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Home My WebLink About143 21ST ST - Building Permits r t CITY OF COSTA MESA /4,-, BUILDING DIVISION F t, I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. us S. FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER. B07-01019 PERMIT TYPE B_ROOF2 STATUS: ISSUED DATE ISSUED: 11/09/2007 ' ISSUED BY: BJK JOB ADDRESS: 143 21ST ST CM - Suite/Unit: • Vicinity: RESIDENCE AND ATTACHED.GARAGE Squares: 1100 - - Valuation: . $2,000.00 SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING COMP ROOF,REPAIR/REPLACE SHTG AS NEEDED, 2 LAYERS 30#FELT,APPLY 20 YEAR 3-TAB COMP SHINGLES.PITCH 4:12 11 SQUARES OWNER: YELICH, DONNAAILEEN TR. Address: 345 WESTBROOK PL Unit: PHONE: ,. - : City/State/Zip: COSTA MESA,CA APPLICANT: VILLA,CHARLES -• Address: 1923 CHURCH ST Unit: : • PHONE: 949-650-1079 City/State/Zip: COSTA MESA,CA _ CONTRACTOR: R C I ROOFING COMPANY • _ License No. - 704392 Address: 1923 CHURCH STUnit: - - PHONE: 949-650-1079 City/State/Zip: COSTA MESA,CA 92627 CELL: ARCHITECT: - License No. . PHONE: • ENGINEER: License No. r. PHONE: • FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $69.25 - , F' Reinspection Fee: $0.00' TOTAL FEES $69.25 3 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE I. INSPECTION TYPE DATE IN1mALS CODE O INSPECTION TYPE DU)� IN1plALS 1616 Fixed System Final Fire Prevention 4 206 Final Mechanical 1266 Pool Spa Final I 208 Final Plumbing 200 Final Re-Roof 4At 1 i :, 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy r , , WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's .e. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: • Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ZI have and will maintain workers'compensation insurance,as required by ion 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • permit is issued. My workers' com•=nsation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: ` « � person is required to descend,will be made in connection with work authorized //�� by this permit,and that no building structure,scaffolding,falsework, demolition Carrier: \"lor dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This section need not be completed dthepem,l is valued at one hundred dollars($100)or less.) 2,Art 2.Sec.341.Title 8,California Administrative Code). Policy Number: J /amu - Z03-7 L IC, ❑ As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued t employ any person in any manner so as to become subject such person has a permit to do such work from the division. tH e workers' c pensation laws of California, and a r that-if I should ecom su t to he workers' cornovisions of Section 3700 of Apphranl's Signature Date the Labo ode I s comply with these provisions. r I„,Q .Q 7 Division of Industrial Safety Permit Number: Applira Date R HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No ($100,010), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full for e and effect. r/.G1 /' a registration form for acutely hazardous materials? 0 Yes ❑No Lic.# ��\_::�/ Class# 1�� ` - 2,9 (Section 25533 of the Califomia Health and Safety Code, with some ��1' L- exceptions, requires registration with the Costa Mesa Fire Department by (� n each business which at any one time has on hand a quantity of acutely azure Date 7 hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CO - - • LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? CIYes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes El No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS-LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter,(improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑ No issuance.also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the properly, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8. (If'yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she , CERTIFICATE OF:COMPLIANCE: I certify.that under.penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions: LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and'city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the ' - • to esa to enter upon the above-described property for • section purpose . agree not to occupy or allow occupancy of any building authorized by this per:y until final inspection. a • . fFC^ iw—:a_ Date �r/—.MS Date _ � IF —c? 3057-46(3/07) uth•.1]• Applicant Date ,j i\:� CITY OF :OSTA MESA • •, Ce BUIL*1 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t, 7fa 1 PERMIT �►'� Y305-00845 gtlbossnso (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 143 21ST ST Status: ISSUED Suite: C Applied: 05/27/2005 Vicinity: ROOF Issued: 05/27/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42618216 Zoning: Applicant: CHARLES VILLA ISSUED BY: Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 - Owner: YELICH, DONNA AILEEN TR Address 345 WESTBROOK PL - Phone: COSTA MESA,CA Zip: 92626 Contractor: R C I ROOFING COMPANY Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 License: 704392 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL 1 LAYER OF 15#FELT,20 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED.8 SQUARES FOR UNIT C • FEE SUMMARY Plan Check: $0.00 Calc Valuation: 51,000.00 Permit: $38.75 Claim Valuation: $1,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 - Total: $39.25 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 . - Rear 0-0 • Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) rimm=amiimmiminum WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. I have and will maintain workers'compensati n Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My qO worker9:eempense,Iloncertie and policy number are: Carder. I \ T� Policy Number: /(�Q /g, )y -Q `y (This section need not be completed If t e permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in th9yerformance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensati• -laws of California; :nd agree that If I shnmd h''"" _ ars'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply ' these provisions- t ?' —C -35 O T Applicant Sl•nat.•.: Date: 7 z7 WARNING:FAL- RE TO SECURE WORKS:: ::•r,• RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND.• .. ..... ... ON TO THE. • . - .SATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice und-eTp cions oof 9 a Iter 9(commencing with Section 7000)of Division 3 of the Businq�s and Plofes,5jpps ,and my license is in full force and effect.Lk.e _ l-� `7 �— Class a L 5 C7 Contractors Signature: - Date: 55 -7 7`Oc CONSTRUCTION LENDING AGENCV: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply t0 an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Lew does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure), 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?"- 0 Yes aterials)?"