HomeMy WebLinkAbout3453 PLUMERIA PL - Building PermitsCITY OF COSTA MESA . �� ' '
.
s`p'" R BUILDING DIVIS/ON
t . � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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�. d FOR INSPECTIONS CALL: (714) 754•5626
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PERMIT NUMBER: B09-00187
PERMIT TYPE B_ROOF2
APN: 41217318
JOB ADDRESS: 3453 PLUMERIA PL CM
vicinity:
Squares: 0
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
09I08/2009
KJB
Valuation: � $14,000.00
. .. . . �:,u;e.
SCOPE OF WORK: TEAR OFF EXISTING ROOF. RE-SHEATH ROOF, COVER WITH 40 YEAR COAi1P SHINGLE PER CODE. ROOF PITCH
IS 4:12. INCLUDES ATTACHED GARAGE. �
OWNER: MARSHALL, JOHN H TR
PHONE:
APPLICANT: BIRDSONG,SANDRAA
PHONE: 949-933-3921 .
CONTRACTOR: OW NER-BUILDER
Address: Unit:
Ciry/State/Zip:
n =.. .
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Fteinspection Fee:
Bldg Std Admin Fund
TbTALFEES
fr.
i;:
$o.00
$23725
$0.00
$1.00
$238.25
Address: 3453 PLUMERIA PL�
City/State/Zip: COSTA MESA, CA
Unit:
Address: 3453 PLUMERIA PL Unit: :
City/State/Zip: COSTAMESA,CA� „ ��n*��_��,���
License No. 000000
PHONE:
CELL:
License No. PHONE: �
License No.
PHONE:
, . �'. Rp��F f-'ITCFi
Un;r.
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
MSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable wdes, 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.
COOEp. INSPECTIONTYPE D�T INTITIRLS CODEi INSPECTIONTYPE �ORTE',u,l:' �,'�INTITIRLS
1616 Fizetl System Final Fire Prevemion
1266 POoI Spa Final
200 Final Re-Roof
201 Final Block/Relaining Wall
202 Final Factory Fire PlaGe
203 Final Sign
204 Finai Demolition
!�%� ` -:r�
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Preven�ion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
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iPq±: '
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•
WORKERS' COMPENS�ATION dECLARATION: �
I hereby aNirm under penalty of perjury one o! the following declaralions:
❑ I have and will maintain a certifcate ot consent to self-Insure (or workers'
compensation, as provided for by section 3700 of the �Labor Code, for ihe
pedormance of the work for which this pertnit is issued.
❑ I have and will maintain Horkers' compensation insurance, as required by
section 3700 of the Labor Code, for the peAortnance ot the vrork (or which this
permit is issued. My workers' compensation Insuranw carrier and policy
number are:
Carrier.
(Thusetlionneetlrrotb d lhepeimQ¢value alon huntlrMddlars(5100)wless)
Policy Number:
T '
❑ I certi(y �haC in Ihe pedormance o Ihe vrork for which Ihis permit is
issued, I shall not employ any person in any manner so as to become subject
to th workers' compensation laws of Califomia, and agree that if I should
beco subject lo the workers' compensation provisions of Section 3700 of
the L or Code, I sh I/ort ith com ly with [hese provisi ns. `
lJ
�Sgrro ur
WARNING PAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I herehy affirm thal I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Cotle, and
my license is in full (orce and eHect.
Lic. # Class #
CoNraclar s SignaWre
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirtn tha� there is a cons[ruction lending agency for Ihe
performance o( the wnrk ta which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signalure
OWNER-BUILDER DECLARATIONS:
I hereby affrm thal untler penally o( perjury Ihat I am EXEMPT FROM THE
CONTRACTORS UCENSE L/1W for the following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit to
construcl, alter, improve, tlemolish, or repair any simcWre, prior to its
issuance. also requires the applicant �or such permit lo (le a signed statement
Iha� he or she is licensed pursuant to lhe 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 ihe 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 tlred dollars ($500).):
I, as owner of the property, or my employees with wages as their sole
co pensation, WILL DO THE WORK, and the siructure is not intended or
oftered for sale (Sec. 7044, Business and Professions Code: The Contrectors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or oftered 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 lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to construct the project (Sec. 7044, Business antl
Pmfessions Code: The contractas License Law dces not apply to an owner of
property who builds or improves ihereon, and who contracts tor such project with
a coNractw�s) license pursuant to the Cont2ctors License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code (or Ihis reason:
�� � � ��
�p� ture�� _ D Ip���
305]-46 (3IOJ)
Owner ID verifed by driver's license. ❑ Yes ❑ No g
Driver's License No. Expires:
Verification of Ownership by (rype of document, i.e. - properly tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certHy Ihat no excavation frve (5) or more feet in depth into wfiich a
person is requiretl to tlescend, will be matle in connection with work authonzed
by this pertni[, and lha[ no buildinq s�rucWre, scaFfdding, falsework, a demoli[ion
or dismantling thereof, will be more Ihan thiny-six (36) teet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Atlminist2tive Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division of Industrial Sa(ery, as notetl above, unless
such person has a permit to do such work from the division.
AppliwnCs 99^aWre oate
Division o( Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will �he applicant or present or Wture building occupant need to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safe�y Code requires, wi�h some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Departmen[ by every business which has a[ any one time durinq a reported
year a quantiry of hazardous materials equal ro or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressetl gas
at s�andard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to fle
a regisiration /orm (or acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Salety Code, with some
exceplions, requires registralion with [he Costa Mesa Fire Departmen[ by
each business which at any one time has on hand a quantity o( acutely
hazardous ma[erials equal to or greater than a weighl of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at s[andard
temperature and pressure).
