HomeMy WebLinkAbout157 22ND ST - Building Permits CITY OF COSTA MESA
.O S.X. BUILDING DIVISION
44 _F77 FAIR DRIVE. COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
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0. a .? FOR INSPECTIONS CALL: (714)754-5626
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PERMIT NUMBER: E10-00024
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42613305 DATE ISSUED: 02/16/2010
ISSUED BY: KJB
JOB ADDRESS: 157 22ND ST CM Suite/Unit:
Vicinity:
SCOPE OF WORK: SERVICE UPGRADE T6200 AMP FOR SFR. NO RELOCATION OF SERVICE. •
OWNER: KOZUKI,MARK AND JESSICA Address: 157E 22ND ST Unit:
PHONE: 714-345-7545 City/State/Zip: COSTA MESA,CA
APPLICANT: KOZUKI, MARK AND JESSICA . Address: 157 E 22ND ST Unit:
PHONE: 714-345-7545 City/State/zZip: COSTA MESA,CA
CONTRACTOR: License No.
Address: Unit PHONE:
City/State: ZipCode: CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
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: 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 S. INSPECTION TYPE DATE INTIOALS CODES INSPECTION TYPE DATE, IN1111AL6
1616 Fixed System Final Fire Prevention _ 208 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
1
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 0 Yes 0 No
1 hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownershipby(type of document,i.e
compensation, as provided for by section 3700 of the Labor Code, for the (yp -Property tax bill or deed):
performance of the work for which this permit is issued. .
0 I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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 0 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,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap. 3.2,Grp
(This section need not be completed lr the permit is valued at one hundred dollars($100)or less.)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Poly Number: 0 As owner-builder, I will not employ anyone to do work which would
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, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
do Ai workers' compensation laws of California, and agree that if I should
become sub'. t to the wor.- ss' co se provisions of Sec on 3700 of
Applicant's Signature Dale
the La•• Vie, shat h !. pl • ese provisions
/6 t,a Division of Industrial Safety Permit Number:
n
••tics•' ore "-' `t .� 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 0 No
($100,000), 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 force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (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
Contractor's Signature Dale 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
CONSTRUCTION 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)? 0 Yes 0 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 Dale
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 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? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished 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 0 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 property, 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 0 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
(�diiddnonot build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
`Q 1, 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 Dale
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 City of Costa Mesa to enter upon the above-described property for
inspection • rases. I agree not • a• upy o w occupant of any building
autho' -d „ Hs perm' s
" l!�
�� �O mature•-,•aOwner( 1/4.-- _•.le
-"'°ngnatureJ c ateCi
3057-46 0/07) And/or Auihonzed Applicant Date
r , ,.,cWot�+
FGORDINQ R(=Alf tED BY
• f j',.C�' � Recorded in Official Records,Orange County
Ir.
kL=" ''-''""`"l" ,''.•H
Torn Daly,
pClerk-Recorder
AND WHEN RECORDED MAIL THIS DEED AHD TNI STATEMENTS TO 111.111"IIIIIIfflIllIIi�lllliIIII�IIllllitlllII Ill�ll
9.00
MARK KOZUKI & JESSICA KOZUKI� 2010000059738 04:10pm 02/05/10
ADDRESS157 E. 22ND ST. e64040362216
on& COSTA MESA, CA. 92627
SIAmL 27225 272.26 0.00 0.00 3.00 0.00 0.00 0.00
Title Order No. 3439951 /(}3
Escrow No. 69711-AE
Assessor's Parcel No. 426-133-05
Date January 12, 2010
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DEED
The undersigned declares that the documentary transfer tax is $544.50 and
is computed on the full value of the interest or property conveyed. The
property is located in the city of COSTA MESA .
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged ,
SCORP CORPORATION, a California corporation
does hereby GRANT to
MARK KOZUKI and JESSICA L. sOZUKI, HUSBAND AND WIFE AS JOINT TWHTS
the following described real property in the City of COSTA MESA, County
of ORANGE, State of California :
SEE ATTACHED EXHIBIT 'A" FOR COMPLETE LEGAL DESCRIPTION.
