HomeMy WebLinkAbout852 CORTEZ ST - Building Permits(714) 754-5273 • Faz (714) 754-4856 •
JobAddress: 852 CORTEZST
Suile:
Vicinity:
Primary Occ: R3
Parcel Number: 14132214
CITY OF COSTA MESA
BlIILDINh' DIVASIORf '
DEVELOPMENT S 1'^[eS DEPARTMENT
PE.�. ,�.>6 ,
Applicane SCHWARTZ, DAVID
Address: 852 CORTEZ STREET
COSTA MESA, CA
Owner: SCHWARTZ, DAVID ALAN
Address 852 CORTEZ ST�
COSTA MESA, CA
Contracror: OW N ER-BU I LDER
Address:
Zip:
Arcn : CRAIG MONROE SMITH
Address: 1041 W 78TH ST
�:r
Type o( Constmction: V-N
Zon��Pg�ES
SUITE A208 Phone: 949-764-0010
COSTA MESA, CA
Zip: 92627 License: C20154
Phone: 714-549-2769
Zip: 92626
PERMIT NUMBER
BOS-02246
I 4
COSTA MESA, CA 92626
Status: ISSUED
Applied: 12/09/2005
Issued: 12l30/2005
ISSUED BY: • /
Phone: �
Zip: 92626 V"
`e
Phon ��' s r.
License: 00000
Eng: JEFFREYALANCROSIER
Address: MIYAMOTO INTERNATIONAL INC
SANTA ANA, CA Phone: 949-579-1170
1901 E ALTON AV STE 160
92705-5847 License: 53525
SCOPE OF PERMIT
ADD 1,974 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD 1,341SF 2ND STORY ADDITION AND 633SF TO THE 1ST FLOOR. REMODLE OF 1S
EXISTING 3 BEDROOM, 1 AND 3/4 BATHROOM SFD TO BE CONVERTED INTO A 3 BEDROOM, 2 FULI BATHROOMS, 1 3/4 AND 1 12
BATHROOM.
Pian Check: $1,373.94
Permit: $2,113.75
SMIP Res: $30.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $3,517.69
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0. 0
PARKING Ezistino: o
Rear 0- 0
Rear 0-0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lefi 0- 0
Reouired: 0 Pr000sed: 0
Calc Valuation:
Claim Valuation:
Righl 0- 0
Right 0-0
5300,000.00
5300,000.00
NOTICE: The work authonzed by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) .
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work-is suspendetl or abandoned
for a period of 1 BO days. �
INSPECTIONS: In order for tha work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requirad Inepectlone and Iinal epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaawa la�ao�
WORKERS' COMPENSATION DECLARA710N: � �
I hereby aHlrtn untler penalry ot perjury one oi lhe tollowing dec�'arations: ,
❑ I heve end will malntain a certificate ol consent to sel4lnsure tor workers�om ion, as provided tor by section 3700 of the Lebor Cotle, tor the pertormance oi the
work tor which ihis permii is issue0.
p I have antl wlll maintain workero' compensation insurance, as required by secti 3700 ot the Lebor Code, tor the pertortnance of Iha woB for which Ihis pettnii is issued.
My workars' compensation Inswance cerner and policy number ere: '
Cerrier:
(This se
Policy Numher:
or less.)
.�=1 certity that in the peAormence of the work for which this pem�it is Issuod, I s�ell not employ eny person in any manner so as to become subjact to ihe workers'
�compen5ation laws o� Celifomia, entl agrea that if houltl become ublecc to the workars' compensation provlsions of Sectlon 3700 of the le6or Code, I shall PoRhwith
camply with these ions. /�
qeplicenLSignaWte�: / � �Datei T / 2 � 7j d ��y (J o $�
r
WFRNINGLEAIWRE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNL4WFUL AND SHALL $UBIECT AN EMPLOYER TO CRIMINAL PENALTI S AND CIVIL FlNES UP TOONE HUNDRED
TNOOSAND DOI,LARE (5100.0OO�.IN ADOITIqJ TO TME WSi OF COMPENSATION, DAMAGES AS PROVI�ED WP IN SECTIqJ 3]O60F TME LABOR CODE, IMEFEST, AND NTTOPNEVS FEES.
LICENSED CONTRACTORS DECLARATION:
I Pereby aflirm t�at I am licensed under Omvisions of Chapter 9(commencing with Saction 7000) oi Division 3 of tha Business enA Pmfessions Cotle, and my license is in tu��
�Qrce and eflecL Lic. M Class N
Contractofs SlgneNre: Date:
, CONSTRUCTION LENDING AGENCV:
[] 1 hereby eflirm t�et ihere is a construc�ion lending agency for the pedormance of ihe wo�k for which Ihis permit is issued. (Sec. 3097, Civil Gotle).
Londefs Neme: Lentler's Adtlress:
SignaNre: Da�e:
OWNER-BUILDER DECLARATIONS:
I nereby aHirtn Ihel under penalty of perjury Ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Busineu antl Professions
Code: Any ciry or counry wM1ich requires a permit to consimct, alter, improve, demolish, or repair any stmcWre, prior to its issuence, elso requires ihe applicant for such pertnit
to file e signed stetemem Ihet he or s�e is licensetl pursuant to the provisions of tne Contrecrors License Law (Chepte� 9(commencing wlih Section 7000) of Division 3 of ihe
Btlsiness and Protassions Cotle) or that he or she is exempt tharefrom and the basis tor the ailegad exemption. Any viWation of SaMion 7091.5 by any applicant ior a perm%
s�Ub/jects tfie epplicant to a���il penalry of not more than five hundred tlollers ($500).):
'►g i, �s owner oi the pmpert'y; or'my employees with wages as Iheir sole compensation, WILL DO TME WORK, and the structure Is not intendetl or otterad for sale (Sec.
