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Home My WebLink About1104 DANA DR - Building PermitsCITY OF COSTA MESA A BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ciMILDING PERMIT ,lob Address: 1104 DANA DR Suite: Vicinity: Parcel Number: 41207417 Zoning: R1 R1 Applicant: SAWYER, TOM Permit: $237.25 Address: 19562 DITMAR LN SMIP Com: $0.00 Other: $0.00 Phone: (714) 593-9840 HUNTINGTON BEACH, CA Zip: 92646 Owner: CHALMERS, RODERICK D Address 1104 DANA DR Phone: COSTA MESA, CA Zip: 92626-1633 Contractor: UNDER COVER ROOFING Address: 19562 DITMAR LN Phone: (714) 593-9840 HUNTINGTON BEACH, CA Zip: 92646 License: 687961 Arch : Address: Phone: Eng: Address: AMIT NUMBER B03-01352 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 08/11/2003 Issued: 08/11/2003 Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF WOOD SHAKE ROOF. INSTALL SHEATHING, COVER WITH MONIER CEDAR LITE TILE. LESS THAN 6.0 LBS. ICBO # 2093. Plan Check: $0.00 Permit: $237.25 SMIP Res: $1.33 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $238.58 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: o NOTES: Rear 0-0 Rear 0-0 Required: 0 FEE SUMMARY Calc Valuation: $13,300.00 Claim Valuation: $13,300.00 PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0, Right 0-0 Proposed: 0 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, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final 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 244646 (6=) I WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury One of the following declarations: �• ' ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I e and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. y workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be complefed if the permit Is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of liforpia, and agree that If I should become subject to the workers' compensation provisions of Se/eQ 3700 of the Labor Code, I shall forthwith comply with these to ion ./ Applicant Signature: Date: InWARNING: FAILURE TO ECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINALLTIES AND CIVIL F P TO ONE HUNDRED THOUSAND DOLLARE ($1 OD,001U IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION TrU6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. If Class q Contractor's Signature: Date: CONSTRUCTION LENDING A CY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to 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 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for 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, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Coda: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ 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 Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 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 present or future building occupant need to file a registration lortn for acutely hazardous materiels? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................ .............. ................................................................................... .................................... ...................... ... ............................. .._._._.......................................................................................................... ....................... I........................ 3 Does or will theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4.......If an RMPP is presently required, has Section 25534 of the California Health and Safe-Safety Code been fully complied with? ❑ Yes_...........❑�No_................_............................. ............................................................................___......._.........................................._............................._............................__..........................._—_..........................................................._...__...............___..............._. ............................ _._ 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication apermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............__.....any P .............................iyio'...—_-_-..........................._._..P....................."et,__.....lih-6....................._................................................. .........................-................