HomeMy WebLinkAbout3388 SUMMERSET CIR - Building Permits` �
CITY OF COSTA MESA
�` _ � BI/ILDING DIVISION
: DEVELOPMENT SERVICES DEPARTMENT
� aaa_nnnn�
���, PERMIT PERMITNUMBER .�,
(714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 3388 SUMMERSETCI
Suite:
Vicinity:
Parcel Nunmber: 41208308
Applicant: DUVALL, JOHN
Address:
Zaning: R1 R1
Phone:
Zip: '
Owner. SLATIN, JAMES A ' ,
Address 3388 SUMMERSET CIR � . � ' '
i
� , - �, , Phone: , � , , _ , � _
COSTA MESA,CA _ . Zip: `_,,92826 -. ' _ . .- ��
. , . . ,. _ _ - =,.' _ �., _ - ��
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Contractor: � DUVALCROOFING &�CONSTRUCTION • , �� �' ��V'-'-
� �..'-: ,:. . �� /� -.���_� ,
Address: ,� 2903 CABALLISTA DECSUR � ' = � � � . ��, .
_ _ ,.. Phone: 714-366-2896 �� C` ,� � , ���`,
SAN CLEMENTE CA Zip: 92673 �V�„��--� `�,: A
, . �,..
Status: ISSUED
Applied: 05/26/1998
Issued: OS/26/1998
�
Arch./ Eng : .
Address: � ,
Licenser 680352 � , " � ���,�
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� Phone:-, � -� �� �.��. - . . .
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. . .Zip:�� � . � � , - �
� - License: , _ , ., , t� , ,
�
SCOPE OF PERMIT '
� WOOD SHAKE & INSTALL 40LBS FIBER & 30LBS FELT WITH LIGHT WEIGHT CONC. TILE 3.8 PSF, ICBO# �3682 �
� ` .
� ,.
Plan Check: $0.00
Permit: $12475
Other: $0.00
Inspection: $0.00
.
FEE SUMMARY r
-.- - - / ,'
. i
- _�
�
_ - Calc Valuation:
� Claimed Valuation:
$6,633.00
$6,633.00 � ,
. ._ _ ' /_ }'1.
� Total: � $125.41 � � - � �
� ' ' FLANNING &�ZONING �
. . l i � .� �� - . ' . �
SETBACKS � � , �.
i,
MAIN STRUCTURE Fmnt 0- 0 . ,Rear �; 0- 0;. -.. Left �, 0- 0 ;- Right 0- 0�
ACCESSORY Front 0- 0 � Rear 0- 0' - • Left 0- 0 � Right 0- 0 �
PARKING Existinq: 0 Required: 0 Proposed: 0
NOTES:
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetiona end final approvel must be obtained. Failure to obtain inspedions and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATON DECLARATION: �
I hereby e%rm under penalry of perjury one of the following declerations: �
❑ I heve end will melnteln a ceNiicate oi consent to self-Insure for workers' compensation, as provitletl for by section 3700 of ihe Labor Cade, for t�e pertortnence of the
work for which Ihis pertnit is iuuetl.
.Q� I heve and will maintein vrorkers' compensatlori insurance, es requiretl by seaion 3700 of ihe Labor CoGe, for ��e perfortnance o1 lhe work for which Ihis pertnit I5 issued.
My workers' compensation Insurance cartier flnC poliq number are:
Carrier.
❑ � certily
Pdicy Number.
not be completed ll fhe permitls valuetl at one hundretl dollers ($f 00) or less.)
In Ihe performance of ihe work for which this pertnit is issued, I shall not employ any person in any manner so es to Decome subject to ihe workars'
i laws af Cellfomia, end agrea that Ii I shoul46ecome sub�ect ta the workers' compensetion provlsions of Sectlon 3700 of the Lebor Cotle, I shall farthwit�
e: � Date: �� Z le �— 9�.f'
TO S RE WORKERS' COlAPENSATION COVERAGE IS UNUW FUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENAlT1ES AND CIVIL FlNES UP TO ONE HUNDRED
E($100,OW),IN ADDRION TO hIE CQST OF COMPENSATION, DAMAGES AS PqOVIDED FOR IN SECfION 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEI"S FEES.