/7044,.Business and Professions Cotle: The Contracrors License Law does not apply to en owner of Oropeny who builds or impmves thereon. antl who does such work
himsatt ar hersell or througii his or her own employees, pmvi0ed that such improvements ere not intended or oflered tor sale. II, �owever, ihe bullding or improvement is
sold within one yaar o1 comD�efion, the ownar-builtler will have tha Gurden ot pmving ihal he or she did not build or impmve tor purpose of sale.). �
❑ I, as owner ol Ihe pmperry. am E%CWSNELY CONTNACTING WITH LICENSED CONTRAGTORS to construct the project (Sec. 7044, Business antl Pmfessions
Code: Tha contractors Licensa Lew tloes not appl o an owner ol propeny who builds Or impmves thereon, antl who conlracts br such project with e comracmr(s)
license pursuan� to the Coniractors License Ww .�,.
❑ I em e�rem�Uuqder sec. �� �;�. �usiness antl Professions Code tor this reason:
Sigva�r � Date: �'y�/ 3 0�[ z c�o �
OWner ID venfied hy tlrivers license. s ❑ No Ddve�'s.lkense Na <<: Ezplres:_ 1 L>/Z 3� i o
Ve�fication of Ownership by (�ypa of tlocument, i.e. - property tex blll or deatl): �----�'`�
DI�ISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cehity ihat no excevation tive (5) or more feet in tleplh into which e person is requiretl to descend, will be metle in connection with work euthorized by this
permi6 and Ihat no builtling siructure, scaflolding, falsework, or Gemolition or tlismanNing Ihereof, will be more than t�irry-six (36) faet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title 8, Calibmia Atlministretive Code).
❑ As ownerbuilder, 1 will not employ anyone ro do work which would require a permit fmm �he Division of Indusinel Safery, es notetl above, unless such person hes e
pertnit to do such work Irom ihe division.
SignaWre: Date:
Di�ision ot Intlusirial Salety Permit Num6er
CERPFICATE �F COMPUANCE AN� AUiHORIZATION OF ENTFiV: I�certify uoder peoalry of perjury that I have read Ihis application and state lhat the inionnation given is
cortect. I egree to comply with ell stete lews end city ortlinances relating m bullGing construction, and authonze representa�ives oi Ihe City ot Coste Mesa to enter upon the
ebtl�e-d�esc ' `° �erty for Inspection pury I aq�re� ot °occupy or ellow occupancy of eny building authorized by ihis Dermit until final inspection.
/ ��-�� ��Y/1 �/'30 �z�o S'
�Signature Ot Legal Owner(s � r e�s
�—� J
AnNOr Authorizetl Applicant Date
�QQf,�, INSPECTIONTYPE PAiE II�A65
1616 Fiaed System Final Fire Prevention
1266
200
201
Pool Spa Final
Final Re-Rooi
Flnel BIocWRetaining Wall
202 Final Faciory Fire Place
203 Finel Sign
204 Final Demolition
CODEI INSPECTIONTYPE
206 Final Mechanical
200 Final Plumbing
210 Finel Eletirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
a�iE 1�eL�
(7/4) 754-5273 • Fax (714) 754-4856 • www.Ci.Costa-mesa.Ce.Us 77 FAIR DFiIVE, WSTA MESA, GA 92626
PLUMBING PERMIT
Job Address: 852 CORTEZ ST
Suite Na
Viciniry:
Parcel Nunmber: 14132214
Applicant: SCHWARTZ, DAVID ALAN
Address: 852 CORTEZ ST
COSTA MESA, CA
Owner: SCHWARTZ, DAVID ALAN
Address 852 CORTEZ ST
COSTA MESA, CA
Contredor. OWNER-BUILDER
Address:
EXT�N� ��
ALL�PER
EXPIRES � o BY:
Phone: 714-549-2769
Zip: 92626
Phone:
Zip:
License: 000000
Status: ISSUED
Applied: 12/302005
Issued: 12/302005
�
' • T� � ��
.� �
SCOPE OF PERMIT
PLUMBING PERMIT TO ADD 1,974 S.F. TO EXISTING S.F.D.
REF#:BOS-02246
WORK TO INCLUDE: 2 BATHTUBS, 1 DISWASHER, 1 GAS EARTHqUAKE VALVE, 1 GAS (OVER 4
OUTLETS), 1 LAUNDRY TUB/WASHER, 3 SHOWERS, 1 KITCHEN SINK, t SERVICE/MOP SINK, 5
WASH BASINS, 4 WATER CLOSETS, 1 WATER HEATERNENT, 1 WATER PIPING (INST OR REP), 1
WATER REPIPE AND 1 WATER SOFTENER.
