HomeMy WebLinkAbout949 DAHLIA AVE - Building Permits�DURESSOFBVILqNG: �Q9 DAHLIA AV � � uxr. � CITY OF COSTA MESA — AUILDING FERMIT
ownercsN�ueivaiavn: KANAGA, LYNN D TR FLOOD: P.H-38 • PERM NO: P 074697
ADORE55: 999 DAHLIA AVE ' ' � �
COSTA MESA,CA 92626 �� V PERMIT NO; P 074697 -, PLAN CAECK NO: N G04JT: N SUPP: N
AVPLWUIINGIODRE55: � � ' � CONSTROCTIODI TYPE: V—N . PERMIT TYPE: PLU � PURPOSE: OTH
�xcxrt�cTonu+axvn: • U � uc.r�o: JOH DESCRIPTION , CHANGE OUT DISHWP.SHER „ SQ FT; '
APLIL ON ENG'S ADONE55: , ,. u !6 � UNT: , • � - �
`° .CLAIM VALUE:' CALC—VALUE: GROTIP OCC: R-3 / '
CONiNACiOp'SNAME: NOCK PLUMHING ' � (714)895-1296 � ' ' . - ' •
CIXfIPACL0A5MNIJNfi 1161U SEABOARD� CIR - COMMENTS: NO HUILDING PERMIT REFERENCE � �
woxcss: STANTON � CA 511971 *�**�:**��x�**�x�*�**x*x**�***x��****x+t+��****x*+�*��*-��*�***���***�����*�**x�*x���*
� 90680 ��� 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
110EN5EU COMFACTOflS UECLAN�TION: I hereby eA'em �Mm penetly d pe�ury thet I em Icanaed uMn ywiama d Chaqm 9 � - � .
(cammamiq wnh Senun ]000) d Division 3 d Ma Buaireea eM Pmleaaiora Code. ard mY �'erue u in lull lorce vd eHed. ' ,
cmuc.No.:050386 uacuss:C-36 uc.No.: 51�971 EXP: 02/96 ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ----------
G � ��R� (� FRNT: FT IN`R�.AR• FT IN • FRNT: FT IN REAR: FT IN '
.ome:16-'?�S—! � c�i�aa: U� T�UM��� LEFT: FT IN RGHT: FT IN LEFT: FT � IN RGHT: , FT � IN
OWNEH BUILDEP DECIAF�TION: I MreW effi�m uMer pe�ly ol perNrv �� I em avemp Imm IM Conlretlae Liceree Lew iw the
�dwwvw��=o�lsaaio��osi.se��s�dP��ooacoee:nm�ev��+�rowni�nrec���ev�n�oo�wn.en«,imao�, PARKING REQ: PROV: " PARCEL: 41218343 ZNE: � REF NO;
demol'ah, or npei eny slmclure, pior lo As esuerce, elso reQuires ihe ep0liasnt br euch peimn io fila e ei0�d etmement ihal he w eha 1] LANN I N G NOT E S> �
is liceireed pursuent lo Iha O�a'iaions d Ihe Conlradors Liceroe Lew �Chapur 9(mmmendnp wnh Sed'ron ]000) W Diueion 3 W IM ' ' '. . .
Business entl Proleeviona Code� or Ihel he w ehe ia exempt ihaelmm end �M besia la Ihe elleped exampbn. My vidmion of Sed'on % �'"' � �
' >Wi.ebrenvaVWiraniforevarmnaubjmsineavvlkeniioeciNlosnelNMnamoretnenMenunaredad�enR5ool1. iE3E1EiF9EiEiEiEifiEiEjElE1EiE9fif3E*ifiEiE9E9EjEiflE*3EjEiElEiEiEjE3EiEjE�E3E3fifi(�fElEifiE�lEiEiEik3fiEiE3E1EiFiEiEiEiEif3EififiEiE3EiE�EitififiE�F3fiE3E
❑ i,�o.,,e.dmemaoamo�mr•mwor��nw�<s�m<o-�ia�m����o�,wneoin„�,o�,�ein„w���e��amte�eae D E V E L O P M E N T S E R V I C E S � R E Q U I R E M E N T S
a oilered br ule (Section �paa, Busirea end PMaeniona Code: The Conlraqors License lew doee iat epptylo en ownero/ papem� ,
who budda «inpwea �Mreon, eM who Eoea suM xwk himeell a henetl a throuph he a Mr oxn empbysn, prwideE IM1et wc� � . !�� � .
�m��em.�s�a�ma,eee«arereai��.n,n�„V,.,mew�ni�«m��am�..m.�mnm,�.ye.,w�da�.ine ZONING APPROVED HY i'� , DATE;
ownmbuiltl« xill have iha buNan a P�'ine M or ahe dd na Wik «imwo'ie la iM Wm�e a eab). -.. . � -
❑ i.a.a.,�.,dm.po�ny.�a.a�r���a:p..nni��aooi,v�w��o�o-wm.aoaa�sw��oes.a�.m�„�a BUILDING APPRO��ED BY :' //�i DATE:
Pm/e�onn Code: TM Comratlaa Licenx lew doea ml epply to en o�wr d popeny xM builda a impov« thneon erq who `
<0111l8d9�IXWCM1pf0�M9M11IIBmf1�ftltlOf�9IICBl19BAW911B11110�MCIXIVOf}Of9L�.YBIISp�BW�. � .�l��_
❑ i�,,.,ma��e„s«i�,: e.aa.c.,iamro,,,�: . APPLICATION ISSUED BY: �� DATE: D
ifiEif1f1E1EiEifif3fiEaf�EaE'lE1EiE'tEiEif3fif X �.. iliE�3�3E�f3ElEiEiFlEiEiEiE3E��'1Fi��FiEiEif
o�'° °""°` LEGALIZATION:N ; F E E S U'M M A R Y.'_ , STRUCTURAL SEGMENT:N
I do hereby ceXily ihel I em eware W end uManiand tha reyuiramenta ol CelAwnie Heellh arM Selery Code Sedian 25505. 25533, erd � _� �
zssx.�eme����y�m��an�imi�o«��m�n�wei�wi�d�bo�a���eio<omo�vwen�dne�aooen�dma����a��ta, BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
epermitloreonslruclbnormoEilWbnhwntheA'v e�ty enegemeniDistna.Reaidemielmnavud'pneppicelioneeraaxamq/romihese
o��s�o�s. P ERM I T 7. 0 0 '
o�a- noois�: 25g f � � ' SMIP/NON—RES � �
•PLAN •
� WORKEF'3 COYGENSATION OECLAFATION: I Mreby eifi�m uMer panelly d pe�jury oro d tM tdbwiiq detive�'an: I S S U E F E E 2 0. 0 0 "�
❑ in�„oe���„�m;.�.�«u�ea�im.en;��ro�wo�x���,a�,,,ww+e.ai«eysw:�a�ooama�n« BUILDING—DIV—> PERMIT. ISSUE PL'AN—CHECK TOTAL PAID DUE
cae.i�insosn�ain.,.«xe«�mm�o«mn���e. TOTALS----> 7.00 20.00 1/`-' 0.00 27.00 27.00 � �, 00
,, � i n�. �e w�� �m� wo�xa.� �v��� �re���.. d�a���.e M saa�, aroo a u� �n« coee. ro� ine o�o�m� w m. . � '
wwk la whidi ihie pemin u iavued. My waMn' wmpawiion inaurence'emar end poliry num Wr era: /� �
cardsr GULDEN EAGLt� EXPIRES REVENUE'DIVIS.ION TOTALS--> COL'L'ECTED: Z7.O0 OVER/SHORT: OO �
��' _ aoikyN�mn«: ww� G l.�tvv 09/O1/96 BLDG PMT PLUMBING ELECTRIC M�ECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK .
(This saction nead nIN be eanplefeE! Ihe paimrt is br one hundied Cdlers /S100j a bss.) - 2%. U O � . , '
� I cenM �he� in �ha parlamence 1 ihe work lor whkh thie permit ie ieeuad, I eny peno eny m ao m to � " �' ' � '
becomeauDlenm�hawarke'comPensetionleweo/Celtlanie.enE IhetH haddbacom b' othaworka�e' �IE�1EiEiFiEiF�)kiEiFiEifi(iE1EiE�E1Eif�lEiEiEiE�7EiEiE3F�EiElfiFdElE3fiF-1�.IfiEifiEl4iFiEjEff9EiEdE�EiEjElE�lEfEiE3EiElE#if1FiE�f-IE3E�E�7E�Fif�1(-lE�IE,1EiFi61fjE3E9fiE
�om����o� v�ab�y� py�+� �r cma i.ndi i�n y_ in� I N D I V I D U A. li/. F E E B R E A K D O W N
Dme: � - - Applicenl: . ' � �'� , .
.� werribp:v�nvnros�cunwoncen'rompxuanonrovxp�b�nbwiu6meuunue/«tmxrp�oyxrocNm�n�peiuMume �--- QTY D E S C,Fi I P 7.' I ��i� . Ui�IT COST • TOTAL C�$'1' •
n.n n�., ,y ro m. nuner.d mou,.nd dwr�. fs�oqaoaA �n .miuon ro m. eo.r o� nmo«v.iron d+�w .+ vA.�ww ror in . .
seouo�»aso�me�mo�corv,/�r�ta�earcomey��w. � PLU 1 DZSHWASHER � 7,00 � 7,00
CONSTNUCiION LENDINfi �GENCY: I hereby elfi�m ��e.� ��y a��„� mm m,�. s e�w�,ao� is�a�� ,o,�y ro, w, , END OF FEES � � , i
paAom�eMa o/ ihe woek Iw whM ihe pemil is'ewed (�4n ]OB). Gv. CI. ' . .
LEN�EN'SNAME: � � • �' ' , �
LENOEN'S ADUPESS: � '
I carlity ihm I heve reed ihia epplicelion enE stata ihel �he ebova infortnelion is corteU. I epree to compN ��h ell dly entl munry oMinencea � , �.y
end ateie levn relelin8 �a buildnB �^���aion eM hereby emhorrze npreeen�etivee ol �his cny m anter upon �he abava�mentbned pmpeM /� '
ro,m:v�+�o�w,o�s. RON NOCK , ���
P�°�" ' Qi OD19?9ti5-00i42465 T�aT :7.tlt�
ms: � 1�S � D0.?E: t0/25/9: "f1tkE: i2:0G
, SipneluradOwrer/AgenUAOP�enUCo�irada �
(5151-a6 WP) Whee-BuiMvq d SeleN: GrearFla: Cenery-Applrani: Rnk-Revenue: Gddenro�Reaevor . . . . ^ . .
�
' CONSTRUCTION AN� Pl-'ANNING � ' ` } • POOI & SPA
' ,�Date Inspector - Date Inspector
� APPROVALS Permit #` -� , � , � : 'APPROVAIS . Permit,#
•�L Temporary Elect�ical4Seniiceor Po�le' `�; �'%, r, ' '52. Pool & Equipment tocationr,-� � � - ����
�- � •�
' 2? Soii�Pipe'Undrgmd�.��� ,:�- � � - -. ' � ' 53: Steel Reinforcement . " , . " � ��
�
B. Electrical Conduit Ut�litv-Undrgmd. . _ , � 54. Forms' . , , - ' � � � `' '
4. Electrical Conduit=Undrgrnd. � " � 55. Electrical Bonding ; '� . ' , ;.�,_.
.5. Steel Reinforcement � Y1 ' . 56: flough Plumbing & Pressuie Tesi �
' 6. Eiectrical UFER Grnd. � �' , `' ` �- � - 57. APPROVAL TO COVER=GUNITE �
,
� 7., Footings _ , � � ` � � ' ' 58r, Electrical.Conduit �Undrgmd.� .. - '
� ��8. Foundati0n ' ., ' ' - ' `,59. Gas Pipe, O Undrg�"nd:; Test - ' ' '
9. Water Pipe-Undrgmd. �-� _� ' _� 60' Backwash Lines,�P-,T.rap; C Undrgrnd. �,�
70. Structural Ploor System �. . l i - ' - ' -S3? APPROVAL�TO�DECKs.r�- ' �,
it. Propertv 5ewer Line & HouseCorinection' -� - ' 62: Sackwash &_Receptor-Ftnati�y `� � '
12. Sewer Cap . �j I -• ' • .. _, � 63. Heater & Vent-Final �r' �ti i -. ,
.t 3. Roof Orains . �,,,�� ' - ' ; '.6A. Plumtiinq SYstem - Finai' f Sv � � ' ''.
14. Rough Plumbing� - . �' � � s-� � � ` ' 65. Electrical-Final .� ' a
- '_
, 75. Rough Electrica6Conduit � ^ _'� ' , . ' 66. Solar Sy'stem-Final �'� %
. / 4� • �
.76. 8ough Eiactric Wiring ' 4- -�� E f � 67. Fencing & Access Approval � . � -"- "��
77. Raugh Wi�ing Sig� � � �� _ .: , - ' , �68. APPROVED'FOR PLASTERING� � �'
18. Rough Electrical-T Bar Ceiling i � - � � "� � � 69. POOUSPA SYSTEA9S�FINAL � -� � '
� 19. Rough Heating & Air' Conditioning � � �- � � � � � , � ��. FIRE DEPT. RE4UIREMENT
' i .
20..Rough Facto.ry Firepiace �- ' -� . , . - ' AppROVALS Permit #
21. Ducts, in Structure � , ' 74.- �Underground Hydro �
22. Ducts, Ventilating . ' -�71. Product Piping OGas COiI
23. Gas Pipe-Rough & Test - � _ . 72. Underground Flush
24. Roof Fran?inj� . 73. Undergmd.Storage Tank O Gas ❑ Oil
25. Roof Sheathirtg ' � ' 74, Overhead HYdro
26. T-Bar.Ceii�ng {Struc'tural) & Monocoat , 75. Dry Chemicai
27. Freme and Flashtng �� ' � 76. Dry Standpipe
28. Lathing & Siding , 77. FIXED SYSTEM�FINAL
29. Insulation •- �_ 78. FIRE PREV. FINAL
30. Drywall Nailing � � � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat . ' � 79. PINAL INSPECTION :
' 32. Electrical Powzr Meter�Finai 80. F000 CERTIFICATE ISSUED
33. Final-Electric ' � Notes: /-7 /-�����.�,
34. Final Heating & Air Conditioning , , - ��` J �f=!!+=✓/-�L-- - - - -
35. Final Gas P�Pe-Test -
' 36. Hood or Canopy ' , � � , ,
37. Final�FactorY Fireplace�� • - � ' ^
38. Final Plumbing - 1_�3�r ,� � .
39. Water Service-Finat �+
( :�
40. Gas Service-Final ' � � • �� �. _ . .
41. Solar pomeSticFinal �� � � . _ -
42. Backfiow Preventer ` � '. � `_ ,
-43. Backflow Irrigation � - � �
� 44. Landscape trrigation System - . �
; 45: Sound Attenuation � � � '.
? 46! Handicap Regulations � � � .
' 47. FINAL STRUCTUflE & BUILDING �
�.
� 48. FINALPGANNiNG ' U' i : .
� 49. Electric Release to Edison �` . . - ,
� 50: �Gas flelease to Southern California.Gas Co .�i � ..'
57. CERTIPICATE OF OCCUPANCY ;"
No. Date '
�
�
qC� '�� � � AOC�icant to fill in ali spaces exeept those within �eavy borOer lines anC sign all appropriate Geclarotions.
rt
OF COSTA MESA � CON(J RUCT,ION PPER IT . PER IT NO .� TRACT.NO. LOT NO. � UNIT NO. A P#.
. Project Addr¢ss� ��4 �(�n � .cTn n.l � � f . � S Main Building: �
AppliCant'S Mailin Addfess � . � -. .�• "' TYPE OF CONSTRUCTION' NEW • ADD ALTERATION ftEPA1R �'E
� (���'��� ❑ CONVERSION ❑ DEMOLISH 0 OTHER� •' T Front'
'�. Owner's Name' Phone�Lly �-� �� ' - '� � g ,
DESCRIPTION OF WORK/USE OF BLDG. .� I, Rear � _- .
Address � ' ' . . ' - : � . ,. . . . , " � � • �' _ � A' .
C Right •
Arch/Eng " � LicenseNo. ' TYPEOFPERMIT , GaaoWG�❑FOVrvDATIOrv: STaUCruan� ' i,K •
Atldr¢ss' � � � � ' �❑ TENANT ❑ ELECTRICAL . ❑ PLUMBING �❑'MECHANICAL � � � . ', g�t Left •
Contractor'iName� � PhOne� � � . ❑ OTHER � � ' - ' Pln � Ref. #
�9.
� - PROJECT�DESCRIPTION 5�. FT. � ' � oCCUPANCv � Plannin �
Addre55(mailing�-- - , , . �CONSTRUGTIONTVPE � ,.VALUATION$ � 9'NOteS:� �
�. City�LicenSeNo. . . ZONE GRADINGCU.VDS. - ACRES� '
L'ICENSED CONTRAGTOR DECLARATION . " • " � �
1 he�eby affirm thal I am Ilcensetl untler provisions ot Charte� 9(commenGing Rertiarks: � ' . �. '
with iection 7000) of Division 3 of tne Business antl Professions Cotle, antl
rtPy license is in tull torce antl e�tect. . � � . . . � . • � , '
License Ciass � License No.
Date Signature '
WORKERS' COMPENSATION OECLARATION� ' . '
I M1ereby affi�m that I have'a ce�tlficate ot consen[ to Telf-insure or a certlficate
of Workers',Compensation Insurance, or a Certifietl copy the�eof'(Section, ,_
3800. Lab. CJ__ ' ' ,- _... �� ,-. . -. f . . ,
Po1icY No. � - ComPanY � � .
' eCertifietl copy is hereby furnished. . - '
Cer 'tietl cop 1 filetl with the city Builtling Division.
�ate . Applicant '
EXEMPTI N FftOM WORKERS',COMPENSATION DECLARATION
'(Thissection neetl not be completetl i£the permit.is for one,huntlretl ($100) or :"
Ie55): "- -_ .: . . . ,
I cert�(y tha[ in the performance of the woik for which this perm�t is issu¢tl I
shall'no[�employ any person in any myqner so as (o become subject to't{�e
Date
compiy wim sucn provisions or mis permit snau oe, aeemea revoued. .
CONSTRUCTION LENDING,AGENCV
I hereby affirm that there is a consiructlon lentlin9 agency for the pertormance .
of [he work for which tM1is permit, is issuetl (Section 3097 Civ. C.)
Lentler's, Name; �
Lentler's Atltlress � � '
OWNER BUILDER DECLARATION - ' -
I hereby atfirm.lhat I am. ezempt from the Contractor's License �aw �for the
foilowin9 r¢ason (Section 7031.5 Business antl Protes5ionabCotle: Any city or
munly which requires a pe�mit lo construct, al[er, Improve, tlemoli5h or repai�
any structu�e, priOr to its issuance, al5o requires the applicant for such.pe�mit
lo file a signetl 5tatemenC Ihat he/she is licensetl pursuant to the p�ovisions of
�he Contractor's License L.aw (Chapter 9(mmmencing with Se�tion �000) of
Divisiom 3 of the Business antl Professions Cotle) or that ne/she is exempt
therefrom antl the basis for the allegetl'exemption. Any violation of Section
��031:5 by any applicanl for a.permit subjects the�applicant to a civil
�enalty of.not more than five huntlretl tloilars ($500). '
I, as owner o( the prooerty or my employees with wa9es as theirSole
compensation, wlll tlo the work, antl the structure is not intentletl or-otteretl
fo� Sale (Section' 7044, Business antl PrOt¢SSlonal Cotle: The Cont�acto�'S
License Law tloeS�nOt apply to an owne� of a property who bulltls or imprOves
the�eon, an0 who tloes Such wo�k�nimselt/ner5elf or Ihrou9h his or h¢r Own
emploYees, p�ovitletl Ihat 5uch�improvement5 ar¢ not intentletlior offe�e0 tor
sale. If,.however, the builtlin9 or improvement is soltl within one year ot com-' . ,
pl¢tlon, the 0`�'�ei v✓III have tM1e burtlen of proving h¢/she ditl not builtl o� Im- DuC[ - Und¢� GrouOd .
r ve for the Purpose ot 5ale).
