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Home My WebLink About384 SUNRISE CIR - Building PermitsG�'�p M 'r t � o, > r J •�2yrovmac A�' (714) 754-5273 • Fax (714) 754-4856 � CITY OF COSTA MESA � B!/ILD/NG DIV/SION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 384 SUNRISE CI Suite No Vicinity: Parcel Nunmber: 43915140 Applicant: LORIE GLOVER Address: 2737 S CRODDY SANTA ANA, CA Owner; ALLISON, SUSAN L PLUMBING PERMIT Phone: (714)241-7414 Zip: 92704 Address 384 SUNRISE CIR Phone: COSTA MESA, CA Zip: 92627 Contrector: COAST ROOTER PLUMING HEATING & AIR CONDITIONING Address: 2737 S CRODDY Arch / Eng : Address: SANTA ANA, CA WATER HEATER CHANGE OUT. ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifier System Connect pce,Soda,elc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $D.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY Phone: (714)241-1414 Zip: 92704 License: 529727 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 Sewer Connect $0.00 Sewer Privale Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, wmmercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: O6/30/2000 Issued: O6/30/2000 ISSUED BY: � " ` SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(i-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping Qnst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES: E35.80 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 7 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) , EXPIRATION: This permit shall automatically expire and becoma void i( work is not commenced within 780 days, or if work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapectlona and final epprovel musl be obtained. Failure �o obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALI: (714) 754-5626 WORKERS' COMPENSATION DECLARATION: T o� I hereby attirtn under penalry oi perjury one af Ihe lollowing daclaretions: ❑ I hava antl will meiniain a certificate o� consent to self-Insure for workers' compensation, as provitleC tor by sectlon 3700 ot the Lebor Cotla, for the pertortnance of ihe work for which this permit is issued. �J I have end will maintain workers' compensation insurance, es requiretl Dy section 3700 ot Ne Lahor Cotle, for tha pedortnence oi Ne work for which Ihis pertnit is issuetl. My wo� /r$�' Fomo'p� nsat%io� Insuren e carrier and policy number are: pp Cerrier. �xf I Cf �( ��.� POlicy Number: �� v�� A (This section deed not 6e comp etetl i/ th permi is valued et one huntlretl tlallars ($100) or less.) ❑ I certity that in Ihe pertortnance of Ihe work for which this pertnit is issued, I shall not employ eny person in any manner so es to become subject to t�e workers' compensation laws of Calibmia, antl &gree that it I shoultl 6ecome subject m ihe workers' compensation provisions of Section 3700 of the Labor Cotle, I shell torthwith camply with these provisions. /' Applicant SignaWre:��">> Date: io ��0— � WARNING: F CURE WOF MPENSATION COVERAGE IS UNL4WFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAN� OOLLARE (5100,000�, IN ADOITION TO THE COST OF COMPENSATION, DNMAGES AS PROVIDED WP IN SECTION 3IW OF THE LABOR CODE.IMEREST, AN� ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aBirm thal I am force and