HomeMy WebLinkAbout870 20TH ST - Building Permits�
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RDOPESSOFBNIdNG:_ 8%O W 20TH'ST
ONMEHSN�I/EIFqlMYN:OATIZ, CARLOS.�A
10DPESS:S%O W 20TH ST
COSTA MESA,CA
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IiqCHRECT OX FNtlNEEX:
ARCN. ON ENG'S ADDRE55:
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LICENSED COMRACTORS DECLAN�TION: I heieby dlim uMx penely d pa�ury Nm I em IiemseE urder pevriaiane ol Cheqx 9
(mmmemiq wilh Section ]000) ot Gwion 3 d iM Bwiroo eM PMeaabm COEe. eM mY � o in h0 faca eM eltetl.
cm uc. No.: uc. cuss: uc. No.: EXP : _
ome: comrea«:
OWNEH 9UILDEfl DECLANATION: I Mreby alfirm undar penely d per'ryry �lut 1 em exemq Imm Iha CaNreqaa Licenae law /w iM
lolbwing reeson (Seabn ]031.5 Buaneea erd Proleesiore COEe: AnY eiY w wuMy whieh epuirea e pmme �o eamruel. eXer. improw.
bmd'uh, a repei airy Mrueiure, pior �o iro ewenw, elao rpuiree Ihe epplireM la eueh permit lo file e sigewE stetemeM Net he a eM
e licenmd W��� �o Ihe povieiona d iM Conlreclas Lioenee lew �CAeptx 9(canmemrip xilh Setlion ]000) d D'v'oion � d �he
Burinev enE Profa�nna Code� or thet he a ehe ie eaemq ihsehom end ihe bnvis fa �ha ellepad azempion. My videlion d Seaion
'/o3t.5 b/ em aVdiraM 1« e permil wbj u iM epDlicenl lo e cHil penelry M na mwe ihen live hurdred ddleis �5500�).
�] 1, es axm�er d Ihe propMy or my empbyeee wRh wepas ae ihe'v eola compenae�ion, will do tM xnM, eM iM sVucture o nd inleMeE
or oflereE(ormla (Section J004, Busimea vM Pmimaione Coda: The Conlreclon licenae lawtloee rwl epply ia an owmr d pmpe�y
who WJds or improvea ihereon, eM who Aoes such wwk Mmeetl or henetl or thraph ho w Mr own em0loyeea, prwkeE iMl euch
improvemenls era ml iniaMed a oflereJ lor eale, II, howawr.lhe WikinO or imprcrvement is soN wilhin one yeer d compl&ion, ihe
�,-w�u.. �;n ne.e me wme� d wa,��a ne o, cna a�e oa wad a �mo�e �« �na wm�. a swl.
❑ I. m ovmar d iM peopem/. am nadudvey mnirmip wilh lieenaed wntrectae ro conskud Na pqad (Sxfm'lWd. Buair�ss vM
Prdevione Cada: TM Coniretlae Licenu law does m� epply �o an owror poparly x1w buiNa a� tMreon eM x1a
conlrecle fa eud� p�apCs xilh e mMrepor(a) I'ranaeE WnueM lo Ihe a Lew). ^
� I em uamq uMm Seciion: B. 8 P.C., br Nis ���i
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W OHKEH'S COMFENSATON DECLARATION: I hereby elfirm under qneXy d perjury me d ihe lolbwiiq Eetlueliom:
� 1 heve arM wil meinlen e cenifine d mieenl io eallynwn for xakere cpnpenmibn. m pwNed fa by Saman 5)OD d �M lebor
COEe. fa IM paAamenr.a d tM xwk lu wlich ihia peimn ie iaued.
❑ in...�a�;����won�,��o�����,,.�....�c���a�ys«r�o�a�adma�n«coe�.ro,�n�wn«�.am.
xroA la which Mia permB o i»ueA. My wabn' mmpense�bn inwrence fsrrir end pdi�y number era:
Camar:
Poliry Number.
