HomeMy WebLinkAbout3058 TAYLOR WAY - Building Permits 14% BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
wiSia
PERMIT
�04-00251
(714)754-5273 • Fax(714)754-4656 • www.ci.costa-nesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 3058 TAYLOR WY • Status: ISSUED
Suite: Applied: 01/27/2004
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 01/27/2004
Parcel Number: 14160436 Zoning: R1 R1 •
Applicant: NUNEZ, DAVID ISSUED BY: V
Address: 176 S PINE ST
Phone: 714-639-5632
ORANGE,CA Zip: 92866
Owner: ALMARAZ, SUSAN
Address 13792 MARGENE CIRCLE
Phone:
IRVINE,CA Zip: 92620
Contractor: DAVID NUNEZ ROOFING
Address: 176 S PINE ST
Phone: 714-639-5682
ORANGE,CA
Zip: 92866 License: 448472
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: • License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.REPAIR/REPLACE SHEATHING ONLY AS NECESSARY,COVER WITH 30 YEAR COMP, INCLUDES ATTACHED
GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,750.00
Permit: $97.25 Claim Valuation: $3,750.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
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
L2446ie(WOO)
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
work for which this permit is issued,
O I have and will maintain workers'compensation ins rance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My workers'c• pens, ion I ur:rice carrier a 'oli number are:
arrier: N S. /I/I Policy Number:
is section need not be completed It the permit•s valued at one hundred dollars($100)or less.)
edify that in the performance of the work or which this permit is issued,I shall not employ any person in any manner so a to become subject to the workers'
compensation laws of California,end agree at If I should become subject to the workers'compensation provisions of Sect n 3700 of te Labor Code,I shall forthwith
comply with t ions. ' 2 O
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS' ~ VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTI�D CIVIL FIN S UP TO ONE HUNDRED
THOUSAND DOLLARS($ICO,OWI,INN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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 effect. s.R Lig g 3.Z 5 Class# G'" 3
Contractors Signature: --- Date: 1 2-1 (
CONSTRUCTION LENDING AGENCY: t `J
❑ 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: 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.). '
O 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. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation live(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,fafsework,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 e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 appermit 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 LJ 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 and Safety Code Section 42303 been made? ❑Yes ❑No
......................................................
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply Nth all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
bovd propgrty inspection p es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
77Lt, Si re Of Legal Owner(s) 1 MIM
And/Or Authorized Applicant `•Date
SODS t INSPECTION TYPE QGTF IluII19L5 CODE I INSPECTION TYPE PATE Itn&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
/
/1266 Pool Spa Final /�� ,C� 208 Final Plumbing
pp0 Final Re-Roof 2 all/ 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 _ �
A
Twining Laboratories f t/ d f'•f ,o ou zz�n a c oeMzia ]zc.
P.O. BOX 41 . 3310 AIRPORT WAY. . LONG BEACH, CALIF. 90601 . (213( 426-3355 . (213) 6362386 • (714 628-6432
SRANCU OFFICEES.
TESTING 1514.0 Nonh Harper s•...: La g S.&ch.C0I..108
Sem.An.,C.Vand.R2Y61 �•, 2955 Redondo Ave,.P.O 80.47
In.)5)1.2045 � e � long Beech.CeLI..0601 1T11 ele836e
Examination: 5C70-5627
COMPRESSION TESTS ON GUNITE CYLINDERS
I.. Eo Sprague
2133 Miramar Drive
Balboa, California 92661• R E C
En, E D
PROJECT CHARLES NORTON BUILDING SAFETY DEPT.
ADDRESS 3058 Taylor Way, Costa Mesa
SAMPLE FROM B.B., Shallow End, Deep End SEP 21 1510
(�
^ Ey ('M
^';
ARCHITECT CONTRACTOR : 119T1311111211121 1AI6
ENOINEEE SUBCONTRACTOR
SPECIFIED '
MIX Gunite STRENGTH 2,000 psi
DATE CAST 9-10-70 SLUMP 4"
DATE TESTED 9-17 9-17-70 9-17-70 II 11H.OLD11
IV "HOLD"
CYLINDER NO. I III V VI "HOLD"
COMPRESSION 7-Days 7-Days 7-Days
TOTAL LOAD, LBS. 78,000 61 ,000 49,000
POUNDS PER SO. IN. 3,003 2,349 1,885
•
COMPLIANCE
MADE BY DELIVERED IV RECEIVED ON
CYLINDERS Sprague Sprague 9-11-70
DISTRI W TION:
L. E. Sprague - 2
Whitaker Pools
583 WO 19th, Costa Mesa 92627
Costa Mesa Bldg. Dept.
C4_,FaM 6--"d5C-1-
.LL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS, AUTHORIZATION FOR PUBLICATION Or OUR REPORTS, CONCLUSIONS, OR ES.