I, as owner of�the property, am exclusivery contracting with licensetl con- Duc[-Structural
r ctors to co�struct the project (Sec[ion ]044, Business antl Profe55ion5 Cotle: �
The Contracto�'s LiGense Law tloes not apply to an owner of property who DUct- V20tildling '
builtls or imOroves [hereon. antl who contracts for such oroiecis with a�on-• ''
t�actor(5) 1¢ense pu�suan[ [o tne Conttacto�'s License Law). I�,am aware that Exhaust System ❑ MultiPle ❑
proof of tneir Worker;s Compensation insurance shoultl be provitletl to me. . _
❑ 1 am.exemPt untler Section B. & P. C. for this reas n Firepl/Fact. BIL IC80 �
Date owner � 1 ating System & Ducting �
Y heretiy c ity t at I have reatl his licatio n tate mat e aDove �100,OOOBTU �100,OOOBTi
informahon is correct.'I agree to comply ith all city antl county tlinances
antl-s[ate laws relating to builtling construction, antl hereby autM1orize repre- � , ,
sentativ¢5 of this' city to te� upon IFe abOve-m¢ntioneG property for, , ' �
inspection p es. � � 1 Q� '
Signature � ate�
�rivers' License S� Reinspection Fee $15�
0865-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Accountinq; Goltlenrotl - Assessor
Backflow Irrigati0n
Baffimbs
Clarifiers �
Dishwasher � '
Drinkin9 Fountains
Floor Orains, - �
floor Sinks[ -.
Gas Service
Kitchen Sink
Lavatories ` �
r- i rap
Roof Drains 4 "'
Reinspection Fee
'�' ." -. -
Outlets
$15
Service Sink- ---r � � ' -
Sewer Cap '
Sewer�Connection �
Solac Collecrors t
Solar Tank. - -
Swimming Pool w/Spa
Urinal.�. - - - - .
Water Closet �- - -
�Water Heater . � :-
� Water SerJice � '
Auto=Wash .
' Laundry Treys � -
" Issue Fee�.
Hood or Typel U
Canopy Typell ❑
9efrigeration Sysiem
❑0-t00,0006TU� ❑11
System Repair/Alterati
Fire Dampers
Registers �
c
tl
: .
i\ , . �
,�. .s,F'�',
. � . . ' Zone .
. ' Accessory Building:
Automatic Washer'
Construction Pole Sub.
Cooking Unit.�: -
Dishwasher ' -
Oryers �Gas'-DElectric
Fan
� ':•
F.¢7U. '. - - ' �
Fixtures '
�evice�8oxes `
Outlets
Switches � �
Garbage Disposal
Generetor 00.5 KW �5-15 KI
� Reinspection Fee
. �
.��3, DEVELOPMENT_SER
ZoninB APProved By _
FEES' Building Approved By
1,000 BTU{_
�
�
. Parkin9 Req./Provided.
1 .
O
N
� I
• N
G
R'
E
Q
M
_ T
S.
.ICAL � . ' '� . FEES .`
Trensformer.�� 75-50 KW '
' , ,� 50'+KW
Meter:"�up m 100amps'-� - -
Meter ❑over 100 amps '. •
Sub Panel � ! ;
Motors �0.7 HP O1 %'- 8�
Inc.Solar �9-15 HP 076-15+ ' ""
Microwave '
Pole Light' ' • �
a�,.,,e . . � � -
Standing Section�
Trash Compactor
1
$15 Issue Fee
REQUIREMENTS:-
$ 3
� ' SUMMARV OF FEES � � ,
BUILDING PERMIT $ SMIP $:
PLAN CHECK � ' -$', � . PERMIT " � � ,
PLUMBING ' $ ISSUANCE $
PLAN�CHECK • 25% $ � � ENERGV P.C. $- �
ELECTRICAL $ . . GRADING $
PLANCHECK 50Yo $ �j� ,MICROFILM. $ �•�� ��
MECHANICAL $. � �'�"' TOTALFEE $ Sd�(L
PLAN CHECK , 25% $' � , . , . ,.
� laue Fee q �S ' $.0�. = '
_�
f /�
� 2 ��J�140�27-00040227 'e' r� � ' . 2S.00t
. . ' . . .. . "9TE� C18/t4/Q9 . TI7=� .Ii:S[
. . . * � c: �A,rL . . . , . =. �:.: ".� .. _.�. , �.., . ..�. .. . . . �-ti�S., .Cj
CONSiRUCTION AND PLANNING �_-L & SPA . ti,i _
Date .Inspector • � ' - r�' Date Jnspector
� APPROVALS Permit # „�, APPROVALS Permit # � - .
' 1 cn /'s
d. Temporary Electrical Service or Pole �y,',;; 3 52. Pool & Equipment Location . ', . � � �
' "' 2. •Soil.P�pe-Undrgrnd. � tt• � 53. Steel Reinforcement - ' C
, ' •3��Electrical Conduit Utility-Undrgrnd. n; ` 54. Forms . - - ' ('�� � il� � �
�T :r" 'l
4:Electrical ConduiriUndrgrnd. � �'" ' 55. Electrical Bonding - � `!
1 i �
� � 5.+Steel;Reinforcement � � 56. Rough Plumbing & Pressure Test - `��
n i ; , --r a? �
�Elec�ical UFERVGrnd. �if ��� . %�'�
57. APPROVAL TO COVER-GUNITE
7.�JFootizgs �'��:. 58. ElectricalConduit-Undrgrnd. �'�j� G��Z
� 8..Foundation � � � 59. Gas Pipe, O� Undrgrnd., Test � � � � �
C i
_9.-�Wa'te�Pipe-Undrgrnd. , in,� 60. Backwash Lines, P-Trap, � Undrgrnd. �. -^;�
10.�Structural Floor System � � 61.' APPROVAL TO�DECK .� y��`,' � �' i
11. Property Sewer Line & House Connection ,.`�.� � 62. Backwash'& Receptor-Final - -j ���
� �
12:(Sewe�Cap f. 63. Heater & Vent-Final r,�, . ��F!i
,,, � .
13.iRoo��Drains � ?r 64. Plumbing System - Final - � � v
� �
14. �Rough Plumbing � � f 65. Electrical-Final . � ~�
J
� 15. Rough Electrical-Conduit - 66..Solar System�Final - -
• 16. Rough Electric Wiring � 67. Fencing & Access Approval �
� �
17`Rough Wiring�Sign � . 68. APPROVED FOR PLASTERING ' �
�1'8� Rough Electrical-T Bar Ceiling ' . � 69. POOUSPA SYSTEMS FINAL � .
1�9., Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - .
�
20� Rough Factory Fireplace � � APPROVALS' Permit #
.�t .
