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Home My WebLink About599 KNOWELL PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 599 KNOWELL PL Suite No Vicinity: Parcel Nunmber: 42213207 Appllcant: NOCK, RON �',.�%%"' � � � ' Address: � � � ' _ � '�� , � /�..,�,�. � . -� . -- � i � � Owner., BUTTELING,.BENNY � Address 599 KNOWELtrPL � � : i: COSTA�MESA, CA ' Conlractoi: �NOCK PLUMBING Address: 1,1612 KNOTT ST',� . , 'GARDEN GROVE, CA Arch / Eng : Address: Phone: 714-895-1246 � Zip: Phone: Zip:' 92627 ,.-''. - . (. Phone: p14) 895-1246 � Zip: 92841 Status: ISSUED Applied: 09/06/2001 Issued: 09/06I2001 ISSUED BY: � v � , � License: 707775 � • � i -• r: / .` _ � , _ _ �_ � � . � . � Phone: ._ , � : ` � ; . . . Zip: ' - ' _ _ - , . _ _'_ -_ _ _�License: . � -, - ��' - /'„. � � �:� r i . .. . . i j� ' . _ ' , SCOPE OF PERMIT � WATER HEATER CHANGE OUT. - �- � � � �FEE SUMMARY , � AMT QTY � - �AMT �'' QTY ISSUEFEE : ,� $23.50;�, i.,;.., .1LaundryTub/Washer � $0.00., .0,-_�,- Backflow irrigation $0.00 ' 0 � Landscape.lrrigation $0.00 0 Backflow Preventer � $0.00 � 0� � P-Trap ` " $0.00 0 Bathtub 50.00= ; 0� �- Pressure Regulator $0.00 0 Clarifer System ' � $0.00-"- .0 � �Process Piping (per 10 ft) $0.00 0 Connect Qce,Soda,etc) $0.00 - ,� 0 � Receptors . $0.00 0 � Dental Units ,, $0.00 . � 0 ; . Septic Tank $0.00 " 0 Dishwasher .$0.00 0 � � � -Sewer Cap for Demo $0.00 �0 Drain, Floor $0.00,. � 0 � : Sewer Connect - ' $0.00 �0 Drain, Rainwater $0.00 � 0 -. � - Sewer Private Line $0.00 �� 0 - � Drain, Roof $0.00 0, � - Shower � � $0.00 0 Drinking Fountain $0.00 0�� . Sink, bar $0.00 0:' Ezpansion Tank $0.00 0 ' Sink, Commercial : , $0.00 � 0 . - Gas Earthquake Valve 50.00 0 Sink, Floor $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 Gas Repipe $0.00 0 Spa (private) $0.00 0 Gas Service 50.00 0 Spa (public) $0.00 0 Interceptors (Grease, Oil) $0.00 0 Mterceptors (Sand Auto ) $0.00 0 COMMENTS I SPECIAL CONDITIONS - SumpPump - Swimming Pool , Trep Primer �" Urina( � � � � Vacuum Brkr Bkflow(1-4) ' Vacuum Brkr Bkflow(5+) �,Wash Basin �'� " � � Wash Basin�Set � Waste antl Vent System -WatecCloset (Toilet) _- - Water Heater/ vent - Water Piping (Inst or Rep.) Water Re-pipe Water�Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES: E35.80 QTY 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 NOTICE: The work authorized by ihis 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 commencad within 1 BO 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 Inapecdona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 xaaaae �doo� WORKERS'COMPENSAnON DECIARAnON: ' I hereby aXirtn under penelry o1 parjury one o1 the tollowing declaretions: ❑ 1 have end will maintaln a cetltlicete of consent to selt-Insure tor warkers' compensetlon, as provided for by section 3700 of Ne Labor Code, for the pertartnence of the for which this pertnit is issuetl. I have en0 wiil malniain wwkers' pensatlon Insurance, as