HomeMy WebLinkAbout724 20TH ST - Building Permitse
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�.�LDING PERMIT %� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 724 W 20TH ST
Suite:
Vicinity: ROOF
Primary Occ: R3
Parcel Number: 42225220
Type of ConsWction: V-N
Zoning:
Applicant: KELLY RHEA WILLIAMS .
Address: 613 SHASTA LN
COSTA MESA, CA - � �
Owner. CURIEL, LUIS
Address 9 SHILOH •
" �IRVINE, CA - �
Convactor: ALL COAST ROOFING
Address: 613 SHASTA LN
. COSTA MESA, CA
Zip: 92626 _ �
Arth :
Phone: (714)444-1111
Zip: 92626
Phone:
Zip: 92620-2555
Phone: (714)444-1111
License: 598440
Eng:
Status: ISSUED
Applietl: 05/27/2005
Issued: OS/27/2005
ISSUED BY: � "`��
9
i
Address: � - � . - � .Address:
� � � • -Phone: Phone:
Zip: � License: � License:
SCOPE OF PERMIT
TEAR OFF EXISTING COMP ROOF TO SHEATHING ON ATTACHED HOUSE AND GARAGE. INS7ALL 30# FELT AND 30YR GAF TIMERTINE
SHINGLES. REPAIR AND REPLACE SHEATHING AS NEEDED. '
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$125.25
$0.60
$0.00
$0.00
$0.00
$125.85
SETBACKS
MAIN`STRUCTURE Fmnl 0-0
ACCESSORY Front 0. 0
PARKING Existin : 0
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE'SUMMARY
_ Calc Valuation: Ss,000.00
Claim Valuation: Ss,000.00
PLANNING & ZONING ' � . -
Left 0- 0 Right 0. 0
Left 0-0 . . Right 0.�0
Proposed: 0 �
NO710E: Tha work authorized by this permit shall� comply with all applicable handicap access requiremenis untler Califomia statutes and relatad
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 woAc.authonzed underthis permit to be considered legel, such work must eomply with all applicable codes, and all
requlred Inspactiona and�flnel,epprovePmust be obtained. FeiWre to�o6tain inspactlons and�finel approval will result in ihe expiration of this permit.
FORiNSPECTIONS-�CALL:: (714)7545626
WORKERS'COMPENSAnON DECLARAnON: '— —' �
I hereby aflirm untler penalry of perjury one ot Ihe following tleclarations: '� �' : � r: '• �
❑ I have antl will maintain a certiticate ot consent to self-Insure tor workers' COrtIPYI's2lii30; 4 Providetl for by section 3700 oi the Labor Code, tor the pertormance of�the
_ work for whic0 this parmit is issuetl. ' '
3nsation insurance, as requiretl by section 3700 of the Lebor Code, for ihe pertortnance of the work for which this pertnit is Issued. '
carrier antl policy number are: p �l ./ '
�Policy.Numbe_r: � � �� O �— O'i.VJ
ermit is velued at one hundred dollers ($100) or less.) �" '
❑ I certity ihat in ihe pedortnance of ihe work for whiCh �hi5 permit is 15sued, I shall not employ eny person in any menner so as to 6ecome suhject to the workers'
compensatlon laws of�alifornia, entl agree t�et H I shoultl become subject to t�e workers' compensetion piovisions oi Section 3700 of the Labor Cotle, I shall forthwith
comply.with�lhese'p�°%�is �' /�n � /
Appli�� �"�-t'ore':w�FC4� 1 1_1�1CY -.� Dete:_ SI �� /O�
WARNING: FAILURE TO SECURE WO RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHAIL SU&IECT AN EMPLOYHHT�O CRIMIN�CPENALTIES MID GVIL FMES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF CO!dPENSATION, DAhL1GES AS PROVIDED F9R IN SECTION 3106 OF THE LABOR CADE, INTEREST, AND ATTOHNEI^5 FEES.
LICENSED CONTRACTORS DECLARATION:
under provisions of Chapter 9(sqmmencing with Section 7000) of Division 3:ot.�he Business and Professlons Code, end my license Is in full
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that Ihere is a consiruction lending agency for Ihe performance of ihe wo�k for which ihis Dermit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: Lender'S Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn that under penally of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW br ihe following reason (Sec. 7031.5, Business antl��Professions
Code: Any city or counry which requires e permit to consimct, alter, improve, tlemolish, or repair any simcture, prior to its issuance, elso requires ihe epplicant tor such pertnit
to file e signetl statement that he or she is licensed pursuant to ihe pmvisions oi ihe Contrectors License Law (Chapter 9(commencing wiN Sectlon 7000) of Division 3 oi the
Business and Protessions Code) or that he or she is exempt lherefrom entl the besis for ihe elleged exemption. Any violation of Section 7031.5 6y any epplicent for a pertnit
suhjacts ihe applicant to e civil penalty ot not more then tive hundred dollars ($500).):
❑ I, as owner of Ihe property, or my employees with weges as their sole compensatlon, WILL DO TME WORK, and the sWCNre Is not Intentled or oflered tor sale (Sec.
7044, Business and Pmfessions Code: The Coniractors License Law does not eppry to an owner of propeny who huilds or improves thereon, antl who tloes such work
himself or herself or through his or her own employees, provided ihat such impwvemems are not intended or oHered tor sale. If, however, ihe building or impmvement is
sold within one year of compietion, the owner-buiider will have ihe burden of proving that he or she did not build or improve fa purpose ot sele.). -
❑ I, as owner ot the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consbuct the project (Sec. 7044, Business and Pmfessions
Code: The contracrors License Law tloes not apply to an owner of propeny who huilds or improves Ihereon, and who coniracls for such project with a contrector(s)
license pursuent to the Conirectors Licanse Laws.).
❑ I am ezempt under sec.
Signawre:
Owner ID verified by dnvers license. ❑ Yes ❑ No
6usiness and Professions Code lor �his reason:
Veritication of Ownership by (type of tlocument, i.e. - pwperty tax biil or deetl):
Drivers License No.
Da�e:
Expires:
OIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certih/ that no ezcavation five (5) or more fee� in tlepih into which a person is required to descenq wiil be made in connection with work authonzed by this
permit, and that no buildinq stmcture, scattolding, falsework, or demolition or dismantling ihereot, will be more ihan thirty-six (36) feat high. (Chap. 32, Gry 2, An 2, Sec.
341, Title B, Calitomia Adminisiralive Code).
❑ As owner-builder, I will not employ anyone m tlo work which would require a parmit from Ihe Division ot Industriel Sefety, as noted above, unless such person hes a
pertnit to do such work irom Ihe divi5ion.
Signature: Date:
Division ot Intlustriel Sefety Permit Num6er:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cehity under penalry ot perjury that I have reatl this epplication and state that the intormation given is
correct. I agrae to compty with all sta�e laws entl ciry ordinances relating to building consiruction, and authorize representatives of ihe City of Costa Mesa to enter upon the
ebove-described propeny for inspection puryoses. I agree not to occupy or allow occupancy of any buiiding authorized by this permit uMil tinal inspection.
COOE 1. -INSVECTIONTYPE
1616 Fized System Final Fire Pre'vention
1266 Pool Spe Finel
200
201
202
203
204
Finel Re-Roof
Finel BIaWRetaining Well
Final Factory Fire Place ,
Final Sign
Final �em
- • D1TE .. �NTITIALS t
a '—�— ��---1
CODEI'- INSVECTIONTYPE '
206 Final Mechanical
208 Finel Plumbing
210 Final Electrical' �
212 Final Fire Prevenlion
220 Final Planninq Approval
222 Final Site
250 Final Builtlinq/Occupency �
�
October 11. 1999
.
,
CITY OF COSTA MESA
CALIFORNIA 92828-1200 P.O. BOX 12IX1
DEVELOPMENTSERVIGES DEPARTMENT
The at[ached Counry of Orange documents are for unit # 3 located at 724 W. 20`h St�eet. Documents were submitted
by the property owner after being notified by the City of Costa Mesa Code Enforcement office for a possible illegal
unit on the property.
%�
�Bill'��+` \_.
Code Enforcement Officer.
77 FAIR DRIVE
&+Ilding Division (714) 754-5273 • Code Entorcement Qt4) 754-5623 • Planning Division (714) 754-5245
FAX (714) 754-4856 • TDD (716) 754-5244
,RF � Taacr
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NER _ �BLOCK^f_,' AM�
ROOF BUILT—INS ROOM AND FINISH DETAIL
L M F.P.
- e.e.o. ROOMS FlOORS FLOOR FINISN INTERIOR FIN
v Kir Fex A I 7 MATERIAL OR. WAlLS CEILINOS
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REMAHKS 6q SIOE ,[�. OF ��
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VE VEN FEW FAiR STRUCL FND. CON. EXT. ROOF FL INT SIZE
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WOOD REC. 220
T STEEL FENGE
ni FOUNDATION
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GONST. OATE
DESION TYPE
DEPRE TYPE
EF�ECTIVE YEAR
DEPRECIATION TABLE
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IIVINO RMS
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or
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COST 84 OTHER I I
85 CENTRAL HEAT VES�
B6 GENT. COOlINO VES�
B7 COSi LEVEL BASE
COST FACTORS
B8 OU4LITY
CLASS I�✓',OA'
B9 A�EA FOR L (,
MOD. l/
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Aop�icant to fill in a1l soaces ezcept thase within heavy Eoraer Iines ana sign all apvropriate tleclarations.
ci7Y OF COSTA MESA CONSTRUCTION PERMIT
Projeci Address �2� W �� � 5�1 �
Applicant's Mailinr�ddress �$� pw r
Owner's Name � l � Phone r%f �
Address �• -S!'�///fL7 �iQ;!/N� 927'"J D
Arch/Eng. License No.
Address I�2
ConVactor's Name '�•C• ��E1-I�'T��' Phone �%✓I— (Q�
Address (mailing) �0• � IOYSZ � �i%1 qZ�O2�"
City License No. 0��'y }}
LICENSED CONTftHCTOR DECLARATION
I hereby aftirm that I am licensetl untler provisions of Charter 9(commencing
witn section �000) ot Division 3 ot the Business antl Professions Cotle, antl
my license is in full (orce ntl effect.
Licens� Cl�ss ' d i eNo.5N�1�1
Date —.SL �' S _ t ii�t -
WORKERS'COMPENSATION DECLARATION
�e�e0y affirm tha[ I hdve a certificate of con5¢nt [0 5elf-insure o� a certificate
Workero' Compensation Insurance, o� a certifietl wpy thereof (Section
J0, Lab. CJ
Golicy No. Gompany
BCertifietl copy is hereby tumishetl.
Certifietl copy is filetl with the city Builtlin9 DiviSion.
�ate APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not Ce completetl if the permit is for one hontlretl ($300) or
IessJ.
I certify that in Ihe pertormance of the work for which this perm�t is issuetl, I
snall not employ any person in any mann o s to me subject to the
WorkerY�Co�p e�ion Laws ot Califomi ��
Date � _ 1 �� Signature
NOTICE: If, after making tnis tleclaration, you shoultl become subject to the
Workers' Compensation Drovisions of the Labor Cotle, you must forthwith
comply with such O�ovision5 or thiz pErmit shall be tleemetl rewketl.
�CONSTRUCTION LENDING AGENCV
1 hereby aifirm that there is a construction lendin9 a9ency for the performance
Of the work for which thi5 permit i5 issuetl ($ection 309] Civ. C.)
Lentler's Name
Lentler'S Atltlress
OWNER eU1LDER DEGLARATION
I hereby atfirm lhat I am exempt from the Contractor's License Law for tne
fo�lowing reason (Section 7031.5 BuSiness antl Professional Gotle: Any dty or
county wM1ich �equires a pe�mit to construct, alter, improve, tlemolish o� �epair
any slructure, prior to Its isSuanG¢, also require5 the applicant fOr such parmit
to file a signetl statement that he/she is licensetl pu�suant to ihe p�ovisions ot
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
'Wision 3 ot the Business antl Professions Cotle) or that he/she is exempt
refrom antl the basis for the allegetl exemption. Any violation of Sectlon
31.5 by any applicant for a permit subjects the applicant to a civil
�nalty of not more Ihan five nuntlretl tlollars (E500�.
LJ I, as owner of the property o� my employee5 with wages as thCi� sole
mmpensation, will tlo the work, antl the structure is not intentletl or offeretl
for Shce ($¢ction 7044, Bu5ine55 antl PrOfessional Cotle: The ContractOr'S
�icense law tloes not appty to an owner of a property who builtls or improves
thereon, antl who doe5 sucM1 wo�k himself/hers¢If or tM1rough hi5 or he� own
employees, provitletl that such improvement5 a!e not intentled or otfefed Por
sdle. I/, howeve�, th¢ bulltling or impvovemenf Is soltl within one year o( tom-
pletion, the owner will nave the burtlen oi proving he/she tlitl not builtl or im-
prove for the purpose of sale).
❑ I, as owner ot the property, am exUusively contracting with licensetl mn-
tractors to cons[ruct tne project (Section 7044, Business antl Professions Cotle:
The Con[ractor's Licenze Law does not appry to an owner of property who
builtls or improves tnereon. antl who contracts for such oroiects with a con-
tractor(s) license pursuan[ ro[ne Conttac[or's Llcense Law). I am aware [bat
proof of their Worker'S COmpensation insurance shoultl be provitletl to me.
❑ 1 am exempt untler Section B. & P. C. for this reason
Date Owner
I hereby certify that I have reatl this application antl state that the above
iniormation Is correct. I agree to comply with all city antl county ordinances
antl slate laws relating to builtling construction, antl hereby authorize repre-
sentatives of [nis city to enter u on the above-mentionetl Property for
inSpeGtion pu�y��5��,. �
Signature �_�r��Q�[_ ` Date G'— 1 ,�'9
Drivers' Li � � ��
, _,,,.,., ,..,. ..... .-- -- - ,,,.,, ,..,.
�. 3 $ � I - � -
TVPE OFCONSTRUCTION NEW ADO ALTERATION� REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER _
DESCRIPTION OF WOFK/USE OF BLDG. �lij � L' �
TVPE OF PERMIT LI GRAOING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 54. F7. ocCuaarvCv
CONSTRUCTION TVP VALUATION $
ZONE GRAOINGGU.VDS. ACRES—
Remarks: � _..-. . !'f /�n �r. .
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen $ink �
Lavatories
P—Trap
Roof Drains
PIUMBING
Service Sink
Sewer Cap
Sewer Connectian
Solar Collectors
Solar Pipin9
Solar Tank
Swim�Pool w/Spa
Water Cloret
Water Heater
Water Service
Auto-Wesh
Laundry Tra"ys
FEES
Reinspection Fae I $15 � � Issue Fee � $ 3
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. iC60 #
Heating System & Ducting
❑P700,000 BTU 0100,000
Reinspection Fee � $15
0865-46, rev. 5/88 White - Builtling; Canary - Applicant: Pink - Accounting: Goltlenrotl - Assessor
Hood or Typel ❑
Canopy TyyWi' ❑
3efri ation System
-100,000 BTU ❑100,000 BT
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
A.P. #
S Main Buildi
E
T Front
6 Rear
A
C Right
K . Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Si
Cooking Unit
Dishwasher
Dryers ❑Gas ❑E
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Gar6age Disposal
Generamr �0-5 KN
lectric
Zone
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
z Meter �p to 100 amps
Meter ❑over100amps
z, Sub Panel '
Motors OO-1 HP O1'fe - 8
� IncSolar �9-'IS HP �16�15+
°ble Light
Range
Standing Sections
5-15 KW Trash Compactor
� Reinspection Fee �$15 � � Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
2oning Approved By
Building Approved 6y ,� /
FEES
N
I
N
G
R
E
Q
M
T
S.
SUNIMARV OF FEL�
BUILDING PEFMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25%� $ ENERGY P.C. $
ELECTRICAL.t $ � GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ 7�i-.0�2
PLAN CHECK 25Yo $
JL �.IV�J.]Y�Y� ^�Vu"`.)YJ � ��
UC.rE: �6/07id9 u7Yl"�: 13:O:i �..
CONSTRUCTION AND PLANNING � � POC iPA
� APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
L Tem,porary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. �- 53. Steel Reinforcement �
3� El�ctric9l Conduit UtilitY-Undrgrnd. � 54. Forms '
4-Electrical Conduit-UndYgrnd. .- 55. Electrical Bonding '
5. Steel Reinforcement_ � 56. Rough Plumbing & Pressure Test
6:' Electrical UFER Grnd: 57. APPROVALTO COVER-GUNITE ` •
. �
7\ Footings � , 58. Electrical Conduit-Undrgrnd. ��
8r Foundation - � 59. Gas Pipe, Q Undrgrnd., Test �
9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P-Trap, O Undrgrnd. ,
10. Structural Floor System � 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap r '' �
-- 63. Heater & Vent-Final �
13. Roof �Drains • 64. Plumbing SVstem - Final
14. Rough Plumbing 65. Electrical-Final "
15. Rough Electrical;Conduit 66. Solar System-Final
iT6' Rough Electric Wiring 67. Fencing & Access Approval
��. Rough Wiring Siyn � 68. APPROVED FOR PLASTERING
�1�6. Rough Electrical-T Bar Ceiling'_ 69. POOL/SPA SYSTEMS FINAL
'19. Rough Heating & Air Conditioriing fIRE DEPT. REQUIREMENT
�20. Rough Factory Fireplace ��� APPROVALS Permit#
'�-21' Ducts, in Structure . 70. Underground Hydro
22. Ducts, Ventilating �-.i �' �r 71. Product Piping O Gas ❑ Oil
?:3. Gas Pipe-Rough & T.est �;� .,y 72' Underground Flush �' �
.r .
24. Roof Framing � r �73. Undergrnd. Storage Tank O Gas ❑ Oil .
�5. Roof Sheathing i� ' . 74, Overhead Hydro �
26. T-Bar Ceiling (Strucwral) "& Monocoat ' 75. Dry Chemical �
27.iFrame�and Flashing 76. Dry Standpipe �
28. Lathirig & Siding �• 77. FIXED SYSTEM FINAL
29. Insulation �� • 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaste'r Brown Coat Z 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 pomestic-Final � •
., f .
42. BackflowPreventer v ��j �a �
43. Backflow Irrigation - '"' ' '
44. Landscape Irrigation System _ t., r/
45. Sound Attenuation , �� � .
46. Handicap Regulations �'
47. FINAL STRUCTURE & BUILDING `•
48. Sqecial Requirements Completed
49. El�ctric Release to Edison
• ,•'
50. Gas Release to Soutfiern Caiifornia Gas Co � . -
r
51. CERTIFICATE OF OCCUPANCY y - . , , '" ' '
No. Date � - � • %� . �
,
� OWNER �R
�� JOB ADDRESS'
��GENERAL C0�
�AP "�o.
I1. =TIONS
soi.
GAS
WATER
ROIIGH PLUMBING
PROP. SWR.LINE
SPRINKLING SVST
ROUGH NEATING RND FIP CONDITIONING
TEMPORARV SERVICE OR POLE
UN�ERGROUN� [] POWER �
ROUGN WIRING
TRENCHES � FORMS STEEL REINF.
F�OOR SYSTEM
BONO BEAM � STEEL FEINFORCE ❑
SHEATHING
FRAME ANO FLASHING
LATHING - IN n OUT
PLASTER,BFOWN COAT
ST'---TURAI, FINAL
HI G. VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL ANO GAS TEST �
ELECTFIC, FINAL
BUILOING, FINAL
DATE 10-4-74
BUILDING PERMIT N0. :
SUBCONTRACTOR
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,+" 3 n68
aalo �. iro���
ar.r —a-�a�N�,00 z�4 5.50
� COSTA MESA BUILDING-SAFETY DEPARTMENT 3Q�68'
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLI ATION FOR BUILDING PERMIT
Far Applicant to Fill in Completely
RECEI DATE RECEIVED D� IS
BUILDING '/' �
ADDRE55 yv -
� CU EL ` PE TN
OWNER A.P. NO.
MAIL
5`'�' ADDRE S 7G ✓(/ 2�
ADDRESS
CITV GO .� NOL ���a�I TRACT LOT BLOCK
CONSiRUCf10N
LENDER �/I
I�
BRANCH ' �/L IE�
OWNER 1
AODRESS VALUE �
ARCHITECT TEL. S $
OR ENGINEER
FIRE
ADDRE55 ZONE TVP GROVP
APPROVEO
CONTRAGTOR Q w E BY ' DATE � �
ADDRESS
TEL. Z�NE NO.OF USE OF NEW
FLAPLS BUILDING
CITV NO.
STATE CITV YAROSAPPROVED VAROSAPPROVED
LIC, NO. LIC. NO. MAIN BUI�DING ACCESSORV BUILDING
SIZE NO.OFBLOGS. (FFOMC/LSTREET)
OF LOT NOW ON LOT ONT FT. FT.
VSE OF
E%ISfING BLDG.
SI2E OF NO. OF
NEWBLDG. R OMS STORIES L.SIDE FT. FT.
EMEFIOR WALL RDOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WORK TO BE ERFORMEO DISTANCE BET. BET. MAIN &
MAIN BLOCS. AOCESS. BLDGS.
U U S� VAR.aW DATE
C.U.P. qW APVRpVED
//` /[ APPFOV ED
f «r v
S7qTE
I heraby acknowlatlBa thet I have reetl ch(s applieetion antl Rata
thet the ebove InformaHon Is correct and apree to comply wlth
all laws ragulatlnB buildin8 �onsvuetion, antl I shatl not amploy /
any parmn in violetlon of the wO�kman'a compenwtion lews ot
the Ste[e of Californla.
1 heraby cartity Mat I em properly Iicansatl es e tonirOctOr untlar $Q. FT.
the Siero of Californla Businass and Pro(euion� Cotle, Dlvlsicn 3, THE AMOUNT SHOWN UNDER VALVATION IS FOR
Chapter 9, entl that such licenxs ere In lull force entl etfxt, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV:
em ezempt from t�e provlslons of tha Stata of California B�sinen VALVATION /�-�
entl Protessiona Cotla, Dlvision 3, Chaptor 9. ��
///� O PERMIT FEE $
Slpnatare of� � � l • X
Parmittee �.+n A�X�C�� t S 5OO D�� PLAN CHECK $ r_
C
Authorized ABent TOTAL FEE 5 �
O /
OWNER � TIOWLER� FRANK -__ DATE l`J ��',Fi �`1�v.ioJ.
JOBADDRESS 72µ W, 20th Street BUILDINGPERMITNO. #4-��� '
GENERAL CONTRACTOR �[,/Yt2I' BZdI'• VALUE $ �OOO.00
APll$-3Lt1-12
u �& 20 s�ocK C TRACT 612 Relocate home
GROUP I TVPE 4 ZONE RI� FIRE DISTRICT I�l I�7
INSPECTIONS I DATE I SUBCONTRACTOR I DATE PIRMITS�NUUMe
Foundation Forms and Grade to Garage (/.LLfrd ��,Ty�G /—'T v"
Rough Framing
Plumbing, Rough to Slab ('� �_«y��f /a'3i-s� % (s�/� .i
Plumbin4. Rouah Complete �I2 �S j�.1 -J 7
wiring, Rough ��'I�/�L`1 JAN17 1957 VCB �"-- �so-yt �—/ 6-5 7 ,3g �frf' '
Heating, Rough � u .„i 1.2 �.3/—.5% 7 G/l --
Heating, Final
Sewer, Hnuse Sewer, St.
Septic Tank or Cesspool
Lat�� �, In Out
Plumbing, Final, Fixtures Complete I"YI � ,�,��{
Plum6ing, Fin•al GasTest l lj,s —,$''
Wiring,Final 'kb � _ �1`JbI
Occupancy �
FOHM 210 3M 10�•v5 v
f ta mesa lstniding Department
` P. O. Box 3!7
1�=� COSTA MESA, CALIFORNIA
FOR A�PPLICANT TO FILL IN
Building � � Q
Address
Costa Mesa, California
Nearest n O � � j� //��
Cross St. -C A'
Owner G /k/Lfj/
Mail yn /'
Address / .� y.
City -
Architect or
Engineer
"+dress
..ontractor �%-Zj�
Address
Legal Loi
Description No.�'
(Attach Metes and B�
Size of Lot �Q �
ljse of
Existing Bidg. (/
Setback Line am
benter of Street
; DESC I
New I I,
/� �'6 a
� Block `yTrac�
/�s-3y/-��.
No. of Bldga
Nowon Lot �
No.of lo,of� —
.e Families Ro
. Rear Vard ,
Demolish
.
APPLICATION FOlc PLKmi�
a�d`7 BUILDINt�
FOR OFFICE USE ONLY
_ � Receipt No. Permft No.
i �/o�
Received by Date Rec'd. � Date Issued
- � -.1"� � _ i' -.�G
Buildin 1
Address : /
Costa Mesa, California
Nearest y'
Cross St. ' i
�e�1..f.G-�@-[-y -.. .
LJ C �. �
��ze� �,,� �� ,� y o Raoms Gl Stories �
:erior Wall � Roof �) —
.vering Covering c.v (�PP�,QV��S
Use of New ,�, , � � _ / Q _
Building '�fj@�{�'� ��Qiyj,[� Foundation Location Inspecto
Forms, Materials�
��/}/���Q �y�j�-Q L�y, Under-Pinning
' ' Frame: Fire Stops,
Bracing, Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath. Int.
with all City Ordinances and State Laws regulating
huilding construycti4n. Lath. Ext.
Signatureof T��`�W�!/G �d`'Lf/'L[�- �
Permittee / Plaster,lnt
Authorized Agt. Plaster, Ext
Valuatton Permit Fee $ %a — Masonry Reinforced
�/ O � p.� Plan Check $ � Bond Beam
$ � Total
Fee $ / FINAL
wla'J.f16 IO.S3 D.P.85.
y
�
Show locatlon and distaneea irom
property Iine and between bulldinpa
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