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Home My WebLink About329 ROCHESTER ST - Building PermitsCITY OF COSTA MESA �o�` "'f, BUILDING DIVISION i`�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wvw.ci.wsta-mesa.ca.us r ° � FOR INSPECTIONS CALL: (714) 754-5626 �r,o,,,�, �`' PERMIT NUMBER: E09-00042 PERMIT TYPE ELEC STATUS: ISSUED APN: DATE ISSUED: 0 211 212 0 0 9 ISSUED BY: BJK JOB ADDRESS: 329 ROCHESTER ST CM Suite/Unit: Vicinity: TREATMENT HOME SCOPE OF WORK: UNITS A 8 B HARD WIRE 8 SMOKE ALARMS IN A TREATMENT CENTER HOME, NATIONAL THERAPEUTIC SERVICES, INC. OWNER: TRAPP, DAVID L TR Address: 24232 DAVIDA LN Unit: PHONE: � City/Slate/Zip: LAGUNA NIGUEL, CA APPLICANT: SULLIVAN, RICK Address: 10461RVINE AV Unit: PHONE: 949-515-5147 CitylState/zZip: NEWPORT BEACH, CA CONTRACTOR: 1 SUPERIOR ELECTRIC INC - License No. 883400 Address: 1048 IRVINE AVUnit: PHONE: 949-515-5147 City/State: NEWPORT BEACH, CA ZipCode: 92660 CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $32.30 Reinspection Fee $0.00 TOTAL FEES $32.30 NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Calitomia stalutes and related regulations. (Ord. No. 92-28, § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order (or the work authorized under lhis permit to be considered legal, such work must wmply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. COpE/, INSPECTIONflPE OATE INTITIALS ODE� INSPELTONTYPE U� INTITIRLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electriwl �� 201 Final BIocWRetaining Wall 212 Final Fire Pravention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildinglOccupancy WORKERS' COMPENSATION DECLARATION: I hereby affrtn under penalry of perjury one of the (ollowing tleclarations: ❑ I have and vnll maintain a certifcate of consent to sel4lnsure for workers' compensation, as pmvided for by section 3700 of the Labor Code, for the peAormance of the vrork for which this permi[ is issued. I have and vnll mainlain vrorkers' compensation insurance, as required by section 3700 of [he Labor Code, for the pertormance of the wnrk for which this pertnit is issuetl. My vrorkers' compensation Insurance carrier and policy number ary: j I e Carrier ��1'GL�`�-P_� �.Qil1SUe V.� �)� �NG (Thissea�bnneeenoroemcm-�pet/ nme^0�7�isvaloedaton�a^�n idieacaiars(St00)aiess) Policy Number: / L> C7 � L��— �—( ❑ I certify thal in the per(ormance of Ihe vrork for which IhiS permit is issued, I shall not employ any person in any manner so as to become subject ro the vrorkers' compensation laws of Calitomia, and agree that if I should become subject to the vrorkers' compensation provisions of Section 3700 of the Labor Code, hall forihwith comply with Ihese provisions. z-i Z-v°I pp icanfs SignaWre Da�e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHAIL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Prolessions Code, antl my license is in full force antl effect. n Lia # �� Class # l_ —� C� 'Z -� Z-D�i or's Signalure Dale CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm that there is a construction lending agency (or the pedortnance o! the v.ork fa wfiich Ihis pertnit is issued (Sec. 3097, Civil Code�. Lender's Name: Lender's Address: SignaWre OWNER-BUILDER DECLARATIONS: I hereby aKrm that under penalry ol perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any city or county which raquiras a permit to construct, alter, improve, demolish, or repair any SlrucNre, prior lo its issuance. also requires Ihe applicant for such pertnit lo 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 0( the Business antl Professions Code) or that he or