HomeMy WebLinkAbout1912 WALLACE AVE - Building Permits . • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - - -
PERMIT NO. TRACT NO. LOT NO. UNIT NO. •
CITY OF'COSTAMESA -C�O)NS-T�R/UCTIO_N PE IT �, 3439
• Project Address\/91 Z _ W =AY 1 -
-� � TYPE OF CONSTRUCTION LL NEW U ADD U ALTERATION ❑ REPAIR' -
•
Applicant's M ling Address C ❑ CONVERSION. ❑ DEMOLISH ❑ OTHER _ - A.P.
Owner's Nam , 1 Phone ��'929i DESCRIPTION OF WORK/USE OF BLDG. •
Address i. 3 a 0•--a r s+----� - S Main Building: en Onnn.,i ccessgaNc§,lcGllg:•,��� '
1 '-` -,ZL
Arch/Eng. License No.�6 9O 3 S TYPE OF PERMIT ❑ GRADING _f OUNDATION ❑ STRUCTURAL E Front O
❑ TENANT ❑ ELECTRICAL ✓�A PLUMBING ❑ MECHANICAL B N
Address ///� A Rear
Contractor's Namr• L•s f-/s-./y phone74�' ❑ OTHER �[ - - - N
qq VQ F41-C)�/ •�•f-yrs.+i'C. PROJECT DESCRIPTION SQ. FT. OCCUPANCY �"7 C Right -
G
Address(mailing/�-s O CONST RUCTION TYPE VALUATION$ S Left R
City License No. J f 2- ZONE GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION '
Ping. •Ref.# Parking Req./Provided Q
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: • Planning Notes: - _ . M
with section 7000) of Division 3 of the Business and Professions Code,and T
my license is in full forc-an effect. • -` _ _ S
Licen - Class C ' Liven : N• 3 - -
Date ! - C. • signature ,t _- _ _.r. fr PLUMBING - FEES .
.
WORKERS'COMPENSATION DECLARATI•t Bar Sink Showers ELECTRICAL FEES -
1 hereby affirm that I have a certificate of cons'nt to self-Insure or a certificate - - .
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink '
3800, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap - • Construction•Pole Sub. • - -❑ 50+KW
8 Certified copy is hereby furnished. f
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
Date Applicant -
EXEMPTIONFROMWORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors . Dishwasher Meter ❑over'100 amps
(This section need not be completed if the permit is for one hundred ($100) or Dishwasher
less). Solar Piping -. Dryers ❑Gas ❑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 • an er so as to bec• a ject to e Drinking Fountains Solar Tank ' Fan Motors❑0-1 HP ❑1'h-8
Work�Fj Crynpe a an Laws of Calif. ni.. —
Date /- l+- Signature '—.— _4(ir• Floor Drains Swimming Pool w/Spa • F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE: If,after making this declaration, you shot], become subject to the - k. - --'
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal , Fixtures Microwave '
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet Device Boxes '
I hereby affirm that there is a construction lending agency for the performance Pole Light.
of the work for which this permit is Issued (Section 3097,'Civ. C.) .
Lender's Name -. Interceptors / a[er Heater ` .00 Outlets • - Range
• Lender's Address • - Kitchen Sink Water Service s Switches Sign - ' " - "- " -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections .
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,•alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains •
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of • :
Division 3 of the Business and Professions Code) or that he/she is exempt ' s -,
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 •
LJenalty of not more than five hundred dollars($500). •
I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 - - .
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee - ! $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL • :FEES - - - - -
License Law does not apply to an owner of a property who builds or improves y- __- - -_
thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler . Hood or Type I 0 -
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II D Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building Approved By Date 7/
LIrove for the purpose of sale).
I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System = Application Issued By Date_ ` CYUy
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating . . • 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System D Multiple 0 System Repair/Alteration . BUILDING PERMIT $ SMTP $
proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ PERMIT
❑-1 am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers - PLUMBING $. S (j'-L7 ISSUANCE $
Date - owner - Heating System& Ducting Registers ' - PLAN CHECK 25% $. ENERGY P.C. $ -
I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BTLt— • ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances - •
and state laws relating to building c•• ruction,and hereby authorize repre- . -• • - PLAN CHECK 50% $ MICROFILM $
sentatives of this city to eryt2r • the a•�ye-mentioned property for
inspectio •u •oses. iG , /��('/ MECHANICAL $ TOTAL FEE $ _58 a
Signature l 7�
Date b o - .
