HomeMy WebLinkAbout948 CARNATION AVE - Building Permits. -11.�'
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Job Address:
Suite No
Vicinity:
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
948 CARNATION AV
COMPLETE HOUSE
Parcel Nunmber: 41217410
npp�icant: JACOBS, MYRON G
Address: 948 CARNATION AVE
COSTA MESA, CA
owner: JACOBS, MYRON G
Address 948 CARNATION AVE
COSTA MESA, CA
Contractor.
Address:
ArchlEng:
Address:
PLUMBING PERMIT
Phone: (714)641-8234
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License:
Phone:
2ip:
License:
SCOPE OF PERMIT
COMPLEIECOPPER REPIPE OF EXISTING SFD.
ISSUE FEE
Backflow irrigation
Backflow Preventer
BathWb
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-a ouUets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
szz.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
Qn
FEE SUMMARY
Laundry Tub I Washer
Landscape Irrigation
P-Trap
Pressure Regulalor
Process Piping (per 10 ft)
Receptors
Septic Tank
Sewer Cap for Demo
Sewer Connect
Sewer Private Line
Shower
Sink, bar
Sink, commercial
Sink, Floor
Sink, kitchen
Sink, service/mop
Spa (private)
Spa (public)
AMT
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
RI
PERMIT I�UMBEP.
�
�P99-00363
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 07/01/1999
Issued: 07/01/1999
ISSUED BY: ��
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Soflener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.75
$0.00
80.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: $30.75
QTY
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
NOTICE: The work authorized by this permit shall comply with all epplicable handicap access requiremants under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
tor e penod of 1 BO days.
INSPECTIONS: In order (or the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
raqulred Inapeetlona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
i
�
WORKERS' COMPENSA710N DECLARATION: . �
1 hereby ettirtn untler penalry ol perjury one ol the following tleclara�ions:
❑� I heve and will maintein a certificete of consent to self-Insure tor workers' compensation, as provitled for by section 3700 of the LeDor Code, tor Ihe pertormence ol Ihe
work for which this permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the La6or Code, for the peAormence of �he work tor which Ihis permit Is issuetl.
My workers' compensatlan Insurance carrier and policy number are:
Cerrier: policy Number.
(This section need not be tomp/eted il the permit is veluea ef one huntlreU dollers ($100) or less.)
❑ I certify ihat In ihe peAormence of the work for which this permit is issued, I shall not employ eny person in any manne� so es to become subject to ihe workers'
wmpensation laws of Califomia, end egree thef if I should become sublect to ihe workers' compensation provisions ol Section 3700 of the Lebor Code, I shall fotlhwith
comply with these provislons.
Applicant Signature: Dete:
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION CAVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000). IN ADDITIIXJ TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, ANO ATTORNEY'S FEES.
LICENSED CONTRACTOHS DECLARATION:
I hereby aflirm ihat I em licensed under provisions ol Chapter 9(commencing with Section 7000) of Division 3 of the Business and Protesslons Cotle, antl my license is in full
force and eHecL Lic. a Class a
Con[raaofs Signawre: Date:
CONS7RUCTON LENDING AGENCV: '
❑ I hereby aHirm thet �here is a consiruction lending egency tor t�e pedormance ot Ihe work tor which this pertnil is issued. (Sec. 3097, Civil COCe).
Lendar's Name: Lentlefs Atldress:
Signeture: Date:
OWNER•BUILDER DECLARATIONS:
I hereby affirm thet untler penelry ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e tollowing reason (Sec. 7031.5, Business end Pratessions
Code: Any ciry or counry which requires a pertnit to construct, alter, improva, demolish, or repair any siructure, pnor to its issuance, also requires �ha epplicant for such permit
to tile e signetl steiement ihat he or she Is Ilcensetl pursuant to the provisions ot the Contractors Llcense Lew (Chepter 9(commencing wlih Section 7000) of DiNsion 3 of Ihe
Business antl Protessions Cotle) or that he or she Is e:empt therelrom and the basis tor t�e allegetl eaemption. Any violation of Sedlon 7031.5 by eny applicent for a permit
sub'�nQls Ihe applicant to a civil penalry o1 not more than five hundred dollars ($500).):
� 1, es owner ol Ihe propeny, or my employees with wages es their sole compensation, WILL DO THE WORK, and ihe strucWre is not intended or offeretl lor sale (Sec.
