HomeMy WebLinkAbout945 DAHLIA AVE - Building PermitsAOOPESSOiBUILdNG: (34S DAHLIA AV
avNear�•v1eirabxm: DRIVER TEX W TR
' � A0°"�' 1030 D�P.MASCUS
COSTA MESA,CA
�PPI. YAlIlN0.1DUPE55:
�pCNITECT ON ENtlNEFA:
UNT:
FLOOD: AH-38
92626 _
I_ .
� '
uc. No.:
urcx on erb.•s Aoox�ss: uNr:
cornn�croxsx�ue: ACTION DECK AND ROOF INC ( 714 ) 892-9122
cam�crars�uww 7q7z SLATER AV
�ooeess: HUNTINGTON BEACH CA uc.ra.: 688649
92647 uNr:
LICENSED COMN�CTOHS UECUP�TION: I Mroby tll'rm uM�r qwly d psrjury tlw I un I'ramed uMm povi�bm d Chepter B
(mmmendrp xilh Saclion ]000) d Divieion J ot the Buairoes vd PMeeeiom CoEe. enE my limnae u in hll bru vd eHeq.
c uc.no.:0 9302 uc.cuss: C 39 �//�C'� /N� 688649 P �EXP�•�_ /OS/97
me' —.� ConUaaa:LAf �i0� ��/3 I F�[ V�
('"'s
� W F BUILUEP DECLANATION: I Mnby elfirm under perWy M parN�Y �� �� exemq trom Ihe Contredae licensa lew Iw tM
' w'vp nemn (Sadion ]031.5 Bueiieee enE Pro/evione COEe: Any eny or eounly whidi raquiree e permil to mmVucl, eXer, imDrow,
demolch, w repv eny ewnuro, prbr b ila u�uerwe, ebo requirte IM epplimnt lo� wch pamin to fila a vpmd etalemant Net M a eM
ia licemed punuent lo Ihe pwieiona d tM Conlredon Licanae Law �Chepar 9(mmmendiq wilh Sedion ]000) d Diveion 3 d tb
Buaineea end Proleaum CaEe� ar tAm M a ehe u exemq Ihxehom arM IM buia la ths elbped e�amqion. My violelian d SeGion
1W 1.5 by eny epplimnt for a permil eubpq� Ihe epplirent ie a avil Po�aItY �� more Ihen iNe hunEred dollen �5500�).
� I. ea owrer d tM popenY a my employeee v.ih wepm av ihei eob oompeneetion. will do Ne wak. erM Ne evutlure e nd inbndad
a MereE tar aele (��n l0aa. Buarim arM Pmtmabns Cada: Tha Canlredws Lioensa Lew tloea iat app�ytoen owner d piopeity
who builds ar im0�s thereon, eM who Eoes euch work Mmaetl or hereep or thraph h6 a her own amplayeee, prwnded ihet euch
improvemaMs ere ial inlanEed w dlereE lor sab. II, howaveq tha buiking or improvemeM is eoM within ona yeer of complmbn, iha '
owror-builder xill heve tM buNm d provirq ha or Me Ek ml Wik a improve Iw tM WF�a d eele). .
�-I. as ow�wr of tM MWaM. em eaduaiveN mn�raaM wnh licanaed wnvxian ro consUixf iM1e Wq� (Seaion 1011. Buai�vs enE
�Professiona Gode: TM Conlrec�on License lew Eoea iat apply io en oxmwr d properly who buips w impoves ihereon eM x1a
cnnvacm br autl� pmjecYs wnh e mnlredor(s) Icen�eJ pureuenl Io IM Comredon Licenae lew�. '
� I em exemq uMm Seciion: B. 8 P.C..Ia Nia raeaon:
Dale: Owner
I do hereW cenify UW I em awara d md uMemeM iM rapuiremema d CelAomie Neallh eM Sa/ay Cotle Sedian 255U5. ?55�3. eM
25530. e�M ihe� I a enY �ure Wikiig orapem will / wil �(ticb ore) nead ro camply wYh aek peia mden vd iM repuimmema lor
e parmn lorconsvuctim or �mEAifetion han IM Ri-O-Ty .T�anagement Osfnd. Readentiel mnecrudon appicalioneere exmmq imm Iheee
pravisiana. . . . . ,
De�B: �VG�ranl:
WONKER'S COMPEN5ITION OECLAR�TION: I hereby elfi�m uMer penel�y d pe�jury wro d tlre /olbwi�g dedareliwre:
�- I heve vM wil manien e cenAiceie d consenl to eetl�imure br worken' wmpenae�on, m pravided Iw by Saqbn 9)0p q Ihe Labor
Coda, f« tM peNormarce d Ne wak lor Wvch thie perme u iaaueE.
Cl I neve e�M wie m.imavi woiken cwnqn�elion inauraMe, m requireE by Seain �)00 d Hre leb« Cade, for �M perlormence d tl�s
2� woM lor whieh Ihis parmit ie issued. My wakeis' eompanaelion inaurar�ee eertier eeq poliry number are: '
c�a�: GOLDEN EAGLE EXPIRES
Pdcy Number. � iJ W C� �� � '��� 0 9/ O 1/ 9 6
�(This secfim neeE na be compbted'd tM permAis lor one hunEred Cdbrs (51001 w bss J _ �
'_ � I mMAy thel in �he perlormenca d tM1e wok fw wh'rh ihie parmA u ieauatl. I shell nd employ e�ry pereon in eny menner ao es to
cwre a4«t m Ne HaMna' camV��ion kvn d Calilania. eM eBree tMi d I ahauk bacmma wbjed-ta ina worken'
co pensation ro ' ionap 3]00 dlheleborCode.lµdllanhwilM1 mmyy �,.� p�rov�isb(na. /yy��� . .
Dete: ` `AVGliranc J i��Q� •��� 1 ��� V`
W ny: Fsuun ro ucurs worten'rompwuatlon rorsieps la unbwNl, arrtlWll aWHct �n �mpleyw ro crlMivl pwMu entl
vll nnw up ro on� huntlred tMua�N doll�n (SfOqPPDA M�tlL/tlon ro M� rost or ron�vewrlon, tlenup� u provltlM ror In
SxHon 3)O6 0l Ms 66or COW, Infen�t, end attomsy'a Isu.
CONSTRUCTION LENDINO AGENCY: I hereby elfiim uMar penely d PorN�Y, �� Ihere o e mnv�uabn bMiiq epency fa Ne
�n«m� d me .,wk ia wnia� ins oe�i �. as�ae Iseaon xs�. civ. c�.
