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Home My WebLink About530 STURGEON DR - Building Permits(714) 754-5273 • Fez (714) 754-4856 • wrnv.ci.costa-mesa.Ce.us 77 FAIR DRIVE, GOSTA MESA, GA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: ELECTRICAL PERMIT 530 STURGEON DR ADDITION TO EXISTING BEDROOM 41802219 GRIBBLE, WILLIAM 1782 LA COLINA � SANTA ANA, CA STANLEY. EDNA N TR Address 530 Sll1RGEON DR COSTA MESA, CA Contracror: MANCON INC Adtlress: 1782 LA COLINA ISSUE FEE Temp service test Res. a/c package New Res (1•2 unils) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Molors to 70hp Motors l0 50hp Motors to t00hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole SANTA ANA, CA Phone: (714) 832-3528 Zip: 92705 Phone: Zip: 92626 Phone: (714)832-3528 Zip: 92705 License: 496467 Status: ISSUED Applied: 07/20I2001 Issued: 07I20/2001 ISSUED BY: ' SCOPE OF PERMIT ELECTRICAL PERMIT FOR ADDITION TO EXISTING SINGLE FAMILY RESIDENCE. INSTALL 3 LIGHT FIXTURES, B RECEPTACLE OUTLETS, 4 SWITCHES, & 1 ELECTRICAL SERVICE UP TO 200 AMP. REF:807-00851 523.50 50.00 50.00 50.00 50.00 50.00 53.30 58.80 Sa.aO so.00 50.00 530_50 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 so.00 so.00 50.00 50.00 Quantiry 0 0 0 3 8 a 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist Syslem / Lighting Busway I100 ft Standing Sedion Misc Electrical Equipment Transtormers up l0 1 kva/kw ................uP to 10 kva/kw .................up to 50 kva/kw .................up to 700 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech nde or lighls) Christmas Tree Stand Fireworks Stand Other Eledrical fee Investigation Fee Plan Check Fee Reinspeclion Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 50.00 $0.00 $0.00 TOTAL CALCULATED FEES E70.50 COMMENTS / SPECIAL CONDITIONS NO710E: The work authorized by this parmit shall comply with all applicable handicap access requirements under Californla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) E%PIRA710N: This parmit shall eutomatically explre and become void if work is not commenced within 1 BO days, or if work Is suspended or abandoned for e pedod of 180 deys. . INSPECTIONS: In order for �he work authorized under this permit �o be considered legal, such work must comply with all epplicable codea, end ell required inepectlona end final epprovel must ba obtained. Feilure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � � / 2aa e�aao� WORKEPS'COMPENSAnON DECLARAnON: I hereby eKrm under penalty of per�ury ona of the following dedareUons: ❑ I heve entl wlll mein�eln e ceNfrcate ai consent ta self-InSure tor workers' compensation, es proWtleA for by section 3700 0l the Lebor Code, lor Ihe peAortna�xe ol the �ork for which this pertnit Is issued. I have aritl will mainfein workers' compansetion inwrance. as raqWred by seclbn 3700 W Ne laEor Cotle, lor Ne peAwma�e W the work fw whlch Ihis pertnit I5 Lswetl. ' My workers' com �sailo Insuren�er entl p�cy number are: �y ,✓ Certler: � � �' // �/L/yL.�t� ( ) ) 'PolityNum6er. �fr �'�./�� Y%t� (Th/ssecf/onne n ecom lefetll! ifnliTD u detonehundreddol/ars 5700 orless. '� - ❑ 1 certity Ihal Ia the portormance ot t�e woAc lar whtch this Dertnit Is Issue4 I shall not employ any person in any manner so es to become auh�ocUo tha workers' crompensetlon lews oi Califomie, end agree II I sh Itl e sub�ect to the workers' compensation provisions ol Sectlon 370D of theyyy�� Dor Code, I shall forthwith comply with these � j� � �/?