HomeMy WebLinkAbout1091 SEA TERRACE LN - Building Permits \. r-. . I
CITY OF COSTA MESA
o5 ,p - v BUILDING DIVISION
Fa'"^ ,,'A( I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
v FOR INSPECTIONS CALL: (714)754-5626
R-"° %� PERMIT NUMBER: M10-00121
PERMIT TYPE MECH STATUS: ISSUED
APN: 42201318 DATE ISSUED: 11/12/2010
ISSUED BY: KJB
._,..w-..�.a.�,.-,.�.�.-r-19'-'
-
JOB ADDRESS: 01'091-SEATERRACE LN CM 1 Suite/Unit:
vicinity: .
SQ. FT: 0 ,
SCOPE OF WORK: CHANGE OUT FAU/SAME LOCATION. REPLACE DUCTING
OWNER: KATZOFF,DAVID J Address: 1091 SEA TERRACE LN Unit:
PHONE: 714.227-1338 City/State/Zip: COSTA MESA,CA
APPLICANT: EZZAT ANDRAWES Address: 1616 NEWPORT BLVD Unit:
PHONE: 714-534-7186 City/State/zZip: NEWPORT BEACH, CA
CONTRACTOR: ATLAS COMFORT AIR INC License No. 869893
Address: 1616 NEWPORT BLVDUnit: PHONE: 714-534-7186 '
City/State: NEWPORT BEACH, CA ZipCode: 92660 CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $52.00
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $52.00
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE P. INSPECTION TYPE DATE INTITIALS CODE It INSPECTION TYPE _DATE INTRIpp
1616 Fixed System Final Fire Prevention 206 Final Mechanical X - -11-- ,1011 W I N
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention _
4.
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECt4%RATION: j Owner ID verified by driv, .ense. ❑Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations: • Driver's License No. Expires: _
10I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
pe Affiance of the work for which this permit is issued.
Lhave and will maintain workers'compensation insurance, as required by
��� Ion-3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 10 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: �-7 —+� person is required to descend,will be made in connection with work authorized
nag mer /B > ! by this permit,and that no building structure,scaffolding.falsewvrk,or demolition
` A ham '1' or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(this seat need 1 p ead he on alue0a mehvnmetl dollars(5100)or less)
2,Arlt Sec.341,T11e 8,Califomia Administrative Code).
Poli b. Kfri See
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the wo�. e compensation laws of California, and agree that if I should
beco /�.ject to the workers' ompensation provisions of Section 3700 of Applicants Signature Date
the ar...: I s•.ll forthwit. ... "th these I,o isions.
./� lie /: -17f,"-.�a Division of Industrial Safety Permit Number:
410774X?
�--� ir7�'ure CDa/te_—" HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in I:r - . • -ffect. a registration form for acutely hazardous materials? 0 Yes ❑ No
'L_ _ ,i e Class-tag (Section 25533 of the California Health and Safety Code, with some
///��� exceptions, requires registration with the Costa Mesa Fire Department by
/ / i 1� `,j- .---!0 each business which at any one time has on hand a quantity of acutely
all.
// ,:yam�,,".1G*' ignature [ ohm hazardous materials equal to or greater than a weight of 500 pounds, or a
l�'� i volume of 55 gallons. or 200 cubic feet of compressed gas at standard
CON- -SA N LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued. (Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 10No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
S.gnature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own
8. (If yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for control officer).
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
CII, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
CI I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
• ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to e er upon the above-described property for
inspection t loses. I agree n. to occupy or allow occupancy of any building
authorize• / is/ ` al inspection. /
1g•gm /gal r ner(s) Date
Signature Date
30946(3107) •
l aindorAathonzed'Apptirant cerate---_—_,
Simplified Prescriptive Certifi - of Compliance: 2008 Residential HVAC. •ations CF-1R-ALT-HVAC
Climate Zones 1 and 3-7
I A/U- Dol? J
Site Addrgsg,� ter ' �.,.ep telt! Enforcement Agettery.• ,,� rt DT1t-tz—/T Permit 1/:
111 U!/ll •'\ Conditioned (�(Duucct iinnsulatio L 11 •
Equipment Type' cL"isl Minimum.Efficiency' Floor Area requiremep Thermostat
Packaged Unit (� Over 40/duc rtrr
mace s A ER - COP Served NES)
system added,y u 0 Setback
Indoor Coil ❑SEER ❑HSPF 14'JV sf n�yfiditio e pace f/fnor ah'eadl'present,must be
❑ Condensing Unit ❑EER 0 Resistance !n'R 6 (CZ/,3-5) installed) .
