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HomeMy WebLinkAbout2110 HARBOR BLVD - Building Permits OWNER SORENSEN, VERNON'L. DATE OCT 1 61964 _}� JOB ADDRESS 2110 Harbor Blvd. BUILDING PERMIT NO. 23092: do GENERAL CONTRACTOR Owner-Builder VALUE $ 150.00 Int. Alts. ♦P,g'':No. 115-236-49 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK COMMerCial Bld L..'�'4-"'ECTIONS Signature DATE GROUP F2 TYPE V ZONE C2 Soil PERMITS ISSUED Gas SUBCONTRACTOR 'DATE NUMBER Water Rough Corn. Refrig. ❑ Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line.❑ House Con. 0 St. Swr. 0 _ _ Sprinkling ystem cif Construction Pole _ _ Or 'I'j Underground 0 Power 0 � _ - - d _ Rough Wiring —FT iD'i'G f ,VGa:-G,,.-_ 'milia - 2 , o —+ Trenches I❑ Forms.❑ Steel Reinf.0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing 01/°--/-41-51/p`_6_y Lathing— In.,011/ Out❑ e nia6 1.3"';`".;:r, brown coat Q/tea- J.�-....1_ Itssitg. 0 Air Con. 0 Final Heating, Final Plumbing Fixtures, Final Tag fl 0( OWNER KEMMER CYCLE CENTER DATE DEC 1 0 ISM JOB ADDRESS .2110 Harbor Blvd. BUILDING PERMIT NO. .23310 — ° GENERAL CONTRACTOR Owner-Builder VALUE $ 100.00 Non-Elec do.11s-236-49 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Facia Sign ItSECTIONS Signature DATE GROUP J TYPE — ZONE C2 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. O Air Cond. I] Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line 0 House Con. 0 St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power 0 Rough Wiring Trenches 0 Forms❑ Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing _ Jsigiing— In0 Out0 _,? er, brown coat Refrig. ❑ Air Con. Q Final Heating, Final Numbing Fixtures, Final • OWNER HUB AUTO SUPPLY - DATE 4-23-59 JOB ADDRESS 2110 Harbor Blvd. BUILDING PERMIT NO. y��3 GENERAL CONTRACTOR Pacific Neon Lite VALUE $ 200,00 AP. I45-231.41.13T TRACT . FIRE ZONE DESCRIPTION OF WORK Sign t "OUP TYPE ZONE C2 PLAN NO. • 9113 t .SPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBS: Trenches Forms Steel �/ k Floor System Steel Reinforce Chimney Re-Rod • Bond Beam Frame and Flashing Lathing, hi Out Plaster„brown coat Underground soil W/G Pipe Test Top Out Furnace Gas Vents • Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final • C” bing Fixtures, Final 1 Gas Test Construction Pole 9str -SSYJ 5 ', I Underground Power / Rough Wiring 1��� Fixtures, Final & 1/Gd OCCUPANCY Form 210-5M-1-57 9111 ' CITY OF COSTA MESA BUILDING DIVISION tot:os DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F lg. I PERMIT � � P03-00101 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2110 HARBOR BL Status: ISSUED Suite No Applied: 02/19/2003 Issued: 02/19/2003 Vicinity: Parcel Nunmber: 41917146 ISSUED BY: Applicant: PELLISSIER, TIM,. Address: 2400 LINDBERGH ST Phone: 530-888-8114 AUBURN,CA ' ' Zip: 95602 Owner: V E SORENSEN FAMILY Address PARTNERS L P � PIO WN,CA Phone: bbb��P P oBOX 68 Box sa zip. 92268-0068 Slig�, 30 DAP Contractor: AMERICAN ALLIANCE DBA DRAIN PATROL Address: 2400 LINDBERGH ST Phone: 530-888-8114 AUBURN,CA Zip: 95602 License: 422136 • Arch / Eng: - r - - Address: - - - - Phone: • Zip: License: " SCOPE OF PERMIT REMOVE/REPLACE AND RELOCATE ONE TOILET,REMOVE AND REPLACE AN ADDITIONAL TOILET, REMOVE AND REPLACE ONE SINK ALL IN A UNISEX RESTROOM. • FEE SUMMARY AMT QTY AMT QTY AMT OTY 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) S0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 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) $19.60 2 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 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 It 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)7545626 2446-46(6'ee) DECLARATIONS 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 