HomeMy WebLinkAbout3090 YELLOWSTONE DR - Building Permits t` 9 CITY OF COSTA MESA
BUILDING DIVISION
Y :-i ..4i DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
J 7� • PERMIT
E01-00644
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 3090 YELLOWSTONE DR Status: ISSUED
Suite No Applied: 07/17/2001
Vicinity: NORTH SIDE OF HOUSE Issued: 07/17/2001
Parcel Nunmber: 14107220
Applicant: GLICK, BRUCE ISSUED BY: •
Address: 21121 GREENBORO LN
Phone: (714)536-7728
HUNINGTON BEACH,CA Zip: 92646
Owner: SHARP, THOMAS C
Address 3090 YELLOWSTONE DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: E M G ELECTRIC
Address: 21121 GREENBORO LN
Phone: (714)536-7728
HUNINGTON BEACH,CA Zip: 92646
License: 743243
•
SCOPE OF PERMIT
UPGRADE EXISTING ELECTRICAL SERVICE TO 200 AMP.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 • up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $30.50 1 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
L❑_ _I certify that in the performance of the work for whlohtthi emit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califo ia,and agree the Id become.subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr • /
Applicant Signature: !i //-�" 7 -6 /
Date:
WARNING:FAILURE TO SECURE WORKERS COMPE COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES 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 p Nsions-Qf Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect. 4 / 7(-( 3 A 4 - //�/ Class e ((/
Contractors Signature: � ff� ;Date: 7-/7-O
CONSTRUCTION LENDING AGENCY:
❑ i hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perm+,
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,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the properly,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,end who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers 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,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Heath and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature end pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
.....D...........the ..p
5 Does he will the applicant or Quality
or n building o from at requirethr for the work which is the soof this a estion aNnit for such construction or modification
from the South Coast Air Quelity Management District or from any other air pollution control district or agency? �Yes U 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 0 No
Of'yes-,the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Coda).
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 0 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.
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.
doss ,J, al Owner(s) Date
APT
And/Or Authorized Applicant —�� :Date
CODE I INSPECTION TYPE RAIL MEM POOL( INSPECRON TYPE PdIE UTIPM,Si
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 72..'S0)
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
,. OWNER CRIPPEN, DONALD WILLIS DATE 4-1-b5
3 JOB ADDRESS 3090 Yellowstone Dr. BUILDING PERMIT NO. 23835
GENERAL CONTRACTOR Bonded Bldrs. DESCRIPTION OF WORK Add Fam.Rm. to Res.
AP No,141-072=20 LOT TRACT FIRE ZONE VALUE $ 2,500.00
I ECTIONS Signature Date GROUP I TYPE V ZONE Ill
Sou PERMITS ISSUED
Gas SUBCONTRACTOR I Date I Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.C]
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
' Rou:h Wirin: rea -1/-`.S Heating and Vent.
Trenches& Forms i Steel Reinf. 0 11,r��"
Floor System ''��%7wr
Bond Beam 0 teel Reinforce 0, - �
Sheathing cAJ�
Frame and Flashing Q Qi %)I(_
Lathing — In ❑ Out 0 - ('�T'1'.. .
Plaster, Brown Coat O- i
S tural, Final Electric
h -ng, Vent., Refrig. and A.C., Final = ded7tLe ` - ', =Mr 3Y6
Plumbing, Final and Gas Test 0
Electric, Final I/arei-- -
Ruilding. Final IA' MIT iz-2.-ar
Wi l tot b I✓ZiiA MESA
23835 APR 1 1965
COSTA MESA BUILDING-SAFETY DEPARTMENT
. - P.O.BOX 317 COSTA MESA.CALIFORNIA
For Applicant to Fill In Completely ".: lik, w tar
TYPE OR PRINT BUILDING
Bu1LDING �` �//��" ,[ For Office Use Only
ADDRESS 20 / 0 ) //&stow DIAD
RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA a -3 a3 r
//•7Q p RE BY [�pATER HIVED
� JSSUED
//`S�
OWNER 11/#4//7.xMAIL / /�/Ai `-�/- /�'y/ C/� BUILDINO�O !Q (�/•+-4W�1 J/ iC
ADDRESS,id yo J(✓/!l`♦J c 'o,yC 41 € • ADDRESS
,//� - TEL. Al �Y-T ZONE ' VTYPE GROUP C_
CITY�/J('f� ///PSH NO. Qrls ! {c,APP D /�Q` /T• <i
ARCHITECT TEL. BY n 1 y `1J / /�'� DATE // -;J
OR ENGINEER NOTE �1 �(�
V IN
♦ .ESS tNO.OF^ - U '
SE OF NEW 1
��jj / ' I PLANS // I BUILDING I 1
CONTRACTOR.$A//ACQ�/�1[�JS
1 0� �(/�
LEL r /
ADDRESSS.-,3//�I Jest4Joca P I DESCRIPTION ', / / �1 n l •
CITY /� .? • (p4 A.P.NO. /LJ / - " "(1- l0
Z S_a / NOTE: NO EAVE��OVERHANG SHALL BE LESS THAN
STATE TEL. 90'TO SIDE B REAR P.L.
