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Home My WebLink About2839 ELLESMERE AVE - Building Permits(714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.��LDING PERMIT n FAIR DRIVE, GOSTA MESA, GA 92626 V ,lob Address: 2839 ELLESMERE AV Suite: Viciniry: Parcel Number: 13933507 Zoning: R1 R1 Applicane BRAKKE, EUGENE LAURENCE Address: 2639 ELLESMERE AV COSTA MESA, CA Owner: BRAKKE, EUGENE LAURENCE Address TR COSTA MESA, CA 2839 ELLESMERE AVE . Contractor: OW N ER-BU ILDER Address: �. Zip: Arch : Address: Phone: 714-557-2399 Zip: 92626 Phone: Zip: 92626 Phone: License: 000000 Eng: Address: Status: ISSUED Applied: 10/09/2002 Issued: 10/10/2002 �. � � : �►�./� Phone: Phone: Zip: License: License: SCOPE OF PERMIT LEGALIZATION OF EXPIRED PERMIT #: B060526 - ISSUED 12/31/92. - EXPIRED 11/19/93 DUE TO NO FINAL INSPECTION. 247 SQ. FT. ICBO ALUMINUM PATIO ENCLOSURE. ICBO # 4383P. Plan Check: $0.00 Permit: $0.00 SMIP Res: $0.50 SMIP Com: �0.00 Other: $0.00 Inspection: $0.00 Total: $0.50 SETBACKS MAINSTRUCTURE Front� 0-0 ' ��Rear 0-0 ACCESSORY Front 0. 0 Rear 0- 0 PARKING Exis[inq: o Reauired: 0 FEE SUMMARY PLANNING & ZONING Lek 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 so.00 So.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and relatad regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a perlod of 180 days. I� INSPECTIONS: Iri order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all , required Inepeetions end final approval must be obtained. Failure to obtain inspections and tinal approval will result in Ihe ezpiration of this permit. ' FOR INSPECTIONS CALL: (714) 7545626 ?aa6�a8l�oo) J WORKERS' COMPENSATION �ECLARATION: � � „ I �ereby eHirm untler penelty o� perjury one of the following tleclarations: ❑ I heve entl will maintein e certificate ol cansent to self-Insure lor workars' compensation, es provitletl br by section 3700 of the Lebor Cade, for the peAormance of ihe work for which Ihis permi� is issued. ❑ I heve entl will malntain workers' compensetion insurence, es required by section 3700 of the Labor Cotle, for the pedortnance ol Iha work tor whic� ihis pertnit is issuetl. My workers' compensation Insurance cerrier end policy number ere: Carrier: Pollcy Number: (This section need not be cromp�eted il the permit is velued et one hundred dollars ($100) or less.) �11 certily Ihat in the pertormance of t�e work lor which tNs permit is issueQ I shall not employ eny person in eny manner so es to become sub�ect lo lhe workers' - compensatlon laws ol Ca��omia, end a��s�ltl b e su6' t o he workers' compensation provisions of Sectlon �700 of (he Lebor Cotle, I shall fotlhwith comply with these provis�on . / '^ ( �Iicanl�Sign�atwe:? ��,� /Datej /O �VJ OZ WARNING'FAILURETOSECUREWORKERS' ENSATIONGUVERAGEISUNL4WFULANDSMALLSU&IECTANEMPL�OVERTOCRIMINALPENALTIESANDGVILFlNESUPTOONEHUNDRED TKKISAND OOLLARE (5100,000). IN ADDRION TO THE COST OF GOMPENSATIIXJ, DAM4GE5 AS PROVIDED FOR IN SECTION 37080F THE LABOR CODE, IMEREST, M!D ATTORNEI"5 FEES. LICENSED CONTRACTORS PECLARATION: I hereby ottirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Olvision 3 of Ihe Business and Professions Coda, and my license is in full force antl eHecL Lic. p Class a ContrectoYs SlgnaWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm ihet there is a consiruction lending egency for the pertortnance ol ihe work lor which ihis permit is issued. (Sec. 3097, Civil Catle). � �flndels Name: Landers Atltlrass�. Signeture: Date: OWNER-BUILDER DECLARAnONS: I hereby eflirtn that untlar pena�ry of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor lhe following reason (Sec. 7031.5, Business and Professions Cotle: Any city or counry whicd requires a permit to construc�, alter, improve, demolish, or repair eny s�ructure, prior to its issuance, elso requires Ihe applicam tor such pertnit to file e signed stelement thet he or she Is Iicensetl pursuant to the provisions ot t�e Contradors License Law (Chapter 9(commencing wit� Sedlon 7000) of Dlvision 3 oi the Business end Protessions Code) or thel he or she is exempt theretrom and the basis lor Ihe elleged exemption. Any violetion of Sectlon 7031.5 by eny epplicent for e pertnll sublecis Iha epplicent to e civil penalry of not more than flve hundred dollars ($500).): � I, as owner of Ihe property, or my employees with weges as iheir sola compensetion, WILL DO THE WORK, end ihe strucWre is not IntenUed or ofleretl tor sale (Sec. 7044, Business end Professions Cotle: The Coniractors Licensa Law tloes not epply to an owner of p�openy w�o 6uilds or improves ihereon, end who does such work himself or herself or