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: • •(This section need not be completed i/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 be oma subject to the workers'compensation provisions of Section 3700 o7f�the Labor Code,I shall forthwith comply with these provisions. '' .ti // / J b Applicant Signature: ...A9....., Date: / , ?) WARMNG:FAILURE TO RE WORKERS TON COVERAGE IS UNLAWFUL MID SHALL SUBJECT MIEMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE( 00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE,INTEREST,MID ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Ch:. : •(co: ening with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a '' Class 0 Contractors Signature: -- Adir i SarDate: q —( CJ —(),._ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). 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(commenting 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 Professbns 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 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,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: 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). _ 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 en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 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 appermit 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 LJ 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? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely 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 reed 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 a.ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �� Sign:`Of L.: • ner(s) �( 61 JO nd/Or A I orized Applicant ate CODE r INSPECTION TYPE UN Its CODE! INSPECTION TYPE QM Ra1d14 • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval • 203 Final Sign 222 Final Site , 204 Final Demolition - • 250 Final Building/Occupancy • ~ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. SCI' 195 PERMIT NO. TRACT NO. I LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTION UCTION PERMIT �] ��-rye- A-P.# I Zona Projgct Address air 0' AAR(n3"_ B E 3 • `1 t S 1J'` - I� S Main Building: Accessory Building: Applicant's Mailing Address q�CI Na k er C M . TYPE OF CONSTRUCTION U NEW LI ADD U ALTERATION W REPAIR E Z r' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front 0 0wr4r's Name I,/Ff ItJnALJ STY?FIU s CC.. Phone S40-73M /7 N p.. fi n fIr,� DESCRIPTION OF WORK/USE OF BLDG. CA`` P/,e,A e. B Rear Address ` 29 3S K P r C,11.S4A rn eon-. . A I Arch/Eng. License No. TYPE OFof PERRADING ElFOUNDATION U STRUCTURAL I C Right - N fppK G Address 111I TENANT Liv ELECTRICAL ❑ PLUMBING ❑ MECHANICAL i S • Left R Contractor's Nam w I - L ' ,Q/` IV OTHER - S !. / Ping. Ref. # Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. , nQ OCCUPANCY Iww G Address(mailing) �, n Planning Notes: M N ./ CONSTRUCTION TYPE v VALUATION$ �(_/ r ,- ,-- T City License No. ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. ELECTRICAL FEES License Class License No. Date Signature PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATION Construction Pole Sub. 0 50+KW 'reby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter Dup to 100 amps —do, Lab. C.) Backflow Preventer Service Sink Policy No. Company Backflow Irrigation - S ( p - t., Dishwasher Meter Dover 100 amps BCertified copy is hereby the cit - Dryers ❑Gas ❑Electric Sub Panel Cer 'fi co s filed with the city Building Division. Bathtubs Sewer Connection • (Ji Date Applicant -- Fan Motors 00-1 HP OVA-8 EXEMP ION RO WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - (Thissection need not be completed if the permit is for one hundred($100) or - 'F.A.U. Inc-Solar 09-15 HP 016-15+ less). Dishwasher Solar Piping -{- I certify that in the performance of the work for which this permit is issued, I / - Fixtures {� shall not employ any person in any manner so as to bec e s bject to the Drinking Fountains Solar Tank r. y/ Microwave SO Workers' CorgpIpensaµµµµpp�l1ggqq,,,,Laws of California. (1 FFF"' Date L•-'f.