HomeMy WebLinkAbout932 DAHLIA AVE - Building Permits�
�
CITY OF COSTA MESA .
t(, �p MF BUILDING DIVISION
%�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� � '� FOR INSPECTIONS CALL: (714) 754-5626
'"��^"` PERMIT NUMBER. E10-00239
PERMIT TYPE ELEC STATUS: ISSUED
APN: 41218332 DATE ISSUED: 10/13/2010
..___- . _ . _ ISSUED BY: RMD
JOB ADDRESS: 932 DAHLIA
Vicinity: .
SCOPE OF WORK:
OWNER: BARNET.
PHONE: 714-549�
APPLICANT: HAMILTON
PHONE: 949-097-49:
CONTRACTOR: HAM
Address: P.0.'��
Ciry/State: LAGI
ELECTRICAL PE
Electrical Plan Check
Electrical Permit Fee:
Reinspection Fee
TOTALFEES
f' '.N.
!} d :
�I , r
M �;r �'
�°-: r er�
� �r
<�
)HN i `-��
i=,�
'� I .
X1761UniG � �P
4 BEACH„CA � Zi
d `�
1:
r ,�"
MIT FEES �
ee �
�
:; s
�
;M�� u �" ; 'i
- _ �,. -. . �„.r-. �., _ : t' .
BREEZWAY FOR SFD.
� ' ?Address: 932 DAHLIA AVE
� "City/State/Zip. _, COSTA MESA
. � ., . , -� i�
�
' Address �� Unit ��
^ �„�:�� � - "`City/State/zZip '
. � t�aa t � � 's � ��..
� " i
°, -�3 License No:;?^6'�
�� . . _.. . _ ,., :
IONE: ._949d974939 _.. . � ,-}
�Code:�92651- ��"% ' CELLi ���'�
��� '' sv ° .'i.':.
3 "_,.._ _ .�e-�. / ,1 �---
�� i
�0:00 - _ '
$54.00
$0 00
$54 �00_ �,,', � s
�;, ,
y, �,, ` ,� �-�a
r ,� � �, ;z � �� „ �
�,; � : '
� �-z :j' � ., >�' �
'�T' 1 ifd a ti h 1_- , .-
f
-' — „r
P . `� �. : ".:... i ... , ;i'
.::� 1 x
�
��y� _y,
z'+
�*'°s t G ,�, r
"iy ,2 .. -��
NOTICE: ,The work authorized by this permit shall'comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) � �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized unBer this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiration of this permit.
COUE N. INSPEC710NTVPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
207
202
203
204
Final Block/Retaining Wall
Final Factory Fire Place
Final Sign
Final Demolition
�RTE
INTITIFLS COOEp MSPECTIONTVGE
206 Final Mechanical
208 Final Plumbing
' 210 Final Electrical
212 Final Fire Prevemion .
220 Final Planning Approval
222 Final Site
250 Final Building/pccupancy
DATE IN1111AL5
/ , � ; �� �►
WORKERS' COMPENSATION DECLARATIO� Owner ID veri(ied by drive—r's license. ❑ Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations' ��� _.' �Driver's License No. Expires:
❑ I have and will maintain a cerlifcate ot consent to selt-Insure for workers' ::,' Venfcation of Ownership by (type of tlocumenC i.e. - property tax bill or tleed�:
compensation, as providetl for by section 3700 of Ihe Latior"Code, /or'tlie �
pertormance ot the work for which this permil is issued. _, „, _,-- - -
❑ I have antl will maintain workers' compensation insurance, as reqwred by� '�' �. ��.��
section 3700 0( the Labor Code, (or ihe peAormance of the v+ork'for which�ihis ��� ��DIVISION OFJNDUSTRIAL SAFEN PERMIT CERTIFICATION:
pertnil is issued. My workers' compensation Insurance carrier and policy � I hereby cetlify that no excavation five (5) or more fee� in depth into which a
number are: person is required [o descend, will be made in connectbn vrith work authonzed
6y this pertnit, and [hai no building structure, scaftolding, falsework, a demolition
Carrier: or dismantling thereof, will be more Ihan Ihirty-six (36) fee[ high. (Chap. 3.2, Grp
(rnissectionneedno(becomplefedAMepeimnisvalveaaronehuntlredtlonars(9too)o�less.) z MZ Sea341,TitleB.CaliforniaAdministrativeCode�.
Policy Number: '
��I certify that in the pedormance of the vrork for which this permit is
issued, I shall not employ any person i� any manner so as to become subjecl
lo �he workers' compensation laws o( C,alifornia, and agree that if I should
become subject to the workers' compeqsation provisions of ection 700 of
th ab Code, I all fortlwe� mply with [hese pro� sions %� �
n �
AG-�� 2nfs SignaWre ��
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions of Chapter 9,(commencing
wilh Section 7000) of Division 3 of the Business and Professions Code, and
my license is in ful fo ce an effect.
u�." tt� �J � �O aa-�> G /'
r� v
Conlractor's ignaWre le^ ^^"
CONST CTION LENDING AGENCY:
❑ I hereby affirtn [hat [here is a construction lentling agency for the
pedormance of Ihe Hork (a wfiich this pertni[ is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affirm lhal under penalty of perjury thal I am EXEMPT FROM THE
CONTRAC70R5 LICENSE LAW for the following reason (Sec. 7031.5,
Business and Pro(essions Code: Any city or county which requires a permit to
conslruct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ihe applicant for such permit to file a signed statement
lhat he or she is licensed pursuant to Ihe provisions o( the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 ot the
Business and Pmfessions Code) or that he or she is exempt Iherefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 Dy any
applicant for a permi[ subjec[s ihe appliCanl to a civil penalry of not more than
frve hundred dollars ($500).):
❑ As owner-builder, I will not employ anyone to do work which would
require a permit trom me Division o( Industnal Sa(ety,-as notetl above, unless
such person has a permit to do such work from the tlivision.
AOPlicanfs5ignaWre _
Division of Intlustrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICA710N:
1. Will the applicant or present or fulure building occupant need [o file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous ma�erial? ❑ Yes ❑ No
(Section 25505 of the Califomia Heal[h antl Safety Cotle requires, with some
exceptions, that a Business Plan be fled wilh the Costa Mesa Fire
Department by every business which has a[ any one lime tluring a reported
year a ouantity o( hazardous materials equal to or greater than a weight o(
500 pounds, or a volume of 55 gallons, or 200 cubic tee[ of compressetl gas
at standard temperaNre and pressure).
2. Does or wiil ihe applicant or present or (uture building occupant need to file
a regislration form for acutely hazardous materials? ❑ Yes ❑ No � -,.
(Section 25533 of the Cali(omia Health and Sa(ety Code, with some
ezceptions, requires registration with fhe Costa Mesa Fire Departmenf by
each business which at any one time has on hand a quanti[y o! aculely
hazardous materials equal to or greater than a weight ot 500 pounds, or a
volume ot 55 gallons, or 200 cubic feet of compressetl gas at standard
temperature and pressure). .
3. Does or will the applican[ or present or fu�ure building occupant need lo
prepare an RMPP (Risk Management and Prevention Program (or aculely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of [he Calitomia Heal[h and Safery Code provitles that the .
Costa Mesa Fire Department may require the preparation, certifica[ion and
fling with Ihe Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials wilh the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Cali(ornia
Health and Safery Code been (ully complied with? ❑ Yes ❑ No
5. Does or vnll the applicanl or present or future building occupant require for
the work which is the subject of this application a permit for such constmction
or modi6wtion from the South Coast Air Quality Management DisMct or trom
any other air pollution conlrol tlistrict or agency7 ❑ Yes ❑ No
(Section fi58502 of �he Califomia Govemment Code requires that Ihe requested
information be fumishetl on applications fa noo-residential building permits).
6. Will any part of Ihe facility to be consUucted under Ihis permit be within
1000 feet from the ouler boundaries of a school? ❑ Yes ❑ No
Q( "yes", Ihe facility musl meet ihe requirement of Sections 25534 and 42303
of the Califomia Health and Safety Code).
❑ I, as owner of lhe property, or my employees with wages as their sole 7. If a pertnil (rom the South Coasl Air �ualiry Management District or other
compensalion, WILL DO THE WORK, and [he strucWre is not intended or air pollution control district or agency is required for the work which is the
oKered for sale (Sec. 7044, Business and Professions Code: The Contractors subject of this application, have all of the disclosures prescdbed by California
License Law does not apply to an owngr of property who builds or improves Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
thereon, and who does such work himself or herself or lhrough his or her own
`employees, provided [hat such improvements are not intendetl or.oRered for �8.. Qi "yes", attach certifcate of compliance from the appmpriate air polWtion
sale. If, however, the building or improvement is sold within one year o( �control oKcer�.' � � , � `.' � . '�
completion, the ovmer-builder will have the burden of,proving.that he or she CERTIFICATE_ OF COMPLIANCE: I certify that under penalty' of perjury the
did not build or improve for purpose of sale.�. �� ��•' ' �`��' �'information-given above is�covecL I agree�to comply�with albstale laws and
' '� � � � city,ordinances regarding,HazardousMaterials and Emissions. . _ .
�Or �I, as ovmer of the'proper�ly, am;EXCLUSIVELY CON7RACTING WI7H ' ,
LICENSED CONTRACTORS to construq [he pmjec[ (Sec. 7044, Business and � � � ' '- �� " -' ��� ' ' '
Protessbns Code: The contractors License Law dces not apply to an ovmer ot Siqnawre oaie
property who builtls or impmves thereon, antl who contracts (or such pioject with
a contractw�s) license pursuant tothe Contractas License Lews.). �•
❑ i am exempt under sec. " �' �'
Business and Professions Code for this reason: � �
�� ' " ' � ..Signaeore' � Dale
3�51�96�(3%0]) . . ^ - . ' '• . . . .
CER7IFICATE OF COMPLIANCE AND AU7HORIZATION OF EN7RY: !
certify under penalty of perjury that I have read this application antl state lhal
the information given is wrrect I agree to comply with all state laws and city
ordinances relating to building consWction, antl.authorize representatives of
the City o! Costa.-Mesa to enter upon the above-described �property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until final inspection.� � '
naWre galOwne Oale
� 3 .l0
�'A6�rA�honzeaApphcanl iDate:
5�A Mf
4 �
O,
> ,.,. :
: �
J
��o �
�
�
CITY OF COSTA MESA .
BUILDING DIVISION
C� oOP�
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us �
PERMIT TYPE ELEC
APN: 41218332
' � FOR INSPECTIONS CALL: (714) 754-5626 � .
PERMIT NUMBER: E10-00239
STATUS: FINALED
DATE ISSUED: 10I13I2010
_,,._ - ., __ ISSUED BY: RMD
JOB ADDRESS: 932 DAHLIA
Vicinity: „
SCOPE OF WORK: i
OWNER: BARNET
PHONE: �714-549-
APPLICANT: HAMILT�
PHONE: 949-097�
Address:
City/SWte:
HAMILTON
P O. BOX 17
�,
LAGUNA BE
. +;..� �e,:� . .. .���- . . . - :� • _ . .-...' . r -t
� 1:.
,
�:�.- `�' :z , .! ':.. .:.�..
;<i - i� . ...,'
'�
i
'er} s � J.�" r .... ... �"'�. � �� �� Jt
11T FEES � i ,___ n
� `rv $o.00 - _. ' w�,
`y$54.00
� .:. ,
;$0.00
"'�" � $54 00 . `
., ,',. q, , ;,,, >
t_ � '��r * -� t�x ;
� �s ts � • � 'r„r'1
'�'"�4 ._,, � s v r�-,' .
.'.:.\t ; -�..^h a�� h -s-.. Y., a
,fi,4 � : —.> ��,. 1 ..,� ..'.' . ' ���•
M1�� ::i .,,., r _ ...__ +`--�
.':�� "` _ =.�4n,
f .`tr � _ � �"
j "i .: C A A�.
^'1�j s ..lR 'e .rD:.- - �
Electrical Plan Check
Electrical Permit Fee:
Reinspection Fee
TOTAL FEES
� w;
#..
;'
�;,,�
BREEZWAY FOR SFD.
� . . ,�t _:
� ,y��' , r =
� - r i1
ti 1a"_'.
} ''
"AHdreSs: 932 DAHLIA AVE�. Unrt �`',.
%�++;�� City/State/Zip: � COSTAMESA�CA s ' �
t� �: i-•�- " { .��1F � J��
� 1 Y
'� i��.�e: e` "'-'" Addf¢55 . '� Unit r '"`" �'�:,
' � � � ' � � City/Siate/z7�p � � �5.
;:i .
._ , .. .. �! ,
IC ��� License No , �,.888368 � � �
; PHONE 949,497,�939 - - . ' �
! .2ipCode� 92651'� - " � � _ ' _ . '� CELL: � -� �;�'
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, i2-21-92) '� �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must compty with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
�
COOE tl. INSPECTION TYPE
1s16 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roaf
201 Fina181ock1Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
�ATE
INTITIALS GO�Ek INSPECTONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Elecirical
212 Final Fire Prevention
220
222
250
Final Planning Approval
Final Site
Final BuildinglOccupancy
OATE INTITIALS
�C io-ai- �o RF3 �
� R�(ERS�OMPEt�$ATI DECLARATION�
I h r 6y�a�firrq q� II f perjury one of the following declarations i:�'�
� have antl vn maintam a certificate of consent to sel6lnsuieYor workers:
compensation, as providetl for by section 3700 of the Laboi'Code; for�tfie
performance of Ihe work for which this permit is issued. ,
i
❑ I have and will maintain workers' compensation insurance, as required by
sectbn 3700 of the Labor Code, for the peAormance o( tlie vrork for which ihis
pertni� is issued. My Workers' compensation Insurance carrier and policy
nwnber are:
Carrier.
(Tbis seclion neetl no( be �mplefetl �Ihe permrt is valuee a( one huntlretl dollars (5100) or less )
Policy Number:
❑ I certiTy that in �he pedormance of the work !or which Ihis permit is
issued, I shall not emplby any person in any manner so as lo become subject
to the vrorkers' compensation laws of California, and agree tha[ if 1 should
become subject to the workers' compensation provisions of Section 3700 of
Ihe Labor Code, I shall forthwi[h comply with Ihese provisions. �
ApPhcanfs SgnaWre Date
WARNING: FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR,CODE, INTEREST, AND
ATfORNEY'S FEES. .
LICENSED CONTRAC70R5 DECLARATION:
I hereby aKrm that I am licensed under provisions ot Chapter 9(commencing
wi[h Section 7000) o( qivision 3 0( the Business and Professions Cotle, and
my license is in full force and eftect.
Lic. # Class #
Contrac�or: Signawre oa�e
CONSTRIICTION LENbING AGENCY:
❑ I hereby aKrm that Ihere is a constructbn lending agency for lhe
pedormance of the v.ork for which this permil is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Date
OW NER-BUILDER DECLARATIONS: .