required by section 3700 of the Letwr Code, for the peAortnance of the woAc tor which this pertnit I5 issued. M workers'�° �rti -e�nsailon Insuren carriar antl oli number are: / , ,�//Gy ? �p � Cerrier.Y /�CFr�—/ � P� Policy Number:LV /.J CJO (lh/s sectlon need nof be comp/eted i! fhe permit /s ve/ued af one hundred dollers ($100) or less.) ❑ I certity thet in the pertormance of tha work for which this pertnit is issued, I s�all not employ eny person in eny manner so es to become subject to the workers' compensetlon laws of C and egree that Ii I should becoma sub�ect to Ihe workers' compensatlon provislons of Section 3700 of t�e Lebor Coda, 1 shell forthwith comply with these provis s. ¢ Applicant SiBneture: � Date: /—� � � d� WARNINO: FAILURE TO SECURE WOFKERS' COMPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE MUNDRED hqUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATIqJ, DAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE, INiEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirtn that I am farce end ettect. LJa a_ ContrectaYs Signature:. .; 9(commencing wlth Section 7000) of Division 3 oi the Business antl Pro ssi s Code, antl my license is in full ciass x G �� — �� Date: 9 —/D — O / CONSTRUCTION LENOING AGENCV: ❑ I hereby ettirtn that there is e construction lending egency for the pertortnance ot the work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lendefs Name: Signewre: _ OWNER-BUILDER DECLARATONS: Lentler's Adtlress: Date: I hereby aflirm that unAer penalry ot perjury Ihet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Buslness and Protessions CoOe: My ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit ro Ille e signed stetemeN t�et he or she is Ilcensatl pursuant to Ihe provisions ot t�e Coniractors License Lew (Chapier 9(commencing wRh Sectlon 7000) of Didslon 3 of ihe Business and Pmfesslons Cotle) or thet he or she is exempt theretrom and the basis for tha alleged e:emption. Any vloletlon of Section 7031.5 Dy any epplicant for e Oerm+1 sub�ecis ihe epplicant to e dvil penalry ot not more Ihan five hundretl tlollars ($500).): ❑ I, as owner ot t�e property, or my employaes with we9es as iheir sole compensation, WILL DO TME WORK, and the structure is not intended or oHeretl tor sale (Sec. 7044, Business and Professions Code: The Conirectors License Law tloes not apply to an owner of properry who builds or improves ihereon, and who tloes such woM himsetl or herseH or Ihrough his or har own employees, providetl that such improvemenis ere not intentletl or ottered lor sale. If, however, the building or improvement Is sold within one year of wmpletion, ihe owner-builder will have the burden ot Drodn9 lhat he or she did not 6uild or improve tor purpose of sale.). ❑ I, as owner of Ihe property, em E%CLUSIVELY CONTRACTNG WITM LILENSED CONTRACTORS ta construd the O�Mect (Sec. 7044, Business and Professions Code: The conireciors License Lew tloes not apply to