HomeMy WebLinkAbout313 16TH PL - Building Permits CITY OF COSTA MESA
a BUILDING DIVISION
• •,,,•' al Lit—iel DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
I lir PERMIT
f"°� • 1606-00061
Ir/
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.RtBLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 313 16TH PL Status: ISSUED
Suite: Applied: 01/17/2006
Vicinity: DUPLEX ROOF Issued: 01/17/2006
Primary Occ: R3 Type of Construction: V-N
Parcel Number 42521105 Zoning:
Applicant: CAMBRAY,JOSE
Address:
Phone: ISSUED BY: .
Zip:
Owner SHEAHAN, DIXIE LEE
Address SPURGEON,DIXIE LEE ,.
MARTINEZ,CA Phone:
2288 YELLOWSTONE DR Zip: 94553-5442
•
Contractor: FIRST QUALITY ROOFING
Address: 906 S FIGUEROA ST
Phone: 714-775-3375
SANTA ANA,CA
Zip: 92704 License: 776969
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 30#FELT AND REROOF WITH 30 YEAR COMP SHINGLES APPROX 25 SQURES AND HOT
MOP APPROX 10 SQUARES ON FLAT ROOF FOR ATTACHED DUPLEX.REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $7,500.00
Permit: $153.25 Claim Valuation: $7,500.00
SMIP Res: $0.75
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $154.00
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 . Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 - -Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
,--sl.have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.My workers'compensation Insuranc carrier andmepolicy number are:
Gerrie: c��-(/1�--P M/ ,f FPolicy NNumbers W U Cl 00 T 80
t(This sec' eed rot be completed if the permit is Clued at one hundred dollars($100)or less.) t/
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisi (V/o�� ��99���roti 1"�`'0 L /1 7'/ 0G--)((ApplicantSig—-- X7x Data:
`WARNINO.'FAILURE TO SECURE KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DO(JARE($110,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of ChaRter 9(commencing with Section 7000)of Division 3 of the Business and Pro sions Code,and my license is in full
force andeffedl Cic.4 2 C"4. (Classm& C:::- 7S
Contractors-Signature: rQQA /vVI T D ) !Q / / �/ v J�
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.It,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IL Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
�Si nature Of Legal Ownersat(
/o s c/ t / ,rh
A „Authorize poi.
S%' at �/ v
CODE 6 1/12. gNrfE IATE INTffIALS CODER INSPECnONTYPg p9Tf. 1NTrMLS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208
208 Final Plumbing
200 Final Re-Roof flb , 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition _ 250 -Final Building/Occupancy
----- — Applicant to fill in all spaces except those within heti*,border lines and sign all appropriate declarations.
CITY OF COSTA MESA - ' PERMIT NO. �7 r TR)CT NO. LOT NO. , BLD .NO. -
CONSTRUCTIGN PERMIT�(/ 7p7 pL g r r T
J/ - IV I ( .3684 9/I-J/o., �,'p�._
Project Address z //" '� tI -• ''s TYPE OF CONSTRUCTION U NEW U ADD L I ALTERATION REPAIR
Applicant's Mailing Address i T ❑ CONVERSION ❑ DE�OLISH ❑ O.,=fes ' �/�I� A.P.# Zone
1' . I �'"-� V DES RIP ION OF WOR ! - ��• 0
Owner's N �1 0AfV Pho 'jk - S Main Building: Accessory Building: Z
/6 ry ,JACO C'osrAiris-sA )4, '4'n f�'��s CP. &i /neeS .. it) SA/0 Du fly E G
Address TYPE OF PERMIT U GRADINGrr--IUI FOUNDATION '4 STRUCTURAL T Front N
Arch/Eng. License No. ❑ TENANT _❑ LEC IC '.J PLUMBING ❑ MEC{i{1NICAL B Rear I
ll'1 F/-�I A N
Address // �/�/O ❑ DTHER /�6 C Right - G
Contractor's Namflx7� CA per lens-h53!3 PROJECT DESCRIPTION SQ. FT. OCCUPANCY a�Brl g Left - R
. CONSTRUCTION TYPE VALUATION$ o{
Address(mailing) ZONE GRADING CU.YDS. ACRES Q
City License No. - Ping. Ref.# Park.Fees $
U
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided I
I hereby affirm that I am licensed under provisions of Charter 9 (commencingR
with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: E
my license is in full force and effect.
