HomeMy WebLinkAbout2344 Ticonderoga Way - Building Permits HPROJECT ADDRESS: 2344 TICONDEROGA WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069484
OWNER'S NAME: MC NEILLY RANDALL K TR
I ADDRESS: 1581 PONDEROSA ST PERMIT NO; B 069484 PLAN CHECK NO; N GOVT: N SUPP : N
\!N1 COSTA MESA,CA 92626
r.E CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCIIIENGINEER: REG.NO.: JOB DESCRIPTION : TIO RESTH 6 REROOF W/COMP 6 HOT MOP SQ FT; 2, 508
ADDRESS: UNIT:
CLAIM VALUE: 2, 508 . 00 CALC—VALUE: 2, 508 .00 GROUP OCC: R-1 /
PERMITTEE: STOUT ROOFING, INC. ( 310) 923-6775
ADDRESS: 9700 WASBURN RD COMMENTS: REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DET. REQUIRED
DOWNEY CA 90241 ***********+h>t+ ****r;,k**r;tE****r*rraErBr*Br*«Ek+E*************+tr**circ*err****ar*rrr+t*+Er*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section ZONING R EQU I R EMENTS
7000)of Division 3 0l the Business and Professions Code.and my license is in full force and effect. S ETB ACK S
CITYLIC.: 05937I7G suTELIc.: 402536 cuss: C-39 EXP: 10/95
oate:l�'ag�1`-'7 Signature:_ ' MAIN BUILDING
FRNT; ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm than naves certificate of consent to self-insure pracenifirate of Workers' FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation 1ppmagge2ty.bto4ti52d copy mereol(Section 3800,Lab.C.1.
POLICY LEFT; FT IN AGHT; FT IN LEFT; FT IN RGHT; FT IN
POLICY NO.: 7 G L C 7 7 EXP.DATE:
COMPANY: EN
PARKING REQ: PROV: PARCEL: 41916363 INE; REF NO:
❑ Certified copy is hereby furnished. L?Certified copy is ti,.with the city Building Division. PLANNING NOTES> -
o/ �g� >
Date Applicant rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr**************r*rr**r*rrrrrrr**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
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 the Workers'Compensation Laws of California. ZONING APPROVED BY ••
DATE: .
Date: Signature: BUILDING APPROVED BY ;
NOTICE:It.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor '/�I1 DATE;
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ;O
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: 1 ' DATE;
which this permit is issued(Section 3097.Civ.C). **************************** ****r*r******r****rrr**r****r******* *r* r *
UNDER: *******r***********r******** ***********************************r******r* ****
ADDRESS: LEGALIZATION;N E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 , 00 , 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commenting with Section 7000)of Division 3 al the Business PLAN SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My 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). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, will iso the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered lar sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTAL S——--> 54 , 50 0 , 0 0 0 . 00 5 4 , 5 0 54 . 50 , 0 0
does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.Il,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: 00
orimprovementthe
is of sold e)ninoneyear of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for the purpose of sale).
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 , 00 ' S0
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ************************************************************************r****r*
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BR EAK D OWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dale' Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 508 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification Iron the Air Duality Management District.Residential construction applications are exempt from
Mese provisions.
Date: Applicant 01 00170511-00170512 TOT 54.50
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county DATE; 10/28/94 TIME: 12:31
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes.o
Date: LO/��rp1 Le Signature: A _
Driver's Licenselllor Social Security 0:
t641-46 White—Budding;Green—Code Enforcement Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. :, • 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
•
4. Electrical Condug-Undrgrnd. ' 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - I
6. Electrical UFERibrnd. -. 57. APPROVAL TO COVER-GUNITE
• 7. Footings58. Electrical Conduit•Undrgrnd. -
_ ,_
8. Foundation " r - 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P Trap, 0 Undrgrnd. 1
'.10. Structural Floo: System :' 61. APPROVAL TO DECK I
I
11. property Sewer Line & House Connection 62. Backwash & Receptor•Final
12. Sewer Cap 63. Heater & Vent-Final
,i -
13. Roof Drainsp 64. Plumbing System - Final
14. Rough Plumbing - 65. Electrical-Final
15. Rough Electrical-Conduit-, 66. Solar System-Final
16. Rough Electric-Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Cedingi
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace I .c 0-1 C - " • • :APPRO VAtS '';Permit #
a-•�
, . • •y - - • .-
21,'Dudts,inStruct%e ,• •
r y, 4. 70. C1nde-rgiotin�l Hydro `n
j
22. Ducts, Ventilating i D^ c ''. o i* 171. Producf:Ripmg O Gas gOil
23. Gas-Pipe•Rough & Test ',i<.: ,, Ill _ -� , : r72. Underground Flush
24. Roof Framing -, . ••r• 1 t 73,4Undergrnd.Storago`Tank*0Gas 0O
25. Roof Sheathing ' a, a. 7I:..-0--qq c i.vQ' : 174;;Overhead Hydroa•- :
IT A
26. T-Bar Ceiling (Structural) &iMonocoat c rr• '1 4 757Dry Chemical 6 .-j 1 C
27. Frame and Flashing n -"r _ r ' :: 'v
• -q 1 76`D'ry $taniPe �..CD
•
28. Lathing & Siding-t {a' •' • i •• 4 11 774 FIXED S•YSTEM
n 7 FINAL ;
29. lnsulati l '. -° ' `D " " " „ " I I. 7B FIRE PREY' FINAL .r .'
30. Drywall Nailing * •• w HEALTH.9EPT. REQUIREMENT
31. Plaster Brown Coat' r,�, h ; „79: 'FINAL IPIISPECTIf]N , a �' .'
_
32. Electrical Poyer Meter-Final; ,y • I: . 11800•FOOD CERTIFtCANTE ISSUED
1] - ' I - I k _ --
33. Final Ele'ctriC ' •'1 I '1 Nob s: r" . *i _; ,` .,•
t.
'34. Final Heating &4ii.eenditignir+: 'j' • '• I c N -r• . r _ -4
-. .1 1 l• . •t ..• .1
35.•Final Gas Pipe-Test 1' rt1 " - 1 i• • r _7 '' 14 an,
36: Hood or Canopy-. t'-• .r -1-, . ' C. . • . el C., ' ^
61
naatory r ,7iace -"': r .r, i I 11-: d r� n
37. .Fil FcFie `t
1• • r 1
-Li38. Final Plumbing - -• I •• . • - < O
39. Water Service-Final" I ' I I• r • 'i'
u' I It k
40. Gas Service-Fi,nal'_ ,, z • r-, I I, : • 't r.
41. Solar Domestic-Final-. •. _ ' I N ' -t"' '
i• - t .
42. Backflow Preventer" .i
" '� '•. ; - r.- . - +
43. Backflow Irrigation: • _ r'
• T P • .
44. Landscape Irrigation System]. `•i, - , :1' 7: :1 J : • n .. '3 •
< • -r
45. Sound Attenuatto.Thn " ' r-' • ' -1t;
46.';Handicap Regulatiofs •- i - , _ ,
47, FINAL STRUCTURE & 8UItDING 6% 4si 6:,...et ' .
48. FINAL PLANNINGt v n I I: . r.Eir r; -•
49. -Electric Release to Edison I • - - ^-'
I . - ,z� 3
.
50. Gas Release to Southern California Gas Co , . -I , . J
51. CERTIFICATE OF OCCUPANCY r _ ... . _
No. Date
w 7 /l/ •
- ei4 Ad Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - - -- -
CITY OF COSTA MESA C NSTRUCTION PERMIT RMT N TRACT NO. LOT Na UNIT NO. 0596 8/01 /86 5.00 TL
, ProjecttAddress ,p ." 7i C 44 1h egoG A- 1? ' b Li A- H -
Applicant's Mailing Address TYPE OF CONSTRUCTION E NEW DD ❑ ALTERATION REPAIR - - ,
•
rr77,
• ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# - Zone
Owner's Name r)t/7) 4/14 -'--
�� (J R Phone DESCRIPTION OF WORK/USE OF BLDG.