ihroVgh his or �er own employees, provitletl that such improvemems ere not Intendetl or oHered for sale. II, however, Ihe builtling or Improvement Is saltl within one year of completion, the owner-builtlor will have Ihe burden of proving Ihet he or she tlid not build or improve for purpose oi sala.). ��I, es owner ot ihe properlY. am EACLUSIVELV CON7RACTING WITH LICENSED CONTRACTORS b construa the project (Sec. 7044, Business and Professions �� Cotle: The coniractors License Law tloes not epply ro an owner ol property who bulltls or impmves thereon, and who contracts lar such pro�ect wlth e contractor(s) license pursuaN to the Comractors Cicense Laws.). ❑ I em ezempt n iness and Professions Code for Ihis reason: �Sgnetms_ - �Date:_ Z Owner ID vedlied by ar's li nse. Ves ❑ No �D✓ ~"—r� -� DIVISION OF INDUSTRIAL SAFETNPERMIT CERTIFICATION: ❑ I hereby certity ihat no excavetion flve (5) or more feet In depth Into which a person is required to descend, wlll be made In connectlon with work authodzed by Ihis permit, and that no building structure, scaflolding, lalsework, or demolition or dismantling t�ereol, will be more than thirty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, lltle B, Celilornia Administrative Cotle). ❑ As owner-builder, I will na� employ anyone to do work which would require e permit imm Ihe Division of Industnal Safery, es notetl abwe, unless such person has e permit to do such work irom ihe tlivision. Signature: Date: Division of Indusinal Safery PeRNt Num6er: CERTIflCATE OF COMPLIANCE AND AUTHORIZATON OF ENTHV: I cenify under penelty of perjury that I have read this application antl state Ihat Ihe intortnatlon given is conect. I egree lo compty with all state laws end ciry ordlnences lati to building construction, end euthorize representatives of the Ciry of Costa Mesa to enter upon the ebove-described pro e inspection pu�s. I noI to u r allow occupancy oi eny 6uiltling authorized by this permil un I fne�l�'^spection. /��lf% �Z ��L�epeliOwpei(s)� �D te And�Or Authodzed ApDlicant Date CODE I, INSPECTIONTYYE PAIE INTRIALS 1676 Fixetl System Final Fite Prevention 7266 200 201 202 203 PooV Sps Fina1 Finel Re-Raof Flnel BIocWRetaining Wall Final Factory Fire PIaCe Final Sign 204 Final Demolition COOE� INSYECTIONTYPE 206 Finel Mechanical 20B 210 212 220 Final Plum6i�g Final Elec�ncal Final Fire Prevention Final Planning App�o�al 222 Final Site 250 Final Building/Occupanq QAIE 1li�Lfl Pfl0.1ECTRODNE55: zH3(.� ELLESMERE AV OWNEfl'S NRME: BRAKKE, EUGENE LAURENCE AOUHE55: TR 2839 ELLESMERE AVE COSTA MESA,CA 92626 FHCH/ENGINFEP: ROUXE$$: NEG.NO.: UNIT: UNIT: PEHMITTEE: BGB INSTALi.ERS ( 714 ) 997-8630 aooness: R10 W, KATELLA AV ORANGE CA 92667 ULENSED CONTBRLTOB OECIAPAT10N: I �ere0y aifirm Ihat I am licensea unCer Orovisions oi C�apter 9(tomm¢ncinp vnth Sec�ion 7000) oi Oivlsion 3 0l Ihe Business antl Pmies5ion5 Code, and my license is in tull torce antl eftec�. cirr uc.: 0 3 3 5 srnTe uc.: 3 316 2 9 n��ss: p �, �- U�]� �/�s� i� �a1e'. ` $�q�a�uset _ n �— WOflNEflS' C00 ENSATION ECLANATION: I hereby affirm that I have a certilic3lA o1 ConSent �0 5eti�in5ure or a cetli�iCale o� Worker5' Compensation Insurance. or a cenifieA coDY thereof (Section 3800. Lab. C) aoucrNo.:1317575-92 E%P.OATE: ],OIOiI93 COMPFNY: STATE FUND � Cenifiea copy ¢ nereey lurnisnetl. � Cetlifie0 copY is fi h t�e ciry Building pvisio . �� a�e: �'L ' �L Applicani: I E%EMPrION FNDM WOflKEflS' fAMPEN5RTI0N OECUB�TION: (TNs secuon neeG no� be qleteC il �M permii is fa we huNreA (4100) or less�. I cetlity Ihal in IAe pedormance oi t�e work tor w�ic� Ihis De�� is iuued. I shall not ¢mploy any DQ«n in any manner so as to become su�ject to Ihe WoikerY ComDensation Laws ol Cabbmia. Oale' SignaWre: NOTICE: I�. atter making this tleclara�ion, you shoultl become suble�< <o ihe Workers' Compensation D�ovisions ol t�e LaGor CoaE, you mu5� �orthwi�� comply wi�h such pmvisions or t�is Oe�mit s�all be AeemeU revoketl. CORSiPUCiION IEN�ING �GENCY: I nereby allirm Ihat Inere is a constmction IenAing agenty lor ine pertarmance of ihe wOrk lor w�ic� Ihis permil i5 issuetl (Seclion J097, Civ. C�. LENUEF: ADONESS: OWNEB BWLOEN OELUMTION: I Aereby aflirm tAat I am exempt imm the Comractors' State License Law lor the �ollowing reamn (SetiiOn 7031.5 9u5in¢55 anC Pm1e55i0nal Cotle: Any ciry 01 County whith reQUireS a Dermi� �o conSWt�, aller, im0�ov¢, tlem0lis�, or repair any slNdure. prior lo ils issuance, also repuires Ihe applicanl for such permit to file a siA�eG statement t�al he/s�e is licensed pursuam m Ne provisions o� Ihe Comractors' Slate License Law (Chapier 9(commencing wi�h Seclion 7000) oi