HomeMy WebLinkAbout2508 Alder Ln - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 9.2526
BUILDING PERMIT
Job Address:
2508 ALDER LN
Status: ISSUED
Suite:
Applied: 09/01/2000
Vicinity:
BLDG 29
Issued: 09/01/2000
`t39 -172-z/
FEE SUMMARY
Parcel Number:
4 Zoning:
Permit:
Applicant:
COOTER, LYLE
ISSUED BY:
Address:
23015 DEL LAGO
Other:
Phone: (949)583-1858
LAGUNA HILLS, CA Zip: 92653
Owner: LAUREL POINT TOWN HOMES HOA
Address
Phone:
COSTA MESA, CA Zip: 92627
Contractor: PRO -TECH WEATHERPROOFING
Address: 23015 DEL LAGO
Phone: (949)583-1858
LAGUNA HILLS, CA
Zip: 92653 License: 620476
Arch : Eng:
Address: Address:
Total: $125.80
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
PLANNING & ZONING
Rear 0-0 Left 0-0 Right 0-0
Rear 0-0 Left 0-0 Right 0-0
Required: 0 Proposed: 0
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
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)
Phone: Phone:
Zip:
License: License:
SCOPE OF PERMIT
REROOF'BLDG 29": T/O EXISTING SHAKE, INSTALL 15# FELT, APPLY GAF 30 -YR COMP SHINGLES.
SQUARES.
FEE SUMMARY
Plan Check:
$0.00 Calc Valuation: $5,500.00
Permit:
$125.25 Claim Valuation: $5,500.00
SMIP Res:
$0.55
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $125.80
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
PLANNING & ZONING
Rear 0-0 Left 0-0 Right 0-0
Rear 0-0 Left 0-0 Right 0-0
Required: 0 Proposed: 0
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
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)
WORKERS' COMPENSATION DECLAKATIO :
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
1 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 is issued.
/ My workers' compensation Insurance carder and policy number are:
Carder: Policy Number:
(This section need not be completed i/ the permit is valued at one hundred dollars ($100) or less.)
❑ 1 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 workers'
compensation laws of California, 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 provisioA-- 9 ) O D
Applicant Signature:Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($1 DO,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:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. If Class x
Contractor's Signature: Date: av
CONSTRUCTION LENDING AGENCY:
❑ 1 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: 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 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ 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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, All 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? ❑ Yes ❑ 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).
..............................................................................................................................................................................................................................................................................................................................-................................................I...........
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ 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 an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
...................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this appplication a emit for such construction or modification
from the South Ccast Air Quality Management District or from any other air pollution control district or agency? Yes 19 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
................................................................................................................................................................................................................................................................-....................... I .
........................................................................................
fi Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ 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 Quality 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? ❑ Yes ❑ 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.
Signet a Of Le .Owner(s) Date
7 / 70
And/Or Authorized Applicant Date
CODE 0. INSPECTION TYPE INTITAL CODE. INSPECTION TYPE RAIE INTI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing -
200 Final Re -Root !7 () QIP" G 1 210 Final Electrical
201 Final Block/Retaining Well 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
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Property Address Z Z'/)'Z l
Owner IA -k12.(, 0�
Contractor ALO —Tt'G
59
7
State Contractor License Number
Permit No. U,J (J/J �✓ S�
D -c -/L
bI)
Classification Ci367
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 15, and Appendix 15 of the latest adopted edition of the Uniform
Building Code, and the installation instructions of the manufacturer.
❑ I further certify that I am the owner of the property. (Owner -Builder permittee only).
❑ I further certify that I am:
❑ Owner of sole proprietorship company
❑ Full partner of the company
❑� Limited partner of the company
p Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this
certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
By:
0990.06 MW 6/W White - Building Div.;Canary -Conaagor', Pink - Owner
Company or Corporate Name
Z 3261 �+:Z I -A (S v 5
Address
2_�
Signature Date
Printed or Typed Name
CITY OF COSTA
REQUEST FOR OCrC�UU ANCY
TRACT NO. 10097 //iTYNE: January 14, 1980
LOT NO. 63
ADDRESS 2508 Alder Lane, Costa Mesa, CA 92627
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been conpleted and its streets
accepted by the City of Costa Mesa.
