HomeMy WebLinkAbout980 AZALEA DR - Building Permits(71d) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 980 AZALEA DR
Suite:
Vicinity:
Parcel Number: 41217106
Applicant: NGUYEN, CUONG
Address: 14351 EUCLID ST
Zoning: Rl R1
Phone: 714-545-6994
GARDEN GROVE, CA �- Zip: 92843
owoec NGUYEN;THIEN DO ,
Address -1922�WESTMOORE AVE - . �
- � � � Phone: � '
�SAN`fA ANA, CA " - Zip: 92704
Contractor. VILLA ROOFING PROFESSIONALS INC
Address: 14351 EUCLID ST #E
Arch :
P,ddress:
Zip:
Phone:.�(774)545-6994
GARDEN GROVE, CA
Zip: 92843 License:- 758361
Phone:
License:
TEAR OFF WOODSHAKES. RESHEATH, COVER
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$111.25
$0.50
$0.00
$0.00
$0.00
$111.75
$ETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Reauired: 0
Eng:
Address:
�OPE OF PERMIT.
30 YEAR COMP ShiINGLES. •
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Status: ISSUED -
Applied: 07/22/2002
Issued: 07/22/2002
ISSUED BY
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
Phone:
License:
Sa,zoo.00
$a,zoo.00
NOTICE: The wofk authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This peimit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 780 days. �� - . . .. .
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work musf comply with all applicable codes, and all
�equired inspeetfone and flnal approvet must be obtained. Failure to obtain inspections and finaf approval will resufl in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 � _
zaasas (s�oo)
WORKEHS'COMPENSAnON DECLARAnON: � �
I hereby aHirm under penalty of perjury one ot the tollowing declerations: ,
❑ I heve end wlll main�ain a certificate of consent to self-Insure for workers' compens�lon, es`pilrvided for by sectlon 3700 of Ihe Lebor Code, for the peAormence of the
work for which ihis pertnit is issued.
�oI ha end will mairi n warkers' compensetion insurence, az required by seclion 3700 of Ne Lebor Code, for the perfortnance of the work for which Nis pertnit is issued.
rkers' comper�atlon Insurence cerrier and policy number are:
CerHer: policy Number:
(Thls section need not be completed!/ fhe permit Is velued at one huntlred dollers ($f00) or less.)
❑ I certity that in the pertormance of the work tor which this permit is issuetl, I shall not employ eny person in any menner so es to becoma su6jact to the workere'
compensetion lews oi Celltomia, entl egree thet It I shoul0 become sub�ect to ihe workere' compensetlon provislons of Sec on 3700 o the Lebor Code, I shall forihwlth
comply with these provisions. � ��
Applicent Signeture: �� Dete:
WARNINO: FAILURE Tp SECUflE WORK ' E ATION CO RAOE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES ND CIVIL FINES UP TOONE HUNDREO
THWSAND DOLIARE ($100.000). IN A N�THE COST OF CAMPENSATION, DAMAGES AS PFOVIDED FOR IN SECTION 7)pfi OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby eHirm that I am�licensed und�r 519
force end ettect Lic. # a
Contracrofs Signeture: �.�a�
9(commencing with Section 7000) of Division 3 of the B
Cless #
r Date: _
Code, end my license Is in full
CONSTRUCTON IENDING AGENCY: �
❑ I hereby aNirm ihet there is e construction lending agency for the performance of ihe work for which this permit is Issuetl. (Sec. 3097, Civil Code).
Lendar's Name: Lendefs AdAress:
SIg�eWre:
Date:
OWNEH-BUILDER DECLARATIONS:
I hereby aHirtn t�at under penelry of perjury that I em EXEMP7 FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons
Coqe: Any city or counry which requires e permit to consfruct, elter, impmve, demolish, or repair eny strucNre, pnor to its issuance, also reqWres ihe appllcani for such pertnit
to flle a signetl statement thet he or she is Ilcensed pursuant to the provisions of the Contrectors Llcense Lew (Chapter 9(commencing with Section 7000) of Divlslon 3 of the
Business end Professions Code) or thet he or she is exempt therefrom end the besis for the alleged eaemptlon. Any vlolation of Sectlon 7031.5 by any epplicent for e pertnit
subjeds the appliwnt to a civll penalty ot not more than tive hundred dollere ($500).):
❑ I, es owner of iha property, or my employees wlth weges es thelr sole compensation, WILL DO THE WORK, end the slrucNre is not intendetl or oHeretl for sele (Sec.
