRICAI
Transformer ❑ 15�50 KW
❑ 50+KW
5-15 KW
I Reinspection Fee I $15
DEVELOPMENT SER VICES REQi
2oning Approved 8y
Building Approved By
Meter lJup to 700 amps
Meter ❑over100amps
Sub Panel
Motors�0.1 HP �iX-B
Inc.Solar �9-15 HP �16-15+
�Microwave
Pole Light
Range
Standing Sections
Trash Compacror '
y� . ..
luue Fee ��
1
o�occ
FEES
$ 3
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S.
ation Issued By ,�7 '� DaYe �-zZ'-�j�
;gy SUMMARV OF FEES
[i}JILDING PERMIT $ ' �� SMIP $ w5�
PLAN CHECK $ � PERMIT
PLUMBING $ .'�i•CC� ��UANCE $
PLAN CHECK 25% 3 • SO ENERGV P.C. $
ELECTRICAL S �-F.(o(� GRADING $
PLANCHECK 50% $ .9I) MICROFILM $
MECHANICAL $ TOTALFEE $ �Z•�S
PLAN CHECK 25% $
CONSTRUCTION ANDPLANNING � POOL�,.SPA
A�'PROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
7. Temporary Electrical Service or Pole ' �` 52. Pool & Equipment Location
2�Soil P.ipe-Undrgrnd. ?,?,�f' G�() � 53. Steel Reinforcement � , �
3. �lectrical �Conduit Utility-Undrgrnd. � � 54: Forms �
4..Electrical Conduit-Undrgrnd. � 55. Electrical Bonding �
5. Steel Reinforcement " 56. Rough Plumbing & Pressure Test
6. Electrical UFER 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, O 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 3(�g/ L . 65. Electrical-Final ' '
� 15. Rough Electrical-Conduit . ,� 66. Solar System-Final �-
76. Rough Electric Wiring v�+�' C � 67. Fencing & Access Approval .
17. Rough Wiring Sign � - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T 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 O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing , 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. floof Sheathing 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 3�_ S� LL Notes: �
34. Final Heating & Air Conditioning � - _-
1
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 pomestic-Final �
42. Backflow Preventer
43. Backflow Irrigation .. , , . �
44. Landscape Irrigation System _
45. Sound Attenuation E'X P I R E D
46. Handicap Regulations . � ��� �
47. FINALSTRUCTURE&BUILDWG � ' LY�tE � S16' ---
48. Special Requirements Completed � „
49. Electric Release to Edison i ' �
50. Gas Release to Southern California Gas Cn , �
_51. CERTIFICATE OF OCCUPANCY _ ,
No. Date •
�
GENEftAL CONTRACTOR
DESCRIPTION OF WORK
ZOA'E
Date I GROUP
Gas �k_ � 4 SUBCONTRACTOR I Datc
WBtQi (.� rr � � 6�A'�-( ./.i i G�6a"( . PIUIDb10E _
- -�� 25694
.� ,. ..
' CdSTA� MESA BUILDING-SAFETY DEPARTMENT
r. O. BGX 91] COBTA MlBA. CALIFORNIA
For Applican} fo Fill In Comp►efely
TYPE OR PRINT
, ARCHITECT
COSTA MESA, CALIFORNIA
��S A 3�2C ��-2
�
CIMIC
uc. r+o. �
S12E %
OF LOT �P
U5H OF
EXISTINO BLOp,
BETBACK LINB PROM
DESCRIPTION OF WORK
BUILDINO 2�'3Q
SIZE
EXTERIOR WA�{f.C)
COVERINO 7
USE OF BUILDING AI
�
� i `2 � � (�' /L �L
I XBRBBY ACKNb LEOOB TXAT 1 HA HEAD THIO APPIICATION
AND BTATB TNAT N8 ABOVH IB C GplCT AND R88 TO LOM.
