HomeMy WebLinkAbout1925 KAUAI DR - Building Permits . . - • _
• CITY OF COSTA MESA S
4 t L!7 BUILDING DIVISION •
,°y; 1,
• ^_ ' 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
If 0. � FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: 809-00027
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 13951304 DATE ISSUED: 02/1012009
ISSUED BY: RMD
JOB ADDRESS: 1925 KAUAI DR CM Suite/Unit: '-:.
Vicinity: HOUSE AND GARAGE ROOF
Squares: 3200 -- - - Valuation: $9,800.00
•
SCOPE OF WORK: TEAR OFF,;(E)SHAKE'MATERIALS, INSTALL 1 LAYER OF 30#FELT ANDREROOF WITH.LIFETIME COMP
SHINGLES ON AN ATTACHED.HOUSE AND GARAGE,APPROX 32 SQUARES. REPAIR AND REPLACE SHEATHING AS
NEEDED.
OWNER: HATTON,JAMES A . Address: 1925 KAUAI PL . Unit:
PHONE: 714-957-0705 ,' -City/State/Zip: COSTA MESA,CA ,
•PPLICANT: WILLIAMS,'LARRY ` I Address: 101 THE MASTERS CI Unit: :
PHONE: 714-444-1111 . City/State/Zip: COSTA MESA,CA • - -
CONTRACTOR: ALL COAST ROOFING AND COATINGS . - . • License No: 598440
Address: 101 THE MASTERS ClUnit: . ' - PHONE: 714-444-1111
City/State/Zip: COSTA MESA:CA 92627 .. .. ., CELL:
ARCHITECT: . . License No. .` PHONE: 3 .
•
ENGINEER: - License No. . PHONE:
FEE SUMMARY
Reroof Plan Check: , '.$0.00.
Reroof Permit Fee: <"'$181.25 . ... -. _ - .. •
Reinspection Fee: $0.00_ .
Bldg Std Admin Fund
TOTAL FEES $182.25 -
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE O. INSPECTION TYPE on INTITIALS CODE! INSPECTION TYPE D INITIALS
1616 Fixed System Final Fire Prevention 208 Final Mechanical .
1266 Pool Spa Final ---- 1
,1 208 Final Plumbing'
L'a i
200 Final Re-Roof - I 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
WORKERS'COMPENSATION DECLARATION: - Owner ID verified by drive nse. ❑Yes ❑No , ,
I hereby affirm under penalty of perjury one of the fo owing declarations: Driver's License No. Expires:
A
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. - -
❑ I have and will maintain workers'compensation insurance,as required by •
section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
permit is issued. My work rs' compensation Insurance carrier and policy D I hereby certify that no excavation five(5)or more feet in depth into which a
number are: . ^ �� ^ person is required to descend,will be made in connection with work authorized
Carrier: .. LLlnv ref C/ `tr(,`L//'o�`dby 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
(This secfun need not be completed A the permit is valued al e hundred dollars less)
2,Art 2,Sec.341,Title 8,Calfgrrlla Administrative Code).
Policy Number: j .v
cr ❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the pe •w-nce of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ - to any manner so as to become subject such person has a permit to do such work from the division.
to the workers' com. .. California, and agree tha if I should
become subjSt to the . - nsation provisions of Se. ion 3700 of
Applicants Signature Date
the Lab. e,I - all •r • . with these provisio .
• ' 0 `. • Division of Industrial Safety Permit Number:
—Appli..nrs Signature _ ,Dae HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAIL-'E TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No
111.
_Class#. cetio 25533 re the California Healtheand SafetysaCode, with sometb
exceptions, requires registration with the Costa Mesa Fire Department by
_ irffraA each business which at any one time has on hand a quantity of acutely
act re Date. , 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
Lender's Address: (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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE'OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree,to comply with all state laws and
properly, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
❑ I. as owner of the '
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this applicatiomand state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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 y this permit u• spection.
ignature of L= i •.