LIC.NO.2.Z// 2-3 NO.
EAVES
BIZE
OF LOT 6 a JC(6! a NO.OF 51.005 / ALLOWED (U.B.C.REQUIREMENT)
e NOW ON LOST
YARDS APPROVED YARDS APPROVED
USE OF
EXISTING BLDG., ,,(/Pi/'',714,74nA 2/+qe MAIN BUILDING ACCESSORY BUILDING
z (FROM
CENTER OPINE FROMEET • REAR YARD 3Q, FRONT C/L STREET e F7
SIDE YARD! LEFT .f I I RIGHT 3„... ' R.SIDE CI. (
FT.
DESCRIPTION OF WORK L.SIDE /.-13
-1I3FI'. FT.
NEW ALTERATION _ ADDITION x REAR -1 - RT. FT.
DISTANCE BET. BET.MAIN B
REF,..R MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
BUILDING - /NO.OF VAR.$t DATE
SIZE /0 X 7 Q ROOMS / STORIES / _C.U.P.# APPROVED
EXTERIOR WALL S I ROOF // APPROVED (1,/,(4) /i/ t
COVERING /4/Q/1/j COVERING (,:�0�7�7 BY re""E �( I[J J
USE OF BUILDING AND WORK TO BE PERFORMED
���h1/17 _goon? AICD -
N
" SO.FT. ..
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
•
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. D
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION /Pw '
BUILDING CONSTRUCTION �1U
PERMIT FEE $ f.);
SIGNATURE OF/ —� 12—m
PERM ITTEF (
152/LTO PLAN CHECK $ b
AUTHORIZED AGENT Cl $ •••••//2. L
N TOTAL FEE
OWNER CRIPPEN, A. DATE 3.20-69
JOB ADDRESS 3090 Yellowstone Drive BUILDING PERMIT NO. 29870
GENERAL CONTRACTOR Master Builders, Inc. DESCRIPTION of WORK Add Fam• Rm. Study & Bath
E. ` 'bo- 141-072-20 LOT 8 TRACT ¶23 FIRE ZONE VALUE $ 6,860.00
itY'",t+ECTIONS Signature Date GROUP I TYPE V ZONE R-1
soil SUBCONTRACTOR PERMITS ISSUED
GAS Date Number I Signature
WATER Plumbing
ROUGH PLUMBING ZIP/ eJ�..�tELcirin Z
41:•744--(2,y 5406-0," ry-
PROP. SWR. LINE Q HOUSE CON. U
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER E l 9
ROUGH WIRING APe fl. G
Y. Heating and Vent.
TRENCHES 0 FORMS fl STEEL REINF. E I
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE Il yyj/,/',gJ/,�
SHEATHING Af ltca L( !%/"/W C/-'R-(1 tY
FRAME AND FLASt LH / A r-7i-EG
LATHING - IN rt OUT �4d C-'9-fr rV
PLASTER, BROWN COAT JJ M 7-,(.-p{f f
S TURAL, FINAL • y Iesicic � �J ♦��J ( /
H. .NG, VENT., REFRIG. AND A.C., FINAL GS/7°
_ /jj l• V-1 C_C(� i` 1-67 y�7EG�/
PLUMBING, FINAL AND GAS TEST n �l/� `!' T �(n I /
ELECTRIC, FINAL /I/1, 1-/B-7d
BUILDING, FINAL /94411--/0.7Q .
