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HomeMy WebLinkAbout1159 DORSET LN - Building Permits • PROJECT AOORE55: 1159 DORSET LN UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM N0: E 053915 OWNER'S NAME: SEWELL, JOHN EDWARD ADDRESS: TAYLOR TR PERMIT NO: .E 053915 PLAN CHECK NO: N GOVT: N SUPP: N' 1159 DORSETT LN - COSTA .MESA, CA 92626 CONSTRUCTION TYPE; 5-N PERMIT TYPE: ELE PURPOSE: OTH I . ARCM/ENGINEER: REG.NO.: JOB DESCRIPTION ' : PATIO ENCLOSURE (ELECTRICAL PERMIT) SQ FT: ADDRESS: - UNIT: PERMITTEE: HARTKE VALUE: CALC-VALUE: • GROUP OCC: R-3 / HARTKE CONSTRUCTION ( 714 ) 646-9474 .. ADDRESS: 1948 ANAHEIM AV COMMENTS: RE: B53914 PRIMARY BLDG. PERMIT. • COSTA MESA CA 92627 *+FRk*+F�FSF+FRF�r*�F�ESF***�F�F�F*stat+ESE****�F*+F****SF*** �F***�Fx****** ******+t4************ x**• LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section • Z O N I N G REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.:pO167� STATE LIC.: 602528 LASS: • �" Date: / 7/7 /p/ Signature: _ _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' - FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: TT IN Compensation Insurance,or a certi0ed copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN •RGHT: FT IN POLICYNM: 1241406-91 . EXP.DATE: 03/01 /92 COMPANY: STATE FUND PARKING REQ: PROV:, PARCEL: 14114117 ZNE: REF NO: • '7 Certified copy is hereby furnished Certified copy is filed lib thcity B•"+ _, :' ision PLANNING NOTES> (� f 7 > - G. • Date: 9//7 / 1 q/ Applicant / �l/�`-0tt _ / alb ***************************************************************IE*************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S E:-R V I C E S REQUIREMENTS 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. ZONING APPROVED BY ��� '%" DATE: 7/47�y Date'. Signature: • . . NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY, : '' r • DATE: 77.:47/Pyy Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. %r= / - 4 ;$;:ttIlt$1i;k / /whNhTRUCpION LENDIuG ASENCn: 0 7erCby affirm That mere is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; �., rDATE'Cwhich this ONSTUCTIN is 309hereby C). **PLIC******ISSUE***Y: P** * ** ** ATE• ** ** LENDER; • *************I***********SSE*S***ICC ADDRESS: LEGALIZATION:N IF E• E SUMMARY STRUCTURAL SEGMENT-7,N OWNER BUILDER DECLARATION: I hereby affirm that I em exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/RES GRADING (Section 70315 Business and Professional Code: Any city of county which requires a permit to construct,alter.improve,demolish,or PERMIT '8 25 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed j 0% SM I P/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business . and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PIAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15,00 I. as owner of the property or my employees with wages as (heir sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE • ' ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 8 . 25 15. 00 0. 00 23. 25 23 . 25 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through . hi • s or her own employees,provided that such improvements are not intended or offered for sale.u, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 23. 25 OVER/SHORT• :00 improvement is sold within'one year of completion,the owner will have the burden of proving he/she did not build or improve or the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 23. 25 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon • and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).lam aware ******0******C C****************************************************C*********** That proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN • ❑ I am exempt under Section: B.8 P.C. for this reason - TYPE QTY D •E S C R I P T I O N UNIT COST TOTAL COST • Date. Owner: ' ELE 3 FIXTURES LIGHTING 1 ST 20 EA. ' . 75 ' • 2 . 25 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 5 RECEPT/OUTLET 1 ST 20 EA. . 75 3 . 75 25534 and that I or any future building occupant will/win not(circle one)need to comply with said state codes and the requirements for a ELE 3 RECEPT/SWITCH 1 ST 2 0 EA. . 7 5 2 . 25 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from mese provisions. END OF FEES Date: Applicant: . ' I hereby certify that I have read this application and state that the above formation is correct.I agree to comply with all city and county , ordinances and state laws relating to building construction and hereby ouch rite rept ants tiYeSa this cyto enter upon the trove-mentioned • properly for in� np specupnpurposes. r - • I..-- Date:4/r E/ /, Signature:( Driver's License or Social Security#: 01 00097342-000973342 T CD T 23.2`. DATE: 09/17/91 TIME?. 12=17 1641-46 White-Building;Green-Code Enforcement Canary-Applicant;Pink-Revenue;Goldenrod-Assessor _ r 1 • CONSTRUCTION AND PLANNING POOL ..:13A " APPROVALS Permit # _ Date Inspector APPROVALS Permit# Date Inspector' 1. Temporary Electrical Servicer6r Pole - • _ , 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. c 'cc 53. Steel Reinforcement �,�1yler%ical ConduigUtility-Undrgrnd' ': 54. Forms _ rt4'r• ..1.: ,- L.:. �i4;tileclrical COnd.4A-wdrgrndl , r, - 55. Electrical Bonding • 225.- SteerReinforcemeni' - , - 56. Rough Plumbing & Pressure Test • :7 o,'n :n - x ;76, ElectricalUFERGY.rtd. - 57. APPROVAL TO COVER-GUNITE v' 7. Footings -' -, 58. Electrical Conduit-Undrgrnd. .- a r s' ,8. Foundation ;Q --� -'C' 59. Gas Pipe, 0 Undrgrnd., Test 9, Water Pipe-Undrgrnd. . ^'" _` 60. Backwash Lines, P-Trap, 0 Undrgrnd. } • 10. Structural FIoo7System 1 o is`� . 61. APPROVAL TO DECK } . 11. Prop`"erty Sewer Lint& House Connection 62. Backwash & Receptor-Final l 12. Sewet Cap Y'^ i 1� 63. Heater & Vent-Final • 2 a. 13. Roof Drains ....I .1 _.,:� • 64. Plumbing System - Final •7-1- 14. Rough Plumbing (-- 65. Electrical-Final �'` 15. Rough Electricril-Conduit P 66. Solar System-Final - -j 16. Rough Electric®iring /.; 1 - 67. Fencing & Access Approval •`�;{ r, 17. Rough Wiring gn .� - 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 Fir place , :',,c.. .,-; K= T, " APPROVALS; 7'cPermit # x �0 : 21 -Duck;, in-Str ct4� ` .- f : e 2 _„r „ 70. t-{d ��quh`dr Hyro * ... 22:Ducts, Ventilating .• I !:"S 7 , S: tC- x '.71. ProductrP ing D:Oas 60- it 232-Gas'‘PipeeRough &'?'est 's :IT ''* o '72, Underg oiind Fig-3g.: r11 6:,. 1 'rrr :.J.J l_ 'v- ? 24,.,Ro&t Framing. •q r _ . -•- > * c73LT7Undergrnd•.StorageITank 0 Gas YD Oil- . t 25. Roof Sheathing x >: n7 '' M a ::'r ± '"74-cOverhead Hydro- r ,_-r d .�. ,y ,, , 26.jT-far Ceiling (Structural) &_Monocoat •. !z+ G %e; r 75-Dry Chemical - .7 i•t I. 27.0-Frame and Flashing,- m�,r - '� w: :: 76.-Dry StandsiLpe , to _r ,, : 28. Latting;& Siding-* ,._ 1-1--:1;2::2 i,: Y s; •• -• ••x, - 77.-- FIXED SYM; L<STEF,INA - >29. Insulation5:.„ C " " " 'r i) i" /ft w 78.,3-:FIRE PR EV. FINAL x -. .r. p . 30, Drywall;Nailing• i, -.clk ` > ./, '�,U-lfw A HEALTH,DEPTYREQUIREMENT ;_31. Plaster Brown Coat• ,. ; , r %� f' A . .r,79 FINAL INSPECTION? 7, " 2. [.'32.:Electrica4Power Mater�Final, ,-:,•.t • /j ;t &�.0..rFOOD CERTIFICAYE ISSUED' - s33 'Final Electric •',� nr ! a'. B " '5q otes: .7' 7 77• _ ... _ifu :l - -7',: :r r:- r34...Fin lHeating,& F,1GrConditi9nln9, r'� ! I. ^.. r- n; a r k .S - V35:�FinalGas!Pipe-Testi; .%!I ' [''t cn [':S " C rX t, ^ I `•n _ ,_36:Hood o iCanopyf•:r - ' : !r•-, I ri-/7-Mit-1.7 7 >: era . in ' t--it 37.