The URL can be used to link to this page

Home My WebLink About201 DARTMOUTH PL - Building PermitsCITY OF COSTA MESA BUILDING DIVISION r � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT 699-01215 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 201 DARTMOUTH PL Status: ISSUED Suite: Applied: 08/04/1999 Vicinity: Issued: 08/04/1999 Parcel Nunmber: 14145508 Zoning: Applicant: WELLS, WAYNE ISSUED BY: Address: 843 W 17TH - - - -- �],'. ,Phone: 949-548-3012- .% COSTA MESA,`CA-.-/--�., Zip: 92627 i Owner: POW ELIL;-RANDY E" Address 2di,6ARTMOUT'H PL �i Av A Phone: n J COSTA MESA, CA/ - Zip: 92626 Contractor: AMESA'ROOFING I/ /Address: 843 W 17,TH �/ ,_j i/ Phone: 949-548-3012 �(�/ COSTAMESA,CA f^f� Zip; 92627 License: 564151 f f ili Arch_. e �1, Eng: ;Address: Address: ,"y;. �' -�, ;;. - - Address:, Phone: - - -; .,,, Phone: ZIP License: Zip: License: -� V - - SCOPE OF PERMIT " /REMOVE EXUST. ROCK ROOF�INSTALL%2 LAYERS OF 15LB FELT UNDER 20 YEAR COMP„ SHINGLES Plan Check- F_ti $0.00 $99.75 �SMIP-Res:,ti'\,4�, $0.50 'SMIP Com: ,A\" $0.00 \ Other. ,Inspection \ 'ti,iO.00 .��\Total: $100:25 NOTES: SETBACKS\`� MAIN STRUCTURE -Front, 0-0 _ CC m Valuation j $4,590'.00i ACCESSORY \, Front�. 0-0 PARKING Existin _ -0 NOTES: FEE SUMMARY t� CC m Valuation j $4,590'.00i -Rear- X0;0, Rear 0-0 r Required: 0 FEE SUMMARY CC m Valuation j $4,590'.00i r G / I 4NNING&ZONING ,;t., -.y, Left 0-0 �_ Right 0-6 - Left 0-0 Right - 0 -0, - Proposed: 0 ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and became 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 authorized under 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 result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 DECAARATIONS m`f WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this pennit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Carrier: Policy Number: (This sect/on need not be completed i/ the permit is valued at ne hundred dollars($100) or less.) ❑ 1 certify that Vlh�port rmance of thew k for w is this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' comped 'oflitomia, end egr the if I h uld became subject to the workers' compensation provisions of Section 3700 of the Labor Code, shall forthwith y with tov' tons./plicant SI Date�1 �— i —4� D: FAILURE T ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM IMINAL PENALTIES AND CIVIL INES UP TOONE ONE THOUSAND DOUARE ($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 here mi I nsed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the 'ne nd Professions Code, and my license is in full rce effect. Lic. tt Class a director's Si re: NSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement 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 and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions 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 that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 6, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or presgnt or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time cl ring a reported year a quantity of 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 temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this aaiplication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan o1 the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 11 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 6 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the abo e -described