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Home My WebLink About2191 AMERICAN AVE - Building Permits�4ji:I.:T�i;. y�. � ".�.".-::� i � CITY OF COSTA MESA � BUILDING DIV/SION ,,� , ' , �. 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4&56 • www.ci.costa-mesa.ca,us FOR INSPECTIONS CALL: (714) 754-5626 - PERMIT NUMBER: M09-00014 PERMIT TYPE MECH STATUS: ISSUED APN: 42208117 DATE ISSUED: 02/10/2009 ISSUED BY: BJK JOB ADDRESS: 2191 AMERICAN AV CM �Suite/Unit: Vicinity: HALLWAY CLOSET , � - , . - - , . _ � ' � SQ. FT: 0 - � � � SCOPE OF WORK: CHANGE-OUT OF�A��FURNACE IN THE HALLWAY CLOSET OF AN EXIS7ING SFD. OWNER: GOSNELL, �EORGETTE TR" � Address: PHONE: _ - , � ' Oify/Stafe/Zip: APPLICANT: ELLIS,JOE�� . � . � �,_ - � Address: PHONE: 310-836-0408 X120 � � � � City/State/zZip: � ; , CONTRqCTOR: ORANGE CO SVS INC DBA GEORGE BRAZIL PLU Address: 3801 LENAWEEAVEUnit: CirylState: CULVER CITY, CA ZipCode: 90232 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: � $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: ' � � $0.00 REINSPECTION FEE: - - $0.00 TOTAL, FEES: $38.30 2191 AMERICAN AVE UniL COSTA MESA, CA 3801 LENAWEEAVE Unit:." CULVER CITY, CA � License No. 679898 � � PHONE: 310-838-0406 X120 CELL: �O G�u y �G�G- Su�t • �e►-„�:t F,�rp:��s 4-/8=/I H�9N EXPIRED DATE � �� ` � �� NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requiremenLs under Califomia sfatules and related regulations. (Ord. tJo. 92-28, § 1, 12-21-92) . EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � INSPECTIONS: In order for ihe work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all required inspeetions and flnal approval must be obtained. PaiWre lo obWin inspections and final approval will result in lhe ezpiration of Nis permit. woe�• i�cnoxTrve D� ��5�4 4� ixseEcnoxTrre o� iNmu�s 1818 Fixep System Final Fire Preventlon 206 Final Mechaniwl 1266 P�I SOa Final 208 Final Plumbing 200 Final Re-Roof 270 Final Electncal 201 Final Block/Retaining Wall 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 WORKERS'COMPENSATION DECLARATION:� . I hereby aHirtn under penalty of peryury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for vrorkers' tompen5a[ion, as provided (or by SeCtion 3700 of the Labor Code, fOr ihe eRormance of t�e work tor which this permit is issued. � I hava and will maintain wvrkers' compensation insu2nce, as required by s tbn 3700 of ihe Labor Code, (or lhe pertormance of the work for which ihis permit is issued. My wnrkeis' compensation Insurdnce carner and policy Cnumberare: �� ^��. ��/� ` arrier:� � � � (This sec(.bn neetlipf /be�cum etetl Athe permn i/s vLa4.,�etl at on�e hundre/d tivllars (Sf00) wless ) Policy.Number: ( � ) � ��q ! V � v ❑ I certify that in the pertormance of the work tor which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compens ion laws o(/� a' omia, and agree [hal if I should become su � � e o cQ �m Ensa on provisions of Section 3700 of ihe Labor o, I sh I f N' ly wi these provisions. � Z 'CO -a� AGP ��'s'Signature - } ` Date_� WARNING: FAIL RE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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 affrtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 0( the Business and Professions Code, and mylicense� inful,tnr a�e�ecL �✓� J Licr#�, Class # 2 -/b�v� on o _ aNre Dale j CONSTRUCTION LENDING AGE CV: ❑ I hereby aKrtn that there is a construction lending agency for the peAormance of the work for wfiich this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Atltlress: Date OWNER-BUILDER DECLARATIONS: I hereby affirm that under penally of perjury thal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe (ollowing reason (Sec. 703L5, Business and Professions Code: Any ciry or county which requires a permit lo construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires Ihe applicaN for such permit to fle a signed statement that he or she is licensed pursuant [o the provisions of [he Con[ractors License Law (Chap[er 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or [hat he or she is exempt therefrom and the basis for Ihe alleged exemptioa Any violation of Section 703t5 by any applicant for a permit subjects ihe applicant to a civil penalty of not more than fve hundred dollar5 ($500).