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HomeMy WebLinkAbout1124 DANIELLE DR - Building PermitsCITY OF COSTA MESA q pMFq BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 www.ci.costa-mesa.ca.us ' f � FOR INSPECTIONS CALL: (714) 754-5626 ♦t"400.rn♦N' PERMIT NUMBER: B09-00225 PERMIT TYPE B ROOF2 STATUS: ISSUED APN: 41207426 DATE ISSUED: 10/r/13/20p9 ISSUED BY: JOB ADDRESS: 1124 DANIELLE DR CM Suite/Unit: Vicinity: Squares: 3000 Valuation: $12,000.00 SCOPE OF WORK: TEAR OFF SHAKE ROOF. RE -SHEATH ROOF, COVER WITH 2 LAYERS OF 40 LB FELT. COVER WITH MONIER SAXONY TILE- 7.2 PSF. ROOF PITCH IS 7:12 PER ENGINEER REPORT. INCLUDES ATTACHED GARAGE. NOTE: INSPECTOR TO FIELD VERIFY ROOFING MATERIAL AND FRAMING PER ENGINEER'S REPORT. OWNER: GAUNTT, BETTY JANE Address: 1124 DANIELLE DR Unit: PHONE: 714-549-2882 - City/State/Zip: COSTA MESA, CA APPLICANT: HOYT, BRIAN Address: 1809 N ORANGETHORPE PARK ~..Unit;/ PHONE: 714-773-1820 City/State/Zip: ANAHEIM, CA '"r �-M) � 2 J 5 CONTRACTOR: HOYT ROOFS - - License No. 606111 Address: 1809 N ORANGETHORPE PARKUnit: PHONE: 714-773-1820 City/State/Zip: ANAHEIM, CA 92801 CELL: ARCHITECT: License No. PHONE: ENGINEER: DARY ENGINEERING License No.C56259 PHONE:626-330-2611 FEE SUMMARY Reroof Plan Check: $136.01 Reroof Permit Fee: $209.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTALFEES $346.26 .. .. knit: r�: &2 3 'A'rl 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) ;. P6;1 EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must 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. CODE 0. INSPECTION TYPE DATE INMALS CODEC INSPECTION TYPE DATE,`,, P,t IN PALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 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 WORKERS' COMPENSATION DECLARATION: 1 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 rformance of the work for which this permit is issued. have and will maintain workers' compensation insurance, as required by ion 3700 of the Labor Code, for the performance of the work for which this permit is issued. My rkers' tom ensation Ins ante carrier and policy number are: Can` (This sedan need not be mmple(ed dfhe ermR rs valued of one hundred dollars (S ) or less.) or.y,Nurn _�.LD�� �� ��4 OZ ❑ 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these �provi sons AppiDa. tecanfs5i namre��- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS 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 Code, and my license is in full force and effect. "`[Ic=N�' (`,�(n (o Cla"ss.!!3 3 CONSTRUCTION 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). Lender's Name: Lender's Address: 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 contractors) license pursuant to the Contractors License Laws.). ❑ lam exempt under sec. Business and Professions Code for this reason: 3057-06 (3107) Owner ID verified by drivers 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: ❑ I 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. 3.2, Grp 2. Art 2, Sec. 341, Title 8, 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. Applicant's Signature Dale Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present 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 fled with the Costa Mesa Fire Department by every business which has at any one time during 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 California 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 application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ 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 part of 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. if 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 8. (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 slate 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 above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature of Legal 0 er(s) Dat �AirdldiAiilfanzeEApyic2nt� a Dar r 2Y OF COSTA MESA REQUEST FOR C jPANCY TRACT NO. DATE `,U k-(3�, LCT N0. dl d ADDRESS The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he -she -they) Sd'A (was or were) u,)-af3 advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. RECEIVED `AUG 2 01980 BY Ar'zz.r °Hc"'e'� ADDRESSOFSMLUING: 1124 DANIELLE DR UNIT: OWNER•SNANENRalatt1:BETTY BAUNTT Arfonss1124 DANIELLE DR / C.M 92626 2� UK. NAILING ADDRESS: ARCHITECT OR ENGINEER: UC. NO.: AROC OR FNG's ADDREW: UHT: coNTRACTows NANE:NOCK PLUMBING (714)895-1246 COVIACTORSIAlln+G11610 SEABOARD CIR ADDREMSTANTON CA u,.w.: 707775 90680 UNIT: LICENSED COMPACTORS DECLARATION: I hereby affirm under penaby d perjury that I am er erw licensed undue d m Chapter e (mmmercinp wth Section 7000) of Division 3 of the Business and Professional Code, and my Closures is in lull forte snd elled. C"LIC.No.U50286_/uc.cLAss:C-36 uc_"n77077,7y EXP: 02/97 diffjltR BUILDER DECLARATION: I hereby alum under penalty of