In Witness Whereof said corporation has caused its corporate name and/or
seal to be affixed hereto and this instrument to be executed by its
officers thereunto duly authorized .
SCORP COR'• - •TIO era
c—
BY :
KI • ; ICO, President
STATEOFCALIFORNIA.COUNTY OF dg-Al { }ss.
Orl.7A/V'a0J pOO/D before men DtNJ/diti ec4tL1 J,Notary FOR NOTARY SEAL OR STAMP
Public, personally appeared KIM ARICO,who proved to me on the basis of
satisfactory evidence to be the person whose na ys_,sub gplbed to the
)yj)pin,yijYVment and acknowledged 192itips �l(lddcut"ed the same In
u or zed capacity, and that by'SiizATgh`5 urs on the instrument theabskaala
person, or the entity upon behalf of which the person acted, executed • DDNNAL.HDANS01�
!
the instrument. I certify under PENALTY OF PERJURY under the laws of the Oir�:z< COMM. 1ffKAN
State of California that the foregoing paragraph Is true and correct. I- _e:t� O
U \s�-��-/ NOTARY PUBLIC O CALIFORNIA 1
WITNESS my hand and official seal. Co `'� / ORANOECOUNTY 0
S. / My COMM.Emmet Meth 23.7010
Signature . / s LJ
,/
MAIL TAX STATEMENTS AS DIRECTED ABOVE 8681270AA REV.VW
racriptioar Orange,CA Docuweat-Pear.Docry 2020.59738 Page: I or 2
DOC ID th 00021895806702010
EXHIBIT A
Real property in the City of Costa Mesa, County of Orange, State of California, described as
follows:
THE NORTHWESTERLY 50 FEET OF THE SOUTHEASTERLY 555.21 FEET OF THE
NORTHEASTERLY 135.05 FEET OF LOT TWO HUNDRED EIGHTY-TWO OF NEWPORT HEIGHTS,
IN THE CITY OF COSTA MESA, COUNTY OF ORANGE, STATE OF CALIFORNIA, AS SHOWN ON A
MAP RECORDED IN BOOK 4 PAGES 83 OF MISCELLANEOUS MAPS, IN THE OFFICE OF THE
COUNTY RECORDER OF SAID COUNTY.
APN: 426-133-05
Legal Description Exhibit A
1C404-XX (08/08)(d/i) Page 1 of 1
11111111111111
'ILII
' 2 3 9 9 1 ' ' 2 1 8 9 5 8 0 6 7 0 0 0 0 0 1 C 4 0 4 '
racription: Orange,CA Document-Year.DocID 2010.59738 Pages 2 of 2
PROJECT ADDRESS: UNIT:
157 22ND ST CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 068688
• OWNER'SNAME: CRONIC ELSIE M I
ADDRESS: 157 22ND ST PERMIT NO: B 068688 PLAN CHECK NO: N GOVT; N SUP P : N
lialhav
COSTA MESA,CA 92627 PURPOSE: ALT
CONSTRUCTION TYPE: V—N PERMIT TYPE : STR
646-2930
ARCH/ENGINEER: flFG.NO.:
ADDRESS: UNIT: ; SQ
JOB DESCRIPTION T/OFF & REROOF W/CLASS "A" COMP SHINGLES FT: 3, 700
li CLAIM VALUE: 3, 700 , 00 CALC—VALUE: 3, 700 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: MESA ROOFING ( 714 ) 548-3012
ADDRESS: 843 W 17TH COMMENTS : SMOKE DETCTORS REQ PER UBC 91 , REROOF 2000SF RESIDENCE & GARAGE
COSTA MESA CA 92627 ***d6iFpE+tdE***yFerdE*****+FdP+ESrdE*sP***+6*********JE**p6**pP**pP*p6**dF*****d6**dESFeFe6*********k ***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(comm ting with Section ZONING R E U IR EMENTS
7000)of Division 3 of the Business and Professions Code,and y license is in full force and a ect. SETBACKS
aTYLICC'.`—�05681 STAELIC.: 56415� CLASS: C-39 E /95
Date:,jT ^ O ^9 Signature:_ _ _ .acy MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DEC RATION: thereby affir at have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.Cl. LEFT : FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICYNO.: PWC 24167501 EXP.DATE: 07/01 /95
coMMNY: CNA INS, COMP . / PARKING REQ• PROV; PARCEL: 42613305 ZNE; REF NO:
❑ Certified copy is hereby furnished. a Certified copy is le with he city Building Divi n. PLANNING NOTES>
'•••—j, Date: ^S JI gi Applicant: / (CQ >
•
***************
****************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R EQU IR EMENTS
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. ZONING APPROVED BY
DATE:
Date: Signature:
NOTICE: It.atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY , DATE:
Code.you must tonhwith comply with such provisions or this permit shall be deemed revoked. ,
CONSTRUCTION LENDING AGENCY; I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y : il,x—\ (•
f DATE: 30*********** ************* *WW**