�J / Appllcant Signature: / G �l � Date: ^� � -.WMNINO:FNWHETOSEWR WORKERS' SATI EISUMAWFULMIDSHMLSUBIECTANEMPLOYERTOCRIMI NALTJ�SANDGVI�FlNESUPTOONEHUNDREO TKKISPND Od1ARE (5100,�). IN ADDRION TO THE WST OF COMPENSATION, DMIAGES r1S PROVIDED FOR IN SEGTON 31O80F THE IABOfl C06E, INTEREST, AN� ATTORNEN9 FEES. LICENSED CONTRACTOAS DECLAHATION: I hereby eHirm that I em I�ensed r mNsl I,�papter 9(wmmandng with Sectlon 7000) of Dlvislon 3 ot Ihe euJslness en mtesslons Code, entl my Ilcense is In full rorce ena enectruc: a 7 CI899 M Contrectofs SlgneNre: J � :Date: � , CONSTfiUCTION LENDING AGENCV: ❑ I hereby eHirtn Ihat Ihere Is e construction Ientlinp a9ency for ihe pedormence of the work for which ihls permit is Issued. (Sec. 3097, Civil Cotla). Lendefs Neme: Lentler's Address: SigneWre: Date: OWNER-BUILDER DECI-N�AnONS: � I �ereDy aMirtn that under penalty ot perjury Ihat I em EXEMVT FROM T1iE CON7HACTORS LICENSE LAW lor Ihe tollowing reason (Sec. 7031.5, Buslness antl Professions Cotle: Any Gry or counry whic� requires e pertnit to conswct, alter, Improve, tlemolish, or repalr eny strudure, pdor to Its Issuence, elso requlres the eppllwnt for such pertnil ro Ille e slgnetl stetement �het he or she Is Iicensetl pursuent to the proWsions of the Contractore Ilcense Lew (C�apter 9(commenUng wlth Sectlon 7000) of DMslon 3 of Ue Business end Prolession9 Code) or t�at he or she Is exempt tharefrom antl the basis for Ihe ellegetl ezemptlon. Any violetlon ol Section 7037.5 Dy eny epplicant tor e pertM: sub�ects Ihe applicant to 6 clvil penelry oi not more than fWe hundred dollers ($500).): ❑ 1, as awner at t�e pmperty, or my employees wl(h wages es lhelr sole compensalion, WIL� DO TME WORK, and tha st'ucWre Is `wt intended o� otte�ed tor safe (Sec. 7044, Business and Professians Cotle: The Conirectore License Law tloes not epply lo en owner ot properry who builds or Improves thereon, end who does such work hlmsell or �erself or Ihrough his or her own employees, provided thet such Impmvements ere not IntenCed or oflered for sale. II, hov+ever, t�e building or imprwement is sol0 wit�in one year ol completion, the owner-builder will hava tha burtlen ol proving that he or she did not builtl or Improve for purpose of sale.). ❑ I, es owner oi the properry, am EXCLUSIVELV CONTRACTNG WfTH LICENSED CONTRACTORS to construct the prqact (Sec. 7044, Business and Pwfession9 Code: The comracttl�s Licensa law does not eppty to en owner of pmperry who builds or Improves theraon, antl who comracts tor such project with a contractor(s) license pursuani to t�e Conirectors License Lews.). ❑ I am exempt under 5ec. eusiness and Protessions Cotle for Ihis reason: Signeture: Dete: Owner ID venfietl by drivers Ilcense. ❑ Ves � No Drivers License No. Expires: Vedlicatlon ot Ownership bY (NPa oi document, I.e. - property tac blll or deed): DIVISION OF INDUSTRIA� SAFETV PERMR CERTIFICATION: ❑ I hereby certlly tha� no excavetion tive (5) or more feet In Aept� into which e person is requirotl to descentl, wlll be mede In connection wlth work euthorized by Ihis permlt, and ihat no building structure, scalloltling, lalsework, or demolitlon or dlsmantling Ihereof, will be more than ihlrty�six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Cellfom�a Administretiva Code). ❑ As owner6ulltler, I w��l not employ enyona ta tlo work w�ich would repuire e permit Irom the DMslon oi Intlustdel Setory, es noteA eDove, unleu such person hes e pertnit to tl0 Suth w0* ��om Ihe division. SlpneNre: Date: Divislon o1 Indusirial Safery Pertnit Number. ARDOUS MATERIALS AND EMISSIONS