'1NACTA PROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS, THE PUBLIC AND OURSELVES
OWNER NORTON QHARL ES DATE 8-26-70
"JOB ADDRESS 3058 Taylor Way BUILDING PERMIT NO. 32203
GENERAL CONTRACTOR Qwner-Buildtr DESCRIPTION of WORK Legalize Patio Cover
N A '. 141-604-36 LOT 26 TRACT t�565 FIRE ZONE VALUE $ 840;00
�IN... ECTIONS Signature Ir Date GROUP J TYPE V ZONE R-1
SOIL
SUBCONTRACTOR PERMITS ISSI1ED
GAS
Dare Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING `` Heating and Vent.
TRENCHES ❑ FORMS 0 STEEL REINF. 0 byhe 76 2/i-
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE ❑
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PL "TER, BROWN COAT
S' 'URAL. FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL /J ///.�
BUILDING, FINAL ylid 4,11 j0
1
OWNER NORTON, CHARLES DATE 8-24-70
JOB ADDRESS 3058 Taylor Way BUILDING PERMIT NO. 92198
GENERAL CONTRACTOR Whitaker Pools DESCRIPTION of WORK Private Swim Pon)
1 x. 141-604-36 LOT 26 TRACT 4565 FIRE ZONE VALUE $ 3,500.00
IN....-ECTIONS Signat re Date GROUP J TYPE III ZONE R-1
sol y,_ail_ _91-17 4) SUBCONTRACTOR PERMITS ISS ED
GAS ( A Date Number Signature
WATER {.(9 net S'Q-tG [ C7 /�, L I '/ ins ,Plunbin rt' , / "7.5416-----
PROP.
r/' _
ROUGH PL MBI NG .OUSE11 1 iW /RV& y/r72U a-7e-c �It'9 l -Lci - 2 7.541' --
PROP. SWR. LINE �HOUSEE_QION. ( �✓ /
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONO NING
TEMPORARY SERVICE OR POL '`4a 'L.-A / ?---5(70
UNDERGROUND POWER E I (nom.{-,I`P 9.17-9 U
ROUGH WIRING _ l� /� Heating and Vent.
TRENCHES El FORMS�+]�STEEL REINF. S-'� 7t-i_�Y 'Zc.
FLOOR SYSTEM r T
BOND BEAM D./STEEL REINFORCE IE- f 711-7°
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLA'-ER, BROWN CO.a is 4,Ce_ ,e1/1,e1/1--1 ' MUS 9— 'fsN
ST URAL, FINAL ! • E ectric - ",
HEA..NG, VENT., REFRIG. AND A.C., FINAL •„/�__/--• �g - ,da •H 3 ��
PLUMBING, F INAL AND GAS T EST U La sea"--2, •�/�/_I��r� -a
ELECTRIC, FINAL rr•t 2
BUILDING. FINAL 44 Cin •9-f.,-'7d
32203 AUG 26-70�WSAOO1124 0*****9.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For ApplicanttoFill in Completely/` ` �,A,, GE,C ,[y 'J
3eS-$ L'J � I 2 WAS RECEIVED BY
el---.? E70 !Y DATE ISS
ED
BUILDING _
ADDRESS ry��-/��'Y� � 2//�
OWNER a(1 a S t -/'<.,(/V- ''\l A.P. NO. /97 6d 5. I �3
Z BUILDING
ADDRESS ®5 e / ` c1r- ['Oa ADDRESS 4 �y `C/
MAIL �]``ff ` /,. '�'j',n,sy/
0 O CITY e O?4- 03.4• I NO. TRACT�,s�s- LOT,z‘ BLQCK
ZZ Q CONSTRUCTION . NEW ADD ALTER REPAIR MOVING DEMO! ISH
O N LENDER
0.
J CO BRANCH .diced �,A'7
O NER gate ������/p o^k,y/
m--
-
ADDRESS � V�0€1 LU$ 81 � /
J CO ARCHITECT TEL.
Q OR ENGINEER OC'.t..Qr.G�� NO.
FIRE *
W CC ADDRESS ZONE ,. TYPEr GROUP
0- W APPROVED ,J/,I/ Q' f
J Z CONTRACTOR p L,.)M�i�. BV j/ DATE o `�-740
CO •
JCC ADDRESS __ � ��/�
W W ZONE NO.OF USE OF NEW iJf6s
z= CITY NO.- �/ (PLANS at BUILDINy 4
Z HLL
uJ O STATE CITY YARDS APPROVED YARDS APPROVED
rn CC LIC. NO. ----______ -- MAIN BUILDING ACCESSORY BUILDING
D O SIZE I THJO.OF BLDGS. (FROM OIL BVITt •
LOT / y 1('' NOW ON LOT FRONT // ., FT. FT.
