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HomeMy WebLinkAbout1124 DANA DR - Building Permits1 CITY OF COSTA MESA OSiN R'FSq BUILDING DIVISION 1 A F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BX10-00288 PERMIT TYPE B_MISC STATUS: ISSUED APN: 41207412 DATE ISSUED: 12/16/2010 Zoning: R1, ISSUED BY: RMD JOB ADDRESS: 1124 DANA DR CM Suite/Unit: Vicinity: ROOFTOP Primary Occ: Const Type :?? SQ. FT: 360 Valuation: $9,800.00 SCOPE OF WORK: INSTALLATION OF A 360 SF ROOF MOUNTED PHOTOVOLTAIC SOLAR ARRAY 4.62 KW WITH 22 MODULES, MISC EL EQUIP, 1 INVERTER, DISCONNECTS. OWNER: WEAVER, HARRY WILLIAM City/State: COSTA MESA, CA Phone: 714.641-1414 APPLICANT: GLOBERSON-LAMB, SONIA 140 2265 S GRAND AV City/State: FOSTER CITY, CA Phone: 510-414-8120 CONTRACTOR: SOLARCITY CORPORATION Address: 2265 S GRAND AV City/State: SANTA ANA, CA Zip Code: 92705 ARCHITECT: Phone ENGINEER: Phone FEESUMMARY Building Plan Check: Building Permit: Electrical Permit: SMIP Residential SMIP Commercial Bldg Std Admin Fund Address:: 1124 DANA DR Zip Code: 92626 Address: 393 VINTAGE PARK DR Zip Code: 94404 License No. 888104 Phone 714-290-9521 $117.81 $181.25 $62.10 $0.98 $0.00 $1.00 License No. License No. Cell: Unit Unit: STE Unit: TOTAL FEES $363.14 HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday that Friday - 7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE t. INSPECTION TYPE DATE INTI➢ALS CODE I INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 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 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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. ❑ 1 have 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. My workers' compensation Insurance carrier and policy number are: Came-'Cj"C--\r('�S /This secYbn need ne! De mmye(e0 A the permit is valued we hundred abllars (5100) w less ) Polite Number: Q baa . �k ❑ I 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 California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall to with porapy with these provisions. _ n 5 Si *W'1 1 _ \110/10 �P 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 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 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. Idc: #> `S\ Class:#__ 0yDi, ctw , \'Ll�e/IQ ars Si t a CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which (his permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's 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 five 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (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 contracts for such project with a commctor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature 3057-46(3/07) • Owner ID verified by driver's license. ❑ Yes ❑ No Driver's 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. falsework, or demolition or dismantling thereof, will be more than thirty-sm (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia 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. Applicant's 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 forth for acutely hazardous materials? ❑ Yes ❑ 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). 3. Does or will the applicant 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 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 application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for ran -residential building permits). 6. Will any part of the facility to be constructed under this permt be within 1000 feet from the outer boundaries 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 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 6. (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. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state 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. /aturee of Leg r(s) Date ���.A anzedAPPuwnt a3t a ' CITY OF COSTA MESA • wF BUILDING DIVISION f77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.m.us °. FOR INSPECTIONS CALL: (714) 754.5626 PERMIT NUMBER: EOB-00036 PERMIT TYPE ELEC APN: 41207412 OF,26 JOB ADDRESS: 1124 DANA DR CM Vicinity: REAR YARD SFD STATUS: ISSUED DATE ISSUED: 01/24/2008 ISSUED BY: BJK Suite/Unit: SCOPE OF WORK: ELEC AND PLUMBING PERMIT FOR ANEW BAR -B -Q IN CONJUNCTION WITH LANDSCAPING WORK TO BE DONE AT AN EXISTING SFD. PERMIT ALSO INCLUDES REINSTALLATION OF A TANKLESS WATER HEATER. ELEC: 1 OUTLET, 1 RES APPL < 1 HP; PLUMBING: 1 GAS OUTLET (1-4), 1 TANKLESS WATER HEATER OWNER: WEAVER, HARRY WILLIAM PHONE: APPLICANT: GREYSON, STEVE PHONE: 949-279-5597 CONTRACTOR: GREYSON CONSTRUCTION INC Address: 23022 LA CADENAUnit: UNIT 104 City/State: LAGUNA HILLS, CA ZipCode: 92653 t i ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $29:35 r Reinspection Fee $0.00 TOTAL FEES $29.35 Address: 1124 DANA DR Unit: City/State/Zip: COSTA MESA, CA Address: 23022 LA CADENA Unit:UNIT 104 City/Slate/zZip: LAGUNA HILLS, CA 203 License No. 810475 204 PHONE: 949-279-5597 CELL: is i K.' -L- AT <1 iiP; 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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.. CODE t. INSPECTION TYPE DATE INTInRLS CODE INSPECnON TYPE DATE INTRIQS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 200 Final Re -Roof 201 Final BlocklRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: 0 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I 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. XXI have and will maintain workers' compensation insurance, as required by Ion 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Ins"urprice carrier and p licy numberare:SZ`yarj`_ CrJmperISWTiow ous fiur>•i� Carrier: (The senon need Add compleledtllh permit is Val✓ed al one hundred "am (5100) or less) Policy Number: I _24 7 94 1 ❑ I 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 California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Lab C e, I