HomeMy WebLinkAbout195 BRANDYWYNE TERR - Building Permits •
,5 NMF CITY OF COSTA MESA
BUILDING-DIVISION
arr> •-bl p 4. DEVELOPMEItT SERVICES DEPARTMENT P MIT NUMBER
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J• OM PERMIT B06-00821
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaBUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
• Job Address: 195 BRANDYWYNE TR Status: ISSUED
Suite: Applied: 05/26/2006
Vicinity: ROOF Issued: 05/26/2006
Primary Occ: R Type of Construction: V-N
Parcel Number: _42926302- Zoning:
Tpucmco023
Applicant: 8ISFELD
Address: 8941 MINT AVENUE
Phone: 714-847-7663 ISSUED BY:
WESTMINSTER,CA Zip: 92683
Owner: '(&39� f\E �
Address 195 BRANDYWYNE TER
Phone:
COSTA MESA,CA Zip: 92627-1577
Contractor: CALIFORNIA ROOF LIFE CO INC
Address: 8941 MINT AVENUE
Phone: 714-847-7663
WESTMINSTER,CA •
Zip: 92683 License: 509623
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL 7/16 OSB,50 YEAR G.A.F.,GRAND SEQUOIA COMPOSITION SHINGLES OVER 1 LAYER OF 15#FELT.38
SQUARES.UNITS 195-199.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $1,200.00
Permit: $44.85 Claim Valuation: $1,200.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $45.35
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
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,at provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
Se I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'coLenation Ins1ukance carrier and policy number are:
Carrier: 7.079-Z" FZG Policy Number: 17(0 3 P7? -zBoe
(This section need not be completed it the permit is valued at one hundred dollars(5100)or less.)
❑ 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 workers'
compensation laws of California,and 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 provisiio,
Applicant Signature: Date: C –�r0
WARNING:FAILURE TO SE •• • .",. SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND OOLLARE(al••,••'., • •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 under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.U S`09- - Class 8 C 3 9
Contractor's Signature: /f— _ Date: S`' --6 -496
CONSTRUCTION LENDING GENC
❑ '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,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end 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 driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division,
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 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 California 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? ❑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 a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If 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.
Date
n. ' :. icant Date
t
LODE I " r•. •' PZL 1NTmA15 LODE! INSPECTIONTYPE ZEE MERU
1616 Fixed S "Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 7 bat
Final Plumbing
200 Final Re-Roof !
/`3,0I) b, s 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.
CITY of COSTA MESA CONSTRUCTION PERMIT 11�,JJ .jy
PERfyI , 4/7 B TRACT NO. LOT NO. UNIT NO. - -
1003 I2/07/37 •,1,i; i•
Project`Address 195 Brandywyne rr -
Applicant's Mailing Address 195 Brandywyne TYPE OF CONSTRUCTION Li NEW LI ADD LI ALTERATION LI REPAIR
Owner's Name Joseph Scott Phont46-1230 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
DESCRIPTION OF WORK/USE OF BLDG.
Address 196 Rrandywyne S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT El GRADING L I FOUNDATION Li STRUCTURAL E Front 0
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name A—Alma Plumbing—Hew ingihone 530-2440 ❑ OTHER C Right N
Address(mailing) 10477 Trask Ave PROJECT DESCRIPTION SQ. FT. OCCUPANCY K g G
CONSTRUCTION TYPE VALUATION$ _ s Left
City License No. 4 ZONE GRADING CU.YDS. ACRES # ParkingR
LICENSED CONTRACTOR DECLARATION - Ping. Ref. Req./Provided ' E
1 hereby affirm that I am licensed un•• • r "•ns of Charter 9 commencing Remarks: Planning Notes: O
with section 7000) of Division 3 nd Pa-0 i•• Code,and _ ay. 1�/ M
my license is in u11 prce and of �� IJJ�I1 T
License Class ta- O — License _0307 ECtlVtIkDEG
1 RECEIVED DEC - 4 1987 S
/o Date 11-27-87 Signatu - PLUMBING FEES 1
bo
WORKERS'COMPENSATIO D CLARAT, Bar Sink
hereby affirm that I have a certificate of c• ent to self-insure or a Certificate ELECTRICAL FEES
3f Workers' Compensation Insurance, or a certified copy thereof (Section LI Showers I
i 3800, Lab. C.)978832 . Backflow Preventer Service Sink IIRepublic Indemintyio Automatic Washer Transformer 0 15-50KW •
Policy No. Company P0
M• 8 Certified copy is hereby furnished. Construction Pole Sub. 50+KW
' / C r ii o lis filed with the city ud iv HEATING Cooking
• ■ a a ' I
Date��— �— / Applicant �-W�'g§� �L97r�sINa—
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIONBathtubs • • , • . - Dover up • •a amps 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
work not employanyperson of any manner so as to become subject to the ,Drinking 1 ,■ • Motors ■• . ■
shall t CompensationLaws in California.
