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PROJECT ADDRESS: 244 WAKE FOREST RD UNIT' CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06883T
OWNER'S NAME: KLAASSENS WILLEMYNTJE
ADDRESS: 244 WAKE FOREST - PERMIT NO; B 068837 PLAN CHECK NO; N GOVT: NU SUPP ; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE; ALT
556-6745
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/FIBERGLASS SHINGLES SQ FT: 2, 200
ADDRESS: UNIT:
CLAIM VALUE; 2, 200 . 00 CALC—VALUE: 2 , 200 .00 GROUP OCC: R-3 /
PERMITTEE: ROY CHAFEY ROOFING (714 ) 636-1747
ADDRESS: 9692 LUDERS AV COMMENTS : SMOKE DETECTORS REQUIRED PER 91 UBC, REROOF 3300SF RESID
�r
GARDEN GROVE CA 92644 ****** +r+rx+Ex-*******+e*** -+e**�t �E�r*tltie-x*�FBr+ekE*srar�HB6x*********x*******tlrsE+Fs6+H**kr+rip*x***k1.
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my lice is in full force and effect, SETBACKS
DCITYate: .: 02561 j STATE LIC.: 556629 //cuss: 07/94
Dare._ 56 l( Signature: y/f MAIN BUILDING ACCESSORY BUILDING ———--————
ORKERS'COMPENSATION DECLARATION: I hereby affirm t at l hay/a certificate of consent to I-insure r a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT : FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3BD0.Lb C). LEFT: FT IN RGHT: FT IN LEFT: FT ' IN RGHT: FT IN
POLICYND.: 446-94UNIT00241 EXP.DATE: 01 /01 /95
COMPANY: STATE FUND PARKING REQ: PROV; PARCEL : 14146211 ZNE: REF NO:
❑Y Certified copy is hereby furnished. A Certified copy is filed • a city Budtlin .ion. PLANNING NOTES>
97 0/99 � > •
Oat : Applicant ********************************************************************9�.**********
EXEMPTION FROM WORKERS COMPENSATION DECLARATION: (This section ed not be completed if the per is lar undyed($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issu I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY •
•
• DATE:
Date: Signature: \
NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : / DATE: -
1 Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: J .
DATE; '�2"y
which this permit is issued(Section 3097.Civ.C). **************'***************** ** **lest__)
****** ****************** **
LENDER: ******************************************* *tFiF* .******************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 . 00 . 50
repair any structure.prior to its issuance,also requires the applicant far such permit to Zile a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DI V—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or onered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 54 . 50 0 . 00 0 ,00 54 . 50 54 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his roher mnt i employees,witin provided thatsuch improvements are not e the btldeoof for sale. If, ihowever d or iimprvr
ie REVENUE DIVISION TOTALS--> COLLECTED; 54 . 50 OVER/SHORT: . 00
torptheepoposeoilsde)hin one year of completion,the owner will have the burden of proving he/she did not build or improve). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner at the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 0 0 5 0
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
•
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: owner. SFR 2200 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 •
2, 200 , 00
Ido hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Dale: Applicant:
I hereby certify that I have read this application and state That the above info- on is correegree to co,.Ch al ity and county
ordinances and state laws relating to building construction and hereby a"• epresenta er Ihiy2,4 up�Jp .•ove-mentioned
01 00167567-00167568 TOT
property for insp'• on purhses. /
5;.50
i
DATE: 09/12/94 TIME: 13:27
Dale: Signature: �/i
Driver's 'cense or octal Scanty*/: '
1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
1
t
CONSTRUCTION AND PLANNING POt"_ S SPA
iAPPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole . • 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical ConduitUtility-Undrgrnd. - • 54. Forms
4'. Electrical Conduit-Undrgrnd 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd- 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
B. Foundation - , .. 59. Gas Pipe,0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. T 60. Backwash Lines, P-Trap, ❑ Undrgrnd. ,'
