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Home My WebLink About172 BAY ST - Building Permits OWNER FENCHAK, Michael DATE 14-30-62 JOB ADDRESS 172 E. Bay St. BUILDING PERMIT NO. 16959 GENERAL CONTRACTOR Owner-Builder VALUE $ 330.00 /to Res. AP No. 118-061-011 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add Coy:Porch/ INSPECTIONS Signature DATE GROUP J TYPE p 'ZONE R=1 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBE Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. 0 St.Swr. 0 Sprinkling System Construction ?ole Underground 0 Power Rough Wiring Trenches 0 Forms 0 Steel Reinf. 0 ors- c-i - 6 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing -71•0 ?9 Lathing — In 0 Out 0 Plaster, brown coat Rang. 0 Air Cond. ❑ Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final OCCUPANCY FORM BU4.5M - 7.61 16959 OWNER SHERWOOD FOREST DEV. DATE 3_13_57 JOB ADDRESS 172 E. Bay Street BUILDING PERMIT NO. #4680 • GENERAL CONTRACTOR Lido Construction VALUE $ 12,304.00 LOT 21 BLOCK TRACT 3106 Res, W/att, gar. GROUP I & J TYPE V ZONE FIRE DISTRICT 4593 PERMITS ISSUED INSPECTIONS /'- DATE SUBCONTRACTOR DATE NUMBER (f v �� Footing Trench 3 -.24— 7 Foundation Forms and Grade to Garage �]. Rough Framing �4 .,c7i -I 6 _l pp G Plumbing, Rough to Slab y l++.Gt A- v Q !(.Gt, d- SU�tol 3'/2-J 7 SS'/ a0 Plumbing, Rough Complete y12 C S /74-/J--4-,7 F/I Temporary Pole Wiring, RoughAPR 1 8 1957 VCD �� - `gyp' ��y-'s1 4737 Heating,Rough MO Y-12-.r> a .� 3,g9-,T7 '3ya Heating, Final k11•d-S 4'-074/-6- _/ / Sewer, Hmouse/ Sewer, St.rn��j S' _ _ _ . 7/--(5.--S7 pp 9c2 y Septic Tank or Cesspool Lathing, InX outX -ft-'(fp 4 -23".'7 -_ Plastering e--6/ 3-7 Plumbing,Final,Fixtures CompleteJC3 6"•1 i4-3-.7 _��/// � � • Plumbing,Final Gas Test /S- ma-5 S'-dy47 -� '"` S y �l"r� Wiring, Final yn MAY 2 2 1957 Vol • / _ occupancy 7-y1 /o/c•I•r 41 4t' 457 FORM 210 9M 10.59 • ,417:1,!., S s CITY OF COSTA MESA • �' 't i G\@ BUILDING DIVISION F ,I a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 60 PERMIT J' ,,„,,,e>� B04-01841 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT , Job Address: 172 E BAY ST . Status: ISSUED • Suite: Applied: 11/01/2004 Vicinity: ROOF Issued: 11/01/2004 Parcel Number: 42619213 Zoning: 5:14/L Applicant: Applicant: MICHAEL BURKE ISSUED BY: Address: 1653 SUPERIOR AVE - - - Phone: (949)642-7222 - COSTA MESA,CA � Zip: 92627 ' Owner: ARCHULETA TRUSTY , Address 172 E BAY ST ' • . Phone: , COSTA MESA,CA 'I Zip: 92627 Contractor LEE ROOFING"OF COSTA MESA Address: 1653 SUPERIOR AVE . . . Phone: (949)642-7222 ' COSTA MESA,CA ' Zip: 92627 License: 349686 Arch : Eng: . Address: - Address: -Phone: Phone: Zip: License: • License: SCOPE OF PERMIT • TEAR.OFF EXISTING ROOF. INSTALL 1/2'OSB,30#FELT,30 YEAR,COMPOSITION-SHINGLES,AND REPAIR/REPLACE SHEATHING AS ' NEEDED.27 SQUARES INCLUDES ATTACHED GARAGE.. - FEE SUMMARY Plan Check: ' $0.00 - - Calc Valuation: - S7,500.00 Permit: $153.25 Claim Valuation: $7,500.00 SMIP Res: $0.75 t SMIP Com: $0.00 ' Other., $0.00 Inspection: . $0.00 ' Total: , $154.00, _ PLANNING &ZONING SETBACKS - ' - - MAIN STRUCTURE Front,/0=0 - - :Rear 0-0 - 'Left 0-0 - -Right 0-0- " 7 ACCESSORY Front 0-0 ' , Rear, 0-0 Left 0:0 Right 0-0 r PARKING Existino: 0 - Required:- 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 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 2446+6(600) . DECLARATIONS J WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: kih!"Zectibn 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 rk for which this permit is issued. I have antl 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 worke`r4 'c/pmpensatiioo�['� Insuranc arrierr}nd policy number are: :~• ...lT�i'%p ( JU40 tUA_)(1 . Policy need not be completecilif1he permit is valued atone hundred dollars ($100) or less.) - ❑ . I certify that in the performance of the work W 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 no aa at if 1 sh old become sub)ect to the workers' compensation provisions of Section 3700 of the Lbor Code, I shall forthwith comply with I ase��jjw Applicant Signature:- /'yifAUV/ �--� ,- ..Data: l (% WARN NG'-.ARVIRE'TO SECURE Wp KERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL-PENALTI AND CIVIL FINES UP TO ONE HUNDRED p` AND DOLLARE($100,00), 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`andn�jldcx#yam 4� �GonVo ac. 1o�Sgh " store."' '. Bim -�- CONSTRUCTION LENDINGAGENCY: ❑ 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: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: 