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HomeMy WebLinkAbout1031 EL CAMINO DR - Building PermitsApplicant to fill inall spaces CITYtDF COSTA MESA CONSTR TION PER T -- PERM I NO. /o3i � _ ��/rJ/ND Project)Address q , / 4 n� - °Applicant's Mailing Address 73 VZ4t /7f7 /%0-0N ' Owner's Name' rD/'yI �2jT �N�Cj� - Phone= Z' ' Address �U ��'-��-��� d9l Arch/Eng.- License No. Address Contractor's Name �^t I Phone Address(mailing) /'+z73 USA' (JyOW Aywl vgvi;i , City'Lieense No. i 137 //6 LICENSED CONTRACTOR DECLARATION ' I hereby affirm that'I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and 1� my license is in f I f f'j� antl tett. ' 1 `' License Cl S. ✓ License Nm G�� 7 OiQ Date///(F �� Signature a WOR COMPEN,1SATION DECIL"ATION 'hereby affirm that I have a certificate o1 consent o self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 1 10Q LabC. C wC )� So s /✓ Policy No.. ompany IIr�����''IIII �� f`rtlfie cop is hereby furnished. LlS lertl If I filed with the city Bui Ing D' o Date I Applicant -EXEMP 10 FROM WORKERS}COMP I SATION D LARATI N (This section need not be completed if th ermit is for ne+hundred ($100) or less). - , I certify that in the performance'of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Data ` - Signature ' NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Lobar Code, you must forthwith comply; with such - provisions. or, this permit, shall be deemed revoked_ CONSTRUCTION LENDING -AGENCY ' ' .. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued .(Section. 3097 "Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License -Law for the' following reason (Section 7031.5 Business and Professional Code: Any city or county which requires.a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement'that he/she Is licensed pursuant to the provisions of .the Contractor's License Law (Chaptei.'9'(commencing with Section 7000) of nivision 3 of the Business and Professions Code) or that he/she is exempt srefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a .permit subjects the 'applicant to a civil' malty of not more than five hundred'.dollars ($500): . E] 1, as owner of the property or my employees with .wages as their sole compensation, will do the work,;and the structure is not intended or offered for sale (Section, 7044, Business and Professional Code: The Contractor's' License' Law does not apply to an owner -of a property who builds or'improves' thereon, and who does such work himself/herself-or. through his or her own employees, provided that such. improvements are not intended or offered for sale. If; however, the building or improvement is sold within one year of com- r pie rm the owner will have the burden of proving he/she did not build or im- ) drove for the purpose of sale). L I, as owner of the property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an'owner of property who' builtl$ or improves thereon, and who contracts for such projects with a can. license pursuant to the Contractor's License Law). I am aware,that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason D ate Owner -I hereby certify that I have rear „uthc I— the above ,,rdinances within -heavy border lines and sign.all appropriate decla'. [ACT NO. - LOT'NO'. UNIT NO•. s TYPE OF CONSTRUCTION I I NEW - IJ ADD LJ ALTERATION LJ REPAIR' S , ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A.P. DESCRIPTION OF: WORK/USE OF BLDG. TYPE OF PERMIT���yyylll''' 'LI GRADING FOUNDATION '❑ STRUCTURAL- El TRUCTURAL❑ TENANT ¢+y ELECTRICAL' ❑ PLUMBING ❑ MECHANICAL ,. / r ❑'OTHER - , PROJECT DESCRIPTION Sq. FT: OCCUPANCY ' CONSTRUCTION TYPE _VALUATION $ ' ZONE GRADING CU. YDS. ACRES it Sink ackflow Preventer ackflow Irrigation 0 PLUMBING ? IF Showers Service Sink' Sewer Cap Sewer Connection ! Solar Collectors _ Solar Piping Solar Tank Floor Drains I Swimming Pool w/Spa Floor Sinks r - -Urinal Gas Gas Service ' Outlets '-' Water Closet - Interceptors , -Water Heater Kitchen Sink _ Waller Service Lavatories' .Auto -Wash Roof Drains Reinspection'Fee 1 .,,Laundry Trays _ $15 Issue Fee +MECHANICAL _ Boiler - Duct - Under Ground Duct -Structural , Duct - Ventilating Exhaust System ❑ Multiple ❑ F irepl/Fact. Bit. ICBO ,# Heating System & Ducting ' 1J0.100,000 BTU-❑100,000BTI 'I Inspection Pur ds sf' :// Signature e a Date o Y Drivers't Li SS # _ �% Reinspection Fee '$15 CMF 