HomeMy WebLinkAbout222 WALNUT ST - Building Permits Ile r Os •
CITY OF COSTA MESA
0'"'` rQ BUILDING DIVISION
F�A� �If 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
. FORINSPECTIONS CALL: (714)754-5626
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1 p PERMIT NUMBER: B07-00949 3
PERMIT TYPE B_ROOF2 • STATUS: ISSUED
DATE ISSUED: 10/01/2007
ISSUED BY: SOK
JOB ADDRESS: 222 WALNUTSTiCM Suite/Unit < ;_, •
Vicinity: ROOF
Squares: 2500 . - -' ;•Valuation '. '. $6,000.00
T
SCOPE OF WORK: TEAR OFF.EXISTING-ROOF. INSTALL NEW SHEATHING, 2 LAYERS OF-,-15#FELT, 25 YEAR COMPOSITION
SHINGLES FOR DUPLEX. 25 SQUARES INCLUDES ATTACHED GARAGES. -
OWNER: LITTLE CHURCH .._ Address: INTERNATIONAL- - - • Unit: LAGUNA
BEACH,CA , •
PHONE: - City/State/Zip:.P 0 BOX 636
APPLICANT: TIM COX "r" 's '' -_.. Address: 163 MORRISTOWN LN • ;r' Unit:
PHONE: 714-928-5192 • City/State/Zip: COSTA MESA, CA ''
CONTRACTOR: OWNER-BUILDER : - . ' ' ' _. -- ' . License No. 000000
Address: Unit: PHONE: --
City/State/Zip: • CELL:
ARCHITECT: License No. PHONE Y
ENGINEER: License No. - . PHONE:,
•FEE SUMMARY ,
Reroof Plan Check: - "$0:00,'• - . .
Reroof Permit Fee: $125.25'kr-.. . - ``- '
Reinspection Fee:
s;
TOTAL FEES
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. •
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.
CODE A. INSPECTION TYPE DATE INTIOALS CODES INSPECTION TYPE ElINTTnALS
1616 Fixed System Final Fire Prevention ' 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 114e-P7 210 Final Electrical
201 Final Block/Retaining Wan 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
WORKERS'COMPENSATION DECLARATIONS Owner ID verified by dries. ❑Yes El No _
I hereby affirm under penalty of perjury one of the following declarations: (,.?.�/Orlygrs'Licensa'No::.. ri irys: c1-2 J 'o`1
❑ have and will maintain a certificate of consent to self-Insure for workers' rs+Verifidation oorOwnership by(type of document,i.e.-property tax bill'or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
• ❑ I have and will maintain workers'compensation insurance,as required by •
section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more-feet in depth into which a
number are: 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
Carrier: or dismantling thereof,,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This seclon need not be completed One permit is valued at one hundred dollars($100)or less.) 2 Art 2,Sec.341,Title B,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
issu" I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as.noted above,unless
ed I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of - Applicants Signature Date
the Labor e,I shall forthwit comply with these provisions.
/ ' e_ _ t O - ) -0-' Division of Industrial Safety Permit Number:
< �,'?pplicant's.Signaluf AR-.'1^'^'-" ?Date
"'. '-�-" �'t;a�r � c= HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No
Lic.# Class# (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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own B (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for •
sale. If, however, the building or improvement is sold within one year of control officer). •
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
--r-r5?' city ordinances regarding Hazardous Materials and Emissions.
Ea, I,.as•pwner of the property, am EXCLUSIVELY CONTRACTING WITH
ENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
•
-' f'DrItAer -.'(fes-., /Si nature offLegal�Owneerr ) Date
30'� _ 5f9nature� '..a. (�,Date�..•-r" '—lo—S '/✓W�.� 1-� .4�=07
3p57A 101016 ) rrrfff
�U+�AnElor Autligrized Appl�q 1 ? I', : -krDale 'li 7
OCT-01-07 MON 07 :30 GiM P; 01
14001/001:.;*
iotoi/2007 00. 19 FAX 714754485E
-7 esti
DECLARATION OF AUTHORITY SIdg.Permit#
FOR AGENTS OF PROPERTY OWNER This Permit# •
TO APPLY FOR PERMITS .