Signaturey
Date ii
3051-46(3101) _ - Ill��l
PROJECT ADDRESS: 1925 KAUAI DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 060396
OWNERS NAME: HATTON, JAMES A
ADDRESS: HATTONSYLVIA B PERMIT NO: P 060396 PLAN CHECK NO: N GOVT: N SUPP: N
1925 KAUAI PL
COSTA MESA,CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: OTH
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : INSTALL GAS LINE & OUTLET FOR BBQ SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
PERMITTEE: RON PECA LANDSCAPING ( 714 ) 557-5488
ADDRESS: 1062 SAN PABLO COMMENTS: NATURAL GAS FUEL FOR BACK YARD BBQ
COSTA MESA CA 92626 ******************************************* ir*****Nsr**sr******************SEsr** sr
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I ant licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code •. • '..nse is i . • , .nd effect. SETBACKS
CITY uc.: O 33STATE UC.:335 i 18 C •
Date: /"3//7/9.2— Signage;_ MAIN BUILDING ACCESSORY BUILDING
Nillfr
WORKERS'COMPENSATION DECLARATION: I hereby a all have a cent consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
raRcg�q[ cjrone pv thereof(Section 3800.Lab. ). LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
Compensation lnsu
POLICY No.: 04J 37�.S-$4 EXP.DATE: 0X6/24 /93
COMPANY: STATE FUND � `% PARKING REO PROV: PARCEL: 13951304 ZNE: REF NO:
Certified
copy hereby grmsnetl. Cenifie. opy is lile. '1 t‘city a iMi Division. PLANNING NOtES>
• Date: lai/4— `� Applies *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIO . I eclion need not be completed it the permit is for one hundred(5101)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Syoushould
BUILDING APPROVED BY
NOTICE:If.after making this declaration,you shoulul d become subject to the Workers'Compensation provisions of the Labor DATE
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. I l ;r o-/�y
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: L 1 4`_� DATE• 1 2 D/ 7 Z
which this permit is issued(Section 3097.Civ.C). *******se****************$ L* * * * *** * * *** *******************iE if iF ll#FF iF iF iFif iE
LENDER: ********************************************* *********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I 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 5,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5 3 — SMIP/NON—RES
pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by .'x
PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 20. 00
I, as owner of the progeny or my employees with wages as their sole compensation, wit 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----> 5 . 00 20.00 0 . 00 25. 00 25.00 . 00
does not apply to an owner 01 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.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 25. 00 OVER/SHORT: ,00
improvement
SOW
in one year of completion,the owner will have the burden of proving he/she did not build or improve
tor the purpose olsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 25 . 00
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
2.
Dale: Owner: PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 5. 00 5 . 00
I do hereby certify that I am aware el and understand the requirements of California Health and Safely 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. r ri
Date: Applicant:
I hereby certify that I have read This application and state ti S • :•ve infor ion is c 1.I agree to comply with all city and county
ordinances and stale lawsrerla g to building construct.'.ad hereby. third/ epresenta ive of this city to enter upon the above mentioned /
property ton insp tion aur les `I/
�� Date: Sign lure: ,
Driver's License or Social Security N:
164 t'46 White—Building;Green—Code Enforcement:Canary—AoolicanC Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POO. WA
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 UF ER Grnd. i 57. APPROVAL TO COVER-GUNITE
T..Fodtings - 58. Electrical Conduit-Undrgrnd.
8, Foundation a 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 Lineg& 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
r i L?
20. Rough Factory FTeplace I C' . • '• x APPROVALS.�o:'Permit # �,
21: Ducts,in-Structure. I - - - r 170. Underground Hydro
22. Ducts, Ventilating • i - .� •t - . 171. Product Piping 0 Gas 00i1I 23:,GacPipe= ough&jest r I i -s" r-
R rr ��:. 72. Underground Flush, a
24. IRoof Framing ax 1 i . •• .- • '. 73r.Undergrnd:Stordge'Tank 0 Gas 0Oil
25. Roof Sheathing _
, r' ;t .74, Overhead Hydro:
26'J-Bar Ceiling (Structural) & Monocoat K 75-•:Dry Chemical - • -- r:
•
27. frame and Flashing` r ` _ . 76. Dry Standpipe . . .
