HomeMy WebLinkAbout310 ALTA LN - Building Permits400PESSOFBUILqNO: 31O ALTA LN
axxEasruxEiF�vr+: TRUDI BRADLEY
�ooxess SAME
IPP�.IWIBM ADDNE55:
APCNRECT OP ENtlNEEN:
wcx on etic.�s �oon[ss:
c«im�cTarsxu�: NOCK PLUMHING
CO�AN�CTORSYYI➢q 11612 KNOTT ST
m+*: D 10 3
uc. xo.:
UNT:
(714)895-1246
�oo�ss: GARDEN GAOVE CA uc.no.: 511971
92691 uxr: 17
UCENSEO C0IRRRCTOflS DECLANITION: I hereby eRirm uMer peneFy of parjury thel I em liceneed uMer qwieione ol Chepter 9
(mmmeMinB ��h Section ]000) W Divisian 3 0l lhe Busi�nes enE Profeaeians Code, aM my lioenae ia in hll lorce end aMep.
cro s.No.:05 3 6 uc.cuss: C-36 uc.No.: 5 1971 EXP: 02/96
�e ��a: /So� IPLUrI�Is�-�
IEH BUILOE D CIAflATION: I he�eby etfiim uMar penely d perjury ihe� I an ecemq fmm �he Contretlwa Lirome Lew la tlro
qwmp roaaon (Sepion J0�1.5 Buairese eM Pideeaiom Cotle: A�ry ciY a ooun�y xfiiM iequiree e peitne ta mnahuct. Mx. impwe.
mol�h, ar rapei eny el�ucture. pia� b ila oeuence, ako requirea iM eppliranl la wch pa�mA lo fib e aiB� „�ement Ihel M a eM
ie licenaed punuenl to the poNsbm d ihe Comredora License Lew �Chepla� 9(commandtq xilh Sed'pn )000) d DNuion 3 of �M
Buainess eM PrWeaeona Code� or thv M or ehe ie exemp therelran end the bavis la �he dbped exemption. My volelion d Sed'an
]0�1.5 by any eppliranl Iw e permit wbjede iM opdwN� lo a dvil penelry d nd mae tlan INa huMred ddlen �SSW�).
� I, ea oxmier d IM propany a my empbyeea x'vh wepes m IM� ede compevatbn, Mill Eo IM xaA, arM Ne awnure e ria inteMed
«m«�aiaawcs�r ��aa.e�M..�aa�a��c«i.:rnecan,ea«,�K,�,a�.eo..�meodr�o�o�.dwowro
who W iM or inpmves Ihereon. eM nfio doea+uM wark IimeeM a Mnetl a Newph lie a Mr own empbreea. pwideE Ihet weh
impovemeMa ere nd iniaMae a W«ed tor aeb. d. howa.er. tM buiNieq a'vnpovemeM ie edd xilhin om Yeer W eompbtion. Na
o.�,a��ua, �;n n� ma d,� a ww�� n. a an, eu �a w�a «�mo� �« ma o�mo.e a�).
❑ I. av ovmar d �M papaM. ��tlueivey coniredip wilh IioeneeE conVenwa �o condruq iM prolb (��'�. Bwinma vM
Proiwione Code: The Contreaon license law Eros rwl eppty to en owner d pmpeny xfio buitla w impavm thoreon vd who
convecb br euch prol�s �^�h e wmfedar�e) Icensed pureuent to Ihe ConVedan Licenee Lew�.
� I em exampt under Seciion: B. 8 P.C., im Ihn mewn:
i m narenr �.nM inv i em eware a ena u�daa�.�e u,e �a����. a cm�omie Heenn ene sak�r coee smon. assos. nsaA. ene
2553a. eM �M1e� I a ury Mure Wiki�q am�pent xill / wil'wl (dmb one) neeE to canply wYh eeid ama oodes ud �M raquiremmn br
epermnlamrmMutionwmodifratianhan�MAi3ueil.�y enepement0iqrid.RavdaniWoonY�ud'onappFitiwreeraeaemqlmmNma
provisions.
oe�e: nvWwam:
WORKEF'S COMPENSRTION DKL�H�TION: I Mraby elfirm uiMer penelty d pe�jwy one d tM /dbxi�q Eetlerazuna:
� I heva vM xil mainten e canJirele d caneent io aeMim�e M v.arkere' cnmparmtion. n protidad lor by Semm JIOD d tM labor
CiOdO.�b��1B �MIIIBM! C� UIB Nqk�IX N�IICh1�1m�IB111111b �11l�.
I hm vk wil meinten wakarm' mmpemetion imureroa. m'epuirad by Seeim 3]W d Ms lebor Cada. tor �M pMamenro d IM
work Iw xfiich i�b permn u weued. MY waksn' mmpenamion inwra�we rarrier eM pdicy number ue:
c�a,: STATE EXPIRES
Poi�r N�m��: 11 F, 7 a 9 — 0 3/ O 1/ 9 6
�m;: sanr� ,�d mm �. comWerod r me o�R �+ ro. �e nvndred eaie�elsiool o. ross.�
� I cenly ihel in IM perlormence d IM xrork Iw xhch thia permn ia iaued. I diell rwl em a�ry penon in enY mennm eo m lo
c«a�re .ubjee m �ne won ri canro�veibn lewe a cmn ' e earae �nm H M nxoma wbpa �o �ne waxen•
compemmb ymv' ona d aqion 3 tM lebor COEe. I I I rmh mmp�y wnh 1 protitiaa.
i
�� RGP�iianl: v � ���
`I}'/�nflny: FaNun ro sxuro woilcen' mmpxwtlon rororap� ls un/ewNl, antl �Nll w4Nct �n xnploysr ro eNMrol psneMu antl
c!vl1 flns� up ro ons huntlre0llro�aentl doll�n (SfOQ000). M eeE/Hon b fhs cost o/ compx�ufbn, damps� u prav/tlM br In
SxHm 3]OS o/ Ms Le6or Cocb, lnfxul, entl efbrnsyY /ws.
