HomeMy WebLinkAbout1116 DENNIS DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address:
1116 DENNIS DR
Permit:
Status: ISSUED
Suite:
$0.89
SMIP Com:
Applied: 06/17/2003
Vicinity:
ROOF
$0.00
Issued: 06/17/2003
Parcel Number:
41207442
Zoning:
$168.14
Applicant:
SELL, RON
ISSUED BY:
Address:
18032 LEMON
Phone:
(714)528-1758
YORBA LINDA 1 CA
Zip:
92686
Owner:
VU; DAT K
Address
1116 DENNIS DR
'
Phone:
COSTA MESA, CA -
Zip:
92626
Contractor:
SELL ROOFING COMPANY
"Address:
18032 LEMON
-,
".
Phone:
(714) 528.1758
-
YORBA LINDA, CA
Zip:
92686
License:
323842
Arch
-
Eng:
Address:
Address:
- Phone:
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING. INSTALL 112 -OSB, 2 LAYERS OF 30# FELT, AND EAGLELITE. 5.7 LBS. ICBO 4660.27 SQUARES INCLUDES ATTACHED
GARAGE.
Plan Check:
$0.00
Permit:
1$167.25
SMIP Res:
$0.89
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$168.14
SETBACKS.
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
Rear 0-0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0-0
Left 0-0
Proposed: 0
Calc Valuation: $6,900.00
Claim Valuation: $8,900.00
Right 0-0
Right 0-0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
fw (a=)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensen Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit t Issued.
My work ers'�/J/ ,/p '!on 19.Uvance car r and policy number are;
%�
Cartier: t=_ Policy Number:
(This section need not be competed if the permit /s valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califomia, an a that if 1 s d Deco ubject to the workers' compensation provisions of Section 37pppppp'''of tryryryeee LaboVCCCotle, 1 shall forthwith
Complywiththese provisions. X1'4 / / / _ ! /
Applicant Signature: Date: L(-�///o c/.-/
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE N TIA 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, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed unde,L,pr vislo f,C6apter 9 (commencing with Section 7000) of Division 3 of the Business and Profes 'o Code, antl my license is in full
force and effect. Lic. # — G Class #
Contractors Signature: Date: /6
I
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. It, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet In depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some axes lions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................. ............... ......................................................................... .............................. -.........................................
0
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ N
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.............................................................................ed",.................................................................i*f"o'......................................f-e-t...............................................'p-li......,w-i.....................................................................................................................
4 If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Cade Deen fully complied with? ❑Ves ❑ No
5 Does or will the applicant orpresent or future building occupant require for the work which is the subject this a plication app�ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control tllsiriel or agency? UYes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
...
....................................................................................................................................................................................................................................................................................................................................................................................
8 Will any part of the facility to be constmcted under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
............................................................................................................................................................................................................................................................................................................................................................................................
7 If appermit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
appllcatlon, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No
8 '(If'yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comp) I state laws and city 9rdinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described prop for peclion p ose 11 rea not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ours fLe�Lnea. / Data 6.
s /
And/Or Authorized Applicant Date
CODE t, INSPECTION TYPE PAIS INTITALS CODEtt INSPECTIONTYPE 2ATE lKrMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root 210 Final Electdcal
201 Final Bbck/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
2G4 Final Demolition 250 Final Building/Occupancy
OdEC1'AODRESS: 1116 DENNIS DR UNIT:
OWNEK'S NAME: DAT K • VU
—auDRESS: 1116 DENNIS DR
COSTA MESA,CA 92626
ARCHIENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: DAT K. VU (714)443-1685
ADDRESS: 1116 DENNIS DR
COSTRA MESA CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Cotle, and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a candidate of Workers'
Compensation Insurance, or a certified copy thereof (Section 3800, Lab, Q.
POLICY NO.: EXP. DATE:
COMPANY:
❑ Certified copy is hereby burnished. ❑ Certified copy is filed with the city Building Division
Date: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (ThISSetionneed not be completed it the permit is for one hundred(S10D) or less).
I certify that in the performance of the work for which this permit is i sue I shall not ell ploy any person in man er so as to become
s
o�Ikmgpt*
on Laws of Callfornia.
Signature
eclaration, you should become subject to th Workers' Compensation provisions of the r
Cotle, you must forthwith comply with such provisions or this permit shall a deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civ. C),
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
1, as owner of the property or my eurloyees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale (�ection 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
Eland Professions Code : The Contractors' Stale License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law),I am aware
that proof of their Worker's Compensation insurance should be provided to me.
I am exempt under Section: B P 7 0 4 4 B S P C.
ror 'srea B OWNER 6 NON WAG LP
•Da Own'
do hereby certify that a n aware of and understand the requirements of California Health and afety Cotle Sections 25505, 25533, aqd
25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements to a
permit for construction or modifitahon from the Air Duality Management District. Residential construction applications are exempt fro
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the
ordinances and state laws relating to building construction and herel
or Social Security x:
motion is correct. I agree to comply with all city and county
representatives of this illy to ente"pon Vie above-mentioned
1641 46 While—Building: Green—Code Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 06689
PERMIT NO: E 066848 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION : ONE METER 6 SUB—PANEL UPGRADE SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
COMMENTS: INCLUDES REMOVING SOME HAZARDOUS WIRING FROM THE GARAGE
aF iE * * aE iF * 9E if * iE aE lE iE iF if iF iE iF Bf iE ifik BE iF it iE iE iE * iE * iE i6 if if aE 1E if iE iE if of iE if B(� Bk M 1E if iE iF iF if iE iF aE ae iE iF 9E ie 9F iE iE iE iF iF iF if iE if iF if a1' if iE if if
Z 0 N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN
BUILDING ----------
RECEPT/OUTLET
---------
ACCESSORY
BUILDING---------
FRNT: FT IN
REAR; FT
IN
FRNT:
FT IN
REAR: FT IN
LEFT; FT IN
RGHT; FT
IN
LEFT:
FT IN
RGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
41207442
ZNE:
REF NO:
PLANNING NOTES>
11,00
11,00
ELE
2
>
LISTED REQ
END OF FEES
PERMIT
111100
mowp 22.00
If'
iE #E iE iE fE iE BE 1E fE i41f iE 9E 1E 1E iE 1E if
iE iE iF lF iE if iE ie k 1E * ie et iE le 1E i!!f iE �e iE 1E iE !E fE fE'lE lE 1f * 1k
iE * BE iE iE * fE ie iE 1E if
iE iE * iE lE iE fH iF iE iE 1E M !P iE'k iF iE lE dk
D E V E L O
P M E N T S
E R V I
C E S
R E Q U I R
E M E N T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY: i�/Yb�— DATE:
1E iE OE iE aElE of iE lE iE lE iF iE if it iE if lE aE iE ♦f lF iE aE iF iE fE if lE iE iE iF if lE iE �bFFi�iF ie iF if aE iE if iE**iEj: iE iE if *iF iE of lE iE aE iE iE *1E fE iE iE 7E ff
iE 1E iE ic-iF BE ik BE iE iF iE iE if iE iF**1F iF 1F 1E 1E 1E iH if iE iP iE iE iE iF iE lE aE ie fE it lF lE iE lE iEfE*aE iE 1E'Ie♦E iE iE iE*iE if *aE 1E iE if jE dP iF aE fE 1E lE iE iE 1E if lE if 1E 1E le Bk
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 56.00
50% SMIP/NON—RES
PLAN
ISSUE FEE 15:00.
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 56.00 15.00 0,00 71.00 71,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED:71,00 VER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FI —SgIP/TOT GRADING PLAN—CHECK
71.00
if iE Bf 1E ie if Bf iE iE iE aE iE iE iE if BE ik iE iE iE iE iE iE aE 4E * * * * iE iE ih if if iE aE ie %Bf iE lF 1H iE iE if !E if if iE lE lE if iE BE iF iE iE iE iE iE iE aE iF iE iE iE iP of iE if iE ie iE iE 1E iF iE if- ie
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE
2
RECEPT/OUTLET
1 ST 20
EA,
,75
1,50
ELE
1
RES APPLIANCE NOT
OVER -
1,0 HP
3,00
3,00
ELE
1
SERVICES BELOW 600
V 6 BELOW
201 AMP
18,50
18.50
ELE
1
SUB -PANEL
11,00
11,00
ELE
2
MISC APPARATUS NOT
LISTED REQ
END OF FEES
PERMIT
111100
mowp 22.00
If'
N APR
CITY OF
A MESA
C04STRUCTION AND PLANNINGPOOL
` - APPROVALS Permit # Date
Inspector
.PA
APPROVALS Permit #
Date
Inspector
1 � Temporary Electrical Service or Pole
-
52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER.Grnd.
57. APPROVAL TO 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, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Prpperty Sewer Line &House Connection
!
62. Backwash & Receptor-Final
12, Sewer Cap
63. Heater & Vent-Final
'
13. Roof Drains
64. Plumbing System - Final
.'
14. Rough Plumbing
_
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16, Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
`
68. APPROVED FOR PLASTERING
r
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL`; _
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS -: Permit #;
20. Rough Factory Fireplace
-
21: Ducts, in Structure ..
