HomeMy WebLinkAbout3206 DAKOTA AVE - Building Permits� CITY OF COSTA MESA �
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT TYPE ELEC
APN: 13908502
JOB ADDRESS: 3206 OAKOTA AV CM
Vicinity: REAR SFD '
PERMIT NUMBER: E08-00436
STATUS: ISSUED
DATE ISSUED: 1 211 912 0 0 8
ISSUED BY: BJK
Suite/Unit:
SCOPE OF WORK: CHANGE-OUT OF AN EXISTING ELEC SVS AT THE REAR OF A SFD. 1 SVS TO 200A
OWNER: JENNESS, VALERIE . - Address: 3206 DAKOTA AVE Unit:
PHONE: ," City/Slate2ip: COSTA MESA, CA
APP�ICANT: DAVID E BURGER .�
PHONE: 949331-3692 : a
CONTRACTOR: DAVID E BURGER
Address: 2677 ORANGE AVEUnit APT A1 -
City/State: COSTA MESA, CA ZipCode: 92663
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TO7AL FEES $54.00
Address: 2677 ORANGE AVE Unit:APT At
City/State/zZip: COSTA MESA, CA �
License No. 835541
PHONE: 949•33� •3692
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regUlations. (Ortl. No. 92-28. § 1. 12-21-92)
EXhIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
IN9PECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspeclions and final approval will result in the ezpiration ot this permit.
CODEs. INSPEC710NTYGE QpT� INTITIRL COOE/ INSPECTIONTYPE D_RRTF.F IN7I71AL5
161G Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool SOa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electncal ►�$E b�
201 Final Block/Relai�ing Wall 212 Final Fire Preven6on
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolilion 250 Final Builtling/OccuDancy
WORKERS' COMPENSATION DECLARATIO�
I hereby aRrm un0er penalry of perjury one o( the following decla2tions:
❑ I have antl will maintain a certificate of consen[ lo sel4lnsure for workers'
compensation, as provitled for by section 3700 of tha Labor Code, for the
pertormance of ihe work (or whlch this permit is issuetl.
❑ I have antl will maintain v.orkers' compensation insurance, as required by
sectbn 3700 of the Labor Code, (or the pedortnance of the work (a which ihis
pertnit is issued. My workers' compensation Insurance carrier and Dolicy
number are:
Carner:
(Tha setlon neetl iwt be cnmp1e1e0alhe permrt is valuetlef wre nuntlred Mllars (Sl W) a less )
Policy NumCer:
O �� I certify that in the performance of I�e work for vfiich this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws o( Califomia, and agree that if I s�ould
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shal Rhvnl ply vrith these provisions.
��q'' �i� /Z-/90�
� nCs gnaWre �ate •
� .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE L4BOR CODE, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0l lhe Business and Professions Code, and
my license is in full force and eflect. /'
Lic. #� - � � Class # c- �D
` _ _ / 2 -/9- O,�
Cant s Signa ure ',Daie-'
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn Ihat there is a consWction lending agency for the
peAormance of the v.ork fa wfiich Ihis permit is issued (Sec. 3097, Civil Code�.
Lender's Name:
Lentler's Adtlress:
SiBnalure ' Date
OWNER-BUILDER DECLARATIONS: �
I hereby affrm that under penalty Of perjury [hat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
constNct, aller, improve, tlemolish, or repair any strucWre, prior lo its
issuance, also requires ihe applicanl for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contracrors
LitenSe Law (Chapter 9(commenting with Section 7000) o( Division 3 of Ihe
Business and Professions Code) or that he or she is ezempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a pertnit subjecis the applicant to a civil penally of not more ihan
five hundred dollars ($500).):
❑ I, as ovmer o! the propeny, or my employees vrith wages as their sole
compensa[ion, WILL DO THE WORK, antl the structure is not intentled or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply to an owner of property who builds or improves
Ihereon, and who dces such wark himself or herself or through his or her own
employees, provided ihat such improvements are not intended or offered for
sale. If, however, the building or improvement_ is sold within one year of
completion, the ovmer-builder will have the burden of proving Ihat he or she
ditl not build or improve.for purpose of sale.). ,
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business and
Protessbns Code: The cont2ctas License Law tices not apply to an ovmer of
property who builds or improves thereon, and who contracis fw such prqect with
a contracla(s) license pursuant lothe Conlractors License Lavrs.).
