HomeMy WebLinkAbout1080 SANTA CRUZ CIR - Building Permits •
yfp Mac CITY OF COSTA MESA •
4�, ►9. BUILDING DIVISION
> �t'c DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
fl
t ! t- PERMIT
JMO2-00461
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1080 SANTA CRUZ CI Status: ISSUED
Suite No Applied: 10/21/2002
Issued: 10/21/2002
Vicinity:
Parcel Number: 41206123 ISSUED BY:
Applicant: ORANGE COUNTY SERVICES INC
Address: 3801 LENAWEE AVE
Phone: (310)253-5229
CULVER CITY,CA Zip: 90232
Owner: HOBBS, WILLIAM 0 TR
Address: 1080 SANTA CRUZ CIR
Phone:
COSTA MESA,CA Zip: 92626-1618
Contractor: ORANGE COUNTY SERVICES INC
Address: 3801 LENAWEE AVE
Phone: (310)253-5229
CULVER CITY,CA Zip: 90232
License:679898
SCOPE OF PERMIT
CHANGE OUT OF FAU. SAME LOCATION.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust • $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 .0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 . 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $41.70
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 it 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
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
2446-46(6/00)
DECLARATIONS c1 r" ')
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have 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
work for which this permit is issued.
I have 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 ued.
My workers workers'goqlpepsatkalnsurence carrier and policy number are: /
Carrier: lci e h ID Policy Number: I(a�'Y 3a- /f
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which thiepermit is issued,I shall not employ any person In any manner so as t•become subject to the workers'
/ . •-• •tion laws of California,err a ee that if I should become subject to the workers'compensation provisions of •actio 3700 of • a Labor Code,1 shall forthwith
c.d.' I•..•tse Provisions. ( , 1 t-
•� ••pllcanl Signatur- nate:
•-• . URE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN E .• ; 0 ' INAL P NALTIES • D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby:•' • g- I am licen edyp er r'vi�j?ns of Chap,jac9(commencing with Section 7000)of Division 3 o1 BusiDss aidProfessions Code,and my license is in full
tonate Llc.e 1 Y las #
.ntractors .i nature: �1 D
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).
Lender's Name: Lender's 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 permit
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 property 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 properly,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 Will 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? 0 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 apermit for such construction Cr modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? pi Yes 0 No
(Section 65850.2 of the California 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 California Health and Safety Code).
7 If a permit from the South Coast Air Duality Management District or other air pollution control district 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? 0 Yes 0 No
8 (If yes,attach certificate of compliance from the appropriate-airpollution 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.
•
Owner(s) ' y Date
E V I
•nd/Or Aut onze. :n 'a-1 Date
x
CODE I INSPECTION TYPE all INTIMI 4 CODE it INSPECTION TYPE DAli ^ 21122111616 Fixed System Final Fire Prevention 206 Final Mechanical ii-s-0a`
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining 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
ADDRESS OF WILDING 1080 SANTA CRU$ CI um: CITY OF COSTA MESA — BUILDING PERMIT
I
OMNERSNAME IF KNOYM: HOBBS, WILLIAM O FLOOD: AH-38 /PERM NO: B 078286
ADDRESS: 1080 SANTA CRUZ CIR
COSTA MESA,CA 92626 PERMIT NO: B 078286 PLAN CHECK NO: N GOVT: N SUPP : N
'APPL.IWUNGADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : REROOF 100SF FLAT AREA W/BUILT—UP SQ FT: 7, 048
MCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: 7, 048 . 00 CALC—VALUE: 7,048 . 00 GROUP OCC: R-3 /U-1
CONTRACTOR'S PLANE: A PLUS ROOFING ( 714 ) 754-1000
CCWRACTORS MMUNG 11237 SLATER AV COMMENTS : T/OFF SHEATH & REROOF 2900SF W/COMP, SMOKE DET REQUIRED PER 94UBC
ADDNEss: FOUNTAIN VALLEY CA uc.NO.: 675241 *+E '*+A 'x'fri[x'* 'x'**x'***sL'*****'x'*'x'it- 'SL'RE*'*'x'+e*sL'SF'sB 'ill 'sit -x' ' 'x*****sESEitx-* *x'*fESF -x-*Rf***it******
92708 UMT: ZONING REQU IREMENT MOKEDETECTOR
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 S E T B A C K S
(commenting with Section 7000)of Division 3 of the Business and Professions ode,and m license bin full force end effect
CITY uC.NO.: 060847 umcuss: C 39 m.NG: 67 �01 /97 MAIN BUILDING ACCESSORY B a£iJ ED--- .
/' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR T IN-a6'
L/—t/ ¢6LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Dale: Contractor:
OWNER BUILDER DECLARATION:1 hereby afinn under penally of perjury that I em exempt from the Contractors License Law for the
Slowing reason(Section 7031.5 Business and Professions Code:Any cry or county which requires a permit Io construct alter,improve, PARKING REQ: PROV: PARCEL: 41206123 Z N E: REF NO:
'coolish.or repel any structure,prim to its issuance.also requires the applicant lm such perm)to fib a signed statement that he or she PLANNING NOTES>
e licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting 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 permit subjects theapplicanl to a civil penalty of not more than five hundred dollars[S5001). **********************************************•*********************************
o I.as owner of the prosody or my employees with wages as their sole compensation,will do the work,and the stricture is not intended DEVELOPMENT SERVICES REQUIREMENT' S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License law does not applyto en owner of property
who builds or inproves thereon.and who does such work limsel or tenet or through his or her own employee°,provided that such
improvements ere not intended or offered for sale.X.however,the building or improvement is sold within ore year of completion,the ZONING APPROVED BY DATE: r�`
owner.builder will have the burden of proving he or she did not build or improve for the purpose of sale).
0 I,as owner of the property,an,exclusively contracting with licensed contractors to construct the project(Section 7044,Business end BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and veno
contracts for such projects with a contractors)licensed pursuant to the Contractors License Law).
El Ian exempt under Section: 1 B.A PL..for this reason: APPLICATION ISSUED BY: DATE: C0 2r
********************************************* ********************* **** *****
Date: Owner LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby cety that I an aware of and understand the requirements of California Meath and Safety Code Sections 25505,25533,and
25531,and that lorany future building omupenl will/win nor(circle one)need to comply with said state codes end the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
aprprmo^«construction or modification from the Aar Crustily re
y Management District.Residential construction sppicatimue exempt from these PERMIT 137 . 25 701
Dae: Applicant: SM I P/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE
El I have and MI maintain a certifcale of consent to sell.insure for workers'ownsensation,as provided for by Seli011 3700 of the Lekm BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code.for the performance of the work for whish this perms is lessee. TOTALS----> 137 . 95 0 . 00 0 .00 137. 95 137 . 95 . 00
r d] I have e will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the
7C work for whim this pend is issued.My workers'cors sation Insure ice caner end policy number are:
Cartier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 137 . 95 OVER/SHORT: . 00
Policy Number: 28S-9bUN1T1O8O 01 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need nor be completed I the pent is for one hundred dollars(5100)Of less) 137 . 25 . 70
❑ I certify that in the performance of the work for which This pens is issued,I shall not employ any person in ruiner so as to
become subject to the workers'compensation laws of California, d Wren t(1 k esu eu' to the workers' *******************************************************************************
onm/op aatkron /
n p +loa Sectionm+ Section+703 a the Lana core.l anal f swan sun INDIVIDUAL F E E BREAKDOWN
Date: Z i - C Applicant. ,
Warning:Failuna to see"workers'conpenvtion coverage M unlawful,and shall sublecf en employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($100,000),In addition to the cost of compensation,denwgea as provided ler In
Simeon 3706 of the Labor Code,Interest,and acomey'•fees. SFR 7048 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 7, 048 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I hay read this application and sate that the above information is correct.I agree to comply with all city and county ordinances