eflect Lic. a_ Contractors SignaWre: ot Chapter 9(commencing with Section 7000) of Division 3 of Ihe Busine s and Protessions Code, antl my license is in full Classa ��n Date: /Rn � �D— O(7 CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm that there is e consirucdon lending egency for the peAortnance ot the work for w�ich this permit Is issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lentlefs AOdress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aNirm ihat under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or county which requires a pe�it to consiruct, alter, improve, demolish, or repeir any siructure, prior to its issuance, also requires the applicaN tor such partnit to fila a signed stetement ihat he or she is IiCensed pursuent to tha provisions of the Contrectors Llcense Law (C�apter 9(commancing wlth Sectlon 7000) of Division 3 0l �he Business antl Professions Code) or ihai he or she is exempt theretrom antl �he basis for the alleged azemption. Any Noletion oi Sectlon 7031.5 by eny eppllcant for a pertnit subjacis the applicant to a civil penalry of no1 mora than live huntlretl Aollars (8500).): ❑ I, as owner of [he property, or my emp�oyees with wages as their sole compensatlon, WILL DO 7HE WORK, end the sWcture is not Imended or oNeretl for sale (Sec. 704d, Business and Prolessions Cotle: Tha Contrectors Litense Lew tloes not apply to an owner of praperty who builds or improves Ihereon, and who tloes such work himself or herself or through his or her own employees, provided that such improvements are not intended or otteretl for sale. If, however, the building or improvement is sold within one year ot completioq the owner-builder will hava the burtlen of pmving thet he or she tlitl not build or improve for purpose ot sale.). ❑ 1, as owner ot the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo construct the pro�ect (Sec. 7044, Business entl Professlons Cotle: The contractors License Lew does not appty to an owner of proparty who builds or improves thereon, and who contracis for such project with a contrector(s) license pursuant lo the Contractors License Laws.). ❑ I am exempt untler sei SignaWre: vn�� Owner ID verifietl by drivef5 Verification of Ownership by Business and Professions Cotle for this reason: Yes ❑ No i.e. - pmperry tac bill or Geed): Drivets LitanSe No. Date: Expires: DIVISION OF INDUS7RIAL SAFE7V PERM�T CERTIFICATION: ❑ I hereby certify that no excavation tive (5) or more feet in depth Into w�ich a person is requiretl �o tlescend, will he matle in connection with work authorized by this permi6 end Ihat no builtling strucNre, s�nolding, falsework, or tlemolition or dismantling thereot, will be mora than thirty-six (38) feet high. (C�ap. 32, Grp 2, An 2, Sec. 341, Ttle B, Califomia Adminisirative Code). ❑ As owner-6uiltler, I will not employ anyone to tlo work which would require a pertnit irom Ihe Division ot Industrial Safery, es noted above, unless such person has a permi� Io do such work from Iha tlivision. Signawre�. Date: Division oi Indus�nal Safe�y Pertnil Num6er: CERTFICA7E OF COMPLIANCE AND AUTHORIZATON OF EMAV: I certity undar penalry of perjury Ihat I have read this epplication and state ihat tha infartnation