__..................._................._. e Will any an of the facili to be constructed untler This ermit be within 1000 feet from the outer bountlaries of a school? ❑Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................... .... ................. ............. __......................................................... ................. _....................... _........ ............................ __.._........................ __..................................................... ....._.......... ... __...................... _................ _.......... 7 If appermit from the South Coast Air Quality Management District or other air pollution control district or agency is rotred for the work which is the subject of this appllcatlon, have all of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cavity under penalty of perjury that I have read this application and stale that the information given is correct. I agree to comply with all stale laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to 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 final inspection. Signature Of Legal Owners) ` I CL�ate And/Or Authorized Applicant Tom_ to CODE I. INSPECTION TYPE Da1E INITRALe CODE INSPECTION TYPE PAIL INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final -} 208 Final Plumbing 200 Final Re-Roof 210 Y" •'►� 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy' MDRESSOFSUILDING: 1104 DANA DR UNIT: OwNEWSNAMEDFIwa`N' IMAI, HIROSHI FLOOD: X L38 ADDREss, IMAI, VERONICA M 804 EMERALD BAY 2414 LAGUNA BEACH,CA 92651 APPL. MAILNG ADDRESS: ARCHITECT OR ENGINEER: ARCH. OR ENG: S ADDRESS: UC. NO.: UNIT: CONTRACTOR's NAME: NOCK PLUMBING (714)895-1246 comAOTORSMAIuO 11610 SEABOARD CIR ADDRESS: STANTON CA mw, 511971 90680 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby Min under penalty of perjury thin I am Iicemed under Provisions of Chapter B (p rmtemiq with Section 7") of Divnun 3 of IM Busmen end Pmleasiom Code, end my 5camme is In IW Ian end Klee. c c."o.:050386 uc. CLASS: C — 3 6 LIC. NO.:1L5.,11971 EXP: 02/97 cpmmoy N PG��a•W, i�� O R BUhe BUILDER DECLARATION: I reby W. uMer maty of perNry that I am e.empt Imm the Contractor Licenes Lew la the dnwig radon (Sept. 10313 Due— end Profession. Code: Am Ny or poorly wokh repuires a pemd to cons". Mer. imawe, demdah, or repair any stmeuro, prior to e, aww¢e, elan M.a. IM apptinn for wch penes Ip We a eyned atmem rM Nm M or and is lir w*W prusuara to IM ptowion of that Ca4rmon Limn Law ICheptw 8 (pwmnedrq wah Seean 1000) d Derision 3 of the Buaares, and Prdees'rom Code] a th o he or endo exempt therehan end the baso for the heaped exemption. Arty videtion of Section )031.5 by any, appOdm for a permed wbpcta the apptnam to a dull penalty d cad move then Ewe hundred ddlers [55001). ❑ 1, as ower d IM properly or my employees "It wags, as thew sate campereaion, will an IM w . and IM stmaun it not intended or offered for eels (Section 70a4, Busirra end Pmfs,sions Code: TM Contractovv Litems Lew Bros not apply to an awnwof propany who Mids or bnpmves thereon. and wino dose ouch work Iimsell or MnM a Nrouph he or her own empo aria pm that wch impmmemwd we ata b to or dared In, ante. ff. hommear, the Wilding or bnpmvemM a sdcl wilNn ane year d canpteticn. Dat ro owr-0 wi0 theory, the Modal of pon m,; M a ata ds, not add or improve for IM purl of sae). ❑ I. as owrror of the property, am exrhrsbey contract"° wah frowdd contractors to cp,eppd the project (Section 10u, Blind and Pmled'am Code: The Gonueaors l nem a Lew clod nal apply to an owner d property who Wilde or imprvmes thereon and who contracts for wrh pmpaa wlth a maraaor(e) licanad pen not 1. the Corraaav U... Law). ❑ 1 am exempt order Semon: B. d P.C., for the aeon: I W hereby tansy Net I am ewme of nod undenuuxf the nRuiremeda of Caomie Ifaebo and Safety Code Sections 35505. 