28. Lathing.& Siding - r - t, • I I ••I 77. FIXED SYSTEM;FINAL- _ r
.29. Insulation .. - I. I.- 78. FIRE PREV. FINAL -
30. Drywall Nailing r. _ - • •HEALTHT.DEPT. REQUIREMENT
.• Y
-31. Plaster Shawn,Coat79. FINAL INSPECTION . -
32._ElectricalPower MeterrFinali - I.
y •80.. FOOD CERTIFICATE ISSUED
33.i•Final Electric I I falt.._.. :Notes: IZ-alt.._*kir. Zet.,04-- L.I 4
34. Final Heating:& Air.Conditioning I
$5:.Final Gas•Pipe-Telt g/ Q2- 4 '. '
36. Hood or Canopy •
37.Final Factory Fireplace - - - _
38. Final Plumbing i /7./zaa4Z (�9 -. ~
'39. Water Service-Final • t- I - . ~
40. Gas Service-Final - I
I _
41. Solar Domestic-Final - - • - I -
42.'Backflow Preventer -- - - If • '
43. Backflow Irrigation . -
44. Landscape Irrigation System- ; , - - ,- •' _ - -•
-45..Sound Attenuation '
56. Handicap,Regulations -
47.,FINAL STRUCTURE & BUILDING I I •
48. FINAL PLANNING _
• 49.•Eleciric Release to Edison
50.
Gas-Release to Southern California Gas Co -. I I ,r .
51. CERTIFICATE CF;OCCUPANCY • • • ,
No. Date
PROJECT ADDRESS: UNIT:
1925 KAUAI DR CI�1 Y OF COSTA MESA — BUILDING PERMIT PERM NO: E 060395
OWNER'S NAME: HATTON, JAMES A
AOOREss: HATTON SYLVIA B _
PERMIT NO: E 060395 ' PLAN CHECK NO: N GOVT: N SUPP; N
1925 KAUAI PL
COSTA MESA,CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL ONE ABOVE GROUND PORTABLE SPA SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
PERMITTEE: RON PECA LANDSCAPING ( 714 ) 557-5488
ADDRESS: 1062 SAN PABLO COMMENTS: PERMIT INCLUDES MISC. ELEC. CONDUIT 6 OUTLET RUNNING TO GAZEBO.
COSTA MESA CA 92626 ;PSP ¢�e**;P�rsE;EkF*;¢xsr;r*;ESE;6;rsPSESPSE*;P;r;r;rsr;rsr;P;¢sEsr;rstx****;r;r;t*+E**;ts¢**srsrsr*sryr*erFFSP*srsr;rsr****sr;r***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed u •, •rovisions of Chapter 9(commencing with Section ZONING R EQUIREMENTS
7000)of Division 3 of the Business and Professions Code .•• y licens• in f I •rce and effect. SETBACKS
CITY LAC.:01/3 31 STATE LAC.:3 3 • 18 I CLASS: - 7
ii—V//V gal— Sign.ure: ' - ) MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPEN ATION DECLARATION: I hereb . ' that I have ac• icate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C) LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
POucYND.: 0453353-92 EXP.DATE: 06/24 /93
COMPANY: STATE FUND PARKING REQ• PROV: PARCEL: 13951304 ZNE: REF NO:
7 Certified copy is(hereby
y furnished. 3 Certified :•y is file. 'Ih a city :u d g Division. PLANNING N TES>
Date: ii�J! %�— Applica I: / ****-1e**************************************************if****1E***************1E**
DEVELOPMENT S E R V I C E SR E Q/� U I R E M E N T S
EXEMPTION FROM WORKERS'COMPENSATION DEwhich this
IO . a•'.section m•• • ••completed it the permit is for one hundred(5100)or less). ld
I certify that in the performance of the work for which tDermil 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 — L DATE:
Date: Signature' BUILDING APPROVED BY : :/A-2- _7 c '
Di. .d.:* /72—
Code.
q
NOTICE:If.alter making this declaration.you should become subjectpermito the Workers'Compensation provisions of the Labor L— d.1 DATE: /�( � /2
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. pk,aL! (�/k 1� 1(�F�I
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for lFieltM iFRiFiFlP% }�F} - ' - r' e.....-....m.- DATE• l v/72
which this permit is issued(Section 3097.Civ.C). *44;n
* . . .; . . . . . ************* ****,***
LENDER: *********************************************** ******************************
ADDRESS: LECALIEATION1N F R N SUMMARY STRUCTURAL SEGMENT;N
OWNER BUILDER DECLARATION: I hereby affirm that I 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 1325
.