Oivision 3 0� the Business ana Prolessians Ca1e� or tha� hrJsne is exempt iherefmm an0 IAe hasis (or Ne allegeG eKemption. Any violation ol Section 7031.5 Dy any aoVlicant tor a Dermi� su�jecis Ihe apDlicanl lo a civil Denally ol not moa inan five nunar¢G edlars (5500�. I. as awner of the pmpeny or my employees with wages as iAeir sole compensation, will Oo Ihe work, anJ me ❑ stmaure is not intenOeA or ollerea for sale �Section 70aa, Busmess and Pmlessional Cotle: T�e Coniractors' State �icense law Eoes no� ap01y m an owner ol a pmpeny w�o OuilOs or impraves thereon, an0 wAo Ooes suc� xrork himsell/h¢rself or t�wugh Ais or A¢r Own employees, pmNO¢a ihai Suth im0�ovemenl5 are noi iniended Or OflereU lor sale. II, howeVer ihe buil0inq Of impmveme0l is sdtl vn��in one year ol cample�ion, Ihe owner will have I�e burden oi pmving �e/sh¢ tlitl no� buil� or im0�ove lor ihe purpose of sale). I, as owner of �he Omperty, am exclusively comracting witA licensed contraciors to constmct ihe pwjecl lSection 7044, Busineu ❑ antl Prolessions Code: The ConVacmrs' Slaie License Law tloes no� appry to an owner ol OropetlY who 6m105 or impmves �hereon ane who conVans �or 5uc� pmlecls wit� a wmracmr(5) license pursuam �o I�e Conirac�ors' Sta�e License Law�. I am aware Ihat Droof tl� ��eir Worker 5 Com0en5dlion insuran[e ShoNG Ge pmvitle0 to me. � I am exemtl� under Seclian: B. 8 P. C. br ihis rea5an: Daie�. Owner: I Eo �erehy ceNty Uwi � am aware ai antl unCerSlanA I�e r¢Quiremenl5 0� Calibmia Neait� and Sal¢ly CoGe Seclions 25505, 25593, antl 25534 and Ihal I or any fulure Guilaing ottupant will/will nol (circle one) neeG lo tomDN ��h 5ai0 siate co0es antl ihe reQuirements tor a permil Iar conslmctian or modi�ication irom Ihe Nir Ouahiy ManaAemeni �islricl. FeSitleniial conslNc�ion ap0�icaiions are exemD� �mm 'IAese provisions. qa�e: Fpplicant: I �ereGy cetlity I�al I have read ihis application ana slale t�a� ihe a�ove information i5 correcL I agr¢e �a comply wilh 311 ciiy antl counry orainancesandstai Ia::srelalinglo�viPoin9conslmdionarbhere��yy��WuNC00__r¢erepre5eniativesof�hiscityjj}�� e uponlhEabove�mentioned properry for'_inspe ion purpo es / , l �� .Uate: �� t Sgnature: � / � �•�:c¢nse or Sociai ApObcan�; Pink—Fevenue Golaenrod—Assossor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 060526 PERMIT NO: B 060525 PLAN CHECK NO: 05027-92 S GOVT: N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR FURPUSE: ALT JOB DESCRIPTION : INSTALL ONE ALUMINUM PATIO ENCLOSURE S� cT: 247 CLAIM VALUE; CALC—VALUE; 9,139.00 GROUP UCC: R-3 / COMMENTS; RE: ICBO REPOR'tti 9383P/ PROVIDE SMOKE DETECTORS PER 1991 UBC +t+t�**�xx��t***�**�r*****�*��rx�*�+c-**�*��**�r�***�**��t**��r�*�*u�� *****�r*��c>'�x*u 7. 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 BUZLDING ---------- --------- ACCESSORY EUILDYNG --------- FRNT: 80 FT IN REA.Tt; 20 FT IN FRNT: FT IN REAR: FT IN LEFT: 36 F'P IN RGHT: 20 FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV• PARCEL; 13933507 2NE; R1 REF NO: PLANNING N(31'ES> 247 SQ. FT, PATIO ENCLOSURE LOCATED AT REAR OF EX. SFR, i *��r,�*��*,��«*�*��******�e*,��*�******,�#*�e*�x�****��****��***�**�**��>*��**�*-� 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 7.ONZNG APPROVED BY S C� DATE; /�• / 3/�^�� .' BUILDZNG APPROVED BY :� DATE: _f� ��.2 APPLICATION ISSUED BY: DATE: ��€��Z lf3EifaFaEifikiFiEiFiF�lEififiFaEififif#iF�E � . . #�jkifiElfatjf�ifiEiE 3Eib iFiFitiiiEiE�7FiFif�iFIf3FIFRiEi('iFiEifiFiEiFiFlEiEiF'3fiEiEiFiEiFiEifa6if1FiF941c�16ifiE�7F �ifiElElEifi!�iFif�l!iE14?fifi6iFii��ElEiEIE-1c�7FiFifiF3Fii�1F1Ei(�iFiF3F LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y HLDG PMT' PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMZT 717,00 ,91 SMIP/NON—RES PL�AN 76.05 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID DUE TOTALS----> 117.91 0.00 76.05 193,96 193.96 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 193,96 OVER/SHORT; .00 BLDG PMT PLiIMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—('HECK 117.00 .91 76.U5 if iF iF iF iE fF iF if iEaf if if 3E iFjF if iE �14 if ik if jE iE iF i(� if if� iE iF IF iF if N� �f if if �E if * 14 iF iE iE 34?E if If iE 3(� if it 3i if� �F if iF �F # iE iF i�� if -1f �f i(� iE �f 1E IE iE �1E iF 1F iEiF 3(� aE )E if� I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R, I F T Z O N UNIT COST TOTAL COS'F' �,SFR 247 RES—PATIOiCOVER—ENCLOSED PATIO 37,00 9,139,00 � ET3D OF FEES EXPIRED � plot liu�t� � ��.