3. Does or will [he applican[ or present or (uWre building occupant need to
prepare an RMPP (Risk Managemen[ and Prevention Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Sec�ion 25534 of the California Health and Safety Code provides Ihat the
Costa Mesa Fire Departmen[ may require the prepara�ion, certifcation and
fling with Ihe Fire Department o( an RMPP by businesses which are required
[o register acutely hazartlous 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? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or (uture builtling occupant require for
the work which is the subject of this application a permit for such construction
or modifcation from Ihe South Coast Air Quality Management Dis�ric[ or (rom
any other air pollution conhol disirict or agency? ❑ Yes ❑ No
(Sectbn 658502 0( the Califomia Govemment Code requires Ihat Ihe requested
infortnation be fumished on applications for nornresidential building pertnils).
6. Will any part of the faciliry to be constmcted under this permit be within
1000 feet from the ou[er boundaries o( a school? ❑ Yes ❑ No
Qf'yes", [he facility must meet the requirement of Sections 25534 antl 42303
of the Califomia Health and Sa(ety Code).
7. If a permit from the South Coast Air Quality Management Disirict or other
air pollution control district or agency is required tor the work which is the
subject ot this applicatioq have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Q( "yes", attach certificate of compliance from �he appropriate air pollu[ion
control officer).
CERTIFICATE OF COMPLIANCE: 1 certify lhat untler penalty of perjury the
information given above is correcL I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have reatl this application and state that
the information given is correcL I agree to comply with all state laws and city
ordinances relaling to building construction, antl aulhorize representatives ot
ihe Ciry of osta Mesa to enter upon the above-tlescribed property for
inspection rposes. I agiee not to occupy or allow occupa y of ny building
au[horize ythispermitu ' nal' pectioa �
�� � ��is �s
Antllor AWhonzetl Ap0licant Dale
.;'";=.- �
�.-�-�.�
Costa Mesa
City of Costa �lesa BuiCding 1�ivision
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # � �� - � � � � �
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been sub itted in your name li ng yourself as the builder of the
property improvements specified at � S 3 P � vm ��F �� ��.
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authorify.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
D/RECTIDNS: Read and initia/ each statement below to sig�ify you u�derstand or verify this information_
-�1 -1-1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material persona!!y. I, as art Owner-Builder, may be held liable and subjeci to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
�2._I�understand building permits are not required to be �signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�3�I,understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
�4�-1_understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
�61'I"understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
�6:'I�understand if I am considered an "employer" under state and federal law, I must register with the state
' and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
/� )►-,�7-1�understand under California Contractors' State License Law, an Owner-Builder who builds single-family
`�sidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is pertormed under contract with a licensed general building Contractor.
314830 CALBO Jan 1, 2009 OB Packet template 1 of 2
�8�understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
jl understand I may obtain more information regarding my obligations as an "employer" from the Internal
evenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
'that-I-a�rr the party lega}� and financially resp�nsible for proposed construction activity at the following address:
��/ S.� i" ��l m e Yt �' a �
�j1.�1 agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide'by all applicable laws and requirements that govern Owner-Builders as well as employers.
12� I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
i formation I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property-� owner_'7
�iiver_'s-license;�form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to verify the property owner's signature.
�-ex� a � �� 3�97 �
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
314830 CALBO Jan 1, 2009 OB Packet template 2 Of 2
,
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIft DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lobAddress: 3453 PLUMERIAPL
Suite:
Vicinity: FLAT ROOF
Primary Oca R3 Dwellings/ Cong Res <10 Type of Construction: V-N
Parcel Number: 41217318 Zoning: R1
Applicant: MIKE BURKE
Address: 1653 SUPERIOR AVE
COSTA MESA, CA
Owner: MARSHALL, JOHN H TR
Address 3453 PLUMERIA PL
COSTA MESA, CA
Contractor. LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AVE
COSTA MESA, CA
Zip: 92627
Arch :
Address:
Phone:
Phone: (949)642-7222
Zip: 92627
Phone:
Zip: 92626
Phone: (949)642-7222
License: 349686
'. Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 04/OS/2005
Issued: 04/OS/2005
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING FLAT ROOF ONLY. INSTALL 1 BASE, 2 PLY, ROCK AND HOT TAR BUILT UP. 5 SQUARES FOR S.F.D.
Plan Check: $0.00
Permit: $9725
SMIP Res: $0.50
" SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
SETBACKS
MAIN STRUCTURE Fronl 0- 0
ACCESSORY Fronl 0- 0
PARKING Existinq: o
NOTES:
FEE SUMMARY
PLANNING & ZONING
Rear 0- 0 Left 0- 0
Rear 0- 0 Left 0- 0
Required: 0 Pr000sed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
$3,300.00
$3,300.00
INOTICE: 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)
IEXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandonetl
��� for a period of 180 days.
� INSPECTIONS: In order tor the work authonzed under ihis permit to be considered legal, such work must comply with all applicable codes, and all
� required inspeetlons and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
I FOR INSPECTIONS CALL: (714) 7545626
L
w,a-.o �a�,�
WORKERS'COMPENSAnON DECLANAnON: �
I herehy eHirm under penalty af perjury one of the tollowing declaretions:
❑ I heve end will mainteln e certifica�e of consent to self-Insure tar workers' compensation, as pmvided for by section 3700 of ihe Labor Code, for ihe pertortnance of ihe
work for which this permit is issuetl.
i �
[��I have and will maintein woMers' cOmpensetion insurance, as reqWred by section 3700 of the Labor Code, for ihe peAormance of Ihe work fo� which ihis permit is issued.