S**
this permitis )Section 3097,Civ.C). ****,**,*,**,*,***,**,*,******,***********,*********** *********** ************* **** **
LENDER: *******************************************************************************
a00REss: LEGALIZATION; N F E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 6 3 , 0 0
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed . 50
pursuant to the provisions of the Contractors'State license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES
and Processions Code)or that he/she is exempt therelrom and the basis for the alleged exemption.Any violation of Section 70315 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 63 , 50 0 . 0 0 0 . 00 6 3 . 5 .' 63 . 50 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or throughL/
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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 63 . 50 OVER/SHORT• , 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the protect(Section 7044,Business 63 , 00 , 5 0
0 and c ofessions Code: The Contactors'State License Law does not apply to an owner o1 property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware *,**,*,***.************************************************************************
that proof of their Worker's Compensation insurance should be provided to me.
❑ am exempt under Section: B.&P.C. INDIVIDUAL F E E BREAKDOWN
for this reason: TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Pate: Owner: SFR 3700 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 3, 700 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534 and that I or any future building occupant wil0will not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit tor construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. Vite
Date; Applicant:
t hereby certify that 1 have read this application and stale that t abov information is correct.I agree to co ply with all city and county 1 00166941-00366942 TOT 63•`0
ordinances and state laws relating to building construction and h ret aut orae representatives (this sty to en r upon the above mentioned DATE: 03/30/94 TIME: 14:44
propert r inspection purposes. [
Date', --;0 -I if Signature: 440A
Driver's License or Social Security a:
1641.46 While—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
ITS ----`
C
ti
CONSTRUCTION AND PLANNING POOL ,PA •
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 UF ER Grnd. 57, APPROVAL TO COVER-GUNITE
7. Footings - 158. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
•
-
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House-.Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains • " 64. Plumbing System - Final
14. Rough Plumbing •
65. Electrical-Final
15. Rough Electrical-Conduit , a 66. Solar System-Final
16. Rough Electric Wiring' - -- - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure - • • 70. Underground Hydro
22. Ducts,Ventilating
71. Product Piping ❑Gas 0 Oil
23, Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing g_-,,.,Gqc f 6444 74. Overhead Hydro
26. T-Bar;Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame ande
•
•
28. •
76. Dry Standpipe
•
28. Lathing & Siding . 77. 'FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing • I I' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat , 1 I'. 79. FINAL INSPECTION
1
32. Electrical Power Meter-Final t 80. FOOD CERTIFICATE ISSUED
33. Final Electric. I Note's: -
34. Final Heating & Air Conditioning • I l J
35. Final Gas Pipe=Test I I i •
36. Hood or Canopy . _ - •
37. Final Factory Fireplace .
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final •
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations •
47. FINAL STRUCTURE& BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER CRONIC, Rev. M. E. DATE 2-24-67
JOB ADDRESS - 22nd _ treet BUILDING PERMIT NO. 26 16
N GENERAL CONTRACTOR Robert M. Wilson DESCRIPTION OF WORK Add Patio Cover '.
