HomeMy WebLinkAbout834 WILSON ST - Building Permits.
�
CITY OF COSTA MESA
BUILDING DIVIS/ON
. �
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER B07-00772
PERMIT TYPE B ROQF STATUS: ISSUED
• DATE ISSUED: 06111/2007
ISSUED BY: RMD
JOB ADDRESS: 834 W WILSON $T CM '' Suite/Unit:`
Viciniry: HOUSE AND GARAGE ROOF • Const Type; :??
SQ. FT: 1500 � ' - �- � � ' Valuation.- -';. $3;00�0.00
SCOPE OF WORK: TEAR OFF (E) ROOF MATERIALS, INSTALL A MINIMUM OF 2 LAYERS OF 15# FELT ON A LESS THAN 4:12 ROOF
PITCH OR A MINIMUM OF 1 LAYER OF 30# FELT ON A 4:12 •� .
ROOF PITCH AND REROOF WITH 30 YEARS COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE, REPAIR AND REPLACE
SHEATHING AS NEEDED. „�- � : .� - . , �
' . _ r . " . . - , .
OWNER: TOLEDO,LUCRECIA, -. - -- Address: ..834 W WILSON ST Unit:
PHONE: 949-933-6901 Qity/Sta[e2ip: � �_ �� COSTAMESA,CA � � ,
APPLICANT: TOLEDO,LUCRECIA, , .-,:. �. ,- .Address: 834 W WILSON�ST. Unit: .
PHONE: � 949-933-6901 - . � - , . . .. City/State/zZip: ` COSTA MESA, CA _
CONTRACTOR: OWNER-BUILDER ' - � License No. 000000
Address: Unit �. �� � -PHONE: � - � . � � � � �
City/State: � � - ZipCode: � CELL: .
ARCHITECT: �� , , � ..-;� , . ''-` License No. , .. � � ,: � � � ' - PHONE:
ENGINEER: � � Litense No. - � - � PHONE:
FEE SUMMARY =„
Reroof Plan Check: $0.00��.- �� � . .. _ - - � � i . � � - � �
Reroof Permit Fee: $8325 « ,
Reinspection Fee: $0.00 � -� ,
TOTALFEES
$83.25
NOTICE: The work authorized by this permit shall comply with all applicable �handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) . . .
EXPIRATION: 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 wnsidered legal, such work must wmply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
COOE1. INSFECTIONTYiE ORTE INiRIRLS '�� INSPEGTIOXTYPE 4R� IN1171R15
1618 ' Fixed System Final Fire Prevention 206 final Mechanical
126fi Pool Spa Final � ' 208 Final Plumbing
200 Final Re-Roof �� � 210 Final Elecincal
201 Pinal Block/Relaining Wall p12 FinafFire Prevention '
202 Final Fattory Fire Place 220 Final Planning Approval �
203 Final Sign 222 Final Site
204 Final Demolition 250 Final BuilOing/OccupanCy
.
WORKERS' MPENSATION DECLARATION:
I hereby affirm under penalty o( perjury one of tha I�...,+aing declaretions:
� I have antl will maintain a certi(wte of consent lo self-Insure for vrorkers'
compensa�ion, as providetl for by section 3700 of Ihe Labor Code, for Ihe
pedormance of the work for which this permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of Ihe Labor Code, tor the peAortnance of the work !or which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrie[
(IDis seCinn neetl rwt be mmple(etl tl fhe permrt is valued nt one huntl.etl dollars (E100) oi lessJ
Policy Number:
I�certify that in the pertormance of the vrork for which lhis permit is
issued� I shall no� employ any person in any manner so as to become subject
to the workers' compensation lavrs of Califomia, and agree that it I should
become subject to the vrorkers' compensation provisions of Seclion 3700 of
ihe IoA{C,�� fotlhwith comply wilh ihese provisi ns.
X 1
�p0 �wnl's SignatuR�-� r' a � +
\i
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 DOLLARS
($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF iHE LABOR CODE, IMEREST, AND
ATfORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions o( Chapter 9(commencing
wit� Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force antl eflect.
