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Home My WebLink About929 DAHLIA AVE - Building Permits(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa��MBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 , Job Address: J29 DAHLIA AV Suite No Viclnity: GARAGE Parcel Nunmber: 41218338 Applicant LAPAGE, RICHARD Address: 12025 ARROW ROUTE Owner: Address !�/ ; �:e a y ; ��,�� / �. �ti / // '�t� r � ri)t �' r, ' �li! n RANCHO �;'/ r\ �' �' W" ..�l;,: Jr.1�}�. l% ./h:� � '. -.{ ... �"%9>C'-a'r"" �COSTA MESA';,CA'"`,,,^�'",�'' : `�%'%� �'f�� l ^��• i"�!�i'e/ .� ALL-PRO�PCUMBING CORP + 12025ARROWROUTE ! .� fi/n� � RANCHO CUCAMONGA, CA , �.�� , i �/ irv --r--• � !t�#; ��/�,-,�'�i �� a :$�P7�.� ! `l � � `� 1 � ,�.,;?,, � • � � /- I � � I� � AMT � _.��c___ � �y � ISSUE�FEE � S '� �--� $23.50 ` � � �� :Backflowirrigation� �� $0.00 0_,.� 'BackflowPreventer,�� $0.00- -� 0� ��Bathtub`�--� ] t� i so.00 � .}^o� Claiifier'System � ��"tl $0.00 0 �rl, .Connect (Ice,Soda etc) �I $0 00 . � 0 - � Denfal Units� �1��j n $0 00 "' 0�;.:'�: Dishwashe� i` . $0 00 �•• �0 � Drain; Floor 1�� $0 00 '° 0 Drein;.Rainw� er�� $O.OQ �� 0"°� DrairipRoof \ )$0.00' -��0 �n.�.,u:.�-c.....,�..:., \ +fennn. . n Gas Eaiihqi Gas (1-4`ou Gas (Ove� 4 Gas Repipe Gas Service Interceptors Interceptors e �$0.00) 0 $�.0�•-�'0 \ �� c Zip: 92626 Status: ISSUED Applied: OS/09/2007 Issued: OS/09/2007 ISSUED BY: r� "� -� � -,.:,,_` �-�```^�C\ \ `. o � ('.!'` : ��.� ` ✓ '' f�: �;✓i - •� �. � �. �;,�.JC�� `��',� ~ � � 7223 �4��`,,'�"�.: �"�.7��`'�� ,�� ,�` \ \C��,�a '�,�`'� \ \ � �`.t � �%�� E� � � 8E153330 �so 6 -�-- 4< WATER HEATER CHANGE OUT SAME LOCA � Sewer Cap for Demo $Oi00 �! �SewerConnect $0.00� ,Sewer Private Line � �$0.00� � Shower ""'$0.00-'" �Sink, bar , � .�q„x..., . $0.00 ',Smk commercial� ,�4.i $000 �Smk Floor%� �' 0 � $0 00 Sink?kRch n° �� o� �_'��$0 OOk,.� '�Sink service/mop � ' S $0 00�`� ' 1'SPa (Privat )), tvj' ��C�o� $0 OO�o�o � '�S a ublic �� ' ?, `'' o`, '� _� r n �' �i o �p � � ,'.+' -• ,-'� 5`. 0 . � ° o 0 :A"�._�'1 .r�"'_�'J ° t'p � . � `-�--..�' : -�.�,i� :! � '_ � - 1 _-,��J.�i!�� N'(GA� GE) FOR � � v �_y � i ��1�/ AMT��'Q 0��-Sump Pump i��{ (� f �-$0:00 - 0 A_ ..�_ jSwimming Foolf ,'� I 50.00 ��0 09 � ��,Tra Primer 1 � � �g0.00 \0 0�/ . Uri al � J��'" $0.00 'r�j�0 09..�.._,.� � Vacuum Brkr Bkflow(t; 4) ��$0.00 !-i i 0 OY� �� Vacuum Brkr Bkfloiv(5+) ��-..$ODO r 0 �.a-.c 0�-.- � _WashBasin 11 � $0:00� �0 0 Wash Basm Set�� ( C$O.00j .� 0 0 Waste and VentSystem� $0.00 rI 0 0 WaterClosety(Toilet) { $0.00 0 0 WaterHealer;/ve'nt ��'$12��30� 1 0 Water Pipin`g (Inst or Rep.) $0.00� 0 0 Water Re-pipe �.:; " $Q.00 0 o water§ervice � $o;oo 0 0 Watei Softener�.� . ' �r$0.00 0 �p� xj ��,�OTHER� 1�-' �� $0.00 0` E "�'��' VIOLATIOIV ��$0.00 0 � �PLAN CHECK � $0.00 �^ v'� ��'R`EINSPECTION� $0.00 0 �!/'� �, l �!� C� /(��,� : �� A� �EDFEES: 535.80 z% IONS 1jv//ij'' 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, 72-21-92) �� ' . � . i� 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 1 BO days. , . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codas, and all 'I requlred Inspections end finel epproval must be obtained. Failure ro obtain inspections and final appro4al will result in the expiration of ihis permit. �'� FOR INSPECTIONS CALL: (714) 7545626 . � WORKERS'COMPENSATONDECLARAnON: I hereby atfirtn under penalry of perjury one of the following declaretions: � ❑ I have and wiil maintein � certificete ot consent to self-Insure for workers' compensation, as provided for by saclion 3700 oi ihe Lebor Code, for the pertormance of ihe work for which lhis pertnit is issuetl. - �I have antl will maintain Workers' compensation insurance, as required hy section 3700 of ihe Lebor Code, for the peAortnence of ihe work tor which Ihis pertni�s issued. My wotic s' com §nsatio nsurence cpdrder end policy number ere: (� /J/ �i Cerrior: ��L(�'P�II S G�. PolicyNumber. YGDJO %(q�� Li. ,(This section need not be completed i! the permif is valued et one hundred dollers ($100) ar less.) . ❑ I certify that in the peAormance of ihe work for which h1s��fermit is issued, I shall not employ eny person in any manner so es to become subject to the workars' � canpensation laws of Celifor �', d � ree�t If ho d become subjecf to the workers' compensation provislons of Sectioq 70 of the Lebor Code, 1 shall forihwith comply with these provision � / �// � Applicent Signeture: L , Date: �f i/CJ�% ' WARNINO:FAILURETOSECUREWORKERS'COMPENSATIONCOV RAGEISUNLAWFULANDSMALLSU&IECTANEMPIOVERTOCPIMIWQPENALTIESANDCIVILFlNESUPTpONEHUNDRED TNOUSAND DdlARE ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAANGES P.5 PROVIDED FOR IN SECTION 3�06 OF THE LABOR CODE, INTEPEST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS pECLARATION: I hereby attirm ihat I am licensed u er vi ia force antl eBect. Lia !t Contracbfs Slgnature: 9(commencing with Sectian 7000) ot Divislon 3 oF the Business ary� Pro e�sions Cade, enC my license is in tull Class k /� � Date: S CONSTRUCTION LENDING AGENCY: . � I hereby aHirtn Ihat there is a construction lending agency tor the peAortnance of the work for which this pertnit is issued (Sec. 3097, Givil Code). Lenders Name: Lendefs Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby eHirtn thet under penelry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, eusiness entl Protessions Code: Any city or county which requires a permit to construct, elter, Improve, demolish, or reDair any siructure, prior to its Issuance, elso requiras the epplicant for such permit to file e signetl statement that he or she Is Ilcensed pursuent to the provislons of tha Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe Business end Professions Cotle) or ihet he or she Is exempt therefrom end the basis for the alleged e:emption. Any violation of Sectlon 7031.5 by eny epplicant for a permit subjects the epplicant to e civil penalty of not more than five hundred dallars ($500).): ❑ I, es owner of t�e property, or my employees with weges es their sole compensation, WI�L DO THE WORK, antl the structure Is not Intendetl or oNeretl for sale (Sec. 7044, Business and Professions Code: The Contrectors Licensa Law tloes not apply to an owner of property who builds or improves thereon, and who tloes such work himseN o� herself or through his or her own employees, provided thet such improvemenis are not intended or oHered tor sele. If, however, ihe building or improvement is sold within one year o� completion, ihe owner-builder will heve the burden of proving that he or she did not Duild or improve for purpose of sale.). ' ❑ I, as owner of ihe proper}y, am EXCLUSIYELY CON7RACTING W1TH LICENSED CON7RACTOAS to construG !he p�qeU (Sec. 7044, Busine5s end Pro(essions Cotle: The contractors License Law tloes not epply �o an owner of property who builds or improves ihereon, and who