HomeMy WebLinkAbout2116 WALLACE AVE - Building Permits •
41 F 9 CITY OF COSTA MESA
4 BUILDING DIVISION '
DEVELOPMENT SERVICES DEPARTMENT PERMIT'NUMBER
t. 1101141
s PERMIT
Mc 02-00789
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2116 WALLACE AV Status: ISSUED
Suite: Applied: 06/06/2002
Vicinity: THROUGHOUT S.F.R. Issued: 06/06/2002
Parcel Number: 42246207 Zoning:
Applicant: GAYTAN, AURELIANO ISSUED BY:
Address: 2116 WALLACE AVE
Phone: 949-548-5640
COSTA MESA,CA Zip: 92627-2930
Owner: GAYTAN, AURELIANO
Address 2116 WALLACE AVE
Phone:
COSTA MESA,CA Zip: 92627-2930
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CHANGE OUT 14 WINDOWS THROUGHOUT HOUSE IN SINGLE FAMILY RESIDENCE WITH DOUBLE PANE GLASS WINDOWS TO
MEET 1997 BUILDING CODE REQUIREMENTS. DIMENSIONS WILL REMAIN THE SAME.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,500.00
Permit: $83.25 Claim Valuation: $2,500.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
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 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
•
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 .
WORKERS'COMPENSATION DECLARATION: /
I hereby affirrx under pe0alty of perjury one of the following declarations: 1 • }
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.
:COI have end 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 are:
Carrier: Policy Number:
(This section need not be completed i/the permit is valued at one hundred dollars($100)or less.)
Kir—(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,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 pr isions.
.Applicant'SA i�naturet /-/r% ✓l/2c7 ( 7�cy[`�/7 {\Date:—ThC: — g.--6:92
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEUECr AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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.Uc.R Class N
•
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 Ucense 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.).
-Ar _I em exempt under sec. Business and Professions Code for this reason:
I Signature: - :---"ii/fr/r4'/an ,'r/fi1 ( Deane g - 6-0�-
Owner ID verified by drivers license. Yes 0 No Drivers License_No. , `xpire-r-6-.--(.75,-�`�
Verification of Ownership by(type of doc me ,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? ❑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 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 Califomia 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 en 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 application a jaermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ 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 part 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 Califomia 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 for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
I -, / im .. r -. 61---6---c- P
S Signature Of Legal Owner(s) s 1____Oate________.-;
And/Or Authorized Applicant Date
CODE F INSPECTION TYPE PIE ItinlA4$ CODFt INSPECTION TYPE RATE INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 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
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
RESS:
�BOWNE 'S NAME' 2116 WALLACE AV ' UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 065600
awxER's NAME: SNELLEN TERRY E
ADDRESS: 2116 WALLACE AVE PERMIT NO: B 065600 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: 0TH
642-2034
ARCH/ENGINEER: flEG.NO.: JOB DESCRIPTION : REROOF 0/1 LAYER W/FIBERGLASS SHINGLES SQFT: 2, 587
ADDRESS: UNIT:
CLAIM VALUE: 2, 587 . 00 CALC-VALUE: 2, 587 . 00 GROUP OCC: R-3 /
PERMITTEE: QUALIFIED ROOFING ( 714 ) 850-4166
ADDRESS: 351 NEWPORT BLVD 462 COMMENTS: SMOKE DETECTOR REQUIRED PRIOR TO FINAL
NEWPORT BEACH CA 92663 *+tit***ar*ir**FE*xyEr;tt*********+ri6+t*+r*****>ETH**+e****+r****+t*****at*x***********+c****ak***
LICENSED CONTRACTOR DECUBATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU I R EMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full torte and effect.