I hereby affrtn that untler penalty o( perjury tha[ I am EXEMPT FROM THE
CONTRAC70R5 LICENSE LAW for Ihe (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any ciry or coumy which requires a permit to
construct, alter, improve, demolish, or repair any struclure, prior to its
issuance, also requires the applicant for such permit to fle a signed statement
Ihat he or she is licensed pursuant to the provisions o( [he Contractors
License Law (Chapter 9(commencing wiih Section 7000) ot Division 3 of the
Business and Professions Code) or Ihat he or she is exempt therefrom and
ihe basis for the allegyd exemption, Any violation of Section 7031.5 by any
applicant (or a permit subjects the applican[ to a civil penalty of no[ more Ihan
five hundred tlollars ($500).):
❑ I, as owner of the property, or my employees wilh wages as their sole
compensalion, WILL DO TME WORK, and the stmcWre is not intended or
oRered for sale (Sec. 7044, Business antl Pro(essions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided lhat sucti�improvements�are not�intended�or oHered for
sale. I(, however, the building or improvement is sold within one year of
completion, the owner,builder will have the burden of proving thzt he or she
did not build or impmve for purpose of sale.). '� ' ' �- —
❑� I, as.owner of the.property, am: EXCLUSIVELY�CON7RACTING WITH �
LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business and ��
Professions Code: The contractas License Law does not apply to an ovmer of
propetly who builds or improves thereon, and who cont2cts for such prqect vrith
a cont2ctor(s) license pursuant to the Contrectors Cicense taws.). �
❑ I am exempt under sec. �
Business antl Professi0ns Code for this reason: �
Signawre , Da1e
305/-46 (3I0]) " ' ' � .. . ' � . .
Owner ID verifed by driver�se. ❑ Ves ❑ No
� �Driver's License No. Expires:
�_�Verifcatioqof Ownership by (type ot document, i.e. - property tax bilFor tleetl):
.: DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:�� �
❑ I hereby certrfy Ihat no excavation frve (5) or mo2 feet in tlepth into wfiich a
person is required to descend, will be made in connection wi�h vrork authorized
by this pertnil, and that no building structure, sca(fdding, falsevrork, ar demolition
or tlismanlling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Tipe 8, California Administrative Cotle).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division of Intluslrial Safe[y, as noted a6ove, unless
such person has a permit to do such work (rom the division.
Apphcanfs SignaWre
Division of Induslrial Safety Permit Number: _
HAZARDOUS MA7ERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or present or tuture building occupant neetl to fle antl
certi(y a Business Plan for emergency response [o release or [hreatened
release o( a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Heaith and Safety Code requires, with some
exceptions, ihat a Business Plan be fled with the Costa Mesa Fire
Deparlment by every business which has at any one lime during a reported
year a quantity of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to (ile
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Cali(omia Health and Sa(ety Code, with some
exceptions, requires registration wfth the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and pressure).
3. Does or will fhe applicant or present or future building occupan[ need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health and Safety Code pmvides Ihat the
Cos[a Mesa Fire Departmenl may require the preparation, certifcation and
fling with ihe Fire Department of an RMPP by husinesses which are required
to register acutely hazardous materials with the Fire Department.
4. I/ an RMPP is presently requiretl, has Section 25534 of the Calitomia
Health and Safery Code been fully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or fuNre building occupant require for
[he work which is the subject of this application a permit for such consUuction
or modifcation from lhe SoWh Coast Air Quality Management DisMct or from
any other air polWtion control distnct or agency? ❑ Ves ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires ihat the requested
infortnation be fumishetl on applications fa non-residential building pertnits).
6. Will any part of Ihe facility to be constructetl under this permit be within
1000 feet fmm the outer boundaries of a school? ❑ Ves ❑ No
Qf'yes", ihe tacility must meet Ihe requirement of Sections 25534 antl 42303
of the Calitomia Health and Safety Cotle).
7. If a permit from the SouN Coast Air Quality Managemenl Distnct or other
air polWtion control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribetl by Califomia
Heal[h and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certi(ica(e o( compliance (rom the appmpriate air pollution
control oKcer�' � � � ' � � �
CERTIFICATE OF COMPLIANCE: I certity ihat under penalry of perjury the
information given above is correctr I�agree to comply with'albsiate-laws and
ciry ordinances regarding Hazardous Materials and Emissions. , .
. . . . .. , . 'i . . �i.l. .. „ , . . .
SignaWre �a�e
CER7IFICATE OF COMPLIANCE AND AUiHORIZA710N OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
Ihe information given is correcL I agree to comply with all state laws and city
ordinances relating to building consWction, and authorize representatives of
the Ciry of Costa Mesa to enter upon the above-described property �for
inspection purposes. I agree not to occupy or allow occupancy of any buiiding
authorized hy this permil un[il fnal inspection. " '
SignaWre o! Legal
Antlbr AutM1o�ixeE Apphcant Ddle
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us -
�' ELECTRICAL PERMIT
.lob Address: 932 DAHLIA AV I�
Suite No
Vicinity:
Parcel Nunmber: 41218332 �
Applicant: GARY KRZAKALA ,'
Address: 17885 SKYPARK CIRCLE �I
IRVINE, CA
Zip:, 92614 j...
l_J i 1
Owner. B� RNET,,JOSE M'� ��--���
Address 932�DAHLIA�AVE ���-� �"-�
�Q��� ��,,�� Phone:
�J � COSTvMESA; �/ Zip: 92626
,�°/�� ��/� /
ontractor. PREMIUM BUILDERS ' �
J t <� /!1 �i-'/ �
/Address: 17865�SKYPARK CIRCLE . tEe ��
, � �, ��Ph.one:,T 949=5:
)� ;�/I��E:C� ,'�po�`9�y.Zip:l 92614
( � r ' "J —
l ���r i� � ,�,� �- - � License:`.'49204
� �1�7L'"��/\\ �a� .�—'.
l ��
��
� " �� % ��, SCOPE OF PEI
�� ADD 284 S.F. TO.EXISTING�S:F:D:�WORK TO��INCCUDI
) Q �
�1��ND ADD INTERIOR��WAL'LS'TO�CREATE'A�LARGER�(
I n�604-01119 � �i.�� � � �..f%/1 � � .��.
�
�
Res. a/c packai
New Res (1-2�units
New Res (3+units),
Pool / Spa �
Lighting Fixts
Recept Outlels
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Molors to 1 hp
_ECTRICAL TO INCLUDE: 20
i�PLIANCES:., l�
I/21/04: SUPPLEMENTAL PEI
� 7 ^ t
\, ` . �
\\Q Quantity��
�$23.50
$0.00 '
$0�00 <
�$O:UO ; y....0,3 .,��
'�$o:oo\��o-�
$OAO `�,\�10
¢�� nn �\\ on +•`,
$0.00
FIXTURES, 15 OUTLETS,
�'ha 0 •' oanuuiyxw�u.`ti'
�, prJ oOQ Misc Electrical:Equ
Q g; ,� F� �u � O`�T�a�sformers up, to
�, 4 .. �......�'.f..:..up'to 10
�a' oago ocO`�...°�....:..upt050
� �vo.. n...^...dup:to�10
/�,`l12 i'\,,..�� �.:- ..
/ 11 0� "----�; �Low,
�``/ 2 `�y //��,,,} Low
_ O.C�/,�_J���Mis�
��o`yi Cl - nn�sc
0 . � ��Circi
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 09/07/2004
,Issued: 09/07/2004
ISSUED BY:
9
:W+BEDROOM, NEW BATHROOIv1� (" '�
� � E�BEDROOM. REF.: � ���
7 � 'SWI�AND 2 RES. J �
� (( �
IA' . " l! r� 1I
� � Quan/tity�/ �7 ~V,�.�/)l (�j/,
/Lighting $0.00 �jJO��\ f n`?!
50.00� 0 (
�2S,�y°s�- $0:00 0 -��f' �J :
kw ',�I�'`$0:00� 0 � -, _
��$0.00' ��}0� �„(J
,w $0.00� 0 %
W �Cso.00 o�G
$0.00 �;0
Ckl�t$0.00•��0
$0:00�0
,�so.00 0
�C�"Pso.00 0
�d�^"'��^� $0.00 0
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 wlthin 1 BO days, or if work is suspended or abandoned
for a penod of 180 days. �
INSPECTIONS: In order for the work authorizad u'nder this permit to be considered legal, such work must comply with all epplicable codes, and all
requlred Inspectlone and final epprovel mus� be obtalned. Failure to obtain inspections and tlnal approval will resufl in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 .
/'
2aae�ae l�oo) ;� . . . . !/
Q/
WORKERS' COMPENSAnON DECLARAnON: '� . ' � , . ��
I hereby aflirm under penalry,of perjury one of the following declarations:�,' � ' �� "" � .
❑ I heve end will malntain a certificate of consent to self-Insure tor workers' compensation, as provitled tor 6y�section 3700 of ihe Lebor Code, for Ihe pedormance of the
work for which Ihis permit is issued. � . ,
� Phave end will meinWin workars' wmpensation insurance, as required by section 3700 of tha labor Cotle, lor ihe pertortnance ot ihe work for which this permit is issued.
My workers' comp sation /In5urance rtler and policy number are: � '/
Carrier: - S"�T^� .fif/G� � Policy Number. V U'Z 7�' ��-'��:� 7
(This section need nof be com eted il fhe permit is valued af one hundred dollars ($100) or /ess.J _ ,,,_ . . _
❑-� I certily that in Ihe perfortnance ot the work tor w�ich �his permit is issued, I shall not employ any person in any manner so as to become subject to ihe workers'
compensation laws oi California, and gFee that if I shoultl become subject to Ihe workers' compensa�ion pmvisions oi Section 3700 of the Labor Cotle, I shell forthwith
comply with these provisi �'y ��
Applicant Signature: {/�p pece: • l�(j � vy
WARNING: FAIWFE TO SECUR� /ORPC(ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HIINDRED
THOUSAND OOLLARE (5100.00Sf, IN NDDITION TO THE COST OF COMPENSATIIXJ, OAMAGES AS PROVIDED FOR IN SECTION 3]O60f THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS OECLARATION:
I hereby aflirtn that I am licensed under provisions oi Chapter 9(commendng with Section 7000) of Division 3 oi lhe Business and Professions Cotle, and my license Is in full
force and eflact. Lic. A � �l /r�"O'� 9 Class N� �—�.
Conirectars Slgnature: � l7 - Date: /�a l>! <<Y
CONSTRUCTIOMLENDING AGENCY:
❑ I hereby attirm that there is e constmction lending agency for the pedormance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lendefs Adtlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettlrm ihat under penalty of perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Protessions
Code: Any ciry or counry which requires a permit fo constmct, alter, improve, damolish, or repair eny simcture, prior to its issuanca, elso requires ihe applicant tor such permit
b file a signed statement that ha or she is licensed pursuent to the provisions of the Contrectors License Lew (Chaptar 9(commencing with Sactlon 7000) of Division 3 of ihe
Business entl Professions Code) a that he or she is eaempt therefrom and the basis tor ihe alle9ed exemption. Any violation of Section 7031.5 by eny applicant tor a permit
subjects the applicant to e civil penalty of not more ihan five huntlred dollers ($500).):
❑ I, as owner of the property, or my employees with wages as Iheir soie compensation, WILL DO THE WORK, and the stmcture is not in�entle0 or ottered lor sale (Sec.
7044, Business antl Pmfessions Code: The Coniractors License Law does not apply to an owner of property who builds or improves theraon, and who does such work
himself a herself or ihrough his or her own employeas, provided ihat such improvements are no� intended or oHered for sale. If, however, ihe building or Improvement is
sold within one year of completion, ihe owner-builder will have the burden of proving that ha or she did not build or improve tor purpose ot sale.). '
❑ I, es owner of ihe property, am E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Protessions
Code: The contrectors License Lew does not apply to an owner of property who builds or improves thereon, and who contracis for such project with a contrec�or(s)
license pursuant to the Con�ractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for ihis reason:
Signature: Oate:
Owner ID veritied by tlriver's license. es ❑ No Drivar's License No. Expires:
Verification of Ownership by (type of doc ment, I.e. � property ta: bill or daed):
DIVISION OF INDUS7RIAL SAFETY GERMIT CERTIFICATION:
❑ I hereby certify ihat no excevation five (5) or more feet in depth into which a person is required to descend, will be meda in connection with work euthonzed by this
permit, and that no building simcture, scaHolding, falsework, or tlemolition or dismantling thereof, will be more than ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
347, 7tla 8, Calitomia Adminisiretive Code).
❑ As owner-builtler, I will not employ anyone to do work which woultl require e permit irom the Division ol Industrial Sefety, as no�ed above, unless such person has e
permit to do such work irom �he division.
Signature:
Division of Industrial Safety Permit Number:
Date:
CERTFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I cehity under penalty of perjury that I have read ihis epplication entl state Ihat the information given is
correct I agree to comply with all state laws and city ordinances relating to building constmction, end authorize represantatives of the Ciry oi Costa Mesa to enter upon the
ebove-described property tor inspec�ion purposes. I egree not to acupy� allow occupancy ot any building authorized by ihis permit until final inspection.
Signature Of
CO�E;1' INSPECTIONTYPE . �
1616 Fixetl System Final Fire Prevention
1266 Pool Spe Finel ,
200 Final Re-Root
201 Final Block/Retaining Wall ,
202 � Final Factory Fire Place �
203
2 4
Finel Sign
Final Demalition � �
�
• Qejf. INTRIRLS
�
COOE I INSPEGTION TYPE
206 Final Mechanical
; . 208 Final Plumbing .
210 Final Elecirical
212 .
220
222
. . ... . . , . . . . . 250
ate
4�2� oy
Date ,'
. . . . . .PAIE INTRIALS
Final Fire Prevention : -
Final Planning Approval �
Final Site � . �
Final Building/Occupancy - �
0 -f:�%'
���
_ t.
(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us
ELECTRICAL PERMIT
JobAddress: 932 DAHLIAAV
Suite No
Viciniry:
Parcel Nunmber: 41218332
ApplicanC GARY KRZAKALA �
Address: 17885 SKYPARK CIRCLE
� v– (
IRVINE, CA �L% �� 1 Zip f
/,v�.���� �, ',�
�.✓e�'_ � ' -`"
Owner: /BARNETIJOSE M�� ��j`
/'./1'7.. l \ \ � \ .ii' ...� _.
\jA% �
� �,
�i
BUILDERS .
RK CIRCLE
� � ADD 204 S.F. TO,
AND ADD INTEfi
B04-01119 L
C
� � ELECTRICAL TO
�� � APPLIANCES. .
f ��,�
New Res (1?2 units) � �
New Res�(3 `nits)
Pool/Spa� �
Lighting Fixts �
Recept Outlets
Switches c� J
Non Res Appl �
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1hp �
Motors to 10hp
Mators to SOhp
Motors l0 100hp
Phone:
Zip: 92626
� .a..��-...
