HomeMy WebLinkAbout929 CROCUS CIR - Building PermitsP
AC}EiFA40f9NLOW@ 9zg CROCUS CI u"T:
ariERs""YE"'wv""MURILLO, MARGARET FLOOD: AH-38
�� � ��pE�929 CROCUS CIR
'' COSTA MESA,CA 92626
556-8388
AYPL.MlIlINO �DDNE53
IJICN?ECT OP ENdNEFA:
�xcx. oa u+o: e woe�ss:
uc. ra.:
UNT:
c�m�ttareru�:PRESTIGE ROOFING COMPANY ( 800 ) 427-6630
CONfPACTOR�Y41➢l0 657 W 19TH ST
mo�ssCOSTA MESA CA uern: 597956
92627 urn:
UCEN9ED COMX�CTON9 OECLANATION: I h�nby Ntrm uM�r p�ndy ol p�r�ury !GI IbnwE uMv poMdon� ol Gluq�r Y
(oommmtl�q vMh e�clbn ]Oa0) a�� � d N� BUNnea and Pmlado � ad� E mw b in h0 toru W qf�p.
cmue.no.p57081 ue.euas:�_gg ue. o. S 7 6 EXP: 08/96
odr eonv.aor:
� OWNER BIIILOEX OECLARRTION: I Mieby elfi�m uMar peneAy d perWry Ihet 1 em eumq hom tM Comrraon Lloenea Lew Iw ihs
folbxinp neun (Setlbn 1W 1.5 Bu�nne enE Pmlueione Coda: Rny ciy a munly wfiidi nquim e psimil lo aon�Yucl, ellx, improvs,
demoleh, or npai ury �Wclur�, prior to iu ewenm. eho repuire� tM epDliunt lor wch permil to fib ��ipmd �tatemenl ihel he or ahe
'n IicarueA WA�� �o IM pwivme d Na Comreaas Licenea Lew �Chapx 8(aommentiip hilh Serlion 1000) d DHeion � d IM
Buainoa ud Prdva'w COEaI a thet M a sM u eumq ihselrom ub iM Eaeu la tM elbpad azomqian. MY v'dtlion M Sedion
)O�t.S by vry eppYceN fa e permG wbprte iM eppiiram io e wil perWry W ml mas ihen live hunEnE dollen �5500��.
� I, es awrer d the popeM a my employees wih we9� %9 ��'v role wmpemeiion, il Eo IM xwk, eM Ne suunure o rwi in�endeE
w dlereC for+eb (Sectbn ]016. Busmea end Proleaeioro Cotle: The Comreeon lioenae lew doae ea epqy m en oxnerd D�oeM
wM10 buids ar inyoves Iherson, vd who daea auU wak IvmaeX or henJ a thraph h'v rc her oxn empbyeea. povideE iMt euch
'unprwamxua ere M iweitlatl a dlsed for aele. II. howavar. tM buiNieq a inpwemeM u soN xithin aroY� d oomqelion. IM
o.�maad.. �u ne.a ina wreen a aw�ro ne «.ne ea �a bwa «imw�* �« me wmas a adel.
� I. av o�mer d iM properry. em udusrveM �treemg wiih licenaed convec�an io conmuq tM projed (�� )�. Bwirwee eM
PMaswme Coee: Tne C«urmon lieiue lew does na epply m en ownar W propeM ��'d a impo+m tnereon eM wno
wnvazta la vuN W4�a wh e conlr+dor�a) IranaeE W�ueni lo Ihe Contrman l'xeroe lev).
� I em eaemq uMer Sectian: B. 8 P C., for �hn reeaon:
Dele: Owner:
i eo ne�eev oenM u,m i� a.�.. a e�d u�denw�e me r«iunemeou a cdao�,e �nn e�e sm.y coee s«+�,a zssos, zss�, ena
25510. erd ihet I a azry iNuro buiMilq ompeni will / wtll rwi (orcb me) neeC Io compy wIn uk pata mEea W Ihe nQuiromen�e lor
epeimelamruuuctionnmod'dimlionhamlMAi u�TeiyFl�erepameMDietrid.RedEemielomvrunioneppire�imsersexamqfromtMea
w��
o�a: �vpe�c
WONKEF'S COMPENS�TION UECL�RATON: I Mraby elfimi urMs perelly d pajury aw d �he Idbwinp AMeimiom:
❑ I heve aM xil me'v�ten e centliute d m�sent lo eep-inwn lor xakmi canpeneetion, n yaided trc by Sad'ai ])00 d iM lebor
coae. �n in. wnmmence a uie ywx �« w+:cn inn re�il u ivi,ee.