=Final Factory Fireplace : Via' - 'K :a 1 ;Ai , s - + - �'c=�M -, .k i `C a CO '38. Final Plumbing 'i ,-.2 ._. + I At x S [:39. Water Service-Final= - i - !4 1 . C Lati . .r,' 1[ s ,• , C- I ti v. >- ,ntnn: r40tt Lt , Gas Service-Final ; , y: i,t i » ; , • f T 6 >41. Solar Domestic-Final s v. : I `- .- „ _ 1 I w "r au 42i Backflow Preventers , CO e. :- l ke a Q-- . S [L' , n * r. 'rO 43. Backflow Irrgationl •r. it;'t r .. `�44. Landscape Iriigatign System,r c .', tr.: C .y C.:t r.; x .v z �r_✓ WC. >A5.-Sound Atterivatiorr - X: f-.), V _ ''+ •X y *u 346FHandicap Regulations ',:1 1 ,` "`•- ••y+ .. =^J A 47,:FIt?ALSTRUCTURE & GUIDING 7/1Yi1-, . " -i . 48rFIr.ALPLANNING; it-, '[ -)' -/('.Jt1' 'r. x iT •;.% .c 1 :l < t 49.=Electric Release to Edison i 47/ .��"icy :: 57 u , ''-50. .Gas_Release to Southern California Gas CO . '`' S - o,L u" ._ * I r .. - ,t ,r . . • 51. CERTIFICATE OFACCUPANCY y. t;,c ,. No. Date • PROJECT ADDRESS: 1159 DORSET LN UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 053916 OWNER'S NAME: SEWELL, JOHN EDWARD • ADDRESS: TAYLOR TR PERMIT NO: B 053916PLAN CHECK NO: N GOVT; N SUPP: N • 1159 DORSETT LN ' COSTA MESA,CA 92626 • CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR . PURPOSE: OTH • ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE "BONUS ROOM" COMPLETION - ' SQ FT: 1 , 800 ADDRESS: UNIT: • CLAIM VALUE: 1 , 800. 00 CALC-VALUE: 1 , 800 . 00 GROUP. OCC: R-3 / ' PERMITTEE: HARTKE CONSTRUCTION ' ( 714 ) 646-9474 • _ ' ADDRESS: 1948 ANAHEIM AV COMMENTS: REPLACES EXP 'D PERMIT 30416 ISS 'D 061369 COSTA MESA CA 92627 ************************iE*****sr******************+E*SE**x****>E***+r*************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E .T B A C K S CITY LIC.: 51 3 STATE LIC.:60 2 5 2 8 Lass Date.�- LI — q 2_ Signature:_ — _ _ _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers•' PRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN- Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C) LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN • POLICYNO.: 1241406-91 EXP. DATE: 03/01 /92 • \ COMPANY: STATE FUND . PARKING REQ: PROV: PARCEL: 14114117 ZNE: REF NO: 1 Certified copy is hereby furnished. [X Certified copy^is fileith t city Bdldi s'n. PLANNING NOTES> Date: g—r7 — 9/ '///, > EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N, T S 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 'le ' subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature: ' . NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor ' BUILDING APPROVED BY : (///� DATE: e/4-0/ /G/ Code. you must forthG comply with such firm that this permit shall beendingdeemed revoked. ��� `)F iF,X �iE if CONK this permit LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the'work for APPLICATION ISSUED B Y; DATE; / which this permit is issued(Section 3097.Cw.C). *********************** i *R *R * * *** ******************* ** **** LENDER: ************************************* *** ************************************ - ADDRESS: LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT:Y • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE SMI P/REST GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 82 . 00 . 50' repair any structure.prior la its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business • and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE . 'l, as owner of the property my employees with wages as their sole compensation. will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL - PAID ;', , DUE ❑ or structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS---->- . 132 . 50 0. 00 0 . 00 . 82 . 50 82 , 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through' his or her own 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED• 82 . 50 OVER/SHORT• 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING' PLAN-CHECK • I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ' 82 . 00 • . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon f.— andwhocontractsforsuchprolects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware, ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. - INDIVIDUAL F E E BREAKDOWN 0 I am exempt under Section: . B.8 P.C. lot this reason: TYPE QTY D E S C R. I ,P T I O N UNIT COST TOTAL COST Date: owner: SFR 1800 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 • f 1 , 800 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534'and that I or any Iulure building occupant will/will not(circle one)need to comply with said state codes and the requirements for a 4; permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from4 these provisions. r1- Date'. Applicant: " I hereby certify that I have read this application and state that the aha e information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby..horize epreser .'es of t s city to enter upon the above-mentioned properly for inspection purposes. / i Date: 9'/e7 r: ( / Signet' e: AILS _s. • �'• 01 00097340-00097341 TOT 52.50 "Driver's License of Social Security a: • DATE: 09/17/71 TINE: 12:12 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor - I •.._ I CONSTRUCTION AND PLANNING. POO. ;PA - ' APPROVALS Permit Date Inspector APPROVALS Permit# • Date Inspector, ,7 1. Temporary Electrical Service:or Pole . -52. Pool & Equipment'Location • 2. Soil Pipe-Undrgrnd. T[' 53. Steel Reinforcement • : '8,, Ele&ical Conduit Utility-Undrgrnd_Y" n . 54. Forms ' Eledtrical Conduit-Undrgrnd(r•` r` • a 4'.r , 55. Electrical Bonding ,‘,-z75: Steel ReinforcemmenE, 56. Rough Plumbing & Pressure Test > ;,•G. EleciricaIUFERG/Rd• -. 57. APPROVAL TOCOVER'GUNITE ,r r-7. Footings - 58. Electrical Conduit-Undrgrnd. --) .7 cc -8. Foundation - -,,; 59. Gas.Pipe, 0 Undrgrnd., Test , 1 �. 8: Water Pipe-Undrgrnd. '` -1 60. Backwash Lines, P-Trap, Undrgrnd. --------.5 10: Structural Floor-System .'- 61. APPROVAL TO DECK r. -' 11. Property Sewer Line'& Housefonrie_ction 62. Backwash & Receptor-Final ' • r t 12. Sewer Cap z 4:;.' 63. Heater & Vent-Final ` �Y �;,� 64. Plumbing System - Final 13. Roof Drains 14. Rough Plumbing -- `.3 l 65. Electrical-Final .i' • 15. Rough Electrica`I-Conduit g - 'fi' 66. Solar System-Final ,�) 16. Rough Electric Wiring / 1 67. Fencing & Access Approval ,f 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 i ,r_t.� .r; s• 0; �+ *. APPROVALS'ucPermit # + t: - Y . t - __ 21:Ducts, in,Structur•er ifi •t .-71 .s `�70. US�dergr5uni'Hygro .r �' 22. Ducts, Ventilating`- : ^ r+: -- ¢a * -71. Product'Piping ©lGEs 040i1 23'Gas Pipe'Rough & Test I -4. x J w ° y7p, Underground Fluslr',r y" i2 - 24..RooI Framin•g ' : - �•` Y = cr :r s j73:zUndergrnt Storage-Tank 0 Gas 0 OP 25. Roof Sheathing . _ b 7it" n-. 91* 74.-O.verhead!Hydro_' 26, T-Bar Ceiling (Structural) &,Monocoat 't u.: Li. l*? . 75.-D_ry Chemical .� -'H 144-4 < 27;Frame and Flashing'. * V�. a 76: Dr Stand,I e C>: 3 S. "' ! t. ,, •-r_.t- z ,, i+ u, . . Y b9 o to ``28. Letting& Siding -a c q," a Y r: . T s x. 77.r FIXED SYSTEM E..INAL+ � .o .r >29. Insulation ' - , 4 -- x 78 FIRE PREY. FINAL a. Ix. 30. Drywall,-Nailing -444 s i#.:'4t - : r i HEALTH:DEPTtREQUIREMENT rl 31. Plaster Brown.Coat' ( 7:).'' t• ,79E4-FINAL INS,,ECTION = Cr itis -J X .r Z - f:32..Electrical Power Meter-Final ., ca + '/_2 r80.-:-FOOD CER1'IFIG TE ISSUED a33?Final Electric `- _ _ '"'" ' +�� 1• ' '•Notes: - =? _ if G ': .. f V. I : .T y 0.11. 34;;.Fin3`I Heating,& Rir,Conditioning- A. y jF x u. ^;p J C C 35.4 Final Gas Pipe-Test 't: - 4 'x in:5 •- to SC , ,.. 1 t li.