an awner ol pmperty who bullds or improves thereon, entl w�o conirects for such pro�ect wlih a contrector(s) license pursuant to the Comractors License Wws.). ❑ I am exempt under sec. Business antl Professions Cotle for this reason: Signetura: Date: Owner ID venfied by drivers license. ❑ Yes ❑ No DnveYs Llcense No. Expiras: Vedlicetion ai Ownership by (type o1 tlaument, I.e. - properry tan 6111 or deed): DIVISION OF INUUS7RIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenify thet no excavetlon five (5) or more teet in tlepih into which a person Is required to descend, will be made in connection with work authorized 6y Ihis permit, and that no building sirudure, swHolding, talsework, or tlemUition or dismentling thereot, will be mora then thirty-six (36) feet high. (Chap. 32, Gry 2, An 2, Sec. 347, Title 8, Calitomia Atlministrative Code). ❑ As owner-builder, I will not employ anyona to do work which would require a pertnit from ihe Division ol Industnal Safery, es noted ehove, unless such person hes e partnit to Oo such work from Ihe division. SignaWre: Date: Divislon oi Intlusirial Safery Pertnit Number. CEHTIFlCATE OF COMPLIANCE AND AUiHORPJ1TiON OF EHTRY: I certify under penelry ot perjury that I have read this application antl state Ihat ihe infortnation given is correct. I agree to wmply with ell stete laws entl ciry ordinances releting ro builCing construction, end euthodze represeNatives ot the Ciry of Costa Mesa to enter upon the ebove-tlescnbed properry for inspection purposes. I agree not to occupy or ellow occupancy oi any building authonzed by Ihis permit until tinal inspection. Si eture Of al / D�teO/ O ' AnNOr Authonzetl Applicant � Date CODE �. msvecnoNrrve QAg INfffIALS 1878 Fixed System Final Fire Prevention 1268 Pool Spe Final 200 Final Re-Raot 201 Final Block/Retelning well 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Demdition GODE� ItlSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency BAIE It�SLS • � a PNOJECj POOflESS: � 9 q ��OW Vj' Y.L ow�ee'ooass:�iiiiSL_NGr J=?�iNY �'' S99 xtiOWE:,L r�L �,r COSTA iy_SA, Ct� i RNCH/ENGINEEP: 6 G 5 / 5 5'B ADONESS: UNIT: 92627 flEG.NO.: UNIT: PEflMITTEE: BENNY BC,�TTELING ( 7? 4) 645-7558 FODHESS: S59'tCI�lOW=LL PL �'H LA 92677 LICENSEO CoNTHpLT�B OECUIBATION: I hereby aHirm Ihai I am IirenSeU unUer pmvisions of Chapter 9 �commencing wi�� Section 7000� ot Urv�sion 3 0l I�e Business antl Pmiessionc Code, antl my license is in full lorce antl eifec�. CITY LIC.: STRTE LIC.: CLASS: Oaie: Signalure: WOPNEflS' COMPENSATION DECNflATION: I hereby aflirm that I have a certificale ot consem m sel4insure or a ceni�ica�e af Workers' Compensalion Insurance. or a ceriilied copY �hereof �Seciion 3800, Lab. C�. POLICY NO.: EXP. OATE: ' COMPANY: ❑ Cetlilied copy is hereby �umi5he0. ❑ Ce�i�ie0 tODY is �il with �he ti�y BUiltlingpi ision. � p � ��,,�� ai '. � ' J , ApplicanC � MPTION FPOM WOBREP fAMPENSRTI�N UECNflPTION: (T�i55etlion ne¢ o� be wmple�etl if �he permil is �or ane hundretl ($100) or less). certify Ihat in �he perlormance o� Ihe work lor whic� Ihls permit is issued I hail not employ any Derson in any manner so as �o become sublec� to Ihe Workers' Comp¢nsa�ion Laws o� Califomia. �a�e�. Signalure'. NOTICE: II, afler making IAis Declaration, you shoultl become sublect Io Ihe Warkers' Compensation pmvisions of the Labor Catle. you mus� lonhwi�h comply wi�� suth pmvisions ar this permil shall be Deemed revoked. CONSTBIICTION LENUING RGENCY: I �ereby afiirm Ihal Ihere is a constmc�ion lenaing agency lor Ih¢ pedormance o� Ihe work �or � which I�is permil is issuetl (Semion 3097. Ci¢ C�. LENOEfl: aooeess: OWNEB 9UILOEX OECLABATION: I here�y a��irm Iha� I am exemp� �mm Ihe Contraciors' Stale License Law for Ihe following reason .(Sec�ion 7031.5 Business antl Pmfessional Code'. Any cily ol coun�y which repuires a permi� to constmc�, al�er, impmve, demolish, or repair any simcWre. prior lo rts issuance. also requires ihe applicant 1or such ve�mit to file a signed slalement that he/she is licensed pursuam to ihe pmvisions ol Ihe Comraclors' State License Law (Chapter 9(commencing wi�h Section 7000) oi oivision 3 of t�e Business and Pro�essions Cotle) or Ihal he/she is exempt t�ere�mm ana ��e basis �or the allegetl exemp�ion. Any viola�ion oi Section 7031.5 by any applican� br a permit sublec�s �he applicant lo a civil penalry o� not more �han five hunared tlollars �$500�. I, as owner of Ihe pmpetly or my employees wiih wages as Iheir sole compensation, will do ��e woB, antl Ihe ❑ 9mcWre is nol mlentletl or atleretl lor sale (Section 70aA, Business and Professional Cotle: The ConVactors' State License Law tloes noi apDly Io an owner of a property who builds or impmves thefeon, antl who does such work himsell/hersell or I�mugh his ar her own employees, provitle0 �hal such Impmvemenis are no� in�en0e0 of offered for sale. If, however �he builtling or impmvemeni is sold wiihin one year oi tompielion, ��e owner will have Ihe burden oi pmNng �e/5he tlitl noi builtl or impmve lor Ihe purpose a� sale�. I, as ownerof�he propeny.am exdusively conVacting wi�hlicensea conlrac�orsio conslructthe projecl�Section 7044, Business ❑ and Pm�essions COAe: The Contrac�ors' Staie License Law does no� apPly to an owner of Ompehy who builds or impwves thereon antl wha comracis for sucA D�olecis wiih a comracloqs�ficense pursuam ro ��e Contracmrs' S�a�e License Law�. I am aware I�aI proo� o� Iheir Worker's Compensation insurance shoul0 be provitletl m me. ,Q I am exempi unAer Sec�ion' B. 8 P. C. io�tnrsreason: ��P��44 S/L /A,�.-3L1 Wj�Ri( BY O•r1AiER /� •�. Date. r � M Owner / / ' I tlo hereby cenify inat I am aware ol an0 understantl the requirements of California Health2 tl Salery Cotle Sections 25505. 