HomeMy WebLinkAbout483 ABBIE WAY - Building Permits(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 483 ABBIE WY
Suite:
Vicinity: HOUSE & ATTACHED GARAGE
Parcel Number: 11737227
qpp�icant: STRAIN, BRUCE
Address: 483 ABBIE WAY
COSTA MESA, CA
Owner: STRAIN, BRUCE
Address 483 A861E WAY
COSTA MESA, CA
Contractor: O W N E R-B U I LD E R
Address:
Zip:
Arch : '
Address:
Phone:
BUILDING PERMIT
Zoning:
Phone: (949) 642-0579
Zip: 92627
Phone: (949) 642-0579
Zip: 92627
Phone:
License: 0
Eng:
� � Address:�
ISSUED BY:
Status�. ISSUED
Applied: 06/20/2000
Issued: 06/20/2000
Pfione:
Zip: License: License: .
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (32 SQ). REROOF WITH 30 YEAR�COMPOSITION
SHINGLES OVER EXISTING 2 LAYERS OF COMP. -
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$54.00
$0.50
$0.00
$0.00
$0.00
$54.50
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existina: o
NOTE5:
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY '
PLANNING & ZONING
Left 0- 0
�eft o- 0
Pro osed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
S�,soo.00
s�,soo.00
0
NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requlrements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shail automaYically 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 inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOfl INSPECTIONS CALL: (714) 7545626
WORKEHS' COMPENSATION DECLARATION; �
I hereby aHirm under penalry of perjury one of the following declarations: '
❑ I have and will meintain a certificate of consent to self-Insure for workers' compansation, es provided for by sectlon 3700 of Ihe Labor Code, for Ihe peAormance ot the
work for which ihis pertni� is issued. �
❑ I have and will maintain workers' compensetion insurence, as required by sedion 3700 of the Labor Code, for the peAortnance of the work for which this permit is issued.
My workers' compensation Insurance cerrier and policy number are;
Carner: Policy Number:
(Tfiis section need notbe campfeted 17 the pemnit /s ✓alued et one hundred daUars ($100) orless.)
❑ I certify that in the performance of the work tor which this permit is issued, I shell not employ any person in any manner. so as to become subJect to the workers'
compensation laws of Celifornla, and agree thet if I should become sub�ect to the workers' compensation provisions of Sectlon 3700 of Ihe Labor Code, I shall forihwith
comply with ihese provisions.
Applicant SignaNre: Dete:
WARNING: FAILURE TO SECURE WORKEPS' COMPENSATION WVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO TME Cp$T OF COMPENSATION, OAMAGES AS PROVIOED FOR IN SECTION 3108OF TNE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRAC70RS DECLARATION:
I hereby aflirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 of the Business and Professions Code, and my license is in full
force and eHect Lia N Class #
Contractor's SignaWre: �ate: _ _
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm ihst there Is a constmclion lendiog agency for the pedormance of the work tor which this permit Is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS: � �� �
I hereby aNirm thet under penalry of perjury that I am EXEMP7 FfiOM THE CONTFACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Protessions
Code: Any city or county which requires a permA to consWa, alter, improve, demolish, or repair any swcNre, prior to Its Issuance, also requires the applicant tor sucti permit
to file e signed stetement that he or she is licensed pursuent to the provisions of the Contractors Licensa Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Professions Code) o� thet he or she Is exempt iherefrom antl the basis for Me alleged ezemption. Any violallon of Section 7037.5 by arty applicent fa a permit
sub�ects the applicent to e civil panelry of not more ihan five hundred dollare ($500).):
owner of the property, or my employees with wages as ihelr sole compensation, WILL DO THE WORK, end the structure is not intended or oftered for sale (Sec.
7044, Business and Professions Code: The Contractors License Lew does not apply �o an owner of property who builds or improves ihereon, end who does such work
himself or herself or through his or her own amployees, provided that such improvemems are not intended or oBered for sale. If, however, the building or improvement is
sold within one yaar ot completion, ihe owner-builder will have ihe burden of proving that he or she did not build or Improve for purpose of sale.).
❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Professions
Gode: The cont�ectors License Le does not apply to en owner of property who builds or improves thereon, end who contracis for such project with a coniractor(s)
license ant to the C or 'cense Laws.).
❑ I e x t under se\c. Business and Protessions Code for this reason: �-
Signaty \ �/�C�.—. . - O
Owner I�ve�f18'�by drivar's license. ❑ Yes ❑ No Drivefs License No.
Verification of Ownership by (type of document, i.e. - property tex 6ill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '
❑ 1 hereby certify thet no excavation five (5) or more feet In tlepth into which e person is required to tlescen4 will be matle in connection with work authorized by this
permit, and that no builtling siructure, scaffolding, felsework, or demolition or dismantling ihereof, will be more than thirry-six (36} feet high. (Chap. 3.Z, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Cotle).
❑ As owner-builder, 1 will not employ enyone to do work which woultl require a permit from the Division of Intlustrial Safery, as noted above, unless such person has a
permi� �a do such work from the tlivision.
