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Home My WebLink About182 BRANDYWYNE TERR - Building Permits j . CITY OF COSTA MESA . c r � BUILDING DIVISION > •/ ,,,,,,'r.. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F, 1 emirs• I irigi • PERMIT M06-00701• d. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 182 BRANDYWYNE TR Status: ISSUED Suite No Applied: 11/08/2006 Issued: 11/08/2006 Vicinity: GARAGE Parcel Number: 43926308 - ' ISSUED BY: II, i i Applicant: TEJEDA, GEORGE �/ Address: 2295 S GRAND AV Phone: 949-279-5575 SANTA ANA,CA Zip: 92705 tbitt Owner: STORME, DOLORES J Address: 182 BRANDYWYNE TER • • i!: p:,,'., Phone: ' COSTA MESA,CA Zip: 92627 Contractor: COAST AIRE Address: 202 E STEVENS Phone: 949-279-5575 SANTA ANA,CA Zip: 92705 License:355425 SCOPE OF PERMIT CHANGE-OUT OF A FAU IN THE GARAGE OF AN EXISTING CONDO. 1 INST FAU<100K BTU NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Ins(FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Ins!FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 • 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 . Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers - $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent - $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 .Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 COMMENTS/SPECIAL CONDITIONS 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 2446-46(800) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 work for which this permit is issued. 0have 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. ,021 2i My workers'comp satlon Insurance carrier and policy number are: (Carden 57“4,t c&d Policy Th r: /00/// 9 t'mfsectlon need not be completed Il the permit Is valued et one hundred dollars($100)or less.) ❑ 1 certify that in the partormence 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 California,end agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. p/47' ApPNmnt.SIgnatunr- Date" /2' a ' QG WARNINGFAILURE TO SECORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed u r•rovisio.s•f hapter 9(commencing with Section 7000)of Division 3 fjhe Business and ProfessionnsCode,and my license is in full force and effect.LI T q p icia r% - --4 Contractor'" sSiggnatur_e:�- i (Orth.7 // - 1. O( 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: Lender's 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 to 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 Code)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 Code: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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers 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? 0 Yes 0 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 form for acutely hazardous materials? ❑Yes 0 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 Calif omia 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification U from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 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 t000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 II 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? 0 Yes ❑No 8 (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 final inspection. Signature Of Legal Owner(s) Date Ar,_ // • /•D6 A • • uthorizedapplidant— Deta� soDE A INSPECTIONTYPE DAIS INRTIAL5 CODE( INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical i I/J (/G7 t-oni 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 Site 204 Final Demolition 250 Final Building/Occupancy • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTI•ONPERMIT 30 i?2 nd1, We/P, aea/ � �� Project Address , 7 N U ADD U ALTERATION ,"REPAIR OSSO 3/ 13/a: - T� ///LI'va�Z1�t Phone 0 TYPE OF CONSTRUCTION ❑ NEW ) f Applicant's Mailing Address Qr� / 0 Ve 11Q/ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name /,1//I n t1 Phone Sd DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Accessory Building: - Arch/Eng. License No. — TYPE OF PERMIT U GRADING U FOUNDATION E O • ❑ STRUCTURAL Front Address {{y{{{��}}}}}}��7��7yyyy}},�gypy �j y qq q ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N Contractor's Name i r;('ie. N//In?!