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Home My WebLink About3086 COUNTRY CLUB DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c�ILDING PERMIT �� FAIF DRIVE, COSTA MESA, CA 92626 JobAddress: 3086 COUNTRY CLUB DR Suite: Vicinity: ParcelNumber: 13916303 Applicant MILLARD MARK Address: 2219 N FLOWER ST Zoning: R1 R1 � . Phone: 714-542-0801 - SANTA ANA, CA , - � � � Zip: 92706 , , - . ' i Owner. MAYFIE,LD, FLORENCE LOUISE �� , Address 3086 COUNTRY CLUB DR ' . � , Phone: - � COSTA MESA, CA ' � Zip: 92626-2342 - Contractor: DOUGLAS SMITH MILLARD ROOFING INC Address: 2219 N FLOWER ST _ �"-�� Phone: 714-542-0801 SANTA ANA, CA Zip: 92706 License: 433205 ISSUED BY: Status: ISSUED Applied: 10/15/2003 Issued: 10/15/2003 Arch : � , Eng: Address: � , _, � �� Address: � . Phone: - � Phone: Zip: � License: ' License: SCOPE OF PERMIT TEAR OFF �XISTING CAPSHEET ROOF:�INSTALL B.U.R WCLUDES'ATTACHED GARAGE:� �• Plan Check: $0.00 Permit: $12525 SMIP Res: $0.56 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.81 SETBACKS . MAIN STRUCTURE Front 0- 0 ACCESSORY .Fronl 0-0 PARKING Existinq: o NOTES: FEE SUMMARY PLANNING & ZONING Rear 0- 0 Left 0- 0 Rear 0- 0 Left 0- 0 Required: 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0-0 $5,600.00 ss,soo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1B0 days, or if work is suspended or abandoned for a period of 1B0 days. - INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetione and linal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 >aas-as�yoa� WORKERS'COMPENSAnON DECLARAnON: I �ereby eNirm untler penelry of perjury one of Ihe following tleclarations: �� '� _ ❑� I heve and will meintein a certificate of consent to setl-Insure for workers' compensation, as provitled for by section 3700 of the Lebor Code, for the peAormence of ihe work tor whic� this permit is issuetl. ' ' ' ' ❑ I have end wiil maintain workers' compensetlon Insurance, as required by section 3700 of the Labor Cotle, for the pertortnance of the wo foJ which this partnil is issuetl. My workers' compe setio Insure�n�c�e ca�r%r�( ntl policy number are: r A /n/ g^ Certier. C :��' YYt/i-/'� � � � PolicyNumbar: `�` 171��i� l� (This section need not be complefed il he pe it is velued et one hundred dollars ($100) or less.) �1 cenity ihet in the peAormance of tha work for which this perrnil is issued, I shalfnol employ any person in eny manner so as to become subject to the workers' compensation laws of Califomie, and agree that if I should 6ecome su6ject to the workers' compensation provisions of SecC}qn 700 ot the Labor Cotle, I s�all torihwith comply with these provisions. ` ,n / � � \ //� ( U ' ��j ��a Applicant SignaNre: ��E,d.i ,! LJ Date: � � 1 WARNING: FAIWRE TO SECUFiE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL rWD SHALL SUBJECT AN EMPLOVER TO CRIMINQ PENALTIES AND d FINES UP TO IXJE HUNDflED THOUSAND DOLLAFE (§100,000J, W ADDIiION TO THE COST OF �MPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3)O60F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm Iha� I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Pmfessions Code, flnd my license is in tull itorce entl eflect.lJc. q Class x Contrector's SignaWre: � �J Date: I ��'�% CONSTflUC710N LENDING AGENCV: ❑ I hereby attirm that ihere is a consiruction lentling agency for Ihe pertormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). LentlaYs Neme: Lender's Address: Signe�ure: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm thet under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which reQuires e permit b construcL alter, improve, tlemolish, or repair any structure, prior to its Issuance, also requires ihe epplicant for such permit to file a signed statement that he or she Is Ilcensed pursuant to the provisions of the Contradors License Law (Chepter 9(commencing with Sedion 7000) of Division 3 ot the Business end Professions Code) or that he or she is exempt therefrom and Ihe basis tor the alleged ezemption. Any violation of Section 7031.5 6y any epplicant for e permit subjects the applicant to a civil panalty of not more ihan five hundred dollers ($500).): ❑ I, es owner ot �he proDerty, or my employees with wages es their sola compensation, WILL DO THE WORK, and ihe structura is not intendetl or otteretl for sale (Sec. 7044, Business and Pmfessions Cotle: The Conirectors License Law tloes not apply to an owner of pmperry who builds or improves thereon, end who tloes such work himself or herself or ihrough his or her own employees, pmvided ihat such improvements ere not intentletl or oHered for sale. If, however, the builtlinq or improvement is sold within one year ot completion, ihe owner-builtler will �ave�the hurden ot proving that he or she did not build or improve for purpose ot sele.). � ❑ I, as owner oi ihe propeny, em EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and Professions Cotle: The conirectors License Lew does not apply to en owner ot property who builds or improves Ihereon, end who con�rects tor such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Signelure: Owner ID verified by tlrivers license. ❑ Yes ❑ No Business and Professions Code for this reason: Venfication ot Ownership by (typa ot tlacument, i.e. - propeny �ax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Drivefs LicBnse No. Date: E.pires: ❑ I hareby certify that no excavation five (5) or more feet In depth into which e person is required to descen4 will be matle in connedion with work authorized by this permit, and that no building simcture, scaflolding, falsework, or tlemolition or dismantling thereot, will 6e more ihan thirty-six (36) teet �igh. (Chap. 32, Grp 2, Art 2, Sec. 341, Tlle 8, Calitomia Admini5treiive Code). ❑ As owner-builder, I will not employ anyone to tlo work which woultl raquire e permit irom ihe Division of Indusirial Safety, as noted above, unless such person �es e permit to do such wark irom the division. Signawre: Date: Division of Intlustrial Safety Permit Numbar: CERTIFlCATE OF COMPLIANCE AND AUh10RIZATION OF ENTRV: I certity under penalty of perjury Ihat I have read this application and state that the information given is corract. I agree Io comply with all state laws end ciiy ortlinances relating to building consiruction, antl authonze representatives of the City of Costa Mesa to enter upon the ebove-describetl property for inspection purposes. I agree not to occupy ar allow occupency of any huilding authorized by this permil until finel inspection. � Signat Of egalOwner(s) � 6j �D /,s a � And/Or Au orized Applicent �ate COUE II, INSPECTONTYPE ' 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Finel Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition ' Qsjf, " � INTRIRLS �.1�'!L � CODE� INSVECTIONTYPE 206 Final�Mechanical - 200 Final Plumbing 210 Finel Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Si�e 250 Final Building/Occupancy� � I� � '#� w . _ . . _ ... . .' . .._ _.... . S' . , �I � �.y AVP��anl to fill in all s0aces except those within heavY bartler lines anE sign all appropriale Oeclaration ��Il�L 8/25/ 6, . 