_ 1"I � neva ene w mai�v.n.vwwen• mmw��mion Nsurenoe. av rea��.ea M seaion sloo a the Lebor eoae.la. �ne oaebrmerce d ine
`(— wwk ta whitli Nu pemul o bsueC. MY wmWn' campenminn inararwe feriim enE po4e/ numbx are:
c�«: STATE FUND EXPIRES
Pd'ryNumber. �aS4�nonn 7�01/O1/97
lTM1is sxiion need iwf 6e conpbred / �M pmml is la ona hundred ddlers (51001 a bn.)
� I mn/y thet in tM pxlormence W IM1e wwk /a xhch �hia pamw ia iv , I M d em ury peiwn in eny meninr eo sv lo
ber.ome subl�l lo tM xaekere' eom0�ion kwe d Gelilwua E m het d houk beemie w4� io iM �wkere
cwnpanaeion pmiaum d Swion 3)ao d IM labor CoCe. I IM th inpy h Ilae paiawm.
oa�e: �vwK��:
Wam/np' Fillun ro wcan wrtsn'rnmpenutlon eovenp� 4 un wNl. �ntl Lu/l �uDlKt an wryrloyx ro eNMrW pmeMss uM
dvll Nns up ro wro hintl�eC rnouund dol/an (ffaqaaaJ, In sedltlon ro ms cast ol mmpawtbn, samsq� si povltlW ror In
Ssetlon 9)06 oI tlis la4or Cotls, InM1n�q enE �ttomsy'� fw�.
CONSTPUCIION LENOINO AQENCY: I heroby elfirm under poneM1y d perNrY �� ��� u e wns�iudion IeMinp eger�cy lor ihe
Pon�,� a in� ..� i� �,m,m �ne w��"a,�,e cs,am� aas�. cw. ci. �
LENUER'4 NAME:
LENOEH'S �OOPE53:
� ceniy ihe� I hew reed inu eodi:e�bn ud mm. ihei ina ebove inlormetion is rorrea. i eqme b candY witn ell my ene ooumy orai�e
eM alale IeMe rele�ip lo buildvq coruV Wion eM heraEY eNM1arrze repraeanlelivea d Ihu tilY �o enla upon IM ebv.•e�men�qnaC pmpoM
Iw i�upedion W�W�+�
D f�tENIC VALVANO
"�'�° 6
Dme:�� —,�
o N IirenVConlredor
(5151-16.WP) WINe-BuiMiq 8 Sa�ety: Gr�le: Cenary-�PC�'��: Pink-Revenue: GalEenrod-Aaxfwr
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: B 077477
PERMIT NO: B 077477 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
SOB DESCRIPTION : COMP OVER 1 LAYER SHINGLE SQ FT: 4,350
CLAIM VALUE: 4,350.00 CALC—VALUE: 4,350,00 GROUP OCC: R-3 /U-1
COMMENTS: RESIDENTIAL REROOF
�t+t�t�t�**�*�r**���*x*�*�r*�r*�r�**�r�t**�*�t*�t�t*�r�t**�*�*�t*x***�t�**�*�*x*+��t�x*�t�r**�t�e�r�x*�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ----
FRNT:' FT IN REAR: FT
LEFT; FT IN RGHT: FT
PARKING REQ: PROV;
IPLANNING NOTES>
)
---- --------- ACCESSORY HUILDING ---------
IN FRNT: FT IN REAR: FT IN
IN LEFT: FT IN RGHT: FT IN
PARCEL: 41218329 ZNE: REF NO:
1E fE 1E 1f 1E 1Elf 9f �E iE iE iE fE iE jE 9E fE iE iE k 1E 1E 1E jE 1E 1E iE if jE iE �E iF fE 1f if iF if 1f iElElE iE iE 1E iE 1E ff �E iE iE iE iE 1f if ik iF 1f iE ik IE fE iE 3k �f fE iE iE iF if if �F iE �E iE 9E �E iElE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY . DATE•
��� � ��Z� ��:�I��� �Z:��� i
APPLICATION ISSUED HY: �
IE 1E 1E iE 1E if iE 1E 1E �E iE iF 1E iElE fE 1F iE iE 1ElE 1E fE
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
PERMIT 99.75
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL
TOTALS----> 100.25 0.00 0.00 100,25
