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Home My WebLink About240 WAKE FOREST RD - Building Permits psi 1- CITY OF COSTA MESA 4 • BUILDING DIVISION %l "4i - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER =1 �wsa O PERMIT E02-01072 amw (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT . Job Address: 240 WAKE FOREST RD Status: ISSUED Suite No Applied: 12/05/2002 Vicinity: Issued: 12/05/2002 Parcel Nunmber: 14146212 I Applicant: WEINSTOCK, RAYMOND A ISSUED BY: Address: 240 WAKE FOREST RD .. - - - _ - .Phone: 714-545:6979 COSTA MESA,CA' - Zip: 92626-6464 / , / - _ Owner:/' WEINSTOCK, RAYMOND A . �v Address - 240 WAKE FOREST-RD • N"`-'- Phone: , .��. ` / �, . ti COSTA MESA,CA Zip: 92626-6464 / t- ,. . ,. ,�. Contractor: OWNER BUILDER *\ • Address: o Phone ..Zip. - r . . - License: 000000 / - - - SCOPE OF PERMIT - - ' 390 SQ.FT. FAMILY ROOM ADDITION.ELECTRICAL TO.INCLUDE:5`OUTLETS; 14 LIGHT . FIXTURES,5 SWITCHES.- - - -- -- - -.- -' 1: ---- - . . -FEE SUMMARY , ;.; - , . ,`- V' , Quantity • - ---- �, i - Quantity ,-� t ISSUE FEE - $23.50 Temp Dist System/Lighting $0.00 0 - - `,Temp service test $0.00 Busway-/100 ft: $0.00 Res.a/c package - $0.00 Standing Section • $0.00 0 ' ' / - ' New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 ,0! / ' New Res(3+units)' , $0.00 0 ..,Transformers up to 1 kva/kw $0.00 „%,,0;" ," - Pool/Spa, '. $0.00 0 up to 10 kva/kw $0.00 '; 0 Lighting'Fixts `,•-$15.40 - 14 - "upo 50 kva/kw $0.00,',/0 Recept Outlets. ' $5.50 5 up to 100,kva/kw - $0.00`-' 0- " Switches -''' ' $5.50- i- n 5', - over 100 kva/kv).`" $0.00 0 Non Res Appl,' - Low Voltage Equipment ,$0.00 , ".0 Res Appl V' N, -�/ $0.00 ` _ 0 Low Volt Wiring System/Ckt,=-. $0.00✓i .0, Service to 200a, • - $0.00. -0- Misc."Conduit - - $0 00 v-' 0' /' " ' ,' Service to 1000a A- ' $0.00 . - 0 - - Misc.Conductor $0.00-" . '0 - ' ' Service over 1000a \ . • $0.00 0 Circus(gen or ride) Motors to 1 hp $0.00" ' `0 Circus-(meth ride or lights) - ,$0.00 '' 0 Motors to 10hp ' $0.00 - ,0• Christmas Tree Stand ., -$0.00 �'0 Motors to 50hp \' "$0.00 , - 0 Fireworks Stand • .$9.00;'" 0 Motors to 100hp $0.00 . 0 Other Electrical Fee / _ $0.00 Motors over 100hp $0.00' 0 . Communication drops $0.00 --0 Investigation Fee. ' ' - • $0.00 Sub panel to 200a $0.00 0 Plan Check Fee - - $0.00 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. , INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS n r\I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: . • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. , ❑ I have and will maintain workers' san insurance, required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'com11pen/$/atio nsurante ance carrie a (olicy number are: Carrier: \ y '1r' Policy Number: his section need not be t'am d v the p it i valued at one hundred dollars($100)or less.) I rtify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' mpensation laws of California,and agree that If I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision �$�\� � n/ Applicant Signature: Y — Date: .I lJ WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.a Class I Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: ... Date: r H Owner ID verified by river's license. 0 Yes 0 No Driver's License No. xpires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California AdmInlstrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IU Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize represeptatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized bylhis perr$it until final inspection, 21 C7 - Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date cODE0 INSPECTION TYPE DAIS LNTITIAL$ CODE INSPECTION TYPE DAIS IjfTITIAL$ 1615 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing p Q 200 Final Re-Roof 210 Final Electrical 4/1°3 RµA6k 201 Final Block/Retaining Wall 212 Final Fire Prevention o 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy p CITY OF COSTA MESA a BUILDING DIVISION .1 swA-‘"-.-.7.1.A.I) o > %f« DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 : PERMIT B02-01975 iltbittromnso el' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 240 WAKE FOREST RD Status: ISSUED Suite: Applied: 12/05/2002 Vicinity: SIDE OF DWELLING Issued: 12/05/2002 Parcel Number: 14146212 Zoning: _____ :_; ____ Applicant WEINSTOCK, RAYMOND A ISSUED BY: Address: 240 WAKE FOREST RD ., , . .Phone: 714-545-6979 COSTA MESA,CA " Zip: 92626-6464 ' - - Owner WEINSTOCK;,RAYMOND A /7 ', ( - -••N Address 240 WAKE FOREST'RD- / " - . Phone: COSTA MESA,CA'" " - - Zip: 92626-6464 - " Contractor: . 'Address: ' ; ' Phone: �� Zip: i License:,." o Arch : ��- , Eng: - n Address: • - ' Address:" /- Phone: - Zip: - License: - . License : / SCOPE OF PERMIT - - I 390 SQ.FT.FAMILY Room ADDITION:CHANGE OUT EXISTING LIVING-ROOM WINDOW1TO AN8.0 X 4.0 TO COMPLY WITH LIGHT AND VENITLATION REQUIREMENTS. '--1-1 ' -- `-' - -1.t ''- -' -II.--'.. . . FEE SUMMARY �� Plan Check: . ,$333.42 _ __ • _ / Calc Valuation -$36,036.00, " Permit: $512.95 - . - ' . ," 7/.' - Claim Valuation: ,i 1 ' r $,o.00 C 'SMIP Res: ` ' $3.60 "SMIP Corn: •- '- $0.00 _ .. � ', Other: ,$0.00 ��. ';Irispection: x;$0.00 Total: . '$84997 . 7 v:\ i',i H PLANNING-&ZONING SETBACKS -�\ MAIN STRUCTURE,Front 0-0 ' `Rear 0-0 Left 7 0-0 - - • -J Right 0-,0', ' " " ACCESSORY Front -.0-0 - Rear 0-0 Left 0-0 ' Right "0-0 "/ PARKING Existing:/ ', 0' Required: 0 , Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§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 required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS n r.. WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work f r which this,pennit is Issued. My workers'co'')Pensatiop Insurance carer end policy number are: n p Carder: \ )‘/J)-Y- Policy Number: Q ,u1—\ 'This section need rrrrr of be&filleted i]]t rpermit is valued et one hundred dollars($100)or less.) zanily that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 the Lab Code,I shall forthwith comply with these provisions. '5 - 1 �, Applicant Signature: ' �"' Date: (2 d WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVI FINES UP TO ONE HUNDRED THOUSAND m I ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Llc.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property.or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt undejsec. Business and Professions Code for this reason: Signature: 1:---4.'