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Home My WebLink About1105 DANIELLE DR - Building PermitsV i I ' (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOS I A MESA, GA 9262b BUILDING PERMIT Job Address: 1105 DANIELLE DR Status: ISSUED Suite: Applied: 02/05/2001 Vicinity: HOUSE & ATTACHED GARAGE Issued: 02/05/2001 Parcel Number: 41207434 Zoning: Applicant: PITMAN, VERNON ISSUED BY: Address: 7522 SLATER AVE 108 Phone: (714)375-9500 HUNTINGTON BEACH, CA Zip: 92647 Owner: BREKHUS, STANLEY R Address /1105 DANIELLE DR , Phone: COSTA MESA, CA Zip: 92626 Contractor: SOUTHLAND ROOFING INC Address:, 7522 SLATER AVE . . 108 Phone: (714)375-9500 .. HUNTINGTON BEACH, CA Zip: 92647 License: 750442 Arch Eng: Address: - Address_: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (28 SQ). TEAR OFF EXISTING WOOD SHAKES & ; RESHEATH WITH 1/2 COX PLYWOOD. INSTALL 2 LAYERS OF 30# ASTM FELT UNDERLAYMENT & REROOF WITH " "PREMIUM DURALITE" - ICBO #2093 (5.9 LBS). Plan Check: $0.00 Permit: $209.25 SMIP Res: $1.20 SMIP Com: $0.00 Other:,-' Inspection: $0.00 Total: $210.45 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: Claim Valuation: PLANNING & ZONING Left 0-0 Left 0-0 Proposed: 0, Right', 0-0 Right '0-0' � r $12,000.00 $12,000.00 i 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 it 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) w 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. _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. i-My workers' compensation insurance�c.yTder and policy number are: -Cartier. 1_ �f---e /YI - , i Policy Number. ffhis section need not be completed /f 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 so as to become subject to the workers' compensation laws of Califomi ,end a eCIfTT Uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. __ Applicant Signature: Date _ �Z -,6 S WARNING: FAILURE TO SECURE WORT S' OMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYE O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), IN AD ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR WOE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter men with Section 7000) of Division 3 of.the Business and Professions Code, and my license is in full force and effect. Gc:a—.1 ^O Class x % . G' - 3 G/ Contractors Signature: Date: - . s 19 Z - CD j - 0 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 hlmsell or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, 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.). ❑ 1, 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 driver's license. ❑ Yes ❑ 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: ❑ 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 8, California Administrative Code). ❑ As owner-builder, 1 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). ��antor�presentor future �buildin Occup�antneed�i......................................................... fife �B �re istrationform for�.............. cutel ��hazar.......s ..... ..................................................pp............................................................. ..... 2 Does or will thea applicant p g p g y hazardous dous 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 10 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 en 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 aggermit for such construction or modification from the South Coast Air 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 (1f `yes", the facility must meet the requirement of Sections 25534 and 42303 of the Calitomia 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 (Il'yres", 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 AUTHORI7ATI0N.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 Ow sj- — - Date %And/or Authorized Applicant - - _- - _ 'Date-- CODE Date' CODE It. INSPECTION TYPE GATE' INITIAL S CODE INSPECTION TYPE UR IlftmALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final %ems 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 P' -jC17"i OF COS'I'/� T^liGA 1'.liQ,UL`u'l' !�'Ofi OCCUPIu'VCY - i �7 q TRACT NO. !p l? _ DATE�— / LOT NO., ADDRESS__) / V `J qQQ� I 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. I The undersigned, by executing this agreement, acknowledges that (he -she -they) -I (was or were) advised that /his tract has not been given final inspection nor has it been accepted by the City of Costa i 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 damagc or personal injury to 'Lli1 undersigned by reason of Lne aforementioned uncompleted condition. RE.CEI.VED CITY OF COSTO NAESA .AUG -11979 AM PM 7A9110illi121112131415i 6 A By Pure er BY Deve oper d/or authorized representative BY CITY OF COSTA MESA cCO/N/STRUCTION P RMIT Project a,ldresslU.Jl„fe. , 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. Owner's Name 'rte ,/� Address �� S n �'' Al!/� Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No. LICENS D CONTRACTOR DECLARATION 1 hereby'a ) m licensed under provisions of C mmencing with section 7000 of DIw r3-eLihe Bus'nes Professions Code, and my license is in full force �d ffC t LicenseCI y _.____ .— ._ Date._._,- Sionah.re WORKERS' COMPENSATION DECLARATION ",ereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section J0, Lab. C.) Policy No. Company eCertified copy i5 hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($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 s0 as to become subject to the Workers' Compensation Laws of California. Dale Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/She Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 70 00' of livision 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section 131.5 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 License Law does not apply to an owner of a property who bullet or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. 11, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). as owner of the properly, am exclusively contracting with licensed con- rtracror5 to construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such omiects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that 'Zp oof of their Worker's Compensation Insurance should be provided to me. 1 am exempt under Section! & P. C, for this reason and stale lam sentatiyes of Inspection pt Signature _ Drivers' Lice, 0865-46, rev y Owner hat I have rea, act. I aaree to, I stale that the above and county ordinances erebv authorize reore- TYPE OF CONSTRUCTION Lj NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DE5CRIRT1ON OF WORS/USE OF BLDG,,—,/ ALTERATION U REPAIR TYPE OF PERMIT LJ GRADING LJ FOUNDATION L STRUCTUI u❑-� TENANT P& ELECTRICAL /❑1y LAP.L2U-GMy�B-/I1-N%G -v 1:1 MECHANICAL OTHER PROJECT DESCRIPl OCCUPANCY CONSTRUCTION TYPE -'Sr-AJ VALUATION $_ ZONE GRADINGCU.YDS. ACRES - S Main Building: Accessory Building: E T Front B Rear A C Right S Left Ping. Ref. # Parking Req./Provided Planning Notes: Zone T N G R E O M T S. Remarks: 40e r ELECTRICAL FEES PLUMBING FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel Clarifiers Solar Collectors Fan Motors E10-1 HP ❑l % - 8 Dish Washer Solar Piping F.A.U. Inc Solar 09.15 HP 016-15+ Drinking Fountains Solar Tank Fixtures Microwave Floor Drains Swimming Pool w/Spa Device Boxes Pole Light Floor Sinks Urinal - Outlets Range Gas Service Outlets Water Closet Switches Sign Interceptors Water Heater Garbage Disposal Standing Sections Kitchen Sink Water Service Generator ❑0.5 KW 05-15 KW Trash Compactor Lavatories Auto -Wash P -Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By ✓� �� Date Application Issued By 61s�.1Yt11 /• /9R�/1... Date Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type I El_T Canopy Type I1 ❑ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY F F $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ --t? $ Duct -Structural Refrigeration System Duct -Ventilating ❑0-100,000BTU ❑100,00013TU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG# Fire Dampers Heating System & Ducting Registers ❑0100,000 BTU ❑100,000 BT SS - - I Reinspection Fee 8 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fees 3 \_- CONSTRUCTION AND PLANNING APPJIOVALS Permit # Date Inspector POC SPA APPROVALS Permit # Date Inspector 1. 4n,porary Electrical Service or Pole 52. Pool & Equipment Location 2. SU 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. APPROVALTO 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, 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 K 66. Solar System -Final 116. Rough Electric Wiring 67. Fencing & Access Approval i`7. Rough'Wiring Sign 68. APPROVED FOR PLASTERING ;18. Roug Electrical -T Bar Cei`ng 69. POOL/SPA SYSTEMS FINAL :19. Rough'Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# .20. Rough,Factory-Fireplace r21r Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating �M v 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & past 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas ❑Oil 25. Roof Sheathing's 74. Overhead Hydro 26. T -Bar. Ceiling (Structural) &-Monocoat 75. Dry Chemical 27., Frarne and Flashing 76. Dry Standpipe 28. Lathing•& Siding 77. FIXED SYSTEM FINAL 29. Insulation :{- 78. FIRE PREV. FINAL 30. DrywallNailing ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final' 80. FOOD CERTIFICATE ISSUED 33. Final Electric /-7�y/ 7-/ ! 