/m;s sanron ��d nw ae comWerae r me w�a;s ro, �. n�nd�d dab�. B+ao� w iees.l
❑ I cenM tne� in ina ua�lomume d the woA t« whcn inie V�il is ueued, I shall na emqw enr aa�n in eny menn« ao ea m
becana aubjee to iM waken' wmpeneetion lexs M Cdilamu, vM epree ihe� il I eM1ouk became abjea to tM worFen'
compenselion pmvisiona d Seeion 3)00 W Ihe Lebor Code, I ehell foMhwilh oompN �h Nme qwiaions.
Dele: APq��
Wem/ip: Fallvn ro wcun worken'rompaustlon eoverep� l� unl�wlul, antl aMll ub/aet an amploysr to eAMnN psneMu �nC
clvll flnu up N aro hwtlrstl tlrowerd EWMr� (SfOQP001. M eWitlon ro fM cwt ol rorrywatbn, tlsnu�ps u povlCetl br In
Sxtlon 3)05 0/ tln la6ofCotls, IMens4 Nd eMmey� /�sa
CONSTi1UCfI0N LENqNG ACENCY: 1 hereby dfirm uMx pareXy M perjury �lat �Mre e e consliudion bM'up epem.y M Ne
(91IIX111811[B W �M NVfM IUf WM1KJI �I16 P�� 9 L9WlA (SBQG113U3%. CM. CI.
LENUER'S NAYE:
LENDEH'S ADDNESS:
I cenity Ihet 1 M1ere reed Ne epplireiian end etma thet Ihe eEova iMame�ion u mnep. I eqrea �o cwnpy wrth dl cey e�M muMy pEinenms
eM aime IeMs ralat�Blo bnWvq cmrouebn end MreM a ' a rapeeenle�ivea W �hu dtY Io enler uD� iM ebova.meniioned piapeny
����°�°�`°�C OS ORTI
Dab: �? •9��
uee r/RpaM/ApplranV�onlreela
(5151-46.WP) Whtla-BuilEvp 8 Selary; Oraeo-Fle; Cenery-AOPFrant; Pink-Fevenue; Goldenrotl-Asmaor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: H 087145 PLAN CHECIC NO: N
Bq - oa3oS
PERM NO: B 087145
GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION : T/OFF AND REROOF W/COMP SHINGLES SQ FT: 2,200
CLAIM VALUE: 2,200.00 CALC—VALUE; 2,200.00 GROUP OCC: R-3 /
COMMENTS; REROOF 1200SF PART OF RESIDENCE W/COMP
�atitr�ritat�r**�r*ria�ria*riaia******ititiait**it**it**ia***�rat+rititat*+a+f+�*If+r+r**it*ititat*+e**��tat;t+titir**�+r�r
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUZLDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT:. FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ • PROV: PARCEL: 42250517 2NE: REF NO:
PLANNING NOTES>
7
if ik if ik iF iF ik ik �If iF itlf 1f iF iE if if ik ik if ik ik iF 1t iF it if k 4 i! if iE ik iklFlf ik if 3F if IE 1F if if �F ik fF iF k ik if if ii ik 1E 1klF it 1k ft'!F if 1E'lk 1F'14 iF'lF iF M!F �k 1k if if ik it 3f'!k
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 T S
20NING APPROVED BY . DATE•
BUILDING APPROVED BY :
APPLICATION ISSUED BY;
�e�**�ex�r*�e**�*******r�r+�
LEGALIZATION.;N
F E E S U M M A R Y
HLDG PMT PLUMBING ELECTAIC MECHANIC
PERMIT _ 74.75
DATE;
DATE Z- 2 � �'
�+e+r***���** �*
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES GRADING
.50
SMIP/NON—RES
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 75.25 0.00 0.00 75.25 75.25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 75,25 OVER/SHORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
