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HomeMy WebLinkAbout2017 MAPLE AVE - Building Permits - f • F 9 CITY OF COSTA MESA 4 BUILDING-DIVISION o, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT .aroo a B04-00363 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2017 MAPLE AV Status: ISSUED Suite: Applied: 02/13/2004 Vicinity: Issued: 02/13/2004 Parcel Number: 42213401 Zoning: �-M Applicant: JERRY HELGUERO ISSUED BY: /22.. c_ Address: Phone: 714-612-1472 Zip: Owner: MARQUEZ, JESUS M w Address 2017 MAPLE ST • -�Y) Phone: w COSTA MESA,CA Zip: 92627 *vj. L �I � 1 Contractor: OWNER-BUILDER _ 5 Address: W _ Phone: • Zip: License: 000000 Arch : • Eng: Address: ' ' • Address: Phone: Phone: Zip: License: License: SCOPEOF PERMIT EXPAND EXISTING BEDROOMS BY 116SF FEE SUMMARY Plan Check: $90.51 Calc Valuation: $6,500.00 Permit: $139.25 Claim Valuation: $6,500.00 SMIP Res: $0.65 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $230.41 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 • NOTES: 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) ONS - WORKERS1COMPENSATION DECLARATION: t•�, 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 pd!{Brnance bf 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: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT M EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND C011 ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR 000E,INTEREST,MD 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 a 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: fl hA I hereby affirm that under penalty afperjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county whiih-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 of 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 s elects the applicant to a civil penalty of not moreithart five hundred dollars($500).): U .,a • -e property,or my employees with:wages as their sole compensation,WILL DO THE WORK,an.1h: -• ' • "=d or offered for sale(Sec. •44,B : :ss and Professions-Cade: Iho -• .ct•r ' -• .•• ..- . " •.ownero •a... • .wilds or improves thereon,and who does such work hint: or h: : . - •••tT s or n.employees,provLre+tharm.cltimprovaments.are.not intended-oroffered forsalerlf-however,the building or improvement is sold within one year o on,rtherowner-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 tothe Contractors License Laws.). art 1t ntler /-7 "24-1//*Business and Professions Code for this reason: l r' �" `� Tea � • Verification of Ownership by(type o document,i.e.-properly 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? ❑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? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia 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? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 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 ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia 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. Ar ignatur. •falre3. er(s) O Date •n.r1 A tori - Date CODE f INSPECTIONTYPE r RATE It:MALU CODEf INSPECTION TYPE DAIS INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retalning 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 , r • • \ DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER This Permit# • TO APPLY FOR PERMITS Street Address: 2-0 L-1- "'V Vip e-1 el e_ AP Number: 1. I (we), V S i✓�(t\V 6 Z , declare that I am the Owner of Title of the above referenced real property, and that I (we)herebyauthorize: (�, I Name: 1\F 5 1) S w( �.�-CT/ rTelephone Number: " k°1 v 14. �3 V Street Address:7 ©l.�- kp1 p I. E A U P City:@.D STA -S n State: C ' Zip: cl 2G3 to obtain permits in my behalf,as owner/builder,for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa,as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this day of 20 ,at ,California. Print Name: U a , \ CSL v Signature: Af U C-,- Date: Date: Z — 1 Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 0779-48(rev.11/00) Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITY• MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. • Ii mapie.. 91-. S 3+C4 3 2-'713 Applicant's Project Address ADD Li ALTERATION U REPAIR • TYPE OF CONSTRUCTION LI NEW z Applicant's Mailing Address 701 He Itrro-tk-v pe- ❑ CONVERSION El DEMOLISH ❑ OTHER Owner's Name rMs..c pl.er- A- \W5a Phone £'10 Ho A.P.