HomeMy WebLinkAbout1173 KINGSTON ST - Building Permits ' •' • CITY OF COSTA MESA
`, 9
BUILDING DIVISION
F �,,,• #4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
ditelbodb
.aw B03-00295
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1173 KINGSTON ST Status: ISSUED
Suite: Applied: 02/20/2003
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 02/20/2003
Parcel Number: 41204243 Zoning: R1 R1 .
Applicant: SELL, RON ISSUED BY:
� _
Address: 18032 LEMON
Phone: (714)528-1758
YORBA LINDA; CA Zip: 92686 .
Owner: SARNA, MICHAEL E ' '
Address 1173 KINGSTON ST
Phone: -
COSTA MESA,CA Zip: 92626 -- ,
Contractor: 'SELL ROOFING COMPANY ,
Address: 18032 LEMON"
Phone: (714)528-1758 - .
YORBA LINDA,CA
Zip: - 92686 Licenser 323842
Arch , i Eng:
Address: - Address:
Phone: - Phone:
Zip: License: License:
.y SCOPE OF PERMIT_
REROOF RESIDENCE AND ATTACHED GARAGE:T/0 EXISTING WOOD SHAKE: 7/16"OSB SHTG,2 LAYER 30#FELT,APPLY"EAGLELITE
MALIBU TILES."27 SQUARES ICBG#ER:4660 5.5 PSF
FEE SUMMARY „
Plan Check: $0.00 -- - - . .- _ Calc Valuation: - $8,900.00
Permit: $167.25 Claim Valuation: . $8,900.00
. SMIP Res: $0.89
SMIP Com: $0.00 .
Other: $0.00
Inspection: $0.00
Total: $168.14 -
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
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)
DECLARATIONS U L-
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. •
❑ I have and will maintain worke 'compensation insure. as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'comp-••_/.. .r . urance - =r and• number are: CiC, /
Carrier: i�L/� -_ Policy Number: MLP C�/ .
(This section need n••e completed if the permit is v:ued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and a• at if I should come bjecl to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. 2 A V 7 _6 3
Applicant Signature: v l Date:
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FiNES UP TO ONE HUNDRED
THOUSAND DOLIARE(5100,000).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 licensed unci_ provisionsof ro e
C :ptgr 9(commencing with Section 7000)of Division 3 of the Business and Pssion rpdje,and my license is In full
force and effect.Uc.a C 3 �-_ _ _ Class it — /
Contractors Signature: Or 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 properly 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. ❑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,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 ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 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 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 end 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 COMPUANCE 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�1TO�i�f�Legal O er(s ;Jit O 3
n r Authorized Applicant (Date
CODE INSPECTION TYPE ZIT" INTRIALS ,'ODEI INSPECTION TYPE • QATE INTRUIL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / [/ 208 Final Plumbing
200 Final Re-Roof 3..rf.-oJ (O 210 Final Electrical
201 Final Block/Retaining Wall - 212 Final Fire Prevention .
202 Final Factory Fire Place 220 Final Planning Approval •
203 Final Sign 222 Final Site - •
204 Final Demolition - ' 250 - Final Building/Occupancy •
'PLICATION FOR A BUILDING PEr T
Jam) BUILDING P -MIT NO. Electrical 1 W
Tract ���yyy Block Lot / S Permit No. S.
mbinging ./ N ps{Q� (( Plumbing a
• I J // Permit No. m
Cross / ( Mechanical C
Area Street Permit No. O.
Ce
Owner , 2 In/
1 \I1 et S i
1 • N A"" ��/sJ N E Type of Project: ❑ -w ❑ Alter ❑ Addition
Address i' 1 7 3na1 ill�5 7' 0- -J IIIRepair II] ConveDemo ❑ Occupancy Pmt.
City CAPS VW t�t'
^^`.1?-5I4 Zip Phone A.P. Sup.Dista/
Ins..Area
Architect/ License No.
Designer /1'3 / 7 7 Zone Spl.Pmt.No.
