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Home My WebLink About921 DAHLIA AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 i Job Address: Suite No Vicinity: Parcel Number: Applicant: Address: �J � �:/ i �ontrecror� Address: �/ � 921 DAHLIA AV 41218336 DULANEY, 31566 RAILR� BLVD #200 MECHANICAL PERMIT Status: ISSUED Applied: 02/12/2003 Issued: 02/12/2003 ISSUED BY: �� r�-, � -1 -,'��—� j �� i � /� � � Phoneil 909-443-'1211 ��/ � �/`�� t.� � L1 , 1 /r /'�'v �..� Zip:_�_.92587_--,,;_",,, f�,(�...1 % (`..�� .�\ .,��-�.. �c�,��' -✓ �� ,` ,j �� ` \ �.----- ��,�\�/,�`. � > Phone: ��'�C i Zlp: 92627-2162 ��`� \ � a i C � �\ �'��' �;� �,�/� i e \ ��. i%�� A �� '� ?} � 1 � \ ( �„ ` ,__-� , J,ti� � `� `- =--, \N & SON FIRE RESTO LROAD�CANYON RD "" r'1" I /� 0 A�. CA% ��/'�O S; i �-- �� (/ � REPAIR FIRE C �O� � � ��-JOISTS,WALL �� I I�2 � REMODELS TC 1� I � I,�, � I EXISTING RES � ��' ��'�--�} 1��i � �L� ,J 1`{(�I,MECHANICAL' `ll ; (` 1 U i . 1� ��,. r' � �`. \ � �� k Inst 1 $23.50 $0.00 $1820 $0 00 License: 688391 Aea C It�`� � { 121�� z._---�� _ I : �� SCOPE OF PERMIT \ � �'� � ' ! l �., ,r � '1�, GE=TO��RESIDENCE::FIREDAMAGETOSRUSSES�AND.FIRST FLOOR CEILING�� y /---"�, � �� AING AND�DRYWALLT; WINDOWS�AND INSUCATION.',NO�ADDITIONS OR i j, f,- ' i� .L 11 11 UJ/ll� 11 LCIIl� f�;ltii 1! n� � ��?�%'� i'�.___ i��1 CE;FIRE'DAMAGE�REPAIR��ONLV:-- ��—_= _=� � , � ( n.. � � i �y�)��I .'�-�_'i �.L CLUDE:.INST�1 FAZ > 100K BTU. REF.::•801-01657 � ; . (� �i � � `�� -\ _l�.'_._WNj"^,�,�,'��"'i`-_�b'�-.��li`�C��-�� :�%��I� �-l--j l,;'f� �s.--�_1---FEE�SUMMARY�%� =----�I l/�� '� '� 1 � l �, Quantity l� �� , �,jl r'�=Quantity Repaic-/'AltAbsorbtlon Unit�� i� � $0.00 � 0 0 Repair'RAICRefngeration Unit �;,�� $0.00-' 0�� 0 -��,F;'1��'`��%Eva�lo�ratieCooeer ? i/'/ \$0�00 �0��/ ..,r .....,....y.....,,, \ ,�� . P Inst/Rep-�RecessWallHtr�� $000 0 ��,r�� Commeroiallncinerator G' � $000 ��0� Refng Sys <100 k BTU� �� $0 00 0 �- � � � Domeshc Incinera6 r Refng Sys�>100 k BTU� � �$0 00 ,.,_0,�� - p-F � E G.Compressors / Abs Gas Piping�\\ /� \$0 00 0: � ° r � r i-. Up to 3 hp / 100 k�l Factory Fireplace� �� $0 00� 0 7 ��.� '� 'Q3 To 15 hp / 500 k Hood w/Mech Exhaust ��l $0.00V0�� ;- ,^�� ,"` � �15,To 30 tip7 1;00( VAV Box �� $0.00�'`0��'\� �� 30 To 50 hp / 1,75( > Vent Fan / Single Duct�� $0.001 0��-:;. ;- � ; , _`-__=�.. �. -. -r-0ver 50 hp /�Over�' Appliance `� �$0�00% 0� �'-- `-- - �`Boilers�� Fire Dampers \$0.00 0� Up to 3.hp� Smoke Dampers �--,,.�$0.00 �0� ��(��'�. - C� f_; 3�To,15 fip�. �� Inst or Relocate Appl Vent $0:0 ��0 ��(_�� j r, �/ �15 to 30 hp�� Air Handler5 < 10000cfm $0.00 LO-._„ _ L, �, �. �,30 to 50 hp �- Air Handlers > 10000cfm $0.00\OJ-J� ^� �� Over 50 hprjc %` FloorFumace $0.00 0�,� 'c`%��>�,,:�,_Other-MechanirafF Floor or Suspend Heater $0.00 0 -"'------ —Investigation Fee � �J//�/ � � $0 00 � ��0 �tion�Svstertis' , � , i � 1- i%' r � $0.00' 0 ��%"�� C/�� /$0.00 0 BTU" /� /> 1 � � $0.00 0 BTU,� �A`! ��"�, �: .$0.00 0 i0 BTU �J, %�,� / � 50.00 0 \\�« J!/'�'/ �/ $0.00 0 // � $0.00 0 jj,�� $0.00 0 J�� $0.00 0 � $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This.permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 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 Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaasre(woo) WOR�ERS'COMPENSAnON DECLARAnON: • � �-" ' . � I hereby aflirm under penalry ot perjury one of the tollowing declarations: � , � • ' ❑ I heve end wlll melntaln a certificate of consent to seli-Insure for workers' cnmpensation, as providetl for �y section 3700 of the Lebor Code, for t�e peAormance of the work br which this permit is issuetl. � �' , I have an0 will maintain workers' compensation insurence, as required by sedion 3700 of Ihe Labor CoOe, for the pertortnance ot ihe work for which this pertnit is issuetl. My workers' compe atio Insure carrier end policy number ara: � i arrier: ��L(.- �Gt..�. l/ PolicyNumber: �U��yy � � ( is sectlon need n e completed il the permit is valued et one hundred dollars ($100) or less.) . .. . _ . . , ❑ I ceM1ity Ihat in the peAormance of tlie work for which this pertnit is issued, I shall not employ any person in any manner so as to become subject to Ihe workers' compensetion laws of Califomia, end egrae ihat if I should become su�ject to ihe workers' compensation provisions of Section 3700 of the Labor Cotla, I shell torlhwith comply with these provisions. // � Applicant SignaNre: /(/(i(.L � Date: Z �/L —!� WARNING: FAILURE TO SECUFE W R RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TOIXJE HUNDRED THOUSAND DOLLARE (5100.000). IN AODITIqJ TO THE COST OF COMPENSATION, DAMAGES AS P(iOVIOED WR IN SECTION 310fi OF THE LABOq CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn ihat I am licensep ufind porovisions of Chapter 9(commencing with Section 7000) of Division 3 of the Businef.end Professions Code, and my license is in full forca end efFecL Llc. # F�.f � S 7� qess N :J Contrectofs SlgnaWre: Date: Z � Z—D��T, . , r CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm that ihere is e construction lending egency for the pertormance of the work for which ihis permit is issuetl. (Sec. 3097, Civil Coda). Lentler's Name:� Lentler's Adtlress: Signeture: Date: OWNER-BUILDEq DECLARATIONS: I hereby aflirtn that under penalry of perjury ihai I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Protessions Code: Any ciry or counry which requires a permit to constmct, altar, improve, demolish, or repair any structure, pnor to its issuance, also requires the epplicant tor such permit to file a signed statement that he or she is licensed pursuent to the provisions of the Comrecrors License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 of the Business entl Protessions Code) or thet he or she is exempt therefrom and the basis for Ihe alleged eaemption. Any violation of Section 7031.5 by any epplicent for a pertnit sublects ihe applicant to e civil penalry of no� more Ihan tive hundred dollars ($500).): ' - ❑ I, as owner of ihe property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and ihe sWcture is not intended or oHeretl for sele (Sec. 7044, 8usiness and Professions Code: The Contractors License Law dces not epply �o an owner ot property who builds or improves thereon, and who does such work himsetl or herseN or ihrough his or her own employees, provided that such Improvements ere not intended or o%ered tor sale. If, however, ihe building or improvement is .sold within one year of completion, ihe owner-builder will have ihe 6urden of proving that he or she did not build or improve for purpose of sale.). ' ❑ 1, as ownar of the property, am EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Professions Code: The contrectors License Law does not apply to an owner of propeny who builds or Improves ihereon, antl who conirects for such Oroject wlth a coniredor(s) license pursuant to the Conirectors License Laws.). ❑ I em exempt under sec. SignaNre: Owner ID varified by driver's licensa. ❑ Ves ❑ No Business and Professions Code for this reason: Verificetion oi Ownership by (type ot daument, i.e. - propeny taz bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Driver's License No. Date: E:pires: ❑ bhereby certify that no excavation five (5) or more teet in depih into which a person is required to descend, will be made in connection with work euthorized by ihis permit, and that no building sirudure, scallolding, talsework, or demolition or dismantling ihereot, will be more then ihirry-six (36) teat high. (Chap. 3.2, Grp 2, Ar12, Sec. 341, Title B, Callfornia Atlministretive Code). . ❑ As owner-builder, I will not employ anyone to do work which would require a parmit from the Division oi Intlustnal Safety, as noted ebove, unless such person hes e pertnit to tlo such work from �he division. Signature: Date: Division of Intlustrial Satery Permit Number. CERTIFlCATE OF COMPLIANCE AND AUfHORVATION OF ENfAV: I certity under penalry oF perjury that I have reatl t�is applica�ion and state ihat the informetion given is correct. I agree to comply with all state laws entl city ordinances relating to building consimction, and authodze representatives ot Ihe City of Costa Mesa to enter upon the above-descnbed property tor inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until finel inspection. COOE� INSPECTIONTYPE � 1616 Fixetl System Final Fire Prevention 1266 200 201 202 203 2 4 Pool Spe Final Final Re-Roof Final BIocWRetaining Wall Final Factory Fire Place Final Sign Final Demolition ` ' QA¢, �NTITIALS Date z �Z-d3 Date CODE� INSPECTIONTYPE � 206 Final Mechanical 208 Final Plumbing 210 Final ElectriCal 212 Final Fire Prevention 220 Finel Planning Appioval 222 Final Site 250 ' FinalBuilding/Occupancy �E � 103 �s � (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT _ Job Add�ess: 921 DAHLIA AV Suite: Vicinity: Parcel Number: 41218336 Applicant: MCCONNELL,MARY Address: 1505 GARDENIA ST Owner. SOOfTH-COA: Address n {^\�j n�l,� \ V ST Zoning: Rt Rl ��ri'��"�c }�� ihonfe:, 818-507=6906 � Zip� 91204 � � DREN SOGETY� � � � ��Phone:`—"-'-^—� Zip: SERVICES,INC. Phone:�1818-507-6906 ✓ 91204� Q I /1/�/ r---, �� o � G Po� i��o ` r ' ,an Phone:l^ �o� �Q � LiCense: �/� / Y,U o ml_. �:��RT �; nIDUE TO FIRE REPAIRyREF 801-0165' 1 � �� $o.00 ,.- �"______r,�� r$12525 � --,� � $0.60 � $0.00 • ��$0.00 ) ' $0.00 \� �� n_,$125\\\� , �„ oQ G?i�+n'1� �_ � �(l ( /�%/1 �.�� `�°., ° � ° � apQ= oe hi - o 0 0 � o� o0 O r✓ �. o `�., °pO'o ��0 °o � o ' g � ,. �,�Pn �a'n°o-:� StaWs: ISSUED ' � � Applied: 02/73/2002 Issued: 0 211 3/2 0 02 �. —_._. ISSUED BY: �� L4 � �.� �.� �� '�� _�_...-�� ACCESSORY Front• 0- 0 CRear 0- 0�' Ceft"`"0- 0 �/ � PARKING Exi\�0� Reauired:� � I� I (Piop�d�� U U 1-J�.,� NOTES: ��'i��..-., _ �.�',.�G" Valuation: i Valuation: � ,� 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � . EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended 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 cotles, and all requlred Inapectiona end tinal approval must be obtained. Failure to btitain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � . , � .� zaawelaao� � , • C WORKERS' COMPENSATION DECLARATION: ' � . . , , , _ - I heretiy eHirm under penalty of perjury one of the tollowing tleclaretions:. � �� . ' ❑.- I have and will maintain a certificata of consent to self-Insure br workers' compensation, es provitled for 6y section 3700 of the Labor Code, for tfie pertormence of the work for which ihis permit is issuetl. �� . � I have antl will mtintain workers' compensation insurance, as required by section 3700 ot ihe Labor Cotle, for the pedormance ol the work For whiU this pertnit is issued. My workers' compe sation Insurance cardar and policy number ere: -� 1[�, 2 . Carriar. �� ( ��'I n PolicyNumber: V'l0 —�O��:J J� '� (This section need not be completetl il the permiiis velued at one huntlretl dollare ($100J or /essJ ❑ I certiy that in the pedormance of tha work for which this permit is issued, I shall not employ any person in any manner so as to bacome subject to Ihe workers' � compensation lews of Calitomia, and agrae that it I shoultl become sublect to Ihe workers' compensation provisions ot Section 3700 0l ihe Labor Cotle, I shall forihwith ' ihese provisions. �l�� I . pplicant SlgnaNre �17.1 YU( C l� � ��—'��— WA O SECURE WOR ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP TO CRIMINAL PENALTiES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOF IN SECTION 3)O60F THE LABOR CADE, IPREREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I am licensed under provisions of Chapter 9(commencing with Seclion 7000) of Divi ' i ihe Business and Protessions Code, and my license is in tull #�7 `f.�' ss 1d ,�e -r�_,�—�-�-�_.�.�, , a; � � a�-�Z CONSTRUC710N LENDING AGENCV: ❑ I hereby aftirm that ihere is a constmction lending agency for the pertormance of ihe work for which this permit is issuetl. (Sec. 3097, Civil Code). LentleYs Name: Lender's Address: Signature: � � Date: OWNER-BUILDER DECLARATIONS: I hereby aflirtn Ihat under penalry ot perjury ihat I am EXEMPT FROM 7ME CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnif to construct, altar, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant for such permit to file a signed statement thet he or she Is licensetl pursuent to ihe provisions of ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot ihe Bu5ine55 end Profe55ions Code) or that he or she is exempt thereirom end tha basis for the elleged exemplion. Any violation of Section 7031.5 by any eppliwnt tor a pertnit subjects the applicant to a civil penelry of not more than five hundred dollars ($500).): ❑ I, as owner of the proparty, or my employees with wages es Iheir sole compensation, WILL DO TME WORK, antl the siructure I5 not intended or ottered for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law does not apply to an owner of properry who builds or improves Ihereon, and who does such work himself or herself or Ihrough his or her own employees, provided ihet such improvements are not intentletl or oflered for sale. If, however, ihe building or improvement is sold within one year oi complelion, Ihe owner-builder will have the burden of proving that he or she tlid not build or improve Por purpose of sale.). ❑ I, as owner of the proparry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe project (Sec. 7044, Business and Protessions Cotle: The contrectors License Law does not apply to an owner oi property who builtls or Improves thereon, and who contracts for such prolect with e contractor(s) license pursuant to ihe Contrectors License Laws.). ❑ I am exempt untlar sec. Business and Protessions Code for this reason: Signatura: Date: Owner ID ventietl by tlnvers license. ❑ Yes ❑ No Drivefs License No. Verificetion of Ownership by (type of document, i.e. - pmperty taa bill or deetl): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenity that no excavation tive (5) or more teet in dep�h into which e person is required to descend, will be made in connection with work authorized by this pertnit, and that no building sWdure, scattol�ing, talsework, or demolition or tlismantling Ihereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Adminisiretive Code). ❑ As ownerbuilder, I will not employ anyone to do work which would require a permit from ihe Division of Industriel Setety, as noted ebove, unless such person hes a permit �o do such work from ihe tlivision. Signature: Date: Division oi Industrial Safery Parmit Number: CERTIFlCATE OF COMPLIANCE AND AU7TIORIZATION OF EN7RV: I cetlity under penalry of perjury that I have read this application and state thet ihe information given is correct. I agree to comply with ali stata laws and ciry ordinances relating to builtling construction, and authonze representatives ot the Ciry of Casta Mese to enter upon �he above-descnbed property for inspection puryoses. I egree not to occupy or allow occupancy of eny building authorized by ihis permit until final inspection. , CQOE1, INSPECTIONTYVE 1676 - Fixetl System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Roa� � 201 Final BIocWRetaining Wall 202 Final Factory.Fire Plete - , 203 Final Sign 204. Final Demolition. �g I� �� INSYECTIONTYPE � 206 Final Mechanical 208 Final Plumbing _ � 210 Final Elecirical L �`"V'FJ1 � , .... 212 Final Fire Prevention �� . � .�m. : 220 _ Final Planning Approval � 222 Final Site 250 . Final Building/Occupancy . , � �� (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 hAIH UHIVt, GVS IA Mh.�A, GA 8Zti26 Job Address: 921 DAHLIA AV Suite No Vicinity: Parcel Nunmber: 41218336 Applicant: DULANEY r Address: 31566 RAILR STE60��/'�� '� , CANYON LAKE, CA""�� „�;'i%��-/ii� 1 �� / ,!�� ; G� �/ �..� f �� conc/��racior / �.�i � Address:J � _J � V , ' '. �� C� REFAIR FIRE C �� A�� JOISTS,WALL �� l � To,\\C7.. ,\� � EXISTINGRES ��_` � `\ �� v"PLU I G�TO � \� �'• TUB/WASHER; RE-PIPE.� � REF � B01-016° � c, ��/` \��. `ti i ISSUE FEE $23:50 Backflow irrigatlon $0.00 Backflow Preventer $0.00 Bathtub $19.60 Clanfier System $0.00 Connect Qce,Soda.etc) $0.00 CA f BLVD #200 2 0 0 PLUMBING PERMIT Status: ISSUED Applied: 02/12/2003 Issued: 02/12/2003 .: :�� .-.-"1-,..:",�i� _'�\ =�r � ; �,_�� ' // r/' '.�� 1 , � hone = 909-44,� 1211" �t ` % /''U\` �"? �� '"^Zl.- � �"✓t ��\ ��\� ip:_ 92587_,,`-�.�.,_� (�� \� ��-�_ .=,�, =��\\ � \ �� ,.�� -,.� �� REN'S � � �� \��\.� Phone: �.��:�, c 62 e �so � ;�,,� _.._-_--,_�.-.---"2v. -� Phane: 909-043-1211 Zip: 92587 License: 688391 �.��9� �%%�° �� -�' i� ��_� _'�—� —Phone: ` ' r �----G!"l��.�Zip -- ''t.i.. � e.�/�� --�,: � J� �.. .L..,—� ` -�"'Lir.rncr.�� !( "� ,.1�) .,....� � ..� � ��.�� . �GE TO RESIDENCE. FIRE DAMAGE TO-TRUSSES AND FIRST FLOC NING AND DRYWALL, WINDOWS AND INSULATION. NO ADDITIONS ��3,r .:� t , ICE, FIRE DAMAGEREPAIR ONLY ,. � G'� -t- � �� o a""(' � 2.,+- � ��_ ��rr � � o„ � � a,�.� �... ., • i - '.UDE:2,BATHTUBS,�-bDISHWASHER 4GAS�(14)OUTLETS 1-LAUN IOWER, 1 KITCHEN SINK 3 WATER CLOSETS 1 WATER HEATER A � � ,� �,/ , v a� �, � . �� U o� ,: 7 � ' e C' - /,. / � � �, c _ _ r � r / ' / � /. � �� 1�� /), `��-==FEESUMMARY=--� \��..%^�� ('��;� ��i, c�-,'7 r-� _ —� nnnT�c v U`� ,// / 'Landscapebm`g ti n�) �1 C$0.00 j0`'" !%SwmmngPool 'c_�j �P-Trap �--� �.' \� �.I �-% $0.00" 0�..-� j� �jTrap Primer \� Pressure Regulator ,__$0.00 ;; 0 =� /� Urinal Process,Piping"(perl0�.ft)��'$0.00".�-0`'� VacuumBrkrBkflow(1-4) Receptors' "---"�$0.00 0 Vacuum Brkr Bkflow(5+) % � �\`1`t i� L� \ ��\ ��\ ��,1` � � 1 �� vvi �� —, ti�1 �' -' �� , ��--�-t � `;� » n:�� I �� ;,� i � _ �� 1 �A �, �� ,� �.; ,� .� ` ,. ;-J �`��' �- j ' �� l i , %(; �`= J ) \� ! (� � �-� ' i � �I,�� /; � � ��,� r � � ;, , / , , � �� /'/j ! � � � t� %+ %/' � � �! ��1 �, �"� �� .r� . - EILING~� � .,� / REMODELS J��ii I � ��/i/�"/� �� `�, I�'� YI, � , 1 WATER�•, � %�� i �%,% ;, AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO 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 ba �considered legal, such work must comply with all applicable codes, arid all requlred inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 zanwelvoo� WORKERS' COMPENSATION DECLARATION: ' ' .. 'y , ' ' . I hereby aftirm under penalry of perjury one of ihe following declarations: � ' " � "" •❑ I heve and will maintein e cetlificate of consent to salf-Inswe tor workers' compensation, es provided for by section 3700 of the Lebor Code, for.ifie pertortnance of ihe work tor whiCh Ihis permit is issued. � " . ,, ,? � � I have entl will maintein workers' compensation insurance, as required by section 3700 of tha Labor Code, tor the pedortnance of the work for which this pertnit is issueG. IMy worke c mpe sation Insur nce carder antl policy number ere: n��it— ,` ' (�nrtier. ��i' �j�6 � Policy Numher //O �4 L`� \ f ^ � " (7his section n'ed� e c pleted i! the permit is veluetl e( one hundred dollers ($100) or less.) . . , -. . . . . , , ,, ❑ I cenity that in the performance of the work for which ihis permit is issued, I shall not employ eny person in eny manner so as to become suDject to the workers' �� compensation laws of Celifo end egree that if I shoulA become subject to the workere' compensation provisions ot Saction 3700 of the Labor Code, I shall forthwith comply with these provisi p� 7 - /� Applicant Signature: �� Dete: G�Z —� J WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT FN EMPLOVER TO CFIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RE ($100,000�, IN ADDITIIXJ TO THE COST OF CAMPENSATION, DAhNGE$ AS PROVI�EO FOR IN $ECTION 37060F THE L4BOF CODE, IMEqEST, NND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm ihat I am licensed u er rovisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business an Professions Code, and my license is in tull force and eXect. Lic. A �,�� Class N Gontrector's Signature:�� y, � Dete: 7 l� �9--� CONSTRUCTION LENDING AGENCY: � ❑ I hereby attirtn that there is a construction lending agency for the pertormance oi �he work for which this permit is issued. (Sec. 3097, Civil Code). Lender'S Name: LentleYs Atldre55: Signature: Date: OWNER-BUILDER DECLARATIONS: � I herehy aHirtn thet under penalry ot perjury ihat I am EXEMP7 FROM TME CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business and Professions Code: Any city or county which requires e permit �o construct, el�er, improve, demolish, or reDair any simcWre, prior to its issuance, also requires the applicant tor such pertnit b tile a signed statement that he or she is licensed Dursuent to ihe provisions oi the Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) oi Dlvision 3 of the Business and Professions Code) or Ihat ha or sha is ezempt therefrom end tha 6esis for ihe alleged e:emption. Any violation oi Section 7031.5 by any applicflnt for e permit subjects the epplicant to e civil penalty of not more than five huntlretl tlollers ($500).): ❑ I, as owner of ihe property, or my employees with wages es their sole compensation, WILL DO 7HE WORK, and ihe structure Is not intendetl or olfered for sala (Sec. 7044, Business end Pmfessions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves Ihareon, and who does such work himsalf ar herselt or ihrough hls or her own employees, provitled ihat such improvements ere not intended or oflered for sele. If, however, the building or improvement is soltl within one year of completion, ihe owner-builder will have the burden ot proving that he or she did not build or improve tor purpose of sale.). � ❑ I, es owner of the pmperty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the projed (Sec. 7044, Business and Professions Code: The conirectors License Ww does not apply to an owner of property who builtls or Improves thereon, end who comracis tor such pmject with a contractor(s) license pursuant to iha Conirectors License Laws.). ❑ I am exempt under sac. Business antl Professions Code for this reason: Signature: Date: Owner ID veritied by tlriver's license. ❑ Ves ❑ No Driver's License No. Veritication oi Ownership by (rype ot tlocument, i.e. - property taa bill or deed): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTFICATION: Eapires: ❑ I hereby certify iha� no escavation five (5) or more feet in dep�h into which a person is required to descend, will be matle in connection with work authorized Dy ihis permit, and ihat no building siructure, scaHolding, talsework, or demolition or dismantling thereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, Calitomia Administretive Cotle). ❑ As owner-6uilder, I will not employ anyone to do work which would require a permil from the Division of Indusinal SaFery, as noted above, unlass such person hes e pertnit to do such work from the division. Signature: Date: Division ot Industrial Safety Permit Number: CERTIFlCATE OP COMPLIANCE AND AUTHORIZJ1T10N OF EMRY: I certify under penalty ot perlury that I have read ihis eppiication and state Ihat ihe iniorma�ion given is correct. I agree to comply with all state laws entl city ordinances relaiing m building cons�ruction, and authonze representatives of the Ciry oi Costa Mesa to enter upon ihe above-descnbed propeAy for inspection purposes. I eqree not to acupy or ellow occupancy of any building authorized by this permit until tinal inspection. �//,f�ig�na�t/uf_e O�t Legel Owner(s) '` And/O uthorized Applicant CO�E 1, INSPECTIONTYPE 1616 Fizetl System Final Fire Prevention 1266 Pool Spa Final . 200 Final Re-Roof 201 Final Block/Re�aining Well 202 Final Factory Fire Place � 203 Final Sign 204 Final Demolition PI�7E INiRIALS � Date y-1Z��i,. ate COUEA ,INSPECTIONTYPE 206 Final Mechanical 20B 210 212 220 222 �' 250 Final Plumbing Final Electrical Final Fire Prevention Final Planning Approval � Final Site � Final Building/Occupancy � �fl , -03 � (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 921 DAHLIA AV Suite: , Vicinity: Parcel Number: 41218336 Zoning: R1 R1 Status: ISSUED Applied: 10/19/2001 Issued: 02/13/2002 Applicant: TURNER, LARRY ISSUED BY: �%'�'� Address: 31566 RAILROAD CANYON RD - ' -�- �'. �' ^��-��; '_- STE609 y��-, ; - `�� Pfione' 909-443-121f �t� -`~ - CANYON LAKE, CA. ' : •' . ., � ' :. ��.' % Zip:'..92587 "`. . ` - � . .�s� _.i � ,. �,c . � `t�ti . Owner. SOUTH COAST CHILDRENS SOCIETY`.; �,��ii �;? r. (\1r ��+.� r_ . .� ; �.�.: . �_ Address 921 DAHLIAAVE � ,� , , „ - µ ii . �� / �� r ... ��. .a.�f �. .M1 • '` _ _ Phone- .. ^ �. ' `� < �� ; ., w�' • . "' �•�-'..� �_� �- �`-. �. _u �-�. � ,. � � COSTA MESA, CA ',;;r � -' " Zip: 92626 " ` ''�, � '` � � �:�"` '. � __� y �'. . . -:, L2 � . �r. ��t� Contracror. '�FREEMAN & SON FIRE RESTORATION �� ' � �� \ , .1�,: � ,�` , , Address: 31566 RAILROAD CANYON RD � � � � \�: , e � �,. .,.,��-.'` ��ti:..' � ' STE 609 ��' � Phone: .909-443-1211 �;��.A - „ , . +; � ' � � ` CANYON LAKE, CA - � _ �,Z . ' � Zip: i 92587 ; � License:�'j688391 -. �. ' -':'`.;' � :� 1 r . Arch : � ,. , ' � Eng: DAVID WEBER _ • _ Address: � � ^ �" '�� ` „�Y Address: 5450 ORANGE AV , • , �; ', _� ` �� '� .. . ' . . �-� �P,hone i.. � '. •� .. � �.� , =�,i, V ��:. Phone: 71489&3862�. a. ._ ti ' � � -,� Y .-``" � � CYPRES5 CA. . . �. . . .. , : '�� 1 � `�Zip: -'c, ,License: 90630 ',;; r �License: C30987 '��' . . . - . ;( ^ s:' � . . ' ,�. .•. ,� . �. . ., ..... :�.. . . . ,. .:...c, - ,: , h.: _ . ..,-, .,,_ SCOPE OFPERMIT>., .. u. .� ` , ., . . �, _' ,. ,,. " '� �' ' REPAIR FIRE�DAMAGE.TO RESIDENCE FIRE DAMAGE TO TRUSSES AND FIRST FLOOR CEILING JOISTS WALL �` �• FRAMING AND DRYWALL;,WINDOWS'AND INSULATION NO ADDITIONS OR REMODELS TO' ` �"' -'- � .�! EXISTING RESIDENCE; FIRE DAMAGE'REPAIR ONLY„ � - � � � � � � � � � � � �� " � � ""' � - � 1 � . � ` - .. � . . . .._ '2•... .. . � � - - � r'f� . . . � , . , : , -��= Plan Check.'•' � $36624 ° �t- •- ,-.i •�Permit:'�r`$563.45:"` ;� ti SMIP Res: '-. ;$4,20 �; � ' � iSMIP,Com.', ; $000 ,' ' Ofher. $0 00 '� : : Inspection: $0 00 . ' , �� ` � _'t ��Total: " $933.89:� , ` ;i' , �i y. J FEESUMMARY-'�' r � - : �, „� �' :,; � . ��;� .:` ". ;; ' ;: ,� _ .- �Calc Valuation f _ � Sdz.000.00` Claim Valuation a ; � • ga2,000'Oo - , a� , � ��,; � r�r . ^•-�: �:r , ys, - - _,. � � ..� . ., ; . , r�: �, , G , -, _,, �x ,�� $,�; �. �,. , �,,, '�.€,,. ,; ,/ . d� t �'°s� � �, � - '> . ty, a,,„�."+.... � ' �' �.�_ps�� -' �!,a' i. / , ` ' �''�!;- PLANNWG&ZONING %'� ; .. , i i �;�. ,;. �.4 .�- �,-^� . _ .� ` r -/ � � "y �, �i SETBACKS -. ., , , ' � " `. , �,'.� � > 1 �,. � ,� , .. ,,..,� �, 7 � . ;-�� t-. � � , `�,. � , , ;, s MAINSTRUCTURE�Front� 0=0� P� + � rRear 0 0 - _ -�Left 0'�0 " Right �0-0� ; i� / . °.. . � . AM,., . �� .� „ . ACCESSORY Front '•'0 0. 1 ��Rear- - 0- 0' �' � � � s �� :" „T � j;;� Ceft 0 Ot. m Right 0.-0 : �:; .{l; r ' `-`:: �i: i' � 4^" r � � r PARKING existinp: o" '�Required: o�-� . _:.�.F�oposed: ` � . ;,;'-,+ , �' 1 _ ' jiJ�� 4 ' NOTES: � �� - _ �y�.�-, __ NOTICE: The work authorized by this permit sFiall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 780 days. - ' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable cotles, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 en+o+o �aw� 4 WORKERS' COMPENSAnON DECLARATON: , „�_� 1� � ' :� �� • I hereby eHirm under penalry of perjury one ot the tollowing tledaretions:, �, �,' - , ,•� ❑ I have antl wlll maintein a certiticate of wnsent to selt-Insure for workers' compensetion, es pmvidetl for by seqion 3700 of the Laboi Code, for ihe pertormencebf the �ork for which this pertnit is issuetl. ' � ,; F _� �f�ave antl wlll mair�tain workers' compensation insurance, as required by sectlon 3700 0l ihe Labor Cotle, for the peAortnance ot the work for which Ihis permit is issued. ' My workars' compensatlon Insurence carriar and policy number ere: • v/�� r. � Carrier.a �� '� � f1�A/D � P,oncy.N`umb? (i� 'C��. y.�'d15�7ab'' �(lhls section need not be comp/etetl il the pe�mit is valu one hundred dollers ($100) or less.) ❑ I ceniy ihat in the performance of th r which thi it Is issued, I shall not employ any person in any manner so as to become subject to the workers' compansation laws oi Celifornie, e ihat If I d come sub�ect to Ihe workers' compensatlon provislons of Section 3700 of ihe La6or Code, I shell fonhwith _ comply with ihese provisio �y • ;Applicant�6igne�e: '� lDat-e:`� O ��/do�. aIw � WARNWG FAILURE TO SE PEN RAGE I lA AND SHALL SIIBIECT AN EMPLOVER TO CRIMINALPENAL S AND CIVIL FINES UP TOONE HUNDRED THOUSANDOOLUFE($1 ),IN DiTI O TOFCOMPENSATION,DAMAGESASPROVIDEDFO(iINSEC(ION31080FTHELABORCODE,IMEREST,ANDATTORNEVSFEES. LICENSED CONTRACTORS DECLAPATION: I hereby aHlrm that I am license un � i,' ns of er 9(commencing with Section 7000) of Division 3 of the Business 8uQ Professions Cotle, and my license is in full (om�a.eqPetteclSL'(c�W C� dHiG Contrectors�: � Dat.