she is exempt therefrom antl Ihe basis for the alleged ezemption. Any violation of Section 7031.5 by any applicant for a permil subjects the applicant lo a civil penalry of not more lhan fve hund�ed dollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the struclure is not intended or oflered for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, pmvided that such improvements are not intended or offeretl for sale. If, however, the building or improvement is sold vnthin one year of completion, Ihe ovmer-builder will have the burden of pmvinq that he or she did not build or improve for purpose oi sale.). ❑ I, as ovmer oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CON7RACTORS Io construct Ihe pmject (Sec. 7044, Business and Professbns Code: 7he contractors License Law dces not apply lo an owner ol property who builtls or improves thereon, and who contracts for such project vrith a contractw(s) license pursuant to the Cont2ctors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 305]<fi (3/0)) Owner ID venfied by tlrivei a license. ❑ Yes ❑ No Driver's License No. Expires: Venfcalion o( Ownership by (type of document, i.e. - property lax bill or deed�: DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICA710N: ❑ I hereby certity that no excavation live (5) or more feet in depth into wfiich a person is required to descentl, will be made in connection with wvrk authonzed by this permit, and ihat no building strucWre, scaf(olding, falsework, or demolition or dismantling thereo(, will be more than lhirty-si. (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttie 8, Cali(omia Administ2We Code). ❑ As owner-builtler, 1 will not employ anyone to do work which vrould require a permit from the Division of Intlustrial Safery, as noted above, unless such person has a permit to do such work from the division. Appllcanfs SignaNre Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fNure building occupant need to file antl certily a Business Plan tor emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the California Health and Safety Cotle requires, with some exceptions, Ihat a Business Plan be fled with Ihe Costa Mesa Fire Department by every business which has at any one time tluring 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 compressetl gas at standard temperature and pressure). 2. Does or will the appliwnt or present or WWre builtling occupanl need to file a re9istration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety Code, with some exceplions, requires registration with the Costa Mesa Fire Department hy each business which at any one lime has on hantl 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 ihe applicant or presem or future building occupam need m prepare an RMPP (Risk Manaqemen� and Prevention Program for acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Cotle provitles Ihat Ihe Costa Mesa Fire Department may require the preparation, certification antl fling with the Fire Department o/ an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presenUy required, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or (uture building occupant require tor lhe woB which is lhe subjecl ol this appliwtion a permit for such wnsWction or motlification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Sectbn 65850.2 0( Ihe Califomia Govemment Code requires that the requested informati0n he fumished on applications fa rwmresidential builtling permits). 6. Will any part of the faciliry ro be constructetl untler this permit be vrithin 1000 (eet from the outer boundaries of a school? ❑ Yes ❑ No Qf'yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Heallh and Safety Code). 