HomeMy WebLinkAbout1986 FULLERTON AVE - Building Permits - CITY OF COSTA MESA
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BUILDING DIVISION
F I ^^. I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
n . PERMIT
�• spria� B05-00832
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDINJob Address: 1986 FULLERTON AV Status: ISSUED
Suite: Applied: 05/26/2005
Vicinity: ROOF Issued: 05/26/2005
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 42603227 Zoning: /��
Applicant: JOSEPH NATHAN LANGDON , ` ISSUED BY: I� 44 )
Address: 16312 ARLINGTON LN . - , .
„ .-" Phone: 714-536-1816 `-
HUNTINGTON"BEACH-CA ' - 'Zip: 92649 L
,
Owner: WILSON, JAY M--- -
Address " 1986 FULLERTON AVE ,. -, - '
,c Phone:
COSTA MESA,CA ,: " r Zip: 92627-2232
Contractor: J N L ROOFING INC
."Address: 16312 ARLINGTON LN v
'Phone: 714-536-1816 - '•
_ HUNTINGTON BEACH CA - - ` t
•
- Zip: 92649 - - License:- '648337 - - k.` :
Arch : ' Eng:
Address: -Address: -
• Phone: Phone:
-Zip: - License: License:
SCOPE OF PERMIT ' ', •
REMOVE ROCK ROOF ON HOUSE AND:DETACHED GARAGE,REROOF WITH 2 PLY 15#FELT,50 YEAR OWENS CORNING COMPOSITION.
REPAIR AND REPLACE SHEATHING AS NEEDED. —•
FEE SUMMARY' i (
Plan'Check:' • . $0.00 - _• __ _ Calc Valuation: . , - $3.x00.00
Permit: $97.25 ( Claim Valuation: ,-$3,400.00
' SMIP Res:, $0.50 ' -
SMIP Corn: . $0.00 -
Other: ' $0.00 -
Inspection: $0.00
t
'Total: ' $9775Q‘,,„I; .
,
PLANNING &ZONING1- '2 =iii ./ /
SETBACKS - -
MAIN STRUCTURE Front- 0-6% , ,- • ','Rear 0-0 Left 0-0 Right 0.0
:A J
ACCESSORY Front -A-A - . -- Rear 0-0 'Left 0-0 • . ; Right ,0-0',
PARKING Exi_ gti : 0�'"^.-,"Required: 0 v'• Proposed: 0
i.
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
2448-46 WOO)
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.
larliftve 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.
F y workers'crrtpensation Insuransecarrier and policy number are: / � 2
97�Geer j7—//Y�47 f olcvNumber, 9 7
(Thts:secNomribed not be completed' the permit is valued at one hundred dollars($100)or less,) •
❑ I certify that in the p•���yIII1 •
sss•rman.: • the work for which this permit Is issued,I shall not employ any person in any manner so as to•_ •me sub], to the woikers'
compensation laws :life - : and agree that if I should become subject to the workers'compensation provisions of Section 370,of the :••r C•,•e,I shall forthwith
comply with these p • •ions. C2-6AppfdantignaturSw— Date_ -
ARNINW O:FMLURE TO SECUR' -KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO - 'ALTIES • D GVIL FINES UP TO ONE HUNDRED
THOnISAND DOLLARE(5100,000)r ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE •r•-CODE,I REST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license: 'der•revisions of Chapter 9(commencing with Section 7000)of Division 3- e:�loess and Professions Code,and my license is in full
ficeend3f_ f A _ Les
ctors_Sgnature. ate•._:
CONSTRUCTION LENDING AG NCY:
❑ 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).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
•
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 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).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
__._ _..___._.f ..._ 0
0
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves 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 aately 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).
...._...._ need
to _..
3 Does es will the❑applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
_ ...._.._._ _
4 If en RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a2ermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? IJ Yes 0 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).
