HomeMy WebLinkAbout270 23RD ST - Building Permitspia� �sa-s2�a • Fax (��a) �ss-aess • wwv+.ci.costa-mesa.ca.�fILDING PERMIT
Job Address: 270 23RD ST
Suite:
Vicinity: HOUSE 8 ATTACHED GARAGE '
PrimaryOa: R3 TypeofConsWctlon: VN
Parcel Number: 11913101 Zoning:
npplicant: PITMAN, J. VERNON
Address: 7522 SLATER AV
�pg Phone: (714) 3759500
' HUNTWGTON BEACH,CA Zip: 92647
Owner: WALLACE, THOMAS W JR
Address 270 E 23RD ST
Phone:
COSTA MESA, CA Zip: 92627
Contrector. SOUTHLAND ROOFING WC.
Address: 7522 SLATER AV � � �
108 Phone:,i(714) 375-9500
HUNTINGTON BEACH,CA � � "- �
Zip: 92647 License: 'Z504424 f
ArGi :
Address:
Zip: *'
� �t� �
f:•.i ,
/�.::- �
REROOF EXISTING�SING�
WITH EXISTING SFiEATHI
1HINGLES./G r•' /
r�....�
; i � i.
Plan Ctiecki; i 3
Permit:, _� 51
SMIP Res;;�.;�
SMIP Com:. '•+;" $
Ot�er::' "• t$
;. .
Inspection: �. _ 1.� :;S
Total: $�11.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING ExisGna: o
NOTES:
Y f�E51DENCE 8
..,_�t /.� .
-,:
. . ��
/4't��: �i•il..'�
77 FAIR ORIVE, COSTA MESA, CA 92626
StaWs: ISSUED
Applied: 10R6/1999
Issued: 1026/7999
ISSUED BY:
.
' ` (Address:" ';%,!,.y �
- . i, ��
;� ^.+ '�•i>S;w Phone:
>�✓'�:� �'m'.r
y�',:� %� 'r. License:
✓
i
)F FERMIT
E(21; SQ). TEAR OFF EXISTING 2-LAVERS OF COMPOSITION SHINGLES
LT � DERLAYMENT 8 REROOF WITH 25 YEAR COMPOSITION
PLANNING & ZONING
Rear 0- 0 Left 0- 0
Rear 0- 0 Left 0- 0
Reauired: 0 Pr000sed: 0
Calc Valuation:
Claim Valuation:
Righl 0- 0
Right 0-0
54,875.00
sa,a�s.ao
NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requiremenis under Calilornia statutes and related
regulations. (Ortl. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void il work is not commenced within 180 days, or it work is suspentletl or abandonetl
lor a periotl oi 180 days.
INSPECTIONS: In order lor Ihe work aulhorized under this permit to be considered legal, such work musl comply with all applicable codes, and all
required Inepectlons antl Iinal approval musl be obtained. Failure to oblain inspections and linal approval will result in the expiration ol lhis permit.
FOR INSPECTIONS CALL: (714) 7545626
aa646�W001
WORKERS' COMPENSAT�ON DECLARATION:
1 hemby bftirm untler penal�y ol perjury one of �he lollowing Ueclaraiions:
❑ I hovo antl will maimain a c^_nilicato cl congenl lo s�ll-Insure lor workers' cornponsation, as piovieiod tor Uy soclion 37U0 0l Iho L, hor Cotl4 br ihe potlo�mance ol t�o
work br whir,h Ihis permil is asuetl.
❑ 1 fieve anU will maiman� �vorkeis' wmpensalian inswance, as requiretl by sec�ion 3700 0l iho Wboi Cutle. lu� thc p�ltlormance ol tfie work lor whith ihis Oermit is issuetl.
�ny wmiar<• comoonsaiion Insuranca ca«ier antl poiicy numbo� aw:
Camac ' Policv Number.