7. It a permit fmm the South Coast Air Quality Management DisMct or other air pollution control districl or agency is required for the work vfiich is Ihe subject of lhis appliwtion, have all of lhe disclosures prescribed by Cali(ornia Health and Satety Cotle Seclion 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach cenificate of compliance trom the appropriate air pollution control officer). � CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcL I agree to comply with all state lavrs antl ciry ordinances regartling Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF EN7RY: I certify under penalry ot perjury that I have read this application and state Ihat Ihe information given is wrrecL I agree to comply with all state lavrs and ciry ortlinances relating ro building construction, and authonze representatives of the City of Costa Mesa to enter upon lhe above-described property for inspection purposes. I agree not to occupy or allow occupancy of any builtling authorized by this permit unlil final inspection. Signature LeB ��er(z) Da1e Date � /l_%\ .l� e l % —� Z—d � An , t onzeE APW�� Dale {714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa�DING PERMIT 77 FAIq DRIVE, COSTA MESA, CA 92626 Job Address: 329 ROCHESTER ST Suite: Vicinily: Primary Occ: R3 Parcel Number: 42501316 Type of Construction: V-N Zoning: R2-MD Applicant: CAL COAST ROOFING AND RAINGUTTERS Address: 8329 VALLEY VIEW ST BUENA PARK, CA owner: LAMBARD�,CLEMENT Address Phone: 774-827-5371 Zip: 90620 Phone: Zip: 92677-4021 Contractor. CAL COAST ROOFING AND RAINGUTTERS Address: 8329 VALLEY VIEW ST BUENA PARK, CA Zip: 90620 Arch : Address: Zip: Phone: license: Phone: 714-827-5371 License: 828394 Eng: Address: Siatus: ISSUED Applied: 01/09/2006 Issued: 01/09/2006 ISSUED BY: r �� Phone: License: SCOPE OF PERMIT INSTALL ONE LAYER OF 30 YEAR COMP. SHINGLES OVER EXISTING ONE LAYER OF COMP. SHINGLES. INCLUDE DETACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.59 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.84 PLANNING & ZONING SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existina: o Calc Valuation: $s,soo.00 Claim Valuation: $5,soo.00 Rear 0- 0 Lek 0- 0 Right 0- 0 Rear 0- 0 Lek 0- 0 Right 0- 0 Reauired: 0 Pr000sed: 0 II NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and relatetl li regulations. (Ord. No. g2-2B, § 1, 12-21-92) EXPIRA710N: 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 oi 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 Inspeetiona end tinal approval must be obtained. Failure to obtain inspactions and final approval will result in �he expiration of this permi�. FOR INSPECTIONS CALL: (714) 7545626 »� o �awi WORKEqS'COMPENSAnON DECLARAnON: I nere6y attirm untler penalry of perjury one ot tha tolbwiog tlaUamtions: - [] I heve antl will maintain e certificate ot consent to setl-Insure for workers' compensetion, es provitled for by section 3700 of tha Labor Code, for the pertortnence of Ihe work for which this pertnit is issuetl. I have and will maintain workers' cnmpensa�ion insurance, as requiretl by section 3700 of ihe LaOor Cotle, for �he OeAortnanrs of the work for whlch Nis pertnit is luuetl. y orkers' compensation Insurence carner and policy number a�e: '�� C�nier - _. . •� P r: secfion need not be completed i the permit is velae af one hund�ed dollars ($100) or less J ❑ I cetlily that in ihe pedotmence of the work for which this permit is issued, I shail not employ any pereon in any manner s0 es to become subject to the workers' ' n laws oi Celifornia, end agree that if I shoultl bacome subject b the workers' compensetion provisions of Section 3700 of lhe Labor Code, I shall forthwlth comp ith �- rovisions. /1 �p qppli Si re: � ��ic - De ' .