HomeMy WebLinkAbout679 WILSON ST - Building Permits�
•
CITY OF COSTA MESA
�o�""'Fs, BUILDING DIVISION .
4
i",,,1., � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� �..,,Y` � FOR INSPECTIONS CALL: (714) 754-5626
'`°°�^"` PERMIT NUMBER: BC11-00526
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 11/10/2011
ISSUED BY: MDM
JOB ADDRESS: 679 W WILSON ST CM
APN: 42217106 Zoning: , ,
Vicinity: REAR OF HOUSE
Const Type: V-B SQ. FT: 312
Suite/Unit:
Primary Occ:
Valuation: $28,828.80
SCOPE OF WORK: 312 SF ADDITION TO A SFD. WORK TO INCLUDE THE ADDITION OF A NEW DEN AREA AND A NEW
BATHROOM W ITH 1 VENT FAN, 7 LIGHT FIXTS, 8 OUTLETS, 4 SW ITCHES, 1 SHOW ER, 1 WASH BASIN, 1 WATER CLOSET.
OWNER: GARCILAZO, ISAIAS M
Phone: 949-922-6738
APPLICANT: AUSTIN, STEVE
Phone: 949-5�4-2895
CON7RACTOR: ORANGE INNOVATION INC
Phone: 818�461•9078
Cell:
ARCHITECT:
ENGINEER: TIEN CHU PE
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Blumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: 679 W WILSON ST
City/State/Zip: COSTA MESA, CA
Address:
City/State/zZip:
License No. 832810
Address: 5301 BALBOA BLUnit:
City/State: ENCINO, CA
License No.
License No.72324
$280.90
$432.15
$44.40
$30.75
$52.90
$2.88
$0.00
$2.00
$845.98
Unit
Unit :
;, "i �; .. .''J � �
UNIT C8
ZipCode � 91316 � �
PHONE:
PHONE:714-829-5053
- . �_ .,';�:4
�li-'..,, ..`�i:rl
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 01 ��
Monday thru Fritlay-7:00 am thru 7:0a pm. Saturdays-9:00 am thru 8:00 pm. Prohi6ited all hours - Sundays and the following Fede�al
New Years Day, Memorial Dav, Indeoendence Dav. Labor Dav. Thanksaivina Dav and Christmas Dav �.'� ".
,.
z
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California staWtes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order foi 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.
CO�E%. INSPELPONTVPE OqTE INTITIRLS GOOE1 INSPECilON7YPE "DRTE ",IN1111AL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical ,�( .�- � d- �2 ��
� 266 Pool Spa Final 20B Final Plumbing pC ' a-�O' I 2 M p
200 Final Re-Roof 210 Final Electncal �`C '3 - � O I� '"'� P
201 Final BlocklRetaining Wall 212 Final Fire Prevention J�
I
202 FinalFactoryFirePlace 220 FinalPlanningApproval *�"�=���'!�(���:'+� i
203 Final Sign 222 Final Si�e —�— —- �
204 Final Demolition 250 Final Building/Occupancy � � � u���
WORKERS' COMPENSATION DECIARATlO O
I hereby a�rm under penalry of perjury one of the tollowing declara�ions:
❑ I have and will maintain a certificate of consent to sel4lnsure for vrorkers'
compensation, as providetl for hy section 3700 of the Labor Code, for �he
performance of Ihe work for which Ihis permit is issued.
❑ I have and will main�ain workers' compensation insurance, as requiretl by
section 3700 of lhe Labor Code, for the peAormance of the vrork for which ihis
pertnit is issued. My workers' compensation Insurance carrier and policy
num6er are:
Carrier.
(Thrs seclion need irof be wmplefetl A�pe peimrt is valuetl a( one huntlietl dollprs (5100) or less )
Policy Number:
� certi(y that in the pertormance of the work (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe workers' compensation laWs of Califomia, antl agree that if I should
become subject ro the vrorkers' Compensation provisions of Section 3700 of
Ihe Labor Cotle, I shall fo witF�-sqmply with these provisions.
i-�Z �,-lo-�\
— A�ppyc SignaWre� Daie
WARNING FAILURE TO SECUR[ WpRKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 37p6 OF THE LABOR CODE, WTEREST, AND
ATTORNEY5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm 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 (ull torce and effect.
