HomeMy WebLinkAbout940 DARRELL ST - Building Permits] . .l � - r 1
' CITY OF COSTA MESA � � - •
�
BI/ILDING DIVISION ,
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.cost -mesa a�.us ;"' �_ ,
� '? FOR INSPECTtONS CALL: (714) 754-5626 � - � . � . '
�� . . .. ! � . . . . . . �
� .. PERMIT NUMBER. P08-00206
PERMIT TYPE PLUM STATUS: ISSUED
ApN: 42235228 DATE ISSUED: 09/23/2008
� � � ISSUED BY:' BJK "
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JOB ADDRESS: 940 DARRELL Si=CM ' Suite/Unrt *'�
,:
Vicinity: GARAGE ;��� � a �i -,,� �-''. •� "�� «�,c: ; 'i `�° ,� . �'T _ �
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SCOPE OF WORK: LEGALIZE WATER HEATER CHANGE-OUT IN THE GARAGE� �+� ";" �'�, •�
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OWNER: LATIMER, ROBERT E�'r' ��'�' A�ddress: +940 �ARRECL ST j�z; :: �. :
PHONE: ;� r . , 1'� ,� x:-., � ' . Cdy/State/dp ` COSTA'MESA1CA� "� � ��
APPLICANT: LATIMER, ROBERT E� r �`- Address +940 DARRELL ST '� rY �; .
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PHONE: 949-646-0132 ��„� � ' �='7` �'""'r'Cdy/Slate/zZip ,'�,COSTA MESA CA5 ` x ' � � -
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CONTRACTOR OWNER BUILDER "' ,� License No '�:000000 v i��'� � �
Aqdress: �;i t`� y`� f � .�:' . , --a PHONE � � .� ,
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' 4 � � °':' PLUMBING PERMITSFEE SUMMARY `�;� �
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PLAN CHECK FEE. "'' ` �-""'"" � '' � $0 00 ,,, �'L -
PERMIT.F EE ` Xt� °°k r,'�'�-', ,r i, �'�'$35 80 �'...� ,
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TOTAL FEES � ;� � ,- j ' ` $35.80 � �
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NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, §�1, 12-21-92) � � ' ' -• � •
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �_� �� • ���
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must wmply with all applicable codes, and all
required inspections and Flnal approval musl be obtained. Failure to obtain inspectlons and flnal approval will result in the expiration of,this permit.
c_ooer, ixsv�cnox.rve . � o� IN1fIlALS . QU€f n+srecnoxTrve �. ' o� '' iN71TIAL5
1618 FixeO System Final Fire Prevenli0n 206 � Final Mechanical . . -� . m �
�1266 PoolSpaFinal . ' 208 FinalPlumbing "'�=1-OD �
2pp Final Re-Roo( . 210 Final Electriwl .
201 Final Block/Retaining Wall 212 Final Fire Prevention � � �
202 Final Factory Fire Place ?ZO Final Planning Approval
203 Final Sign 222 FinalSite '
204 Final Demolition � 250 Final Building/Occupancy --
� � r
WORKERS' COMPENSATION DECLARATIO� .: ' ��_ Ownec ID verified by driv. yense. �Yes ❑ No�- `
I hereby aKrm under penalty of perjury one of the following declarations: � � /
/oriver'sLicenseNo. Expires: —��Ci
❑ I have and will maintain a certificate of consenl to sel4lnsure for workers' Verification of Ownership by (rype of document, i.e. - property taz bill or tleed):
compensation, as pmvitletl for by.section 3700 of the Labor Code, for the � ..
peAormance of Ihe vrork for which this permit is issued: ' ' �. � ' � ' �' `
❑ I have and vnll maintain workers compensation insurence, as reqwred by.
section 3700 of the Labo� Code, for the pedormance of the wnrk for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(ihis seqion neetl irot Oe mmde��Athe pertnd is valuetl at one hundiea dWlars (E100) orless )
Policy Number:
❑ I certify that in lhe pedormance of the vrork for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of Calitomia, and agree iha[ i( I should
become subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
Applicants SignaWre 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
($10Q000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrtn that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of ihe Business and Professions Cotle, antl
my license is in full force and effect.
Lic. # Class #
Conbaclor's SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a constructbn lending agency for the
peAormance of the work (a wfiich this pertnit is issued. (Sec. 3097, Civil Code).
lender'S Name:
Lenders Address:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalry of peryury [hat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 703t.5,
Business and Professions Code: Any ciry or county which requires a permit to
conStmCl, alter, improve, demolish, or repair any stmcNre, prior b its
issuance, also requires lhe 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) o! Division 3 of Ihe
Business antl Pmfessions Code)�Ar [hat he or she�is'exemp['there(rom:antl��
the basis for the alleged exemptionyAny violation'of Sec[ion.7031.5:by any7
applicant for a permit subjects�tbe,applicant lo a civil penalry of riot mo7e than�+
five hundred dollars ($500).): `�p x'""' �� -�.,.'� .','{' !`,�
❑ I, as owner of [he property,yor my employees with wages as their sole
compensation, WILL DO THE WORK, and the sWCWre is not intended or
o((efed for 5ale (Sec. 7044, Business and Professions Code: The ContraClors
License Law does not apply to an owner of properly who builtls or improves
'thereon, and who does such vrork��himself or herself or through his or her own
employees, provided that such improvements are not intended or oNered for
sale. I(, however, the building or improvement is sold within one year of
completion, the owner-builtler will have the burden of'proving that�he or�slie
tlid not builtl or improve for purpose of sale.). , . .
C��, as owner of �the property; am� EXCLUSIVELY CONTRACTING WITH
CENSED CONTRACTORS to construct the project (Sec.,7044, Business and
Professbns Code:-The cont2clors License Law dces not zpply lo an owner o(
property who builds or improves lhereon, and who cont2cts for such project with
a tont2ctor(s) license pursuant to the Contractas License Laws.�. _
❑ I am exempt under Sec. -
Business and Professions Code for ihis reason:
0 9 . — 08
. • `Signature-^""�� - ' �Date� .
305]-46(3/0])
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATIONi �� . �
❑ I hereby cert'rfy that no excavation five (5) or more feet in depth iMb wfiich a
person is required [o descend, will be made in connectbn with vrork aulhonzed
by �his permit, antl that no building s[ructure, scaffdding, talsework, ar demolition
or disman[ling [hereof, will 6e more than thirty-six (36) (ee[ high. (Chap. 32, Grp
2, Art 2. Sec. 341, Ttle 8, Cali(omia Administ2tive Code)..
❑ As owner-builder, I will nol employ anyone lo do vrork which would
require a permit (rom the Division of Industnal Safety, as noted above, unless
such person has a permit to do such work (rom [he division.
AOPhcanYs SignaWre Dale
Division of Industrial Sa/ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or present or future building occupant need to file and
certity a Business Plan for emergency response [o release or threatenetl
release of a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 of the Cali(ornia Health and Safety Cotle requires, with some
exceptions, [hat a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantity of hazardous matenals equal to or grea[er Ihan a weight ot
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperawre and pressure). �
2. Does or will the applicant or presenl or tuture builtling occupant need to fle
a registration �orm for awtely hazardous materials7 ❑ Yes ❑ No
(Section 25533 of the California Health and Safery Cotle, wilh some
exceptions, requires regislration with the Costa Mesa Fire Department by
each business which a� any one time has on hand a quantity o( acutely
hazartlous matenals equal to or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and pressure�. �
3. Does or will the applicant or present or fuWre builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code pmvides thal the
Costa Mesa Fire Department may require the prepara[ion, certification and
Ning with the Fire Depariment of an RMPP by businesses which are required
to register acu[ely hazardous materials with the Fire Departmen[.
4. If an RMPP is presently requiretl, has Sec[ion 25534 0( the California
Health and Safety Cotle been fully complied with? ❑ Yes ❑ No
5. Does or will �he applicant or present or fWure building occupant require for
the work which is [he SUbjeC1 of this appliCatiOn a permit fOr Such construction
or modification from ihe South Coast Air Quality Management Dis[rict or ftom
any other air pollution control dislnct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requestetl
infortnation be Nmishetl on applications fa non-residential building pertnits).
6r•Wilbany part of Ihe faciliry to be consWc�ed under [his pertnit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
'. �wy:`
(Ifyyes";}he facility must mee[ [he requirement o( Sections 25534 and 42303
o(the California Health and Safety Cotle�.