and state laws ng to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection
j724jArALONE - •
- -Print7foo
Print Date: G —4%9� -
7 Signature of Owner/Agent/Applicant/Contractor .
'/ (5151<5.WP) Whale-Build g&Safety:Green-File:Canary-Appicant Pink-Revenue;Goldenrod-Assessor
,I
CONSTRUCTION AND PLANNING PG 1 SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1-
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - •
•
rir2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
C3. Electrical Conduit-Ufility-Undrgrnd. 54. Forms
4. Electrical Conduit:Undrgrnd. 55. Electrical Bonding -
St Steel Reinforcement- 56. Rough Plumbing & Pressure Test
' :6; Electrical UFERJcInd. 57. APPROVAL TO COVER-GUNITE C
27: Footings -a - 58. Electrical ConduibUndrgrnd.
_-8• Foundation _7...` - 59. Gas Pipe, 0 Urmir9crnd.,Test
- 9. Water Pipe-Undrgrnd, 60. Backwash Linesre•Trap, 0 Undrgrnd. '
10` Structural Floor System r. 61. APPROVAL TO.DECK
11. Property Sewer Line& House Connection 62, Backwash & Receptor-Final
•
12. Sewer Cap - 63. Heater & Vent-Final
E12. Roof Drains -,- 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final "
15. Rough ElectricatConduit 66. Solar System-Fina]
46. Rough Electric.lA firing 67. Fencing & Acca Approval •
17. Rough Wiring S(gn c 68. APPROVED FQf' PLASTERING
18. Rough Electrical-1- Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning _ v: ` F,4RE.OEPT..REOUIfiEMENT t•
20. ;lou Factory Fite`lace .' ^ * - - 4t L -' er -
$b y p ,c- :I: c ti APPSOVE1.li:�.p. Permit#
21. Duan, in Structure = r ._ 2 * -1 70.',;1Jnder yrtd Hydro r
n P s _ 4: " 14 r;. !�'ri
22. Ductl, Ventilating•- -- n �• 4, -, . '.r 71. Produc_tiaiping_Aas -0Oil
23. Gas Ptpe,Rough & Test .r " - - S ; 72, Underground Flush` 'y,
24. Roof Framing' `"r- "` " C _.
rn � s 791 Undergrnd.StorageTank.0Gas ❑Oil
25. Roof-Sheathing r ' 17,1//`1:- 74-.-Overhead Hydro'
26. 7-Bar,"Ceiling (Strac{urall & Mo7tocoat ;.CCC- ; - `1_ * 7i; .Dry Chemical • ,n
27. Frame and Flashing* ^t s r '` 75. Dry Stafl'pipe`1r rl
'- 28. Lathing & Sidings . - _E. _ }' t f 77, FIXED;SITSTEIVEFINAL- r '
Z
-
29. Insulation' • * J _ 1 `` 76. FIRE PREV. FINAL ,`s '' '
• 30. Drywall Neiling ,., �; i--, 'x - r-.11DEPT.RE5UIF�EMENT
. 31. Plaster Brown-Coat* --•r * I 6 r 79, FINAL fNSPECTaON ' _ .
D.
11
•- 32. ;E lectrical_Power Meter' F,iaaal 4 ^'' I I. `-'f 8& FOOD CERTIFICATE ISSUED. t;,
33. Einar Electric- T• � `r Notes: Ti Tr - O .0 Er,
34. FinairHeating Ar Conditioning- t - ` „ -I. '' z V
35. Final Gas Pipe-Test' - b Hrr
f T y
36. Hood;or Canopy ' '' ` - �' '• " e. ems• •
37, hlnal.Faetory Fireplace - .e 1 r�
- r N; - 4 it lf
-
_38. Final Plutgbioj ` i - f- • = r 4 -
w. rr [A f K 4C( C'
39. Water Service•Fina`I'..• -,- < i • .; 7 •, -
4
r 40. Gas Servide-Final - t'" :' n,.... a.,
y
_ 41. Solar Domestic•Final- ` cr. .< :'
L
42- Backflow Preventer =
• :' .
