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Home My WebLink About236 BROADWAY - Building Permits(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DFiNE, GOSTA MESA, GA 92626 JobAddress: 236 BROADWAY Suite: Vicinity: ROOF Parcel Number: 42540310 Applicant: ALBERTSON, MIKE Address: 351 N NEWPORT BL SUITE 462 NEWPORT BEACH, CA Owner: O'BRI Address 236 BR m CA I � l-:.. % ��.b��y.."�' ` j �`� Phone Jl ' � J � 'v � �. J r . t ,,��,2��i �1 f / `i. n �Z�p:`'"` ! 1 � t�f 1 � ��License. � (?:<< � � 'ir,^v.�� 1 /-i�C-�" ."� _ ,,_� ,�,,, "�% � - / A ^.. �OFF,EXISTING.ROOFS. INSTALL PLYWO �GE.`WORK,TO B�E DONE CONCURRENTL �,.t, .:� �-i .s �, � � i ,.. ; � �� jPlan.,Check� ,, r � �Permit � ". SMIP Res �r�,�'SMIP Com , .�\ ; Other Zoning: Status: ISSUED Applied: 11/OS/2002 Issued: 11/O5/2002 �. i� / � • �t�i/ �YZip: �?� 92663.�-i'=�z—:�..'- :,.m.:.... 1-�-��-� i-....., ' �.wc_:...p..�r:ti.. e , s �.. : I i, t _ � �� :. . ,i , � , ,'`�.;. `�-.� '�� '-�''�{7 � `� ,� ,f k „-�` '°., ' �'`� r. �v �'btn� =f�`} ! F"� t �� \��\ Ph�one ( Y w y�, f k^ , �:\ 'Zi 92627 2820 '�� . ( \ ° ��.� � ��`�ui`' �.T^>_ *, + +i� { �,.\ � �� \ K�`:'��'. ' \`, �; �� t . { ` ,%� � Phone: (714) 850-0166 �`�� `v` �� .4�Y.\,� icense:r,517602 ,`�},\ s i`�. � �' �\ , Eng. �. 1✓"��, Address. E �i ! �,�.� '.�` -- � ��.#, ,1 f } ;r':�; t, � � r'' �7 � y� j" �' ' �a� �.c✓ }s`'-� � � � x��i \ r �r SCOPE OF PERMIT ".-�^\ ' OD CDX, CLASS A, 30 YEAR COMPOSITION SHINGLES. 2,800 S. Y._..a5c.��.�_--�.-.�.� -.ar�..�=s—=--'r , - � . __ _._ _ �. �,... �i 1�r'-'k L�_� v�?�.�_FEESU �}f � $0.00 '� � �;,�t $12525 z.r-�.,='�,�` �:�.., s'�n��$0 ;60 ��! ----4�,--� `�`�` �' �� ;.�'$0.00` �U��- _ ."' _ ' �'; i �� a$0 OOx ��"'$0 00„��' . S �T c, � \'\�l`b�� $125 85 ` '�� "`_',��;��°=: � �< � �`�a\�.�,��:;.�•,, � ' �%°��'' J <' y �`�`��d `��nF�PLANNING L �.'�l � t "a' : x.3Y�^5i'� . ";� �,. , „ SETBACKS�, ��,� `��1 �—.�� j� 0�7 y�+,�rr MAIN STRUCTURE Front!�°�0- 0 �° R�ear �� a 0 0 G` �. � '�;'��- C� +��"rf= ��'`�``�.�. o`u�o � �i ACCESSORY ',,`�F`ont��0-0 �fr,,,ti Rear= 0"0,�� ;f.`-�-�, �''�� l��.I' G'��. �'`"''^.�—_,' PARKING Existinq: 0�� Requved:,�; o ��'"� : �� E��_;f'-:Y �_ ~�` ��.��' °�%'�;� � � .,� � 0 OJ � � � t . .� � : Valuation m Valuation ,,:,� i _• � � ": 0-,Oi �/ `~� /�� . i� {`i;� �✓ ' " � �0-0/ V �✓ �'1'�,% 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, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for iha work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all reqWred Inspections and tinal epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626� .ncoco �ww� WORKERS' COMPENSATION DECLARATION: � I hereby ettirm under penalry ot perjury one of iha tollowing declarations: , ❑ I heve and will maintain a certificete ot consent to self-Insura tor workers' compensation, es provided for by section 3700 ot Ihe Lebor Cotle, for the peAormance of the work for which ihis permit is issuetl. ❑ 1 have and wlll maintain workero' compensation insurance, as requiretl by section 3700 of ihe Labor Cotle, for the pertortnance of t�e work for which Ihis pertnit is issuetl. My workers' compensation Insurence ca�ner end policy num�er are: Cartiar. Policy Numbec � (This sectlon need nat be completed ll fhe permif is valued et one hundred dollars ($100) or IessJ T�1 certiy that in 1he peAormanca of the work for which this permit is issued, I shall not employ any person in any manner so as to bacome subject to ihe workers' ��•compensetion laws of Calitomia, end agree that If I should become subject to the workers' compensalion