�M workers' nsetion Insu nce cerd%e� nd oll number ere: //
�GerrierY ��ffT� !i �/1Y'�I.i/P�Y PolicyN�u .mher�- /75I��D� D�
(.Fiiis sectlon need nof be completed il th e it is velue0 al one hundred dollers ($100) or less.) --
❑ I certify that in the per
compensation laws of
comply with these pra
DOILARE (E100.000). IN
of the work t u ich this permit Is Issued, I shall not employ any peroon in any manner so as to become subject to the workare'
i, 1 I sho Id becoma sub�ect to (he warkers' compen58tion provisions ot Section 3700 of he Lebor Code, I shell forihwith
�
� ' rOetB:� � . �5
5' �OMFENSATIIXJ COVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOY TRE O CRIMIN PE TIES AND qV4 FINES UP TOONE HUNOPED
"lOn1 TO THE COST OF COMPENSr1TION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR �E. IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARAT�ON:
I hereby a^�tt�aU�am�licemetl under p�ohsions al Chap�er 9(commencing wilh Sactlon 7000) of Division 3 0l the Business and Pmfessions Code, antl my license is in full
(prceetWelfec4Flic�'"'31'`'� Cless �. [� `3
GOfiti�sFSig--�"a+�R�'e v,>1'_` ,.. ' ,.-_. ._ �� __.S �
r f`
CONSTRUCTION LENDING AGEN V:
� I hereby aHirm that there is a cans�Nction lending agency for the peAormenca ol lha work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Atltlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby ettirtn Ihat under penalry oi perjury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW lor ihe following reason (SecJ031.5, Business and Professions
Code: Any ciry or counry which requires e permit to constmc�, eiter, improve, demolish, or repair any slmcWre, Orior lo its issuance, also requiws Iha apqlicant for such permit
b tile a signed stetement thet he or she is licensetl pursuan� to the pwvisions of the Contrectors Licensa Law (Chepter 9(commencing with Section 7000) ot Division 3 of the
Busineu and Prolessions Code) or Ihat he or she Is enempt (herehom and t�a basis for ihe elleged ezemption. Any violation of Section 7031.5 by any applicant for a pertnit
sublects the applicant to e civil penalry oi not more then five hundred dollare ($500).):
❑ I, as owner of Ihe property, or my dmployees wlih weges es thelr sole compensatlon, WILL DO THE WORK, and the stmcWre is not intended or ottere0 for sale (Sec.
7044, Business and Pmfessions Code: The Contractors License Law does not appty to an owner of property who builds or improves thereon, and who aoes such work
himseli or �erself or through his or her own employees, provitled ihat such improvements ere not Intendetl or otterad br sale. If, however, ihe builtling or improvement is
sold within one yeer ol completion, �he owner-builder will have the hurden ot proving that he or she did not build or improve for purposa of sale.).
❑ I, es owner ol tha properry, em E7(CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions
Code: The contradors Licensa LsW does not applY �o an owner ol pmpetly who hulltls or Improves Ihereon, antl who contrecis lor such project with a contractor(s)
license pursuant to the Comracror5 License Lews.).
❑ I am exempt under sea Business antl Professions Code br this reason:
Signeture: Date:
Owner ID verifietl by tlnveis litense. ❑ �es ❑ No Driver'S License No.
Venfication of OwnerShip by (rype Of deCument, i.e. - propeny Iax bill or tleetl):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certify ihat no ezcavation live (5) or more taet in dep�h into which a person is required to descend, will 6e made in connection with work authonzed by Ihis
permit, and �hat no building s�rucN�a, scaHolding, talsework, or demolition or dismamling ihereof, will be more ihan thirty-six (3fi) feet high. (Chap. 32, Grp 2, Art 2, Sec.
3a1, TiOe B, Calitomia Adminisirati�e Code).
❑ As owner-builder, I will not employ enyone to tlo work which would require e permit fmm Ne �ivision of industrial Satery, as noted above, unless such person has a
permit to tlo such work trom the di�ision.
Signature: Date:
Division oi Industnal Safery Pertnit NumUer:
CERTIFlCATE OF COMPLIANCE AND A�MORIZA710N OF ENTRY: I cenify untler penelty ol perjury tha� I have read ihis epplication and state ihat Iha information given is
correct I egree �o comply with ell state laws end city ordinences relating !o building constmclion, end aulhorize represan�ativas o� ihe City of Costa Mesa Io enier upon Ne
ebove-descnbetl propetly br inspection purposes. I agree not to occupy or allow occupency ol eny huilding aulhorized by ihis permit until final inspection.
LODE �.
1616 Fixed s�em Final Fire PrevenNon
1266 Pool Spa Final
200 Pinal Re-Roof
201 Final Block/Retaining W ell
2�2 Final Factory Fire Place
203 Final Sign
204 Final Demolilion
I�/i7 / � /�
� I
COOE 1 INSPECTION TYPE
206 Flnel Mechenical
208 Final Plumbing
210 Flnal Eleciricel
212 Flnal Fire Prevention
220 Flnel Planning Approval
222 Final Sila
250 FinalBuiltling/Occupancy
D�TE ItiIQIELfl
December 10� 1973
�
Robert Burton -
3k53 Plumeria Cr. �
Costa Mesa� CA
Dear Mr. Burton:
A building permit h been issued to Ke$�stone Pools to
construct a private sw pool on your property:
In order that your pool will be a saYe one and for the .
purpose oY ad ing you of your responsibility regarding the
requirements o e Costa Mesa Munlcipal Code, we reYer you
to Section 8107� copy of which is attached. �
This letter ia directed to you in order that you will be
aware of our ordinences end cen make a complete safety check of
your pool aree. .
Sificerely iydiu��,
RICHARD HAI�iART
Building Safety Director
REi: bh
TRACT ?�0. �sr �3.
DATE (� 1 �♦
The deveiope: o£ the above eaei:led tract desires zo sell the above set
forth lot pricr to the time that the tract has beer. completed and its streets
accented 'oy the City of Costa Mesa.
