HomeMy WebLinkAbout844 CORTEZ ST - Building Permits(714)754-5273 • Fax(714)754-4856
CITY OF COSTA MESA
BlIILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Job Address: 844 CORTEZ ST
Suite:
Vicinity:
Parcel Nunmber: 14132213
App�icant: MC KINISH, JERRY
Address: 915 LAKE ST
H. B.
owner: ANGELO, JAMES LEONE
Address 844 CORTEZ ST
COSTA MESA,CA �
Contractor: JK CONSTRUCTION
Addressi 00975 LAKE ST �
, HUNTINGTON BEACH CA
Zip: 92648 �.
Arch :
Address:
Phone:
Zip: License:
BUILDING PERMfT
Zoning: R1 R1
Phone: 714-960-7052
Zip:
Phone:
Zip: 92626
Phone: 714-004-9846
License: �. 450297
' Eng:
Address:
SCOPE OF PERMiT
RE-ROOF: 7/O EXIST; NEW il2" OSB; NEW 30-YR COMP SHINGLE 0/ 30k ASTM FELT
FEE SUMMARY
Plan Check: $0 00
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$137.25
$0.75
$0.00
$0.00
$0.00
$138.00
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existina: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
PLANNING 8 ZONING
left 0- 0
Left 0- 0
Proposed: 0
77 FAIR DRIVE, COSTA
1
/ r �.
iyrtocn /
/
255 l�
CA 92626
Status: ISSUED
Applied: 12117/1998
Issued: 12/17/1998
� ��C_.f�l/C.�C�
�L//(,� C%1��
Phone:
license:
Calc Valuation: g�,soo.00
Claim Valuation: S�,soo.00
Right 0- 0
Right 0- 0
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended andoned
for a period of 180 days. .
INSPECTIONS: In ordgr for the work authorized under this permit to be considered legal, such work must comply with all applic le codes, d all
required inspeetions and final approvel must be obtained. Failure to obtain inspections and final approval will result in ihe expiraC n of this permi
FOR INSPECTIONS CALL: (714) 754-5626 �
WORKERS' COMPENSATION DECLARATION:
I hereby aHirtn untler penalry ot perjury one of the following tleclarations:
❑ I have and will meintain e ceniticate ot consent to self-Insure for workars' compensetlon, as provided for by saction 3700 ot the Labor Code, for the peNormence ot ihe
work Por which this permit is issuetl.
❑ I have end will meinlain workers' compensetion insurance, as required by sedion 3700 of Ihe Lebor Code, for ihe performance oi ihe work for which Ihis pertnit is issuetl.
My workers' compensation Insurenca cartier and policy number are:
Cartier: Policy Number.
(This sectlon neea nof be comp/eted i! the permit is valued et one hundred dollars ($100) or Iess.)
❑ I cenity Ihat in the pertortnance o ihe work for hich Ihis pertnit is issuetl, I shall not employ any person in any mannar so as to become sublect to Ihe workers'
compensation laws of Celifomia, tl egree !(a I sh�J Id become subject lo the workers' compensetion pmvisions oi Section 3700 of Ihe Lebor Cotle, I shall torthwith
comply with �he e p visions. G /� ) `/
ApplicaniSigneture: x✓'� Date: I<—�� r 6
WARNING: FAILURE T SE R '�RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT MI EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO IXJE HUNDRED
THIXISANDDOLLA (E 000 ADDITIONTOTHECOSTOFCAMPENSATION,DAMAGESASPROVIDEDWRINSEGTION3/060FTHELABORCODE,INTEREST,ANDATTOHNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn thet I am licensed under provi i�
force and eHect. Lic. # �
Conirector's Slgneture:
with Sectlon 7000) oF Divislon 3 of ihe Business and Professior�s Code, and my license is in full
_ Class #
_ Date: � ' � �/� �
CONSTRUCTION L�NUING PriENCV:
❑ I hereby ettirm thet ihere is a consiruc6on lending agency for the peAormance of the work tor which Ihis permit is iuue0. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
SignaNre: �
OWNER-BUILDER DECLARATIONS:
Date:
I hareby aHirtn that under penelty of perjury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or county which requires a pertnit to consiruct, alter, improve, demolish, or repeir any siructure, prior to its issuance, also requiras the applicent tor such permit
to file a signetl stetement Ihat 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
Businass and Protassions Gode) or that he or she is exempt iheretrom and the 6asis lor tha alleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit
sublecls ihe applicant to a civ�l penalry oF not more ihan five huntlretl tlollars ($500).):
❑ I, es owner oi Ihe property, or my amployees with wages as their sole compen5ation, WILL DO THE WORK, and ihe structure is not intended or otteretl for sale (Sec.
