HomeMy WebLinkAbout490 20TH ST - Building Permits(714) 754•5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesaya.ILsCTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626,
tLt
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
Applicant:
Address:
Owner:
490 E 20TH ST
LEFT SIDE SFD
42625238
DANIELS, JOHN
25331 CAMPINA DRIVE
MISSION VIEJO, CA
WEST. JAMES R
Address 490 E 20TH ST
COSTA MESA, CA
Comracror. C B I ELECTRICAL SEVICES
Address: 25331 CAMPINA DRIVE
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool I Spa
Lighting Fixts
Recept Outlets
switcnes
Non Res Appl
Res Appl
Service to 200a
Service to 7000a
Service over t000a
Motors l0 1hp
Motors to 10hp
Motors to SOhp
Molors to 100hp
Molors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
MISSION VIEJO, CA
Phone: 949 235-8959
Zip 92697
Phone:
Zip: 92627
Phone: 949-235-8959
Zip: 92691
License: 845254
ISSUED BY:
SCOPE OF PERMIT
CHANGE-0UT OF AN ELECTRICAL SERVICE ON THE LEFT SIDE OF AN EXISTING SFD.
1 SERVICE TO 200A
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
523.50
so.00
50.00
50.00
50.00
50.00
50.00
$0.00
50.00
50.00
50.00
530.50
50.00
50.00
so.00
$0.00
50.00
50.00
$0.00
30.00
$0.00
50.00
50.00
50.00
50.00
Quantiry
FEE SUMMARY
Temp Dist System / Lighting
Busway I100 R
Standing Section
Misc EleCtrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................uP to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kvalkw
Low Voltage Equipment
Low Volt Wiring System / Ck�
Misa Conduit
Misc. Conduclor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electriwl Fee
Investigation Fee
Plan Check Fee
ReinspeIXion Fee
EO.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
so.00
$0.00
so.00
50.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
TOTAL CALCULATED FEES 554.00
COMMENTS / SPECIAL CONDITIONS
Status: I SS U ED
Applied: 05/04/2006
Issued: OS/O4I2006
�uanlity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 7, 72-27-92) �
EXPIRATION: This permlt shall automatically expire and become void il work is not commenced within 180 days, or If work is suspended or abandoned
tor a period of 7 BO days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapectlone end tinal approvel must be obtained. Fallure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
z+naae �erm�
WORKERS'COMPENSATON DECLARATON: .
I here6y eNirm untler penelry oi per�ury one oi t�e Idlowing tleGaretlons: �
❑ I.heve entl wlll�meintaln e ceNlicate at consent to self-Insure br workers' compensetlon, es provided br by secHon 3700 oi the Lebor Cotle, tor ihe pertortnflnce of the
wofk tor which Ihis pBrinll is Is5u8C.
❑ I have en0 wlll meintein wwkers' compensetion inwrexa, es requiretl by sectim 3700 ot Ne laDor Cotle, Iw Ihe peAortnance of the work tor w�kh Ws peimit is Is.wed.
My workers' compen58tion Insurence tertier and pdity number era:
Certier: � PdiCy Number:
(T�is secNon neetl not Oe crompleted U(he perrNt is valued at one hund�etl dollars ($700) ar less.)
certlty ihat in the petlarmance oi t�e work tor which this pertnit is issued, I shall rrot employ eny person in any menner so es to Eecome subject to the workers'
ompensetlon laws of Californla, and epree thet II I should Decpq�e sub�ect to the workers' compensetion provislons ot Sectlon 3700 at Ihe Lebor Cotle, I shall forthwlih
ompty wil� l�ese pro�slOns. � . ' )
�:fR1mlq.��Pln:ta
i � eJ--- oa-��e:� �- D�- — D G
IPENS�TIIXJ COVERAGE IS WMW FUL M1D SHRLL SUBJEGT AN E�bVER TOCRIMINAL PENN.TIES AND CML FWES UP TOONE HUNDRED
THE CO6T OF COMPENSFTION, DMNGES AS PROVIDEO FOR IN SECTION 3]OB OF THE UBOR COOE, IMEREST, M1D ATTOfiNEYS FEES.
LICENSEO CONTRACTORS DECLARATION:
I hareby eMirtn Ihat I am liCenSetl �{nde�pr�siy
torce antl enect. yc_a—. 1C `t'
CONSTRUCTION LENDING AGENLV:
9(commencing with Section 7000) oi Division 3 of t�e 8usiness entl Profeulons Code, end my license Is In full
❑ I hareby attirm t�at ihere is e consWctlon lantling eBency tor the peAormence ot the work for whic� this permit is issuetl. (Soc. 3097, Civil Code).
Lentler's Neme:
Signeture: _
OWNER•BUILDER DECLARATIONS:
Lentlefs AOtlress:
Date:
1 hereby eHlrm ihet under ponelty ol per�ury thel I am E%EMPT FROM TME CONTRACTORS LICENSE LAW tor the lotlowing reason (Sec. 7031.5, Business entl Professions
Cotle: Any city or counry which requires e partnit to construc6 elter, improve, demolish, or repair any strucWro, prior to its Issuanco, also wquires Iho epplicant lor such pertnit
b tile e signed statement that he or she is Ilcensed pursuem to Ihe praNsions of Ihe Comrectors License Lew (C�apter 9(commencing wil� Section 7000) of Division 3 of Ihe
Business end Professlons Code) or ihet �e or she is e:empt therelrom anC the Gesis tor the ellegetl exemptlon. Any violetlon ot Section 7031.5 by eny epplicant lar e pertnit
sublects Ihe epplicant to e civll penalry of not mare then live hundred dollers (5500).):
❑ I, es owner ol the pmperty, or my employees with wages es thelr sole compensation, WILI DO THE WORK, end the swcwre Is not Intentletl ar otteretl for sale (Sec.
7044, Business end Professions Cotle: The Contractoro License Law tloes not epply to en owner of properly who bullds or improves thereon, and who does such work
himsell or hersell or Ihrouph his or �er own employees, pmvitletl that such improvements are not Intendetl or oNered lor sele. tl, however, ihe bulitling or improvement is
sold within ona year of completion, tha owneo-builtler will have the burden of proving that he or she ditl not build or improve lor puryose of sale.).