LENDEH'SNAME: � -
' LENDER'S AODPE%: �
I cenM �� I heve read thu epplcmion eM ama thet �he ebove infpmaiun is corteq. I epiee lo wmqy wilh ell rily eM counlY �inancea
enE aiete lexs relaiing to building consvudion erN hereby euthmae rep'esenlelivea M thia cny io emar upon tM ebwe-memioned papeny
�OlIf19FBtllOfl pYlDOSB9. . '
_ DORI$_,WADA �
• Pnn� Nema ' % �7 [�j/' G //
..e�...e.e......e. e..u..w..... �— Dele:[��
(StSt-48 WP) WhASBuiWvp 8 Salely: Greeo-Fle; Genery-ApplicenG Pink-Revenue: GoldenraE-Rsseaear
CITY OF'COSTA MESA — HUILDING PERMIT
PERMIT NO: B 078332 _ PLAN CHECK NO:_,
CONSTRUCTION TYPE: S—N PERMIT TYPE: STR
JOB DESCRIPTION : T/OFF RESTH & REROOF W/COMP.
i.
�ERM NO: H 078332 ,
GOVT: N SUPP: N •
PUitPOSE : OTH
SQ -FT: 4,985
CLAIM VALUEi 4,985.00 CALC—VALUE: 4,985.00 GROUP OCC: R-3 /U-1
COMMENTS; SMOKE DETECTORS ARE AE�UIRED �IN EVERY BEDROOM 6 HALI.WAY
�x��x��+r��r��***�r�r+r+r***+r+rx*�r****�r** *��*x�**�**x�r*�****��**�*��***��****+��**+rx�+�x�**
' Z O N I N G R E Q U I R E M E N T S
S E T H A C K S .
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT. IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ •� PROV: PARCEL; 41218342 ZNE: REF NO:
PLANNING NbTES> , �.f'
� )1 �
IE1E1ljF1E�E1FIf1EiEibiF1E1E.iFiEiElEififik�EiffF1F1E1E1E1E1ElEIEiE9EfE�EiFiE1EiE1E1E1E1EiEiElFifiElflF�flFiflEiE3k1ElE1E1E1ElElEifikiF*iF1E1E�iiEiflE�EiFiEif ,
D E V El�L O P M E N T S E R V I C E S R E Q U I R E M E N;T S '
�^
ZONING APPROVED�BY DATE: �
BUILDING APPROnED BY : DATE: /r%• —_ /
APPLICATION ISSUED BY: DATE: �J +�
itiElElEiE1E1EiEiElElElElEiE.fEfE1E1f3E9EiElfiFiE��f�f3f�3fiFiF���f����� ����{E�.��{F�{E{EK1flfifiElElE�IE If �
LEGALIZATION:N_,__ F E E.•S U M M A R Y SrTRUCTURAL� EGMEN :Y '
(j�„� � ��;",--
BLDG PMT PLUMHING ELECTRIC MECHANIC F�I�RE �'�SMIP/RES GRADING
PERMIT - _ . __. 99:]5 . .. .. `%r`.;. i'' .50
PLAN . .
ISSUE .FEE .
BUILDING—DIVr>Y.._PERMIT . ISSUE PLAN—CHECK TOTAL
TOTALS---->.�_ ._100. 25 0. 00 . 0, 00 100. 25 "i
�
REVENUE_DIVISION TOTALS--> COLLECTED: 100.25 0
_BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/
� 99..75 _... .. _ ..�- •
i �
iF 1f 1E iElf 1E 1E if if 1E If iE 1F fE iFlE iE iE iF if K iE fE iE iE 1E 1f If fF iE fE if 1E IE 1E fE iE iE iE iE fE 1f iE iE 1ElE fE iE 1E 1E 1E iE IflE 1E 1f
� � ;,_.I N,D.I V,I D U A L,_._E E E B R E A K�
TYPE _QTY __... D E S C A I__P T I O'N , _ ,
SFR__ ___ 4985 , REROOF..HY_ VALUE RESIDENTIAL NOZONE
� END OF FEES
�
SMIP/NON—RES
PAID DUE _ .
100.25 .00
00
ING PLAN—CHECK
if 1f iE IE IE 3E iF iF fE 1E iE it iE 3E if 1f if 1E 3f
W N
ST TOTAL COS�T '
0 4,985,00
T617'1 i�0.:�
. i6:Ub
�' CQNSTRUC710N AND PLANNING j ' ` r; : �' ' , f - P�:; � $ SP? r���`,_ . -
" Date Inspector �� � �� � � �� t � � Date Inspector.-
', ��APPROVALS' Permit# �` �� _ _ � 'APPROVAIS =-Permit# �
: a . . .._�-.
' 1.. Temporary EleLfrical,Service or Pole "- • ' ` - ' 52. �Pool &' Equipment Location ,
t� - -
� �2. Soil Pipe-Undrgrnd: 1 -';� �'��-'.'�'� � - '� ' � � 53.:Steel ReihforcemenV • -e � • �`+' . -. �� , ��
: � i � :.
f-..�-. . � . � i .� � . ' _
F3;�E(ectrical CondurE;jl�rlity-Un��`r'�md. � � . ' , , 54. Parms; ' , - � -� � � C _ r
s�. 4� Nlectrical Condutt'+Umdrgrod. i � - _ . � 'f 55:. Eiectrical Bonding - . -^, � . x -.
�. ���Steel FieinforcerrtAc�t�a ^ � ; � -. ', r.• - 56. Rough�Pium6ing & Pressure Test�� . � ,�'��
^i-6_;EtectricalUPEft'Crond. � - . _ � 57. APP�ROVALTOCOVER�GUNITE � r �`+� �
,..f ._.� -
^?j��Footings f � �� ' ' r". ' . 58. Electrical'CondUiGUndrgrnd.- � - .. � 1- � -
G: t c : 5 �r'� _ .s
tV r,. � �. �,.• - . � - � i . �
�-8. Foundation S�a;ri,a� , � v ` - • ? �� • 59:'Gai Pipe, O Urnirgrnd., Test - ; ' ���
� �.. .ti�.e.. - - - � � ' .� , : - ,.� ' . S�
°� r9. Water Pipe�Undrgrnd7'r; �. "" �'� �_ . _" 60: Backwash LineSSP,:Ttap, O Undrgmd.. - _
P . � � - - - �:w " . -
�• 10. Structurai Floor�SYstem ' � ' .� ' .61. APPROVAL TO�iDECK ' ' {i ' ' �
n
7 i. Roperty Sewer Line & House=Gonnection�' � �' � '
�, � �; �, 62. Backwash & Re�eptor-Final '� `
12. Sewer Cap �� �� _' -�' ' i'�`•"' : .63. Heater &'Vent-Final -�''; � ��
tr3. Roof Drains � , •i' - � � : ;,. 64. Plumbin� $ys[em;- Final �-. T +, � � u ;
t
� }4. Rough Plumbing, , r-, _ _ -`i • 65. Eiectrica!-Finai ! � ' � � � • -
,�--
'� ' T5. Rough Electric2�-Condult �, c.-r �' - i 66.' Soiar SYstem-Fina� ' � .