� - Signature U car e. r,CUjyr�--�--�- Device Boxes Pole Light r( 9 Q Floor Drains Swimming w/Spa 9 NOTICE:If,after maks g this declaration, you should b oma subject to the v ' /o Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal Outlets r}! R 9 ane ,.. comply with such provisions or this permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Signod I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors Water Heater Garbage Disposal Standing SectionID Lender's Name Lenders Address Kitchen Sink . Water Service Generator 00-5 KW 05-15 KW Trash Com-pactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash •.- following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repairP-Trap Laundry Trays t-- C any structure, prior to Its issuance, also requires the applicant for such permit _ �, _ to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains r the Contractor's License Law (Chapter 9(commencing with Section 7000) of ` ` cion 3 of the Business and Professions Code) or that he/she is exempt — - Reinspection Fee $15 lssue.F,ee^ i '�';-1.rom.5 by nd he basis oralleged exemption. y violation of any for a permit subjects theapplicant to Section civil �f• r- PPeppally of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS: �'J LY,I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 Zoning Approved By �y "'' Date for sale (Section 7044, Business and Professional Code: The Contractor's > License Law does not apply to an owner of a property who builds or Improves MECHANICAL FEES Building Approved By Date thereon, and who does such work himself/herself or through his or her own Application Issued By /•�- Date employees. provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 sale- If, however, the building or improvement is sold within one year of com- - Canopy Type II ❑ SUMMARY F FEES I pietion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground OP) prove for the purpose of sale). BUILDING PERMIT $ SMIP ' $ 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK 'J-'1 Z PERMIT tractoro- onstruct the project (Section 7044,Business and Professions Code: $ The Cl:Wctor's License Law does not apply to an owner of property who. Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE-'$ builds or Improves thereon. and who contracts for such oroiects with a con- _ traclor(s license pursuant to the Contractor's License Law). I am aware thatI PLAN CHECK 25% $ ENERGY P.C. $ Exhaust System 0 Multiple ❑ System Repair/Alteration z7 GRADING $ proof o their Worker's Compensation insurance should be provided to me. ELECTRICAL $ 0-i am exempt under Section B. &P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLAN CHECK 50% $ MICROFILM $ Date L r_44.____ Owner - Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ !O(?'� I hereby certify that I have read this application and state that the above -00-100,000 BTU 0100,Oo0BTl Information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building co struction,and hereby authorize repre- sentatives of this city to enter P the above-mentioned prop rty for Inspection purpose Signature v/rjL,�� Daten - 6/2-1717 01 00026753-C002676/ TOT 131.75 Drivers' License or SS C7 Fee •$15 Issue Fee $ 3 DATE: 02/22/89 TINE: 08:29 0865-46,rev.5/88 White - Building; Canary - Applicant; Plnk -Accounting; Goldenrod -Assessor Alk CONSTRUCTION AND PLANNING POC" SPA ¶APPRS4ALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole ', r 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. ',Electrical Conduit Utility-Undrgrnd. 