7044, Business and Professions Code: The Contractors IJcanse Law does not apply to an owner of properry who builds or improves thereon, end who does such work
himself or herself or Ihrough his or har own amployees, provided ihet such Improvemenis ere not Intended or offered for sale. Ii, however, lhe building o� improvement Is
sold witnin one year of completion, the owner-builder will hava the burden of proving that he or she did not build or Improve for purpose of sale.).
❑ I, es owner of Ihe properly, am El(CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business entl Professions .
Coda: The conirectors License Lew Ooes not epply to an owner af property who bullds or Improves ihereon, end who conirects for such praject with e coMrector(s)
license pursuant to ihe Contractors License Laws.). ,
❑ I am exempl Under sec. Business and Professions Cade for this reeson: -
Signature: Date:
Owner ID verified by driver's license. ❑ Ves ❑ No D�Ivefs License No. Expires:
Verificetlon of Ownership by (type of document, i.e. - propar�y �ax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity that no excavetion five (5) or more feet In tlepth into which e person Is required to descend, will be mada in connection with work euthorized by this
pertnit, and that no building strudure, scaftolding, falsework, or demolition or dismantlinq thereoi, will be mora then thirry-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec.
341, Tltle 8, CalNomia Administretive Code).
❑ As owner-builtler, I will not employ enyone to do work which would require a permit irom the Division of Industnel Satery, as noted ebove, unless such Derson hes a
permit to do such work from the division.
Signature: Date:
Division of Intlustnel Satery Permit Number:
CEpTIFlCATE OF COMPLIANCE AND AUTHORRATON OF ENTBY: I certify under penalty of perjury that I hava reatl this application antl state that the Infortnetion given is
correcL I egree to comply with all stete laws antl ciry oNinences relating to building construction, end euthodze representetives of Ihe City of Caste Mesa m enter upon ihe
ebove-describe�rty for Inspedi puryoses. I agree not to occupy or allow aapency of eny building euthorized by ihis permit until finel inspedion.
Y� vIC�
oGCD,�� ��G�i�`'S�/ � � Z 0 a�a
AncVOr Authorized Applicent Date
GOpE � INSPECTONTYPE
1616 Fixed System Final Fira Prevention
1266 Pool Spe Final
200 Final Re-Root
201 Finel Block/Retaining Well
202 Rnel FaGory Fire Place
��3 Finel Sign
204 Final Demolition
P67E ixrrtu�s
���
CODE� INSPEGTIONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel Elecirical
212 Finel Flre Preventlon
220 Final Planning Approval
222 Final Site
25o Final Building/Occupancy
PdI€ iNIQ19LS
� Applicant to �ill in all spaces within heavy DorCer lines antl sign all appropriate tleclarations. "
GTY OF COSTA MESq ' ae 1Y O. TRACT NO. � �- LOT R10. BLDG. NO. " - ' -' "
CONSTRUCTION PERMIT ���. 9� 4710 4! I 6/02 .� I.9�!+7 7L�
Project Address D � Z L� TYPE OF CONST UCTION "' 3� ' '- �
' OWnEf G PhonC .0 ❑ NEW �D ❑ ALTERATION ' - - ' - . ' .
�AddfeSS �/�J � " ❑ REPAIR ❑ CONVERSION' ❑DEMOLISH �� .
� Arch/En � " ❑ OTHER � - � ' ZONING REGULATIONS �
` , g.'^'� � License No. ,_ .. - . �
'� Add�e55 � DESCRIPTION OF WORK• P"P' � � �
\ " _ ' ' 6 { ' .• . � ZONE _PLNG. REF,� .