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Conned pce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas EaAhquake Valve
Gas (1� outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$79.60
50.00
$0.00
$0.00
$9.80
50.00
so.00
50.00
$0.00
50.00
$0.00
$6.15
$0.00
$9.80
$0.00
$0.00
$0.00
�
FEE SUMMARY
AMT
LaundryTub/Washer $9.80
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) 50.00
Receptors 50.00
SepticTank 50.00
Sewer Cap for Demo $0.00
SewerConnect $0.00
Sewer Pnvate Line $0.00
Shower $29.40
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $9.80
Sink, service/mop $9.80
Spa (private) $0.00
Spa (public) $0.00
l:f1MMFAITC / CDFl:IAI rnun
QTY
1
0
0
0
0
0
0
0
0
0
3
0
0
0
1
1
0
0
SumpPump
Swimming Pool
Trep Pnmer
Urinal
Vacuum Brkr Bkflow(1�)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent Syslem
Water Closet (Toileq
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Soflener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
30.00
$0.00
$0.00
$0.00
$49.00
$0.00
50.00
$39.20
812.30
ss.eo
$9.80
$0.00
$9.80
50.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: E257.55
�
0
0
0
0
0
0
5
0
0
4
1
�
1
0
1
NOTICE: The work authorized by this permit shall comply with all applicable handicap access raquiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92) _
EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order tor the work authorized under this permlt to be considered legal, such work must comply with ali�icable codes, and all
requlred Inapeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaas-ae �avo�
WORKERS'COMPENSAnON DECLARAnON:
1 hereby attirm undar penalry of perjury one of the toh ing tledaretions:
❑ I have antl wlil maintain a certificate of conseni to selt-Insure for workers' compensetlon, as provitleA for by section 3700 ot t�e Labor Cotle, for the peAormance ol the
work for whiGh this permit is issued.
❑ I have antl wi�l mein�ain workers' compensation insuranca, as requiretl 6y sectlon 3700 oi Ihe Labor Cotle, �or tha parto1mance of the work tor which ihis permit is issued.
My workers' �mpansation Insurence carner end polity number ere:
Carner: Policy Number:
(�Tlri�s section neetl nof be canpieted ii (Ae permif 15 valued et one Auntlred tlollars ($100J oi /essJ
Id'=�'certify,Mal'in Ihe peAortnance ot Ihe work for which it is issuetl, I shall not employ eny person in any manner so as to become subject to the workers'
�compensatlon laws ol ' emi , 0 egree Ihet' shoul econ �c the workers' compensation provlsions of Section 3700 of the Lebor Code, I shall torthwith
�comp�vitHthe rovisions. �
Apyicarit Slgnatura: � �Dere:—�-� %� �D/Z vUS�
WFRNING FAILURE TO SECURE WOfiKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CPIAAINAI PENALTI ANO CNIL FlNES UP TOONE HUNDRED
THOUSAND OOLLARE (5100,000�. IN ADDITION TO THE C0.ST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SEGTION 3]O60F iHE LABOR CODE, IMEflEST, AND ATTORNEI^5 FEES.
LICENSED CONTPACTORS DECLARATON:
I hereby attirm ihat � am licensed untler provisions N Chapter 9(commencing with Section 7000) ot Division 3 0l the Business and Professions Code, ana my license is in tull
force and ettecL LiC. N Class A
Contractofs SigneNre: Dete:
CONSTRUCTION LENDING AGENCY:' . ,
❑ I hereby attirtn that ihere is e construction lending agency for the peAormance of lhe work tor which this permit is issued. (Sec. 3097, C+��I Code).
Lender's Name: Lentlers Adtlress:
Signature: Date:
OWNER-BUILDEH DECLARATIONS:
I hereby aHirm Ihat under penalty of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Profes5�ons
Code: Any ciry or counry which requires e permit m construct, elter, improve, tlemolish, or repair any siructure. prior to its issuance, elso requires ihe applicant for such pertnit
to file e signed stetement that he or she is licensed pursuaN to the provisions oi the Contrectors Llcense Law (Chapter 9(commencing with Section 7000) of �Ivislon 3 of the
Business anC Professions Code) or Ihet he or she is e:empt therelrom entl the besis lor the allegatl eaemption. Any vloletion of Section 7037.5 by eny applicant for a pertnit
subjects.the applicbnt to a civii penalry ol not more then five hunGred tlollars ($500).):
,_I,.es owner of Ihe properry, or my employees wi�h weges as iheir sole compensation, WILL DO TME WORK, entl Ihe sirucNre Is not inlendetl or oHered tor sale (Sec.
7044, Busine5s and Professions Code: 7he Contractors License Law does not apply �o an owner of property who 6uilds or improves Ihereon, and who does such work
himself or herselt or Ihmugh his or �er own employees, providad Ihet such improvemenis ere not Inten00d or oHerea for sale. If, however, ihe builtlinq or impravement is
sold within ane year of completioq t�e owner-builtler will have ihe �urden ol proving thet he or she did not build or improve for puryose of sale.). �
❑ I, as owner of the property, am EXCWSIVELY CONTRACTING WITH I,iCENSED CONTRACTORS to construct the project (Sec. 7044, Bnsiness antl Protassions
Coda: The comractors License Law tloes not epply lo en owner ol property who builds or Impwves t�ereon, antl who contracts for such prolect with e contrector(s)
license pursuant to the Comractors License Laws�.� _
em
Owner ID verified by tlriver's license. �❑Yes ❑ No
Verification oi Ow��rship by (type ot docL�nent, i.e. - property tex bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Professions Code tor Ihis reason:
�-- �' rDete: � z �-J_ 2 d0 S
��
Driveas�Gcense No. . �-Expiies i z/�3 /v
❑ I hereby cenity ihat no excavetion five (5) or mora feet in depih into which a pereon is requiretl to descen4 will ba made in conoection with work autharized by t�is
permit, and Ihat no building swcture. scattolding, talsework, or demolition or dismentling ihereof, will be more Ihan Ihirry-six (36) leet hiBh. (Chap. 3.2, Grp 2, An 2, Sec.