License Class License No. - - PLUMBING FEES Planning Notes: M
E
le Signature N
•'RKERS'COMPENSATION DECLARATION Bar Sink Showers T
.nereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink . S
of Workers' Compensation Insurance, or a certified copy thereof (Section. _ - -
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES
Policy No. Company
A
Certified copy Is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50 KW •
Certified copy is filed with the city Building Division. • 0 50+KW •
Date - Applicant Clarifiers Solar Collectors Construction Pole Sub.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - Dishwasher Solar Piping
(This section need not be completed if the permit is for one hundred($100)orCooking Unit • Meter [pup to 100 amps • -
less). Drinking -
Fountains
I certify that in the performance of the work for which this permit is issued,to I Solar Tank Dishwasher Meter Dover 100 amps
shall not employ any person In any manner so as to become subject to the
workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Date Signature •
NOTICE: If,after making this declaration,you should become subject to the Floor Sinks . Urinal Fan ' Motors 00.1 HP ❑l%-8
Workers' Compensation provisions of the Labor Code, you must-forthwith -
comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets , Water Closet • . F.A.U. Inc.Solaf 09.15 HP 016-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater Fixtures Microwave
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name Kitchen Sink i Water Service - D• evice Boxes Pole Light
Lender's Address Lavatofies-
OWNER BUILDER DECLARATION Outlets Range •
I hereby affirm that I am exempt from the Contractor's License Law for the P-Tre •
following reason-(Section 7031.5 Business and Professional Code: Any city or P - - Switches Sign
county which requires a permit to construct,alter,improve,demolish or repair
,any structure, prior to Its Issuance, also requires the applicant for such permit Roof Drains - Garbage Disposal Standing Sections
'ILA',file a signed statement that he/she is licensed pursuant to the provisions of - ,
Contractor's License Law(Chapter 9(commencing with Section 7000)of Generator DO-5 KW 05-15 KW Trash Compactor
,',.,,...• Contractor's
3 of the Business and Professions Code) or that he/She is exempt '
-therefrom and the basis for the alleged exemption. Any violation of Section - '
7031.5 by any applicant for a permit subjects the applicant to a civil Reins coon Fee $ 3
e Ity of not more than five hundred dollars($500). Pe _ $25 Issue Fee
I as owner of the'property or my employees with wages as their sole Reinspection Fee $25 Issue Fee $ 3
omuensation, will do the work,and the structure Is not intended or offered MECHANICAL FEES
for sale (Section 7044, Business and Professional Code: The Contractor's - -- -- - ----' "—'--- -_.. PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0 ,
thereon, and who does such work himself/herself or through his or her own Zoning Approved By Date
employees, provided that such Improvements are not intended or offered for Duct-Under Ground Canopy Type II 0 •
sale. If, however, the building or Improvement is sold within one year of com- _ Application Approved By Date `!�
piotlon, the owner will have the burden of proving he/she did not build or im- . �..5- is
prove for the purpose of sale). Duct-Structural Refrigeration System - Application Issued By e i Date k
❑ I,as owner of the property, am exclusively contracting with licensed con- ❑0.100,000 BTU 0100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SlAkAMARY OF FEES
The Contractor's License Law does not apply to an owner of property who _ ^�
builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 - System Repair/Alteration BUILDING PERMIT $ U. -"' SMIP $ • 5�
tractor(s) license pursuant to theontractor's License Law). - PLAN CHECK , $ PERMIT
0 I am exempt under Section /0 y�r B.& P.C.for this reason Firepl/Fact.alt. ICBG 4 PLUMBING $ ISSUANCE $ ,
•
Date Owner r/Qq� e - Heating System&Ducting - PLAN CHECK , $ ENERGY P.C. $
I hereby certify have read this application and state that the above ❑0.100,000 BTU 0100,000 BTI. 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- PLAN CHECK $ MICROFILM , $
sentatives of is city tor upon the above-mentioned property .for
inspection pur •
.Y ,
y/jp �• / — - MECHANICAL $ TOTAL FEE $ 30,
Signature ed c7[
�"�
CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-'Assessor _ - -- I -- - _- _ •
_-
CONSTRUCTION AND PLANper . - F . & SPA
' APPROVALS Permit# !" f� io Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6.. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation " 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgfnd. - 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
''f7. 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
• V
-/ 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 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 Note+.(1 � p2A/4 o/5- /sza..4I(o
34. Final Heating & Air Conditioning (.G.
O.K.