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 PLAN SOY SMIP/NON—RES
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($500). t ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: the Contractors'State License Law k TOTALS----> 13. 25 15. 0 0 0. 00 2$ . 25 28 . 25 • 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 sate.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 28 . 25 OVER/SHORT: 00
improvement sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
foror the purposeeof sale).
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the propeny.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 28 . 25
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: ELE 3 RECEPT/OUTLET 1 ST 20 EA• . 75 2 . 25
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 1 MISC APPARATUS NOT LISTED REQ PERMIT 11 . 0 0 11 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from END OF FEE
these provisions.
I
Date: n Applicant:
herebycertifyd that laws
r readn this ingtion and state that the above inforri; e isnt • : agree to complyruwith all city and ned J
ordinances and state laws relating to building construction antlr •'.t rtin epr¢sentaliv of this city to enter upon the above-mentioned
property for inspection pure ses.
Date: lW`rsP. iffa' Slgnatur
Driver's License or Social Security#: : .
1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:'Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POO, 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.,Fogtings - 58. Electrical Conduit-Undrgrnd. .
I
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 Lin&& House Connection 62. Backwash & Receptor-Final
12.p Sewer Cap 63. Heater & Vent-Final
13. Roof Drains -u 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
T --
20. Rough Factory Fireplace I _ I r.. - -"- APPROVALS, ' Permit #
21: Duets, in Structure .. . - .. ...1 • r = 70. Underground.Hydro
22. Ducts, Ventilating, ; ; -f, t t 17 n _ 71. Product Pipiltg ❑Gas 0Oil
23.`:Gas PipetRough & lest r, it -
." - 72. Underground Flush + •
24. RootFraming • ; ' " '' n '73: Undergrnd.StorageTankf7Gas 0 Oil
•
25. Roof Sheathing ' : ' ;' " U. ' 74,- Overhead Hydro- -
26. T-Bar Ceiling (Structural) &.Monocoat - :< h 75.-Dry Chemical , .-
27._Frame and Flashings .-...z. y 76. Dry Standpipe -. "
-28.• Latfing,& Siding- -.1): > .?I 77.j.FIXED SYSTEM;FINAL^ -
>29. Insulation 78: FIRE PREY. FINAL • .
30. Drywall Nailing _ HEALTH DEPTH REQUIREMENT
�t31. Plaster Brown Coat;, 79.- FINAL .INSPECTION. ' ..
32. Electrical Power Meter'Final i' . '® f- FOOD CERTIFICATE ISSUED --_
33. Fina ,.t . - Ml Electric " I31 /Pt - No^ . t' l -
'34. Final Heating;& Air,Conditionigg: r _
I-
,35.,FinatGaiPipg,Te4t" s. I` '
$6. Hood or:Canopy . I - ® .' _ • •
37, Final Factory Fireplace - - - -. ' , _
-38. Final,Plumbing
..39. Water Service-Final i - . - .
'
,40. Gas Service-Final ` _ '1*1
41. Solar Domestic-Final •-
42. Backflow Preventer - -
43. Backflow Irrigation
44. Landscape Ireigation System - " „ _ ' . . -
45.-Sound Attenuation
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING , I
48. FINALPLANNING •
.- I _ .
49. Electric Release to Edison i {
•50. Gas Release to Southern California Gas Co . - " - .
,51. CERTIFICATEOF:000UPANCY
No. Date
PROJECT ADDRESS: 1925 KAUAI DR UNIT: lS% CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 060392 ,
OWNER'S NAME: HATTON, JAMES A -.