OLY WITH ALL Cl ORDIM�NLdB O 8TAT8 LA R80ULATINO
9OILOINO CONBTR ' ION.
PERMIT'fE e �F �� G � v \
AUTHORIZED A6ENT
FiRe
---------._� .____.
C�T�' �a: , � , .'
€;..:.,.� � r��
L
MAY 11 1966
APPLICATION FOR PERM
RbY OfEic��JOo�y
. .:+V.::. .
1�6C[II! NO. P6HMIT NO.
:�V • OSTj C8 6D �DAT61H9U81
NO.OI UB80P
PUNH _ �/ 01MDII
,�-
D88CP�P1'ION�//M/ �L// ri��L�.�A. • )��
\
9. P. NO.
VOTE: NOEAVEOVERHAN68HALLBELESBTHAN
90' TO 61DE @ REAR P. L.
:AVE6
4LLOWED (U. B. C. REpU1REMENT
YARD8APPROVED YARDSAPPROVE�
MAIN BUILDINO ACCESSORY BUILDINO
( FROM C/L S'[$F�ET 1
F� I
R. SIDE V FT.
/ /
L. SIDH O F"f'.
i
REAR � O hT.
D16TANCE BhT. BET.
MAIN BLDGS. ACCE
VAR. $ DATB
TNH AMOUM BHOWN YNOEH VALl1ATION IB pOp TH8
PYNPOBE OR 88TAB�I9XIN0 A PEHMIT FEE ONLV.
VAlU0.T10N �
PERMITFEE
5�,�� ( 9 7
TOTAL FEE � O
JOB ADDRESS �-590 Grand Haven Circle
GENERAL CONTRACTOR B18CkID8II F6RCC CO. DESCItIPTION OI'
P' Yo. None LOT 1�-16 �tnCT 5698 FIRE ZONE VnLUE
7 F.CT(ONS I Sienature I Date � GROIIP _T TYPE
SUBCONTRACTOR
. �����
COSTA MESA BUILDING-SkFkTY DfPARTMENT
' P.O. DOX 1IP� - COSTA MESA� CAI_IFOANIA 92826
' '"�, . �•'�-^._'�- .' "^ •r`�§nri-r�^'..�t."a'�F�'
For dpyi3cant fo Fi6! /n Camplote(y
� naF .o� , , �, U.,
' om�o�No>-n/ �v /.. ._�
STATE
LIC. NO.
s¢e
OF l0T
USE OP
EXISfiNG BL
iCTOACN YM[
F�
CALIFORNIA
��on�:
HO.OIOlDO�.
DESCRIPTION OF WORK
BV ILDINO
s�ze
[ E%TERIOR WALL
WORKM CS
� 1 HEPCOY ACKHOWLG006 TNAT 1
AND STATH THAT THH AEO`j¢ 16
PLY NITH ALL CIiY O¢¢¢GIt1AtlCFA
BUILOINa CON9iRUQ/O[I. � �
/ / /
SI6NAl'UREOP V v
PERMITTS6__�
' AUTHORIZ6OA6RNT
� �'�.' `y�'w""r!..�,.":`A�"'._'�-'�;�1i�
raia �.._:.. 5.00
FE3 23-6�cr,sa�O 488 �.<t.. ,.�
APPLICATtON fOR P'cRMR
6UILDIfV6
�or O€€ico Uss Onfy
RHCCIPT XO, � y
�� /1 1 J
OY - D�T6 RSCiIYHD ,� ,.�GI
ETL��i(/ L�/X /C-% DATE_ ��i�..% {✓Y
ZOPtiNG y'.'� . ,��
2Q(� HO.O� YG[O�N[W (}�
\X ^ I tLAlll '�/ CVILDINO /"V
936CAIPTION �- �'�I ) I � � , /� ��
y � '
A. P. NO. /Y"�'—' � � ,
_ _— " � I �_r.
NOTB: NO EdVC OY6F.H.i^f• �.. �. As LEES TH.1N
�O' 70 91 OE a P.fiAR P. L
CAVED
wuow¢o W. B. Q REQUIREMENT) .