7044, Business and Protessions Cotle: The Contractors License Lew does not epply to en owner of properry who builds or improves Ihereon, and who does such work
himself or hersetl or through his or her own employeas, provitled that such Improvamants ere not intended or oRered for sala. If, however, the builtling or Improvement is
sold within one year oi completion, ihe owner-builder will have �he burden ot provinq ihat he or she did not build or improve for purpose of sale.).
❑ I, as owner oi lhe propeny, am EXCLUSIVELY CONTRAC7ING WITM LICENSED CONTRACTORS to construd lhe projecl (Sec. 7044, Business antl Protessions
Code: The contrectors License Law does not apply to en owner of property who bullds or improves thereon, antl who coniracts tor such pmject with a contractor(s)
license pureuant to ihe Contractors license Laws.).
❑ I am exempt under sec. Business and Professions Cotle for ihis �eason:
Signature: Da�e:
Ownar ID verified by driver's license. ❑ Yes ❑ No Driver's License No.
Veriticetion of Owners�ip by (rype ot document, i.e. - properry tax bill or deed):
DIVISION OF INDUSTRIAL SAFE7V PERMR CERTIFICATION:
Eapires:
❑ I hereby cently Ihat no excavation five (5) or more taet in tlepth imo which a person is required ro descend, will ba made in wnnectlon wit� work euthotlzed by Ihis
permit, entl thet no building structure, scaRolding, talsework, or Oemolition or tlismentling thereof, will be more than ihirty-sie (36) feet high. (Chep. 32, Gry 2, An 2, Sec.
347, 7tle B, Celitamie Adminisiretive Cotle).
❑ As owner-builder, I will noi employ anyone to do work which woultl require a permit trom the Division ot Intlusinal Safery, as noted ehove, unless such person has a
permit to do such wark from the division. �
Signe�ure: Da�e:
Divisian of Indusiriel Sefery Permit Numbec
CER7IFICATE OF COMPLIANCE AND AUiHORIZATON OF ENTRY: I certify under penalty of perjury that I have read this application and state thet ihe information given is
correct. I egree to comply with ail state laws and ciry ortlinances relating to building cons�ructioq and authorize representatives of the Ci�y of Costa Mesa to enter upon ihe
abova-described property tor inspection puryoses. I agree not to occupy or allow occupency of any 6uilding authonzed by Ihis permit until tinal inspection.
1616
1266
200
zai
202
203
Fixed System Finel Fire Prevention
Pool Spe Final
Finel Re-Root
Final 81ock/Retaining Wall
Final Fectory Fire Place
Final Sign
204 Final Demolition
2d46 46
�AIE II�AIS
�/-5-9 9 �
j�QpEj INSPECl10NTYPE
206 Finel Mechanical
208 Finel Plum6ing
270 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
DateY
/� Date ^��-
IaH��SmO!�1
(774) 754-5273 • Fax (714) 754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
Contractor:
Address:
ISSUE FEE
Temp service test
Res. alc package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fints
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 10ooa
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors to 700hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
� CITY OF COSTA MESA \_�
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
844 CORTEZ ST
14132213
MC KINISH, JERRY
915 LAKE ST
H. B.
ANGELO,JAMESLEONE
844 CORTEZ ST
COSTA MESA,CA
JK CONSTRUCTION
00915 LAKE ST
ELECTRICAL PERMIT
Phone: 714-960-7052
Zip:
Phone:
Zip: 92626
Phone: 714<04-9846
HUNTINGTON BEACH CA Zip: 92648
License: 450297
SCOPE OF PERMIT
REPLACE I-OUTLET AND 1-SWITCH..