(7hi� cocbon neao nof ba cOmple�eJ ill�o parm�f is valuetl a1 onn �untlretl Jollar5 (5100) or IeS.J
❑ I ceniP� tliai in ihe pe�ionnanco of Ihe wurk lor anich Ihis permit is issuetl, I Shall nol anploy nny peison in nny manner so as lo become subject lo Ihe workers'
com0eusa:ion la�,vs ol CelAomia, antl agrae thal i1 I snouW bacoma subject to lhw wakors' eompans��ion provisions ot Sociion 3700 ot the LaDo� Cotlo, 1 sha11 toqhwith
camply wiih ihesn pro✓isions. '
Apnlicant S�pn�tuw: L`a1a:
WqRNING. FAItURF TO SECVPE WORnERS' GOMP[NSPTI(� CpVEFAGE IS WJV.VJFLIL A:JD SHALL SUNLCT AIt EMPLOVER i0 CHIlAHAL PENALiIES nfJD CIVIL FlN[5 UP 10 UNE HUNpP[D
'�HOUSANOUOLL4RE141W.0(?91.INADOITIONTOTHGCOSiOPLOfAAEnS/TIOu,OArdAGE5A5PROVIUEDFOnRlSEC�IOtt�IOGOFTH[LABORGODE.INTERESt,ANDAiIORNEY'SFEES. �
LICENSED CONTRACTORS OECLARA710N:
I heruby atliim Ihai I am liconsea untler pmvisions ol Gnanlor 9(commoncing v:ilh Sqclion 70001 ul Uivision 3 o11ho dusinoss miU PrNosSions Cotlo, nntl my OCense is in �ull �
bica mitl cltiicl. Lm. u Class e
Cnnlracini's Signaturo: Dmc.
CONS7RUCTIOI� LENDING AG[NCY:
❑ I hoiebv &flum Ihnt iha�e is a cons�mclion Izntlinp apCncy �or Ihe pedomiance ot Ine work br which Ihis permi� is is=_ued (Sec. 3097, Ci•nl Cotle).
LentlLis N:mle: Lender5 AtltltCss:
Siqnalwo: Date:
OWNER-OUILDER DECLAflATIONS: � � .
I hemDy allinn Ihal untler penally ol pe�jury i�ai I am E%EMPT FROM TNE CONTRACTORS LICENSE LAW lor Ihe tollowing rCa50n (Socr 7Q31,5, Businnss ancl Professions
Cotlo: Any Ciiy or county which requiies a pormil lo conslmct, aller, improve. demolish, or iopair any Structum, prior lo ils issuance, also ropWre9 tho applicanl lor such permil
to file a signetl sl.nomom Iha� he or sho is licansetl pwsunm to t�e pmvisions of Iho Convac�ois License Law (Chapler 9(tommencing wfM Sectlon 7000) ot Division 3 of I�o
f3usiness and Prolossions Code) or Ihat ha ot she is uxompl t�orelrom antl ihe basis lor Iho nlloged eAomption. Any violetion ol Seclion 7031.5 by any applicant lor a Geimit
suhloCis Iha applicani l0 a Ci�il penalry oi no� mor0lhan five hUntlred tlollars (5500).): � � ,
- �`� '... i '
❑ I, as on'nei ol Ine propeny, or my employees wi�h wages as ihoir sole compensation, W ILl DO 7HE N/ORK, antl tlie simciure Is not Intentletl or oNeretl tor sale (Sec.
7044, Husiness antl Pio;essions Cotle: The Conlrac�ors License Law tloes not appty to an ownor ol prope�y who builds or Improves Ihoreon, and who tloes such woik
himsell or hersull or Ih�ough nis or her own employoe^., pwvi0etl �hal such imp�ovemenis ere no� Inientletl or ofleretl (or sale. If, however, ihe builtling or imp�ovement is
soW w�toin one year o< <�mptc:ion, t�e owner-Duiltla� will have the buatleo ol p�oviog thet he or she tlid not bniftl o� lmpiove tor puryose o1 saie J.