�e�. � CONSTRUCTON LE D G AGENCY: ❑ I hareby aNirm t et there is e constmction tending agency for ihe pedormance of the work tor which this permit is issuatl. (Sec. 3097, Civil Code). Lendefs Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLAHATIONS: I heroby eHirm thet under penelty of parjury ihat I am EXEMPT FROM THE CONTRACTOHS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to consirucl, alter, impmve, demolish, or repair any stmcture, prior to its issuence, also requiras the applicant tor suc� permit to file a signed stetement that he or sha is licensed pursuam to Ihe provisions of the Comrectors License Law (Chapter 9(commencing wlth Sactlon 7000) of Division 3 oi the Business and Professions Code) or ihat he or she is exempt therefrom end the basis for Ihe alleged exemption. Any violation of Section 7031.5 by eny applicant for a pertnit subjecis the applicant to a civil penalty of not more then ilve hundred dollars ($500).): - ❑ I, es owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, end the structura is nol intended or otteretl for sale (Sec. 7044, Business antl Professions Code: The Conirectors License Law tloes not apDly to an owner of properry who builds or improves thereon, and who Coes such work himsel� or herselt oi ihrough his o� her own employees, pmvidad that such improvements are not intended or oflered lor sale. N, however, the builtling or improvement is sold within one year of completion, ihe owner-builder will have iha burden of proving ihat he or sha did not build or imp�ove for purpose of sele.), � I, as owner of Ihe property, am EXCLUSIVELV CONTRACTING WITIi LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business end Professions Code: The contractors License Lew tloes not aDPly to an owner oi property who Duiltls or Improves thareon, and who coniracts for such project with a contrecror(s) license pursuant to ihe Contractors License Laws.). ❑ I am e:empt under sec. Business and Professions Code for ihis reason: SigneWre: Oate: Owner ID venfied by drivers license. ❑ Ves ❑ No Driver's License No. Expires: Venfication of Ownership by (type ot aocument, i.e. � property tex bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certify ihet no excavation tive (5) or mora teet in depth into which a person is required to descend, will be made in connection with work fluthonzed by Ihis permit, end that no building siructure, scaflolding, talsework, or demolition or dismantling ihereof, will be more than thirry-siz (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ttle B, Calitomia Atlministretive Code). ❑ As owner-huilder, I will not employ enyone to do work which would require e pertnil from the Division of Indusirial Safely, es noted abova, unless such person has e pertnit to do such work from �he division. .. Signature: Date: Division oi Intlusinal Setery Parmit Number: CERTFICATE OF COMPLIANCE AND A ORIZATON OP ENTRY: I certity untler penalry of perjury thal I have read this eppliwtion antl state that the information given is correct I agrae to comply wi� II st aws nd city ordinances relating lo building constmction, antl euthonze representatives oi the Ciry of Costa Mesa to entar upon the above-descnbetl property t�p ion purpos�es.�re� not to occupy or allow occupency of eny building authorizetl by this permit until finel inspection. Q�1j� �NTRIALS 16� Fi:etl System Final Fi�e Preven�ion 1266 Pool Spe Final 200 Final Ra-Rool 201 Final Block/Retaining W ell 202 Final Factory Fire Plece 203 Final Sign 204 Final emolition COOE� INSPECTIONTYPE 206 Final MeChanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency PSIE 1t�L5 � �/ ; , . <� (714) 754-5273 • Fa�c (714) 754-4056 • www.ci.costa-mesa.ca.us \ BUILDING PERMIT _ i' . . Job Address: 921 DAHLIA AV Suite: . Vicinity: . Parcel Number: 41218336 �r � .. , Applicant: MCCONNELL, MARY Address: 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 10/19/2001 Issued: 02/13/2002 Zoning: R1 R1 �,-;�'=�!-``,� . �sLr .�::.. w - . 1h . .� : » . �a _�. . . K�, � / �--��_ � ISSUED BY: Owner. SOUTH�G�ASi L�'H,IL`UK}tN55UGl� U �_✓� Address 92��DAHLIA AVE / / �o� `� Q�/�� \��Phone:--�--��qC�,� Q COSTA MESA, CA � Zip: 92626 �� n1 � � /� ntractor T.EMPCO�DISASTER SERVICES,INC. �.,�i . .��i 4�ress: 1505�GARDENIA ST �� /��/ Phonei � 816-507-6906 G�ENDALE Zip: �12�� Licen��I74`56 p.a i`� ��„ /�—� �,.� � � ;�:� � 1} �`'�Eng: ' o� .5.y S; � oo�0 99 Addiess " . , --„_""`_.—.'.�--�-_.�----�� ,Qa Ptione: � o ip:' �� . L�ense: / --s U — —'SCOPE OF=PERMIT ��nU 0 ,r��rrrncrr ,rn ,. . .. . . .. , . 4EPAIR FIRE�DAMAGE TO RESIDENCE. FIRE DAMAGE TO�TRUSSES AND F RYWALL'tWINDOWS AND INSULATION-NO:ADDITIONS�.OR,REMODELS_TO ENCE� FIRy�Et DAMAGE REPAIR` ONLY. ,n� � _� �"lll...� 1 .. �.. ,' >.l �1_ , � �� ""�� ''�FEE:SUMMARY/ Check�,� �$366.24 ��--�'�---� �.�� } �ermit: �, (�$563.45 �� .�o, � � . _. ., o . 0 0 � o ' *- �_ ��m �00 �PpQ'0�� o o .n/J� n `�'-� Od ��p�° 0°� ° `- i� c� ., � n c= �b °�R� `� ��nao o°$PIANNING°&20NIN( WEBER 4NGE AV f FLOOR'CEILING JOISTS'WALL ( � � 1��11 � �� —Calc Valuation: � Saz � Cleim Valuation: ,.,, $az � � �% � � ��d ��`��',� � � �� SETBACKS " � ��'=�`��r--_�� _�--� �_� � O MAINSTRUCTURE Front� 0-0 � r�Rear/�-�0,-0'""�---�-�--L"eft----0=0 �� Right� ACCESSORY Fron\ 0� R�--0-f� ��Lv -1 0�\ V) Rig� I i PARKING Existing: 0\Required:`o'�Uti�`'Propos tl: �o�l_� NOTES: :.ea..� . . ,� .'i- `:�� . . � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 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 raquired Inspections and itnal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of ihis permit. FOR INSPECTIONS CALC: (714) 7545826 ...��.,. :� �v � WORKERS'COMPENSATIONDECLARATION: ��' . — ' ' " - . • ' � I heieby eflirtn under penalty oi perjury one of the tollowing tleclarationsr. ��r ' ', � - �� . .. .� ❑ I have and will mainlein a certificate of consent to seli-Insure br workers' compensation, as piovided for hy section 3700 of the Labor Cotle, for the pertortnance of the work for which t�is pennit is issued. � , " �j�l heve and will maimain workers' compensation insurance, as required by seaion 3700 of ihe Labor Cotle, for ihe peAortnance oi the woAc tor which tlNis pertnit is issued. �� My workers' compensation Insurence carrier a policy numDer are: 2 (� arrier. ��TF � V�� Policy.NumDer.1�'J�� u�.�C�CJ �% H �5 secfion need not be completed il the permit is valued a( one hundred dollars ($100) or less.) ❑ I certify that in the pedortnance of Ihe work tor which ihis permit is issued, I shall not employ any person in'any manner so as to become subject ro Ihe workers' compensation lews of California, antl egree ihat if I shoultl become subject to the workers' compensation provisions of Section 3700 of Ihe Labor Code, I shall forthwith comply with ihese provisions. • / . pliGent;SlgneWre: � � ate: % 2 Z O 2_ WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SU91EC� AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSANO DOLLAFE ($1 W,000), IN ADDITION TO THE COST OF CqMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3]O6 OF THE L400R CADE, INTEREST, AND AiTORNEI^S FEES. LICENSED CONTRACTORS DECIARATION: , . I hereby affirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 of Ihe Business and Pr f�essions Cotle, and my Ilcense is in full CONS7RUCT10N LENDING AGENCY: ' . . ❑ I hereby aHirm ihat there is a consiruction lending agency for ihe performance of Ihe work for which Ihis pertnit is issued. (Sec. 3097, Civil Code). Lendafs Neme: Lendefs Address: Signature: � Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm ihat untler penalry oF perjury that I em�EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the fotlowing reason (Sec. 7031.5, Business entl Professlons Code: Any ciry or county which requires a pertnit to consimct, alter, improve, tlemolish, or repair any strucNre, prior to its issuance, also requires iha applicant for such permit ro file e signetl statement that he or she is licensed pursuant b the provisions of the Contracrore License Law (Chapter 9(commencinq with Sedion 7000) of Division 3 ot ihe Business and Professions Code) or Ihat he or she is exempt therefrom and the basis for the alleged ezemption. Any violation of Section 7031.5 by any applicent for e permit suhjects ihe appliwnt to a civil penalry of not more than five �undretl tlollars ($500).): ❑ I, as owne� ot ihe property, or my employees with waqes as their sole compensation, WILL DO THE WORK, and the struclure I5 not intended or oHered tor sale (Sec. 7044, Business and Protessions Code: The Coniractors License Law does not apply to an owner of property who builds or improves thereon, antl who tloes such work himself or herself or tNough his or her own employeas, providetl that suc� improvemems are not Intendetl or oNered for sale. If, however, the building or improvement is sold within one year oi comple�ioq the owner-6uilder will have the burtlen of proving ihat he or she did not builtl or improve for puryose ot sale.). ❑ I, as owner of the propertg am E%CLUSIVELV CONTRACTING WITH LICENSED WNTRACTORS to constmct the proJect (Sec. 7044, Business and Pmteuions Cotla: Tlie comractors license Lew does not apply to an owner of property who builds or Improves ihereon, and who contracis for such projeci with e contractor(s) license pursuant to the Coniradors License Laws.). ❑ I am exempt under sec. Business and Professions Code for ihis reason: Signature: Date: Owner ID verified by tlnver's license. ❑ Ves ❑ No Driver's License No. Expires: Verification of Ownership by (type ot document, i.e. - property taa bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certify ihat no excavation five (5) or more feet in depih into which a person is required to descend, will be matle in connection with work authorized Dy this pertnit, and that no building siructure, scaflolding, talsework, or tlemolition or tlisman�ling �hereof, will be more than thirty-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, California Administretive Cotle). , ❑ As ownervbuilder, I will not employ anyone to do work which woultl require e permit from ihe Division oi Indusirial Safety, as noted above, unless such person has a . pertnit to do such work from ihe division. , SignaWre: Division of Indusirial Safery Pertnit Number: Date: ARDOUS MATERIALS AND EMISSIONS CERTIFICA710N: Will the applicant or presenl or future builtling occupam neatl b file end certity a Business Plan for emergency response to release or threatened release ot a hazardous maierial7 ❑ Yes ❑ No � (Section 25505 of lhe Celifornia Health and Safety Code requires, with some enceptions, thal e Business Plan be tiled with the Costa Mesa Fira Department by every business which has at any one time dunng a reponed year a quantiry of hazardous matedals equal �o or greater than a weigM of 500 pounds, or a volume o155 gallons, or 200 cubic feet of compressed gas at stendard temperature and pressure). ......................................................................................... ................................................................................................................................................................................................................................................................................... Does or will the applicant or present or imure building occupanl need to file a re9istration torm for acutely �azardous meterials? ❑ Ves ❑ No (Section 25533 of ihe Califomia Healih end Safery Code, with some exceptions, requires registration with the Costa Mesa Fire Depanment 6y each business which at eny one time has on hantl e quentity oi acutely hazardous matenels equal to or qreater Ihan a weight of 500 pounds, or e volume ot 55 gallons, or 200 cubic feet oi compressed pas et stantlard temperature end pressure). 