Date Signature Drains Inc.Solar 09-15
• ■
NOTICE:Compensation
making this ions declaration, you itshould becomeusubject to ith . ■ ■
16-15+
Workers' Compensation provisions of the 1-abor Code, you must forthwith Floor Sinks Urinal Fixtures
I
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas ServiceOutlets
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
Lender's Name 2Range
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for theGarbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or
Generator 5-15 KVV Trash Compactor
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays
any structure,s prior to nce, also requiresicethe tcto applicant for such permit
1 .' ■I ■
• to file a signed statement that he/she Is9 licensedcingpursuant to the provisions-700 ) f DrainsRoof
the Contractor's License Law(Chapter 9(commencing with Se/she 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
herefrom and the basis for the alleged exemption. Any violation of Section
/031.5 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 (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves Reinspection
thereon, and who does such work himself/herself or through his or her own • •'employees, provided that such improvements are nod w tendod or rered forsale. If, however, the building or Improvement is sold within One yeaear of cam- Zoning Approved By Datep , the owner will have the burden of proving he/she did not build or imDuct-Under Ground
-
prove rove ffor the purpose of sale). Building Approved •'❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structurallication Issued By Dat -2--
tractors t0 construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who • P1'!':
•ss sal BTU 0100,000
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that ■Exhaust System 0 Multiple ■ BUILDING
proof of their Worker's Compensation Insurance should be provided to me.
PLAN CHECK $ PERMIT
❑ 1 am exempt under Section - B.&I'.C.for this reason eel- Fire Dampersr __-
PLUMBING $
Date Owner Heating System& RegistersPLAN CHECK 25% $ ENERGY P.C. $
I hereby certif at I have Cad this tier '• and state that the above ■00-100,000 G 0100,00013T
• , ■ - .
information correct. I agree toea co city and county ordinances ELECTRICAL $
and state I. s relating lob ding •� n, and hereby authorize repre- •e
sentatives f this cit • enter u'' - - ab•ve-mentioned property f•r PLAN CHECK 50% $
FILM $
inspec -0' •
•ur•. - de
Signatu•.\��� ��i �•,!� y TOTALMECHANICAL $ 11
Driver License or SS Jr � '�� $15 . issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND-PLANNING POOL& SPA
APPROVALS Permii•# Date Inspector APPROVALS Permit# Date Inspector
1..TemporarytElectricalService 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 & Pressure3Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER;GGNITE
7. Footings - 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Tesi
9. Water Pipe`Undrgrnd. 60. Backwash Lines,P-TraF;❑ 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 0 Gas 0 Oil
..23. Gas Pipe-Rough &Test 72. Underground Flush
• 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
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 PREV. 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: pa..g9 LCq-cp• C C-D
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace t' `
38. Final Plumbing (-1244j tb c, r, '
39. Water Service-Final -- - -
40. Gas Service-Final i_
41. Solar Domestic-Final c '
42. Backflow Preventer C
43. Backflow Irrigation . t.
L.
..
44. Landscape Irrigation System L.
45. Sound Attenuation N
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING I -
r } '
48. Special Requirements Completed ^ i
49. Electric Release to Edison
I •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
W04.1 e t 4 9 I q 5 • .,
•
COSTA MESA BUILDING-SAFETY DEPARTMENT 4618 3%09)79 rr
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 {4,� -� Irr�l-�-
APPLICATION FOIlrS RU� (SNIT IQ �•
For Applicant to Fill in Complete) Use I k Only "``"''�4�4�,�,
��ssg9 RECEIVED BY DATE RECEIVEO DATE ISSUED
BUILDING pat 04144-5 F
ADDRESS no$75:1 ..&%4I Nap .tea/111\\\LO� �� r'1 PERMIT NO.
