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Home My WebLink About2512 BOWDOIN PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesaB.UILSDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2512 BOWDOIN PL Suite: Vicinity: RESIDENCE & ATTACHED GARAGE Parcel Number: 14141220 Applicant: ENRIQUEZ, MIGUEL Address: 1420 E EDINGER AV #111 SANTA ANA, CA Owner: LORMAN, YURETTA Address %LORMAN, GARY COSTA MESA, CA � 2512 BOWDOIN PL Contractor: BEST VALUE ROOFING Address: 1420 E EDINGER AV #111 SANTA ANA, CA Zip: 92705 Arch : Address: Zip: Phone: License: Zoning: � Phone: (714) 542-5222 Zip: 92705 � Phone: Zip: 92626 Phone: (774)542-5222 License: 715903- � � Eng: .Address:' ISSUED BY: Status: ISSUED Applied: 05/17/2001 Issued: 05/17/2001 Phone: License: � "' J -, SGUPt UF YtKIVII l ' , . - REROOF; T/O EXISTING ROCK ROOF, REPAIR SHTG AS NEEDED,"1 �LAYER 35#�FELT & 1 LAYER 15# FELT, 25-YEAR � COMPSHINGLES. . � �, � . � � 23SQUARES , � ,. - ' " � � � .. . � _ FEE SUMMARY'� ;;= _ _ _ ' , : � � Plan Check: $0.00 Calc Valuation: � Ss;000.00 Permit: $11125 - �� Claim Valuation,;'� . � �Ss,000.00 SMIB Res: �� $0.50 � - �-'�•- i;'% : . , r ; SMIP Com: � $0.00 - � i�� Other: $0.00 _�'��' ' ' ,��, , „. , , _ ; , Inspection: $0:00•: � � �`��r;. .:ii ^ � � -. .� � , � � _ , � , , - >v Y / Total: $111 75 �' �� _ �- � = , ' � �� ' . �� i �'\ ��/ r;__ ��j��` ' , , � � _� _�'=i%>`'�i�; /i;'�" ��\ \ `,\ + i / ��`% ,'"�, �'`a` SETBACKS �` � MAW STRUCTURE Front _ 0- 0� -' �„�Rear ,�0-0 ACCESSORY Front 0-�0 '� ,_ Rear 0-0. PARKING Ezistin : 0 Requi�ed: , 0: NOTES: LANNING'BZONING%% ,-'��,��"�/i ! %�� , r, `. LeR .0- 0 - � � �, Right� ` 0- 0'. . � � . _ _ , � �i i/, �, �: . - Left , 0-0 � Rightj';0-0 . - , - � -;i�` i " � �i � Proposed::; .,0-! : . NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No, g2-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or ahandoned for a period of 180 days. � INSPECTIONS: In qrder 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 (inal approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aas-as (sroo) WORKERS'COMPENSAnON DECLARATON: � � I hereby aHirm untler penalry of perjury one oi Ihe following tleclerations: ❑ I heve enC wlll maintain a certificate of consent ro self-Insure tor workers' compensation, es provitled for by section 3700 oi tha Labor Cotle, for tha pertormance of ihe work tor which Ihis pertnit is issuetl. �� I have entl wlll maintain workere' compensation insurance, as required by section 3700 of Ihe Labor Code, for ihe peAormance of the work for which this pertnit is issued. My workere' compensation Insurance cerrier end policy number ere: _ Carner. Policy Number: _ (This sectlon neetl not be comp/eted i! Me peimit Is velued et one hundred dollars ($100) or /ess.J ❑ I certiy that in ihe performance of ihe woAc for which this parmit is issued, I shall not employ any person in any manner so as to become suDjec� to the workers' compensetion laws of Calitomia, anA egrea that if 1 should become sub�act to the workers' compensation provisions of Section 3700 of ihe Lebor CoOe, I shall forthwith comply wlth t�ese provisions G� f Applicant Signeture: ��-y�� Date: J" � �^ � 1 WARNINO: FAILURE TO SECU�JORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNORED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVI�ED FOF IN SECTION 3]Ofi OF THE LABOR