7044, Business end Profassions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves t�ereon, end who does such work
himself or harselt or through his or �er own employees, proNded ihat such improvements are not intentled or oflered for sale. If, howaver, �he bulltling or improvement is
sold within one year of completion, the owner-builtler will have Ihe burden of proving that he or she did no� builtl w improve for purpose ot sale.).
❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business antl Professions
Code: The coniractors License Lew does noi apply to an owner oi propaRy who builds or impmves thereon, antl who contracts tor such project with e contrectoqs)
license pursuent to Ihe Contractors License Laws.).
❑ I em exe under sec. Business antl Professions Code tor ihis reason:
SignaWre: .d(iS111'H �f
Eaplres:
Verification of Ownership by (type of daument, i.e. - property tax blll or daed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N:
❑ I hereby cenify Ihat no excevation ilve (5) or more leet In Gepth into which a person Is required to descentl, will be made in connectlon with work authorizetl by this
permit, entl thet no bullding siruclure, scatfolding, felsework, or demolition or dismantling thereoi, will be more than thirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, 7�1e 8, Califomia Atlminisireilve Code).
❑ As owner-builtler, I will not employ enyone to do work which would require a permit trom the Division ot Intlustrial Safery, es noteC eDove, unless such person has a
permit to do such work irom ihe division.
Signature: Date:
Division of Industriel Safery Pertnit Number:
CERTIPICATE OF COMPLIANCE AND AUTHORVATON OF ENTRV: 1 certify under penalty ot perjury ihat I heve read ihis epplication entl steta that the intormation given is
corr I agrea to comply wlih all state laws entl ciry ordinances relating to building consiruction, and authorize representatives of the Ciry of Coste Mesa to enter upon the
a e� s��operty fq� ins ction pu � a not to occupy or allow occupancy of any building authorized by� perrtjt� tIl Ilnel inspection.
v� � �
� ii
Si ature Of Legal Owner(s) �T— Date
AnNOr Authorized Applicant Date
COOE 1. INSPECTION TYVE
7676 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Roof
207 FIna1 BIocWRetaining Wall
202 Final Fectary Fire Place
203
204
2468 68
Final Sign
Final Demolition
�
j[dQJ��j $�QUj( INSPECTIONTVPE
206 Finel Mechanical
208 Finel Plumbing
210 Final Electdcal
212 Final Fire Pravention
220 Finel Plenning Approval
222 Flnel Site
250 Final Building/Occupancy
PAIE
�-L.,-99 �M
Hr. Myron G. Jacobs
948 Carnation Anenue
Coste Meaa, California
Dear Sirt
92626
November 2� 1973
�
A building permit has been sued to you as oxner-builder to
conatruction a Qrivate spa o our pzoperty.
In order that your apa will be a eafe one and for the purpoae of
advlaing you of your reaponsibility regarding the requirementa of
Lhn Coata I�sa ipal Code� ve sefer you to Sectioa 8107� a
copy of which !a at hed.
This letter ie direeted to you in order thet you vill be axare
of our ordinancae and can make a complete safety check of your
pool area.
RNt�D
Sincerely youra�
RICHARD HANHART
Building Safety Director
^ �L%��l - ' �-v �'`
_; r-
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO . � � / �
LOT N0, ��p�
a�Dx�55 9 4 8 C'G-ti., �,:. c�,u�e .