•
Setbacks P/L Front C/L St. Street idth
Address
Yards Left Right Rear
City Zip Phone
Eave Proj. Left Right
{./.-meq F.P.
Engineer License No. /93 / //
ea. ( f Parking Spaces Required Provide Cover d
Np, Address ,
m City Zip Phone Struct No.of No.of
Height Stories Family
S LICENSED CONTRACTOR'S DECLARATION Park Fees ❑ yes
Fee
• coI hereby affirm that I am licensed under provisions of Chapter 9 Required LJ No C.T. Receipt
L (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date
w Professions Code,and my license is in full force and effect).
License Class License Number
5- Date Contractor Misc.
E Address Proposed Use
of Structure
Li: City and Zip • Phone .
in . CONSTRUCTION LENDING AGENCY
E I hereby affirm that there is a construction lending agency for theCode
9- performance of the work for which this permit is issued (Sec. 3097, Clas Type Year
• Civ. C.). Class Const. Year
y' Lender's Name USE/OCCUPANCY SIZ SQ. FT.
C Lender's Address_
'.I OWNER-BUILDER DECLARATION
• y1.
I hereby affirm that I am exempt from the Contractor's License Law
Ofor the following reason: .
C
0 I, as owner of the property, or my employees with wages as their 2.
sole compensation, will do the work, and the structure is not
2 intended or offered for sale.
w 3,
3 ❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project.
«' 0 I am exempt under Sec. , B&PC for this reason 4'
m
C Date Owner
E WORKERS'COMPENSATION DECLARATION Total Valuation
8 I hereby affirm that I have a certificate of consent to self insure, Encroachment Permit Required •
« ElV¢s LIor a certificate of Workers' Compensation Insurance, or a certified
mC copy thereof. Grading Pmt. Grading
y Policy No Company Required ❑Yes ❑No Pmt. No.
is hereby fuished.a ❑ Certified copy
❑ Rough Grading V
O.
Certified copy is filed with Orange County, EMA. Approved by: •ate N
Date Applicant - 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE 2
(This section need not be completed if permit is for $100 or less). C
I certify that in the performance of the work for which this permit is I.
issued, 1 shall not employ any person in any manner so as to become it
subject to the Workers' Compensation Laws of California. PERMIT FEES
Data Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with such Special
provisions or this permit shall be deemed revoked. Electrical $ Invest. $
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY RUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE Ac• E TIe• - ------ Y FOR INSPECTION PUR- Pre-Grade
Inspection $
- Aie' /2_/O -O V
n Pre-Grade Per it
Si netu
M ,n�/S �
Plan Issuance
Al!spaces within this box must be completed to process _ Check By: Approved:
CMF 0335-46(BU-28) rev.6/80
CITY OF COSTA MESA
REQUEST FOR OCCUPANCY �{
TRACT NO. lea 7 S DATE: U/27/O Q
IDT NO. 'Vs L
ADDRESS //7_, /L��✓�/J�P/f(. �/
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
By executing this agreement, the undersigned acknowledges that he/she/they
was/were advised that this tract has not been given final inspection nor has
• it been accepted by the City of Costa Mesa as having complied with the conditions
of approval which were imposed by the City at the time the Final Tract Map was
approved. •
The City assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condit on (s).
(Sign.t.re of1Puf as- )
BY7.‘4.4.,.. (i /��,
(Signature of Developer and/or
authorized re sentative
BY Lkk
(Signatur f Le e
HOME SAVINGS & LOAN ASSOCIATION
"RI
4/79
1 1 ; ! i i I I, I ; I I I I 1 I I I I I I I ! 1 1 i
1. f APPR E -
Qj5City of C Mesa Buildin Dept.