$22.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
51.00
81.00
so.ao
so.00
$0.00
$0.00
50.00
$0.00
$0.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Temp Dist System / Lighting
Busway /700 R
Standing Sedion
Misc Electrical Equipment
Transfortners up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kvalkw
..................over 100 kvalkw
Low Voltage Equipment
Low Volt Wiring System I Ckt
Misc. Conduit
Misc. Conductor
Cirws ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspedion Fee
P��
PERMIT NUMBER /
E98-01282 �
77 FAIR DR�VE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 12/17I1998
Issued: 12/17I7998
Quantity
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E24.00
COMMENTS I SPECIAL CONOITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if woAc is suspended or abandoned
for a period ol 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 Inapeetlona and flnal epprovel must be obtained. Failure to obtain inspections and final approval will resuli in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I �ereby alfirm untler penalry of perjury one of the lollowing declarations:
❑ I heve end will meintain a certificate of consent to self-Insure br workers' compensetion, as provitletl lor by section 3700 ot the Labor Code, tor the peAortnance of the
work for which lhis permlt is Issued.
❑ I have and vnll melntain workere' oompensetlon insurence, as required by section 3700 ot tho Labor Code, For �he pertortnance of ihe work for which Ihis pertnit is iswed.
My workers' compensation Insurence certier entl policy number ere:
Carrier:
(Titls sectton neea nof be comp/eted if fhe rmit is
❑ I certity ihat he peAormance of he work
compensati la ol Celifomia, e egree JI
comply wlih t
Applicant Signeture:
WAfiNINp: FAILURE
TIqUSAND OOL E �
Policy Numbe[
a( one huntlred tlol/ers
this pertnit is issued, I shall not employ any person in any menner so es to becoma sub�ect to tha workers'
tltl Eecome sub�ect to the workers' compensecion provislans of Sectlon 3700 of the Labor Coda, I shall tort�with
Dalo: � Z - �� � / �
bRKERS' CmA1PEN5FTION COVEiUGE IS UNUWFUL AND SMALL SU&lECT AN EMPLOYER TO CRIMINAL PENALTIES ANO dVIL FlNES UP TO IXJE HUNDRED
ADDRION TO THE WST OF COMPENSFTIpJ, OMMGES AS PROVI�EO FOF IN SEGTION 3108 OF THE LABOfl CODE, IMEREST, AN� ATTORNEV'S FEES.
LICENSED CONTRACTORS OECLARATION:
I hereby eHirm Ihet I am II sed under pnvislons�oj Cly(dler 9(commencing with Sectlon 7000) of Divislon 3 af Ihe Business and Pmfessiuns Code, end my license is in tull
larce end eHect. Lic. M // /� _ Cless q
Contrectors Signeture: � �ate: � —� '
CONSTRUCTION L
❑ 1 �ereby aHirtn
Lentlers Name: _
Signature: _
thera Is e construNan lendinp epenry for the peAartnence ol the work tor which this pertnit is Issued. (Sec. 3097, Civll Coda).
Lendefs Address:
Date:
OWNER-BUILDER DECLARA710NS:
I hereby eilirtn Ihat untler penalcy of per�ury Ihet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW tor Ihe tollowing reason (Sac. 7IXi1.5, Buslneu end Professiore
Cotle: Any ciry or counry which raquires a permit to consWd. alter, improve, tlemWish, or repair any strucWre, pnor to its issuance, also raquires the applicant for such pertnit
ro file a signed statement ihat he or she is Iicensetl pursuant m the pmvisions of the Cantrectore LJcense Law (Chepter 9(commencing with Section 7000) at Division 3 0l the
Business and Prolessions CoCe) or Ihet �e or she is exempt Iherelrom and the basis lor the elleged exempiion. Any viola�ion of Section 7031.5 Dy eny applicani for e Dertnit
subjectt the epplicent to e civJ penalry of not more Ihan five hundred ddlan (5500)J:
❑ �, as owner of the property or my employees with weges as Uelr sole compensation, WILL DO THE WORK, and the swcture is not intenAetl or oNered tor sale (Sec.
7044, Business and Prolessions Code: The Contractors LJcense Lew tloes noi epply to en owner oi property who builds or improves ihereon, end who does such work
himsetl or herselt or t�mugh his w �er own empla/ees, provldad that such Impmvements are not intended or otteretl tor sale. If, hor.evar, t�e 6ulltling or imprrnement is
soltl vrithin one year ot completion, ihe owner-bullder wlll �ave the burtlen ot pmving t�at he or she tlld not build or improve for pufpose of saleJ.
