HomeMy WebLinkAbout3345 ALABAMA CIR - Building Permits� '�
PP0.1EC7p0UflE35: 3345 ALABAMA CI
•OWNEN'S�SRME: iVATtIY� GEORGE H
aooeess: ;�345 A{.ABAMA CIR
COSTA MESA,CA 42026
5q0-7170
RHCNIEXGINEER: HEO.NO.:
AODHESS:
uxrt:
UNIT:
PEflMITTEE: j(AN�S CQNSTRGCTION (714)631-3355
aooxess: 1835 WAITTIER F-9
CM CA 92627
UCENSEU CON7MC70B OEClAM710N: I Aerehy aflirm that I am IicenseE unAer D�%'��ons af Chapler 9(commencing with Sectian
7000) ol Division 3 of ihe Business antl Pmtessions COEe, anA m en is in full rorce anU eflec�.
cmuc.: 03a�6t.`39 sra�uc.: 47233J ss: ,,
Date: //"' ��7 � SiqnaNre:
WOPKE�COMP SATIONUECUMTION: Iherehyaflir thatlhay acetlilicl icansenl[osell-insureoracetlifiWteofWorkers'
ComDensation Insur nc , r cehi�ietl copy [hereof (Section 380U!Lah. C
ooucr xo.: i(� .� (� f� tf b exr. o�Te: ��/ O 1/ 9 i
COMPRNY: S l IiTE
� Cerlifie0 co y is here�y fumisheU. ❑ Certifiea copy is fi wit e ciry BuilOi A Divisio
' Uate: � Appliwnt:
IXEMPTIO FPOM V/OflNFflB' COMPENSIITION UEClAM710N: (ihis section not Ee co ea il the Oe�mil is lar one AunOreA (5100) or less).
I cetlity that in the DeAormance oi IAe wark lor whic� this permit is iss A, I shall nat D�oy any person in any manner so as to become
sublect ro t�e Workers' Compenuiion Laws oi Califomia.
Date: Sipnature:
NOTICE: II, atler makinA [his Oeclaration, you shoulA hecome suhlect ta (Ae Workers' Compensation provisions oi the LaDor
Cotle, you must forthwith comDly with such pmvisions or Ihis Dermit s�all be tleemed revoked.
CON5T8UCTIOX LENOINC 1GENCY: I �ereby aKrm [�a[ ihera is a constmction IenAing a0ency far Ihe Detlormance of the work for
Which this perm� is i55ue0 (SeCtion 3097, Civ. C�.
�noex:
' aooness:
OWNEP BUIlDEO OECUNITION: I here0y attirm that I am exemDt irom ihe Coniractars' State License Law for the followinp reason
(Section 7031.5 Business and Pmiessional Co�e: My ciry oi caunry which repuires a permit ro constmct, alter, impmve, tlemalish, ar
repair any stmctur¢, Onor lo As issuance, also requires tAe applicant lor such De�mit to file a signeU statement ttwl he/she is IicenSeE
pursuant ro Ihe Dravisians oi the Contracrors' State License Law (Chapter 9(commencinp with Section 7000) of Division 3 of the Business
an0 Professions COEe) ar tlut he/she is exempt t�erefrom anE the hasis for the alle0etl exem0�ion. My violation ol 5¢ction 7031.5 �y
any apDlicant tor a De�it sublects Ne aDPlicant lo a civil penalry ot not more than INe hunOreU tlollars (5500).
I, az owner oi t�e D�aOeM or my employees with wapes as their mle compensalian, will Uo Ihe work, anE Ne
❑ simcWre is not intandeA or ottere0 far sale (Section 7044, Business and Protessional Caae: TAe Caniractars' State Licensa Law
Aoes not apDly to an owner of a pmpeM who builtls or improves thareon, and who Ooes sucA work Aimself/herseli or [hmuqh
his ar her awn em0loyees. D�%'iGed that such imprmemenis are noI intenEed ar offereE for sale. If, hawever the UuilainA or
impmvement is saltl within ona year al comDletion, the owner will have tha Curden oi provinp he/5Ae Aia not huild or impmve
for Ne purpose of sale�.
I, as owner oi tAe Omper1y, am exclusively contractinA ��h licensetl contractars to consimct IAe Omlect (Section 7044, Business
❑ anA Protessions Code: The Contractors' SWte Licenu Law Ooes not apDty ro an owner of OrapeM w�o �mltls or improves Ihereon
an0 who conlracts tor such pmjecis o�ih a contracror(s) license pursuant ro I�e Contractars' State Licenu Law�. I am awara
that pmoi al t�eir Worker's ComDens:lion insurance s�oWtl Oe OroviEed to me. '
� I am exempt un0er Section: B. d P. C.
tor this reazan:
Date: Ownec
I Ao hereby certity that I am aware of and unAersWnO ihe requirements oi Califomia Healih antl Satety CoEe Sections 25505, 25533, an0
2553o and ihat 1 or any future 6uildinA occupant vnlllwill no[ (circle one) need to com0ly wit� sai0 state cades an0 t�e reQuiremenis lor a
permit for constmction or motlification fmm the Air �ualiry Management Uisirict. Hesiaential constmction applications are exemD� ��om
tAese O�oNsions.
Date: ApDlicant:
I here�y cetlity [hat I have rea0 this aDDlication and state ihat Ne aUove information Is correct I a0ree ro comply with all city antl counry
ardinances anE state Wws reWtinp ro buil0inp wnsiruction antl her auf '¢ reDreun tives of � is Ury ro enter uDon Ihe above-mentioned
omoem �a� i��COeciion urposes.
.� /,,.