-1 to .Q -i 'or :kill I.:. , .,r) * !:) ,,.36.THoot1 or-CanoPY: -, , ;. - cio K•r 'v.37.CFinal Pact ` ory Fireplace • r,' 'i ,i i i `;-fCir. - - - ;,i . i i -- 3. id -38. Final Plumbing L d iI "y c r # •-39. Water Service-Final - * I Ise * , . xtri is •i •> , tr n * ... (-40. Gas Service-Fx inal . 7 '44, *_;-, '' p1 • • t.7 _ I . t.trill S i- 1 Y. r)61 ..'rt., 2. ;41. Solar Domestic-Finales - •• .�., i .I `4.1-,,4.4 „ •-42:-Backflow Preventers_ `' 02 1 1 p. Ar - (� . • r z 43. Backflow Irrigation C z x = z 4.4::---44° i- O -- 744. Landscape I'rrigatio'n System„•' '`•' 1 ' t .,I �� '� -CI `� it I:. 'h v l7 O+ a r; ii i'^ N .. >45:'Sound Attepuation +^ '. .r r 11 [ + _ Iia v 'i It/ ry` Y c1-46 -Handicap Regulau ns • c t `c, ` •rv47.tiFINAL STRUCTURE & BUILDING /&.7"qi (1;f,✓$_; ._ 1 ;_ _LC d4- ' &il _at_e 48 FINAL PLANNING' I i;;_ * i; I I I v ll n .y t. F i - . ,49: Electric Release to Edison I r ' /1.* is I 50.,.Gas Release to Southern California Gas Co i ' /Fr * s. ='''- - ;51. CERTIFICATE OF'.000UPANCY ;_ :44 ;; ;o i No. Date i • PROJECT ADDRESS: 1159 DORSET LN ' .. 0N1T CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 053917 owNEA00 Ess: SEWELL, JOHN EDWARD • TAYLOR TR • PERMIT NO; E 053917 PLAN CHECK NO: N GOVT: N SUPP: N 1159 ' DORSETT LN • • COSTA MESA, CA 92626 CONSTRUCTION TYPE; 5—N PERMIT TYPE: ELE PURPOSE: OTH ' ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : LEGALIZE "BONUS ROOM" COMPLETION SQFT: PERMITTEE: CLAIM VALUE: CALC—VALUE: • GROUP OCC: R-3 / • HARTKE CONSTRUCTION ( 714 ) 646-9474 • • • ADDRESS: 1948 ANAHEIM AVCOMMENTS: RE: B53916 PRIMARY BLDG. PERMIT• • COSTA MESA • CA 92627 **BP******************************4****�E�E�r*****�6****�E ****se********************* . . LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z 0 N I N G R E Q U I R E M E r N T S 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK' S CITY LIC.; 051673 STATE LIC.: 602528 c ss: B Date: 9_(-) -911 Signature: ' MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: 1241406-91 EXP..DATE: 03/01 /92 COMPANY: STATE FUND PARKING REQ• PROV: • PARCEL: 14114117 ZNE: - REF NO: • • 7 Certified copy is hereby furnished. LX Certified copy is Bled 'th the city Iding Division. PLANNING Ni)TES> • I— Date: / " / -7 - ( / Applicant'. , **********************************'*********.************************************ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(3100)or less). D E V E L 0 P M E' N T S . E 'R V I C E S R E Q U I R EM E N T S 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 I..subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: • - -. Date: - Signature: ___ . NOTICE:It.atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : ! • DATE: 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 APPLICATION ISSUED BY• a `'/ ' ' DATE• #£ tit, which this permit is issued(Section 3097.Civ C). ************************** *** . 4 4-***' ****************4* * ***** ' LENDER: ****************************************** *********************************** ADDRESS: LEGALIZATION:Y F E 'E S U M A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING - ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 25 50 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 Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0% SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 25. 50 15 . 00 0 . 00 40 • 50 40 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her awn 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 will have'the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: - 40 . 50 OVER/SHORT: ,00 forme purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK • I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business. 40 . 50❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).l am aware *,***,**.*.****.*-**-*.**.****.*..**.*****.***.**.****.**.***.**.*.***.**.**.)f***.****.**.*.*.*.*..)E**.**.*.*.***-*.*. • that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E . B R E A K. D O W N ❑ I am exempt under Section: B.&P.C. , for this reason: • TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date. owner: ELE 2 FIXTURES LIGHTING 1 ST 20 EA. . 75 1 . 50 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 12 • RECEPT/OUTLET ' 1 ST 20 EA. . 75 9 . 00 • 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements fora ELE 3 RECEPT/SWITCH 1 ST 2 0 EA. . 75 2 . 2 5 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. - END OF FEES ' Date: Applicant: I hereby certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to building construction and hereby a thorize repres 'yes of his city to enter upon the above-mentioned . property for inspection'/ purposes. , Date !l ti/ - -IJ Signature Driver's License or Social Security 4: . . 01 0000177337-00097337 TOT 4D.50 1641-46 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor DATE: O'/1A191 TTIiE- 12'1fl. I I 1 CONSTRUCTION AND'PLANNING POOL _- . PA . . APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector - 1: Temporary Electrical Serviceror Pole , - - - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. cL- 53. Steel Reinforcement -2,3 E(eciical Condiht:tUtility-Undrgrnd', `- - ' 54.-Forms m4;•Flecirjcal Conduit--Undrgrnd' .7 55. Electrical Bonding • -5:.Ste-a ReinforcemeotY, •-'1"�. 56. Rough Plumbing & Pressure Test n.:6:, Ejeetalcal UFER;Grnd. ok. 57. APPROVAL TO COVER-GUNITE ,p , �'7a Footings - 58. Eiectrical Conduit-Undrgrnd. _ •. LI ..741-? Foundation -- _% 59. Gas Pipe, 0 Undrgrnd:, Test -•-S.7 " 91; Water Pipe-Undrd. grnd. -- - _..i - 60. Backwash Lines, P-Trap, 0 Undrgrnd. '1 • 10' Structural Floors System ..j‘ 4. 61. APPROVAL TO DECK - •", 11. Property Sewer Linr& House Connection `) 62. Backwash &Receptor-Final . r . 12. Sewet Cap lr ., 63. Heater & Vent-Final __I` 13. Roof Drains • fc •• � "';;� 64. Plumbing System - Final- .. G� 14. Rough Plumbing 4'• 65. Electrical-Final 1 15. Rough Electrical.Conduit .;7 �,i 66. Solar System-Final - re 16. Rough Electric Wiring. Q. ' ';6 • 7. Fencing & Access Approval A 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. RoU*h Factory Fireplace 1 'Xtr; *i : C t.7:11 = '.APP ROVALS .7"-Permit# - r 7••r 1 S1:• :1V,- • :C -• Z,•.t t1' C N -11-• .T [I�n '3 Y:!. •I - RS • , 7x At - 'S ` dry n r 21.Ducts, in_Stroture- 1 :r -t x- _ .-.y 3 0. Underground,Hydro .. 22. Ducts, Ventilating _ - a. _ :S 2A_ t >•71. Product'Piping Otis DtiI 23. Gas Pipe'Rough &•Test ;nq * -n < J. 1.. '32. Undergr•ound Flush ,, v. •J 24..-Root Framing- rqa Ii J 7 Y + •••73.?Undergrnd'Stora�e- ankElGas OOiW' 25. ROOT,Sheathin > pJ .' :r1 '*! _ tit e >" - -. :c g •.I:r v , z r0}. ,. 74.-0verhead Hydro �. 26..4-Bir Ceiling (Structural) &'Monocoat • _ •u i. i[7 ! _ 75:-Dry Chemical _ , - - o is 27.oFrame and Flashrn§;1 to .• ' to t' "� 76. DryStandpipe e 1' �'`i • .DrXIC l Cr' ;N `n, ,pP i_ '. - t•+.n 1 h .01.al t: .4 ...+ }. .e. - .1 -- Y V '.•J U .. , 28.--Lathing.& Siding_-_•a: r. 7tit,:t u; :?. z • t ' 77.^FIXED SYSTEM:NNAL• U:'-' -11•.:_ , it • -f'. n1,-, tic 29. Insulation .i.:1: S � " 78 FIRE PREV. FIr AL t u �" "g 530. Drywall.Nailing 'x -` k - HEALTH:DEPT: REQUIREMENT ... I:i. [ Y ,,.. -t X31. Plaster Brown,Cogt; _ 1 „ [ I{4•' , LL ..,.79.`-'SINAL INSPECTION; .',. C `• _ i 32.,,ElectricakPowe M er;Final l " `~ s 1 i ;1:80.,rFOOD CERTA'TE ISSUED ,-33.ttinij Electric' ,n <• 0 ID 9t I C- -,. r •Notes:, -1 r •-S LL34.,Final Heating& AiraConditionirjgc t-., x 1.. '.1:1%.• "r; .,g tr S .._,, . - l . 2'' 1 _ 1 �'.� 'x 35:Final ca's•Pip'c-Test' " ` ''O =`� ` " _ r . .,36.`Hoofd on-Canopy'' ..r i t•' _ -- •. ^I 1 -l`),� t no :, irir- �37..Final Fa tory Fireplace, ., " ; 6! 