❑ 1. as or:ner nl ihe pm0�nv, am EXCLUSNELY CONTRACTING WITM LICENSED CONTR4CTORS 10 wnstrvcl me project (SacJO1d, Business antl Protessions
Cooe: l'he comraclors �icuns� Law tloos nol apply �o an owner ot propeny who build5 or Impro•:e= IhBreon, end who r.oNiqdS folSUth pmjnc� wil� a Conlrzdor(s)
license pursuani �o me Convac�ors License Lax�s.�. �- �` I i '
❑ I am uamnpt untlm <_eG. � Business ar.tl Prolcssions Cotla for inis roason: '
S�Aitalur¢ � � •� � . Oale: � .
Owno� ID veulieU by tliiver's license. ❑ Ves ❑ No �. DrNefs Licanse No.• � ' ' Expires:
Verinwtion ol Ownersnip by OypN ol documont, i.o. - propeny tex bill or tleetl): � ,
DIVISIONOFINDUSiRIACSAFETVPERMITCERTIFICATION: i � �
i
❑ I ht3roby certifY ���n� no excavalio0 five (5) o� more 1001 in doplh inlo whieh e porson is requlretl lo tlu9cend. n'ill be mad� in connoclion with work aulnorieod oy �his
oermil, entl tna� no bui�ding stmcNre: scalloldi�, falsewoik, o� demWilion or tlismantling Ihe�aol. �.vill be mom Ihan Ihiny�sia j36) lee� high. (Chap. 3.2, Gry 2. Art 1, Sec.
3A 1, litic B, CalAomla Administrative Code). � • � ,
1
❑ A5 ox�nur�builJor. I wiU���o� employ onyono to�tlo work whiUi woultl �eQuiro u pormi� from Ihu Division ol Intluseial 501a1y. BS nO1Ctl aLOvO. u0IB55 Such pOt54� hdS a
Uermil ;o Uo suCtl wofk ��orn Ino UivisiOn. � �- ��
$II�O'JWt�. �d�C:
!
Uivision ot Inaustual Safety Permit Number. '
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: � �
i W ill Iho nppiicant or present or luture Duilding occupant nood io Itlo antl ceitity a Ousinoss Pian lur emoinency rosponso lo roloaso or Inma;onod wlease ol a na7artlous
malRii.l? ❑ VaS� ❑ No
(Seci�on 255U5 0l Ihe Galilomiq Hoallh and SalCly CoAI• ioqUileS, wiih Some eaCCpllon.5, Ihal a i]ufiinas� Plan ho lilatl wiih Ihe CoStH Me50 Fim DCparimen� by Cverv
Uusines� which has at Pny one timo tluring a wponeU year a quamiry ol hazartlous maierials uquel to or greaier Ihan a woighi of 500 pounUs, or a volumo of 55 galions.
w 200 cu�ic Ieel ol coir�P�essnd gas al stantlm� temperalure and pmssure).
..............................................................,.,............._............._..............................,...................................................................,.,,.,.....,,.................................................._..,..,.........._,......_._....,................................................................................
1 GoeS or �vill Iho aVu�iwn� or presem or luWre builtling OCcupant neetl lo filo a roqislranon torm br acutety hazaidous molerials'7 ❑ Yes ❑ No
ISOGIion 7.5593 0l rt+e Calibrnia Heall� antl Sal�ly COtlo, wi�h 5omo exceplions, roquiros iu4islrLllun wilh Iha Cosla Idesa Fire Uoparlmoni by oaeh businoss which ai , ny
ono Iim�r has on hano e quantity ol acNoly harmtlous mato�ials aqual to or gioamr tl�dn n woiqhl ol 500 poun�;, oi n vuluma ol 55 yallons, or 20G cunic loal ol
r,�rnu�vssatl ans nt s;antl:utl tempeiatcro anU o�esswol.