74,75 .SO
if ik if if if if ik 1f iF 1F'lF±F 1F if �F if iF M iFlf iE iE ik if 1F ik ik iF iE if if iE ik iF 1FlF iE 1E fE!! iF if iFif i! ik k iF if iE 1k it iE iE iFiE ik'k iF iklt'IE iE it iE �k iE'N� 16 iklk ik �)k!! ik ik k iE i4
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 UNIT COST TOTAL COST
SFR 2200 REROOF BY VALUE AESZDENTIAL NOZONE 1.00 2,200.00
END OF FEES
��PI�D
��:�+,�'�'�� 82-27-1998/81:11 DM/S7�.E5
RCDTq:01—�020246
87145
,\�
CONSTRUCTION AND PLANNING - P�L` � SPA
APPROVAIS Permit# Daie Inspector AppROVALS Permit# Date Inspector
7. Temporary Electricai Service or Pole 52. Pooi & Equipment Location
_ 2;,�Soil Pipe-Undrgrnd. 53. Steel Reinforcement (,
a�rc�n�lectrical Conduit Utility�Undrqrnd. 54. Forms ^`
L
�3:"�lectricaf ConduirUndrgrnd. . 55. Electricai Bonding J
a
'���teel Reinforcement 56. Rough Plumbing & Pressure Test �
��fi �Iectrical UPER Grnd. 57. APPROVAL TO COVER�GUNITE
r -�
: `J�,'.yFootings 58. Electrical Conduit-Undrgmd. ��
F�=�;8. Foundation . 59. Gas Pipe, O Undrgrnd., Test
9. Warer Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, C7 Undr9rnd.
10. Structural Floor Svscem 61. APPROVAL TO DECK ,
11.;Property Sewer Line & House Connection 62. Backwash & Receptor�Final
72.� ewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Firtal
74. Rough Plumbing j , 65. Electrical-Final
75. Rough Elearical�Conduit �• 66. Soiar SYstem-Final
16. ftough Electric Wiring 67. Fencing & Access Approval (
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79.;Ftoygh Heatirrg &!i.au Conditiohin9 ;r� �: c7 �;x o' F_'TRE'�FZ�fPT=3iEQU1REMEfdT ^�
.-. .. .m v rr �- .: t � � �. 7�
20.:fiouQh Fa�cto`r� F��lace � �� �� � S ,�' �� �? APP�iO�Y%kYSi� P�mit#''_� �-
27.EDu�,iqf¢tructu�.v'�.�. i �ia � �� fi iln 70FUnderiqro�'tid �dro �
22. u t, V� tit�tin x : ^�7 ��' = Q r� rz . .. . � �
, � �P 9v, -�: � ,� .� ,7 i„�.r , 71. ProduCi'Pipinc�yd�ias �] Oil C: �.�
23. Gas�ipe�iough 8�'b'ost i r,;� �p ,: '� r^ �� �' 72. Underground �iushi �_ �+ �
24. Roof Fra ing ���' ��� � '� �'"�* ' 7�,`,�', Under cnd.StorT Tan OGas ❑Oil
C)� f :J .. n Ct� .:1 03x 9 ��=. �
25..,.,Rou •Sh athing r�',,.j „ ` �x ^y �� � � ,^, � 74,aOverhead Hydcz��
26.�'-Bar Ceiking (Strvct�ural) & M�r'n�coat „�� O , D Cy 7��ry Ch��cal �� �' � ,� �
, 27.;;Frame a� F�ta'shi "� J"x �x °� '" '' M `". , �
i, �9:y� ..:-�CJ x �• k 76. Ory StaF4iP�PeC�-+ K C7 .� O
• 28. Lathingt& SiBing"+. ,� �J�Ar ;� � m � � �K �. FIXED�`SYST�-K:?FINF�`"- '�
w
.� 29. Insulatio� ,• G�r � � i � rg �8. FIRE PREV. F.tP;;4L *�
� 30. Drywall'Nailin9 hx � X E-� j � �+ S ��FIEALFN DEPi,AE�Ui[ijEMENT
� iz r. r-� y: •:
i i r,:.S i,�;+ ' .,.��
� 31. Piaster �ow�Co�;t* , �,c., � 4* 79. FINAL�uxo-�PECf:ON �� � F. � .
� v , � o � �. . : � --�-t'lr= , �
t� 32.'ElectricaDPower MptervFti�al +� � I �!� Slx FOOD Ct,ERTi�l�fSTE �siJED' �.x�,'
r .v. i � �i '. �b'. �: ^ ,::�
33."�ind,Elec[ri� 'ti.'��,. �m .�,.,� i,� �; �� I �,� (�lotes: � m;^, i: H�C _
� I .� y . . i . . , u. . . �
34.;,�ina�liHeaiing_& A,cn'yCoi�ciitioning' lr �� ( � �a' i� �� t-+6 x" Gt h� !
c. r� �r� .� -�+ •k ;`. •-t rt.`.'j x.:�, SG I
:kH IE' �..�J �.F- .: �r[.
35.'_final Gas'.Pipe=Te t:� � " � �;; .� l
�. t�,.R et x: � {r. R, . ..,� s: i-;
; 36.:�Flood or Cano �
pY .iY' � t'1 i'�:?] �n a: � C_7 TU k rn, y't� �
n' t i".' T # ir' � 1 Y [; i
� 1 i--c. -.� * tY. X .0
' 37. FinafFa'c,s�ory FireFi�irLe` i „„ � � ,�; � � i* � �;. �; s
: 38. Fin2l�Plu(nbing �+ � -r��J i � � I � I• �+ - +: ~ c�
�� z rr
39. Water S"�ice<Final* � � � '�� � ' "' � � S
�i, .� x �� � � I � �.�. . �-i a;
= 40. Gas Service-Final � '� nE..,;., �'r, x ��� i � � i= • ._ : * -.
�. I I IY .?'r/ ^�N i
� 47. Solar pomesf+c-Fina'I �� �- �* " ="-' 'T e'� �
�. - . r� n� r � � f+ �- ,� �.�: s
42. Backflow Prev�nter v r3 Q,-+� x.-. t'. t'1 [T70^� *� � .
� .,
3. Backflow Irr Stion�' � � � �' � ^ �' �' '
4 ':.'S r. ac F :u c � p:.�
r• �; a � �• ,�,t. �_ ,• ., � u, , .� ' . _
;d4.f.Landscape IrnAatio�a System� E;,.; t� K<L <S* � a" � :. �.� � � S •
��
45.�Tsound A�teri�ation= "�-' .. ' '* ��. �T: M.'r. F cY `Z ' t-''7 X
t�, x J w C-3 . .. ..�; � . �:n ••.-�
�?t6. Handicap�Regulatioyis S �: t r � i t.i: � tT:vii v V :� i�
-:47. FIN7TL STRUCTURE & BUILOING �` f" I I �" `' �' •r `''
r.t T w :r. �^ k I I r� '7 * :�
( � t r-�~ +.�_� �• .�•. -
48. ��IN,�L P6ANNING1 x I�: r � ro � �: 6
i r,
=49. Electric ftelease to fidison � c: '" �� ~ G
:, � � ' � � :i o,'^. ;i c:
Y
",50.'Gas�Belea'se to Sout�`ern Califor+ia;GasCo x � r � po �r'i x to 0
51. CEFiTIFICATE OF OCCUPANCY
No. Date
�� _--_I_.a _ � -� . _
'____'_.-__"�!Cl-�"�: 9 �-f��-?l�v�.��.4� _'_. _ _".___'._ __' .'_ __
��� �i �� �
- 'i�, ; �u,�.Q,:e-w-�'(�-ar.,�. � C�� 4-01�-- -
-- . -� -� - � - - # �_E - - ; - --_ __ . . - - - - -
'`�-Q-� �.w,�=---
_ ��,�, . c.�,,,c.�Q� `�, �Q� _��.i�ere.. � ��:.��
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_ . . ���� �
OWNER .S:�J:�.Co6ki-: Sf.?"GEj: '• DATE 8—�l-5�1
JOBADDRE83 S7O W. 20th Street BUILDINGPERMITNO. I15O
GENERALCONTRACTOR S. J._C003C & SOII VALUE 5 300.00
i (�87 e�ocK rRncr 1712 Sin�le Gara�e £rom Carport
INSPECTION$ I DATE I' SUBCONTRACTOR I PERMITSISSUED
Foundation Forms and Grade to
Rough Framing
Plumbing, Rough to Slab
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough
F ;ring
Plumbing, Final, Fixtures
Plumbing, Fi�l Gas Test
Wiring, Final
Occupancy
. Ha�m z�o r.-a iet iasa
Costa Mesa. Building Department
171 EAST 20th STREET
^"�`� 'COSTA MESA, CALIFORNIA
. FOR APPLICANT TO FILL IN
COSY� MCSfL,
Cross St.
Owner
Mail
Address
Tel.
S.¢ No.
Lic.
r
Address��/ � ��A-GE�yi7yQ�-1! c�
Descr ptfon I No. ��� I Block I Trac�.
(Attach Metes a�d Bounda)
SizeoTLotI/O�%�<Q��LINowonBLt� �
Useof No.of No�
ExistingBldg. W���h%t" IFamiliesr Ro�
Set6ackLfnefrom � RearYard
Center of Street SJr Side Vard /
I I Moving I
�QX 2�I No.of �
Rooms
Vall./1 .. I Roof
Z
APPLICA�'ION FOR PERMIT
458 BUILD,�NG '�
k'OI� OF'FdCE iJSE ONLY
_ ..� ReceiptNo. _I - PermitN
ZL-L
Building
Address
Cross
Zone
�
�W � 0.� �,�
a Mesa, California
��
APPROVALS
ioh• ^ I Inspectoi
�s. ,z ]
Fire Stops,
ip. Bolts
I hereby acknowledge that I have read this Application �ac�. inc.
and state that the above is correct and agree to comply �ath. Ext.
with all City Ordinances and State Iaws regulating
building rnnstruction.
Signatureof Plaster, Int.
Permittee
Plaster, Ex1.
Authorized Agt.
Masonry ReinTorced
Valu.ation Permft Fee $ ,9. �C
� p e Plan Check $ A Bond Beam
$ D� � Total �f
Fee $ ic . .� � FiNAL
. FORM 204 �-H 2M 5-54 ' � .
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PLOT PLAN
Show �loeatipp and.� isYances�fromr
propeHy�lin�e and�tieKv'een bui�ltlings.� ���
. 458.` .;. ' :
, �: ; .. ':
�_ . , ,
\OWNER
��JOB AC
GENER
0^ No.
soi� E�
� GAS
W ATER
DAVIES� Aldis E.
PROP. SWR. LINE U HOUSE CON. U
SPRINKIING SVSTEM
MISCELLANEOUS
ROIIGH HEATING AND AIR CONDITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUN� � POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF.
FLOOR SVSTEM
BON� BEAM n STEEL REINFOfiCE n
FRAME ANO FLASHING
LATHING - IN n (
PLASTER. BROWN COAT
S" 'TURAL, FINA�
! NG, VENT., REfRI
PWMBING, FINAI. AND
ELECTRIC, FINAL
BUILOING. FINAL
[a�
TRACT
FIRE ZONE
DATE 6-4-75
BUILDING PERMII
K Legali
VALUE S i �nn _ n
SUBCONTRACTOR
.., ._.
�� 40086 )lIN—i�"�SPAICOO �Zli# �*k�30.50
���5,
COS7A MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
A PL CA ION FOR BUILDING PERMIT
For Applicant to Fi!! in Completely REc DATE RECEIVED
/'-�j �. /^' D TE ISSUEO
ADDRESS O K/ � GC/ �� (.� �' �7
OWNER /� � E� VIES A.P.NO. ���G� PE '
MAIL BVILDING
Z . /,/
ADDRE$5 S�n7�. �+DDRESS O �/�
aU CITV �eS NOLlMS'7ySj TRACT Z LOT BLOCK
H Z
2 Q CANSTFUCTION �Lf/ �G•/�.
Oy LEN�Ei� ,
am
J � BRANCH )
J� OWNER I/C vIC�
m J ADDRESS y � ,�/ VALUE /�
m ARCHITECT TEL. $ IZL �/✓`' /Y v$ IO'� ✓
J N OR ENGI EER �
V FIRE
w� ADORESS 20N PE GFOUP
� w APPROVED �
J O CONTRACTOF G/,uH,Q n BV � DATE ��
m Z
J � ADDRE55
w w TEL. ZON NO.OF USE OF NEW
Z= CITV NO. � P��� BUILDIN
H
w � STATE CITV VAROS APPROVEO VARDS APPROVED
y¢ LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
_ � 512E /� � � NO.OF BLOGS. / (FROM GlSTREET)
OF LOT 7v >C�/U NOWONLOT / p({ FT. FT.
USE OF / �� �j �`
E%I5TING BLDG. /yp iM ! /� C% G_ + FT
Z NEWBLDG.�° I flOOMS STORIES L.SIDE K,/ FT. FT.
U EXTEfiIOP WALL ROOF
COVERING GOVERING REAR FT. FT.
J USE OF dUILDING AND�MORK TO BE PERFORMED' DiSTANCE BET, gET. MAIN &
a MAIN BLOGS. ACCESS. BLDGS.
a �7
Q VAR.qW OATE � I' / S
O �L /% —U • C.U.P.�b�-+ � � APPROVED
y APPFOVE �� tl 7�
7�
Z HOLD OR PEC
o ,fyy�
VI horeby acknowlatlga t�at I have reetl this applicetion antl state S�G ,//7 ij�j'E
� [ha[ t�a abOve Intormation is correct antl aprBe to comply with
� ell laws reg�la[inp builtlinp construction, antl I shall not employ
r eny perso� �� ��olallon of Me workman's companution laws of
y the Steta of Califomia. � m�p
? 1 heraby cartify Nat I em pro0erly Iicansotl af a eonnector untlar n• FT. d
Na Stero of Californie Buzineu ontl Prafavlons Cotle, Dlvialcn 3, E AMOUNT SMOWN UNDER VALUA IS FOR ;
Chepror 9, entl that such licenses ere in full torce antl afiact, or I THE PURPOSE OF ESTABLISMING A VERMfT FEE ONLV: ¢
am exempt trom the provisions of tha Siate ol COIlfornie Bu�inoa VALUA710N
nntl ProlessionsCotl Div on , Chap[e� . PERMR FEE $ �
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SI natura 0� / /�/�/ ,�'7� � m
Permlttee /C �r l� 5 I.L(J (J PtAN CNECK $ E
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AuthorizBtl Apent LL
TOTAL FEE S .
rv�rc ' UAIt
B ADDRESS • ^ BUILI
A� �0.117�4-/'L-1'/ LOT TRACT FIRE ZONE VALUI
I1. cCTIONS Si naeore Dare TYPE GROU
soi� SUBCONTRACTOR
� GAS
WATER P1.....6{.... _
PaOP. SwR. IiNE U HOl15E CON. Lf
SPRINKLING SVSTEM
MISCELlANE0U5
ROIIGH HEATING ANO AIR CONOITIONING
TEMPORARY SERVICE OR POLE
UNOERGq0UN0 � POWER �
FOUGH WIRING
TRENCHES � FORMS � STEEL RE
FLOOR SVSTEM
BOND BEAM ❑ STEEL REINFORCE I
SHEATHING
FRAME ANO FLASHING
LATHING — IN rI OUT [�
PLASTER, BROWN COAT
'TURqI, FINhL
N. iNG. VENT., REFRIG. AND A.C., FI
PLUMBING, FINAL AND GAS TEST �
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- 39959 ,NY-9-�s�„—s.00 365- S.SC
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
PP I TION FOR BUILDING PERMIT
' For Applicant to Fill in Completely
REC DATE RECEIVED ATE ISSUED
ADORESS 0� O C G MG �` �� `7
�
+ ' A.P. NO.��S�� (Z� L� PEFMI NO.