25533, antl 25534 antl Ihat I or any �ulure builtlmg accupan� willlwill not (ci�cle one� neetl �o comply wilh SaiU sla�e codes antl the requiremenis for a permit for mnslmclion or modificatian Imm Ihe Air Ouality Managemeni OisVict. Fe5i0eniial conslmction applica�ions are exemp� imm Ihese provisions. �a1e: NpDlicant: I her �y [etlity��at I have read �his apDLcation antl s�aie thal Ihe above in�ormalionis correcl. or ances antl sialelawsrelalingto building conslmdion antl herebV aNhorizerepresenlaiives o� oper�y larinspection purposes. / �aley�r-. �� Signature: t �river's License or Social Securily a: lo comDly wi�h all ciry and caun�y to emer upon I�e a0ove-memmnetl �� / t6aba6 W�ne—Bulltling'. Green—Cotle EnforcemenL Canary—Appllcanl; Pink—Revenue; Goldenmd—Assessor CT_iY OF CU�:A MESA -$i3ii.DING P�RtPeIT PERM NO: 3 U6?188 P�:cN._ i AiO: � 062? 88 PLAtv C??cCK �G: N GOVT: y SUPn; N C�tisT3uCi=��Di YYYE: V-N rER;!ZT :YPE: S:R PuRPUSE: A�T JOB DtSCRiPTIO�i , i/OFF fiESHT RfiROOF W/ CUMP SQ FT: ?,500 C�AiM VALU�: 1,500.00 CALC-VALUE: 1,500.00 GROuP Or_C: R-3 / CO,uMENTS: SMUK� DETECPt�RS REQU, i3BC S=CT?t 1216 �*�r,:*�**x*?��u*�*��*�t��x�t?r�F*tt��r�e**±�� **k�t�ts��r-�**#***�€�i�t��*+�*�**?��*#�***�?�_x Z U!v ? � G R E(� II,I H F M E N: S s=�aA�xs -------- --- MASN Bi.i=�7ING ---------- -------- ACC�SSVRY BLtI�D3NG --------- �?tNT: Fi I!v REAR: FT IN F�NT: FT iN REPR; cT ZN LEFT; F i I� RGfii : FT IN LEi T; FT ZP] RGHi : FT � Z.N PARKING RE�: PRt'�V: PARC_L: 92213207 Z1VE: RE� Nv: ��a?�Ni?�c n r=s> . � _> — , 3E iE t i' ii'k'Jf i"r i�`. ,L' Y.jc �"y' {E iF �} Y jf �E'1F?� IE iE � iE iE �'IE 3c iE iE ii')E'N"N' 3(")E :�E'JE 3! )E ih'1F iE iE iE iE?E iE # K"lE iE iF'iE if'X'?�>.' K'?� iE iE 9'r 3! iE'%�3E 3%'74 !i' ii ii' 1!'1E iE iE D � Vr�'_ :, O P N? N? 5 E R �� 1 C E S R E Q U I R c u E N T S ;r' - ..I. ZUNING APPRGi1,.cD BY DATE; EiJZ�DI�iG A?PRUVED 3Y : DATE; -i APP�SCATIUti,�SUEll BY: �ATE• �_—� ifiF?Fif?fifif�7E?ffE1't'i''iEiE1E3f?fjEiEiEiE��.,`.`t � n-�c<±.i.% - r�"�e� �'�iF£?EikiEjEiF�lEiE### xx : 1F�f 3f ?E?f if 3E if iE ?f ?f 1E ie # if iF if if iF ic if a?E � if <iE � 3E?E'.E jf iE jf i: jE i� 3E 3E 3E if iE i: . 3f ?f ±E jE iE?E iE #!E �)E lE �7f �F iF # 1E 3E 3E 3E if�?E?E t iE )f �lf �f ?E iE if 34 iE 3c �le }'f. � LEGAI,IZAT�Oti;N F E E S U M M A R Y STRiJCTURAL SEGM_tii:Y 3i,JG P2�.T P?,UMBItiG ��ECTRI MECAAT3IC FIR= SMIY/RES GRF�TIING PERMST 35.40 �'l P�AAI ISSUE FEE / Bi7_i,DltvG-DZC'-> PErMI? ISSu2 PLAiv I TOTAi,S----> 35.50 G.00 '�,; -Ci-iECK 0.00 ,50 Sj`:2� %!V17�1—'.'Z �.r'_+� TOTAL PASD UU� 35,50 35,7G .00 REi7'cNJE DSVZSiON TOTA�S--> CO�LE�=TED: 35.50 OVER/SHORT: OG B�UG PMT PLU�?BING E�ECTP,IC �!E�:-?AD?IC F�RE SMIP/TOT GRAUItiG PLAh-�N_CK 35,00 t' ' .�0 )Ei�'iEifl4;F�{Y�f}?f*�?f�%rifif�!ati�'iFif±�.�iE�!CKafi�� Kif�k�c�if}al��'��Y*iEif?ii!afi�'{f#af?ix3cifif*afiE}.*xx*�#N'iflEi%a!?4ii'f[ S N L1 i V I U u A L!.