..................................:......... ......................._......._....................................... ..................................,..........__ _......._........_............................................._.,..._....................._........................................._..........._...................._.................
o Iloes or wiil �ho ;qipllcani or prosem or fulure builUing uccupanl neeJ to prepaie . n HIdPP (RisF Mauagement anJ Prevenlion P« �gr.m� tor aculely hazartlous mawrmts)?
❑ Ye5 ❑ Np
ISeciion 2553� ot Ine Gatibmia Heal�� antl Salery Cotle piovides Ihat Iho Costa Mosa Fir� Dopanmenl mav i?auire Ihe urepaation, cortdicafion antl fdino wim tlw P�m
' Depanmam ui an R61(°F' �y businesses wh¢h nio �e�ryirod Io �ogis�e� acu�ely haea�tlous ma�orials �+'ilh Ihe Piro Depanmeni.
.......... ......................._......... ....................................._............._.........._..................._..................._......_............._..._......................................................._......................._................................................_.......___..............__......_...._...
a It an fi1.+PF is yies�nlly �eyuirnd, has Section T.553� ol �he Calilomia Heaiih antl Satety Cafa boan iuily compGed wi�h7 ❑ Yes ❑ No
............................................_._.................._._._._........_......_._...._..........................._... ....._..............,..............................,............_............._......... _............................................._............._...._............._....... ......_....
� Doe. ui wdl mo applican� o� P�aseN or IuImA LwlUing oecupaN �equire lor �ne wo�F which is Ibe s�bject of tliis a�plicailon apermii tor such eonstmction o� motldica�ron
:mm in� So�t� Cw;t Au �-`ualiy Idanapemont Oisliicl or irom any other air pollu�ion comiol tlisbici or ayoncy7 � Yes �J No
ISeciipn 65U502 0l me Galdurni, Govemmenl Cale mquiies thai Ihe �equesled inlormation 6e Wmish�d on a0olications lur nomiesitleniia� builtlmg ommus).
........ .. .. ...... . . ........... _.. . ............... .. . _ ................... . .. ... ... ........... ,... . .. _.......... .,. ... ... ..._ ... ........ .._......
5 W II any pan of �hn lac b�y �� b�� aonsliac�otl un�ioi Nis pomiil Ue wiihin 1000 toel Irom Iht; oule� bountlanCs o� a sChoul? ❑ Ye5 ❑ No
QI "ye.s". Ihe tacilav musi meet the roymmmonl ol Soclions 25534 and a2303 ot me Calitoinia Heal�n antl Salely Cotle)
.......... „ ..... ...... ...... ._.__.... ......... . ................. .. ...... . .._.._.._..,.. .. ... ...._....... . ....._..... ...._. ......... ... ....... ..._. ._......... . ..........
7 11 a por.nit nnm Ino Sau�n Coasl Air Oualiry Managament D�sirici or oltier air nolluiion convol tlivria or ag�ncy 1s requiroU Io� Ino work which Is Ine subjecl of tnis
a0plica�ion, n:rc? all ol �he Cisclosures p�escribotl by California Meal�h anU $alo�y Cotl�l Snclion A2303 boon made7 ❑ Ves ❑ No
...._ .... ... ..... ....... ............ .. ... .._............................ . .....__...... .. ............. . .... ...... .. _....._..... .... .. ........... ... ... .._ .. ......... . ....._.
B (II "ye.s", aliacn cen�iiCale ol wmpiiante IrOm Ihe appropnate air p011ution conVol olOter�.
CERTIFICF t[ OF COMPLIAIJCE I cenify Uial under penatry of perjury �he iNonnalion yiven above is wneci. I ayre= Io comUly wiVi a11 slate laws antl ciry o�tlinances
r�p�Ning Hatartluus Ma�enais antl Emissions. ,
Signawie: Uaie:.
CEFi1FICA7E OF C01dPUANCE aW D Al17HORIZATiON OF ENTRV: I cer,ily untler penalty ot peQury �Lal I have reatl this aDP�������n antl slale Ihat In= inloimation given is
cornttL ! n�ieo to comply •.vilh all slale I.�ws and Cily o�tlinances wlaiing to building conslructinn. antl , ulnonze represenr,�livo5 0� Ine City ol Cosia ldesa tu emnr upon Ine
ubo�o�dnsr.nvetl proputy lor mspeaion purposes. I agme not to occupy or allow occuponcy ol any Uudoing autno�ized Dy Vns Fmimii until linal ins0ection.
Signawre Ot Luyal Ownoqsl
AndlOi Aulhoniotl AOPlicanl
coo� ,. IN$VECTION TYC�
IG76 fixetlSystemFinalFiiePiavenhon
12GG .Fool Spn Final .
7.00 Final Ra-Root ' „ ..
201 Finel BIocA/Fotaininy Vlall
:02 , Final Fectory Fiw Place ' �
11i3 ' Final Slgn �
�OA finnl DCmMiiion
P�TE NTIT4L
i' —
� " 1
£ODEi LN$,PECTIONTVFE
7.OG Final Mochenical
20B Final Plumhing ,
2t0 Finel�Eloclricel '
212 Finul Fire Prevenlion ,
220 Finel Planning ApprOval
222 Finul Si1e
250 Final Eluduiup'Occup:incy
D,ia
Ualu
j1�E INTRIALS
�. . . _. . ._-.
(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.�{y�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
,lob nddress: 270 23RD ST
Suite:
Viciniry: GARAGE INTERIOR
Pnmary Occ: R3 Dwellings/ Cong Res <10 Type of ConsWction: V-N
Parcel Number: 11913101 Zoning:
Applicant STUMP, NATE
Address: 132 VIRGINIA PL
COSTA MESA, CA " - "_
Owner: HANKIN, MARSHALL TR
Address - 198 DESERT LAKES DR �
� �RANCHO MIRAGE, CA -'
' - - RANCHO MIRAGE DR � -
� '
Con tra ctor: O W N E R-B U I l D E R
Address:� � .
Zip:
Arch :
Address:
Zip:
Phone:
License:
DEMOLITION OF THE INTERIOR TO AN EXISTING
REF:COS-0971
Phone: 714-231-0763
Zip: 92627 �'
Phone:
Zip: 92270-4053
Phone:
?License: 000000
Eng:
Address:
�OPE-0F PERMIT
; /
ISSUED BY:
Status: ISSUED
Applied: 05110I2005
Issued: OSI10/2005
Phone:
License:
FEE�SUMMARY '
Plan Check: $0.00 � � Calc Valuation: 8300.00
Permit: $23.50 - Claim Valuation: 5300.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
inspection: $0.00
Total: $24.00 �
- ' . . ' J` - ' .
� . � � , PLANNING & ZONING . �
SETBACKS � � ' � , � �
MAIN STRUCTURE Front 0- 0 Rear 0. 0 �-Left 0- 0. � Right 0- 0 ,
ACCESSORY Fmnl 0. 0 Rear 0- 0 , Left 0= 0�� Right 0- 0
PARKING Existinq: 0. Reavired: 0 . Proaosed:.. 0
NOTICE: The work authorizetl-by ihis permit shall compty with all applicable handicap access requiremeMs under Calilomia statutes and related
regulatlons. (Orcl. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automaticalty expire end become void It work is not commenced within 180 days, or R work Is auspended or abandoned
'tor a period of 180 days.
'INSPECTIONS: Ircorder for the work euthorized under this permit to be considered�legal, such work must compty with all applicable codes, end ell
requlred�inapeetions end Mal epproval must be obtained. Failure to obtain inspections and final�approval will resutt in the expiratlon of this pertnit.
FOR INSPECTtONS CALL: (714) 754-5626
zus�e �emo�
WORKEFS'COMPENSAnON DECLARAnON: '
I hereby affirm under penalty of perjury one of the following tledaretions: • , • ' ��
❑ I have entl will maintein a certificate ol consent to sell-Insure tor workers' compensetian, es provitled tor by section 3700 ot the Lebor Cotle, br the'peAormance of Na
work lor wNch tMs pertnil Is issuetl. •� - ,
❑ I have antl will meinteln workers' campensetion insurance, az requiretl by SecUm 3700 ot Ne Labor Code, for the peAortnance of Ihe work tor which Nis pertnit is issued.
My workers' compensatlon Insurance carder and policy number ere: '
Cerner: Policy Number:
(Thls sec0on nee0 not be oanplefed il (he permit is ve/uetl et one hunEretl ddlers (5100) or less.)
'pl 1 I cetlily that In the pedortnence oi I�e work tor whith Ihi9 permit i5 issued, I shall not employ eny per5on in eny manner so as to �ecome 5ub�8CI to �he workere'
�V compenseilon laws of Cellfomia, end egree lhat II I shoulC becwne sub�ect to �he workers' compenselion provisions at Sec�ion 700 of Ihe Lebor Cotle, I s�all forihwlih
comply wlth Ihese p�—mr17s/�j �n�s. -/
ApP.y��ntSipne�W`ei' VL�(i1�i' � Date� ��/�
WARNIN`G� NLUqE TO SECURE WORI(ERS' COMPENSATION COVERAGE IS UNUWRIL AND SNALL SU6IECT AN EMPLOYER TO CRIMIIUL ENAL ES AND GVIL FlNES UP TOONE HUNDRED
T110USAN0 DOLIARE (f100.000), IN ADORqN TO THE WST OF COMPENSATION, DAMr1GE5 !S PROVIOED FOR IN SECTION 31O60F THE UBOR CODE, IMEREST, AND A170RNEY5 FEES.
LICENSED CONTRACTORS DECLAf1AT10N: �
I hereby aHirm thel I em Ilcensed under provisians ol Chapter 9(commencing with Sealon 7000) ol Didsion 3 0l Ihe Business and Pmtesslons Code, entl my Ilcense Is In tull '�,
lorce antl eHect. Llc. a Class a
GontrectoYs Slgnature: Dete:
�, CONSTRUCTION LENDING AGENCV:
❑ I hereby ettirm Ihat there is e construction lentling agency far the peAortnance of t�e work lor which this pertnit is issued. (Sec. 3097, CiWI Cotle).
�'i Lontlefs Neme: Lentlers Atldress:
��. Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm thel under penalty at per�ury Nat 1 em EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business entl Profe55ions
Cotle: Any ciry or counry whic� requires e pertnit to wnsiruct, elter, improve, demolish, or repair eny structure, pnor to its issuanca, elso requires the epplicant tor such permit
to file e slpnetl statement lhat he or she I5 Ikensed pursuent to Ne provislons oi the Conlractora license Lew (Chapter 9(cammenGng with Sectlon 7000) ol Dlvision 3 oi the
Business entl Profeulons Cade) or Ihat he or she is ezempt therelran end tha besb tor the allegetl exemppon. Any vidation of Sectlon 7031.5 by eny epplicant for e permit
�� �ects Ihe epplicant to e civil penalry ol not more than frve hundred dollers ($500).):
I, as owner ot the pmperty, or my employeas with weges es lheir sole compensatlon, WILL DO 7ME WORK, and the swcture is not IntendeC or oHered br sale (Sec.
70a4, Business end Protessions Code: The Cont2ctors License lew does not eppty to fln owner at properry who 6uilds or improves Nereon, entl who does such work
hlmsetl or hersell or Ihrough his or her own employees, provitled ihe� such improvemenis ere not intended or oHered lor sale. Ii, however, Ihe builtling ar Improvement is
sold within one year of completion, the ownerbuiltler will have the �urtlen of proving thet he or she tlitl not build or impmve tor purpose oi seleJ. '
� I, es owner of the property, am EXCLUSIVELV CONTRACTNG WIT}1 LICENSED CONTRACTORS to construct ihe project (Sac. 7044, Business and Professions
Cotle: The contractors License Lew does not eppty to an owner ol pmpeny w�a bulltls or Impmves thereon, and who coniracts br such pro�ect with a coNractoqs)
license pursuant to iha Contractors License LewsJ.