SlgnaNre: ' Date:
Division of Industnal Safety Permi� Number:
1 Will ihe applicant or present or fuWre builtling occupant need to tile and certify a Business Plan for emergency response to release or ihreatened release of a hazardous
materiel? ❑ Yes ❑ No
(Section 25505 oi the California Health antl Safery Code requlres, with some exceptions, that e Business Plan be filed with the Costa Mesa Fire Department by every
business which has et any one time during a reported year a quantiry of hezardous materials equal to or graater then e weight of 500 pounds, or e volume of 55 gellons,
or 200 cubic feet of compressetl gas at standard temperature and pressure).
.__. .. . ...... ........ ........ ..... . ..._.__....,. . . ...._.......'.._. . ... . . ...._..._.. _ _ ._ ....._' _ .._._.. ........ _ ....._.
2 Does or will the applicant or present or future bmlding occupam need b tile a registration torm for acutely hazartlous meteriels? ❑ Yes ❑ No
(Sec[ion 25533 of the Galifomia Health and Satety Code, with some exceptions, requires regisVation with the Costa Mese Flra Depertment by each business which at eny
one time has on hand a quentiry of acutaly hezarUous matenals equal to or greater than a weight of 500 pountls, or a voluma of 55 gallons, or 200 cubic feet of
compressed gas at slandard temperature end pressure).
'...... . .__....._ ' . ..____ ,_.___.. ... .. _ . . ....... ........._.._.... _..... . . ._ _.._....__. ........... .._....
3 Does or will the applicant or Dresent or tuture bulltlmg ocapant need to prepare an RMPP (Risk Management end Prevention Progrem for acutely hazardous matenals)?
(Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require ihe
Depariment of an RMPP by businesses which are required to reglster acutely hazardous materials with ihe Fire Deparimei
............_..—._"'......._...._...._......._...._ .............._..,_..__.._.._...........__'._.... ,_....__..._._.._'.'...............__..
4 If an RMPP is presently required, has Section 25534 of ihe California Health and Safety Cotle been fully complletl with?
. . ...._.._.__._.___..�.______—.....__._...
5 Does ar will the applicant or present or tuture bullding occupant require br the work which is the subject of this a plicatic
from the Soufh Coest Air Quality Management Disirict or tran eny other eir pollution control dlstrict or agency7 � Ves
(Section 658502 of the Califomia Govemment Code requires ihat the requested informetion be furnished on applications i
..._._......_..__—.........._...._._...._.....__......_ ......... ..................____.._._.._..'._........._..__..,._...'...___......_.—....___....__.........__ _....
6 Will any part of the feciliry to be constructetl untler this permit ba within 1000 feet from the ourer boundaries of e school7
(tl'yes°, the feciliry must meet the requirement ot Sections 25534 and 42303 of the California Health and Safery Code).
..._.__...__..._.._.._.._._.___ .............._..._' __--_..........__ ___._—......___._' _�_____.._.._........._......................_....___._......
7 If a permit trom 1he South Coast Air Dualiry Management DisiriM or other air pollution control disirict or agency is rec
application, have all of the disclosures prescnbed by CaliFornia Health and Safery Code Section 423W been made9 ❑ Y
certification and tiling with the Fire
� ermn ior sucn consiruaion or
No
non-residential 6uilding parmits).
which is the subject
8 (If'yes", ettach certiticate of compliance From ihe appropriete air poltution con�rol olficer).
CERTIFICATE OF COMPLIANGE: I certiy that untler penalry oi perjury the intormation given ebove is cortecL I agree to compty with all state laws and city ortlinances
regarding Hazardous Matenals and Emissions.
Signature: Date:
CERTFICATE COMPLIANCE AND- ORIZATION OF ENTRY: I certify under peneAy of perjury ihat I heve read lhis application and state that [he information given is
correcL I o comply wi�h s� aws and city ordinances�relatiny to building�onsiruclion, and authorize representa�ives ot ihe City ot Costa Mesa to enter upon the
a6ov e " ed properry for nspe i oses. I agree,not to occupy ofellow occupancy of any building authorized by this pertnit un}il final inspection.
, �� � „�. us��. 6/ao/aa
� Signature Of iegal wner(s) �A�+ . o e
And/Or Authorized Applicant Date
0 1.
1616
7266
200
201
202
203
204
244616
Fixod System Final Fire Prevention
Pool Spa Final
Fine! RaRoo}
Final BlocWqetaining Wall
Final Fectory Fire Place
Final Sign
Final Demolition
��
RL COOEN INSPECTIONiYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Electrical
212 Finel Fire Prevention
220 Final Plenning Apprpval
222 Final Site
z50 Flnal Building/Occupancy
D�T INTRIpLS
r
• CITY OF COSTA MESA �
BIIILDING DIYISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (774) 754-5626
PERMIT TYPE PLUM
APN: 11737207
,'';
JOB ADDRESS: �� 3 ABBIE Wl( CM
Vicinity:
� ,`r
SCOPE OF WORK: WATER HEATER CHANGI
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, ��rF�� �
OWNER:
PHONE: - -
OUT FOR A SFD.
