HomeMy WebLinkAbout947 DENVER DR - Building Permits(714) 754-5273 • Faz (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 947 DENVER DR
Suite:
Vicinity:
Parce� Number. 41808135
Applicant: SELL, RON
Address:
Owner: HUYNH, FRANK DE HONG
Address 947 DENVER DR �
COSTA MESA, CA
Contractor: SELL ROOFING COMPANY
Address: 18032 LEMON
YORBA LINDA , CA
Zip: 92686
Arch :
Address:
Zoning:
Phone: 714-528-1758
Zip:
Phone:
Zip: 92626
Phone: (774)528-1758
License: 323842
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 09/26/2001
Issued: 09126l2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE SHAKE ROOF. INSTALL NEW SHEATHING AND COVER WITH 30 YEAR COMP ROOFING.
Plan Check: $0.00
Permit: $9725
SMIP Res: $0.00
SMIP Com: $0.82
Other: $0.00
Inspection: $0.00
Total: $98.07
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Righl 0- 0
$3,900.00
$3,900.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1247-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all
requlred inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CAIL: (714) 754-5626
2406i8 (N00)
WORKERS'COMPENSAnONDECLAAAnON:
I �eraDy ettirm unde� penalry ot perjury one oi Ihe following tleclaretions:
❑ I have and wlll maintain a certiticate of consent to selbinsure tor workers' compensation, es provideA tor by section 3700 ot Ihe Lebar Code, lor the peAortnance of Ihe
work tor which Ihis permit is issued.
❑ 1 have antl wlll meintain workers' cOmpensatlon Insurence, as requirea by section 3700 of t�a LflDor Code, lor the pedortnance ot the woB for w�ich this pertnit is issued.
My workers' compensptlon Insurance certler end policy number are: ,, �,
Cerrier. �� Policy Number.
(This section neetl not Oa comple(ed il the perml( Is velued et one hundred tlollers ($f 00) or less.)
❑ I certity that in tha partortnance of the work lor which ihis pertnit is issued, I shell not employ any pareon in any manner so es to become subject to the workers'
compensation laws of Celifomia egree thet II I oultl be me sub�ect to the workers' campensation provisions o1 Section 37 0 of the Lebor Coae, I shall torthwith
comply with Ihese provisions. /�j ��� E/ Q'
v
Applicant Signeture: � ✓LL Date: �
WARNINO: FAI�URE TO SECURE WORKERS' �aPENSATION COVERApE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA�TIES ANO GVIL FlNE$ UP TOONE HUNDRED
LFqUSPNO OOIiPAE (SI00,00�),IN ADOI�ION T� THE OOST �F CaMPENSATIpN, ppNAGES l5 PFiOYlOE� FOR lN SECTION 3JO60F THE IAWR GUDE, INTEREST, AND ATTORNE`f5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm Ihei I am licensed under provisions of
force end eNect Lic. N
Cantractofs Signeture: � e
9(commencing with Section 7000) of DiWsion 3 0l the Business and Professlo s Cotle, and my Iicense Is in full
Class # /'i1
� Date: _ _ _ ,. � �
CONSTRUCTION LENDING AGENCV:
❑ I �ereDy eflirm thet there is a cons�Nction lentling egency for ihe DeAormance ol the work for which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lenders Atldress:
Signature: Date:
OWNER•BUILDER DECLARATONS:
I hereby eMirtn that unCer Denalry ot perjury Ihel I am EXEMP7 FqOM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business entl Professions
Coda: Any ciry or wunry which requires e permit to construct, alter, impmve, demolish, or repair any structure, prior to its issuance, elso requires the applicant for such pertnit
lo Hle e signe0 statemenl ihel he or sha is Ilcensetl pursuant to iha provisions of Ihe Coniractors License Lew (Chapier 9{commendng wlih SecOon 7000) ot DlNslon 3 of the
BuSines9 entl Prolession5 Code) or lhal he or she Is ezempt t�eretrom and Ihe basls lor Ihe ellegetl exemption. Any violation Of Section 7031.5 by eny epplicant for e perrt+i
subjects the applicant to e civil panelry o� �ot more then tive huntlretl dollers ($500).):
❑ I, as owner ot the pmperry, or my employees with weges es Neir sole compansation, WILL DO THE WORK, antl ihe sWCWre Is not ImentleG or ofleretl for sale (Sec.