CONSTHUCTION IENDINO AGENCV: I hereby eMrtn uMm penely d per'ryry ihet �Mrt a e mns��udion bMiip epercy M IM
peA«maxn d �M MOM lor whi�h tha pertni n eeued (�1bn �091. Civ. CI.
LENDEN'S NIJI E:
LENDEP'S AODHE55:
I ceMity �Am I hero roeE �hia eppiketion eiM de�e ihet Ne ebova inlarmelbn o cmm. I epree io comON �h ell ary end wumv oNinancea
end aima leva rebliip lo buikvq mnavuaion end �meby au�Mrae repaeemetrvea of Ihc city lo mbr upon ihe abwa-men�bneE prtpaM
lorinspaclion purpoaea.
RON NOCK /
Pn Nem /
� � - Dele:
sre��,e a o� i,m
(5151d6.WP) While-Buildvq 8 Sdmy; Greeo-fle: Ganery-RppfunL Fnk-Rarenue; Oddenrod-�esamor
�
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P 072750
PERMIT NO: P 072750 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : C/O WATER SOFTNER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED HY THIS PERMIT
*�r*��r*+�**�r****�r********+�***��***��*�*�r�r+�**�r**�*��**��r****��*******�r*��r*�r*******
Z O N I N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN HUILDING ---------- --------- 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: PAACEL: 93825027 ZNE: REF NO:
PLANNING NdTES>
i
1F i! if i! iE if 1F iF 1k 1F Il� 1E 1E if iF if 1E 1E 1E 1f 1E ik ik 1(� iE 1(' 1k iE'lf' 1F iE 1E'lE 1E 1E if 1F if k 1(� 1f if� iE 1k i! iE IE iE 1E iE if 1E iE 1f 1E iE if 1E i(� iF 1f iE IE 1k 1E'IE 1E 1E 1ElE 1E iE 1E 3! 1E 1E'IE 1E �)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
20NING APPROVED BY DATE:
BUILDING APPROVED HY : DATE: n
APPLICATION ISSUED BY: DATE: G 7�
ifiEifK�Flf�iFiFiFifiEiEiEi(�3fiElEiEiElEaFiF iEiFlflEiFifiEiFlEiF �EiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
PERMIT BLDG PMT PLUM�Ioo ELECTRIC MECHANIC FIRE SMIP/RES GRADING
25� SMIP/NON—RES
PLAN
ISSUE FEE 20.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 7.00 20.00 0.00 27.00 27.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT; 00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
27.00
f! 1E 1F 1t �Ik 1E 1E iF iF ik iF 1F 1k iE IE iE if 1F i4 fE i! IE I! iE iE 1! iE'k i! iE 1E iE 1E ik * ii if 1E 1f'k 1f 1[� if ff �! 1f 1E IE iElF IFlF ik 1f it 1E 1E 1E iE iE fE iE 1F!! 1E iE iE 1F 1F iEiE iE iE IE iE 1k 1E'!F it
I N D I V I D U A L F E E B A E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 FIXTURE SET/TRAP W/PIPING & BACKFLOW
END OF FEES
�i..S �ut] cS2� 6��
1�A�,��'� .�i<7����
7.00 7.00
r n�. ' _" __' •_
i �i �i': ' , �
C;Tt• . . .. _ -,. .�a.�- ..._
• CONS7RUCTION AND PLANNING � & SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # date Inspector
7. Temporary Etectrica! Serv�ce or Pole 52. Pooi & Equipment Location ,
2. Soil Pipe�Undrgrnd. 53. Steel fleinforcement � �
3. Elearcai Cnnduic-tJt�f(tty-UnUrgmd. 54. Forms �
�.4. EIe.Erical ConduitTladrgmd. • 55. Electricai Bonding - • I
:'5. S;eel fteinforcertu9r 56. Rough Plumbing & Pressu�e Test �
'�_6. Electrcal UFEF[Grnd. � 57. APPRbVAL TO COVER�GUNITE � �
�- 7. Footinqs �� �� 58. Electrical Conc{uii-Undrgrnd.
S, fourdation 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgmd. .. ' 60. Backwash Lines, P-Trap, O Uhdrgrnd. �
10. Struc.ural Floor Svstem _ 61. APPROVAL TO 6ECK ' j
1 t. Property Sewer �ine & House Connection 62. Backwash & Receptor-Pinal
12. Sewar Cap - . 63. Heater & Vent•Fina? .
13. Roof Drains . 64. Plumb�og System - Finai �
14. Rough Plumbing - 65. Electricai-Final
15. Rou9h Electrical�Conduit " 66. Solar System-Finai '
16. ftaugh Eiectric bViring _ 67. Fenciny & Access Approvat 4
77. Rough Wiring Sig� 66. APPROVED FOR PLASTERING �
78. Rough Electricai-T Bar Ceiling 69. POOLlSPA SYSTf�AS FINAL
19. R�ugh Heating ffi Air Conditioning ; , F(RE p�PT, RE4UIREMENT (
. _ (
20. �Rough Fyctory FiwRlace .�� ^� � . ��` � APPRIOVALS. Permit # 1
- �
21. 9utts, in Structure '� •• � r "` 70.' Unde�rourrd Nydro '
22. Ducts, Ventilating �� " . � - '.. 71, product Pipinc� Ct Gas ❑ Oil
23. Gas �Pipe.Rough & Test -S * � � = 72. Underground Ftush ' -
24. Roof Framing' � `` � ;"� '� �- __` ,. 73. Undergrnd.Stora§eTank OGas GOiI
25. Rooi-Sheathing - t �c � r � 74. Overhead Hydro _, '
26. T�6a� Ceiling iSvue�urall & Monveoat k l ' .' 75. Dry Chemical �
27. Frame and Flashing q: =. _ �- • 76. Dry Standpipe ' -
28. Lathing & Siding �,� � - ' ' � �' � 7T; FIXED SYSTEM FINA�
* ._,
29. Insulatioc� �,* � �• • 78 FIRE PREV. FINAI �
30. Dryavall'Nailin9 '_ ' " _ � - � H�ALTH DEP7: REQUIREMENT
31. Piaster Brown Coat � • ' -�� 79. FINAI tNSPECTION -
32.-Elec�ncaF'Power Meier-Final ' � '�� S0, FOOD CERTIFICATE ISSUEO
33. Finai Electri��. � _ • Notes:,7� f:- � �
•' �G��1'�.izs.'2'_Q.5FY�aY�
34. Final-Heating & Ait Conditionir}9 , -' �L -� � ' � � `
�
35. Fina! Gas Pipe�Tesi . � . - - , . . � .
36. Hood�or Canopy � - � � ' , _, . �
.
a .