�: ❑ I, as owner of lhe property, or my employees with wages as their sole tompen5ation, WILL DO THE WORK, and the sVuc[ure is not in[ended or offered foi 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 vrork himself or herself or through his or her ovm employees, provided that such improvements are not intended or offered for sale. If, however, Ihe building or improvement is sold within one year of completion, the ovmer-builder will have Ihe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The con[ractors License Law dces�not apply to an owner of property who builds or improves thereon, and who coniracts for such project with a contracta(s) license pursuant tothe Contrdc[as License Laws.). ❑ I am exempt untler sec. Business and Professions Code for this reason: SignaWre Dale ' 305]dfi (3/01) Owner ID verified by Ariver's lice .❑ Yes ❑ No Driver's License No. Expires: , Venfcalion ot Ownership by (type of do%}�mecd, i.G. -�jFoper.q ax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetlify Ihat no excavation frve (5) or more feet in depth in[o which a person is requiretl to tlescentl, will be made in conneclion with work au[horized by this pertnit, and that no building siructure, scaHdding, falsework, m demolition or tlismantling Ihereo(, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Ttle 8, Cali(omia Adminis[rative Code�. ❑ As owner-builder, I will not employ anyone to do work which would require a permil from �he Division of Industrial Sa(ety, as noled above, unless such person has a permil lo do such work from the tlivision. Applicanfs SlgnaWre Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupanl need to file and certity a Business Plan (or emergency response to release or Ihreatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 0( the Calitornia Health and Safe[y Code requires, with some exceptions, lhal a Business Plan be fled wilh the Cosla Mesa Fire Department by every husiness which has at any one time du�ing a reportetl year a quan[ity of hazardous materials equal to or greater Ihan a weigh� of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature antl pressure). 2. Does or will the applicant or present or fuNre building occupant need b file a registration form for awtely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health antl 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 quantiry of acutely hazardous malenals equal to or greater �han a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas at standard temperature antl pressure). 3. Does or will the applicanl or present or future building occupant need to prepare an RMPP (Risk Managemen[ and Preven[ion Program (or acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provitles that the Costa Mesa Fire Depadment may require the preparation, certifcation and fling wi�h the Fire Departmenl o( an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Sa(ety Cotle been fully complied wi[h? ❑ Yes ❑ No S. Does or will the applicant or present or (uture building occupant require tor the work which is ihe subject of this application a permit for such conslmction or modifcation from the South Coasl Air �uality Management District or tmm any other air pollution control district or agency? ❑ Yes ❑ No (Sec�ion 65850.2 0( ihe Califomia Govemment Code requires that the reques�etl infortnation 6e fumishetl on applications (or non-residenlial 6uiltling pertnits). 6. Will any part ot Ihe facility to be constructed under �his permil be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Q('yes", the facility must meel lhe requiremen[ of Sec[ions 25534 and 42303 of lhe Califomia Health antl Safery Code). 7. If a permit from the Sou[h Coasl Air �uality Management Dislrict or olher air pollution coMrol disMct or agency is required for the work which is the subjecl of Ihis application, have all of lhe disclosures prescnbed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach certificate of wmpliance fmm the appropdate air polNtion control oKcer�. � � CERTIFICATE OF COMPLIANCE: I-certify ttiat under penalty of perjury the infortnalion given above is correct I agree to comply with all state laws and city ordinances regarding Hazardous Materials and�Emissions. � SigM1atore Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that lhe in(ormation given is correcl. I agree to comply with all state laws and ciiy ordinances relating to building constmction, and authorize representatives of the City o( Cos[a Mesa [o enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any buildinq authorized by this per it until (e2�i � ectio SiB�a re Legal w / Dale J 2 � ID -o� And/O�AulhOr CAPWifant �Dd�¢� � � � PN0.IECT AUOflE55: OWNEH'S NRME: aooAEss: 642-0486 RflCH/ENGINEEfl: RDOflE55: ICAN AV COSNELL flEG.NO.: uxiT: UNIT: PEflMITTEE: LEE ROOFING OF' COSTA MESA ( 714 ) 642-7222 aoonEss: 1653 SUPERIOR COSTA MESA CA 92627 LICENSED CONTAACTOB OECL1flRTI0N: I hereby altirm Ihal I am licensed untler pmW5ion5 ai C�apler 9(commencing with Sec[ion ]000� ol Oivision 3 of �Ae 9usiness antl Proicssions CoOe, ana my license is in fulliorce and eiteci. QTYLIC.:OZA%SS sTaTeuc.:34968��'_ c/jNss: 3g o„e: 9—+6 -9L Signa�ure: `�,.