HomeMy WebLinkAbout3037 DONNYBROOK LN - Building Permits�
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�lrNLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Jobnddress: 3037 DONNYBROOK LN
Suite:
Vicinity: SIDE OF HOUSE
Primary Occ: R3 Type of Construction: V-N
ParcelNumber: 14116518 Zoning: R1
E+ppliwne MARCO FERNANDEZ
Atldress: 4337 WHITEWOOD AVE
LONG BEACH, CA
owner: BOMBOY, ROBERT J
Phone: 562-421-6278
2ip: 90808
ISSUED BY:
Status: ISSUED
Applied: OBN52005
Issued: 09/15/2005
Address: 4337 WHITEWOOD AV
Address: 2489 SAN SIMON ST
Phone: 562-427-6278 PAone: 714-734-9888
LONG BEACH, CA TUSTIN, CA
Zip� 90808 License: C25199 92782 License: C55045
SCOPE OF PERMIT
189 SF BONUS ROOM ADDITION TO AN EXISTING SFD. ADDITIONAL WORK INCLUDES KITCHEN REMODEL; INSTAILATION OF 2 NEW SKY
LIGHTS AND REPLACEMENT WINDOW IN LIVING ROOM; DINING ROOM AND MASTER BATH REMODEL.
FEE SUMMARY
Plan Check: $353.11 Calc Valuation: Sao,000.00
Permit: $54325 Claim Valuation: 5»,as3.so
SMIP Res: $4.00
SMIP Com: $0.00
Other: $0.00
Inspection:- $0.00 '
7otal: $900.36
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0• 0
Rear 43-0
Rear 0-0
PARKING Existin : 0 Reauired: 0
PLANNING & ZONING
Left 6• 0 Right
Lek 0• 0 Right
Pr000sed: 0
�
��
0- 0
J
NOTICE: The work authorized by this permit shall compty with all applicable handicap access raquirements under California statutes and related
regulations. (prd. No. 92-28, § 1, 72-27-92)
EXPIRATION; This pertnit shall automatically expire and become void if work is not commenced within 180 days, or If work Is suspended or ebandoned
for a period of 180 days.
INSPEC710Ng; In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all
requlred Inepeetione and final approval must be ob�ained. Failure to obtain inspections and tinal approval will result in ihe expiration ol this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaaee �eroo�
WORKERS'COMPENSAnON DECLARAnON: � - �
I hereby eflirtn under penalry ot pe�ury one ot tne following tledaretions: �
❑ I heve end Will mainteln e cenllicate of consent m selldnsura tor workers' compensatlon, es proNded lar Ey seaion 3700 of t�e Labor Code, tor tha pertortnance of che
work for which this pertnit Is issued.
❑ I �ava and v�lll maintaln workers' compensalion Insurence, as requiretl Oy section 3700 of the Lebor Cotla, for tha perfortnance ol the work �or whiU this pertnit I5 Issued.
My workers' �mpensatlon Insurence carder and policy num6er are:
Cerrier. Policy Number:
(rnrs seceon need nar ee canpletee u fhe perMr �s veNen er one nundred da�ers (s lo�) or �eu.�
❑ I certlfy thet in the pertortnance ol the work lor w1Uch this partnit L9 I55ueQ I ahall not emplq eny person In any manner so es to 6ecome sub�ed lo the workers'
compensetlo� �aws ot Calllomla, entl egree that il � should become sub�ect lo the workers' compensetlon provisions of Sectlon 3700 of the Lebor Code, I shall IOMwit�
compty with Ihese pro�risions.
Appllcant Signeture: Dete:
WMNINO: F/ILURE TO SECURE WORKEBS' COMPENSATION COVERAGE IS UNUWFUL AND SHAl1 SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES M'D GVIL FlNES UP TOONE HUNDRED
hKK1SAND OOILARE (5100,000), IN aDDfiION TO TNE COST OF COMPENSATION, OAlMGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE, INTERE5T, AND ATTORNEI"S FEES.
UCENSEU CONTRACTOHS DECLARATIQN:
I hereby ottirm iha( I am licensetl untler provisions of Chapter 9(commencing with Sectlon 7000) ol Dlvislon 3 ot the Business end Professlons Cotle, end my license Is in lull
force end effect. U�. M Clau p
Contractofs Signa�ure: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aNirm ihat the�e is a consiruciion lending egency tor lhe pertormance ol Ihe work lor which Ihis permit is issued. (Sec. 3097, Cihl Code).
Lendefa Name: Lentlor's Atltlress:
Signeture: De�e:
OWNER•BUILDEq DECLARA710NS:
I hereby effirtn thel untler penelry of perJury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing reason (Sec. 7031.5, Business anO Professions
Code: Any Gy or c��ry which requires e permit to conswct, alter, imprwe, tlemWis�, or repair any siruCture, prior to its issuance, elso requires Ue applicant for such pertnit
lo flle a signad stelement ihet he or she Is Iicensed pursuant to the proNsions ol the Contrectars License Law (Chapter 9(wmmencing wltM1 Secllan 7000) of Dlvision 3 oi the
Business end Pmtesslons Cotle) or thet ha or s�e is exempl Iheretrom end Ihe besis tor tha ellaged e:emptian. My violation o1 Section 7037.5 by any applicant for a pertnil
suh�eds Ihe applicant to a civil penelryof not more than frve hundred tlollars ($500).):
❑ I, es owner o� the property, or my empiqrees with wages es their sole compensation, WILL DO THE WORK, entl �he siructure Is not intentletl or oflered lor sale (Sec.
70d4, Business and Protessions Cade: The Coniractors License Lew does not apply �o an owner ol property who builds or Impraves thereon, and who does such work
himsetl or herself or through his or her own employaes, providetl ihet such improvements ere not Intended or oflered for sale. If, howaver, ihe builtling or improvement is
sold within one year of completioq the owner-builder will �eve the burden of proving that he or she did not builtl or improve br purpose of sale.). •
I?es owner of Ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Protesslons
^Code: The contrectors LJcense Lew does not appry to en owner ol propeny who builds or improves thereon, end who conirects for such project with a contrector(s)
icense Dursuant to ihe Contractoro License Lews.).
❑ I em exempt untler sec. Business antl Pmfessions Cotle tor Ihis reason:
Signeture: �%t�c5��.[ a-n Date: /r I
�OwnerlD verltiatl by tlrivers license. � es ❑ No o��ars u�osa No. '� Ezpires: �'�
Vedtication ol Owners�ip by (rype of tlac t; f.e. - proparty tes 6ill or Eeed): �"� r--^-'"
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby ceriHy ihat no excavetion fiva (5) or more feat in tlept� Into which a person Is requlred to Oescend, wlll be metle In connectlon with work authorized by Ihis
permit, end Idat no building strucWre, scattoltling, falsework. or tlemoli�ion or disman0ing iheraof, will be more then �hirty-slx (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Calilomia AdminislretNe Cotle).
❑ As owner-bui�der, I will not employ enyone to do wark w�lch would require e permit trom the Division oi Intlustriel Sefety, as noted eDove, unless such person hes e
pertnit to tlo such work Irom Ihe tliNsion.
SlpnaNre: Deta:
DiNslon ot Industda� Satery Permit Number:
COOE �. �y$Q�QKTYPE PLIE I[�ELS
1616 Fixed System Final Fira Praventlon
1268 Pool Spe F�nal
200 Final Re-flooi
2D7 Finel BIocWRetaining W ail
202 Final FaCtOry Fire Place
203 Final Slgn
204 Finel Demolition' '
COOE 1 INSPECTION TYPE
206 Flnel Mochanlcal
208 Flnal Plumbin9
210 Final Eleclricel
252 Final Fhe Prevenlion
220 Finel Planning Approval
222 Finel Sila
250 Finel Bullding/OCcupency
�
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(714) 754-5273 • Fex (774) 754-4856 • www.ci.costa-mesa.ca.us
ELECTRICAL PERMIT
JobAddress: 3037 DONNYBROOK LN
Suite No
Vicinity:
Parcel Nunmber: 14116518
Applicant: BOMBOY, CHARLOTTE
Address: 3037 DONNYBROOK LN
COSTA MESA, CA . . �)" � �.
y,
owner: BOMBOY, ROBERT J ,
Address 3037 DONNYBROOK LN . -
--- ' -COSTA MESA, CA ' _ -� =�' =�-,
Contractor:
Address:
OWNER-BUILDER
`
�
�
Phone:-' 714-546-0452 ; - .
. -� �a,--..