37. Finai Factory Firepiace� - � . � -� -
38. Final Plumbing �=" " ' : ' �
�y _�i
39. Water Service�Finai ; - � � _ �
40. Gas Service-F�nal ' ' - ' � ' ' + '
- r
41. Solar pomesticFina� _ �� � - � � _ - .
42. Backflow Preventer K � • � - � �
43. Backfiow irrigation; ^ � , � . .
44. Landscape Irrigation System ':' • ' r'' �`� ' t• .� • �
� � -, �
�45. �Sound Attenuation; � . - ; - � ^ -., r; , . `
'd6. Handicap�Regulations • � _ _ '
�
47. FINAL STRUCTUR,E & BUI�DING ' ; ,
48. �FINA� PLANNING ' :�� � ` ' '
i
49. �Electric Release to Edison ' � ' '
. .i
50. Gas Release to Southem California Gas Co • '
51. CERTIFICATEOPOCCUPANCY • •
No. Date
RU�qE550FBUILqNG: '�j,S^0 �ALTA•.LN � �� , ' ' �NT.;i ' � , ,,,_ , , ,t. ,. _ '��.'_.__.._ CITY� OF.-'COS,TA� MESA"— BUILDING: _PERMIT � ' � ` ` - " ' ` ' �
wmewsruueiva+avN:gRADLEY, TRUDI R � � � �, � . ,�,: ' � , . .', ` PERM NO.�,H �. 07672'3 '
r''t �ooness: 310 ALTA LN ' — !. . . . - • • .- . • _ . . . _ . , � : �
- �COSTA+MESA;6A ' 9.2627 - , . ,- F,:., , � �PERMIT ,NO,: H �076723 _ ,P,LAN CHECK NO: „ �. ; ;� ( , N � , GOVT:; ,N, SUPP.: .N;
. . � . . , � • �
�vv�.wuuriciooness: . ' � „CONSTRUCTION':TYPE: 5—N !., � , ; ' PERMIT TYPE: 'STR , ' PURPOSE: ' OTH
� , a , . . , � :, , . � + . � . , ' . . .
u�cxneaon�nx�x: , ' , ' ucwo.. JOB 'DESCRIPTION' T/OFF ROCK .ROOF & REROOF W/BUR, � � SQ' FT; � ' 1, 677 '
IJiCX.OP ENG.S �ODPE55: ' - ' . i, • � . � UNT. , , . ' . , � ' . ' , � . .
" ��' ' CLAIM;VALUE,: ',� 1„677.00t;,CFiLC—VALUE: 1;677-:00 ;GROUP. OCC:, R—T /U 1,
'_coxmec7oxsru�:SANTA�ANA ROOFING ' (714J558—.3707 ` � ' . , , , ,. , '•' - ',. . •- '' , , �'
-��'CURHACTOR'SMYIJNG 9�2-3 ,N. LOGAN, . ' '� COMMENTS,:,_X . . � ' � , � . . � - ' : -'
.-�oonEss:SANTA`ANP...:•. � . .CA .uc.ra.:__463596 . � � ��+�*�*���*��*�**�***�-**«���*�*�**+�**���r****�**�-�-*x�***��*�����-*�x�**�*+�*���**+�*��**.
. .92702.• ,' uxr: -. .. .. .�. ._. Z.O N I'N G� R E.Q�U I R E.M E N T S {�. r' "- :
� �ICENSEU CONTPRCTOfl3 DECLApATION: I hereby ellirm uMer peneMy M perjury ihei l em Ibenaed uMar O�ione o� Ghepim B, .'�}�' ' ' ' - : .� S� E, T, B A C� K� S . . . "' � _
� �mmmenrin0 ��h Section 1o00) d DiWsion J d ihe Bueir�eaa end Proleasiona Code, uM my licenee n in hll lorce end eHep. " � � - �� 1 . ' , - i ' . � ,�
'. �
c�rycNo.:035308, uacuss:C-39 uc.No 359 ._ _EXP:,O1/97,' —=— ----- MAIN BUILDING ---------- --------- ACCESSORY'BUILDING =-- �—
;, ��j ,FRNT . FT IN REAR: FT. IN ' FRNT: FT IN REAR: FT IN _
�o�a �� f� c°""°tla' ' LEFT , s ' FT 3N RGHT: FT IN ,. LEFT:. FT, IN RGHT: ��'� FT IN � ;,
�R BUILOEN OEClAR4TI0N: I hareb/ elfiim uMer penely d wrv �� I am esmmq hom iM CoMmaon ikenea Lew lor tM . , � .