❑ I, es owner ot Ihe property, am EXCLUSIVELV CONTRACTNG WRH LICENSED CONTAACTORS to construct the prolect (Sec. 7064, Business antl Professions
Code: The comractors License Law tloes not eppty ta en awner at pmpeny who builtls or improves ihereon, antl who contracts lor such project wit� e contractor(s)
license pursuent to the CoNrectors License LawsJ.
❑ I em exempi untler sec. Business and Professions Code tor this reason:
SignaNre: �ate:
OwnBt ID vanfietl by tlrivefs licen58. ❑ Ye5 ❑ No Drive/s License No.
Veriticatlon of Owners�ip by (rype oi daument, i.e. - property tax blll or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
ExD��es:
❑ I hereby cenity that no excavetion tiva (5) ar more leet In depth into which e person is raquirad to descend, will be made in connectlon with work euihodzed by Ihis
permit, antl that no building siructure, scaNOlGing, lalsework, or tlemWition or tlismantling t�ereof, will �e more �hen thirty-siz (38) teei �igh. (C�flp. 32, Grp 2, Atl 2, Sec.
341, TUe 8, Cellfomia Atlministrative Cade).
❑ As owner-6uiltler, I will not employ enyone to do work which woultl require e pertnil irom the Division ol Intlustrial Sefety, es natetl ebove, unless suc� person hes e
pertnit to tlo suc� work trom t�e division.
Signature: Date:
Divisian ol Induslriel Safery Partnit Number:
CER7IFlCATE OF COMPLIANCE AND AUTHORVA710N OF EMRV: I cenify under penalry of perjury that I have read this application antl state �hat t�e intortnetlon given is
cortect I egree to wmply with ell slate lews antl city ordinances relating co builtling consiruaion, end authorize represeNatives oi t�e Ciry of Cosla Mesa to emer upon the
ebove-described properry lor inspection purposes. I egree rwt to occupy or ellow occupancy of any building authorized by this pertnit unt�l linel inspection.
,� � Signemre Of Legal Owner(s)
COOE �. INSVECTIONTYPE
7fit6 Fixed System Flnal Fire Preveniion
12fi6 Pool Spa Finel
200 Finel Re�Roof
201 Final BIocWRetalning Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Flnel Domolitlan
Q� INiIiIpLS y0DE1 INSPECTIONTYPE
� 206 Final Mec�anical
20B Final Plumbing
2t0 FlnalElectncal
212 Final Fire Preventlon
220
222
250
Finel Planning Approval
Final Site
Final Buiiding/Occupancy
�
��
�nness: 490 E 20TH ST
�%NAME: WEST, JAMES R
nooAess: WEST, CHERYL
P O BOX 2966
NEWPORT HEACH.CA
APCN/ENGINEEP:
AOOflESS:
uNiT:
92663
PEG.NO.:
UNIT:
PEXMITTEE: JAMES WEST (714)631-8540
aooxess: q98 E 20TH ST
C.M. CA 92627
UCENSEO CONTBACTOR OECIAPATION: I hereby atlirm Ihal I am licensed un0er provisions ol Chapter 9(commencing wi�h Section
7000� ol Oivisan 3 of Ihe Business anA Pmfessions Cotle. antl my license is in �ull force antl e��ect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signamre�.
WONREBS' COMPENSpTION �ECLABRTIUN: I hereby afiirm I�a� I Aave a cehi�icale of consen� Io setl-insure or a cehificate o� WOBers'
Compensation Insurance. or a certihetl copy thereol �Section 3800. Lab. C�.
POLICY NO.: E%P. DFTE:
COMPANV:
� Cerliiiea copy i5 �ereDy �Umishea. ❑ Certilie0 copy is filea with the city euiltling Divisian.
Uate: Applicant:
EXEMPTION fPOM WOXREflS'COMPENSpTION OECIAPPTIO .(i�i5 Ftio�e Ibecomplete0ilthe Oermiiisforone hunared�5100�orles5)
1 cerlily I�at in I�e perlormance al Ihe work lor which 1 permii 5��tl. sh I employ any person in any manner so as �o become
su�lect to Ihe Workert' Compen5aiion Laws of Califo ia.
Oale: � Signalure: �
NO CE: If, afler malwg ihis aeclaralion, you s�oul ecome 5ublecl Ia Ihe WOBers' Compensation pmvisions of the Labor
Code. yrou mu5i lorihwil� comply wii� such pwv ns or t�is Oermil shall Oe tleemetl revokea.
CONSTBUCTION LENOING AGENCY: I hereGy affirm tnat there is a constmction IenOing agency for tne pedarmance of Ihe work for
which i�is permit is issuetl (Seclion 3097. Civ. C).
LENDEP:
ADOPESS:
OWNEfl BWLUEB DECtAflATION: I �ere0y ailirm �hat I am exem0� ��om �Ae Coniracmrs' State License Law 1or the following reason
(Sec�ion 7031.5 Busine55 an0 Pwlessional Catle: Any [i�y ai county whic� repuires a Oe�mil b conSVucl, al�er, impmve. OemolisR or
repair any slmclure. prior lo ils issuance, also requires Ihe applicant for such permit ro lile a signe0 statement that he/she is licensed
pursuam �o t�e pmvisions ol I�e Camracbrs' Sta�e License Law (Chapler 9(commencing with Section 70110) o� Division 3 0l ihe Business
antl Prolessions Cotle) or that he/she is e�emp� Iherelrom antl ��e �asis for Ihe allegeG eMemD�ion. Any viola�ion o� Sec�ion 7031.5 by
any aOPlitanilor a permi� su�leClS Ihe ap0litant Io a Civil penally Of no� mor¢ t�an �ive AunOretl tlollars (5500�.
i. as owner ol t�e O�openy or my emyloyees wit� wages as their sole comDensation, will ao t�e work, an0 ihe
❑ sirucmre is nol imenUeA or olteretl br sale �Seciion 7044. Business ana Pm�essional Cade: The Cantrac�ors' Sta�e License Law
does nol apPly to an owner oi a O�oDe�y who builtls or imD�oves �hereon, antl who tloes such work himself/hersell or [hrough
�is or her own employees. provitleA �ha� SucA impmvemenis are no� inlende0 or o�feretl �or sale. I�, howeve� �he buil0ing or
improvemen� is solE wiihin one year ol com0leiion. �he owner will have �he 6ur0en ol proving he/she tlid noi 6uila or impwve
lor I�e purpose ol sale).