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 ❑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_Q Legal Owner(s) Date
CODE F INSP ONTYPt ' PAIL II IBhI5 SODS. INSPEGTIONTYPF RAIL MAL9
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final q / 208 Final Plumbing
0�6 Final Re-Roof • /I / 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
PROJECT ADDRESS: 1986 FULLERTON AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PE,M NC;. ;, 0:4737
OWNER'S NAME: MAHER, DON C
MAHER GIACINTA A PERMIT NO: B 054787 PLAN CHECK NO: N CGVT. .0 'CUPP. N
ADDRESS: 1986 rULLERTON AVE
COSTA MESA,CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION ; REMOVE ROCK ROOF & REPLACE W/SAME SQ FT: 2, 200
ADDRESS: UNIT: CLAIM VALUE: 2, 200 , 00 CALC—VALUE: 2, 200 , 00 GROUP OCC: R-3 /
PERMITTEE: LEE ROOFING ( 714 ) 642-7223
ADDRESS: 1653 SUPERIOR COMMENTS: SMOKE DETECT() REQUIRED
COSTA MESA CA 92627 *****>E*>E******* ** **** ->f***** x* > *****+E*x*******************kP*> ***x**>Ex*****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R £ Q IJ I R E M E N T S
700010l Di ¢,Business and Prolea,i t d ed mylicense is in I fore¢ d effect. S E T B A C K S
VLB //]1 J' 70�b lJ�
CITY uc//.• �jSTa/TEuc.: CLAfr MAIN BUILDING ACCESSORY BUILDING
Dale:l -3 — / / Signature: ter / ._Dill FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
•WORKERSt'oOMP0�6p?4EC�eATION: to of I hereb ctionhat I h veLaa�n6ificte f consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
CompensPOLICY NO.: USF&G CO. EXP.DATE: PARKING REQ: PROV: PARCEL: 42603227 ZNE; REF NO:
COMPANY: qy PLANNING NOTES>
0 Certified copy is hereby furnished. 6 Certified copy is filed 4th the cit Buil01 Division. >
/O- j, 9/ �� *******************************************************************************
mat Applicant: i6� D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T SS
EXEMPTION FROM WORKERS'COMPENSATION DECLABATIO ' is section need not be completed it the permit is for one hundred($100)or less).
I certify that in the performance al the work far which th' rmit is issued.I shall not employ any person in any manner so as to became ZONING APPROVED BY DATE:
Subject to the Workers'Compensation Laws of California.
•
Date: Signature: BUILDING APPROVED BY : ` A DATE:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor 4/]
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED BY; // a �- �� DATE: /°.--36.-1/
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for *******.)E*********j(******7E*****7{**-**.*.3i..k.*. N•.**.y,-***.ic***-Xe*.7c-***%3(..)(.)b?4-)p*.*.**. .*.** . ;.**.
which this permit is issued(Section 3097.Civ. C). ***********K,*Ii,****fE**IF*****-*,****,********** •*******,N,*,***3!*****lf****************
O.
aLoDER: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
ESS
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the fallowing reason PERMIT 54 . 00 50
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed SMIP/NUN—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE •
($500)
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars . ISSUE DUE
PERMIT ISoPLAN--CHECK TOTAL PAID ;,••
I, as owner of the property or my employees with wages as their sole compensation. will do the work, and the TOTALS----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50'-- - ' , 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State 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 REVENUE DIVISION TOTALS---> COLLECTED: 54 . 50 OVER/SHORT -- '' y . 00
his or her own employees,provided that such improvements are not intended or offered for sale.11,however the building or
improvemeni•is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING. PLAN—CHECK
for he purpose of sale). 54 . 00 . 50 t _
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ,!t':
•
❑ and Professions Code: TheContractors'State License Law does not apply to an owner of property who builds or improves thereon ********************************************************K*********df*1***********
and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law).I am aware INDIVIDUAL F E E BREAKDOWN - '
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.8 P.C.
mnhis reason: TYPE QTY D ESCR IP T ION UNIT COST ' TOTAL COST
Date: Owner: SFR 2200 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00. 2, 200 . 00
Ido hereby certify mat I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from 1
(hese provisions. G / e n :
1 Date: Applicant: 1 (/ C J( P I v
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county 1 Incomple:-s ii... ,i:tions
ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned ` ;? ',t : n, -.
property for inspection purposes. �y� - - - .