" owi� r�so� (saero� �aats e�ebhs arie Rw�io�a coes: ��y o�y or �wmy �nid� ��ires e Po�n �o �rewn. enac imv��. PAR K 2 NG RE(� _ PRO V: PARC EL : 9 3 4 2 0 O 1 3. Z N E: R E F NO :
�iofmh, a npeir eny swcluro. pnor lo i1s ocuence, e6o requirea the epplirant /or wch pe�mA to �le e si0�� eletemenl thei he a eM p LAN N I NG N V T F.' $> ' � � � ' �`
.iceneed Wnuen� �o ��e Mo�Siom d �M ConVeqae Liceme Lew �CheNx 9lcommentiM wilh SeUun )OOO) M DHoion 3 M �M . . � . i _ . . ... � . . . .. .. ". r ...,, . � . . ._ . .. ... � �- � .
auainav eM Prdwione Codel a �het he a Ma o aaemp therehan eM tM bevs Iw �he dbpeE ezamqbn. MY violetion d Sedion ��'�' . � ' . � /� � � � i
. 103t.5MenYeGWiranilorePamAwbedelheeVVlica�IloedvilVe�Yoi�maatMniWehuMredddlen�3•`�Ol). iEif1ElEiEiElE1ElEfEiE1E1EiE.f%,'#lEfElElEfF�lEiEiE1EiElFififlEfE1ElEIElEiE1E1E1EiE1EiElEikiEif.ifiEiE3EiEiElEiEiElFlEiElfiEfhiElEiElE3EiE�E�1E.�lE*iE*IE�ElE1E1ElE
'❑ �, m o�wr d �he oropeny or my empwyeee �.vh wepee ev ihai ede mmpanaetio�, vn�� do ihe v.a'k, arie �he evun�rs a �a imeMed ' ' ' D E V E L�, �� P i+i �.' N, T' �S E R �7 � I L' E-$� Ei E [J I R' E M� E N� Tt � ' �
adleraCbrseb(SeetionloM.Bude+neMProleeaimaCOM:ThaComredwaLimnseLewEweialapplymenownardpropeM . �. . Q /'S . . '
wlw Wide or inprovea ihemon. eM Ma doea euch work IimceX a Mnell a tMaph hc a hm own empbyeea, povided thm wch � � ' . � ' - ��:'
impovememeeranotinmMeEaoNeredloraeb.M,howeveqlheWilCinOavnqovememnroldwnhinomyeardmmpbfnn,the ZONING,APPROVED BY' ' ' ' • � DATE:� ' "
� , owner-buiker will heva �he burdan M D�'��B � w ehe EiE nM build or improve Iw the W�a W eele).. .. ' '- _ . - . • . .. - -. . . , . , . , . ..
� . m, , �
� I, a� ovmsr d IM propeny. am mchmvely oonvmiq wnh IioenW convxlore Io oondrud Ne qqed (Seaion'lWI. &nimee and B U I LD I NG ' AP P RO V-ED B Y "''' � ' � �
PMauion Cotle: The Conveaae Lironas lew doo nd ewh m en owwr d nWe�Y wM Wilda a'un0�'ro Ihereon eM who . �v,� .: DATE :� /�.1.
•.. convea� Iw wch Drol�s wilh e ewNmclorle) liceneetl punuent to ihe ConlreUon Lionse lew). �
❑'i��emp��ea�s«r�: e.aP.c.,i«u�.,�,: - APPLICATION ISSUED BY: ' k DATE; � �!
Dete: f � .Owner � - ' � ' 3E3EiElEiE�lEfEiE1E1EiEfEiEiE1E�%iElfiEiEiE1E IE1EiFiEiEiEififiEiE fElE �
� . LEGALIZATION:N �i', � F E E S U M M A R,Y . STRUQTURAL SEGMENT:Y --
I Eo hereby wnAy thm I em ewere d eed urdemtenE iM requiremenb M Celfania Hmhh end Seleiy Code Sepbna 25505. 25533, enE � . .. , . '' � ��' , � ' ' ,
25530, eM thet I or erry Mum buiWiip ompen� will / wll rw� (arcY are) nead lo wmph/ wih eaid elele mdm eM iM ,epuiromenb b �
e�um.�.wnro�o��efima�r�ine�s�-�ir '�aememu�na.r�aaam���wa����wd+�..mw��me.. � BLDG;PMT • PliUMBING ELECTRIC. MECHANIC �FIRE' SMIP/RES GRADING
� Praveana ! � , . , • . '.
� :, PERMIT' . ,, _ �.39,.00, y 50 �
o�e - , .. ;._ : now�m. - > � � , . . 4 ' ' 'SMIP/NON—RES � i
WOHKEN'S COMPEN9ATION DECIAP�TON: I Mreby elfiim uMar perWiy d pmjury aw W �he /ollowiip Jetluetoru: ' PLAN `'' � � � � , ., . � , ' ' ' � '
ISSUE�FEE. .
❑ �h��e�u��i�aoenn�adw�esoimeeh-i�a��eror�ork�oomar�wior�,mpwiewmrWs«no�a�000�me�na HUILDING—DIV—> PERMIT' ' ISSUE PLAN—GHECK • TOTAL '- � PAID 4.. '"DUE !
� COEe, lor IM pMamw;e d iM v.wk fw w1Jch ihia permn o ioued. . .. � - ' 1 � .
�] �h��dm�mdntdnwohanmmpeneeioninaurence.mraQuireebyseaims�aodihe�eborcode.MihapsnurmenmdiM. TOTALS----> _ 39,SO 0.00 '0.00 • 39,50 39.50 . .00
. work lor which thie pemin ia iouad: My warMen' mmpenaetion Inwrenm cerrbr eM policy number ere: '' �� '
c�«: GOLDEN EAGLE EXPIRES_ REVENUE DI•VISION�TOTALS=.—>� COLLECTED: 39.50 OVER/SHORT: . 00
' rd�N�me�.:• OS/OS/97. BLDG PMT PLUMBZNG•;ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
� � lm;, .snro� ds.d �o� n. �omWdr.d a rna oe,ma �: �o� o� nd�e�,e ea�:n Isrool w a�.l . . � . ' . <3 9 .. 0 0. . - ' . ' ' , ' . , . �' . �. S 0 .. .
I cenN thet in Ne ps�lomu�re d tM wark tor wTc� Ihu peimN ia uewd. I ehdl ml mmpby enY Vs� in anY mennx eo m to � , ' '�- �• '. : . ' .� � �' " � ' �.