��
� .q9�Zip��92614
f. ; ° _.�—=`c,------
Quantity '
523.50 �
50.00
C50.00 �,
�$0.00 0 .
50.00
$0.00
50.00
FIXTURES, 15
0
Temp Dist Sysi
Buswav /100 fl
se+ i�c+'U __,__.`.
� �o - oMlsc Ele�
'�,., � � 0 ° Transfom
���OP �� o n�a....
�.p � p l � � � 0 °,r: '� �,
J
� 6 OO �' U p ....:K./.J.....
� b 8 o uos ��.,...::: :°:
r j,., 2,^�.,_-�-v' � v_-_`-�
\(' �O�F* �`–
�' ��i�Q' � �
\�-'�(�
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 09/07/2004
Issued: 09/07/2004
ISSUED BY:
� . \�
�
� �
�
\����� � �.,
\C\�\
Lighting
/ Ckt�\'
u
NEW BATi
�OM.REF
AND 2 RES.
��J
�
�
�
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related�
regulations. (Ord. No. 92-28, § 1, 1241-92) - .
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. , � �—
INSPECTIONS: �'In'order for the`�work authonzed under this permit.to'be, considered legal,�sueh work must comply with all applicable code�sr and all�
required inapectlona and finel approval must be obtained. FaiWre to obtain inspections and final approval will result in the ezpiration of thie•pe ��
FOfl INSPECTIONS CALL: (714) 754-5626 � � � ��
24d6d6 (&00) �� .
WORKERS'COMPENSAnON DECLARAnON: � � • � . � '
I hereby aftirm under penalry of perjury one of the following declarations: '��- � �
❑� I heve and will maintain a certificate of consent to self-Insure tor workers'�compensetion, es piovitletl tor by section 3700 of the Labor Code, for Ihe peAormance of tha
work for which Ihis permit is issuetl. . .� .
�–I have end wiil maimain workers' compensa�ion insuranca, as required by sectlon 3700 of the Labor Code, for the pedormance ot Ihe work Por which this pertnit Is issued.
My workers' co en tion Insurance c rrier antl policy number are: �7 �
Carrier: �i�� �C/K� PolicyNumber. d�� / oZ dy ��'.crUy
(This secfion need not be completetl i! the permif is veluetl at pne huntlred dollers ($100) or less.) , ,, ,
❑�I cetlity ihat in tha peAormance of ihe work for which Ihis permit is issued, I shell not employ any person in any manner so es to become subject to iha workers'
compensation laws of Califomle, end agree Ihat if I s ould become suDjact to iha workers' compensation provisions oi Sec��� of the La6or Cotle, I shall tonhwith
comply with ihese provisions. � /a�
Applicant Signature: Date: �
WARNING: FAILURE TO SECURE WORKERS' CAMP COVERAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNORED
T/10USMIDDOLLARE�$100,000),INAODITIONTO E TOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECilON3]O60FTHELABORCODE,INTEREST,ANDATTORNEI^$FEES.
LICENSED CONTRACTORS DE
I hereby attirtn ihat I am licensetl
forca and eflecL Lic. # '
Conlrector's Signalure: _
ot Chaptar 9(c mmencing with Section 7000) of Division 3 of ihe Business antl Professions Code, and my license Is in full
class # /J —
oa�e: y�7 e�'
CONSTRUCTION LENDING AGENCY: ' ' �
❑ I here6y aHirm that �here is e constmction lending agency for the pedormance of ihe work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Adtlress:
Signeture:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn iha[ under penalty of perjury thet I am EXEMP7 FROM THE CONTRAC70R5 LICENSE LAW tor the following reeson (Sec. 7031.5, Business and Protessions
Cotle: Any ciry or counry which requires a permit Io construct, alter, improve, tlemolish, or repair any sirucNre, prior m its issuance, also requires the applicant tor such pertnit
to file a signed statement ihat he or she Is licensed pursuant to the provisions ot t�e Coniractors Licanse Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Professions Code) or lhat he or she is exempt iherefrom and ihe basls for the ellegetl e:emption. Any violation of Section 7031.5 by any applicant for a pertnit
subjocts Ihe applicant to a civil penel�y of no� more ihan five hundretl dollars ($500).):
❑ I, as owner of the property, or my employaes with wages as their sole compensation, WILL DO THE WORK, and the siructure is not intended or oHeretl for sala (Sec.
7044, Business and Pmfessions Code: The Coniractors License Law tloes not apply to an owner of propeny who builds or improves thereon, antl who does such work
himself or herself or ihrough his or her own employeas, providetl ihat such improvements are no� intentled or oNered for sale. If, however, the building or improvement Is
sold within one year of completion, ihe owner-builder will have �he burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I, as owner oi the property, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRAC70R5 to consiruct the project (Sec. 7044, eusiness and Professions
Code: The contrectors License Lew does not apply to an owner of propehy who bullds or Improves thereon, antl who contracts for such project wit� a coniractor(s)
license pursuant m the Con�rectors License Laws.).
❑ I am exempt under sec. Business end Professions Code for Ihis reason:
Signature: Date:
Owner ID verifietl by drivers licen5e. ❑ Yes ❑ No Driver's License No.
Veritication ot Ownership by (type of documen6 i.e. - properry �az bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
Enpires:
❑ I hereby certify ihat no excevatlon tive (5) or more faet in depih in�o which a person is required to descend, will be matle in connection with work authorizetl by this
permit, and that no builtling structure, scattoltling, talsework, or demolition or tlisman�ling �hereof, will be more than thirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title e, Calitornia Atlminisiretive Code).
❑ As owner-builtler, I will not employ anyone to do work which woultl require e permit irom ihe Division of Indusirial Safery, es notetl e�ove, unless such person has a
permit to do such work irom the division.
Signature: Dete:
DiviSion of InduS�nal Safe�y Permii Number:
CERTIFlCATE OF COMPLIANCE AND AIJT}IORIZATON OF EMRV: I certity untler penalty of perjury ihat I have read this application end s�ate ihat ihe iniormation given is
correct. I agree to comply with ell stete laws and city ordinances relating to building construction, and authonze representatives ot the Cily oi Costa Mesa to enter upon Ihe
ebovo-descnbed propeAy for inspection puryoses. I agree not to occupy or allow occupancy ot eny building authorized by this permit until tinal inspection.
�n ��Signe}ufe Of Legpl Ov{ner(s) / � Dat j
Ku�ZA,G�1 �o� 7 t 7 Gv
nNOr Au�honzed Applicent ��a�e
CODEI, INSVECTIONTYPE pp1F� Iy�J�¢ 5�4.4E� INSPECTIONTYPE. , Q�[ �yj�{,fl
1616 Fixetl System Final Fire Prevention 206 Final Mechanical ' , '
12fi6 Pool Spa Final _ , 208 Final Plum ing� ,� - , '
200 Final fie-Roof 210 Fi � e ical �
201 Final BIocWRetaining Wall 27 F' Pr
202 ' Final Factory Fire Place � ' ' 220 � Final Planning Approval -
203 Final Siqn 222 Final Site " -• '
204 Final Demolition � ' - "� • z50 Final Building/Occupancy �
Job Address: 932 DAHLIA AV
Suite:
Vicinity: REAR OF PROPERTY
Parcel Number: 41218332
Applicant: GARY KRZAKALA
Address: .
�r
I(
�
BUILDING PERMIT
Zoning: Ri R1
�� �� r � �JJ1 �
owner. BARNETi;!JOSE M '
/ .l / / %--,
Address 932�DA/HCIA'AVE 1. `
/�%r( ��� � '��i�Phone,o
/'_--_-...__. ' i��-'�-�^=_:_—,.,
t �Zip:
f
. Status: ISSUED '� �
Applied: O6/17I2004
Issued: 09/07/2004
ISSUED BY:
�
o�
'J �
�U ��
�
�
���� �. �
�t �
Phone: 949-553-0678 - �
i� { -�-- - ��� !
�C-SMITH, ARCHITEC� �+�'"
'ORTBLJ i�roo , r�a,9.9��` �Add
. j �Phorie: h949-361 3682 �---�� o
\CH, CAooa � �� .-._..
��� License: C14146
� ��
,/ SCOPE OF PEF
S.F.D. WORK TO INCLUDE: ADD A NEW�BEDROO�
iR BEDROOM�� �� �Y ��1 � ��I .
iING 1 BEDROOM,'2 BATH :
R�YARD COVERAGE O�rK.�(3
I
\U � � �.-.
���$267.77
$411.95
\ ��$2.62
� $0�00
$0 00�
�, $0.0 `��at,—i:
�n_��
F.D.
Jo. TAGGART�P.HIU�_ W \\`-�`-'� `�`
ress: 1300 BRISTOL ST 1
m�SUITE 100 \Phone: 949-261-7740
`-= ` , �Y " r\`h1�1 �' 1\
NEWPORTBEACH;CA }
9266�-�� Cicense: 2� +
�� 1 _ �� ��1l�i �--, n� �Q
MIT_..� , i ���1I�� ."� �� I
1 NEW BATHROOM, AND ADD INTERIOR WALLS TO C� ATE A
�.� � �' � ' ��'J
���_ . � � ,�
, =�
4..;�� _,.
,. " oo � �
'- � p o � p . o � .r
.� � O� �0 �� n o O' i
��� .,, °����� ���o , o .s
x! G 0. � cy O�. o'� ," p
'��. -flQ}��eJpoo.�...��o�}
�.�..� ���`$ �0�..�oop ��
�' `�=f?L-ANNIN(i•tSi:'LUNINCi"' �-' �'
J'� �
SETBACKS � � / ��-- � ��'�� � � � `' � G �
MAINSTRUCTURE Front "0=0 �.. Rear�O-'0'- (��' Left 0�0 1�� Right �0�0
��'�;�-- {��� ���� � ��--� .✓�.
ACCESSORY Front 0- 0 �R_ear 0- 0 Left 0- 0� /Right 0- 0
W
�
�. �
NOTICE: The work authorized by this permit sha�l�comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92•28, § 1, 1241-92) �
EXPIRATION: This permit shall automatically ezpire�and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a penod of 180 days. �
i
INSPECTIONS: In order foi the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and�� li
requlred Inspeetiona and final approval must ba obtained. Failure to obtain inspections and final approval will result In ihe expiration of this pertnit
FOR INSPECTIONS CALL: (714) 7545826 �
d
2448d6(6/00) . � ; , .
WORKERS'COMPENSAnON DECLARAnON: � � � - � �� '
, v
I heraby aRirm under penalry of perjury one oi the following declarations: � �� - � - � '
❑ I have antl will meintain e ceRiticate of consent to self-Insure for workers' compensation, as�p�ovided for by section 3700 of ihe Lebor Corle, for the performence of ihe
work for w�iCh Ihis pertnit is issued. _ . , . ., -
�I heve end wiil maintain workere' compensatlon insurance, as required by section 3700 of ihe Labor Code, for ihe performanca of the work fa which ihis pertnit is issued. �
My workers' c9m�pen1sa,tion Insurance �/arder and policy number are: -
Cerri�ar:"'-'��T�-�l �NA .Policy.N-y.u+mber: ��-%d���Z�'���
�hisrsection'need not be completed il the permit is valued af one hundred tlollers ($f 00) or less.J '� ':��
❑ I cenify thzt in the performance of tha work for which ihis permit is issueq I shall not employ any person in eny manner so as to become su6ject to Ihe workers'
compensation laws of Celifornia, end egree that If I sho IB become subject to t�e workers' compensation provisions ol Section 3700 of [he Labor Code, I shell forthwith
comply with ihese provisions. � �
er/
AppllantSignat� uie�- �Dat� �7 7
�� dSc'.,.
9MIN : FAILURE TO SEWRE WORKERS' N I COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMBLOYER,TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSANDDOLLARE(5100,000),INADDITION TH TOFCAMPENSFTION,DAMAGESASPROVIDEDFORINSECTI�WOFiHELABORCOOE,IMEREST,ANDATTORNEV'SFEES.
LICENSED CONTRACTORS DECLARATION:
Chapter 9(commencing with Section 7000) of Division �f.�he,Buslness and Professions Code, antl my license is in full
CONSTRUC710N LENDING AGENCY: � �
❑ I �ereby aNirm ihat ihere is a cons�ruction lending agency for Ihe pedormance of the work for which ihis pertni� is issuetl. (Sec. 3097, Civil Code).
Lendors Name: Lender's Address:
Signeture:
OWNER•BUILDER DECLARA710NS:
Da�e:
I hereby affirm that under penalty of perjury Ihet I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professions
Cotle: Any city or county which requires a Dermit to consiruct, alter, improve, demolish, or repair any sirucNre, prior to its issuance, also requires the applicant for such permit
to file a slgned statemant ihat he or she Is Ilcensed pursuant to the provisions of the Comrectors License Law (Chepter 9(commencing with Section 7000) ot Division 3 of the
Business and Professions Code) or thet he or she is ezempt therefrom and ihe basis for the allegetl e:emption. Any violation oi Section 7031.5 by any applicent for e parmit
sublects ihe epplicent to a civil penalty of not more ihan five hundratl dollars ($500).): �
❑ I, as owner of ihe property, or my employeas with wages as thei� sole compensation, WILL DO THE WORK, and the siructure Is not intended or oNered for sale (Sec.
7044, Business and Pmfessions Code: The Contractors License Law does not apply to an owner of propetly who builtls or impmves thereon, antl who does such work
himself or herself or ihrough his or her own employees, provitled ihat such improvements are not intentled or offered lor sale. If, however, Ihe building or improvement is
sold within one year of completion, ihe owner-builder will have ihe burden ol p�oving that he or she did not buiid or improve for puryose oi sale.). '
❑ I, as owner of ihe property, am ERCLUSIVELV CON7RAC71NG WITH LICENSED CON7RACTORS to conswct tha project (Sec. 7044, Business antl Protessions
Code: Tha contractors License Lew does not apply to an owner of property who builds or improves thereon, and who contrecis for such project with a contractor(s)
license pursuant to the CoNrectors License Laws.).
❑ I am exempt under sec. Business and Professions Cotle tor Ihis reason:
Signature: Date:
Owner ID verifietl by tlnver's licen5e. ❑ Ves ❑ No Driver'S LiCense No.
Verifiwtion of Ownership by (rype of tlocument, i.e. - properry tax bill or deetl):
Etpires:
DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION:
❑ I hereby cetlity that no excavation five (5) or more feet in depih into which a person is required to descend, will be made in connec�ion with work euthorized by this
permit, and ihat no building siructure, scallolding, falsework, or demolition or tlismantiing ihereof, will be more than ihitly-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celitomia Administretive Cotle).
