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HomeMy WebLinkAbout690 RANDOLPH AVE - Building PermitsV digs CITY OF COSTA MESA 0,,!II 4% CALIFORNIA 02626 P.O. BOX 1200 )' 1"1-St 1w F ti. * •� FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY • yC°RPnWfEO lfA Project Address a 676 ?4N p0 L 7 .2.0r Permit # i--8z_ Project Name 'Type Owners Name J 0 F41'/ 1, 5'co// Owners Address 60 Lp4N 77,,2, 7/../ City Use Only Owners Telephone 6-4-9 - 55-33 ' D i I t� . as Owner, Contractor, Agent (strike out all except .'e) do hereby attest that employment of any person, or persons, is not antici.Si ed at the time of seeking the above-referenced permit. In the event that any per.. , or persons, are employed under the provisions of this permit, I shall inmediately cause a valid Certificate of Workmen Compensation to be filed with the Costa Mesa Building Division. I agree to defend at my awn oast, and to indemnify and hold harmless, the City, its officers, agents and/or employees, from and against, any and all liability, damage, costs, losses, claims and expenses, howsoever caused, resulting directly or indirectly frau, or connected with the improvement under this permit. I further state that I have read and fully understand the implications and re- sponsibilities of the above statements, and will comply with all provision of the Contractors State License Law found under the Business and Profession Code, Division 3, Chapter 9, of the State of California. JoNN A , 5cv // -Print N_.., t !!17 /O// d gn.ture 1\ CMF 0777-46 } «.,.�.e. 3 -. Y`4 radA ,H. nyJ y� y...r{-..r-,....+}�} R 5,. Fn._ �7 �... ... 4 7 ) etc,.. .A .5 m /2 �E:J: p 1 r. t x Lrai.«rTr ).. $", >'0. h V ,• n t,',' T'fi4W`M1. > ,. yd`veayk h r�y A :v M �Y a . k5 2;, 4. i" "S '' 5 abal �*S f ..„ , - #Y' far ,A.s: ,y r,12{;i, •Itt rthx3` '4C4,.1...7' 1. ... 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Y3•-\'1".::;47. «. rF, '.'r t '!'r+`S� .�bn. ... _ . .._ .-a ... •i s .[ a. _ :.,•,-_.. - ip ,,.-.-.• l'..... _ d A [..r Yr sW i3Y,yr._ .<Y` •llr R.Y.. , ., w YR.ca -.. APPLICATION FOR A BUILDING PERMIT �1 Sz l5� BUILDING PERMIT NO. Electrical CO Tract J Block Lot permit No- C, Building (/� /, //•--�� Plumbing . C Address VCTv z�NDOc r, \ O %�/ Permit No. m Cross _ •V\ Mechanical Area Street 0 et 5 ) O L Permit No. a I�ll ✓ / fpr m Owner .l o I 1 n/ In , 6 cc 1 ' Type of Project: ❑ New ❑ Alter �t IZ] Addition Address -ROT I V2�DaL/'� ❑ Repair CI Convert ❑Demo I�Occupancy Pmt. CCZ$%` A MSSA I n p Dira/ CItY ZIP��p�f7 Phone�j -,��;, A.P- Sup. Area Architect/ Zone SDI.Pmt.No. Designer Ucense No. Setbacks P/L Front C/L St. Street Width Address Yards Left Right Rear City Zip Phone Eave Proj. Left - Right I-.P. Engineer ,3 F1cic SPENCER License No. CE I 13 Ll 09-in - Parking Spaces Required Provide Covered rya Address City Zip Phone Struct No.of No.of Height Stories Family b LICENSED CONTRACTOR'S DECLARATION Park Fees 8 Yes Fee to Required No C.T. Receipt m I hereby affirm that I am licensed under provisions of Chapter 9 s (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date Professions Code,and my license is in full force and effect). License Cies License Number > Date Contractor Misc. E Address Proposed Use A Li: City and Zip Phone — of Structure CE04MiC 5 / ❑V ) O in CONSTRUCTION LENDING AGENCY N I hereby affirm that there is a construction lending agency for the Class Const. Year tit- performance of the work for which this permit is issued (Sec. 3097, ClCons Code ` Civ.C.). Gas y Lender's Name USE/OCCUPANCY SIZE SQ.FT. E Lender's Address OWNER-BUILDER DECLARATION /�/, Y I hereby affirm that I am exempt from the Contractor's License Law 1 �Y'1Z�/"�/L Top/(] - 6`�t) 0 for the following reason: ❑ I, as owner of the property, or my employees with wages as their 2. C sole compensation, will do the work, and