❑ I, as owner of �he property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to consiruct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not appy m an owner of property who builds or improves thereon, and who contraas tor such pwject with a conirector(s)
license pursuani to Ne Contrectors License laws.).
❑ I em exempt unAer sec. Business and Prolesslons CoOe tor Ihls reason:
Signawre: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivefs License Na.
Venficalion of Ownership Dy (typa ot documenl, i.e. - properry tex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
Ezpires:
❑ I hereby certify lhat no excevatlon INe (5) or more leat in depth into which a person is requireC to tlescenQ wlll 6e mede in connectlon wlih work euthorized by this
pertnit, end Ihat no 6uilding strudure, scetfalding, felsework, or tlemolltion or tlismentling I�ereot, will be more ihen thirty-six (38) feet high. (ChaO� 3.2, Grp 2, An 2, Sec.
341, Title B, Calllomle Atlminislretive Cotle).
❑ As owner-bulltler, I wlll not employ enyone to tlo wark which would require a permit trom �he Division oi Intlustrial Sefery, as noted ebove, unleu such person hes e
pertnit to Eo such work Iram the diWslon.
Signeture: Date:
Division ol Intlusidal Selery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORVJITON OF ENTRV: I certify under penalry ol perjury that I have read �his application end 5tate thet the infortnetion given is
conect. I egree to rnmpty with ell state laws end dry ordinances relating to building wnstruction, end authorize representatives of the Ciry ot Costa Mesa to enter upon the
ahove-described property lor inspectlon purposes. I agreb not to occupy or allow occupanCy of eny builtling authorized by ihis pertnit until linal Inspection.
t61fi Flxed System Finel Fire PrevenUon
1266 Pool Spe Finel
200 Finel Re-Rool
201 Finel BIocWReteining Wall
202 Finel Fectory Fire Place
203 Final Sign
204 Finel Demalitlon
24d&48
GOOE I INSVECTION TYPE
206 Finel Mechanicel
208 Final Plumbing
210 Final Elecidcal
212 Final Fire Preventlon
220 Finel Plenning Approval
222 Final Si�e
250 Finel Building/Occupanty
Date
/ot -/ �- j
Date
GAg II�ElS
(714)754-5273 • Fax(714)754-4656
Job Address:
Sulte No
Vlcinity:
� CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
844 CORTEZ ST
Parcel Nunmber: 14132213
Applicant: MC KINISH, JERRY
Address: 915 LAKE ST
H. B.
Owner. ANGELO, JAMES LEONE
Address 844 CORTEZ ST
COSTA MESA,CA
Contractor: JK CONSTRUCTION
Address: 00915 LAKE ST
HUNTINGTON BEACH CA
ArchlEng:
Address:
PLUMBING PERMIT
Phone: 714-960-7052
Zip:
Phone:
Zip: 92626
Phone: 714-404-9846
Zip: 92648
License: 450297
Phone:
Zip:
License:
SCOPE OF PERMIT
RREPLACE KITCHEN SINK, 2-WASH BASINS; AND REPAIR 1-SINK DRAIN.
ISSUE FEE
BackFlow irtigation
BackFlow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-0 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Interceptors (Sand Auto )
AMT
szz.00
$0.00
so.00
$0.00
50.00
$0.00
50.00
50.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$O.OQ
$0.00
$0.00
$0.00
so.00
so.00
QTY
FEE SUMMARY
AMT
Laundry Tub I Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank 30.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $8.75
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
Qn
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
COMMENTS I SPECIAL CONDITIONS
��
P6,�
PERMIT NUMBER
P98-00907 ✓
77 FAIR DRIVE, COSTA MESA, CA 92626
Stetus: ISSUED
Applled: 12/17/1998
Issued: 12/17/1998
SumpPump
Swimming Pool
Trap Primer
Urinai
Vacuum Brkr Bkflow(1-0)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Waler Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
707AL CALCULATED FEES:
AMT
$0.00
$0.00
$0.00
80.00
80.00
$0.00
817.50
$0.00
$0.00
$0.00
$0.00
$8.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$57.00
Qn
0
0
0
0
0
0
2
0
0
0
0
1
0
0
0
EXPIRATION: This permit shall aUtomatically ezpire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a periotl 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 inepeetlane end Hnel approvel must be obtained. Faiture to obtain inspections and final approval wi11 result in the expiration ot this permii.