4 J�7/ •
Address / «7 77 B -k47S Main Building: Accessory Building:
Arch/Eng. I - License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION El STRUCTURAL E Front.. o
•
Address - • // ❑ TENANT '❑ ELECTRICAL 13 PLUMBING LI MECHANICAL BRear - N
Contractor's Nama ��,(IQ-(�S. -f,/ y Phone 7.57-77-25-4( ❑ 'OTHER AC Right - - N
'/14/ PROJECT DESCRIPTION SQ. FT. OCCUPANCY K _ G
Address(mailing) is /� , '
_ CONSTRUCTION TYPE VALUATION$ S Left
City,License No. n A < !. / - - R
S ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION •-
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: N
with section 7000) of Division 3 of the Business and Professions Code, and - d.9 Ni
my license is in full for - aPd effect. / �� _ • RECEIVED J U L ? S
License Clas Y/ icense/., tli GfYG Y •
Date '— Signature `ice Bar •
SinkPLUMBING FEES
WORKERS'COMP@NSATION DECLARATION ELECTRICAL . FEES
(� I hereby affirm that I have a certificate of consent to self-insure or a certificate • Showers 1
of Workers' Compensation Insurance, or a certified copy thereof (Section •
y p _ ,Backflow Presenter , Service Sink , Automatic Washer Transformer ❑ 15-50 KW • ' •
3600, Lab. C.) /} /' r I
'\ Polic No. •4-&�9t4. Company ,S ��� Backflow Irrigation Sewer CapConstruction Pole Sub. 0 50+ KW • ,
Certified copy is herebyfurnished. ' I
�\ Certified co is .�.Q with the city tiny Division Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps
bate C/ Applicant —'W1 e..& � ��
EXEMPTION FROM ORKE RS'COMPENSATION DECLARATION Clarifiers - -+ Solar Collectors - Dishwasher -- -- - - - ' Meter .Dover 100 amps - -
•
(This
section need not be completed if the permitis for one hundred ($100) or
less). Dishwasher ' Solar Piping, I DrIIIyers ❑Gas ,0Electric Sub Panel
I certify that in the performance of the work for,which this permit is isauetl •
ore not employ anyperson in any manner so as to become subject to me Drinking, Fountains Solar Tank • ■,■ Fary • ' 11.1
Workers' Compensation Laws of California, Motors Do-1 HP D1X-8
Date Signature - Floor Drains Swimming Pool w/Spa . F.A.U. I.NOTICE:If,after making this declaration, you should become subject to the •• _ - Inc.Solar,09-15 HP 016-15+
Workers;-Compensation provisions'of the Labor Code, you must forthwith , Floor Sinks ' Urinal Fixtures Microwave '
comply with such provisions.or this'permit: shall be' deemed revoked. _ '
CONSTRUCTION LENDING AGENCY - - Gas S¢Nice . Outlets ' 'Water Closet l Device Boxes i
I hereby affirm that there is a construction lending agency for the performance _ Pole Light •
' ii
of the .work for which this permit is' issued (Section .3097 Civ. C.) Interceptors. - Water Heater ) Outlets •
Lender's Name - - - 3' Range
Lender's Address '_ . • Kitchen Sink _ •Water Service Switches Sign i
OWNER BUILDER DECLARATION - - -
I hereby affirm that I am exempt from the Contractor's License/Law for the Lavatories _ Auto-Wash - Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or • _ •
county which requires a permit to construct,alter,improve,demolish or repair P-Trap , Laundry Trays ., • er
Genator D
DO-5 KW 5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
-to file a statement that he/she is licensed pursuant to the provisions of •ROoflDrains • - •
the Contractor's License Law(Chapter,9 (commencing with Section 7000) of ) •
Division 3 of the Business and Professions Code) or that he/she is exempt -,`
therefrom and the basis for the alleged exemption. Any violation-of Section
7031.5 by an more icant for a permit subjects the applicant to a civil .i • l • ,
penalty of.not mora than five hundred dollars($500). .` .pp - • $.3 d l ,
0 I; as owner of the property or. my employees with wages as their sole Reinspection- ee - $15 . - , Issue Fee
compensation, will do the work,and the structure is not intended or offered ' - Reinspection Fee ,I $15 , Issue Fee . $ 3 •
for sale (Section 7044, Business and Professional Code: The Contractor's . . i , ' MECHANICAL i FEES - -- .� - ,.