❑Yes No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or wit the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes j�No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes b No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with at state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc i•,. • •••V for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ` ignature gal Owner(s) Date Z7 -a-, A n tom\- Date CODE I. INSPECTION TYPE Va1a V I(iilWS CODE INSPECnIONTYPE gSTE OILS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof (O7-65— t AJct/�A 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,71:1' CITY OF COSTA MESA AC BUILDING DIVISION F , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMI+ - - aa.t • B05-00849 (714)754-5273 • Fax(714)7544656 • www.ci.costa-mesa.comsDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 143 21ST ST BUILDING Status: ISSUED' Suite: D Applied: 05/27/2005 • Vicinity: DETACHED GARAGE ROOF Issued: 05/27/2005 Primary Occ: U Type of Construction: V-N Parcel Number: 42618216 Zoning: Applicant: CHARLES VILLA ISSUED BY: Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA-. Zip: 92627 - Owner YELICH, DONNA AILEEN TR Address 345 WESTBROOK PL - Phone: COSTA MESA,CA ' Zip: 92626 , Contractor: R C I ROOFING COMPANY Address: 1923 CHURCH ST , Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 License: 704392 Arch : - - Eng: Address: .Address: - Phone: Phone: Zip: License: License: - SCOPE OF PERMIT TEAR OFF EXISTING ROOF,INSTALL 1 LAYER OF 15#FELT,20 YEAR COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEATHING AS NEEDED.4 SQUARES FOR DETACHED GARAGE BEHINDUNIT D FEE SUMMARY - Plan'Check: $0.00 Calc Valuation: $500.00 Permit: $23.50 Claim Valuation: $500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • • Total: $24.00 .- PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 ' Rear 0-0 Left 0-0 Right 0-0 ` ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 . Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) '' 1 DECLARATIONS C', , WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations::- - . , ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. IX 1 have and will main-In workers'compensation insuppnce,as required by sec' 3700 of the Labor Code,for the performance of the work for which this permit is issued. My worker' • •:n ation er and policy number are: �y ,/ I. I. Carrier: OA*, Policy Number: ( ice Q 1 ----ail --c)y (This section need not be co plated if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this Benoit is issued;I shall not employ any person in any manner so as t0 become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: ' 21 - o WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDrTION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 'censed• •- •r• 'sions of Chapter 9(commencing with Section 7000)of Division 3 of the Businemandd PrgjAssi��e,and my license is in full force and effect.Lie. . R9 Z Class p L ` Contractors Signatu •: Date: >,---C / CONSTRUCTION LENDING AGENCY: v ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civi Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Qualify Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No • 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCi AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is cor :Three to'compty with ell state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the c ve-described propertyf occupancy I agree not to occupy or allow of any building authorized by this permit until final inspection. Si... • Legal Owner(s) Date Z2 — ate -••r•r Auth •Appli aarrt Date CODE. INSPECTION TYPE ' ' `DATA!_ AAy1 CODE! INSPECTIONTYPE PMTS • 1NOMA15 1616 Fixed System Final Fire Prevention -206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof ' (-1^'cE vi41•^^ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 - Final Factory Fire.Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' Stu CITY OF COSTA MESA a ct BUILDING DIVISION F„ ' '� DEVELOPMEh1T SERVICES DEPARTMENT PE IT NUMBER /s PERMIT e. B05-00846 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 143 21ST ST Status: ISSUED Suite: D Applied: 05/27/2005 Vicinity: ROOF Issued: 05/27/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42618216 Zoning: Applicant: CHARLES VILLA ISSUED BY: Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 - Owner YELICH, DONNA AILEEN TR Address 345 WESTBROOK PL Phone: COSTA MESA,CA Zip: 92626 Contractor: R C I ROOFING COMPANY Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 - License: 704392 Arch : Eng: Address: Address: Phone: Phone: Zip: - License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL 1 LAYER OF 15#-FELT,20 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS • NEEDED.8 SQUARES FOR UNIT D • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,000.00 Permit: $38.75 Claim Valuation: sl,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • - Total: $39.25 PLANNING &ZONING SETBACKS MAIN STRUCTURE,Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(&W) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: H ❑ I have and will maintain a certificate of consent to self-Insure for workers'canpensat, _as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. g I have and will maintain workers'corn•:nation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers' •omp:—•�� -.. :nce :rder and policy number are: /-/, --C)�y� Cartier: • \:� . ' Policy Number: i�y/ /1 Q c 1 (This section need not be completed it the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the •ormance-o&Qhq work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation -,s of California,antetr:,that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with ase provisions. (u� Applicant Signatu : — Date: C —Z 7 -c3 " WARNING:FAILURE TO URE WORKERS'•% -ENSATI• IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOILARE($100,.,., • TO THE COST OF COMP • -"ON,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed d under revisions of Cha ter 9(commencing with Section 7000)of Division 3 of the Business end Profgssionns Code,and my license is in full force and effect.Lic. � Date:# _ Contractors Sign Date: �j '77—O/� CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: • Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work . himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to en owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,end that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _...._.._...— —__ o 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Cade,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does�r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ICI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within Tow feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct.I agree to comply with all slate laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE MD AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc' pisOAKfor inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig ur Of Legal Owner(s) Dat J C - 7 '7 C An r Aul plicant Date CODE T, INSPECTION TYPE PAIL 91111181& SODS T INSPECTION TYPE PAIL =AU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final LOW .,� 208 Final Plumbing 200 Final Re-Roof 7L•O `'W— 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Slte 204 Final Demolition 250 Final Bulldln /Occupancy • CITI(OF COSTA MESA et . BUILINO DIVISION , �� F ILS I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Pita PERMIT • 605-00847 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 143 21ST ST Status: ISSUED Suite: E Applied: 05/27/2005 Vicinity: ROOF Issued: 05/27/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42618216 Zoning: Applicant: CHARLES VILLA ISSUED BY: Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 Owner YELICH, DONNA AILEEN TR Address 345 WESTBROOK PL Phone: COSTA MESA,CA Zip: 92626 Contractor: R C I ROOFING COMPANY Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 License: 704392 Arch : Eng: Address: Address: Phone: Phone: Zip: - ' License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 151$FELT,20 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED.8 SQUARES FOR UNITE • FEE SUMMARY Plan Check: $0.00 Calc Valuation: 31,000.00 Permit: $38.75 Claim Valuation: 31,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 - Other: $0.00 Inspection: $0.00 Total: $39.25 PLANNING &ZONING SETBACKS MAIN STRUCTURE.Front 0:0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 ' Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: •' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. SC`I have and will aintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My w�ozkug'co p en urance cam}r and policy number are: / ^- /(oTd 1�� Carder: P W �J Policy Number: fig- (This section need not e complete the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California.and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. 5 7 7-c Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TOONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that)em licens urder provisions ofhakkter 9(commencing with Section 7000)of Division 3 of the Business�nd Pra io e,and my license is in full force and effe t.tic.N —70(1c,1 ? Class M /C `� Contractors time. Date: 3 –�7 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this:Application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? yes S No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). _...._ _.e_._ aschoo?.___...... 6 Will any part of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality bygement DistrictHor and Safety pollution controloon3be or agency? is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health Safety Code Section 42303 been made? 0 Yes 0 No e (If "yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and dry ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.i agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d:- •bedproperty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Slg=Of Legal Owner(s) Date r 77 4s 'n• •rAr' '•Applicant Date CODE t INSPECTIONTYPE PAIL I11TITIALD CODE! INSPECTION TYPE PATE IITTRALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof (1� '� •__A4 \ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy _. _ l L' n CITY OF COSTA MESA < BUILDING DIVISION oqs > • �! DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t •h. PERMIT • Ve B05-00848 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.C3l` LDING Ij'ERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 143 21ST ST BUILDING Status: ISSUED • Suite: B Applied: 05/27/2005 Vicinity: DETACHED GARAGE ROOF Issued: 05/27/2005 Primary Occ: U Type of Construction: V-N Parcel Number: 42618216 Zoning: Applicant: CHARLES VILLA ISSUED BY: Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA , - Zip: 92627 Owner: YELICH, DONNk AILEEN TR ' • Address 345 WESTBROOK PL • Phone: COSTA MESA,CA Zip: 92626 ' Contractor: R C I ROOFING COMPANY Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 - - License: 704392 Arch : - " . Eng: Address: Address: , Phone: Phone: Zip: • License: License: SCOPE OF PERMIT • TEAR OFF EXISTING ROOF.INSTALL 1 LAYER OF 15#FELT,20 YEAR COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEATHING AS NEEDED.4 SQUARES FOR DETACHED GARAGE BEHIND UNIT B. FEE SUMMARY Plan Check: • $0.00 Calc Valuation: $500.00 Permit: $23.50 Claim Valuation: Ssoo.00 SMIP Res: $0.50 • SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 • Total: $24.00, -. - , PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 • ACCESSORY Front 0-0 Rear 0-0 Left 0;0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5628 2448-46(WOO) DECLARATIONS ( ') ,�l WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: - ' 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. l' .2 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'SO mp6ns� surance crier and policy number are: Carrier: ?�Y P uAYt Policy Number: gbQ Ab `0 q (This section need not be completed i the permit Is valued et one hundred dollars($100)or less.) O I certify that irythe-performan of he work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compens' 16n laws of Califomia `r[Q'a_:that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply , h these provisions. ?- Applicant Signe •e. Date: G— 7 '7 -05-- WARNING:FAILURE T• . RE WORKERS'•• - SATI• a A`•GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(6100,000), •. • OTHE COST OF ••- SATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR COOE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licenseeuse r visions of ha ter 9(commencing with Section 7000)of Division 3 of the Business and ofessions C e�8 nd my license Is in full force and effect.Lie.Ir 9 251 Class a t51C-S 7 Contractors Signature: — Date: Z, —C —.moi �.. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a CMI penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business end Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). - ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application.have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above tri d ierry for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. \'V(` Signa Of Legal Owner(s) Date •• •r Auchan Applicant Date CODE r JNSPECRON TYPE - • 'INTINALt ' CODE! INSPECTION TYPE PAU- BOMBS 1616 Fixed System Final Fire Prevention . ' 206 Final Mechanical 1266 Pool Spa Final / I , �,� 208 Final Plumbing 200 Final Re-Roof (,r7-45' .kA ",_\ 210 'Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place ' ' _ - 220 Final Planning Approval • • 203 Final Sign 222 Final'Site 204 Final Demolition 250 Final Building/Occupancy CITY OF CQSTA MESA BUILIJING DIVISION 1.° .:r , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER %r pr jPERMIT �' 1"1111 4144,PoRmso 64. / B05-00844 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 143 21ST ST Status: ISSUED Suite: B Applied 05/27/2005 Vicinity: ROOF Issued: 05/27/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42618216 Zoning: Applicant: CHARLES VILLA ISSUED BY: Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA Zip: 92627 Owner YELICH, DONNA AILEEN TR Address 345 WESTBROOK PL Phone: COSTA MESA,CA Zip: 92626 Contractor: R C I ROOFING COMPANY Address: 1923 CHURCH ST Phone: (949)650-1079 COSTA MESA,CA - Zip: 92627 • License: 704392 Arch : Eng: Address: • Address: Phone: Phone: Zip: License: License: • SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL 1 LAYER OF 15#FELT,20 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED.8 SQUARES. • • FEE SUMMARY Plan Check: $0.00 Calc Valuation: 31,000.00 Permit: $38.75 Claim Valuation: 51,000.00 SMTP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total; $39.25 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(W DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. a I have and wet maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensaattllt r ce cam rend policy number are: p� r ((_ may[,/ Carrier: CY Policy Number. / 5-C {cbt( C 1 (This section nee hot completed U the permit is valued of one hundred dollars($100)or less.) l ❑ I certify th= - • • -,nee of the work for which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the workers' compo tion laws of Calito • , ,• gree that If I should• u: • -• • .-.workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comp with these provisions. Applicant Sig • ur:• Date: W..._..