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Pfl(r`"CT AOOPESS: 3 S 4 3 P T ERCE AV
O�INEfl'SNAME: llL 5••�•j•0 vAVil� B
aooRess: 3143 PI�iRCE AVF.
COSTA MESA,CA
PflLHIENGINEEN: J 5 7—�' 6 I�
AOUNESS:
UNIT:
92626
NEG.NO.:
UNIT:
PEflMITTEE: WEjTERN SIERRA ROOFING ( 719 ) 660-8505
aoosess: �•�y32 SRYPARK CIRCLB
IRVINE CA.`32718
LICENSEO CONTRACTOP OECIANATION: I hereby aliirm t�ai I am litensed unCef OronSions oi Chaprer 9(wmmen[ing wilA $ecii0n
7000� nl �rvlsion 3 0l the Business an0 Pmlessions Code. anG my license is in full lorce and eifecl.
cirr u�_ I`�'_�I sTare uc.: 4 9 2 5 9 cusc'��
aie: SignaWre: _
WOfl8EH5' COMPENSRTION OECIAflPTION: I hereby aifirm �hal I have a r ficat •oi consent m sel4insure or a cenificate oi Workers'
�Compensalion Insurance. or a certifietl copy Ihereol (Section 3800. La6.
oucvxo.: OiWCY12072D E%P.ORTE: O4IOZI91
comvaxr: SUP, NATL
J Ce�ifietl copy is hereby furnished [� Cetlilie0 copy' liled with Ihe ciry B iltling Di i 1 n.
Oale: �- I �-q I, Applicanl:
E%EMPTION FflOM WUBHEBS'COMPENSPTION OECLABATION: (Thi55edi0n n¢ed o be can ple�edii�he permiiis�oronehuntlred�$100�or1e55�.
I cetlily Ihai in Ihe pedormance ol the work lor whiC� IhiS pefmi� is i5sued, I SI II no� employ any person in any mann¢r So as lo become
sublecl Io Ihe Workers' Com0en5aiion LawS of Calilomia.
�ale: Signalure:
NOTICE II. a�ter making ihis tleclaralion, you shoula become sublec�lo �Ae Workers' Compensation pmvisions of Ihe Labor
Cotle. you mu5i forihwith wmpry wil� such pmvisions or Ihis permit SAall 6e deeme0 revoketl.
LONSTBUCTION LENDING AGENCY: I M1ere�y aliirm ��at Ihere is a wnSVuctian lending agency for Ihe pedormance oi Ihe work lar
wnicn �nis permit is issuee (Section 3097, Civ. C1.
LENOEfl:
aooeess:
OWNEfl BWLOEN OECtANRTION: I hereby allirm Iha� I am exemp� �mm t�¢ Cantrac�ors' S�a�e License Law for Ihe followinq reason
(Sectian 7031.5 BuAness ana Pmlessional COOe: Any city of county which repuires a permit to consiruc6 aller, impmve, demolisA, or
�� repair any 9ructure. prior to ils issuance. alw reQuires ine apo�icant lor sucll permit �o lile a signea statemenl tliat he/she is Iicense0
� Oursuam lo t�e pmvisions ol I�e Convatlors' Sia�e LicenSe Law (ChaDter 9(commencing with Section 7000) of Division 3 0l I�e Busineu
an0 Prolessions Catle) o� Ihal �e/s�e is exempl lherefmm antl ��e Gasis lor �Ae alieg¢tl exemp�ion. Pny violalion ol Setlion 7031.5 Uy
any apD�icant lar a Oermil SUEI��s t�e aD0licanl io a civil penalty of not mor¢ Ihan �ive hundretl tlollafs (5500).
