HomeMy WebLinkAbout1097 DANIELLE DR - Building PermitsCITY OF COSTA MESA RUEST FOR '.000PANCY
TRACT NO.
LOT NO.
ADDRESS
LATE
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'exe'cut`ing this agreement, acknowledges that (he -she -they)
(was or were) l e-ae advised that this tract has
not been given finai,'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. r
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
aforementionea uncompleted condition.
BY
BY
,1
CITY OF COSTA MESA
BUILDING DIVISION
F DEVELOPMENT SERVICES DEPARTMENT B98-00824
v PERMIT PERMIT NUMBER
(714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1097 DANIELLE DR
Suite:
Vicinity:
Parcel Nunmber: 41207432
Applicant: MIRANDA, FRANK.
Address:
Owner:
QUIMBO, GENEROSO P
Address
OUIMBO, ARACELI C
Issued:
COSTA MESA,CA
Zip:
1097 DANIELLE DR ,
Contractor:
ISLAND PACIFIC ROOFING
Address:
17762 CAMERON ST
H.B. CA
Arch / Eng :
Address:
Status:
ISSUEDQW
Applied:
05/12/1998
Issued:
05/12/1998
Zoning: R1 R1
Phone:
$0.00
Zip:
$112.25
Other:
Phone:
Zip:
92626
Phone:
$112.85
Zip:
92647
License:
631472
Phone:
Zip:
License:
SCOPE OF PERMIT
T/OFF, INSTALL SHEATHING & REROOF 1800SF RESIDENCE W/LT WEIGHT TILE (5.6PSF MAX W1), ICBO#2093
Plan Check:
$0.00
Permit:
$112.25
Other:
$0.00
Inspection:
$0.00
Total:
$112.85
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0
ACCESSORY Front 0-0 Rear 0-0
PARKING Existing: 0 Required: 0
NOTES:
FEE SUMMARY
Calc Valuation: $0.00
Claimed Valuation: 36,000.00
PLANNING & ZONING
Left 0-0 Right 0-0
Left 0-0 Right 0-0
Proposed: 0
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
e
WORKERS' COMPENSATION DECLARATION:
I hereby alfinn under penalty of perjury one of the following dOclarations:
❑ 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.
❑ 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' compensation Insurance Tamer and policy number are:
Comer: Polity Number.
(This section need not be completed if the permit Is valued atone hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner se as to become subject to the workers'
compensation laws of California, and agree that if 1 should become subject to the workers' compensation provisions o1 Section 3700 of the Labor Code, I shall forthwith
comply with these provlslon
Applicant Signature: �/Ul�"Lfr!/iri�/I Date: //�fr
WARNING: FAILURE TO SECUR ORKERS' COMPENSATION COVERAGE 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 ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license °fir 9�� l 10 Of pier 9 (commencing with Section 7000) of Division 3 of the Business nd P Less}'4ns Cade, and my license is in full
force and effect. Lic. # %�i/ Class # /-7%`7
Contractors Signature: . �� Date: T
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 Ucense 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 o1 the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professiors
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 Ucense Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers Ucense No. Expires:
Verification of Ownership by (type of document, i.e. - property lax 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, Art 2, Sec.
341, Title B, 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 bulltling ocoupant need to file a registration forth for acutely hazardous matedals? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Masa 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).
......................................*p'Ii'......'r.p.r..............f'u.i.........................................-........-.-......-........-.-......(Ris..-...-...............................enfi........rogr...............utel.......................ater......?
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for ecotety hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Cade provides that the Costa Masa 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 en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully compiled 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 application eppernit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? Yes LJ 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? ❑ Yes ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
....................................................................................................................................................................................................................................................................................
7 If apermit 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? ❑ 9as ❑ 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 Materiels 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 Costs Mesa to enter upon the
e ve-das2ribed props br.ins 4 11 n p rposes. I agree of to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign e IVagal Owrer(s �/ e
And/Or Authorized Applicant Date
CODE E. INSPECTION TYPE DATE DOIDAlS CODE Y INSPECTION TYPE gs¢ IMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re -Root 210 Final Electrical
201 Final BIOcWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
2D3 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2416-48
ADDRESSOFBUILONO: 1097 DANIELLE DR
UNT:
OMNER9NAhlEIFIOIOWN: UIMBO, GENEROSO P
FLOOD: AHL38
ACES%QUIMBO, ARACELI C
-FikM: FT IN
1097 DANIELLE DR
FT IN
COSTA MESA,CA
92626
ARPL. MMIpIG ADDREss:
LEFT: FT IN
ARCHITECT OR ENGINEER:
UC NO.:
IRCIL OR ENG'S ADDRESS:
UNIT..
cOMRACTORsN -NOCK PLUMBING
(714)895-1246
COMNACTORs MARgd011610 SEABOARD CIR
PARCEL:
ADmEss STANTON
CA mmo: 707775
90680
UMI:
LICENSED CONTRACTORS DECLARATION: I hamby aRhm ureter penely d Perim Ow I em fi w urda prwisiam of Chapter 9
(oom mehan, with Section 7000) of Dlylebl 3 of the Bushmen end Proleveiam Cab, acct my lie» 6 in hA force acl allied.
C.NG.:0503 6 LIC.CusS:C-36 uC-N --
70 775 XP: /97
CaXreda:
>
jSYINER BUILDER DECLARATION: I hereby aHum under paelY Of perjury that I em exempt horn IM Commotm Littre law for Ne
jogo i reason (Seo ioo 7WI S Busnevv ad Prdaasiona Code: Ary ky or mumy wfiidr mqu"vee tt perm9 to soman, atter, improve.
demol sh, or re eur Any structure, pia to m ewa,e, deo requires IM applicant to such;emit to fib a signed eWament Dust M or she
is licensed pmoom to the poyieions of IM Commoom Licame law [Chapter 9 (commamdng with Section 7000) of Minion 3 of the
Busim a ad Prcleeslam COdaj or that he or she 0 exempt IMreham aM the bees to Be, alleged eaemptiarr. My violation d Sedion
7031.5 by any appficw lo. perme vubpda the eppticem to a dv9 penally d not mm IMn Erva hurdmd dollen (9Soop.
❑ I, as owner of the I,ro,,arty or my amoloyen Wh wages as IMi sob ompeneatlon, wig do the wax. ad the strudare b rel intended
or offered to ale (Section 7044. Business ad Professions Code: The Contredm License Law does not apply to an owrwr of pmpery
wW Wma m ihpmvea Ihemon, ad %tho does such wok Nmead or heme9 or through he or her own employees, pros l that euch
hnpowmema ere w irme or offered to sale. h, hawemr. the WOding or kngovemem m sold whhm one Year of camplelion. Oro
awner-0uikbr will hew the Wdw of proving he or she did rid Wild or improv to the purpoee of sale).
❑ I, as owner of the pmpm y. am exclusively oontracting with licemed coolmom to construct the pmlm (Section 7044, Bueimm, and
Pmressiom Coda: The Cmtndm not apply to an owner of popery wM Wildo royn s impIharaonM awho
oonlM to etM projects with a cnmmCm.) licensed Wreunt to the Conlraam Lipoma law).
❑ 1 am exempt under Swoon; B. A PC.. M rhe
Dee: Cenmr
I do hereby cMYy that 1 am .were of W urdemerd me mquummenta of Calfmie /ieelh end Safely Code Sections 25505, ?5533. end
85534, errd test I or any Mum WIMmS omeram will l wN not (omb me) meed to comply with said date eotles aM IM mpuimmexm for
e perch facomtmd'en or rrwdifiutionhmlMA'r BueC ylrenegemenl District. Residential construction eppleations. exempt Iran these
ouwsiom.
Date: Appfcam:
WORKER'S COMPENSATION DECLARATION: I hereby arum uMer pemity of perjury o a of the IdloeAng detlerelioes:
❑ I haw sal he and a of the d musent to throe munW wue,l. rlDerwatbn, n provided la by Section 3)00 d the lobar
Cade, for IM pMamaca d the wok la elicit thb permit o beuetl.
_ I l 1 Mw and eil reamum wakes' mmparewn. here., as repand by Section 3700 of the labor f:oda. Im the pMornunce of IM
work to eN., Nb perch is inued. My waken' campenseion imumoce carder vat policy number are:
Cad«: GOLDEN EAGLE EXPIRES
Pdxry Numb .. MW(' r42113101 09/01/97
phi, section need net M romplaM i the pent! n la one Wndred ddbn !Scoot o Iw.l
❑ Nat in Ore pedomarce d IM wak tar which Ihb parch le ®u elus9 nd employ .ry' Perm m aM meow w n to
beta a wbpd to the ;wM1ere' co ion laws d tl eg a ofd become subled to 104 wanken'
comp sheen pwiao Sect' 00 d IM labor Code. I I tarNwi am watr Orme
Apptcam:
am : F�9um a n n Iwrkv ronervraetlon coverage b unlawM, end elall.raNal M employer ro cdMrW pv )
rtn apt m dto ab.dme fnpuaerd dollen ft-WggA ti eddlrbn m me mer of anrrpwaWM1 darnegn ea pnvMed roc In
5octlan 3706 of rhe Ltlor Code, Iderev4 slid albmeye len.
CONSTRUCTION LENDING AGENCY: I hw&y alfimureteruer peny d lperpuy Ihre b at thee cmmd
aion bnd, ag
irency for the
'doom. d IM wok for ermoh the M., vs awed (Section 3097, Civ. C).
LENDER'S NAME:
LENDER'S ADDRESS:
1 cemiy the, I hoe need Nb spM tern errd sate That the Above idom thon b caned. I epee to compy with e9 o y ad mumy ordimnces
end we lees mere, to Wilde, tom uotion and hereby athctum repreaenldivm d the city to emer upon the above-mentia»d polo"
la impedion WnDmee.��e. x.r-.ry
Dae:
(5151- vvp) WMe-Suibi g A Soley: Gm Rle: Ca wy-Applicant; Rnk-Raenm; Gol&mrod eerhmm
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P 080981
PERMIT NO: P 080981 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : C/O DISHWASHER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
♦E fE fE if dE IF 1E 1E dk i9 * oft * d( -4k dk iE ♦E iE dF dF iE iE dE iE iE * iE df if iF iE it oft ♦E 9E lE iE dE iE 9E 1E iF * ♦E ♦E 9E iE dE 9t N- dE dE iF 9f if * iE 1E * iE iE iE iE �' iF iF iE * * 4E dE * 9E * *!f ff ik
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN
BUILDING
----------
---------
ACCESSORY BUILDING---------
-FikM: FT IN
REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING REQ•
PROV:
PARCEL:
41207432
ZNE:
REF NO:
PLANNING N TES>
>
r
*1E*IE 1E*IE ik iE♦E*9F fE 9FlFiE*9E
dE*iE*iE**iE fE dE iE iE fE IE iE 1E 4E fE*1E fE fE 9E fE*iE*♦E ik iE lk*dE
iE iE dE 1E*1E*fE dE fE fE iE 1E 4F iE iE iE lF 3f it iE*it ii**1E 4E
D E V E L O
P M E N
T S E R V I
C E SQL)
R E Q
U I R E M E N T S
ZONING APPROVED BY
`,
DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
� rtdEfEyE*iEiE iE iE iE iErtiE•iE*iE•iE***ie it�3FiF�F iF�F�F�F�F3FiFifiFiFTF3F�iFlF iFTF �FiF7F
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 8.75
258
PLAN - r
ISSUE FEE 22.00
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK
TOTALS ---- > 8.75 22.00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
30.75
_ DATE: t� n
DATE: V
�FiFiE 1E fE lE eE iE iE if dE 3F iE iF
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
30.75 30.75 .00
30.75 OVER/SHORT: 00
FIRE SMIP/TOT GRADING PLAN—CHECK
d( -k dE 9klFN-iE1E**tl ff fE***lf*dE lF iElElF*NDE**dE iE iE iE lF iE iE iE**9F*9F 9E lF 1E♦fN-♦E*dE iF iE eE iE df♦E*1E fEk♦E*lE ie lE lE dE ik iE lE 9E 109E iE 9E dE oft It lE dF
I N D I V I D U A li F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O'N UNIT COST TOTAL COST
PLO
1 DISHWASHER 8.75 8.75
END OF FEES
01 00221488-00221483 T O T
DATE: 12/24/95 TIME: 09:54
30.75
307.52 ,
.00
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & oPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pate
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 UFER Grnd.
-
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation _ i
59. Gas Pipe, C1 Undrgrnd., Test
9. Water Pipe-Undrgrnd. -
60. Backwash Lines, P -Trap, 0 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 Electrlcal•T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0O0
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 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: -2 -17S
34. Final Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43, Backflow Irrigation
44. Landscape Irrigation System
45, Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
Z
3
c0 8
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING i, EL/ /�
ADDRESS f� L -G
OWNER Properties West Develonmg-Tit Corp.
ADDRESS MAIL 508 is 29th Street
TEL.
CITY Nraa "t Rnarh C'.Q NO. 471Z_A O1!
BRANCH
ADDRESS
ARCHITECT
OR ENGINEEF
ADDRESS
ADDRESS
TEL.
CITY NO.
STATE CITY
LIC. NO. LIC. NO.
OF LOT Approx. 60r x 80� NOW ON LOS 0
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
a0V 10-77PACRSA
'000 571i* *=*122.64
APPLICATION FOR STRUCTURAL PERMIT
ByDATE RECEIV+EJD
DATE ISSUED
_(/ O(�
PERMIT NO.-
/
n s t
�AWI9866
rA.P.NO44?�_
LOT 2 BLOCK
'
TEF1 REPAIR
MOVING QPMOLISHerties
any person In violation of the workman's compensation laws of
We De e O eVALUE
the State of California.
td Ga $
0
' FIRE I
ZONEI I I TYPE Y i GROUP L4 V
APPROV // ^_ I t
FROM
VAR.
APPROVED
BET. o1,_ ABET. MAIN &
BI house Plan # 4 WJIY— I 2stA 1/li1?7 I
I hereby acknowledge that I hafreatl this appWation and state
Cp �!
JI
that the above Information is c rrect and agree to comply with
n s t
'
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
o
the State of California.
-
I hereby certify that I am properly licensed as a contractor under
SQ. FT, 2%90
a
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
D
03
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
iO
and Professions Code, vision 3, Chapter 9.
VALUATION
PERMIT FEE $
n
n
m
PLAN CHECK $
Signature of///�//{
o
/J .LL±t �J5"
Permittee iCiYlii
$ 73,400.
TAX $
LL
U
Authorized Agent rLV�L,p
TOTAL PAID $
v
DEC-Q-77LCAs°00 518 i;***7.35.00
APPLICATION FOR STRUCTURAL PERMIT
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely —Use Ink Only
ZONE
BUILDING
ADDRESS
OWNER �✓
MAIL
BY
ADDRESS
TEL.
CITY NO.
CONSTRUCTION
ulr[•P/IC[•1
LENDER
BRANCH
ADDRESS
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ARCHITECT TEL.
YARDS APPROVED
OR ENGINEER NO.
DEC-Q-77LCAs°00 518 i;***7.35.00
APPLICATION FOR STRUCTURAL PERMIT
FIRE
ADDRESS
ZONE
•
APPROVED
t
CONTRACTOR
BY
DATE
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ADDRESS
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USE OF NEW
BUILDING
TEL.
CITY NO.
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FIRE
ADDRESS
ZONE
TYPE GROUP
APPROVED
CONTRACTOR
BY
DATE
ADDRESS
ZONE
NO. OF
PLANS
USE OF NEW
BUILDING
TEL.
CITY NO.
F
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
w
SIZE
NO BLOGS
(PROM C/L STREET)
6,
OF
OF LOT
NOW ON LOT
ROM FT.
FT.
Q
USE OF
EXISTING BLDG.
R. SIDE FT,
FT
h
FSeparate
WREAR
permits are required for
electric, plumbing and heating work.
L. SIDE FT.
FT.
FT.
FT.
[..,
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
QMAIN
BLDGS.
ACCESS BLDGS.
Q
VAR.+
C.U.P.+
DATE
APPROVED
APPROVED
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x
w
0
(Y,
am
1 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
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z
any person In violation of the workman's compensation laws of
the State of California.
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3
I hereby certify that I am property licensed as a contractor under
SO. FT.
ry
THE AMOUNT SHOWN UNDER VALUATION IS FOR m_
THE PURPOSE OF ESTABLISHING A PER FEE ONLY:
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the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or 1
am exempt from the ovislons of the State of California Business
and Professions Coda Division 3, Chapter 9.
Signaturevf t"
Permittee z /�'//L
VALUATION
$ 0
PERMIT FEE $ v
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PLAN CHECK $ ro
IL
TAX $ g
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Authorized gent/jfZ.LY---C'G�>
TOTAL PAID $ �