HomeMy WebLinkAbout2066 VALLEY RD - Building Permits . � , • i
CITY OF COSTA MESA
4 BUILDING DIVISION
>air $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
VIna/A/W let
t I pica •• PERMIT l
ScPcmaiso
,acs J 602-00115
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2066 VALLEY RD Status: ISSUED
Suite: Applied: 01/24/2002
Vicinity: Issued: 01/24/2002
Parcel Number: 42233130 Zoning:
Applicant: WEAVER, PAULINE E TR ISSUED BY: ---I_
Address: 2066 VALLEY RD - - ' -
,;<'- ' Phone: 949-54870891 •
COSTA MESA;CA ' Zip: 92627 -
Owner: WEAVER;PAULINE E TR -
Address 2066,VALLEY RD - ' ' ;
. Phone: -
/COSTA MESA,CA - Zip: 92627 - - - v ' "
Contractor: `OWNER-BUILDER / "
Address:
/'^�-
- Phone: •
Zip: ' License: 0
' Arch : Eng:
Address: ' Address: -- • - •
Phone: ; Phone:
Zip: - . License: 'License:
SCOPE OF PERMIT, '
REROOF:T/O EXISTING WOOD SHAKE, REPAIR SHTG AS NEEDED,FOR PORTION OF THE ROOF AND APPLY 5/8"CDX
ON PORTION WITH SPACED SHTG, 1 LAYER 30#FELT, INSTALL."30-YEAR TIMBERLINE COMP SHINGLES."2800 SQ
FT.
___ -__ _ FEE SUMMARY'; -. _ ,
Plan Check- , $0.00 - - - Calc Valuation: " ' ' $6,500.00
Permit: . $139.25 Claim Valuation: - 'ss,soo.00
SMIP Res: $0.65
SMIP Corn: $0.00
Other ; ' $0.00
Inspection: $0.00
Total: $139.90 - _ - __ - -
PLANNING & ZONING
SETBACKS - . "
' - . . "
MAIN STRUCTURE Front 0-6 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:
INOTICE: 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 n fy L
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.
❑ 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:
Carrier: Policy Number:
(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,and agree that if I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOU.ARE($100,000),IN ADDITION TO THE 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 effect.Lic.# Class#
Contractor's Signature: Date:
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 end 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 perm+'
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
)4 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 exemot under sec. Business and Professions Code for this reason:
Signature: iiit.Ql:,mtt7 -�✓[1 Date: it"2z} (J2
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: -9--(^uhj
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 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 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 ❑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 a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the Califomia 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? ❑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? 0 Yes ❑No
e (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-de ' ed epprrope�rrty for inspeoti
on loses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ta
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE r INSPECTION TYPE PATE INTITIAL$ CODE! INSPECTIONTYPE PAIS INTI1IAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /' � 208 Final Plumbing
200 Final Re-Roof 7-1-0 2 - SFA'W<'1/r 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
r +1;
•
.PROJECT ADDRESS: 2066 VALLEY RD UNIT: CITY OF COSTA MESA - BUILDING PERMIT . PERM NO: B 052444 •
OWNER'S NAME: .WEAVER PAULINE E TR 1
ADDRESS: 2066 VALLEY RD PERMIT NO: B 052444 • PLAN CHECK NO: 02120-9.1 L GOVT: N SUPP: N ,
COSTA 'MESA,CA 92627 - r . -
, CONSTRUCTION TYPE: 5,-N . PERMIT TYPE:. STR PURPOSE:
' IARCH/ENGINEER: ' ' - RED.NO.: - JOB DESCRIPTION : 5 LIN FT OF RCMU WALL @ 6 ' HIGH SQ FT: : H 5
ADDRESS: ' • UNIT: . r- `
• CLAIM VALUE: CALC-VALUE: • 100'. 00 GROUP OCC: R 3 /
•
PERMITTEE: EARL' WEAVER ( 714 ) 548-0891 -
ADDRESS: 2066 VALLEY RD . COMMENTS : * -
• COSTA MESA CA 92627 *4e***************************-************************* *****arx.yE1E#***x.*;i*i*#N*x-*x
UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section , Z ONING R E Q U I R E M E N 1T S
7000)of Oivision 3 of the Business and Professions Code,and my license is in full force and effect. • _ SETBACKS
1
CITY UC.: . STATE LLC.: CLASS:
Date: S nature: MAIN BUILDING ACCESSORY BUILDING
° FRNT: FT IN REAR: FT IN FRNT: , FT IN REAR : FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure ora certificate of Workers' IN '
•Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C). LEFT; FT • IN RGHT: FT LEFT: FT IN RGHT:' F1 IN
POLICY NO.: , EXP.DATE: .
COMPANY: PARKING REQ: PROV: PARCEL: 42233130 ZNE: R1 REF NO:
Certified copy ishereby furnished..❑ CertifedcopyisfledwiththecityBuidingDivision. PLANNING NOTESS> CONSTRUCT 6OFT. LONG, 6FT, HIGH BLOCK WALL, ONLY . .
Date: Applicant. *******M-l4* E*****x******#1434)4* **.,4l F*********-• **************,****_%.N-*'b*-**4**********
DEVELOPMENT SERVICES R E Q U I R. E M E W'T. S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Ibis section need not be completed if the permit is for one hundred($100)or less). 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 to the Workers'Compensation Laws of California. ZONING APPROVED BY • : C3—. EE , DATE: 6//tit./
Date: Signature: '' - BUILDING A?FRUVED BY t 40Jr •_ _ _ _4(0 - .
I NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE
CTRU you must foNG compwith such irmithat this permit shall bt fndingdeemed revoked.cy �--- •
Tt */
which this perm LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for *AP***I 'ATC ION ISSUED BY: �: — �� • DATE:
which this Dermic is issued(Section 3097,Civ.C). ********%******%******3F it � * . * .****iE**%** F n'• {t%
, _ LENDER: x**#***!F**#if***343E*x*1(****#3E************1rif - * *#******iF*)E1E***********tf**)i******
ADDRESS: LEGALIZATION:'N F E E SUMMAR Y - STRUCTURAL° SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/REST • GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT ' 15 . 00 •
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SM 1 P/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 9 . 7 5 ' re •
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by -i
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
' BUILDING-DIV-> PERMIT - ISSUE PLAN-CHECK TOTAL PAID • DUE
I, as owner of the property or m employees with wages as their sole compensation, wit do the work, and the e25. 25 . 00
❑ structure is not intendedorroferedforsale ° TOTALS .15 . 0 ,'0 , 00 9 . 75 25 . 25 • .
(Section or 7044,Business and ProfessionalwhoCode: .The Contractors'rkimself State License Law
does not apply to an owner of a property who builds improves thereon,and does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 25. 25 OVER/SHORT: 00
improvement is sold within one year 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).
15 . 00 . 50 9, 75
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business •
and Professions Code: The projects License Law does not apply to an owner of properly who builds or improves thereon %****.**_****%*****iE*.***3E*fL************Y-*#*********u**%3434.*****34***x*****Kk?E**h Y.
and who contracts for such projects Contractors'Statea contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compenscsion insurance should be provided to me. I N D I V I D U A I., F E E BREAKDOWN
❑ Lam exempt under Section: B.&P.C. '
for c • TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
•Date: �• / . / / Owner.J .��7/--C.�tri-Ve•� SFR, 5 , RES-CONCRETE BLOCK WALL / FT. • 20 . 00 100 .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'williwill not(circle one)need to comply with said state codes and the requirements for a -
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from '
these provisions. , ( .
Date: Gq'—/ / VI , Applicant: .,.. �•.� , gyp/
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
ordinancesand state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned - _N!"
property for;inspection purposes. - o yN - -' - -
al
Date: ( /..--- 7/ Signature: 2'y !'r`v-/moi/ \ - — -----4i Sil0� ' G�—
Driver's License or Social Security a:
1641-46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING' - - POOL ..SPA - - .
ik
Date Inspector Date Inspector,
APPROVALS Permit # APPROVALS Permit #
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 UF ER Grnd. . - 57. APPROVAL TO COVER,-GUNITE -
7. Footings - 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 •Undrgrnd.,Test d'
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System . ' - 61. APPROVAL TO DECK '1 -
11. Property Sewer Line & House Connection - . 62. ,Backwash & Receptor-Final f
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 F
. 16. Rough Electric Wiring'• a 67. Fencing & Access Approval
y 17. Rough Wiring Sign • - 68. `APPROVED FOR-PLASTER I NG '
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating-81 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 j
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank 0 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 �'1/4/ 78. FIRE PREV. FINAL I
30. Drywall Nailing ! HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ; i 79. FINAL INSPECTION
32. Electrical Power Meter-Final !80. FOOD CERTIFICATE ISSUED
33. Final Electric _ - Notes: j
34. Final Heating & Air Conditioning . 1
35. Final Gas Pipe-Test
36. Hood or Canopy -
37. Final Factory Fireplace 1
I
38. Final Plumbing ;;• I
39. Water Service-Final I
40. Gas Service-Final ` I
41. Solar Domestic-Final - I
42. Backflow Preventer I
1
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations I
47. FINAL STRUCTURE & BUILDING .Z7-'j(- 664f¢ r 4, G(4
48. FINAL PLANNING /
49. Electric Release to Edison • i
I
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date
WE
CITY OF COSTA MESA
PARK ES
Fee Payment Receipt Np� 041
Project Address 20 Co c, V4.1-1---Cc
Y 1``17 , Park Area
A. P. No. 115 - (vii - 3D
Building Permit No. 38 So 3
Owner's Name eel-9e //4��(i�Li NC �e , WEAU&
I Mailing Address 7002— (Vt/tiS6r47��� -
/
L-�
FEE
j Single Family * No. of Units / @ $338.27 . = 338, 27
Multiple Family ** No. of Units @ $238.78 =
Total Fee 338. 2-7
Planning Department Approval Date l-^ -/7-7_,,V By 6J4, 30 tr
Applicant's Signature ��4---// , 604.6 _
* City Ordinance 72-44 } 71
"* City Ordinance 72-45 OiO A �1 m
OWNER WEAVER, EARL AND PAULINE DATE b-1II4
JOB ADDRESS 2066 Valley Rd. BUILDING PERMIT_ 38503
GENERAL CONTRACTOR Owner Bldr. DESCRIPTION of WORK ReING PERMIT NO.r. —
AP No. 115-631-20 LOT TRACT FIRE ZONE VALUE $43,000.00 •
INSPECTIONS Signature Date TYPE V GROUP I & J ZONE R1
SOIL • PERMITS ISSUED
�C{ SUBCONTRACTOR
GAS R.6 g-i6-T` Date I Number Signature
WATER 2� ./ Plumbi�g ""�� o
ROUGH PLUMBING nscr. _747.9 alir. ,(! bi ./g 7.-Qq. 4S/S/ '—
PROP. SWR. LINE HOUSE CON. 1 70-77 Ott l yce> r 7a9.>9 4 SY so a".''.-
SPRINKLING
,SPRINKLING SYSTEM
MISCELLANEOUS ,,��//
ROUGH HEATING AND AIR CONDITIONING y'y S q- ; z_ t •
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING "S:77(1 Hear�i/nq�J an Vent.
TRENCHES D FORMS 0 STEEL REINF. ❑ jllyf , -f ,P'"7�/ T42 99.-
FLOOR SYSTEM - T
BOND BEAM n STEEL REINFORCE nn /
SHEATHING /Z7—I C /0.7Y/
FRAME AND FLASHING • fi S /t -4 C;/A
LATHING — IN n OUT f 1
PLASTER, BROWN COAT '
STRUCTURAL. FINAL is
HEATIN( VENT., REFRIG. AND A.C., FINAL COe-7.•7ir,(yI AL-J3-7y s7�8'p
PLUMBING. FINAL AND GAS TEST I� e, t-1F-a•'7b'
ELECT R``11C, FINAL {/(e Q ,}� /( l'M/� 10-3 s 6
BUILDINU, FINAL /mfr.._
(1,( 1.- 4/1y
T 9 r- / !
,O4
cer
sel
•
IIIPP
38503 ,! .1 -5-7L`H` oO 338 ? '70.01
-
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely J RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING �`0s-1--/--/__4_,�1.P%`p,-•`��
ADDRESS 'tP Ir V (O 77
////--�� // ((J� P `/ �y / ,3 r> O PER I T N O
OWNERE.9d ,lam &//�'(F. E/�'7 WNaveil A.P. NO. 1` S/- `( �/ ..�] ' I�,/�1QYjrn .�
W W ADDRESS7a;g/�7,5 / AEL ADDRE S�GQ Yi`y,,,ef C
BUILDING
MAIL
Z /� /C// 76 !�' 314•70
CZ CITY O$ /y/ e/'c: % NO. /O//O/ TRACT LOT BLOCK
CONSTRUCTION T NEW ADD ALTER REPAIR MOVING DEMOLISH
ON LENDER J^/ •va/C° , `�/[/`
all] •
J O BRANCH /�1�/C.�C_s1J- 4i
J — - OWNER
CO J ADDRESS /J VALUE
-CO ARCHITECT TE'y�'z//J �Jp USE _.C•/[/-/�-t/.Q $
J< OA RR
a/4 /rJ Avivs N1!)1 y/r//� T
W Q /O(J,, �V/L ,C,, ZONE GROUP.FIRE
co ADDRESS / r�APPROVE&L/YPE- DATE J -/1 - 7¢W Z CONTRACTOR,S �1-- BY
J O /
03Z
J K ADDRESS •
W W ZON F,� INO.OF USE OF NEWS(h1C , F-PUV1.
o= CITY NOTE. ' _) P - 2_. BUILDING
Z F- ��. /Digitin.
WO STATE CITY YARDS APPROVED YARDS APPROVED
to 2 LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
D OSIZE
//,�, NO.OF (FROM CI//LL STREET)
OF LOT 6/ V //0 NOW ON LOT //' e FRONT ,_,) FT. FT.
USE OFV{
EXISTING BLDG. f R SIDE FT. FT.
I- SIZE OF
2 NEW BLDG. O2/ / ROOMS 17 gI�STO R I ES 2 L.SIDE FT. FT.
UEXTERIOR WA te.)/ j ROOF C/2 / e Cld_T. Corr FT.
_ COVERING t JJ�/C�f r:'c COVERING c/I7 /'C REAR 'ESE ,
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
CL MAIN BLOC'S. ACCESS.BLDGS.
CL VAR.# DATE
Q < // 14?-7 ! C.U.P. APPROVED
f'... /c e 71C e _
I- APPROVED J L/
co - BY DATE
O now FO SP C[AL 'Es 'M' 1 • s .
L~.1 I hereby acknowledge that I have read this application and state _+o f
O that the above information is correct and agree to comply with 1�
CC all laws regulating building construction, and I shall not employ TAX
F- any person in violation of the workman's compensation laws of
Cn the State of California. m
ZsoB
I hereby certify that am properly licensed as a contractor under SO. FT. (Q J�Fv/ a
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 0
chapter 9, and char such licenses are in full force and effect,or THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State-Of-California Business CC
VALUATION
and Professions Cocie,0 ivision 3,ChCpCle N
ri PERMIT FEE $ O
Signature of F ���y�l /] � D
Q`� m
Permittee c.--,...0-7,A7/ -Y .- •ee(, " $13 DOV PLAN CHECK $ !Y E
7777 / o
Authorized Agent ✓ LL
` TOTAL FEE $
P"=° 134.00
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PP (CATION FOR BUILDING PERMIT
For Applicant to Fill in Completely� ) RE EIV D DATE RECEIVED DATE ISSUED
BUILDING (/Cr]�Co L/ALLb, k/ C- 0-/
ADDRESS L J o ID (/�J
OWNERCQ& 7 d o C-/tic. (cn vacA.P.NO. PopR rJO.2-.,
MAIL BUILDINGDRS 20,$('o I /&LL`� en
Z .
ADDRESS ADDRESS �Lff�] V , J
Wa U TEL.
CITY • NO. TRACT LOT BLOCK •
Z < CONSTRUCTION NEW ADD I ALTER I REPAIR (MOVING DEMOLISH
O N LENDER
aco
JD BRANCH `A0,..cr,I`
J to OWNER &. P vV-
ca J ADDRESS - D(� ^may . VALUE .�((���..��
•03 ARCHITECT TEL. USE 12 7I1,/cN Gi+ $ �iCJ r/Q
< OR ENGINEER NO.
U N
Q FIRE
W IL ADDRESS ZONE TYPE GROUP
a W • APPROVED
W Z CONTRACTOR BY DATE ',\
J Q l�
CO
J cr ADDRESS
W w TEL. ZONE NO.OF USE OF NEW
O= CITY NO. PLANS BUILDING `,
Z r J^`Il�
W O STATE CITY YARDS APPROVED YARDS APPROVED
cn O LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING .
SIZE INO.OF BLOCS. (FROM C/L STREET) /�
USE OF �/ JI
OF LOT • NOW ON LOT FRONT FT. FT. ' / I
EXISTING BLDG. - R.SIDE FT. FT.
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT.
UEXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
J USE OF BUI G AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
0 CL !`,, MAIN BLDGS. ACCESS.BLDGS. _
E L C)�ry wT C.0 P.# APPROVED
F' APPROVED
CO —ELY ATE
Z
0
0 I hereby acknowledge that I have read this application and state
r that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ 77.14
. ,v
F any person in violation of the workman's compensation laws of - 'W
•
V) the State of California. 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 in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a
am exempt from the provisions of the State of California Business Q
VALUATION ^'f [,fy m
and Professions Crime, Division 3,Chapter 9. PERMIT FEE $ /J / `- N
Signature ofm
Permittee $ PLAN CHECK $ E
�.t'
Authorized Agent TOTAL FEE $
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