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HomeMy WebLinkAbout132 CECIL PL - Building Permits ,r• • ;�*jja�_ CITY OF COSTA MESA F;rfr "4 BUILDING DIVISION Y DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER '*tenor 698-01290 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 132 CECIL PL Status: ISSUED Suite: Applied: 07/17/1998 Vicinity: Issued: 07/17/1998 Parcel Nunmber: 42605313 Zoning: ' Applicant: SKIRZYNSKI,JOHN Address: __- - - - - -- ::%r Plione:=7-14.771=01184,-,- 213 Zip:, 1 I—Z ` '-C� - Owner: CROSS GERAALDWTR I CROSS, R Address °hHERBERTs,CURT� ? _` - : - ' LI�-� // �\ V�� COSTA MESA,Cq L=>_�cPhohe:=\z \2 \\ 234 EA7TH ST #Y 18 Zip: 92627���� Contractor. ,HARP ROOFING \� �� V v� Address: 20062 FRANK STS -\ '�\\ �vL// ij�� Phone: \\,\� � � / ORANGE CA Zips,, 92669 7/C' (\ License:;571575 - \'`' ' Arch�Eng: - : 11) t kt:/ Address: //- I°v A. ,t t i,, / J/ //r / \ /I. v I. f .' Phone_ _ _,.1 ``r,-%` i / "_ c _.�'� A ; %I �'\ 1 -. �� N License: R", j\ j SCOPE OF PERMIT II \ / �/T/O EXIS AND INST1/2CDX WHERE APPLICABLE AND/NST 30YR TIMBERLINE GAF SHINGLES.ON / f HOUSE'A' / � S ©u � . t ; .gi ,- _ 1. 1 S;jwL - :a :. .FEE SUMMARY 1 INry tai�'�4!,y',2'1‘y+✓_ v a !,,, _ 1 Plan Check r $0.00 j _ Calc Valuation: $3,400.00 'Permit: ' " "'$87.25 Claim Valuation:,, 13,400.00 SMIP Com: \\x\$0.00 �' \\ Other:� `$0.00 Ai - / -'1'/ • Inspection $0.'00 �' �; �' � / ,, �_ �,r �,/ / ! \\S\ \- < $87.75 i E'(/ i no- +� Y fi o/i j 2�j/ v / \ --\ /7 V`�A 5-� . �, PLANNING'&ZONING ' '/ U& /J; / SETBACKS \\ %;�,-<> �\�NN\- J ' / , � r-,,,,,,, %j - \ % /:, , �i c� ,,/ MAIN STRUCTURE Front0-0J ,/ ///`ear 0.0---- -Left 0-0- -- Right 0-0-7 ' -�0 0 �iC/v J _O.6T 1 '--> �,--- \\ : k " .-41//, ACCESSORY Front 0=0A Rear,�0-,0 , , r- /Left,h 0-;0>vvA-%, Right--i/0-0 PARKING Existing: 0 -_-,_Required:- 0 " - Proposed: _0-/ice NOTES: - - - - - - - EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work 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 G DECLARATIONS 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 sett-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the for which this permit is issued. I have and wit 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. M workers' a tion I saran vier and number number are: G���Ty; -1 Carder. / �LC�( Policy Number..I2 7 ✓WT'7/ 9k (This section need not be completed If the perm) valued at one hundred dollars($100)or less.) ❑ I certify that in the perto ance he. ork for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation la of I ornl a thetJff should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith LLL��� //illi comply with the b ns. 1 �/ r7'-(6 �;S \//WARNIApplicNG:Signature: IS Date: iD 1]-�WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CIVIL FINES UP TO ONE HUNDRED THflJSAND D U_ARE(5100,000),IN ADDmON TO THE COS{OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed u••er•rovlsio •l:. : r (commencing with Section 7000)of DMsion 3 of the Business and Professions Code,and my license Is in full force and effect.Llc.a '1Tf: /jam Class a Contractors Signature: '!S V�� — Date: ..----2--et, ' C'' 'b..-- CONSTRUCTION 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,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penally 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 DWLsian 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).): in 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,Ie.-properly 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)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. Signature: Date: — Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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 0 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 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 torn for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California Government Code requires that the requested intonation be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed ender this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 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 Calitomia Health and Safety Code Section 42303 been made? 0 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 state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTH•RELATION 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 law •nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property rty forin,• on u 's.