perjury that I sm emmpt from the Cminsoore License Lew ler IM ldbws, reason (Sedion 70315 Russians and Prdesekam Code: Any city or marry which requires a permit to construct, aper, humans, bmolfrh, or repair my stluotme, prior to ps issuar sue, afro requires the applicant for such peers to file a dOrwd aletement Ind M or she I i Kneed Wmumt to the provisions of the Cmtradors Liorme Law 101apler B (MmmencinD with Section 7001 of DNblm 3 of the diseases end Plefessione Codel or that he or she u exempt therelrom and the beau la the dlened exemption. My violation of Sedion \7001.5 by sly applicant fa a permit svbpda the appliced to a dvil penalty of nal more than flare hundred dollars 155001). ❑ I, ss owner of the Pmeny or my employees wish wepes as their sole compensalim, will do the work, and the drudurs u net intendnd wa aredforsale(Section7016,Busne erd Prdessdns Code: The Contractors_kwaa Lawdoss not apply loan owner of Property whe hullo a inprwea thereon, and who does such work Inhered or herself or through his or her own emplotees, pleaded this such imprwemame are ml intended or dlaed fa sahe. lf, nowawr, the Widirq or inprworneM a add within one year d comple ion, the owner.buider unit have the Wden of pamdn8 he or she dal nor bull or implore for the purpose dada). ❑ I, se owner of the propei are exduviaely mmtradkH with licensed mnlraoms to construct the proled (Section 7014, Business and Prolmicm Code: The Caaradors Lineae Law does not apply to an owner d property who buds or imprwaa Insulter, "who contras, for wdr plasma vdh a coruredor(a) Icemed pursuant to the Contractors Lt.. law). ❑ 1 ern a emat under Section: B. E P.C., lar this reeson I do hereby cenily that 1 ern aware of end undemand the n to norm nta of California M h and Sday, Code Semimn 25505. 25533, and 25530, and thal I or any future WIMkq serpent will / wN not (drtfr me) need to campy with said dale cads end the req Armes Ns for e mrmutnmrsmreimwmodifmionhanlMAi ueh%nmemely Cutdq.Ratidmtial oondrWbnwdretbnsars azamq fmmlMea Dale: Applicant: WORKER'S CONPENSAnON DECLARATION: I hereby affvm under penally, of per'lury ens at the taken, declarations: ❑ I hove and coil mdntahi a cartiiats of consent to senins ma lar worker' comnenadion, as provided for by Sadism 3700 of the Labor Cade, for the parfmasm s of the orad for wrich this Poland is issued. X❑ I neve and wit ma men workers' parepareafnn nemeses, as requbed by Sed m 3700 of the labor Code, for the perfameem of the work fa whiclh this Ramp asd. My w aP.pampa, e: Carrier. rEXPIRES Policy Numbs: 09/01/97 (This section ,reed nor oe comphafed l ds psrml is far are hundred dd/en ($1001 or hens) ❑ 1 pertly that in the pMama rte d the work fat wfiich Ihie nemp fr i n. sheep rot empJpy any panda in my mmner eo m to become subject to the werksut iepensatin laws d Caklanie end eilee Ins i I Hp� become aubpa to the waken' mpanealen pro " rw d sed 00 d the labor Code. I Imhr ropy wish Moya ewisio de: Applicant Itp: Fenu W spun wpIf "' pompann saffem oaesGa he unheeird, and still saddled an an employer fa edntlml Pedant eldl fines W no elle hundrW tlloussd dellen ($104=A M sdditen so Me cost of conpedi damages as psor/dsd for In Secffm 3706 01 Me labor Cods, In(susat, and adomeys /cos. CONSTRUCTION LENDING AGENCY: I hereby affirm ands penally of perjury Ins then is e condrwicn ,Ming agency for the padorw. of the work for whim the speak in; owed (Section 3087. Civ. C). LENDER'S NAME: LENDER'S ADDRESS: I candy that I haae read Nu application and data Ind he aboae Mammalian is correct. I allies to comity wdh all any and county ordirwvs end slate laws retailing to Wilk, construction and hereby autMriae repre9enlallVn of this any to enter upon the above menl'annd property Dale: (5151<6.WP) Wh4s_8rddiq$ Safety:Green-Fd:Cenery-Appkrad:Pink-iewnue: 0oldmnd-Aaaav CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 080912 PERMIT NO: P 080912 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH SOB DESCRIPTION ; C/O DISHWASHER SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT *iE 1E*dE dF*dE dE**3E iE****dE it it SE iE dE**iE dE iE**IE iE*it iE*dE 1E 4E 4E 3E iE IE dE iE iF iE iE iF iF iE**iF iE iE+E iF iE iE iEiE*iE iE fEiE i(�**iF �E lE �E �E***lE Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING R PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> > * 1F 3E 4E 1E iE i(- iE iE iE iE if irk lF alk iE iE iE if iE irk iE iE 1E dE alk in iE if iE ih nth dE dE iE 4 iE iE dE iE N-* * 4F iE N-iF iE iE SE iE 3E ii in irk it dl IE dE * * * iE * iE iE dE IE N-iE iE * iE �(- If K-dE iE dE 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: DATE:q deiEdf-**irkiEiEiESEiEiEiEiEiF*iEiEindninN-7F�iF1 iP1EiE3EiElEifdEiEit � Z . * 6 LEGALIZATION:N F E E S M M A R Y STRUCTURAL S GMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 8.75 PLAN 258 SMIP/NON—RES ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30,75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30.75 I N D I V I D U A 1 F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 DISHWASHER 8.75 8.75 END OF FEES 01 00221484-00221484 T 0 T 313.75 DATE: 12/24/95 TREE: 09:50 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POO SPA APPROVALS Permit # Date Inspector 1. Temporary 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 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe,Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 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 O Gas C Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 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 r-- 33. Final Electric Nates: 2'Zi 'sl`I 17o 1Yef 34. Final Heating & Air Conditioning 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49, Electric Release to Edison 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date a' 17 ©° i COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ILDING ()DRESS //;;j/f)^V«ir 11 i{ -i vya-i OWNER ..cob uc v c.LUV1=itb Cor -n. MAIL ADDRESS 508ADDRESS508 29th Street P (� CITYNewport Beach, Ca. NOLb75-491( CONSTRUCTION LENDER IFI' ,� LLE pa r� /[ TRACT 7866 BRANCH BLOCK .7 ADDRESS the State of California. 1 84 m ARCHITECT OR ENGINEER Frank Sna1'IF� TE NO 7 _00e ADDRESS 224.0 NPwr nr I" iii \rri CONTRACTOR oWn,,.r .� ADDRESS OWNERper CITY VALUs4S 200 TEL. NO. STATE LIC. NO. CITY LIC. NO. SIZE OF LOT U NO. OF BLDGS. NOW ON LOT iov i 0-7700 SA00 532;* ****95.37 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY7 DATE RECEIVED DATE ISSUED I hereby acknowledge that I have reeds appllca n and state P (� . . NO. Lir, I'' that the above Information Is correct d agree to comply with �j' BUILDING ADDRESS IFI' ,� LLE pa r� /[ TRACT 7866 LOT 48 BLOCK .7 A the State of California. 1 84 m 1 hereby certify that I am properly licensed as a contractor under SQ.FT. N the State of California Business and Professions Code, Division 3,T SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect, or I OF ESTABLISHING A PERMtT FEE ONLY: am exempt from the provisions of the State of California Business ]_e West Dev�ro Tent OWNERper Res. Atd. Gar. VALUs4S 200 FIRE ZONE A:zTGROUP APPROVED gV DATE Z E NO. OF USE OF W PLANS BUILDIN YARDS APPROVED YARDS APP OVED 6 Separate permits are required for fDISTAN electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMEDConstruct single family 3 -bed- DATE APPROVED I hereby acknowledge that I have reeds appllca n and state n that the above Information Is correct d agree to comply with all laws regulating building construction, and I shell not employ OLD] EPEC' f� AL R,EVq�Ii�ElsgEf�IT i any parson in violation of the workmen's compensation laws of .7 ` the State of California. 1 84 m 1 hereby certify that I am properly licensed as a contractor under SQ.FT. N the State of California Business and Professions Code, Division 3,T SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect, or I OF ESTABLISHING A PERMtT FEE ONLY: am exempt from the provisions of the State of California Business e PERMIT FEE y N end Professions Code, D1 1 1010 3, Chapter 9. Signature of /�/ .0 y� PLAN CHECK S 92.00Permittee /`ti-iiAA«I� S //A//%�/� TAX $ 3 U Authorized Agent ��Kc�GLu TOTAL PAID E Z 3 PDD COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS /(N Olt OWNER MAIL ADDRESS CITY TEL. NO. CONSTRUCTION LENDER REAR FT. BRANCH USE OF BUILDING AND WORK TO BE PERFORMED ADDRESS BET. MAIN & ACCESS BLOCS. ARCHITECT OR ENGINEER TEL. ADDRESS m v N CONTRACTOfld�Z ' ADDRESS u• s • u,• �. CITY TEL. NO. STATE LIC. NO. CITY LIC. NO. SIZE OF LOT NO. OF BL DGS NOW ON LOT USE OF LIN -9-771,--�"00 479 APPLICATION FOR STRUCTURAL PERMIT FIRE V ' ZONE IND. OF I USE OF NEW PLANS BUILDING ' YARDS APPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING (FROM CIL STREET) Separate permits are required for electric, plumbing and heating work. L SIDE FT. V REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED BUILDING BET. MAIN & ACCESS BLOCS. VAR.# C.U.P. 9#6 DATE APPROVED m v N • • Ilslrr♦a� m PLAN CHECK S u• s • u,• �. ^ I o LL f TAX E FIRE V ' ZONE IND. OF I USE OF NEW PLANS BUILDING ' YARDS APPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING (FROM CIL STREET) Separate permits are required for electric, plumbing and heating work. L SIDE FT. FT. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLDGS. BET. MAIN & ACCESS BLOCS. VAR.# C.U.P. 9#6 DATE APPROVED m v N APPROVED m 1 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 shell not employ any person in violation of the workmen's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Djvialon 3, Chapter S. Signature of Permittee Authorized Agent u�•Lt==� n m i m SQ. FT. (my THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE E m v N m PLAN CHECK S ^ is� $/(/ o LL f TAX E u TOTAL PAID E s