coniracts lor such pmjact with e contracror(s) licensa pursuant to the Contractors License Laws.). ' ❑ I am eaempt under sec. Signature: Owner ID verified by drivefs license. ❑ Ves ❑ No Business and Pmfessions Code tor this reason: Veniication of Ownership by (lype of document, i.e. - property tex blll or deed): DIVISION OF INDUS7RIAL SpFETY PERMIT CERTIFICATION: Dnvars License No. Date: Eapires: ❑ I hereby certify ihat no excavetion five (5) or more teet in depth inio which e person is required to descend, will be metle in connection with work authonzetl by this permit, and ihat no building sirucWre, scaHolding, falsework, or demolition or dismantling ihereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Gry 2, Ar12, Sec. 341, Title e, Califomia Atlministrative Code). , ❑ As owner-builder, I will not employ enyone to do work which would require a permit irom the Division ot Industrial Setety, as noted ebove, unless such person has a pertnit to do such work trom the division. � Signature: Date: Division of Industrial Safety Pgrmit Numbec CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTHY: I ceAify under penalty ot perjury ihat I have read ihis application end state Ihet ihe infortnation given is correct. I agree to comply with all state laws end city ordinences releNng ro building conslmction, and authorize representatives oi the City of Coste Mesa to enter upon ihe ebove-described property for inspection puryoses. I egree not to occupy or ellow occupancy ot eny building authorized by this permit until final inspection. � n t Legel Owner(s) S��1ate � � An Or Authon etl Applicant Date COOE �. INSPECTIONTYPE Qdg 1676 Fiaetl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Ra-Roof 201 Final8lock/Retaining Wall 202 Final Factory Fire Place ' 203 Finel Si9n 204 Finel Demolition IMtfIALS fQ,Q€t INSPECTIONTYPE 206 Final Mechanical . 208 Final Plumbing 210 Final Electrical 212 220 222 250 Finel Fire Prevention Final Planning Approval Final Site Final Builtling�Occupancy Q�IE Itffi� '-a -o � � S 929 DAHLIA AV ^mE: JACOBSON, DENNIS ooaess: JACOBSON' DENICE + 929 DAHL'!A AVE COSTA MESA,CA 545-7223 pHCMIENGINEEP: PUOflE55: � . " uxir: 92626 flEG.NO.: ' . I1NIT: PEHMITTEE: MORRIS CONSTRUCTION ( 714 ) 572-8719 aooness: 2138 TYNES DRIVE PLACENTIA CA 926Z0 LICENSED LUNTXACTOB OECIABATION: I here�y allirm that I am IicenseA untler pmvisians ol Chapter 9(commencing with Section � 7000) ol Oivision 3 0l t�e Business antl Pmfessions CoOe, an0 my license is in full force an0 effect. , CITY UC.: / �j S7ATE LIC.:18OS7O CLASS � �ate'. �� `�� ` � Signature�. — WOflNEflS' COMPENSRTION OECLAflRTION: I �ereby afiirm thal I have a ceniticale ol consem ro sell-insure or a certificate of Workers' Compensation In�(� °ryq[y,cp�niliea cop,y ereol (Sec�ion 3800. Lab ) �.POLICYNO.:Pn�<V/7V4—V� E%P.OATE: OISSI93 � ' comrnxv: GOLDEN EAGLE ' � Ce�ifietl copy is Aereby fumi5�e0. ❑ CertilieE capY is lilea wii� �he i u'x Division. � , �a�e:/o`'��• /1 PPDlicam: - E%EMPTION FBOM WOFREBS' COMPENSpTION OECIAflATION: (This sec�ion need not be cample�etl il lhe permii is for one �unOred ($1W) ar less�. I cerlify Ihai in the petlormance of �he work �ar which Ihis permi� is issuetl, I shall noi employ any person in any manner sa as �0 6ecome sublec� to the Worker5' Compensation Laws of Calilomia. _ Oa�e: - 'SignaWre'. � NOTICE: I�, afler making t�is tleclara�ian' you 5�ou10 bewme suhlec� to �he WorkeK Compensation Dmvisions oi lhe Labor ' Cotle. you mus� brNwi�h comply wi�h such provisions or �his permit shall 6e�tleemetl revoked. . CONSTBUCTION IENDINC AGENCY: I hereby aifirm tha� Ihere is a constmclion IenAing agency for Ihe peAormance of �he work for � whic� Ihis permii is issuetl (Section 3097. Civ. C�. ' LENOEfl: ' - . ADOflE55:� ' - — - . � �. OWNEP BltILOEB oECLABRTION: I �ere6y affirm iha� I ain exempt imm t�e Coniraclors' State License Law for ihe following reason (Sec�ion 703t5 Business and Pm�essional Coae: Any ci�y ol coun�y which requires a permit �o cons�mct, alter, impmve, Jemolish, or repair any simclure, prior to ils issuance, also reduires Ihe avDlicant for sucn permit to tile a siAned statement Ihat he/sne is licensetl pursuam lo ihe pmvisions of Ihe ConVac�ors' S�a�e License Law (ChaO�er 9(commencing with Seclion 7�00) o� Division 3 ot �he Business an0 Pmfessions Cotle) or Ihat he/she is exemp� �herelmm and Ihe basis for the allegetl exempiioa Any violation of Section 7031.5 by any zpDlicant for a permit sublects t�e apPlicant io a civil Denalty of not more �han live hundretl Oollars (5500�. . I. a5 �owner ot th¢ prop2tly� or'my emyloye¢5 wiih wages a5 Iheir SOIe compen5ation, will Oo ��e woik, antl Ihe ❑ s�mcmre is noI inienaed ar offeretl �ar sale (Section 7044, Business anU Prolessional Cotle: The Coniractors' State License Law tloes noi aDPly �o an owner ol a pmpetly who builds or impmves thereon, and who does such work himselUhersell or IhrougA � his or her own employees, provitled [hai suc� impmvements are no� in�en0etl or otteretl for sale. It, however ��e Uuilding ar , impmvemen� is sa10 within one year ol comple�ion, the owner will have Ihe bur0en o� pwving he/she Ai0 not builtl or impmve for ine purpose ol sale). � I, as awner ol lhe pmpehy, am exclusively coniracting wilh licensetl conVaciors �o cons�mcl Ihe prolec� ($ection 7044, Business ❑ antl Pmiessions Code'. The ConVactors' S�a�e License Law tloes no� apply lo an owne� of pmperty who builtls or impmues Ihereon antl who conVacis lor such pmlects with a wnVac�or(s�license pursuant�o �he Con�ractors' S�a�e License Law�.l am aware Iha� prool al t�eir Worker'S Compensation insurance 5hoW4 pe pmvitletl �o me. � I am exemp� untler Section: B. 8 P. C. lOr �hi5 rea5on: � Da�e: Owner I 0o nereUy cenify Ihai I am aware oI an0 untler5lan0 i�e requiremenis 01 Califomia Health ana Safery Cade Setti0n5 25505, 25533. antl 2553A and tha� I or any luture �uilding occupanl willlwill no� (circle one) neetl lo comply with SaiU s�a�e cotles antl Ihe requiremenis for a permii lor cons�mction or matlification Imm Ihe Air �ualiry ManaAemen� Oistrict. fle5ideniial conSVuclion applications are exempt �mm Ih¢5¢ pfOV1510115. Oale: ApDlicanl: I �ereUy teriity I�al I �ave rea0 �hi5 aDPlitation antl Slale thai the above ini0rma�ion i5 wrr¢ct I agree Io tomply wifh ali ciry antl Counly ortlinancesantlstatelawsrela�ing�obuiltlingconslmc�ionantl�erebyauthorizerepresen vesollAiscirytoenlerupon�heahove�mentioned pmperry lor inspeclion p'ur/pose/sJ / �Dale: �� —/U'/ � Signature: Driver's �icense or Sociai Securiiy a: t64t�C6 Wbite—Buil�ind: Green—Gotle EnlorcemenC Canary—Aoolicanl; Pink-Revenue: Goltlenrotl—A sessm ,' . ,CITY OF�COSTA MESA — BUILDING PERMIT ' PERM NO; B 06039 PERMIT NO:�B 060390. • PLAN,CHECK NO;�� N, GOVT; N,SUPP: N CONSTRUCTION TYPE; V—N � PERMIT TYPE: STR PURPOSE; ALT � ' - JOB DESCRIPTION ; T/OFF RESHT, REROOF•WTIMBERLINE . , SQ FT; 3,000 CLAIM VALUE: 3�,000.00 CALC—VALUE: 3,000.00 GROUP OCC; R-3 r/ COMMENTS: SMOKE DETECTOR RE�UIRED PRIOR TO FINAL - �t+t�t�t�t�r�t�r****�r***�r�**�r*�r**�e� �r**�r�r��r�r�rx�****��**+t*�r*��t�r+r�rx�r�*�******��r****x**�t*�t Z O N I N G R E Q U I R E M E N T S - S E T'B A C K S ------------ MAIN BUILDING ---=------ --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN- ,LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARRING'REQ•"" . PROV;. PARCEL; 41218338 ZNE; REF NO; PLANNING Nt3TES>� � j ' �s �f it iF�E it 1F �t itr it if it k ik iE_it.it itr i6 iF it it it it ibif iE k it if it k iE if iF ik �E ik itr it itle iFit it kit it it if iF i! iF iF 1E it if iE iF k if it it it iE ib it iP *� iF�it iElt �F it ie it if 1E D E V�E�L; O P M E N T S E R V I C E S, R E Q U I R E.M E"'N�T—S ' , ZONING APPROVED BY � DATE; � �l BUILDING APPROVED BY ; DATE; •.