•,m�Pa�^ COMPENSATION��'-Iva yam•_ WELL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOIIARE($100.000).IN ADDrON TO THE COST OF COMP + • . ES AS PROVIDED FOR IN SECnON 3706 OF THE LABOR CODE•INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I 'C nsed un provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business d Profesiiqns dale and my license Is In full force and effect,U .N "7 778 Z- Class 0 "- '7 Contractors Signal re: —- Date: r--2"7- 05 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she U licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Coda for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers Ucense No. Expires: Verification of Ownership by(type of document,I.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building—occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (Section 25534 of the Celifomia Health end Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes%the fedlity must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Alr Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sid ature'.al Ownnr/af Date Date ;ODE I INSPECTION TYPE PAIS BM= ODE INSPECTION TYPE 281E MOML9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final A 208 Final Plumbing _ 200 Final Re-Roof (n`�� +T'T'•'-� 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ri v- . • . COUNTY OF ORANGE . . ' BUILDING DEPT. 3 .0 ? // •Permit No 636 No. Broadway Santa Ana, California Application for Building Permit Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy Date.#VC° 1 •1 1. OWNER'S NAME ' P PHONE• II il MAILING ADDRESS_ 424-401441 j '1. CITY Cie& 11414C.... Name Name ID ri / taAAA/11/ (Architect or Engineer) - (Co Address Address..3 t City City State State Lic. No. .Phone Lic. No. Ell v 3 Phone(4124.tex C141 PROPOSED USE: f ct th e It tit-a t 7-€ 2. JOB LOCATION __Iy c -)-/..tt edi4 mat', (House No.) i (Nameereet14 c.c EchoM,DifriArt 4,45 3. LEGAL DESCRIPTION: Lotfiali. CY.-1# 1W:ct /or("Iixtla -).- c (Metes and Bounds Description—Use resers side of fo ) 4. CORNER LOT ( ) INTERI LOT ( X ) THROUGH LOT ( ) SLOPE OF LOT ( ) / 5. SIZE OF BLDG.:16 1 x. So lt.AREA: Val/ SIZE OF LOT:._4 1"l't 30z AREA: tc_ Mal? 6. HEIGHT OF BLDG.: tap- CEILING HEIGHT• riell- NO. OF STORIES efilt42- 7. NO. FAMILIES CIA& Size of Smallest Bedroom: illi..0 Size of Kitchen: ?it4 IC) 8. EXTERIOR WALL CONSTRUCTIONT4-0M4Lst INTERIOR WALL COVERING mot. (Frame, Stucco, Etc.) (Plaster-Drywall, Etc.) 9. SETBACKS: Front Yard from Center Line of Street ,r_fpet I Nearest Side Yard riet Rear Yard Distance in Feet Between Bldgs. on Same Lot 11044 , 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 64 If II. For (a) Footing: Width i4 Depth in Ground /11/ Width of Wall 5•-***CC's Accessory 64 Bldgs. and (6) Size of Studs: "Ve)' Spacing------------ 14. "CC Material of Floor eintOtta Similar Structures: (c) Size of Floor Joists: — Spacing ' "CC ... (d) Size'of Rafters: ill )4 C:. Spacing 3d - "CC 12. VALUATION OF PROPOSED WORK: Incluccrtg all labor, plumbing, electrical wiring, heating, fire sprinklers, paint- -_ _ ing and sewage disposal $ ,.,670 .1). 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. ?"41494- fritU Plans Filed- Signed: 1/0-0 /1, to. wner) By• CaUtti (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: .i EGKING BY i...., en. _a Bldg. Permit - $ / d•-• '''.. GROUP__________________ APPLICA _... .0.fif. .--- HEALTH ZONING Plan Check - $ TYPE St -t. FIRE MARSHAL Total - - - $ DIST. MAP aele PEC'S.. ST-ATE PLANS A_ ,.,.,t ......._,C Receipt No. -- S Paid to - - )•••••..±4.l SHEET NO _Si_ CORRECTIONS ENGINEER Date . P- ip-st__ VERIFIED CAL PERMIT BY . 0/ : • DATE , 5M-7-50 Ceree6 R 11`o•R-R (Rev. 6-59) cb ri 4D74- bCs*roy ),�,� SE. cLRITY MIrI �,E ( (, INSURANCE COMPANY 825 North Broadway, Santa Ana, California L( 3 i� Telephone Kimberly 7-7251 000prelZ4,//‘(97 3 Your No PRELIMINARY REPORT Our Order No 207649-DD a. Planning Department City of Costa Mesa Costa Mesa, California This report is issued preliminary to recordation, final closing, and issuance of policy of title insurance in connection with this order. Our liability is solely that expressed in such policy. No separate lia- bility is assumed by this report except that if no policy is issued under this order the amount paid for this report shall be the maximum liability of the company. i� SECURIT S RANCE COMPANY jivBy l Dated as of 7:30 A.M. on May 17, 1961 Don Dorks Vestee: LEWIS A. WEISBERG and IRINA WEISBERG, husband and wife, as joint tenants . The land referred to in this report is in the state of California, county of Orange . PARCEL 1 : The Northwesterly 52.5 feet of the Southeasterly 105 feet of Lot 241 of Newport Heights, in the Costa Mesa Sanitary District and Newport Heights Irrigation District, city of Costa Mesa, as shown on a map thereof recorded in book 4, page 83, Miscellaneous Maps, records of said Orange County. PARCEL 2c An easement for road and public utility purposes along the Northwesterly 7 feet of the Southeasterly 52.50 feet of Lot 241 of Newport Heights, in the Costa Mesa Sanitary District and Newport Heights Irrigation District, city of Costa Mesa, as shown on a ,map thereof recorded in book 4, page 83, Miscellaneous Maps, records of said Orange County. •a CF,. .LIQC' 4A Le C\ -�(�Y'(A,Q •3/4.,1/44.-4.‘ ,..) :‘,.. 3 k .b.4eiket I itl_ 1- w7 js Ill .,.„ I 207649-DD Page 2 NOTE: Said land is described on the County Tax Assessment Roll for the fiscal year 1960-61 as A. P. No . 118-020-23 . SUBJECT TO: 1 . Taxes for the fiscal year 1961-62, a lien, not yet payable . 2. An easement across said land for pipe lines and incidental purposes, as reserved in deed recorded August 9, 1913, in book 237, page 326, Deeds . 3. An easement along the Southeasterly 5 feet of said land for roads, public utilities and incidental purposes, as reserved by J. 0. Garrison and others, in deeds of trust hereinafter shown under Items 4 and 5. 4. A deed of trust dated June 18, 1956, executed by J. 0. Garrison and Minnie M. Garrison, husband and wife, and Shelby Garrison and Elizabeth F. Garrison, husband and wife, to Security Title Insurance Company, a corporation, trustee, to secure an indebtedness of $5, 250.00, in favor of Costa Mesa Savings and Loan Association, together with other amounts as therein provided; recorded June 25, 1956, in book 3555, page 475, Official Records . The beneficial interest under said deed of trust has been duly assigned to Southern California Building and Loan Association of Los Angeles, by assignment recorded October 1, 1956, in book 3662, page 348, Official Records . 5. A deed of trust dated January 7, 1960, executed by Lewis A . Weisberg and Irina Weisberg, husband and wife, to California Bank, a corporation, trustee, to secure an indebtedness of $3,618.50, in favor of Burt W. Dreyer and Grace J. Dreyer, husband and wife, as joint tenants, together with other amounts as therein provided; recorded January 13, 1960, in book 5052, page 223, Official Records . cc : Shoreline Construction Co . 2280 Newport Boulevard Costa Mesa, California . 1 en s 9 i QC4I j . /5-06 i II /3- 06 /5- /0 — --- -- - AVENUE —, 15-44 3.1.7. f3 ti, . T 7 , ,.. W k. � Ict 1 I I 1.1o 0) �6 I7 1 1 8 _. - 0r1 FY/ (.i:' i COT 23/ r14i I I LOT 1241 . Ir-4-&-4C 0) ( I Ie. a /.9/ AG. /. 1-0.K. 2.87 AC. 1 Iti) O r 0 b I 1 In M _oie - zI et zz In cI CL LIJ 1 1;, �' P za 3 H PCL_ - SOyHE/GHT i - –—ti f— N.-_ —_ J PC PCL2 I y _1 6.3.i5' I y s" I l0:. 06' 1.1 i.AB.o9' ":'':;I HEI,GHTS M. M 4 - 83 -- OTE — ASSESSOR'S BLOCK ASSESSOR'S MAP 8 LOT NUMBERS BOOKI18 PAGE 02 k . . SHOWN IN CIRCLES COUNTY OF ORANGE I � ' t . . s � iR( ` lY £D Film , � MryINs ' a //711`5 I 1 F ? r . 'r li,S -•� '$� ri • r VLe,z.+�'r v 1�.A, 1 41 n JAtI Jif t96i1 + ^ a �i • r.1y[ C - ",.aT" a d +'1w- f' 'e4 • `.rAe'.. yyyy f t. • its. . t *et. .a f" .