the structure is not 1 — a intended or offered for sale. N I, as owner of the property, am exclusively contracting with 3 licensed contractors to construct the project- * 0 I am exempt under Sec. �fy rich�6 ream _ °1 e-'� '80 Owner C/ (cerci — _wy-} (Q} /� a Data n Q/000/ co E WORKERS'COMPS ATION DECLARATION Total valuatio 3 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required ❑ Yes © No or a certificate of Workers' Compensation Insurance, or a certified E copy thereof. Grading Pmt. Grading `4 Policy No Company Required ❑Yes ®No Pmt.No. .n 0 Certified copy is hereby furnished, Rough Grading '0 0. ❑ Certified copy is filed with Orange County, EMA. m Approved by: Date Date Applicant 3 • CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE Z (This section need not be completed if permit is for $100 or less). 3 I certify that in the performance of the work fo hich this permit is c issued, I shall not employ any perso• n any . aim to become subject to the Workers't�Compensat'•n L- s . -.lif. / PERMIT FEES Date /.J DC, 5'1 /vwpplicant Li Ai /#flair NOTICE TO APPLICANT: If, yer making this Certificate of Structural $ Plan Check $ Exemption, you should become su ject to the Workers'Compensation -- - - - - --- provisions of the Labor Code, y• must forthwith comply with suchSpecial Electrical $ Invest- $ provisions or this permit shall be deemed revbked. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $ COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $ ORIZ - PRES `TATIVES OF THIS COUNTY TO ENTER UPON TH- ABC VE .dr D PROPERTY FOR INSPECTION PUR- Pre-Grade P• ES.' ' c -� Inspection $ W_y'R Pre-Grade Permit Signa 're• Applicant or Agent Date Rec.No. $ Issue $ of N G Print Applicant's/Agent's Name Is All spaces within this box must be completed to process -. Clan I Approve Check BY: uancetl: CMF 0335-46(BU-28)rev.6/80 • A - A A . 42183. ,, ,1;= onz, ::23.1G COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A LI l• ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely— Use Ink Only /' /�) y� ,`. . RE•E L'i`• f s•T ••C. .. ' DATE ISSU D ADDRESSBUILDING �6Cl/�/�� (anta5c072--- '%L/� 4 E: AAI I��S{1.I - I ' ' I/r/pl�yJr� OWNER JV kkII !, • JCC 2- A.P. NO. 1. 1•l -284-07 P 01 { C! 5 MAIL �` 2 '�.�'� /� �L BUILDING /�D T/J. /�` 1 ADDRESS � �LJ3 k✓ AIK4 /NO �.s ? ADDRESSt 9O j�� KV CITY Cb 57—?? NES/9, CNC. No..TELSJ�SS33 TRACTSI52. LO1C BLOCK CONSTRUCTION .•� NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER >Y\s/ BRANCH OWNER ON111 SCOTT ADDRESS t ',I ,�J /�`W c[ • ARCHITECT TEL. USE HAMEL FIEC?t2/ �,J a so OR ENGINEER NOEIRE �/j ADDRESS ZONE s✓aloe_TYPE�� GROUP/\/Era CONTRACTOR 0/a/.V, APPROVED aloe_ DATE7/ I ' ADDRESS ��//��/ TEL. ZONA I INO.OF� USE OF NEW N CITY NO. n/I PLANS BUILDING F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO, LIC. NO. MAIN BUILDING ACCESSORY BUILDING 62,1 SIZE , in NO.OF BLDGS. (FROM Cl EET) 0. OF LOT I Ilr(�L, X D,, NOW ON LOT O RONT F FT. FT. Q USE OFcn q� EXISTING BLDG. R,SIDE KGJ ET. FT, .,., �j SF Separate permits are required for L.SIDE • _3 FT. FT. electric,plumbing and heating work. REAR 227 'O FT. FT. [.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Q MAIN BLOCS. ACCESS.BLOCS. GI DATE I Z C- C� /Tr^IIC '1`flti• •%KlN4 t VAR.9W C.U.P.qp APPROVED — o APPROV % ,,,__,--- >-' //S�� •/��5f .rl —BY / I J DATE 7_/J —/ . w a. -(OLD FOR. FEC!• .L REQUIREMENTS 0O I hereby acknowledge that I have read this application and state / tn / CC that the above information is correct and agree to comply with / m 0. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of S the State of California. gi I hereby certify that I am properly licensed as a contractor under SO. FT. (NI the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ce Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the pr• 'ens• a St.n • ".