HomeMy WebLinkAbout2877 EUROPA DR - Building Permits� �
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� CITY OF COSTA MESA
� BIIILDING DMSION
> � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w.wv.ci.costa-mesa.ca.us
:
°. FOR INSPECTIONS CALL: (714) 754•5626
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PERMIT NUMBER: B08-00325
PERMIT TYPE B_ROOF2
APN: 13945510
STATUS: ISSUED
DATE ISSUED: 11/24/2008
ISSUED BY: KJS
� � � �-
JOB ADDRESS: 2877 EUROPA DR CM Suite/Unit:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Squares: 0 -. � ' . � - � " � ' Valuation: � $5,000.00
SCOPE OF WORK: TEAR OFF EXISTING-AND COVER WITH CLASS "A" METRO SHAKE. CLASS AASSEMBL'Y. RE-ROOF FLAT
PORTION OF ROOF. INCLUDES ATTACHED GARAGE_ �
OWNER: LITTLE, JOHN C JR �' Address: 2877 EUROPA DR � � Unit
PHONE: � ,� , ` � � � - ..City/State/Zip: COSTA MESA, CA � .
APpLICANT: JOHNSON;�SCOTT � ' � � � Address: 13672 ONKAYHA CIRCLE ° � � � Unit :
PHONE: 714-651-6190 ,,� , � . _ � " , City/Stale2ip: IRVINE, CA� � � ,. ' �,. , ,
CONTRACTOR: POPAROOFINGINC ����- -� � -' "��. � . � � LicenseNo. " 675902
Adtlress: 13672 ONKAYHAUnit: � , � � - - PHONE: , 714-778-6Z94
City/State/Zip: IRVINE, CA_ � 92720 � � CELL: � - � �
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Remspection Fee:
TO7ALFEES
License No.
License No.
PHONE: .
19.N7�13
$o.00 ,
$111.25 � , - . : � . � - - '
$0.00 ' .
$111.25 ,::� �. . � � - �
�' � �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply wiN all applicable codes, and all
required inspections antl final approval must be obtained. Failure to obtain inspections and fnal approval vAll result in the expiration of this permit.
C��, INSPEGT�NTYPE QRi� IN�§ COpE� INSPEL710NTYPE �� � INTIiIRLS
1616 Pized System Final Fire Prevention 206 Final Mechanical
1288 Pool Spa Final —�,-�—u.�:i 208 Final Plumbing � '
200 Final Re-Roof 12� � �' �'v 210 Final Elecirical "
201 Final Block/Retaining Wall 272 Final Fire Prevention
�2 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/OccuOancy
. '
WORKERS' COMPENSATION DECLARATIO . �
I hereby aHirm under penalty o( peryury one o( the follovring declarations:
❑ I have and will maintain a certificate of consent to self-Insure for vrorkers'
compensation, as provided for by.section 3700 ot Ihe Labor Code, for the
performance of the work for which this permil is issuetl.
/,�qQ/ I have and will maintain vrorkers' compensation insurance, as required by
�SeDtion 3700 of the Labor Code, for the performance of the vmrk tor which this
permit is issued. My workers' compensation Insurance carrier and policy
numberire� /Q� /7M /J
�Camer._ 7 -7`7� Dc
(Thu secfion neM�rol De mmple(e0 Afhe peimrt is valuetl al one hunO�edCWlars (EiOp) w less J
�Rbficy�Number. �v/���Q
❑ I certify that in Ihe pertormance ot the work for which this permit is
issued, I shall nol employ any person in any manner so as lo become subjecl
to the workers' compensation laws ot California, and agree that if I should
become subjec[ to the vrorkers' compensation provisions of Section 3700 0(
the Labor Code, I�,h forthwith comply wilh these prov�sions.
1 � �
�App�� nl'sSigoaWre CD'ae�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOI.LARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm lhat I am licensed under provisions o! Chapter 9(commencing
with Sec[ion 7000) of Division 3 of lhe Business antl Professions Code, and
�my lic�ens/e is in full qforce and eHect. �7 � q
L�- �ic'#� CD � ( 6 2 C�a�#�� c..i !