Lic. # Class #
Coniacmr's SignaWre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn Ihat there is a constructbn lending agency tor the
peRortnance of lhe work far which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Atldress: .
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penally of perjury lhat I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
eusiness and Professions Cotle: Any city or county which requires a permit to
constmct, alter, improve. Oemolish, or repair any slructure, prior to ils
issuance, also requires the applicant for such permil to file a signed statement
that he or she is IicenSeC pursuant lo the provisions o( the Contractors
License Law (Chapter 9(wmmencing with Section 7000) of Division 3 0( the
Business and Professions Code) or that he or she is exempt therefmm and
Ihe basis for the alleged exemption. Any violalion of Section 7031.5 by any
applicant (or a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as ovmer of lhe property, or my employees with vrdges as lheir sole
compensation, WILL DO THE WORK, and the sWcture is not intentled or
oftered for sale (Sec. 7044, Business and Professions CoCe: The Contractors
License Law does not apply to an owner of propeAy who builds or improves
thereon, and who Cces such work himself or herself or ihrough his or her ovm
employees, provided thal such improvements are not intended�or oRered for
sale. I(, however, the building or improvemenl is soltl wilhin one year of
completion, the owneo-builder will have the burden of pmving�that he or she
tlid nol build or improve for purpose of sale.).
❑ I, as ovmer of Ihe property, am E%CLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS lo construct the project (Sec. 7644. Business and
Professbns Code: The contractors License Law dces not apply to an owner of
property who builds or improves thereon, and vfio contracts for such projec[ with
a contractw�s) license pursuant to the Comractors License laws.).
❑ I am exempt under sec.
Business and Professions Cotle (or Ihis reason:
/�� �.
1111/.�i. ,./�i�
�
Ovmer ID verifetl by drivt ise. es ❑ No
DnVerS�L�se Nor � �F�pires:— � � I�
Verification of Ownership by (rype of tlocumen�, i.e. - property tax bill or tlee ):
OIVISION OF INDUSTRIAL SAFEN PERMIT CER7IFICATION: '
❑ I hereby certdy that no excavation (ve (5) or more feet in depth inro which a
person is required to descend, will be made in connection with work authorized
by this pertnit, and that no building structure, scaffdding, talsev.ork, a demolition
or dismantling thereoF, will be more [han �hirty-six (36) (eel high. (Chap. 3.2, Grp
2, Arl 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-builder. I will not employ anyone to do work which woultl
require a permit (rom the Division of Intlustrial Safery, as noted above, unless
such person has a permi[ [o do such work from Ihe division.
ApplicanCs SlgnaWre
Division of Indusirial Safe[y Pertnit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuNre building occupant need to file and
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material7 ❑ Yes ❑ No
(Section 25505 0( the Califomia Health and Safery Cotle requires, with some
exceptions, lhat a Business Plan be (led vrith the Costa Mesa Fire
Department by every business which has at any one lime tlunng a reportetl
year a quantity o( haurtlous materials equal to or greater Ihan a weight o(
500 pounds, or a volume of 55 gallons, or 200 cuhic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or fuW re building occupant need to !le
a registration fortn (or acutely hazartlous materials? � Yes ❑ No
(Section 25533 of the Calilomia Healih antl Safery Code, with some
excaptions, requires registration wi[h the Costa Mesa Fire Department by
each business which at any one time has on hantl 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
tempereture and pressure).
3. Does or will the applicanl or present or fulure building occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
haZardoUS malerial5)1 ❑ Ye5 ❑ No
(Section 25534 of the Califomia Health and Sa(ery Code provides that Ihe
Costa Mesa Fire Department may require the preparalion, cehification an0
(ling with ihe Fire Department ol an RMPP by businesses which are required
to register acutely hazartlous materials with ihe Fire Depanmenl.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safery Code been fully complietl with7 ❑ Ves ❑ No
5. Does or will [he applicant or present or future building occupanl require for
the work which is the subject of this applicalion a permit for such construction
or modifcation from t�e South Coast Air �ualiry Management DisMct or Irom
any other air pollution control district or agancy? ❑ Yes ❑ No
(Seclion 65850.2 of Ihe Califomia Govemment Code requires Ihat ihe requestetl
infortnation be fumished on applications fa non-residential building permits).