AATE%�'� %.T
The developer of the above entitled tract desires to aell the above aet
forth lot prioz 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)%r,� __ _(was or were)_�C%� .��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 hazmless from
any claim resulting in dar.iage or personal injury to the undersigned by reason
oY the aforementioned uncompleted condltion. �%� -
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Developer andTor authorized
representacive
' BY /�"C,c-eCCU �.Ga-(��.
Lender
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PFOJECTAOUFESS: (348 �ARtiA:IOK F?�� I
OWNEB'S NPME: JACOB Pi � �':Y:iO� G
aooeess:gqg �A.RNAiIOti AV�
COSTA MESA,CA 92626
� 64:-8234
AHCHIENGINEEF: AEG.NO.:
ADUNE55:
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UNIT:
PENMITTEE:IIL��SQ:V � i.�{ii C�VrJ ia�L��.Ti�� ( 7� 4) 530-277:
aooness: 1 � 401 WEST?:ITiSTE� AV
uARDEn GROVE CA 92642
LICENSEO CONTflACTOB OECIAflATION: I hereby alfirm Ihai I am licensetl untler pmvision5 0l C�apter 9(commencing with Section
7000) o� �ivison 3 0� Ihe Business antl Professions Code, antl my license is in WII force an� ellecl.
c�Truc.:015644 psrn,euc.:338E103 c s.�—^g
�oate: � � �O ^ 1 3 signature: _ . _ — _ .
WOBRENS' COMPENSATION DECIABATION: I hereby aflirm Ih I have a cerli�icate o� consenl lo sell-insure or a certilica[e ot Workers'
Campensalion Insurance. or a wnifie0 copy Ihereo� (Section 3800. LaO. C).
POLICY NO.: E%P. OPTE:
COMPANY:
❑ Certilied copy is hereby furnished. ❑ Cenifie0 copy is 61e v' 1 t�e 'ip Builtling �ivi n.
�Oate: � ApPlicanC _� ' �
E%EMPTION fPOM WOPNENS'COMPENSATION OECLPBRTION: Qhi55ecUon neeA notbe comDlele4if�hepermiti5�oronehunEretl(4700)orless�,
I cerlity Ihai in Ihe pedormante of Ihe work for whic� Ihis permit is issue shal ot employ any rs�so as to become
su�lecl Io rIhe Workers' Compensalion Laws of Calitomia.
� Oa�e- 1— � V'�� SignaNre'. ,
NOTICF.If. a�ter making �his aeclaralion, you shoultl become su�lect�o Ihe Workers' Compensation D�ovisions olihe La�or
Cotle, you musl totlhwilb comO�Y w��h such pmvisions or Nis Dermil s�all be tleeme0 revoke0.
CONSTBUCTION LENOING FCENCY: I hereby aftirm I�at Ihere is a constmclion lending agency �ar the pedormance oi the work tor
which I�is oermii is issued (Seclion 3097. Civ. C).
LENUEH:
aooaEss:
C�:Y VF rGSTA X=SA — 8;:=',D�:�:G P�R':;: �+�Rti: :�:t�: fi OF�`_:
t��RXIi K�: 9 062? ^_2 Pi.Ati C'r.ECK �O: � GOV.: ?7 Si:PP; ?'