341, Title B, Galifomia Administraliva Cotle).
❑ As owner-builder, I will not employ anyone to tlo work which woultl repuire a permit Irom the Division of Indusinal Setety, es noted ebove, unless such person has e
permit to do such work Irom the division. '
Signature: Date:
Division of Intlustriel Sefety Permit Number:
CERTIFICATE OF COMPLIANCE ANO AUTTIOpIZA'f10N OF EMRY: I certify untler penalty ol perjury Ihal I have read this epplication and state thai the information given is
correcc I agree to rPmply wi�h all state laws entl ciry ordinanc ting to Guilding consiruction, and authodze representatives ot Ihe Ciry of Costa Mesa to enter upon the
above-d�libaA-pr ior mspec�i�o j ree m�c y or allow acupancy of any building euthorized by this permit until linal inspection.
�- �_�-�`- �_. , �.f �i / 'Zf 3v �z- J c� c —
Signature OLLega � +ner(s) Da� �
f,
AnNOr Authorized Appliteni Da�e
CODE �. � INSPECTIONTYP.E PEIE II�LS
7616 Fixed System Final Fire Prevention
7266
200
207
202
203
204
Pool Spe Final
Finel Re-ROo�
Finel Block/Retaining Wall
Final Factory Fire Place
Final Sign
Finel Demalition
COOE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupan�
� ��
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 852 CORTEZST
Suite No
Viciniry:
Parcel Number: 14132214
Appliwnt: SCHWARTZ, DAVIDALAN
Address: 852 CORTEZ ST
MECHANICAL PERMIT
E��ENS� �
r����
pER�
ExPIRES / D BY:
Slalus: ISSUED
Applied: 12I302005
Issued: 12/302005
Phone: 714-549-2769
COSTA MESA, CA Zip: 92626 � �
Owner: SCHWARTZ, DAVID ALAN
Address: 852 CORTEZ ST �
Phone:
COSTA MESA, CA 2ip: 92626
Contrador: OW NER-BUILDER
Address:
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
MECHANICAL PERMIT TO ADD 1,974 S.F. TO EXISTING S.F.D.
REF#: BOS-02246
L D
E� � o
DA'�
WORK TO INCLUDE: 2 INST FAU LESS THAN 100 K BTU, 1 GAS PIPING, 1 HOOD WITH MECH
EXHAUST. 3 VENT FANSISINGLE DUCT AND 1 INST OR RELOCATE APPL VENT.
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt CoolingMeat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Faclory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers �
Inst or Relocate Appl Vent
Air Handlers � 10000cfm
AirHandlers> t0000dm
Floor Furnace
Floor or Suspend Heater
$23.50
$29.60
$0.00
so.00
$0.00
$0.00
$0.00
$6.75
$0.00
$10.65
$0.00
$27.75
so.00
$0.00
so.00
$10.65
$0.00
30.00
$0.00
$0.00
�uantity
2
0
0
0
0
0
1
0
1
0
3
0
0
0
1
0
0
0
0
PEE SUMMARY
Repair / Alt Absorbtion Unit
Repair I Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercial I nci nerator
Domestic Incinerator
Comoressors / Absorotion Svstems
Upto3hp/100kBTU
3 To 15 hp / 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up l0 3 hp
3To15hp
15 to 30 hp
30 to 50 hp
Over 50 hp
Olher Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTALCALCULATEDFEES
COMMENTS I SPECIAL CONDITIONS
Quanlily
$0.00 0
$0.00 0
50.00 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
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
Eto2.3o
NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 7241-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or II work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable cotles, and ali
requlred Inspeetions and final epproval must be obtained. Failure to obtain InsDect�ons and final approval will result in the expir� on ot ihis pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zaowa Itiwl
WORKERS'GOMPENSAnON DECLARATON: - .
I hereby aKrtn under penalry ot perjury one ol ihe following tledara6ons:
❑ I heva e�tl wlll maintein a certifirate ot consent to self-Insure tor workers' compensation, as provitled tor by sectlon 3700 of ihe Labor Code, for the pertormance ol the
work for whic� t�i5 Oertnit is issuetl.
❑ I have and wlll maintain workers' compensatlon insurence, as requiretl by section 3700 of Iha Lebo� Cotle, lor Ihe perfortnance of ihe work fo� whiU this pertnit is issu9tl.
My workers' compensation Insu�ance carrier antl poltcy numhe� are:
Carner.
not
Policy Number:
'I cetlify ihat in the poAormance ol the work br which this ermit is issuetl, I shall not employ any person In eny menner so as to become subject to iha workers'
compen8ation lews ol Celifomia, antl agree Ihat If b ome �ct t e workers' compensetion provislons ol Section 3700 0l Ine Labor Cotle, I shall lorthwith
comply With lho isi ` ,�/j .
:ent�Sipneture: I V r-�e�e:..' /Z�3b�2(JU(�
IINO.^FAILUAE TO SECURE WORKERS' COMPENSATION ODVERAGE IS UNUWFUL ANO SHALL SUBJECT pN EMPI.OYER TO CRIMINAL PE TIES ANO GVIL FlNES UP TOONE MUNDRED
SrWD OIXA+�RE (5100.0OO�.IN ADqTION TO THE WST OF,COMPENSATION, OAMAGE50.S PROVIDED PoR IN SELTON 3]OB OF THE UBOR CODE, IMEPE5T, AND ATTORNEV'S FEES.
LICENSED CONTHACTORS DECLARATION:.