I, as owner of ��e DmDe�y, am exclusively contraciing wilA Iicense0 conVa s to cons�mct the O�olecl (Seclion 7044, Business
❑ antl Pm�essions Cotle: The Coniracwrs' S�ale license Law aoes no� aD0 o a owner o� pmperty who bml0s or improves ��ereon
anU w�o conirac�s lor such pmlecls wi�� a conlracbqs) license pur an� Io he Contractors' Sta�e License Law�. I am aware
Ihai Omof ol Iheir Work¢r's Compen5a�i0n insurante S�oultl be pm tled �o e.
� i am exemp� under Seciion: H p-� � 4 4 B. 8 a. G �
m� tms �ea^so�: /O�W N ER — H U I LD ER
' Oale'. '-1 —'7 � Ownec
I Oo here0vi cenity ihal I am aware of anA understantl the requiremenis ol omia Healih and Safery CoOe Sections 25505, 25533, and
2553n and Ihal I or any imure Ouilding occupant will/will no� (circle one� need Io compty wiih saia s�a�e cotles and �he reQuiremen�s for a
permit lor consimction or motlilicalion imm Ihe Air Oualiry Management DisVicl. Residen�ial cons�mction apPlications are exempt hom
mese pmvisions,
�ale: ApPlicanl'.
I hereby cetlily�hal I have reaa I�is applicalion and state th Ihe above� ormation is correc�. I agree�o comply with all ciry and coun�y
or4inance5antlsUlelawsrelaling�obuiltlingconsVuclionan herebyau ite presenlative ' atytoenterupontheabove-mentionetl
property for m5peciian purposes.
�aie'.�� $ignalure:
oriver's License or Social Securi�y a;
1641�46 Wliiio—Bmltling�, Green—Cotle EnbrcemenL Canary—Appllcanl; Pink—Revenue: Goldenmtl—Assessor
CITY OE' COSTA MESA — BUILPING FERMIT PERP7 NO; B 06516�
PERMIT NO: B 065164 PLAN CHECK NO: N GOC'T: N SUPP; N
CONSTRUCTION TYPE: V—N PERMZT TYPE: STR PURPOSE: OTFi
JOB DESCRIPTION : T/O,RESHEATH & REROOF W/COD1P. SFIINGLES SQ FT: 5,000
CLAIM VALUE: 5,000.00 CALC—VALUE: 5,000.00 GROUP OCC; R-3 /M-1
COMMENTS: SMOKE DETECTORS ARE REQUIRED PER 1991 U.H.C.
��*�r+r**+�#�****�**�r�r+�**+r*�r*�rx��r+r+��r�*�*�****�***�+�**+�*���+�***�*�*�********�c***���
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
FARKING REQ: PROV: PARCEL: 42625238 ZNE; REF NO:
PLANNING NOTES> i
> �
��*�r�*+�***+�*�rt****�rx�+��*�*�***�+��r******�****�**��+��***+��+�*�******���a'��x**�*�*�
D E V E�. L O P M E N T S E R V I C E S R E Q U I R E M E N�tf S
ZONING APPROVED BY DATE: •
BUILDING APPR6VED BY : '✓ DATE: ,, /
APPLICATION IS�UED BY: �� DATE; I ( O�/QQ
***�r****�-***�x-*�-*******��iF;r....�ri xiF'+�n . *i�****�t**-x�3t3k�F3F'�F-�'��F*
iE iE iE iE iE iE -)E iE 3E jE 3f if 3f if i4 iF if iE K iE iE iR iE if if if iE if iE if if iP ih if if 3f if if jf iE 3E �E jE iE iE 94 aF iF it iF iP iE iE aE �t 9f �4 iP 9E iF iE iF iE if 1E if ic jf iE 7f iE if iF iF aF iE iF iF �E
LEGALIZATION:N F E E S U M M A R Y S'FRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72.00 � 50
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 72.50 0.00 0.00
REVENUE DIC'ISION TOTALS--> COLLECTED:
HLDG PMT PLUMBZNG ELECTRIC MECHANIC
72.00
�SMIP/NON—RES
i '
TOTAL PAID DUE
72.50 '72.50 .00
72.50 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CAECK
.SO �
fE 3E �1F 3c 3E iE iE iE iE iE if !E iF iE it iE iE if if if jf iE if iF iE iE iE iF iE if if !f ik if jf iE if if iF �k if jE �E 1E 3E 9E if !E iF iE % if !f �E if if if if iE at jy3FaF ii iPlf- if �4 �E 1E ic iE * dF dE dE iE iE iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UN�T COST TOTAL COST
SFR 5000 REROOF BY ��ALUE RESIDENTIAL NOZONE 1.00 5,000,00
END OF FEES
. ^
��`t
SN10KE DETECTOR
AEQUIRE�
,-:
01 001.;266�; D�151b67 To �T
DAT"e: 13/!l_I93 IIhE: iri;14
t.
.( :.
72. S+]
�ONSTRUCTION ANO vLANNING ,.
, APPRQVALS Permit#
!�.
t. Temporary Electrical Service or Pole
2. Soil Pipe�Undrgrnd.
3. ElecVical Conduit Utility�Undrgrnd.
4. €Iectrical Conduit�Und�grnd.
5. Steel Rein`orcement '
6. Eiectncal UFER Grnci.
7. Footings
8. Foundation
9. Water P�pe-Undrgmd.
10. Structural Ploor System
ii. Properry Sewer Line & HouSe ConneCtion
12. Sewer Cap
13. Roof Dra�ns
14. Rough Plumbing
i5 Rough Electrical-Conduit
i6. Rough EI?ctric4Virinq
ll. Rough W'ring Sign
18. Roogh Electrica6T Bar CeiGng
i9. Rough Heating & Air CondiLonin9
20. Ro�qh Faaory Firepiace
21, Ducts,in Struciure
22. Ducts, Ventilating
23. Gas Pipa�Rough & TeSt
24. Roof Framing
25. Roof Sheathing !
26. T�Bzr Ceiling (Slrucw�alM & Mor,ocoat
27. Frzme and Fiashinq
28. W;hina & Siding
29. Insulatian
30. DryN.�all Nail�ng
37. Piaster Brown Coat
32. Elecirical Power AleterFinal
33. �ine! Elec.ric �
34. Finol Heating & Air Cond�tioniny
35. Fina! Gas Pipe�Tesi
36. Haati or Canopy �
37. Fina+ Factory FireplaGe
38. Final Plumbing
39. Wa;er Service-Final
40. Gas Serv+ce�final
4t. Solar Qomestic-Fina!