6. Will any part of the facility to be cons[ructed under this permil be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
p( yes", the faciliry must meet the requiremenl of Sections 25534 and 42303
o! the Califomia Heatlh antl Safery Code�.
7. If a pertnit from ihe South Coas[ Air �ualiry Management District or other
air polWtion control district or agency is requiretl for the work which is lhe
subject of this application, �ave all of ine disclosures prescribetl by Califomia
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No.
8. pf yes". attach certificate of compliance from,the appropriate air pollution
control officer). .
CERTIFICATE.OF COMPLIANCE: I certify that untler penalry of perjury the
information given above is cortect. I agree to compty with all state laws and
ciry ordinances regarding Haiartlous Materials antl Emissions. '
Signawre , Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of�perjury that I have read this application and state that
the intormation given is covecl I agree to wmply with all state laws antl ciry
ordinances relating to building construclion, and authorize representatives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspecC � ur oses. I agree not to occupy or allow occup � cy ( any builtling
autho d p rtni� until fnal inspection.
LSiB�aWre o1 e0a1'Omnerts�--� _ ie�`
` ��>
Ana/a AutbonEea Nop��wnt Dale
APD���ant t0 ���I in all ipaces excepl those within neavr eoraer lines ana sign all aporooriate aeclarations.
-, �IT.�K OF COSTA MESA CONSTRU 'Tf PERMIT PERMI O TRACT NO. LOT NO. UNIT NG.
� ' Project Address �3� W W iL56N �.T G � . � 7 �Sa � � �o� 2/04/87 �
ApplicanYsMailingAddress SAu+E -q5 I��OIIE TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR � rJaOD
Owner'SName �%SA GAM NVNT 8—�(� 7 � CONVERSION ❑ DEMOLISH ❑ OTHER qp # . ' 2one
Phone � DESCRIPTION OF WORK/USE OF BLDG.
Address �-RM� FiS A�UVE S Main6uilding: AccessoryBuilding:
AfChlEng. LiCenSe No. TVPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL T Front ' p
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL '
Address ❑ OTHER . A Rear N
Contractor's Nam Phone C Right ' N
Address Imailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCv
"��`J CONSTRUCTION TVPE VALUATION $ g Lefl G
CityLicenseNo. � 1 ZONE GRADINGCU.VDS. ACRES R
LICENSED CONTRACTOR DECLARAT�ON Pin9. Ref. # Parking Req./Provided E
I he�eby attirm lhat I am licensetl untle� Provi5ion5 of Charter 9(commenclnq aemarks: - Planning Notes: M
with section 7000) oi Division 3 of the Business antl Pro�essions Cotle, antl
my Iicense is in tull force antl effecL T
License Class License No. S
Date Signature
PLUMBING FEES � �
WORKEF35' COMGENSATION DECLARATION gar Sink ShOWerS
'=reby affirm tnat 1 have a certificate of �onsenl to self-insure or a cerHticace ELECTRICAL FEES
Norkers' Compensation Insurance, or a certifietl mpy thereot (Section gackflow Preventer Service Sink
.0, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation Sewer Ca ❑ 50+ KW
P Construction Pole Sub.
Certifietl copy is her¢by fumishetl.