1 �) Aft- s' .r .. nrcl r 'l � .. .. .L a A U. 38. Final;Plumbing . pj 1 ' a ly r /• i�� w ..*.7 - U 1, '39. Water Service-Final* = ' • • •3 . •" "^ 1 V > •1. 1%: I R i1 -t >- C- 3 ,[1t[IIT• Vi cLc40. Gas Service'Final x ,,, .rp-,:• . tq i �`, - '730_, t.1; . =41. Solar Domestic-Final x S • •• ": C 1 I rt. -K :-. r,..!:-. r,..!:-. r,..!In i , I , tr 'S `K 6-42.'Backflow Preventers • {.'. ;,. '" `r. ;i '-. '•:.- 43. Backflow Irriation' u-,5'S r. r. 1.....(-- tr '., p t[.S a t - l'+ S ,44. Landscape Irrigation Systeml:tr;;, u. . In C' - .7* * k 'r.. .. w 1545.CSound Atterivation' a:. '' $ -" - -- r ^ ' -+C IL's: i4 1[• - .. t:1 . . _n L ' T _ ec . :46.`Handicap.Regulatiops -% n1 - •. "' 47..+INAL STRUCTURE & 6UI`LDING [' • 1 j •YL t. 1 1.12, `.& - • 48.''FINAL PLANNING; i F•• ': co I • t ,ia. - c49'Electric Release to Edison ' ,. I I(ns :. >, c - r• v .1 i ..en r. .r; ••( •t* r . !' ti V :J,4 6:spas_'Release to Southern California Gas Co Y I - i, 3- .- _ 2... , j 51. CERTIFICATE OF;OCCUPANCY : :r. S ;; •1 _ ; . - . . op:-1 No. Date • PROJECT ADDRESS: 1159 DORSET LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 053918 OWNER s NAME: SEWELL, JOHN EDWARD ADDRESS: TAYLOR TR • - PERMIT NO: M 053918 PLAN CHECK NO: N GOVT: N SUPP: N 1159 DORSETT LN • - COSTA MESA,CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE "BONUS ROOM" COMPLETION- SQ FT:' ' ADDRESS: UNIT: PERrAITTEE: CLAIM VALUE: CALC—VALUE: - GROUP OCC:• R-3 / ' ADDREss: HARTKE -CONSTRUCTION ( 714 ) 646-9474 • • 1948 ANAHEIM AV- COMMENTS: RE: B53916 PRIMARY BLDG. PERMIT. _ _ COSTA MESA CA 92627 • **�F****+F4aP�Fsr�F*+F*�F�F***�E****�P�F�F*EE�F************TP** �t*�E ***+P*****+F***************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am lie Sed under provisions of Charter 9(commencing with Section . Z ONING REQUIREMENTS . 7000)of Division 3 of the Business and Professions Code.and my lip se is i full force and effec ' SETBACKS CITY LICQO 51673 /1 7 3 /q�sra/jE tic.: 6025 8 cg's ' B r-- Dale'. [�/ 7 — —1 ! Signature: - 9..% elf MAIN BUILDING ACCESSORY BUILDING I WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: .FT' • IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab. C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ' POLICY NO.: 1241406-91 EXP.DATE: 03/01/92 COMPANY: STATE FUND PARKING REQ• PROV: • PARCEL: 14114117 ZNE: REF NO: Certified copy is hereby furnished. [}t Certified copy is filed ith ity Building Dm ' n PLANNING NOTES> 9-i7 - 9 ( > r-- Dale: APolicanR ***********************************IE******************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES R E. Q U I R E M E N T S 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. ZONING APPROVED BY • • DATE: . Date: Signature: .- • NOTICE:If,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. /q//�//fes'/ CONSTRUCTION LENDINGssAGENCY: hereby. affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: 9F'3F f4 iE a which this,permit is issued(Section 3097.Civ.C). ***************************/ 3F iF iE iF itF dF iE ** ']t***********3E** iE IF IE iE LENDER: ************************************* *******1**. **************************** ADDRESS: • LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I herebyaffirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING (Section 7031.5 Business and Professional Code:' Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18 7,00 ' repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed e 5% ' SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption. .Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE . ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 18 , 00 1 5. 00 0 . 00 33.00 33 . 00 . 00 , does not apply to an ownerof a property who builds or improves thereon,and who does such work himself/herself or through his oc her own employees, proiided that such improvements are not intended or offered for sale..ef, however the building or, REVENUE DIVISION TOTALS--> COLLECTED• 3 3. 00 OVER/SHORT• • 00 lforptheepuurposee sold f sale). one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE • SMIP/TOT GRADING PLAN—CHECK ' I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33. 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN r ❑ I am exempt under Section: B.&P.C. . or this reason: TYPE QTY D E S C R I .P T I O N UNIT COST TOTAL COST Date owner: MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS ' 9 . 00 9 . 00- I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES • 25534 and that or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements fora ' . permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Dale: Applicant: - • ' I hereby certify that I have read this application and state that the abo •information is correct I atree to comply with all city and county ' ordinances and state laws relating to building construction and hereby a horize epresen. .-5 of tr•city to enter the above-mentioned - ' • property off inspection purposes. Date.—( —/7- �/ 'Signaler' �_ 01 00097338-00097338 TOT TIME: 12:10 '3°t70 DATE: Driver's License or Social Security n: 09/17191 T 1641-46 white—Building:Grekn—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor - ' I. i CONSTRUCTION AND PLANNING _ POC ;PA " APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service oor Pole - - 52. Pool & Equipment Location "� 2 Soil Pipe•Undrgrnd. c <' 53. Steel Reinforcement -3:`Electrical Conduit Utility-Undrgrne_ic f • 54. Forms L�-. „41tgle`ctrical ConduittUndrgrndd�. .L 55. Electrical Bonding 5, Steet ReinforcemehF� 56. Rough Plumbing & Pressure Test _•n c x fi 'Eteciical UFER Gr"rid. n, 57. APPROVAL TO COVER-GUNITE c - :-7. Footings --) 58. Electrical Conduit-Undrgrnd. -) O •8_. Foundation rr __ 59. Gas Pipe, 0 Undrgrnd., Test • jll + 9; Water Pipe-Undrgrnd, ,Ri _- --� 60. Backwash Lines, P-Trap, 0 Undrgrnd. -----`) i ' 10. Structural Floor-System ,>-; 61..APPROVAL DECK !•I 11. Property Sewer Line- House Connection 62. Backwash & Receptor-Final 12. Sewer Cap i r 63. Heater & Vent-Final - • k.--.." 13. Roof Drains "-^r) 64. Plumbing System - Final • ` 14. Rough Plumbing - •�` 65.-Electrical-Final- - r} 15. Rough Electrical-Conduit I' �� 66. Solar System-Final • �.E'-1 16. Rough Electric Wirin i'� • 9 9 + ; 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 , i[ni < =- + e , r-c tsi •APPRQVAL'S:--:Permit # ` - .r r_• S ' e - . r �-.•- ¢ 21'Ducts, in.Structure' -7!.S: '• . 'c .S ^�� °� ...: :t S '. y 70. l.)ndergyounl.Hydro Y .it 22.-Ducts, Ventilating:. I l.: - ter,= e. -171. ProductiPgng D'Gas DOiI •23.'-Gas Pi e1Rouh at-test .• . T �-'` - P g X72. Underground Flus{ .. s;S A. LI: l: rt t� A; 9 :,1 :c 24.-,Rodf Framing. =t_, `" -` > e- > k ti73xUndergrnchStorag-Tank-aGas'n0 Oil ei s- 25. Roof Sheathing u, • v “1 I„. C .fit ,. '74XOverhead'Hydro= .:I. : 26.�T-Bar Ceiling (Structural) &.Nlonocoat � u; v il1X a: 75:TDry Chemical - t: '-+ u: - .. 27.1Frameand Flashing' x i; ' 76:-Dry Stand'pi'pe I`>• '' - t'' cr .1l:✓ t - >. • -{ lL.. ' 28. -Lathing& Siding - - -Lt= /..c , )-;'-xX • < c L•• .. -.. 77FIXED SYSTEM..F_INA !+' 29. Insulation J a 78 FIRE PR EV. FINAL °'_ w `t , 0. DrywaI(Jailing 1., i. S -Il HEALTH:DEPTH REQUIREMENT _31. Plaster Brown Coat' %rY` T 79 FINAL INSP.ECTI,QN !S !Ox .. • I+ w ('.b: :G r` c yam. :0 .- ti Y • 1 :- l 4-t- f is n _ _ _ " ..32.-Electrical Power Meter-Final. i > ,80.-FOOD CERhIFICATE ISSUEDF T -33:Final Electric - a, 1 IF X 'Notes: r '• •-' '34.-;34. Heating`& Fiir;Conditionin 14ir .