0865-46, rev. 10/84 White Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or, Type ❑ Canopy, Type II ❑ I Refrigeration System 00-100,000 BTU;0100,000 BTU System Repair/Alteration Fire Dampers Registers 76501 i i/2I %86 .TL E T _� -. Front- SUMMARY OF FEES 1 _ _ - - Z. O, ARear $' PLAN CHECK t .. -t N C Right ; ISSUANCE $ PLAN CHECK 25% N .S Left I ELECTRICAL [.; _ !GRADING G R Ping. Ref. # ;MICROFILM Parking Req./Provided. ., E' Planning Notes: I - - - OM, TOTAL FEE $ • PLAN CHECK 125% $ S. I ELECTRICAL j FEES Automatic Washer, I Construction Pole Sub. Transformer ❑ 15.50 KW ❑ - 50+KW Cooking Unit• Meter El up to 100 amps Dishwasher Meter. ❑overf100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors l]0-1 HP ❑1'/:-8 ' F.A.U. I ' Inc. Solar 1:19-15 HP 1:116-15+ , Fixtures - I Microwave ' Device Boxes- Pole Light I Outlets I Rarige - Switches Sign ' Garbage Disposal ; Standing Sections I Generator ❑0-5 KW 115-15 KW Trash Compactor $.3 FEES Reinspection Fee $15 DEVELOPMENT SERVICES REQUIR Zoning Approved By Building Approved By Application Issued By t ' Issue Fee ! $ 3 Issue Fee , ( $ SUMMARY OF FEES 1 BUI LDINGPERMIT' $ l SMIP $' PLAN CHECK $ PERMIT I PLUMBING f $ ` ; ISSUANCE $ PLAN CHECK 25% $ 'ENERGY P.C. $ I ELECTRICAL $ !GRADING $ ' PLAN CHECK '50%; $ ;MICROFILM $ ' MECHANICAL' $ TOTAL FEE $ • PLAN CHECK 125% $ I , j a CASTRUCTION AND PLANNING ,APPROVALS Permit # Date Inspector POOL ?A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole •" 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. •, 53. Steel Reinforcement -, 3: Electrical Conduit Utility-Undrgrnd. 54. Forms - 4� Electrical Conduit-Undrgrnd. 55.. Electrical Bonding 5. Steel Reinforcement r, 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '7. Footings* - 58. Electrical-Conduit-Undrgrnd. 8.• Foundation 59. Gas Pipe, 0 Undrgrnd., Test 0 9. Water Pipe-Undrgrnd: - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10: Structural Floor System 61. APPROVAL TO DECK • 11. -Property Sewer Line & House Connection - 62. Backwash & Receptor -Final 12. SewertCap 63. Heater & Vent -Final - 13. Roof Drains - 64. Plumbing System - Final 14. Rough` Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit - - - 66. Solar System -Final " 16. Rough Electric Wiring 67. Fencing & Access Approval 17: (Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS _ Permit # 20. Rough Factory Fireplace - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test, -- 72. •Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy - - 37. Final Factory Fireplace - - 38. Final Plumbing ' 39. Water Service":Final I 40. Gas Service -Final 41. Solar Domestic_Fyinal 42. BackflowPreven`tner 43. Backflow Irrigsti6n - - 44. Landscape Irrigati Wystem 45. Sound "Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING . 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. - - . Date- _ 14:- City of Costa Mesa - Building Safety Department CERTIFICATE OF OCCUPANCY N? 2316 Ce P. O. Box 317 Costa Mesa, California The Building located at if171 • IM RL caduO b`tye has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 7-2 Occupancy. Use of Building .� ffi1E CO®B1C181 A.tlA�ee Legal Description I&I'=.01 (See reverse side for Metes and Baurtds) Building Permit No. 22969 Electrical Permit No. 2278T Plumbing Permit No. �3 Floor Load Signs have been installed as Room Capacity Signs have been instated as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Me 8t Chapter 9, Article 8. Building Off by This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Poral BU34-1M-11-e3--s-s Is Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address eOJ/- Agft-!i LrL C191fl AAO OA . Applicants Mailing Address 4100 .(/ ,C.f'vA/JldAYtAnriAA.yA [ Owners Namef(C&' Phone 45 00 Aditress 2/o2B,fayO w,9Y SA7y i7D ANA m 9170e' Arch/Eng. License No. Address Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Dale Signature - ,,"ORKERS'COMPENSATION DECLARATION ''$r,`,. reby affirm that I have a certificate of consent to self -insure or a certificate Norkers' Compensation Insurance, or a certified copy thereof (Section JJ00, Lab. C.) Policy No. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is JLWed, I shall not employ any person in any manner so as to become sutTect,ft the Worker,s Cor� pen to ws of California. Date l�-^r� _(1'►f'l Signature NOTICE: If, after making this declaration, you should beco bject to the Workers' Compensation provisions of the Labor Code, you ust forthwith' comply with such .provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _ Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any, city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of lision 3 of the Business and Professions Code). or that he/she is exempt refrom and the basis for the alleged exemption. Any violation of Section ,31.5 by any applicant for a permit subjects the applicant to a civil toES na lty of not more than five hundred dollars ($500). I, as owner of the property or. my employees with wages as their sole compensation, will do the work, and the structure is not intended or -offered for sale (Section 7044,.Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale.If' however, the building or improvement is Sold within one year of com- pletlo . he owner will have the burden of proving he/she did not build or, Im- WDAx Pvd for the purpose of sale). I;, as owner of the property, am exclusively contracting with licensed don- tractorsto construct the project (Section 7044, Business and Professions Cotle: The uiltl�TJr' iC'ppntractor's License Law does not apply to an owner of property who bimproves thereon. and who Contracts for such oroiects with a Can- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me.' ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state tha a above information is correct. I agree to comply with all City and'countVordinances and State laws relating toto�building construction, and hereby authorize repre- sentatives of this city / er• upon the above-mentioned property for Inspection purposes. Signature..... Date Drivers' License SS jr TYPE OF CONSTRUCTION 1% NEW a ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER rDESCRIPTI9N,OF WORK/USE OF BLDG. — ALTERATION JJ REPAIR TYPE OF PERMIT 1-4-J GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. lQ 000 OCCUPANCY_ CONSTRUCTION TYPE VALUATION $ -gT00 ZONE GRADINGCU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO d6 Heating System & Ducting 110.100,000 BTU E1100,060 Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash. Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0.1GO,000 BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee A.P. + S Main Buildi E T Front B Rear A C Right K s, Left Ping. Ref. + Planning Notes: FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW C $ 3 FEES $ 3 Zone Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100a tops Meter ❑over 100amps Sub Panel - Motors F-10.1 HP ❑1y,-6 Inc, Solar ❑9-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections 15 KW Trash Compactor Reinspection Fee ! $15 I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By FEES $ 3 O N I N G R E Q M T S. 01 00021280-00021281 TOT 204.35 `3' DATE: 12/06/88 TIME: 11:12 SUMN1�' BUILDING PERMIT $%7 v_FEES SMTP $ / 3s PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ � MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ ' 01 00021280-00021281 TOT 204.35 `3' DATE: 12/06/88 TIME: 11:12 CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POO SPA _APPROVALS Permit # ' Date Inspector 1. TeCporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement t 3:'Electrical Conduit Utility-Undrgrnd. .1 54. Forms 4`.• Electrical Conduit-Undrgrnd. %� 55. Electrical Bonding 51 teel Reinforcement 56. Rough Plumbing & Pressure Test 11 6.1*Electrical UFER Grnd`.- _ 57. APPROVAL TO COVER-GUNITE 7. Footings •' v 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ,.. 62. Backwash & Receptor-Final 12. Sewer, Cap J ��! 63. Heater & Vent-Final rY 13. Roof Drains 64. Plumbing System - Final i 14. Rough Plumbing 65. Electrical-Final 15. R"gh Electrical-Conduit 66. Solar System-Final 16.-,Rough Electric Wiring 67. Fencing & Access Approval 17: Rough Ming Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19.-Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 2d. 'Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas EJ Oil 23. Gas Pipq-Rough & Test - - 72. Underground Flush 24. Roof Framing ' • 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro. . 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing 1 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat .• 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. FinalElectricNotes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation' I 44. ,Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison t- r ,,.. 