--N-^---\\._ C "c ' Date: 57 (i1� Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. pires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property insp ction purposes.I agree not to occupy or allow occupancy of any building auth ori d b thhh�pepnit untill inspection. Signature Of Legal Owner s / l/`I Date ' And/Or Authorized Applicant Date CODE I INSPECTION TYPE DAIS ifanfeLS CODE! INSPECTION TYPE PAIS IIIA& 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 204 Final Signm 222 Final Site 204 Final Demolition 250 Final Building/Occupancy otmo JP1Wicci • OWNER PASADENA BUILDERS, INC. DATE - 1-28-58 JOB ADDRESS 240 Wake Forest Road - . BUILDING PERMIT NO. 6353 GENERAL CONTRACTOR Ili ice & Gni e roves Inc. VALUE $ 13,072'600 AP. No. LOT 85 TRACT 2955 FIRE ZONE DESCRIPTION OF WORK Residence w/att Garage GROUP I & J TYPE V ZONE RI- PLAN NO. INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenchesgln Forms Steel dl-- �IS/1Sf Floor System Steel Reinforce Chimney Re-Rod Bond Beam - �� T/$S _Frame and Plastein �¢¢/ ki Lathing, In t it..74:1 6A Plaster, browncoat -1e ,�2/ Underground soil M *'HS WIG Pipe Test �a/Sr , Top Out .1-11'.+'T _ Furnace MAY' Ir-e-r-7?Zc ,%,,.. t. 7„g? FEB 2 0 1963 '.2614 Gas Vents 71 Rough Plumbing /l(/f5 H//-s-t"' r;,(,[tn; ,.2„ei. 1-.27-.5-r /,$4ii Cesspool Septic Tank Prop. Swr. Line House Con.11/,FSt. Swr. 2-20- -P' /0 ..Q. - 2-N-rt 13A7/ 11 Sprinkling System Heating Final .yl kI-C G-24-hf/ Plumbing Fixtures, Final -44/4-5 G^24/-.Sri ..Final Gas Test /6 M i -S '-14' t n/ Construction Pole A' (l Underground Power _ Rough Wiring A2-1----4-2-51--1-2-4441•..../_ q- t_1104i 1 i. 17:11' Fin • al nal zI 7-2-ry - OCCUPANCY Lire I )..1r-S-,f( / Form 210-5M-1-57 r 6353 • • • 6353 COSTA MESA BUILDING DEPARTMENT P.O. BOX COSTA JAN 28.58 jjsa` 45458T. *** *148.00 COSTA MESA. CALIFORNIAL FOR APPLICANT TO FILL IN . APPLICATION FOR PERMIT BUILDING 240 Wake Forest Road BUILDING ADDRESS COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO. OWNER Pasadena Builders, Inc. . 6353 MAIL 419 E. 1( h St., RECEIVED BY DATE RECEIVED GATE ISSUED ADDRESS Calif. .� � 1'o2J'ST JAN 2 8 195 BUILDING CITY Costa Mesa, CalTEL. LI 8-1159 ADDRESS ARCHITECT Carlsoh and LIC. COSTA MESA. CALIFORNIA OR ENGINEER Middle runt( NO. ADDRESS Garden Grove FIRE ZONE Dike & Colegrove, Inc F ITY LIC. 7333 TONE/ pw05 TYPE GROUP - • CONTRACTOR NO. _L`f///� ADDRESS 419 E. 17th St. , C.M.M. Li. 8-1159 BVPROVED DATE / LEGAL LOT [ CORRECTIONS DESCRIPTION NO. 85 BLOCK TRACT 2955 A.P. NO. . SIZE 70X 100 NO.OF BLDGS. OF LOT d NOW ON LOT none . . USE OF Cr EXISTING BLDG. none SETBACK LINE FROM 55' 22i — CENTER OF STREET REAR YARD 22 SIDE YARD RIGHT I 51 LEFT 5' I DESCRIPTION OF WORK NEW X ALTERATION I ADDITION REPAIR • MOVING I DEMOLISH BUILDING 1511 sq. ft.ROOMS 7 STORIES 1 EXTERIOR WALL ROOF COVERING StUCCs COVERING Comp. • USELOFNGEW Single family residence • itt. and/fgarage. Plan 740A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE 15 C RRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES ANO ST LAWS REGULATING BUILDING CONSTRUC- TION SIG .,��. VALUATION n SIGNATURE OF T -� PERMIT FEE $ 32.00 PERMITTEE ./ C [ /�/� PLAN CHECK S 16.00 INC. S 13,072.00 AUTHORIZED AGENT DIKE & COLEGROVE, " TOTAL FEE $ 48.00 vT