�-o�� _ j L ' �P �j(i� � ��9 �a � '� DEC 31 1992 � CITY OF C�STA MESA • c..J'�ti CONSTRUCT�ON ANDPLANNING APPROVALS Permit # 1. Temporary Electrical Service or Pole 2. Soil Pipe�Undrgcnd. , 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit�Undrgrnd. - 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings 8. Foundation 9. Water Pipe-Undrgrnd. � 70. Structural Floor System 1 t. Property Sewer Line & HousaEonnection 12. Sewer Cap 13. Roof Drains t 14. Rough Plumbing � 15. Rough Electrical-Condurt 76. RoughElectricWiring � 17. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Hea[ing & Air Condi;ioning � 20. Rough factory Fireplace 21. DuCts,in Structure 22. Ducts, Ventilating 23. Gas Pipe�Rough & Test 24. Foof Framing 25. Roof Sheathing 26. T•Bar Ceiling (Structural) & Monocoai 27. Frame and Flashing 28. Lathing & 5iding 29. Insutation 30. Drywall Na�ling 31. Plaster Brown Coat 32. Elecirical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Ga: Pipe�Tesi 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plump�ng 39. Water Service-Finai 40. Gas Service•Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Re9ulations 47. FINALSTRUCTURE&BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to $outhern California Gas Co 51. CERTIFICATE OF OCCUPANCY Jo. Date ___ _ Date Inspecior 0 POOL a SPA APPROVALS Permit # Date 52. Pool & Equipment Location 53. Steei Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Piumbing & Pressure Test 57. APPROVA�TOCOVER-GUNITE 58. E�ectrical Cqnduit•Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent�Final 64. Pl�mbing System - Final 65. E�ectrical�Final 66. Solar System-Final 67. Fencing & Access ApProval 68. APPROVED FOR P�ASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hytlro 77. Product Piping OGas ❑Oil 72. Underground Flush ' 73. Undergmd. Storage Tank � Gas ❑ Oit ' 74. Overhead Hydro 75. Ory Chemical � 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Pnspector CA �. �k ; (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 uniLs) 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 htotors to t np blolOrS to 10hp �;otors to 50hp 6lotors to 100hp PAotors over t00hp 2839 ELLESMERE AV 13933507 BRAKKE, EUGENE LAURENCE TR 2839 ELLESMERE AV COSTA MESA, CA BRAKKE,�UGENELAURENCE TR COSTA MESA, CA 2839 ELLESMERE AVE Phone: 714-557-2399 Zip: 92626 Phone: Zip: 92626 Phone: Zip: License: Status: ISSUED Applied: 10/09/2002 Issued: 10/10/2002 SCOPE OF PERMIT LEGALIZATION OF EXPIRED PERMIT E 060527 - ISSUED 12/31/92 AND EXPIRED 11/ig/g3. REF: 8060526 - EXPIRED 11/19/93 FOR PATIO ENCLOSURE PERMIT. REF: 802-01650 FOR BUILDING PERMIT FOR FINALIZATION. 3 OUTLETS INSTALLED FOR PATIO ENCLOSURE. so.ao $0.00 $0.00 so.00 $0.00 �o.ao $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 �uantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System I Lighting Busway /100 k Standing Section Misc ElecVical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 700 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stantl Fireworks Stand Other Electrical Fee Quantity so.00 0 $0.00 0 $0.00 0 $0.00 0 so.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 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regula�ions. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced vnthin 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectlons end final approVal must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit. FOR INSPECTIONS CALL: (714) 75M5626 zaae�ae �doo� WORKERS' COMPEN&ATION DECLARATION: — � I hereby eflirm untler penalry of perjury one of Ihe lollowing decleretions: ❑ I heve and will meintain a cenificate of consent to salf-Insure for workers' compensetion, es provided tor by section 3700 of the Lebor Cotla, for ihe peAormance of the work lor which this permit is issued. ❑ I have and will maintain workers' compensatlon Insurence, es required hy sectlon 3700 of the Lebor Cotle, lor Ihe peAormance ot ihe work lor whicl� Ihis pertnit is Issued. My workers' compensation Insurance cerrier end policy num6er ere: Cerrier. palicy Number. (Thls section need nof be cromp/eted i/ fhe permit is velued et one hundred tlollars ($100) or /ess.) �f 1 certily that in the Pertortnance of iha work for which Ihis permit is issueQ I shall not employ eny person in eny manner so as to become suD�ect to Ihe workers' compensation laws ot Calilornia, antl egree Ihet II I sho d become subje orkers' compensation provisions of Secti n 37pppppp 0l the Lebor Code, I s�all iorihwlth comply with these p�ahsi� �� 9� /� 2 APP�ri�. ,9s na• �ure:� . . ete: �; / WAR N0: FAILURE TO SBCUPE WORK RS' C IPENSATIdJ COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVEF TO CRIMiNAL PE TIES ANO CIVIL FINES UP TOONE HUNDRED TTIOUSAND DOLIARE (5100.0001� IN ADDITION THE COST OF COMPENSATION, DAhNGES AS PROVIOED FOR IN