property for ins B tion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. tL re Of Legal Owner(s) nd/s) uthorizetl nt e CODE I. INSPECTION TYPE 2ATF. INTIMAL 5 CODE r INSPECTION TYPE PAIS INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof y-199 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-06 CITY OF COSTA MESA BUILDING DIVISION ROOF COVERING CERTIFICATION Permit No. — Property Address Zy k YA tLTtii oOQ t } Pi _ OwnerIck t]��— is . s S paw a_Z__ Contractor M &5oQ- G! .i(s 6'alo State Contractor License Number�(oqf � t Classification C 3Qi I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the manufacturer. ❑ I further certify that I am the owner of the property. (Owner -Builder permittee only). ❑ I further certify that I am: ❑ Owner of sole proprietorship company ❑ Full partner of the company ❑ Limited partner of the company Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. j?&0A-4<. a/L 3 (".-N 11 r-" STM -i 'i� Received by Building Division LSrc Gf!] By: l r /111U, Signature Initialate Aj % Printed Or Typed Na 0990.446 MW 957 White - Building Div.; Canary- Contractor; Pink - Cwner q4 r7 C� ( Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF•COSTA MESA CONSTRUCTI N PERMIT Project Address Applicant's Mailing ddr3 ,f Owner's Name ess Phone"/ Address Qr 30-, S 1 TYPE OF CONSTRUCTION D NEW LJ ADD ❑ CONVERSION ❑DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION L-siREPAIR —12 Arch/Eng. License No. TYPE OF PERMIT El GRADING--, /EPUNDATION STRUCTURAL ❑ l Address ❑ TENANT ELECTRICAL i—OLUMBING ❑ MECHANICAL Contractor's Namephon $ � ❑ OTHER Address (mailing) ^Gl�J9�"PROJECT DESCRIPTION SQ. FT. OCCUPANCY— City Licence No � 6� CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YDS. ACRES— LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in futlfAr and effect. '-cenS Ids IC2nse TEArte Signature ORK RS' OMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. S',,,�y v n �, / r� Policy No. �t��((�(��// Company Id' Certifietl copy is is f eledbwiththec furnished. yyi tpggJa i oo Date Apr licant EXEM ON FROM WORKERS' C PENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less).. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner. so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed,revoked. CONSTRUCTION LENDING AGENCY 1. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued* (Section 3097/ iv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License 7Law for the following reason (Section 7031.5 Business and Professional Code; Any city or -aunty which requires a permit to construct, alter, improve, demolish or repair structure, prior to its issuance, also requires the applicant for such permit he a signed statement that he/she is licensed pursuant to the provisions of Contractor's License Law (Chapter 9 (commencing with Section -7000) of vision 3 of the Business and Professions Cotle) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himielf/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- plethmn the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale)., ❑ I, as'owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to.an owner of property who builds or improves thereon; and who contracts for such projects with a con- tractors license pursuant to the Contractor's License Law). I am aware that proof V their Worker's Compensation insurance should be provitletl to me., ❑ I am exempt under SectionB. & P. C. for this