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Home My WebLink About1101 DEBRA DR - Building PermitsPROJECT ADDRESS: UNIT: OWNER'S NAME: 1101 DEBRA DR ADDREss:WECKWERTH, VIVIAN PANICH 1101 DEBRA DR COSTA MESA,CA 92626 ARCHIENGINEER: 641-3823 REG.NO.: ADDRESS: UNIT: PERMITTEE: A—AMES PLUMBING & HEATING (714)530-2440 ADDRESS: 10422 TRASK AVENUE GARDEN GROVE CA 92642 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section —7000) of Division 3 at the Business and Professions Code, and my license is in full force and effect CRY 1:006664 STATE 150 307 �CLASs.t'- Date: � Signature: q��MM��/`'�/�/ WORKERS' C0 PENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a cerlilicate of Workers' Compensation Insurance, or a certified copy thereat (Section 31 Lab. C). POLICY NO.:pC941094 EXP. DATE: 03/01/93 COMPANY:R EP UB L I C Certified copyis hereby furnished. %]Candied copy is filed with the city Building Division. �% Date: / q3 Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is far one hundred ($100) or less). I ceraty 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 WorkersCompensation Laws of California. Date: Signature: NOTICE: If, after making this declaration, you should became subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency tar 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 Contractors' State 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 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 (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a properly 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 friars did not build or improve for the purpose of sale). I, as owner of the properly, am exclusive)y contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code: The Contractors' State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Slate 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. C. lot this reason: Date: Owner'. I do hereby cemfy that I am aware of and understand the requirements of California Health and Safety 25534 and that I or any future building occupant will/will not (circle one) need to comply with said stat permit for construction or modification from the Air Duality Management District. Residential construe these provisions. Code Sections 25505. 25533, and e codes and the requirements for a lion applications are exempt from Date: Applicant I hereby certify mat I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for Inspection purposes. IDale: `' Signature: Driver's License or Social Security 1641.46 White—Building, Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P �060869 PERMIT NO: P 060869 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION ; REPLACE WATER HEATER SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS; NO OTHER WORK AUTHORIZED BY THIS PERMIT � * DE * 9E i! RE if iE 1F 1F 9E ik if 1E RE 9E if 1E 1E 3E 9F iE iE iE BE N- iE iF 1E ik UE Rt Bf jE iE if 9f 9f i! 3r RE iE 96 �t * RE * r * � * * 1ERE B6 * 4F RE 1e 9E 9r IF k 1E iE RE iF iF RE i6 R� � 1E * * � � Z O N I N GS ERTEBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ- PROV: PARCEL: 41207105 ZNE: REF NO: PLANNING N TES> > iE if iE iE Rf iE it iF 9t * IE * iE iE 1E iE N-* iF iE 9P iP iF iE iF iE RE it 3E Rf iE iE * 3E iE * iE * 9E iE iE iE iE * 9F iF iF,itiF 1E iE 9E BF IE 3f --IE 9E iE 9l -1E iF iP iE iE iE 9E iE 1(• RE iE aF iE 9E 9E 9f ie 9E iE iF D E V E L O P M E N T S E R V I C E S 0_1^R E Q U I R E M E N T S ZONING APPROVED BY DATE: 4 BUILDING APPROVED BY APPLICATION ISSUED BY: iF 9f iE 9P BE ik * iE 9E 9E ie iP 1E * iE iE 1f iE iE *!e iE iE 9f• iE R! i! 1F 1E 9t Rf 9E iE iL-Rt 9E RF iE * * iE 9ERF 9E k iE iE 9E 9E iE RE RE 1E i! * iE 3E 1E Rk iF iE 1E RF iF DI LEGALIZATION:N F E E S UM, BLDG PMT PLUMBING ELECTRIC,' ME PERMIT 7,00 _.—.-. 