3 Does or will the applicant or present or fuNre building occupaN need to prepare an FMPP (Fiisk Management antl Yrevemlon Yrogram tor ecutely nazamous ma[enais)�t ❑ Yes ❑ No (Section 25534 ot ihe Califomia Health entl Safery Code pmvides that ihe Costa Mesa Fire Department may require Ihe praparation, certitication antl filing with ihe Fire Depariment ot an RMPP by businesses which are required to register acutely hezardous materials with ihe Fire Department. ................................................................................................................................................................................................ ................................................. ........................ .................................................................. 4 If en RMPP is presently required, has Section 25534 of tha Califomie Heelth and Safaty Code been fully complied with7 ❑ Yes ❑ No .........................................................................................................................................................................................................................................................................................................'.............n.......................................�'............ 5 Does or will the applicant or present or fuNre building occupant require for the work which is ihe sublect of this a plication a ertnit or suc wnstruction or m i icat on irom �ha South Caast Air Qualiry Management Distncl or from eny other eir pollution control distdct or egencJ7 � Yes � Na (SeClion 658502 Of IhB Callfofnia Govefnment Code require5 ihat Ihe requested information be furni5hed on applications for non-residential building permits). ........... ........................................................................................................................................................................................................................................................................................................................ 6 W ill eny part ot �he facility �o be constmctetl under this permit be within 10001eet from �he outer boundanes of a school? ❑ Ves No Qf "yes", the feciliry must meet the requirement of Sections 25534 and 42303 of ihe Califomia Heal(h and Safety Gode). ...........................................__.................................................................................................................................................................................................................................................................................................................._.................... 7 N a permit fmm the South Coast Air Oueliry Manegement Disirict or othar alr pollution wnirol district or agency is requiretl tor the work which i5 Ihe 5ubjeC� of ihis aoolicatlon, have all of Ihe tlisclosures prescnbed by Califomia Healih and Safery Code Section 42303 been made? ❑ Ves ❑ No CER7IFICA7E OF COMPLIANCE: I cenity ihat untler penalry oi perjury the infortnation given above is correct. I agree to comply with all stete lews and ciry ordinances regarding Hazerdous Ma�erials and Emissions. Signatura: � � Data: CERTIFICATE OF COMPLIANCE AND AUh10RVATON OF ENTRV: I cetlity under penalry ot perjury ihat I have read this application and state that the information given is correct. I agree to comply with all state laws and ciry ordinances relating to building conslruction, and authonze representatives ot ihe Ciry of Costa Masa to enter upon the above-descnbed property for inspection purposes. I agree not to occupy or allow occupancy ot eny building authorized by ihis permit until finel inspection. CODE I. INSVECTIONTYPE 7616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Final Block/Retaining Wall 202 �Final Factory Fire Place 203 Final Sign 204 Final Demolition . .,, p� iMmn�s 0 CODE� INSPECTIONTYPE 206 Final Mechanical � 20B Final Plumbing 210 � Finel Elecirical 212 Final Fire Prevention -� 220 . , Final Planning Approval. 222 Final Site , , .. 250_ Final Building�Occupancy (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 hAIM UHNt, GV.1' I A MtJA, GH BLtiLb ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: Applicant Address: 921 DAHLIA AV Gff'li[:Bki:l DULANEY, BILL 31566 RAILROAD C STE 609 � #200 Status: ISSUED Applied: 02N2/2003 Issued: 02/12/2003 ISSUED BY: �` I�� --� �1 r� �. U� — �Phonei 909-443-1271 � �� 1 ,1 Zip: 92587 � . / �� ,� L ,� ��/�� .��\`��` -�=-=_ � t �, �.-�. _..n.�}C�.��\ � )� '`.`� � �� \/ ` �� 1'�� `� /�\\ �� Phone: ��( �� Zip: 92627-2162 � \ / % \ �\\L� Conuactor: f FREEMAN & SON FIRE RESTORATI,ON Q �, � i/Ut t �_ � Adilress: 31566�R41CROAD CANYON RD �� °„� a ��. STE 609 ( �� Phone: 909-443•1211� � ��`�l �„,r � t �, �� `'` � � �a ''�� /CA�(NYON LAKE,.CA � ,9 Zip:�925872,,.._ �.�, 1 /At T ��-.�� License: 688391 � REPAIR FIRE DAMAGEJTO'R JOISTS, WALL FRAMING'AN[ TO � EXISTING RESIDENCE, FIRE °CTRICAL TO INCLUDE:,32'LIGHTW� 200 AMPS. REFrB01�-01657�"=.- ISSUE��FEE..� �,\" Temp service test �, �, Res. a/c,package � New Res (1-2�units) New Res (3+units) � Pool / Spa �� Lightlng Fixts �'1� C�� Recept Outlets � � Swilches �\ Non Res Appl .� Res Appl Service l0 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp $0.00 $0.00 $0.00 $0.00 REPAIR ONLY. � FEESUMMARY-= �"_- ` Quantity .i-.r ti"+� ��. I � � �,`r." �.3" . � Temp,Dist System / Lighting � i � /�. ��,� � - _ Busway /100 k :`, I �� :, un � - � „ . Standmg Sechon:t,,,, � 9� „ '. � 0`� � ' ,- �1 . Misc Electrical Equipment -" � �0 0, � �� j� rTransformers up.to t kva/kwi;/ ��0 �'-- ��_ �� : .up to=10 kva/kw - '/ 7 32�� .,� �, .. ' ...up to 50 kva/kw � 40 . u to,100�k`va/kw i ., /n ��;��.>'�,c�`..�:..:.._:_P � 40 ..� - -- :.over 100 kva/kw� v� 10�� '-�—Cow Voltage Equipment �� C �0-/ ��r �---� Low�VoltWiiing_System/Ckt" 7� �� ) O I Mi'sa Conduif--` ��-'�j � �0 � �-� V�� Misa Con.ducto� '� �, ��, � �`'�-0"': —� Circus'( gen or ride) �-�/' %f 0 "�—_=,= _"`ChristinasSree: 0 Fireworks Stand � �'� � ; � ! �'�i FLOOR CEICINGI� I • �-� ( t �� 'IONS OR REMODELS�._. J � \I +� y �Y,ri � ( ' -�` � �i _ , , I r''fj(Il � � r,�li � AND 1 SERVICE�� '--� I��, J i�,//` (" �� '�' r �f/� \ `,l� j��j � l+ l ,i�%" �.! �/��`'�.�.. /� ,, Quzntiry" � - : , ii/, . / / I.00�/i � �� r i ).00 ! ' 0 ' ! 00�� 0`� �`,, ��'�� ) 00 0 � ; �� , 100 � 0 1 00'�� 0 ��= ' 1.00 � �/0 '.� �, 1.00� 0'� � $0.00%�/ 0 $0:00� 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes'and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if work is suspended or abandoned for a period of 180 days. _ , � �� INSPECTIONS: In order fo� the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaacrs (s�oo� WORKERS' COMPENSATION DECLARA710N: � . I hereby aHirm under penalry of perjury one of the following declarations: . ' , ❑ I have antl will maintain a ceNtiwte ot consent to seH-Insure for workers' compensation, es provided for by section 3700 ot ihe Lebor Code, for the peAormance ot ihe work for which this permit is issued. � . : .� I have and ill maintain workers' compenution insurance, es required by section 3700 of Ihe Lebor Code, for the peAormance ot the work tor w�ich ihis� pertnit is issued. My worker compansatlop� surance carrier and policy number ere: Carner: ' �-�' % �--.ii7 PolicyNumber. ��C%'%(�-- (ihls secfion need nof be complete0 il Me permit is valued at one hundred dallers ($100J or less.) .. , . , ❑ 1 certify ihat in tha peAormance of the work for which Ihis permit is issuetl, I shall not employ any pereon in any manner so es to become subject to ihe workers' compensetion lews of Califomia entl egree ihat if I should bacome subject to the workers' compensetion pmvislons ot Section 3700 ot Ihe Labor Code, I shall forthwith comply with these provision�/f � Applicant SignaNre: ��Lu --. i Date: � —/2_ �_ WARNING FAILURE TO SECURE WORKERS' COMPENSATION C RAGE IS UNLAWFUL AND SH�1LL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED i110USAND DOLLAfiE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 3]O60F iHE LABOR CODE, IPIrEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm ihat I am force and eHect. llc. q_ Coniractors Signeture: of Chapter 9(commencing with Section 7000) of Division 3 of the Busines ntl Protessions Code, antl my license is in full Class a � Date: 2—/ L—O i CONS7RUCTION LENDING AGENCY: ❑ I hereby aHirm that there is e construction lentling agency for ihe pertormance of fhe work for which this pertnit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Adtlress: SigneNre: OWNER-BUILDER DECLARATIONS: Date: I her�by aNirm that under penelty of per�ury thet I am E%EMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Protessions Cotle: Any ciry or counry which requires a permit �o consiruct, alter, improve, demolish, or reDair any stmcture, prior to its issuance, also requires the epplican� for such permit lo file a signed statement ihet he or she is licensed pursuant to the provislons of the Contrectors License Lew (Chepter 9(commencing with Section 7000) oi Division 3 of the Business and Profeuions Code) or that he or she is exempt therefrom and t�e basis for the allegetl axemption. Any violation of Section 7031.5 by any epplicant for a pertnit subjacts ihe ap011cant to a civil penalry ot not more than five hundrad dollars ($500).): 0 I, as owner ot Ihe properry, or my employees with weges es their sole compensatlon, WILL DO THE WORK, end the structure Is not inlen0ed or oHered lor sale (Sec. 7044, Business ana Professions Code: The Contractors License Law dces no� apply to an owner oi property who builds or improves thereon, end who dces such work himselt or herself or ihrough his or her own employees, provided that such