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
48. Special Requirements Completed
49. Electric Release to Edison - -
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY •
No, Date
OWNER GERWICK, F. & J. DATE 9-29-61
JOB ADDRESS 313-A R. -P Ea q-1- JAth Flan-e BUILDING PERMIT NO. 15b68
GENERAL CONTRACTOR Owner VALUE $ 0 • 00
AP No. 117-231-11, LOT TRACT FIRE ZONE DESCRIPTION OF WORK Dupl.w/att.gal
INSPECTIONS (E 2� Signature DATE GROUP I & JTYPE V ZONE R-2
s 411 s" 4-e-lii PERMITS ISSUED
G-_ , — rr SUBCONTRACTOR DATE NUMBER
Water _
Rough Corn. Refrig. 0 Air Cond. 0 ee // p _ -je
Rough Healing A. L , PN7- jf 'rt _ b- C;L &—LE!!b_ a669i,\j
Rough Plumbing 44J //.y. ,f Y
�l
e.S6oTiaw 1o_6_I_323.23
Miscellaneous �' i
Prop.Swr.Line 0 House Con. 0 St.Swr. 0 /( n cz+ y, ,,Q s„ /L/ --tc/_ 3 ��� o _AI
Sprinkling System — _
Construction Pole -4,c, en-cenc.,/v ?-2,2-&/_ /sb p
Underground 0 Power ❑
Rough Wiring /,`Z, //20-e/ - �,,. -1-0-IOC gar.�w�z-6L.L.z-t, F-76 i sit
trenches Forms 91, Steel Reinf. 0 /P /o-/0-L/ eL
Floor System - _
Bond Beam 0 Steel Reinforce 0 !6 V—f•�
0
Sheathing a p c / - ,tel _ _ 3°.
Frame and Flashing f--,E j/ - U -(/ _ r _
Lathing — In ❑ Out ❑ /`}'/ c..- et -- _C:-- C I 1 if
Plaster, brown coat /I fy O. -245-- N -1� i+
ge
RPrri,. \n v t'� /Air Cond. ❑ Final
I ng, Final 17 ,nn / / Fj1�� �
Thumbing Fixtures, Final _ _ °� o :d • al,
Final Gas Test /ell' � /'_,.m r / 1 I
Electric Fixtures, Final iraib ~./V-0 '1/
Building, Final t_1 �,''/ - A •,r. .^/, ) in V ,
OCCUPANCY (w'" 5 ie-‘+ • 7• .40
FORM BU4 5M — 7 61 tsOLD FOR - 'EOM, REQUIREMENTS 151460
1.
15468 FEE RECEIVED
( �' SEP 221961
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
[[;;IIA
For Applicant to Fill In Completely CITY
Full PgraT
TYPEOR PRINT BUILDING
BADDRESS3� 446 E -filo
rn Pt
COSTA MESA. CALIFORNIA For Office Use Only
6 RECEIPT NO. I /pBRM\T j10
OWNER �''7�1) FEW/']/GK Juttp,ifAp'
AMAIL
DDRESS / -]�J L 0,14/ER S�. RECEIVE) BY DATE RECEIVED AT8 18 u8D
F �1 zz.-6/ 1-21 - I�
7-A
TEL. LI. �[ /� /� / P o
CITY CO c A Fri SA NO.N.-R a ADDRESS •713• -A 1- 1J F 1(7 • •l
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OORR::,`ary,.FINEER NO.
ADDF2ESS FIRE Te--
�" �/ ZONE TYPE ?� GROUP� -L/
CONTRACTOR C F .1 �Q ry JC(�. BYPROV DATE %/Z7 - . '
ADDRESS ,_7c 7 FL O PI/Fie S i, ZONING T -t-'1\
�/J ZON NO.OF BE OF NEW 2 1 L
CITY +/-/1 ���) PLANE 2......--13'.....6;gj PQM( U/
STATE �T go TEL. LA• LEGAL ,y�T `I ,,+ t
LIC.NO. O aZ y / NO. at- 3 W 9 a. 1 1` to Z lorr6 r` �"
D86CRIPTION rr / iii-)SIZE /_n X /3 L' I NOW oFN LOTS A.P.NO. )1 7-23) II ! /f'J
OF LOT C(CJ' JB I- 111
USE OF - YARDS EVES
EXISTING BLDG. APPROVED ALLOWED .J
SETBACK LINE FROM SO/ REAR YARD attn. FR(CENTER LINE BT.)
