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HomeMy WebLinkAbout1089 DANIELLE DR - Building PermitsPY OF COSTA MESA REQUEST FOR C JPANCY TRACT NO. '3� p(p(o DATE LOT NO.gi _zn n n ADDRESS ! n R q The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he -she -they) (was or were) advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. BY �w By De'eloper llnd/or' auET orized representative (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 1089 DANIELLE DR Suite: Vicinity: HOUSE & ATTACHED GARAGE Parcel Number: 41207419 BUILDING PERMIT Zoning: R1 R1 77 FAIR DRIVE, COSTA MESA, CA 92626 Applicant: SELL, RON ISSUED BY: Address: 17072 ROSEBUD Ph 714 993 3328 Status: ISSUED Applied: 09/07/1999 Issued: 09/0711999 CA _ one. ( ) _ _ YORBA LINDA-.' Zip: 92686 - - - i Owner: ROBERTSON, KEVIN Address 1089 DANIELLE DR Phone: MESA; COSTA CA _ Zip: 92626 Contractor i SELL ROOFING COMPANY 11 Address: A 17072 ROSEBUD-' Phone: 714-993-3328 �\ • YORBA'LINDA CA ' Zip: 92686,;' License: 323842 •- -, Arch %, /. Eng. r - Address: - Address: " - Phone: - - Phone: - Zip: License: - ,`License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED,GARAGE (27SO). TEAR OFF EXISTING SHAKE ROOF & REPLACE SHEATHING WITH 1/2" OSB. INSTALL 2 -LAYERS OF 30# FELT,UNDERLAYMENT & REROOF WITH "EAGLELITE ` MALIBU" LITE WEIGHT TILE (5.5 LBS) --ICBO #4660. FEE SUMMARY Plan Check: $0.00 _ Calc Valuation: $8,800.00 Permit: $167.25 Claim Valuation: $8,800.00 yi SMIP Res: $0.88 /' r 'SMIP Com: $0.00 Other: Inspection: Total: SETBACKS $0.00 $0.00 $168.13 MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY ,Front 0-0 Rear 0-0 PARKING Existing: 0 _ Required: 0 NOTES: PLANNING & ZONING Left 0-0 Right •0-0 ' Left 0-0 Right 0-0 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 1. WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' compensation in rant i, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' co do l sura corner a olicy number are: / Carder: Policy Number: 6 Y (This section need not be complete if the permit Is valued at one hundred dollars ($100) 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 Celifor ' d agree at if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisio Applicant Signature: X Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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 ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under rovisio s of plat 9 (commencing with Section 7000) of Division 3 of the Business and Profession Code, and my license is in full force and effect. Li, x Class N — 3 Contractors Signature: Data: / e9 — CONSTRUCTION LENDING AGENCY: ❑ 1 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). Lenders Name: Lenders 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 Cr 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, An 2, Sec. 341, Title 8, California Administrative Cade). ❑ 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 Cade 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 ❑ 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 ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appeit for such construction or modification from the South Coast Air Quality Management District or from any other air Pollution control district or agency? LJ tm Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications tot 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? ❑ Yes ❑ 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? ❑ 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. 