pmvlsions of Seclion 3700 of the La6or Cotla, I shell fort�wit� � comply with these provis-ion�s.. n y� ApDlicenPSignelure:r �r1�.iL.. I �f� �Data:�. � � — ."r� — O Z- u=_,x �WARNING:FAILURETO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL ANO SHALL SU&IECT AN EMPLOYER TO�CFIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED THOUSAND DOLURE (5100,000), IN ADDITION TO THE COST OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR M SELTION 31O60F THE LABOR CODE, IMEREST, AND A170RNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm,ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) oF Division 3 ot the Business antl Professions Code, antl my license is in full r�°�"a'.��:axn�i' ati S I% h� Z „�3°"r�i^': �. /. i G CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirm that ihere is a consimction landinq agency for ihe pedormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aNirtn ihat untler penalry oi perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business end Professlons Code: Any ciry or counry which requires a pertnit to construct alter, improve, demolish, or repeir eny structure, prior to its issuence, also requires ihe applicant tor such permit b tile a signed stetement ihat he or she is licensad pursuant to the provisions of Ihe Contractore Licensa Law (Chapter 9(commendng with Sectlon 7000) oi Division 3 ot ihe Busineu end Professions Code) or Ihat he or she is exempt theretrom and the basis for the alleged exemption. Any violetion of Section 7031.5 by eny applicenl for e permit subjects the applicant to a civil penalty of not more Ihan five hundred dollars ($500).): ❑ I, as owner ot ihe properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl ihe slrucWre is not Intended or oflerad for sale (Sec. 7044, Business and Protessions Code: The Contractors Licanse Law does no� apply to an owner of property who builtls or improves thereon, antl who tloes such work himself or hersetl or �hrough his or her own employees, provitletl that such impmvemenis ere not intendetl or aHaretl for sale. If, hawever, t�e building or improvemen� is sold within one year oi completion, ihe owner-builder wili have the burden of proving thet he or she did not builtl oi impmve for purpose of sale.). ❑ I, as owner of the pmperty, am EXCLUSIVELV CONTRACTING WITH UCENSED CONTRACTORS to constmct the prolect (Sec. 7044, 8usiness and Professions Cotle: The comractors License Law does not epply to an owner of property who builtls or improves the�eon, and who conlrects for such projact with a contwctor(s) license pursuant to the Conirectors License Laws.). ❑ I am exempt untler sec. Business end Professions Code for ihis reason: Signature: Date: Owner ID ventied by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification ot Ownership by (type ot doament, I.e. - O�oPerry tan blll or deed): .. DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON: ❑ I hereby certify ihat no excevetion tiva (5) or more leat in depth into which a pereon is required to descend, wiil be made in cannection with work authonzetl by �his permit, and �hat no building simcNre, scaHolding, falsework, or demolition or dismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Title e, Celifomia Administrative Cotle). . ❑ As owner-builtler, I will not employ anyone �o tlo work w�ich would require a permit irom the Division of Intlustrial Safery, es noted ebove, unless such person hes e pertnit ta do such work from the dlvision. Signature: Date: Division of Industrial Safery Permit