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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: I �L % I � .. . 0990�46MW6108 While-BuiltlmgDrv.',Canary�Contractor,Pmk-Owner .;�1R- .P�o r- „�q .S.E.e vi C. i= .! t.rie ' � ompany or Corporate Name �o6s7 sr,�.aFalzo ,.K Address �PD ,v ovE A 9Z��v 7Zfro� Signature Date Printetl orTyped Name OWNER gE JOB ADDRE55 3 AP No. INSPE( SOIL GAS W ATER ROUGH F PROP. 5 SPRINKL MISCELI 61NG LINE � HOUSE CON. UNDERGkOUND U POWER L ROUGH WIRING TRENCNES � FORMS � ST FLOOR SYSTEM BON� OEAM � STEEL REINF SHEATHING FRAME HNO FLASNING LdTHING - IN n AT STftUCTUPAL FINAI HEATING, VENT., REFRIG. ANO PLIIMBING, FINAL AN� GAS TE ELECTRIC, FINAL B111L01NG. FINAL S REINF. e 1 �. I/r�-7 DATE 9_ BUILDING P FIRE ZONE VALUE TYPE GROUI SUBCONTRACTOR r ;. � 4� �58 l: , Z . aU z za H d m J � J N ¢] J m J Q U N Z a W ¢ aw w Z J Q m Z J � W w � zF w� 70 COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 rai� ,EP 2��-75�x�.00Sn95� A��:r�5.50 APPLIC TION FOR BUILDING PERMIT For Applican[ ro Fill in Completely qECEIp �ATE RECEIVED 3� O� /� ✓ � � -2S =�IS' BVIIDING ADDRESS c ERMIT NO. OWNER � � A.P.NO. I���O ,7" QZ MAIL ADDRESS 3206 Ako7'q ADDRE55 � C G ?ICC A 9 �> NOL TRACT l L�� LOT�� BLOCK c�Tv �'�s u �>�se Syo-�o s CANSfRUCTION � W ADD IENDER ' G V ^ BRANCH OWNER :7U -�?/4" ADDFESS /� VALUE ARCHITECT TEL./�9 r�/O S �� U\L�[' $ O7 OF ENGWEER � T/ N G-d" / ADORESS � Ir.0 y I�i/.�.y� � � FIRE ZONE TVPE GFOVP` L APPROVEO / 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