❑Other 1
I. Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,75%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement a ncy for pproval wit the permit
application.
pNam`e {A.272 A/r pt 4 {�es ,•Signature- �y
g tEompan)': / I/L/+rFr ✓ sDate:�"f /
' ddfire—/3 f 7 L.44 r•5�o- ) / A P j A 2.04 cense:--- go ,1813
.city/State/Zip: a t / tfax-A-[�!r'�9iStit/7 honer a (i7
«C___���///DDD � /
2008 Residential Compliance Forms March 2010
(ENFORCEMEN=TAGENCI'
CAN:CI =OIIIZEIG!!ITHLEIZERFIEAD/SEAL)
•
l
2008 Building Energy Efficiency Standards Residential HVAC Alterations
Climate Zohes 1 and 3 through.7 C'Z=,6 c Gasp.0r,cs4-
BUSINESS AND PROFESSIONS CODE,SECTION 7110
Willful or deliberate disregard and violation of the building laws,including the California Building Code,and
local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board
working in conjunction with the local building department. This action may consist of fines up to$5,000 per
violation or suspension/revocation of a contractor's license.
R'HEN IS A PERMIT REOUIRED? .
A written construction permit shall be obtained from the enforcement agency prior to theerection,construction,
reconstruction,installation,relocation,or alteration of any mechanical system,except as permitted in Appendix.: ,:
Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include,but are not
limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of fumace,coil,FAU,or condenser •
• Relocation of an existing HVAC unit
•• Adding or replacing more than 40ft ducting in unconditioned space •
•
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REOU R.EMENTS INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception: Wall&floor furnaces;room heaters).
2. Central air conditioners&heat pumps less than 65,000 Btufltr must have a Minimum 13 SEER. •
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points)is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
All joints and openings in the in the HVAC system must be sealed.
• Only UL 181,UL 181A,or UL 181B approved tapes or mastic shall be used to seal duct openings.
Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4ft.max for horizontal runs with no more than 2"
of sag between supports and 6 ft.max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector will collect
this form and verify that the model numbers are the same as the installed equipment.
•
f
s
• CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. SM121 DATE tl--2"g")5
LOT N0. 'S RECEIVED
ADDRESS 1091 Sea Terrace CITY
1 Y O NINGSTDEPTESA
APR 27 1979PM
The developer of the above entitled tract desires to IJI h1�l 19 3121ri3tthhiC
lot prior to the time that the tract has been completed l its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was pr were) 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. The undersigned acknowledges that this
agreement is made solely for the benefit of the city and does not inure to
the benefit of the undersigned or any of them. -
BY
Purchaser
J .H . e , 0 ' i /.!. PP ' Y
BY " /1 // -
Developer d/or authorized
represen ative
GREAT WESTERN
• BY SAVINGS & LOAN ASSOCIATION
:.,g. e :el
BEVERLY HILLS, CALIF. 90211
/t •Crit-- f�tt� GCJ 4 cf'M22a
yic.g PRESIL Ui
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 1n01R DATE April 9[t 1979
LOT NO. 35
ADDRESS 1091 Sea Terrace Lane, Costa Mesa, Ca.
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was or were) 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 _a I L.d/ Al.,
BY , 'r .000
,j -/ A?
Developer Ari/or authorized
represent ive
BY
Lender
•
' ' • CITY Of COSTA MESA
BUILDING SAFETY DEPARTMENT
POST IN CONSPICUOUS PLACE
• ON THE JOB
•
A.P. NO.
BUILDING ADDRESS
10.1 Sea Terrace
TRACT BLOCK
1001$'..
NEW ADD ALTER REPAIR MOVING DEMOLISH
11•
; vii
MOLD FOR SPECIAL 1UCRJi[tEM;Thrrc
SETBACKS
' Front Yd 6'41.1 Side Yd. R 0' L 0' Rear 4'
Side Yd.R L Rear
BUILDING INSPECTION RECORD •
• TO KEEP BUILDING PERMITS VALID, WORK MUST BE COM-
. MENCED WITHIN 60 DAYS WITH ROUTINE INSPECTIONS AT
• LEAST EACH 120 DAYS THEREAFTER UNTIL COMPLETED.
