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Home My WebLink About938 AZALEA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa,pa.p9MBING PERMIT - n FAIR DRIVE, COSTA MESA, CA 92626 h'LV �obAddress: 938 AZALEADR Suite No Vicini�y: Parcel Nunmber: 41221207 Applicant: E J ELLIS JR Address: owner: DICKERMAN, YOSHIKO Address 938 AZALEA DR COSTA MESA, CA Phone: 310-838-0408 Zip: Phone: Zip: 92626 Contractor: ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU Address: 3801 LENAWEEAVE CULVER CITY, CA WATER HEATER CHANGE-OUT ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System �Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drein, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 � Phone: 310-253-5229 Zip: 90232 License: 679898 SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 SewerConnect $0.00 Sewer Privale Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 02/13/2006 Issued: 02/13/2006 ISSUED BY: �� SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Insl or Rep.) Water Re-pipe Water Service Water SoRener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 535.80 � 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by ihls permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced wi�hin 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work euthorized under ihis permlt to be considered legal, such work must comply with all applicable codes, and all required Inepectlo�s and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448-68(8/00) WORKERS' COMPENSATION DECLARATION: � , � . I hereby eflirm under penalry of perjury one of ihe followinq tleclarations: . ❑ I heve end will mein�ein a cehificale of consent �o self-Insure for workers' compensetion,.es provided for by sedion 3700 of the Labor Code, for ihe pertortnence of Ihe �work for which this pennit is issued. I have and will meinfain workers' compensalion Insurence, es requiretl by section 3700 of Ihe Lebor Cotle, tor ihe peAortnanca oi Ihe work for which Ihis pertnit is issued. M workers' com ecr�� tl s�ura anlermL.d/�� li� rwI�wD�er ere: / �.iL L'., /�S1 (�G �}/1n�/ / Carrier:y P H� / L.-. L�V I V✓ C Policy Number. 1 O {Iw "D O� 1iVlJ �O C the permi( is veluetl et one hundred dollers ($f 00) or Iess.J ❑ I certity ihat in the peAortnance oF ihe wyyy(((k for which 4i� 't is i , I shell not employ any person in eny manner so es to beCome sublect to the workers' compensatlon laws oi CalBornie, eny4qc6 � ii hpGl su ed to the workers' compensetion pmvisions ot Section 3700 of e Lebor C I shell forthwi�h comply wi�h �hese pro�islons. � Z,�� Applicant Signature: / Dete: � WARNING FAILUHE TO SECURE WORKERS' COMPE ATION CAVEMGE IS U WFUL ANO SHALL SU&IECT AN EMPLOYEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TiOUSANDDOLIARE(§100,000),INADDITIONTOTH TOFCAMPENSATI DAMAGESASPROVIDEDf-0qINSECTION3)WOFTHEL480RCODE,IN�EREST,ANDATTORNEY'SFEES. LICENSED CONTRACTOpS DECLARATION: I hereby aHi�m that I am licensed under�°Y� force and eHect. Lic. q�[ ` I Comreaor's SigneWra: 'y l -� Section 7000) oF Divislon 3 of the Business e�ro�ee�OnyCode, end my license is in full � Cless s J b _� Date:_ I�,%� ✓ `% . CONSTRUC710N LENDING AGENCY: V ❑ I hereby aflirm Ihat there is a consiruction lentling agency for the pedormanca of Ihe work tor which ihis permit is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lenders Atldress: Signe�ure: OWNER-BUILDER DECLAAATIONS: Da�e: I hereby efiirm that untler penelty of perjury thet I em EJ(EMP7 FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons Code: Any city or counry wfnch requires e permit to construct, alter, Improve, demolis�, or repair any structure, prior to its issuance, also requires the epplicant }or such pertnil to file a signetl statement thet he or she is licensed pursuaN to the provislons of the Contreqore License lew (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Gode) or ihat he or she is exempt ihe�efrom and the basis for ihe elleged e:emp�ion. Any violetlon o� Section 7031.5 by any epplicent for e permit subjacts ihe epplicant to a civil penalry of not mare than five hundred dollers ($500).): ❑ I, es owner of tha property, or my employees with wages as their sole compensation, WIIL DO THE WORK, end the structure Is not Intended or oflered for sale (Sec. 7044, Busioess aatl P�ofessions Code: The Coalrectors Lice�vse Law does ool appty to an owner of property who buiWs or improves thereon, efW who does such work himselt ar herself or in�ough his or har own employees, p�ovidetl thflt such improvements ere not intended or oHered for sele. It, however, the building or improvement Is sold wilhln one year of completion, ihe owner-builder will have ihe burden of proving that he or she did not build or improve tor puryose of sale.). ' ❑ I, as owner ot ihe pmperty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTHACTORS to constmct the project (SecJ044, Businass antl Professians Code: The contractors �Icense Lew does not apply lo an owner o1 property who bullds or improves ihereon, end who conirecis tor such proJect wlth a contractor(s) license pursuent to the Contractore License Laws.). ❑ I em exempt under sec. Signature: Owner ID varified by driver'S license. ❑ Yes ❑ No Business and Professions Code tor ihis reason: Venfication oi Ownership by (rype of document, i.e. � propeny tax blll or deed): Driver's License No. Dete: Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ 1 hereby certity that no eccavation five (5) ur mare feat in depth i�to which a person is required to descerW, will be matle in connedion with work authorized by this permit, and that no buildinq structure, scaftolding, falsework, or demolition or dismantling thereof, will be more ihan thirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Atlministrative Code). ❑ As owner-builder, I will not emplay anyone to tlo work which would raquire a permit from ihe Division ot Indus�rial Sefery, es noted above, unless such person hes e permit to do such worK �rom the division. Siqnature: Da�e: Division of Intlustrial Safery Permit Number. CERTIFlCATE OF COMPLJANCE AND AllTHORIZATION OF ENTR�: I certiTy under penalty of perjury that I have read this epplicalion antl state that the informatlon given is correcl I agree to comply with ell state laws end ciry orEinences releting Io building construction, and authonze representatives of tha Ciry of Coste Mesa ro enter upon ihe ebove-described property fof inspection purposes. I agrea not to occupy or ellow occupency ot eny building euthorized by ihis permit uMil tinal inspection. COUE t. INSPECTIONflPE � PLTE UIDi1BLS 1616 Fixetl System Final Fire Prevention 7266 200 201 202 203 204 Pool Spa Final Finel Re-Roof Final BIocWReteining Wall Final Fectory Fire Place Final Sign Final Demoli�ion / COOEf INSPECTIONTYPE �206 FinalMechanical 20B Finel Plum6ing 210 Finel Electrical 212 Finel Flre Preventian 220 � Finel Planning Approval 222 Final Site 250 Final BuildinyOccuoanc "( `7 'V �o Date � PAIE INTITIRLS C� � (714) 754-5273 • FaX {�ia� �sa-asss Job Address: 938 AZALEA DR Suite: Vicinity: Parcel Nunmber: 47221207 CITY OF COSTA MESA BVILDING DNISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning: R1 R1 PERM}T NUMBER / �[ 99-01217 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 08/04/1999 Issued: OS/04/1999 Applicant: CLAYTON , MAT ISSUED BY: �L Address: 00833 W 17TH ST - - � � �%�r: :` '- r� �- � � Owner: Address ,'_,+ / ,�� '�,.'' f� � L �, � ' � _Zip: ) " / t �.