CITY • STATE LIC.:517602 '' � ,,��yyCLASS: C
S E T B A C K S
. :,� -5- Signature:W _1,/ MAIN BUILDING ACCESSORY BUILDING
°ORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate 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.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 42246207 ZNE: REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> _
>
Date: Applicant: *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). D EVELOPMENT SERVICES REQUIREMENTS
I certify that is the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
sublet the porkers'Compensation(LLaws of California. - ZONING APPROVED BY
at _ 5 - _I 4 Signature: Iia •
DATE:
TICE:If.after making This declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING : •V ED BY : DATE:
Code,you must lodhwnh comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: hereby firm that there is a construction lending agency for the pedor war or gg • •p,a I SUED BY: 1 Y j . M j�-� I•
which this permit is issued(Section 3097,Civ.Cf. FaR I� �;". 9T;9JIl Ai76�T�.1�* #**tF ib *cal**********************
R DATE: '1
LENDER: .. ******** ************************ **************************** * *********
ALENESS:
LEGALIZATION:•
1 F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that tam exempt from the Contractors'State license Law to the following reason CA" '
HLA
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter. prove.demolish,or 1 �, 40 PMTO PLUMBING ELECTRIC MECHANIC FIRE SMIP/RSDS, GRADING
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement I at he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Divi'on 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 9 Section 7031.5 by PIdtN et
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). I FEE
I. as owner of the property or my employees with wages as (heir sole compensation. will do he work, and the 71•Dj i NG-DIV—> . PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractor '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 himsx/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If.how • .
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: 54 . 50 OVER/SHORT: . 00
for the purpose of sale). (�[J]({qa�� 7{�F��) ECTRIC 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 S V,`iiP % , V . 50
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon M
and who contracts Worker's
proCompensation
ansuranceshl should
erovided to the Contractors'State License Law). lam aware *******.rink „**********************************************************
that proof or their Worker's Compensation insurance should be provided to me. ''YY�UU(( Yip J'L` ,),ID
❑ I am exempt under Section: B.8 P.C. IVIDUAL F E E BREAKDOWN
for reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owners
Iso acertify Janam aware and understand the ofrequirements of California ply Healthi and Safety Code e and 25505,uir25533,anda
SFR 2587 REROOF BY VALUE RESIDENTIAL NOZONE 1 ,00 � . 2 , 587 , 00
25534 and that a any future building occupant ht Air
Qua not Management
one)tneed to R sly with saidostate i codes and the are
for a END OF FEES
permit for construction or modllicalion from the Air ouallly Management District.Residential construction applications are exempt fromt ,
these provisions. 'Z . /x
Date. Applicant: D r r'
•
I hereby certify that I have read this application and stale 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 PI to enter upon the above.mentioned
property for inspection purposes. 0 e r '—f TOT 'r
` / O1 0 1 3Ds_-001.3337 `ti.�
Dale' I -S-G E Signature: , L L A•IE: O1.'Oi/94 TIE: 14:07
Drover's License or Social Security a:
164146 White—Building:Green—Code Enlorcemonl:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
-- - - ----- - -- --- POOL aq
CONSTRUCTION AND PLANNING
APPROVALS Permit m Date Inspector APPROVALS Permit Date Inspector
1. Temporary E eetrcai Servrca or Pole . { 52. Pool & Equipment Lucat on --
2. So i Pipe-Undrgrnd. i 53. Steel Reinforcement I
I.-3 !e:trrra1 Cond',: • Lf*•IIty•Undrarnd. I 54. corms
L4 E'+'c••ra' Concut Lk-dr-”'Id. ---- I 95 c'ectrica! Bard mu
. "-S+:e, Rnnforrtr^nt I 36. Rough Plumbing 8• P,...{.are lest
E'ectr wal JP ER L'i-"d - 57. APPROVAL 70 COVER GUNI-E I i
-�--- - - - - - j-- r
7, i',rotings -- -- I 58. Electncal Cor cu't vrd crud.
8. foundation _ 1 59. Gas P.ce, U"Ur.'c' . T._ .- ---
-t -- '-- - - ----- I --!----
9. Water Pape Urdrgrnd.
10. St cetera' Flux, System 61. APPROVAL_ -L1J :;t 'I.7-: I- ___-_ -- . _ -
i
11 Prone•lv S • Lr L -.e Hu..._ D-- m:en -__ ' u2. 3scs.+,,n & ":cc,.•, r ,.,.„
12. Sc 'der Cap - 63. iieater & Vent-F,n 'i
13. Roof Drains 31. Plumbing System (,-,-.I
-
14. Rough Plumb-ng f I C5. Elentrical-F;ra-- --- _ _ - -.
I _I__
15. Rough E:ertr.cru-Cordu: -_.T-,.� _ Solar SY,tarrFln;,
---r-
' 16. He.7n Er•ctr '
e,.'uirg -- _I -- } WI 6/ Fencing &Acc:Ss ADP ov it -- - - - '-- - '
17. Ruh eg S'9.; ._I i E9. APPROVED FQR PLt5: ; c„\G I•
18. Rauh hlcctric+t•T 8:r Ce ' • �I P 'SF S i
9 69. OCL A a`: 'S PHA.
1
19. Rc i.;h Ne�th,q & Art Cur:ft amng L..I -f_I 1- IRE 'U'TIR ED L:12 .,F. 'l •I ---
n .7
20: Rough Fact::.y FL.eplace i �'r I A•ct'R^t/4,bir '1-Pr tl..t -.. .- _____-_, 1
I rt);-,
- - - '7"1":.T ::-;--0-_:0,-.7-- ------- - --- - - - -- - -
21. .Quats,'n Structure - I :. - " 70. !-..44 -cc d't-'H1'Crn-, I
_ r,..t_ ;7777,7
_ - -.----__.-_
1 22. Duan, VC't 6tt,nq I 1 i�j . I Tit Pet=UMT;P-'i - G,:_, h_' -�--
7.3. Ga; P,P.,.Rwgl- Si- les: __ .- - , -• � _ --__ T.
::. _ -_ -1 -
1 24 Son:c.en r, - • v - ' _ _
2-5 n ' S.,. ..__ _- _ - - -- = ���rl . / ---- - _- _- - _ _
I
23. Ti;'• .ng :S: :.�_ a p:._cr it t 7., 7,q Cnernlca, Y`t= I I
27. rcme and FI,-,;hie N�.-1 =1J s- - - - - I
y
I 78 'Lathing P •1
. S, .ngr •.• J" 77.
I . F Y.ED cY :,. •
-1 '`I• •1
w
20. 'n 'ata -- - � .i! I 78. ERE ?HE__��f •_-__ - __-_ - - - -
4 _ _ _ _ ritf.LTI_'L'.-P-+R t;)'_ilh ci- ct.17
.-. -
:2. `.it:tr,.o. P Luc. date F. 1 °�. 7C'OD 21" R1"Yr I.4,/•C. F 'I " I
33. I-Ir,a N:etr•c - I I I R'uta::
34 r,rf rh t.r-,$: A:• Coy.tel el =r--* - II
35. Pu- c.1: P.n+;-Te-:t '
I---- - - -- ---- ----- - .- .1- --- -} -- --- - - -- ---- - - -- - --- -- - -
33. Fond or r.rapy ru __•1 _-- I -
77. LI F'r:c-y F.rsnlce _ . - t. I
.._ _ _ __-i_ _._ __ _ __ .•
_.
.
4.� ___.__ . - -.� {- • I _ -I • . ..
l ..t1. Ec,',Jr Uo-cr;1_c•Fir'=R _ I _-- _ - - '
42. •0e C.c}.Ol'r .Piuventer, F_-_ ___ ____.I - .I _�-_I __ __ _ __-____ _ _ _ ._ .-_ . _ _ _
! .r _-__ _ ._ -tet
43. 3d dt i'ay.' hrltj�h On _ I ^ --
4' d,c c'e 'r:iut.p 51,st.- t - - - -
•
---- - -- 'F- J---__Li_- i, -- - - -- - - --- - --
415 Sart At:c...'.:.or. • I
- ---- - -- -- - ---{- - - +'- -- - -+ --- - -- - --- : - -- - - -- - - -- - -- - -
i'5 J.:.-"'cn Rtgulat.o:,s ..
41. F iNAL STRUCTURE & BUILDING I-(O..qW N _i •� 4 !/ `/rte-a 4 _ 6 c ii '
1 48. FINAL PLANNING' _ . Oo't
.49. Electric Release to Edison .
'�C. Ge; Pule.se to Southern California Gas Co
I Si. CERTIFICATE OF OCCUPANCY I - -'----- -- -- '--- - - ------ - - - '
No. Data -
OWNER TOBIAS & CRR . / DATE 1-26-55
JOB ADDRESS 2116 Wallace Avenue VVV BUILDING PERMIT NO. 865
GF^'ERAL CONTRACTOR Dike & COleProve VALUE $ 8,5oo.00
LOT Ztl BLOCK TRACT 1881 Single Family Residence
GROUP I TYPE V ZONE Rh FIRE DISTRICT 880
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
-- _ DATE NUMBER
Footing Trench e,�d ,-As-1 5
Foundation Forms and Grade to Garage
gee
Rough Framing ' r
k y 3 -- `ss
Plumbing,Rough Slab ai 2-2S �a�
to
Plumbing,Rough Complete £ "t 3 'AS--Cr - _ -.( .0 -a... , a7./4 -Sr /y z9
Temporary Pole �r / V ,/
Wiring,Rough £44 3'' 4?9Ztw-ni-.s-... Q-�.ct-L . 3-/T'SP
- o yJ
Heating,Rough
Heating,Final _ice I .. —/`5{ hJ/.r - ('C r .iwb. _I ../. , _ ____2.12....27_442_3
Sewer / }�( fl -;2-51 ( 7 (!/✓ U - 6- /7/t
La...mg Tan ko { tr't' .tiE�-� 3 -is:3 J'/� •!p, „/ _ $S 77/�
Plastering 51^p.¢... ._- Ar « & 4 nir...5
Plumbing,Final,Fixtures Complete _ — r— 17
Plumbing,Final Gas Test /'g- LL/ - -J-J.1- sta ,\�
5 —>Ce
Wiring,Final F-1 23— Ji-
c .
Occupancy jet-"f5 - - /-ST
Form 210 G-H 111 12-18
.—costa Mesa Building Department APPLICATION FOR PERMIT
!• 111 EAST 20th STREET 880 BUILDING 1
COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
F'OR APPLICANT`TO I'ILL IN Receipt No. Permit No.
Building
Address 2116 Wallace Ave. 397/ �'6 c"
Costa Mesa, California Received by Date Recd. Date Issued
Nearest —a 6 — S SJ
Cross St. Hamilton & Victoria Building
Address
Owner Tobias & Orr Costa Mesa, California
Mail
Address 419 E. 17th. St. Nearest
Tel. Cross St.
city Costa Mesa No.
Tel., Zone 7 I No.of I Type ' / I Group
Architect or Lie. /� Plans
Engineer Hugh Gibbs No. Approved
by Date
Address Long Beach CORRECTIONS
City tic.
infractor Dike & enlegrrcve4lo• 12(11
•
Address 419 E.17th. St., Costa Mesa
Legal Description I No. -1-Lot �i I Block I Tract 1881
(Attach Metes and Bounds) - El
No.of Bldgs 'a ` '
Size of Lot 60 x 130 I Now on Lot None
0
Use of No.of No.of as, lir w�. 9
Existing Bldg. I Families I Rooms
Centero Setback Linefrom
551 SideYa a 60 r O=1 � _IAN 2 h .C 'i D
DESCRIPTION OF WORK 5 pl r
New I X I Alteration I I Addition I CITY OF COSTA MESA
Repair I I Moving I I Demolish I
Building „, No.of
Size 120Rooms 6 Stories 1
—xterior Wall I Roof
vering Stucco 1 Covering Compo. APPROVALS
se
P
of New
BuildingFoundation Location Inspector Date
Single Family Res. Forms,Materials,
Under-Pinning
Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application Lath. Int.
and state that the above is correct and agree to comply Lath. Ext
with all City Ordinances and State Laws regulating
building construction. .
Signature of Plaster, Int.
Per ittee
Plaster, Ext
Au homed Agt. fiti°
Masonry Reinforced
Valuation Permit Fe 2
Plan Check $ .� Bond Beam
$ 8,500 Total 25.00
Fee $ FINAL
FORM 204 0-H 2M 5-54
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Street
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PLOT PLAN •,
Show location and. distances from ••
• property line and between buildings. . .
.i
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•
•
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