❑ I am exempt untler sec.
Business and Professions Cotle for this reason:
SiB�awre Date
305]-06 (3ro))
Owner ID verified by d�nse. � Yes ❑ No
Dnvers License No. Expires:
Verification of Ownership by (rype of document, i.e. - property tax bill or deed); .
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: :
❑ I hereby certrfy Ihat no exwvation Me (5) or more feet in depth into wfiich a
person is require0 to descend, will be made in connection with work authonzetl
by this permit, antl that no building stmcture, scaffdding, falsev.ork, or demolition
or dismantling thereof, will be more than thirty-six (36) (eet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle B, Califomia Administ2�ive Code).
❑ As owneo-builder, I will not employ anyone to do work which would
require a permit from the Division of IndusMal Safety, as noted above, unless
such person has a permit to tlo such work (rom Ihe division.
Appliranfs Signalure Dale
Division of Industrial Safety Pertnit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fu[ure building occupant need to file and
certi(y a Business Plan (or emergency response to release or threatenetl
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 0/ the Califomia Health antl Safery CoOe requires, with some
exceptions, that a Business Plan he filed with the CosU Mesa Fire
Department by every business which has al any one tlme during a reported
year a quantiry of hazar0ous materials equal to or greater Ihan a weight ol
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or presenl or future building occupant need to file
a registration tortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of lhe Califomia Health and Safety Code, with some
exceptions, requires registration with Ihe Costa Mesa Fire Department by
each business which at any one time has on hantl a quantity of acutely
hazartlous materials equal to or greater Ihan a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at standard
temperature antl pressure�.
3. Does or will the applicant or present or fuWre building occupam need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes � No
(Section 25534 0( the California Health and Safety Code provitles that the
Costa Mesa Fire Department may require the preparalion, certifcation and
fling with the Fire Departmenl of an RMPP by businesses which are required
to regisler acutely hazardous materials with the Fire Departmenl.
4. If an RMPP is presently required, has Seclion 25534 of the Califomia
Health and Safety Cotle been fully complied with7 ❑ Yes ❑ No
5. Does or will the applicant or present or fWure builtlinq occupant require for
the work which is the subject of this application a permit for such constmction
or modifcation from tha South Coast Air Qualiry Management Dislrict or from
any other air pollution conlrol district or agency? ❑ Yes ❑ No
(Section 658502 of Ne Califomia Govemment Cotle requires �hat the requestetl
infortnation be fumished on applications for rwn-residential buil0ing permitsj.
6. Will any part of lhe facility to be wnstrucled under this permit be vnthin
1000 feet from the outer boundaries of a school7 ❑ Yes ❑ No
Qf'j�es", the faciliry must meet the requirement of Seclions 25534 and 42303
of the Califomia Health and Sa(ety Code).
7. If a pertnit (rom the South Coast Air Ouality Management District or other
air pollution control tlistrict or agency is required for the work which is the
suhject ot this application, have all of tha disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", atlach certifiwte of wmpliance from the appropriate air polWtion .
control oKcer�. ' ' • - '
CERTIFICATE OF COMPLIANCE: I�certify ttiat unCer penalty ofpe�ury the
information given above is wrrect. I agree to compty with all state laws and
city ordinances regarding Hazardous Materials and Emissions. �.
Ji9ndWre Da1e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury thal I have reatl this application antl sWte that
the information given is wnect. I agree to comply vnth all stale laws and city
ordinances relating to builtling wnstruction, and authorize represenWtives of
the Ciry of Costa Mesa to enter upon the aDovedescribed property for
inspection purposes. I agree nol to occupy or allow occupancy ot any building
authorized by this permit until final inspection. �
�9^ �e 9 (s� Dale
i /2-�9-Og'
An0/rnAWhmxGEqppllranl : DJ�e�
a
CITY OF COSTA MESA
4 �pMF BI/ILDING DIV/SION
F��S 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www;ci.costa-mesa.ca.us
� � FOR INSPECTIONS CALL: (714) 754-5626
�"°"°"�� PERMIT NUMBER: B09-00137
PERMIT TYPE B_ROOF2
APN: 13908502
JOB ADDRESS: 3206 DAKOTA AV CM
Vicinity: RESIDENCE AND ATTACHED GARAGE �, .
