HomeMy WebLinkAbout2781 WAXWING CT - Building Permits a
,501 4.
9 CITY OF COSTA MESA !
4 BUILDING DIVISION
Y •q-.,,,. s DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
ft w M�
; 111 • PERMIT MO -00542
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, ..OSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2781 WAXWING CI Status: ISSUED
Suite No Applied: 09/23/2005
Issued: 09/23/2005
Vicinity: - .
Parcel Number: 13962132
ISSUED BY: A-
Applicant: DAVE FOLDER
Address:
Phone: 215-9011 _
Zip:
Owner: RUSHER, DAVID LYNN TR . .
Address: 2781:WAXWING CIR.• �. _
° �`, _ "Phone - -
'COSTAMESA,CA Zip: 92626-4850 - '
Contractor:, FOLGER HEATING &AIR CONDITIONING
Address: 8842 LUSS DR - `
- Phone: -(714)334-4433
'HUNTINGTON BEACH,CA Zip: ; 92646
'.License::763312 I "" - - -
'I {' , 'SCOPE OF PERMIT ._ '
' RELOCATE EXISITNG AI
FURNACE TO ATTIC, INSTALL AN C UNIT ON THE RESIDENQE SIDE:;. ?r,
FEE SUMMARY
Quantity ' ' • Quantity
ISSUE FEE $23.50' - - _• - _. . _ - Repair/Alt Absorbtion Unit - $0.00 0 .
Inst FAU<100k BTU' .±j,- $14.80" •1-jr- • . - ',Repair/Alt Refrigeration Unit -'�;"- ` ,. $0.00 0 -,,a
Inst FAU>100 k BTU; $0.00 .0 a`. ,`T,Ventillation System _ "• ;'1 .i' $a00 0 • ' `
Repair/Alt'Cooling/Heat' ._,$0.00r" 0 '-" • • Evaporative Cooler - - $0.00 '0
Ins(/Rep.Recess Wall.Htr $0.00. 0 Commercial-incinerator - . - $0.00 0 .
Refrig Sys<100 k BTU $14:80 1 _ Domestic Incinerator $0:00 0
Refrig Sys>100 k BTU $0.00 0. ' - Compressors/Absorption Systems --
Gas Piping • $0.00- " 0 , _ ;`Up to 3 hp/100 kBTU- - - ' $0.00 0 j'
Factory Fireplace , $0:00' 0 - `3 To 15 hp"/500 k BTU ; _ , $0:00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU . ,` $0.00 0 '
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0:00 0
Vent Fan/Single Duct $0100 0 Over.50-hp/Over 1,750 BTU H -$0.00 '-0.
Appliance - - • $0.00 0 - Boilers
Fire Dampers $0.00 0 • ' Up to 3 hp - $0.00 0
Smoke Dampers ,,$0.00 0 '''''P .3?To.15 hp $0.00. 0
Inst or Relocatppl Vent. - $0.00 0 , -;' -- to'15 30'hp_- $0.00 0
e'A
Air Handlers< 10000cfm ':$0.00,:,:0• -_<z,- -;•'. ;30 to 50.hp= $0.00 0
Air Handlers> 10000cfm ,
$0:00,, -0, .eg; , Over50 hp $0.00 0
Floor Furnace $0.00;:<',4,0 ".Other Mechanical Fee
Floor or Suspend Heater-' J' $0.00 0.'_ ° Investigation Fee.,,-'- : - % :`.'$0.00
i ? �:_." Plan Check'Fee $0.00
�; Relnspect_ion.Fee $0.00
-..TOTAL CALCULATED FEES $53.10
COMMENTS/SPECIAL CONDITIONS .:- -
•- --? - • '- _
R RI . P
. _. _ .
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)7545628
2446-46(6/00) '
WORK RS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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.
❑ 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 arid policy number are: OI
Carder: .Srt"—� 'i-�^ Policy Number: f gi 71
(This section 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 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 provisions.
Applicant Signature: / Date: L/
WARNING:FAILURE TO SECURE WORMERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE MST 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.# 7 6 '3 t Z Class 8 C —2J
Contractor's Signature: / Date: 9
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 License Law does not apply to an owner of properly 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 driver's license. 0 Yes 0 No Driver's 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,faisework,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? 0 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 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? 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 a plication appermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes 0 No
(Section 65850.2 of the California Govemment 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 end Safety Code).