` r-• -It' " • 35 :Final Gas'Pipe-Tait, - y. - '� `4.;; y -•:.S `I' 1 -.3• _ .. .. �. . i - : .-, 'to --i-c• r-i- ,t' •--.a ii • '--- y rr Frl • •.ne K,t- ,36: Hoo or-Canopy > I .,•••i . -, =r ,E r .. fah• -37_'Final Factory Fireplace AD. f k ." c'. r^ W w,,1 , i tl I ink ." y. :'.1 _38. Final Plumbing ---,LI i * ,=39. Water Service-Fina L• y 7 t. 1., .- ^o•:- ..... c; S'. 140. Gas Service-Final - ` ''""✓" ` " -` i'' .�. a .Lt: it - I r -. r% p:u c•? a. n} >?lt. Solar Domestic-Final.-. - i _: .a Wit=% -'_= '42.-Backflow Preventers ,ii ;e Y : 'J'- °` r x 43. Backflow Irrigation/ �•::.� r cv x r �` n • t'44. Landscape Irrigation System, r' c " ` . :L.,: r: Cu ,. s i_, , -45._Sound Attenuation 'cKt i v i t- --x x '' - � v - •get -- ' •.- .• • •:i .r• ,t'-•• S - rr rr U t-'tj t 46.,Hand ica Re ulatio'ns ' ` 'r' D c '-1G ^'-+ x 47.-.FINAL STRUCTURE & BUI1DING • 1 -: C •� • 48: FINAL PLANNING ' tli;. ; � t: :; trt 49:JElectric Release to Edison I t/- x >; iJc " - 1 • I 1. , n c w. -56 Gas-Release to Southern California Gas Co I • jF. 1. 51. CERTIFICATE OF OCCUPANCY * t x i:ic No._ Date PROJECT AODRESS: 1159 DORSET LN UNIT: • CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 053914 OWNER'S NAME: SEWELL, JOHN EDWARD ADDRESS: TAYLOR TRPERMIT NO: B 053914 PLAN CHECK NO: 03597-91 S GOVT; N SUPP: N' 1159 DORSETT LN ._ • COSTA MESA,CA 92626 CONSTRUCTION TYPE: 5—NPERMIT TYPE: STR PURPOSE; ALT - CI • ARCH/ENGINEER: • REG.NO.: JOB DESCRIPTION, PATIO ENCLOSURE • SQ FT: 231 ' ADDRESS: UNIT: •PERMITTEE: CLAIM VALUE: CALC—VALUE: 8, 408 . 40 GROUP OCC: R-3 / ADDRESS: HARTKE CONSTRUCTION ( 714 ) 646-9474 1948 ANAHEIM AV • COMMENTS: SMOKE DETECTOR(S) REQUIREDINsESE�E�EHOME. COSTA MESA CA 92627 ****************************** ** *iE*�r�r*******************************+E***** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my lice se is i full force_andd elf t. SETBACKS _ CITY LIC.: n516 3 STATE LIC.: 61325 8_ DLA B` a I Date: C7— I1.— ,/ Signature_ �d MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a cent icate of Workers' FRNT; • FT IN REAR; 28 FT IN FRNT; FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). .LEFT; FT IN RGHT; 20 FT IN LEFT: FT IN RGHT; FT IN POLICY NO.: 1241406-91 EXP.DATE: 03/01 /92 COMPANY: STATE FUND • PARKING 'REO• • PROV; PARCEL; 14114117 ZNE• R1 REF NO: 11 Certified copy is hereby furnished. (4tCeHdiedcopy isfiledr Ihthe itye'.:-., livisio PLANNING NOTES> ENCLOSED PATIO TO BE CONSTRUCTED BEHIND AN EXISTING SINGLE el-- I ^� / \ > FAMILY RESIDENCE & ATTACHED ON THE LEFT SIDE TO THE RES. ^— Date: L I / APPlicanl: �1�� �_ / J ******************************************************************** 3f********* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N:;yT S 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. ZONING APPROVED BY _ / DATE; '7/J�� Date: Signature: �''� . NOTICE:N.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : IP • i DATE: c�7�p7 Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. A. CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: ,��. i dll.. lijare4� DATE• %/J�/ which this permit is issued(Section 3097.Civ.CI. ********************** /, /;FBF iY***** LENDER: ******************************************* ********************************** ADDfless: LEGALIZATION:N F E E SUMMARY STRUCTURAL; SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES• GRADING (Section 7031.5 Business and Professional Code Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 1 0 8 .0 0 , 8 4? 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 Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON(,RES and Professions Code)or that he/she is exempt therefrom and the basis for,the alleged exemption.Any violation of Section 7031.5 by PLAN 70 . 20 r'. . any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE • t ❑ I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID . r DUE structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 108 . 84 0 . 00 70 . 20 179 . 04 179 . 04 ' . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through . his or her own employees, provided that such improvements are not intended or offered for sale.If, however the building or ' zy ' improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED; 179 . 04 OVER/SHORT: • -•W 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC -MECHANIFIRE SMIP/TOT GRADING' PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 108 , 00 . 84 70. 20 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. b tormisreasore TYPE QTY ' DESCRIPTIO N UNIT COST NOTAL COST Date: Owner: • •I do hereby certify that am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 231. RES COVER—ENCLOSED PATIO 36, 40 8, 4 0 8 . 4 0 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES—PATIO , permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from rdi43 these provisions. • f% r. Date: Applicant: r I hereby certify that I have read this application and state that the abov information is correct.I.rree to comply with all city and county fl;' • ordinances and state laws relating to building construction and hereby au onzer re ' • oft. city to enter upon the hove-mentioned properly for inspection purposes. Dale: 9' 1 9 Signature( % / • • 01 00097334-0009733E TOT 179.04 DATE: 09/17/91 TIDE: 12:09 Driver's License or Social Security it . 1641-46 Whue—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ' CONSTRUCTION AND PLANNING • POOL .PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector r? 1. Temporary Electrical Service-or Pole �1 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. - - 2 < . 1 53, Steel Reinforcement •_ 3.Electrical Conduit,Utllity-Undrgrnd'' 4 _ - 54. Forms: Q� 41 :. rElecirical CoriduitUrtdrgrnd.L ' - 55. Electrical Bonding - . • ..- '715'Stee[Reinforcement' - 56. Rough.Plumbing & Pressure Test f j.6: Electrical UFER:Gind. r' 57, APPROVAL TO COVER-GUNITE rr- - 7i Fooiings >_ r� - 58. Eiectrical Conduit-Undrgrnd. '1 cr , ''.Ell Foundation _ / 59. Gas Pipe, 0 Undrgrnd.,Test --.; '` ' 9 Water Pipe-Undrgrnd . �,.' .- " ' • 60. Backwash Lines, P-Trap, 0 Undrgrnd. •-, o 10. Structural Floor System-•,.-1 ,-• 61. APPROVAL TO DECK ,/:T 11. Property Sewer Line'& HouseiConnection 1 62. Backwash & Receptor-Final r. 4 e . . r . 12. Sealer Cap i 0 63. Heater & Vent-Final . -, , 13. Roof Drains 64. Plumbing System - Final _ 7 ' 14. Rough Plumbing, - ' l % 65. Electrical-Final 1 15. Rough Electrical-Conduit f') .1 66. Solar System-Final // . •c - 16. Rough Electric Wiring /.. '` 67. Fencing & Access Approval Al . 17. Rough Wiring Sign ! 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS ANAL • 19. Rough Heating &'Air Conditioning FIRE DEPT. REQUIREMENT _ _ :!i-' J C 0:420. 'Rough Factory Fireplace ' rs r <t;7 - Ci 0 '-APPROVALS:=CPermit# : >' "• S. st 1 , 0Yd S r % '+ .. J: Fir.:Li---` a U. 2l.:Ducts, in Structure.r 1< x'70 • dedH• f argrotnydro .' ' . 22. Ducts• , Ventilating. t-_'.4 :� - Yr i_ Sal .`, '�2-' 1. Product tirhg DG'as OeOil 4. 1 _ 23`Gas°PipeRough'V test ITC w ; ,. ..7. ,�- Cp. * : 72. Undergrotrud Flu`S,lr`.M •, 24.uRoof. Framing- . . ~..r. . 0 c - _ ' :S73u1-Undergrnd?Storatge:jank E Gas 0 Oil . ru>c > IN 'ry ..j i.:' X7v �r- 0 k25. Roof Sheathlng ./;,( S /1. ; > NY a 4--Aver pad6ydro 26:-T-Bar Ceiling (Structural) & Monocoat rr-' a' -: tr.'' �• _ . . .. , .._ - r e- _ 75.=Dry Chemical' . • z r ;c • 27'-Frame and Flashin a •'+. _d - x " r _, .r S .zi '>, w 76: D?y StandRkme „r r 1� • >,28. Lathing:& Siding,_. -.. :c- _iru'-:w s: •a .,_ 77CFIXED SYSTEMFINAL' •:C T. '29. Insulation ' ,'" t' " r„ �1 ,1 `je z 78.