Certifietl copy is filed with the city Bu��tling Division. Bathtubs ' . Sewer Connection Cooking Unit Meter ❑up to 100 amps
�ate Applicant
EXEMPTION FROM WORKERS' COMPffNSATION DECLHRATION Clarifiers $Oldf COIIEctO/5 DiShWdShe� Mete� ❑ov2! 1�OdmpS �
(This section neetl not be mmpletetl if [he Permi[ is for One huntlretl ($100) or ,
iess). Dishwasher Solar Piping � Dryers ❑Gas ❑Electric Su6 Panel � -
I certify that in the pe�formanGe of the Work fOr which this p rm�t is issuetl, I "
shall not employ any person in any m r o as t bec ubjec[ to th� Dlinking Fountain5 Solar Tank Fan
Workers' Comi� n C�p Laws of Calit Motors DO-1 HP �t %- 8
Date �_�( —�( Si9nature' Floor Orains Swimming Pool w/Spa --
NOTICE: If, afte� making this tlecla�atio�, Yo shoultl beco e s bject to the _ F�A�U' Inc. SOId� 09-15 HP 016-15+
Workers' Compensation provi5ion5 of [he LabOr Cotle, you st forthwltM1 FIOOf$inks Ufinal
comply wiM such Orovisions or tM1is permlt shall be Eeemed revoketl. Fixtufes Microwave
CONSTRUCTION LENDING AGENCV GasService Outlets WaterCloSet DeViCeBoxeS
1 hereby affi�m ihat there is a con5tructio0 lentlin9 aqency tor the pe�formanCe POIe Light
ot the work for whicn this permit is issuetl (Section 309� Civ. C.) �nterceptors Wate� Heater Outle�s
ttntler's Name Range
1_entler's Atldress Kitchen Sink Water Service �
OWNER BUILDER �ECLARATION � Switch¢s Sign
1 hereby aftirm that I am exempt from the Contractor's License Law for the Lavatoties � Auto-Wash �
tollowing reason (Sectlon 7031.5 Business antl Professional Code: Any city or Garba9e Disposal $tanding Sections
county wnich requires a permit to construct, alter, improve, Cemolish or repair p—Trep Laundry Trays Genera[or �0.5 KW 05-15 KW
any st�ucture, prior [o its issuance, also fequi�es the applicant for Such permit T�BSh COmp2ct0�
to fi�e a signed Statement that he/she i5 IicenSetl pursuan[ [o ihe provisions of ROOi D�dinS
the Contractor'S License Law (Chapter 9(�ommencing with SectionJ000) of
r"•�ision 3 of the eusiness antl Profe55ions GotlC) o� that ne/she is exempt -
�from antl tM1e Oa5i5 for Ih¢ alleqetl exemption. Any violation of Se[tion
..5 by any applicant for a permit subjects th¢ appliwnt to a civil
..alty o� not more than five huntlretl tlollars (5500),
� I, as owner of the property ' e]rsola- f7einspection Fee $15 Issue Fee $ 3
�py�pawsaF�erY, will tlo the work, antl the structure is not intentletl or offeretl Reinspection Fea $15 Issue Fea $ 3
tor sale (Section �044, Husiness and Grofessional Cotle: The Contractor's MECHANICAL FEES
Litense Law tloes nol apply to an owne� of a O�oPerty wlto builtls or improves
thereon, antl who does such work himselt/herseli or mrough his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provitletl tM1at such improvarr�ents aro not intentletl or ntteretl for BOiI¢� HOOd O� Typ¢ I ❑
sale. It, however, the Cuiltling or improvement is soltl within one year of tom- CanOpy Type II ❑ Zoning Approved By Data
pletlon, the owner will have Ihe burtlen Ot proving he/She dId not builtl o� im- DUCt - Unde� G�Ound Building Appfoved By Det�
�rOve tot tne purpoze Ot sale). 2
I, as ownel of the property, am exclUlively tontracting with Iicensetl con- OUCt -Structulal R¢ffiy¢fdtiOn SYstCrtt ApplicatiOn ISSUBd By Ddt
t�aCto�s to construct [he project (Section �044. Business antl Professions Cotle:
Tne Contractor's License Law does not apply to an owner ot property who Duct - Ventilating -❑0-100,000 BTU ❑700,000 BTU SUMMARV OF FEES
builtls or improves the�eon, antl who contracts for such project5 with a con-
tractor(s) iicense pursuant m the Contractor's License Law). 1 am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteretion - BUILDING PERMIT $ SMIP $
proot of their Worker's Compensation insurance shoultl be provitletl to me. � _ P�AN CHECK $ PERMIT �
❑ 1 am exempt untler Section B. & P . for this reason Firepl/Fact. Blt. ICBO # Fire Dampers � pLUMBING $� ISSUANCE �$
� — p - y�y..J. _ Heating System & Ducting Registers � � p�p,N CHECK 25% 5 ENERGV P.C. $
I nereby certify'tnat I have reatl this aPP�icztion antl st hat the above ❑0-100,0006TU �100,OOOBT GRADING $
information is rorrect. I a9ree to comply wnh all city antl county ortlinances ELECTRICAL $
antl state laws relating ta builtling conSUu[tion, antl hereby authorize repre- $ MICR�FILM $
sentatives ot th' ciry ro-enter u n the above- entionetl property for PLAN CHECK 50% �
inspection o5 5 (7
Signature Data � �d . MECHANICAL $ TOTAL FEE $
peinspection Fee $15' Issue Fee - �$ 3 PLAN CHECK 25% $ '
Drivers' License or 55 �
CMF OB65-46, rev. 30/84 White - Builtling; Canary - Appucanr, Nmk - Accounting; Goltlenrotl - Assessor
CONSTRUC710N AND PLANNING POOL & SPA �
APPROVAL$ Permit# Date Inspector p�ppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd. 54. Forms . '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinfqrcement 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor SYstem 61. APPROVAL TO DECK
71 . Property SeWer Line & House Connection 62. Backwash & Receptor-Final
72. 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 Eleciric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elecirical-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 �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush ,
24. Roof Framing � •73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
2�. Frame and Flashing 76. Dry Standpipe ,
28. Lathing & Siding 77. FIXED SYSTEM FINA�
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: -��
34. Final Heating & Air Conditioning
, 35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace
38. Final Plumbing /�e�/y7 if��
39. Water�Service-Final /'y �7 ���e
r
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
f43. Backflow Irrigation � � . �
44. Landscape Irriqation System �
.45. Sound Attenuation
'46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICqTE OF OCCUPANCY •
No. Date ` , �
:r
owNea BRZSTOi EST9TES DATE 9-5-56
JOB ADDRESS 83� Wilson Street BUI�DING PERMIT NO. #jSSB
GENERALCONTRACTOR S. V. Hup�aker VALUE $ 8a856�QO
L�.� 12 BLOCK TRACT 2873 Si�le Rea. W�Stt, gar.
GROUP I&.I TVPE V ZONE E�i FIRE DISTRICT �Fi99
INSPECTIONS
Footing Trench
Foundation Fon
Temporary Pole
Wiring, Rough
Heating, Rough
Heatina. Final
DATE I SUBCONTRACTOR
s and Grade to Ga�age
to S— lab� Q �v,E �'
Complete iiJC�° 5 �
�A�i 'l /(1 •
%n C > �
ih L S �',
Sewer, St. %11 t� S /n.
S� ''cTankorl�esspopU
L .na.ln Oui
Plastering
Plumbing, Final, Fixtures
Plumbing, Final Gas Test
Wiring, Final
Occupancy j7 �,_
FONM 210 9M 10�5�
PERMITSISSUED
DATE I NUMBER
�i�
_Costa Mesa Bnilding Department APPLICATION FOR PERMIT
. -��• P.O.Box3�� .��2� BUILDING �
COSTA MESA, CALIFORNIA
_ FOR OFFICE USE ONLY
. FOR APPLICANT TO FILL IN Receipt No. Permit N�of
Building ` / .�7— r�' Y
Addross � L So � J i - �J !!