- r E E B R E A K D u W N iYPE QTY n E S C R I P T I�O`N iiAilT COST TOTAL C05T SFR 1500 R_ROO: BY VA�uE R:.3.IuED7YIAL NOZONE 1.00 ?,SG0,00 ENiJ OF n'E£S � /`�� QS 00139110-QO1'9111 T�] T � �I �`: UATE: QS/14f9s y71tIE: 11:02 '1N�fRUCTION AND PLANNING I ��P� rtOVALS Permit# 1. Temporary Eleccrical Service or Pole 2. Soil Pipe-Undrgrnd. �'', 3. Electrica� Condurt UtilitY•Undrgrnd. �' 4. Electncal Condurt-Undr9rnd. � 5. Steel Reinforcement 6. Electncal Uf ER Grnd. 7. Footings 8. Foundation 9. Water Pipe-Undrgrnd. � 10. Structural Floor System i � it. Property Se�ver Line & HouseConnection � 12. Sc�.ver Cap ' 13. Roof Drains 14. Rough Plumbing 75. Rough Electrical•CondU�t � 76. RoughElec[ricWiring 17. Rough lNiring Sign 18. Rough Eiect�icai•T Bar Ced�ng 19. Rough Hectiag & Air Co�dit�oning 20. Ro�Gh Factory Fireplace 27. Duccs, in Structure 22. Ducxs, Nentitating 23. Gas Pipe�Rouqh & Tesc 24. Roof Framing 25. Root Sheathing 26. T�Bar Ce�hng IStructu�a�l & Yior.ocoat 27. Frame ar.ti Flashing 28. Lathing & Sid�ng 29. Insuistion _^ 30. Oryv.a11 Nailing 37. Pia;ter Bto�vn Coat 32. Eiectrical Power Meter Final 33. Final ElectriC 34. Final Heat�ng & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Pinal Factorv Fireplace 38. Fnal Plumbing 3B. l7ater Service�Final 40, Gas Sernce•Final 41. $olar pomesticFinal 42. Backflow Preventer 43. Backflovi Irrigation J4. Landsc:.pe �rriqation System 45. Sound Attenuacion � 46. Handiwp Regulations � 47. FI��AL S7RUCTURE & BWLDlNG 48. FINALPLANNING � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co _ __ _ Date i Date POOL & SPA Inspector pppROVALS Permit # Date 52. Pool & Equipmenl location 53. Steei Reinforcement 54. Forms 55. EleCtrical Bpnding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER�GUNITE 58. Etectrical Conduit�Undrgmd. � 59. Gas Pipe, O Undrgrnd., Test _._Y 60. Backwash Lines, P�Trap, � Undrgrnd. 61. kPPROVAL TQ DECK � 62. Baak�wash & Fieceptor•Final 63. Heaier & VenfFinal ' 64. �Ptumbing System � Final 65. E�ectrical-Final � 66. Solar SYscem-Final 67. Fencing & Access ApProval . 68. APPROVED FOR PLASTERING . 69. POOLlSPASYSTEMSFINRL . FIRE DEPT. REQUIREMENT APPROVALS Permit # � i0. Underground Hydro 71. Product Piping � Gas ❑ Oil 72. Under9round Flush ,ry�{� 73. Undergrnd. Storage Tank 0 Gas ❑ Oil -' v 74. Overhead Hydro � 75. Ory Chemical 76. Dry Star.dpipe 77.� FiXED SVSTEM FiNAI � 78. FiRE PREV. FINAL _�_ HEALTH DEPT.. REQUIREMENT 79. FtNAL InSPECT10N 80. F000 CERTIFICATE ISSUED � Notes: , /' !.,_ /% Q %i .i% 0 � Inspector OW NER ROGERS, K. K. v DATE 9-3-54 6� 9 JOB ADDRE3S � Knowell Place BUILDING PERMIT NO. 519 GENERALCONTRACTOR Owner VALUE $ 9�SZO.00 �or 21 BLOCK TRACT 2168 Residence GROUP i TVPE V ZONE +W FIRE DISTRICT 7�LE� PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE � NUMBER Foundation Forms and Grade ta Rough Framing Plum6ing, Rough to Slab E Plumbing, Rough Complete Temporary Pole Wiring, Rough � Heating, Rough Heating, Final Sewer ,(/��/ Septic Tank or Cesspool Lathing y� Plastering � Plumbing, Final, Fixtures Comp, Plumbing, Final Gas Test Wiring, Final Occupancy Form 110 GH 1M 12-68 _(]osta Mesa Building Department /��n APPLICATION FOR /P+ERMIT 'tJ� �.