HomeMy WebLinkAbout919 20TH ST - Building Permits� � �oowFssaem�uw: 919 W 20TH ST
j avrrtxsr«�eiva�wrr+: RENFROW, FRAMPTON YOUNG
.onxEss: RENFROW CAROLE B
919 W 2bTH ST
OSTA MESA,CA 92627646-5455
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mr+m�aarsxu¢ LUKE ROOFING ( 714 ) 633-8798
CdNfp�CTOR4YYWq 448 S MONTGOMERY
,�m�ss ORANGE CA u�xo: 672569
92667 u,.i:
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who bulUe a inpwea Ilwson, wd wfio doee audi wak FbnnE a henM a Wap� hu a Is own emplryau. pvrided iM woh
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WOFKEH'S GOMPENSATION DECLAPATON: I MroEy Nfim uMa penepy d prNvy w d ihe bAow'uq detluebm:
� I hew eM rN mei�uen e ca�ilktle d mwni to ��p�inwn br wahsi mmp�nWbn, n pwNod la b/ 8eqbn ]]00 d �M lebar
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ri' ���,.nw�mmo.�n��m�.a.My..«��S1ATE FUND �'���m�v EXPIRES
c�..:
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bec e euEjea to ina xorluri canpanwion lew+ d Celiromie. eM yree ihx M I�Muk Ea�OiiTe uE�w io �M worMen'
compe�iuyetion pw/i�iom d Sadion J]00 d iM lebor ('ade. I tluY IonhrMA wmDl Ab Opwy� pvAy '��1
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Ssctlon 9106 0l fh.Wo. co6. Intwu4 �ne.trom�V: Iww
CONSTNUCf10N LENqNO AOENCY: I Mraby dfirm �adr qrotly d perjury tAe tMn u e amn�uGbn Wd'np yricy br tlr
perlormema d IM woek la whiM ihe permi e eawC (Soqion �041. Cw. C).
lENOEP'S NMIE:
LENDER'S ADDFESS:
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�°`��'P'tl�'0�`°�"' GARY LUKE
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yp ApeN/ �eda
(St51�8.WP) Whne-BWd�q85dwY:G�esrFde:Ge^uY-�DGk'�:Rnk-Mavn:OaMavod-Aaamor
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: B 079485
PERMIT NO: H 079485 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLE SQ FT: 3,000
CLAIM VALUE: 3,000.00 CALC-VALUE: 3,000.00 GROUP OCC: R-3 /U-1
COMMENTS: RESIDENTIAL REROOF
if if if iE 1E iE iE iE 1E 1E if 1E fF �E 1! 1f 1!!E iE it if !f 1E if ik 1f if !F!E!E k ik if i! if 1f 1f it IE ik it iE iF fk 1f iF it i! 1f k jE k 3f if 1F 14 iE iE ih fE ik 1f !k df IE �k �If 1E 1E iF iE 1E 1E iE iE iE iE iE iE
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 HUILDING ---------
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: 42249447 ZNE: REF NO:
PLANNZNG N6TES>
%
jE iE iE 1E iE iE iE 3f IF iF iF iF IE if iE iE iE iE iF iE 1ElE k IE if IE 1E iE 1ElE iE 1E IE IE IE 1E iE IE iE 1E 1E IE iE fE 1E iE IE iE iF iE iE iF iE iE 1f iF iE if iF iE iF If iE iE iE iE iE iE iE IE iE iE iE 3E iE iE jE 3E iE
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
ZONING APPROVED HY . DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
iE �k iF iF if if iE if 1E iE iE iE IE 1E if if if fE iE iElE if
LEGALIZATION;N
F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 74.75
DATE:
STRUCTURAL SEGMENT;Y
FIRE SMIP/RES GRADING
.SD
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
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
74.75 .50
1E fk fE If 1E iF iP 1E iE �E IE IE IE iE 3E iE 1E it iE ib ib 1F iF 1k iF iE �E if if 1F fE iF iF Ik 1E if if 1E 1E 1E 1E IE 1E 1E 1E IE �F M 1E 1E iE ff 1E 1E 1F iF if iF ik if IE 1E jE 1E If �F if 1E 1E iE iF if iE IF iF 1F 1E 1E iE
I N D I V I D U A L F E E B R E A K D 0 W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3000 ALTER HY VALUE RESIDENTIAL NOZONE 1.00 3,000.00