LILENSED CON7RACTORS OECLARATION:
I hereby effirtn ihet I em licensetl under provlsions ot Chapter 9(commencing with Section 7000) ot Divislon 3 of the Business end Protessions Cotla, entl my license is in full
force and eflect. Llc. # Class q
Mr torsSigneNre: Date: S— 7(2_L�i3'f
�7RUCTION LENDING AGENCY:
I hereby affirtn Nat there Is a consiructlon lending agency for t�e pertortnance oi t�e work tor w�ic� this permit is issuad. (Sec. 3097, Civil Cotle).
Lentlefs Name: Lentler'S Atltlress:
SignaNre:
OWNER-BUILDER DECLARATIONS:
Da�e:
I hereby attirm that under penalry of pehury t�et I am EXEMPT FHOM 7ME CONTRAC70RS IICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Business and Professlons
Code: Any ciry or counry w�ic� requires a pertnit to wnstruct, alter, impmve, demWish, or repair eny siructure, pnor ro Its issuance, elso requires the eppllcant for such permit
to flle e signed stetemem thet he or she Is licensetl pursuent to ihe provisions of the Contrectors LJcense Law (Cheptar 9(commencing w%h Sectlon 7000) af Division 3 ot Iha
Business anC Professions Cotle) or ihat he or she is exempt theretrom and the basis for tha alleged exemption. Any violatlon of Section 7031.5 by eny applicant for a permit
sub�ects Ne epplicant to e civll penelry ot not more Nen five hundred dollars ($500).):
❑ I, es owner of the property, or my employees wlih weges as their sole compensation, WILL DO THE WOHK, and Ihe siructure is not intentletl or oHered for sele (Sec.
7044, Business an0 Protessions Coda: The Contractors License Lew does not apply to an owner ot property who hulltls or improves thereon, antl w�o tloes such work
himself or hereelt ar ihrough his or �er own employees, provitled that such improvements ere no� intentled or oflered for sale. tl, however, Ihe buliding or Impmvement Is
sold wiihin one year of completion, Ne owner-builtler will have the burden of proving that he or she tlitl not build or improve for purpase of sele.).
❑ I, es owner ot the praperry, am E%CLUSIVELY CONTRACTING WIT}I LICENSED CONTRACTORS ta construct the project (Sec. 7044, Business antl Professions
Code: The contractors License Lew does not epply to an ownar oi propeny who Dulltls or improves thereon, end who contracis for such proJad with e conirector(s)
Iicense pursuant ro the Contrecmrs License Laws.).
❑ I em axempt untler sec. Business and Protessions Cotle tor ihis reason:
Signamre: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers Licensa No.
Vedficetion of Ownership by (rype of tlocument, I.e. - proDerty tax Dill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
Expires:
❑ I hereby certity that no e:cevallon five (5) or more taet in tlepth Into whlch e person is requlretl to tlescend, will be mede In connectlon with work euthorized by ihis
pertnit, end thet no building atructure, sceHolding, falsework, or demolitlon or dismantling thereof, will be more then thirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec.
341, TiGe 8, Celifomia AGministratNa Code).
❑ As owneo-builtler, 1 will not employ anyone to tlo work which would reQuira e permit from the Division ot Industnal Sefery, es notetl above, unlass such pereon �as a
pertnit to do such work from the division.
Signeture: Date:
Division ot Indusirial Safey Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTFiORIZATON OF EMAY: I ce�ity under penfllty of perjury that I have reetl Ihis epplicetion end state thet ihe infortnetlon given is
correct. I egree to comply with all stete lews end ciry ordinences releting �o builtling consWction, and authonze representatives of ihe Ciry of Coste Mesa to enter upon t�e
ebove-Aescri4ed prQperty for ingpeyMion Durposes. I agree not to occupy or allow accupanry of any building autharized by this permit unUl finel inspeclion.
�pp� ixsvernoxTvre
1616 FixeE System Finel Fire Prevention
1266 Pool Spa Final -
200 Flnel RaRoof
201 Finel BIocWReteining Wall
202 Finel Fectory Fire Place
203 Final Sign
204 Final Demolition
2406d6
� _I 1fl�l;�iii[�
6 -2 -9� ��
- _ S -2��9Sr
Dete
COOEt INSPECTOMIYPE
206 Finel Mechanicel
20B Final Plumbing
210 Finel Electricel
212 Final Fire Preventlon
220 Finel Plenning Approvel
222 Final Site
250 Finel BulltlingiOccupancy
DAff IlI�AlS
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moxessoFew�on+c: 3388 SOMMERSET CI � °Ni`
°w"E"s"""E"'Q'°w": pAULSON HOWARD G FLOOD: AHL3 %
AD°"�5 3388 SUFIMERSET CIR
COSTA MESA,CA 92626
557-5660
�rv�. wuurw woness: .