❑ As owner-�uiltler, I will not employ enyone to do work which would require a permit irom the Division of Industriel Sefery, es notetl above, unless such person hes e
permit ta do such work irom Ihe tlivision.
Signatura: Date:
Division of Industnal Safery Permi� Number:
CERTPICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penalry of perjury ihat I have read this application and state that ihe information given is
correct. I egree to comply with all state laws end ciry ordinances relating to building conswction, and authorize represematives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
CQOE1, INSPECTIONTYYE v'� ,
7616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining W ell ,
202 .c Final Fectory Fire Place �
203 Finel Sign
204 Finel Demolition � � • �
pdjg � INTRIALS
, �QpF�, INSPECTIONTYPE �¢, � �
206 Final Mechanical . "
, 208 Final Plumbing .
210 Final EleCiriCal �
•. 212 Final Fire Prevention .
�' 220 �Final Planning Approval � �
222
- ^' 25
Final Site
FinaPBuildincyOccupency - - • 7 — �
p�a) �sa-s2�a • Fax (�ia) �sa-aess • www.ci.wsta-mesa.ce.us 77 FAIH UHIVt, GOSIA MtSA, GA 9'L6Z6
JobAddress: 932 DAHLIAAV
Suite No
Vicinity:
Parcel Number: 41218332
Applicant GARY
Address: 17885 :
Owner:
BUILDERS
\RK CIRCLE
MECHANICAL PERMIT
Status: ISSUED .
Applied: 09I07/2004
Issued: 09I07/2004
ISSUED BY:
; ( . �� f�`''y� .�
��-
Fhone � 949-553-0678 f / ��
� Zip: j�92614 �1 �/ 1 l\\� --,
i-.. / � � ,�^,`,.7 � ,
� '"--------_ � �
������� ��'�� �
��\,\,1`ti C/ �/�
Phone: ��\ �/
Zip: 92626 �
. �a
�
r�-' \ �., , SCOPE OF PERMIT
284 S.F. TO�EXISTING S.F.D. WORK TO INCLUDE: ADD A NEW
iROOM, AND:ADD:INTERIOR;WALLS_TO:CREATEA:LARGER:C
Bo4_o,,,l �'���'� ��` �°��' A�
HANICAL TO�INCL'UDE:51=1NST FAU�<-100K+BTU=1=REPAIR/Al'T--
=CH EXHAUST, 1 VENT FAN/SINGLE DUCT AND 1 COMPRESSI
i l\` i'"� � �
ISSUE�FEE,.+� �
InsGFAU <100 k BTU �
Inst�FAU?100 k BTU �`
Repeir% Alt Eooling/Heat� Q
Inst / Rep. Recess Wall Htr ,�
Refrig Sys��100�k'BTU �
Refrig Sys ?100 k BTU�-j �
Gas Piping��\ �
Factory Firep�ace� �
Hood w/Mecli Exhaust
VAV Box �� ��
Vent Fan / Single Duct� /
Appliance ((
Fire Dampers �
Smoke Dampers
Inst or Relocate Appl Vent �`'�...
Air Handlers < 10000cfm �`�.,�
Air Handlers > 10000cfm
Floor Fumace
Floor or Suspend Heater
50.00
1
0
1
0
0
0
$0.00 0
30A0 0
50.00� 0
$0.00 �0
$0.00`0
$O.00J�O
$0.0'0"�0
50.00 0
�� o ai� »�•.:
,rY'� ; 0 Domes
' � D° = o �o Com i�
>: � �n O,. oGfjU' -tp3
cr0' Q� fj��� Opp3do°1�
G a 'o G,15 To q
0.� � o 0o a ��
�4 0� o u`� �30Toi.
�...�`C...� ., r,° .>��e oCOVey-51
0 ,, , J����� � �
� `
� (� �
—�=� � z�/ \ ��1 c�
BED OM�NEW • ��1��, �
-OS�EfVT:IlN MASTER BEDROOM. �
�All1 �
«� ..
COOL'ING/HEAT, 1 HOOD
)R UP T0�3 HP/100K BTU.{' t�
I
/ Alt Absorbtion
Cooler
Incinerator
I�/'-� 3To15hp�
��/ ( ) �-y �r.,.�15.to 30 tip���
I `-30to50ihp��
lj•'Ove%50 hp �
f�1
k BTU�� ( V
kiBTU
,750 B�t�`,.�,��J/
�O v �/U
n%% %
S�a.�o i
$0.00 0
50.00 0
50.00 0
$0.00 0
$0.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) '
EXPIRA7ION: 7his permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.,, � .
INSPECTIONS: In order for lhe work authorized under�lhis permit to be considered legal, such work must comply with all app�icable codes, and all
requlred Inapeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permiL'4,%�
FOR INSPECTIONS CALL: (714) 7545626 � ;�
244838(&00) . �, .. .
WORKERS' COMPENSATON DECLARATON: w� ' " ' �� .
I hereby attirm under penalry of perjury one oi the following dedarations: � ' ,� ' �� �' , �
❑ I have entl will maintain e certiticata of consent to self-Insure for woikers' compensetion, es providetl tor by section 3700 ot ihe Wbor Code, for the pedormance ot ihe
work for which this permit is issued. - .
� I have antl will maintain workere' compensetion insurance, as requireG by section 3700 of the Labor Code, for the pertortnance of ihe work for which this permit is issuetl. �
My workers' compensat n In ranca caarrler a policy num6er are: (/
Cerrior: ��� � PolicyNumber. ��� 7Z4�� - � DU/
(This sectian need naf be completetl il fhe permif is valuetl at ane hundred dollars ($100) or less.) _ .
❑� I certity that in ihe pertormance of the work for which t's permit is issued, I shall not employ any person in eny manner so es to become subject lo iha workers"
compensation laws of Californla, end agrea t at' I s uld become subjact to the workere' compensetion provisions oi Section 37p 0 of trye Labor Code, I shall totlhwith
comply with ihese provisions. � / � / _ /
! � V
Applicant SignaNre: Dete: /
WARNING PAILURE TO SECURE WORKERS' ATION CAVERAGE IS UN�AWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINA� PENALTIES ANO CIVIL FINES UP TOONE HUNDRED
THOUSANDDOLLARE(5/00,000),INADDI T COSTOFCOMPENSATION,OAMAGESASPROVIDEDWRINSECTION31060FTHELABORCqDE,IMEREST,ANDATTORNEV'SFEES.
LICENSED CON7RACTORS DECLAHATION:
I hereby aHirm that I am licensed under provisio
force and eNect. Lic. # � /�j<
ConVactoYs SignaWre: . i
9(commencing with Section 7000) of Division 3 of ihe Business antl Prof sions Code, antl my license is in tull
' Class� �-�.
Date: T 1 ��
CONSTRUCTION LENDING AGENCY: `
❑ I hare6y eHirm that ihere is a consimction lending egency for the pedormance of Ihe work tor which ihis permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address:
Signature:
OWNER•BUILDER DECLARATIONS:
Date:
I heroby aFlirtn tha� under penalty of perjury thet I am EXEMPT FROM THE CONTFiACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Professions
Cotle: Any ciry or county which requires a permit to consimct, alter, improve, demolish, or repair any sWcture, prior to its issuanca, also requires ihe applicant tor such permit
to illo e signed statemant thet he or she is licensetl pursuent to the provisions of Ihe Contrectors License Law (Chepter 9(commencing with Sactlon 7000) of Division 3 oi ihe
Business and Professions Code) or ihet he or she is exempt theretrom and ihe besis for ihe alleged exemption. Any violation of Section 7031.5 by any applicant for e pertnit
sublects the applicant to e civil penalry of not more ihan five hundred tlollars ($500)J:
❑ I, as owner of ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the siructure is not in�enCeG or ottered tor sale (Sec.
7044, Business and Profassions Code: The Coniractors License Law does not apply to an owner ot property who builds or improves thereon, and who does such work
himself or herealf or through his or her own employees, provided that such improvemenis are not intended or oHared for sale. If, however, ihe building or imp�ovement is
sold within one year of comple�ion, the owner-builder will have ihe burden ot proving that he or she did not build or improve for purpose ot sale.). '
❑ I, as owner oi the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business end Professions
Cotle: The contrectors License Lew tloes no� epply to en owner of property who builtls or improves ihereon, and who comracis tor such project with a contrector(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sac. Business and Professions Code for ihis reason:
Signature: Date:
Owner ID verified by tlriver's licensa. ❑ Yes ❑ No Driver's License No.
Verification of Ownership by (typa ot tlocument, i.e. - properry tau bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
E:pires:
❑ I hereby certiy ihat no excavation five (5) or more fee� in tlepth into which e person is required to descend, will be made in connection with work authonzed by Ihis
permit, and that no building structure, scaMolding, falsework, or demolition or tlismantling Ihereof, will be more ihan thirry-six (36) feet high. (Chap. 32, Gry 2, A� 2, Sec.
341, Title B, California Adminlstrative Code).
❑ As owner-builder, I will not employ anyone to tlo work w�ich woultl require a permit irom the Division of Industnal Sefety, as noted above, unless such person has a
permit to tlo such work from the division.
SignaNre: Date:
Division of Industrial Safety Permit Number:
CERTIFlCATE OF COMPLJANCE AND AUTHORVA710N OF ENTRV: I certify under penalry of perjury that I have read this application and state ihat iha intormation given is
wrrect. I agree to comply with all state laws end ciry ortlinances relating to builtling construction, end authonze representatives ot the Ciry ot Costa Mesa ro enter upon the
ebove-described property for inspection purposes. I agree not to occupy or allow occupency of any building authorized by this permit until final inspection.
(� Lg�- n�ature Legy1 O�wner(s)
l x�� `f�^ � 1�-n W
And/Or Authorized Applicant
CO�E �. INSVECTIONTYPE .
16/6 Fixed System Final Fire Prevention
1266 . Pool Spa Final
200 Finel Re-Raof
201 Final Block/Retaining Well
20?
203
2
Final Factory Fire Place
Final Sign
Final Demoli�ion '
CO�E 1 INSPECTION ttPE
206 Finai Mechanical
. . 208 Final Plumbing
210 Final Electrical
. .. � 212, Final Fire Prevention , �
�- 220 " Final Planning Appmval '
222 Final Site � �
250 Final Building/Occupancy `
Job Address: 932 DAHLIA AV
Suite No
Vicinity:
Parcel Nunmber: 41218332
Applicant GARY KRZAKALA
Address: 17885 SKYPARK CIRC
{?�J Address:
/�� ���
ISSUE FEE �
BackFlow irrigation
BackFlow Preventer
Bathtub
Clari(er System
Connect(Ice,Soda,etc)
Dental Unils
0
PLUMBING PERMIT
Status: ISSUED
Applied: 09/07/2004
Issued: 09/07/2004
ISSUED BY:
�
�" r-t �l (1 �
Phone:. 949-553-0678 - �"�r'�
�Zip:i 92614 � f� �
_� �! U'
�==~\�� /% �
J�J� q �``�\� �
Phane: � �4`,� "
Zip: 92626 �,� ��
�V(/'� \`��`
\� "
� �,��
� � �
`` �--.-�
l
� v� i
� ���
t�lr �
vl BUILDERS „40. �� sa�,p
PARKCIRCLE ^ � ��",
� G. _�
S Up� , �Phone; 949-553-067�
� e _..,, ---___,
,/ oam� °° � z�p: szsia "—�
\ . License: 492049
284 S.F. TO
ADDINTER
)1119
r�
Zip:
%.a � . :i /� ►li.ti�
STWG S.F.D. WORKTO INCCU[
WALLS, TO CREATE A LARGER
TO INCLUDE: 2 BATHTUE
ER CLOSET. � . r+r"
k. I "�'°go
/7,.-..:.,.\\~J� =�
ir ����
�AMT /�TY ..
623so ,.��
$o.00 � o ( )1/�
'$0:00�.,� 0„/I„
$0.00 0
$0.00 0
i
� �ll�
�
:: ADD A'NEW BEDROOM, NEW BATHROOM, '�^,
:LlOSET'INjMASTER BEDROOM. REF.:
�/,�
ITLETS), 1 KITCHEN SWK�1 WASH'BASIN,
EPIPE9 �t����a^ � /
"�^� �,.m����� �� �!':
Rv a�° ° � ����� /�"G%��? //J"l
o ". 0 0 00 �AMT�QTY�
�asnec,c�go:oo� o�'
ition"""� $0.00� 0�,.,...`
$0.0020�
ito�� � ��$0 00 0
�Vacuum Brkr Bkflow(1-4)
.Vacuum Brkr BkFlow(5+)
Wash Basin
AMT
So.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
QTY
0
0
0
0
0
0
1
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 end 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 tor ihe work euthorized under this permlt to be considered legal, such work must comply with all applicable codes, and all
required Inapectlons and finel epprovel musl be obtained. Fallure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
eaawa law�
WORKERS' COMPENSATION DECLARATION: � � � ' � , y •
I heraby eflirtn under penalty of perjury one oi the following declarations ` ' ' ' � � ' ' ' •' . � . � .
❑� I have and wlll maintain a certificate of consent to sel4lnsure�for workers' compensation, es providetl for by section 3700 of ihe Labor Code, for the pedormance of Ihe
wark tor which Ihis permit is issued. �
❑ � I have and will meintain workers' compensation insurence, as requiretl 6y section 3700 of the Lebor Code, for the pedormance ot the work for which this permit is issuetl.
My workers' compen/s�ation nsur,afn�ce carder nd policy number are: - .�
Carner: SA--4� F��-� PolicyNumber. 60 27}�Y"���`
(This section neetl not be comp/etetl i/ the permif is valued at ane hundred dollars ($100) or less.) ,, ,. ,
❑�I cenity that in ihe pedormance oi the work for which Ihis permit is issued, I shall not employ eny person in eny manner so as to become subject m Ihe workers' -
compensation lews of Calitornie, end agree ihat If I should bacome subjact to iha workers' compensetlon provisions of Section 3700 oi ihe Labor Cotle, I shall forthwith
comply with these provisions.
Appliwnt SignaNre: Date: � �J�1� �r y
WARNING FAILURE TO SECURE WORKE , PENSATION CAVERAGE IS IINLAWFUL AND SHALL SUflIECT AN EMMOYER TO CRIMINqL PENPLTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000), IN AD�[ 4 ON TO THE COST OF CAMPENSATION, DAMAGES AS PROVI�EO FOR IN SECTION 31a6 0F THE LABOR CODE, ItJrEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirtn tha� I em
force antl eNect Lla p_
Contrector's Signeture:
with Section 7000) of Division 3 of the Businass and Professions Code, and my license is in full
Class'a i4- %
�--�ate:� ro-�-�-a`/
CONSTRUCTION LENDING AGENCV:
❑ I hereby aXirm that there is a construction lending agency tor ihe performance of ihe work for which ihis permit is issued. (Sec. 3097, Civii Cotle).