50. Gas`Release to Southern California Gas Co • 1 51. CERTIFICATE OF OCCUPANCY No. Date ti•I i•t LIMITED STATEMENT OF RESPONSIBILITY TO WHOM IT MAY CONCERN: Street Address Bldg. Permit # This Permit # AP Number I, ��C✓i! Lim �ha �onc K G/7/ as Owner in Title of the above referenced property, do hereby authorize: Z////o eV- ;DX k k14) 9S3 -.4-?00 Name ��' Telephone No. Bibi/. /A/ C� �/oo �!/. %PoAA cv,9 Y s�lrF 2ao Street Address c,9 J.,ci 7676' to obtain permits in my behalf, as owner/builder, for I EROoF/N G at the above referenced property. Should anv person become an em Ip eTee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any resulting in damage or personal injury to myself or any other parties. Date 0]]946, rev. 6187 ii ADDfas of eaLaxc: 1031 EL CAM I NO DR 0111,9TSMANiEIR'Da1+N:LEONEL D ROMAN .WDRESS:2730 W HARVARD i COSTA MESA 92626 APPL. MMUND ADDRESS ANCNRECT OR ENGINEER: ARCH. OR ENG.'S ADDRESS: UD. NO, CONTRACTOR'S NAME: CONTRACTOR'S MAIUNO ADDRESS UC. Ni UNIT: UNIT: UNIT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commenoW wish Section 7000) of Division 3 of the Business and Pmfeaslone Cade, and my license is in full force and Med. CITY I.C. NO.: tie. CLASS: UC. NO.: EXP: 'effNER BUILDER DECLARATION: I hereby affirm under penalty Of perjury thal I am eserept fon the Csatredors License Lew for the owing reassert (Section 7031.5 Busi ees and Professions Code: AM city or county which re0uiras a perm4 to construct, eller, improve, .naleh, or repair any, structure. prior to its Mai also requires the applicant for such permit to fib a signed statement gat he or she e liceemol pursuant to the movi.iors of the Contredore License Lew [Chapter 9 (commencing with Section 7000) of Dbeion 3 of the Business end Professona Code) or that M or and in; exempt therehum end the bums fear the alleged exemption. Arty violation of Section 7031.5 by any applinaM for a peril subjects IM applicant to a civil penalty of pa more than live hundred Balers If500j). ❑ I, ns owner.the property or my employees with wages "their safe compensation, unit do the wok, end the strumure'a rat intended or aRerad for sale (Sectio 7041, Business and Profo.vons code: rhe Comadon License Lawdoes not apply man owners property who Wads or bmyroves thereon, and who does such work himself m terse or through his or her own employees, wooded that such improvements ere not intended or afaad for sale. 0. however, the building m improvement is sold within one year of simpleton, the owner4builder will have the burden of praying he or she did ma Wild or Improve for the - e a sale). XO I, u owner a the propend, am exclsi usively ntrectRcg with licensed com m t. to prmlea (Becton 7014. Busirresa Lid Professions Coda: The C. tredors License Lew does not apply to en owner who build. impoves thereon and who comrana fm su h pmi.ct. with a mmredar(s) Ican.ad pumuanl to IMC nae law). ❑I am exemptunder Sml B. A RC., for that n: Dole: O 9t ase / I do hereby certify that I am aware of and andeal til rets nemia Neaten d safety coda w5, z5e33, sed 95534, and that I many future Wilding co mpant will y will ha refs one) nave m comply with saw dale codas ad th m ment. for apemhforsinstmcllonormodificetimfimnlhe A'a u try gement Diana. Ruidential consumson applications ase exempt from these provision.. Data ApvlMe, WORKER'S COMPENSATION DECLARATION: I hereby affian under penefty, of perjury one of the following dedaaioru: ❑ 1 haver ad w maintain a onrtilicee of Meat to sell insure for worker' mmpensahn. ase prnvided lm by Semon 37M of the Lenon Codafor the padormanca of the wok fm which this penin I. round. ❑ 1 hie ad will mantim workers' compensation im menae.. n shred by Section 37W of the Lenon Code. for the pedormance of the work Ion which this pear o seem. My workers' compensation inwrencei orris and pd umben are: Cedar: policy Number: (This udion nese nm be completed I the permit is her one hundred dollaca (f10ol o s l X❑ I cen'ty that in th pedonns e a th wok o vete h thio perp o he ued shalt real IOY and Pe m in enY enter co n to became subject to rM v�odiers' simpansatian W. a Cananu, i I should become amnjed I M workers' mmoenaetlon wmi.im of Swann 37M of thRrEaf Code. I about 1 Dae: _�� / / �! /S� \APPlicagt: it Waring: Failure no secure wearm.' compenwtlon cpvsiepe I mhemi e d shell sublet(an amp yla��to otlMral perospes and civil fires W m one hundred thousand dollen (fa00000), eddinch to Me cost of mmpenulim; delA esp{s_ prov/ded yor In Saint. 