Costa. Mesa, ria11i0I'II13 :teceived by Date Rec'd. Date Issued
Nearest ' / � ��� ��� �
Cross St ,; ,oiv� / +4 Building �
' � Address
Owner o 1
ma�i T I^ Costa Mesa, California
Address Q' ,C .qS �i✓�FS �/'� Nearest
City ,�,�c C.� // No'. �`//. ��/ Zone St� I P�ans I Type ✓ Group-7c
Arohitect or Lic. . ••��
Engineer —� No. Approved
6 Date
nddress — CORRECTIONS
_ c-,i .i/ ,J cityLio..% b,ci
■ Address
No. of 81tlga /y
Size oT Lot �O o'O Now on Lot C/ 0
l�seof �„ I No.of I No.of s
Existing Bldg. Famillea Rooma �j
Setback Line from � Rear Yard �,�
Center of Strcet �6 Side Yard 'v� ,�• j
DESCRIPTION OF WORH ''
New I Alteration I I Addition I
Repair I I Movfng I I Demolish I �
Building No.oT ✓ /
Slze �� /�J Rooms r3- Stories
E •tor Wall `_ Roof
C ing / C�. Covering ApPR,�VAi,R
BuildfnNeW � � " Foundatian Location Inspector � Date
a � - '� '�� Forms, Materials,
�y � � Under-Pinning �
� Frame: Fire Stops, �
"� Braeing, Bolts
I hemby acknowledge that I have read th(s Application �
and state that the abwe is correM and agree to rnmply Lath. int
with all City Ordinances and State Laws regulating
building rnnstruction. Lath. Ext �
Signature M /f�
Permittee �✓� Plaster,lnt
Authorized Agt Plaster, ExL
Valuatlon Pe�mit Fee $�a � Masonry Reinforced i,
Plan Check $ Bond Beam
$ ���� �� Total � �
�
� Fee � FINAL �
FOFM 204 IO�SS D. P. G 5, �
I �,
c
c
a
�
t
Show Iocatlon and distances irom
property Ilne and between bulldinga
� ' •. ' .
. �� . " . - ,
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_. _ �
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?-OWNER PT,TTh{MFR� GF.(1RGE R. SED Q � �q5� DATE 5-21,-57 �
JOB ADDRESS $"�(� W. W11SOri BAILDING PERMIT NO. %�5138
GENERAL CONTRACTOR Qymep Bl�p. VALUE $ 116.00
An, No. LOT 1Z TRACT 2573 FIRE ZONE DESCRIPTION OF WORK Fence
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PLAN NO.
INSPECTIONS I DATE I SUBCONTRACTOR I DATE r��M",NUMBER
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Final Gas Test
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COSTA PAESA BtlILDI�G DEPARTfiAENT
P. 0. BOX� 317
COSTA MESA C{ LIFORNIA
C•L. OF STREET �
IFT.IST.
�iPROP TINE
T. FOR 60 FT. ST}2EE'
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MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES------
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES
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I 5244 I
FOR APPLICANT TO FII.L I1V
BUILDING A,�`D"DRESS � 3� u,/�! r�-��/L 5!%�
Owner!�'�(%��>� GC . ���%L1/iN�'�--
Mail Address T �' �f�s /�%
City � � S � �E � A Ph. No. � -- �d �1/
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Contractor • � �'L /' Ph. No.
Address s ��r'
City Lic._No. _ Siate Lic. No. —
Size of Lo --� -- � AP No,�k�G� a87� �/2
Setbacks: C/L Street :i �% �' Rear 0
Side Yard - Right � LeEt /��A ' �17C'_+
Type of � ence E �
V � � G � .
I hereby acknowledge that I have re d this applicatiorf nd state
that the above is correct and agree to comply with all ity Ord-
inances and State L ws regulatin uilding construction.
Signature � 0 ,, /
of Permitiee �/l� � A���Z""' —
FOR OFFICE USE ONLY
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Received by Date R�ec(e,ived�7 Date Is_�s7ued
� ���a/ S/ � "�f" �'��
VALUA ION � �
� Permit Fee $
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$ ��[O P1an Check $
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TOTAL FEE $
USE REVERSE SIDE FOR DETAILS �
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