Oate: �� H SipnaNre:
Drimr's Licenu or Social Secunry M�
16a1-a6 WM�e—Builtlin9l Grean—COOe Enlorcemam; Cenery—Applicen�; Pink—Ravenue; GOIEenraE—Asseseor
�
C1TY OF COS'TA M:SA — bUI"LDING PER�I'P P:RM NO; H U51447
PERMIT NO: H 052447 PLAN CAECK NO: U2122-91 S, GOVT; N SUPi7: N
CONSTRUCTION 7'YPE: V—N PERMIT TYPE: STk PURPOSE: Ai.T
JOB DESCRIPTION : REMOVE FSREPLACE/REPLACE W/ WINDOW SQ FT: 3,000
CLAIM VALUE: 3,U00,00 CALC—VALGE: 4,500,00 GRUUP OCC; R-3 /
COMMEN'LS: REPI.ACE FIREP7�ACE W/ WINDUW
�� iFi!� �1c ?(� iE K 1!� %-lF iE IF # iF �lE 1E 3F 9E k if �k iE iF�E �1E �% 9e if 1E �lE if �If K jF %�'7E # 1F �iE )f #�7F�if fE �1(� )f )f iF �3F iF iE �IEdf a( �c #�Ie K Y iE �Y k iE �k �-1c IF�IF 4E �741E ic # iE #�}` iE ���
1 O N 3 N G R£ Q i7 Z R E M E N T S
S E T H A C K S
------------ MAITv BJILDING ---------- --------- ACCESSORY BUILUZNG ---------
FRNT; FT IN R£AR• FT it�3 FRhT; FT ]:N REAR: FT IN
LEFT: FT IN RGiiT: FT IN LEFT: cT IN RG:iT: FT Ii�'
PARkING REQ• PROV; PARCEL; 13958120 ZNE: REP NO:
PLANlJING N6TF.S>
>
�1F if !f 1F �M� i(� if if 3i� iF if 3f 3h %iF 3(� IF iE iF 9f iF iF iE iF fe R iF�k *�1f� %� �if DF 3(� if ie 3i� le 3E #}E iE iE 3c l(� di� k�K� 3F 36-%�-%�(� �l( K IE ff� iik iF iE iF-% # iF ii-ii� ie X i(� di� df i4 i�� if 3F # Sc #f -1F
D E V E L O P PS E N T S E ft V T C E S R E Q U I R c M E N i S
ZONIfvG APPROVED BY t�AiE;
e�;::.�zt;�; ��es�v��, �Y : DA'I'=:; �
APPLICATZON TSSUED 3Y; L —'--��� � DATE;C' � ``�
IFiFiEit�3'rdhieieiEieaFiFiEif-.T'�7'ri(��K�#ifN��l(-T�T�L-T ,�F#7iiFiE�la(�3(�3i�3iKif3Ex� r r ir �jE
iFifiFk)Fieif�]FiF3E1M1iE3f�lfi61f3i�if�iEltlfkj'riek3Fi!`M9P?Fii—it'�- iE�iE�1F3F�IFjFY��iFi43E3EiFiP34iF1f1'rN�iE-%��:�iE1F'r'rh'�ii�3FiEifxl4%�if;f-iPafi�+f�Ifii��P�1pY,�
LEGAL.iZATIOh;N F E E S' M A R Y STRUCTURAL SEG"IENT:Y
BLDG PN.T PLUNBING ELECT IC MECHANIC FIRE SMTP/RES GRADZNG
PERMIT 72.00 ,50
SMIP/NON—RES
PLAN 46.&0
rssr.r� FE�
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK iOTAI. YAID DUE
TOTAL5----> '72.50 0.00 46.80 119.3U i1ti,30 ,UU
REVr.NUn DIVISTON TUTALS--y COLLECTED: 1?9,30 OVER/SiiORT: 00
BLDG PMT PLUMBING r.LECTRIC M$CHANIC FIRE SMIY/TOT GR,�TI�G PLAN—CHECR
72.OU ,50 46,BU
3h% iP IF %if 3(� IE ib � iE if %iE iF jf ME Y� �f iF K� *# if u 3F If #� 3E K� � k� 3G %� 3(� ie # dE �%� f41(� 3i� iE iP iP �lE� �1E 3E N� 14 if Y� i(� # iE 1F x� iE iF iF ii��±� iE N� �)f iF #+E i4 # 3P ic �if Y� �(� %� 7i� 3f-?R
I N D I V I D'J A L F E E B R E A K D O W iV
TYPE QTY U F. S C R I P T I O N UNIT COST TOiAL COST
SFR 4500 ALTE� BY VALUE RESIDENTIAL N020NE
END OF rEES
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�'� CONSTRUCTION AND PLANNING . PO.. _ d SPA
�APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
'1. TemporarY Electrical Service�or Pole : 52. Pool & Equipment Location '
2. Soil Pipe-Undrgmd. -- 53. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER G�nd. 57. APPROVALTO COVER�GUNITE
7. Footings 58. Elect�ical Conduit-Undrgrnd. �-`
8. Foundati0n - - � 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�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
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Hsating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O 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 Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Final EleGiric Notes:
34. Final Heating & Air Conditi0ning
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic�Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ? �
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY
No. Date
�nooeEss: ; ;45 ALA�At-0A CI
OWNEB'SN�MF. (;F.URGT' MA'1'HZS
noor,tss: SAMF AS ABOV7;
771/5�0-7179/692��5946
RRCNIFNGINFEN: ' BEG.NO.:
�ooness:
uxrt: CIT`f OL•' COSTA MESA - BU,ILDING PERMiT PERM TIO: A nar,i�r
PERMIT NO: D U461a5 PLAN Ci[ECK NO: N GOVT: Dl SUPI?: 14
CONSTROCI'ION TYPE: • PLRMT.T TYPE: aTR FURPOSE: AT(f
, �
JOD LE�CRIPTION . RERQOF aFD WITII SHAI{�S 5 GRAVEL SQ F'C: S,S52
uxrt: .