3106 of Me labor Code, Interest and eMIIY'- it. \\ CONSTRUCTION LENDING AGENCY: I h eby affi under penalty of perjury that Mare is a construction larding agency for the pedoneance a the work fm which the para is isw (Section 3097, Ca. C). LENDER'S NAME: LENDER'S ADDRESS: I cenffy that l h m applcaio to that the acne information is coned. l agree to comply win all city end county onlirlencea end slate laza rel I uildl conabdime hereby authorize repreumaivae of this cry to eater upon Ma ebovamentioned pmpeM W for inspection p a� ,% '-_ / KL'EXANDRA RDMAN Data: (5151 <6WP) Wlet"i ildiq 8 Seery; GreerrFle: Canary-AppiranC Pink -Revenue; Gddenrad-A.asnor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 077481 PERMIT NO: E 077481 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: REP JOB DESCRIPTION ELECTRICAL REPAIRS PER CODE ENFORCEMENT SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: M / COMMENTS: REPAIRS PER LETTER MAR 12 1996 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 RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 14167117 ZNE: REF NO: PLANNING NOTES> > iE sf dE iE RE ii * if ii -0E dE iE d1' iE iE SE iE iE')E iE RE iE iE if Rf * ii'')E iE iE iE'IE 1E iE N' * RE iE if if df RE iE * * * N' i6 iE iE 3E iE 1E iE if iE iE iE iE'lE N' �E RE RE RE iE')f N' Ri iE R4 * * iE SE Re sf iE')E 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 DATE: UILDING APPROVED BY : DATE: APPLICATION ISSUED BY: DATE: iE*«iEREiEifififif***�*RE**iE1E+ERE Rs*sE*�*«*�« ** LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 61.00 1 50% SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 61.00 15.00 0.00 76,00 76.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 76.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 76.00 i RE eE RE RE RE RE Ri irk*****k*iF*N-RE IE*iE 1E iE RE RE*RE SE SE*1EN-iE iE RF*1EN-1E eE iE*if*RE RE*iE***SE iE****RE dE RE RE RE ii RE SE *eE iE Ri iE RE 1E IE RF*iE*iE I N D I V I D U A L`m F E E B R E A K D O W N TYPE QTY D E S C R I P T I OWN UNIT COST TOTAL COST ELE 2 FIXTURES, LIGHTING ,l ST 20 EA. .75 1.50 ELE 1 SERVICES BELOW 600 V & 201— 1000 AMP 37.50 37,50 ELE 1 MISC CONDUCTOR NOT LISTED REQ PERMIT 11,00 11.00 ELE 1 MISC CONDUIT NOT L''iISTED REQ PERMIT 11.00 11,00 END OF FEES EXPIREDr DATE 'q L . 00205735-0020r,7395T:_ T CAT": U;l02J95 '�''E: 10:;5 0 6ONSTRUCTION AND PLANNING �AP,PROVALS Permit# Date Inspector PC i SPA APPROVALS Permit # Date Inspector 1.'Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ; 3. Electrical Conduit Utility-Undrgrnd. _ 54, Forms - 4. Electrical Conduit -Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumping & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 1v 7. Footings 58. Electrical Conduit-Undrgrnd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 1 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System,- Final •, 14. Rough Plumbing 65. Electrical -Final ! t• 15, Rough Electrical -Conduit 66. Solar System -Final i 16. Rough Electric Wiring - 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL " 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT* APPROVALS - Permit # 20. Rough Factory Fireplace - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas C) Oil h'-?± 25. Root Sheathing - 74. Overhead Hydro j --- - 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical F g 27. Frame and Flashing 76. Dry Standpipe - 28. Lathing & Siding -• - 77. FIXED SYSTEM FINAL 29. Insulation ", 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric - Notes:/ t_ 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy - 37. Final Factory Fireplace- 38. Final Plumbing 39. Water Service -Final , 40. Gas Service -Final - - 41 . Solar domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44: Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas, Release to Southern California Gas Co ,. 