�yecome wbjeu m iM xoM1en' awnW�ion levn d CalAomie. eM?Oree Net il l MouM become wM� m tM worken' � iElE9E�E1ElEfEfE�lEfEiE1E.fE1E1EiElf-1E1ElE1EiFiEifiFiklFlfiElEfElfitiEfEfE1E9EiE1F�ElE�IEiEiFiElFiEiE1EiE9F%iEiElEiEififfE1f1E1EfE1EiE1fiElElEiEiElEiEifdflEiE1E
/' �/mpeneelion O��ebna N SeUion/3100 W Ihe lebor Code, I��NI iu� in �omvM � n mo� �a� , '-- � " I. N D I V I� D, U'A L F E� E B R E A K D O W N
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W�m/n p:FallunMaxurowotlnrirompnwtlonewmapsbumwiu4mea�un�ub/�crm�mp�oyxrocr/mbu� p�n+rowene.. .TYP,E, .._,,,QTY� ,� D�.' .S. C..�i I P. T:. I � N � ..� "UN'IT COST TOTAL C�$Z'
a
dvll flnsa up ro ons hundrod thouwnJ Colbn ISf00,0001, In etltlltlon ro M� rn�t o/ eomp�nutbn, tlerrrp� �� povltlM br In . , , . , ' � ' , �
ON
s.�n�amso�m.wo,eoa,��r.�..e.�a.eroi�.y.�.... '_ . SFR ; . 1677. _ REROOF BY VALUE RESIDENTIAL NOZONE� ' 1.00 ' 1, 677'.00 ..
CONSTRUGTION LENDINO AOENCY: I heraby elfirm uMer penehy M perNrv �� ��� a a consVuabn b�inQ epe�y mr ms - ' ' END �F FEES � . '
: DBlIOlIIIBfIM OI �M WOM1 IOf VAfICII IM1O OBIIIIX 18 BBUlE (SGdp11 HO�%. CN. CI. ' Y � � � . . � . . � - ' ' � � ,
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' LENOEN'S NAME: e I i • . . . ' . . � � + ' ' . . . . , ' . , � f '
' - LENDEWSADORE39:1 .• � � . . . . . • - ' '
I cetlily ihet I heve reed thia eppiketion enC elele �ha� ihe ebove inlomietion ie corteG. I eprea m mmpy wnh ell dry and munry ordironcee' �
end etele lewe releliq b buiWvp wnaVueion end heroby eu�hurize �apasenteiivea W iho dly ro enbr upon IM ebove-menlomtl pmpeM
�o`��'°�'�°�`P�"'�JOHN KIDWELL , � • . .
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Se/ery: GreemFle: Cenery-AppFwn: Pink-Hsvenw: Oddenro�Asxmar � -' --
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� CONSTRUCTION AND PLANNING PO t SPA
APPROVALS Permit# Date Inspector APpRQVALS Permit,f",� Date lnsPector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Locadon �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrica� Co�duit-Undrgmd. . 55. Electrical Bondiny �
5. Steel fleinforcement 56. Rough Plumbing & Pressure Test
6. Electric2l UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footingt 56. Electrical Conduit�Undrgrnd. �
8. Foundat�on � 59. Ges Pipe, O Un�rgmd., Test �
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, C U,r.drgrnd.
10. Structural Fioor SYstem 61. APPROVAL TO DECK �
7 t. Property Sewer Line & House Connection 62. Back�vash & Receptor�Final .
12. Sewer Cap - 63. Heater & Vent-Finai
13. Roof Drains , 64. Plumbing System - F�nai �
t4. Rough Ptumbing 65. Efectrical-Final
75. Rough Eleccricai-Conduit 66. Solar SVstem-Final
76. Rough Electric Wiring 67. Fencing & Access Approval
ll. RoughWiringSign 68. APPROVEDFORPLASTERING �
78. Rough E�ectriral-T Bar Ceiling 69. POQLlSPA SYSTEMS FINAL
19. Rough Heatfng & Air Condrtioning FIR�E DEPT. REQUlREMENT
20. Rough Factory Pireplace . APPROVALS Pcrmit # ,
21. Ducts, in Structure 70. Undergrou^d Hydro �
22. DuMs, Ventilating 71. Product Piping 7 Gas ❑ Oil
23. Gas Pipe-Rough & Tesx 72. Underground Fiush
24. Roof Framing 73; Undergmd. Storaye Ta�k O Gas � 0�1
25. ftoof Shea2hing �� � 74. Overhead Hydru
26. T-Bar Ce���ng (Structural) & tvlonocoat 75. Dry Chemical
27. Frame and Rashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTE\i FIiJAL
29. Insulation . 78, FIRE PREV. F�NAI
30. Drywall Naifing FtEALTH QEPT. REQUIREMENT
31. Plaster 6rown Coat 79. FINAL INSPECT�ON
32. Electric3l Potivzr MeterFinal 80. FOOD CERTIFICATE ISSUED
33. Finai Electric Notes: , �
34. final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Pinal PlUmbing
39. Water Service-Final
40. Gas Service-Finai �
41. Solar pomestic-Final "
42. Backflow Preventer
43. Backflow Irrigation
44. LandscaPe irrigation System
45. So�nd Attenuation '
46. Handicap Regulations
47. PINAL STRUCTURE & Bl11LDING � 2 4 ,�p�
v7
48. FVNAL P�AWNVNG
49. Electric Release to Edison
50. Gas Release to Southern Calitornia Gas Co '
57. CERTIF�CATE OP OCCUPANCY
No, Date
•, . . . . r t_. . , . ,�--._. . . . . . . . . .
�,. �,� -' , ' � � AOP�icant to �ill in all spaces except those within heavy Doraer Iines ana sign all appropriate tleclarations. - . � - . ' ' �
PERMIT NO. ' - T�+ CT'NO. -..LOT NO. ! UNIT NO: • , � i
; CITY OF COSTn MESA � CONSTRUCTION PERMIT� , ' �a� ;� A.P. # .. , Lj. �ff� _ — � _ �; �, , , za�a •
?i o•' -�4 �. "r�' .c'.;i .. , �5:3, L'33(�''�. � Cj ,'� � " •
Pro�ect Address - � � � � � S - Main Bwlding: ( ' Accessory Bwlding
� Applicant idailingAddfe55�,�o/of%d. F/�fiSroF'/�%�E Sf%�, : TVPEOFCONSTRUCTION �' �,, �;NEW � 'ADD '.ALTERATION�, ' REPAIR• 'E, -. _ � -_. Z
i �, , . - . . . . . . . � � OTHER � r �° "r � _.,_ . r ,T:. F,rOnt � . . S. -. ' ( � f .. T�' O
' B�8 SF�Q� E.�,f� ' �0 CONVERSION� ❑'DEMOLISH
Owner s-Name � - �Phone6+��-� S'�f= � DESCRIP 10 F WORK/USE, F BL ` ` � � I� B � Rear E ; - - � �- • '�'"`" N
AddrE� 4/ /J /�� TR. ti.(. , � � ; : � � ' � � � � �' hf i � , . . .'•. ' i _ .. . s. :A' . ti -"�; I
. � - .,- � . - , � , . . . � , .C; Right ,.. N
" t -• t � i' ' �, ' ' TVPE OF PERMIT � GRADWG FOUNDATION - STRVCTURAL
ArcfilEng - License No f _ � • ' K { , - . , - G
r� t � -'❑ SENANT„O ELECTRICAL�O PLVMBING,.❑ MECHANICAL' -. �$' Lef • �- i ;y.3•.-
Address � � �- ' ' � ' ' � ' . . _ � : :n � , . � � . . R, •
r � . -, �c1' .f : � � - ; .'.,� �OTFiER• ' ' �. •, . � . ' - .+ , ' .: ' Pln Ref �# - ' ' "�arkin �
� Contrecmr s Nam �'Q £ .�f:..aoE �.-� phone %'1.� 2�J o , . . - . � 9� g Req./Provided r ' � r E
, �. � ' � PFOJECT DESCRIPTION - 5�. FT. - - � ' � - oCCUaaNCv � w � �n e.�
Address ImaJing) � ' ' � ' '�i ' ' • - � � - ]�'�- ,'Planning Notesr M
n .� CONST{3UCilON'SVPE � 'V1� � ,,ViILUATION$� ,+C��L�_ ,_ ' T
. ., - 8:�F63 � : :. :
.. CityLicenSeNo. -' �t ��ZONE• ' GRADINGCU.VDS.� � ' ACRES � T - ' i' S.
� �L'ICENSED CONTRACTOR DECLARATION � � " ' � � � ' - ' r ' ' � � , � i' � - . - • � , � � ' r `- �p .
I hereby-affirm that 1 am licensetl untle� provi5iOn5 of Charte� 9�(comm¢ncing ; Remarks: ;� r ,� + � '' � " --
with section �000) ot,Oivision 3 of the Business antl Professions Cotle, antl,� ,M. - ' '. �' , " , . . � _ _ . . ELECTRICAL � { - 'FEES ��
my license.is in full force eife t. . j ' � � ! , � _ . , � . . q�. � : � . � : , ' , .'" , '
5.73oDZ
- ' License..,I.S .,, t -�� + o: . . � .. "'. ; - . � � .
� ' P6UMBING - � - � � FEES ?utomatic Washen ' � Transformer �O 15 50 KW i' =
�Dafe � Si9nature� "' " ' . . �. ,
WORKERS'COMP NSATIONDECLARATION ' - ' - �� � � ConstructionPoleSub.: r• . '�50+KW� , �;: � �,
,
. -- ' BarSink -' : o ShowerY' - - --'
, •eby�atfirm that I Itave a certrticdte�ot consent to self-in5ure or a Ce�LfiCate � ` � � - � -
� /orkers'.Compenzation,.lnsurance;",or.a,certilietl:copyjthereof.(Sectionv ,�, ' • ' ' ` CoOkingUnit Meter❑upto100amp5 ,
� .J. �Sb. CJ '� � �i ' y + �... . BackflowPreventer.-+ :'.�. �-r� �ServiceSmk �wt' - ,�-� -�" - -. . . _ .:,,... � __. ._ _ .R. _ '
p�,my No. ��OS �2 2 0 � �CompSny S T9 r � �'� �� � ' Backflow Irrigation . � Sewer Cap �j � � ` v f ' Dishwasher :' ^y � . � • . Meter ❑over 100 amps �•' -�
'{�1�� Certifie copy'S M1ereby furmshetl:.' �,,���$ Oryers ❑Gas ❑Electric Sub Panel �„ �
�� LJ'Cert�� i� q d with�the aty [�ij�in�/DA/vbn. ; . • Bathtubs ' : � � . Sewer Connection.' ` ' .� � �
Date `+ L� E APPlican[��/ 6r�' � - I •.�., ' . Fao . . . , . '. �
' EXEMPTION� _ OM WORKERS' COMPENSATION"DECLAftAT10N ,�� Cldf�fi¢!5 r_ .� SOldf COIICCt0�5 �. � ? MOt0�5 OO-1 HP �1�%-- 8� �
' (This section neetl not be completetl if the'permit�is for'one huntlretl ($300) or � Dishwashe�' ' x. � � � F,A U. � �� ' � ' -
' iess). ' � � ' � :. . . ' ; , . ' Inc:Solar �9-15 HP'016�15+ '
• . f Solar Piping�'C. 1. � i. �� -
, _ I c¢rtify.thal�in the peifo�mance Of the wo�k fo��which thi5 perm�t i5 issuetl, 1 • � � .. ; i � �Fiztures ' ' ' � ' ' + � - �
. ShalFnot employ any pe�son'in any manne��so a5 to beGOme subiect to the � D�inking Fountains.� ` Solar Tank' Microwave 1;
� ' WOrkers' Compensation Laws of California.. . ,_ ; : . , . ' _ .� -� 5 , ' ' i _ - � � - - �� .
Date ' ' Signature Floor Drains � y. ' Swimming Bool w/Spa •� Device Boxes Pole Light
�� � NOTICE:'If, after making this tleclaration, you�shoultl become subject to the ^ . ', . �' - -
�� �-Workers:-Compensation provisions,oi tM1e.Labor.Cotle,.you must forthwith. ..,. FIOOrSinks�.' : -.-�, . '�� -Urinal � °.�.�. + - =.. . .{>." . �utlets`,� Range:; �
(y� comply with' such.prOviSions o�,_this� permit Shall be' tleemetl revoketl. _ _ - ' � , ,
Y� CONSTRUCTION� LENDING=AGENCY.' � � f +� ' . ' ' . ' ' .:' Gas Service� '�Oudets _ � �Water Closet � � - Switches . ,g�y� �� � i~
. 1 I hereby a((Irm tnat there is a construction lentling agency for the oerformance , , • y _
�of tne work �.for .wmm�, tnis, permit is issuetl,, (Section- 309� -Civ. CJ IntercepmPs - Water Heater. rt ' Garbage�Disposal Standing�Sections�
�LentleCs NameL - - � ` ' � ' '�' - - . �
- � � � �entler's'ABaress. - � '=' � ± _ _ �. ' �� � ' `_ � Kitchen Sink . „� - . Wafer Service '- - . J � �i Generator �0�5 KW. �5-15'KW Trash Compactor
OWNER BUILDER DECLARATION '
I hereby atfirm Lhat I am'ezemp[ from the ConVactor'S License Law for tne� Lavatoties , =Auto-Wash� ` �. �
O' following reason (Section �7031.5 Business antl Professional Code: Any'city or " ' . . . . . , ,i . , , ,
county which'requires a permit to construct, alter, improve, tlemolish or repair, � P-Trap ' Caundry Trays ' . �
' any sVucture, prior to�its;issuance, also requires the applicant for,such�permit � � ., - ,
�-, �to file a signetl stafem¢n[ that he/she is IicenSetl putsuant to the provisions�of .Roof Drains.�' � ' ' r�' � �� i - , 4 � � •Y'
1M1e ConVactOr'S LicenSe Law (Chapter 9 (commencin9 with Section �000) oi . - � � , � _ � + "
�sion 3 ot me Businezs antl Professions Cotle))or thal he/she is exempt' � ,_. . • , . Reinipection Fee $15 luue Fee , ' $ 3� ,
I efrom antl the basis for the allegeE'exemption. Any violation of Section , - �-� _ . , _
� Q-.S:by, any applicant for a •pe�mit Subjects the applicant:t0� a �civil, ' '� ' • � - - .
' �nalty of.not more than five huntlretlitlouars (g500)! �, �: � . y; � . . _ DEVELOPMENT SERVICES REQUIREMENT$,� � �] �� , •
Reins ectian.-Fee � ' 3 , � � � (�(.J�\y.(�� �
((( ❑ 1•,-as owner o( the property-or'my emploYees:with wages as thelr sole � P . $15 ' ' ,. ,. ISSue'Fee ( $„3- �Zoning.AppfOved�6y-� •��- `�- � -� Date ��f�
� compensation, will tlo the work,�antl the:structure is not mtentletl or:ofteretl' � � - � .
for sale (Section� 7044, Business antl Pro(essional Cotle: The Contra<tor's � 1: ' MECHANICAL , . � FEES' Buildinq Approved By Date '�
� �� icense Law Uoesnot apply.to an owner�of.a,property who builtls or improves ' ' : . ^ '
. it�iereon, antl who tloes such work.nimselqnerselt-ar tnrough his or ner own . � Hood or Type I ❑ , .� APPliption Issuad By Dat 'a.� , ,
empioyees; p�ovltletl that sucM1 improvemen[s ure not intentletl,or offeretl for: BOil2� - ,�• ... ; � _
sale. If,;however, the'builtling or improvement is soltl within,one year of com-� -. ' �Canopy Type II ❑- ' ' � , ' SUMMARV OF FEES . � '�
' pietion,:the�owner' will have the burtlen of�proving.he/she tlitl not builtl or'im-, � Duct�--Under GrOund ' � - !- . ,� , ' ' '
Moveforthe�purposeofsale). .t ' ,� � . � `� � ' ; � BUILDINGPEFMIT: $ -Z�- i SMIP'- � $. O--
�J I,jas'owner oi:the property, am exciusively contracting with licensetl con-: Duc[ - Strucmrel , � Refrigeration System' ' � �� � PLAN CHECK $�, ( � �/� �- . PERMIT" - ' ' '
[ractorsto construct Ihe p�oject (5«tionJ046, Business antl Profez51on5�Cotle: , . , • , , ,
The.ConVactor's'License Lawdoes,not.applytoanowner_ot.property'who' _Duct�,Ventila[ing . . ❑0-700,OOOBTU ❑100,OOOBTU : �-� , PLUMBING $� ' ISSUANCE�,� $
.. builtlsor improves,thereon. antliwho contraGts�focsucn oroi¢ct5 with aicom � � - � ' � • - ' ' � � '
tractor s1 1¢ense pursuanc m me Contractor•s License Law): 1 am aware mat� �.F t �' PLAN CHECK ,e25% $� � ENERGV P.C. .$�
Ezhaust System �, �MulLple ❑ `, System•Repair/AlteraLon , �
prooi'o( thev Worker's eompen5ation3insurance shoultl;be provltletl to me. � � - - � $�; � ' - . GRADING � $ � •�
� • � - � � . r - , � ELEC�TRICAL � ' - '
❑.I am e%Cmpt untlEr SCc[ion 'B. & P. C. for [h�5 reason FIfE I/FBct. BIt. ICB� #". t Fif¢ DdT E�5 . . , '
�. � + 3 � � P . }• P � MICROFILM $
. . . . . PLAN CHECK 50°h $ �
Date ' ' owner � " � - ' � � Heating System & Ducting � ; Registers � j � MECHANICAL' � $ - - � ( 2 � Y�
I'tieieby� c'e�tify`thaT'I'have"read'this-5pplmation a`otl�state"that�the above'; 7' �0-100,000'BTU �100,OOOBT � -' ' ^/ �"' -� + � r �'- +• � � TOTALFEE $'� •
t
information is wrrect.9 agree to!comply with all.city antl county ortlinances'. ' ' � i� PLAN CHECK ;. 25% $ f � • j' . -
' antl;sta[e'laws relating to builtlin9 �onstruction; antl nereby authorize repre- . � � � �
5¢ntabves of- thiz � t p�, upon the above-mentiOnetl, property' to� � + ; ' ' - • � ' . - . , _ ' � t , , . '
1' 1 . �
t � InSPecbon PurPo � � Da[e��.L?'%/�.� . . . _ r . .1 : . i ' . • � .
Siqnatu'e � � 1 qeinspection Fee• �;$75,. ' laue Fee ' �C, � $ 3 ' � o� - � v
o���er: License.or 55 � ' �' _ ' . I j C�� 40C4s 13-0`�!]�0415� 70T a:t.15
0865-46,�rev. 5/BB Wnite - Builtlin9. Canary - APPlicant: Pink - Accounting; Goltlenrotl - Assessor �. ' • ' � ' - �� � � � � " t�'�`y �•��--�j,tj�E7 �(��� ���g.'� -�(.Y��; .�(�.;�,� ' � � _ . ... .,
CONSTRUCTION AND PLANNING POO' SPA -� .
,4PPROVl�LS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Te�mporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Unqrgrnd. 53. Steel Reinforcement
3. Electrical Coriduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
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 Plum6ing 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
]8: Rough Electrica6T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts,�Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ 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 Met�r-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-Ffnal
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation �
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING 3 �
48. Special Requirements Completed
49. Electric Release to Edison .
50. G�s Release to Southern California Gas Co
51. CERTFFICA7E OF OCCUPANCY
No. Date �
,:
� t�` :��� Y i dd Y P� �!./
City of Costa Mesa Building Dept.
� BY ��_�� DATFe'Z319�
THESE PLAN$ MUST C:E Otd J03 aT ALL iIM"e5 MAKE
NO CHANGES �NITHOUi ^rRiCR 4P?ROVAL OF DEPT.
�3��3�.
THE�;SSUANCE OC G9AN I;Ji; C?( P?HtAli Od flPPROVAI OF �
PLANS AND SPEGIi�:CAr�pNS Sr.All r-']; SC GON57riUED i0 uE A
PERNi7 fCZ, CR AN APFfOVqL qF, An:'( VtOIAiIUrv OF ANY CF
TKf PF.UVIJION$ OF TNI i CC'DE "dC'.2 �?.���T f'�ei:il�M:NG TO �!VE
� AUTHOkIN TO V!O.A',t ON CAN�PL lH2 PZi^.'SIOPiS Of 6ib �
�CODE $NhLI 5F. NALID, EkCi?7 !T' S0 FH.4 AS ?rl.`. vvp;�'K O"n USe
WHiCH IT AUI'IiGRIZES IS iAW7Ul.
�THE ISSUANCe OF A Pe?f.1R BAP'cD I:�CN P! �NS 4�iD
SPeCIFICP,TiOMS SHALL NGi Fk'tv��v� 7NE Bll�l'J���G Q�PI(:14!
4 fP.ON, TH:RE1.FfEF �[OU!��ING iHE CCRR:CTiv.�+ Oh `_RF:?CS IN
� S.aiD PLnNS AND SPKiFiCA?IONS On FfiOM PR�VLNiIKG
�BUIIDING vPERAT10N5 EEiNG C4RRIEG CN 1!1EFEUN^ER WHEN
IN VIOIaTION OF THIS CUDE Ok O` <NY CTHER OR�INANCE Of
iHE CITY.
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CITY OF COSTA MESA
PLANNING DEPT.
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BO% 1200 COSTA MfSA, CAIIFORNIA 92626
OWNER
MAIL
arv ��-�q
CONSTRUCTION
LEN�ER
BRANCH
ADORESS
ADDAESS / %y,:
CONTRACTOR �
ADDRESS 1�9j�
CITV �f//�
STATE �
LIC. NO.
SI2E ��a /
OF LOT
USE oF �
EXISfING BLDG.
512E OF
NEW BLDG. �,��
EXTERIOR WALL�j
COVERING LC)/y
USE OF BUI�DiNG
PAI�
:tAY 15-75�ric+�� 65?_'c **'`719.�i5
APPLICATION FOR BUILDING PERMIT
RECEIVEPBV DATEFECEIVED DA.T.61�S'�1
IIIRI
)
PERMIT NO
A.P. N0. � � — � .(r
T�� BUILDING �/D L - � ��•
A�DRESS �
O�s/�Sj CT LO�T H BLOCI
w a
OWNEF ;i
VAIUE
Q�%! S �Z $
����� FIRE �
ZONE YPE GROUP
APPROVED ,/' �`
^T.n/ av , DATE h �IS �
TEL. (J
NO.�^/�
CIT�
/ LIC. NO.
i NO. OF BLDGS.
NOW ON LOT
NO.OF
ROOM`
ROOF
COVEfl
KT08'
L7
VARDS APPROVED
DISTANCE BET
E OF NEW
LDING ,
VARDSAPPqOVED
BEf. MAIN &
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I hereby acknowlatlpa that I have read this appliwtio nd state /�
that ffia abo�e information is correct and apree to eomply wtth '�
all taws regulating builtlin8 conatructlon, and 1 she11 nos employ V -�
any parson in violation of the workmen's compensation laws of
t�e State of California. � �j '�.1
t heteCY certify that I am proparly IlcansaE es e conttacta� �nder V� SQ. FT. D W�1I O
tha State of California Bus(ness antl Proteasions Coda, D(vBicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chepter 9, antl thet such licenus are in full force antl effect, or I THE PUFPOSE OF ESTABLISHING A PERMR FEE ONLV: Q
am ex¢mpt from the provisions ot the Steta of CalHornta B�siness VALUATION
and Profassions Code, Divislon 3, Chapter 9. rv
l PEFMIT FEE S / � � ]
Sip^eture of 1 / /n/ � � (� m
Permlttee T I I I�'h�--L —/ �"`9 �$35oa PLAN CHECK S � E
/� G
Authorized Ageni �/ LL
TOTAL FEE $ N� � Q