HomeMy WebLinkAbout1961 FULLERTON AVE - Building Permits i
m<OW MF 9 CITY OF COSTA MESA
BUILDING DIVISION
F i i 41 DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER
J• � • PERMIT
'`bend '6. P06-00670
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1961 FULLERTON AV Status: ISSUED
Suite No 5 Applied: 08/21/2006
Issued: 08/21/2006
Vicinity:
Parcel Nunmber: 42626426 . CI(
Applicant: JOHN MELROSE ISSUED BY:
Address: 1525 MAC ARTHUR BL.
Phone: 714-641-1545
COSTA MESA,CA Zip: 92626
Owner: REOCHIA, DOMINIC J
Address 18 FOXHILL ,
Phone:
IRVINE,CA Zip: 92604
Contractor: C AND R DRAINS INC
Address: 1525 MAC ARTHUR BL.
Phone: 714-641-1545
COSTA MESA,CA Zip: 92626
License: 531746
SCOPE OF PERMIT
REPLACE GAS LINE FOR APT.UNIT 5.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 ; P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 - . Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 - 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $9.80 1 ° -. Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 . 0
TOTAL CALCULATED FEES: $33.30
COMMENTS/SPECIAL CONDITIONS
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
2448-413(sim)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: "' •
O 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.
.00;ir.My`w rkers'compensation Insurance carrier and policy number are: _ 3
Gigrier. rn^>�N�i'M�/�-SS//iP.(IT<� fi_Poilcy Number/ 3 7
n,.. "---7i
section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
ly with.these provisJo ..
C c Applies cant Signature:E � RafeTY—_.....7--A-04
W�`WARNING:FAILURE TO$ E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM OVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLAREIS ,404),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.Lam.licensed.under,provisions of Chapter 9(commencing with Section 7000)of Division 3.o(the'Buslnegs and Professi ns Code,and my license is In full
for ec end effect..Uc,p::.- 5773/iiii V4 IaesN— i--:-.744
iirriler
� : „ "—
CONSTRUCTION LENDING AGENCY:
O 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,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 lite 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 en 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 ermit 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 Califomia 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-described property for inspection purposes,I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Leg Owner(s) Date
�A +Aulhodzed Applicant_---- T Date.,,_
I"y4DE I INSPECTION TYPE; DIIE Mal CODEI INSPECTION TYPE _—_ PATEINTITIAI$
1616 Fixed System Final Fire Prevention ' 206 Final Mechanical // Q
1266 Pool Spa Final _ 208 Final Plumbing ab ,d N
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.
9 CITY OF COSTA MESA
4 ArlkoBUILDING DIVISION
F r.,,, I DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
FSERMIT �B03-02075
gtbibv;rio es.
•
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.BlfILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1961 FULLERTON AV - Status: ISSUED
Suite: Applied: 12/02/2003
Vicinity: RESIDENCE ONLY Issued: 12/02/2003
Parcel Number: 42626426 Zoning:
Applicant SHERK, KEITH
Address: 537 NEWPORT CENTER DR ISSUED BY:
Phone: (949)673-9222
NEWPORT BEACH,CA Zip: 92660
Owner: REOCHIA, DOMINIC J
Address 18 FOXHILL
Phone:
IRVINE,CA Zip: 92604
Contractor: ABOVE IT ALL ROOFING
Address: 537 NEWPORT CENTER DR
Phone: (949)673-9222
NEWPORT BEACH,CA
Zip: 92660 License: 765842
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.REPAIR/REPLACE SHEATHING IF NECESSARY,COVER RESIDENCE WITH 30 YR COMP.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,200.00
Permit: $111.25 Claim Valuation: $4,200.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75 •
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 Existing: 0 Required: 0 Proposed: 0
NOTES:
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 t6OO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I hay nd 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
w for which this permit Is issued.
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'Compysation Insurance carrier and policy number are:
Cartier: S'A-e fv'+O Policy Number: '71-y 5'
(This section need not be completed If 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 Ca f e that if I should become subject to the workers'compensation provisions of Section 3 00 of t e Labor Code,I shall forthwith
comply with these provisi n nn
Applicant Signature: i��a'i Meat- Date: j Z" V/l
'WARNING:FAILURE TO SECURE W ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND pylL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(Si C0,000).IN ADDn1ON 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.Lic.M 105842- Class
Contractors Signature: List L Date: WMZSI`!�
L
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,CMI 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(5500).):
❑ 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 wit 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 em exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers 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,faisework,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).