By executing this agreement, the undersigned acknowledges that he/she/they
was/sere 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 conditi {
BY
gna re of Purchaser)
'.� G 1 r BY vt✓
,IT
(Sig-natur of
Developer ao
lzed ACALIFORNIauthIDIIGt
JAN 1a 1990 aLOAN ASSOCIATION
AM PM BY
7i8i9jiui11iui�i4iui415i6 r ISi natu of. Lend
Richard A. MauntAssistant ice President
t. 4
"UM
4/79
/
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING/4InQ _Aln1+, / Aulr
OWNER
MAIL
CITY Tff tuannr+ Rcnrh NO. 7P42—
BRANCH
ADDRESS
ARCHITECT
CONTRACTOR
ADDRESS
TEL.
CITY NO.
STATE CITY
LIC. NO. LIC. NO.
SIZE NO.OF SLOGS,
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
7781 10/27/78 216.51 TTi
7781 10/27/76 216.51CK4
7781 DOOCT4469 43 ' 1 A "
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY I D%;rE RECEIVEDrnrc
BUILDING
ADDRESS
RMIT NO.
BLOCK
'FIRE
ZONE TYPE `V _ GROUEJ,1* J
APPROVED
' ZONE n S 1P° NS eI BUSE OF UILDING EW 67a o I
YARDS MAIIN BUILDING D I ACCESSORY BYARDS UILDDING
DISTANCE BET. BET. MAIN &
Nnaw^ATown homeslroiect A MAIN BLDGS. ACCESS SLOGS
L .�L / /i r� VAR. +.. 'ZC. i7_7L� DATE
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of Calif n!a Business and Professions Code, Division 3,
Chapter 9, an such licenses are in full force and effect, or I
am exempt h revisions o S tate of California Business
and Profess! de is n pter 9.
Signature oll
Permittee
Authorized Agent
APPROVEp i ,00By
I DATE7��CJ
HOLD FOR SPECIAL REOUIREMENTP
SRI/✓OO
TAX
i
FA ---,SQ.
FT. V
w
l�l
THE AMOUNT SHOWN UNDER VALUATION IS FOR
m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
e
VALUATION
PERMIT FEE $
`t
N
m
PLAN CHECK $ 1n9
�w
mo
SRI/✓OO
TAX
$
—$$
LL
U
TOTALPAID
l�l
7
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. ROX 1200 COSTA MESA_ CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS
OWNER
MAIL
ADDRESS
TEL.
CITY NO.
CONSTRUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT TEL.
OR ENGIN ER NO.
ADDRESS
CONTRACTOR
ADDRESS
TEL.
CITY NO.
STATE CITY
LIC. NO. LIC. NO.
SIZE NO.OF BLDGS,
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
ail laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State Of California.
I hereby certify that I am properly licensed as a contractor under
the State Of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
Signature of
Permittee
Authorized Agent
APPLICATION
BUILDING
ADDRESS
TRACT
FIRE
7
ZONE INO. OF
YARDS APPF
MAIN BUIL
(FROM CIL STIR
DISTANCE
MAIN BLD
VAR. #
LOT
VALUE
USE OF NEW
BUILDING
BET. MAIN
ACCESS Bl.
DATE
APPROVED
32040 TTLL
3209DOCK16
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION PERMIT FEE $ soft
PLAN CHECK $
$ /fJ TAX $
/ TOTAL PAID $ r4ft
r
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use [nk Only
BUILDING/yin���._ �%�/qL�-s /n�iT
MAIL
CITV TTovmnrt Raarh N0.752—
BRANCH
ADORESS
CONTRACTOR
ADDRESS
TEL.
CITV NO.
STATE CITV
�IC. NO. LIC. NO.
SIZE I NO.OF BIDGS.
OF LOT " NOW ON LOT
USE OF
EXISTING BLOG.
Separa[e permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PEIiFOFMED
I hereby acknowledge ihat I have reatl this application and stete
that the above intormation is corract antl agrea to comply with
all laws regulating builtling consttuction, antl I shall not employ
any person in violation of the workman's compensation laws of
Me State ot California.
I he�eby certify that I am proparly licansatl as a coniractor untler
the State of Celif n1a Business antl Professions Cotle, Division 3,
Chapter 9, an such licenses are in full forca antl affect, or I
am ezempt h rovislons o t tate of California Business
end Professl tle is n, pter 9.