Thz unde igr.ed, by executi^.g t'r.is a�reeme.^.:, acknowledges that
.(ws�1l�they) �ses►were)�� advised that this trac: has
aot �eer. give^. �. �_^.spection nor hss i: been acceoted by the City of Costa �fesa
as havi^g complied with the coaditior.s of approvzl v.nich were iapose� by the C�ty
at the t�-:e the fir.al :ract :�ap was approved.
T!:e City assu:.es r.o liability for the er.fo:ce.^..e :t of tne conditio: s
r.eczssary for app:oval other tha: those co^.ditioas protected by surery bond.
?he undetsig^.ed agrees to i.^.darnify 2r.d hold the City har;:less froa
�.y clain resu2ti^.g in da^�age or personal iajury to the undersigned by reason
o£ the afore..-�eatioaed uncompleted condition.
RECEIVED
CITY OF COSTA h1ESA
PtANN�NG DEPT'.
OC I �. 1J/.i
A�vl �A9
7i8�9�1!�te ��,.ra.r�r�r5i6
� .
��
B `�l . .
Purchaser
�� � ' �
BY � - �, -1 C` -L �' i i� t'I, .l1�5. •( _
Develooe: a.^.c/or autho:ized
representa[ive
BY .��_�/��:, l �i.<�i.
Lender
- - —. .. . _ - �,�— - _
Applicant to fill in all spaces encept those within heavy �ortler �ines anC si9n all appropriate Oeclarations.
OF cOSTA MESAQ CB NSTRUCTION PERMIT
�t Address -3�Sv 1 �K M�_I � _
�ier's Name
Address �
Arch/Eng. _
Address (mailing) L-i y�- F_--,�;--tJ C�`"�''� ���,,�'��`�/y�tl
Ciiy LicenseNo. y-�—�� � �r���a, 7���'
LICENSED CONTRACTOR DECLAR TION
I hereby atfirm that I am licensetl untle� provislons o( Charter 9(commencin9
wiih section ]000) of Division 3 of the Business antl Professlons Cotle, antl
my license is in full torc antl effect. �^ 1 ��
License[+��'ass C License No �
Date �p`� 'p 5"9 t
WORKERS' COMPENSATION D C RATION
�ereby affirm that I have a certi( e of con5ent to 5¢If-in5ure Or d Certlfi<ate
Workers' Compensation Inzurance, or a certifietl copy thereof (Section
l800, I..ab. C.)
Policy No. Company
BCertifietl cooY is hereby furnishetl.
Certifiea copy is filetl with the city Builtling Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if the permit is for one huntlretl (5300) or
less).
1 certity tha[ in fhe Perto�mance ot e wOrk � which tM1is pe�m�t is i55uetl I
shall not employ any Derson in an manner o as to become subject to t�e
Worker = mp ion Laws of Cali mia. �1
�ate�,�f�.-Signature /�"�� �
NOTICE: If, af er making this tlecl a on, y u shoultl become subject to the
Workers' Compensation provision o the Labor Cotla, you muzt forthwith
comply wilh such provisions o is permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby atfirm that lnere is a consVuctlon lentling agency Tor Ihe performance
of tne work for which this permit is issuetl (Section 3097 Civ. C.)
Lentler'S Name
Lentler's Htltlress
OWNER BUILDER DECLARATION
I hereby atfirm Lhat 1 am ezempt from the Contractor's License Law for the
following reason (Section ]031.5 Business antl Profezsional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
. any structure, prior to its issuance, also requires the applicant for such parmit
to file a signetl Stat¢ment that he/she i5 liGenzetl Ou�suant to the p�ovi5iOn5 ot
[he Contractor'S License Law (Chapter 9(commencin9 wi[n Seclion 7000) of
�ivision 3� ot the Business antl Professions Cotle) or that he/she is exempt
.herefrom and the basis for Ihe allegetl ezemption. Any violation oi Section
]031.5 by any applicant for a permit sub�ects the ap0�icant to a civil
�enalty oi not more than tive M1untlretl tlollars ($500).
I, as owner of the property or my employees with wa9es as their sole
tompensation, will tlo [he work, antl the SVucture I5 Oot in[entletl O� offeretl
tor sale (Section ]044, Business antl Professional Cotle: The Contractor's
License Law tloes not apply to an owner of a property who builtls or improves
thereon, antl who tloes such work himself/herself or throu9n his or her own
employees, provitletl [hat such improvemenfs are not Intentletl or ottcretl for
sale. If, however, the builtling or improvement is soltl withln one year of com-
pletioq [he owner will have the burtlen of proving he/she tlitl not builtl or im-
prove for the purpose ot sale).
tra fin with Iicensetl con-
am exclusivel con c
❑ I as owner of the ro ert Y 9
Vactorsto mnstruct the project� (Section 7044, Business antl Professions Cotle:
The Contractor's License Law does not apply to an owner of Property who
builtls o� improves thereon. antl wito cont�acts to� Such oroiact5 with a mn-
tractor(s) license pursuanc to me Con[ractor'S License LawJ. I am aware tha[
proof of their Worker'S Compensation insurance shoultl be provltletl to me.
❑ I am exempt untler Sectian B. & P. C. for tnis reason
Date Owner
I hereby certify [hat I have reatl this application antl state that the above
Information is correct. I agree to comply with all city antl county ortlinances
dntl state laws �elatin9 to builtling cons[�uctlon, anC hereby authO�lze repr¢-
sencatives f this ci to enter upon the above-mentlonetl property tor
inspection po5e5. �� A__ n /7_ �� 1)
Drivers' 'ce e or 55 � �-
0865-46, rev. 5/88 WM1ite - Builtling;
TVPE OF CONSTRUCTION LJ rvEw U P.00
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
D��� ION OF WORK/USE OF BLDG. —
TERATION 6GREPAIR
TVPE OF PERMIT LJ GRADING LJ FOUNDATION L7 STRUCTURAI.