30�. JV' TL� ctxY oF coSTn MEsa • CONS RUCTION PERMIT PERM/i� NO. ` TRACT NO. ' LOT NO. �UNIT NO; �!,_.� ' , t' � �JProlect Address � � D�6 ' �D K 1�7/`�/ C�l c,.G D.� � • "� :o��s �� ' • � . : - : . i � �- � . , ' . � � Applicant'sMailingAddress : �6-�:r�P' � � ' TYPEOF'CONSTRUCTION � NEW °.DD .ALTEftATION REPAIR � ' ' q�� q�� ❑ CONVERSION ❑ DEMOLISH ❑ OTH R � • ' q,p, �! � . .Zone � Owner's Naqme �/��a ' PhoneccL-[_Li pESCRIPTION OF WORK/USE OF BLDG. �"'-: P -` /Zp�enry�wn � �� ' ' Address Jb�`� Ceccw"ini/ ClwL Av� e�r✓l "t �- pY Tti' 7 6'J Ce T �— E MaimBuildin9:-' � AccessoryBuilding: i Z Arch/Eng. � ' � LicenSe�No. ' TVPEOPPERMIT GRADING ❑ FOUNDATION�� STRUCTURAL T Front � ' . ' ' 0 Addre55 ' • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g ' � ❑ OTHER. A Reaf ! . N Contractor'sName ��t d�r� trs� �. �h� pnones�� ---- ^ - - - � - - - - r PROJECT DESCRIPTION 'SQ. Fr.- �O .aot. ' ocCuvarvCv b Right N Addfe55�mailing) �33�,y e�7�..'S��A.M� Qk� ' CONSTRUCTIONT,YPE —��+TION$ �c%D��-�' K Left � G S City�License No. �� _ • zpNE � � caaoirvG cU.vDs. ,vCRES p�ng. Ref. # I . Parking Req./Provided � . E LICENSED CONTRACTOR DECLARA'fION ' � ' I hereby affi�m that I am licensetl untler provisions ot Charter 9(commencing Rema�ks:� ' ' . ' _ Pldnpiflg NOt¢51 . � � � . � with�section ]000) of Division 3 of [he Business antl Professions Cotle, antl - M � T my Ilcense is in full torce�antl effect.� . ' ' � Lj`� ' ' ' � ' i _ ' ' ' ' S LIC2lISE CId55 � _L CCfI �VO. � , y �ate.,�j'-'{S-OG Signature ' ' ' -PLUMBING • FEES' ' ' �� ' � • ' � � WORKERS'COMPENSATION DECLARAT N � � � � � � � ' _ . 4 I hereby aHirm that'I have a certificate of consent co seif-Insure or a certificate � Bat Sink �' Showers ELECTRICAL ' ' FEES • Workers' Compensation Insuranre, or a certitietl cooY thereof (Section ' gackflowPreventer . ServiceSink I ^ '�00, Lab. C.) '/ p� ' - Automatic,Washer' . � Transformer-.� 15-50 KW ' ! '� .�olicy No. ��w ��/� Company S�(yZ'v �4.nJ ' Backflowlrrigation . . . SewerCap' � � t ' ConstructionPoleSub: ' � � 50+KW� - '' � ❑ Ceriifietl copy is hereby furnishetl. • ' - , ' . � � � - • '� ' - C�-Eer ufiea copy}'i} ilea with the city I `ng Div'si . -T Bathtubs SewerConnection Cooking Unit Meter ❑up to 100 amps �ate' e �LS -3O APPlicant �I2w Btr� �ei 1�a.G - - . . . � EXEMVTION FROM WORKERS' COMP.ENSATION DECLABATION ClarifiCrs : - Sola! ColleCtors' • • , Di5hwa5het - Meter ❑oyer'100'amps '� (This sectibn need not be completea if the permit is tor one huntlretl ($300) or '- _ ' less). � . � � Disfiwdsher . - Solar Pi in . ' - � i 1 certify that in the� perfo�mance of the wo�k'fot which this erm� P 9 ' Dry'ers'OGas ❑E12ci�iC Suti,Panel ' ; p t is i55uetl, I sna11 not employ. any oerson in any manner so as to become subject to the Drinking Fountains � $olar Tank Fan ' � �� ' � Worker5' CompenSation Laws ot Calitornia. � � Motors �O-7 HP � 7%; 8'. Date' ' � Si9nature � Floor Drains � � Swimming'Pool'w/Spa F.A.U. � � ' � • _NOTICE:Jf, atter. making