DATE: ��
DATE: ✓ � ✓
IEiEfE�E�EiE1EiEiE 1Eif
STRUCTURAL SEGMENT:Y
SMIP/RES GRADING
5�
SMIP/NON—RES
�. PAID DUE
100.25 .00
EVENUE DIVISION TOTALS--> COLLECTED: 100.25 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
99.75 .50
1E ib iE if 3k 1E iE 1E fE 1ElE 1f fE 1flE 7E iE 1E ik iE if !E iE iE if !E if if iE fE iE iE iE 1ElE iE iE IE IE iE iE 1E fE 1f 1E dE �E if iF If if 3E iE fF iE �E iE iE 1E jE iE IE iE if If iE if 1E iE 3E iE jE IE iE iE 3E 1E IE iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 4� � VALUE RESIDENTIAL NO'LONE 1.00 4,350.00
END OF FEES
DATE � - I� �' " , ,
�/ /% +`.n,
� (x�
:. _. _ '.,�' .J „� -
� •CONSTRUGT�ON AND PLANNiNG PO� _ & SPA
`� APPROVALS Permit# Date Inspector pppROVALS Permit# Date Inspector
1. TemOorary Electriral 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. Steei Reinforcement 56. Rough P�umbing & PreSsure Test �
6. Electrica� UFER Grnd. 57. APPROVAL TO COVER-GUNITE �
7. Footings 58. E�ectrical Conduii•Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Strucwral floor System 67. APPROVAL TO DECK• � ,
i L Property Sewer Line & House Conriection 62. Backwasfi & Receptor-Finat
12. Sewer Cap . ' 63. Heater & Vent�Final � '
13. Roof Drains 64. Plumbing Sy:tem � Final
74. Rough Plumbing , 65. Electrical�Final .
15. Fough Electrical-Conduit 66. Solar SYstem�Fina�
76. Rough Electric Wiring 67. Fencinc� & Access ApProval
77. Raugh Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough EleCtrica6T Bar Ceiling. 69. POOUSPA SYSTEN7S FlNAL
19. Rough Heating & Air Condixioning FIRE DEPT. REQUIREMENT
�40. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventifating 71. Product Piping O Gas OOiI
23. Gas Pipe•Rough & Test 72. Underground Flusti
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oij� „
25. floof Sheath�ng 74. Overhead Hydro
26. T�Bar Ceiling (Seructural) & Monocoat 75. Dry Chemicai �
' ._
27. Frame and Flashing 76. Dry Standpipe - �
�I
28. lathing&�Siding 77. FIXEDSYSTEMFINAL �� �
29. Insulation � 78. FIRE PREV. FINAL
30. DrV�Yali Nai�ing HEALTH DEPT. REQUIREMENT
37. Plaster 8rown Coai 79. FINAL INSPECTION
32. Electrical 7ower Meter-Finai 80. FD00 CERTIFICA7E ISSUED
33. Fina� Electric Notes:
34. Final Heating & Air Conditioning .
35. Final Gas Pipe-Test
36. Hood or Cenopy - - '
37. Final facto�V Fireplace
.�
38. Final Plumbing
39. 1Vater Service-Finaf
40. Gas Servic¢-Finai '
47. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation � �- � � `.,�
44. Landscape Irrigation System �(/�-
45. Sound Attenuaiion
46. Handicap Re9ulations
47. FINALSTRUCTURE&BUILDWG
48. FtNALP�ANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFIC%+TE OF OCCUPANCY
No. Date
F�S ua�IY . GA 2na-nUn
Applicant lo fill In all spates except lhose within �eavy DorEer Iines anC sign all aOD�oD�iate tleelaratloni.
