HomeMy WebLinkAbout1915 KAUAI DR - Building Permits f 11.1
9 CITY OF COSTA MESA
4 � BUILDING DIVISION
> •0- ,,,r , DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
V• Ira • PERMIT P05-00318
`
(714)754•-X5.73 754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT -
•
Job Address: 1915 KAUAI DR Status: ISSUED
Suite No Applied: 04/29/2005
Issued: 04/29/2005
Vicinity:
•
Parcel Nunmber: 13951302 ISSUED BY: �
Applicant: SZABO, KEVIN
Address: 1730 MT.CLIFFWOOD
Phone: 714.241.1414'
17390 FOUNTAIN VALLEY,CA Zip: 92708
Owner: CLEMANS, SUSANNA T
Address 1915 KAUAI PL
Phone:
COSTA MESA,CA Zip: 92626
Contractor: COAST ROOTER PLUMBING HTG &NC
Address: 17390 MT CLIFFWOOD
Phone: (714)241-1414
FOUNTAIN VALLEY Zip: 92708
License: 529127
SCOPE OF PERMIT
WATER HEATER CHANGE OUT
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 - Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
" Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 _ Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(14 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
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)
•
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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.
Fitave 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.
Ilaworkers'compensation Insurance carrier and policy number are: (�/_{�(
Cater: Srt'P11`� cU n.1� P61i,Niptfi y /yO OJ z0'7
(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 Califomie,,end agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fdrthwlth
comply with these provisions! .r-----
AppIi N'SfgneWr'3: c � L at M'1 '4/Za'/0f
1';i J ((
Wr NTNG:FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm tha am licensed under provisions of C apler 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full .
force andeffecteL Y r2-°7 It-7 owd"1 C-3 L
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CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Cale).
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 tho 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 Ucense 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 tho burdon 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 exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes ❑No Driver's 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 California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 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? 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 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�Yes LJ 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? 0 Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cale).
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? 0 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.
gnat - • egal Owners) D e
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I An. •r Aul ied'Appliiant L le` ;
ODE/ QISPECTIONTTPE PATE INITIALS CODE. INSPECTIONTYPE QAIE INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical / ,v!
1266 Pool Spa Final 208 Final Plumbing 6—/Z-o6 clC
200 Final Re-Roof 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
ADDITIONS, ITL'ETIONS, OR CORRECTIONS SHALL _ FOR INSPECTIONS
190 DE AP.'R,'vtu ;Y 1EL PLANKI °I; DEPARTMENT INSPECTIONS��UU
CALL (,R15 Thr,
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_• ,.�..,...__.__—_ 754-5626
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Eget. 754-5627
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_ I I BY _ DATE 63—26,19"t_Q_
hi NOTE
2 i9NOlE THESE PLANS MUST BE ON J E AT ALL TIMES MAKE
NO CHANGES S WII 'PROP,O , n 2 Ok,L-� Di D6?T.
ADDITIONS, 0 ELETIONS, OR CORRECTIONS SHALL THEISSUANCE OR a i.JG C A F EM o «a ,4�?or
BE •
APPROV i BY THE PLANNING DEPARTMENT FLAN AND SPECj COTQNS EiI NOT E C vST R,ED-V1 EEA
• PEEIT EON, CE AN APP:NOVAL Cr, ANT VIOLFI,,ON OP ANT OP' I
1HE PROVISIONS OFTHS COD_ A 'iitii PRcSIA,5Y10 ;-,NE _
• I AOTHOPETY ?G VIOLATE CE CANCEL 7H5 PROVISIONS CC i:-;IS
I CODE SHALL F:E V.GHP v:0- 6S SO FAR AS TNrz 470RK OR;ISE
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;MIXT ADDRESS: 1915 KAUAI DR UNIT: CITY OF COSTA MESA — BUILDING PERMITPERM NO: ' B' 048790
OWNER'S NAME: TRACY, NORMA J
ADDRESS: 1915 KAUAI PL PERMIT NO: B 048790 PLAN CHECK NO: 05516-90 S '
GOVT : N SUPP : N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
/ 545-0147
', ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 2 SKYLIGHTS ICB0#2469 IN GARAGE SQ FT: 300
ADDRESS: UNIT:
;`LE CLAIM VALUE: 300 . 00 CALC—VALUE: 300 . 00 GROUP OCC : M-1 /
PERMITTEE: PACIFIC CONST. 6 INT. ( 714 ) 953-1763
ADDRESS: 17751 MITCHELL COMMENTS : REFER TO #B48161
IRVINE CA 92714 ***>FTETE -*****+E* **aE*aE*tE>FSE********x-************+r*****+r** **>E**>F>E **************ak*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY UC.:0 3 3 8 6 STATE LIC.:4 4 4 014 CLASS:B
Date:�f.I5s; `k c' Signature: ,�Y '-7 7 MAIN BUILDING ACCESSORY BUILDING
rFRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I herebya at I hav certificate of consent to self-insure or a certificate of Workers
Compensation,19suan&itrrAu ig09o5fthereof(SectionMOO,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
• POLICY NO.: 5b EXP.DATE: 06/01 /91
COMPANY: NATIONWIDE PARKING REQ: 2 PROV: 2 PARCEL : 13951302 ZNE: R1 REF NO:
"1 Certified copy is hereby famished. ® Certified copy is filed with the city Building Division. c PLANNING NOTES> TWO, 2X4 SKYLIGHTS TO BE INSTALLED IN NEW GARAGE ROOF ( FIRE
c� F\` > DAMAGED) . GARAGE NOT TO BE USED FOR LIVING PURPOSES.,.