�b j�Contrector 'r' L� hones'S7 �f TVPE OF PERMIT -D TpgU t pING �
� _ __ r' ' ,}, � � SETBACKC L T. PROPE�TV LINE• ' '
� , Addless / �� � �- � �/ . - ❑ GRADING . ❑ FOUNDATION - 1_75TRUCTURAL SIDE VARD �- -- ; " - "�
1 WCENSED CONTRACTOk DECILARATION -" ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA IDE YA ' - - - � - - '
�, I hereby, afflrm th:.t I am Iicansetl untler provisions af Charter 9(com- . . -: -��� � � RIGHT �' '
mencing with section 7000) of .Divislon- 3 ot tne Bu6lness antl '� OtHER" ` - •qEAR VARD (TO P/L)
Protessions Cotl any my Ilcense is In full for e ntl fiec . pROJECT DESCRIPTION
Licens lass � LiC se � ,� � . ~ ' �PKG.SPACEREQ. PROVIDED
Date _ ' � Si9�ature _. . , � SQ. FT. -; ' _ �"" . .. . . " '
OCCUPANCV�� CONSTRUCTION TVPE. STREET WIDTH •-PARK FEE $^
WORKERS' COMPENSATION'OECLARATION - ' " ,y�• ' ZONING APPROVE��BY �ATE -
I hereby.affirm that I have a certiiicate of consent to sel i or a' VALCIATIOM �� S�'nQONE � "� � �� '
certitiwte ot�Workers'�Compensabon'Insurance, or'a c rt ie0 copy i- � ISPECIALCONDITIONS:
thereof (SecUoq 3800 la¢, C.). � �-c ^ GRADING�CU'. YDS. ACRES '
� INo. �/9/n%9-$�7 romPanYS�al6�.�%'�T. ' ' _ ' . " ' ' __ _. _ _ ` _ _ '
zrtitled copyis hereby Yumishetl.- - � • -- - - - REMARKS: ' - - - � - � - - - � .
r Itied copy is tileG with the city Builtlin9 Division. �� �� �� V.�T
EXEMPTION FROM WORKERS' COMPENSATIOr1 DECLARATION �� `� � � - � � ' - �
(This-settio� �eetl•not be ComplateE�if the permit is Sonone huntlretl . .. . _ _ _ . . . ,_. _ ._ _. _ . . _ . �,� ` �� � �
(E300) or less). i . � - ' � -
I C¢rtify that in-the p¢rtorry�ance of the work for Which thiz permit i5
issuetl, I shall not employ any person in any manner so as to�become PLUMBING(�• ... PLAN CHECK ��ELECTRICAL � � PLAN CHECK -
subject to the Workers' Corqpensation �Laws of California. - - ' _ _ . . _ _ _ �
Date Si9qature BATHTVBS SHOWERS � � �
NOTICE: If atter making this tleGaration, you shoultl become-subject TOILET,S' � 'URINAI'.5- � �- GENERATOR � 0-1 KW�1d0 KW , ��
to the Workers' Compensation provisions of the Labor Cotle, you must __., _, _ _ TRAIVSFORMER � � �
forthwitn mmpry with such provisons or Ihis perrriit shall be tleemetl LAVATORIES DOUBLE LAVS .APPLIANCE '30-50 KW 50 + KW ' .
ievokatl.. . " • "'_ . - _ _ . _ . . . - _ " " "
CONSTRUCTION LENDIryG AGENCV KIT. SINKS DISHWABHERS r' � MOTORS� - '0-1 HP�_1-30 HP " -'
1 h¢reby affirm tbat there i5 a mnstru<tlon lentlin9 ag¢ncy for the per- SERV ICE $INKS { �� SUMPS '' �- (INQ SOI:AR) - 10'-50 HP�50 +�HP`- - I
tormance of_the.work tor N.hich tbis_permit is issuetl (Section 3097 • �`� � `�� � � ^ � �
Civ. C.). '�O,v� FLOOR SINKS � FLOOR DRAlIVS ` � �� FIXTVRES - OUTLETS � �SWITCHES ' -
LentlerJs Name.
Lentler'sAtltlress DRINKINGFOUNTAINS .� � r - - 'GASTUBESIGNS ' � '� � --- - '" " '
OWNER BUILDER DECLqRATION � INTERGEPTORS CLARIFIERS� POLE LIGHTS - - - " ` ' " -- �
Lhereby affir,m that I am exempt fromlhe Contractor'S License Law for � �•�� ,
the followin9 reason (Section 7031.5"Business antl Protessiohs Cotle: SWIMMING POOL PTRAP - - ' - " - ' ' ' ' - '�
Any ci[y or.,county whiCh reguires a permit, to construct, alter, �POLES METERED ^•SUB .
improve, tleinolish or repalr any structure, prbr to its issuance, alio re= yyqTER SERV ICE ALTERATION . � PANELS - MAIN SUH -� ' .
quires the,ap:licant for such permit to file a signetl 5tatement tnat he
is licensed pursuant to tne'providions ofThe Contractoi's License 1..aw GAS SERVICE OVTLETS ' �SERVICE " - 'AMP
(Chapter 9 (commencing �yith, Section ']000) of Division 3 ot the _ - � . _ _ _ _1
Bu<xhess antl Profes5ion5 Cqd¢) or that he is exempt theref�0in aOtl the y./qTER HEATEFS BTU OUTPUT' .
b��w�Y�;.,�or th6 allege0 exempHon. Any viold[ion of $eCtiOn 7031.5 by � �
a,„ '�;'-PP���ht for a pErmiF subjetts the applicant to a civil pendlty SEWER CONNECTIONS �� � �� � -� ��-` -� �"� � -. � j
C'. �2 ,mOre than five_huntlretl_Gollars ($500)_ _ ' ' '
� : . .. _ . _ _ _ . . _ ' _ " _ _ " "' ' ' ' ' " _" '
❑ I, as owner ot the property, o� my employ¢es with wages as their SOLAR TANK COLLECTORS ' "�� "' --� - � ' -�
sole-compensation, will tlo the work,.antl�the stwctU�e�iS not intentletl _ ,i
or offeretl for sale. (Sec[ioq 7044, Business antl R'ofessions Cotle: The SOLAR PIPING SYS. ISSUE FEE -" -' � --�- -` "'
Contrattor's-License� Law-tloes-not-apply to an owner ot a property ' - -- 1qppLICATION'.4PPROVED BV' '-'- OATE
who builtls or improves thereon, antl who tloes such work himself or ISSUE FEE ' i
through his owmemployee9, p�ovitletl-that such-improvements are not _
Intentletl or ofieretl tor sale, If, howeveq the builtlin9 or improvement MECHANICAL PLAN CHECK � SUMMARV OF FEES_ �-•
is soltl within-one year of Completion, tM1e.owner.wlll M1ave the.burtlen � 'BUILDING " v-' �
of proving he tlitl not bUiltl or improve for the Purpose of sale). HEATING SVSTEM 0-300,000 BTU � IPERMIT y �S � �SMIP.. y ' S� �
❑�I; as bwner-6!'-the'p�operty, am'exclu5lvely"contrac[ing wit� qryDOUCTIIVG ^ � � ` -- � ' '-' ' -
licensetl con[raptors to coqstruct the prolect (Section ]044, Businesz 100,000�+ gTU � 'PLAN CHECK $ ' RERMIT �..� �!,^
and'Pr6fessions "CoBe[ The Contrattor'sticense"Law tloes noYapply to ' - - - - - - - -- -• t55UANCE y - - ��
an owner of propercy who builtls or improves thereon, antl who con- REFRIGERATION 0-100,00U BTU 1 �PLUM8ING $ i v �- -� .,t.
tra8i from such projecls with'a' contractor(s) liresnetl �pursuant'to - SVSTEM '- " - ' ' - " � -- - � -- GRADING � �$
the Contractor'S License LaW). 100,000�+8TV ' - i � �� � ` �PLAN CHECK S . � � _ �, ' , ��,�
❑ I am exemPt untler Section B. & P. C. for this BOILERS BTU � a
ELECTRICAL $
reason � - - . - . MICROFILM y
SVSTEM REPAIR� ALTERATION PLAN CHECK $� �
Date" ' 'Owq¢r ' ' - � - - • -' � � - - � _ . TOTAL PEE y '
I hereby certify tnat I have reatl this application antl state [nat the above EXHAUST SVSTEM MULTIP�E �MECHAN�CAI. E�
PLAN CHECK` E" �- LE55 A�='
informatlon is correct. I d9ree [o comply with all city anG county � i _ --- VANCEPC g_ -
ortlinances.antl 5[ate laws relating to construction,.antl. hereby authorize. -
representat tnis city ente upon the above mentionetl ' � '
property for i cti p . , �� ,
Signature ate��� _ - - . .. FINALFEE $ ��
Drivers' License or 55 � �SSUE'FEE - ' � - - � • �
CMF 0865-46 Whit¢-Builtling; Cdnary-Applicant; Pink-ACCountin9: Goltlenrotl-A55esso�
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CUT N� �A�'1R5
STRUCTURAL APPRONAL ONLY
SEPARATE PERMITS ARE REQUIRED
FOR ELECTRICAL, PLUMBING,
HEATING, VEIVTILATING AND
REfR{GERAT���� 1d'^ .;:
���._��t� �!.3 3��.5'
THlS NUiviBER f';tlST ACCOh1PANY
ALL IRSPECTIDN REQUESTS
'' F6Z d�:LDiiS�S YWHERE P�RSOAS ARE TQ
�BE EMPlOYED, 6�iE SUG6EST THAT TFIf
STATE OF C..iiFORNIA �lVISIOfd Of
�; iNpi!STRIAL SkFEiY 8E COP�SULTED FOR
; _ADai7lONAL REQUfREMENTS. _--
�rr#�M�ti'v`.