�—•' r;i� ' �I 2 APPLICATION ISSUED BY: ' 'DATE:.��','I � � ifiEiEiEikiklElEiEfEitfflEiFiEiflEifiFiFlf3f iFiFlfiFififiF�Eik3f i!!E iEiEiEiEifiFifiEiEiEitillElE�EltfElE�fiE�kikiffFiE iEififiEifiEikiFilit ifikifiFitiFikjElk3FiFiF�lkiEiFiEikifiElEikitifiFiFlFiEiPifiPiEiEitiE�EjkiEkil�lEiE LEGALIZATION:N " 'F E E S O M'M A R Y` '',STRUCTURAL SEGMENT;Y . � � HLDG PMT PLUMBING.. EliECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT _ 54,00 ,50 PLAN � � , SMIP/NON—RES , ISSUE FEE - ' BUILDING—DIV—>-- :PERMIT._. ISSUE,_.pLAN-CHECK TOTAL .. _ PAID _D,UE . „ TOTALS----> 54.50 0,00 0.00 59,50 " 54,-50' � ,00 " REVENUE DIVISION TOTALS-->. COLLECTED: �54.50 OVER/SHORT; ,00' ' BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK , •54.00 ' • ,50 � .. � � ' k iE iE f! �k iF iE iE df ik 1E �f 1f iE iF 1FiF 1F 1k if if iE iE iE iEiE iF 1E if iE iE if iF if 1F if if iE iE iF iF iF iE �E iE iE i! if iE 1! i!lFif iF 1F if iEiE if 1E if iE 1FlE iE iE if iFiF iFif 1F iE �F iE �k iE iE iE I N D I V I D U A L F E E B'R E A K D O W N � � TYPE QTY D E 5 C R I P T I O N � UNIT COST TOTAL COST SFR 3000 . REROOF BY VALUE RESIDENTIAL NOZONE ' 1.00 3,000,00 END OF FEES 0 Ui YQ�.�n:!'.{I��J��i-.C. b-�(jP f�NT�: 1::/�:'%t: ',`:�i=', � i:�� 0 � 0 , VoiRUCT10NAND,PL`ANNING-�,y'�5 � � -- � �� __ .�. P�-_�&SPA _ � - � ;' ,. pate Inspector ` '' � �Date � -lnspectorM , PPROVALS Permio# �,, � � _ - _ r. .. . � - APPROVALS Permit # - � . � �, ir - �.�.�TemporaryElectiical Service�or Po�G,�� ' -: _ : '52. Pool &Equipment Locaiion. � - ' �'�{ = r - � , � 2. Soil Pipe-Undrgmd. '• �;,+� �; ' � 'f ' �; , 53.'SteeC:Reinforcement -- � . r : f� .` 7 ,� .r. ^rw rr x' - i ' _ �'..; _ - �. ��;3.iEi@ctncalConduii;UtilitY-Undrg�nd ; .,, �;�:' 54.�Forms�' _ ..- � - v - - � � r .' 4;!�Electiical ConduiYUrSd�grnd. ,� � �= ' ' - _ 55. Electrical Boriding _ � � - °� " n.s n• �.r : �:' 5 `St2el'Reintorcement .. ' ;�' � " � � 56. �Rough�PVumbing & Pressure Teet � `'� •G � � - ` �:6• Electrical UFER.Grnd. - ' ` ~�� '?'`.' � `� 57.'APPROVALTO,COVE_R;GUNITE �`k �., - • rr 'S!P_�Footings �,�� _�� ' � ' ', _'` , 58."�ElectricalConduit�Undrgmd. � ��5 ti��.�-�oundation ;��:., y t �` �- ' . 59. Gas Pipe, O�Undrgrnd., Test I.'1 .�.�... . /. . . / i' " 9. Water Pipe-Un$�grnd.'��, f r -' ; y � �' _ 60.--Backwash Lines, P�Trap, O Undrgmd. � - � i, � 1 � •. - 10. Structurel Ploor System. � � i � C i - • 61.-APPROVAGTO DECKr. - .: � r �,� .{v ii. Prop�erty Sewer Line�&.H �u��Conrtectio�� f '� : 62. Backwa3h & Receptor-F,inal' /:' 72. Sewer CaP _ � �, `:� �' � ""ji ,;4� 63.-,.Heater�& Ven{-Final , r, Y `U� �� . - �� i:. - .._. : -_ : . _. . 13. Roof Drains '�' � 64. Ptumbing System: FinaL,. - ��. � . .� _ . . ;-� - - � 14. Rough Plumbing `� �' � • . - 65.�Electrical�Fina1 �� - - " 15. Rough Electrical-Conduit ; � . � - 66.-Solai-System=Final � ' ' ' ' _ N. r��16. Rough Electric Wiring`. �. _ 67. Fencing & Access ApP�oval � � 17. IRoughWiring$ign �� , ' � - `� 68..APPROVEDFOR.PLASTERING � � 18. Rough Electrica4-T Bar�Ceiling € 69.;�POOLfSPASYSTEMS FINAL � `"19�. Rough'Heating'&'Air'Conditioning` `- - " -- ' "" FIRE DEPT:�REQUIREMENT �� - ' ' J U' c7'i� .L� F �C *' .'� 20."Rough F�ctor� FaiBplace � �'-T! �� '`' '� �=' G'# * �APPROVAES��' =Permit # ` >` =r 7� !:i S �.:.- i S T :.'-'r. � H �t �' �3, -� t .�- t � H . - � i�[•� : ? �L 1-Y "J .a �. � . .9•l' J'V 1 n ,4 21;.DuCts, in,Sxructu[e. , .. •. ;.�� r ;� t-_ �-.'•;!: �K -j7p, UndergwunddHytlro �t� 22. Dusfs, Ventitatirig!'� � ��a R ^ � d`� �` ?77, productYP�A�rg O'G�s �;Oil n �;r i n > :-� a. �^, .J>: �. ` T, ` �. .. � fi �: �S �.��:: .�; ^ : I � x a ,�, 23.,Ga5:Pipe_Rough 8i�'�est � �r,� a: �r, �' K[ O�!: x-+72. Undergiound Fiush�-.� -. G 24TM'fto6f Praminq S�� i F-fr vE a> t� 7�l �� *?73sUndergrnc�t Storage T�nk � Gas' OOiI i .s: M :� �+ S Hr.? . .,�.. 25. Roof Sh athing Y��' ' �" ��' - V ' " �' �v ��-' � � �: s .� < ,r. � 74:}O,verhead�iydro�� 26:�T-8ar Ceifing (Stcucturaly &�Monocoat Y 's' C3 ;�fi � 75� Dry Chem;cal tt `� ^ " �= 'z 27,`.`Frame and Flashin ` ?�~ ` ' R� '� '� " , r,: + �s x „ .r, � �� .i,� c_ ,9� .,r.:'G :c c y ;t: i• 76: D"ry StantlP�pe i.ci O i--28��Lathing;&Sidin9^-,s"� .�.��,...� � '�:' "Ky 77?FIXED�SY�TEM'•P�INAL�°.y h �� '29. Insulation '`' �K'� S '� �� ' ; "� ! 78<FIRE PREV. FINA�L F ^� ;� I'' ' �� -.�. � ., v �., - :. ,. .. ... .. .�30. Drywall:Nailing :•Z�+ ;< � -' F x +- HEALTH�DEPTSREQUIREMENT� « � c ,� s. '�`�j37. Plaster Brown Coat� , ; �.i-�. , ;; r ,.79�'P WAL INSPECTION r " - �� 32:,-Elecirical Power�Meter..Finali ~� �u ^� �%='� a c80:�.F00D CERTIFICA�TE ISSUED � - .4 ( ' 'a' �' 4J �33�Finai Elhctric, ��i. ,� � � :: `*t i.f •: :. -,Nqf s ,''�r ��. :�: �, t 2 -k -� � '�: '�.r; . Y'7 C,� .3.; - . y . i fi .�. ' � . . �s� • �4+ l e <: �� ;. . � � . P- :.. �, �. . +� �.t34rFinal Heatingi& Air:�Cooditioni�+g; i� r �' � K�FK< -� ,� C�i = �; � ;.J :'\.. . �. � � . ii 4 � �J {! .'35.^_`Final Gas PiPe-Test� .,^-' - "' • ,.;�" , t� `, �r' �.:" •-`'-' t) X. .: H i '.: % 7 'ZO �-1 � .-. Y r t •• �� •• :`- n w �.� . .-�� .. , . �36TFIood oi.Canopy` M � �y , � .c . � _ _1� .� � t•r - - n ,�37�Fina1 Factory Fiieplacez � S,r „i , M �n , z z ;� ,; - ;. .. * a: :� : 38.•Final Plu hing L;r �•�n� j � w x �V �.� � � • �-:D �,j � - .� i' r� - .?39. N'ater Seivice=Finan � � a, � ': '� C� :� r '- ,z �: � � ' - : r �. j ��40. Gas Service-Final � r � rrt�' :> _ .a � x J�� '+-+:� � � � � 4 ✓ s'41. Solar pomesticFinalS i'� � •• ^ =� ` - -+''� ��'• * � r k -[ r ;7 :1 `-42r'Backflow Preventer,� ^ ��. �'� , �'� �'' � . ` ry ; x. ,+ x �: �-7 .::-,. _43. Backflow Iri.iyation" �'c :` - '. - a;:=o � a -� . r r a.c i' :: �, i �� . ff44�. LandscaPe I'�'cipation SYstem� -j� � x �: (�`• �,7 = � �i x :+) ,,; C,; v " �i ;� S45�Sn��d Attenuation - . v ^ -- -^ rx': � �� c R,� ,- '< �n '. �: :r � .y t � a: T • . c +: / ~ • ��46rHandi� R gulations � � :� ` � �� ,;, •y :' �� ..y . _ 47�.�FIN'AL STRUCTURE & BULLD�NG � � /�,� �� _� ^ � r � ;i r : /� , r :�+ .z ;. . 