Z If a permit from lhe South Coast Air �uality Management District or other
air pollution control tlistrict or aqency is required for the vrork which is the
subject of lhis application, have all ot Ihe disclosures prescnbed by California
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8: (If'yes", attach certificate of compliance fmm the appropriate air polWtion
control officer). ' - � ' � - �
CERTIFICATE OF COMPLIANCE:�.I certify that"unCer penalty of'perjury•the
information, given above is correcL I agree to comply vrith all state laws.and
city ordinances regarding Hazzrdous Materials and Emissions. ��
" - � Signalure ^ 9ate '. - �
CERTIFICATE OF COMPLIANCE AND AUTHORRATION OF ENTRY: 1
certify under penalry of perjury that I have read this application and state that
the infortnation given is correcl 1 agree to comply with all state laws and ciry
ordinances relating to building construction, and authorize representalives of
lhe Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy o( any building
aulhorized by �his permil u til f nal ins ection. �.. .� ��
�Z�yP� '�a D9-23-�R
Sig�aWre ol �egai Ovmeqs) `Oa�ea
Antllor AutM1onzetl Applrtan�
} , ,. .
CITY OF COSTA MESA .
•.-�:
BYILDING DIVISION '
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. .us � '
�, � FOR INSPECTIONS CALL: (714) 754-5626 . -��
��� PERMIT NUMBER P08-00181
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PERMIT TYPE PLUM
APN: 42235232
JOB ADDRESS
viciniry:
SCOPE OF WORK: R
SHOWER/TUB, SINK &
OWNER: ' OOSTEF
PHONE:
APPLICANT: PRqDO,
PHONE: 714.g60�
CONTRACTOR: J K
Address: 915
City/State: � HUP
CELL: 714•960-7052
ARCHITECT:
ENGINEER:
956
STATUS: � ISSUED
DATE ISSUED: 08/12I2008
:�"aISSUED BY: YH
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N 40 GALLON WTR. HTR., R
& REPLACE KITCHEN SINK.
City/State/zZip:
..e � f _5 ` fi _` .;�-.iP
License No.
TOTAL FEES:
s 5 E ';i
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N BATHROOM #2, REPLACE
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NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requiremenLs under Califomia 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 inspectians and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
COOEt. INSPECTIONTYPE DRTE INPMLS LODEt INSPECTIONTYPE � U1TE �'. IX , L
1616 Pixed System Kinal Fire Prevention 206 Final Mechanical
7266 Pool SOa Final . 208 Pinal Plumbing �—� �
200 Final Re-Roof 210 Final Electrital
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 FinalSign . 222 FinalSite '��'�
204 Final Demolition �� 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalty of perjury one of the following declarations:
❑ I have and will maintain a cehificate of consent to self-Insure for workers'
compensation, as provitled for by section 3700 0( the Labor Code, (or the
pedormance of Ihe work for which ihis permit is issued. �
� I have and will maintain workers' compensation insurance, as required by
sectbn 3700 of the Labor Code, for the pertortnance of the work (or which this
permit is issued. My woikers' compensation Insurance carder and policy
numberare:C� �
Carrier: J
(IDisSMbnneetlnotbemmpleteCrl( �pe-r-m—rt/isvaluCed�atmehundredt,bllars(8f00)oiless)
Policy Number. `��� J CS� J
❑ I certity 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 subjec[
to the workers' compensation laws of California, and agree that if I should
become l,bjecl to the vrorke s' compensation provisions o( Section 3700 of
the Lab r Cd e I shall o il� th com ly with tfiese provisions.
�— � o - 6g
Applica "sSgnaWre �ate
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT 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, IMEREST, AND
ATTORNEY'S FEES. �
LICENSED CONTRACTORS DECLARATION:
I hereby aNrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0! Ihe BuSiness and Professions Code, and
my license is in full force ran ffect. �
Lic. # _ _l _ Class #�
_ � -1 �-(7�1
ConUa tor'sSignaWre Oale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm lhat there is a consiructbn lending agency for Ihe
peAormance of the work for which Ihis permit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atltlress:
OWNER-BUILDER DECLARATIONS:
I hereby affrm [ha[ under penalty of perjury that I am E7(EMPT FROM THE
CONTRACTORS IICENSE LAW for the following reason (Sec. 7031.5,
Business and Pmfessions Cotle: Any dty or county which requires a permi[ IO
construtt, alte�, improve, demolish, or repair any strucNre, pnor to its
issuance, also requires the applicant for such pertnit to fle a signed statement
that he or she is licensed pursuant to lhe pmvisions of the ConVactors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pmfessions Code) or lhal he or 5he i5 exempt Iherefrom and
the basis (or [he alleged exemption. Any violation of Section 7037.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as owner of Ihe 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 Contrecrors
License Law does nol appty to an owner of pmperly who builds or improves
ihereon, and who does such vrork himself or herself or through his or her own
employeesi proyided that such improvements are�not intendetl or oRered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden,ot pmvinq that he or she
did not build or improve for purpose of sale.). '-' � ' : � ' '
❑.. I, as owner ot�the propeAy,�am,EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70RS to cbnsWct the project (Sec. 7044, Business and
Professions Code: The contrectors License Law does not appry lo an owner ot
property who buims or impmves [hereon, and who con[2ct5 for such prqect with
a contractoqs) license pursuant b the Cont2ctors License Laws.). '
❑� I am exempt under sec. � � �
Business and Professions Code (or this reason:
305]-i6 (3IW)
Owner ID verifed by tlriver's lia ❑ Ves ❑ No
Driver's License No. Expires:
Verification o( Ownership by (rype of document, i.e. - propeny taxbill or deetl):
.: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:�,�
❑ I hereby ceAAy thal no excavation (rve (5) or more feet in dep[h into which a
person is required to tlescend, will be made in connection with v,�rk authorized
by this permit, and thal no building structure, scaffdtling, falsework, or demolition
or tlismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp
2, AA 2, Sec. 3A7, Ttle 8, Cali(omia Administrative Code).
❑ As owner-builder, I will not employ anyone to do woik which woultl
require a permit from the Division of Industrial Sa(ety, as no[ed above, unless
such person has a permit to do such work from the division.
Appliranfs SignaWre Date
Division of Industrial Sa(ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building xcupant neetl to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazardous malerial? ❑ Yes ❑ No ���
(Section 25505 of ihe California Health and Safety Code requires, wilh some
exceplions, that a Business Plan be (led with the Costa Mesa Fire
Department by every business which has al any one [ime dunng a reported
year a quantity of hazardous malerials equal to or greater than a weight o�
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
a� standard [emperaWre and pressure).
2. Does or will the applican� or present or /uture building occupant neetl to file
a registra[ion form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of lhe Califomia Health and Safety Code, with some
exceptions, requires registration vrith the Cosla Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous matenals equal lo or greater than a weighl 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 ro
prepare an RMPP (Risk Managemen[ antl Prevention Pmgram for acutely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Heal[h and Satety Code provides that the
Costa Mesa Fire Department may require the prepara[ion, certification and
filing wi[h [he Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Fire Deparimenl.
4. If an RMPP is presently required, has Section 25534 of �he California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will ihe applicant or present or fuWre building occupant require for
ihe work which is the subject of this appliwlion a permit for such conS�NCli00
of modifiCalion from the South Coast Air �uality Management District or trom
any other air pollulion control district or agency? ❑ Yes � No
(Section 658502 of the Califomia Govemment Cotle requires that the requested
information be fumished on applications for noo-residential building pertnits�.
6. Will any part o/ the facility to 6e constmcletl untler [his permit be within
1000 feet from the outer boundanes of a school? ❑ Yes ❑ No
Q( yes", the Facility must meet ihe requiremen[ of Sections 25534 and 42303
of the California Heal[h and Sa(ery Code).
7. If a permi[ from the South Coast Air Qualiry Management Distric[ or other
air pollWion control district or agency is required for lhe vrork which is Ihe
subject of this application, have all of the disclosures prescribed by California
Healih and Safety Code Section 42303 been made? ❑ Yes ❑ No
. 8. Qf'yes", attach certifcate of compliance.from the appropdate air pollution
control oKcer). � " -- ' . ' - �
CERTIFICATE OF COMPLIANCE: I�certify that under penalty of perjury,the
infoFination given above�is�correcL I agree to comply with�all state laws and
� ciry 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 antl �state that
the information given is correct. I agree to comply with.all state laws and city
ordinances relating to building construction, antl authorize representatives o(
the Ciry of Costa Mesa to enter upon the above-described properry for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
Sign 1 ( e al Ow � �1�� �
A' �onze p L n Date
Job Address: 940 DARRELL ST
Suile:. ' � ,.. - ' .