No. 118-041-08,2QOT TRACT FIRE ZONE VALUE § 265.00
I ECTIONS 07,12,13 Signature Date GROUP J TYPE TY ZONE R-2
g Sou PERMITS ISSUED
Gas SUBCONTRACTOR I Date I Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line ❑ House Con. 0 _
Sprinkling System
Miscellaneous
Rough Heating and Mr Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches O Forms 0 Steel Reinf. 0
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster, Brown Coat
S' 'ural, Final Electric
K .ng, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final a 6-?.AVG 7
Building, Final
26719FEB 24-67[NSAFAI�00 933 v***` *3.Q0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 93026
•
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRI T BUceDING
BUILDING q p �J''�11j • For Office Use Only
• ADDRESS /4-7_ /� /�
noun NO. PE MIT NO.
COSTA MESA, CALIFORNIA .�•. /r/P7
RIC' awl. GTE REC IV D _ TE10 UI
OWNER R?I/, Nei r/I o,v i e Is .-..1-----;-) --� �=.�y c
I MAIL [ /-� / BUILDING
ADDRESS / l / "'• 73/4:2- -- - ADDRESS
�
TEL. FIRE
CITY �/ A' NO. a` ZONE ��� TYPE GROUP /
,. ARCHITECT TEL S " APPROVED /H/�� DATE 2 IO
NGINEER / ” _st. j _ NO. - "O �r 000"'
ZONING
ADDRESS , 0. .1.• •_4r ✓ • 41j/. Ave EON/ l'
PLOP BUILD (/f�'//-LG
p ./ / PLANS y BUILDING ,,
CONTRACTOR ( I �/ A Q r/ _
/� _ X //�
AD•RIESS . i la J I Si 1• . 1 A. / •••• D. DEICRITON �J�d-y1 ) T. • i
CITY , ?NT/1 /fA' A.P.NO. •/'-`/ /'�J- .10/7/.2I
S / �/� NOTE: NO RAVE OVERHANG SHACL BE LESS THAN
LIG.NO/ATE '/ SIC•-e-VI NQ, 01 oea +, 90'TO SIDE&REAR P.L
HAES
SIZE 17 NO.OPS }LDOS. LOWED I U.B.C.REQUIREMENT)
OF LOT �O / Y NOW•N ( YARDS APPROVED Y :•S APPROVED
USE OF - MAIN BUILDING CESS• -Y BUILDING
• EXISTING
SETBACK LINE FROM
cenraR OF STREET ��0
REAR YA'D a •
lirIi SIDE YARD LEFT 7 RIGHT 0 Irr'
DESCRIPTION OF WORK •- /ale Ff.
x 887.MA
ALTERATION •
le • 3ACCESSA•GS.
REPAIR MOVING - DEMOLISH
BUILDING .- v NO.OF VAR.# DATE
`. SIZE / / /� �Q rROOMS STORIES . C.U.P.# A / APPR• ED
i EXTERIOR WALL I ROOF APPROVED '-- //.
COVERING COVERING ' BY '� ///��� DAT - j . •
USE OF BUILDING AND WORK TO BE PERFORMED 0'
is .411l0i: St,ca e nett! 99
8G.Pr,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _ THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT'AND AGREE TO COM• PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. F11
PLY WITH ALL CITY ORDINANCES AND STATE LAWS EGYLATING VALUATION - D
BUILDING CONSTRUCTIO y
SIGNATURE OF � '�� r PERMIT FEE
PERMITTiP 7 W
h ti Q
• AUTHORIZED AGENT w
.._y .. ....mss•: •.r. .I I s;,- _E; TOTAL FEE $