�----- I�ypqKEB$' COMPENSFTION DECWBpT10N: I here�y aflirm lhat I have a cetlifica�e ol consent �o self-insure or a certilica�e ot Workers' ', Compensalion Insurance. or a cenifie0 copy thereollSeclion 3800, Lab. C). I roucrxo.: 1300948-92 E%P.ORTE: OCI3O�93 comraxv: STATE FUND � Ce�ilietl copy i5 hereby fumishetl. � Certi�ie0 cop✓y is� �ilea wi�� the ci�y BuilOing �ivision. �a�e�. � � 'y� - �% � Applicanf��T� .Jt Q� ��- E%EMPTION FflOM W08MEB5' fAMPEN5ATI0N UECtABRTION: Qhis sec�ion neeA noi �e comple�ea il �he permi� is for one hunare0 �3100� or less�. I certity Ihai in I�e perlormance o� Ihe work br which this permi� i5 issued. I s�all not employ any person in any manner so as to �ecome sublecl �o I�e Workers' Compensation Laws o� Calitomia. Date: Signalure: NOTICE: tl. a�ter making Ihis tleclara�ion. you should become suDlect �o Ihe Workers' Compensa�ion pmvisions of lhe Labor Cotle. you must fo�hwilh comply wiih such pmvisions ar this permi� shall he tleemetl revoketl. CONSTBUCTION LENOING RGENCY: I here�y aflirm �hai ihere is a constmction lentling agenCy lor �he Oerlarmance o� Ihe work tor which I�is permit is issue0 �Seclion 3097. Civ. C). IENDEN: aooxess: OWNifl BWLDEB OECIABRTION: I Aereby aifirm Iha� I am exempl imm �he ConVaciors' State License Law for ��e lollowinq reason �Seqion 703L5 Business and Pmtessional Code: Any ci�y ot Wunty which reQuires a Oefmil to conSlNct, alter, improve, Oemolish, or repair any simc�ure. prior Io its issuance, also requires ihe applicanl fo� such permi� �o file a signed statement ��a� helshe is licensed pursuam to ihe pwvisions of ihe Coniractors' State License Law (Chapter 9(commencing wilh Section 7000) of Oivision 3 of ihe Business an0 Pmlessions CoOe) or tha� �e/she is exemp� ��ere�mm antl �he Uasis br I�e allegetl exemDtion. Hny viola�ion ol Set[ion 7031.5 by any applicanifor a permit sublects ��e applicant to a civil penally o� no� more t�an live hunAred Oollars (5500). I, as owner of ihe pmpeny or rtry employees vnth wages as I�eir sole compensation, will Oa the wotle, antl the ❑ s�mcwre is not inteneetl or oilerea for sale (Secnon 7044, Business and Professional Coee: T�e Cantractors' State License Law does no� apply �o an owner o� a pmpeny who 6uilOs or improves �hereon, an0 w�o tloes such work �imsel�l�ersel� or �hmugh �is or Aer own employees. provitletl Iha� such impmvemen(s are no� intende0 or ofiereA for sale. If, however �he huilding or im0�ovement is 5010 wit�in one year ol completion, ��e owner will have �he burden ol pmving he/she tlia noi �uiltl or impmve lor Ihe purpose of salel. - I, as Owner ol Ihe pmperiy, am exClusively contracling wilh licensed con��ac�ors to cons�mct the pmlec� (Sec�ion 7044, Business ❑ an0 Pmfessions Coae: The Coniractoa' S�a�e �icense Law Aces no� apD�Y �o an owner o� praperty who butltls or improves lhereon antl who coniracts lor suc� pmlects wi�A a contractor(s�license pur5uani lo ��e CanVaclors' Slate License Law),I am aware �hat pmoi ol �heir Warker's Compensaiion insurance shauld be pmvitled lo me. � I am exem0� unaer Seciion: B. 8 P. C. lor Ihis reason: Oate: Ownec I tlo hereby cetlily �hat I am aware oi an0 unaerstantl Ihe requiremen�s o� Calibmia Healih an0 Safery Cotle Sections 25505, 25533, antl 25534 and Ihat I or any fulure hwlding occupan� willlwill no� (circle one) need to comply with saia s�ale co0es and �he requirements for a permi� for cons�mclion ar mo0ilica�inn Imm Ihe Air Oualiiy Managemen� OiStricL NeSiUen�ial conslmc�ion applica�ions are exempt imm Ihese provisians. Oale: NpDlicanl: I hereby cer�ity Iha� I have reatl ihis application antl slaie Ihat the above inlormation is correc� I agree �o compty wilh atl ciry antl counry ortlinancesanastalelaw5relalinglobuildingcon5imc�ionandherebyau�horizerepresen�a veso��isciry�oen�eruponlheabove-men�ionetl pm0e�y lOr inspedion pur0ose5 � /J va oate'.