51. CERTIFICATE OF OCCUPANCY No Date ACDRESSOFBUILDING: 1031 EL CAMINO DR UNT: CITY OF COSTA MESA — BUILDING PERMIT ONNERSNAMEIFICIOWN:LEONEL D ROMAN PERM NO: P 077482 ` „ MDRES5:2730 W HARVARD COSTA MESA 92626 PERMIT NO: P 077482 PLAN CHECK NO: N GOVT: N SUPP: N ADPL. MIXING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: REP ARCNRECT OR ENGINEER: ARCH. OR Ef10.'S ADDRESS: u NO.: CONTRACTORS NAME: CONTIIAMIYSMNUNO ADDRESS: LIC. NO.: UNIT: UNIT: LICENSED CONTRACTORS DECLARATION: I hereby alum under Per ely of Perjury that I am licensed under prevordome of Chapter 9 (cermmenang with Section )000) of Division 3 of the Business end Professions Code, end my license is in lull Icvce end .fed. CITY LIC. NO.: LIC. CLASS: LIC. NO.: EXP: Date: Contractor: OWNER BUILDER DECLARATION: I hereby affirm under Penalty of perfury that I am exempt from the Camradon License Lew for he lowing meson (Section 7Wl S Business and Professions Code: Any city or county whits roquiree a permit to Comaud, eller, Improv, )moleh, or repair any structure, prior to its oeuance, also require. the applicant for such Permh to file a signed statement then he or she .a licensed pursuant to the provisions of the Contractors License law [Chapter B (commencing with Section 7000) of Didion 3 of 1M Business and Professions Code[ or Ihal M or ever is exempt Iherehom and IM basis for the alleged exemption. My violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a dvil Penalty of not mora than live hundred dollen [55001), ❑ 1, as owner of the property or my employees with wages as their ads comPeneation, will do the work, and IM structure a not intended or offered ler sets (Section 7044, Budneas and Prohmmouns Code: TM Commove Jowas Lew does not apply to an owner d property who builds or improwea Iheraon, and who does such work himsef or herself or throa%ghh he or her own employees, provided that such improvements we not intended or offered for sale. f, however, the building or improJemwN is sold within one year of completion, the YOownerbuilder will have the burden d proving he or she did not build or improve for the perp -.,d sate). I. as owner of the property, am exclusively, buttressing with licensed contrsdom W�co/ilstruct the pmjdct (Section )Ws, Business and Professor. Cods: TM Commeors License Law does rad apply to an ownv'tifoopeay who Wilds arimproves Ilea. and who concern M suM propria wilt a cemrmoH.l licensed Penuenl Ip IM CorYreaon liceme Law). \\\i\ ❑ I am exempt under 5Stiblo)n: / G B. A P.C., la Dere: Vey `CG er: Ido hereby canny that I em aware d vol understand 1M rout ends d C Comte Health and Satery Section 255g5, 25533, and 25534, and that I or any future Wilding oot,pam will / wit not 'rob one) need to comply wilt said state�cadesa�IM requirements for e permit for construction or modification from the Ar y agement Dieted. Residential construction appicalions an emptsC fmm these provisions. \\ Data: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby affirm under Penalty of Perjury one of the following captivation.: ❑ I have cad wig mammon a cenfiute of consent to sell -Insure ler workers' compeneehen, as provided for by Section 37M dim Lebon Code, for its Performance of the m* for which this Permit M Issued. ❑ I have and will maintain wurea%compenwsron insurance, ae mounted by Section 37M d the labor Code, ler the Perormuwe d the woM Io which this Permit is issued. My workers' comuem salon incur moa artier sad policy number sari: Camixer. Policy Number. (Me asol. need roil be completed it the per ck is for ons hundrW dollen jdf Maw ) }�] I permit, Ones d that in the penformarwIM work ler which this Perms is issued, I employ my person in any manner so ere to become subject to the workers' dameen.ation laws of California. and afpea)h(eC hea I sM mocim.,sub[ed Ip the woman'' ormpswor. Provision 01 S than 37M d IM ts Labor Co, I "I tomb, ft a —* with those prodsims. Deor: AAQPlead: Wim/rap: Fatlun to seeun woAsai eempanaAtlsD,pow1 • Is unlreful, and shell stub f en a piopr Mcriminal Penalties;and civil firms d W m one hundrethpuserrd ddlsre ($it 1, In addition to Na coat of comp.thon, dsMgaa as provided ler In Section 3706 of Ne Labor Coda, Interest, and • ey's fees. CONSTRUCTION LENDING AGENCY: 1 he eNrm under Penalty of perjury that team is a comW nuction lending sneY lot the Performance of the work for which the Pe Is issued (Section 3087, Cl,C). LENDER'S NAME: ' LENOEI3$ ADDRESS: I csrti [het I haysmad! this application and dare that the above infommlion is correct. I agree to complywith all dry and county ordinances end sInwa rd to Wilding construction and hereby aohorrte representatives