7044, Business entl Protessions Code: The Contractors License Lew does not apply lo en owner of property who builds or improves therean, entl who does such work
himsell or hereelt or thwugh his or her own employees, providetl ihat such impmvements ere not Intended or aHeretl tor sele. If, however, the building or improvemem is
sold within ona year ot completion, iha owner-buildar will have the burtlen ol proving Ihat �e or she did not builtl or improve Por puryose ol sele.).
❑ I, es owner ol the property, am E7(CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the prolec� (Sec. 7044, Business end Professions
Code: The conirectors License LeW does not epply to an owner ol property who bullas or Improves thareon, and who conlrects lor such p�o�act with e contractor(s)
Iic8n5B pur5uant to lhe Contraclor4 UcenSe Lews.).
❑ I em e:empt under sec.
SignaWre:
Owner ID veAfied by drivers litense. ❑ Ves ❑ No
Business and Prolessions Code fOr �hi5 reeson:
Vedtication of Ownership by (type oi tlocumen6 i.e. - property tae 6111 or deed):
DIVISION OF INDUSTRIAL SAFE7V PEAMI7 CER7IFICATION:
OrivefS License No.
Date:
Expires:
❑ I �ereby certify Ihe� no axcavetion five (5) or more feet in depth into which a person Is required to descentl, will be mede in connectlon with work authorized by Ihis
partnit, and thet no boilding siructU�a, scafloldinq, talsev+ork, or demolition or dismarnling thareoY, wllf be mora than ihirry-slx (38) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title B, Celifomia AtlminlstreU�a Code).
❑ As owner-builder, I will not employ anyone to do work which would require e permit irom the Division ot Intlustnel Setety, es noted abova, unless such person hes e
permit to do such wark trom the di�ision.
Signature: Data:
Division ol lndustnel Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND P�MORIZA710N OF ENTTiV: I cenity under penelty ol perjury thal I have reatl this applicatlon and stale Ihat the intortnation given is
wrrecf. I agree to comply with all state laws entl ciry ortlinances relating to bulldinq constructlon, entl euthorize representatives of t�e Ciry of Costa Mese to enter upon the
above-described property for inspection purposes. I eqrea not to occupy or allow acupency ot eny building euthonzed by this permil until final inspection.
ignature 0� egel r(s)
And/Or Authorized Appllcent
CODE�. INSPECTONTYPE PdIE INTRIALS
i616 Fixed System Final Fire Prevention
126fi
zoo
201
202
203
Pool Spa Finel
Final Re-Roof
Final Block/Retaining Wall
Final Feciory Fire Place
Flnel Sign
204 Final Demalition
� � (� /�� )
Date
CO�EI RISPECTIONTYPE
206 Final Mechanical
208 Finel Plumbing
210 Final Electrical
212 Final Fire Preveniion
220 Final Planning Approval
222 Finel Site
250 Finel Buiiding/Occupancy
� �
�oonEssaemioma: 9q"7 DENVER DR
wmEaexy�EiF�awx: WILLIAMS, PAULP. M
AODNESk 947 DEN��ER DR
• ��OSTA MESA,CA
�vvi. �uuwo wo�ss:
9'l6 "l6
uxr:
FLOOD: X 47
UICHIIECTOXFIMINFEN: I(IRK CROSS ���� 3fi(I6
urcx.one++ors�oon�ss: 319E1 AIRPORT LOOP DR urar: D
C.M. CA 92626
CMlfp1CTORSN�ME:
CONfPACTOR4 W111➢l0
10DRESS
I!G N0:
uxr.
