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HomeMy WebLinkAbout2817 LA SALLE AVE - Building Permits p 9 CITY OF COSTA MESA 04 BUILDING DIVISION Y •4�,,,' ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER nt f t P1 I PERMIT 4.%oimnia P02-00340 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2817 LA SALLE AV Status: ISSUED Suite No Applied: 06/03/2002 Issued: 06/03/2002 Vicinity: Parcel Nunmber: 14167211 ISSUED BY: Applicant: NOCK PLUMBING ' . Address: 11612 KNOTT ST ' Phone: (714)895-1246 - - , GARDEN GROVE,CA Zip: 92841 Owner: PAYNE; T BRENT ' :� , ft- Address 2817 LA SALLE AVE `N 111 Phone: , li• COSTA MESA,CA Zip: 92626-5701 O t DA Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Phone: (714)895-1246 ' GARDEN GROVE,CA Zip: 92841 License: 707775 Arch / Eng: . . Address: ' Phone: Zip: License: - SCOPE OF PERMIT . WATER HEATER FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 ' Laundry Tub/Washer $0.00 • 0 • Sump Pump $0.00 0 Backflow irrigation 50.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 - Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 . Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 i Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent ' $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service - $0.00 0 Gas(1-4 outlets) $0.00 0 • Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 • Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS I SPECIAL CONDITIONS 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 ( j 11 WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: O 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. . 41jl 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. y compensation Insurance carrier and policy number are: �� ,//�� n O c Carrier: A(3 f M SL)P 4 Nf2.L GP,nlicyNOmllerr `^zl.-I Iq 3S2 (9S ?This-section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensate of California,and agree that If I should become subject to the workers'compensation provisions of Sect 3700 of the Labor Code,I shall forthwith comply with these pr visions. (� _ S O plicenY tura: \ cDate:- WARNING:FAILURE TO SECURE WO S'CO PENSATIQN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOUARE(S100.000).IN ADDI ON TOI HE 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 under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force.and.effecL.Lic-_a 7T?7 N mac,l(-(( CO r Contrecto S -�_.,({77 LOate:---'-o( -107 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). Lenders Name: Lenders 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 toy?civil penalty of not more than rive hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: • Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,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 B,California Administrative Code). O 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: I 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 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 Califomia 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 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IU Yes LI 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 aermit 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 B (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. ignature Of Legal Owner(s) ( '�' Date _ p 02- CCC\ r.Authortzed"AppBcante--' eara�— - CODE r INSPECTION TYPE PATE INTRIALU CODEP INSPECTION TYPE DATA !MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing I-P.-CI it y IW O n^ ) 200 Final Re-Roof 210 Final Electrical ', 201 Final Slock/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 • . CITY OF COSTA MESA BUILDING DIVISION Q F q' ,AI; 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us� �.rFOR INSPECTIONS CALL: (714)754-5626 , io PERMIT NUMBER. B08-00044 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 14167211 DATE ISSUED: 02/07/2008 . ISSUED BY: BJK JOB ADDRESS: 2817 LA SALLEAV CM , Suite/Unit:-. Vicinity: RESIDENCE AND ATTACHED GARAGE, ' .,i - r' Squares: 3200 Valuation ' '$6,030.00 SCOPE OF WORK: REROOF'RESIDENCE-AND ATTACHED GARAGE:I/O EXISTING WOOD SHINGLES,-,7/16"OSB SHTG, 1 LAYER 15# FELT,APPLY"GAF ELK 30-YEAR COMP SHINGLES."4:12 PITCH 32 SQUARES OWNER: PAYNE,T BRENT Address: 2817 LA SALLE AVE Unit: PHONE: .City/Stale/Zip: COSTA MESA,CA.� ' APPLICANT: VAN NGUYEN - "Address:- 20725 SOUTH WESTERN AVENUE, ' Unit: :UNIT 150 PHONE: 310-781-3012 - City/State/Zip: TORRANCE;CA 4x . .. - ;,t f. CONTRACTOR: PACIFIC HOME WORKS INC- ... . -. .. ..-. License No.- 784477 Address: 20725 SOUTH WESTERN AVENUEUnit:' -UNIT.150 PHONE: 310.781.3012 City/State/Zip: TORRANCE,CA ` 90501 • - . - CELL: . ARCHITECT: License No. - PHONE: ENGINEER: License No. -- -. `-"PHONE: FEE SUMMARY , Reroof Plan Check: $0.00 Reroof Permit Fee: Reinspection Fee: TOTAL FEES $139.25. . • :'i9il' 159 q ; .i. 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 M. INSPECTION TYPE DATE INIITIALS CODEA INSPECTION TYPE DATE INTTT1ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final qq141.--0 9 /'_!, / 208 Final Plumbing 200 Final Re-Roof % ty^'W 210 Final Electrical _ 201 Final Block/Retaining Wet _ 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 _ I • WORKERS'COMPENSATION DECLARATION Owner ID verified by drivers lice..__. 