�/iW %. ✓I4��%� WARNI O: FAILUPE TO SECURE WORKERS' COMPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUflIECT AN O CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNORED THOUSAND DOLLARE ($100,000), IN ADDITIQV TO THE COST OF CAMPENSATION, DAhNGES AS PROVIDEO FOR IN SECTION 3]O6 OF THE L480R CADE, INTEREST, AND ATiORNEV'S FEES. LICENSED CONTRACTORS DECLApAT10N: I hereby aflir m licensed under provisions of Chapter 9(commencing with Section 7000 the Business antl Pmfessions Cotle, end my license is in full fo,� ak sz ��,� S� �'�, e-3 g H� � „ Co� s looulure-� ��2�- .---._.�'— n .G hJ �2M / CONSTRUCTION LENDING AGENCY: ❑ I hereby eBirm t�at ihere is e consWction lending agency for the pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotla). Le�defs Neme: Lender's Adtlress: SiOnature: OWNEF-BUILDER DECLARATIONS: Date: I hereby eflirm Ihet untler peoalty of pe�ury that I am EXEMPT FHOM THE CONTRAC70RS UCENSE LAW tor the tollowing reason (Sec. 7�31 S, Business and Protessions Code: Any ciry or county which requires a permit to construct, alter, improve, tlemolish, or repair any stmcture, pnor to its issuance, also requires the applicant for such parmit to file a signetl stetement ihat he or she is licensetl pursuant ro the provisions of ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) oi Divislon 3 of the Business and Professions Code) or ihat ha or she is exempt therefrom and iha 6esis for the allegetl exemption. Any violation of Section 7031.5 hy any applicant for a pertnit sutllecis ihe epplicent to e civil penalty oi not more than five �undred tlollars ($500).): ❑ I, as ownet of ihe property, or my employees with wages as their Sole compensetion, WILL DO THE WORK, and ihe struCture is not intendea or oHeretl for sala (Sec. 7044, Business antl Professions Code: The Coniractors License Law does not apply to an owner of property who builds o� improves �hereon, and who tloes such work himself or herseN or ihrough his or her own employaes, provided that such improvemenis ere not Intended or ottered for sale. If, however, the building or improvement is sold within one year of completion, iha owner-builder will have the burden ot proving ihat he or she tlid not build or improve for purpose oi sale.). � ❑ I, as owner of ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to cons�ruct the projec� (Sec. 7044, Business and Professions Cotle: The contrectors License Law tloes not apply to an owner ot propeny who builtls or Improves ihereon, and who con�racis for such project wi�h e contrector(s) license pursuaM to tha Contractors Licensa Laws.). ❑ I am e:empt under sec. Signature: OWner ID ventied by tlrivar's license. � Yes ❑ No Business and Professions Cotle br ihis reason: Ved�ication ot Ownership by (type ot document, i.e. - property tax bill or tleetlJ: Drivers License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I here6y cenify Ihat no excavation five (5) or more feet in tlepth into which a person is required to tlescend, will be made in connection with work autho�zed by Ihis permit, and lhat no building structure, scaftWtling, talsework, or tlemolition or dismantling thereot, will be more lhan ifiifty-six (36) teet fiigh. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle B, California Adminisirative Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit from the Division oi Indusirial Safery, as notetl above, unless such person Nas e permit ta tlo such work from the divisian. Slgnature: Dale: Division ot Indust�ial Safery Parmi� Number. ICER7�FICATE OF COMP�IANCE AND AUTHORIZATION OF ENTRV: I cenify untler penalty of perjury that I have read ihis application antl state ihat ihe information given is I correct. I ag�ee to comply with all state laws antl ciry ordinences relating to building constmction, end authorize representatives of ihe City of Costa Mese to enter upon ihe aboVe-described property tor fispecPion purposes. I aqree oot to occupy or aflow occupancy ot any buildinq authorized by ihis permit until final inspection. Signeture Ot Lagal Owner(s) /L T�.� — �iQE 1, INSPECTIONTYPE �� 7616 Fixed System Final Fi�e Prevenlion 7266 Pooi Spa Final 200 Final Re-Rooi 207 Finel BIxWRetaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Damolition .1 1 .: /L�� d,l COOEI INSPECTIONTVPE 206 Final Mechanical 20B 210 212 220 222 250 Final Plumbing Pinal EIBdnWI Final Fire Prevention Final Planning Approval Final Site Final euiltling/Occupancy G AS W ATER ROl1GH PLUMBI� PROP. SWR. LIp SPRINKLING SV: MISCELLANEOU! ROtJGH HEATING TEMPORARY SEI UN�ERGROUND [ ROUGH WIRING TRENCHES � FLOOR SVSTEM FRAME AND FL� LATHING — IN P' � 'TER, BROV ITURqL,F HEATING, VENT PWMBING. FIN ster St. ANO AIR CON�ITIONING VICE OR POLE � POWER � FOftMS � STEEL REINF. STEEL REINFORCE ❑ SHING � OUT ❑ V COAT BWLOING. FINAL �(/'y///� a DATE BUILD DESCRIPTION of WORK De FIRE ZONE VALUE Date GROUP J TYPE SUBCONTRACTOR �l 3b113 . 'COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant [o Fill in Completely BUIIDING �2 p �p � 1 ADDRESS � Mi, Fc-Wf OWNER U �w MAIL �3� ` • ADDRESS CITV � POr' CONSTRVCf10N NON' LENDER BRANCH ADDRESS �- ARCHITECT T' CONTRACTOR (x,KijQ� ADDRESS 130� ��, CITV IIQ��y�� h[ 1_�—_ STATE LIC. NO. ^ OF LOT SCl `X � 3S VSE OF EXISTING BLOG. SIZE OF �C, �! � NFW RLfIC�. x USE Qq BUIIOING AND TEL. MasG ro No. c�dtn _ {.�1�� I�./:! ROOF Fr.tn �� -%i�.,FiQG �'��<% :._ `;:35.00 APPIICATION FOR BUILDING PERMIT FECEIVEqrBV DATEfiECEIyF� �eTpissw BUILDING r ADORESS �1L/ /_^.// TRACT EF FIRE ZONE APPROVED LOT TEL. ZONEn NOAF r-� USE OF NEW �)�`-7{�GI NO. �� P�� L BUILDING CITV �'AROSAPPROVED VARDSAPPROVED LIC. NO. — MAIN BUILDING ACCESSOFV BUILOING NO.OF BLDGS. (FROM C/L STREE/T� u I NOW ON LOT � RONT� Fp. I.I FT. � BET VAR. #E QU.P. # APPROVED BET. MAIN & ACCESS. BLp DATE APPROVED ri'"__ �-' /i I hereby acknowletlge that I have reatl Mis aOPlication antl state Sp�l��" l �U Shat the above information is correct and agree to comply with all laws regulaNng buildin8 consttuction, antl I shell not emplay �{Q any parson in violation of Me workman's compensation laws of the State of Califomia. � m I hereby certify that I am properly licensed as a contractor untler SQ. FT. o the Stete of California Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALVATION IS FOR � Chapter 9, antl that such licenses are in full fo�ce antl effact, or 1 THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONIY: Q am ezempt fro the p�ovisions ot the $tate ot Calltornia Business VALUATION antl Profess' n otle, ivi ' n 3, Chipter 9. � PERMIT FEE $ � � � Signatur n /� m Permlttee $ // '//��- (/// � PLAN CHECK $ i�Q E �C �( " _ `o Authorizetl Agant �� v� LL TOTAL FEE $ i -^� _ � �r_ "��T • /. „�.�.- 35799 COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 12fq COSTA MESA, CALIFORNIA 82628 For Applicant to Fill in Completely iILDING 7 .