46:'_fINALPLANNING� ��_ � u � � -� w . .� _ � ',., . 1 ay ,r �- .J c49.^,Electric Release to:Edison i * � " �• `: � � � � . x r. •f` J _ 1 . . _ .' .: � � .� � � 'K -. .. - u._ � t : v ''�50,�Gas Release to Souihem Californ�a Gas Co ,: I �? �,. �c - - C . -,�,.; � - � • � =511 CERSIFICATE OFiOCCUPANCY I j; � ; ;i ;nn ;� •i , �� No. Date ' • Ii Pp0.1ECT AOUHESS: J 2 9 DAHL IA AV OWNEP'SNRME: SACOBSON, D£NNIS .,,.aooeess: JACOBSON DENICE 929 DAHLfA AVE COSTA MESA,CA 595-7223 ABCHIENGINEEH: . RODNESS: 92626, uxir: flEG.NO.: • " UNIT: PENMITTEE: MORRIS CONSTRUCTION ( 714 ) 572-8714 AODHESS: Z138 TYNES DRIVE ' PLACENTIA CA 92670 UCENSEO CONTHRCTOfl OELIABATION: I heieby alfirm �hat I am Iicense0 untler provisions ol Chapler 9(commencing with Seciion 7000) ol �ivision 3 0� Ihe Business and Pm�essians Cotle. antl my license is in �uli lorce antl eneci. ' CITY LIC.: 5T TE LIC.: 1 S O S% O CIASS: _. ' Date: — �� Signature: �� — � WOBKEHS' COMPENSATION OECIABATION: I nere0y ailirm ihat I have a certilic f con ent to sel4insure or a certiliwte of Workers' . ComOensa�ion �ja P7J�{' �yr�f{ie co�(%� ereof (Section 3800. Lab. ) ' ' POLICYNO.:�^�LL�I`��—`"� EXP.ORTE: �I'SII93 . �omrnxv: GOLDEN EAGLE Cenified wpy is hereDy fumishea. ❑ Cehilietl copy is tiled wit� th ciry 8�1 mg Oivi a � � Oa�e: /� — � � /� APplicant � E%EMPTION FBOM WOflKEflS'.COMPENSRTION DECUMTION: Q�is 5ection nee0 no� be complNetl i� Ne permi� is iorone huntlretl ($10�) or less�. I cetlity I�al in Ihe pedormance ol the work lor which �his permii is issuetl.'I shall no� employ any Derson in any manner so as ro Decome � subleti l0 �Ae Workers' Gompen5a�ion law5 of Cali�Omia. ' �ate: ' Signature�. NOTILE: II, alter making ihis tleclaration. you shoul0 become sublect to Ihe Workers' Compensation Dmvisions of ihe La6or Code. you must �orthwi�h comply with such pmvisions or t�is permi� shall �e Oeemetl revokeA. CONSTBIICTION LENOING AGENLY: I hereby a��irm Ihai Ihere is a constmciion lending agency tor the DeAormance of �he work br w�ic� �his permn is i=.suetl (Section 3097, Civ. C�. ' , lENOEfl: � aoosess: ' OWNEfl BUILOEfl DELLAPATION: I Aerehy aifirm �ha� 1 am exempt imm Ihe Contracbrs' Slate License Law for �Ae tollowing reason (Seclion 7031.5 Business an0 Pmfessional CoGe: Any ci�y ol counry w�ich requires a Dermit to constmc�, alier, impmve, Oemolish, or repair any stmcture. prior �o ils issuance, also requires the applicant for such permit Io �ile a signetl statemen� ihat he/she is licensed pursuanuo ��e provisions oi ihe ConVac�ors' Sia�e License Law (C�apter 9(commencing wi�h Section 7000) of Division 3 of �he Business anU Protessions CoOe) or ihat he/she is exemD� Iheretrom antl the basis lor t�e allegeA exemDtion. Any violation oi Section 7031.5 by � any applican� Por a permit sublec[s Ihe apDlican� to a civil penatly af.no� more Ihan �ive hunOfeU tlollars ($500). I, as ownerollhe propeny or.my emp�loyees witfi wages'xs iheir sole�comDensation;_Will Oo.the.work, an0 ihe ❑ s�mcWre is not inlentletl or ofieretl for sale (Section 7044, Business an0 Pwtessionat Code: The Coniractars' State License Law Ooes noi appty to an owner o� a pmperly w�o OuilOs or impmves lhereon, antl who Goes such wark himseli/herself or thmugh his or her own emDloyees, provided [hai such impwvemen�s are noi m�enAetl or o��ered �or 5ale. II, however �he 6uiltling or ,�improvemem is sold vn�hin one year o� comple�ion, ihe owner wi0 have ihe Durtlen oFpmving he/she Oitl no� bui10 or impmve .lor Ihe Durpose ol sale�. , � , � . I. as owner ol Ihe property, am extlusively coniracling with licensed coniraclofs lo cons�ruct the pmlect (Section 704d, Business ❑ antl Pmlessions Coae: The Cantractors' Stale License Law doeS no� aDPly to an owner o� pmperly w�o bmlds or impmves �hereon antl w�o comrac�s for such D�ole��s with a conUactor(s� license pursuant m Ihe Coniractors' State License Law�. I am aware Ihat D�oot o� Iheir WOBer'S Compensation insurance 5�ou10 be pmvitletl �o me. � . � I am exemp� under Section: B. 8 P. C. � ' br Ihis reason: - ' Oa�e: � ' Owne[ . I �o hereby Cenity �hai I am aware Of antl untlersiantl Ihe reQuirem¢ms o� Cali�omia Health antl Salery CoOe Seclions 25505, 25533, and � 2553a antl Ihai I or any luture �uifUing occupanl willlwill no� (circle one) neeU b comply wiih Saia s�a�e cotles antl the requiremen�s for a permil �ar conslmciion or modilicalion imm �he Air Oualily Managemen� DisUici. flesitleniial cons�mction applica�ions are exempt imm �Aese pmvisians. �ate: ADpliwnl: ' I hereby cerlity��at I have reatl Ihis aOPlication and sla�e�haithe aboveinforma�ion is correcl. Iagreeio comply wilh all ci�y antl coun�y ortlinances an0 slaletaws relatingto building cons�mdion and hereby aulhorizerep�emn ' S of�his ciryto en�er uponihe above�mentionetl pmpetly �ar in5peciion purposes � . Oate:,/`� !L z —� Signamre: � � orrver's �icense or Socia� Security x.� 1641-46 White—Butlamq', Green—CoOe Enlorcemenl Canary—Aoplicanl; Pink—Revenue: Goltlenrotl—Assessor •, CITY OF COSTA MESA - BUILDING PERMIT 'PERM NO, IB 060435 PERMIT NO: IB 060435 � PLAN CHECK NO; N , . , CONSTRUCTION TYPE: V-N� . PERMIT TYPE; OTH STR - PURPOSE; ALT JOB DESCRIPTION� ; REINSPECT. FEE FOR ROOFING PERMIT B60390 SQ FT: ,' , CLAIM VALUE; CALC-VALUE: � GROUP OCC; R-3 ,/ COMMENTS: SMOKE DETECTOR RE�UIRED PRIOR TO FINAL � • , iEiF1flPikiFiklEiFiEiFiFiflFlEiklEiElF1E,iEifif�fiEdF1E fEiEiFjfifiEiE�E�ElF*3FiEifiEiEiFiE�EiflEiEiEfflFlEiEifiEiliEiFiE�FlEifiEiElklEiFifiEiFiEiE-IE1fiF*iE Z O N I N G R E Q U I R E M E N T S S E T B A C K S, . , ' � FRNT; FT �IN BUILDING ---------- ------=--,ACCESSORY BUILDING --------- �IN REAR; FT IN FRNT: FT IN REAR; FT IN LEFT;. FT IN RGHT; FT IN �LEFT; FT IN RGHT: FT IN PARKING REQ • . PROV; PARCEL; 91218338 2NE; �' REF NO; PLANNING NiSTES> � ' ' • � �.: . � - . . 3F ik iE fE iE 1E if if iE if ik i! if iF iElk ik �E if iE �E fF if fk �F iE iF iElE iE�E �F fF �E iF iElF iE k-1f if iE if if iF iF �F ik �f iE if iF iF iFif iFlk iE iF if iF iF ff ik �k 3F ik �E k,dkaiE iE iF if iE iE iF iE 1f 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 ErN °T S . 'f:_ _. ZONING APPROVED'HY � DATE; �J�':i BUILDING APPROVED HY : � +� �DATE: V_ APPLICATION ISSUED BY: 5--�_ DATE,: <<': 1 Z'�-C �L� iFil�i4ifiE1E1FiF�ElEififlkiEiFiFititiflEjfif�FiFifiFiFiFiF7F'iFifiFiFiFiF�f�F�F7F3FiFiF 'if3FlFiFiFiFiF'iFiFiFiFififiE-1fiFiEitiE-lEi!'iFiF' it3E iF 3E iE iE iE iF jF �f if �E iF iFlf iE if �F �E fF iE �E iklE �Elf iE it iE iE iE �E iE if iF if fF�F 3E 3E iE if iF 3f jF jf jF jE if iF if ik �E �E if IE 1E�f iE if -l! if iE if fE if iF 3k�E iE�! 1!'iE if �t it iE if if !f ik 'LEGALIZATION;N' . F E E �S U M M� R Y�: ",'STRUCTURAL SEGMENT;Y HLDG PMT PL'UMBING ELECTRIC- MECHANIC ; FIRE SMIP'/RES GRADING PERMIT 30.00 �%y , PLAN ✓ ,SMIP/NON-RES ISSUE FEE � 'L BUILDING-DIV->: PERMIT. ISSUE PLAN'-CHECK TOTAL � PAID; DUE TOTALS---'->;_. 