Loading...
HomeMy WebLinkAbout1103 RIDGECREST CIR - Building Permits .w- +: /"P''" -"M 9 CITY OF COSTA MESA ` 4 BUILDING DIVISION F rT ,I DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER • 4. "Ka ) PERMIT `#* B01-01768 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1103 RIDGECREST CI Status: ISSUED Suite: Applied: 11/05/2001 Vicinity: HOUSE&ATTACHED GARAGE Issued: 11/05/2001 Parcel Number: 42203135 Zoning: Applicant: CRAWFORD, KEN ISSUED BY: 111K2„ :' ' Address: 2079 NATIONAL AVE - , - .Phone: (949)548-6685 A; COSTA MESCA'` . • Zip: 92627 -, ' Owner: GREYSHOCK, ANTHONY F • , :•v Address ,/1103'RIDGECREST,CIR - z. Phone: COSTA MESA, CA - Zip: 92627 - N' , Contractor: 'CRAWFORD CONSTRUCTION . - Address: 2079 NATIONAL AVE l \ , , Phone: (949)548-6685 - COSTA MESA, CA -Zip: ' 92627 License: , 464356 - . •- , Arch : - - Eng: - - Address: ' / Address: - • ' - Phone: - - Phone: Zip: License: 'License: • ' SCOPE OF PERMIT - REROOF EXISTING SINGLEFAMILY RESIDENCE&ATTACHED GARAGE(15 SQ).TEAR OFF EXISTING ROOFING& RESHEATH WITH 1/2"OSB. INSTALL 30#FELT UNDERLAYMENT&REROOF WITH 25 YEAR COMPOSITION SHINGLES. . - - . FEE SUMMARY • '.Plan Check: $0.00 •-- .. - -- - Calc Valuation: $5,000.00' Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: • $0.50 - - SMIP Corn: $0.00 - . Other: - $0.00 - Inspection: - $0.00 - - . . - Total: $111.75 ' PLANNING &ZONING SETBACKS. ' MAIN STRUCTURE'Front 0-0 Rear 0-0 - Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: - 0 Required: 0 Proposed: 0 NOTES: . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all P required Inspections and fInal approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(WOO) rilialiall.IMIMIIIWORKERS' �'COMPENSATION DECLARATION: •rm under penalty of perjury one of the following declarations: and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the for which this permit is issued. and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. rkers'compensation Insurance carder and policy number are: n need not be completed it the permit is valued et one hundred dollars($f00)or less.) / �.yfy that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomi and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio / ///J / / Applicant Signature:. .Lt- 2---" 1�YE Ase Date - 1 l /�4/ WARMNG:FAILURE TO SECUR WORKERS'COMPENSATION RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P /AALLTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($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: 1 hereby affirm that I am licensed undgr provi ��cpter 9(commencing with Section 7000)of Division 3 of the Business and j rOfessions Code,and my license Is in full force and effect:LICE 1 '4//G Class o /7J! Contractor's Signature etc '7 es% Dat J. /`/r/o; _ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perm4 subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 W III the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes j�No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). District 7 If a permit from the South Coast res prescribed i ed Management Di Heal or other airgold tion ooncontrol district03 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 7/4 Signature Of Legal Owners Date�0 /j r And/Or,Authon Ap c ' /ate BODE If INSPECTION TYPE PASS MITMAI.4 ODE INSPECTION TYPE PAIS 1tlImALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final '7 208 Final Plumbing 200 Final Re-Roof / —OZ 210 Final Electrical 201 Final BlocldRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _. • 'PROJECT ADDRESS: 1103 RIDGECREST' CI UNIT: - CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 048997 • ON*IER'S Anna: TONY GREYSHOCK 'AODREss: 1103 RIDGECREST CIR PERMIT NO: E 048997 - PLAN CHECK NO: N , GOVT: N SUPP_: N , COSTA MESA,CA 92626 • - • • CONSTRUCTION TYPE: ,V-N PERMIT TYPE: ELE PURPOSE : 0TH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ABOVE GROUND SPA HARDWIRESQ FT: - ' ADDRESS: UNIT: - 2' . CLAIM VALUE: CALC-VALUE: - GROUP OCC ; R-3 / PERMITTEE: TONY GREYSHOCK ( 714 )722-7585 . • ' ADDRESS: 1103 RIDGECREST COMMENTS : ABOVE GROUND SPA ELECTRICAL HARDWIRE. 