�Lj � _ „��i�„ IJA: IT OWNER MAIL Z ADDRESS a�3 aU CI7V jV�f.Q FZ CONSiRUCT10N ON LENDER am J � BRANCH J y m j AODRESS m ARCNITECT / J a OR EN INEER/ U y Q W � ADDRESS gS d W J O CONTRACTOR mZ J � ADDRESS �J- W yJ �= CITv �(J 2 F- - 0 STATE y � LIC. NO. � � 512E OF LOT SO ��+ T�T-�_ Pn_o „Er io_7<<,4�.00 FQ3::• .r,"�,:53.13 APPLiCAT10N FOR BUILDING PERMIT E�V6DBV OAT@RECEIVED neToicmicn VC. ! /I !' A.Y.NO. /— Bl11LqPlp Flr[LHAJP/4� D��ve NODRESS �� TEL. �P' �qG NO. �6� / TRACT F/6A OWNER !S /�'IRSCS2I�'B TEL. Gi, � ' � Q p FIFiE ��/ �� 20N APGROVED DW?er_ e,. av Fva..usco r� P _�. _. - 20NE.. _ NO.OF CITv , �' � LIC. NO. - T � NO.OF BLOGA �y (FR( � � ] NOW ON LOT "p OI tT USE OF NEW BUILDING � J P (,; � EXISTING BLOG. `'.9 F `� NEWBL�G.��I Q/ ROOMS yy S ORIES � L SI � F � FT. a EXTERIOR WAL ROOF ryP�I V COVERING �4C�Q COVERING Sk1M REAR FT. � USE OF BUILDING AND WORK TO BE PERFOFME DISTANCE BEf. BET. MAIN & MAIN BLOGS. ACCE55. BLDGS. Q n��_ I I� VAR.# �ATE O WLISiYK�-T IaK O C.U.P.# APPfiOVED r APPROVED � 73 N OUI�ES�{` ' „ UI hereby acknowletlpa that I have reatl tFis application entl srote R gpE � +� thet tha ebova informetion is cotrect antl apree to comply wfth � all laws repulating b�ildinp consttuc<ton, antl I zhell not amploy TAiC r anY Person in vblaHon of Me wOrkmen's compBnsatlon Iaws Of � Me Stata of Celifornla. m � I hereby certify ihat I am proparly licensetl as e coniractor untler So. FT. o tna Sieta of Cplitornia Bvsinan entl Professions Cotle, Dlvbicn 3, THE AMOUNT SHOWN UNDEH VALUATION.IS FOR �� Chapter 9, end Met ch licansez ere in fuil force antl effeet, or I THE VVRPOSE OF ESTABLISHING A PERMIT FEE ONLV: m em ezempT from t provisions of tha Stete of Celffornia Buqness ¢ entl Professto f C e, Divi' n 3, ia ar 9` VALVATION � PERMIT FEE $ ` � �V , Slpnetura of ��777 m Parmittee ��' $�/� D P�,4N CHECK S E AuMorizad Apant , ✓� �9 - LL TOTAL FEE $ Z . ww a U ZQ O t~i� am J � J N 0] J •m J Q U � Z a W � y W W 2 J Q m Z J � W W � _ zr w° N � 70 / � � ~ � � � � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CAL�FORNIA 92626 "F3 �2-73�aI�,CD 319 � �'•r'� 111.50 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Com letely FEC VE BV DATEREC VED Df�TEIS UED BUILDING � _//� ADORESS LC PER OWNER v A.P. NO. MAIL BVILDING AD�RESS ADDRESS �� TEI. TRACT LOT C CITV NO. CONSTRUCfION LENDER BRANCH � �' ' OWNER ADORESS VALUE ARCHITECT TEL. S OP ENGINEER Flfl E ADDRE55 20NE TVPE GROUP APPROVED CONTFACTOR � BY DATE AODRESS TEL. ZONE NO.OF USE OF NEW CITV NO. P�� BUILDING STATE CITV �'ARDSAPPROVE� VARDSAPPqOVED LIC. NO. IIC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OFBLDGS. (FR�MC/LSTREET) OF LOT NOW ON LOT ONT FT. FT. USE OF EX15TING BLDG. T. FT SIZE OF NO. OF NEYVBLOG. ROOMS STORIES L SIDE FT. FT. EXTERIOR WALL ROOF COVERING COVERING :�EAF FT. FT. VSE OF BUILDING ANO WORK TO BE PERFORMED OI5TANCE BET. BET. MAIN & MAIN BLDGS. ACCE�. BLOGS. VAR. iW DATE C.U.P.aW APPROVED APPROVED I hereby ecknowledga that I have reatl this applicaiion and stata that the above intormetiOn is to��ect antl ap�ee t0 cOmply with all laws regulatinB builtlinB �onstruction, antl I shell not employ eny permn in vlole[ion of the workman's �ompansatiOn laws Of the State of Calitornia. m � I hereby certity that 1 am prope�ly licensetl as a conttacID� untle� SQ. FT. O the State ot Calitornia Business antl ProfessiOns Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR � Chapter 9, antl that such licenses are In f�ll forca antl effect, or I TNE PVRPOSE OF E57ABLSHING A PERMIT FEE ONLV: m em ezempt from t�e provisions ot tha Steta of California Business ¢ and Protessions Codo, Division 3, Chaptar 9. VALUATION /%/ O m PERMIT FEE $ � � SiB^ature of m Permittee $ / PLAN CHECK $ �� E `o Authorizatl Apont / / /I Q u TOTAL FEE $ (