HomeMy WebLinkAbout1969 MAPLE AVE - Building Permits ,501 ." CITY OF COSTA•MESA
4
BUILDING DIVISION
. • r �It la 1.,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
ti. f Rnr
ERKR ' Fp
805-02098
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SLMLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1969 MAPLE AV Status: ISSUED
•
Suite: Applied: 11/21/2005
Vicinity: ROOF Issued: 11/21/2005
Primary Occ: R Type of Construction: V-N
Parcel Number: 42214109 Zoning:
Applicant: OLIVARES, ARTHUR A
Address: 1969 MAPLE AVE . '-
Phone: 949-642-5135 ISSUED BY:
COSTA MESA,CA Zip: 92627
Owner: OLIVARES, ARTHUR A -
Address 1969 MAPLE AVE `BB .
- Phone: EX fi 41
COSTA MESA,CA Zip: 92627 rp. po' ,'
Contractor OWNER-BUILDER .:DA
Address:
Phone: "' -• - ,
Zip: - License: 000000 . -
Arch : Eng: - ,
Address:- Address:
` . Phone: - Phone:
r
Zip: s , , , License: .: _.,,_.- -- License: .
SCOPE OF PERMIT '
TEAR OFF EXISTING ROOF.INSTALL 1 LAYER OF 30#FELT,30 YEAR COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEATHING AS
NEEDED. 1,100 S.F.FOR-S.F.D.
FEE SUMMARY .-
Plan Check: $0.00Calc Valuation: $2,200.00
Permit: '" $83.25 Claim Valuation: $2,200.00
SMIP Res: $0.50 .
SMIP Com: $0.00 . . . . ..
Other: $0.00 . '
Inspection: - $0.00
Total: $83.75 .
• PLANNING&.ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear' 0-0 .. Left 0 0"."-- - ',-Right - -0-0
ACCESSORY 'Front 0.0 Rear _0-0 Left 0-0 ,y;„ -Right 0-0
PARKING Existing: • 0 Required: 0 Proposed .' 0 _ • -
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448-46(6/00) •
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: ,•
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued. .T:, YZ e
❑ I have and will maintain workers'compensation insurance,asiequired fry`'ttt&i 3700 of tt)etabor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carder id policy nuprhber are:' [54 -
Carrier: .'U R '$i-4 •45.14�.y•.f Policy Number:
(This section need not be completed If to permit is Valued at ode hundred dollart($100)orless.),,?+;j{
u
C y ertiy 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,and a at if ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with.these provisi �` __
CApplicant Signature:., - t W1F/L.AA1 `Date:--- •// � �/ 0�
-WARNING:FAILURE TO SECU WORK PENSAT COVERAGE IS UNtAS UtAA��yyyyA 0 SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESJAND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND COLLARS(St W,000),IN AD ION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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 and Professions Code,and my license is in full
force and effect.Lic.a Class o
Contractor's Signature: Date:
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: "-
F_N
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 requiresa 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,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 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.).
I am exe er y/ r
Business and Professions Code for this reason: -
C Signature r [ Date:
-Owner ID verified 6 driver's lice e. f.&r'e0 No Drivels License No.
Expires;_
Verification of Ownership by(type of doc ,i.e.-property tax bill or-deed): �- - G
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 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? 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 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 filing 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_aPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j l Yes u No
(Section 65850.2 of the Califomia 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? 0 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 W 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
corre -: :e to ' wit : state laws ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
e•- a-••sc�� •r Ins con p ses.I a eon not to occupy or allow occupancy of any building authorized by this permit until final inspection.
—
Slgnature Of Legal Owner(s _ __ -> ate
And/Or Authorized Applicant Date
CODE P INSPECTION TYPE PAM INTRIAL5 CODE ll INSPECTION TYPE PATE MALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final w� 206 Final Plumbing
200 Final Re-Roof S-�`� t by O^ ). 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERS NO_ ^ TRACT NO. LOT NO. UNIT NO. BO6�IT 'I.2IO2/BG I5a550 TL
.Project Address 1969 Maple St. C/•S �'S7 N/ - •kJ
,
,pplicant's Mailing Address 126 Commercial, C.M. 92627 TYPE OF CONSTRUCTION U NEW L I ADD lSJ ALTERATION U REPAIR '
Ka Nelson Phone 646-8624 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name Y DESCRIPTION OF WORK/USE OF BLDG. remove existing roof from
Address — St-St ,xncFFZMeci('8_Q2c7� 2 rear seri-i On41 El�lY i. - e• _ .e � _ S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT (.J GRADING S FOUNDATION N STRUCTURAL • ! E Front 0
Address ❑ TENANT ❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear ' N
Contractor's Name Crank Bros. Roofing Phone 548-5569 0 OTHER A I
PROJECT DESCRIPTION SO. FT.1,347 OCCUPANCY family- C Right • N
Address(mailing) 126 COIIIQI' - W, •_ •- II'. - ' •• 7 K
CONSTRUCTION TYPE r,ac, Sent,Al VALUATION§1 ,750 no S Left
City License No. 05993ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref•' Parking Req./Provided E
I hereby affirm that a licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 70 rsion 3 of the Business and Professions Code, and
my Iicensfi e4/xad effect. 4" '677 s
"N„, License fM f !:
Date sea - —.. Signet u ;•1 e A ,ALF...... • FEES _
q
WORKERS' COMPENSATION ' LARATION Bar Sink Showers
\ ' hereby affirm that I have a certf cafe of consent to self-insure or a certificate ELECTRICAL FEES
1 !Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
.- .00, Lab. C.) OC Automatic Washer Transformer 0 15-50 KW
Policy No. p.285/Unit224ra6mpan 1 - •ei• . / C3 Backflow Irrigation Sewer Cap 0 50+KW
aCertif' o s heks.. furnished. Construction Pole Sub.