Signat�re
Permlttee
Auihorizetl Agent
asog � �s10 ��-��
7781 a0/27/1B 216.51 T
�778.I' I0/27/78 81'fi.51CKf�
778'I� ' OQO[744"69 43 "-I A "` "'�
APPUCATION FOR STROCTURAL PERMIT
RECENED BV D'rYE RECENED nnTc �cci icn
BUIIDING
ADDRESS
OWNER
\
FIIiE
ZONE
APPROVED
BV
ZONE Q�
VARDS/
MAIN 2
(FROM C/L
RMIT NO.
BLOCK
NS, V BUILDING EW CU�'lFt
VED VARDSAPPROVED
OISiANCE BET. BET.I
MAIN BLOGS. ACCE
VAR.# / �7 DATE
C.U.P.�h�Z" /'�p+ � APPR(
na�aovea�:_,.�l7D .
P10LD FOR
THE AMO
THE PURP(
VALUATION
$ �Z�j�00
REOUIREMENTS
JN UNDER VALUATION IS FOR
'ABLISHING A PERMIT FEE ONLY:
PERfNIT FEE $
PLAN CHECK $
TAX $ �
TOTALPAID $
�
n
m
i
d
m
J
m
b
�N
m
m
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626
BUILDING PERMIT
Job nddress: 2508 ALDER LN
Suile:
Vicinily: BLDG 29
�f39-/72-z/
Parcel Number: �r'��i=rzi-i
App�icant: COOTER, LYLE
Address: 23015 DEL LAGO
Zoning:
Phone: (949)583-1858
LAGUNA HILLS, CA Zip: 92653
owner: LAUREL POINT TOWN HOMES HOA
Address
Phone:
COSTA MESA, CA Zip: 92627
Contractor: PRO-TECH WEATHERPROOFING
Address: 23015 DEL LAGO
Arch :
Address:
Phone: (949) 583-1858
LAGUNA HILLS, CA
Zip: 92653 License: 620476
Phone:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 09/Ot/2000
Issued: 09/Oi/2000
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF "BLDG 29": T/O EXISTING SHAKE, INSTALL 15# FELT, APPLY GAF 30-YR COMP SHINGLES.
�'SQUARES.
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.55
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.80
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existinq: o
Rear 0- 0
Rear 0- 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$5,500.00
$5,500.00
NOTICE: The work authorizad 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 1 BO days, or if work is suspended or abandoned
for a period of 780 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-4fi(fJ00)
WOBKERS' COMPENSA710N DECLARA710IT�. �
I hereby effirm undar penelty of perjury one oi the followinq declarations:
❑ I heve antl will meintain a certificete of consent to self-Insure for workers' compensation, es provided for by section 3700 of the Lebor Code, tor the pertormance of the
work for which ihis permit is issuetl.
I have antl will maintain workere' compensation insurance, as reduired by section 3700 of the Lebor Code, for the pedortnance of tha work for which this pertnit is issued.
/ My workers' compensation Insurance carner antl policy number are:
Carner: Policy Number:
(This sec(ion need not be completetl il the permit is valuetl et ane hundred dollers ($100) or less.)
❑ I cetlity Ihat in Ihe pertormance of the work for which this permit is issueQ I shall not employ any person in eny manner so as to become subject to the workers'
compensation laws oi Califomia, and agrea that if I should 6ecome subject b the workers' compensation provislons of Section 3700 of the Labor Code, I shall Forthwith
comply with these provision n .
Appliwnt Signature: � Date: `�/ � `� D
WARNING: FAILURE TO SECU�ORKERS' COMPENSATIpJ COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDREO
THOUSAND DOLLARE (5100,000), IN A�DITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, INTEREST, AN� ATiORNE1"S FEES.
'I LICENSED CONTRACTORS DECLARATION:
I hereby attirm ihat I am licensetl under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code, and my license is in tull '�
torce and eHecL Lic. N Class x I
Contractor's SignaNre: _ / oate: L� �� I
CONSTRUCTION LENDING AGENCY:
❑ I hereby atFirm Ihat theie is a construction lending agancy for the pedormance of Ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lendefs Address:
i Signature: Date: �
OWNEH-BUILDER DECLARATIONS:
I hereby eflirm that under penalry ot perjury ihat I am EXEMPT FROM TT1E CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires a permil to consiruct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires t�e applicant for such pertnil
to file a signed siatamen� that he or she is licensed pursuant to Ihe provisions of tha Contractors License Law (Chepter 9(commencing with Section 7000) of Division 3 of the
Business end Professions Code) or ihat he or she is exempt theretrom and che basis for the allegetl e:emption. Any violation of Section 7031.5 by any applicant for a permit
subjects Ihe applicant to e civil penelty ot not more Ihan five hundred dollars ($500).): .