>;FIRE PREY. FINAL q;. r . , . :r i,L._. r :. X30. Drywall.•Nailing --r •L '' ..1 i,is s -+ HEALTHeEPT.REQUIREMENT �• 3 t ✓ rar'-1. -4-111:".7' ' '6: S cr -_31. Plaster Brown Co'�i; 1 .;., ,;�_,;�� ;_ , .,,79. •FINAL INSRECTION - 1.; 1 32.cElectric_Power Meter;Final; -:•:., n: f 1.4.;• l., :,BO..rFOOD CERTIFIC9`i'E ISSUED _"33-'Final Electric '-^ ' .r,„ s•r< t'1 fY, W 'Notes: 3- 5, ` 0 ;' ..-7,34...-Final &nal Heating Air',.Conditioning:, r' •, k. :, CC +:1: r S 35;Final Gas Pipe-Test- - - _ 14 . _ cEr -�36."Hood or Canopy=- . - ,y . -•4 n i -'z�. .•.'+< >: 5. I.y.i •` < I4. - '-37 CFinal Factory Fireplace,,, 1 ` "• �,p i t m AlI 'dn sF P, .4 -1I" •-38.;,Final Plumbing -r ^c�' -' ?._ _. ;s : .133 .:39.'.Water Service,Final•' ✓ `y. .1' I I n �- • ' o: ' . 4.1111 - b- 1 ,. :a > Q•... 1. ;40.`"Gas Service-Final '•` 1 `" 1 }. _Ey : aCG .,.x t„ it x' a., ::;41:-Solar Domestic-Final:. - "s r• C" I 4 lt, -SO x 42:Backflow Preventer' ,),; ` y i'r '` I a ,; 44 Jr , • - - ., 43. Backf low Irrigation* r`S:t. r.. t: •• r _o 'n "- A C x t 3, , -. 4. S1' "44. Landscape Irrigation System,....,:r.• - , , ; .. •.n - -a s .- te0 % ; o "45.:Sound Attenuation lW'. - ' 5' i• ' 1 ' ''. 1 t' - a'o: u;� .i r. • . .. r �r C,}y-. * -- - t( • _ 16.-„Handicap Regulations `,•,i„ ; ,y n, ,.,n, a 47 FINAL STRUCTURE & BUI'LDING 0" r CP j _ Atli:. it 48.; FINAL PLANNING, i =r r = u� -,i lV'-'rt "At. .� n u-+ :•. '749:,7Eleotric Release to Edison ; 'r ('. ii' •,At. ' >: :.c - 1 _ i t t . t. . r cr •✓'•'_,- 7 50. Gas Release to Southern California Gas Co ; ` Il o • y :3 „51. CERTIFICATE OF:OCCUPANCY • i r ,a ti- r .r No. Date FOR INSPECTION . I NOTE: SHOW AND DIMENSION PROPOSED 754-5626 PATIO COVER AND YARD AREAS CALL ; or v SEE DE • ILS ON RE S55 9E • . N F o ROOF SHEATHING P. ,��•"`•...•� OVERHANG- - I II gVz" I , •••... S" I fit"0 Iicy`PADo I , Z X to RAFTERS „."••...... . pp I f p_ \ AT -" • `�.. •• 1 N.� 2. A A l P t I V E D BI �X.t BEAM 'I$ MOKE DETECTOR City of Costa N10 Building Dept. T- STRAP EA. SIDE FCR POST- BEAM ct REQUIRED BY �'e t LJAI'Ef(/ 7 .i'i.�Z[CONNECTION. o O o a (.) THESE PLANS MUST BSO 1111103 AT ALL TIM!::; i AKE Crw a w 1 • I NO CHANGES W THO T-n R• APPROVAL CF DE.YT. mm N i_ a i • ' AIATIr-1 ' THE ISSUANCE OR GP.ANTr1G PERMIT OR APPROVAL OF N -= a b0 cc � ' PLANS AND SPECIE ATION�611A '•T BE CONSTRUED 10 BE A - u ' p i /WWI I INS, DELETIONS, OR CORRECTIONS SHALL Titcc PERPROVISIONSIT FOROFA IFFSCAPPR (L ANY VIOLATION OF ANY OF O THE OF THIS COWS. Is ERMIT PRESUMING TO GIVE U -cm Z U W AUTHORITY 70 VIOLATE OR :• J THE PROVISIONS OF'THIS a - g •'ROVED BY THE PLANNING DEPARTMENT, CODE SHALL BE VAL D EXCEPT INN' FAR As TIt> p 113 SE LL O W LL i x 0 IL o WHICH IT AUiHORIZf S IS LAVIPA.1 FLOOR 2" CE Z \ O 0 co C r I ,oma ED UPON PLANS AND q, t O /0 THE ISSUANCE OF n Rt B �� . 1 SPECIE TM SI-W-L Kir PR to ISECERS.TO MOM- S to I PLATE 1 j� FROM THEREAFTER icUUJgIWiT -iPi ,'T v'T-���"t'ja' • l ABOVE SLAB.-..„4.4 ♦ fir ! Y ® � •{. 1 SAID PLANS A .`) :'PECIF!CAT 0 BEr:Si;CIL•Trt T Ff4i . +o r' .".1 a . i 1) �r ') BUILD!NC CQE-k T't S R%i.\'i; J" . i di IQ h". 'Ir N VIOLATION O7-;- S coot: Cfi OF NCI: R O2OE J? PCE OF -' I ''Ll 1 r A THE CI IY 26 GA. G. I. FLASHING N I I 1.— ' MANNING Dom. 1 wnyyl I __1__L__ -1 Ls TO BLDG. p@T.� -:�: CONSTRUC ON PIERS 12�� SOJI W 6 wl�tLSETT a THIS NUMB .R MUST ACCOMPANYcl i • ALL INSPECTION RE IDES SE NATION LL STREET Dt PLOT PLAN CONSTRUCTION DETAILS . 1 • 20110ROOF CONNECTION DEVELOpFENr PATIO COVER DETAILS • SERVICES DEPARTMENT CONT. - BUILDING SAFETY DIVISION T Y P. PLANS i LEDGER SOLID BLOCK OWNER: � CI IC ,�.We-1- -- DATE: I(o - it / ' ' .- -- . .. - - ADDRESS: ICC-el BnrSr.„+ 1 4 PHONE: 1V) 53Lv- 3r-72 • 1/2" DIA. X 5" LAG SCR. CONTRACTOR: (1 A g- r « C.o oi,T ' . LIC.. NO. U (e02S-2-'S AT 32" O.C. ADDRESS: tni-ie An1Ab11 wrn A ie PHONE: (OyCF - 9'41'4 . DETAIL I RAFTERS RAFTERS APPROVED FOR CARPORT, PORCH OR PATIO LIGHT WEIGHT ROOF COVER OF BUILDING PERMIT NOT SUPPORTING CEILING LATH, FIBERGLASS, ALUM. - By Date SIZE , SPACING SPAN SIZE SPACING SPAN 22"x4" 12"O.C. . 9'-6" 2"x4" ).16"O.C.,:'..:' ',' 9''-6" ' .. CR 9 CL "TECO" GENERAL NOTES: GRIPS OR JOIST 16" 8'-0" - 24" -• . -8'-0" HANGER 24" 6' -6" 32" _ . .Y .6". " '; I. These plans must be CLEDGER �� 32" 6'-0" 48" 5'-6"-. kept .on the job at '4'® 48" 5' -0" ' 2"x6" 16" - . . -16'-6" ---•. r all time dur ing . 2"x6" 12" 16, -6" 24" 14.!-6",,. All framing '. . 16" 14'-6" . 321° . 12'-0'9' 2. All framing be 3/s" DIA. X 5" LAG SCR. 24" 12.' -0" • i .. .48" ) -101 -0" • Douglas Fir `N4 2 AT 16 " O.C. 32" 10'-6" 2"x8" 24", 19'-0" grade, minimum. 48" , 8' -0" 32" 15'-6" 3.. Rafters may'not DETAIL 2 2"x8" 24" 15' -6" - • ' 48"• 13'-6" attach to facia ex- 32" 13'-6" • cept for 101beroofs as- shownon details; 48" 1l' -6" 101t4OR LIGHT WEIGHT ROOFS 4"x6" 24" 17' -0" HEADERS' .' r 4. f:•.20-;--,; fs .must use ONLY CONNECTION DETAILS 32" 15' -0" LIGHT WEIGHT ROOF: ONLY a continuous ledge:. 36" 14' -0" attached as shown 2" X FACIA -MIN. REO. 4"x8" 24" 21 '-0" SIZE POST-SPACING ' . .-, .on details #1412. 32" 19' -0" 4x4 6'-0" 4. Light weight roofs ,_ „ 48" 160 4x6 •9' -0" may attach to facia 1 . - --•) . 36 18 0 4x8 12"-0" for 14'_ span max. , ►� ®ga 4"xL0" 32" 22'_0„ 4x10 '15' -0", , '_•spans;,_over 14' must 36" 21'-0" 'use a continuous • CARPORT, PORCH OR PATIO ledger as shown in APPROVED METAL 48" 20' -0" SIZE POST SPACING detail #3. HANGER 72" 17'-0" 4x4 5' -0" 4x6 . 8'-0" DETAIL 3 4x8 LO'-0" 4x10 12' -6" ' % PROJECT ADDRESS: 1159 DORSET LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 053919 OWNER'S NAME: SEWELL, JOHN EDWARD ADDRESS: TAYLOR TR PERMIT NO: P 053919. PLAN .CHECK NO; • N GOVT: N 'SUPPd N N . • 1159 DORSETT LN - . COSTA :MESA,CA 92626 ' CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU • PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE "BONUS ROOM" COMPLETION SQ FT; ADDRESS: UNIT: • PERMITTEE: CLAIM VALUE: CALC—VALUE: , GROUP OCC: R-3 ./ •• . ADDRESS:TTEEHARTKE CONSTRUCTION ( 714 ) 646-9474 1948 ANAHEIM AV COMMENTS; RE; 1353916 PRIMARY BLDG, PERMIT, COSTA 'MESA CA 92627 *�6�r****it�E�L***�E****�E*****�r�ri'EBF****�6**�E�E�E�e�e�r4************************************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am li ensed under provisions of Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E' N T S - 7000)of Division 3 of the Business and Professions Code.and my li nse is n fun f d elle 1 SETBACKS • - ' CITY uc.: ` ( 5 73 TA uc.` 602528 c s: B - , • .-- Date' �` ' �• Signator • MAIN BUILDING ACCESSORY BUILDING •WORKERS'COMPENSATION DECLARATION: I hereby of firm that I have a certificate of consent to self-insure or a certificate of workers' FRNT; FT IN REAR; . FT IN FRNT: ' FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: 'FT IN POLICY NO.: 1241406-91 EXP.DATE: 03/01 /92 COMPANY: STATE FUND PARKING REQ" PROV: PARCEL: 14114117 ZNE; REF NO: '7 Cerlloed copy is hereby furnished. LX Certified copy is filed ith t city Bondi vision PLANNING NUTES> 1 • /�/� 9/ > Jate'.—/ �7 l / APPlicar **********************************3E*3f*********'********************3k*******3f**** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E R V I C E St'.. R E Q U I R E M E N T S I curdy 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. ZONING APPROVED BY - DATE: Date: Signature: - NOTICE: If.after making this declaration,you should become subject to the workers'Compensation provisions of the Labor BUILDING APPROVED BY : -,� DATE: • - - 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 APPLICATION ISSUED BY- * riE r DATE: which this permit is issued(Section 3097.Civ.C1 *.