END OF FEES
EXPIRED
DATE 1 � �"1��� —
O1 002Y4992-00214993 T O T 15.25
DATE: 09/!6/9` TIItE: 13:ib
�
\�/
CONSTRUCTION AND PLANNING POf '� SPA
qpPqOVALS Permit �p Date Inspector qppROVALS Nermit # Dace Inspector
7. Temporary Eleczrical Service or Pole 52. Pool & Equipment Location• •
2. Soii Pipe-Undrgrnd. 53. Steal fteinforcement
3. Electrical Conduic Utiliry-Undrgrnd. 54. Forms
4. Electrical Condu�t-Undrgrnd. 55. Electrical Bqnding
5. Steel Reinforcertient 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. Eluctrical ConduiFUndrgmd.
8. Fountlation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe•Undrgrnd. 60. Backwash �ines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Cannection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent�Final
73. Roof Orains � 64. Plumbing SYstem � Final �
14. Rough Plumbing 65. Electrical�Final
75. Rough Elettriwl•Conduit 66. Solar SYstem-Final
16. Rough ElectricWiring 67. fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVEO FOR PLASTERING
18. Rough ElectricahT Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace . APPROVALS Permit #
21. Ducts, in Structuce . 70. Underground Hydro
22. Dvccs, Venci�ating 7ti. Product Piping OGas OOit
23. Gas Pipe-Rough & Tesc - 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI
25. Foot Sheathing q��7-�� �(�. 74, Overhead Hydro
26. T-Bar Ceiling (Strucwraq & Monocoat 75. Dry Chemical -
2L Frame and Flashing . 76: Dry Standpipe _
28. lathing & Siding 77. FIXED SYSTEM FIIVAL
29. Insulation � � 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREAAENT
31. Plasrer Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIPICATE 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-Finai
40. Ga: Service-Fina� � - �
47. Solar Oomestic-Final ,
42. Backfiow Preventer �
43. Backflow Irrigadon �
44. Landscape Irripation System _
45. Sound Atte�uation � �
46. Handicap Regulations . .
47. FINAI. STRUC7URE & BUILDING
46. FINAL PLANNING �
49. Electric Release to Edison •
50. Ga: Release to Sou[hern California Gas Cn
51. CERTIFICATEOFOCCUPANCY .
No. Date ,
AGo���ant to fill in a11 spatts exceot [�ose witnin heavy Dortler lines ana si9n all approvriate deelarations.
�CITrY ��STA MESA9 CONST,�UC�T��N �ERMIT
Project Address w U r�, ''d�
Applicant's Maili AdtlN es � �J.(.�'�
Owner'sNam(�g ��N'��� ���% �one ���r7
Address `����• r �T
• Arch/Eng. — - -- Licenu No.
Address
Contracror's Nam � �G� �/� Phone �
Addresslmailingl�� �2W�T
Ciry License No.
LICENSED CONTRACTOR OECLARATION
I bereby aflirm that I am licensetl untler proyi5iOn5 af Charte� 9(commencing
witn section 7000) oi Divlsion 3 of t�e BUsiness ana Protessions Cotle, antl
my license is in (ull rce antl elfect.
License CIais ��.�i se No. � �
Dale �L17.0� cionrt�re _
WORKEAS' C MPENSATION DECLARAT�ON
' 1 her¢by aHi�m thal I have a certiflca[e of COhSCn[ to selt-Insure o� a cerfifiWte
of Workers' Compeniation Insurance,� or a�ertifietl topy tpereot (Section
3800, Lab. C.) -
Poiicv No. �`L� ���'7� rCompany (/✓�155!(�%l
� Certif�1e�tl copY is be�eUY'[hr[hehc [Y Itli�g p �
`
�ate ((L� �Applicant
E%EMPTION FROM WORKERS' COMPEN$qTION DECIARATION
(Tbis section neetl no[ be campletotl if the pe�mit Is for one huntlretl (y100) or
less).
, I certify that in [he pe��o�mance of th¢ work tor whicn lhi5 pe�m�t i5 issuetl, I
",Snall noi emplOy any pe�son in any mann@� so as to beCom¢ SubjeCt to the
�Workers' Compensation Lawz of Calilomia.
Date Signature
NOTICE: If, after makin9 this tleclaration, you shoWtl becoma subject to the
Workers' Comp¢n5ation provislons of th¢ I�bor Cotle, you must forthwith
comply with such p�ovislons or tlfis permit shall be'tleemetl tevoketl.
CONSTRUCTION LENDING AGENCV
I nereby ai(Irm tnat there is a construction Ientling agency for the pertormance
of the work for which ihis permit is issuetl (Section 3097 Civ. CJ
Lenaer's Name
Lentler's Atltlreis
OWNER BUILDER DECLARATION� �
I hereby affirm that I am exempt irom the Con(ractor's License Law Por Ihe
followin9 reason (Section 7031.5 Business antl Grofessional Cotle: Any <ity or
county wM1ich requi�es a permit l0 conStruGt, alta�, improvB, tlemolish or �epai�
any structure, prior to its issuance, also requires the applicant for such permit
to fil¢ a sign¢a statement tM1al he/She Is Ilc@nsetl purzuant to the provision5 of
the Gontractor's License Law (Cnapter 9(commencing with Section 7000) of
DiviSion 3 of [he Business antl Profession5 Cotle) or that he/zne is exemp[
theref�om antl Ihe basls for Ihe allegetl ex@mption. Any violation ot Section
7031.5 by any applicant for a permit subjects t�e applicant to a civil
�enalty of not more than five nuntlretl tlollat5 (5500).
1, a5 owne� of the property or my ¢Mployees wilh wages as Iheir sole
compensation, will tlo t�e work, antl the structure is no[ intentletl or offeretl
for sale (Seclion 7044, Business antl Proteszional Cotle: The Contractor's
LicenS¢ l.aw tloes not apply to an owner ol a oroperty who bulltls or improves
the.eon, antl who tloes such work himself/herzolt or throu9n his or her own
employees, proviGetl tM1at suCh improveman(s aro not intantletl or ofte�etl tor
sale. It, however, the builtlin9 cr improvement is soltl witnin one year oi com-
pletion, Ihe owner will nave tha bu�tlGn Ot p�ovin9 he/ihe tliC nol builtl o� Im-
�rove to� ttte purpose at Sale).