. ADDRESS: HATTON SYLVIA B PERMIT NO: B 060392 PLAN CHECK NO: 04919-92 S GOVT: N SUPP: N
1925 KAUAI PL
COSTA MESA,CA 92626 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH
ARCH/ENGINEER: REG.NO.:
JOB DESCRIPTION : 40LIN FT OF RCMU RET. WALL @ 30" HIGH SQ FT: 40 V
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: 1 , 200 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: RON PECA LANDSCAPING ( 714 ) 557-5488
ADDRESS: 1062 SAN PABLO COMMENTS: SMOKE DETECTORS�F REQUIRED PER THE 1991 EDITION OF THE UBC
COSTA MESA CA 92626 ****** *4********�¢iE�F�F�F****D¢*F �F+F�F�P******�P�F�P+E�F�F�P� ***�E�¢RFs¢*�t�P�P�P*�F�F�F*�¢X* ***********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code.and ,, •n i is in full f. effect. SETBACKS
CITY LIC.:01 319 STATE Llc.:3 3 5 0 : ,' •SS:
— /.a/ Z �� • MAIN BUILDING ACCESSORY BUILDING
Date, / E Signature:ereby - --
FENT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certifi anent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation fgsyr8c5 IA gertifig0 copy thereof(Section 3803.Lab. 1
POLICY NO.: t/97 J.S D.f—`12 EXP.DATE: 6/24 /93
cOMPANY: STATE FUNDPARKING REQ: PROV: PARCEL: 13951304 ZNE: R1 REF NO•
1 Certified copy is hereby furnished- IN Certified co• is filed•I h the ty Wirt , Division. PLANNING NOTES> 30" HIGH RETAINING WALL TO BE BUILT PERPINDICULAR FROM REAR
•._ p > OF EXISTING SINGLE FAMILY RES TO BACK PROPERTY LINE.
Date: 1y/Op / `)• Applicant. ************************************************************************** ****
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: section need not.'completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
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:y:uL making this ywideclaration.you should become t i subject the a Workers'mCompensation provisions of the Labor ��
Cade.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: /g.//r 2
which this permit is issued(Section 3097.Civ.C). **********************•**** * ***** ***7{E **9E* *************i* *** ****
UNDER: ********************************************k!. ********************************
ADDRESS: LEGALIZATION:N F E E S U M,M A R Y STRUCTURAL SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'Stale 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 Io construct,alley,improve,demolish,or PERMIT 29 . 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 r 8
18 . 5 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 I
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars MOO). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation. will do the wont, and the
BUILDING-DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Prolessional Code: The Contractors'State License Law TOTALS----> 29 . 50 0. 001'8 . 85 48 . 35 48 . 35 . 00
does not apply to an owner o1 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 ottered for sale. If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: , 4 8 . 3 5 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHEC- K
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 29 . 00 / L' c.– . 50 18 . 8 5
❑ 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 a contractor(s)license pursuant to the Contractors'Stale License Law).I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL ' F E:E BREAKDOWN
❑ I am exempt under Section: B.8 P.C. ,e ✓
lot this reason: TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date: Owner: SFR 40 RES-`kET WALLS <= ITT W/SURCH4/ FT. 30 . 00 1 , 200. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safely 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
EXPIRED
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
G X P I R E D
these provisions.
Incom to Inspections
Date: Applicant: ' ' I p /
I hereby certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county 'mow. vj l'�- ,(jf� "r Ir////
ordinances and state laws relating to building construction.• 'reby a. size rep f this city to enter upon the above mentioned
Dote Sig
property for mspeption purp es � I
Date: `1/ ' �/ Z Signatu " .i t • .