, Vicinity:, FAMILY ROOM �
.. � Primary Occ: �• R-3 � Dwellings/ Con9 Res <10� Type of Consiruction: V-N
Parcel Number: 42235228 �` Zoning:
App�icant:_ BEKEMEYER, LEN ,
Address:' � . �
0
�- � ' � . Phone: 714-662-5952
, Owner: LATIM
Address 940 DAF
� //��� -� Phone:� ^�'r•
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Zip:? ��� � � ��� License: e a
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TRUCT, 387SF FAMILY�ROOM ADDITION AT THE RE
200M FOR ENYRY FROM�THE�FAMILY ROOM. � ^
`_I f� �i�/1 v % ,
i Ctiecfcf;r J$326.85 ' n �1( ��( �.
Permit`',,��� $502.85
91P�Re's: �', $3.58
IPCom:``'�,�,�� $0.00 ��
Other' l i) r� $0.00 j--��—�- .".��-�
p�n:�. i� $0.00
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Total: �\Ud $833.28
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License:
Eng: CHARLES
6Address: PUO.BOX 628
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� GARDEN GR
92846 �'
_ � '» n'" 4 �
. Sfatus: ISSUED
Applied: 04/14/2006
�� � Issued: 11/16/2006
ISSUEDBY: � �"��V
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� Ciaim Valuation: i� �
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. NOTICE: The work auttiorized by ihis permit shall comply with all applicable handicap access requiremenis undar California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)„ , - „ , , � - .
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 180 days. . -, . . , _
INSPECTIONS: In. order for the work aufhorized�under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapectiona and final approval musl be.obtained. Failure to ob�ain inspections and tinal approval will result in the expiratlon of ihis permit.
FOR INSPECTIONS CALL: (714) 754=5628 _ ; �
, , ., _
244&481&00).. , . _ . � n . .. . . ... - . . . . �
WORKEHS'COMPENSATONDECL�4RATION: ',S. - ��v� ' ' , � � , '
I heroby eHirm under penalry ot parjury one of the following declarationsi�'�� '� ' � � � .� „� •- �
❑ I heve enE wlll meinteln a certificete of consent to self-Insure fo`r viorkers' compensetlon, es provided for by sectlon 3700 oi the Lehor Code, tor the pertartnance ot the
work for which this pertnit Is issued. , . , - ••
❑ I have antl will mein�ain workers' o�mpensation insurance, as requiretl 6y section 3700 of t�e Labor Code, for iha perfortnance of the work for which this pertnit is issuad. �
My workers' compensation Insurence carner ana policy number are: � �
Carrier: ': - - Policy Number.
(This ctian need nof be complefed il ihe permit is velued ef one hundred tlollare ($100) or less.). �. .... ... . ,„., o.., ., ...
I certify Ihat in Ihe pedortnence of the work tor which ihis pertnit is issueQ I shall not employ any person in any manne� so es to become subject to tha workers'
compensation laws of Califomia, and egree tha �f I should hecome subjact to the workers' compensation provisions ot Section 3700 ot the Labor Code, I shall forihwith
complywit�these rovisgions.�/ I � I �
Applicant Signature: aL�e/� � Date: I��' �%
WARNINO: FAILURE TO SECUiiE WORKERS' COAIPENSATION COVEPAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL P�TIES ANQ CIVIL F ES UP TOONE HUNDRED
THIXISAND OdlARE (5100,000�. IN ADDITION TO THE WST OF COMPENSATION, DAhNGES AS PROVIDED iOR IN SEC710N 310fi OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N: � � � � � � '
I herehy affrm that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of DiNsion 3 oi lhe Busine3s and Professions Cotle, end my�license is in full
force and eHect Lic. # � Cless p
Contractor's Signeture: Date: � -
CONSTRUCTION LENDING AGENCV: ,
❑ I hereby attirm ihat there is a construction lending agency for the peAormance of the work For which this permil is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address: - ' - -
SignaNre: Date:
� OWNER-BUILDER DECLARATIONS: �
I hereby aflirm Ihat untler penelry of perjury Ihai I am E%EMPT FROM THE CONTRAC70RS LICENSE LAW for the following reeson (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires the epplicant for such permit
to file a signed statement tliat he or sha is licensetl pureuant to the provisions of lhe Contrectors License Law (Chapter 9(commencing with Section 7000) oi Division 3 ot ihe
. 8usines nd Professions Code) or that he or she is exempt therefrom and t�e basis tor the alleqetl e:emption. Any violation of Section 7031.5 by any epplicent for a permit
sub' s ihe applicant to e civil penalry of not more than fiva huntlred tlollars ($500).): �� � '
I, es owner of the property, or my employees with wages as iheir sole compensetion, WILL DO THE WORK, and ihe siructure is not intendetl or otteretl for sele (Sec.
7044, Business and Professions Code: The Coniractors License Law tloes not apply to an owner of property who builds or improves Ihereon, and who does such work
himseH or herself or through his or her own employees, pmvided Ihat such improvemenis ere not intended or oflered tor sale. N, howeve�, Ihe building or imDrovement is
sold within one yeer of completion, the owner-builtler will have ihe burden of proving that he or she ditl not build or improve for purpose of sale.).
�❑ I, as ownar ol Ihe property, em E%CLUSNELY CONTRACTING WITH LICENSED CONTHACTORS to consimct ihe prolect (Sec. 7044, Business antl Pmfessions
Code: The contractors Licanse Law tloes not apply to an owner oi propeey who 6uilds or Impmves Ihereon, antl who contracis tor such pmject with a conirecior(s)
' licensa pursuant to the Contractors license Laws.). . . - '
❑ I am exempt under sec. Business and Professions Cotle for t�is reason:
Signature: � n.�,�-V� £ � - Date:
Owner ID veniietl by drivels license. ❑ Yes ❑ No Driver's License No. E pires:
Verilication of Ownership by (type of tlocument, i.e. - property ta: bill or tleed):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: .� � . ' � .
❑ I hereDy certity that no excavation five (5) or more fee� in depih into which e person is required to descend, will De made in connection with work euthorized by this '
permit, and that no building stmcture, scaflolding, falsework, or demolition or dismantling thereot, will he more than thirty-six (36) leet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle 8, Celifomia Adminisirative Cotle). � _ � . �
❑ As owner-builder, I will not employ enyone to do work which would require a permit irom the Division of IndusMal Safery, es noted ebove, unless such person has e
parmit to do such work from ihe tlivision. . '
Signaturo: - ' Date:
Division of Industriel Satety Permit Number.
CERTIFlCATE OF COMPLJANCE AND AUiHORVATION OF ENTRY: I ceniy under penalry of perjury that I have read ihis application and state Ihat the informetion given is
correct I egree to comply with ell state lews end city oidinances relating to builtling construction, end authorize representatives ot iha Ciry ot Costa Mesa �o en�er upon Ihe
aboye-descnb�op�for inspe tion ps uryoses. I egree not to occupy or allow ocwpancy of any building euthorized by this perp�it until tin�l inspaction. ,
�� 7 0 �-Y' IYZ 1 I �/"T�
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. Signature Ot Legal Owner(s) ' , � T � te
And/Or Authorizetl Applicant Date
CQOE /. INSPEL90NTYVE � . „ j1eTE; - . •f�� �=.c � ����. INSPEQIONTYPE � � � , _ Q/�jE ' IN7IfUL5
161fi Fixed System Final Fire Prevention �� 206 Final Mechanical � -
1266 Pool Spa Finel . ,. , , , - , � 20B . . Final Plumbinq - , '
200 Finel Re-Root . � - 210 Final Electrical ' '� '
201'r. �- Finel BIocWRetaining Well , - - . ' , 212 n. Final Fire Prevantion }• , ; r , ,�q • � ,
. � r - ... N . . .
202 Final Fadory Fire Place ' ' - - ' � 220' 'Final Planning�Approval • � -
� , � �
203 Finel Sign 222 Final Sita .,
204 " Final Demolition � ' "' � � � - � � — " ' ' � 250 "FinaPBuildiriryOccupency -
� CITY OF COSTA MESA .
