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Home My WebLink About879 PROSPECT PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 879 PROSPECT PL Suite: Vicinity: ROOF Parcel Number: 41806419 Zoning: R1 R1 Applicant: ALAN HOSKINS Address: 8231 E BLACKWILLOW CI ANAHEIM HILLS, CA Owner. LI, STEPHEN TR AddresS 879 PROSPECT PL � COSTA MESA; CA . ,� " Contracror: HOSKINS ROOFING COMPANY Address: 8231 E BLACKWILLOW CI Arch : Address: Zip: ANAHEIM HILLS, CA Zip: 92808 Phane: , License: Phone: 714 279-9420 Zip: 92808 Phone: Zip: 92626 Phone:� 714 279-9420 License:- 614309 � � Eng: � � Address: TEAR OFF EXISTING ROOF. INSTALL 1)2" CDX PLYWOOD, 2,350 S.F. INC�UDES ATTACHED GARAGE. - ' Plan Check: $0.00 Permit: $195.25 SMIP Res: $1.04 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $196.29 SETBACKS� � MAIN STRUCTURE Front 0- 0 . A � � ACCESSORY Front � 0- 0 � PARKING Existin : o Rear 0- 0 Rear _ 0- 0 Reauired: �,0 Status: ISSUED Applied: 07/28/2003 Issued: 07/28/2003 �, / � • /./�, Phone: License: PERMIT 30# ASTM FELT, EAGLELITE MALIBU TILE, ICBO #4660, 5.5 LBS. FEE SUMMARY Calc Valuation: Sio,a3z.00 Claim Valuation: Sio,a32.00 t' PLANNING & ZONING Left 0- 0 Right 0- 0 Left 0-,.0 Right � 0-0 .- , Pr000sed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No, g2-28, § 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 tor a period o� 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 754-5626 >aas-as �woo) WORKERS' COMPENSATIOFI DECLARATION: — — . I hereby aNirm under penalry ot perjury one ot the tollowing declarations: ❑ I have antl will maintain a certificate of consent to self-Insure tor workers' compensation, as pmvided for by section 3700 of Ihe Labor Code, tor the pedoimance oi ;he work for which this permit is issued. � I have and will maintain workers' compensation insurance, as required by section 3700 of ihe Labor Code, for Ne perfortnance of the work for which this pertnit is issued. My workers' compensation Insurance carrier and policy number are: / / L �a,,;a,: :�r� y� �v.Jo Policy Number: i0 1� �� L� '�o �C� (This section need not be completed i/ the permit is valued at one huntlretl tlollars ($100) or less.) ❑ 1 cerlify that in the peA��the w9ork for ��issu, I shall not employ anP person i Pany manner so as to become subject to Ihe workers' comp � sation laws� lito an a ree if s uld bec me 'ed \the workere' com ensation rovisions of Section 3700 of the Labor Code, I shall torthwith com I with these oh on Applicanl Signature: � �A Date: iS 7— 7 fr � O� WARNING FAILUFE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT fW EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES l/P TO ONE HUNDRED THOUSAND DOILARE (5100,000), IN A�DITION TO THE COST OF CAMPENSATION, DAhNGES AS PROVIDED FOR IN SECTION 3/O60F THE LABOF CODE, IMEREST, AN� ATTORNEV'S FEES. LICENSED CON7RACTORS DECLARATION: I hereby aflirtn Ihat I am force and ettect. Llc. M_ Comractofs Signamre: ot Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, and my license is in full aassn _�`3�7 `oate: D 7—� 8- D 3 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a constmction lending agency for the pedormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lenders Address: Signalure: Date: OWNER•BUILDER DECLAi7ATIONS: I hereby affirm that untler penalry ot perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protessions Code: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant tor such permit to tile e signed statement ihat he or she is licensed pursuant b Ihe provisions of tha Contradors License Law (Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business entl Professions Code) or ihat he or she is exempt t�erefrom and the basis tor the allaged exemption. Any violation of Section 7031.5 by any applicant for a Dermit subjecls the appliwnt to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner of Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure is not intentled or oNered for sele (Sec. 7044, 8usiness and Protessions Code: The Contractors License Law does not apply to an owner of property who builds or improves iheraon, and who does such work himself or herself or through his or her own employees, providetl that such improvements are not intended or ottered for sale. If, howaver, �he builtling or improvemant is sold wit�in one year of