43. Backflow Irrigation; c a: t -' r r, -
-,
'44. Landscape iriigatitir$System- '- t.-)i' _
-. . - r.- C ti: _ _ 7.i Y
• 1i r
45. Sound Attenuation, - +: n,I .• rc. .�
46. Handicap•Regvtatio% . - {• ////__ T ^n c"- R
4.7. FINAL STRUCTUR &BUILDING 11/le. lll��� / -- - `
t A
48. FINAL PLANNING i ,t, E• - '• `' `'
r. r r ..:1 - f:
•
49. Electric Release to Edison ' ° I. Et _ .
50. Gas Release to Southern California Gas Co I , '-.' - • .-
51. CERTIFICATE OF OCCUPANCY ' -
No, Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 888d 3/07/8b ---JGa O0 f t
-
, CITY OF COSTA MESA CO``NSTRUCTIOOII+J PERMIT PERMIT NO. •R R TRACT NO,. LOT NO. UNIT NO.
Project Address /OS-0 5nn-4-A �-At-u-L 17 v `-� ' •
r '
Applicant's Mailing Address •
TYPE OF CONSTRUCTION LI NEW LJ ADD ❑ ALTERATION LI REPAIR f
` M/6- 3L( ❑ CONVERSION ❑ DEMOLISH ❑ OTHF� A.P.# - • Zone
Owner's Name �OQ7b5 Phone) DESCRIPTION OF WORK/USE OF BLDG. l• n.V�Er-l-,• 5 D I Arc--- i
(�.. Address aArvt t— 'J J ' po s IgE - S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION LI STRUCTURAL E Front ZO
W Address ❑ TENANT Q ELECTRICAL El PLUMBING ❑ MECHANICAL BRear N
Contractor's Name Fnu. (Ye S15h .i-roc-- Phone C Right N
PROJECT DESCRIPTION SQ. FT. OCCUPANCY -
Address(mailing) /42U GIA SSC.II ^ /� S Left G
1 q 1�V C O N ST RUCTION TYPE VALUATION$ R
City License No: JLL ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION 1I'1' ts7-11'`{/"I 11 l3 Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Chartdrr99 (commencing 'Remarks: ' Q�-fes 1 QG -yam S Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and , -IT 1 C J v
0 5 T
my license is in fW.Lforce and effect.r. '�L^i L12 fs \ - S
Licenie Class K Li nse No.�`L� 1 v
Date 3"7-fs-� Signature . .xu-fin PLUMBING . FEES -
WORKERS'COMPENSATION DECLARATION BarSink Showers
hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink.
3800; Lab//.�c� /� Automatic Washer 'Transformer ❑ 15-50 KW '
Policy No."'L a a/3310)S(oOCompany 1`t 2r�'n_hAl..'r Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+KW
'Certified copy is hereby furnished.
Certified copy is filed with the city Build'{�g •' ision. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date 7-S-1.-• Applicant YV- - /Qi
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers 7 Solar Collectors u 00 Dishwasher '
Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or - . I ' '- • "
less). Dishwasher ' r Solar Piping Z pC Dryers ❑Gas DElectric Sub Panel
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 subject to the . Drinking Fountains olar Tank Fan '
Work's' Compensation Laws of California.. a""S (//1 _ Motors❑0.1 HP ❑1 h-8 -
. Date ' ' - Signature Floor Drains - Swimming Pool w/Spa •
F.A.U.
NOTICE: If,after making this declaration, you should become subject to the Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith _ Floor Sinks _. Urinal Fixtures •
comply with such provisions or this permit shall be deemed revoked. Microwave •
CGp4 ,TRUCTION LENDING AGENCY - • Gas Service Outlets Water Closet Device Boxes
Ihereby affirm that there is a construction lending agency for the performance . Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors Water Heater Outlets Range Lender's Name - 9
Lender's Address Kitchen Sink Water Service
OWNER BUILDER DECLARATION - Switches Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' '
following reason (Section 7031.5 Business and Professional Code: Any city or Auto-Wash Garbage Disposal ;Standing Sections
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 P—Trap Laundry Trays - Generator ❑0-5 KW❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains •
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of - - . '
Division 3 of the Business and Professions Code) or that he/she is exempt . .