# ��4 Q ' Zone 701 Nelfo{-vopz Ale Gyv o� �y� DESCRIPTION OF WORK/U$�OF BLDG. £Tr.4CM,V Address e O c* Mar- U Z 0p'2+� S Main Building- Ol,y't-- Mi Accessory Building: rch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL E Front [p`t/v 3G�v $ q O dress ,,((''''�� /! ���j//••777 El TENANT El ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B A Rear ' 7 ' N Codress is Name L// Phone ❑ OTHER _ co J L. C Right N dress(mailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCY /- v//!l1 CON ST RUCTION TYPE VALUATION$ aco.Oa $ Left rj G City License No. ZONE GRADING CU.YDS. ACRES E 21 ' LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PC 470-. CSS • Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and T my license Is in full force and effect. 2 Ca V �(4V F yh . 51=2 License Class License No. C •,'\ �J $ Date Signature PLUMBING FEES SOD 10 WORKERS' COMPENSATION DECLARATION • , hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ,00, Lab. C.) Automatic Washer Transformer 0 15-50 KW Construction Pole Sub Policy No. Company Backflow Irrigation Sewer Cap . 0 50+KW. Certified copy is hereby thcity furnished. • Certified copy is filed with the citBuilding Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date - Applicant - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This Section need not be completed if the permit is for one hundred($100)or - less). Dishwasher Solar Piping 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 at to subj the Drinking Fountains Solar Tank Fan Motors❑0-1 HP Di 1/2-8 Date/5 C,Qmpey sats�p}.aws of Califosrfl3-. j--(46"b`'R Signature/ Floor Drains Swimming Pool w/Spa F.A.U. • Inc.Solar❑9-15 HP 016-15+ NOTICE: If,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Mierdwaye comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes ' I hereby affirm that there is a construction lending agency for the performance ,P,OIe'Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Ran ' Lender's Name - i Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections following-reason (Section 7031.5 Business and Professional Code: Any city or - • county which requires'a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays / Generator ❑0-5 KW E15-15 KW Trash Compactor 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 Roof Drains the Contractor's License Law(Chapter 9 (commenting with Section 7000) of --- . • revision 3 of the Business and Professions Code) or that he/she is exempt refrom and the basis for the alleged exemption. Any violation of Section . 11.5 by any applicant for a permit subjects the applicant to a civil • _(natty of not more than five hundred dollars($500). . wy I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES thereon, Law does not apply to owner if a propf who builds or improves /J) to and who does such work himself/herself nts arelf or through his or her own Boiler Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: (7�) j 7 bs.>, employees,le. If, provided that such improvements eves are ointendedwihiyear red c for Zoning Approved By J'}� Date '� sale. If, te however,wthe building improvement of pro i soldhwithin one your of rim- - Canopy Type II ❑ ll elation, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By t•s i Date // /�� prove for the purpose of sale). • LI i as owner of the property, 1_IAIO am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Data 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 Duct-Ventilating 00100,000 BTU Ell 00,080 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- — •-, n tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ 10. 0.00 SMIP $ •Sd proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ / 0 PERMIT 0 I am exempt under Section - —B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ PERMIT ISSUANCE $ Date /1 -I Own L- C Y't„�_�g__P�t Heating System& Ducting Registers PLAN CHECK 25% $ _ ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0100,000 BTU 0100,00087 ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances • and state laws relating to building construction, and hereby authorize repre- PLANCHECK 50% $ MICROFILM $ sentatives of this city to e on a above-mentioned pro erty for en p /� inspection purposes. MECHANICAL $ / ro •7d .Signature c- Date TOTAL FEE $ Drivers' License or SS Reinspection Fee $15 Issue Fee S 3 PLAN CHECK 25% $ 1 ----.'MF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor 01 00009747-00009749 TOT 173.78 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. �)../� 2, 57. APPROVAL TO COVER:GUNITE 7. Footings • Orli gg- 58. Electrical Conduit-Undrgrnd. 8. Foundation • S/vv, &r !!!///`�'/cj,/ 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - W /r/� 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 FORPPLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 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 / l3I$F( 6u• 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:!"y( t/" 34. Final Heating & Air Conditioning ` j# .�/ ^�.- �� 01 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final 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 II/�Zs Ly J✓ . a.'• 48. Special Requirements Completed (( V 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date _ -__-- _1__C► lR4s aZe_�6 _a5time_ _ ow_vs-r___-Quttee_r e—gcoprI-c Cocotkec3 cct oL rm Pel _ _acco_ra, -- = - Appcc,,e. __ 63wIJ,..3 PSS , - — - • OWNER NAEGELI, H.A. . DATE 2-6-62 JOB ADDRESS 2017 Maple Ave. BUILDING PERMIT No.1G368- GENERAL CONTRACTOR :0wner'. VALUE $578.00 AP No. n5-315=1 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Carport INSPECTIONS Signature DATE GROUPJ TYPE V ZONE g2 Soil PERMITS ISSUED C SUBCONTRACTOR DATE NUMBER Rough Corn. Refrig. ❑ Air Cond. ❑ Rough Heating Rough Plumbing _ Miscellaneous Prop.Swr.Line 0 House Con. Q St.Swr. 0 Sprinkling System Construction Pole Underground ❑ Power Q _ Rough Wiring �y�t Trenches ❑ Forms 0 Steel Reinf. ❑15 /r+ 2.— /A_ 6 Z Floor System _134 Bond Beam 0 Steel Reinforce ❑ Sheathing Frame and Flashing FAL y-C-(1 Lathing — In 0 Out 0 Plaster, brown coat Refrig. ❑ Air Cond. ❑ Final He, _,'; g, Final PK;N;ks;ng Fixtures, Final Fin' t Gas Test Electric Fixtures, Final ��t�� // Building, Final yQt fr - ) . -CO.- OCCUPANCY FORM BU4.5M — 7.61 AVIA F E RECEIVED 1 6368 FEB 5 1962. COSTA MESA BUILDING-SAFETY DEPARTMENT 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 BUILDING /, jADDRESS y O / 7 44,1(0/....E At V r COSTA MESACALIFORNIA For Office Use Only �// y�./ rt �/{� /rL �1/ RECEIPT NO. ��pyey��.y}q(. OWNER 7I� / G �✓ l� h-- 1 _ cEMAIL � j I ' 3VV ADDRESS ._E.7 (l �I/} PA E.-.14 �i/ABY I Te Erv/ D I/ & /''� J TEL BUILDING 070 ��ff f0Vatic CITY `V a 3 1 4 Al X b A.-_ NO.4 k j ock ADDRESS O(O�� ARCHITECT TEL. COSTA MESA. CAL ORNIA - OR ENGINEER NO. ADDRESS FIRE ZONE TYPE/-1���j'' GROUP) CONTRACTOR 41:1)wN 1 RAPPROVED BY �j-� /_ ATE �'1/ ADDRESS IZONIING ///'''��, .712I NO.OF [j I USE OF NEW CC_EG_(I) CITY PLANS BUILDINIC(Lt /„ STATE TEL. LEGAL rj 7J ' 3 Lot? -1-6,0-{�1//� LIC.NO. NO. DESCRIPTION I IR 2 J SIZE ./ NO. OF BLOCS. , G OF LOT Gd`I / Q O NOW ON LOT p P NO fir— USE /� 315 USE OF //jj YARDS EVES EXISTING BLDG. CYA R fit, T I r APPROVED eeeTpp���' ALLOWED CENTERK LINE FROM 1 (CENTER T LINE ep:f' - �� CENTER OF STREET p�S` H. REAR YARD[ 7-1_ ( FRONT /l�(/1 IN. SIDE YARD I LEFT a` I RIGHT S R.SIDE 7 FT. IN. DESCRIPTION OF WORKq o t r ,VE V _ REAR L. E /{J T. 4sz• IN. rE Z NEW I II ALTERATION I II ADDITION I "- REPAIR I Il MOVING I II DEMOLISH I BPPROVE�Y ..?_S 6 .- - BUILDINGy I I, NO. OF > SIZE Ie "LO ROOMS ^ STORIES 1.01:1/1 ,t j�Lr. r L,a A •1---0 EXTERIORNWAL{{.._ ✓ I ROOF T7419-R /1 ` ,� LLQI I n_t �+ �� COVERING 6Yd/. .L.` COVERING//-SGA( / LL G' �I// USE BUILDING AND RK TO B PE Fc.ORMED 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. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OF, PERMIT FEE SLI PERM ITTEF 42:76C-01-e-1(1 ���JJJ(�/ a �� n $ '/,1 PLAN CHECK $ AUTHORIZED AGENT / V se-(f - - -. TOTAL FEE - E • Costa Mesa Building Department • ' APPLICATION FOR PERMIT „ ---4 ,. Ac ill EAST 20th STREET 969/ B U I L D I N G COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY �pgeipq'lyp. pert No. Building `/(i(�,l(�/ U 9 Address 2017 Maple Avenue - Costa Mesa, California Received by Date Recd. Date ssued Nearest I0 --') —s `r Cross St.Hamilton Building Address Owner $.$.K.&. H. , Inc. Costa Mesa, California Mail Address 419 E. 17th St. , Nearest Tel. Cross St. City Costa Mesa No. Li 8-1159 Zone ei I No.of I Type I Group Architect or Carlson & Lic. l� Plans Engineer Middlebrook No. Le-91580 Approvof S Date — Address Garden Grove, Calif. CORRECTIONS City LID. — Contractor Dike & ColeRrove No. 1301 Address 419'E. 17th St., Costa Mesa LegDescription l I No.Lot 7 I Block I Tract 2313 (Attach Metes and Bounds) I AN Size of Lot 65 X 99.22 I NNowon Lot None ®_. 444 kb Use of No.of No.of . 0 Existing Bldg. I Families I Rooms O Setback Line from Rear Yard 24.22 Center of Street SO' Side Yard 15.70 ' _3 2 4 19 -Jr D DESCRIPTION OF WORK • r New I X I Alteration I I Addition I C11Y OF COSTA (} Repair I I Moving I I Demolish I .r,E A Building No.of Size 973 sq.ft. Rooms 5 Stories 1 Exterior WallI Roof tu Covering beco Covering Camp APPROVALS Use of New Building Residence and Carport Foundation Location Inspector Date Forms,Materials, Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply Lath. Ext. with all City Ordinances and State Laws regulating building construction. Plaster, Int. Signature of S AP - Permittee Plaster,Ext. • Authorized Agt. / r Masonry Reinforced Valwation Permit Fee $ YU Plan Check $ 3 Bond Beam $ 8,000.00 Total Fee $ , 3 FINAL FORM 204 G-X 21.1 5-54