HomeMy WebLinkAbout296 16TH PL - Building Permits 1.4/2_2/LULU IYJ: 3YJ 11410140OJ UHYO !IGH! HIND HIM rsoc UL
4
.
12_-22 -2c[4D
Jays Heat and Air
8411 Denni St.
Cypress Ca. 90630
1 714 7613969
SL# 858366
Hi Regina Diaz, I hope your day is going good for you. I spoke with you
on the phone about withdrawing permit number M10-00159. Please send
mea check for 38.30
The address is 296 A 16th P1 CM, I'll fax this over with the yellow sheet.
If you have any questions call me. Thank You.
State Of California
!; tONTRACTORSSTATE LICENSE BOARD';.^,'�'Tr ,. •
�^- ACTRIE LICERSE
It?
ARmn - +MJ
858366 INDI11
JAY'S HE-At AND AIR SERVICE
i.,
C20
r.
05/31/2011 I Ali,
Sincerely
y Holrloway
CITY OF COSTA MESA
^ipRti.wq BUILDING DIVISION
•^� 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
°°Po^.^°"° PERMIT NUMBER: M10-00159
PERMIT TYPE MECH STATUS: APPLIED
APN: 42522213 DATE ISSUED:
ISSUED BY: CAC
JOB ADDRESS: 296 A 16TH PL CM Suite/Unit: A
Vicinity: - •
SQ. FT: 0
SCOPE OF WORK: REMOVE AND REPLACE FURNACE 45K BTU
OWNER: BENNETT, ESTHER M TR Address: SURVIVORS Unit:COSTA MESA,CA
PHONE: City/State/Zip: 3015 CLUB HOUSE CIR
APPLICANT: JAY HOLLWAY Address: 8411 DENNI ST Unit:
•
PHONE: 714-761-3969 City/State/zZip: CYPRES ,CA
CONTRACTOR: JAY HEAT AND AIR SERVICE License No. 858366 10-00159
Address: 8411 DENNI STUnit: PHONE: 714-761-3969
City/State: CYPRES ,CA ZipCode: 90630 CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN NVESTICHECK
ATION F: $0.00 ��
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30 DATE:
•
F:)••
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 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.
CODE S. INSPECTION TYPE DATE INTRIALS CODES INSPECTION TYPE DATE INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 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 Firial Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive. dense. ❑Yes ❑ NS '
I gereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' :Verification of-Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm
(This section need not be completed if the permit is valued al one hundred dollars(Sloe)orless) 2 Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
iss ed, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
thjt / ictStnature
bor Code,I s I forthwith comply with these provisions.
/' Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
G:: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business ran�d Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect.
C `� a registration form for acutely hazardous materials? 0 Yes 0 No
Lic. : .�� it ' / _ (Section 25533 of the California Health and Safety Code, with some
/�� i _ 42--
n - exceptions, requires registration with the Costa Mesa Fire Department by
In"- /�. `2— IV l o each business which at any one time has on hand a quantity of acutely
/ gaS, 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? CIYes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑ No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9 (commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended,or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am
EXCLUSIVELY
ordinances regarding Hazardous Materials and Emissions.
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 Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Si. ure of Legal 0r(s) Dale
Signature Date. .) D`2. 1 CI G°
3057-46(3/0))
nn`
•Applicant
12/22/2010 11:02 714/6141flJMYn MLN I AND RIM rf-IUL ocby 0 001/001
12/22/2010 11 :31 FAX 7147544
" 1 11-1 -75z-t- .
CITY OF COSTA MESA
REFUND REQUEST FORM
From: nance Vendor*:Building Safety Permit#: nil Q 411215j
0 Planning Amount $ $0•129
❑ Public Services f
El Community Services ate: r q iI0
❑ Other
dgar,(�nent Signature
Account Fund Organimtion Program (/Project/Grant Amount
1415150 lo( • (neap , aotllo 3O•ld�
Name and address of applicant, 0-QXi ItQ , 4.4,A Arr---
tt/ 0€A-A-1 Si—
GGy/_r&s s gro al c
Phone: / l.— 7/g — 7 ( —3 96
/z-- --2- r/v
A icant's Signature { Date
REASON F4 UND: /'74 dra 4.-44-7 (frffinT G ow/i^.e-zj'
71-4),5 ,r?t_;cc/L.,
'451- Yl S Inc/(4 K. PL , CA cch. 7'P i��`�S l71C a E ►1.-A1�
APPROVALS:
Finance:
City Manager:
240137 MW ONLINE
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
WCOSTAMESA CONSTRUCTION PERMIT PER NSa TRACT NO. LOT NO. UNIT NO.
