HomeMy WebLinkAbout264 WALNUT ST - Building Permits 1PPLICATION FOR A BUILDING PE" 'IT
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// BUILDING PERMIT NO. c
Tract / Block Lot Permit No. ,
Plumbing _a'
Building xt / // /1- / /g Permit No.Ad dress[w'( /V�r -/./!/ NLS!//i(sC- / sv/sto
Cross /— Mechanical C
Area Street Permit No. C.
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Owner` S:14/ i � _of Type of Project: ❑ New ❑ Alter �u Addition
Address I((//l.,,rV� //ini11i e- ❑ R pair ❑ Convert ❑Demo ❑ Occupancy Pmt.
atY `Ady4"' I UU,finbs'[—ice Zipel 1,hone�r((r/�'1//'l A.P. Sup.Dist./^�'�.�iV 77 /�/t {{'_I IGOLia t Sup. ista.
Architect/
Zon Spl.Pmt.No.Designer License No. •
Yaks Front St.
C/L Street Width
Address ��,�D VV yl S �A�71Jis� Yards Left Right Rear
CItY n _rynZ1 444("hone"1.9410)
Lave Prol. Left Hight F.P.
Engineer License No.
Parking Spaces e• 'red Provide Covered
D. Address
�p Struct o.of No.of
m City Zip Phone Height tories Family
LICENSED CONTRACTOR'S DECLARATION Park Fees LI Yes Fee
cl
c73I hereby affirm that I am licensed under provisions of Chapter 9 Required ❑ No '.T. Receipt
t (commencing with Section 7000 of Division 3 of the Business and Zoning Approved BY: Date
Professions Code,and my license Is in full force and effect).
License Class License Number
_>- Date Contractor Misc.
E Address Proposed Use
of Structure
IL City and Zip Phone
re CONSTRUCTION LENDING AGENCY
B I hereby affirm that there is a construction lending agency for the
9- erformance of the work for which this permit is issued (Sec. 3097, Occ. Type Code
Civ.C.). Class onst. Year
y Lender's Name— USE/OCC s' •NCV SIZE SQ.FT.
E Lender's Address
J OWNER-BUILDER DECLARATION
Y1.
I hereby affirm that I am exempt from the Contractor's License Law
afor the following reason:
B I, as owner of the property,or my employees with wages as their 2.
sole compensation, will do the work, and the structure is not
Eintended or offered for sale. 3
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project.
m 0 I m exempt under Sac. B P this r son
ar
'AO�d'l rJ�o � �
2 Date Owner
E WORKERS'COMPENSATION DECLARATION Total Valuation
3 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required ❑ Yes ❑ No
or a certificate of Workers' Compensation Insurance, or a certified
C copy thereof. Grading Pmt. Grading
.m} Policy No Company Required ❑Yes ❑No Pmt. No.
C 0 Certified copy is hereby furnished. Rough Grading V
Q ❑ Certified copy is filed with Orange County, EMA,
Approved by: Date
Date Applicant 3
CERTIFICATE OF EXEMPTION '
FROM WORKERS'COMPENSATION INSURANCE 2
(This section need not be completed if permit is for $100 or less). c
I certify that in the performance of the work for which this permit is 3
issued, I shall not employ any person in any manner so as to become co
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subject to the Workers'Compensation Laws of California. PERMIT FEES
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with suchSpecial
Electrical $ Invest. $
provisions or this permit shall be deemed revoked.
I CERTIFY THAT I HAVE REAP THIS APPLICATION ANO STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MEN'T�/p NED PROPERTY FOR INSPECTION PUR- Pre-Grade
P �" Ks�s - /j a /S / Inspection $
Signatture of_ dru-es0] a Pre-Grade Permit
Signatu�rre Applican r Agent Date Rec.No. $ Issue $
Print Applicant's/Agent's Name
All spaces within this hos must he completed to process Plan Issuance
By: c
PlanApproved:
CMF 0335-46(BU-28)rev.6/80
6"144-4. CifY OF COSTA MESA
O % CALIFORNIA 92626 P.O. BOX 1200 •
> ( a ( n
1•
J.• •° FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY
qo fi.
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Project Address MogidAPermit # Sf3g
/ 7
Project Name O �,���a�Q� Type (/
Owners Naim
Owners Address A �� `���� City Use Only
Owners Telephone (D eit(p it 4 6p .
I�,jyl n as Owner, (strike out all
except one) do hereby attest that employment of any person, or persons, is not
anticipated at the time of seeking the above-referenced permit. In the event that
any person, or persons, are employed under the provisions of this permit, I shall
immediately cause a valid Certificate of Workmen Compensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my own cost, and to indemnify and hold harmless, the City,
its officers, agents and/or employees, Fran and against, any and all liability,
damage, costs, losses, claims and expenses, howsoever caused, resulting directly
or indirectly frau, or connected with the improvement under this permit.
I further state that I have read and fully understand the implications and re-
sponsibilities of the above statements, and will canply with all provisions of the
Contractors State License Law found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
Print Name
GZ _/Jn) d- -9e'
ig�ature Date/ /
CMF 0777-46
OWNER jh( gS� CHARLES W. DATE 2-14-62
JOB ADDRESS 264 Walnut Place BUILDING PERMIT NO. 16407
GENERAL CONTRACTOR r. AAA Siding Contractors VALUE $ 1,095.00
AP No. 118-133-4 LOT TRACT FIRE ZONE DESCRIPTION OF WORK reside res.
INSPECTIONS Signature DATE GROUP I TYPE V ZONE El
S PERMITS ISSUED
SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line ❑ House Con. ❑ St.Swr. ❑
Sprinkling System
Construction Pole
Underground ❑ Power ❑
Rough Wiring
Trenches ❑ Forms ❑ Steel Reinf. ❑
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Frame and Flashing 1t3.JfC , .2 - /S - G =-
Lathing — In ❑ Out ❑
Plaster, brown coat
Ref rig. ❑ Air Cond. ❑ Final
3" Ing, Final
1-. _thing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final R frig 'N^/Y- (4-
OCCUPANCY
moon nun.con — zai 1 hIU If
FEE RECEIVED
16407 FEB 14196? •
CO$TA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. 0..BOX 817 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
1
TYPE E ORPERMpel IT
1S BUILDING
BUILDING 7//f /�/ / /Q[-i/i
ADORES COSTA MESA. CALIFORNIA�[ .IF�p` IForOfficeUse Only
OWNE��,/////J N / 2-a//%F� /y9 1 RECEIPT NO. I/ PERMITTE §ONO.
MAIL �G 7 �O 42197/" .0e1 U1 1i n�A RECEIVED
Y�o7 I�j`-/,Y(f/'B D�
ADORES gig-4
/.��"p/ /� IV�I �p//.DA
CITY �(/d /Q I/(r! 4 NO. ADDRESS t (�� �LA'il///�u.�
ARC""`"ECT TEL. COSTA MESA. CALIFORNIA
OR INEER NO.
FIRE
ADDRESS ^
ZONE TYPE GROUP E
�,//` ///Jy
CONTRACTORS/1Xfj / /V�/`62- . e n`/ QG YJ APPROVED DATE
ADDRESS/PE"? /G/ v-"(L// / 4 CIL- ZONING
CITY Cd'/�4"PH 6 hditt° ZONE Po.OF use of NEW=
// y//��/���/ I I PLANS '"j�/ BUILDING If�/I ,�
LIC.STATNO es-76/ NO.�/ / (/7 A/ LEGAL -1? L la 7 4 o1 - (-I,
DESCRIPTION 1 / ` //
SIZE NO. OP BLOCS. r 1 g'— / 3 —\1
OF LOT NOW ON LOT A.P.NO. /1 L/ [/
USE OF YARDS EVES
EXISTING B DG. _/ (7 C/? C_7 APPROVED ALLOW
SETBACK LINE FROM (CANTER LINE ST.)
CENTER OF STREET REAR YARD FRONT � /L. .-- n IN.
SIDE YARD I LEFT I RIGHT R.SIDE
/nr IN.
DESCRIPTION OF WORK
L.SIDE IN.
NE' I X II ALTERATION I II ADDITION REAR �p FT. 7 IN. /�A
REPAIR I' `II MOVING I II DEMOLISH I BYPROLI DATE // ('SCJ 6/
SUILDING NO. OF L-/
SIZEUIROOMS STORIES �L/
EXTERIOR WALL I ROOF
COVERING COVERING
USE-13F EIU DING AN WORK TO BE PERFORMED
AES Pk ce
-SIth a)bg
)-Q /a 4ss`44
&cuc, at-a ( Cva•��J"le ,
1 HEREBY ACKNOWLEDGE THAT I HAYS READ THIS APPLICATION THE AMOUNT BROWN UNDER VALUATION IS POR 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
BUILDING CONSTRUCTION. VALUATION /Xy
SIGNATURE OF a PERMIT FEE $ V
PERMITTEE e
//' /}
( 1541:5‘
/j//ij,5` PLAN CHECK $ ..r, --
' , 'E
AUTHORIZED AGENT/ f (4,4 !!! f.� / ^ -ice_ ' o
TOTAL FEE ab:a '� a
OWNER SEAN ROWLAND DATE 2/23/81
JOB ADDRESS 264 Walnut Street BUILDING PERMIT NO. 51397
GENERAL CONTRACTOR Owner-builder DESCRIPTION of WORK Room Addition
AP No. 426-283-21LOT 4 TRACT 767 FIRE ZONE VALUES 9,475.00
II iCTIONS Signature Date TYPE V GROUP R-3 ZONE R1
PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
4-) PROP. SWR. LINE❑ HOUSE CON. ❑
SPRINKLING SYSTEM
jMISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
N UNDERGROUND ❑ POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES ❑ FORMS STEEL REINF. ❑ E X p 1 R E 0
C4 FLOOR SYSTEM t8 Grllcol
T1Gf IeCLtOn$
BOND BEAM ❑ STEEL REINFORCE ❑ InCOIIPI�
SHEATHING IttapC
FRAME AND FLASHING O ��
LATHING - IN fl OUT fl Oast
PLASTER, BROWN COAT
5T" --TURAL, FINAL Electric
H IG. VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST ❑
ELECTRIC, FINAL
BUILDING. FINAL
• COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 nom brn, tol 7g 66_ IL
s RECE BY PERMIT (.J.7 397
For Applicant to Fill in Completely— Use Ink Only PERM
7
BUILDING / / - A.P. NO. 4.2i2 --( vi — 24
ADDRESS J / / a BUILDING 2 / el Ll Vi•
OWNER OR, ADDRESS (D
TENANT ��///j "...nail/ 4 --a- ��— UNIT OR
MAILINGADDRESS �7^_'v SPACE NO.
f.-�ICLL. TB,LYO. 7 LOTAil ELK.
TEL. ,/, C/f/C_7
CITY a, /H')` j NO.��cy ��� NEW ADD /ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION /v-, ' I •VJ
LENDER
BRANCH 5
OWNER n /
ADDRESS ' /� VALUE (''
ARCHITECT TEL. USE 8� wesgy7J
OR ENGINEER NO.
ADDRESS // ZONE C .1 TYPE ,�
�j •• GROUP 2-3
AP
CONTRACTOR 020.1.L
. f BVPROV ED DATE 2/Z3k/
ADDRESS lir
TEL.
CITY NO.
[-• STATECITY APPROVED SETBACKS
p—sLIC.NO. LIC.NO.
W SIZE NO.OF BLOCS (FROM C S/�i .�T)
a OF LOT NOW ON LOT FRONT T.
CAUSE OF 2.6EXISTING BLDG. R SIDE LL. FT.
V)
FSeparate permits are required for L,SIDE FT.
C electric,plumbing and heating work. REAR A-5 FT.
1.17 USE OF BUILDING AND WORK TO BE PERFORMED PLANNINGACTION
Q
'1 1
Q✓ I / /c_ DATE
`�W 4 L APPROVED APPROVED
SHY RGwlr•l DATE 2—/Z5/8 1
C
W
0 I hereby acknowledge that I have read this application and state n
p( that the above information is correct and agree to comply with
A. all laws regulating building construction, and I shall not employ
Z any parson In violation of the workman's compensation laws of g
the State of California. /��� .t
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 m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY: b
am exempt from the provisions of the State of California Business VALUATION e
and Professions Code,Division 3,Chapter 9. PERMIT FEE s SZ. 00 u+
n
�/ PLAN CHECK s Z6 s DO n
Signature of �� ( .// Q o
Permittee cep, �( /� s / TAX $ t l/
is
Or _ / l y tPp U
Authorized Agent Date ,a AA- - 4 TOTAL PAID $ 7p . 6 a