PERMIT NUMBER: P08-00022
STATUS: ISSUED
DATE ISSUED: 0111612008
.. ISSUED BY: RMD
Suite/Unit: '
Address:
� _ City/State/Zip:
APPLICANT: CALIFORNIADELTA'MECFiANICAL�INC - -�• Addre'ss:
PHONE: 800•898-0008 , ' ' � " - ' City/State/iZip�
'`„a .`:
CONTRACTOR: CALIFORNIA DELTA MECHANICAL INC
Address: 1235 GRAND�AVENUE -� . � . . _
City/State:
ARCHITECT:
ENGINEER:
\
�
: ,�
��3Asaie ivx � `'�
COSTA ME§A, CA
1235 GR4ND AVENUE`,;;: `'
,.SPRING.VALLEY;CA��, �
-. .,.� " .-i
_ t. �
License No. ` 891174 ,
.�
.. . .. . .-898-0008 gv,
JGVALLEY;,CA �-�ZipCode:91977 � - �" 'p'�- . '�' PCELLc $00
.; . ,., . . , .._�`_.,:� . ... ,_ , - Ei
� '� . License No. , � ' PHONE:. `
+' � � -- ��License�.No._ . _ , -. .- PHONE:';t;
�� � �_ •.
'";: 'id. . . _ .._ �_ _ � ,_t
,,, . .�.� , _ ,.ti; �, �,'�
, . � . � ._., ' =. _ ` . �. , `
� PLUMBING P.ERMIT FEE SUMMARY
+
� °� �. PLAN CHECK FEE�: �: " � �-� ` � $0:00�: '
PERMIT FEE: ' ` ' � $35.80,°� '
��.•- ,_. .
'.). � ' . . .. _ . jr.
TOTAL,EEES t ' $35.80
--- ..I_�.
\
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered le9al, such work must comply with all applicable codes, and all
required inspeetions and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the ezpiration of this permit.
COOEtl. INSPECiIONTYPE ORTE INT11AL5 COOEp INSPEC➢ONTYPE UAIE IN7171RL5
1616 Fized System Final Fire Prevention 206 Final Mechanical i�
1266 Pool Spa Final 208 Final Plumbing �% —(�9 �]�
200 Final Re-Roof 210 Final Eleciriwl
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Fadory Fire Place 220 Final Planning Approval
203
. 204
Final Sign
Final Demolition
222 Final Site
250 Final Building/Occupancy
WORKERS' COMPENSATION DECUIRATION:
I hereby affirm under penalty of perjury one of the following eclaretions:
❑ I have and will maintain a certificate of consent to self-Insure for vrorkers'
compensation, as provided for by�seclion 3700 of the Labor Code, for lhe
performance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance o( the vArk for which this
pertnit is issued. My wo ers' compensation jnsurance carrier antl policy
numberare: �u�^ Ci
('C�arrier.,,
�j--(Thadedionneetl f6emmplefedA disvaluetlafarehuntlrcdtlotlars(Ef00)orless.)
Pa���Y��: �69 7���
❑ I certify that in the pedormance of the vrork for which this permit is
issued, I shall nol employ any person in any manner so�as to become subject
to Ihe workers' compensation laws of Califomia, and agree that if I should
become subject to ihe wArkers�' ompensation provisions of Section 3700 of
ihe Labor Cotl , I shall orth ' 14�comply with these provi�fonp.% ,r!)
I I f7 —OX
App' n'sSj na_,� �Oale
/ �
WARNING: FAI RE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENAI.TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am Bcensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my licens in fu I or e and effect.
���..� ��r 1 �s�_ c-3�
l.�" "''--'�%�—
_ _ � � v .- v
L reilors$� naWre —"- �Dece_
� �_�
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm that there is a constructan lending agency for the
peRormance of the �+ork fqr which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereby affirm Nat under penalty of perjury [ha[ I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
8usiness and Professiong Code: Any city or county which requires a permil to
construct, alter, improvB, 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 pursuan[ to the provisions of the Conlractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the
Business and Professions Cotle) 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 lhe 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. 704q, Business and Professions Code: 7he Contractors
License Law does not apply to an owner of propeAy who builds or improves
thereon. and who does such work himsel( or herself or through his or her own
employees, pmvided that such improvements are not intended or offered for
sale. If, however, the bUilding or improvement is sold within one year of
completion, the ovmer-builder will have the burden oi proving that he or she
did not build or improve fOr purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Pro(essbns Code: The contractors License Law dces not apply lo an ovmer of
property who builds or improves thereon, and who cont2cts for such projecl with
a con[ractor(s) license pur5uant to tha Contractors License Lavrs.).
❑ I am exempt under gec.
Business and Professiong Code for ihis reason:
Signalure '
305]<fi (3I0�)
Ovmer ID verified by driver's lic� Yes ❑ No �
Dnver s License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAfEN PERMIT CERTIFICATION:
❑ 1 hereby ceAify that no excavation frve (5) or more feet in depth into which a
person is required to descend, will be made in connection with vrork authonzed
by this permit, and that no building stmcNre, scaffdding, falsewnric, or tlemolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which �wuld
require a permit from ihe Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Appiiwnfs Si9naNre Dale
Division of Industrial Safety Permit Number: �
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICA710N:
1. Will the applicant or present or future building occupant need to file antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 of Ihe California Health and Safely 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 lime 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 tempereture and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutety hazartlous matenals? ❑ Yes ❑ No
(Section 25533 0( the Califomia Healih and Safety Code, with some
exceptions, requires registretlon with ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous ma[erials equal to or greater ihan a weight of 500 pounds, or a
volume of 55 9allons, or 200 cubic teet 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 awtely
hazardous mate�ials)? ❑ Yes ❑ No
(Section 25534 of ihe Calitomia Healih and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
fling with ihe Fire DepaAment 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 Califomia
Health and Safely Code been fully complietl with? ❑ Yes ❑ No
5. Does or will lhe applicant or present or future building occupant require for
the work which is the subject of this application a pertnit for such construction
or modifcation from the South Coast Air Quality Management District or from
any other air polWtion wntrol tlistrict or agency7 ❑ Yes ❑ No
(Section 658502 of lhe Cal'rfomia Govemment Code requires that the requested
information be fumished on applications for non-residential buildinq pertnits).