Lend�r's Name: _ Lendar's Address:
Signawre:
OWNER•BUILDER DECLARATIONS:
Dete:
I hereby eNirm ihat under penalty of perjury ihat I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the toilowing reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or county which requires a permit to constmct, elter, improve, tlemolish, or repair any stmcNre, prior to its issuance, also requires the epplicant for such permit
to tile a signed stetement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom antl the Dasis for the ellegad ezemption. Any violation of Section 7031.5 by any applicant for a pertnit
subjects the applicant to a civil penalry ot not more than tive hundred dollars ($500).):
❑ I, as owner ot iha propeny, or my empioyees with wages as iheir sola compensation, WILL DO THE WORK, and ihe stmcture is not imentletl or oNered for sala (Sec.
7044, Business and Professions Code: The Contractors License Law tloes not apply to an owner of properiy who builds or impwves thereon, and who does such work
himself or herseli or ihrough his or her own employees, provided ihat such improvements are not intended or oHered for sale. tl, however, lhe building or improvement is
soltl within one year of completion, the owner�builder wiil heve ihe burden of proving that he or she did not build or improve for purpose ol sale.). '
❑ I, as owner of Ihe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The comractors License Law tloes not epply to en owner ot property who builtls or Improves ihereon, and who coniracis tor such project with a contrector(s)
license pursuant to the Coniractors License Lews.).
❑ I am exempt untler sec. _
Signature:
Owner ID verified by dnver's licensa.
Verification oi Ownership by (type of
Business antl Professions Code for this reason:
s ❑ No Drivers License No.
i.e. - property tex bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
Date:
Eapires:
❑ I hereby certify ihat no excavaiion five (5) or more feet in tlepth into which e person is requiretl �o tlescend, will be made in connection with work authorized by Ihis
permit, and that no 6uiltling stmcwre, scallolding, falsework, or demolition or dismamling thereof, will De more than ihirty-six (36) teet hiqh (Chap. 32, Gry 2, Ar12, Sec.
341, Title B, Celifornia Administrative Code).
❑ As owner-builtler, I will not employ anyone to do work which would require a permit from the Division of Industrial Sefety, as noted ebove. unless such person has a
permit to do such work from the tlivision.
Signature: Date:
DiviSion of Indusiriel Sa�ety Permi� Number:
CERTFlCA7E OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I ceniry under penalty of perjury that I have read this application and stale ihat ihe information given is
correcL I egree to comply with ell state laws end ciry ordinances relating to building cons�ruction, and aNhorize representa�ives of the City ot Costa Mese to enter upon the
above-descnbed property for inspection puryoses. I agree not to occupy or allow occupancy of any buildinq authorized by this permit until finel inspection.
COpE �. INSPECTIONTVVE ' 0 O
1616 Fixetl System Final Fire Prevention
7266 Pool Spa Final , .
200 Final Re-Roof
201 Frnal BIocWRetaining Wall
202 � Final Fectory Fire Place
203 Final Sign
204 � Final emolition "
Qsjf� IN�TIILS
.�l�yg <ef+
Date
:. CO�E� INSPECTIONTYPE.
206 Final Mechanical
20B Final Plumbing , .
210 Final Elec�nCal
212 .. Final Fire Prevention..
�� 220 Final Planning Approval ��
222 Final Site .
"" 250 " �Final Building/Occupancy
�_I JIII. .
/:1 J �/ti
lob Address: 932 DAHLIA AV
Suite No
Vicinity:
Parcel Nunmber: 41218332
Applicant: GARY
. . .Address: 17885 S
/ �
�
PLUMBING PERMIT
E� ;
9
CA i
'
UILDERS
KCIRCLE �Go 0
� �o
aao J U
�
�
� i .
�� \AND
B04;
O P UI
�J �� D
ISSUE FEE �
Backflow irrigalion
Backflow Preventer
Bathtub
Clarifer System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Status: ISSUED
Applied: 09/07/2004
• Issued: 0 07/ 4
�
ISSUED BY: � � �
� � ) " � ����
Phone: 949-553-0678
�Zlp��.-92614 �� �� ,
,---_— O
=`�c�C � 1, �
�--"..— � � \ �
�' �
��\� O �
Phone: �\\`'� 0 � �
Zip: �92626 � `�,V�
oaoo
Zip: 92614
License: 492049
I l / N .ti�
. ; � o�.vr� vr r�r
284 S.F. TO-EXISTING S.F.D. WORK TO INCLUDE
ADD INTERIOR WALLS TO CREATE A LARGER C
)1119 , � 4 r��
\`i„ �
ABING TO INCLUDE: 2 BATHTUBS;-'to AS (1-4�OU
1'NIATE`\R�CLOSET. pe' '�pd D oo-0 -°
���"�\ �i.x'+�--ic?�`� t� 9 ?G'po ra � U .
�'`�'� � � � '��;�1�FEE'SUMMAf
4MT QTY� p� o o� 1"� °°� ° d
0
13'.50 OLaund �Tub7 Wastie `� O =
- _-l� \�__ �Y_ _ a
$0.00 �0 �� .,:
$0.00 0!�'°�.� �
$0.00 0 :
��1 �I �����r�
EW BEDROOM; NEW BATH OO�M, �
MASTER BEDROOM. REF,:� J
� �/ O !!/
KITCHEN SINK. 1 WASH'BASIN.
`�,�T�,
'..w m._-,$0�.00` Oy„�
lator $0.00 �0^^i�
(p�70R,)l rS0:00 OU
f n `I lJ 50.00 o.r
U � 50�00�0��
Demo S0.00-�=.0��`
Vacuu"m"'Brkr BkFlow(1-4)
Vaouum'Brkr BkFlow(5+)
N/ash Basin
Wash Basin Set
Waste and Vent System
AMT
�o.00
50.00
$0.00
$0.00
$0.00
30.00
$9.80
50.00
50.00
QTY
0
0
0
0
0
0
1
0
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 expira and become void if work is not commenced within 1 BO days,.or if work is suspended or abendo d
for a period ot 180 days. � � , • �
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
raqulred inspectlons end final�approvel must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626 � - � .
zus�a6 (doo) „
WORKERS'.COMPENSAnON DECLARATION: � "�� � - �, y �
I hereby aRirm under penalty of perjury one ot �he following tleclaretions: ' '� ' " '�' ,
❑ I have and will maintain e cenificate of consent to self-lnsure for workers' compensation, as provided for by section 3700 of ihe Lebor Code, for the pedormance of the
work for which ihis permit is issued. . ,
�- I have and will maintain workers' compensation insurance, as required by section 3700 of ihe Labor Cotle, for Ihe pertormance of ihe work for which this permit is issued.
My workers' compens on Insu�ce card r antl policy number are: � �
Camer: S-l� /�G.y� PolicyNumber. ��2 %adY�-a�y� �
(This sectio�not be complete i( the permil is valued at one hundred dollars ($100) or less.), ,
❑ I certity ihat in the peAormance oi ihe work for which Ihis pe mit is issued, I shall not employ any person in any manner so as to become su�ject to Ihe workers'
compensation laws of Calitornia, antl agree t t if I shoul ecome subject to the workers' compensalion provisions of Section 3700 of ihe Labor Code, I shall forthwith
comply with these provisions. � /� �o�
Applicnnt Signature: Dete: �
WARNING: FAILURE TO SECURE WORKERS' CO SATI CAVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TOONE HUNDRED
THOUSANDDOLLARE(5100,000),INAODITION E OFCOMPENSATION,OAh1AGE5A5PROVIOEDFORINSEGTION3]O60FTHELABORCODE,IMEREST,ANDATTORNEV'SFEES.
LICENSED CON7RACTORS DECLARATION:
I hereby aflirtn Ihat I am licensed
force and eHect Lic. N
ContrectorsSigneNre: _
with Section 7000) of Division 3 of the Business and Professions Code, end my license is in tull
Class # ��
oaca: �7 �Y
CONSTRUCTON LENDING AGENCV: �
❑ I hereby aflirm ihat there is a consiruction lending agency for ihe peAormance of �he work for which this permit is issued. (Sec. 3097, Civil Code).
Lander's Name: Lender's Addrass:
SignaNre:
OWNER-BUILDER DECLARATIONS:
Date:
I he�e6y aHirtn ihat under penalry of perjury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or county which requires a permit to consiruct, alter, improve, demolish, or repair any strucfura, prior to its issuance, also requires the epplicant for such permit
to tile a signed statement ihat he or she is licensed pursuant to the provisions of ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of t�e
eusiness antl Professions Coda) or ihat he or she is exempt therefrom and ihe basis Por ihe allegetl exemption. Any violation oi Section 7031.5 by any epplicant for a pertnit
sublecis ihe epplicant to a civil penalry of not more ihan five hundretl tlol�ars ($500).):
❑ I, as ownar of the property, or my employees wi�h wages as iheir sole compensa�ion, WILL DO THE WORK, and the siructure is not intentletl or offered tor sale (Sec.
7044, Business and Professions Code: The Coniractors License Law tloes not apply to an owner of property who builds or improves thereon, end who does such work
himselt o� herself or through his or her own employees, providetl Ihat such improvements are not intended or oflered tor sele. If, however, the building or improvement is
sold within one year of completion, the owner-builder will have ihe burden of proving ihat �e or she did not build or improva tor purpose oF sale.). '
❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions
Code: The conirectors License Law tloes not epply to en owner of property who bui�ds or improves thereon, and who conirects for such project wlth a coniractor(s)
license pursuant to the Contractors License Laws.).
❑ I em exempt under sec. Business and Protessions Coda tor ihis reeson:
Signature: Date:
Owner ID veritied by tlrivefs license. ❑ Yes ❑ No Drivels License No. Expires:
Verification of Ownership by (rype of document, i.a. - properry tax bill or deed):
DIVISION OF INDUS7RIAL SAFETY PERMIT CER7IFICA710N:
❑ I hereby certify �hat no excavation five (5) or more tee� in depih in�o which a person is required to tlescentl, will be made in connection with work euthorized by Ihis
permit, antl Ihat no building slrucNre, scaflolding, talsework, or demoli�ion or tlismantling ihereot, will he more �han thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Title B, Califomia AdministratNe Code).
❑ As owner-builder, 1 will not empioy anyone to do work which would require a permit from the Division of Indusirial Sefery, as noted above, unless such person hes e
permit to do such work from iha division.
Slgnalure: Date:
Division oi Indusinal Safery Permit Number:
CERTIFlCATE OP COMPLIANCE AND AUTHORVJ1T10N OF ENTRV: I cenify under penalry ot perjury Ihat I have read �his applica�ion and state that tha information given is
correct. I agree to comply with all stale laws and ciry ordinances relating ro building construction, and authonze representatives of ihe Ciry of Costa Mesa to enter upon Ihe
above-described propetly for inspection purposes. I agree not to occupy or allow occupancy ot any building authorized by ihis permit until final inspection.
�/� Signatur Ot LA gal Owner(s)
9 0. ^`P i`��Za �.Cs,
And/OrAuthonzed Applicant
CQOE I. INSPECTIONTYVE _ . . 1L�L . . LN�96i
1616 Fixed Syslem Final Fire Prevention
1266 Pool Spa Finel �
200 Final FB-Roof
201 Final BIocWRetaining Wall ,
202 Final Factory Fire Pla
203 Finai Sign
204 Final Demolition � � ' ' ' '_
Dale
� ��iY
�— �Date
_ 0 X INSPECTIONTYPE
206 Final Mechanical
20B . Final Plumbing ,
PD7E It�LS
Final Building/Occupency
�
�ooness a em�ano: 9 3 2 DAHL ZA AV
OYINEAS�WEIfIPlOWII: [nIARP.EN, JO?-IN f:
�. �ooxess: 932 DAHLIA AL�E ,
COSTA MESA,CA
� 537-4258
wr�. uuuNc wonFss: . .
ANCXRECT OP ElNiNEEP:
YICII OX EfM.'S ADD11E5:
coxm�cTarsw,��.
caxrn�croxs�uuxo
ADDf1E55:
UNi:
FLOOD: AH-38
. 92626
ucxo.:� . , �
UNT: •
� - � uc. rn.: . . . '.
uxr:
IJCENSED CONTRACTOPS DECLAfl�TON: I hereby eR'rm uMx peneYy d pe�ury thet I em I'renaed uMer yoviaione of Chapter 9
(mmmerwinp wilh Saciion )OOO�otDiviaion 3 d�he Bueirian eM PrWeaeiom Cade,uM mylicema uinlulllorce vd eHea.
cm uc. No.: - uc. cuss: uc. No.: � k p.
Deb: ' ' ComreUw. �
OWNEN BUILDEN �ECLAHRTION: I Mreby elfiim uMer penelly d per'ryry thet I em evsmp Irom tM ConlreGan licenee Lew fa IM
lollowing reeaon (SeUion 1031.5 Buaineaa enJ Prolessian Code: Arry cry a counly xfiich iayui� a pe�mu to mmtrun. Mx, impova,
Eemdoh, a repei eny avuciura, pior lo ils esuarce, abo repuim ihe epplirant fa euch psrmil to fila e ei0�� slelemeM t�et �e a ehe
e licenaed W��� �o ihe D��ieiona d IM Conlredom Liceme law �Chepler 8(wmmmdrp weh Sxfion lOW) d 0'vuion 3 d Ib
Buainesv eM Prdroeuna Cade� a ihet he a ahe ie uamq thereimm enE IM basis lar Na elbpaE memqion. My v'detbn d Sedion
]W 1.5 by any epdifant ta e permd eubpr�a iM eppliceM lo e civil penelry d na mwe ihen Me hurMred dd4n �S:Ao�).
�. I, av owner d �ne ProDeny or mY emWuYaes xiln we9m s+�Mk wle eom0�eelion, will Eo Ihe xoAc, eM tM Nrve�um e ml imeeWad
•• wdlerediaeelel��]OIi.ButireweMPMesabruCode:TMComrea«alioenaelewdoeanoteppytoenowrrorWpropa�ly
wM W ida or'unprovea Ihereon, end wlw Eoae sucM1 xwk himaett ar henell a Ihraph hie a Mr own emplvyaea, pwNed ihm wch
impiwemmte are nd inlmded «dlereA la seb. tl. however, iM W itli�q a'vnpev.emsm u add xiihin me ymr d canpleiion, ihe
wrer-0uiYbr wll heve tM buMen d pmvinp he or she tlk ro� buik w impraro ta iM W�e W eeb�. �
� 1. m oxnx oi ihe propeM. � extlusiwly cantrea'rp wnh IicenaeA coMrectae to conavW IM papc (Setlion )WI. Busi�ne� end
Pmteviam COAe: TM Comrmon License lew doae nal epWY a en owner d p�apMy v.1w Wild� or impovm iheroan uM wtw
mnuecM iw su h prol�s'MN e mmredor�a) IicenaeE pumuen� �o ihe Conlredon Licema Lew�. ' .
exem� uMer ection: B. 8 P.C., br I�is///re���aron: -�{/��/� ' '
ala: 7 ' � Owner:�4 //N�7'Cv��
he�eby cMiy �hei l em ewera ol aM urMerslenE Ihe re4uirem W Calilomie HmI1M1 end Selety Coda Seqvre 25505.25533, arM
255�a, end �het I a eiry INun buiki�p oaupent will / wil �(arck one) need io canply wih eeid pele mAm eM ihe repuirtmenb br
epertniliwcauwciionamodif tionhanlheA'r ei�iy erepementDimnq.RezidanlidcanqrudoneppG�ionewuemqiromthue
ao�swos. . � . , � ,
I WONKEF'S COMPENSATION OECLAF�TION: I hereby eifi�m uMu penalty d pejury aro d �M blbxi�q Cadarmioen: '.