Zip - 92626 - ,. - .
� ; ,. ` ,.
..�Phone: � � -. , ... ...
"� Zip: 92626 ' .
Phone:
Zip: , ' ' . ' '-
License: 000000
77 FAIR DRIVE, COSTA MESA, CA 92626
� Status: ISSUED
Applied: 1026/2005
Issued: 1026/2005
�
ISSUED BY:
�r
SCOPE OF PERMIT
189 SF 80NUS ROOM ADDITION TO AN EXISTING SFD. ADDITIONAL WORK INCLUDES KITCHEN �
. � REMODEL; INSTALLATION OF 2 NEW SKY LIGHTS AND REPLACEMENT WINDOW IN.LIVING ROOM;
`,-DINING ROOM AND MASTER BATH REMODEL. REF.: 805-01322 � . .
._. , . , � , . .
�,- � . ELECTRICAI TO INCLUDE:,17 LIGHT FIXTURES; 15 OUTLETS, 11� SWITCHES, 2 RESIDENTIAL ,
, . APPIIANCES, 1 SERVICE TO 200 AMPS, AND 3�MOTORS TO 1 HP FOR ELECTRICAC OPERATED _
,. -SKY,LIGHTS:�� _. _ . _ �. . . .. ' � ..- . . _ .. -_ .
` ISSUE FEE . -
Temp service test �
� Res. a/c package '-
New Res (1-2 units)� , ,
New Res (3+units) , , �
Pool / Spa � .
Lighting Fixts ,
Recept Outlets
Switches
Non Res Appl � � �
Res Appl
Service to 200a
Service to 1000a , _
Service over 1000a
Motors l0 1hp .
Motors to tOhp
Motors to SOhp -
Motors to 100hp �
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Lighl Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Quantity -- - �
$23.50 �; _ , , '-.
$0.00
s$0.00 "'^ �.
$0.00 0
� $0.00 �., 0
�. $0.00�. �..�� 0
$18.70 �. 17
-$16.50 �� 15
$]2.10 . 11 ,
�' �$0.00 �. 0 �
$9.50� -..^2 .: ,
$30.50 7
...$0.00 .; , .p".-
$0.00 0
$1425 3�..� . .
$0.00., �,. 0 .
$0.00 0
$0.00 ?', 0 �
$0.00, 0
$0.00 , 0 � � �-
$o.o0 0
$0.00 -0
$0.00 0 "
$0.00 0
$0.00 0
FEE SUMMARY
. ' - ' � ' Quanlity -
.�'� Temp Dist�Syslem / Lighting . $0.00 - 0
� �Busway/100ft $0.00 0
Standing Sedion -� - $0.00 � 0^�
Misc Electrical Equipment $0.00 0
Transformers up�to 1 kva/kw $0.00 -- 0-.
................up to 10 kva/kw $0.00 ,.. 0-
.................up to 50_ kva/kw $0.00 � 0
........>.......up to 100 kva/kw $0.00 � 0
...:..............over 100 kva/kw $0.00 0
- Low Voltaga Equipment $0.00 0
,. - Low Volt Wiring System / Ckt „$0.00 0
- Misc:-Conduit � $0.00 0
, �Misa Conduclor'�- � � � -$0.00 : 0
Circus ( gen or ride) '- - - $0.00 0
� �Ciicu's'(mzcli �ide or Ilghts) $0:00 ' � 0
....,ChristmasTre@Stand $0.00. 0 .
- Fireworks Stand $0.00 0
Other Electrical�Fee .., : E^. $0.00� �
. ,....... .i......t.�.._..r .......... .. ..
� Invesligation Fee �' - $0.00
Plan Check Fee , � $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES 5125.05
COMMENTS / SPECIAL CONDITIONS
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, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In ortler for the work authorized under this permit to be considared�legal, such work must comply with all applicable codes, and all
requlred Inspeetlone and flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this pertnit�
FOR INSPECTIONS CALL: (714) 7545626 /s�
241Bd8 (B�W)
WORKERS' COMPENSATION DECLARATION: � . , ' , � �
I herehy aNirm under penalry of peryury one of the following declarations: .
❑ I have and will malntain a certificate of consent to self-Insure for workers' compensatlon, as provided for by section 3700 of ihe Labor Cotle, for the peAormance of the
work for which this permi� is issuetl. -
❑ I �ave and will maintein workers' compensation insurance, as requiretl by section 3700 of the Labor Code, for the pedormance of ihe work for which this pertnit Is issued.
My workers' compensation Insurance cerner and policy number ere:
Carrier. Polity Number.
(This section need nof be canpleretl il the Dermif is velueU et one hundred dallers ($100) ar less.) .
`
Ity.�hat in Ihe pedortnance oi the work for which this pertnit is issued, I shell not employ any person in any manner so as to become suDject to the workere'
iensation laws of Cali}omia, antl agrae that if I should become subject to tha workers' compensation provisions of Section 3)00 of the Labor Code, I ahall torthwit�
tly�hese,provisj�Jls „ �y / g
iignature: � Date: (' %�.�iii a'G o�PD '�
°AILURE TO SECURE WORNERS' COMPENSATIIXJ COVERAGE IS UNIAWFUL AND ALL SUflIECT AN EMPLOVER TO CRIMINAL PENALilES AND CIVIL FINES UP TOONE HUNDREO
OOLL4RE(5100,000),INADDITIONTOTHE�CQSTOFCOMPENSATIdJ,DAMAGES PROVIDE�FOFINSECTIIXJ3]O60FTHElABOHCOOE,IMEREST,ANDATTORNEI^SFEES.
LICENSED CONTRACTORS DECLARATION: ' -
!'i.' .
I hereby aHirm that I em licensed under provisions of Chapter 9(6'ommencing with Section 7000) of Oivision 3 ot the Business end Professions Coda, entl my license Is in full
forte end eHeCt Lit. M 4°`�� ' Class N
Gontrector's SignaNre:
CONSTRUCTION LENDING AGENCY: `
❑ I hereby attirm that ihere is a constmction lending agency tor the pertormance of the work for which this permit is issuetl. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signa�ure:
OWNER-BUILDER DECLARATIONS:
oate:
I hereby aHirm t�e� under panalty of perjury thet I am E%EMP7 FROM THE CONTRACTORS LICENSE LAW for the foilowing reason (Sec. 7031.5, Business and Professions
Cotle: Any city or counry which requires e permit to construct, alter, impmve, demolish, or repair any sWcture, prior to its issuance, also requires t�e eDDlicflM for such permit
to file a signetl statement ihat he or she Is licensetl pureuant to ihe provislons o� ihe Contrectors License Lew (Chepter 9(commencing with Seclion 7000) of Divislon 3 of Ihe
Business and Protessions Code) or ihat he or she is e:empt therelrom and the basis lor the elleged exemption. Any violation of Section 7031.5 by any applicant tor e pertnit
subiects the applicant to e'civil penalry of not more than five huntlretl tlollars ($500).):
t -
❑ I, as owner of the'property, or my amployees wit� wages as their sola compensation, WILL DO THE WORK, end the structure is not intended or oHered for sale (Sec.
7044, 8usiness antl ProFessions Cotle: The Coniractors License Law tloes not apply �o an owner ot property who builds or improves ihereon, and who does such work
himseli or herself or through his or her own employees, provitled �ha� such improvements ere not intended or ottered for sale. It, however, !he building or improvement is
�% Id,within one year of completion; ihe owner-6uilder will have the 6urtlen of proving ihat he or she ditl not build or improve for purpose of sale.).
�y' 1 as owner of the proDerty, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prqect (Sec. 7044, Business antl Protassions
��Code: The conirecrors License Law tloes not epply to an owner o/ property who builtls or Improves thareon, and who contracts tor such project with a conirecror(s)
license pursuant to lhe Conireclors Licen50 Lews.).
undecsec.
Owner ID verifietl by tlnvafs license. .[7'��Yes ❑ No
Verificetian af Ownership by (rype oi daulnent, i.e. - propert
eusiness antl Professions Cotle tor this reason:
Licensa
Ezpires: (�
DIVISION OF INDUSTRIAL SAFETY PEHMIT CEFTIFICATION:
❑ I hereby certity Ihat no excavation five (5) or more fee� in depih into whlch e person is required to descend, will be meda in connection with work euthorized by this
permit, and ihat no building strucWre, scaHolding, talsework, or demolition or dismantling Ihereof, will be more ihan ihirry-sia (38) taet high. (Chap. 32, Grp 2, Art 2, Sec.