Lia # Class #
Conlrac�or's Signawre Dale
CONSTRUC710N LENDING AGENCV:
❑ I hereby aHirm that Ihere is a consiruction lending agency for lhe
peAortnance of [he v.ork fa which Ihis pertnit is issued. (Sea 3097, Civil Cotle).
Lender's Name:
Lender's Atltlress:
SignaWre Daie
OW NER-BUILDER DECLARAT14N5:
I hereby aKrm �hat under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit to
construct, alter, improve, tlemolish, or repair any slrucNre, prior to its
issuance, also requires the applicant for such permit to file a signed statement
lhat he or she is licensed purguant lo lhe provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pmfessions Code) or that he or she is exempt therefrom antl
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant (or a permit subjecis Ihe applicant to a civil penalty of not more Ihan
fve hundred dollars ($500�.):
❑ I, as owner of Ihe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and Ihe structure is not intended or
offered for sale (Sec. 7044, Busiqess and Professions Code: The Contracrors
License Law does not apply to an owner o( property who builds or improves
lhereon, and who does such vrork himself or herself or through his or her own
employees, provided that such impmvements are not inrended or oHered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden o( proving that he or she
did not builtl or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70RS to consiruct the project (Sec. 7044, Business and
Pmfessions Code: The cont2ctors License Law does not apply to an ovmer of
property who builds or improves thereon, and who contracts tor such prqect with
a con�ractor�s) license pursuanl to ihe Contractws License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
309-G6 �3/0])
Owner ID verifed by drive�ense. ❑ Yes ❑ No
Driver's License No. Expires:
Veri(cation of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
� hereby certrfy that no excavation (rve (5) or more feet in depth into which a
person is required lo descend, will be made in connection wi[h work authonzed
6y this pertnit, antl that no building structure, scaffdding, falsewnrk, or demolition
or tlismanlling thereof, vnll be more Ihan thirty-six (36) feet high (Chap. 32, Grp
2. Art 2. Sec. 341. T�le 8, Cali(ornia Administra�ive Code).
❑ As owner-builtler, I will not employ anyone [o do work which would
require a permit from the Division of Indus[rial Safery, as noted a6ove, unless
such person ha�c work (rom the division.
sSiqnaWre � Da� G �I
Division o( Industnal Safety Permil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicani or present or (uture building occupant need to (ile and
certify a Business Plan for emergency response release or [hreatened
release of a hazardous material? ❑ Yes No
(Section 25505 0( the California Health and Safety Code requires, with some
exceptions, tha[ a Business Plan be filed with the Costa Mesa Fire
DepartmeM 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 o( 55 gallons, or 200 cubic fee[ of compressed gas
at s�andard temperature and pressure).
2. Does or will the applicant or preseN or fuNre building occupant rned�ile
a registra�ion form for awtely hazardous ma�erials? ❑ Yes � No
(Section 25533 of the California Health and Sa(ety Cotle, with some
exceptions, requires re9istralion with [he Cosla Mesa Fire Department by
each business which at any one time has on hand a quantity of acu[ely
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 �he applican[ or present or fut re building occupant need to
prepare an RMPP (Risk Management an revention Program for acutely
hazardous materials)? ❑ Yes o
(Section 25534 of the Califomia Health antl Safety Cotle provides Ihat Ihe
Costa Mesa Fire Department may require the preparation, certifica[ion and
filing with the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials with �he Fire Department.
4. If an RMPP is presently requiretl, has Sec[ion 25534 of t�ornia
Health and Safety Code been fully complied with? ❑ Yes No
5. Does or will [he applicant or present or fu W re building occupant require for
the vrork which is the subjecl of lhis application a permit for such construction
or modification from Ne South Coast Air Quali�y Managemen[ Districtpr from
any other air pollution coNrol disMct or agency? ❑ Ves �ll�
(Sectbn 658502 of the Cali(omia Govemment Code requires Ihat the requested
in(ortnation be fumished on applications for non-resitlential builtling permits).
6. Will any part of Ihe facility to be constructed under this perrpit be within
1000 feet from the ouler boundaries of a school? � Yes [Z]'f�
Q('yes", Ihe facility must meel the requirement af Sections 25534 and 42303
of Ihe Califomia Health and Safery Cotle).
7. If a permit fmm the South Coast Air Quality Management District or other
air pollution conirol district or agency is required for the work which is the
subjecl o( this application, have all of the disclosures prescribed by -�ajiomia
Heal[h and Safery Cotle Section 42303 been made? ❑ Yes C�No
8. Q('yes", a[tach certifcate o( compliance from [he appropriate air polWtion
conUol oKcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury Ihe
information given a ��'s-cormct I agree [o comply wi[h all stafe laws and
city ordina e egarding Hazardous Ma[erials and Emissions.
����G�� �
SignaWre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury �hat I have read this application and siate tha[
the information given is correct. I agree ro comply with all state laws and city
ordinances rela[ing to building construc[ion, antl au[horize representalives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not [o occupy or allow ocwpancy of any building
authorized by this permit until final iraspection. .
c�--- i
Slgn ' IOwner�s� � , pale /`
— � V� �1
And/or AppLcant Date
' � CITY OF COSTA MESA� � �
BIIILDING DIVISION
m
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B07-00952
PERMIT TYPE B ROOF2 STATUS: ISSUED
DATE ISSUED: 10/02/2007
ISSUED BY: RMD
JOB ADDRESS: 679 W WILSON ST CM � Suite/Unit:' .'
Vicinity: HOUSEANDGARAGEROOF.`. � - '" � ". � .. - � �- .-
Squares: 2500 - � .. - � ' - � . ValuaGon: . $4,500.00
,.'."�r`� � . . . �- . _ _
,� �s.: `. -- . ,
SCOPE Of WORK: TEAR OFF(E) ROOF MATERIALS, INSTALL A MIMIMUM OF 1 LAYER OF 15# FELYON A�4:72 PITCHED ROOF
AND REROOf WITH 30 YEAR COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE, APPROX 25 SQUARES.
REPAIR AND REPLACE SHEATHIG AS NEEDED. -. '
OWNER: GARCILAZO, ISAIAS M� - �� Address: , 679 W�WILSON ST , "� Unit:
PHONE: 949-5'IS-2097 ' , _ � -. City/State/Zip:- COSTA MESA, CA � � - -
APPLICANT: GARCILAZO, ISAIAS M"� � � � � Address: 679 W WILSON ST ,, . Unit: :
PHONE: 949-515-2097 " , City/State2ip: COSTA MESA, CA , �
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: Unik , PHONE: , �� , _ �� ,
City/State/Zip: , , , � CELL: � -
ARCHITECT: . � - License No. '� � � � PHONE:'�� �, �
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
TOTAIFEES
° $o:oo ,
$1'11}25 �-.
$0.00 .
$111.25
License No.
PHONE:
NOTICE: The work authorized by this pertnit shall comply with ail applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) ��
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit.to be considered legal, such work must comply with all applicable wdes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this permit.
C�DE� INSPELTIONTYPE DRiE INi171RL5 COOEt INSPECTIONTYPE ORTE INPTIRLS
1616 Fixed System Final Fire Prevention 206 � Final Mechanical �
1266 Pool Spa Final 20B Final Plumbing
200 Final Re-Roof �� � � � 210 Final Electrical
201 Final BIocWRetaining Wa0 212 Pinal Fire Prevention
202 Final FaClory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
20a Final Demolition ' 250 Final Builtling/Occupancy .
WORKERS' COMPENSATION DECLARATION:�
1 hereby aHirtn under Denalty ol perjury one of the following declarations:
❑ I have and will maintain a certificate ot consent to self-Insure for workers'
compensation, as provided for by section 3700 of Ihe Labor Code, for the
performanCe o( lhe work for whiCh IhiS permit i5 issued.