10. Structural Floor System ' 61. APPROVAL TO DECK
11. Property Sewer Line & Home Connection �� 62. Backwash & Receptor-Final
12. Sewer Cap / �' 63. Heater & Vent-Final ,/ !'
13. Roof Drains N !r 64. Plumbing System - Final
14. Rough Plumbing ::� -i 65. Electrical-Final
15. Rough Electrical-Conduit ' 66. Solar System-Final ! •
16. Rough Electric Wiring ;/ 67. Fencing & Access Approval r
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING •
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS- - Permit #
21. Ducts, in Structure. 70. Underground Hydro
22. Ducts, Ventilating • 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough& Test - 72. Underground Flush .
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing `ey-t l ace40, 74. Overhead Hydro
26. T-Bar, Ceiling (Structural) & Monocoat i 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding • 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final { 80. FOOD CERTIFICATE ISSUED
33. Final Electric -- Notes:
34. Final Heating & Air Conditioning
35..Final Gas Pipe-Test -) -
36. Hood or Canopy 1
37. Final Factory Fireplace - • • II
38. Final Plumbing v
39. Water Service-Final
40. Gas Service-Final I
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation -
44. Landscape Irrigation System - - - !
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING qt16 4w
48. FINAL PLANNING - •7
49. Electric Release to Edison I • " -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
COSTA MESA BUILDING DEPARTMENT _ [ 8663
•• P O. BOX 317 a- EE RECEIVED '
i' COSTA MESA CALIFORNIA
.-" 1 11 145�f FOR APPLICANT TO FILL IN eat
a{
C.L. OF STREET'S I INANC Df:PT.&r'BUILDING ADDRESS � 11U�� �_d ^
CIT( OF C STS MESA
(IL_ ,iPROP LINE Owner
irmiszete 10 FT. FOR 60 FT. STREET 50
FT. 6IF1-FOR .-1 W LC(��v2
50 FT. STREET Mail Addresa
• I i Cityltalitatect- - Ph. No.
I6.
I I Contractor S-73Ph. No S`
I I d Ey � .I I Address/4/F -. -—e/ 7r �_ —Id.
50 il IF FRONT CityLic. No.�/ 72 State Lic. No. /729 �fa2`?'
I f CITY 0;' COSTA MESA OF PROP. — —
PLAt NING DEPT. I f Tax/Di 1
150 FT SUBJECT 1 /LDG. DEPT. REG. W ct Size of Lot . AP No.��% +�'�f �a9n
I- wI I- Setbacks: C/L Street cr0 1- Rear d
La BY
P AN cCI . DATE-4/k D ` u. Side Yard - Right ‘ / Left' to/1
I (0r a. 0i . Type of Fence
'/9"//tF'/X/d" ���' -! C
a ALLEY QR PROP. LINE aI d4 ✓4L • / ' 2 ' — l' n,
0. g y/rj/� ---I I hereby a nowledge that I have read this application and state
m a= that the above is correct and agree to comply with all City Ord-
Ntp I inances and State Laws regulating building construction.
\ -----is---<; I Signature C i `/ —
V �• %,74,
"'� of Permitteev ' ` �dt�/ '
10
.fir
- FTI Agent j /
37 6 IN._ Ts I
FT. m �1 I 40 FOR OFFICE USE ONLY
IZ II FT,1 Permit No.
o 866
0 60 FT ST. Received by Date Received Date Issued
LI
I �",/C2 I --//,‘�
II50 FT. ST. _ili ! a VALUATION //� J O
L _. ..C_PROP. LINE _— _- - - — _ _ - - -, / Permit Fee $
\\\\ Lo
Lo // o
I I $ _"�` — Plan Check $
- C.L. OF STREET_ 4C-C)
TOTAL FEE $
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- — ---
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS
Orc- c=am 2'i a.. _..
"" . . ___ _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - - _, - _
CITY OF COSTA MESA C•NSTR UCTION PERMIT PERMIT N TRACT NO. :LOT. UNIT NO. i ( I
'`�/ Fares'I- a �� • 5122 3/3.11 /87 5.00 TL
P.toject Address ,Addy `s r/ 1 r-'r ; •
I
• Applicant's Mailing Address • /LAY t �A TYPE OF CONSTRUCTION ILJ NEW ❑ ADO U•ALTERATION REPAIR
�n ,e.09[ '❑ CONVERSION- ❑ DEMOLISH ❑ OTHER A P # _ - + q Zone
Owner's Name K� iL�J 1'� Phone ;DESCRIPTION OF WORK/USE OF BLDG. - •
Address /- ZP'� ' I I I rrrii�����tttII , ' S
Main Building: . Accessory,Building:, _ Z
' Arch/Eng. • License No. TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front , ' , I I , 0
Address I - 1 i /1 :❑ TENANT i❑ ELECTRICAL /PLUMBING ❑ MECHANICAL B Rear ick , N
Contractor's Nam• I. LL ' I - •�Phon• 1•
l9 ❑ OTHER _ . _ _ - -- t - - C Right . 1 , • 4 -•
- N"
Address(mailing) / '2/ f 4,�je ') • / : /�/V/ - PROJECT DESCRIPTION SQ. FT. OCCUPANCY _ K G
3 /� / CONSTRUCTION TYPE . VALUATION$ $ Left i • ' r ' R
• City License No. • / ) ZONE - (GRADING CU.YDS. ACRES •
• LICENSED CONTRACTOR DECLARATION . -r Ping. Ref.# - _ (Parking Req./Provided E
I hereby affirm that;I am licensed under provisions of Charter 9 (commencing Remark(:e ' ' - - Planning Notes: ; '" ( M
• with section 7000) of Division 3 of the Business and Professions Code,and . - _ T
my license is in fu�l. • e and effect. - „ " ' , -, , • ������L S
License Cl.ss _ _ • e s No. __ _ - L
Date Signature �S7 �! L ( ? PLUMBING , - ; - FEES , • D MA, •=
WORKERS'COMPENSATION DECLARATION
k. hereby affirm that I have a certificate of consent to self-insure ora certificate
Workers''C/Compensation /IInsurance, or a certified copy thereofhe (Sectionct
Policy No.`s2 7igoFYom) Company��7' 4/ ff/UllI IkilfisirL 5IU$:' ®� I r
y
�' Dater-5.- / pt �eetlb•with
icant rVT! i L2-l' -4slonie17 L/'4' • • 100.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ,Bathtubs �•
••• Dover- 111a• ®,
(This section need'not be completed if the permit is for one hundred ($100) Or
. less).' , Dishwasher' ® Dryers DGas ❑Electric' - Sub-Panel.
I certify 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 Drinking Fountains Solar Tank , , ,
r. • s
Workers' Compensation Laws of California. '
Date ' Signature ■ • ,
NOTICE: Iftafter /this declaration,you should become-subjectumust to the
• . Workers' Compensation provisions of the Labor Code, you forthwith Floor Sinks ' 'Urinal - ' o , - ' Fixtures : i "
Microwave "
comply with such provisions or this permit shall be deemed, revoked.
CONSTRUCTION LENDING AGENCY :v I' OutletsI Water Closet
I_._
vice Boxes I •
o I hereby affirm that there Is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097/Civ. C.)
Lender's Name • ...Ate - Outlets
Lender's Address - - - 1- •- . - ..
OWNER BUILDER DECLARATION - -
I hereby affirm that I am exempt from.the Contractor's License.Law„for the Disposal
• following reason (Section 7031.5 Business and Professional Code:'An'city or •
county which requires a permit to construct,alter,improve,demolish or repair rays ; Generator a
-5 KW OS-15 KW Trash Compactot' ' 1
any structure, prior to its issuance;also requires the applicant for'such'permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law(Chapter 9 (commencing with Section•7000)of
:,ai vision.3 of the Business and Professions Code) or that he/she is exempt
";,arefrom'and the basis for the alleged exemption. Any violation of Section
'31.5 by any applicant for a permit subjects the; applicant to a civil
7I"'A'enalty of'•not more than five hundred dollars($500).
1.-II 'as owner of theproperty or my-employees with wages as their sole ■ • Issue Fee $ 3
•
compensation, will do the work,and the Structure is not intended or offered
: I for sale (Section 7044, Business and Professional Code: The Contractor's
, ) License Law does-not apply to an ownerof a property who builds or improves
'thereon, and who'does such work:himself/herself or through his!or her own DEVELOPMENT
employees, provided that such improvements are not intended or offered for
I sale. If,however, the building or improvement is sold within one year of comCanopy Type II 1:1-
pletion, the owner will have the burden of proving.he/she did not build or im- ■ Approved Date
.prove for the purpose of sale).. •
0 I, as:owner of the property,am exclusively contracting with licensed con- •
'tractors to construct the protect (Section 7044,Business-and Professions Code:
The Contractor's License Law does not apply to an owner of property who ■ ■1 ,I 1111 S 11 111 :
builds or improves thereon, and who contracts for such projects with a con-
'tractor(s) licenfe pursuant to the Contractor's License Law). I am aware that Exhaust SyStem • Multiple
I proof of their Worker's Compensation insurance should be provided to me.
❑ I amezem pt under Section• B.& P.C.-for this reason • - - ■- ,
Date - ' Owner - • -
I hereby certify that I have read this application and state that the above; DO-100,000 D100,00067 - ■ •
;information is correct.-I agree to-comply with all city and county ordinances .
",and state laws relating to building construction, and hereby authorize repro--7 '■
' •sentatives 'of-this,city)-to :e ter upon the above-mentioned .property-for + • ®lPLAN C ation
, �r
•inspection Shoo- 7/ /� q / (i
'.Signature/J' / - 1 /it.f %/
® $15 . Issue Feel $ 3 PLAN
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
r.
.
CONSTRUCTION AND.PLANNING POOL & SPA :
APPROVALS Permit# Date 'Inspector APPROVALS Permit# • Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcements.
3. Electrical Conduit Utility-Undrgrnd. 54. Forms Ct
4., Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test ,
6. Electrical UFER Grnd. 57. APPROVAL TO COVER -GUNITE •
7. Footings . 58. Electrical Conduit-Undrgrnd. •
8. Foundation 59. Gas Pipe, 0 Undrgrnd ,T,est •
. 9. Water Pipe-Undrgrnd. I 60. Backwash Lines, P-Trap, 0 Undrgrnd:
•
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap . 63. Heater & Vent-Final
13. Roof Drains • 64. Plumbing System - Final '
14. Rough Plumbing _ 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign - . 68. APPROVED FOR PLASTERING
18: Rough Electrical-T Bar Ceiling - ' 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT • •
20. Rough Factory Fireplace APPROVALS Permit# - -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27.-Frame and Flashing 76. Dry Standpipe - ,
28. Lathing & Siding 77. FIXED SYSTEM FINAL '
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION - , .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED _ •
33. Final Electric • Notes: 3.1l-$7 LEFT C0920: L,ii.6 -
34. Final Heating & Air Conditioning . .
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing • c/i /ri /�rf)r - •
39. Water Service-Final / `/ �/�� •
40. Gas Service-Final
41. Solar Domestic-Final
.
42. Backflow Preventer
43. Backflow Irrigation
44. .Landscape Irrigation System •
•
45. Sound Attenuation
46. Handicap Regulations - .
47. FINAL STRUCTURE & BUILDING .
' 48. Special Requirements Completed
• 49! Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY J" 1
No._ Date //
•
OWNER PASADENA BUILDERS, INC. DATE 1-28-58 _
JOB ADDRESS 21.4j Wake Forest Road BUILDING PERMIT NO. 6352
GENERAL CONTRACTOR Dike & ColegrOVe, IBC. VALUE $ 10,702.00
AR No. • LOT 8h TRACT 2955FIRE ZONE DESCRIPTION OF WORK Residence w/att Garage
! UP I & J TYPE V ZONE R1 PLAN NO.
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
•
Trenches rms Steel a_/y-6?
Floor Syst V .
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing (-9t
Lathing, In e#31.1,--Outer� Orli;Plaster, brown coat y/-,.,r,f
Underground soil//1 W/G Pipe Tes " I ,i-,0-6-4,
Top Out ' S _
Furnace 41,-C 41-911,s-Ci /� Z. .