_2
�oJi [br'sS�g�twe- �oale
�
CONS7RUC710N LENDING AGENCY:
❑ I hereby aKrm that there is a construcibn lending agency for the
perfwmance of the v.ork fa which tlus permil is issued. (Sec. 3097. Civil Code�.
Lender's Name:
Lentlers Atltlress:
OWNER-BUILDER DECLARATIONS: -
I hereby aKrm ihat under penalty of perjury lhat I am EXEMPT FROM THE
CONTRACT6RSZLICENSE LA � t ollo ' eason (Sec. 7031.5,
eusiness a rofessions 6otle' Any a y or�q un i h e r �it �to
consWct, a �mprove, li h,�dir t c r o I�Is
issuance, �ires tha pli t ermit to d a st t
that he or she is licensed pur�an� Q�ti� lr��
License Law (Chapter 9(commencing vnth Section 7000) o( Division 3 ofitT�
Business and Pro(essions Code) or Ihal he or she is ezempt lherefrom antl
the basis for lhe allegetl exemplion. My violation o( Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of nol more than
five hundred dollars ($500).):
❑ I, as ovmer of lhe property, or my employees with �rages as their sole
compensation, WILL DO THE WORK, and the swcture is not intentled or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who tices such work himself or herselt or through his or her ovm
employees, provitled that such improvements are not intended or oHered tor
sale. If, however, the building or improvement is sold vnthin one year o!
wmpletion, the owner-builder will have the burden of proving thal he or stie
tlitl not build or improve for purpose of sale.). !
❑ I, as �ovmer of the property, am E%CLUSIVELY CONTRACTING WI7H
LICENSED CONiRACTORS to constNct lhe project (Sec. 7044, Business and
Pro(essbns Code: The mntractors License Law dces not apply to an ovmer of
property who builds or impmves thereon, and who contracls for such projecl vrith
a cmt2ctor(5) license pursuant to Ihe Contractors License laws.).
❑ I am exempl under sec.
Business and Professions Code (or lhis reason:
JOS]-66�9/0])
✓ \
Owner ID verified by tlrive. _.�cense. ❑ Yes ❑ No
Oriver's License No. Expires:
Veri(calion o( Ownership by (lype o( Oocumen[, i.e. - property tax bill or deedj:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certily that no excavation five (5) or more feet in deplh into wfiich a
person is required to descend, will be made in connectbn with work authonzed
by �his permit, and lhal no building slrucNre, scaf(dtling, falsewnrk, or demolition
or dismantling ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Tlle 8, Cali(omia Administrative Code�.
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Intlustrial Safety, as noted above, unless
such person has a permit lo do such work from the division.
ApPlif2nl's SignaWre
Division o( Industrial Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or present or future builtling occupan[ need to file and
certify a Business Plan for emergency response to release or Ihreatened
release of a hazardous matenal7 ❑ Ves ❑ No
(Seclion 25505 of the Calilornia Health and Salery Cotle requires, wi[h some
exceptions, thal a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one [ime during a reponed
year a quanlity of hazardous malerials equal to or greater [han a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at s�andard tempera�ure and pressure).
2. Does or will the applicant or present or fulure building occupant neetl to file
a registretion fortn for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health antl Safery Code, with some
exceptions, requires registration with Ihe Costa Mesa Fire Department by
each business which at any one [ime has on hand a quantity o( acutely
hazardous matenals equal to or greater Ihan a weight o( 500 poun05, or a
volume of 55 gallons, or 200 cubic leel of compressed gas a[ standard
remperaWre and pressure�.
3. Does or will Ihe applicant or present or tuture building occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous matenals�? ❑ Yes � No
(Seclion 25534 of the Calilomia Heallh and Safety Code provitles that the
Costa Mesa Fire Department may require the preparatioq certification antl
fling with the Fire Depariment of an RMPP by businesses which are requiretl
ro register acutely hazardous materials with the Fire Department.