*.*,*.**.**,**.K.***-**.**-*-*.**..** +A.• * n****************** - - *,* LENDER: ***************************************** fir *********************************** ADDRESS: . . LEGALIZATION:Y . FEE ' SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 4 ,00 repair any structure.prior to its issuance.also requires the applicant for such permit to lite a signed statement that he/she is licensed 25% $MIP/NON—RES i pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt Therefrom and the basis for the alleged exemption:Any violation of Section 7031.5 by PLAN . any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE 3 .00 • . - I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 4 . 00 3 . 00 0. 00 7. 00 7. 00 . 00 does not apply to an owner of a properly who builds 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.If, however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> ' COLLECTED" 7. 00 OVER/SHORT' ,00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE • SMIP/TOT • GRADING PLAN—CHECK• I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 7.00 ' ❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware **.*.**-*-*******.*.***.*.******.****.*.************.**.*.*.*.*.**.*.***.*****.**.*.*.***B(.*BE.****.****.*.**- that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN • ❑ I am exempt under Section: ' B.6 P.C. tor this reason: TYPE QTY • D E S C R I. P T I O N UNIT COST TOTAL COST • ( cote: owner: PLU 1 WATER HEATER AND/OR VENT . 2 . 00 2 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and That I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a • permit lot construction or modification from the Air Duality Management District.Residential construction applications are exempt from • • these provisions. ' Date Applicant: I hereby certify that I have read this application and slate that the above information is correct.I agr e to comply with all city and county • ordinances and state laws relating to building construction and hereby a Jodie r present of thi Ily to enter upon the above-mentioned - , property f inspection purposes. • — Date: 7-/7 - / signaw ' 01 00097335-00097339 TOT . 7.0E DATE: 09'/17/91 TIFIE= 12:11 Driver's License or Social Security k: Canary—Applicant;Pink—Revenue;Goldenrod—Assessor I - ' CONSTRUCTION AND PLANNING POOL SPA ' APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Servic'Cor r• Pole '�• 52. Pool & Equipment Location - . 2. Soil Pipe-Undrgrnd. - . r 53. Steel Reinforcement = PROJECT ADDRESS: 1159 DORSET LN —7 UNIT: • OWNER'S NAME: PHAN, THUY �G CITY OF COSTA MESA — BUILDING PERMPE NO: P 066269. ADDRESS: 1159 DORSET LN PERMIT NO: P 066269 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE; PLU PURPOSE: OTH ARCH/ENGINEER: flEG.NO.: ADDRESS: UNIT: SQ JOB DESCRIPTION INSTALL WATER HEATER FT: PERMITTEE: CLAIM VALUE: CALC—VALUE; GROUP OCC: R-3 / ADDRESS:TTEENOCK PLUMBING ( 714 ) 895-1246 11610 SEABOARD CIR COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT STANTON CA 90680 **w-*at***1E*****+t-**+Lac**+rx-*ka*tE*Bt******BE**+6+6 -***tc-*1E -BE-*******utak*at*tc-x****16**********i6 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 'Z O N I N G R E U I R E M E N T S at 7000)of Division 3 of the Business and Professions Code.and my nse is in full force and effect. $ E T B QA C K $ c c.: 0 5 0 3� 6 STATE : 51 19 cuss: C_ `:0 d,_ Signature:_ / MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION EC RATION: I hereby affirm t at l have a certificate of con - a self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT: FT IN LEFT : FT IN RGHT: FT IN POLICY NO.: 1 167992-94 EXP.DATE: 03/01 /95 COMPANY: STATEl� PARKING REQ: PROV: PARCEL : 00000000 ZNE: REF NO: ,0 Certified co y is hereby furnished. q Certified copy is ith the city Building ivi . PLANNING NOTES> C > >�Sate- ! f Applicant —id ******************************************************************************* MPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred MOO)or less). D E V E L O P M E N T SERVICES REQUIREMENTS 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. -_ ZONING APPROVED BY DATE : Date: Signature: NOTICE:If.aftm making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : -C'. DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. [� CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE: 4 —1 which this Permit is issued)Section 3097.Civ.CI. **,*,******************************>. ****************************** 4*** t LENDER: ***********************************************************************e ** •**** ADDRESS: LEGALIZATION; N F E E .SUMMARY STRUCTURAL SEGMENT: N • OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7 00 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 Contractors'State License Law(Chapter 9(commencing with Section 7000)01 Division 3 of the Business 25% SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not mare than five hundred dollars($500). ISSUE FEE 20 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 7 . 00 20 . 00 0 . 00 27. 00 27 . 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for sale. II,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 27 . 00 OVER/SHORT: . 00 for the purpose of sale), BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 27 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law). I am aware ,)E,*k*,x,**,**,****,**,*******************************3e******************************** that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt ander Section: B.8 P.C. IND IV IDUAL — F E E BR EAKD OWN for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of Caldornia Health and Safety Code Sections 25505,25533,and FLU 1 WATER HEATER AND/OR VENT 7 . 00 7 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END{ OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from r these provisions. Date. Applicant: 'S I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county . ordinances and state laws relating to building construction and• ny authorize representatives of this city to enter upon the above-mentioned • r property for ins�pec ion purpo es. „ a1: rJ `7 Signal �/ �� 01 00156668-00156668 TOT 27.00 Driver's License or Social Security a DATE: D3/D7/94 TIME: 09:40 1641-46 White—Building,Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL 'A APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole "' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54., Forms .