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S�,r�.,c�yt �" u�,rrE�=� � ;
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APPR4V�D ' ��
` City ofi Coste+ Mesa Buitding Dept. �,
TNESE PLANS MUST BE ON JOB AT AlL TIMES
' MAKE NO CHANGES WITHOUi PRIDfl A4PROYAL
OF DEPf.
TNE ISSUANCE OR GRANTING OF A PERMIT OR APPftOYAL
Of PlAlJS AN6 SFECtFICATiONS SHALI N0T BE CONSTRUED
TO BE A PERMIT FOR, OR FlN APFAOYAL Of, ANY VIOIATION
OF ANY Oi THE PROVISiQNS OG THIS CODE, Np PERMIT PRE•
SUMING TO 6tVE AUiNORITY TO VIOIATE OR CANCEL THE
PROVISIONS OF TNIS CQDE SNALL BE VALID, EXCEP7 IN SQ
PAfl A$ THE WORN OR USE WHICH Ii Au7HORIZES IS LAWFU4
TNE ISSUANCE OF A PERMiT 9ASED UPON PLANS qNC
8P�CIPIOaTION$ SNAII NOT PREVENT THE BUILOING OFFICtAL
FR6iA fiM�R�A��R REQUIRiNG THE CORRECiION DF ERRpRS
IN bSIB P6AMS 9ND SFECIFICATIONS OR FROM PREVENTING
BIN�IHG �BEflATiONS BE1NC CARRIEO tlN 2HEREUNDFR WHEN
(N VI�iAfiIQN CE )MIS CODE OR Of ANY 67HEA pRD1NANCE
0� iHE 61i1�
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301 CR COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING
ADDRESS
OWNER �RWIN SOUT RN CALIFORN71
.M000Aess 16255 Ventura Blvd.
TEL.
CITV p.,,,..,,. I��1 ; F NO.1
BRANCH 16255 Ventura Blvd.
nooaess ���e�a��€. 9���6
ORENGIN ER LARWIN SO. CALIF. NO�2%3-
ADDRESS 9100 Wilshire Blvd., B. H.
CONTRACTOR Larwin Southern Californ
ADOFESS 16255 Ventura Blvd.
TEL.
cir� Encino, Calif. NO 986-
STATE CITV
LIC. NO. 1(Jl'3 � LIC. NO.
oF ior 60 x 100 n�iowoN �o'
SIZE OF 1987 sf
NEW BLDG.
EXTEFIOR WALL
COVERING Stl1CCl
USE OF BUILDING AND
NO. OF
ROOME
ROOF
Single Family Res./Garage
1
I hereby acknowletlge that I have reatl this application antl state
that the above intormation is correct antl agree to comply with
all laws regulaiing builtling eonsttuetion, and I shall not amploy
any person in violation of the workman's compensation lews of
the State of Celifornia.
I hereby certify that I am properly licensed as a contractor under
ihe State ot California Business and Profassions Cotle, Divisicn 3,
Chapter 9, antl thai such licenses are in full force antl effect, or 1
am ezemp2 from ttie provisions of the State of Callfornia Business
and Professions C Oivision 3, Chapter 9.
Stgnature of
Permittea D. DOWTIS
a p�
Authorizetl Aeent
JUL —S'73PA'OOO 2eo� *** 173.40
LHSF
APPLICATION FOR BUILDING PERMIT
FE �IVF� BY DATE RECEIVED D TE ISSU
/✓J- /_ - Jn_ 7�, �i c
A.P. NO.
BUILDING �
AODRESS
TRACT
OWNEF
FIRE
ZONE
APPROVE
`� LOT � BLO<
i _
VALUE
$
'E � GROUPy S
� /
DATE� �7 �
NO.OF USE OF �
PLANS 2 BUILDING
VAFOSAPPROVED VARO
MAIN BUILDING ACCES:
ROM GL ST$EET)
DISTANCE BET.
MAIN BLDGS.
VAR. #
C.U.P. #
APPROVED
—2
HOLD FOR SPECIAL
e
SQ.FT. � o
THE MOUNTSHOWN UN�EF VAIUATION IS FOR �
THE PURPOSE OF ESTABLISHI G A PERMR FEE ONLY: Q
VALUATION �?O m
3�/��. � � PERM T FEE $ � �
/ �'Yl!/ � �� m
$ �' Q� PLAN CHECK $ � E
` � `o
/� LL
TO AC FEE $ �
�,I � �'"' ..