YA4DBMPftG`f'cD YARGS}p 'I�:VED
MAIN BUILDIIrO +"CESSOR �`INO
�fFROMG/LiTREiTI � ��--�� y
rnnr�r cT. i/JII: ��Ff.
rtsuuunna
��
rr. Fr. -
rr. _ r�.
r. eer. mn�H a
DATfi
�V � 1 ' � ' 0.
p
o Ba. iT. "' �
0
TH6 AMOVM ONOWN UNOER VALUATION IB FOR TH6 j
PUR'IOOC OI IATAOLIGN1110 ♦ PEpMIT FEC ONLY. R
VALUATION ✓ �� �
�� �� PERMIT FEE / I �
h
$ � �A C
�
�
�nvcR SMART, SHELDON v��� 7-31-69
JOB ADDRESS 590 Grand Haven Circle BUILDING PERMIT N0. 3e5 5
�!]FAIFDAI ('f1AITDA�'Tl1D f1Ffl'DIPTIfI�.I..lWl1D1f_» —__� —___ e __i._ _______
owriv
A" `�o. �F1H-041-12 LOT
I_ 9CTIONS
SOIL
GAS
WATER
ROUGH PLOMBING
PROP. SWR. LINE � HOUSE CON. ❑
SPRINKLING SVSTEM
MISCELlANE0U5
ROUGH HEATING AN� AIR CONOITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUNO U POWER LJ
ROUGH WIRING
TFENCHES FORMS � STEEL REINF
FLOOR SVSTEM
BON� BEAM � STEEL REINFORCE �
SHEATHING
FRAME AND FLASHII
P+
LATHING — IN' O�T
PLASTER,BROWN COAT � �
5- TURAL, FINAL
H. AG, VENT., REFftIG. ANO A.C., FINAL
PLUMBING, FINAL AN� GAS TEST �J
ELECTRIC. FINAL
)UP TFnT TYPE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAl1FORNIA 92626
For App/icant to Fill in Completety
BUI�DING '
ADDRE55 S90 G'nA.vd F/t�dcr �IKC�e,
OWNERSy�eIL{ON Si'YfA%LT
MAI l �
ADDRESS ,�% V (r.tp.v.l I�q U E.� C��kcIQ
TEL.
CITV��,fT/j %NE� � NO.�'yi�/Y9
CONSTRUCTION �0 �..�
LENDER
BRANCH
ADORESS
ARCHITECT . . TEL.
ADDRESS
CONTRACTOR �(/O�wR-
ADDRESS
TEL.
CIT V NO.
STATE CITY
LIC. NO. LIC. NO.
SIZE INO.OFBLDCaS. /
OF lOT NOW ON LOT
USE OF �
EXISfINGBLDG. ��UPJIIw�
SIZE OF ��+�r� a�"` NO.OF
N6W�GLBO. ROOMS STORIES
EXTEFIOR WALL ROOF /� _
COVERING LUGOd COVERING CC%N/�L.���.o
USE OF BUILDING AND WORK TO BE PERFORMEO
U R ✓
I hereby acknowletlBe thet I hava reatl xhis application entl stare
that the abOvo InfOrmation Is torract antl apree to comply wi[h
all laws repulotinp buildinB �onsttuction, antl I shall not employ
any porson in vlolation of the workman's compansation lawa of
Me Stem ol Celifomia.
I hereby certily that I am properly Ilcensetl as e contraetor untlor
the State of California Buslnasa antl Professions Cotle, Dlvisicn 3,
Chapmt 9, ontl thet such Iicanaes ere In tull torto ond eHett, or I
om oxomp� from tno ovisiom of tna State of Celitornle Businecs
antl Profazslona , ivhlon •hapt .