❑ TENANT n`�ELEC RICAL ❑ P M81NG p� MECHANICAL
❑ �OTHER �\00�\ �S� ��T^t\ _
PROJECT DESCRIPTION 5. F7 oCCUv.a Gr1 3 '�—
CONSTRUCTION TVPE� VALUATION $ _4 00
20NE GRADIN CU. VDS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
rinking Fountains
loor Drains
loor Sinks
as Service
Kitchen Sink
Lavatories
P-Trap
Roof Dreins
Reinspaction Fee
Shawers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Qiping
Syl`dr Tank
Swimming Pool w/Spa
Urinal
Outlets Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
Boiler
Duc[-UnderGround
Duct - Strucmral
Duct � Ventilating
Exhaust System ❑ Mult
Firepl/Fact. Blt. �CBO #
Heating System & Ducting
❑0-100,000 BTU �100,1
Reinspection Fee
Applicant; Pink - Accounting: Goltlenrotl - Assassor
$15 � � laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
le ❑ Syst Repair/Alteration
ire Dampers
(iegisters
10B
$75 Isue Fee
$ 3
FEES
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
SLeft
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlet5
Switches
Garbage Dispoul
Generetor O65 KW C
Zone
Accessory Bui
ELECTRICAL FEES
Trensformer ❑ 15-50 KW
❑ 50 + KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors 1HPO1'h-8
Inc. lar �9-15 HP �i6-15+
icrowave
Pole Light
Range
I I Standing Sections
5 KW i Trash Compactor
. Reinspection Fee $15 luue Fee '
DEVELOPMENT SERVICES REQUIREMENTS:
2oning APProved By
Building Approved By �
�' Application luued By � �
SUMMARV OF FEES V
BUI�DING PERMIT $ u%. C%f% SMIP
PLAN CHECK
$ PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLANCHECK 50% $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
O
N
I
N
G
R
E
�
M
T
S.
O 1 00021030-60021031 T U T i' i. bS
DAiE: 12/02/88 1II1E� 12:SE
�UCTION AND PLANNING . POl . S SPA -
A PROVALS , Permit# Date Inspector qppROVALS Permit# Date Inspector
.
1. Temporary Electrical Serviceor Polp ,�i 52. Pool & Equipment Location
r.'� .
2. Soil Pipe-Undrgrnd. �•, �r% 53. Steel Reinforcement �
..
3: �Electcical Con&uiTUtility-Undrgmd. 54. Forms � �
4'��lect�ical Cond�it-Undr�qrnd. ' 55. Electrical Bonding -
5.� Steel'Reinforcement' ',� 56. Rough Plumbing & Pressure Test �
+ t.
6:: Elecf'r.ical UFER Grnd; � _._. ' �.57. APPROVAL TO COVER-GUNITE
7 ;Footi�ngs. � . �� 58. Electrical Conduit-Undrgrnd. .,�y
8:•,Foundat'ion �- a�. ``� � l'i 59. Gas Pipe, O Undrgrnd., Test ,� '
9:.Water Pipe-Undrgrrid. ,,.� ' 60. Backwash Lines, P-Trep, � Undrgrnd. �� /
�
10� Structural Floor System � �' . 61. APPROVAL TO DECK -
�
11. Property�SewerLine•&"HouseConnection ;i 62. Backwash&Receptor-Final •�
:. �'�
i�
12. Sewer�Capr .' , �, , -• ) y 63. Heater & Vent-Final , . �
13. Roof. Drains •� f •. - i �' � 64. Plumbing System - Final `," �s
14. Rougtj Plumliing��. ' � 65. Electrical-Final •-
15. Rough Electrical-Conduit 66. Solar System-Final .
'16. Rough Electric Wiring � - 67.' Fenci�ng & Access Approval
77: Rough�'iring Sign �' 68. APP.ROVED FOR PLASTERING -
18! Rough'i�lecirical-T Bar Cei�lin'g'• "�'-• 69. POOL/SPA SYSTEMS FINAL
19: Rough Heating & Air Conditioni+�g i I FIRE DEPT. REQUIREMENT
20�. RoughFactoryFireplace �,'t r APPROVALS� Permit#
, �r
21._Ducts, in Structure '� 70. Underground Hydro
22. Ducts, Ventilating ; �: ~' ,71. Product Piping O Gas ❑ Oil .
23. Gas Pipe-Rough"& Te'sx ;'�'��. . 72. Underground Flush
24. Roof Framing , !, .�''��� �. � � 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing �, • i� - 74, Overhead Hydro .
�
26. T-Bar Ceiling (Str,uctural) &,Monocoat � 75. Dry Chemical •
�
27. F'rame and FlasHing ,. 76. Dry Standpipe , � �
28. Lathing & Siding ., 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing i � .� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat •` }- 79. FINAL INSPECTION
,-•. _
32.� Electrical Power Meter-Final • 80., FOOD CERTIFICATE ISSUED
33. Final Electric � � Notes: y
34. Final Heating & Air Conditioning 1 i C
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing .
39. Water Service-Final
;�}�
40. Gas Service-Final '�'�
41. Solar pomestic-Final � I
/
42. Backflow Preventer :� ��i'�� �
��
43. Backflow Irrigation � "; • �.
44. .Landscape Irrigation System % ' ' �' �
� : .•
45. Sound Attenuation . � , '�'
r
46. Handicap Regulations �r•'
47. FINAL STRUCTURE & BUILDING 7 '�
48. Special Requirements Completed
49. Electric Release to Edison ��
�
� 50. Gas Release to Southefn California Gas Co � f,( ., '�
51. CERTIFICATE OF OCCUPANCY ` '
�� 1 .