CADE, IMEFEST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn that I em licensetl untler provisions of Chapter 9(commencing with Sedion 7000) of Division 3 ot Ihe Business antl Professions Cotle, and my license is in full torce afW ettect. llc. a Gass k CoNrectors SigneWre: � � � Da�e: S� ^ 07 �� CONSTRUCTION LENbING AGENGY: ❑ I hareby ettirm that there is a conslruction lending agency for the performance of Ihe work for which ihis pertnii is is5ued. (Sec. 3097, Civil Code). Lender's Name: Lenders Adtlress: Signature: OWNER•BUILDER DECLARATIONS: Date: I hereby efllrm �hat untler penalty ot perjury that I em EXEMPT FROM THE CONTRAC70R5 LICENSE LAW for the following reason (Sec. 7037.5, Business end Professions Code: Any city or counry which requires e permit to consiruct, alter, improve, demolish, or repeir eny sWcture, prior ro its issuance, also requires the epplicant for such permit to file e signetl statement thet ha or she Is Ilcensetl pursuant to the provislons of the Contractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 oi the Business and Protessions Code) or that he or she is exempt therefrom entl the basis tor the elleged exemption. Any violation oi Sectlon 7031.5 by eny epplicant tor a pertnit subjects ihe applicent to a civil penalry at nat more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages es iheir sole compensation, WILL DO 7HE WORK, and ihe structure Is not intentletl or oflered tor sale (Sac. 7044, Business and Professions Code: The Coniractors Licensa Law does not apply to an owner of properry who builds or improves thereon, antl who does such work himself or herselt or through his ar her own employees, provided thet such impravements ere not intended or aHeretl for sala. If, however, ihe building or improvement is sold within one year of completion, the owner-builder will have iha burden ot proving ihal he or she did not build or improve for purpose of sele.). ❑ I, es owner of ihe Droperry, am E%CLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the project (Sec. 7044, Business and Pmfessions Coae: TTe wnirectors License Lew tloes not apply to an owner oi property who builds or impmves thereon, and who contrads tor such projact with a contractor(s) license pursuam to the Contrectors License Laws.). ❑ I em eaem0� under sec. � Business antl Professions Code for Ihis reason: Signature: Date: Owner ID venfietl by tlrivefs license. ❑ Ves ❑ No Drivefs License No. Venfication ol Ownership by (rype ot document, i.e. - properry tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: E:pires: ❑ I hereby certify ihat no exwvation five (5) or more feet in depth into which e pereon is require0 to tlescend, will be ma0e in connection with work euthonzetl by ihis permit, and iha� no building siructure, scaHoltling, falsework, or demolition or dismantling Ihereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifornia Atlministrative Cotle). ❑ As owner-builtler, I will not employ enyone to do work which would require e permit irom the Division of Indusirial Sefety, as noted above, unless such parson has a pertnit to do such work from the division. Signature: Date: Division ot Industrial Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AU7HORVA710N OF EMAY: I certity under penalty of perjury ihat I have read this application and state ihat the infortnation given is correct. I eqree to comply with all state laws antl city