❑ Aa 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? ❑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).
._t._.r..f_ b'ui___._...._..__ ... ^,..
2 Does or will the applicant or present or futureturebuilding occupant need to file a registration form for acutely hazardous materials? CI 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 end Prevention Program for acutely hazardous materials)?
❑yes 0N
(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 on 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 implication eermit 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 pan of the tacitly 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 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 slate 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.
Signatur' • ,:c400`•er s) I D e
,I4_s.Ztila..:
And/O ' thon -.y3,ppiicant Date
CODE t INSPECIION TYPE PATE INTIMLS CODE f INSPECTION TYPE PATE 1NMIA49
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / 208 Final Plumbing
200 Final Re-Roof /1141 'tJ a.(1 ," 210 Final Electrical
201 Final Block/Retaining Wail 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 LIVINGSTON, IRA B. DATE 10/22/63
JOB ADDRESS 1961 Fullerton Ave. #14 BUILDING PERMIT NO. 20880.
GENERAL CONTRACTOR Owner-Builder VALUE $ 1400.00
AP No, 118-014-35 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORIGring Res.toCodt
I. INSPECTIONS Signature DATE GROUP I TYPE V ZONE R2
Soil PERMITS ISSUED
G SUBCONTRACTOR DATE NUMBER
Rough Com. Refrig. 0 Air Cond. ❑
Rough Heating
Rough Plumbing - 2.. W .-,.-,-, 9'3o-63 51rcc2 0 -
Miscellaneous pi• Fl. 71/ j4€/1_. .O co-.a fr."-el 3 9F -z_."7.---p
Prop. Swr. Line 0 House Con.0 St. Swr. 0 '
Sprinkling System
Construction Pole t
Underground 0 Power 0
/al
Rough Wiring r /p./vr-+, (-4 r CZE-c- /1,-..--,..2-6.3 -2 0 9 $65 C ') -
Trenches 0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing— In 0 Out O
Plaster, brown coat
Refrig. 0 Air Con, 0 Final
Heating, Final
P" bing Fixtures, Final 2 i*' /0-Jci-G?
FF. . Gas Test
Electric Fixtures, Final /1/7-j /U V/-C.3
Building, Final id->q.- C?
OCCUPANCY •
Form BU4-6M-3-63—S-B P 20880
.cr 20880 rtt titUEIVED
°n /" -OCT 2 2 1963
OSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT,
P.O.BOX 317 COSTA MESA.CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT Y/ `1 BUILDING
For Office Use Only
ADDRESSBUILDING I T/96/F/.4,J PIt roN A ve
RECEIPT NO. PERMIT OJe
COSTA MESA. CALIFORNIA D QI/
QQAA ��jj RECEI EDB gA�yE ED / A S'U1
OWNER /\/f 5 �/VINci ,. v VVQSyyyy o 13 /} 23
MAILq/ / / /� BUIL/ /i M/
AD RESS // `/./q/A` e/L toff •A vrFIRE a
ADDRESS
��/C�'L�II�� l/v�_ _
/j TEL. ////q ZONE TYPE GROUP
CITY (Y/n S tic Me_ 5 A NO. �/Oyy.l/7‘
p n / APPROVED 13
eR3Ii@tR9EROWA/eS_B U (1i1RNO.A/77p7C BY & DATE j �'
/9G / 2.--e-t_ BONING J `°-
AL S3 F on or NEW �V
ZONE�_ PLANS 2,---BUILDING .1
CONTRACTOR _ YP Lei
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DISCAL PP7 . LV✓ // / 1 l
ADDRESS
DEEeRIPIIOn �j �/ I �-
CITY A.P.NO. II d - 0/ Y'- 3S
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL. SO'TO SIDE&REAR P.L.
LIC.NO. NO. - - -
EAVES
SIZE �J F. p / NO.OF BLDOE.
NOW ON LOT y ALLOWED (U.B.C.REQUIREMENT)
OF LOT /3 [ ]. C
f!+ RR/�Ap �/ YARDS APPROVED YARDS APPROVED
USEOONG BLDG./se 3 &s(DzxLp MAIN BUILDING ACCESSORY BUILDING
(FROM C//L�S�TREET
SETBACK LINE FROM /�/ f �// FRONT /+/ FT. FT.
