HomeMy WebLinkAbout3405 SUMMERSET CIR - Building Permits• Fax (714) 754-4856
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�- Job Addre:
3ui
Vicini
Parcel Numb
CITY OF COSTA MESA
BlIILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
3405 SUMMERSET CI
HOUSE & GARAGE
41207321
�
\pplicartt:,� SELL ROOFING COMPANY
Address: 17072 ROSEBUD
YORBA LINDA CA
Owner: VANUS, ANTHONY M
Address 3405 SUMMERSET CIR
COSTA MESA, CA
Contrector SELL ROOFING COMPANY
Address: 17072 ROSEBUD
YORBA LINDA CA
Zip: 92686
Arch :
Address:
Zip:
BUILDING PERMIT
Zoning: R1 R1
Phone: 714-9933328
Zip: 92686
Phone:
Zip: 92626
Phone: 714-993-3328
License: 323842
Eng:
Address:
Phone:
License:
NUMBER
I B99-01541
77 FAIR DRNE, COSTA MESA, CA 92626
ISSUED BY:
SCOPE OF PERMIT
REROOF - T/O, INSTALV/i6" OSB BOARD, 2 LAYERS OF 30# FELT AND ICBO #4660 EAGLELITE ROOF.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation:
Permit: $167.25 Claim Valuation:
SMIP Res: $0.89
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.14
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
PLANNING & ZONING
Left 0- 0 Right 0- 0
Left 0- 0 Right 0- 0
Proposed: 0
Status: ISSUED
Applied: 09/27/1999
Issued: 09/27/1999
Phone:
License:
$8,900.00
$8,900.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitornia statutas and related
regulations. (Ord. No. 9248, § 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
requlred inapectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiiation of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSATION DECLARAnON:
I hereby attirm under penalry of perlury one of ihe following tleclarations:
❑ I have and will maintain a certificate of consent to sel}-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the peAormance of the
work for which this permit is issuetl.
❑ I have and will 'ntain workers' com nsation insu nce, as required by section 3700 ot the Labor Code, tor the peAortnance of the work for which this permit is issuetl.
M workers' � s�ar�� ien Insura ca�rrie�r and'p,,%�'i number are: G � S C
Carrier:Y�t� ��CTd � PolicyNumber. / � J �
(This section need not be completed d fhe permif is velhed et one hundred dallars ($700) or IessJ
❑ I certiy that in the pertortnance of the work for which this permit is issuetl, I shall not amploy any person in any manner so as to become subject to the workers'
compensation laws ot Califomia, an ree Ihat if I ould be ome subject to ihe workers' compensation pmvisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
ApplicantSignaNre: ,�21 Date: y � —� �
WARNING FAIWPE TO SECURE WORKEFS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED
THOUSAND OOLL4FE (5100.000), IN ADDITION TO THE COST OP COAIPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 31060F THE LABOR fADE, IfJrEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm tha! I am licensed under provisions of
force and effeci. Lic. tt
Contractofs SignaWre:
(commencing with Section 7000) of Division 3 of Ihe Business antl ofess9pg Code, antl my license is in full
� � .
Dates � �U (3 / - D O
CONS7RUCTION LENDING AGENCV: �
❑ I hereby attirm that thera is a consiruction lentling agency for t�e pertormance oF ihe work for which ihis pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn that under penalry ot perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (SecJ031.5, Business and Professions
Code: Any city or county which requires a permit to consiruct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires the applicant for such permit
to tile e signed statement that he or she is licensed pursuant to ihe provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 oi Ihe
Business and Professions Code) or ihat he or she is exempt iherefrom and ihe basis tor the alleged exemption. Any violation of Sedion 7031.5 by any applicant tor a permit
sublects Ihe applicant to a civil penalty of not more than five huntlretl dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the strucWre is not intentletl or offared for sale (Sec.
7044, Business and Protessions Code: The Coniractors License Law does not apply to an owner of property who builds or improves thereon, and who tloes such work
himself or hersalt or ihrough his or her own employaes, provided that such improvements are not intandetl or oHered for sala. If, however, the buiiding or imprcvement is
sold within one year of completion, ihe owner-builder will have the burden ot proving that he or she did not build or improva for puryose of saie.).