30.00 0.00 l, 0,00 30,00 30,00 , ,00 � . . ' _ ' " _ , ' � REVENUE DIVISION TOTALS--> •- COLLfiC-TEDe "' —`30:00 OVER/SHORT:. .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE •SMIP/TOT GR'ADING PLAN-CHECR- . 3�.00 , . . L'� ; . � � . , ' � ^ I i .- iE iE iF �f iF �t iE i!!E �F iE �F 1E iE k if if iEiF iF iF ik ik iF if iFif iFif iE if iEil1E 1E iF1E iE ik�lif iElF iF k iE 1E 1f if it iE iE 1k 1t ik if if 1E iF 1E il� iE iFiE iElE iFlF ik 1f iF if if 1E if iElE if 1E I N D I V I D U A L- F E E B'R E A R' D O W N ' � TYPE ' QTY �D E S C R I P T I Oi NY�� UNIT COST , TOTAL COST INS 1' BUILDING RE-INSPECTION FEE 30,00 30:00 ENDJ' OF FEES , . .. � ' /�� /� �a . � � % F3 t-,,.� , . 3/z�1 � ��-; _, ; i i +Y .. ^ "_ ' �r? y'!�' ; Ll�i�: . _. ... : - ��'tL . ?, Y � � � . . ' � . . _ . . . . '/ _ � . _ . . - _ _ 0 I - ��. -i� -- CONSTRUCTION ANDiPLANNING-> �k. • � � ? � �- ` " P�- - �' SPA, � . -. �^ -'� ` ,t; �Date • 'Inspector - -' � � "� '� Date ^ Inspector) . APPROVALS Permif# - - ;,� APP.RO.VALS_ Permit # _ �' = i" - - - � �i �Temporary?Electiical 5ervice or Pole,�, - �' � �52.�Pool`& Equipment. Locatiori ; � � � - x � 2. ,Soil.Pipe-Undrgrnd. � -� ��; � '� . i �� -. � �53 �Steel-Reinforcemeni . - � � �' �,,,3;�Elecfriral Conduit+Utility•Und'rgmd�-� � - : , .. o- 54.«Forms � , - � , . N L � R�4.'Electrical Cond�u�t Undrqr�d�.� ''- =�: � 55 ElecVical Bonding. - � . �� .� G ,,. ' ` = - y �r 5�.Stee'i'Reinforcement, '_ . �' � � `�'�, � � • 56. �Rough:Plumbing & Pre;SureiTest • v� �- r � ...: ' ,: ` ' - .. '- . , _ . . . �. ''-! 6. Elec"trical UFEki'.Gmd; �� p �� -- '�°? 57.`-APBROVAL�TO COVER�GUNITE ' � 3� ��r - - `y�7.'rFbo{ings ;,.,., �.�� ? , ' � � _ � 58. Electrical Conduif�Undrgmd. °'� t � _ , ` �i8.. �Foundation J >a ^ � � r , � 59. -Ga'rPipe, O Undrgrnd.,-Test _- .__,� _ _ - , 9. lVater Pipe-Und�gmd.� , '� ; � � �' � 60.;Backwash GneS;P:Trap,_��Undrgmd.�- _ _ �.,j� �'�� 70. Structurel Ploor SYsiem ;� � �� : . . 61. APP�ROVALTO DECK' i - ;-• 17. Froperty Sewer Line�& HoG"se Cohnection _�- ° 62. Backwadh &'ReceptorFF.inaf �. - - > 12. Sewer CaP V �• : . •� _ � ' . ' '� � � ' - ± s a: t, _ 63.�`Heateri& Vent'-final ' r 13. Roof Drains �' � ' �� '' � 64. �Plumbing Systerri�� Finel � �Y n ,, 14. Fough Plumbin9 ��- �`_. 65. Electrical-Finai .� _� .- � i 15. Rough Electrical�Condult � . 66.. Solac System�Finai - � , . 16. Rough ElectricWiring• - � � - • 67.: Fencing & Accese App�ov'al � �,. � •_ , j : k - � � 17. Rough Wiring Sign � } ! . , , ! � . � - . . - . � � . , 68.'APPROVED;FOR PLASTERING 18. RoughElectrical-78ar_Ceiiing �� . . _ _ 69'POOLLSPA'.SYSTEMS`PI�NAI � '19"Rough Heating & Air Conditioning -��`- ' � ` '� ` ��FIRE DEPT, REQUI�REMENT - � '- � � " ' - - J r � � � tc - h w l � t . 20aRoagh FpetoTy sireplace ��! ^; { C� O �� X TqppROVACS?'-Permit #' � t 27: Ducts, ipJStrfctuier j ` . . - S '> � �� i70. Underground Hydro � � 22�Ducts, Venti�atiri�q': � ��C •? ��'� �` '=7�. Product'Piping O''Gas I�OiI G� h i.i r� i i. � i� � i � - x t^ �rt w u - ; i "rJ .. �.f � - � 23.,Gai Pipe�Rouyh $�:�est � ;.,� �; t C. _� ,,,; ;� _,7y, Underground Flush� ,. 24!-Rotif Praming "�> ' F c- rE- a� «� G t�' *�< �73.':,Undergmd. Storage.Tdnk'O Gas ❑ Oii v+ ±..a f"�r hi x .� --�:�..n � 25. Roqf Sheathing Y;,, �I, � '� ' �= �" �'�` � '7470yerhead Hvdro `� � 26.T�Bar Ceiling (Structurall &SMonocoat 'r � � o, K � 75-"D.ry Chemical � '` - � .7 T v n r� x �, :� 27: ��Frame a�d Flashing `� '� 'A ' �' 76: Dr Stand i e ` ` � � � w .-�.-�, ? t'. w Y P P ..� � . `-�28vLathing:& Siding:�� :^ ''y•L;� n f` � i 77: FIXED SYSTEM F.INAL V �' '�29. I�sulation T"� t' =�� " I; s 78:,FIRE PREV. FINAL �-. . " �J � C30. Drywall'Nailing �� h ' HEALTH�DEPT. REQUIREMENT ,. � �c � `31. Plasrer Brown Cod,t` � � ii � � ` "k ; 79�'FINAL INSPECTION ' � � : - " � ,�32b+Electrical Po�er.Meter: Pinali `� - ' �. +_ r,gO:�.FOOD CERTIFICATE ISSUED `-' _ ' � .� �� ,~33�Finai Electric u � r� � E ,'`, `� � �. ;� �'Notes: _ _ " �l�� • � ^j34nFinal Heati g,& AirConditioning, � . �� ~� � r �. ' � _ 5 r�,:, /I�i t F � _ 1(�/ It�� ' 35`.sFiriaiGasPipe�Test` " .`'�` G '. "` � ,- ��, � ct . �:�:�^ � � < s. : � v c . � _ ; 3 �36i1Hood oi;�CanoPY_' . � � �. <<. � �" : �-- " ,�'. � ' �;�* .� '., '37>'Fin'al Factory Firepiacei `•' `' x .' ,`� _ #• Y �38. Final Plumbing "j x �W � ^... �J .. I i � �ti - r ,. - �"'39. Water Service-Final� f , • =- ` s , I . ��' ' �;: - ,40. Ga3:5ervice-Final � r �.y, << r , - � �^ c '� - � � � .. 7'41. Solar D'omesticFinaiS f�` ^ -� ^� I �' +� 2. �S ( �� C I� �`. L ..7 I ' ` a ' E'42: Backflow Preventer� � _ x . _43. B2CkfIUw Irfigati0 � �. :� - � w: e. `� ', � � � , r . �-: � ' � . g, " . . +� . _. U Q',44. Landscape lirigation System; g�i ,, ., - - �-c :�: J� .� . , c•; .. �. ' „ _ . : - -' -. ' ` . _ T�45r'Sound Attenuation � . . �'`. - r. _ ; .,, . _. ,_ ,K_,. f. . �- - a: r, r,'•; �.: • � i'. • �.,t.' a�: .,_ � �' - : �iJ . . ..n i! " .. „ J46; ,Handicag Regulauons � ,; � ,. ; � ,, �; - ; 47c�PINA�STRUCTURE&8U1�DWG` •� r ~ ' � x r �,'48:cFIN'ALPLANNING �r:==; `��' � r;, c r ' � 4 .. r_49.�Electric Release to-Edison � � i� ` .. � � -. i. � -6r.K .+ t. .. n 'k I h- l . i ' . • �50� „Gas,Release to Sou(hem Califomia Gas Co -� �, x .� _ _ - . , �� . `.51i. CEBTIFICATEO,:,OCCUPANCY �..n „ ;; „ -, ;� p� r� No. Date - �""'�'�... , � _�." . . � • • - • _ _ - ' ' ._. . .-. Appl¢ant �o fi11 in all.ipaces exeept.those.within heavY�borEer.lines.anE Sign aIl aoCrovriate tleciarations. . , _ . _ , _ _ - _ : ,y _ q . . �/ . j �� CITYtiF COSTA� � COj�NST�UCTI.R N�'PERj/�l�� IT � /u �!� � PERMIT^� NO. (� 3 'T-R-7ACT NOp. . , LOT NO�. � � UNIT NU. _ � , � � � � i ; ! ; � � i I � ProjectAddress �� ✓�� l�' M/i(�i'� L"��I1I�./I/K�Urli' '•7��d i � /� %O i i i.J � —�� t � . 1 t r ; � 7 �( Appl¢anYS Mailm Address� ° C6ll �� -1 D/SMNA �f'pt0 P TYPE OF CONSTRUCTION � �NEW ADD �� ALTERATION REPAIR � � ' � ' � �-9-- � . O CONVERSION ❑ OEMOLISH_ ❑.OTHER ' ' ' .q p, # _ .��„- I g 'j � ., . ., '. :, _ _ Zone ...�I. . Owner'sName -��'��aN ��„ lV IS� 1 phona�-%�'��; i - � ' �j . 1 _ . . � -DESCRIPTION OF WORK/US OF B G.� � � � . , . . . ; Address �`'��q ��'L� �' ' ��' � � f, . % • � ' _ � ;� ! 'E Main Building: , � � � Accessory Building: Z Arch/Eng � LicenseNo. � � "TVPEOFPERMIT ; �GRAOING F UrvDATiOrv TRUCTURAL ;T Front � '��G�.J�G �l e�Q�l(i�369-GOQU3ti74 �•T � 34D,pij . ; � �-� � , � . ❑.TENANT ELECTRICAL� � WMBING EGHANICAL B Reaf� � '� I - N� Address ; . . . . . ' � ..�� orHER• - . - . , . � i ' t : ' . . .A� . . � • CJ' ; I. Contractor's Nam = .• we �• �- Phone . � - - " � � • � - •C Ri9h{ . .�as /i � ' � "' � � ' N� ;� �E : :` � � ��I PROJECT DESCRIPTION SQ.'FT. OCCUPANC � ' ;� Addresslmailinp) . '\J�y �� -� X ; ., � � , _ -�G.LG� . � .