❑ I am e:emp) untlar
Owner �vedfletl bytlrivefs license.
Vedfication ol Ownership by (rype at
Business end Prolessions Code for Ihis reason:
Yes ❑ No
it, i.e. - pmperty tvc bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATON:
❑ I hereby ceM1lty Ihet no ezcavailon tNe (5) or more feet in depth into which e person Is required to descand, wlll be mede in connectlon with work aut�orizetl 6y t�is
pertnit, entl that no bullding sirucWre, scattdtling, talsework, or demditlon or tlismentling t�ereol, will6e more t�en thiny-six (36) feet �Ig�. (C�ap. 32. Grp 2, Atl 2, Sec.
341, Tltle B, Celllomia Atlministrative Cotle).
❑ As owner-builtler, I wlll nat employ enyona to do work wMch would repulre a permit irom t�e Division of Intlustrial Safety, as noted ebove, unless such person hes e
permit to do such wark trom t�e tlivision.
Signawra: Date:
Division ot Intlusirial Sefery Permit Number:
CERTiFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I ceniy under penalry ol perjury that I have read this application entl state thel tha Infortnatlon given Is
correcl I egree lo wmply wlth ell stete laws end ciry orGlnances releting to bulltling consirucNoq end authodze representa�ives ot the City of Cosle Mesa to enter upon the
ebovo-described proDerty tor inspection purposes. I egree not to occupy or allow acupancy of any building authorized by this permit umil tinal inspection.
COOE I. INSPECTIONTYPE ' """ BdIE ` U�LS
1618 Fixetl System Flnal Fire Preventlan
1286 Pool Spa Finel
200 Final Ro-Rool
207 FInaI BIocWReteinlnp Well
202 Final Fectary Flre Place '
203 Final Sign
20a Final Domolition
• �1 INSVECTIONTYPE
206 Finel Mechanical
200 Finel PlumDing
210 Final Elecidcal
212 Final Fire Prevention
220 Final Plenning Apprwal
222 Final Site
250 Final Builtling�Occupancy
PAIE II�ELS
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Maa 09 OS 07:23p
� DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY 0111►NER
TO APPIY FpR PERMITS
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so-aa<,nao�a: .2%0 -' ;Z 3 QD ST.� Co.Sra�ES��C'/a nvntu�,nar.
,. ,�1. .N%¢QSHq�4.�. I^I/fNK //�/ , ocdaze ucn i am me 0�„�er or rne of ine aum�e
Merenced Mal piopetty, and that I(we) herchy autho�ize:
r�,,,a: Ng*'��,a..� J!UM�J. 7eiepnonnNumbm: TI�-' 23�' d%ia.3
� SueetAtlareas I �L ' ✓lRG�N/rF f�e� .--__......._._._
�;�. eoS�A �G�- ��: �� �„ ���Z�
tn obtain petmlb in my Oehalf, as owner/buBtlar. (w L7'7�tsfo+• Caivriru cii..�N ��F�f CP�/e REsu.q�'�
at tne enwe retarcnxa orovom. •u ��s
2. Snould any prson beCome an amployno ongapad in 1M impro�amenl al thu property, I(wo) ahall immeeiatey pa.dde Workers
Compsnsation Insurence co�e'age and caum a xnificate ot Nat covaogn to be tled with the BWlding Oivfsio� of iho Cty of Costa
Mesa. as� req�rired Dy S�ate of CaGlomia laws.
3. AS ox��erlbu(Ider In fec� I widmstand und aeeept tl4it my r@6pOnamliities tlo not Vanslar t0 Er1y WMf plMon, COmpeny Or
corpora�on, .
