HomeMy WebLinkAbout1971 FULLERTON AVE - Building Permits CITY OF COSTA MESA
ittt BUILDING DIVISION
77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL:(714)754-5626
04)
PERMIT NUMBER: P09-00165
PERMIT TYPE PLUM STATUS: ISSUED
APN: 42626421 DATE ISSUED: 12/23/2009
ISSUED BY: RMD
JOB ADDRESS: 1971 FULLERTON AV CM Suite/Unit:
Vicinity: METER TO HOUSE
SCOPE OF WORK: PLUMBING PERMIT TO REPLACE GAS MAIN FROM METER TO HOUSE.
OWNER: LOVERIDGE,JANET SZABO AND JOHN R Address: 1971 FULLERTON AV
PHONE: 949-631-8491 City/State/Zip: COSTA MESA,CA
APPLICANT: MARMAUD, BRIAN Address: 2142 IRIS PL :
PHONE: 714-420-3123 City/State/zZip: COSTA MESA,CA
CONTRACTOR: BCM CONSTRUCTION License No. 900014
Address: 2142 IRIS PL PHONE: 714-420-3123
City/State: COSTA MESA,CA ZipCode: 92627 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $33.30
TOTAL FEES: $33.30
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODES INSPECTION TYPE D)AA✓FF INT111ALS CODE/ INSPECTION TYPE DATE IN1111AL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical -1
1266 Pool Spa Final 208 Final Plumbing A "yY O4 Ayn�1 asn)
200 Final Re-Root 210 Final Electrical J
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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes D No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
O 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 carder and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: J1person is required to descend,will be made in connection with work authorized
C' ( by this permit,and that no building structure,scaffolding.falsework, demolition
Carrier: C-�F C'l� - a or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm
(This section need not be campletedethe permrt is valued anehundted dollars(5100)or r, 4� 2,Art 2,Sec.341,Title 8,California Administrative Code).
PoL /licy Number: / G' Coo /)9
0 As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued,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.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Date
the La Code,I shall forthwith�1 comply with these p}ovisions.
Gruel 0 /W60/'Z`(/ /61/4•72'/6 ) Division of Industrial Safety Permit Number: _
Applicant's Signature Date J , 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
(isin,full force and effect. (� /' a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# 9i/(J0// CI ss# 13 -(36 (Section 25533 of the California Health and Safety Code, with some
zi
ro exceptions, requires registration with the Costa Mesa Fire Department by
-7,1.54 ')6-0 -'; � G7r1li� 4:2—'02- "-1 each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date 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 Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safely 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 furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 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 properly who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. "yes",attachcertificate
employees, provided that such improvements are not intended or offered for ( y ofcompliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ 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 properly for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
? Signature of Legal Owner(s) /J nO�oYGj
Signature Date Ij)''6�) J2 1&%w-taca �� Q
305736(3/07) /
And/or Authorized Applicant Date
RESSOFBLtLWC: 1971 FULLERTON AV UMI: CITY OF COSTA MESA - BUILDING PERMIT
IE RSNAMEIFIDlDWN: SZABO, FERDINAND F TR PERM NO: b 085414
ADDRESS 2947 PEMBA DR
COSTA MESA,CA JLG[b PERMIT NO: B 085414 PLAN CHECK NO: N GOVT.: N SUPP : N
APPI.MAIWIO ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: SIR PURPOSE: ALT
ARCNRECT DR ENIII4EER: LM.NO.: JOB DESCRIPTION : T/O CEDAR SHING,RESHEATH AND REROOF SQ FY: 2, 495
ARCH.OR ENGY ADDRESS: WIT:
CLAIM VALUE: . 2 , 495 .00 CALC-VALUE: 2, 495 .00 GROUP OCC: R-3 /U-1
c JTfACTgysNAm LEE ROOFING OF COSTA MESA ( 714 ) 642-7222
CCNIRACTORSIINIMO 1653 SUPERIOR AV COMMENTS : T/OFF CEDAR SHINGLES/APPLY 1 /2"OSB SHEATHING 6"DIMENSIONAL SHING"
ADDRESS COSTA MESA CA Lx w.: 349686 Went xwx+exxTewwwwwwwWi it Wil irwwwxwwwwwwii..........**sinew wirwww
7 LGL / DMT: Z ONING REQUIREMENTSS
LICENSED CONTRACTORS DECLARATION:I hereby Slimrlel
under pey d perjury that I rn gwiliau d
eared under prChaser 9 S E 1 B A C K S
(commencing with Section 7000)of Division 3 of Ihe Business end Professions Code,god my Trerme e n full force and Sled.