6. Will any part of the facility to�berconstructed under ihis permit be within
1000 feet from the outer boundanesy o�La� school?�❑1Yes��" ❑ No
(If "yes", the facility must meet iheYequirement ohSecti'w$�25534 and 42303
of the Califomia Health and Safety Code).
7. If a permit from the South CoashAir=Quality.Manag mentTDistrict or other
air pollution control district or agency is required for the vrork which is the
subject of this application, have all o( the disclosures prescnbed by California
Health antl Safety Code Seclion 42303 been matle? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control offcer).
CERTIFICATE OF COMPLIANCE: I certi(y.that under penalty ot perjury the
in�ormation given above is cortect. I agree to comply with all state laws antl
city ordinances regarding Hazardous Matenals and Emissions. �
SignaWre Uate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and sWte that
the infortnation given is correct. I agree to comply vrith 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
authonzed by this permit until fnal inspection.
Signalu ol alOvm s) D e
/��'6—
��IorAut�onzetl pplirant-� Date�
cr
ADC��cant to fill in all spaces except those wit�in heavy bortler Iines anA sign ail apprapriate tleclaretions.
CITY OF COSTA nn��3 CONS R CTION PERMIT
r
Project Address �j rt '�'
"�Applicant'sMaili�ng/AJd^dress /V �'
Owner's Na GGCJ �`�� ���� Pnn�o/7!"91G3
Address �a 3 ���
Arch/Eng. Licenu No.
Address
Contractor's Nam Phone 7'��`����
Address (mailing) 'l 1 •
City License No. � 3 �.�.
LICENSED CONTIiACTOR D CLAf2ATION
I hereby atfirm that I am licensetl untler provisions of Charter 9(commencin9
witn se<tion 7000) ot Division 3 oT the Business antl Professians Cotle, antl
my license is in�ll t�ce�antl eftect. - ��y4, -/
R'
Date� Signature
WOR ER COM ENSATION VIRATION
I hereby atfirm ehat I have a cert icate ot consent to selt-insure or a certiflCate
of Workers' Compensation Insurance, or a certitietl copy thereof (Section
3800, Lab. CJ �
licy No. Company
Certifietl copy is nereby furnishetl.
� Certifietl wpy is filetl with the city Builtling Oivision.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION �ECLARATION
(This se[tion neetl not be completetl if the permit IS for One huntlretl ($300) ar
less).
1 cer[iTy that in the performance of the work for which this perm�t is issuetl, I
shall not employ any pe�son in any m ner So 35 t000��� bCcome /ub�'ecjj�e
Work �o�my�� n.s �t' n Laws of Califo ia. `(y �/ �1
Date�'�z�%_`_°�-Si9nature �/!// <t�La�i
NOTI E: If fter making �this tlec ion, you shoultl be ome sub) ct to the
Workers' Compensation provision of the Labor Cotle, you must forthwith
comply with such p�ovisions or thi5 permit Shall bE tle¢metl �evoketl.
CONSTRUCTION LENDING AGENCV
I hereby attlrm that tM1ere is a construction lentlin9 agency for the pertormance
oi the work for .wKich this permit is issuetl (Section 309] Civ. C.)
Lentler'S Name
LenAer's Atltlre55
OWNER BUILOER �ECLARATION
I nereby atfirm that°I am exempt from the Contractor's License L.aw ior the
following reason (Section ]031.5 Business antl Professional Cotle: Any city or
county which �equire5 a pe�Tlt to con5t�uct, altev, improve, tlemolish o� �epair
any structure, prior to its issuance, also requires the appliwnt for such permit
tn fiie r uonetl statement that he/she Is licPns¢tl Oursuant to the provisions ot
therefrom antl the basis for the alle9etl exemption. Any violatlon ot Secilon
]031.5 by any applicant tor a permit subjects the applican[ to a civil
�endlty ot not mo�e than five huntl�etl tlolla�s ($500).
� 1, as owner of the properfy or my employees wi[n wages as Iheir sole
k�mpensation, wiil tlo the work, ana the structure is not intentletl or oiferetl
�or sale (Section 7044, Business antl Professional Cotle: Tne Contra<tor'S
License Law tloes not ap01y to an owner of a property who builtls or improves
thereon, antl wno aoes such work nimseli/herselt or through his or her own
em0loyee5, provitletl tnat such improvements are not in[entletl o� offeretl to�
sale. If, however, the builtling or improvement is soltl within one year of com-
pletion, the owner will have tne burtlen of proving he/she tlitl not builtl or im-
�ove tor the purpo5e of sale).