wmpletion, ihe ownerbuilder will have the burden of pmving that he or she did not build or improve for purpose ot sale.). - ❑ I, as owner ot Ihe propetly, em EXCLUSIVELV CONTRACTING WITH LICENSE� CONTRACTORS to consiruct the prolect (Sec. 7044, Business and Professions Code: The coNrectors License Law does not apply to an owner oi property who builds or improves t�ereon, antl w�o coniracts for such pmjact with a coniractor(s) license pursuant to the Contraclors License Laws.). ❑ I am exempt untler sec. Business and Protessions Code for this reason: Signature: Date: Owner ID verifiad by tlnver's license. ❑ Yes ❑ No Dnvefs Licensa No. Verification of Ownarship by (rype of tlocument, i.e. - property tax bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: � ❑ 1 hereby certify ihat no excavation fiva (5) or more faei in depth imo which a person is required to descend, will be made in connection with work amhorizetl 6y this permit, and that no builtling sWCWre, scaflolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Atlminisirative Code). � As ownervbuilder, I will not employ anyone to do work which would require a partnit from the Division of Intlusirial Safery, as notetl aDove, unless such person hes e permit to do such work irom the division. Signature: Date: Division of Indusinal Sefery Permit Number. CERTIFlCATE OF COMPLIANCE AN� Al7THONIZATON OF ENTRY: I certiry under penalry of perjury that I have read this apDlication and state that the intormation given is correct I agree to comply with all s[ate laws antl ciry ordinances rela�ing to builtling constmction, and authonze representatives of Ihe Ciry of Costa Mesa to enter upon the above-described Dmperty for inspedion puryoses. I agree not to occupy or allow occupancy of any building authorizad by this permii until final inspection. � � ^ /` /��ignat� Q( Legal wqa _ Date . / . � D7—�fr-03 nd/Or Authonzed Appl'icant Date COOE �. INSPECTIONTVVE 1616 Fixea Syslem Final Fire Prevention 1266 Pool Spa Final � 200 Final R8-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion o�re INfITIRLS F� �� COpE I INSPECTION TYPE 20fi Final Mechanical 208 Final Plumbing 210 Final Eledrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy pAjF INIITIALS �ICATION FOR A BUILDING PERP BUILDING PERMIT NO. Eiettriwi po Tratt Block Lot Permit No. � Building ^/ Plumbing � Atldress G� "� _ i�(L '�i�n �rmit No. m •Cross , � � O J � Mechanlcal 6\ Area Street Aermlt No. ? m Owner � P��. � 'fYpe of Grojech ❑ New ❑ AI[er Atltlitlon � Atltlresz ❑ Repair ❑ Convert ❑ Demo ❑ Oc[upancy Pml. City Zip Phone A. Sup. Dist./ Insp. A�ea Architect jL �i � Designer ` �� {( �Ltil No. ' �' •� !✓(� Z ne Spl. Pmt. No. AtlOress 't - Se backs P/L Fron[ C/L SL Street Witl[h `-{ ..[. 'L C� • .i� City Zlp , Phone �'a s Lef[ qh ear �Y� - ave ro�. e g . . Engineer Licen,e No. ,� � a�king SPaces ¢qu re rov 0 overe a Atltlreiz m [It Zip Phone 5[ruct No. ot No. ot Y H¢i9ht $tories Family �. LICENSED CONTRACTOR'S DECLARATION Park Fees Yes Fee � I hareby affirm that I am licensetl untlar provisions of Chapter 9 Requiretl No C.T. Receipt m (commancing with Section ]000 of Divisian 3 of the Business antl « Zonln9 AGPro tl By: �ate Profossions Cotlnp antl^my 'cense is in full force and aff/ ctq' 'l,,u?Q "y� Licanse Class_.��— License Nurnber ��,aq ✓ , T Date Conv��l1/r.t`o�r � Misc. E Atltlrass ��1� C ProPoseE Use jy City and Zip � 4 e � Phone �'F2 O/ 1� o( SfruC[ur¢ a CONSTRUCTION LENDING AGENCV N � I hereby affirm that [M1ere is a consttuction lentling agency tor the d performance of Ihe work tor which this permit is issued (Sec. 3097, Occ, e Cotle ' Civ. C.1. Class Con . Vear C Lontlar's Name USE/OCCUP NCV SIZE SQ. FT. Londer's Adtlress "� OWNER-BUILDER DECLARATION 'Yr I hare�y affirm that I am exempt from the Contractor's License Law 1� 10 for the following reawn: � ❑ I, as owne� ot t�e property, or my employees with wages as their 2. solo compensation, will tlo the work, antl the s[ructure is noc r intentled or oftered for ssle. 3 . � ❑ I, as owner of the property, am exclusively contracting with IicensaC contractors to consvuc[ ihe projact, �d.,, ❑ I am exempt vntler Sec. , B&PC for this reason 4• N a Dats Owner E WORKERS' COMPENSATION DECLARATION Total Valuation � I hereEy affirm thai I have a certilicace of consent to ulf-insure, EnL�oachmEnt