CITY LIC.NO.h: Q5" / UC.CLASS: C 39 AIC.�D.: 3 , ;-86 -r ' 02/58 MAIN BUILDING ACCESSORY BUILDING
Date 'V-y ' `g7 comreaa:,,. FRNT:
FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty A.-rjury that I ? exempt from the Contradon License Law la the
Idfowup rason(section 7031.5 Brenna and Pro essiar Code: city a count which requires a permit to mason,altar,Improve. PARKING REQ: _ PRGV: PARCEL: 42626421 Z NE: REF NO:
�mdnh,a rapei any almdom,prior to as nsuar.M,ebo requiem appuxs la etc!.prink to Ola a signed statement that he a she
Inaneed rp mens to the ode! h d en the I, n Ueanae Lew(Chase 9(mnmrwng wit Section)BW)of Division 3 d the PLANNING NOT E:S> _
amen and Professions Coda]or that he a she la exempt therefrom end the bean to the alleged exemsion.MY violation of Section >
'3ost.5 by ww epp4uN for a permit subjects the apscrd to a civil penalty d not more than fee hundred doges(55001). ..................-se it iw W x**di iw ii ii ii ii ii W W ii ii it iw W Si W ii di ii ii W ii di W ii ii ii Si W W ii ver W W W*********W it W W W W W W tic*********
❑ I.es owner dIheproperly ormyemdoyeeanth wages as thee sole mnpereation.toll doge work and thesmemue is di intended D E V E L G P M E N T S E R V I C E S REQUIREMENTS
or offered for nn(Sated 70M.Business ed ProfessiosCode:TheCmeadm License Lew does naepcly to an ironer of papery
who beads or improves Iherecn.anddoesch who such work himself or herselfhen.
or through he et roemployees.psvided the each .
•improvements re m upended or offered to sale.II.however,the building or improvement is sold within one year of completion,the ('
ownerdrddr will have the burden of proving header did not build or improve for the purpose of sale). ZONING APPROVED BY DATE:
❑ I.es owner of the property.am exclusively contracting with licensed contractors to conoid the project(Sadist 7044.Bwnos end
Professions coda:The Cot or License Law den m appy to an armee al property wln bolds o improves thereon and who BUILDING AP PRGV EU b.. DATE:
contracts for such projects with a corarada(s)turned pursuant to the Contractors Lions Law).
CIImSection: reason:n: B.a P.C.,for this APPLICATION ISSUED BY: DATE: JO�a -y/97
.•••••••••••••*******w******** rmnW * fwWw,IA w WWWWWWwwww,WWWWWiiWWWWirw nwww-n*wwww wii
Data: a'T°m LEGALIZATION:N FEE tS U MARY STRUC'TU'RAL SEGMENT:Y
I do hereby codify that I m aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and
25534.and that I or any future building occupant will/veal not(arch one)need to comply with said state codes end the requirements for
a permit formnvunion a modification from the Ar eWy ampmne Diane.Residential=sow:.appicmione are exempt frm Mese BLDG PMI PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 74 . 75 . 50
Date: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of peejaone of the blowing docents: PLAN
Elr
I have d veil maintan pnfraconsent a te ofto and s
-inswe for worke 'compenestion.re provided to by Seneca 3700 dlhe Labs ISSUE FEE
cps..I«the peama .du»wmmw:ctDilpmm .naee. BUILDING-DIV > PERMIT ISSUE PLAN-CHECK IOIAL PAID DUE
y I h",end Ml mannmn
maintain insurancinsurance.insurancreed/add it
on mr. , reed/ad by Section 3700 s Labor Code.kr the performanced the TOTALS----> 75 . 25 0 . 00 0. 00 75. 25 75 . 25 . 00
3C eak to MSch this permit is issued.My waken'compenalko insurance Tamer and poky number are:
Cartier; STATF t•ilND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 75. 25 OVER/SHORT: . 00
( Policy Number. 1llsln44R-97 06/30/98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
iem
s section need not be completed the error one hundred clothes nim or lest) 74 . 75 . 50
El1 eenfy that in Me performance of the work for which this permit'Surd,I shell not employ any person n any4n,^ner so as to
become aubied Io Ihe wohas'wmpenwion law°d CSgomia.end raw'd 1 ehwid when t Ilwwvekeea' iiiiiiiiiiitiiiiiiiiiiiiiiiiiiwiiiiiiwiiiiiiiiiiiiiiiiiiiEwiiwiiiiiiiiiiiiiiiiiiiiiiiiifiiiiiiiiiiiiziiiiiiiiiiieiiiiiitiiiiiiiiiiiiiiliisiiiatiiwiiwieii
sump' lion of 700 d the Labor Cale 1 �II1LI`/
-- Dalt Il)'" c n' Cl° Appian: no
• INDIVIDUAL F E E BREAKDOWN
warning:Failure to secure workers'conpehsasoncoverege le awful,and SW We en employer to erlmw 04041044 End TYPE QTY D h S L K i P 1 1 V N UNIT COST TOTAL COST
eel tines up to one hundred thousand dodos(3104000),in Non to the cost compensation, e.densepas provided for In •
the Code, ro
,nd. m.Y.y..a SFR 2495 REROOF BY VALUE RESIDENTIAL NOZONE 1 . O0 2, 495. 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there In a Conlon lending agency for We END OF FEES
performance of Ihe work for vehith this permit is issued(Section 3097,Civ,C),
LENDER'S NAME:
LENDER'S ADDRESS:
I rarefy that them reed this appfv:edon and state That the above Information a coned.I agree Io comply with al cry end county ordinances
and arra taws setyM to mildig construction and hereby authorize representatives of this city to enter upon the above-mentkned property
Ir inspection purposes.