CITV OF COST MESA CONSTRUCTIJ(j�N PERMIT PER NO� ��� �� TRACT NO. LOT NO. UNIT NO.
ProjectAddress �1�9 e�oevs L",�/p '
Applicant's Mailing rAdndre��ss�,�
Owner's Name �Cls!_'r'N_� � i3n-I- Phone�� �3
Address q'� � � OQ! 5 g �n iL -
Arch/Eng. Licenu No.
Address
Convactor's Name� Q//�4�/.�� �1$ %'n��hone �
Addreulmailingl—�.�-�/�/Q �L1.3 � ��
City License No. _�}�r_YL�
LICENSED CONTRACTOR DECLARATION
1 he�eby atfirm that I am Iicensetl untlet provisions ot Cha�te� 9(commencing
with section 7000) of Division 3 of the Business antl Professions Cotle, antl
my license is in full t rce an effect. /���� rj
License CI Lic No. 7
Date � 519 t � � - �-�J� �
WORKERS' COMPENSATION DECLARATION
1 hereby aftirm [nat I have a cer[ificate ot consent to self-insure or a ceriificate
ot WorkerY Compensation Insurante, or a certifietl mpy ihereof (Section
3800, Lab. C.)
Pnolicy No. ���9/� Company ��Z'F
l]�Certifietl coOy is hereb�i[h�the�c ty B ng 'pIiv-isw`nO c/,��
Ddte —� AOP���ant ��'�^ a�' -C�%l% //
EXEMP�ROM WORKERS' COMPENSATION DECLAftATION
(Tnissec[ion neetl not be completetl if the permit is for one huntlretl (g100) or
less).
1 certi(y that in th¢ Perfo�mance of the wOrk for which this perm�t is issuetl, I
shall no[ employ any person in any manner so as to become subject to the
Workers' Compensalion Laws ot Califomia.
�a[e � 99��tur¢
NOTICE: If, a(ter makln9 this tleclaratlon, you shoultl become subject to the
Wotker5' Compensalion proviSionS o/ thG Labor Cotle, you must forthwith
compty witM1 such provi5ion5 or [his Oermit shall be tleemed revoketl.
CONSTRUCTION LENDING AGENCV
I hereby a/flrm that there iz a construction lentling agenCy tor the perlormance
of tbe work for which lhis permit is issuetl (Section 3097 Civ. C.)
�entler's Name
LontleYs Ftltlress
OWNER BUIL�EH DECLARATION
I hCreby aftirm that I am exemOt from the Con[ractor'S LltenS¢ Law tor th¢
following reason ($ection 7031.5 Businesz antl Profes51ona1 Cotle: Any tity or
counry wnich �equires a permit to construct, alter, improve, tlemolish or repalr
any structwe, prior to its Issuance, also reqWres the applicant tor such permit
O tile a Si9nad statemenl Ihdt he/she i5 IIC¢n5etl pufsuant to Ih¢ PlOvi5ion5 ot
ne Contractor's License law (Chap[er 9.(commenUng wlth Sectlon ]000) of
DIVI51on 3 of lb¢ BUSlness and'ProlezsiOns Cotle) or [hat he/5M1e is exempt
lher¢Gorti antl th¢ basis tor the allegetl exemption. Any vlola[ion o1 Secllon
7031.5 by any ap0lican[ tor a permi[ subjects the applicant to a Civil
�. penalty ol not-more than tive �untlretl tlollars (E500).
Ll I, as owner of tha property or my employees with wages as tneir soie
, compensaeion, will tlo the work, antl the ztructure is nol intentletl or o/toretl
' for sale �Section 7044, Business anG Prolessional COCe: The Contractor's
I Licenso Law tlOes not apply to an owner Of a property wh0 bulltls or imprOveS
tpe�eon, antl who tlOes such wo�k ItimS¢If/lierselt or through hI5 or her own
employee5. PrOvlOetl thal such imOrovements are nOt Intentletl or otferetl for
5a10. If, boweveq Ihe bulltlin9 or Improvament Is soltl within one year ot com-
pletion, cM1c owner will nave tne burtlen of proving he/she tlItl not builtl or im-
p�Ove tor tho purpo5o Of zale).