Pe�mit R¢q ❑ No or a certificate of Workors' Compensa2ion Insuranee, or a certitied c copy rnereot n� �`L� (, / GraOing Pmt. G�atlin }g Policy No Company �+->�� u� Requiretl ❑Yes ❑No Pmt. o. Certitietl copy is hereby fvrnishetl. a Rough G�atling � � a Certified copy is filetl with Oran ounty, EM , � qpprovetl by: Date � a Date _ Applicent � 3 CERTIFIGATE OF EXEMPTI � � FROM WORKERS'COMPENSATIONINSURANCE Z (iTis section neatl not be cornpleted if permic is for $100 or less). � I certify [hat in thu portormance of ffie work tor which this permit is 3 is5ued, 1 shall not employ any person in arty manner so as to become A subject to the Workers' Compensation Laws of California. . PERM FEE$ Datn qpplicant NOTICE TO APPUCANT: It, atter making this Certifiwte ot StruCtural b Plan Check E Exemption, you should become s�bject to the Workers' Compensation provisions ot the Labor Cotla, you mus2 for[hwith comply wixh such Electrical SPe provisions or this permit shall be tleemetl revoked. $ Invesl. $ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $ COMPIV WITH ALL COUNTV OR�INANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEFEBV AUTH- Mechanical 5 ORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER VPON THE ABOVE MENTIONED PROPERTV FOR INSPECTION PUR- pre-Gratle POSES. /w� // �O jjO InSpettion s y' CJ Pre-Gratle Permit Signe e Applic nt r Agent �� All spacez within this box must be completed to process vlan Issuanca Check By: Approvetl: �.mr uosowo �eu-[a� rev. o/eu ,woqcssorew�ov� 87G PF.QSnECT Pi, unr: qYNEH8NIJIEIFR101YN: LI, STEFHEPJ FLOOD: X 97 .00x� LI, CLAIRE 879 P�OSPECT PL _��;T�? M^c5A,CP, 92c.°.6759-6/t7? �vv�.wuuxc,�ooxEss: �IiCHRECT OP ENfiNEEP: acx. on eac.�s �ooxess: uc. xo.: uxr: coxm�crarsru� GALKOS COtdSTLUCTIOPI ( 714 ) 373-8595 caxrx�cToxsw,uuec 15102 EOLSA CHICA RD mo�ss: AUNTIP]GTON BEACH CA ucao.: 492715 92649 u�r: UCENSEO COMFICTOFS DECLANRTION: I Mreby eRvm unEer penetly d pe�ury ihm I em Iceneed urMm prwiaiona N Chapter 9 (oomme�iq wiih Seetion )000) M Division 3 d Ihe Buaircae eM PMeaaorm Cab, enE my lioenae ia in hll bece eM ellee. cmuc.No.: pq9?zGq uacuss: g uc.no.: 4/9/�/'y�)15 /P�• OS/96 D�e: �' / CoMraaa:�� %!/Ji // OWI fl BIIILOEF UECIAPATION: I Mieby eifiim uMx pnuly d perN�Y �C�I em asemq fmm tM reqon Limn�e lew la Ne id in0 �� (�� )�1.5 &nneea mM Pm�esaione COEe: My cty or munry xfirh nyuiree e imE �o omstrucl. eller. imptaro. moleM1, or repeir eny avuquro, pior b m esuerra, e6o reQuieea iM appli�anl lor eueh peimX lo fib e eipmd e�etement Net M or sM is liceneed punuenl lo iM qovieione W Ihe Cantrenom Limnse Law �Chepter 9(mmme�a�p wuh Sspun ]000) d Divoion 3 d �he Buainan end FMeaiwu Code� a thn M a ehe is exemp thaehom eM �M bvu for IM NbpeE exempion. My violetun d Sed'on )W 1.5 by vry eppliunl for e permil wbpb� iha epplicenl lo a tivil pmelry d ria mwa Ihen fxa huMred dd4n �550p��. � I.uowmrdiMpeopenYamY�VW��hwepesesihaiaabmmpemqion,wiAdoqrowork.eiklMaVuetureemlinteiMeC w oMered lor eele (Saclion ]Oad, Buei�rova eM Prolmaiorre Cade: The Conlredors licenas lew doee ral epplyta en ownerd popeM wlw buiks a'un0�ovee ihereon. end x1w Eom such Mwk Mmeetl or heneM a IhrouOh hi a hm own employeaa, pmideE thet euch impmvemenla are mt imeMeE or WeraE lor seb. p, howavar, tM buitli�p a'vnqwemeM ie wd xilhin ma ymr d compbtion, iM owrerbu� xill heve �M WNm d pwirq M w eM d'd rM buiW a improva la �M puryme d Wa�. � I. m oxTMr d IM O�PoM. ��dueively ewNreclirp xilh IicenaeC comrecipe lo conelrud IM prol� (Sedion ]MA. Buainre arM Prolessiare COEe: TM Conlraclan licenne Lew Joee iwt epply to en owner d p�opeily vAw Witls a'unqwee Ihereon erd xfio eonveeb la wh prqeq� wdh a mmeeda(e) Icamed Wnuem to iM Caniretlm liame lewl. ❑ I em memq uMer Secibn: B. d P.C.. la �he �emon: De�a: Owner: i eo nmenv �M uw i� e.,.e a.�d ��aers�d me �w��«�, d ce�aomie r�eaim w smar coee s.a�m. zsws. assa�. e�d 25531, eM Nat I or eiry Mure Wikirq ocapeni xiil / wil mi (wcb aro) neeE to canpy x'th eek pna mdea vd iM rpuinmenb br epsmnbrmnavuctionormodiRrelionhamlMFi ue-CTlrennpemamDistria.RseldenlWconevuqbneppYceliomenezempimmiheee protisiom. Dele: Appcem: WONKEfl'S COMPENSpTION UECL�N�TION: I hereby alfirm �nEer peraM1y W perjury pp d tha followinp dadaratbna: � I heve arN Mil meimen e cenRicma d mroent to eaM�inawa tor xMere' wmpenmibn, n prwidaE lor by Serlion �)00 d IM lebar . COM, la tM pMamenca ot Ne wM la wli:h I�u pama u iuued. I heva eed xil meimen xwken' mmpemmion imurenea, m repuired by SSGion 3)Op d IM Lebm Code. br tM pe�ormanoe d tM ` wark fw which Ihia permX ie ieeueE. My waken' wmpeneation ina�rence fsrrier uM pdiuy numMr era: 1 c.