/ Al •
//� / VGI�. -.amu__ _ . _ -.41 _IIr, •.
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Driver's License or Social Security 4: ¢$
1641.46 White—Building.Green—Code Enforcem t,Canary—Applicant:Pink—Revenue,Goldenrod—Assessor Yr
i
IIIP
CONSTRUCTION AND PLANNING POOL 'A
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 l
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 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 Plumbing65. 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 d Oil
25. Roof Sheathing O ili( ' 04K 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat `t 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation _ 78. FIRE PREY. FINAL ‘1
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat , 79. FINAL INSPECTION
32. Electrical Power Meter-Final 7 80. FOOD CERTIFICATE ISSUED •
33. Final Electric Notes: - - ,�
34. Final Heating & Air Conditioning "
35. Final Gas Pipe-Test ,fit
36. Hood or Canopy `� TI
37. Final Factory Fireplace _ J
38. Final Plumbing
39. Water Service-Final .
40. Gas Service-Final
n.3
41. Solar Domestic-Final ,
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System - '
45. Sound Attenuation 1 1
46. Handicap Regulations EXPIRED
47. FINAL STRUCTURE & BUILDING '� P� Inspection
48. FINAL PLANNING 1 )ate _//�/ IP at8
49. Electric Release to Edison
"1"---, s
50. Gas Release to Southern California Gas Co � , 0
51. CERTIFICATE OF OCCUPANCY
No. Date
GE COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT
636 North Broadway BUILDING
SANTA ANA, CALIFORNIA
FOR APPLICANT TO FILL IN - FOR OFFICE USE ONLY
BUILDING `(�(`� }� A RECEIPTXrN PERMIT NO.
ADDRESS Q\SNI Page ,(�0/ A v ei. +- V f 1 I -cb 3 79
ORT OWN IST co S7'a. /v/ 0 5
a - CEIVED BY DATE RECD. DATE ISSUED
CROSSBST. 2 o �. {I G !i I� 9-.� -.S'3 9-5 S�
G. M DIS/ P�,h O SONS �DDRESS // / p //> / „Sett
OWNER TTTIT»Y>Y
ADDRESS /GG_ �, lJ 1.11' S f: ///SCHOOL DIST. (I' ^'/�J
jL OR TOWN
TE
cm( L�l /
ITo $t4 hie 4 NOL b. (�La J 7 NEAREST Y a-,
ARCHITECT OR LIC. CROS ST. / OF
ENGINEER NO. ZI/ I NO. OF I TYPE I GRO�
((7I�L PLANS -'J,1/'//_
ADDRESS /L ///111
�J
APPROVED 41_ C
q^Oji/y. LIC. BY //L�(�If DATE J
I -eNTRACTOR NO.
CORRECTIONS
JLEGAL DRESS I TU d I I TRACT/U/ Q
DESCRIPTION NO / BLOCK
(ATTACH METESS6 BO�U/NDS/
No r
SIZE OF LOT a/ , l• /I O / I NOW ON LLOTS O
USE OF I NO. OF I NO. OF
EXISTING BLDG. FAMILIES ROOMS
SETBACK LINE FROM: ` ( REAR YARD S7 1
CENTER OF STREET ✓ d SIDE YARD 'R
DESCRIPTION OF WORK o
3
NEW I v<ALTERATION I I ADDITION I O
2
REPAIR I I MOVING I I DEMOLISH I _ D
r
S ZIE DING /o 7p NROOOMS. OF
STORIES
EXTERIOR WALL_LL /
COVERING �aGG6 I COWERING G/(We/
cle„../.....