I, az owner of the property, am exclusively contracting with licensetl con-
[ractors to construct the Oroject (Section ]044, Bu5ine55 antl Professlons Cotle:
The Contractor's �icense law tloes not apply to an owner ot property who
�uiltls or imp�oves thereon, antl who cont�acts tor such projects with a con-
tracior(s) imense purzuant to the Contractor's License Law). I am aware that
proot of their Worker'S Compensation insurance shoultl be provitletl to me.
❑ 1 am exempt untler Section B. & P. C. tor this reason
3 j � ! L- �, ' r
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OT C q,p, #
,/�D CRIPTIO OF WORK/USE• F BLDG. y�G�!
`'� __� �! � /� � S Main Buildi
TYPE OF PE IT G DING ❑ FOUN�ATION LJ STRVCTURAI. T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER p'
PROJECT DESCRIPTION SQ. FT. OCCUPANCV ' C Right
CONSTRUCTIONTVPE� -�✓ VALUATION$ 7,�2�� S Left
ZONE GRADING CU. VOS. ACRES P�ng. Ref. #
Remarks: p,�,��7� PlanningNotes:
Sink
Preventer
Irrigation
rinking Fountains
loor Drains
loor Sinks
as Service OuUets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspectian Fee � $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
ExhaustSystem � Multiple
Firepl/Fact. Blt. IC80 #
Date Owner Heatin9 System & Ducting
I hereby certlty that I nave reatl this application antl state that the above ❑0.100,000 BTU �700,000
intormation is correct. I a9ree to comply with all tlty antl munty ortlinances
antl state laws r lating to builtling constructio tl hereby authorize repre-
sentatives of t s city to ter up n ove-mentionetl Dro erty for
InSpection pur ses.
Si9�ature Date• peinspection Fee
Drivers' se or 55 �
tF 0865-46, rev. 10/84 White - Builtlin9; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
$15
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee $ 3
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer ' Transformer ❑ 15-50 KW
ConstructionPoleSuh. • �50+KW
Cooking Unit Mecer ❑up to 100 amps
Dishwasher Meter ❑over100amps
Dryers ❑Gas ❑Electric Sub Panel �
Fan Motors �0-7 HP � 1%- 8
F.A.U. IncSolar �9-15 HP 016-75+
Fix[ures Microwave
Device Boxes ' Pole Light
Outlets Range
Switches Sign
Garbage Disposal Standing Sections
Generamr DO-5 KW �5-15 KW Trash Compacmr
IANICAL FEES Reinspection Fee �$15 Issue Fee
Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS:
CanoPY TYPe I I ❑ Zonin9 APProved By
. _ _ Building Approved 6y ��.���
Refrigeration Sys[em
❑aioo,000eru ❑ioo,000sTu
System Repair/Alteration
Fire Dampers
Registers
laue Fee � $ 3
SUMM_ ARV OF
BUILDING PERMIT $ �
PLAN CHECK $
PLUMBING $
PViN CHECK 25% $ �
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
SMIP $ "� v
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $
TOTALFEE $ G'3'sz
�CONSTRUCTION•AND�PLANNING POOL & SPA '
APPROVALS �Permit # Date Inspector qppROVALS Permit # Date Inspectot
i.,"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 UFER Grnd: f 57. APPROVALTO COVER-GUNITE
� 7. Footings . �:� � 58. Electrical Conduit-Undrgrnd.
8. Foundation � r. "�� 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd� 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK
11. Property Sewer Line,&�House Connection 62. Backwash & Receptor-Final
�h,.
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
�r
i8. Ro�gh Electriral-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT Y y /
20. Rough Factory Fireplace APPROVALS Permit# �� �� •
21. Ducts, in Structure 70. Underground Hydro � .
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test � 72. Underground Flush �'. �' (
24. Roof Framing . 73. Undergmd.StorageTank O;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 SYSTENI FINAL �� „' � ��� �
�i- , .
29. Insulation 78. FIRE PREV. FINAL (�
�
30. Drywall Nailing HEALTH DEPT. REQUIREMENT � �i�
31. Plaster Brown Coat 79, FINAL INSPECTION �' �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �r "
�.
33. Final Electric � Notes: - ' �. �i
34. Final Heating & Air Conditioning � :;�' '
35. Final Gas Pipe-Test . � ' '"'
36. Hood or Canopy � , �� �
37. Final Factory fireplace , IF'. �•
3�. Final Plumbing �.�; ' ' ' iv�, '
� �.
�, �� '
.39� Water Service-Final � � � '
; a:
40. Gas Service-Final �' � � � � , -
i
� 47. Solar pomestic-Final '�
, •. , ,
� 42. Backflow Preventer � i
r43.i�ackflow Irrigation � � � ' � . •
i � �, �l
�'4'4. Candscape Irrigation SYstem ' � • � ' � !.' � '
45. Sound Attenuation e - � . ' �
�-'46: Handicap Regulations �
_ . �
47.. FINALSTRUCTURE&BUILDING b) &� G ' , �; '
.� 1 K
4$. Special Requirements Completed � '`�' ' ' -
, �h � ,
:49. Electric Release to Edison � �
r
�,50. Gas'Release to Southern California Gas Co '' � `�
51. CERTIFICATE OF OCCUPANCY �r
No. Date _ _ , .� ...I
' r�.
, , � a; �����
CO�`fA MESA BUILDING-SAFETY DEPARTMENT
P. O� BOX SP7 GOBTA MF$A. CALIF�RNIA
Fo� Applicant to Fill In Compietely
YYPF (lG Ori1NT
GOSTA MESA. CALIFORNIA
NO. OF BLO66.