� � � Phone: � 949-646-7884 �--� 1- . \ COSTA MESA CA�j � �� Zip: 92627 � : =,!�j �� , � � i �� r . � .-� -• , � . . ,, , � DICKERNTAN,�YOSHIKO �, � - �' � 938AZALEA.DR�� -��,�) - .� �- � , � � �,� �� ;/j / � ,. � � -'�. ��_ Phone� -" �� •- � _� `- � 'J �� COSTA�MESA CA�, -%�- "" Zip: 92626 � t ti, � ., `��./ ' i% AA� 1� ( � �.� ..�'� �� V � l� � A�� '*:,� CL'AYTONROOFING �� `'u �'� ' �� 5 �� , � A �� 00833 W 1,�H�ST `��,/ �,�� \\ � � �� r Phone:M 949-646-7864 ��`�� / ` \�"; � /.L :� COSTAMESACA % �;��;� ' `- '�� ii�i A' 928Dj Licensei � 601226 i . - ': � �� A � t / �.� �'�� , ,/Y': ... �:.- .. .... ' - - ,�� ,�= -1;A ,.� � r`Arch : %��-�� P'�. � , , l / ,Address; � ,' � � , � - ` � ,' �.' �'� � .( . ,'`. �..��.: . . / / . Phone . 1� / ! ( I � � �� y�� , j '� Zip �.,, � . � , �L7cense: ,i �4'� �� , ' � , / _ ; ' ,�'` ; , ! ; - � SCOPE OF PERMIT . , , �� y.�: V �� REMOVE EXIST. COMP. SHGINGL'ES;ANDiREROOF WITH SAME, 25 YR AND 3008 FELT. � �� I11� i . �y� .. _ . ", _... _. _. ._.._ _ � . _. �._.. . - l,� ��, � �., 1, FEE SUMMARY - P�lan CNecK� � $0.00 � _ �� ^ Calc Valuation: �� i � ��, . , Permit i� '` $87.25 '^ _ \ "r �.' _ r �� i`�� _' > - Claim Valuation: �,- r � ;j' SNIIP Res t�,.; $0.50 � - - � < % ' %i � \ ��SMIP Com.`. �'�' $0.00 - _ J . ,�-� �,�,', `�Other: '' ; $0.00 ' � — - � %' � � �`�Inspection �; `z$0.00 � � .. . . . _ � _ � � • ,, ; � � � ��- . �� -- -,t G'�.' �� A1�� . �� 1'� �\ ra • . � `�`� Total � $87.7,5 � , � -�� V ' � ��. � ' -, �� . �._. �i �. . . . � 'j,; �. - Eng: ' Address:, _, Zip: . � � � ,. � �� \- ��, ;� ��' r„�`, � '`�r Phone; �. � � �- � �``. . . �.� 1 � � \ � `'� License: � 4 � ,�. ,,,,.,,. PLp . � �. � �� , . ;�- . SETBACKS� �; � �� - r V �j�. , � � � MAIN STRUCTURE;Front� .0-0 , ' �:Rear. � 0-�0 . _� ' � _ � � � � � ,-:, ACCESSORY � F,ront�- 0- 0� ',Rear , 0- 0 PARKING Existin : 0� ` Requir'ed: -' 0 NOTES: Left / i i . i � �_' i � „ -$3,500�00; $3;500,001 " �.t� � -� l,v/ ' ,� ,'.�, r ��„' � � G��. � ZONING . ��,� .� ; �'�- �� \ -� � �; •_ . �L ^i `� ��/ �' //'�%�/� /f. { � / . � , � � -0- 0 � -Right � 0 0; ;;� ` /�, / Left 0- 0 Right �"�0- 0;'� �� <'/. i .'ProPosed: �0 ' �J , � r „ ', , . , .� . NOTICE: The work authorized by this permit shall comply with all applicable handicap accass requirements under California statules 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 780 days. � INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all requfred Inapectlons and flnel approval must be obtained. Failure to obtain inspeclions and final approval will resull in the ezpiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 WOflKERS' COMPENSATION DECLARATION: I hereby eflirtn under penalry o� perjury one oi the following decleratlons: -� ❑ I hava entl will malntein a certificate of consent to self-Insure for workers' compensetion, es providetl fo� by sectlon 3700 of the Lebor Code, far tha paAormance of the for which this pe�� Is Issued. have entl wlll maintein workers' compensetlon