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HomeMy WebLinkAbout1857 PAROS CIR - Building Permits • CITY OF COSTA MESA , ��r BUILDING DIVISION P y: : WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers,..,ense. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Drivers License No. Expires: a 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. ' ' ❑ 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . permit is issued. My workers' comp nsation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: �a( 2 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: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp (This section need not be wmypleetedelhe permit is valued`at Oneh fired dollars(8100)w less.) 2,Art 2,Sec.341,Title B,California Administrative Code). Policy Number: da ova ;11 Vo5 0 As owner-builder, I will not employ anyone to do work which would ❑ 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' compensati• laws of California, and agree that if I should become subject to the or •rs' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code. s o ith comply with these provisions^n / / /�'/ Division of Industrial Safety Permit Number: /'ppll•Ti ig =wre Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING/ AILURE TO S.CURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNL • FUL 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 0 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 a�n/d a ect. 6 a registration form for acutely hazardous materials? ❑Yes 0 No 'Lit.# r (*I / Class# G 3 (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 / •'rt-'lor's'.tgnature Dale 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 CONST• CTION LEN SING 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? ❑Yes ❑ 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? ❑Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 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? ❑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? 0 Yes ❑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 sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of'proving that he or she' CERTIFICATE OF 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-slatelaws and 0 '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 contractors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and statethat ❑ I am 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 til final inspection. Signature at Owner(s) Dale , - Signature Date /444 3057-46(3/07) ` n Pr razed Applicant Date • ' CITY OF COSTA MESA o i1,►'D BUILDING DIVISION Y:l; : ,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 14. -- t PERMIT M03-00560 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1857 PAROS CI Status: ISSUED Suite No Applied: 11/03/2003 Issued: ;1-1�/00033//2�003 Vicinity: IZ ' Parcel Number: 13942120 ISSUED BY: Applicant: STEVE SCHNIERER Address: 2057 MANDARIN DR Phone: 714-719-1689 COSTA MESA,CA Zip: 92626 Owner RICO, THOMAS TR Address: 1857 PAROS CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: SERVICE CHAMPIONS Address: 22911 SAVI RANCH PKWY Phone: 714-777-7777 YORBA LINDA,CA Zip: 92887 License:799170 SCOPE OF PERMIT REPLACE 1 FURNACE 90,000 BTU AND 9 DUCTS. MECHANICAL TO INCLUDE: 1 INST FAU< 100K BTU AND 1 REPAIR/ALT COOLING/HEAT. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 • Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 • Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $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: This permit shall automatically expire and become void If work Is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2440-48(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. gI 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'compensation Insurance carrier and policy number are: �+ Carrier: _ •. •n 7." i .. Policy Number: 1-1N 30Co0 16 O (This section need not be com.lated it the pe f Is valued et one hundred dollars($100)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 f California,and a ee that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these visions. Applicant Signature: Date: 11 13103 WARNING:FAILURE T SECURE W RS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND[CLARE($100,000),IN ADDmON 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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force and effect.Lica a 79 170 Class a GZO Contractor's Signature: 7 Date: 14/.310-5 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 drivers 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 B,Callfomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work front 