No, Date � ,:�'1 ,
OWNER J• MARSHALL
f
ING
MISCELL�NEOUS
ROUGN NEnTING RND 41R CONOITIONING
TEMPOFRRV SERVICE OR POLE
ROUGH WIRI
TRENCMES '
FLOOR SYS'
60N0 eERM
FRRME PNO FLASXING
V' 'NG — IN (� OUT [�
P !R. BAOK'N CO�T
STRUCTUR�I, FIN4L
ME�TING. VENT., REFRIG. �NO �.C., FIN��
PLUMBING, FINR� �NO G�5 TEST n
ELECTRIC, FIN�L
BUIIDING, FIN�L
DATE 3-20-80
BUILDING PERMIT N0.
FIRE ZONE VALUE
SUBCONTRACTOR
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COSTA MESA BUILDINGSAFETY DEPARTMENT APPUCATION FOR STRUCTURAL PERMIT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
RECEIVED V PERMIT 1I0 49858
For Applicant to Fill in Completely — Use Ink Only 1�
BVILDING 2 � n���n � A.P. NO. 'yI� — I7 3---. I�
AD�RESS � /�
BUILDING
OWNE0. OR �� �, / /_ � �- ADDRE55 3�I ; 3 � �;u•meriw
TENANT v'✓ QDJ
UNIT OR
ADDRE S ,r-�j ((�� e�l Q %� SPACE NO.
,(� / TR; O. _ LOT ,p p BLK.
CITV � S� /� PS�C�-� NO�r�Lb �„�� ss U�
CONSTRURION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH l,� �S I
OWNER I� hLt
ADDRESS -I VALUE
ARCHITECT TEL. USE �SIVICM��LC . EI�40•�
OR ENGINEER a
ADORESS ZONE ^�I TYPE GROUP
APPROVED [�
CONTRACTOR Q BV OATE �-2��pp
AD DR ESS sv.�rsF,4a r_
TEL.
CITV NO.
STATE CITY APPROVEDSETBACKS
LIC. NO. LIC. NO.
S12E � NO.OF BLDGS. (FROM C/L STFE T
OF LOT GO X I40, NOW ON LOT OM'
.aTT� � To rxir7.
USE OF J 7
EXISTING BLDG.
Separate perrttits are required for L SIDE Z FT. `
electric, plumbing and heating work. REAR 7 FT. �P
VSE OF BUILDING AND WORK TO BE PERFORMED PLqIVIVING ACTION '
� DATE
APPROVED
� ✓G APGROVED 3 —ZO �' C�
I hareby acknowletlBa that I have raetl thls apP��cation and atate
that tha ebova tnto�metion Is corract enG aBrae to comply with
ell laws reBulatlnB builtlinp construction, end I shall not employ
any person in vlolatlon of tha workman's compensation laws of
the Stace of Celifomle.
I hereby ceriify thet I em p�opetly Iiceneatl ns a eonttactor untlar
6o sa. FT. v � �
tho Stam of Californie Business antl Profess�ons Coda, Dlvbion 3, THE AMOUNT SHOWN UNDER VAIUATION IS FOR
Chapter 9, end t�et auch licenaes are In full forta entl etiatt, or 1 THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV:
am axempt from [he provisions of the Smta of Cellfornle Bucinass VALVATION PERMIT FEE E ^ �-
antl Protessions Cptla, Divlsion 3, Chepter 9. �,� •
� � I. PLAN CHECK E
SiBnetura of ,� � � 5 /7 LID, TAX y �, _�
Parmittae � (]
or / � /]�' dd O
Auihor etl ent Date 0 TOTALPAID S
�'� Q
��OWNER gURTON� Robert DATE 11-20-73
JOB ADDRE55 �54 Dli�moria ['r_ BUILDING PERMIT N0. 37569
� 'ERAL CONTRACTOR vnoLs DESCRIPTION oF WORK Pvt. Swim Pool
Ne3+stone
... No. 3_lg LOT gq TRACT 7557 FIRE ZONE VALUE $ 2 340.00
INSPECTIONS Signoture Date GROUP J TYPE III ZONE Rl
Pool Location SUBCONTRACTOR PERMITS ISSUED
Forms
Main Drain _
Steel Reinforce
Elec. Bond _
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines _
Backwash Lines and Recep.
Electrical Final
ier and Vent Final
Filter System Final
Backwash and Recep. Final
Fencing Final
Electric
Plumbing
3
'r
• � • � 37�69
�� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican�F� in Comp/etely n
�� VAlu � J'u;ririu !�
OV Zn-73��,-;.09 8e i`�� 3�.�0
APPLICATION FOR BUILDING PERMIT
'EIVE�B DATiREC'IV D DATEISSVE
�� 3 //-02 v -
OWNER '
MAIL BUILDING �
Z
ADDRES ADDRE S�' 3
a U rE�.
CITV 2J NO. C L BLOCK
H Z
Z Q CONSfRUCTION . W P
O � LENDER
am
J � BRANCH
ER
m ADDRESS VALUE
m ARCHiTECT TEL. $
J N OR ENGINEER •
ZQ �. FIRE
w� ADDRESS 20NE T E GROUP
a w APPROVED ' � �/%/
J O CONTRACTOR BV DATE /T%
m Z
J� ADDRES � QA��/ I,
W w ZONE NO.OF USE OF NEW Ri V
�= CITV TE� �� � P�`� BUILDIN � Q
Z F
—� STATE CITV �'AROSAPPROVED VARDSAPPROVEO
y Q LI4 NO LIC. NO. MAIN BUILDING ACCESSORV VILDING
�� SIZE NO.OF BLDGS. (FROM C(L STREETI
OF LOT NOW ON LOT ROM FT. T.