- 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe,0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd, - 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ) FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure , 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 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 PREY. FINAL 30. Drywall Nailing • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric ) Notes: 34. Final Heating& Air Conditioning "S ayP ; i 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 4-s-q21r0 • 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final ua 42. Backflow Preventer earn 43. Backflow Irrigation n, 44. Landscape Irrigation System • 45. Sound Attenuation 46. Handicap Regulations a.r.. 47. FINAL STRUCTURE & BUILDING I-- • 48. FINAL PLANNING �-J . r, • 49. Electric Release to Edison m 50. Gas Release to Southern California Gas Co _ 51. CERTIFICATE OF OCCUPANCY No. Date r_� c • OWNER SEWELL, John E. DATE 9-2-64 .4 JOB ADDRESS 1159 Dorset Lane BUILDING PERMIT NO. 22898 GENERAL CONTRACTOR Owner-B1dr. • VALUE $ 350.00 AP No. 141-141-17 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add Pat.Cvr. \ I ,CTIONS Signature DATE GROUP J TYPE V ZONE .i R-1 S SPERMITS ISSUED SUBCONTRACTOR Gas DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating _ Rough Plumbing Miscellaneous Prop. Swr. Line 0 House Con. 0 St. Swr. 0 Sprinkling System Construction Pole _ - - - Underground D Power 0 Rough Wiring Trenches ❑ Forms 0 Steel Reinf. ❑ ;2f 9-17-4/ e 4-o/ j/o ieE Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing V-//-6✓ Lathing — In ❑ Out❑ P—'er, brown coat ;. ❑ Air Con. ❑ Final h....ang, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final -gat' -/7-a OCCUPANCY Form BU4-5M-3-63-5-13 F nnpnQ .a •'• 22898 FEE RECE V MA -COSTA MESA BUILDING-SAFETY DEPARTMENT F'NF+IVCEIDry' P.O.BOX 317 COSTA MESA.CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING /ADDRESS ! r9 /..., ) rc I•,, LeN p _ RECEIPT NO. Pp�f{{T O�yy 'COSTA MESA. CALIFORNIA ,yl`�, I G //'' "RSC/�•BY- DAT REC `ED TTE ISSUED OWNER Joky `. IP to.. //MAIL �� k Y-,.2-�a� - TT�� // � BUILDING . rn '�` ADDRESS J / c-9 /JQ NG e t la H 10 ADDRESS/l,7 / Q�© �S� 1 �^-��-y—y� C p 5 q TEL. ZONE TY E V GROUP J CITY 0S N0.Sf1G 753J APPROVED /p��--� �,Z' ARCHITECT r-.-----. TEL. BY /,�., DATE OR ENGINEER - NO. ZONING ADDRESS M� / � ZO'Lly}/ NO.OF t..1.„ USEOFNEW a 1� ( I PLANS 'I BUILDING CONTRACTOR D 14J PI P r- et, / zt 0.- I __ LEGAL a ( a- 9 fi e ((3 !J ADDRESS CITY A.P.NO. / q t "' RI / //'�p/�/ STATE -�'YEL. 90NO"r TO SIDE 8 REAR P.LE: NO EAVE NG SHALL BE LAS THAN LIC.NO. NQ. - EAVES SIZLE OT 4::�LA(� NO.OFBL NOW ON LOT TS. ALLOWED (U.B.C.REQUIREMENT) OF ry ice YARDS APPROVED YARDS APPROVED USE OFGL,, MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. I7 Orm A: { ` (FROM C/L STR SETBACK LINE FROM / I / 2 J/ FRONT FT. REAR YARD CENTER OF STREET I SIDE YARD LEFT • 19 _ I RIGHT /5-(t /Cit.R.SIDE / . ± "- IFT. DESCRIPTION OF WORK / L.SIDE (t, (j1 ,e1- FT. NEW ALTERATION 1ADDITION Jl REAR 2 FT. ///"' DISTANCE BET. BET.MAIN& REPAIR MOVING PEMQLISH MAIN BLDGS. ACCESS.BLDGS. - BUILDING NO.OF VAR.# DATE SIZE ROOMS STORIES1 [RIC.U.P.# APPROVED rte/ EXTERIOR WALL/gay, 1 ROOF �� C��G APPROVED• CC , TE C / ---e ' COVERING L0'�� USE OF BUILDndNORK TO BE PERFORMED ' • Pq 1J.0 Co r- ..--- o /er5 SQ.FT. or 71 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE Y AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCESANDSTATE LAWS REGULATING VALUATION 'CO lr m BUILDING CONSTRUCTION. PERMIT FEE $ 301 • SIGNATURE ORner /? D B PERMITTEE $ 3 S° PLAN CHECK $• and O n AUTHORIZED AGENT TOTAL FEE $ OWNER SEWELL, JOHN DATE 6-17-69 JOB ADDRESS 1159 Dorset Lane BUILDING PERMIT NO. 30416 GENERAL CONTRACTOR A. B. Construction DESCRIPTION of WORK Finish Bonus Room t)4.704,.141-141-17 LOT 29 TRACT 4395 FIRE ZONE VALUE $ 1,800.00 ' ;tCTIONS Signature Date GROUP I TYPE V ZONE R-1 S SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. n SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND n POWER ❑ ROUGH WIRING- - - Heating and Vent. TRENCHES FORMS ❑ STEEL REINF. n FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER. BROWN COAT ST" 'TUBAL, FINAL Electric H G, VENT., REFRIG. AND A.C., FINAL _ PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL BUILDING, FINAL 30416 JUIV 16-69CMSAPATO 0014 2+P ****27.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEI/yED BV DATE EIVED DATE ISSUED BUILDING / • ORECEIVED J ADDRESS / (` ��jVVii /lVT7.1/ . OWNER / .� -2.4 / .. A.P. NO) 4/j-- ?/` /7PV/`f/a.7 BUILDING MAIL ADDRESS 1/ 5•( (C "o—C /l.4� � — ZADDR SS //.. ( /9 .0244 0% Vre,./zX W W �� •T �/� TEL �J 7} EL CITY >n-i {2 0.441., NO.•17 ribs/� � TRACTI/3/ LOT�/ BLOCK Z �/s / NEW ADD ALTER R AIR MOVING DEMOLISH ' I— Q CONSTRUCTION O N LENDER am - J D BRANCH ti�J C J In OWNER t/�//f�/ CO J ADDRESS ------ ALUE (y� nw{'�, Jm ARCHITECT /J// TEL R-.- USE4/!l/U�L�+/�/f/au.'�✓ '�I $ ///1�'�"I Ua OR ENGINEER AC./Vett" AY-0..N O.771Y2DO• FIRE T Z Q /.7/ Q C ZONE ' TYPE r GROUP .L WCC ADDRESS/7/i (/ /N/vU a.W APPROVED , le mO CONTRACTOR A, -�-t-ow BY DATE' Ze 1 JCC ADDRESS / //�,�t ��.„/� ,, WW [..���II,Z/�7� V�'AIiL -_ TE G//[ G/�/ ZON • i e. �. 111.11119 ZFCITY eclz2/„a f,), 7l � 6 ^! -/ T! a •�_i_i W-O STATE CITY CITY YARDS APPROVED YARDS APPROVED ch tc LIC. NOM D •9 /cc 7 LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE c� J INO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT SD FT. FT. USE OF �/���}}.�// EXISTING BLDG. - R._SJDE 62-.. .�T.5 !• FT. I— SIZE OF NO.OF /) Z NEW BLDG. ROOMS STORIES L.SIDE / FT. FT. VEXTERIOR WALL ROOF /�y..(/ _ COVERING COVERING REAR 4 I1 6,..a..,0FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& a a MAIN BLDGS. ACCESS.BLDGS. Q VAR.# APPR O -ni i nA 1_�jr C.U.P.#F�Q ///1 DATE /ED —/ CO (f/� M./- i l7�r PATE {9 C ���� a 0 VI hereby acknowledge that I have read this application and state ✓ that the above information is correct and agree to comply with IZ all laws regulating building construction, and I shall not employ F any person in violation of the workmen's compensation laws of tM the State of California. zI hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR s Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: IC am exempt from the provisions of the State of California Business and Professions cle, Division 3, apter VALUATION /t'f/ Fe N /��J PERMIT FEE $ CXJXJ Signature zw 4I (- Permittee _ ,C/f A) C 0-7.1e/I/ $i /l.// PLAN CHECK $ ?./ E Authorized Agent / V I/ o 7� LL TOTAL FEE LOT 29 TRACT )1395 r. 16304 FU RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 3 11362 P. O. BOX 817 COSTA MESA. CALIFORNIA FINANCE. DEPT. For Applicant to Fill In Completely APPLICATION FCIRT�EIA�iIIOSTA MESA TYPE OR PRINT _ BUILDING ADDRESS //59 ,Pne-sef Acne COSTA MESA. CALIFORNIA For Office Use Only OWNER K RA 'K I IFVFI OPMFNT Co., INC. I RECEIPT NO. PE�2�T.,l04 MAIL RECEIVE BY DA RECEI D DATE1IISSSUEEDD64 ADDRESS 1555 PLACENTIA AVELN,UE J 7-4 UN 31 1962 CITY NEWPORT BEACH NOMI 63227 BUILDING ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NONE NO. ADDRESS FIRE ZONE n,/ FONE TYPE / GROU3l"�V//(/' CONTRACTOR K. W. KOLL APPROVED AP DATE ADDRESS 1555 PIACFNTIA AVFNIIF ZONING CITY NEWPORT BEACH ZONE NO.OF USE OF NEW:7.7. , �.�1 PLANS a BUILDING cry/ Pin - LIC NO. 61195 TEL M I . 6-3227 DESCRIPTION Lai- Z 9 ./e 4/ 3 SIZE � / xNO. OP SLOGS. OF LOT S 1no'/ NOW ON LOT O to A.P.NO. -- USE OF YARDS EVES EXISTING BLDG. NONE APPROVED ALLOWED SETBACK LINE FROM6 / n (CENTER LINE ST.) CENTER OP STREET � REAR YARDdj (/ FRONT J FT. IN. o 'y SIDE YARD I LEFT (J / I RIGHT / / R.SIDE 7 FT. IN. �Q DESCRIPTION OF WORK L.SIDE FT. N. NEW I X IV ALTERATION I II ADDITION I REAR 2 9 FT. 7 IN. REPAIR I II MOVING I II DEMOLISH I APPROVED BY 4//I 40 EV- DATE /I.1O/6-Z BUILDING 1'2/77s ICj(. NO. OF SIZE 6,g,f vs-Ed/ Sy'cE ROOMS nW7_ STORIES 1 A�-t/ �/ COVERING WALL ROOFSturro I COVERING mP o-ri//�91e /'/ / C USE OF BUILDING AND WORK TO BE PERFORMED / / /�1 (rte SING( F FAMII Y RFS InFNC'E WITH V/-;- ATTACHED GARAGE . ��77 PIAN # .TX..6 I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE r AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE• or ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ` ' Q� VALUATION // SIGNATUR OF >2/ E7 iCKILC . /// f'5/y/ PERMIT FEE $ _�C N S PLAN CHECK $ �'— Z AUTHORIZED AGENT /— tt ., .r. ..... _ .. TOTAL FEE / — IGi