❑ I, as owner of the o�operty, am excWsively contracting with Ilcensetl con-
tractorsto conSVuct [he project (Settion 7044, Business antl Prote55ion5 Code:
The � Contractor's License L. w tloes mt apply to a� owne� of Ptope�ry who
builtls or improves thermn, antl who conVacts for such projecls with a con-
tra<tor(s license pu�suant to the ContraCtor'S Licanse Law). I am aware that
proo/ o� their Worker's CompenSaliOn insurance Shoultl be proviEetl to Te.
❑ I am exempt un0e�_Section B. & P. C. tor [hi5 rCaSon
Date �Owner _
I nereby certify that I M1ave reatl tnis
information Is wrrecL 1 a9ree to comp
antl state laws relating to build�n n
sentatives of lhis city to e fer oi
inspection purp s �
Signa[ure � •
DriverY l.icense or 55 �
- APPlicanp Pink - Acmuntlng; Goltlenrotl - Assassor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heacer
Water Service
Auto-Wash
I�sue Fee
Hood or 7ypel 0
CanopY Type II ❑
Refrigeration Sys[em
❑0-t00,0008TU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Isue Fee
fEES
S 3
$ 3
06 �65�
A.P. �
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher �
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generaror �0-5 KW �5��
7741 500^ T
�741 Fi��.
�Zo�a —�.,� ri
:cessory Building: •
Park
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 700 amps
Meter ❑overi00amps
Sub Panel
Motors �61 HP �1'/: � 8
InaSolar �9-15 HP �76-75+
Microwave
Pole �ight
I I Standing Sections
5 KW I Trash Compacror
� Reinspection Fee �$15 � � Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Buildine APP�oved By —�
Appliwtion luued By
FEES
5 3
Z
O
N
I
N
G
R
E
Q
M
T
$
SUMMARY OF FEES
BUILDING PERMIT $ SMIP 5
PLAN CHECK $ —�— PERMIT ��,f,�
PLUMBING § � ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C.- 5
ELECTRICAL $ GRADING $
PLAN CHECK 50% S MICROFILM S
MECHANICAL S TOTA�FEE S ,�, 00
PLAN CHECK 25% $
CONSTRUCTION AND �PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS 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. Founda[ion 59. Gas Pipe, O Undrgmd., 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
72. 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
i 6. Rough Elecvic 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 Heacing & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �
37. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. FinalElectric Notes:6-Z-$7 L�FT Cq(L(J• L,E.�
34. Final Heating & Air Conditioning (�•���Cq��� {� Pi,Q ZO•g UMG (, FiD
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �
39. Water Service-Final •
40. Gas Service-Final �
41. Solar pomestic-Final
42. Backflow Preventer ,
43. Backflow Irrigation
44. Landscape Irrigation System ,
45. Sound Attenuation
46. Handicap Regulations • . �
47. FINALSTRUCTURE&BUILDING .
48.� Special Requirements Completed
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY .
No. Date
�OOPESSOFBUILqNG: fJ.'l(3 CRQ�`UCJ' �`I UNi:
°""ERs"""E'°'°'°''":MURILLO, MARGARET FLOOD: AH-38
moxEss:gZg CROCUS CIA
COSTA MESA,CA 92626
556-8388
APPI. WUI➢M NDXE55:
ARCNRECT Ofl FNCdlFEP:
dPCX. OH F1W.'S AOONESS:
uc, ra.:
UNi:
c«rm�crarsxua:pRESTIGE ROOFING COMPANY ( 800 ) 427-6630
caxrx�croxsxu�mo 657 W 19TH ST
�oo�ss:COSTA MESA CA ucno.: 597956
92627 uxr:
LILENSED COMX�CTOPS DECL�PATION: I henEy eflim uMs pmetly d parjury Wq I uylc�naed uMs pwirion� d CNqm 9
(mmmamriq xilh Seclion )OW) o/ D'meb� 3 d Ne Bueinw enE Vrd»ei�� oAa E n fiwnve u in IUA Mcs eM eXetl.