❑ 1 have and vnll maintain warkers' compensation insurance, as required 6y
sectbn 3700 0( t�e Labor Code, for the peAortnance o( the vrork for which [his
permit is issuetl. My workers' compensation Insurance carrier and policy
number are:
Cartier.
(ihis section need rwl De cwnpefetl d tne pemN 6 valuetl ar we nundrad tlo9ars (Sf 00) w less.)
Policy Number:
`� 1_certify that in the peAortnance of lhe work tor which this pertnit is
��ssued� I shall not employ any person in any manner so as to become subject
to the wnrkers' compensation laws o( California, and agree thal if I should
become subject to the vroBers' compensalion provisions o( Section 3700 0!
ihe l.@bor Code, I shall forthw Ih comply with the pmvisions.
� ,s.�'�.�ou _6.�.�,,�.' � I d 2�7
l=Applicam's SignaWre / oa�e
V
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIP,RS
($100,000), IN ADDITION TO 7HE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensetl under provisions of Chapter 9(wmmencing
vrith Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # Class #
GonVaclor's
CONSTRUCTION LENDING AGENCY:
� I hereby affirtn �hat there is a construction lending agency for the
peRortnance of the �wrk fa wfiich this permit is issued. (Sec. 3097. Civil Code).
Lender s Name:
Lentler's Address:
Signature
OWNER•BUILDER DECLARATIONS:
I hereby affrm tha[ under penalty o( perjury tha[ I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit to
conslmct, alter, improve, demolish, or repair any sWCNre, prior to its
issuance, also requires Ihe applicantlor such permit to file a signed statement
[hat he or she is licensed pursuant ro the provisions o( the Contractors
License Law (Chap[er 9(wmmencing with Sec[ion 7000) of Division 3 of the
Business antl Pmfessions Code) or that he or sha is exempl therefrom and
the basis for the alleged eaemption. Any violation o( Section 7031.5 by any
applicant for a pertnit subjects the applicant to a civil penalty of not more than
five hundred tlollars ($500).): ,
� I, as owner of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and the strucWre is not intended or
oftered for sale (Sec. 7044, Business and Professions Coda: The Contractors
License Law dces not apply to an owner ot property who builtls or improves
Ihereon, and who does such vrork 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 improvemenl is sold vnlhin one year of
completion, ihe ovmer-builder will have the burden of provinq that he or she
did not build or improve (or purpose of sale.).
❑ I, as owner.of the property, am, EXCLUSIVELY CON7RAC71NG WITH
LICENSED CONTRACTORS to construc[ the project (Sec. 7044, Business antl
Professbns Code: The contractors License Law dces not apply to an owner o(
property who builtls or improves [hereon, and who cont2cts 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:
���, .�giA �r�' �D Z 7
3051�a6 (3/0]) (�9�at LDate _
ovn,er io venrea ey am�e. � es ❑ No Q�j� o/ a(/
Ddv' er's�License No. � ,�pires:
Verification of Ownership by (rype of documen�, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:� '
❑ I hereby cetlAy Ihat no excavation fve (5) or more feet in deplh in[o wfiich a
person is required to descend, will be made in connection with work authorized
by Ihis pertnit, and tha[ no building sWCWre, scaftdding, false�wrk, a demolition
or dismanlling the2of, will be more than ihirty-sa (36) fee[ high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administrative Code).
� As ovmer-builtler, I will not employ anyone �to tlo work which woultl
require a pertnit from the Division of Industrial Safery, as notetl above, unless
such person has a permit ro tlo such vrork fmm the division.
ApP�����'S Signalure
Division of Industrial Safely Permil Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or future building occupant neetl to file and
certify a Business Plan for emergency response to release or ihreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(ery Code requires, with some
exceD�ions, that a Business Plan be filed with the Costa Mesa Fire
Department by every Dusiness which has at any one lime during a reported
year a quantiry o( hazartlous ma�erials equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet o( compressed gas
al stantlard tempereture and pressure).