Signature Of �
Permittae
Authorizetl Agent
JUL 31-6 P�002703• *** *4L
CMSA
APPLICATION FOR BUILDING PERMIT
RECEIVED B,Y OA� REC�IYEp nnr.c �ssw
BUILDING � -
ADORESS �j
TFACT ,
Y/ . �// �. �'Ai� VALUS S
/1Ll.r�y
TVPE GROUi
OVED
ATE
_ NO.OF . USE OF NE
PLANS BUILOING
iR S APPROVED VARDS APP
�AIN BUILDING ACCESSORV
M C/L 5T E T�){�-
T �w) F'
1 3U FT � F'
i
�E S FT. F'
il /i � �
VAfl. aY+
C.U.P.qW
APPROVED
MOLD FOR
/ . s �
THE AMOUNT SI
THE PURPOSE OF
�V�
BEf. MAIN &
ACC65. BLU
DATE
APPROVED
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0
VALUATION IS FOR �
A PERMIT FEE ONLV: Q
. y�q,
E $ �� �
J �
K $ / V / ~ m
^ E
T O . � `o
' LL
S
�OWNER SMART, SHELDON
JOB ADDRESS
IA_.E
SOIL
GAS
W ATER
CTIONS
R CONOITIONING
UN�ERGROUNO � POWER
ROUGH WIRING
FRAME ANO FLASHING
LATNING - IN n
PL^`T
5
FINAL
BUILOING, FINA� VTALV' I� 6-��
DATE �_
SUBCONTRACTOR
s for Fut
100.00
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
DEC 17-70�qsp00 733 0*****5.00
APPLICATIOIV FOR BUILDING PERMIT
For Applicant ro Fill in Completety REc ive V DATE flECEIVED
BUILDING DATEISSUED
ADOFESS � � G,.a Nd NRv� N e��'��Q �Z'/ � �Z/`�7 �7 �
/ / �^ C _O C� I PERMITNO.
OWNER �'1 4(�b i..' � iVl Ei n I A.P. NO.
MAIL BUILDING 'D (� ^ ,Q,; _ �_
ADDRE55 � Q ADDRESS '4J a[l�u�..��yC �:l/t.C,Ef!/
GTV NOL�QS'��%�%S TRAC�� LOT (,n BIOCK
CONSi'RUCTION W AD A P
LENDEF �
BRANCH
OWNER (
ADDFESS ' VALUE J^
AFCHITECT �� TEL. S / $ � �'
OR ENGINEER N
FIRE
AODRE55 �- ZOfSE TVPE GROUP
CONTRACTOR � W 'V � Ic BVPR�VED DATE/� �^7
ADDRESS `� -•_"
TEL. �ONE NO.OF USE OF NEW
CITY NO. � P�� a""' BVIIDING
STATE CITV �'ARDSAPPROVED VAR�SAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BLOGS. (FROM C/L STREET)
OF LOT NOW ON LOT RONT FT. FT.
E%�ING BLOG. S�I �< ,"�/�iJK� I ' WAII�N �� F. FT.
SI2E OF NO.OF /�7{`.L_
NEWBLDG. ROOMS STORIES LSIDE�'M �F$ FT.
EMERIOIi WALL AOOF
COVERING CpVERING REAR FT. FT.
USE OF BVILDING AND WOFK TO BE PERFORMED DISTANCE BET. BET. MAIN &
i N �t %� G4 t � � rl� MAIN BLDGS. ACCESS. BLOGS.
G G�1 ti J /�O 1' /'4 T�t /� �c7 T� d C URP # APPROVED
S�U C 74 4�G . APP VE �� / / / O
��F � ���
I hereby acknowledBe that I have read this aOPlica[ion antl stam L� �
that the obove informetion is corract antl apree to comply with
oll lawa rogulatin0 builtlinp construction, entl 1 shnll not employ
ony De�son in violatlOn of the workmon's compensa[Ion lews ot
che Stete ot California.