License Law,does not apply to an owner of a property who builds or improves , -'
thereon, and who does such work-himself/herself or;through his or her own ' - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are nob intended or offered for Boiler $ I • Hood ori Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type 11 D , ., Zoning Approved By Date
pletion;the owner will have the burden of proving he/she did not build or im- Duct-Under Ground r Building Approved ey Date .
prove for the purpose of sale). I / h
D I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • • ' Application Issued By -1.( s� Dat
e—�T�
tractors to construct the project (Section 7044, Business and Professions Code: '
The Contractor's License Law does not apply to an owner of property who- Duct- Ventilating - ❑0-100,000 BTU ❑100,000 BTU - •• - SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- '
tractor(s) license pursuant'to the Contractor's License Law). I am aware that ' 11.1BUILDING PERMIT , $ • SMIP $
ofExhaust System 0 Multiple 0 System Repair/Alteration
proof their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
D Iam• exempt under Section : • B.& P.C.for this reason Firepl/Fact.Blt. ICBG# ' IIII Fire Dampers • 1 $ ISSUANCE $ - 411.E
PLUMBINGT n-$ 0_71'
Heating System& Re isters !` PLAN CHECK 25% $ ENERGY•P.C. ' $
Date ' : Owner - Ducting B I
I hereby certify-that I-have read this-application and state that the above 0o-100,000 BTU ID f00,000 BTL , GRADING $ '
information is correct. I agree to comply with all city and county ordinances . - - ' ELECTRICAL . $
and state laws relating to building cons uction:and'hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to a to up a above-mentioned property for . ,
inspection purposes, /y�' /p ������(/� MECHANICAL • , $ ' • 1 TOTAL FEE ' $ r' DQ
Signature ��Ls/ 7 �� /'U Date_._�7� _ _ + I ,
Drivers' License or 55# - _ Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK .25%, $
_ �% - - • . .
CMF 0865-46,rev. 10/84 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
ti CONSTRUCTION AND PLANNING POOL& SPA • •
• APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final •
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing• 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 12-16-e4 Ltz.r('" }a. Leo
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final PlumbingI-b�.11i LLD
:c. •
39. Water Service-Final
C?
40. Gas Service-Final If"
41. Solar Domestic-Final
42. Backflow Preventer Y.
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
-47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
-51- CERTIFICATE OF OCCUPANCY
No. Date
wwiNe.n SAN VISTA Building CO. DATE "(-21-b(
JOB ADDRESS 2344 Ticonderoga Way BUILDING PERMIT NO. 27322
GENERAL CONTRACTOR Sanista Bldg. Co. DESCRIPTION OF WORK Res.w/att.gar.
AP No. 930-03-84 LOT 84 TRACT51G0 FIRE ZONE VALUE § 13,240.00
INSPECTIONS Signa ure Date GROUP I & J TYPE V ZONE R-3
Sod (1" 73(-G PERMITS ISSUED
SUBCONTRACTOR
Gas a•s. ._ I Date Number Signature
Watera. _ P umbin_
Rough Plumbing -c 22 iAi.7_ iii as. . - i
Prop. Swr. Line 0 House Con. ty-- . c r-3-02
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning 7,2,4-L 7
Temporary Service or Pole
Underground 0 !Power 0
Rough Wiring a ! 7- f Heating nd V nt.