341, TUe 8, Celifomia Atlminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industnel Sefery, es notetl abova, unless such person hes e
permit to do such work from ihe division.
Signature: Date:
Division of Indusirial Safery Permit Numbar:
CERTIFlCATE OF COMPLIANCE AND AUT}10RIZATION OF ENTAV: I certity under penalry of perjury that I have read �his application and state that the infortnation given is
correct. I agree to comply with ell state laws antl ci ordinances rela�ing �o building consimctlon, antl au��orize representatives ot ihe City ot Costa Mesa to enter upon the
above-d cn property for inspection puryos I gree not to acupy or ellow occupenq of eny building euth by this ermit un�il final inspection.
�,��A����. ���--/ i - �L, o �� � �-
� �gnaCure,Ol.Le al wner�_ �—t i Date -�
l
And/OrAut�onzed Applicam Date
GOUE I, INSPECTIONTVPE
7616 Fizetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Rooi
201' �FIneIBIocWRetainingWell
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
O�TE IMRIALS
COpEI INSPECTIONiYPE ,
206 Final Mechanlcai
20B Finel Plumbing
210 Final Electrical
212 Finel Fire Prevention
220
222
250
Final Planning Approval
Final Site
Final Building�Occupancy
(714)'754-5273 • Pax (714) 754-4056 • www.ci:costa-mesa.ca.us 77'FAIR�DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 3037 DONNYBROOK LN
Suite No
Vicinity: KITCHEN
Parcel Number: 14116518
Applicant: BOMBOY, CHARLOTTE
Address: 3037 DONNYBROOK LN � � . , .
. �`- � r � �" � Phone: 714-546-0452
COSTA MESA, CA�,: �� � �, Zip:. 92626 .
Owner. BOMBOY; ROBERT'J AND"CHARI:OTTE "
Address'�� �3037 DONNYBROOK LN :( ��- -
, ��� `- �� Phone: 774-546-0452
-' ; i �COSTA MESA, CA; Zip: 92626
Comracroc . O W N E R-B U I L D E R
Address:
Stalus: ISSUED
Applied: �11/09/2005
Issued: 71/09/2005
� � L ��
�` �12� �
�'�'� �� �
`�� �
.� ; � `�
�
�Phone:
, , . , � � ... ; Zip: . ' - � �
� . � . ,License: 000000 � . , - _
� ; SCOPE OF PERMIT- -- , .
,,PERMIT FOR 189 SF BONUS ROOM ADDITION AND KITCHEN REMODEL TO AN EXISTING SFD
REF#:BOS-0'1322 �
WORKTOINCLUDE:-1VENTFAN/SINGCEDUCT � -
ISSUE FEE
Inst FAU <100 k BTU �
Inst.FAU >100 k BTU '
RepairlAlt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance �
Fire Dampers
SmokeDampers �� �
Inst or Relocate Appl Vent
Air Handlers < 10000c(m
AirHandlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
� � Quantify . , -
$23.50 , . . - Repair/AltAbsorbtionUni�
$0.00-�� 0__ _: - � - _ ' ��' Repair/AltRefrigerationUnit
. $0.00 0 _ � ' Ventillation System- �- .
- $0.00 0 - Evaporziive Cooler
. $0.00 0 Commerciallncinerator
$0.00 0 Domestic Incinerator �
$0.00 0 . Compressors / Absomtion Svstems
$0.00 0 Up to 3 hp / 100 k BTU
$0.00 0 ,- ,'�" 3 To 15 hp / 500 k BTU
$0.00 0 ., � 15To 30 hp / 1,000 k BTU �
. $0.00 0 . � 30 To 50 lip,/ 1,750 k BTU � -
$725_ .. .7 � � = Over 50 hp /tOver 1,750:BTU , �, . �,
,. �:; $Q00 �..� _,.- .. . - Boilers ' '�%v.,>:... , ,:.
, $0.00�. 0 � ' - Up to 3 hp ,
, - � $0.00?.�0-, .. � - - . 3To75`hp , i:,::;. , -
"- $0.00 � �0��_ ,, - , 1510 30 hp -- . � � � , .
� $0.00 0 - - 30 to 50 hp . . . ,
. :,+ $0.00 � 0 Over50 hp � � �
- $0.00 � 0 - Other Mechanical Fee . -.
. .�-$0.00� � 0 � . .Investigation'Fee.' � � '
� Plan Check Fee - � -
. , - Reinspection,Fee� ,
. � - . _ _ _ TOTAF�CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
, ' Quaniity
$0.00 0
$0.00 0
$0.00 0 ,
$0.00 - 0
$0.00 0
$0.00 0
$o.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 ,0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
530.75
��NOTICE: The work authorized'by this.permit shall comply with all applicable handicap access requirements under Cal'rfomia statut�d�related
regulations. (Ord. No. 92-28, § 1,-12-21-92)
EXPIRATION: �Thispermibshall.automatically ezpire.and become void if work is not commenced�within 780 days,�or if work is suspe tled or abandoned
' for a�period of 780 days.
INSPECTIONS: In order�for the-workauthorized under this.permit do�be considered �legal,:.such�work must comply wN II applicable codes, and all
� reqWred Inspectlons�and flnal��approvaP�must be�obtained. Failuredo�ohtain inspections and finafapprovabwill resulbin.the expiration of this permit.
� FOR �NSPECTIONS'�CALL:� (714j�754+5626 �I
zanses lvoo�
WORKERS'COMPENSAnON DECLARAnON: '�' � ' � �
I hereby attirm undar penelty of perjury one of ihe tollowing tleclaretions: '��' �. � � �
�
❑_ I have and wilt maintain a certificate of consent to sel4lnsure.tor workers' compensetien, qs provided Por by seclion 3700 of the Labor Code, fw the pertortnanca of the
work for which this permit is issuetl. � � ' ' � • � . .
❑ I heve and wili maintain�workers' compensation insurance, es required by section 3700 oi Ihe Labor Cotle, for the pedortnance of Ihe work tor which ihis pertnit is issued:'
My workers' compensation Insurance carner end policy number are: ,
Carrier: ' PoliCy Number:
(This secrion.n�ee_d�,r ot be completed it the pe�mit is velued af one hundred dollers ($100) oNess.)
�'tl�iNdhat in the pedormance of the'work tor which this permit is issued, I shall not employ any person in aoy manner so as to'become subject to the workers' '
� compensation laws of CaOfomla; end agrae thet i( I should become subject to Ihe workers' compensation provisions ol Section 3700 ot the Labor Coda, I shall torthwith
comply with these provi ions. /� _
�dsi9^r ce�.���4 �� � O"�7�( _/ ��/ �O ��_
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVEFiAGE IS UNLAWFIIL AND i1AlL SUBJECT AN EMPLOYER TO CRIMINAL PENA TIES AND QVIL FINES UP TOONE HUNDRED
TIqU$AND DOLLARE (3100,000), IN ADDITION TO THE COSi OF COMPENSATIIXJ, OAMAGES AS PROVIDED FOR IN SECTIqJ 3106 OF THE LABOq CODE, IN�EREST, PND ATTORNEI^5 FEES.
LICENSED CONTRACTOfiS DECLARATION:
licensetl under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business antl Pmfessions Code, and my license Is in full
Class N
� - Date:
CONSTRUC710N LENDING AGENCY: • � . � "'
❑� I hereby aflirtn ihat there is a construction lending agency.for ihe peAormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: __. __ ._ __ _.. __ ' _ Lender's Address:
Siqnature:
OWNER-BUILDER DE �_qRA.
Date:
I here6y aHirtn that unde of per� ry iha� I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor ihe following reeson (SecJ037.5, Business and Professlons
Cotle: Any ciry or counry w requiie - rmit m construct, alter, improve, demolish, or repair any structure, pnor to its issuance, elso requires the applicant for such partnit
to file e signetl stetemant ih, e or sh I icensed pursuant to ihe provisions oi ihe Coniracbrs License Law (Chapter 9(rommencing with Sectlon 7000) of Division 3 of ihe
Business and Pmfessions Code) or t 1 e or shaRs�B�wmpt therefrom antl the �asis for tha alleged ezemption. Any violation of Section 7031.5 by any applicant tor e partnit
s�ub.�jectps the epplicant to a civil pene not more t all lyp,huntlred tlollars ($500).):
�yy�r es owner oi the property, or my emploTM�C�es es iheir sole compensation, WILL DO TME WORK, ana the sWcture Is not inten�etl or oHeretl for sale (Sec.