CLAIt4 VALUti: ; 5,15'.00 CALC-VALUF_: 5,752.00 GROUP OCC: I2 9/
PEHMITTEE: CRANK EiROTFIrRS RUOFING ( 7].9 ) 54fl�-5563
ROOflE53: 1; 6 COMMERCIA,L W�AY
C.t4. CA 9262'7
LICENSED CONTMCTOB OECIAMTION: I herehy attirm that I am Iicense0 under pmvisions oi ChaO�er 9(commencinp witA Sedion
7000) oi Division 3 of Ne Business an0 Pmfessions CoOe, an0 my license is in full force anC eHect.
ciTr uc.: p 0 5 9 9 � STIITE LIC.: � Q�J (� "] % cuss: C 3 9
Date: Signamre:
WORKEBS' COMPENSIITION OECLAMTION: I herehy aifirm that I Aave a cetlificata of consem ro seli-insure ar a certificate oi Workers'
Compen5aiion In5 raQce or a certifieE capy IAereot (Section 3800, LaU. C).
roucv xo.: 2�f 5 L l'1 y 0 EXP. �RTF. U 1/ O L I� S
COMPRNY: �TATE
� certniea coPy is nereoY mm�snea. d Cetlifie0 coOY is file0 with the ciry BuilAinp Uivision.
,.ete: � AOD�icant
E%EMPfION FBOM WONNFRS' COMPFN&1TION OECIAMiION: (Tltis section nee0 not be completeC if Ihe cermil is tw ane hundred (5100) or less�.
I certiry tAat in tAe pedormance of the work for whicA this permit is issuetl. I s�all not employ any person in any manner so as to Uecome
su0lect to ihe Workers' Compensatian Laws al Cali/amia.
Date: oSignature:
NOTICE: Ii, after making tAis tleclaration, you should become suhlect to Ihe Warkers' ComDensation provisions of the Labor
Cotle, y0u mUsllorthwilh tomply vn[h SUC� provisions ofihis Defmi� 5�all �e Ueem¢0 revOkeE.'
CONSTNUCTION LENDING RCENCY: I'Aere�y aifirm that ihere is a construction IentlinA aAency tor tAe Detlormance of [he work for
w�ich �his permii is issuetl (Se[�ion 3097, Civ. C�. .
LENOEH:
nooness:
OWNEB BUIIDEB OECUMTION: I hereby aHirm t�at I am ¢xemDt fmm the Cantractors' State License Law for the followinp reason
(Section 7031.5 Business antl Pmfessional COAe: Hny ciry ot county whic� requires a permit to constmct, alter, improve, tlemolis�, or
repair any stmcture, priar to its issuance, also repuires the applicant for such Dermit ro file a sipneC statement that he/she is IlcenseU
pursuant to the pmvisions of t�e Contactors' State License Law (ChaO�er 9(commencing with Sectian 7000) af Division 3 of ihe Business
an0 Professions Cotle� ar ihat he/she is exempt therafrom anA the 6asis Por the allegetl exemption. pny violation oi Section 7031.5 by
any applicani lor a Dermit suEjecLs t�e aOPlicant ro a civil penalry ol nat more ihan tNe huntlre0 Uollars (f500�.
COMM EN'tS :
'�r'��*�t-�x-�fiE�ie�'*�r'i,.,c�'�*�r�t*x-'x��*�'�x"x'*'��'�*'x':e****�-'x'�-*�c-�x-x'*x'*�'r.'-r,:Eia'�tx"x-***'�'x�#ii�,�*.ie'��iE��e�'�ii'�'
Z O N I N G R� Q U I R F•. M E N T 5
S E T II A C IC S "
-- ------ - MAIDI FIUILDING -------- -------- ACCESSORY BUILD7:P]G ----- --
FRN7': F1' IN REAI2: P'T IN I'RNT: FT IN P.EAR: - F"C It�1
LF:PT: FT TDl RG11T: P2' TN LEI'T: FT IN RGfi1': F'P '.CI�I
PARlCING REp• PROL�: FARCEL: 13958120 2NE: � RF.F NO:
PI,ANNTNG DI�JTE5>
>
i����it�***�: Kr��r�x*�x�e���fi�*�ti���c-�t-#�c����t��v-i�**+t�x-**�**�t��-ic�c�t�t�t*�t**ft*���u�**�t�**�t*�x-�x��i.i�-**���t;e��-i�
ll� V E L O P M E N T' S E R V I C E S R E� U I R E M F' 1,Y�•T S
ZONING APPROC'Cll BY DATE; �
IIUILllING APPRUVI?D BY :__ _i__ _ DATE: �`,
A'E�PLICATION ISSULD BY: �' DATE: '�/�-y�/ ZJ
*��r*+�****�x�*-��x�?���r?���c-**�-�k��F"iF�'b€�"i�'�t"iF'�'i�iF�SF"fF f.�F+"iF�Fg�i-i�-�i��****�t*#*at��'+�'3�*�i-iF`#"+��*x#
9E M# 3E 3E H# if 3E iE * iE iE if iE i' 3f iE iE M if %� 9E 3(� iE 3E # iE if� Y- �lE iE �1f i� �lE iE iE if 3E ?E if lf 3F if-* iF iE iE?6 3E iF )F N� �K iF iE iE 3E �1E dE jh jE �E jE # i(- iE �-if Y� �F±F #'v- dE ?E �N- 7( i'
LECALI'I.A'PTON:h! F L-' E S U M M A R Y STROCTORR'L �SEGb1Eh17':-Y
RI,llG PM1' PLUMBTNG PLECTRIC MECHANIC FIRE SM.T.P/RF.:S GdtADINC
rcx��il•r tsi:uo .so
- sMZF ir�or� -F��s
et,An�
ISSU� FFE '
I, as awner of ihe D�operty or my em lo ees with waAes as iheir sole com ensation, win oo the work, ana me ���ILDING -U LV- i �PERMIT �- TSSOE PLAN-CIiiCK TOTAL , )?ATll OUE
