The URL can be used to link to this page

Home My WebLink About1170 KINGSTON ST - Building Permits 0J' n CITY OP COSTA MESA • Y 4 ' BUILDING DIVISION ' : `, DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER PERMIT OS-01402 •stb4rs�,r,o i% (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BlUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 1170 KINGSTON ST Status: ISSUED Suite: Applied: 08/22/2005 Vicinity: Issued: 08/22/2005 Primary Occ: R3 Type of Construction: V-N Parcel Number: 41204212 Zoning: R1 Applicant: SELL, RON Address: 18032 LEMON ___624( Phone: (714)528-1758 ISSUED BY: YORBA LINDA,CA Zip: 92686 Owner: FROMDAHL, RICHARD'N Address 1170 KINGSTON ST; '4. ,r=' err` jkPhone -�,• COSTA MESA,CA Zip 92626 ,' ,;a Contractor SELL ROOFING`COMPANY a '�''' Address: 18032 LEMON" p; _ Phone: (714)528-1758 P;, - _ '_ ,,•:-. YORBALINDA,CAy` ` - Zip:' 92686 a License: 323842 , '. Arch :- ::`, Eng: �. x Address:, 'YAddress: ', ,, Phone: Zip: y,- i'License , ` i License: - SCOPE OF PERMIT ;;,. , x „ TEAR`OFF WOOD SHAKE INSTALL:I 30LB FELT AND 5.0PSF FIRE FREE SHAKE BY RECON CEMENT SHAKE ICBG _, 5075" ," L'« • <".� �� «1 � �.r i :exp - " FEE SUMMARY . . Plan Check: • ',4$0"s.•- 0 ' Calc'Valuation ' _ ..$.8,900-../00 permit ,$167 25 ' Claim Valuation`' 58,90000 SMIP Res: $0 89 y + SMIP Com , $0.00 F « Other $0 00 g Inspection !x $0:008-' Y -. . 4 F , > ` "Total $16&.1:4."„.< PLANNING &ZONING z' SETBACKS * ./ MAIN STRUCTURE Front 0---'0 Rear .....0,./0'..t.-% ;Left 07 0:„. -r: Right ,...w.0-.0. ,, N ACCESSORY - Front 0;0''�"• Rear y 0 0 : ,a.`-"•Left 0-0 °-- Right 0 0 PARKING 'i >Existinq: , 0 Required 0 ; .� ,,,,,,,:-,-,A, Proposed 0 * - • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) /' DILALARATIONSf ( ) • WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ ave and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. er workers'co�p�sa on-nsurancp-card and policy number are: _-. ___--- r /0 CP SIC0 (This�pei/on need not be completed If the permit Is valued at one hundred dollars($100)or less.)—� in I certi •- .. •e performance of the w•. for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' -. pe -: ion la , of California,a that If I ould e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I -hall forthwith y with these •rovisions. • �7 �Q '•pllcant Signature: .. •. WARNING: --i TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM• •YER TO CRIMINAL' NALTIES AND CIVIL FINES UP TO ONE HUNDRED • ••-i+ D On r ARE($100,004 IN ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTIt- .iii.. • • •.c•R CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I here. .- . , licensed oderjis'ur s o ...ter 9(commencing with Section 7000)of Division 3 of the Busi r .ndProfessions• ode,and my license Is In full . Co tura: Weft r------'-->., �r- ^2 r _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 properly,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. ❑Yes 0 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Tale B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 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 C�+est Air Quality Management District or from any other air pollution control district or agency? DI Yes jNo (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes./s.s. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. !Fre Of And/�orize Applies / Data CODE I I$SPECT1ONTYPE PM UtTIRALS CODE INSPECTION TYPE ( peg IHIfALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final q iii �� 208 Final Plumbing c200 Final Re-Roof [t7 5 J 43t 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 It CITY OF COSTA MESA 449BUILDING DIVISION o rj _-> ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER `) PERMIT stberia.airo ft '03-00767 (714)754-5273 • Fax(714)754-4856 • vrww.