�I � Q� .x� - f _ - i '
1J. Rough Electric44irin9 '; '� - ' �'- 62:� Fencing & Acce s Approyal�, - � " � � '
17. Rough Wiring S�Bn � ,� �� - . � '' � 66. APPROVED�F�R-PLASTERING � _ �A
9'8, Reugh Elecerice�7 Bar Ceiling' . � { �� �69. POOUSPA SYST,��MS PINAL' �� ' ' `
. 19.-Rou fiHeafin &-AirConditionin ' "- � � - - � ""�� �� � � ' � ��� � '
9 9 9� �"� � PIRE�DEPT. REQUIREMEM ��
- - l: :7'r-,�r.. CC �" N
p�{ ^Fir (ace � •• "".� ' "`' *
� 20. �?',ou ^ Factor eA. � r^'� `�' "' � °''�� �APPiiOVpl:S C Permit # �'' �'
,T. u'I � s�� I:�C' �K 'K S� �7l'.i y. �..���H?-.
21. 6Lcts�in��truzture=t�r . •• . � � _ �: .�x �.:70. Lndergroun`d Hydro *
22. Duct�' V€ntilata�9�=�' � �� � ;�' � � �w �; 77. Produr� P+pin �i.`_G,as �+. Oil
!Lx � � C, CJ .�.,, 9 .V,
23. Gas Pipe :Eou9N & Te"st � z!:7 ;p r O'P �+ 72. Undergrd'lind Flushti �!� ��
24. Rbof`-Fraining•' � � ��"' �'�r y_= � � F* .7� Undergmd.S[o�a,ge,�nk'�Gas ❑Oil
25. Roof�5hea�hin9 t�,+ �� ��^��(y�-�q�' �,(ti� 74^•�Dverhead�HYdra.���- �:
X � n_7 �7 � a .,. �: H
26. T�SaYCeiting (5trSet9�a41 & M1�isYtl�oat x�, �_ r. y. 75;.�CSry Chemicai . ''
27. F�amsan Pla hin�' a.^.., < c :. r-,�., :-.�, �✓� �- ��, ^�
� 3, �;�= ��,� x c � m:�. 76. Dry StandpiPe =,� x V Ci
�28. Lathing&%�Sidin9 `--"� �'' '�='�= � * � ••� `•'* 77r FIXED �SM,1'.ti,S�TEh1�FINAG ` ' r
a C i'Y. �i :T � � ] . E-+ C1
?� Cr N �-'. (� Fi .. .. -� *. �r � � .�, w
29. Insulation . tir: _ •• +; I �a 7$' FIRE PREV. FINA� x r+ V: >�
'30. Drywall Nailirtg 4 �, Y; � x_, �. S �L�ALTH�DEPT.�REQUIF�EMENT
�31. Plaster B ov,�n;�foa�' ;� � �;:•;» r � �r �-79� FINAL I�NSi?ECT�19N v'l J� _
�32. E'lectricab'Pow'�Y MetE}�"Fi�ai � � n% � �•+8d',�F40D CERTIF•LG�ATE ISSUED, �
�•33. �ina(�Elecfric� �� � '- v� N`�es. �� , ��
z K :TI � v^, �� 4t . �'!�7 K" 'J i0_-1
v34. FinalEHeaIi�g'&A1r�ConditioningS f1 �� � bR = = C%:� .s ,- O'�
.r i'i .;n: r.• :�;5 � �[i H I !+� � M
/ 4� !p M � {X l 1 1: :� � A l. - �. ^/
i 35. �ina�GarPip�:'�eSS.h O .: .; `t � '.�::z N:�:� �7-� a �.�
`.,u � . : t',"" a x : = f �r: � :c � � �ic �� <�s-'
b36. Nood��or CanopY -� -;%
c f. r� .�t' l't I�r.+ �-i ,i �: iT1 :LO i:l? �C.
n 7: ... �<_' �n r. � 3 LT. ' : � -
-;37. F�na�;Factnry Fire�S;�ce � ; �,r, � �-;��. :�; �j
138. FinaLPlumbing i'-t yN f ..� *� -� � S � ±� CG C� ---
4 �, � , I ��: �. H _�: >
'7 V
.�39. 4Vate��Service;F,inaf��F c. j �'' '� � � �i • � o�
' 40. Gas Service-Final r.��e �y {r;-+ � :K r•, ( h+� po :nv �
., . � • � c.. i s t-. r� < �= �C
� � Y
��41. Solar pomesticFinal�' �� n` ' k i'" .'�'.j ''
i J ['i �K � I � ST' '7�V :: i. �
.. � _
`�42. 6ackflowPreventens N . � }� -
Y (v: tl � 'R '�t ��
-43. Backflow Irri�tiop�'i ��S X x * �r� - - �-
,� � ^ �� '� �� - - - - - -. � .. - -
, �r4. Lar,dscapetlrriqation+SYstem �'^:� '*� t* d � ��;; ,�^��, 5,� � �� x e F �'
� - `- r. -, � F C " i :-� t-� n :� . � r-+ ..� G .--; � x -
45: Sound F�enuDtiotr:, ... ;; m R± t.y::� t� c� cr a' . �-�� r
�
' 4fi: Handicap�Regu�ations -+ O �< �i� � � :%: " rn. � M
- v e. � h, �.'1 ,� r
� 47 � F1NA,� STRI}{-,�TUR� & BUICDING _Z� � '� - N�.^.S u �
� 7 -� �,� �: �.
„
� 48., FiNA_t PLANI�JING.i: -,- k ct: ', ��, ": •,� x. E'
- Y �:r � n ; o
� 49.i Elecfrie Ryteas.¢ to Eilison ! � ��jl`";. - r^ � ' � a
j�: � : u� � c�
� 60.; G2s Rele s to�Southem California�GasCo �z i*'`;+: �.' � a� ari x' O • �
> _i-,r . �� r: x r� o
51_ CERTIFICATE OP OCCUPANCY� k >-' G tic. v: •- .- .