CGtiS:RliCT=ON �YPE: �—N PER�:�T ':YPE: S';R P:JRr�OS=: A:.:
JU3 DESCRT_PT_ON : R�ROUF OVEA �XiSTiNG W/CO:�:P SHINGL£s" £� FT: 2,300
CLASM VA�JE: 2,300,00 CALC—VAi.JE: 2,300.00 GROL'P OCC: R-3 /�v-1
CO`!�:EI�TS: REROOF 21005F R=SIUEtiCE s GARAG= :�'/CO:�:P SF:Iv�;,Es
'�dE?Eii'X'X'3E',Y'3E?Fi!iEiE.+�ijE')EiflE3F)FiE3fiE')f'JFiEifiE'H'iEi%'iEjFi%'JE9EiE!E9C'9FYif3EiE'IF')t!Eit#")i'#IEK'3Fi%iFIF��+'.��cjq[.g.Y�jF-YYT-iF3%iF�'N'if'1kiF,iFi�"Wi:
Z O N S?� G R E Q u I R � N E N : a31V1�f�� L1� � L:+.� I�JF`t
5 E T 3 A C K S
------------ A".AI1 Bli�;.D=tiG ---------- --------- ACCESSORY �EQUlREQ----
Pk:�IT: FT IN REAR: rT ZN rRNT; FT I�1 REAR: r':' Iti
i:FT. :'T IN RGH':. 'i Zti i,EFi. FT Iti AGi", '. I\
PARRING REQ: PROV; PARC�L: 412?7450 ZNt.: hEF NO:
PLANNING NOT£S>
i
iE ii iE i� iE k�?f iF?%?f iF 3E if ?!� # 3E aF #?E ie if 1� 3E 3'r?E iE # iE �1F iE±E �1FlF?E?E if ?f iF iE-1ElE?f iE iF # ic !f # iE ?E!f ##?f # iF ## lf iE i!� :f iF � iF #�3f�;t.Sg iE 3F ;F # i!-?E iE ?E
D- V E L O P N. E N? S E R Cr S C E S R E Q;J i R E X E:1 =:; S
ZONING A�PROVED BY UATE: � �
BU�i.LIDiG AP?RO�fE1 5Y : UA:E: �
a��� Tca;laN issJLu �y: nA:��;� 5,,:���
?EiEicjEiEiEiEafiF#ifiFiE3f�f1E#iE###ifui[xir�z��t'FiF�exx3riF�irfr+[xuuf.-�tC-T.4r<>.-xtt��rs�?FiE#rt�A#1E#iEiE ur,� x..t ..�iF#
��f?FjfiFi!�3FiE�1EiF3EifiFi.'?Eif'f.�#iFiFii�#'-#�1fif?EiF?f�E)FiE}}iEiEiEiEiciEiE#iEiEiE3EiE###iF'i-i(�#i:-###iE'r:##�;�;:f:�itiE;:�� w{r##.:;'ifA�iEiFi@
i,EGAiIZATT_ON:N F E E 5 II M y A R Y STRUCT;TRAi SEGN.EN3:Y
OWNEfl BUILUEB OECIAXATION: I hereby afbrm Ihal I am exempi Imm �he CONractars' Sta�e License Law �or �he followinp reason t,{I,,UG l�l� 1 �uU1':B I hC� t.j.r GC i R IC N .�.
(Seclion 7031.5 8usine55 and Pm�essional Code: Any city of county w�ich requires a permii to cons�ruct, al�er, impmve, Demolish, or F7 ��N? T 5 4. 0 0 t CHAN=C c I RE SM I P/R S (�it�.�l,� 1 iJi'i
repair any slmcture. prior lo iis issuance, also requires �he applicani for such Oermi� to lile a 5igneA Sla�ement �hal �elihe i5 iicensea r-� 7� �
pursuam m the pmvisions al Ihe CONracmrs' S�a�e licenre Law (Chap�er 9(commencing wi�h Sec�ion 7000) o� Divisian 3 o� �he Business ♦ S V y Fi �ti(')rj <T�. F�
antl Professions Catle) ar �M1al he/she is exemp� Ihere�mm anA the basis for �he allegetl e�empiion. Nny viola�ion oi Sec�ion 7031.5 �y PLt�.:� �.�,. _
any applicant lor a permil subjecis ihe applican� to a civil penaliy ol not more I�an five Aundre0 tlollars �5500). 1 SSLTE F� E '�
� �
I, as awner ol lhe pmperly ar my employees with wages as their sole campensa�ioq will Oo �he work, antl Ihe �uILDI�G—U�V—> 1�-Fft�i! 1CrJU� F�,'J�i1V�L!'I C� 1�1%iL PA_TL� r DUE
❑ stmcmre is not intendetl or olleretl for sale (Section 7044, Busness antl Pmtessional Coae: The Con�racrors' S�a�e License Law 1 �! AL S— ---> 54 . 5 0 �, G � ',y � 0,� 0 � 5 9. 5 0 5 4, 5 0!/�^ . 0 �
does nal apply �o an owner ol a pmpetly who bui105 or impmves �hereon, antl who tloes such work himsell/�erselt or �hraugh .