Numbar. HAZARDOUS MATERIALS AND EMISSIONS CERTFICATION: 1 Will the applicant or present or tuture building occupent need to file end certify a Business Plen lor emergency response to ralease or threatened releese of e hazerdous ma�erlal? ❑ Yes ❑ No (Section 25505 of ihe Celifomia Health antl Satery Cotle requires, wiih some exceptions, that a eusiness Plan be tiled with the Costa Mesa Fire Depariment by every business which has at any one time tluring a reported year a quantity of hazardous matenais equal to or greater than a weight of 500 pountls, or e volume of 55 gallons, or 200 cubic teet of compressed gas at standard temperaWre and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will I�e applicant or present or fuWre building occupant need to tile a registretion form for acmely hazardous materials? ❑ Yes ❑ No (Saction 25533 of the Calltornia Health and Satety Code, with some exceptions, requires registration with the Cwla Mesa Fire Departmant by eech busineu which at any one time has on hand e quantity of acutaly hazardous meterials equal to or greeter then e weigM of 500 pountls, or e volume oi 55 9ellons, or 200 cubic faet of compressetl gas at stantlard tempereNre and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will tha appiicant or present or tuWre building occupam neetl to prepare an RMPP (Risk Management and Prevention Progrem for acutety hazardous malenals)9 ❑ Ves ❑ No (Section 25534 oi the California Healih and Safety Cotle D�ovitles that the Costa Mesa Fire Department may require �he preparation, ceriification antl filing wlth ihe Fire Department oi en RMPP by businesses which are requiretl to register ecutely hezardous matenels with Ihe Fire Depanment. .......................................................................................................................................................................................................................................................................................................................................................................................: 4 Ii en RMPP is oresentiv reouired. has Sec�ion 25534 of �he California Heelih and Safetv Code been fullv Comolied wi�h7 ❑ Yes ❑ No 5 D085 Or will the appllCent or presen� or fuW ra builtling occUpan� r0quire Pof Ibe Wolk WhlCll IS Ihe SubJeC� 0� thls a plita�ion apB,rtnl� �or SUch conStNCtiOn or motli�iCetlOn trom the South Coast Air Oueliry Menagement District or tmm eny other air pollution conirol district or agency? � Yes LJ No (Section 650502 ot the Calitornie Govemment Code requires ihat ihe requested information be lurnishetl on applicatlons tor non-resitlential 6uiltling permiis). ........................................................................................................................................................................................................................................................................................................................................................................................ 6 Will any part of Ihe taciliry to 6e construded under this pertnit ba within 1000 teet from the omer boundanes ot a school? ❑ Ves ❑ No (If "yes", Ihe tacility must meet ihe requirement of Seciions 25534 and 42303 of Ihe Califomia Healih entl Safety Coda). ........................................................................................................................................................................................................................................................................................................................................................................................ 