� : eva��N6 �►ws�oN
F� , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
� PERMIT
�,��� ,. E06-01302
�(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.��sCTRICAL PERMIT � 77-FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: .940 DARRELL ST � -, � Status: ISSUED
Suite No � '' � Applied: 11/162006
� � Vicinity: Issued: 11/162006
Parcel Nunmber: 42235228 • � .
" npp�icant: LATIMER, ROBERT E
� . Address: 940 DARRELL ST - � • • � . ' . ISSUED BY: ��
_ Phone:'949-646-0132
COSTAMESA,CA � �/�Zip-Gf9 2µ��o �� � �
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ownec LATIMER,�ROBERT E �� �� � ,
. . � iii�_� ✓C\� Ui-.l
Address 940.DARRELL ST -�'� �}t �
' �U /� A�'� / / �p``�.�>000�."�.. ��
; . ' � r�/COS A\ES\A,rCAf ��j�,�Zip:-`92627 �"'`y \� �\�\'� .
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Conti�f �OWNER�D R ` � \'� ^ \� �� "
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AGdres///s: f
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' Q� � � �icen� e: o00000 8 p ��
,�/,� . � � � ���:° � �3 �;�.\ ���� �
� �i ( �`�,� ���/f%°�� � 1 � �"�o �SCOP_E OF_PERMIT�� � � � � �' • � � �
�.�� � ,J�,REF: BO6-00560:"ADD�FAMILY ROOM AND LAUNDRY ROOMAREA TO AND�EXISTING SFO. `}"`
�r.'t " i`�/!( ECECTRICAL�TO�INCCUDE: 10 LIGHT FIXTS, 10 OUTLETS, 5 SWITCHES; RELOCQTE'AND UPGRADE �
�'f j ��� oELEC SERVICE T0200 AMP, 1 MOTOR TO 1 HP (VENT FAN). � r"""'�
.. � � r,;? �sr' � �' ' � �� ��,���� ;7, r�� � ,
` � � i � i j( (1(� ! �/ c�-�--- FEE�SUMMARY-/��(J} ��%((�" � �4�I ' \, �
; Oj � �1����`"'". / QulitTy � �1Y1L' 1L �r7I1P� �`'II//�} /� �1} Q QuantityCt/ �� �
� ISSUE FEE �� O $23.50� Temp:Dist System GLighting $0.00 0�
�� Temp service test $0.00 Busway /100 fl $0.00 0�
n�Res=alc packagei $0.00 � Standing Section� $0.00 0 � q
w Res (�1-2'unils)' � � $0.00 r-�t0����Misc�Elecfncal Equipment $0.00 , 0 � 11� .
. �New.Res(3+unitsj �� � $0.00 �,�_0 __;_-- GTransformers�.uqto�t�,kva/kw. $0.00 0?) � U �
Fool'�/ Spz � `��. �, $0.00 �.0 �...�.;.� up�to i 0 kvalkw� - $0.00 � � 0 •
Lighfing Fixis � � $11.00 10 - ........... �up to 50 kvalkw �30.00 _ 0
Recept Outlets \� $11.00 10 .......... !� up to 100 kva/kw $0.00 � 0 �
� Switches \j , $5.50 5 � . ...�...... ��over 100 kva/kw � $0.00 0� �„„
Non Res Appl �'� $0.00 0 •� Low Voltage-Equipment $0.00 0 I)
Res Appl� ��\ �0 $0.00 0 ��..,gLow,Volt Wiring System / Ckt $0.00 �0 {� '1
Service to�200a �/ \� $30.50 � 1 T��i�`�-Misc�Conduit $0.00 � 0
SeNicetoJ000a � ��\1�0.00 0 .,.y �� �1 Misc:Contluctor ' $0.00�0 �
� ",,,L 0
Serviceover�1000a 1� \$0:00 0 ,�.•;�'�,i\G �� o��Circus(�gen'or;ride) ,_ � $0.00 0,� '
Motorsto�'Itip� ��J $¢.75 ,1�=�' 3* �� �p� �Ciicus(mech�ndetorlights)'' $0.00 0% �
Motors to tOhp� $0.00-\� 0�'�'� ° �0� b� �U, �Chiistmas Tree Standa ��SO 00 ''� 0� .
Motors to SOhp� $0.00\ 0� �`'� � l o Fireworks�Stand> $0 00 J �0, ��
Motors to 100Fip,� ���$0 00 \\\ � 0`' o0 0�' �. y° ��Olher E�ectrical'Fee'x �$0 00 1 V �O
Motors over 100fi ! � ° � � �� U�
P�� / �$0:00 �0 0 � O r0 oy,� 0�;,� /� � ,
- Communiration drops�v`�$0:00/'�,� 0`,.��� ° Investigatiori-Fee��J (�' $0:00 0 .
Sub panel to 200a \ $0.00�7 � 1/�0 '^--"'-� Plan�.Check�.Fee � ry�j$0.00 f% ; �
• Pole Light Pkg - $0:00 ��,f �I CO3 �Reinspection Fee \ � C$o.00 D� .
Si9nCircuits �So.00��u`o1 � �-«-^����� ll �i�
Temp Pwr Pole ��$0'00 0� �, O TOTAL CAL'CULATED,FEES E86:25
Intermetl Pole . . $O.00��OI ��� � �,� �i��� - • �
�.J l� Ll� .
� .
„'�COMMENTS GSP.ECIAL'.CONDITIONS �
--�--�----------
� �
; � , , �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and relaled
regulations. (Ord. No. 92•28, § 1, 12-21-92) � . _ �� -
EXPIRATION: This'permit shall automatioally expire and become void if work is not commenced within 180 days, or if work is suspendetl or abandoned
for a period of �180_days.'. � � � . ,
INSPECTIONS:. In �order for Ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapections and flnal approvel musl be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5826 .. . � .. . " �
. zaa�ac (�ao) . . ...: . .. . - , t;:'o.;,-' . .. � . � . " . � ' .
WORKERS'COMPENSAnON DECLARAnON: "�� � . 1,�: - �
I hereby elTirm untler panelry'of perjury one of tha tollowing declaratlons: ,�� �� ��'" � .��: �
❑ I heve end wlll meintein e ceniticate ot consent to self-Insure tor warkers' compensetion, es provitletl for by sedion 3700 of ihe Labor Code, foi ihe perfarmence of ihe
work for which ihis permlt Is issuetl. � , •••
❑ I have antl will maintain woiicers' compensation insuranca, as requiretl by section 3700 of the Labor Cotle, tor the perfortnence of the work lor which �Ihis partnit is issued.
My workere' compensation Insurence carrier anA policy number are: �
�Carrier: Policy Number: �
(Th/ ecfion need not be cromp/efed il the permit is valued ef one hundred dollars ($100) or /essJ � .. . . . . . .. . . . . . , .. ,
rtity Ihat in Ihe pedortnance of the work tor which this pertnic is issueQ I shall not employ any person in any manner so es to become subject to tha workers'
compensation laws of Califomla, and egree Ihat if Ipphould become sub�ect to Ihe workers' compensation provisions ot Section 3700 0l the Lebor Code, I shell forthwith
complywiththeseyLavisiq�s. , � � � I �'����
ApplicantSignawre: i�tt�i.P�1.iE Date:
WARNING: FAILURE TO SECURE WORKERS' COlAPENSATION COVEFAfiE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINA PENPLTIE ANO CIVIL FlNES UP TOONE HUNDRED
TFqUSAND DOLURE ($100,OW), IN FDDITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDE� FOR IN SECTION 3]O60F THE LABOH CADE, IMEREST, AND ATTOfiNEY'S FEES.
LICENSED CONTRACTORS DECLARATON: .
I hereby eHirm thal I am licensed under provisions oF Chaptar 9(commencing with Section 7000) ot Division 3 oi the eusiness antl Professions Code, antl my license is in full
forte ond afrect Lia N Class a
ConlreccoYs Signature: Data: � �
CONSTRUC710N LENDING AGENCV:
.❑ I hereby ettirm that there is a consimction lending agency tor the pedormance of ihe work for which ihis permil is issued. (Sec. 3097, Civil Code).
LentlaYs Name: Lender's Address:
Signeture: Date:
OWNER•BUILOER DECLARATIONS: .