VSE OF
EXISTING BLOG. T FT
F SIZE OF NO. OF
aNEW BLDG. ROOMS STOFIES L.SIDE FT. FT.
U E%TERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
U BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
� i MAIN BLDCS. Aa�, BLDGS.
Q VAR� DATE
O C.U.P.�W APPROVED
y APPROVE j �
l�-•
z \
O „SPSE
UI hereby acknowlatlBa the[ I have reetl [his applicatiOn antl state �7
� thn[ tha above inlormation is correct antl aprae to compty with �� �'
� all laws regulnNnB builtling consttuccion, antl I ahall not employ /
r any parwn in vlolation oi the workman's compensation Iaws of '�
y t�e State of Calilomla. � �
ZI hareby certify thnt I em properly licansatl as a tontrectar �ntler SQ. FT. o
[he Stata of Celi�ornie Business entl Proteu(ons Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNOER VALUATION IS FOF
Chnpter 9, antl [�at s�th licenus are in tuil forte end eftect, or I THE PURPp$E OF ESTABLISHING A 7ERMR fEE ONLY: �
om axempt from tl e p�ovisions ot the Stata ot Cnlifornfa 8usinasa p� ¢
antl Profossions ^��e, Division� r 9. VALUATION �� .. m
PEFMIT FEE 4 �
SiBnnture o S� ]
m
Permitto 5�.�' O PLAN CHECK S E
`o
Authori � LL
TOTAL FEE 5
. � .�
JOB ADDRESS umerlf
GENERAL CONTRACTOR �'r3
�p �. 12-173-1 LOT
�.IN., cCTIONS
�501 L
V GAS
-� wATER
��
l., ROUGH PWMBING
'� PROP. SWR. LINE � HOUSE CON. �
� SPRINKLING SYSTEM
MISCELLRNEOUS
ROUGH HE/TING ANO AIR CONDITIONING
TEMPOFARY SERVICE OR POLE
UNDERGROUND � POWER �
ROUGH WIRING
TRENCHES FORMS STEEL PEINF.
FLOOF SYS EM
BON� BEAM � STEEL REINFORCE n
SHEATHING
FRRME ANO FLqSHING
LAiNING — IN �J OOT n
PI'^TER, BROWN COAT
TURRL,FINAL
HEni ING. VENT., REFPIG. AND A.C., FINAL
PLlIM81NG, FINAL nN0 G�5 TEST (,
ELECTRIC, FINRL
BUILOING, FINAL
SUBCONTRACTOR
ERMIT N0.
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� "' COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
�Fo� Applicant to Fill in Complefely
BUILDING •�A,2 p�V �✓i ��I.T I.
Af]ORFSS T J
OWNER
MAIL
TEL.
CITV NO.
CONSi'RUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT TEL.
OFi ENGINEER NO
ADORESS
CONTRACTORCI�Q%T� � �j(J �,p�yrF�c.�(y„�
�p �j�/ I
ADDRESS 1'pi �x�y � �J'
CITV� /�IJN�T�IIV VR� NOL�GL-L
LTC. NO. 27,7� J LICVNO. � Z,
SI2E i
�—� NO. OF BLDGS.
OF LOT � � �C 1 b} I NOW ON LOT
USE OF Q�� ^
EXI5TING BLDG. j\�-
SIZE OF NO.OF �
NEWBLOG. flOOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
�ATo .o �iP.
:�AR-5-74P��`Cl0 132" *�*`1C.50
r,pis '
APPLICATION FOR BUILDING PERMIT
RECEpVE,� DhTE 9ECEIVE nnro iccin
BUILDING
ADDRES;
FIRE o..
20NE
APPROVED
N NO.OF
PLANS
VARDSAPPROVED
DISTANCE BET
MAIN BLDGS.
VAR. �
0.U.P. #
VALUE
�1�
USE OF NE
BUILDING��,'�Q CL
YARDSAPPROVED
ACCESSORY BUILDING
BEf. MAIN &
ACCESS.BLD
DATE
APPROVED
I hereby acknowledge that I have reatl [his applitetion and stata
thet the above informntion is mrrect antl agree ro comply with
all lews rea�ie���a builtlinp consVuction, antl I shall nOt employ i
any person in violation of M¢ workman's compensation lews oi
tne State of Calitomia. j� �
I hereby certi(y tha[ I am prope�ly licensetl as a cOntrector untle� SQ. FT. O
the Sta[e Ot Califarnia B�sinasz antl Protessions Cotla, Dlvislcn 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOfl
Chapter 9, antl that such licanses are In full torce and effect, Or I THE vVRPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am oxempt from [he provisions af [he State ot Calitornia Business Q
VALVATION
antl Protessions Cncie, Division 3, Chapter 9. O� N
C/- - oo,�`/-��-// /OU PERMIT FEE S �
Peemlttee a' � VAM D� �_ _' '" A $ /OO� � P�AN CHECK $ E
Autho�izetl Agent �—� LL
TOTAL FEE $
OWNER �gWIN So. Cal. DATE
JOB ADDRE55 3453 Pli�eria-Plaqe��- --= BUILDI
GENERAL CONTRACTOR sante � DESCRIPTION of WORK
A . LOT 8q TRACT 7S57it FIRE ZONE VALUE
GAS
PROP. SWR. LINE �'NOUSE CON.
SPRINKLING SVSTEM
R CON�ITIONING
UNOERGROUN� �l POWER
SHEATHING
LATHING - IN OUT �
PI 'ER, BROWN COAT
5 fURAL, FINAL
HEATING, VENT., PEFRIG. AND A.