his or her own employees, provitled Iha� such improvements are no� in�endetl or afleretl lor sale. If, �owever Ihe builtling or
impmvement is som wi�hin one year a� comp�e�ion, me owner wiu have me bumen ot pmving he/she �ia not bui�tl or impraue R E V ENUE U I V: S iUN 1 t71 F:L S-- > C�LI.LCTED :.' 7 9. 5 0 �V Y.1� / SHORT : 0 0
lor�hepwposeolsale). 3i.,DG PMT P:..IINs`9ItiG �.i.,: C:RIC N.EtHr�:L�i�C � : IRt. S.`2.'P/.UT GRAD�\'.G �L.�,N—CHECK
I, as awncr of the pmperly. am exclusively cnnVac�inB with Ilcen5e0 contraclors lo tonstmc� Ihe pmlect (Section 7044, Bu5ine55 5 4. 0 0 ,_ ., , 5 0 ��!
❑ anA Professions Code: The ConVaciors' S�a�e License law tloes not appty to an owner ol Oroperiy who builtls oi impmves ihereon '
andwhoconlrad5forsuchprolectswilhaconVaclor(5)IicenSepursuantlo�heConiraclort Sta�eLicenselaw�.lamaware *�ac��ct*.�a**{(�;(��s(�jc#aFiE3f3EiE#�kiE#iEificiEiEjciE?F�iE?E!!�?FiF?FlEi�?Elf�1F##7Eif##!E#####if#1ElEie?EiFiE###�6�E#Y#3E1E!E?fiFil�
iha� pwo� o� ineir worker's Compensa�ion insurance shoWe �e pmviaea m me. 1 1 E� D I V 1 L� L7 7i L i' L E B R E A K D �'lti % .�
� I am exempi untler Sec�ion: B. 8 P. C. �
io�misreaso�: TYPt. TY D E' C R'1 Y�' O�i "N'T COST " "'OTA' C''ST
oate: Ownec SFFi
I ao hereby cenify Ina1 I am aware of antl untlerstantl I�e requiremenis ol Califomia Heal�h and Safery CoOe Sections 25505, 25533, antl
25534 antl Nat I or any �uiure building occupan� willlwill not (cucle one� neetl to comply wil� saitl state cades and the requiremen�s for a
permil loi con9mctmn ar motlificalion Imm �he Pir Ouali�y Managemenl Oistric�. flesieenlial constmc�ian apPlica�mns are erempt imm
I�ese pmvisians.
Oa�e: Applicanl:
hereby wtlity ��ai I have reatl �hls appl7caiion antl s�ate �hat ��e abovo Iniormalion is correcC I agree to comply wi�h all ciry antl counry
or0inance5 and nate laws relalmg lo building conslmclion and hereby aN� ' e r sentatives ol is cily �a enter upon �he above-men�ione0
pmpeny lar inspeciian pwoasesc.
Oa�e'. � � � + `� Signalure: �
.,
oriver's Liwnse or social Securiiy a: �
I6a4a6 WNte—Builomg: Green—Cotle EnlorcemenC Canary—Applicant: Pink—Revenue; Goltlenrotl—Assessor
�1 S 1 1 _ � , , .. 1 . �, J .
2300 RrROOt BY VA:,IIE RESIPENT'.A:.. NOZOVL 1.G0 2,300.00
END OF F�ES '
• /j .
