HomeMy WebLinkAbout1061 WESTWARD WAY - Building Permits •
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41 CITY OF COSTA MESA
4 9 BUILDING DIVISION
>• litallaligiLIADEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT 403-01722
S4titt Rar to#.
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBlaILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1061 WESTWARD WY Status: ISSUED
Suite: Applied: 10/06/2003
Vicinity: FLAT PORTION ONLY Issued: 10/06/2003
Parcel Number: TPN99015 Zoning:
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Applicant: PEARSON, VESS
PAS
ISSUED BY: I .
Address: P 0 BOX 3908
Phone: 562-429-7663
SEAL BEACH, CA Zip: 90740
Owner: WESTBLUFF VILLAGE HOA
Address MIKE BERRY
COSTA MESA,CA Phone:
1024 SEA BLUFF DR Zip: 92626
Contractor: G M ROOFING
Address: P 0 BOX 3908
Phone: 562-429-7663
SEAL BEACH,CA
Zip: 90740 License: 472566
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF ON FLAT PORTION OF ROOFS ONLY. INSTALL 4-PLY HOT MOPPED GRAVEL ROOF SYSTEM. INCLUDES 1061-
1069 WESTWARD WAY. -
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,125.00
Permit: $139.25 Claim Valuation: $6,125.00
SMIP Res: $0.61
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.86
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
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
244646(6100)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one 01 the following declarations:
❑ I he 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
drk for which this permit is issued.
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.
I
My workers'compensation Ins Tana carrier and policy number are: COCarrier: le1 3 CY G nsr�i Policy Number: w M.(0 2 - 2 0 b M
(This section need not be completed if the permit is valued at one hundred dollars($100)or leis.)
O 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 alifomia,and agree that If I should become subject to the workers'compensation provisions of Section 700 of the Labor Code,I shall forthwith
comply with these ro ions. I
Applicant Signature: Date: I Q) C
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE IES 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 al)d ProJap ns Code,and my license is in full
force and effect.Lia# ` �j L. Class# ���`ly
Contractor's Signature: A—___ ,(A w� Date: ''lam-)
CONSTRUCTION LENDING AGENCY: v .�
❑ 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 Processions
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 property who builds or improves thereon,end 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.).
O 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,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gry 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 ❑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? ❑Yes ❑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 tiling 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? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? ❑Yes ❑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 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 Hazardous Materials and Emissions.
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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.
/� ture Of Legal Owner(s) ate
V �b
And/Or AuthorzedT Applicant ate
CODE 1 INSPECTION TYPE QAIE INTRIAL$ CODEf INSPFCTION TYPE QAIF It(1IDAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa FinalII.� J�� �.7gtw-y?7_-- 208 Final Plumbing
200 Final Re-Roof ry1( W 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
ADDREssOFeIcom 1061 WESTWARD LN
[
MIT: CITY OF COSTA MESA - BUILDING PERMIT
OwNEasciIMEIFIOn.m: WESTBLUFF HOMEOWNERS
PERM NO: B 072551
ADDRESS: 7400 CENTER AV
HUNTINGTON BEACH PERMIT NO: B 072551 - PLAN CHECK NO: N GOVT: N SUPP: N
APPL.SWUNG ADDRESS: CONSTRUCTION TYPE: 5-N PERMIT TYPE: STA PURPOSE: OTH
ARCNRECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF ,REROOF W/TORCH-ON BUILT-UP ROOF SQ FT: 7, 000
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: 7, 000 . 00 CALC-VALUE: 7, 000 . 00 GROUP GCC : R-1 /
commamowm EVERGREEN ROOFING ( 714 ) 529-7427
causcroRmum 1175 ORANGEWOOD DR COMMENTS : SMOKE DETECTORS REQUIRED PER 91 UEC, REROOF 3700SF-6 UNIT APARTME
ADDRESS BREA CA uc.NG: 679865 ;(-**************sir-+ca-+c****.caFw-iF****ti->E********+r•,cap,cic->F,t+r+F*+Fac+4***4rt***-1“-:a[****.+c+cr is*«wear
92621 UMT: Z ONING R EQU IR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby stem under penny of perjury that I am licensed under .' , .of Chapter 9 S E T B ACK S
(commencing with Section 7000)of Division 3 d the Business and Professions Code,and my I'.. ., in full . '...'•'...'•and effect.
CIIYuc.NO.: 060741 uC.cuss: C39 uC.N% 6798 . P : 11 /! .., MAIN BUILDING ACCESSORY BUILDING --
S FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
(Q.: : canreda / ���� LEFT: FT IN RGHT: FT IN LEFT: FT IN P.GIIT: FT IN
ER BUILDER DECLARATION:I hereby affirm under penally of penlury that I• exempt from the Contractors License Law for the
flowing reason(Section 7031.5 Busi ess end Professions Code:Any city or county which requires a permit to construct,alter,improve. PARKING REQ: P RO V: PARCEL; 93523006 Z N E: REF NO:
demolish,or repak 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 PLANNING NOTES>
Business and Professions Code)or that he or the is exempt therefrom and the basis for the alleged exemption.Any violation of Section .1>
7031.5 by any applicant for a permit subjeds the applicant to a civil penalty ofnol more than five hundred dollars]$500j). ****K.****..jf.k.**.)E.K***********iE*+f*.fE*****it**ataE+f#of**+F*+r-****w.ifs:orf*ori****M***y(:.-]Ea(.****#'*>i(•al
o I,as owner of the propeny or my employees with wages as the&sole compensation.will do the work.and the sttucture is not intended D E V E L O P M E N T SERVICES R E U I R E M E N T S '
or offered for sale(Section 7045,Business and Professions Code:The Convenors License Law does not apply to an banter of properly Q
who builds or knproves thereon,and who does such work limed or herself or through his or her own employees,provided the such
improvements ere not intended or offered for sale.ff.however,the building or improvement is sold Within One year of completion,the ZONING APPROVED BY DATE;
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I,as owner of the property,am exdusiefy conflating with licensed contractors to construct the project(Section 7014,Business and
BUILDING APPROL7ED BY
Professions Code:The Contractors License Law does not applyan owner of property who builds or improves thereon and cols DATE:
m
contracts for such projects with a convectogs)licensed pursuant to the Contractors License Law). J //
ElIamexempt under Sectioe: B.&P.C..for this reason: APPLICATION ISSUED BY; /n/ DATE; cJ Tc
********* ****************iF iT'S az* ** *****�i* ;t�c wts~ ****************....t*.****
Dal °WOe' LEGALIZATION:N F E E SUMMARY STRUCTURAL EGMENT:Y
I do hereby certify that I am aware of and understand the requirements of California Health end Safety Code Sections 25505.?WM.end
25534,Gard lea rmoddfuture e he scamp (omewn)tedmmnpywlhaadsetecodes and exempt from
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a for y anglemeo Dines. tocomly mtwnmlon appkatiwnuee requirements
these
provisions. PERMIT 90 . 00 . 70
Date: Applicant: PLAN SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby elf=under penalty of perjury one of the following declarations: ISSUE FEE
o Dune and will rnaintan a cariificate of consent to sell-insure for nodal&compensation,as provided for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
ret
Code, the perfarmancedthe work for wNoh this ke
permimgnd. TOTALS----> 90 . 70 0 . 00 0 . 00 90 . 70 90 . 70 . 00
I have and coil 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 camp and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 90 , 70 OVER/SHORT: , 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed I the permit is or one hundred dollars Alegi,'less.) 90 . 00 . 70
❑ I certify that in the performance of the work for which this permit is issued.I e not employ in any manner so as to
becomesubjed to the workers'compensation laws of California.and d1 : . ome subject to the worke ' *************************+fiF**i:**}1f*>;*aE*********Nff***************ay.************** '
compensation provisiops of Section 3700 of the Labor Code I shall f ply
wbn weir I N D 2 Lt 2 D U A L F E E B R E A K D 0 T^7 N
Det .S 3° — V Applicant ` sat.....--///
Warning:Failure to secure workers'compensation coverage s unlawful,and shall ' /act an employer to criminal penalties end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
cal fines W to one Modred thousand dollars(SfOg000A In addition to the cost of compensation,Mumps as provided for In
Section 3706 of the Labor Code,Interest,end attorney's Int SFR 7000 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 7, 000 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perry that there is a construction ending agency for the END OF FEES
performance of the work for which the permit is issued(Section 3097.Civ.C).
LENDER'S NAME:ADDRESS INCLUDES
LENDER'S ADDRESS: 1061-1069 WESTWARD LN
I certify that I have read this application and state that the above information is coned.I agree to comply with at dry and county ordiram es
end state laws reWig to buildig construction and hereby acho¢e representatives of this city to enter upon the ebovernentMwd property
for inspection purposes.
D //) AZ E0 U/CH— .
P yame p
<'A .� Dere: � �� /l4 01 00182951-00132959 TOT T i 1,i=�
' Signature OvmerlAgent'Appk trade DATE: 65,'30/95 TIME: 11:34
(5151-45.WP) White-Building A Safety:Green-File;Canary-Appicant;Pink-Revenue;Goldenrod-Assessor
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t CONSTRUCTION AND PLANNING , -L & SPA
f 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 I ,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement I 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE •
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test .
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9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ 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
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15. Rough Electrical-Conduit, 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
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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 O Gas ❑Oil
25. Roof Sheathing f� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat �t'V' �, G 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. 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 & BUILDING cJ G,(r
48. FINAL PLANNING 1 I
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
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PAL
6 Qrr,c?I
.� �� 76,= :00 90 247.83
J COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING
.9/4„:74—..
^ r �L Al ( �(9.__....(9.__.... (,iJ [ll I
fel
ilgeltild
PELtv11ittO.IOWNER �/ ' .- 4,- A.P.NO. i/�I,, f, c - ( L 1
BUILDING
MAIL. vi / ' ADDRE STOW -1-J I 1 $Je htmao
ADDRESS 2-11-z2.,•• pyy�
^w� �a TE f /� TRACT LOT BLOCK
CITY �I// tF-"/JJJ` NO�
CONSTRUCTION NEW , ADD ALTER REPAIR MOVING DFMOI ISH
LENDER
BRANCH
/OWNER Arrpoper2 HQWtshp0
ADDRESS / ♦ �p/�1f1��,��` r �t rr
ARCHITECT •.�i /J • y /IEL. USE c `ONO -ON at VALU$
OR ENGINEER1 /1 P /t(i ms.„, NO
FIRE
ADDRESS ZONE TYPE GROUP }-4
APPROVED
CONTRACTOR oze y 1^e^ BY DATE
ADDRESS
TEL. ZONE IPLANS BND.OF USE
UILDIOFNG NEW
CITY NO.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO..,2L al b7 ? LIC. NO. MAIN BUILDING ACCESSORY BUILDING
LLI SIZE J NO.OF SLOGS. (FROM C/L STREET)
O. OF LOT s NOW ON LOT _FRONT FT. FT.
Q USE OF
(13 EXISTING BLDG. R.SIDE FT. FT.
Cl)
9 Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
ID REAR FT. FT. •
E-- USE OF BUILDING AND WORK TO BE PER ORMED DISTANCE BET. BET.MAIN& '
"C Cil _ ` MAIN BLOGS. ACCESS. BLDGS.
Q / //��r G /--A/!A! VAR. APPR
�/ (et �,Z— 6/ KILC�nik n'lu C.U.P.,qy+ APPROVED
7 APPROVED A7E
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BY 0 0h(r r/2 .D¢ T-C71'j(Ae€4,
W
0 I hereby acknowledge that I have read this application and state `� I') Milt/
/7 ;46,J;
G-s,4/s s rr..� �n
gt; that the above Information Is correct and agree to comply with C� (' J O 7i C r�.L �c.�'f -
a all laws regulating building construction, and I shall not employ • Q
Z any parson In violation of the workman's compensation laws of
x the State of California. m E.1n
'
I hereby certify that I am properly licensed as a contractor under SQ. FT. ev i\�"•
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m0 cl
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e•Ni..
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ e
and Professions Code,Division 3,Chapter 9. /4o v,
Signature p�kF”", fr $ Y { S OO D TA PLAN CHECK $ ?!I4 6 s`+
Permittee
U
Authorized Agent TOTAL PAID 5 2i a
a.< 3t �7� �`r00t32? �u �424.5C
V196 49
/
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
AUB
..n7-7Wec,rw,g LA/
PEA 1/ 0 ...
PERMIT NO.
OWNER A.P. NO. /�� /]��s� p
MAIL BUILDIIO((�Q/3 cJ 7"f h tat2 ,, /J'
ADDRESS ADDRE
TEL.
CITY NO. TRACT I LOT BLOCK
CONSTRUCTION NEW ADD ALTER I REPAIR I MOVING DEMOLISH
LENDER ><
BRANCH
OWNER/^ _ -of��/
ItJC�Y/l7
ADDRESS
CT TEL. USE_ c VALUE
C
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
PLANS BUILDING
CITY NO.
F' STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF SLOGS.
(FROM C/L STREET)
Be OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
V) EXISTING BLDG. R.SIDE FT. FT,
CA
I—.
Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work. REAR FT. FT.
Lt] USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN
O MAINAIN BLOCS. ACCFRS BLDGS.
•
VAR.* DATE
..1 C.UP.SW APPROVED
Q
APPROVED
} BY DATE
...1
CO
w
QI hereby acknowledge that I have read this application and state vi
C that the above information is correct and agree to comply with
0
O. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
Sthe State of California. m
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. CV
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
t from the provisions of the State of California Business w L u.e
am exempt VALUATION PERMIT FEE $ 7 ,l a
and Professions Code,Division 3,Chapter 9. /-/- r n
PLAN CHECK $ 1n
Signature of r O
LL
Permittee $ TAX $ 2
� U
Authorized Agent TOTAL PAID $ ` A_ ,
q . r
9,261/
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to F'l in Completely — Use I k O y APPLICATION FOR STRUCTURAL PERMIT
y� p ` RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING J / / I /, / �.// /�`- z,
ADDRESS L/ V // W /�j(/L///
V��,.A/L O ^T,�[/p PERMIT NO.
OWNER 1/�l AL1 j^J� /IN_Uz-��ff//-'-�f� / IA O-— —0I 0
ADDRESS 24U LI/ Caja. /P' ADBUDRESS/
SLDING/� ��
MAIL t�^`��'
CITY 97.4. Nl ¢s .lam TRACT /J .J •• 1a2r/O •CK
jz,CONSTRUCTION ��r NEW ADD ALTER REPAIR MOVINF: D MOLSH
LENDER �94/]s.... L_
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BRANCH -�C 4 //����,,,,��,.// !l'n�/.' ^
-�' � _ OWNER
/ ir/ jJ'a Atha A
ADDRESS .}. •9Y(G(r`_ t�
ALUE
ARCHITECT TE _� SE ad e.� / /I S
OR ENGINEER C A,-_ .t ea..
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FIRE
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ADDRESS 2��3 vN-LQ � 4- ZONE TYPE GROVP 1
APPROVED
CONTRACTOR AVysja.e., BY DATE //�
, (./�) �,�^J
ADDRESS TEL. NO.PLANSO USE OFBUILDING NEV /
CITY NO. VI I '
F STATE CITY YARDS APPROVED YARDS AP-=OVED of
LIC. NO. &8z3 LIC.NO. MAIN BUILD! G ACCESSO'.'�=UILDI
SIZE NO.OF BLDGS. (FROM C/L T )
w OF LOT ,r041.4._ NOW ON LOT FRONT T. FT.
Q USE OF ►�
con EXISTING BLDG. R,SIDE /FT, bejE FT.
co
9 F Separate permits are required for L.SIDE /4 FT. FT.
electric,plumbing and heating work. /f / h
WREAR 1K F . FT.
I-. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q /j MAIN BLDGS. ACCESS.B�LDDG'S`. ''7 �7
Q 2 be t/Yl.1/il
alv/�Gt1//J4 ill VAC URP �'`///p���$ 3 DATE EnO -7'l�—%/,
�'" /� _ �YROVE . ( y DATE / ILI /7a /IM/ HOLD FUO�R'SSPECI L REQUIREMENT',
w
0 I hereby acknowledge that I have read this application and state n
cd that the above Information is correct and agree to comply with m
O. all laws regulating building construction, and I shell not employ
I
Z any poison in violation of the workman's compensation laws of ,r2
the State of California. /a/0 TI St .....atm,
ysl /�/�
I hereby certify that I am properly licensed as a contractor under SO. FT. //.r/fi/(/r/ '� 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 PURPOSE OF ESTABLISHING A PERMIT FEE ONLY;
ez
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE e
and Professions Code,Division 3,Chapter 9. $ n
m
/ PLAN CHECK $ m
Signature o • o
Permittee 4 $ TAX $ U.f
u
Authorized Agent TOTAL PAID $