❑ I, as owner oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS b constmct the project (Sec. 7044, Business and Professions
Cotle: The coniractors License Law does not apply to an owner of property who builds or improves thereon, and who conVacts tor such project with a contractor(s)
license pursuant to the Contrectors License Laws.).
❑ I am exempt untler sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Ves ❑ No Driver's License No.
Veritication ot Ownership by (type ot tlocument, i.e. - propehy tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Expires:
❑ I hereby certify that no excavation five (5) or more feel in depth into which a person is raquiretl to descend, will be made in connection with work authorizetl by this
permit, and Ihat no building stmcWre, scattoltling, falsework, or tlemolition or tlismantling Ihereof, will be more Nan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, California Administrative Cotle).
❑ As owner-builtler, I will not employ anyone to tlo work which woultl require a permit from iha Division of Intlusirial Safety, as noted above, unless such person has a
permil to do such work from the tlivision.
Signature: Date:
Division of Industrial Safety Permit Number.
CERIiPICA7E OF COMPLIANCE AND AUlHORIZA710N OF ENTRY: I certify under penalry of perjury Ihat I have reatl this application and state that the information given is
correct. I agree to comply wi II state laws d city ordinances relating to building constmction, antl authorize representatives ot the Ciry of Costa Mesa to enter upon ihe
above-describetl propert r i eclion pu es. I ee not ro occupy or allow occupancy of any building authorizetl by this peynit�l final in�ctiOn.
� �" � �
SignaNre Of Legal ner(s) Date
Antl/Or Authorized Applicant
COpE �. INSPECTIONTYPE
1fi16 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Ra-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203
204
2446-46
Final Sign
Final Demolition
DATE INTRIALS
9/a� q9 �
CODEN INSPECTIONTYPE
206 Finai Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning ApProval
222 Final Site
250 Final BuiltlincyOccupancy
pRTE
INTITIALS
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Pfl0.1ECTRDONE53:� ,14OS SUMMERSET t:I ! ' UNIT: �
OWNEH'SNRME: WAYNE EDD'IE � - � � - � �
. RDOflES3: $AMF , , . � _ ,
,, � . �
�RflCM/FNG�NEEP: .7 1 4 I.6 G Z — S % A O , �. " iREU.NO.: � ' .l .
nooeess: -. , : : ' uriir: ' :
; - ' .
PEflMI1TEE: WAY�NE EDDIE ' � . � ( 714 ) 662-5780
', � RODNESS: 74OS SOMMERSET ' ` ' : •
:` c . CM ' CA �92626
LICENSEO CONTMCTOP OECUMTION: I �erehy aliirm that I am IicenseE under Omvisions oi Chapter 9(commencing with Section
7000) of Oirision 3 ot the�Business antl�professions CoAe, antl my license is'in full lorce anC ettttt.
CITY LIC.: , . STRTE LIC.: IXASB: ' • � . , '
Date: i SignaWre: ' '
;� �IIRFBS' COMPENSRTION OEClAMT10N: I �ereby affirm that I have a certifiute of consent Io sell-insure or a cetlificate af Workers
,^. �+Oensation Insuance, or a certifieU coOY �hereoi (Section 3800, La�. C�. �
{'��j�''�Y1CY NO.: . • . EXP. ORTE: . � � '.
. COMPqNY,. , . ' ' ; . . � .
' O' CetlilieC coOY is herehy fumished. � O Cetlified copy Is fileE wttti the ciry BuilCinA Oivision.
Date: ' � ' APVlicant: . , . � . �'
IXEMPfION FIIOM WOPIIENS' COMPENSATION DFCUIUTIOX: (ihis secoan neM not be iompktW if ihe permit is lor one hunEreO �E700) m less�. I
I cetliy that in the De�mmance of the work for which tAis permit is issueA, I sAall not employ any person in any manner so as to 6ecome
SuElect t0 the WOrk ' Com nsati0n LaWS ol Cafl�omia. � j'1 ��� p/ �� � �
Date:�� SignaWre: �� ��+�� � �-r`�� � �
NOTICE: II, aher maldng ihis Oeclara[ion, you s�ould become SUEiect t t�e Workeis' Compensation pmvisions of I�e Labor
Cotle, you mus[ forttiwitA comply wi[h such pmNsions or this permit shall be CeemeE revokeE.