I hareby certify Met I am prOpor�y �i�ensetl as a contracta� untla� SQ. FT.
tho Stnto of Calitornia Buzinass entl Professions Code, Oivislcn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chaptar 9, antl that such licenses are In (ull forea and effeet, or I THE PURPO6E OF E5TABLISHING A PERMIT FEE ONLV:
em nxampt trom tha qroiisions of ShaSiate of Cellfornia Bus(nass VALVATION '�"�
antl Protesiions C J D�islon 3, Chapt 9., ��
PERMIT FEE SS
Slpnnture oi `L
Parminee § �� PL.AN CHECK S —�
Authorizatl Agant �
TOTAL FEE 5 �
OWNER
P" 'o.
WRT� Sheldon
590 Grand Haven
RACTOR Owner-Bldr.
-12 LOT
GAS
W ATEft
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGN HEATING AND AIR CONOITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUND � POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL RE
FLOOR SYSTEM
BON� BEAM ❑ STEEL REINFORCE [
SHEATHING
FRAME AND FLASHING
LATHING — IN I� OIIT I I
5
FINAL
DATE 12-28-70
BUILDING PERMIT N0.
21PTION of WORK Patio Cover
ZONE VALUE$400.00
)UP J TYPE V 2
SUBCONTRACTOR PER
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MHSA, CALIFORNIA 92626
DEC 2A-70cwsa00 002 0*****5.00
APPLICATION FOR BU�LDING PERMIT
For Applicant to Fi!l in Completely
RECEIVEDBV DATERECEIVED DATEISSUED
BUILDING GI (� ��� 2'1�'%O �,2-2�-%O
ADDRESSS O �. M� /'7 UOqI �j✓� Y.
PERJ�QIT
�^ }- A.P. NO. jf
OWNER N ) ✓V� %2
MAIL BUIL�ING L
ADDRESS G ADDRESS (/
TEL. TRACT(�J LOT BLOCK
arv pJT � f' No.,S-• -/
CONS7RUCTION W A P
LENDER \.
I�
BRANCH
OWNER
ADDRESS � • /�yr.�,� // VALUE
ARCHITECT TEL SE y v v v 5
OR ENGINEER N
FIRE
ADDFESS ZONE TVPE .GROUP�
CONTRACTOR G W N Q� ByPROVED ?j��� DATE ��L(f D
ADDRESS
TEL ZON —/ NO.OF VSE OF NE Q'8
CITV NO. P�� BUILDING
STATE CITV �'ARDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BLDGS. (FROM C/ISTREET)
OF LOT NOW ON LOT ROM FTY " FT.
USE OF / � /
EXISTING BLDG. �' ( j M SI {� TFT. FT.
S12E OF NO. OF u
NEweLOG. ROOMS STORIES L.SIDE FT. FT.
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DI5TANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
f� ' �1 VAR.�k DATE
d(,/'P�'� C.U.P.# qPPROVED
APPROVED /
I hereby acknowledge [hax 1 hav¢ reetl this applicaxion and stare
thet the ebove information is correct antl agree to comply with
all lows �ae�ie�t�e builtling construction, antl I shall not employ
any Oerson in violation of the workman's compensation laws of
the Stete of California. �
I hereby certify that I am properly licensetl as a convactor untl¢r SQ. FT. o
the State of California Business a�tl Pro(essions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chapter 9, antl t�at such licenses are (n full force and affact, or I THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONLV: ¢
em axampt from the provisions of �he Staie of California Business VALUATION
antl Professfons o Divislon 3, Chap� r 9. �� �
/� �/ p8 PERMIT FEE $ �
v G( OL / iv`GsN'� �— J
SI neture of m
Permittee 5 O� PLAN CHECK $ E
`o
Autharizatl Agant �, �� u'
TOTAL FEE $
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Givll Engln��r 10161
Gard�e Gro�• �
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14666 BEACH 90ULEVAFO
WESTMINSTER, CALIfORN1A 92683
(714) 898J881 �
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