improvements are not intended or oftered for sale. It, however, ihe building or improvement is sold within one year of completion, ihe owner-builder will have �he hurden of proving that he or she did not build or improve for puryosa of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business and Professions Code: Tlie contrectors License Law does not epply to en owner of propeny who builds or Improves thereon, antl who contrects tor such pm�ect with a contractor(s) licensa pursuant to ihe Conlractors License Lews.). ❑ I am exempt under sec. gusiness end Protessions Code for this reason: Signature:. Date: Owner IO verified by drivefs license. ❑ Ves ❑ No Dnver's License No. Verificotion of Ownership by (type ot documeN, i.e. - property taz 6ill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expire5: ❑ I hereby certity that no excavation five (5) or more teet in depih into which e person is required to descend, will be made in connection with work euthodzed by this permit, and that no building siructure, scaHolding, talsework, or demolition or dismantling ihereof, will be more than Ihirty-sia (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title e, Celifornia Adminisiretive Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permit tmm Ihe Division ot Industnal Setety, es noted above, unless such person has e permit to do such work from Ihe division. , Signature: Date: Division ot Indusirial Satery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORVJ1T10N OF ENfAY: I certity under penalty of perjury that I have read ihis epplication and state ihat ihe infortnation given is correct I agrae to comply with ell stete laws end ciry or0inances relating to buiiding constmction, and authorize representatives oi the Ciry of Costa Mesa to enter upon iha ebove-described properry for inspection purposes. I agree not to ocwpy or allow occupancy of eny building authonzed by this permit until final inspection. �Signa Of Lega� ner(s) —T And/Or Authori d Applicant COUE I. INSPECTION TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final , 200 Final Re-Roof 201 Finol BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 ' Finel Demolition � �.�IG751 Date �-IL-�3 Date CODE� INSPECTIONTYPE � 206 Final Mechanical 208 Final Plumbing , 210 Final Elecirical 212 Final Fire Prevention 220 �� Final Planning Approval ' 222 Final Site - . 250 � Finai 8uildinryOccupancy � ADplicant to flil In a11 soaces ezcept thosa withm heavy.eortler Iinas ana sign alPappropnate aeclarations. ' � � CITY OF COSTA MESA, ' ; .s �. ' { _ - - ; - � . - . . _,__� ` .. . � - - ` -' ^- � , i ``' i-- . _. : . ; i � ^ . . - � � . P MIT NO - ,s ,TRACT NO. � � � LOT,NO.,,� BLD . ,' � : .i � K� ' . _ , CONSTRUCTION PERMIT, i � I: ., . , c, �... � _�i� �3 ;.. . .., . t , � ._. � i t.� j ; : r:_ i . ; 3 , ., � o� o; 1029 I�%�6/'8�L f �.�70 � i� . PrOjectAddress� � L� � � - s� �, TYPE�OFCONSTRUCTION- �NEW � ADD, ALTERATION ' REPAIR�. '`' "� :'t � ' " ,. � ' ' � f ' ', ^ � � A�ppliCdnt�S M2ili0y Addf¢55 . �� ' � � - � ❑ CONVERSION :� DEMOLISH 0 OTHER ' � �` � � - A�P. # _ , - � { Z��Q� � . ' - ( �+ �DESCR ION F WORK ' " ' ' ' ' � � Owner's Nam s2 ' M ' � � � Phon '? � _ '.. � ` . ,' . , . .. �' � S. Main.Bmldm9 _ ✓. . � . . Accessory Building:� . � ' ' 2 = �ar� - L./: c� ' N� . Address e E •TVPEOFPERMIT �� GRaDING ^ FOUNoaTiorv STRUCTURAL ' ,T, Front - �- . . •'` � %. ' N ArCh/Eng ' � i ` ' ^` ' � Lic¢nse No � ' � " ❑ TENANT ❑'ELECTRICAL PWMBING' 0 MECHANICAL � g. Rear - � + ' �� Address � r ' s t � f ❑ �OTHER . '_ ' '� '_. , �." - .A. ' ` 1 � . . N `I�, . . . . . . ., ' , , . . : ' • � : � i C Right :, t � .. _ . _ . ' ' G �. Contractor'sName �'C�'��f�-RL �Hy� ^/� Phone PROJECTDESCRIPTION, So F7.�� oGCUaANcv K , , .. ' R � 4 Addfe55�lmailing) ��0 x�'(� '� CONSTRUCTION TVPE � ' VALUATION $ ' ; , g Left,` ' � ' » • ' ��i _ c } ' ' E � ' 20NE ' GRADINGCU.VOS. �'ACRES � � • t � " Y, � 0 � � City�License No. _-�9��_ 2 � i � ' . - Ping � ftef. # � � � . Park. Fees $ , _ U LICENSED CONTRACTOR DECLARATION � � �J � � � Remarki: ' � , � _ � � � � � . Parking Req./Provided ' ' � . � 'r ' - � I,hereby affirm thdYl�-am li[ensetl untler. provisions ofiCharter�9 (commencing � � , . , ' � � � � ' R with section 7000) of �Olvision 3rof the Business antl Professions Cotle, antl � � , �=- � . . �� - �Use of Building: . � � C.- j, ; .. , � E my license is in full f rce and effect. . - i ' - - , . ^ ucense�Cl — 6 � se No � � � ' ' ' � • ' PLUMBING � ` ' � FEES Planning Notes: , . � � ' ' ; ' M ate /� Si9nature �� + .1 - , , . . ` . ` , _ , ; E �ORKERS'� ? - ' ." , i � t 1 BdI Sink � ' . � ShOwEIs � i • , : � t t N ' . OMBENSATION DEC ARATION �' ' 7 ' �i�tiereby�aitirm.that I have a certificate ot.consent m sel -insure oi a certificate � gackflow Preventer -"'� � - - Service Smk - . " -" -' "� ' �� !"'• �� ' r �' " -�' - -�- - ^'- -- � '• � -� - t- �S �� of Wo�ke�s' Compensa[ion� Insu�ance, oi'a certiti¢tl�Gopy thereot (Settion t� - � y Y � � 3800, Lab. CJ , . ' �'! � � � -� Backflowirrigation " SewerCap ' ' '� ' , '' ELECTRICAL' ' � . � � 'FEES � ' PolicY No. ' comPanY � , ' . . . , ' . . , ' , , ,. . : _ � . . • e Certitietl co � . � ' ; • �� Bathtu6s � Sewer Connection � � �v ' ' ' ' ' � ' py is hereby�(umishea. - � , -, � � i v . • . . . AutORldtic WashC��'� � , T�3n5iO�rt1E� ❑'15-50 KW Certifietl copy is.(iletl with the ciry Builtlinq Dlvision. ;- �-'� � . � , . �oate � � • applicant ' ' ' ' �� ' " ' • � "�i Clarifiers . .. " . , - Solar Collectors � ; , � i �, Conscruction Pole Sub. ' � , � � � 50+ KW , , ❑ . � t - EXEMPTION'FROM'WORKERS'COMPENSATIONDECLARATION � �' � � � (Thissection neetl not be completetl iLthe permR is for one nuntlretl ($100) or '�' Di3hwasher' � .�Solar Piping �' ��Cooking Unit 1-- � . Meter �up to�100 amps� j iessl. t .i ' � ' . . . .. . ' _ " . ! - . Drinkin Fountains I certiry th5t in the•performance ot tne work tor whicn this permit is IssueE, I 9 � Solar Tank � � �Dishwasher • � � � 'Meter pover 100 amps, � , � .� snall not employ�any pe�son in any ma e� so'as'to become subjett to the : � . �- •.- . ' " worker p t 6m Laws of Califo " •" � ; Floor Drams Swimrriing Pool w/Spa � D y re �Gas ; �Electnc ; Sub Panel� ; '� ', `, s � Date Si nature . ` �. ' ' Y. _ y:;}. *; .., - . . -�, •' , � t r e Workers: Com ensation9 rovisions of the� Labor C tle, you must forthwitn � _ L • + 9 � NOTICE. If,ia ter i akin this tleclaration, Ov shou be me�subject to the Floor Sinks - -- - � -Unnal. �. ' £-�-� � �'Fan .� , �.' Motors O67 HP'O1'h � 8= + ' P P .,. ^ .' . . , • � ,tompty -witM1 such' pwvisions' o� thiz"'permlt � shall be tleemetl revoketl.,, Gas Service ��Outlets rw W3t¢t CI052t, . ' F.A.0 InG SOId� �9-15 HP 076-15+ ' CONSTRUCTION' LENDING �AGENCV ' ' � � ' ' ' " ' �''� - - - -- - • - � �- , 1 hereby aftirm that Ihere�i5 a const�uction lentling a9¢nty fOr the pertotmance � Ipt¢�CCpt0�5 � - WdtE� H¢dt2� ;-y, ��'- F,ixture5 y, -� � Microwave�^. � � of Ihe.work tar which;this permit�;is'i55uetl �(Sec[ion'3097.Qv C) ' ' " •` � ' � • � txnCer's Name � � KitchenSmk �;� � � � � WaterService � � " - - '�- I � ' -L.enGer's 'Aaaress� � • ' ' � - • - � ' � • � . -- .. - ; Device Boxes ' � ' ��Pole Light r . . _. . - � '� ' Lava{ories,. '� " ° ` . i. '�� i � . OWNER BUILDER DECLARATION � ,e � t - , t ` i � � � 4 ' ' td - �Outlets� � -� ' 'Range , : ' I�hereby;attirm',that I am ezempt from the.Contractor'S Lwense,Law.tor the � � � - . . following reason�(5¢ctioni7031:5•Busines5antl�Profeszlonal Code:�Any aty or • P-T�ap' ' � _ ' c ': .��: , - ,Switches - � Sign� ��- � � � � tcounty which �eqWres a pertitit'to,ConStruct, alteq�im0�ove; tlemolish o�'repair '- .. -, � ' ` �ny st�uctu�e, p�lor to It5:is5Uance; also �equires Ihe applicant torsuch pe�mib � �.ROOf� Dfdi05 "^-a � •, �� " � +� ., � ,Garbage Disposal�, � � `,� . Standing Seccions .� A�' I -+- " • file a:signetl statement-.that'he/she is licensetl pursuani to the.provisions af� ' L - , ' - ' ' � � - - � ` •e Contractor•s'�License Caw (Chapter�9.(commencin9�wim•Section 7000) of ?" . M � ,� , �, � .. j ^ � f !.':` T"r �- � / � -'Generotor;O0.5 KW.O5�15.KW ��` Trash Compactor � -�''•.� � ,.� � .ivision �3 bf the"6usiness•antl Professions Cotlep or tha[ he/she,is�exempt �,� = �, . y i, �f th¢retrom�antl Ih¢ basls to�tthe allegetl exemption. Any vrolatiOnbf�SecHon . -' �, , - � �� .x .- ,7031-:5 by'any applicant, for a, permiC subjects:the applicant •to'a. civil "'7 •+� ' • ~ i � ' ' ` � � � � � enalty oi.not more Ihan five huntlretl tlollars (g500).-' ' , . � , '] + .' � F7einspection'Fee t , •,[$25 : Y• � ; �' Issue Fee'; �:� `� $ 3 � � i •" ' � �' � ' � �. �� . - � � "�-I,' asjowner of the!propertypr�my'employees'with wageslas their'sole- L _ . , � iReinspectionFee '$25 ilssue�Fee. •i ;$-3" �� . compensation, will tlo tne work, antl the,structure is not intentletl.or ofteretl - ,L,-. j, � � � k' ' � MECHANICAL 'i � y FEES. �!' � -� - � - x �� ". � for wie' (Section Jo44', Businesz and Protessional Cotle:� The7Contractor's�'.r' , . ti � , . , .. � :PUBLIC SERVICES'REQUIREMENTS: � , � � j ' q ' ��. „ � UcenSe l2w tloes mt applY to an,owner ot a property•who builtlz or improves :_ gO�le�, y t Hood ot T,ype I'i ❑. '�� .- : �` � .# ' ,} thereon; antl who-tloes Such wo�k�himself/he�selt o� through�bl5 or M1erbwn . . '�+� � � !•Zaning�Approved By - ' Date � F � ' employees, provitled tnat such+improvemen[s are'.not intentlea'or offeretl,fon �!. � i � �nopy � Type II; ❑. , � � , +- , . . . � Duct°'UnderGFound � ` � Buildin A ioved, ' � ° �' - � ''�' ��` � �_ 'sdlE. �If, howeve�, th¢ builtling or Improvement IS Soltl within'one year-of cOm- �� , ... ! l .' f ' 'i ��' � g pp By ' Dete 'f -• � pletion, the owneqwill'have;the burtlen of provmg.he/she tlitl not builtl or Im-.. � � �, � / � /�.�� , ' rove�for the puroose ot.sale). ,^ • i ' - � ._ �'„ 7 �' ' .�, , / - -1 Duct -Structural . • � �.. Refrigeration$ystem' . � r' �.ApplinLan Issued By � '� E � 'Date�llf�V/ n_`�� - �� I, az �owne� ot th¢ property, am�exCluSively mntiacting2wlth1licensetl con � i �� , � ' - , � . � '4 ; � tra<torstqmnstruct the oroject,(Section J044; Busmess antl Professions Cotle _� ;- Duct. Venvlating _� 4:^J;w! ��-100,000 BTU�`�100 000 BTU ' -�fj y�!' . .