I_ � I hew uM wil meintein e cenGcele d oonaent io aallinaure M xv�lceia' compemmian. m pwketl la Ey Sei.tim 3]00 d �he lebw
--.Code. for tM paAmrerca d Ne xwk tw wlach �his permit ie issued.
'). ❑ I he�a uk wil meinlen wwMere' oompenset i� inaurarice. s4 �equired by Serlim 3]00 d Ihe leba COEe. fa tM peAamerwe d IM
work lor whid� thia permil ia immued. My waNen' campenmtion imurvice urror vd pdiry number are: '
. c.�.: .
adrr N�mea,: � - ,
(This ae tiar need nw be complered Y �he permrt'u lor one hunJred Eollers R100/ a lesv.) ' �
❑ I cen/y ihm in �he pa�lameMe d the wwk for whch thie �parmn is �uetl, I aMll �wl smpby erry pseon in ury menmr eo o �o
pecome wbjm to IM1e xwkna' wmpensetbn lewa d Ce4lanie. enE pree Ihet il I shouk Esome wbjed lo ihe woMrs'
compensetion provisions W Se�fvn 3]00 al �he lebar Code, I Mell lonhxith wmpy wiM �hoee proveons.
ode: endbem: �
W�m/np: F�Auis ro�wvro woiken'rompxo�tlon covm�p� l� unl�MNl, entl WI/ nbNct �n ntployn ro ctlMns/psn�ttlu �nJ
clvll Iliros �y ro on� h�ndrM fMuwM tlo/l�n (S1Pq000A M M11tlan b M� cwf ol ro�vxwWrt d+�p� �+Provltlstl br In
Sxtlon 3)O6 0/ tlu labor Cods, InNnst, entl ettornsys Iw. - ., - �
CONSTHUCl10N LENdNO ROENCY: 1 Mmby �rtn uMer penelry W perjury Ihe� �hem ia e eansleudian IeMing epency /m Hro
parimmanm W �he MvM la xfiich t�a permi ie aweE (Seaion 309]. Cb. Cl. ' .
LENDEH'S NNdE: �
LENDEWS ADDRE55: - ' � ,
I caniN �� ����his epplcetbn eM qma thet Iha ebwe in/ormetion is wrted. I epree to canply wnh ell ary end munty ordinencea
enE stele lewa relet'inp to buildin0 conavuaion vk hareby eu�Mrae repmaniaivae d ihe ary to eMer upon the ebwa�memioneE qoparry
m, Insveaioo purpwes. '
Joxr7 wnxPEr�
D�e: 7 Z �'
(5151dfi.WP) WM1�e-6uikiq d Se1etY:OreemFb: Car�ary-Rppirent: Rnk-Revenue:
, CITY OF COSTA A1ESA — BUILDITIG PERMIT
T_'ERMIT NO: H, 072394 PLAN CHECK DIO: N
CONSTP.UCTIGN TYPE: PERMIT TYPE: STR� •
JOB UESCRIPTION ; T/OFF HESTH E AEROOF W7COP4F. SHIPIGLES
:'EFM P.O: B 072394
GOVT: I�I SUPF.: N ,
PURPOSE; O:H
SQ FT: 200 .
CLAIA4 VALUE; 2,OQ0,00 CALC—VALUE; 2,000,00 GP.C�UP OCC; R-3 ,
- �
Cr�MMENIS• SMC�KE LETECTOF:S ARE REQU-IREL 'IN EPEP.Y bEDF,00D1 & HALLWAY, 1991� UHC
3: iE �Y it �c jt;. iF �c jf �-1f aF �rt iF *�1t u+t it �E jf i4+t * iE iF �k * aF it iE s aF * iF �f +t iF �t jf ac ir�;F-lf -R jf *�f +F iF.c aF 1F af -1F �rt �lE iE u ac **+t it+F i; �-. Y� �f *. iE Y-+F -rt s ac
Z O N I N G R E Q U I F. E D1 E N T S _
s F r s a c x s •
------------ h4AIN EUrLDIA�G ----------
FRD]?; FT IN R£AR; FT IN
LEF2'; FT ZN RGHT: FT IN
F�ARHING P.E�• , PROV; PAF.CEL; 412I8332 ZNE; P.EF NO;
PLANNING Nt�TE5>' .
.' , . . . . , t.,
3t dfiF�N if jE iE > aF �f�1f�1E�lE df�iF=F i� 3FiE iF k iF�1F 3E iE-K i� �f ifiF jF V�ac�)Fa-�Y�7: iF-1(�if'1f ifY�if jf 1E af�N iFiFlfif ii af K#*iEif il-iF iF�le iF i: i4 i� if�N 1F�1E-1F iF K�k K aF iF
U E V E; L O P M E P7 T S E R V I C E S � R E Q U I R' E M E N �T, 5
' '�" � . i , . �
20DIINC APPRUC'ELl� HY DATE� "
" � � .1. . ' . ' "
BUILDZNG APPROVED BY ; ➢ATE: .>
APPLICATION ISSUED BY; �'�' DATE; �'. 1 l � I��
*�;e+��*�t*�t-�c*�c*-1F�c**-�ru�c*iF��-�Z�F.sF�e3F*�TF�r*�«��.az�iF���w-��:.c.�*�+.r.�u--��a�±�*u�c.;�.r+r�,�*� �x��*ic
LEGALIZATION;N F E E S U M M A R Y �STnUCTURAL'SEGMENT:Y
HLDG PMT '.PLUMHING ELECTP.IC MECHANIC • ' FZP,E SMIP7RE5 GP.ADI^]G
PERMZT 45.00 50
PLF.N , ' . SMIPlNON—RES
ISSUE.FEE
BDILDING—DIC?—> PERMIT ISSUE PLAN-CHECK' TOTAL FAID UUE
TOTALS_---> a5;50 Q.00 0,00 45,50 45.50 ',00
_ -------_-.,- -=_ — - —� -- �
REVENUE DIVISION TOTALS--> LL COLLECTED; — —"95; SQ= �OVER/-SHORT:— _-- -= OU_<_�
HLDG PMT PLUMBIA7G;ELECTRIC MECHANIC FIRE SMZP/TOT GP,ADING PLAN—CHECf;
45.00 ' .50 '
if ii-% �M- if iP if �k 1i� �it # il� yF #P �k �N aF iF it �M if iE �1f �if �Y-E � if i4 iE K:f if 7F # if iE �Y+F if iE If ii� Y i(--K ih }�.,' 1E iF # 4 n aE i�-� Y-if iF �ti?f a- aE it i an iR+�- ii� iF # iF 4 s i%�14 iF �1E
I N D I C' I D U A L F E E B R E A A D O W N
TYPE ' QTY D E 5 C F. I P T I O N � UNIT; COST TOTAL COST
SFR 200Q REROOF BY L'ALUE RESIDENTIAL NOZUNE 1.00 � 2,000.00
' END OF FEES
--'------- A�CESSOR`i BUILDINC ---------
FRNT; FT IN REAR; FT IN
LEFT: , FT IA7 RGHT; FT ;.IN
0
0
a
�
,
n= !�`�1.321:�7-0�2�21i$ T3]�T
, • Of,TE: GS/17iS; TThtEe 13:33
e
45.5p
�
' d
,?- �CONSTRUCTION AND PLANNlNG • , -� l 1 � �, -•�00� & SBA - . , . -
Date Inspector %' Date � lospector
�, APPRpVALS Permit # , � ��, APPROVAIS Pennir# � � . . .
: i, Temporary Electncai Service or Pole �� ' �, ("' . 52. Pool & Equipment Location �`
�-2. Soil Pipe-Undrgmd. ' � � � u' . 53. Steel Reinforcement�� - ' c
�fT
3. Electricai Condui[ Utility�Undrgmd. � .. � � � �54: Forms � � � � - � ,
•4. Electricai Conduit-Undrgrnd. ' - , .55. Electrical�Bonding- ' , � � . �,r-�
5. Steel Reinforcem�nt -, � . , ; 56. Rough Plumbing & Pressure Test - �' Y��
6. F.lectricai UFER +3rnd. � .- � � 57. APFROVAI TO COVER�GUNITE _ �_
�7. Pootings � _ ,5&. Electrical Conduit-Undrgmd'. � � . �$
$. Foundation �� � � 59. Gas Pipe, C Undrgmdo, Test • z� r �
9.� Water Pipe-Undrgrnd. ' -- - L;s' � 60�. Backwash Lines,,P�Trap, rJ Undrgrnd. - '
10. Structural Floor System ; � �' " � �'� 61. APPROVAL TO DECK '� � r -
i t. Property Sewer Lioe & House Connection' , : ' �/ '62, Bac,kwash &,Recepror-Final ', ' �
12. Sewer Cap � "' � , °� 63s Heater & Vent-Fi�sl � ' : . , �
�
13. Roof Drains - _ � . ' _ �- ;64'. Plumbing SYstem �,Final � �- • _ -
74. Rou h Plumbin ' " . �� .� . . 1 � , .
9 9 . _ )� ,�65. Electr.ical-final � ' � _ .
75. Rough ElectricabConduit , ^ . � � � � � ' �66. Solar SYstem-Final ' � j�
16. Rough Eiectric YViring � '� `- ' 67. Fencing & Access Approva! ± �� � %' ' �
i i ��
17. Rough Wiring Sign � j�- - �-68. APPROVEO FOR PLASTER�ING� - ,'" . I
18. RoughElectrica678arCeiling � - : - �69. POOLISPASYSTEMSFINAL � � �
19. Rough�Heating &-Air Conditioning � ' ` " ' �' FIRE DEPT. REQUIREMENT' `
. �
20. Rough Factory Firepiace � APPROVALS Permit # �
21. Ducts, in�Structure � ' 70. Underground Hydro . ��
22. Ducts, Ventilatinq - 77. Product Pipinc� �7 G. s❑ Oil
23. Gas Pipe•Rough & Test � • 72. Underground FWsh -
24. Roof Framing , ' 73. Undergrnd. Storaye Tank C Gas ❑ Oil
25. Roof Sheathing 5�,2 j-q�j �L✓� 74�. Overhead HVdro
26. T�Bar Ceiling (Strucwrail & Monocoat � 75. �Dry Chemicai .
27. Frame and Flashin9 . � 76. Dry Standpipe "
28. Lathing & Siding ' ' � 77. FIXED SYSTEM FINAL
29. Insulaiion • 78. FIRE PREV. FINA�
30. Dry�vali-Nailing .' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION .
32. Eiectrical Power Meter-Ffnal ' � � ' 80. FOOD CERTIFICATE ISSUED
33. Finai Electric � �� Notes: � - '
34. Finai.Heating & AirConditioning �
35. Final Gas�Pipe�Test - - � . � J. ��
36. Nood or Canopy w � '
37. Finai Factary Fireplace . � � ��
� 38. Final Plumbing ' '
39. Water Service�Final. '
,
40. Gas Service-Final • . . ' � � �
41. Solar pomesticffnal
42. 8ackflow Preventer
- 43. Backflow irrigation . �
44. �andscape Irriyauon System � � � �
i
45. Sound Attenuation _ -
46. Handicap Regulat�ons �
47�. FINAL STRUCTURE & BUILDING /g,,,� � ;(.�� '
l
48. FINAL PLANNING � .�
49. Electric flelease to'Edison ' ' � �
50. Gas Relea4e to Southem California Gas CA �
5T. CERTIFICATE OF OCCUPANCY � V
No. _ Oate
_ _ _ _ _ __ __ _,r,._�,_. ,.., a,.�. ' .�_... AVPlicant,to fill,in,all ipaces.exceptthose witnin.heavy.border lines ana sign al1 apvrovriate tleclarations. ,� _ _ � __ - '.�� _ _ _ _ t , � .+ -
CITYOF-COSTA�MESA I.CO ST,R ;CTION PERMIT ` ? PER - ' ic- 7RACTNO.i.r _LOT.•NO:: •tr .iUNIT�NG ' ' � ' w r •{,�; ;,. F � - r � r } 1 � � � : ,,'�'�
9��� � .ct � . � . 1 '1 t � � ' l .� r i �r ' r. �� 4 C � 4 -1 , � � �:
�/� � I ' ; � a.3y8� ; . , � � � : � � '� � " �-r � � • s52� 4i�i�e� � � , 5o0c; , TG
.�;f?.ro�ect Address. Q //l ��- � y ' f r ' . _ . � _ rt' ' r � :•_ t ' a � � �. u i � ! � ✓ � �, j r es � 3 tt,� : � �
� ,Applicant'S Mailin A � ess� � � �� + - � i � �� TYPE OF CONSTRUCTION - � rvEW 't�Do,' �ALTERATON REPAI R.. ' - � - ' - '
•+ v - ' / ❑ CONVERSION �O DEMOI'ISH O OTHER . ' ' � f (�: � � - ' � ' ` _' " � ' { '
', Owner's Name J � . :/•� ' o�, � ' - 1 � r � - I ..1 . _ A.P. # . . - . 1 - : w .:. f � 1'�: Zone , "r i
�����- � j, DESCRIPTIONOF�WORK/USEOFBLDG.�
, `A'ddress' r i ' �- � . � _ .). .. � : � '' . I r, n - t .• . � °' � ' i ` S Main Bwldm9. .' � - "• ;5 S J �' rAccessory;Buildin9.-; - CC 1 - °''� _ ' � �f '.
{ , `;� C� ! - � � � 'TVPEOFPERMIT I �, �GRA�ING�OUNDATION: ' STRUCTURAL� � � E ' i';� � J� } ;' � � .�2 � � � � "� "{_ O' `
� Areh/En9- � License No . , ,i� 7 Front i ; � � �r � { _ � � , ,
°' ' � f ' 4 f ^..'� � � ' �' } `❑ TENANT "❑O ELECSRICAL� PLUMBING ❑O MECHANICAL� , ' � 1 �g �, t - � � �T N� �
AHdress • - , . . • ' - +
' Y n - _ ' '.' 1 - %�,OTHER �, (T t t ..ri , � � � : = � �.` -�' f � . � Reaf' .i . 'I�P. °' i,e � � I ;. i .s.i ^ . L T C . , .