• Drivers' License or 551- Reinspection Fee $15 Issue Fee $ 3 ,PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
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 Reinforcement
3. Electrical Conduit Utility-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 1. 58. Electrical Conduit-Undrgrnd.
•
8. Foundation. 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe fUndrgrnd. 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 Signr.. 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.StorageTank OGas ❑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: - .
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37"Final Factory Fireplace • '
38. Final Plumbing • s - In
, 39. Water Service-Final _ -/i
40. Gas Service-Final - t . ,
•4441. Solar Domestic-Final . ) Ito ..0
r 42. Backflow Preventer ;,. . 7(
r
43
, , Backflow Irrigation , - a .-7'l0
' 44: Landscape Irrigation System t ,U
- •
y45. Sound Attenuation - .;t•
•4146. Handicap Regulations _ � 41n
•47. FI NAL STRUCTURE & BUILDING
•
48. Special Requirements Completed _ ..
•
49. Electric Release to Edison _ r.
50. Gas Release to Southern California Gas Co • ,!.- . 3
51. CERTIFICATE OF OCCUPANCY r
No. Date
CITY OF COSTA MESA
PARK FEES N2 I S O
Fee Payment Receipt
Project Address IS
—1 I 2 ��.L--L AN.) . Park Area /
A. P. No. US 2S
Building Permit No. 414 / /
Owner's Name K .-"Pb Q t NSt 3
Mailing Address 2-S2.S OCCAO Tot,. e 3 CSI M
FEE
Single Family * No. of Units @ S455.20 =
Multiple Family ** No. of Units 9 @ S321.32 = Was, t-
•
Total Fee I ZB S. L$
Planning Department Approval Date € erg Co By (t&. )ifpJ
Applicant's Signature /
* Clty Ordinance 72-44 - -
** City Ordinance 72-45
*** City Resolution 74-124
White-Planning;Canary-Planning;Pink-Finance;Goldenrod•Applicant CMF 0174-26 1 1
ADDRESSOFBUILDIG: 1912 WALLACE AV and: CITY OF COSTA MESA - BUILDING PERMIT
DrmERSNAUEIFIWmn+: KENNETH ROBINSONPERM NO: B 0816871
emus: P.O. BOX 11930
1192 WALLACE PERMIT NO: B 081687 . PLAN CHECK NO: N GOVT: N SUPP: N
17OSTA MESA 714 ) 723-5678
APPL.MMNG ADDRESS: CONSTRUCTION TYPE: V—N _ PERMIT TYPE: STR PURPOSE: ALT
•
4, ARcxgECTORENGINEER: UC.NO.: JOB DESCRIPTION : REPAIR ROOF W/COMP SHINGLES SQ FT: 500
1 ARCH.OR ENG:S ADDRESS: WIT:
CLAIM VALUE: 500 . 00 CALC—VALUE: 500 . 00 GROUP OCC: R-1 /
-
CONDIACTORS NAME:
Ca4TRACTORS MAKING COMMENTS: POSSIBLE TEAR OFF AND REAPAIR
ADDRESS: NC.NO.: ***4E*iE*4E4E4E4E4E**4E**4E4E4EM4EiE4Ek4E*4E4E#4E4E4E4E4E4E4E4E4E#4E#iEiE4E#iE4Ek4EiE*ttk4EiE*4E#k4EiEiF4EiE♦EiE4E4E4EiE#4E4E4E41k*iE
uMr: Z O N I N G, . REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalylof perjury than I am licensed under provisions of Chapter 9 S E T B A C K S
(commencing with Section 7000)el Division 3 d the Business and Professions Code,and my license is in lull force and affect.
CfTY UC.NO.: UC.CLASS: LIC.NO.: . .. . EXP:. _ _ _ _ _ _ _ MAIN BUILDING _ ACCESSORY BUILDING
FRNT; FT IN REAR: . FT IN FRNT: FT IN• REAR: FT IN
Dane: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the C«Nred«e License Law for the
bemiring reason(Section 7031.5 Business and Professions Code:Any cryo county which requires a penny a mnatrucl,alter,improve. PARKING REQ: P ROV: PARCEL : 42226224 Z N E: REF NO:
demolish.or repel any structure,prior to m issuance,also requires the applicant tor such permit to file a signed statement than
he or she PLANNING NOTES> �1
ie licensed pursuant to the provisions al the Contractors
License Law(Chapter 9(commandos with Section 7000)of Division 3 of the
Business and Professions Code]or that he or she is exempt therefrom and she basis/or the alleged exemption.Any violation of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penally of nd more Then five hundred dollars($5001). 4E 4E 4E*4E 4E 4E 4E 4E**iE**4E 4E 4E 4E 4E 4E 4E 4E 4E 4E 4E 4E 4E#4E 4E 4E 4E 4E 4E 4E iE 4E 4E 4E 4E 4E 4E 4E*4E*4k 4E*iE 4E 4E 4E 4E 4E 4E 4E 4E 4E 4E 4E*4E 4E 4E 4E***4E 4E 4E*4E 4E 4E*4E 4E
1.3I.a owner or the properly or my employees with wages as their ere compensation,will do the wort,and the stnrcture is ltd intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for see(Section 7044,Business and Professions Code:The Contractors license Law does not appy to an Owner of propend
who builds or improves thereon,end who does such work himself or herself or through he or her own employees.provided That such
improvements are not intended ooffered for sale.If,however.the building or improvement is sold within one year of completion.the ZONING APPROVED BY DATE:
ownezbuilier will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.avoweerettheprapemy.antexdueiveyoontradegwithkmnaedcontracte"tocanseudtheprojec(Sectun7044.Buaktmaand BUILD ING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who
contracts for stab projects with a contractor(s)licensed pursuant to the Contractors License Law).
)Gj IamexemptunderSeeten$P7044 B.AP.c.,fortheresson:ALL WORK BY OWNER APPLICATION ISSUED BY: DATE: 2 'Zit r'I
Dane: ,'J/�J n�47 Owner: iYvP. ii 4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E4E********4E4E************4E 4E 4E4E4E4E4E4E4E4E4E4E4E4E4E****4E*** * 4E 4E#
�Y ' LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of Cslomie Health end Soley Code Sections 25505.25533.end
25534.and that I or any Baur.building occupant we,/win not(drcle one)need lo comply with said state codes and the raquirements for II BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification from the A' iy anagement District.Residential construction aptkshone are exempt from these
provisions. . PERMIT_ 21 , 00 . 50
Date: Applicant:
PLAN
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: .. ISSUE FEE
❑ Ihave and wilmeintab a certificate of consent toseeinawe for w«kerncompenalion,as provided for by Section 3700 o the Labor _ BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.(«the pedmmaroeathe work f«which this permit is issued.
TOTALS----,> ._ 21 . 50 0 , 00 0 .00 21 . 50 21 . 50 . 00
El have and woe maintain workers'compensates insurame,as required by Soden 3700 of the Labor Code,for the performance of the '
• work for which the wrier .Myw«k«a'mmpeamminwreneaM«end policy number we:
Carrier REVENUE DIVISION TOTALS--> COLLECTED: 21 . 50 OVER/SHORT: , 00
Policy Number. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed I the prink is for one hundred dollen(stool or less.) 21 . 00 , , — _ . . 50
o 1 certify that in the perp mance of the work for which this permit is issued,I shall not employ any person in any manner so es to
become subjed to the workers'c«npenseetion laws of Callomiaark agree that al should becomembjed tothe wMet' 4k4E4E4E4k4E4F4E4f4E4E4E#4E4f4f4E4E4E4F4k4F4E4E 4E4E 4E 4E4k4E4f4E4f 4Ek4fk4f4F4E4f4E4f4E4E4E4f4k4f4E4E4f4E4616k4f4E414E#414E4E4E444k4F4F4k4F4E4F4t444F4f4F4E
compensation provisions dSectioSectiono n 3700 the Labor Coe.I shall forthwith complywith those provisions. ` : ' - .I N "D...1,V. I. D U 'A L L . F E E BREAKDOWN
Date: Applicant:
Warning:Failure to secure workers compensation coverage launlawhd,and shall subject en employer to criminal penalties ands. TYEE,�,__,.QTY , _,D E_ S C. R I P, T I 0 N_ _ UNIT COST TOTAL COST
civil tines up to one hundred thousand dollars(slalom In addition to the cost of compensation,damagesas provided ler In
' Section 3IDsoflheLabor Cools,Interest,and atemmesfees.
SFR _ 500 _„ REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 500 . 00• ,"
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction ending agency for the ",. " END OF FEES
performance of the work for which the permit is issued(Section 3097,Civ.C).
LENDER'S NAME: ,
' LENDER'S ADDRESS:
I candy that l have read this application and date that the above information is correct.I agree to comply with ell city and oounty ordinances EXPIRED
end state laws meting to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly EXPIRED
f«inspeasn purpuces"SANDRA ROB INS ON _• _ _. 4\-.--. v 82-20-1997/08:51 pp/$21.58
Prim Name DATE — RCPT0:01-8082273
- (L-4',23/10".44c a.l� Dae: 2/2d/47 PERMIT:8816/37
Signature d Owner/Agent/Applant/Conlractor 1
(515148,WP) White-Suildkg&Soley;Green-Fe;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor •
--- ,,,,,
POOL & SPA i
CONSTRUCTION AND PLANNING
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
APPROVALS
Temporary Electrical Service or Pole - + 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
•.3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms -
•
4: Electrical Conduit-Undrgrnd. . 55. Electrical Bonding- - i
- 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test -
6. -Electrical UF ER Grnd. . 57. APPROVAL TO COVER-GUNITE _
7. Footings - . -58: Electrical Conduit-Undrgrnd.. -
.8. Foundation 59,' Gas Pipe, 0 Undrgrnd.,Test .
- 9. Water Pipe-Undrgrnd. - 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 t 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 - ,' ..-• 'tAPPROVALS - Permit # ' •
-
21. Ducts,in:Structure _ - • 70. Underground Hydro '
22. Ducts, Ventilating- - - - •
,, 'll 71. Product:Piping OGas 0 Oil
23. Gas Pipe-Rough & Test _ - - - - 72. Underground Flush • - -
' 24. Roof Framing - 73. Undergrnd.StoragecTank OGas ❑Oil
25. Roof Sheathing - - - 74. Overhead Hydro _
26.-T-Bar Ceiling (Structural) &Monocoat - C . " 75.-Dry Chemical • ' - ,
1
27...Frame and Flashing _ - 76. Dry Standpipe- i
28. Lathing & Siding- '' 17. FIXED SYSTEM'FINAL_ ft
' 29. Insulation • a- 78, FIRE PREV. FINAL -
30. Drywall'Nailing ' ' `HEALTH DEPT •
. REQUIREMENT CI
r
31. Plaster Brown Coat - , - 79. FINALiNSPECTION _ , 5-
32. -Electrical Power Meter-Final ' n 80, FOOD CERTIFICATE ISSUED . t
r
• 33. Final Electric 7: _ .- Notes: - -
34. 'Final Heating& Air Conditioning. _ = -_ - - - .;I al
35. Final Gas Pipe-Test ' _ - - Jr
36. Hood or Canopy = • _ _
37. Final Factory Fireplace - - T
• 38. Final Plumbing R - . -
39. Water Service-Final .,, c
40. Gas Service-Final - • < -
41. Solar Domestic-Final -,-- - _ _
42. Backflow Preventer . - c- - -
43. Backflow Irrigation' ,- - - -
-44. Landscape lrigation System- • : 7
45. Sound Attenuation - •: . . ._
^46. Handicap Regulations _ = . _ - -
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING -
49. Electric Release to Edison . - -
50. Gas Release to Southern California Gas Co - _ 7
.51. CERTIFICATE OF OCCUPANCY .
No. Date
kit':
, PGiJ 192.15
4 147 '+AR 29-76-cP�.00'i457 *x*
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• APPLICATION FOR STRUCTURAL PERMIT
For Applicant
ttto/Fill in Completelyr —UseseInk Only�A gECE/,["� TE RE 1-y7E $$ ED
BUILDING Vire- /i'//Iic r /7va"� c- - / TE RE
5-Elie-76
ADDRESS
le'n O(I//✓SD/y0 /,(����.(/� 28
�7 rye( PERMIT NO.
OWNEISeCa4USFQ, A.P. NO.ItS-J itJ^ /
MAIL �r / BUILDING f/`�, AL
UNITS
ADDRESS yj 24 OCt."Tj /JL LAO. / .3 ADDRESS { l' 12. LA)
wAL (^�� 1-44^
�s TEL., TRACT ( 8 LOT tv BLOCK`
CITY Cd,CL1Nf3 eel- ///� NO.G7J:.Tfd �y
CONSTRUCTION - NEW ADD ALTER REPAIR MOVING DFMOI ISH
LENDER
BRANCH40
OWNER
ADDRESS •, r�- 1'rr ///��s
sW I V I�/1- VALVE / mss--.
ARCHITECT y J� TEL. S tjAi V Ap ( 8 4q//y.e
OR ENGINEER Cs' /✓ /�iC Ezd<<�-L7 N
�� �,. ,f ,r,� FIRE
ADDRESS /170 SS/74 /$vA 5 Lei/- ZONE GROU
�WW67C BYPROVE4,Jj0JYPE1
5 )8-7
CONTRACTOR APDATE
ADDRESS 7,..-3-2..,-5- Oct- l its-440 j A-2 ��QQyyEE NO.OF USE OF NEW rI}�
//c� � / ,AsemA ,A/ TEL. _ 'V��PLANS Z BUILDING '
CITY t-A,�N4 /�/fL �i+�r— (.V NO.41,37107y I�� —'i
STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
14SIZE r r NO.OF BLOCS. (FROM C/L STREET)
W OFLOTj3.J X/ j6 ( J NOW ON LOT / FRONT 6-0 FT. FT.
Q USE OF `.
rib EXISTING BLDG. frAf ,4w ter 9,SIDE C FT. FT. O
V)
H Separate permits are required for L,SIDE J FT. FT.
electric,plumbing and heating work.
CC REAR /J FT. FT.
E..i USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
MAIN BLDGS. ADATE
CCESS. BLDGS.qd 'r 041// /ter ,lA- /!rIL C.0P. y yzyAPPROVED ^ISS
Q
APPROVED t �J p� ^/
>„ RY'— -DATE J 4g-t:"
-f-P-
..1
' HOLD FOR SPECIAL REQUIREMENTS,
o I hereby acknowledge that I have read this application and state
h
that the above information is correct and agree to comply with Lr
co fa%
i-2',
all laws regulating building construction, and I shall not employ •
Z any person in violation of the workman's compensation laws of /.' Q ti
Ithe State of California. / � -
I hereby certify that I am properly licensed as a contractor under
IDO SO. FT. ( 2 m N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR mQ
Chapter 9, and that such licenses ere In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $
and Professions Code,Division 3,Chapter tnt 140.
x .25 '"
PLAN CHECK $/
Signature of _Permlttee / /elt4-
$ ?BOO TAX $ U.
e 9 a U
./
Authorized Agent. TOTAL PAID $/Us/S,
4147¢ +avla-76 PAIL,77001139 ilj5***Z85.00
' COSTA MESA BUILDING-SAFETY DEPARTMENT
ei__ P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
P I ATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
R 'C BY DATE RECEIVED rt n T E�l¢s; ED
BUILDING 4 .2 WQooe pkw.
-S b� �7/{O
ADDRES5 WY 1rG
5a A.P.NERMIT NO.
OWNER A.P. NO. ------^^���
MAIL BUILDING 4 I n -I I��A 'e. U�IT I ,A _
ADDRESSADDRESS 4 �V Ftl T
TEL. TRACT LOT BLOCK
CITY NO.
CONSTRUCTION ✓NEW" ADD ALTER I REPAIR (MOVING DEMOLISH
LENDER
BRANCH
OWNER R. g
/�Q_e,Nl.s(sV ,�A,
s/r
ADDRESS . . ►(y Q,. /� VALUE
ARCHITECT TEL. USE4U�IT h f t �trN>✓-$
OR ENGINEER NO
FIRE
ADDRESS ZONE TYPO GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
CITY NO. PLANS BUILDING
Fe
H.. STATE CITY YARDS APPROVED TAROS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OF BLOCS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
cm EXISTING BLDG. R.SIDE FT. FT.
U)
F Separate permits are required for L.SIDE FT. FT.
Welectric,plumbing and heating work. REAR FT. FT.
[-., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q< MAIN BLDGS. ACCESS. BLOGS.
VAR.+ DATE
aC.U.P.#. APPROVED
APPROVED
} —ELY DATE
a
a
w
0 I hereby acknowledge that I have read this application and state
v
IY, that the shave information is correct and agree to comply with m
0.1 all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of i
..'!"W.• the State of California.
I hereby certify that I am properly licensed as a contractor under SQ. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 3
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of California Business 2X j}V vz
and Professions Code,Division 3,Chapter 9. VALUATION PERMIT FEE $srV r�
VV�J
PLAN CHECK $ in
o
Signature of
Permittee $ LL TAX $ u.
—
asp — U
' Authorized Agent TOTAL PAID Sa hPil.--