•
1 Jt.
Driver's License or Social Security a k
164146 White—Building:Green—Code Enforcement:Canary—Aoolicanl:Pink—Revenue:Goldenrod—Assessor • ,
CONSTRUCTION AND PLANNING POO ,PA
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
a..,.Electrical Conduit Utility-Undrgrnd: 54. Forms
4. Elecfrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement' 56. Rough Plumbing & Pressure Test
•
6. Electrical OF ER Grrid. 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.
1% Structural Floor System _ 61. APPROVAL TO DECK
11•. Property Sewer Line& House Connection 62. Backwash & Receptor-Final
1:t 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
. i �r , - ,
20.'Rough Factory Fireplace ' r 1. '- • - J : APPROVALS' -Permit # 'a • •
` . 1 -,-d" 2 y . .t, r. r.t
21; Dugs, .. .. •.,•: i ' i , . :70. Underground'Hydro •
22.-Duca, Ventilating " i i, .,? ;"<,` { 71. Product Piping OG`as 0011
23. Gas Pipe''Rough& test ' r ,, , .r • j 72. Underground Flush . i.
24. Robf Framing = _ a `, :73, ;Undergrnd.Storay&Tank F]Gas ❑Oil
25. Roof Sheathing ' - - "74.,Overhead Hydro
26. I-Bar Ceiling (Structural) &Monocoat - 'v - ' 75ti•Dry Chemical '
27, Frame and Flashing; ; - ` .r _ . , 76: Dry Standpipe " ' _ '
28. Lathing& Siding ? . r.. . , it •• -; r 77.:,FIXED SYSTEM FSNAL _
-29. Insulation •• :. " ii 78.:FIRE PREV. FINAL
30. Drywall Nailing ^C?` HEALTH DEPT.REQUIREMENT
31. Plaster Brown COI.. -.7; : i -- -
- .. -... Y --79. FINAL INSPECTION • - .
It
• 32. Electrical Power Meter-Final I n '80. FOOD CERTIFICATE ISSUED - �,
Y ,
. 33.:Final Electric. , ! .. • • aNgtgs: 6 .-_///J/j -a/. / Sr ,,-
34. Final Heating& Air.Conditioning-, v - s Q
`� P
35.'Final Gag.Pipe-Test;' ,_ ' jam/-//J _
36. Hood or Canopy O� ��ia✓T Llt/�3i��6 'r
37. Final Factory Fi,eplace - ': •
� f
38. Final Plumbing - . . - .
'39. -Water Service:Final I -
40. Gas Service-Final • - ., . •
'-41. Solar Domestic-Final - •r,' .- - x •
42. Backflow Preventer I +, •
43. Backflow Irrigation, • . 1 -- - .
•
r . .,. -
_44. Landscape Irrigation System r _ ( - - s
; . _ -
•45 Sound Attenuation -, a • - - ' - •
--
46. HandicapRegulnttons - , ,- . -.
47. FINAL STRUCTURE & BUILDING J r i • - . '
48: FINAL PLANNING . I . •• •'
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co _ .
51. CERTIFICATEOF;OCCUPANCY
No. Date
OWNER FILDES, JOHN DATE 2-20-68
JOB ADDRESS 1925 Kauai Place BUILDING PERMIT NO. 28228
GENERAL CONTRACTOR Os '—Builder DESCRIPTION O ARK Retaining Wall.
AP No. LOT G3 TRACT 6384 FIRE ZONE VALUE $ 50.00
• INSPECTIONS Signature Date GROUP J TYPE 77Z ZONE R-1
Soil
Gas SUBCONTRACTOR Date I Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con. 0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing—In 0 Out 0
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final
Building. Final /?../0/ Z./L/—Yl
• 28248 0 Ff-26-68- 0Pal° 0 535 L'�T*****5.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92020
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADDRESS
/] / y • �f�/ For Office Use Only
ADDRESS /%.27 A4'rP1,IVD"/ / /�I�t %�N(p`
RECEIPT NO. 282748
COSTA MES
A. CALIFORNIA REY /Y GQRI
V,eL 'r
L
OWNER (91, -Mj(14O BUILDING /o MAIL ADDRESS
ADDRESS jYZ6 / L4ANI ,/j�p17fI
` Sfr ,��T
CITY NO..)7 S��l ZONe � TYPEnt GROUP
X09-6/ s}�uaa. pp2 y�,p//
.NIG NEER NO.