Squares: 2500 � . - . � �
STATUS:
DATE ISSUED:
ISSUED BY:
' Su ite/U nit:
ISSUED
0712812009
BJK
-� - � Valuation: $7,500.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING 2 LAYERS OF ROCK, REPAIR/REPLACE SHTG AS
NEEDED, INSTALL 2 LAYERS 15# FELT, INSTALL "30-YEAR COMP SHINGLES." PITCH 3:12 2500 SQ FT
OWNER: JENNESS,VALERIE ' " Address: 3206DAKOTAAVE. � �� Unit:
PHONE: -- � ,� �• � � City/State/Zip: COSTA MESA, CA , �
APPLICANT: BOLTON,'CARL - , �
PHONE: 714-636-5679 ` , . � ""
CONTRACTOR: MR ROOFINGSERVICES INC
Address: 10657 STANFORD AVUnit: � ` `
CitylState/Zip: GARDEN GROVE, CA � 92840 -
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$o.00 `
$153:25
$O.Ob
$1.00 . .
5154.25�-�, . .
Address: 10657 STANFORD AV . � Unit: :
City/State/Zip: GARDEN GROVE�, CA , �
PHONE:
License No.
License No.
License No. � � 765080
N4-636-5679 "
CELL:
PHONE:
PHONE:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § t, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODEtl. INSPECTONTYPE OATE IN1111AL5 CODE% INSPEC110NTYPE DATE 'INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final --/����/� 208 Final Plumbing
200 Final Re-Roof �� ��� '��P 210 Final ElecUiwl
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Fac�ory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolilion 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalry of perjury one of Ihe following declarations:
❑ I have antl will maintain a certificate of consent b self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, /or the
performance of the vrork (or which this permit is issued.
L'�I have and will maintain workers' compensation insurance, as required by
sec[ion 3700 0( the Labor Code, for the peAortnance of Ihe vrork for which this
pertnit is issuetl. My workers' compensation Insurance carrier and policy
number are:p�,t v
' /.IC2�cc� �l�.zo�-
� Carrier
(Tbis secfqn neetl nof �e complefed � fhe permR is valued af one huntlretl tlollars (5100) or less.)
Policy.Number: �'�f7_ S7�7NJ0.�
❑ I certify that in the peAormance of the work (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
[o Ihe workers' compensation laws of Califomia, and agree Iha[ if I should
become subject lo lhe workers' compensation provisions of Section 3700 of
ihve L��� I s II forthwith comply with Ihese pmvisions.
�/ %ZFsO�
APO���nl's SignaWre oa�e'
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALI SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) o( Division 3 of the Business and Protessions Code, and
my license is in full (orce and eHect.
Lic. #�7 .S O Clzss #' �3�%
�z�09
Conlractor'S SiB�aWre � Dale� '
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm Ihal there is a construction lending agency for the
peAormance of the work fa which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OW NER-BUILDER DECLARATIONS:
I hereby aHirm lhat under penalty of perjury Ihal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the followinq reason (Sec. 7037.5,
Business and Professions Code: Any city or counry which requires a permit to
conslruct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires Ihe applicant for such permi[ [o file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0( ihe
Business and Professions Code) oi tha[ he or she is exempt therefrom and
ihe basis for the alleged exemptioa Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant [o a civil penalry of no[ more than
five hundred dollars ($500).):
❑ I, as owner of ihe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucWre is not intended or
oftered tor sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, Ihe building or improvement is sold within one year of
completion, the ovmer-builtler vrill have the burden of pmving that he or she
did not build or improve tor purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS ro construct [he pmject (Sec. 7044, Business and
Professbns Code: The cont2ctors License Law dces not apply to an ovmer of
propetly who builds or improves ihereon, and who contracts for such projecl with
a cont2cta(s) license pursuant to Ihe Contractors License laws.).
❑ I am exempt under sec.