42. Backfiow Preventer
43. Back4low Irrigation
44. �andscape Irrigation SYstem
G5. Sound Attenuation
46. Nandicap Regulations
47. fINAL STfiUCTURE & BUILDING J
L
48. FINALPLANNING
49. Elect: ic Release to Edison
50. Gas Release 2o Southem Caiifornia Gas Q
51. CEftTIPECATE 6F OCCUPANCY
No. Date
Date
Inspector
-Y 3 1 ��k
�f'
Pp0' PA
APPROVALS Pennit #
52. Pool & Equipment �ocation � �
53. Steel fteinforcemeni �
54. Forms '
55. Electrical Bonding �
56. Rough Plumbing & Pressure Test
57. APPROVAITOCOVER�GUNITE
58. Electrical Conduit�Undr9rnd.
59. Gas P�pe, � Undrgrnd., Test
60. Backwash Lines, P-Trap,'-J Undrgrnd.
67. APPROVAL TO DECK ,F
62. Backwash & ReceptorFinal " ' �
63. Heater & Vent-Final , '�'�_
64. Plumbing System � F�nal -
65. Electrical-Final `
66. Solar System�Finai
67. Pencing & Access APproval
68. APPROVED FOR PLASTERING
69. POOUSPASYSTEMSFINAL
F1RE DEPT. REQUIREMENT
APPROVALS Permit #
Date Inspector
70. Underground Hydro
71. Product Pipin9 C Gas ❑ Oil
72. Underground Fiush
73. Undergmd. Stora9e Tank �J Gas ❑ O�I
74. Overhead Hydro
75. Ory Chemical
76. Dry Standpipe
77. FIXED SY57EM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREPIIENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
�
z`��`� yQ`�',�
�2�� , 'oZ TW11'Llilq
`� � �O 90x .1 . 17i0
TESTING
Laboratories �f s�.�.��:,t c����f�,=,.«t, �,t�.
n.i:aO+i 'J.'�Y . LONG BEAG� C�.LIF 9p6G� • 1717� �]e'3S5 .�1�7� e'e 7750 • PH) 878 c�71
p�rn�C� �%�� CES
s... •�, c,� , �.Si�oi .. ..` oo, a, _ . ., .�
ii��Sl�Z:+S' ;^:��='Y , r. +. .e �OeJ��Sq elc]lP[
'L ° ;i
September 11� 1978 Examination: SC78-U307
COMPRESSION TE5T5 ON GUNITE CYLINDERS
i�lr. Robert C, Bennett
4109 W. Fifth St., Unit G-2
Santa Ana, California 97_703
PROIECT SWIP1 POOL AND SPA
nooREsS 490 E. 20th St., Costa Mesa
snrnp�e FROM Deep end, shalow end and floor
..u.ire,r
�tim..tE=
D. Kraemer
MIX
DOTE CAiT
OATE lESYED
CYIINUER NU.
COMPRESSIUN
TOTAI IOAD, 1B5.
POUNDS PER SQ. IN
COMPLIANCE
CYL�NDER:
4,2 to 1
5-28-75
9-7-78
1
10-llay
43,000
1,655
M�DE er
Calvin
o�stvteunow
R. C. Bennett - 3
� a Mesa Bldg. Dept.
CONIPACIOG
Newport-Irvine Pools
S��BCGNiPq�IOF
Grove Gunite Co.
SPECtF1ED
SiRENGTH
CYIINDER SIZE
9-7-78
2
10-Da�
41,000
1,580
OFI�vEOED !♦
HennetL
2,000 psi
5-3/4" x 12"
9-7-78
3
10-Day
42,000
1,617
oKErvEC ON
8-29-78
R�@��T�EI!
JGr iu 1�"s�d
�A
�',�_�.�_..� -- /r
��. �� -
.,._....,, ,..,..� ....,. �..... �,>. .. .. ...,_ e . ,.,-..,�,�,-s��,.�o..s,�,.
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TESTING
r-
Twininq Laboratorie: �,f s��.��2,� c�t��f�,,,�ut, �,��.
�O BOr �� •?li0 niFopo� •,.�..r . LONG BEnC.+ G.UF o0B0i . �1i7� •7o735i •�til; elol?fie . P��I 878�e�77
� 8¢�n'.�� f,ec�CES
Sr � •.� C�Y ...qiW . � •�� oP 6, . .. e• .c
u�i.� s��:ws � � r 4 .:.., i, � ac_. �r�� em:iac
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September 23, 1978
September 11, 1978
Eaamination: SC�B-4j07
COMPRESSION TESTS ON GUNZTE CYIINDERS
Mr. Robert C. Bennett
4109 W. Fifth St., Unit G-2
Santa Ana, California 92703
PFOJECf S4lIi1 POOL ANU SFA
ADDRESS 490 E. 20th St., Costa Mesa
SAMPIE FROM
�PCMI:fCI
EHGi•.ito
D. [:raemer
htlX
DaTE CaiT
DATE 7ESYED
CYIINDER NO.
COMPRESSION
TO7AL LOAD, LBS.
POUNDS FER 50. IN.
COMPIIANCE
Deep end, shalow end and floor
4.2 to 1
8-28-73
9-7-78
1
10-Da�
�3,U00
1,655
COMIPnCIOo
Newport-Irvine Pools
H�BCO�+f+pC�G4
Grove Gunite Co.
�PECIFIED
STRENGTH
9-7-78
2
10-Day
41,000
1,580
CVLINDER SIZE
2U-Day test cor�plies with specificartons.
M�Dk !Y
CYLINDER: Calvin
DIfi�1�VtIOM
R. C. Benr.eit - 3
—Cn�a Mesa Bldg. Dept.
