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Home My WebLink About2969 ANDROS ST - Building Permits�STu Mgy, . � , > .. : J °o��A' CITY OF COSTA MESA BlIILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.costamesaca.00v FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE ELEC APN: 13922329 JOB ADQRESS: 2969 ANDROS ST CM Vicinity: PERMIT NUMBER: E12-00121 � STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 07/09/2012 RMD SCOPE OF WORK:ELECTRICAL PERMIT FOR THE WSTALLATION OF NEW 3 TON A/C UNIT.-REF#:'M12-00115 NOTE: FINA� APPROVAL OF PERMIT SHALL NOT BE QtANTED UNTIL ACCESS TO DWELLING-UNITISI IS PROVIDED FOR VERIFICATION OF SMOKE qND CARBON MONOXIDE ALARMS BY THE CITY INSPECTOR. SEE ATTACHMENT W/INSPECTION CARD (RESDENTIAL ONLYI OWNER: REDENBAUGH, THOMAS J� . Address: 2969 ANDROS ST Unit: ��. PHONE: 714-557-3705 - -� -- City/State/Zip: COSTA MESA, CA � APPLICANT: DOMINGUEZ, ROY �� , � PHONE: 714-901-0500 . �� Address: Unit: . ', . City/State/Zip: - . . CONTRAC70R: A PLUS HEA7ING AND AIR CONDITION Address: 11330 KNOTT STUnit: PHONE: 714-901-0500 CitylState: GARDEN GROVE, CA ZipCode: 92841 ELECTRICqL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $78.00 Reinspection Fee $0.00 TOTAL FE�S $78.00 License No. 763154 CELL: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related re9ulations. (Ord. No. 92-28, § 1, 12-21-92) / EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and Fnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE/. INSPEC710NTYPE Q[iE IN7171RL �a INSPEGiIONTYPE �j[ IN11(IpL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ��/��, �,p�� 200 Final Re-Roof 210 Final Electrical -(�� . 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 FinalSite 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: � � � I Oereby aKrm under penalty of perjury one of ihe (ollowing declara�ions: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by sec�ion 3700 of the Labor Code, for the pertormance of the work for which this permit is issuetl. ❑ I have and will maintain vrorkers' compensation insurance, as required by section 3700 of the Labor Cotle, (or the perfortnance of Ihe vrork (or which this permit is issuetl. My workers' compensation Insurance carrier and policy number are: / Carrier ��C�( P Pi� /1 � � �—�(TiusseclronneN�We(etlA epemMi val� ,a�to ^untlreJtlollars(5100�wMss.) r-,-�. � �� ) P�olicy'Number: ❑ I certify that in the peAormance of the work for which this permi� is issued, I shall not employ any person in any manner so as to become subject to ihe workers' compensation laws of California, and agree that if I should � become subjec[ [c the workers' compensation provisions of Seclion 3700 of or Cotl \ shall forihwith comply with lhese provisions. � 9-� � �¢anf $i9naWre D^at�,yR^ WARNING: FAILURE TO SECURE WORKERS' 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 aKrm that 1 am licensed under pmvisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in /full� force and effec . Lic�#� ..` .cix. l r"Class`ft"�� l�� " y�,�-,... Cont s SignaWre Dete � ��„`4^�✓�`�� w-�'a CONSTRU TION LENDING AGENCY: ❑ I hereby a(firm lhat there is a wnstruction lending agency for ihe perfortnance of the vrork for which this pertnit is issued. (Sec. 309�, Civil Code). Lenders Name: Lender's Address: SiqnaWre OW NER-BUILDER DECLARATIONS: I hereby affrm that untler penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pmfessions Code: Any ciry or counry which requires a permit to cons�rucl, alter, improve, demolish, or repair any strucWre, prior to its issuance, also requires ihe applicant for such permit to fle a signed statement that he or she is licensed pursuant to the provisions o( Ihe Contractors License Law (Chapter 9(commencing wiN Section 7000) of Division 3 of ihe Business and Professions Code) or that he or she is exempt Ihere(rom and lhe basis for the alleged exemption. Any violation of Section 7037.5 by any applicant (or a permit subjects the applicant to a civil penalty of not more than fve hundred dollars ($500).): ❑ I, as owner o( lhe property, or my employees with wages as their sole compensalion, WILL DO THE WORK, and the structure is not intended or oHered for sale (Sec. 7044,.Business and Professions Code: The Contractors License Law does not apply to an owner of properry