ry� '� VP i sift ptoKPPROVAL ONL P 'CJ .1 ..--_'� _ ' f l ( 3 (\ I N(�F ARMITS ARE RE UIRE BY ------oArE_ .._.LL TIM
y Q THESE PLANS MUST BE ON JOB ALL TI
/n } Ti' ' i FOR. ELECTRICAL, PLUMBING, MAKE NO CHANGES WITHOUT PRIO APPRO XL
1 ; ; . '- •� • , ;ti . QIEATING ¶EPTH TING AND i oP DEPr. 1
i ' '�^• _ -i x REFRIGERATION WORK THE ISSUANCE OR GRANTING OF A PERM( OR AP VA, -
• ✓ 71 R F PLANS AND SPECIFICATIONS SHALL NOT E CO R Z9
' EF 0 BE A PERMIT-FOR, OR AN APPROVAL OF, NY N
`�'�'�'�!� !"��'•-•,
?' ( p� r �-•- IF ANY OF THE PROVISIONS OF THIS CODE. N PEWE-
lm
-
I Per it # 1 �°
_ , •LIMING TO GIVE AUTHORITY TO VIOLATE 0 CANCEL THE
' _ z THIS' NUM,ER I•NI Sf ACCOMPANY 'ROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO
` ( �,. % •'• �' •' 'ALL'-INSPECLr{4�<L�EQUESTS AR AS THE WORK OR USE WHICH IT AUTHORIZ S IS LAWFUL
?-;
ate - n - - I THE ISSUANCE OF A PERMIT BASED UPIN PLANS AND
�����-
-G �' - FOR BUILDINGS Vk , S 1, 1 ROMIFIHAT ONSEREAF SHALL NOT PREVENT THE BUIL (INC OFFICIAL
RS
-T2 ARE TO 'ROM THEREAFTER REQUIRING THE CORRECTIO• R ERRORS
BE EMPLOYED WE S'.JC , SI THAT THS I SAID PLANS AND SPE
' I///A/Irt ,.J •-- ,I ,. PREVENTING
;' I STATE OF CALIFORP�„ -DIV SIDN 0 g1IILOING OPERATIONS BEI CARRIED ON THEREUNDER WHEN _.
1 I '.y, _ INDUSTRIAL SAFETY BE CONSULTtD'FOR. iN VIOLATION OF THIS COI OR OF ANY OTHER ORDINANCE
1 ; : ✓ t` . _ ' _ ADI T{4NA RE* I' u_L (IF THE PITY,
I
I ' ; 6. -
IVorc
SS--
I k "'k)f ! 1 PS
(((v�i+M4
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ki\ 411
ki
r o ,� :T V°> . iv 1 a
Iii
44::01 ( t� " tvJ A/$17
LANNING DEPT.l I!
c.)1/4
,� a C� % SUBJECT TO BLDG. DEPT. REG.
.`N\ ` ) •k`� BYL�CaliTE,
+ • 0,� :`C m) `" 1(
1 �•• \� i DIRECTOR OF PLANNING
'v
PATIO COVER DETAIL 6/1/67 ,. TYPICAL JOIST ANCHOR
.i„n
ealli
ass3SPACING SPAN 1;Q �,�
SIZE a
OVERHANG r`N r
RAFTERS: ® • it '
FOR DRAIN
STATE LENGTH
.4--SLOPED ' or O^*�
4iiii
t SPAN ., J`. Ty }.�' O
MAXIMUM /� ZS 9 '1j O CONTINUOUS '-i
g 3/g x 5'Logs 32% LEDGER .Blockin Predrill Led er 4-...9 / 4' % MAXIMUM s�/\ Predrill Existing 'A-3 Deep
JOIST HANGER
BEAM , or other approved methods NOTE USE REVERSE SIDE FOR PLOT PLAN.
of support • tie.
-,4xg . T. _
STATE SIZE NO I RAFTER — CHART No 2
ALL LUMBER DOUGLAS FIR FOR OPEN EGG CRATE FOR SOLID SHEATHING.
�� ,y 3/16X2"-T-STRAP CONSTRUCTION" GRADE ALUMINUM OR PLASTIC SHINGLES OR BUILT UP
ROOF COVERING ROOFING.