Cert" f£bWith the city Bullpin•ea Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
Dale Applicant C.�_,O_ IS•i: fsei1 1A. •.
EXEMPTION FROM WORKERS'COM; ATION DECLARATION Clarifiers Solar Collectors
_ Dishwasher Meter Dover 100 amps
(This section need not be completed I •ermit is for one hundred ($100)or _
Dishwasher
less). Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance ot e work for which this permit is issued.I 1
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0.1 HP 011/2-8
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa • F.A.U.
NOTICE:If,after making this declaration, you should become subject to the Int.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 Mi[rosvave
CONSTRUCTION LENOING AGENCY Gas Service Outlets Water Closet Device Boxes
1 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 Water Heater Outlets
Lender's Name Range
Lender's Address - Kitchen Sink Water Service
OWNER BUILDER DECLARATION Switches Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
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 Laundry Trays
any structure, prior to its issuenee, also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000)of
revision 3 of the Business and Professions-Code) or that he/she Is exempt - -
efrom and the basis for the alleged exemption. Any violation of Section
l.5 by any applicant for a permit subjects the applicant to a civil _�
.alty 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 I $15Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to en owner of a property who builds or improves a
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 Boiler 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
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale). - p
U I, as owner Of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By • Date I Z ' 2 - SA
tractors to construct the project (Section 7044,Business and Professions Code: '
The Contractor's License Law does not apply to an owner of property who ❑0-100,000 BTU x100,000 BTU
builds or Improves thereon, and who contracts for such projects with a con- Duct-Ventilating SUMMARY FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ �S• �� $ . . S-1)
prSMIP
0oI f oftheir Wnderr's Compensation insurance should be C.
for ded to me. PLAN CHECK $ PERMIT
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG 4h Fire Dampers
PLUMBING $ -ISSUANCE $
Date Owner Heating System&Ducting Registers - ENERGY P.C. $
• PLAN CHECK 25% $
I hereby certify that I have read this application and State that the above 00-10o,00o BTU 0100,00067E GRADING $
information Is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $
sentatir .f this city to • .r upon the bove-mentioned property for Kr /TT
inspecti.n p. r MECHANICAL $ TOTAL FEE $ IS'J V
poses. t'. /—
Signature ifs I .. 1•- Date/ ' t" V� t
Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
•
Drivers' U se- or SS q/ _
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -
C Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# - - Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS.FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ElGas 00i1
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0Oil
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:
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 i0la 47. FINAL STRUCTURE & BUILDING !y'/gb o f ---
48. Special Requirements Completed /'
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date _ /
OWNER NELSON, Kevin DATE 7-23-62
JOB ADDRESS 1969 Maple Ave. BUILDING PERMIT NO. 17552
GENERAL CONTRACTORA1ert Const. VALUE $ 111,956.00
AP No. 115-321-72 LOT TRACT FIRE ZONE DESCRIPTION OF WORKRe6.1/att.gar.
INSPECTIONS Signature DATE GROUP MT TYPE V ZONE 11-2
G+� /q ��5 qR-7-02 SUBCONTRACTOR PERMITS ISSUED
Water �, J�/Ti / -1-67 DATE NUMBER
Rough om. Refrig. ❑ Air Cond. 0 / t�
Rough Heating C-o 9- -r4j /f -' _ T - _i- o /, ‘
1-fCtet
Rough Plumbing _ 3 -21- _ , /W'_ &-t-6 z- _6 `^
Miscellaneous ,� ,u'
Prop.Swr.Line 8-House Con.F12,-.St.Swr. 0 �( ,&/ L 6,
- -, Wf 6 L -Arne
�- ��_�" e
Sprinkling System /VI
Construction ?ole y
Underground ❑ Power Q
Rough Wiring __ 'Ji 47 2G4-ta-C-LJ 7-4-61/ /k 2 '?./
Trenches 16,...---FormsJ6iSteel RemJf. U . �///. �" 9—
Floor System v�
Bond Beam 0 Steel Reinforce 0
Sheathing �-M Q�GL
Frame and Flashing /-071 1-2r Iy
Lathing — In 0 Out 0 t0 --6y--
Plaster, brown coat /3 hi e- !l — -- C. -n---
P
f7 `g. 0 Air Cond. 0 Final
1 ng, Final 1A/� !6'�ir2
Plumbing Fixtures, Final i /-1 f 2- ,
Final Gas Test ! �- -!