L JENN�IFEE1R� HITE �p�/� •
Hi-24-1997/83:38 PM/$75.25
\ ( fly. k) gl 7 PERMITPTO85414
�,w /, � . i� r one
' • S'.i ueeof• SIL,-nt/APpli•, ' onlreda
(5151d6.WP) White-80441g A Safely;Green-File:Canary-Appian;Pink-Revenue Goldenrod-Assessor
CONSTRUCTION AND PLANNING POO' :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 ,
:4rElectrical Conduit-Unflrgrnd. .. 55. Electrical Bonding -
5,-Steel ReinforcemenR 56. Rough Plumbing & Pressure Test
1 -6 ' Electrical UFER Gond. 57. APPROVAL TO COVER-GUNITE
-7_ Footings - 58. Electrical ConduikAlndrgrnd.
•
:B. Foundation r •. 59. Gas Pipe, 0 Undrgrnd. ,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,,PP-Trap, 0 Undrgrnd,
10. Structural Floor System 61. APPROVAL TO:DECK
14. 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
1. q
•
18. Rough Electrical-.T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ^ r-FIRE DEPT. REQUIREMENT
T
20. Rough Factory Fireplace r r - F y _ `- APPFI'OVAL�S' ' Permit# "
21. Ducts,in.Strusture, , T .S 7 . 7 70. •Underground Hydro `
22. Duct! Ventilating- I J -, , , 71. Product Piping 0 Gas La Oil
23. Gas Pipe-hough & Test ti. L- r 7 C J 1 . , 72. Underground Flush •
24. Roof:Framing- ;. : ' • - ''Ti s -' '5 T.,': ♦ r 73; Undergrrid.Storaije tank;O Gas 0 011
25. Roof,Sheathing ..+ ait:•••.4...111-tie.:-..)€.446. ' 74,•.Overhead Hydrtit '
26. T-Bar Ceiling IStructlural) & Morjot:oat •" _1
,yi ' 7 Dry Chemical
27. Frame and Flashing , r g r i.
, - 'N :, 76. Dry Standpipe I-
, t A .
28. Lathing& Siding . i c . : ` - ", , -;, 77; FIXED S1c, TE -TrINAL
29. Insulation! ' .0 .• - _I' 78 FIRE PREY. FINAL '
30. Drywall RJjiling ' - -' :1-IEALTl3i DEPT. REQUIREMENT
' 31. Plaster Brown Coat ` -• r r i . 1! r 79: FINAL INBPECTION .
_ r
• 32. Electrical Power Meter:Final ' ` .'' . ii,"1 8071 FOOD CERTIFTATE ISSUED-, h
• 33. Final;Electric-. ,, •,I. Notes: -t . . • _ -
y •
34. Fina4leating. Air Conditioning` r. I I+' 1 i. =
35. Final Gasipe;Test . _ r ,. i t- _ ;
f
. 1- -
- 36. Hood-or Canopy 2 "' t - ' 'a•'.. r _
37. Final;Factory Fireplace - . - c •; 1 I :>i•
cr
38. Final'J'IuM1lbing :I - ''l _ - -- -
1 39. Water'Servicetinal:' i • t: I is t
40. Gas Servile-Final '. • n - . r! fikc : U .1
=41. Solar DotFt'esti2-Final : '- . it-
t
_ 1
42. Backflow Preventer . -
n
-. 43. Backflow Irrigation ' t • - - .