u�cxrtecTa+e�ax�n: uc.ra.:
qCX.ONEN6'Si1UDRE55: UNT:
CWliNACTON'SNANE: NOCK PLUMBING l714)695-1246
CONfNACTORSMNIING 1 1 6 1 2 KNOTT ST
"0°"� GARDEN GROVE CA �� 707775
92841 uM: 17
UCENSE� COMFpCTONS DECL1flATI0N: I heraby eXim uMx penetly d perjury Ihm I em licenxd under pmisiortv d Clapm 9
(eamme�ep xilh Senion )OW) d Oihaion 3 d Ne &ni�se eM PMaesbns COAe, ud my limnae is in lull iwee arM elled.
cmuc.No.: OS 38 10 ""�' C-36 uc NO�707 EXP: 02 /98
Dme: Cmmretla: 1 S{�i
OWNEfl BUILOEfl ECLAH4TION: I Mieby elfirm uMer penely d parNrv �hm I am e�smq Imm ihe Camreaan licanee w
/olbx'vp rmson (Seeion ]0�1.5 Bus'vroaa eM Pmlemiona Code: Any ciY a counlY �� �9�� e q�me b awbue. atls. imyova,
demd'eh, a repei eiry etrudure, p'v io m"swarce, eho repuirea the epdicant br euch parmn lo file e eiB� atetemeni ihet he or eM
w Irenaed punuenl lo IM povidma d iM Convedas Licenx law �Cheqx B(mmmendnp vrilh SeUion )000) d 0'vuion 3 d ihe
Busmae eM Prdeaeiona Code7 a tAet M a ahe ie axamq thereM1am eM Ihe beeia iw tha dlped a�ampfon. My voletion ol5edian
)0]1.5 by eny epplicent lor e perme wbjetls IM eppliceM b e dvil panelry d na mae ihen Ma huMretl Edlen �5500�).
� I. es owner d IM qopenY or mY �Pb1'� �� wapee av �Mi eob eomperoelbn. will Eo tM �k. erd iM atruclun e M WeMeE
a oPxed br eeb (5aclion ]oa. Buvrea ud Proiaeaom Cada: The Conlredon Licensa Law doen ml WdY�oen ownerd puoaM
wM WiIEs w mqovee thareon, ad who Eoas cuch wak Hmaell or Mnatl or thraph he a her own empbyeea, providad thm wrA
imqovemeMe ere nd in�eMad n dlsad la sab. tl, lawevar, iM buiMiip a'vnpwamem n eatl wnhin om yev d camd�a�. �ha
owner-WiNar will heve tlre Wkan d provi�p M or ehe did mt build a imqove la iM W�P�a d aeb�.
� I, m owner d �he D�PaM. em e�duviveM ����irp wnh licensed convectwn to conmrw tM projeq (Sedion 1W4, &ni�e erd
Protessiwu CoCe: The Coniradas licen+e Lew dms rw eppy io en awmr d popeny xho buitle a impo+ee the�eon vd who
conlrecte Iw wch piqetls xilh e wnVada�s) Icaneatl pursuenl lo Ihe ConlraGore lioenfe Lew).
� I em saemq uMm Seciion: B. 8 P.C., br Ihia reeaon:
o�e: o.�,�:
i eo nereW cenM �nm i�..�e w.�e �neemene me reamremen�s a ce�eom�e r�enn d,e sma�r cm. seaion. uws, usaa, ene
255�4. end thm 1 a eiry fNure Wildirp xapen� will / wil �(�6 ww) med to comply wih aeid eWa oodee vM IM ispuiremaN far
epermillawrevunionwmodifiWionhwniMAi u�y enepemeMqMrkl.ReeiAemieloonviudionepplcetiauereexemqlramlheae
qwnsiona.
WONKEP'S COMPENS�TION DKL�NATON: I Mreby eif uMa pxutly d pxj�vy an d Me fdbwiiq ddvmiore:
� I heva eM wil meintein e ceMHiceb d roroem �a saM�iruun b xaken' compensetbn, m pwidad la by Saeim 3]00 d tM LeEn
coea. i« me v�«�e a ub � i« �, m�. v�u A:.�.d.
f7 in�..m���m.:,.�a,��o�oo��re�...a�.a�eMsm�a�aodme�coda.ro.msp.�ro.m.�o.dm.