d this city to enter upon its above mentioned proPeM for i P n gry"-ae;� ALEX- DRA ROMAN Pn ems Date: �A (5151d6.WP) Whits-Suild'mg S Safety; Orswr­Flle; Canary-Appinnt; Pink -Revenue; Gddanrod-Meea.ar JOB DESCRIPTION : PLUMBING REPAIRS PER CODE ENFORCEMENT SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: M / COMMENTS: REPAIRS PER LETTER MAR 12 1996 **161616*�-et*SE x-iF aE*ie x*�t*iEaE*St**SFS-�E ie iE x-+E�-it �E SE iE iF iE iE SE iErtie SE iE iE iE iE iE*iE*it*x-IE SE SE*�E**ie iE ie****jE ie i6 iE it rt+t SE if 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: 14167117 ZNE: REF NO: PLANNING NOTES> > iE 1E 161E 1E * iF 1E 1E 1F 1E 1E R61E RE iE 1E 3E 1E 1E 1E 1E 1E 1E iE 1E 3E iE ♦E 1E ♦E * 16161E iF 1E 1E 16 R6161E * 1F 1E RE 1E ♦E 1E 1E 1E ♦E RE ♦E 1E RE 16 iE 1E 1E 1E 1E 1E * 1E 1E 1E 1E 1F 1E to- 1E 1E Ri 1E 1E iE 161E 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 BY BUILDING APPROVED BY : DATE: DATE: APPLICATION ISSUED BY: /ii/ DATE: 1E**iF 1E*161E ♦E iE iE if 16161E iE 16 i6 ♦E*iE 1E iF 1E 1E 1f d6**1E 1E iE 1E* LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 59.00 258 SMIP/NON—RES PLAN ISSUE FEE 20,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 59.00 20.00 0.00 79.00 79,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 79.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 79.00 iE'IE iE'IE'IE 1E'IE 1E'IE 1E ♦f iE'IE'IE'1E 1E iE iE'iE'iE iE 3f * * * * * SE *'if iE Sr if S6 * iF 1E RE i6 iE it ie * * iE if * * ♦f ♦f iE iE iE iE iE 1E iE * iE iE iE iE'iE iE iE iE iE'lE'M' iE iE iE iE 1E iE 1E iE iE 1E 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 P T I O N PLU 1 WATER CLOSET (TOILET) PLU 1 WATER HEATER AND/OR VENT PLU 1 BACKFLOW PREVENTER PLU 4 SINKS, FLOOR PLU 2 VACUUM BRKR/BACKFLOW PROT. 1 TO 4 END OF FEES ETRED DATE UNIT COST TOTAL COST 7,00 7.00 7.00 7,00 7.00 7.00 7.00 28,00 5,00 10.00 01 00205740—C9105740 T07 '7 , CATE• C",O2/75TIME: 10:35 'AT-, CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector PO S SPA 'APPROVALS Permit# i Date Inspector 1 Temporary Electrical Service or Pole 52. Pact & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement I. 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms' ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test r 9. Water Pipe�Undrgrnd. .60. Backwash.Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System j 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final , 12. Sewer Cap 63. Heater & Vent -Final I 13, Roof Drains 1 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical -Final ' 15. Rough Electrical -Conduit 66,. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical-.T'.Bar Ceiling _. 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - - FIR E'DEPT.'REQUIREMENT APPROVALS - Permit # '- - 20. Rough Factory Fireplace 21. Ducts, in Structure - - 70. Underground Hydro 22. Ducts, Ventilating' 71. Product Piping L7yas Out 23. Gas Pipe -Rough & Test _ .72. Underground Flush 24. Roof Framing _ - 73. Undergrnd.Storage Tank'©Gas 0011 25. Roof Sheathing - - - 74. Overhead Hydro':- 26. T -Barr Ceiling.(Structural) & Mohocoat_ 75.1 Dry Chemical :- - - r A"na 27. Frame and Flashing .. - 76. Dry Starrd.pipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation . - - -- 78. FIRE P.REV. FINAL 30. Drywall Nailing -- - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION -, 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED" 33. Final. Electric Notes: - - 34. Final Heating & Air Conditioning - 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace_ ... •. .' ••-' 38. Final Plumbing - 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final' - '- 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation , 46. Handicap Regulations _ 47. FINAL STRUCTURE & BUILDING - 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date f _ 39937 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely TEL. NO. BUILDING I 31 ADDRESS OWNER E TEL, MAIL ' �. NO. Z ADDRESS NENGINEER W W d U CITY ZQ O N CONSTRUCTION LENDER am J D BRANCH J N ER L...