70. Underground Hydro
22. Ducts, Ventilating
71. Product, Piping 0Gas Ooil
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73, Undergrnd.StorageTank OGas OOii
25. Roof Sheathing
74. Overhead Hydro'
26. T-Bar Ceiling (Structural} & Monocoat
-
75. Dry Chemical "
27. Frame and Flashing
76. Dry Standpipe ,
28. Lathing & Siding
77, FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL -
30. Drywall Nailing -
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION'
32. Electrical Power Meter-Final
33. Finai Electric
34. Fina! Heating &Air Conditioning.••
35. Final Gas Pipe-Test
� (�
80.. FOOD CE TIFICATE ISSUED
Notes: 9Y - �jn #W Cp K
eJ
: ��a,,,.[,07_-�-�
La e !-•=-1(-s��c
36. Hood or Canopy
, -
37. Final Factory Fireplace
38. Final Plumbing
39, Water Service-Final
-
40. Gas Service-Final
-
41. Solar Domestic-Final
,
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
-
47. FINAL STRUCTURE & BUILDING'
''--- -
48. FINAL PLANNING
49. Electric Release to Edison
L
50. Gas Release to Southern California Gas Cc
51. CERTIFICATE OF OCCUPANCY
No. Date
»-
DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
1116 DEA) vi S &ki V-C—
Street Address
Bldg. Permit #
This Permit # r
AP Number
1. I (we), r ` declare that I am the Owner of Title
of the above referenced real property, and that I (we) hereby authorize:
1-13
Name Telephone No.
,�i 13�2C�c.JcS'0� 011-1- ,
I
City
('2I -Lt
to obtain permits in my behalf, as owner/builder, for �1 VL CGT'��✓-
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we) shall im-
mediately provide Worker's Compensation Insurance coverage and cause a certificate of'that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
4. 1 agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties as a result of work authorized
by the permits from the City of Costa Mesa.
5. 1 declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of �'i 191—�-, ata N aztx alifornia.
PAT K
Printed Nan
J
Vugl� V
Date
NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides
for limited power of attorney to secure this permit in anyrbehalf.
NOTARIZATION REQUIRED -1.
0779-46 (Rev. 2/91)
00.TaICIAL sant.
K. Stagner
Zpa
NOTOYeIIC-CA�IFOFWIA
Or2ANOECWNfY Canm. EYPlm Oq.30, 1BG5
72 2
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
G— Use Ink Only
ADDRESS BUILDING SII DEMNI-)
OWNER Properties West Development Co
MAIL 508 29th Street
ADDRESS
L.
CITY NevrmTt Reach. CA NO. 675-4910
BRANCH
ADDRESS
ARCHITECT
OR ENGINEER Frank Spangler TEL.673_0952
ADDRESS 2240 Newport Blvd, Ne ort Beach
CONTRACTOR 0tvr1PT
ADDRESS
USE OF BUILDING AND WORK TO BE PERFORMED
Plan 3#
I hereby acknowledge that I have re this applicat fjn and state
that the above Information is correcYand agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.
1 hereby certify that 1 em properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
em exempt from the provisions of the State of California Business
end Professions Code, D Islon 3, Chapter 9.
Signature of
Permittee Lrt�+1/6!s
Authorized Agent,��C.(
* ***
NOV 10-77F4"'00CN5�ss6 109.78
APPLICATION FOR STRUCTURAL PERMIT
AP. ND. ¢I /_ -V I I -
BUILDING 1 I �' ^
ADDRESS lt/
TRACT QAA
NEW A
I---
OWNER PYl1TPY1"IPC
es. Atd.
TEL.
CITY
NO.
STATE
CITY
LIC. NO.
LIG. NO.
SIZE
I NO.OF BLDGS.
OF LOT
Approx. 60'x 80'
NOW ON LOT
USE OF
EXISTING BLDG.
PLAN CHECK $
Separate permits are required for
USE OF
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
Plan 3#
I hereby acknowledge that I have re this applicat fjn and state
that the above Information is correcYand agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.
1 hereby certify that 1 em properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
em exempt from the provisions of the State of California Business
end Professions Code, D Islon 3, Chapter 9.
Signature of
Permittee Lrt�+1/6!s
Authorized Agent,��C.(
* ***
NOV 10-77F4"'00CN5�ss6 109.78
APPLICATION FOR STRUCTURAL PERMIT
AP. ND. ¢I /_ -V I I -
BUILDING 1 I �' ^
ADDRESS lt/
TRACT QAA
NEW A
I---
OWNER PYl1TPY1"IPC
es. Atd.
Gar. vALu$ 61,100.
IE
NE TYPE GR UP
'ROVED
3
al
DATE
l JII�
PLAN CHECK $
NO. OF
USE OF
0
PLANS
BUILDIN
�
YARDS APPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDIN
MAIN &
VAR. 916
C.U.P.,
SO. FT. 2295
THE AMOUNT SHOWN UNDER VALUATION IS FOR
3
al
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
PERMIT FEE E
PLAN CHECK $
105.50
0
61,100.
TAX $
4.28
$
i
U
TOTAL PAID S
/ .9D