% 1/4.1 ..�- :i 6 • l ' �^ ., � a .SFV!.. N,. . is k• -4.47___H- � � orf g��'Js•6vari- _ " .i - p _ — 1. Ips' I i A'...INSeberg%e+aA - -Weisberg, - and ria l dMftllRC1R . v1a D: 313.Hel• le rc cSt.: Corona del Ihl. Calif. —70: `zit ca -...,,.., wt bask 4.. 'y y ,> ,i,., ORANGE COUNTY TITLE COMPANY o f -. A Cards Caprallep.Semis Slid Ma e d I I -It"' ..'{.' I _; f MIRA!:SAVINGS AND LOAN ASSOCIATION Of SANTA MIA ,"• 44!-',j'Y .-3'. ACOrparrkn.lays Ma Caibatna.horde SIM trNMCIAI Y. l y - ',1 `WIjpR�11L That hoaxIrRVOG1RY Owns.TMNSFEr3 AND ASSIGNS TO MUSTS!EN mm,�wm1 Sity:0„.S Of,bea betpgMnyki CergP Coady,UOkrNt, 1 a .,i 1 ;. . : t 1 \1; f 4 . s ' ! ti • (Y ' i P gThebt South y 32.3 feat of Lot 241•ef.__ _ �'^,`,- • Newport Helgbte. in the Cee • Nis• gaol —elCos (� and Serport Height* Irrigation District, city of Costa, • a" •• Nass, as •born on a sap thoevisso'fr•voorrddedO in book n4, ypa go I • el- $a we r ee Eo3--idnid lmd � eSta u1r P'u"Y' I ' see,,�', - Parcel 2. An ••nemnt along the SoutheaaterlY 5 feet t g, A of..tb I.Et a xi:SS)—, trisLLQ•.:i" a • i I • , to • 'er}M-CC • -:hta, • �` •'.1,a; r , n : t Heights Irrigation 'I• H' . District, city of Costa `lea*, ea shown on a map thereof -. - recorded In book 11. page 83. Xlscellaneous Maps, records 4.-', - . of said Orange County. f T V,' . ; I i . ichiv,....) ... d-i f � illi. t - 1151 4 kV •1 - „ - -,4 4 ,--..• • .:i•,-,..•33. ---, . nt.3, • . . • ' . 14?, . '.• _ , 'b:Z i fJAPC 13 1960 L 1 Nirstt; , <.* •••••)-‘..Pt-,„ , t3/4Y,! t. ••i. • -4.2; ' • SC: , ..,. ....,../ - .- ../..a, t.'1....- . - ' ' • A' 1.t:1.7 $.1 r ... ...g*...f#:#!•.;%.‘..!,`,1"..ta,..1. WC.4. i a . *C4VFe r ' "?. ;LI ‘ -4.., .t*It ,. ' .....-• a ' :,: C....1.1‘;....,C a...r 4;• Gittiiiii y eryn:',...at-4 d . •••; Alt':t t . 4„.• ,.... idf.;•... , •.• ' . ' . • . •'' ' 4- ... .• ... " 100000e••••4 ad impwa••••••et boses••••••••••.•belt•••••••01 aol sped as A Yaw• • c.r., a NAOS a awe•awes..—inn le.Awe.••••••.ed••••••.in Fed...at spat. ' •• a en ail sateed maw II••••••••s,••••••••0 4 Sr indulges••••••••••et -t •! • 11 W Sines I a teW al Ole•me ma Mot web. t .; • t ea. 't 101 BO 1•111•0111•••11110110IO e • ...• • e. •• F.''_ft'ewe ins.•••••••,IS Saves••tavales.Soda.a how•0 Os sat•re.I.-5•SO.4' ein....‘‘ ogle belanen'Maw se.0.•••my.••••••••••••••••Aar......am IreSik.me op As MOS•Os Sent • •'ef•' " . . Oa await's"wel at•••••••*weal le le•••••0 e•et••••••••vs mak leas Ars.e maw••betake bars/'• • I, I tem 60.••••••• SrWmewl•••••I.ea.•mid Nag"*O.•••••••SS WO..•••••••••••••0 W. ' 10 MAW mg Warn einem oF mamma?airs lare*••••••••••••••p•••loaf•Taw aid Sr a.,nand••••••Oa raWita• I..•17,1.•••••••Gad ed taw .. Amer ow ft.*I.1114 a WS Mt asp II a/••••Ansa t•*a sir a Sr c.•••11••••••Onris Onwen CMS:. . hi la••le,a'webs 1•••••••••1•••,as••••1.,•••,••Pon..Is a••••••••ev*r es am.•SS Imsl•• " ' • See Sr-••••400.eed estlese as swages,sir••••••••gas•••••••••'web misted I.*SI le WWI DP a•••SO 0 lomat 4 OA MS Steam We So inter,soma.••••es 04 ea Sera i•ern Ow tang le.EY OBS ?Cleo ihe t•.•Ts.'•••••••••-•••••TA••••••a wad DWI.OM b......•••e.••••••?war. swat Swift WOW et.•••OW DO Oa*WI braD Nektwatriert Sae•SO tan 4 tad Wawa 1 to IT,Wan•la INS slit, . Was WO.ad Oar it 1••Iss1.11•ow a ip.faraw*Walt as/a/WW/T. Walls eat•Csag et••••kW&al"WS And 0 es S We'sit he mils/••hew•51. . . So 1••••••••••funk. Strews of Mato, 1,I-f..•11,U. • 9z..,./. kre,”te.),. S/A11 OP CALIPOSVLS, INC1000•SOS 11100111•1110 at, c011ere OP MASK I_ Do Jatttu,ry 5th, 1960 5.725052 nig 216 00ilaWined.•ID•W WS a sel Is rid Ceso,eel *OA pataWy wend littONOCD AT REGIUZIO OF •••• Lovi• a. Voieb•rg and SaCURITY TITtal 0111.00. I r I na ..talars in orriCist.resConat or ws,....•r n, 01•••41 COW.1”.tau" •••*se..6.,s,....•• a , . =1.•,..t.•••da,lesaista al saaaapul la roo I'mesa an ea. Na I a JAN 13 1950 V•11740..• Fmk , , RIM IknittAlet WSJ Itstarkr • • r mango IlY A TON Strait r.' ''''-'—'1 OF ACOICIWY00•10(F SO ri ung $2.80 . , _ ,z - 1 . 1 DO MOT POCONO . e • NOW/OS 101.1111020nOVARICI S. t •be•...1•••de..•••im,1•••via 1. 1 WO ONOON COMM THU MEWL a.M. Oat. 4: I Ma/V DORA AN•GALS ..in =Ira as MIS.%trat taw by Sr nit•.••%a.NI••••awe bp W?as e/tio F..0...a us •re......so Ns•mid ..../Tia•...a a i I oars:Tr:" ma:.hztrOtr i CT=sfint...•.....lion.I.Ple wN•Ai•SI Ord w Inr. I S I .Sr ans.on la taw we Sr ow OW SM S me we S06/11Cat OP 8•11111 flit I . . SAS IllenealletMICI.0. I . . - • --las...sow.* . ., . Ono lane*so ebb••••••••••••••W.hi a Seib as•la dainaa••••••••••••••••••OW Walsa•WW ,• • . . ./k --A . .. • .- . , t . , i • = •1 . - .; .. I . . • .• , I . • . • , . -• ;. . .:('• . , 1 .. , • • . I . • • • . . 4 . .. . . II t 1.:},vt ,4- ;•-. . . • .W 1":\ V: wV. 1 4 . • , . I • 4.1 4..t..1 -^1-• .. . . • • • 1 • • ' . .. : • • . -, . - .• . . . • '' . _ . •• . . If ,- . ,... . .• ..• .i."' ' *. ...4 • , . 0.. t-.- -. .-..1., . • ,. ; , • . . co o �'\ a \\10 � ' •1 pk VGosPUcQj` Izl • • J N. 13 1880 ^•a. , t-��'n. x: a .. . •--tet$.,... J _.t- yq. ^�` es2aJrti • a;m.51352 3 s • :: This Deedof Trust,mast ibid._ 7th --..__day of___ Jci art'_ _ _19..60 El ,tII r• Bendiadd WM A. 11¢ISB61G end IfaNA Mh:1 Hl�G, hueblp4_N_211f•______. ixt _ __—__-- _hertirn called nusros, 1 '.1'.' Whose addre9 1s, 315 ReliotrppGerrie e Ger del Nor _ Celiforhi _ ___ i . iv" ISeee and Number) (Orli 'Sale) 1 California Bank I a California corporation, herein called Trustee.and BUNT i_DHE__1P and GRA-CN Ji DYSf®t. _ 1 kmsband`spahkrife es aolnt tenants __. _ ___ _ _ , he '__ _ _. _ __ _ ._. .__ __ __herein called BENEFICIARY /w,,i}^ rI ituessetb: That Thatch'irrevoably GRANTS, TRANSFERS AND ASSIGNS TO TRUSTEE IN TRUST, y R.ag . term POWER of site.,that p t,4rania .. __—.____._ _ _. _._ ____.__, 7#!1^�'r County.,California, described•Northwesterly 52.5 L r of .the !Tub:easterly 105 feet_ 1 3.. of lot 21sof Newport WSypta in •-m-CosRasa Sant a$ Dia ricrehd rewporf-Freightsi in RRawwwcion urstn c, Cst7`flr .Data Fees as shown on p p,(fi tosf Cad in book 4 e 74w, tlJ NLcella.neoue Maps, record. of said 4r a Couni; .h-- et I' saiid ' an s rent tor' • "C IF.P!•4"N4a n G is dill aIg� n alo P c '• cru ; E fes n]' said nd. f rte azprass agrae�fy Ent between crane duties nereto that if hereafter during the .+ec first five years of the life of the trusts crested by this deed of trust, the trustors, or err'!+ their successors, desire to obtain a construction loan in an aneunt not exceeding $2tl,hOC,C( to be evidenced by a pronlaaory note or notes secured by a first trust deed or eortF,age upor4� f ••., said promisee, then the parties hereto, for themselves, their heirs, devisees, successors arta r: assigns In consideration of the mutual benefits accruing to them and for the protection of the holderor holders of any note or notes, secured by such deed of trust or mortgage covering { said property hereafter executed by the owner thereof, and complying with provisions herein. I. ', sitar set forth, do hereby stipulate and agree ea follows. 