DflWE9FD !V
Bennett
2,000 psi
5-�/4" x 12"
9-7-78
3
10-Day
42,000
1,617
�FCFiVED ON
8-29-78
_ /
�� .�� �
9-21-78
4
24-Day
57,000
2 ,195__
... �� _ ..... , ., .. . .� . _.. .. ..� . .. . .. . ... . ... ....�...e. . , o• o. oE..,o., ��, ._�o, o� �.
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69M ;
HEA i�!G,
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' L� ALL jINSPE!CTION� REQ
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„L��S�Oft.i�L ftE��fREME)lTS.
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City of Costa Mesti i�ding Dep+
B��_ _._.__._.,. . ... _'_DATE..�.. �-9.19�1
THESE PL0.NS MUST BE ON JOB AT All� TIMES
MAKE NO CHANGES WITHOUT PRIOR APPROVAI
OF OEPT.
THE ISSUFNCE OR 6RANTING OF A PERMIi OR �°�ROVAI
OF PLAyS RND SNECIFICRTIONS SHALI NUT 6E lYiN3iRUED
TO BE A PERMIT FOR, OR AN nPN80YAl OF. 'N VIOLATIDN
OF ANY OF THE VROVlSIQKS DF THIE �OUt. �0 YcRMIT PR6
SUMING TO GIVE AUTHORI7Y TO YIOLATE OR CANCEL THE
PR041SIONS OF TNIS CODE SHALL BE YALIC, E%CEPT IN SD
FAR AS THE WORN OR USE WHICH I7 AUTHORIZES �S LAWFUI..
� THE ISSUFNCE OF A PERMIT Bl+SED UPON PI.A.M� kNO
i;!FICATIONS SHALL NOT PRiViit7 7HF BU!I.DlNG Of-FIf,IAI,
. '`' THEREAFTEq REI�UIRING TWC JUNRtCi;li�' ^h FRRORS
. 7 PUN$ `�,i�D SPECIFICAT!p�' p� �'i01.0 ��r7FtJ71idG
'.' "^PERP.TIpNf 6£ING CkRR(EOOf 7H:fcC!iD'cR WHEN
""L4TIPF Of I415 COOE OR OF ANv OTHER OitOfNANCf
'4� CITY
�
; STRUCTURAL APPROVAL O�LY
f _._" - �-- � �it4�D
' SEPARATE PERMITS ARE R ' ,
FOR ELECTRIC^� " � � i
N!�itP. u, Vc•�� � •. ;_, ;) +
RE�RIGtRi,T",:: �':�:;K �
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TNIS NUPPi3ER 0��'ST ACCOfi�PANY �
� ALL INSPECTION REQ�lcSTS _ �
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FO �_._u.;;_3 :,. _-' �`Si' N.4T TH� s
eE �,•a��o,.�, ��•: �
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., , �- ,L c ��T BE �.����uLTED FOA �
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G-1�. j'�% c�. � 3- S-�.`�
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'_ 1 �FR 77'7'IPAI�OO 815R�*,re
/ �v � 140.00
CITY OF COSTA MESA PLANNII._ DEPARTMENT
A. P. No. 118-302-33
Bldg. Permit No. 33987 an3 339A8
PARK AND RECREATIONAL FEES - Apartment Developments
Fee Payment Receipt
Project Address 490 und 498 E. 2Qth Street
Owner's Name David Millar
Bachelor or 1- Bedroom Units @$25.00 =
2 - Bedroom Units @ $40.00 =
3 - Bedroom Units @ $55.00 =
4 - Bedroom Units Z @ $70.00 = $140.00
5 - or more Units @ $75.00 =
Total Fee
Total number of Dwelling Units � 3140.00
Planning Department Approval Date 12/23/71 Park Area No. 8
AAAB
ey Applicant's Signature
CITY OF COSTA MESA PLANNIN(, llEPARTMENT �G917-7c�NS�CQ 815 0***
A. P. No• 118-302-33 140.0�
Bldg. Permit No. �g87 anc7 �a4RR
PARK AND RECREATIONAL FEES - Apartment Developments
Fee Payment Receipt
Project Address 490 and 498 F._ �Oth Ct,+PP+
Owner's Name David Miller
Bachelor or 1- Bedroom Units @$25.00 =
2 - Bedroom Units @ $40.00 =
, 3 - Bedroom Units @ $55.00 =
4 - Bedroom Units 2 @ $70.00 = $140.00
5 - or more Units @ $75.00 =
Total Fee
Total number of Dwelling Units 2 $140.00
Planning Department Approval Date,�F P N�
By Ann6 Applicant's Signature - �
�.
Street
,,,. 3-i,���_
BUILDING PERMIT N0.
AP No11t3-302-53 LOT TRACT FIRE ZONE VALUE
Pool Location
Forms
Main Drain _
$teel Reinforcc
Elec. Bond —
Approval [o Cover
Underground Electric _
Gas Piping Test
Filtering SYstem Lines _
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final
Filter System Final
Backwash and Recep. Final
Fencing Final _
SUBCONTRACTOR
Electric
Plumbing
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use [nk
BUILDING // � f� /� �
ADDRESS 7 (..�
OWNER G �Q Q� D A
MAI e��� ��� 9 Y��F�
CITV (,�s�
CONSiRUCTION
LENDER
BRANCH
ADDPESS
ARCHITECT
OR ENGINEER
ADDRE55
CONTRACTOR
ADDRESS
CITV
STATE
IIC. NO.
SIZE
OF LOT
USE OF
UsE OF
TEL.
CITY
LIC. NO.
NO.OF BLDGS.
NOW ON LOT
Separa[e permits are required for
electric, plumbing and heating work.
I heraby ecknowletlBe thet I tfava reatl this applieetion antl stnta
that the abova Information ia correcc end apree to comply wlth
ail laws reBuleting builtling construction, antl I shall not employ
any person in violation ot t�e wcrkman'a compansatlon laws of
tha State af California.
I hareby certify thet I am properly Ilcensetl es e coniractor untler
the Siate of Celifornia Businez5 entl �rofesstons Cotle, Dlvislon 3,
epter 9, and that such Ilcen6es ere in full force nnd etfect, or I
am xem f�om ihe provisiona of the Stata ot Callfornia Buainess
and f�ions CoMa. Oivision 3, Chapte� 9. i
50�8' 9%'I'4[79 . -25:50CA?Q
5p66' 0000�47685 %� ):? �, '
�} /
APPUCATION FOIt ST�RUCTURAL PERMIT `�
RECEIVED eV DATE FECEIVED �o-rF iscucn
BUILOING
ADDRESS
ZONE NO.OF
PIAN$
YAflDS APPROVEO
MAIN BUILDING
DISTANCE
MAIN BLd
VAR. 3W
APPROVED
DATE
USE OF NEW
BUILOING
VARDS A{
J FT,
&
THE AMOUNT SHOWN UNDER VALU
THE PURP�E OF ESTABLISHING A PEFiI
VAIUAT/I�O/N�//,��� ERMIT FEE E
$ �% 1/ I V PLAN CHECK E
�/ , TAX S
TOTALPAID E
N
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OWNER MILLER� IIAVID DATE 2-17-72
JOB ADDRE$$ 1tQ0 F.act 2(ri:h Rtreet BUILDING PERMIT
AS
TRACT
SUBCONTRACTOR
- r��s���=+_�-����.��s�r��:r�ir�.�!�-o�i-.�r�rx�crirr
■ ■ �u���ni ___ _�����v�s���e
ROUGH HEATING ANO AIR CONOITIONING
UNOERGROUND LJ POWER
ROUGH WIRING
FLOOR SYSTEM
BONO BEAM � STEEL REINFORCE
SHEATHING
F0.AME ANO FLASHING
I-
PLASTER, BROWN COAT
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339a7
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. eOX 1200 COSTA MESA. CALIFORNIA 92626
=•3 i �- �z�Y�`QO s> > �*� *�91.50
APPLtCATION FOR BUILDING PERMIT ��
ForApplicanttoFillinCompletely RECEIVEDBV DATERECEIVED
DATE ISSUED
BUIL4ING 4 0 E, 20th St. "A"
ADDRESS 9
PERMIT NO.
OWN�q DAVld M111CT � � A.P. NO.
MA I L BUI LDING
ADDqESS ADDFESS
TEL. TRACT LOT BLOCK
CITY NO.
CONS7'RUCT�ION W A A P
LENDEfi
BRANCH
OWNER
AODF{E55 VALUE
ARCNITECT TEL. SE S
OF E GINEER N
FIFE
ADDRESS ZONE TVPE GROUP
APPFOVEO
CONTRACTOR OWI1@T BV DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
CITV NO.
PLANS BUILDING
STATE CITV vMAION BUILDING ACCESSOPV BUILDING
LIC. ��0. LIC. NO.
SIZE NO.OF BLDGS. (FROM C/L STqEET)
OF LOT NpW pN LOT RONT FT. FT.
USE OF
EXIST�NG BLDG. S FT. FT.
512E OF NO.OF
NEW6LDG. ROOMS STORIES L.SIDE FT. FT.
EMEqIOR WALL • ROOF
COVEqING COVERING REAF FT. FT.
USE QF BUILDING A.ND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN Bl.OGS. ACGESS. BLOGS.
VAR.� DATE
Res,w att.Gaz'. c.u.r. � APPROVED
APPROVED
I hereby acknowletlBe thet 1 hnve raotl this appllcation antl stota
thut [he abova informe[ion is mrrec[ antl aprae to comply with
oll la�ys regulatln0 builtling construction, antl I shall not employ
nny person in violation ot tha workmnn's compensation ivws of
ffie Stare of Californie.
I hereby certity t�ot I em properly licensetl as a contractor unEer SQ. FT.
tM1e Stete of Californie Businass antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDEIi VALUATION IS FOR
Chepter 9, antl thac such licensas are in full force antl eftact, or I THE PURPO$E OF ESTABLISHING A PERMR FEE ON�V;
am exempt from the provisions of the State ot California Business VALVATION
antl Professions Cotle, Division 3, Chapter 9.
PERMIT FEE 5 9• �
SIB�atu�e of � � � � � _ �
Permiitee $ PLAN CHECK 6
g1.5o
Authprize0 ABant TOTAL FEE $
m
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OwNER ��
JOB ADDRESS
�GENERAL C0�
AP No. u$-�
INSPECTIONS
�Pool Location .
�orms —
Main Drain
teel Reinforce
Elec. Bond _
Approval to Cover _
Underground Electric
�as Piping Test _
Filtering SYstem L/ine
Backwash Line�s a�((d -�
Elecvical Final\ V�
Heater and Vent Fini
Filter Sys[em Final�
/
Backwash and Recep: Final\�� `
Fencing Final _
Ii:L•Nll
DATE
BUILDING PE
SUBCOMTRACTOR
Electric
Plumbing
No. 46381_
. � � ��: �6381��
, COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BVIIDING 1 /'�
ADDRESS T v
OWNER ,
MAIL q �
ADDRESS [1 'QS' L
CITV
�nf'fis /�/otii 'NO.[i7�"//.
BRANCH
ADDRESS // / d Of.!!/1G.O /7✓['I
ARCHITECT �y TEL.
OR ENGINEER �Q��/t'L /1✓GFHn/i' NO. �
� ,��y
ADORESS ySO,�/C(:��/�F �(/SI/�
CONTRACTOH�pr,iy�y� �./-n ../�elf
/� �,/ TELj. (,
CITV l ls' 74. /%Pi4 NO.G7.S'
LIC. NO.G�-s3 �S%���, UCVNO. ,�S
SIZE NO.OF BLDGS.
OF LOT NOW ON LOT
VSE OF
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO 8E PERFORMED
e
�..9429 7%'1LY78 54.50 TL
APPLICATION FOR STRUCTURAL PERMIT ' ' ' ' -
RECEIVED BY DATE RECEIVED nnrc iccucn
A.P. NO.
BUILDING
FIRE
ZONE
APPqOVED
�
ZONE NO.OF
PLqN$
VARDS APPROVE
VAR.
BET.
-� PERMIT NO.
LOT � BLOCK
�
�_.
GROUP
DATE
USE OF NEW
BUIL�ING
VARDS PROVED
ACCESSORY BUILDING
FT
6 FT
^� 9 FT. �
� FT. r'� �� �
BEf'. MAIN & l �
ACCESS. BLDGS. ' '- � �
�ATE t
APPROVED
__J
I haraby acknowletl8e that I heve reatl thia application antl state '^
n
thet the ebove into�mation ir correct antl apree to eomply with m
ell laws repulatin8 builtling consttuction, antl I shall not employ �
eny perwn in vtolat(on of Me workman'a compansation laws of m
the Stata of Californie.
m
I hareby cartify that I am ptope�ly Iicensetl as a contractor untler S�. FT. �v
the State of Californie Businass antl Profeoions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, enC that such licenses are in full force entl effect, or 1 THE PURPO6E OF ESTABLSHING A PERMR FEE ONLV: �
am axempt from Me provisions o1 the State of California B�siness VALUATION a
antl Profassiona Cotle, Oivision 3 hapte . PERMIT FEE E � a-.� �
m
jjj PLAN CHECK y ^�
Sipnetute of' � � �
Petmitte � 5 / �� TAX b � � �
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AuthorizetlAgent TOTALPAID S �
OWNER MILLER� David DATE p_1'
JOB ADDRESS 49p & 498 East 20th Street BUILDING PERMIT P
GENERAL CONTRACTOR Owner-Bldr. DESCRIPTIONofWORK Demo.Res.
AP No.11 -3�' -33 LOT TRACT FIRE ZONE VALUE $ 0.00
ROUGH PLUMBING
PROP. SWR. IINE rI HOUSE CON.
UNDERGROUNO I� POWER
BONO BEAM ❑ STEEL REINFORCE
SHEATHING
FRAME AN� FLASHING
IATHING - IN ❑ (
PLASTER,BROWN COAT
STROCTURAL FINAL
HEATING, VENT., REFRIG. AND A,
PLl1MBING, FINAL ANO GAS TEST
ELECTRIC, FINAL
FINAL
SUBCONTRACTOR
; ' 342�8 F" i7-72�y�.��� 810 o*,reea8.00
..I .
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA M�SA, CALIFOqNIA 92626
� APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely qECE D DAT RECEIVED DATE ISSUED
BUILDING . ��L �. d f/l ) ��' � %� '1'/� �
ADDRESS � o�
P I
OWNER �� (� A.P.NO. �� • �J� �
BUILDING T
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AD�RESS ^ �� �/� �+DORESS O {�.� �
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�= CITV NOL V`� P�� O BUILDING �
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w � STATE CITY �'�+RDS APPROVED VARDS APPROVED
�� LIC. NO. LI0. NO. MAIN BUILDING ACCESSORV BUILDING
� O (FROM C/LSTREET)
SIZE� . NO.OF BLDCaS.
OF �OT X� O NOW ON LOT RONT FT. FT.
VSE OF
EXISTING BIOG. (� ' � S E F FT
f" SI2E OF NO. OF '
Z NEWBLpG. RbOMS STORIES L.SIDE FT. FT.
U EXTERIOR WALL AbOF
COVERING C VERING REAR FT. FT.
J USE OF BUILDING AND WOFK TO BE PERFOFMED DISTANCE BET. BET. MAIN &
a '� MAIN BLDGS. ACCE55. BLOGS.
a %� �,l p �A
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r APP V Q
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VI hereby ecknowledge ihat I havB reatl [his application antl ste[e
� that the ebove info�metion is cOrrec[ entl aBree to comply wlth
� all lews ragulaNng builtlinB consbuction, antl I shell not amploy
F uny person in violation ot the wprkmen's tompensation laws Of
y the State ot Cali nia. m
zI hereby cer y that I a proparl cen tl as a contr ct untler SQ. FT. O
che Stere o Calitornia B ines ntl P ofe sions Co vision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �.
Chepter 9, nd that such ic sas ar � n f II`force ntl ffect, or I THE PURPpSE OF ESTABLISMING A PEfiM1T FEE ONLV: ¢
am exemp trom the pro Orts ot e S te df C f nia Business
VALUATION
entl Profess ns Cotl , Di slon 3, a t �— °�
P PERMIT FEE 4 j
SiOneture of m -
Permittee $ PLAN CHECK $ E
� o
Authorizetl Agent � LL
TOTAL FEE $
�""CK k�chard Uorpaa
JOB ADDRESS 490 E. 20
GENERAL CONTRACTOR G
AP No.li8-302-53 LOT
INSPECTIONS
SOIL
fiAS
W�TER
ROUGM PLUM�iNG
PROP. SWR. lINE Q MOUSE COM.
SPRINK�ING SYSTEM
MISCELLANEOUS
ROUGX ME�TING �NO AIR CONOITI(
TEMPORRFV $ENVICE OR POLE
UNOERGROUND � POWER �
ROUGM wIRIN�
TRENCMES F00.M5 STE
FLOOR SYSTEM
BOND BEAM [� STEEL REINFO�
$XEATMING
FRRME RND FLASHING
L�TMING - lu I-I Ol1T n
ELECTRIC, FI
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COSJ'A MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant [o Fill in Completely — Use Ink Only
BUILD�NG �AO E` LO / pT S�
ADDflESS j
°E A T�RR�CH�3n0 Vi�:PhAi«
MAILING
ADDRE55
CITV �OS
BRANCH
AOORESS
CONTPACTOR
ADDRESS �
CITV i/1 v
STATE 35
LIC. NO.
512 E
OF LOT
USE OF
�s %
TEL.
NO. I
L.
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�� ��H
TEL.
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CITY
�/O Z � � LIC.NO. �
NO. OF BLOGS.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
BUILDING AND WORK TO BE PEfiFORMED
APPLIC TIOIV FbR�STRUC�URAL PERMIT 2 �• 50 Tl,
RECEI PERMIT N� � 4$ gfl 0
A.P. NO. I I p�3O �
BUILDiNG [/ D Ee 2o T� C/
ADDRESS T ( V
UNIT OR
SPACE NO.
�wi /�
a
NEW ADD ALTER REPAIR MOVING
OWNER �• voePA4Et
USE J � G �.( VALUE
„� E
ZONE R � TVPE GROUP
APPROVED
BV DATE
APPROVEDSETBACKS
(FROM C/L STR�ET) �
PLANNING ACTION
1 herebV acknowledpe thai 1 hav¢ ieatl tfiis applicetion and nate
thet the ebove Information Is corract antl eprea to comply with
all laws reBulotinB builtlinp conrtruction, antl I shell not employ
any pe�son in violation of the workmen's componsatlon laws of
Me Ste�e of Cullfornia.
