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Home My WebLink About954 BEGONIA AVE - Building Permits; � CITY OF COSTA MESA BlIILDING DIVISION 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci: costa-mesa.ca.us ' FOR INSPECTIONS CALL: (714) 754-5626 . . PERMIT NUMBER: E08-00153 PERMIT TYPE ELEC STATUS: ISSUED APN: 41221405 DATE ISSUED: 04/2912008 �. ISSUED BY: JOB ADDRESS: 954 BEGONIA AV CM , SuitelUnrt �- Vicinity: SCOPE OF WORK: UPGRADE EXISTING 100 AMPf PANEL�TO 200 AMP. PANEL IN `SAMELOCATION .?;..:: �'10l23/08 - PERMIT SUPPL FOR �EL�ECT. JUNCTION BOX IN ATTIC SPACE.S - .,,, OWNER: USSMANN; �LISA A " � - � Address: .. � .954 BEGONIA'AVE Unit:- -� PHONE: .,� � � � �City/State/Zip: .--COSTA MESA, CA. ' -;�;.. APPLICANT: USSMANN�;LISAA �: Address: 954�BEGONIAAVE��Unit � ' PHONE: 7'I4 5463384 , "' � , � �,.. �� . .... -, ,,,. . � Cit /State/zZip: - COSTA MESA, CA; �"- � ��' ,. ; ,.. �� . Y . . �... , ... CONTRACTOR: License No. Address: . Unit'�"'_ � ' ... � PHONE: - � �- � ' ' City/State: � � _' �� ZipCode". . � . � - - �CELL: - -i'�c . -. . . � ' �, : ... -" � ; � .` ��.; .�.?. _ ; ...._ � .. � .' �`: ELECTRICAL PERMIT FEES :' Electrical Plan Check Fee: = .; � ' , $0.00 . ,.. Electrical Permit Fee: $72 20 Reinspection Fee $0.00 , TOTAL FEES � - $7g'.70�'� � �� . a',: � NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under.California statutes and related regulations. (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 lo 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 final approval will result in the expiration of this permit. COUEt, INSPECTIONTYPE 1678 Fixed System Final Fire Prevention 7268 Pool SDa Final 200 Final Re-Roof 201 Final0lock/Retaining Wall 202 Final Factory Fire Place 203 FinalSign 204 Final Demoliiion OATE INi1TIpL5 COOE� INSPELPONTYVE 206 Final Mechanical 208 Final Plumbing 210 Final Electriwl 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy o� iNnnn�s ��i. �%�' WORKERS' COMPENSATION DECLARATON: � � . - I hereby aRrm un0er penalry of pe�ury one of [he foilowing declarations: - ❑ I have and will maintain a ceRificate of consent to self-Insure (or workers" compensation, as provided for by section 3700 of the labor Code, for the peAormance of the vrork for which this permit is issued. � � I have and will maintain woAcers' compensation insurance, as required by section 3700 of the Labor Cotle, fw the peRormance of the Hork for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: (This secfwr need irol �e mmp'ete0 d Ihe permd is valuetl at one hunprtd �llars (81C0) a less ) Policy Number: ❑ I certify that in lhe pertormance of the vrork for which this permit is issued, I shall no[ employ any person in any manner so as to become subject to the vrorkers' compensation laws o( Califomia, and agree that if I should become subjed ro the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Appl�canl's SgnaWre Oale WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALI 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, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions o� Chapter 9(commencing wilh Seclion 7000) ot Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class # CaNrador's SignaWre CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm [hat there is a cons[ruction lending agency for Ihe peAortnance of the �wrk fa which this permit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaNre Dale OWNER-BUILOER DECLARATIONS: I hereby affrm that under penalry of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the tollowing reason (Sea 7031.5, Business and Professions Code: Any city or county which requires a permit to constmct, alter, improve, demolish, or repair any stmcNre, pnor ro its is5uance, also requires the applican[ for such permit [o file a signed stalement that he or she is licensed pursuant m the provisions of the Contracrors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pro(essions Code) or thal he or she is exempl therefrom and the basis for ihe alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjec[s the appliwnt to a civil penalty o/ not more ihan fiv huntlretl tlollars ($500).): I, as owner of the property, or my employees with vrages as their sole C mpensation, WILL DO THE WORK, and the structure is not intended or oftered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply to an owner o( property who builds or improves thereon, and who does such work himself or herself or chrough his or her ovm employees, provided Ihat such improvements are not intended or oflered 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 sale.): � .. �� - . ❑ I, as owner of ihe property, am EXCLUSIVELY CONTRACTING WITH- LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law dces not�zpply to an ovmer of property who builds or improves thereon, and who contracts fw such project wilh a contracta�s) license pursuant to the Contractors License laws.). , ❑ I am exempt under sec. Business and Professions Code tor this reason: GO . '� 3 -c: 5�, '� Signal re " .�' Date 30513 3ro]) Owner ID veMetl �y drive� .. �icense. ❑ Yes ❑ No Driver's License No. Expires: � Verifcation of Ownership by (rype of document, i.e. - property taz bill or tleed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: . ❑ I hereby certify that no ezcavation fne (5) w more feet in deplh into which a person is requiretl to descend, will be made in connection with wnrk autFrorized by �his pertnit, and tha� no building shucWre, scaf(dding, falsework, ar demolilion or dismantling ihereof, will be more than thirty-sa (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Cali(omia Administra[ive Code). ❑ As owner-builtler, I will no� employ anyone to do work which would require a permit from the Division of Industrial Safery, as noted a6ove, unless such person has a permi[ [o do such work from the division. Ap0licant's SignaWre Division of IndusMal Sa(ety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicanl or present or future building occupant need b fle and certify a Business Plan tor emergency response to release or threalened release o( a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Heallh 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 pountls, or a volume of 55 gallons, or 200 cubic (eet of-compressed gas a[ s[andard temperature antl pressure). 2. Does or will the applican[ or presenl or future building occupant need to file a registration (orm !or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, vnN some ezceptions, requires registration with the Costa Mesa Fire DepartmeN by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will Ihe applicant or presenl or fuWre building occupant need to prepare an RMPP (Risk Management and Prevention Pmgram for aculely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that ihe Costa Mesa Fire Department may require ihe preparation, certification and filing wi[h the Fire Department of an RMPP by businesses which are required �o register acutely hazardous ma[erials vrith the Fire Department. 4. If an RMPP is presently required, has Section 25534 of lhe California Health and Sa(ety Code been fully complied wi[h? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require (or the vrork which is the subject of this application a permit for such construction or modification (rom the Sou�h Coas[ Air Quality Management Distric[ or 6om any other air polWtion control tlisirict or agency? ❑ Yes ❑ No (SeC[bn 658502 of the Califomia Govemmen[ Code requires Ihat Ine requested informa[ion be fumished on applications for non-residential building permits). 6. Will any parl of the (aGility to be consiructetl under Ihis permit be within 7000 feet fmm the outer boundades o( a school? ❑ Ves ❑ No (If'yes", the facility must meet the requirement of Sections 25534 and 42303 of [he Califomia Healih and Safe[y Code). . 7. If a pertnit from the SoWh Coast Air �ualily Managemen[ DisMcl or other air pollution control district or agency is required tor ihe vrork which is lhe subject of this application, have all o( ihe disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf 'yes", attach certi�cate of complianc'e from the appmpnale air �pollution control oncer). ' � ' � - � � � � - � . CERTIFICATE OF �COMPLIANCE: �I �certify tfiat �under penalry �of perjury.the information given above is correcc I agree to comply with all state laws and ciry ordinances regarding�Hazardous Malerials and Emissions: � � signawre � . Date . CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and.state that the informalion given is wrrect I agree [o comply with all state lavrs antl ciry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon ihe above-describgtl pmperty For inspection pur oses. I agree nol to occupy or allow occupancy of any building authori�s per{nil unlil fnal inspection. . .. � 3 � �Uti—�'—� lU � —c� SignaWre o Cegal Owneqs) �— Date i An0/or qulM1onzea Ap011[an� Dale CITY OF COSTA MESA � BlIILD/NG D/VIS/ON 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.wsta-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E08-00153 PERMIT TYPE ELEC STATUS: APN: 41221405 DATE ISSUED: _ ', ;ISSUED BY: � - JOB ADDRESS: 954 BEGONIA,AV CM SwtelUmt ��;, vicinity: , � � , , r l' `•. .: �:, .,,�- ' .: � '.�, �.i.. SCOPE OF WORK: UPGRADE.EXISTING 100 AMP. PANEL�TO 200 AMP. PANEL IN.SAMELOCP ISSUED 04/29I2008 i r... .::- -. � � r..+r` � �7°:.'_' �� 5 � �� + _ l x :ti�-',. � , OWNER: USSMANN, LISA A; �-- �.�Address: 954 BEGONIA�AVE Umt � PHONE: t �`� � , City/State/Zip: (. COSTA MESA CA _ cy� �� APPLICANT: USSMANN,�LISA A � .' � - � �Address � .'��:, 954 BEGONIA AVE Unit: � PHONE: 714g46-3384 �.,��, „, `+ - �- �" City/State/zZip:'��COSTA�MESA CA '` � ti��' ;;' '�` % , ' � ^' ; :k CONTRACTOR �4 � �. � � License No = �� , ��' ' R Address: UniL'.,i �E...":. PHONE. :, �. ,. ' . , .. �.: ,..,: -. --: . �-�. �. City/State: ` ' ":.4 `'-ZipCode. � . _ � . - . � CELL:.�'� , -=�`+ �. ' , . 7 _ `i ir: .. - � _ � ' . .. � �- ELECTRICAL PERMIT EEES�' Electrical Plan Check Fee $0.00 Electrical Permit Fee: $54.00 Reinspection Fee ` $0 00 � . TOTAL FEES ` ' ` . $54:00 ;j'� ��.''y _s i �:. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenls under California slatutes and related regulations. (Ord. No. g2-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed 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 lo obtain inspections and f nal approval will result in the expiration of this permit. OL UEi. INSPECl10N7YPE 1876 Fixed System Final Fire Prevention 1288 Pool Spa Final - 200 Final Re-Roof 201 Final8locWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 0� IN7fIlALS COUER INSPEC➢ONTYPE 206 208 210 212 220 Final Mechanical Final Plumbing Final ElecMwl Final Fire Preveniion Final Planning Approval 222 FinalSite 250 FinalBuildincyOccupancy oAh ixnnn�s �o' ��r�� . . .q WORKERS' COMPENSATION DECLARA710N: � I hereby affirm untler penalty of perjury one ot the following declarations: ❑ I have and will maintain a certificate o( consent to self-Insure for workers' compensation, as provided for by section 3700 ot the Labor Code, for [he performance of the work for which this permit is issued. � ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for the peAormance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier. mnpetetl AMe peimd is valued at one nundretl cbnars (SIDO) p less.) Policy Number: ❑ I certify that in lhe pertormance of the work for which this permit is issueC, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, antl agree that if I should become subject to the vrorkers' compensation provisions ot Section 3700 of the Labor Code, I shall forthwith comply vnth these provisions. Appliwnfs SignaWre Dale WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT 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 affrm lhat I am licensed under pmvisions of Chap[er 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and eftect. Lic. # . Class # Gomraclor's Signalure CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a constmcibn lentling agency for ihe peAortnance o� the �+ork fa which this pertnit is issued. (Sea 3097, Gvil Code). Lender's Name: Lender's Address: Signature Date �OWNERTBUILDER DECLARATIONS:_% I hereby affvm -that under penalty of perjury tha[ I am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or the following reason (Sec. 7031.5, Busines5 and Professions Code: Any city or county whith requires a permit [o construct, alter, improve, demolish, or repair any strucWre, prior to its issuance, al5o requires ihe applicant (or such permit ro fle a signed statemen[ that he or she is licensed pursuant lo the provisions of Ihe Contractors License Law (Chapter 9(commencing with Section 7000) o� Division 3 of the Business and Professions Code) or that he or she is eaempt theretrom and ihe basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicaN to a civil penalty o( not more than five undred dollars ($500).): �' / /I, as owner of the property, or my employees with wages as their sole \ cqm pensation, WILL DO THE WORK, and the slructure is not intended or oKered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply to an ovmer of properry who builds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, provided that such improvements are not intended or offered (or sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of provinq that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH UCENSED CON7RAC70RS to consiruct the project (Sec. 7044, Business and Pro�essions Code: The contractors License Law dces not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contracta(s) license pursuant to the Contrectas license Laws.). ❑ I am exempl under sec. Business and Professions Code for this reason: y- �4'-�� TSignalure' - t • Da�e 305]-46(0/0]) Ovmer ID verified by tlrivei .. ] Yes ❑ No Dnver's License No. Expires: _�:� t. Verification of Ownership by (type of document, i.e. - property tax bill or deed): �� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: , ❑ I hereby certrfy that no excavation fve (5) or more feet in depth into wliich a person is required to descend, will be made in connectbn with vrork authorized by this pertnit, and that no building sWcture, scaHdding, falsev✓ork, or demolition or dismantling Ihereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title 8, Califomia Administ2tive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit fmm ihe Division of Industrial Safery, as noted above, unless such person has a permit to do such work from Ihe division. Applicant's SignaWre pate Division of Industrial Sa(ety Permit Numbec _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neea to file antl certify a Business Plan for emergency response to release or ihreatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 0( the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be fled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazartlous matenals equal to or greater than a weigM of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will Ihe applicant or present or fuW re building occupant need to file a registralion (orm for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration wi�h the Cos�a Mesa Fire Deparlment by each business which at any one time has on hand a quan[ity of acutely hazardous materials equal [o or greater lhan a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupam need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Cali(omia Health and Safety Cotle pmvides that [he Costa Mesa Fire Department may require the preparation, certifcation and fling with [he Fire Department of an RMPP by businesses which are requiretl to register acutely hazartlous materials with lhe Fire Departmen[. 4. If an RMPP is presently required, has Section 25534 of ihe Califomia Health and Safely Code been fully complied with7 ❑ Yes ❑ No 5. Does or will ihe applicant or present or future building occupant require for the work which is lhe subject of this application a permit for such construction or motlifcation from lhe South Coast Air Qualiry Managemen[ District or from any other air pollution control distnct or agency? ❑ Yes ❑ No (Section 658502 of [he Califomia Govemment Code requires that the 2quested information be fumished on applications t« non-residential building permits). 6. Will any parl of the facility to be constructed under this permit be within 1000 feet from the ou[er boundaries of a school? ❑ Yes ❑ No (I/ "yes", the faciliry must meet the requirement of Sections 25534 antl 42303 of [he Califomia Health and Safety Code). 7. If a permit from the South Coast Air �uality Management DisMct or olher air pollution contml tlisMct or agency is required tor the work which is ihe subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate of compliance from the appropnale air pollution control oKcer). ' .. � � � ' CERTIFICATE OF COMPLIANCE: I certify IhaLunder penalty of peryury the information given above is correcL I agree to comply with all state laws and city ordinances regarding Hazartlous Materials and Emissions. �- ,.. SignaWre �a�e , CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I certify under penalty of perjury that I have read ihis application and state ihat ihe information given is correct. I agree to comply vnth all state laws and city ordinances relating lo building conshuction, and authorize representatives of Ihe Ciry of Costa Mesa to enter upon Ihe abOve-described property for inspection purposes. I agree not to occupy or allow occupancy ot any building au� ri B by lhis pertnit until final in5pection. �/- �j _ c �- _ igna � f egalOvmer(s) Date � An0/or Aut�or¢etl Applican� D3�e CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT N0. �,j�.�7� DATE G� % � TAT NO � IO v�✓ /' .. . , .✓/ . ` . - . . The developer of the above entitled trxct desires to seil 2he above set forth lot prior to tha time that the tract has been completed and its streets .6 accepted by the Cicy of Costa Mesa. The undersigned, by executing this agreenent, 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 ae 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 agiees to indemnify and hold the City hatmless from any claim resulting in damage or personal injury to the undersigned by reason of tfie aforementioned uncompleted condition. __._..� - ----�-�-- -- R'�E C� E��:V E p, ��' �� c�rr oF �p�r.a' �aesA � � � �� n�ult,/^-'n.;P,�, � � `;, . , �u� z �rs�3 , ,. : � AM' �`. �r � pM i "::. 7�8i9il0iUt12r�t��i4i r�6 ,-, >; � ' '. � � � , , '; sY l�-.��--�.�� ll. '�iC��a��o Developer and/or authorized representacive $Y � . t.r.eCCv �a�uv�• Lender „ �� ; �� ,. � , , :' , . ' � ' �, i' � � - ' . ��. �_:.-:_. - 35�64 Z . ww aU �z Z Q ON n- m J � J N Q W (T1 J - p] J Q U� Z a W � aw w Z J Q m z J � W W � Z � W � � � � z Q U J a a Q 0 F � z O F U � � F N Z For Applicant [o Fill in Completely ADDRESS � S� � v� GD N\R �6 OWNER Larwin So. Calif. nooaEss 16255 Ventura Blvd. cirv Encino, Calif.. nTio�986-8890 CANSTRUCTION _ _ _ BRANCH ADDRESS ARCHITECT CONTRACTOR ADDRESS GTV STATE IIC. NO. SIZE OF LOT USE OF EXISTING BLDG. TEL. Calif. No.986-8890 CITV LIC. NO.R-1 � NO. OF BLDGS. I NOW ON LOT O S12E OF NO. OF NEW BLDG. 1%S�V ROOMS STOF EXTERIOR WALL ROOF COVERING SillCCO COVERING WOOd S VSE OF BUILDING AND WOFK TO BE PERFORMED N;.,� J;��12b-73�r;�.0�135i,t t:''�142.�Q APPLICATION FOR BUILDING PERMIT RECEIV Da]V DATEF�iEIV�O DATEI�aSUED U" ! 7 �-� %3 �� PERMIT NO. A.P. NO. BUIIDING p5(' � AODRESS � -[ OWNER FIRE VALUE DATE Z E NO.OF USE OF N �, P.LAN52 BUILDING �yj � YARDSAPPROVED VAROSAPPROVED MAIN BUILDING ACCESSORV BUILDI (FROM GLSTREET) S E �� FT. 1 L. SIDE S FT. ],e REAR � FT. OISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDi VAR. # DATE e C.U.P.