loGo
Project Address 296 F. 16th Place, C.M. ALJ
Applicant's Mailing Address 126 Commercial Way. C.M. 92627 TYPE OF
STUCONSTRUCTION
SHEW LI ADD❑ OTHER XA ALTERATION LI REPAIR
Owner's Name Paul Bennett Phone 548-0168 D - RPmnVP PX1 Ctl n(� app] A.P. Zone
Address 292 F. 16th Pl. , C.M. 92627 1-2t33f & I&TIO�pF,1NORK/USEAF,BLDGp .�.�CRs—Nh AR?A,Y S Main Building: Accessory Building:
L I 9f Te1LS WflO t. dS Z
Arch/Eng. License No. TYPE OF PERMIT El GRADING U FOUNDATION ❑ STRUCTURAL E Front O
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB Rear S 5 iNs
❑ OTHER nt •nnr i411-A-0001.369 TOT • 'I•'
Contractor's Name—Crank memBros. Roofi g Phone 548-5569 PROJECT DESCRIPTION SQ. FT. a OCCUPANCY sing e C Right DATE: 09/14/88 TINE: UY+'L7 N
Address(mailing} 126 Cn mmPl'C 1 B� Way, C.M. 92627 G
CONSTRUCTION TYPE garage VALUATION$ 891.50 S Left
City License No. 005993 R
ZONE GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: 0M
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force a et.
C° l3 408677 I s
Ucense lass Lice N..
Date ySvir1r' Signature <"�� PLUMBING FEES
/y WORKERS' COMPENSATION DECLARATION Bar Sink Showers
—11�5 -eby affirm that I have a certificate of consent to self-insure or a certificate —
ELECTRICAL FEES
.Yorkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
0000, Lab. C.>285 X224-88 State Fund Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap0 50+ KW
a
Construction Pole Sub.
Certified copy is hereby furnished-
Certyjied copy Bled with the city Bui g gLvisioy. _ /) Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date ` / 0 Applicant TI LeCiLARA��
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or '
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
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 Drinking Fountains Solar Tank Fan Motors ❑0-1 HP 011/5
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE: If,after making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there Is a construction lending agency for the performance 8
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name — _ -
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section-7031.5 Business and Professional Code: Any city or s
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator 00.5 KW ❑5.15 KW
any structure, prior to its.issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License-Law(Chapter 9 (commencing with Section 7000)of
'cion 3 of the Business and Professions Code) or that he/she is exempt ifrom and the basis for the alleged exemption. Any violation of Section
1.5 by any applicant for a permit subjects the applicant to a civil -
LIenalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered ' - Reinspection Fee I $15 Issue Fee -$ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type 1 0
sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved BY /'� Date
prove for the purpose the of oe). l///^r1�1 ���
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU SU RV F FEES
builds or improves thereon,and who contracts for such projects with a con- _
tractor(s) licenseLaw). e
proof of their Worker's Compensatin Contractor'sissurnLicensehoule Irovied awaretothat. Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ •� SMIP $
PLAN CHECK $ PERMIT
0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑0100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter upon the a ove-mentioned pr per for
inspection pup
SignatureCt�G+e-L4, ` 1Q3t iS - MECHANICAL $ TOTAL FEE $ .. ...3 SO
I Drivers' License or SS# _ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ACCOUNT 4: 8117402002
1 n1 nnno nm nnn14768-nanlsiA9
•
I
CONSTRUCTION AND_PLANNING POOL &SPA 1
APPROVALS •Permi4-# Date Inspector APPROVALS Permit# • Date Inspector
\
1.'-Temporary ElecfricalService or Pole 52. Pool & Equipment Location
2.' Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation /; 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undfg'rnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. .
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 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 78. FIRE PREY. 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
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
•
44. Landscape Irrigation System
45.•Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING golgt ` u ad
•
48. Special Requirements Completed `/ •
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY •
No. Date -I I
.I;
9366 it :i ' ;' aLL.
COSTA MESA BUILDING DEPARTMENT ^' MAY 21 1959 s.
P.O. Box 317 Ft filo DEPT.
COSTA MESA. CALIFORNIA `N(I r
�,j C •�r4 PICCA
.FO- :.PF- ,� , NT TO We. IN APPLICATION"FOR PERMIT
BUILDINGqq�ry _- }} t '' � n BUILDING
ADDRESS 296 I.t., A, B, C •
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. c,li 4
0.4
OWNER Santa Araya Patio Homes, Inc. �^/
MAIL 1555 Fla centra " RECEIVED BY rDATE/RECEIIVED�/ DATE ISSUED
ADDRESS pJ �V—.6 / 5-0.,/-S7
CITY Newport Beach, Cal. TNo.MI 6-3227 ADDRESS
OR CF 'Isame O.
E N
OR E ITER NO.