4. If an RMPP is preseMly required, has Seclion 25534 of the Califomia
Heallh antl Salery Code been fully wmplied vnth? ❑ Yes ❑ No
5. DoeS or will Ihe appliwnt or present or (uNre building occupant require for
the work which is the subject of Ihis application a permil (o� such wn5WGi0n
or modification from the South Coast Air Quality Management Distncl or from
�py other air pollWion control disMct or agency? ❑ Ves ❑ No
�i�pection 65850.2 of the Califomia Govemmenl Code requires that the requested
Tnformation be fumished on appliwtions for nomresitlenlial building pertnits).
6. Will any pan o( the facili�y to be consiructed under this permit be within
1000 (eet from the ouler boundaries of a school? ❑ Ves ❑ No
(If "yes", ihe facility must meet the requiremen[ of Seclions 25534 and 42303
of the Califomia Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or olher
air polNtion control dislrict or aqency is required (or the vrork vfiich is the
subject of this application, have all of the disclosures prescribed by Calitomia
Health and Salely Code Seclion 42303 been matle? ❑ Yes ❑ No
8. Qf yes', attach ceAi(cate of compliance (rom the appropriate air polWtion
controloffcer�. ' �
CERTIFICA7E OF COMPLIANCE: I certify that under'penalty of peryury the
information given above is correcL I agree lo comply with all state laws and
city ordinances regarding Hazardous Matenals-and Emissions. �, �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certily under penalty of perjury that I have read this applicatiomand sWte that
the information given is correcL I agree to comply vrith all state laws and city
ordinances relating to building construction, antl authorize representatives of
the Ciry of Costa Mesa ro enter upon the above-described property for
inspection purposes. I agree not lo occupy or allow occupancy of any building
authorizetl by �his permit until fnal inspection. , �
� Sigryn Owner(s) Da�e
SiB�ature Date % 11 Z\.f �
w.Ap� onz ApPlman��� Oal¢_
/
/
�
PBOJECT ROUflESS: 2 8� I EDROPA 1)R
OWNEF'S NFME: i ITTLE JOIiN C 3R
nooness:287�� EiJROPA UR
CUSTA MESA,CA
ABCH/ENGINEEF: 5 4�— � 7 5 R
AOUHE55:
UNIT:
92625
NEG.NO.:
UNIT:
PEflMITTEE:E�LS PLUMBING (7i4)772-3470
A�ORESS'. 1533 W. L'iNCOLN
ANANHEIM CA 92801
UCENSEU CONTPACTUB OECIAFATION: I here�y aflirm Ihat I am Iicen5e0 untler provisions ol CAap�er 9(commencing wiN Section
7000) of oivision a ol ine 6usiness antl Professions Cotle, and my license is in full force and elfect.
ciTruc.:005938 STpTEUC.:zl'�Ej57 cuss�_�
� /y
Oa�e'. Signamre:.L/"
WOPNEB COMP NSFTION DECLANRTION: I hereby allirm t ave a cenificate of consent m seli-insure or a cenificate ai Workers'
Compensaiion Insurance, ar a ceni�ietl copy Ihereof (Semion 00. Lab. C�.
aaucvxo.:1339225-93 exr.oaTe:03/O1/94
COMPANY:S TATE
� Cenifietl copY is herebY �umishe0. � Certifietl copy is liled witn ihe city Builaing Division.
G �/�j
..ale: S , ApDlicanC <"' , %�
E%EM ON F OM WOflNEflS' LOMPENSFTION �ECIAflRTION: (T ' sec�ian neetl na1 be camplete4 if the permn is forone hunOreA (51W) ar less).
I certify tha� in Ine Dedormance ol Ihe work for which this permii is issued, I s�all no� employ any person in any mannar so as �o become
sublec� �o ihe Workers' Com�ensation Laws o� Cahfamia.
�aie: Signa�ure:
NOTICE: II, a�ier making this tleclaiation, you shoultl �ecome su0leci Io Ne Warkers' Campensation provisions ol ��e Labor
Code. you must �otlhwith compty wii� such Orovision5 or �his permil SAall be tleemed revoketl.