� 7044, Business and Protessions Code: ord tors LicenSetl:aw does not apply to an owner of propeny who builds or improves thereon, and who does such work
himself or hersatl or through �is or her own emq�oyees, prov �d�e'd theRsuch impmvemenis ere not intentletl or oHered for sale. H, howaver, ihe building or improvement is
sold within one year of completion, the owner-bu7dor will e 1('�te"ti�iden of proving that he or she did not build or improve for purpose of sele.). �
❑ I, es owner of ihe properry, am E%CLUSIVELY CONTR�QI TH LICENSED CONTRACTORS to conslmct the project (Sea 7044, Business and Pmfessi0n5
Cotle: The contractors License Law tloes not epply to an ownef�ropeny who huilds or Impmves thereon, antl who coniracts for such projact with a contractor(s)
license pursuant to the Contrectors License Law�
Protessions Code for this reeson:
Owner ID verified b dnvers license. ❑ Ves ❑ No ,��
�
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity ihat no excavation five (5) or more teet in depth into which a pe�son is required to descend, will be matle in connection wi�h work authonzed by this
permit, entl that no 6uilding sWcture, scaHolding, talsework, or demolition or disman0ing thereoi, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec.
341, Title B, Celifomia Atlministrative Cotle).
❑ As owner-builder, I will not employ anyone to do work which woultl require e pertnit irom ihe Division of Industnel SafeN. as noted abova, unless such person hes a
permit to do such work irom ihe division.
Signature: Date:
Division of Intlustrial Safety Parmit Number:
CERTFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penalty of perjury Ihat I have read this application and s�a�e �hat �he information given is
correct I a9rae to comply with ell state laws end ciry ortlinances relating to building consiruction, end authorize representatives oi the Ciry oi Costa Mesa to enter upon Ihe
above-described prop�e ,�,tor' pection purposes. I agree not to up or allow occupancy of eny 6uilding authonzed by ihis permit until finai inspection.
/l� - -+%.,.r �- � < <-p -o �
Sigpatura e9 i� ��
40oE�. INSPECTONTYPE " '
16�6 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 ' � Final Re-Root
201 Final BIocWRetaining Well
202 Finai Faciory Fire Place
203 Finel Sign
204 Final Demolition
Gdg, . . .�I�A4fr "
�
CODEI•`INSGECTIONflGE ' �
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 finel Building/Occupancy
� �JL7-
(714)'754-5273 • Fax (714) 754-4g56 • www.ci.costa-mesa��MBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
3037 DONNYBROOK LN
14116518
Applicant: BOMBQY, CHARLOTTE
Address: 3037DONNYBROOKIANE
COSTA MESA, CA" , � .
Phone: 714-546-0452 �- -
Zip: 92626 ' ; �
ISSUED
Owner: BOMBOY, ROBERT J AND CHARLOTTE �' �
Address' 3037 DONNYBROOK CN -- " � _ ���
- � . � � � � Phone: 714-546-0452 � �C���
- COSTA MESA, CA �; � Zip: 92626
, . � ' . . . ' .,
Contracror: OWNER-BUILDER �
Address: �
Phone:
. Zip:
- � � � Cicense: 000000 �
Slatus: ISSUED
Applied: 11/09/2005
Issued: 11/09/2005
' " ' SCOPE OF PERMIT
PERMIT FOR 189 SF BONUS ROOM ADDITION AND KITCHEN REMODEL TO AN EXISTING SFD.
REF#: B05-01322 - � � . , �. � � � �
WORK TO INCLUDE: 1 DISHWASHER, 1 KITCHEN SINK, 1 WATER REPIPE.
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
ClarifierSyslem �
Connect Qce,Soda,etc)
Denlal Units
Dishwasher
Drain, Floor
Drain, Rainwater '
Drein, Roof �
Dnnking Fountain
Expansion Tank � .
Gas Earthquake Valve �
Gas (1-0 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Interceptors (Sand Auto )
AMT
$23.SQ
$0.00
$O.OQ
$0.00
$0.00
$0.00
50.00
$9.80
$0.00
50.00
$0.00
50.00
$0.00 ,
50.00
$0.00 '
$0.00 `
$0.00
$0:00
$0.00
$0.00
QTY
0
0
0
0
0
0
7
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
- nrnT arv
� LaundryTublWasher $0.00 �0 �
Landscape Irrigation $0.00 0
P-Trap ' $0.00 0
Pressure Regulator 50.00 0
Process Piping (per 10 ft) 50.00 0
Receptors , 50.00 0
Septic Tank " 50.00 0
Sewer Cap for Demo $0.00_ . 0
Sewer Connect $0.00 .�.0
- Sewer Privale Line -� 50.00 - 0�-
Shower $0.00 0 � .
Sink, bar � - 50.00 ' 0
� Sink, commercial $0.00 0 `�
� Sink, Floor 50.00 0�
Sink, kitchen $9.80 " - 7' � '
Sink, service/mop 50.00 0
Spa�(private) 50.00 �- �0
Spa (public) � - - $0.00._ .0 `
COMMENTS / SPECIAC CONDITIONS
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum 8rkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Sel
Waste and Vent System
_ : ' Water qoset (Toileq
� � Water Heater / vent
-. Water,Piping (Inst or Rep.)
� Wate� Re-pipe - �
- � Waler Service �
' Water Softener
OTHER
� VIOf.ATION
-PLAN-CHECK
�REINSPECTION
TOTAL CALCULATED FEES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements.under
regulations. (Ord. No. 92•28, § 7, 72-27-g2)
EXPIRATION: This permit shall aUtomatically expire and become void if vrork is not cammenced within 180 days, or if x
for a period of 180 days.
AMT
$0.00
$0.00
$0.00
50.00
50.00
$0.00
50.00
$0.00
50.00
50.00
50.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
552.90
QTY
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
C
and related
orabandoned
INSPECTIONS: In order for the Work-authorized under this permit to be considered legal, such work must comply widi all applicable codes, and all
requlred Inapections and flnal epproval musl be�obtained. Failure to obtain inspections.and final approval will result in the expiration ot this pertnit.
FOR INSPECTIONS CALL: (714) 7545628
zuass �eroo�
WORKERS' COMPENSATION DECLARATION: � - ' � -
I hereby eRirm untler penalry of perjury one of the following tleclaretions: '� .
❑ I heve end will meintain e certificate of con5eni to selt-Insure.tor wOrkers' compen5ation,�es proviaed tor by seclion 3700 of lhe Labor Code, lor the pertormence ot lhe
work for which t�is permit Is issued. • -
❑ I have entl will maintain workers' compensation insurance, as requiretl by section 3700 0l Ihe Lebor Cotla, lor Ihe pertortnance of ihe work for w�ich this pertnit is issued.
My workers' compensation Insurance carner and Ooliry number are:
Carner: Policy Num6er:
(lh/s section need not be completetl il (he permif is valued et one hunOred dW/are ($ f00) ar less.)
��Lenity thet in t�e pertormanie of lhe work lor which this pertnit is issuod, I shall not employ any person in eny mannei so as to become sublect to Iha workers'
compensatlon laws of Celifornie, and egree ihat if I should beco ubject �o ihe workers' compensation provisions ot Section 3700 of the Lebor Code, I shall fonhwith
comply with Ihese pro!visions. /' / �
p�N�O81g'nature: ��[i��i7i ��� . •IM.� .Dela. ' �� %-v -r-
WARNINO: FAILURE TO SECURE WORKER$' COMPENSATION WVERAGE IS UNL4WFUL AND �ALL SUBJECT AN EMPLOYER TO CR�MINAL PENALTIES AND CNIL FlNES UP TOONE HUNDPED
T/1IX15AND DOl1ARE (5100,000), IN AD�ITION TO THE COST OF COMPENSATION, DAM1NGES PS PROVIOED FOR IN SECTION 3](I60F THE LABOR CODE, INiEFEST, ANO ATTORNEV'S FEES.
, LICENSED CONTRACTORS DECLARATION:
i I hereby eHirtn that I am licensed under pravisions oi Chapter 9(commencing wil� Section 7000) oi Divisian 3 ol ihe Business and Pmfessions COGe, end my license is in full
'. force entl eHecl Llc. x Cless a
Contraaor's SignaNre: Dete:
CONSTRUCTION LENDING AGENCV: �
❑ I hareby aMirm that ihere is e constmction lentling agency for the pedormance ol ihe work br which t�is permit is issued. (Sec. 3097, Civil Cotle).