❑ stmcWm a not Intenaea or onereo tor sate (�eciion 7044, Business an0 Protessional Cone: rhe Contractors' Stata License Law T'OTAL S----% 8 1, 5 0� 0�. 0 0 0. 0 0 8 1. S 0 !3 l. . S 0 . 0 L'
Ooes not apply Io an owner ot a pmOeM w�o builds or improves thereon, an0 wha Oces such waM himselVhersetl or ihroup� � � ''
his or �er own employees, pmviAed that sucA imDravements are not intenEed or ottere0 for sate. tl, however ihe builtlinq or �.2EV�NUE D IV I`u 1 ON TOTAI.S--> COLL EC'.CED • � 1. 5 � OVEIi /SHORT : . 00
improvementissoltlmt�inoneyearofcompletion,t�eownervrill�avetheGuNenoiprovingAe/sheAiOnatUuilUorimpmve BLDG I'M1' PI,UMBINC ELECTRIC MECHANIC F'IRE SMTP/TOT �CRZi1:ID1G PLAId�—CI�GCEC
far �he purpose of ule�. �
I, as axner oi the propeM. am uclusively wntracting unih Iicense0 coniractors to rnns[mct the project (Section 7044, Business 3 l� . 0 0 � . . . 5.0
❑ an0 Pmf¢ssions Code: The Contractors' Stata License Law does not apDh �o an owner ol Oroperty w�a budCs or impmv¢5 thereon �
anEwhoconirac[sforsuchprojectswithaconVacror(s�licensepursuanitatAeConiractors'StateLicenseLaw).lamaware �*�'�'H"K'*�'�`�'�"�'#if�ltitiFi'9f3f��)E#iEfFj(-�k-*ri�kft#iEiE3FiFiF3E�1EiE�lE9t#iEiftt##iEit�E�ltiE#i!�iE3Fikifi(-ihiE�%jtjEiPiEiE3PiE?EfE#i(-?�iE#t<.�f!f3(�
�. tAat prool ot meir worker's ComDensation insurance snould oe pmviAea ta me. I N D I V]. D O A` I� F E G B R E A R D O 1^I Dl
'�, � I am exempt under Section: � B� 8 P. C. • �
�orinisreason: TYPE QTY D E S C' R I P T.f. O N UNIT COST T01'AL COS'1'
Date: , 0'^me�� $FR 5352 R�ROOF 9Y VALUL•: RESZLFNIAL N07.ONE 1.00 5,3'i2.Q0
I Ao AereGy certity ihat I am aware ai ana undars�and �he reQuiremen�s of California Health antl Satary Coda Sections 255Q5, 25533, antl ETj]� (�F .�t' L;r'�j
25534 anU that I or any luture UuilAinA �cuDan[ will/will not (circle one) neeU ta comply with saitl state cotles antl the reQuirements tar a . . . ' , ,
permA lor wnstmctian or moditication Irom the Nr Qualiry ManaAement Oistnct. ResiEemial consimction aDPlications are exempt imm . '
these pmvisions. . '
Oate: Applicanl:
1 Aereby utliTy that I have aatl IAis appliwtion and state t�at t�e above intormation is correct I�apree ro comply with all city and counry
oNinances anE sWte lavrs relatinp �o builEinp construc[ion anA AereUy authorize rep2sentatives ol Ihis ciry to enter upon Ihe aDove-mentioneJ
pmDerty /or inspection DurD�ses. � � /� �� �� � ��%
Date: Z'� 2'� — 9� Signature: �SG�O�Q:O�K-K�U ."�'—"'Y
Dnver's Lianu or Social Securiry
= 1601A6 White—BuilEinp: Green—COEe EnbrcemenC Cenary—ApP�ican�; Pink—Revenue: GolEenroC—rUsesso�
'� .
Ol 00054499-D0054500 TOi" $1.50
DATE: 02/21/90 TSflE: 09:2b
' CONSTRUCTION AND PLANNING
APPROVALS Permit #
1., Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd. � . ' ,
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement .
6. Electrical UFER Grnd.
7. Footings
8. Foundation �
9. Water Pipe-Undrgrnd.
10. Structural Floor System
71. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing .
15. Rough Electrical-Conduit
16. Rough Electric Wiring �
17. Rough Wiring Sign
18. Rough Electrical�T Bar Ceiling
19. Rough Heating & Air Conditioning �
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating,
23. Gas Pipe-Rough & Test
24. fioof Framing
25. Roof Sheathing �
26. T-Bar Ceiling (Structurall & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
�30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter�Final
33. Final Electric
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�Pinal �
41. Solar pomestic-Final �
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Q
51. CERTIFICATE OF OCCUPANCY
Date � Inspector
�
Date � � -
POO: PA
APPROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
Date Inspector
�,
�
i
�
� .
>�.
i �
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;. '
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0. `� � % � DATE _� �/ " � n
LOT N0. /�G�
ADDRESS � ��`j �� �/�/ .