I hereby eHirtn that untlar penalty of perjury thet I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor Ihe tollowing reason (Sec. 7031.5, Business an0 Protessions
Gotle: Any ciry or counry which requires a pertnit ro construct alter, improve, demolish, or repair any siructure, pnor to its issuance, also requires the applicant for such permit
to file a,signed stetement thet he or she is licensed pursuant to ihe provislons of the Contractors License law (Chapter 9(cammencing with SeIXion 7000) ot Division 3 oi the
Busin s antl Professions Cotle) or Ihat �e or she is ezampt t�erefrom and the basis for the allegetl ezemption. Any violetion ot Section 7031.5 by any epplicant for a permit
u6" ts the applicant to a civil panalty c� not more than five hundred dollars ($500).): �
I, as owner of the property, or my employees with wages as their sola compensation, WILL DO THE WORK, antl �he siructure is not intended or otteretl tor sale (Sec.
7044, Business and Protessions Code: The Contractors License Law does noi apply to an owner of property who 6uilds or improves ihereon, and who tloes such work
himself or herseN or through his or her own amployees, provided that such improvements are not intended or otfered tor sale. If, however, Ihe building or improvement is
soltl within one year ol completion, iha owner-builder will heve ihe burden of proving that he or she did not build or improve for purpose oi sale.).
❑ I, as owner oi iha property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe projecl (Sec. 7044, Business and Professions
Code: The contractors License Lew tloes not apply to an owner oi property who builds or improves Ihereon, antl who coniracts for such project with a contractor(s)
license pursuant to the Contractors Licensa Lews.).
❑ I am exempt u der sec. Business and Pmfessions Code br this reason:
Signature:��a-�-� � - ' Date:
Owner ID veritietl by tlnvefs license. ❑ Ves ❑ No , Driver's License No. ' E:pir85:
Venfication ot Ownership by (type of tlocumen6 i.e. - property taa bill or tleetl):
DIVISION OF INDUS7RIAL SAFETV PEHMIT CERTIFICATION: �' '
❑ I hereby ceriity that no excavation five (5) or more teet in depth into which a person is required to dascentl, will be made in connection with work au�honzed by ihls �
permit, and ihat no building simcture, scaflolding, talsework, or demolition or dismantling thereof, will he more than thirry-six (36) tee� high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B.,Celifornia Adminisiretive Code). � ' �� .
❑ As owner-buildar, 1 will not employ anyone to tlo work which would require a permit from the Division of Industriel Sefety, as noted above, unless such person hes a
permit to do such work from the division.
Signature: Date:
Division of Intlustrial Safery Pertnit Number:
1 Will the applicent or present or Future building occupent need to tila and certity a Business Plen for emergency response to release or ihreatenetl release of e hezerdous
meterlel7 ❑ Ves ❑ No . � -
(Saction 25505 of ihe Celifornia Healih and Satety Code requires, with some exceptions, ihat a Business Plan be filed with ihe Costa Mesa Fire Depariment by every
business which has at any one time during a reported year e quantiTy of hazardous matenals equal to or greater ihan a weight o1500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2�������Does or will the epplicant or�present or tuture�building occupant need to file e registration form for acutely hazardous materials7 ❑ Ves ❑�No �� ����� ���� �������������������
(Section 25533 of the Califomia Health and Safery Code, with some azceptlons, requires registretion with Ihe Costa Mesa Fire Depanment by eech business which at any
one time hes on hend e quantiry of acutely hazardous meterials,equal to or greater ihen e waight of 500 pounds, or e volume of 55 gallons, or 200 cubic.feet oi
compressed gas at standard temperature and pressure). -
..............................................................................................................................................................................................................................................:............................................................................................................................::.:.........
3 Does or will the aD0licant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely ha¢ardous matanals)7
25534 of the California Health and Satety Code provides thai the Costa Mesa Fire Depanmem may require the preparation, certification and filing with Ihe Fire
anl ot en RMPP Dy businesses which are requiretl �o register ecu�ely hazardous materials wit� ihe Fire Departmant.
en RMPP is oresentiv reauiretl. hes Section 25534 oi the
5 Does of will the applicant or present or tuture building occupant require br the work whicn is the subjea of this eQplicetion aRertnit for such consWction or
(Section 650502 of iha Calitomia Govemment Cotla reQuires that the requestetl iniormatlon be fumishatl on eppliCations lor nomfesitlen�ial building pefmits).
Will any patl ut ihe taciliry lo ba constructed undar this permit be within 1000 feet Imm the outer boundaries oi a school? ❑ Yes ❑ No
(If "yes", ihe faciliry must meet the requirement of Sections 25534 end 42303 ot the Califomia Health and Safery Code).
.......................................................................................................................................... _ ..................................................................................................................................................................................................................................
If a permit irom the South Goast Air �ualiry Manegement Disinct or other air pollution control disiricl or egency�is required br the work which is the subject of this
eoolicatlon. have all of ihe disclosures orescnbetl �v Calitomie Health and Satery Code Section 42303 been made7 ❑ Yes ❑ No .
8 Qf "yes", atlach cerlificate ot compllance rrom Ine appropriete eir ponuuon commi orticep.
CERTIFICATE OF COMPLIANCE: I cerlify that under penalty of perjury the intortnation given above is correct. I agree to comply with all state laws and ciry ordinances
regarding Hazardous Matarials antl Emissions. "
SignaWre: � Date:
CERTIFlCATE OF COMPLIANCE AND AUfliORIZA710N OF ENTRV: I certify under penalry of perjury ihat I have read this application and state that the information given is
correct. I agree to comply with ell state laws end city ordinances relating m building construction, and authonze representatives of t�e Ciry of Costa Mesa to enter upon ihe
e�Gv�tlesc'Pbed property tor inspec � n puryoses. I agree not to occupy or ellow occupancy oi eny building authorized by t�s' erqi� ntil fi �I'io`s�e� n.
�
`/� /�-(�il_R�v(T G / WJ 1 ) l
Signature Of Legal Owner(s) � T D t�e�
And/Or Authonzed Applicant Date
COOE.t, INSPECnONTYPE � , � ,, ;, � . 1ISIII19�a „ � QQ.Q�1 INSPECTIONTYPE ; Qf� INi1fUL5
1616 Fixetl Sysiem Final Fire Prevenfion „206 Final Mechanical . . •
1266. Pool Spa Finab . , , ,, r� , � • , 208. , Final Plumbing , , . - �
200 Final Ra-Roof , 210 Final Electncal �
201 . Final elock/Retaining Wall � • . � , � 212 Final Fire Preven�ion � - . ,
202 ' Firial Factory Fire Place� � � ' � � ' 220 Final Planning Approval � � _ �`���� �� -
203 Final Sign 222 Final Site _ " '
204 � Final Demolition " ' ' - ' � � ` 250 ' �Final BuildincyOccupancy .. �
. , r,....�..
�r ,
(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us , .
MECHANICAL PERMIT '
JobAddress: 940 DARRELLST
� . � Suite No - � � � ' - � �
viciniry:
� Parcel Number:. 42235228
App�icant: LATIMER, ROBERT E
Address: 940 DARRELL ST�C
// rAI FI V IYI V C� lrV J I H MCJH. liH tlCOLO
Stalus: ISSUED
� - � Applied: 11/16/2006 �
� Issued: t1/16/2006, .
�ISSUED BY: �(�
�
�
�
f $0.00
530.75 � -
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and relatsd
regulations. (Ord. No. 92-28, § 1, 12-21-92) .
EXPIRATION: � This permit shall automatically expiie and become void if work is not commenced within 780 days, or it work is suspended or abandoned
for a,penod 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, antl all
requlred inepeetlons and tinel epproval musl�be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (774) 7545626 -- , � � . � ., �
2aa6�a6(8�o0). .. . - .. . _,� .. , ..vft�d't:5q,—:. • .. ..�.,r - . . ..
WORKERS' COMPENSATION DECLARATION: � � -' -. � , �
I hereby aHirm under penalry of perjury one of the tollowing declarations �'`- "'' "- � � v
. . , ., - . . . i . . - ,
❑' I�heve entl will maintairi e certificete of consent to sel4lnsure for workars' campensatlon, es providetl br by section 3700 ot the Le6or Code, tor t�e peAormance of Ihe
work tor which Ihis pertnit is issueilfiip_ '_, � • - ,
, _ � . ....., . ,
❑ I have end will meintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for the peAortnance ot Ihe work ia which this pertnit is issue0. `
My workers' compensation Insurence wrrier antl policy number ere: . .