MAXIMUM SPAN SIZE SPACING MAXIMUM SPAN
m
7' 0" 2"z 6' 12% 15' I"
s 6' 0" 2'x6" I6% 13' 3"_
Z POST-BEAM 5' 0 " 2-x 6" 24.% 10' 11-
s CONNECTION 2' 0" 2"x 4" 12'% 9' 11"
I ' 0" 2"x 4" 16% 8' 8"
PosT 0' 0" %2'x 4" 24 7' I"
MEW
*--.I PAT
SW SI E SHOW SPACING NOTE: WALLLSRR OPOSED ARE TO BE BUILT. USEOR FUTUREOOMNO.2R CHARTWHEE ONLY
' SHOW LOCATION ON REVERSE SIDE,
WIDER RAFTER SIZE MAY BE INTERPOLATED FOR
IA" ; I
SPACING ONLY.
hagDROP PATIO FLOOR FOR PROPOSED OR FUTURE ROOM OR WHERE PATIO
�-- SLOPE TO DRAIN— Z
L/ i : ' ::.::.• FILL A'3r 1 WALLS ARE TO BE BUILT SUBMIT COMPLETE HOUSE
gg t ` THICK sLAe •`• > AND ADDITION PLANS
fl_ PUDDLED SAND
i 2 ,. .
r% _ .. .
eTxxe ' I Remove Grass And Weeds Down To Natural Grade w
12" •..
' . t CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT
POST ANCHOR I '..'.,. 7t GALLONS PER SACK CEMENT.
For Pipe Poet. Embed k12--4 ' Provide 26 Ga G.I. Flashing At Wood Floor Const. COSTA
MESA BUILDING DEPT.
Pipe In Footing.
Provide Flange Or Weld Plate Screwed Or Bolted To Frame.
77 FAIR DRIVE 556-5273
FORM eu•.o - _
OWNER (Ar 2. Mrc Payne DATE 12-19-80
JOB ADDRESS11 73Kingttnr Street BUILDING PERMIT NO. 51151
GENERAL CONTRACTOR Polk CnnStrUctf-an DESCRIPTION of WORKPatin Cover
AP No.412_0A2_a3 LOT g5 TRACT 1027R FIRE ZONE VALUE $ 1 .018.00 _
INSPECTIONS Signature Date TYPE v GROUP r9-1 ZONE p11R-MI)
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. 11
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND [I POWER
ROUGH WIRING Heating and Vent.
TRENCHES 2- FORMS fl STEEL REINF. f a3A,y E 1�V P LR E
FLOOR SYSTEM T inspect*BOND BEAM 71 STEEL REINFORCE n IncOmPlet� to
SHEATHING •aIICef
FRAME AND FLASHING _ • A•; `orb
LATHING — IN I� OUT El Date
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C.. FINAL
PLUMBING. FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
X588 12/0780 17.00 TU
COSTA MESA BUILDING-SAFETY DEPARTMENT APPL CATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 !_
�. - PERMIT N2 51151
For Applicant to Fill
li/in Completely —Use
Ink Only
BU "--LDING0,92.--
'ADDRESS I1� 3 fC W 45471:"G{/''''''V��� 571 •
BUILDING /����r ��
OWNERENT E 2 4- 4n 27�, ' /�N ADDRESS �(' /��
TENANT , y\ r
UNIT OR
MAILING SPACE NO.
ADDRESS i 17 3 A--;,0-5 S +c •tiJ
S TR.NO. /,T �f BLK.
/1 TEL.
CITY\ b5--/14 (M e$d} NO. NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH /I Suer
•OWNERADDRESS (, ^ ' _ VALUEARCHITECT TEL. USE (¢F�� $ /.