- Phone OSgyoor ❑'OTHER C Right - - N. Address(mailing) ��Y(JC7k 7/`/jji IrV' PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left • G s6f/ / ti CONSTRUCTION TYPE VALUATION $ S n R City License No. 6!/ / ZONE GRADI NG CU.YDS. ACRES R �./ E LICENSED CONTRACTOR DECLARATION Ping. Ref.# (�E�VC� MAR PaFkin Provided 0 I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: R�G �� M with section 7000) of (Division 3 of the Business and Professions Code, and �� 1 1 T \:� my license is in f Pr e and effect. {''t(CD 1 S `Y License as LI en a .. �/ ,T RECO @ G \� Date ° n«k1�.i ignature tit/ - - . - .i/. PLUMBING FEES RS'COMPENSATION DECLARATION f Bar Sink Showers ELECTRICAL FEES ip I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink r}/ ) Automatic Washer Transformer 0 15-50 KW M3800, Lab. Fy)U{_J _7 / Policy No.r/+/_ Company A�/�7 S Backflow irrigation Sewer CapConstruction Pole Sub. 0 50+KW Certified copy Is hereby furnished. LCe r t ifietl 9Py'ii • with the city 9r Id' tyisi n Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps ' Date ((// / fat, Applicant i /r�� E%EMPTIa�FR• • WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). / Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I 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 Drinking Fountains Solar Tank Fan Workers' Compensation Laws of California. Motors 00-1 HP ❑1'h-8 Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016.15+ NOTICE:If,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such previsions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet - Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name Lender's Address Kitchen Sink Water Service I Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I em exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal 'Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00.5 KW 05-15 KW any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor to file a signed Statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/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 LIenalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole • Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered Reinspection Fee ! $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICALFEES License Law does not apply to an owner of a property who builds or improves _ _ __ __ __. thereon, and who does such work himself/herself or through his or her own _ DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date ;Mellon, the owner will have the burden of proving he/She did not build or im- Duct-Under Ground Building Approved By Date_.q_(�/,_ prove for the purpose of sale). . a� 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or Improves thereon,and who contracts far such projects with a con- — tractor(s) license pursuant to the contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT IDI am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBO# Fire Dampers � PLUMBING $ i✓ OU ISSUANCE $ Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $ information is correct. i agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives Of ti's city to enter upon the above-mentioned property for inspection pun• .s. iMECHANICAL $ 0 �j- ' rs / TOTAL FEE $ ,-JQ Drivers' Signature _ I s. �/ .. Date- /-3 /es-. 6:7, Drivers' License or SS ///' _ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ � rte.. CMF 0865-46.rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING Pt,,+L& SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 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 Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater &Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring • 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 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 ❑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 _ r 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final T"'s 40. Gas Service-Final iri 41. Solar Domestic-Final 42. Backflow Preventer (:L ..J 43. Backflow Irrigation tr- 44. Landscape Irrigation System 45. Sound Attenuation "•' "- r� _ 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date . a O4.'7,: �.1 `, COSTA MESA BUILDINGSAFETY DEPARTMENT 45fl 3/08/79 ' 1771,1 T�+ ' P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 Gb6G 3708/79 1'77.1'1'CKTD APPLICATION twrimman/sniff I For Applicant to Fill in Completely-Use• I y BUILDING �• 4/ GQN��g.ri nRECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS c&OS ,o &, , 60. 