35.533. and 3553x, and that I or any Mur. WiMnI pcwPW will I wR one (oma aro) need to campy wbh veld stele coda end the reeuiremmu lor aP mafaooruouaionamodrtirationhantMAi e3lr iyy enepemenl Diamd.Rmkmliel oonflnebon applications en exemptfrom there pra scans. Dere: Applicant: WORKER'S COMPENSATION DECLARATION: I oemby elfirm under pwWty d par'ryry ora d the IOOowirq dedmmem: ❑ I have end wii mantes a cananae d nmenl losett insum ter wakerv' pNnpenmian, n wovided fa fry Ssctlon 3700 d IM Labor Code. for the nrformwice d the wok fa whiph this Pamit a ieaud. I Mva end w mention w ' c mPeneal inumnce. as Mulyd by Seam 3100 d the Lobar Code. for the pedamvwe of IM `� wok fa whidt the perms o Dead. ifl' waken' campenaehcn irourerra ron'w end pdiry camber aro: Cmher: STATE EXPIRES Pdnoy Numbr. niwra1)T 1'A1 nn 09/30/96 (This sedian need Trot M complatd i the pem,P is Act aro hundred dollars 1111051 or Ans.) ❑ I natio IMI in Na pdanance d IM work la rMnh the peva is ieaued, I shell M employ arty person n any manor so d to become wbject tc the workers' nmoeratafion en d CeMade, res * tlkh to IM wMws' canpaambn /dr Section 3150 d IM Labor Code. I aN�Tmmpy wL %�T �. Appl'rem: 'Gm� 'F'aminp: Fellun W ucuro worten' mmpwwtlon co we 1. unlawful, and ~ wblecl an wnployn to cctMn/ pensld. uM c/vll ff.. up to one hundred thouaaM dden ($104°55), In ampidon ro Ne cwt of eompwaeflan, da ya,,as sa provldd ter In Seca. 3100 of the Labor Cods, Interest and alromey'a few. CONSTRUCTION LENDING AGENCY: I hereby affirm uMer penalty of perjury tom then e e oonstrwion tending epeyp, W the perlam. of the work tar whidi Iho pmmi at awed (Section 3081. Civ. C). LENDER'S NAME: LENDER'S ADDRESS: I rorty IMl I here cad No application end atone Ilam the above inform akm is rosea. I spree to comply with all day end county orclimorsa end ante le. retetblp to WMM convtructian and Mnby weborae repreeemetives of IM pry lo enter upon IM ebwe-manlioned popery for imspedion Wrpwea_ SISI_ae.Wp) WMe-BuildiG B Pink -Revenue; Gdclen o aas,or CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 076561 PERMIT NO: P 076561 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION C/O DISHWASHER SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: X Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41207417 ZNE: REF NO: PLANNING NOTES> ..11 iE iE BE if****iE iE N'*fE iE BE iE iE iE BE iE iE iE iE iE************8E iE 8E iE fE iE iE iE iE iE 1E 8E iE di iE BE*Bf fF fEiE iE iE 8E 8E 8F iE *RE 8E 8E lE 3E 8F iE iE BF iE*iE if*k 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: BUILDING APPROVED BY : APPLICATION ISSUED BY iE * 1F iE iE RE iE * iE 1E iE irk iE iE K iF i( -ii iE iE iE LEGALIZATION:N F E E S U M M A R Y DATE: DATE: %6 liiiiEiEi *** RE RE 1EiE STRUCTURAL EGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 7.00 25t SMIP/NON-RES PLAN " ISSUE FEE 20.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 7,00 20.00 0.00 27,00 27.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 27.00 iE iE iE iE**1E 7E 1E iE iE*1E if 1f ii lE iF if-iE 1F**iE ii lE iE 4RE Rf lb iE iF iE 5E iE 8E liriE Ri iE***1E******iE RE SE 1E iE ii lE ib ib iF iE iE iE iE iE iE fE iE iE BE iE lir3E ii iE irkfEiE I N D I V I D U A Ii' F E E B R E A K D O W N -TYPE QTY D E S C R I P T I 0 UNIT COST TOTAL COST PLU 1 DISHWASHER 7.00 7.00 END OF FEES CONSTRUCTION AND PLANNING. APPROVALS Permit# Date Inspector PG__ & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement -3rfEtectrical Conduit Utility-Undrgrnd. 54. Forms _ _ 4.. Electrical Conduit-Undrgrnd. 55. Electrical Bonding = 5-- Steel Reinforcement 56. Rough Plumbing & Pressure Test _67 Electrical UFERIGdnd. 57. APPROVAL TOCOVER•GUNITE 7: -Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation _ - 59, Gas Pipe, O Unargrnd., Test - 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. 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 16. Rough Electric Wiring 67. Fencing & Acces; Approval t7. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ ., - FIRE DEPT„REQUIREMENT APPROVAXS- - Permit # 20, Rough Factory Fireplace.- - - - 21. Ducts, in StructureT' - r,. - -. 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping OGas E? Oil _ 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof -Framing 73. Undergrnd.StorageTank0Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro . - 26. T-Bar.Ceiling (Structural) & Monocoat �. 75- Dry Chemical - - - 27. Fram3 and Flashing ' - * - 76. Dry Standpipe 28. Lathing & Siding t 77, FIXED SYSTEM FMAL 29. Insulation - 78. FIRE PREV. FINAL - 30. Drywall Nailing :- - .HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 32. Electrical Pow& Meter -Final y 79. FINAL INSPECTION 80.. FOOD CERTIFICATE ISSUED - 33. Finale Electric - ' _ _ Notes:9;(r�Iti-A 2- 34. Final Heating & Air Conditioning 35. Elnal Gas Pipe -Test -36. Hood -.or Canopy 37. Final Factory Fireplace - fi 38. Final -Plumbing _ Z-2,6 - 39. Water Service -Final _ 40. Gas Service -Final- _ _ ,r, t 41. Solar Domestic -Final. R- - 42. Backflow Preventer -. - 43. Backflow Irrigation y 3 44. Landscape irrigation$ystem-- 45. Sound Attenuation• f 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING s 48. FJNAL PLANNING ` 49. Electric Release to Edison I- 50. Gas Release to Southern California -Gas Co _ 51. CERTIFICATE OF OCCUPANCY No. Date T ' CONT c� C01% OVIILsM COSTA MESA BUILDING -SAFETY DEPARTMENT �� APPL ATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 -^ �• I RY+1 RE PERMIT' U - - I N-. 