4` CM CA 92627 **************************** ********* ******* ******* *********x* ***x'**iter*** 'LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of.Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS •CITY LIC:: STATE LIC.: CUSS: Date: • Signature: MAIN BUILDING ACCESSORY BUILDING I WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT' IN REAR: - FT JIN I Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT:. FT IN RGHT: FT IN POLICY NO.: EXP.DATE: . ' -WMPANY: PARKING REQ• PROV: PARCEL: 42203135 INE: REF NO: • Certified copy is hereby furnished. 0 Certified copy is fried with the city Building DMsion. PLANNING NOTES> ' > _ - .._ - 'Date: Applicant: **********************************4'j4**?E**************************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: RIB section need not be ompleted if the permit is for one hundred(SILO)or less). DEVELOPMENT S E,R V I C E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become 'i subject to Cthe Workers'Compensation Laws of California.,� ZONING APPROVED BY ' ?' • DATE:1 ' , Data: I-i Y^4'a Signature: ,�/ ca.-------- + - - - NOTICE:It,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : '%:V DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCY: I hereby.affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y : er�-t•mH1111/ DATE: 04) 41-44O which this permit is issued(Section 3097.Civ.C1. **********************w„**********wy +se-+�"-.c,. r*************************7 OnElir F,.iF** LENDER: ******************************************* :*********************************** ADDRESS:-, LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N • .OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING ' (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT ' 11 , 00 repair any structure,prior Co its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed • pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0% SM Z P/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN , any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). I S SUE FEE 15i._-CHECK 5 00 I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE . ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 11 :00 1 5 . 0 0 0 . 00 . 26 , 00 26 . 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through -his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or • Improvement Is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 26 . 00 OVER/SHORT : . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLANLCHECK I,as owner of the propertyy,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 26 . 00 1 ❑ and thereon • d who contracns ts for such project with e Contractors' tate con[actor(s)lonse puLaw does not rsuant to the Contrato an owner of ctors'State License Law)who builds or .Iam aware {!.*****************.*************************,E************%******************%*** that proof of their Worker's Compensation insurance should be provided to me. I N -D IV IDUAL F E E BR EAKDOWN 0 lam exempt under Section:B P 7 04 4 B.8 P.C. for this reason: ALL WORK BY OWNER TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: '�•"i y - 90 owner _ LTac ELE ' 1 MISC APPARATUS NOT LISTED REQ PERMIT 11 . 00 11 . 