HomeMy WebLinkAbout1025 CANNONADE CIR - Building Permits(714) 754.5273 • Fax (714) 754-4656 • www.ci.costa-mesa.B.ULDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1025 CANNONADE CI 'Status: ISSUED
Suite: Applied: 09/11/2003
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 09/11/2003
Parcel Number: 41237123 Zoning: R1 R1
Applicant: FERGUSON, LEW ISSUED BY:
Address: 4091 E LA PALMA
SUITE D - - Phone: (714) 630-5543
ANAHEIM, CA Zip: 92807
Owner: KRUEGER, DOUGLAS C
Address -1025 CANNONADE CIR _ -
- Phone: - - -
COSTA MESA, CA", Zip: 92626 -
Contractor: ' MC CORMACK ROOFING
Address: 4091 E'LA-PALMA-
SUITE D" Phone: (714) 630-5543 "
ANAHEIM, CA
Zip: 92807 License: 643700
Arch : _ Eng:
Address: Address:
Phone: Phone:
Zip: License: License: ;
SCOPE OF PERMIT
TEAR OFF EXISTING WOOD SHAKE ROOF, INSTALL SHEATHING, FELT AND COVER WITH EAGLE LITE MALIBU TILE - ICBO #4660. ADD
SKYLIGHT- ICBO ER 6075. NO RAFTER CUTS:
NOTICE: 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: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
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 final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
244646 (SM)
FEE SUMMARY
Plan Check:
$0.00
Calc Valuation: $7,000.00
Permit:
$139.25
Claim Valuation: $7.000.00
SMIP Res:
$0.70
SMIP Com:
$0.00
Other:
$0.00
Inspection:
,$0.00
Total:
$139.95
PLANNING&ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 -
Rear 0-0 Left 0-0
Right - 0-'0
ACCESSORY
Front 0-0 -
Rear' 0-0 Left 0-0 -
Right 0-0
PARKING
Existing: 0
Required: 0- Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
244646 (SM)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: ( 9
I hereby ofirn under penalty of perjury one pf the following declarations: '
❑ 1 have and will. maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
ork for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My warkerompensption Insurer)Ce cgrnepolicy num[prAre: !� 1 2$` 7 y 53��
Carder: ( 'blt3�/w9G�7B/ 5 ua /� Poli Number: G 7
(This section need not be Completed it the permit is valued atone hurrom dollars($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Californy, 3nd agree that if hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these visi ' O_5
Applicant Signature: _ �� Date: V�
WARNING: FAILURE TO RE�OSECU W RKERS' COMPENSATION COVERAGE UN FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,ODO), IN ADDITION TO THE COST OF COMPENSATI , DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed nder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business anyprof ssions Code, and my license is In full
force and effect. Lia If i �o Class R C 17
�-
Contractor's Signature: Date: i
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior t0 its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner Of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure 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 offered for sale. If, however, the building or improvement is
sold within 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 the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cade: The contractors License Law does not apply to an owner of property who builds Or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California 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 feet of compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration torte for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight 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 the applicant or present or future 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 Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.................................................................................................................................................................................................................................................................... ith"..............................................................................................................
4 If an RMPP is presently required, has Section 25534 of the California Heelih and Safety Code been fully complied with? ❑ Ves ❑ No
..................................................................................................................... ildi........................................................................................................................................................................................................................................... difi................
5 Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication aEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Byes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
...................................... .............................................. ................................................................................................................................................................................._................................ .................................................... -...............................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If `yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
............... ....... ............................................................................................................................................................................................-............................................................
7 a a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No
.................................................ertiific................................................. ..................................... ..........11ut................trol............................................................................_........................................................ .............................................................
B (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances 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 authorized by this permit until tint inspection.
Si ur Legal Owners)q / / Dat9
IY-o
VI�U'tY�
And/Or Authorizeff Ap icant Date`-
CODE 1. INSPECTION TYPE 2AT& INTRIALS CODE INSPECTION TYPE PETE INTITALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root 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 Final Silo
204 Final Demolition 250 Final Building/Occupancy u
�esia
n ^ City of Costa Mesa Plan Department
Post Office Box 1200
77 Fair Drive
Costa Mesa, California 92626
(714)556-5245
REQUEST FOR OCCUPANCY
(Single Family Residential or
Condominium Units)
Tract No. Date,
Lot No.
Address /6) � `i
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
(h �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.