SECTIOfJ 3'10fi OF THE LABOq fAOE. IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACYORS DECLARATION: � I hereby aNirm ihat I am licensed under provisions of C�epler 9(commencing with Section 7000) oi Division 3 of the eusiness and Prolessions Code, entl my license is in full torce end eHect. Lic. M Class k Comrector's Signature: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby eflirm the� Ihere is a consWc�ion lending egency for ihe pedormanco ot the work tor which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lentlers Address: Signeture: Date: OWNER•BUILDER DEGLARATONS: I hereby eNirm ihat unde� penalty of perjury Ihet I em E%EMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (SecJ031.5, Business and Pmfessions Code: Any city or counry which requires a permit to constmct, elter, improve, demolish, or repeir eny stmcture, prior to its issuance, also requires tha epplicant for such permit� to ille a signed statemen� that he or she is licensetl pursuant to the provisions oi �he Contracbrs LJcense Lew (Chapter 9(commencing with Sectlan 7000) of Division 3 of Ihe Business entl Protessions Code) o� t�al he or she is exempl lherefmm and the �asts tor the alleged examption. Any viWation ot Sectlon 7031.5 by any epplicaM for a permM subjects the epplicant to a civil penelty of not more then tive hundred tlollers ($500).): ❑ I, as owner of the p�operty, or my employees wlih wages es iheir sole compensation, WILL DO THE WORK, and ihe strucwre Is not Intendetl or oflered for sale (Sec. 7044, Business end Protessions Cotle: The Conlractors License Law does not apply to an owner ol propeny who builds or improves ihereon, and who does such work himseli or hersell o� through his or her own employees, pmvidetl Ihet such improvements ere not Intended or oHered for sele. Il, however, the builCinp or improvemen� Is soltl within one yeer of completion, the awnerhuilder will heve ihe burtlen of pmving Ihet he or she did not build or improve for purpose ol sale.). � I, es owner oi the p�operty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo construct the pro�acl (Sec. 7044, BuSiness entl Professions Gode: The contrallors License Law tloes not epply to en awner ot properry who builtls ar improves Ihereon, antl who conlracts lor suc� pro�ect wlth e contractor(s) license pursuant to �he Coniractors Licensa Laws.). ,,, � ❑ lem Owner ID vedfied by EnveYS/license, VedtksUon of Ow�ershlp 6y (type of end Prolessions Code lor this reason: Yes ❑ No OrNe�i�sW.t,Gcensa No. �.I.e. - property tax 6iil a tlaed)�. DIVISION OF INDUSTRIAL SAFETV�PERMI7 CER7IFICATION: ❑ I hereby certify thel no excavetion tive (5) or more feet in depih into which e person Is required lo descend, wlll be metle In connedlon wllh work euthonzed by this permlt, antl ihat no building structure, scaHoltling, falsework, or demolition or tlismantling thereof, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, CelifoMa AdmiNstrative Cotle). ❑ As owneo-builder, I will not employ enyone to tlo work which would require a pertnit Imm the Divlsion ot Intlustrial Safery, es notetl ebove, unleu such person has e pertnit lo do such Work from ihe division. Signature: Date: Divisian oi Intlustrial SafaN Permi� Number: CEpT1FlCATE OF COMPUANCE AND AUTHORWITION OF ENTRY: I certiy under penalry of perjury ihat I have reatl ihis ap0��ion and state that the informatlo� glven is correct. I egree to comply with ell state laws entl dt ordinanc el t� to building construc�lon, antl euthonze representatives ol the Ciry ol CaSta Mesa to enter upon the ebove-descda �tl r �or inspection pu e e noI G cc pJOr allow accupancy of eny builGing authonzed by Ihis permit until fi al in clion. y�� ..�[� /.Q��d.��2 ��'��gn�aturi�e:Ot � T� wner(s).J= �Dei � And�Or Authorized Applicant Date COOE 1. INSPECTIONTYPE 1616 Flxetl System Final Fire Preventlon 1266 Pool Spa Final 200 Flnel Re-Roof 201 Final BIacWRetBininq Wall 202 Final Factory Fire Place 203 204 Final Sign Finel Demolitian PdIE It�kfl COOEI INSPECTONTYVE 206 Finel Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Apprwal 222 Final Site 250 FinalBuilding/OccuDenq Q� � h �ectnoosess: zg39 ELLESMERE AV OWNEfl'SNRME: BRAKKE, EUGENE LAURENCE pDOPESS: TR 2839 ELLESMERE AVE COSTA MESA,CA 92626 ANCN/ENGINEEfl: nooeess: HEG.NO.: uxir: uxiT: • PEXMITTEE: BFvH 7NSTALLERS ( 714 ) 997-8630 aooness: 810 W, KATELLA AV ORANGE CA 92667 LICENSEO CONTFACTOH OECLRHFTION: I herehy ailirm that I am licensetl untler pmvisions oi Chapier 9(commencing wilh Section 7000� of �ivisiun 3 oi I�e Business and Vrotessmns Gotle, antl my license is In lull lorce and el�eci. ciTr uc.: �9 B,�S a.e uc.: 3 316 2�ss: � Date: � � SignaWre: _ _ _ � _ _ WONNEBS' COMP NSATION OECIAflATION: I hereby a��irm that ve a cenilicate a c se o sell-in ure or a cenilicale of workers' ComDensalion Insurance. or a cenifiee copy Inereof (Section 3800. lab. C). POLICYNO.: SiI�IS%S-9Z E%P.DRTE: SU�O1I93 'COMPRNY: S�I�ATE FUND � Cetliii¢E CopyI1S �¢reGy �ur ' AeA. W Ce�i�ied toOY �s �ile with ihe city BuilAinB �'�nn. �aie:—I�'� 1—�L11—� +_�� AV�Iitani: � E%EMPTION iBOM WUPI(E85' fAMPENSATION DECUPATION: (This SecYan necd nol Ee omplete0 il Ihe permil is for one �un r � or less�. 