� work iw which I�ie pe�m� o ieeued. My wakere' mmpaneetan inwrenca famer aM pdiq numbar ere:
c�: r.nT.nFw FA(;T.F EXPIRES
PWiryNumber. ywr a���a�n� 09/OS/9'1
Rnis s«r� ��e �w na �p.ree r rna �,mn is ro� o� nuneree dd� R�ao� a�..�
� I cenAy thm in the pMoimenca M IM work far whch �hie paimil ie ieaueE, I ehell irot employ eny pereon in vry menner w n ta
bemm wdae �o tl ^ waMne• camDen+e�bn lexs d Calaomu, eM�p e inm a1 elwuk Exmn wbl� m IM xaMna'
cwnpenu�b/nJ��� e W Se on 3100 0l iha Lebor Lotla, I shall b IIF' ompN �h� �oe pmvieioro.
Dma: 1!� ApqiceM�
Wem/np: Fall�rs ro ucun woiken'rompsiuetlon rovorap� l� unNwNl, entl Mell sWJset en employsr ro er/Miul pmelf
elvll flrwa �q N aw �inOrM tMuaxtl dal/an fSIPqOPO), M M�Ifbn ro fM cwt o/ ronpwuatbr5 Wm�ps� � povWW br In
Ssetlon 9]O6 0/ tlrs LeDoi CorY, Intsnif, end etlomsy'� lsex
CONSTfiUC110N LENDINO AOENCT: I hweW atfi�m under panelry W perjury ihet there ia e mmtruaion IaMinB e0e�wy br Iha
peAwmerim d tha wik la whitli Iho pwmY o ewW (�� �/. CN. Cl.
LENDEN'S NAME:
�plDEF'S �OOFESS: -
I unity �hm I heve reaE Iho epplicelian eM qme ihel me abwe inipmmion is vnrtec. I prae to wmpty xnh ell rny enE mumy oNinencee
entl etate kxs rel+tirq io buildip conavuenn enC Mraby eulhar¢e npraeenlelivm d iNs dryto emx upan �M ebwe-memord papercy
lainapaeion purposas.
RON NUCK
PnN Neme
� ' � Dab: �� ` .
. Signeluma �ier/RgenVApiram/Convaew
(5t51-�l.WP) WhesB�ikip 65elery: GreerFb; Cenery-Appiranl: Rnk-ilevenua; pddenmd-Aasemw
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P p83014
PERMIT N0: P 083014 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION ; DISHWASHER CHANGE OUT SQ FT;
CLAIM VALUE: CALC—VALUE: GROOP OCC: R-3 /
COMMENTS: NO OTHER WORK ASSOCIATED WITA THIS PERMIT
�lE fl' 1E if iE iF 1E 1E iE 1E IE 1E iE'!f IE 1E iE 1f if 1E IF fE iF 1F if ik iE if iF 1E 1f 1E 1E 1E 1f 1f 1F iE 1E 1f #!E 1E �IE 1f 1f iF iF iE 1E iE iE 1FlF iE 1E if iE ik IE 1E iE'IE iF iF 1E if fE fF 1E IF iE iE iE IF 1f iE 1F iF
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ----------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN
— ACCESSORY BUILDING —
FRNT; FT IN kEAR: FT IN
LEET; FT IN RGfiT: FT IN
PARKING RE • PROV: PARCEL; 41208308 ZNE: REF NO;
PLANNING N�TES>
i
**�*x�***�� �r� **� x *****x �*****�****+�***+��+�*�+�**+�i�***� *� *� *�*,«� �r**�r� *x �+�� **�*�r��*,r
D E V E L O P M E N T S E R V I C E S"` R E Q U I R E M E N T S
�.
ZONZNG APPROVED BY .