I, as owner of the property, am excluiiytly conlracting with Iicensetl Con-
ira<to�slo COnst�uctthe project ISection 7044, Bu5ine55 an0 PrOte55ion5 COtle:
The ConVactor's License Law doe5 nol apply [o an Owner ot pmperty who
builas or improves th¢reon, antl who con(racts for such projects wlth a con-
tractor(sl license pu�suanl to the Contraclq�'s License �aw). I am aware Iha[
proof of tlteir Worker'S COmPensation InsuranGe ShOultl b¢ p/ovitletl to me.
❑ I am eaemo� untler Se<tion 8. & P. G. for Ihis reazon
Date
I hereby certity tnat I
Iniormation is correcL I
antl s[ate laws relating t
sentatives of thi ty
insoe�tion purp . '
Si9nature
Drivers' License or 55 �
Owner
have reai
to
1 this aOPIiWtlOn antl Slate that the above
comoly witn all clty antl county ortlinances
9<onstrutHon, antl nereby aulhO�Ize repre-
�upon tha abovC-mantionetl p��o�p/¢/rty fOr
� Date_��_
, _...� i-3�3 . .._.l.;Z -z - ..,.,, ,.,..
TYPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH OTHER `�J�� q.p, #
DESCRIP710N OF WORK/USE OF BLDG.C'��'� ���'��`� ---
S Main Buildi
E
TVPEOFPERMIT GRAOING FOVNDATION STRUCTVRAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reaf �
❑ OTHER
PROJECT DESCRIPTION 5�. FT. OCCUPANCV �— � C Right �
CONSTRUCTIONTYPE VALVATION$��D���� g Left
ZONE GRAOING CU. VDS. ACRES ping. Ref. #
Remarkz: �G, �� I 4-84s �l Nl�l..�� �o � b�( PlanningNotes:
. 4�/�t�2c7 !1'1��1'L <
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceprors
Kitchen Sink
Lavarories
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct- Under Ground
DuCt - SVUCtufdl
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BI�. IC80 #
Heating System & Ducting
❑ 0.100,000 BTU � 100,000 BT�
Reinspettion Fee � $15
CMF 0865-46, rev.4/89 White - Builtlin9; Canary -Applicant; Pink -Accounting; GolOen�otl - ASSesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Warer Heater
Water Service
laue Fee
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000eru ❑ioo,000
System Repair/Alteration
Issue Fae
253Q 6�2�/84
._ Zone
Accessory Buildin9:
�
( S �G11
S _Di�
Parking Req./Provided
Automatic Washer
Constructior Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elecvic
Fan
F,A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generotor �0-5 KW �5-15
$ 3 '
Reinspection Fee
FEES
T DEVELOPMENTSER
I 2oning Approved By—
Buildin8 APProved By
$ 3
$15
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+ KW
Merer ❑up w 100 amps
Meter ❑over 100 amps
$ub Panel
Motors �0-1 HP Oi'h - 8
Inc.Solar �9�15 HP �76-15+
Microwave
Pole Light
'#p Range
S9.I? TI
FEES
Standing Sections
Trash Compactor
luue Fee $ 3
uTs: i_�n
Z
O
N
1
N
G
R
E
�
M
T
S.
SUMMARV OF FEES
BUIL�INGPERMIT $ ��� SMIP $ � S�
PLANCHECK $ 2S•O%i pEFM1T
PLUMBING y �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL y `I-•� GRADING $
• PLANCHECK 50% $ .-1D MICROFILM $
MECHANICAL $ TOTAL FEE $ �� • � ��
PLAN CHECK 25% $
� � ONSTRUCTION AND PLANNING
� APPROVALS Permit #
�. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical ConduibUndrgrnd.
5. Steel Reinforcement. �
6. Electrical UFER Grnd.
7. Footings . a�
8. Foundation , S
9. Water Pipe-Undrgrnd.
10. Structural Floor System
1 i. Property Sewer Line & House Connection
12. Sewer Cap , �
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Cqnduit
16. Rough Electric Wiring ��
17. Rough Wiring Sign •
78. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & 7est
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing ��
28. Lathing & Siding � �
29. Insulation ' �
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric �o
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 pomesticFinal �
42. Backflow Preventer
43. Backflow Irrigation . .
44. .Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulatiqns
47. FINAL STRUCTURE & BUILDING ��
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
57. CERTIFICATE OF OCCUPANCY
Date
Date
C
POO� _ SPA
Inspector AppROVALS Permit# Date Inspector
52. Pool & Equipment Location
53. Steel Reinforcement -
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57: APPROVALTOCOVER-GUNITE
�) 58. Electrical Conduit�Undrgrnd.
5 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
- 62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
t 67. Fencing & Access Approval
- 68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL .
FIRE DEPT. REQUIREMENT .