CENTER OF STREET/,* REAR YARD&OXL7 ..[ //''��
SIDE YARDI LEFT 5o X 3 �o I RIGHT R.SIDE I KFr. / FT.
DESCRIPTION OF WORK L.SIDE .?Fr. Fr.
NEW ALTERATION Y' ADDITION REAR /FT. y FT.
DISTANCE BET. BET.MAIN B
RE. .< MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
BUILDING ;_,./,,,,. / NO.OF VAR.# ' 'a '' DATE 5 -I6-i'3
SIZE / A 3
^ V ROOMS STORIES / : C.U.P.# APPROVED
EXTERIOR WALL APPRO LO( DATE / Q a/- �
COVERING VOOIJ IROING ASH/{L/
USE
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OF BUILDING AND WORK TO BE PERFORMED
fee-51DeNGP
!-pNFaRMA to n/`7y CaobP bo LI I ` CA N
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I HEREBY ACKNOWLEDGE THAT I HAYS READ THIS APPLICATION �•-THE AMOUNT SHOWN UNDER VALUATION IS FOR THE X'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.A� O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALU _ION J—kq
BUILDING CONSTRUCT ON. G�; , N
/�{J PERMIT FEE D
SIGNATURPERMITTER OFA--���C'/ . f�✓L/� s/
Z / I PLAN CHECK S o
/ c
AUTHORIZED AGENT ��
\ TOTAL FEE /
4441
FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT ._./ ' 7 ^ Q
P.O.BOX 317 FINANCE DEPT.
COSTA MESA. CALIFORNIA CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ADDRESS ill '% / F4 / 'r •-1-c4 BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. PE:MIT NO.
PIMMENIMEMPIE66
MAIL RECEIVED BY
ADDRESS " L Frail C Y+Dl7 __ . i MENZIERv
Q S '/
CITY L - ' IVI e4 Q. TN O. /V``. C DING
ADDRESS
IT
ORCHECT LIC.
OR ITINTER NO. COSTA MESA. CALIFORNIA
FIRE
ADDA__,S ZONE
CONTRACTOR /6 w h e Y CITY LIC.ODipJ NO. ���
ADDRESS t q4 1 run 6-'1'011 TNA. APPROVED� DATE •
LEGAL LOT I / / ' � 'irld. ..
DESCRIPTION NO. .�`
Mitrinraral
NO.OF BLOCS. PLANN:1 0 • .
NOW ON LOT _• • . DEPT. REG.
USE OF 4
EXISTING BLDG. 'VS
SETBACKNTERLINE FROM ,/ J• 8� � ��
CENTER STREETFROM
C J\ . REAR YARD C A. u rn
f
SIDE YARD RIGHT LEFT r,C,
DESCRIPTION OF WORK '
NEW 1 ALTERATION NES
REPAI.. !"'"--# 1 MOVING ■ERMIll
BUILDING NO.OF
SIZE ROOMS STORIES
EXTERIOR WALL ROOF
_COVERING COVERING
USE OF NEW n
BUILDING ,i G �� oc9 A -^ CS .r�enG
/
�� ... •_d/ -a..
/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC.
TION. J VALUATION
SIGNATURE OF // cart-4.----47 �, PERMIT FEE $
CA PERMITTEE / ^ �
n V , PLAN CHECK 5
b a. •IXy'Gy�•.•(� A TOTAL FEE 5 / 9r'
AUTHORIZED AGENT •�
OWNER HEMENWAY0 JULIA S. DATE 5-22-58
JOB ADDRESS 1961 Fullerton Avenue BUILDING PERMIT NO. 6799
GENERAL CONT JackJack Cornair VALUE $ 9)110100
AP. No. 1'18-0-UCO"r9191 TRACT NpttW ZONE 3 DESCRIPTION OF WORK Dwelling Ad c i.---y-
GROUP I. TYKE v ZONE pl, PLAN NO. 6709
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER
1. hes Forms Steel , A -4 -.3 W
Floor System I
Steel Reinforce Chimney Re-R d
BondaBm ad IL rCi; L iY
mr •
Frame and Flashing // G/4y/
Lathing, In c V.Out .o'-J P/EG S'9
Plaster. brown coat IJ y4- el//lin/
Underground soil fl 14$ W/G Pipe estM/f5 pa4-SIr' -
Top Out 5 "9 sie yC:.E.&c.e .st J,.G.a, s --'7-S a' / yo 6 6
Furnace MAK{ 6-10-sr • .