LICENSEU COHfPAttOPS UECLAXATION: 1 hereby � iedar peroly d perjwy ihtl I am IicMmE inEer prowions W CMqar e
(commendn9'Mlh Section )000) d Diveun � N the Buaineea vM Pmleaaiona Cods, eM mY Gnnee u in lull brce enE aXad.
cm uc. No.: uc. cuss: uc. No.: EXP ;
Dme: �mnmea:
OW NEN BUILDEfl DECIANRTION: I Iwoby effirtn uMer penNy d per�m� ihtl I em azanq han ihe Can�rfm lioema lew ta Me
IdbwnY eeeaon (Setlmn ]W 1.5 Bus'rnae anE Pmleaima Coda: MY eiY o muM' rMitl� �eqwres e V�1 �o aombuet, eXm.'vnqwe.
bmdnh, a repei any svucwre, qia io ila eaivxn, ebo iepuirea �he epplirem tn wch pmnB lo fib e epmd sWement tlW M a eM
� licenaed pursueM lo IM pro.'v'vu d tlq CaNretlaa Lireme lew �Cheqer 9(ouvnenuq wGh $etlian 10p0) d Div'vion J d Ihe
Busirea eM PrWeaaiau Codel a inm ha or eha iv exemq �nerehan vN iha Eavs /a Me ellaped uempion. AM'videtion d Seaion
]o3t S M am' e0dirav 1« e v�a w4�+ �he ePN�p �o e dW v�W a ria mon �hen fi�re huntlmE EaAan �f.i00�.
� I.mownerd�MpWeMamYa^CM�awihwega�m�heiadecomqmeom.rriGdothe�wrk.eMNeetruqureem�WaMed
a oflerad M sab (Ser,iion ]016. Butinme ard Pmimmu Coda: The Coruemon Limve lawdaea m� eVONto en oxnerd popMy
wM WAE+m inpwas t�erean, vd Wo does swh xwk Nmaell a henel a Nraqh hb a hx ovm empbyeee, pwked ihet auch
improwmow ve ra'vueMed a dbeed la aeb. tl. howv.er. iM brildvp a inpwrnav w wtl wnkn me yeer d mmpMion. Ne
�,�a�,�a« w�n n,.�, in� wb«� a v��o ne «.n. ed oa nma «�wa+�« me wmo» a�1.
� I. ea oxner d �ha P�OeM. � ezdiuney ooniredip xM f n+od contrec�as 10 cmmua Ne qqm (�� ��. Businme end
wam.�,. coaa: rne com�naa+ ucebe � me. �a mWr ro� o�.n« a ww�v .no w�b. « mnp+� �ne.on .na wno
convecu la wdi propan weh e mCr+daHe) liuroed pursueiu to ihe COM�etlas Lienss lex�.
�[Lj,�y,.,,,,a�yyr�d;o,,:BP7044 e.ar.c..ro,w.,�:OWNER -BUILDER
<enOr uw i� e� a�a ��e me �.w�*«m a cw«ry. �.m,.od smen cod. s.a�. uws. us:u..oe
thm I or airy INuro buiM'uq omWaN will / wil rwi (tl�cb one) neeE io comply wY� eek pele ootl�e enE �M �pui�omsnb lw
wrevunionamoE'ifralionhan�MAi wSTry7.ia�pemsa0inrid.ReudaqilmmrueuneGP�'vneneaamqiraminesa
� o,�a: �wr�:
WOPKEP'S CONPENSATION OECURATION: I Mreby df uM« pmNy d psjuy aw d Ne bAowiip AstlarUom:
� I heve uM vril meiiven e<erlifctle d mnaaM lo �Mi�mre lor xvrkai wromvtion, m paMW la Ey Satlion �100 W �M LWa
coes. i« m. wn�. a u» .on� �« w:m w w�u s��.d.