7 If a permi� irom the South Coas� Air �uali�y Management Distnct or o�her air polWtian conirol disMct or a9ency is raquired tor Ihe work which is ihe subject ot IhiS applicatlon, have all oi ihe tlisclosures prescribed by Califomia Health and Salary Code Section 423W been made9 ❑ Ves ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................ 8 Qf'yes", ettach cenificete of compliance irom the appropriate eir pollution control oHicer). CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury ihe information given a�ove is correct. I agree to compty with all state lews and ciry ordinances regarding Hazardous Ma�erials antl Emissions. Signature: Da1e: CERTIFlCA7E OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I certify under penalty of perjury that 1 have read �his application and sta�e that the information given Is corred. I agree to comply with all state laws antl city ordinances ralating to builtling conswction, and authorize representatives of the Cily of Costa Mesa to enter upon Ihe ebove-tlescribed property for inspection purposes. I agree not to occupy or allow occupancy of eny building authonzed by Ihis permit until final insDection. COOEI, INSPECTIONTYYE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Root 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 � Final Dem IZ1i�CiY111.i4. ll-lt-o2 �_ COUE 1 INSPEGTION TYPE 206 Final Mechanical 20B Finel Plumbing 210 Flnal Eiecirical 212 Final Fire Prevenlion 220 Final Planning Approval 222 Final Site 250 � � Final PdIE It�L4 � * . ._ . jcOUN'I'YOFORANGE AppCicaiion for Building Permit - /J '`�•� � BUII,DING DEPT. ' � - Permit No..-_.:I�. ..�.�'...�i_� . 636 No. Broadway AND FOR A _ ,_ SaataMa�CaGfornia �. CQ�tlEicate of Use and �ccu anc - � Phone: KI 2•6211 ., � P Y � � - Date.../.p....-"-- a=.Q..'_c'...a...Z......."'-_"_'_' 1. OWNER'S NAME........W.. � ...al--.__�-�.11..1..f-.k--E- ............ - -------------------------�� --- ---- PHONE:.b�.E:---S �.�.(a_.: <% MAILING ADDRESS -� �.L 8- � ...L.`I_�...._.. ---5-� �----- - -- ---------------------- - --- CITY_Gei.S.:�!�. ------r�E-5-�----- Name (Architect or Engineer) Address ' City _...-'-- - - -- ....--' -.....-` '�---... -.....----- --- -- State Lic. No. -- ....... ---- --"--- --- Phone--...-'----- ------- -------'-'-- Name - ��y- -..C'.�.fl/..S.T-�f'.w-�-T�-Q'J------C'-�---� (Contractor) Address ._[z�...$��cz........11.�.�.W_PA...(s?-T----..�.t.��-II-'_---- City .....J.i(.�.G.1..Pc�..RT---��.RG..!a-r'-C��'''`c'----• State � Lic. No.-1-P--�%-°Z-�...7..-------- Phone.li/� __3��....%9.------ PROPOSED USE:-----.....�--�_S.!.�..�%_�lbLC--�-------�----�-�-?'---�-�--`-'-,-�i.PA_G E----------------------------------�----- -- ---.......--�--------- z. Joa LocnTioN- ---�-3.�- - -�----3.R o_A.3�--��'-Y----------------------------- -----= =�'o s-��--�1_ ��,�t-- - - ------- ----� ------------- (House No.) � (Name of Stceec) � (Town or School District) NAME OP AND DIRECTION FROM NEAREST CROSS STREET......C�.�.%tilf�Lfv..E...A.u_�._,________________t,.�__�_S_t'________ 3. LEGAL DESCRIPTION: Lot-------.[-Q-------------------_.------_-------Block ----------...G..-_-.- (Metes and Bounds Description—Use revetse side of form) 4. CORNER LOT ( ) INTERIOR LOT (�) THROUGH LOT ( Tract----�- � Sl.....--�--- -�---� SLOPE OF LOT (�j i. SIZE OF BLDG.:__.3.(a_2S_.�_1.....AREA:----1.3._8_�----.-----SIZE OF LOT:....r�b?i..../.3..