The URL can be used to link to this page

Home My WebLink About203 21ST ST - Building Permits 1 41.1w$4 - ' Mt? CITY OF COSTA MESA BUILDING DIVISION -• ( DEVELOPMENT SERVICES DEPARTMENT PER NUMBER l;1 /.a t PERMIT J *b"'oRc^'""I E05-00049 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 203 21ST ST Status: ISSUED Suite No Applied: 01/21/2005 Vicinity: Issued: 01/21/2005 Parcel Nunmber: 42620214 Applicant: MOUNTAIN-ORAVETZ, MARILYN ISSUED BY Address: 203 E 21ST ST Phone: 949-645-5956 COSTA MESA,CA Zip 92627-2125 Owner: MOUNTAIN-ORAVETZ, MARILYN Address 203 E 21ST ST Phone: 949-645-5956 COSTA MESA,CA Zip: 92627-2125 Contractor: Address: Phone: Zip: License: SCOPE OF PERMIT UPGRADE SERVICE TO 200 AMPS. 2/4/05-PERMIT SUPPLEMENT TO INCLUDE 2 DED.OUTLETS TO SERVICE REFRIGERATOR& . MICROWAVE. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 - Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 _ Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 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(6100) 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. ❑ 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed/f the permit is valued at 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. Applicant Signature: Date: 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(Sl08, ),IN ADDITION TO THE COST OF COMPENSATION,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 licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lia.R Class 0 Contractor's Signature: Date: 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).): #09I,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 Contrac• License Laws.). ❑ I am exe •lund- se Business and Professions Code for this reason: Signature:• ) L t at car., TCILt Owner ID ven ie by drivers1k", ■"".„..21:1 No D`ve/s License No. _ -• Expires: 4• - 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? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be flied 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 Celifomia Health end 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 California Health and Safety Code been fully complied with? ❑Yes ❑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 LJ No (Section 65850.2 of the Calif omia 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 ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Oualfty 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? ❑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 COMPLIANCE AND A ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree t comply with all state laws nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described r y fortpe n ses.I agree not to occupy or allow occupancy of any building authorized by this ppPit Ingl jnspection. V ignature Of Ld Owner(s)J /attee>t And/Or Authorized Applicant Date CODE I INSPECTION TYPE QAIE MALS CODES DISSECTIONTYPE DAIS I[ S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 3/,24in 7nY 201 Final Block/Retafning Wall 212 Final Fire Prevention �� C 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy t");.A CITY OF COSTA MESA BUILDING DIVISION - e r� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I�r PERMIT E05-00049 (714)`754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 203 21ST ST Status: ISSUED Suite No Applied: 01/21/2005 Vicinity: Issued: 01/21/2005 Parcel Nunmber: 42620214 ISSUED BY: Applicant: MOUNTAIN-ORAVETZ, MARILYN IV /l /xL l'me- Address: 203 E 21ST ST Phone: 949-645-5956 COSTA MESA,CA Zip: 92627-2125 Owner: MOUNTAIN-ORAVETZ, MARILYN Address 203 E 21ST ST Phone: 949-645-5956 COSTA MESA,CA Zip: 92627-2125 Contractor: Address: Phone: Zip: License: SCOPE OF PERMIT UPGRADE SERVICE TO 200 AMPS. • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment • $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 -up to 50 kva/kw $0.00 0 • Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 . Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 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) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I. 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. 0 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed i/the permit Is valued at 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 it 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: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,0001,IN ADDITION 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 I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.# Class# Contractors Signature: Date: 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: 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 old 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.). pr I am exam un er sec. Business and Professions Code for this reason: Signature: Y a --- Date: /•N. 8.55 Owner ID ve ed by drives ense. Yes 0 No Driver's License No. Expires: —r'O/ 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 California Health end 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 ermit for such construction or modification 0 from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 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? ❑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 state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF C MPUANCE AND 'UTHORIZATION 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 mply with all s .1i+:ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ pr p y for pe• •urposes I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Air,. _ /' a,' Sig . 1:Of Leri • ner(s) Date And/Or Authorized Applicant Date CODES 18SPECTION TYPE GATE INTITIAIE CODE INSPECTION TYPE DISE 1t�AE$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 OWNER WELLS, B. L. DATE 9-8-61 JOB ADDRESS 203 E. 21st Street BUILDING PERMIT NO. 15421 GENERAL CONTRACTOR Owner-builder VALUE $ 495.00 Se AP No. 118-102-11 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add att.cpt.to INSPECTIONS Signature DATE GROUP J TYPE V ZONE R-1 PERMITS ISSUED SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 I-louse Con. 0 St.Swr. ❑ Sprinkling System Construction Pole Underground 0 Power ❑ Rough Wiring Trenches 0 Forms 0 Steel Reinf. 0 _ Floor System Bond Beam 0 Steel Reinforce 0 Sheathing _ Frame and Flashing 0. Lathing — In 0 Out 0 Plaster, brown coat P•r Ref rig. 0 Air Cond. 0 Final ing, Final .ibing Fixtures, Final _ Final Gas Test Electric Fixtures, Final Building, Final 9 e/.Z a 6 OCCUPANCY FARM RUQ.SM - 7.61 • 15421 FEE RECEIVED . 1542i_ y SEP d 1961 • COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT 1 TYPE„pR PRINT 1 BUILDING q�..ry --I{ADR BUILDING ADDRESS i( (/ cR•�"E✓ /p/•CCCOSTA MESA. CALIFORNIA/{ FFor Office Use Only OWNER" /O� iiii////��rr--iii%��I �I/gl,I RECEIPT NO. I A P;RMIT 210. Ht pp • 4 MAIL �J s� rrJJQQQ�� RECQIV D /V I D .=er* 7TEi /SU ADDRESS X oy -�/�/�'/�2/��io�i lSS 3 .�'`� �I CITY "f: JPA"`v"�� N I,��"(V., _ oiE ADDRE6b Q l -'�/ ARCHITECT TEL. G� OR, . INEER l � NO. COSTA MESA. CALIFORNIA AD S �-�' FIRE V [I/ ZONE TYPE GROUP AN-nig ,.' " ' /�/ / APPROV��//j�'��(JJ(�� CONTRACTOR P yy-may// /�.�/ BY /KJ� 4 DATE ADDRESS s....--...-..".' ZONING ZONE NO.OF USE OF NEW CITY G�—_ p -t I PLANS C. I BUILDING /� - LIC.NO. NO.ATE TEL. �- LEGAL AO', IlaVig- 1 R ^ dpi /C/ 2-119 DESCRIPTION " Vie SIZE P NO. OP /LOOe. OF LOT �.+" yip': �/ I NOW ON LOT Ai A.P.NO. '7 LJ -- /OZ II USE OF �i11 YARDS EVES EXISTING BLDG ___ I • 4 .."1,-4.794._ APPROVED ALLOWED SETBACK UNE PROM if 0../'-. RE �J # (CENTER LINE eT/1�/ y-, rkifh CENTER or STREET ?A:AA / REAR YARD / .4- FRONT �7�/v /"FT. IN. SIDE YARD I LEFT I RIGHT R.SIDE /S- FT. IN. DESCRIPTION OF WORK 3� -- L.SIDE FT. IN. NEV' -r I II ALTERATION I DAM ITION REAR 7 IL * FT. IN. ' REPw.rt I II MOVING I II DEMOLISH APPROVEDGU / DATE 9/8/61 BUILDING O/A / NO. OF • ,C ila SIZE /J ROOMS / STORIES / EXTERIOR WALL i ROOF -' iP a. 1 it cpt COVERING COVERING Q/.