APPROVALS Permit #
70. Underground Hydro
71. ProductPipingOGas ❑Oil
72. Underground Flush
� 73. Undergrnd. Storage Tank O Gas � Oil
�,�� 74. Overhead Hydro
75. Dry Chemical
C 76. Dry Standpipe
�,_.� 77. FIXED SYSTEM FINAL
� n "Z_ , 78. FIRE PREV. FINAL
HEALTH DEPT. REQUIftEMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
C� Notes: O.K T/FlSui ./(�iI!/��� L•.CC,
m
ApPlicant to fill in all spaces except thase within heavY bortler lines anG si9n all appropriate tleelaralions.
CIT� OF CDSTA MES ) /C�'/ONS�ua��y S�MIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.
Project Address �j –/ � �/ /� �'
ApplicanYs Mailin,99���(A�dd�r�e3s,� �� 4/ e W��/���
Owner'sNamce '�I[�t�t�n:'��% Phane�,�G;�2.J
Addreu YY�`!�
Arch/Eng. License No.
Address �-�/�� �j�
Contractor'sNam f�.�� � Y'� Phone�77��
Addresslmailing) -�"��
City License No.
LICENSED CONTRACTOR DECLARATION
I h¢reby a/firm that I am licensetl untler provisions of Char[er 9(commencinq
with section 7000) ot DivlSion 3 Of the Busine55 antl Grofesslons Cotle, dntl
my Ilcense Is in /ull torce ana ettect. ��/O
IJcense Class - . � e �
�ater/>"R � Signature
WORKERS'COMPENSATION DECLAR ION
'e; hereby aHirm that I �ave a certifica[e of mns¢nt to selt-Insure oi a cartiliCate
�[tiyt Workers' Compensation Insurancey . or a certifietl cOpy,thereof (SeCtion
3800, Lab. �J��LUO� G7G ( �/1
PolicY No. d� ComPanY � /�//N
eCertitietl copy is �ereGy fumi5hetl. �
Certi/letl cboX �s (iletl with the city Buil i��
Date ��%"�'�� ' ApP�icant
EXEMPTION FROM WORKERS' COM E SATION OECIARATION
(Thlssection neetl nol be com0�etetl if the pe�mit is to� one huntlretl (E300) or
lezs).
I certity that in [he Derto�mantt Of [he wotk fot which t0i5 perm�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' CompensatiOn Laws ot California.
Date Si9nature
NOTICE: II, a(ter making [�6 decla�ation, you Shoultl become subjeGl to lhe
Workers' COmpCnSation provisions o( Ihe Labor COOe, you must torthwilh
comply wilh sucb provi5ion5 or thiz permit sball be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby a(Ilrm tnat tbere is a construction lentling agency tor [he performance
of the work tor which thiz Oermit �is i55uetl (Section 3097 Civ. CJ
Lentler's Name �
Lentler's Htltlress
OWNER BUILOER DECI.ARATION� �
I hereby aftirm that I am exempt from the Contractor's License Law for the
followin9 reason (Settlon 7031.5 Business antl Protessional Cotle: Any tlty or
county wM1ICM1 requires a Oeimil to wns[ruct, alter, improve, tlemolish or reDair
any structure, prlor to Its issuance, also requires the applicant tor such permit
to file a sign¢tl slatement [hat he/sne is IicenSetl purouant to [he provi5ion5 of
the Contractor's LicenSe taw (Chapter 9(commencing wi[h Section �000) of
livision 3 of [he Business antl Pw(essions Gode) or thaf he/she is ezemp[
ierefrom antl the basis fo� the all¢getl exemption. Any violatlon oi Section
,031.5 by any appllcant fOr a Oetmit Subjects ihe aOP��<ant [o a civil
Qendlty of not more than tive huntlretl tlollars ($500j.
L� I, as owner of the property or my employees with wa9es as their sole
comp¢nsatlon, will tlo the work, antl the structure i5 not intentletl Or ofteretl
tor sale (Se<tion 7044, Business antl ProfeSsional Cotle: The Contractor'z
License Law tloes not apply to en owner of a Oroperty who builtls or improves
thereon, antl who tloes such work himseli/herself or tnrough his or her own
employ ees, proviaea that such improvements are not intenaetl or otferetl (or
Sale. I/, however, [�e bulltlln9 m improvement is soltl wllhin one year of com-
pletloq lne owne� wlll have the burtlen of Oroving he/Sh¢ tlitl not builtl or Im-
�rova for the purpo5¢ Ot sale).
I, a5 own¢r Oi the property, am exclusively contracting wi[h Ilcensetl Con-
tractors to construct the Oroject (Section ]044, Business antl Profession5 Cotle:
The Contrac(or's License l2w does not apply to an owne� of pro0erty who
builas or Imoroves thereon, antl wno wntracts for such orojects wilh a con-
traclor(sl Ocense pursuanl�lo the Conl�acto�'s License Law). I am aware lhat
proof of their Worker'S Compensation insurance Shoultl be prOvltleU to me.