6¢TBACK LINB FROM
DESCRIPTION OF WORK
BUILDING �
BIZE f� %f
EXTERIOR WALL
COVERING
USE OF BUILDING
NO. OF
1 HERHBY ACKNOWL8DG8 TNAT 1 HAVE ReAO TX18�
RNO 6TAT6 THAT THE ABOVE 16 COfiRECT AND A61
PLY WITM ALL CIN OND�NANGEB AND 9TAT6 LAW9
91)ILDIN6 CONBTR��c/�¢J[
BIGNATURE OP // Y�. _ /J/, s_
AUTHORIZED AGENT
COM-
NG
FEE RECEIVED
'�/ SEP261961
�yFINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
qECE1PT NO. � PERMI� �
S 7
� I OATE riESLEIVE[� �{ � DA�E I661�E
COSTA MESA. CALIFORNIA
.— I PLANSP '� 6UILDINGeW �J
LEOAL a R
OEBCPIPTION /
A.P.NO. Ilf ' l �.�%�ps
t s 'r —�r
YAROS EVES
APPROVED ALLOWED
(CENiER LINE BTJ � % A
APPROVED
'�� w�s
% u
w
TXE AMOUNT BXOWN UNO¢H VALUATION IB POq THE N
PURPOBE OP EBTABLI8HIN0 A PEqMIT FEE �ONLY. •
VALUATION �
O PERMIT FEE $ IO � N�
/j �' � "- p
$ /� �D pLAN CHECK $ � „�
pc � O,
' TOTAL FEE � y �';
OWNERFIRTH� D. DATE 9-26-61 �
JOB ADDRESS ��g3 Abb�e Wa� BUILDING PERMIT NO. ��jlBl
GENERAL CONTRACTOR Alue HavPn Pools VALUE $2,500.00
AP No.11 - �-11 LOT TRACT FIRE ZONE DESCRIPTION OF WORK pvt.5W1ID pc
INSPECTIONS ISignaturel DATE GROUP TYPE ZONE R-1
SUBCONTRACTOR
❑ Steel Heinforce ❑
coat
930
� COSTA MESA BUILDING-SAFETY DEPARTMENT
W.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For AppGcant to Fill in Campletely — Use Ink Only
BUILDING ^
ADDRESS T�
OWNER 11( � 7 A� � AI�i I1 T
aTv L�.S
CpNS7qUCTION
BRANCH
ADDRESS
ARCHITEGT
l �`��1C
TEL.
C—. fA No.
TEL.
ADDRESS
CONTRACTOR �I`�1
ADDRESS �J � "ru�'
TE . (
CITV NO. ,
� STATE `, CITV
� LIC. NO. O /J LIC. NO.
{aj SIZE �j � ^, NO.OF BLDGS.
�+ OF LOT c�Q • �.` NOW ON LOT
a USE OF
� EXISTING BLDG, p
H
� 5eparate permits are required for
� electric, plumbing and heating work.
[.W.i USE OF BUILDING AND WORK TO 8E PEfiFORMED
a
� l N i 1J LU� Nl � 1�. 1P n
�
.�d
0.'
W
pI hereby aaknowled0e that I heve raad this eDP��cetlon end state
p�. that the ebove Info�metion Ic eorroct an� apree to comply wlth
a ell lawa repulatinp buliding con�truction, entl I thall not employ
Z eny peraon In vloletion of tha workmen'v compeneetion law� of
E� the Stete of Celifornle. �l
�� �•� Sa. F7.
3 I hereby ceftify that I em properly Ifcansed as a contrector untler
the Stefe of Cellfornle Busineu entl Profeaiona Code, Dlvlsion 3, THE AMOUNT SHOWN UNDER VAI.0
ChepTet 9, P�tl thet euch Iicanses era in full force entl affect, or I THE GUHVOSE OF ESTABLISHINO A PERP
em exampt from the provislone of the Stete of Cellfornla Bufinea VALUATION PERMIT FEE i
antl ProfenlonsCoda, Divle m3, Chapnr 9.
� PLAN CHECK E
SIO�eture of �
Permlttee � $ � TAX f'
Authorizetl /+9ent TOTAI PAID E
PAIO 4 ir :4ttst,t
OCT 2b-77ci�sA001 .GO ' 42.50
FOR STRUCI'lJRAL PERMIT
NO.
OwNER � \.(�AL(.AiIVUT
� - n VAWE
IC�4 S
FIRE
20NE TYPE ROUP
APPROV /�
BV DATE ,(/ �
ZONE NO.OF U$E OF NEW D/A.N«
� PLAKS BUILDING
VARDSAPPROVED YARDSAiPROVED
MAIN BUILDING ACCESSORV BUILDII
(FROMC/LS REET) �
FT FT.
� � T
�+
L�_/ � FT. FT.
REAR C yf( FT.
DISTANCE BET. BET. MAIN &
MAIN BLOGS. , ACCESS. BLDGS.
VAR. $ DATE -
C.U.P.yW APPROVED
APPHOV Q� nnrc ;/(/'���.
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KY7 uSKYil,l.` .
OWNER ��
JOB ADDRESS
n�
WRTER
ROUGH FLUM9ING
PROP. $WR. LINE � HOUSE CON.
