HomeMy WebLinkAbout1865 PARKVIEW CIR - Building Permits CITY OF COSTA MESA
�'��Jw FAQ • BUILDING DIVISION .
F` •
N" �I$ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
�. . •
PFOR INSPECTIONS CALL: (714)754-5626
4To` PERMIT NUMBER1/ M07-00534
PERMIT TYPE MECH STATUS: ISSUED
. DATE ISSUED:
ISSUED'BY: SOK
JOB ADDRESS: 1865 PARK AV CMSuite/Unit:
Vicinity: ROOFTOP FIRE STATION.#3-- " • - . •
SQ. FT: 0 . . . . .
SCOPE OF WORK: REPLACE4:NC ROOFTOP UNITS FOR"THE CITY OF COSTA MESA FIRE STATION#3"
OWNER: CITY OF COSTA MESA .''.;-...: -- Address: . P O BOX 1200 Unit:FIRE .
PHONE: - - - - -- . - •City/State/Zip: COSTA MESA, CA -• ' ' .
•
APPLICANT: ROBERT BARBANO_ _ ' - ' r- ; ' Address: • 1702 W 5TH ST-Unit:
PHONE: 714-973-1771 City/State/zZip: SANTA ANA,CA
CONTRACTOR: CHANDLER'S AIR CONDITIONING AND REFRIGERATION License No. -677263 x
Address: 1702 W.:5TH STUnit: • "PHONE:' 714-973-1771' - .
City/State: SANTA ANA, CA ZipCode: 92703 , CELL: "
•
MECHANICAL PERMIT FEE`SUMMARY
MECH ITEM FEE: - ,. "$104.95
PLAN CHECK FEE: - $0.00 '
INVESTIGATION FEE: _ $0.00 •
REINSPECTION FEE: • . $0.00 •
TOTAL FEES: $0.00
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work 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.
CODES. INSPECTION TYPE DATE INTITIALS CODE/ INSPECTION TYPEDDATE MODALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical I(— n 1 -0�
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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's ..e. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
0 I have and will maintain a certificate of consent to self-Insure for workers' •
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. .
g---I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:.
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: j/✓/�'N or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section ne not be cu plr�l eted i(the permit valued at one hundred dollars(S100)or less.)
2,Art 2Sec.341,Title 6,California Administrative Code).
Policy Number: C( /7`J' a.5 -t °°7
❑ As owner-builder, I will not employ anyone to do work which would
0 I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date
the Labor Code,I shall forthwith comply with these provisions.
/7—/ o 7 Division of Industrial Safety Permit Number:
iwnt's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force effect. a registration form for acutely hazardous materials? 0 Yes ❑No
{/
Lic.# 77p•r�,3 Class# � (Section 25533 of the California Health and Safety Code, with some
//-117-4) exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
co .r's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
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 (Section 65850.2 of the California Government Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): _ of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for control officer
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 CERTIFICATE QF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). - information given above is correct. I agree to comply with all state laws and
I] I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
CII
exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
Signature of Legal Owner(s) Date
Signature Date 1/—/ 07
305746(3107) —��
n or Authorized Applicant Date
CITY OF COSTA MESA
04 a • BUILDING DIVISION
't 'l DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
I. I leinefral II
0 PERMIT
444e ,r E06-00608
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa..ca.usICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRJob Address: 1865 PARK AV Status: ISSUED
Suite No Applied: 06/15/2006
Vicinity: • Issued: 06/15/2006
Parcel Nunmber: 42422121
Applicant: JOSE ALVARENGA NELSON 2C
Address: 1618 OHMS WAY ISSUED BY:
Phone: 949-631-8777
COSTA MESA,CA Zip 92627
Owner: CITY OF COSTA MESA
Address P 0 BOX 1200
FIRE Phone: .
COSTA MESA,CA Zip: 92628
Contractor: NOOR ELECTRICAL SERVICE
Address: 1618 OHMS WAY "
Phone: 949-631-8777
COSTA MESA,CA Zip: 92627
License:452774
SCOPE OF PERMIT
ADD DEDICATED CIRCUIT FOR FIRE STATION#3 ,
FEE SUMMARY
• Quantity Quantity
ISSUE FEE $0.00 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft - $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 _ 0 up to 50 kva/kw $0.00 0
Recept Outlets $1.10 1 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee • $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $0.00
Intermed Pole " $0.00 0
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: 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)754-5828
2448-48(8/00) . .