� .�
COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use lnk Only
a���o�N� A�0.1e
ADOFESS
OWNER / 1�' �0.\rv� o Z`1'
MAIL ��O Az�,lea
ADDflESS
CITV \._AC�..�. ��PCi] NOLSS7�3
BRANCH
TEL.
a1 1
CONTRACTOFi�O�,. -'�,,IMa.� ^ a SC
0
ADDRESS `Q^3� ��V�t l��Q•
CITV �(,Lr- .h G J Q NOLS3I'
F f�
`°c LIC.NO. 3 v��� � LICVNO. �2(
{�xCj SIZE NO.OF BLDGS.
�.. OF LO7 NOW ON LOT
a USE OF
.,N. EXISTING BIDG.
y
FSeparate permits are required for
q electric, plumbing and heating work.
� USE OF BUILDING AND WORK TO BE PERFORMED
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� I hareby acknowletlpe thet I ha�e �ead thia applicetian antl state
a that the abova Informetlon is corract antl a0�ee to comply wlth
� all laws rapulatinp buildinB construction, antl 1 shall not emp}oy
z any pe�lon In violetion of the workman's eompensation laws of
� tha State of Californla.
3 I hereby ce�tify Mat I am prope�ly Iicensed as a contractor under
the State of Callfornia Businesa end Professions Code, Dlvision 3,
Chapttr 9, antl t�at such licenses ara In full force end effect, or I
am exemPt from the provisions of the Siets of Celifornia Business
end Profassions Cotle, DWlsion 3, Cha�p` tar 9.
SiBnatura of/� `�', `A/_", _�,�
Permittee t� (r(.1� Z �i"Uvnrv�
.�
Authorized Agent
PHIL
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FORSTRUCTURALPERMIT
DATE RECEIVED ..�r� ��c� �«
BUILDING
ADORESS
OWNER �• L
SE
FIRE
ZONE T
APPROVED
BV
Z NO.OF I
l PLA
VARDSAPPROVED
:I
BLOC
DATE � /
USE OF �
BUILDIN
YARDSAPPROVED
FT.
' BEf. MAIN &
4CCESS, eLDGS.
DATE
APPROVED
1 /'P - - -- /_ /r�
THE AMOUNTSHOWN UNDER VALUATION IS FO
. THE PURPOSE OF ESTABLISHING A PERMIT EE ONLV
VALUATION � PERMIT. FEE $ e
$ �r PI.AN CHECK $ �_
TAX $ .� �
TQTALPAID y
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OWNER CAIiPB$I,L, GuY S. DATE �_77-77
108 ADDRESS 9&0 Azal ea Drive BUILDING PERMIT N0. �z�� �
SUBCONTRACTOR
ROUGN PLUMBING
PNOP. SWF. LINE � H045E. CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGN HEATING RND �IR CONDITIONING'
UNOERGROUNO U POWER
ROUGN WIRING
SHE�THING
FRRME ANO FLASHING
LATHING - IN n
FINAL ANO
FINAL
FINAL
�
TRACT N0. / S S 7
IAT N0. / .3
- 4 +A6". a�u.�n� +i_.�Vh+� � by\.l:
. . . � ,3 � � . .
�'
DATE_����� / ' �
The developer of the above entitled tract desires to sell the above aet
forth lot prior to the time that the tract has heen,campleted and its streets ,
accepted by the City af Costa Mesa.
The undersigned, by executing this agreemen:, acknowledgea that
(he-she-they) (was or were).�C�/,�Q/ advised that this tract has
pot been given fin^�ection nor has it been accepted b the Cit of Costa Mesa
Y Y
ae having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
e
The City assumes no liability for the enforcement of the conditions
riecessary for approval other than thoae conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim reaulting in damage or personal injury to the underaigned by reason
of the aforementioned uncompleted candition.
REC IV �
CITY OF' OSi� . ESA
� vn n _DT
� pr1.. 197�1
7,s, ,io,u,��1� �a���"E I V E �
� CIT.Y OF ,COSTi\ M�SA
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PM
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BY � � �
P ser
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sY ��< <. �?-, c_Z.�n �i�l�-�„ L�c , �
Developez and(or authorized
represei�tative
BY ����i,i 1,� .,<,�,z*�
ender ,
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