00 • I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these•provislons. ' Date:-' Applicant: O e • t • I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county KE,/�DET ECT ordinances and state laws relating to building construction an�ereby au representatives of this city to enter upon the above-mentioned S N E`^ property for inspectioniopurposes.GSVS TED v Date: " 1 -to Signature: r t-7 License or Social Security N: 901 00069577-00069577 T f E T ' 26.00 cant;Pink—Revenue:Goldenrod-Assess•or �A'. DATE:. 09/14/90 TIM: 11:06 1841-46 White-Building;Green-Code Enforcement;Canary-ApP'ti I 1 CONSTRUCTION AND PLANNING - POr •SPA - Date Inspector - • Date ' Inspector APPROVALS Permit # • APPROVALS Permit # . • r. -1. Temporary Electrical Service orPole I 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 UF ER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit=Undrgrnd.1` .rI 8. Foundation _ 59. Gas Pipe, 0 Undrgrnd., Test , v 9..Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap,-0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final A 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains 64.•Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final T 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67., Fencing & Access Approval • 17. Rough Wiring Sign 68._APPROVED FOR PLASTERING c • 18. Rough Electrical-T Bar Ceiling " 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 SYSTEM FINAL , 29. Insulation • I, ,, 78. FIRE PREV. FINAL ' 30. Drywall Nailing / ii HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ti 79. FINAL INSPECTION - . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric IO//5/0 gt.4. Notes: - • 34. Final Heating & Air Conditioning / , I . • r. , 35. Final Gas Pipe-Test 1 !1'. : 36. Hood or Canopy j; '"' '-a" , 37. Final Factory Fireplace :. VIS 38. Final Plumbing i • 39. Water Service-Final 40. Gas Service-Final ' 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations I f1 47. FINAL STRUCTURE & BUILDING C.- 48. FINAL PLANNING (:_ 49. Electric Release to Edison 501. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date LIMITED STATEMENT Ur RESPONSIBILITY Bldg. Permit # TO WHOM IT MAY CONCERN: NOTARIZATION This Permit # r REQUIRED 1103 P ta5e et'es-F Street Address AP Number I, "re-714_, &Try5J'Loc k- , as Owner in Title of the above referenced property, do hereby authorize: IJA(1;a "300oir syz 3/6/ Name Telephone No. ) 220 Co. eflvevutiC Street Address Sf A AAA e4 9.20o 3 City State Zip to obtain permits in my behalf, as owner/builder, for SP/1 To sifrartiit 'I at the above referenced property. Should any person. become an employee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. i ' i sal i 0 . '104P all (1.i q\— q0 -rin ed Name ate —_A 111, ' Signature �� OFFICUU.SFJLL 4101 i;T. CHRISTINE BELLING > Notary Public-California "Tv ORANGE COUNTY C - ICcirl:skEVlef .17r,27,1993 t-tt1 /44,1 C�€� CJ // 77/1 ' w. es ea � e- 47 a:. /yzr- 6.,e,' 077946.rev.6/87 X24,27 'a ' • • CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT WO. 8915 DATE 7-i3 -77 IAT NO.. 110,�rV /® ADDRESS 42%;74a6257- C.42CLE //ag The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he-she-they) " (was or were) _16..6.4_41,L..../advised that this tract has not been given final inspection.nor has it been accepted by the City cjf' Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety 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. /���' AP is BY �/` Purchaser BY ...„00, •,, Developer an. • authorized represents BY %Lt !i.<. . /Is Lender. ^`r /, : ATO l� ct-EUr-::L :P' . , . .,CCIt - _670 C::L k-'.;r ��L..Li +.. . .GEUc:, l..,iJfC:37i:\ u-C.'5d tF.a . . 4n71.5WR16-765x.00 863* t***3].57 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only _ y� ' V • BY (BATE RECEIVED .- DATE ISSUED BUILDING ADDRESS r3 i 0 r .� L cJ �. !_.' /. . -. ..t '•O / . , �7 57" PERM. Ne OWNER RWpNG MAIL // p�%S.LIT .1L A.P. NO , , r• ^ _ .c.r.BUJ/. •/'/'ice( ADDRESS rz"'t C.