shall to It, comply with these provisions. Applicant's Si nal Date 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 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 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. IR. Lic. # d I D ¢ 7 S//-- Class # G' �- �. Contractors Signature Date CONSTRUCTION LENDING AGENCY: ❑ I 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). Lender's Name: Lender's Address: 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 five hundred dollars ($500).): ❑ I, as owner of the property, or my employees vnth 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 Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project vnth a contractors) license pursuant to the Contractors License laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature 3057-46 (3107) Data Owner ID verified by driver'sle ❑ Yes ❑ No Driver's 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, falsemrk, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ttle 8, 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. Applicant's Signature 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 wth 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 form for acutely hazardous materials? ❑ Yes ❑ 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). 3. Does or will the applicant 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 Safely 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 application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code), 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ 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. Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state 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. gnah, or eget Owners) Date /-2q-0d —� And/or Authorized Appbrant Date April 28, 2010 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Harry William Weaver 1125 Dana Drive Costa Mesa, CA 92626 PERMIT NUMBERS: E08-00036 1124 Dana Dr., Costa Mesa, CA FOR: New Bar -B -Q Our records indicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of the last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on May 10, 2010. Additional fees will be required to finalize expired permits. Requesting an inspection - If you need to request an inspection, please call our Inspection Request Line at 714-754-5626. Requesting an extension -If you wish to request an extension, requests must be made in writing addressed to Bill Nunes, Chief of Inspection at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, Barbara J. wart Office Specialist II cc: Greyson Construction Building Division (714) 754-5273 • Code Enforcement (714) 754-5623 - Planning Division (714) 754-5245 FAX (714) 7544856 • TDD (714) 754-5244 • w .ci.costaamesa.ca. us CITY OF COSTA MESA BUILDING DIVISION i 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 l0n�o `'h PERMIT NUMBE P08-00031 PERMIT TYPE PLUM STATUS: ISSUED APN: 41207412 DATE ISSUED: 01/24/2008 ISSUED BY: BJK JOB ADDRESS: 1124 DANA DR CM Suite/Unit: Vicinity: REAR YARD SFD SCOPE OF WORK: ELEC AND PLUMBING PERMIT FOR ANEW BAR -B -Q IN CONJUNCTION WITH LANDSCAPING WORK TO BE DONE AT AN EXISTING SFO. PERMIT ALSO INCLUDES REINSTALLATION OF A TANKLESS WATER HEATER. ELEC: 1 OUTLET, 1 RES APPL < 1 HP; PLUMBING: 1 GAS OUTLET (1-4), 1 TANKLESS WATER HEATER OWNER: WEAVER, HARRY WILLIAM Address: 1124 DANA DR PHONE: City/Slate/Zip: COSTA MESA, CA APPLICANT: GREYSON, STEVE Address: 23022 LA CADENA :UNIT 104 PHONE: 949-279.5597 City/State/zZip: LAGUNA HILLS, CA CONTRACTOR: GREYSON CONSTRUCTION INC License No. 810475 Address: 23022 LA CADENA UNIT 104 PHONE: 949-279-5597 City/Stale: LAGUNA HILLS, CA ZipCode: 92653 - - CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY ` ."�r^ 10 PLAN CHECK FEE: $0.00 Ar PERMIT FEE: $41.95 TOTAL FEES: $41.95 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE //. INI S CCnONN DATE INTRULS CODE/ INSPECTION TYPE DAL - 'INT7UL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 5. 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 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 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 have and will maintain workers' compensation insurance, as required by tion 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: / Carrier: `JT'°Tj=- Ca''l pE"t5f1TiD� �l-�. F�fi L"( (This sec6nnead not hacmn/rde'feTtl lgNepcvm(4 s valueal of one nwgrM [Hors (Sf00/ o-Iesi.J Policy Number: J "f / f 4 ❑ 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 California. and agree that if I should becomesub ect to the workers' compensation provisions of Section 3700 of the Labor C de, I shall fon with comply with these provisions. -�,4-o$ Applimnl's Signatur Dale 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 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 affirm that I am licensed under provisions of Chapter 9 (commencing wilh Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. Lic. # I O i s Class # G— 2 I - SCJ - off Contractor's Signature Date CONSTRUCTION LENDING AGENCY: ❑ I 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). Lender's Name: Lender's Address: Signature OWNER -BUILDER DECLARATIONS: I hereby affirm that under penally 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 five 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 Code: 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 contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature - Date 3057.46(3/07) Owner ID verified by driver's lic,_ ❑ Yes ❑ No Driver's 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, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, 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. Applicant's Signature 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 form for acutely hazardous materials? ❑ Yes ❑ 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). 