No._ Date ! �� -
�'+,
vxaEci aoosess: �.i 9 4 5 DAHL I A AV . ._ uxiT: p.
OWNEB'SNIIME:�UPTON' • ' ' � � . • � ,
C� RODRESS: .SAME AS ..ABOVE . ,, ,. . , ' ,. ` , , t .
. T . - . ." .. � � ="
� �: ,
714/966-0292 � ' .
' RflCN/ENGINEEB: ' - ' ` � REO.NO.:. � "� . � �
`. RDOPESS: y _ . . �^ , ' ' � ' . ' � UNIT: . �
,- PERMITTEE:'NOCK PLUMBING ( 714 ) 89.5-1246
-,eooeess: 11610 SEABOARD CIRCLE •
� � � . ' �STANTON" ' ' ' CA 90680
uCENSEO CONTXAC70B OECUM7lOM: I nereDy anlrm inat I am licensea unaer prov6i0ns of Cnapter 9(commenGnp witA Section
7000� oi Uivision 3-af t�e Business and Professions CaOe, an0 my licenu is in full lorce antl eHecL , .�
ci�uc.:050386:..sur�uc.:511971 � SS 6 :
Oate: � � � �' `�� SignaNre: '�`�i��
WOHKEBS' COMPEN&1710N OEClAMT10N: I Aereby affirm fhat 1 have a ceNfiwte of consent to sNbinsure or a certiticate of Workers'
ComDenutian Insurance r a c Nfie copy thereof (5ection 3800; La�. C). ' ,
��aucr xo.? 116 7�3 9�1— � 0 , exr. onTe: 0 3/ O 1/ 91'
vnrexr: STATE FUND •
. Certdie0 copy is herehy fumisheA.: m CeNiieO coDY is fled ith the ary Buildinq Oiv i n.
`'7 i'_
Date.T � I { S� � 0 ' ADPlicanc �1 ,� •' . . .
E%EMPTION fHOM WOXKERS' fAMPENSRTION OECIAMTION: Rhis uNon nee0 not be comDleteA if ihe permit is for one hunEreA (5100) or less).
I certiry that in t�e Derformance of the work far wAich this permit is issue0, 1 s�all not employ any person in any manner so as to 6ecome
subjecl to Itre Workers' Campensation Laws of California. ' .
i �
Date:" '"`�' � % - '' �" SiAnaWre: -� ' - - ' ' "
NOTICE_ If, afler makinq this declaratlon, you shoul� Uecome suble�� to ihe Workers' Compensation pmvlslons oi the La6or
Cotle, you must forihvnth compty wit� such prodsions or t�is DermiLshall ha UeemeO revokeU. . '
CONSTBUCTION lFNOINC IIGENCY: 1 �ere6y affirm that thea is a mnstmction IenAinp aBenuy for �he Dertormance oi t�e woM for
which.�his permii i$ issued (Section 3097, Ge C�. � . , � - �-
` LENOEN: � � I � , - . .
' 'R�ONE88: . _ . . .. .. . . _. _. . .. _
� , t ,- .
:� s' ;, - � �
OWNFB�BUILOER OECUMTION: I here�y aifirm tAat I am exemDj �rom [he Contractors' State Licerise Law far ihe followinp �reason
(Section 7031.5 Business antl Pmtessional Cotle: Nny ciry oi counry w�icA 2quires a Oermi[ to constmct; alter, imDmve, Oemolis�, or.
. repair any stmcNre, pnur to its iuuauce, also 2quires the aDDlicant for such permiLro tile a siOneU statement that he/sne is licansed.
pursuant to t�e pmvisions of tAe Con[actors �State license Law (COapter 9(commencinq wi[fi Section 7000) oi DiNsian 3 W the Busineu
anE Pmfessions Cotle) or t�at he/she is exempt Iherelmm antl I�e bazis lor the alleqeA exemDtion. My vialation of Sectlon 7031.5 Ey
� any ap0�icant tor a permh SuDlects Ne apDlicant ro a civil Denalry af not more [han iNa hundre0 Gollars (5500�. , ,
: � . � ,
�I; as owner oi tAe proDertY ai my,employees witA�waOes as their sole compensation, will'Ao the wark, and [he
� simctura is not intenEeO or oMereA for sale (Section 704d, Business antl Professional CoEe: The Contractors State Licenu Law
Oces not aODly to an owner ui a pmDeny who EmIAs or impmves Ihereon, antl wtw Ooes suc� xrork �imsetl/Aersetl or Nrouqh
� his or Aer own-em0�oyees. D�ovitled Ilwt suc� imDrovements are noi inten0etl or ottere0 lar sale. Ii, �owever the huil0inp or
' �imOrovement is wltl wrthin one year of comDletion, the,owner vnll have ihe 6urtlen of praving he/s�e Oid nat hui10 or ImDrove,
� for the purpose'oi�sale). � � , � ' � '. ' � ' � � , � � - .
-` � I, as awner of the OmpeM, am exclusiveN iuntractinA with IicenseE contrzctors ta constmct the D�olect (Section 70W, Business �
� '❑ ` anU Pmfessions CoOe: ihe Contactors- �Gte License Law Uces iwt appry ro an awner ai pmpeM � bwlQs or improves I�erem
_ anA w�o coniracts for such pmle�u �i?h a coniracmr�s) license Dursuant to tAe Contracrors' State Laense Law�. I am aware
t�at prnof of t�eir�WaMer's Compens:➢ominsurance 5hou10 be prontleC fo me. . .,�
� I'am exempt unAer Section: � � B. 8 P. C. - - � � � � �
ror t�is rea'son: � - �� j � . . ' I ' � . .
� � � ,
Da�e: � � � ' � Ownec� � �
� ' I Ao hereby cenity that I am aware of antl untlerstanA the requiremenis af Califamia Health anA Sa/ety Code Sections 255Q5, 25533!anJ
25534 an0 t�at I or any fumre Euiltling accupant wilUwill not (iircle one) need to compty with sai0 state co0es anA the requirements for a
permtl tor constmction or moAifica[ion tmm tha Nr Uualiry Management OisMCL Residential wnsimction aDDliwtions are exemD� �rom
iheSe�DmWsionS. � � ' , . ' �
Ua[e:{ � � Applicant: �
I hereby certiry Nat I have aaE this apDlication antl state ihat [he a�6ve inlarmatlon is corred. I a0ree ro camDly wit� all ciry an0 counry
orEinances anG state laws relatinp to builGinp cortstrucUon anE hea , hor¢e apresenutives M this i to emer upon the ahov�mentianed
pmperry tor inspection purposes. ' , _� ; .