CONSTBUCTION LENUING �CENCY: 1 herehy aifirm Iha[ tAere is a constmction lentling a0ency for Ihe Dertormance oi the work for
wAich tAis Dermil is iwued (Section 3097, Civ. C): . �
IENUEfl: ' - '
' ROUflE35: � - . . _. . ... - _
;v � . , �
�'
OWNEB BUIIDEB DECUMTION: 1 hereUy affirm ihat I am exempt Irom t�e Coniracrors State License Law tor the following reason
(Section 7031.5 Business an0 Pm�essional Cotle: Any ci�y o� counry which reQuires'A permi� to c6ns�mc�, al�er, impmve, Eemolis�, or
repair any simcWre, Orior to its issuince, also requires ihe appliwnt for such permil to file a siA�eO statemenLihat �e/s�e is licensetl
pursuant to the pmvisions oi tAe Coniractors' State License Law (Chap�er 9 �commencing wi�� Section 7000) o� Division 3 a� Ihe Business
an0 Professions Code�'or ihat �e/she is exempt therefmm anA ihe basis for ihe alleAetl exemptlon..My violation�of Section 7031.5 hy
any apDlicantior a De�mit su�lec[s ihe aDPlicanito a civil penalry oi not more than live hunAreO tlallars'(5500).
I, as owner of [he O�operty or•my employees with waAes as their sole com0ensation, will'tla"t�e work,�and the
simctua a not imenUeO or oiferetl for ule (Section 7044, Busineu 2nA Professianal Catle: . The Contacibrs State Liunse Law
� Uaes not appty to an awner oi a D�oOerty wAo builds or,impmves thereon, an0 who Ooes such woM himseli/herself or tArouAA �
� Ais or �er own employees, Omvitletl that such improvemenis are not intende0 or attereA for sale. Ii, however the �uildinp ar
improvement is soltl vnihin one year oi campletion, IAe owner will have Ihe DurCen ol O��inp he/she OiA not 6uiIE or impmve
lor Ihc_Ouryose ol sale),I , ' ' , . . - .
I, as owner oi the D�opeM, am exclusiveN wntracting with licensed contrxcmrs to wnstmct the pmle�� (Sectian 709d, Business
❑ ana Protessions Cotle: ihe Controctors' State License Law Ooes not ap01y to an avmer oi pmpeM �w 6utl�5 or im0�aves the2on
anA�who contracis for such pmleds with�a coniractar(s) license pursuant Io ��e ConVac�ors' S[ale License law). I am aware ,
t�ai prool af their Worker's ComDensation insuranu sAaulE he DroviOetl ta me.
� I am exempt un0er Section: , � . 8; d P. G � ' '
�or �his reason)))' � 1' � r /�� �',
Dale: ���% �Qli � Owner: /.�/�i'/�-��i.C-fi�!�--�
I do hereEy certiry that I am aware of anA understantl iha requiremenis af Calilomia Health and Safery CoOe Sections 25505, 25533, anE
25534 antl t�at 1 or any fuNre builtling occupant vnNwill not (circle one) need ro comply with saitl state cotles an0 the reQuirements for a
OermR for construction or moAifiwtion imm Ihe tir �ualiry Manapement Distnct. p¢si0ential constmction aODliwtion5 are exempt imm
�. tAese provisions � , • . . '
I' Oate: � ' qpplicant: ' - ' � � '
I herehy certiry ihat I Aave reaA tAis �
application anE state t�at the above iniormation is correct. I agree tu comDly wii� all ciry and wunry
- OrEinances dnU Slate laws relriinp IO CUilOing cansWciian an0 hereEy autlwr¢e repre5en�alive5 0� I�is ciry �o enier u0on IAe a�Ove�menti0netl
proDeM �or inspecti n OurD es. , --_ � .� �
Date: Signawre: � �� w�
Dnver's License ar Sacial Secunry a: � �
18CL06 W�ite—Building; Green—Cotle Enlorcement: Canary—Applicant; Pink—Revanue; GOIEenrotl—Assessar"
' CITY OE C06'fA HESA —;HUILDING.PERMIT PERM NO; B�' 0�5655 "'
PERMIT NO: B. 045655 PL'AN C.HECK NO:,02199-90 S� : GOC�T: N SUPP: N
CONSTRUCTION TYP.E: ' ", " .PERMIT TYPE: STR ' _ . PURPOSE:•P.DD.