2. Does or will the applicant or preseN or fuNre building xcupanl need to file
a registretion torm for acutely haZardous materials? ❑ Yes ❑ No
(Section 25533 of the Calitomia Health and Satery Code, with some
exceptions, requires regislration with the Costa Mesa Fire Department by
eaCh busine55 which a� any one lime ha5 on hand a quan�ity of aculely
hazartlous matenals equal to or greater lhan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas a[ standard
temperaWre 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 0( the Calilornia Health and Safety Cotle provitles that Ihe
Costa Mesa Fire Department may require the preparation, certifcation and
filing with the Fire Department of an RMPP by businesses which are required
lo register aculely hazardous material5 wi[h [he Fire Department.
4. If an RMPP is presently required, has Section 25534 0( lhe Califomia
Health antl Safely Code been fully complied with7 ❑ Ves ❑ No
5. Does or will Ihe applicant or present or future building occupant require (or
the work which is lhe subjecl ol lhis application a permit for such construclion
or motlificalion from the South Coast Air Quality Management DisMct or from
any olher air pollution control distncl or agency? ❑ Ves ❑ No
(Sectbn 65850.2 of the Califomia Govemment Code requires that the requested
infortnation be (umished on ap0lications for non-residenlial builtlinq pertnits).
6. Will any part of the (acility to be construc[ed under this permit be within
1000 (ee[ from the outer boundaries of a school? ❑ Ves ❑ No
(If "yes", the facility must meet me requirement of Sections 25534 and 42303
of the Califomia Health and Safety Cotle�.
7. If a permil (rom Ihe South Coasl Air �uali[y Management Dis�ric[ or other
air polWtion control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribetl by Califomia
Health antl Safety Code Section 42303 been made7 ❑ Yes ❑ No
8. Qf 'yes", atlach certifcate ot compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF �COMPLIANCE: I certify Ihat under penalty of perjury lhe
information given above is wrrect. I agree to comply with all state laws and
city ordinances regarding Haiartlous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury Ihal I have read this appliwtion and state that
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building construction, and authonze representatives ot
the City o( Costa Mesa to enter upon the above-tlescnbetl property for
inspection purposes. I agree not to occupy or allow occupancy o� any building
authorizetl py this permit until mal inspection.
- _ �i0_Z�7
�-- ignawreolLeBal vmer(s �jv Lome
AnClor Aul�onzeC AOPli�nl
.
OWNER HUNNY INV. CO. DATE (i_ 'j_55 �}�
JOBADDRES$ 679 wilso 71 $t� BUILDINGPERMITNO. 1],(�9
GENERALCONTRACTOR S, V. Hunsaker VALUE $ 9�OOB.00
'y BLOCK ' TRACT 7� SinglP Famil�__]jggll' ro
TVPE V ZONE Rl� FI
INSPECTIONS I DATE I SUBCONTRACTOR I DATE P IRMITS�NL1uMB
Foundation Forms and Grade to
Rough Framing
Plumbing, Rough to S�ab ��
Plumbinq. Rouph Complete a,6
Wiri
Heating, Final � y�
Sewer, House i/ Sewer, Si _.._T�.��' ,7� y3 L l,. vti
Feptic Tank or Cesspool
t �g, In out � —/O `
F�_�.ering —F 7'S'.f3 , l
Plumbing, Final, Fix
Plumbina. Fin.al Gas
Occupancy
r..,r.,, ��i
;+Cd*�ta Mesa Building Department
711 EAST 20th STREET
�"'aR'�" COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
Building /
Address (� ��
Costa Mesa, California
Nearest . / /
"+dress
I I Lot
tion No.
Metes and
Existing Bldg.
Setback Line from SO i
Center e1 S2�eYT
New
N o.
APPLICAI`ION FOR PERMIT
�l�g BUILD�NG °�
� FOR OFFICE USE ONLY
. Receipt No. permit No.
1/ � 9
Received by � Date Ree'd. � Date Issued
Costa 1VIesa, California
Lic. I Plans � V
No. Approved/
b
,,,... , ,_ CORRECTIONS
No.of No.of.
Famfliea Rooma
Rear Ya�
c:a_v.._w .