who builds or improves ihereon, and who does such work himself or herself or ihrough his or her own employees, pmvided Ihat such improvements are not intended or oftered for sale. If, however, the building or improvemenl is sold within one year of completion, the owner-builder will have ihe burden of proving that he or she did not build or improve tor purpose of sale.). ❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct [he projeC� (Sec. 7044, Busine55 and Professions Code: The contractors License Law does not appty to an owner of property who builds or improves thereon, antl who wntracts for such project with a contractor(s) license pursuant to the Contractors License Lavrs.). ❑ I am exempt untlersec. Business and Pmfessions Code (or this reason: Owner ID verifed by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verifcation o( Ownership by (rype of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavalion five (5) or more (eet in depth into which a person is required to descentl, will be made in conneciion with work authonzetl by lhis pertniL and [hat no building slrucWre, scaHolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) (eet hi9h. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safery, as noted above, unless such person has a permit lo do such work (rom the division. Applicanfs Signa�ure Da�e Division of Intlustrial Safety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neetl to fle and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safery Code requires, with some exceptions, tha[ a Business Plan be fled with the Costa Mesa Fire Department by every business which has abany one time during a reported year a quantity of hazardous matedals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic (eet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to fle a registration torm for acutery hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some excep[ions, requires registration with the Costa Mesa Fire Department by each business which at any one lime has on hand a quantity o( acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 wbic feel of compressed gas at standard temperaWre and pressure). 3. Does or will the applican4 or present or fuWre building occupant need to prepare an RMPP (Rfsk Management and Prevention Program for acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the Califomia Healih and Safery Code provides lhat lhe Costa Mesa Fire Department may require the preparation, certifcation and fling with the Fire Depariment of an RMPP by businesses which are required to register acutely hazardous malerials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied wit�? ❑ Yes ❑ No 5. Does or will the applicant or present or future builtling occupant require for the work which is the subject of ihis application a permit for such construction or modifcation from the South Coast Air �ualiry Management District or from any olher air pollution control tlistrict or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Code requires that Ihe requested infortnation be fumished on applications for non-residential building pertnits). 6. Will any part of the facility to be constmc�ed under this permit be within 1000 feet from the outer boundaries o( a school? ❑ Yes ❑ No (If "yes", ihe faciliry must meet ihe requirement of Sections 25534 antl 42303 of �he California Health and Safety Code). 7. If a permit from the South Coast Air Qualiry Management District or other air polWtion control district or agency is required for Ihe work which is the subject of ihis appliwtion, have all of the disclosures prescribed by Califomia Healih and Safery Code Seciion 42303 been made? ❑ Yes ❑ No 8. pf "yes", attach certificate of compliance from the appropriate air pollution control officer). . CERTIFICATE OF COMPLIANCE: 1 certi(y that under penalty of perjury lhe intormation given above is correcL I agree to compty with all state laws and ciry ordinances regarding Hazardous Matenals and Emissions. Signature Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certiry under penalry of peryury [hat I have reatl lhis application antl state that the information given is wrrect. I agree to comDly with all state laws and city ortlinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building au�horized