Datern 1I.e.a I `i r' Applicant: Md ,/ .��r-�.—'� �y / ********************dF*****************it*******************************it********
EXEMPTION FROM WORKERS'COMPENSATIO DECLARATION: is recti need not be completed if the permit is for one hundred($100)or I DEVELOPMENT SERVICES REQUIREMENT)• S
I certify that In the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY CLA0 DATE:
6T2P,- 7 0
Date: Signature:
NOTICE:If.atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: '
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. '.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: 8c----re -cia
which this permit is issued(Section 3037,Civ.C). ******************************************** * *********************.aE• *********
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 15 . 00 . 50
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN 9 . 75
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($580). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 15 . 50 0 . 00 9 . 75 25 . 25 25 . 25 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersell or through ..
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 25 , 2$ OVER/SHORT; . 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 1$ . 0 �l . 5 0 9 . 75
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or Improves thereon
and who contracts for such projects with acontractor(s)license pursuant to the Contactors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUALF E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIOAN UNIT COST TOTAL COST
Date: Owner: SFR 300 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 300 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END' OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: •
•)
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county r
ordinances aro state laws relating to building construction and hereby authorize representatives of this city to 1.above-mentioned ^'
property far igspection purposes. ! / y
Date ."1/,..L.1t' (9 c signal_ /�`-^— _-_ •.•• i, 01 00068569-00063571 TOT 25._5
DATE: 02/28/90 Tia: 14:41
Driver's License or Social Security N:
1641-46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
y POO, ,PA
CONS#UCTION AND PLANNING
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 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26, T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 572.1. go, $ %9-Q'4 , 4 7
34. Final Heating& Air Conditioning O `j'
35. Final Gas Pipe-Test v-
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. Backf low Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
�46q. Handicap Regulations
V' FINAL STRUCTURE & BUILDING stnic, &W
48. FINAL PLANNING v
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
DRESS: 1915 KAUAI DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO:,- 13'; 048161
NAME: CLEMENS -
RESS: SAME PERMIT NO: B 048161 PLAN CHECK NO: N GOVT: N SUPP : N
CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE: REP
ARCH/ENGINEER: 545-0147 REG.ND.: JOB DESCRIPTION : REPAIR FIRE DAMAGE TO ROOF SQ FT : 2, 000
ADDRESS: UNIT:
CLAIM VAL'TJEit . 2, 000 . 00 CALC—VALUE: 2, 000 . 00 GROUP OCC : R-3 /
PERMITTEE: PACIFIC CONST. 6 INT. ( 714 ) 953-1763
ADDRESS: 17751 MITCHELL COMMENTS.: MIGHT NEED PLANS
IRVINE CA 92714 f�E�Eax 'F � p *-x* * r* F* *�E *aF*�EaE+aaE Ee ar rx E F** * E� r E � +E *r * *�r * ix*�a� F
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T S
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S' E T B A C K S
areuc.: 0333X6 STATE UC.: 44014 C
Dale:-]��z �`r C� �si9nawre:�_ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby allimlHhsfhha a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT ; FT IN REAR: FT IN
Compensation lQsprance oracyrtifle cop thereof(Section 3800,Lab.C).. LEFT: FT IN RGHT: FT IN LEFT : FT IN RGHT; FT IN
POLICY NO.: / 3WGsu004562 EXP.DATE: Ub/O1 /91
COMPANY: NATIONWIDE PARKING REQ: PROV: PARCEL : 13951302 ZNE: REF NO:
❑ Certified copy is herebyy furnished. (71,Certified copy is filed with the city Balding Division. `^l PLANNING NOTES>
ate: —7)l to ' !0 ( Applicant: ��E,--�14:2C— J / *********M*****!it**.i4e$E*****W********M**********#dE******************#if'3E�E**-1F*****
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION:��not be 6mnwlelei D me permit it to one hundred(St2D)a less). D E V E L O P M E N' 'Ir S E R V I C E S R E Q U I R E M E N •T; S
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
•
Date: signature: BUILDING APPROVED BY'' : DATE;
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor . ��
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. ', - _ `� /
CONSTRUCTION LENDING AGENCY: I hereby affirm that there Is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; C.