•
V L'L Z a 1• tilt AP Number:
Street Address:
1 •,;41 a C,-Sim 1,t W!-n (CQ levity _R , declare that I am the Owner of Title of the above
I (we). L
referenced real property,and that I (we)hereby authorize:
•
Nome: r c —. Telephone Number: 714 23 S 1412
Street Address: _ 1G 3 1n or r NA-z,r r n L n -
city: Cos-7-Pt f`1uaPc — state: CA _ zip: •.;••
•
•
to obtain permits in my behalf,as owner/builder,for /?-e--ron
At the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall Immedletelt'provide Wolit'er's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Divisidn'of the City of Costa
Mesa,as required by State of California laws.
3, As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, comperili'dr
corporation.
4, I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any delft fesultirig 1n'dariiageYdr
personal Injury to myself or any other parties as a result of work authorized by the permits from the City of Coifs'Mesa.
5. I declare under the penalty of perjury that the foregoing Is true and correct. Q
Executed this day of d L 20 01 ,at t+ Q'7i'w+MCCt. 1 f 4's" 7 .
- 1 CaliftimTa.
•
•
•
Print Name: L; k4-1 e. CIeut -St.
/
1,�}i l ct SCeil�J
SIgnature: j i rC�
Date: l t S. 7
•
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Note: This authorization does not grant authorization tp perform the work as owner,
it solely provides for limited power of attorney to secure this permit In any behalf.
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077916 y.v,,nn0)
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PROJECT ADDRESS: 220 WALNUT ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 05656C
OWNER'S NAME: SARAH CONALY
ADDRESS: 220 WALNUT ST .. a PERMIT NO: P 056560 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA
CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE; OTH
aRUNrtxcIxEER: (714 )645-1062 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : WATER HEATER REPLACEMENT SQ FT:
PERMITTEE: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
ADDRESS: GEORGE BRAZIL ( 714 ) 535-7905
3022 N. HESPERIAN WY 101 COMMENTS: CHANGE—OUT ONLY
SANTA ANA CA 92706 QEF ******4* t*xlt*x**+t*********atx************aE****IE*atatat*****at*+t*******at******+t***r
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. my license is in lull force and effect. SETBACKS
CITY LIC.: 2 9 L�9STATE LIC.'4430 . C s: 3 6
-- Date: ill v.— a Signature: J MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to seg-insure or a cenificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified Copy theteol(Section 38W.Lab.Cl. LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICYND.: /9/yrCR0298489-01 EXP.DATE: 01/01/93
COMPANY: ItELIANCE INS.CO PARKING REQ: PROV: PARCEL; 00000000 ZNE: REF NO:
, r] Certified wpy is hereby(relurntshed. 12 Certified c ' filed with the
Bedddingg�Div�isionn.. // PLANNING NOTES>
date: %// 34 Applicant: 4itr \./"`�K/I iW�+� '' **********************************************_*********************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(9100)or less). DEVELOPMENT S E R V I C E S' REQUIREMENTS
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:
Code.you must forthwith comply with such provisions or this permit shad 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• Jy DAT E
which this permit is issued(Section 3097,Civ.CI. ************************ F*** 1 t A.iP * * * *iter **************�**
LENDER: **************************************** ** *********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city at county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 , 00
repair 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 Contractors'State License Law(Chapter 9(commencing with Section 7000)01 Division 3 of the Business 25% SM I P/NON—RES
and Professions Code)or that eve/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 live hundred dollars($500). ISSUE FEE 3. 00
I. as owner of the property or my employees with wages as then sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 2. 00 3. 00 0 . 00 5.0 0 5. 00 . 0 0
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.II.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: 5. 00 OVER/SHORT: . 00
to 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 5. 00
❑ 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).lam aware **************************************•*.N•*****•**•*.)f*****•**•************.*.***.******.Id
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: OwnerPLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
I do 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 MUM!not(circle one)need to comply with said state codes and the requirements for a
permit Im construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Dale: Applicant:
I hereby certify that I have read this application and state t above information is correct.I agree to comply with all city and county
promotes and slate
stlaws relating to building contauclian authorize neon utives ofenter upon the above-mentioned
property for ids ct onpeses. (,
A V
Date: ( (� Signature: A 4..r,
Driver's License or Social Security or:
1641.46 White—Building;Green—Code Eelorcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL .;PA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Servte or Pole. x 52. Pool & Equipment Location
..
2, SoilPjpe•Undrgtnd. . - t• - 53. Steel Reinforcement
a\-Electrical Condaii thility-bndrgrndr,: 54. Forms
,-N
4. Eleolrtcal Condult•Undrgrnd. 55. Electrical Bonding
?"-#51 Sfpe,llteinforcemet`tZ - 56. Rough Plumbing & Pressure Test
Z a _ -
8: Electrical OF ERGrnd, 57. APPROVAL TO COVER-GUNITE . .
7 Footihrgs - 58. Electrical Conduit-Undrgrnd. :
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe•Undrgr`nd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line& HoTse Connuttion 62. Backwash & Receptor-Final
•
12.Sewer Cap .c 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
- - .- - y - - 7 ' - t * - -
20.Rough Factory F,B,teplace ' .fl• n'C, ._ _ -• + •- 1'APPRQVAL$'_- :Permit# ,. -;
21'_Ducts, in Structure. .. - i { :1 - '.70. Underg Dunt Hydro
22. Ducts, Ventilating =S ' S ' ° 71. Product in CTC5s 00il
23.7Gas Pipe-Rough & Test ;t.- _ r -+ a -72. Underground Flush-
24. Roof Framing _ , - - 7•• : `73°Undergrnd Stora'1cank QGas OM
25. Roca Sheathing r ', .- n - ',1`t n �74,'Overhead (iydro"7.
r
26:T-Bar Ceiling (Structural) & Monocoat ' _ -v =r lrt` 75•7Dry Chemical
_
, ,, 4, i -!
27. Frame agd Flashing` •n o ' A. 76: 'Dryn •g ,r
.� :.x ; a r 1 Stands, "r
- 28. Lathing& Siding:- . cz. , • --, T 77.EFIXEDS,Y$-1,�-Ef aj AL:
•
'29. Insulation •-.- i ' ` I •,.. , 78sFIRE PREY. FINAL , -- _ tr
•r30. DrywalUUNailing g+ 'c - •t• •HEALTH'DEPT-REQUIREMENT
.( - - .. , ,117] • c
X31. Plaster Brown Coat, , z L;; ;,, ,79.`•F�NAL�TN2ECTIfN t ,r
C 5 '• r C r a ._2 - 2
32.-Electrical Power Meter.Final, I • ; 'r60rfOOD CERTIFIC4CTE ISSUED
33-,kin41 Electric '‘ 'Noris: . - ` ,
-av >
X34;-Pinel Heating& Aiy Conditionigg; I t ,a . X g
35._Final Ga Pirie-Test' F `o. - ^. m's • T
-36. Hood or,CanopY - - _ _ ) k : ~ X : .� r -
C" - r 1-r . r • .r n
r37.-Final Factory Fireplace., • =7? _ '' •l 4 s -
.38. Final Plumbing ' _ alt' z_ Lam. 14" - o
i39. WateY Service-Final- • - I - rr I CX
• y -c i .
40. Gas Service-Final ��
41. Solar Domestic-Final , • -
: •• ' 'ti i t'- 1 .r=
rr t i! 1 - ..
.Ni , r .. .
42. Backflow Preventer' ,; .r _
43. Backflow Irrigation =5 - x- • - -•
a Irrigation '
44. Landscape System- - „ - - �< < .t; i - •
'45:Sound Attenuation ' ' x 1
- .. - , in r a 2 t
46.-,Handicap Regulations : - - -` '
47. FINAL STRUCTURE & BUIiDING • , . , -
48- FINAL PLANNING • ; ,• - ;
49Electric Release to Edison .: i j, , -' it -
c ..- , -
n
r50.;Gas Release to Southern California Gas Co p . - J - _
51. CERTIFICATE OF:OCCUPANCY : , = -
No. Date
uwr rat mno. D. B. Gu1vtBALLI DATE (-4Y-07
IJOB ADDRESS 220-222 Walnut Street BUILDING PERMIT NO. 2)484
GENERAL CONTRACTOR Owner/Builder DESCRIPTION OF WORK Private Block Wall
AP No. 118-09i-29 LOT TRACT FIRE ZONE VALUE $ 100.00
INSPECTIONS Signature Date GROUP J TYPE III ZONE B-1
PERMITS ISSUED
SUBCONTRACTOR I Date J Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground C] Power 0
Rough Wiring Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. D • J/-65
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing—In ❑ Out 0
Plaster, Brown Coat
Structural, Final Electric
V 'ing, Vent., Refrig. and A.C., Final
.bing, Final and Gas Test 0
Electric,gFinal 0/0//64,-;Buildin Final e-
COSTA MESA BUILDING=SAFETY DEPARTMENT CITY ;ii" C.}S j,ti M SA
P.O.BOX 317 COSTA MESA,CALIFORNIA
31111
For Applicant to Fill In Completely AN AL 1 \I)FOR1 PE
TYPE gORPRINT BUILDING
BUILDINGDRESS WO-z�IA90.DAAAA- r 1Qfti ff t Only
COSTA MESA. CALIFORNIA• � ((////f� �:� ,.--
OWNER
F{/16J9[
D
OWNER Mrs, .r Cvh •`Q�:�[. RBC IVSD SY DATE2C/' BV✓I D -I E�/� '
BUILDING
AAIL :Z2 ; ^,,^ Q _ ADDRESS
7-2
-2 Cl
ADDRESS %JLM. v
11. o - FIRE
CITY C 'x`rte+-Q` NO. ZONE TYPE�GROUP Y�
APPROVED £9
ARCHITECT - TEL. BY DATE
OR ENGINEER ,.1:2O----- NO.
ZONING
ADL a ZO NO.OP BUE OF NEW?`JAf!K
,,8B � � /I ^ ��ad PLANB I BUILDING
CONTRACTOR �^ ZN� (2A L`Y1 ((�� 5 Z kir
'�"
3 G LESCRIPTIOI ? kr 1 / 1 i 1' 1-,7-
ADDRESSp 7 0. ��Z B x' ) 7- Q Q,
CITY `,O- bi-Q n[h, A.P.NO. II — O / ��/
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL. 30'TO SIDE a REAR P.L.
LIC.NO. NO.
EAVES
����11 /,�7
OF LOT C V \ 13 SC 0 / I NNO.OF BLDOS.
OW ONLOT ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C''JJ/JLJ��S//T�REET)
SETBACKO
LI NE FR TO
'7 0 FRONT`J,y (/7I'. FT.
CENTER OP STREET ,��..0/ REAR YARD �/
SIDE YARD LEFT 0 I RIGHT i5 R.SIDE 0 FT. FT.
DESCRIPTION OF WORK L.SIDE I,
NE"" ALTERATION _ ADDITION REAR FT. FT.
DISTANCE BET. BET.MAIN A
REP..,R MOVING DEMOLISH MAIN BLDGS. ACCESS.SLOGS.
BUILDING NO.OF VAR.?C DATE
SIZE ROOMS STORIES C.U.P.# ^. APPROVED
EXTERIOR WALL I ROOF APPROVE• -2q-(
COVERING COVERING BY ,. i 7
.AAAA A DATE /
US�iB/II�DUJG^AND WORK TO BE�PEujiFORMED
+ n NI
-64
L' 111////`/'lip N
60.FT. 0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m
BUILDING CONSTRUCTION. N
'l �/V� �_ �1 '�1// O PERMIT FEE $
SIGNATURE OFin , V(J/^l)I,l�{� V!/ O
PERMITTEE 7),44'4) .tUe- 1 0
V $ /0___
D-� PLAN CHECK $ E
AUTHORIZED AGENT �J
`2 �
. TOTAL FEE $