reason Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Kitchen Sink Lavatories Roof Drains Reinspection Fee Outlets $15 Boiler Duct- Under Ground Duct -Structural Duct - Ventilating Exhaust System D Multiple Firepl/Fact. Blt. ICBG # Date OwnerHeating System & Ducting I hereby certify that I have read this application and state that the above 00100,000BTU 0100,000 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection purpos Signature Dare Reinspection Fee Drivers' License I SS CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w. Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy 'Typell ❑ Refrigeration System DO-100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee A.P. # S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: 5466 9/1.7/67 Accessory Building .5.00 ,TL Zone r Z O N I N G R E Q M T S FEES ' ELECTRICAL ,- FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑50+KW Cooking Unit Meter- ❑up to 100 amps Dishwasher - Meter Dover 100 amps ' Dryers ❑Gas ❑Electric Sub Panel , F an Motors 06-1 HP D1'/:-8 F.A.U, Inc.Solar 139-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign ' Garbage Disposal Standing Sections Generator ❑0-5 KW 115-15 KW Trash Compactor $ 3 Reinspection Fee $151 Issue Fee ! $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By Date Building Approved ByDate Application Issued By ,/�, - Da to ' BUILDING PERMIT PLAN CHECK PLUMBING PLAN -CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $. $ $ $ $ OF FEES SMIP . $ PERMIT ' ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM_ $ p _ TOTAL FEE $ C7 = $ 3 CONSTRUCTION AND�PLANNING APPROVALS Permit-# Date Inspector POOL & SPA - APPROVALS Permit Date- Inspector irTemporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4'. Electrical Conduit-Undrgrnd. - 55.- Electrical Bonding t,b 5. Steel Reinforcement56. Rough Plumbing & Pressure Test - 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNYTE 7. Footings rn 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, El Undrgrnd., Test;,j 9. Water PipqUndrgrnd`_, 60. Backwash Lines,,P-Trap, 0 Vnd rgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final = ' 12. Sewer Cap 63. Heater & Vent -Final 13. - Roof Drains 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring - - 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING ' 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ' 20. Rough Factory Fireplace" 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping LIGas El Oil _ 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank C'Gas Coil 25. Roof Sheathing j 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Mohocoat 75. Dry Chemical, 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. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric - Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing j 39. Water Service -Final. I -. 40. Gas Service -Final I ., 41. Solar Domestic -Final .42. Backflow Preventer ,.43. Backflow Irrigation I � 44. Landscape Irrigation System 45. Sound Attenuation •� ,' 46. Handicap Regulations' - - - 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed - 49. Electric Release to Edison - 50. Gas.Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY - No. Date - - I PROJECT ADDRESS: 201 DARTMOUTH PL 1 /_ O UNIT: OWNER'S NAME: POWELL, RANDY E /l7 ADDRESS: POWELL CATHER1,NE. J_ 201 DARTMOUTH L" COSTA MESA,CA 92626 ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: NOCK PLUMBING (714)895-1246 ADDRESS: 11610 SEABOARD CIR STANTON CA 90680 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod;rand m license is in full force and effect. CITYLIC.: 05 6 ST TE1511971�� class: C-36� Date: Signature' WO S' CO PE (SATION 0 LARATIOW I hereby affirm that I have a certificate of consent to self insure oratlitic to of Workers' _Compensation Ify1�yiipcce. t ce(Iifiep,c py thereof (Section 3800. Lab.f� POLICY NO.: lib /7�[-7� EXP. DATE: V3/O1/9S COMPANY: STATE ,vA� //❑ Combed copy -`her/e/p'y lit fished. L•T Certified COPY is d wit the city Building Oi 'son / p G L Applica/H 1 — /EXEMPTI N OM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred (5110) or less). I ce that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become su fact Io the WorkersCompensation Laws of California. Date' Signature: NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must fonhwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction leading agency for the performance of the work for which this permit is issued (Section 3097. Civ. CI. LENDER: ADDRESS: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 066706 PERMIT NO: P 066706 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION : INSTALL WATER HEATER SQ FT: CLAIM VALUE. CALC—VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT iE iE iP it * iE aE * * iE 1f ie aE it iR 1E 1F * iE lE it 1F iF of 1E iP iF iE iE 9E iE iE iE iE ie iE iE iE aE 9E IF iE i! iE+E * iE 9E rt if iE if iE iE aF iE iF iE at iE iP if * * if 9t 9E it 9E 6E 1E iE * it k iE * iE iE Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN —L—EFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN. PARKING REQ: PROV: PARCEL: 14145508 ZNE: REF NO. PLANNING NOTES> TOTALS----> 7.00 20.00 0.00 27.00 27.00 offered for sale (Sections State License is Business and Professional Code : The Cork structure is not to > .00 or him elf does not apply to an owner al a properly who builds pr improves thereon, and who does such work himself/herself or through an owner lE 1E IH 1E if if iE lE*iE iE 1E iE 1E iE iE 10*iEkit iE lE iE iE 1E**iE**iE*7E iE lFitiE Bt iE iE**aE 1E iE*k7E ik lE iH**iE iHi!***iH if iE iE It 4E iE iH 9E it fElE it iE 1E �E 1F ae iH D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: l DATE: 1f 101E 4f Jf 1f 1E 9f it+t*+P �E it*fE�E �E x�E kE*iF FtTE'iF'i�if3F3F �E �E��F'iFfE xfE�E �E x*x�E x iE iF iEiE iE JE 9E JE 9E iE 1E ik JE iF 4F iE iF iE iE iE 9E fE 1E iF if4fEkiE 1E*it*iE 1E 1E JE 1E ie 1E4iH iflH fE iE 10 MiE iE iE aN ie iH iE lE iH*iH 1H aE iE 9E iEM*1E fE iH JE 1E iE iF iE iE ie iE iE LEGALIZATION:N F E E SU M_M-A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P /RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve. demolish, or PERMIT 7 .00 repair any structure. prior to its issuance. also requires the applicant for Such permit to file a signed statement that he/she is licensed 25% SM I P / NON—RES pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business PLAN and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by five hundred ISSUE FEE 20 any applicant for a permit subjects the applicant to a civil penalty of not more than dollars ($5001. BUILDING—DIV—> PERMIT .00 ISSUE PLAN—CHECK TOTAL PAID DUE I, as owner of the progeny or employees with wages as their sole compensation, will do the work, and the ❑ Law TOTALS----> 7.00 20.00 0.00 27.00 27.00 offered for sale (Sections State License is Business and Professional Code : The Cork