�� FT it r•/� �/w [ 1
CENTER OF STREET �I/I ``�`•\1L_
SIDE YARD I LEFTI RIGHT /�
R./ •
R.SIDE , FT. IN.
DESCRIPTION OF WORK . �
�/I/ L.SIDE Li-0
� FT. L IN.
NEW I /ALTERATION ALTERATION I II ADDITION I REAR LSO FT. C+ t l IN. /
REPAIR I MOVING�CI II DEMOLISH I BYPROVEC(I S U\, .(-� DATE 9' 2��( LUIz
BUILDING 6/)(.. .�J,ROOMS sr STORIES / W jj`� �1•�(~j(J`_ W
SIZE {.
EXTERIOR WALL ly ce4ROOF /� 5
COVERING ]/UI.LfI COVERING .ROC./C p•A Qom-
USE OF BUILDING AND WORK TO BE PERFORMED Cw G/I , -r a
cc
R€,YT.4 L vv/ %S ib.c '
a
0--
u
- UI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION 15 FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CAM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING COMBIRU ON. VALUATION CO Q
SIGNATURE OF �,.x//, .DO PERMIT FEE $ /{O. — B U...
PERMITTEF '^"�� • -� 1 /� 07
$ I`Q I I�+ PLAN CHECK $ �'Jes' � _ CI
AUTHORIZED AGENT /' ea c S
TOTAL FEE $ (•I a • r
• O
0.
23955 CITY OF COSTA MESA
,
STA MESA BUILDING-SAFETY DEPARTMENT MAY 3 1965
1 P.O.BOX 317 COSTA MESA,CALIFORNIA
•
For Applicant to Fill In Completely irAz s.1 islc.it 4 PE•
TYPE OR PRINT :1 In I,•r
_ ` For Office Use Only
ADDRE65 21 -5 / 4 ~4 J 7-,O 11
RECEIPT 73756
COSTA MESA. CALIFORNIA l�J''l
MICE BY 5 AT RECEIVED rc 3 I cDr
/ �/' /�,a {/-� t�
OWNER ryy Y'CL1 /^`A / Vet-i../..,i G 1, y� I /J titIr`�D�
AMAILDDRESS 3o/ GL(QL/J �'NC` ADDRESS 3I g ,[' fr., 1�LA-q.Py
/r A.I. �/ TEL. FIRE 7 r-�
CITYI Col-one( /70 L NO. ZONE TY e I� GROUP G�
APPROVED )/////fa
ARCHITECT TEL. BY /// DATE
OR ENGINEER /-'� NO. TZONING
c88ZrNO.OP UBEOFNEW
Q `'yl PLANS .) I BUILDING
�/�'
CONTRACTOR /�r E$ )(.c I� 14F‘O n ..-:76 1O n w
ADDRESS if e".."- t✓d�Lr-/A G LESCRIFTIon �Q /� L 0 ]� 6 �/` �Q 3�
CITY J' OPC /Y•I •ar r ( '���/. A.P.NO. /, - lJ/` 12- et
�T NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
LTC.NO. _La / 73D}}}��� NxTO. 2 i^ yr 73 Sr TO SIDE a REAR P.L
OF LOT 60 IS.){�V (, I NOW Ory LOT ( EVES
SIZE 11N(1]Xc/, NO.OPBLDOS. ALLOWED (U.B.C.REQUIREMENT)
USE OF YARDS APPROVED YARDS APPROVED
EXISTING BLDG. �,Q MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACK LINE FROM FRONT FT.
CENTER OF STREET REAR YARD ' q
�- R "
.SIDE -FT. FT.
SIDE YARD I LEFT RIGHT
DESCRIPTION OF WORK L.SIDE FT.
NEV Y EALTERATION ADDITION REAR —Fr-- FT.
f DISTANCE BET. BET.MAIN
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLDGS.