(lam Ytic V� • USE OF BU ILDI AND W T BEP FO MED -O X a4 �, A JD " �� ! qac // 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ' ' AND STATE THAT THE *DOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. .PLY WITH ALL CITY ORDINANCES AND ATE LAW REGULATING BUILDING CON/TRD �/ 'N �t VALUATION '/ SIGNATURE OF // PERMIT FEE $ 7 PERMITTEE (i '— �/�� N $ y X PLAN CHECK $ RY AUTHORIZED AGENT V/j•/ ¢¢ TOTAL FEE $ / 4 OWNER WELLS, B. L. DATE 7_5_50 JOB ADDRESS 203 E. 21st Street BUILDING PERMIT NO. #3285 GENERAL CONTRACTOR Jack 0ornair VALUE $ 6,51(mo LOT AP1182100-33 BLOCK TRACT Npt. Hgts. RPP Rr gar GROUP I & J TYPE p ZONE p), FIRE DISTRICT 1296 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR u DATE NUMBER Footing Trench _L/r. Foundation Forms and Grade to Garage Rough Framing J-t- i 7-3,3 --.9 Ei Plumbing,Rough to Slab .[9,1!-A 2-/i. F4 4, ue-,-1/4 7-9-SG .57.57Jr — Plumbing, Rough Complete ,g ,C n £ 7 J1t4 Temporary Pole ' Wiring, Rough 947. 7nf4 tivLf.cv�, d7-2 27 // Heating,Rough Heating, Final ewer, House arc S _, J 7-a-7• , _ - •,_ .,4s' 7-a-7-SLS ,3 L / 3 Septic Tank or Cesspool Lathing, InX Out f ( 3/-` 4 rvg P ,ring b -g P. .lbing,Final,Fixtures Complete,i),e -.-, Plumbing,Final Gas Test 0, y eif I ff% 'Ft, LAPPr 6 Wiring,Final r6Y P ray -- — Occupancy .9-nA'at, - FORM 210 3M 10533 3285 Costa Mesa Building Department c APPLICATIONBUILDING FOR PERMIT P. O. Box 3!7 , COSTA MESA, CALIFORNIA 329P) / FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN I Receipt No. `Permit/ryor Building `Jl 1�l< Address g p3 ,1 ,1/ i ,ri�£FT Rec iv by Costa Mesa, California // Nearest I7 2-..s-Date Reed. I Date Issued 7-3---6.b Cross St 'v?4 w ,c rk Building Address w Owner X,{, /4,49-2 ,e..5 Costa Mesa, California Mail Address ,t ev ,F,, ,2/ .2 cis .I9, Nearest Tel. Cross St City Ce, f' 4 /yf,ks4-4, No. Zone No.of I Type, I Grou T Architect or Lic. I Plans I VJ Engineer No. AJpro� T b/ AV p O S Date Address Olt1L�•1Nl�LJ�S1,rlTl I itractor NA ft() /204,44/4 /,(' Noty Lie. 1 CI 1": Ur 4-.N..3TA M i'L,..t,i,:r4G DEPT. Address //f 1. ..t.? -hy C. A2, SUo IFrT TO RI CG. DEPT. REG. LegalLot 1 age/Or:r, Description I No.,j.41? I Block I Tract//,Tp; /�/ C:)-0 (Attach Metes and Bounds) J / R—r Q o — ~ti.__YYY� "g -� UNY' -; ,DP.TE' A Ta No.of Bldgs. ____�� TT' " Size of Lot Ccx /c'- I Now on Lot ;l u t A �c� n -�- IKer rf',Odsrca `- No.of No.of b+ O -a 2 Setback Existing Bldgfr m ('r�� Families Roomsr — !"� r4 II 1 R �-2 Setback Line from Rear Yard .f ' •--!`---aJ n t- ' Center of Street /2 9 Side Yard S lit .t i t�Yde D DESCRIPTION OF WORK - , �{� ��y(p —r New I X I Alteration I Addition I "" ,- .J0,„v �:.a-_- - . JJ-'� DATE o G_�_._ �> Repair I I Moving I I Demolish I ' ;AR NO�....:Q -,A?Pe9Vj D ,Y '—ri1,-v 10 I Building ,I No.of Size 74'9 A Rooms X Stories / + .� r.terior Wall I Roof S1/4„.-4,c4 eringS1/4„.-4,c c s+ Covering ,rip r rt. APPROVAI;S Building ' Foundation Location Inspector • Date Building �C,t- til. 2.-d.,44r .9— Forms,Materials, - � -,s9 0 62-9 C-' t--� Under-Pinnin. b`' I i�,Si1 i. . _ " Frame: Fii•e[Stops,'- li r"" ' Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building construe • . Lath.Ext Signature of LPtre c,__ irt J{ Plaster, Int. Authorized A t. 74 ..cn Plaster,Ext Valuation Permit Fee $ /K \ Masonry Reinforced Plan Check $ 9 .. Bond Beam $ f' /(7 Total '7 Fee $ L2/ FINAL FORM 204 10.39 O.P.&S. • \ • ci. nnCOST^ a.- 0 L IL "627- • •— - to • 'a* t• . . • • - Street . . • PLOT PLAN I Show location and distances from 7. property line and between buildings. •• ' _ e •_ • —