ortlinances relating to building constmction, antl authonze representatives of the City of Costa Mesa to enter upon the ebove-described propetly tor inspection puryoses. I egree not to occupy or ellow occupancy of eny building euthorized by this permit until final inspection. GOUE 6 INSGEC110N7YPE 1676 Fixed System Final Fire Prevention 1266 Pool Spe Finel 200 Finel RB-Roof 201 Final BIocWRetaining Wall 202 203 Final Faciory Fire Place Final Sign 204 Final Demolition OpTE INTRIALS -2 ! � S-�i^O� Date CO�E♦ INSVECTIONTYGE 206 Finel Mechanical 208 Final Plumbing 210 Final ElecMcal 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency PA7E irrmu�s � ` CITY OF COSTA MESA . • � BUILDING DIVISION ROOF COVERING CERTIFICATION Permit No. //D� vD �� Property Address o� S �� 1"70 W� O I� � �• Owner GiJ' �. � O f mt� v� _ Contractor K7es� Va.�'tiZ Koo �i �� Lo. �✓� C' State Contractor License Number "l I�S 'r'I C7 � Classification C— 3�i I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Buildi�g Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instrudions of the manufacturer. ❑ I fuAher certify that I am the owner of the properry. (Owner-Builder permittee only). � I further certify that I am: ❑ Owner of sole proprietorship company ❑ Full partner of ihe company ❑ Limited partner of the company � Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of fortn to the Building Division for acceptance. Received by Building Division By: � � %,i � _ . 0980-�6 MWeR] Whi�e-euiltlingDiv.;Canery-ConVecmr;Pink-Owner es-�- �Q ��i �u � Qv o-�i`n� �. T hc . Cartipeny or Cpporete Neme ! �-(r�i � �� (=cQ �✓t�P.r Q-VC � � � l , naare ��Sw�( C.��.•�,��. Pnnted or Typed Name � � PBOJECT p00NESS: Z J 1 � ��wU��lN p�. UNIT: OWNEfl'S NpME: LORMAN, Y[JRET?A aooeess: LORNAN GARY zsiz abwDo�ra �L � COSTA.ME5A CA 92626 �'' (714)'/51-6.F,90 AflCH/ENGINEEB: MC L tAN S SCHIIi�TZ flEG.NO.: S 2 i J O aooaess: `.2000 EAST CHAPNAN AV • uxir: FCiI,LERTON CA .92631 PEflMITTEE: GARY LORMAN ('719 ) 751-6590 aoosess: 2512 BOWDO.IN PL COSTA MESA CA 92626 UCENSEo CONTHAC7aB oEClANA7lON: I hereby allirm ihat I am Iicense0 under pmvisions of Chapter 9(commencing with Section 7000� ol �rvision 3 0l I�e Business antl Pmlessions Code, antl my license is in �ull �orce ana eflec�. CITV LIC.: - STATE LIt.: ClASS: " �ate' Signature� WOBREHS' COM7ENSpTIUN OECLNXATION: I hereby a��irm that I have a cetlificate of consent to setl�insure ar a ceni�icate o� Workers' Compensation Insurance. or a cerllfled copy I�ereoi (Sectian 3800. Lab. C). POLICY NO.: EXP. DATE: LOMPRNY: � Cenifietl copy is hereby furnisnetl. ❑ Ceniliea capy is liled with ine ciiy Building �ivision. Oate: � Applicant^ ESEMPTION FHOM WOHKEH$' COMPENSATION OECLAMTION: (ThiS se[Iion nee0 nol b¢ cOmple�eU il �he permii is lar we hunOreO (5100) Or 1¢55�. I ceNty tha�jn ihe petlormance of Ihe work for which ihis permit is issuee, I shall not employ any pe6on in any manner so as to Decome sublec� to t�e Workers' Compen5aiion Laws,ol Cah�omla. , �aie'. ' Signature: NOTICE: I�, afier making Ihis tleclaraiion, you shoultl�become suble�� o �he Workers' Compensaiion pmvisions oi Ihe Labor � Code. you musl forihwith comply with_such pmvisions or �his permrt shall be 4eeme0 revoke0 CONSTflUCTION LENOING pGENCY: I �ereby aftirm Ihat there is a conSVuction lentling agency �or �he pedormance of �he work lor wnich Ihis permll ls