Garrier: - . . Policy Number: � �
(This hon need not be completed i! fhe permif is valued ef one hundred dollers ($100) or IessJ. ..: . . . .. „_ ,, .
I ieitify that in Ihe pertormance ot the work for which ihis pertnit is issuetl, I shall not employ eny person in any manner so es to bacome sublact to the workers' �
compensation laws of California, and egree thet il I sho tl become subjacl to lha workers' compensatlon provislons oi Sectlon 3700 of ihe Labor Cotla, I shall forthwit�
camptywit�these rovisiorp15� �[ 1 I 1 �
AppllcanlSignaNre: �o-C�iO- � � Date: �U� �1� I O—�
WARNINO: FAILURE TO SECURE WORKEFS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOVEF TO CRIMINAL PBJALTIES AND CIVIL FlNES UP TOONE HUNDRE�
TIIOUSANO DplARE (E100,000), IN ADDITIIXJ TO THE COST OF fAMPENSATIIXJ, DAMAGES A$ PiiOVIDED F-0R IN SECTION 3]W OF THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATON: �
I heraby aHirtn ihat I am licensed under provisions ot Chapter 9(commencing with Section 7000) oi Division 3 of the Business ana Professions Cotla, and my license is in full
lorce and eHect. Lic. # � Class a
Contrnctofs Signeture: Date:
CONSTRUCTION LENDING AGENCY: - � �
❑ I hereby eHirtn that there is a consiruction IanOing agency for the pedortnance of the work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Neme: � Lenders Address:
Signature: � Date:
OWNER-BUILDER DECLARATIONS: � -
I hereby attirtn that under penalry ot perjury Ihat I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions
Code: Any city or counly which requires e permit to conslmct, alter, improve, demolish, or repair any strucWre, prior ro its issuance, also requires Ihe applicant tor such permit
ro file a sign d statemant thet he ar she is licensed pursuem m the provisions of the Comracmrs License Law (Chapter 9(commencing with Section 7000) af Didsion 3 of the
Busines nd Professions Code) or that he or she is ezempt iheretrom and ihe basis tor the alleged exemptlon. Any violation of Section 7031.5 by any appliwnt for e permlt
ubje the applicant to a civil penalry c� not more ihan five hundred dollars ($500).): � .. -
I, as owner of Ihe pmperty, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe sWcture is not intentletl or oflered for sale (Sec.
7044, Business and Professions Code: The Gontracbrs Licensa Law does no1 appry to an owner of properry who builds or improves Ihereon, antl who does such work
himself or herself or ihrough his or,her own employees, provided that such improvements are not intended or oHeretl for sale. If, however, the builtling or improvamen� is
sold within one year of completion; the owner-builtler will have ihe burden of proving that he or she did not build or improve tor purpose ot sale.). � ,
❑ I, as owner oi the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Prolessions
Code: 7Te contracbrs Licanse Law tloes not appy m an owner of property who builds or improves thereon, end who comraas for such project with a contractor(s)
license pursuant to the Caniractors License Laws.). ' f ,� � � ,
❑ 1 am e t un er sec. Business and'Professions Code for this reason:
Signature: ���- n. ' a Dete:
Owner ID veritied by dnvefs license. .` ❑ Yes ❑ No , Driver's License No. — " ' Ezpires:
Venfication of Ov.•nership 6y (type of daument, I.e. - pmpeM �aa hill or tleetl): � -
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby certity ihat no excavation five (5) or more feet in dep�h into which e person is required to descend, will be made in wnnection with work authorizetl Dy thls
permit, antl �hat no building siructure, sca%olding, talsework, or demolition or dismaritling Ihereoi, will be more Ihen thirty-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Calitornia Adminis�retive Cotle). '
❑" As owner-builder, I will not employ anyone to do work which would require a permit irom the Division ot Intlustrial Safery, as noted above, unless such person has a
permit to do such work irom Ihe tlivision. � � �
Signaturo: - Date:
Division ot Indusirial Satety Permit Number:
CERTIFICATE OP COMPLIANCE AND AUTHORI2ATION OF EMAY: I cehify under penalty of perjury that 1 have read this application and s�ate thai �he iniormation given is
correct I agree to comply with ell state laws entl city ordinances relating to building consiruction, end euthonze representatives of ihe Gty of Costa Mesa to enter upon the
a e-descnbed pr �perry tor inspe ' oses. I agree not to occupy or allow occupancy of any building euthonzed by t1his erm(it u�ntil n in pection.
��L� � �1�� I 1 l!/ 1 ��
Signature Of Legal Owner(s �De�e ,
And/OrAuthorized Applicant � �Date �
COpE t INSPECTIONTYPE e ; • .� . . . . �TE .. ^ ��� ..� , SS�BE.S , INSPELTIONTYVE ' ' —f Qaj� , �
1616 Fixetl System Final Fire Prevention 206 Final Mechanical � � -/ �
1266. , ,�Pool Spe�Final , , , � , . � 208 .� ,Final Plumbing, �:: �: � . .
200 Finel Re-Roof , -210 Final Electrical � � ' �
201„ FinelBlocWRetainingWell�� , ���� � .. ,�212�i,,,FinahFirePrevention „ , .
202 Final Factory Fire Place ' ' ' � ' � - ��� 220" � �Final Planning Approval � �� � '
203 Final Sign 222 Final Si�e � .+ . , , - ' ' '
204 � ' Finul Demolition - " ' ' ` " "`250 Final Building/Occupancy " ' ' ' ' ' -
��ia> �sa-sz�s • FaX (�ia� �sa-aess • www.ci.cos�a-mesa.��u�MBING PERMIT
� Job Address: 940 DARRELL ST
Suite No " � "
. , . Viciniry: - . . . .
.� ParcelNunmber. 42235226 �
; ,4pplicant: LATIMER,.ROBERT E
- � Address: 940 DARRELL ST
,-�r>.-- ^-,----
. , �..��hone: �949=646=01$2-
n
77 hAIH UHNt, I:VJ I H MCJA, GA tlLbLO
. � Slalu's: ISSUED . ,
� Applied: 11/16/2006
Issued: 11/16/2006
ISSUED BY: �
/�,------�_�. -^--.����
COSTA MESA, CA� � � Zip: 92627 ---���
("�]� j` ��
n J��rJ \ �� � V `~�
�_/ t -t_:.
Owner: � LATIMER; ROBERT E� � � /
Address '9�/O�DtARRELLST` �Ca`� /
��/�'\ ��� 1 . i' ,--��=-�-_Phone:—`-_'�-O`��. .��
�—' AMT QTYt
�� $23.50 �`�
� 50.00 0
50.00 0
� 1 50.00 0
i�, �� - $0.00 0 �
^)� � $0.00' 0 C�
i $0.00 0
��t} $0.00 0
\\�,\\ 50.00 0
, Gas Eaitfiquake Valve�
. Gas (1-4�outlets) 4 f�
�. Gas (Over'4 outlets)
Gas Repipe �
� Gas Service � �j <
,- Interceptore (Grease; Oip
Interceptors (Sand'Au\to�)•
\
E
%
a
5 _�{�'-
� �2
0
_Y ROOM AND LAUNDRY ROOM AREA TO
1 WASHER, 1 WATER PIPING.
P-
Septic Tank $0:00� 0
Sewer Cap for Demo 1$0 00 0
Sewer Connect - - y�$0.00� 0
Sewer Private Line � `TM$0.00�0
Shower - $0.00 0 �
+,. � 'W.'Sx",.
Sink,barw,�:;7t-cr"�: ., $0.00 0
Sink, commercialcp' � �.$0.00 0
Sink; Floor 7" `�- a e' U�'$OAO��',"p,0
„�_ ,�Sin'k; kitctien_r Q ` �° g! o �� $0.00 ��0� J�
=�,..�Sink;seivicelmop,�D•`":�$0.00 <0�'�
�'� o Spa'(privafe)r: �, o�� $0.00,- 0 0 `
�; Spa�(public)�' ,� � �a � o $0.00 c p0u�
��..,','�'��..,� �o a0�o n � ` ..i
V'�.A�v � ,DQ.. � '0 O/
o . � 0_� '�`�
�� C.� �` U u
Sump Pump
Swimming Pc
Trap Primer
Urinal
Vacuum Brkr
�Vacuum Brkr
Wash Basin
Wash Basin :
�Waste and V�
rJ
CAM7
$0.00
0
0
0
0
0.