� 21� DuCts, in Strucwre� . � 70. Underground Hydro . , - �
22. Ducts, Ventilating - 71. Product Piping O Gas ❑ Oil - -
� 23. Gas Pipe-Rough & Test - ' 72. Underground Flush • ' -
24. Roof Framing , 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Robf Sheathing � � _ � 74. Overhead Hydro .
26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical . �
, 27. Frame and Flashing � ' • 76. Dry Standpipe � -
28.. Lathing & Siding . ' � � � � . � ,77. FIXED SYSTEM FINAL , '
129. Insulation , � 78. FIRE PREV. FINAL . � �%
�
30. Dry'w`s11�=Nailing � ' ' HEALTH DEPT. REQUIREMENT N�
31. Plaster Brown Coat � � ;; _�����, J 79. FINAL INSPECTION � � -�
32. Electrical Power Meter-Final �� � 80. FOOD CERTIFICATE ISSUED � '��
33. Final Electric . � Notes: ' � � - � - � - � � �
34. Final Heating & Air Conditioning �.�c�' [��p � � , � �� �
35. Final Gas�Pipe-Test -' , � . � . -
! 36. Hood or Canopy � � � ' � -
' 37. Final Factory Fireplace - � � " � � ' ' :' ' � �
38.. Final Plumbing � , . , , � . , . .
39. Water Service-Final � , , � ,
40. Gas Service-Final ' . � '. . . �
41. Solar pomestic-Final . ' , � � � � � � �� _ , n ,
42. Backflow Preventer � , .� - . � ' Gi �,-
r�.
43. Backflow Irrigation - ,, � � : - �
44. .Landscape Irrigation System . � �•. � - ' . • � .�
. 45. Sound Attenuation. . ':g�?;'� . �.'�" � � , . . � � � . . .
I 46. Handicap Regulations - � � , � . � . •
�. 47. FINAL STRUCTURE & BUILDING �' � � � . ' � . . , � �
�,4; 48. Special Requirements Completed . ; . � ' .
� � 49. Electric Release to Edison ' ' • � .
- r,9 .rt
� 50. Gas Release to Southem California Gas Co , , � ' � �,..� ' - � �; .
� 51. CERTIFICATE OF OCCUPANCY , , . ' � i" . „� •
' No. � Date ' . . .. . � . , . � � .��. . ' .�
�L,
��
I �
aooness: 949 DAHLIA AV
rsxame:KANAGA. LYNN D TR
aooeess: y49 DAHLIA AVE
COS'TA MESA.CA
APCNIENGINEEF:
PDDHE55:
uxiT:
FLOOD: AH-38
92626
NEC.NO.:
UNIT:
PEHMITTEE: LYNN KANAGA ( 714 ) 545-7913
PODHESS: �j49 DAHLIA
C.M. CA 92626
LICENSEo CONTPAC70P OECIANaTION: I hereoy affirm tnat I am licensetl uneer provisions of Cnao�er 9 Icommencing wilh Section
7000) o� Division 3 0l �he Business an0 Pwtessions Cotle, anU my license is in futl force anA eHeci.
CRY LIC.: STATE UC.: ClA$S: �}(j� �
oate'. ' - . Signature: '
WOflKEHS' COMPENSAiION OECIABBTION: I �ereby aflirm Iha� I have a certilicate ol inn5en� �o Self-insUre or a certifiCa�e of Wo(kefs'
Compensalion Insurance. or a cerliM1eO copy Ihereo� (Seclion 3800. Lab. C�.
POLICY NO.: EXP. OATE:
COMPpNY:
❑ Cenifietl capY is herehy furnishetl. ❑ Cenified copy is filed with ihe ciry BuilOing Oivision.
Daie: Applican�:
E%EMPTION FflOM WOBKEFS' COMPENSATION OECIAPATION: Qhis sepion nee0 no� be completeE it �he permii is for one huntlretl (51011) or less�.
I cetli�y I�a� in Ihe petlormanre ol �he work lor which ��is permi� is issued I shall not e�mp y any person in any manner so as ro become
su�lecl b �he W rkea ComD nsation Laws of Califomia. /
� Oa�e: I Signature:
NOTICE: If, a�ter making Ihis declaration, you 5hou10 �ecom u�laci Io Ihe Wo�kers' Compensation pmvision5 of � abor
Cotle, you mu5i forihwith comply wiih such D�o�isions or thi ermi� shall he Oeemea revoked.
CONSTHUCTION LENDING AGENCY: I hereby aifirm Ihat Ihere is a consimction lending agency for lhe pedormance ol Ihe work for
which Ihis permi� is issuetl (Sec�ion 309Z Civ. C�.
LENDEfl:
AO�NESS:
OWNEB BWLOEH oEClA8RTI0N: I hereby aifirm ihai I am exempt 1mm ihe Comraclors' State License law for the following reason
�Sec�ion 7031.5 Business antl Protessional CoOe: Any ciry of couniy which requires a permi[ Io consimc�, alter, improve, tlemolish, or
repair any siructure, piior Io its issuance, also requires Ihe appiicant �or such permi� �o file a signetl s�a�emen� �ha� helshe is licensetl
pursuam m �ne pmvisions ol the Comrac�ors S�a�e License Law (ChaD�er 9(commencing wiih Section 7000) ot Division 3 0� Ihe Business
antl Pmiessions Code� or Ihal �e/she is ezempt iherefmm antl ihe Gasis for ihe alleAeO exemption. Any violation of Section 7031.5 by
any applicant ior a permi� su�lec�s Ihe applican� to a civil penalry of no� more ��an tive �untlrea aollars (5500�.
I. as owner of �he propehy or. my employees with wages as their sole comp¢nsation, will do ��e wo�k, anA �he
�� SimcWre is na� intentled or oflerea �or 5ale �Seclion 7044. 9usine55 anE Pm�essional Cotle: The Contratlor5' State License Law
Ooes nol apply m an owner oi a pmpeny who bui105 or impmves �hereon, and who Uoes such work himsell/herself or IhmugA
his or her own emplayees, pmvitled that such impmvements are not intentletl or oflered for sale. It, however ihe builJing or
impmvement is soltl within one year ol compl¢tion, �he owner wili have �he burtlen o� D�oving he/sAe Oitl no� builU or impmve
for Ihe pwpose o� sale). .
