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Home My WebLink About1121 DENNIS DR - Building Permits(714) 754-5273 -i Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1121 DENNIS DR Suite: Vicinity: Parcel Number: 41207452 Zoning: R1 R1 Applicant: SELL ,RON Permit: $167.25 Address: 18032 LEMON SMIP Com: $0.00 Other: $0.00 Phone: (714)528-1758 YORBA LINDA, CA Zip: 92686 Owner: CHRISTOPHER, THOMAS E Address 1121 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 : Address, Phone: Eng: Address: ISSUED BY: Status: ISSUED Applied: 11/01/2001 Issued: 11/0112001 Phone: Zip: License: License: - SCOPE OF PERMIT TEAR OFF WOOD SHAKE INSTALL 1/2" OSB WITH EAGLE LITE TILE ICBO# 4660, 5.07PSF Plan Check: $0.00 Permit: $167.25 SMTP 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 NOTES: FEE SUMMARY Calc Valuation: 58,900.00 Claim Valuation: $8,900.00 PLANNING & ZONING Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 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 !m6 -4e lamol DECLARATIONS WORKERS' COMPENSATION DECLARATION: • +r 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. I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensatio In @ carrier and policy num r are: Carrier: O 4' Policy Number: l O 6 �,�� (This section need not ba completed if t e armit fS valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issuetl, I shall not employ any person in any manner so as to become subject to the workers' corn IDI n laws'W Calitomia, an roe that if hou�become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forthwith coo ply.wNhMese/p[dvisions. t`�! (ApD I"I cant Signat�ur/e✓ l�iC Data: ! Wi9NiNG:-FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT ANE OYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FORIN SECTIO 660E THE LABOR LODE,IMEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm IcenT dander provisions o1 Cha ter 9 (cq¢ynencing with Section 7000) of Division 3 of the Business and Protes ions C e, nd my license is in full force a . Llc, a y L ass a— C ractor' Signature: [)at. 171 CON9Tl LENDING AGENCY: ❑ I 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). Lender's 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 perm+' 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. 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.). ❑ 1, 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 contractor(s) 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 driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I 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). n r future building occupant need to file a registration form for acute) hazardous materials? Yes No ................................................................................ ....... ..... 2 Does or will the applicant or present o g p g y ❑ ❑ (Section 25533 of the California Health and Safety Code, with some exceptions, 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). ............................................................................................................................................................................................................................................................................................................................................................................................ 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 ❑ No (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. ....................................................................................................................................................................................................................................................................................... ............................................................................................. 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 the applicant or present or future building occupant require for the work which is the subject of thisa plication a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? M Yes jJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..... ............................ ......................................................................................................................................................................................................................................................................................................................... 6 Will any part of the facility to be constructed 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 a permit 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 application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? Cl 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 comply with all state laws and city or relating t building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection- urposeI agre of occupy or low c pancy of any building authorized by this permit untilel Tispe ion. O Si natu e4X Legal Owners)O ` ate (l�J l And/Or uprFW-Aplplicant > Date CODE Jr. INSPECTION TYPE DATE INrmALS CODES INSPECTION TYPE DATE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final y/ — ,� 208 Final Plumbing 200 Final Re-Roof z--t. r Y` 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION PE MIT NUMBER DEVELOPMENT SERVICES DEPARTMENT ° PERMIT B00-00408 (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1121 DENNIS DR Status: ISSUED Suite: Applied: 03/30/2000 Vicinity: RIGHT SIDE OF PROPERTY Issued: 03/30/2000 Parcel Number: 412,07452 Zoning: R1 R1 4 ISSUED BY: Applicant: DAVID VENTURA Address: Phone: Zip: Owner: CHRISTOPHER, THOMAS E Address 1121 DENNIS DR Phone: COSTA MESA, CA Zip: 92626 Contractor: DAVID VENTURA CONCRETE & MASONRY Address: 740 MAIN ST Arch : Address: Phone: (714)969-6492 HUNINGTON BEACH, CA Zip: 92648 . License: 747448 '. Phone: Eng: Address: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 15 LF, 6 HIGH BLOCK WALL ON THE EASEMENT EDGE (5' IN FROM THE PROPERTY LINE) FILLS IN AREA BETWEEN BACK OF THE HOUSE AND THE REAR PROPERTY LINE. EXPI.H M DATE 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 FEE SUMMARY Plan Check: $15.28 Calc Valuation: $300.00 Permit: $23.50 Claim Valuation: $0.00 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $38.78 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 EXPI.H M DATE 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 WORKERS' COMPENSATION DECLARATION: d hereby affirm under penalty of perjury one of the following declarations: ❑ I 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. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the pedormance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need no a completed i1 the permit is valued atone hundred dollars ($100) or less.) ❑ 1 certify that i theL.f..fi,. ce 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 wte, and agree that if I shoultl become subject to the workers' compensation provisions of Section 3700 of the labor Code, shall forthwith comply with the Applicant Signature: Date: Ze V U WARNING FAILURE TO SECUR WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($104000), 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 under provisionChapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. N `I q-1 N'1Ci 8 Class a e- z5- c- Contractors Signature: f, Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction (ending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's 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 00 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. 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 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I 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 (hat 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 certity 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). -----..-_-- ............... .-----..-------------- .. -..- --------' ------- I—- .....-.........--......... .._.......--._.._._..,_.........-------------------------------------------------- a - .--.......-----...-.--. 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 exceptions, 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). 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 ❑ No (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. 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 the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed 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 a permit 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 application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (It "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: 11� Date: CERFICATE 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 come . agreAVo comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above- a ibe�rTT rope y for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of Legal Owners) Date -Pemoi• Z�l- OD r Authorized AppliantAn Date CODE 1. INSPECTION TYPE DATE INImALS CODE INSPECTIONTYPE 2AjE INTITIAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244646 THIS SKETCH IS FOR INFORMATIONAL PURPOSES ONLY. APPLICANT IS RESPON5IBLE FOR PROVIDING AN ACCURATE REPRESENTATION OF THEIR PROPERTY IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND WITH THE INFORMATION PROVIDED ON THIS SHEET. APPROVED- CI`C1 OF COSTA MESA PLANNING DIV. BJECZ 10. BLDG. DEET. REG. ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIVISION BE SETBACK AT BAST IB' FROM FRONT PROPERTY LINE. • SOLD WAILS/FENCES SHALL NOT EXCEED Y 6' IN FIDGET WITHIN 17 OF THE FRONT PROPERTY LINE (NOT CURB UNE). • VERIFY DISTANCE FROM CURB TO PROPERTY LINE AND SHOW ON PLAN. VERIFICATION FROM THE CTIYS ENGINEERING DIMON S REQUIRED. CALL (714) 754SW This set Of Am aid s 2. pny lesaraa rd aafsty, C 1 Of Casl REaDENCE=-•�:^,,:ngE fh:spa ;nti'x1 nl arY ON OF BUILDII`'G SAFETY CITY OF COSTA MESA APPROVED -{ bw I to ' RESIDENCE I IMME.?l RESMNCE I 11124, 112S+ JSTREET BLOCK WALL LAYOUT FOR BUILDING PERMIT PLANNING DIVISION unlawful TYPICAL Cement Coping Optional Channel Block With -1-3/8,6 Horizontal Top of all' Fences For Fences 5' or Leif I - Ven. Bars 3/8-95 at 4', :0" O.C. For Fences Higher Than 5' - Ven. Ban 3/8-0 it 32'' O:C. Fill Cells Solid With Grout Where Steel Occurs " Reinforcing Steel Shall Conform to Sec.A 15,99 A.S.T.M. All Steel to be Laptfed. 24" or to Code NATURALGRADE TWO 3/8"Q BARS L' CONTINUOUS TOP 8 BOTTOM HCMG STEEL MUST BE TIED IN PLACE AT TIME OF TRENCH INSPECTION. 611 CONCRETE BLOCK FENCE !- —WIDTH c SEE CHa BELOW ole FOOTING REQUIREMENTS CHART GENERAL- NOTES MORTAR: One Part Plastic Cement, and Three Parts Sand GROUT: One Part Cement Three and One Half Ports Sand COPING: One Part Cement, Three Parts Sand CONCRETE: Well Mixed 1:2-1/2:3-1/2 Mat of 7-1/2 Gallons of Water Per Sack of Cement GROUT MAY BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCURS. CELLS AND AREAS OF HORIZONTAL REIN FORCEMENT SHALL BE CLEAR. CLEAN 6 FREE OF ALL MORTAR DEBRIS, ETC. H LF EARTHTCOTH V! THE HEIGTH OF FENCE IrLOW BOTTOM OF FOOT -NG SCALE: 1/2e = I' WIDTH . . . 14" .14" 12". 12" THICKNESS .10" . .10" g" 8" - ' DEPTH OF EARTHTOOTH 24" 20" - 16 12" SPACING OF EARTHTOOTH. 12' 14' 16' 16' BUILDING DIVISION yGOSTP.O.A MESA BUILDING -SAFETY DEPARTMENT BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only 10V 10-77CNPRSf ' I000 577 ***122.64 APPLICATION FOR STRUCTURAL PERMIT RECEIVED By DATE RECEIVED n Tc �ccucr OWNER pm MAIL 508 Street BUILDING ABU DDING RESS ADDRESS c1Tv Ne ort Beach, CA TEL 675-4 CONSTRUCTION I hereby acknowledge, that I have tl this eppli tion te �n LENDER {'—I AO AL F? E =�1-"� that the above Information Is correct end agree to comth m BRANCH t52 ADDRESS Frank Spangler NoL 673-0ADDRESS OR ENGINEERARCHITECT - 2240 Newport BLvd. Newport BchFIRE SO. FT. 2790the State of California Business and Professions Code, D3, CONTRACTOR Own& ADDRESS am exempt from Me provisions of the State of Californiass TEL. CITY NO. —1 L. STATE CITY YARDS LIC. NO. LIC. NO. MAIN SIZE OF LOT Approx. 60'x HOS NO. OF SLOGS. NOW ON 0 (FROM C/I ONT L USE OF Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORa VALUE NO. OF USE OF NEW PLANS BUILDING APPROVED I YARDS APPROVED BUILDING I ACCESSORY BUILDING Construct le family 4 bedroIt VA C URP.� gJ _ — APPROVED house Plan # 4APPROVED I hereby acknowledge, that I have tl this eppli tion te �n EC {'—I AO AL F? E =�1-"� that the above Information Is correct end agree to comth m all laws regulating building construction, and 1 shall noy any parson In violation of Me workman's compensatioof e Me State of California. - 1 hereby certify that I am properly licensed as a contracer SO. FT. 2790the State of California Business and Professions Code, D3, THE AMOUNT SHOWN UNDER VALUATION IS FORChapter 9, and that such licenses are In full force antl aI THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from Me provisions of the State of Californiass antl Professions Cotle, ivislon 3, Chapter 9. VALUATION PERMIT FEE 3 q of PLAN CHECKPerm(Signatura 117 50Permittee _73, 3 400. TAX3 AuthorizedApent r1 sl.+-..'dTOTAL PAID 3 d 40