BYP/11 G(�6e DATE-c26--6—d
ZONING QW
ADDRESH EONS No.OF
USE.OF NEW
/1 ���Jj, I �/ PIANS �I BUILDING
CONTRACTOR l n� W/""Y . (.
ADDRESSn^_l/ / 'et:1 I,�/t,L(s
DESCRIPTION Lilt a 3 �2 g y
CITY (%�'O'/4. •// A.P.NO. '�..______.
��77 //'�-- �/ NOTE: NO[AVE OVERHANG/SHALL BE LESS THAN
Ua.42S4 258' Np,Si/Se AN0 RO'TO SIDE S REAR P.L.
EAVESIZE I NO.OF BLDGS. WED (U.S.. C.REQUIREMENT)
OF LOT L NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE PROM FRONT FT. FT.
CENTER OF STREET REAR YARD
SIDE YARD' LEFT I RIGHT R.SIDE FT. 0 FT.
DESCRIPTION OF WORK L.slog PT. 0 PT.
Ci
NEW ALTERATION ADDITION REAR PT. PT.
DISTANCE BET. BET. S. &
REPAIR _MOVING DEMOLISH MAIN AINSL
BLDq;, ACCESSBLOCS.
LDGB.
BUILDING NO.OF win.* DATE
SIZE ROOMS STORIES C.U.P.# ���JJJ APPROVED
EXTERIOR WALL I COVERING or
PROVED(tip, A / //y
COVERING ^/v 1/ //n
USE OF SUILDINS AND WORK TO BE PERFORMED (L
97
/1 SQ.PT. X
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECTAND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. i15
PLY WITH ALL CITY ORDI CIS AND STATE • REGULATING VALUATION
BUILDING CONSTRYCTI v�/ /�. PI
SIGNATURE OF /1 O M2 PERMIT FEE $ (/ (/ D
PERMITTE `[ /' f•I / Go
$ �/��a PLAN CHECK $ �'
AUTHORIZED AGENT .�
TOTAL FEE $ b`A ' C�1J.0
n UWNN:K FILDES, JOHN DATE 2-2b=bb
nJOB ADDRESS 1925 Kauai Place BUILDING PERMIT NO. 28248
GENERAL CONTRACTOR Ca 01 Masonry COntr. DESCRIPTION 0. )RK Comm. Block Wall
4 AP No. LOT 23 TRACT 6384 FIRE ZONE " VALUE $ 430.00
INSPECTIONSSignature Date GROUP J TYPE III ZONE R-1
Soil PERMITS ISSUED
Gas SUBCONTRACTOR Date Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con. 0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power .0
Rough Wiring Heating and Vent.
Trenches ry Forms 0 Steel Reinf. @ I4 c—J' .
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing— I❑ ❑ Out 0
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final „�
Rnildinv Final fY�/L 2.,/? %Ci'
- it 28228
- • PAH)00 431 0*****2.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to FiU In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 7L n �/� ' �/ For Office Use Only
ADDRESS /9zS aa9i L�{� N/`
RECEIPT NO. O �C"V
�[C/�/OSTA MESA. CALIFORNIA (C% ,wry
OWNER %1%v /-yZ bS / � EEI ��� �E �V
NG
MAIL /175— �n//�/ i ADDREBUILDSS
FIRE
MAIL B yiL l7G!
CITY NO. ZONE TYPE GROUP
IITECT TEL BBYPROV[D DATE .3-
NGINEER NO.
�/] ZONING /2j1
ADDRESS A//� ZONE No.OF
USE OF NEW ,n
L. I PLANE '� BUILDING NE?"
CONTRACTOR I I
( / IAGAL `�/ 2-3 Pk I / 3 GY
ADDRESS / C (- LEGAL PTIOM�L_.( •O o
A.P.NO.
CITY
NOTE: NO RAVE OVERHANG SHALL BE LESS THAN
STATE TEL. SO'TO SIDE ft REAR P.L
LIC.NO. NO,
EAVES
SIZE I NO.OF BLDG,. ALLOWED C 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 ...v.-Yr FT.
CENTER OF STREIT REAR YARD
p B Ql-1„[FT RIGHT R.SIDE "F'r FT.
