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Home My WebLink About101 EUCALYPTUS LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 101 EUCALYPTUS LN Suite: Vicinity: 101 AND 103 EUCALYPTUS LN Parcel Number: 43917201 Zoning: R3 R3 Applicant: MC COLLISTER, ELISE Address: 28816 CONEJO VIEW - Phone: 818-735-7876 AGOURA HILL, CA Zip: 91301 Owner: LAUREL POINT TOWN HOMES Address ASSN NEWPORT BEACH, CA Phone: 4631 TELLER AVE SUITE 130 Zip: 92660 Contractor: PRO -TECH WEATHERPROOFING Address: 23261 DEL LAGO STE 5 Phone: (949) 583-1858 LAGUNA HILLS, CA Zip: 92653-1330 License:-_ 620476 Arch Eng: Address: _ Address:, Phone: Zip: License: Status: ISSUED Applied: 04/29/2002 Issued: 04/29/2002 ISSUED BY: ��1 p3 Arm ( Phone: License: - SCOPE OF PERMIT - REROOF 101 AND 103 EUCALYPTUS LN (LAUREL POINT HOA): T/O EXISTING SHAKE ROOF, SHTG PER MFGR SPECS, 1 LAYER 30# FELT, APPLY "GAF GRAND SEQUOIA" SHINGLES. 25 SQUARES Total: $125.78 Calc Valuation: $5,300.00 Claim Valuation: $5,300.00 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 -Left 0-0 Right ACCESSORY Front 0-0 Rear 0-0 Left - 0-0 Right PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 0-6 0- 0 i 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: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2"646 (8W) FEE SUMMARY Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.53 SMIP Com: $0.00 Other: $0.00 Inspection:. $0.00 Total: $125.78 Calc Valuation: $5,300.00 Claim Valuation: $5,300.00 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 -Left 0-0 Right ACCESSORY Front 0-0 Rear 0-0 Left - 0-0 Right PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 0-6 0- 0 i 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: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2"646 (8W) DECLAIRATIONS WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code. for the performance of the Wrk for which this permit is issued. ave and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. workeGrsy' Com ansagQn Insurance carder and licy number are: 3 1-1c:Jrier_ /I!/L (.tel �lGf/!<5GZ' ✓j Policy Number: / (This section need not be completed i/ the permit Is valued at one hundred dollars ($100) or less.) ❑ 1 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 law alifomia, errrrWWWW ea th orkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thes i 'o2 f — d Applicant Signature: Date: % Ci WARNING: FAILURE TO SECURE WORKERS' OOMPENSATIGN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Cha ter 9 (commencing with Section 7000) of Division 3 of the Business d Prolessions Code, and my license is in full force and effect. Lid. 8 Z I . V Class # , 3, C 3.3 Contractors Signature: Date: Lf— Z,9 —0.2 -- CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions 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 or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professiorii Code), or. that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a CMI penalty of not more than five hundred dollars ($500).): Fa ❑ I, as owner of the properly, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended 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 does such work himself or 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 completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (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 contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this Permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: - 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration torn for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic loot of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes [1No Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................ro'qu. ir........................................................................f**o"r..................................................................................................................................................................-............................................................. 4 II an RMPP is presently requiretl, has Section 25534 of the California Health end Safety Code been fully complied with? ❑ Ves ❑ No 5 Does or will the applicant orpresent or future building occupant require for the work which is the subject this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? )? Yes � No (Section 65850.2 Of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...........................................................................b"e-....................................................................................................................................................d"a'................................................................................................................................................. 6 Will any pert of the facility 10 be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................. ......................... ....................................................... .................................... ......................... ...................................... ... ................... .... ............................................................................................ ................... ................... I.......... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cortify that under penalty of perjury the information given above is correct. I agree to Comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until final inspection. Sig atu f L at Owner(s Date �-2 q - aZ And/Or Authorized Applicant Date CODE 0. INSPECTIONTYPE QAIE INTMALS QQQQ! INSPECTION TYPE QM INTMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ccaUiLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 9'2626 Job Address: 101 EUCALYPTUS LN Suite: Vicinity: PATIO AREAS Parcel Number: 43917226 Zoning: Applicant: FRANKODDO Permit: $83.25 Address: 1412 S CENTRAL PARK AVE #A $0.00 Required: 0 SMIP Com: $0.00 Phone: (714)991-7773 $0.00 ANAHEIM, CA Zip: 92802 Owner: LAUREL POINTE HOA Address 2521 POPLAR LN Phone: (949)645-8217 COSTA MESA, CA Zip: 92627 Contractor: ORANGE COUNTY FENCE Address: 1412 S CENTRAL PARK AVE #A Phone: (714)991-7773 ANAHEIM, CA Zip: 92802 License: 506245 Arch : Address: Phone: Eng: Address: Status: ISSUED Applied: 08/22/2000 Issued: 08/22/2000 ISSUED BY: ctlm Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 101 LF OF 5-6" HIGH BLOCK WALL TO REPLACE EXISTING WOOD FENCE FOR ADDRESSES AT 101, 103, 105 & 107 EUCALYPTUS LN. Plan Check: $54.11 Permit: $83.25 ACCESSORY Front 0-0 SMTP Res: $0.00 Required: 0 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $137.36 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: FEE SUMMARY Calc Valuation: $2,020.00 Claim Valuation: so -00 PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0 Right 0-0 Proposed: 0 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: This permit shall automatically expire and become void if work is not commenced within 180 days, or it 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 required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"646 (6100) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder. Policy Number: (This section need not be completed if Me permit is valued at one hundred dollars ($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 I of California and a ree t t if I should become subject to the workers' compensation provisions f 5 coon 37 of the Labor Code, I shall forthwith comply with thea,`5`wespr ions. ^y/9 �,��/ Applicant Signature: j�l fy J Date: UI Z7 1'l lV WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI 9 AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDmON TOTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Busines an essions C?!, agg my license Is in full force and effect. Lia It 4 1 Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing reason (Sec. 7031.5, Business and Professions Cade: 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 or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty 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 (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 does such work himself or herself or through his or her awn employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (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 contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PHRMIT CERTFICATION: ❑ 1 hereby certify that no excavation tive (5) or more feet In depth Into which a person Is required to descend, will be made in connection with work authorized by this Permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tale 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 5DO pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas et. standar temperature and pressure). ............................................................................................................................................................................................................................................................................................................................._............................. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials aqua to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........__..................___...._..................._..._._.._._—_............................................_._....................____.........R"I".........__—_o'n't...............__..................._........ curel...........___......a m. ai'e'6'..._—. 3 Does or will the aDPliwnt or present or future builtling occupant need to prepare an RMPP (Risk Management end Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire ...4..........epartment. ......_ ....._..................._..........___........__.............._a_.R.M..P is presently required, has Section 25534 of the CaliforniaCalifomia Health and Safety Code been fully complied with? ❑ Yes ❑ No ..............._............................... __...................................... ,............................................. _.. _. .............................. _..... ............................. _...................................... _............................... . _......... ....... . . ................ _............... . _ _.......... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this 92plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................__...._.................................._................................................____............................._................................__.......... ..............._....._._.................._................_................__. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......... . ......................... .................................. ................................ ...................................................... __................................ _................................... .............................................................................................................................. _................. 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .................__.......... ............ __........................___......____.........................................__.........................____.........................__............___.._..--__.......__............. .._._........ _........ .___.. 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. Si r e ner(s) (7 � L/cam ) /0?'A AndD flonzea X-ppllcant Yz Date CODE t. INSPECTION TYPE GDIE II11ITAUS CODE I INSPECTION TYPE gKU INTIMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaming Wall (B 9-6� 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy I:. 5`3 COSTA MESA BUILDI G -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS �� r OWNER MAIL ADDRESS TEL. CITY NO. CONSTRUCTION BRANCH ADDRESS ADDRESS s CONTRACTOR REAR FT. ADDRESS USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLDGS. TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF BLOG9. OF LOT NOW ON LOT USE OF EXISTING BLDG. 7920 j0/30/70 215.00 TL 7920 1'0/30/78 -21'5e000KT_U_ 7920 '0000446953 1A APPLICATION FOR STRUCTURAL PERMIT EGEIVEDBY I DATE RECEIVEDna-r�cciTcn APPROVED DATE ZONE INO. OF I USE OF NEW PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDI Separate permits are required for electric, plumbing and heating work. L. SIDE FT. FT. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLDGS. BET. MAIN & ACCESS. BLDGS. VAR.+ C.U.P.+ DATE APPROVED APPROVED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. 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 full force and effect, or 1 am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee _— N n m m SQ. FT. w THE AMOUNT SHOWN UNDER VALUATION IS FOR 0 THE PURPOSE OF ESTABLISHING A PERMR FEE ONLY: e VALUATION PERMIT FEE § o m / PLAN CHECK § IL /,A,7` / o S TAX § LL f U Authorized Agent TOTAL PAID § a, s 1 F F_ 46 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 11-1.96 TL 779.1 10/27/78 HT4 9SCKTD 7791 'D000446953 .__ APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BVTIVRECEIVED ISSUED _ BUILDING �qTE O ADDRESS as ty ay ry�y'��:�y r OWNER A.P. NO 'Y�� JVIt MAIL BUILDING G'G4� V ADDRESS �L 3 S ZN) ADDRESJ)01 Dove St. #225 TEL. CITY ach NO752-507 TR BLOCK CONSTRUCTION '0' PQI 151d LENDER BRANCH OWNER. vTls� ADDRESS IUE ARCHITECT t TE 615-585 OR ENGINEER B s FIRE 4 N. Ngtw&P!op t Blvd202 AODRESdgeW Ort iSea.Ctl ZONE TYPE ROUP 1 APPROVED nn CONTRACTOR pAT 9 ''29F/- /V ADDRESS TEL. ZONENO.OF USE OF NEW CITY NO. �^3 PLANS �' BUILDING STATE CITV YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OFBLDGS (FROM CIL S REET) OF LOT NOW ON LOTPONT FT. FT. USE OF EXISTING BLDG. R. SIDET FT. Separate permits are required for L SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & New Townhomes Project MAIN SLOGS. ACCESS BLDGS. VAR.0 C.U.P. 41 Y-77-24_5_ DATE APPROVED 2- D -'77 APPROVE /) Q BY DATE /O -,,2 7_ .lQ OO OLD FOR SPECIAL FEOUIREMENTS I hereby acknowledge that I have read this application and State that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of 2 L SO. FT. W� the State of California. 1 hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of Callforn Business and Professions Code, Division 3, Chapter 9, an a ch licenses are In full force and affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt It m rovi ions of th to of California Business and Professlo 1 3, Ch 9, VALUATION PERMIT FEE E PLAN CHECK E 0 s L -l� Signature of Permittee VV / n , -S S l/�/T /A/1 va TAX E Authorized Agent / TOTAL PAID E