29870 MAR 20-69c1- 00 509* ****52.50KSA
• • 'COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
R%ECEIV Y- DATE RECEIVED
DATE ISSUED
BUILDING 7-1/_65-20-‘7.3 09 YELU. CO t€1Ok.)t ..b(2_
_ 'tom PERMITr
OWNER b„CR-t I-A A.P.NO. /ill-aria .10 296 ��
MAIL /� BUILDING ^� yyy
ADDRESSw is; A-Ne t a��n13 ADDRESS 3�/D (/Q�`�
C U CITY Cs 0c7A (Vit \, NO.TE0 (oZ TRACT I�/� 3 LOT7 BLOCK
Z CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMDI ICHOZ N �FJ�LENDER A2, a.:Z�
a 03
J D BRANCH
J N '` ,
C ADDRESS OWNER U ( ��Y L
�fi `_jam_ VALUE m�
C S N( /J/r M. /y�O
ARCHITECT /n /� TEL. l8• USE ! 474`1 $ �r/ ""'
J 4 OR ENGINEER(fijr D. C'r(���v*3tQ .. NO. 7.--/
5 in
LI���Z oc,,, _14 Jt2�1 FIRE -1C
W C ADDRESS F+t�7a N- ZONE#� TYPE-1C GROUP �j
0_ Ly 1f�At�,. / _
JO CONTRACTOR 1;41343-43Zad �v1L6(3,jg f�C APPROVED iJy/ qTE -�-�
JCC ADDRESS 23,SI- k. Llact • 6 .42 "' /
0 TEL. 87_6. -- Z E NO.OF USE OF NEW ht�
Z i CITY A� _`
A� - NO. 46„1_0
-/ ']/PLANSBUILDING 31-/J
W O STATE CITY YARDS APPROVED YARDS APPROVE
In X LIC.NO. �1- 1 /'J LIC.NO. MAIN BUILDING ACCESSORY BUILDING
_0 SIZE NO.OF BLOCS. (FROM C/L STREET) if ,,���`,,��.,r{{{{{�
OF LOT �>c too— NOW ON LOT 1 FRONT I) FT. 6 / FT.
USE OF r �y /����/� /
EXISTING BLDG. bit"g LL 1..i 5 _R.SIDE L`""Y 2S --(-7 FT,
I- SIZE OF ']CNO.OF /
ZZ NEW BLDG. ' ROOMS - STORIES .2— L.SIDE •f FT. AL1 FT.
EXTERIOR WALL ROOF ^� • .,^�D /
t_.1 COVERING 6T"-'-O _COVERING 3Com- REAR QL/T.J/ FT.
I USE OF BUILDING AND WORK TO BE PERFORMED
)• DISTANCEABET. AEC.MAIN&
/, MAIN BLOCS. ACCESS. SLOGS.