� I hew eM xil mvnien weken' aom0�+mon imuranu. m rsiwred M SWian �100 d Ne leEor CaM. M tln M�ameno G iM
wwk Iw wAich Ihu permn ie iaueE. My waMei+' mmpensetion irovvice rarrier end pdiry number ue:
c�«:
Pd'ry Number
� m;a a«rian r�ead iwt bs candaree I rhs vs'mt u k. aa IwMisd dmen R�ool n Iw.l
� I oenN Net in Ihe V�oemanee W ihe wak lor xfiirA �hu O+�e o uweE. I tleY � emO�N' �Y Dw� in enY meniwr m m �o
e«om. wN� �a m. xwk ,: canw��^ b•• a cdiian,u. d,a eo�e. mm n �.na,b nxom. .uww m ina won�e�
com��w� w�on. a seeo� aroo d me �ee« coee. i.nm �onn.vm m�oN �*n mo.s pwv�a�m.
Deta: ApqiceM:
W�minp: F�llun ro ucun ro'kui rompwwtlon cov�rp� Is �n/awN( �ntl �IWI wb/�cf m�mplryw ro crlMrrl pm�ltlp �ntl
c/Hl flw i.q ro om �,nArM tlauuN Aolhn (JIOq000A b��n ro tlN cwl ol rompwrutbn a�P� u prvHGM ror In
9xtlon J�GB ol tln LeDor Codq /nhn�4 �d �ttomsy'� I�a.
CONSTNUC110N LEHqNO P4ENCY: I henby elfirm uMa peroCy d pajvy tha tMn b e conetrvCian WMinp epeM.y M tM
perlotmenm W IM1a xoh la xfiitl� t�u pem�i u ewed ($etlun 309]. C'v. C).
LENDEfl'S NAME:
LENDEP'S AODPE55:
I eMM �M1m I here reed Nia eVd'cetion ad pate II� the ebwa inlormuun o eanw. I e9� to eomW with ell NY eM eoumy ordiewioes
uM 8181G bw3 �M0��1B �O buddM CMW Wqn eed hBlGbY W�I�01¢! �lpMl11�8�1VM d lhC GIYb ON> IID� �M GbOM�RMUYJ11Btl p1OpM1)'
�«�°'°°tlp�°�`P�"' LARRY WEICHMAN
ome:
(5151JB.WP) M/Aita-6uiMig d Selery; GieemFb: Ganery-Appirent: Pink-Rewnw: (3dEenmE-A�aeaaor
CI'i'Y OF COST'P. 1dESA - BUII�DING PERhl:l1'
PERM NO; B OfSOG4�
PERMIT NO: B 080646 PLAP! CHECK D10; 04990-96 L GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE; STR PURPGSE; OTfi
JOH DESCRIPTION : LEGALZZE 2ND STORY COVERED DECK & PATTO SQ FT; 2,000
CLAIM C�ALUE: 2,000.00 CALC-VALUE; 2,000,00 GROUP OCC: U-2 /
COMMENTS: T,EGALIZE 2ND STORY DECK 6 PATIO "180SF", INST 2ND FL SLIDING UOOR
iE It �E 1E 1E IE �(' �IE f(' 3E if iE iE IE # if ###!f iE iE 1E iE iE iE iE 1E )E if iE if iE 1E IE iF iF 1E 1E if iE if'lE �)f !E 1E iF �lf 1F # iE iE IE iE iE ik If # iE �E #'lE 1ElF 1E iE if �1(-iE iElE 1E iE �IE iE 1�' iE iE 1E
Z O 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 -------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: 20 FT IN FRNT: FT Itd REAR: FT IN
LEFT: FT IN RGHT: 5 FT IN LEFT: FT IN RGfIT: PT IN
PARKING REQ: PROV: PARCEL: 41808175 ZNE: R1 REF NO;
PLANNING NOTES> 12'X15' (180 SF) BALCONY OFF OF 2ND FLOOR MASTER BEDROOM OF
> EX. SF RESIDENCE (AT REAR) - LEGALIZATION,
iE iE �IE jElE 1E iE iE i(-iE iE iE iF iE �f IE �IE !E �)E iE iElf 1h �IE iE �IE # iE IE')E iE iE'lE # iE �(-!F!E if iE 1E 1f 1E if !t!E �t 1f IE 1E dE iE iE �)F # iE 1f # ik i(�'Y.� 1E K- iE iElF * ff iF iE #!f if iE �lf iE �(- iE 1t
D E V E L O P M E N T S F. R C� I C E S R E Q U I R E M E N T S
ZONING APPROC�ED BY DATE:
BUILDING APPROVED BY : �y_i�Ia DATE: /
AFPLICP.TIUN IS.SUEC� B`s': �� DATE: � 21 �� u
*�crt**�*��e3E��*�ct�*�;f*,E��- � * *** e. �* �F�'�'3F'i�'��t�r��f�*�-*****#� � �FiF��"iF**
LEGALI7.ATION:Y F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 114.50 ,SO