• �r F ['fyVALUE I ADDRESS TEL. NO. J ■ USE OF BUILDING AND WORK TO BE PERFORMED O � Ll'J�+r rx r r r•w . F to Z 0 1 hereby acknowledge that 1 have read this applicatio and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of y the State of California. Z I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in" I force and effect, or I am exempt from the provisions of the St a of Calitornia Business and Professions Co e, ivisIon 3, Chapter 9. Signature of . Permittee Authorized Ape Pn,806 2a2 *kms*61.20 'ANY -(r�cJ rpSf. AFj`PLI¢ATION FOR BUILDING PERMIT HITECT DATE RECEIVED TEL, SUED_ 5 ' �. NO. PERI�11 N NENGINEER [AD LOTZp BLOCK A D P WZ< CCRESS ER L...• �r F ['fyVALUE d W/ W ZTRACTOR^,b Jp $ jV �( OCiNif%L ytQ,N 00 ` J RESS os/ W W TEL Z 2Vc,r/ p NHOTE k CITV in D:. NO. LICJ 0 NO.OF "LOGS. LOT NOWON LOT OFTING BLDG. OF NO.OF Z BLDG. ROOMSSTORIES QERIOR WALL ROOF L%ERING COVERING J ■ USE OF BUILDING AND WORK TO BE PERFORMED O � Ll'J�+r rx r r r•w . F to Z 0 1 hereby acknowledge that 1 have read this applicatio and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of y the State of California. Z I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in" I force and effect, or I am exempt from the provisions of the St a of Calitornia Business and Professions Co e, ivisIon 3, Chapter 9. Signature of . Permittee Authorized Ape Pn,806 2a2 *kms*61.20 'ANY -(r�cJ rpSf. AFj`PLI¢ATION FOR BUILDING PERMIT FIRE 1 lrvpa �V _r antic r _I FIRE BY APPROVE IA /1//{/ DATE 1-751 ZON NO.OF USE OF NEW/ Vj> 'T -0I PLANS BUILDING G'tML •U YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING DISTANCE BET. MAIN SLOGS, VAR. BET. MAIN & ACCESS. BLDG DATE APPROVED IJ S - STATE THE AMOUNT SHOWN UNDER V THE PURPOSE OF ESTABLISHING A VALUATION $2©�aoo E 7 1/ 0 IS FOR V ONLY: 2 N N J E� `o LL I EPVV JQ DATE RECEIVED DATE S SUED_ 5 ' �. NO. PERI�11 NO DING 1 E4(�� RESSTRACTS [AD LOTZp BLOCK A D P ER L...• �r F ['fyVALUE $ FIRE 1 lrvpa �V _r antic r _I FIRE BY APPROVE IA /1//{/ DATE 1-751 ZON NO.OF USE OF NEW/ Vj> 'T -0I PLANS BUILDING G'tML •U YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING DISTANCE BET. MAIN SLOGS, VAR. BET. MAIN & ACCESS. BLDG DATE APPROVED IJ S - STATE THE AMOUNT SHOWN UNDER V THE PURPOSE OF ESTABLISHING A VALUATION $2©�aoo E 7 1/ 0 IS FOR V ONLY: 2 N N J E� `o LL SIZE NO.OFEL OF LOT 2 Now aN LOT —Q— USE OF EXISTING BLDG. SETBACK LINE FROM CENTER OF STREET REAR YARD SIDE YARDI LEFT I RIGHT DESCRIPTION OF WORK IES .OWED (U.S. C. REQUIREMENT YARDSAPPROVED I YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING NO. OF 7 VAR.* ROOMS I STORIES 1 C.U.P. DATE COVERING IWALL ROOF!ANR OI COVERING IFOOd Shake BTP �'^'�DATE USE OF BUILDIANDORK TO BE PERF ARMED Sh0 in' Center Q. a I HEREBY ACKNOAT 1 HAVE RE/ O THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THATE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH PLL CICL9 ANO 6TAt8 LAWS REGULATINGVALUATION BUILDING CO N STRiPERMITFEE $ rY YJ 3SIGNATURE OF -/��?PERMITTEE _1N CHECI AUTHORIZED ArnTal FFF 3 --3 / 7 ...�- RECEIVED- ... G� l SSA zuILDING-SAFETY DEPARTMENT 4Y 4 Md ` 1 1 • `' ".".I P.O. BO;x117 _' ` TANGS DEPT. CORA MESA. CALIFORNIA ;-. JY OF COSTA MESA :-Poc-Appllcont to Fill In CC-Pleref APPLICATION APPLICATION FOR PERMIT oR , BUILDING -, - V For Office Use Only BUILDING n ADORES. + lIl Camino Drive COSTA MESA. CALIFORNIA I� .R6C81 P! NO. �. Pj!JIMIT NO. RECEIVED BY GG DATE R[CEIV[D S IS-�l1 OA SUED , "I LAd OWNER Triple D Inc. MAIL ADDRESS 1598 Monrovia Avenue BUILDING ADDRESS FIRE /L✓ •Y CITY NeFport Beach No`846-3958 ZONE TYPE I GROUP Ray Ilevana9 No`673-%010 APPROVED BY DAre6 CRC NIG N ER 3432 Via Oporto, N.B. ONING ADDRESS ZOIM'. I NO. S ^ PUNS I USE OPj{8W •tel BUILD CONTRACTOR Don K011 Co. Inc. //" VSE t .� 0 Cs^vwt'1 O ADDRESS' 1598 Monrovia Avenue LEGAL DESCRIPTION BIZ _ii Beach A. P. NO. Nl' %��-SIS• CITY Newport C- iii. LIC. STATNO. 221764 TEL 646-3958 NOTE: NO SAVE OVERHANG SHALL I LES. THAN 30' TO SIDE a REAR P. L SIZE NO.OFEL OF LOT 2 Now aN LOT —Q— USE OF EXISTING BLDG. SETBACK LINE FROM CENTER OF STREET REAR YARD SIDE YARDI LEFT I RIGHT DESCRIPTION OF WORK IES .OWED (U.S. C. REQUIREMENT YARDSAPPROVED I YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING NO. OF 7 VAR.* ROOMS I STORIES 1 C.U.P. DATE COVERING IWALL ROOF!ANR OI COVERING IFOOd Shake BTP �'^'�DATE USE OF BUILDIANDORK TO BE PERF ARMED Sh0 in' Center Q. a I HEREBY ACKNOAT 1 HAVE RE/ O THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THATE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH PLL CICL9 ANO 6TAt8 LAWS REGULATINGVALUATION BUILDING CO N STRiPERMITFEE $ rY YJ 3SIGNATURE OF -/��?PERMITTEE _1N CHECI AUTHORIZED ArnTal FFF 3 --3 / 7 ...�-