1. That at arta tion durin the first five years of the life of the trusts created by this deed of trust provided said deed of trust is not in default, there may be placed, kept and • i• f. mmintained, as a lien upon said property prior and superior to this deed of trust, a deed of 1 ' treat or mortgage deli recorded securing a note or notes not exceeding the principal mm of P28,1200.00 bearing interest at not to exceed 7.2 per cant per annum and for a period of not • exceeding 18 years, 2. That any deed of trust or mortgage covering said property end complying with the foregoirr provisions shell be deemed to be the deed of trust or mortgage contemplated hereby. PAFCBL 2a An eaeernnir for reed end ;;uh]!c utility,roens�_lenC . L fir'.ir..cterly T feet i n. South-,etsrlLa '1 .: s� r ,he city here . r:ts e ' - "' ' c 0, e_. cru a-r luap •u on a r _lr.ofrecerE•d ,.' Lrnk 4,r^ e I 83• e ri Rtseelienenus asps, records of sale County.' i1( 1 TOGETHER mR1'the,arae imeu cid pans pert',SUGEl.,,HOa'ESER i.sae riga pen.ad.naerip Fence tlA m ..a 4.444,41-44 ..r. seaaevy la Nim set apply...a ream Sows W 5/44th. { i / ,s • V1,1 • • 1 ii _--•�_�� i, � � � fAa 13 1960 X • � c ; _ ee5052 nu224 • • for the Purpose of Securing Payment of the indeSednear evidenced by one prom;vory note whpsntially in the following form andy,gEfoemance of each agreement of Tauter herein contained. e-S/n a m imodlmmn as twain anydae+•M pots•Joe tI to parr to •'••-: d. •-Et. ed C � �s bustral tea, CO • s_gmer del sra w_lhfap ,ww•�.ae 1W®N step swiss V ter tra_�r.-61`E.eL6r1 • .'v6 Stmt Iran aaaaS _—_ _m unpaid prioipJ a the tab of d.4••;^ _ pa ter maim;ana ; cipal tad twat paper io tramline=of -d�l9-Aiil� -- -- -- - -- - -- w.. - Dollars s mar on the - _ lRS9._ _da cinch_ .201.1AMAY ) meal)hrtin�oi.y d —r 7 tic 'e SN. lL N mind 7 LJfu :[t.y_a Pea pears tall be-mated tit onmince then dor.rd the maunder on pan' ;pal;and intent ahtu thrtupon ran rpm the prndei a credited.Should default be made in pyosmt of any installment what date Sr wbolt awned pm dpi ad intone Ault beonto iereedistdy dm m the goon of the hYd. of due cote. Pnnaptl sod interest pp.ble u. lode!nrceey of the United Stan If.num be unarmed on this orae I promise to pay soh am en the Cmntil fir canna .This ea m maned by a Wm or TIM m rt C.ue•T. Roo , l en,m:pn.atim a1 Si -a— truth t110.110011i •.��if e• -MtiTd A. To protect the security of this Deed of Trust, Trustor agrees: lil.T.hrs., W property S pd...Juinalt r. k;r u cub sake w rwmtiut a-4b land.., or tnmtn rr pv wL I.a Start n.e,haaatr. tae Vdada the 'rl•Ie1.pe at 1.an w.to who delh l.•T:T.L'uses tad ese .l1. dt . grrlaw, w.tevrh lw•Le a Jul. ••rentteno g sidcarni,..Mini.peps...w.- Iw:r nog!, Ob 11 S.aearia.N pen,w rpuiel.. .Irb mtrrm,m'ui4 pa doe•.II.•nmbmww.ehvp.M ha, po4....ant con JmN, pini rp. ..fl,,LAT.ow aie.;y x w•lads .aieb iia.. ba.,&np . iawn a.0 be . p.nT :� .W Tia..this Don Id rte.M d tort...Nada be.:abe bp Tess. Jo Int d not .=at the bs ngdred M 4. Ito! 'on Ire 18.b.h•basted woe+.tub,.r.n teat Alter r.he 1.d ed M warwr Slue ria.Lot athirst Worths Ow rattan.1 a aid rsou.ooted J arta a. nowt swab.anentatm •p..mt.a•1 Iwo a ehup Sure..ler at .Je ami t'•Via s Sr.'faded h.I...Trac--slats dabelner.n...L S the papacy buaedn. Co The Undersigned Trustor Requests tint,copy of say notice of default and of any notice or ab hereunder be nulled ro him a his.ddma herenbefwe set forth. •5(152 Pig 223 Square col Tatter RACOROEO FF REOULST On SECURtry TITLE INS CO. E> .tcc.-l••stle L�• // -^ - _- Ut•CAL FCORos orFTe- O'aanOe COUNTY.CAL . JA del eGerq a� ]L-- I rY JAN I:1 1960 x J2/nr. J,'2, e,.,? I $3.60 Rimy anACIFSI.Corny Reath/ -- rrrna a;1 P I Seen!OF CALIFORNIA. Coorr or Orenga + r (edam._ / or_ Littegrl I9_� Mac .cede_. .-1 paad --_ ..Noun Public in and for mud County. lF iwria�c dr,ttaharR and kelp* 'del pumlly ppptwd— _ ebgrE . - I• 1 - - • ironn meta titrtofa whm Nmr_n—lrL —ab%rdcd to the within (N..id Sad) m+mnem,sad.damrhdped that - executed the tate. Tennm mf tri and ofadsl d. / -/ IflQt�-r •=' / ' ..-soma avow . .• 14-1pN—ya.r Aaaa.a.Jp. y!p I.� I/exotica by a Crwane the c..prrm Anamu ih:f+..1+.�airily •t...w... ` J Ia/.able Pats us Catenate 1 CO • _ a s . , 11' • -/ /ice -- OWNER WETSBERG. L. DATE 7-31-61 JOB ADDRESS lip 3–B East. 21st Street BUILDING PERMIT NO. 111791 GENERAL CONTRACTOR Sbnreline Constr. Co. VALUE $ 1,000.00 AR No.11 8_020-23 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Det.gar. INcPECTIONS DATE I GROUP J TYPE V ZONE R-1i rground Soil U.G. Water PERMITS ISSUED L....erground Gas — — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing dere 'U1 I�'`3'8ir3't– Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures lT, Final Gas Testr I Construction Pole ‘) Underground Power // Rough Wirin• . 9 9—L.-lil `T11c4n9..a.. F ti. .P• 23-L I a • Trenches tZ Forms (---Steel hi ir 7.-- ? -cR" - teer System , � Steel Reinforce Chimney$e-Rod l�1k�Ub �( /�/ 6 Bond Beam Sheathing e 04 4.-&- 6r 1 F me and Flashing y / 2S vl N . _ ing, In Out Q-27-(y _ Piaster, brown coat / b ^-23 -4 i' / Plumbing Fixtures, Final - Electric Fixtures, Final 7i e' (9 /_L/ 7 Building, Final I/ 'PTI 4.-2_4.--fr _ OCCUPANCY I 7 ' Form 210-5M-11-59 5-B P HOLD FOR SPECTAL RFOTtmfl mute 14791 Cam 14791 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JUL 3 1961 P. O. BOX 917 COSTA MESA. CALIFORNIA P FINANCE DEPT. For Applicant to Fill In Completely APPLICATIOGITIIOOFPCREM MESA TYPE OR PRINT BUILDING BUILDING /r2 B ` ,r a� / S52 ADDRESS CALIFORNIACOSTA Al!��MESA. �, I For Office Use Only g[q�y)� C�J1 OWNER Lam`[ J, ec I RECEIPT NO. l"! /T/ MAIL RECEIV^ED...4/ /DIATE RECEIVED .9AAT/E IBBVED ADDRESS /�,/ nTEL ��1 /�j{� I •}-3 —4- t...--/ ✓ I / /I /� CITY aJ.9A Dal_g4 /2 NO. BUILDINGDRESS ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. f FIRE ADDRESS / /�/', J ZONE TYPE GROUP / / CONTRACTOR 55,,,r�A. n/L.-C (a'—r%4Kn BP•PRO DATE 7i/- 1(J/ , v ADDRESS ��r•' 'v ew Mier ,Ian ( ZONINGTi / ,,''AA Lf O V—) Li; PLANS ') BBLe:GNEw/p'_/—n CITY C_OSA AlleSZ' I {� `J/'� �!_ - 4 ATE LIC.NO. 191-7 94- NO. /"(/ J"3) LEGALESCRIPTION #iPr • q' itr)_L( ( J C'J(,yIL�.,( SIZE :472..,..5—A300-/C I NO. OP BYOB. 1 JJJ ( 1 OF LOTNOW ON LOT / A.P.NO. ' I9 —G - 'L\ `� 1 USE OF ! 4 'r /nom"` YARDS EVES / Jp1G.BLDCy �— RYv/y Y !� APPROVED ALLOWED V..)ELINE PROM // / ( ( R LINE BTJ4 /JOLFFRO (O /gre.,jeI/ EAR YARD(p �T�+jQ - FT. -c(� f,� IN. SIDE YARD I LEFT 2-7.5- I RIGHT R.SIDE -CFT. IN. -` DESCRIPTION OF WORK L.SIDE J/7 FT. N. It NEW I k II ALTERATION I II ADDITION I REAR 6 FT. .{ISN.! REPAIR I IIMOVINGI II DEMOLISH BYAPPRO��• DATE 1-9 1 . 1tx`+/ j SIZEBUILDING .1 ROOMS STORIES? JJ EXTERIOR WAL ROOF n ]5 COVERING CLO I COVERING C , USE OF BUILDING AND WORK�T�O�B�E�PEGRFCOr MED I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POP THE tM AND STATE THAT THE A VE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL OITY O NANCES AND STATE LAWS REGULATING m BUILDG CONSTRUCT N! VALUATION SIGNATURE OP / ersiT � - PERMIT FEE $ (Iif —^ PERMITTEE J �I e_ $/ p41 T PLAN CHECK $ �' ~PRIZED AGENT U I� �" =y. O TOTAL FEE • OWNER WEISBEPG. L. DATE-11-61 JOB ADDRESS 113_D East 21st. Street BUILDING PERMIT NO. 111792 GENERAL CONTRACTOR Shoreline Construction VALUE $ 1,000.00 AP. No. 118-020-23 LOT TRACT FIRE ZONE DESCRIPTION OF WORK net agar. INSPECTIONS DATE I GROUP J TYPE V ZONE R4 1 rground Soil U.G. Water PERMITS ISSUED L__erground Gas — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power J--- Rough Rough Wiring Da. 9-640( mirQ,9nr. f9. it ,�, e-23-Ai 1 S7o�1 Trenches t.-Dorms 4...'' Steel M r 7.-- r.----74. — Los 1 'Floor Systempj(r Steel Reinforce Chimney Re-Rod / I Bond Beam �� 7c3 �� ',nnSheathing gb4 q- v (o/ / F^-*ne and Flashing "3j/yJ e- 9'— /13---(4 ( ng, In Out 9-zZ- L/ Piaster, brown coat /e _y_3 ^G t /' Plumbing Fixtures, Final Electric Fixtures, Final —;/. ' Building, Final /J ii-7-/_ Cr OCCUPANCY 11I Form 210-5M-11-59 5-13 P HOLD FOR SPECIAL REOUIRFMENTC 14792. 65-4-erne Er. 14792 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT ��/ Jill 3 196rP. 0. BOX 317 COSTA MESA. CALIFORNIA I` N �tFor Applicant to Fill In Completely APPLICATt TYPE OR PRINT ESA ADD Ells (if f D tr,Isr 2/ s BUILDING COSTA MESA. CALIFORNIA For Office Use Only / �7 C RECEIPT NO. /pyE 1 OWNER Z . ti J e / ! ,,7.2.... MAIL x - Br - f'/ I 17/577 ADDRESS // E6/ADDRESS I/11 CITY SS7aN0q DcL/'i/ NO. ILD ADDRESS • ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. FIRE ADDRESS // � /�`+ ZONE -TYPE / ! GROUP r // CONTRACTOR �7.4r f4; ( LI 5 1 -- APPROVE CONTRACTOR DATE 7/�-.(tel/ ADDRESS t)--"2- d v #JdL.I �/-r/ 44 ��LLL////C�ZONING .`�% A /f// 41 20 NO.OF USE OP NEW CI CITY CM- -r /" cc,q- •— I PLANS ?e..........1 BUILDING YVL /,[/� TS F'7!'\ �y� , I VVV V LIC.NO./95.1 L/ NO./% `, �3 C LEGAL yL.�� •1 II '�/y7+.A� Q2, -t'&'t ( $ ,t `� f/ /q DESCRIPTIO Y 1 C`Y�W / OF LOLci_ S Joo' J I NOW Of r N Lot / , A.P.NO. i!!!!' Z r fVVV' �m 2� 'JC USE OF { ,jq, 7�� YARDS EVES JI EXISTING BLDG 3/pQ/e w':7- [Dw P//. APPROVED ST.) ALLOWED SETBACK LINE PROM /j-..,. 0 . r / 'Jen, CENTER OF STREET4. /)�Wim/REAR YARD((J /•• �kRONT �. FT. � IN. F SIDE YARD I LEFT •L/. 5 I RIGHT � R.SIDE -6-- FT. IN. V DESCRIPTION OF WORK L.SIDEFT. /J I VVV NEW ,I II ALTERATION I II ADDITION I REAR FT. 2 IN. ({j REPAIR I MOVING II DEMOLISH NYPRO ; f Lh.` DATE /��-� t A . LIJ BUILDING NO. OF / l ry SIZE ROOMS STORIES rJ EXTERIOR WALLROOF cL COVERING (COVERING USE OF BUILDING A7VORK30^E PERF/4RC �t o,/ (r/7 C//a a '47, -' a U I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE r, AND STATE THAT THE ABOV IS, CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. UI PLY WITH ALL CITY ORDIN CES AND STATE LAWS REGULATING BUILDING CONSTRUCTION VALUATION / ed SIGNATURE OF / (Qr/// l� e------.. PERMIT FEE $ ((JJ �� o C PERM ITTEF ( ' ,I Q $ I ~r PLAN CHECK $ �_ / 2 AUTHORIZED AGENTFFF��6 2% E .0 TOTAL FEE $ OWNER WEISBERG. L. DATE 7-11-61 JOB ADDRESS 1)13-B East 21st Street BUILDING,PERMIT NO. 1)1793 GENERAL CONTRACTOR Shoreline Construction VALUE $ 9,81,0.00 AR No.118-090-23 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Single res. INSPECTIONS 64,1 DATE I GROUP I TYPE V ZONE R-h ti:T tvsground Soil . tfiU.G. Water [ (f/ oCAP.14/ PERMITS ISSUED 5" /s-/, SUBCONTRACTOR ; 1'rground Gad /�/�/ / DATE NUMBER Overhead Water and Gas I.' Rough ,f -QIi. 1� ( 1o,1L ) C. ed -" t .7 • -3oS) -� �/ Rough Plumbing „, e7,.../4--61/ Miscellaneous """"/� ,� Prop. SNIr_I.ine- Hot$(Con. St. Swr. Tr 2/G I 5-+,-i,-7.,, ..+.•- rl((I f G 1 1 (4)"l '- Sprinkling System Heating, Final u/ /0.13-4./ Plumbing Fixtures f ± iv tot--0 Final Gas Test /5 td4.1-54 / - • Construction Pole f/ Underground Power f� 1, (/� Rough Wiring ✓ 4r' Pi? /. .Ll -'rt r yQ gra Qt�c ,. e-z1-' 15 •7 n / " �f- �� Trenches f/Forms Steel !/.� -2 - Ya y ) ,y1Gie/ Floor System 7/ / Steel Reinforce Chimney Re-Rod (,ii,/,12 / Bond Beam `(J Sheathing a740 q- [ /,V�"]V' - (y /` ) Fc ea and Flashing 7 Pito- ? $' - C I ,ag. In Out ./.1g-/. , L1 I i' ` /7la _____ brown coat tnri' u-.2/ .GSI Plumbing Fixtures, Final /Pa►f Electric Fixtures, Final _ - : % • _E~ Building, Final -re- //-1/- f OCCUPANCY Form 210-5M-11-59 5-B P HOLD FOR SPECIAL REQUIREMENTS 1lj793 ,• �4793 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT �Iv JUL 3 7%I P. O. BOX 817 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APPLICATIONCI•rkR PEtZtiIff MESA / TYPE OR PRINT BUILDING BUILDING/ / l+fi21 S ADDRESS /(COSTA,MESA. CALIFORNIA� jFor Office Use Only OWNER < ••• L�0 y f `,(RECjEIPT NO. I X79 73 MAIL RECEIVED BY I/4 -3 -4/4� I 7-1/-6 ADDRESS '' �J'� /J� Y/ / CITY doeom l DeL/%/q2 NO. BUILDING ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. I FIRE ADDRESS `�-• ZONE /, TYPE GROUP Or / CONTRAGTOW •e& AuA C .& 0 VC cr...) BVPROVED' DATE /J/1/-6 ADDRESS -2.--2-SID , €a. POie �C-1/o ZONING /�/( 4j _It CO //,J SON NO.OF n USE OF NEW `�,, CITY W tq-/q A(Ct-f9 fI PLANS . I BUILDING • 1 ,\ STATE /� /� TEL �/� /�•--� CoA' LG JII LIC.NO. �/ c...),-74 NO.fit (n .> v?r 'J 4 ti---6 . DESCRIPTION SIZE 5-a. ^ y' i cri-NO. OP CLOGS. '7 OF LOT ]"LJ / NOW ON LOT A.P.NO. 1t • ...0.07..0Lys J 1 USE OF ..�� YARDS EVES EXISTING BLDG J/H L , • ' _/• / APPROVED ALLOWED SETBACK LINE FROM Z�I Arco . 1 -EAR YARD'//1 •� HONT LINE BT.) 2 CENTER OF STREET cfJl1 W/V PR NT �f y��• FT. IN. SIDE YARD I LEFT 4 -J I RIGHT • R.SIDE •V FT. IN. DESCRIPTION OF WORK L.SIDE . FT. 5' •N. NEW I I ALT'RATION I I ADDITION I REAR FT. / IN. C REPAIR I I MOVING I I DEMOLISH I APPROVED w->d T`C Lam„-, DATE Q --Sed--6/ 0 BUILDING NO. OFAulA� �b'Y'o VVtVI ei SIZE /a zc ROOMS STORIES / EXTERIOR WALL` I ROOF 0 COVERING /TUc CC COVERING .p USE OF BUILDING AND WORK TO BE PER/�/F�""ORME_, Ani �4 Y,y-t yT�.. 07 -C ER DOJ n (� r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE m AND STATE THAT THE ABOVE ORRECT AND AGREE TO COM- PLY WITH AU. CITY ORDINAN E6 AND STATE LAWS REGULATE 0 PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. p BUILDING CONSTRUCTION. I VALUATION �I�jr� C SIGNATURE OF i KO it. • PERMIT FEE $ • 7i PERMITTED / /_ / /�/ 1,04 _ Ill $ % 9a PLAN CHECK $ 1 n•C • .l r1 AUTHORIZED AGENT / J f/l • - ri 2 TOTAL FEE a . N OWNER WETSPERO4 L_ DATE 7-11-61 JOB ADDRESS 111-C East 21st Street BUILDING PERMIT NO. . 11179h GENERAL CONTRACTOR Shoreline Const,rnrtion VALUE $ 9,8/10.00 AP. No. 118-020-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Single res. INSPECTIONS r✓ DATE I GROUP I TYPE V ZONE R-ii rground Soi AtitpU.G. Water), /41 (/4%/I/ SUBCONTRACTOR PERMITS ISSUED t.__..erground Gas - �( 4.* =tA C,' DATE NUMBER Overhead Water and Gas - _ Rough Heating A Mad _y,/r,+-(i✓ Rough Plumbing / :99 .1_4.14 !7 i a-.�c1k_te� Miscellaneous r Prop. Swr. Line House Con. St, Swr. Sprinkling System Heating, Final t/J Act-C-(,/ Plumbing Fixtures ,fesit..41 lit/ /O.15".- ,,i rl Final Gas Test Ib- /O f*---4/ per` Construction Pole /iik_C (e 1 Underground Power I 'Rough Wiring - t di 9n.. r9 -VI<� ( 4s'-73—h( ( c 7c aTrenches L/Porms (/Steel � �'» �— 5.-Floor System Steel Reinforce Chimney Re-Rod ir Bond Beam C "''�Sheathing ( �{i1- 6/ �/yv� //��F-,me and Flashing �j `n o— `�' '16' / l�J'� ,f / ing, In Out q-22- 6, J/!/ 1•.oster, brown coat - / /,-24�-G'- /// Plumbing Fixtures, Final L /®.,Qr,;�,.y (: Electric Fixtures, Final (0 3,'-c/� 1 Building, Final q 1p--3r-(„i 1 OCCUPANCY ' Form 210-5M-11-59 S-B r HOLD FOR SPECIAL REQUIREMENTS 1117914 14794 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JUL 3 1991 P. O. BOX 917 COSTA MESA. CALIFORNIA 1r!''FIINOANCE DEPT. For Applicant to Fill In Completely APPLICATIOIV1FOR PERMIT TYPE A MESA / TYPEniOR PRINT BUILDING ADDRESS /1v.._7 C - Z/ sr ' COSTA MESA. CALIFORNIAA / For Office Use Only OWNER 1-. cccsec12� I RECEIPT NO. (,N I pEFIJAI�jW� MAIL ReC61 8D I. I 9A Te .ENFC/ I //pA/T//7eL�U�/ ADDRESS /� �/J� �'`/1T/ �(d Ci '/ CITY CDa1A-.14 pei-'t$Ve NO. ADDRESS- AUILDIN ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. Fl RE ADDRESS !// //// - ZONE TYPE GROUP�7 . ` /\� CONTRACTORJI/'oo/3v4_eSI BYPRO DATE 7�/ - 4/ I N ADDRESS 2`i V gel..,()ter ZONING //'' � // /1" /� ZON NO.OF USE7c4 EW 4.7 CITY `US-]6' / -/ riy �� PLANS ��•fI-BUI r-1STATE / / ` 1� / TEL /�`� LEGAL O ,J i •Lc ) L�LIC.NO. / ( ' •7 LF- NO �j (pJDESCRIPTION ir cT AP S '7,,,DBLOTS. / 1 91 , — !•I `� OIZEF LOT - �,� �/'S NO.NOWOP ON Lar A.p.NO. ..-c /3 USF USE OFG BLDG F / /� CL), /1"--, YARDS EVES APPROVED AL WED SETBACK LINE FROM (CENTER LINE ST.) CENTER OF STREET ,// O/L•'L7A,/REAR YARQG!