�rCONSTRUCTIONTVPE �/ �- �/4LUATION$ � �+�Zf�S� ;g Left� �� r � � G Gty LicenSe No. •;ZONE � GRADING CV. VDS. iACRES � R � LICENSED CONTRACTOR DECLARATION � J � , � 'Ping: Ref. # , Parking Req./Provided " �I E' !• 1 hereby atiirm that I ain licensetl.untler provisions of Charter 9(commencing Remarks: � ' ,• � �- , ' '� n with section �000) of Division 3 of the Business antl Professions Cotle, antl � C�� 'I �- a ��1� I S' ;•' � �Planning Notes: �rje��...' r f M ' my license is in full c ntl�effecL � r ' � � �" � ' �� ' � . . � - , - T � L�cense Claj� ' � ' �Lme�n,ie'Dlo �3�/�'3 � , t = 8 � � � � ' � � } - � S � . -�ate �//Z - a t ��G+�----j�%'tS� , { ' • ' PLUMBING . '; 'FEES' . . � . � � � � � � + .> �� 'ORKE 5' OMPENSATIONDECL/IRFTlO� i� � . ' � - � 1 u - � ' . hereby affvm that I nave a cerLtmate ot consent,to self-insure or a certiLcate � Bar Sink . ' Showers � y i ,. ELECTRICAL � �FEES " t i of Worke�s' Compensation, Insu�ance, o� a certifi¢tl,cOpy thereot ($ectlon �' BddkflOw Pf¢v¢Ot¢I ' ServiC¢ $ink '' � �' � ` I ,. . . i . . , : . � � . • AutomaticWasher � ,, Transtormer�01550KW�� }� 3800, Lab. CJ � . � - � . -+ . � . r- ' - - � � 50+KW ' Policy No. - Company � � Baekflow Irngation ' � � Sewer Cap . , , : � „ , ' Constructwn Pole Su6' - • �'� ' � � ; e Certifietl mpy is hereby fumizhetl. � � .� . , �- - ` - ' Cerlifietl ropy is filetl with tM1e city Builtling Division. t ;[ Bathtubs ,� ' Sewei Connection� �� ro .Cooking Umt , . Meter �up,to 100 amps� � , Date APPlicant � t .. , . � � �- _ - . . •. � '. . ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION' � '� Clarifieri � �� Solar Collectors _. � ' . Dishwasher- !. ; Meter QOv¢� 100dmp5 : � t' '� , ' (Thissection neetl not be completetl it the permit is for,one huntlretl ($300) or � � - . � less)�. '� � -. � , . �_ Dishmrasher - � Solar�Piping ; � � � Dryeis ❑Gas' �Electrre ', Sub Pariel, � , F I certify that in the performance of the wo - or whic his rrn�t i5 issuetl, I � y '" ' � '�''' ' ' ' shau notjemploy.an person in any ma er so as t bec subject ro tne a t Drinking Fountams .- - ' Solar Tank ' �' � � �• ' `Fan ��Motors �0-1; HP 01'h� 8, � ` ' j Workers' M1t�e sdt dn Laws ot Califo a � : � ; ' ' . . . " ; . ' 3 � f Date � Z Si9nature � � ' . Ploor Drains' ' - � Swimming Pool w/Spa� � F.A.0 � � � � 'NOTICEi If, ef er making [his tleclaration, you.sh ultl�beco e subject'tdthe- ' - ' - _ InaSolar �9-75 HP: �76-15+_ . Workers'�Compensation provlsions of the Labor Cotle, you mu5t forthwith � " FIOOYSinkS � � U�in01 '_' - �Fi%tu�¢5 f � . � MiC�owave . �. compry with; such p�ovisions or this permit �sha1P be �tleemetl �evoketl. � ^ � ,` ` -_ � S _ �CONSTftUCTION LENDING �ACaENCV . � i ' , Gd5'SBrvicE �'.l1' OUilEiS � �' � W3t2f�CIO5E2. . �'. ' � � pp '� iDevice'Boxes ' - � � , r � ^ . 1 herety afflrrzi tM1at there is a construction lenaing agency for the performance � � ' � �^ ` :' . , , ' fJ •" �Pole'Light'� ' . � ,l,�, � � ' ' of the work for Jwhich this pe�mit is ;issuetl (Section 3o9T Civ. CJ , Interce rors �'� [�'T � � °� � � , ;: Watei Heat¢� '' � ' �" � :+ �i � "` , � " � / ' . � Lentler's � Name ' �' � ' � � � - P - � . ' i _ � • Outlets� , � %r '� � . Range � ,- � � � Lentler'{Atleress "� �"" " ' -- ' 'w ' ' t- ' ' Kitchen.Sinki � � � '' a ; Water Service ` ' � Y Switches'^ i' '� - " � '�' - � � . � I OWNER�BUILOER-OECCARATION � . � ' � - � 1 - �� _ �5�� - � - . �.�� ,Siyn. ,y � �N I hereby,affirm that'I.am exempt from the Cwtractor's LicensetCaw for the � Lavafories W �. �'�' Auto=Wash � �� > j pv _ Garbage Disposal , �p �- „i,-t^ -St2nding Sections � � following'reasare (Section,]031.S,Busine55 antl Professional Cotle: Any city or ' " ' � ' " _ � , , ^ - ,- � -� r �:�� . ` ' . county which reqwres�a permit m wnstruct, alter,�improve, tlemolish�or repair � + p Trap ��s � -o �)-• Laundry Trays '� � �,Generator OO-5 KW 05-75 KW ° e�:. . �.%' � "� any, structure; pnorto•its issuanc¢, also �equires the applicant tor5uch'permlt= � � ' y' •' I• '/ . T,ldSh COT�CtO� „� � �, � to (ile a signetl,statement thdt he/she is IicenSetl pu�suant to the p�ovisions of � ' / - � �"y. :J�r_' :p1 ` ' .J,3 : �, . R, . ^'� , . - � �Roof.Drams - _ � :he�Contractor's�L'icenze'Ldw.(Chapter 9.(commencing with SectionJ000),of �rR �' � _ . �� Oivision'3 of, the�8u5iness an0 Profe55ions Cotle) o�. that he/she is exempt � ' � 1 � . .-.._�...:. . ' ' _. � " Iherefrom antl lM1e basis fo� the allegetl exemption. Any violation of Section � ' ' - - ` - � _ � - - -' ^ �� ' _ ! i .�]031.5 by any ap0licant fOr ai pe�mit subjects the applicant to a civil _ �� ' --' - � " j . ` enalty,ot not more than five huntlreG tlollars (E500).: � � - � ! . ' • ' �.I, �as owne� ot the.property �or my employees with wages as their sole � ReipSpectiOn F¢0 �$15 � �,, � : IRu¢ Fe¢ $ 3 ; , _ - �.w�� compensatlon, will tlo.the work, dntl Ihe structu�e is not intentletl or offeretl ;R¢inspection Fae ' $15 .IsSU¢ Fe¢ -- ' ��n � '� for+sale�(Settion 7044', eusiness antl Professionai Cotle:, The Contractor's � , � � � � MECHANICAL ' , � FEES• - - � License Law does not apply to an owner of a properry� who builtls or imOroves � ' . , .. . thereon,�antl.wM1o.tloes such work himseif/nerseli or through his or her own - . � � - ' DEVELOPMENT SERVICES REQUIfl�ME�s: , -��, :� y a� ' employees, proJitletl.tnat such improvements are not intentletl or ofteretl for Boiler ; Hood or � Type I ❑ � . /' $ '•.sdle. If; however, the builtling or improvement is soltl within one year of com- -� , � Canopy ' Type I I�❑' Zaning Approved By -__� / '�Date __�_� . ', pletion, tbe'owner will�have Ne burtlen Of proving he/she tlitl no[ bwltl or'im- t DUct - Und¢nG�OUOd � .-, , : - . Byilding App�oved By � � Dat¢ '' '- �� p�ove for the purpose of sale). - - j w i � � '-� ' � : , _ � � �.� �.!�.ft ❑�I, zs owner of tne pioperty, am exclusively roniractin9 with licensetl con- � Duct - Sttuctural ` � Refrigeration System , _' Application Issued By - �' '� Date ��- ��__; ' traCto�st6 mnsttuct the'projecL(SectionJ044,.Business antl P�otessions Cotle: . ' • , _ The ContractoCs Licenze Law"tloes;not'appty to an owner of property who Duct- Ventilating� .. ❑0-100,000BTU ❑100,OOO�BTU �" i -- �SUMMARV� FEES � , (��% '�� '� �� . builtls or Impwv¢s thereon, antl wM10 contracts fo� such Orojects wlth a con- ' - - ' � � tractor(s) ucense pursuantto the'Contractoi's �icense law). I am aware that , ExhaustSyst �.MWtiple �� System Repair/Alteration : � BUILDING PERMIT $ � z43.� �$MIP� '$� ��Z �' � � proot oE their Worker's Compensation insurance shoultl be�provitletl to me.. . _ . . . �PLAN CHECK � $ � ' PERMIT � �� *• � ' L7 I am exempt'under,5ection. , B. &-P. C: for this reason•, Firepl/Fact Blt. ICBO Fire.D'ampers, ' ' �� pLUMBING' ' $ � if� •O b' ��SSUANCE �'�$ , Date ' • �' �owner - �' - -� � "- � � Heating-System & Ducting Registers . - DU . ' -p�qN CHECK � 25% $ - - � �. .Z.S� �. ENERGV P C. , $. I 'herebyl certiry that I have reatl this application antl state tM1abthe above ❑0-100,OOO�BTU �100,OOOBT � . . - - : , $ � ,2� GRADING - , $ ' informabon is corr . I a9ree t compty with all city and county;orainances , ' ' . .ELECTRICAL, �, ' ' antl•state laws rel �ng to-buil {ng nstruction, antl hereby authori;e��ep�e - � - � � � . ' � . ' '% � MICR�FILM� ' $ � �ry v - � PLAN CHECK so% � s- �� i I� . G � sentahves ot tni at to-e er� n the ove-mentionetl prop rty- r . - . + ' � - ' ; ` � '= - . � .