given is correct. I agree to comply wlt� all state laws end city ortlinances relating to buiiding consiruction, end authodze representatives of Ihe City of Coste Mesa lo enter upon ihe above-tlescnbed property tor inspaction purposes. I agree not to occupy or allow occupancy of eny bullding authonzed by this permit until final inspection. re Ot Legel Owner(s) Dete (� �o-aa And/Or Authorized Applicant Date CODE 1. INSPECTIONTYVE 1616 Fixed Sys�em Final Fire Prevention 1266 Pool Spe Final 200 Final Re�Rool 201 Final BIocWRetaining Wall 202 Finel Fectory Fire Piace 203 Finel Sign 204 Final Demolition zaas�as �E �� CO�E 1 INSPECTION TYPE 206 Finel Mechanical 208 Finel Plumbing 210 Final Electncal 212 Final Fire Prevenlion 220 Final Plenning Approvel 222 Finel Sita 250 FinalBuildinglOccupancy D�LE INTRIALS � � \ � � �oox�ssaem�w+o: 384 SUNRISE CI axNemsr+uieivaa�vn: ALLZSON, SUSAN L �oopEu: 384 SUNRISE CIR COSTA MESA,CA 92627 548-0701 AVFL. MIJIlNO �DDNE59: ARCNRECT OR FNtlNEFR: IJICN.OX EN0:4 1UOPE54: cormucraxsw�ue PETRONELLA ROOFING LGRNACTOR4MI11JN0 2626 NEWPORT �noness: COSTA MESA 92627 uc. ra.: UNT: UNT: (719)548-1645 CA uc.no.: 00460707 uNr: 201 UCEN4ED COMP�CTON4 OECLANATION: I harsby dikm undar ps d pmjury OW I em Ibn�W uMar pwbim� d Chep�er B (wmma�ip MIA 9etlion ]WO) d Divi�ian J W ihe BudMu W Pmin � Goda, W my 9ama b In INI bres aM a11sG. cmuc.No.:032605 cuc.euss: C 39 uc.N 00 707 EXP; 07/96 od.: � �—�3 — t.� co�mw �WNEN BUILDEN DECLAN�TION: I hemby dfimi uMar roty d paq.� Ili 1 I em ammq hom IM Gomreaon Uunss Lew ta tM �,�-�,�:bxirq iaaaon (SMion )oa1.5 Bwiw�� W Pml ' �tla: �nY W� oouM' �hkh n0uirae s W�mE 10 mmuuG. Mx. impraro. bmd'eh, w rapei eny aW�Mu'e, piq� Io Ya efuente. e6o quitm IM ep itsN Iw prli pemE lo fik e eqnad sW emeM �hel M a�he �ie I'ironeeE W�uani io �he prm'vims d Ihs Contrmoro innae lew [ epp B(oommanaiq xitA Swion ]OW) d Dvuion � d Ihe Buainees aM Fdesiau Gotlel a �h+t M a ehe b eze Ihsehan C iha buie In Ne eAepeE saemqion. My voblion N Sedion ]0.t1.5 by enY aOV�^� la e perm! wEjeC� Ihs eppfran o e avi d ml mas ihen (xa hurd�ed ddlen �5500u. � I. ea owmr dtM vwaM a mY emdweea wh i eale comVa��. wiil Go �he wak. end Ihe slrucv�n e rol imeMed wMeredlorsebl��n)01d.BusirouenEPrdeaabna :TMConiredwaLimnaaLewdoeerwtappytoenownerdpropeM wAo Euibs a inpavea iheieon. eM Mn doea cutli wk FaneeX a henell a ihraph he a har own employeee, prwidaE ihet e�ch 'mpmdneNa ue evx imenEeE aWaed In eab. tl. hawawr. Ne WdNirq a inpv.aneN b edd xitnin meY� d oompbtion. �he owner-buiMer aill heve IM1e buNen d qoJup M a ehe Ak nal Witl or impraro lor �he WNose d eele). � I. es owror d �he V�M, em udum*N mntree�q Mith 4carued eanvectac b m�wue tha G�4a (Sequn )060. Bueinme ard Vrofeaiwre Code: The Camredas L�erue Lew doee nd eppty io en ox.rr W peopeny who Wilis a impov» thaeon erd who convecia lu wd� pqeqe xvh e mmratlor�e) licemed punuW to 1!n Cauraum liane Lex�. � 1 em eiemq uMar:eaian: B. 8 P.C., la Nn emaon: Dete: ��: I do Mraby cenih � I em aware M vd uMentaM tM requiremmu d Cellanie hlaatlh eM Selery COCe Senims 25505, 255]3. erd 25530, enE IMI 1 a eny INu�a WilEiip ocwpenl will / wil ml (oicb ane) reeC �o mmply wIM1 edd qete cadm eM �M rpuiremente la epormnlucoraVuciionamodif�unhaniM�i�y enpemmtDiqrie.ReeitlantbloonssivaioneppGatiamueesemplmmlMae poWswne. De�e: Appfram: WORKEN'S COMPENSATION DECLAN�TIOH: I Mraby dfirm wder perel�y al pxjury pw d �he I011oxin0 d�a�boe: � I hew vM Mil meimen e cenAcme d ewueni to �eX�inwn for xwkere' wmpenW ion, u pm�deE Iw Ey Setlion 3�00 0l �M Lebor Code, la iM penwm�ce d tln wark la Mich thn pa�md'a 6sued. � I �eve eiM xil meiMeii v.wken' mmpemelon imure�m. n ipuiied by Sedian �100 d Ne Lebor Coda, M IM pMormvice d tM woh la wliieM1 �M1u pe/mil e utuetl. My waYen' compeneYYion'viw'anee tnrtiee eM po4q wmba� ve: c��: ARGONAUT EXPIRES Pd'ry Numbm: 0 1� Q 1� 9�J (Thls secfian neatl iwf 6e mnpbtM / tM prmR o M wro hurdreJ EdWe (Si W/ a ku./ ❑ 1 mhAy IM1e� in iM pMmrerce d Ila wark la which ihu perme i mued. I WY nq smplry enY Ge� ��Y menner eo m to bacoma eubi� �o ihe xoM1are' canpemetbn kvn d Cefdani�M eyree iMt M I eAoulE become euEjecl lo ine xoMe�e' Waminp: Fellun ro��cun worter�'rorrywwtlon covxs Is unY lntl �IWI Wbper �n �mplor�r fo criMiW ponaltlss nrd c/vll flM� up ro ons �unlrotl fMuurd tlo/Yn (JIPO,P00 In addltlon M� roaf ol rompxwtbn, Cemepea u poWtlM br In Sxtlan 91P6 0l Ms Leeoi Cob, InMu4 eM artomryl CONSTflUCT10N LENDIN� AGENCV: I Mreby �rm uMe neAy Po�Nrv �� haie u e conalrudion bMinp epancy br tM parfarmerce d Ihe wak la whiM ihc perm� u'sewd (Sxfun ) . C). LENOEN'S NAME: LENUEF'S AODFE45: 1 cenity IMI I heva reeE �his epplcmian erd qme thm iM eGove iNamdion is mrred. l ap�ee lo rompy wnh M dry enC ooun7 �inences BM S�BIB IawH �Neleq 10 WYEfp Ca15Vuman eM Mrebj eUlhWae rapeMmeirvae d Ihc CYy b aNv uppn Iha 96v.•B-meniuned papony �p��D��P��D��LOID WATTS (515118.WPI o�.:� �� Wlae-BuiIEM b SdM': GieerWa: CenarY-ADO�: Rnk-Pawnue: Goldenod-Aaseaor CITY OF COSTA MESA — BOILDING PERMIT PERMIT NO: B 075158 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION : T/OFF & REROOF W/FIHERGLASS SHINGLES SQ FT: 2,334 CLAIM VALUE: 2,334.00 CALC—VALUE: 2,334.00 GROUP OCC: R-1 / COMMENTS: REROOF 1667SF RESIDENCE, SMOKE DETECTORS RE�UIRED PER 91UBC �**�*�*�*��*�*��*��*��*��*�� I�I��CTOR 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 ---------- --------- ACCESSOR�D2ICU�"-`�'�L1'—+J— FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 43915140 ZNE: REF N0: _, PLANNING N6TE5>. i iE iE 3E 1E fE 1k * iF 3E iE iE * iF 1E iE �E iElE 1E if 1E jE 1FlE jE iE iE iE 3ElE iE iF 1E �1(� �f 1f if 1E ik fF iE 1E 3E 1E 1f 1E fE iE 3E iE if iE iE iE iE fE fElE fE iE i6 jF iE �f !E 3f iE 1E iE�1E fE 1F 1f if if if if if 1E 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 PERM NO: H 075158 GOVT: N SUPP: N ZONING APPROVED BY . BUILDING APPROVED BY : APPLICATION ISSUED HY: 1E1fiEiEiE1E1E�EiF1EiEk1E�EiE1EiE1E1EiEaEifiF7FifiFiFTF7fifiFiFiFiF�F3F7F�F�F3F�F{F�F3F7f iEiFiE LEGALIZATION;N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 54.00 PLAN ISSUE FEE HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 54.50 0.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMHING ELECTRIC MECHANIC 54.00 FIRE DATE: DATE: �'� DATE: �i -I3 �.� 1E it 1E 1E iE 1E �E if�iF�FiF �E STRUCTURAL SEGMENT:Y SMIP/RES GRADING 50 SMIP/NON—RES TOTAL PAZD DUE 54.50 54.50 .00 54.50 OVER/SHORT: ,00 FIRE SMIP/TOT� GRADING PLAN—CHECK 1E iE iE �E iE iE �E iE 7E iE 1E iE IE 1E �E iF Ik 1E 1f iE i! iE iE 1E iE fF aE fE iF 1E aF 1f �E iE iE 1E 1E iE iE 1E iE 1E 1Elf iE 1f if i!!E fE 7E 1E 1E k�F IE �E iE 1E 1E 1El6 iE 1E iE �E fE ik if jE 1E iE iE 1E �E iE 1E iE iE 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 COST SFR 2334 REROOF BY VALUE RESZDENTIAL NOZONE 1.00 2,334.00 END OF FEES / 41 h0}9��i5-;J.�4�.7 'f^3 i `s_-D UATE= 11, S�:';5 ',ii5: �5::� ' � i ,, L--'. CONSTRUCTION AND PLANNING � P� '$ SP'0' APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector t. Tempor8ry Electriral Service or Po�e 52. Pool & Equipment Location • 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement - 3. Electrica� Conduit Utility-Undrqr�d. 54. Forms �• 4. Electrical Conduit�Undr9rnd. 55. Electricai Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test fi� Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE ' 7. Footings _ 58. Electrical Conduit�Undrgrnd. . 8.� Foundation � 59. Gas Pipe, O Undrgrnd., Test J. Water PiPe-Undrgrnd, 60. Backwash Lines, 2�Trap, C} Ur�drgrnd. 10. Suuctural Floor System 61. APPROVAL TO DECK �' 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fin81 12. Sewer Cap � 63. Heater & Vent•Final 13. Roof DrBins � 64. Plumbing System - Finai ' 74. Rough Plumbing 65. Electrical�Final _ � 15. Rough E�ectrical-Conduit 66. Solar SYstem�Final 16. Rough E�ectric Wiring 67. Fencing & Access A�proval 17. Rougti Wiring Sign 68. APPROVED FOR P�ASTERING 18. Rough E�ectrical-S Bar Ceiling 69. POOUSPA SYSTEMS FINAI 19. Rough Neatfng & Air Condi;ionin9 FIRE DEPT. REQUIREMEfVT 20. Rough Pactory Fireplace . � ; APPROVALS` _ Permit # ' 21. Ducts: in Structure 70. .Underground HVdro 22. Ducts, Vantilating - , � 7}. p�oduct PiPing �Gas C30iV 23. Gas Pipe-Rouph & Test � 72. Underground F�ush -- 24. Roof �Framing� ; - 73. Undergrnd. Storage Tank O Gas � Oil 25. Roof 6heathing //_/L�� 9'S �W[� 74. Overhead Hydrq _ � [ �r 26. T�Bar Ceiling (Structural) & Monocoat � 75. Ory Chemical 27. Frame aMl Flashing - ' 76. Dry Stanilpipe' ' 28. Lathing & Sidinq �� 77. FIXED SYSTEM FINAL 29. Insulation - . 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEP7. REQUIREMENT 37. Plaster Brown Coat • 79. FINAL INSPECTION 32. Elecirical Power MecerFinai � 80. F000 CERTIFICATE ISSUED 33. final Electric Notes: � - 34. Finat Heeting & Air Conditioning � � T � 35. finai Gas Pipe-Test � � - � 36. Hood or Canopy , • ' �. . ' � 37. Final Factory Pirepiace - . . 38. Fina( Plumbin9 , " � . , 39. iVater Service-Final. - � - � � 40. Gas Service-Final "" , - '' 41. Solar �omestiaFinal � - � � 42. Backflow Preventer •, _ 43. Backflow Irrigation � 44. Landscape Irrigation'�ystem,,. ' . . 45. Sound Attenuation ;� • . ' 46. Handicap Regulations" �, . -, �; � ' 47. FINAL STRUCTURE & Bl'It;D1NG �1�'-�6 �W� 48. FINALPLANNING ' ' 49. Electric Release to Edison � 50. Gas iielease to Southern California Gas Go � - '. 51. CERTIFICATE �F �CCUPANCY No Date • 3��21 COSTA MESA BU�LDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely �— ..�.... .� _ . �- �. . . OWNER Z. r..,...._"_ ` ` ___"' _ " ___'.�. d U CITV �u No.