nerefrom and the basis for the alleged exemption. Any violation of Section _ •
_
/031.5 by any applicant for a permit subjects the applicant to a civil - : - -
penalty of not more than five hundred dollars($500). I -
U I, as owner of the property or my employees with wages as their sole Reinspection Fee 1 $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered YYY /
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES ' •. Reinspection Fee I $15 Issue Fee $ 3'
License Law 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 DEVELOPMENT SERVICES REQUIREMENTS:'
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ _
sale. If, however,the building or improvement is sold within one year of coin- Canopy Type II ❑ - Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground : Building Approved By Date
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System sC Application Issued By Date 7
tractors to construct the project (Section 7044,Business and Professions Code: - - -
The Contractor's License Law does not apply to an owner of property who Duct-VentilatingDO-100,000 BTU ❑100,000 BTU - SUMMARY OF FEES
•
builds or improves thereon,and who contracts for such projects with a con- - _ _
tractors) license Pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provides to me. Exhaust System ❑ Multiple ❑ System Repair/Alteration
17I`am exempt under Section B.& P.C.for this reason PLAN CHECK $ PERMIT Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ 32-'CO ' ISSUANCE - $
Date Owner Heating System& Ducting Registers
PLAN CHECK 25% $ ENERGY P.C. $ ,
I hereby certify that I have read this application and state that the above LOA 00,000 BTU ❑100,000 BTL . GRADING
information is correct. I agree to comply with all city and county ordinances _ ELECTR ICAL $ $
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
•
sentative of this cit to enter upon the abve-mentioned property fob_
inspectio urp es � � � r� I '
Signatur�l.C.h�ti Date �\ MECHANICAL $ TOTAL FEE $ 3Z-�
Drivers' License or SS# . Reinspection Fee $15 ' Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White . Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
•
CONSTRUCTION AND PLANNING POS _8(SPA y --
APPROVALS Permit ,Date - Inspector Date Inspector
I APPROVALS Permit#
1. Temporary Electrical Service or Pole • - 52. Pool & Equipment Location q •
2.. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms I,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test it
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
h
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
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
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains I 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval •
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING '
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 F
22. Ducts, Ventilating 71. Product Piping O Gas ❑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 78. FIRE PREV. FINAL it
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Note : 144 47 Lr c&,P'Iat,4j 40-012.-
34. Final Heating & Air Conditioning 2A.3 LLP.4 L. Z A
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
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 ,
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY -
It No. Date `
4
.::,•• -' 4' _ .-5aia ifi'1..:•i; :......'.. : .. .-Ji C.. ,.4122 r4-. F _+u_-'k +4,1"*.....tss� fir" 1 re'c. ir`U.ui^` .. t?,
Permit # -
THIS NUMBER MUST ACCOMPANY
ALL INSPECTION REQUESTS A P
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Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION
tPERMIT EMIT NO. - TRACT NO. LOT NO. UNIT NO. 8892 3/07/03 Loi li
Project Address (CIRO S trPs CsZI.. L. _/`O."/pz 2 i
TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION 0 REPAIR
AppliOwner's
Na Mailing Address C4L-�13 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.qfb I Zone
Owner's Namef 017i� S Phone �/ DESCRIPTION OF WORK/USE OF BLDG.
Address Ses1'1'x-e-' S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT U GRADING 0 FOUNDATION U STRUCTURAL E - Front O
Address ❑ TENANT ig ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear N
0 OTHER A I '
1 Contractor's Namp a AL/1120n me✓4'tASr.C. O' Phone
Address(mailing) 14.2o G/A c,/) PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G
CON ST RUCTION TYPE VALUATION$ S Lett R
City License No. ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: •
0M
with section 7000) of Division 3 of the Business and Professions Code a d T
my license is in fu rce and effect. O S
License Class _Ljcense No
Date V-2?–"St-T— Signature -- 41–..... PLUMBING FEES
-. WORKERS'COMPENSATION DECLARATION Bar Sink Showers
tusi
"of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
Automatic Washer Transformer
3800, Lab._CJ �1�// /n �l�j� 0 15-50 KW
Policy No. /C rt'o 331&oS 9-npany ACOO/10.1-L�5 ' Backflow Irrigation Sewer Cap 7 /Construction Pole Sub. • 0 50+ KW
Ce ified copy is hereby furnished. V
'etl p is tt'jed with the c' I on. Bathtubs Sewer Connection Cooking Unit • Meter ❑up to 100 amps
-
Dae �� 3 App licant�- ���
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors • Dishwasher Meter Dover 100 amps
(Thissection need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping • ' Dryers ❑Gas DElectric Sub Panel
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 subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'h-8
Workers' Compensation Laws of California.
- Date Signature Floor Drains Swimming Pool w/Spa
'NOTICE:If,after making this declaration,you should become subject to the _ ' F.A.U. Inc.Solar ❑9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. _ Microwave
CONSTRUCTION LENDING AGENCY . Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there Is a construction lending agency for thperformance Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets
Lender's Name - Range
Lender's Address Kit• chen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby at firm that I am exempt from the Contractor's license Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5.15 KW
any structure, prior to its Issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9.(commencing with Section 7000)of
'Division 3 of the Business and Professions Code) or that he/she is exempt
herefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
openalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Foe I $15 Issue Foe $ 3
compensation, will do the work,and the structure is not Intended or offered -
for sale (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL FEES Reinspection Fee $15 Issue Fee $ 3
License Law 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 • DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale). — /n1 G -
-
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By V I /('� / Date3 7 /7 S
tractors to construct the project (Section 7044,Business and Professions Code: 'r/
The Contractor's License Law does not apply to an owner of property who ' Duct- Ventilating 00-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon„and who contracts for such projects with a con-
tractor(s) license pursuant to the contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt.ICBG'# Fire Dampers PLUMBING $ PERMIT
ISSUANCE $
Date • Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
1 hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BT -
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ ,'f'16b GRADING $ ,
and state laws relating to building construction,and hereby authorize repre-
sentatives of this ci y t0 enter upon the above-mentioned property for /G
I Signet
o s MECHANICAL $ - TOTAL FEE $ T
•
Signet Date 3�T�J
Drivers' License or SS '-' Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
•
CONSTRUCTION AND PLANNING POC.-&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
• 1. Temporary Electrical Service or Pole 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar Systeni-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
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 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric
34. Final Heating & Air Conditioning --
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
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
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
( 51. CERTIFICATE OF OCCUPANCY '
•^gy ' Date
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO,
6638 DATE Dec. 2, 1970
LOT NO. 22
ADDRESS 1080 Santa Cruz Circle, Costa Mesa
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)
William 0. Hobbs(was-or-cere) Anne E. Hobbs advised that this tract has
not been given final inspection nor has it been accepted by the City of 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.
BY GC/ ' Cl/ G
chaser "
BY _.f, /
y ZC',/
RECEIVED Developer and or authorized
BUILDING SAFETY DEFT, representative
DEC 31970 BY
Lender
;lisp PM
•1810,10111112,1121314151U
a
OWNER HET,T7.ER ENTERPRTSES - C. M. DATE 9-26-69
JOB ADDRESS 1080 Santa CruCircle BUILDING PERMIT NO. 30877
GENERAL CONTRACTOR Same DESCRIPTION of WORK Reai deride Li/Attache;? Carew
AP No. - LOT 22 TRACT .638 FIRE ZONE . VALUE $ 24,636.00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-..