� , . i . inspection purp s. �;"� " � ' � � � � ,MECHANICAL , $ �`% V � � u'G• Si9nature' °j � � •. Date'S � ' -' . ' �, �.. ' .. . ' _ . ' • . a4� TOTALFEE : $�� Reinspection Fee � $15 �Issue Fee ` � $,2� PLAN CHECK" 25%' $ __ �L (�S_ s ' Diivers' License o 55 � � � CMF 0fl65-46, rev. 30/84 White - Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Aszessor . , - . .. _ _ _ . ..,:.. - . ._. _ .._. .;_.} :-. - - - �- --- -. -,--�-- T - ---- - _ - � i : -- -�•- ' c . .,. __rn .' . "'` '+ ' ' ;•`i7w� �ii�' . . i ; % POOL&SPA � ..,,.,, :�,: :. =1, � . CONSTRUCTION AND PLANNING •J.�--� --I-^� � - �-- ,- -�� -� --� ��-- � - ,- �� + � - � - ._ .�i.ti i f Date "c`� ,.Inspectoi� jC � � • � ` � , • Date '..Inspector �APPROVALS Permit# � .�� . APPROVALS P.ermit# ` � . �. - '��_ f:±. ,.i : i ; 1 1RTemporary Electrica(�Service:or Pole ' ! �}� ; � 52. IPool & Equipment Location ' � � � . G • ..y. T_. . , �A , � f-.�.'-•- -- 1_.. ( r � I ' . , 2. Soil Pipe-Undrgrnd:'� � � �Q� � � 53.'Steel Reinforcement" ^ � � j� � ' �i ' s�9 �'6' � , , , �. , , , , � 3. Electrical Conduit"Utility-Undrgrnd. � ' � � � 54. �Fo�ms` � � :- � . �Y"! �� 1 ' � :✓ � �.�' � �. 44 Electrical'Conduit-Un�drgrnd. ' � ; . ' i � `55. jElec4rical Bonding .� , , �- S �� • t ' ! � 5: Steel Reinforcement , � ' ' ��,J ; "56. �Rougfi Plumbing & Pressure;t�est � � ��`;,_ -' � ! 6. ElectricalUFER'Gmd. ' - 57.�APPROVALTOCOVER-GUNITE � ,c��: �e r .. r . � = �v,_.:.�.�.� ' . � � 'b r '• �i jiZ.�F.00tings C �ii� �:� � 7 .� • , a- � 'Gj - 58. Electrical�Conduit�Undrgrnd.� i � , «.,� �: , « : h'8-.VF.oundati n , ;j�- :d�,1 ',_, � �� ,�� G, � � 59. �Gas Pipe; O' Undrgmd., Test`+� ' � • - ` ' : �. ' 9. N/afer��Pipe-Undig7nd. '" � � , � S f� �Y' GP.n': - � '60. �Backwash, Cines; P ITrap, O'Undrgrnd � � ` �� .� �r � 10. Structural F.loor System � � �� ' 61. APPROVALTO�DECK' ,i � � � , +`; : ; � • � 11. Propert Sewer Line & House Connection � � � t � ' � � -�` Y � 62. �Backwash, & ReceptorFinal� � � i , �� ; r '� _ f% r'tfsr 'Lk0 �. � rr � ,_t � - �12. Sewer Cap � .,. - � � � � 63. Heater & Vent-Final � � � ' fi1 �; �i�.� � ,13. RoofDrains� . �� ' ' � - � �� 64. PlumbingSYstem-Final � , i F �i- '�'�. ' 14.� Rough�Plumbing - � ,. � ; �. � �ji tQIY� �G�j,I� � 65. �Electrical-Final ' � � �i 15. Rough Electrical-Conduit - . - - � � ' •�66. Solar,System;Final ,'• i �= i . _ �- ; ' 16. Rough Electric Wiring ' , � ' � G-G/,��'' , , � y 67. - Fencirig & Access Approval � i , ;�, _ � �• � , �. . _. . .... __ . _. . _ �.. .. ,- . .,.. ... 17'. RoughcWiring Sign� . ; , ' � : .. ' � 68. APPROVED FOR PLASTERING � � � ' 4� � C' 1 1 C �/' •! AS! Fough'�Electrical-T Bar.Ceiling =' -(j - .)? . ; 69. POOL/SBA SYSTEMS FINAL .�r� � � � 19. Rough Heating & Air Conditioning ' �a/� L� �' FIRE DEPT. REQUIREIVIENT �� - 20. RoughFactoryFireplace � � ! APPROVALS � Permit#' - � _' '-� � , : �. � 21. DuCts,in'Structure . ' rt � : i 70. Underground�Hydro� - . ' � ' � - 22. Ducts, Ventila�ting: , , ' � �-�-�Y � RO 1 71. Product Piping O Gas ❑ Oil � - � � � �� ;r�,� ' �� 23. Gas Pipe-Rough &,Test � . ' . 72. Underground�Flush ,-. � " 7� - %; � �:i ` '24. Roof,Framing � � . ' , �,73. �Undergrnd. Storage Tank C7 Gas �D Oil , � � � - � 25. Roof �Sheathing� , ' , � y r ' G 'J4' Overhead �Hydr,o� . � �U�, c ' ' � ' f � _ 26. T-Bar Ceiling (Structural) &'Monocoat � ' � -' � � �75.�,Dry�Chemical ��'� f ~-��V, .. � t�j �� %�' �',C�J .� • 27. Frameand Flashing � , � , , 76. DryStandpipe i . 2) ' '} (�` ` � .. l b b' Fr' -- `c0 ; c• `'1 , ;- ��; ,, :�': ° �28. Latliing & Siding , . , � �a ( . 77. i FIXED SYSTEM FINAL��-� ' ; - � ' � .. , . ' . . . .; :I�'' r 29. Insulation\ � ' � f/ i✓ • � 78. FIRE PREV :FINAL ,._ i, � � � , 30. Drywall Nailing � � ', � f�� (y � � 1 , � HEALTH DEPT: REQUIREMENT - •��,� .� , 31. Plaster:Biown,Coat � � � • " ' 7� �$ ; 79r FINAL IN$PECTION ,,��, �!L` . t • � '�;_ 32. Eleciriral Power Meter-Final � � - � , , � � ' � -;80. FOOD CERTIF.ICATE ��ISSUED � � - �� `r� ` .33. Final�Electric � � � � � _3-� ' � Notex' "' � ' • , � � _� � , " �r'�•` r �.. 34. Final Heating &'Aii_Conditioning. . � � � - ' � - ��. ' � _'' ' N' -Hf C.ftr�-'- i.i CcS QC (Is : 35, Final Gas Pipe-Test _ . _ '_ .. . _ '� _� � .' _ ' - ._ � '. . . ' ' . " � � 36. Hood or Canopy - _ , � . � , (r .�� !�, 37�+Final Factory Firaplace- - - � � .. _ , � - � � ��' . ,�� -y� j 38: Final Plumbing . - - _ . Y�f=:� (,�Ep a-: __. �% . ' �; � ��/ •. . S , r �� ;�� ' � _r., 7 39. Water Service-Final - ' � ` �� .' �+�� . . ' � (.' � t' T-.', � 40. Gas Service-Final . ' � '. - � � . ' ; j'�, " ,� �_' . .. � . a � . �f, 41. Solar•DomesticFinal - . '- . � _ A ' " ' . - �^'.�` . - � yll ' ' ' .' . .,� K �j: - „42. Backflow Preventer . � , � ' ' ;( ' : +': �. ' . />, : I� �_ (, _ - 7 ,. : . , �a... t/.� `- 4,. r . `43.`�Backflow Irrigation. � � � � '� .� . � , a v. -,. . � ," � � `• .. - - n t,1e �� J� . : Y. %f'Ir ti- 1. ��44 `�.tandscape Irrigation System - � - � ' ' -� '? �`�� i ��'v �' �� ' � "�' } % t .l, i . .y. � �45. Sound Attenuation . ' . . _ " . .. . �,.. - � ' � � �s��;1 4 i. � ��' . 46. Handicap Regulations � .'- � � ' - � . � L ..:'`;'�;�'� t �- = ' "�= � � I�. 'r.Y` f 47.�FINALSTRUC'fURE&BUILDING 7 � �� ' � : uL�,, � p' �'f "7�j1;�. ;';�.-,�.:' �48: -Special Requirements Completed • . � - �"� � � � � ij�, ,- , l � A„{r-.•�; M i' . - 49: Electric Release to Edison; - � � . � ';,; .: � , �,j.• _ ' . , t-•'.t+! ^' � - r � .,-50. Gas Release to Southem California Gas Co . � . � r � �� • � . A �� - ... , . - . _ . .' , 51. CERTIFICATE OF OCCUPANCY _ - . � c .` � � � _ � - - . � � _ � . _ _ . � No.- ,Date. . . . . . _. � , ..�. _...�_�..'_� . � . ._'--^--- - ...`��s_�"- -- - . � � . � . �. . . . . . � ` Developer Address: 1'elephone : . . ; .. , ,;; � � CERTIFICATE'OF COMPLIANCE PAYMENT�OF SCHOOL FACILITY FEES NEWPORT-MESA'UNIFIED SCNOOL DISTRICT . � ��-o� � ' , . Tr-ac-t/-Pa�r-ce-1 and .Lot Number(s): Location' of Project: �.�-� ��iA- � . , u Number of Square Feet of� Residential Space ', ��O - x $1.50 Number of Squaie Feet of • Commercial and ` Industrial Space { x $0.25 � �O� T o t a 1 �O�`�' �� Total � The provisions of Government Code Section 53080 aie not . applicable. . ,. ' � , „ � This cert`ifies.tfiat the'above-named Developer/Applicant has paid school facility fees in'compliance with Government Code Sections 53080 and 65995. � Che'cks are to be made payable to Newport-Mesa Unified School District. , - '� � � , � /� �"�>r�l� /L�v�}'��✓l7,C¢i+l�tJ � �� e � Busin'ess Manager � ' Newpbrt-Mesa Unified School District The above representation as to square footage is true. Developer/Applicant agrees.that if it is later determined that such representations a�re not true then this cer.tificate shall auto�natically terminate and the appropriate City/County shall be notified. ' ' � �' , i � � �� Date; � %% � � _� � � ,l. i� . per./App�licant � \ l!