I hereby affirtn t�at I em Iicensetl under provisions ol Chapter 9(commenGng with Section 7000) ot DlNsion 3 0l ihe Business antl Professions Code, antl my license Is In fuil
farce ana efleC�. UC. A � Cless M
Contractor's SignaWre: Dato:
CONSTRUCTION LENDING AGENLY: , �
❑ I here0y dnirm Ihet thero is e conslruction lentling aponcy lor ihe peAormance al the work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lontlefs Neme� Londer's Address:
Siqnature: Date:
OWNER•BUILPER DECLARATONS:
I hereby eMirm Ihat under penalry of perjury thet f em EXEMPT FROM THE CONTRACTORS LICENSE �AW lor the �ollowing reeson (Sec. 7037.5, Business antl Professions
Code: Any ciry or counry which reQuires a pertnit to construct, elter, Impmve, tlemolish, or repair eny strucWre, prior to its Issuance, elso requires the epplicant br such pertnil
to lile e signe0 statement that he or she is licensed pursuant to the provisions ot the ContraUors Ucanse law (Chaptar 9(commendng with Sectbn 7000) of OlWslon 3 oi the
Bu5in85s entl P�ote55i0ns Catle) or ihet he or she i5 exempt therelrwn entl the basis tor t�e ellegetl Bzempllon. Any vi0lelion of Seclion 7031.5 by eny appllcant tor a pertnit
subjects IhsepPlicant to a civil penalty o� not mora than fiva hunAreC dollars ($500).):
✓I; es �ner ol the property, or my employees with weges es thelr sWe compensation, WILL DO TNE WORK, entl the sWcwre is not intentlatl or otteretl for sale (Sec.
7044, BuSiness antl Professions Code: The Contraciors Licensa Law tloes not appty to en owner of proDerry who builds or improves thereon, and who tloes such work
�imself of herseN or thmugh his or her own employees, provitled that such improvemeNs are not intended or oNered tor sale. II, �owever. Ne building or Improvement is
sold within.one year of completion, ihe ownerbuilder will have the 6urden ol pmving that he or she did not builtl or improve tor purpose ol saleJ. •
❑ I, as own6� ol the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the prolect (Sec. �044, Business antl Proleuions
Code: The contractors�License Law does n epply to an owner ol property w�o 6uilds or Improves Ihereon, and who contraas br such project with e cnmractoqs)
license D�'�suant to the Contiac5ors Licens Laws.).
❑_I e tler sec. �m-. _ Business and Pmiessions Code lor this reason:
Signawre;, +'( ��� D`
�/ E:piresi �"�Z v
i
Verilication of Owners�ip by (type of tlacumem, i.e. - propeny tex blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity Ihat no excavation five (5) or more leet in Oept� into whic� a person is required to descend, wlll be matle in connection wi�h work euthodzetl by this
parmit, antl that no 6uUAing stc�cture, scattoltli�g, falsework, ar tlemolition w dismanUing thareol, wi11 be more ihen thiRy-slx (38) teet fiigt�. (Chap. 32, Gry 2, An 2, Sec.
341, Title B, Califomia Atlministratrva Cotle).
❑ As owner-builtler, I will not employ anyona to tlo work whlch woultl reduire a permit trom the Divislon ol Indusirial Salery, es notetl above, unless suc� penon has e
permit to do such work irom the tlivision.
Signature: Date:
Division of Intlubinel Sefery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AIJTHOR¢ATON OF EMRV: I certily untler penalry of perjury Ihe1 I have read this epplication antl state c�at Ne Nformation given is
correci. I ya o wmply wit� ell state laws end clry ordlnances rela�ing to building construction, antl au�horize representatives ot Ihe Ciry ol Cosla Mesa to enter upon the
e��scribed pro lor inspe�ctiojn wes. grea n � oc py or ellow occupancy of eny builtling euthonzed Dy ihis permit ,u�ntil /linal inspe ion.
� / / L/ za�7�Z rJ � Si
LSignature Ot Lega ne e�-- Oat
And/Or Authonzetl Appllrsnt
400E �, iu<�v�nONiYPE
1fit6 Fizetl 5Ystem Final Fire Prevenuon
1266 Pool Spe Finel
200 Final Re-Rooi
201 Final BIocWRetaining Well
202 Finel Factory Fira Place
203 Final 519�
204 Final Demolition
PAg 1[iiID9Li
COOE 1 INSPECTION TYPE
206 Final Mechanicel
20B Final Plumbing
210 Finel Eloctrical
212 Finol Fire Preventian
220 Finel Planning Approval
222 Final Site
250 Final Bullding/Occupancy
PAIE I[�L5
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
Appliwn�:
Address:
Owner:
Address
Contractor:
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+unils)
Pool / Spa
Lighting Fixls
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 70hp
Motors l0 50hp
Motors to 100hp
Molors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
852 CORTEZ ST
14132214
SCHWARTZ, DAVID ALAN
852 CORTEZ ST
COSTA MESA, CA
SCHWARTZ, DAVID ALAN
852 CORTEZ ST
COSTA MESA, CA
OWNER-BUILDER
EXTENSION Status: ISSUED
ALLO�ED Ass°ea iz�aonoos
PER�--�
EXPIRES � ISSUED BY:
Phone: 714-549-2769
Zip 92626 �
EXp�I
� , DA�
Phone: �
Zip: 92626 - '^"'-`��
�.
��:�
�
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
ELECTRICAL PERMIT TO ADD 1,974 S.F. TO EXISTING S.F.D.