COSTA MESA. CALIFORNIA
A
FIRE
ADDRESS Kell
(� Same ZONE
Ks yy Bell Const. Co. CITY LIG. 1217 ZONE NO.OF TYPE GROUP
CONTRACTOR NO. / PLANS
TEL. APPROVED J /
ADDRESS same NO. same BY� /� /L'e (DATE 4C/�j
LEGAL - ( `lOf.l(�
DESCRIPTION NOT 11 BLOCK TRACT 2996 f N
},
• L'�� l+ ( b`'1
SIZE NO. OF BLOCS. �',•p 1
OF LOT 102.5 x 125 NOW ON LOT 0 f r f Ti 7 Ti r'N wt in,
USE OF
1e`u ii:i ' r `ij L''' 3 t` i
EXISTING BLDG. .�/ ti II
SETBACK LINE FROM /J� 1✓Jv �
CENTER OF STREET REAR YARD 15 tP Ci/Ir �
.r /�' 7 DATE
SIDE YARD RIGHT 10-6 s LEFT '. ! 1 \/
DESCRIPTION OF WORK - �� spy
NEW i ALTERATION I ADDITION I .
REPAIR MOVING I DEMOLISH
SIZE
BUILDING 2 ROOMS NO.OF 16 STORIES 2
•
EXTERIOR WALL
COVERING stucco • •
USE OF NEW
BUILDING •
Triplex residence and att. garage.
Plan 4:ffi 5
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
ER. VALUATION
SIGNATURE O
PERMIT FEE S 46.00
PF
PERMITTEE 26,378.00 PLAN CHECK S 23.00
S
AUTHORIZED AGENT TOTAL FEE $ 69.00 Y5 AIF
27158 PAID
COSTA MESA BUILDINGSAFETY DEPARTMENT JUN12 67cNsaOO 736 Eli*****3.00
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92620
For Applicant to Fill In Complololy APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
_ For Office Use Only
ADDRESS Z' . 4-/b PL Retain No. ryrS9eST NO
COSTA MESA. CALIFORNIA --- 21's ..66 �,,5
RECQ V/DB DA, /1 I DATE ISSUED
OWNER�. kiC0-gS 0L_ I`l/[J G 7
BUILDING
{' MAIL ADDRESS 99e_d. i6 .�
.. ADDRESS SdM✓� FIRE �/j +y-
CITY No.
ZONE 4J, '/l,TYPF�GROU/P X
UNITE= TE B•TPROVQD y.//� • DATE 4-47-77
//////JJJ"•VVV ZONING
ADDRESS
- SCyx�t NO.OF USE OF NEW )
i '' // �I �S 3�PI PLANS 2
!WILDING Y
• CONTRACTOR 140,3(-- /l/ Ia741- ` ./-/- / f�--��L�
Lt ADDRESS .7Q2+7o -E /0 i- DucRIRtoN -(�/'7/ ii �� .299
CITY L..7 A.P.NO. / 1 / I( ,.— 7/
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
'; LIC.N0.Z14 1 < I TE G4-311) DO'TO SIDES REARp.L
EAVES
SIZE // 7J '/ /� ^� NO OF SLDC[. ALLOWED (U.B.C.REQUIREMENT)
OF LOT L/ 2- L / ID(` i,25, NOW ON LOT
3 ) YARDS APPROVED YARDS APPROVED
8 USE T (T^7 -J �� � MAIN BUILDING ACCESSORY BUILDING
'
EXISTING BLDG. `I<F
5 -- (FROM C/L STREET) /
SETBACK LINE FROM FRONT 0.-79F'T, Y(9 ' i/
CENTER OP STREET REAR TARO � �C( �� // ,,
sun YARD LEFT I RIGHT R.SIDR /.(/SFT, t �FT•
DESCRIPTION OF WORK L BIDE /SFT. FT.
ALTERATION ADDITION )( REAR — PT. FT.
DISTANCE BET. BET.MAIN S
REPAIR MOVING DEMOLISH MAIN BLOOD. ACCESS.BLDOS.
•q, BUILDING NO.OF VAR•# DATE
�, SIZE ROOMS STORIES C.V.P.# APPROVED
• EXTERIOR WALL I ROOF COVERING glory
COVERING DATE (o iia- -(p7 USE OF BUILDING AND WORK TO BE PERFORMED r// 1 7
i.
04
/o ' xly ' PnnbbLk,0 1
SQ.FT. 2
J I HEREBYACKNOWLEDGE THAT HAVE CtADTHIS TOTHE AMOUNTSHOWN UNDER VALUATION IS FOOTHE 0
AND STATE TEl OVE IH CORRECT AND AGREE to cos. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH A CI Ty 8S AND STATE LAWS R DEATH VALUATION d/'1
BUILDING ,L•N iI (/V co
SIGN TTU� _'+ �7�C�QA y✓ f p� PERMIT FEE $ •lJ F
Y,(,'/ S /„J PLAN CHECK S ,E/, wG
� AUTHORIZED AGENT . TOTAL PEE $