� l�Z �/�nl� . e e Jdg ��.��ss � �i� S �l�- % JA-�a �s�, CCF.� `tT(. Q L �B�l� 0 , , �t . . = m ; � �� .. 3 3 SS�� '' ��' ��.� s ,� .�`( -�. �'L/Nf� l 7�d 2 �ca'lcf-�-7 .�i� �. �� '� � �� 5��8� ��-� f �.-�.��.� ;c,� N�--� ��-, � c�-�� '�� b,�� ' � 5 l %�� s�� `�� s �� u OWNER CRAZN, MCCHAEL JOB ADDRESS ' 929 Dah: GENERAL CONTRACTOR � 'AP No. 12-1 3-3 LOT GAS WATER SPRINKLING SVSTEM MISCEL�ANEOUS ROUGM NEATING ANO AIF CONOITIONING �` TEMPORARY SERVICE-OR POLE - UN�EFGROUND � POWER � ROUGH WIRING TRENCHES �' FORMS �' STEEL REINF. FLOOR SVSTEM ' BONO BEAM ❑ STEEL REINFORCE [� SHEATHING . FRAME AND FLASHING LATHING - IN n OUi PLASTER,BROWN COAT MBING, FINRL ANO GAS T CTRiC, FINAL f�7 DATE4-25rT5 SUBCONTRACTOR . v�ia00 900� *•-***8:50 � � , l�P3 7_�-75��.�st, ,: , �� COSTA MESA BUILDING-SAFETV DEPARTMENT ' � . . � � P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � , - - '� � � PP lC ION FOR BUIIDINGPERMIT � For Applicant to Fill in Complete/y � R EI DATE RECEIVED DA E ISSUED - BUILDING ' � �� ' i ^ � ' ADDRESS �t 10 (� � OWNER . A.P.N .��""IO�^�U P R NQ. �� MAIL � � BUILDING �j�� '.� . ADDRE55 .. i� ADDRESS � W W " TEL. Q / � a U GTY Q S e,C� . NO.' TAACT �O LO'�O—� BLOCK - Z Z Q CONSTRUCfION ' , ' , . �) � W AD . O N LENOER � �i � ' a m '� J � BRANCH '—"' � ' � � ' �J t0 . . , OWNER E. � . Q W ADDRESS � ' . ;� . . , tt1J �'� i VAWE m ' ARCHITECT � TEL � T $ � J a OR ENGINEER N � � PIRE Z a -- � �� ZONE TVPE ROUP w � AD�FESS d W ' � �I APPROVE , J O CONTRACTOR � �� BV DATE — � m Z J � ADORE$$ ,i W W - ZO NO.OF USE OF NEW � �= CITV� �" , - ' NO�.� P�� Z BUILOING � � ZH WO STATE . ' qTY VARDSAPPROVED VARDSAPPAOVED , y� LIC. NO. � LIC. NO. MAIN BUILDING ACCESSORV BUILDING � O ' (FROM GL STREET) SIZE � �' .� NO.OF,BLDGS. (� �}. . , OF LOT 6p r— � NOWON LOT FflONT p PT.%--- FT. ' USE OF � �' � ' EXISTMG BLDG. � r T. � FT. � SIZE OF �NO. OF ° . Z NEW BL OMS' �� STOFIES L. SIDE �FT. FT. �% COVEERINGA" COOERING FEAR /� fT. FT. J USE OF BUILDING AND WORK TO BE PEFFORMED DISTANCE BET. BET. MAIN & d 1'' ' MAIN BLDCaS. ACCE55. BLDGS. a ,Q T � � VAF.#` DATE � � O / i '' ' � C.U.P.# . APPROVED . . , F �� . APPROVED�/ G� � �S" � y �•T/ Z . • 0 � I herabV acknowletlge that I have reed this application and rtate - jthat Ne ebove information is carrect antl agree to comply wlth . � � ell laws �ag�la2ing building construction, and I shell not employ F anY Person in violation of tne warkman's compensation laws af - y the State of California. �' ZI heraby certify thet I am proParly Iicenutl as�a conttactor untler. O SQ. FT. � the State of California Business end Professions Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDER VA , _ Chapter 9, antl Nat such licenses are In full.force antl atfect, or I THE PURPO6E OF ESTABLISNING A P am exempt from the D�ovisions of he State of Californla Business VALUATION entl Professions Code, Division 3, apt � 9. � - �� PERMIT FEE : Signature of /�///f � � ' /A/� .� . ' Permittee /�U $ �/�IQ � PLAN CHECK ! (�y . Authorizatl ABent TOTAL FEE 9 W O ' R i ¢ � W N . 7 m / `o LL ��.. .. r . I�. �'� _ �` ,.� . . . . . . . .. ' 35087 Pp�� dI1G 15-72�M,F001012# ***142.85 �, . . � , . . . - � COSTA MESA BUILDINGSAFETY DEPARTMENT _ � � ' � . � ' _ � . SOLC P.O.BOX7200 COSTAMESA,CALIFORNIA92626- " - � ' � . � r� ° � PPLICATION FOR BUILDING PERMIT.�� • � � • ' ': ��.�'' - Fo'rApplicantto•Fillin�Completely � c ev DATERECEIVED pATEISSVED . � ' � = �/y 7 no�o ess �Dahlia�1Adenue• L ; ` , . .. , . �I . :_ . . � . . ' . , PERMIyjd9' � . OWNER Larwin S�outhern�.,Cali•f::' Inc.�.- � �A�P�^1O� � � � J/7 ' MAIL" ' - BUILDING ' - / '� �, AODRESS 16255 Ventura BLVd. '.j , ADORESS '� ' � �/�('/ � d U CITV � ' NOL�JH6-HHJO �- TRACT ' LOT BLOCK ' , F Z, Encino Calif. .R � Z Q CONSTRUCTION . W� ADD A� P ' 'f-. �LENDER Larwin Southern Calif.. � . . _ O�m-:- ...,, . � ., Y - . � .. ;: "S. .' - -' - , � �. eanNcA^16255 Ventura Blvd.' " ��/�� 'I ^ J�� - . OWNER� ry/�WI��✓ �C , N� ^' m J' ADORESSERClilO Cd11P. '-' U .1 ' ' ' ." � ' / - , .. /^ VALUE ' ag J m.• ARCHITECT ' . ,. - • ,TEL ' � - SE � /��K �� $�� • � , a ORENGINEERLHYWIR' • N .2%3-�F�FG�F . . U Q ." . ,. . � _FIfiE � ' /T� w � ADDRESS 9100 W11SI11T0 � . Be.VET'Lj? Hll`LS� � �ONEr� - � �TVPE . GROUP , .! � dW- .. .. � ,.-. . .n : ..ry . JO CONTRACTORL8LWIR Southern Ca�l'if. . ' evP y DATE'�'i�>� � „ m� nooaess 16255 Ventura $LVd. � ZONE I NO.OP USE OF NEW �' /�� _: � � � � - , , TEL. � p�qryg BUILOING� zF cirv Encino,, Calif. No.986-8890 02 Gci� � R� —� � STATE � CITY-. � �'P.ROSAPPROVED. VApDSAPPROVED � _ y� uc. No. 191311 UC�'NO. B-1 MAIN BUILDING '�� . ACCESSORV BUILDING � . �0,; - � (PROM-C/-5 EET�'_. � ' � - �� SIZE � , . NO.�OF BLDGS. � • ' � _ '� '- � OF LOT � . (�1 X LOO� � NOW ON LOT � � . RONT' . FT. . FT. . � USE OF ' ' EXISTINGBLDG. - - ` � �f�. S� FT.. .FT �'� SIZEOF� '�NO.OF � �Z NEWBLDG. 1�40�. qOOMS �" ��STORIE5��1' -.LSIDE.�' ��FT. • ' ' ~. FT ' ' a .EXTERIOR WAIL ROOF � � ' ' ' V COVERING `� t O COVERING� d�� Il�il REAR � T= FS. � ' � J. -USE OF BUILDING AND WORK TO BE PEFFORMED: '' DIS7ANCE BET.' -� BET�. MAIN &� � . n' . ... MAIN BLDC$. ' ACCESS. BIOGS. a . ' Q' ' . . - ��'q: ' .. VAR# . . . ' DATE� _• � . .•-Q- ', . `i ' ' C.U.P.#` ' 'APPROVED . . r . , �. .. . .�.. .. . � APPFOVED LU .. ' �Z�' vi o s r s'n amil dwellin �p�` � : O . ^ s; ' . / . ~ I. nerebv acknowletlge �that I have reatl Mis appliwtion and state �� HOLD FOR� SPECIAL' RE�UI �' that the above information' is correct and agree to complv with ` M � TS` �� all laws regulating. building, consvuction, antl P'shall not employ � � _„ , F any person'in violaiion of che�workman's compensation laws of � ,� � � y the State of Calitornie. � . ' ^ . , , � � �, � �� :`� �.. ' � � ' - � � � . zI hereby ceriify ffiat I am properly �licensetl as a contractor untler SQ. FT: � O � � the Staie of �California Business and Protessions Code, Divisicn 3;�„� ,THE AMOUNT SHOWN UNDEF VALUATION IS FOR � � Chaprer 9, antl'that such lic'enus are in tulLforce antl etfect, or I THE PUFPOSE OF,ESTABLISHING A PERMIT FEE ONIV: d � ., am'exempT.from ffie provisionsof the�State�of California Business � - „ ¢� . antl Professions Cotle;•Division 3, Chapter9l � � , � . ' VALUATION' _ .. : • "" � � , - �j PERMIT FEE� $ � � � SiB�atare of� . � � �yb m /i�LrJi'�� D. Downs '/ .,�- .:. ' E . Permittee��_ ��'� $�T� . P�ANCHECK'$ ' ' Authoraed Agent � � Y�� / TOTAL FEE ' $ / � LL