-1 r i
Date: � 1 � � —.� O SiAnature:
� , . _ �
onver''s License or;saciai'Secunry x: � , �
Enlorcemen�; Cenery-Applicant; Pink-Revenue; GoltlanraE-Aasessor ' ' '
, ' CiTY GF COSTA MESA'- BU2LDING PERMIT �.,PERM NO:: P� 04997;2 `
. . . .� .. . . . , .. - t � r , ^ .. � � .. � L � (
P�ERMIT NO: P' ' 04,7972 '' , PLAN ,CHECK NO: � � ' N.,, ;, GOVT:� �N: SUPP: N,� �
.,_ . �.. . . . . r � i ., ' � '. .� i _ ' - �r � t �
CONSTkUCTION TYPE;' PERMIT TYPE; PLU��• '� �i:PURPOSE?�OTH
� '
JOB �DESCRIPTION. ; WA'PER..HEATER REPLACEMENT � � � y -� SQ �FT.i j;T � � � : .;,
. • ' p 1 - , - ' '} ; '
CLAIM VALUE:-- CALC-VALUE: .GROUP_ OCC ;i= � r7 .
, i,� �• ;
COMMF.NTS : x, i . s ' � •' ' , `.. I % ' i ' ._ � . i .- '� , i F, ' �� ,� � ',
�**�r��t***�t*�t**��.**�t�t*�t****x�x�*�**�t**�t*�t*�t�*��tx*****�tx��t�cx+�ic*+�i�***�'*�±��**�****** � .
� Z O N I N G R'E Q U I R E'M'E N T S ° '' ' -��
. ' ; S E ' T' b A C ; K S . ; � i i '` ' f , � - ` ,
------"--r--- MAIN"BUILDING ---------- ---------'ACCESSORY.BUILDING=---:-;-'-=` «
FRNT: , FT '• IN REAR� FT � IN FRNT: "FT� i IN REAR:' � FT ' IN"• `�
LEFT: FT IN RGAT: FT IN LEFT:� � 'FT IN RGHT: � FT j IN�` I �
I, j, � t { °1 , . �.; �
PARKING REQ• ' F'ROV: PARCEL: 11910302 ZNE: �,'REF NO;! i};:. �
PLANNING'NOTES> ' ' ' � � ? • � ;. '
. . . ). ', -.t .- . . . . . : . " " ' _" ' L. 'j_ {. ,.. . " _'i .'" -.'...�_' _i
iEiEitiEiEiEjEjEiEdE3f.iEiEiEiEiEiEiEiFitififiE*iEiEjEiE3Eil�iEiE�EiEitiE�ikiElEiEiEiEiEitifiEifikifl6iEiEiEiEifjF9EiEdEiEikiEifiEff�dtiE3f�E9E�EiE3fiEiFiEiEiE 'i
D'E V E L O P M E N T S E R' V' I'C fi S 1 R�E Q U I, R�E M E N� T S 1 �
7.ONING.APPROVED BY. � ' � � 1 �DATE: � �
. �, ' .
. _.. . .. .. � . . . ._ . ._ _ .. . . . . .._.r� _ . , . - .. .. ' t" , " " _ '_.,�'_
BUILDING'� APFROC�ED BY : t , � ' ? �� � y ;DATE: � � � �
' �p . . . . ,/' k � . . � � ' / %— f .
APPLICATION ISSUED bY:/JG� "
?! iE'.f iF ia iE'lE iE'�E if iE iE i! 3E iE it'.f jE',E iE iE'aF x�if'iF'3FiF+T'�FiF'iFif'iFiF'iF3F3F3F3FiFiFiF iFiFiFiF3F'£
iE if # 3E iF iflE iE �k'�f 1f if iE jk if� �)E ik 1f ?E iF iE ik iE?E �f iE�iE # iF If it,iF # iE 1E #�iE iF if ik 1F iFlE itlklf !f !E'.F
liEGAL'IZATION;N , �' ; F E E - S��;i3� M M A R•
_ ' - , ', r . .
BLDG PMT PLUMBING ELECTR3C� MECHANIC
PERMIT . � : .zi25t -:'.:;_f:�-sy! t
PLAN ' t . '
.
ISSUE FEE .9i. 00 . . `%_� l, ;���. ' �
BUILDING-DIV-> , ; PERMIT� ZSSUE ���Pi:AN=CFI�ECK.
TOTALS----> - ' "l', 00 > ' ] . 00 . •� i� � 0;.00 •
- � ' 1 ,
REVENUE DIVISION TOTALS'->; ' COLb-ECTED: ' '
bliUG PMT PLUMHING'ELECTR'IC?MECHANIC � FIRH
'-. . __ , � . rJ . Q � � - ' ' ' ' �+� f� ' �
• �� .
if'.f iF iE iE if'.k iE iElf iE if iF iklf if ik iE�lt iE d! # iE iE.it iE if ?E iE if if iF iE if iEaE iE iE iE if�if ff it �t iE iE iE iE jE
'' I N D, I; V I. D U. A li" F E E B R
' � � � � - � _ � ..; :t'r' _�
�TYP.E QTY D E S: C R I� P T I: CS3 N;
. � � � ,
PLU • 1 WATER�HEATER AND/OR'UENT
. . , ' - " _ . _ E�dDr�OF FEES '
_ . .%% �
E ?
ij'' c%;
� r' �
� (.
�' � !i.
v:���
� t
'v � �
it iF,iF ik if iE iE 3F iE it df �E ik it iE iE iE fE i� �/f�TiEh'�F �FTFiFiE iE
# it iE iElE �E iE iE iF iE if iE ik �)t iE iE it if if if iE iF iE �E iF iF if jE?E iE
Y `� ' STRUCTURAL 5EGMENT: N
. ,
�FI�RE) SMIP/RES GRADING
r. ' i
' � iSMIP/NON-RES; • �
: : �
TOTAL � � � PAI�D �' iDUE
•5.00 , � 5.00 � �.00
5.00 ' OVER/SHORT: � , .0�0 '
SMIP/TOT �GRADING'PL�AN—CHECK
; + � ' , i
i
,
'� �'x� x�'� �'x' �'x' * jt * ie'�.'�.?�'x * it'�'� ie *-� �-'�±f �e * �-
E A K D O W N� � �
'UNIT�COST� � �TOTAL COST
; � 2.00 `, t � ! 2�.00
1 � , I
1
�
� � � i
, � , I
0! QUU6b5bo�Q00665ob
DATEj 07/31l,40 'TIME:
. . -- - ' -
t
)
, i
�
1,
� 1
� ` i ;
Tr�T � ! S.OQ
15.tl0 .' !