� \ r
O1 0013EE71-0013E812 TO T 54.50
DATE: Q5/11/93 TItIE: 16:38
---� -�--------=----- --r--� ---- -- -- -� -- --------
� COi�Si RUC710'n� A�:D PLA�:RIt:G I � i
u'JC' C SP^.
APPROVALS Pe�nii=? Data �nsRecmr� R�PR01'ALS Pcmit-=---
-__ _- __�_; _-�-_ '--_._-___--_____
��1. Tempora:y Eiccv�ca� Serv�c�e o� �^in I � 52. Po:l C: Coi� �-n;:,�: !;,c„' °--- -
2 5n�1 Pipc�Undrprnd. --- - I:-�--�i --_ 53 Stcol IlainicrcPr.e�rt
d E�:�. n Co�d� L•,'�tv�U�i��:,�.y.; _ _ ' _-__' _ -i -64. f-�r�.�. - _- _"_ _
---- v_. �.= .-----I-----:---I 55 . !- . 3�,� ---
--t `--
(-:; � � ...,� � ,,, . --- � --- I. �� , ,, _ , �. .�_ ,.
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OWNER ypRWIN DATE 1�12���
JOB ADDRESS 948 Caznation Ave. BUILDING PERMIT N0.
FIRE
GAS
WATER
ROUGH PLUMBING
PROP. SWR. LINE [al0U5E CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH NEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUNO � POWER �
ROUGH WIRING
TRENCHES FORMS STEEL RE
FLOOR SVSTEM
BOND BEAM ❑ STEEL REINFORCE [
SHEATHING
FRAME AND FLASHING
LATNING - IN OUT
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. ANO A.C., FII
PLUMBING, FINAI nND GAS TEST �
ELECTRIC, FINAI
BUILDING, FINAL
SUBCONTRACTOR
► 35a��
3O1 CCOSTq MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completety
BUILDIN6 ..... .. .. .
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OWNEP �Q�in So. Calif.
ADDRESS 16255 Ventura Blvd.
TEL
CITY Encino, Ca. No.
CONSTRUCT�ON . _ _ _ ,__
BRANCH 16255 Ventura Blvd.
ADDRE55 Encino. CA
ARCHITECT � _ •. TE
ADDRESS YIUU Wilshire lilvd., t5ev. t1i11s
CONTRACTOR Larwin $o. Calif.
nooaEss 16255 Ventura Blvd.
ciT� No`.' 986-8890
Encino, Ca.
LIC No. 1913�� LICYNO. B—�
OF LOT VO X 1 OO I NOW ON LO � O
USE OF
EXISTING 6LDG.
NEW�BLDG, �957 ROOMS STOF
COVE R�INGALL SYUCCO COVOERING WVW
USE OF BUILDING AND WORK TO BE PERFORMED
'Construction Sinale Familv Residence
I hereby acknowletlge that I have raetl this application antl state
[hat the ebova information is corrBct and a8ree to tomply with
all laws regulating builtlin8 cons[rucNon, and I shall not employ
any person in violatian of the workman's compensation laws of
the Stata Of Calitomia.
I hereby c¢rtify thot I am properly licensatl as e convactor under
the Stat¢ Of California Business entl Professions Cotle, Oivlslcn 3,
Chaptar 9, nntl that such licenses ere in full forca antl effect, or I
am ezempt trom the provisions of xhe Stete of California Buziness
antl Prot¢ssions C tle, Division 3, Chapter 9.
SiBneture0�� � / D. Downs
Permittea �1//t/��'
A�thorize� qgent
�:��. �.�1
;n;� 2H-�3�;'°Gnt2oe� � 1s'- ;
APPLICATION FOR BUILDING PERMIT
:EI D/�.TE Fj�iEIVED DATE ISSUI
/ / /3 / /.Z- :
BUILDING
ADDRESS
FIRE
20NE
APPROVED
DATE
ZON NO.OF USE OF N ^ f
PLANS � BUILDING � ��4
YARDSAPPROVED VARDSAPPROVED
MAIN BUILOING ACCESSORV BVILDII
(FROM GL STREET)
F. SIDE ✓
L SIDE �
REAR 2O
DISTANCE BET.