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 lei` 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. Special Requirements Completed 49. Electric Release to Edison i';-• ' 50. Gas Release to Southern California Gas Co - 51. CER' IFICATE OF OCCUPANCY No. Date COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only M BUILDING ♦/nr' /%A kll rs Ir f%it 1 40V 10-77P=10CNSF00 558* *** 109.18 APPLICATION FOR STRUCTURAL PERMIT ECEIVED BY I DATE RECEIVEDw 11T11111111 ® „ house i . Pian # 3 1 AM5dV/IAP XUR— I .__ �'W//�%/l/ I hereby acknowledge that I haVeVao this epplication and state k!Q1 r) I 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 the State of California Business and Professions Code, Division 3, THE AMO Chapter 9, and that such licenses aro in full force and effect, or 1 THE PURPI am exempt from the provisions of the State of California Business VALUATION and Professions Codtlee,, D/',rislon 3, Chapter 9. Signature Parml"ee ./v.,e� /f �'""`% $ 611100, Authorized Agent CMo.. "'' — —D 1319' 2295 OWNER PrnnPrHFq West Develop BUILDING VN UNDER VALUATION IS FOR m 'ABLISHING A PERMIT FEE ONLY: MAIL ADDRESS 508 2 S e ADDRESS e T N PLAN CHECK S 1 ^ 0 TAX $ 4.28 TEL CITY Newport Beach CA NO. 675-491 TRACT LOT BLOCK CONSTRUCTION LENDER Ll_� BRANCH � . OWNERPrO ertles West Development CO ADDRESS VALUE s Res. Atd. Gar. $ 61,100. ARCHITECTFrank S ler TE`673-0952 OR ENGINEER FIRE ADDRESS 2240 ZONE TYPE GROUP r4 Ir APPROVED CONTRACTOR ChmmerBy DATE �t ADDRESS TEL. �O NO. OF USE OF N CITY NO. PLANS BUILDING 2 STATE CITY YARDS APPROVED YARDSAPPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLDGS. (FROMC/L EET) OF LOT A rox. 60' X 80' NOW ON LOT 0 RONT FT. FT. USE OF EXISTING SLOG. R. SIDE FT, FT Separate permits are required for L SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN MAIN SLOGS.. ACCESS. BL—��)�/s /'n.. �.F...nt �......ln fa mils. Z Isarl,•/vsm 101 C URP.. 46 ]JJ'� / I DATE APPROVED I LLTJ / / ® „ house i . Pian # 3 1 AM5dV/IAP XUR— I .__ �'W//�%/l/ I hereby acknowledge that I haVeVao this epplication and state k!Q1 r) I 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 the State of California Business and Professions Code, Division 3, THE AMO Chapter 9, and that such licenses aro in full force and effect, or 1 THE PURPI am exempt from the provisions of the State of California Business VALUATION and Professions Codtlee,, D/',rislon 3, Chapter 9. Signature Parml"ee ./v.,e� /f �'""`% $ 611100, Authorized Agent TOTALPAIDTOTALPAID $1O m i 0 2295 VN UNDER VALUATION IS FOR m 'ABLISHING A PERMIT FEE ONLY: PERMIT FEE $ e T N PLAN CHECK S 1 ^ 0 TAX $ 4.28 u TOTALPAIDTOTALPAID $1O a a i� 7 L5 7EC-9-77CPISA00 503 v *211.00 APPLICATION FOR STRUCTURAL PERMIT Is foo COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING GROI ADDRESS s OWNER MAIL $ ADDRESS DATE ADDRESSTEL. TEL. CITY NO. CONSTRUCTION LENDER BRANCH CITY ADDRESS ARCHITECT TEL. OR ENGINE v4rnvermm�lp 7EC-9-77CPISA00 503 v *211.00 APPLICATION FOR STRUCTURAL PERMIT Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED 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 person In violation of the workman's compensation laws of the State of California. 1 hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I em exempt from the provisions of the State of California Business and Professions Code, DIvii0on 3, Chapter 9. Signature of Permittee Authorized Agent BET. MAIN & APPROVED n i m SQ. FT. r D THE AMOUNT SHOWN UNDER VALUATION IS FOR rg ADDRESS VALUATION e GROI m s fit! CONTRACTOR $ LL TAX S U $ DATE ADDRESSTEL. f fAPPROVED USE OF NEW CITY NO.BUILDING WWI am v4rnvermm�lp D Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED 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 person In violation of the workman's compensation laws of the State of California. 1 hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I em exempt from the provisions of the State of California Business and Professions Code, DIvii0on 3, Chapter 9. Signature of Permittee Authorized Agent BET. MAIN & APPROVED n i m SQ. FT. r D THE AMOUNT SHOWN UNDER VALUATION IS FOR rg ADDRESS VALUATION E TYPE GROI m CONTRACTOR $ LL TAX S U $ DATE ADDRESSTEL. f fAPPROVED USE OF NEW CITY NO.BUILDING STATE CITY D YARDS AI LIC. NO. LIC. NO.ACCESSORSIZE NO.OF BLDGS.OF LOT NOW ON LOT USE OF Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED 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 person In violation of the workman's compensation laws of the State of California. 1 hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I em exempt from the provisions of the State of California Business and Professions Code, DIvii0on 3, Chapter 9. Signature of Permittee Authorized Agent BET. MAIN & APPROVED n i m SQ. FT. r D THE AMOUNT SHOWN UNDER VALUATION IS FOR rg THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; VALUATION m PERMIT FEE $ q n m PLAN CHECK '^ 0 $ LL TAX S U $ U TOTAL PAID E f