Lentlefs Name: - Lentler's Adtlress:
Signeture: ' � Date:
OWNER-BUILDER DECLARATIONS:
I hereby�aHirtn thet under penalry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business and Protessions
Cade: Any ciry or coun �ich requires e permit ta conswct, alter, impmve, tlemolish, or repair any sWcture, pnor to its issuance, also requires the epplicant tor such pertnit
to flle a signed statemacpl�e or sha Is Iicensed pursuant to ihe provisions ol the Contrectors License Lew (ChaPter 9(commencing with SecUon 7000) oi Division 3 of the
Bu5in855 end Profe55iy� ) or Ihatlhe or s�e Is eaempt therefrom end lhe besis tor Ihe allegetl ezemption. Any violation of Section 7031.5 by any eOPlicanl for e pertnit
subj c the epplicant to � penalty oLriot more Ihan tive hundred dollars ($500).):
v I. es owner oi Ihe orooenv. or mv emolovees with waaes as their sole compensation WILL DO 7HE WORK and Iha strucWre is not intende0 or ottered tor sale (Sec
' hIm501f Or her501f or �hroug0 �IS-0� h6r Owrl.e�flplOyBBs, {
sold within one year of completion, the ox�r`ei-builder will
❑ I, es owner of lhe property, am EXCLUSIVELV-CONTRI
Code: The contrectors Licanse Law does not appty to an
license pursuant to ihe Contractors License Lews.).
❑ I em e:empJyqtlar sec.
_icense Law does not epply to an owner ot properry who builds or improves thereon, antl who does such work
�rovided that such Improvements ere not intended or oNared br sele. If, however, the building or improvement is
heve ihe burden ol proving that he or she did nol build or improve for purpose ot sele.). �
�CTING WITH UCENSED CONTRAG70RS m construct lha project (Sec. 7044, Business and Pmfeuions
�1W a"r otpiopeny who builds or improves Ihereon, entl who contracts for such proiect wlih e contrector(s)
Business entl Protessions Code tor this reason:
wner ID venfiea by driver's license. 1�'✓yes ❑ No (
y
Verification ot Ownership by (type of document, I.e. - proper�y �a�c blll or
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby certify thal no excevatlon Ilve (5) or more teet in dep�h into which e person is requirad to descend, wlll be metle in connection wit� work euthorized by this
permit, entl that no builtling stmcWre, scaHolding, talsework, or tlemolition or tlismantling Ihereof, wlll be more Ihen �hirty-six (36) faet high. (Chap. 3.2, Gry 2, Art 2, Sec.
341, TiUe 8, Calitomia Atlministretive Cade).
❑ As ov+ner-Duiltler, I will not employ enyone to tlo work which would require a pertnit irom Ne Divislon of InGustnel Safety, es nated ebove, unless suc� person hes e
pertnit ta do such work from Ihe tlivision.
Signature: Date:
Division of Intlus�nal Safery Pertnit Number.
CERTiFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certlfy untler penalry ot perjury thel I heve read lhis application and state that the infortnation given is
correcL I agree �o comply with ell staie lews end ciry ortlinances relating to building construdion, an0 authodze reD�esenta�ives ot �he Ciry of Costa Mesa to enter upon ihe
ebove-�cnb property for inspection puryoses. I /aq��ee� not to occupy or allow occuDancy of eny building authorized 6y t�i��m��til finel i�nspection.
�i�i � /rf-cs�v�PA-�- �/
eOYLegel'0�,,�;vT,ner(S)-:'- �? �at `
And/Or Au�honzetl ApP����t Date
COUE �. INSPECTIONTYFE ' - ' " Q1LE "' ' INTRIALS
1676 Flxed System Finel Fire Prevention
1266
200
201
202
203
Pool Spa Finel
Final Re-Roof
Final BIocWRetaining Wall
Final Factory Fire Place � ' - '
Final Sign
204 Finel Demolition
CODE�'INSPECTIONTYPE �-
206 Finel Mochanical
20B Finel Plumbing
210 Finel ElecMcal
272 Final Fire Prevemlon
220 Final Planning Approval
� 222 Finel Site
250 Final Bullding/Occupaniy
PA7F I[�ELS
�t'.�[)'l:� �,
(714j 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c��jILDING PERMIT n FAIF ORIVE, COSTA MESA, CA 92626
JobAddress: 3037 DONNYBROOKLN
Suite:
Vicinity: ROOF
Primary Occ: R-3 Dwellingsl Cong Res <10 Type of Construction: V-N
Parcel Number: 14116518 Zoning: R1
ApplicanC BOMBOY, CHARLOTTE
Address: 3037 DONNYBROOK LN
COSTA MESA, CA
Owner: BOMBOY, ROBERT J
Address 3037 DONNYBROOK LN
COSTA MESA, CA
Contractor: OW N ER-BUILDER
Address:
Zip:
Arch :
Address:
Phone:
Phone: 714-546-0452
Zip: 92626
Phone:
Zip: 92626
Phone:
License: 000000
Eng:
Address:_
Status: ISSUED �
Applied: 10262005
Issued: 10262005
ISSUED BY: �
�
`
�
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXIS7ING ROOF. INSTALL 2 LAYERS OF 15# FELT, 40 YEAR COMPOSITION SHINGLES AND REPAIRIREPLACE SHEATHING AS
NEEDED. 1,349 S.F. FOR EXISTING S.F.D.
FEE SUMMARY
Plan Check: $0.00 ... ....... ._ Calc Valuation: ss,000.00
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin : 0
Rear 0- 0
Rear 0- 0
Reauired: 0
PLANNING & ZONING
Lefl 0- 0
Lefl 0- 0
Pronosed: 0
Claim Valuation: 53,000.00
Right 0- 0
Right 0- 0
NOTICE: The work authoAzed by this permit shall comply with all applicable handicap access requiremenis under California statutes antl 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 abandonetl
tor e period of 180 days.
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all epplicable codes, end ell
required Inspectlona end finel epprovel must be obtalned. Failure to obtain Inspections and tinal epproval will result fn the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5828
zas+e �avo�
WORKERS'COMPENSAnON DEC�AnON: . ' ,
I �ereby affirm under penalry of perjUry one ot the following declarations: � ,
❑ I have anA will maintain a cenif�ce�e of consent to self-Insure for workers' compensetlon, as proNAed lor by sectlon 3700 0l the Lebor Code, lar the peAortnance ot the
wark lor which this pertnit Is 155uetl.
❑ t have antl will mainuin worker5' �mpensetbn insu2rke, as requirea 6y settion 3700 of ��e Lebor Code, for the peAoimance of the work for whiU Nis pertnR Ls iswed.
My workers' compensatlan Insurence cartier end pdiry number are:
Carrier. Policy Number.
(lhls section nesd not be comp/e(ed �� Ne permi( Is velued et ane huntlred tlollers ($100) or /ess.)
I cohity ihat in the peAormencB ot Ihe work lor which t�is permlt is issuetl, I shell not employ eny person in any mennor so es to become subJect lo Ihe workere'
wmpensation laws ol Celitomia, end egree that it I s�ould become sub�ect Io the workers' compensatlon provisions ol Sectlon 3700 of the Lebor Cotle, I shell forthwit�
comply with these o�sions. r/����� OQ �
Applicenl Slpnelure: Dete: �-/ ali O� �
WARNINO:FAILURETOSECUREWORK£�'WA�:'ENSATIONCOVEMGEISUMAWFULANOS SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDGVILFlNESUPTOONEMUNURED
TFKKI$AND DOLURE (5100,000), IN ADDITION TO THE CQST OF WMPENSAT1pN, DAMNOES IDED FOR IN SECTION 3]OB OF THE UBOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CON7RACTORS DECLMA710N:
I hereby ettirm that I am Ilcensed under provisions ol Chapter 9(commendng with Sectlon 7000) oi Divisian 3 0l tho Business antl Professions CoOe, end my Iicense Is in full
torce entl ettect. LJc. a Cless q
Contractor's Signeture: Date:
CONSTRUCTION LENDING AGENC�:
❑ I hereby eHirm that there is e c0�siruction lentling egency for lhe pedormance ol iho work br w�ich this pormit is issuotl. (Sec. 3097, Civil Catle).