by Ihis permit until final inspection. naNre,p_i \legal Owner(s) Date Signalure Oate � \ �.b��' 305]<6(3/0]) �� 7 � �_"3 -� A onze qpp� �,p! Dale p5�p'WF 9 o ! � . jo, % u 6` J�� CITY OF COSTA MESA � eu��ni�v'v�s�oN 77 FAIR DRNE, COSTA MESA, CA 92626 • p14) 754-5273 • Paz (714) 754-4856 • www.costamesaw.aov FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE MECH APN: 13922329 PERMIT NUMBER: M12-00115 ✓ STATUS: ISSUED DATE ISSUED: 07/09I2012 ISSUED BY: RMD JOB ADDRESS: 2969 ANDROS ST CM Suite/Unit: , Vicinity: � - - SQ. FT: 0 � . . - � SCOPE OF WORK:MECHANICAL PERMIT,TO INSTALL A NEW A/C UNIT AND REPLAGE AN EXISTING FAU LOCATED IN HALLWAY CLOSET. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. REF#: E12-00121 OWNER: REpENBAUGH, THOMAS J� � Address 2969 ANDROS ST Unit: -- PHONE: DQMINGUEZ; ROY � . �� City/State/Zip: — COSTA MESA, CA APPLICANT: DOMINGUEZ, ROY - - Address: Unit: - - -� . . PHONE: 714-901-0500 -� � - City/State/zZip: -, - - - - CONTRACTOR: A PLUS HEATING AND AIR CONDITION License No. 763154 Address: 11330 KNOTT STUnit: PHONE: 7'14-901-0500 CitylState: GARDEN GROVE, CA ZipCode: 92841 - CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: . $53.10 PLAN CHECK FEE: $0.00 INVEST�GATION FEE: , � � $0:00- � REINSPECTION FEE: � - - $0.00 �_ TOTAL FEES: $53.10 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIR4TION: P�RMIT EXPIRES 160 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. CO�Et. INSPEGTIONTYPE ORTE, INTITIA CO�E% INSPELTIONTYPE � N A 1616 Fixed System Final Fire Prevention 206 Final Mechanical • e2d• e20/ EI .l�y � 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 final Electrical 201 Final Bbck/Retaimng Wall 212 Final Fire Prevenlion 202 ' Final Factory Pire Place 220 Final Planning Approval 203 Final Sign 222 Final Sile . 204 Final Demolition 250 Final 8uilding/Occupancy WORKERS' COMPENSATION DEC�qFtqT10� �� vvner iD�.verifetl by drive� se. ❑ Yes ❑ No I hereby affirm under penalry of perjury one of the following declarations: , )river's License No. Expires: ❑ I have and will maintain a certifcate o( consent to self-Insure for work: �.'� Verifcation of Ownership by (rype o( tlocument, i.e. - property �ax bill or tleetl): compensation, as provided for by Section 3700 of the Labor Cotle, for tne- pedormance of the work for which this permit is issued. � � ❑ I have and vrill maintain workerg' wmpensation insurance, as required by section 3700 of Ihe Labor Cotle, for the perfortnance of the vrork for which this DIVISION OF INDUS7RIAL SAFETY PERMI7 CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy � I hereby ceAify that no excavation five (5) or more feet in depih into which a number are: person is required to descend, will be matle in cpnneclion wi�h vrork aulhorized � ,� n 1� by this pertnit, and thal no building sirucWre, scaHolding, (alsevrork, or demolition �1e�� -F' � L � or dismantling thereof, will be more than thirry-six (36) (eet high. (Chap. 32, Grp ��sedionneedno! mmpleteddfhepermif�valucbataiehurMmtltldlars(5100)wless.) �1 � 2, AA 2, Sec. 341, Title 8, Califomia Administralive Code). �WlcyNumbec L%�� ` � As owner-builder,� I will not employ anyone to do work which would ❑ I certify ihat in the pertormance of the work for which this permit is require a permit fmm ihe Division of Indusirial Safety, as noled above. unless issued, I shall nol employ any person in any manner so as to 6ewme subject such person has a permit lo do such work fmm [he division. to ihe workers' compensation laws of Califomia, and agree [hat if I should � � become su�ject to lhe workers' compensation provisions of Section 3700 of �P�;�,nrs s�¢naw.a oaie the L e, I sh 1 forthwith comply with these provisions. Division of Indus�rial Safety Permit Number: � �Apy c2n gnaWre I .De[ �i V' WARNING: FAI RE TO SECUR RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL JECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP Tp 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 DECLqRqTION: I hereby affrtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) o( Division 3 of the Business and Professions Cotle, and my license is in full force and effect. _ n GONSTRUCTION LENDING AGENCY: ❑ 1 hereby afirtn Iha� lhere is a construction lending agency for the pedormance o( the vrork for which