HomeMy WebLinkAbout1033 LINDEN PL - Building Permits •
.
CITY OF COSTA MESA i
� BUILDING DIVISION
ti ...-,i
� DEVELOPMENT SERVICES DEPARTMENT B98-00974 .
PERMIT PERMIT NUMBER
(714)754-5273 • Fax(714)754.4656 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1033 LINDEN PL Status: ISSUED
Suite: Applied: 06/05/1998
Vicinity: Issued: 06/05/1998
Parcel Nunmber: 42247320 Zoning:
Applicant: VAN BOERUN, JEFF
Address:
•
Phone:
Zip:
Owner: SOLOMON, TERRY
Address 1033 LINDEN PL
Phone:
COSTA MESA,CA Zip: 92627
Contractor: TOP NOTCH ROOF CO -
Address: 05011 ARGOSY DR
Phone:
HUNTINGTON BEACH CA Zip: 92649.
License: 625296
Arch/Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
REROOF RESIDENCE,T/O SHEATH&REROOF 4100SF W/COMP SHINGLES, REROOF 650SF W/HOT MOP
FEE SUMMARY
Plan Check: $0.00 • - Calc Valuation: $10,650.00
Permit: $174.75 - Claimed Valuation: $10,650.00
SMIP Res: $1.07
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $175.82
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
NOTES:
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
DECLARATIONS
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
�q work for which this permit is issued.
gi 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.
My workers'compensation Insurance carrier and policy number are:
Cartier: -fl7E FE3-7.3--D 3--D Policy Number. F,190/C17_y
(This section need not be completed if 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'
compensation laws of California, : agree t'at if l should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions
APE-
Applicant Signature: _ i/ i/NS Date: 062 �`�j(�
WARNING:FAILURE TO SECU-"WO- RS'•• PENSATI•r•' ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,c00),IN••DRI• TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3705 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 00)of Division 3 of the Business and Professions Code,and my license is in full//—
force and effect.Llc.N Class# C— I'��
Contractor's Signature: — n T Date: P/Ve/
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 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.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMfi 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,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 Safely 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 a plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 10 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 pad of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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 Nes;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.
nature • .:gal Owners Date
And/Or Au'..rized Applicant Date
MDF I, INSPECTION TYPE DAff 20261.5 ODE INSPECTION TYPF QA¢ INTIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ��//�,' / 208 Final Plumbing
200 Final Re-Roof • -� ✓/✓ 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Anal Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
kJOB ADDRESS 1033 Linden Place BUILDING PERMIT NO. 26890
GENERAL CONTRACTOR owner DESCRIPTION OF WORT ret. wall
re-AP No. 2.15_531_20 LOT TRACT FIRE ZONE VALUE $ 250.00
F;, ACTIONS I Signature Date GROUP J TYPE ITT ZONE RI
\Sq�st PERMITS ISSUED
Y Gas SUBCONTRACTOR Date I Number I Signature
VS Water Plumbing
hough Plumbing
Prop. Swr. Line 0 House Con.CI
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring ' �" , —' Heating and Vent.
Trenches t9..�'orms El.-- ' askSteel Reinf. '�
Floor System
Bond Beam 0 Steel Reinforce p., e-7
Sheathing
Frame and Flashing
Lathing— In 0 Out 0
Plaster, Brown Coat
Str,;rtural, Final Electric
»ca.
F"' wig, Vent., Refrig. and A.C., Final
Pl°i'tiibing, Final and Gas Test 0
Electric, Final
Building, Final ' _n°J -./2/67
26890 APR 13-670- 00 846 )'_*u*3.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
/J /J//� For Office Use Only
BUILDING /0 3 J r ,.(�pr�c> W.
RECEIPT NO. _
+' ADDRESS /
��C��/OJ�STA- MESA.- CCA/LIFORNNIIA^
OWNER /•/�"(.7.Qye�� //"�.t C.It/L,GBU I LDI NO
/ .ig
ADDI REBS Lam( 00"re e^I ei
i / /7 TEL./76-.6,635. -" •- -RESS
FIRE / /'
CITY F NO.(02(/ { / .
OR EMIT HEER ICL�C'//� NO.5 jo^270 � `it, DATE L.91_44
/ (f Z•MING .p�
I, ADDRESS 207 9 NO.OF USE OF NEW// '
, / PLANS .; BUILDING
• CONTRACT•R tI res — • /-1 •
tam.
/,V/ .--..5.-. 'c7 a `_
ADDRESS DESCRIPTION '7
CITY A.P.No. .,� /03' ,/,..7/..Zi
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE TEL 30'TO SIDE B REAR P.L
F. LIG.NO. NO.
VES
' SIZE GO K/e/ K SP�3 X II NO.OFSLDSS. ALLOWED U.(U.S.C.REQUIREMENT)
s OF LOT L NOW ONW( /
USE OF YARDS APPROVED YARDS APPROVED
fMAIN BUILDING ACCESSORY BUILDING
? EXISTING BLDG. ei V
(FROM C/L STREET)
SETBACK LINE FROM �Q / REAR YARD FRONT --PTS— FT.