�.---.AREA:...-�9 7�_V------------- 6. HEIGHT OF BLDG.:.._____�02--� .......................CEILING HEIGHT:.......8_.�.3_��.._..__...NO. OF STORIES.........%.................... 7. NO. FAMILIES----....---_-.--C------._......-._-Size of Smallest Bedroom:....I..�_X....L/ ................ Size of Kitchen-_1..'2--X.!_�?_.-------.. 8. EXTERIOR WALL CONSTRUCTION:..__..f..�.�f.i'L'2.�'±C: �u«.`YNTERIOR WALL COVERING..___.�hA_S.r.E_/�___._..._. � (Frame, Smcco, Etc.) (Plaster•Drywall, EtcJ ROOFING COVERING�'�-.`-"�--_�.N/ N 6/- � 5---_----------------- -- ........ - - � - - -- -__ ...............-- - -�--� -..._.... 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH._ .................N..a..N_�..__....__...._._..__..... / 10. SETIIACKS: Front Yard From Center Line of Street-----...__.<+.�..d'-_-----��.......---'--.---....-'--'----'-_-_---------------_-_-----................--_---.-. Nearest Side Yard-----_3..--�.----_--Reaz Yard..�� .....---Distance in Feet Between Bldgs. on Same Lot----_a�-$-_�-.__--._._..-.-----.-. (Property Line) (Property Line) ' . 11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. �� ,� �. 12. (a) Footing: Width....-.------------ ....................Depth in Ground.......L--z.---..........Width of WaIL------i�°----------.-------... �, . . „ (b) Size of Studs:...a...X__5�.....I...Spacing.........L(e....0_C.:'CC Material of Floor...�lX__�v_____.._l.U._C�_.�_.. 13 ]4. �/ � ., i (c) Size Of,Floor Joists:.-----fi---.� � .....................Spacing--•--...y.....:.._......._...._..:'CC .. � . (d) Size of Rafters:......-�'x-��-------� -- ---.Spacing -a-� -- -- - : ...........: `CC ' VALUATION OF PROP05ED WORK: -Including all labor, plumbing, electrical wiriag, heating, fire sprinklers, painting and� sewage disposal $-....I.� �....4. �:C?--------------------- - . I HEREBY CERTIFY T,HAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE. COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Plans Filed FEES: Bldg. Permit Plan Check rotat - - Receipt No. Paid to - . - (Authorized Agen[) FOR DEPARTMENTAL USE ONLY �� GROUP....� � �------- --- " �d........ TYPE..------� ---------.....--�---- - ----------- DIST. , _ �MnP...--�� ---.1�.._�f.... � -- - ..._----- SHEET NO.---`-7------- � -- -- I»l:i�lYtl DATE.---l�l...-- --`--�--�-- ---=s-�. S000-->-s1 ' ZONING----------. �----- PLANS AND � SPEC'S --- -----....... - ---- CORRECTIONS IH'f! � HEALTH--�----....---�� - - ---- FIRE MARSHAL..........- -----...... STATE....--� -`----...-- ------- ENGINEER � �covrrrroFowarres -• Application for Building Permit • �/ � �L . BUII.DING DEPT. � . � Permi[ No...Y..� :3.a`/- 636 No. Btoadway AND FOR A . s��a.�a,Califomia CertiFicate oF Use and Occu anc I Phone: KI 2fi211 , P y Date...lA...-....2.o-r-?-Z .............. ....--- 1. OWNER'S NAME__.1!v. �.,.I--,....1SL�.u.1.�...�-_.�........- ---�- �----.........--- ----- ----- ------------ PHONE:�.....�� :.4a-=-� MAILINGADDRESS.........a..l �� -----.1...4-�-----.ST------------------ --- .......-------� ._. CITY---C.Q9..T..FJ-.K.E-SA-------------- � Name---...'-------'-----'-----'----�---------------`--'--`--...--'------------------.... Name ..�-Q..%......L4:N_STR_l1..C..T.t-n�s�-----'�.o.,....---'-------- (Mchitect or Engineer) ' (Contractor) ! Address ......------ -�--------------------- ------------ ------------------ Address .a?.$.� �+- -- N�.Gc2..P_v..4.-�--- -•�k.V D.-----....---- Ctcy .....-- - - - -- ...:... � - : ............ .. ..°- - - --.......... C�cy -- ��.r.s1.P.. 0.�2..r.. -.._...��kfc, �f --.._.....ck?..c..