❑ I, as owner of ihe property, or my employees with weges as iheir sole compensation, WILL DO 7HE WORK, end the stmcture is not intentletl or o%eretl for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who doas such work
himseli or herself or through his or her own employees, providad Ihat such improvemems are not imentlea or oMered for sale. tl, however, Ne building or improvement is
sold within one year of completion, the owner-builder will have the burden ol 0�oving ihat he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of the property, am EXCWSIVELV CONTRAC7ING WITH LICENSED CONTRACTOHS ro consiruct the prqect (Sec. 704a, Business entl Protessions
Code: The conirectors License Law does not apply to an owner oi propetly who builds or improves ihereon, antl who contracts br such prolect with e comractor(s)
license pursuant to ihe Coniractors License Laws.).
❑ I am e:empt under sec. Business and Professions Code for ihis reason:
Signeture: Dale:
Owner ID verified by drivefs license. ❑ Ves ❑ No Drivefs License No. E:pires:
Vedtication of Ownere�ip by (type of tlwument, i.e. - properry taz bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hareby certify ihat no excavation five (5) or more feet in depih into which e person is required to descend, will be made in connection with work eut�orized by Ihis
permit, and Ihat no building struMure, scaHoltling, falsework, or tlemolition or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Califomia Atlminis�ralive Code).
❑ As ownervbuilder, I will not employ enyone to do work which would require e permit from the Division of Industnel Safety, es noted above, unless such person hes e
permit to do such work from �he tlivision.
Signature: Date:
Division oi Indusirial Safery Pertnit Numher.
CERTIFICATE OF COMPLIANCE AND AUTHORVATON OF ENTRV: I certify under penalry of perjury that I have read ihis ap0liration and stata that ihe infortnation given is
correct. I agree to comply with all slate laws and ciry ordinances rela�ing to Duilding construction, and authonze representatives of the Ciry of Costa Mese to enter upon ihe
above-described property for inspection purposes. I agree not to occupy or allow occupancy of eny building authorized by ihis pertnit until tinal inspection.
Signat e Of Le . I.Owner(s) Date
7� / '>O
AnNOr Aut�onzed Applicant � Date
CODE t. INSPECTONTYPE
1616 Fixetl System Finel Fire PreveNion
1266
200
201
202
203
204
PoolSpa Final
Final Re-Root
Final Block/Retaining Wall
Final Factory Fira Place
Final Sign
Final Demolition
o"re INTITIALS
COOE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PSIE 1�L9
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING/�'Q / n • IT
OWNER nI
MAIL
ADDRES4)01 Dove S #225
TEL.
CITY New ort Beach No -7
52-507
CONSTRUCTION
BRANCH
ADDRESS
ARCHITECT
CONTRACTOR
ADDRESS
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of Calif nia Business and Professions Code, Division 3,
Chanter 9, an such licenses are in full force and effect, or I
am exempt h rov isions ot tL9,,5tate of California Business
and ProfesWAgent
pter 9.
Signature
Permittee
Authorize
7781 10/27/78 2.16x5.1 T
7781 10/27/78 2I'6.51CK4'
2 7781 000(J4469 0 IA
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY I D%;rE RECEIVED naTv icmirn
A.P. NO.I/Y'UxJ-Q/ LG_%1 j"i
BUILDING -1 n
ADDRESS
OWNE
1
APPROVED
DATE
T NO.
BLOCK
ZONE
TEL.
CITY
NO.
STATE
CITY
LIC. NO.
LIC. NO.
SIZE
NO. OF BLDGS.
OF LOT
I NOW ON LOT
USE OF
EXISTING BLDG.
PERMIT FEE $
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of Calif nia Business and Professions Code, Division 3,
Chanter 9, an such licenses are in full force and effect, or I
am exempt h rov isions ot tL9,,5tate of California Business
and ProfesWAgent
pter 9.