0 Yes CINo ' I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: O 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 eclion 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are:— Carrier: rg: - person is required to descend,will be made in connection with work authorized ',,,/� Or k e,�p on by this permit,and that no building structure,scaffolding,falsework,cc demolition Carrier. Lw\ Ov[�•—S �•tV�V\ (M ,r U or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This section not be pleted dthe Vpermrs�aYaluMdd al me hundred dmars(S100)or less.) 2,M2 Sec.341,Title B,California Administrative Code). Policy Number: Gi C! 10.•J O.2-s- ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance 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 any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the La r e,I shall forthwith comply with these provisions. S l-�1 f/f-,Q 9 Division of Industrial Safety Permit Number: Aooli Cs Signature 1 'sD-a"lre/ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE 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? El 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. 1�� C Ja registration form for acutely hazardous materials? ❑Yes ❑ No Lic.# Class# C7 ' (Section 25533 of the California Health and Safety Code, with some 1 Fefd�4) 1 exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely ontraaor's Signature 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 for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? CIYes ❑No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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? ❑Yes ❑ 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? ❑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? ❑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? ❑Yes 0 No 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 8. (If"yes", attach certificate of compliance from the appropriate air pollution 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 ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Dale 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 application and state that ID 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 by this permit until final inspection. n re of Legal Owner(s) Date Signature nate 305746 p3/07) And/or Aut zed Applicant Date • OWNER MESA DEL MAR CC. DATE 9-10-63 JOB ADDRESS 2517 La Salle Ave. BUILDING PERMIT NO. 20522 GENERAL CONTRACTOR Macco Realty Co. VALUE $ 20,288.00 . AP No. LOT A' TRACT 5252 FIRE ZONE 3 DESCRIPTION OF WORK Res.&.At.Gar. INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R1 Sop J /J _3 -a 7S17,-, PERMITS ISSUED SUBCONTRACTOR Gas DATE NUMBEr Water/ /u- -G3 /1..0-G..)" Rough Com. Refrig. ❑ Air Cond. 0 v Rough Heating l+- j - 3-C.7 J 1r _�1 OCT 2--1963 A -I'i - Rough Plumbing ij /2-6-67 'C-...6-6 SIP 1 7 19W s - , . - Miscellaneous • ,,,�+ Prop. Swr. Line ❑ House Con. 0 St. Swr. 0 ry�&tt /o-2/-Gy �jQ,ti 1/c.2t OCT 2 8 1963 • P f; �"•/' Sprinkling System N-£szi 3-//-c., '='t'l9,P. .`0) -k.O-toL( _ � Construction Pole vJ • 161ICi Underground 0 Power 0 Rough Wiring .-r, n -9Z-Z /.rz e t�izJ• /2-/.?1.<.3 — Trenches 1A----"Forms t4- Steel Reinf. ©�� d" /0.--c/-0, .. Floor System or 79-tel-9 Bond Beam 0 Steel Reinforce 0 Sheathing 111 is -7.-6) Frame and Flashing , , ,,-(e-7,; Lathing-In Er Out KI---- 48-di n -3ei-63 Plaster, brown coat JCS/ /--je -4r/ Refrig. 0 Air Con. in Final ' Heating, Final rxa/ ;3-/2 -CA/ _ Plumbing Fixtures, Final ‘-•::-A✓ ,?%✓-6y Final Gas Test ,--5-711 . >p -ji . Electric Fixtures, Final -/1,[c/ _ i Building, Final C-;.,i 3-f71=w OCCUPANCY ✓✓ Form BU4-5M-73-63--S-B p 20522 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT SEP 1 0 1963 P.'O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. OSTA 1 For Applicant to Fill In Completely cAPPLIIY CATIION ORA PERMIT TYPE OR PRINTBUILDING BUILDING ADDRESS 02 8I0 4,4- ,SA-L kr ,4-vt?. COSTA MESA. CALIFORNIA For Office Use Only , RECEIPT NO. L owNEI$desa Del Mar Development Co 5? MAIL Recely Te cery D rD''lT I�Buss"DO��3 ADDRESS 3800 E. Coast Highway , I �p—�-�I$ a 1� 19nd TEL. BUILDING CITY ennuis Del Mar NOOr.34220 ADDRESS - ARCHITECT TEL COSTA MESA. CALIFORNIA OR ENGINEER Mate() Realty CO. HOOT-34220 . ADDRESS 3800 E. Coast Highway FIRE ZONE TYPEGRO CONTRACTOR Macco Realty Company APBY DATE ADDRESS 3800 E., coast Highway ZONING (' - CITY Corona Del Mar, Calif. =ONE2 _J I NO.OF� I USE OF Nit aA j '/�1� Puna USE OP • ST TrEo. 207343-SB-1 TEL. LEGALLLot #4 - Tract 5252 98808 BB l DESCRIPTION OF LOT 72 x 93 I NO. OPSLDG@,one �— NOW ON LOT A.P.NO. USE OF None YARDS EVES EXISTING BLDG, APPROVED ALLOWED SETBACK CENTER OFINZ STREETM 551 REAR YARD 23'10" FRONTR LINE ST.) 5 S FT. IN. SIDE YARD'I LEFT 5'6" ' I RIGHT 5 R.SIDE FT. IN. DESCRIPTION OF WORK S FT. ( IN. L.SIDE • NEW I X II ALTERATION I II ADDITION I REAR FT. /v IN. REPAIR I 1 MOVING I II DEMOLISH I APPROVE'D BY y� ] W✓' DATE 6)-6279 BUILDING. 61'6"x54'2ROOMS F 6 STORI S 1 Lavin area 1 96 SF EXTERIOR WALL wood ROOF S ` Garage area 483 SF COVERINGsturrn & (COVERING - Shingle g USE OF BUILDING AND WORK TO BE PERFORMED Single Family Residence w/attached garage • Plan #400-A • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY�.q PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING [`V ) BUILDING CONSTRUCTION. VALUATION �� SIGNATURE OF PERMIT FEE $ f' PERMITS - Del Mar D've, o.,��ent Co. ''JJ_`` n By:- . - - •_ $ 20,288.00 PLAN CHECK $n Jn AUTHORIZED AGENT / La a ® TOTAL FEE $ 4