Electric Fixtures, Final �I ,
Building, Final -- ,
OCCUPANCY
FORM BU4•5M — 7-61 11552
F E RECEIVED
17552 JUL. z 21962 -
COSTA MESA BUILDING-SAFETY DEPARTMENT If `FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BE
ADD SS i //�1/4,1-
COSTA
tCOSTA MESA. CALIFORNIA For Office Use Only
y /j RECEIPT NO. PE M I.
/fi
OWNER e✓I IJ CLS O / .
MAIL �j q ,1� REC v Br ATE REc v8D DAT (BSu P
ADDRESS / / G / 44 4 la/A A 0Q. /-4--,& ..d. 7- 5- X
1 TEL. BUILDING ���D
CIS S 6- 6S/f- NO. ADDRESS/ w!9 W� Oat'
ARCHITECT TEL. - - COSTA MESA. CA ORNIA
OR ENGINEER NO. •
ADDRESS T-�' FIRE
//��// J -/ ZONE /7'�/TYPEGROOU y
CONTRACTOR Ne `�rL.�(1�ST/: BYFROVE[�/ DATE` G 3 /F C
ADDRESS Z :1. ICrD 1�aW ISSO AI- ZONING
L q ZO NO.OF USE OF NEW �(
CITY Ge,S//4' �j/�F_>�'Lr `( - �� IT1P�,uwlue, '�.�
BUILDING I/w/,41'� �� �J
6TATE // Y/ G / TNO. i 6-5f1 V j DESCRIPTION C ��I\ 471 �.)'-r�iw'-4'U'�-(•�
LIC.NO. YW' (P V/ V
SIZE `/ '/ O NO. OF BLOCS. A.P.NO. /Lc
3,
OF LOT CL' 71. I NOW ON LOT I/ 9 2 tad-4
•
USE OF YARDS EVES
EXISTING BLD . - C-e APPROVED ALLOWED
SETBACK LINE FROM7 0 (CENTER LINE ST.)
CENTER OF STREET ! -V!� REAR YARD _ FRONT 6 111
FT. I IN.
SIDE YARD I LEFT d '�O" I RIGHT Sr, ��
0R.SIDE �F'T. IN.
DESCRIPTION OF WORK . .�
L.SIDE U FT. IN.
NEW I X II ALTERATION I II ADDITION I REAR ! 9 FT. (I�N./
REPAIR I II MOVING I II DEMOLISH I APPROVED 111 to DATE -2 /-((I
SUILDING/ NO. OF L Ltd,
f
SIZEUIT73 NOOF ES STORIESZ� ?f'l
EXTERIOR WALL/ ,, ROOF
COVERING i/✓c.UO COVERING 206 IL-
USE OF BUILDING AND WORK TO BE PERFORMEED ��C/ ..
/�
�'vS .-d'6roc-iC w/.•1 tLAL t C•
/ /Ot�Sb i l
sL /J O 1 i .1 J
.l a _ < ads i __, 4_ . cs.....
I HE,EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOU SHOWN UNDER VALUATION S FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- ' PURPOSE Or ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDIN NOES AAAANNNND 4TATWS REGULATING
BUILDING CONSTRUCTIOVALUATION
SIGNATURE / PERMIT FEE S
N
PERMITTEE � ( L� $/ 9s' TPLAN OTALFEEKloWl
aAUTHORIZED AGENT f((!!�/ as ¢
OWNER DARBY,' 'ORDEN L. v DATE 11-1-54
JOB ADDRESS 1969 Maple •Street. 'BUILDING PERMIT NO. 684
GENERAL CONTRACTOR Owner-Builder VALUE $ 7:712.00
L AP.135-321-2 BLOCK TRACTpn�� Dwelling & Garage
GROUP I TYPE V ZONE RI4 FIRE DISTRICT 593
PERMITS ISSUED
INSPECTIONS DATE • SUBCONTRACTOR
I DATE NUMBER
Footing Trench 6.---E---57. J 8-4
Foundation Forms and Grade to Garage _
Rough Framing L;'•C- is 11—0`d`c'ii
Plumbing,Rough'to lab 7/ /7
Plumbing,Rough Complete / - �d, p^ , „ •/ - 4 • 4'9 4/
Temporary Pole
Wiring, Rough 3•!(. ,-. l -:57-3,5...:(..-A.-7.---/ _
79i.!/. //-/s•P-.1-ce / ./z) •
Heating, Rough
Heating,Final
Sewer rO /9-...„,,,,,,.__.