I. as owner ol ihe pmpeny or my employees with wages as iheu sole fAmDensation, wiil tlo Ne work, an0 ine
❑ s�mnure ¢ notimenaeC oroflereAforsale(Secuon 70a4. Business an0 PmfessionalCode: TAe Contractors' State License Law
Uoes not appty lo an owner ol a pmpeny who builtls or impmves ihereon, antl who tloes such work nimsell/herself or ihmuAh
tti5 ar h¢r own employ¢es, provid¢a Nal 5uch imOmv¢menfs are n01 intentl¢d ar atl¢rea �ar 5aie. II, hOwever lh¢ CuilJing or
impmvemem is mld vAi�in one year o� complelion, Ihe owner vn0 Oave Ihe buNen of proNnp he/she OiA no� �uiltl ar improv¢
for ine purpose ol sale).
I. as owner of ihe properiy. am exclusively comracting wi�h licensetl coniracmrs to wnstmct ihe pmlect (Sec�ion 7044, Business
❑ antl Professions CaOe: IDe Conlracmrs' State License Law aoes not apPly to an owner oi pmDerry w�o buAOs or impmves thereon
and who wnVa[IS lor Suth O�Ole��S wiih a Comradoqs) liCense pursuan� �o �he ConVacmrS' Siale LitenSe Law�. I am aware
I�ai pmol o� �heir WOrker'S Compensation insurance ShoWa Oe pmviaed ro me.
� I am exempl un0er Seninn� 8. 8 P, C.
bt inis reason:
ox�e: owner:
I tlo hereby cenify �hat I am aware of ana untlersianA the requiremenis ol Cahbmia Health and Salery Cotle Sections 25505, 25533, an0
2553d antl Ihai I or any IUWre builtling occupant will/wiil noi (circle one) neeJ to comply wi�h said stale codes antl Ihe requiremen�s for a
permil lor conslmclion or motlilicalion Imm IAe du Oualiiy ManaAemen� �islricC FesiOential consimction apDlicaiions are exempi imm
I�ese pmvisions.
Oate: ApPlicanl:
I here�y certily I�at I havereaU Ihis applicalion an0 sla�e Iha���e a0oveinbrmation is correci. lagree lo comply vnlh all ciiy and coun�y
ordinanws antl 5lalelawSrelalingio OuilUing conSlmciion antl here�y authoriierepresen�atives otthis ciry�o enteruponlhe a�ove�menlionea
pmpeity �ar mspec(ti�on puGr0jose5.
Da�e: 1 � I I� `( Signaiwe: `'
�riverS l¢ense oi Social Sewriry xr ,.
t6aba6 W�ite—Burltling: Green—Coee Enlorcemom; Canary—ApplicanC Pink—Revenue: GOIEenrotl—Assessor
_ CITY OF COSTA �ESA - 3UILUING PERMIT PERN 1�0; H 0517��
PERMTT NO: B 051750 PI�AN (:3tCFi NO: �I GOVT: N SUPP: tV
CONSTRUCTION TYPE: V-N PERMiT TYPE: STR PURPOSe,: P.L7
J03 DESCRZPTZON ; T/OFF SHAF:E REROOF WIPROLINE CO,�F. SQ FT: S,OOU
CLAIM VALUE: 5,000.00 CALC-VALUn: 7,000,00 GROUP OCC: R-3 /
COMMENTS: SMOiCE DETECTOP. RE�UIRED
i!-1f�1F1E��Y.#%�K�-1f�K%�Y,%�IEif�Y.-�3E�Fif3f�Y.-�%aiX•3f% Y.-ifdfif�iFif%�Jf�if?Fd(�E�i:��7f�ai�lf�lEif#iF�%�iEIE*1�N�Y.-�R%1i1(�Xif74ifii�Kii.lE.lC.di3fdi-�iFrilElc�XV
'L O N I N G R E Q U I R E M E N T S
sErBncxs
------------ �'iAZN BUIi.DING ---------- --------- ACCcSSORY BUZLDING ---------
FRNT; FT 1N REAR: Fi IN rRNT; FT IN REAR; FT Ilv
LEFT: FT IN RGHT: FT IN LEcT: FT IN RGHT; FT :t�l
PARKING REQ• PROV: PARC�L: 19].65110 ZNE: REir NU:
PLANNING 'NZ5TE5>
�
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D E V E'L O P M E N T S E R V 2 C E S R c Q U I R E M E N i S.
ZONING APPROVED.BY DATE:
HUYI�pING AFPROL'ED HY ; DATE: '
APFLICATION �SSUED 3Y: DATE• 4 9 �////f
'{.iEiEY.�iFifii�3flM1i!�-fEtfY'rlhi'r!'iEiF�l6ii�IfiETiF'�'ciF"n r� iF�'7F'iF r � � r� � Z'r�%�'if���le%-16�iiii�K�ii�}i'rif�?!. �l±r�:'kir3E#
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LEGALIZATION:N F E E S U M M A R Y STRUCTF7RAL SEGMHNi:Y
BLDG PN1 PL'JMBING ELECTRIC MEC3ANiC
PERMIT "1"1,00
PLAN
ISSUE FEE
FIRE SMZP/RcS C-RADiNG
.50
SN,3 F /NON-R::S
BOILDZNG-DIV-> PcRMIT ISSIlE PLAN-CHECK TOTAi PAID DJE
TOTAiS----> 72.50 0,00 0,00 72,50 72,.`,0 .OU
REV?ivi7E DIVIS�ON TOTALS--> COiLECTED: 'i2,50 OVER/SHORT: .00
BLDG P,�T PLi1MHING ELECTRIC MECHANIC FTRE S'MIP/TOT GRADING Pi,A�-CHcCFt
?2.00 .50
?f� 1f if if �E K 7F }•. iF 1F+E �!'� �li�-k ii iE i43F ie 1f ie iF �i 141f IE )i� Ih iF iE jE fi iE i* iF �16 �1F jE IE If iF i4 %3F iE i:� #� �k �F iE! X•?i- A� i!�+i� aF?i �7:'r� ii� iE ff- ii� ?!� iF iF af �: if i(� ii� �1E 1E A� k H'�+ N�
I N D 7 V I D U A I, F E E H R n A K A Q W N
TYPE QTY D 3 S C k i P T I O N
5F'R SOOU REi200F BY VAI�t1E RESTllr:N.T.A'L NOZONE
END OF FcHS
?JNZT COST TOTAi COST
1,00 - S,UQU.OU
U1 OOGF52d�-CQ�Ea39U �"c�": -� ;;:
DkTE- 44/15f91 TIIiL•a G?:,8
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CONSTRUCTION AND PLANNING P� & SPA
���APPROVALS Permit # Date Inspector AppROVAIS Permit # Date Inspector
1. Temporary Electrical $ervice or Pole � 52. Pool & Eq�ipment 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. APPAOVALTO COVER�GUNITE .
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
77. Property Sewer Line & HouseConnection 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. Aough EleMricaFConduit 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 O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing Y��`f �p�(,�. 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 - 76. FIRE PREV. FINAL
30. Drywall Nailing i HEALTN DEPT. REQUIREMENT
37. Plaster Brown Coat - 79. FINAL INSPECTION �
32. Electrical Power Meter-Final B0. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final He3ting & Air Conditioning -.
35. Final Gas Pipe•Test ' ��
i
36. Hood or Canopy " �
37. Final Faatory Fireplace �
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscape Irriqation System
45. Sound Attenuation �„�y��, � `
46. Handicap Regulations � � (,�L
47. FINAL STRUCTURE & BUILDING �� / q 6�
48. FINALPLANNING
49. Electric Release to Edison '-``
50. Gas Release to Southern California Gas Co �• �
�
51. CERTIFICATE OF OCCUPANCY
No Date
a , ` I9917
.
COSTA MESA BUILDING-SAFEf`! DEPARTMENT
P.O.BOX ]17 COBTA M88A.CALIFORNIA
For Applicanf fo Pil1 In Complelely
TYPE OR PRINT
BIIILDIN6 �
AODRE53 � �
COSTA MESA, CALIFORNIA
■ MAIL
1 R.
SIZE
OFLOT
USE OF
EXISTING BL
6ETBACK LIN6
EXTERIOR
COVERINC
U&6 O� BL
FEE�'�RECE�VED
fP�IVI��� PERMR
ciT��oF�vs��v s�,�y
RBCCIP� NO. rp�
1 �.�
IV CY OAjtP8C61V6q�_ DATE199UlO
/_ /� / J II'
�C/ /� V" dY��.�
IN6
iSS
_'__ � "_""' �Q �
ZONING
ZOX6 HO.OF UB[
�, _ ruxa ,. 'eun
TEL. T 8— "a°o? i 8�IDfi @ REAR pH LNG SHALL BE LESS THAN
NO. �
� I EAVES
No.opaLDaa. ALLOWED fU.B.G.RECUiREMENT�.
NOW ON LAT
YARDSAPPROVED YARDSAPPROVED
. MAINBUILDIN6 ACCESSORYBUII.DING
, , fFROMGLSTREET)_
6YT lp I K��dMT'
DESCRIPTION OF WORK
AND
I HEREBY ACttNOWL
AN� 6TATE TH�1T E
PLY WITX ALL C
BUILOINO CON9
SIGNATURE
PERMITTE
AUTHORIZfiD AGBNT
1
BE
DIBTANCfi BET. � BET.1
MAIN BLDGB. ACCH
VAR.iC DATE
�
► v �
— ea. �.
1�8 APPLIGTON THE AMOU T BHOWN YNOER VALUr�TION 18 FOR THH
AORE! O COM- PURPOSE fiBTABL�6HIN6 R PERMIT FEE ONLY.
�a e u r a WA � �S^
/�
/-- � PERMIT FEE $ .(
� �/{I c c �[ �56
�/ �0 2 ._ _
"J � TOTALFEE i�
�c3,s
JOB ADDF
GENERAL
T""PECTIONS
or
BUILDING
[�PTION OF WORK Pri
:ONE VALUE $
�UP J TYPE II
SUBCONTRACTOR� I
�-� % 24562
?OSTA MESA BUILDING-SAFEfY DEPARTMENT
P. O. BOII 9p COBTA M68A. CALIFORNIA
, For Appliconf fo Fill In Complefely
TYPE OR PRINT
■ MAIL
COSTq MESA. CALIFORNIA
TEL.
NO.
TEL.
NO.OP
BETBA<K LINe IROM " j% �/
CENTER OP 9TR8ET (v � REAR
SIDE YARD I LEFT � "� I RI6H7
DESCRIPTION OF WORK
NO. OP
ROOMB
I ROOF
'1 HEREBY ACKNOWLlppE THAT 1 X�Ve PBAD Tl118 APPLIGTION
ANO 8TAT8 THAT TM6 ABOVE IH CORNECT AND AGREE TO COM-
PLY WITH ALL CITY qfp1NANCfiH ANG 8TAT8 LAWB p6OULATINO
BUILCINO CONBTRIICf�ry,
C AUTHORIZED
CITY OF COSTA MESA
AUG 18 1965
APPLICATION FOR PERN
�r�(�i�D� Only
��
ZONING
ZONi,O—� NO.OF O U6[OFNBW
G; PLANB �� sY1LDINO
6s�R„�„�. ot -s/ 7-,�S' ys3 G
i : �so - �o \�-
NOTE: NO EAVE OVERHAN6 SHALL BE LESS THAN \�
90' TO SIDE 8 REAR F �
EAVES
ALLO W EO
YARDSAPPROVED
MAIN BUILDIN6
VAR. Ji
l�Bi�D FOR S
��
,.ct. C �
N.B.C.REOUIREMENT) \
YARD9APPROVED _1
ACCESSORY BUILDINti �U
�/r R. ' \
�/ Ff.
Q 'fo �
Ff.
� F-r. �
BET. MAIN R — `\ ,
AGCE55. BLDOB. ,�1
\
DATE \"
APPROVEO (�, J
DATE ( � ��� \"
, REQUIREMEN"I'a �'
a
BQ. �. �
TNE AMOUNT BXOWN UNOEH VALUATION IB FOH THE £
PURP09E Op BBTABLIBHINO A PEFlMIT FEH ONLY, 0
VALllAT10N ^ �� p
PERMIT FE8 $ �% j
� �Q ,/� � m
g � c e �1 0
� .ti A 4