2 5 PLAN ISSUE FEE BUILDING—DIV—> TOTALS ---- > 2 PERMIT TISSUE 7.00 20.00 REVENUE DIVISION TOTALS--> COL-L—ECTED.:,, 27,00 OVER/SHORT-0W BLDG PMT PLUMBING ELECTRIC MECHANIC 1 FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 i iE iE 1E 1f iE 9P if RE rE 1E 1r+E * 1r * * * 4r * * * it iE it * �E xiE iL• iE XE iE 9F iE if 9f k iF 9E -lf iE RE iE if iE RE RE it iE * * 1r iE 1r it * x BE 4� 1P iE iE iF DE 3F iE 3f 1E iF iF 9E iF RE 3f9e RE rE aE �E IND I V I D U A L'• ,F"—EE B R E A K D O W N h � TYPE QTY D E S C R I P T I Or N.' t UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR,VENT 7.00 7.00 END: OF• FEES oI !,, r l FES O 2 A r j CITY OF COSiA MESA ') r r � v DATE: - DATE: 2� 1E 3C 1E 9E iE if BE BE iE )FRF 9E iE * RE RFiE iF DE RE 9t 1k it ik DE i6 iE iE RF 9F iF 9E XE iE A R Y STRUCTURAL�SEGMENT:N _1*a Atj,�,C FIRE SMIP/RES GRADING SMIP/NON—RES TOTAL PAID DUE 27 00 27 00 00 1 - � CONSTRUCTION AND PLANNING - APPROVALS Permit # Date Inspector POG SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE .7. Footings 58. Electrical Conduit-Undrgrnd. .. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9-. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 16. Structural Floor System i 61. APPROVAL TO DECK 11. Property Sewei Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap • r 63. Heater & Vent -Final 73. 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 1 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning __Fl�q€ D.FPT. REQUIREMENT -APPROVALS -.Peripit# - 20. Tough Factory Fireplace 21. Dulls, ih Structure 70. Underground Hydro 22..Ducts, Ventilating ;71. Product:Riping ❑Gas 41011 23. Gas Pipe -Rough &Test - 72. Underground Flmh 24. Roof Framing - . .' .'.73. _Undergrn6.Stora geTank OGas ❑Oil 25. Roof Sheathing - 74. Overhead Hydro- _ 26. T -Bar Ceiling (Structural) &Nlonocoat 75: Dry Chemical 27. -Frame and Flashing 1 76. Dry Standpipe 28. Lathing & Siding_' - 77. FIXED SY .'EM.FINAL; . 29. Insulation 78. FIRE P$EV. FINALS ` 30. Drywall Nailing : , - I ,' HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat i 1 r -79. FINAL INSeECTION - 32. Electri6l,Power Meter -Final- i I 80. FOOD CERTIFICATE ISSUED 33. Final Efeciric - - I Notes; Z -•/f -Y.3 "oORCK vfa M1j;� ^(... _, COuw (.11el 34. 'Final Heating ,& Air Conditioning •I - h(o o ME upcn r2'- (,lr4o G6r 35: Final Gas Pipe -Test. - - 'j,�gk3 �� ON,�GI,�pyy�Fip�-Gp�p•�,� •36. Hood or Canopy:-. 37. Final Factory Fireplace - Fih2halc•Finalenter- ESere E I i 43. Backflow Irrigation 44. Landscape Irriqation System "' - - - - - 45. Sound Attenuation -46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING �_� •' - ' 48. FINAL PLANNING ,- - 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' ' Applicant to fill in all spaces except CITY OF COSTA MESA . CONSTRUCTION PtRMI I Project Address 1101 Debra Dr. .'Applicant's Mai ling Address 10422 Trask "e.G.G. 92642 Owners'Name Howard Weckwerth Phone 540-9644 Address 1101 Debra Dr. CM Arch/Eng. License No. Address Contractor's Name A-ames Plumbing=HeatinR+hone 530-2440 Addres's (mailing) 10422 Trask Ave. G.G. 92642 City License No. 6664 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed unde r�pr�.. n f Charter 9 (commencing with section 7000) of Division 3}t�flte Business a tl Profess! rm E nd, '` %,, my license is in full force and aff (,t. V-Licensq CJ�-S I"Date L Signa' r WORKERS' COMPENSATIOPPECLAR I hereby affirm that I have a certificate of nsent to self -insure or a certificate' r of Workers' Compensation .Insurance, or a certified, copy thereof (Section 3800, Lab. .C.) Policy Np. 9788321 COmpanyRepublic Indemity Certified copy is heretiylf u rn!shed. ' CeV d ny is filed With the cit Building Islo Date �•-�-c+o AOplic-..-X mes�,�Yumrbing-Heating EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). 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 California. Date Signature 'NOTICE: If, after making this declaration, you should become subject t0 the Workers' Compensation provisions of.Ahe Labor -Code, you . must. forthwith comply with such provisions .or this permit shall_ be 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 30971 Clv. C.) Lender's Name Lender's Address' OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the,Contractor's License Law for the following reason;(Section 7031.5 Business and Professional Code: Anycity=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/she is licensed pursuant to the provisions of the Contractor's License ,Law (Chapter 9(commencing with Section 7000) of Division -3 of the Business and Professions Code) or that he/she is exempt 4<`St herefrom 