CONSTBOCTION LENUING PGENCY: I �ereby a��irm Iha� there is a cons�mclion lentling agency for Ihe performance oi Ihe work for
whic� this permil is issuetl (Semion 3097. Civ. C)-
LEN�Efl:
ADDflESS:
OWNEP BUILOEfl OELLAflFTION: I here0y aifirm I�at I am exempt imm IAe ConVacmrs' Sia�e License Law �or ihe following reason
(Sec�ion 703L5 Business an0 Pralessional Catle: Any ci�y ol caunry which requires a permit �o cons�mcl. alter, improve. Oemolish, or
repair any slmeture, prior �a'��s Issuance. also requires Ihe aOP�'iwnl ior such permit to flle a signed statemeni Ihai he�she is ficensetl
pursuam m Ihe pmvisions o� the Comracmrs' Siate Liwnse Law (Chapter 9(commencing wi�� Sec�ian 7000) at Division 3 0l l�e Business
and Pm�essions Cotle) or Ihat helshe is exempt �here�mm antl Ihe basis �or �Ae allegetl exemption. Any violation ol Section 7031.5 by
any applican�far a permit subjec�s Ihe applicantio a civil penalry o� no� more �han �ive hunaretl dollars ($500).
I. as owner o� �he Oropetly or my employees wi�h wages as IAeir sole compensafion, will tlo �he work, anA t�e
❑ simcWre is not intende0 or o�lerea tor sale �Seclion 704a. Business anU Pm�essional Cotle: The Cantractors' S�a�e License Law
tloes not apply ro ai� owner al a pmpetly who builds or impmves therean, antl who tloes such work himsell/hersel� or Ihmugh
his or her own employees. pmvidea �ha� such impmvemen�s are not miendetl or otlere0 for sale II, however �he building or
impmvemenl is sold wi�hin one year o� comple�ian. Ihe owner will have Ihe burtlen ot pmving he/she Aid no� builtl or improve
lor ��e purpose ol 5ale).
I. as owner ol lhe propetly. am e�clusivety conlraciing with licensed conlrac�ors �o consimct �he pmlec� �Sec�ion 7044, Business
❑ an0 Pmfe55ion5 Code: The ConlraCrorS' Sta�e Lirense Law tloes nol apply Io an owner ol pmperty who builds of improves ther¢on
and who conlrac�s �or such pmlects with a conirac�or(s) license pursuan� to the ConVactors' State License Law),I am aware
Ihat pmal o� Iheir Worker's Compensa�ion insurance s�aultl be D�ovitletl �o me.
� I am exemp� under Seciion'. B. 8 P. C.
lor ��is reason:
Oa�e. Ownec
I tlo hereby cenily I�at I am aware o� antl undersiantl Ihe requiremems oi Califomia Health ana Sa�ery Cotle Sections 25505, 25533, antl
2553a antl Ihal I or any fulure builOmq occupant wlll/will nol (circle one) neetl to comply with saitl state cotles and ihe requirements �ar a
permil �m consimclion or moAifica�ion irom �he Air Oualily Mana9emen� �iSlricL Resitlential conslmction applicalions are exempt iwm
Ihese pmvisians.
�aie: Fpplicant:
I here�y cetlify I�at I have rCae �his apPlication antl state ihal lhe above in�ormaiion is correc�. I agree �o comDty wilh all ci�y antl coun�y
ortlinances and statelawsrelating�o builtling consimqion antl hereby aNhorizereprasentatives ot�his ciiy�a en�eruponihe above-men�ionetl
pmpetly for ins0ection purposes.