Gas Vents
Rough Plumbing //J/f<.4 -at/-61' *_.(i�.c..r( 74.-?w— .it Ay 7 re /CL(/C+ C.
Cesspool Septic Tank
Prop. Swr.agiC Halkt"pf.4 St. Swr. 7(+- ?c r ter* N 7(2->/e'Y I } 7e[c
Sprinkling System /./
Heating Final I Iry e-ia.ep 7
�
Plumbing Fixtures, Final I?/ 7 -J2• SR'
Final Gas Test I h 1W' L-he (t%— 17-SI•/ ,I N,
Co--truction Pole
I ground Power t Q
,L,
Rough Wiring a._ D
lul4 0 1958 SU F�we /Zs,� l��r -� �.S a p
Fixtures, Final 2-1T K-,-,/y ./ , \
OCCUPANCY H'. 7-12-4ce /
Form 210-5M-1-57 HOLD FOR SPECIAL REOUIREMFNTS / 6799
'' 6799
COSTA cc
****3(.00
COSTA MESA BUILDING DEPARTMENT •'AY 22-58P ira
916
P.O. BOX 317
COSTA MESA, CALIFORNIA •
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING ea
ADDRESS 1961 Fullerton Ave. °' 0 BU I LD I N G
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
c� RECEIPT NO. PERMITtip,
OWNER Julia S. Hemenway G Y
AMAIL
DDRESS �,ED BY Z1 RREc ,E ` X55 UUE ,
1961 Fullerton Ave. s d' J /S
Costa Mesa TEL. BUIL INS / 9 / ) a, I'e It 4s)
CITY NO.LADDRESS 7 ((;
O
ARCHITECT LI .
OR TENGINEER LIG. COSTA MESA. CALIFORNIA
FIRE
ADD. .a ZONE
EON NO.OF TYPE / GR(�NP
CITY LIC. '/ PLANS r)
CONTRACTOR Jack Comair No. • 767 _ G-._
TEL. APPROVE •
ADDRESS 1536 Newport Blvd M'D. 12444_BY • OF- DATE S 23/
LEGAL I /q
DESCRIPTION LOT s�2 at7aohed C 1 CORRECTIONS
A.P.NO. / 7�[ / _ V'7 N /.d P f
SIZEl_
('J S! NO.OF DLDGS. I '• S •1 ' I
OF LOT 84 x 137 •• NOW ON LOT 2 it A'4 •. ,
EUSE OF XISTING BLDG. dwells • CITY OF5T 1 N.ESA
•
T.
SETBACK LINE FROM ( L' V ✓E. ,
CENTER OF STREET SO REAR YARD 72 /// SUBJECT TO UG. DEPT. REG.
SIDE YARD RIGHT 5 LEFT
191
fencer j C 9.'4-8
DESCRIPTION OF WORK -Ir BY/J (�, n TED
a PLAN TcCH
NEW X ALTERATION II ADDITION
REPA MOVING X DEMOLISH — __
{ 1
BUILDIN NO.OF 6l Fqi �y{ !f
SIZE st51x 401 ROOMS 6 STORIES 1 ^� y N V i
EXTERIOR WAIS ROOF 7 a I( it r)
_COVERING �7 tUCCO COVERING composition +V� I'f P �`1'.+� F. na
USE OF NEW { (c D / ELi ��
2 La� L. t.J
BUILDING dwelling l N+Ll./G(.(y'
III"' /LL.1c.i 5 b-.. ItfitSo R
D%IiI�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND I _��' ��'"-PRVVED �S_: .�/-,5'
CTHATIN THE ABOVE TE CORRECTAND AG E TO COMPLY WITH ALL HOLD FOR SPECIAL RE UIRr'MENTS
CITYAORDINANCES THEA BOV STATE LAWSRND NG BUILDING L CONST ALL
TION. yA LU AT I ON tc PERMIT FEE S
SIGNATURE A �jjF,i�//f e5Ft 2Y
PERMITTEE ./ceigf/! f/� 1
PLAN CHECK S if ` 1
AUTHORIZED AGENT 91) / /o\ TOTAL FEE S 3E• \ I oMF