HomeMy WebLinkAbout2378 WESTMINSTER AVE - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. •
PERMIT O. r1 TRACT NO. LOT NO. UNIT NO.
cITYOF COSTA MESA CONSTRUCTION PERMIT �j aSR /IJ
tPro$t Address 2378 Wes m n r Ave. C.M. (f 1� 1 '
'Applicant's Mallin Address 196.Commercial C.M. 92627 TYPE OF CONSTRUCTIO H NEW L i ADD LA ALTERATION L I REPAIR
'I g ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p # 5669 0/21/E (Zone
• Owners Name Barbara R(3 n Phone 645-6579 DESCRIPTION OF WORK/USE OF BLDG. Remove exi sting,- applyD7.5f1 Ti
2378 Westminster C.M. 92627 3/p1 fiberelass s stem w hot a .hal and n- ml. S Main Building: Accessory Building:.
Address r
Arch/Eng. License No. TYPE OF PERMIT ll GRADING II FOUNDATION U STRUCTURAL T Front 0
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B flear N
El A 1
Contractor's Name crank Pros Rnofi rg Phone 548_S56) OTHER C Right N
PROJECT DESCRIPTION SQ. FT. 2 700 OCCUPANCY ai 1 e
Address(mailing) 11 26-Com!'nm(gs ci a G ., C M 926s27K G
005993 �r —- CONSTRUCTION TYPE res. VALUATIONS 3,495. 0 $ Left R
City License No. ZONE GRADING CU.VOS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am ii9iised under provisions of Charter 9 (commencing Remarks: , , Planning Notes: 0
with section 7000) of Division 3 of the Business and Professions Code, a)d M
my license is in full force and effecti T
•
License Class ' Licen if o. 'sl• • , S
Date a - / /- Signatur: T __ ..r -rPLUMBING FEES
WORKERS'COMPENSATION . CLARATION
I hereby affirm that I have a l/state of consent to self-Insure or a Certificate
Bar Sink I Showers ELECTRICAL FEES
' Workers' Compensatio surance, or a certified copy thereof (Section Backflow Preventer Service Sink
•
.� 00, Lab. C.) Automatic Washer Transformer 0 15-50 KW
-olicy No. WP851624.66 CompanyFr nnt,--I Backflow Irrigation Sewer Ca 050+KW '
P Construction Pole Sub. -
Certified copy is hereby furnished.thecit -/
Certl opy I tl with the city Building Division. y./��.q Bathtubs Sewer Connection Cooking Unit - Meter Dup to 100 amps
ate lhf'�/tf v Applicant Crank Bros� l2n ni ng Co.
EXEMPTI N FR M WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - - Dishwasher ' - Meter Dover 100 amps
(This section need not be completed if the permit i5 for one hundred ($100) or
-
less). Dishwasher -- Solar Piping Dryers ❑Gas DElectric
P 9 , , VSub Panel
I certify thatm in the performance In the work for which this permit is issued, I
shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 011/4-8
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE:If,after making this declaration,you should become subject to the Inc.Solar ❑9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks ' Urinal Fixtures Microwave
• comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Deviee Boxes •
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors
Lender's Name Water Heater Outlets Range
•
Lender's Address Kitchen Sink Water Service -
OWNER BUILDER DECLARATION Switches Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal '
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections •
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW
any structure, prior to Its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of •
Division 3 of the Business and Professions Code) or that he/she is exempt • -
"•erefrom and She basis for the alleged exemption. Any violation of Section '
31.5 by any applicant for a permit subjects the applicant to a civil
;ally of not more than five hundred dollars($500). 3
JI,'as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee - $ 3
for sale (Section 7044', BusIness and Professional Code: The Contractor's MECHANICAL • FEES
License Law 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 DEVELOPMENTSERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0 ZoningApproved By '
pP ved
sale. If, however, the building or improvement is Sold within one year of cam- Canopy Type II ❑ Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By GI: Data
prove for the purpose of sale).
0 I,'as owner of the property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System Application Issued By Dat: 6 fait,
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's-License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU $U V F FEES �c'-n
builds or improves thereon, and who contracts for such projects with a con- - V -
tractor(s) license pursuant to the contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP . $ r J
proof of their Worker's Compensation Insurance should be provided to me.