(Hernia Business 'o and Professions Code on ha. =. VALUATION PERMIT FEE $ • O� m in PLAN CHECK $ ^I Signature .f /� ^� - • o Permittee A/ � $ S TAX $ '� 2 sD U Authorized Agent/ TOTAL PAID $ A.3 L cm15-76�hs-7001579 v****36.Ou a COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill Completely mpletely — Use Ink Only n Co RECEIVED BY DATE RECEIVED1 DATE ISSUED BUILDING J ADDRESS (� PERMIT NO. OWNER L. A.P.NO. MAIL BUILDING 9 ADDRESS ADDRESS p • TEL. TRACT I LOT BLOCK CITY NO. CONSTRUCTION NEW (ADD ALTER REPAIR (MOVING DFMOI ISH LENDER BRANCH OWNER ADDRESS VALUE /�• ARCHITECT TEL. USE �" OR ENGINEER NO. S. FIRE ADDRESS ZONE TYPE GROUP ganger—. /l� _ / APPROVED CONTRACTOR L/Y// BY DATE ADDRESS TEL. ZONE INO.OF USE OF NEW CITY NO.EPLANS BUILDING FSTATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING laSIZE INO.OF BLDGS. (FROM C/L STREET) 0. OF LOT NOW ON LOT FRONT FT. FT. a USE OF VS EXISTING BLDG. R SIDE FT. FT. F2 Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. WREAR FT. FT. F. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& CMAIN BLDGS. ACCESS BLDGS. a ///t� /��t VAR# DATE • C.U.P.# APPROVED J11.11 /�;f( APPROVED } —BY DATE .-1 CG I. 0. I hereby acknowledge that I have read this application and state NN N f that the above information Is correct and agree to comply with m 0.. all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of P. Sthe State of California. - I hereby certify that I am properly licensed as a contractor under SO. FT. co the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: us am exempt from the provisions of the State of California BusinessTr VALUATION PERMIT FEE $ /{ e and Professions Code,Division 3,Chapter 9. �/ s r<J" m m PLAN CHECK $ rn Signature of a Permittee $ .../1 r"--..., TAX $ u.2 u. U Authorized A ent \ 0/ .. � AgTOTAL PAID $ Ol `\ A COSTA MESA BUILDING-SAFETY DEPARTMENT APPL; . ION F& YTRUWVRigs- PERMIT 79.80 TI.Y •: P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 --- - - •. - - - - RECD :• PERMIT N° ' 50451 For Applicant to Fill Filll ink Completelyt — Use Ink Only BUILDING c1R0 00ND0Lcs,tit A.P.Nyeff-• 2 rd7 ADDREBUILDING ((/7O LS*J OWNER OR lOµ� f CQ 1 j ADDRESS l/Y� TENANT J 7 MAILING �(tt SPACE NO. ADDRESS MAILING ,- C 24-N no L-Pel �.� TR.NO. LOT BLK. TEL CITY COSI-7? I '11_54 NO. 551-5533 NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH � _.JJ OWNER i ( �� ADDRESS LUE A ARCHITECT TEL. USE �•�f Q Si);520 OR ENGINEER NO. _. ADDRESS ZONE TYPE j'AJ GROUP /Q,s{t1 � 1 ��/ APPROVED /Q CONTRACTOR V W n C_.1 BY DATE r/ b ei ADDRESS II TEL. CITY NO. F STATE CITY A'•ROVE• 5�: • 5 LIC. NO. LIC. NO. z, AO v -_/.. / i a W SIZE NO.OF BLOCS. FROM C/,- C. OF LOT NOW ON LOTRONT En USE OF EXISTING BLDG. CSA-MIG 5Tv 7a/� R SIDE / O CO EEI-. Separate permits are required for L,SIDE FO3r electric,plumbing and heating work. REAR /4/ /F'0 11 W F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION YS G '-1 6;0054 A-ADrrwAi 7-02 7S g0-7, DROVE xle APP )•• C/3/24-+M11C 6l vv'a ROV 'F DATE S S JS v ,1 a n. a.0 I hereby acknowledge that I have read this application and state eN. a that the above information Is correct and agree to comply with CU all laws regulating building construction, and I shall not employ Z any person in violation of the workmen's compensation laws of ilnl n FAD CPECIALR€ rrrrs�. o 41 the State of California. ROa¢�syz'R— I hereby certify that I am properly licensed as a contractor under 600 SD. FT. `- Io the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR CO Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: - to am exempt from a pro islons of the State of California Business VALUATION q PERMIT FEE $ and Profession e, vision 3 F r 9. s� m PLAN CHECK E 3 s it m Signature of .J/ 9 0 Permittee r ,M $ V S20.6a LL / TAX $ �a f Or 9Authorized Agen Date •S��Q ` TOTAL PAID $ 7 9 , a U