Signature
Permittee
Authorize
7781 10/27/78 2.16x5.1 T
7781 10/27/78 2I'6.51CK4'
2 7781 000(J4469 0 IA
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY I D%;rE RECEIVED naTv icmirn
A.P. NO.I/Y'UxJ-Q/ LG_%1 j"i
BUILDING -1 n
ADDRESS
OWNE
1
APPROVED
DATE
T NO.
BLOCK
ZONE
NO. OF
USE OF NEW CiFJ>'iFii
PLANS, L�
BUILDING
YARDS APPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
(FROM C/L STREET)
REAR FT. FT.
DISTANCE BET. BET. MAIN u
MAIN BLOCS. ACCESS, SLOGS,
VAR. # ++��!! DATE
C.U.P.#LL'7aw
APPROVED/2 -,2 7
APPROVEe: 7J2 JO- '2-!
HOLD
�FOR
KKSPECIA REOUIREMER'T4
TOTAL PAID $ �Ja�e,G1
n
m
'v
SO. FT. VOUNT
SHOWN UNDER VALUATION IS FORPOSE
rVALUATION
OF ESTABLISHING A PERMIT FEE ONLY:
PERMIT FEE $
PLAN CHECK $LO
TAX $
U
TOTAL PAID $ �Ja�e,G1
1"
LW
M"
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
OWNER
MAIL
CITY Newport Beach No. 752 -
CONSTRUCTION
BRANCH
ADDRESS
ARCHITECT
OR FNr91NFFR B
ADDRES,Tqe�t]
CONTRACTOR
ADDRESS
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.
1 hereby certify that I am properly licensed as a contractor under
the State of Calif n[a Business and Professions Code, Division 3,
Chapter 9, an such licenses are in full force and effect, or I
am exempt h rov isions o t tate of California Business
and Profess[ de is n Ater 9.
Signature o
Permittee
Authorized Agent
asog 4-
7781 10/27/78 216.51 TL
7781 10/27/78 21'so51CKTp
2 7781 000044-6943 "I A
APPLICATION FOR STRUCTURAL PERMIT
ECEIVEDBV I owYE RECEIVED Hort rocirn
A.P. NO.
BUILDING
ADDRESS
OWN
APPROVED
DATE
RM
BLOCK
ZONE 4 IP ANS. I BUILDING EW ��USEOFN~�D
YARDS APPROVED YARDS APPROVED
MAIN BUILDING ACCESSORY BUILDING
REAR FT.
TEL.
CITY
NO.
STATE
CITY
LIC. NO.
LIC. NO.
SIZE
NO. OF BLDGS.
OF LOT
NOW ON LOT
USE OF
EXISTING BLDG.
m
v'
Separate permits are required for
electric; plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.
1 hereby certify that I am properly licensed as a contractor under
the State of Calif n[a Business and Professions Code, Division 3,
Chapter 9, an such licenses are in full force and effect, or I
am exempt h rov isions o t tate of California Business
and Profess[ de is n Ater 9.
Signature o
Permittee
Authorized Agent
asog 4-
7781 10/27/78 216.51 TL
7781 10/27/78 21'so51CKTp
2 7781 000044-6943 "I A
APPLICATION FOR STRUCTURAL PERMIT
ECEIVEDBV I owYE RECEIVED Hort rocirn
A.P. NO.
BUILDING
ADDRESS
OWN
APPROVED
DATE
RM
BLOCK
ZONE 4 IP ANS. I BUILDING EW ��USEOFN~�D
YARDS APPROVED YARDS APPROVED
MAIN BUILDING ACCESSORY BUILDING
REAR FT.
FT.
DISTANCE BET.
_
BET. MAIN &
MAIN FLOGS.ACCESS.
BLDGS.
VAR +DATE
C U.P *'0G!' 77W? J
APPROVED Z 2 ?— 7-7
APPFIOVEe:Gy_
By
CSPECIA1
/O_07-7
DATE ce
HOLDFORR/
REOUIREMENTS
m
v'
THE AMOUNT SHOWN UNDER VALUATION IS FOR D
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
e
VALUATION
PERMIT FEE $ v
h
n
PLAN CHECK $ A6 Lnm
0
S 1 /�,I/ ✓OQ
TAX $
� V
TOTAL PAID S A.GI