� _'. _ i ..1.,... _
CONSTRUCTION AND PLANNING_ _ ' ' . . � �. ''.' ..'�., ` Pl & SPA•. =7 - - ; ; ^ 1 �
Date � lospector " "" � Date = �Inspector "
` APPROVALS Fermif# . � �, , _ APPROVALS .Permit# - , �_�
., -
-1: Tem orar ,� Electiical Se`rvice or Pole� � � �� ' " - ' - � . ' ` �
. p , y ' 52. •Pool`&,Equipmenr Location�
2. ,Soil P,ipe-Undrgrnd. = ," t �_'' - , 53. Steel:Reinforcement '_ - ' . +
. 3. �Electrical Conduit Utility-Undrgrnd. - - 54.�:Forms- ��� � � ' � � '
4.'Electrical Conduit-Undrqrnd. • � - . 55. Electrical Bonding, � . , '
5. Steel Reinforcement � � � � T..z . - 56. �-�Rough Plumbing�& Preswie�Test ' �
6. Electrical UFER Gmd.-.' ' . � z'- 57..APPROVAL'TO.COVER�GUNITE �_
- , -
- 7. Footings - � � � � 58.. Elect�ical Conduit-Undrgmd. _ � .- � �, '
� 8. Foundation _,' _ `� - _ � 59. Gas Pipe, O �Undrgrnd ; Test < < -
- �' �
9. Water Pipe-Undrgrnd..:' R,�� ,. '� -.. � ` 60.�i8ackwath Lines' P-Trap, O Undrgmd. ' , y"
70. Structural Ploor System' , ' e � - 6L�APPROVALtTO.DECK•;. ' - , � L' `
11. Property Sewer Line &�House Connection _ ` � - � � i . _
. . ., -�� �`F -62.°�Backwash &TReceptor-F�inal i
12. Sewer Cap . - _ �' ' ' �,�" � 63.�•Heater�& Vent-Final ' �
�� - • -
13. Roof Drains _- "' �_ " _ 64. �Plumbing System�� Final�- '.` � � '� �
14. RoughPlumbing ' ,' , F,: , _ 65.-Electii'cal-Final'-• �� � � � '
- n
� 15. Rou h Ele�trical-Cond'uit - _ (. � =' ' cr -, s• _,
9 � � = � : � 66.�`Solar.System=Final
�
'16. Rough Electric Wiring£ � � i� �'" � 67.,Fencin & Access'A � '- F°
9 - pProval i � :^ ,�
17. Rough Wiring Sign a " , ';�- . ` ` '� , t ",
� ;; 68.=APPROVED�FOR�PLASTERING ; z .'
18: Rough Electrical-T BarCeiling�� �� I ��� " 69.�POOUSPA'SYSTEMS�FINAL � � � � F � �
. . . _ _ �... ..�_.. ---l- - - �. -_ �_.__ -- - --�---,- --.
� 19.fRough Heating &,4ir Conditioning , , . FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace _' - APPROVALS Permit # ,
21 .� Ducts, in �Structure' ' " • - - , ' , 70. Uhdergrou�d, Hydro
. 22: DuMs, Ve�tilating . . . . �,71. Product Piping OGas OOiI
23. Gas Pipe-Rough & Test - . - � ' � �� ._7y. Underground Flush �
24. Roof Frarn�ng , � � : 73. �Undergmd. Storage Tank O Gas ❑ Oil
25. Roof Sfieathing - � - � 74.�Overhead Hydro .
26. T-Bar Ceiling (Siructural) & Monocoat _ 75. Dry Chemicai . '
27. Frame and Flashing �. ^- "' -� ' 76. Dry Standpipe '
� 28. Lathing & Siding .' � , - "- �,,/�, , 77. � FIXED SYSTEM FINAL� �
:' '
29. Insulation ; . � ,. 78..FIRE PREV. FINAL - ' �
30. Drywall-Nailing . .. • � . HEALTH DEPT. REQUIREMENT
= 31. Plaster BroWn Coat' �. � 79. PINAL INSPECTION ' '
� 32. Electrical Power Meter-Final � � 80. FOOD CERTIFICATE ISSUED -
"33. Final Electric � • , � Notes: f( 2(.�9p j`!� Qry�'I(p/y,E- [,�'('�ipQ�,[„E!%
34.• Final Heating.�& Air'Conditioning ' - � �2-�1�-q0 (7�pyypT iv1�P72kD Q� PFfL
35.. Final Gas'Pipe-Test� �. � � � . �,3 v �,� � �
=36. Hoodor.Canopy ' � , �
37. FinabFactory Fireplace � • • ' , ' -
38. Final.Plumbing � �
� 39. Water Service-Final� TM- � . � � .
40. Gas Service�Final _, " ' � - -- . .
--41. Solar pomesticFinal . � . � � � .
42. Backflow Preventer � � ,. �. � � - �
� .
43. Backflow Irriqation . ' � ' - � " ' � . - '
-44. Landscap¢ Irripation System�' � � ��
�45.,Sound Attenuation �� � � �� ' . � _ --
46. 'Handicap Regulations ' ', � ,
47. fINAL S7RUCTURE & BUILDING -
,f .
48.•FINALPLANNING � f : . •
49. Electric Release to Edison `^✓� ' � •
y
50. Gas Release to Southern CatiSornia Gas Co �
51. CERTIFICATE OF OCCUPANCY - � �
No. Date
OWNER
ROUGM PLUMBING
PROP. SWR. LINE � NOUSE CON, �
SPRINKLING SVSTEM
MISCELLANEOUS
ROl1GM HEATING RND �IR CONDIT�ONI
DATE
SUBCONTRACTOR
❑N�ERGROUNO U POWER ' ' � �, /j jY-�"�� [j �. J E� -
r+oucH winiNc � X°aeina and Vent" ° � '�z^`J t' �..,,
TRENCHES �J FORMS STEEL REINF. �
FLOOR SVSTEM -���� �.
BOND BEAM [� STEEL REI!
SMEATHING
FqqME AND FLASHING
�ATMING - IN r� OUT �
PL�STER, BROWN COAT
STRUCTURAL, FINAL
NE�TING, VENT., REFRIG. AND
PLUMBING, FINAL FND GRS TE
ELECTRIC, FINAI
BWLOING, FINAL
� .. , . . . . • .
45850.. ; . .. .