JOD DESCRIPTI6N : ATT�IC�CONVERSION TO 2ND .`�iTORY'� � SQ FT:' , 145 '
CLAIM VALUE:� � . 10, 000.00 CALC—VAI,UE: � : ; 10, 005.00' 'GROUP OCC: `R= 3 , '/. ' , ,
COMMENTS: LEGALIZE ATTIC-CONVERSION,757 SF � - �
*�r*�r�r�r� �t****��t**x,*x ****�*******�*���t**�r*�t+r�r*�r**���t�t*�t****�t**�t+�*�+t*****��t� *�e�t��t*
Z O N I N G R E Q U I R F. M E N T S , �
: •'S, E T H A C K S � �
�
------------ MAIN BUl'LDING ---------- ---'------ ACCESiSORY BUILDING =--'------
FRNT: ; FT IN REAR: ' FT IN ,�FRNT: FT IN REAR: FT �IN
LEFT: , FT �. IN' RGF[T: FT IN ;LEFT: ;FT IN RGFIT: FT IN
PARKING REQ: ' PROV:' PAR�EL:i41207321 ZNE: PDRM REF b10:
PLANNING NOTES> LEGALIZE CONV OL" ATTIC INTO A REC ROOM. ATTIC/REC ROOM IS QN
- > 2NU FLR.OF-EX RES•—•REG ROOM CONTAINED WITHIN EX WALLS:
iE iE �E ff iF 9E �f k if i( if k!E If if 1E iF if iF 3E 3f if dE iE 3F iE 1E if 1F k iE !E 3Flf 3E iE iE iE iE iE iF iE i! 3E �k M iE if it ik �)E 1E �F IE iE 3t ft iF iE it ff i! iE iE iE iF if if iE k if !E iE iE 3E aE if % 3F
ll E V E T 4 P M E N T. S E R V I,C E S R E Q U I R'E M E N 7':5
20NING APPROVED HY DA`I'E; f—g—g�
BUILDING APPROVED BY :� ! J DATE: _%�qTq ?
APPLICATION ISSUED BY: DATE: ���#' ��
ifilifikititiE�fiEifitififiEifkiEkiEiEi4iF�F'� iPiEifiEiEitaf9E�lEiE iEjE
1E�iE iE ik iE �E aE fF iE it iE iF ik 3E fE iE iE iE iF 3f 3E 3E 3E k iElE IE IE iElE 9F 3FlF IF 9ElF iE 1E iE IF iE it it 3E 1f IE iEiE fF iFlf iE iE ik if iE 1E �k If ik iE IE 3f �E iE iE �1F iE M ik if !f !E �t 1f iE ik iElE
LEGALIZATION;Y — F E E: S.U�M M A R Y STRUCTURAL SL:GMEDIT:�Y
, .
BLDG PM'T PLUMBING EI,ECTRIC .MECHANIC FIRE SMIP/RES,�'"GRI�ING
PERMIT' 252.00 • _ "� • 70' `
PLAN • 163'.80 , , . � ' SMIP/NON�RES. •
..ISSUE FEE� � , ` '
BUILDING—DIV—> PERMIT ISSUE' PLAN—CHECK` TOTAL � PAID • ;DUE
TOTALS==--> 252.70, ; 0.00 ,, 81.90 � 339.60 779.60 '�. " �.p0
. ' .
REVENUE DI�'ISIODl.TOTALS-—.> COLLECTED: 252.70 OVER/SHORT: •�'�- 00
; BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT 'GRADID]G P,I.P.N—CgECK
252.00 , .70 : ; ;',
if 1F 3E iE If iE it 1E 1E if 1E if k iE IE iE iE 3F iE 3f iE 1k iE iE iE iE if 1E iE iE �E it iE �F k iE if k �E k if it M iE if 1E iE 1E �E if IE 1E M k!E 3f 1E !E if k 3f it it iE M iE iE IE iF ak 1E if 3t �f 3f if iE �lf 3F
�I N' D I V I 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, •UNIT COST . TOTAL GOST
. . ' ' . ,n�i..,.•s
SFR �145 DWE—TYPE V-WOOD FRAMC --GOOD 69.00 ."•cl0)005.00
" END OF FEES � , i
. .