�. STAT:. FUND EkPIRES aaryN�mn�,: t��—y�uuvlzi�y O1/01/90 (This ee tion need rro16e compleleE ] tM pemir ia iw wre huntlred Edlers (Stool w bssJ � � I ceMily the� in the perloimence d tM wdk la which thn Po�� le iauetl, I ehed iwl empby eiry perton in eny menrier eo u to becoma wbjep b iM xoMxs' <anVe��ion kvn d celdomie. erd eurea Nm d I ehouk eudb m the woka�s• //�m� mpenseiian pwisiore d�w� 3]00 d iM lebor Cade. I eheA iwlhrrilh vilh Il�oae.!i� Lnm.� 1 �--� � — , a��i:.w Wam/ny: Fallun ro�ecun woA�ri rompwvetlon covereps Is vnkwNl�(ntl Lull �ubJ�cf an sip/Ioysr ro eNMrol peneMu uM c/H/ 11nu'q N om h�nLM Mouaartl JNYn fSI0Q000A N aGs/tlon b fM cwt ol rompwwfbrt d+�p+ u qvHWtl br In Sectlon 3]O6a/tlro LaDorCotls. Inten�f, endeMmsy'i Iw. CONSTNUCTION LENDIN(i pOENCY: I hwaby elfiim urMer penely d par'ryry iM1el IMn b e canst�udion bndi'p apmcy /a �he pmlamenoe d iM wk /u wAitli Ihc pwmi e'nw»d (Sedon �OB). C'v. C). LENDER'S NMIE: , LENDEN'S ADDNESS: I ceNN IM1eI I hava reed ihia epplicmian eM Yaie ihm tM eEove inlametbn o cartw. I qrea io canply xiih ell ydy ud ooumy wdirivices eM sle�a lexa ralpip Io WiMip con9rudpn eM Mreby eNharrza repawnte�ivae ot Ihif d1Y Io mtx upon iM ebo.e�mentip�eE popMy m,��o«'�w•w"' JIP4 SLAGLE .� �,- , Dma: (5�51�46.WP) Whne-Buildiq 8 Sel&Y: GrearFb; Cenery-AOGG�� Pink-fievenue: GOIEenm�Asseeaor CITY OF COSTA MESP — BUiLL�IP7G PERMIT PERM NU: E 072566 PE3MI? NO: E U72566 PLP.N CHECK NU: A7 GOC'T; PJ SUPP: N CONSTRUCTI(�N TYPE: PEP.MIT TYP�: ELE PJRFOSE: CON JOB D�SCP.IPTIC��1 , TRELLIS PATIO 216SP & 192SF SQ PT; CLAIM �?ALLTE; CALC—VALUE: GROTJP OCC; R-3 !. COMP^.ENTS: REF: B-72993 Af Y iF �V-Y if If iF iF-1F Y�Y i4 �%�lt �If il� iF -1R.y. y.K..y.Y i4 �%Y-1f !F -X' �1f iF 1E af .K �1f �1! �N-if ii M Y Y�.1{.14 Y�iFY JF iA iF �4 �%'N� k-Y }:.M iF iF.r. Y{(..y.y, .y..�.y.-)F-IG �Y �%' Y i!?"X' �' �"k zoNzr�c xeQoza Er�eraTs S E T B A C K S ------------ MAIN PpILDI�]G ---------- --------- ACCESSOP,Y 5lJILDITIG --------- FRP7T: FT IP7 EAR• FT IN FRP7T; F't IN REAR: FT IPS LEFT: FT IDi RGHT: FT IP] LEFT: FT IPI RGF?T; FT iP7 PARF'IP1G P.EQ: FROV; PARCEI�: 91806419 7.NE: P.EF NO; PLAP]NING NOTES> i -1F AE i �F iFY'F jf ±'IF 1f'N"7F'N' K ii' iV iL �F �1 {f if'i(�'�'le 1F tf # iE �Y'lf iF'Y�Y-'R iF Y-if iF i�' �F aF'% if'K i'F iF Y-1�' �lf iF i4 i4'K' Y- iF'�F M iF if '/F {v iF #= if ii iF �F i4 if iF if -K-1F #'� #' af' #'' U E V E L G P A9 E N T S E`.R V I C E S R c Q U I P. E M E N T S 20NIP7G APPP.00'ED 5Y DATE; BUZLDING APPROVED bY : P.PFLICATION ZSSUED BY u�*if�u-usu��ar��*-N�a�.x�u+t+.iEiF L EG1�L I Z AT I OA] ; P] BLDG FMT PERMZT ti F E,E� � S U M P9 A A Y nLUP1EIDIG ELECTRIC MECHANIC 6.OU 50� UATE: �j DATE : �1 �J1 � �i �*��*t�.w »_x��-�-�� STP.UCTURAL SEGMEP:': : D7 FIRE SMIP/RES GP,AUING SMI?' /NGN—P,ES eLar� Is`SUE FEE 15.00 SUILDIP7G—DIV—> YERD9IT ISSUE nLAPI—CHECK TGTAL PAID DUE TOTALS----? 6,00 15.00 0.00 21.00 2?.00 .00 REVENDE DIVISION TOTALS--> COLLECTED: 21.00 OVER;SuORT; 00 BLUG PMT PLUMBID7G ELECTRIC MECHe?NIC FZRE SMIP/TOT GRP.DING PLAN—CH�CK � 21.00 t( lE �lk i4 iF i� �Y iR iF-k if iF if iF iE 1f �1F+Y� ii i(- iE?E iw� iF �1f ie # if if it-Y �IF i4 iF-iF i4 ii s iF i�- if if � aE i' if ;� 1f �1F if fF # iF �F if if M iF iF>- a-Y- {: #- ai- iF if Y- #'� -1F i4 A�lE 1�. if iF i'� Y- I N D I V I D L' A L . E E B P, E A K D U'i? P7 TYPE QTY D E S C R I F T I O N iIN2T COST TOTAL COST ELE 2 FZ:{TURES, LIGHTING 1 ST 2Q EA. .75 ELE 4 P,ECEPT/OUTiET 1 ST 2U EA.� .75 ELE 2 RECEPT/SWITCH : ST 20 EA. .75 Er�n a� FFEs ai aols.;n�s-ooiaa,a?., �-A:T 6AiE: D;/30/SS TihiL: Sb>l�5 3.00 1,SU ?7.ua CONSTRUC7ION AND PLANNING Pc�yL & SPA •� APPROVALS Permit # � •"Date Inspector � AppROVALS Permit #� Date Inspector 1. Temporary ElectriCai Service or Pole 52. Pool & Equipment Location. 2. Soil PiOe•Undrgrnd� ' 53. Steel Reinforcement � ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � �� 4. Electrical Conduit-Undrgrnd. �" 55. Elect�ical Bonding �' • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �; �' �.; 6. Electrical UFER Gmd. 57. APPROVAL TO COVER-GUNITE � 7. Footings 58. Electricai Cqnduit-Undrgrnd. � � 8. Foundation 59. Gas Pipe, u Undrgrnd., Test � � 9. Water Pipe-Undrgmd. 60. Backwash Lines, P�Trap, n Undrgmd. ' 10. S[ructural Floor System . _ 67. APPROVAI TO DECK • . ' 11. Property Sewer �ine & House Conhection 62. Backwash & Receptor�Fi�l'• 12. Sewer Cap • 63. Heater & Vent-Final 13. Roof Drains .� 64. Plumbing SYstem - Final , " 14. Rough Plumbing ' 65. Electrical-Final '` . � 75. Rough Electrical�Conduit !,� 66. Solar SYstem-Final 16. Rough Electric Wi�ing . ' 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PIASTERING 16. Rough Electrical�T Bar Ceiling 69. P00 VSPA SYSTEMS FINAL 19. Fough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fi�eplace APPROVALS Permit # 27. Ducts, in Structur¢ 70. Underground Hydro 22. Ducts, Ventiiating 71. Product Piping GGas OOiI 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceiling iStr�cturali & Monocroat. . 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78, FIRE PflEV. FINAL 30. Drywall Naili�9 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�Tes[ � 36. Hood or Canopy 37. Final Factory FirePlace \ 38. Finai %umbing . 39. Water Service�Final 40. Gas Service-Finai 47. Solar pomescicFinal 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Attenuatio� 46. Handicap iiegu�ations 47, FWAL STRUCTURE & BUII.DING 48. FINAL PLANNING 49. E�ectric Reiease ta Edison `_� 50. Gas Release to Southern California Gas Co "-^---- 51. CERTIFICATEOFOCCUPANCY �' No Date � � j�E550FBNLOWG g79 p,�pSFECT F�L � uwr: ��E��a+�**+ LI, STEPHEN — FLUOD: `: 97 woxEss: LI, CLAI-E 379 PROS�'ECT PL TA t1cSA,Ct�. 92626759-6�172 xuuxc noonEss: uc. ra.: Ofl ENG.'S �DORE55: UNT: coxmectars�u� GI�LKOS CONSTRU��TION ' ( 714 ) 373—$595 camecroxswuuac ? 5102 BOLSA CI-IICA AD moxEss: HUPITINGTOP.' BEACH CA uew.: 992715 92699 uxT: LICENSEO CONfP�CTONS DECLAp�TiON: I M'ebf eHim uMx penely N pa�jury �hm I am Icaued uMm pa+�+d Cheqm 9 (cwnme�iq v.ilh Seclion ]000) d Oivision 9 M iM &++man e�d Pmlessbn Code. enE mY lim�w w in lull bru ud aHep. c.No.: 093224 uc.cuss: g uc.wo.: qg7^^ 5 0/00 Dma: '�� Comreaa� OWNEH BUILDEN �ECIAXATION: I Mreby eifim� uMer penely d perjury �h em uemq hom tha Coq qae Licenee Law tor Ihe lolbwino �eeeon (Sedan ]0�1.5 Bus'vwan eM Pru�esebne Cotle: A�ry c1Y a�umy whiM requim e penl{it to oonetruct. ellar. imyove. Eemolah, a repei eiry slruclure, pior b ne uauen�e. eko reQuiree tM epd�� la such parmil to file a eipmE elelemeM ihel he a aM ia licenaed Wnuenl lo Ihe p�ovisiona d �M Conl�etlore licenee Lew �Chep�m 9(camme��p ailh $edpn )000) d 0'veion 3 of �b Buaineaa eM Proleaeona Cadej or ihei he or ehe ia exemq thereirom end tM bssc Iw �ha dleped exemqion. My vbletbn of Sedion ]031.5 by eny ep0liraM ta e permil wbjecb ��e Ppplcent to e tlril pe�lry M nm mwe Ihen fve hundred ddlan �5500�). � I, m owner Nthe propeM or my empbyaes W�h wepes es iha> wb companaelbn, will do ihe work, end IM elriwNro e nM inleMaE w oilered br aele (Seclian ]oae, Buznass end Proleadons CoJe: Tha Conlreaare Licerea lew dma �at eppyto en amar W prope�ry wM Wlda a'vnpwm ihareon. vM wha dde euch �wrk IimceM or henetl a ihraph ho w her own emO�oY^ae• W�4 �� h im0�*menla ara m� inteMea a dlered lor eele. X, hawever, the hiNi�q a mproremem u votl xi��in orw year d compblion, tM1e ownar-0uilder till heve Ihe burden W provi�p M1e m eM L'M iwl Wik ar impwe tor iM Wmoae d eeb). � I. av ovmer d IM poVeM. am uduerveN cM�recM xrh liceved contrecbn ro conslrW ihe M9� (5etlion ]DM. Bwinms ard Pmle�ons Coda: The CoMradaa L'ceme law doea rwi WdY W en owmr d PWahY who Wilde a imV�'m IM�ean eM wM convena fw auM prqeea xnh a mrvretlar��) IkemeE Wnuem to tM Cant�mas licema lew). ❑ � em .=amq una« s«ron: e. a r.c.. k, ma remon: . oda: o.�a: i eo n.��sy <enav a.r �� a�e d w��ue u,a �w��«�u a cwomm �an �a smmy coaa s.u�. asus. usaa. �e 2553a, eM ihet I« eny Muie Wiki�p opvpeni w�� / wal nd (orc4 aro� meE to canpy wih veid ewa mdae ud �he rWuinmmb br e pemin lamnniuctmn or modifrationhomlM �i��ene0emenl Dim�ie. ResideMid mnatNpian eppYratbnsere memq IromNme yrovi:iwn. Dele: ADd�: WONNEfl'S CONPENS�TION DECLIPATION: 1 M1ereby elfirm uMer paraliy d perjury aw d ihe bllowiip dede�eto��: ' � I heva and wil mantein e cenAiceta d mneent io eeX.inwre for wpken' compensetbn. ea proviEad la Ey Setlbn 9)UO d IM lebor �oda ia ma aeno�� or ina ..ax ra.�n in�. ro�n �. �a�ad. I M1eve enE wil meiMem wurlwA mnpenmtOn ineurerce. m reyuireE by Seaim 3)00 al Ma Lebor Code. f« ths peAormuiu d �M ork fa wfiich ih'v pamn is iaueE. My wvksn' compemetion imurenea e�artier eM pdiry numbm ue: c�a,: S1'ATE FUHD EY.FIRES. ' PdicyNumber: %ty—y�uuvii/jy 01/01;96 (Thia ae tion nee0 mt 6e rompbfed i Ms p�mm! A�u' aro hundmJ Ldlers /S1P01 w hv.) � I mX/Y thet in Ne periwme�we d IM wwk �a xAich Ihia pemiil o iaeuetl. I#�eA ml ampby erry pawn in em/ man�wr ao m to beeama euM� to IM xa4en' eomG�ion levn d CelXanie. aed eGree Ihet+L 1 ehouk bew�e eu4� �o tM xabn' mmpenae�ion povciom d ion �100 M�M labor Coda. I ehdl IMhvril c�p�y Eh IMee eie. � AppliceM: ______ I/� .� / I�g: F�llun b�x�n workeri rompemetlon cov�rep� I� wr4wN ntl �htll sWJset an Nnp/ r M e�lmlro/ pwMu siM clHl fln�s up b aro h,ntlrerl thous�ndCWMN (S10qODJ), M eEJltlon M M� cwt ol ronpxwflort e+�p� �� GAvMM br In 9ectlon J106 0l tlrs LeborCotle, Intsnst enG P�msys /su. CONSTNUCTION LENDING AGENCY: I hereby �� unAer penely of parNrY �� here ie e conel�utlion bMi�p epency Im the paAormance d �he waA fa which ihu perml is beued (Sedion �09]. Giv. C). LENDEN'S NMIE: - ' LEN�Eq'S ADDPESS: I ceniy ihm I hew neE ihu epdK�im end &de ihei the eEove iniwmelion ia coiren. I epree to comON �h ell dly ard mim�Y oMirencee end eiqe lewe rele�ing to build'ng mnwutlion eM hereby eNMrrze reD��mivm of ihis ary b enter upon tM ebove-mantomd pmperiy �«i�so�+��w,o�. JiM SLAGI.F. ome: ---�� (515t-aB.WP) Whilo-b�iMiq6SeMy:Oraert-Fb:Cenary-Appiranl:Nnk-Re�enue:GoNeneoE-/uaeem CIT's uF COSTA MESA — BUILDIAIG PERPIIT PERf9 P10; B �7299? PEnMIT NO: B 0?2493 PLAP7 CHECK t•do: a1962-95 L GO:'T: Pi SUPP: P] CGT7STP.UCTIO*1 TYPE; PERAIIT TYPE: STR PU:iFOSE: CON J05 LESCRIPTIOPI ; IR^cLLIS PATIO 216SF E 192SF SQ FT: 908 CLAIM VALUE: 6,BQO.UO CALC—PILLUE: 10,&33.6Q GROUP OCC; R-3 / COMMEPITS: 2165F ENCLOS�D PATIG IC90# 15:4F 6 192SF OPEA7 TRELLIS ICB08 2621P +F �1F iF # Y if iM if 1F if iF iF if if iF-lt'k� iE iL ic iE �1E �f iF �1E iF �E w-Y iF Ye iE 1F �iE af �lE iF ti i4 -lE Y� iF i: ae if iF if iF #'� if ii 1f } it+iF+f .4 �iF iE iE {. if � 4-1:L i: i4 �k yf ac iF iF 1f �i iE iR iE Z O P7 I r] G R E Q li I P, E M E N T 5' S E T E A C K S ------------ MF�IN BUILDIP]G ---------- --------- ACCESSOR': BUILDIP7G --------- FRNT; FT IN REAR: FT _TPi FRNT; FT ZP! REe'1R; 21 FT ZA1 LEFT: FT IN P.GF3T• FT I2•l LEFT: 10 FT IA] RGHT; 9 PT IN PARKIDIG REQ: PROV: PAP.CEL: 41$06419 ZPJE: R1 RcF P70: PLAf1P72PJG P70TES: COP7SIRUCT A COMBINATIOPI ERICLOSED 'AC]D OPGPI PATIO T� THE REAk > OF ADJ E::ISTING SFD. EAJCLO5ED=216SF; 2 OPEP7=1925F TOTAL. �N� iE iF �N-i4 i4 X� i4 ic �iF N�-!F,`k dF �Y �%� if if If it i4-iF iE iF -1FlE i4 �IF i4 if �i4 if i�� if -N� af if 1E 1'-li iF -lt -ic-1F iG iF if i4 i� iF i�-if �Y� N� if iFY.� t[ aM1 i4 1f i(-�1.-?f k'� �N� i��-%iF'�IF �Y- ii �4 �i.y. x�it� iR ie� D E V E L O P M E N T S� R V I C E S A E Q U I R E M E N�T S ZOT]ICIG 11PPROVED EY : �8� DATE: BUILDING APPROVED BY :_ __ __ _ _C'�{Ci'� DATE: �"1 /"t �� a.�_r_ APPLICATIOP7 ISSLTED fiY; C'�1'� DATE; Y�Ki!�Y.�iF�M-aFN�iFiF��N�ifM�irvi�*lf�X-Ififi[�-rtiFi'YF,`tit+�F,ti•�v-i�-iFM?:-Y-lt-Yi�`-�fiF� ��if-YYit �itit�ltiticac�t�Y�ti4a��Y�k�M��li- LEGALIZATIOf1:N F E E S U M M A P. Y STP.UCTUR i�'riFii �1sV;* EGMENT:Y bLDG PMT PLL7MBING ELECTR3G• ME�HAP7IC FIRE ShiIP/fiE5 GP,ADIPIG PERMIT 126,00 � 2,08 � srizP ir�o*�-:��.s PLAr7 81.90 � ISSUE FEE ' BUILUI"7G—DIV—> PERMIT ISSUE PLAN,—C??ECK TOTAL PAID UUE TOTALS----> 1<^7,Og 0,00 'L8i',40 208,98 208.98 ,00 %' 'r.EL'ENUE UIVISION TOTALS--> COLLECTEU• 208,98 OVERlSH[:P,T: 00 HLUG Pl1T PLUl1BING ELECTRIC MECHAA7IC FIRE SMIP; TOT GRALIPlG PLArI—CH�CK sz6.00 ' � s,oa ai,90 )i � +E �X jE'Y-E'l� if -N'ik'1c'k M ic iF #�f iE iE iE 1f iE'If �f �: if +f �E �f if i!'k if if Y IF iF if iF 4�k�� 4.E ii- iF if iE fF 1f ir if ak �k iE M✓+E iE+E iE 4 ii* k�+. r+f i�Y!� w- Y iF iF if if if+(- iE ##'- I N D I C' I L U A L ! F `E = � R E A F: D O S•I N TYPE SFL SFk QTY D E S C R I P T I O P7 • 192 P.ES—LATIO COVEP.—FO£T 6 TRELLIS 216 RES—PATIO i:OVER—ENCLUSED PP.TIO END UF FEES �� r. . .� �'': � , .� � UNIT COt:T TUTAL CC�ST 14,H4 2,891,50 :?.QO '',992,00 OL OOSE266�}—OOlE2b62 T�aT ?pg„qg DATE: OSl211•PS TI17F: 09:`4 � .