1 cerlily I�al in the petlormance at I�e work lor which t�is permit is issued, I 5hall no employ any p¢rson in any manner so as to become suElecl lo �Ae Worker5' CAmpensatian Laws o� Calitomia. Oate: Signature- NO710E: II, atter making I�is Ge6laration. you should bewme subjeci to I�e Workers' Compensation Oramims ol t�e Lahor COOe. yau must lonhvn�� comply wit� such pmvisions ar Nis permit stull Ee GeemeG revokeE. CONSTflUCTION 1EN01NG RGENCY: I hereby allirm �hat �here is a consimc�iw lentling agenty �or t�e pedormante ol t�e work for wnic0 Ihis permii is issuetl (Section 3W7. Civ. C�. LENOEfl: FODPESS: OWNEP BUILUEB DECIABATION: I hereby aifirm t�at I am exempt iwm t�e Comractors State License Law br the following reason (Sectian 7091.5 Business anA Pmlessional Cotle: Any ci�y of coun�y which reQuires a Oermil to constmci, alter, impmve, demolish, or reDair any S�mCiUr¢, pri0r �o ils i55uante. a150 require5 Ihe apphcanl tor suth permil l0 lile a Sipned Slalement I�ai h¢/She is litens¢tl pursuanl Io ��e pmvisions of I�e Contraclors' State License Law �ChaO�er 9(commencinp wiN Sec�ion 7000) ol Oivision 3 0l �he Bu5ine55 ana Pmlessions Codel or Ihat helshe is evempl lnerelmm ane the basis for Ine a�leAeA eremption. qny violalion ol Seclion 7031.5 by any a0�litanl lOr a p¢rmit Subleti5 Ihe aOD�itanl Io a tivll penalry o� n0i more Ihan live huntlre0 tlollan (5500). I, as owner of Ihe D�openy ar my employees with wages as I�eir sole compensation, will Ao ihe woB, antl the ❑ simcwre is noi inlentleG or o��ered lor sale (Section 7044, 9usiness anG Pmiessional Code: The Contraclors' S�ate License Law , Does noi apOty m an owner oi a pmpeny w�o builds or impmves thereon, antl w�o tlaes suc� work �imsell/herseli or thmugh hi5 Or her Own employ¢es, proviEeG �hat Suth impmvements are no� inlendetl or ofl¢reG �or Sal¢. II, AOwever IAe Luilding Or imprOv¢m2n1 is sold vnihin one year o� wmple�ion, the owner will have Ihe burden o� proving he/5he dia n0� 6uiltl or impmve for ine purpose ol salel. I, as owner ot me pmpeny. am exciusively contracting with lirensed coniractors la cons�md Ihe D�ale�� (Section 7044, Business ❑ anA Pmfessions CoGe: The Conlrac�ors' Slale Lit¢nse Law aoe5 n01 apP�Y �o an owner o� O�opefiy who �UAUS or im0�ove5 ��¢reon an0 w�o conlracts for suc� O�ole��s wi�� a wntractor(s) license pursuam to tAe Contractars' S�ate Licenu Law�. I am aware IAai Oroot o� Nei� WOBei 5 Compensalian in5urante Should b¢ pmviGeE IO me. � I am ¢eemD� un0er Section: B. 8 P. C. lor Inis reasOn: oaie: Owner. I oo nereby cenity Inat I am aware ol an0 unaerstana tne reqwrements ol Calilomu Heallh anA Safery Coae 5¢ctions 25505, 25593, an0 2553E antl Iha� I or any fuWre �uil0ing occupanl will/will no� (circle one) nceC lo compty with saitl itate cades ane ��e reQuiremenis �or a permi� lor consimc�ion or motlilica�ion �mm Ihe Fu Oualiry Management DiSiric�. flesitlenlial conSlmc�ion aOVlicalion5 are exemD� ��om IIICSC pf0Vi5i0�5. Date: PpplicanC I hereoy certity Inat I have read Ihis avPlicalion antl state ihal ihe above inlormalion is correcL I agree to camply wiln all tity an0 counry oiamanre5and51alelaw5relalingloUuilDingcon5lmclionanOherebyauthonzerepresenta�m¢solthisci�y emeruponl�eaEove-mentione0 pmpetlY �a mspecU n Durpo 5. � Oate: , �L"' Signa�ure: � i Oriver's License or Social Securiry t6at�a6 Whito—Builtlina'. Green—Cotle Enlor<emenL Canarv—Aoolicnnl; Pink—Revenue: GOltlenroG—Assessor CITY OF COSTA hIfiSA — BUILDING PERMIT PERM NO: E 06052" PERMIT NO: E 06052'7 PLAN CHECK NO; N GOVT: N SUPP; N CONSTRUCTION TYPE: 5—N PERMIT TYPE; ELE PURPOSE: OTH JOB DESCRIPTION : INSTALL ONE ALUMINUM PATZO ENCLOSURE SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS; RE; ICBO REPORT41 4383P/ RE: B60526 PRIMARY BLDG. PERMIT. ��r***��*�x*�r****�r��*��r�r**�*�****� ��c ��**x�*x**��*****��+�**�*+��*�*��****�*x**x�x K K 7, 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 BI3ILDING --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN FARKING RE�j • PROV; PARCEL: 13933507 ZNE: REF NO: PLANNING N�STES> 7 if iE 1E if 3f iE if iE iF if if iE iF iF if l� K� 1F �f IF 1F iE iE iElf ik if 1f 1E 1h 7f'if if %if af iF iF iF if 1f ih �f iE �f iE if �lf if if ib iF ik Ik ih ikiE �h iE iE if iE if 1E if� iFjf �E ib �F iE iE 1E ff iE iF N-i! iE D E V E L O P M E N T S E R V I C E 5 R E Q U I R E M E N T S ZONING APPROVEA BY DATE; BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY• _—_��at.