thi8 permit is issued. (Sec. 3097, Civil Code). Lenders Name: _ Lender's Address: SignaWre Dale OWNER-BUILDER DECLARATIONS: I hereby affirm that untler penalry of perjury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any sUucture, prior �o its issuance, also requires ihe applican[ for such permit to fle a signed statement that he or she is licensed pursuant to ihe provisions of ihe Coniractors License Law (Chapter 9(commencing with Section 7000) o( Division 3 0! the Business and Professions Code) or Ihat he or she is exempt iherefrom and the basis for lhe allegetl exemption. Any violation of Section 7031.5 6y any applicant for a permit subjecis the applicant to a civil penalty of not more than fve hundred tlollars ($500).): ❑ I, as owner of Ihe property, or my employees with wages as iheir sole wmpensation, WILL DO THE WORK, and ihe slruc[ure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offeretl for sale. If, however, the building or improvement is sold wilhin one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of saleJ. ❑ I, as owner of the properry, am EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo con;truct ihe project (Sec. 7044, Business antl Professions Code: The contractors license Law does not apply to an owner of property who builds or improves thereon, and who wntracts for such pmject with a contractor(s) license pursuant m the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code (or ihis reason: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant need to fle and certify a Business Plan for emergency response to release or threa[ened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel o( compressed gas al standard temperaWre and pressure). 2. Does or will the applicant or present or fuNre builtling occupant need to fle a registration form for acutety hazartlous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safery Code, with some exceplions, requires registration with the Costa Mesa Fire Department by each business which al any one lime has on hand a quantity of aculely hazardous materials equal lo or greater than a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard temperaWre and pressure). 3. Does or will the applicant or presenl or fulure building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safery Code provides that the Costa Mesa Fire Depariment may require the preparation, certiflcation and fling with the Fire Deparlment of an RMPP by businesses which are required to register acutely hazardous malerials with the Fire Department. 4. It an RMPP is presenpy required, has Section 25534 of the California Healih and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does orwill lhe applicant or present orfuWre building occupantrequire tor the work which is ihe subject o( �his application a permit for such constmction or modification from lhe Soulh Coasl Air �ualiry Management Districl or from any other air pollulion control disUict or agency? ❑ Yes ❑ No (Section 65850.2 of Ihe Califomia Govemment Code requires ihat Ihe requested intortnation be fumished on applications !or non-25idential building pertnits). 6. Will any part of the faciliry to be constmcted under this permit be within 1000 feel fmm ihe outer boundaries of a school? ❑ Yes ❑ No Qf "yes', the (aciliry musi meet the requirement of Sections 25534 and 42303 of �he Califomia Health ana Safety Code). 7. If a permit from the South Coast Air Qualiry Management District or other air pollution control district or agency is requiretl for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safery Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certifcate of compliance from ihe appropriate air pollution control offcer). � CERTIFICATE OF COMPLIANCE: I ceAiry that under penalty of perjury the information given above is correcL I agree to comply with all state laws and ciry ordinances regarding Hazardous Matenals and Emissions. Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury ihal I have read this application and state that the intormation given is correcL I agree to comply with all state laws and city ordinances relating to building constmction, and authorize representatives ot the City of Costa Mesa to enter upon the above-described pmperty for inspection purposes. I agree not to occupy or allow occupancy of any building authodzed by this permit until final inspeclion. Signal / Legal pwner(s) Oata,� �� Signamre Data . �l �.L_--- 305]-06 (310]) �� '�� r �,,,� -� O'f iborizedAppliCdnl r9B{e ' �� APPROVAL City of Costa Mesa Planning Div. Subject to Building Division Regs. Any Revision must be approved. Re uired Pri f to Buildin Final: OYES �I�" Zoning Inspection ❑YES pN0 Traffic/ Park Fees BY�� Date: / I I //p� '/ ! ,C-. . _ . -,, -�-�-'%�b�� ''��. ./ •)�- -.��,..�n �� .�-.-- � �- `T � I�i � �� S �: -� �'Vl I'2 - � � �S ��J dl��t. D�� I �'�" 1�--� — /� c u ��'�'" ;{,,,;�� r i t F�+ C W 6. Q m ti F G v� F G J a > � � � w n. � �r 4 z W 3 ��967 , COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applican[ [o Fill in Completely — Use Ink Only BUILDING r_�p'�� u��S ADOFESS ��'.� OWNER / OM (�EIJFIV B�UGIF MAIL C� NC ADDRESS J CITV ,L C� ) CANSTRUCTION BRANCH ADDRESS ARCHITECT TEL. NO. TEL. ADDRESS TEL. CITY NO. STATE CITV �IC. NO. LIC. NO. SIZE I NO.OF BLDCS. OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED O',y,ii!!.�_ R.nrle /=.��Ev= . d�� Rc / L-/U, I hereby atknowled80 thet 1 have read this applicatiOn and rtate that the above info�mation is correct entl agree to comply with all laws raguleting builtling construction, and I shell not amploy any parson in viqlation of the workmen's compensatian laws of the State of Califbrnla. I hereby certlfy that I am propeNy Iicansatl as a contractor untler the State of Californle Business antl Professions Code, Divlsion 3, Chapter 9, antl ihat such licanses ere in full torce antl effect, or I em ezempt from the p�ovisions ot the Stete ot Callfornia Business end Professions Cnde, Division 3, Chapter 9. . Sienat�reof �� /7��/3�G�� Permlttee ��' AuthorizetlABant �j�.�e IY6i� . Naio NAY 72-77cnsn�� 58`Ln *=0**�.50 APPI:ICATION FOR STRUCTURAL PERMIT ECEIV BY DATE�REC V O DA E ISSUEC , _s-.-/�-�� _��.�_7 A.P. NO ' BUILDING ADDRESS / FIRE /� ZONE T PE Y APPROVE� DATE �'1 � / L' �/ NO.OF USE OF NE ! / PIANS BUILOING VARDS APPpOVED VARDS APPROVED MAIN BUILDING ACCESSORV BUILOII DI5TANCE BET. I BET. MAIN & MAIN BLDGS. ACCESS. BLO VAR:#` DATE N n m i : SQ, FT. . � t�v THE AMOUNTSHOWN UNDER VALUATION IS FOR m THE PUfiPOSE OF ESTABLISNING A PERMIT FEE ONLV: � VALVATION PERMITFEE S �O a N n �� PLAN CHECK $ �� 0 $ t�00 TAx a , p � y U TOTAL PAID $ p _ �j�J OWNER g��gpUGH, TOM DATE 5 JOB ADDRESS Qq(q pndros Stree+ BUILDING $L._ ` GAS WATER ROUGH PLIIMBING PROP. $WR. LINE � HOUSE.CON. SPRINKLING SVSTEM MISCELLANEOUS ROlIGH HERTING AN� �IN CONOITIONING- TEMPOR�FY SERVICE OR POLE UNOERGROUNO � POWEN � ROUGH WIRING TfiENCMES FORM STEEL RE FLOOR SYSTEM BOND BEAM � �STEEL REINFONCE SHERTNIN6 FRAME AND FLASHING LRTXING — IN � OOT n P� �STER, BROWN COAT TURAL, FINAL .IG, VENT., FEFRIG. AND A.C., FI! PLUMBING. FINAL AND GAS TES� ❑ ELECTRIC. FINAL BUILOING. FINFI cacnai - ecnuiwcucun �Zi7:l SUBCONTRACTOR �j S ��r% "}, � COSTA MESA BUILDING-SAFE7Y DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA fOR APPL/CANT TO F/LL /N COMPIfTECY � - TYPE OR PRINT � ADDRE'SS G'v9 A��S St• COSTA MESA, CALIFORNIA c�rv�lboa Island ARCHITECT ' OR ENGINEER , E Fs � � ._ �:J �. �i'J+ b. `✓ _�cd �Y - �7-.�� i (�.i�•��C r�-�" (� i �iGr�1.�/�L iJLi •, . 1.'��,1� �ii ll�:J::� ��CJ!�1 APPLICATION FOR PERMIT BUILDING FOR OFF/CE USf ON[Y � rseceirr no. � pgaM}r � RECEIVEO.BY %��r • TN�or3-422o BU�LDING ADDRE55 �x 65�Balboa Island�Calif. LEGRL - LOT � 3 DESCRIPTION NO. �� BLOCK ITRACI�j A.P. NO. SIZE .7000 I NO.OF 9LDG3. o OF LOT How orv �oi USE OF EXISTING BLOG. SEfBFCK LINE FROM cerureR oF siAe� SO REAR YARD 3� SIDE VARO ILEFT. S IRIGHT S DESCRIPTION OF WpRK NEW I X II ALTERATION I II AOOITION I SIZ'EDING�[^S/�.�Q ROOMS >t /4 EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE F � . � �G o � 1 NEREBY ALKNOWLE�GE THAT 1 HAVE NEAD THIS APPLICATION AND STATE THAT THE ABOVE IS COFRECT qND qGfiEE TO COM- PLY'WITH FLl CITY ORDINANCES AND STATE LAWS REGULATINQ BUILOING CONSTFUCTION. SIGNATU�� I�E HOM�S�ZNC� PERM�E ` � � FIRE �— APPROVED GOSTA MESA. CALIFORNIA TYPE Y GROUPcf'Y ZONING � NO. OF I USE OF�R. PLqNS y- BUILDING (CENTER IINE ST.� REAR THE AMOUNT SHOWN UNDER VALUAT�ON IS FOR THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION ' PERMIT FEE $ �S �� / r p�pN CHECK $ � /iS0 $ - TOTAL FEE $ � ��.��