❑ I am exempt under Section B. h P. C. for thiz reason
Da[e Owner —
I hereby certity [hal I have reatl tbi
into�mation is correcl. I a9ree to cortf
antl state laws relating to builtling co
sen[atives ot this cil
insoection purpos
Siqnature
[ion antl state that tba above
aIl city antl county oralnances
i. antl herebv authorize repre�
Date�
.l—C � C�
TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, �6
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TVPE OF PERMIT � GRADING FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT ❑ EIECTRICAL ❑ PLUMBING ❑ MECHANICAL B R¢af
❑ OTHER A
PR0.IECT DESCRIPTION 5�. FT. OCCUPaNCv C Right
K Left
CONSTRUCTIONTVPE VALUATION$ S '
20NE GRADING CV. VDS. ACRES Ping. Ref. #'
Remarks: � I %J� � �R, �T*-- Planning Notes: _
nk
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks �
Gas Service Outlets
Interceptors -
Kitchen Sink '
Lavatories
P–Trap
Roof Drains
Reinspection Fee � $15
Duct - Untler Grountl
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple �
Firepl/Fact. Blt. ICBO �i`-
Heating System & Ducting
❑0�100,000 BTU � 100,000 BT�
pF55 � �� ,/ I I Aeinspection fee
Drivers' �icense
CMF 0865-46, rGv. 4/84 White - Builtling; Canary - ApPllcant; Pink - Accounting; Goltlenrotl - ASsezsor
$15
Showers i
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Isue Fea
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000eru ❑ioo,000sTu
System RepaidAlteration
Issue Fee
FEES
Automatic Washer •
Constructior Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electri
Fan
F.A.U.
Fixtures
Device Boxes
Outlels
9738 10/09JB4
Zone
� Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter IJup to 100 amps
Meter �over100amps
Sub Panel
Mators �0.1 HP 01 X- 8
Inc.Solar �9-15 HP 016-15+
Microwave -
Pole Light •
Range
Garbage Disposal ' Standing Sections
Generator �0�5 KW �5-15 KW Trash Compactor
-10.50 T�
FEES
Z
O
N
1
N
G
R
E
Q
M
T
S.
$ 3
Rainspactian Fee $15 laue Fee $ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approvad By Date
Appliwtion Issued By Dat � �
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING - $ �SSUANCE $
PLAN CHECK 25% $ ppp ENERGV P.C. $
ELECTRICAL $ � GRADING $
PLAN CHECK 50% $ Z. MICROFILM $
MECHANICAL $ TOTALFEE $ �� "S�
$ 3 PLAN CHECK 25% $
CONSTRUCTION ANDPLANNING - � � POO .SPA
�APPROVALS Permit# Date Inspector. qppROVALS Permit# � Date Inspector
. 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
►
2. Soil Pipe�Undrgrnd. 53. S[eel Reinforcement -
3. Electrical Conduit Utility�Undrgrnd. 54. Forms -
4..Electrical Conduit-Undrgrnd. ' 55. Electrical Bontling .
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �.
�6. Electrical UFER Grnd. .57. APPROVALTO COVER-GUNITE � �
�7. Footings • • , 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Und�grnd. � 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 ,
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 � �p o�c� �(� 67. Fencing & Access Approval .
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21.�Ducts,in Structure 70. Underground HYdro
22. Ducts, Ventilating " 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test , � 72. Unclerground Flush
24. Roof Framing .. 73. Undergrnd. Storage Tank O Gas ❑ 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
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air�Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy � -
37. Final Factory Fireplace � -
38. Final Plumbing ,
39. Water Service-Final
40. Gas Service-Final .
41. Solar pomestic-Final � �
42. Backflow Preventer � �
43. Backtlow Irrigation, , . , -_ �
44. fandscape 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. CERTIFICATEOFOCCUPANCY '
No. Date
ACPlicant to flll in all spaces axcapt thosa wit�in �eavY Gortler Ilnos anE sign ail approD��ata Coclaratlons.
CITYOF.►:OSTAMESA CONSTRUCTIONPERMIT PERMITNO. , TRACTNO. LOTN�� UNITNU.
�iojectAddress 9/9 W'LOTi�/ S�: GCM. �!Z •'L /
Applicant's Mailing Address SA/�7G
Owner'sName �QOLC �. RCNFA�O1,4�phone�'
Address 9/4 W_�__'L OTH Sl. G:f7SiANlc'SI?-
Arch/Eng. License No.
Address
Contractor's Name /� _Phone
Address (mailing) ' `
City License No.
LICENSED�CONTRACTOR DECLARA710N
I hereby affirm tM1al I am Ilcansetl untl¢� p�ov75ionz of Cha�te� 9(commencing
with section ]000) of Division 3 of e siness antl Professlons Cotle, antl
my Ilcense Is in full force ana effect. .
LI<ense Class ic nse No.
Oat¢ ' Si9natura
WORKERS'COMPENSATION DECLARATION �
hereby affirm tnat I �ave a certificate ot tonsent to selt-insure or a certlficate
f Workers' Compensation Insurance, or a certifietl copy thereot (Sectlon
3800, �ab. C.) .
Policy No. Company
❑ CerHfietl copy Is �ereby fumisheC. . �
❑ Certifletl capy is filetl with the <Ity Bulltling Division.
'ION FROM WORKERS' COMPENSATION DECLARATION
ion neetl not be cOmpletetl It the permit i5 tor one huntlretl ($100j or
that in the petfo�mance of the wOrk for which thi5 �m�t is Issuetl, I
�employ any oerson in any man r so as t.bec e subj t to t e
Cn�r�en�a i� Laws of C I�m��,n �� M��S
after making this Gecl6ratlon, ydu shoultl become
comply wl[h'sucb provislOns or [nls permit Sllall be tleemetl revoketl.
CONSTRUCTION lENO1NG AGENCV - ' -
I beraby affirm that thera is a constructlon lentlin9 agency for the performance
ot the work tor which this perTlt I5 issuetl (Sectlon 3097 Civ. CJ
Lentler's Nam¢
Lontler's Atltlress .
OWNER BUILDER �ECLARATIOfJ '
I hereby atfl�m Ihat I am exampt �rom the COn[racto�'s License I..aw (o� th¢
following reason (Soction 7031.5 BuSiness antl Protesslonal Cotle: Any U[y or
tounty whi<h reqWres a permit to construcq alter, improve, tlemolizh or repali
anv structure. orlor to Its issuance. also reauires the aoolicant for such oermit
i1.5 by any appllcan[ tor, a.pErTlc zuoJec6 [ne -applicani �o a crvu
wlty of no[ more than flve huntlretl tlollars (E500).
I, as owner of tha property or my employees wlth wa9es as thelr sole
�pensation, will tlo the work, antl the structure is not intentletl or ofteretl
sale (Sectlon 7044, Businas5.antl.Protessional Cotle: The Contractdr's
ense Law tloes not apply to an owner ot a properry who builtls or improves
r¢00, antl who tloes such wOrk hlmsel(/hersetl or Nrough hi5 Or her Own
O�oy ees, provitletl that SUGh ImO�ovements are not intenaea or offe�e0 fo�
• If, however, the building or Improvement Is soltl wit�in one year o/ com-
[IOn, the owner Iwill have lho burCun ot proving ba/sne dltl not builtl or Im- ,
�ve tor ihe purposa oi sale). �
I, as owner ot iha property, am exclusively contracUn9 with Ilcensetl con-
:tors tb construct the project (Section 7044, Business antl Professions Cotle:
� Contra<tor's License Law tloes not appty to an owner of properry who '
itls or Improves thereon, antl who contracts for such projects wlth a con-
:tor(s Iicense pursuant�ro the Contractor's License Law). I am aware that
�oi o� their Worker's Compensation insurance shoultl be O�ovitletl to me. ,
I�am exempt un0er Se<tlon B. & P. C. tm Ni5 r¢ason
-oate Owner _
I hereby-certlfy ihat I have reatl thls
informatlon is wrrect. I agree to comp
and state laws relating to bulltling Wn
sentatives ot this city to enter poi
ip5y ection pu�yc�e � �
Agnature ( /[�N-(Ei �r,
�Drivers' License or SS �
TYPE OF CONSTRUCTION LI NEW I.J ADD LI ALTERATION �LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH
DESCFiIPTION OF WORK/USE OF BLDG. ��l-� ���'�-1--
TVPE OF PERMIT Li GRAOING �U FOUN�ATION U STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sa. FT. OCCUaAN,Cv�
CONSTRVCTIONTVPE�=CCA�WALL VALUATION�'�
ZONE GRADINC+CU.YDS. ACRES_
Remarkz:
ai'the above ,f�
ty ortlinances
�.horize repr2-
property ior
Sink'
Preventer
Irrigation
Dishv.asher
Drinking Four
Floor Drains
Floor Sinks ,
Gas Service
Interceptors
Kitchen Sink
�3VdL01IC5
Heinspection Fee
0
tlets
$75
Boiler �
Duct - Under Ground�
Duct - Strucmral ' '
Duct - Ventilating . _
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO # '
Heating System & Ducting
❑P700,000 BTU'0700,000
Reinspaction Fee � $15
CMF 0865-46, rev. 30/84 White - Bulltling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
PLUMBING
Service Sink
Sewer Cap
Sewer Connection
$olar Collectors
Solar Pipin9 -
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater �
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Type I ❑
Canopy Type II ❑
Refrigeration Sys[em
❑0.100,000 BTU 0700,000
System Repair/Alteration
� Fire'Damperz �
� Registers �
Issue Fee
FEES
$ 3
FEES
r
$ 3
A.P. �Y+ —
S Main Building:
E
T Front
ARear
C Right
gLeft
Ping. Ref. #
Planning Notes: 7�
Aummatic Washer
Canstruction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
FixWres '
Device Boxes
Outlets
Switches
Garbage Disposal
Genereror 00�5 KW C
Fee
1578 II/02/84
,� Zone
' Accessory Building: ' j{
1
� TZ'J. l
' S � � L
Pa�ng Req./Provided
• 'P�Ll K 'ia �O� � �j� }-}
o � �-�'LEr!-� TO � � �
F�'-uP�'`�T�-(' Lth� •
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Me[er LJup to 700 amps
Meter ❑over700amps
i Sub Panel
Motors �0-7 HP �i'r5 - 8
Inc.Solar 09-15 HP 016-75+
Microwave ��
Pole Light