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 e n_alty of not more than five hundred dollars ($500). ' I, as,owner of the property or my employees with wages asitheir Sole compensation, will do the work, and the structure is not intended or offered I for sa le (Section 7044, Business and Professional- Code; The Contractor's License law does not apply t0 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. It, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). • ❑ I, as owner of the property, am exclusively, contracting with licensed con- tractorsto construct the project (Section 7044,•Business and Professions Code: The Contractor's License Law does not apply to an owner of property who 'builds or improves thereon, and who contracts for such projects -with a con- tractor(s) license pursuant oto"the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. B. P. C. for this reason Date Owner he above ordinances state W'v hive of within border lines and sign all riate declarations. NO. TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION ❑ REPAIR' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT El GRADING ❑ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL'® PLUMBING ❑ MECHANICAL ❑OTHER - PROJECT DESCRIPTION SQ. FT. - OCCUPANCY— CONSTRUCTION CCUPANCvCONSTRUCTION TYPE VALUATION $ ' ZONE GRADING CU.YDS: ACRES Remarks: Replace Water Heater , YLUMBING 1 FEE Bar Sink Showers ' Automatic Washer Construction Pole Sub. Backflow Preventer I- Service Sink - - - - Backflow Irrigation Sewer Cap MECHANICAL" Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Clarifiers Solar Collectors Fan Dishwasher I Solar Piping F.A.U. Drinking Fountains Solar Tank Duct - Under Ground Floor Drains Swimming Pool w/Spa Duct - Structural Floor Sinks - Urinal - - Refrigeration System ❑0-100,000 BTU ❑100,000 BTU Gas Service Outlets Water Closet Switches Interceptors 1 Water Heater3 Garbage Disposal Kitchen Sink. Water Service Exhaust System ❑ Multiple ❑ Lavatories - '" Auto -Wash - System Repair/Alteration ' P -Trap Laundry Trays $ Roof Drains - ELECTRICAL Automatic Washer Construction Pole Sub. Reinspection Fee $15 - Issue Fee $ 3 MECHANICAL" FEE Dryers ❑Gas ❑Electric Boiler Fan Hood or Type 1 ❑ Canopy Type I I ❑ F.A.U. Inc. Solar ❑9-15 HP LJ 16-15+ Duct - Under Ground -- Microwave - -- - Duct - Structural Pole Light Refrigeration System ❑0-100,000 BTU ❑100,000 BTU Range ' Switches Duct - Ventilating . Garbage Disposal Standing Sections ' Exhaust System ❑ Multiple ❑ Trash Compactor 1 System Repair/Alteration ' I $ Firepl/Fact. Bit. ICBG # 50% Fire Dampers MICROFILM 1 Heating System & Ducting ❑0-100,000 BTU 1:1100,000 BTI Registers �— $, 5.00 / I-- - - Ni.,v rs' License or S < I Reinspection Fee CMF 865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 1 1 - Issue Fee 1 $ 3 A.P. # S Main Building: E T Front .A Rear„ C Right K Left Ping. Ref. # Planning Notes: 9298 2/13/86 ` Zone Accessory Building: f I Parking Req./Provided Reinspection Fee $15 ' '1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By n Application Issued By' E,;00 JL FEES $ 3 Z O N I, N G R E Q M T S ELECTRICAL Automatic Washer Construction Pole Sub. Transformer,❑ 15-50:KW- ❑ 50 + KW Cooking Unit V Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps " Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑ 0-1 HP 1:11% - 8 F.A.U. Inc. Solar ❑9-15 HP LJ 16-15+ Fixtures - - " -- Microwave - -- - Device Boxes Pole Light Outlets Range ' Switches Sign Garbage Disposal Standing Sections ' Generator 00-5 KW 05-15 KW Trash Compactor 1 , I Reinspection Fee $15 ' '1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By n Application Issued By' E,;00 JL FEES $ 3 Z O N I, N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ ' SMIP $ PLAN CHECK $PERMIT. X5.00 PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ i ENERGY P.C. $• ELECTRICAL' $ I GRADING $ PLAN CHECK 50% $ MICROFILM $, MECHANICAL $ TOTAL FEE $, 5.00 / PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector -POO SPA APPROVALS Permit# Date. Inspector 1. Temporary Electrical Service or Pole ' - 52. Pool & Equipment Location 2. Soil Pipe=Undrgrnd., 53. Steel Reinforcement - 3. ElectricalConduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. 