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1170 KINGSTON ST Status: ISSUED Suite No Applied: 11/20/2003 • Issued: 11/20/2003 Vicinity: Parcel Nunmber: 41204212 - ISSUED BY: i Applicant: TIMOTHY NOCK':/' r . ' Address: 11612 KNOTT/SIT- - ' , ' Phone: (714)895-1246/ : \ GARDEN'GROVE:.CAT/- Zip: 92841 / l /iib / / � _ Owner:'' FROMDAHL; RICHARD N Address 1.170 KINGSTON ST .A - %/ Phone: ` COSTA MESA,CA Zip: 92626 ' 'Contractor: NOCK PLUMBING - _ . - - Address:' 11612 KNOTT ST - / ' .. ' Phone: (714)895-1246 / I . - • GARDEN GROVE,CA Zip: 92841 , j _ " - License: 707775 N Arch / Eng:. �� i � . . -_ .. , Address: Phone: . _ _ _ • - Zip_" - - - License: - � r- SCOPE OF PERMIT" vCHANGE OUT WATER HEATER. N', - - - ' FEE SUMMARY.- ' , AMT.'. QY ISSUE FEE AMT QTY ▪ - ' $23.50 ..:'<, .", " -Laundry Tub/Washer - $0.00- 0 _ „-Sump Pump $0.00 0 Backflow irrigation- $0:00 '-' O.'. Landscape Irrigations $0.00 0 Swimming Pool .'$0.00 0 Backflow Preve▪ nters , $0.00 , 0 - F P-Trap • " . $0.00 0 ' Trap Primer, ' $0.00 0 Bathtub ''$0.00 0 ' . o 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),\1'$0.00, - 0' - v Receptors $0.00" - 0 ' C , Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units \ '$0.00 ' 0' 'Septic Tank $0.000- - 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 ".-T,„_---- Water Piping(Ins(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 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) 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 e work for which this permit is issued. I have and aim in workers'compensa insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit u 1My worker comp/ sgt1/n/I sI�ance car r a �oli y nnumber are: +� /�//� Legs'][ry` Carder. / Y 1 Policy Number: I K LU J (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) co ❑ 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 o the Labor ode,I shall forthwith comply with these provisions. �J /� ]� .� Applicant Signature: Date: I l L/� V LJ WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL Fl ES UP TO ONE HUNDRED THOUSAND DOLLARE($1 W,WO),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice v l I apter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code, . " •: se' in full force and effect.Llc.# Class A _ Contractor's Signature: Date: I11M1ne_ 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 properly,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 Driver's License No. Expires: Verification of Ownership by(type of 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,Califomia 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 0 No (Section 25533 of the Califomia 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 Calif omia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aziPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 8 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 0 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 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. A i Sig9 - : • -I Own,r(s f to •n•Or •ro L ' App . t to CODE. INSPECTION TYPE PATE IMAIS WOE INSPECTION TYPE DATE REALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing --c ^Z-ipti 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 • • • .. orteaa • • .. _.. _r'av linevalve- _ .......2 an-air Imo _ _ AiR i. check valve• BLG roER -- - ^— �— ��1 21lair line . tUTG ! NOTE I I --_ 1i______ � I CHLORINATOR HYDRC JETS �� 1) 2_air-1i nes tube P,_ranel I I I_ J 2�Ireturn line and apoye ;21 A-Ater fines. - SKIMI/ER C copper HEATER 2) Blower or._P,v.0 loop_ I I I I I min. 5' heat to be elevated above - I II sink from ' Spa DRAIN I I heater copper FILTER 3) For above groun C instal. - - .I hose bibs HYDRO j I 2 suction lino,both pumps, must have JET I - h p gate valves on suction •- I 41-- PUMP and return lines I I Is�c tion Lne LEGEND I • HYDRO / I . 