cmuc.No.p57081 ��c.cu9g:�_gg uc.No:S 7 6 EXP; OB/96
Dme: Cawaaa: / �
OW NEN BUIIDEP DECIANATION: I Mreby dfiim urdar parely d parjury �M� I am eumq Irom tM ContreGm lironee lew lor IM
�bwnB �e%9^^ (�ion ]0�1.5 &uiwes end PeMevions COEe: Arry cYy a oounry whiM iaqui�as e peimX lo oonaWcl. ellm, impove,
imdoh, v repei eny eVuclun, peim m ns eaueMe, ebo repwrea �he epd�� la wch permil to !b a eqrod sblemenl ihet M a eM
e licenved pumivu io tM pwiaiam W Ne Contreaon Licenae Lew �Cheqm H(rommendnp wil� Sedan ]0001 a�eion � d the
Buvrca erd Prdmaiau Cadej or ihei he a aM u axemp threhom eM tM bam la Na elbped memqion. My v'nleiian d Seebn
)0�1.5 W eny apWiraN lar e parmG abpaa iM eppiceM io e dvY peneM1y ot nd man Ilien fva M1UM�oG JdWe �5500�.
❑ 1. m ox�nr d �M propenY or my mmpbyeea v.yM1 wepm m tMi ede mmpanuiion. xill do iM xwk, ard iM nruciure c m� inienEeE
or ollared la sab (�tion ]061. BuvreaaM Vrolessbna Code: TM Cmtrudon limnu Lew Coea nd eppyloan owmr d popaily
who buids a inpovea Ihe�ean, ud Mn Eoes e�cM1 xwk IimaeM n henM a IMauph he a her oxn ompbyses. pvrided ihm wch
'unpwamxua ere nd "vueMed a Wared Im eeb. tl. Mwmm. tM WiNiiq a inP�emeN o edd wGhin an Yw M wmG�ion. Ne
ow�w�Eialtler xi0 Mv �M buNen d D�'��q M a ehe did na duM a impw+lu iha WN�e W eebl.
❑ I. as owrer W iM O�P�Y. em udimvM' mMred^Y xilh IicenseE coniractae lo mn9rup iM WQed (Sepun ]Os1. &rei�s vd
Prolesaiana Cade: TM Conlreqore Lironse Law tloes mi epqy io en ovmer d pope�y xtw buitle a impovm ihareon vM xfio
wnvecv t« wW w9ms wiM e mureaM.) IkanaeE wnueni �o �he Contrm«e liorus lewl.
❑ I em uamq under Seabn: . B. d P.G.. br Nu ren+on:
Deta: Ownar.
i ao n,�M �enM wi i a� a.,a,e d�e u�wers�d ine nao��a�m d cva�e �.nn �a sdmr cme s.a�. zsws. zssaa. ene
2555a, eM Net I a e�ry M1aure buiki�q ompen� will / WI �qt (acb me) neeE to camqy wIh vaiE elele mdm xN iM repuimmenn lu
e G� tummbucYana modRretionhantM �raueTty I.�vupemw Outna. Raademial mnuwion eOP�broen exmmq irom IMae
a�.
Date: Applcenl:
,
WORKEH'S COMPENSATION DECLAN�TON: I hereby effum under penelty d perHuy me d Ne IWowiip Ee�W Wiam:
p in�,.�ew�m�.�ne�aa�im..n:�nro,.,�x�w�vMw�.mw�aeei«wsea�a�aoam.�.c«
coee. �« ma oen�a a o» � �a..uon mo �a �. a.�e.