DATE: ) ' 6�,b
which this permit is issued(Section 3097.Civ.C). **1E**9E****eEeF3EeEfEiEeEiE9fiE3EaE3E*if9fiE9f BE4EaE1E**if*3E1E3E1E*3EiEx '�*!E9EdEeE 4eEiE*W 9F£�F33F3F*3E
UNDER: **eE*eE*eEiEefeEiEdE***1lEiE%iEiE3EiEjE********3EiEiE9E#iEfE9E9E3E1EjEfE****jE1EiE?E****iEjEiE?EiE#?(-9E#fEjE*3 +c. xac{Ei ***
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 45 . 00 . 5 0
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
•
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE F E E
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intendeor offered for sale(Section 7044, Business ess and Professional Code: The Contractors'State License Law TOTAL 5————> 4 5 , 5 0 0 • 0 0 0 . 00 4 5 . S 0 45 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS——> COLLECT ED • 45 . 50 OVER/SHORT• ,00
improvementsold one year of completion,the owner will have the burden of proving he/she did not build or Improve
for the enoseBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
tis of of sale).
I,as owner of the properrlyry,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45 . 00 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ************************************ *,N,****,N,#it, *iF,E*iFiEitik**************i(*********
and who contracts for such projects tsth a e License to the of Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY D E S C R I P T I O ':N UNIT COST TOTAL COST
Date: Owner: _. - SFR 2000 FIRE DAMAGE/VAL RESIDENTIAL NOZONE 1 , 00 2, 000 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and END OF FEES
25534 and that I or any future building occupant wig/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Ah Duality Management DtsWct,Residential construction applications are exempt from Ai
these provisions. ,
Date: Applicant:
• 1
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county r
ordinances and state laws relating to building construction and hereby authorize representat$ 5n iter the above-mentioned
property for inspection purposes. /
(Signature' 01 00065392-00065392 •T E31 T /r5.i:(
Date: 7/I L4 i 40 `Signature: i '' DATE: 07/16/90 TIME: 11:0$
Driver's License or Social Security 9: ::::: •S/ 01 00065390-00065391 T LJ T ?:
164146 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor r DATE; 07/16/90 TIME: 11:07
NSTRUCTION AND PLANNING POOL A
''ROYALS 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,CI Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O 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 I 64. Plumbing System - Final r
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 FORPLASTERING
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. Duct5, 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 0 Oil
25. Roof Sheathing ?ef(2p df 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing 174�� 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 0/M
78. FIRE PREV. FINAL
30. Drywall Nailing OarHEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ff . 7cx . A dal. 4
/ 'tdc'i � SGcB Io m
34. Final Heating & Air Conditioning rC�
35. Final Gas Pipe-Test �E
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47 FINAL STRUCTURE& BUILDING �� 6tV /7
48. FINAL PLANNING !!
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Wry-
psi 4, CITY OF COSTA MESA -
4 ,
BUILDING DIVISION
y ,4 DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
•t J �°•
PERMIT
t BOO-01781
epommw
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.�UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1915 KAUAI DR Status: ISSUED
Suite: Applied: 11/06/2000
Vicinity: Issued: 11/06/2000
Parcel Number: 13951302 Zoning: R1 R1
Applicant: EATON, JEFF s19
Address: ISSUED BY:
Phone:
Zip: 92626
Owner: CLEMANS, SUSANNAT
Address 1915 KAUAI PL
Phone:
COSTA MESA,CA Zip: 92626
Contractor: ROSS & BARROWS INC.
Address: 260 E.ALTON AVE
• Phone: (714)557-7440
SANTA ANA,CA
Zip: 92707 License: 327802
•
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISITING SHAKE ROOF, INSTALL CLASS C SHAKE. -
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $12,900.00
Permit: $223.25 - - Claim Valuation: $12,900.00
SMIP Res: $1.29
SMIP Corn: $0.00
Other: $0.00 7'
Inspection: $0.00 •
•
Total: $224.54 •
•
•
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 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)7545626
2446-46(6100)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: L
0 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
�tt__�,,//g11 work for which this permit is issued.
,Ca/ I have and will maintain workers'comps ation insurance,as required by section 3700 of the Labor Code,for the performance of the work for w ' f{his permit is Issued.
My workers'compensation Insurance erne?and policy number are: 84— �r
Carrier: 7�/,/�� A. Policy Number:
(This section need not be cPpi;ted if f ermif is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance o e work for which this permit is issued,I shall not employ any person in any manner so as to bee e subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 37 0 of the Labor Code,I shall forthwith
comply with these provisions.
eppiica`n6Signeture:— .c.--- -- Date: f Crtt
WARNING:FAILURE TO SE .c.--- --KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES A D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000), DDITION 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.It Class#
ontractoriSignature:> —
er
LC ----- 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:
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 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 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,talsework,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 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 ❑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? 0 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 ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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? 0 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 correot. 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.
atu�Legal Owner(s) g67/60
Date
LAnd/O_Authorized"Applicant-- (JDate
CODE N INSPECTION TYPE UAT€ INTITIALS CODE I INSPECTION TYPE 481E INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof /r ti— Co 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
tilOWNER TRACEY, RICHARD DATE 2-26-68
JOB ADDRESS 1915 Kauai Place BUILDING PERMIT NO. 28246
NN-
GENERAL CONTRACTOR Capitol Masonry Contr. DESCRIPTION OF WORK 2 Ret. Walls and Jock Fence
AP No. LOT 25 TRACT 6384 FIRE ZONE VALUE $716.00
Ski INSPECTIONS I Signature Date _ GROUP ,7 TYPE III ZONE R-1
LF PERMITS ISSUED
. SUBCONTRACTOR I Date I Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con. p �
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rowh Wirin — Heating and Vent.
Tre
Trenches� Forms ❑ Steel Reinf.fry
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing— In ❑ Out 0
Plaster, Brown Coat
Structural, Final Electric
He,;;?:, Vent., Refrig. and A.C., Final
Plti g, Final and Gas Test 0
Electric, Final D y�
RA/.Lnilrlina Final {Z'
of 2Q., - Tract 6384
Plan11—A w4
i Oit
PAID
COSTA MESA BUILDING-SAFETY DEPARTMENT MAY 25-67EMSAO01417* F.A 147.00
P.O.BOX 317 COSTA MESA.CALIFORNIA
\ /
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS 1914 Ka,iai P1 an C M RECEIPT NO, p�eWT
COSTA MESA. CALIFORNIA '�" 4 N t.Yy
RID TE RECEIVED DATE ISSUED
owNERC1ub House Road Joint Ventura. t/ ,5"--,Pa-67 C 2-‘7
MAIL BUILDING
ADDRESS 2850 Mesa Verde Drive ADDRESS
FIRE /
CITY Costa Mesa No'549-0395 ZONE TYPE {/ GROUP /1).-----
APPROVED
AP^HITECT'GINEER E.G. Kaltenbach x'547-804 BY DATE
C
ZONING 12.e_4t,‘
ADDRESS : . ant, Ana EON No.OP i UBE OF NEW
M1I '�/�PunE r BUILDING u�� �
CONTRACTOR Republic Homes Corp.
"V1\\1
LEGAL ,e. S j 7-R. 6 3��
ADDRESS 2850 Mesa Verde Drive DESCRIPTION
CITY Costa Mesa A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
uoA.No. 197838 TEL 549-0395 SO•TO SIDE REAR P•L
EAVES
SIZENO.OF BLOCS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT 60 x 1001 I NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FRO REST)
SETBACK LINE FROM
CENTER OF STREET 4 5 1 REAR YARD 30 I FRO FT.
C
SIDE YARD I LEFT 5 I RIGHT 5 ' R.SIDE -) FT. FT.