Ihis tleclaration, you shoultl become subjec4 to the _ ' ._ .. _ __ Inc.Sola� 09-15 HP �16-15+ _ Wo�kevs' CompenSatiOn provision5 of the Labor Cotle, you must (ortbwltn Floor Sinks � Urinal ' . � Fixtures ' Microwave ` � comply with such' p�ovisions or this pe�mit shall , be tleemetl revoketl. . � CONSTRUCTION LENDING AGENCY Ga55CrviC¢ Outl¢t5 WaterCloset � - ' � � � I hereby affirm�that there is a mnstructton lentling agency for the performance Device Boxes Pole Li9ht � , of the wOrk for �which this permit is issuetl ($ection 3097 Civ. C.) ' � ' ' Lentler•s Name Interceptors � Water Heater Outlets Ran9e � � .LentleCs.Aaare`ss ' `� � ' Kicchen Sink - � . - - Water Service+ - -- �- • Switches - ' ' ' - - � ' - - - - OWNER BUILDER DECLARATION � . ' Sig� � . 1 hereby 2ffirm that I"am exempt trom the ConVactor'S I..icense Law tof the LBvdtOfi25 � , AutO-WdSh � ' ' t ' . tollowin9:reason (Section ]031.5 Business antl Professional Goae: Any city'or � Garbage Disposal , Standing Sections county which requires a permit m construct, alter, improve,�tlemolish or repair . P-Trap � Laundry Trays � � � Generator O0.5 KW'05-15 KW � ' ! � any structure, pflor, to�its issuance, also Iequire5 the applicant tor Such permlt TI2Sh COrt�pdCtOf � � to tile a 5iqnetl statement that h¢/she is licensetl pursuant to the provisions of . ROOi D�dinS � ' ihe Contractor's License Law (Ghapter 9(commencing with Section �000) of ' ' I ' � Division•�3 of the�6usine55 antl� Profezsions�Cotle) or tnat M1e/she is exempt - � - � . , - . - - - - � - - , ' therefrom antl the basivfor the allegetl exemption. Any violation of Section � ' � ' � � • � � , . • ' '031.5 by any applicant tor a.pe�mit Subj¢ct5 th¢ appliGant to a civil ' ' enalty of not mo�e tham five huntlred tlollars ($500�. i - • � -� � � I ❑ I, as Owner a( the' prop¢rty o� my employees witM1 wages as their sole ReipSpectiOn FBe, $15 �. ISSue F88 • $' 3 compensation, will'tlo the work, antl the structure is not intendetl or offeretl ' ' ' Reinspactian Fee $15, Issue Fee " � ,_ '$ 3 for,sale (Section �044, Buziness antl Pwfessional Cotle: The Contractor's '- ' � MECHANICAL' FEES; - � ' License Law tloes nol�apply to an owner ot a,property who builtls Or iTp/oves . , ' thereon, antl who tloes such:work himseif/herself or throu9h his or her own . . . �DEVELOPMENT SERVICES REQUIREMENTS: ' . '' " employees, prOvitletl that suCh improvements ale Oot intentletl or offeretl (or BOi12I ' � • HOOd Of Typ¢ I ❑ � � , sale.'It,.however„tFe building or imorovement is soltl within one year of com- � . Canopy . Type I I ❑ . Zoning Approved By � Date = � pletion,-the�owner will have the burtlen of provinq he/sne tlitl not builtl or im- Duct � Undei Ground ' ' � . ' � guilding Approved $y ' ' � ' Date I prOv¢ tor [he pu�pose of sale).; � . . ; ' ' ' � � , . � , � �O�-1; a5 owner of the property, am ezclusively contracting with Ilcensetl�con- Duct -Strucwral Refrigeration System Appliption Issuad By n Dat�-� Vactors to const�uct the project ($ection ]044, Bu5ine55 antl Professions Cotle: - 4 The,ContractoYs License Law does mt appry.ro an owner ot oroperty'who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU . SUM ARV O FEES ! builtls or improves thereon, antl who contract5�tor such projects wifh a con- � � �: - 4_ _ �/� � , � . . •FST', tractor(sl iicen'se pursuant to the Contractor's