. ' ' ' •. ' ' � { �'i
• t ' 4 i ' .. 1 , •
I . � ; •
0] ODD51411—�OOS1412 TUT
DATE: DI/09l90 TIME: 10�41
CONSTRUCTION AND PLANNh...' �',. ' . � :OL & SPA � �: - .
APPROVALS Permit # � .Date Inspector p�ppROVALS Permii #. Date Inspector �
- 1: Temporary Electrical Service or Pole � . , 52.: Pool & Equipment Location • ' '
�2.; Soil P.ipe-Undrg�nd: , � ` . � , . 53.'SteeLReinforcement � � , � - •
r��3.�Electrical ConduitiUtility-Undrgrnd. � 54. Forms _ � ' ' �
`��4. Electrical Conduii'Undrgrnd. � - . � 55. Electrical Bonding � � �
:"5'. Steel Reinforcement � � � � - 56. Rough Plumbing & Pressure Test
a� r: - s•
^'�6: ElectncalUFER�firnd.� � � - 57. APPROVALTO-COVER-GUNITE �
..-�!.
i;:7. Footings - � 58. Electrical Conduit-Undrgmd., -
�" 8. Foundation `' 59. Gas Pipe, O Undrgrnd,., Test
�- 9. Water Pipe-Undrgrnd.- 60.� Backwash Lines, P-Trap, O Undrgrnd. .
10. S[ructural Floor SYstem � 61. APPROVAL�TO DECK � �
11. Property Sewer Line�& House Gonnection � 62. �Backwash & Receptor-Final -'i '
12. Sewer Cap � � 63. Heater & Vent-Final
�a
13. Roof Drains .� rt" . 64. Plumbing System - Firial� _ ' � . .
�
14. flough Plumbing , � ,_ , 65. Electrical-Final �
75. Rough Electrical-Conduit � - 66. Solar System-Final . _ � ,
� 16. Rough Electric Wiring � _ ._, 67. Fencing & Access Approval �
77. Rough Wiring Sign � � 68. APPROVED FOR PLASTERING :
18. Rough Electrical-T Bar Ceiling ' ' 69. POOL/SPA SYSTEMS FINAL � �
� 19,_Rough Heating &_AKr Conditioning� _ _� � ,7 V y. , _, ,,.,FIRE D�PT. REQUIREMENT
20�-Fough Facto_'ry Fi:eplace Y-n ,� _= .; , a; �: :APPROV/�LS}� _LPer`iiit # �� - .
21.^-Du�[s, in StructuTe� ' " " - = '= �'` '� r70. OndergYound� Hydro ��
:"f P.. i � ti .� Ci.r {: - � .
22:-Ducts, Ventilatin - ` �' x ` � ' -
9ix . � �°_ -r: -- K t. .77. Product*P,iping O�Gas O;OiI
23.�GarPipeTRou�h & Test 1�� !� �T! '=' �� �-�`� �� ��7Q, Underground FIUsh"�� x '�
e .,-� ;c c -, �c >. -�r �n >:
- 24'�Roof Framing `�; " ` � �� x � � �' ��73=,Undergmd. Storage'_Tank �O Gas' OOiI
25. Roof SFieathing -� Q '�+ � _ ''� � 74:`'Overfiead Hydrq=�. x
,L -.t oi r � r� �_• •:ti�: J '; K Y �• '� �; x: .- r
26_ T�Bar Cei�ing (Stt,uctural) &=Monocoat; �: �,� - - ; _, 75_Dry Ghemical . - v; -
3
27 � Frame and F.lashing. _ `=. * " � '� �F� 76. Dr Stand' i e � - ' '
� _ r.;_. Y ��P r_
�',=,28.� Lathing`_& Siding_,�� "" -."0�- ,- � r �� � ��: y. 77:': FIXED SYSTEM. ,F„INAL � - =
29. Insulation ~' � � - . ' _.;-;" �., ' �' � 78=`FIRE PREV. F.IN,9L � =' ��
�30. Drywall:Nailing 'cyr .� , � �,� z REALTH=DEPT,� REQUIREMENT
•�31. Plaster BroNfi Co�atx = � - -� " *79.�FINAL INSFECTION x� �
r - '
.. �. ..J ~ y ,� . , 1 3: f:i ' 1ti �: -
'�32''.Electrica� Power�Meter-Einal, � ' ��.,, Ir x''SO:-FOOD CERTIFfCATE IS$UED:y -
._335Final EYectric , � =".`- x � � r �Notes: h -�� : s ". '
_ C:7
-� -
�34��FinslH�Oting�&Aii;CO�ditioning�� !"':�` � ,r'' ' `' �..e. �
"C• s ^ s *
r35^Final Gas Pipe-Teit.,. �" �� - '' • - � � �ti �:� x - �=
a36 _Ho d oi-CanoPY-��i. D � '^'� =�4 �x : � ! �t' � � : �c � -.' �.