Business and Professions Code (or this reason:
305]-ab (3/0])
Owner ID verifed by drivers license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (type of tlocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby cetlRy that no excavation (rve (5) or more feet in depth into which a
person is required to descentl, will be matle in connectbn vrith work authonzed
by this permit, and that no building strucNre, scaffdding, falsework, or demolition
or disman0ing thereo(, will be more Ihan thirty-six (3fi) feet high. (Chap. 32, Grp
2, lvt 2, Sec. 341, Ttle 8, Califomia Administra[ive Code).
❑ As owner-builder, I will not employ anyone lo do work which would
require a permit from the Division of Industrial Safery, as notetl above, unless
such person has a permit [o do such work from the division.
Appliwm§ SlgnaWre oate
Division of Industrial Safety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupaM need to file and
ceAify a Business Plan for emergency response to release or Ihreatened
release of a hazartlous ma[erial? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Departmenl by every business which has a[ any one time during a reported
year a quantiry of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feel o( compressetl gas
at standard temperaWre and pressure).
2. Does or will ihe applicant or presen[ or future 6uilding occupanl need lo file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Satery Code, with some
exceptions, requires registra[ion with Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantily of awtely
hazardous malerials equal to or greater [han a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic teet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or (uNre building occupant need to
prepare an RMPP (Risk Management antl Prevention Pmgram for acWely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the California Health and Safety Code provides thal Ihe
Costa Mesa Fire Department may require lhe preparation, certifcalion and
filing with the Fire Deparlmen[ of an RMPP by businesses which are required
to regis[er acutely hazardous materials wi[h ihe Fire Department.
4. I( an RMPP is presently required, has Section 25534 of the Califomia
Healih and SaFety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or fuWre builtling occupant require for
the vrork which is the subject of this application a permit for such construction
or modifcation fmm the South Coast Air �uality Management District or from
any other air polWtion contml district or agency? ❑ Yes ❑ No
(Sectbn 658502 of Ihe Califomia Govemment Code requires that the requested
information be fumished on applications for nan-residential building pertnits).
6. Will any part of the (acility to be constructed under this permit be wilhin
1000 feet (rom the outer boundaries of a school? ❑ Yes ❑ No
Qf'yes", the taciliry must meet the requirement of Sections 25534 antl 42303
of the Califomia Health and Safety Code).
7. I( a permit trom the South Coast Air Quality Management District or other
air pollution conhol district or agency is required for Ihe work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certificate of compliance from the appropriate air polWtion
control offcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I have read this application and state that
the info'rmation given is co�rect. I agree to comply with all state laws and city
ortlinances relating to building construction, antl authorize represenlatives of
the Ciry o/ Costa Mesa [o enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until (nal inspection.
igna �� of I ovmer(s) Date
oa�e 7 � � O�
'/ Nu1M1orizetlAOG���n1 Dale - �
, . . . , . . ,
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Permit No. ��� (iC//✓ 7
PropertyAddress,� _ d6 DA.tOT.4 .i✓ l'OSrA �f6S.( l'.I 9261�
Owner �//r'KV /ZASoGo
Contractor %%JiP Roo6i� S'.�R y�CF s I�uC
State Contractor License Number 76.5� �I U Classification C' 3 9
I hereby certify that I have installed, or caused to be installed, a minimum Class B roof covering at the above
address in conformance with Chapter 15, of the fatest adopted edition of the California Building Code, and the
installation instructions of the manufacturer.
❑ I further certify that I am the owner of the property. (Owner-Builder permittee only).
� I further certify that I am:
❑ Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
Q� Officer of the wrporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this
certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance. •
i� �'�ti
�
Received by Building Division
By:
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Signature Date
Printetl orTyped Name
OWNER gE
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
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,EP 2��-75�x�.00Sn95� A��:r�5.50
APPLIC TION FOR BUILDING PERMIT
For Applican[ ro Fill in Completely qECEIp �ATE RECEIVED
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BVIIDING
ADDRESS
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OWNER � � A.P.NO. I���O ,7" QZ
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ADDFESS
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ADORESS � Ir.0 y I�i/.�.y� � � FIRE
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CONTRACTOR I/ ,' i GC. ,AYGi BV �ATE �.