Range • �,
.\
4I.75 TL
FEES
; Standing Sections�� �
5 KW Trash Compactor� ,- �
S15 luue Fee . ' $ 3
DEVELOPMENT SEPVICES REQUI
2oning Approved By
Building Approved By
� � SUMMARV OF FEES - �
� BUILDINGPERMIT $ z-J�C`�� SMIP ~,$ � S�
, PLAN CHECK $ � b• Z� pERM1T � �
PLUMBING ' �§ � ��UANCE 3
PLAN CHECK 25% $ ENERGV P.C. $
� ELECTRICAL $ GRADING �S
PLAN CHECK 50% $ ' ' MICROFILM $ � �
MECHANICAL ' $ � TOTAL FEE �$ /' 7�
PLAN CHECK 25% �y '
Z
O
N
I
N
G
R
E
Q
M
T
S
CONSTRUCTION ANDPLANNING POO�.�SPA
�:APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
S. Temporory Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3..Electiical�CondUit Utili[y-Undrgrnd. � 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6:• Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE �
7. Footings G �_ 56. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water,Pipe-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgmd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13., Roof Drains � 64. Plumbing System - Final �
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit ' 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure �-! 70. Underground Hydro
22. Ducts, Ventilating ; 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Tesi 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oi�
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Fiashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailin� � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat • 79. FINAL INSPECTION
32. Elecvical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: • ¢ 8r� � Y. G•
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 �
42. Backflow Preventer
43. Backflow Irrigation
44. �Landscape Irri�ation System
45. Sound Attenuation �
46. Handicap Regulations
O�
47.FINALSTRUCTURE&BUILDING �_ � .D� L�g�v
48. Special Requirements Completed ,
49. Electric Re�ease to Edison
50. Gas Release to Southern California Gas Co •
;51. CERTIFICATE OF OCCUPANCY
No. Date �
� STRUCTURAL A RPP OV Lq ONLY
SEPARA7E PERMI=_ pR R�2��RED
FOR ELECTR!^� �, p. -,. ,,.,�
HEATI;'�'- •- ��,
.�, : ".1; � rn
aeFFi�,.�-,�,�� ,.,:n
��J �,7�it
��"17 "�i YI' � (//p`� I7'�/.a_~1
l.� �.1. d " `
� ���I� �'.����8
i ALL CiSP .. , -,; :� �PA�VY
- -~ , �• ��srs
r F�
(�3f �. , c. a..�:Sl�RE TO
;� ST.,i� ., --�T iH,.T TkE
itr'O�S: .;�_ S rcl • L��iiSIUN Of
! ADDlT)pyql REQJlREu� �J�SULTfD FO(t �
M�diS
`'�--��
�
4
�
W
W
Q
ti
N
1
/
�i 0 t o,vcf
,
1�► �=ss� o�y
(o' ��C
REttOENC[
�/N W/D�
�IN �✓!D�
��N��N gLvcK wHcc.
3 r�i9'N 13[a�K WifiGG
� I�J �ctDc Z�L'' +-t,E,t+ �LocK �.c.6��
11[e1D(NC[ �
9 �3 � .
+� �
N Z9
k
�
sraeEr
IIEf10[MC[
9�q
�
II[sIDEMtL
�
.4;.;. CI1y ���� �
w:. LG�-� �
j�� � P�N �05��/_J
, , �&T ip e � D EPT,
r � Rg�,
R /
��►pt � �p.�TE',--...�j.L� / s�an
tl�
�
W
W
N
N
I
Cement Coping Optional �
Channel Block With �� �8���
Norizontal Top of i0 �
Fences
For Fenees 5' or Less �
Vert. Bars 3/8'� at 4' •0" O.C.
Fo� Fenees Higher Than 5' —
Vert. Ban 3!8'� at 32" O.C.
Fill Cells Solid With Grout —
Where Steel Oecurs
Reinfo�cing Steel.Shall
Conform to Sec.A-15-39
A.S.T.M.
All Steel to be Lapped
16"or to Code
NATURALGRADE
TWO 3/8" BARS �
CONTINUOUS TOP
& 80TTOM
TYPICAL 6�� CONCRETE BLOCK FENCE
�
0
a x
��
�
> w
�_
a
>Z
a
i�
W O
U f
z
�.ec
7. o 'p N
O
° wioT
p� SEE Ch
Q BELOW
oL
i o" , .
ING REQUIREMENTS
GENERAL- NOTES
MORTAR: p�e Part Plasfic Cement, and
Three Parts Sand
GROUT: . One Port Cement TMee and
One Holf Ports S�cnd
COPING: O�e Part Cement, Three
Parts Sond
CONCRETE: Well Mixed I: 2� : 3%2
MaK. of 7%2 Gallons ot
Watflr Per Sack of Cement
CROVT MAV BE POURED FqOM THE TOP
OF THE FENCE
CELLS ANO AREASOF NORI20NTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN &
FREE OF AlL MORTAR DEBRIS, ETC.
BONDS SHALL BE PROVIDE� BV LAYING
BLOCKS IN STHETCHER COURSES SO THAT
VERTICALJOINTSALTERNATEIN EACH
COURSE.
'H OF E4RTHtCOTH
1/3 THE HEIGTH OF FENCE
�B�LOW BO?TOM OF FOOTING.