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
Developer
represent
-�� nder
zed
0
i
�
PqOJECT RODNE55: j 3[ S /�L.�? �iuJ: :. I
OWNEH'SNRME:yA�.H+S, G..^-.ORGE H
nooeess:'3395 AiABA.KA CIR
� COSTA :!ESA,CA
pflCHIENGINEEP: �40_7'79
AUOflE55:
�
�
UNIT:
92626
NEG.NO.:
UNIT:
PEBMITTEE:ISLAND PAC�F�_C ROOFING (714)637-2493
aooness: � qq12 NC:,ARE�I :,ti
'r.J4TING.O�: BEACH CA 92646
LICENSE� CONTPACTOH OECNflPTION: I �ere�y a��irm Ihai I am licensea un0er pmvisions of Chap�er 9(commencing with Section
7000� o� �ivsion 3 al I�e Business antl Prolessions Code, and my ' nse is in lull lorce and effec�.
cirvuc.:�c�7po srn,euc.:53�47� c ss:- ,�
Daie: Signa�u .
WOBRENS' COMPENS ION OELNflATION: I h lirm thal I haue a cetlihcate o� consent to sell-insure or a cehihca�e ot Workers'
ComDensaiion Insurance, or a certified copy Ihe ection 3800. Lab. C�.
POLICY NO.: E%P. �ATE:
COMPANV:
❑ Cerlilietl copy is �ere�y Wmishetl. ❑ CerlilieA coOY is liletl with t�e ciry Building Division.
�t¢: Npplicant:
EXEMPTION FNOM WONKEBS' COMPENSATIDN OECIANRTION: Qhis section need not Ue comDleleO il lAe permit is lorone hunOred (5100) or less�.
1 cetlity Ihal in Ihe perbrmance o� t�e work lor whic� this permi� i5 i55ue0. I shall nol employ any persan in any manne� so as to become
sublec� �o Ihe � Bers' C� ensa�ion Laws ol Calilornia.���
r
Oale. ' O � � S. a � /
NOTICE: If. a��er making I�is 4eclaraiion. y s uld Uecome suDlec� lo ��e Workers' Campensa�ion pmvisions of ��e Lahor
Cotle. you mus� Iorihwilh comply with suc nn ovisions ar �his permit shall be tleemed revoke0.
CONSTFUCTION LENOING AGENCY: I �ereby allirm iha� I�¢re i5 a cons�mction IenOing agency lor the peAormance of the work �or
which Ihis permit is issuetl (Seciion 3WZ Gv. C).
LENDEfl: ��Qh� UE1tC1ORS REptiZRED
aooeess:P``R ':HE 1991ED OF THE UBC
5.8PSF `!AX
OWNEFl BUILDEH DECLABATION: I hereby afiirm Iha� I am exemp� �mm Ihe Conlraclors' State License Law for the following reason
�SetUOn 703L5 Busin¢s5 and Pmie55ional Cotle: Any ciiy 01 coun�y whith repuires a permii Io ConSlmC�. aller, impmve, tlem0lish, or
repair any slmciure, prior lo iis issuance, also re0uire5 Ihe applican� lor such permii �o fiie a signed 5�a�emeni �ha� he/she is Iicen5e0
pursuant to t�e pwviSlons ol Ihe Conlraciors' Stale License Law (Chap�er 9(commencing with Section 7000) oi Oivision 3 o� ihe Business
C�:Y OF C��S':A `:�;'A — Bi:�:��I\G ��K:'.�_ P=P.:. 'tG^ � '_�'_
Y�P.XIT �1G: B 0621=4 PLP.:�i CHECR NO: �7 GJCr:c ?: :;;FF: ti
CO�I5:RIIC';IO:v �YPE: 5—:I PER;,�i :YPE: STR PURP��5�; AL:
JU9 �ESCR�P.ION .;/G, RESriEA.H 6 APP;,Y \c'.d "::O�IER ;ii,�" SQ ::: �,600
CLAIi�: VA:,JE: 5,600.00 CA�C—VA�liE: 5,600.00 GROJP vCC: R-3 /U-1
CO:✓.?!ENTS: T/O EXIS�. APP;,Y 1/2"CUX 6"::Oti'_ER T=LE" PER ' B# 2G73
�**t?���x�**�t*���#u���t�*�r*�tit�t��+t�t�ri�#�;t**t�t-i�**��<:tst�;�:t�;f:a:;:r.�. �,y: >. y�,r�wy
Z O ti_ N GS ERTEBQ�licIhRSE :S r 1: 5�C✓�� D��C�V't�:
REC�UIREQ_
'__'_ _ ___ ____
------------ , - _t, :� ---------- ---- ACCE5SURY BJIL.�-+��
FRt� : FT I:�i REAR: F� �N FRNT: FT Iti ?EAR: F�' -�•
L5� :. � T IN RGHT: F': ��I :,EFT: F: Iti RGH� : r'" :\
PARKI�G REp: PROV: PARCE_T,: 13958120 ZVE: REF NO:
PLANNIhG NdT�S>
>
���+��*****;���rt�?�*�*�Y��±�**�**#*+�*�t#****#�#t� ,*��tr*�:��x���*#*#�:��tt**�: ;a�t�-t.;:*�;�*�*
D E V t i O P,'✓i E N T S E R V S C E S R E Q iJ I R E X E N': S
ZVivItiG APPROVEL� BY L>ATE:
3liIiDT_NG AP?R�iF�L BY : LllA':E;
APPLZCATZON ISSJtll BY: C` \'�� DATE: �i7(��
j43FiE�1e3Efi£#?E3EiEiE�1E?4#?EiE??iEjfiFiEtc . . �'iFiF�Yc#3fiE#iEiEiE#tF -fi�.ci.-7. Fibie
u��************��*#�**##***�*****�*****��*���;�*�*���#����;�s:****��*�##u?e�:��.��*�..