USE OF .�/ 9..-f--
, > �J
EXISTING BLDG. ✓ t . w FL SIDE % / F_T. FT.
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE !9 FT. FT.
QEXTERIOR WALL ROOF (f
COVERING COVERING REAR //j FT. FT. .2
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q. i MAIN BLDGS. ACCESS.BLOCS.
Q f/ VAR.# DATE
O -�y`€//�d4cfQ ov�J C.U.P.# APPROVED
I- APPROVED/ � A P_js70
V) .RY G Q DATE
Z
0
UI hereby acknowledge that I have read this application and state
✓ that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
H any person in violation of the workman's compensation laws of
N m the State of California. to
zI hereby certify that I am properly licensed as a contractor under $D. FT. 6
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR s
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
CC
am exempt from the provisions of the State of California Business
VALUATION co
and Professions Code, Division 3,Chapter 9. PERMIT FEE $ 9, 00 w
D
Signature o ' 07 to
Permittee
7/7.0
t 'Get° /%• . .211.774'.....- d$ �(4O• � PLAN CHECK S E
((JJ / o
Authorized Agent u
TOTAL FEE $ . 00
OWNER Seaview Homes,, Inc. DATE 6-19-62
JOB ADDRESS 3058 Taylor Way BUILDING PERMIT NO. 17317
GENERAL CONTRACTOR S. V. Hunsaker & Sons VALUE S15,411.00
AP No. LOT 26 TRACT 4565 FIRE ZONE DESCRIPTION OF WORK res w/att gar
INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R1
Soil57, /-6y PERMITS ISSUED
C Ir }(�"(i7.• SUBCONTRACTOR DATE NUMBER
i, r 7- .7---
Rough om. Refrig. ❑ Air Cond. 0 _ �7
Rough Heating A.,W 7�-- - _ glo tad'_ a�4.T f�
Rough Plumbing f//e k/-6a: _ -/-1 i° L- - - 3-i 9 9 I V
r/ 6(
Miscellaneous
Prop.Swr.Line In-House Con:$St.Swr. 0 Bi 7 j)/ -�s,/,�,t_ �(��/,�, /-Lq 7 'Liet
Sprinkling System -��-=e-��Construction PoleUnderground ❑ Power 0
TRough Wiring 'a.'9-4-17 ?( '+-!(7, y��}}yyV���,A eJ -'Fires, 7--76---2.4. 72/O 7
renches 0 Forms ❑ Steel Remf. D 60 hi c.-_7 - J-_ -)..--
Floor System
Bond Beam 0 Steel Reinforce 0 _
Sheathing 1 Its-2-9-(,Y
Frame and Flashing _7�'1 YriS� S' 61
Lathing — In B "Out [Q7--
Plaster,
L
Plaster, brown coat 0" 4_2/-6'1.
Refrig. 0 Air Cond. 0 Final
Heating, Final kW, Z619----al,
nbing Fixtures, Final v'^-i/c S',yn1,
t_.al Gas Test/3-- /���
Electric Fixtures, Final f 7 l o-/r (-
Building, Final 7- P Th-.40-1''
OCCUPANCY 17317
FORM BU4-5M - 7-61
,, FEE RECEIVED
173 ! 7 ✓ ,tun VS 1952
COSTA MESA BUILDING-SAFETY DEPARTMENT �' FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely CIC' COSTA MESA
PP P Y APPLICATION FOR PERMIT
TYPE OR PRINT Z 4P
BUILDING 3o se Z i-y c c e ('--, BUILDING
ADDRESS COSTA MESA. CALIFORNIA For Office Use Only JJJJJJ
I RECEIPT NO. I IP INf�
Beane/VI SeaHomes, Inc. VVVVVV
MAIL RECEIV O BY 1 DATA RECEIVED DATE ISSUED
ADDRESS 1602 W. Almond .4r...- �j-/-o y I JUN 1 9 ;gr,,"
TEL. BUILDING
CITY Orange NO. ADDRESS
AR' 'ECT TEL. COSTA MESA. CALIFORNIA
OR INEER Ramberg & Lowery NO.KI.76131
ADDRESS 2127 N. Main. Santa Am FIRE ,// D
ZONE TYPE I GROUP O 74,x/ --
CONTRACTOR S. V. Hunsaker & Sons APPROVED U
BY DATE
ADDRESS 15855 E. Edna Pl. ZONING
ZONE NO.OF USE or NQWfi) 4,.., /�
CITY "I"IndTT4ale /{_I PLANS a I BUILDING /IOC/:59h
LICTNO. 69.0qp NO. ED. 87361 `EGA` �c�" Z6 TiPYs�6✓-
1 L3 DEBCRI PTION
SIZEOT (g.