structure is not to .00 or him elf does not apply to an owner al a properly who builds pr improves thereon, and who does such work himself/herself or through an owner his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: 00 improvementl within one year of completion. the owner will have the burden of proving he/she did not build or improve forthepose o epurisale BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ •— y and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractions) license pursuant to the Contractors' State License Law). l am aware iE it iE itfEit iE*iE*iE it lE iE iE . 1E iE 1E if 7E 1l1E 1E iE iE IE iE iE iE iE JE iEfEiE if iE iE iE iE iF iE iH iFk it iE iF iE 4E iE iH iE iE iE iE{EfF{EiE{F{ElE1E{E 1E if {E lE �k1F f(. i!{E fE iE iE iF iF iE that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L 'F'E E B R E A K D O W N ❑ I am exempt under Section: B. 8 P. C. 1) for this reason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST Dale: _ Owner I do hereby cenity that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I ar any future building occupant wilvivin not (circle one) need to comply with said state Codes and the requirements lar a permit for construction or modification from the Air Quality Management District Residential construction applications are exempt from these provisions. Date: I hereby certify that I ordinances and state property for inspech or Applicant _ read this application and state that the above information is correct. I agree to comply with all city and county gating to building construction and herebb honae repress nta^tives\of this city to enter upon the above mentioned pose II]] Signature: / Security a: 164146 Whae—Bmldmg: Green—Cotle Enforcement; PLU 1 WATER HEATER AND/OR VENT 7.00 7.00 END -.OF FEES 01 00153481-00158481 TOT 27.00 DATE: 04/05/94 TIME: 09:08 CONSTRUCTION AND PLANNING PL,,. � & SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location y_ 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement t 3._ElectricalCond6iI'Utility-Uncirgrnd-.'` 54. Forms 4.'Electrical CondutL-Gndrgrnd. 55. Electrical Bonding ' S'. Ste Reinforce`Pn44 56, Rough Plumbing & Pressure Test - �' B. ETeytrical UFER;55,rid. _, 57. APPROVAL TO COVER-GUNITE - _ 77F06ti ngs _ -' 58. Electrical Conduit-Undrgrnd. -' -,: foundation 59. Gas Pipe, 0 Undrgrnd., Test ,- 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. •- 10. i;tructural Floor System ;� 61. APPROVAL TO DECK 11, Property Sewer Liqe & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap -� u 63. Heater & Vent-Final I , 13. Roof Drains - I 64, Plumbing System - Final 14. Rough Plumbing- 65. Electrical-Final 15. Rough Electrical-Conduit 66, Solar System-Final 16. Rough ElectricWiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING I 1B. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVAIS'_�C'Petnlit # - 20. Roggh Foctoiy`flt Place i;; - = r 21,'pucts, ipiStructure; ..'„ -+ -170. Underrgrou : Hti�dro r; 22. Dins, VPntitating X71. Produci Piping 0!CF�s 00il 23'•GZ` ipeflough &'test�72. Underground Flusht 24.-Roof Framing T Y S73yUndergrn�,.Storage tank ElGas 0Oit 25. Ro -f ShEathin9 o f _ 74 j0verhead Hydro-, '- z; . f 26.�T-Bar Ceiling (Strnotural) &-jytonocoat-r !T 1t ^'Y 75'�Dry Chemical- r .J 27.-Frame and Flashin _ f Y 76: Dry Stand¢ipe Joy: M ''1 `•-' �T,' 28.