, :` • . - . 9426- 4/I8/78 10:50 TL
-�`f COSTA MESA BUILDING-SAPETY DEPARTMENT � ` � � � �' : ' � (�
� � ' . P.O. BOX 1200 COSTA MESA, CAUFORNIA 92626 • �' ' /] �[/
PLI A ON FOR STRUCTURAL PERMIT U
, For Applicant to Fill in Completely - Use Ink Only
- REC 1 D. DATE RECEIVED D TE ISSU
a���o�N� - S .�i�h/r� � 5 � —
. nooaess' .
. �"�//f^A /�n ^ ��/ � `/ P RMITNO. ,
owNeR' �ay %f /(�//�N/7LD A.P.NO. /
' MAIL ' G /� / . . - BUILDING. � ��/ i/� S/ _
- ADDRE55 / S L��/��% • ADDRESS �����
TEL. TRACT LO BLOCK.�
��T� . cos�A e sa . = No. ss�-o;j
CONSiRUCTION - . � A . .
� . LENDER ' ' ' � '
BRANCN � ' � ' ' . ~ + � .
� -- . O W N E O%N�/` C /NtA�L •'
'ADDRESS ' ' � � ,f� ALUE - '
ARCHITECT � . . ' � TEL. ' ` 7 S �
ADDRE55 � � '<urve, i�r tinuur
' ' �� p .'APPRO E ^/
� � �CONTRACTOR �.FAIPQ CS� ' � ' � � eV �- DATE r � / ,
, s . . tl �i
' ADDRESS �, ' ". � �v •
' TEL. • ZONE''� NO.OF SE OF N���' .
- CITY EI �R O� '' ' NO. . %C PtANS UILDIN
. F STATE � � � „`CITV ��'ARDSAPPROVED VAPDSAPPiiOVED '
LIC. NO. ' . ' -�LIC. NO. ' MAIN BUILDING ACCESSORV BVILDING�
� SIZE • � ' ' NO.OF BLDGS. (FROM GL ST E � �M// �
' W OF LOT - � . -� ' NOWONLOT RONT ✓f/ FT. '
a USE OF . . � .
i.�. EXISTING BLDG . ' ' - ' ' ° ' F '
vJ . .. . / - ///,[/ . , .
- F � Separate permits�are required for �� ' �. sioe 1S'•' FT. ' '
� electric, plumbing and heating work. REAR F.� FT.
W USE OF BUILDING AND WORK TO BE PERFORMED ' -
� F' DISTANCE BET. BET. MAIN &.
.Q. ' - ' /J MAIN BLDGS. ' ' ACCESS BLDGS. ' .
� �"� ' /e / LP G�L-C.O�S�/�.-c C URP.qW APPROVED '
• ' �7, /,. ' / ^
. �+ IS�////�C' . � �l(J � APPROVE � /
;� . . ,
/
, �
w
p. I heieby acknowlatlBa thet I hava reatl this aDP���etlon entl stete . ' ' - �
n
p: - ihet tha ebove Informatlon ie correet and apree to comply with � �
a • �.
all taws re0uletin8 builtling conrtructlon,-antl I shell not employ .
' z any pe�son in vlolation'ot the workman's compensatlon laws of - m
. � � ffie Steta of Califomie. , ' � _ • ,
i
- .� I hereby certlfy ffiat 1 am prooarly'Iicensed as a contractonundar SQ..FT. �' � - H� ,
" the Sto[e of Califomia Business antl Professiore Cotle, Dlvlsion 3, THE AMOUNT SHOW N ALUATION IS FOfi .m .
- Chepter 9, and 4het such Iicenses are in full forw antl etfect, or I- THE PURPOSE OF ESTA L PERMIT FEE V: " �
am exempt from tho p vislans of che Stat - alifornia Business � � - y �
VALUATION ' PE IT EE
� antl Professlons Cotle ivislon haPter . �' . ��, i. E m
m
' PLAN CHECK E ' ' "�
0
� Signaturo of � ��%�� , � LL �
: Permlttoe $ ✓"'yJ (f . TAX S � ' � ,
.%— U"
AuthorizetlAgent ' ' . ' TOTALPAID' S
)WNER WEST, Harry E
OB ADDRESS
GENERAL CON
AP No.
iINSPECTI0N5
OiL
AS
ATER
ROUGH PLUMBING
PROP. SWR. LINE
SPRINKLING SYST
MISCELLANEOUS
� ROUGH HEATING AND AIR CONDITIONING
�.TEMPORARV SERVICE OR POLE
UN�ERGROUND � POWER � �
ROUGH WIfiING
iRENCHES FORMS 57EEL REINF.
FLOOR SVS EM
BOND BEAM ❑ STEEL REINFORCE �
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT ❑
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFftIG. AND A.(
PLUMBING, FINAL AN� GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
DATE April
BUILDING PERMI'
VALUE
SUBCONTRACTOR
,, 3b4b�
�:�..�
-�F�%�WSTAMESA'BUILDINGSAFETYDEPARTMENT �� � �� ' �PR11-75�;ji.�OO o2i��� �°,�u.=18.50
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 • � ' .. . �
� � PL C TION FOR BUILDING PERMIT '
ForApplicant to�Fill in Completely . ��
'� FE EI D TE R CEIVED D E'IS UE }}
BUIL�ING -� � ..t �.' — i � �—� 1
� ADDRESS / / �
. lQ �j E T
�OWNER /r/ E- % . . A.P. NO.� t��-i (,i' '
� � MAIL - " � ' ' . r, -� BUILDWG � " �� '
- ADDflESS L � • � P.DDRESS ' L - �
Z . . ({
W W � . ' . TEL. �' � TR.4CT ' LOTS' � BLOCK
a U CITV ' . NO
2
Z Q CANSiRUC710N - . ' . •- W ADD A P '
O N LENDER � ' _ _ '
a m � ' - . � , , . - ..
J � . BRANCH. . ' . . . '
JN . . , . . . OWNER �iIZI�L -
' m J ADDRESS ' ' � ' VALUE
J m AFCHITECT ' , . TEL S -$
a OR ENGINEEIi N
U � - . . " . .. PIRE �
Wa 20NE VPE ROUP
� ADDRE55 � ' •
a W. . - . � � APPROVE .
W Z CONTRACTOR J� BV �'DAT �
J Q
0� Z � . . . , _ . , .
J � ADDRESS - � � ' � ' �,
w w ' ' TEI. � - �ONE' - NO.OF USE OF NEW A-`� b'
zF CITV " ' . . .•. " NO. 'I PLANS � BUILDING C ,O'
' W� STATE � � . CITV � , �'ARDSAPPROVED VARDSAPPROVED
N� LIC.'NO. LIC.'NO: MAIN BUILDING ACCESSORV BUILOING
_� S12E ' NO.OF BLDGS: (FROM G�L�/��/�/ �RpEEFl
OFLOT - ' ' � . NOWONLOT � FRONT CM�+'FT.' ' -FT.