REF#: 805-02246
WORK TO INCLUDE: 83 LIGHTING FIXTS, 75 RECEPT OUTLETS, 50 SWITCHES, 3 RES APPL AND 1
SERVICE TO 200A.
523.50
$0.00
$0.00
50.00
$0.00
$0.00
$67.99
362.15
$43.90
$0.00
$1425
530.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
50.00
50.00
$0.00
Quantiy
0
0
0
83
75
50
0
3
1
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 fl
Slanding Section
Misc Electriwl Equipment
Trensformers up to 1 kva/kw
................up to 10 kva/kw
.................uP l0 50 kva/kw
.................up l0 100 kvalkw
..................over 100 kva/kw
Low Vollage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Eleclrical Fee
Investigalion Fee
Plan Check Fee
Reinspection Fee
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
80.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 5242.29
Quantiry
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by Ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRA710N: This permit shall automatically expire and become void It work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180 days. /
INSPECTIONS: In order lor the vrork authorized under this permlt to be considered legal, such work must comply wflh all applicable cotles, and all
requlred Inepeetiona end finel approval must be obtained. Failure to obtain Inspections and final approval will result in the'expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
xaawa faroo)
WORKERS' COMPENSATION DECLARATION: . �
I hereby aHi�m under penalry oi perjury one ot the following tledarations:
❑ I have antl will maintain e certlticate oi consent to selGlnsura tor workers' wmpensetlon, es proNdetl lor by section 3700 0l tha Lebor Code, br the pertormence ot t�e
work for which ihis permit is issue0.
❑ 1 heve antl wlll maintain wofkars' compensation insurence, as �equiretl by section 3700 ot tha Lebor Cotle, tor tha portortnance oi Ihe work for which Ihis pertnit ls issued.
My workers' compensatlon Insurance carrier and policy number are:
Carner. Policy Number.
(This sectio� need no! be completetl il fhe Oermlf !s veluetl af one hundred dollers ($ f 00) o� /oss.J
`I certiry t�at in the poAormance ol tha work lor which Ihis perm' �s issueQ I shal�t employ eny person in eny manner so as to 6ecome subject to the workers'
cofnpBnsation lelv s.d{}afifomiyend agree that It I s acome ' et to 7 workers' compensetlon provislons of Sectlon 3700 ot the Lebor Code I shall lorihwit�
provi5ions.
WAi1NING: FPILURE TO SECUPE WORKERS' COMPEN$ATON COVERAGE IS UM
T1K%115M10 D�RE ($100,000), IN qDDITIIXJ TO THE COST OF COMPENSATION;
LICENSED CONTRACTORS DECLARATION:
� Data:—� -/ 2/ � v /2 d e S�
�
M'DSNALLSUBIECTANEMPLOVERTOCRIMINALPENALiIES DGVILFlNESUPTOONEMUNDpBD
:5 AS PiqVIpE� FOR IN SEGTON 3]080F THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES.
I hereby aHirm lhat I am Ikensed untler provisions ot Chapter 9(commendng wi�h Section 7000) ol Oivision 3 of Ihe Business antl Prolessions Code, enC my license Is in full
force and eNect. Lic. a Class a
Gonirectofs Slgneture: Date:
CONSTRUCTION LENDING AGENCV:
❑ I �ereby ettirtn that ihera is a construction lending agency for Ihe pedormance ot Ihe work for which �his permit is issued. (Sec. 3097, Civil Catle).
Lendefs Neme: Lentler's Adtlress:
Signaturer=� � Date:
OWNER-BUILDER DECLARATONS:
_.�.�.
1 hereby aflirm Ihet untler Oenelry o� perjury thet 1 em EXEMP7 FROM THE CONTRAC70RS LICENSE LAW br the following reason (Sec. 7031.5, Buslness antl Pmtessions
Code: Any ci�y or coumy which requires e permit ro consimct, elter, impmve, tlemolish, or reDair eny atructure, pdor to Its issuance, elso requires the epplicant tor such permit
�o lile e signetl statement that he or she Is IicenseA pursuam to the provisions ot the Contreaors License Lew (C�epter 9(cammencing with Section 7000) ol Division 3 at the
Busipess.and Professlons Cotle) or that ha or she is exempt therefrom and Ne basis lor the alleged ezemption. Any violation of Section 7031.5 6y any applicant for e permit
subjecis Ihe'epplicant to e civil penally of not more than five huntlretl tlollars ($500).):
�
es owner of Ihe property, or my employees wiih wages as their sole compensation, WILL DO THE WORK, antl iha stmcture Is not intendetl or oMeretl br sale (Sec.
7044, 6usiness antl Prolessions Cotle: The Comractors License Law does not apply lo en owner 01 pwpehy who builtls or improves thereon, an0 who tloes such work
himsetl or herselt or through his or her own employeas, provided ihai such imp�wemams ere not inten�atl or oriered for sale. If, however, the huiltling or Improvement Is
sold wi�hin ona year oi completion, Ne owner-builtler will have the burden ot proving that he or she did no� build or improve for purpose of sale.). '
❑ I, as ow�er ol the pmperty, am EXLLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct ihe project (Sec. 7044, Business and Professions
Code: The contractors License Lew tloes not apply to an owner ol pmpeny who Ouiltls or Impmves thereon, end who coniracts lor such pmject with a contractor(s)
license pursuant to Iha CoNrect se Laws.).
S%❑ I e ��'� der sea �/ p Business antl Pmlessions Cotle lor this reason:
� / -�r�—:� � ��9te '. / 2 2c705
Ownar ID ve�fie0 by ddver's license. ❑ Yes ❑ No D�s �cense�Na Expires_ ~.2 3 / �
Veriticetion o� Ownership by (type of documeni, i.e. - propeM �� bill or deed): �— ._
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby cenity thet no excavation five (5) or more feet in tlepN into which e person is require0 to descenq will be mede in connection with work euthorized by this
pertnit, antl that no builtling structure, scaHoltling, falsework, or GemWition or dismantling thereol, will ba more than thirty-six (36) leet high. (ChaO� 3.2, Grp 2, An 2, SeG.
341, TIOe B, Calibrnla Adminisiretive Code).
❑ As ow�eo-buUtler, 1 will not emplq anyvne to do wock wNch wouW require a pennit kam t�e Division ol lotlustrial Salery, es �wted above, unless such person hes e
pertnit lo tlo such work Iwm Ihe tlivision.
Signalure: Date:
Division of Industnel Sefery Permit Number.
CER7IFlCATE OF COMPLIANCE AND AlITT10RVA710N OF ENTRY: I certify under penalty ol perjury ihat I heve reed Ihis application and state Ihat the information given is
correct. I agrBe to comply with ell steta laws entl city ortlinances rela�ing to bulltling cons�mction, ena euthodze representetives at the Gty of CaSte Mesa ta enter upon Ihe
abova-desari prope inspectian pu s. t to or w occuDanty ol any building authorized by this peRnit until final inspec�io�.
~ ���--�-� �� ,L /yvD�'��
/ z �v
� Signature OI Legal Ow .ner(s) .' ,, �Date�
1
And/Or Autharizetl Applicant Date
GO�E �. INSPECTIONTYPE
1676 Flzed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Rool
201 Final Block/Reteining Well
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolltlon
EyF I�LS
j�,QQf,,,( INSPECTONTYPE
206 Final Mechanical
20B Final PlumCing
210 Final Electrical
212 Final Flra Prevention
220 Final Plonning Approval
222 Final Site
250 Final Building/Occupenc
QAIE Iti�ALS
`
z'� • ' � _ �"'
(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.caB.UILDING PERMIT �� FAIfl ORIVE, COSTA MESA, CA 92626
Job Address: 852 CORTEZ ST
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 14132214
Applicane COFFEY, BR,41N
Address: 2428 NEWPORT BLVD #5
COSTA MESA,CA
Owner: SCHWARTZ, DAVID ALAN
Address 852 CORTEZ ST
COSTA MESA, CA
Contractor. THE ROOFING SPECIALISTS
Address: 2428 NEWPORT BLVD #5
COSTA MESA,CA
Zip: 92672 .
Arch :
Address:
Zoning: R1 R1
Phone: (949) 722-8846
Zip: 92672
Phone:
Zip: 92626
Phone: (949)722-8846
License: 734068
Eng:
Address:
Phone:
ISSUED BY:
SIaWs: ISSUED
Applied: 10/11/2002
Issued: 10/11/2002
Phone:
Zip: License: � License:
SCOPE OF PERMIT
REROOF: T/O EXISTING WOOD SHAKE, 7/16' OSB OVER SPACED SHTG, 1 LAYER 30# FELT, APPLY "30-YEAR ELK COMP SHINGLES" AND
RELATED FLASHINGS. 28 S�UARES
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.52
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.77
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Ezlstinq: o
Rear 0- 0
Rear 0. 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
55,200.00
55,200.00
iNOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
� EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned
tor a period ot 780 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
requlred Inspectione and (inal epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446d8 (fl�00)
WORKERS' COMP� �SATION DECLAqATON:
I hereby eHirtn under �enalty oi per�ury ona of the tollowing declaratlons:
❑ I heve end will � einteln e cenificate of consent Io sell-Insure lor workers' compensation, as provitled for by sealon 3700 0l Ihe Lebor Cotle, tor the pertortnance ot the
�work for which i iIS.Dermit is issued.
I have end will n fintain wwkers' compensatlon insurance, es requiretl by section 3700 ot the Lebor Cotle, lo� Ihe performance of the work for wNch Ihis pertnit Is issuetl.
My workers�' °n en�s5ay(10� Insuranceccaar,�`ner and pollcy number ere: c�
Carner: "7 ��� / `-� �i� � ' / pallcy NumCor. _ � U s V 2—
(This secfion�! be cnmp�eted i( the pe'rmifls velued ef one hunCred tlollers ($100J or /ess.)
❑ I certity Ihet in the pertorRience of �he work f r which this portnit is IssueQ I shall not employ any person In eny menner sa es to 6ecome suD�ect to lhe warkers'
compensation laws ol Ca��fomia, entl agre ha� If I should become sub�ect to Ihe workers' compensetlon proWsions oi Section 3700 0l the Lebor Catle, I shell torthwilh
comply with Ihese Provisi G, /
AppllcamSipneture: � l/ Dale: ���((—�-z—
WARNIN(3: FAILUHE TO SECURE WORKEf6' COMP� TION COVEPA(3E IS UNLAW FUL AND SNALL SUBIECT rW EMPLOYEq TO CRIMINAL PENALTIES M1D CML FlNES UP TO ONE HUNDRED
TiKK15AND00LURE(5100,000),INA���TOTH CQSTOFCOMPENSATION,DFMAGESASPiiOVIDEDWRIN5ECT10N3lOBOFTHEIABORCODE,ItJrEREST,PNDATTORNEVSFEES.
LICENSED CON7RACTORS DECLARATON:
I hereby aHirtn that I am
force en0 eflect. Lic. q_
Contrectofs SignaWre:
ol Chapler 8(comm ncing wlih Section 7000) ol Division 3 ot the Business antl Pmfessions Cotle, and my Iicense is in full
aess« C -3S
� oare: �r9—r —D"L
CONSTRUCTION LENOING PGENCV:
❑ 1 here6y aNirm �het ihere is e construction lentlinp epenty lor Ihe peAormanca ol iha work tor whic� thls parmit is issued. (Sec. 3097, Civil Code).
Lentlers Name: Lendefs Adtlress:
Signeture:
D8�9:
OWNER-BUILDER DECLARAT10N5:
I hereby aMirtn Ihet untler pena��y ol pe�jury Ihat I em EXEMPT FROM THE CONTAAC70RS LICENSE LAW br �he lollowing reeson (Sec. 7031.5, Business flnd Professions
Code: Any clry or county which requires a permit to construct, alter, improve, demolish, or repair any stmclure, pdor to its Issuance, elso requires Ihe appliwn� far such pertnit
to file e signetl statemem thet de or she is licensed pursuam to the provisions of the Contrectors License Lew (Chepter 9(commencing wiih Section 7000) oi Dlvislon 3 of t�e
Business end Prolessions Code) ar thet he or 5he is exempl cheretran arW the ha5is lor the allegetl B:emption. Any violatlon Of Section 7031.5 by flny epplicant for e permlt
subjacts the epplicent to e civil penalry of not more than five huntlred tlollars ($500)J:
❑ I, as owner ol Ihe propeny. or my employees wlth weges as Iheir sole compensatlon, WILL DO TT1E WORK, and the strucWre Is not imended or ottere0lor sale (Sec.
7044, Business antl PwlBssians Code: The Contractors License Law does not apply to en owner ot property who builds or improves thereon, and who does such work
�imsell or herself or ihroVgh his or her awn employees, pmvidetl that such Improvements are not Intended or oNeretl for sale. It, however, Ihe building ar Improvement is
sold within one year ol completion, ihe ownerbuilder will have ihe burden of D�o�ing that he or she did not build or improve br Ourpose of sale.).
❑ I, as owner of Iha property, am E%CLUSIVELV CONTRACTNG WITM LICENSED CONTRACTORS to consiruct t�e projed (Sec. 70d4, Business end Professions
Cotle: The contrectors Ueense Lew tloes not aQply to en owner ot pmpeny who 6uilds or Improves thereon, end who cantrects tor such pmject with e contractor(s)
license pursuant b the CONractors License LewsJ.
❑ I em exempt under sec.
Slgneture:
Owner ID veAtieO by tlnvefs license. ❑ Ves � No
Business entl Professions Code for Ihis reeson:
Verilicetion ot Ownership by (rype of document, i.e. - properry te�c bill or daed):
DnveYs License No.
Dete:
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certiy that no evw�ation frve (5) or more feet in depth Into which e person is required to descend, wlll be matle in connectlon with work eut�odze0 by Ihis
permit, and that no building structure, scaMdding, falsewark, or tlemdition or tlismantling thereol, wlll be more �hen tNrty-six (38) leet high. (C�ap. 32, Gip 2, A� 2. Sec.
341, Tltle 8, Celifomia Adminl5tratNa Cade).
� As owner-Duiltler, I wlll not employ enyone to tlo work which would require e pertnit from t�e D'Mslon ol IntlustAal Selery, es noted ebove, unleu Such peraon �fls e
permlt Io tlo such work trOm t�e dlvlsion.
Signature: Dete:
Division ol Industnal Safoiy Petmit Number:
CERTIFlCATE OF COMPLIANCE AND AUTFIORVATON OF ENTAV: I certity under penalry ot perjury Ihat I have �eatl ihis application and state t�at the infortnation given is
correct. I egree to wmply with ell state laws end dry ortlinances relatinp to builAing conswctlon, end authodze representatives oi the Ciry ol Costa Mese to enter upon Ihe
ebove-described property lor inspectian puryoses. I egree not to occupy or ellow occuDency ot eny bullding euthodzed by Ihis permit unGl finel inspection.
COOE �. INSPECTONTViE �
7618 Flaetl System Final Fife Preventlan
1288
200
201
202
203
Pool Spe Final
Finel Re-Root
Finel BIocWReteining Well
Final FectOry Fire PIaGe
Flnel Sign
204 Finel Demolition
PAIE II�1ll5
0-1 -0 �
COOE� INSPECTONT'VE
206 Final Mechenicel
208 Flnel Plumbing
210 Final Elecirical
212 Finel Fire Preventlon
220 Finel Planning Appmval
222
250
Data
/D�/l� 02
Date
Finel Slle
Finel BUIl01ng/Occupenq
� It��
, " g.34,.3;�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P, O. BOX 917 C06TA MEBA. CALIFORNIA
For Applicanf to Fill In Compleiely
TYPE OR PRINT �
BLJILDING
ADDRES9 O t@Z Street
COSTA MESA CALIFORNIA
� MAIL
NoDR 34220
tionHo' OB 3422
- -n,., Y .
� :�1�..ildLti.��� .
�'OEC 4 1960
Lo r � �, P�A,V, ,3���'�E�DE?i.
. uF cu�ra mEs�
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RZL6IPT NO. ��II��I�Qi�V
Y A:J
R6C�lVHD GY I DAT2AEC¢IYeD. I DAT[ �68U[U
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