PLUMBING, FINAL AN� GAS iEST
ELECTRIC. FINAL
FINAI
FINAL
SUBCONTRACTOR
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� � COSTA MESA BUILDING•SAFETY DEPARTMENT
3O1 BR P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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For Applicant to Fill in Completely
BUILDING
ADDRESS
OWNER Larwin Southern California,
ADDPESS 16255 Ventura B�vd,
TEL.
cirv Encin�. Califomia No.
BRANCH 16255 Ventura Boulevard
nooaEss Encino. California 9131
ADDRESS 9�OQWiI5F1i�P Rn�ilPvarrl R_ Hid
CONTRACTORL�fWlfl $outhern California,
aooaess 16255 Ventura Boulevard
TEL.
CITY Encino, California � N�� 98E
IIG. No. 191311 LICyN0.6—�
OF LOT C)O X LOO NOW ON 101
USE OF
H SIZE OF NO. OF
Z NEW BLDG. �.9g7 ROOMS STOFIES 1
aEXTERIOR WALL ROOF
COVERING YUCCO COVERING WOOCI Sh11lgl!
0 USE OF BUILDING AND WORK TO BE PERFORMED
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I hereby acknowla0ga that I heve reatl this appliceiion anA rtate
that the above information iz correct entl agrea to comply with
all laws reBulatinq building consvuction, antl 1 shall noi employ
any person in vio�ation of Me warkman's compensation lews of
the Stare of CelifOrnia.
I �ereby car<ity that I am properly licensed as a conttactor untler
the State of CelifOrnia Business and Professions Code, Divisian 3,
Chapter 9, entl that such licenses ere in full forca entl effact, or 1
am exampt trom the provisions of the Stete of California Business
and Professions COtle, Division 3, Chapter 9.
sio�e���a?������. Downs
Perm(ttee �
Authorizetl ABant
APPLICATION FOR BUILDING PERMIT
�JV BV DATERECEIVE ATEISSU�
�� � /O—%� �R 10 1
BVILDING
ADDRESS
557-
OWNER G�/✓�W IN SfJ �rAL-
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FIRE
ZONE TVPE � GRO/U
APPROV /
BV DA r�
ZON NO.OF USE OF NEW S% E
.�'' PLAN$ � BUILDING T aAR-
YARDSAPPROVED YARDSAPPPOVED
MAIN BUILDING ACCESSORV BVILDI
(FFiOM GL STFEET)
VAR. aF`
HOLD FOR
fiHEAMO
THE PURP(
VALUATION
$ 29,800
DATE
APPROVED
f7
f SH N UNOER VALUATION IS FOR
OF ABLISHING A PERMIT FEE ONLV:
PERMITFEE $ LOl.SO
PLAN CHECK $ SO. JS
TOTALFEE $ �S�.ZS
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COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATTON FOR�ST1tU�'�JR�A �PERMIT i�Q�a
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
RECEIV BV PERMIT _ � � �
For Applicant [o FHI in Completely — Use Ink Only
BUILDING � 1'`�? V� e�/ � / ��� A.P. NO. � — �
ADORESS J J L1� /�
-�OWNE OR ADDRE55 S J �IY!�er/K /Q
T � j�nJ 'i� •/`?.9 ns /.Fir C(, f2 3 4^
UNIT OR
MAILING � SPACENO.
ADDRE55 3 y�! 3 /vm e2� a- �L
TR.NO. LOT BLK.
CITV�l-(� TEL. �[/
�S'J�1 I /CS'/� � NO. �" /b�
S�� NEW AD ALTER REPAIR MOVING DEMOLISH
CONSfRUCTION
LENDER v
BRANCH �S 4
OWNER O��yl
ADOflESS � VALUE i.
ARCHITECT TEL. USE Rt.S1�QIYl�'�k' I E IS 00�•
OR ENGINEER �/�
ADDRESS ZONE TVPEr �N GROUP R- 3
//� ��� APPROVED � _�- Q J
CONTFACTOR �t� {/✓y1.�V BV DATE d
ADDRESS
TEL.
CITV NO.
STATE CITV %�PPROV SETBAC
LIC. NO. LIC. NO.
SI2E NO.OFBLDCS. (Ffl0 C/LST E
OF l0T NOW ON LOT qOM T
USE OF
EXISTNG BLDG.
Separate perrttits are required for L S1DE FT. `/
electtic, plumbing and heating work. i ('
REAR FT.
USE OF BVILD�NG AND WORK TO BE PERFOFMED PLqry�.J�NG ACTION
6 /��Lj` [�^ DATE
�r� �ll APPROVED
�i. ✓ � �7� APPR E � ��
/\ /
1 hereby acknoW�etlpe that I heve reatl ihis applicetion antl rtete �
t�at the above ��formetlon Is correct antl agrae to comply with
all laws reg�letin0 builtling conrtruccion, end I shall no[ employ �
any person in violation of the workman's compenmtion laws of m
Me Steia of Californie. ^� .:
3�C.� ��3Q. FT. I S OOCJ '�� m
I hereby certify that I am properly Iicensetl es e conttactor und¢r �
tha Siate of California B�stness antl Proteszions Coda, Oivision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chaptar 9, antl that such lieanses are in fuil (orca entl effett, ar I THE PURPOSE OF ESTABLSHING A PERMIT FEE ONLV: e
am exempc from tha provislons of the Srote of California Business VALUATION `�
and o ess s Gotla, Divislon 3, Chepter 9. PERMIT FEE E 2. �� ,�
m
PLAN CHECK E ^�
0
Sign of /��� TAX E LL
PermlRa $ �'
O� /�O� U
Auth izetl BeNt Date �_ 7� TOTAL PAID E� .��