- ,, ,./-6 C iczX FEB 2 0 1958 26._
Gas Vents
/
Roughh Plumbing .41,‘,“ H-/rl S� �i.v ,ty.,�.,, J� }7-3-� x.2493
Cesspool Septic Tank $P o �hVA
Prop. Swr. Line House Coq.4/{fr$t. Swr. y.-2p-5-(( , „�� 4-N
�- -S� __13-1-__13-1-70/ 7Q
Sprinkling System / /Y/1
Hr^Hng Final ��t 7.2.- Fj F(
F ing Fixtures, Final J// {�.ms���s ,, 4- 6Q` ( /.l
Fiu , Gas Test V•4t 1. W/ 9, 2- _ t/
Construction Pole ( / {h
Underground Power r� /�11 I � tY,NJ�rj/
Rough Wiring /i/ G-2rJ !GAJ v6516,..saii: 1 119583 fJ 5
Fixtures, Final `/,Z, ' /
OCCUPANCY •e 1-.2"1 /
4
Form 210-5M-1-57 / 6352
6352
COSTA MESA BUILDING DEPARTMENT COSTA
P.O. BOX 317 IAN 28-58P0 iiiA 457E ****39 00
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
AOR ISS 244 Wake Forest Road - BU I LD I N G
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. PEt'�'EL Mel
OWNER Pasadena Builders, Inc. - j1J
RECEIVED BY DATE RECEIVED DATE ISSUED
MAIL
ADDRESS 419 E. 17th St., • ��� p
1 , • .
CITE Costa Mesa, Calif. WO. LI 8-1159 BUILDING
ADDRESS
Al NERarlson and .[ ENoCOSTA MESA. CALIFORNIA
Middlebrook
FIRE
ADDRESS Garden GroveZONE
Dike & Colegrove,,. Inc. 7333 AN/ I NO.OF PE ,/ GROUP n
CITY LIC. PLANS // Q,!/
CONTRACTOR NO. nn
ADDRESS 419 E. 17th St. , C.M. NO.L1 0-1159 BYPROVED DATE
LEGAL LOT 84 ITRACT CORRECTIONS
DESCRIPTION NO. BLOCK TRACT
A.P.NO. 100
SIZE 70 X NO.OF BLOGS.
OF LOTNOW ON LOT none
USE OF
EXISTING BLDG. none
SETBACKLINE FROM
CENTER OF STREET 5Ot REAR YARD 33,
SIDE YARD RIGHT 51 LEFT 5,
.DESCRIPTION OF WORK
NL X ALTERATION ADDITION
REPAIR MOVING ry DEMOLISH
BUISIZE 1222
NO.OF
1222 sq. ft. ROOMS 5A STORIES 1
EXTERIOR WALL ROOF
COVERING Stu(,'(`,. COVERING Comp.
USE OF NEW Y •
BUILDING Single family residence
anddgarage.
Plan 720CR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE,LAWS REGULATING BUILDING CONSTRUC•
TION. �� e...y/6n/) VALUATION -
SIGNATURE OF / PERMIT FEE S 26.00
PERMITTEE ✓N
DIKE TrY� cru $ 1G,702."" PLAN CHECK $ 13.00
•AUTHORIZED AGENT DIKE & COLEGRG 'E, INC. TOTAL FEE $ 39.00 ye.«r
OWNER F PLY - 1 illlN DATE
JOB ADDRESS 21111 Wake Forest Rd.- BUILDING PERMIT NO. 8663
GENERAL CONTRACTOR Safeguard Const. VALUE $ 375.00
AP. No. LOT 811 TRAC12 955 FIRE ZONE DESCRIPTION OF WORK Block Wall
_ UP TYPE ZONE PLAN NO. 8663
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel 07,-A, Z 'col
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
Top Out __
Furnace
Gas Vents
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
H.-.ing final
I ing Fixtures, Final
F,.._. Gas Test
Construction Pole
Underground Power _
Rough Wiring
Fixtures, Final 77
aOCCUPANCY} sr-0 -' ' '49
Form 210-5M-1-57 8603