HomeMy WebLinkAbout1600 WHITE OAK ST - Building Permits PROJECT ADDRESS: 1600 WHITE OAK ST UNIT: • CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 063824
OWNERS NAME: BOSSLER, KATHLEEN
ADDRESS: 1600 WHITE OAK ST PERMIT NO: M 063824 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: OTH
( 714 ) 545-9072
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL A/C 6 FURNACE SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /M-1
PERMITTEE: CALIBER HEATING & AIR ( 714 ) 669-9320
ADDRESS: 195 SOUTH "C" STREET 250 COMMENTS: INSTALL BOTH HEATING & AIR
TUSTIN CA 92680 **********************+ESE+E***xkE**************x** ******LE********kE********+r******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY in.: 052671 STATE Ltc.:589544 CLASS: C20
Date: 9—el' 71.Th Signature: `7h 9-e Cd2,-4 MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation l�spraQce.9r}r,;ndi¢p Eppy thereof(Section 3800.Lab.L) LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY ND.: 1L711btl `!,7 EXP.DATE: U1/01 /94
. COMPANY: STATE FUND,vv, PARKING RE • PROV: PARCEL: 13921309 ZNE: REF NO:
9 Certified copy is hereby furnished. L^J Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Dale: ?— J— ! Th Applicant: OZ � ***************
****************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($109)or less). DEVELOPMENT SERVICES 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: BUILDING APPROVED BY : ., DATE:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor r
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. /Q
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: �- , DATE. J'/ 73
which this permit is issued(Section 3097.Civ.Cl. ************************** **** ** ** *** ***************** *'*********
LENDER: ************************************************* ****************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby allirm 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 18,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5 t SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/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). ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their 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----> 18 . 00 15. 00 0 . 00 33, 00 33 . 00 , 00
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. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 33. 00 OVER/SHORT: 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
' for 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 33. 00
❑ and hProfessionsCode: ce projects
thState contractor(s)
nntenseLaw doessutoo howner of SimprovesicensorIathereon *******************************************************************************
and who contracts forsuchTe Contractors'
a comedo Law
awidoesenotpursuantaly to the erContractors'Stalewh builds or
aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
9 I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner. MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
I do hereby certify that lam aware of and understand the requirements of California.Health and Safety Code Sections 25505.25533,and MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00 9 , 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit for 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 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
property for inspection purposes.
C1 > signature ''m" e Z �: 01 00146355-00146355 TOT 33.00
Dale' y 1 ' i DATE: 09/03/93 TIME: 11:55
Drivers License or Social Security a:
164146 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING - POS i 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 1
3. Electrical Conduit Utility-Undrgrnd. i 54. Forms I
• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
.
• 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. 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. 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
• - . . I � - . ..
20.'Roiigh'F'actory Fireplace ' •' r.-' -• t i"' . 'APPROVA'L,t "-'Pelmit 4 _
Ii•i .< r r : - 1 - I ' r • -'-."4•
21,.iDucts, in Structure i •• - v ' 70, Undergradnd Hydra j
22. Ducts,Ventilating' t • , :o ' E.C. 0 "' 71. Product,(Mng ii.Qas Oil
i , i 1 i I i n , fI
2j .Ga,S'Pipe-Rough &Test i .1 • . 72. Underground Flush •
N'_ '
24: Robf Framing r r -r i ' .73:' Undergrnd.Stofa4e Tane0 Gas T.Of
25. Roof Sheathing _ - • - . + • 74. OverheadHydro
26. T-Bar Ceiling (Structural) &-Monocoat75: Dry Chemical '
27: Frame and Flashing _ , - . 76. Dry Standpipe
•28. Lathing& Siding - ••i_ 77., FIXED $YSTE�,FINAL , I -�__-- -�j
29. Insulation . :. I- 78: rFIRE PREV. FINAL -
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat i t; t. , 7t, FINAL l\SSBECTION . T
32) Electrical Pbwer Meter-Final i 80C FOOD CE RTI F'GATE ISSUED
+
.,_ j
i
i
I
-- 33.-t Final E'fgctric t . e ' Nptes; - j- • , 1 ,
i 34.•Final Heating & Air Conditioninru t i O/ es 4 '- ._. .• ., -
135. Final Gas PIpe-Test ,' , , - ' t ' •• r'
-.r -,
36. Hood or Canopy I r . i i
• ----
'- 11.• �'-- . - --I : {
37,.Final Factory Fireplace.. _t , , _ • ..
I .. . _.- - - r - - - --- -'
38. Final Plumbing I • •- . • -
39. Water Service-Final - .
40. Gas Service-Final .. • ; . • ..
`
41. Solar Domestic-Final• I
I i
42. Backflow Preventer n •{ -_ - - •± j
43. Backflow Irrigation ' -` - t...t...? - a.
44. Landscape Irrigation System -c.'. - 7 i - .. .F . - .. c "r c•
' 45.•Sound Attenuation i i-• i : d " 7 T . i, T
•46..Handicap Regulations •• -
47. FINAL STRUCTURE & BUILDING l r -
48'. FINAL PLANNING . . ^� - - • _ �
49. Electric Release to Edison - ��{'
50. Gas Release to Southern California Gas Co I I - • - •
-,51. CERTIFICATE OF OCCUPANCY
No. Date
I,
Applicant to fill In all spaces except those within heavy border lines and si• gn all appropriate declarations. 9160 2/1I /36 -
•
��
CITY OF COSTA MESA CONSTR CTION PERMIT PERMI, O. TRACT NO. LOT NO. UNIT NO.
Project Address /0 0 cPt: 7/.a. -
rte-
Applicant's Mailing Addre 5 ?flh a I•A Y�1/ TYPE OF CONSTRUCTION ❑ NEW H ADO ❑ ALTERATION LJ REPAIR ,
��02 ❑ CONVERSION. ❑ DEMOLISH; ❑ OTHER A.P.# • - , .I Zone
Addresswner's Name TI e- Phone / DESCRIPTION OF WORK/USE OF BLDG.
Address - S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front 0
Address /� '� ��// ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear • - N
Contractor's Nam. vinll��V 44-I /!'hone Mr or 0s El OTHER A I
r /- 1 / PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) ? (i / - K G
_ CONSTRUCTION TYPE VALUATION S Left •
City License NO. 4 7- ZONE - GRADING CU.YDS. ACRES R
Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION - - Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: _ r• - M
with section 7000) of Division 3 of the Business and Professions Code,and yr..1 - 1'' n War'
my license is in f ll .r e and effect. h'L V t1 V LU r LO J 1.10U T
License Class Ligon po.
IL. S
Y
Date ' / dtr Signature ern .�J PLUMBING • FEES -
- YORKERS' COMPENSATION DECLARATION Bar Sink
' Showers rereby affirm that I have a certificate of consent to self-insure or a certificate • ELECTRICAL FEES
,f Workers' Compensation .Insurance, or-a certified copy thereof (Section Backflow Pf¢venter Service Sink . " In•
Automatic Washer • Transformer 0 15-50 KW
3800, Lab. C.)/' //� p-T ❑ 50+ KW
Policy No. e' t_is [hereby
.-/0(J Company - R� &,f Backflow Irrigation Construction Pole Sub.
Itertified copy is hereby furnished. Cooking Unit Meter Duo to 100 amps
edified c py(I d with the city B l l g i o Bathtubs Sewer Connection '
Date /-0 •'—' '� Applicant /•-!� � - '
- EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers. Dishwasher - - Meter Dover 100 amps
(This section need not be completed if the permit is for one-hundred ($100) or
less). Dishwasher ' Dryers ❑Gas ❑Electric Sub Panel
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 Drinking Fountains '
Fan ' Motors 00-1 HP 01'/::-8
Workers' Compensation Laws of California. ,
Date Signature Floor Drains F.A.U.
NOTICE:If,after making this declaration,you should become subject to the IOC.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith -Floor Sinks ■ Urinal ■
comply with such provisions or this permit Shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING AGENCY - Gas Service Outlets ' Water Closet '
Devic¢BOx¢s
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 //11
Lender's Name - p(/ Outlets - Range
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION •
- Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal 'Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap - Generator ❑0.5 KW ❑5-15 KW
any structure, prior to Its issuance, also requires the applicant for such permit , p Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of • Roof Drains • -
he Contractor's License Law (Chapter 9(commencing with Section 7000)'of
ivision 3 of the Business and Professions Code) or that he/she is exempt
.nerefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the-applicants to a civil
-penalty of not more than five hundred dollars($500). -
.0 I, as owner of the property or my employees with wages as their sole Reinspection,Fee ( $15 § 3
compensation, will do the work, and the structure is not intended or offeredr Reinspection Fee ! $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 ' DEVELOPMENT SERVICES REQUIREMENTS:
-
employees, provided that such improvements are not intended or offered for Hood or Type I 0 -
sale. If,•however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pe the ownerwill have the burden of proving he/she did not build or im- - e -x Building Approved By Date
•
prove for the,purpose
urpthe of sale). ._// cif
O t as'ownerr the property, exclusively7044, contracting with licensedcon- a Refrigeration System Application Issued By Date 0( (I/o
trThetors t constructctors he project (Section Bosiness and Professionsfproperty
erCode:
uil Contractor's License Law does notoraapply to an owner je pro ithta who ❑0-100,000 BTU' ❑100,000 BTU • '
builds or improves thereon;and who contracts for such projects with atom- — SUMMARY OF FEES
tractor(s) license pursuant'to the Contractor's License Law). I am aware thatExhaust System VentilatingEMultiple ■ System Repair/Alteration BUILDING PERMIT $ SMIP • ' $ '
proof of their Worker's Compensation insurance should be provided to me.
0 I am exempt under Section B.& P.C.for this reason INFire Dampers PLAN CHECK $ PERMITPLUMBING $ ,5/3-0 • .ISSUANCE $
Heatin System .. PLAN CHECK 25% $ ENERGY P.C. $
Date Owner - g & Ducting Registers
I hereby-cattily that I have read this application and state that the above 00-100,000 BTU 0100,000 BT GRADING $
information is correct. I agree to comply with all city and county ordinances • I ELECTRICAL $
and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM §
sentatives of this city to a t-r upon t - above-mentioned property f t
inspection ,,JQj•os— / / 'I_/� + MECHANICAL $
Signature /._Ar _ _ Art AL Date TOTAL FEE $ �� L�
Drivers' License or SS# Issue Fee $ 3 PLAN CHECK 25% $ '
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING PO. x 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, ❑ Undrgrnd., Test
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
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 ❑Gas O Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
'26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
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:6--G-1!l (,I--T c.'iep, Leo
34. Final Heating & Air Conditioning 10.14-yi 04l1GE4 Q.$ PER-243 U.P•C. tat)
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
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Oa
51. CERTIFICATE OF OCCUPANCY _
No. Date •
PROJECTADr9ESS: 1600 WHITE OAK ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 063825
OWNER'$NAME: BOSSLER KATHLEEN
.-- ADDRESS: 1600 WHITE OAK ST PERMIT NO; E 063825 PLAN CHECK NO: N GOVT; N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5-N PERMIT TYPE: ELE PURPOSE: OTH
( 714 ) 545-9072
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL A/C 6 FURNACE/HOOK-UP COMPRESSOR SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /M-1
PERMITTEE: CALIBER HEATING 6 AIR ( 714 ) 669-9320
ADDRESS: 195 SOUTH "C" STREET 250 COMMENTS: RE: M63824
TUSTIN CA 92680 ********4***aE;E*******;H*******;E************;ESE* ***********;E********+P***** ******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 o1 the Business and Professions Code,and my license is in full force and effect. SETBACKS
cmuc.: 052671STATELIC.:589544 CLAssA20
Date: Y C— 3- ( 7 signature. - T `e'._�- t MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-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 3600, Lab.81. LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PDLICYND.: 1191168- 93 EXP,DATE: 1 /01 /94
COMPANY: STATE FUND PARKING RE PROV: PARCEL: 13921309 ZNE: REF NO:
❑ Certified copy is hereby furnished. aC Certified copy is filed with the city Building Division. PLANNING N TES>
Date: CY '— I— l Th_ Applicant' v \ 0-e l Q.l:•-a ********************************* W********************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S -E tR VICES 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 : x DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. 7l .; f/1
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY. #� !/ / e -a'�^-• DATE: —EiZE
which this permit is issued(Section 3097.Civ.C). ************************ **** ******#**** E***** ************ **'
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: Any city of county which requires a permit to construct.alter,improve,demolish.or PERMIT 22 50- e S,
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 S 0% L -} 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 !7
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500). ISSUE FEE 15 . 00 ..—' '•'r . J'
L as owner of the properly or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK. (`J TOTAL. PAID DUE
❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 22 . 50 15. 0 0 0 . 00r>.44, :3 750 37. 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 r r 1
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: r 2' 7. 43.7 .50 OVER/SHORT: 00
for thee urpi is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE ' SMSPx/TOT GRADING PLAN-CHECK
for the purpose s dotal.
37. 50 :1
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business . . . 7
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon —' 4.--.- '.m
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware ******************************************'fe****1}*.******************************
that proof of their Workers Compensation insurance should be provided to me. I ND IV IDUAL F E ,'g -'' B 1R-ESA' K D O W N
❑ I am exempt under Section: B.&P.C. 1 -) . / ,—,
for this reason: TYPE QTY DESCRIPTIO N - `-)' "• " i) UNIT COST
t TOTAL COST
Date: owner. , ELE 3 MOTOR/POWR APPARATUS � y.
1 . 110f CCHP 7. 50 22 . 50
I do hereby certity 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 will/will not(circle one)need to comply with said state codes and the requirements for a hitt'
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from • ,' j,, hl
these provisions. .r
Date: Applicant: - 1-•-• I Ir./
�!"'
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county — C.
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above mentioned
properly lar mspeclion purposes. -
/1 '
Dale: 9 --D _ C
nature' �/7\ t_ � /W/a
.'0100146'354-00146354 TOT .37.50
Driver's License or Social Security e: --' DATE: 09/C3/93 TIME: 11:54
1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor _
J
,1 '+
POs. . & SPA
CONSTRUCTION AND PLANNING
---_-- -- _
el APPROVALS Permit#_ Date Inspector APPROVALS Permit -- Date Inspector
i
41 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. clecv,cet OF ER Grnd. _ 57. APPROVAL TO COVER-GUNITE
*7. F ootungs 58. Electrical Conduit-Undrgrnd.
3. Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test 1
• 9. Water Pipa-Undrgrnd. 60. Backwash Lines,P-Trap, 27 Undrgrnd. I l
-
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection i 62. Backwash & Recaptur-Final
'2. Sev:e, Cap 63. Heater & Vent-Final {{
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing 65, Electrical-Final
L t I
15 Rough Electrical-Conduit 66. Solar System-Final
ra Thugh Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL -yI
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT I
20' Rc'r.gh Factary Fireplace a ,. , , i.WPRUVAL$ 'Perfnit t I
21i. Ducts, it,Structure ' '70. Undergrounu Hydro
22, .Ducts, Ventilating - J' , I; , 71. Product,Piping n Gds LIOil
1-27737Gas Pipe Rough L.Test i . - - k.72. Underground Flush • I
74 • Roof Framing r., • ' - ' '' ; ; 73.:,Undergrnct.Storage Tank• i Gas :O+i
25_Real.. Sheathing - 74. Overhead Hydro
76"--haer Ceiling (StrGeturai' & Monocoat 75' Dry Chemical -11,
27,. F r.me ano Flashing - 076. Dry Standp:pe - -
.28. Lattrn3& Siding 77.', FIXED SYSTEM F,l^JAL' ,
29. Insulation 78a FIRE PREY. FINAL
I
1--30. Dryv ail_NailingHEALTH DEPT. REQUIREMENT
' ._-
`31. Plane, Bram Coat. , I 79. FINAL INSPECTION
37 Electr,cai Power Meter•Finall -'q i(�/' 1 ,80. FOOD CERTIFICATE ISSUED _1 --
33. Fi•:a1 Electro. - , ' 7 7J I •Notes: rr __ �1�
/ [Q Q5 b -1� ZdOa
34. Final Haat.ng& Air Conditioning • I - I
i -1' 16)' lq4,/e_ Pai.'.
u35; ,Final Gas Pips-Test, I I�IT___^_
36. Hoed or CanoPY • ' 1 •• 11 II
I_,*4°/ rn20wh�
37, Fog! Factory Fire4lace- i ' I _ / , / t'T/ - ,_^
•
38. Finai Plumbing III ( �
,v)./...a_. -I
39. Water Service Final' ' ' �,
! _
40. Gas Seance-Final . / ^_/4L+IL l q9-_ -
41. Solar Domestic-Final, I• I '
+ 42.'Backfldw Preventer - -_ 1
43. Backflow Irrigation: I
44. Landscape Irrigation System l: . . -
45..--Sound Attenuation -
46. Handicap Regulations .1 -
47.-FINAL STRUCTURE & BUILDING _
43. FINALPLANNING
49. Elec:ric Release to Edison . ' •
50. Gas Release-to Southern California Gas Co
.:
. .
+ 51, CERTIFICATE OF OCCUPANCY k .
No. Date
_'�
GOO 4% ITY OF COSTA MEQ_
' ' 4 CALIFORNIA 92628-1200 PA. BOX 1200
d jaFF DEVELOPMENT SERVICES DEPARTMENT
September 27, 1994
Dear Costa Mesa Property Owner:
In reviewing past permits, we find that work has been done on your
property located at 1600 White Oak Street, Permit No. E63825, for
an electrical permit. The permit is valid for 180 days from
issuance or your last inspection, per Section 303 (d) of the 1991
Uniform Building Code. Should we not hear from you within 10 days,
your permit will expire as stated herein and additional fees will
be required to finalize the permit.
To activate the above permit, please follow these steps:
1. Telephone (714) 754-5626 or 754-5627.
2 . Request an inspection; state address, permit number, and type
of inspection.
3. Be sure to have working smoke detector's as required per
Section 1210(a) of the 1991 Uniform Building Code.
4 . Have an adult present at the property at the time of
inspection to provide us access.
Should you have any questions regarding this process, please
contact me at (714) 754-5273 .
Thank you for your cooperation.
Sincerely,
Yolanda Huapaya
Permit Processing Specialist
77 FAIR DRIVE
Building Division(714)754-5273 Code Enforcement(714)754-5623 • Planning Division(714)754.5245
FAX(714)5567508 • TDD(714)754-5244
PROJECT ADDRESS: 1600 WHITE OAK 'ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PEKM NU: b UbDbiLl
OWNER'S NAME: BOSSLER, KATHLEEN
ADDRESS: 1600 WHITE OAK ST PERMIT NO: B 065824 PLAN CHECK NO: N i3OV i ; N surra N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V-5 PERMIT TYPE: SIR PURPOSE: OTH
7
♦ ARCJMENGINEER: REG.NO.: JOB DESCRIPTION : T/O , RESHEATH & RE—ROOF W/COMP . SHINGLE SQ FT: 4, 785
ADDRESS: UNIT: -
CLAIM VALUE: 4, 785 . 00 CALC—VALUE: 4, 785 . 00 GROUP OCC: R-3 /
PERMITTEE: PETERSON ROOFING ( 714 ) 979-7111
ADDRESS: 3006 ENTERPRISE COMMENTS: SMOKE DETECTORS ARE REQUIRED AS PER 1991 U.B .C .
COSTA MESA CA 92628 ***+r****+r********+ESE************ *********+k**+kir********************s************
LICENSED CONTRACTOR DECLARATION: I hereby affirm Thal I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000) .1 OW io o I e usines• and Pr. e C d d my license is in full for nd effect. SETBACK $
. : a • • D i bgi 7C d CLASS: C-3 9
`_J��� MAIN BUILDING ACCESSORY BUILDING
Signature:_ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
r"ER/OMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RG HT: FT IN LEFT; FT IN RG HT: FT IN
ompens ion 0s0a2c1;9 5c5tilic0 9py thereof(Section 3800,Lab.04 /0 1 /9 4
POLICY NO.: STATE FU. D EAP.DATE: PARKING REQ: PROV: PARCEL: 42227211 ZNE: REF NO:
COMPANY: PLANNING NOTES>
] r lip
op IS• ruby r/%. ,e Certified copy is filed with the city Building Division. >
Oat ' /J. s/s. Applicant• DEVELOPMENT SERVICES REQUIREMENTS
EXEMP FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($110)or less).
I tend hal in the performance 01Ihe work for which this permit is issued.I shall not employ any person in any manner so as to become ZONING APPROVED BY . DATE;
subject to the Workers'Compensation Laws of California. -
Date: Signature: BUILDING APPROVED BY : DATE:
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions 01 the Labor
Code.you must forthwith comply with such provisions or this hermit shat)be deemed revoked. APPLICATION ISSUED BY; MIL_ DATE: ® -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for *********************se ********** , • • , „ **
which this permit is issued(Section 3097.Civ-C).
*********************************************************************** i*******
LENDER:
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason eee '6w0''KE
pursuant
ELECTRIC MECHANIC FIRE $MIP/RES, GRADING
(Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PE . 50
repair any structure,prior 10 its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed y�.�EQLitFt¢GD SM I P/NON-RES
pursuant toJj the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by ISSUE FP{L.wC
lWl
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars 85006 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID i. DUE
❑ I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS————> 72 . 50 0 . 00 0 . 00 72 . 50 72 . 50 ' . 00
structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State 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 employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 72 , 50 OVER/SHORT: . . 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SKIP/TOT GRADING
_PLAN—CHECK
for the purpose el sale). 72 . 00 . 50
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ,
❑ and Professions Code: The Contractors'State license Law does not apply to an owner of properly 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
that Woof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BR E AK D OWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 4785 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 785 . 00
I do hereby comfy 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 will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify 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 la enter upon the above-mentioned
roperty for inspection purposes.
Date Signature:
01 00154312—D0154313 TOT 72.50
en's License or Social Security n:
DATE: 01/2t/94 TIME: 10:43
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING I POS & SPA I
APPROVALS Permit Date Inspector APPROVALS Permit . _ I Date IInpectsr
p
1. Temyorary Electrical Service Pi' Pole - 52. Pool & Equipment Locat.on I
2. Soil Pipe-Undra nd. 53. Steel Reinforcement
3 Elo-•n c_' Co^d,:a U; ',1,, -tv i'grcd. .TIT 54. Fran,
r - I ' i F---- - j i
4. E.rata: Cono...t-U'-dre: i; `` 55. Electrical Bord r; 1 I
5 Stt, R.anforceme.n' ,ter /' 56. Ring', flurr.b.rg it PrL.'urc Test
I -
6 E::-t-:a, LIP ER G'nd _-. ' 57. A° L PPOVATC CI'Vl-R O'.'\ 'F
I- - --_-_---4-- - _- -1- t - --_.
I 7 =aot:rec. I I , 59. E ect`ca' Cort u• v. .n
L_-__-- --- --_I.
;-_-_ _- - - - __ __ _ -_ _.
a. Fa_, at on - 59I . Cur are. Lint -n _ -
9. '."tater P,pe'Undrgrnti. 60. B..Us r;ash L:na. P.Tr,:p. L• U1-,J'c^.n
10_ Structural Floor System I 61. APPROVAL TO C:CI; _ _ I_ _ 11
I 11 P, .:1.: •y S=_:rer L1r_ &. 1:.:..=e G ,. ..;.on 62. Hi!,
12. S�'.er Csp I I -- I 63. Huatcr & Vent-Fin; . I I -
13 Roo{ Clams I 64. Poumbing System FT ,..1
14. Reign Piumb,ng -. 1 65. Electrical Final 1
15. Rough E:ectrical'Cond-r; Y __----I 6. S
6 ',lar Systam-Firz'. -- -- ----1 - I
16. Rough Electric\Yirinq ---- i I 67 Fencing & Acc'ss Anon,:' j
- -- - - - -- -- - - --t---- -- -- ----- ---- ----- -
17. Rough WiringSign I 68. APPROVED FOR PLASTCH;NG 1
�_ 0 9 1 I
I
18. Rough Electrical-TH rCh'ing -__- I 69 POOL/SPA SYST: '_S FINAL �_--� --- I --
19. R:.,ah H -d
eating & A i C .t:^n,ry L_
--1- I ;"IRE DEPT. elf OUIRCiv'.E"'T
I 29. Re.igh Factory Firer 'zee I • : APPROVALS n_. n.i . _ _-.
11--- -_ _ __--__i-- __--I_.-1/4._____- - - --._- ____i_ __ _
21. Devi, in Structure If 701411.'do:,rou^� su,.. ,.
22. Dr cts, Ventilate-9 1--.___ . 7(l Pr r6_rt P n; • ^ 7,1 1
•
23 G. . :.R,ugh 1_4 r_ . _ -_ 7.2 Lir rrot c -_ _ -_ --r
I
25. R rr Earl.. /-a.(f - { G ' 7. !iid ]rl .l _ ..
! 26. T.".r Coling IS.. i hro.loe -t 1 7r Y'�.lierr ca - - - _
2-/ F. .-c t^.d P:a3' '^' '4-
-:it:rg;: . 1 c'
F___ -- __ - _ _{_ _ --{- _-__ -.__ •-__ __ _ - _- __-- __ _ - .-
7.5. ' r.,,.,.rar. -_--- _-.I �I-.-. _-.I 7B:_.IHi-_'REV. FI^si- _--. - - I _ ----_1_
I 3J. � - 1�a,img _--- I --_ 1 • 1 -- HEEL T:{ DEP?. F:EQUIItEA,
3- .i ;ro .n Cour . 71_. F: .A:- 4:':;'c:T.C'.
9.1. ..C. Ji hi . ... I tsS
- - - I- - - - � -
I 34 F.. „ ,!rating 8; °if Cu. utoilirt�
, 3 .. E r:i ( �i rine-le;t 1 1 _
30. H: . _ C.: opv _ .-__ _ ___r _ _y- - . _ _ _ _. __
•
I 38. F1,ial Plumbing I -- - - - -- - -- - - - -
39. l:'..'.:r Strvice-F: i- - .___- -._ _
60. G.: Sire'c, F _,.:I --__�_. - _. - - - - - --_ - _. - - -_
__- 1. _ __ --__ __- __ __
41. So'.-.r Dame : [ : l__ _
F . 3a Ccf lo•,y Preventer _ _- _I_ _ .._._ _ _-I_-__ __ ___ -__ - __ --_ .
1
, 43. Per'r 'o:: Irrigation
' 414. �. a '''.”71:. Irncat C. 5 -
L .
-
4 Ha dcaP c9
6. Rulatiu'is .. - - --'-- - -- -- -'
I 4/, i 1HL51 RUClI.P' L r !_OI .IG Z_3_CtLI (w6L d $u.�,�_ /J +,L� � `
:NAL _6.----vi---
49- ..IEAL_'LAXidl�i'G - ----- -I- ,I _ _ __
.
49. E:..erne Ra'eas2 to EC .o, I --T-- -----
50. Gas Release to Southern California Gas Col __ . - - _ _ __51. C. RTIFICATE OF OCCUPANCY
I - -
tNo. - D✓e -------I-- -- -- -- --
- -
R 10063 •
ii
AUG 71 1959
COSTA MESA BUILDING-SAFETY DEPARTMENT ;7,11 p'nr: I-I r0i
P.O.BOX 317 COSTA MESA. CALIFORNIA - - '
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADDRESS 1600 White Oak St.
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY fl!M.'s in
OWNER Rosslane Land Co. RECEIPT NO. I JPERABi kat"
MAIL E.
RECEIVED BY DATER EIVED ISSUED
ADDRESS 419 17th St. )V R—(-- Au 1 0 195u
CITY Costa Mesa NoLLI81159 ADDRESS /lo 0 0 (,cti tetc-10-64--e._
AR OF -SNEER ECT Carlson & NO. COSTA MESA, CALIFORNIA
--Mac dlebrook
ADDRESS FIRE
nn���I�qq
O (lard Grove ZONE TYPE GROUP
CONTfYALYR& Colegrove, Inc LSTNTOE 167294- APPROVED
BY DATE
ADDRESS 419 E. 17th{ St., Costa Mesa�� - ZONING
LEGAL I LOT 193 I I 2822 ZONE �/ I NO.OF USE OF NEW
DESCRIPTION NO. BLOCK TRACT PLANS A I BUILDING /��
A.P.NO. r BBAYPROVED (4.211a
, In Y_ V DATE��‘A)
SIZEOF LOT 80 x 95 I NOW ON SOT none YARDS C/L zG/_ALES
REQUIRED ALLOWED
USE OF (CENTER LINE ST.) /�
EXISTING BLDG. FRONT (/ FT. IN.
SETBACK LINE FROM Cg( 25'
CENTER OF STREET / REAR YARD 5. R.SIDE /7)(--V
n FT. IN.
SIDE YARD I LEFT 6' (RIGHT 10 L.SIDE FT. IN.
DESCRIPTION OF WORK REAR 9 O. �� FT. IN.
NE •
I Yi II ALTERATION I II ADDITION
REPAIR I I MOVING II DEMOLISH
SIZEIDING 1601 NO.OF ROOMS 6 STORIES 1
EXTERIOR WALIs 1 ROOF
COVERING St11CC0 COVERING rock .
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence with
attached garage. .
Plan 750A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCT ON VALUATION
SIGNATURE OF , PERMIT FEE $ 35.00
PERMITTEE e-
$ 15,928 PLAN CHECK $ 17.50
AUTHORIZED AGENT Dike & Colegrove, Inc. TOTAL FEE $ 52.50
OWNER CATLIN, D.H. AUG 1 0 1961 DATE 9-29-60
JOB ADDRESS 1600 White Oak St, BUILDING PERMIT NO. 12919
RWERAL CONTRACTOR Owner-Eldr, VALUE $ 200.00
I!e`No. 113-593-09 LOT TRACT _ FIRE ZONE DESCRIPTION OF WORK Block Wall
INSPECTIONS DATE I GROUP TYPE ZONE la
Underground Soil U.G. Water SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas _ 0Rough Heating _ _ ,,,3Z •`'
Rough Plumbing •
-` 4 Miscellaneous 4� .
Prop. Swr. Line House Con. St. Swr, 074
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test
Construction Pole
Underground Power _
Rough Wiring
Trenches/OV-Forms Steel IO-7-40
Floor System
Stool Reinforce Chimney Re-Rod
I Beam
jQ Sn.athing
Frame and Flashing _
,4Lathing, In Out
.`„4'9 Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final t
Building, Final //WIC f/S"G,
OCCUPANCY
Form 2W-5M-11-59 S-B P 12919
J
'I 12919
COSTA MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED
P. O. BOX 317 COSTA MESA. CALIFORNIA 11Jof--e7 6 Q,, _
For Applicant fo Fill In Completely APPLEI prN,'C(E�7y-ApkT. / Vevai /
TYPE OR PRINT . ..
" BUILDING
BUILDING / to f`J'�� /a
ADDRESS
COSTA MESA. CALIFORNIA For Office Use Only 1
, n RECEIPT NO. _t✓RAii� D.(�
OWNER C.A.-- 1 • _�*P'' l
MAIL • RECEI D B • TE RE EIV�_DT . TB ISSUUCD40
ADDRESS • ,L1 A% I i; ' [!/1/ I
ya V TEL. ,Q �
CITY U _( p.--'- 14.i,-_12_ J NO. -' )•A ADDRESS//6-o 0 ~-.
COSTA MESA. CALIFORNIA
OR ,INEER NO.
FIRE .
ADDRESS ZONE TYPE GROUP
APPROVED
BY DATE
ADDRESS ZONING
ZONENO.OF I USE OF NEW
PLANS BUILDING
STATE TEL. LEGAL / /�{'^ 1
DESCRIPTIO S/a
1 I` �'n7
A.P.NO. ria a - Jc, -6 - /
_ YARDS [[[[ EVES
EXISTING APPROVED ALLOWED
SETBACK LINE FROM (CENTER.LINE ST.)
CENTER OF STREET REAR YARD FRONT .5
( T. f IN.
/tOA,y
SIDE YARD I LEFT IRIGHT R.SIDE Ft 441
/ - / IN.
DESCRIPTION OF WORK
I L.SIDE �- FT. IN.
NE% I V I ALTERATION I II ADDITION I REAR FT. z2---,...7N.,0
j -DIN.
I IMOVING I II DEMOLISH I APPROVED L/ , /0f •DATE /7N.X
REPAIR ( L5�
BUILDING NO. OF
SIZE ROOMS STORIES //
EXTERIOR WALL I ROOF COVER // / /
,xb� x
COVERING
USE OF BUILDING 4-)4,-R a BE PERFORMED O 1/m/� � / /
az,,A (/ �/ " X /a•' Y �
A .. i /i i i
. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'cp. AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. - RPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. ' VALUATION rJ
SIGNATURE OF [ //J _�� PERMIT FEE $ 6717PERMITTER /! � YfGri' n
Chi
$ PLAN CHECK $
E
AUTHORIZED AGENT au
TOTAL FEE - _ y