FOR INSPECTIONS CALL: (774) 7545628
WORKERS' COMPENSATON DECLARATION:
I hereb %irtn under penalty ol perjury oryg of the idlowing declaralions:
I heve end will meinteln a certlllcetp of ConSenl to Sell-Insure tor workers' compensallon, es provided for by sec�ion 3700 0l the Labor CodB, lor lhe peAormenCe ol Ihe
work for which this pertnit is issued.
❑ I have end wAI maintain woficers' compensation insurence, as required Dy seclion 3700 0l Ne Labor Code, tor the peAortnance of Ne work fw which �his permit Is issued.
My workers' compenSeUon Insurance cartler end poliq number ere:
Cartier:
(This si
❑ I certify that in the
compensetion I
comply wlih ihes�j
Applicant Signeture:
WARNINO: FNLUHE SE(
Policy Number:
permu rs vemee er one n�ndred ew�ers (5 �oo) o� iess.)
the work jor�/ li this pertnit is issueA, 1 shall not em0loy any person in eny manner so as to 6ecome sub�ect to Ihe workers'
] egre9 IS 'f oulA Eetome Suhjecl �o the workers' compensafion provisions o� Sec�ion 3700 of Ihe labor Cotle, I shell Iarihwith
C Date: �� ' /P � � �
OM ENSATION ODVEMOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTES AND (]VIL FlNES UP TOONE HUNDRED
�'O THE CO".a70F CaMPENSaTION. U0.W GES AS PfiOV10E0 FOR M SECTION 31080F THE LABOR OOOE, IN1EflESi, ANO ATTOFiNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y eHirtn Ihat I am Ilcensetl under provisions o C pte 9(crommencing wlth Secilon 7000) ol Dlvisian 3 at Ihe Business entl Professions Cotle, enC my Iicense is in full
force end effect. Lic. x Class q
Conirectors Slgnewra: Date: �r} ' � —�
CONS7RUC710N L ND G NCV:
❑ I hareby attirtn t at ihere is e construction lending agency lor I�e pertormance of the work for w�ich this pertnit is issued. (Sec. 3097, CINI Catle).
lentlefs Name: _
Signature: _
OWNER•BUILDER DECLARATIONS:
Lenders AAdreu:
Date:
I hereby eNirtn Ihet under penalty of perj4ry thet I em E%EMVT FROM THE CONTRACTORS LICENSE LAW lar the lallowing reesan (Sec. 7031.5, Business entl Proleulons
Cotle: Any ciry or county which requlres a permit to construct, elter, Improve, tlemollsh, or repair eny siructure, pdor to Its issuance, elso requlras the applicant lar such pertnit
to tile e signetl statemem thet he ar she Is IicenseC pursuant to the provisions ol Ihe Contrectors License Law (Ghapter 9(commencing with Section 7000) of DlWslon 3 ot the
Business entl Professlons Code) or thet he or she is exempt therefrom and ihe besis tor the allegetl exemption. Any violation of Seciian 7031.5 by eny epplicant for a permit
sublects the epplicant ta e civ�l penalry ol no� more then five hundred dollers ($500).):
❑ I, es owner oi the property, or my 0mployees with wages es their sole compensatlon, WILL DO TME WORK, and the structure Is not intendetl or oHeretl for sale (Sec.
7044, Business entl Protessions Code: The Contrectora License Lew tloes not apply to en owner of property who builds or improves Ihoreon, end who does such work
himself or hersetl or through hls or her own employees, provided that such impmvements are not intendetl or oHaretl for sale. If, however, iha bulltling or improvement is
soltl within one yeer ol completloq t�e ownerbuilder will heve the Durtlen ot proving thet he or she did not build or improve tor purpose of sale.).
❑ I, as owner oi the properry, am EXCLUSIVELV CONTfiACT1NG WI7H LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Buslness and Professions
Gode: The wntreciors License laW does not apply to an owner of property who builas or improves ihereon, end who contrects tor such proJect wlih e contractor(sj
license pursuant to the Contractors License Lews.).