DESCRIPTION OF WORK L.BIDS CET. FT.
- ALTERATION -_ ADDITION REAR 3 a FT. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLD¢S. ACCESS.SLOGS.
BUILDING NO.OF VAR.$ DATE
SIZE 2478sq . f1FtOOMs 9 STORIES ]3 C.U.P. APPROVED
EXTERIOR WAL,lWood& ROOF APP��''ppyyE
COVERING at UC CO COVERING ]Mood BYL(f.'i�!- DATE cc� ( I- �1
USE OF BUILDIt - - - PERFORMED
te ilintir If
J a /7'/' 97fri ll
N
BQ.FT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN U DER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECTECAND AGREE
�{}TTO COM. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. 4
PLY WITH ALL�; ON ORDINANCES ANOND/ B REG LATIryG VALUATION 5 //
BUILDING CO/ '�//' '\�Ls 0
PERMIT FEE/
$ N
SIGNATU•,) / m
PERMITT- l.,O` 4/9- y
/ -/�/��er eget S 30-2,. / v P4,AN CHECK 5
`�O i %E/�/i/L!/ 4
AUTHORIZED �/
: �, TQTAL FEE 5 /% / --
e 28246 0
FW 26- , ;00 533 d*****6.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
•
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING /JG9/ For Office Use Only
ADDRESS .7 X4f4 i�
RECEIPT NO. �EgM�71{O`
COSTA MESA. CALIFORNIA �w � JpR-'� "CCC..JCyUUJ�`P)`w}6p
F. ,, y� ETEC FE� 4,1:072;77
//f 6-� 4b-6r7
OWNER ilie iAieD //e..)C. r
MAIL
p _ J/ ^ / BUILDING /9 jL. 41(it , L f,A �.
ADDRESS/'1 1 -/m /� UA AVi Ly// 'T FIRE E � \.J fC.0-C.C/
CITY l /J-A 'O2& '( . NO.Wio/V/ ZONE �j't?TYY�PE GROUP
'HITECT TELNO. APBYCPpRJYi[OD/nI KYCJv 010 "
/_ DATE K�J/`�-
if
NGINEER NO.
ZONING 4 V
ADDRESS t'aa,x,, � ZORI I HOOP I BB[OPN[W p �A/`," silt//
C, /ii/44i ��, �/J,L) Pun[ y BuuDlno ��p_(Y•4!/O�JL'
CONTRACTOR ./-
� Q/� Q
LEGAL ` r / / ]tel( /
ADQRESS /1/-1r/ SAL( /LCU DESCRIPTION / ,F+ 7 1 LJ
C44,4
/Ma
z'g. . A.P.NO.
CITY VT+TL^ P//"`d"'L
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
UC.TNO.2S ��yyc' CSS' Tit S4/5 vVii 0 EO'TO SIDE a REAR P.L.
EAVES
SIZE I NO.OF SLDYS. ALLOWED (U..B.C.REQUIREMENT)
OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
'. EXISTING BLDG.
(FROM C/L STREET) —.--
' SETBACK LINE FROM FRONT FT. r FT.
' CENTER OP STREET REAR YARD
1,3
'* SIDE YARD LEFT RIGHT R.SIDE FT. .
DESCRIPTION OF WORK L.SIDE PT. OFT.
et
_ ALTERATION ADDITION REAR PT. Oen.
DISTANCE BET. BET.MAIN&
'� REPAIR MOVING PEMOLISry MAIN BLDGS. ACCESS.BLDOS.
I VAR.# DATE
": BUILDING NO.OF
SIZE• ROOMS STORIES C.U.P.# APPROVED
t: EXTERIOR WALL I ROOERING APPROVED / ^ /^ / -Q
! COVERING (�/1 ,1,.DATE J� /-`+ `� /J
USE OF BUILDING AND WORK TO BE PERFORMED uJj \, D,
7 Q„I SG.FT.
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. JN.
PLY WITH ALL CITY ORM NCE/AND STAT[JAWS REGULATING
N BUILDING CONSTRU VALUATION D
L�J ”"����,,,, / n $ 6 '4D E
, SIGNATURE OF / iyr/// // y, 40
PERMIT FEE
• PERMITTEE C" 4a ///���CCC l J/' J �� �� w
1 f 7/G . PLAN CHECK S
AUTHORIZED AGENT / n i�
TOTAL FEE $ (O �(/