License,Law). I.am aware that � Y ' " BUILDING PERMIT �$'_-+SC`� SMIP -. �$ U roof of their workers Com ensauon insurance� houltl. be Exhaust System �--Multiple S stem�Repair/Alteration � �� P p s provitletl to me. ' ! PLAN CHECK ' $" � '-PERMIT' i �- ' L7 I_zm exempt untler Section ' B. & P. C: for this reason . FirepVFact..Blt. ICBO # � Fire Dampers ' ' . � pLUMBING , _ � ' $ - ISSUANCE � ' �$ , _ � �� Date� ' ' � � Owner ' � Heatin9 Sys[em & Ducting: � Registers � ' - � - ' p�qN CHECK '- 25%� $- � " - ' � � ENERGV P.C. �$.; 1 hereby certity'that I M1ave reatl,this applica[ion zntl state thaf the atiove �❑0.100,000 BTU �100,000BT � ��- " GRADING _. $' -� , information�is coirect: 1 agree'So comply with all city antl county ortlinances- ' ' � � ELECTRICAL .� , $. _ . antl state laws'relating to builtling construction, antl hereby authorize repre-- � �• ' - � ` PLAN CHECK 50%�. $ ' MICROFI LM .$' �- �' ' sentatives of .tM1is city to� ente� ❑pon, the dbove-mentionetl �Property �fo� ' _ � • ' , . � , , ' • _ � . , . • • , $ '.. �, SD. inspection puro . ' 1.�.t �+ r^� � � ' MECHANICAL $� : TOTAL FEE Signature -. .� � •/ l � � Dated�_Z. !Ov . - - - - � • . - - . , �:Driverz' License or 55 - ��( � S Reinspec[ion�Fee $15 . � . � Issue Fee . • $•3 - � PLAN CHECK 25% $- � 'I CMF 0865-46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor - CONSTRUCTION AND PLANNING, ' POOL & SPA . ,_ APPROVALS Permit # ' Date � Inspector � APPROVALS Permit # Date Inspector �'� . ,, , ' 1. Temporary Electrical Service or Pole { ' 52. Pool & Equipment Location /'� � 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement � � � � i 3. Electrical Conduit Utility-Undrgrnd. ' • 54. Forms ,� 4:, Elect�ical Conduit-Undrgrnd. ' � 55. Electrical Bonding ' �: .i . 5. Steel�Reinforcement � 56. Rough Plumbing�& Pressure Test . --- ---" _�;' � 6. ElectricalUFERGrnd. 57. APPROVALTOCOVER-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 . ' 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 Plumbing � 65. Electrical-Finaf 15. Rough Electrical-Conduit � , , � 66. Solar System-Final � 16. Rough Electric Wiring , +"- � � 67. Fencing & Access Approval 17. Rough Wiring Sign � � • � � -� � ' � � 68. APPROVED FOR PLASTERING � 18.�Rough�Elecfrical-T'BarCeiling,. , , 69. POOL/SPASYSTEMSFINAL � 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.StorageTank OGas ❑Oil 25: Roof Sheathing' .� . 74. Overheaii Hydro � 26: T-Bar Ceiling (Structurap & Monocoat � : 75. Dry Chemical . � 27.�Frame and Flashing -. �� 76. Dry Standpipe 28. Lathing & Siiiing ' � � 77. FIXED SYSTEM FINAL ' 29. Insulation ' 78. FIRE PREV. FINAL �� ' � 30. Drywall Nailing ' � , HEALTH DEPT. REQUIREMENT � 31. Pla'ster Brown Coat � 79. FINAL INSPECTION - � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � - � Notes: �(. gg -LQ � 34. Final Heating & Air Conditioning " 35. Final Gas Pipe-Test 36. Hood or Canopy . � 37. Final Faaory Fireplace _ � 38. Final Plumbing' � � . � � � 39. Water Service-Final � ' ' � � , � � � , � 40. Gas Service-Final : �� ' =41. Solar pomesticFinal- - - � � ' � � �'- ,42. Backflow Preventer � ' � � � � �43. Backflowlrrigation� � � - � � - � . '. . _ 44�. Landsrape Irrigation System � . ' � - � • '45. Souncl Attenuation . ', . . , . , 46. Handicap Regulations � � ' � ' � • • '•47. FINALSTRUCTURE & BUILDING - � pQ �^ �, , � 48._Special Requirements Completed • ' ' • , 49. Electric Release to Edison - --` 50. Gas Release.to Southem Califomia Gas Co � � � � 51�. CERTIFICATE OF OCCUPANCY - • �• ;- � No. � � � Date _ � � MNN OFFICE 1835 WEST GAY�ORD ST.. — P.O. BO% 9J05 LONG BEACH 10, CALIFORNIA HEMLOCK S��d93 SPRUCE 5�2001 �'�rini�tt� Laborai��i�� T.xamination No. Project Sample from Architect Contraccor \[ix \Vater, gal./sk. cement Size Dace cast Date tested t .t BHAIM1CH OFFICE 1514�D NOfVTH Ii4RPER ST. $ANTP FNA. GLIFORNIA JEFFEFSON I-20G5 JEFFERSON 1.20G6 o f souf�E �n eac� foZ,Z�a, 0,2�. r�ay 22, i96i QINITE REPORT OF TEST CYLINDER SC61-2820 ROBEFtT WARD RESID&NCE 3086 Country Club Drive, Costa Mesa Gunite Swimming Pool Hal Whitaker Pools - 430 - 31at., Newport Beach American Conat. Co. - 11421 Rosecrans, Norwalk 1:4� - Riverside teated cement 3 gals./sk,max. 6 x 12 4-24-61 5-1-61 C}'linder No. 2 C017PRLSSION 1TST 7 Days Total load to destruction, Ibs. 29,000 * Pounds per square inch 1,025 C}'linder made by Cylinder delicered by Cylinder received ai 5 7/8 x 12 5-22-61 2-A 28 Days �l. $� 2,010 Ray Blasik for Wm. S. Millez H. Cribba 4-26-61 �r� �•-- `k,��` � MA� 2 e� !� � � � a��Q� * C�linder Jtl contained rebound • cc: Whitaker Pools Rovert Ward Costa Mesa Bldg. Dept. American Const. Richard J. Blair - 267 W. Commonwealth, Fullerton � � SA Lab � �� J ' ALL PEPOFTS FRE SUBMITTED AS TME CONFIDENTIAL PPOPERTY OF CLIENTS� AUTHORR.�TION FO PU�OF U�ORTS. CONCLUSIONS. OR E%. TRACTS FNOM OR liEGAF�ING THEM IS RESENVEO PEN�IrvG OUR WflIT?EN APPflOVAL PS A MVTVAL PPOTECTIOR t0 CLIENT9, THE Pl1HLIC ANI] pUFSELVE3. OwxER WARD, NIR. FAJB JOB ADDRESS � 30 C OCCUPANCY Form 110-SM-71-59 S-B P PUG `` D t96� r Dr. er CT FIAE ZONE L DATE I GROUP i�L-� SUBCONTRACTOR DATE 3 -21 BUILDING P ✓ � ✓� . . ': 1��_�� COST.q MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MEBA, CALIFORNIA For Applicanf io Fill In Complefely TypE OR PRINT ) BUILDING � �� a, {„ ADDRESS i �..ti«�� COSTA MESA CALIFORNIA B MAIL I��/%//i � i � l STATE / ^ f, TEL. p / LIC. NO. �p /�-`' 8 1" NO. i 0��S 1 � / � NO. OP BLDGB. s�ZE k� �C k� OF LOT NOW ON LOT 66TBACK LINE FNOM ,gw I�� Y ( CENTeR on STxeei 6l� REAR YARD O j r ' I 81DE YARO ILEFT I W RIGHT � e DESCRIP7101d OF WORK iR10R WALL I :zOOF _RING COVERING OF BUILDING AND WORK TO BE PERFORMED I NEREBY ACKNOWLEDGE THAT 1 HAVE REAO THIB MPLIGTION AND 6TATE THAT THE ABOVQ IB CORRECT AND AGREE TO COM- PLY WITH ALL CITY OIiDINANCE9 AND BTAT6 LAWB HEGlIL1TiNG BUILUING CONeTRUC/i]�ON�9. SIGNATURE OF `(�, //J(/ �j�� PERMI'1"fEF 4(•K. ` 1 AUTHORIZED AGENT FE� RECEIUED C j 67AR 211961 rINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT euaciNG For Office Use Only REGEIPT NO, I PC/F�MfI%/�� BY I. OATE�FECEIVEO � OATE 185UEO BUILDING ADDRESS COSTA MESA. CALIFORNIA ZONING ZON�I I NO. OF I U6E OP C PLAN6 � BUIL�IN LEGAL ��/ , J � � �� YARDS APPROVED (CENTER LINE APPROVED '-' J i J EVES 'Z � �J THE pMOUNT BHOWN UNOER VqLUAT10N IB FOR THE PURPOBE OP ESTABLI9HING A PERMIT FEE ONLY. VALUATION �� n O�/ PERMIT FEE $ �D' f `� �/ L/ $ � PLAN CHECK S .Il � OWNER MdVFTFTT MAY DATE j� ub Drive ....._ __...._.._._.. ........ � � 139-163-03 LOT �In�PECTIONS OIL r15 nTER �OUGH P�I1MBiNG 1�ROP. ?N'R. LINE �__� NOIISE CON. � SPRINN�ING SYSTEM MISCELL4NEOU5 ROUGH HEATING AN� RIR CON�ITIONING TEMPOR/.AY SERVICE OR POLE UNOERGROUN� [� POWER � ROUGH 'MIRING TRENCHES iJ FORMS � STEEL REINF FLOOR SYSiEM BONO BEAM [� STEEL REINFORCE � SNEAiHING FRAME AND FLASHING �qTq�NG — INi� OUi � ER. BROWN COAT .TURAL FINAL HEATING, VENT., REFRIG. AND A.C., FINRL PWMBING. FiN4L AN� GAS TEST ❑ ELECTRIC, FINqL BOILOING. FINAL SUBCONTRACTOR r F � L Q y y .T. � G � F a q ..1 a > � .a a w w 0 4L� a Z � 3 � A '7 `? : � `°-� COS7A MESA BUILDING-SAFETY DEPARTMEN ' P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING �%?� d/ .1 / / . �. OWNER / �� ADDRESS �(JS C� 'f (;(�c( R /' � ///J � NOL. CITY A.n J BRANCH ADORESS ARCHITECT TEL. CONTRACTOR �/ ADDRESS �� D �(�f�, �� , TEL. CITV �(iytq�(/�l(� i� NO.rf 2— LIC. NO. 33�� / I C�+3� LICVNO� � SIZE i NO. OF eLOCS. OF LOT NOW ON LOT USE OF EXISiING BLDG. Separate permits are required for e]ectric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PEFFORMED R 2524 'j%26%79 FOR STRUCTURAL PERMIT DATE RECENED nn-rc icsiicr / APPROVED � ✓ BY ZON NO.OFr. 7 PLA r AqOSAPPROVE� ) MAIN BUILDING , (FROMC/LS'lREET] I he�eby.acknowlatlge that 1 have �eatl this application antl state that tha above information is correct entl agrea to comply with all iaws regulating builtling construction, and I shall not employ any person in violation ot the workman's compensation laws of the Stata of Californle. I hereby cettify that I am properly licensetl as a contractor untler the SWte of California Businass and Professions Code, Dlvision 3, Chapter 9, antl that such licanses ara in full farce antl etfect, or I 'am exempt from the provisions of the State ot California Business entl Professions Coda, Division 3, Chapter 9. Signature of Permittae � Auffiorized Agent � �/i�� DISTANCE BET. MAIN BLO('a5. VAR. #` C.U.P.� OATE /�G(Q USE OF N BUILDIN " VARDS APPROVED OATE APPROVED /.. THE AMOUNTSHOWN UNDER VALU THE PURPOSE OF ESTABLISHING A PERI VALVATION PERMIT FEE S Q y PLAN CHECK $ $� / TAX $ TOTALPAID § 60.52 TL � n m i m m N ON IS FOR m FEE ONIV: � � � m /f� m 7V o LL � U . , r— _ �� COSTA. MESA BUILDING-SAFETY .DEPARTMENT _ P. O. BOX 9f7 COBiA MEBA. CALIPORNIA � For Applieanf fo Fi11 In Compleiely TYPE OR PRINT AD RHSS 3086 Country Club Dri.ve � COSTA MESA. CALIFORNIA OWNER Jamaica Construction Co. "'"" 3120 Bermuda Drive ADDRESS CITY V�Sta T�pesa ryE�TD —C� ARCHITEGT KeT1T1G44Y�&_� TEL.Qli�.(' Del Auar ��'i 3120 Bermuda Drive Costa BZesa 180186 No: KI 5- C�il 6.� _� I NO. OF �EE R E�� i�E�-, �INAN CE S�APM SA APPLICATION ��R PERM�i eua�in�� For Office Use Only qECE1PT NO. I / �.1�jd 6� i K •' RECEIVED BY �ATE pECEIVEO � DNTe 188UEU .,--��-a� Y �9��0 � HrX 2 9 7san ILDING FIRE LEQAL COSTA MESA. CALIFORNIA ZONIIdG NO. OF USE OF eurve em�mn � USE OF None Yi1RD5 EXISTING BLDG APPROVED 6HTBAGK LJNB PROM � � � (CENTER LING BT.) 7Ot u CeMeR OP BTPCET (�� / REAR YARD FRONT BIDE YARD I LEFT l� / I RIGHi �`f� L, R. SIDE � DESCRIPTION OF WORK I.SIDE NEW I�1r� II nISERATiON I� II AD�ITIDN I ....... �BUILDING !1 /� /� NO. OF SIZE IX. ( / ROOMS EXTERIOR WAL � ROOF COVERING U COVEF USE OP BUILDING AND WORK TO,E : Sin�le �amilv i HEIiEBY ACKNOWLHD6H TNAT 1 XAVE REAO TH18 APPLIGTION AND BTATE THAT TX2 AmOVE 18 CORRECT AND AOREE TO COM- PLY WITH ALL CITY OIiDINANGE6 AND HTATE W8 REGU TING eU�Lo�Na COI�I�tUCI'ION� � � ��' n APPROVED H EVES 0 THE AMOUNT BXOWN UNDER VqLUAT10N I6 POR THE PUPP09E OF ESTABLI6HING A PERMIT FEE ONLY. VALUATION // ,: PERMIT FEE $ J`/ �� $ .'�( �� PLAN CHECK $ �G, J O