SGHINKLING SVSTEM
ROUGH NE�TING RND MF CONDITIONING
TEMPORRRV SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGH WIRING
^ TRENCHES I� FORMS STEEL REINF.
�FLOOR SVSTEM
BOND BEAM STEEI REINfORC^E
SMERiXING �. � �,{�Q.�
lR4ME /.ND FLASXING !�I
LRTMING — IN OUT 1 �
PLASTER. BPOWN COPT '
VENT., REfRIG. �NO A.C., FINAL�
., FINnL nND G�5 TEST ❑
FINAI
DATE 10-26-77
BUILDING PERMIT N0.
21PTIOi, _rwORK pdd Dininaroo:
ZONE VALUES 3,200.00
PE GHOUP 2
SUBCONTRACTOR P
.�;�
.,
:%�., t.. .
COSTA, MESA BUILDING•SAFETY DEPARTMENT
p, O. 6GX T17 GoBTA MEBA. CALIFORNIA
Fo� Applleanf fo Fill In Completely
SYPE OR PRINT
40D E'S6 .O J ��giF u>A-
COSTA MESA. CALIFORNIA
�WNER
MAIL
Lv
FEE RECEIVED
SEP 2 21961
FINANCE DEPT.
APPLfCTATIt7N "��ft'PERMR
BUILDING
For Office Use Only
RECEIPT NO. 'rP�� TI�ND�
REC6rvED !V ` qA7E RECE,VEq �I rTE IBBUED
I Y Z 6 �-7 �-�
BUILDI G 1 . l
AODRESS �I�� 1��� �1OS
7
COSTA MESA. CALIFORNIA
FIRE T-
ZONE TYPE : GROUP , �'
CONTRAG7'OR - � /J%SSFLL ✓.�L/�/C BYPROV DATE Z �� Y
ADDRE59 r 2 J � ���5� ZONING
ci7r L' 6 5 T"fJ !�I/J � Sfl zoNe I PIOANB � I BUILD�Na EW
uc No. /b0/ 9'/ No: L� �'` �//L LEOAL ,�j
OE9CR�PTION V\ 1
BIZE xo, oF e�oos.
OF LOT � � ��� NOW oN LOT q, p, NO. —�%� ��/
EX18'!IN BL�G. S L / l L'� I�� � YARDS EVES
APPROVED ALLOWED
93TBACK I.�NC PROM .c� r � (CENTER LINE 9TJ
CeNT6R Op s�� J Q REAR YAR� �i FRONT F � IN.
,
IDE YARD I LEFf S' I RIGH7 S/ R. SIDE cJ O FT. IN.
DESCRIPTION OF WORK
L. SIOE FT. IN.
EW I IIALTERATION IIADDIiION I REAR �FT. IN.
EPAIR I IIMO(�VING I IIDEMhOLISH I ByPROVED ��� r OA7E 9 ay-�
ZIELDING ' 2 K �/� ROOMS I�, DSTORIES �
SER{OFt WALL flOOF
OVERING S UL�b COVERING CV MPO �
SE OP BUILDING AND WORK TO BE PERFORMEO
�' � - 7 6� �S /_�� r-H � 2
/� ! �� Tc �,c� 1 S 1 G- �•� V
�. � o
i XBHEBY ALKNOWLEDOC THAT 1 HAVE READ THIB APPLJCATION TXE AMOUNT 9XOWN UNDER VALUATION 19 POR TNL
AND eTATE THAT TXE ABOVE IB CORNECT AND AGREE TO COM- pURPDBC OF EBTABLIBF11Na A PERMIT FEE ONLY.
PLY WITN ALL CITY OROINANCE9 AND BTATE UW9 R80ULATING
BultnlNo coNBTRu oN. r, �! VALUATION an
IGNATUFtE OF q��yf ���/ C� PERMIT FEE $ 1 y� � N
ERMITTg � 9 ^/ �J ev m
�] ',( $ � I � I � PLAN CHEGK $ / •
UTHORIRED AGEN7�L (f/ ,,Cr vu / `l o
TOTAL F8E s� „
� �
oWNER FIRTH, DAV7" �.
JOB ADDRESS 483 A��ie Way
GENERAL CONTRACTOR Frank Bissell Bldr.
AP No. 117-3%1-11 LOT TRACT I'IRE ZONE
INSP�CTIONS
DATE I GROUP
C�J'
DATE 9-29-b1
rro. 15L�69 � i s+e
VALUE $ 4,y17.00 bqth,pat.to re
D�SCRIPTION OF WORK Add dOri�StOP.�
. .tTYPE v 7,ONE o_�
SUBCONTRACTOR
b�
OCCUPANCY I � 1 � I � ri.c., j�
�ORM 9116 - 5M - 7-61 "
RlcHrnoND 9�3411
SMI7���-ro-����z�T coM���nT�T
INSPECTING AND TESTING ENGINEERS
FORM p.18 yM 9�60 LC
,
781 EAST WASHINGTON BOULEVARD A950CIATE� WITH
PITTSBURGH TESTING
LOSANGELES 21,CALIFORNIA LA80RATORY '
ILL YEPORiS pRE SIIItM1'II� It INf (Orvflltrryi��� pppo�AiY Oi CIICMii AIIiNORIZ�iION �OR /UDLICAlION pi 011R REfOPiS. COXClU510Y5, OP C%�
iR4I5!'q(�u O� aF..axmxl. iNI:M IS nl if�roE[i PFYOIFf. OYR WPIIIFN dPfPOV�I e3 � MUIIqt eROi[CI�ON i0 [tiFHR, }Hf. RIPLIC �N� pUPVELVEi.