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 materiels equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 2 Does or will ilt..... cant. r _.... the applicant or present or future building occupant need to lila a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Cade,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 wit the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential buikfing permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑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 / •f Legal Owner(s) Date And/Or Authorized Applicant Date CODE INSPECTION TTP PAg INTmAl. CODE! INSPECTIOMTYPE , 1616 Fixed System Final Fire Prevention 206 Final Mechanical )*" "C ' 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 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 O4 E CITY OF COSTA MESA 4� 9pe BUILDING DIVISION >:l ,i a DEVELOPMENT SERVICES DEPARTMENT PERMI NUMBER F1 15 �4:� . PERMIT 4tbibe oeF P03-00667 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1857 PAROS CI Status: ISSUED Suite No Applied: 10/10/2003 Issued: 10/10/2003 Vicinity: Parcel Nunmber: 13942120 ISSUED BY: Applicant: SHANNON CLEVEDENCE Address: 01911 S MANCHESTER Phone: 714-953-6300 ANAHEIM CA Zip: 92802 Owner: RICO, THOMAS TR Address 1857 PAROS CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: CULLIGAN WATER Address: 01911 S MANCHESTER Phone: 714-953-6300 ANAHEIM CA Zip: 92802 License: 663091 Arch/ Eng: Address: Phone: Zip: License: SCOPE OF PERMIT INSTALL WATER SOFTENER FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 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)754-5626 2448-480100) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. IST 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'compensation Insurance carrier and policy number are: .Carder.-.U/NIC 14 (a-(4 P2i 0 Pkiu SNC' co 0 ib-1-4:.-1-4:. w vPolcyNumber: �f g&7S0 U i(7his section need not be completed If the permit is valued at one hundred dollars($100)or less.) .. El 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 agre that If I s uld become ubject to the workers'compensation provisions of Sectlo 3700 of the Labor Code,I shall forthwith comply with these Bions. ,ApplicantSignature:, - rDate: ?<;2- 47//o 5 CWARNING:FAILURE TO SE ^-WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL'PENALTIES AND CIVIL FINES UP TO ONE HUNDRED -TTXXJSAND DOLLARE(S1 .IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby_atfirm,that.l.am.licensed and:r prpvision�IA-lapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full Iorceeand-effectrtdc7r �L ' '%i i A / (Class#J a -5_— tConlr�eetDYS Slg 2 tire: - Li r r Iv Q- .'i� t�i#�. f� <Date r _ 0 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than 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. ❑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,This 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any ono time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modificat from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes D ion Na (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Cale Section 42303 been made? 0 Yes 0 No 6 (If ytees",attach certificate of compliance from the appropriaair 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. Signature Of L gal Owner(s) ate A ia�y�0 . Authoized ice j Dat �t ;ODE Ir INSPECTION PdIE INRRAI4 ;ODE; INSPECTION TYPE PATE PE1A1S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 20B Final Plumbing i cZ 1 200 Final Re-Roof 210 Final Electrical 14P 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 er Applicant to(ill.In all spaces except those rder lines and sign all appropriate declarations. CITY OF COSTA MESA • PERMIT NO. r LOTS. BLDG.NO. COI'��ITRUCTION PERMIT )6 - //I/ 1 I 4802 2/24/84 26.90 IL / grLigjett Address . t7 Th S 02r.S. TYPE OF CONSTRUCTION' HNEW U ADD U ALTERATION U REPAIR , �1 Applicant's Mailing /dress , • 0 CONVERSION 0 DEMO ISH •i /![i - A.P,# i 3 9-"9 p•L/ - at Zone 1 Owner's Name .�_,.r,O�Cs ��,..yysl /J!/�//may. Phone 9�Sfnj1!p�jQfl�]F Wc]ijK l�f i0 5 yy�elM i Accessory Building: Z Address Ear 7H1R (`!FL' c- TVCbjE(O PF PERMIT 2 GRADING •-- Fb/UNND/ATION STRUCTURAL E Front /00 N Arch/Eng. License No. ❑ TENANT 0 ELECTRICAL II PLUMBING ❑ MECHANICAL B O I , _ A Rear �,` - - N Address __ -4� ❑ OTHER C Right AA. � g 3D/ G Contractor's Nam- .4a.. atatii.6I *hone �=in7 PROJECT DESCRIPTION SQ. FT. OCCUP Y e ��--��,,// 7, I /y- i CONSTRUCTION TYPE VALUATION 5 Du K Left 7 R Address(mailing) s-7�s�-t/G �% • S Q(l _.L. E City License No. `Y (C • ZONE GRADING CU.YDS. ACRES Ping. Ref.# rr Park.Fees $,--- Q U LICENSED CONTRACTOR DECLARATION Remarks: • i Parking Req./Provided •--- I • 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing R with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: r .S 7� /. E Lylicense is In ful or a effect. i'/ - i-w License Cn -ss �� Ucens- •��!! : Sl PLUMBING (FEES Planning Notes: (/ M to - - A� Signature !In aga E Bar Sink Showers N )RK RS' OMP NSATION •EC RATION • T r hereby affirm that I have a ce Pirate of consent to self-Insure or a certificate Backflow Preventer Service Sink eV S of Workers' Compensation Ins -lice, or a certified copy thereof (Section - 3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES Policy No. Company BCertified copy Is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15.50 KW Certified copy Is filed with the city Building Division. - ❑ 50+KW Date Applicant Clarifiers Solar Collectors Construction Pole Sub. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher Solar Piping Cooking Unit Meter pup to 100 amps (This section need not be completed If the permit is for one hundred($100) or less). - DrinkingFountains Solar Tank Dishwasher Meter I certify that in the performance of the work :r whichothis permit is issued 1 Dover 100 amps shall not employ any person in anymanner/o as to b s b Octto site Workers' C Laws of Calif. /���sss Floor Drains' Swimming Pool w/Spa Dryers ❑Gas DElectric Sub Panel Date _ ��/ �`)�� Signature 1/,�4y (':� y NOTICE,I` flu ng this decl-ration you shoulrbec•me subject to the Floor Sinks Urinal Fan Motors 00.1 HP 01%-8 Workers' Compensation provision of t-e Labor Code, you must forthwith - comply with such provisions o , permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. Inc.Solar 09-15 HP 016-15+ CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance Interceptors Water Heater Fixtures Microwave of the work for which this permit is Issued (Section 3097 Civ, C.) I Lender's Name --- Kitchen Sink Water Service Device Boxes Pole Light Lender's Address Lavatories OWNER BUILDER DECLARATION Outlets Range I hereby affirm that I am exempt from the Contractor's License Law for the p-Tra - following reason (Section 7031.5 Business and Professional Code: Any city or p Switches Sign county which requires a permit to construct,alter,Improve,demolish or repair ny structure, prior to Its Issuance, also requires the applicant for such permit Roof Drains Garbage Disposal Standing Sections 4:7f /lie au signed statement that he/speel e Is licensed pursuant to the provisions of _ _ ciib Contractor's License Law(Chapter 9 (commencing with Section 7000)of 3Generator ❑0.5 KW ❑5-15 KW Trash Compactor ,``lvision 3 of the Business and Professions Code) or that he/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 Reinspection Fee $25 Issue Fee $ 3 penalty of not more than five hundred dollars($500). - LJ 1, as owner of the property or my employees with wages as their sole - -MECHANICAL Reinspection Fee $25 Issue Fee $ 3 compensation will do the work, and the structure is not Intended or offered FEES p' for sale (Secilon 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQ REMENTS: License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0 _ (�,/� thereon, and who does such work himself/herself or through his or her own CanopyType 1, ❑ Zoning Approved By Date / s-c employees, provided that such Improvements are not Intended or offered for yP yy Duct- Under Ground sale, I/, however, the building or Improvement It sold within one year of com- Building Approved By Lw Date �4-gam elation, the owner will have the burden of proving he/she did not build or Im- - prrove for the Purpose of sale). Duct-Structural Refrigeration System Application Issued By _ - Date �-%til ' " O I, as owner of the property, am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES The Contractor's License Law oes not apply to an owner of property who BUILDING PERMIT /4i^m0 •SO builds or improves thereon, and who contracts for such projects with a con• Exhaust System 0 Multiple 0 System Repair/Alteration $ SMIP $ tractor(s)license pursuant to the Contractor's License Law). PLAN CHECK $ 2/2•"0 PERMIT ❑ I am exempt under Section B. & P.C.for this reason Firepi/Fact.Blt-ICBG# PLUMBING $ ISSUANCE $ Date Owner Heating System& Ducting - PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000BT1. ELECTRICAL $ GRADING $ Information Is correct. Ia9ree to com• y with all city and county ordinances and state laws relating t• buildid C-• true .n,and hereby author's rep PLAN CHECK 50% $ MICROFILM $ sentatives of this cit to e `. t, : .•ova-mentioned pro.- ty for elb inspection purposes //� Awed ell. MECHANICAL $ TOTAL FEE $ ?`6 Signature -. /✓ Da F. .r // Drivers' License or SS* ��_" Reinspection Fee $25 Issue Fee - $ 3 PLAN CHECK 25% $ _ Ma -� CMF 0865-44%rev. 12/83 White-Building:Canary-Applicant;Pink-Accounting;Goldenrod-Assessor . i . . CONSTRUCTION AND PLANNING PC &SPA APPROVALS Permit#i 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 3,/2/84 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grrid. 57. APPROVAL TO COVER-GUNITE 7. Footings Eligq OS 58. Electrical Conduit-Undrgrnd. • 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap • 63. Heater & Vent-Final - - 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring . 67. Fencing & Access Approval - 17. Rough-Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-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 .d: Gas Pipe-Rough & Test 72. Underground Flush .,Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil 5..Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27;rFrame 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 Gal Pipe-Test 36. Hood orliCanopy 37. Final Factory Fireplace . r - 38. Final-Plumbing" .t.+ 39. Water-Service-Final - 40. Gas Service-Final ; , 41. Solar Domestic-Final - 42. Backflow Pre4enter 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation - • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 3I31�,�ff/ 2 48. Special Requirements Completed ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. • Date - , ii. TYPICAL 411 CONCRETE BLOCK FENCE TOP VIEW 3/8 Bar a r � I - i ; 1 ; I "GENERAL- NOTES" 4 Blocks 8"Blocks I I I 1 I MORTAR: One Part Plastic I/4" 0 Pencil Rod Below Top ■. i i � . 1 . i i Cement And Three Parts Sand. Course Of All Fences IIMI ' I GROUT: One Part Cement And 4" Concrete Block Fence With 8" - '1_� i . Three And One Half Parts Sand. Pilasters. One 3/8" Vertical Bar I . , I 1 I COPING: One Part Cement Continuous From Earthtooth Thru ■. , ; ; .-_- ' $ I - ; ; , Three Parts Sand. 8' Pilaster. l ; I 1 I : , CONCRETE: Well Mixed 1'2 1/2, 3/8" Vertical Ties 2' Long i � -__ ' I I 3 1/2 . Maximum Of 7 1/2 Hpoked In Footing, And Grouted In 1 Gallons Of Water Per Sack 4' Blocks 4' 0/C Maximum. ■, : -� a ' , Of Cement Provide Cleanout And Inspection I 1 i I , : IREINFORCEING STEEL SHALL Hole At Pilasters. 1 , --- , , I I ll1 . 1 I , I I I CONFORM TO SEC. A-I5-39 1 1 I I H ELAP lin II =III I I i WHEREA.S.T.M. SPLICEDALLST, 2EEL- 0'�TOMINIMUM. --� Iii i i ■ GROUT MAY BE POURED FROM TOP OF FENCE IN CELLS WHERE •'•:o .' "' 1"......./t5°.•;.;":1?-; • •: '.O:' o. s ° - 1 VERTICAL STEEL OCCURS. HOLES NATURAL GRADE , •° ' . +Oe a'.o . ea. oo�I 14..* c0.p'.,.dl i FOR WIDTH SEE CHART £1:;7!--• ' .'..1-5 e.q:•••• _ 'I ^"r rt SHALL BE CLEAR , CLEAN , AND _ .:�:bn __ s. ...n_ I _ ° � °•� FREE OF ALL MORTAR , DEBRIS, •. °r TO TO 16' O.C. MAXIMUM I°y o 1 ECT. WITH INSPECTION HOLES TWO 3/8 BARS CONTINUOUS of e.. I I -P 16'9 AT BOTTOM. BOND SHALL BE ^� ' i F.- ie./ PROVIDED BY LAYING BLOCKS FENCE MAY VARY IN HEIGHT ae ", � DEPTH OF EARTHTOOTH 1/3 1/2:: 1''i IN STRETCHER COURSES SO FROM 31 TO 6 • oei THE HEIGHT OF FENCE i?� >• THAT VERT. JOINTS ALTERNATE STEEL MUST BE TIED IN PLACE lit FOO?NG.BOTTOM OF ,', •.; IN EACH COURSE. I'r.e a AT TIME OF TRENCH INSPECTION L_ -1 11.-42.9 rJ ' 3" CLEARANCE FROM BOTTOM kro.. l SCALE; 1/2".. CHART HEIGHT . . 6' . . . . . . . . . . . . . . . . 5'.. . 4' 3' WIDTH . . . . . . 14". 14". . . 12" . . . . . . . . .. . . . . . . 12" THICKNESS .10" .. . . . . . . . . 10" 8" .. . 8" DEPTH OF EARTHTOOTH . . . . . .24° . . 20'. . . 16" 12" SPACING OF EARTHTOOTH. . . . 12'. . . . . . . . . . . . . . . . 14' .16' .. . . 16' City Of Costa Mesa , California OWNERS NAME: JOB ADDRESS: Building Department PERMIT NUMBER: • SIGNATURE: Fom PIII -9M-I-J c-eo I \ t° 5",DO. 00 ,.Ei. 11I�(�, .. +ATE-- . DY Dismaos �NN1NC� —4 • 4_____---)30 (----, 4 r�; cc.' r C 0 . dl RESIDENCE RESIDENCE RESIDENCE RESIDENCE I- LI it 153 I�s� I N in K 2 STREET d Wof.) ejecig _ _Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ - CITY OF COSTA MESA CONSTRUCTION PERMIT P IT TRACT NO. LOT NO. UNIT NO. 2182 2/11 /87 5eGil 7L •Proroject Address 1857 Paros Cir, Applicant's Mailing Address 10422 Trask Ave. TYPE OF CONSTRUCTION IiiNEW LiADD LiALTERATION LI REPAIR Owner's Name RiCCO Phone 546-2744 ElCONVERSION IllDEMOLISH ❑ OTHER A.P.# I Zone . Cir. DESCRIPTION OF WORK/USE OF BLDG. 1857 Paros C Address S Main Building: Accessory Building: Arch/Eng. License No. TYPE-OF PERMIT ❑ GRADING ❑ FOUNDATION U STRUCTURAL E Front RF�'t=•I;finD IAN 1 6 t'7 N Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB Rear I Contractor's Name A-ames pi'Kahl IIP-He at.inig hone 5302440 ❑ OTHER C Right �, _ PROJECT DESCRIPTION SQ. FT. OCCUPANCY - K g E EI �� FEB -1.-•�a r. G Address(mailing) /RR 10422 Trask Ave. CONSTRUCTION TYPE VALUATIONS S Left 'f s"'f City License No. 6664 ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLAR•TION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am Ikons-, oder proy^ sof Charter 9(c• mencing Remarks: Planning Notes: I RECEIVED JAN 5 1987 M with section 7000) of Divlsl• 3 of the Busbies 'nd Pr. • s C-de,and my license is In full force . fee T �\ License Class �'rt L cense g ' 7 S '1� ss Date J2-31-86sign� �i- �I •- PLUMBING FEES �C 'ORKERS' COMPENSATION DE LARA: Bar Sink Showers ELECTRICAL FEES :ereby affirm that I have a certificate of ent to self-Insure or a certificate ,f Workers' Compensation Insure , •r a • ' ed co•. he -of (S-ction Backflow Preventer Service Sink 3800, Lab. __ ( Automatic Washer Transformer ❑ 15-50 KW �9�78832 Re•u'•lil� mita 0 So+KW Policy No. ompany Backflow Irrigation - Sewer Cap Construction Pole Sub. Certified copy is hereby f nish•p /y� Cer k ked cpp I filed wit the c tl• vision. - Bathtubs Sewer Connection Cooking Unit Meter Out)to 100 amps 1 • / Date .Lv-3 1.-Ob Ap• .04'n".1.11......- • EXEMPTION FROM WORKERS'C•• PEN • ON DECLARATION Clarifiers Solar Collectors _ Dishwasher Meter Clover 100 amps l (This section need not be completed i he p: it is for one hundred ($100) or . • less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of • e work for which this permit is issued. I shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑D-1 HP ❑1''/ -8 ' Workers' Compensation Laws of Cali .rota. _ Date Signature Floor Drains Swimming Pool'.v/Spa F.A.U. ❑ Ino.Soler 9-15 HP 016-15+, NOTICE: If,after making this declaration, you should become subject to the - - workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes ' I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit Is Issued (Section 3097 Civ. C.) Interceptors 1 Water Heater 2 00 Outlets Range Lender's Name Lender's Address - Kitchen Sink Water Service - Switches • Sign OWNER BUILDER DECLARATION • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or D Standing Sections county which requires a permit to construct,atter,Improve,demolish or repair P-Trap Laundry Trays r f any structure, prior'to its issuance, also requires the applicant for such permit Generator ❑0.5 KW❑5.15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains he Contractor's License Law(Chapter 9 (commencing with Section 7000)of ivision 3 of the Business and Professions Code) or that he/she is exempt .nerefrom 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 0enalty of not more than five hundred dollars($500). $ 3 I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee ' compensation, will do the work,and the structure is not intended or offered - Reinspection Fee ,I $15 Issue Fee $ 3 - for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does.not apply to an owner of 8 property who builds or improves I thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ • DEVELOPMENT SERVICES REQUIREMENTS: , employees, provided that such improvements are not intended or offered for yp Zoning Approved By Date sale. If, however, the building or improvement is sold within one year of com- Canopy Type II D -pletion, the owner will have the burden of proving he/she did not build or im- - Duct-Under Ground Building •Approved ey , Date prove for the purpose of sale). 1:1I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By .111/1 Data ZJ ti lQ '/ tractors to construct the protect (Section 7044,Business and Professions Code: • The Contractor's.License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU.0100,000 BTU • SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLUMBING $ 5/00 ISSUANCE $ Date Owner Heating System& Ducting Registers • PLAN CHECK 25% $ • ENERGY P.C. $ I hereby itv that I hav= rea•��; •p' anon and state that the above ❑0.100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $ •informati.n is correct. I a• e to IS , th all city and county ordinances and sta laws$elati.• • buildi IZITy cti• ,and hereby authorize repre- t _ PLAN CHECK 50% $ MICROFILM $ sentati s •f th s t ,• enter .•l' .•• • ention-d proper , for inspect[ • y�' � // MECHANICAL $ TOTAL FEE $ 5. 00 Signatur- - CMF 0865 •6,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL & 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•,T'est • • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrndrb 8. Foundation 59. Gas Pipe, 0 Undrgrnd., I 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.�, 10. Structural'Floor System 61. APPROVAL TO DECK ;i` 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Finaljj 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 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 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 . Y -G-v7 L,EI) 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING - i . • 48. Special Requirements Completed . . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • No. Date ; 1'hnc/ac 7-:1737r.A.uL A/ 1Panr ADDRESS OF BUILDING: 1857 PAROS CI WIT: CITY OF COSTA MESA - BUILDING PERMIT OWNERS NAME IFKNOWN: RICO, THOMAS TR PERM NO: P 073565 ADDRESS: 1857 PAROS CIR COSTA MESA, CA 92626 PERMIT NO: P 073565 PLAN CHECK NO: N GOVT: N SUPP: N 546-2744 APPL.MAILING ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH ARCHITECT ORENGNEER: UC.ND.: JOB DESCRIPTION : CHANGE OUT WATER HEATER SQ FT: ARCH.OR ENG.'S ADDRESS: UMT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / CONTRACTORS NAME A-AMES PLUMBING E. HEATING ( 714 ) 530-2440 CONTRACTORS WRUNG 9911 LARSON AV COMMENTS : REPLACE WATER HEATER WITH LIKE KIND ADDRESS: GARDEN GROVE CA uc.NO.: 250307 +A**********+EBEAE+E*** Ear***Bt BtAEAEBE-Bt*x**rtRERERERFREAEFE*x**AE********RE+EBEiEBE*RE*AE*REAE+E+EBE*+E+E***AERE+E* 92642 u : B Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby alum under Penely of perjury that I licensed und Provision Chapter 9 SETBACKS (commendng with Section 7000)of D'msie 3 d the Business end Professions and nsa is in full is and ed. CRY LI�O.—: 06694 �J55i C 36 �c " 5 07 • 06/96 MAIN BUILDING ACCESSORY BUILDING 7 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN 94 Due: Cen0adoc LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN WWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the Connectors License Law for the flowing reason(Seaion7031.5Business and Professions Code:Any ctyor county wtinngdres apennit to cons0ud,der.improve, PARKING REQ: PROV: PARCEL: 43920214 ZNE: REF NO: d demolish.or repair any atncture,prior to to issuance,also requires the applicant for such pento file a signed statement that he or she is licensed pursuant to the provisions of the Contradors License Law(Chapter 9(commencing with Section 7000)of Division Sof the PLANNING NOTES> 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 permtsubjeds the applicant to adW penalty of not more than five hundred dollen(SSOOI). iE1E1EiE1E1E1E1E1E1ElEIE1EiE1EiE1EiE1E1EfEiEfElE1E1EiElEiE1E1EiE1EiE1EfE1E1EiE1E1E1E1fifiEif-1E'#iE1E1EiEiEiE1k1E#1E1E1Eif1ElE1E1E****1E1E1EffiEiElE*** ❑ I.as owner el the properly«myemdo)ees wth wages=their sole compensation.will do the work,and the structure i not intended DEVELOPMENT 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 or offered for sale(Section 70th,Business and ProfessionsCode:The Contractors License Lew does not apply to an owner of proper ,t . who buids 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 f«sale.II.however.the building ce improvement is sold within one ear of completion,the ZONING APPROVED BY DATE: owner-budder will have the burden of proving he or she did not build or improve Sr the purpose of sale). ❑ I,as owner of the proper.am esdus vely contracting with licensed contractors to to the pmjed(S en .Business and Professions Code:The CUMradors License Law does not apply to an el y who Wilds or ereon and who BUILDING APPROVED BY : i, DATE: contracts f«such projects with a contractor(s)licensed pursuant tot s Lioanse ❑ IE,exe=pa seat, C B.AP. ,err e : APPLICATION ISSUED BY: DATE: i 3 Dela: °We A. LEGALIZATION:N F E E S U M M A' R Y STRUCTURAL SEGMENT:N I do hereby caddy thal 1 ern aware of and understand the requirements d California Heath and Safety Code Sections 25505.25533.and apern,and anythmlorfuture omthaAt DuallRaanagem not one)need tocomMycted wcosuudi000deseered erequirem these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING e permit for construction or n modification buildingio cthe ni Dual/ly Management e) toaoortel coh said stale codes and the requirements Irons throe provisions. PERMIT 7 . 00 Date: Applicant: 25% SMIP/NON-RES PWORKER'S COMPENSATION DECLARATION:I hereby elfin.under penalty of pe0ury one of the following dedvetions: SSN ISSUE lo IFEE 20 . 00 ISS ❑ I haveCode, rt iEeamm�ccofthMwdmrwiththis eintSrwueers'c«npevmion,asprmidedl«bySeclion37ggathelebor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE cod.,I«tMpedomaneamewwf«w:ntnlsp«d.®.d. TOTALS----> 7 .00 20 . 00 0 . 00 27 .00 27 . 00 . 00 ❑ I have end wit maintain workers'compensation insurance.as required by Section 3700 of the Labor Code.or the performance of the work for which this permit S sued.My workers'compensation insurance carrier end policy number are: Carrier: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 27 . 00 OVER/SHORT: . 00 ' Policy Number: UTSURISRle z 0 / 01 96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be completed t the panne is for one hundred dollars(5100/or less)/ / 27 . 00 ❑ I eerily that in the pedomaance of the work for which this permit is SRI‘r.,I shall•'employ any Peron in,r mann. eq as to become s bjed t the worker:compemaM�of.Coll Iran* • t I should • . �. ., ,`witere' . ********RERERE*SE**SE*RE*****SEBh****RE*ii**dE1EdEdEif:iE*BEBEiEikdEBEihii BEdEHERESERE****REiE*REBE*SESEBEBEIEREREIE*BE**lfih pveS�a� INDIVIDUAL F E E BREAKDOWN Dae; (Y sew"a37god Applicant: Warning:Failure to secure workers'conpensadon coverage Is unlawful,and snail*Woo an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil lines up to one hundred thousand dollars(3104000A M addition(0 the cost of compensation,damages as provided ler In Section 3700 of the Labor Goe.,interest,andatromey's leu. PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there s a conamdin lending agency ler the END OF FEES performance of the work for which this pend is issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I caddy that I have mad N' cation end Maes .information is coned.I agree to comply wish all city end county ordinances and state laws m ' t Odic g construction/ •as representatives of the city to enter upon the above•mentioned proper for inspection MER E _ c: O81O3i95 TI11E: 11:48 • W.---- r 01 00187552-00187552 TOT 27.00 ., Signature of Owner/Agent/Applicant/ContractoraOwner/Agent/Applicant/ContractorDate: DATE: k (5151-46.WP) White-Building&Sleety:Green-Re;Canary-Appian is Pink-Revenue:Goldenrod-Assessor . a CONSTRUCTION AND PLANNING PL _ & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # - Date Inspector I - 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location a _ 2. Soil Pipe-Undrgrnd. c' 53. Steel Reinforcement ' n Sr Electrical ConduitiU%riiity-Undrgrnd. r 54. Forms P7 . •;• .4. Electrical Condunt-Uridrgrnd. - 55. Electrical Bonding ` _51:•St$Q,I Reinforcemenj ; 56. Rough Plumbing & Pressude Test S3 . '6_ Electrical OF ERti . 57. APPROVAL TO COVER-GUNITE n''Jr,Footings r s r 58. Electrical Condu'it_:Undrgrnd. - :-8'xFoundation 59. Gas Pipe, 0 Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. 4 60. Backwash Lines:E.:Trap, Undrgrnd. . 10. Structural Floor:System s 61. APPROVAL TO DECK!' '•' 11. Property Sewer Line,& House•Qonhection , . 62. Backwash & Receptor-Fipal 12. Sewer Cap - _ . 63. Heater & Vent-Fina] ' • 13. Roof Drains - , `• 64. Plumbing System Final 14. Rough Plumbing , - 65. Electrical-Final 15. Rough Electrical-Conduit' 'J' _ - 66. Solar System-Final; • ' 16. Rough Electriclt",t)ring,w „r' 67. Fencing & Access.Approval - 17. Rough Wiring Sign - 68. APPROVED FOO TPL/ STERING 18. Rough ElectricaLT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning_ f - 1 FIRE DEPT.BEQUIREMENT . 20. slough Fa.{:tory:Ficetace 7.tr -, c '.+ �'APPROVA'LS''. Permit# - 21. $acts,in Structure-* '• •• f - 1 i - y _ 70. underground Hiro 22. Ducts. Ve til-'n 'r I ': _ , w ..a. aIr 9- - t ,-: .- 71. Produgt-Piping C16as di Oil 23. Gas Pipe-dough & Test =_ • *. ' r, 72. Underground F�Ush - 24. Roof-Framing" `n. r c• - ,•,.$ ",7�.r. Undergrdd.StorageeTank,0Gas 0 Oil 25. RoofSheathing i% K v. . rt •y 74;Overhead Hydra! " - 26. T-BarCeiling (StnF;4Gral) & 1'.'fon4coat �, ~' 75- � �Dry Chemical . A. L 27. Fiameand Flashing*t s l - T 76. Dry Stan6pipe r 28. Lathing$cSiding 42: - _;;J;'= :r E " . ".a 77._ FIXED SYSTEMIFRVAL .. 29. Insulations a • 78 FIRE ?REV. FINl. L ,, - 3• �. 30. Drywall Nailing F r s- _ ,c'A . ':})!ALTVI7DEPt 'REOUIF�EMENT • m 31. Plaster Brown:Coat.., v - it ' 79. FINAL INSPECTION e ,p32. Electricall'ow�r Ivlet4r•Fipal • 80'FOOD CERTIF': ATE I$SUE[i•, , • 33. MnaF,EleCtric--, - r Notes: . '-.1:*, ' 34. FInaL.Heat'i1ng & Aii.Conditionirig S ...*1 '_. S rix ` 1 _ d '„') < !l fr! i . _• •-1 35. 6inatGas-RipeTestix , : . •4 ' :j : < n. 36. Hoodror Canopy Ti T ' y ''7'Y 'n 1, "4"'• - l - 37. Einal•Factory Fireplace r i n_ t ,>r ,r _38. Final_Plumbin9 a ��C9C //� ' t' 139. Water Service-Final . - ;, H ��' - 40. Gas Service-Final - - } k r _ .. i y r n •. r . r 4 '4-' ri 41. Solar Domestic-Final --- 1. 5' .• - - x _ - I 42. 8ackf tow Preventer (- - - i* a O "' n , En.: A c-. 43. Backflow Irrigation It )' c ,,; v. ti. 1/4-1 44. Landscape:Irrigation -,r System - . rr• CK ' ll �s 45. Sound Attenuation ; . .. - 46. Handicap Regulations - - -_iL- . -I. ; 47. FINAL STRUCTURE & BUILDING , _ ° " _ 48. 