� I hew eM wl meinivi woMwa' oompemeiion inaureMe. m mp�ired by Sadim �)00 d iM Lebor Coda. la Iho pe�ormonco d iM
wwk la whidi ihn permM1 is mued. MY ��n' wmperueiion iiuurarce umar ud pdicy number ere: '
.- c�.: STATF FUND EXPIRES
� aa:yrmme«: 7R5q5f1(1(100745 O1/OL/9i
(This section neee rwr ba complered / �he permM is /a one nuMieC Cdiers (Stool w' b's'.a/d
� I mnAy Nei in �ha peRormerice d iM woM Ia v.hih ihie pertnn ie im , I u�w am �erry pereon in eny menner eo av lo
Ne y�
beconn subjea io tM xorken' canpenaeiion kwe d CelifaiJe.�fnE Ore Md n k beconn abjea �o the wMen'
wmreremo� w�ore a smo� a�ao d me �ena coe.. i wwion m mcN � w��+.
, Dale: { ApqicaM:
l
WaTIIIp: FIIIYIO M�KY/1W0/IfMI comperwHon mverep� Is un ewNl, entl �NII sub/�cl en smployer fo crlMru/ penelHw an0
cnn nns, w ro are nuna..a mou,.nd eonm frwuaool, �� .���� ro m. rn,t or rnny.rwrron avuw, u povmw ro. �n
Sxtlon 91a6 0/ Ms laEor COW, In�xuL ��4 etlornsy's Issi.
CONSTflUCIION LENpING AGENCY: I hareby alfiem uMar penelry d parN�Y �� ��� a e connivaion NMinp epericy lor IM
'van�e�m or ma.wn �or wn�m mm w�e o ma�ad IseaA� aov�. ca. q.
� LENDEH'SNAME:
LENDEN'S ADUPE53:
� CBIIIry' 1118� � h9VB R04Ih19 MPIIC9�1M 911d 51BI8 ��1BI Ih0 9�OVB 1I1�q111B�101119 C0110d. � BQfBe �O LtlT�' Ntl�l B�� MY 0114 N11111`/ Of�111B11CB8
end aieie lews mlalinp io buildin0 ��rudion eM hemby eNhorae repreeante�ivoe W ihia dly to emar upon Ihe ebove�mantbned pmpaM
�OfIf19pBC11011p11lpJ8B9. ��
D 1NENIC VALVANO
- Pnm Neme i- n /
�AAA / �� /� /i
//i�%.9A�/ J Deta�. `� �
'a17i�t'O��wn�A DYcenVConlreclor
�5�5t<fi.WP) While-BuiWip 8 Sefery; GreamFla; Cenery-Appir.ent: Pink-flavenuo: Gddenrod-Rsfefeor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 077477 PLAN CHECK NO: N
PERM NO: B 077477
GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: GTH
JOB DESCRIPTION : COMP OV$R 1 LAYER SHINGLE SQ FT: 4,350
CLAIM VALUE: 4,350.00 CALC-VALUE: 4,350.00 GROUP OCC: R-3 /U-1
COMMENTS: RESIDENTIAL REROOF
*�e�e�+a��r��r*�r*�r#�r�e�r�r*�r�r**�*�e**�r#�r�e+r**�r**+t#+r+t�r�r�*��r��x�*x�**�*****�e**�+eit�r�**#**��r�x�*
Z O N I N G R E Q U Z R E M E N T 5
S E T B A C K S
------------ MAZN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT ZN
LEFT: FT IN AGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 41218329 2NE,: REF NO:
PLANNING NOTES>
�
iF if i4 if if if' 1i' 1f 1f if if if if if if'If if i! if iI"7F iF if'N' # if # i(' if il'iE1f i{'if 1f i8 # iE if 1F if iF1FiI' iEif IFif if if'If iI' if ikiF if # 1f iF if ii' if if if if if if if'if if i4 # if'iF iF if i6 il' ik
D E V E L O P M E N T S E R V I C E S R E(j U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
iF iE IE iF IF7f !k IP if if 1f iF iE iE iflEif 1FiF iE iE M
LEGALIZATION:N
I��i�-^Si�S���i�:;9
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 99.75
PLAN
ISSUE FEE
� DATE:
T �
DATE:
3F{Fif 1f 1Fif 1f 1E1f 1f 1f iE 1l��F{F�# 1f
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES. GRADING
SMIP/NON—RES