I, as owner ol ihe propeny, am evcWsively coniracting with licensed coniractors to construct tne pmiect (Section 704d. Business
❑ an0 Pmfessions Cade: The Contractors' State License Law aoes not apDly to an owner oi pmpeny who hudAs or impmves iherean
an0 who comracts br such pmlecis wilh a conVactoqs)license pursuan� to ihe Con�rac�o�s' Sta�e License Law�.l am aware
Ihat proal ol �heir Worker'S Gompensalion insurance shoultl be pmviaed lo me-
� I am exemp� under Secuon: 8. 8 P. C.
br Ihis reason' � � ^
oaie: � �✓I (.h`�'. �Hf Ownec �i
1 do hereby cenity tha� I am aware oi antl unders�antl ��e requirements ot Calitorniay ealth an0 Safery Code Sections 25505, 255 , n0
2553A ana �hal I or any fu�ure buil0ing occupant willlwill not (circle one) neetl to com0ly wi�h saia state wJes anA Ihe reQuir¢men or a
permii for conslmctmn or mo0ilication hom the Air �ualiry Management Distric�. Fesitlenlial constmciion applica�ions a�e evempl twm
inese pmvisons.
Daie'. ApplicanL
I here0y cetlify�hall have read Ihis applicaUon an0 Slate tha� Ihe abave in�armalionis
or0inance5 antl staie laws rela�ing lo builtling constmc�ion an0 herebyaulhorize reD�esen�
pmoer�y for inspectian pur osei /
�ale: 1 - Signalur ' L
Oriver 5 License ai Social Security p: � _
I agree to
all ciiy antl
1641�a6 WNte—Builtlmg�. Green—Cotle Eniorcemem', Ganary—Appl¢anC Pmk—Revenue; GOltlenro0—Assassor
CITY OF COSTA MESA - BUILDTNG PERMIT
PFRMIT NO: B 0%0390 PLAN CHECK NO: N
CONS'TRUC'TION TYPE: PERMIT TYPE: STR
PERM NO: B 07039
GOVT: N SUPP: N
PURPOSE : O'TH
JOB DESCRTPTION : 1?EROOF W/COMP05I'TION SHINGLES SQ FT: 3.000 '
CLAIM VALUE: 3,000.00 CALC-VALIIE: 3.000.00 GROUP OCC: R-3 1M-1
*��* � �*�t�Ei�E**��*�E*�*���O�N�I�N*G**�tR�E*��EU*I*R�E�xM-�Ei�NNT*S'� �71V�91�*������t,.
S E T B A C R S �p C^' ilp�(`�, -
--- ----- MAIN BUILDING - --------- ACCESSOR��i4-ILDIN�Gt6J rl v
FRNT; F'T CN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: XT IN LEFT: FT IN RGHT: FT IN
PARRING REp: PROV; PARCEL: 41218343 ZNE: REF NO:.
PLANNING NdTES> � ` ' "
� �.
ifiEiE'%iFifiEiEiE�fif'7EifiElfifififiEiEifiEiEiEjEifiEiEiEiEiEiEifiEiEjE�FjEiEiEiEiEifiEififiEifififififif�kifififiEiEiElEiEifiEiEiEiEiE�fifiFififiE�iE�E�fiE �
D E V E L O P M E N T 5 E R V I C E S R E Q U I R E.M E N�T S
[ ' �'
ZONING APFROVED BY DATE: '✓'
_'__' __'__._._ '____'"".__
BUILDING APPROVED BY :___.___. ___,____ DATE: �:
APPLICATION ISSUED BY: � DATE: ��I��
iElfiEiEiEifiEifiFiFiEiEiE�fiEiEiElfififiE�ii3f�E3FiF�f �iiiFiE�FiF7fiEiFifiEifiEiFiEiE3f3E1F��F�iFi� *
�� if iE if iE iE # iE �k if �� jE iF �E if iE iE'%if 3f -lf jf � iE'lE �f if iE iE iE iE jE jE �E iE iE iE if iE iE �F iE if iF iF if iE iF'k �� if if if iF iE 3E if if iE iE if if iF iE iE iE jE if �lE if iE if if iE'3E iE iE iE iE
LEGALI'LATION:N F E E S U M M A R Y STRUC'TURAL SEGMENT;Y
' �.
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIF/RES GRADING
PF..RMiT 54.00 �„ �' SMIP/NON-RES
YLAN � , /"
ISSUE PEE:
BUILDING-D'IV-> PERMT'T ISSUE PLAN:=CHECR TOTAL,/' PAID DUE
TOTALS----> 54.50 0.00 ���0.00 54.50�"'� 54.50 .00
REVEPdUE DiVISION TOTALS--> COLLECTED: 54.50 OVF.R/SHORT: .00
BLDG PMT PLUMBtNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
sa.00 � �� r.so
iE iE iE jE iE iE jE if �� iE iE 3f iE � iE iE iE if if iE �7E iE 3f iE jf 3E 1E �E if 3E if 3f if jE iE if iE if if if aE jE jf iE if iE 3E if jE iE if iE iE if iE iE if jE if �� if if 3E iE jE iE iE 3E iE iE if iE iE �� iE �M iE if �f
I N D 2 V I D U A L r.r4',rF E E B R E A K D O W N
TYPE QTY D E S C R I P I' I O N4 UNTT COST 'TOTAL COST
FR 3000 REROOF BY VALUE RESI�IiEN'fIAL NOZONE � 1.00 3.000.00
END'.�OF FEES
�v , "
�
�
:%� -�'' � �}
z�"� oi oo1i35oo-ODi73501 TC�T
� DA7E:'12/15/S4 T?ME: 13:53
54. St�
� � : .��
./
C ��JSTRUCTION AND PLANNING P�%�� & SPA �
�\ APPROVALS Permit,$ - Date Iaspector APpROVALS Peimit?� Dare Inspector
L Temporary Electrical Service or Poie � ,= 52. Pool & Equipment Location '-�� - �
2.,.Soii Pipe-Und�gr,nd.. . 53. Steel Reinforcement � � .`"
c,3�.Etectricai Conduii-Utility-Undrgrnd. 54. Forms � �
��
"'4?.EI"ecirical Conduii Undrg:nd. - ,' �'� r� 55. Electrical Bonding -
:5..Stee! Reinforce.ment , . 56. Rough�Plumbing & Pressure Test
"�6.'Efectrical UFER.Grnd_. � 57. APP.flOVALTO COVER�GUNITE
zT.:Footings � � 58. Electrical Conduit�Undryrnd. -
�VS��Foundation ' _ � 59. Gas Pipe, O Undrgrnd., Test `��^
9`. GVater Plpe-Undrgrnd.- � � 60. Backwash Linet, P�Trap, C Undrgmd. �
10. Structural Floc� SYste'm .� �� 61. APPROVAL TO DECK �
ii. Property Sewer line'& HouseConnection - , 62. Backwe9h & Receptor�Final �r- ,;
. �
12. Sewer Cap �,.� " ' " ' �" 63. Heater & Vert-Pinal . .� --
73. Roof Drains ' "' ' � . � " • �
� ,� =,� 64. � Piumbin� System � Final �: �_ i
14� Rough Plum6ing � � - � � �' � 65. Electricai-Fir,al. - _
_
15: Rough Etectric � Condurt � ` 66. Solar SYstem-Pinal , �•
�16: Rou9h ElectricHll�ing � . ' � ' �� 67. � Fencing & Access Approval ��; '
j.