1 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. Signal gal Owner D7 _ 7 q Q An r�rize`d Applicant Date CODE.. INSPECTION TYPE IjAjj AL CODE? INSPECTION TYPE PATE INTITIAL¢ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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 2"&46 •i m 17 w,r � r w7s ++ �' /tOg% .?&t) &IC D11.Building Address CITY OF COSTA MESA t DEPART IPIT OF f /y2 BUILDIF:G SAPETY J 1411,,t),✓ /qVLL( Contractor Registered Deputy Building inspector - .3 A/EGe POST �fitc� Certificate of Compliance q e Address Permit Date Date of this Certificate _(,�Jumber Q?L " Issued // To the Director of Building Safety:; t = ' - I hereby certify that the following portions of work on the buildings .'- I at the above address which required 'continuous inspection and which I was .r employed to inspect, were inspected by me and comply with the provisions d +'•_ of the Building Code applicable thereto. • f - �a 1) Concrete 3) Welding 5) Special Cases 2) Masonry 1 1.) Reinforced Gypsum S �Slze Gunite hand. Pack .5011 41 "e'7 - Sacks Cement .:3�� Tons of Sand /,o Approximate % of water in aggregate 5;70 This report covers work completed during week ending__ RLHARKS;?(j REGZ ER D DRPUj' UILDIhG I::SPFCTOR Name Laboratory WnJ/.0 G /J Telephone �7/'",-3�•sE_ / - Form BU 6 C �•E'/1.C�GE C-O� - , - '73K �y+ , —•,lr * < r i" .^ ' �t -- � i ! ;" •.. :ny- n •rn n� j :'a'' Z � f 'r �.. P.. e• CITY OF COSTA MESA t DEPART IPIT OF f /y2 BUILDIF:G SAPETY J 1411,,t),✓ /qVLL( Contractor Registered Deputy Building inspector - .3 A/EGe POST �fitc� Certificate of Compliance q e Address Permit Date Date of this Certificate _(,�Jumber Q?L " Issued // To the Director of Building Safety:; t = ' - I hereby certify that the following portions of work on the buildings .'- I at the above address which required 'continuous inspection and which I was .r employed to inspect, were inspected by me and comply with the provisions d +'•_ of the Building Code applicable thereto. • f - �a 1) Concrete 3) Welding 5) Special Cases 2) Masonry 1 1.) Reinforced Gypsum S �Slze Gunite hand. Pack .5011 41 "e'7 - Sacks Cement .:3�� Tons of Sand /,o Approximate % of water in aggregate 5;70 This report covers work completed during week ending__ RLHARKS;?(j REGZ ER D DRPUj' UILDIhG I::SPFCTOR Name Laboratory WnJ/.0 G /J Telephone �7/'",-3�•sE_ / - Form BU 6 C �•E'/1.C�GE C-O� - , 20 Zs A Twin inq Laboratories of ,�So,gEl,Z nilfotnia, -Y,=. 3310 Anport Wav / Misting Address P O Bo, 47 /Long Be:rcn, CA 90801 12131 4263355 ' 12131 6362386 / 17141 828-6432 TESTING BRANCH OFFICE 1514 D Nmm na:pei SnPe: Sana Ann. CA 9]703 117141 531.1045 November 28, 1979 Examination: SC79-6404 COMPRESSION TESTS ON GUNITE CYLINDERS Mr. Errol F. Heesch 12921 Aspenwood Lane Garden Grove, California 926110 PROJECT SPA FOR MR. & MRS. HANLEY ADDRESS 1089 Danielle Drive, Costa Mesa SAMPLE FROM GUnite Spa Only ARCHITECT ENGINEER MIX DATE CAST DATE TESTED CYLINDER NO. COMPRESSION TOTAL LOAD, LBS. POUNDS PER SO. IN COMPLIANCE CYLINDERS 4} to 1 11-6-79 11-16-79 1 10 -Day 38,000 1,530 COMPA'I OR Irvine Pools SUBCCNTRACIOR S & A Gunite SPECIFIED STRENGTH 2,000 psi CYLINDER SIZE 1: 5-5/8n x 1211 2: 5 ZEE x 121E 11-24-79 2 18 -Day 53,000 2,230 18 -Day test complies with specifications. MADE. BY Donny DISTRIBUTION E. F. Heesch - 2 / Mesa Bldg. Dept. DELIVERED BY Heesch 3 "HOLD IN FIELD" RECEIVED ON 11-8-79 G Z • .R 2 s �22W�� Foy Twininq Laboratories of �ouEi1 3310 airport Wav / Mading adm ess PD. Box 47 /Long Bench. CA 90801 / 12131 426-3355 / (21 31 636Q386 / (7t al 828-6432 TESTING 9RANCN OFFICE 1514 0 mann nsarr Siren: Sarna Ana, CA 92703 r 0141 531.2045 Examination:, SC79-6404 COMPRESSION TESTS ON GUNITE CYLINDERS Mr. Errol F. Heesch 12921 Aspenwood Lane Garden Grove, California 92640 PROJECT SPA FOR MR. & MRS. HANLEY ADDRESS 1089 Danielle Drive, Costa Mesa SAMPLE FROM Gunite Spa Only ARCHITECT CONIRALIOR Irvine Pools ENGINEER SUBCONTRACTOR S & A Gunite SPECIFIED Mix 4} to 1 STRENGTH 2,000 psi DATE CAST 11-6-79 CYLINDER SIZE 5-5/811 x 1211 DATE TESTED 11-16-79 CYLINDER NO, 1 2 3 "HOLD IN FIELD" COMPRESSION 10 -Day TOTAL LOAD, LBS. 38,000 POUNDS PER 50, IN. 1,530 COMPLIANCE MADE BY DELIVERED BY RECEIVED ON CYLINDERS Donny Heesch 11-8-79 DISTRIBUTION E. F. Heesch - 2 Costa Mesa Bldg. Dept. UWNtH HANLY UAlt II -LU -/y JOB ADDRESS 1_089—Datdel la Ort.ve __ BUILDING PERMIT NO._ 49199_ _ AP No.419—n71—nR LOT 9? TRACT 9RF(, FIRE ZONE VALUE $ II Poo I. I Form: Main Steel Elec. Apprc Under Gas P Filteri Backv Electr Heate F' B. __a Fenci CTIONS - Si nature Date GROUP TYPE ZONE .ocation SUBCONTRACTOR PERMITS iSSUEr Num6c_ I S_gnntura Drain ?einforce 3ond Electric val to Cover - Q • C - l -2U N.r ground Electric ping Test Plumbing ng System Lines :rR J,, 'a f o 9 -7-o-717 71-576-1 ,ash Lines and Recep. cal Final and Vent Final I• System Final ,ash and Recep. Final Ig Final & A $ `� C. J -- COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT .F.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 50 TL REC V D Y P R IT I I *TB ­­49199�y 1� For Applicant to Fill in Completely — Use Ink Only ADDRESS /W� IE C A P NO OWNER OR UILDING i DRESS / - ,A' v TENANT /Y UNIT MAILING N SPACE NO. ADDRESS TR.NO. LOT BLK. TEL. CITY NO. NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH 71 WNER ADDRESS VALUE ARCHITECT TEL. USE E OR ENGINEER ADDRESSU� ZONE TYPE GROUP BYFROV ED CONTRACTOR t / cr�S DATE ADDRESS TEL. CITY NO. STATE CITY APPROVED SETBACKS LIC. NO. LIC. NO. SIZE NO. OF BLDGS (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. USE OF EXISTING BLDG. Separate permits are required for L. SIDE FT. electric, plumbing and heating work. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APPROVED By nATF I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any parson in violation of the workma ' compensation laws of the State of California. 1 hereby certify that I am proper ensed as a contractor under SQ. FT, the State of California Busine Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such I' s oia In full force and affect, or I THE PURPOSE OF ESTABLISHING A PERMIT EE ONLY: am exempt from the or ons the State of California Business VALUATION and Professions Co v' to , Chapter 9. PERMIT FEE E :• PLAN CHECK E Signature of /©e' Fermi ties 5 /(� S TAX E or /1 H/ /✓ Author Agont Data TOTAL PAID E 50 TL 0 I N -9-77s00 517 J*** 235.00 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED By DATE RECEIVED DATE ISSUED BUIf.DING ADDRESS PERMIT NO. OWNER A.P. NO. MAIL ADDRESS BUILDING /D ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION NEW I ADD I ALTER REPAIR LENDER BRANCH OWNER ADDRESS L USE ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR s BY DATE ADDRESS TEL. CITY NO. ZONE NO. OF PLANSBUILDING USE OF NEW STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT, USE OF EXISTING BLDG. R_ SIDE FT, FT Separate permits are required for L. SIDE FT. FT. REAR FT. FT. electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR, ys DATE C.U.P.# APPROVED APPROVED I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person in violation of Mo workmen's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the proylslons of the State of California Business and Professions Code, Ivision 3, Chapter 9. VALUATION PERMIT FEE S PLAN CHECK $ / Signature of I L Permittee Authprize0 Agent .(.�¢�s..G4--.� $ / TAX f TOTAL PAID E :�-.. r h COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. SOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING //W_,V �A . 1,L 1 1 — ...rrf OWNER MAIL CITY Neap ort Beach, CA NOL CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT Frank R CFR ADDRESS USE OF BUILDING AND WORK TO BE PERFORMED NOV 10-77PCAansaIAOO 571 ;r :t*,t 122.64 APPLICATION FOR STRUCTURAL PERMIT BY DATE RECEIVED TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE OF LOT Approx. 60'x 80' F BL NOW ON LOT USE OF 2790 w sG. FT. m EXISTING BLDG. THE AMOUNT SHOWN UNDER VALUATION IS FOR m Separate permits are required for THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED NOV 10-77PCAansaIAOO 571 ;r :t*,t 122.64 APPLICATION FOR STRUCTURAL PERMIT BY DATE RECEIVED DATE ISSUED efy that the above Information Is correct an ree to comply with P 1 N m (/" +. � A i nGfZl f.p17AA E IT; any person In violation of the workmen's compensation laws of the State of California. r.r e rEED LOT BLOCK 2790 w sG. FT. m Perties THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. amexempt from the pro yjslons of the State of California Business West Develo ent CUSE Atd. Gar. VALUE 73,400. FIRE ZONE I. I YPE GROUP APPROVED Wert USE OF PLANSZI BUILDIN U/'/' d62!tjI VARDSAPPROVED I YARDS APP OVED I VA.* DATE c onRlTlerr Rinalp familtr 4 I arirnnm I C URP,+&-/ /-1;h I APPROVED )7z // I Plan # 4 N I hereby acknowledge that I have read t, aagpplicatrdn and state �n that the above Information Is correct an ree to comply with m all laws regulating building construction, and 1 shall not employ +. � A i nGfZl f.p17AA E IT; any person In violation of the workmen's compensation laws of the State of California. r.r e I hereby certify that 1 am properly licensed es a contractor untler 2790 w sG. FT. m 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 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. amexempt from the pro yjslons of the State of California Business VALUATION end Professions Code, islon 3, Chapcar 9. PERMIT FEE E Signature of PLAN CHECK $ 117.50 0 Permittee tiG;� $ 73,400. TAX a 5.14 AA Authorized Agent Gj�(� TOTAL PAID s F. .;: 5!MESA BUILDING -SAFETY DEPARTMENT .O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only 944.4 1/03/80 5x50 TL APPLICATION FOR STRUCTURAL PERMIT N° 49459 BUILDING - r , I ,�. ADDRESS A-AJIG'WV- 5I A.P. NO. /-2 — 67 O _ O OWNER O p BUILDING /OQ ^i • �/ P� ADDRESS Q �jAi/(�(�� Q 1 TENANT /�L UNIT OR MAILING SPACE NO. ADDRESS TR.NO. LOT BLK. TEL CITY r(a A NO. -Q(63,7 NEW I ADD LTER IREPAIR IMOVINGIDEMOLISH CONSTRUCTION' LENDER Ot V) BRANCH OWNER ADDRESS I.VALUE ^�f� ARCHITECT TEL. USE V $ OR ENGINEER NO, y�,/� _ ']K ADDRESS ZONE 7 TYPE GROUP II APPROVED y� DATE V CONTRACTOR l�l� BY ADDRESS 9(0/7 RC A /L T EL. CITY C 5 NO. S STATE CITY APPROVED SETBACKS LIC. NO. Z SZZ LIC. NO. SIZE I NO. OF BLDGS (FROM C/L STR ETI r OF LOT Q X NOW ON LOT / ONi USE OF d EXISTING BLDG. 140 M Separate permits are required for L. SIDE FT. electric, plumbing and heating work. REAR 7 FT. O USE F BUILDING AN WORK TO BE PERFORMED PLANNING ACTION OATS APPROVED APPROVED 1 //3 /.7 p 7 I hereby acknowledge that I havo road this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. 1 hereby certify that I am properly licensed as a contractor under O SQ. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE S 646 and Professions Cc a, Division 3, hapter 9. t Signature of PLAN CHECK S /�� Permittee S s4 ri A� TAX E Sb or A 113 V �/ s Authorized Agent Date �+ TOTAL PAID $