��6^�Z-- Signamr� � — oa�er's ocense o� sociai secudty a: 164L46 White—Bulltling; Green—Code Enlorcemen�; Canary—Applican�; Pink—Revenue: Goltlenm0—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 059097 PERMIT NO: B 059097 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION ; REROOF W/COMFO5TION SHINGLES OVEH EXISTI SQ FT: 3,500 CLAIM VALCTE: 3,SU0,00 CALC—VALUE; 3,500,00 GROUP OCC: R-3 /M-1 COMMENTS; REROOF 2900SF RESIDENCE 6 GARAGE �� '�� *�r�*��r**�x*�r*��****�e*�r**�r**#**�*�t�rx��r�rx� �r*��r�� r�**x��r*�e Z O N I N GS ERTEB�AUCIKRSE M E N T S R EQ UIR E D ------------ 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 PARICING RE � PROV; PARCEL: �9-9&2frdfl'd—�LNE; REF NO: PLANNING N TES> y226g/ /� i '(_ it iE iE aE fF IF * 3E iE iE iE iE it iP 3E it- iE 3E if 3t iE iE lt �ll� �lf iF if if 3f 3E �IF iE �lb af iE �f df �%jf iE it iF it iE iE If �1F iEif it �lE iF it If iE iE iE if 3E if IE �]E fFiE k iP jF iP;E�� if iE 1F iF # iF iF �t �f D E V E L 0 P M E N T S E R V I C E S R E Q U I R E M E NF;T S ZONING APPROVED BY DATE; ✓T BUILDING APPROVED BY ; DATE; '� APPLICATION ISSUED BY• /�� DATE; :� I�o �� iFiFif-)E�lEif1ElElE7EiEiEi(�if�Fifif3E3FiEiE'IFit3FiFTe;F3f3FiFiFiFiFiFif3F3E3EiFii�if 'K- iFit3EiF3FiFifffififiF3F3f�E��iEiEiEiE�lFiFihif t �lE it iE iE ih iFif iF �� IE �lE if 3E �lE iE 3F iF lf if- N�lE 141E �lE ik iE-)f �E iE �lElE �lE if ik �lh 3F if 1F �lf iE d(-iF # iE i61E 1E iF iF iE if if 1E 1E if �lE �f� 3E�1E iE it �E �JE lF if iE �lE iF 3F �lE iE 1E iF If �1E 1E 3E iF if LEGALIZATION:N F E E S U M M A R Y STRUCTURAL'SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES` GRADING PERMIT 63,00 ,50'' SMZP/NON—RES PLAN r ISSUE FEE �. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID '� DUE TOTALS----> 63.50 0.00 0.00 63.50 63,50 � ,00 REVENUE DIVI5ZON TOTALS--> COLLECTED; 63,50 OVER/SHORT; (1 .00 BLD63P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TO�T GRADING/p�,AN—CHECK �E iF iE iE iF if 3E iE if 3E 1E iP 1E iF iF iE if iE 1Ef(� iF 1E iE iF if iE iE if iF 3k jf iE �%if if if 3P 3E �E iE iE jE iE if iE 1E iF if if iElF iE * iE iE iE if iE �E a4 iE fF if iP jE iFlf lk fF i(-if ik ik iF iE iFlE 1E if I N D I V I A U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST SFR 3500 REROOF HY VALUE RESIDENTIAL NOZONE 1,00 END OF FEES l ��OTAL COST r 3,500,00 r� �n $`� u'�TC.� ,: !_ _ ; : 1��.. � a CONSTRUCTION AND PLANNING � PO .SPA APPROVAIS Permii# Date Inspector 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. ElecVical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. ' 8. Fo�ndation � ' 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgmd. 70. Structural Floor System 61. APPROVALTO DECK 17. Property Sewer Line & HoUse Connection 62. Backwash & Receptor�Final 12. Sewer Cap . 63. Heater & Vent-Final 13. Roof Drains 64. Plumbinc� System � Final 14. Rough Piumbing 65. Electrical-Final 15. Rough ElectricB��Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 77. Rough Wiring 5ign 68. APPROVED FOR P�ASTERING 18, Rough Electriral�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • � APPROVALS Permit # 21. Ducts, in Struc4ure 70. Under9round Hydro 22. Ducts, Ventilatin9 71. Product Piping �Gas ❑Oii 23. Gas Pipe�Rough & Tes[ � 72, Underground Fiush 24. Roof Framing 73. Undergrnd. Storage Tank rJ Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceiling (Structurai) & Monocoat 75. Dry Chemical 27. Prame and Flashing 76. Dry Standpipe 28. Lathing & Siding � 77. FIXED SYSTEM F'INAL 29. Insulation � � 78. FIPE PREV. FINAL 30. Drywall Naili�g � ' HEALTH DEPT. REQUIREMENT 37. Plaster Brown Goat I � 79. FINAL �NSPECTION 32. Electrical Power MeterFinal � � 80. FOOD CERTIfICATE ISSUED 33. Finai Electric � I i' Notes: 34. Final Heating & Air Conditioning � � � t 35. Final Gas Pipe-Test � � � i 36. Nood or Canopy � 37. Fi�al Factory Fireplace � 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final � ' 41. Solar pomestic-F�nal ' 42. Backflow Preventer I � 43. Batktfow lrrigacien 44. Landscape Irriqaiidn System 45. Sound Attenuatt�o�+ = 46. Handicap Regulations'��j 47. FINALSTRUCTtiRE•�&_�BUILDING �.�..sjy�,`c ��N ./% /' ��_ �'�� . G�� 48. FINALPLANNING r;- 49. Elec[ric Release gd'Edison , _� � 50. Gas Release to Sauthem California Gae Cp � I 51. CERTIFICAT� QF OCCUPANCY No. " Date oFF v�croe,a- ciTY oF COS7A mESA CONSTRUCTIO_N/ PE�MInT�, Project Address �-� �� 'M�'� C R",V S T✓� �_ ApplicanYs Mailing Address Owner's Name S 5 F b`- �0 5^� L� phone �a — 0�7 Address '�' I�2� /h'^'1 £(Z 1 CIi'1' S�'f iFOf-�} Arch/Eng. License No. , Address Contractor's Name �� o�-� � }Z-��`�" Phone fr� �r2 j Addresslmailingl3pZz � f�='�{—t•ft��4i'� `'U�`-�� Ciry License No. 2�q�9 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensetl untle� provi51on5 of Char[er 9(commencing wi[h section �000) o! Divisian 3 of tbe Business antl Professions Cotle, antl my license is in full torce antl eflecL � Licens�cias� � � 5 c nse Np. ��301¢ Date g t t-F�� a�� "','1RKER5'COMPENSATION DECLARATION �`�:i�"3No kers'rCompen atlon Insarance,�or a�cert f etl Itopy thereofe(Section sti00, Lab. C.) ��_1 Policy No. w�'�+�p2 �� Company �w'V �J �$�� ifietl copy is hereby furnishetl. p L�Cert}'f'ietlS opy is <t/iletl with the city Builtling�Q Ivisiayn. _�� oate E'Z`F—+% Applicant Q�y'(/�- r �=.+__ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl if the permit is for one huntlretl ($100) or less). I certify that in the performance ot lhe work fOr which Ihis permi{ is issuetl, I shall not employ any person in any manner so as to become subject to the Worke�s'�Compensation Laws ot CalifOrnia. Date Si9na[ure NOTICE: It, atter makinq this tleclaration, you shoultl become subject to the Workers' Compensa[ion p�ovisions of th¢ Labo� Cotle, you must forthwi[h comply with su�h provisions or this permit shall be tleemetl revoketl. �CONSTRUCTION LENDING AGENCV 'i I hereby atflrm that ehere is a construction lentlin9 agency for the pertormance ot the wark for whicn this permit is issuetl (Section 309] Civ. C.) Lentler's Name Lentler's AtlEress OWNER BUIIDER �ECLARATION 1 hereby aftirm Lhat I am exemp[ from the ConVactor's License Law for the following reason (Section �031.5 Business antl Professional Cotle: Any city or county which �equires a p¢rmit to con5[ruct, alter, imptove, tlemolish o� rCpai� any structure, prio� to its issuance, a15o require5 the applicant to/ such permit to file a signetl statement that he/she is IicenSetl pu�suan[ to Ihe p�ovi5ions of ' Contractor's License Law (Chapter 9(tommencing with Section ]000) of sion 3 0l ihe Business antl Professions Cotle) or that he/sbe is exempt efrom antl tM1e basis for the allegetl exemp[ion. Any violation o� Section _31.5 by any applicant for a pe�mit 5ubject5 th¢ applicant to a civil enalty of not more than five huntlretl tlollars (E500�. � I, as owner ot the property or my employees with wages as their sole compensation, will tlo the work, antl the st�ucture is not intentletl o� o(feretl for sale (Section 7044, Business antl Professional Code: The Contractor's l.icense Law tloes not apply to an owner of a property who builtls or improves thereon, antl wM10 tloes such work him5elf/he�selt or tnrough his or her own employee5, provitletl that such improvemen[s are not inlendetl or otteretl for sale. If, hOweveq the builtling or Improvement is Soltl within one yea� ot com- pletion, tne owner will have the burtlen of proving he/she tlitl not builtl or im- prova for the purpose of sale). � ❑ I, as owne� of the proper[y, am exclusively Cont�acting with IicenSetl con- trattors to con5truct the project ($ection 7044, Busine55 antl Protessions Cotle: The Contractor's License Law tloes not apply to an owner of property who builtls or improves thereon. antl who mnVacts for such oroiects with a ron- tractor(s) hcense pursuanc 20 [ne Con[ractor's License Law). I am aware that proof ot their Worker'S Compensation in5urance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Applicant to fill in all spaces exceo� ihose within heavY boraer lines ana sign aIl appropriata tleelarations. Date Owner I hereby certity that 1 have reatl this application ana state that the above Information is mrrecL I a9ree to comply with all city antl county ortlinances dntl State laws relating to building cons[�uction, antl hereby autho�iie �ep�e- sen[atives o his c' [o enater �pon t' he above-meniionetl prop�erty for inspection r se I I/ Si9nature (T��'�, Dale i(" �^� S Orivers' License or 55 � TYPE OF CONSTRUCTION LJ NEW LJ ADD �ALTERATION L� REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPJ1Qy OF WORK/S1$E�OF BLDG. _/ � TVPE OF PERMIT � LI GRADING LJ F`CJUNDl1T10N LI STRUCTURAL '❑ TENANT ❑ ELECTRICAL ❑ PLVMBING �v1ECHANIGAL ❑ OTHER PROJEC7 DESCRIPTION Sa.FT. oCCUvaNCV CONSTRVCTIONTYPE�� VALUATION$ ZONE GRA�INGCU.VDS. ACRES Remarkz: �� Sink Preventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains ReinSpection Fee � $15 Boiler Duct- UnderGround Duct - Structural Duct - Ven[ilating Exhaust System ❑ Multiple ❑ Firepl/FacL BIL ICBO # I Hea System & Ducting 100,000 BTU 0100,000 BT Reinspection Fee � $15 0865-46, rev. 5/88 White - Builtling: Canary - Applicanp Pink - Accounting; Goltlenrotl - ASsesm� PLUMBING 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 Laundry Trays FEES. laue Fee � $ 3 Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee A.P. �p S Main Buildi