L/C /✓ 11 I NO. OF BLDGH.
OF LNOW ON LOT IO A.P.NO. —____-
USE OF YARDS EVES
EXISTING BLDG. ^-- APPROVED ALLOWED
SETBACK LINE FROM ` ( (CENTER LINE ST.)
CENTER OP STREET U D REAR YARD /S FRONT 6a FT. IN.
SIDE YARD I LEFT RIGHT R.SIDE 5 FT. —
IN.
DESCRIPTION OF WORK —
L.SIDE 7 FT. IN.
NE\ I X II ALTERATION I II ADDITION I REAR ` -4— FT. IN.
REPAIR I II MOVING I II DEMOLISH I ABPPROVED �pQ� DATE 67z4-....
BUILDING X /.Q NO. OF 7
T'��
SIZE G -I ROOMS STORIES 3.
EXTERIOR WALL $tUccC7 ROOF
EI '/
COVERING cdcttnn (COVVERIING s in les /4615 N10� 77
USE OF BUILDING AND WORK TO BE PERFORMED
Bingle family dwelling with ;.-74771-44:e• r- -te"
attached garage
Plan 99 E-
I HEREBY ACKNOWI-EDGE THAT 1 HAVE READ 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 FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION `
SIGNATURE OF PERMIT FEE $ ✓/—
N
PERMITTEE S R4S"��y"-
y�L�1_` No _
S /�/ //^ PLAN CHECK $ 0-5 i� 6'
AUTHORIZED AGENT - / ��, _ 2/ 0 0
TOTAL FEE - - a
32198AUf, ?_4 70PALM1BSA001044* ****39.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
3058 Tricf(c7a WA I REC%,EBY IDAX-at)
E RECEIVEDODATE ISSUED
BUILDING .sal((KKjj����,,�r���f t/dI 'OIC VA 7 .Z if 7 0
AODR ESS /�� �/ 9�1
OWNER l.(T4 3. � O 1\ ' 0 & A.P. NO. /(F/IL/VSI PE✓ J,j�O9 r
MAIL 8 trio ^ s - / Cf
BUILDING ES (/ m p )p{I�
ADDRESS -3 0 5 ( k /` VV 4 ADDRESS ]J l
Z7�� '//
o-U CITY C.0(S (A / i6g4 NO. '.� TRACT �j„� LOT(47,44 BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
O m LENDER n� s �_ \✓Y/\
_i ' BRANCH
OWNER 31 �.
a& J it / `
`oo J ADDRESS-corn net
t�/ V�A�t�VE ///��� ��.
J to AOR HITECTNGINEET! rt4 N (R'/V176t/�TELO 3z?Z.. USE T' �Lr t`FN-t �/ �(1
o LI
Z CC / 7 .� ` •— CICIA t ZONE TYPE I l l GROUP T
FIRE
Za. w ADDRESS
APPROVED DATE
JO CONTRACTOR 4-3W H�[ITAK^E2�.�+���LJ' BY ' 2 e� ,v-70
JCC ADDRESS /95v6�G ft EGA Oi . NO.OF USE OE E�\���(�iQ A
LL w CITY 4 Al NO. �� ZOA+/ PLANS ni BUILDING t//L4m( +JI _[I
�= TEL. '{ tQ! \'G'fre.
Z
~ `a YARDS APPROVED YARDS APPROVED
N CC LIC. NO. `GLZGD a+ LIC. NO. %c-� MAIN BUILDING ACCESSORY BUILDING
7 -
SIZE /� Q NO.OF BLOC'S.," / (FROM C/L STREET) �}
OF LOT !`aO X p INOW ON LOT dAlp FRONT FT. Q FT. S;
USE OF /
EXISTING BLDG. 5( l a k CC-. _R.SIDE FT. 7 8 FT. yY
I— SIZE OFm ) I NO.OF /
2 NEW BLDG. Soo ROOMS STORIES L.SIDE FT. .L_ FT.
< EXTERIOR WALL ROOF
COVERING COVERING REAR FT. 6 FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q. MAIN BLOCS. ACCESS.BLOCS.
a ode Y� 6 L.) t AA a esJ VAR.# DATE
C.V.P.# APPROVED
I—
ROVELy,/ DATE 9� 71,
z Et may_
0
VI hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
N the State of California. m
b
ZI hereby certify that I am properly licensed as a contractor under SQ. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are n full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
am exe pt from the rovisions of t : •to a of C Iifornia Business C
and Pro $Ions C d , Divi ion ,C er VALUATION �� m
PERMIT FEE $ ry
m J
Signature of r . K ' 3 r Q/ + /� m
Permittee �w/���III $ ,'"'107\ PLAN CHECK $ ! ,3• `l0 E
"!! �J `o
&
Authorized Agent TOTAL FEE $ 55 t e50