RECEIVEL)
CITY OF VTA MESA
FI , "
S? .';197$
RIW Pi
718191MIM41AM1516
By LC ]YLei oZcttLt/
Purchaser
By
evelope or torized
Represe tie
By
Lender
TYPICAL 4`t CONCRETE BLOCK FENCE
TOP VIEW 3/8 Bar
4 Blocks 8.,Blocks
1/4° 0 Pencil Rod Below Top —
Course Of All Fences
4° Concrete Block Fence With 8°
Pilasters. One 3/8° Vertical Bar
Cqntinuous From Earthtooth Thru
8, Pilaster.
3/8° Vertical Ties 2' Long
Hooked In Foqting, And Grouted In
4 Blocks 4 0/C Maximum,
Provide Cleanout And Inspection
Hole At Pilasters.
"GENERAL- NOTES"
MORTAR: One Part Plastic
Cement And Three Parts Sand.,
GROUT: One Part Cement And
Three And One Half Parts Sand.
COPING: One Part Cement,
Three Parts Sand.
CONCRETE: Well Mixed 1:21/2,
31/2. Maximum Of 7 1/2
Gallons Of Water Per Sack
Of Cement
REINFORCEING STEEL SHALL
CONFORM TO SEC. A-15-39
A. S.T. M. ALL STEEL TO LAP
WHERE SPLICED, 2'-O" MINIMUM.
GROUT MAY BE POURED FROM
TOP OF FENCE IN CELLS WHERE
(FENCE MAY VARY
IN HEIGHT
1DEPTH OF EARTHTOOTH 1/3
IN STRETCHER COURSES SO
FROM 3' TO
6
i, o.ol
....... ..........
THE HEIGHT OF FENCE
I,, .e v01
IP i' -I
NATURAL GRADE
),,,
BE TIED IN PLACE
m
w.,. �n of
ELOW
FOOT NG.BOTTOM OF
VERTICAL STEEL OCCURS, HOLES
N
,.'•P.P i
� - L,.=<'1.> .e..Po o,. o." o..•�oi di
�'�-•"�'�I
1I.; v:
SHALL 8E CLEAR, CLEAN, AND
FOR WIDTH SEE CHART
��y.. o' `�''�<4e
�E_�oU :•r
a�'yTp''`p'.'
-�
. .....
I-°-34•t1",'o:
FREE OF ALL MORTAR, DEBRIS,
16'
�!
a
'Y('
_:�___ic_o=QI
LQ"!:,'.�bxf_df
I
HOLES
ECT. WITH INSPECTION
NUOUS ', -
TWO 3/8 BARS CONTIlz
I�•'•'�'i
��
TO
16'�O.C. MAXIMUM
I•p,
00
AT BOTTOM. BOND SHALL BE
Ib. e✓�
PROVIDED BY LAYING BLOCKS
(FENCE MAY VARY
IN HEIGHT
1DEPTH OF EARTHTOOTH 1/3
IN STRETCHER COURSES SO
FROM 3' TO
6
i, o.ol
....... ..........
THE HEIGHT OF FENCE
I,, .e v01
IP i' -I
THAT VERT. JOINTS ALTERNATE
STEEL MUST
BE TIED IN PLACE
m
''I
ELOW
FOOT NG.BOTTOM OF
%'• ,
I4.en I
IN EACH COURSE.
AT TIME OF
TRENCH INSPECTION
..............
L.VJ
SCALE: 1/2% I
3 CLEARANCE FROM BOTTOM
City Of Costa Mesa, bdi-fornia OWNERS NAME _ _ _ _ _ _ _ _ _ _ _ _ _ _
JOB ADDRESS
Building Department PERMIT NUMBER:_ _ _ - _ _ _ _ _
SIGNATURE:
F.,.3U13-2M-4-& S -BP
Ur /AN I
HEIGHT...........:....f..
.6' .'.. ............
5'...................4
....... ..........
3
WIDTH.. ................14"..
..........:.
14"...:..............12°.
...............
12..
THICKNESS. ............10"......:.:.....'
10 ..................8°..._............
8..
_ DEPTH OF EARTHTOOTH ...24
..............
".. 20..................16"...
.............
12°
SPACING OF EARTHTOOT..12'.
. .....
........ 14..................16'...
.............