CERTFICATION: WIII tha epplicant or present or �uture bulltling occupant neetl to Ille entl ceNty e Business Plen lor emergency responae to releese ar threetenetl release ot e �ererdous meleriel7 ❑ Yes ❑ No (Sectlon 25505 of thB Celltomia Heelih enC Satery Cotle requires, with some exceptions, thet e Business Plan be tiled wit� Ihe Coste Mese Flre Depertment by every business which has e� eny one tlme tlunng e reportetl year a quantiry of herartlous meteriels epuel to or greeter Ihan e weight of 500 pountls, or e volume of 55 gallons, or 200 cubic feet ot cOmpressed gas et standard temperature end pressure). ..._"..........'__.._.-_ ..............__......................._ .._ Does or will ihe eppliCem or present or luWre 6uiltling occuDant need to lile e registration torm for acutoly hazardous metedels7 ❑ �es ❑ No (Sectlon 25533 ot t�e Calllomia Healih end Sefery Catle, with mme esceptlons, requlres registretion with the Coste Mesa Fire Department by each Ousiness which et any one time hes on hand e quanliry ol eculely hezerCous meterials equal to or greater Ihen e weight o/ 500 pounds, or e volume of 55 gellons, or 200 cubic leet at compressed ges et stantlertl tempereture enC preuura). .........._ ................_...................' __ ..._...._..................._._.........................................................................................................�_._.............._...........__.......__........._ Does or will the e pliCent ar present or luture bullAing occupant neetl �o prepare en RMPP (Risk Menegement antl Prevention Program tor ecutely hazerOous metarials)? ❑ Yes ❑ �o (Section 25534 ot the Califomia Health end Safery Code oepartment of en RMPP Oy businesses which ere reqWn ........__............— _ 4 If en RMPP is presenfly require4 has Section 25534 of II .......... _ ................."_""_" 5 Daes or wlll the eppliGem or present or tuwre building a tmm lhe South CoaS� Air Oualiry ManegemeN Disttict or (Sectlan 658502 0l Itle Celifornia Govemment Cotle req ..................._.................._......................................._—............_.__..__ B W III eny pan ot the lac�liry to be constructed untler this p� rides ihat Ihe Costa Mesa Fire Depanment may n repister ecutety �aeardous metedals wlih the Fira I '_._....—_._._..� ...........................__........... Jifomia Heelih entl Safery Code been fuly complle _...._.—__'_' ............._._....."_............ mt reQuire tor the work whic� is the sub(ect ol Ihis any other alr po0ution contml distdct or egency? ihet the requested infortnation be furnished on ep{ '_.-....._.___.........._...._ ........................__......................... be within 1000 feet from the outer boundedes af e Qf yes", tha faciliry mqst meet the requlrement of Sec6ans 25534 anA 42303 of �he Califomla Healih end Safery Cod ...................................................._._................................._..."_"_—..._........_.,.._........__....................._......................................_ 7 I� e pertnii from lhe Swrth Coest Air Quelity Management Distrkt or other air polWtbn contml Alsidq or agenq eppl�catlon, have all o� �he tllsGosuras prescAbetl 6y Califortua Health enA Safety Code Sectlon 42303 been made7 ihe preparation, cenification end lilinp with the Fire ment. .......................... _... _......... _ 7 ❑ Yes ❑ No etian e Eertnit br such construction or motliflcailon s u No ns Por nornresidemlel building permits). 