4 8 3 5 For Applicant to Fill in Completely — Use Ink Only any person in violation of the workman's compensation laws of BUILDING// [L I A.P. NO. ADDRESS T OWNER OR BUILDING //D �( ^ ADDRESS LL TENANT ( L SO. FT. UNIT MAILING SPACE NO. ADDRESS I h T R., 0. LOT TEL / 98 V t0 CITY S NO. NEW I ADD JALTER IREPAIR IMOVINGIDEMOLISt BRANCH ADDRESS ARCHITECT (i OR ENGINEER ADDRESS CONTRACTOR ADDRESS L CITY d STATE LIC. NO. SIZE OF LOT USE OF S CITY LIC. NO. NO. OF BLDGS. NOW ON LOT Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED OWNER ZONE rloQ APPROVED APPROVED SETBACKS PLANNING ACTION DATE DATE APPROVED I hereby acknowledge that I have read this application and state 0 that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of v the State of California. 1 hereby certify that 1 am properly licensed as a contractor under SO. FT. m N THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Cotle, Division 3, m Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m exempt from the provisions of the State of California Business Y and Protessio s Cc a, Division 3, Chapter 9. VALUATION n PERMIT FEE r O N dO n o $ PLAN CHECK $ 2' Signature of 0O TAX $ Permittee $ •///1 �� (�/ L U or �7 L TOTAL PAID $ L3 IG. n0 Authorized Agent Date F{ C 1 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only OWNER MAIL ADDRESS CITY b CONSTRUC LENDER BRANCH ADDRESS ARCHITEi OR ENGINE ADDRESS ADDRESS TEL. NO. TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF SLOGS OF LOT Apprmt. 60'x 80 NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED Plan # 4 I hereby acknowledge that 1 have rtid this applicdston and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any parson In violation of the workman's compensation laws of the State of California. 1 hereby certify that I am properly licensed as a contractor under the Sure of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and affect, or I am exempt from the provisions of the State of California Business and Professions Code, 0 bn.3, Chapter 9. Signature of Permlttea / Authorized Agan t 'N 10-77PA1"00 570* * * 122.611 CIISA APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE EDD DATE ISSUED •)RECEIIV7 f// —az DATE —J APPROVE "PCI S BUILDING OA ADDRESS TRACT 9866 LOT 21 BLOCK NEW v ADD ALTER REPAIR MOVING nFMOi rH OWNER Prgperties: West Development USE Res. Md. Gar. VALUES CID 73,400. FIRE ZONE APPROVED NO.OFUSE OF EW . �I .N.7Jl/d/LN PLANS BUILDIN `I 'ROVED YARDS APPROVED ROM DISTANCE BET. MAIN BLOGS. BET. MAIN & ACCESS B VAR. C.U.P DATE —J APPROVE APPROM ,Qu�Q G nl rnn nc n nrnt nnranr.r THE AMOUNT SHOWN UNDER VALLI THE PURPOSE OF ESTABLISHING A PEM VALUATION PERMIT FEE E PLAN CHECK 3 $ 73,400. TAX s TOTALPAID $ P. � COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to F9I in Completely — Use Ink Only BUILDING OWNER MAIL ADDRESS CITY CONSTRUCTION LENDER BRANCH ADDRESS TEL. NO. ARCHITECT TEL. OR ENGINEER NO. CONTRACTOR /I//////L//J r ADDRESS TEL. CITY NO. STATE CITY UC. NO. LIC. NO. SIZE NO. OF BLDGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED PAID ]EC,-9-77cnSA00 516 vsz*235.00 APPLICATION FOR STRUCTURAL PERMIT BY DATE RECEIVED DATE ISSUED USE OF NEW THE AMOUNT SHOWN UNDER VALUATION IS FOR m PERMIT NO. I BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY Will / e / + LEE LOT BLOCK TOTAL PAID $ IALT VALUE $ t FIRE ZONE TYPE V GR_OV_P APPROVED BY DATE ZONE NO. OF USE OF NEW THE AMOUNT SHOWN UNDER VALUATION IS FOR m IPLANS I BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY Will , VAR. sw DATE /t I �i • C.U.P. APPROVED APPROVED I hereby acknowledge that 1 have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I em Properly licensed as a contractor under the Stet. of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisionsof the State of California Business and Professlona Code, DI Ion 3, Chapter 9. Signature of tx� Permittee bra Authorized Agent n — m i m SQ. FT. r THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION W PERMIT FEE 5 e m n PLAN CHECK $ o / e / + LL TAX $ U TOTAL PAID $