- ,
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBO,# Fire Dampers PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
Date _ Owner Heating System& Ducting Registers PLAN CHECK • 25% $ ENERGY P.C. $
I hereby certif that I have read this applicn an• state that the above ❑0.100,000 BTU 0100.000 BTL GRADING $ -
:Information i rrect. I agree to comply wit" cit and county ordinances - ELECTRICAL $
and state la -rating to building constr, an• ereby authorize repre- - PLAN CHECK 50% $ MICROFILM $
Inspection of c' y to enter .n e abOv' entioned opW ori � �s--S �l/J\
Inspection pun.os- i /� MECHANICAL $ TOTAL FEE $
Signature A . .4� 4 Date
Drivers'.,ns or SS# Reinspection Fee $15 Issue Fee $ 3 ` PLAN CHECK 25% $
CMF 0865 •.,,rev. 10/84 White - Building; Canary • Applicant; Pink -Accounting; Goldenrod - Assessor /'
CONSTRUCTION AND PLANNING POOL& SPA
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, 0 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. POOL/SPA SYSTEMS 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 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
r 27. Frame and Flashing - 76. Dry Standpipe
d 28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 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:
34. Final Heating & Air Conditioning `
• 35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar-Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations ,
47. FINAL STRUCTURE & BUI LDI NG pidth , '
48. Special Requirements Completed 1'r �'y' ,
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY !'-7
No. Date - y'
OWNER MATRANGA, GEORGE F. DATE 7-10_56
JOB ADDRESS 2378 Westminster Place BUILDING PERMIT NO. #32.$
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 30,07.00
1 (I BLOCK TRACT 2959
GROUP I & J TYPE V ZONE Rk FIRE DISTRICT 1323
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Footing Trench ��
Foundation Forms and Grade to Garage
Rough Framing �'n �
Plumbing,Rough to Slab�cf 4An�� ijiJ /{",y , � Gcn..t[, �„l 7_ ) 9-5% 5790
Plumbing, Rough Complete �f3�
Temporary Pole
Wiring, Rough 'Its MAE 1'1,.,.,, 3. -5K
Heating,Rough r e 4 '-..c?. f.re.", ,dea/ 9-a4/-SG %-s---'/ z_, --
Heating,Final °Ira i/'s
r� i
Sewer,-HouZ Sewer, St. �r b .9,4,CAy pn-7,- 7-.,77-5 K (, 6/0 '-
Septic Tank or Cesspool -,g2 ,
_
La' ng, I n Out at al-) , f. �y��iJ—z��`y _._ y'.A 2 -S l to 4 C7
P. ring - AA G 0. 7n i l O,/
Plumbing,Final,Fixtures Complete., 1
Plumbing,Final Gas Test • IT/
Wiring,Final acid , L✓ a
Occupancy
, FORM 310 3M 1095
MAY 1 3
OWNER f'.ARRRTT� -,T. 5, .1957
DATE 1-28-57
JOB ADDRESS 2378westminstor P1 re BUILDING PERMIT NO. #h2LL
GENERAL CONTRACTOR owner Bldr• VALUE $ 221,00
It BLOCK TRACT 2959 Fence
GROUP TYPE ZONE FIRE DISTRICT 4287
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER
Footing Trench
Foundation Forms and Grade to Garage
Rough Framing
Plumbing,Rough to Slab
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough
Heating,Rough
Heating, Final
Sewer, House Sewer,St.
Septic Tank or Cesspool
Lathing, In Out
F :ring
Plumbing,Final,Fixtures Complete
Plumbing,Final Gas Test
Wiring,Final
/ _ 1
Occupancy
OWNER MATRANGA, GEORGE F. DATE 7_]0_56 .