OR
OR ENGINEER NO. ''�I�•�� ,/
ADDRESS -1�/ ZOOIC�/�/MD YPE V� GROUP MQ /Q
CONTRACTOR {6 I [k'1' re W 5 f (� AP ROVED DATE /2 //`" J
ADDRESS / 39 / 1 L /ein `F °
/'� TEL. /7 /'F
CITY G4 inri IO2 o . 6 NO. 5-3 7 3%).1
F STATE CITY +� APPROVED SETBACKS
LIC.NO. /7 3y? 7' LIC. NO.s.333a /y//1
Ow SIZE (NO.OF BLDG& (FROM C/L ST ',/ V/
6i OF LOT I NOW ON LOT FRONT q/ F [C
cn USE OF / tllJ /FT T nCe l l0 /IG /I / v./ V z/
� EXISTING BLDG. _R.SIDE
ca e
(—•
Separate permits are required for L.SIDE FT.
Ci electric,plumbing and heating work:
REAR zit 3 FT.
w. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
/ DATE
Te
7OVED
APPArtoeti
ss /y-� ��/j��
>-' � RO D DATFJJ -7 V
a
W
0 I hereby acknowledge that I have read this application and state m
Q \
that the above information is correct an
agree to comply with
L all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of v
.T the State of California. n
I hereby certify that I am properly licensed as a contractor under
G SQ. FT. N
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 / / a
and Professions Code, Divisi n 3,C VALUATION PERMIT FEE $ !/ p0
n
Signature of / /X� PLAN CHECK $ c c� a
Permittee 9 / 9� $ //Ot TAX $ S. ‘21
Ja U
or
Authorized Agen Date /2 d TOTAL PAID $ " . 60
mi.— 6662 11/14/79 926.71 TL
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT 'c:
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVED BY lj.2vi1/a7 *g - e .. ] ,�
For Applicant to Fill in Completely -Use Ink Only f/-f/'Y �(/,N, 1�1�Ja.��
BUILDING A.P. NO. 'earl: ,,r--10* O)
ADDRESS Tract 10278, Lot 45
OWNER OR BUILDING i ��// ``''
TENANT McLain Development COUNIT OR
ADDRESS 11�� 1-1VlQs h JTr
MAILING SPACE NO. �`lJ
ADDRESS 1470 Jamboree Rd.
TR.NO. LOT BLK.
CITY Newport Beach NO. 640-680(L. �01nSj �"$ • '�
CONSTRUCTION ✓
NEWr ADD ALTER REPAIR MOVING DEMOLISH
LENDER '\
BRANCH
OWNER
ADDRESS VALUE
ARCHITECT TEL. USE $
OR ENGINEER COrbi n/Yamafuj i NO. 752-5567 gyp •
ADDRESS 3661 Spruce St, Newport Bch. ZONE(']DR In 0 TYPE GROUP •
CONTRACTOR
McLain Development Co. BYPRoveD
DATE
ADDRESS 1470 Jamboree Rd.
TEL.
CITY Newport Beach NO. 640-6800 _
F STATE CITY APPROVED SETBACKS
gLIC.NO. 273875 LIC.NO. 18873
is 512E NO.OF BL (FROMC/L STREET)
L OF LOT I NOW ON LOTDGS. FRONT J..S FT.
Q USE OF
-ti EXISTING BLDG. R SIDE FT.
rA
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Separate permits are required for L.SIDE 5 FT. •
G electric,plumbing and heating work: ' REAR 4el a 5T.
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
DATE ,
4]igle family residence, APPROVEDAtt
APPROVED(W,f /67/1/' e
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›. New house __av RATE
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L I hereby acknowledge that I have read this application and state ei 0
0y„ that the above information is correct and agree to comply with Q
B. all laws regulating building construction, and I shall not employ
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any person in violation of the workman's compensation laws of m /`
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S the State of California. -: /1�..�
I hereby certify that I am properly licensed as a contractor under SQ. FT. N r' U
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the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: n
am exempt from the provisions of the State of California Business -a
and Professions Code,Division 3,Chapter
VALUATION PERMIT FEE $� �/ m
Signature of jiff, C A J PLAN CHECK $/ �� LL
Permittee 'Y ( /l/�� $mss�j f `'�
ar { �` TAX +Jb71 $ -C__&41)
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Authorized A t Date TOTAL PAID $ SI
3q/r!7) J9G- 70