44. Landscape 1rr gatiort System : r 7 '3 3 '
_ , T
45. Sound Attenuation = _
46. F.{andicap,Regulations -S. - t
47. FINAL STRUCTURE & BUILDING cY lam"j c
y "
•
48. FINAL PLANNING -, • Ir '
49. Electric Release to:Edison • - - - - •
50. Gas Release to Southern California-Gas Co i •_ • r, - '
51. CERTIFICATE OF OCCUPANCY " =• - -'
No. Date
I do mss - 61
-42/;,/, r e Zj
2t ,A-G
•
56. X2r
atoepez.R--.
OWNER HILE$) MAX 7 DATE 2-1.1-55
JOB ADDRESS 1971 Fullerton Avenue BUILDING PERMIT NO. 908
C =RAL CONTRACTOR Owner-builder VALUE $ 1,82)4.00
LOT AP#118-014-34 BLOCK TRACT Living Room
GROUP I TYPE V ZONE Rh FIRE DISTRICT 918
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Footing Trench
�� 2 SS
Foundation Forms and Grade to Garage 7
Rough Framing ?. L'�'5 J /nd
Plumbing,Rough to Slab
Plumbing,Rough Complete (ft c t' ._4
Temporary Pole _( /,�,�� //
Wiring, Rough �l-Gv�y j 3��1 ara r'e-a"ai, 3 -3-5i_277 L -L�3 ,'i
Heating,Rough i
Heating,Final
Se-"`-
St Tank or Cesspool �441r— a _
Lathing '1( e i _
Plastering • e —
Plumbing,Final,Fixtures Complete •w �O-' AK'S E� ��
Plumbing,Final Gas Test `L �, _ SSL Si
Wiring,Final //' 4,99.-.A fst
an- Lz--
Occupancy > -e7S , 1-a r'-Jf
- Form 210 GH 1M 12-58
Costa Mesa Building Department., / APPLICATION FOR PERMIT
•
tit EAST 20th STREET BUIL„DI, NG
” COSTA MESA, CALIFORNIA _V 91$•-- -- - - - �'
I FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN 3 ceipt 7o.. Permit No.
Building (/ I 3 6•'
AddresrST/. idel, r_c_� /_ E 3 0 Id!
Costa Mesa, California Received'by ate R 'd. Date Issued
Nearest r .7,..5.‘,....3.r‘.1.-
Cross St.�D .•, Building
)�� _ Address
Ownerka.4 i Costa Mesa, California
Mail �p/� /�.� i
2 Mall Address , Aa. t: Nearest
7 L Tel. ;; Cross St. , t
• City ' „94.., _:- No. ' Zone No.of T / I Group
Architect or Lic. ,r r- I Plans I Type V I
Engineer � 2., No. ' Approved
by Date .
Address CORRECTIONS •
City Lic. c.
infractor (P..U;.vtLI No.
Address (
Legalg ' i
Description I o."_,_/ I Block I -ct '. - r - •
•
,
(Attach Metes and bounds pL�-� - Ot�� [J - •',7`i �'
5• ,�/� �� ,rte/ No.of Bldgs. 't'f
Size of Lot-/ -/ I Now on Lot r .� ,�f O
Use of No.of o. • /+ FEB -4 y a
' Existing Bldg.p� WWI/ Families/I Rooms /
Setback Line from Rear Yard Jr „i 1? (J %/2'O `-3- -
Center of Street y,t�J SSr Side Yard y" y
DESCRIPTION OF WORK 79-' t 0 ,f ` r
r New I Alteration I I Addition I `V
•
Repair I I Moving I I Demolish Ii.
Building i' J No.of •
Size / Rooms Stories
`erior Wall,_ Roof 'l -n C f • f
eying ' I Cover g j� APPROVALS
Use of New '€
' Buildin : Foundation Location Inspector Date
g - �' � 9 Forms,Materials,
Under-Pinning
Frame: Fire Stops,
Bracing,Bolts
Lath. Int.
I hereby acknowledge that I have read this Application '
and state that the above is correct and agree to comply Lath. Ext.
with all City Ordinances and State Laws re:ulating i.—
building constr tion.
Signature of� i T Plaster,Int.
, Permittee • SI.
Plaster,Ext.
Authorized Agt.
-.- t . . . c Masonry Reinforced
Valuation ..,.fff l / Permit Fee $
is/Dv ST Plan Check $ /t O 0 Bond Beam
$ /. Total 0 o
Fee 7, FINAL
u
G
a
a z•
Street
PLOT PLAN• •
Show location and distances from
property line and between buildings.
ati3On .
Do You earrY_V7or
kmari�s cowPens.. .
No
• • Yea
insurance? ',700 o£ the io}te
i am re of Fro a - rel every e"a
- awa ,1 r,..,.° tY o;.
Ocae ,we-a a liabill
-. tatior ed asai";t
to be it uS�e;DD flB en''atipn. •
workflan U� - / ! r
Signed: