HomeMy WebLinkAbout421 WOODLAND PL - Building Permits(714) 754-5273 • Fax (77a) 75a-aB56 • wv+w.ci.costa-mesa.��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Jobnddress: 421 WOODLANDPL
Suite:
Viciniry: ROOF
Parcel Number: 42624105
Applicant MORIN, MICHAEL
Address: 1013 E WALNUT ST
SANTA ANA, CA
Owner: HARNOSS, SHIRLEY C TR
Address 421 WOODLAND PL
Zoning:
Phone: (714) 7313425
Zip: 92701
Phone:
COSTA MESA, CA Zip: 92627
Contractor: WEATHERLINE ROOFING INC
Address: 1013 E WALNUT ST
SANTA ANA, CA
Zip: 92701
Arch :
Address:
Phone: (714) 7313425
License: 729560
Eng:
Address:
Phone:
Status: ISSUED
Applietl: 11/12/2002
Issued: 11/12/2002
�l /
Phone:
Zip: License: � License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 15# FELT, 30 YEAR, COMPOSITION SHINGLES. 2,500 S.F. INCLUDES ATTACHED
GARAGE.
Plan Check: $0.00
Permit: $9725
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
SETBACKS
MAIN STRUCTURE Front 0- 0 � Rear 0- 0
ACCESSORY Front 0-0 Rear 0-0
PARKING Existinq: 0 Required: o
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$3,100.00
$3,100.00
NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 7 BO days.
INSPECTIONS: In o�der for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiratlon of this permit.
FOR INSPECTIONS CALL: (714) 7545626 -
2a4fid8(8/00)
WORKERS' COMPENSATION DECLARAiION: � �� � ,
1 hereby aflirtn under penelty of perjury one oi the following tleclaretlons:
❑ t have entl will maintain e certifiwte of consent to seli-Insure lor workers' compensetion, es pmNded tor by section 3700 of Ihe Lebor Code, tor the peAormance of Ihe
work tor which t�is permit is issued.
� I have entl will maintain workers' compensation Insurance, es requlred by section 3700 of the Labor Cotle, for Ihe pertormance of the work for which Ihis pertni� is issue0.
My wo wmpensation�rance carrier entl policy numbar era:
Carrier: TF. �.t r✓d Policy NumCer. _� 4'3.i 1�c/ — �%�i-
(This section neetl not be cromple(etl i! (he permif is ve/ued at one hundied dollars ($700J oi lessJ
❑ I certify that in the performance ot lhe work tor which I�IS pertni[ is issued, 1 shall not employ any person in any manner sa es to become sub�ect lo the workere'
compensation laws of Calitomi , entl agree that if 1 shoultl become sub�ect to Ihe workers' compensation proNsions oi Section 3700 0l the Lebor Cale, I shall forthwith
comply with ihe���s¢¢¢yyy///�����Aov���i ans.
Applicen� Signe�ure: �___�O"��—� Date: �1 I ��-I a Y
WARNING: FAILURE TO SECU E WORKE PENSATION COVEPAGE IS UNI.AWFUL pND SHALL SU&IEGT AN EMPLOYER TO CRIMINAL PENAL IES AND CML FlNES UP TOONE HUNORED
THOUSAND DOl1ARE (5100, ), IN ADDRI TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SEGTION 31O80F THE LABOR WDE, IMERE57, AND ATTORNEI"S FEES.
UCENSEO CONTRACTORS DECLARA710N:
I hereby aflirm that I am licensed under provislons ol Chapter 9(wmmencing with Section 7000) of Division 3 of the Buslness and Prod
torce end ettecL Lic. a a 5(.'= Class N L' —
Contrectors Signatura: ✓JA � �n �"�— Date: _�
Cotle, end my license is in full
Z�
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirm ihat there I5 a constmction lentling eqency for ihe Dedormance ol the work tor w�ich �his permit is issued. (Sec. 3097, Civil Cotle).
Lenders Neme: Lendefs Address:
Signature: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm that under penalty ol perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ue following reason (Sec. 7031.5, Business and Profession:
Code: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or reDair any structure, prior to its issuance, elso requlres the epplicant tor such pertnii
to file e signed statement ihat he or she is licensetl pursuant to ihe provisions of ihe Contrectors License Law (Chepter 9(commendng wit� Sectlon 7000) ot Divislon 3 ot ihe
Business and Professions Cotle) or that ha or she Is exempt therelrom antl Ihe basis br the alleged exemption. Any violetlon of Sectlon 7031.5 by eny epplicant for e pertnii
subjects ihe applicant to a civil penalry of not more ihan live hundred tlollars ($500).):
❑ I, as owner of the property, or my employees wit� wages as t�elr sole compensation, WILL DO THE WORK, end t�e siructure is not Intentled or oXered tor sale (Sec.
7044, Business and Professions Code: The Contrecrors License Law tloes not apply to an owner oi property who builds or improves t�ereon, and who does such work
himself or herseN or through his or her own emplayees, proviAetl ihat such improvements are not intended or oHered lor sala. If, however, t�e builtling or Impmvement is
Sold within one year Of comD�etion, �he owner-builtlef will have lhe burden of proving Ihat he or she tlid not builtl or improve for purpose ot sale.).
❑ I, as owner of Ihe properry, am E%CLUSIVEIV CONTRACTNG WITM LICENSED CONTRACTORS to construct Ihe pro�ect (Sac. 7044, BuSiness end Professions
Cotle: The coNractars License Lew tloes not epply to an owner ol property who builtls or improves Ihereon, antl who contrects Por such pro�ect with e contractor(s)
license pursuant to tha Contractors License Lews.).
❑ I em exempt untler sec. 8usiness entl Prolessions Code for this reason:
Signature: Data:
Owner ID verified by drivers liCen56. ❑ Ye5 ❑ No Dnvefs Licanse No.
Venfication of Ownarship by (type ol document, I.a. - properry tex blll or dead):
Expires:
DIVISION OF INOUSTRIAL SAFE7Y PERMIT CERTIFICATON:
❑ I hereby ceRify �hat no excavation five (5) or more leet in Cepth in�o which e person is required to descend, will be made in cannection with woAc euthorized by this
permit, antl ihat no building swcWre, sceHalding, lelsework, or demolitian ar dismantling thereof, wiil be more ihan thirty-six (38) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
367, Title B, Califomia Atlmini5ira�Ne Cotle).
❑ As ownerbuilder, I will nac empioy enyone to tlo work whlch would requlre a pertnit irom the Division of Industdal Sefery, es noted ebove, unless such peraon has e
permit to do such work from the division.
Signature: Date:
Division ot Industrial Safety Permit Number.
CERTFICATE OF COMPLIANCE AND AUTFIORIZATON OF ENTRV: I certity under Denalty of Derjury that I heve read this epplication and state ihat the Informellon given is
correcL I agree to comply with all stete laws antl ciry ordinences rela�ing Io buiitling consiruction, and authorize represeniatives ol the Ciy of Costa Mesa ta enter upon the
ebove-described pmperty tor inspection purposes. I egree not to occupy or ellow occupency of any 6uildinq amhorized by Ihis permit until tinal inspection.
COUE 1. INSPECTIONTYPE
761fi FIxeO System Final Fire Preventlon
7266 Pool Spa Final
200 Final Re-Roof
201 Flnal BIocWRetaining wall
202 Final Feciory Fira Place
203 Final Sign
204 Final Demolition
pAg It�9LS
//��Z !!/�l�
t'_.�'
lA I L
liZ/
� Date
CppE� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Eleclrical
212 Final Fire Prevenfion
220 Final Planning Approval
222 Final Site
250 FinelBuilding/Occupancy
QAIE II�IELB
�-1 ��.w;�..;�., 'fi.s-w�.g -vo
I�„ � 1 APplicant to fill in all spattz exte0t thase within beavY Oortler lines antl si9n all appropriate Ceclarations.
CITYOFCOSTA�AESA 'gO TRU TI PERMIT � �FR�AITNQ __ TRACTNO. LOT.NO. IINITN(1
Project Address � W '�p/
Aptilicant's Maili�� Ad–y� //S f/ � L�./ /
Owner's Nam S �/ P7hone �
Address z � /
ArchlEng. U u� LicenseNo. �
Address � f y '
Contracror's Nam G�y ��� 1��"/C Phone Z OG
Address (mailingl- -/ C� �, L•�
City license No.
LICENSED CONTRACTOR DECLARATION .
I h¢reby atfirm that I am licensetl untler provision5 of Chdrter 9(commencing
with section ]000) of Division 3 of the Business antl Professions Gotle, antl
my license is in tull orce antl effecL �i Q, ��
License,C,l n � Cens No'
Date Signature
WORK RS' OMPENSATION DECLAR 1 N
hereby affirm that I have a certificate O onsen[ 0 5elf-insure o� a certifiCate
Workers' Compensation Insurance, r a cerC fietl copy thereot (Section
.eoo, �ab. c.� - � �
Policy No. - Company �v�
❑ Certifietl copy is ne�eby (urnishetl. ' �
❑ Certifietl copy,is filetl with tne city Building Dlvision.
Daie APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl ii tM1e permit is for one huntlretl ($300) or
less). ^.
I certify that in tne performance of the work for ich thls pertn�t is issuetl, I
shall not employ any person in any ma oecome subject to the
Workers'.0 ��� iyn Laws ot Califom' .
Date __�.Y�° LQI.�—Si9naWre -
�NOTICE: �f, aftEr making lhis tle<laration, � shoul ecome Subject to the
Workers' Compensation provisions of th bo� e, you'mus[ fo�tbwlth
compty wilh such provisions o� this -rmit all be deemetl revoketl.
CONSTRUCTION LENDING AGENCV � -'
I hereby aHi�m that there is a construction IEntlin9 agency tor the performance
of the work for whi n tn� p it is issued (Section 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDER bECLARATION
I hereby affirm that I am exempt from the Contractor'S Li[ense Law for the
foilowinq reason (SecHon 7031.5 Business antl Professional Cotle: Any tlty or
county which requires a permit to construct, alter, improve, aemolish or repair
- any structure, Prio� to its issuance, alm �equire5 the applicant tor such perTit
to file a signetl sta[ement that he/she is licensetl purzuant to the p�ovi5ions ot
the Contractor's License Law (Cnapter 9,(commencing witn Section ]000) of
'livision 3 of the Business antl P�ofe55ion5 Cotle) or that he/5M1e is exempt
erefrom and the basiz for tne allegetl exemption. Any violation ot Section
J31.5 by any applicant for a permit subjec[s ihe applicant [o a civii
�enalty of not more tM1an five huntlretl dollars ($500).
I, as owner oi the properry or my employees with wages as their sole
"mmpensation, wili tlo the work, antl Ihe structure is no[ Intentletl or otferetl
for sale (Section ]044, eusiness anE Professional Cotle: The Contractor's'
�� License Law tloes not apply to an owner of a property wM10 builtls or improves
I thereon, antl who does such work M1imself/M1erself or through his or her own
' employees, provitletl that such improvements are not Intentletl or otfe�etl tor
sala. If, M1oweveq t�e builtlin9 or improvement is soltl within onc year of com-
pletion, tne owner will have the burtlen of proving he/sne tlitl not builtl or im-
p�Ove to� Ihe purpose ot sale).
❑ I, as owne� of�the property, am exUusively contractln9 with licensetl com
fYdCSOISLO COf15[IUCL IM1C pIOj2C� ($2CLIOII J044r BUSIf1255 dOC� PYOf0551005 COdZ:
The Con[ractot'S License Law tloes not apPly to an owner of p�ope�ty who
builtls or improves therean, antl who contrac(s for such projects with a con-
tractor(s) license pursuant [o [tle ConVactor's License Law). I am awa�e [hat
proof of thei� Wo�ker's Compensation insurance shoultl be provltleG to me.
❑ I am exempt untlet $ection B. & P. C. tor this reason
Dale Owner '
I hereby certify that I n ve reatl [his application antl state that the above
information is correct. r to comply with all city antl county ortlinances
antl state laws rel in iltling�consVuc9on, antl hereby autnorize repre-
Sentatives of ci en r upOn tbe above-mentionetl pr per to�
inspection pur /
j Si9nature Date
Drivers' Cfrenze
TYPE OF CONSTRUCTION L1 NEW Lpl ADD LJ ALTERATION Ll REPAI R
❑ CONVE{3510N ❑ DEMOLISH ❑ OTH R q,p, � �� �
DESCRIPTIONOFWORK/USEOFBLDG. �`�� �J ��'
S Main Building:
TVPE OF PERMIT GRADING FOUNDATION � STRUCTURAL T Front s�y
❑ TENANT I�I ELECTRICAL PLUM8ING ❑ MECHANICAL B Rear
❑ OTHER A �
PROJEC7 DESCRIPTION S�.FT. oCCUP y C Right �
K Left
CONSTRUCTION TVPE VALUATION S�� S �'O �
ZONE GRADING CU.YDS. ACRES Ping. Ref. iF
Remarks: „ PlanningNotes: ����/�
Bar Sink
Backflow�Preventer
Backflow Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks � �
Gas Service Outlets
Kitchen Sink
Lavatories • �
P—Trap
Roof Drains � �
�
P
Reinspection Fee $15
Boiler
Duct - Under Ground .
Duct - Structural
Duct-Ventilating �
Exhaust System ❑ Multiple ❑
PirepUFact.6lt. ICBO #
Heating System & Ductin
❑0-100,OOOBTU 0,0006T
Fee � $15
cMF 0865-46, rev. 10 4 � hite - Builtling; Canary - APPlicant; Pink - Amounting; Goltlenrotl - Assessor
Showers
ServiceSink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar, Pipi n9
Solar Tank •
Swimming Pool w/Spa
Urinal � � ' �
Watef CbSei
Water Heater
Water Service
Auto-Wash
2 �
- Isue Fee ' $ 3
iANiCAL FEES ..
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 t00,0008TU
Sy Repair/Alteration '
Fire Dampers
Registers
Issue Fee � '� $ 3
!'6'103 5%@3%86
i^,ir.... - _'
Zone
Parking Req./Provided
ELECTRICAL
Aummatic Washer - Transformer ❑ 15-50 KW
Construction�PoleSub. � 50+KW
Cooking Unit, � Meter ❑up to 100 am"p5
Dishwasher Meter ❑over100amps
Dryers ❑Gas .�Electric Sub Panei �
Fan ' j Momrs �0.1 HP �1 %- 8
F.A.U. . ' Inc.Solar �9-75 HP �16�15+
Fixtures � � � Microwave
Device Boxes Pole Light
Outlets Range
Switches Sign
Garbage Disposal � � ;Standing Sections
Generator �0�5 KW �5-15 KW Trash Compactor
Fee
Zoning Approved By _
Buildin9 Approved By
Aoolication Issued Bv_
$15
Issue Fee
j53.(7 TL
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
SUM A V F FEES :f�
BUILDING PERMI7 $ d SMIP � $ � . `
PLAN CHECK $ PERMIT � �
PLUMBING $ OO ISSUANCE � $
PLAN CHECK 25% $ i7 'ENERG� P.C.- $
ELECTRICAL � $ GRADING �$
PLANCHECK 50% $ MICROFILM $
MECHANICAL 3 TOTALFEE � $ �
PLAN CHECK 25% $ � ,
\�
CONSTRUCTION AND PLANNING POO� ;PA
Date Inspector Date Inspector
APP�iOVALS Permit# APPROVALS Permit#
H. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. �P� q G 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 Plpe-Undrgrnd. � 60. Backwash Lines, P-7rap, � 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
i6. Rough Electric Wiring (s �CJ C/� 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 Strucwre '� � 70. Underground Hydro
22. Ducts, Ventilating , 71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rough & Test --- 72. Under9round Flush
24. Roof Framing � 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing � � vC� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing �3 �` �(� 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation '� ( �l/ 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �� � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD ERTIFICATE ISSUED
33. Final Electric 9�0 G Q Notes: ��� � rQ,�,�
34. Final Heaiing & Air Conditioning ' I �' � ��
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 9ro �'G �('%
39. Water Service-Final
40. Gas Service-Final
i
41. Solar pomestic-Final ,
42. Backflow Preventer � r • � � � � ,
43_ Backflow Irrigation � �
44: Landscape Irrigation System
45. Sound Attenuation
46? Handicap Regulations
47� FINAL STRUCTURE & BUILDING , (�
48. Special Requirements Completed
49. Electrie Release to Edison • .
50.i�Gas Release to Southern California Gas Co � � .
51,' CERTI F ICATE OF OCCUPANCY '-
No � Date ! ' '" �
CityofCostaMesa INSULATION CERTIFICATION� euildingSafetyDivision'
12� `��o����L ���' ��' `r
Number and Street � City Coun
Subdivision
DESCRIPTION OF INSTALLATION
ROOF �. O
Material
Thickness (inches
EXTERIOR WA
Material �
Thickness (inches
CEILING / L
Batt or 8lanket Type � 7
Thickness (inches)
Loose Fill Type
Minimum Thickness (inches)
Area Covered (ftZ)
FLOOR,ELEVATED
Material
Thickness
FLOOR,SLAB �/
Material � ��// ���
Thickness (inches�
Width (inches)
FOUNDATION WALL
Material
Thickness (inches)
Lot Number
Brand Name �*/ , �
Thermal Resistance (R Value)
Brand Name (,/�lPif/ ! !7�/i/�/��
Thermal Resistance (R Value� %����
Brand Name (/�/PN �O/7/1� Ai�
Thermal Resistance (R Value) ��(�
Brand Name
Number of bags Weight per bag Ib.
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Val
Brand Name
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
DECLARATION
i hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administrative Codel.
Si9nature and Title
CMF 1306-46
�����y�
License Num�ber
� � �
Date
License Number
Oate
oWNER Ray & Shirley Harnoss DATE 8/2�/59
JOB ADDRESS �421 WOOd12rid Pl. BUILDING PERMIT NO. 102%12
GENERAL CONTRACTOR OWrieP VALUE S 19L.
1� TRACT 25y8 FIRE ZONE DESCRIPTION OF WORK blOCk w311
I�"�ECTIONS DATE I GROUP J
_ :rground SoIl U.G. Water —I SUBCONTRACTOR
.' �
:' � �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 31] � COSTA MESA. CALIFORNIA
fOR APPI/CRNT TO F/L[ /N COMPLfTELY
TYPE OR PRINT
BUILDING
ADDRESS Z
COSTA MESA. CALIFORNIA
■ aTr
Y
LEG1L I LOT l I I�L��J �YS
oescwirnon NO. BLOCK TRAC7'�
A.P. NO.
512E I NO. OF BLDGB. /
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
SETBACI( LINE FNOM �{y- �
CENTER OF 9TFEET J O � REAR YARD
q 1I
SIDE VARD LEFT �/ RIGHT
DESCRIPTION OF WORK
BUILDING
SIZE
EXTERIOR WALL
"x � . _�
�-- x - 4
�.
1 HEREBY ALKNOWLEI
AND $TATE THAT TI{!
PLY WITH ALL CIT�Y C
eUILDING <ONS/TKuC{T�
SIGNATURE�
PERMITTEE
AUTHORIZED AGENT
NO. OF
ROOMS
ROOF
COVERING
� � LYe�.rm>.
,�
THAT HAVC qEAD THIS APPLICATION
OVE 1 OHRECT AND AGREE TO COM-
IN6NCE�ND STPTE LAWS pEGULhTING
, , �,�,�a`�,I�`► ��
' ,I..'� ,I�� 1�_]j
APPLICATION � FOR PERMIT
BUILDING
fOR Off/Cf USE ONLY
IRECEIPI NO. I� ���Q�
NECEIVEO BY I OATE NECEIVED _I OATE 185UEC
COSTA MESA. CALIFORNIA
APPROVED �
BY DATE
ZONING
ZONE NO.OP USE OF NI
� ' PLANB BUILDIND
APPROVED
BY l�J,� DATE
o�'��
YARDS EYE3 �
REqUIREO ALLOWED
ICENTER IINE ST.1 _
�
�
THE AMOUNT BHOWN UNDER VALUFTION IB FOH TNE
PURP08E OF EST/�BLI6HING A PERMIT FEE ONLY.
VALUATION
PERMIT FEE $ pZ r ��
$ /� � �Q PLAN CHECK S
TOTAL FEE S � - �J
OWNER HARNOSS
JOB ADDftESS ,
DATE
GENERAL CONTRACTOR G. L. Grover VALUli S 259•0�
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK block walll__
IP'�PECTIONS I DnTE I GROUP Q TYPE %i� ZONE Rl
SUBCONTRACTOR
.. - .. 9892
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
fOR APPUCANT TO f/[L /N COMPLETELY
TYPE fOR PRINT
BUILDING �_ / fA _ _ _. . � ^
COSTA MESA. CALIFORNIA
LEGAL LOl
DEBCRIPTION NO.
SIZE NO.OF 0LDG8.
OF LOT NOW ON LOT
r 5¢TBI.CK IINE FROM
� DESCRIPTION OF WORK
BUILDING NO.OF
SIZE ROOMS
EXTERIOR WALL IROOF
r
I HEPEBY ACNNOWLEDGE THAT I HAV6 REqO THIS APPLICATION
NNO BTRTE TMAT THE ABOVE I CORRECT ANp �IGPEE TO COM-
PLY WITN ALL CITY ORDINA AND BTATE lPWS HEGULATIN
BUILDINO CONSTRVCTI N
SIGNATURE OF . /f/ /J] _ �� .�
AGENT
_ rz . '
. . .�. .e._..:._. . . .,-
' �l'Jl 1 � 195�5
Fll�'.P'CE J�:�'�i.
��T`! �� ��:'"` � �.o,�
APPLICATION FOR PERMIT
BUILDING
fOR OFF/CE USE ON[Y
APPROVED
BT I `AT6
COSTA MESA, CALIFORNIA
ZONING
NO.OR q UBE OF NI
PLANB 1 BUILUINO
xv�y
(CENTER LINE 6TJ
FRONT
R. 51 DE
TNE AMOUNT BHOWN UNDEN VALUATION IB FOR THE
PUHP09E OF EBTABLIBHING F PEHMIT FEE ONLY.
%ALUATION
PERMIT FEE S � -
S�G��__ PLAN CHECK $
�J
TOTAL FEE 5 � �
OWNER FJLIRWLN� H(1�S �PTC DATE 1—Z7-51 _
IOB ADDRESS L�'t Lr,.,.ai .,..a vi.,,,., BUILDING PERMIT NO. fi)i7Fi
GENERAL CONTRACTOR BgV Constr VAL[IE $ 16�177 (1f1
AP. No. LOT 1� TRAC'1' FII2E ZONE DESCRIPTION OF WORK RP.4_ W at.t,�ar
��OLIP r a. .i � TYPE n ZONE pi PLAN NO. oi.-,c
�..dPECTIONS I DATE � SUBCONTRACTOR � _ __ PERMITSIBSUED
Gas Test
r
A
w1
, ' ��_ / �
♦,
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31]
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
OUILDING
ADORE55 �i 2 i � neo �,v.�. �9�
COSTA MESA. CALIFORNIA
IOWNER
CITY /V .I'
ARCHITECT
OR ENGINEER
ADDRE55 IC
LEGA� LOT
DESCRIPTION NO.
A.P. NO.
SIZE
OF LOT C Sf
TN�Mi�
� �QNS� �iC.
N o.
PL�ce•�-r�N it
fr1� � Cm NO. � O�
TEL.
`�� N(l.
v IBLOCK TRAC
�� NO.OF BLOGS.
MOW ON LOT
SETBiCN LINE FPOM l. �, � •
CENTER OF STREET ��
SIDE YARD RIGHT
DESCRIPTION
NEW K ALTERATION
FEPAIR MO
BUILDII:G �/oO �
SIZE 6
E%TERIOR WALL
COVERING
USE OF NEW �i �S
BUILDING R
REAR YARD � �
LEFT S I
OF WORK
I II nooirioN
I II OEMOLISH
NO.OF
ROOMS STORIES
r�
.. .�:
� l'��L� G� ��-.IJLLu �'J .s,�J
�' �JAN 2 71959�,r�
FINRP!CE DEPT.
"ITY OF GOS?!1 ;.9ES�
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. p{PmIT NL
BUIIDING
ADDRE55
COSTA MESA. CALIFORNIA
APPROVEO
CORRECTIONS
The Amoun
I NEFEBY FCKNOWLEDGE TNAT I H4VE PERO THIS qPPLICFTION RND pur ose
STPTE TXAT THE /BOVE IS CORRECT ANO RGREE TO COMPLY WITM RlL D of esfablishing a permit fee onl .
CITV ORpINRNCES l�ND $T/�TE L<W$ REGVLATING BUILDING CONSiRVG�
TiON. V A W ATI ON
SIGNATURE OF PERMIT FEE S � 6 -�
PERMITTEE
// /''f - PLAN CHECK S ��'
�^ n 3 �O/ ( '/
eirrunvi�rn ercur � Q���_ {'In i'. u-..� TOTAL FEE 5 J y�— �sM�
