HomeMy WebLinkAbout241 21ST ST - Building Permits CITY OF COSTA MESA
BUILDING DIVISION
• DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
F I I
k `4° PERMIT
ekbePoRnno1803-00837
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 241 21ST ST Status: ISSUED
Suite: Applied: 05/20/2003
Vicinity: RESIDENCE ONLY Issued: 05/20/2003
Parcel Number: 42620227 Zoning:
Applicant: MARISCAL, JOSE ISSUED BY:
Address: 18449 LA CANADA CT
Phone: 909-820-0933
BLOOMINGTON,CA Zip: 92316
Owner: OLGUIN, GUY
Address 241 E 21ST ST
Phone:
COSTA MESA,CA Zip: 92627-2154
Contractor: J L M ROOFING CO
Address: 18449 LA CANADA CT
Phone: 909-820-0933
BLOOMINGTON,CA
Zip: 92316 License:. 786931
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF RESIDENCE ONLY:T/O EXISTING ROOF, 1/2"OSB TO PARTIAL ROOF AREA, 1 LAYER 30#ASTM FELT,APPLY"30-YEAR COMP
SHINGLES."17 SQUARES
•
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,500.00
Permit: $83.25 Claim Valuation: $2,500.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
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 Existino: 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 II 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
244646(6/00)
DECLARATIONS J r.
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.
tr 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 workke-rs'rc�pm-lpeensation Insu/�a�Dce carrier and policy number are: / y� p
Carder: .5! /7 ! t / U Al J) Policy Number: /6.3 (�6 / 6 - 0
(This section need not be completed if the permit is valued at one hundred dollars(5100)or less.)
❑ I certify that in the performance of th work for which this permit' slued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of C ifomia, agree th t I cold be a subject to the workers'compensation provisions of Section 3700 of the La Code,I shall forthwith
comply with these pro ' ons.
Applicant Signature:, ,r - Dale: O 5—/?i0 3
WARNING:FAILURE TO S RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PES AN CML FINES UP TOONE HUNDRED
THOUSAND DOLLARE( ,0013).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I em licensed under rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Profs ions Code,and my license Is in full
force and effect.Lic.q---?''E2 / Class a - r
Contractor's Signature: -/— .- ..� Date: r S
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 tile 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 toe cMl 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 loan 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. Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of d mens,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
pemlit,and that no building structure,scaffolding,lalsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 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 lima 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).
_._._Does or..wi_ alit .. _erial..._...._.._ ...
2 or will the applicant or present w future building occupant need to lila 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 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.
_ __ _................._...._..___._ alit _ _______
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 subiect of this application aagermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_.._ __ollution 'thew&_ which_i.._.... _..._____
7 ifa a permit lon avh the South st s(Duality ed management District or other et poldtion c4l district3 or ade?y 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 0 No
_t..._..alit..._.. alit _ alit-..r_ _ _...alit_.
6 (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 AUTHORUATION 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.
V
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A Of Le ner(s) oDa
tend/Or Aul oozed Applicant atNSPECRON TYPE RAILif AU CODE! INCTION TY
SPEPE - PATE INTm•EL6
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final206 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 _
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
- CITY OF.,EOSTA MESi i CO II TR CTION PERMIT PER N VS-17
TRACT NO. LOT NO. UNIT NO.
Pr:*1,'Address n]PC �M
CO e
Ss
TYPE OF CONSTRUCTION LI NEW ❑ ADD U ALTERATION U REPAIR
Applicant's Mallin• • .dress 7 PhoneSt ...r ❑ DEMOLISH ❑ OTHER
fi�rr-- • et ❑ CONVERSION A.P.qts Zone
Owner's Name�d �1 !�/ � A'IG I - �� DESCRIPTION OF WORK/USE OF BLDG.
Address c2 ` i LLQ • r54 S Main Building: Accessory Building:
Arch/Eng. _License No. TYPE OF PERMIT ,/U GRADING LI FOUNDATION Li STRUCTURAL T Front ' "' +'' ""s"i'C ° =' ° '0'
Address (Z ❑ TENANT L16 ELECTRICAL ❑ PLUMBING 0 MECHANICAL BB Rear N
//^� P ❑ OTHER
Contractor's Name V Phone C Right N
PROJECT DESCRIPTION SQ. FT. OCCUPANCYK
Address(mailing) G
CON ST RUCTION TYPE VALUATION$ S Left
City License No. ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION !� ,,�,p -tI I �� 1 �, /��� Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: U s /C?r�s.'"c -elf, Mr1�Q1 T'QS 4O TV/Way Planning Notes: a
with section 7000) of Division 3 of the Business and Professions Code,and fr T
my license is In lull force and effect.
License Class _License No. S
Date Signature PLUMBING FEES
WORKERS'COMPENSATION DECLARATION ,
'hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section t
JO, Lab. C.) Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap0 50+KW
A
9 Construction Pole Sub.
Certified copy is hereby furnished. ry
Certified copy is filed with the city Building Division. • Bathtubs Sewer Connection Cooking Unit Meter Rim to 100 amps /g ego
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed If the permit is for one hundred($100) or
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which ails permit is issued I
shaii not Crr)ploy any person in any man :r so as_to gppome subject bj� to the Drinking Fountains Solar Tank Fan Motors❑O7 HP ❑1:4-8
Werke C Ona i Laws a Calure,'xd {xAVAif/—/�-{(LL/•'1���
Datp� •� Signature�� Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 9.15 HP 016.15+
NOTICE:I after making this declarati• you should become subject to the
Workers' Compensation provisions of . Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Clv. CJ
-
Interceptors Water Heater Outlets Range
Lender's Name
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or p Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator 00-5 KW❑5.15 KW Trash Compactor
any structure, prior to Its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(Commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she Is exempt
,refrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil ,
Sl lty of not more than five hundred dollars($500).
Se I, as owner of the property or my employees with wages as their solo Reinspection Fee I $15 Issue Fee $ 3 /Soo
compensation, will do the work, and the structure is not intended or offered — -- - .. Fee Reinspection
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES p ' $15 Issue Fee $.3
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own Boiler Hood Type I 0 DEVELOPMENT SERVICES REQUIREMENTS:
or
employees, provided that such improvements are not intended or offered foryP
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale). -
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date 7-19-4 g
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ID 100,000 BTU SUMMARY OF FEES
builds or Improves thereon,and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt nder Section B. & P.C.for this reason Firepl/Fact,Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date/ .3]-�-- Owner 7/ fAl I '—]s n-e.... HeatingSystemDuctingPLAN CHECK 25% $
& Registers ENERGY P.C. $
�1 � U-L—
I hereby c rtify that I have read this application and state that the above 06100,000 BTU 0100,000 BTL. ELECTRICAL $ 33.5-c, GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre• PLAN CHECK 50% $ MICROFILM $
sentatives of thisg city to enter upon the above-mentioned pr pert f r
inspection par/ Le.G/41/07./K2........- MECHANICAL $ 33 .5
Signature pF��([/,f /
Reinspection Fee $15 Issue Fee S 3 PLAN CHECK 25% $
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting: Goldenrod - Assessor "•.
I
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd, 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe,0 Undrgrnd.,Test
9. Water-Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final •
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing& Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing • 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . FINAL INSPECTION
32. Electrical Power Meter-Final . FOOD CERTIFICATE ISSUED
33. Final Electric /7/4 otes:
34. Final Heating& Air Conditioning !! 1'
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
1.42. Backflow Preventer
43. Backflow Irrigation
„44. Landscape Irrigation System
:45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed •
49. Electric Release to Edison
r.
50. Gas Release to Southern California Gas Co •
1 '
51. CERTIFICATE OF OCCUPANCY,
No. - • Date -
OWNER NORR. A. - - DATE 10-18-56 -
JOB ADDRESS Al '219t -Strppt BUILDING PERMIT NO. #3868
P 'ERAL CONTRACTOR Jack Cornair _ VALUE $ 9,1)1L00
AP118-10-42
LOT 42 BLOCK TRACT Newport Heights Residence
GROUP 1 TYPE V ZONE Rh FIRE DISTRICT 3898
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Footing Trench ''ir- --• Jo "30 it
Foundation Forms and Grade to Garag_ A
p��
Rough Framing it r lfi8�'
Plumbing,Rough to Slab / • 3o SZ lC , ,t,.�--0., /0 '44 - 5-4 7d. Sy
Plumbing,Rough Complete 'hi e c /, is
Temporary Pole y
Wiring, Rough 4t ./ i - J --Yr /J'13-.5.L359�q6 -'
Heating,Rough I/43 i'Set �. /0-, x-,5-6 las / -----
Heating,
Heating,Final /42.jq-5-G
l =ewer, House -ewer,St 2, MM` //-& //,Jr_sx / 7,7,33t ;Tank or Cesspool
� E.0� is
Latning, InX Out^ (jj 1/ .--2/-
Plastering &t /2.6 — G -
Plumbing,Final,Fixtures Completemes p.-/J-s ` ./:, I ' 7,
Plumbing, Final GasTest/SN ynC 5 a-•/g-.Jt �- -, fly ka-' .
Wiring, Final / , Ar/' A
g - . Fes` �l_�«0-, .
Occupancy ��) P .29f-re
FORM 210 3M 10.55 3868
; - Ualfesa Building Department APPLICATION FOR PERMIT
COSTA MESAO.
3598 BUILDING
Ilk - FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN 1 Receipt No. I Permit No.
Building p‘e
Address V/ 7�1� ,Sj� O
Costa Mesa, California ReReceivedceby Date Recd. Date Date Issued
Nearest %`e /7/c 6'� /0 /f 6
Cross St. /9,4z.4,4//j Building
Address
Owner A. ,,n,,, it, Costa Mesa, California
Mail
Address Nearest
Tel. Cross St.
City No. Zone • I No.of Type / Group
Architect or LW. F Plans ✓
Engineer No. Approved
by Date
Address $ r :. !!!"•i - . r
p74,..-4.. 7.:�/�a 1� City Lic. j *1
Contractor � No. � � � ' a
Address //9 -1, :Z. C.1, - -.. - _ .
LegalLot I I ,y/,yiy/-igj�) CITY s ,
Description I No. j/ Z Block I Tractn,,/y3 • . -
r pEFT• REG.
(Attach Metes and Bounds) a,/0-4..VJj—/eJ—Si,
No.of Bldgs. L�
Size of Lot 5/4 /222 I Nowon Lot 0 , , b-Jasi. O
Use ofNo.of No.of 9
Existing Bldg. I Families I Rooms ii
Setback Line from . ., Rear Yard .1m*YC
Center of Street COC Side Yard 5 ' j
DESCRIPTION OF WORK
New Ix I Alteration I I Addition I
Repair IMoving 1 I Demolish
Building No.of .-I
Size //A• Rooms C Stories / 4
Exterior Wall . I Roof —
Covering S-T{/CCO Covering COMIt'/7 APPROVALS
Build ngse of Foundation Location Inspector . Date i
Building ...M-75il)x�÷C Forms,Materials,
Under-Pinning „4
Frame: Fire Stops, a.
Bracing,Bolts 0
I hereby acknowledge that I have read this Application 0
and state that the above is correct and agree to comply Lath.Int.
with all City Ord' ances and State Laws regulating A I
building contra Lath. Ext.
Signature of n
Permittee / f eF4r rya-e--C Plaster,Int.
AuthorizedfAgt. » � `� Plaster,Ext. 0
8. a
Valuation Permit Fee $ 02.ce— Masonry Reinforced N
Plan Check$ /ct? — Bond Beam
$ 9/�y Total u
Fee $ 3z it FINAL C
, FORM 204 10.55 O.P.&S. C� I
W- fk
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Street
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PLOT PLAN
Show location and distances from 7
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J property line and between buildings.
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OWNER SgRVAISTed DATE . 8_12_75
$JOB ADDRESS 241-E. 21st Street BUILDING PERMIT NO. 40391
G'"'.RAL CONTRACTOR Owner/Blare DESCRIPTION of WORK Carport
A. .0. 118-103-35 LOT TRACT FIRE ZONE VALUE $ 600.00
INSPECTIONS Signature Date TYPE GROUP ZONE R-1
SOIL SUBCONTRACTOR PERMITS ISSLED
l GAS Dote I Number I Signature
WATER Plumbing •
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES FORMS ❑ STEEL REINF. ❑
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATmING — IN n OUT In
P ER, BROWN COAT
51....GTURAL, FINAL Electric
HEATING, VENT.. REFRIG. AND P.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
RUn niur. rime! /1 i_<-A'
1 , r .. X5039 : PAIL.' i 12-75t;,S•00 599" __ =t55C
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLL'IC�TION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECE%L%'y o ®GPT
IVED� O E lMU.Q(e
BUILDING � T 1 E ^ i R C
ADDRESS 4 tX
��� tam� , //f^/d. 3� PERMIT NO.
OWNER T.� A.P. NO. '71,
MAIL � // y� 1 BUILDING ea 15� 5/
Z ADDRESS 4'\ /./to 210 ADORES`��/ bei.r
t1 Q CITY N Py.. NOw 111 . 7 2/�//I TA'M4 IJ% /.� LOT LJ BLOCK
Z �T
CONSTRUCTION NEW ADP ALTER REPAIR MOVING DEM-UN-1
a m LENDER
J 7 BRANCH OWN j O -fr�
J to / ///
J IV ADDRESS I (L r VALUE / 01/-
03
Jm ARCHITECT JCC/--` TEL. USEOFL(' .Otf1/` $ r����
U N OR ENGINEER NO. t
Q FIRE
WCC ADDRESS �/'/j ZONE fa'
GROUP
JO CONTRACTOR I /��,,„a� APPROVED //a' DATE .12
m Z 1/ /
J CC ADDRESS Q �
W W TEL. ZON NO.OF USE OF NEW LC�La -i L/
ZI- CITY NO. / PLANS �1 BUILDINC��}r "lel ex
O �� APP
W STATE CITY. YARDS IN NGD YARDSESAPP BUI D
j O LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE 'NO.OF BLDGS. (FROM OIL STREET) ��V�II yfl _
OF LOT �5
NOW ON LOT FRONT FT. Fy.. e. .2/
•
USE OF
EXISTING BLDG. R.SIDE FT. SFT.