OWNER �
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Z 1n �n
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m ARCMITECT TEL. $ �J��
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a W APPROV }.�
W Z CONTRACTOR / r BV OATE �/� �
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m Z 1
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w W TEI. 20N NO.OF USE OF NEW •
�= CITV NO. P�� � BU�LDING („E(s Z
Z F
w � STATE CITV 1'AROS APPROVED VARDS APPROVED
y� LIC. NO. LIC. NO. MAIN BUILOING ACCESSORV BUILDING
_� SIZE � � NO.OFBLDGS. (FROMC/LSTREETI
OF LOT � Q�[ � NOW ON lOT r OM FT. FT.
USE OF c �
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F� SIZE OF NO. OF ' S FT. � FT.
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a {-� �Q �[
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o � '�OLD FOR SPEC! 4 t� UIR�MENT
v1 herebY acknowletlpe thet I have reetl t�iz application antl smte
� thax [ha aCova informatio� Is correct antl apree to complY wtth
� all Iaws ragulatin9 builtling conrtruction, antl 1 zhall �ot employ �
F any person in vlolation Of th¢ warkma� s eompensation laws of
y the Stete of Celitomla �
zI heraDy certify thet I em Properly licensetl as a connector untler S�. FT, o
Ne Siaro of Callfornla B�siness antl Profenions Cotla, Divisicn 3, TNE AMOUNT SHOWN UNDER VALVATION IS FOF �
C�eptar 9, antl that such litonses ara In fuli forca antl eftact, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV: �
am axampl }rom Ne provisions of cha S�ete of Cellfornla Businesa VALUATION Q'�
anG PrOfassiO�s Codo, DIvItIOn 3, Chapta� 9. �� H
PERMR FEE 5
SlBnature of (�,, n /� ]� p o-� °�
Permfttea �`r`�A- �Qv��� %���/�(�� S D`f PLP.NCHECK S E
d.� G
Au[horizatl Apent � �' LL
TOTAL FEE $
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BUILDING PE
�1 AP No. LOT 4t57 TRACT 1712 FIRE ZONE VALUE
� GAS `
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ROUGH PLUM0ING
PROP. SWR. LIN6 ❑ HOUSE CON. �
SPFiINKLING SYSYEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONOITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUNO � POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF.
FLOOR SVSTEM
90N0 BEAM ❑ STEEL REINFORCE n
SHEATMING
FRAME ANO FLASHING
LATHING - " ^"� �
PLASTER,B
STRUCTURAI
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SPFf I41 V FFtllll F
REFRIG. AND P.C.
...,. �.� r«� r
SUBCONTRACTOR
�
+- -- �
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C05fA MESA BUILDINGSAFEfY DEPARTAAEt�R
p, O. BOX 12J0 COSTA MESA� CALIFORNIA OZ22E
For ApplicaM ro F711 In ComplsNly
s
TYPE OR PRINT
Bui�o�Na �Q7� �2'. ei�r �T
ADDRHYY
CO3TA MESA. CALIFORNIA
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LIN6 IROY
DESCRIPTION OF WORK
1 N6PQSV ACKHOWL[DCt TIAT.1 M�V6 R�AD TNI� AI�L�GTON
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VAR. Ii
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VALUATION 19 FOR TNB �
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