STRUCTURAL J�'T/1n DATE •
• - Trenches LI Forms :1 ,iaLAY- 'Z. SMC- e
Floor System •(ty��+ 1d�raia— 6--
Floor
Steel Reinf• 6/r����
Sheathing il�a� ' - ' 9
Frame and Flashing Ie �M.
•
I• nsulation «,�allI
PARZEII
• Lathing
ienin
Dry Well Nailing /I[e/V-��} {
- Plaster,Brown Coat aran
Sound Attenuation
Handicap Regulatior
FINAL Al 3/8�7�
PLUMBING
/L
• � Soil , p/��j1�'. ..
Underground Water F[y�3�iS/ "'-/ -- 7 /-1
Rough Plumbing P"/= - / ?
•
Prop.Sewer Line and House Conn [dai�.�7O 1�- B-
Street Sewer Conn. VA.'S �_fid_
Water Service
lFl•
• Sprinkling System RSNI:/`IBI_ ._
Gas Test � � ir�l��
FINAL t13711 '
HEATING,AIR-COND.AND REFRIGERATION
Refr. Lines,Pressure Test
' Ducts, Underground ��,yyy��/qqq n
Ducts,in Structure f V- iZ f
Ducts,Ventilating r[� /'2 7
• 1 J )
• Rough Heating one Air-Gond ^ 'J' t /� 1 e--y'7T
FINAL .L"/�`/n13-7-19
ELECTRICAL
Temporary Service or Pole �--- ��
Underground FIMAIV/•i�
Power Meter pr.7!1w' ��}I ������
Rough Wiring EsiR' lr722IE2
FINAL �•••j
Do not occupy this project until final inspection has
been rrpdc•end octupancy has bps�,p1 ap)pr
Building Final �/ 1_j;,,,. •
Special Requirements ---�r`III���i fVV/
Occupancy •`
_.. .. NOTICE •
24-hr. notification required when the job is ready for inspection. You
must furnish PERMIT NUMBER and the JOB ADDRESS FOR EACH
. • • RESPECTIVE INSPECTION. CALL 556-5273.
APPROVED PLANS SHALL BE ON JOB AT ALL TIMES
CMF 0559=0 t•
OWNER THE GREGORY CO. DATE 3-3-78
JOB ADDRESS 1091 Sea Terrace BUILDING PERMIT NO. 45390
GENERAL CONTRACTOR _ Same DESCRIPTION of WORK Res.v/att. Garage
AP No. LOT 35 TRACT 10018 FIRE ZONE VALUE $ 33,100•
INSPECTIONS Sianoturs Doty TYPE V GROUP & J ZONE PDR-MD
SOIL PERMITS ISSWED
GAS SUBCONTRACTOR Number
I I
- Date Siyn alur•
WATER ry
ROUGH PLUMBING r-� I '/��' bin t I� /, 7�/"a
PROP. SWR. LINE ❑ HOUSE CON. 0 �� -..�n 7�/-')� 9y 541
SPRINKLING SYSTEM -yp_• 3 a•7-)9 767/3
MISCELLANEOUS T•
ROUGH HEATING AND AIR CONDITIONING • �7
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING H.olin d V f, /J.^��^J
TRENCHES a FORMS Li STEEL REINF. L� • -4-1--„i7-17,
�c ���T/ J4'27,Y •
FLOOR SYSTEM I � / ! �-7 /.413�4j
BOND BEAM n STEEL REINFORCE I]
SHEATHING
FRAME AND FLASHING
LATHING — IN n OUT in
PLASTER. BROWN COAT
STRUCTURAL. FINAL Elortd[
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL y
BUILDING, FINAL r� �y�
SPECIAL REQUIREMENTS 4,/)Q 'Y/- - '
1
' 45390
Itlp _-•;• 41496 1 /19/78 9247 TL
!. COSTA MESA BUILDING-SAFETY DEPARTMENT p
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING
ADDRESS /D 9i 5E/ ^ —�in
a �P
OWNER the gregory company A,P. NO.14�" V539
MAIL BUILDING
ADD3187-g airway ave INO.� ADDRESS /d ff/ S,
CITY costa mesa /51-3850 TRACT 10018 LOT 3 BLOCK
CONSTRUCTION NEW (ADD ALTER I REPAIR (MOVING DEMOLISH
LENDER
BRANCH
OWNS the gregory company '1
ADDRESS • VALU
ARCHITECT harrison/lorenzi L• 751-3851 "51 _ w/att garagb3f6Q.4.0
OR ENGINEER
FIRE
ADDRESS 3187—g airway ave ZONE TYPE V GROUP I&J
APPROVED
CONTRACTOR gregory construction co. BY DATE
ADDRESS 3187—g airway ave
TEL. ONE –hi NO.OF USE OF�1EW n A
CITY costa mesa NO. 751-38 e -hy PLANS7 BUIL DIA(y ACt,r�'I 1e1If/'
gF STATE 285981 CITY 008179 YARDS APPROVED YARDS ARNiOVE0
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
WSIZE INO.OF BLOCS.
0. (FROM Cr STREET) irI
OF LOT 11.27 s x992 s NOW ON LOT 0 FRONT Q FT, FT,
AC USE OF
FLI EXISTING BLDG. R SIDE O FT. FT.
M Separate permits are required for L,SIDE 0 FT. FT.
electric,plumbing and heating work.
CI REAR 474 FT. FT.
IQ
E. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q< ,,//�� MAIN BLDGS. ACCESS. BLOCS.
// VAR. OATE��p MM,, 7
..1 � T - •� C.U.P. APPRQ a,.Pr 7
attached garage> 7: r ,b)e PD DATE-3— rr/lp, /7�"
ce HOLD FOR SPECIAL REQUIREMENT`
'Li0 I hereby acknowledge that I have read this application and state n
n
r>: that the above information is correct and agree to comply with
as
G• all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of o
SSW the State of California. 1219 11 O
I hereby certify that I am properly licensed :- a contractor under SQ. FT. 458 garage Si
the State of California Business an• P ns Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such license- .r force and effect,or I THE PURPC6E OF ESTABLISHING A PERMIT FEE ONLY:
am exemp o the provision- -- .te of California Business — 'p
/�ar9 VALUATION PERMIT FEE $ o
and Prof cions •de,Di - o J
en
Signature • � ', /�/� //4 PLAN CHECK E /Q.11a� o
Permittee U.
'ar'�� 6 `�[ /co TAX $ ^.9_
✓V/ I{ �� U.
Authorizegigai '• - U
TOTAL PAID $ ill I
446:949
COSTA MESA BUILDING-SAFETY DEPARTMENT 7275 3/13/78 139e00 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 7275 3/13/78 139.000KTO
APPLICATION FFOR-STRUCTURALPERMIT IA
For Applicant to Fill in Completely — Use Ink Only
�, RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING /n / /
ADDRESS (f
OWNER I�t/.� _ PERMIT NO.
A.P. NO.
MAIL BUILDING / 9/i�/ �.,e�rey € "n ,
ADDRESS ADDRESS ((` ■%t.((,iG.l%
TEL. TRACT LOT BLOCK
CITY NO.
CONSTRUCTION NEW I ADO ALTER I RFPAIR MOVING OFMOLISH
LENDER
BRANCH /fJ
OWNER (•p.r
ADDRESS LUE
ARCHITECT TEL. USE ad.Ire $
OR ENGINEER NO.
FIRE
ADDRESS ZONE TY GROUP
CONTRACTOR APPROVED
DATE
ADDRESS ZONE INO.OF USE OF NEW
TEL. PLANS BUILDING
CITY NO.
Ib• STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIG.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLOCS (FROM C/L STREET)
0. OF LOT I NOW ON LOT FRONT FT. FT.
Q USE OF
:12 EXISTING BLDG. R.SIOF FT. FT.
VI
PE F Separate permits are required for L.SIDE FT. FT.
welectric,plumbing and heating work. REAR FT. FT.
I.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q ^ MAIN BLOCS. ACCESS.BLOCS.
/get
.. C.U.P.lin APPR
f(/�//yYJ re), C.U.P.qW APPROVED
ATEa
APPROVED
.—I _ BY DATE
Ce
GLI0.
I hereby acknowledge that I have reed this application and state N
N
Lthat the above information is correct and agree to comply with m
all laws regulating building construction, and I shell not employ
Z 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 50.FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR &
Chapter 9, and that such licenses ore in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: u
am exempt from the provisions of the State of California BusinessVALUATION PERMIT FEE $ ` �t e
and Professions Code, Division 3,Chapter 9. ie.......---
( a(s�/ in
m
PLAN CHECK $ �n
Signature of
0
Permittee $ TAX $ LL
F
i eD D
Authorized Agent TOTAL PAID $ ge