- ' Contractor's Nam � Phone, ' � . ti. "' : , � .A . . � _ . � �. N, �
� . n. . � C Right � c I - r' �-.. " I- ; l
� t ' � , � � f _ I ' � ; PROJECT'DESCRIPTION. Sci. F7. �" � � � OCCUPANCV' � � - °" i
A�ddress.lmailingl', t' , � ` �`• �- . �'CONSTRUCTION:TVPE � � ^� f � ;VAWATION$ �� f � - LS Lefh • � r j � r� ( , i �T j'. � � � --�; .Gy,
. . City Lmense No. ' i , t, i �� � . 1 � i � � � ) � � '. . 1 , . ' 1 . . :. . , 1 . R � .
� . .. . . . , �. . 'ZONE GRADINGCU.VDS:' �ACRES ' � � : : • ' ' � - � �_ E; ��
LICENSED CONTRACTORbECLARATION � � y �. � � . � i � � +� � ' . : �4 i , i - � Ping. Ref. # , � i Paiking REq./Prowd¢d� �
I'
L-hereby x(flrm that:l am I�censetl untler provisions of�Chavte� 9�(commencing Remarks � � . I � �- . � r � � �� '} Planning Notes: i .� ' � � '.} _ _' � 1•'r � Mi �' '
witn 4eclion �]000) ot �Drvision 3 of. the Business antl Professions Cotle, antl ! ' ' ' ' " � " � ' � ' � ' '
" � � % r I. L �" " i ' . � t' ' . � - ' • T�1 i
mY license is in 1 -ce antl etfeiL� j i 1 ' f t � � C t . { � : - f } • - � : i � � ( . � ! � ' � � � {�PC . y y�, 7 � . �t_
�icens la s� i' : : . ic i � � . . , . � � aV - , . S � � .
Date � � .Signeture � � • � � �- � � j � ; � � � • � � PLUMBING �.; ! } �.� � I iFEES � 't ' �� . ! ' , �,4� � � `} % , �
� WORKERS'COMPENSATIONDECLARATION� � �. . ' ,- � ; + BarSink � k � � Showers � ' t � � � ; � � � '
� I hereby�aRirm thaTl have a cerL'icate'of�consent to selt-insuie or a certrtmate � . � F � � ! . � C 1 i i j � '� � ELECTRICAL � -' � � � � �� � FEES :' �
1 -of-Workers'-Co � ' � surance,� or-a�-certitietl•coOY thereot (Section -- - - y-- -- - � - � - , � —i--+ --+• - - -�, _ - ��---,- � - , . . �
� 3800, Lab.' . � �� + � � r f i�� C - � Backflow�Pre`ven[er �. , I I Service.Smk �� ! . , . � Automatic Washer �- � Transtormer O 15-50 KW ' i � � ` ( '
Policy No. Company-i�`--� ° � BackflowlRigaLon f Se�.Jer�Cap : e� '� � .' � � � i ❑ 50+KW I � � �
[]� rtifietl copy is hereby tarnishetl. � � " %tlri,� � �"�!% � �i � - � � ! � - � ! • 1 Construction PoleSub. ; j. � , , r j
� .YS'Cer'tiep/� py' ",}�¢a witn the'city Id i o � � �, Bathtubs { �. ;, ? i '' Sewer�Connection � j I � � .Cooking Unit: H�' F � � Meter ❑u to t00am s �� I �,
Oate.�'/// �YJ� AP�Iican�����L. � � � .i � . i . .-. . r i . . .nl . . . P. . P � i
_EXEMPTION.F.ROM.WORKERS:.COMPENSATION�OECCARALION -._.-r.-� � � �.}... Cl2nfi¢f5_ ! _ M �,.�. � �$Ola� Collectors� _.... {._ : c { : _ .Dishwasher :�y _ y I__ ��_„ � �
(This section need not be complet¢tl i( the permrt�is tor one huntlretl ($300) or - , � � , " '� �� � ' .M2i¢�_�OVE�;100 dmp5�,. .,,.�y�.. .... .
. iezs). � '� • � � , r , ; � . � � � - �� . Dishwasher t " � . ' Soiar Pipin9� k � ; j , I' / Dr ers �Gas° �Electric i .
I certify tM1aCin the erformance ot the work toi.which th�i erm� - Y , �. ; � ' Sub�Panel , •�! �� j
P P I IS.ISSIIEG� I . . � , , � . -� 4
'shall not empioy any person in any manner saas`to become subject to�the D�inking�Fountains . }� .Solar�Tank � - f Fan ' ' � ' I ! ' ' - ' � �
workers' Compensation Laws ot Czlifornia., ! ' � i - � , � ` ' ' ' ' ' ' - - � ' . . '� �'Ii p Motors �0 1 HP 01'/x -�8 '
. Date � ' �� Si9nature ' � • � ' � � � � Floor Drains ! � � 1 ' Swimming Pool w/Spa�. .� _ ' i � . � � • ' �
�NOTICE: If, atter making this tleclaration, you shoultl become subject to;the '� ` � � � j � ' - F.A:U. � ,�' . i , In0. SOldf �9�15 HP �1C-15+ �
� Wo�ke�s' Compensation provisions-of}the haborCotle;yov-muSYforthwith^ � - FIOOfSinkS?- "''� ' - -'�1� U�ipol�� �����+ � }""r'�'�`�' -- - -' -'.•`i""--"--'--"'-'- -"_._.._. -_ _ _ _ _.
complyywi[h such„p�ovisions o�rthis..permiNshall be•tleemetl revoketl. ' � ` �""��� � . i � ��Fizturesr� � � MicrowaJe '� �� .'�-I �
CONSTRUCTION� LENDING �AGENCV_ � � �S �� �- J , � t_ ; �,: Gas$¢iviCe FOutl¢t5� " � "; 4�/�IaLe�,CIOiEt ��'. � �'' ' �? � ' � � ^ � � � ' ' i ' ��
� . , ( r � . . , - ; Device Bozes ; Pole Li ht � { � ' �
1 hereby affirm that there �5 a�con5truct�on lentlmg agency for the pertormance- - - .} ��� . , 9, � �' � .
� oi thelwork �-for �which� this permitt is� Issuetl.�($ecLom^309] Civ. CT) � � Int¢�C¢ tOfS �� + � � 1.� 4 � � � �l' � + ' / • �
�� , '� � : Wate��Heater - r . � � r� ' �+ �Outlets � - - � i , ,. � �
� Lentler s Name; . ! � - � -- _ z � � .a { _ � . P � . { ' Range '
� Lentler'sAtldres's � ' � ' '� � � ; - � ' � Kitchen5ink,�, �� � ,_�: WaterServicey._ :�,.^`h �q' ' '�,.� �,7 Switches�� �� . !' a� � Sign `� .�._d. _--� , '
- OWNER'BUILDER OECIARATION�' � =^ ' - " �- �- � � ' . . _'.:_ ... -
�. . . . . , .. � ._ � . _ �r .-. . .. �, ,. . • � - . y . •' __ -
� � I M1e�eby affirm that I am�exempt from the ConVaCtoYS l¢enSe.Caw to� the' L3vdtOneS � ' �y AutO-W25h i_j 4 t��_ �� _}� -- _ -r - -- " � � '.
. � , '' � "� L ' --�' -r �� - = "Gaitiege'DisPosal . i ; Standmg'Sections i .
. rfollowingirea5on (Section']031'.5 Business antl Protessional Cotle:-Any city or ` " ' -- � '- � • � � . s ! . j
":ounfy which requires'a.permit to�construtt,-alteq,improve,�tlemolish or repair�= �+ P �T�'yp `T ' � ^ ' c ' �du'ndr T.ra 5 + � " �� i'S%� ' ' ' ' � r � "
- any:sVucture; pno�'to!its'issuance, also requires the applicant for�such�peimit � �� ' ' � �Y Y '^ � I r� � k � G202f2iOf �0-5 KW OS-75 KW � � TraSh Compactbr - �
'.to file a siqnetl,itatementethat=he/she is'licenietl pursuan[ to tM1e prov�sions ot � - - - r •C � _ � : } + - � . �" i �- � � - , � � � � ` ' � � '
��,the,Cont�actor'S'License Law-(Chapter,'9!(commencing with Section 7000)�of ,� � -i Roof�Drains . ��. r ; � �r � - � ry- � - , � _ � �
. Division 3' ot the Business antl^Protessions Cotle)jor that he/she is exempt � : � � .. y. - � �. .. ' - � . � � r ' � ' � ' � � '
. therefrom'antl the basis for [he alleqetl exemption. Any�yiolatlon of Sechon � = { " 1 � � t = � i^�.� _ � + � � !� f � � r � :r � L � � � � � , i � � -F J � �-
�0031.5'by, any>applicant for, a�'perini4 5ubjects•-tM1e!'appllcani=[o�a 'avil-� �� � t � �• ' _ _ - > � �
'� enalty of.not moie than five huntlretl tlollars;(g500). I ��._ - � � f i�_, � •;t, ��' .1 � � -� . '
. i . . .. � � ' t � . 1 i � !
' r, - 'Rei`ns�ection'Fe 1 G - �'�� �$`3' t' 'F � j �
e 15
.� I as owner of the property or� my_employees wrth wages as their sole �' ., P� � �' $ . IStue Fee , ..� _
! i . d.
� mmpensation, will tlo the work, antl the,structure_is�not intentled or ofteretl � � -' ' " -' ' Reinspection Fee � '+ $15� ' Issue Fee� ; + Y $ 3 '
1
� for sale (Section'7044, Business �antl Professional Cotle: The Contractor's i _ , � f i," � MECHANICAL i � ; y 'FEES � � � � ' '
License t2w�tloesnot apply;[o'an owner'Of,a property who builtls or improves , �� ' -' _�
thereon�, antl wno tloes sucM1 work:himsclf/M1crself;or'througM1 nls ort ner own � �-� � y r.� � � � - : � ' �.. DEVELOPMENT SERVICES REQUIREMENTS: � � � . •
employee5, provitletl that such�.-improvements are not in[entletl or offe�etl tor � BOiI¢( 1 _ • HOOd OY Typ¢.I'� ❑ I� �� {-'� t.. � i. � � �' � ,� '� �
sale. If, however, the buildin9 or.improvement is soltl witM1in one year of com- � `� � �1 Canopy�� Type II �� i-� J-�� � y'� Zomng Approved By , � ' ' - - Date '
pletion;tbe owner will have the burtlen of proving.he/she'tlitl not builtl o� im- � DuCt Und2� Ground�� � ; - ', ' t - i ; .
- prove-for the purpose of sale). , ( ; ' � _ � , i , �' .� . � ' ' ' ' � �� � ' �' � ' � � � • ' ' � Building Approved 6y � � � � ' � � �� - Date ��� �.� �
❑ I;as�owner ofithe property, am exclusrvely contracting with licensetl com ( Duct -Structural t i � � Fefrigeration System '�n � Applicatmn luuad By ' 'Z � i � '� �- Date '�nC� �
' trac[ors to construct the proleGt (Section ]044, Business antl Professions Code: j ' ' . • � + t;r ! I . � , .
The,ContractoCs.�License Law.,tloes;not.apply_to an'owner of_property who„� ! _ Duct--Ventilating-�..�- �.�- - : � .�0:100,000 BT,U.;0100,000 BTU �_,,, _ . ' ) ' 1
� , , ; •J � � , i.. SUMMARV,OF FEES j _ � � � I�
� builtls or improves thereon; antl�who•wntractsfot such projects wi[h a con-, • • � �' - - � y } � . ' -
tractm(s)�Ilcense pursuant tb me' Cantracror's License�Law). I am aware:tnat � � Ezhaust System ❑ Multiple ❑ � System Repair/Alteretion � r �� j � � BUILDING�PERMIT �$, � � '-�� SMIP�^ .}$ !- �
�proof o( Iheir WorkeY.s Compensation insurance shoultl be pwvitletl to me.' �� , . . . . � . }
! , �' I � • •'. , � � - - ' PLAN�CHECK i � $ �� � � �PERMIT� i �� '
❑9 am exempt untler Section e. & P. C. for this reason J Frepl/Factr.BlL ICBO�# i Fire Dam ers ' � � r
. ,r f i .- t ' , t � t '� . � e t � . P 'i � I.,' • 1 � � � PiLUMBING. � : $ �I \� 'ISSUANCE r $--; .. i j _
Date ' � � owner � �$ ��� � - � � � �- f - HeatingSystem�& Ducting�i �: j Registers � � � � � � � , PLAN{CHECK '25% $ � ' � jENERGY!P:C'�7 $ �
�, -I`heretiy'certify; Ihat'I'have'rea'C".this applicSbbn�antl'state"that the'atiove'�- "'000.100;000'BTU'0100,OOOBT' �� � .� � � ' ' ' ` ' F, . , � � ' t � i, '
t, �� � .I .GRADING' $
Info�mation is correcL.1 agree tolcomply w�th all aty antl¢ounty orainances � � f . x 1 : , t � I '�'� ELECTRICAL �.' -�$ , i
� antl state laws �elating;to builtlinq const�uction, antl�hereby authorize repre � ,� � , � � , . , i � � ' S � � �MICR�FILM $- ' j �
sent5tives•ot� this: city, to ent r' upon the above-mentlonetl property;for 'j .,� � � � � , : PLAN CHECK •�50%. $ . � � i �� r
inspection po � i � ' 3.. Q_� �� � � � ' � � - } 1 ..�1 7� f , . �f' 1 MECHANICAL' ��$ � ' ' � �TOTALFEE� $ � ���/�+ �
5i9nature Date�i . � , � •y �. � .� i. � .
i • Reinspection Fee �$15 ` � Issue Fee � . � $ 3 '. PLAN CHECK �25% < < - f �
ori"vers'�License or 55 9f ) ° f j i � � • �$ � 1 I
CMF 0865�46, rev. 10/84 White -�Builtling; Canary � Applicant; Pink - Accounting; Goltlenrotl - Assessor �. ' ' - - ' ' ' ' ' " -' ,
�,. . y��! � ��i
I �: CONSTRUCTION'AND PL"ANNING- -� -� �, ' _ . -_: ; ,�- -JOL& SPA , , �, . � . . , _ ; . ..`
Date , � �Inspector � . �-' � �� � , >` '� Date , Inzpector
-;�APPROVALS���Permit# ` � .`•APPROVALS,.,Permit#
- >;
�..-> . r, • - � � ' ;
Ci. Te:mporary Electrical.Service or Pole _ - , _ .52.,PooP& Equipment,Location � � x},� - , � :' � --
� <;'- .