$3a •i3B � Z O N LENDER�ION d m J � gRANCH J V7 m J ADtlRESS m ARCHITECT TEL. J N OR NGINEER U Q w � ADORESS J O CONTRACTOR � � �W' Af,f /� m Z J � ADORESS W W TEL. � CITV NO. ZH W � STATE n �^ � CITV y� LIC. NO. p� 0� LIQ NO. � � SIZE NO.OF BLIX'>S. OF LOT NOW ON LOT USE OF EXIS�ING BLDG. H SIZE OF NO. OF Z NEW BLDG. ROOMS STORIES U EXTEA�OR WALL ROOF COVERING COVEqING J VSE OF BUILDING AND WORK TO BE PEFFORMED a a a � H y 0 F►OLD F UI hereby acknowledge that I have reatl this application and stece � that ihe above information is correct antl a0�ea to comply with � all laws regulating builtli�g consttuction, antl I shell not employ F any person in violaiion ot tha workman's compansation laws ot y tha Siata of Calitornia. ? I herAby certify that I em Properly licensetl as a contractor untlar ffia S�ate of Califomfe Business antl Professions Code, Divisicn 3, Cheptar 9, antl ffiat s h licenses are in tull forca entl etfect, o� I am exempt from i provlsions of the State of Cellfor BuSlnesS antl Professions C tle, Division 3, Chapt 9. s�e�ei�,e or Parmlttee AuthO��ed Agent / , IS� �F -�-�=,�°�`oo �3s �:�.:: ::��.sc TION POR BUILDING PERMIT BVILDING A�DRESS OWNER FIRE NO. OF PLAN$ YARDS APPROV ED VAR. # C.U.P. � APPROVED VALUATION $39�oe� DATE :'i � I � USE OF NEW BUILDIN S Q VARDS APPiiOVED ACCESSOfiV BUILDING BET. MAIN & ACCESS.BLD OATE APPROVED � � � O UNDEIi VALUATION IS FOR ^ LISNING A PERMIT FEE ON�V: ¢ N RMIT FEE $ ] m 4N CHECK $ �� E `O LL �3 �.s � � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. eOX 72W COSTA MESA. CALIFORNIA 92626 Z � w W a c7 2a a� J N Q W mJ . pp J a U a Z� aw J 0 mz �a W w � � zr w� v, a 70 ... -1-75v�s�OQ 058 �=:**157."0 ��, APPLICATION FOR BUILDING PERMIT For Applicant ta Fill in Completely RECEIVEO 9Y DATE RECEIVED DATE ISSUED 6UILDING �� G' ADDRESS � / 1) PERMITNO, OWNER �(l / � ��Ci A.P. NO. BUILDING .� ADDRESS �+DORESS -� � Lu�y(. �� TEL. TRACT LOT BLOCK CITv NO. CANSTqUCTION W LENDER \/ i� BFANCH �/ p 1 OWNER v Ly' ADDRESS VALUE ARCHITECT TEL. 5- S OF ENGINE R FIRE ADDRESS ZONE TVPE GROUP APPROVED CONTRACTOR BY OPTE AODRE55 TEL. ZONE NO.OF USE OF NEW CITV NO. PLAN$ BVILDING STATE CITY VARDS APPROVED YARDS AGPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM C/l STREET) OF LOT NOW ON LOT O FT. FT. USE OF EXISfING BLDG. FT 512E OF NO. OF NEW BLDG. ROOMS STORIES L. SIDE FT. FT. EXTEflIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED OISTANCE BET. BET. MAIN& MAIN BLOGS. ACCESS. BLO('.S. VAR. #e �ATE C.U.P.9W APPROVED APPROVED I heraby acknowletlpa tha[ I hava reatl this epplicailon entl state thet t�e ebove Informallon is corroa entl aBree to comply whh . oll lewa repule[InQ builtlinp construcAon, antl 1 shall not employ ony persOn in viOlation Ot t�e wOrkman'� companselion lew� Ot Mo Steta of Colifomie. I �aroby eartlf y Mnt I em proOerly Iicensetl ea e conttector untler SQ. FT. the Smte o� Cellfotnie Bud�esf and Profealona Cotla, Olvisicn 3, THE AMOVNT SHOWN UNDER VALUATION IS GOH ChaPtar 9, entl thnt �uch Iicanwa are in full forco entl afiect, or 1 THE PURPOSE OF ESTABLISNING A PERMR FEE ONLV: em azempt from the vrovisiona ot [�e State of Celllornla B�slneas VALUATION / / f� and Protassions Code, OWislon 3, CMaptor 9. PERMIT FEE S!.� / r Sipnature ot Permlttee 5/ PLAN CNECK S Authorizetl Apent TOTAL FEE $ / � �J