-a CONSLRUC710N AND PLANNING P.00I & SPA ��, . APPROVALS Permit # � Da2e Inspector AppROVALS Permit # � Date Inspector t. Temporary E�ectrical Service or Pole 52. Pooi & Equipment Location ' � � 2. Soil Pipe-Undrgrnd. ' , 53. Steel Reinforcement � � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � �� 4. Eiectrical Conduit-Undr9rnd. 55. Electricai Bonding � ' 5. Steel Reinfo�cemenc � 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 'r 7. Footings 58. Electricai Conduit-Undrgrnd. �_ � i 8. Foundation 59. Gas Pipe, Q Undrgrnd., Test 9. Water Pipe�Undrgrnd. - 6Q. Backwash Lines, P-Trap, L Undrgrnd. 10. Structural Floor System 61. APPROVALTO DECK . • � it. Property Sewer Line & House Cormection 62. Backwash & Receptor�Fina� , 72. Sewer Cap '! 63. Heater & Vent-Final "'' 73. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing ; 65. Electrica6Fina� u - 15. Rou9h Electrical-Conduic 66. Solar System�Final . � 16. Rough Electric Wiring �' 67. Fencing & Access Approval • � 77. Rough Wiring Sign , 68: APPROVED FOfl PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL � 19. Rough Heat�ng & Air Conditioning FIRE OEPT, REQUIREMENT 20. Rough Factory Fireplace APPRQVALS Permit # 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventflating 71. Product Pipin9 O Gas ❑ OiI 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil � 25. Roof Sheathing 74. Overhead HYdro I 26. T�Bar Ceiling lStructurall & Monocoat 75. Dry Chemical ' 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & S�ding 77. FIXED SYSTEM FINA� - 29. Insulation 76. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT I 37. Plaster Brown Coat . 79. PINAL INSPECTION 32. Electrical POWer Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34. Final Heating & Air Conditioning - - - /6..�„ � �K� �(� 4 / � �h �l 35. Final Gas PiPe�Test , 5F �„�o /„_ �� ,a�,�,c� 36. Hood or Canopy • - - 37. Final FactorY Fireplace 38. Final Piumbing 39. 4Vater Servite-Finai 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irri.gation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Reguiations 47. FINAL S7HUCTURE & BUILD�NG � lq-� (�f 48. FINALPLANNING - � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOFOCCUPANCY • No. Date i � i fi''�- % i.e (�. � ,_ ��. � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � For AppGcant to Fill in Completely — Use Ink Only BVI�DING 'i ! � ADORESS / J OWNER Foley Construt�tion CA. � IT1C. ADORESS Z1OI. E. FOUYth St.� tt1OO c�rv Santa Ana No�� 543-9471 BRANCH ADDRESS L. 3369 APPLICATION FO$�� RECEIVEDBV DA_ __I � /j A.P. NO. �O(Ql r� BUILDING l'�J� C ADDRESS D ( TRACT 1Qrj1,3 W A P X OWNER Folev Gonst� r' r �,j"-�t U(�W$�1�ERMIT I17•2z �� !'1 7":2/CK 1�0 - A. f3 UED IA _- ._.. / PEFMITNO. ?5 s �l LOT LjO BLOCK uction Co. Inc. � VA UE '�%YI $ dfuL/ FIRE ' ADDRESS %]% S. Ma]11 St. �ZOS� OYClIl 2 �ONE TVPE GROUP APPROVEO CONTRACTOR Q,�1px' DEV210 BV DATE , ADDRESS SclIi� ZONE NO.OF USE OF NEW TEL. p�,q� � gUILDING � CITV Sffiil2 NO. G �/ � STATE CITV `�AFlOSAPPROVED VARDSAPPROVED LIC. NO. � IIC. NO. MAIN BUILDING ' ACCESSORV BUILDING � 512E � NO.OF BLDGS. O (FROM C/l STRFEJ)� I �SQ�yFT. � 0. OF LOT NOW ON LOT FRONT �� L V a USE OF / ( � ' � E%ISTING BLDG. N A FT � / � Separa[e permits are required for L SIDE FT. O Fr. 0 electric, plumbing and-heatiug work. REAq Q� FT FT. W USE OF BUILDING AND WORK TO BE PERFORMED � F DISTANCE BET. � BET. MAIN & � QQ MAIN BLDGS. ACC6S. BIDGS. VAR. #e DATE -� Develo t of 41 Sin le—f�[�il c.u.v.�. APPROVED a � detached residence w�its. "°PRo 9 W�RFMF.NTS 0 I hereby acknowletlpe that I have reatl this application and state pLD FOR Sp � ' y� ihat ffie above information is correct and egree to comply wiffi W� m p+ all laws regulatln8 bulltllnp conSlructlon, anE I shell not employ z eny person in violation of Me workmen's compensation laws of � m 1^ ,W�, Me Stete of Californle. Z3 V� / � 3 1 hereby cettify ihat I am properly Iicenutl as e conireetor untler SQ. FT. •� / N the State of Callfornia Business antl P�ofessions Cotle, Dlvision 3, THE AMOUNT SHOWN UNOER VALUATION IS FOR m� Chapter 9, end thet such Iicenses are in full force and etfect, or 1 THE PURPO6E OF ESTABLISHING A PERMIT FEE ONLV: am exempt from the provlsions ot the Stete of California Buslnea VALVATION PERMIT FEE � and Professions Code, Division 3, Chap er 9. y^{ DQ $ m ��// � PLAN CHECK E �^� SlOnatura of � � � Pe�mlttee � $ �� TAX y �� 7 � � U ` Authoflzed ABBnt TOTAL PAID E//�, T G L COSTA MESA BUILDING-SAFETY DEPARTMENT � P.O. BOX t200 COSTA MESA. CALIFORNIA 92626 p.fi76y �.6764 �. .