Daie: � �, SignaWre: �/— ��
Oriver's License or Sociai Sewrity r: �•
164LG6 Wliile—Bulltling: Green—Cotle Entorcemenl; Canary—AppLcanl; Pink—Revenue', GoldenrOtl—Assessor
CITY OF COSTA MESA — BUIt,DING PERMIT PERM NO; P 061610
PEkMIT NO; P 061610 PLAN CHECK NU: N GOVT: N SUPP: N
CONSTRUCTION 'PYPE; PEkMIT TYPE: PLU PURPUSE; OTH
JOB DESCRIPTION ; tNSTALLED WATER HEATER 5Q FT;
CLAIM VALUE; CALC—VALUE: GROUF OCC: /
CONM$23T5: NO OTHc.R WORK AOTHORIZED BY THIS PERMIT
##�*x***�*�#�*#*x�*�#���#*x x x ��#*#x����*���x***�x��#*�**��rx��x�#x x#�ex�*�r��x-��a��t�
Z O N I N G R E Q I7 I R E M E N T S
S E T B A C K S
------------ MAI(J HUILDING ---------- --------- ACCE5SOt�Y BUILDING ---------
FRNT: FT I�1 REAR: FT ZN FRNT; FT IN REAR: FT SN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING RE • PkOV: PAkCFL; 139A5510 ZNE; REr NO;
PLANNING N 'I'ES>
i
IE #)f iF # iE # iE iE iF �1EiElF 1C• 3E # fE �h 3F iE fF�IE if--lE !F 3F ff i(� �F fEiF'X• iE# iE 9E iE�7E iE 1E iE # 1E it iE iE �If�i3�F # 3P# iE iF �14-1f 1F iElt �%iF #�k iElE iF 3F # iF ih # IF ## if IE i(� !f # ii
D E V E L O P M E N T S E R C' I C E Cs ; R H Q U I R E M E N T S
ZONING APPROVED HY �'� DATE;
BUILDZNG APPROVED BY ; DATE:
APPLICATION ISSITED HY; :. DATE; �'
ifiEiEikkiEifififiEiEltiE#fElEiEihM'1HiFk�tie-A-itirltX� �Titk�F�txwt'FTe'�iFir-���tirR�e%'x�%'x%'ifl6lF�fii'dFifiF�Y.�!('xfr�rx'`�3EaF
!F iE # K� iP iE �%iF if 3f # if 1E iE i(� �1f iF if 3E # iF# i4 �f' 34 ��K� �%� iE 3f 1(� i4 k�!f �1(� N� 3E iE dE ib i4 %� k iF �% 3F 1P iEif if 1E If iE �lf )l� !h fE jF�k Y.� !f If !k )E iF !h ih i(� IE ih �7E iE'.l� if 1h H- # i( ji
LEGALIZATION;N F E E S U M N A R Y STRUCTURAL SEGMEPIT;N
PERMIT HLDG PMT PLUM�IQG� ELECTRIC MECHANIC F'IRE SMIP/RES GRADING
25% SMIP/NON—kSS
PLAN
ISSUE FEE 20,00
BUILDING—DZV—> PERNIT I55I7E PLAN—CHECK TOTAI� FAIP DUE
•roTaLs----> �,00 zo.00 o.o0 2�.00 2�.00 .00
REVENUE DIVISION TOTALS--> COLLECTED; 27,00 UVER/SHOkT; 00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
2%,��
3F 3t i! iE fF 1k 1! it i! iElf i! �lf iE 3E K� 76 iE 1E �( if lE 34 3F'%� �k )( if� 14 3E iE �Y.� i(� aF 1h jE#E �1G k if'lt Ih iF X-iF if iF iE IE 3hlf 3E-Ik 1F if 3ElF iE iE fE iE �� 1i� �F�1E �f� �)k #!f iE x-i!� �1E i(� if iE �i� 3E 3E
Z N D I V I D li A L P E E B R E A K D U W N
TYFE QTY D E S C k I P T' I O N UNIT COST T'OSAL COST
PL(J 1 WATER HEATEk AND/OR VENT 7,00 7,00
END OF FcES
\�
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L� : _ .