AODRESS E .S. ryJ bpC /''/v� ZONE NO.OF USE OF NEWP/+�O
TEL. R I p�qryg 2 gUILDING R
��T� �t.�. �, No.s'3 - G
LIC. NO. C GI���S �1`�(, LICYNO. � f vMAIDN BUILDINGD ACCESSORY BVILDDING
SIZE NO.OF BLDGS. (FROM C/L �ST,RIEET)
OF LOT NOW ON LOT ROM �/ •`+IFT. FT.
USE OF fJ �
EXISTING BLDG. J FT. F7.
SIZE OF NO.OF �
NEWBLOG. ROOMS STORIES L.SIDE FT. FT.
EXTERIOF WALL ROOF
COVERING COVERIN �L f L REAR i.Z FT. FT.
USE OF BUIIDING AND WORK TO BE P' RFOFiMED DI5TANCE BET. BET. MAIN &
MAIN BLDGS. ACCF.�. BLDGi.
� VAR. #` DATE
C.U.P.�W .qPPROVED
APPROVE I �' �
�uR -Zy-7s
I hereby ecknowledge that I have �eatl this application antl state STATE
that the above information is correct and agree to comply with
all laws re8ulating builtling construction, antl 1 shall nOt employ
any porson in viOlation ot t�e workman's compansation laws Ot
Ne State ot Calitomie. � �
I hereby certlty thnt I am properly licensetl as a contractor untler SQ. FT. TAX
the State of California Business anC Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VA�VATION IS FOR
Chapter 9, antl [hat such licenses are In full forca antl aftact, or I TME PURPpSE OF ESfABIISHING A PERMIT FEE ONLV:
am exempt from tlie provisions of the Stete of California Business VALUATION
antl Prafassions Cone, Divisi ( Chapter 9.
PERMIT FEE $ /D
Slgnoture of (;JY`i;-" �.
Permittea ,� � � $ �O PLAN CHECK $
AuNorized Agent �O(�
TOTAL FEE $
�OT 76 - TRAGT 3625
,
1��`7�
COSTA MESA BUILDINGSAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
For Applieant fo Fill In Completely
TYPE OR PRINT
BUILDING 'zO6 DAKOTA AVENUE
ADDRESS
COSTA MESA CALIFORNIA
"'A�� jS55 P4ACENTIA AVENUE
AOORE6S
C17.�, NEWPORT �EACH N�aa 6-32z7
ARCHITECf' TEL.
CONTRAGTOR K•W• Ko��
ADDRESS �S�S PIACENTIA AVENUE
ciTY NEWPORT BEACH
STATE 6t>95 TEL. MI p'3zz7
LIG. NO. NO.
SIZE 6Qx � QQ I NO. OP BLDGB. O
LJN! PROM 5Q
I LEFT � I RIGHT / �
DESCRIPTION OF WORK
��� f���El�lE�
`�*`�h S- i3-ba
�1NANCE DEPT.
APPLICATtON FORSPERMII".
BUILDING
For Office Use Only
PHCEIPT NO. P[RMR.NI
DATH
COSTA MESA. CALIFORNIA
FIRE
ZONE
APPROVED
ZONING
Ho. ov I uae or ruew
PI:ANB , /iBY1LDINO�r`
�eaw�
YARDS
APPROVED
� I�BNTlR LINC 6TJ
SIZEDING �597.5SF ROOMS o STORIES �
EJ(TERIOR WALL TU« ROOF �CK
GOVERING � GOVERING
U£�E OF BUILg ING ANDyJ ORK TO BE PERFORMED
SINGLE-YAMILY KESIDENCE AND ATTACHED
GARAGE �AN -
7�
EVES
0
1 HERHBY ACNNOWL6C46 TH�T I XAV6 pBAD THIB APPLIGTION THg AMOUNT BHOWN UNDE0. VALUATION 19 IOR TH6
AND BTATB TXAT TX8 ABW[ Ie CORPGCT /�ND AGRHB TO COM- pUF]08E OF H9TI�BLIBH�NG A PHqM�T FH8 ONLY.
PLV WITH �LL GiY O���M�EB �N� BTAiB UWB ft6pULATINO
Bu�LDlxo CONBTRucT1�N. VALUATION '
81GNATURE OF /� / `� PERMIT FEE $ ��^�
PERMITTE ^ � Q
. I / $ % PLAN CHECK $ � /� �
1 AUTHORIZED