HomeMy WebLinkAbout2050 WALLACE AVE - Building Permits CITY OF COSTA MESA
< ►�pp BUILDING DIVISION
..�I DEVELOP�ENT$ERVICES DEPARTMENT PERMIT NUMBER
4•y PERMIT B06-01225
Pita
ttbownal
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.cEISJILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92826
•
Job Address: 2050 WALLACE AV Status: ISSUED
Suite: Applied: 07/24/2006
Vicinity: UNITS A,B AND C Issued: 07/24/2006
•
Primary Occ: MR Type of Construction:
Parcel Number: 42225212 Zoning:
Applicant: SCHNIERER, STEVEN
Address: 3915 PIERCE
SUITE F Phone: 949-598-8360 ISSUED BY:
LAGUNA HILLS,CA Zip: 92653
Owner MC CARDLE, RANDALL R TR
Address %IPS MGNT CO
IRVINE,CA - Phone:
PO BOX 19528 Zip: 92623-9528
Contractor:" FONTAINE AND ASSOCIATES
Address: 23482 PERALTA -
SUITE F Phone: 714-598-8360'
LAGUNA HILLS,CAS -
Zip: 92653 - License: 708917
'Arch : Eng:
Address: - Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF(E)ROOF MATERIALS,INSTALL NEW 3 PLY BUILT UP ROOF ON APT BLDG UNITS A,B AND C,APPROX 600SF.REPAIR AND
REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: 31,500.00
Permit: $54.00 Claim Valuation: 31,500.00.
SMIP Res: $0.50
SMIP Corn: $0.00 •
Other: $0.00 - --
Inspection: $0.00
Total: $54.50
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 •
Right X0.0
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
2441-40(WO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penally of perjury one of the following declarations: •
❑ I have and will maintain a certificate of consent to self-Insure for workers'ccmpensatloti e'S provl4ed 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'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number am:
Carrier. _ S} -.4 . R '. Policy Number. Z I L4('Z�(..
(This secaon need not be completed If the permit is valued at one hundred dollars($100)or less.)
❑ 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 workers'
compensation laws o1 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 ins
Applicant Signature: _ Date: 7(24'OCo
WARNING:FAILURE T SECU W 'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100000).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 7O6 17 Class N C 3 q
Contractors Signature: Date: aeLlAc. .
CONSTRUCTION LENDING AGENCY: 11
❑ 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).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 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 DMslon 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:
Owner ID verified by drivers license. ❑yes ❑No Drivers License No. Expires:
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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
in 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? ❑Yes ❑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? ❑Yes ❑No
(Section 25533 of the California Health and Safely 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).
_.._.___.._ ._..._ _t_ _._.....__...._.__
3 0 Yesr will th❑e applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
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 ❑No
5 Does or will the applicant or present or future buildingsoccupant at y other for the work which the subject of this a estion a rmlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes U No
(Section 85850.2 of the California Government Code requires that the requested information be furnished 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).
__...from._t__.._...__.
7 If a permit from the South Coast Air quality cri edManagement DistrictHeaor dSr air pollution control district3bor agency? is required for the work which is the subject of tits
application,have all of the dlcr'N+sures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves 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. 1 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 intomlatiom given is
correct. I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
—extr. . re Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE t INSPECTION TYPF PAIL INIIDMLS COpEE INBPECTIONTYPE RAIL ML$
1616 Fixed System Final Fire Prevention - 208 Final Mechanical
1268 Pool Spa Final � 208 Final Plumbing
200 Final Rle-Roof 8 T(%. i/a 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition. .. - . .. 250 Final Building/Occupancy
Imo'
PR04T ADDRESS: 2050 WALLACE AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 055381
OWNER'S NAME: MC CARDLE, RANDALL R TR
ADDRESS: IP. S. MANAGEMENT PERMIT NO: B 055381 PLAN CHECK NO: N GOVT: N SUPP: N
1503 S COAST DR
COSTA MESA, CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
971-2854
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/BUILT UP SQ FT: 3, 100
ADDRESS: UNIT:
CLAIM VALUE: 3, 100. 00 CALC—VALUE: 3, 100 . 00 GROUP OCC: R-3 /
PERMITTEE: W,H, LAVEY & ASSOCIATES ( 714 ) 973-6233
ADDRESS: 1013 E. WALNUT AVENUE COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
SANTA ANA CA 92701 *************************** *******************i****kt***********if**kf•******•****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUI R EMEN TS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: 037560 STATELIC.:409233 CLASS: C39
fl Signature: .2‘.9-------____________, MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm t at I have a certificate of consentf-nsurcertificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: PWC 113 7 31 EXP.DATE: 07/01 /92
COMPANY: GOLDEN EAGLE PARKING REQ„; PROV: PARCEL: 42225212 ZNE: REF NO:
D Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. PLANNING NOTES>
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less): D E V E•_L OPMENT SERVICES R E Q U I R E M E N"T S
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 Workers'Compensation Laws of California. ZONING APPROVED BY DATE
Date: Signature:
NOTICE:If,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: i?.
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. _.. �^ - .
CONSTRUCTION LENDING AGENCY: I hereby affirm that(here is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• v, ' DATE: 1 a--5-7/
which this permit is issued(Section 3097,Civ.C). ************************** **** ****iE ****************************ls�*******3c**
LENDER: ************************************** **************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR IC•J 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 63 . 00 . ` SO
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed' 4
pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business r' 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, wig do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN=CHECK TOTAL PAID DUE
❑ structure is not intended or ollered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 63. 50 0 . 0 0 .0 , 00 63 . 50 63 . 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 4x_
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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED ;, ; 63, 50 OVER/SHORT 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC —.; FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 MECHANIC —.;❑ 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 *.************.*****.*************.***********************.*********-ae***..******.****.**
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B. 8 P C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 3100 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 3, 100 , 00
I do hereby certify that I am aware of and understand the requirements of California jlealth 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 s '
these provisions. n
Dale'. Applicant: ,
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. /; _
•
5-...a--c199/ Signature: Qc� 407-,:
.F. . • •/• Driver's License or Social Security a:
-- 'n while—Budding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
J
./
CONSTRUCTION AND PLANNING POOL 'A
1,11 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 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ 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. POOUSPASYSTEMS 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 ll`lp�(�'L 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 0 75. Dry Chemical -
27. Frame and Flashing - 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. InsulationI 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: i2 17 l/ �__ r,., Y_ .. .
34. Final Heating-& Air Conditioning AA. �"_`-•`.rO:c{�'[�' /?f"°°"��""`
35. Final Gas Pipe-Test ,tfr• QY�
36. Hood or Canopy • . ' �„y
37. Final Factory Fireplace v�
38. Final Plumbing 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 Attenuatiorr •
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ‘...3,72_ 4w�
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co f �.
51. CERTIFICATE OF OCCUPANCY
No. Date
•
City of Costa Mesa •
Building Safety Deportment CERTIFICATE OF OCCUPANCY N. 2218 C
P. O. Box 317
Costa Mesa, California
The Building located at 2050 ff0.118120 Avenue, ate II & C
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group g & J Occupancy.
Use of Building TriBlr,e!xresideace tib dutnnhe6. garage
Legal Description 115•345•51
(See reverse side for Motes and Bounds)
Building Permit No. 23337 Electrical Permit No. 23957 Plumbing Permit No. a576
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group II Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments 3 and/or guest rooms
ISSUED TO: Building Off'cial //
LOW
by 7
Date rat7 25, 1965
• This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form BU34-1M-11-63--S-B r
O JOB ADDRESS e�7V W8118Ce AVC. A, B & C fC44:1‘//BUILDING PERMIT NO. 'aiiul _.
GENERAL CONTRACTOR So. Counties Bldg. Co. , Inc. VALUE $ 28,290.00 / `F -6Y' .
4,110o. 115-445-51 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK fr plex Rea_&
Iii*g. CTIONS Signature __ E GROUP H&J TYPE V ZONE B2 net. Par.
Soli 7, "Vi PERMITS ISSUED
Gas ! SUBCONTRACTOR DATE NUMBER
Water ,egt6-S
Rough Corn. Refrig0 FAund. 04
Rough
4
Rough Heating . -�,/q�� jJ ! C 4 'a - _`ii _/,?S-LS- 7�
Rough Plumbing it, /1-j r_ .= '/ _ /)//,/‘y �/SJ:
Miscellaneous _ __
Prop. Swr. Line®-House Con.�R-gt. Swr. p /'1/J-LS' 3-{/-(h__6 r O (A, =3-er ./707 a(
Sprinkling System 61- , 't
Construction Pole "
Underground 0 Power C _ —~
Rough Wiring !I? 2 T'rCC 2.c.:rCr Wiz,/h 39r
Trenches m Forms d8 Steel Reinf. 0 ,���� /z/ar/F
Floor System 7�9'e' i cr
Bond Beam 0 _ Steel Reinforce 0
Sheathing f
Frame and Flashing - - ."& - L _-`
Lathing- In d" Outr. 1,00,2-7-- 6- -
' ter, brown coat a - - -
'.Ang.❑ Air Con. ❑ Final -
Heating, Final MPS -!)-Gd-
Plumbing Fixtures, Final int-3 r7-c-s-
Final Gas Test/Pt/5-1/a- wg, 6
Electric Fixtures, Final
• 233117FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT DEC 111 1964
P.O.BOX 917 COSTA MESA.CALIFORNIA FINANCE DEPT.
CITY. OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FORPERMIT
TYPE OR PRINT
BUILDING I
BUILDING n _ WA ,1 _ fit' Le' For Office Use Only
ADDRESS 6Q 5a LL.Arit: �i
RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA 23 307
�/5 o� REC$IyEO BY /D Tj�RE p/ WT 188UBq I
OWNER L �jpU /�Y/� BJ 'CJI/O/ / / SU er
MAIL 2O / �W /741_4 C E
c ' ADDRESS <V'i o i AlA I -�
ADDRESS // '}'-
41c4 NO. i2frc Fl RE
ZONE TYPE_.J` GROUP '�,],
ARCHITECT OR ENG N ER//On/SRI C SLt�TTE •
APPROVED„ �-,YFI DATE �� 9/O
��y` r ZONING r
AL. EBS a c A L/G du - -- -
/� SON��f NO.OF USE DI NEW
�n //�� y.• pOP L,044.7. IL �/ PunE Y Bu1LDIND I
CONTRACTOR Sis.JTNETPA/ G,•/D/II£S C.P• Pit:C . I` /� I ,/�� �_
• /J DESCR '/�/^ l. /_ /I .Yf V/. 0 tP i
ADDRESS ,II �',] �f5.- 1-4 eigii I DESCRIPTION ✓{(T 1 ff{ ��dle�///"' /11✓/""� �1KC
CITY s-A4, /74* A.P.NO. / / 'Cr- - I
NOTE: NO EAVE OVERHANG SHALL BE LESS THA
STAE
LICTNO. 22 / / A 2 No. Tc/9''200 30“TO SIDE a REAR P.L. GO /_,1 SW
EAVES
SIZE // I
NO.OF BLOBS. ALLOWED (U.S.C.REQUIREMENT)
OF LOT (O 2 . (o + /1 S NOW ON lAT YARDS APPROVED YARDS APPROVED
USE OF •+ MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. 0 j (FROM C/L STREET) 63--a-
.
//�)J ,r/)�
SETBACK LINE PROM /� FRONT.--5-.0 FT. 19 7 Fr. �I/
CENTER OF STREET 0 REAR YARD / // ''
/
SIDE YARD I LEFT in I RIGHT 2. 2 • 6 R.SIDE FT. b., FT. / //
DESCRIPTION OF WORK L.SIDE �/ L7 T. 3 �F±
/(/
NE" / . ALTERATION ADDITION REAR ' / PT. ' H./ I FT.
DISTANCE BET. BET.MAIN&
REP...rt MOVING DEMOLISH MAIN BLOCS. ACCESS.BLDG*
BUILDING7 NO.OF VAR.* DATE
SIZE /q 5 ROOMS{O /Z STORIES 2 C.U.P.* APPROVED
EXTERIOFkW/LIC '' & OF APP'•V-'•
COVERING .D COVERIN• O G BY ,/..” I, DATE i O'B
USE OF BUILDING AND WORK TO BE PERFORMED /ar'-
/I/th/ COn/ .clAnd<7/C A/ HOLD FOR cpFe'TA:T, R^ IT^^••-..M.-
2 /523"0 SQ.FT. 6r-Cfj
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE,AMOUNT SHOWN UNDERVALUATION IS FOR THE y
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A, PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION �� �� CO
BUILDING CONSTRUCTION.
• ti
SIGNATURE OF, ,,945,0/ 0u/.�l�tl PERMIT FEE $ j
PERMITTEE ••/��, mss•! ✓, C=3 • DO s
£Ly4_o/A' - co . /yc • s.2� 2 c!0 C _
Crn K/o 7 �JoaW
AUTHORIZED AGENT TOTAL FEE $ /J/1- \/
A'
1