HUILDING—DIV—> PEAMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 100.25 0.00 0.00 100.25 100.25 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 100.25 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/TOT GRADING PLAN—CHECK
99.75 ,SO
iF 1k'1F iE if 1f 1! 1F �1E 1F iE iE 1F 1! 1EiF iE 1f 1f 1E 1E IE1E 1f i! 1F1F# 1f iF lkdk 1f 1k 16lEi(�# iF /F if 1E IE 1ElF # iF1E 1E 7f !E 1F if iFif 1k iE 1k if 1F if # 1f 1f'lEik 1Ei!'M' if 1f'iE 1F 1E # i! iF 1F ih
I N D I V I D.0 A L F E E B R E A K D O W N
TYPE QTY D E S C A I P T I O N UNIT COST TOTAL COST
4350 ALTER HY VALUE
id
RESIDENTIAL NOZONE
END OF FEES
� -1, U
5 ���
1.00 4,350.00
02 llD205730-00205731 To]T 100.25
DATE: DS/D2/95 TI11E: 08�40
CIT_ r" WSTA MESA REQUEST FOR OCCUF. ,Y
TRACT N0. ��
IAT N0. �
ADDRESS � ? ��i�/� ✓(/(/�
DATE � �
The developer of the above entitled tract desires to sell the above aet
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The under igned, by executing this agreemen�, acknowledges tha[
�{13e-s�te-the}� (�ee�et were)��� advised that this tract has
not been given nal nspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
RECEIVED
CITY OF COSin pAESA
APP, 2�1 1973
AM PM
7iai9il0i11i12i1i2i3i4i5i6
/
B�.�i����R � K ��%��
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BY C�K:n�J�I/���a.�?-,t��
Developer and/or authorized
representa[ive
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BY „ tiu-G�� � � �
�Lender
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3510I
SOlA.COSo soxE72ao �co��nna SAFCALI ORNFlIA92G26T
For Applicant to Fill in Completely
BUILDING Crocus Circle
ADDRESS
OWNER
MAIL .
CITY
CANSTRUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT
ADDRESS 9]
CONTRACTOR Lg
ADDRESS � F
ciTv En
$TATE
LIC. NO. 1C
SI2E
OF LOT (� X
USE OF
EXISTING BLDG.
SI2E OF
NEW BLDG. 1]�{Q
EXTERIOR WALL
COVERING �
USE OF BUILDING
TEL.
NO.
"o. 986 -
CITY
LIC. NO. R
I� NO. OF BLDGS.
NOW ON LOT
NO. OF
POOMS STOF
ROOF j.]Q
COVERING Sh
K TO BE PERFORMED
fl
PAID fiF dfri��li2-85
AI;G 15-7?_�r�$1�0102�
4TION FOR BUILDING PERMIT
Y DA RECEIVED D E ISSUED
—a2/- 7. _/S� 7
PERMIT NO.
�` _ `ic i
BUILOfM1fG
ADDPE55
TRACT
FIFE
ZONE NO.OF r� USE OF NEW
FLANS p` BUILDING u
VARDSAPPFOVED VAF�SAF
MAIN BUILDING ACCESSOR'
(FROM GL STREET)
VAR. #
�APPROVED / i 1 L
v V��
BET. MAIN &
ACCE55.8LD
DATE
APPflOVEO
N�
I hereby acknowletlea that I have reatl mis application ane state �.;OLD FOR SPECIAL RE � P TS
that the above information is rorrect and agree to comply with I
all laws regulating bu{�ding consVuction, and I shall not employ
any person in violati0n of the workman's compensation laws of
ffie State ot Californig, �
I hereby certify that I am properly licensetl as a controctor untler SQ. FT. o
the State of California Business antl Protessionz Cotle, Divisicn 3, THE AMOUNTSHOWN UNDER VA�UATION IS FOR
Chapter 9, antl that sUch licenses are in full 4orce antl ettect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exempt trom the provisions of the State ot Calitornia Businass Q
antl Protessions Code, Division 3, Chapter 9.
VALUATION � �
�PERMIT FEE $ �
�
Si nature of �./� � m
Permittee ���/i"�/J� n_ POWi1S $�G � PLANCHECK$ "�� E
�� `o
Autharizetl Agent LL
TOTAL FEE