I herebY ccrtify thet I em proparly Iicensetl ea a contractor untlar S�. FT.
the State of Callfornie Businen entl Profeuions Cotla, Divizion 3, THE AMOUNT SNOWN UNOER VALU.
C�epie� 9, nntl thet s�eh licenses ere in tull force enE ettect, or I THE PURPOSE OF ESTABLISHING A PEflA
am ezempt from the provisions of theState of Celifornla Businea� VALUATION PERMIT FEE $
antl Profassione Code, Division J, Cheptar 9.
SiB�atura ot �D PLAN CHECK $
Permittee �/ . 5/� ��� TAX $
o,
Author�zetl ABent �te _ � / 7 � TOTAL PAID S
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OWNER Upgp��, DATE
JOB AODRESS 490 Fast 20th Street BUIL[
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PROP. SWR. LINE �_� HOUSE CON.
SPRINNLING SYSTEM
,ROUGN ME�TING �NO �IF CONOITIONING
"UNOERGFOUND � POWER
ROUGN WINING
FLOOR SVSTEM
BONO BE�M []
$ME�THING
FqAME �ND FLi
L�TMING - IN
BllIL01NG
FORMS I I SiEEL REIMF
IENT., PE�RIG. AND 11.C., FIN�L
F�N�L �ND WS TEST �
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COSTAMESABUILDING-SAFETVDEPARTMENT APPLICATIONFORSTRUCTURALPERMI'C
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 hUuu u/ cy / n� I F.
, RECEIVE V PERMIT N° � 50019
For Applican[ to Fill in Comple[ely — Use Ink Only �J
AD'DFESS Q 'LQ A.P. NO. �Z � - /�.SZ' �,J �'
BUILDING � �• v 1.1
OWNEROR � ADDRE55 �-N
TENANT
UNIT OR
MAI LI NG SPACE NO.
ADDRE55 O/N,p/ LOT �j / ('i BLK.
TEI. / �L d
CITV NO.
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENOER
BRANCH V�r a �'
OWNER
ADOFESS � VALUE
ARCHITECT TEL. VSE h $ 0(�.�.
OR ENGINEER N .
ADDRESS 20NE — TVPE GROUP R� 3
APPROVED 1
CONTRACTOR � jt (.� BV DATE —�L v
ADORESS � K ,D' v /�y�
cirv ��(/ No�ss�y �t/ C L 7� ?.�Z��X Z.��
STATE CITV APPROVEDSETBACKS •� �
IIC. N0.3S� 955 LIC. NO.
512E NO.OF BLDGS. (FFOM C/LSTREET)
OF LOT NOW ON LOT RpNT T.
USE OF �
EXISTING BLDG. T,
Separate permits are required for L SIDE� FT.
electric, plumbing and heating work.
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION '
DATE �j
APPROVE Q O
APPROVED �
I hereby acknowledBe thet I have reatl this application entl stete
that the abova info�mation is conect and eg�ee to comply wlth
all laws regulatin0 builtlin0 co^struction, entl I shall not employ
any person in�violation of the workmen's compensetion laws of
the Stata of California.
I hereby cartify that I am properly licensetl as e conttactor untler SQ. FT. (7 �• ��
tha State of California Business antl P�ofessions Code, Divlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and etiect, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempt from the provisions of the State of California Business VALUATION
PERMIT FEE $ �-
and Protessions C 1 Division 3, hapter 9.
� PLAN CHECK $
Sig^atura ot ,•
Permittea � Q S yOO � TAX S � ("�
Authorized Agent Dat �� �`��O L TOTAL GAID S
5 ,s J
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- ' - 3398.�
. _: .
' COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicani ta Fill in Completely
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BUI�DING '!/J� � �� ^ I
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AOORES:
ADDRESS
CONTRACTOR �
ADDRESS
CITV
STATE
LIC. NO. �� f
SI2E
OF LOT � �
USE OF
EXISTING BLDG.
S12E OF / J�
NEW BLOG. �J
ExTERIOR WALL
L�
TEL
NO.
L.
TEL.
NO.
CITV
LIQ NO.
NO. OF BlDGS.
NOW ON LOT
ROOF e''
/GGO COVERING S��FiI
AND WORK TO BE PERFORMED
'
'fC 7?-1;�,.� D� 9'n � • �� .,
APPLICATION FOR BUILDING PERMIT
REC V D E�i�D DAZ•EI�SryED�
O` � �
P MIT O
A.P. NO. � 30 ' �J �7
BUILDING � ` _� r- �
ADDRE55 ��(/
rX C � LOT BLOCK
n _/
OWNER ���G�. •�.L
VALUE
$
FIRE
20NE TVPE GPOUP
APPROVED
gy DATE
5
ZON NO.OF USE OF NEw�
PLAN$ � BUILDING
VAFDSAPPROVED VARDSAPPROV D
MAIN BUILDING ACCESSORV BUILDING
(FROM GrnL STREET)
ONT .J�/ FT. FT.
S F FT
L SID '�FT. FT.
REAR �SFT. FT. t •
DISTANCE BET. BET. MAIN &
MAIN BLDfv. / ACC6i BLD
C.U.P��E /�—/ ` APPROVEDI�
I hereby acknowletlBe [ha[ I �eva reatl Ihis epplicotion entl sta[e �n .J � f
that t�e above information is correct and agree to comply with
ell laws regulatinB builtling construction, entl 1 shall not employ
any pe�son in vlolation ot Me wOrkmen's tompensation lews Ot
m
tha Sta[e o( Celifornle. �
I h¢reby certi L em proparly Ilcensetl as a co actor untlar SQ. FT. o
Me Sta Californio sinoss antl P o Ion� C Oivlsicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chapt 9, antl Mat such icenms In I for � effxt, or I THE PURP06E OF ESTABl6HING A PERMIT FEE ONLY: Q
em ax mpl from Me pro sio th a ot el rnio Businass VALUATION
antl Pr f¢ssions Code, Di ' n a °1
PERMR FEE S �
�
Sipnetura of r m
Parmittea 5��yUD PIJaN CHECK $ ✓ Q
Autho�ix¢tl Apent �— LL
TQTAL FEE S