BUILDING APPROVED BY :
APPLICATION ISSUED HY: L�=H9
�t*x �r�***�*�t� �t***�r*�t***
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 8.75
258
DATE;
DATE:
DATE
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GR�ING
SMIP/NON—RES
PLAN
ISSUE FEE 22.00
BUILDING—DIV—> PERMIT, ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 8,75 �22.00 0.00 30,75 30,75 ,OQ
REVENOE DIVISION TOTALS--> COLLECTED; 30,75 OVER/SHORT: 00
BLDG PMT.PI,UMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
30,"75
iE iE iE iE 1f # iE if IE 1f')f 1f iE if if if if' 1E 1F if iE iF if if iF if 3I' iE iE k')E if iE if iE iE If if ii 1f iE iE iE iE iE iE iE iE if if'1F if if'k iE iE iE iF iE iE 1F if iE'iE if iE if if if iE if'k iF iE �f iE if if'If
I N D 2 V Z D U A L F E E B R E A K D O W N
TYPE_ _ QTY
D E S C R I P T I O N
1. DISHWASHER
END OF FEES
UNIT COST
TOTAL COST
8.75
°5-Z3-1997/i�;p2 p,�i630.7�
F'ER�IITei0�3814
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Peimit# Date Inspector ' APPROVALS Permit# ' Date Inspecror �
t. Temporary Electrical Service or Pole "' �� ' 52. Pool & Equipment Location � �
2. Soil Pipe•Undrgmd�. � , , . 53. Steel Reinforcement - � �� � '
3. Efectriwl Conduit Utility-Undrgr,nif. ' 54. Forms. ° , • 1�
4. Electrical ConduibUndrgmd. � � . 55. Electrical Bonding . � �
5. Steel Reinforcement- �' � � 56: Rough Plumbing & Pressure'Test
6. Electrical UPER_Grnd. � � ' S7. APPROVAL TO COVER-GUNITE -
� 7. Footings � � 58. Electrical Conduit�Undrgrnd. . � j
�
8, Foundation - .� � � 59. Gas Pipe, CI Undrgmd.,.T.est �
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P,Trap, � Undrgrnd. `
10. Structural Floor System . " 61. APPROVAL TO'DECK �
11. Praperty 5ewer �ioe & House Connection ' - � fi2. Sackwash & Receptor•P�nal .
�
12. Sewer Cap - � , � � 63. Heater & VenrFinal � -
13. Roof Drafns '� � 64. Plumbing System � Finai �'� � �
14. Rough Plumbing ' . ' � �65. Electrical-Final �
15. Rough Electrica6Conduic �� .. . 66. Solar System-Final . ��
16. Rough Electric Wiring � - � - 67. Fencing & Access Approval , ' �'
/•
/7. Rough Wiring Sign 68. APPROVED FOR PtASTERING . '!
18. Rough E�ectrical�T Bar Ceiling ! 69. POOUSPA SYSTEMS FINAL ' . �
19. Rough Heating & Air Conditioning � � FIRE DEPT. REQUIREMENT• -
20, Rough Fectory Fireplace -� _ _ APPROVALS=• -� Permit #
21. Ducts, in Structure - . �-' 70. Underground H,ydro
22. Oucts, Ventila2ing�• � . � � 77. Product Piping GGas ❑ O�i
23. Gas Pipe-Rough & Test � , _ _ . � . � 7z, Underground Ffush
24. Roof Framing� � -- �- �_ - ' . 73: Undergrnd. Smra9e Tank O Gas ❑ Oil
25. Roof Sheathing � � - �' 74. Overfiead Hyd�o .
26. T-Bar Ceiiing (Structural� & Monocoat • � 75. Dry Chemical -
27. Frame and Flashing . � ' 76. Dry Standpipe _�-
28. �Lathing & Siding � � - � - - . � - 77. FIXED SYSTEM-�F�INAL
29. Insulation �� 78-. FIRE PREV. FINAL -� '
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster 8rown Coat 79. FINAC INSPECTION �
32. Electrical-Power Meter�Final - 80. FOOD CERTIFICATE iSSUED
33. Final Electric . ' Notes: _
, 34. Final Heating & Air Condltioning � . " . � �. - ��
35. Final Gas PiPe-Test - - � � `
36. Hood or Canopy �-. - . .. - - �
37. Final Factory Firepiace , - _ - �
38. Final Plumbing ... � ' _ � �Z�'t � -
39. N%ater Service-Finaf ' � �
40. Gas Service-Pinal _ ' � , .
41. Solar pomesticFina� - ' � . -
42. Backflow Prevenier � �' , � _
43. Backflow �rrigation .� - _
44. Landscape Irrigation System � .
45. Sound A2tenuation � � " -- - � .� _. -- _.
46. Handicap Regulations . � � -
47. FINAL STRUCTURE & BUILDING � '
48. FINA�PLANNING `' '
49. Electrie Release to Edison � ' -
50. Gas Release to Southem California Gas Co , . -
51. CERTIFICATE OF OCCUPANCY
No. Date
CITY DF COSTA MESA
CAUFORNIA 42828 P.O. BOX f200
FROM THE OFFICE OF THE DIRECTOR OF BUILDIN6 SAFETV
Project Address 33 88 su.�..0 Ff sE� L'�,e
Project Name
• " � : �' .