SMIP/NON-RES
PLAN Ei0.93
ISSUE FEE
BUILDINc;-C�IV-? PERHIT ISSUE PLAN-CHECK
TOTALS----� 125.QU 0.00 . 40.46
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
124.50
TOTAL PAID DUE
165,46 165,46 .DO
165,46 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN-CHECK
.50 40.4f,
it 1f 1F'k # i( k 1E'k!E iE if iE fE 1E if iE 1E �E �E 1E �lE iE �lE 1E 1E if iE ik'lf �E if If IE iE 1f if iE 1E 1klElE'k iE 1ElE iElE iElf 1! 1E 1E iElf iE Ik �E iE 9E iE fE 1E 1E iE 1k �14 fE iE !E !E if 1E 3E 1k iE iE �1E i('
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 2 P T I,O N UNIT COST TOTAL COST
SE'R 2000 ALTER BY VALUE RESIDENTIAL NOZON� 1.00 2,000.00
END OF FEES
0
�1 QQ219992-�0219994 T O T 165,45
6RTE: ii!?7/95 TItIE: iQ:3E
GhNSTRUCTION AND PLANNING ' POC SPA
APPRdVA4S Permit # Date I�spectoF j APPROVALS Permit # Date Inspector
�l. Temporary Elecirical Service or Pole "52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
i
3. Electrical Gonduit Utility�Undrgrnd. ' � 54. Forms
4. Electrical Gonduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinlorcement 56. Rough Plumbing & Pressure Test �
,
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electricai Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor Svstem 61. APPROVAL TO DECK
17. Property Sewer line & House Connection 62. Backwash & Receptor�Final
i2. Sewer Cap 63. Heater & Vent�Final
13. Root Drains 64, Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical�Finai
75. Rough Ele�irical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access ApProval
17. Ro�gh Wiring Sign 68. APPROVED FOR-PLASTERING
18. Rough E�ectrical-T Bar Ceiling 69. POOLlSPA SYSTEh15 FINAL
79. Rough Heating & Air Conditio�ing FIRE DEPT. REQUIREMENT
20. Rough Fattory Fireplace APPROVALS Permit #
21. Ducts, in Struccure 70. Underground Hydro
22. Oucts, Ventilating 71. Product Pipin� O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Fram�ng 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Ftashing� 76. Dry Standpipe
28. Lathing & Siding 77. FIXED $YSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall NAiling HEALTH DEPT. REQUIREMENT
31. Plaster Bro�vn Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Elect��c Notes: /Z 3��j �O �_, ��ni�
34. Final Heat�ng & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or CanopV
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Finai
40. Gas Service-Final -
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Re9ulations
47. FINAL STRUCTURE & BUILDING Z 6
48. FINAL PLANNING �
49. Electric flelease to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY
No Date
DECLARATION OF _ .UTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
Bldg. Permit #
This Permit # —�_��
�l ��t ��P,�,,,�Prc. a�J�.�,�, �- i�leaa Ci
Sireet Addre ]�� � AP Number
I(we), �LLIrAQ � —�aOX.� , declare that I am the Owner of Title
of the above referenced real property, and that I e) hereby authorize:
y�._�___Gr_/��' r,0�n� ?l�-Z-`f/-,LfS�Z
Name Telephone No.
��� /�-�- �%�" �� �
to obtain permits in my behalf, as owner/builder, for �_�a (�i�
at the above reterenced property. U
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. I 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. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this _�f(�,_ day of �����L��(�/19_�, at�����v�r�rlici , California.
��u�14 f�-/�v� �D�Zu /ili_��9�-
Printed Name Date
NOTE: This authorization does not grant authorization to pertorm the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
NOTARIZATION REQUIRED
W79�a6 IPev. 7191)
STATE OF CALIFORNIA
COUNTY OF ORANGE
ALL-PURPOSE ACKNOWLEDGMENT
(California)
)
) ss
)
On p y?�i , 1996, before me, the undersigned notary public in and for said County
and State, personally appeared PGLt�,�A �E�.ine5 ��e.��
[� personally known to me [orJ
❑ proved to me on the basis of satisfactory evidence
to be the person(�whose name(�'j is subscribed to the within instrument and acknowledged to
me that S4.e, executed the same in ve.c authorized capacity(ies) and that, by her
signature(sj'on the instrument, the person(ts)�or the entity(aes} upon behalf of which the personFsj acted
executed the instnunent.
WITNESS my hand and official seal.
M. CHARMAINE HARKER
COMM.I9B8190 Z
Zv ti NotOiY Pubilc — Califwnia y
�+i.�� • ORANGECOUNiV
, AAy Comm. Enpiree MAR 11. 1997
(O�cia( Sea!)
- v� 1 • �'%'�4��vYYt-d.t.t�C
M. Charmaine Harker
My commi.ssion exprres on Murch 17, 1997
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
C��i7 T11Z'L -M I I:l 1 u I x�] FY�Y [�P. �X:7
� INDIVIDUAL
❑ CORPORATE OFFICER
Title(s)
❑ PARTNER(S)
Limited General
❑ ATTORNEY-IN-FACT
❑ TRUSTEE(S)
❑ Gl7ARD1ANlCONSERVATOR
❑ OTHER:
5470
DESCRIPTION OF AT"1'ACHED DOCUMENT
De�la��-;or e� Q��ri�-�,
�
Title or Type of Documeni
Signer(s) Other Than Named Above
Date of Document: 11 � l'� l��
Number of Pages: r� ��. V-Q;n p$�_
SIGNER IS REPRESEi3TiNG:
A��F
�wneK Frsruuarx r�NCTu�rrTrnn* DATE 3-4-76
�JOB ADDRESS qq7 na,,.,Pr nr;,.A BUILDING PERMIT N0. �nq
OaGENERAL CONTRAC70R �mo DESCRIPTION of WORK Res. w/att. ear/ 4b
CON.
UNOERGROUN� Lf P
ROUGH WIRING
TRENCHES FORMS
FLOOR SVS EM
BONO BEAM � STE
SHERTMING
FR�ME RNO FLRSHING
LnTNING - IN n (
PLRSTER, BROM'N COrIT
ST 'URqL, FINqL
N! .G, VENT., REFRI
PLUMBIN0. FINRL ANO �
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TRACT
VALUE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely - Use Ink Only
BUILDING /�y � n . � .. sL i_
OWNEF
MAIL
CITV
CONSTFUCTION
BRANCH
ADDRESS
ARCHITECT
TEL.
NO.
TEL.
ADORE55 '
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
SIZE NO.OF BLDGS.
OF �OT NOW ON LOT
USE OF
EXISTING BLOG.
Separate permits are required for
elecVic, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOfiMED
I hereby aeknowledpe that I have reatl this application entl state
that tha ebova information is cortect end epree to comply with
ell laws repulaNne builtling conttruciion, and I shall not employ
any permn In vloletion ot the workmen's compensation lew¢ of
tha Steta of Californla.
I hereby certity that I em p�ope�ly Ilcensatl as e contraetor undet
the Stata of Cellfornla Businass antl Profassions Code, �Ivision 3,
Chapter 9, antl that such licenses a�e In full force antl affact, or I
em exempt from tha provisions of the Stete of Calitornia B�sineas
antl Professions Gade, Division 3, Cheptar 9.
Sigoeiura of
Permlttee
Authorizatl Apent
PAIu J�� �
:dR-4-7(�„�.-OQ 244 0 1f�9.0�
APPLICATION FOR STRUCTURAL PERMIT
ECEIVED BV DATE RECEIVED nnTc iccucr
A.P. NO.
BUI�DING
ADORES:
TRACT I LOT I BLOCK
FIRE
ZONE T
APPROVED
BY
ZONE NO.OF
PtANS
YARDS APPROV ED
MAIN BUIIDING
(FflOM C/L STFiEET)
�O
OF NEW
VAROS APPROVED
DISTANCE BET. BET. MAIN &
MAIN BIDGS. ACC6S BLD
VAR..1E DATE
C.U.P.�W APPROVED
APPROVEO
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m
i
m
SQ, FT. a
THE AMOUNTSHOWN UNDEfl VALUATION IS FOF m
THE PURPO6E OF ESTABLISHING A PERMIT F E ONLV: "
e
VAIUATION RMIT FEE $ d
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nl
� PLHN CHECK E ^�
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$ LL
TAX b �
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TOTALPAID S
_ ' ,�i!U�J —�
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fill in Completely — Use Ink Only
BUILDING Lt' . � C_ Ju� \^ '
ADDRESS ��"� �Y7
OWNER /���`///�/�$C/i/C�G/t L�[)���[i
MAIL �� ���79,
ADDRESS ���
TEL. f1ql/
CITV� �i' A/C/���' NO.If� 1 6L�
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BRANCH
ADDRESS
��.�I� L TE L.
CONTRACTOR � /7///�=
AODRESS
TEL.
CITV � NO.
STATE CITV
UC. NO. Z� O. IIC. NO.
OF LOT � J X�✓ �' S NOW ON LO
USE OF
Separate permits are required for
elec[ric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOflA
/�� � .c �`�.S/l��CJlG� 4l �
Rg�E�NRA. BY
vAFDS
MAIN
VAR. $E
P"'° 98.06
'ipV 24-75�.��;00 915r *�*>:
FORSTRUCTURALPERMIT
NO. OF
PLANS
J
VALUE
VSE OF NEW
BUILDING
VARDS APP
ACCESSORV
DATE
APGROVED
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I horaby eck�owlatl8a thet I heve reatl thla eppllcetlon antl stete �^
�
that the abo.'e InformaHon Is correei end apreo io comply with m
ull lews re0uletln0 bulltling construction, ontl I ehell not employ
i
nny porson i� ��oletlon of Ma workman'e compensatlon lews of d
Me Stete of Galifornla. // •
I hereby certify ihat I em properly Ilconsetl es a contractor untlar SQ. FT. � !� w
t�o Stato ot California Businasa antl Prafesaions Coda, Dlvision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF m
Chnptar 9, end that such Iicenses era in fu�� forca antl afteet, or I THE PURPOSE OF ESTABLISHING A PERMiT FEE ONLV: �
nm exompt f�om tha pero"vislons ot thy Suta of Celifornla Business VALVATION d
nntl ProfacsloPs Co yrvizlon 3, t�iepte[ 9. PERMIT FEE E N
�° ��,��� � m
PLAN CHECK E "�
SIB�etur o A • �
LL
Pe�mlite^- 5 a L�� TAX S ��
Authorizad A9a�t � ( U
T07ALPAID E , �