e.,„LDING / )W� t
USE NEW ///Hg
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APPROVALS
FOUNDATION: LOCATION INSPECTOR DATE -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS. MATERIALS, ( `n ,/ Zi S -' t
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING L/r�i
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS, yL�,///JJ
•
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING, BOLTS W /$��3�lD� }
///��'—�/w/ '/ ear
_ LATH. INT. i
SIGNATURE OF �/� `�/'/� �KA/'II G LW/✓ LATH. EXT. � of
PERMITTEE Cf /` PLASTER, INT. n t�
AUTHORIZED AGT. j PLASTER. EXT. I. - /7:17/
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MASONRY REINFORCED
VALUATION S
U(VX gC- _o CNeCK S BOND BEAMLS ��(/ Y J -x
EM 9-90.53
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4GE COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT
636 North Broadway BUILDING
SANTA ANA, CALIFORNIA
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
RECEIPT NO I PERMIT NO.
BUILDING \/.�� A �� _ ,3J7 Sa I�.o
ADDRESS V�
SCHOOL DIST. . ''AA t CEIVED Y DATE RECD. DATE ISSUED
OR TOWN (iia unnn § �T /9]] R \/2
NEAREST Z. O {bi tG 3 / �S /i. / V-V /
CROSS ST. LLL v�T ( -✓]�
p/� S�III u ^ ILDING �/� //a/
OWNER GFORCE M. I,OL STrfu & riI'Ir ADDREBS
MAIL SCHOOL DIST. ,�._f
ADDRESS 166 E. Ilih St OR TOWN /1 Iw-C�.
CITY COSTA MESA, CALIF. NO NEAREST y.H� //�
CROSS ST. r�
ARCHITECT OR LIC. ZO NO. OF ( XTYP I GROUP
ENGINEER NO. I PLANS 11
ADDRESS )
PPR VED
`NTRACTOFrEORGE M. HOLSTEIN & NO In BY DAT J
I !bb E. 1/th St CORRECTIONS
_,.JDRESS (+(ICT /A/MCCA r4I IrLEGAL LO
�{
DESCRIPTION I NOT I V I BLOCK I TRACT /&78
(ATTACH METES
a BOUNDS)
SIZE OF LOT 4,I/J A /I 8 ( I NOW ON LOTS. a
USE OF I NO. OF I NO. OF I
EXISTING BLDG. FAMiLiEs ROOMS
SETBACK LINE FROM: i I 8 I REAR YARD C/
,
CENTER OF STREET SIDE YARD S
DESCRIPTION OF WORK 0
316
NEW I '/�I ALTERATION I I ADDITION I Z
REPAIR I I M VING I I DEMOLISH I D
r
EXIERIOGNO. OF '
SIZE 3 ROOMS I STORIES I •
////1111
EXTERIOR WALL I ROOF
COVERING COVERING
I)SE OF NEW
'LDING
APPROVALS
FOU DATION: LOCATIONUNDER-PINNING RMMATE )ALS. I IySPECTOR /�AT
E I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS. MATERIALS, fIN/``rl, 3E ,,{
APPLICATION AND STATE THAT THE ABOVE IS CORRECTv
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS.
BRACING. BOLTS hin'a®r,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
iit /}� LATH. INT.
,
SIGNATURE OFAI I . LATH. EXT. OAS /ran/.
PERMITTEF //�- P� r'N'L.L
I PLASTER, INT.
AUTHORIZED AGT.
PLASTER, EXT. if �t 1E nil
PERMIT 1FEEk
SMASONRY REINFORCED
VALUATION S 7 7.- O PLAN CHECK S /,"
/ BOND BEAM 0
TOanima EAL s I FINAL �"2
5M 3.90.99 r
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Show location and distances from
property line and between buildings. -