VAR.5SL DATE
0 2,°*•• CID: -cr t�lO///'Z///j''' 0V ..t�l�L$ s C.U.P.# APPROVED /%J
z CI Nyr -Q��t1titg�(/��APPROVEDLail ��// /�/
0
~ I hereby acknowledge that I have read this application and sfate
Dthat the above information Is correct and agree to comply with
cc all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
CO the State of California. so
ZI 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 s liven are I ull force end effect,or I THE PURPC6E OF ESTABLISHING A PERMIT FEE ONLY: 2
am exempt from the vislo f th ata of California Business VALUATION
and Professions Cod isio Ch r 9. M j
W PERMIT FEE $ 1,57e
Signature of l' `,.0,s ,, - Xn/O /7 D m
Permittee ""`a"�1--�" $ 4p• / U O PLAN CHECK S E
_ o`
Authorized Agent i 2 f ` 0 Ia_
�— TOTAL FEE $ ✓
OWNER MR. & MRS. CRIPPEN DATE 1/5181
JOB ADDRESS 3090 Yellowstone Drive BUILDING PERMIT NO. 51189
Gc!`s',ERAL CONTRACTOR Dan Crlmmton DESCRIPTION of WORK B ocksn al l
k= ;;o. 141-072-20 LOT 21 TRACT 4041 FIRE ZONE VALUE $ 800.00
INSPECTIONS Signature Date TYPE GROUP ZONE Rl
SOIL SUBCONTRACTOR PERMITS'I S ED
GAS _ Date Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. U •
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND U POWER
0 ROUGH WIRING Heating and Vent. •
X TRENCHES fl FORMS U STEEL REINF. U
td FLOOR SYSTEM
•
b BONO BEAM n STEEL REINFORCE 7
SHEATHING
FRAME AND FLASHING
UI LATHING — IN 7OUT n
ItF 'ER. BROWN COAT _
a= :TURAL, FINAL < c /j ij�/ //
y 1 Elertric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST fl
ELECTRIC, FINAL
BUILDING, FINAL (�A '7/j/-//'p /
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
RECE BY 1PEIRtifH' 1/ ff}�Di - - U `50 TL
For Applicant to Fill in Completely — Use Ink Only _-- . • t`i' •51189-
BUILDING `y/L' �.�y� �` A.P.NO. k'-' C7Z--aC
ADDRESS .3090 /Ci Lam)3A 37-15 Alp. ` �..}7� ,/j`
C` BUILDING 3 7o ve'a.10041./-0 Ale
OWNER OR ADDRESS V t!
TENANT &ISR _ _ dit7,5 , Jai ?lb en!
UNIT OR
MAI LING SPACE NO.
ADDRESSSQIn rp L L o w An n/Fa T NO. LOT BLK. r
TEL. ' �` 2...3
CITY (1)O 5 /Ff.—/ tdro A NOS.S-7,,..45.F> NEW •ADD ALTER (REPAIR (MOVING DEMOLISH
CONSTRUCTION
�" V/
LENDER
BRANCH I � xsp^ - /
OWNER �` f/ t/l,�
ADDRESS I- VALUE 120
ARCHITECT TEL. USE LCC /.j J�� $
�(J(�
OR ENGINEER NO. 1 ' 34.)
ADDRESS ZONE R` TYPE GROUP
APPROVED
CONTRACTOR-DA
^j R(,,LA-fp GA/ BY DATE
ADDRESS/Se/SZ (To/L-4-v Iii A L.W.
`/' / TEL
FCITY /.70A,71 /8"LCVr,LI NO. n '"SYrf, _
STATE CITY IJ APPROVED SETBACKS
LIC.NO. 3`F Z l/ 2 LIC.NO.
SIZE INO.OF BLD(a5. (FROM C/L STREET)
S OF LOT NOW ON LOT FRONT SO FT.
a USE OF
�/��
.ci EXISTING BLDG. R SIDE FT.
til
F5 Separate permits are required for L.SIDE FT.
la electric,plumbing and heating work. REAR Q FT.
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
v
Q y� _ ^ ,'. 1 ^�L DATE
CJ r1�/ I�[/'y` •�.(i(Y`{ APPROVED
APPRpVE //��//�
�m/Y)li Al/ 7---i) �Y &E& DATE Isis 3 I
cd
ta
aLI hereby acknowledge that I have read this application and state n
that the above information Is correct and agree to comply with
4 all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of
S
the State of California,
m
I hereby certify that I am properly licensed as a contractor under SO. FT. w
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: e \
am exempt from the provisions of the State of California Business
y�7� o
and Professions Code,Division 3,Chapter 9. PERMIT FEE $ 25 Oe N 00
en
Slgnotur. of - / ��` /" PLAN CHECK $ a v l
Permitn - d s S�• TAX $ t..1 ) t: /yt�
Authorized Agent Date ! -- 5_ - J 7 ` TOTAL PAID $ R.5! J W
OWNER CRIPPEN, DONALD W. DATE JUN 1 0 1964
JOB ADDRESS 3090 Yellowstone Drive BUILDING PERMIT NO. -22443.- -
` / GENERAL CONTRACTOR Owner-builder VALUE $ 175.00
AP No141-072-20 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORKB1oCk Wall
L,`.r'NECTIONS Signature DATE GROUP J TYPE III ZONE R 1
ISSUED
SUBCONTRACTOR TERMITS NUMBER Gas DATE NUMB
Water
u Rough Corn. Refrig. ,p Air Cond. 0
l Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line.0 House Con. 0 St. Swr. 0
Sprinkling System
Construction Pole
Underground 0 Power 0
Rough Wiring
Trenches!0 Forms 0 Steel Rein/. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing— In 0 Out 0
Plaster, brown coat
Air Con, 0 Final
I4`1tng, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures. Final
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OCCUPANCY
Form BU4--SMS-63—S-n P / / ,. ) 00)1/12
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• / I 22443 FEE RECEIVED
• -COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. to 198t
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ����TFyI nAFF rr ee7D� MMT���pp
For Applicant to Fill In Completely ! AFPLICA7fON QOR'PFRNtR
TYPE OR PRINT BUILDING
euILDINa For ONice Use Only
ADDRESS So90 YElio wsr er►18 .DR.