[5----- State • � , � � State . Lic. No.....-- ----- ....----... Phone ----......------ --._..... Lic. No.�.C1`f1.J-2.�--�--....---� - Phone_t!Fi.,.--3�--7�------- PROPOSED 2. JOB LOCATION .��3-fc`-� .....................��P..ft.A..�sl../t.Y_.._---�----.........-----�---�s.�--'�--r�---(±fl_6cSA....._...--�-----�--��-------------- . (House No.) � (Name of Stre�t) (Town or School District) NAME OF AND DIRECTION FROM NEAREST CROSS STREET....C%!Q9:/'�.6.�....G.I:.Lt.�________________W..E..S_T...__...... 3. LEGAL DESCRIPTION: Lot----- - Li'1...------- --........._-----Block - - '� - -- -----..... --- -- Tract- -----a---Cr--�-- -- ---- - (Metes and Bounds Ducription—Use reverse side of form) � . 4. CORNER LOT ( ) INTERIOR LOT ( x) THROUGH LOT ( ) SLOPE OP LOT (—j i. SIZE OF BLDG.:----c.�.�'.x--'i�{.AREA:......�i.�.5�ca---...-----..SIZE OF LOT:---�-o-K.-L3--f------AREA:.....ra.ZS_C�..-.---- 6. HEIGHT OF BLDG.:...___ll _� ....................:.._CEILING HEIGHT:....__.....�..�........._..... NO. OF STORIES.........1_.___....__...._..... 7. NO. FAMILIES ..............�::...__._....._._._..Size of Smallest ------------------------- Size of Kitchen---'--------'----- S. EXTERIOR WALL CONSTRUCTION:.._�T�_C �_Q.._....:...INTERIOR WALL COVERING.__....._.. ��.^.�E .............. (Prame, Smcco, Ete.) ' , (Plaster•Drywall, Etc.) _. ROOFING COVERING -- -- ..4v.G24...D... - .....S--f.f1�LG �` f � S --- - -�- ---- -....--�� ---..... -- - -..... 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH.._ .............../�LO.__ME____........__......._... ..r 10. SETBACKS: Front Yard From Center Line of � / .- / , � Nearest Side Yazd.....c� ................Rear Yard.......5._...........Distance in Feet Between Bldgs. on Same Lot.._..__.�.�........_....:............ (Property Line) (Y�operly Line) 1L A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. ,. � , .. 12. • (a) Footing: Width-----.--/..i�---------------_------.11epth in Ground..-.------!_Z..�..--.-:-Width of Wall---......--�----------....... (b) Size uf Studs:..�?�..�._.......Spacing....___t_L--..��-.----:'CC Material of Flbor._.._`'�.�_,�.UNCiCE i F ____'__________'-"- (c) Size of Floor Joists:--------... �------.....------.--Spacing----------------------�-_......--- �CC (d) Size of Rafters:.....c21.. �..�......-- � -......---?- Spacing......---- �-.,�. _..•�_... ----...."CC 13. VALUATION OF PROPOSED WORK: Induding all labor, plumbina, clectrical wiring, hcati�g, fire sprinklers, painting and sewage disposal $....___.�'1..��•' - - --..--- �-�-----...... 14. I H�REBY CERTIFY THAT TO THE BEST OF MY KNOWI.EDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. . cc�.,o�t� �A � co.vsr,P vc r-� o.�� to . - Plans Filed:--------�---------------��------------.._- .........................B a�e�l � . Y'----'-------�� -- --- -' --^----�-----------------'- � (Authorized Agent) . � FOR DEPARTMENTAL USE ONLY FEES: � � Bldg: Permit ' $----�f--o��--------�-- Plan Check - $-----��---�..- -- ---.... Total . , . $---s--- - �- -....... Receipt No. - 2�- �-----..-_- Paid to • � - •------------- - Date -----------�-----------�D.��}...�_..:..�%. s000--�-sz GROUP...... � TYPE---.-.�...--' ...... ... ...... DIST. v,� MAP----..._-'-��:-----v�� - j -- -- SHEET NO.----'�.-----.----- � -a-� s. �-. �K1Nli BY APPLICATION __ .. .._.. HEALTH ....:....................... ZONING-_----_----..��.-- FIRE MARSHAL--�----- . ............ PLANS AND �_. SPEC'S -- ---...------- - - - -- . STATE..........- ...... .. .....--- CORRECTIONS ENGINEER PERMIT I S D BY: c�-' ` e-�'