REPORT OF COMPRESSION TESTS
Fi�[ No:
18s-62 FEBRUARY 6, 19G2
.loo: �AVID W. FIRTH Dwre: JANUARY �6� 1962
qooaess: 4S3 ABBIE WAY� CO3TA MESA� CALIF• PERMITNO.:
OWNER: APPL. NO.:
AHCHITECT: FILE NO.: �e
STRUCT�RAL ENG�NEER: T I BOR Gr i Mes i UNIT: SW I rvIM I NG PUOL
CONTqACTOR: BLUE NAVEN POOL9- FOUR STAR GuuireM�TER���: GUNITE
LAOOR�TORY NUMBER�
V1ARK
LOCATION IN STRUCTURE:
�C-62— 276 IC-62— 277 C-62— 278
� _ _" _' __ __ —_
. . _ . � . ._ < : _ —_ -_ _'.'__---_ . __
1/9/62 `
-- ----_-- ----=-°I-- ____-_ --_ — --_
SWi��MiNG POOL
__ ______ __ �—_--r_ —_ —
cemeNr.6enNo . . . . . . . . . . . PERMANENTE
AOMI�(�URE . . . . . . . . . . . . . . NON�
SANDsouace . . . . . . . . . . . . MILLER - HANSE SAND Sc GRAVEL C0.
ROCK SOURCE . . . . . . . . . . . �
MIX NO.OR PROPONTIJN9 ....... GUN � TE � � Q•
TIME IN MIXER. MIN. . . . . . . . . �'
SLUn1P, INCHE4 . . . . . . . . . . . . �
MnoeBr . . . . . . . . . . . . . . . NOZpZLEMAN
DATEMADE . . . . . . • �/l/6�
DATE RECEIVED . . .~. . . . . . . � /� (�/6[�
DATECfiUSHED . . . . . . . . . . . . p�/� V/V2 2/6�/762 2/6/62
DIAMETER.INCHES . . . . . . . . . . J.7¢Oq J./i� 5,�n
AR[A. SOIIARE INCHES . . . . . . . . �5. JL �I/r1) )� ��I}. �(�� j
MARIAIUM �.ono. Les. . . . . . . . . . 29 � OOO �'tT� 1�1n '� (I� � "�1'�^
.HUSFIING STRENGTH. LBS. PER 6Q.-IN. .�� 35 C I I f 2L•7`I �
AGE CRUSHEn, DAYS . . . . . . . . . � 2$ 28
UNIT WT., PER CU. FT. (AS TESTEO) .
SPEC. P.,ri.l. AT 28 DAY9 ....... 2000
REPORTEOTO: NOTE: �INFORMqT10N ON�TTEA FROM DATA SHEET
r
,�, ��
��
1 Dnv�n W. FIRTH a�_
1 Tieoa Gviu�esi ��J �
2 B4UE HAVEN POOLS �
Z FOUR STAR GUNITE
� COSTA ME3A CITY BUILDING DEPARTMENT
�Eg � 39&2
Citq of Costa Mesa
� Bailding Dept. ,
RESP TFU�LV SUBMITTED
.-�p,�J IT � � RV�OMPANY
Br—�-{/� � r/ %.
I f ^ � G� �� "'�1— -
D. F. ROBERTS
;
Variances:
C. U. P.'s:
REPORT OF INVESTIGAT
Received by: �—'�'`"� - '
,�%/t.� � ( �t/frFc-yL 1
Complalntant (Print) �
Complalnta�t (Signature)
Date
ACtlress
Telepnone NurYiber
�A%ss'�ned to:
L�� �ilding Division
l�L �P anning Division
UG'Joint Investigation
Case No.: Sy
Assigned to: ��aT M �
Date: /� "��' 3 _
��6�e C,fu. U 8
�f� 3 ���
Compl i�
7
Name of Tenant (if applicable)
�Gev� e `�3ouncis
Name of Property Owner Telephone
'� d. Bax 1817'-f- '�'rvi he , CA 9a�i3
t Owner's esiden�tial Address
;�G .�c�i � Coi7✓�r��
�/ r
CG�G/i�J r Cr n i�
�
rni �y Yao�
i
¢r�n;�i i�7
c
a2I ��pQ -
Investigation by:
Time of Day (if applicable)
Building Permit Files Reviewed: ����83 Zoning Files Reviewed:
Initial and Date Initial and Date
Assessor's Parcel No. �� �" 37°Z — a 7 Map No.
Violation of C.M.M.C. Section (sl:
C/6s� /o � q� �3
1st Given: Time Allotted for Correction
Date
2nd Notice:
Date
maximum time
Certified letter advising that if violations are not corrected, the complaint and all supporting data will be forwarded
to the City Attorney's office with requestfor prosecution.
Date Mailed Date Received 7-day recheck of site
Filesforwarded to City Attorney's office with request:
CMF 0829-30 rev, 4/83
Initial and Date
,
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