�• / ST. ADDRESSII11O3 ` bat-rats-sr J'/ CITY�7-� �r,4 NOTEL/Z'4)JO TRACT $9) - LOT ' 0 BLOCK CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOLISH LENDER BRANCHal �//] ./�'� OWNER /1 / z/ - �/ lib ADDRESS 1 / - UE ,', IC ARCHITECT �/j(/t TE • _ SE .�-r• ,�'_/ sr • $ ' ;LP OR ENGINEER 1_[(_�[ N• L-21 _ -,' - - FIRE ADDRESS ZONE TYPE /i GROUP rd CONTRACTOR yGusr /JC. BVPROVED DATE ADDRESS/ • ,c /7—et.. �iW NO.OFys USE OF NEW CITY/ //�SQ NObe12.4'2 .-- OW PLANSc�/�, BUILDING t/1n©� AI,r E^"- STATE ``YY CITY YARDS APPROVED YARDS APPROVED et- LIC. NO. LIC.NO. MAIN BUILDING G��� ACCESSORY BUILDING . (FROMO. OF LOT NOW ON Liol SIZE NO.OF OTS FRONT CfL�OFT.-`^ FT. USE OF, •/(/ ' Cn EXISTING BLDG. R.SIDE / FT. FT. V) FS Separate permits are required for L.SIDE 14 FT. FT. electric,plumbing and heating work. (�� • C REAR 1 J FT. FT. 04 (--I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 'Ile D. /� '7 /`� /> MAIN BLDGS. 7�ACCESS. SLOGS. • / Q 4/l--"A.)4" 2 CeF. _(air(4, C URP# (V "PPROVE /��/�'�ia� } ABY• ROVED/1',- 1e(Pej DATE 7—iIaJ'�YY/Q W �, • HOLD FOR SPECIAL REQ111RFMENITS o. 0 I hereby acknowledge that I have read this application and state n CO. that the above information is correct and agree to comply with O. all laws regulating building construction, and I shall not employ m Z any person in violation of the workman's compensation laws of 22 the State of California. j 17 I hereby certify that am properly licensed as a contractor under / SQ. FT. •/T/�Y H the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses ere In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: _ am exempt from the provisions of the State of California Business 'a VALUATIONPERMIT FEE v and Professions Code, Division 3,Chapter 9, $ n :7‘. m Signature of ,/,,/,‘VDE.lam_ ' IJ to PLAN CHECK $ I Permittee srK///C 1 $ �//1 gaze TAX $ U Authorized Agent • • TV• I �/I/ U TOTAL PAID h 40715 ;uL 28-76�„x`00328u u*** 169.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 1 • P C�TION FOR STRUCTURAL PERMIT For Applicant too FillinCompletely� -- Use Ink Only� R E BV DATE RECEIVED DATE ISSUED BUILDING • ADDRESS IID / t\I OCIErR,G..St l .I tC i PERMIT NO. OWNER A.P. NO. MAIL BUIADDREGSS tic.7) 2ICE&E � Gi ADDRESS ADDRESS f /JS TEL. CITY NO. TRACT - LOT BLOCK CONSTRUCTION NE VJ I ADD!ALTER I REPAIR (MOVING DEMO( ISH LENDER BRANCH rillOWNER ADDRESS • / (/.1.�,VIALUE ARCHITECT TEL. USEKe2w! ATT�-(Ag- $ OR ENGINEER FIRE ADDRESS ZONE TYPE � GROUP T�T APPROVED CONTRACTOR BY DATE ADDRESS ZONE INO.OF USE OF NEW TEL. PLANS ' BUILDING CITY NO. F STATE CITY - YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING LO SIZE I NO.OF BLDGS. (FROM CA_STREET/ L OF LOT NOW ON LOT FRONT FT. FT. Q USE OF cn EXISTING BLDG. R.SIDE FT. FT. rA , . I--. Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. W - REAR FT. FT. [.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& G - MAIN BLDGS. ACCESS. BLDGS. Q VAR.# DATE C.U.P.# APPROVED 7 APPROVED >+ —_BY DATE ..1 CO w 0 I hereby acknowledge that I have read this application and state n N ad that the above information is correct and agree to comply with O. all laws regulating building construction, and I shall not employ m Z any person in violation of the workman's compensation laws of 2 W�„ the State of California. m 3 - I hereby certify that I em properly licensed as a contractor under SQ. FT. iv 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: am exempt from the provisions of the State of California Business 'p VALUATION PERMIT FEE $/4 U� ,n1--- d and Professions Code, Division 3,Chapter 9. {{{LLY / ,n �J' � PLAN CHECK $ n Signature of ........413.7 V - a Permittee $ TAX $ 2 U Authorized Agent ` TOTAL PAID $a 9 ilia