lssuetl (Seclion 3097,'Civ. C�- LENDEN: ' aooxess: OWNEB BUILOEP OECIAflFTION: I here0y affirm Ihat I am exempl Irom the Coniractors' State License Law 1or ihe following reason �Section 7031.5 Business anA Professional Cotle: Any ciry of counry which reduires a permit Io cons�mc�, alter, impmve, demolisn. or repair any stmcNre. prior �o ils i55uance. als0 re0uire5 �he apPlitant for SUC� permi� l0 lile a SigneO S�alemen� �ha� he/S�e is lic¢nsed pursuanl io Ihe pmvisions ol lhe Coniraclors' S�a�e License Law �Chapter 9(cammencing wilh Section 7000) of Division 3 0� Ihe Business ane Pmfesslons Cotle) or Ihat he/sne is exempt iherefmm and ihe basis Ior ihe allegeA eMemD��on. Any violation ol Section 7031.5 by any applican� tor a permii sublecis �he apDlican� to a civil penal�y of nol more Ihan Irve hunOreU aollars (5500�. I. as owner of Ihe pmperiy or my employees with wages as Iheir sole comDensa�ion. will do ��e work, antl Ihe ❑ stmqure is not imenaea or oHereO br sale �Section 7W4. Business ana Pmlessional Code: 7he Contracrors' State License Law Does not appty ta an owner o� a pmpeny who builOs or improves Ihereon, antl who does such work himseli/hersell or �hrouBh �is or her own employees. pmvitlea Iha� such impmvemenis are not imendetl or o��ered Jor sale. If, however �he builtling or impmvemen� is soltl within one year ol compleiion. Ihe owner will �ave Ihe burtlen ol pmving he/she did no� build o� imp�ove ' �or �he purpose ol sale). I, as owner of Ihe DroDerty, am exclusively coniracting with licensed coniractors lo consiNcl Ihe prolecl (Seclion 7044, Business ❑ and Pmie55i0n5 Coae: T�e ConiraClOfs' S�a�e Litense Law Ooes noi apply lo an owner of pmpehy who bui105 or improves �hereon antl wha conirac�s lar such pmleci5 wi�h a conlracior(5)license punuanl �o �he ConVac�ors' S�ate License Law�. I am awa�e that pwo� ol Iheu WOBer'S Compensa�ion insurance should be pmvided Io me. [X� � am exemp� unaer Sedion� B P 7O 4 4 B. 8 P C. m�tnis reason: ALL WORK BY OWI�ER� Daie: ��% —2-� � % � /(Iwnec � I tlo hereby cenity �hat I am aware ol and untlerstand ��e requiremen�s af Calilomia Heal�hS a Safety Cotle Sec�ions 25505, 25533, and 25534 and Iha� I or any lulure builUing occupanl willlwill nol (circle one) neetl Io comply wilh sai0 s�aie co0es an0 �he reQuiremen�s br a �, permil �ar canstmciion or modilica�ion �mm Ihe Air Duali�y Managemen� OisVict. flesiden�ial cons�metion applications are exempi imm �� he5e provi5i0n5 � Da�e'. � U —2"Cl'�l � pPPlicanC �ln�4 I hereby certAy ihal I have reatl Ihis applicalion and slate ��a� �he ahove In ma�lon is wrretL I agree lo compty with all ci�y and counly ortlinancesantlsia�elawsrelatingtobuildmgco mc�ionantlherebVauthorizerepresen�ativesof�hiscirytoenterupontheabove-men�ioneA pmper�y lapr ;mspeclion purpo5e5. � Oate: /V '2-k — 9� SignaWre: ��"y r� orive�S �icense or socia� securiiy a: �641 a6 White—Bwltling; Green—Cotle Enlorcemem: Canary-App6cam: Pink—Revenue; Goltlenmtl—Assessor CITY OF COSTA ,'�1ESA - BfJTLDING PERMIT axi, ��v: rs �v i7 PaRNIT NO: H 0597'79 PLAN CHnCK NO: 0909G-9T �S vuvi: �v Svrr�; rv CONSTRUCT'TON 1'YPE; 5-A3 ' PERNI i T'YPE; STR PURPOSc: OTH JOB DESCRIPTION : INSiALL ONE SATELLITE DISH ANTnNNAB SQ FT: 3,000 CLAIM VALUE; 3,000.00 CALC-VALUE: 3,000.00 GROliP OCC; R-3 / COMffiENT.S; SMOKE DETECTOR ( S) RE�IUIRED 1i�1 HOME. iFiEiE'lEiEiFiFiFiE1EdF�b�fiEifiEiFiEiFiE3fif3eitieiEi(�ifif�JF ?Fi(�if:f�lPif!E��1F�1E1EiEiFi6lEiEifiFiEiFiElFifii�lF�lEiE#E#�f�iFiEY.3ElE?fiflcii-Yti�iF�RiE>:�?Eici: Z O N I N G R E�� U I R E M E h Y S S E T B A C K S ------------ MAiN BUILDING ---------- --- ----- ACCaSSORY BIJZLD1Nt� ------- — FRNT: 20 rT ZN REAR: 10 F'P TN FRNT: FT IN REAR; FT TN LEFT: 5 FT IN c�GAT; 5 cT IN LEcT; F'T IN RGHT; FT IN PARKING REp• FROV: PARCEL; I414122U ZNE: R1 REF NO: PLAAINING NOTES> PERMIT-TO ADD A SATELLITE D�SH ANTENNA TO AN SFR, i !f iF iE if-1c iF iE �E 1f iF iF iE?f iE 3E 1t ie it� iE it' if i(� iE iF iF iF �If lE iE if it iE iE ii- iE ir iE iE kit 3E ib i't if K- i4 if if if if fE 7E ii� Y.� 3F k if i't iE ii 1F �el4 iY 3f �R 1'r )E 3i�iE if iE } 1E 4� 3f if if ii- D E V E I. O P M E N T S E R V I C E S R E Q t7 _T R E M E N'T S � 20NING APPROVaD �Y ,� DATE: �O 2 � BUiLDING APPROVED BY ; ' DAT'r:; � APPLTCATIOiV ISSUED $Y: � � DATE: v �2-� � iEiff%iE�k3f3flfiFiFiEiF±fiFiEie3EiEifiEiiif�FiF3F3F'x�{FTF3F7F'iF7FiFiF3Fifir?FiF�ii3F �'�7F ii1L'�it_g.iFa%r'Fa'r34iF�iFiFiEi'r3i�i4ir � ��'�Y�?'r}� i%fF ")I"If !E'IE iE Y"If ii' iF IE jI"1(' jE' iE'IF 3i' 3E' iI' i!' iE")F'IF �E iI"x"IE' Y.' i%!E' 1E"N"1F"I¢ iE'%"If")'I' ih iF±S' iE if IF iE iE')I' lE' i��' IF if'lE'IE"N"lE' #' iE �.' i(")C-'k �- 9i' )F iI' iE iI' ic'iF iE lR'K'-}' it' Y} J4 jr iEGALIZATION:N F'� E E S U M M A R Y � STRUCTURAI.� SEG,��NT;Y BLDG PMT PLUNBING cLECTRIC MECHANIC FIRE SMIP/RES� GRADING PERMIT 54.U0 .50� PLAN 35.10 SMIP/NON_,RLS ISSUE FEE �'�= Bt7ILDING-DIV-> PcRNZT ISSUE PLAN-CHECK TOTAL PAID � DUE TOTALS----> 59.50 0,00 35,10 89,60 89.60 .00 REVENUE DSVISTbN TOTALS — 7 COLLECTED: 59.50 GVER/SHURT: ' 00 BI.DG PNT PLUMBING ELHCTR.TC MEC�HANIC F'IRE SMIP/TOT GRAIJ�NG'�A.LAPd-CcIcCK 54.00 , ,SO " ,-: ielE iE af iF iF �k 3f �)t �!F if �k � iE le 1F iE iE iE } 3c �1E 3f #e * 3!� # if 7'r fF�?E if� k ii� IE If if'F i(� �1F �:� lE iE 3F ik±F ik ii if iE i'r i(� 3E ) jf iF lE )F iE iE �)c iE iE 1i if i'r !{-if !E iF� 3F � 3F �Y.- fi 3r % ic ii� I N D I-V I D U A L F E E B R E A K D O W N ^ �. ,TYPE Q!Y D E S C R I P't I O N " UNIT COST 'TOTAi COST SFft 30U0 ALT�R BY VALUE RESiDENTIAL NOZONE 1.OQ 3,U00.00 • END OF FEES ♦ 'C; fj1. k�li�li..._. :i.��i - — . �.'-7c; '... , . .. .".: � -. .' �. - . . . . . _ ... - PO � SPA - - . .. . CONSTRUCTION AND PLANNING - APPR�,VALS Permit # Date Inspector AppROVALS Permir # � Date -Inspector' , 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location �` � ! . � 2. Soil Pipe-Undrgmd. - 53. Steel Reinforcement � �- ' 3. Electrical Conduit Utility-Undrgmd. . 54. Forms . . � . 4. Electrical Conduit�Undrgmd. � . 55. Electrical Bonding � � 5. Steel Reinforcement ' /�� q'� 6(,U� 56. fiough Plumbing & Pressure Test . 6. ElectritalUFERGrnd. � 57. APPROVALTOCOVER�GUNITE 7. Pootings /��z,-(.j .��Ca.d 58. ElecTrical ConduiFUndrqmd. � � 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. �. 60. Backwash Lines, P�Trap, O Undrgrnd. ,� 10. Structural.Floor SYstem � 61. APPROVAL TO DECK � 11. Property Sewer Line & House Co'nnection 62. Backwash & Receptor�Final . ' .^ 12. Sewer Cap ,. 