DECLARATIONS .
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.
j�I 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.
My workers'compen§ation Insurance carrier and policy number are:
Carder: r 7 T�co --re farm Policy Number: 00 00/�7305,3
(This section need not be complete farm
permit is valued at one hundred dollars(5100)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 laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provision
Applicant Signature: Date: — IS- QC
WARNING:FAILURE TO SECURE ORKE COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADD ION 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 licensed under PpP�prroo,vi7si,,ions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effeLic.ct. a Class a
Contractors Signature: Date:
0er
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).
Lenders 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 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.).
❑ 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).
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? ❑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 tiling with the Fire
Department of en 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 aggermit lar such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 par of the facility to be constructed under this permit be within 1000 feet from the outer boundartes 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 Ouality 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.
i Signature Of Legal Owner(s)
And/Or Authorized Applicant Date
CODE f INSPECTIONTYPE DATE MALI CODEINSPECTIONR4TIRRLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing AW, 7201 200 Final Re-Roof 210 Final Electrtcal Com!/
201 Final Block/Retaining Well 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
ADORESSOf WALDWO: 1865 PARKVIEW CI UHT: • CITY OF COSTA MESA — BUILDING PERMIT .
OWNERSNMIOwl.A111,INDVALL, JOHN A PERM NO; B 071860
ADNIESS LINDVALL, ELLA MAE
1865 PARKVIEW CIR PERMIT NO: B 071860 PLAN CHECK NO: N GOVT: N SUPP : N
:OSTA MESA,CA 92627722-1935
APPL.MAILING ADDRESS/ CONSTRUCTION TYPE: V—N PERMIT TYPE: STA PURPOSE: OTH
ARCHITECT OR ENGINEER: sec NO. JOB DESCRIPTION . T/OFF REROOF W/BUILT—UP SQ FT: 2 , 365
ARCA OR ENO]ADDRESS: WIT:
CLAIM VALUE: 2, 365 . 00 CALC—VALUE: 2, 365 .00 GROUP OCC : R-3 /M-1
CONTRACT mum FAIRWEATHER ROOFING ( 714 )997-9449
cONRIACTOASYNIDm 3845 E CASSELLE AVE COMMENTS : SMOKE DETECTOR REQUIRED PRIOR TO FINAL, REROOF 1800SF RESIDENCE f �fl
ADDRESS ORANGE CA ucND_ ir
515125 41-******** r*+E+t*err***«*******err+Emir***+t�.****r µ x +L
-K-**vx.xra.r* * *** n
92669 UHT: Z ON ING REQUIREMENTS *IVO® EP *V
LICENSED CONTRACTORS DECLARATION:I hereby affirm wader peroly of perjury that I em licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)W Division 3 of the Business and Professions Code,and my license is in full force and Med. p_M
crrYLIC.ND.: O 7828 uC.cuss: C 39 mi.,: 51 12 EXP: 06/95 MAIN BUILDING ACCESSORY BUIR ��rW...l'--
Dm. / 1 FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
y/��(yf contractor C� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly el perjury that I am exempt horn the Contractors License Law for the
'ddemmWlnh, repair 7031.5 Buenas
walsoreq�urstheapplicantf«suchpemN:Any city Cr county[kith NtoNee�sgnedstatementNmhei'to othetruct.ther. or M PARKING REQ: PROV; PARCEL : 42431139 ZNE: REF NO:
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)el Division a of the PLANNING NOTES>
Business and Professions Code)or that he or the is exempt therefrom and the basis for the Staged exemption.My violation of Sedan >
7031.5 by any applicant for a permit subjects the applicant toe dvi penally of not mon than fire hundred dollars[MOD. *******************************************************************************
❑ I,es owner al the pogeny«mymhpb/ewwill wagesastheiedemmpenmion,hnTdotew k aid the structure is nth intended DEVELOPMENT SERVICES R E U I R E M E N TS
or offered b sale(Section 7044.Business and Professions n Cade:The Contractors License Lew doesnot apply to an Owner d property Q
who builds or improve thereon.and who does such soak Hensel or henna or through his«her own employees,provided that such
impairments we net Intended or Offered for sale.I,however.the building or improvement is sold within one year ol completion.the ZONING APPROVED BY
ownwbiSer will have the burden of Awing he or she ed notbald or improve for the prose of see). • DATE:
❑ I, calmer
eobredctode:The Contractors
sLLaww does not d racting with icensed contractors pro wcasstrixt ho ladtle project 'improves
h threw vend who BUILDING APPROVED BY
DATE:
contracts lar surA projects with a mntredor(e)licensed Passel to the Contractors License Law).