OWNER. falai) Sis[s-?g a +D ts A.P. NO. -OBI -v/
MAIL i^^ ���jjj"�""""_''''''''' /s BUILDING
ADDRESS..2e,f2, �/ S3 Q • p#2 ADDRESS BI/,LLs•1 s.W/•✓G Imo'
�/JrJ n ` TEL. •�.� y •� TRACT loy G LOT BLOCK
CITU T/]/J(AJE /faFI 7L7/a NOr•S ali
LENDER
ST�RUCCiTIOly�J e� r NEN( ADD ALTER REPAIR MOVING DEMOLISH
LE ,s awe T ( ( S
BRANCH Q�Q1{(J4E
ADDRESS
/74/SEGAt/4/4 g44, 6 OWNER
.}•
VALUE
OR ENGINEEP� 1� ftra 2-me NOLB33 X63/ USE $
1 FIRE
ADDRESSIQ' $(af1 ZA, DsQ• ZONE TYPE GROUP
fR// L� /�� ffff/2.. APPROVED
CONTRACTOR C {/ r(/C BY DATE
ADDRESS Aditi ZONE /^/ NO.OF USE OF NEW
CITY TEL. / K,. PLANS 2 BUILDING
STATE �/� NO. �/a
F CITY fffJ YARDS APPROVED YARDS APPROVED
LIC.NO. PM LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLDGS. (FROM C/L STREET)
O. OF LOT R(tp • NOW ON LOT _0e" ROM FTS . FT.
Q
y EXISTING BLDG. Al R.SIDET. sils' FT.
CM
2 Separate permits are required for L.SIDE i 2- FT. FT.
I—.
C electric,plumbing and heating work. REAR _ FT.
1.1.1 USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCEABET. BET.MAIN&
0 MAIN BLDGS.` �,�j ACCESS.BLDGS. 1
73 DuOi�r s(oe�ptiAa a`ifu�v4 VAC URP M�S-76 1 APPROVEDgfr 7g
APPROVig .I/l I'�• n^t� 29
} ,BY C�(/��MC DATE •;79
z MOLD FOR SPECIAL 1'EOUIREMENTS
a-
a e,
0 I hereby acknowledge that I have read this application and state n
Cg that the above information is correct and agree to comply with m
0• all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of 2
the State of California. i _
17ZI16
3 I hereby certify that I ••erly licensed as a contractor under ��i "� SO. FT. �/ N
the State of Californ . ii' f • and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, end that . . are In full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY;
am exempt from �• I f the St. •1 California Business v
VALUATION PERMIT FEE $
and Professions C•.1, • - • �•Ch.- .r9. h
m
1 • PLAN CHECK $ /7a Qs' c
Signature of ///yyy��� (C ! LL
Permittee .ter/LA ,,r��s.s S (/y ct, TAX Sr /- /6 u.
Authorized A:.nt �� 0 0/(//TJVT(/// TOTAL PAID $777 /1 U
ligirr
9291 5/29/79 263:00 TU
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVED BY PERMIT G�
For Applicant to Fill in Completely - Use Ink Only II7 2 c2
BUILDING /9 A.P. NO.
ADDRESS BUILDING /0
OWNER OR ADDRESS / A5,.42,4Ab zahVE T
TENANT Yellow Brick Road Building Co. J
UNIT OR
MAILING . SPACE NO.
ADDRESS 2082 Business Center Dr. , #145 TR.NO. LOT BLK.
TEL.
CITY Irvine NO. 833-8638
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER Republic Federal Savings /!1
BRANCH nrnngera-
RnCj7
OWNER (t/ &xc 7TDAn LSD
1
ADDRESS1745 Orangewood, Orange, Ca 92668 VALUE
ARCHITECT Environmental TEL. USE $
OR ENGINEERStructUreS NO. 957-1811
ADDRESS666 Baker Street, #267, Costa Mes- ZONE GROUP
a
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./9429
SIZE NO.OF DGS. (FROM C/L STREET)
L OF LOT 2,500 sq. ft. NOW ONBLLOT 0
FRONT FT.
Q USE OF
V) EXISTING BLDG. R.$1DE FT.
CI)
E.-1 Separate permits are required for L.SIDE FT.
O electric,plumbing and heating work. REAR FT.
• USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q
A
DATE
• Residential - New Construction APPROVED
7 APPROVED
>. DATE
Ci
W
O I hereby acknowledge that I have read this application and state N.
N
p2 that the above information is correct and agree to comply with
IW all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of e
Eli S the State of California. m
• 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 a
Chapter 9, and that such licenses are in full force and effect or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
co
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ ��tOa e
and Professions Code, Division 3,Chapter 9. v+
m
Signature of , PLAN CHECK $ �— o
Permittee 7 .ol /J $ 0
TAX $ .— a
or U
Authorized Agent Date Ct 7S=Z� TOTAL PAID Soo