HomeMy WebLinkAboutOC_86842 - Permit Applicationu.
-_ - APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE & OCCUPANCY
. - COUNTY OF ORANGE � {-
ENVIRONMENTAL MANAGEMENT AGENCY
REGULATION
REGIONAL OFFICE P.O. BOX 4048, SANTA ANA, CA 92702 CENTRAL OFFICE
26052 GETTY DRIVE 400 CIVIC CENTER DRIV.
LAGUNA NIGUEL, CA. 92677 SANTA ANA, CA.
714-831-2610
rlv-aav-<o<o
BUILDING
ADDRESS
DE9CRIPTION OF WORK
NEW ADO ❑
ALTER ❑ REPAIR ❑ DEMOLISH ❑
AREA
SIZE
SQ. FT. _
Q NO.OF NO. OF
5F'STORIES I FAMILIES
OWNER A I
K
PROPOSED USE OF
STRUCTURE
MAILING2i7� PHONE
ADDRESS •z '��•
CITY ZIP 94-11
CN RI
R NAME
LEENDEENAME
�/-�
WC UNKNOWN
ARCHITECT OR PHONE • I b'
ENGINEER
BRANCH
�
ADDRESS
Ta
ADDRESS
PHONE ^
CONTRACTOR I�
GRADING PRE.
P.C. $�
ADDRESS A13O � ' q fV, (9 Q
INSP. FEE $
FEES a
VALUAMON $
f S(j [�
B. FT,
FEES lQ 3
CERTIFICATE FOR REGULATION PERMIT
Contractors
fp
OCCUPANCY
GROUP f%�•`
oCc-PLA
n
TYPE OF
CONSTRUCTION N
I certify that the fp{IOWmp Contr. Lia No. f. G a and
Classification Jv2 f is in full force and effect.
Workman's Compensation Insurance Certificate on Ne v rifle by
Expiration date: �'7
CHECKED BY
e z
�!
PERMI 5U IC£
APPS Eo
GRADING PERMIT REQ'D
YES X ND❑
ROUVGRA ING O.K.
7COI1 LIt Gradin App
Other Applicants
g uQA
INSPECTION RECORD
I hereby certify I am exempt from Sec. 7031.5 of the Business and Professional
Code, Div. 3, Chap. 9, Contractor's License Law under the following section:
11 Owner (Sect7044),or
0 Minor Work $100 (sec[ 7048), or
❑ Employee working for wages only (sec[ 7053, or
11 OTHER:
APPRQVALS
DATE INSPECTO -S SIG.
FOUNDATION: LOCATION
REINFORCED ❑
•���('•' _ .b
SLAB: REINF. ❑
MEMBRANE ❑
UNDERPINNING
Certification of Exemption from Sect 3800 of the California Labor Code, Article 3,
Construction Permit:
❑ The permit is for One Hundred Dollars ($100) or less.
MASONRY:
BOND BEAM ❑
❑ I certify that in the performance of the work for which the permit is issued
I shall not employ any person in any manner so as to become subject to
FIREPLACE
ROOF SHEATING
RODF FRAMING
`! a -- %7-0
the Workmen's Compensation laws of California.
If, after making such certification the applicant for this permit should become
FRAMING
;
subject to the Workmen's Compensation provisions of the Labor Code, the
applicant shall forthwith comply with the provisions of Sect 3700 or this permit
INSULATION
shall be deemed revoked.
I hereby acknowledge and state that the information I have provided is correct
(SOUND ENERGY)
LATH
EXTERIOR
-'
both on the permit and this certificate and agree to comply with all County
O' Rces an Ms regu Ing building cons �ctio .
r�
LATH ❑ DRYWALL }��
INTERIOR
r ,qq
7- „] "
Dale:
(Applic n[s Signature)
PLASTER
BROWN COAT
ZONING REGULATIONS
LEGAL (
I(
TRACT
BLOCK
�
T
FINAL BUILDING
FINAL ZONING
(PLEASE ATTA METES AND BOUNDS)
_
REMARKS
ZONE � .l VARIANCE NO.
BUILDING 5 ACjK C/Lt ST. PROPERTY LINE` C,c
j
$IDE YAR RIGFTT`/ �f G�� '— E/IVErPHO.IECT N
_
SIDE YARD, LEFT ' PRS
/�A�r
REAR YARD (TOP ) �� ' STRE�I' 4Z1 TH-
_ —
PARKING SPACE REO111RED.. - PROvincn —
- - -
1
MISC.
A.P. NO
ZONING APPROVED .d DATE
VALIDATION
`�,�fi�r1 �r eeeee�����GGGGG �������.'' tttttL���Lff �{/� ,1 (� 1 j
3 C LINER 1'79 DATE NO. PER.1t3 �®'F 1CDDE PLAN na gDTA4g•®® , -y
INSTRUCTIONS TO APPLICANT: US; indelible Pencil or ball point pen and PRINT
F0250-28.2 (R 2/76) Otherwise, fill Out forgo with typewriter.