# APPROVED APPROVED HOLD FOR SPFrte�. nFnrn : I hereby acknowletlge that I have reatl this application and state that the above information-is correct antl agree m comply with all laws regulating builtling construction, and I shall not employ any person in violation ot the workman's compenzation laws of the State of Califo�nia. - I hereby ce�tify that I am properly licensetl as a contractor untler tha State of Calito�nia Business antl Professions Code, Divisicn 3, Chapier 9, and thdt such licenses are in full force and affect, or 1 am eaempt from the provisions of the State ot Calitornia Business and Protessions C e, Division 3, Chapter 9. Sie�ature r�A�_J D. DOWIIS Permitte .t/l�L��L�. Authorized Agant � THE AMOUNT SI THE PURPOSE OF VALUATION � �D � � 0 IN UNOER VALVATION IS FOR � ABLISHING A PERMIT FEE ONLV: m ¢ PERMIT FEE $ 94. 00 � � m PLAN CHECK $ E `o LL TOTAL FEE $ �.� OWNER Lp�N . DATE �� JOB ADDRESS q54 Re�onia Ave. BUILDING PERMIT N0. �5964 o. GAS ROUGH PLUMBING � P0.0P. SWR. LINE (�{i HOUSE CON. MISCELLANEOUS ROUGH HEATING AND AIR CONOITIONING TEMPORARY SERVICE OR POLE UNDERGROUNO � POWER � ftOUGH WIRING iRENCHES � :ORMS � STEEI REINF. FLOOR SYSTEM BOND BEAM U STEEL REINFORCE I I SHEATNING FRAME ANO FLASHING LATHING - IN OUT P�ASTER, BROWN COAT STRUCTIIRAL, FINAL MEATING. VENT., REFFIG. AN� A.C., FINAL PLUMBING, FINAL ANO GAS TEST �� ELECTRIC, FINAL BUIL�ING, FINAL RE ZONE SUBCONTRACTOR _.i L v. . �84-fC Z . a cwj Z 2Q O �i am J � J N Q W 0� J m J Q U N Za W � aW wZ J Q m Z J � W w O= Z � ll! � N � � 0 COSTA MESA BUILDING-SAFETY DEPARTMENT PAIG �`AY 1( �4 �.�� 63c., ��.+�:i.�5.�� C R. P.O. BOX 1200 COSTA MESA, GALIFOHNIA 926L6 � APP IC TION FOR BUILDING PERMIT For Applicant to Fill in Completety p ,y n R V D X DATE RECEIVED DATE ISSUED ADORESS l�Y .l.�L�Jt�i�A �7YE' � � �� G�iQ L. �Lfi4< /�_ � O s PEFi� IT NO. OWNER '4'P' N�• p� � ^ BUILDING ADDRESS �Sy `�."1'�N/A /��' ADORESS �= . �� C1TY CUc�%%} /„�rf NOL ///��78 TRACT LOT BLOCK % CON5TRUCTION EW AD A T R P LENOEF BRANCH � OWNER ADDRESS VALUE ARCHITECT TEI. SE D (%IiC $ OR ENGINEER N . FIRE ADDRESS ZONE YPE GROUP CONTRACTOR [��JN� uU�LLCiC BYPROVEC � DATE �' A�ORESS TEL. Z�N NO.OF USE OF NEW CITY NO. P�� BUILDING O C�U STATE CITV VARDSAPPROVEO VARDSAPPROVED LIC. NO. LIC. NO. ' MAIN BUILDING ACCESSOflV BUILDING SIZE NO.OF BLOGS. (FFOM C/� STREETI' OF LOT NOW ON LOT FRONT FT. USE OF EXISTING Bl0 5 E FT. FT. SI2E OF �;�0 i /`/ NO.OF NEWBLDG�V `s O :�OOMS ' STORIES � LSIDE F FT. EXTERIOR WALL ROOF � �� COVEflING COVERING REAR T. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDf35. ACCESS. BLDGS. �PEN L�7/rf �///(Q' y�/ VAR.a� DATE �V� C.U.P.# APPROVED APPROVED � S-� - c�7p7E I hereby acknowledge that I have reatl Mis application antl state that ffie above intormation is correct antl agree to wmply with all laws regulating builtling ctl�struction, and I shall not employ any person in violation ot the workman's compensation laws of ffie State of California. W � I hereby certity Mat I am proPerly licensetl as a conttactor untler SQ. FT. o the State of Calitornia Busine5s antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR Chapter 9, and tha2 such licenses are in full force antl effect, or I THE PUftPOSE OF ESTABLISHING A PERMIT FEE ONLV: m am exempt from tt:e provisions of the State ot California Business Q VALVATION antl Protessions Coae, ivision 3, Chapter 9. �� m PERMIT FEE $ �� SiBnature ot /�'/ � m Permittee � 'l' $ /� J P�AN CHECK $ E l �� ,� i% `a � LL A�tho�izetl Agent - TOTAL FEE $ OWNER gi JOB ADDRESS GENERAL CON AP No.412-21 INSPECTIONS SOIL GAS WATER ROUGH PLUM6ING PROP. SWR. LINE SPRINKLING SVST MISCELLANEOUS L. egonia Avenue Owner-Bldr. CON. ROUGH MEATING I+ND AIR CON�ITIONING TEMPORARV SE UNDE0.GROUND ROUGH WIRING TRENCHES � FLOOR SVStEM BONO BEAM �i SHEATHING POwER FORMS U STEEL REINF. STEEL ftEINFORCE I-I' FRAME AN� FLASHING � LATHING - IN �J OUT n PLASTER, BROWN COAT STRUCTURqL, FINAL HEATING, VENL, REFRIG. AN� A.0 PLUMBING, FINAL AN� GAS TEST ELECTRIC, FINAL 9111LOING. FINAL � � �_ F INAL DATE 5-16-74 BUILDING PERMIT N0. 38410 FIRE ZONE VALUE TYPE � GROUF SUBCONTRACTOR