'Electrical Bonding 5. Steel Reinforcement- '56. Rough Plumbing & Pressure Test 6.';_ElecfricalLIFER Gr'nd. •, - 57. APPROVAL TO COVER-GUNITE 7. Footings v 58. Electrical Conduit-Undrgrnd. 8. Foundation :,; 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd'. .60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System _ 61. APPROVAL TO DECK 11. Property 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 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 ❑Gas ❑Oil 23. Gas Pipe -Rough & Test - 72. Underground Flush -- 24. Roof Framing 73: Undergrnd. Storage Tank D Gas F Oil 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 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:. ' 34. Final Heating & Air Conditioning 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 Domestic -Final 42. Backflow Preventer s 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - �• _ 47. FINALSTRUCTURE & BUILDI NG , 48. Special Requirements Completed - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co i 51. CERTI F ICATE OF OCCUPANCY No. Date _ i , 44995 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely - Use Ink Only BUILDING ///1/ 1'�/�fV r�QI1tF ADDRESS (� i �I�rJIC fi 1 1 V OWNER MAIL CITY Nei CONSTRUCTION rties West 29th Street ort Beach, i PAIR .CV io 77cfis.+00 527 ****95.37 APPLICATION FOR STRUCTURAL PERMIT EGEIWD By I DATE RECIVED nnTE IMIPI COrn' A P NO.L n4 BUILDING ADDRESS BRANCH ADDRESS ARCHITECT —. - — _ TEL.. CONTRACTOR Owner ADDRESS SPI CIAL RE0U1??`-,4,"1F TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF SLOGS. OF LOT NOW ON LOT USE OF Separate permits are required for electric, plumbing and heating work. OWNER E West. Develo VALUE FIRE ZONE T APPROVED By NO.OF i PLANS e YARDS APPROVED DISTANCE BET YARDS APPROVED BET. MAIN & Construct single family -3 bed- 1 t.-6:f-4,ft' - I APPROVED I /GU 7 roam House._ Plan #1 1 4?PRovyDI,/jD 10))J211 I hereby acknowledge that I hevdy4ad this aptnication and state that the above Information Is cor act and agree to comply with all laws regulating building construction, and I shell not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as 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 am exempt from th9 provisions of the State of California Business and Professions CVO, Division 3, Chapter 9. Slgnatu [� Par ' AuthorizeC 6 Agent lac/. e (11 fl -!,D SPI CIAL RE0U1??`-,4,"1F T m i m 1, SO. FT. 1,784 m ry THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE E N 48,200 200 0 PLAN CHECK S 92.00 $ U. TAX S 7 ,�3v �s TOTAL PAID E Ol. Al �I COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS // D / OWNER MAIL ADDRESS p CITY, .�rLLub_J A.P. N1.412 CONSTRUCTION LENDER If// i BRANCH TRACT ADDRESS W ARCHITECT OR ENGINEER �Z �J ADDRESS i CONTRACTOR . TEL. NO., TEL. NO. 661,9 7/07/76 AP41YA'(ON FOR STRUCTURAL PERMIT RE DDATE R,EtCEIVED�J DATE ISSUED A.P. N1.412 --O 79 !/? D3 P RMI O. BUILDING ADDRESS Q TRACT LOT BLOCK W AD A R PMW NO.OFBLDGS OWNER . E VALUE $ FIRE ZONE APPROVE DATE ./' , -/ NO. OF USE OF NEW A%o r01 TEL.(/� CITY NO. I� PLANS t: BUILDING F STATE CITY { �(J%J LIC. NO. LIC. NO .'� J // YARDS APPROVED YARDS APPROVED MAIN BUILDING. ACCESSORY BUILDING W SIZE NO.OFBLDGS (FROMC/LSTREET) O. OF LOT NOW ON -LOT FRONT FT. Q USE OF .y. EXISTING BLDG. FT y FSeparate permits are required for L SID FT. electric, plumbing and heating work. C REA FT. FT. Fw. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & Q 'MAIN BLDGS. ACCESS BLDGS. La VAR. # DATE aC.U.P.# A APPROVED QQ APPROVE a i7 •: ��j DATE — a w I hereby acknowledge that I have read this application and state � m p(, that the above Information is correct and agree to comply with Ad All law$ regulating building construction, and 1 shall not employ Z any person in violation of the workman's compensation laws of ° ' the State of California. 3 I hereby certify that I am properly licensed as a contractor under SO. � FT. m the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business $ e And Professions Cod Ivislon 3, Chapter 9. VALUATION PERMIT FEE •', Oiv " PLAN CHECK $ o Signature o TAX E Permute L�✓�/ .CLQ BYE $ T, TOTAL PAID $ 3� Authorized Agent