1
0
0
0
$0.00
$0.00
$0.00 0
549.25
F
NOTICE: The work authorized by this permit.shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) � .
EXPIRATION: This'perinit shall automatically expire and become void if work is not commenced within 780 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 Inspeetlons and final approval must be obtained. Failure �o obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 . �
ao-an �uw� . . .
WORKERS' COMPENSATION DECLARATION: � . - . 1 p..,; , . . � , , .
I hereby eftirm untler penalry of perjury one of the following declarations� � '_ ,� . ..
. ; �, ,
❑ I heve end will maintein e certificete of consent to selbinsure for workers' compensation, es provitled for by saction 3700 ot Ihe Lebor Cale, for Ihe pertormence of the
work for w�ich ��is permit is issuetl. " , �� -� '
❑ I have end will maintein workers' compensation insurance, as requiretl Gy seclion 3700 of the Labor Code, for Ihe perfortnance oF the work for whic� this pertnit I5 Issued.
My workars' compensation Insurence carrier antl poticy number are: _
..r
Carrier: Policy Number: �
(This ction need not be canplefed i! the permit is valued ef one hundred dollars ($100) or less.).. - �� ..�. .
�I certily Ihet in the pedortnance of the work for which this pertni� is issued, I shell not employ any pereon in eny manner so as to becoma subject to ihe workers' �
compensatlon lews of Celifornia, end egree tha f I should become su�ject to the workars' compensation provisions of Section 3700 oi the Lebor Cotle, I shall torthwith
complywiththes rovij� ions. (� ` �
Applicant Signeture: � M�k..a� L- � Dete: �1 I '� / �DLo
WARNIN(3:FAILURETOSECUREWORKERS'COMPENSATIIXJCOVEPAGEISUNLAWFULANDSHALLSUBJECTANEMPLOYERTOCRIMINAL�ENALTIES� IVC ILFlNESUPTOONEHUNDREO
THOUSANDDOIIARE($100,000),INADDITIONTOTHECOSTOFCAMPENSATION,DAMAGESASPROVIDEDFORINSECTIIXJ3lO60FTHElABORCODE,IPfrEREST,ANDATTORNEP5FEE5. -
LICENSED CONTRACTORS DECLARATION: � .
I hereby attirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in tull
force and eftect. Lic. a Class N
Contructofs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm that ihere is e constmction lentling agency for Ihe pedormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lender's Address:
Signature: Date:
OWNER-BUILDERDECLARATIONS. � , �
I hereby aHirm that under,penelry of perjury that I em EXEMPT FROM 7ME CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or counry which requires a permit to constmct, alter, improve, demolish, or repair eny stmcture, prior �o its iuuance, also requires ihe applicant for such pertnit
to tile e signed statement that he or she is licensed pursuan� to ihe provisions oi the Contractors License Law (Chepter 9(commencing with Sectlon 7000) of Divislon 3 of ihe
Busine 'end Protessions Code) or that he or she is exempt therefrom end the basis for ihe alleged ezemption. Any violation of Section 7031.5 by any applicent for a permit
sub' s ihe applicent to e civil penalry cf not more than five hundred tlollers ($500).): �
I, as owner ol the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and the structure is not intended or oHered for sale (Sac.
7044, Business and Professions Code: The Contractors License Lew does not apply to en owner oF properry who builds or improves ihereon, end who tloes such work
himself or hereelf or through his or her own employees, provitled ihat such improvements ara not inientletl or oflered for sele. If, however, ihe building or improvement is
soltl within one year oi completion, the owner-6uilder will have t�e burden oi proving ihat he or she tlid not 6uild or improve for purpose oF sale.).
❑ I, as owner ot ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to conslruct the project (Sec. 704d, Business and Professions
Code: The conirectors License Lew does not epply to en owner of property who builds or improves thareon, and who coniracts for such prolect with a contractor(s)
license pursuant to ihe Contractars license Laws.).
❑ I am enempt untler se�a1 � �� 8usiness antl Professions Code for ihis reeson:
Signature: � niW-nJF t- I�X<�... � ' Date:
Owner ID venfietl by tlrivefs license. ❑ Ves ❑ No Drivers License No. Expi es:
Verification ot Ownership by (typa of tlocument, i.e. - property tax bill or deed):
OIVISION OF INDUSTRIAL SAFETV PEHMIT CERTIFICATION: , - .
❑ I hereby certify thal no excevation five (5) or mora teet in depth into which a person is required to descend, will be made in connection with work authorizetl by this
permit, and t�at no building structure, scattolding, felsewolk, or demolition or dismantling thereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Calitomia Atlministretive Code). .
❑ As owner-builder, I will not employ anyone to do work which wouid require a permit from ihe Division of Intlustrial Sefety, es noted above, unless such person has e
permit to do sucfi work tram the tlivision. -
SignaNre: Date: � �
Division of IndusMal Satery Permit Number: :
CERTIFlCATE OF COMVLIANCE AND AIffXORIZA710N OF ENTHV: I certity under penalry of perjury that I have read ihis epplication and stale lha� �he intormation given is
correct. I agree to comply with all stete laws and ciry ordinances relating to building construction, end euthonze representatives of the Ciry of Costa Mesa ro enter upon the
ebove-des bed property for inspe ' oses. I agree not to occupy or allow occupancy oi eny building authorized ihis per until final inspection. •
`,�a-�v�.s%- �' �- (.l. %�/ Co %(Xo
Signature Ot Legal Owner(s) - —�� Date
. And/Or Authorized Applicant Data
LOOE � INSPECTIONTYPE . � ,
1616 Fixed System Final Fire Preveniion
1266 Pool Spa Final ,
200 Final RB-Roof
201 Finel BIocWRetaining Well .,
202 Final Factory Fire Place � "
203 FinnlSign
204 Final Demoliiion ' ' � '
paj� .� , � NLjj�iL3^i . ,� ;j�Qfj�b INSVECTIONTYPE . � . � . J�E
206 Final Mec�anical . . ' ' , '� ' -
. i , 208 Final Rlumbing . .. .
210 Final Elecirical �"
, . ;212 , , Final Fire Prevention , . , ,
' - � 220 �Finel Plannirig Approval' �' � � � • .t ,-
- 222 � Final Site � .. , . , � � . . . .
" _ ""^ '' 250 ' Final Buiitling/Occupancy' ' � `" ' - ' - -
e
,. i ,
COSTA MESA BUI�DING. DEPARTMENT
P. 0. BOX 317
COS7A MESA CAIIFORNIA
C.L. OF STREET
' J�PROP TINE _
r 10 FT. FOR 60 FT. STREET
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PROP LINE �
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I 5329 � I
FOR APPLICANT TO FTLL IN,�j—
BUILDING ADDRESS—�� ��7 / r � /% �"""" �
Mail
City '� r �� � Ph. No.
Contractor�r�" • ��' � �oc� raph. No _, � � � f��" +'
Address �'� � � � r � o / � ys. �
i
City Lic._No. ��'Yo State Lic. No. %�7'SL7%?S �.
Size of Lot /O�_ �Y�P No�%���4—./ �./ ilc� aa �.�.
� —� //� G
Setbacks: C/L Street � � Rear
Side Yard - Right f�� Left ���
r
Type of Fence � ���-�.� �
,. i r
I hereby acknowledge that I have read this application and state
that the above is correct and agree to comply with all City Ord-
inances and State Laws regulating building consiruction.
Signature f/�� h_
nF Pc.,,.;+4co t..� _ e�.�_ �� \ /^4.s.��_ /
FOR OFF'ICE USE ONLY
I Permit No.
5_� y �_
Date Received Date'Issued
� lo- //-.("7 6 -�i -y-i
�CEIVED I VALUATION
�� I<<� <1 � _� .
�.� _..r � �
�_. C.�. OF STREET�� , ��Y OF �p$ip MESA
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES------
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOI.ID LINES
Permit ,Fee
Plan Check
TOTAL FEE
USE REVERSE SIDE FOR DETAILS
7 .
ow NFR � ristol Estates' �-• onre �-18-56
JOB ADDRES3 940 Darrell Street. BUIIDING PERMIT NO. 2839
GENERAL'CONTRACTOR S.V.Hllri3d�C9P VALUE $ 8�856.QO
LOT 92 BLOCK TRACT z873 Single Res� W/att gar
GROUP I�'J TypE V ZONE+v.{ FIREDISTRICT 2865
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
r DATE NUMBER
Footing Trench �
Foundation Forms and Gra e to Gara9e �
Rouah Framino � � �-'— _i � .
Plumbing, RougFYt3Sla6� �i
Plumbing, Rough Complete G`
Temporary Pole
Wiring, Rough
Heating, Rough
�Heating,Final '
Sewer: Ho�/ ./� Sewer, St.
Septic Tank or Cesspool
Lathing, In Out
Plasterinq
Fixtures Co
9.,V iv „ � _G, ^ L� �-� cz l ,�� � � �
-ia-h-tllu,r��-. �r.
_��-�� „ „ ,,
Plumbing, Fin.al Gas Test /SL /'6� (? 5 P
Wiring,Final y{S�. �
occupancy �l. F ,� f�! ;
FOfiM 210 3M 10�55 � �
i
� 07 % '
�l3
-.�� � _
_.' C�osta Mesa Bnilding De�artment APPLICATION FOR PERMIT ;
~" P.O.Box3�� 28�� BUILDING '
•: �Y{� COSTA MESA, CALIFORNIA
,,, ,
� FOR OFFICE USE ONLY
FOR APPLICANT TO FII�L IN �' Receipt No. Permit No.
Buildfn9 9.s�o scG. sT- = a7 �3 9
Address
Costa Mesa, California i Receivf d br Date Rec'd. Date lasued
Nearest / �f� ` ,�' �/� �'� �'�( ����
Cross St. 0[� fj- L�iN �A (�.� - Buildin9 �
. � AddreSs �
Owner Q ��" S Costa Mesa, California
Mail / s�
Addres Qz �, C.f(-S l!lAJ.+¢ S J//li • Nearest
/} Tel. Cross S � ' -
City �/li% L�. Cs %% Noff�' �/�� Zone .1 /I No. of I Ty,pe Group T� �
n.�ti��...a... �:.. JC S"I Plans ..F .
� Contrector�
�.c i �oc
Description No. � Block � 7ract
(Attaeh Metes and Bounds)
No. of Bidgs.
Size of Lot �o � X I L°C� Now on Lot �
l�seof � I No.of I No.of
Existing Bldg. F,amilies Rooms
Setback Line from � Rear Yard Z S'f'
Center of Strcet G . Side Yard ( �
DESCRdPTION OF WORH
New I� I Alteration I I Addition I
I I I I I
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O
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Repair Moving Demolish
Building �j '7J/ No. of � /
Size ��� / y+ Rooms S Stories
Exterior Wall Roof
Covering $ % UGG� Covering ��`�,�" .,� APP$,QV�i�.s
Use of Ne /� / , Foundation Location Inspecto
9ui�aios ��tJ4[.� Jl"/�iQ1�LS� �cLEGG%!�-`s
_ Forms, Materials,
�y ,rJ� � �� Under-Pinning
� ` Frame: Fire Stops,
��" �`��Bracing,Bolts
I hereby acknowledge that I have read this Application .
and state that the above is correM and agree to comply Lath. Int. .�
with all City Ordinances and State/Laws regulaIIng, (� �,, r,�
building construction. lil I 1 �Jr (�(„ ILeath. Ext�Q
Signatureot
Permittee � Plaster, Int
i
Authorized Agt. Plaster, Ext. �
Valuatfon P it Fee $�L `L .�O Masonry Reinforoed
�� r/' O p Plan Check $ /� . d � gond Beam
$ S w Total
Fee $ 33 .�� FINAL
FORM 209 10�55 O. P. 8 5.
PIAT PLAN
Show loeatlon artd disGncea from
' property Iine and between buildings
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,OWNER 7�TIMER, RO
JOB ADDRESS gl�p Darz
GENERAL CONTRACTOR
AP No.115-582-28 LO'
INSPECTIONS
SOIL
GAS
WATER
ROUGH PLUMBING
PROP. SWR. LINE � HOUSE CON.
SPRINKLING SYSTEM
MISLELLANEOUS
ROUGH HEATING AND AIR CON�ITI
TEMPORARY�SERVICE,OR-POLE-
UNOERGROUN� � POWER �
ROUGH WIRING
FLOOR SYSTF.M
BONO BEAM ���, STEEL REINF(
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING. VENT.. REFRIG ^AND Al
DATE
BUILDI
RIPTION of WORK G
ZONE VALUE
DUP J TYPE
SUBCONTRACTOR
r^
• . - NW 16-67cwsn�0 720 oa*,ta,tj.00
: - . '.2%826 ' �, . .
COSj/1.MESA BUILDING-SAFETY DEPARTMENT ' • �
P.b BOX iTL9 COSTA MESA� CALIFORNIA 92EZB
Fo► AppllcaM To F(11 in Complotely ' AIPLICATION FOR PERMR ��
� . TYPE OR PRINT . � ' � ' � ' . BUILDIN6. . . ' , �
. Eor.' ON(c� Us� Only
eun.c�Na .
wooneaa �
. . n�cnrt no. �pm��
. . COSTA,MESA. CALIFORNIA C7C
. . 11[C[I D�Y D 11[ [If6D� = 169=D„
owNen'� � � • � � 6
MAIL'�. +L1 . OUILDIN4 . /n .
ADDR �I l ADDRi 'f{l
% T`L ZON6 ��l TNP " 6ROUP �
c�rr � c't 1 S" no.6y6-a �
ARCHITECT - . Tg�, - .. " BYPROV6D �� . DATB 'ZD'(ji
OREN61N68R N . ' � �
Z NING
ADDREYY tpry No.o! Y�[O�N[W . '
• �U1Nt �7�� �OUILDINO
CONTRA R
�a�. L � �
. � ' D[iCRIRION
ADDR
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c�rr
- N0T6:NOEAVeOVERHANOBHALLlfiLl88THAN
BTATE ' �L ' � 80' TO HID6 0 REAR . L.
LIC. NO. N . - ' �
EAVEB
SIZE / / No.oISLDO�. ALLOW6D�� <U.B.C.RBCUIR8M8NT)
OFLOTg C X NOWoxLOT �%
YARDlMPROVED . YARC9APPROV6D
USEOF � ' MAINBUILDIN6 ACC6880RYBUILDINO
EXI8TIN0 BLDO.
(FROM C/L@TRHtT)
BCTBACK L�H6 FROtl - � � � �
CeNTlR OP BTR86T ' R6AR YAR
tIDR YAR L6Ff ' 'pIQXT R.DIG � � � ^U IT. �
DESCRIPTION OF WORK -' �. e�n rr. rr.
NEW � A{,7'8pA ION ADDITION RBAR ' PT. �� PT.
.. DIBTANCR B6T. BET. MAIN Q ._ .
RBPAIR� MOVINO DlMOLI q � MAIN BLDOD. ACCESS.BLD08. -
BUILDINO n/ / �NO.OP ' VAR.$. DATB •
61ZE 6 .� ROOMB � HT RI C. . MPROVfiD
EXTERIORWALL ROOr (+IkST:(� M�ROV[D
COVERIN6 COV8RIN6 ATQ
U360rlUILDINYANDWORKTOBtP[RFORM�D � � a
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1 NHRlBY 11CNNOWL[p0� TI�AT.I MAV[ RfAp'15��� AV�LIGTION TM� AMOYNT �XOWN UND6R VALYATION 19 POR THB �
wNn eiwi6 TMwT TMi ASOVi IB �ORR6CY AND AOR66 M COY. I � �UAroef C� tOiMyeXINO A P[qMlt P68 ONLY. �.
PLY WITH wLL'CITY ORDINAMCf��AMD �TAT[ I.AIM� pWYL11TIN6,', yALUATION �� }
BUILOINO COHBTiUCT10M. � � �
8I6NATUR80/ - - � ' PERMITFEE �
PBRMITT6 _ , s � �%� � F
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AUTNORIZ[D A06NT ' " ' ` ' �
TOTA1 PEfi
OWNER WOODLEY� A.s. DATE 6-11-57 _
los anDxEss 9�L0 �3T2'ell Stre2t BU[LDING PERhll'I' NO. #5295
GENERALCONTRACTOR M01^t• t. OCk VALUE$ 1 9•� �
AP. No. LOT 92 TRACT 2573 FIRE ZONE DESCRIPTION nF WORK e Wo0 ence
GROUP ' TYPE ZONE PLAN NO.
INSPECTIONS I DATE � _SUBCONTRACTOR
Focros
Final Gas Test
PERM