SCALE: I/2"= I'
WALL HEIGHT 6� 5� � 4� 3�
WIDTH OF FOOT�NG 14�� 14" 12" 12�
THICKNESS 4FFOOTING 10" 10� 8� 8"
DEPTH OF EARTHTOOTH 24" 20" 16° 12�
SPACING OF EARTHTOOTH 12' 14� 16� I6�
OWNERS NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _
City of Costa Mesa, California J0e ADDRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _
Building Department
. y i• • n• �r ia
.
R4i7s I�C3�EII+ffS1T, made ard entered into this Z 9 7T�-i day of
r'J %, , 19� by acd between CA i2 O[ E" S. I? Fn� F jZ � u/
hereinafter referred to as "I�ID OFd�R", and G,� . �.ir i l./�..�
hereinafter referned tv as "AA7A(��PP P12p�ERiY U4NER".
It is hereby agreed that a party wall will be constructed on the
properiy line between
9 �3 _�. �z vTr� si, e� vsT.a r�ES,� - - -
in the City of Costa Mesa, Coimty of Orange, State of California, as per map
reco�ded in Bock ��� , Page�� of Miscellanews Maps, in the office of the
CamCy Recorder of said Co�mty. 'I4ie party wall shall be peLmitted b� encroadi
IN WI1t�'SS FFIEFtEOF, the parties have entered into this Agreement the
day arYi year first abwe written.
i : � . •�;�. �:
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CA2_GL� i� �ZtNFRGu/
N�ne (2j�ed or Printed)
�/�j'W �ZO%H � C'OSfA N1F_'$/1
(A[��2SS )
• � • M� • •,�r •a • i a�•
.
(S ignat�e )
C E, Srr . L e
N�ne (4YI�'d ar Prin ed)
�-//3 ���-� ST, Cvsr�e Mcss/f
(Af3aCESS)
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�i J..T ����V l.l-11-4(--��
i��z��Y
(NOTE; please see revetse side for notary's state�ent)
OwNE� DATE 7/06/79
JOB ADDRE55 919 W_ 7flth Ctroo* BUILDING PERMIT N0. 373
�. 715-514-26 LOT 245 TRACT 1719 fIR
SOIL
c�s
W�TER
PAOP. SWR. LINE � � MOUSE CON.
SPFINKIING $VSTEM
MISCELL/.NEOUS
ROl1GN NEnTING �ND �IR CONDITI
�EMPOA4AY SEPVICE OR POLE
uNDERGR0UN0 rJ POwER �
AOUGH wIRING
ME ANO FLNS
LATHING — IN L I OUi � �
P� 'ER. BRO�'N �O�T
S ipR1L, FIM�L
HE�TING. VENT.. REFAIG. �ND �.C.
PWMBING. FINaL �NO W$ TEST [
ELECTRIC. FIN>L
SUBCONTRACTOR
%
F
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W
a
a
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F
5� 93o s,' S'a
COSTA MESA BUILDING-SAFETV DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
Y.V.6U.� I[UV GUJIAMtJN�GNLIYVMNIHtlLbLb
RECEIVEDBV P - .r7O
For Applicant to Fill in Completely — Use Ink Only "� -�� 4 8 3 7
ADDRES$ l.(� Q/ S/ A.P. N°. ►- 5►4 '��
BUILDING � /� I '
OWNER OR � B L /� m ADDRE55 I ot�l �Tj
TENANT
MAILING UNIT OR
ADDRE55 S � � SPACE NO.
TR.NO. � I LOT � � BLK.
TEL.
CITV [.'�s/ HS NO. 6—��/
CONSTRUCTION — . NEW ADD LTER REPAIR MOVING DEMOLISH
LENDER
BRANCH Q^ '-\
O W NE F�(/ (�J
ADDRESS VALUE
ARCHITECT TEL. USE L ��� E '�
OR ENGINEER
ADDRESS — ZONE TVPE GROUP
APPROVED
CONTRACTOR � C� R U L BV DATE
ADDRESS '
TEL.
CITV NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. �— IIC. NO. —
SIZE NO.OF BLDGS. (FROM C/L ST E
OF LOT NOW ON LOT
USE OF
EXISTING BLDG. ES C �� I
Separate permits are required for L. SIDE
electric, plumbing and heating work.
REAR
USE OF BUILDING AND WORK TO BE PERFORMED PLANNING A ION .�—�
� c, w � � ;
3 � DATE ���
APPROVED
APPROV � / .
�O
I heraby acknowlatlBe thet I heve reatl thia application antl rtate m
n
that the above Intormelion is eor�eci antl apree io comply with
all lews reBuletinp building construction, antl I shell not amploy �
any perwn in vlolation ot Me workman's compensation laws af m
tha State of Celitornie.
m
I hereby certify that I em properly licensetl as a contrector untler SQ. FT. N
the Stata of Californie Business antl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, antl that such licenses are in full torce and etfect, or I THE PURPO6E OF ESTABLISHING A PERMIT FEE ON�V: �
am exampt from the provisions ot tha Stete of Celitornia Buzineu VALUATION PERMIT FEE S 4
antl Professions Cotla, Divislon 3, Chapter 9. B L � u+
m
Signarira of � PLAN CHECK $ p
Permlttee ��?� L—�� . ��—az� $ ���//�� TAX E LL
or /� 'ai�/ 'S V
AUNorizatl AOent Date/—�—� TOTAL PAID E �