CENTER OP STREET
I; SIDE YARD I LEFT I RIGHT R.SIDE PT.T. FT.
DESCRIPTION OF WORK Fr.
NEW v ALTERATIQN_ ADDITION FT.
.rilliMa BET.MAIN Pt
.. r ACCESS.BLDGEL
REPAIR _MOVING PEMOLISN
VAR.* DATE
• BUILDING NO.OF
SIZE ROOMS STORIES C.U.P. -
EXTERIOR WALL I ROOF -
COVERING COVERING
'. USE OF BUILDING AND WORK TO BE PERFORMED P.
W
off'V.r( /e LLP ',�' c •-lACP C
cJ &/ —I`e/--'//,/��//; SQ.PT. X
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I HEREBY ACKNOWLEDGE THAT I EAD THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT PEE ONLY. ,IDJS,
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ". VALUATION
BUILDING CONSTRUCTION. �/
- PI-
.
!: 51�� ';'+i � PERMIT FEE $
• SIGNATURE OF
' PERMITTEE 8.�� ��t'+L /�
'.: $ 015 V -/• PLAN CHECK $ -------
AUTHORIZED AGENT
. Q • .'� TOTAL FEE 4 0
UWNER WES'IMAN, WAL'T'ER DATE 4-.1.5-01
JOB ADDRESS 1033 Linden Place BUILDING PERMIT NO. 26557
GENERAL CONTRACTOR owner DESCRIPTION OF WORK add bedrm/fam.rm. & drat gar
AP No. 115-5314-20 LOT TRACT FIRE ZONE VALUE $7,000.00
'ECTIONS Signature Date GROUP I&J TYPE 1J ZONE El
a ' < SUBCONTRACTOR PERMITS ISSUED
\,Gas Veer tI Date I Number I Signature
\Water �� ' Plumbing 76°'Rough Plumbing -k�G? aiAnr/4)-22 17-4-471/771‹
Prop. Swr. Line:0 House Con..p
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning yT,-)
Temporary Service or Pole
Underground 0 Power M4fl't co VPk5/5 y'/)-C7
Rough Wiring_ /( AC '4'-C,7 Heatin and Vent.
Trenches f_9' Forms 0 Steel Reinf. 0 .2.o,✓ J'�/ _ ,0_��,, d i'�,� . -_ J'
Floor System 7.;-b-1.01. ,7y /�,
Bond Beam 0 Steel Reinforce 0
/// 66
Sheathingr'�•} 5---/ 7_67 _
Frame and Flashing lam - 72/9�( 7
Lathing- In 0 Out 0
Plaster, Brown Coat ," e b
F' ',Aural, Final / - d—% / 1 Electr'c I/
:ng, Vent., Refrig. and AC., Fjaal S -M7 l . - �� - ,/ U� • y'Z7-47de7c77
Plumbing, Final and Gas Test ie' ( V.G. /
Electric, Final
Building, Final
Z )IW
ID
(gyp y
2685 PA
APR 6 67PID 332* ****36.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
/ /j) For Office Use Only
BUILDING ,;0,3
33 //AJIIPAJ /r/.
ADDRESS �L RECEIPT NO, PERMIT NO.
COSTA MESA. CALIFORNIA a�
7
nag,/
O7�D DATE ISSUED
OWNER b.../ Ii...) P S-7fit-t / 7/427
�J BUILDING
ADDRESS 17 RESS . a' /en en_t_e.0_-f.c-[//� e-e ADDRESS f/
/ /� 9, //
FIRE
N j/ GROUP
CITY/(�¢/� ,/�_ /'�NO.W yC'-6,94/
�.'/�J1TYPE 44-r
ARCHITECT (1 TEL APPROVEDY /70J DATE 'reinei u
OR ENGINEER3 ,, (r• al- - NO. /, O� ,,�,,:rt.c-e f „
ZONING 6 ; (Q d-v
ADDRESS ZONNO.OF UBE or NEW �LI 'L
/� _ 11,,_ ! I PLANS BUILDING�(�}c
CONTRACTOR (/./l/.Ui`---)n p y/ _ I
ADDRESS `�j/� DEDCRIPTON Ili
CITY /C v//l,(--a.i - A.P.NO. I I — S��
NOTE: NO RAVE OVERHANG SHALL BE LESS THAN
STATE TEL. SO'TO SIDE B REAR P.L.
LIC.NO..., NO.
ZE6.0
X /y� y3 X i.S/{[ EAVES
I NO.OP BLDae, / ALLOWED (U.B.C.REQUIREMENT/
OF LOT newt/ON LOT
USE OF YARDS APPROVED YARDS APPROVED
EXISTING BLDG. MAIN B DING ACCESSORY BUILDING
/ / (FROM �•' - -ETI /
FT.�
SETBACK LINE FROM [� FRONT CO
CENTER OF STREET D REAR YARD d 0 / o/ ✓
i
SIDE YARD I LEFT 10 I RIGHT /0 r R.SIDE PT.
DESCRIPTION OF WORK L.SIDE /0 err. 4 D rr.
jj
/t
NEW X ALTERATION _ ADDITION REAR L"- `-' D FT.
DISTANCE BET. BET.MAIN it
REPAIR _MOVING QEMOLLBN MAIN BLDGS. ACCESS.BLDGS.
V
E EXTERIOR
00 WALL ��I OO 7 STORIES
/ APPP.O..fl ^ �e�ATEAPPROVE� `��
EXTERIOR WALL I ROOF APPROVED V/LYJI///
COVERING COVERING BY
USE OF BUILDING AND WORK TO B8 PERFORMED L4
7-
of - L�, t 1
y - &1 4I!..Y{�fC'CI c�,(l �/ so.FT. �/0 1
"0-Ar 4 .P-fit- .�C.I'�`�"'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A LICAT N • THE AMOUNT SHOWN UNDER VALUATION IS FOR THE -
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT PEE ONLY.
1
5
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. / ,�Q,. PERMIT FEE $ 4
SIGNATURE 0 r:�s/� 4�'p-_- �4 l" E
PERMITTEE (L!G!P I' sss/A/U//A// ��YIGL $ i �/ PLAN CHECK $ '- 1i
AUTHORIZED AGENT �1
TOTAL FEE $ 6
OWNER WESTMAN, W. R. DATE 9/1/72
JOB ADDRESS 1033 Linden P1. BUILDING PERMIT NO. 35350
GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Garage - Patio
No. 115=54l+-20 LOT 105 TRACT 1712 FIRE ZONE VALUE $ 3200.00
SECTIONS Signature Dote GROUP J TYPE V ZONE R-1
U SUBCONTRACTOR PERMITS ISSUED
GAS
Date I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0 1�M
ROUGH WIRING ,l q, r/'j /4 Heating and Vent.
TRENCHES 0 FORMS 0 STEEL REINF. O
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE v"..7
SHEATHING qqq 2
FRAME AND FLASHINGFLASHING
UT IIIA✓✓✓✓/ l t"N(y Y
PLASTER, BROWN COATI //- i�
:TURAL, FINAL JJ�/�{�/�I/j/'j� �j /
I. INC, VENT., REFRIG. AND A.C., FINAL Jallii / Ur iIY""'�+� 7 lit 3444(f2
PLUMBING, FINAL AND GAS TEST n '/'L� I
ELECTRIC, FINAL < IL./S%PG-o.... niun r, ai A" 12./C 722.- I
3LJPATO
3�J0 SEP —1-72c;;s,00 025* ****39.22
q3� COSTA MESA BUILDING-SAFETY DEPARTMENT
ii P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
P
P• IC ION FOR BUILDING PERMIT
For Applicant to Fill in Completely aEel v D v D TE EDEIvED
q / ^/ 7�/ DAT ISSUED
BUILDING /Cif l ` /A/OL--4/ /-f-. • We '/ /-/
ADDRESS
/ � JJ 'Co S / 'T mESA P 'RMIT NO.
OWNER, 4 , r� , 4 E.S T n14 /V •' A.P. NO. I1 S-.c3L'I —3-0 TSB S7U
BUILDING in
MAI L
Z (f
ADDRESS 2 o86 8., Lnleg69 L Pl.... ADDRESS/VI,. �jy SCJ] I!
-L) CITY Cos/ rsq. NOL674-683s TRACT,, Iu)-... LOT LOS BLOCK
FZ
CONSTRUCTION NEW to DD ALTER REPAIR MOVING DPW!EH
OI- LENDER '--
a. CO
J D BRANCH
J to OWNER
Q W ADDRESS
CO.03
J ARCHITECT TEL6sI�.� AG 1Ge VALU ,
J N OR ENGINEER (../ /j�/��/e, NO, FIRE ) ,/J/ _
W CC
ADDRESS f'-D�J(JL {YJ f}r�4L PL- ZONE TVP6/[/iGROU
Il W BPPRO • q/_?
- OCONTRACTOR y V E / By I - I. DA //
m Z
•
J(r ADDRESS
111 W TEL. ZONE NO.OF USE OF NEW oAr1%oc&E r-
e CITY NO. R1 PLANS BUILDING 1p/eclo
_F IRO l
O STATE CITY YARDS MAIN ED YARDACCESSORY
BUILDING VED
co Q LIC.NO. J _ /�,J�r LIC.NO. MAIN BUILDING ACCESSORY BUILDING
OO ' / TT (FROM C/L STREET)
OZE NO.OF BLOCS. /- �{•4y /,,
SIZE NOW ON LOT / FRONT FT. V/. FT. -"-_'
USE OF
EXISTING BLDG. S^ R SIDE FT. I FT.
I- SIZE OF / // / NO OF Lam(
Z NEWBLDGIP E X96 ROOMS STORIES / L.SIDE FT. S-1 FT-
EXTERIOR WALL, .- N
ROOF
U COVERING .3 *o CC (COVERING/ / ERAL- R REAR FT- L FT-
J USE OF BUILDING AND WORK TO BE PERFORMED 6 1//
O. DISTANCE BET. BET.MAIN&
CL MAIN BLDGS. ACCESS.BLDGS.
QQ /J VAR.# DATE
O G)19 r� /�GP
C — -'9770 C.U.P.# APPROVED`� ry
V) _Y APPROVED �t /. •'
,l _DATE (!/////T..
Z V� IJ
O \ "TECO L� �MENfS
UI hereby acknowledge that I have read this application and state HOLD ROK a
n that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
I- any person in violation of the workman's compensation laws of
(n the State of California. /nJ i� //..1./�/J yc CO
Z I herebycertifythat I am 10
C7C/!. SO. FT.t,-/r]/C- V61// "�/7 ti
properly licensed as a contractor under
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses ere in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
cr
am exempt from the provisions of the State of California Business �/�
and Professions Code, Division 3,Chap r 9. VALUATION �I, din
l y
,(�//7
et-PERMIT FEE $?( N
Signature of f/f! //
Permittee l $3 410 PLAN CHECK $ / fI E
no
Authorized Agent �..!
re, u.
TOTAL FEE I
•
, OR4NGE COUNTY BUILDING DEPARTMENT • APPLICATION FOR PERMIT a
636North BUILDING
SANTATA ANA, CALIFORNIALIFOR '
FOR APPLICANT TO FILL IN FOR.OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
BUILADD ESS 10 3 Linden Place 9 Lki .3-7 4 i 7
SCHOOL DIST. RECEIVED By DAT OF APPL. DAT ISS ED
OR TOWN Costa Mesa /\
NEAREST
. State Ave. R fa l /0 AY/sem /0 7 Sc1
. BUILDING /)
OWNER PAWNEE HOMES, INC. a ADDRESS 0 3 3 tai a 1) 1
ADDMAILRESS 9363 WILSHIRE BLVD. ,, SCHOOL DIST. / / 'J w
1 OR TOWN Li a
BEVERLY MILLS TEL CITY NO, CR. 511361 NEAREST
CROSS ST. . / i
ARCHITECT OR TEL.o 1. ZON€ O. OF T I GROUP /
ENGINEER CAIN & MCKERRACHER NO. SY. 64891 r. A�/ I PLANS I'� r} J
/' p �C� /
ADDRESS/2110 E. WALNUT Sr., PASADENA • SETBACK LINE F OM CENTER OF ST. P11.0
TEL. • REAR YARD 251 SIDE YARD 1 O 'I-101
CONTRACTORNER
WPOT VISTA CD.ND. CR. X61 APPROVED
BY p'�/ /f DATE 4 R.
ADDRESS 9363 WILSHIRE BLVD., BEV.HI LLS.
LEGAL CORRECTIONS
DESCRIPTION I LOT NO. 105 I BLOCK 1712
(ATTACH METES & BOUNDS)
TRACT
�J PITS NO.OF BLDGS. 0
SIZE OF LOT 200 SQ.r 1 I NOW ON LOT
USE OF I NO. OF I NO. OF
EXISTING BLDG. FAMILIES ROOMS
DESCRIPTION OF WORK
NEW I y I ALTERATION I I ADDITION 0
REPAIR 1 I MOVING I I DEMOLISH 2
y
BUILDING NO. OF r
SIZE 1034 SQ.FTROOMS 5 STORI El
WALL COVERING STUCCO I ROOF SHHO ( I
COVERING COI HOLES
USE OF NEW
BUILDING RFSIDENCE %Att,Carpo t . .
i
APPROVALS
FOUNDATION: LOCATION INSPECTOR DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS, .J 1
APPLICATION AND STATE THAT THE ABOVE IS CORRECT ', UNDER-PINNING C.-a /C�.`p `)r
.j
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS, y>rJ //03- - fl
BRACING, BOLTS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. -
LATH. INT.
•
SIGNATURE OF NEWP r RT VI STA Co LATH. EXT. J / ' /•7,
PERMITTE
PLASTER, INT. /�
AUTHORIZED ACT. �
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