r 4. �-• r i I -f',.• i., ^ f x t t: � o s. r-. �-i . .
-37�final Factory Fireplace � ^r "G �"r. � � �e - * ;u
G
.�.38:=Final Plumbih '' ��� , "�;' � , �` �' = �" "' �
n 9 a� r. %.,-1_: l ::K �- 'rr S' � �.�
: . ... � . - . . t � � • �t. • � . _ _ .. , .
•`39vWaier Service:Finalg � . ��� < : ,., _. � V r� ' � .
r- �:
-,�00�GasService-Final ^`�! �;'•' -=='=��` ' tx' _ �.�� . .
�,F• .�:�1.,;�. t `r x - . - _.
'e. G .' a 1 c� � .« i �- i c. .. -
'.,41. Solar pomesticFinal' � �3. ` ' , i�- , , -:� _ . � _ _
� 42. Backflow Preventer� � ;�� �..��.:': - , 'i � - '= � . j• `- � . ,
x n; , N+ _. . .: ;-� !-� �^ .- r. - - - : n
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION
For Applicant to Fill in Completely - Use [nk Only
ADf]RESS Tract 10277, Lot 13 .
R�
� 3925 2/2.1'/79
� 3H25 ' 2Y2�1'/Z4
OWNER McLain Develo ment Co A.P. N�. 7��L
MAIL BVILDING
ADDRESS 1470 Jamboree ROdCl ADDRESS 3yC
TE�. TRACT ]_O
cirv Newport Beach No. 640-6800
CONSTRUCTION W ADD AL
LENDER �
BRANCH ��
OWNE
ARCHITECT
ADDRESS 3661 Spruce St., Newport Beach
CONTRACTOR McLain Development Co.
ADDRESS 1470 Jamboree Road
TEL.
aTv Newport Beach No. 640-6800
LIC, NO. Z73875 LICyNO.
OF LOT 45 X 1�6 NOW ON LO�
USE OP
Separate permits are required for
elec[riq plumbing and heating work.
VSE OF BUILDING AND WORK TO BE PERFOR�
Single family residence,
New Aouse
I �e�eby acknowledBe thet I have raetl this appllcatlon and steta
that the above Intormation is corract and a8rea to comply with
ell laws raguletln8 builAinB consvuctlon, antl I shall not employ
any person In vlolatlon of the workman's compansation laws of
Me Stete at Californle.
I hereby cer<Ify that I am properly Iicensetl as a contractor under
ihe Stexe ot Calitornia Business antl Protessions Cotla, Dlviston 3,
Ghapter 9, antl thet such-Iicenses era in full force end effect, or I
am exempt from the provislons of t�e S[ete of Celifornia Businecs
antl Professions Cnotla, Olvision 3, Chapte/r 9�.
signature ot V � „ ( �y /' M '
Permittee -�� ������ �� Y
Authorizetl Ag
FIflE
APPROVED
NE NO.OF
�2-rn P�,�
VARDSAPPROVED
DISTANCE BET.
MAIN BLOGS.
VAH. qIE
�.�.P.�. zE-78-3
APPROVED �, � n � �
293..19 TL
-293,1'9CKTD
� --Ip'- --
PEFMIT NO.
DATE
USE OF NEW
BUILDING
VAFDSAPPROVED
ACCESSORV BUIL�ING
BET. MA�N &
� House 1685
sn. Fr. �'aqe 436
THE AMOUNT SHOWN UNDER VA�UATION IS FOR
THE PURPO6E OF E5TABLISHING A PERMIT FEE ONLV:
VALUATION PERMIT FEE $ 3� �
PLAN CHECK § - Q
V
$�� � TAX § �
TOTALPAID $
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