1 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers 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, talsework, 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. Signature: Date: 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 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 Dces 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 Oces 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 E]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 Al by businesses which are required to register acutely hazardous materials with the Fire Department. ..............................................................................................................................................................................................................................................................................................................................._........... ........... ..................................... 4 It 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 a plication 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? LI Yes U 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 ....................................................................... ......... .................. -............................................................................................................ ....................................................... .............................................................................................................. _..... e (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 above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. re O gal Owners) Date r7,_Or.Aulhodzed.Applicant,�*,•,_ CODE 0. INSFECTIbI11129 I INTRIALS CODE INSPECTION TYPE 2&U INiITIAL$ 1616 Fed System Final Fire Prevention 206 Final Mechanical 7 1266 Pool Spa Final 208 Final Plumbing 7< 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 172E BAY ST Suite: Vicinity: ROOF Parcel Number: 42619213 Zoning: Applicant: DEPINHO, NELSON Applied: Address: 2832 N OLIVE AVE 10/14/2004 . $0. 0 - -Phone: -(714) 632-7663, -.Calc Valuation ORANGE, CA .-'"�-i"!� Zip: 92665 ' 25 -- — _— %" Owner: ARCHULETATRUSTI, l �.. SMIP Res. Address 172 E BAY ST - - _ =Phone: - i COSTA'MESA, CA , !:- - Zip, 92 7 - ,SMIP Com: Contractor: DEPINHO R FING Address: 2832 N OLIVE AV Other.. . �' •�- �� hone. 14) 632-7663 " - ORANGE, CA nspection: ,l ,Inspection- Zip:` 926\ L nse:. 683894 Status: ISSUED Applied: 10/14/2004 Issued: 10/14/2004 ISSUED BY: -20 Arch ; i. - \ \ \\ / Eng: Address: r .. Address: -P ne: �� Phone: ` Zip: �,,.. i nse: ,License: \, SCOPE OF PERMIT TE OFF EXIS G OF. INSTALL 7/.16" OS8,.15# FELT,.40 YEAR COMPOSITION SHINGLES, AND REPAIR/REPLACE SHEATHING AS' -NEE D. 23 SOUA ESI LUDES ATTACHED GARAGE:.- I- 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 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 244646 (6/00) FEE SUMMARY , \•Planec . . $0. 0 v_ ^~ -.Calc Valuation $6,000.00 Per if: 25 -- — _— %" Claim Valuation $s;000.00 �.. SMIP Res. $0.60 ,SMIP Com: $0.00 Other.. $0.00 nspection: ,l ,Inspection- .• $0.00 �IT,otal. $125.85 IT. r, �`�'. ' ��,• :' 'PLANNING & ZONING SETBACKS -Rear; �0 0�0 MAIN STRUCTURE Front ,0'0'x) O -�lCeft 0 0 Right.- _� ACCESSORY 'Front 0 0� Rear 0-0- .Geft 0-0 Right'-' ight -- 0-'0 PARKING Exist a 0\ Required: -.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 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 244646 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: t I hereby affirm under penalty of perjury one of the following declarations: ❑ I he rid 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 for which this permit H Issued. 1 ave 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' mpe se Insurance carder and policy number ere: i� su3z iii Cemer:7 umber: :(This sect ed not be completed if the permit is valued at one hundred dollars f$100) or less.) ❑ I certify that in the performance of the work for which -1 s'f`Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, 96d agree t s hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions./ P� /✓� / iJ / y G Ap _ Ignature: �Y� W AEI�YNDrPAT10 TE O SECUR2'WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EML& ERTO-CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($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.aflim>_that.l am licensed upcerpro" sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business aand_professions Code, and my license is in full �force and effect. Lfc,.0 1- v3 i `� ass :J rrecrofrMgnature: lye %`"Oat 691y1c CONSTRUCTION LENDING AGENCY: ❑ 1 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: 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.). ❑ 1, 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 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. 