oomers Address 3�84 5' G M MFE C�
O�mers Telephone SS �-
F�2L7111i # f J� Da?a 7
Zj'Pe �
City Use Only
I c��R„_���,_/� as Owner, Contractor, Agent (strike out all
except one) do hereby attest that employnent of any person, or persons, is not
anticipated at the time of seelcing the abovrreferenced permit. In the event that
any person, or persons, are employed under the prwisions of this pernut, I shall
i�miediately cause a valid Certificate of Worlarens Co�nq�ensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my own oost, and to indemnify and hold hazmless, the City,
its officers, agents and/or e�loyees, fran and against, arry and all liability,
damage, costs, losses, claims and expenses, howscever caused, resulting directly
or indirectly fran, or connected with the improv�nent under this permit.
I further state that I have read and fully imderstand t
sponsibilities of the above statertents, and will canply
Contractors State License Iaw found under the Business
Division 3, Chapter 9, of the State of California.
-�{o w� a d � w /4�.J
Print Name
5����-�-
CMF 0777-46
�e implications and re-
with all provisions of the
ind Professions Code,
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Filt in Completely - Use Ink Only
BUILDING
ADDRESS Tract 10277, Lot 23
OWNER MCLain Development Co.
MAIL
ADOFESS 1470 Jamboree Road
TEL.
cirv Newport Beach No. 640-6800
CANSTRUCfiON
BRANCH
ADDRESS
ARCHITECT _ _ . .__ _ .. TEL.
ADDRESS 3661 Spruce St., Newport Beach
CONTRACTOR McLain Development Co.
ADDflESS 1470 Jamboree Road
C�TV Newport Beach No�� 640-6800
L C NO. 2%3H%S LICVNO.
OF LOT SO X I.ZS I NOW ON LDOT��
USE OF
EXISTNG BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WOfiK TO BE PERFORMED
residence,
New House
1 hereby acknowledge ihat I have reatl Shis epplicaiton ond rtete
that the above informatlon is correct antl agree to comply wlth
all laws regulatln0 bullding construcilon, enC I shall not employ
any permn In violation of Ma workman's compensation laws of
the Staie of Celifornla.
I hereby certlfy that I am properly Iicensetl az a contrector untlar
the Stete of California Business and Protesslons Cotla, Dlvislon 3,
Cneprer 9, end rhet such licensas ere in full force enA affect, or I
am exempt from Me provisions of the State of Celifornia Businass
antl Protassions Code, DiviSlon 3, Chapter 9n.
Sipnature of (\�\ ,f/// c �� - /
Permlttee `+\n�� F��_ i.I (./V`-�=-/
Authorized Bent
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� 3B.0 2/2J.%.79 957.62 TL
fe- 38.17' 2/2'I`/79_ __ 357.62CKf-6
APPLICATION FO���'RU�}�i,��I�MIT � A
A.P. NO. 7II� �
BUILDING
ADDRESS 3,%j8,
TRACT LO�
E
APPROVED
�DR-m0
VAROS AF
LOT 23 I BLOCK
DATE
USEOFNEW RES
BUILDING
YAqDS APPROVED
REAR I S FT. � FT.
D4STANCE BET. BEf. MAIN &
MAIN BLDGS. ACCE�. BLDGS.
C URP, qW 1E�%p ' j APPROVED Z/2. %/% p
APPROVE � ( ` /
.� !
FIOLD FOR PECIAL REOUIREMEN S
� House 2352
Garage 678
SQ. FT.
THE AMOUNT SHOWN UNOER VALUATION IS FOR
THE PURPOSE OF E5TABLISHING A PERMIT FEE ONLY:
VALUATION PERMIT FEE $
PLAN CHECK y / /' �'/
rJ � Cr
$ /��%/I./S TAX S S �
�� /�/✓(�
TOTALPAID $ �
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