tl.n� Rough Wiring 5iyn ;' - 6S. APPROVED FOR PIASTERWG `�' '�
78. Rough Electricil��T Bar Ceiling "� � , 69. -POOUSPA SYSTef.1S FiNAL -" �� �
E
� 19. Rough Heati�g & Air Conditioning .tiM ' - - � � �H - FIRE DEPT. REQUIREMENT ' - (
t.^ 7' �-•: u �+
20.�iough Factory ri[.epiace r�1 r�'�' '`� ;� .'�N'' t�APPRO,VAIS' `��'Permit #': __ ` I
( . 1. 1 ' .K �. '� 1. .� .ot-��-•
2t�0uccs, irt.Structure= �• •• .-�� �K '� % � ^.70. Undergr`ou�i d!Hti;dro �
.� r� .- .� .> >
22. DucLs, �:'entilatin '" � �;';; '^ ' " -`s " y '- '
� � 9'� i"• :•.0 ¢!� r71. Product�Pipiny'�'6as O.Oii
23.`Gas Pipe:Rougn & 7est � ;+i•� x. p7 _ �; ��' x�.72. Underground Flush. " - d
,�
24.�Roof�r'raming' 4.'�Y ��' �; �`� ;� ti�;' r73.'_Underymd:Storacje:i`ank OGas `CCtI
25. ftoof,Sheathin9 �j. ��' - � � _ � e 74��Overhead Hvdro.�` �
26. _T-8a`r Ceiti�g (5cructurall &1lvtonocoat �; �� �% �' �'�-" `° 75~Dr.y Chemicat :� `� � "`
�r. �C
X u
27.;Erame and Flashing , ,; � ;; �;, ;;� 76.� Dry Standpipe -�i^ � <`
�28. La,hing�& Siding;r.r � % �r;«'� � `� �• "� I'•�� 77,""FIXED SYSTEM�FIN�1L'h ,y �, -
"29. Insuiation `. � .� * �� � � '� x- 78:JFIRE PREV. FINAL . ' :r
�'30. Dry�vall�Nailing �� � H x � ,�^,` r HEAL7H DEPT; REQUIREMENT
r,: � .:.
_37. Plaster Broetm;Coat-�.; ' r. :• �, ` � r r79.`�FINAL INSPECTIOJ� W~l J� , I I
- -i "-i-__t
>32..Electrical'poivzr Metei��inal � �'�-�� � �� Y�80:'FOOD CERTIFIGfi.TE ISSUzED� ,
� �� : � �: , r' �. �.; ... � z, �:+ .- -y� .�e ;.i !
�-33.�FinaLElectric, rt ;; . � ' ,g. 'Notes: ., nf: .�7 _ .?�.T. �
;34.CFinatHeating&Afrr.Co,nditionin9:- `•� ~ � ' '�"�<:��i�� 'l ...J �� �
� �. � , -� le_/�/�s_ -;
35.CFinai'Gas�Pipe,-Testf,ns •• _^, �Y-J . ,.i x ty`.
_36. Hood orCa�oPY _"-< , � _ �: ,� � i �:.� .� ,�: '. � ;._ . �' �.-.: !
._ �.., • Ri �: �' ��- �:i^� I
::37. �Final;Faaory FirePlace - ���. `"� ' � � s � �! W "* ` y '.. ej --��
�38. FinaCPiumbing _ -�o� . . .. . , `t�:;. > �� :,, �, r, . � ------
I V Y' J r.5
� �39. Water $ervice; Finaly . • � �- � r ' k ?� .y � r � �t^, h� =: � -
°40. GasSzrvice-Finalp;,, r• a�.�,:• , t . ,.0 i�:� •! • �; ..
�." �
�41. Solar pomestirFina! :� i � - .. ,<C. ' ':. x -tn� .-�
L1 C'� F�1.'G �T `t � '�' :.� (T' �-i`^1 L� � .
� J '`. : �
�42. `Backfiow Prevenfer>; `�� �,j ;,� ; ' .r M �� l 6 -�C/�. � G' r-
�T ^...
_43. Backfiow Irrigetion'� �^�-, . . '�` i �` "'c r, ' ", -
u�. J C .. :< C. � r , f.
1 ' � Cr'� e+. � '�-: G: r. �.. 1 r+ ... . _.. ' . .
;,44. Landscape I�nqatron�System=:;�.� ; �; �,;:7 � - �-.., � o_ T,�, • �; �
r�r c.
:45�.'Sound Attenuatioh="�` ^�F ?" � �. r- F F•h<;. i � t -+ �... t< i.
i'> r ...�� a: E'i :Tl R;:i.:+c i-� c c .�, . i.
� 7 `- :i-['i • • ••�'n.
�;46� EHandicap,Regulatio;s� 3;{� �, � � ,; ,� p; ,- ��, ��; . �
- 47;:F,INALSTRtJCTUFE�&'�UILDING ; Z +� "i ,"o.'" '
., � .-� .' 4 �O �ci�: � ;-
Y'� � v-T x i-- --« �. "
48;:F,IMALP�ANNWGy. • � ,F, :.c: -w�; - � '-• ;
- ...
:49� :Electric Release to�Edisori� • :r: i " ••�;: �x `. � ~ ��- _
.! Y a.x.R: 'Ii �r
'i�50�.Gas,Releseto5outtiernGalifornia,GasCo * `-��`;,;F a � • p�r; , •
� -51: CERTIFICATE OF;OCCUPANCY' „ �;�,; �, {j ��n = ., � ,-
No. Date
: �� ��� _�,,,,.-. , . , . r � �
�8
. . , .
r,� ._ 3 Jr o&' L. ,. • d'JG .7 5'-72cnss001007� +�** 154.34
, �
"- COSTA`MESABUILDING-SAFETY�.DEPARTIVIENT:� � - ' � - . .. � '
_ , • 3O1'BR P�O. BOX 1200 COSTA MESA, CACIFORNIA 92626 _ ' . �� - . � � � -
� � � � �-� r 'PP ICATION�FOR BUICDING PERMIT .
.� �"� -, For Applicant fo"Fill�in Completely .. � � '
� . � - R EI BV �. DATE FECEIVED DATE ISSUED
aoo ess Dahlia Avenue �Z���z �l -
. PERM [�
owNEa ': �' Lanvin SouthemCalifornia lnc. pP'NO. ' .�i J(1
'�., � ,eUILDING , �? '
��ADDRESS ' �-'- � 255 E�f, C1.5 ' BVQ C�':�'.• ;':ADDRESS ;, . ` --�/
Z � � ��" LOT� BLOCK-
a cwi cirv '' ' Encino California �No�986-8890 raacr
z
' Z Q CONSiRUCTION . . � . . ' - ADD A P �
oN �ENOEa - L'arwin.Southem Califomia. . ,
' a m '-- 16255 Ventura Boulevard `'
J � BRANCH- � � '
' J N .� . . . � � �OWNER . � �G SuL .
'' m� aooae'ss . Eneino Califomia /J^�j- -� / VALUE. �•.
- "J a ' ARCHITECT� ` . '�TEL: - SF/lG'�� � $ �
.OR ENGINEER . . " �� + ' N . � .
N . -. �
';,Z� 'nooRess 9100 Wilshire Blvd. Bev. HIIIS ZONE .- TVP GROUP
: d W ' . . . ' • ' • ' - ,APPROVED; �� � '
�. J O � CONTFACTOR Larwin"Southern�California'� Inc.� •'eV _ � - 'N DATE � . .
'` m� r,00REss �}6255 Ventura B le a d . .I
W �y _ 20NE ' NO OF � USE OF NEW �(f F/�� V
°= arv_ -. Encino, Califomia,'No�'986-8890 P�+�..a- BVILDING� � ��
- z�� �
. � ; STATE "� ' -' . � . •CITV �.. _,�. �-: ' `' • VAROS APPROVED VAR�S APPROVED �
- N,2- CIC.NO.' �9�3�� ��LIC.NO. B�� � ' MAINBUILDING a ACCESSORVBUILDING.
'� � O - - � � . (FROM G STftEET). ,
. SIZE � .' NO.OF BLDGS.� �
OF IOT.� � 1 •� _ . NOW ON LOT. Q FRONT FT. FT. '
�, ._ . ", • _. � .-- - - . .
USE OF �' a Q
� � �EXISTING BLDG• �" "' ' ��' I" S �' J � F � FT. ' .
M1 H 'SI2E OF � � ' NO. OF . � 5 ' �. , +
Z NEW BLDG. I.9H% •� iROOMS �� STORIES 1 LSIOE � FT. • � ' FT. � �
� ' �a �EXTERIOR WALL -� • ROOF ' ' � � ' �
• V COVERING• � COVERIN` REAR ��„ FT.� . FT."
� J' USE OF BUIIDING AND WORK TO BE PERFORMEO; ' OISTANCE BET.' ' � BETt MAIN &�- �
a � '- ' � MAIN BlIX'>S. ACCESS. BLDGS..
- a
'. .Q -. . � • . � - . . VAR. � ' , DATE �
•.� .u^.- - ' C.U.P.9k - APPROV
O* . ' '• ` ' � � - " !i � I� �
' y ConstrucE� Sin le Famil Residence A�RovEo` 7� ��jZ
Z� .. . - � � - - � �
O • . r
.�V�. ' I hareby.acknowletlge'ffiat I'have-read inis applicaiion and state � HOLD �EOR SPECIAL REQUIt '1�� � �
•:_� Shat ffie aboJe information is' correc[ and agree to wmply with ,
all laws regulating 6uildin8 consttuction, antl I shall not employ . , . � '
" �
�. �any person in violaiion of the wo�kmen'S mmpensa[ion laws of � �
' . y ffie State of California. •�'.: . ,', � . + / G . ' �
� z I hereby certity ffiat.l am �properly �licenud ai a contractor untler ' ��SQ..FT. (�o � _ o �
[he State of California Business and Professions Cotle, �ivisicn 3, THE AMOUNT SHOWN"UNOER VALUATION IS FOR
' '.Chapter 9, antl that such licenses'are in full"force antl etfect, or I. THE PURPpSE OF ESTABLISHING A'PERMIT FEE ONLV: m
_ ' am exempt from the provlsionsbt the 5[ate ot Callto�nia Business � � . ¢
antl Professions Cotle;'Division 3,�Chapter 9., " . �w VALUATION
- �- �. PERMITFEE.�$ � C'
. �. 7
- Signature ot . . m
Permittee��111��.4 D."Downs $ .�/Jrj.a� �p�NCHECK$ �`�� E
��� p
. .. . Auffiorizetl Agent - � " ��% �!, LL�
TOTAL FEE $� �
- r� , ' + . . �_ _ L
� �..ti . . . ^ . , . , , . . �` . � .
� � <. . . " ' � . ' .
'` COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATTON FOR4STRUG�URAI,PERMIT-�O�OO i T�
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �
RECEIVED V PERMIT
For Applicant to Fill in Completely — Use Ink Only N� 5 Q 3 7 8'
� .BUILDING (`� p (�' _ �.,`r. : A.P.NO. ���," 3� .
ADDRESS ��I /}'l�'(,QJ m
BUILDING r
OWNER OR � Q� �f � AODRE55 �, y
TENANT �J �,L�iV�QR
VNIT OR '
MAI LI NG SPACE NO.
ADDRE55 �,� J. LOT � . BLK. ,
TEL. �
CITV � -� NO.
. NEW ' ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION ' . ' _
LENDER � '� / '
v
BRANCH I ^
OWNER `yM.A/l. I�J • M(�(� �'
ADORESS VALUE / �
-� i c� �o li'cr 2
ARCHITECT � TEL. USE v
� OR ENGINEER N . _
ADDRESS � ZONE � TVPE? '� • GROUP � M
APPROVED . o .
� CONTRACTOR O ' BV DATE — ZZ-(�
A�DRESS ��
TEI. a
CITY NO.
� STATE � CITV APPROVEDSETBACKS
LIC. NO. LIC. NO.
� � SIZE , NO.OFBLDGS. (FROMGLSTREET
0. OF LOT ' NOW ON LOT RONT F.
a USE OF
'� EXIS�ING BLDG.
y /p
FSeparate permits are required for . �, S�6E�� � T. ��� ��ei ��
� electric, plumbing and heating work�. REAR GJ / FT. ��
F USE OF BUILDING AND WORK TO BE PERFORMED P�qNNIN� ACTION
a
� � DATE
, APPROVED �
� /� � � � APP O �
r
J
CL
W
� I hereby acknowletlge Shat I have read ffiis applicetion antl state " �
y� that tha abova information is correct antl agree to comply with
0+ all laws regulating building consttuction, and 1 shall not employ '
,'� any parson in violation of �the workmads compensation laws of m
� W th¢ Stata ot California. / '
3 1 hereby cartity ffiat I am properly �licensetl as a contractor untler �� SQ. FT. I. � O' ^ rv•
7`,
the State of California Business and Profession5 Code, Division 3, THE AMOUNTSHOWN UNDER VALVATION IS FOR t�''
Chapter'9; 5ntl that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A FERMIT FEE ONLV: �
am exampt trom the Orovisions ot the State ot California B�siness �
' antl Protessions Cotle, Divisio Chapter . VALUATION PERMIT FEE 5 N
m
PLAN CHECK § ^
. Signature of � $ , � / ' � �
Pe�mittee 2, � LL
TAX $
or � �
' AuthorizedAgent Date n . TOTALPAID $ZO •
. 0 �%