16'
City Of Costa Mesa, bdi-fornia OWNERS NAME _ _ _ _ _ _ _ _ _ _ _ _ _ _
JOB ADDRESS
Building Department PERMIT NUMBER:_ _ _ - _ _ _ _ _
SIGNATURE:
F.,.3U13-2M-4-& S -BP
STREET
1
FNO
STREET
G
STRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE REQUIRED
FOR ELECTRICAL, PLUMBING,
HEATING, VENTILATING AND
REFRIGERATION WORK
Permit
THIS NUMBER MUST ACCOMPANY
ALL INSPECTION REQUESTS
FOR BUILDINGS WHERE PERSONS ARE TO
BE EMPLOYED, WE SUGGEST THAT THE
STATE OF CALIFORNIA DIVISION OF
INDUSTRIAL SAFETY BE CONSULTED FOR
ADDITIONAL REQUIREMENTS.
City of Cos!2!�Mesa Building
THESE PLANS MUST BE ON JOB AT ALL TIMES
MAKE NO CHANGES WITHOUT PRIOR APPROVAL
OF DEPT.
THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL
OF PLADS AND SPECIFICATIONS SHALL NOT BE CONSTRUED
TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION
OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE.
SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO
FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL,
THE ISSUANCE OF A PERMIT BASED UPON PLANS AND
SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL
FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS
IN SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING
BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN
IN VIOLATION OF THIS CODE OR OFANYOTHER ORDINANCE
OF THE CITY,
OWNER KRUEGER DATE 8-16-79
OBA025 Cannnnada Cir_ BUILDING PERMIT NO. 48648
r_cMco AI rnMTDArTA0 . .. — rte,......
AP ND. 412 -37l -p2__ LOT TRACT FIRE ZONE VALUE E nnn nn
INSPECTIONS
Si nature Date
ITYPE GROUP
ZONE R
SOIL
SUBCONTRACTOR
PERMITS ISS ED
GAS _
Date Number Si nature
WATER
Plumbin
ROUGH PLUMBING
PROP. SWR. LINE _1 HOUSE CON. C]
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUN D�� POWER ❑
ROUGH WIRING
Heatin and Vent.
TRENCHES FORMS STEEL REINF.
FLOOR SYSTEM
If
BOND BEAM 7_ STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING 7 IN i 1 OUT
PLASTER. BROWN COAT
_
STRUCTURAL, FINAL
_
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
I
tanceij
171
ra
COSTA MESA BUILDING -SAFE -TY DEPARTMENT
APPLIC
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
curve
fff
For Applicant to Fill in Completely — Use Ink Only
APPROVEd
BUILDING ��
any person in violation of the workman's compensation laws of
ADDRESSOWNER
BV
ADDRESS I�
�
OR
tA.P.
(� TENANTMAILING
m
s ADDRESSEL.CITY
SQ. FT.
f�� �– NEO
CONSTRUCTION
APPROVED
BRANCH
OWNER
ADDRESS
ARCHITECT TEL. :4USE L
ADDRESS
L. SIDE T.
electric, plumbing and heating work:
curve
FEAR FT
=r —O G/YE
APPROVEd
CONTRACTOR
any person in violation of the workman's compensation laws of
BV
ADDRESS I�
�
CITY
m
TEL.
NO. p,s33
SQ. FT.
STATE
CITY
APPROVED
LIC. NO.
IS FOR m
UC. NO. ��,f( 7
THE PURPOSE OF ESTABLISHING A PERMIT
FEE ONLY:
am exempt from the or 'ions of the State of California Business
VALUATION
(FROM C/
SIZE
and Professions Code si 3, Chapter 9.
NO. OF BLDGS.
OF LOT
Signature of_
I NOW ON LOT
PONT
'46AI PERMIT 5, 50 TL
No 48648
LTER ]REPAIR IMOVINGI DEMOLISH
Separate permits are required for
L. SIDE T.
electric, plumbing and heating work:
'
FEAR FT
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
N
VALUE
$
DATE
I
DATE
APPROVED
I hereby acknowledge that I have read this application and state
A
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
>
any person in violation of the workman's compensation laws of
the State of California.
-
m
1 hereby certify that I am properly licensed as a contractor under
SQ. FT.
N
7
the State of California Business and Professions Cotle, Division 3,
THE AMOUNT SHOWN UNDER VALUATION
IS FOR m
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT
FEE ONLY:
am exempt from the or 'ions of the State of California Business
VALUATION
PERMIT FEE $
and Professions Code si 3, Chapter 9.