F- SIZE OF NO.OF
Z NEW BLDG. f O S. 2.9 ROOMS ( STORIES L,SIDE FT. r FT.
Q EXTERIOR WALL ROOF '
✓ COVERING COVERING REAR FT. 4F��' P
-t USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
0..
CL MAIN BLDGS. ACCESS BLDGS.
CL ///^^^
Q / n� nom-- VAR.#
0 ( 2 O C.U.P.# /J�,DATE VEjD'1,
I-• �Y ROVE[ /p/�✓DATE /1 /.2��
O �f/(J /1MIc
C.) I hereby acknowledge that I have read this application and state 5
D that the above information is correct and agree to comply with
M all laws regulatlhg building construction, and I shall not employ 5 o
I" any person in violation of the workman's compensation laws of
N the State of California.
Z hereby certify that I am properly licensed as a contractor under 2� SQ. FT. TAX o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: cre
am exempt from the provisions of the State of California Business / C6
and Professions Code, Division 3,Chapter 9. VALUATION 6, m
PERMIT FEE $ c'
D
Signature p V ..r• m
Permittee �i/ s $ YYY///�� PLAN CHECK $ �OB E
Authorized Agent a
TOTAL FEE $
OWNER NRR Hnan SEP Z 4 1957 DATE 7..3,.57 _
JOB ADDRESS 2111 E. 21st St, BUILDING PERMIT NO. 5381
GENERAL CONTRACTOR Owner-Builder VALUE $ 117.00
,`n No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Wood Fence
JUP TYPE ZONE PLAN NO. 514l6
INSPECTIONS • DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel e.---f/GC 7—3 '.1—J
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
Top Out I
FurnaceQ t. 1
Gas Vents Op " I
Rough Plumbing /
Cesspool Septic Tank
ell/
%` 7 �?
Prop. Swr. Line House Con. St. Swr. �//j'l _ f(�
tr. Sgrinkling System i-1as VV((��//
;atlG.ag
Final _
•
i<: . bing Fixtures, Final 1
-'-.....,Final Gas Test
Construction Pole ill
Underground Power •
Rough Wiring
Fixtures, Final
=OCCUPANCY end— '/%/n
Form 210-5M-1-57 giAl
COSTA MESA BUILDING DEPARTMENT
P. O. BOX 317 -5446
I
i I COSTA MESA CALIFORNIA
FOR APPLICANT TO FILL IN
C.L. OF STREET-"-- I BUILDING ADDRESS 7Y-/ A 2-i `S2( -
_ ____ ROP. LINE Owner 'A/ ✓ )Zo-l/_.
I r �iP10 FT. FOR 60 FT. STREET- -11-rt -CiN FbR \ I Mail Address f j- w )�
50 FT. STREET
City atW C Ph. No d t-g n
' • Contractor Ph. No.
,
Address
50 T1IF FRON City Lic. No.— State Lic. No.
OF PROP. . -
150 FT wtc Size of Lot S k �N/'
l AP No.
w i N Setbacks: C/L Street S '�n � Rear 0
W D m ix is. Side Yard - Right tO Left_
I N r---- r a. v C T0 _jype of Fence . - r4..�i. ��_/
•
u. ALLEY QR PROP. LINEN tc d Afl. // ,- 00 .-- ud--y'Y"
0.
F": —57 --1 . I hereby acknowledge that I have read this application and state
m U.Z that the above is correct and agree to comply with all City Ord-
jalp inances and State Laws regulating building construction.
i V
\ Signature � tt -
> of Permittee`1 VW 1v•wc: F ' itty 1..
y� // 10
I 9 �/ ^' / Agent 1
y�
FT 6 1 m.— r FOR OFFICE USE ONLY
a0
13 J FT I Permit No.
10:1.
I • �„al -4---2 3/
I Id 60 F ST. Received by Date Received Date Issued
I50 FT. ST. i if I R i �EtVED VALUATIONS' / -3i`'�
��� _- -tr.f_ . LINE _- - O- - - _ _ _ _ _ 1 � 4 '� Permit Fee $ �'�
\\ ► i 3 a .>
NAN 11�r'p T� / I � / Plan Check $ `
CI Y OF PIIS MESA $ _
C.L. OF STREET
•
I TOTAL FEE $ • c. ,
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- - ---
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS