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Home My WebLink About3435 PINE BROOK CIR - Building Permits1 (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3435 PINE BROOK CI Suite No Vicinity: Parcel Nunmber: 93506700 Applicant: SCOTT,JEANET Address: 502 S LYON ST SANTA ANA, CA Owner: VO, NEALSON Address 3435 PINE BROOK CIR UNIT 100 COSTA MESA, CA Contractor. CULLIGAN WATER Address: 502 S LYON ST Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect Qce,Soda,etC) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earlhquake Valve SANTA ANA, CA INSTALL WATER SOFTNER AMT $23.50 $0.00 $0.00 $O.OD $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 PLUMBING PERMIT Phone: 714-750-2233 Zip: 92701 Phone: Zip: 92626 Phone: 714-750-2233 Zip: 92701 License: 663091 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY QTY AMT QTY Laundry Tub / Washer $0.00 0 0 Landscape Irrigation $0.00 0 0 P-Trap $0.00 0 0 Pressure Regulator $0.00 0 0 Process Piping (per 10 ft) $0.00 0 0 Receptors $0.00 0 0 Septic Tank $0.00 0 0 Sewer Cap for Demo $0.00 0 0 Sewer Connect $0.00 0 0 Sewer Private Line $0.00 0 0 Shower $0.00 0 0 Sink, bar $0.00 0 0 Sink, commercial $0.00 0 0 Sink, Floor $0.00 0 Status: ISSUED Applied: 12/10/2004 Issued: 12/10/2004 ISSUED BY: SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 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, 12-27-92) 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 1 BO days. INSPECTIONS: In ortler for the work authorized under ihis permit to be considered legal, such work must comply with ell applicable codes, and ell required Inspectiona and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CqLL: (714) 7545626 . 2aa6a8 (8/00) WORKERS'COMPENSAnON DECLARA�ON: I hereby ettirm under penalty of per�ury one of the tollowing declarations: ❑ I have en0 will maintain a cenificete ot consent to selbinsure tor workers' compenseHon, es provided for by section 3700 0l the Lebor Cotle, for ihe peAormance oi the wOrk for which thi5 pertnli Is Issuetl. heve end will maintaln workers' comp�nsation insurence, es required by section 3700 ol the LeOor Code, for the paRortnance of I�e work for which Ihis pertnit Is issuetl. y wor ers' compensetlon Ins rance cerrier and policy numbe�rIare�: � c er: �v!\r i P.l��r/vl E2s c� ✓•1 n/ �=/�S �� —e�.y�tar: I�UC 37�� `/S%4U Thls sec0an neetl nof be com`p/etetl/l fhe permit is velued at ane huntlretl tlallars ($100) or less.) / 1 v ❑ I cartity that in the pertormence ol the wo* �or which this pertnit is iuuetl, I shall not employ eny person in any manner so es to bacome wblect to the workers' compe ' laws of Calllomle, entl ree thai ii houlC beco subject to the workers' compensation provisions of Sec{{IIon 37QQQ000 ot the Lebor Cotle, I shall forthwith e5 ovi51on5.� .y //� /_ � i S' ure: = � � Date: / � � � ARNING:FAILURETOSf REWORNERS'COMPENSATIIXJCOVERAGEISUNUWFULANDSHALLSUBIE EMPLOYERTOCRIMRULPENALTIESANDpVILFlNESUPTOONEHUNDqED THOUSANODOILAPE(5 ),INADOfTIIXJTOTMECOSTOFCOMPENSAT10N,DAMAGESPSPROVIDEDFORINSECilON3/060FiHEUBORCOOE,INiEREST,ANDATTORNEY'SFEES. LICENSED C IRACTORS DECLARATION: I her t am licensed under pro�V'lsiqns of Chepter 9(commencing with Sectlon 7000) of Division 3 of ihe Business antl Pr ssions Code, entl my license is in full fo e ' �D3(/Y / IQ tt� L'- � Co s ign � A a e: 9/ 0 LD � A � CONSTRUCTION LENDING AGENCY: V ❑ I hereby aflirtn that there is a construclion lending agency tor t�e peAormance of the work tor which ihis pertnil is issued. (Sec. 3097, Civil Cotle). Lentler's Neme: Signeture: _ OWNER-BUILDER DECLARATIONS: Lentlefs Atldress: Date: I hereby eMirtn ihat under penalry ot perjury t�at I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end ProFessions Code: Any ciry or counry which reQuires a pa�it to construct, elter, Improve, demolish, or repair eny sWcture, pnor to its issuance, also requires the eppliWN for such permit to file e signed statemant that �e or she is li�ensed pursuent to Ihe proWsions oi ihe Contrectors IJcense Lew (Chapier 9(commencing with Section 7000) ol DlWsion 3 of the Business and Professions Code) or that �e a� she is exempt therelrom entl the basis for t�e elleged exemption. Any violatian of Section 7037.5 by eny epplicent tor e pertnit sub�ects the epplicant to e civil penelry ot no� more than five hundred tlollars (3500).): ❑ i, as owner ot tha proparry, or my amployees with wages as t�atr sole compensation, WILL DO 7HE WORK, antl Ihe struaure Is nol iniendetl or oHaretl ior sale (Sec. 7044, Businass and Professions Cotle: 7he Conirectors License Law tices no� aOPly to en owner of property who builds or improves thereon, enC who does such work himsalf or herself or Ihrough his or her own employees, provided t�et such improvemenis ere not intended or offeretl for sele. If, however, the builtling or Improvement is sold within one year oi completion, ihe owner-builder will heve the burden of proving that ha or she did not build or improve for purposa of sale.). � ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe pro�ect (Sec. 7044, BuSiness end Protessions Coda: The contractors License Lew tloes not epply m en owner oi properry who bulltls or Improves Ihereon, and who comrects for such project with e contrector(s) license pursuam to Ihe Comrectors License Laws�. ❑ I am eaempt under sec. Signeture: Owner ID venfietl by tlnver's IitenSe. ❑ Ves ❑ No BuSiness and Proleuions Cade lor Ihis reason: Ved/icetion ol Ownership by (type ol docum0nt, i.e. - property tax blll or deed): Drivers License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify thet no excevetion five (5) or more feet In Gepth Into which e person Is required to descend, wlll be mede In connection wi�h work eu�horizetl by ihis permit, and Ihat no building stiudure, S�Holding, felsework, or demolition or tlismantling lhereoi. will be more ihan thirty-six (36) teet high. (Chap. 32. Grp 2, Art 2, Sec. 341, Ttle e, Calitomia Adminisirative G�eI� � ❑ As owner-builder, I will not employ enyone to do work which woultl require a permit irom lhe Division of Intlustnal Salery, es noted above, unless such person has a pertnit to do such work Irom the division. SigneWre: Date: DiviSion of InduSinal Safety Permil Number: CER71FlCA7E OF COMPLIANCE AND AUTHORVATION OF ENTRV: I certify undar penalry of perjury thai I hava read this epplication antl state ihat the intormetion given is correct. I egree to comply with ell stete laws and ciry ordinances releting to buildinq consiructlon, and authorize reDresenlatives of the Ciry of Costa Mesa to enter upon ihe ebove�described proparty for inspection puryoses. I agree not to occupy or allow occupency of eny building authonzed by this permit untii final inspectlon. COEE�. INSPECTONTYPE �� 1616 Fi:etl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Root 201 Final Blxk/Retalning Well 202 203 Final Factory Fira Place Finel Sign 206 Final Demolition Q�jf, nL � COOE I INSPECiION TYPE 206 Final Methanical 208 Final Plumbing 210 Finel Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/OCcupency PAg 1� 3��7_0� � PNOJECT AOOHESS: j 4 3 S P IN E BROOK uxit: �� owaensxame: VILLAGE CREEK HOMEOWNERS nooeess: ASSOCIATION 3429 TIMHER LAItE CM VA 92625 AHCHIENGINEEP: CHESTER CARVZLLE aEc.xo.: C18305 I aooness: 7922 ARMOUR ST uxir: S.D. CA 92111 PEflMITlEE: PHOENIX ENTERPRISES INC. ( 213 ) 690-9559 aooxess: 411 COMERCIAL WAY LA HAHRA CA 90633 LILENSED C pCTOfl OECLRNFTION: I hc;eby allirm thal I am lice se0 tler D�ovisions ol Chapter 9(commencing with Section 7000) of Oi i 3 0l Ihe Nusiness an0 Pmie55ions Cotle antl my e- n lullforce antl effec ciTvu 07 8 �ic.:376639 ss: /B� �. �a�e. ' � Signature'. —I„� _ _ WOPNEHS' COMPENSATION OECLANATION: I hereby a��irm Iha� I have a cetlilita�e o� con5eni Io 5etl-inSUre a teM1ifica�e o� WorkeK comoensauon �u�� 03 �c$nued coov mereo� (seciron 7eoo. �ao. �-� � O 1/ 91 POLICY NO.: CA COMP & F I RE E%P. ORTE: �OMPANY: Ceni�ietl c py is here6y lurnishe/tl.� ❑ Cer�ified coDY is �ile 1 e c Building Division. oa�e: — — V aPPlicanc E%EMPTION FNOM WOflKEBS'COMPENSFTION OECLAflATIdN: (Thissec�ion neetl n becompletetlifthe permitisfarane tlre0�S100)orless). I wnily ihat m ine pedormance of ine work tor which ihis permit is issue0. I shall not employ any person in any manner so as to become sublect Io Ihe Workers' CompenSalion Laws ai Calilomia. Oare: SignaWre: ' NOTICE: If, ailer making this tleclara�ion, you shoul0 became subject �o Ihe Workers' Compensa�ion provisions o� the labor , Code. you mus� Iorihwith comply with such pmvisions ar thi5 permi� shall �e �eeme0 revoketl. CONSTBOC710N LENUING PGENCY: 1 here�y allirm ihat ihere is a constmction lentling agency tor Ihe Dedormance of Ihe work tor w�ich I�is permil is issued �Sec�ion 3097. Civ. C). IENOEH: ' ADOHE55: ' OWNEfl BUILOEfl DECL4HATION: I hereby atlirm Iha� I am exempt fmm ihe Contmctors' S�ate license law tor the �oilowing reason (Sec�ion 7031 5 Business antl PmleSsional Code: Any cily of county which requires a permil �o con5�mci, alier, improve, tlemolish, or repair anY s�me�ure. prior �o I�Slssuance, also requires the apPllcant for such perml� lo hle a signea s�a�emen� that he/she is licensed puuuanl Io Ihe provisions o� the Contracmrs' Stale License Law (C�apter 9(commencing wi�h Seclion 7000) ol Division 3 0� I�e Business antl Pmlessions Code� or Ihal helshe is exempt ��erelmm ana the 6asis lor ��e allege0 exemplion. Any violalion o� Seciion 7031.5 by any applican� far a pe�mil subjec�s the applicani to a civA penai�y ol not more Ihan five huntlretl doliars (5500�. I, as owner ol Ihe prope�y or mV employees wiih wages as �heir sole compensa�ion, will tlo �he work, an0 Ihe ❑ slmcWre is not intentletl or oflereA lor sale (Sec�ion 7044, Business an0 Pm�essional Code: The ConVac�ors' Sta�e License Law Uoes no� apply �o an owner o� a propertY �+ho builtls or improves thereon. and who does such work himsel�/hersell or ��mugh his or her own employees. pmvitled Ihat such impmvemenls are no� inientled or of�erea �or sale. II, however ihe builtling or imOmvemen� is soltl within one year ot comple�ion, �he owner vnli have Ihe �urden o� pmving he/she did no� builU or improue . lor Ihe purp05e ol 5ale). I.as ownerollhe pmpeny.am exclusrvel9 conlrac�ing wi�hlicensed coni�ac�ors�o constmc��he pmlec��Section 7044, Business ❑ and Pm�essions Code: The Coniraclors' State License Law Qoes noi aDPly Io an owner of properry who builds or impmves �hereon antl who conirac�s �ar such pmjects with a conlrac�or(s�license pur5uani to t�e Conirac�ars S�a�e License Law�.l am aware ' I�al proo� ol iheir WaBer'S Compensalion insurance s�oultl �e pmvided Io m¢. � I am exemp� under Section'. B. & P. C. for this reason'. �aie: Ownec I do hereby cenity Ihai I am aware ol and untlerstana �he requiremenis of Califomia Nealih and Safery Code Sec�ions 25505. 25533, antl 25534 an0 �hal I or anY �uWre builtling oceupanl wllllwAl not (circle one) neetl �o eomply wi�h said sla�e codes antl the requiremen�s for a permil lor cons�mction or motli�icalion imm �he Nir Oualiiy Management DisVicl. Fesiden�ial cons�mction applicaiions are exemp� �mm �hese piovisions. Oale Applicani: _ I hereby cerlily �ha� I nave reae Nis appliwlion antl 51aie Iha� �he or0inance5 antl siate laws rela�ing lo builaing con5�mciion and herel pmpetly I r msDec i n Durpo�es Da�e: �� Signature:. _�� oriver's License or Social Securi�y I agree m compty with all ci�y and 164t-a6 Wlute—Botlaing: Green—Cotle Entorcemem: Canary—Appli<ant'. Plnk—Revenue', Goldenmd—Assessor CITY OF COSTA MESA — HUILDING PERMIT . PERMIT NO: H 049842 PLAN CHECK NO: 06453-90 A , CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: REP JOB DESCRIPTION ; REPAIR SETTLEMENT DAMAGE SQ FT: 143 CLAIM VALUE: 19,388.00 CALC—VALUE: 14,300.00 GROUP OCC: R-3 / COMMENTS: BUILDING SETTLEMENT REPAIR/FOUNDATION ***� �****� x�*�****�r*�**+�**�r��**+�x ***�x�**�r*�r**x+�**�x�* x��**�r*****�r��r*��*+��***** Z O N I N GS ERTEH�AUCIKRSE M E N T S , ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REO• PROV: PARCEL: 93506124 ZNE: R2 REF NO; PLANNING N(5T'ES> REPATR EXISTING FOUNDATSON: > �� #S�F�C��r�(�DIREMENTS 1F iE iF if IE iE �lF iE if iF 1E if if iE �f 1E 1E iE iF IE if iE if ff IF iF 3F iE if IF iFlf If 1f df if iF-lf !f if 1F �f� 3E if M 1E 1f k IF If 1F if iF iE if iF 3F iF iF IE jf if 3E D E V E L U P M E N T S E R V I C E S R E Q U I R E M E N�T S ZONING APPROVED BY :__�� " DATE; �`d%�`b S�'/a BUILDING APPROVED BY, ;�.J ti�t>Pct�� DATEt` � APPLICATION ISSUED HY• DATE- �'J , if iE )f iE if if iE iF * iF if # iE iF iE iE iF IE iE �k 1f �IE 1E iF 1E IM1 IE if 9E IE if iF�iE if �EiEiEififiE�EilaliElEifiEkltifiEkMkiflfiE iEjFiFifiEiflEk iFififififaFifkifMlEiF%iEffkiElflFif�f1E1f1E1f�ElE3E1f1tiFlFdEiEiflfiEiE�fiEitiEiF3f LEGALIZATION;N F E S U M M A R Y STRUCTURAL'SEGMENT:Y :i BLDG PMT PLUMHING ELECTRIC�. MECHANIC FIRE SMIP/RE$ GRADING PERMIT ' 162.00 , SMIP/NON-RES PL�N 26.33 2,15 ISSUE F'EE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 169.35 0.00 26.33 190,48 190.48 ,00 REVENUE DIVISION TOTALS--> COLLECTED• 190,48 yOVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 162.00 � , 2.15 26.33 if fF 1E 1f k if iE if iF i! iF 3F �f Ik if Ik if iE )f iE k �F �f IE )f If k iF if fF ik iF it k iE 3k aE �E iF iF if iE iF if Ik �f iE If k ff IE IF IE if iF f! k ikif !E �F 1E 3f IE iE if k 1k ik IE41f !E iF �F IE iF if iF I N D I V I D U A L F E E H R E A,IC D O W N TYPE QTY D E S C R I P T I O N �UNIT COST TOTAL COST SFC 143 FOONDATION HY VALUE. PER $100 � l00,00 14,300,00 END OF FEES � az oanr��s-r�ao�Ys�r �� i�r�.4;� OA1'E: 11/27l9Q TIpir: Q8:y4 \' CONSTRUCTION AND PLANNING . PO� .� SPA APPROVALS Permit # Date � Inspector � AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or PoIC ,-, 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinfortement ' n." Y ''.3i;;Electrical�CpridGit Utility`-Gndrgrnd;£ 54. Forms ' .4%Electrical ConduibUhdrgrnd. � 55. Electrical Bonding =�5`.'�Steel Reinfoice`ment �z_ 56. Rough Plumbing & Pressure Test � .^:��Electrical.;UFE6;Gmd� : - 57. APPROVALTOCOVER�GUNITE " ��'-7.`Footinqs'�� t';�� 'L 58. Electrical Conduit-Undrgmd. i,� r :=•�8. F„oundation :¢ �� 59. Gas Pipe, � Undrgrnd., Test �" y"8. Water Pipe-Undi'<}'rnd. � 60. Backwash Lines, P-Trap, O Undrgmd. ir r�,,:, 19• Structural Floo System . 61. APPROVAL TO DECK 1�1. Property Sewer, Line & House Conaection 62. Backwash & Receptor�Final _ 1'2. Sewer Cap . '� 63. Heater & Vent-Final 13. Roof Dreins�� 64. Plumbing System � Final 14. flough Plumtiing `" 65. Electrical-Final 15. Rough Electrical-Conduit � 66. Solar System-Final 16. Rough �Electri8 Wiring � 67. Fencing & Access ApP�oval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT - - - c� i_�r.c-:. r_ 20nRough Eactory Fireplace .::'� _ r: .,; - x� t'APPROVY\tiS�%��Perfiit # '+ `'- ' r ., - - .z.. �i� - 21�:'Ducts, ia St�uctur,e� : , �., �'� �� c �' 70. �Ondeigroun� Hyiiro s -' 22. Ducts, Wentilating:< ca'S - �: ':"� .� := 77, producf Piping �:Gas O Oil . - 23r Gas'Pipe-Rough &;Test ' ��; ' • ' '�� - ' 7Z, Under iound Flus � ' _ i = � �, �>. ; 9 �1 v 24 ^Roof F`saming `;i -,- •• -. � _ r-. �[ 73(= Undergrnd. Storaae Tank-O Gas ❑ Oil _'I� ��'S'i Y' 25. Roof Sheathing= �, ? •- �= - � ' 74" Overhead'Hydro,� " � � 26 �T�Bar Ceiling (Structural) & MonocoaT�; � :s = �• 75J Dry Chemical N � � ' T' 27'.-Frame ind F�ashing '��` 1 - - �_ r 76. Dry�Stana�pipe F'n� _' � :n = ..28: � Lathin`-& Sidin`Ji ., �l �: � � T '. s � ` . j � _ ,� �t . 9 9 ��d�.� :,t, %> �� • 77: FIXEDSI`STEM'F.INA� "29. Insulatipn ' `�'° `�""' �='�'? ` " 78: FIRE PREV. FINAL � r:r' 1 {• - - �30. Drywall Naiting;•� " � � } � � �. �MEALTH�DEPT.�REQUIREMENT � 31. PlasterBrown Coat _ � z, _ ' f I �I � ` ' , . 79, FINAL INSPECTI�JN ' � � �" `32-ElectricalPower:iVleter-Final'�� ` I � !�;�;.�y80�,FO0DCERTIF,ICATEISSUED 33EFinal Efectric � ' =� � - =F ' _ = - -� r -:_ -�x � .S:C � � ��' ��`��VdtBS: _if� ' ' �r.Cn] ;, 34: Fi��l Heating & Air Conditipning - `- f '�' �i� 't, S ,- r/ �I 35�'Final Gas Pipe-Test- �� - ' I� � � � /f r - �-. n36`Hoodo`FCano =r,-�� ,,-�- :..� -,- �,� �•.* -- - � .. . PY • 1 �; _ ' 3T:: Firtal Fattory Fireplace � � �' ' • ` �'� � F �� '= � r : s-'- c. �•r .� n : 38�Final Plumbing Y,;'',�� ._. " i � �_ , ai �,39:'.WaterService�Final � -• � ' * .- ��T. � -. 1 � � '�i '�40.'Gas Service�F.inal ` y, ,t�,., � - . i �` �, 1�; ,��u ., '' i >.41�.rSolar pomesticFinal� - � •• -� �•. �s .: �(�$ Sj''L�U� `�� - � -HCLD .c � -42. Backflow Preventei '' � � i � I. .. i;., �-+�� : �. - �. 43. Backflow Irrigation � cv',�'� 5 - � �� =-i = ` � Y r 44. Landscape.lrripation System� ��= � -'. �,� L - - �,; ;�; _ - , -� ;�� _ '' 45,: Sound �Attenuation :....i. •_ c ,. � - : -� ,'_; : _ . - - � � �. 46: Handicap Regulatians - = ' ' ' ' ' - . �''�' �- � � � + � . �, C_ ��47_;FINAL STRUCTURE & Bl}ILDING - � � �� 481- ,r (/�/�/ i 4 - > > � _ •- u/ f.. I � � i' R . � - 49=Electric Release to,E ison , -_,� i r.;. j; �x �� i� - . _ ' 50 _Gas.Release to Southem California Gas Co � �� I '� ' _ - " • - � r• 51. CEBTIFICATE OF OCCUPA CY ;:� ;; "i�> ..,,. . � c. No. Date unrv[rt JOB AC Ap Na.jY�O-054-0I' I =CTIONS s�� Ga5 WHTER ROUGH LINE U HOUSE CON. SVSTEM MISCELLANtoUs ROUGH HEATING ANO AIR COM1 TEMPORARY SERVICE OR POL UN�ERGROUND � POWEA ROUGH WIFING TRENCHES ❑ FOftMS � FLOOR SVSTEM STEEL FRAME ANO FLASHING �>� LPTMING � IN � OOT (/ PLASTER. OROWN COAT 5" 'CTURAL, FINAL 1 NG, VENT., qEFRIG. PND A.C., FI PLUMBING, FINAL AN��GAS TEST n ELECTRIC. FINAL FtNAI DAIE 4-28-76 ook Circle BUILDING PERMIT N0. DESCRIPTION of WORK ea. w a arage TRACT 8858 FIRE ZONE VALUE$ 39, $imat�re Date TVPE V GROUP J•� ZONE � SUBCONTRACTOR Z . d U z z¢ o� am J � J N Q W m J • �] J Q U Q Z� aw W Z J Q m Z J � w W � ZF W � N Q � � � z Q U J a a a O H � z 0 � U � � H N Z .4�1.850 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Complete/y BUI�DING ADORE55 3435 Pine Brootl �'� firrla OWNER State-Wide Developers, Inc. ADDiiESS 9461 Grindlay TEL. cirv Cvnrnec No.826-45 BFANCH ADDPESS ARCHIYECT S3R�KWtlE£E ADDRESS � ADORESS CITY STATE LIC. NO. 512E OF LOT USE OF EXISTING E SI2E OF R WALL rk Blvd I No.tiLb-e CITV LIC. NO. INO. O LF B�DGS. NOW ON LOT aSter ROOF �oa COVERING Shake AND WOflK TO BE PERFORMED onstruction-Condomini ;Av 13-76�y�`•'00 658'� '..:': �3P.2? APPLICATION FOR BUILDING PERMIT :EIVED BY DATE REGEIVED ❑pTP ISSW �Z—?//..D/�0� �PER�I A.P. NO. ��JD � tAS�R — O I BUILDING n �7 �l ADDRESS —3%3S Y(7'(L AO� [.[2G TRACT �� LOT BLOCK ER VALUE FIRE ZONE APPROVED E NO.OF USE OF Nf 2 ['�O PLANS z BUILDING 4RDSAPPROVED YARDS (FROM FEAR � OISTANCE BET. APPROVED / RV Ci ioLD Foa BET. MAIN & I hereby acknawladBe t�et I M1eva raetl this application ontl cteta J thet the above informe[lon is correet and egrea to comply wit� �� ell lews teB��ating builtlinB conrtrutNon, enC I ahell not amptoy � any perwn in violatlOn of Ma workmen'f compenEaHOn lawe of � Me Stata ot Celifomia. n I heroby certity t�at I am properly Iicanwtl as e eoniractor antlar �`�a� sn. Fr. J-645 the S[ata of Cellfor�ia Busineze antl Profesaions Code, Div(sicn 3, THE AMOUNT SHOWN UNOER VALUATI Chepter 9, entl [ha[ suc� Iicanus era in full forco en ei(ect, or 1 THE PURPOSE OF ESTABLISHING A GERMR am examOt irom tha provlsion6 of the Sio[a of Cali( nla Butinets �A�UATION / entl Profess{ons Cotle, OWision 3, Chepcar 9. Q� PERMR FEE 5 a Stat =Wide Developers nc. �3��- Signature � Permlttae %�L P44N CHECK $ AuMortxatlAgoM �ice President TOTAL FEE $ G m w O i ¢ m N � m E `o LL