E T Front 6 Rear A C Ri9ht K Left S Ping. Ref. # Planning Notes: Building: Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construc[ion Pole Sub. � 50 + KW Cooking Unit Meter ❑up to 700 amps Dishwasher Meter ❑over100amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors �0.1 HP 01 %- 8 F.A.U. Inc.Solar �9-15 HP �16�15+ F i xtures M icrowave Device Boxes Pole Light Outlets Range Switches Sign Garbage Dispoul Standing Sections Generator �0-5 KW �5-15 KW Trash Compactor 2one Reinspection Fee �$15 � � luue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2oning APProved By Buildin8 APProved By Appliption Issued By SUMMARV OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ � PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL 5 �-' � PLAN CHECK 25% $ Z O N I. N G R E Q M T S. FEES $ 3 SMIP $ PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ ��{ , ov '?i �LJ•,L` �!'' l4.iiY� t:t p!,'� �;3, °�, ; "ii_ .. . � ��,.\ `\� l Q . � _ . .� . CONSTRUCTION AND PLANNING ' PO 'i SPA APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location V ' 2. Soil Pipe-Undrgrnd. � " 53. Steel Reinforcement ' �, ' 3. Electrical Conduit Utility-Undrgrnd. " 54. Forms ,- 4-�Electrica� Conduit-Und�grnd. �� 55. Electrical Bonding : 5. Steel;Reinforcemen\. �. 56. Rough Plumbing & Pressure Test . 6:'ElectricalUFER'Grnd'., r 57. APPROVALTOCOVER-GUNITE ��:' , 7. Foofings .. -� � �? 58. Electrical Conduit-Undrgrnd. " 8r Foundation '� - .� 59. Gas Pipe, � Undrgrnd., Test ,� 9: Water Pipe-Undrgrnd. . � 60. Backwash Lines, P-Trap, � Undrgrnd. 10' Structural Floor Sys�tem '- + � 61. 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 Plurr.bing�.' . ' 65. Electrical-Final 15. Rough Electrical=Conduit " 66. Solar System-Final ,16. Rough Electvic Wiring 67. Fencing & Access Approval i7�7'. Rough Wiring Sign 68. APPROVED FOR PLASTERING }8: Rough�Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19'. Rough�Fleating & Air Conditioning FIRE DEPT. REQUIREMENT •i _20. Rough�Factory Fireplace._-• . APPROVALS Permit # 21. Ducts, in Structure - 70. Underground HYdro 22. Ducts,(Ventilating I� �,_ 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test r' 72. Underground Flush 24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof SHeathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &�Monocoat 75. Dry Chemical D.`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: 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 / r 41. Solar pomestic-Final .y , � 42. Backflow Preventer �` �' - 43. Backflow Irrigation ! � 44. Landscape Irriqation SYstem � � 45. Sound Attenuation �� /. � 46. Handicap Regulations �� 47. FINALSTRUCTURE&BUILDING . 48. Special Requirements Completed 49. Electric Release to Edison _' ' � 50. Gas Release to Southern California Gas Co . � 51. CERTIFICATE OF OCCUPANCY -, No. Date . ' ' PflOJECi AOOflESS: i 1 y 1 �1i,.9�H 1 C�1 �V OWNEfl'S NAME: GOSNLLL � GliORG'r.l TL'' �PR aooeEss �191 r.]�RtRZCAN AC7E COa^TA MIi�A,CiI 92fi2"! AFlCHIENGINEEB: �? �l G�' ' ��86 qEG.NO.: aooeess: UNIT: uxiT: PEflMITTEE: ('.vE�RC±F_ Fi}iA,`.�. tL ( %Z�i � S_�S—%qQ.S A��PESS: j O��.� iV , iIL'S't'Iii�'t IAI3 "vTY 101 511NTA .?�NA CA 92706 LICENSEO CONTBRCTOP OECLABATION: I �erehy aifirm Ihat 1 am Iicen5e0 untler pmvisions oi C�apter 9(commencing wiN Seciion 7000) 01 Oivision 3 0� the Business antl Pmtes5ion5 Coae. and my liCeni¢ i5 in Wil brce and ei�¢ct. cirv uc.: �;�sraTe uc.: 4 9 3 U 6 4 cwss: t� - 3- - --- -0aie: Signalure: _ � WOFKEBS' COMPENSATION UECLl�BATION: I here�y ai' at I have a c i' ale of consenl �o sel4insure o� a cehifica�e oi Workers' Compensa�ion Insurance. or a cer�itiea covY thereof (S ' n 3800, La�. Poucrxo.:y,;CO297A93 E%P.UATE: OLIOZI91 COMPANY: �fNITL� FAC_Ii�SC ❑ Ceni�iea copy is �ereby fumishetl L}d Ce�ifiea coDY is filed wi�h �he ciiy Building Divi ion. Oa�e'. � 1—�,? � / .(,� Applicam: ESEMPTIONFBOMWOflNEHS'COMPENSATIONOECIABRTION: sseciionnee a ecampleletlifthepermi�isforonehunOretl�3100�orless�. I cetlity I�at in I�e pedOrmanCe ai I�e work �or which IhiS permit is i55ued, I � no� emDloy any De�son in any manner 50 a5 io become suble�� a �he Warkers' ComDensation Laws ol Calilomia. Da�e'. SignaWre: NOTICE: II, after making ��is declaranon, you shoultl become subjec� to the Workers' Campensation provisions of ��e Labor Cotle, you mus� forthwiih comply wi�h such provisions or �his permi� shall be deemed revoked. CONSTflOCTION LENOINC AGENCY: I hereby aflirm t�at ihere is a consimmion lending agency lor the performance oi [he work for which ihis Dermi� is issued (Seclion 3097. Civ. C). LEN�EN: noosess: OWNEB BUILUEB OECLABFTION: I hereby a��irm Ihal I am exemp� Irom the Con�mctors' Sia�e License Law �or Ihe (ollowing reason �Seciion 7031.5 Business and Pwlessional Cotle: Any cily of counry which requires a permi� lo consimct, al�er, improve, tlemolis�, or repair any structure, prior to iis issuance. also reQuires the applicant �or suc� permi� �o file a signed S�alemeni t0at helshe is licensea pursuani to IAe Dmvisions ol Ihe Contrac�ors' Stale License Law �ChaD�er 9(commencing wit� 5¢c�ion 7000� ol �ivision 3 o� the 9usiness and Prolessions Code� or thal he/she is exempi therefmm and Ihe basis lor Ihe allegea exemp�ion. Any violation ol Sec�ion 7031.5 by any applican� �or a permi� 5u01eci5 �he applicani Io a civil penalty o� not more than �ive hunGretl tlollars �$500�. I. as owner of ihe property or my employees wi�h wages as Iheir sole compensation, will ao �he work, antl �he ❑ simcture is not intentletl or olferetl for sale �Section 70a4, Business and Prolessional Code: The Coniractors' State License Law does nol aDPly to an owner of a pmperty who huilds or improves ihereon, antl who tloes such work himself/herself or ihrougll his or �er own employees. pmvidetl that 5uch impmvemen�s ar¢ no� in�ende0 or ofteretl for sale. Ii, however �he buil0ing a� imDmvement is sola wit�in nne year at completioq the awner will have ihe bur0en oi Oroving he/she OiA not �uild or imD�ove lor Ihe purpose o� sale�. I, as owner o� the property, am e�clusively conlracling wi�h licensed coniracrors to conslmc� �he prole�� ($ec�ion 7044, Business ❑ antl Pmfessions Code: The Contractors' Sla�e License Law tloes not appry m an owner of property who builUs or improves thereon antl who tontrati5 for Sut� proleC�s with B Contrector(s) license pUrsUantta t�e COniraCtOrS' Sta�e LICenSB Law),I am aware �hai proof of their Worker'S Compensation insurance s�oultl Oe pmviUetl m me. � I am exempt under Section: 8. 8 P. C. lor this reason' oale: Ownec I tla hereby cenify Ihat I am aware al antl underslantl Ihe requiremems ol Cab�omia Heal�h antl Sa�ery Code Seciions 25505, 25533, and 25534 and Ihal I or any tuture OuilUing occupanl willlwill not (cirde one) nee4lo comply witn saiU stale co0es antl Ihe requiremenis for a permi� for consimction or modification Imm ihe Fir Oualiry Management Disirict. Besitlential consimction applications are exempt imm Ihese provisions. Dale'. A0�1¢anl: I hereby cetlAy �hat I have read Ihis application antl state I�ai �he above inbrma�ion is carrect. I agree �o comply wi all ci�y antl coun�y ordinances an� s�ale laws rela�ing Io builtlmg cansimclion and hereby aulhorite represen�atives of Ihis ' �o en�er u0 he above-mentione0 pmperty lor inspeciion purpases. Date: � � �' �� Signalure: _ Oriver's License or Social Securiiy x: � t6At�a6 Wnile—Builtling�, Green—Cotle Enlorcement', Canary—ApplicanC Pink—Revewe: Goltlenmtl—Assessor CITY OP <'O�TA td�3�A JUIi,DING F�RMIT Pi:itM NO; MP 0�008 PGR,"�Z i NO: ,�iP 050083 FLAN CiIECK NO: N GOVT: N 3UPP: N CON�'SRUC� ION TYI'E; V N PEi2MI1 TYP�; M73C FL(7 PT.ii2PU3E: U'if] JOB DESCRIPiIO?3 : REFL,ACF.. 2 WTR HTRS ANll I'Ril S�,) FT: CLAZM VAiUF.: CAi,C-VA.-�UE: GROtJP OCC: R-3 / CUMMi:�i'ZS: RL'PLAC�3 �TWCI �i0 GAL WTR H'Ck AND FAU iE �' if Y Jt. af iE 1E i!"1f #E ?f Y?f :f Y}; v. �. :,. y,..., } jF Y�1F i� ik iF af'�E' ?E 7� �1f d(� x±F?F?F Y+f ?4 iF�f if if ?f Ja?F. f'. �F+F i(•::� iF if If 1F if !f ±c {?f dE iF iE iE i! I(' i!� Y.- i:-if Y� if'Y.• i iE �E Z O N I N G R E� U 7 R c M E N T' S S E T B A C it S ----------'-- ��.:ii�! It1?'Gi,D7:NG -..-------- __---_._..._ .r�CCE:SSOKY DJILDING - -' ' - 'r'RNT: 'r'i' IN REAR: FT TN FRNi: F7' TiI REAR: PiT^ ZN LE_•T; FT tti 'it�,['i: rT -IPi LP.I�T: PT Tiv RGH'i; rT IN PARRING REO• PROV: PARCEL; 4220E1].7 'LNE; REF NO: FLMlNCNG NGTES> > �E �I!� �f ac if �IElf !!- if it ##�? X� :e+t ai?F i� �F ## 3f� }i 1E �4.`E x}i >}E+(� if �f ?f .,v,-.Y.� if iE }f if !f If if iE iE � iE if-?F iM1 if 1f?f ?f +f s�)F iE IF if if if ai iF if aE 3Fi(..If..%�'r. u IE � If +t?k D E V i: i� p�' M E N T S c R V I C C: S R E Q U.i R E M E ti T 3 ZONCNC AFFROV�_D 13Y � llAT�.; BUZLD.l'NG APPRQV!{ll ftV : DAi'E; APPLICAiIt)N C:i:>tJEU QY: � DA"iE: +Elf?��ffif?Elf�F?EaF±EIY?`?:.v.:t.X�?F?ElfiE?F . .:... . . . ... ..�. . . � . . . . . . •.?E?FY�?E#iEif�ff9F3E��?c?f ?E'�E !f'lf K-'1F?i' iE 4?f �f SE?f ?f?E i(' %' N' k' ii }. \. k iE iG i:�1F iE ji iF iF+E i% 3E ?E %')F !('?f if' iE?F if' if 3E 3E?F?f �)f �Y�?f iE if ?F :F i!� i�' +?F �f ?f lf 3f #?� if 36?F+.�f 1F?F if ?F Y?� %if ;f �1f I,EGALIZATION:N F G E S U M M A R Y S'iRUC7'URAL SEGMENT;N t?l,�1G t'M7 PLUMI3.iNG EL�.C"TitIC M6:CiiANYC b'l"itE SMIP/RE� Gr"tAD:iAiG �r;tr;ir a . 00 9 . o0 25� 25� SM:iF/NON-�ES Fi.AN t3:iUr: F�(F: 7.00 15,00 DUILD7NG-�DIV-> I'i?tMY1' iS'3[JF PLAN-CItF.CF; iOTAi: PA]:D DC1E TOTAI�S�---�-> L'3,00 18.00 0.00 31,UO 31.00 ,00 REVfiNiIE D1VC:?it)� TO"PALS--> COLLECTi?D: 31.OU OVER/SHOR7': .00 FiLI:�G P.�i7,' PLUMiI3NG ELECTRIC MECi[ANIC FIRF SMIP/'i0'P GRAllTNG PI,Ai�-CEfECR %. �� e�.�.�� 34 iF Y,. I( if i� i4 i(..7(. }{. Y. k. 7(. �} .ry }'. } jf' �Y�'N'?l� jF i(�iE'+f iF �K� bf if?f i{ iF iE?f' ±F 1E if %# d! Y?f Y� ?f if� if �N' < N' �lE )f }: ±F ii'7f if ?f 3f ?f ?F if af �If aF u �E iE 1F jF?' Y.�;F Y,. � �t Y.� ?E if �f I t�� T.1 I V T P U A T� �' E E B R fi A K D O W N TYPE MfEC PS,iI QTY t] i3 � C R i P T I O N liN:iT COST TQ'iAL CQST l :tNa'f F'ORC-AIR JG31AV F'URN r'- 100 Y. B � U 9. 00 9, 00 2 W:1'fii3t t1iiA'!'r;R T1ND/OR VENT 2.00 1.00 LNn or• r• E�.s �i DQOi5i22—O�D75i23 iCa �� 31.00 �1fTE: E1/2&/40 TIML: :�:14 / �% CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector Date Inspector APPROVALS Permit # 1. Temporary Elettrical Service or Pol6 • 52. Pool & Equipment Location �, , 2. SoilPipe-Undrgrnd. `'' •�� 53. SteelReinforcement � 3. Electrical Conduit Utility-Undrgrnd. � 54. Forms ; : � 55. Electrical Bondin ,! 4. Electrical Conduit-Undrgmd. 9 ��- , 5. Steel Reinforcement 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, � Undrgrnd., Test -�� 9. Water Pipe-Undrgrnd. 60. Backwash �ines, P-Trap, O Undrgrnd. ' 1 _- � 10. Structural Floor System - 7 67. APPROVAL TO DECK .�' � . 71. 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 � 15. Rough Electrical�Conduit .,, 66. Solar System-Final -? 16. Rough Electric Wiring /�� 67. Fencing & Access ApProval � �' 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � i 18. Rough Electriwl-T Bar Celling 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Condi[ioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure � 7p. Underground Hydro 22. Ducts, Ventilating � ' ' 71. Produci Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Tesc - . 72. Underground Flush 24. Roof Framing ' 73. Undergrnd.StorageTank �Gas OOiI 25. Roof Sheathing ; 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monoeoat 75. Dry Chemical 27. Frameand Flashing �. ' 76. DryStandpipe 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: 34. Final Heating & Air Conditioning �( 'l� (��' ' 35. Final Gas Pipe-Test ' � � , - 36. Hood or Canopy �; , � ' - . � �' 37. Final Factory Fireplace ' � � ' � ' 38. Final Plumbing � . �� ' � j�� , ' . ' , 39. Water Service�Final � � � i� � . � 40. Gas Service-Final , : i ' . 41. Solar pomesticFinal � • � • . i , � 42. Backflow Preventer ' , � , 43. Backflow Irrigation • � � � 44. Landscape Irripation System � , . � 45. Sound Attenuation - � 46. Handicap Regulations - � : 47. FINALSTRUCTURE&BUILDING ' �� ' I; 48. FINAL PLANNING ' 49. Electric Release to Edison �� 50. Gas Release to Southern California Gas Co � ,� � � 51. CERTIFICATE OF bCCUPANCY ; � _ . No. Date �_3�f.��°� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA. CALIFORNIA For Applicanf io Fill In Complefely TYPE OR PRINT BUILDING p191 American Avenue ✓ ADDRESS COSTA MESA. CALIFORNIA OWNER P�NCETON� INC. MAIL 1533 B�er CJti♦ ADDRESS ��r cogta Mesa 'N�xI 9u5: ADORESS Garden Grove � CONTRACTOR Dike & Colegrove� Iric. aooRess 1533 Baker St. ��.n Costa Mesa� CaliP. �;�TNo. 167293 No: KI. 9-1151 8�=E L.. __ � 1. r� I NO. oP elnp,��, � F�E RECEIVED �, F:E B 2 01961 APPLICATION FO� f��'E DEPT. BUILDIN(fITY OF COSiA MESA For Offiee Use Only zoNe LEOAL BY I� RECEI=E I DATE �l7 r 6N COSTA MESA, CALIFORNIA ZONING xo. oF I use Oa ruNe O euuo�n EVES 66TBACK LIN¢ FROM �O� REAR YARD VZ � «MeR UNH 9T.) CENTER OP BTREBT FRONT SIDE YARD I LEFT 7� I RIGHT �' R SiDE DESCRIPTIOId OF WORK gjZED'N+77V 3Q�ft�ROOMS �'� STORIE6 1 EXTERIOR WALLtuCCO IROOF L.O rock COVBRWG S WVERING �P' � U8H OF BUILOING AN� WORK TO BE PERFORMEO attached garage (tWo living units.) Plan C I NEREBY ACKNOWLEDGE THAT 1 HAVE R2AU TH18 APPLJGTION /WD BTATE THAT THE ABOV¢ IS COPRECT AND AGRE¢ TO COM- PLY WITH ALL CITY OPDINANCEB AND BTATE LAWB HHOULATING BUILOINO CONBiRUCiI �/ /� 91GNATURE OF �� ,J�� 'AUTHORIZEDAGENT Dike & CE(le�rove, TI1Q• APPROVED Gar. W1]. sq. Pt. att gar THE AMOUNT 6HOWN UNDER VALUATION �8 FOR TXE PUPP096 OF E6TABL18NING A PERMIT FEE ONLY. VA W ATION PERMIi FEE $ 37o�00 s 17,979.�0 PLAN CHECK $ �'u�SO : O C