63. Heater & Uent�Final � • 13. Roof Drains � 64. Plumbing System - Final 74, flough Plumbing 65. Elecirical-Final � 15. Rough�Electrical-Conduit � 66. Solar System-Final , ', � 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Reugh Wiring Sign ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning " FIRE DEPT. REQUIREMENT' 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts,in Structure �-. ., 70. Underground Hydro 22. Ducts, Ventilating - - 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test ' � � 72. Underground Flush " 24. Roof Framing - 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing . 74. Overhead Hydro '- 26. T�Bar Ceiling (Structural) & Monocoat �- 75. Dry Chemical • -� � 27. FrameandFlashing �� - 76. DryStandpipe . � 28. Lathing & Siding 77. FIXED SYSTEM'FINAL ' 29. Insulation � � 78. FIRE PREV. FINAL � _ 30. Orywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION , 32. Electrical Power Meter-Final � ' I 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' t �� Notes: �' � 34. Final Heating & Air Conditioning I - . -, _ 35. Final Gas Pipe-Test ` ' ' 36. Hood or Canopy - � 37. Final Factory Firapiacc • 38. Final Plumbing � . ' � �, � 39. Water Service�Final ' • - 40. Gas Service-Final � - � 41. Solar pomestic�Final � � - 42. Backflow Preventer . � 43. Backflow Ir}igation � � � � � 44. Landscape Irri9ation System , . 45. Sound Attenuation - 46. Handicap Regulations �. • 47. FINAL STRUCTURE & BUILDING `;4 �Qf�( 6u,� � q�� ol� 6�v� < 48. FINALPI_ANNWG � • ,� . 49. Elearic Release to Edison � � . � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY � No. Date CITY OF COSTA MESA BUILDING DIVISION OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature.� Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the pro- posed property improvement. � Yes ❑ No 2. I(have/have not) �qv� signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name — Address City Phone ( ) Contractor's Lic. No.. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name _ Address City Phone ( ) Contractor's Lic. No. 5. I will provide some of the work but I have contracted (hired) the following persons to pro- vide the work indicated: Name Address Phone Type of Work I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my per- sonal knowledge, ' compliance with this State law. Signed: ��ddz�.�+.�. Date: !0 - 2.f -�t f Name: %,A2 1 �2rnqnJ ' (Printed or Typad) C.D.L. N or S.S. #�. 754-5273 � . -, g04� COSTA MESA BUILDING DEPARTMENT P. o. eox 3 n COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN COSTA MESA. CALIFORNIA OWNER . MA�� 1555 ADDRE55 ARCHITECT OR ENGINEER ADDRE55 LEGl�L LOT OESCFIPiION NQ, A.P. NO. s[ eOrc � E%ISTING BLDG. INE FROM TEL. �BfiCh� CHZ• NO. 9au�e. . LIC. NO. COrjst♦ C�• CITYLIC. l�,yl, NO. �� C�i�IL� �� w'�� a �ses flN��vCE DEPT.n l''rY �r �.rSin �'1_�Jt APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY BIIILDING AOORE55 COSTA' MESA. CALIFORNIA TEL. APPROVE� NO. � S�e BV pATE e�ocK rancr zg$2 CORRECTIONS NO.OF BlOGS, O PIOW ON LOt REAR YARD SIDE YARD RIGHT l LEFT �I DESCRIPTION OF WORK NEW p ALTERATION AD�ITION REPAIR MOVING OEMOLISH SUZIEDING�LIl�/7O ROOMS V STORIES 1 Vl 4a. EXTERIOR WAIL ROOF L �A COVERING $tl1CC0 COVERING LLOt.—:n0 t,u �lJSE OF �Ew residence and att. garage BUILDING The Amount shawn under valuation is for the I MEREBV �1CKNOWLEDGE TNAT 1 HFVE READ THIS APPLICATION ANO purpose of esiablishing a permit fee only. STFTE TN4T THE �BOVE IS CORRECT AND 4GREE TO COMPLY WITH 4LL CITV OROINPNCE AND STATE LRWS FEGVI,ATING BUIL�ING CONSTRVC� riorv. VALUATION SIGNATURE ' PERMIT FEE S 3S�OO PERMITTEE 15,967�00 pLAN CHECK $ ��'�O $ I AUTHORIZ o nceNT • - TOTAL FEE $ SZ�SO SM