❑ I am exempt under sec. Business end Pwfessions Code tor Ihis reason:
Signeture: Date: '
Owner ID venfled by drivers license. � Yes ❑ No Drivels License No. Expires:
Venilcation ot Ownership by (type ol document, i.e. - property tat bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PEpMR CERTIFICATION:
❑ I hereby certity Ihai no eacavetion INe (5j or mare leet in depth into whlch e perwn Is required to descend, wlll be mada In connecllon wiih wwk authodzed by IhLs
pertnit, entl t�at no building sWcwre, acaNaltling, talsework. or tlemolition or tlismamling Ihereoi, will be more then thirry-sl: (36) feet hlgh. (Chep. 3.2, Grp 2. Art 2, Sec.
3d1, Tltle B, Calllamie Administrative Cotle).
❑ As owner-bullOer, I will not empby enyone to do wwk which wwld requlre a pertnit iran Ihe DMsion of Industriel Selery, es noteO ebove, unless such person hes a
pertnit to tlo such work irom t�e Aiv�,vion.
Signeture: Date:
Division ol Intlustrial Selery Permit Num6er:
CERTIFlCATE OF COMPIJANCE AND qUfMORQA110N OF ENTAV: I certity under penalry ot perjury thet I have read ihis epplication end stete thet the informetion given is
correcL I egree to compy wit� eIl slete lews entl dry ordinences releting to building consWction, end authodze representetives ot Ihe Gry ot Cosia Mesa ta enter upon ihe
above-descdbetl property for inspe1tlon purposes. I egree not to acupy or allow ocwpancy of any building authonzed by ihis permit until final inspection.
pdg II�AlS
'1616 Fixetl Sysiem Finel Fire Preve�tion
1266 Pool Spa Final
200 Final Re•Roof
201 Final BIocWRetelning Well
202 Finel Fectory Flre Place
203 Final Slgn
204 Final Demolitlon
2ai&46
GOOE I INSVELTON TYPE
206 Finel Methenical
208 Finel Plumbing
210 Final Elactdcal
212 Final Fire Prevenlion
220 Final Plenning Approval
222 Final Site
250 Flnal Buliding/Occupanry
Date
/�--/ � ��
Date
�. i .�mrn
UD � � //�
.. � ��':��J
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. CALIFORNIA
For Applicanf to Fill In Compleiely
TYPE OR PRINT
BUILDING _ _ _ _
L
COSTA MESA. CALIFORNIA
coasc
4'!6r
, TEL.
� - f" ' ! f'.
, � ' �I� s,�i','i,:
�— ��C 9 19@0
L 6 i" y�`, ��9�� 3�1r��: �2��{�T.
GII'f OF COSTA VESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO. P[RMIT NO.
l� l
NECEI�EO !Y DATH qECEIVEO -�ATC_i6B O,
�'� /a -7-bn�DEC�� n 14�ri�
BUILDING
ADDRE65 844 Cottez Sti'eet
COSTA MESA. CALIFORNIA
�:,u� r.e� �� �o.,��e �i i�
ZONING
NO.OP 116E OP NEW
PLANB 7 BUILDING �.
�eaw�
SIZE Ho. oR etDae.
OF LOT S� Now aN loT O p, p, NO
USE OF YAROS
FXISTING BLDG. APPROV
6ETBACK LINE FROM , � .i� � � ^/ fC¢NTCR
�/ /
LEF7 J RIGHT S
DESCRIPTION OF WORK
� BUILDING .. _ � _ _ NO. OF
1 HEREBV ACKNOWLED THAT 1 HAVE RCAD TX AP�4QATION
FND BTATE THAT THE BOVE �8 CORREGT AND GR6! TO COM-
PLY WITH ALL CIiY O IN EB AND ATE 8 REGULATIN�
BUILDINO CONBTRUCTI N.
9IGNATURE OF � �� � /fi , O_ ,
' AUTHORIZED AGENT
-
APPROVED
0
�
TNC AMOUM BHOWN UNOER VALUATION I6 POR THE
PUPPOSF OP, EBTABLIBHING A PERMIT P66 ONLY.
$+U��'(y•O� I�'LANCHECK $ I7-80