7 11 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 California Health and Safety Code Section 42303 been made? ❑Yes ❑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 Halardous Materials and Emissions: :r
1 3� F'Ab`'F F'. .._ ' "-'i3;
Signature: ku 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 taws 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.
•
_ gal Owner(s)
3Date
z os /.
• er odzed Applicant Dat
COPE r INSPECTION TYPE DATE WEAILE gODE! IIiSPECTION TYPEILA E �•
1616 Fixed System Final Fire Prevention 206 Final Mechanical 9-,26 -o J
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
4;
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5
APPROVED V
CITY OF COSTA MESA
PLANNING DIVISION
C
SUBJECT TO BLDG. DEPT. REG.
NOTE:ADDITIONS, DELETIONS, .,
OR CORRECTIONS SHALL BE •
APPROVED BY THE PLANNING DIV.
I�Z
BY: DATE�I w/oc
pC/c 0n ttt
r ' 'POJECTADDBE55: 2781 WAXWING CZ UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 068463
A OWNER'S NAME: BOUSE, THOMAS V
ADDRESS: 2781 WAXWING CIR PERMIT NO: B 068463 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: ALT
714 ) 979-8079
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESHEATH 6 REROOF W/COMP. SQ FT: 5, 000
ADDRESS: UNIT:
PERMITTEE: CLAIM VALUE: 5, 000 , 00 CALL—VALUE; 5, 000 , 00 GROUP OCC: R-3 /M-1
LUKE ROOFING (714 ) 633-8798
ADDRESS: 448 S MONTGOMERY COMMENTS : SMOKE DETECTORS ARE REQUIRED PER U. B .C. 1991 I .C.B .O. # 4312
ORANGE CA 92667 **it*** ***********a6***+t**a6*+r*****yr*y6** **Tt*****yE+r+6+tyEar+rx+6iry6*yr**+E+tSE**rsr*****yE*+E**
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S
CITY LIC.: 062058 STATE UC.: 672569 -3 XP: 05/95
r. . —/S-$ Y Signature:— �/J MAIN BUILDING ACCESSORY BUILDING
Irr KERS'COMPENSATION DECLARATION: I hereby affirm that I ave a certificate of consent to sell-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 ; 13962132 ZNE: REF NO: ,
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
>
dale: Applicant: *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D EV ELOP MENT S U IR EMENT 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 ( �� '.�y.K
suti ecl to the Workers'Compensation Laws of California. �� ZONING APPROVED BY i V , 1
C �0.�'J^v rr'Fr'CC/��` DATE:
Signature: .Olet ( U R
OTICE:If.after making this declaration,you should become su to the Workers'Compensation provisions of the Labor BUILDING APPROVED B Y REUUIRED I' •�� DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. a
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• 1-1
which this permit is issued(Section 3097,Civ.C). DATELENDER: *
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
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: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 00 . 50
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)of Division 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 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, will do the worn, 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----> 72 . 50 0 . 00 0 . 00 72 . 50/ 72 . 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 v
hisoris employees.witin provideder thof cmph improvements are note the bddepeered for she/. II,eidwoebild oipvr REVENUE DIVISION TOTALS--> COLLECTED • 72 . 50 OVER/SHORT: . 00
hisimor her ownsp caees.pro yer of t such ion.mp ove entsr well have the edrorn ff edprofor aleshe d o not r the or improvegr
tor 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 72 . 00 . 50
❑ 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).I am aware ***{e*********.*******{e***.**{E***********.**.*{e{t.**.**.**.*****.**********.*****.**.****.*.***.
That proof of their Worker's Compensation insurance should be provided to me. IND I V ID UAL F EE BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason. TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date nor• SFR 5000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 000 . 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 wilt/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification trom the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Dale. Applicant:
I hereby cerbly 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
p rly for inspection purposes. >ry *DLI LICATE RECEIPT*
01 001658E1-00165882 TILT 72.50
a Signature: f/ - DATE: 0$/25/94 TIME: 08:46
Drivers License or Social Security if: /
1641-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
1/4POOL A
CONSTRUCTION AND PLANNING •
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Servictor Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3! EIE;ctrical CondbitlOtility-IJhdrgrnd. 54. Forms
4, Electrical ConduittUndrgrnd. 55. Electrical Bonding
7.5. 5 .e.el Reinforcement 56. Rough Plumbing & Pressure Test
i6: Electrical OF 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. Prpperty 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, POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- 'J.-,
20. Rough Factory Fireplace r• - t - C.- APPROVALS-4
: Permit # '
21. Ducts, ctur� _ -, 4. d t
in.Stru _
-70. Uridergroury'd�-1YeFro i-
22. Ducts, Ventiiatin9; - _ ., 4_ I. . "71. Product ()irking0.0-14's ❑Oil
23. Gas Pipe,,Rough &'Test _ . ,72. Undergrotod Flusli, _
24. RoofFremin -_ 1 .- - -
9• •' -� -73.-Underyrnd:Storage Tank CD Gas 001
25. Roof'Sheathing - 'r 1 ;'eiYj ,Ff% 74. overhead Aydro ', • '
26. T,-Bar,Ceiling (Structural) & Wlonocoat •.? 75.-Dry Chemical -- -
27. Frame and Flashing _ _ r:. 76. 'CS) Standpipe -j
28. Lathing& Siding•• -.a ,
-, t -: : 1 • " - _ 77. FIXEDSYSTEMFINALr .l
29. Insulation ; _, . - ,„ '` -1 I I I 78..FIRE PREV. FINAL .- ;�
30. Drywall Nailingi.
I : i. HEALTH DEPT. REQUIREMENT
31. Plaster B[Qwn Coat' . _ I � -, 79. FINAL INSJ'ECTIOli1 -1
• I,
32. Electrical ovar Miter-Final , - - t 1 1 t 80. FOOD CERTIFICATE ISSUED -
33. Final:Electric_ -- 1 , "Note : , ', -n
34. Final Heating& Air Conditioning :, - �
35. Final-Gas Pipe-Test _ I' t' t •t -
36. Hood,or'Canopy ' I Y
37. FinalFactory Fireplace � ,
1
38. Final Plumbing .i • ` I - .
i
39. Water•Service•Final- _ _ ---.i -
4,
0. Gas Service-Final ' I.
41. Solar Domestic-Final
42. Backflow Preventer' . . -
43. Backflow Irrigation• - - -c -
44. Landscape Irrigation System - . • _ - •
45. Sound Attenuation , - .
_ r - ,
46. Handicap.Regylations , -
47. FINAL STRUCTURE& BUILDING SQ` &q c0-4(
1 • ., -
46. FINAL PLANNING v l rG I „ - -
49. Electric Release to Edison l t -
50. Gas Release to,Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY - - - :•,
No. Date
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. ��JB DATE 22 /7f «/ /9'c'
LOT NO, `_jm
ADDRESS 79' ,C4:3 7.cC rii 2
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-S (was or er Y advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
Purchaser
RECEIVED BY Bct4o�4g L
CITY OF COSTA MESA Developer and/ authorized
PLANNING DEPT. representative
APR 4 1972 BY Zia f,F�their,�A id-914S
S
AM PM
71819110111112111213141516 Lender
A
`'OWNER BOOSE� Phomas V_ DATE 6-8-72
4 JOB ADDRESS 2781 Waxwing Circle BUILDING PERMIT NO. 34812
ERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Egg Crate P"tio Cover
Ar No. LOT 30 TRACT 6758 FIRE ZONE VALUE $ 600.00
INSPECTIONS Signature Date GROUP I TYPE V-N ZONE R-1
SOI L
GAS SUBCONTRACTOR PERMITS ISSUED
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER El
ROUGH WIRING _ Heating and Vent.
TRENCHES X FORMS STEEL REINF. a
7,/g-92_
FLOOR SYSTEM �Y ��
BOND BEAM In STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
L VG - IN n OUT ri
P. ER, BROWN COAT
STRUCTURAL, FINAL _ Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST H
ELECTRIC, FINAL y
BUILDING, FINAL /r/�/C 2- /-73
34812 _ r -77-/-."00 9631 *u*u*6.o`
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in'Completely gECE�1yyr��q�v DA)-E R EI ED
/ T I' % 21 DA/TE ISSUED
BUILDING •� /' /� L / A) d / r0 ISSUED
ADDRESS / Fr syrixfo/N9 li a,L e O�
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OWNER T//ffJ/H/�S ' ?out A.P.NO. //
BUILDING �7 ( i /4 z,.'
MAIL S�/!/ ADDRESS /�+ Z1 /
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CL Z CITY 02
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-N LENDER ('
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W wTEL. ZONE NO.OF USE OF NEWfft/'p
ZF CITY 5-;141-7 e-- NO. s/2/N 2 / PLANS o- BUILDING ems.,/6rC/
-0 STATE CITY YARDS APPROVED YARDS APPROVED
LIJ
v)CC LIC.NO. LIC.NO. MAIN BUILOING ACCESSORY BUILDING
D SIZE NO.OF SLOGS. (FROM C/L STREET) �r
OF LOT l Now ON LOT FROM FT. Air, FT�
USE OF
EXISTING BLDG. R S1QE FT, C FT:C
I- SIZE OF NO.OF ��ff�y
Z NEW BLDG. ROOMS STORIES L,SIDE FT. 010 F1:
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EXTERIOR WALL ROOF
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O STATE
UI hereby acknowledge that I have read this application and state
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? I hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of California Business and Professions Code. Division 3, THE AMOUNT SHOWN UNDER VALUATIONIS FOR 5
Chapter 9, and that such lice -s are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
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5OWNER BOUSE. Thomas V. DATE 7-17-72
Jr° ADDRESS 2781 waxwing Circle BUILDING PERMIT NO. 34969
l :RAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Retaining & Blockwall
$ AP No. LOT 30 TRACT 6758 FIRE ZONE VALUE $300.00
ky INSPECTIONS Signature Date GROUP J TYPE lZ ZONE R-1
SOIL PERMITS_ISSUED
GAS SUBCONTRACTOR
Date I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND El POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES VI FORMS, STEEL REINF. /�� 7.0)/{7'1
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE rl
SHEATHING
FRAME AND FLASHING
I NG - IN n F-�OUT L-1
PL..oFER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT.. REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL /� �/J
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BUILDING, FINAL JQ �O'� S
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34969 ., 17_77r,:..001- g1i* vac:r**5.O2
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECE,t DATE RECEIVED DATEJS
BUILDING / i' v ` /j n e 7—/7 Fri
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ADDRESS i� 7 ,/ !{/�n fA1//yY ( f r. C/CP
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O TE
UI hereby acknowledge that I have read this application and statethat the above information is correct and agree to comply withall laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
• 00 the State of,California. m
zI hereby certify that I am properly licensed as a contractor under - SO. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
CC
am exempt from the provisions of the State of California Business VALUATION
and Professions Code, %: •n 3,Cha er 9. Ste— m
PERMIT FEE $ N..
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TOTAL FEE $
33858 PA r
"!OV 12-71cn_:00 6007, ***141 re
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
ptd 3 o For Applicant to Fill in Completely 7e RECEIVED BY DATE RECEIVED
BUILDING •'/(J 1p1 1/ I 1 DATE ISSUED
ADDR ESS !(I W Q f.titA �! /ERM! IJ
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'C VAR.# DATE
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DATE ///02- V
0
UI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ HOLD FOR SPECIAL REQUIREMENTS
F any person in violation of the workman's compensation laws of AAAA
CO the State of California. lRc� // b
I hereby certify that I am properly licensed as a contractor under n`v�(�`/ SO. FT. /Vie O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UN R VALUATION IS FOR o
Chapter 9. and that such licen are In full farce and effect,or I THE PURPOSE OF ESTABLIS G A PERMIT FEE ONLY:
am exempt from the pr• Isi f the Stat�Californie Business VALUATION
and Profess ode,/ visl•• Chapter • 97o o CO
col) Aw PERMIT FEE $ O
Signature e F ' /1 / �.J o /l LT/ $ 970 Q E
Permittee L� $f7/\l/�i -...--PLAN CHECK $
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LL
Authori;:• Agentx. TOTAL FEE $ /y/