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ,V/JI ,�' '���.nature r�:'I owner(s) 7 / `e Date-,V And/Or Authorized Applicant C Date ( Coln I INSPFCTIONTYPP DATE =ALS OnDPI INSPFCTION TYPE RATE IHMIASS 1818 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final rp/b� 208. Final Plumbing -7 200 Final Re-Roof `u-9 G 210 Final Electrical 201 Final Block/Retaining Wall 212 Anal Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Anal Site 204 Final Demolition 250 Final Building/Occupancy 2448-48 PROJECT ADDRESS: 132 CECIL PL UNIT: B/C CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 067144 !OWNER'S RAMNAME: HUBERTS KURT aoDREss: 132 CECIL PL PERMIT NO: B 067144 PLAN CHECK NO; N GOVT: N SUPP : N 37 - COSTA MESA, CA 92626 {' CONSTRUCTION TYPE: V—N PERMIT TYPE: STR. PURPOSE: ALT ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REROOF W/COMP. SHINGLES SQFT: 2, 000 PERMITTEE: CLAIM VALUE: 2 , 000 . 00 CALC—VALUE: 2, 000. 00 GROUP OCC: R-3 / ADDRESS; SHARP ROOFING ( 714 ) 771-2225 ((2�}}0�00A��6((2� FRANK ST Cil fiat COMMENTS : REROOF 1300SF DUPLEX W/COMP SHIN, SMOKE DET RE U ��u]A] 9e1r �' • LICENSED CONTRACTDADECCAtUIFN: I hereby affirm that l am licensed under,r visions.'fi (commencing with Section ********************************************************4* 7yE� *{��� a a . 7000)of Division 3 of the Business and Professions Code.and my I nse is i f force an,e ed. per9 Z O N I N G R E Q U I R E M E N T S CITY LIC.: STATE LIC.: CLA • y�482 6 orf 57157 `-3 ' S E T B A C K S REQUIRED EQ iIR D Date: -U�` Signature:— _ (flC'�+tV f7GL MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: Ihereby affir that I have a certificate of consent to sell-insure or. enificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN 'POLICY NO.: EXP.DATE: 1277589-93 10 01 /' COMPANY: STATEE F9'NC PARKING REQ• PROV: PARCEL: 42605313 ZNE: REF NO: ❑ Certified copy is ere y furors ed. Certified copy is f ith D ry Buildi ..ce �� PLANNING NOTES> ` Dale' / `�"! IZ iY Applicant: arm.... /—_ *iFiE9EiF****iEYfaEifiEiF****iffEiEiM1iE9EiE****jEiE9(-1E3EiFiEjEifjflfiEit****iE****iE****iFir{E9EyFi(-1E1Elf-ItiEifif*****if*** "�1 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Thi' eifon need not be completed if the permit is for one hundred($100)or less). 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 I 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. ZONING APPROVED BY DATE; Date: Signature: NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDINGAPPROVED BY DATE: Code, you must forthwith comply with such provisions or this permit shall-be deemed revoked. 1 � CONSTRUCTION LENDING AGENCY: Ihereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY : • ' - - - - DATE: .' fp MI-\ which this permit is issued(Section 3097,Civ.C). **,*********,********************************* ********************* * ********* LENDER: ADDRESS: ******************************************************************************* LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed PERMIT 45 . 00 . 50 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE Y. I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE 7 structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 45 . 50 0 . 00 - 0 . 00 45 , 50 45 . 50 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or A improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED : 45 . 50 OVER/SHORT: . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45 . 00 - . 50 ❑ 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 contractor(s)license pursuant to the Contractors'State License Law).l am aware *,**,*,* x,***,*N,**,***,if******,**,*,1F**********,*******,*,********************************** that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN for this reason: TYPE QTY D E, S C R I P T I -O N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 2000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 000 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ,END OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. / / Dale: Applicant: A ��� I hereby certify that I have read this application and state that th: .,•veh info' i an is cor� m:ly with all city and county a11 1 00160424-00160425 TOT 45.50 ordinances and state laws relating to building construction and h' r honz: resentati a the shave-mentioned property for inspection purposes. w�i T it/c/c,47 DATE: 05%22/94 TIME: 13 `2 y "A /2 /55 Drte, Y Signature: Q Driver's License or Social Security a: d%/(/�//////� ---- 1641.46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor 4. i e' CONSTRUCTION AND PLANNING • . .,OL & SPA APPROVALS Permit# - Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service yr Pole - 52. Pool & Equipment Location .�i- 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. r 54. Forms "' 4: Electrical Conduit-Undrgrnd." 55. Electrical Bonding �? 5. Steel Reinforcement56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. , I 8. Foundation - _,-' 59. Gas Pipe, 0 Undrgrnd.,Test , tet: 9. Water Pipe-Undrgrnd. - ,7 1 60. Backwash Lines, P-Trap, 0 Undrgrnd. j 10. Structural Floor System - -1 _ 61. APPROVAL TO DECK - , . 