N[
SOIL S ..—y�7d PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number I Signature
WATER/4 f 1 re riU itz5iy-x+72 PIU in•
ROUGH PLUMBING ll S 4 / -73 _
PROP. SWR. LINE Ji HOUSE CON. [y]- 'l44. 4--7 _
SPRINKLING SYSTEM
MISCELLANEOUS �y
ROUGH HEATING AND AIR CONDITIONING //Lc4 , ?Q
TEMPORARY SERVICE OR POLE •
UNDERGROUND n POWER ❑ I
ROUGH WIRING
- 4 e Heatin• and Vent �
TRENCHES r FORMS n STEEL REIHF. ?M 1S -'2- , , ' 1�! � /
FLOOR SYSTEM . :V! 4-/3'70 g r it - a: i. �_, 4, 7i / -"-
BOND
BOND BEAM n STEEL REINFORCE n ,,,/ / C ,
SHEATHING ,ZO4F� 5421/49
FRAME AND FLAS /_ray 6 ' / 0
LATHING — IN OUT nit Vis' TO
PLASTER, BROWN COAT ' • Ev g /Iwo
STRUCTURAL, FINAL i lee i _
HEATING, VENT., REFRIG. A t aarril tRAL /%jCQ -74 runt PLUMBING, FINAL AND GAS TEST in M t7 -70 SIIIIIIa
ELECTRIC, FINAL 1•Z,7'.7n_
BUILDING. FINAL ii _ 2-2-y'^.
377 :16V 12-69P"—'B00 414* ***133,50
CMSA
Plircops. TAMESABUILDING-SAFETY DEPARTMENT
O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely REC d E Y D• E REC V��FFDD DATE ISSL
BUILDING 1080 Santa Cruz Circle % –(o% SEP 2 6 1
ADDRESS
PERMIT NO.
OWNER Heltzer Enterprises-Costa Mesa A.P.NO. ..
MAIL BUILDING /pj�/j r
Z .
ADDRESS 740 No. La Brea Ave. ADDRESS
!/ �/ OOO...f//J'�
el
CI_ O CITY L.A. Cal. NOL'9x37- 2171 TRACT 6638 I LOT 22 BLOCK
ZQ CONSTRUCTION NEW ,7'ADD I ALTER REPAIR (MOVING 11FMnl ISH
d
m LENDER United California Bank e...
J D BRANCH Main Office •
m al J ADDRESS 6th and Spring, L.A. OWNER /' VALUE S / ref
J Q OR ENGINEER Frank Gonzales NoL532-6878 USE �� �� $aYi�a4�—q�
n / pYn �1
z a 1336 E. Chapman Orange, Cal. ZONE TYPE v GROUP
W CL ADDRESS P , g s
o_W r
J Z CONTRACTOR George J. Heltzer & ASSOCS. APPROVED DATE
m Z
J ADDRESS Same as above
W W — ZONE NO.OF USE OF NEW Single - ''.
Zi- CITY NOL Rl IPLAANS 2 BUILDING
Res. w/att.G:r.
W0 STATE 201098 CITY 1707 YARDS APPROVED YARDS APPROVED
to m LIC. NO, LIC.NO. MAIN BUILDING ACCESSORY BUILDING
D SIZE NO.OF BLOCS.
(FROM C/L STREET)
OF LOT NOW ON LOT ROM FT. f FT.
USE OF C/
EXISTING BLDG. R.SIDF FT, FT,
f' SIZE OF NO.OF ///y
2 NEW BLDG. ROOMS STORIES L.SIDE ! / FT. FT.
UEXTERIOR WALL ROOF / '
_ COVERING COVERING REAR / In FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET.1tt ___ BET.MAIN&
Q.
a MAIN BLDGS. ACCESS. BLDGS.
VA
DATE
a0 Residence wth attached garage .+C.U.P.# APPROVED
yPlan fret ��ye APPROVED WLp DATE (I/
0
0
I hereby acknowledge that I have read this application and state
that the above information is correct end agree to comply with
D
Oall laws regulating building construction, end I shall not employ02.047.c1sy
F any person in violation of the workman's compensation laws of ///���
Ci) the State of California. /�.} / /d W
Z I hereby certify that I am properly licensed as a contractor under / VSO. FT(../S/13- VVV/Y'/v 0
the State of California Business and Professions Code, Division 3, THE AMOUNT SN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R
am exempt from the provisions of the State of California Business VALUATION
and Professions Code,Division 3,Chapter 9. �pyy-/�
/ PERMIT FEE $ p•-,
Signature of • //1�1 � /
Permitted / $ PLAN CHECK $ f 154V it
p a
Authorized Agent ri5-4°•
J ✓ TOTAL FEE $ /-34-3 ' xas