�EGALIZATION:N F E E S U?; N. A R Y S.RuCTLkA� s'EG�:E:d'::Y
3�DG P:�:T PLUK&I?vG Ei,ECTRIC MECF:ANIC FZRE S.�:IP/R�5 G.?AU:\G
PER:�Ii 51.00 ,55
S:�' I P /NU�I—RES
and Pmlessions Code� or Ihat he/she is exempl ��erelrom and Ihe basis lor I�e alle0e0 exemp�ion. Fny viola�ion ol Seciion 7031.5 by PLAN
any ao�licant for a De�mii suble��s Ihe aDPlican� Io a civil penaliy oi nol more Ihan live �untlreG dollars �$500). T SSL t t tE
u
���
i, as owner oi me nroPeny or my em ioyees wim wages as ineir soie compensation, will Oo the work, antl �he tiU�_',J-NG—UILT—> PER.��I:T ISSC7E PLA�I—CHECK �0:.'AL PAIn LI�Tt
s�mcwre is no� imenUetl or o��erea �or sa�e Igection 704a, eusiness anU 7m�essiona� Code: Tne Convac�orY Sta�e License Law 1 �TI? ?-S— ---> 8 i. 5 6 �. � � �. � � 81 , 5 6 $ 1. 5 fi , � �
does not apply Io an owner ol a pmperiy who hui105 or impmves �herean, an0 w�o tloes such work himsel�/hersell or Ihmugh
his Or her awn employees, pmvidetl �ha� suCh impmvemenis are n0i intenaed or offefed for 5ale. tl, however �he building Or
improvement is som wi�hin one year o� comp�etion. ihe owner win have me burden o� pmving he/she tlid no� buim or impmve YC: �.J�:VTI" :J :�.�1$ I ON TOTALS --> C�L?� EC TED : 81 . 5 6 OVER /SAORT ; 0 0
rormen�roosemsaiel. B:,'i�G PN.T PiDMB'1:vG E'Lt.CPRl'C' hfECHA4IC FIRE SX:P/TOT GRADi:�G PT_,A:v—C??EC?C
I, as owner oi �he propeny. am excNsively contrac�ing wiN licensed conVaciors lo conslmct ��e pmlec� (Sec�ion 7044, Business 8 1. 0 Q ,� 5
and Pmlessions CoOe: The Conirac�ors' S�a�e License Law tloes not apPry �o an owner of pmpehy who �uiltls or impmves �hereon
andwhoconlrac�51or5uc�prolec�5wi�hacanlraclor�5�licen5epur5uam�o��eComrac�ors'SIa�eLicenSeLaw�.lamaware �..�.*}.�.�*j(.*aE**+,E{(.�?�#?!�#ifiEiE#afdEiF±FiF�1E�EiEif�lEiEie3E�lfiElfiFif#F�fiE#ie#H�ifdF�!f;F1E3f-N�#lfif###�3E3kiFiEiEfE3Fif#„�3fr#1E:;�#iE3EiE
�ha� pmaf o� meir Worker's Compensation insurance shou�U be providea to me. ' 1 N D I iJ I U U A L t E fi 3 R t. A x 17 0 T^I ?�
� I am exempi untler Semion: B. 8 P. C.
m�misreason. iypp, Q:Y D E S C R 1 P T'1 O N U�IIT CUST TOTAL COS'T
�ate: Owner:
ao hereby cenny iha� � am aware o� anA untlersiand �he requiremen�s o� Ca�i�omia Hea�m ane Sa�ery Caee Sections 25505, 25533, and $ F� 5 6 0 0 RERUUF B Y VP.I.jJi', RES IL ENT IAi NO Z ONE _. 0 0 5� 6 � Q, � �
25534 antl Ihzi I or any fulure bwltlmg accupant willlwtll nal (circle one) need to comply wilh said 5�aie codes and the requiremen�s for a � , � END �F t' G t. J
permn �or conslmciion or modification Imm ihe Air Ouali�y Managemen� Dis�rici. ResiOeniial cons�mc�ion applica�ions are exemp� imm �
��ese pravisions.
�ate. ApplicanP.
I hereby cerlity Ihal I have ma0lhis applica�ion and s1aV
ortlinances znd s�ate laws rela�ing io buil�ing conslmction
pmperiy for inspeclion purposes.
i ��J
Da�e'. /� - /� Signati .
�river's License or Social Security p: �
164b06 White—Builtling', Green— ode
ma�ion is correct. I agree to comply wi�h all citV and coun�y
representalives ol t�is ciry �a en�er upon �he above-mentioned
Canary—ApPlicant; Pink—Rpvenue; Goldenraa—Assessor
EXPIRED
tncomplete lrsspeCtionS
� c.a.� � _ .
�
Oi 00138875-0013E87b T�]T EI.56
DATE: 05/il/93 TItIE: 16:4�
r
— � --
CO��STRUCTIOR� AND PLANNING
F,P?RDV.OLS Permit;,�_
1.� T�ml,�'ary EleCtncal Ser�:,� �:ot Fole
% So�! P�nr Undrgrnd,
___-_-___._._— � _—
y, ._
i= EtCr c� Co�du ; U,�,IrtY-USfrgrnd.
i �i Clec'nGil Candu.t�U�'J��r.�d.