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: 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 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 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). ..................................................... ........................................................................................................................................ ..................... ...................................................................... .................................... .................. ........... ............. I............... ...... 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 compiled 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 a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ILJ Yes U 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 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? ❑Ves ❑ No 8 (It yes-, attach certificate of compliance from the aDPropdate 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 above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign gal Owner(s) Det 4-Z �� v Pd/O�wnzed:AWI1cam� CODE I INSPECTION TYPE 2&U INTITIALS CODE 1 INSPECTION TYPE PA3 ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Well 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 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 017 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDINGC ADDRESSzzx J COSTA MESA. CA IFORNIA �Ae.. 1 u / A — _ / J ZONES TEL. LEf `0A'L NO. DESCH I I NO. OF BLGGS. LOa NOW'ON LOT A. P.1 YARD SETBACK LINE FROM i OF BUILDIN% // ANO. OF SIZE ROOMS STOI EXTERIOR WALL ROOF' ��,�{{ COVERING COVERING 5 IJV USE OF BUILDING AND WORK TO BE PERFORMEC I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STAT H THAT THE ABOVE IB CORRECT AND AGREE TO COM- PLY WITH ALL CITY ORDINANCES AND STk7t.AWS Re. ULA. BUILDING CONSTRUCTION. ./ /I LS I / A FEE RECEIVED APR 3 1 FINANCE APPLICATION F R CgWff COSTA MESA BUILDING For Office Use Only RECEIPT NO. I FgRA11T NO BY I •DATEi ECEIVE. I DATE'ISSUEO COSTA MESA. ZONING NO. OF h USE OF NEW PLANS BUILDING EVES (CENTER LINE ST.) LLa L. SIDE " 4-1 � JL�S 7 IM REAR F IN. BYPROVED /nnrc N/ ./- �� V A 4 390 WN UNDER VALUATION 18 FOR THE PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. VA ATION J�V-T (}N PERMIT FEE 9_4//S _1 1 PLAN CHECK S AUTHORIZED AGENT I/ TOTAL FEE S.-1 �� u r• ( 390 WN UNDER VALUATION 18 FOR THE PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. VA ATION J�V-T (}N PERMIT FEE 9_4//S _1 1 PLAN CHECK S AUTHORIZED AGENT I/ TOTAL FEE S.-1 �� I ,, 4593 COSTA MESA BUILDING DEPARTMENT P. O. BOX 317 II COSTA MESA. CALIFORNIAI FOR APPLICANT TO FILL IN BUILDING i 1 ^� "q"4- nAv 'Tac- /• L L1 JY' FEE RECEIVED Y11'....- , L, I K•7 -&L FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING COSTA.MESA, CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO. n r� OW NE �2f IGL DIG -0:4 . MAIL RECEIVED BY TECEIVEO �--� DATE ISSUED MAR ADDRESS I U 1��//GII /N o/N •- ,7 1 3 14� c r �IJr/ CITY /�1 NO.TEI_{. J ADD EISS ARCHITECT LIC.I OR ENGINEER �yj0// VA A.5 NO. �• % if COSTA MESA. CALIFORNIA i ADDRESS 4/ We W,,q I*f1,C_/P FIRE 20NE CITYLIC. ZONE NOq 10F TYPE GROU CONTRACTOR If NO./ j 11 AA�� TEL COI,(/ PROVED !-a �Vv ,S J DATE _ADDRESS LEG"` LCAT 1 / CORRECTIONS DESCRIPTIOry NO. / BLOCK TRACT/OY A.P. NO. SIZE�/ NO, OF LD... I/1 OF LOT � JT NOW ONIiLOT LI USE OF EXISTING BLDG, SETBACK LINE FROM APPROVED CENTER OF STREET REAR YARD r(..J �,' CITY Of: 0_STA MESA SIDE YARD RIGHT-5-�LEFT 94- IK pill %INNING DEPT. DESCRIPTION OF WOR NEW I L-JALTERATION I ADDITION BY DATA REPAIR MOVING DEMOLISH BUILDING NO OF f� SIZE ROOMS STORIES WA OLI1'1 ROOF e� rr//�� yiNCLE COVEREXTERIING *1we- COVERING USE OF USE NEW N N ��I�JL OF fLL iW I n HER BY ACKNO IEDGE THAT IHA V1.1A. THIS APPLICATION AND STATE THAT THE J.BOVIi IS CORRE /A ND/AGREE TO COMPLY WITH ALL A CITY ORDINANC 5 NO STATE LA 5 REGULALWG BUWDING•CONSTRUC- TION. / ` S IGNATUR OF �.� VALUATION PERMIT FEE S PERMITTY r 666�� PLAN CHECK $ I /Z�/ AUTHORIZED AGENT7/f �L C•r � TOTAL FEE $ tr - v ver