2'' suc:ion line 2 h.p. • • AIR LINES — — — . I PUMP WATERLINES L_ __ _ _ _ ^ _ J • • — 2'Pre turn line • • SANDS AR-if HS102 PLUMBNG SCHEMATIC FOR COMMERCIAL INSTALLATIONS • • • 0 • . •_ - 5 r 1---! D t ` / =1_9 / . f' A ,,'rprovED -1, of Costa A esa Building Dept. (JI Y 1 4th _. ..DATE= -..td�.f- - - T ES E ON JOB AT ALL TIMES _ - - AKE N OUT PRIOR APPROVAL ' • DET. - • ' THE IS: /ANOR GRANTING OF A PERMIT OR APPROVAL v CE - OF PLANS F 40 SPECIFICATIONS SHALL NOT BE CONSTRUED ./1% TO E A PEI NIT FOR. OR AN APPROVAL OF, ANY .. .- - - • A��: IF NY Of T. E PROVISIONS OF THIS CODE. NO PERMIT PRE re. ,, .UM G TO (IVE AUTHORITY TO VIOLATE OR CANCEL THE (/ Il Y I ROS SIGNS 0 THIS CODE SHALL BE VALID, EXCEPT IN SO - !mil �,,,��R F R . THE W RK OR USE WHICH IT AUTHORIZES IS LAWFUL. ' `,�� ,>;N s5TLJN" THE SS ANCE OF A PERMIT BASED UPON PLANS AND y /ytE`i5 ' S "CI CATIO IS HALL NOT PREVENT THE BUILDING OFFICIAL v' 77�L .. FRS M ' HER I R REQUIRING THE CORRECTION OF ERRORS - IN Al' PLA I NO SPECIFICATIONS OR FROM PREVENTING Cf�1V II CP SUI DIN OPE AT ONS BEING CARRIED ON THEREUNDER WHEN IN 4 01A'ION F HIS CODE OR OF ANY OTHER ORDINANCE �n'4TF OFT IE TY. en, \ I7s DO 0 v 2- t_\ P , t P • n �U0 CTURAL APPROV L_ N ck.S � L ' , 'EPARATE PERMITS ARE 'EQUIRED ; LTCi� ��prbS s FOR ELECTRICAL, PLUM RING, HEATING, VENTILATING AND Ab (241-6 !!eeGG ��` y REFRIGERATION WO K G . _.stalk. (tr° hie P 44 pugIPermit # 'o0 I . 0 IS NUMBER MUST P CO APANY ALL INSPECTION REQU 'TS FOR g DINGS WNER`L PERSONS 'RE TO BE EMPLOYED, WE SUGGEST TH T THE STATE OF CALIFORNIA DIMS! N OF • . INDUSTRIAL SAFADDITIONAL REQ RE ENTS,UL7 FOR 0t. • r r,7n 7 1 I p,an �g—=-.-71-1i= COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR'STRUC�TURAL-PERbITT_!_ „ P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - RECEIVED BY PECfel..J- rG For Applicant to Fill in Completely—Use Ink Only [/ �! BUILDING A.P. NO. .4:(-‘)__--04-D:_--0 ) ADDRESS 10278, Lot 11 1 BUILDING �/ r, .sye l .j,,, OWNER OR ADDRESS 117O K-I VK..)/'[��O 1 TENANT McLain Development Co. UNIT OR MAILING SPACE NO. ADDRESS 1470 Jamboree Rd. L. TR.NPdl 723 LOT I i 1BLK. CITY Newport Beach NO. 640-6800 11 CONSTRUCTION NEV.iI ADD ALTER REPAIR MOVING DEMOLISH LENDER V BRANCH OWNER It • ADDRESS VALUE ARCHITECT TEL. USE $ r OR ENGINEER Corbin/Yamafuji NO ' 752-5567 /y/I M(—�I 'C ADDRESS 3661 Spruce St. , Newport Beach ZONE ?nQ MVITVPE GROUP APPROVED CONTRACTOR McLain Development co. BY DATE ADDRESS 1470 Jamboree Rd. CITY Newport Beach TEL.. 640-6800 STATE CITY APPROVED SETBACKS I—. LIC.NO. 273875 LIC.NO. 18873 SIZE NO.OF BLDGS (FROM C/L ST�iEET) ral Ow OF LOT NOW ON LOT FRONT D"(i FT. Q USE OF C '„i„ EXISTING BLDG. R SIDF 5 FT. co) 5Separate permits are required for L.SIDE 5 FT. • L1 electric,plumbing and heating work: REAR %S.sSFT. W USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION • DATE aSing]e family residence. _ APPROVED > New house _APPPROVEDe l/7rr DATE ia!/ Q ' 6/7 9 g 0 I hereby acknowledge that I have read this application and state o' a that the above information is correct and agree to comply with u. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of a xthe State of California. [� SQ. FT. - m �T I hereby certify that I am properly licensed as a contractor under N V the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION t and Professions"ode,Division 3,Chapte( 9. PERMIT FEE $ �3 7 0� v1 ra Perm`tee of ( C 4,.„..2_, — LAN CHECK S / =5A U Permittee C "`"'"1111 ` $ 7 TAX c�-) $ U 2 Authorized ent Date / TOTAL PAID $