remc. a. 6---e- y-/b ' JAWAI�,If
. ., //-'e -rK /O 7,
Septic Tank or Cesspool 4--''‘
:
L 'g Yom✓ t z� ,7�e:F5 "r
Pla,.ering ,f., 6 Cs / ,/-,car ere-
Plumbing,
C
Plumbing,Final,Fixtures Co lete 8,- r/A /I"'-g-. 4/-75/C4:15-
ow—
Wiring,
Plumbing,Final Gas Test a eo�ir7 t- / / . -
Final €v--g �."- . : 1
Occupancy
Form 210 G-H 181 12-68 -
Costa Mesa Building Department 593APPLICATION FOR PERMIT
111 EAST 20th STREET B U I L_D Ii, N G . _ _2._ •
COSTA MESA, CALIFORNIA -
I FOR OFFICE USE ONLY '
FOR APPLICANT TO FILL IN Receipt No. Peer.
Building / / / �. V
AddresST. rePSne/Ne....7 bb bb h o
- , -Costa Mesa, California Received by. Date Recd. Date Issued
Nearest U ' --
/•
//-/ :3
Cross St. // ✓ Building ��� %
Address �j9 Building -
--17—
/�% �,,, J�4vL Costa liYesa, Ca orrna .
Mail
Address Pa ;Q,(• 1::[0...3 . .r Nearest
Tel. Cross St.
CitY_("61-5 To 4lct S/4 No. Zone (/ No.of Type _/ 1 Group
Architect or Lic. �T I Plans Y
Engineer No. Approved i '
by Date
iress : CORRECTIONS
City Lie. '
Contractor 10 n'/,/ .K No. i
•
Address •
Legal I Lot I
Description No. Block Tract /L��-1i1-6i �et
(Attach Metes and Bounds)N?. 1\'-3'a-`- 'rj-•
No.of Bldgs. -_--
Size of Lot 6 0 h i 2 G I Now on Lot /1 "t/,•_ D
Use of I No.of , I No.of OCT 4 1954 . C
Existing Bldg. Families Rooms'./ U
Setback Line from r-.„ / Rear Yard - - - _
Center of Street . ' tJ Side Yard .2 S _CITY !F COSTA:MFSA D
r.
DESCRIPTION OF WORK m
1 .
.
New - I-Alteration I I Addition I
Repair I I Moving Demolish I
Building ,7/ No.of
S' F7J/i 6 Rooms /74 Stories /
E for WallRoof
Covering Sf< n 0 I Covering C O/r f-'l(rpo. APPROVALS
Use of New Foundation Location Inspector' Date
Building ;,t�^J� p��,))) , Forms,Materials, P
/_'��'-Lt t;_,—`, Under-Pinning, `
Frame: Fire Stops,
Bracing,Bolts
Lath. Int. it;
.
I ./hereby acknowledge that I have read this Application ,
and state that the above is correct and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
i .
building construction.�gl //)) Plaster, Int.-
Signature
of 47_,c,et �-/ -
Permittee _ iet (7C
Plaster, Ext. Al -•� V i
Authorized Agt. I
Masonry Reinforced
Valuation �® Permit Fee $ .,,r /'
/�(} ` Plan Check $ Bond Beam /j(I • I /��L
$ p ! Feeal $ Z-3OO FINAL 6--6.-E /2 -284 4
Form 204 <:-H IM 12-53
i. . .
.. .o .• f. I'. .- -
•:
n c The South 60 feet of the North 120 ft.
o J of the East 120;feet of Lot 25, Fair— '
ao view .Farms;"as :per •thap-thereof rec.
.. _ _ _ _ ._ _ _ _ _ _ _1(..._ _ in Book 8, Page /1, M. M. Records Or.
r`' ' `• County•
.2 ,.1:e.; - ;!',..;0' AP number covers E one—half Lot 25
I :
. . ,...7.3
f.
f: 'I• (ate! ' '-
. t11 ._ _ 1
Street' -, e.. .. .. ..
o, , .
Show location and distances from '
property line and between buildings. ' .
Do you:carr? Workman's:;Co-mpensationi
Insurance? Yes . nr7. VL.
I am aware of Provision 37.00 of the Qtatt_ _ .,__ _ ____ _ _ _ -_ _
Labor Code which requires'everyomploy@t s ' . •
to be insured against li8b=ili-ty' f.or.'- "�'. - '
workman' s compensation., ! .._,._ • .
Signed: 1-1---66----1-/ • 454 ` 0 .. ..