4. I agme In lntlemruy aM hoid tha City u( Costa Mesa and its employeea or ofticers ha.mlugs frOm eny da"vn rosulE'rig in tlamage or
parRonal injury to myself oi erry other parties as a rasult oi work outhMimO Dy tt�9 permils from Ne Ciry of Gps1a Masa.
5. � deCae �mder u,e penany or pty'ryy ma� tne roregoing Is we aiM wrrecc
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Ezearted aws � dey w M fIr 20 .v� . at �lCtM .�iiL!l16�+ . Calilomla.
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Noto: T1ia aWwrpation Wo: no7 grrnt autt�wizatlon b per(omi tl�e �wrk as owner,
It scWN �ov�s 1Df Gmit9d Dwver of amrtreY b soauo ih's P�d� h1 enY bdi3fl,
wra�et»•.��an
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OW NER MATRANGA, GEORGE F. DATE 6-18-56
JOBADDRES3 2%O TWEritj�—tl'!1T'C� S'E � BUILDINGPERMITNO. 3207
GENERALCONTRACTOR 1!lli8 and Colegrove VALUE ���(�']'].�
LOT �, 37r BLOCK � TRACT29SI S1Rg. Res, w/att �ar
i GRUJP I Bc J
INSPECTIONS
Footing Trench
Foundation Form ds na�(i�
Plumbing, Rougl
Plumbing, Roug
Temparary Pole
Wirinq, Raugh
`6EG+er, House /�? -A"� Se
S�� 4 or Ceseryeot'
Lathing, In f
� ;ring
F�...rtbing, Final, Fixtures
Piumbing, Fin,al Gas Test
Wiring, Final
Occupancy
FORm 210 3M �O�iS
St.
11 ZONE RL� FIRE DISTRICT 3Q3(�
PERMITSISSUED
DATE SUBCONTRACTOR
DATE I NUMBi
„• Costa Mesa Bnilding Department APPI.ICATION FOR PERbIIT
,' P.O.Box3�� 32,�� BUILDING �
� COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permit No.
Building
Address 270 Twenty-Third St p
Costa Mesa, California Rec ived by / Date Rec'd. Date Issued
Nearest W89tID1TistCT St � b'JS s6 6%f�
Crass St Building
Address
Owner �orge F. Matranga Costa Mesa, California
Mail �9 E. 17th St
Address Nearest
Costa Mesa Te�,i. 8- 1159 c�oss st.
City No. Zone No.of Type ✓ Group�
E�yh�e���arlson & Middlebro�. . A � I P�d15 I .'y�
pproved
Address Garden Grove bY Date
c�tY u�. CORRECTIONS
Contractor Dike & CiO�gPOVe No. 27�
,4ddress � 9 E. 1'7th St
De crption � No 35 � eiook I Trae�9S9
(Attach Metes and Bounds)
Size of Lot � X 13z I
4se of none I
Existing Bldg.
Setback Line from �
center ot street 5�
DESCRIPTION 1
New I $ I Alteration
Repair I I Moving
Buflding No.of
Size 1205 9q ftrtaom�
ExteriorWall _, � R�
No. of Bidga
Now on Lot II0118
No.of No.of
Familles I Rooms
RearYardSQ 12t
Side Vard
iF WORH
I I Addition I
Single family res and gar
,.i.,. i.� .-_
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1 . n v• .J:s..f� _..._JIl
_ APPROVALS
— Foundation Location I Inspector � Date
— Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracina. Bolts
I hereby acknowledge that I have read this Application
and state that the above is correM and agree to rnmply Lath. Int.
with all City Ordinances and State Iaws regulating
building cronstruction. Lath. Ext.
Signature of Dike and Colegrone
Permittee Plaster, Int
Authorized Agt. (.. �, � Plaster, Ext.
Valuatlon Permit Fee $ GiJ — Masonry Retnforced
/� �_ Plan Check $ /J gond Beam
g /C)� �f Total ,
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PLOT PLAN
Show Iocation and dlstances Trom
property Itne and bMween buildinga
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