1 54. Forms 4. 'Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test • 6. 'Elect�ica�lUFERGrnd. 57. APPROVAL TO COVE R-GUNITE 7: Footings; ' 58. Electrical Conduit-Undrgrnd. i . '1 • 8. Foundation . ' 59. Gas Pipe, 0 Undrgrnd.,Test 9. WaterlPipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. ; - 10. Structural Floor System 61. APPROVAL TO DECK . ' .11. Property Sewer Line & House Connection i 62. Backwash & Receptor-Final i 12. Sewer Cap • 63. Heater & Vent-Final 1 • 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 II 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# i 21. Ducts, iniStructure 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 ❑Oil 25. Roof Sheathing ,I 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 3j/c� /ar! 75. Dry Chemical 27. Frame:and Flashing �al� 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall NailingHEALTH DEPT. REQUIREMENT 31. PlasteriBrown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter-Final n 80. FOOD CERTIFICATE ISSUED 33. Final Electric • $1/&r ��GlllUlai Notes: 34. Final Heating & Air Conditioning ' Ci 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace • 38. Final Plumbing - ' 39. Water Service-Final -• 40. Gas Service-Final 41. Solar Domestic-Final i 42. Backflow Preventer .•Cg. t ( : 43. Backflow Irrigation 44. .Landscape Irrigation System EXPIRED - 45. Sound Attenuation Incomplete Inspection? 46. Handicap Regulations _oath Tr O 7 sig 47. FINAL STRUCTURE & BUILDING f '• 48. Special Requirements Completed 1 49. Electric Release to Edison -: 50. Gas Release to Southern California Gas Co • • 51. CERTIFICATE or OCCUPANCY ,_ . . I , •No . Date r • . r _- 23092 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT 16 1964 P.O.BOX SIT COSTA MESA.CALIFORNIA NANCE DEPT, CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATLON FOR PERMIT TYPE OR PRINT BUILDING For Office Use OnlyBUILDING /� ADDRESS Z I/ % '�/I/�1/ l6IY 'R�I RECEIPT NO. 2@I 9Q. COSTA MESA, CALIFORNIA II (' RH DATE REC31V[9// DATE/ISSUED OWNER vefri oit h SO Rh,s6„, /0 /(��//Al//�/T'O-//jJ6 BUILDING AMAILDDRESS�,�JY 2 0 S�' ADDRESS _a//6 /�7', /V'"'V" gird. FIRE C I TY/iissi e e/- f04v4/ NO. ZONE ?`/TfP) I GROUP /� //', C •ITECT GINEER —` NO. APPROVED7i/4. , DATE �o � 4 ��� �-- ZONING Q '' ADDRESS � ZONE NO.Or I UsMEOrnEW/f� ^- - ' S 'y_ P A U- BUILDING CONTRACTOR ,/(1jn[e[/ -.46-10141 - '' ! LEGAL wJ 1 / 7 // ADDRESS I+-,-�[�w DESCRIPTION © OVA I.at / IJ, -�� CITY 1. ,[ , A.P.NO. 1 15 — e 3 1D — LF- NOTE: NO EAVE OVERHANG SHALL BE LESS T N STATE TEL �.---- E0'TO SIDE&REAR P.L. LIG.NO. NO. EAVES SIZLEOT ./y7 NO.OP BLOTS. NOW ON LOT ALLOWED (U.B.C.REQUIREMENT/ OF ]'^ ` / YARDS APPROVED YARDS APPROVED USE OF EXISTING BLDG. P c / J //O jO. MAIN BUILDING ACCESSORY BUILDING 1 (FROM C/L STREET// SETBACK LINE FROM FI� /y/ PT. CENTER OF STREET ((�� REAR YARD3[I FRONT p✓ HIDE YARD I LEFT `/ / • I RIGHT ID R.SIDE .......y.....- FT. DESCRIPTION OF WORK L.SIDE N ALTERATION x ADDITION REAR DISTANCE BET. BET.MAIN& REPAIR MOVING 'DEMOLISH MAIN BLDGS. ACCESS.SLOGS. VAR.# DATE SIZE Iy��''//0 1 SIZE q0 ROOMS STORIES C.U.P.# APPROVED 1 EXTERIOR WALL IVAPPROVED rN09 r O'/4 / COVERING COVERING Y USE OF ByILDING AND WORK TO BE PERWORn%ED /A/Tc ;Jo r pnFf/ T/ Or'f - .. Qc.O • - , [ . 0 H SQ.FT. G I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AOR 8 TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ON�L�.YE. G UL PLY WITH ALL CITY ORDINANCES AND STA WS GATING VALUATION V r BUILDING CONSTRUCTIO Y� SIGNATURE OP PERMIT FEE O/ B PERMITTED f�/NT� ( /1/�Gh�✓ m Z s/a'6 0 • 4 AUTHORIZED AGENT $ "/ TOTAL PEE