8 (If yes', anacn ceNfiGa�e o� compuance rtom me appropna�e art paiunon comra orticer7. CERTIFICATE OF COMPLIANCE: I certiry that under penalry ol perjury the Informatlon given ebove is wrrect. I apree to comply vrith all sfate laws antl ciry ortlinences regartling Hazardous Materials and Emisslons. Signeture: Dete: CERTIFlCATE OP CAMPUANCE IWO AUTH�RIZAT�N OF EHTAY: I ceNty under penally of pefjury that 1 have read this appllcaUon antl sWle lhat ihe IntortnaUon given ls wnect. I egree to comply with ell state laws entl dry ortlinances relating to builtling constructlon, enO euthorize representatives oi the C�ry of Coste Mesa to enter upon the ebove-dexdbed properry b� ��spectlon purposes. I egree not to ocapy or allow occupancy ol eny builtling euthonzed by this pertnit until tinel inspection. CO�E 1. INSPECTIONTYPE 1878 Fixetl System Final Fire Preventlon 1288 Pool Spa Final 200 Final Re-Root 201 FIneI BIocWRetel�Inp Well 202 Final Fectory Fire Plece 203 Final Slpn 204 FinalOemdlUan � ItlI�d� �QQ� INSPECTIONTYGE 206 Finel Mechanical 208 Flnel Plumbing 210 Final Electrical 212 Final Fire Preventlon 220 Finel Planning Approvel 222 Flnel Site 250 Final Buili �. I .1111. i � � I � �� (714) 754-5273 • Fez (714) 754-0856 • Www.cI.005�e-m048.C2.Us i/ rnin univ�. i.�a i N mcar, a.ia nmm BUILDING PERMIT JobAddress: S30 STURGEON DR Suite: Vicinity: EXTEND EXISTING BEDROOM Parcel Number: 41802219 App�icant GRIBBLE, BILL Address: 7782 LA COLINA SANTA ANA, CA owner: STANLEY, EDNA N TR Address 530 STURGEON DR COSTA MESA, CA Contracror. MANCON INC Address: 7782 LA COLINA SANTA ANA, CA Zip: 92705 Arch : Address: Zoning: R1 R1 Phone: (714) 8323528 Zip: 92705 Phone: Zip: 92626 Phone: (714) 832-3528 License: 496467 Eng: Address: Status: ISSUED Applied: 06/OBI2007 Issued: 07I20I2001 ISSUED BY: ' 1 Phone:' Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 208 SQ FT ADDITION TO EXTEND ONE BEDROOM ON THE GROUND FLOOR OF AN EXISTING SINGLE FAMILY RESIDENCE. . 300 SQ.Ff. REAR YARD COVERAGE OK; 160 SQ.Ff. COVER4GE PROPOSED. .465 FAR PROPOSED (MAX .5 PERMITTED UNDER MORATORIUM). 55°h OPENS SPACE PROPOSED. Plan Check: 5190.61 Permit: �293.25 SMIP Res: 51.78 SMIP Com: 50.00 Other: S0.00 Inspection: �0.00 Total: $485.64 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: 2 NOTES: Rear 10- 0 Rear 0- 0 Required: 2 FEESUMMARY 0 PLANNING & ZONING Left 38- 0 LeR 0- 0 Praoosed: 2 u Calc Valuation: Claim Valuation: Right 13-0 Right 0-0 an,�en.00 So.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: Thls permil shall automatically expire antl become void Ii wark is not commenced within 780 days, or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit �o be considered legal, such work must comply with all applicable codes, and all raqulred Inapeetions end flnal epprovel must be obtained. Feilure to obtaln Inspections and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 wwo �aw� WORKERS'COMPENSAnON DECLARAnON: I hereby eHirtn untler penalry ai perjury one of the following declaretions; ❑ I have enA will meinteln e certifcate ot consent to self�lnsura tor workera' compensetlon, es providetl for by sectlon 3700 0l tha Lebor Cotle, lor Ne pertormence of Ihe �/J wOrk for which t�i9 pertnit is issueA. _I5 � t lieva enA wiA meintain workers' com{rensatl� ��tsurarxe, es reqWred by secUon 3700 of Ne Labor Coda, for the pertwmance of Ne work tor whkh this pertnit Is Lssued. _ My workers' compgnse� Insuranrpqlrner an dlcy number era: /ry� Carrier. C jf i. • /I�%YJ �� .�� L'!�,�, �� Boliry NumDer: (This secNon n6�d rfo(bAcbr�(�fe0 i� Ned et one hwMred dotlars ($100) or /ess.) • ❑ I cetlily that in t�e pertortnance ot t�e work br which Ihis permil I5 luued, I shell not employ eny person In any menner so es to become su6�ect Io Ne workers' compensetlon lews of Calitomla, and egree thet shou� D om ub�ect to the workars' compensetlon provlslons of SaIXlon 3700 of the LeDor Code, I shall forthwit� comply wlth Ihese pryMcle . � AppllcentSipnature: � Dete: � +i�/ / WARNINO: FAILURE TO SEGUflE ORKERS' COAIPENS�TIOfd RAGE IS UW M'D SHALL SUBJECT AN EMPLOYER TO CpIMINAL 9ERALTIE D CML FlNES UP TO ONE HUNDRED THOUSMlD DOl1ARE (5100,000), IN �DDRION TO THE GbST OF COMPEN5AT10N, DAMh ES AS PROVIDED FOR IN SECfIIXJ 3]090F THE IABOR CODE, INiEREST, AND ATTORNEYS FEES. LICENSED CONTRAC70RS DECLAHATION: I hereby ettirm t�at I em Ilcensed lorce and eHect. LJc. # ° Contrectors Slgnelure: _ B(commencinp wlih Sectlon 7000) of Dlvislan 3 of the Business end Prafesslons Cotle, and my Ilcense Is In lull � 'CI839 k � Daie: CONSTRUCTION LENDING AGENCY: ❑ I hereby aMirtn that ihere is e consiructbn IenEing agoncy for the peAormance of ihe wark for which thi9 pertnit is Issued. (Sec. 3097, Civil Code). Lendels Name: LendeYs AtlAress: Signeture: OWNER-BUILDER DECLARATIONS: Date: I hereby eNirtn that untler penalry of per�ury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reesan (Sec. 7031.5, Business entl Professions Cotle: Any ciry or wunry which requires e pertnit la consWct, elter, Improve, demolish, or repair any swcture, pdor to its Issuence, elso requlres the epDlicant lor such pertnit to ille e signetl stetement thet he or she Is Iicensed pumuent Io �he pmvlsions af Ihe Contredors License Lew (Chaptar 9(commencing wlth SecUan 7000) of DMslon 3 ot Uie Business end Professions Cotle) or Ihat he or sha is exempt therelrom end Ihe basis tor ihe elleged exemptlon. Any vloletlon o1 Section 7031.5 Dy any epplicant for e partM: subjects Ihe eppllcant to e ciWl penelry of nol more �han INe hundred dollars ($500).): ❑ I, as owner oi the D�aPerty, or my employee9 w�th wages es t�eir sole compensetion, WILL DO 7NE WORK, antl Ihe struclure Is not IntenOed or oHeretl for sale (Sec. 7044, Business entl Pmtesslons Code: The Ca��rectors License Lew tloes not eDPN to an ownar ot property who bullds or Impmves thereon, and who does such work himself or herselt or through his or her own 0mployees, proNded lhet such Improvemenis ere not Intended or offered tor sale. II, however, the building or imprrnement is sold within ona year of completion, the own9r-builtler will �ave Iha burden ol proving Ihat he or she did not build or improve for purpose of ule.). ❑ I, es owner ol the property, am EXCLUSNELV CONTiiACTNG WITM LICENSED CON7RACTORS ro wnstruct the project (Sec. 7044, 8usiness antl Professlons Code: The contractors License Law tloes na� apply to en owner ot pmpeny who builtls or improves Ihereon, antl who comracts for such project wit� e contractor(s) license pursuani to Ihe Contractors License LawsJ. ❑ I em exempt untler sec. Business antl Professions Code lor this reeson: Signawre: Dale: Owner ID verifled by tlr'rvefs Ilcensa. ❑ Yes ❑ No Drivels License No. Ezpires: Vedticetion ol Ownership by (type ol document, i.e. - G�operry len bill or daed): DIVISION OF INDUSTRIAL SAFETY VERMR CBATIFICATION: ❑ I hereby certify t�et no exwvatlon frve (S) or mora teet in depth into which e person is requlretl to tlescend, will be metle in wnnection with work eulhodzed by t�is pertnit, end thet no building siructure, scefldding, telsework, or demdl�on or tlismentling ihereaf, will be more then thirty-six (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, T1Ile 8, Callfomla Adminlstwllve Cotle). ❑ As owner•builder, I wlll not employ enyone to tlo work which would requiro e pertnit from the Division of Intlusiriel Salery, es notetl ebove, unless suc� person hes e permlt to tlo such work trom the tliWsion. Signeture: Deto: DiWsion oi Intlustrial Salery Permit Number. CERTIFlCA7E OF COMPLIANCE AND AllTHOR17AnON OF ENTRV: I certify untler penalry of perjury that I heve read thls epplication and state Ihat Ihe Inlarmation given is correct I agree to comply wtlh ell state laws end �iry ortlinances releting to building conswction, and auUodze representeUves ol t�e City of Costa Meu to enter upon Ihe ebove-descdbed property tor inspection puryoses. I egree nat to occupy or ellow occupency of eny building euthorized by this permil until final inspection. CODE �. INSPELTONTYPE 1618 Fixotl System Finel Fire Prevention 1288 Pod Spa Finel 200 Finel Re-Rool 201 Final BIocWReteining Well 202 203 Final Fedory Flre Placa Finel Sign 204 Final Demolilion PG� II�dLS COOE� INSVECTONTVPE 208 Finel Mec�enical 208 Flnel Plumbinp 210 Final Elocidcel 212 Finel Fire Preventlon 220 Finel Planning ApDroval 222 Finel Slle 250 Finel Bullding/Occupency QdIE AV .� ItiiID�t$ � l0T 130 TRACT 5698 fIRE POUGH PLUMq�NG = I._I NOUSE CON. U TEM PMO �IR COMDITIONING UNOERGROUND � POWEF ROIIGM WIRING .�J FLOOR SVSTEM y��,/ BONO BEAM , STE �/ SMERTHING yFRqME ANO FLRSMING �yLATHING — IN n ( •i-iPLASTER. BPOWN COAT �'�r.x»';a..,TURFL. FIN�L m�i.<,•.:s H.,. A,avSG_VENT.. REFRIG. �NO A iLUM91NG, F�NnL AND G�5 TE51 ELECTRIC.FINRL BUILOING. FINRL DATE BUILDING PERMIT NO. � SUBCONTRACTOR ' �-t,y, . - ' 1 e_kc-�' �JL�9� /�" •� COSTA MESA BUILDIP APETY DEPARTMENT . P.O. BOX 7200 COSTA �..tSA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING /�� .0 ADDRESS J OWNEROR �C1 _ � S WI� TENANT re� MAILING ADDRE55 � �Q.. CITV I/")CXW- imOC�- NOL. 1 TO-��I F C W a a h r � S F C W F Q G :a a > r ..1 FG W 4 0 �i 0. Z W .i.' 3 BRANCH TEL. ADDRESS CONTRACTOR r�{.�'��\ON1Wf�S �SI�LIh( ADORESS Ia�dO �9a{V�Qyv 1�� TEL GTV Cc). r� . NO.�� LC N0.3�^�5�� LICYNO. SIZE NO.OF BLC OF LOT NOW ON L( USE OF E%ISTING BLOG. Separate perntits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMEO 1 hereby acknowletlga Met I have read this epplication antl sta2e that tha ebova Informaiion Is correct end aBrae to comply with all laws reguletlnp building eonstruction, antl I shell not employ any person in vio�allon of the workman's compensetion laws oi the State of Cali40rnla. I heroby certi(y tnat 1 em properly Ilcensatl as a contrector untler the State o7 CalifO�nie Businass antl Professiona Cotle, Division 3, Chapter 9, antl that such licenses ere in tull force and effect, or I em exempt from the Orovizlons of the State of Californie Busines9 antl Pr ons Co e, ivislon 3, Chapter 9. Slgnatura o � Permlttee � �, /o%v/�,-J Au[horizetl ABani Date � APPLICAT FOR STRUCTURAL PERMIT RECEIVED `� PERMIT .. .2p46 I 50 TI� A.P. NO. �I 6 �/ �`- ` � BUILDING ADDRE55 UNIT OR SPACE NO. TR.NO. LOT BLK. �r�9 8 i NEW ADD ALTER REPAIR MOVING OEMOLISH OWNER G GG V UE USE S ZONE TVPE GROUP APPROVED gy DATE APPROVEDSETBACKS PLANNING ACTION APPROVED THE AMOUNT SHOWN UNDER VALU. THE PURPOSE OF ESTABLISHING A PER� VALUATION PERMIT FEE E e O PLAN CHECK E $ � TAX E TOTALPq10 § m � i m � OR m V: � e v� n n 0 LL �O U • • 26553 " �u�so- ; oo ss3# �*��za.z5 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 720� COSTA MESA� CAL�FORNIA 9ZlZE