'o/ •,)/ / S /G(oW /ZC6• PERMIT NO. OWNERAS /� •1 A.P.NO. /JQ��Q/-pG I _ MAIL 24 2 SaS//lf� CY.TQ 02 I� ADIOS ESS Rs, tl/1 QJI1CALJ ADDRESS y •IYG 1G/f TELCITY/CU V& GA 9,27/5 No.83344 TRACT b r/r• LOT BLOCKrRUL-rION �{.�/� / ��x�� .�• NEN( ADD ALTER REPAIR MOVING DEMOLISH LENDER figai iVe 4 344//44 d�/j// BRANCH &/LtrtZE ADDRESS ! _ WNER �?�S A,izAt r 0 ..ve,p0 VALUE 43/ nap OR ENGINEERARCHITECT A O ///1�+� ��•1)KtNOL O. �'t S \ ADORE SS 7CS J s C � #/SS ZONE �ff GROUP `n APPROVED d CONTRACTOR �4/IvNse eo' c de• :Y , / DATE ADDRESSNO.OF USE OF CITY //) .Q NOL -_�J /y ZONE ` IPLANS BUILDING NEW F — STATE •r • CITY YARDS APPROVED YARDS APPROVED gLIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING /� Now (FROM C ST d OF LOT /;�j U•,o ON LOi Q•+ �R FT. a USE OF n�1 � EXISTING BLDG. R.SIDE/F FT. FT. in Fx- Separate permits are required for L.SIDE 3'f FT. FT. electric,plumbing and heating work. ^ Q REAR 0 FT. B FT. !F+•+� USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0 MAIN BLDGS. ACCESS.BLOCS. pane/ ,fssios vrinl Dom4% CV.AFILLP9111.IP a 5.--ROV709117,5-..^ ROVED 6' /9 //��g aABY t.(v([/t AA) DATE a9'7�/ IX ♦ Hnl.n FOR SPFCIAI, REOUIREMENTS a O I hereby acknowledge that I have read this application and state m gthat the above Information Is correct and agree to comply with m 6' all laws regulating building construction, and I shall not employ Z any person in violatio • 'e workman's compensation laws of - / [ r the State of Cacertify th.n . j69G SO.FT. `-� / �+‘ gig I hereby certify e ly licensed as a contractor under the State of Calif or : s -land Profession Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and tha II are In orca and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from • 1 • of . tate of California Business — m 1 VALUATION PERMIT FEE $ • I- - apter 9. n and Professions C•• rt Permittee of ;ill fat PLAN CHECK S/70 9.5 0 Permittee Serne TAX $ /� // 2 W (O 2 Authorized Ape ,i s - / TOTAL PAID $/7T. // U . !. s 9297 5/29/79 26_3:00 TU COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR-STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVED BY 1P=RMIT T For Applicant to Fill in Completely — Use Ink Only BUILDING ra3 A.P. NO. ADDRESS Lot 11 1:94-Brandywyne Terrace WNERTTENANTOR Yellow Brick Road Building Co- ADDRESS '! / ,V /�F�/�� IT OR MAILING SPACE NO. ADDRESS2082 Business Center Dr. , #145 TR.NO. LOT ELK. TEL. CITY Irvine No 833-8638 NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER Republic Federal Savings BRANCH Orange Branch /rit ip-17 t OWNER ADDRESS 2745 Orangewood. Orange. 92668 VALUE ` ARCHITECT Environmental TEL. USE $ OR ENGINEERStruCtlureS NO. 957-1811 a ADDRESS666 Baker St, #267, Costa Mesa ZONE TYPE GROUP APPROVED CONTRACTOR Owner Builder BY DATE ADDRESS2082 Business Center Dr. . #145 TEL. CITY Irvine NO. 833-8638 FSTATE CITY APPROVED SETBACKS LIC.NO. N.A. LIC.NO.19429 iLl SIZE NO.OF SLOGS. (FROM C/L STREET) a OF LOT 2.500 sq. ft. NOW ON LOT 0 -_FRONT FT. E USE OF CA EXISTING BLDG. It.Slr)F ET, to FEl Separate permits are required for L.SIDE FT. G electric,plumbing and heating work. REAR FT. GUUSE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q IDI -� Residential - New Construction 1 DATE APPROVED a APPROVED } ..$Y DATE .-1 'U W I hereby acknowledge that I have read this application and state n cg that the above information is correct and agree to comply with L all laws regulating building construction, and I shall not employ i Z any person In violation of the workman's compensation laws of 141 S the State of California. .: m 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, 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 PURPCGE OF ESTABLISHING A PERMIT FEEyONLY: e m aexempt from the provisions of the State of California Business VALUATION PERMIT FEE $e�b3 e'O 4 and Professions Code, Division 3,Chapter 9. n PLAN CHECK $ ^ Signature of ..�....i "d///��j/ u. Asset0 Permittee yelm S TAX $ '_ f Authorized Agent Date y' , Y TOTAL PAID E3 U /