`-Latjing,& Siding`- ::.t "i t 77"FIXED S_YffER}FINAL' ~ 29. Insula ii'on " s 781=FIRE PREV. FINA�J.. Q :30. Drywall Nailing -�� _ f i �. - _ ^HEALTH,DEPT=REQUIREMENT ' 31. Plaster Brown Coag INAL'If3_jP-€CTIC7N � ._ , 1-1,t,. t.r79.1 32- Electricat'PoLver 1 ee`W;Final' -, �_ -80..*FOOD CERTIFIOATE ISSUED . . r 33. Final Ele'_Ftric - y' ! TNotes:''', ��• 71 = _J„ 34. Find Hea"ting;& Air:Conditioning x ' / 35. Final Gas'Pi pe-Tests r,�%' ^.F i, M. ' • 36. Hooa or Canopy' > U ` �•-- . (`, j ' - .L r -� 37. Finar Factory Fireplace_ 38. Final Plumbing 39. Water Service-Final- ervice-Final40. 40.Gas Service-Final - ' ' .41. Solar Domestic-Final `: r C• 1 iF c G; c. _ ♦. i 1 rr n Y :*' 7 ,fir 42. Backflow Preventers J Di• ,_ 7 re v 43. Backflow Irrigation, _44. Landscape IZ 7r rrigation System-,-,�,,- �• - .,.� .: ❑; n5 ;,-� `45.'Sound Atterivatior - 17 46. HandicaP�Regulations a r* f J z 47.•:FINAL STR&CTURE & BUYLDINGr_. 48. PLANNING` i .i .FIN'AL 49. Electric Release to Edison - i 50. Gas _f elease to Sou!j ern California Gas Co 51. CERTIFICATE OF''OCCUPANCY No. Date 781:1 COSTA MESA BUILDING DEPARTMENT P. O. BOX 317 , COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BUILDING AnnRFSS 7!1'1 T1ewFmmTf_h Plano EEE RECEIVED FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY RECEIPT _SLOWNER Yale Properies of MAIL RECEIVED BY //DATE RECEIVE`De Tel DA(T�E I$ U D 19 a ADDRESS S C� "�J oC TEL. CITY Costa C f NO. 8-11 BUILDING ADDRESS n nn�� ARCHITECT Carlecn OE LIC. OR ENGINEER NO, COSTA MESA, CALIFORNIA FIRE ADDRESS r.Arei}}.�AllNN ZONE yjl:EQ ,�GGITV LIC. ZONE % NO, TYPE CONTRACTOR a jnp NO. \ r1 ADDRESS E 17th St NOL: Tai. 0••11 'APPROVED � �- BY DATE CORRECTIONS DEGAL ERCRIPTION Nor . A.P. NO. SIZE 85 103 NO. OF BLOS. OF LOT O x NOWN LOiGnone O USE OF EXISTING BLDG. SETBACK LINE FROM 1 1 CENTER OF STREET REAR YARD 29 51 12.711 SIDE YARD RIGHT LEFT DESCRIPTION OF WORK Ix NEW ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING, NO.OF SIZE ROOMS 6 STORIES 1 EXTERIOR WALL ROOF n COVERING COVERING Cc USE OF NEW o BUILDING Single family residence with attached garage. Plan 750B I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STAT ASN$ REGULATING BUILDING CONSTRUC, VALUATION TION. C [f PERMIT FEE $ 30.00 SIGNATURE OF PERMITTEE PLAN CHECK $19.00 $ 16,168.00 AUTHORIZED AGENT Dike cit Colegrove, Inc. TOTAL FEE $ 7.00 VBM! OWNER YALE PROPERTIES DATE- 10-17-58 _ JOB ADDRESS 201 Dartmouth Place BUILDING PERMIT NO. 7811 GENERAL CONTRACTOR Dike 8. Coleerove VALUE $ 16,168.00 AP, No. LOT 14 TRACT 2955 FIRE ZONE DESCRIPTION OF WORK Sin. Rac_ & Gnr GROUP I & J TYPE v ZONE R1 PLAN NO. coat Final Gas Test 11 DATE I SUBCONTRACTOR 9921 'LE kLUNEU �FOSTA MESA BUILDING -SAFETY DEPARTMENT 17"59 UT FINANCE DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPL/CANT TO f/ll /N COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT - BUILDING BUILDING ADDRESS {J te• COSTA MESA, CALIFORNIA fOR Off/CGr I/s4r Ui y RECEIPT NO. I -PEfiMI�O. OWNER S. 1VV..11 A`VVJI ��YLpq MAIL y` RELBY GATE RECE VED GATE ISSUED ADDRESS I% a I -�` ,-�,� T BUILDING CITY •i ADDRESS ARCHITECT LI COSTA MESA, CALIFORNIA OR ENGINEER NO. ADDRESS FIRE ZONE TYPE GROUP % STATE 7 APPROVED CONTRACTO qq/ - LLIICC. NO. BY DATE V ADDRESS ` ^ ZONING LEGAL LOT , UP ZONE I NO. OF I USE OF NEW DESCRIPTION IND. i I.SLOCK IT!tT PLnrv6 BUI LDING NL•� APPROVE A.P. NO. BY DATE i SIZE NO. OF BLDGS. YARDS EVES OF LOT NOW ON LOT-- REQUIRED ALLOWED USE OF (CENTER LINE ST.) EXISTING BLDG. • FRONT FT. IN. SETBACK LINE FROM CENTER OF STREET REAR YARD R. SIDE FT. IN. SIDE YARD ILEFT (RIGHT L. SIDE FT. IN. DESCRIPTION OF WORK 1 REAR FT. IN. NEW ALTERATION I ADDITION REPAIR I MOVING I I DEMOLISH BUILDING NO.OF - SIZE ROOMS STORIES - EXTERIOR WALL (ROOF COVERING COVERING USE / A D WOF BUILDING K TO BE PERFORMD i3ORi�E a. •1/ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE THEPAMOUNT SHOWNUNDER VALUATION IS FOR THE OSE OF ESTABLISHING A 'PERMIT FEE ONLY. .PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING FUR BUILDING CONSTRUCTION. VALUATION SIGNATURE OF PERMIT FEE $ PERMITTEE24 ACA* .�L®��,/} � a • 1 ° - _ $ PLAN CHECK $ AUTNORI2ED�AfG''NT�V•+•:MQo-y^/ TOTAL FEE $ �. OWNER PERCY, MR. & MRS. R. S. DATE 7-17-59 _ JOB ADDRESS 201 Dartmouth Place BUILDING PERMIT NO. 9921 GENERAL CONTRACTOR E. W. Entsminger VALUE $ 162.00 _ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK block wall INSPECTIONS DATE I GROUP TYPE ZONE R Underground Soil U.G. Water SUBCONTRACTOR PERMITS ISSUED Underground Gas — DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches Forms Steel Floor System Steel Reinforce Chimney Re -Rod Bond Beam Sheathing Frazee and Flashing _ Lathing, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, inal Building, Final >� r,S OCCUPANCY - Form 210-3M-4-59 I' 9921 ..r Jl.Fi�JO COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 3I7 COSTA MESA. CALIFORNIA For Applicanf to Fill In Complefely TYPE OR PRINT BUILDING ADDRESS I O COSTA MESA. CALIFORNIA FEE RECEIVED 0,,(9-I966 Old APPLF WIERMIT CITY iffilibiTA(FESA For Office Use Only v RECEIPT NO. PERMIT NO. OWNER- J`+ •:_ J MAILeY SATE ECEppo OA 18 UE ADDRESS % - -be) t ��-' CITY COSTA NO. j - 2 BUILDING e D ADDRESS ORCHITECTENGI EER EL -F k LIIT#k U'L-I� •) COSTA MESA. CALIFORNIA 1 d• I4 FAI P—A I a a FIRE ADDRESS ZONE TYPE GROUP 49 CONTRACTOR m ��%'N F APPROVED w a PATE D SAAR ZONING ADDRESS ' �-• CITY f NO. OF ^ I PLANA / USE OF NE BUILDING I. / STATE TEL. / LIC. NO. NO. 1 LEGAL //�� OE.CRIPTION LV IT y II SIZE V/ NO. OF BLDGB. _ OF LOT .o. g MOWS Lor q p NO USE OF -YARDS EVES EXISTING BLDG APPROVED LOWED SETBACK LINE FROM '+ (CENTER LINE STJ CENTER or STREET REAR YARD FRONT IN. I I ' SIDE YARD LEFT i RIGHT R. SIDE R FT."— IN. DESCRIPTION OF WORK L. SIDE FT. IN. 113 NEW ALTERATION I ADDITION I REAR FT. IN. REPAIR I II MOVING I I DEMOLISH APPROVED / DATE -� - BUILDING NO. OF SIZE-' ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED Fir'i t a ow"I vQt-,LV .F i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING 6r) BUILDING CONSTRUCTOVALUATION SIGNATURE OF ,G� PERMIT FEE S PERMITTED- p tom" PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE v PERCY, R.S. AUG 1 0 1961 DATE 10-6-60 BUILDING PERMIT NO. AP. No. 1-0-4c4–Uo LOT TRACT FIRE ZONE DESCRIPTION OF WORK r-ouna.r or eut. INSPECTIONS DATE I GROUP I TYPE V ZONE Arbor Underground Soil U.G. Water SUBCONTRACTOR PERMITS ISSUED Underground Gas -__ DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures - Final Gas Test Construction Pole Underground Power Rough Wiring Trenches Forms Steel O Floor System Steel Reinforce Chimney Re -Rod Bond Beam Sheathing Frazee and Flashing Lathing, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final Building, Final OCCUPANCY 161— Form 21e -5M-11-59 5-B P 12958 4 CrOStA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 817 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDING ADDRESS COSTA MESA. CALIFORNIA FEE RECEIVED iYOV30IWO ote,,,, FINANCE DEPT. APPLIC&;TIOF,J FFQ8S?ARNflTA BUILDING For Office Use Only 0 RECEIPT NO. ,q M-11+ 0 OWNER y .� ,-� \ 1�ATE MAIL ��77 ��)) `7 RECEIVED BY DATE RECENEO 188UE0 ADDRESS��-L� y/ "/'>7 OkfL7 ii /,�y/,// �j''r CITY a Res � NO. � //� ADDRESS ARCHITECT TEL. COSTA MESA, CALIFORNIA OR ENGINEER NO. ADDRESS FIRE ZONE TYPE GROUP CONTRACTOR `PJC if . Cel • APPROVED BY DATE ADDRESS k Q S! ZONING I / CITY - n / ZONE ani NO. OF PLANS ?/' USE OF NEW B[U�ILDING STATE h/ G / NO: -C, a LIC. NO. / / �! / y� DELE SCRIPTION LE% q, p, NO. SIZE/ NO. OF —5., OF LOT \l NOW oN LOT USE OF YARDS EVES EXISTING BLDG. L{%L APPROVED ALLOWED SETBACK LINE FROM CENTER OF STREET REAR YARD /CENTER LINE ST.) FRONT No FT. A10 IN. SIDE YARD I LEFT eA- ,•NC I RIGHT -' R. SIDE FT. IN. DESCRIPTION OF WORK L. SIDE FT. IN. NEW I��III II ALTERATION( ('ADDITION REAR FT.IN. REPAIR I I MOVING I DEMOLISH APPROVE DATE ti BUILDING NO. OF fOa- SIZE ROOMS STORIES F� EXTERIOR WALL (ROOF COVERING COVERING USE OF BUILDINGND O K T BEP R 1AED O 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS BEOULATING VALUATION BUILDING CONSTRUCTION. SIGNATURE OF _PERMIT FEE S PLAN CHECK S PERMITTE iLCgLi( s 1��L �U AUTHORIZED AGENTI ( TOTAL FEE 0 OWNER PERCY, ROBERT DATE 12-1-60 JOB ADDRESS 201 Darmouth P1. BUILDING PERMIT NO. 13340 GENERAL CONTRACTOR Superior Fence CO. VALUE $%00.00 INSPECTIONS I DATE SUBCONTRACTOR I PERMITS ISSUED OCCUPANCY Form 210-5M-11.59 S -B P HOLD FOR SPECIAL REQUIREMENTS 13 33►65 / COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Z a U Z ZQ O t~n am J 7 J to Q W m J J m _ Q U < Z M W Ly aW W Z' JO M J W W Z_N W O �O H z Q U_ J CL a Q O H N Z O F U cc N z 0415-71%5000 575 -VADDRPF ICATION FOR BUILDING PERMIT For Applicant to Fill in Completely AECDA E R CEIVED V DA k/'ADDRESSuG 71 BUILDING �1 _ d Y 0 L1/4 //PERMOWNER '7 /MAIL U �/� .p �+ SC ADDRESS Cp. /f % ` JTEL.CT JBLOCKK LOT/ CITY 7�C _ NO. D A PDEMOLISHLENDERBRANCHADDRESS CONSTRUCTION VALUEARCHITECT TEL.$ OR ENGINEERADDRESS TYPE -!— GROUP CONTRACTOR �t' f O O V d APPROVED ^l /� BY // :1 DATE �v ADDRESS C?,*3 TEL. ZOII��llLE7) / NO. OF USE OF NEW CITY.r V a (' /G PLANS .�/ BUILDING - CITY STATE,.�� YARDS APPROVED YARDS APPROVED `� LIC. NO. G LIC. NO. MAIN BUILDING ACCESSORY BUILDIN IF ROM C/L STREET) "SIZE NO. OF BLDGS. OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE F SIZE OF NO. OF NEW BLDG. ROOMS STORIES L. SIDE FT. FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. � ACCESS. BLOCS. p (] CAR C.U.P. P.# DATE APPROVED " APPROVED By — /6� DATE I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ - any person in violation of the workman's compensation laws of ' the State of California. 1 hereby certify that I am properly licensed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. •1 PERMIT FEE $ —_ Signature of Permittees $ / PLAN CHECK $ Authorized Agent TOTAL FEE $ OWNER DATE JOB ADDRESS 201 Dartmouth Place BUILDING PERMIT N0. 33165 GENERAL CONTRACTOR Jack's Roof Shop DESCRIPTION of WORK Reroo£ Residence LOT TRACT FIRE ZONE VALUE$ 743.00 INSPECTION$ Signature Date GROUP I TYPE/ V ZONE SOIL SUBCONTRACTOR PERMITS ISS ED GAS — Date Number Si nature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER 7] ROUGH WIRING Heating and Vent. TRENCHES ❑ FORMS E:] STEEL REINF. Ej FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT PLASTER, BROWN COAT STRUCTURAL, FINAL Elect,ic_ HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL RimnINr FIN&,