11. Property Sewer Line &•Hd>,iseivonnection , 62. Backwash & Receptor-Final - • 12. Sewer Cap j i .t 63. Heater & Vent-Final r , 13. Roof Drains -- ;? / N 64. Plumbing System - Final 14. Rough Plumbing 1 1 65. Electrical-Final I 15. Rough Electrical-Conduit i 66. Solar System-Final Lt 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 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25, Roof Sheathing 74. Overhead Hydro 26. 'i-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe I 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing • ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECTION i 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED / / 33. Final Electric Notes: 2M 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy • , + 37. Final Factory Fireplace _ I 38. Final Plumbing . 39. Water Service-Final r 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigatior0 44. Landscape irrigatio, iyaem 45. Sound Attenuatiort- r . �- 46. Handicap Regulatit rn 47. FINAL STRUCTUCEfJ & ILDING D 48. FINAL PLANNIN( ' ''_" - rC - --- 49. Electric Release to . ;?:o`:yt 50. Gas Release to So4ern Ca{ifornia Gas Co 51. CERTIFICATE OF i CCUPANCY No. i'-;bate aim __Nat rte.7.+it5.1 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ' A' ' AT ON EAR[9fRURTI£]R71'LPERMIT 65.60 TL For Applicant to Fill in Completely— Use Ink Only ///� q REI I,IE. DATE RECEIVED D TE SSUE• o BUFLDINGill/,' (2 Oen ii& UPS , ...Y / .._ �� � PERMIT NO. _, -ft!OWNER t . - . re A.P. NO. / r '0/73 -33 ' )MAIL BUILDING /� • aft ADDR ESS�I�.�/ � e�(�p6,('J ADDRESS (✓�� �' _]� T TEL.J'"fri' TRACT // / LOT , BLOCK CITY b A di - d NO. _ Jr CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOUSH LENDER AJ nRJ(= BRANCH lit OWNER J .. ADDRESS � ARCHITECT TEL. USE ANY_ • .n;9 4/6? t—1, OR ENGINEER 5i/ NO. - _ FIRE ADDRESS ZONE Y'E GROUP • ///'''� /I-/y�� APPROVED / �I�/ CONTRACTOR 0 / 6 • BY j. DATE rG/ ADDRESSNO.OF ot J� TEL. ZONE Z PLANS 2. BUILDING NEWUSE OF I� • „firm, CITY NO. F+ STATE CITY YARDS APPROVED YARDS APPROVED ;G LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING WSIZE 1 NO.OF BLOCS, (FROM C/L STREET/ 4 OF LOT NOW ON LOT FRONT 7 p FT. 4 FT. Q USE OF p EXISTING BLDG. R.SIDE ol. Q FT. - FT. H Separate permits are required for L.SIDE S FT. es. FT. electric,plumbing and heating work. -r 1=1- a REAR s FT. 0 FT. HUSE OF BUILD G AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& O ASO BUILD Ate. / IAL T . 7 MAIN BLDGS. ACCESS. BLDGS. p . ^-I e CU.P,VAR.# bR -79-06 APPROVED 3/47 /7/ .'.7 ROVEDGLWQI 1 •_ c3 /.Z7 /79 Q I hereby acknowledge that I have read this application and state HOLD FOR SP �' 'I UUIKtMl1'N"t. in n L4 that the above information is correct and agree to comply with - m Wall laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of the State of California. /] / / - I hereby certify that I am properly licensed as a contractor under 7 1/(/•L SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of e State of California Business VALUATION PERMIT FEE v and Professions Code, Division 3, h pter 9. $ •�� m Signature of /��t ///1tt.,, ]]0 0 PLAN CHECK $ a Permittee L-4V $ j/ �7 o/1 TAX $ 2 /O U. Authorized gent /// ry sew V TOTAL PAID $ - .6 a • 5834 3/28/79 I274 TU • COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVED BY PERMIT / , For Applicant to Fill in Completely— Use Ink Only 2t ���! BUILDING �" A.P.NO. / ADDRESS /jf 0toO/L Sr. !J - -- -- BUILDING OWNER OR� r n ADDRESS TENANT Ven nY \ Nr.Sc3 e\ Xth i/ ,CAlIP!/ // UNIT OR MAI LING / SPACE NO. ADDRESS„96,9 s/1 ea NG bsQO ST TR.NO. LOT BLK. /� ,/J� TEL. revs CITY l 'OSTX' ///LSSA NO. p'11 NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER AionP BRANCH OWNER ADDRESS VALUE ARCHITECT TEL. USE $ OR ENGINEER NO. • ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR 0 5 BY DATE ADDRESS S IGJ TEL. CITY NO. F. APPROVEDCITY APPROVED SETBACKS S LIC. NO. LIC.NO. SIZE NO.OF BLDGS. (FROM C/L STREET) e. OF LOT NOW ON LOT FRONT FT. Q USE OF 'ri) EXISTING BLDG. R SIDE ET, V) F Separate permits are required for L.SIDE FT. • electric,plumbing and heating work: REAR FT. _ t" USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q . "'I // //U l T A/I fel[PC� CADfl6 � DATE !"' APPROVED -C APPROVED )14 �B_Y DATE Cg w QI hereby acknowledge that I have read this application and state N. Cd that the above information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of Sthe State of California. m 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT rFEES ONLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ / :R/7 / N and Professions Code, Division 3,Chapter 9. lllf�iii���' Signature of 1 / /I / - PLAN CHECK S a Permittee J±f!_• i. •-..Lc.J $ TAX $ LL pr y �� �V V Authorized Agent Date - TOTAL PAID E/ _ U