'n
m
Signature of_
PLAN CHECK $
/+• ^I
o
LL
Perm ills
$
TAX §
F
or '
i/
` O
Authori d Agent Date
TOTAL PAID $
. So
449.,E
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant toFillin Completely — Use Ink/Only
FBUILDING
ADDRESS A_)a
OWNER
MAIL
EL.
CITY Santa Ana T
CA 92705 NEO 543-9471
CONSTRUCTION
BRANCH 1010 N. Maim
ADDRESS Rant,;; Ana rA q2704
ARCHITECT __ . _ _ TEL.-...
ADDRESS 777 S. Main, #105, Orange 926
CONTRACTOR Foley Construction�olnc.
ADDRESS Sable as above
TEL.
CITY NO.
STATE CITY O
LIC. NO. LC. NO.
SIZEI NO. OF BLDGS.
OF LOT NOW ON LOT
USE OF N/A
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
YARDS APPROVED I YARDS APPROVE
VAR.* DATE
New construction, single family C.U.P.4 APPROVED
detached, Plan 5, 5 BedrotnLs. APPROV /0-x0--77
BY _aATE�
HOLD FOR SPECIALL REQUIREMENT
1 hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, D]visjon 3, Chapter 9.
Signature of /
Permittee ��
AuthorizectAg
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION PERMIT FEE $
PLAN CHECK $
$ 78,61(" TAX $
TOTAL PAID $ 3 U10
OCT 21-77CM14 001090+` ** 373.02
cl+Sr.
P IC TION
FOR STRUCTURAL PERMIT
RW BY I ATE RECEIVED D/pTE IpSSUED/t
.t
14,
PERMIT NO.
� ��
A.P. NO.
5
LDING
ADDRESS 1025 Cannonade Circle
TRACT
9901
LOT BLOCK
EW AD
AL R P
X
OWNER
/(�
ALU$
S
USE �r
$
FIRE
ZONE
T PE GROUP
APPROVED
ij /�
e
BY
DATE
ZONE
NO. OF
USE OF NEW
PLANS y
BUILDING ��� A
YARDS APPROVED I YARDS APPROVE
VAR.* DATE
New construction, single family C.U.P.4 APPROVED
detached, Plan 5, 5 BedrotnLs. APPROV /0-x0--77
BY _aATE�
HOLD FOR SPECIALL REQUIREMENT
1 hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, D]visjon 3, Chapter 9.
Signature of /
Permittee ��
AuthorizectAg
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION PERMIT FEE $
PLAN CHECK $
$ 78,61(" TAX $
TOTAL PAID $ 3 U10
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
' OO 11/06/79 30. 0_ TL
PPLICATIONFOR STRUCTURAL PERMIT '
N° 4
BUILDING t� I
O Zv
A.P. NO. �, 3 ,� L3ADDRESS
OWNER OR
BUILDING IDXr CqN 0NADF_
ADDRESS
W
TENANTUNITOR
MAILING
ADDRESS
SPACE NO. '
A
d��
TRV OHO LOT BLK.
sI
CITY C It NO. %�/S"'
NEW JADO ALTER IREPAIR IMOVINGIDEMOLISH
CONSTRUCTION
LENDER
BRANCH
,�/
OWNER .3)4t) LL I` l^
ADORES
I VALUE
ARCHITECT TEL.
USEd $
OR ENGINEER
ADDRESS
ZONE YPE GROUP
APPROVED
G
CONTRACTOR G `( T'l
BY DATE
/J��C
C�`fC
ADDRESS LIQ, L' fL
TE L.
TE
�C
CITY Gl, Le9—�
STATE/ CITY
APPROVED SETBACKS
LIC. NO. LC. NO.
SIZE NO. OF BLDGS.
IFROM C/L STREET
OF LOT NOW ON LOT
FROMGk
USE OF
EXISTING BLDG. n
Separate permits are required for
L. SIDE < FT.
electric, plumbing and heating work.
3 O
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
r�
DATE
APPROVED
APPROVED C.ii..1/^By /
['!
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
' /�
I hereby certify that I am properly licensed as a contractor under
T I SQ. FT.
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
'VALUATION PERMIT FEE $ d�
and Professions Code/,/J'vls/ion 3, Chapter 9.
,
•
PLAN CHECK
Signature of �`Y_
$
(—
Permittee G /
$ 4? Os DO TAX $ �^u'
or /,
Authorized Agent Date / 16 17�
TOTAL PAID $ 3o s So