��'� "� 11T EAST STREET aSrGV � I L D �� F7 � � COSTA MES .LIFORNIA � FOR APPLICANT TO FILL IN g'OR FFICE USE ONLY � � � - Receipt No. - �Permk No. ' Building 1 �� ' �J fY� S - � Address . �.n�p� �Cin • �"c.- o� T � Costa Mesa, ri&�OPlliB� Received by Date Rec'd. � Date ssued"' r � �•-� l Nearest t�% ,`/. , r� �� , ' . Cross St.��it .i � � .\�.6\4 G.r �� Q �� v � ' Building - I , �-.,, - # Address � .' o`""e� '� { � �� ' �. r � ' Costa Mesa, California Mai{ 1 , Address `/(}'T. ��i i f �A1. i\ r?/ Nearest � � � r / � Tel: ' Cross St. � 'City-� ,_�� ,�'�`{/ NoY`(}�;�,..U� ' Zone '/ No.of Type Group— � Arohitector Lic. � T I Plans I I � - Engineer No. � Approved ', � b r_ Date � �'� ` � ^dd�� CORRECTIONS'•� � � ` cicy uo. "� , Contractor � �� \1,i 112 No. i ' � . v : " Address ��J Q.� I . � � Descrption I No. y� I Blxk I TracS'1/1� '-" - � �`.�� (Attach Metes and Bounds) � � i :'� tt, � ` No. of Bldga �' Size of Lot ��,'�� 1�j U+ I Now on Lot � 0 �� Use of � f "- � � � 70 �+ Existin , j . Gf Setback�Linefrom � RearVard Z CenterofStreet i � Side Va�d y - DESCRIPTION OF WORH � New I I Alteretion I I Addition' �I � =� � = �� .= RePair I I Moving I I Demoiish I . �''";: n-._�, �: .; , .�r cr'' � . ¢ ^,o�.� � � Building � �` No. oi t � Siie i7�1 (�i'1 Rooms Stories ExteriorWa�l � Rooi � �� coveriny �J t�Vtl I covertng �� c,`� ApPROVAI.S Use of Ne - Foundation Lxation Inspeetor Date � Building �[ , �, , �'�, Forms, Materials, . --`� Under-Pinning • �.£' °;,�,;�, Frame: Fi re Stops, , Bracing, Bolts F= � ` - � I.Hereby acknowj edge that I have read�this Application Lath. Int. : arid� state that tNe abwe is correct and agree to comply � - ' � . with all City� manc�s, and State Laws regulating Lath: Ext. - building consttuCtien.' - � . . - , Signatur � Plaster, Int. � Permittee �- • . �! � Plaster, E�ct Authe_r' d Agt. . ' Masonry Reinforced � Valu�ation Permit Fee $ yy' ' / Plan Check $ � Bond Beam 'r'� �.$� S � Total 7 ��-.0 �2`�_�� • � '� Fee $ y/ FINAL Cl�'�G . 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CALIRORNIA For Applican+ to Fill In Complefely TYPE OR PRINT ■ MAIL ■ SIZE COSTA MESA. CALIFORNIA TEL. NO. OP 9LDG8. � I LEFT ��-.� I RIGHT ��-�('J � DESCRIPTION OF WORK BUILDING NO. OF SIZE ROOMS E%TERIOR WALL ROOF COVERING � O WVEF U6E OF BUILDING AND WORK TO B 1 ....1 ....�.1 ..�� 1 XEREBY ACKNOWLED6E TNAT 1 HAVE READ THIB APPLIGTION ANO eTATE THAT THE ABOVE 19 GOpNECT AN� AGpEE TO LOM- PLY WITH ALL CITY OfiDINANCEB AND 6TATE LAWB FIEOULATING BUILDINO CONBTRUGTION. ' SIGNATURE OF/� •-� A ("\ "7_ C� _ �-C� ■ AUTHORIZED AGENi FEE R �EIVEa �E8.131962 FINANCE OEPT. b� R�PLICAT�6f�I' F��FPERMiT sua�iN� For Offlee Use Only MESA. FIRE ZONE APPROVEO ZONING ZO I NO. OF �' U8H OF NQW / PLANB BU�LDINO `�`"` Ln� a Il fi oesca�rr�ox G P N[f I I� '� � I d — O LINB BT.) THE AMOUNT BHOWN 11NDER VALUATION �B voR iHe PURPOB¢ OR, EBTABLIBHINa • PERMIT FEE ONLY. .UATI(O�N -^/ � \� I PERMIT FEE 5/.0 , I � � _ v