',.,._ �,, , . _ . , ,
P
CONSTRUCTION AND PLANNING
APPRQVALS Permit # Date
1, Temporary Electrical Service or Pole •
2. Soil Pipe-Undrgrnd. '
3. Electricai Conduit Utility�Undrgrnd.
4. Electrica! Condwt•Undrgrnd.
5. $teel Reinforcement
6. Electrica� UFER Grnd.
7. Foo2ing�
B. Foundat3on ,
9. Water Pipe�Undrgrnd,
70. Struaurai Floor System
1 7. Property Sewer line & House Connection
12. Sewer Cap
73, Roof Drains
14. Rougn Plumbing
15. Rough Eiecvlcal-Condult�
16. Ro�gh Electric4Viring
77. Rough 4Viring Sign
18. Rough EEectrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
2/. Oucts, in Structure
22. Ducts, Vencilazing
23. Gas Pipe�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structuraf) & Monocoat
27. Frame and Flashin9
28. Lathing & Siding
29. Insula[ion
30. Drywall Nailing
31. Pla:ter Brown Coat
32. Electrical ?owar Meter-Final
33. Final Electric
34. Final Heating & Air Conditio�ing
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Factorv Firepiace
38. Finai Plumbi�g tik/!�
39. Water Service-Final
40. Gas Service-Finai
41. Solar pomes2ic-Final
42. Backflow Preve�ter
43. Backfiow Irrigation
44. Landscape Irripation System
45. Sound Atienuation
46. Handiwp Regulations
4�. FINAL STRUCTURE & BUILDING
48. FINALPLANNlNG
49. Electric Refease to Edison
50. Gas Release to Southern California Gas Co
Daie
POOI 'PA
inspector APPROVALS Permit #
52. Pooi & EGuipment Location �
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Piumbing & Pressure Tast
57. APPROVAL TO COVER�GUNiTE
5& Electrical Conduit�Undrgrnd.
59. Cas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, � Und; gmd.
61. APPROVAL TO DECK
62. Backwash 6� RecePtorFinai
63. Heater & Vent-Final
64. Plumbing System � Final
65. Electrical�Final
66. Solar System-Fina�
67. Fencing & Access ApPruval
68. APPftOVED FOR PLASTERING
69. POOL/SPA SYS'iEMS FINAI.
FtRE DEPT. REQUIREMENT
APPROVALS Permit #
Date � Inspector
70. Under9round Hydro
71. Product Piping O Gas ❑ Oii
72. Underground Fiush
73. Undergmd. Storagc Tank � Gas '� Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
7$. FIRE PREV. FINAL
HEALTH DEPT, REQUIREMENT
79. FINAL INSPECT�ON �
80. FOOD CERTIFICATE ISSUED
Notes:
OWNER PA
JOB ADDRESS 2B
GENERAL CONTRA(
AP No.
P� "ECTIONS
S
f
OCCUPANCY
'ORM 6f14 - 5M -
LOT QQ TRACT
Signature
DATE _
VALU�
j FIRE ZONE DESCRIPTION OF WORK Z'2S 8tt
DA1'E GROUP �-�- TYPE T m7,ONE
PER(vIITS ISSUEI
SUBCONI'RACTOR .�...,-
COSTA�MESA BUILDING-SAFEfY DEPARTMENT
P.O. BO%917 COSTA MEHA. GALIFORNIA
For Appllcant to Fill In Com�p/le� ely
LCLh�(/,� TYPE OR PRINT }�� ��
COSTA MESA, CALIFORNIA
� .A . „ _
■ ARCHITECT
■ 6ETBRCK LINE FROM
REPwIR
BUILDIN6
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FEE RECEIVED
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NOW ON lAT V
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DESCRIPTION OF WORK
1 HEREBY ACKNOWLE�6E THAT 1 XAVB READ TXIB APPLIC�TION
AND STATE THAT TH6 FBOVE IS COHPECT ANO AGREE TO COM-
PLY WITH ALL QTY O 1 NCEB ANO BiAi¢ LAWB pEODUTINO
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SIGNATUREOR - �(�
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DISTANCE BET. BET. MAIN 8
MAIN BLDGS. ACCE55. BL[
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TXE AMOUNT 6HOW LINOER VALIIATION 19 POR THE
PURP08E OF EBTABLI8HIN0 q PEqMIT FEH ONLY.
LUATION I �� —
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