�{ 1 SUMMARV OF FEES :�! i r` � �... ' �� .�The Contractor's License Law does not appry to an owner ot property who , `� � � �v � '� �.� � � � ` ' ..._ -� v � ' � � $ � � i' . builtls or improves tnereon,�antl who conlracts forsuch orojectz with'a con "! Exhaust System ❑ Multiple �� System Repair/Alteration �-,.� '- I `�� ;� BUILDINGPERMIT �$ ^ .`rSMIP.`, y., . Vacror(splicense pursuantto the Contractor,s License L.aw1' :. 1� . _ . , 1; - { - , ' ' .� . . � �; • ;. . . . . i ; �. { . . . . '1 �PLAN CHECK � $ ' PERMIT t � - � I' �, - ❑'I�am ezempYunEer�Section' � B. & P' C for this reason �� . Firepl/Fatt.8lt. ICBO � .� � 'j � � � ! � , � # � , , $ (� � ISSUANCE - a$ �- { .� .,< t 1" Y : f • � � PWMBING� ' Date � � - ' • Owner- ' - ' +' � "' " � +' Heabu9.5Ystem & Ducting .1 ; , �� ' � # . ' � � ' PLAN CHECK 25% ! $ � - ; ' ' �' ENERGV P C .• $ � � '« .{ '. � -I �hereby��certi(y-that-I have�re5a this�application ana.st5te.ttiat.tlie.above..,. + ?. OP100,OOO,BTU-0100,0006T - � � . ' � ' � �- �' ' ' - with all at antl count �ortlinances �� . �� 1 � � . ELECTRICAL� �-$ ••� �, .GRADING �$ 4 L � E � Intormation is correct..l agree to comply_ . y Y � � Y � ��' � - i�' . �� MICROFILM ($, �� ,� antl�ztate,laws relatin9�to builtlin9 mnstruction; antl heretiy au[horize repr-e- �/ �,4, � �� i � � � ' 7 , PLAN CHECK 50% $-F ' 5¢ntativ¢5 OH this; crty; f0 enter' upon the �abOve-mantionetl ��o rty for • - '�I : � � � , � '1 , � _f - ; i , �, . � . . . � � • .F i q � � InsPectionP se t i 1 " y o 71 • .. . , . , , ' V MECHANICAL $ �'' 4'` � TOTALFEE i$ } �O�/ °S9nature . ' .' ' ' i �a[e , t � i k • . , i . , c �S �, �. � Reinspeccion Pee� �1 $25� � Issue Fee � ' •j � � - $ 3 . �- �..PCAN CHECK- 25% �; $ '1 i � 1 1..�. � � Drivers'�Li<ense orj55 � , t � 5 i . ' ' ' _ . . . . • � - . . � . . � � . - : � _- . .. _ ._ _� . . .«� �. _... .. .... . . .... .. .... � _.. . ... ��. � _ _ ..._.�...�..___.�_�_. .' _ ' ...< . " _'�... �.. �. � . . ' ' " ... ,.... _. �.. . ..,, -4.—.._ ..-�......- .. _ � � CMF OB65-46 rav. 12/83. White - Bwltling; Canary - APDlicanh Pmk Accounting; GolilenroC - Assessor � - � . . - . . � - - ` .j ' � � . . . . . . . . . . a . + . ' .. �. . . . . . tr f t w i .--. 'OBESSi L-9 z S DAHL IA AV � NRME:. ! pE� I.OHERTiL: FOHD"" 3366 FUSCHIA� . • I . UNIT: '" 979-.1721 � RflCHIENCINEEfl: '� � � _ � _ � , � - � *- BEG.NO.: 'ADOBESS: , ' � '� . , • , � � ' . UNIT: . ' " . �� ' ' i r ' r- . � _� PEflMITTEE: � � ' . � ` � - nooeess: ROHERT. L. FORD ' ( 714') 979-1721 -r .3366 FUSCHIA �: � . CM- ' � . ' � CA!92626 - LICENSED CONTMCTON DECLAMTION: I Aereby aflirm �ha� I am licensetl under pmvisions ot Chap�er 9 gommencinp with Settion 7000) of Division 3'ai ihe'.Business antl Pmiessians CaUe, anA my license is in tull.torca and eflect. i , CITY LIC.: �, � ;ti STRTE LIC.: � CU33: ,- , Oate: � � � � ' SiOnature: � � ' - � WOBNEBS'COMPENSFTIONOECUMTION: Iherebyafiirm[hatlhaveacetlifiwteoiconuntroseli-insureoraietlifiw�eofWorkers' I Compenutian Insurance, or a ceriified copy tAereoi (Section 3800: La6. C). -, # , � POIICY NO.: " � EXP. DRTE: �� ' �, .,COMPRNY: ' � " ` , ' � . � Certilie0 coDY is hereby fumisheA. ❑ Cetlifietl coDY, is /ileA with the ciry BuilUing Division. � , ' - �—{... _ .. . . a � .. _ � . ._ . _. ._ Oate:. Applicant � IXEMPfION FflOM WOflKER3' COMPENSIITION OELL�N�ITION: (iliis secuon neeE noi be com0le�etl H tl�e pemui is fa oire �undr �5700) or less). I certiry tAat in the periormance af tAe wuM1 tor which this Dermit Is issue � I shall not employ y person in any manner o as to hecome � subject to ihe Workers' Compensation Laws of Califomia. � r • Date:' �. �'�!'� � .Signawre: , NOTILE: II, aker maldnA �his Ueclaration, yau sAoulE Eewme iuUlect to ihe Woders ComDensation Dmv¢io ot the Labor CoOe, you must forthwith comply wiN such pmvisions or Ihis permit shall 6e tleemeA revokeA. , CONSTBUCTION LENOINO �GENCY: I hereby,amrm'ihat there is a consimition IentlinB apency for the pedormance of the wark for which this Dermft is isSueE �Section 3097, Civ. C�. � � ' . i I � r IENDER: " ". _ ROOflFSS:_ , ' ' _ _ . '" ' , _ _' . . � . , ,, _ � � _. OWNEB��BUILUEB OECIAMTION: 1 �ereby aflirm ihat I am exempt from IDe Convactars' State License Law for [he followinp reason (Section 7031.5 Business andProtessional Cotle: My city of counry whicfi requires a Dermit to constmct, alter„improve, Aamolis�, or repair any s[ructum, pnor]o its issuance, aim requires ihe aDO��an[ tor sucA permT to fila a sipne0 statement Ihal �Ushe is IicenuE pursuant to t�e provisions oi Ne Cantrzctors' State License Law (C�apter 9(commencinp wit� Section 7000) oi �ivision 3 al t�e Business anE Pmiessions Cotle) or t�at he/s�e is exempt iherefrom antl the basis for t�e alleAeC eeemD�ion: My Nolation ol Sec[ion 7031.5 hy any applicam for a permR subjecis ihe appliwn� to a civil.penalry of not more Ihan live hunOr¢U dallaa (5500�. _ . � . . . .� . r �' -... -c..- 1-`--�; i . .- -. . .._ ,. I, as ovmer of ihe Oroperty or my emyloyees �with waAes is their sole compensation, will; tlo ttie work, anE the' ❑ simcWre is not intendetl or offeretl for sale (Seqion 7044; Business an0 Pmfessional Code: TAe Cantractars' State License Law ^ does not aDPN �o an owner ol a'DmDerry who builds or impmves [hereon, anE wtw does such work himself/hersell or Ihroup� "his or her own employees, pmvi0etl t�at such improvements are not intentleJ or ottare0 far sale. Ii, Aowever Ihe builUing or imDravementis sold within one yeacoi c6mDletion,[he ownerwill have ihe �urUen af provinp he/she diA not builA orimprova `fortAe�Purpose'of,salel. ' � . . . ' � � � ' . ' FI, as owner oi the pmperry, am exclusively contractinq with Iicense0 cantractors ro consimct ihe projact (Saction 7044, Busineu ❑ � and Pmfessions CaOe: • The Contractors' SWte License law Oces not appty to an owner ol Oraperty who bmlQs or improves Nereon - ane who conirac[s �or such pmle�ts with a wntractor�s) license pursuant to ihe Contractars' State License Law). I am aware �hal prool of ��ei� Workei s Compensaiion insuranoe ShoNG be pmvitleE to me. ' � I am eaempt unUer Section: B P-� � 4� e. 8 P. C. ', � � mrinisreaso�: OWNER DOING WORK � � � Date: �(, �%� `""O'l. d Owner: � • �. . � � I Eo hereby iertiy t�at I am aware al anE un0ersiantl [he repuiremenis ai California Health and Safety CoOe Sections 2550.5, 25533, an0 25537 and t�at I ar any tuNre buil0in0 occuDant wilVvnll not (circle one) neeG ro comply vnt� sai0 state co0es antl ihe reQuirements for a . permit /or constmction or mo0ilicafion irom the Nr Oualiry Manaqemen[ Distnd. HeSiAential constmction appliwtions are evemD� ��om IheSe OmN9on5. ' � � � � Oate:�, � ApDlicant: ' � � I �ereUy certiry Nal I �ave read this aDVliwlion anE state ihat t�e abave iniormation is coract. I aqrae to comDly with�al ciry anU caunry ortlinances anG state laws ralafinp to buildinp consiruction antl hereEy aNhonze 2D��ntatNes of IA¢ ciry to enter upon Ihe mentlonM propeM �ar inspection puipous. � � ' Oate:- SipnaWre: i DriveCs License ar Social Secunry M: ' Green—Cotle Enlorcemant; Canary—Applicent; Pink-Revenue; GoltlenraE—Asseasor � , +„ CITY OF COSTA MESA. - BUILDING.,PERMITf, `iPERM.NO.:!.E: _ 04794�8, PERMIT ,NO;, E. _047943 ., � �?PLAN'CHECK NO: j. . ; � N., �- GOVTc N� SUPPr..N�� r ' , CONSTRDCTION TYPE; V-N ;= �.i PERMIT TYPEc EL& �; �'•_' ,;�.P,URPOSE.'OTH rJOB DESCRIPTION '. : I NEW CEILING FANS f r' � ' ' r ' �S,Q FTd' � �' � ' ' CLAIM VALUEr' ; � ; CALC-VALUE; ; , � GGROUP OCCA: R; 3 / } , � COMMENTS; ADD CEILING FANS ' ' ' �' ' �"'" .�*ar-�r*�tet�r�r*�t'-x��e*�-+t-�r-�t+r-�t�t-x�-x�*-�*�r�t�x-�r***�tir�*��x�*�t�x-�**��t*�-x�-��t*ir*i��t��t�rx��r�t�c-****�t��t-.*�*�* ,Z 0 N I; N G, R E! Q U I-R E M E N T S � � ' � '',S', E T B A C. K S ' ' ' � r ' ;' I ' � � , . , I � s . � ' � ` .. FRNT: ' FT IN REAR• , FT IN, �- ACCESSORY'BUILDING ---'--=-�-= -- MAIN BUILDING ------- FRNT;' � FT; , IN REAR: FT �IN�� . ; LEFT: FT , IN RGHT: FT I,N LEFT: ` FT � IN RGHT: i',FT �.IN �� PARKIDIG RE(�: � ' P,ROV: , PARCEL: 41205131 ZNE': � ; �REF NO:� � � , � ; PLANNING NOTES> � � ' � � , , . �. . _ . .. �... "' " _' ' . . - .. . . . .�. . . -. ' ' .' �.. 1 ' _ it jE iE iE i4 iE iE it at iE it if iF iE if iF iE it iE it iE'iE ik 3t it if'if iE it iF iE jE iE if it iE iE jk it iE iE jE �%iE iE ih �YE jE iE i6 iF it i(� 3E iE it iP jE iP iE iE iE iE jE it iE iF it it if jE iE 1E if iF it if jE jE � 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 � � � � ' ' � ' � ' ` ;DAT�F.:'— � � i ! BUILDING APPROVED BY �; ' - � , T . •, ,- � DATE � ' � �� --, . �, /. APPLICATION ISSUED BY. f �DATE:; �•�� lfiEiE�EifiElEiEiEiEiE.1E'1F�E�)fifiE'lE?EiljE1F . .< < � dEiEiEiElFiEiEiEiEif �iF iE �E3(-*iEi4?f3fitifitiEdtifitiF3EifiFl6iEiEifiEitif'lEiEiEifiFifiPiFit . ��e jE9f�EjEiEiEifiEiE3tjfiEjfiEiEi4iFiEiEjElEififi4jE�E9fjFjEiE�EiEiE LEGALIZATION:N ., .�; F,E,E � 5 U'M '. A R Y ' STRUCTURAL SEGMENT:N ,� , .� � � . . . 1 : ��; P BLDG PMT PLUMBING �ELECTRI� 'M.,CHANIC 'FIRE. �SMIP/RE3 � GRADING PERMIT . � , ' ' - i 3;.75 r • ' . ;!, cJ� � 1 - , ,. , ? i 50$ � ; 'SMIP/,NON=RESi � 4_ ISSUE FEE ; . ,. , i , ., - � 15.00 . ' ' " �u; I -BUILD:ING-DI.U=> ..., PERMZT . ISSUE -.. PLAN-CHECK' ' TOTAL i PAID�'%j "'�`��' ; 'DUE TOTALS----> ��'� _`: -' � 3. 75' �".1'S: 00. :_ � ; 0 .•00 r . 18 . 75 G 's ; ,18 . 75 ;>�"' .. 00 REVENUE DZVISION•TOTAL'5--,>, -�, COLLECTED: � 18.75 OVER/SHORT: i%` �.00 ' , ' BLDG PMT PLUMHING.ELECTRIC MECHANIC F;IRE SNIP/TOT GRADING�'P.LAN=CHECFC , ' 18'• 75 . , ,-.n .d; � ; _ . . . < _ . � � . � i ' I ' I _'�; ' iF iF ik iE if ik iE 3f :E if iE if iE?E iE 3! iF iE �f if iE iF iE iE if jE ie if iE iE iE iE iE �t if iE iE iE iE jf iE iE iE 3t �E jE iE iE iF iE iE 3E 1E 3f iE if jE iE iE iE jE iE iE it iE iE if if iE jE iEliE if iE if iE 9E iE jf� � � ; I N D I V I:. D U A L F E E H R E. A K�D O W N �;}"LL' ua i � � TYPE • QTY . 1 D E 5 C� R I- P T, I; O N� � �� n � I � { �UNIT COST 'TOTAL COST ELE 5 RECEPT/UUTLET 1 ST� 20 EA. • ! .75 �q %�.I _ _` ; :�i� �_�END OF FEES � ; 3.75 , . . . � . . , � i 1 '� . � ' � } , r . . . , , 1 � � , � � , � . . ' � ' , ' � 1 � .. . .' .. .I .. t . '. , . � _ � � � • ' � . ' � � 1 � I �l� ` i • ' � � � , ' i � n' � _ Y . . . O1-�DOb419Q-Q0064;?0-TCtT -� - �'R.%5� DRTE� 06f2El9�1 tIliE: 12:4G i T� ► ( TRUCTION AND PLANNING � `� � - ` '� P�� 'Pp' � � j ' - � - Date � .InSpecfor r�� " ' - • Date "';Inspector,, . �OVALS _ Permij #'- � : �. - . APP.ROVA�LS. :Permit #.. - _ + - t. � �- - - - f-i � <i. Temporary Electrical Service or Pole • J � = ' g ,52..Pool & Equipment Locatiori; ` . ' ' � � �, 3. Soil Pipe-Undrgmd. ,- � ' � � `- "' � 53.'Steel Reinforcement .. _ � = � � ,� 3. Electrical Conduit�Utility-Undrgmd. ' '� � - � 54.��.Forms ' r - ` � :i' i." 4. Electrical Conduit-Undrgmd. _ ' '' � 55. Electrical Bonding ' .- �t, ' i� _ .. . �_' .h . X '5: �Steet Reinforcement - � ' � - - . � 56. �Rough Plumbing & Pressure Test ' - C b �6. Electrical UFER!G�ndP ' ` " � - 57.'APPROVAL TO.COVER�GUNITE • - - ' - n.. • - 7�. Footings ' ' - ' - � "-� �. * ; 4 ; � 58. �Electiical ConduirUndigmd. , � 1 .- ' .� ` � �� 8. Foundation � - � _ + � �= � 59. �Gas Pipe; �',Undrgrnd'•, Test � � ' � � . � � : � 9. Water Pipe-Undrgrnd.`~ �, - � � = ;j �I'�; � S0.•Backwa4h L-inei,'P-Trap,�O�Undrgrnd..= .� .�� f 10. Structural Floor System' r = _ ! � /%;.;;� i 61.'APPROVAL�TO;'DECK�"' ` � ' � %i ? � 11. Property Sewer Line.&�-�House Connectio'n � ;� � � `� � 62.trtBackwash & ReceptorFinal: �,,,� `. = ' , �¢ � 12. Sewer Cap - , � � n ! -`.�. - _ ' 63.:�Heater�& Vent�Final - --�� - . �� :` � � 13. Roof D�ains � " 1 G.� ,G �f %.� ; 64..--Plumbing System - Final . �t, - t 14. Rough Plumbing ' ' , �?� � 65. �,Electiical-Fin'al �T �- j�; , ' i t. � . � 15. Rough Electrical=Conduit �, 1 E `•�, � ` : 66.��Solar SYstem-Final -- '��: � `�� - � ` 16. RoughElectric�Wiring;. . � -�rf � '� 67.'Fencin &Acce'ss_ApP�oval ' y �' '•`" �' � , , . ,_ ' ". ' ' . : _ `9 . . ', - �, /s' J ' . - . ` 77. Rough Wiring Si9n ��; �� 68.�APPROVED;FOR�PLASTERING �. i' I � � ' _ � 78. RoughElectricahTBar;Ceiling : � �='. � � � 69.-POOUSPASVSTEMS�FINAL ' �i19. _Rough Heating & Air Conditioning , � � � - ,FIRE DEPT. REQUIREMENT 20.-RoughFactoryFireplace - ' . � APPROVALS" �Permit# 21. Ducts, in Structure ' � � „ 70. Underground Hydro 22. Ducts, Ventilating � , . ' �� 71. Product Piping OGas ❑Oil 23. Gas Pipe�Rough & Test � " , 72, Underground Flush 24.�RoofFraming � . ' �- � � 73.-Undergmd.Storaye.Tank�Gas ❑Oil 25. Roof Sheathing. ` � � ' 74, �Overhead Hydro � . 26.�T-Bar,Ceiling (St�uctureQ & Monocoat � � � 75.��Dry Chemical � . 27. Frame and Flashing � � ''- 76. Dry Standpipe . �, 28. Lathing & Siding . . . � ' � :� �( 77. :FIXED SYSTEM F.INAL- - � . 29. Insulatiori � � . ��'.�' 78: ,FIRE PREV. FINAL ' 30. Drywall Nailing , �. !� �� -_, HEALTH DEPT��REQUIREMENT 31. Plaster Brown�Coat - ,' ' � ��j � 79. FINAL INSPECTION '', 32. Electrical�PowerMeter=Final' � ��'G�., SO.�FOODCERTIFICATEISSUED, 33-FinalElectric� � � M' � '�` "' '� - �� ,� Notes: , `�34..Final,Heating & Air ConHitioning ' ' : � ,� jQ � -. _ -' _, : � 35. F.inalGasPipe�Test- �F • � i � ��f : . � � 36. Hood or Canopy � � � ( �!i- ? : �. � ., 37. Final•Factory Fireplace � - ,. ' � � �'� � � . � - `__ f t'. I / � 38. Final Plumbing - _'i �%'A � � r_.�_ 39. WaterService�Final.� � . �� j � - - ` t.� - 40. Gas Service-Final � � � ''' . • �� - � - 41. Solar pomesticFinal ' _ � 42. Backflow Preventeri _ � , : _ . 43. Backflow Irrigation � - • ^ � , • �44. Landscape Irrigation System � _ �' � � ' - , : �' . , .- . � 45.'Sound Attenuation. - � - , �46. Handicap Regul3tions • f; , ,' � �� 9� ' � . 47. FINALSTRUCTUR_E&BUILDING %.: '30 3�� /9�Y tiBc � 48. FINAL PLANNING � � �` � 49. Electric Release to Edison � + �"' . ' � 50. Gas Release to 5outhem California.GasCo L� ' ' . � - � 51. CERTIFICATE OF OCCUPANCY - • No. Date �-.. . r. . .. - UWNtK JOBADDRE GENERAL( AP Nd�]2_] INSPECTIO! $OIL Gn5 WATER J�n• ROUGN PLUMBING PROP. SWR.LINE Q HOUSE CON. SPRINKLING SVSTEM MISCELLANEOUS ROUGH MEFTING RNO AIR CONDRI TEMPORARV SERVICE OR POLE UNOERGROUND I-I POWER I-I 60ND BEAM �� STEEL REINFORCE SHEATHING FRAME ANO FLRSHING LdTHING _ IN 11 MEATiNG, VENT., REFRIG. AN� A.C., FINAL PWMBING, FIN4l AND GAS TEST n ELECTRIC. FINAI BUILOING. FINAL UAIt SUBCONTRACTOR �-1-74 � `` � 3877� � � � 1�� ^COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA,.CALIFORNIA 92626 PP 1 A7101 Fo� Applicant to Fill in Completely RE I D V [ BUILDING A '/ � ADDRESS / // L �/� OWNER � A.P.NO. Id' MAIL � BUILDING � ADDRESS ADDRESS W W TEL. TRACT / a U GTV NO. Z Q CAN5TRUCTION ' . W AD A H LENDER � am ' � J � BRANCH ' ' � ` J N pWNER / U m J ADDRESS ' " ' ��r� � m ARCHITECT TEL. �^�P/� J a OR ENGINEER N. N / WU a �' � D f /� 1� ZONE � ADOFESS � d W APPROVE W Z CONTRACTOR BV J Q mZ �6J � ADDRES$ 'qCl �'aiu -1-,a�,;�:OG os4:: �::�::,:�50 FOR 6UILDING PERMIT �TE RECEIVED DATE I SU� i L � Q' 2� �PE� l ( `�tl` J J / �� 7 �OT fl BLOCK. P 4 i � � �� vA � /fVPE GRO,/U�P /� � nnr� Y'�� — /� �w , TEL. y. 20NE /J PO�O�F � Z� CITV NO.�p�(/ ��/ r W O STATE . (J jD/%� �J I LICYNO. yMAION BUPL�DINGO y � LIG NO. Q� T "-CP � O � (FROM C/LSTREET) SIZE NO.OF BLDGS. OF LOT NOW ON LOT / FflOfYT FT. USE OF //�� EXISTING BLDG.S '— !-'/'� F , H SIZE OF NO. OF � Z NEWBLDG. OOMS STORIES L.SIDE FT. . U EMERIOR WALL�I7/� ROOF COVERING o�ii�0 COVERING REAR FT. J USE OF BUILDING AN WOFK TO BE PERFOFMED DISTANCE BET. • a - MAIN BLOGS. a Q ( // vna. # p r c.u.v.� N� � APPROVEO� O • o LOS UI hereby acknowledpe that I have reatl this aDP�ication antl state '7 = that tha ebove information is correct entl aBree to comply with � � all laws reBulating builtling construction, end I shall not employ � any person in violation of the workman's compensetion laws of y the Stece of California. ^'f 2 ? 1 heraby certify that I am properly licensetl as a contrector un0ar �y� $Q. FT. tne Staee ot California Bvsinass entl Professions Cotle, Divisicn 3, THE AMOUNT SHOY Chapter 9, and that such licenses are in full force antl affect, or I THE PURPOSE OF ESl am exempt from the provisions of the State of California Business antl Protessions Co/tl�e(' Olvision 3, Chapter 9. � q VALUATION � SiBnature of / / O �� /lV n /U � ( �` �� Permittee �"(• '�'pVC $ j/ Authorizetl Ageni / USE OF NEWG/4M• BUILDING �pR�.�_�rt YAR�S APPROVED BEf. MAIN & ACCESS.BLp DATE APPROVE� SSA� 7 �� 0 1AT10N IS FOR ' IMIT F E ONLY: � ¢ m N � m r� E ,�/' _ o VJ LL ,_. ,. 65 , . _ _ . . - " ... + . ,' � ' ,lIlG15-7?�A��OO1Q14#. f,*a1-77:2U' �: -. . . -, 9 , ; � . . . . . a COSTA�MESA BUILDINGSAFETY DEPARTMENT � . ' : , ' � , � JOLARP•O.BOX1200, COS7AMESA,.CAWFORNIA92626 � - ,p� �. , . � ' . � � qPPLI ATION�FOR BUILDING PERMIT . .. � . � ., - ForApplicentto�Fill�inCompletely', ' �� R ce� E BV �,DATE.RECEIVED „ . _ DA E ISS�IED, � �: � � .. �.. � . �- . . ' . � '� ' BUIL'DING ' t-. " . .!. .• ; .. '. ..,. . : . _' � �/ .'7Y � nooaess .� �Dahlia Avenue - -� � - . '•. - .. . • . - PERMIT NO. owNEa' arwin Southern�'Calif. ' I'nc. ^ P• "o. .� , . �' ' . cn r - � � - � � . � BUILDING , ) �// � Vv MAIL � 'ADDRESS.�� L�1�� aooaess 16255 Ventura Blvd'. ` 'dcw.��. cirvEncino,'Calif. No�986-8890' Tancr J�� .LOT(�J e�ocK ' Z Q CONSTRUCTION -. . � . � . ��. • � t � � � W . AD A P- oN /�ENoeR. Larwin.Southern,Calif., , am- . . ,� .. . : . .: - • � �� eRaNCN 16255 Ventura.Blvd. :,. r)- J N � � . . - �. OWNER' ` • � � -S:G ./^ � 0]J ADDRES ' O 81� • . .• .,.. •, '• . •.:�✓ . �j� VALUE PQ . m ARCHITECT, ' � TEL • � S C �7 �� J a OR ENGINEER � ' N 273-4464 � N � .. , . _ .. � � w2 ADDFESS J1OO�W11SIlliE: BEVOYLj�;H1�.LS Z�NE' � �-TVPE� -GROUP � ,. .. aw ' . ..: , .. APPRO ' .y.., . ..- +J � . J O CONTRACTOR Lgy'GJ1R Southern � Calif. _ � B�' ' , ' DATE / � . ,. m� nooaess 16255'. Ventura Blvd: ,' � - •' , ' `' 1 w w . . ZONE�+ '��: NO.OF � . USE OF NEW �� ' � -�J�/ z� °1TY_Encino Callf. ' N09S6-HH9O • j�.. � P�� BUILDIN A� - � STATE-•� ' CITV�- ' '�'ARDSAPPROVED ��.VAflDSAPPROVED' ' �[L UC. NO.. 191,31]- ' • LIQ NO. B'�.� � MAIN BUILDING' -� ACCESSOPV BUILDING . " �� SIZE � NO.OF�BLOGS. (FROMC/LSTRE T) „ � . _ OF LOT � g§ 8/{ X LO/{ ' NOW ON LOT " Q RONT Z�.� ' FT. . - USE OF -. . . , �� . ^� 't . .. y ' EXISTING BLDG. - ' D I E�iO�F � " FT � ' F . SIZE OF ' � : NO. OF � '" ' ' � . ' . .. •, � . � �' Z n,ewa��. 2354 �� ROOMS %x' .�'""�STORIES F Z. �LSIDE FT.. ' FS., ' a EXTERIOR WALL ` � � - -ROOF, - .• t. ^�� 1'� ' • ' V COVEFING StLLCCO COVERINGWd.a shin ZE REAR .YG/�FT. � ' -' � FT. � . U USE OF BUILDING AND WORK TO BE�PERFORMED pISTANCE BET. =' � - � BET. MAIN & ^ d . , . � ` . MAIN BLDGS. � ACCE55. BIDGS. ' . ' a � Q' . ' . . ' VAR.#` . :DATE .. ' .. � _ O , ' ' � � - C.U.P.# r APPROVED : -. . F . ' � ' � ' � APPROVED � . .• • - cn onstruct sin le famil 'dwellin (AJL 7�� 2 . O . ., , " , V I hereby acknowledge mat I have reatl �ffiis application and'.state' HOLD'FOR SPECIAL RE � IREMEN � thac tha above information'is correct antl agree m comply witti . � � all Jaws regulating builtling consttuction, antl I shall not employ„ , - , � F any� person in violation of xhe workman's'compensation laws of ' ' � y the State of Calitomia.- , . - • � f ' � � 'z Dhereby�certity that I�am properly licensetl asacontractarunder SQ. FT. ' o ' the State ot Calitornia Business�antl Professions�Cotle, Divisicn 3, . . THE MOUNT SHOWN UNDER VAWATION IS FOR � Chapter 9, and that such licensas ara in full force antl affect, or I THE PURPpSE OF ESTABLISHING'A PERMIT FEE ON�v: ,¢ am exempt'trom the provisions of ffie State of California Business � VALUATION �- - � '. -� {{{ '—O � antl Protessions Cotle, Division 3; Chapter 9.. ' +_ . - - ' /�/ .�J� - N � . ' PEPMIT FEE $ V/ � ] � � ' , � ..'. . .' .'Signature o �.y �' � ; � � ' ' � � ' . ' . . '. . � �Z.S m. . Permitte��oA/`-Q� '�' �� D DOW[1S � �� G� � .�p�qN-�CHECK $ E .�. _�... . . .' .,..�. � . . � , . . .....' �. %'JC-' `o . - Auffiorizetl Agent • . .. . , . 5 ' . '. � LL�� - - � 'TOTAL FEE $ �