5. SL�re, '�-ri+inlor[.:mc��t
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i_
I` 1 U� F71PiCt� i E OF QCCUPANCY
I�! Oatc
L� _— -_ - _
POOL-e A ------�-----
Date Inspector n�ppROVALS 'ermit ;� ' I Cate
52. Pccl d: Equ��or^cnt LocaY.un �—
s �
� i _—
I 53. S�eef Re�nforcemer.t --
L_
5;. FormS �
��I I 55. ElectrieaiBondmg �
0
�
�InspectOr I
i, _ �
r__
SFi. Rough PIum6�rg & P��,sure Test �
57. APPROVAI. Tp COVFR�GU�\�TE � �
�__'_
- � _._ _ I •
� �56. Elcctrical Condu.t�Undrgmd. i r . '�
— r--�-- --j
' 59. Gas Pipe, C� UnUrgmd-, Tes[ ,__ _- � ��
--'— — � - - -+--�;- -- �
, � ' '
B0. E3ar.kwash I!nes, P�TraP. �-' Unc�p-rd „ '
� 61. FlPPROVAL Tp DECK I I
- -- ; - --�--- `�i -I
62. Bad:c:asn & Recr��„�r.F�nal �
-- -- ---- -- - - I- - =� - -�
_ 6� Hester&Vent�=mal'-----�------ �" --�
I _�-_,
_ I 64. Piur�hing SV,!em � F�n'1 _'— _ � � ,�' ,
05. E�ect-�ca Fi�,a! , � �. �
- -�- � -
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�.�--- --- -- - - - ------ - �'- - - - ' - - -
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� � 79. FIi.yL I\�PECTION !
� T^ __ _ __ _ _ � _ _ '
L`V FO�U �.[ii �IFI�'/AT: �.ripL�•_Li I � '
_.'_ __'�—___ _" -__ _.__ __.___ _ _ i ._�__ . __.._ ,
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OWNER ��q DEVFinPMENT DATE 5-1-(�
JOB ADDRE55 ZZkS nlat�ama f�irrlR+ BUILDING PERMIT N0. �0115
No. -
GAS
WATER
PROP. SWR. LINE � HOOSE CON. �/J'
SPRINK�ING SYSTEM
MISCELLANEOUS
ROUGM HEATING ANO AIR CON�ITIONING
TEMPORARV SERVICE OR POLE
UNDERGROUND � POWER �
ROUGH WIRING
TRENCHES FORMS GC� STEEL FEINF.
BOND BEAM � STEEL REINFORCE U
SHEATHING
FRAME AND FLASHING
LATNING - IN OUT
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUM6ING, FINAL AN� GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
CPFfltl FF(1111RGMFNTi /
SUBCONTRACTOR
r
�'� 4R � 30 I I 5
3
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING �-. .� ,. _ i+n i7 /J�
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DWNER Hermes �V. (�i0•
MAIL '"'�_ ' '_.. _.
TEL.
CITV SHlI't8. AIIB NO. �}J�7O�'
LENDER�ION United Stetes IQational Bank
BRANCH 1;�O�Broadwey Avenue
ADDRE55 'p'gp j}jg�0• CflllfOi7119
��p�m�� K. Dorius No� 675-116•
ADDRESS 2712 E. Coast Hwy. Corona D P•i
CONTRACTOR QWT18!
ADDRESS
TEL.
CITV NO.
LIC. No. 25256o LI4 NO.
SIZE NOW ON LOT O
OF LOT ].00 X FO I
USE OF
EXISTING BLDG.
SIZE OF NO. OF
NEW BLOG. �LZOO 9. FtROOMS STOFIES 2
EXTERIOR WALL ROOF C OTIlPO OT
COVERING St.UCCO COVERING WOOfI
USE OF BUILDING AND WORK TO BE PERFORMED
l,l
I hereby acknowletlge that I have reatl this application and state
that ffie above information is correct and agree to comply with
all laws regulating builtling consttuction, and I shall not employ
any person in vialation of the workman's compensation laws of
the State ot Calitornia.
I hereby certify that 1 am properly licensed as a conttactor untler
the State of California Business and Protessians Cotle, Divisicn 3,
Chapter 9, antl that such licenses are In full torce and eftect, o`I
am exempt trom the provisions of the State of California Business
antl Professions Cotle, Division 3, Ch � 9.
Signatura of
Pe�mittee
Authorizetl Agent
^PR 7_4-69PAIo�01309'� *�: * 152.25
CMSA
APPLICATION FOR BUILDING PERMIT
RECEIV BY DATE R)E^CEIVED DATE ISSUED
� /� �O'd'�o s ��li
PERMIT NO.
A.P. NO. (1 I
BUILDING V V t
ADDRESS� S
TRACT�(p�� LOT� BLOCK
EW ADD AL P
OWNER
16% '7. ��n ..i 1� VALUE n/J OT �
FIRE �
ZONE `
APPROVED
I•Ti
YARDS APPROVE�
MAIN BUILDING
FROM GL STgBET)
BET
VAR. #
C.U.P.�
APPROVED
_L.L GROUP—L�
DATE
��
USE OF NE�
BUILDING Q��a
VARDSAPPROVED
BET. MAIN &
ACC65. BLD6S.