BUILDING VAR.# DATE
SIZE OOM8 8Tq IRES C.U.P.# ^ APPROVED /
EXTERIOR WALL r._ APPROVED / / I �// 'I- �/ I'
COVERING COVERING BY �/v�'/ ✓) l0 J
USE OF BUILDING AND WORK TO BE PE FORMED
ys str/ r niat (r 1.00,,e-
G ♦ g7G! Jerry//0 ee 4_ 4--4.-9 e
al
03U� //[ .. I?oh?r%', SO.FT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.M/�� O
PLY WITH ALL CITY ORDINANCES AND STATE LA S REGULATING VALUATION M •CU m
BUILDING CONSTRUCTION. {16 $ r�
SIGNATURE OF /� / PERMIT FEE S D
PERMITTEE �. l (`, .-�r-_m . 7— O
S/2,y O PLAN CHECK $ CkS X
AUTHORIZED AGENT ///��� v `j L
.3
\ TOTAL FEE $
42967
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
Ak C TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
BUILDING / ..!/Gi REC E ti -TE RECEIV D D •. I ��
ADDRESS ?/� f PLr
//�� /'Cp {� n RMIT N
OWNER F��// e' E �i GI` A.P. NO. II ( �. 23 —f�
MAIL aI /d-(o /3AyfiOE I//LLAI0E BUILDING tis /(, 91 ,
ADDRESS 300 4g.TCOAr�T/��'ILL✓V � ADDRESS /� ,s��^
CITY � �a027_
/ s/-Jit // NO. �,�.v L/ TRACT -/o� PI'S /4 BLOCK
CONSTRUCTION `'C/7 "7 NEW ADD ALTER REPAIR (MOVING DFMOLISH
LENDER QW,t/`/t
X
BRANCH GGk11N%
OWNER
ADDRESS / �]��J�� �((GGn�JJ��(A\�JJ C�� ALOE trn
ARCHITECT TEL. USE IVVNtrI_,/#3.JV� `�✓ �
OR ENGINEER NO. FIRE . -
11
ZONE T PE GROUP 1 '
ADDRESS //// r44:1-/PE
/ /
CONTRACTOR �e/pI/t_.1c TI S-.041 DATE//T3,{/
.1rt//aG DAy1,oE vii I-A6� ///
ADDRESS 6C) Sc co fS[t(`„TEL. ng ,� j
NO.OF
USE OF
CITY
/15/6/Are / 13ff40 NO. /�tli ZO E—Z. PLANS Z BUILDING EWb+re, ,NVr•c
STATE ' CITY YARDS APPROVED YARDS APPROVED
LIC. NO. 3/0 ft]t�sLIC.NO. MAIN BUILDING ACCESSORY BUILDING
IC SIZE 4O X /3 .. / NO.OF BLDGS. ti (FROM;/IzJSTR!T) J
f� CIT T �x I flat
P. OF LOT NOW ON LOT FRONT 4 F T.
Q USE OF r' ' ,(
NV EXISTING BLDG. /� Tib LS B.SIDE r FT. FT.
cn
FSeparate permits are required for ,/ L.SIDE ° FT. / FT.
electric,plumbing and heating w9rk. —
_REAR ZS-FT. FT.
W USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET. MAIN&
/� MAIN BLDGS. ACCESS.BLDGS.
�7 � J1 CFD 200 M/f EA / T! C.U.P.# APPROVED
xt �j /I (� _ ,,�A
A-DD/ 7-1 oAl TO REAR Ud/// _APPROVED
P ROVED /L///// DATE /�— Z��
W /G,Y/ef e 7X7 ---Ta? , �����Y
O I hereby acknowledge that I have read this application and state r`
N
C9 that the above information is correct and agree to comply with m
Po all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
m
.hal
i. the State of California. 3S�// T� a�� N
I hereby certify that I am properly licensed as a contractor under / SO. FT. t / '
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATIO IS FOR to
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT NLY:
am exempt from the provisions of the State of California Business ^.°,' y
and Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE $ YIn
m
g PLAN CHECK $ tat
Signature of ire, �/r ye LL
Permittee , $ I(/U TAX $ A
Authorized A e ` TOTAL PAID $ 7 'L 7 51 O
/