Insurence, es required by sectlon �3700 of the Labor Code, tor the performance of ihe work tor which ihis pertnit is issued. y workers' compensation Insurance carrier antl policy number are: Cerrier: ar less.) Policy Number: I certify that In tfie p0rtormance ot Ihe wotk for which this permit Is issued, I shell no� employ eny person in eny menner so es to become subject �o the workers' co ws of Celifornla, and agree thet If I shoultl become subJect to Ihe workers' compensetion rovisions of Sec'on 3700 of the Lebor Cotle, I shell forthwith mpl wi�h p o sions �j�� -��/},—�—� /� c1 a p ant Signa �- �`/" i"T ". ' �e� 'CJ `� I I l � NI . ILURE TO SECURE WORKERS' CAMPE TION CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EM OVE CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNORED $AND DOLaRE ($100.000)� IN ADDITION TO THE COST OF COMPENSATION, DNAAGES AS PROVIDED FOR IN SEGTI OB OF THE 1A90R CODE, IMEREST, AND ATTORNEV'S FEES. 6 CON qS DECLARATION: � irm thet I em ' n ed under provislp(��s of Chapter 9(commencing with Section 7000) 6f Divislon 3 of wNwrl I'r. # i� � vy "' 1 � � Code, antl my Ilcense is In full CO UCTION LENDING AGENCV: I hereby afFirtn thet there is a constructlon Iending egency for the pedormance of ihe work far which this permit is issued. (Sec. 3097, Civil Code). Lentler's Neme: Lendets Adtlress: Signafure: Date: OWNER-BUIL�ER DECLAFiATIONS: . I hereby aflirm that under pBnalty of perjury that I em E%EMPT PHOM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or counry wnich requires a permit to construcL alter, improve, demolish, or repair eny structure, prior to its issuance, elso requires the appliceM tor such permit to file e signed statement ihet he or she Is licensed pursuent to the provisions of the Contrectors Llcense Lew (Chapter 9(commencing with Section 7000) o� Division 3 of the Business and Protesslons Cotle) or ihat he or she is exempt iherefrom and ihe basis tor the allegetl exemption. Any vloletion of Section 7031.5 by eny appllcent for a permit subJects the epplicant to a civil penelry of not more than five huntlred tlollers ($500).): ❑ I, es owner of ihe property, or my employees with wages as iheir sole compensa�ion, WILL DO THE WORK, end Ihe siructure Is not intended or oHered for sele (Sec. 7044, Busfness sntl PrWesslons Cotle: The Contractws Lkense Law does not epply to en owner of property who builds w improves thereon, entl who does such work himself or herself or through his or her own employees, provitled that such improvements are not intended or oflered for sale. If, however, ihe building or improvement is sold within one year of completion, the owner-builder will heve ihe burden of proving thet he or she dld not build or improve for purpase of sale.). ❑ I, es owner ot the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruc� lhe proJect (Sec. 7044, Business and Protessions Code: The conirectors Llcensa Lew does not apply to en owner of property who bullds or Improves thereon, end who conirects for such project with a coniractor(s) license pursuant to tha Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: SignaNre: Date: Owner ID verified by drivels license. ❑ Yes ❑ No Driver's Licensa No. Expires: Venfication of Ownership by (type of document, i.e. - property tex bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' ❑ I hereby cehity that no excavatlan iiva (5) ar mare feet ln deplh Into wt�tcti a person Is requiretl to descefW, will be made in