Demolish
iering � Coverin � APPROVAI.S
Use ot New ,
Building Foundation Locatfon . Inspecto
Forms, Materials, �
Under-Pinning ,�
Frame: Fire Stops, ?
" II Bracing.6olts ?�
v
Lath.lnt. �
I hereby acknowledge that I have read Uus Application ; o
nnd stnte that the above is co[rect end agree to rnmply Lath. Ext. ':
wi[h all Clty Ordinances and State I.aws regulating
building const ction. .�
Signatureof ���� P�aster,lnt. C,
Permitte i PR
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�oOWNER
Ci��J08 AC
PEREZ. Mike d Maria
� No.115-4fi7-
\J .?ECTIONS
) SOIL
� GAS
n WATER
� ROUGH PLUMBING
MISCELLANEOUS
ROWH HEATING AN� AIR �ONOITIONING
TEMPOfiARV SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGH WIRING
TRENCHES � FORMS STEEL REINF.
FLOOR SYSTEM
BOND BEAM ❑ STEEL REINFOftCE �J
SHEATHING
FRAME ANO FLASHING
LATHING - IN n OUT ❑
PL<STER,BROWN COAT
:TU0.AL, FINAL
�N�._.ING. VENL. FFFRI(:. AN�
DATE 6-22-72
BUILDING PERMITI
RIPTION of WORK Blockwall
ZONE VALUE$180.00
)UP TYPE
SUBCONTRACTOR� P
�C' ^ -` �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COS74 MESA, CALIFORNIA 92626
For Ap�('�nt ro Fill in Completely �
BUILOING F
AD�RESS
OWNE
MAIL
Z ADDRESS
W W /�
a U CITv ,6J
~ Z CONSI'RUCTION�,_
ON LENDER
am
J � BRANCH ��—
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ADDRF$$
J Q AFCHITECT
� Oli ENGINEER ���
U Q
W � ADDRESS
aw
W Z CONTRACTOR
J Q
m z
J � ADDRESS
W
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p w TEL.
z � CITY � NO.
� STATE CITV
y� LIG. NO. UC. NO.
� � SIZE / NO.OF BLDGS.
OF LOT /�J � NOW ON �OT
USE OF
EXISTING BIDG.
F SIZE OF NO.OF �
Z NEW BLOG. ROOMS STORIE:
U EXTEIiIOF WALL ROOF
COVERING COVERING
USE OF BVILDING AND WORK TO BE PERFORMED
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a LOG/� � L�
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APPLICATION FOR BUILDING PERMIT
:E}yE� BV DATE ECENED pqiE15�U?D�
%� ,b �o-� �� oa� .
7 , i• �. �a._ ..._ / PEfli�l,li�4: !1
A.P. NO. L �T �"`�'
BUI�DING
ADDRESS
TRACT.J �R�%
X
E
ZONE
(FROM C/L STR
DI5TANCE BET
MAIN BLDGS.
VAR.#
C.U.P.g}`
APPROVED (,
�OT � I BLOCK
VALUE
OF USE OF NEW �
NS � eUILDING
VED VARDSAPI
NG ACCESSORY
BET. MAIN &
ACCE55. BL6
DATE
APPROVED
U I hereby a nowletlge that have reatl this �plicati antl s e L
� that the bove informati Is correct antl gree to omply ith
� all law regulating buii ng Consbuction, nd I sh I not e ploy � �
F any rson in violati of the workm s comp sation ws of 7!�
y the tate ot Catitor a. m
zI ereb certify at am properly censed as contra or u er SQ. FT, o
the 5 te ot Califor a BusinBss a Professio s Code, ivisi 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR �
Cha er 9, and th such licenze are in full otce an effec o� I THE PUflPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
a exempt from he provision of tha State f Celifo ia B iness ¢
a d Profession otle, Divisio 3, Chapter 9 VALUATION O�� � m
PERMIT FEE S '' n'
� �
SiOnatute ' m
Permittee � $ D PLAN CHECK 3 E
� [ � � u
Authorizatl Agent TOTAL FEE $ U "�—