Londore Neme: Lender's AtlOress:
Signature: Date:
OWN BULLDERDECLARATON9:
I hereby eftirtn t�et untler penalry ot per�ury thei l em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reasan (Sec. 7031.5, Buslness enC Professlons
Code: Any ciry or couqry,which reduires e pertnit m construct, elter, Improve, tlemdish, or repair any structure, O�or to Its issuance, also raqulres the apDlicant for such pertnit
to file e slgned staterGent that he or 5he is Ilcensed pursuant to the provisions oi the Coniradors License Lew (Chepier B(commendng vrith Sectlon 7000) ot DMsion 3 of Ne
Business entl Profes'abns Code)bi:�het �e or she is e:empt therefrom end the besis for the elleged exemption. Any vlalation oi Seclion 7031.5 by eny epplicant for e permit
subjects the epplican(to e civi�l�ap�enfl�ty of not more than five hundred dollars (5500).):
❑ I, es owner ot Ihe O�oPerWoymy employees with wages es their sWe wmpensatlon, WILL DO 7ME WORK, end the sWcture Is not intended or oNeretl for sale (Sec.
7044, Bu iness and Pm�essIpns Code: The Conirectors License Lew does not applY to en owner of proporty who builtls or impmves thereon, antl w�o tloes such work
him or herself or thwug1�4I5 or har own emplqrees, pmvided that such Improvements are not Intended or oflered tor sale. N, however, �he bulltling or improvement is
wilhin one year of completion, the owner�builtler wiil heve Ihe burden ot Oroving thal he or she tlid not build or imOrove for purposa ot sale.).
I, as owner ot the pmparty, am E%CLUSIVELY CONTRAC7ING WRi1 �ICENSED CONTRACTORS to construct the project (Sea 7044, Business entl Professions
Cotle: The wntraciors License �ew tloes not eppty to en owner oi properry who builds or Improves thereon, end who wntracts for such pro�ect wlth e contraaor(s)
license pursuant m the Conirectors License Laws.).
❑ I am e:e p under sec. Bu 'nass entl Professions Code lor this reeson:
Signature: ��.�(�,,,�:�. - Data� � ��
Owner ID venfied by drivets licensa. es ❑ No Drivefs Ucensa Na "_ .� � Expires: — _
Verllicatlon of Ownership by (type at tlocument, i.e. - pmperty tau bill ar tleetl):
DIVISION OF INDUSTHIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby cenity that no excavetion fNe (5) or more leet in depth into which a person Is required to tlescentl, wlll be mede in connectlon wlth work eut�orized by this
permit, end that no building stN��ure, scaHolAing, lalsework, or demditlon or tlismantling thereof, will be more Ihen thirry-six (36) feet �Igh. (Chap. 32, Gry 2, Atl 2, Sec.
341, TIUe 8, Celifomia Adminisvetive Cotle).
❑ As owner-builder, I will not employ enyane ta Ao work w�ich would roquire e pertnit trom the Divislon of Industriel Sefery, es noted ebove, unleu such person hes e
pertnil lo do such work Irom th0 tlivision.
Signa�ure:
Division ot Intlustrial Sefery Pertnil Number:
Date:
MAZARDOUS MATERIALS AND EM�SSIONS CERTIFICATON:
1 W III the epplicam or presem or tuWre builtllnp occupanl need m tile end cenity e Business Plen Por emergency response to releese or threotenetl releese oi e ha�rtlous
meterial9 ❑ Ves ❑ No
(Section 25505 0l the Celifomia Heell� enC Safery Code requires, vrith some ezceptions, that e Business Plen be liled wlt� Iha Cosie Mesa Fire Depenment by every
business which has et eny one time during e repaned year e quanlily ol hazertlous materials aqual to or greator �hen e waight af 500 pountls, or e volume o155 gellons,
or 200 cubic teet oi compressetl gas et stantlard temperature end pressure).
....................................................................................................._.................................._.__.......................'_'............................_...................................................................................................._........_.__............__....__..............
2 Doos or will the eppliwnt or present or future building accupam need to lile e regisiretion lorm br ecutely hezertlous metedals7 � Ves ❑ No
(Section 25533 0l t�e Celitomia Health antl Selery Cotle, with wme exceptlons, requires reglstretlan wlth Ihe Costa Mesa Fire Departmenl by each business wh1U et eny
one time hes on hand e quentlry ol ecutey hazardws matedals equel to or greater Ihen e weighl ol 500 pounAs, or e vdume ot 55 gallons, or 200 cubk feet of
compressed gas at stentlarA temperelure entl pressure).
........_._.......__'__ _ �._�.'___ ........................"""""'--'
3 Does or will Ihe epplicam or presenl or tuture builCinq occupant neetl to prepara en RMPP (Risk Manegement entl Prevention Program br ecutely hazartlous matenals)7
❑ Ves ❑ No
(Section 25534 of tha Califomia Health entl Sefery Cotle pmvides that the Costa Meu Fire Depariment may require ihe preparalion, cetlllicatlon and filing with Ne Flre
oepenment of an RMPP by businesses which ere required to register aately hezarGous matedals wilh the Fira Depenment.
_ ................................_._ _..........................---- ___...................._.........................................._......................................................................................................................._.............................���..
4 II en RMPP Is presenity required� has Section 25534 ot the Califomie Heelih end Safery Code been fully complied wi[h7 ❑ Yes ❑ No
5 Does or will Ihe applicent or pre8ent or ruture ouudmg occupaM requtre ror Ine work wn�cn �s tne suD�ect of tms a v�iu
from the Sauth Coest Air Oualiry Menagement Distda or trom any other elr pollutlon contml tlisttict or egency7 � Ve:
(Section 65850.2 0l the Calilomia Govemment Cotle requires thet tha requosted information ba fumishad on epplicatior
.......... ............................._. _........................._..........................._...............................................................................,
�6 ������VJill�any part ot Ine iaciliry to Oe G�sWctetl under ihis pertnit be wlthin 1000 faet trom the outer bountledes oi e school'
Qf'yes', the taciliry must meet ihe requirement of Sectlons 25536 entl d2303 oi Ne Califomia Health entl Safety Code).
.........._._.......... _._.— _...._.._..—_ ..........................._
7 N a pertnillrwn the Somh CoeS� Ak Ouefiry Menagement District or aher air polWtion control diStdCt or agency is
eppliwtlon, �ave all of the tllsUosures prescriCed by Califomia Health and Safery Code Section 42303 been mede? [
❑ No
tor non-resitlentiel
No
or
CERTIFICATE OF COMPLIANGE: I certity ihat under penalryy4qerjury the intormation given above Is correct. I agrea to comply with all stete laws and ciry ordinances
regartling H�{artlpps Maierials and Emissions. // _ _ �_
Data:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I cetllfy un�r penalry ot perjury Ihet I heve read this applica�ion antl state that the inlortnation given is
correct I egree to comply wl pell stA�e laws enG ciry ortlinances re a'ng to builtling construction, end euthodze repre tetives at the City ot Caste Mese lo enter upon the
above-descnbed pr� t 65De��ion purposes. 1 egree nat to c y ar ello occupancy at any building euthon'�hl�rtnit un�fin�l inspect . �
rn � %r G
Slgnatule 01 Legal Owner(s) Y i I D—ate l .
1� — _.
q�d/p� Authorizetl Applicant Date
CQOE I. INSYECTWNTYPE
1616 Fi:otl System Final Fire Pre�antlon
1288 . Pool Spa Final
200 Finel Re-Roof
201 Finel Block/Retainlnp Well
202 Final Fectory Fire Place
203 Final Sign
204 FinalOemolition -
� It�
`' � ' /'�ul..��
COOE 1 INSPELTION TYPE
206 Finel Moc�enical
208 Finel Plumbing , .
210 Finel Electticel
212 Finel Fire Prevention
220 Finel Planninp Approval
222 Finel Sile
250 • Final BuIlding/Occupency
Q� INIm64�
�oonessaem�ou'c: 3037 DONNYBROOK LN
wn�m'r*wEiFa,o�`": gOMBOY, ROBERT J
�noxess: BOMBOY, CHARLOTTE A
3037 DONNYHROOK LN
COSTA MESA,CA 92626
AVVL.WJIINU ADpRE59:
IJICNRECT ON FNtlNEER:
ncx. on �a.•s �noxess:
uNr: CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: P 075429 PLAN CHECK NO: N
f;f�(�is''��t[74;fiti3[d 1'�N�t C�-N PERMIT TYPE: PLU
10.N°' JOH DESCRIPTION : C/O DISHWASHER
UNT:
CLAIM VALUE: CALC—VALUE:
coNm�crarsru�: NOCK PLUMBING ( 714 ) 895-1i46
CONiN�Ci0R5 MNIIINi ].161 �) 5 EAR nARP r' I A
1WNE55' `�r�;;i�fic�i,, 90680 E=� °`.�� yi,i��l
LICENSEO COHfP1CTOfl4 OECLAflATION: I he�eby ellim under paroly d pe'ryry thm I em Icaivad uMor pwiaiona ot Cheqer 9
(mmmennnp wilh Secibn )000) d Diwion 3 d Ne BuzMn erd PMpe'vn Code, erd my limrw u in tull brce a�M efled.
cmuc.No.: 050386 uc.cuss: C-36 uc.r+o.: 51 97��) EX/�P/:� �02 96
�a: ` coinree«: ���,/� y �' /,:fC.?' �
NEfl BIIIIUER DECUPRTION: I Mreby elfirtn uMer pm�ely W perjpy �hai l em uemq fmn iM Comreqae Lirome lew la iM
idbwiq �maon (Seaion'!0.'11.5 Bueibss aM Prote�ona Cods: RM uY a muMy x}iiN rpuim e pertnil to oonatrucY, eller. impwa.
Cemoluh. a npei any etuiure, p'v w ea e��a�ee. etro n4wma the appliani tw aueh prmY lo file e egewE sta�emaM Me� M or ehe
� IicemeE Wn��� to iM pwisiona ol �he Con�reewa l'xen» law ICheqer 9(commma�q wilh Setlion )000) ��'eion 3 d Ihe
duei�row end Rdwum Codel or ihm he a ehe b ezemq tMreham eM IM bess lor Ihe eAe9b azamqian. My vuletun d S«fion
)0]1.5 by ury eppliranl lor e permil aubpd+ iha eppfrsm to e anl perely d rpl mae Ihan ive hunErod dollva �SSWj).
� I.uowrerW�Mpapenyamyemplo+easxihwepeam�hei»kmmpeme�ion.xiTdotlpxoA.eM�hasl�uctureundintanEeE
a o11erM for seb (5acion ]ad. Buinasa eM Pmtmaions Code: TM CONrmas Liceres lawEo» na eVdYto en ownxd o�oeM
who buida a inpwas Ilwiean. e�d Wq does su h v.wk h'unmtl a hwael a INaph hif a her own empb)aea. pew'ded ihe� euch
improvemems ere nd uneMeE a aHaed fa neb. tl, however, the buiNi�q a'vnpwemem u vold xiihin ore yeer d comD�e�b�. lhe
owmrduika xitl nn+�M duden d qm'IM M«ahe eN no1 driM «impove tu Ne WTae a seb).
� I. es o�mer d tM D�WM. am uduakdy mnirmnB wnA lixnud convr�ae �o wnpruq Ma pqaq (Soqun )OId. Buaireas uM
PMeaiom Cab: The Cmnapon L'eenea lew doee iw eCPN m en ownw d pW+�Y x1a buiY6 « imG�+m iMreon uM xfw
C011VBC�9 ��f eYJI p10�ltl� Wllh 8<qlllB4YOI(9) �GBfIHO� WA��� 10 �1M CiOf1�fBLyOlf �KG119B �9W�.
❑ I em e�emp uM« Seciion: B. 8 P.c.. M tliu iaewn:
De�e: O�mx:
� ao ne�eM �eniN �w � em erme a ene uwnwa u�e �w��.me�m a ewanu �we�, ene se�en coee seeian uws. zssaa. ene
255�1, enC Il�el I a eny Mure builEiiq oavpent will / wll �(tlicb ma) nead io cwnply wih uid awa mdm ud �he rpuinmanie br
eC�ulwmnavueiianormodifrdianhomNeA��uC�i anepemsuDmeitl.RmideMielmm�utlioneW�u�iomene�emdlromNme
provisbm.
oe�e: �od�:
WONKEN'S COMVEN9�TION DECIAF�TION: 1 Mnby tlNm wkar qroEyd prjwy me W Na IOAoxi�q dsderpum:
� I heva uM wll meinien a ceNliceie d mn�eni to ealliruuro lor wakere' canpameion, n pwidsd fw by Sx1bn 3)00 d IM labor
Cade, lor tM pe�fmmerca d Ns work la w1Yc� Nn pemw u mued.
C7 in,...�,a.��m�w�«.•�o����.�.m�.a��.eMs.u�,�rooam.�n«coe..m.meoen«�dme
7C work lar w1�iM Ihu pe�mn u iaued. My warYan' eampeneelian imuronee weier ud pdiry numCer me:
c.m..: STAT� EXPIR£S
ro��N�m�.: Nwra ���i(i7i— 09/30/96
.M1is eMion rroM not W canPbfM / lM Gs'mi n b dN hundnd doEv� (Jt00� a NnJ
❑ I canA' � in Ihe prlamencs d iM work lor v.fiich tAn peima h u I ahdl mi ampq� ury pemn in vry menna w u to
become eubjea io IM wwYne' mnpow�ion 4wa d C , eM ree Nel il I e(wult ecome aubjae lo IM horkere'
. compenaeiion v�bns d Smion 3]00� Lebor COJe. I I I 'th mmp�y wM Nwa q'sions.
� �: � 2. � — `� � �vw��:
Weminp: F�llun ro��cun workm'romp�nutlon rov�np� b vnbwN( md tlWl �u4het an �mploya ro etlminl pmr�Mu entl
rlvll Hnu'q N on� �wJrM Mouurd OvlYr� (JIOq000A M Ntl/tlon ro M� cwf ol romp�rwtbr� Wm�p� �a povllM br In
S�cHon J106 0l M� LeCor Code, Inro�uf. �M �ttomry'� I�u.
CONSTPUCfION LENOINO AGENCY: I heeeby elf uMx prWry d perjury tIW thas o e wnp�udion bndirq eperiey la IM
poAwmenm W Ihe wwk lor wM1idi �hu pamiY h 6aued 1�� �). CN. CI.
LENOER'S NMIE:
LENDEN'S AUDRESS:
I canily IM1et I M1eve reeE Ihis eppliraiion eM atete �lu� Ne ebv+e iNartnvbn u mrtea. I epiee lo rnmpy xilh ell cty erd ooumy ordinencee
eM etete lewa eeb��q m buJtlM eonsteupian ud herebY euUw'¢e �w���rvaa d �tus �sY �o mix uw� �M ebwe.memionetl WOMM
lor impeclion Wrpases.
� RON�IOCK
Z�J �j' �
Dme: � <
(5151d6.WP) Whps-Buikip 8 Sddy: �reeMFle: Cenary-Appiren�; Tnk-Ravenue; (3olEenro�Nemwr
PERM NO: P 075429
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
GROUP OCC: R-3 /
C�MMENTS: NrJ rITHER W��RK AUTHOftIZEU BY THIS PERMIT
���#��f��fix�i�:fr��*�F��x�xxx��x�x�u�xx�.sr��x�c�cx-�x�*+�***�t'r'�r*�t,��r�r*x**�tr���***�r�r**��r*��r
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: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 14116518 ZNE: REF NO:
PLANNING NOTES>
i
if if 1f if if 1f jf iF iE iElF iE 1E fE 3f iE if iE 1E iE �E �E 1E �E 1E iE iE iE �E 1E iE IE 1E fE 3E 1E 1E if 1E iF aE i6 3E ik 1E iF aE 3f !E if if if iE iE 1f iE iE 3E aE iE iE 3E 3E �F 1E jE iE iE 3E i6 iElE iE iE fE �E 3f if iE
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 HY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED HY: �/ri-�-- DATE: �� d� 9�
IEIhiEiEiEiElEikiElfiEiEiE�hiFiEiElE�EiEaE�4��f��iF��{F����if iF±��'tt��*������'�'�'����*�***�**** �*
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
����y���
7 . � �
258
SMIP/NON—RES
PLAN
ISSUE FEE 20.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 7.00 20.00 0.00 27.00 27.00 .00
REC�ENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: .00
HLDG PMT PLUMBSNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
27.00
iE i! jE 3E iE iE 1E iE 1E 1E 1E �E 1E ff �E 1E fE 1f iE 1E iE i! 1E iElE 1E fE iE jf iE ik ih ik iE iE iE if iE �E ik 1E ik 1Elk 1k 1E iE iflE M� 1E 1f fE IE �E iE dE iE �E 1E 3E IE iF �f fE 1E fE �)f 1F iE iE iE iE fE ff 1E 1E !E ik
I N D I V I D U A L F E E H 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
PLU 1 DISHWASHER 7.00 7.00
END OF FEES
����iR
;��� ' '��-Lt�l
Qi �1�7:i`i .a- �L1C- �9y _ _ _. `�7 �f.
�:iE= J.�� ._ _ _ `
.
. CONS7RUCTION AND PIANNING - P004 SPA
' APPROVALS Permit# Date Inspector AppROVALS Permit# Date tnspector
.
i. 7emDorary Electricai Service or Pofe 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgmd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Presrure Test �
6. Electr�wl UFEFi Grnd. 57. APPROVAL TO COVER�GUNtTE
7. Footings 58. Electrical Conduit�Undrgrnd.
B. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgmd. � 60. Backwash Lines, P•Trap, O Undrgmd.
10. Structural Floor Svstem � 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-final -�
12. Sewer Cap 63. Heater & Vent-Fina1
73. Roof Prains 64. Plumbing SYstem - final
74. Rough Plumbing 65. Electrical�Final - ,
15. Fough Electrical-Conduit - 66. Solar SYstem-Final �
16. Ro�gh EVectric Wiring 67. Fencinc� & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
i8. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEMS FINAI
79. RougN Heating & Air Ccnditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Firepiace � . APPROVALS Permit #
21. Ducts, in Structure � � - 70. Undergrounc) Hydro
I
22. Outts, Ventilating 7/. Product Piping OGas ❑Oil
23. Gas PiPe�Rough & Test 72. Underground Flush .
24. Roof Framin9 73. Underc�rnd.StorageTank OGas ❑Oil =
25. Roof Sheathing ' 74. Overhead Hydro �
26. T�Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical ' '
27. Frame and Flashing ' 76. Dry Standpipe �
a
28. Lathing & Siding � ' 77. FIXED SYSTEM FINAL �
29. Insulation � 7$, FIRE PREV. FINAL
30. Drywall Nailing , � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPEC71ON
32. Electr�cal Power MeterFinal , 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy � -
3Z Final Factory Fireplace '
38. Pinal Plum6ing .
39. Water Service-Pinal
40. Gas Ssrvice-Final
41 . $olar PomesticFinal
42. Back4low PreveMer
43. Backflow Irrigation
44. Landscape Irripation SYstem .
45. Sound Atienuation
46. Handicap Regulations
47. PINAL STRUCTURE $ BUILDING
48. FINAL PLANNING
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCV
No. Date
OWNER Co11ePe Mesa Co DATE 9/2�,/55
JOBADDRESS qnq7 n�nna.hronk 7anP BUILDINGPERMITNO. 1�i�y2
�BNERALCONTRACTOR j�jgle CO VALUE $ q�pOO (�
L�., A7 BLOCK TRACT n�l_�
GROUP I TYPE
INSPECTIONS
Footing Trench
Foundation Forms and Gratle to Garage,�
Raugh Framing
Plumbing, Rough to Slab
Plpmbing, Rough Complete �
Temporary Pole
� �Niring, Rough � /
Heating, Rough
' H@at'ng, inal
' Sewe �� se Sewer, Sf.
S� �'c Tank or Cesspool
L .ng, In ��� Out
Plastering �
Plumbing, Final, Fixtures Complete /�/f�/j�
Plumbing, Final Gas Test
Wi�in9, Final G
OCcu pancy � , (% �
DATE
ZONE tU{ FIRE DISTRICT 1$(�(j
SUBCONTRACTOR PERMITSISSUED
DATE � NUMBI
� - � o a i �
_ia_ s- /7i
-�-ss- 3osZ�
.�:_c 3.S 3
(;9sta Mesa Bnilding Department
� � 111 EAST 20th STREET
,�- r COSTA MESA, CALIFORNIA
FOR APPLICANT TO FII.L IN
Building
Address 3037 Donnybrook Lane�
Costa Mesa, California
Nearest }]atS011
Cross St.
owner College lfesa Compac�y
Address 8�02 Central Avem7e,
c�cy Carden Grove rye�e,9-2158
Arohitect or Ltc.
Enginee� Da��is & Quigley No, C-1790
naaress 43 ;Salaga Cove Plaza� Palos Verd
The Ilale Cos an City Lic.3A?2
atractor P Y No.
Address R002 Central P.ve.�Garden Grov
De crption I n ot 87 I siock I Tract 23�}
(AtWch Metea and Bounds)
Size of Lot 78n7 I No. of Bldgs NOII@
Now on �ot
Useoi No.of No.of
Existing Bldg. I Families I Rooma �
Set6ack Line Trom Rear Vard 33 �
CenterofStreet $n� SideVard �' �
Alte�ation I I Addition
Size ���' Y330% itooms 6 Stories 1
' '^rior Wail Roaf
=��^9 Stucco I CoveNng Shake
�se of New
euiidt�9 Sin�le far.�il.y direllin� with
I hereby acknowledge that I have read this Application
and state that the above is correct and agrce to rnmply
with all City Ondinances and State I.aws regulating
bullding mnstruction.
s�gnatureot Tt1EHALE COHP
Permittee
1��/j
AuthoNzed Agt. [�,.�! ` 1 a
GSf(aStt�n �aDN� Permit Fee $ °�„Z.i.
t, Q v� Plan Check $ ,.7 ,
$ V Total 1 /
� Fee $ p ��
RM 204 5-HP 2M &SS
1S6�PPLICATION FOR PL�'1i�1�71�
BUILD�NG
FOR OFFICE IISE ONLY
' I Rece�pt No. I% ermlt,No.
J{/ Z.�7�
Address
' Costa Mesa, California
Plans I L�
CORRECTIONS
i APPROVALS
�n Location I Inspecto
Materials,
Int �1
�
Ext
r, Int
i
r. Ext �
�p
II
Date
�
OWN�R
JOR AD
AY No. i i 1_�f,K_l R LOT
?' -^�PLC770NS
Gas�F.l�I�
r
OCCUPANCY
'OflM 804 � 5M - �
JR.
naTE 11-15-b1
���
'�O1S VALUli $ 3�UUO.UU
TRACT RIRG ZON� llLSCRIPTION OF�VORKI
Signature DA'P� GROUP J TYPE jjj ZONE
PF,R�11
SUIICON'I'RAC'COR r,�.�..,T
R-1
�' �.�s,�:�_
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 977 C08TA MBBA. CALIFORNIA
For Applieanf fo Fill In Complefely
TYPE OR PRINT
ADDREiBS 3037 DONNYBROOB LAI�
COSTA MESA. CALIFORNIA
L A BRANN� JR
OWNER �m
MAIL .,S�yyp
ADDRESS
TEL.
C1TY ' NO.
ARGHITHCT ' TEL. !�
OP .INEER NO.
ADD'tESS
CONTRACTOR �Txa�� POOLS
ADDRESS 587T FIR�STONE' BLVD�.
�,.,,, SOUTH GATE� CALIF.
LIG.NO. � � / NO. �T���� �G
SIZE �/� ./ 1 A A I NO. OF BLDG9. /
�
� 8ET0ACK LINB PPOM
DESCRIPTION OF WORK
BUILDING 659 NO. OF �� �'
81ZE ROOMB STORIES
FXTERIOR WALL � ROOF
COVERING COVERING '�
USE OP BUILDING AND WORK TO BE PERFORMED
S1YIM POOL PRIYATE
1 HlIiBEY ACKNOWLCDCrH THAT 1 XAVB pE1D TX19 APPLIGTION
IWC 6TAT8 THAT T VE IB COflRER AND AGREE TO COM-
PLY WITN ALL Oflpl ANCEB AND BTATE L�WS�ULATINO
BUILDING CO UCTION.' . / /
� AUTHORIZED
FEE RECEIVED
NOV 15196'
FINANCE QEPT.
CITY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
REC2IPT NO. PERMIT NO.
RHCEIVEO HY OATH RfiCE1VED/ DAT2 199UHO
/f Z`y'0 ��� �i�—� b �
iDRE65 3034 DQNNYBROOK LANE
COSTA MESA, CAUFORNIA _
FIRE
ZONE
APPROVED
��
U ZONING " - i��
� INO. OPw / UBE OF N
PLAN9 Y BUILDINO
����o�
LdT 87 TRAC 234T
�o. 1! 3 �a�s--��
i5 EVES
YN6 BTJ
TXE AMOUM BXOWN UNDER VALUATION IB FOR TH¢
PL1PP098 OF 68TABLIBNINO A PEHMIT FEE ONLY.
VALUATION
PERMIT FEE $ /O �
3000.00 �_
$ PLAN CHECK $
TOTAL FEE �� �