� USE OF ' ' ' � '
EXISTING BLDG.' ' FT. -FT.
F� SRE OF NO. OF - ' .�// /(
Z NEWBLDG. ' � ROOMS � �STOFIES � L.SIDE� �T. F
' U EXTERIOR WALL ROOF ' . ' p � �
COVERING COVERING REAR � FT3 FT.
' J' USE OF BUILDING AND WORK TO BE PERFOFMED � DISTANCE BET. BET. MAI &
a ' MAIN BLDGS. ' ACCESS. BLDCaS. � �
a �
• Q . . '� . � ' „VAR.# . � . DATE � " '
. Q ID GO/�C � ' C.U.P.#. qpPROVED '
N. . '.' . ... .., ' APPROVED U`�.!3 ��./.'I- . ..
' z. . � . . .. '� . ..
O. , y�P
UI hereby acknowledge that .I have reatl this application antl rtate ' ' '
� that the above°information.,is mrrec[ antl agree to comply with _ ,
� all laws regulating builtlinB consttuc[ion, and I shall not employ ' . . ,`
F, any person in violation of the workman's compensation laws of
y ffie State of California. ' ' . .. m ,
z b
� 1 hereby certity that I am properly licensetl as a contracior untler SQ. FT. . o�
the State of California Business antl Protessions Cotle, Divisicn 3, - . THE AMOUNTSHOWN UNDEF VALVATION IS FOR" �
m
Chapte� 9, antl thai such licenses are�in full force antl etfect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: ¢
am exempt from the provisions ot the State of Califomia Business -
VALUATION
and Professions Cncie, Divii rfi 3, Chapter 9. . ' N
, - ' ' - � PERMIT FEE $ ]
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Permittee ' a PLAN CHECK $ E
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ee�t ' TOTAL FEE $ •
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�� / 2 lACOSTA MESA BUILDINGSAFETY DEPARTMENT � � • , � - � � . . . ' � -
P.O. BOX 1200 . COSTq MESA; CALIFORNIA 92626 . - „ , +
. PLI AT ON FOR BUILDING PERMIT � -
' For Applicant to Fill, in Completely �
� � RE EIV B DATE.REC+IVED Dyy E ISSUED . '
BUIIDING � - �;]+i,. ' 7 . S/ ///-7-
nooAess Lj ,:. Dahlia Avenue � r'- 7
owNeA" .' Larwin Southern.California, Inc. PERMr,nro.p
A.P.NO.�- —+G; JJ�U�
' �'BUILDING
aooaEss 16255 Ventura Boulevard AooREssr.9�S ' i '.
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a cWi c�rv Encino, CQJllOfI11C7 Np�H6�H]O 7RACL ./ LOT BLOCK
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Q CAN5TRUCTION ' � '- NEW ADD A R P
O N � LENDER - '
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2 Q] , .... , . � . . ' .
J � BRANCH. �G'L55 � ' ' � • /) ' /-�
Jtn - OWNER !/�4'G.�GU/N.,S\ �/VL. -
m� aooRess Encino Califomia' �y va�ue �
Jm ARCHITECT � • TEL SE .c.D'`. .'$ �� '
a OR ENGINEER � � NO. �
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W� aooaEss �� 9100 Wilshire Blvd. Bev Hills ZONE TVPE GROUP�
1 W - . . . . - . APP . . . . .
� W O CONTRACTOR Larwin �Southern California ` Iric ��� eY �� � o TE � �
m- _.. . . .
W W AooREss 16255 Q d ZpNE NO.OF USE OF NEW S/AI FfY� ��
TEL.
�� cir,v.. Encino Califomia No 986-8890 P�-4^.'S _2 eui�owc(� H �
O 'STATE . i` " 'CITY' � "�'p.RDSAPPFOVED VARDSAPPROVED �
y� ���. No. � i9131 T' CIC. NO. B� "� - MAIN BUILDING" �: � ACCESSOFV 6UILDING -
� O - , - _ (FROM GL STREET) ' , �
SI2E ' NO.OF BLDGS. ' � '- :
' �' OF LOT �O], X lOO � NOW ON LOT Q FFONT FT. .. -�FT.�.- • �
. �.USEOF ` . �,. . . _' '. " ' '
� , EXISTING BLOG. ' � ' � ' � .51 E �FT. � � � FT.
F SIZE OF � ' NO. OF • ' ' ' ' ' ' '
Z NEW BLDG. L�F.36 : ROOMS "STORIES 1' L SIDE � S`FT. � ' � FT.
U EXTERIOR WALL � �ROOF • � . , ' .
COVERING . SI' C COVERING REAR FT. FT.'
J USE OF BUIIDING AND WORK TO BE PERFORMEO � - � } '
a . , .. �ISTANCE BET. � . BET. MAIN & ' . , . �
a MAIN BLDGS. . ACCESS. BLDGS.
� ConsEruct Single.Famil Residence cuRb #;� , aPPRoveo � /
F " - ' - APPFOVED� . � !i[a�
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O � r
I he�eb acknowled a that I liave reatl Ihis a plication and state
' �V that the'above i�toemacion Is correcC and aePee to comply with HOLD FOR SPECIAL RE � I IVTS
� all laws ragulating builtling construciion, antl I.shall nat employ' . - - � -?�1�7(�
F , any pereon in violation of the'warkman's compensation laws of
0
.. y ' the State of Calitomia. ' .. '; � ,; - . . . . ,b.:� , �D ' � , „
zI hereby certify that I am properly licensetl as a contractor under SQ. FT. o.
.the $tate of California Business antl.Professions Code, Divisicn 3, THE AMOUNT SHOWN�UNDER VALUATION� IS FOR �
' Chapier 9, and that such licenses are in full force and eftect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:. ¢
am exempt trom the provisions of'the�State of Califomia Business VALUATION "' � '� -�
. � antl Professions Cotle, Divisio�3, Chapter 9. . . ' ' ' `� � .� N. �
- _ - � � ' PERMIT FEE $
. .Si9naturaof �', ��/ � '".�. �.OWf15� . .. , _ . l _. m '
Permittee 6E�� d=��Q//�Q� ' ' $�-�V � PLAN CHECK 3 Y'/—'� .�E
' � . . . � - . . , .. _ • J � .. p �
. Authorizetl Agent , " . '" ' " LL
? � TOTA� FEE`_$ - �.
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