�'�� DATE' ��5�� kiEk�IFifiF9fiFiEiE1E1E�EiEiF�/E�1F%�1f3E1fIE�'�F' � jfikjFifiE�Eaf)FiFiF iF* iFitiEik#E1F#iEiEifjf#iflfiEaFiEif�aEiFjfifiEiFlfiE�liF�f�ifiEiFiFiFiEiF�fiFiEaEifkifif1E3f1f F1fiFiE±E1F#�1FiFkaEifiE�EififiFiElEaFaEififiEif�fiEafV.�ii�ifN� LEGALI7.ATION;N F E E S U M M A R Y STkUCTURAL SEGMENT:N PERMIT BLDG PMT PLUMBING ELEC�RZC� MECHANIC FIRE SMTP/RES GRADING 503 SMIP/NON—RES PLAN ISSUE FEE 15.00 HUILDING—DIV—> PERMIT ISSUE PLAN—CHEC3( TOTAL PAZD DUE TOTALS----> 2,25 15.00 O.OU 17.25 17,25 ,OU REVENUE DIVISION TOTALS--> COLLECTED: 17,25 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR 17.25 jF iE if �E �E ik ik 3E ff iE �I(� if� �f iF?F iF if-iE iE �E iF �f jE iF if 3E iE #!� K� if 1� iF if �E ak iE iE?f jF jf iE if iF iE �E �f 3f iE IE it iE i!� iF if iE aE iE iFiF 3E iF-1i-?(- a(� If aE �f 3E 3E iF jF # 3E if if jF ii )E a!� I N D I V Z D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE � 3 RECEPT/OUTLET 1 ST 20 EA. :75 2,25 �ND OF FEES EXPIRED I plete Irsfwctions � � ��'i .�� t - DEC 91 i�� a �.d �1TY OF CQSTA M� "�� CONSTRUCTION AND PLANNING � PO� SPA ��" 9 APPROVALS Permit �`r Date Inspector p�ppROVALS Permit # Date Inspec2or i. Temporary Electrical Service or Pole , 52. Pool & Equipment Location � 2. Soil Pipa•Undrgrnd. 53. Steel Reinforcement � 3. Electrica� Conduit Utility-Undrgrnd. ' 54. Forms 4. Electrical Conduit�Undrgrnd. � 55. Electrical Bonding ' 5. Steel Reinforcement �. � 56. Rough Plumbing & Pressure Test 6. Electrica� UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electricai Conduit�Undrgmd. 8. Foundation � 59. Gas Pipe, O Undryrnd., Test 9. Water Pipe�Undrgrnd. ' � 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structura� F{oor System 61. APPROVAI TO DECK 11. Property Sewer Line & House Connection .. '- 62. Backwash & Receptor�Final . 12. Sewer Cap 63. Heater & VenrFinal - 73. Roof DrBins 64. Plumbing System � Final ' 14. Rough Plumbing ' 65. Electrical�Final 75. Rough Electrical-Conduit 66. Sotar System-Final 76. Rough E�earic Wiring , 67. Fencing & Access ApProval 17. Rough Wiring Sign . 66. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rou9h Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Pipin9 OGas L70i1 23. Gas Pipe•Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergmd.StorageTank OGas ❑Oil ' 25. Roof Sheathing 74. -Overhead Hydro . ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �. 27. Frame and Flashing 76. Ory Standpipe � - s � 28. Lathing & Siding 77. FIXED SYSTEM FINAL ' 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 37. Plaster B�own Coat 79. FINAL INSPECTION - 32. Electriwl Power Meter�Final S0. FOOD CERTIFICATE ISSUED 33 Final Electric Notes: 34. Final Heaiing & Air Condidoning • 35. Final Gas Pipe-Test 36. Nood or Canopy 37. Final FactorY Fireplace . 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final ' 42. Backflow Preventer 43. Backflow Irrigation 44. LandscaPe Irripation System ' 45. Sound Attenuation 46. Handicap Regulations � . 47. FINAL STRUCTURE & BUILDING ' 48. FINAL PLANNING � 49. Elearic Release to Edison . 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY No. Date ` � ��d�2� G��l �� t /o/¢/�� , �� L�✓� �� r �� C� � �....�� ' ' � � ��4`C%A V � lJQ/� / Uh � OY/�� /�,/(� -.8 [�/ �!� (� . �`/' " - � � /�� -y � , �,�� `� ,��-�- �- ,�-�-�-��- _ ,�.-;�, �-�-� � �� ,�e� � _,�-� , ��°�� . ,�.� -� '�' _;��--� � ,�� µ"�` ,��,�- �''I� � � ,,�,�;��- �,� �' �� '�� ¢/ �"��- �. 3 � � 2�3� � � clM 92 (�26 ►� Q�� ^ �� 3 .t�6Lc.�- C r�, . JUL 311969 ��.- COSTA MESA BUILDING-SAFETY DEPARTMENT / � �� (��QT, P. O. BOX 9f7 COBTA M68A. CALIRORNIA (�yrv y�p r�6ff@Yp l!!'tf�P U111 Vf bW�oy R9fi'JH For Applicanf fo Fill In Complefely APPLICATION FOR PERMIT TYPE OR PRINT gU1LDING ADDRESS ' � EL�t��9E=�C e • COSTA MESA. CALIFORNIA FO� Office USE Qnly Pacesetter ft. V2IIt73I'e aece�rt No. �P�q�rt�J OWNER C) MAIL . 1653 �$ �[ij]OiCa aeceiVgG ar O�J� RECEIVEO owre iesusy ennorec �f'� %-�.=-1� i-'Z�_/_% Mesa Verde Builders Inc. , riO3tH ]tf[838 7500 r-i:,r-�_c3:a.r.n � BUILDING No: Ki 9-0395 . I NO. OF BLD69. O � I LEFT 7 I RIGHT / DESCRIPTION OF WORK I X II .. �.-...�...v I II .....�..