RECEIPT NO.
No. 2[RISS
COSTA MESA. CALIFORNIA A 'f74(,�n
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ADDRESS / / /[ /� (� ^ 111
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BUILDING NO.OF VAR.# DATE
SIZE ROOMS STORIES C.U.P.# APPROVED
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I HOMY ACKNOWLEDGE TMAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE C
AND STATE THAT THE ABOVE.IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ES AND STATE LA (DILATING
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SIGNA OCO OF ON/ 3� ; /
PERMITTEE OF 1�L 1//•T/.(///'// 1 PERMIT FEE $ G
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AUTHORIZED AGENT 1 • TOTAL PEE $ J
RVE13596 FEE • ECUD
COSTA MESA BUILDING-SAFETY DEPARTMENTJAN 10 ism
P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
• EOR APPLICANT TO MI IN COMPLETELY APPLICATION FOR UPER�MIT MESA
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 3090 YELLOWSTONE DRIVE
COSTA MESA. CALIFORNIA EOR OffICE USE ONLY
I RECEIPT NO. ILV �Pv bi'NO.
OWNER KWK CONSTRUCTION CO. , INC. V J
MAIL RECEIyyED BYDATE NEC IVEq DATE ISSUED
ADDRESS 1555 PLA CENT IA AVENUE MI GL I / - til JAN i 1 loci
TEL BUILDING
CITY NEWPORT BEACH CALIF NO. 6-3227 ADDRESS
ARCHITECT LIC.
OP TINTER NO. COSTA MESA, CALIFORNIA
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CONTRACTOR K. W. KOLL L C.No.61195 BBYPROVED DATE
ADDRESS 1555 PLA CENT IA NEWPORT BEACH ZONING
LEGAL LOT 1+D 1 ZONE NO.OF UBE OF NEW
DESCRIPTION I NO. 23 I BLOCK I TRACT R-1 I PLANE/ /^/ I BUILDING%/att/gar•
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A.P.NO. none `YARDS °y�.�VC1.f_�
OF LOT SIZE 6OX1OO I NOW ON LOT NO.OF BLOCS.0 REQUIRED ALLOWED
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EXISTING BLDG. FRONT Ilt.J FT. C)q p 3,1(n IN.
SETBACK LINE STREET 451
451 REAR YARD 301 R.SIDE 5 FT. IN.
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DESCRIPTION OF WORK . Z?
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REPAIR I I MOVING I II DEMOLISH I I
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EXTERIOR WAI&J. ROOF lC
COVERING OI UCCO I COVERING ROCK (� y
USE OF BUILDING AND WORK TO BE PERFORMED / C-1)-
ATTACHED
FAMILY RESIDENCE AND �l/(�J
ATTACHED GARAGE PLAN No. 1-AR
I HEREBY ACKNOWLEDGE THAT I HAVE READ IS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT A• •.ACRE TO COM.
PLY WITH ALL CITY ORDINANCES AND STA /LAWS LATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTI VALUATION -T
SIGNATURE OF (/ PERMIT FEE S " ,,,R.------7
PERM J
$ 14.72. /PLAN CHECK $ 4'�__.
AUTHORIZED AGENT TOTAL FEE $ '/f n