connection wtth work anihorizeC by ihis permit, entl that no huilding siructure, sceHoldlnq, telsework, or demolition or dismantling thereof, will be more than ihirty-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Title 8, Celifomie Administretive Cotle). � ❑ As owner-builder, I will not employ enyone to tlo work which would require a parmit from the Divislon ot Industriel Safety, as noted ebove, unless such person hes a pertnit to do such worK irom the tlivision. Signature: Date: Division of Industnel Satety Permlt Number: CERTIFICATE OF COMPLIANCE AND AU7XORVATION OF ENTRY: I certity unde� penelty of perjury ihat I heve raad this epplication and state that the intormetion given is corred. I agree to comply with all steta laws entl ciry ordinances relating to buliding constructlon, end euthorize representatives ot the Ciry of Casta Mesa to enter upon the above-descdbed properry for inspedion puryases. I agree not to occupy or ellow occupancy of eny bullding auNorized 6y Nls permit uoUl tinal inspectlon. CODE N. �xsvecnoxTvre �— 1676 Fized System Final F�re Prevention 1266 Pool Spa Flnal 200 Final Re-Roof 201 Final BIocWRetaining Well 202 203 204 Finef Feclory Fire Placa Final Sign Finel Demolltlon P9IE '' IMRIALS CO�E• INSPECTIONTYVE 206� Final Mechanical 208 Flnal Plumbing 210 Finel Electncel 272 Final Fire Prevention 220 FinelPlenning Approval 222 Flnal Site 250 Final Building/Occupency � �a��F � � 9 oeca r — GerF INTRIRLS ,3oi c 3866� � } COSTA MESA BUILDING-SAfETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 for Applicant to Fill in Completely BUILD�NG ___ . _ _ _. OWNER Larwin Southern Calif., Inc. nooaess 16255 Ventura Boulevard cirv Encino, California No�' 986-8890 CONSTflU ON LENDER arwin So. Calif., Inc. BRANCH 16255 Ventura Boulevard ADDRESS Encino, California ARCHITECT TEL.. _. _ _ _ _ ADDPESS 9100 Wilshire B1., Bev. Hills CONTRACTOR Lanain Southern Calif., Inc. ADDFESS 16255 Ventura Blvd., Encino TEL. CITV Encino, California rvo.986-8890 L C. No. 191311 LICVNO. B-1 SIZE NO.OF BLDGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. SIZE OF _,�„_, NO.OF „ EXTER�OR WALL ROOF COVERING SCUCCO COVERINGWOOd S}I USE OF BUILDING ANO WORK TO BE PERFOEIMED le family residence with I hereby acknow�etlBe that 1 have reed this applicetion and state that the above Information is correct antl apree to comply with all laws ragulaNnO builtling construction, antl I shall not employ any person in vl0lation ot She workmen's comDaneaiion laws of t�e State of Celitornia. I hareby certity that I am properly Itcansetl as a contractor untler the State of Calitornla Business antl Professiona Coda, Divisicn 3, C�apter 9, antl that such ' itses a�e In full torce entl effect, or I am exempt from the pr Isio s of th Stete ot CaJJJjjjttt999rnla Business entl Professions Cad , vis n 3, n pte�. // _ i �� Authorizatl Apent �� t�-7��"��00�6is�~� �•:�'•19?.52 APPLICATION FOR BUILDING PERMIT BUILDING ADORESS TRACT OWNE FIRE ZONE APPROVED �' IPlANS ' VARDSAPPqOVED DI5TANCE BET MAIN BLDGS. VAR. s� FOR VARDS API ACCESSORV 6ET. MAIN & ACCESS. BLDi D�+TE APPROVED ��/� —/ REQUIREMENT� � SQ. FT. o THE AMOUNTSMOWN UNDER VAt,VATION IS FOR ' THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: ¢ VALUATION / m PERMIT FEE $ / O � � /� /y m $39,.5'Go/ V Y PIAN GiECK $ E 'T/JY 2. �! ° FEE � .... .. ��.... .v�w.,. =�JOBADDRE5S93' A�alea Ave. �� saii ` GAS R HOUSE CON. HEqTING ANO AIR CONDIT UNDEFGROUNO ❑ POWER � ROUGH WIRING TRENCHES / FORMS STEEL REINF. FLOOR SYSTEM BONO BEAM n STEEL REINFORCE (-J SHEATHING FRAME ANO LATHING - S MI�1 COAT REFRIG. AN� A.C. ANO GAS TEST r ll\V • E vniL I�il'I� BUILDING PERMIT N0. C Res.w att.Gar. SU6CONTRACTOR . ,- + 39265 i� � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING ii'7 /� /� �] n �..' _ J a LOI' Z • aU Za ON am J � J N QW m J� J Q U� Z �. d W Wx �p my J Q W W � ZO �n G �O r � Q C.% � a a Q � r m Z O V � � F" z OWNER CITY�(J�/h�'�j.% �Q�QC-✓� N�` CANSTRUCTION 1 n /1 , . � � BRANCH ADDRESS '��'d?t-�4�'`=�0QO ��ti=* e<,rsk�;5.5Q r,nsr APPLICATION FOR BUILDING PERMIT � RECEIj/��V D!�%E REGEIV DAJ/E� ISSUED �� o^ i ! /' a�� % , A.P. NO. �.Z ' e7I 3� O 0 I D AODRIE S/ 3 ryZnLM/�L il�i TRACT %SS% LOT.� CONTRACTOP (� �� ( (J ��_ ADOFESS TEL. CITV NO. STATE CITV LIC. NO. LIC. NO, SIZE NO.OF BLDGS. OF LOT NOW ON LOT USE OF EXI5TING BLDG. SIZE OF NO. OF NEW BLOG. ROOMS STORIE', EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFOflMED .n. i . � ...� OWNER FIRE ZONE �i N PI YARDS APPF MAIN BUIL (FFOM C/L STR DI5iANCE MAIN B�D vaR. �f` QU.P. # i VALUE a��„� 7E USE OF N � BUILDING � I �fereby s�'knowledga thet 1 have reatl this application antl state � that the ebove informetlon is eorrect and apree to eomply with ell lews regulating building co�ztruction, end I shell not employ � any perwn in violetion of the workman's compensation laws of tna Stata of Californla. � hereby certify thec I em properiy licensetl es e cont*actor untler SQ. FT. the Steta of Celifornle Bueinass and Profasaions Cotle, Olvlsicn 3, THE AMOUNT SHC Chapter 9, antl <hat such licenaes ere In full force antl effeci, or I THE PURGOSE OF E em exampt from vlcions Scate of Calif /N a Buainess VALUATION entl Protessions e, D isian , Chapter 9. � Slpnetureof �%)D / Permlttee _ $ � AuinoN:ed qpent w a JN UNDEF VALUATION IS POR �� ABLISHING A PERMfT FEE ONLY: Q a '� N PERMIT FEE $ ] �_ m PLAN CHECK $ E o` S� LL TOTAL FEE $ U'/IIVCK iu�a�11�� unriu DATE 11�G1-�'F JOB ADDRESS 93 Azalea Dr. BUILDING PERMIT I SOIL GAS W ATER AOIIGH PLlIM61NG PROP. SWF. LINE Q MOUSE CON. � SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AN� AIR �ONDITIONING UNDERGFOUN� � POWER � ROUGM WIFING TRENCHES [� FORMS STEEL REINF. FLOOR SYSTEM BON� BEAM [� STEEL REINFORCE ❑ SXEATHING FRqME AN� FLASHING LATMING — IN n 01 PLASTER, BROWN COAT 5� TURAL, FINAL N\ AG, VENT., REFHIG PLUMBING, FINFL AND G ELECTRIC, FINAL BOILDING, FINAL DESCRIP TRACT FIRE Z01 SUBCONTRACTOR r� 2RACT NO 2AT NO CI'. JF COSTA MESA REQUEST FOR OCCL 1CY DATE � / � The developer of the above entitled tract desires to aell the above set forth lot prior to tha time that the tract has been completed and ita streeta accepted by the City af Costa Mesa. The under igned, by executing this agreemen:, acknowledges that ..�he-ahe�they) were) t�-�_ advised that this tract has not been given a inapection nor has it been accepted by the City of Coata Mesa ae having camplied with the conditione of approval which were imposed by the City at the time the final tract map was approved. The City assumea no liability for the enforcement of the conditions neceaeary for approval other than those conditions protected by sure[y bond. The undersigned agrees to'indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. �9�fi��7 t�Z[h ��6�8� ��6 �i �3Q 'ld�a L�... . �d VS3W WSO� �0 AL� a3n�3�3� $Y S � Purchaser > y --- sx �'��'(`�-�_�� .�Ilt=� ,-«��,� Developer and or au[horized representacive BY ��i � c.Gf �. , � C��2�. Lender