DESCRIPTION OF WORK L.SIDE 3 O FT. - „2- 1i:
rv[WALTERATION_ ADDITION REAR i/ PT. FT.
DISTANCE BET. BET.MAIN ft
MAIN BLD S. ACCESS.BLOCS.
REPAIR -MOVING DEMOLISH
BUILDING NO.OF
VAR.# DATE
SIZE ROOMS STORIES C.U.P.# APPROVED
EXTERIOR WALL. ROOF APPR V_yF✓ ,'//7 �-T Q
COVERING COVERING BY/6/-p ` •% 10.s.....271 DATE PV-bz
USE •
((,�//Oy/Ppp////BUI•Si I� QR/A /N7 [�fRFO��/Ip/j[(D// 9
e, ped
i
Earn
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. X31
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION.
SIGNATURE OF �.L..� L • 1/ le PERMIT FEE $
PERMITTEE -L. c CL�-Z• / j' �G
v
/1( PLAN CHECK $
AUTHORIZEcg .--r
TOTAL FEE $
Lot 23 - Tract 6384
Plan aiii 2,099
PAID
COSTA MESA BUILDING-SAFETY DEPARTMENT HAY 25 67EzOC1415" .t 147.00
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUIL
DESS
ADDR1925 Nadi. Place C.M.
COSTA MESA. CALIFORNIA For Office Use Only-„`
OWNERClub House Road Joint Ventur • ( RECEIPT NO. I PIp• mu .LRN i'1 . , Tl0
.
MAIL REG D Y DATE RECEIVED E ISSUED
ADDRESS 2850 Mesa Verde Drive �t •�-22.‘7 .5 ,,7747
CITY • Costa Mesa NT&49-0395 BUILDING
ADDRESS
AR ECT
OR .(NEER E.G.KaltenbachNo.547-804 COSTA MESA. CALIFORNIA' / /�/1 ` I/��
ADDRESS 1823 E. 17th St Santa Ana ZIORNE TYPE 7/ GROUP(' Y (� J¢
CONTRACTOR Republic Homes Corp. APPROVED J
BY DATE
ADDRESS 2850 Mesa Verde Drive ZONING /ay_,�
ZA
CITY Costa Mesa ZONE O.OF OUUE OF NEW1/�
drsLANE 7�BOILDING U .�-LQ.
STATE TEL.197838 O549-0395 LEGAL
E6CRIPTION b .a O
2-3 7-�I
),,• NO. OF BLDGS.
OF LOT 60 X 100 NOW ON LOT A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. _„ APPROVED ALLOWED
SETBACK LINE PROM (CENTER LINE Ty/)
CENTER OF STREET 43 1 REAR YARD 32 1 FRONT w.
SIDE YARD I LEFT 5 1 RIGHT 5' R.SIDE ` // '5 FT. IN,
DESCRIPTIONOF WORK L.SIDE JrIN.
NI I X II ALTERATION I II ADDITION I REAR 3)-cr. IN.
REPAIR I II MOVING I II DEMOLISH I APROVEDCe�•`�i0 /
BY DTE -� lGG-0/1n
NO. OF
SIZE BUILDING 2478sq . f tROOMB 9 STORIES 2 l�//
EXTERIOR WALL,Wood& I ROOF
COVERING 0tuc Co COVERING Wood
USE OF BUILDING AND WORK TO BE PERFORMED??
G am, /�64,-64, Li! ,
/ J 97/i v7/
.1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PLY WITH ALL CI• ORDINANCES AND STA E LAW, ;NQPURPOSE OF E6TABLISHING A PERMIT FEE ONLY.
BUILDING CON= 1' 10 / VALUATION �f'
SIGNATURE O! / /1 de PERMIT FEE $ 7 0 —
PERM( -- ✓� $ �� �G� II(
/f. odiJ//i2=e$f� / PLAN CHECK $ ��— I
AUTHOR -L9• o-(Nim-f1i// l7%n {//`1/� $ /5 ' 7 E
TOTAL FEE 7 O
LL