JOB ADDRESS 2378 Westminster Ave. BUILDING PERMIT NO. u1313
GENERAL CONTRACTOR Dike & Colegrove VALUE x11,218.00
L i BLOCK TRACT • • _
GROUP I ,q. ,j TYPE V ZONE RI4 FIRE DISTRICT 3337
PERMITS ISSUED
INSPECTIONS D•TE SUBCONTRACTOR
DATE NUMBER
Footing Trench ,, ��
Foundation Forms and Grade to ar.j
Rough Framing c� !Sr �' Ii v
Plumbing,Rough to Slae417. b p ,If• pc2„, ,.pQ_„, 7-/ Q•SG, ,j 9 D'/ ---
Plumbing,Rough Complete i AUGTemporary Pole A���,,dx 9,7: 7!. %�7 t r•frnL eteta AV • 7r1rr7 --
Wiring,Rough 4.3 J OWq!' b')(�twr-.- w w e.rt, .901.1 x -.—
Heating,Rough L T /"!C, /.Gr`�i�c v.9>•/ L ,- el-"C. C
Heating, Final 1� ;i�� //
i$
Sewer,-House Sewer,St. Z ' e y//,cs,F. 977,....c4 1 „2_ Se, --
Septic Tank or Cesspool ta'*' D ' ,•.- jr.... %y.. 7_ 2.' i L —
Lathing, In Outy. A 91.
Pi ring fr.: , .crti
Plumbing,Final,Fixtures Complete j -
Plumbing,Final Gas Test at //2/i -% ,-.&.J //-2-C _ e 'v✓.
Wiring,Final W. ilh1 if. ,. „
Occupancy ,..
FORM 210 3M 10-55
Mesa Building Department APPLICATION FOR PERMITWa
P. O. Box 3!7 . tBUILDING 1
COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. _Permit No. LI/
Building 34/
Address 237$ Westminster Ave
Costa Mesa, California Received/by Date Recd. Date Issue
•
Nearest • 11/1 7— --( 7-/a s c
Cross St. I Wilson Building
Address
Owner George F Matranga Costa Mesa, California
Mail
Address /119 F 17th St Nearest
Tel. ZoCross/Sp 9
City Costa DteQ� Tel. ft-11 59 Zone No.of Type[ Grou�J
Architect or Lic. I Plans I / ,,,,{�(�(
Engineer (!nylon & MjddlehrdY# Approved
by Date
. Address Garden Grove CORRECTIONS
City Lie
,tractor no & Coleprove No.
Address 110 F. 17th St
Legal of I
Description No. 1g I Block I Tract 2959
(Attach Metes and Bounds) - c1
No.of Bldgs. \
Size of Lot 60 Y 11L1 I
Now on Lot none
O
Use No. itf ]i No.of _ a
Existing Bldg. none I Families I Rooms C)
Setback Line from Rear Yard 321 2
Center of Street 501 Side Yard 51 L $
DESCRIPTION OF WORK r
New I X I Alteration I I Addition I j•1. tf r: i'tpin•.• .
Repair I I Moving I I Demolish I .
Building No.of
Size 129A sq ft. Rooms 6-. Stories 1
- `erior Wall Roof —
_ ering Stucco I Covering Comp APPROVALS
use of New
Building Single family res and gar Foundation Location Inspector Date
Forms,Materials,
Under-Pinning
Plan Z65A Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath.Int.
with all City Ordinances and State Laws regulating
building construction. Lath.Ext.
Signature of Dike and Cole rove
Permittee C.
g Plaster, Int
Authorized Agt e^I C,—.4.y �f Plaster,Ext.
Valuation Permit Fee $ ^2 .�5' Masonry Reinforced
Plan Check $ L// / — Bond Beam
$ ii g/9 ir- Feeal $ O1 " I FINAL
C y .
6
J
•
4)
•
o d
a °
COSTr'
•
•
Street
PLOT PLAN
Show location and distances from
property lino and between buildings.
•
,r
t$UWNtK iUA DAV DATE 4-26-74
[JOB ADDRESS 2378 Westminster Ave. BUILDING PERMIT NO38336
GENERAL CONTRACTOR Overby & Son DESCRIPTION of WORK Add Fam.Rm.& Fireplace
" AP Mo.119-134-02 LOT TRACT FIRE ZONE VALUE $5,250.00
II CTIONS Signature Date TYPE GROUP _ ZONE
TOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date 1 Number Signature
WATER DIg •
ROUGH PLUMBING -
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND t17. POWER 0 .pr-79
ROUGH WIRING%' 7117'•N Heating and Vent.
TRENCHES 9 FORMS 9 STEEL REINF. El/ dQ
FLOOR SYSTEM /-,
BOND BEAM [] STEEL REINFORCE n
SHEATHING 6"--
FRAME AND FLASHING O
LATHING - IN OUT 119---- "PLASTER. BROWN COAT n'e-C-1J'1 krt
STR'" 'IRAL, FINAL '�J Ela rl
HEA VENT., REFRIG. AND A.C.... FINAL /^ y �/���f 1 �1f �- -/
PLUMBING. FINAL AND GAS TESTA•ik,V.1 '0:1� 13/j/7f� (`aJfga' S �iC� 3-7'j , 3k .-----
ELECTRIC,
ELECTRIC, FINAL /� in 4`.2-
BUILDING, FINAL I' . C-3
• ,� —•
38336 •.Fri 2F-14-F47 00iow ;:x*.:48.5
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A
PFOR BUILDING PERMIT
For Applicant to Fill in CompletelyR/Ag .ION
@ID DATE RECEIVED D TE ISSUED
ADILDISG
AI _
ADDRESS lT� \l�)'tS'fKV�\NS'C�< // � �L(/Q'
OWNER <Z1$qLJ\fes Fc,X A.P.NO.//91"/31 C24 PER T N O. /
MAIL BUILDING / ' e...ADDRESS Sgv{Nt..N ADORES 7� /A I.#5/ u3 ^
2
a U f� ` p TEL. TRACTA9s LOT/f BLOCK
CITY C.\��'i\ �\ NvNeSq NO.ss .'iu0[Y
▪ CONSTRUCTION �e NEW IZALTER
REPAIR MOVING DEMOLISH
O H LENDER \VOVC)Q..
0- 03
JD BRANCH —
J N Q /J,�`)<�
OWNER D 9uiD e
Q' ADDRESS //,J. //
J ARCHITECT q`.-<'�CA�\ AO TEL. USE ZIy///� VALUE( /JS
4 OR ENGINEER COOvc_�e Q'cS NO.CX2.O1\\ _
5 FIRE !/�/
W 03 ADDRESS \5'3� �a.5�S\Q G.\CC\'� ZONE T PE Ui GROUP '
n. W ! ��IJJJ
W Z APPROVED �/
JD CONTRACTOR ��'Q«� St„) BY DATE 11/11/-911r
mZ
J 03 ADDRESS -1_1.1J0 G;Sp`\c(tC
MI w TEL. ZONE NO.OF USE OF NEW
O j PLANLS 9 BUILDING 10O�7 Q�
Z I- CITY CC/S\0N " \E.S� NO.CuyO-'NOSE\ �/ J , (eon?
w-0 STATE CITY YARDS APPROVED YARDS APPROVED
0n CC LIC.NO. '7,2,,z $\-0_ LIC.NO.7,-1.0\S MAIN BUILDING ACCESSORY BUILDING
7O ET
SIZE K C/ `y� \NO. BLDGS. (FROM C/L STMEET)
OF LOT (p0 \\0• INOW ON LOT FRONT `*nilEET))
gle:3j] FT.
USE OF
EXISTING BLDG. \ ccXXN\- C.C.S. R.SIDE SFT. FT.
I— SIZE OF NO. OF -
2 NEW BLDG. L0X\5 ROOMS N STORIES \ L.SIDE IC unit. A at FT.
< EXTERIOR WALL. , ROOF �C qJ E� / _ _ -
_ COVERING pcVC_C� COVERING s- I R s.4 FT. r\`__/
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS.BLDGS.
VAR.* DATE
` C.U.P.# APPROVED
FAPPROVE
cn —Co 1C-t•-••/...'"c%. ceS• BY 9i()L[� pU I35F y - -74C
O \--------(
I hereby acknowledge that I have read this application and state Tic, NI‘
D that the above information is correct and agree to comply with \1
CC all laws regulating building construction, and I shall not employ
ccgJ any person in violation of the workman's compensation laws of[he State of Californie. to
? I hereby certify that I am properly licensed as a contractor under SQ.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: a
am exempt from the provisions of the State of California Business Cr
and Professions Cnua,Division 3,Chapter 9. VALUATION �� obi
/� PERMIT FEE $ s-� D
Signature o�rl \ '(/ Y,�`'M /J �� / d"U m
Permittee l'�Os�L� J $
�/ ti��/ PLAN CHECK $ //Q E
(/--/ a-rj `p
LL
Authorized Agent TOTAL FEE $
"" " FOY, David R
JOB ADDRESS 2378 Westminster Avenue BUILDING PERMIT NO. 41555
GENERAL CONTRACTOR Owner/Bl dr. DESCRIPTION of WORK Add Closet
A W�. 117-134-02 LOT TRACT FIRE ZONE VALUE $540.00
J ulTO;._CTIONS Signature Date TYPE V GROUP I ZONE R-1
`aSOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number I Signature
ATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE 7 HOUSE CON. fl
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER El
ROUGH WIRING N jp�\U 144.4(/ Heating and Vent.
TRENCHES ❑ FORMS ❑ STEEL REINF. L� COAr
FLOOR SYSTEM I/'I t /�•�1
BOND BEAM El STEEL REINFORCE Iilr7�
SHEATHING o f (L\.t. tM,lV
FRAME AND FLASHING 64096 pt/ 3 p.Afl
LATHING — IN OUT [ ](Lo r�A _I'C'J
PLASTER, BROWN COAT /04.A.,
'/I^ 0478.• / 4
ST URAL, FINALFlertri a
.,HE.. ..G, VENT., REFRIG. AND A.C., FINAL °Intel, //, &13 . N•IS-744oal1
PLUMBING, FINAL AND GAS TEST rl
ELECTRIC, FINAL 4:S.G c'Lt'
BUILDING. FINAL IQ\G- 't-If
-
FF '
j -- 4 1555 `FT, ,5-7 :,-:00 7511 *- * 550
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
AP'LIQ AT IIN FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
p RE• V'D = D• R CEIV • DA 'E ISSUED
ADILDING DRESS DAV
West
minster /Cie, / 1— , //5y-pt_r•.?.�i
OWNER DAVia �• Foy A.P. NO/0 �/3 y�0 [j P Rf�1� !5
BUILDING Z37Q �_1f+ tkwa a4\ rF
MAIL ADDRESS D ,J��'
ADDRESS Jo.rx,e�i)� o
CITY Cios'tc� r'Ie SC- NoI.Sq -3000 TRAC1'S7 I LOT/'P BLOCK
CONSTRUCTION^ NEW ADD ALTER REPAIR MOVING OFMOI ISH
LENDER
BRANCH /yds
ADDRESS OWN ER/�/�I��A�Mai C.)[ R. ax��[J/(� et
ARCHITECT f�,�I `r� .3.., TEL. USE
"gm
/m��(.06M:/ 4 /��r u; �J / v
OR ENGINEER �I Dig,/
((y ` FO.` ,,(�NO,(�-7441000
FIRE
ADDRESS ac.778 Wet)II't.clei- V //S�/q// ZONEWYPE GROUP .rAP /
CONTRACTOR &Aare ��K�-//ICAC-N/ BY C.
. DATE / _15--7.
ADDRESS IIIISSSS
-- TEL. Z NE INO.OF q USE OF NE
CITY NO. aPLANS`� BUILDING '/Os6-.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. I
LIC.NO. MAIN BUILDING ACCESSORY BUILDING
(FROM L STREET/
LM SIZENO.OF BLDG
O. OF LOT /10 1 X 6o r I NOW ON LOTS.
I FRONT"rr FT. FT.
a USE OF � ) nr
VD EXISTING BLDG. /"f0 n7 e- _EL SIDE�7 FT, FT.
Ca
F /Separate permits are required for L.SIDE 7/ FT. FT.
electric,plumbing and heating work. REAR 7,6 FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
r r MAIN BLOCS. ACCESS. BLDGS.
4 Q C/nse,JI 6 I/X i 1 L [/,'_� C U.P..'3Cy�p��//))o APPROVED
I r ]
(3, 1744 C�'1 �C: [VI5l 11 f([' SI/y re RYA �/ DATE / tel] .
O.
0 I hereby acknowledge that I have read this application and state n
Lthat the above Information is correct and agree to comply with m
all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of a
2, the State of California. co
I hereby certify that I am properly licensed as a contractor under k. SQ. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, end that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F E QQNL.Y:
am exempt from the provisions of the State of California Business / 9
and Professions Cpd1 e, Division 3,Chapter 9. VALUATION PERMIT FEE $ / ro
�.ebutijK / PLAN CHECK $ ^
Signature of O
Sr L LL
Permittee _ S J ) TAX S n 2
z�, u
Authorized Agent TOTAL PAID $ 6 r D