�.. Standard Plan No. 1 HERBBY ACKNOW G8 T T 1 AND BTATH THAT H A60 IB PLY WITH ALL C 1 CE9 BUILDINa CONB U . / 0 1 AUTHORIZED I,1. y8 1 BUILDING COSTA MESA. CALIFORNIA FIRE I/ 9C ZONE TYPE V GROU APPROVED BY DATE ZONING ZONe NO. OP /J UBE OF NEW S�'. �' R�I I PLANB (,.� I BUILDIN6�.j �/�-� LEOAL � � �v yOQ� D88GRIPTION �� uxe er.� 'Y b 7 N/, ybr nouauucu guav5v � 450 Sq.Ft. 4WT1ON THE AMOUNT 9HOWN UNDER VALl1ATION le POR TH8 TO COM� pUPP086 OP EBTABLI8HING /� PERMiT Ffie ONLY. 'U TI O � VALUATION �j� G� PERMIT FEE $ . �l/� S /�Dy/ � PLAN CHECK $ �� ,.,,.., «< a S7— . .- �.. ` ' % � 3056 f. � COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant ta Fill in Completely M 24-6�001936 0****� cnsa $.00 APPLICATION FOR BUILDING PERMIT RECEI/�' D BV D/�TE flECEIVED DATE ISSUED /N'� % a. lL ^/ Q "7 .1 . /. _ / n PER OWNER � � • � -✓`� — MAIL ADORE 5 2 y3 �� l�r Z ADDRESS � ./ - ✓�- W W TEL. TRACT�OO� LOT � a U ci7v No.S L- / 9 �Z w Z Q CANSTRUC'�ION ON LENDER �� am J � BRANCH ` J N OWNER / k .✓� a W/� m J ADDFESS /��, � � VALUE J m ARCHITECT TEL S �%O��l�' $ a ORENGINEER ♦ N � �L� V Q d FIR � W� AODRESS % j'd p i /— .//� IONE TYPE GROI d w APPROVED � W Z CONTRACTOR %�� / y 8Y DATE J � m Z ,p �/ J � ADDRESS / � L (� j/ � W w TEL. ` E NO.OF� / USE OF NEW � � � PLAKSy BU�LDING z� CITV � � / NO. 7� " 3) d � W � STATE CITY �'ARDS APPqOVED YARDS Af j O LIC. NO. � � ��. No. �y� 9 MAIN BUILDING ACCESSOR' SIZE �I NO.OF BLDGS. (FROM C/L STRE ) OF LOT � ,� J� NOW ON LOT ROM � USE OF ,�- EXI5TING B�IX'i. 7 F SIZE OF NO. OF Z NEWBLDG. ROOMS STORIES L.SIDE FT. � U EXTERIOR W�+LL ROOF COVERING COVERING REAR FT. J USE OF BUILDING AND WORK TO BE PERFOPMED OI5TANCE BET. BET. MAIN & �' MAIN BLDGS. ACCESS. BLDC a Q � VAR.# DATE O li. ( C.U.P.q� APPROVED r P.PPfiOVED N � z � UI hereby aCknowlatlBa that I have rBetl this epplication antl steto � thut [he ebe�o intOrmotion is cOrreGt anC apree to comply with � ell lews ragulating builtling construciion, antl I shell no[ amp�oy F eny porson �� olation of Me workman's eompensation laws of y ma Ste�e ol Califomie. zI haroby ca/iify Net I em propariy Iicensetl as e contrecmr untler SQ. FT. the Staro of California Business antl Professions Cotle, Dlvisicn 3, THE AMOUNTSHpWN UNDER VALU� Chapmr 9, A�tl t�a[ such licenses are in full fOrca antl atfect, or I TNE PUFPpSE OF ESTABlISHING A PERN um axampt from ffie orovisions ot Na Stata ot Celifornia Business VA WATION antl Protassions Cotle, Division 3, C�ePter 9. � PERMR FEE $ .� SIB^nturo of /^' / /{� ,. Permltroo ` S C� �y„�� "-.� PLAN CHECK $ �J ti (J Autho�Izotl Apa�t � TOTAL FEE 5 �— FT � � 0 � 0 FOR ^ ILY: � ¢ m N � m `o LL '' 32654 ,� . COSTA MESA BUILDING-$AFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CAIIFORNIA 92626 Z . aU F- Z Z � O �n a m J � J N Q W p] J •m J Q U� Z a W � d W W Z J Q m Z J � W w O= ZF w� � � PAIO 34.50 JAN 21-7lcesaOO G51� �*** APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �'^� RE��D 6 �^TZ `CEIVED pqT�ISSUE% BUILDING � J L� ADORESS /j � OWNER m.�_ /p�r�� ,� � A.P. NO. �% 3�`O PEFiMIT NO. MAI L �� 7 �� BUILDING ��3 9 W✓�� ADDRESS 7 ADDRESS � /�_ TEL. TRACT UOO LOT� BLOCK CITV �,Di(i/Lp� �'C\ NO. CANSTRUCTION •.�_ _ p W AD A P LENDER r�-c�^�` BRANCH OWNER AODFESS VALUE ARCHITECT TEL. SE $ OR ENGWEER _ N FIRE ADDFiE55 ZONE TYPE GROUP APPROVED CONTRACTOR BV /� DATE I�L/� / ADORESS U S 0 %f7M�t/ /� TEI. ZO —/ NO.OF USE OF NE PLAN$ BUILDING CITY �iy�' CL✓�( NO. STATE CITV �'ARDSAPPROVED YARDSAPPROVED LIC. NO. � S� LIC. NO. MAIN BUILDING ACCESSORV BUILDING OF LOT 7 .�D x�� OW ON LO � (F EE FT. USE OF � / E%ISTING BLDG. 51 FT. FT. SIZE OF NO. OF � NEW BLDG. R OMS / STORIES L. SIDE � FT. FT. EXTERIOR WAI.L RqOF •"+tiG COVERING COVERING REAR FT. FT. USE O BUILDING AND WORK 70 BE PEFFOFMED OISTANCE BET. BEf. MAIN & MAIN BLDGS. ACCFSS. BLIX'a5. VAq. � DATE � �'aw\ C.U.P.# APPFOVED APPROVED �. �� % I hereby acknowletlge that I have reatl [his application antl s[ate / that the abOve iMormation is correct and apree ro comply with all laws regulating builtling consbuction, antl 1 shall not employ any perwn in violation of [he wOrkman's compensatiOn laws of the Stare ot Calitornia I � I hereby certify that 1 am properly licensatl as a conttactor untler �L SQ. FT. � i the State of California Business antl Professions Cotle, Divisicn 3, THE AMOUNTSHOWN UNDER VALUATION IS FOfl Chepter 9, antl that such licenses pr0 in (ull torc0 nntl etfe[t, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am enempt irom Ne provisions of the State of California Business � VALUATION A a � antl Professions Cotle, Division 3, Che 'ter 9. PERMIT FEE 5 6J • 0 � ! Signaturv of �,� '/�1�� ,(�{/a O� ( O � Permittee � $ z,�/ Q PLAN CHECK $//� � Authorizetl Agant / y"� G1 � TOTAL FEE 5 � / � S