01NAt PLANNING• '-•` ` m ? `, 49. Electric Release to Edison v -i 50. Gas Release to Southern California-Gas x ' - - _ 51. CERTIFICATE OF OCCUPANCY' ` - `3" No Date OWNER RICO, TOM DATE 7/23/63 JOB ADDRESS 1857 Paros Cr. BUILDING PERMIT NO. 20196-.. GENERAL CONTRACTOR Edward T. Pacana VALUE $ 715.00 AP No. LOT 5 TRACT 4341 FIRE ZONE 3 DESCRIPTION OF WORK B1.Wall,Com.&PV INSPECTIONS Signature DATE GROUP J TYPE III 'LONE R1 Soil PERMITS ISSUED .Gas SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. ❑ Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line ❑ House Con. ❑ St. Swr. 0, Sprinkling System Construction Pole Underground I❑ Power ❑ Rough Wiring Trenches a" Forms ❑ Steel Reinf. C9" -1/-ST Floor System Bond Beam 0 Steel Reinforce ❑ Sheathing Frame and Flashing Lathing— In El Out 0 Plaster, brown coat Refrig. ❑ Air Con. ❑ Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final .�l Building, Final r`fkl OCCUPANCY Form BU4-6M-3-63._S_B P - � n‘ 20196 i COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O.BOX 317 COSTA MESA,CALIFORNIA FEE RECEIVED For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT "LF��rOfflcdJ ,Only ADD'-inti 1957 div s- er CITY 31 £ � MESN E PERMIT NO/ COSTA MESA, CALIFORNIA S ,. 0 /9 f ' ..7-- OWNER .� M • 4 R�ec�gl/v¢yD BY DATE 79 e�JT IBU'D�. OWNER J (f/! f Rlc.0 ULDIN �J U_l 2M-02/2:57 (13x05 ���/� ADIL /11 /) , 1q !!!/// i (CC.�.. ADDRESS �� Q I-l� � dV` TEL. FIRE CITY NO. ZONE TYPE--PC6ROUP APPROVED AR' _'TECT TEL. BY DATE • OI 'UNEER NO. ZONING ADDRESS (� ZONE NO.OF USE OF NHW B�06dI II�Q,I I,, 11/� d f� ^ ?J_/LEGAL PLANE �, BUILDING CONTRACTOR /+ rM 17 r I . /`-P • •C 0 x14 ��II ADDRESSSlhya 32. ^3 c1 S+' DESCRIPTION r /� 937/ CITY GLICS 1// i 1 /vs le/ NOA.P.NO. STATE / Lis ('i TEL.. NO. 30T TO SIDE ft REAR E NO EAVE OVERHANG SHALL BE LESS THAN LIC.NO. ( D EAVES SIZEFL �/ / -0 NOW ON LOT / ALLOWED (U.B.C.REQUIREMENT) OF LOT 70F qARDS APPROVED YARDS APPROVED L/ L/ USE OF ).[/�� G,Lf-4' /q Af/. YMAIIN BUILDING ACCESSORY BUILDING EXISTING BLDG. i O / 4 544Gy j (FROM C/L STREET) SETBACK LINE FROM FRONT FT. • FT. CENTER OF STREET `_ REAR YARD / SIDE YARD LEFT I RIGHT `— R:SIDE DESCRIPTION OF WORK L.SIDE FT. 0 FT. Y NL L ALTERATION _ ADDITION REAR DISTANCE BET. BET.MAIN ft MAIN BLDGS. ACCESS.BLDOS. REPAIR MOVING DEMOLISH BUILDING NO.OF VAR.?C DATE SIZE ROOMS STORIES - C.U.P.S APPROVED EXTERIOR WALL I ROOF . BYPROVED L 0��^ DATE 7/L3/`�13 COVERING4 USE0 B ILDING AND WORKT BE PE ORMED f I ' A' /' 14-" t/�Ioc i(WA it 3R ' A 1' At,¢Y4 oc e-Lehr d a a'>! r <,.k"-- 16c.5"/)t a")16 l J""-' 7926 ,i,1G s"'x ")( Cent I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULAT NG VALUATION p BUILDING CONSTRD�(�(C(JJJ ON. 7\ SIGNATURE OF 7 .I� / / // J PERMIT FEE $ / D PERMITTEE !�/ne-in� s.//J/( /_C B _ PIAN CHECK $ ��� S AUTHORIZED AG NT Oa /l� ., A71 4 Y / / TOTAL FEE $ l(/ I �(J 111/11 18244 ��p$T° con'' Asr+ri70:?S COSTA MESA BUILDING-SAFETY DEPARTMENT "•-' P. O. BOX 917 COSTA MESA. CALIFORNIA • For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING / g S 7 � A-, u� BUILDING ADDRESS COSTA�� � MESA. CALIFORNIA// For Office Use Only OWNER //o)a i c& ' tY b-- T �J I RECEIPT NO. I / 624�0, MAIL _ An/7e- /) / RECBIvko BY I DA REBEL ED I{DATE ISSUEP , ADDRESS 1/n .S 3 / n/e-a /J r4le,, k- _ / /%/ ,e• NOV G 3 tSD, CITY_ (�fi'S ;29- _//Mc , No./`�(/03 9s ADDRESS AR, !CTOR .INEER MI/of /1/80ziy1//9 1/.NO..J772-'3 361 COSTA MESA. CALIFORNIA �/ ADDRESS 1C9neZ.Z.AT � JJ��T/C /YYATTA4 /,�2S ZONE TYPE 1/ GROUP o2Yer CONTRACTO//R/� ( e79.4T'•\Cac Tic-ty (_"OI APPROVED DATE ADDRESS X<S3 /AV0occg ✓,C, ZONING /) Tg /� S ZO NO.OP UES,OP NG� A 61-41 , f CITY (� ��///� •� p G I PLANE ^/I BUILOINO 1 I/1 i(T'4 , LIC.TNO. 977.3 NO /ej/ LEGAL L S ` l.- 1. DEECRIPfION , #I ���� SIZEI NO. OP SLOGS. p OF LOT 7n k/ /0 p 1/ NOW ON LOT ` A.P.NO. / \ V��� N-J--' USE OF YARDS f EVES EXISTING BLDG. �p`� APPROVED ALLOWED SETBACK LINE FROM a[`D REAR �7 (CENTERo LINE ST.) (f FT. IN. CENTER OF STREET t�' \J YARD SIDE YARD I LEFT 7 I RIGHT C R.SIDE B FT. IN. DESCRIPTION OF WORK ��� ]',,V L.SIDE ^ 7/1 FT. I IN. I NEW /' NA ALTERATION I II ADDITION I REAR q /" / FT. IN. REPAIR I II MOVING I 7II DEMOLISH APPROVED -W//L�//.IO �� i ' / r'� BUILDING !7 ROOMS / STORIES 1 / SIZE 7 EXTERIOR WALLC c' ROOF / �� COVERING r57$ Co COVERING USE OF�BUILDING AND WORK TO BE PERFORMED yJ9-Lei/ '-'-L/V&o A24,73/ 'Z /8-4 p I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN DER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCION. VALUATION 9J/ SIGNATURE OF. \� - ( l-`�C.y.- _ PERMIT FEE $ /J o 9-Q eu PERMITTEE y $ P'S, 3�a PLAN CHECK $ % Of25 F AUTHORIZED AGENT " / 2 TOTAL FEE $ /-26717-5