-' J % 3L27/ 9 225.00 TU 3727[79__. �225.00CKTQ OOOtl467449 � i{f �� APPLICATION FOR STRUCTURAL PERMIT For Applicant to FID in Completely — Use Ink Only RECEIVEDBV DATEflEGEIVED OATEISSUED BUILDING ADORESS • PERMIT NO. OWNEF � A.P. NO. MAIL � BUIIDING ADDRESS AODRES TEL. TRAC (/ / LO BLOCK CITV NO. CANSTRUCTION W A A R P LENOER BRANCH OWNEfl � ADDRESS VALUE ARCHITECT TEL. SE S OF ENGINEER N . FIRE ADDFESS � ZONE TVPE GROUP APPROVED CONTRACTOfi Q BV 'DATE ADDRESS . TEL. ZONE NO.OF USE OF NEW CITV NO. PLAN$ BUILDING STATE CITV �'ARDSAPPROVED VARDSAPPROVED � LIC. NO. LIC. NO. MAIN BUIIDING ACCESSORV BUILDING j SIZE NO.OFBLDGS. (FROMC/LSTREET) oF �oT NOW ON LOT FRONT FT. FT. USE OF � EXISTING BLDG. F FT f Separate permits are required for L SIDE FT. FT. � electric, plumbing and heating work. REAR FT. FT. � USE OF BUILOING AND WORK TO BE PERFORMED DISTANCE BEf. BEf. MAIN & MAIN BLDGS. ACCESS BLDGS. f � . VAR. # DATE CC.U.P.ap+ APPROVED ' APPROVED 7 : 7 j I hereby acknowlatlge that I hava read ihis application enG stete � ; that ihe ebove informetion Is correct antl agree to comply with m all laws regulating build(n8 conrtruction, antl 1 shall not employ i any perwn in violeNon of Me workman's compensetion lewa of m 3 the State of Celifornie. � I he�eby certify thet I em properly Ileensetl as a conSrector untler SQ. FT. n me Siaie o1 Cali£ornia Business anC Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m CheptO! 9, Blld thet SYCh IIcBf15B5 BfB Ifl full farce and effect, or 1 THE PURPOSE OF ESTABl15HING N P£RM�T FEE ONLY: � am exempt from the provisions of ihe Staie ot Callfornie Businea VALUATION PERMIT FEE a end Profeszions Cotle, Division 3, Chapter 9 $ m PLAN CHECK $ '^ SiO�ature of � Permittee $ Tqx g LL � V AUNOIl2etl A nt TOTAL PAI D $ S�Q� � ' OWNER �. JOB ADDRESS GENERAL CON AP No. 418—I INSPECTIONS 501 L GRS W nTER ROUGN PWMBING ROUGH HEATING AND PIR CONOITIONING TEMPORARY SEAVICE OR POLE UNDERGROUND �I POWER � � ROUGH WIRING � TRENCHES � FORMS STEEL RE V FLOOR SYSTEM � BONO BEAM � STEEL REINFORCE [ SNEATHING � FRAME ANO FLA�SM1ING ^ N �ATMING — IN `' OUT L, � C PLASTER.BROWN COPT � STRUCTURAL, FINAL � HERTING, VENT., REFRIG. AN� A.C., FII PLUMBING. FINAL RNO WS TEST � ELECTRIC FINAL BUILOING, FINAL DATE SUBGONTRACTOR � r CO oTeoxEt2oo �co5�7�a M SAFCA I ORN�IA 9 626 T APPLIC T[ON F�j�T��l�'�1�, PERMI�T, I,B�:�O RECEI PERMIT N° � 5 1 0 3 8 For Applicant [o Fill in Completely — Use Ink Only ,BUILDING �, � C v A.P.NO. ��O ADDRESS J �j n TENANTOR r / � ADDRE55 �` 9 � X�. VNIT OR MAILING SPACE NO. ADDRE55 �Q� TR.NO ��c+-�/� LOT �ry BIK. TEL. (✓ •Z�� CITV �� NO. NEW ADD LTER REPAIR MOVING DEMOLISH CANSiRUCTION LENDER BRANCH OwNER ' ADORESS � VALUE$ / /�jD ARCHITECT TEL. USE / OR ENGINEER ^� /� ADDRE55 ZONE TVPE � GROUP � APPROVED CONTRACTOR O BY DATE �I ZO �' ADDRESS 1 � LVIU� (�(/�%� TEL. � � CITV ��j� NO. STATE / CITV APP0.0VEDSETBACKS LIC. NO. �(p �� Z IIC. NO. 9 SIZE NO.OF BLOGS. (FROM C/LSTFEET) OF LOT NOW ON LOT RONT USE OF � /� EXISTING BLDG. E T D Separate permits are required for �. SIDE //FT. �// electric, plumbing and heating work�. REAa 26 FT. �l% NIINU USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION � DATE APPROVED APPROVED � ,_�J/1� LC/ I hereby acknowledge that I have reatl this appliceiion and state °i n that the above information is corract antl egree to comply with all laws regulatin8 builtling construction, antl I shall not employ � any person in violation ot ihe workman's compensation laws of v the Stata of California. � ' SQ. FT. rv I hereby cartify thai I am prope�ly licensetl as a coniroctor untler _ the Siare ot California Business antl P�ofesslons Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro Chaptar 9, antl Shat such licenses are in full torce and effect, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV: � empt trom the provisions of the State ot California Business v antl Professions Cod Division 3, Cha ter 9. V A WATION Peaon�z' FEE S , Qp ,� Signeture of PLAN CHECK $ � O Q o Permittee ��V �� § O or `� � ll ? TAX $ Dr S� � Auihorized Aqent Date � �� ' U TOTALPAID 5 TL