� .2. Soil Pipe-Undrgrnd. . � > :� � � '�'} �-; � � ,' ',53 Steel Reinforcement'� - - � ;� :� ,�
' .3. �Electrical Conduif�Utility-Undrgmd � � , � i � ,:,,b- �,54-' Forms _' , a ;:� r � � .. � � �
' '4"Elecf"rical ConduitUnBrgrnd:. :� i' "�� ` • .;55 � Electrical Bonding� " ' -. ' S. ,` > �:' _
�,` .5. Steel, Reinforcement ; • � � ` � " •, I 1 � � ' 56.� Rough Plumbing`& Pressuie,-Test = �� �' ° _ • °� ` �
'• `6. Electrical UFER Grnd. • = �^�:. � �'+�-`. �+ `-% " • • 57. APPROVAL�TO��COVER-GUNITE - . ="
.� � � � - - �;. "�. .
' 17.'Footings ; �� .� �' ^� � i`: � . }o � � �..' C�58.- Electrical.Conduit-Undrgrnd.", j; � � , '�' . �y M i�
y i8. Foundation' � ' t $:: " „ ,�. � - , 'q .�„�, ' �59 '�Gas Pipe .O;,Undrgrnd.; Test � .; �• � - �
i �.
:"9. Water Pipe-Unclrgrnd�i . � � ' � "� ' -- � ��60SBackwash•Lines,`P-Trsp, � Undrgmd.-! � ' .
il ". Y -
�1�O.StructuralFloor�System;� ', � t;�,'q �{ � -'61.^AP,PROVALTOFDECK,^�'-� _' _� `' � _ - -
r. :.
�,1�1. Property Sewer �Line &� House Co.nne�tion _.�. �.; ', � _ .'62., Backwash' &�Receptor-Fina6 , � - � � ` �
,
il72. Sewer CaP � , � �-, , . ' ; . .. ' - .. , - . , ;_ _
� �� �� .', ,,,;,; -a•; �63:'Heater&Vent-Final �. '�
-
+.13. Roof Drains � � ' '�'' -" ' � , �,� �64.,Plumbing System = Final � � ; . � ' - - .
.'r _3^
r�14. RoughPlumbing.�; . ' -.' ' � - � _ � �.65.3�Electrical-Final"-`:��r- :",- . . _ ,;f .. �. r:"� �
'.�15.-Rough Electr,ical-Conduit-�--�--,- ,- �, .-_y.__- -, -�- - �66:�Sola�System-Final-,� - � ^ t �-- - �"'-���� -`-i • - ;
`'.1�6. Rough Electric Wiring, , _ I: � - � ;; � =' - - -_ � _ 67'��Fencing�& Access Approval "- r� � ��� = i`--i-,-. -�� --��- � -
� ;�,17. Rough'Wiring Sign .: - ;. . . ' V �:'� � }'+ : � � ,�� ' 68. ARPROVED{FOR PLASTERING- � ' � , - * �' � � . � �� ;
18. Rough Electi.ical=T BarCeiling' - �; �� � .'. ,i _ � � • 69. ; P,OOL/SPA SYSTEMS-FINAL ' -� - ' `•� � � ,
; �19. �Rough�Heating & Air Conditioning '� j ` ��,- � � ,• � ; ' r FIRE DEPT. REQUIREMENT - � . ��, " � . �
" ' ' ' • � ' S '4' �;. -. �'
� �20. Rough Factory Fireplace! �, i ,± � ' � � � � r � � � � APPROVALS � ,Per`mit:#{� � ' ' - � ^
i � -i� - i
� 21 . Ducts, i�n Structure � �, � ' „ ` � � � 1 � ' 70. � Unclerground Hydro� � , �� ' � - ` - � + --
Q2. Ducts,_Ventilating ' � . �i �� .i � � � j�. �product Piping +� Gas ,-�Oil { , , ; � '
�23. Gas Pi e-Rou h &�Test S � ' � 4-� ' -� .�- ' - J--� , � ' '- ` "
• ,. P 9 . �� ,- '� � '� � 72.iUnderground Flush � �,:: � � -�i-� �
. ' - ' - ..� . : . � �- � - --� � -� � � � : , �-
24.•.Roof-Framing� � � -- , � ,' �. � � �. 73. f Undergrnd. Storege Tank`O Gas' O �Oil � � � �
u ii • •;ry s' - -
,25. Roof Sheathin9 � . ' ' -j ' � �1 ^ ;-� � - � � � �74.�OverheadtHydro �� � , ' ;� � �' : � - . �
�
' i�26. T-Bar Ceiling (Structural).& Monocoat � �� � � � ' ° ' � � � 75. �Dry Che'mical i - �'�. � � � `, � � �
�, ,
!�27. Frame and Flashing � , �� � � � ' i , 76. �Dry Standpipe " � , � : ' F '
�:�28. Lathing &�Siding � • '_ t ; , �� �i�, � �. � � 77. � FIXED SYSTEM FINAC ' � - : 1 i {�
" r29.. Insulation' - - , � �� �; � , r � � � . 78.jFIRE�PR�EV. FINAL � i � ' i � �
30. Dr`ywall',Neiling � [! . �' F � � " � i ' � . � ' - � � 1 �HEALTH DEPT. REQUIREMENT � � � �
� 31. Plaster Brown Coat 4 ; • i -" �� � � ', � '� y 79. (FINAL�INSPECTION. � +,. Fl � '���� � ' . � �
' '�'32rElectrical Power Meter-Finel � '�;�' � ! ` E .� � 1 80. �FOOD CERTIFI,CATE;ISSUED . j � � � �
� . . . ' ' ; . . � -- -' �^ � ' � � � � - , - - i -. - - - . , ` -i' . ' - � -- -
�33. FInal.Electric � � ' , j� � � i �. � Notes �. '� ; � � ' �•��� �
_ - � , . . � , . � i - , �. � - , i
�34�. Final•Heating & Air; Conditioning 4 ' ,I � � '.� � . � � '
35. Final'Ga's'Pipe-Test 'i .� t � ' �' ��, ;` �' ���i' ;•�� -' ,�� � �. i ;�, ,m -' -��f . -
3Fi. Hood or.CanoPY,' � ^ 4.� � - i' � � r t' ' . � � , : P � � f . . t 'c.l : , -i � �� „ ` � I
_� i =�• � �,
37. Final Factory�FirePlace ' � i " ' I .. � � ' I. ' � i � i � � - , { ' '!' . �- � � � a'''
; ; . � � � i :, <. : �. _ .,��.
i . � � • n, ' � ' : r.,� - i:
38. Final Plumbing • i � � � . ,G�si-1Tj? iik�� 1 i • � ._ �� . I�`'� � '' , f .• _ •• �
r e
' �T i ��, � r. . . . - i . . ��i:. . , .,
39. �Water Service-Final �, # � 1,.__ � • . , - � ! � � , ' - �
� i. ��,
40. Gas Service-Finall � �- i '""�y'; ! � , � ` � . j � , - ' ( . " -a� , i. � a , . �� .. .
��:�, i . , , ,�'r.. � { ' 'i
41 . Solar pomesti�cFinal � 1 � ;M_��}„ � _L. . . , � ` �. ' . : , ' . . � ", � # � � ..
P f .p...�.. . ..Z __�. _ �_ _ _
, � ' �, �: .. .... . , . p+ i �
42. Backflow�Preventer � 1Z"';.r., ' f � -7 . � , � .; . F . - , . , � .
I_ 1"
_43. Ba`ckflow Irrigation { � i � f ��':?�' � � ' i ' � ' :' � ' , �''' .I , ' - -- -� .` . ' �', , . � r�
44.� .Landscape Irrigafion System (� � r`i rt 'a ' ' � j � ' ; '� ; � .: • i ` � , ?,,a'� y ,i� � _ � �
45. Sound'Attenuati�ont i ��., ��=� � _ a . � � _ `r, � . !. � � � r . � , . , - ' .
« e 1 - c
46. HandicaP Regulations ';'} _:y �:'� . r„ ' ; T" i � ; t � j � . ,` ` . . m
��: i �
47..FINA`LSTRUCTURE&BUILD�ING�:� � ' F-t' � ��` , � I � � ' ;� . j !� � -'� ; �� .. �:'
R8. Special"Re`qui�emenCs Complefed j � � �. i � � �° "� + � f .! � � + ` � . .. . ••� , �
i 1
49. ElectricRelea`seto.Edison � ; ; ,�-..____.._J.. �....L _ . __ �_...t��--' -- - � . + . . .
F 1 I 1 �_•.� 1
50. Gas'Release�toSouthemCaliforniaGasCo � > � � `- '` + �. , ' -� '�' , ' F. ,
�. � � - i � i � ..
51. CERTIFICATE OF OCCUPANCY '� ^• r ;� , i ' ' ' y�, � �. ' '�� . � �
No. � ' ->: Date"� - �. " f... , ' " . - �.._� -'� - -• .. �....! `. � . . � �. • ' , :
-- .�t.- • i. � � �- �._ - �
;, 69 ,. , ��. .
! .
. ,, ,
vaio001018+�' *** 14Z.88
.-.. . 3Jr��3 '� . H�)G 15'-7?�ysk
' � COSTA MESA BUILDING-SAFETY DEPARTMENT � ' � - - � � ' -
- �. �t� �FOIA� P,O: BOX 1200 WSTA MESA, CALIFORNIA 92626 ..,- �' - ., � . . . . ..
. � � _ � - � �� - - - � APPL CATION FOR BUILDING PERMIT '
' � � FocApplicantto=Fi!liri�Completely „ � " �
� �� � R C V BV - DATE'RECEIVED, DA E IS�S!UED -
eui�oiNc 3 a Dahlia:Abenue : �� � L'^ ' '� -�T-%
. ADORESS �
' .. . . ' . . . . . . . ' - PERMIT '
owriea Larwin Southern Ca�lifornia ; . "o: "-- ` `��9:
..•'"• MAIL , -. .. � . •� � • - �� BUILDING� � ' "
,Z .,
ADORESS 16z55 .�'-Ventura BTud. noor+ess' ,�02 � .
,a� c�r�'Encino, 'Cal'if., rNoJ86-8890 rancr %/ - " �or' , e�ocK =, '
z W ADD A P
.Z,Q-' CAN5fRVCTION .•.. .�. . :. ' II... • . ,. � ' � .
oN �ENoea .Larwin SoutherniCalif. . �•,_� „
,am - - -. .-. . - Fr . � - . . _
.���� eanNCH -16255 Ventura Blvd: " -
JN . . . ,- ' I. ` ' �OWNEP y.. � .. � . G .
"'' m J, � ADDRESS '. ERCIRO� Cdllf '�.'�; - . - -''� . P ' L�I ' -i VALUE / � '
� JQ' ARCHITECT . I�TE � SE/�'����" R7T S !/
ORENGINEER'� •.L3YW1T1 - ��M �173-4464 .
UVI , . . , . .. , il.,r. ... - ' � FIRE � . . .
'wCL �ADDRESS 9100 Wilshire, Beverl .Aill Z�NE �. TVPE� GROUP �'
�. d W , "'. - .. ' - , ` + .', ' '. II: ',.... ..... � ' APPRO / D . . . � ' � �
� JO .CONTRACTOR' LaYWlI1SOUt.Y10TR�ICdL1P. � B�' �ATE_- � � .
� �J,� AODRESS�16255 Ventura Blvd. .� . �� '� � � � -,�,/
W.W - . . . . ZONE NO.OF USE OF NEW . � �
� _ . . TE �^ . p[q� : BUILDING
z� c�rv' Encino; Calif: ' �No`986=8890
I �� SIZE ', - � .NO:�OFBIDGS. '. (-vAROSAPPROVED ��VARDSAPPROVED • � '
� STATE� � � " CITV � '
� y'[[ - "' L14 NO. �.91311 .' ��' LIC��NO ' B-1 � � ' MAIN BUIIDING ACCESSORY BUILDING . - .
FROM GL STREET) - - " ��
�� OF LOT • C)O X-� LOO ' � NOW ON LOT Q' '� . FRONT. FT. ' � FT. � ' '
VSE OF � . . . �� . � . ' - � " " .
' EXISTING BLDG. � ' I� � 5 � �S FT. ' ' FT ' �
� I"" SIZE OF� � NO. OF '� - - . . ' � ,
' � Z NEWBLDG: 1%S�F ._ .ROOMS " - "b�STORIES ..1 ^ L.SIDE � � FT.�'� ' FT.
a EXTERIOR WACL ' ' ,ROOF, �' � �� - �� ' .-
�% COVERING. ': COVERING FiEAF �S FT. ' ' FT. .
� J"' USE OF,BUICDING'AND WORK TO BE PERFORMED,-� � , DISTANCE BETf� � • BET. MAIN & '
,..d ... . ` . ' `.i � . ' '1:,. MAINBLDGS.� ACCESS.BLDGS.' .
a. �
' .'Q ' .. . .VAR.# . � . .�'DATE':'.� .. .
Q (.'On5 'V C.U.P.�- : ' APPROVED "
APPROVED . Z� �
.. N . , , •.'�j�-:_� � �Si .
z .. . _ . . i�. . . . .
. � � . ... ��. � .. <� . ... •� ,. . .
_ � �. . . . . �> . ..
V I nereby acknowledqe„mat I have reatl mis:application and, state HOLD �FOR �SPECIAL. RE � 7 Eb � ' -
:_ ,ffiat the�above.intormation is rorrect�and agree'�to comply vwith , , _ _
� all^laws iegulating building consbudiion, Sntl I sM1all not employ � �' , �'
F„ eny perzon. in violation of the workman's'compensation laws of , - ��
m'
y �' the Siate of California. � ' . . _ , - � .
zJ hereby rertify [hat I am=prop¢rly"licensetl as�a'conbactor untler" . SQ. FT. ' O
' ' the.Stare �ot Calitornia�Business antl Protessions Cotle, Divisicn 3,= �� THE MOUNT SHOWN UNDER VAWATION IS FOR , -
" Chap[er 9, antl that sOc�.licenses are in`.full force and effect, onl� THEPURP06E-0F ESTABLISHING A PERMIT FEE ONLVr '� m
. am'exempt trOm"Meiprovisions ot the $tate ofCalitornia Business�: - . � '
antlPiotessionsCode,`Division3,Ctiapter9. , !i +'� VALVATION ' �,_ �. ."�'. ' �� .� ,
PERMIT FEE �$ � '
1 ,�( 7,
Si nature.ot ' .. `�x .�' � ,�. ///��� .. V V � � �.' �+'�� m . .
Permittae ��� �. D DOWi1S � $ �% `9�. PLAN�CHECK $ '— E -
, ' .. s'+ - j' _ . �0� . . ' , !iU LL � .
Authorized A9eni^'-, . ' .. � ��. � . TOTAL FEE $ ' ' ' '•