Trenches Forms 0 Steel Reinf. %��1�- 7-7iet ' /tli�. `7-//217 ,f;-047-
Floor System , ' e- ' 7 62 (/ /
Bond Beam 0 Steel Reinforce 0
Sheathing C...--
/
��jj/
Frame and Flashing /! _)/} 'i
Lathing—In t Out ./i p 41
Plaster, Brown Coat 4 t //17(27
Structural, Final 9,,pplecHeating, Vent., Refrig. and AC., Final /y 45 C7 . L,efq_77677--7/
Plumbing, Final and Gas Test 0 /w4 .0 -1 ,, �• 1 "
Electric, Final 'tai //,/r 7
Building, Final / /�177cr/ �01
PAID
JUL 25-67Lwa001677-, c-::-."•••61.50
2'7322
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
a'y' For Office Use Only
BUILDING '1 r.(L11 �p,Ey'_ 'Q,,,_,--
ADDRESD oC / „+/'�' -�/ RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA 2iv.N.9ri—s
mese //L • . NEC I ED 0.TR.ISSUED
OWNER T ^ZVU. Lacy . 6 - / .
BUILDING
MAv,a</ q ag ^n,e4 c/ ADDRESS
FIRE
CITY 41)(4,_0410 410 NO. A 5,1,1j41 ZONE TYPE !/ GROU /7
ARCHITECT ///]J��"p�/.� Tfi �
APPROVED DATE
OR ENGINEER 0.01..'Lt'(,l NO/ZJ-i�'�
C� ��II ,,7/42.,' . n al–t ZONING
ADDRESS (.JLiI uCe al-tints p 30N[ NO.OF USE OF NEW
RS PLANS 2 BUILDING Sing. Res
CONTRACTOR 0 aktte,
LEGAL
/...e.-ii- 8'54 ( (to-eV-67
er0
ADDRESS JC{. ((L
AP.No. 930-03-084
CITY g CL./C
NOSTATE TEL 30'T TO SIDE&REAR P.E: NO EAVE L OVERHANG SHALL BE LESS THAN
LIC.NO. NO,
SIZE
OF LOT 4{J 2 _ "7 c I NDO;OQN L co_ A
_ ALLOWEDVES (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLOW.
(FROM C/L STREET)
SETBACK LINE FROM FRONT 0 FT. PT.
CENTER Or STREET REAR YARD
SIDE YARD LEFT RIGHT R.SIDE FT. PT.
DESCRIPTION OF WORK L.SIDE 0 PT. FT.
REAR 0 FT. FT.
NEW ALTERATION ADDITION
DISTANCE BET. BET.MAIN&
REPAIR MOVING OEM4ue1 MAIN BLDQS. ACCESS.BUMS.
SIZE
I LDING2s s‘-74, .NO.OF VAR.# DATE
ROOMS ST Rip I C.U.P.# APPROVED
EXTERIOR WAL&I ROOF p /�(,/ APPROVEc40 p C
COVERING O*1}-(!Or COVERING ^•�D{{�L BY
DATE �-I -V�
USE OF DUI LDINS RAND WO KTq�¢P[RF M[D 0.
TON
,c�ci 'J�9 v.PVc.o.1/2 w
/tel etz71.7Ad
SQ.Fi. V90'11 X
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT ssEMM UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF AELISHING A PERMIT FEE ONLY. Nj
PLY WITH ALL TY ORDINANCES AND STATE LAWS REGULATING
BUILDING CON CVALUATION "��ODOR. PERMIT FEE E
SIGNATURE OF
PERMITTEE 'C.u 12.4- asi �O
PLAN CHECK S
AUTHORIZED ENT ' > od 67'$b
/1 . 2 j O TOTAL FEE $ -fl
i