❑ lamexempt under Section: B.A P.C..lor this reason: APPLICATION ISSUED BY: * DATE: k( IS
********************************************* ******************* **** *****
Date: Owner: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT : Y
I do hereby candy that I am aware of and understand the requirements of California Health end Safety Code Sven 25505,25.533,end
for
s permit
thatloaror modification
odL building the Akupant ll aot(eme1D)rrd.RidenptywM smdonacodes and the nRulremwhse BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
25534,l«a all or an More biuiliinhomtMM lh�.engpnnoei nee d to iomplyntial mmsWbnapcFabmwhe rempemnNss
provision. PERMIT 54 . 00 . 50
Dula: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirmunder penalty d prj ry one d the following dedaratbn: PLAN
❑ Man and mental(l mental(a certificate d consent to eel-insure tor markers'compensation, p
n,ea provided fa by Section 3700 of the Labor ISSUE FEE
Code.tothe pedormanceof the work fowiththis pemmisissued.
BUILDING—DIV—> PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
❑ Ihave and w1maintain woker,' wea
nptioninsurance,as required Section of the Labor Code,fow
rtheperformaeoft. TOTALS ---> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00
wok for which this permit b issued.My workers'oOmpenWicn insurance center sod ploy number we:
Carder: REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
this.action need nol be cdmpwd t the perms a for erne hotrod dinars(Slap)«enJ 54 . 00 . 50
`
(J t ceniy that in the performance of the wok lar which this permit is issued.I Mai rd employ any prow in any Mannar le all to
becwn alibied Mille warkin'oonperumion Winol Caldodd,and!Wee dhm i I Judd bwanwerbledtothewaken' ****.µ**************************************************************************
comae rebaprovisions of Section 3700 d the Labor Code.I shall I arm those
e provision.
Date: N y � S Applicant
INDIVIDUAL F E E BREAKDOWN
Warning: dsnsooverapI�hldland subjectemolopw to criminal and TYPE QTY DESCRIPTIO N UNIT COST
TOTAL COST
civil find up to on*Mildred thousand dollars(slN dtrldonto the aft o/monpwu.rorkdamages aProvided for In
Section 3msef theLabor
Code,
Interest and mronny'sfeet
SFR 2365 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 365 . 00
CONSTRUCTION LENDING AGENCY:I baby affirm under penalty of perjury that there is a construction lending agency kr the END OF FEES
performance of the work for which this perm*is issued(Section 3097,Cue.C). -
LENDER'S NAME:
LENDER'S ADDRESS: EXPIRE • •
I certify that I have read this application and state that the above information is cored.I agree to comply with a0 thy and county ordinances
and state laws relmng to building conetrncaon and hereby authorize representatives of this thy to soler upon the above-mentioned property
for inspection pules. Q DATE asgA�
v 'J/�1t — of r r 4001 001;57;.:; 7119725 1rC+g 54.50
Print1.Nemo `,
—' Date. ` A/ V DATE: 04/11/75 Min 1'!:17
signature of Ownr/lpenUAlaAcant«orad«
(5151 de.WP) White-Buiing A Safety:Green-Re;Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POC SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Fobtings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 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-Ficial -
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 56. Solar System-Final •
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA 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 UGas ❑Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas ❑Oil •ter'
_ .1
25. Roof Sheathing
1175-- 6a.t.L. 74. Overhead Hydro v
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 (.r-IP-14---- 4(4, ti_v`sta 5 _
35. Final Gas Pipe-Test . Co fe.-- f
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. Backf low Irrigation '
44. Landscape Irrigation System 6Cjj�
45. Sound Attenuation 6 0,14 y,�t,pyt,.1O YfrY '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
' - i,�,_;-,'-_,_; CITY OF COSTA MESA BUILDING PERMIT
1 ADDREssasuaara: THEDE, STEPHANIE M MT: FDRN NJ. F 07.:.43.^.
OA'NEWS NAME IF KNOWN: THEDE ERIK N
ADDRESS: 1865 PARKVISTA CIR PERMIT NO: P 075433 PLAN CHECK NO: N COVT. N CUPP . N
COSTA MESA, CA 92627
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
ADPL.MAILDIO ADDRESS:
JOB DESCRIPTION : C/O DISHWASHER SQ FT :
ARCHITECT OR ENGINEER: It ND:
ARMOR ENG.'SADDRESS: MIT: CLAIM VALUE : CALC—VALUE: GROUP OCC : R-3 /
NOCK PLUMBING (714 ) 895-1246
coNTRACTORSNANE: 11610 SEABOARD CIR COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT
CONTRACTOR'SMMWID STANTON CA 511971 **+E•+E+Est+t*4******Sun-*N******jE-HESE**;'HCH***************tl*+ASH*xfH**SEiE*rt*iE******+E**********
ADDRESS: 90680 uC : ZONING REQUIREMENTS
WE: SETBACKS
LICENSED CONTRACTORS DECLARATION:I hereby Slim under penely d perjury that I ant licensed under od.0 P
(commencing volt @n3' Division 3d iTro
the Professions cgd4 a1d3Qi�nse S in CO ede1 ' MAIN BUILDING ACCESSORY BUILDING
Cm LIC.NO.: LIC.CLASS: LIC.NO• FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
/ 42.-1 _ 9 5 K \n�. oLv///2, Al LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Ocmtrectr: a�-+ 1
NER BUILDER DECLARATION:I hereby affirm under penally of perjury Net l are exempt from the Conflation License Law for to PARKING RE PROV: PARCEL : 42431114 ZNE: REF NO:
following reason(Section 7031.5 Butes and Professions Code:Any an or county whichr.eubea a permit to construct.alter.improve, PLANNING NOTES>
demolish.or repo any structure.prior to its ,also requires the applicant for such pet to file a signed statement Nat he or she >
licensedispursuant to theoovuionhofeaCawactdelpLicenseLaw[Chapter atht(commencing theoge eumpen790o)of Division 3dthe *******************************************************************************
Sun s end Rdnainm Code) o the he or she is t exempt therefrom and Ch the bath r eloped a ion 703) D i i tl Seethe
7031.5 by any apoccad for a pet eubpcts the appiat lo a dvi pettedly d not more than fere handfed dollen[MOD. DEVELOPMENT SERVICES REQUIREMENTS
❑ I.as owner d the property or my employees with wages es their sole compenmion,•l do the work.and the structure is not intended
or offered ro '� vP °ma « te'nwaproperty
who buidsoingpthereon. eProfessions n Contractors heroat encilayee. p the such ZONING APPROVED BY DATE:
improvement are not intended or offered for sale.I,however.the building or int roverned S sold within ore year of completion,the
burden .n
ownertdetwuhaveR» denofprovinghe,redid ncebwdorimprove f«ouw® tl
»peeele). BUILDING APPROVED BY : DATE:
o I.as owner of the property.em exclusively contracting with licensed contractors to tot the cape(Section 7044.Business and
Professions Code:The Connectors License Law does not apply m an owner d property who builds or improves thereon and who `` ��
contracts I«such projects wish a cote:Ms)licensed pusuent to the Contractors License Law). APPLICATION ISSUED B Y: l//+ ATE: In
❑ Ism exempt under Section: B.A P.C..for this reason: ************************************* jE ********************D*****';t1 • •• **
Date: ower: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N
I do herebycenfy that l am aware of end understand the requirements of California Health and Soley Code Sections 25505,25533,and BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
25534.and that I or any Mare building compare will/wit not(dreb one)need to cm*web said mete codes and the requirements for
a permit for construction or modification from the Arty vuyeere District.ResidentW m�ictS.oomimitations are exempt from these PERMIT 7 . 00
prvasgn.. 25% SMIP/NON—RES
Data: Apart-art PLAN
ISSUE FEE 20 . 00
WORKER'S COMPENSATION DECLARATION:lhereby dhm under penally tlperjury an.aN.romwig ewmmians: BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ lhave and wilmaitanaroM'cmadmwntlon nefarworkeiaompenmion.=povieedforbySect370DatheLabor TOTALS----> 7 . 00 20 . 00 0 . 00 27 . 00 27 . 00 . 00
Code,for the performance of the work for with Nis pends S Issued.
0 I have and w meiten workers'compensation enquired by section 3790 d the Labor Code.for t the
work for which permit is issued.is permit My workers' i8h insurance carrier end play number are: b REVENUE DIVISION TOTALS--> COLLECTED : 27. 00 OVER/SHORT : 00
Carrier: NWC32113100 09/30 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Pairy ra,m,b27 . 00
s secfian need not bec opshe an the perm/S for one hundred dollars/31901 or lass.)
beady that inthe to themeneadthe ompenkfid wlawstbpermSbissued,lehdlnaamDMaMDaneninaMmanner eqnlota
*******************************************************************************
become subject m the workers'compensation bund spree Nat • become subject to the worker' INDIVIDUAL F E E BREAKDOWN
compensation provisions of spemen 3 of the Labs Code,I all f •h comply welt ... . . :ons.
a... 1,2 —o — ! � Applicant: J • QTY D E S C R I P T I O N UNIT COST TOTAL COST
•
• ng:Failure to secure kiloliters'compen aadon coverage Is unlawful,end shall stalest an employer to criminal penalties and
Dmawtoone hundred fheuard dtlMn(ffatogoA in aWllbnto N.cost of compensation.dltineg.+as Provided con In PLU 1 DISHWASHER 7 . 00 7 . 00
Section 3708 of to Labor Code,Interest and attomeYs fees
END OF FEES
CONSTRUCTION LENDING AGENCY:Hereby affirm under penalty of perjury the there is a construction lending agency for the
performance of the work Ice Meth this permit is issued(Section 3097,Civ.C).
LENDER'S NAME
LENDER'S ADDRESS:
I candy the I have read this application and mea that the above information is correct.I agree to comply with all city and county ordinances XpIRE
and slate lawsrdmig b huddeta[Mmrddr ad hereby althorn('represent*,dThis city to wear upon the ab0 emetionerd property
for inspection purposes. L�l1fiJ IV flys ly �n�
` :ntName 7Illi —7S DATE_ l� of Ur,.L. _ ,,__:i> 6e7
Signature a• - ''• ... Date: PAT': i.72/1)-.."45 *17.-r - _ ,i7 . .
a
15151-06.WP) Whim-Built 8 Safely:Oreen-Fir:w: Applicant:Pink-Revenue:Goldenrod-Assessor
‘r' CONSTRUCTION AND PLANNING P00. ,PA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utilitv-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, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,0 Urfdrgrnd.
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-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,0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush Iy
24. Roof Framing 73. Undergrnd.Storage Tank O Gas O Oil a
25. Roof 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 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 & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
CITY OF COSTA MESA REQUEST FON OCCUPANCY
TRACT NO. 7 -1,3
•
LOT NO. . 7/
••
ADDRESS �1 S l7 2 GG CCX Ghee
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 undersigned, by cxecu ing this agreement, acknowledges_
that '(ire stye-they) (was or 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 enforcement of the condition:
necessary for approval other than those conditions protected by
surety bond.
The undersigned agrees to indemnify and hold the city harmless
' prom any claim resulting in damage or personal injury to the
undersigned by reason of the, aforemen - ' .ned uncompl • =d `condition.
•
•
• BY t/i P.\ / / it
- Purchaser'
21-14,2,2(1/71., (1/2 / •• .
Developer and/or authorizes
representative
• BY 9t C�( ��i�`�i�f
Leder •
., , .I . 11 . • • it . .,..i, )-11-16
. JOB ADDRESS :.
• ^~
BUII !G PERMIT NO. 41968
. GENERAL CONTRACTOR John Ne Clark DESCRIPTION of WORK L-atio Cover
AP No. 116-011-38 LOT 31 I RACT FIRE ZONE VALUE E 1500.00
INSPECTIONS Signature Date TYPE V GROUP J ZONE R1
• SOIL PERMITS ISS D
GAS SUBCONTRACTOR
Date Number Signature
WATER Plumbing •
ROUGH PLUMBING
4 PROP. SWR. LINE ❑ HOUSE CON. O
SPRINKLING SYSTEM
MISCELLANEOUS
YROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND [i POWER ❑ I
ROUGH WIRING Heating and Vent. •
TRENCHES Fil I'ORMS 0 STEEL REINF. 0 (1.2-J S ILA;)la
FLOOR SYSTEM
BOND BEAM [-J STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING — IN [1 OUT rl
PLASTER. BROWN COAT
STRUCTURAL, FINAL Electric
HEATING. VENT.. REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST Cl
ELECTRIC, FINAL
BUILDING, FINAL 9a 5-2406
tow
4.1968n 11-76,-T/7;00 549, -15.5C
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
D�(�/'__//GG � RECEIVED BV,a //D ATE•RECEIVED bEI -GE
I$$yE�
ADIDRESSG
IObc' P/Y/`I/t(fN C /� /0/7� //
OWNER 3CIA IA 4- b /ND1/AL \ 1 A.P. No// —0//ci P I N
MAIL //�� I BUILDING ,�// �
ADDRESS /�/6.,$' Pe'Y/CUIP ( _TE ADDRESS( /1/�S-` /�/�l/IFl�7
CITY Co crn meiQ ONO p ys_}l RFC'ly� LO 1 BLOCK
CONSTRUCTION co• NEW ADD(ALTER REPAIR MOVING OFMOIISH
LENDER �,x/`III ry
BRANCH OWNER L,‘,30,/ICl\
ADDRESS o Y/ VALUE/6-A,
/(- ,0,
ARCHITECT TEL. USS T �['."•_ $ Jam/(/
OR ENGINEER NO
FIRE T
ADDRESS ZONE (PE GROUP
CONTRACTOR JO he No// (Pict-/- APPROVED / DATE 60-810
ADDRESS /.6e0 ((/4/ 7/1/er Il d
/� / w /I • /� /c ZO NO.OF 9 VSE OF N
CITY (�' C3/a / f C Q/`elz NEOL &bye/s///D / \ PLANS C� BUILDING \'�1
H STATECITY YARDS APPROVED YARDS APPROVED
LIC.NO. /5:11 3 '1 0 LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE / �I x NO.OF BLDGS (FROM / REET)
W G
3. OF LOT ,-J �Ud NOW ON LOT / FRONT �` X FT. FT.
a USE OF `
EXISTING BLDG. / car. . 4-7eS ; /e t'/ref B.SIDE Vie' FT. FT.
rn
H Separate permits are required for L.SIDE kb l FT. FT.
C electric,plumbing and heating work. REAR t�i1Aj FT.
W USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET.MAIN Si
MAINAIN BLOCS.
CS. ACCESS BLOCS.
c F � VAR.# DATE
a (_nJeer / /'-O rfG) on /`-Fa/-' C.U.P.vis APPROVED
_ " J / APPRO�FD` l/� -ID
>. n! C`�Y/.S•2<-i--1� he C< -S �'r r �V it\to\ DATE V I s/7
.-.1 /// X/t— 4
w
0. I hereby acknowledge that I have read this application and state tn
11; that the above Information is correct and agree to comply with o
0. all laws regulating building construction, and I shall not employ i
any person In violation of the workmen's compensation laws of o
the State of California. l�/ m
I hereby certify that I am properly licensed es a contractor under
/D SQ. FT. N
the State of California Business and Professions Code, Division 3, TH AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force end effect,or I T E PURPOSE OF ESTABLISHING A PERMIT FEE ONL`i n
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ /5"-e1,
and Professions Code, Division 3,Chapter 9. �i+
m
PLAN CHECK E m
Signature o� e7 ////';r n / ✓ o
Permittee I r �• L (f�/l $/h� TAX E LL
(((/// f
U
Authorized ant ` TOTAL PAID E/�SO
•�2F O - . se "le t` / ***163.50
�DCOSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
%V,j For Applicant
/oto/yFill i/nlCompletely RECEIV D B DATE RECEIVED DATE ISSUED
ADDRESSBUILDIN/ !/�Afl/Y�//E'!r/ /G✓'� �•Z'�-� Q /a oS D v
PE
OWNER
M���/�10�/I/l//Y�9 D //C/.®/l— �P. NO. - 111 I
��/MAIL �,/� / j� BUILDING / /�� ��
Z - -
ADDRESS IA (/ /6Q L, Do r ADDRESS /(Y(�._--��il/vf f/N
W W ,�/ TEL. �/ //
0- U CITY/�I�p/�0a/ 45,044 NO�jrj29Q TRACT-7O Z"-- LOT.F! BLOCK
- 2 -
2 Q CONSTRUCTIO NEW ADD ALTER REPAIR MOVING DEMO]ISH
-N_ LENDER V
d D ���� pZ/L4�i
J D BRANCH //
J V) - OWNE t P
`r ill
V -ADDRESS /,y���� VALUE. f.
a ARCHITECT /J '/ ! TEL/�jyDi S)SE �� y/�-��L- )Sh'
N _ORENGINEEF •/r.Fv/51i(/,j NOb J e
U Q /1 /O ? wi
FIRE
Z m -AD DR E SS�¢eri-i io. /! A" ' � ZONE TYPE GROUP.i�
aW
T APPROVED
J 0 CONTRACTOR A /f v0//d,, BY DATE ^
CO Z /,
-11.cc ADDRESS,.,....c-e:)," /q�
W tLK' TEL.,,,...," ZON NO.OF USE OF NEW
O 2 ( IPLANS BUILDING ""Z�..//
2� _CITY„4-/e^4,2/1:7,01z./ A/ NOffiFi3j L(/cu/!
W0 STATE CITY YARDS APPROVED YARDS APPROVED
co Ir LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE / / NO.OF BLOCS.
(FROM LSTREET)
OF LOTcrQ X/DO _ I NOW ON LOT Q FRONT I .SFT. FT.
USE OF
_EXISTING BLDG. �— R.SIDE SFT. FT. _
SIZE OF/jT/x�/ NO.OF �J S
2 _SNEWIZE Q/✓ ROOMS STORIES J L.SIDE FT. FT. _
EXTERIORLL ROOF /�,�
V _COVERING LLO COVERIN OI��I/j� REAR ,�y'rSFT. FT. _
J USE OF BUILDING AND WORK TO BE PERFORfvIED DISTANCE BET. BET.MAIN&
_ ///J �j� ��///' MAIN BLOCS. ACCESS.BLD/GS.
DATE-
0 let/A441--ei �1✓/ 4.4"IC� C UVARP..SyY4`yC/ 1/• ,�-7O APPROVED Zr-2J'7 0
2I-
tn _ (//J EY.APPRL/r�De7 1 10
/r DATE �._/-70
O
0
UI hereby acknowledge that I have read this application and state HOLD FOR SPEC AL REQUIREMENTS
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
I- any person in violation of the workman's compensation laws of
N m
the State of California. ,v, .(� B
z I hereby certify that I am properly licensed as a contractor under S3 SO. FT. /�O 6
the State of California Business and Professions Code, Division 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
EC
am exempt from the provisions of the State of California Business
VALUATION /�qt a /w m
and Professions -- Division 3,Chapt�Y 9,
PERMIT FEE S ! ff•/ /• C4
D
Signatur- of
m
Permittee ,iii ----. •• $ ��r PLAN CHECK $ �O E
i/ i s `\\ �/ �3 5-0 u.
Authori •gent / TOTAL FEE $ e