3. Does or will the applicant 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 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 application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries 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 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ 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 CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state 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. ignature or Leg O+megs) Date Ana/or Authorized Appliwru Date PROJECT ADDRESS: 1124 DANA DR OWNER'S NAME: RYRIE, THEODORE A ADDRESS: RYRIE, MARY H 1124 DANA DR COSTA MESA,CA 92626 714) 546-1024 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: UNIT: PERMITTEE: DOUGLAS WANYNE FORS (714) 550-4406 ADDRESS: 6631 BRIDLE Cr YORBA LINDA CA 92686 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of CIypter 9 (commencing with Section 7000) of Division 3 0l the Business and Professions Codeand my license is in full Inrce 6 ect DIT 05507E STATE LIC.: 6202 1 CLASS: / I ate' —2 gNERS' COMPENSATION DECLARATION: I hereby affirm ihat-Ih aeoconsent to self -insure ar a certificate of Workers' Compensation spa ce � e,carr ied c py thereof (Rection 3800. Lab. C). POLICY NO.: tg4�:Jy`9� EXP. DATE: 04/01/95 COMPANY: STATE FUND ❑ fur44d copy is hereby furnished.; Certified i ed with the city ding D' cion. Qyte! / - • Applicant: EXEMPTION FROM WORKERS' COMPENSA ION: (This sect ornate it the permit is lot one hundred ($100) or less). I certify that in the performance of the work for which Inds permit is issued. I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. 4 Date'. Signature: NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwdh comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code ' Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License La. (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) orthat he/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), L as owner of the property or my empDloyers with wages as their sale compensation, will do the work, and the ❑ structure is not intended or offered for sale(Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusivelyy contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' Blate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contraclor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date' Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/wilI not (circle ane) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential Construction applications are exempt from these provisions. Date'. Applicant: I hereby certify that I have read this application and shall ordinances and state laws relating to building Construction property for inspection purposes. License or Social Security 9: all city and 1641-46 White—Building: Green—Code Enforcement, Canary—Applicant. Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 06646= PERMIT NO: B 066463 PLAN CHECK NO: 00964-94 S GOVT; N SUPP: N CONSTRUCTION TYPE: V-5 PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION ADD 45SF TO DINING ROOM SQ FT: 45 CLAIM VALUE: 4,000.00 CALC-VALUE: 3,330,00 GROUP OCC: R-3 / COMMENTS: SMOKE DETETORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY, 1991 UBC ##########################################################################TF#### 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: 12 FT IN REAR: 24 FT IN FRNT: FT IN REAR: FT IN LEFT: 17 FT IN RGHT; 6 FT 6 IN LEFT: FT IN RGHT: FT IN PARKING REQ; PROV; PARCEL: 41207412 ZNE: PDR- REF NO: PLANNING NOTES> ADDITION OF 44 SFT. TO EXISTING DINING ROOM IN THEE^ > PLANNED DEVELOPM NT RESIDENTIAL ZONE, 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''"' S ZONING APPROVED HYD DATE: BUILDING APPROVED BY ; CN:d DATE: APPLICATION ISSUED BY; DATE: LEGALIZATION;N F E E S U M M A R„Y„ STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC. MECHANIC FIRE SMIP/RES GRADING PERMIT 63.00 1 50 PLAN 40,95 SMIP/NON-RES _ __ _ ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 63.50 0.00 40.95 104.45 104.45 ,00 REVENUE DIVISION TOTALS--> COLLECTEIj: 104.45 OVER/SRORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT GRADING PLAN -CHECK 63,00 .50 40.95 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 NUNIT COST T TOTAL COST J SFR 45 DWE-TYPE V -WOOD FRAME -GOOD 74.00 3,330,00 .END OF FEES r SiSR0 00157389-00157391 T G T 104.45 - r'3 I I94 TIME: : 15:58 OKE p E7 REQUIRED CONSTRUCTION AND PLANNINGPOOL APPROVALS Permit # I Datel Inspector a SPA APPROVALS 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 3 u-.�y G/( -I 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 'j G/ `evkl58. Electrical Conduit-Undrgrnd. 8. Foundation 5+(a b QIe� 3_Zt-g 9. Water Pipe-Undrgrnd. / y q 164a 59. Gas Pipe, 0 Undrgrnd., Test 60. Backwash Lines, PJrap, 0 Undrgrnd. l 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 & Access Approval 17. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00d 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas C] Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing y p_a 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation &c04el; 78. FIRE PREV. FINAL 30. Drywall Nailing LfL/ C( 6 4.6<- HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 3-z j -G% y- .�/_. 5 / �4 y _ rf/T C2� (� 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test ; _ 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbingt �1 39. Water Service -Final 40, Gas Service -Final 41, Solar Domestic -Final /, h� 6u� 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irriqation System 7 -)_2-"7q-/Zg � QQ4, /,-,- 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE&BUILDING I 48. FINAL PLANNING _ 49, Electric Release to Edison f' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 1124 DANA DR UNIT' OWNERS NAME: RYRIE, THEODORE A ADDRESS: RYRIE, MARY H 1124 DANA DR COSTA MESA CA 92626 ARCH/ENGINEER: 714) 546-1624 REC.NO.: ADDRESS: UNIT: PERMITTEE: THEODORE 6 MARY RYRIE (714)546-1024 ADDRESS: 1124 DANA DR C.M. CA 92626 LICENSED CONTRACTOR 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. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a eendicale of consent to self -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 3800, Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. IX Candied copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM We ATION DECLARATION i n if the ne it diol be plane (Stool work certify that in Inc performance of the work for which orma'ce at the Detrol sue become on so as to become shall not em toy a rspn in try not em suof , o e rknk fu 00e ion of Califon,. � at — " Signalu NOTICE: II, after making this tledaration, you should become sub' to Workers' Cgyf a Ion provisions of the Labor Code. you must forthwith comply with such provisions or INs p all be deemed revo . CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECUBATION: I hereby affirm that I am exempt from the ContractorsState License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 700D) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant lot a permit subjects the applicant to a civil penally of not more than live hundred dollars (55110). L as owner of the property or my emoloyees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business D➢ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance shoudsbs ravi `Lm e. ❑ I am exempt under Section. B. B P. C. for this r son: f,56 hereby certify that I am aware of and understand the requirements of CaliforHealth Safety Co tions 25505, 25533, and 25534 and that l or any future building occupant will/will not (circle one) need to camp y.nth said state co and the requirements for a permit for construction or modification from the Air ualily Management District. Residential construction applications are exempt from these provisions. Dale: Anglican I hereby certify that I have read this application and state that the wflformalion is correct. I)gree mply with all city and county ordinances and slate laws relating to building construction and her • aut o(ize course �grves Io leruponthe above-mentioned property for inspection purposes. —4ns+ ate. 05- Sign On •r's License ar Social Security 54f.4B While—Building Green—Code Enforcement Canary—ADDI canC Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 066944 PERMIT NO: M 066944 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V-5 PERMIT TYPE: MEC PURPOSE: ADD JOB DESCRIPTION ADD 45SF TO DINING ROOM SQ FT: CLAIM VALUE: CALL—VALUE; GROUP OCC: R-3 / COMMENTS: REF: B -66463 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 RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41207412 ZNE: REF NO: PLANNING NOTES> 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 : DATE: �7 p APPLICATION ISSUED BY: DATE: C l� iF3Fx-+FiF * +�3F'�'�IE�iF� iF'iFR� iEieifiEie**iffE***iEiEiFlEiEfE*ielEieKiFMiF41E+Eiiifitie4iEiklffEfEiF7F1flEieiiielEM*ff4aEitiiiEiEiEKaflEiEilafifiEiE*ieiElEjE aEifiEitBeBeiE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 16.00 PLAN 25t SMIP/NON—RES ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 16.00 15.00 0.00 31.00 31,00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 31,00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 31.00 ieKiEiE*ifaEifkE**iEieifiklEiEiEiEieieiiieiFBFiFaEiElFfE9fKiffe*iF*iE**eEie*aE9FTE1FiEiFM*iEaE{EinaElEiFiFiF*iETEiE**iei:aFiE9FiFiFiE{EiETfBf4f 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 MEC 1 GAS PIPING SYS 1 — 4 OUTLETS 3.00 3.00 MEC 2 ^EACH APPL NOT IN OTHER CAT UNDER FEE 6.50 13.00 END OF FEES 01 00159505-00159505 T O T 31.00 DATE! 04/25/94 TIME: 16:04 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector i. Temporary Electrical Service or Pole 52. Poet & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding S. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, 0 Undrgrnd., 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 & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrica6T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rouch Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping []Gas 0O0 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing "73. Undergrnd. Storage Tank []Gas 0Oil 25. Roo` Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monoccat 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 31. Plaster Brown Coat 79. FINAL INSPECTION 32 Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Etectric Notes: 34. Final Heating & Air Conditioning 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation - - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date , PROJECT ADDRESS: 1124 DANA DR UNIT: OWNERS NAME ADODREss: ESS RYRIE, THEODORE A RYRIE, MARY H 1124 DANA DR COSTA MESA CA 92626 ARLMIENGINEER: 714) 546-1624 flEG.NO.: ADDRESS: UNIT: PERMITTEE: THEODORE 6 MARY RYRIE (714)546-1024 ADDRESS: 1124 DANA DR C.M. CA 92626 i0 CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section I Denton 3 of the Business and Professions Code. and my license is in lull force and effect. STATE LIC.: CLASS: / Signature: KERS' C NSATIOCLARATION:—Tiiarety affirm that I have a certificate of consent to self -insure or a cenificale of Workers' Co pensation Insura . or a certified copy thereat (Section 3800. Lab. C). POLICY NO.: EXP, DATE: COMPANY: r�aa'' ❑ Certified copy is hereby fumished. Ek Certilled copy is tiled with the city Building Division. Date'. Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARNAANNN: i s iotrawad not not be completed it In er N or on undyed ($100) or less). I certify that in the performance of l e work for which thl penno sue / shall ry a per n in any net so as to become subject t Ith orkers' G en on Laws of California. ate: Signal -1 OTICE: If after making is declaration, you should became subject o t Worker Com ns provisions of the Labor Code. you must forthwith comply with such provisions or this per all be deemed rev ke CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (flection 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby alfirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt Iherefrom 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 five hundred dollars (5500). 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 (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business CR and Professions Code: The Contractors State License Law does not apply to an owner or property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Slate License Law). I am aware that proal of their Worker's Compensation insurance should be provided to me. am exempt under Section: C. re n: Date Owner: o hereby certify mat am are of and of d ad the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and Inas I or any re building Occup wilVwill not (circle one) need to comply with Said state codes and the requirements for a Permit for construction or modification from the Air Quality ManPgement District. Residential construction applications are exempt from these provisions. Date: Applicant: 1 hereby Certify tat have read this application and State that lh ion is correct. l agree to tom ilh all city and county I hereby and state laws have lating read this building con and state area h x earesentativescorrect.. I a tat/o emir u "the l city and ty f echo^purp>� s. L i License or Social Security x.: 164146 Whhe—Bulldmg: Green—Code Enforcement: Canary—Appllcari Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 066941 PERMIT NO: P 066941 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V-5 PERMIT TYPE: PLU PURPOSE: ADD JOB DESCRIPTION ; ADD 45SF TO DINING ROOM SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 / COMMENTS: REF: B-66463 it 1E 1E 1E 161E iE iE 1E 1E 1E 1E 1E iE iE * 161E it * 1E it i6 iE iE it 161E it 1E iE it i6 i6 iE iE 1E it 1E �r-N-�r+e a6 �6-xat �F -�t it �t it Fr yr+t �6 et a6 �r+r N-+6 jr * kt+e �Tt�6+r-last * �6 *+6 * �-�t Z O N I N GS ERT EBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41207412 ZNE: REF NO: PLANNING NOTES> > 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 DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: = DATE: 2 C`{� if iE 1E***1E 1E 161E 1E***16161E 1E 1E 161E 1E 161E 1E 1E 1616161E** if 1E ". 161E iE 1E 1Ek 1E 1E 1E 1E iE i6 i6 iF 161E aE 9E if if if iE lE lE iE 1E aF 1E i6 aE 169E aEM 161E iE i6 iE iE i6 i6 i6 if 161E iEeE i6lE iE iE iE*iE 1E 1E iE 1E 169E if 1E i6 iE iE iF aE 1E iE iE iE *1E 1E 1E iE i6 LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 35.00 258 SMIP/NON—RES PLAN ISSUE FEE 20.00 BUILDING—DIV—> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 35.00 20.00 0.00 55.00 55.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 55.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 55.00 1E iE iE 1E a6 iE iE * i6 iE 1E iE iE iE 1E iF k iF if 1E iE 9E iF 4E if iE iE eE iE iE 1E k 1E of iE 9E iE * 1E iF 1E aE iE 1E 161E 161E if iE iE if 1E 1E 1E iF RE if 1616 i6 i6 iE iE iE iE i6 it aE i6 * iF 1E 1E iE 1E iE * i6 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 PLU 1 DISHWASHER PLU 2 SINK, BAR PLU 1 SINK; KITCHEN PLU 1 FIXTURE SET/TRAP W/PIPING S BACKFLOW END OF FEES UNIT COST TOTAL COST 7.00 7,00 7.00 14.00 7.00 7.00 7.00 7,00 01 00159503-00159503 T O T 55,00 DATE: 04/26/94 TIME: 16:03 CONSTRUCTION AND PLANNING APPROVALS Permit* Date Inspector POOL & SPA APPROVALS 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 Grind. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit,Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ 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 & Access Approval 17. 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 APPROVALS Permit 20, Rough Factory Fireplace - - 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. Storage Tank 0 Gas 0Oil 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 7B. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test Notes: 36. Hood or Canopy 37. Final Factory Fireplace 38. Final PlumbingAR 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final ' 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING ------ 49. Electric Release to Edison ` 50. Gas Release to Southern California Gas Co r 51. CERTIFICATE OF OCCUPANCY No. Date _ _ PROJECT ADDRESS: 1124 DANA DR 'ZC UNIT: OWNERS NAME: RYRIE, THEOTiORE A ADDRESS: RYR I E MARY" hN ' BUILDING--------- 1124 DANA DR FT IN COSTA MESA,CA 92626 IN 714) 546-1024 ARCHIENGINEER: flEG.NO.: ADDRESS: UNIT: PERMITTEE: DOUGLAS WANYNE FORS (714)550-4406 ADDRESS: 6631 BRIDLE CI YORBA LINDA CA 92686 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70DO) of Division 3 of the Business and Professions Code. and my license in full force act. cITYLlc.:055076 TATE LID.: 62027 C B _ _ Sit WORKERS' COMPENSATION DECLARATION: ?ere;y affirm th ate of consent to self -insure ora certificate of Workers' Compensation Insurance or a certified copy thereof (Section 3800. Lab. C). POLICY NO.: 1 234959-94 EXP. DATE: 04/01/95 COMPANY: STATE FUND ❑ Certdied copy is hereby to had. Certified copy is fil ui! a 121y_ ry iilld/inyN visioi Date: Apllb„J! _ %EMPTION FROM WORKERS' COMPENSATION DECLARATION: (This secti ed ifthe permit is for one hundred ($100) or less). I 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 WorkersCompensation Laws of California. Date. Signature: NOTICE: If atter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097. Civ C) LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (secton 7031.5 Business and Professional Code: Any city of county which requires a permil 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/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) of that he/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 five 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 (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve for the purpose of sale). I,as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code. The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. & P. C. for this reason: Dale: Owner'. I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and trial I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Apphcanl'. I hereby certify that I have read this application and stale that the above information is correct.I ordinances and slate laws relitmg to building construction and hereby authori sentalives property for inspection purposes_ Driver's License or Social Security p: to comply with all city and county ,to enter upon the above mentioned 164146 While—Building; Green—Code Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 066992 PERMIT NO: P 066992 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V-5 PERMIT TYPE: PLU PURPOSE: OTH SOB DESCRIPTION ADD 45SF TO DINING ROOM (NEW GAS LINE) SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / COMMENTS: RE: B66463 iF if iE iE iE if 1E ie BE iE iF RF iF ai iF+(-iE iF iE±F 1E -)E jE if -k �lf lE -lf if jF-%iE 1f iF if it �f +E iE if ie if if -xlE If 1E if iE iE iE �lE jE if iE if iF iE+t it iE iF iF lf3F 1F iE if jE jE i4 3f 3f if 1E ik 3E 3f -1E 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; 41207412 ZNE; REF NO: PLANNING NOTES> **iak iE iE lF ik > iE ik iE*if iE JE 1!!l ie r JE lE k�E iE iE if iF iE iE iE 16#16 ie iE fE 16'36 iE iE iE iE iE*JE*iE iE 1F***fE*kit iE ieM if iF lE iE if iE REM**iE BE Bf iE*fE *1E aE RE!f 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 f, ZONING APPROVED BY BUILDING .A PROVED BY xN f Y J APPLICATION ISSUED BY: ?— iF1F1E*iE 1F 1E iE iE iE 1E iE 1E 1f 181E iE *iE 1E if 1E e E iE if if BB*1E 1F iE iE iE 1E 1F iE*x-iE 1E iE 1F if*1E iE iE lF iE iE ie iE if 1E 1E 1E 1E if 1E iE 1E ie 1E iE BE BE 1F iE iE RF *ik ♦Ex LEGALIZATION:N F E E S U M R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 5.00 253 PLAN ISSUE FEE BUILDING—DIV—> TOTALS ---- > 20.00 PERMIT ISSUE 5,00 20.00 DATE: _ DATE; DATE; g �iFiF iE if lE iF iF 1l 1E 1f -1E .iE 1E ie iF 1f 1E * iE 1E iE iE iF 1F iE 1E 1E iE iE M if * if 1E if 1E 1F 1F STRUCTURAL SEGMENT;N FIRE SMIP/RES GRADING SMIP/NON—RES ✓ t PLAN—CHECK TOTAL PAID DUE 0,00 25.00 25.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED:— 25.00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 25.00 )l 1E 1E iE 1f 1E x-16 iE 1E iE iF lE if lEiEiE♦E♦E♦E**iFieiEx-x-iE iE iE 1E 1E 1E iE 1E if 1f 1E 1E 1E �E*iE fE 1E 1E***iF iE iE lE iE iE i8 iE 1f 1E if 1f 1E*if lE ie*1E 1a 1E*1E *1F 1E iR iE if It if I N D I V I D U A L, IF 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 PLU 1 GAS PIPING SYS OF.- A TO'4 OUTLETS 5.00 5.00 END/OF FEES - r 01 00159723-00159723 TOT 25.00 DATE: 04/29/94 TIME: 16:07 CONSTRUCTION AND PLANNING I POOL . SPA APPROVALS Permit 0 Pate Inspector APPROVALS Permit Date Inspector � 1. Temporary Electrical Service or Pole ! 52. Pool & Equlpmert Location 2. Soil Pipe-Undrgrnd. - r 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bording 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd 57. APPROVAL TO COVER-GUNITF ,e. Footings 58. Electrical Conduit Undrgrnd.�� _i,_--- b. Foundation 59. Gas P.pe, G Urdrgr^d , Tc;t i -r S'. Water Pipe-Untlrgrnd. - 60. Backwash Lines, P.Trap, ❑ Undrgrnd. 1 10. Structural Floor System r; 61. APPROVAL TO DECK r 11. Property Sewer Line & Hou;: Connection 62. Backwash & Receptor Finel 12. Sewer Cap 63. Heater & Vent -Final I 13 Roof Drams . 64. Piumb'ng System - F�aI -1 14. Rough Plumbing lj- 65. Electrical-Firal r 15. Rough Electrical -Conduit 66. Solar System -Fina 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTE.RiNG 18. Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL I 19. Rough Heating & Air Condltiornng _ FIRE DEPT. REQUIREMENT -APPROVALS ?errnrt 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Produrt Piping :; G%s 7D OSI 23. Gas Pipe -Rough & Test's -C-�/ ' 72. Underground Flush 24. Roof Framing Roo` 73.' Undcrgind. Storagi+Tank "Gas _:Oil --I}-- 25. Sheathing 74. Overhead H%dre I 26. T -Bar Calmg IStructurall & ?Ao^ocoat 75. Dry Cheri ica. I�I t - f 27. Frame and Flashing 76. Dry Stagw_ e 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - . - . 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 79. 31. 'r:,rsser B,own Coat 32. Electrical Power Mete,-F,nal '_ 30. FOOD CErrTiFICAI E ISSUED 33. Final Electric Notes:Z4 _ 34 Final Heating & Air Condi;iomnc ZZ 35. Final Gas Pipe -Test -/ . �-^_ -_ �I _ �_V r 73 '1 2_ u--_�G/t-LsCTL.-�C/ y` - - 36. Hood or Canopy - 37. FinaV Factory Fireplace 38. Final Plumbing 39. Water Service Final 40. Gas Service -Final 2Z-5:1�t_� 41. Solar Domestic-F,nO 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation_ 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING r 48. FINAL PLANNING 49. Electric Release to Edison _ -� I 50. Gas Release to Southern California Gas Ge .. 51. CERTIFICATE OF OCCUPANCY No. Date I hOJECT ADDRESS: 1124 DANA DR OWNER'S NAME: RYRIE, THEODORE A ADDRESS: RYRIE, MARY H 1124 DANA DR COSTA MESA,CA 92626 714) 546-1024 UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO: E 066464 PLAN CHECK NO: N CONSTRUCTION TYPE: V-5 PERMIT TYPE: ELE ARCHIENGINEER: flEG.NO.: ADDRESS: UNIT: PERMITTEE: DOUGLAS WANYNE FORS (714)550-4406 -ADDRESS: 6631 BRIDLE CI YORBA LINDA CA 92686 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Professions Code. and my license is in full force and effect. CITY 055076 STATE LIC.: 62027 CLAS.B Dale: 3' / T �_ Sign HERS' COMPENSATION DECLARATION: hereby affirm that I hav, a of consent to sell -insure or a certificate of Workers' Compensation stuaAc d.cx ifie copy thereof (Section 3800. Lab. POLICY ND.:STATE:FUND EM P, DATE: 4/01/95 COMPANY. rrtt emfietl copy is hereby f�ur/nished. lG C¢nilie0 cppY is til e y Buildin Division. r Dale—��— % 7 A r / EMPTION FROM WORMERS' COMPENSATION 0 ATION: is seclion eleO if the permu is for one hundred )5100) or less). I 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 California. Date: Signature: NOTICE: It. after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work Ior which this permit is issued )Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law lot the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/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 01 not more than five hundred dollars (5500(. 1. as owner of the property or my amvloyees with wages as their sole compensation, will do the work, and the ❑ structure is not Intended or Offered fpr Sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselOhersetf or through his or her own employees. provided that such improvements are not intended or ollered for sale. 11, however the building or improvement is Sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the progeny, am exclusively contracting with licensed contractors 10 construct the project (Section 7044, Business Eland Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker s Compensation insurance should be provided to me. ❑ I am exempt under Section: B. S P. C. for ;his reason: nem I do hereby certify that I a 25534 and that I or any lot permit for construction or these provisions. Owner: m aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and ore building occupant will/will not (circle one) need to comply with said state codes and the requirementsfor a modification from the Air Oualily Management District. Residential construction applications are exempt Irom Dale: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. Signature: s License or Social Security • 164146 White—Building: Green—Code Enlorcement: Canary—Applicant: Pink—Revenue; Goldenrod—Assessor PERM NO: E 066464 GOVT: N SUPP: N PURPOSE: ADD JOB DESCRIPTION : ADD 45SF TO DINING ROOM SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: REF: B-66463 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 RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41207412 ZNE: REF NO: PLANNING NOTES> ELE 10 FIXTURES, LIGHTING ADDITIONAL EA. > !. ELE 2 RECEPT/OUTLET 1 ST 20 EA. .75 D E V E L O P M E N T S EIR V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY:-TDATE; � ���� LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 25.50 50€ PLAN ISSUE FEE 1.5.00 BUILDING -DIV-> PERMIT ISSUE P&AN-CHECK TOTALS ---- > 25,50 15.00 . 0,00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 40,50 SMIP/NON-RES TOTAL PAID DUE 40.50 40.50 .00 40.50 OVER/SHORT: ,00 FIRE SMIP/TOT GRADING PLAN -CHECK ############################################################################### 01 00157388-00157388 T CET 40.50 DATE: 03/18/94 TIME: 15:57 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 ELE 20 FIXTURES, LIGHTING 1 ST 20 EA, ,75 15.00 ELE 10 FIXTURES, LIGHTING ADDITIONAL EA. .45 4,50 ELE 2 RECEPT/OUTLET 1 ST 20 EA. .75 1.50 ELE 6 RECEPT/SWITCH 1 ST.20 EA. .75 4.50 END OF FEES 01 00157388-00157388 T CET 40.50 DATE: 03/18/94 TIME: 15:57 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOH - SPA APPROVALS 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ' 58. Electrical Conduit-Undrgrnd. S. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & HouseConnection62. 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'''''' 16. Rough Electric Wiring 17. Rough Wiring Sign y- 24 // GG 66. Solar System -Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocaat 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 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 34. Final Heating & Air Conditioning 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 Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: UNIT: OWNEWS NAME: 1124 DANA DR ADDRESS: RYRIE, THEODORE A RYRIE, MARY H 1124 DANA DR COSTA MESA CA 92626 ARCH/ENGINEER: 714) 546-1624 REC.NO.: ADDRESS: UNIT: PERMITTEE: THEODORE S MARY RYRIE (714)546-1024 ADDRESS: 1124 DANA DR < C.M. CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenting In Section 7000) of Division 3 of the Business and Professions Code. and my license is in lull force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature WORKERS' COMPENSATION DECLARATION: Ihereby alfirm that I have a certificate of consent to self -insure or a certificate of Workers Compensation Insurance. on a certified copy In proof (Section 3800. Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. Q{ Certified copy is filed with the city Building Division Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). eerily Ihal in the pedormanc¢ of the work for which in d. I shall not emplo by pe 'n any manner so as to become sg7pe to e /o ¢, s'•�amp a'on ws of California. nal .. Date'Q Sigu- 10TICE: If, alter making this declaration, you should become feet a Workers'Co gg Saturn provisions of the Labor Code. you must forthwith comply with such provisions or this perm, shall be deemed rVed. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work lot which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the fallowing reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant lar such permit to lite a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/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 penally of not more than five hundred dollars ($500). I. as owner of the property or my empployees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale ecl,on 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a properly who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion. the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044. Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. fort Els - q0al — 9 1-d6 hereby cerbly that I am aware of and understand the requirements of California, and Safety Code ons 25505, 25533, and 25534 and that I or any future building occupant will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby termly that I have read this application and sta h formation is correct. I agree to comply with all city and county ordinances and stale laws relating to building conslru and here au�te representatives 5mrs citytoe a upon the above mentioned property for inspection purposes. ,Vvers License or Social Security 164L46 White—Building: Green—Cope Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 06694_ PERMIT NO: E 066943 PLAN CHECK NO: N GOVT: N SUPP: Y CONSTRUCTION TYPE: V-5 PERMIT TYPE: ELE PURPOSE: ADD JOB DESCRIPTION : SUPPLEMENT TO E-66464 SQ FT: CLAIM VALUE: CALL -VALUE: GROUP OCC: R-3 / COMMENTS: REF: B-66463 S E-66464 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 RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41207412 ZNE: REF NO: PLANNING NOTES> > 9E iP iP*1EfE 1E iE iE aP iP iE 1E***k*iP iP*aE 1F**iP yE*iE if iP iE iE 9P BE 1E aP iP BE****iE fE iE iE iE BP if iP iP iP iP iP iP*iP iP*iE fE iP BF iP 9f 1E 1E iE 9E*iPiEiPiPifiPiPif- 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 DATE; (y� APPLICATION ISSUED BY; DATL� A� APPLICATION 4FrtiE9PiFiFIPBY: iPiPiFiFiFiEdP< jP 9P iP iP iF 4E iP 9E BE 9P aP*aF iF iP iP*iP K 1E iE iP iE iP 9P aF iE iF*iP**BF*fF aE aP iE aP iP iP*1E 9P iE iE*if BE iflE *aE iE iE 1P 9P 9E 9E 9E aF 1E if 1E iP �E iE iE iP*iE 1E aE aE 9F �F LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 3,00 SQ}s SMIP/NON-RES +PLA��N���� i7JIn2fUG 0TV-r 4.50 PERMIT ISSUE PLOLN-CI TfaTAL PAID DUE TOTALS ---- > 3.00 4.50 0.00 7-.30 7.50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 7.50 OVER/SHORT: 00 CE BLDG PMT PLUMBING ELECTRIC MECHANIC FIP/TOT GRADING PLAN -CHECK 7,50 1E iF 1E 1E iF 1PlE iP 1E 9E*1f k1f****M M1P iE 9Fk**iP*1t iE 9P iE iE iE*fP if iE iP BE**iE iE iP*iE iE iEk***9E Bf 9E**iF iP iE iP iE 9E**i�%1E iE iP *1E iE ie iP iE iE 4E 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 ELE 1 NON -RES APPLIANCE NOT OVER 1.0 HP 3,00 3.00 END OF FEES 01 00159504-00159504 TOT 7.50 DATE: 04/26/94 TIME: 16:04 l* CONSTRUCTION AND PLANNING APPROVALS Permits Date Inspector POOL & oPA APPROVALS Permit ?,E 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, C 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 & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69, POOLl SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas 000 23- Gas Pipe -Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank C Gas C Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structuratl & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric 34. Final Heating & Air Conditioning z Notes: 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations _ 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49, Electric Release to Edison • - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date i /j � + cl ix.- I -L o C� O: i tis -~ b�5o vt <<,( 7 r t- 7 45034 COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 F to Fill in Completely — Use Ink Only/�(�ties West Develo ent Co MAIL 08 29th StreetTEL. Ranr•h !'A NO. Fi74 _d01f1 BRANCH ADDRESS ARCHITECT ADDRESS L644U !Newport ulya. , 1Newport Y CONTRACTOR Owner ADDRESS 10 t 0-77PcnsaA1000 568+ ***122.64 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVEDNT., MMMMMF BUILDING ADDRESS TRACT OWNER VALUE FIRE ZONE APPROV ' INO. OF USE OFE PLANS !7-,I BUILDIN1..1 /fdl.i YARDS APPROVED YARDS APPROVEDWV 1 1 we ur au�uu uvu servo vv�nn i u oc rcr.rv,rav,cu DISTANCE BET ET. MAIN & �_J MAIN SL ACCESS BL 0 VAR. aYY- r -1.,) i7/ A I_DATE .... .,.�s0 #4 I hereby acknowledge that I hf/ read this #lication and state}F TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF BLOCS. OF LOT LDT x 8W Approx. 60' x 8W NOW ON LOT o Now N LOT60r USE OF m a EXISTING BLDG. Separate permits are required for 2 electric, plumbing and heating work. 10 t 0-77PcnsaA1000 568+ ***122.64 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVEDNT., MMMMMF BUILDING ADDRESS TRACT OWNER VALUE FIRE ZONE APPROV ' INO. OF USE OFE PLANS !7-,I BUILDIN1..1 /fdl.i YARDS APPROVED YARDS APPROVEDWV 1 1 we ur au�uu uvu servo vv�nn i u oc rcr.rv,rav,cu DISTANCE BET ET. MAIN & �_J MAIN SL ACCESS BL 0 VAR. aYY- r -1.,) i7/ A I_DATE .... .,.�s0 #4 I hereby acknowledge that I hf/ read this #lication and state}F that the above Information Is d6rrect and agree to comply with all laws regulating building construction, and I shall not employ i any person in violation of Me workman's compensation laws of the State of California. I herebycertify that I am y properly licensed as a contractor under m the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I m a am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. 2 Signature u Perm lttee �/w_s�s/y �.y Authorized Age //�-.,.jp�e.trLe�a�[�s..� Aq REQUIREMPs `7 ; I TOTALPAID $ m i 2790N IN UNDER VALUATION IS FOR m ABLSHING A PERMIT FEE ONLY: PERMIT FEE $ m a PLAN CHECK $ 117.50 2 TAX $ 5.14 1 u TOTALPAID $ COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 ,'-C-9-77CASp00 514 J* *235.00 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BV BUILDING ADDRESS Hal i , A OWNER f//L/J/v A.P, NO. BUILDING MAIL ADDRESS ADDRESS // TEL. CITY NO. TRACT W A D A T 4TYPE AGROUP CONSTRUCTION LENDERBRANCHOWNERADDRESSARCHITECT SEOR TEL. ENGINEER FIRE ADDRESS ZONE APPROVED CONTRACTOR / BY DATE ADDRESS ZONE NO. OF I USE OF NEW TEL. CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLIXaS. (FROM C/L STREET) OF LOT NOW ON LOiFRONT FT. FT. USE OF EXISTING BLDG. FT. F Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR. 1/• DATE C.U.P.$+ APPROVED APPROVED I hereby acknowledge that I have read this application and stato 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 am properly licensed as a contractor under SO. T. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business and Professions Cotle, D* 'vision S, Chapter S. VALUATION PERMIT FEE $ PLAN CHECK $ Signature of / aQ! /% B _./ TAX $ Permittee //:,s„ .C.1� s�/�/p TOTAL PAID E Authorized Agent