MAIN BLDGS.
VAR. ;$
IiOLD
VALUATION
$aj�a�
BET. MAIN
ACCESS. BL
OATE
APPROVED
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- D T� o
UNDER VALUATION IS FOR �
LISHING A PERMR FEE ONLV: m
¢
RMIT FEE 5 � O� . O j
4N CHECK $ 50.75 E
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TOTAL FEE
Q� OWN ER Jq
Q.' JOB ADDRESS
�-�GENERAL CONTRACTOR
��PP No. 4�-i�4-io Li
. � INSPECTIONS
Pool Location
c
; � Forms
��-Main Orain
`�Steel Reinforce
Elec. Bond
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines _
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final _
Filter System Final
Backwash and Recep. Final
Fencing Fina1
DATE ��_
BUILDING PERMII
CRIPTION of WORK Art_ Sn�
E ZONE VALUE b 1.F,5i
ROUP TYPE
SUBCONTRACTOR
Dato
Electric
�,1-.- (i-
Plumbing
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fil/ in Completely
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CANSTRUCTION
BRANCH
ADDRESS
ARCHITECT
OR ENGINEER
ADDRESS
CONTRACTOR
ADDRESS
CITV
STATE
LIC. NO.
S12E
OF LOT sQ
VSE OF
EXISTING BLDG.
S12E OF
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NO.OF
CITY
LIC. NO.
NO. OF BLDGS. /
NOW ON LOT
EXTERIOF WALL ROOF
COVERING NoN-e- COVERING N��✓�'
USE OF BUILDING AND WORK TO BE PERFORMED
, -fr s D --�-� / • -
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APPLICATION FOR BUILDING PERMIT
RE�C�E_ IV�Sp BV ����CEIV� DATE �IS/SUED
l:ii � � /� oJ�-
-7 � I PERM�T , .'7
A.P. NO. I L�' O � �
BUILDING (� �
AD�RESS `
TRACT v LOT (Z BLOCK
W q I
OWNER
� V` E �
S �- $ %
FIRE
ZONE GROUP
APPROVED , � � �
NO. OF �
PLANS L
YARDS APPROVED
MAIN BUILDING
VAR. ak
C.U.P.ay+
USE OF NEW
BUILDING �
VARDS APP
ACCESSORV
IO F'
20 fT.
BET. MAIN &
ACC6S. BLDGS.
DATE
APVROVED
'"__ ��i -'��_
I hare0y acknowlatlBe that I have reotl t�is ap{jlication antl stete
thac [ho obOve intOrmatiOn IS cOrract antl aprae to comply with
oll laws ragulating builtling construetlon, antl I ihelt noi employ
ony parwn in v(olallon of Me workman'� componaeHon laws of
the State of Colifornio.
1 hereby <or[ify thnt I am properly IlcenaeC as e eanttector �ndor SQ. FT.
the State of Calitornle Businan anA Pro(esaiona Cotla, Dlviaicn 3, THE AMOUNT SHOWN UNDER V
Chap[ar 9, nntl that s�eh lieanms ero in tull foree entl efixt, or I THE PVRPOSE OF ESTABLISHING A
um exempt from ttie provislons ol the Statu of California Business VALUATION
one Professione C�tl (Dlvision 3, Ch�ap/[a�r 9. pERMIT FEE
$�QI1B[UfB O} V— � / / //�
Parmittae �� S / /_ [-�� PLAN CHECK
( / ((� aC
Avffiorizatl Agent
TOTAL FEE
STATE
/YO
m
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0
�A �ION FOR �
NIT FEE ONLV: m
¢
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J E
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