•/'� /) pRONT h-. FT. IN. / SIDE YARD I LEFT l� / I RIGHT ,5/ R.SIDE rFT. IN. I 11,` DESCRIPTION OF WORK ( ) L.SIDE } FT. IN. I% II ALTERATION I II ADDITION I REAR 1 FT.� N. NEW 7 REPAIR I II MOVING I SII+DEMOLISH I APPROVED i : L/ I'"? DATE , ��C) ' BUILDING/Q ZCQ ROOMS ] STORIES / SIZEJ EXTERIOR WALz�z�,�,, ROOF 41 COVERING CO COVERINGt f uI USE OF BUILDI/N AND WORK TO BBE P ORM€D/ ) a,. D.7417 Y-0 s-.. L/ GnIP/%/-r rJ _ .� V1 C/ 5. I HEREBY ACKNOWLEDGE All' I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE AND STATE THAT THE A t{ IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. U PLY WITH ALL CITY O CES AND STATE }.AWS LATINO ILI BUILDIN CONSTRU ///f� VALUATION ^('4 a SIGNATURE OF/� (� PERMIT FEE $CJI'(, -_ In PERMITTED / '�'(<i u CC $ (////�/G • PLAN CHECK $ /L•• /....4. '2 16 0 AUTHORIZED AGENT / V j G/ O C / TOTAL FEE $ 2 0 I OWNER 14F,TSRFR(; T. DATE 7-11-61 JOB ADDRESS 11.43-D East 21st Street BUILDING PERMIT NO. -14795 GENERAL CONTRACTOR Shoreline Construction VALUE $ 9,840.00 AP.No.118-020-23 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Single res. INSPECTIONS LW DATE I GROUP .I TYPE V ZONE! R-la - 'rground Soil%JE/,i U.G. Water/.6// S'—.C✓.erground Gas PERMITS ISSUED SUBCONTRACTOR �/// ?,/R=// DATE NUMBER Overhead Water and Gas G/ Rough Heating 4-e"...,. 9'-ds-icy ' -a 1 4 C+, wigs 7 ),I/ -C( 30,5-S1 Rough Plumbing $. -4.1 9-1.v..67 w 1 Miscellaneous ,/, Prop. Swr. Line House Con. St. Swr. / 2 Sprinkling System u�" , 6 Heating, Final /04.4--67 ,11, Plumbing Fixtures �"i�/�1 /p..gora Final Gas Test /)%i0J LI/!V .0.4.44—.0 - ;Construction Pole / Underground Power ��yy I Rough Wiring t(14 i-irtt'/ T11rS1+Qe, F9n-c�.. it- 'V-23-0 S / Trenches ll/',t4- Forms k6X'Steel C--I—tel _L Floor System ` Steel Reinforce Chimney Re-Rod Bond Beam /O / / Sheathing it 1 '- 9— '—CD( It 6 _Frame and Flashing /3 kr/C— 9— _/ R— , ( / V 6 '.ng, In Out / 7/ %"2 ' '6> /I 1-.--ter, brown coat d yO /7-,--/— &- Plumbing Fixtures, Final /U,�, .4% Electric Fixtures, Final fee get Building, Final Sr, //----2/--6,- .. OCCUPANCY Form 210-5M-11-59 $-B P HOLD FOR SPECIAL REQUIREMENTS 14795 14795 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT }iJ JUL 3 MI P. O. BOX 317 COSTA MESA. CALIFORNIA ��++ ��FyIINnnANCrrEE(��DeE�PµTc.�� For Applicant to Fill In Completely APPC�CATI6IY"PC& MIT TYPE OR PRINT f� -y��r�� n BUILDING ADDRESS /-/� v C 45 27 S- COSTA I MESA, CALIFORNIA - For iiiOffice Use Only OWNER L._ t.JC?5 �c e� RECEIPT NO. I /P¢g9S MAIL REO V D BY DATE RECErvl9 //w77i//E ISSU/JED ADDRESS ,�.,� ��jj\\ /4-74e NO. 7-3-�/ J��'(�� CITY £-�yS,U/J Da / -74e NO. (D p.3,74 Z� ADDRESS ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA +, OR ENGINEER NO. .y./�' /Y ADDRESS FIRE �/ GROUP C.�V' �^/ 1 ZONE TYPE CONTRAC['OI�J,G/()of.,�/lclq/) �YOt.fY/Y; �j APPROV DATE �J - (p/ ADDRESS D-`_, v /L9.'C4Jber l'3 caD ZONING (\/we. � rNzI rT !] /�(//J��C /� ZONK) NO.OF 1 USE OF NE.II. klirC��\ CITY Cr)5./ •-/ / �� //'� f� % I PLANS _/IBUILDING "!, / Q � 'J�` p �/ �/� / \ III / J�LV LTC.NO. / Z� / T" NO. /� T/1 2 r LEGAL �,I /_ T Y / ter 7DESCRIPTION ✓ly[�/'iJ SIZEF �T- �'{ `7(22' /'CI NOW ONNO. OF LOT / A.P.NO. 1 t T� — 0 7-1-� OF LOT ,A! L ,Al 'w///..-��- USE OF S4y,., A '� auE/il APPROVED ALLOWED „ n EXISTING BLDG -•�/>y ,�/,T''.ItU" 1 86TBACK LINE PROM / /�� / ( f (CENTER' LINE s,_..7 •� CENTER OF STREET 2 AREAR YAR• ¢RONT •l - EFT. IN. SIDE YARD I LEFT 6, l I RIGHT R.SIDE r FT. IN. tA F+ DESCRIPTION OF WORK 7"' w L.SIDE �. FT. IN. I,mo. 'N,. NEW I I ALTERATION VADDITION I R / EE E 0,-; BY k-1..:-1-.-t“, DAT IN. : .: REPAIR MOVING I DEMOLISH I APPROV / 3(t- ( / a, BUILDING/ []/ OF s'- STORIES/ 4: SIZE BUILDING/0 ROOMS �ySTO IE COVEREXTERIOR ING WALL/ -GROOF CC I COVERING L- /P0-/-'o •'3 USE OF BIJILD/?I AND L WORK TO BE PERFORMED V 2r/& a 0 I HEREBY ACKNOWLEDGE 7 I HAVE READ THIS APPLICATION AND STATE THAT THE AB vVIS CORRECT AND AGREE TO COM- THE AMOUNToSHOWN UNDERINVALUATIONMIIS FOR THE O PLY WITH ALL CITY ORD AN CEO AND STATE LAWS RE LATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTI / r�/I�� VAL ANION J O SIGNATURE OF //// I PERMIT FEE 15 / '�� 4 PERMITTEE / '� n^1 �-' (/�) • )) �p g.. S � PLAN CHECK 5 ./Q/ I. AUTHORIZED AGENT TOTAL FEE $.i. j µ O LL OWNER WRTSRVPC T. DATE 7-11_61 JOB ADDRESS 143-E East 21st Street BUILDING PERMIT NO. -14796 GENERAL CONTRACTOR Shoreline Construction VALUE $ 9,840.00 AP. No. 118-020-23 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Single res. INSPECTIONS Lr+/ DATE I GROUP I TYPE V ZONE R-h _L' -ground Soil.pg/,/U.G. Water� PERMITS ISSUED L. ,rground Gas K/ - !- SUBCONTRACTOR DATE NUMBER Overhead Water and Gas J y_ 1- Rough Heating j..u/,Qv1=c/ r3ta-J • Cr-4-4,49:t +4 Q ( q..c74? Rough Plumbing AH/ q'".•/h:,/ Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System / Heating, Final h /,t/ /4't4'4i/ Plumbing Fixtures ' // b(/ 4:1•2,4:0 / r ll, Final Gas Test / ../ NJ ep„(A-G,,/ / /1,,t/ , I Construction Pole ,'" Underground Power /r•i Rough Wiring D//d ce -rn-U-l-rirR,o.,,, �'otrSr,v; R-'3-61 trioli V Trenches Forms Steel - ' loor Bond Systemm Steel Reinforce Chimney Re-Rod Bond Beam 4 / Sheathing )Y/ q- g- Cl lll///��/// �J//�///' lye and Flashing 46 in l c-- q — f r-c Iy ,, f /`_ ' ,/lr I. fk, g, In Out :j . 9 .zz . c/ LlPter, brown coat " ,' : //-a/– Plumbing Fixtures, Final / ethbr / Electric Fixtures, Final -" , (9o/ Building, Final r //— n! OCCUPANCY I - Form 210-5M-11-59 S-B p HOLD FOR SPECIAL REQUIREMENTS 14796 • 14796 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JUL 3 1961 P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APPLiCaradigt4011111SA TYPE OR PRINT BUILDING /// /-� STZ 2 BUILDING ADDRESS /7�3 ` / COSTA MESA. CALIFORNIA For Office Use Only I RECEIPT NO. Id 7,77574 Z. //O e SPcIFO MAIL REC81 B I DATE{0ECE1 7� DATE mum ADDRESS - 5-/I-7 / TEL. CITY SSV«/A-iqJ7e NO. BUILDING ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIAel OR ENGINEER NO. ADDRESS FIRE c /,�//J ZONE PE GROU /- / ce CONTRACTOR_5(�''n�1',{t1IlLtC, l J�/174:/ 14 (D71 APPROVED_ GATE 7/�1`W/ ADDRESS � -{j /v el-ti/ O'�"'1 /� ZO •/1NO.OF ZONING IIJBNe'OP IN`BN�.(. \ J CITY CoS�/•7 �a/�/ w 1 PLANA •/AHUILDINy�•{()•`L- • �Y`L STATE q (} TEL. X74 4. C. ECAL LLL___:/ /L. LIC.NO. / R Z d �� NO. //.[ b 7`�CO3 LEGAL Prlox 1, AL It. , 9�, 1 SIZE �1, ry I NO. OF B1D08. / Il OF LOT J 1. S/1 Joc/,' y NOW ON LOT i A.P.NO. Ii –O , L3 USE OF / / �] ` EXISTING BLDG. S,,, 4? r('f ZIA'el' YARDSRO EVESL �, CPI. l / APPROVED ALLOWED SETBACK LINE FROM 2 I (CENTER LINE ST.), �`� A CENTER OF STREET / y//'/w�REAR YARD `J FRONT h FT. laneIN. 1`.. SIDE YARD I LEFT G e J I RIGHT R.SIDE r FT. IN. 1 -' DESCRIPTION OF WORK -0— I b 'A L.SIDE FT. IN. t ili NEW I II ALTERATION I II ADDITION I REAR ^`, ' FT. IN. REPAIR I II MOVING I II DEMOLISH I APPROVE BY t1% DATE --:;C% 1 a BUILDINGtu /0, 2 ¶ 612E ROOMS STORIES/ . '1/4" 1-,....-. / cr EXTERIOR WAL2..T' I ROOF /'Om�.n COVERING ) / L/C-C-6COVERING 1. 'v USE OF BUILDING AND WORK TO HE PERFORMED ..1 cl / l.7 Inii./ 1/y DW JtAve Ea D. LA K I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION 0 AND STATE THAT THE ABOVE CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. W PLY WITH ALL CITY ORDIN AND STATE LAWS REGULATING BUILDING CONSTRUrnTION. e VALUATION ` ///. 1� CI (GNAT R / 7„I L+'4. /,il,.�IDC PERMIT FEE $�'Y' N 0 PERM G ) A� 1�. R z $9O y PLAN CHECK $ / ..G ' % AUTHORIZED AGENT 1� e TOTAL FEE $.3 >/ — 0