DATE
—b APPROVED S —�(J1
'�f% �eTF � �//-6
EiOLD FOR
�[' (/ m
SQ. FT. J`JO7 0
THE AMOUNTSHOWN UNDER VALUATION IS FOR j
THE PURP�E OF ESTABLISHING A PERMIT FEE ONLV: Q
L T ON j
(�D�B EFMIT FEE $ IO/ � S j
PLAN CHECK $ �D • /� E
1^ '�` O
TOTAL FEE $ IJ/� • C�U LL
OWNER'
JOB ADDRESS
aGENERAL C01
CyAP No.139-5
�INSPECTIONS
�SOIL
,� cns
� WATER
ROIIGH PLUMBINI
PROP. SWR. LINI
MISCELLANEOUS
ROUGH NEATING ANO AIR CONOITIONING
UNDERGROUNO �J POWER U
ROUGH WIRIN6
TRENCHES FORMS � STEELI
FLOOR SVSTEM '
BOND BEAM � STEEL REINFORCE
SNEATHING
FRAME ANO FLASHING -
LATHING - IN OUT ❑
PLASTER,BFOWN COAT
STRI1CTlIRAL. FINAL
ENT., REFRIG. ANO q.C., F
FINAL ANO GAS TEST I-I
TRACT
DATE 3-29-76
BUILDING PERMIT N0. 41473
FIRE ZONE VALUE S 1
TYPE V GROUP I
SUBCONTRACTOR
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'� �.COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BVILDING �3 %�
ADDRESS
OWNER �U �yE -� N %H'IS
MAIL ����
AODRESS
TEL.
CITY / No. 'yv7/
CANSTflUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT TEL.
ADDRESS
CONTRACTOR � w NL r(
ADDRESS 5 /J M L
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
SI2E I NO.OF BLDGS.
OF LOT NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
i.ri� r.L/ �1�L �
FDLaCFS
��;n?o-7�P�1000151'I:• ����1Q.5G
APPLICATION FOR STRUCTURAL PERMIT
BUILDING
ADDfiESS
FIRE
ZONE
APPROVED
� �•� � r � �
VAROSAPPROVED
VAR. �
C.U.P.aW
7 � L
. �� PERMIT NO.
.QL,4�,4H�1 �
LOV BLOCK
� �!f/�iS
>�/vAWE `�ov
�/r/ $
GROUP
DATE� � �
USE OF NE
BUILDING
YAROSAPP OVED
ACCESSORV UILDINC
FT.
F .
FT. ,/
BET. MAIN & /�
DATE �
APPROVED
---'� _�q=
I hereby acknowletlge Shat i have �eatl ihis applicallon and state '^
n
thai the above info�mation ia cotrect and agrea to comply with m
ail laws regulating builtl(ng eonsirucNon, and I shell not employ �
any person in vlolatlon of the wo�kman's compensation laws of �
the Stete of Californie. -
I hereby certify that I am properly Iicensad as a contractor untler SQ. FT, w
the State of California Business end Professions Code, Divisiori 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and ihat such licenses a�e In tull force antl effeei, or i THE PURPOSE OF ESTABLISMING A PERMIT FEE ONLV:
am exempt from the provisions of tha State of Callfornle Business y
antl Professions Code, Division 3, Cheptar 9. VALUATION PERMIT FEE O Q m
PLAN CHECK $ �.� ^�
SlBneture /�� �
Permitt _ /N`v� �� ��Ci $ 1�D0 TAX $ LL
� T� —�.. O u
Authorizatl Agent TOTAL PAI D E �
AP No. I59-581—"LO LOT
INSPECTIONS
SOIL
GAS �
WATER
AOUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AN� AIR CON�ITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUN� � POWE0. �
0.0UGM WIRING
TRENCNES � FORMS STEEL RE
FLOOR SYSTEM
BON� BEAM � STEEL REINFORCE �
SHEATHING
FftAME ANO FLASHIN6 �
LATMING - IN ❑ OOT n
PLASTER,BROWN COAT
STRUCTURAL, FINAL
HEATING. VENT., REFRIG. AND A.C., FII
PLUMBING. FINAL ANO GFS TEST ❑
ELECTRIC, FINAL
BWLOING, FINAL
DATE
FIRE ZONE
SUBCONTRACTOR
�, .
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.: .:
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
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OWNER Irf �,/�/S
MAIL �
AODRESS
CITV �S� �"I�S� NO
CONSTRUC710N
BRANCH
ADDRESS
ARCHITECT TEL.
ADORESS
CONTRACTOF ��r(�1� �f )D(/�
ADDRESS/71�� �yb/6�O��jf�,j�
TEL.
CITV � (�� NO.
STATE CITV
LIC. NO.[;- �S.¢.�54' LIC. NO.
SIZE INO.OF LC
oF LOT NOW ON L(
USE OF
EXISfING BIDG.
Separate permits are required for
electric, plumbing 9nd heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
FE818-76�a��00 671� *��`*54.50
APPLICATION FOR STRUCTURAL PERMIT
BUI�DING
�/
OWNER/—
APPROVED
ZO NO.OF
PLANS �
VAFDS APPROVED
MAIN BUILDING
(FROM C/L �TREETI/
LOT- - BLOCK
M
� �A`�$ Sa
O
GROUP
DATE �/�X I
USE OF N
BUILDIN -
YARDSAPPRO ED
ACCESSORV BUILDI
� 7/
S E F FT.
J
L. SIDE T. FT.
� ii
REAR FTI FT.
DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
VARa� DATE
C.U.P.# APPROVED
APPROVED/ JA J/� � ..,.r� �—I P-
I hareby acknowledee that I ha�a reatl this application entl state �
that ihe above infarmation is c.orrect and ag�ee to comply with m
all laws regulaiing builtling construction, antl I shell not employ �
any person in violation of the workman's compensatian laws of �
the State of Californie. � �� •
I he�eby certify that I am propR�ly licensetl as a contractor under SQ. FT. n
the State of California Business and Protessions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and thet such IicansBs are in tull torce antl affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE NLY: �
am exempt trom the provisions af the Stete ot California Business VAlUAT10N PERMIT FEE $ A(7 d
antl Professions Code, Division 3, Chapter 9. in
�/ m
Signature of ) �7/ �e J� PLAN CHECK S � D(� o
Permittae �%/.� K��«`� $ l-1 �QO TAX $ v �
J I V
Autho�ized ABent TOTAL PAID $ d