HomeMy WebLinkAbout763 19TH ST - Building Permits:4141 *
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� CITY OF COSTA MESA _ �
BUILDIN6 DIYISION
DEVELOPMENT SERVICES DEPARTMENT.
PERMIT
Job Address: 763 W 19TH ST
Suite:
Vicinity: GARAGE AND HOUSE
Parcel Number: �42420106
Applicant: AUSTIN HAN
Address: 1022 W ORANGETHORPE
FULLERTON,CA
owner: HASSAN,MOHAIVIMAD
Address 28 EMERALD
' IRVINE, CA "
Contractor: ACE ROOFING
Address: 7022 W OR4NGETHORPE
FULLERTON,CA
Zip: 92838
Arch :
Address:
Phone:
BUILDING PERMIT
-.
..
Zoning: '
Phone: (774)877-9923
Zip: 92838 �
Phone: 949•548-3365
Zip: 92614
Phone: (714)871-9923
License: 679543
Eng:
Address:
PERMIT NUMBER
I B00-00603
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 05IO1I2000
Issued: 05IO1I2000
Phone:
Zip: License: License:
SCOPE OF PERMIT
. TEAR OFF BUR ATGARAGE AND REROOF WITH BUR. ON THE PITCHED SIDE; GO OVER WITH 1 LAYER OF 20 COMP
SHINGLES OVER EXIST 1 LAYER OF COMP. SHINGLES.
Plan Check: $0.00
Permit: $139.25
SMIP Res: $0.68
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.93
SETBACKS
MAINSTRUC7URE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0• 0
Right 0-0
$6,750.00
$6,750,00
NOTICE: The work authorized by this permit shall compty with all applicabte handicap accass requirements under Celifomia statutes and related
regulations. (Ord. No. 9248, § 7, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if xrork is not�commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In ordar for the work authorized under this permit to be considered legal, such work must eomply with e�l applicable codes, a�d all
requlred Inapectlona end (inel approval must be obtained. Failure to obtain inspections and final epprovel wiit result in the expiretion of thia permil.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARAnON:
I hereDy eMk�PGnde'� Qenelry ot per(ury one of tho I011owing dederations: ' ��
❑ I have end wlll meintain a certlfltate of consent to selFlnsure tor warkers' wmpensetlan, es providetl for by sectlon 3700 oi Ihe Labor Cotle, for the pertormanca of the
work for which �his permit Is Issuetl.
I have entl will maintaln wwkers' compensetlon Insurance, as required by sectlon 3700 of tha Lahor Code, for Ihe peAortnance oi t�e work for which this pertnit Is Issued.
y workers' compensation Insurence carrler and policy number are: .
Cerrier.
(This secf/on need nof be wmp
❑ I ceNty that In Ihe �
compens ws oi Ca
vis��
c nt Signeture:
WARN : FAILU ECURE W
RE (5100,000), IN
LICEN CON OR D
h by � that I em li nse
brc tl ettecl Lic. p�
Policy NumOer:
3rm'( /s ve/ued et ane hundred dollars (S100J or IessJ
3 tor whic� Nis it is issued, I s�ali not employ flny pereon in eny manner so es beco sub�ect to Ihe workers'
�r et if 1 shou e sub�ect to the workers' com e ' lons of Sectlon 3700 t the bar Cotlg, 1 shall forthwith
� C/
e:
EN IIXJ WVEiiAGE IS UNIAWFUL AND SW1LL SUBJECT AN PLOYER TO MINAL PENALTIES M10 IVIL FINES UP TOONE HUNDRED
THECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINS OFTHELABORCO�E,INiEREST,ANDATTORNEV'SFEES.
ot C�epter 9
7000) ot Dyvfsion 3 of ihe Busineks antl
/ Class a
Date:
:iFUCT10N LENDING AGENCY: ' " -� ��
I hereby eMirm Ihat there is e consWClion IenOing agenty for the pedormence of lhe work for which �his permit is issued. (Sec. 3097, Civil Cotle).
ifs Name: Lentlefs Atldress:
Signeiure:
Date:
my Iicense Is in full
OWNER•BUILDER DECLARATIONS:
I hereby eHlrm that untler penalry oi perJury that I em E%EMPT FROM TME CONTRACTORS LICENSE LAW tor tha tollowing reason (Sec. 7031.5, Business entl Professions
Cotle: My ciiy or counry which requires e permit to consWct, elter, improve, demolish, or repeir eny sWCWre, pdor to ils issuance, also requires ihe applicam tor such permit
ta file e slgned stetement Ihet he or 5he is Ilcensetl pursuen� to ihe proWslons of ihe Conirectore License Lew (Chepter B(commencing with Sectlon 7000) oi DlWsion 3 0l tha
Busineu antl Pratesslons CaAe) or that �e or she Is exempt �herefrom enA the besis tor the elleged exempflon. Any videtion ot Sectlon 7031.5 by eny applicent lor a pertnit
sub�ecls the applicent to e ciNl penalry ot not more then Ilve huntlratl tlWlero ($500).):
❑ I, es owner at Ihe property, or my employees with wages as their sole compensatlon, WILL DO THE WORK, end the structure is not Intentletl or otfered for sele (Sec.
7044, Business and Professions Code: The Contreccors License Law does not appty to en owner of property w�o builds or improves ihereon, and who tloes such work
himselt or herself or ihrough his or her own employees, pmvided �het such Improvemenis are not intendad or oMered for sale. I( �owever, the Duilding or improvement is
soltl within one year of completion, tha owner-builder will have the burtlen of proving that he or she did noi build ar imprave tor Durpose of sale.).
❑ I, as owner of t�e property, am E%CLUSIVELY CONTHACTING WI7H LICENSED COMRACTORS to construct the project (Sec. 7044, Buslneu flntl Protessions
Cotle: Tlie contrectors Licanse Lew tloes not epply to en owner of properry who builtls or Improves t�ereon, end who comrects lor such project wiih a con�rector(s)
license pursuant to the Contrectors License Lews.).
❑ I em exempt untler sac. Business entl Professions Cotle tor t�ls reason:
Signature: Date:
Owner ID verified by tlrivefs license. ❑ Yes ❑ No Oriver's Ucense No. Expires:
Venfication of Ownership by (rype ol tlocumem, i.e. - properry tax 6ill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
� I hereby certify that no exnvetion fNe (5) or more leet In depth Into whlch a pereon Is requlred to descend, will 6e made in connectian with work euthorizetl by this
permit, end Ihel no Duiltling structure, scaHolding, falsework, or tlemolltlon or dismaniling thereof, will be more than thlrty-six (36) feel high. (Chap. 3.2, Gry 2, Atl 2, Sec.
341, TLLIe 8, Celifomia AdminislretNe Code).
❑ As owner-builtler, I will not employ anyone to tlo work whlch would require a pertnll trom Ne Division of Intlusirial Sefery, es notetl ebove, unless such person hes a
pertnit to do such work Irwn the division.
Signature:
Division of Industriel Safery Pertnit Number.
Date:
HAZARDOUS MATERIALS AND EMISSIONS CER7IFICATON:
1 Will Ihe epplicant or present or tuture builtling acupant neeG to tile end cenity a Business Plan for emergency response lo release or threatened release of e hazardous
matenal? ❑ Yes ❑ No
(Sectlon 25505 oi the Callfomia Heelth end Sefery Code requires, with some exceptions, that a Business Plan be liled with Ihe CosW Mese Flre Depanment by every
Dusiness which has at erry one time durinq e reported year e quentiry at hazerdous materials epual to or greater t�an e wei8�t ol 500 pounds, or a volume ot 55 gallons,
or 200 cuDic feet of wmpressetl gas at stantlerd temperawre anC pressure).
2 Does or will Ihe appliwnt or present or luture bullding occupant neetl to file e registration fortn lor acutely harartlous materials7 ❑ Yes ❑ No
(Section 25533 of tha Califomia Heal�h and Salery Code, with some ezcep�lons, requires registration with Ihe Cosia Mesa Fire Depanment by each buslness which et any
one time hes on hand a quantlry oi acutely harerdous meterials equel to or greeier than a weight ot 500 pountls, or a volume ot 55 gallons, or 200 cubic leet ot
wmpressed ges et siantlartl tempereture and pressure).
3 Does or will ihe aDPlicant or presem or tuWre bullding occupant neetl to prepare en RMPP (Risk Management entl Prevention Propram For acutely �azartlous meterials)?
�
�
6
(Saction 25534 of Ihe Califomla Heallh antl Safery Code proddes ihat ihe Caste Mesa Fire Depanment may require Ihe
Depertment of en RMPP Dy businesses which ere required to register acutely harardous meterials with Ihe Fire Depertme
II an RMPP is presentty require4 has Sectlon 25534 of the Calilamle Heelt� enG Satety Cotle �een tully wmplleA with7
)es or will t�e epplicam or present or tuWre bulltling oaupant requlra ror ine work wn�cn is tne sub�ect ot cnis e pncatlon
im the SouN Caast Air Duallry Manegement Disttld or frwn any other elr pollution contrd distdd or egency7 � Yes
eCGOn 658502 of ihe Celifomia Govemment Cotle requiras Nat ihe requested infortnatlon be fumished an eppliwtlons lor
ill eny pan oi Ihe faciliry ro be constructetl untler ihis pertnit be within 1000 feet from the outer bountlanes oi a schooll [
yes', the taciliry must meet �he requirement ol5ections 25534 antl 42303 of ihe Califomia Healih and Safery Cotle).
a permlt from Ihe South Coast Alr Oueliry Menagemem Dlstrict or ot�er eir polWtlon wntml district or egenty Is redul
�olication. have all of �he disclasures orescnbed by Califomle Healf� entl Sefery Cotle Section 42303 Geen matle? ❑ Ye:
3perelioq CertifiCetion end filinp wiih IhB Fire
Yes ❑ No
i�e rmit tor such construction or modilication
�J NO
nomresitlential building permics).
ves ❑ No
etl for Ihe work which is the subieCt 01 Ihis
❑ No
(II yes". atiach certiflcate ot wmpllence from Ihe approprie�e air pollution control otlicer).
CERTIFICATE OF COMPLIANCE: I cenity Ihet under penally ot perJury Ihe Informatlon glven above is correct. I egree to comply with ell stete laws entl city ordinences
regarding Hazertlous MeteAels entl Emisslons.
SlgneWre: Date:
CERTIFlCATE OF
cortect I agree to
ebove-0escnbed p
CODE �. INSPELTIONTYPE
1818 Fixetl System Finel Fire Prevenlion
7266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202 ` Finel Factory Fire Plece
203 Finel Slgn
20a Finel Demolition
26e8-a6
JRVA710N OF . M1ify under penalry ot perjury that I have read Ihis epplication and �.
and ciry ordi rei ng to building wnsWclion, and authorize representatives ot Ciry
�sey�� not to occupy or ellow occupancy at eny building euthodzetl by thls pertnrt ¢il fina
reg Ii�Ass
COOEA INSPECTONTYPE
206 Finel Mechaniwl
208
210
212
220
222
250
Final Plumbing
Final Electdcel
Finel Fira Preventi0n
Finel Planninp Approval
Final Site
Final Building/Occupancy
Uat Ne iniortnation given is
uta Mesa to enter upon t�e
Pdffi U�I�LS
- i ApD��eant ta fill in ali soaees exeept t�ase within �eavy �ortler lines anG sign all ap0�opriata Oaclantions.
CITY OF COSTA MESA CONSTRUCTION PERMIT . "^ir N ncr LOT NO. UNIT NO.
� - "' .r� �E' �� � !
Prqjettff�.lres5 �b3 �11 ) �{�r S'�'. ��S�RNK,�'S/4 �
Applitant's Mai�ing Address - Q TYPE OF CONSTRUCTION t�Ew nDD ALTERqTION REaAiR
TS�. YV�NG��'/NiiIUKk MRIVI.'�j � CONVERSION ❑ DEMOLISH ❑ OTH R A p �y
Owner'sName o e D S RIPTION WOR OFBL t'
Adtlreu S Main 8uildi
E
Arch/Eng. License No. TVPE OF PERMIT�q GRADIrvG FOUNDATIOrv STRVCTVRAI T Front
Adtlress ' ❑ TENANT ld ELECTRICAI ❑ PLUMBING ❑ MECHANICAL B Reaf
Contractor'sNam ��'Rn��o^� ���4-5 PhoneS�IQL�6Z ��OTHER %�
y s �f PROJEC7 DESCRIPTION Sp. oCCUPnrvCv C Right
Adtlresslmailingl--��O��"L l. D�/� 1�R: �ilN�"�Sel'�. K
CONSTRUCTIONTYPE VALUATION$ Z�%SD g Left
Cit� LiCensE No_ ZONE GRADING CU. VDS. ACRES p�n Ref #
LICENSED CONTRACTOR DECLARATION
I h4teby aHi�m Ihal 1 am licrosetl untlar proWslons ot Charter 9(comm¢ncing
w��n saction �000) o/ Divislon 3 of tne B siness antl Protesslons Cotla, anE
my Ilcensa Is in fullj„/(�or<e antl eilact. 7 1 I
V�CI15C �Id55 y � Li e I No.
Date A'11'Y< Si9ndtura
NJORKERS'COMiENSATION DECLAR TION
1 bEreby allirm that I nave a terHtltate oi sent to solf-insure or a certiflcate
o� Workcrs' Componsation InSurance, Or a certl(Ie0 copY thereof ($ectlOn
3800, Lab. C.) "
Pol��y No. COTpany
8 Certilietl copy is hereby tumizhetl. '
-Certili<d copy Is liletl with the city B�iltling Division.
Date APPlicant
EXEMGTION FROM WORKERS' COMPENSATION DECLARATION
(T4is section neetl not be compie[etl if the perm"t is for o ie huntlretl (E300) or
less). �
I<prtlty tbat in tne performancn of Ihe work which �hls permR is Izsuetl, I
sha�l not employ any oerson in any manne as to e ome SUDjoct to lhe
Workers' oe�p ns�t pryLaws of Californid.
Date �� I �-2S�Si9nature
'NOTICE: 1�, ailer making tnis tlaUa�ation, u shoultl become sub�oct to [h0
WO�keri' CompensatiOn 0/ovisions of thC r Cotla, y0u must lOrtnwit�
tomply wilh such provlsions or tnis oarmit shall be tleem¢tl revoketl.
CONSTRUCTION IENDING AGENCV
I hereby altirm that there is a wnstruction lentlln9 a9ancy for tha performantt
of (he work tor whiGh tn15 petmit IS Issuetl (Section 3097 Civ. C.)
�enaer•s rvame
Lentler's HtlGress
6WNER BUILOER �ECLARATION '
� hereby afflrm that 1 am exempt from Ne Contrattor's License Law tor the
fo�lowin9 reason (Sectlon �031.5 Buziness an0 Professional Cotle: Any cily or
county whlch �eqWres a petmit to Const�uGt, alter, improve, tlem011sb or repdir
any ztruclure, prbr to ils issuance, also requires tha applicant for such permit
ro file a 5ignetl slalement that he/she iS Ilcensetl pur5uant to [he provisions oi.
the ConVa<tor's Ucense law (ChaO�er 9(commencing with Section 7000) o/
DIvlSion 3 01 thC Bu5Ine55 dntl Profes5ion5 Catl¢) Of thdt he/shC Is ex¢mpt
Iher¢Irom antl Ihe ba51s tor lhe allegetl ezemptlOn. Any vlolatiOn ol'Section
7Q31.5 by any app�lcan[ for a.permit sub�ects Ihn aOP�lcant to a civil
�enalty ot not moro tnan flVe huntlretl t1011dri (ES00).
I, a5 owner of tho OropO/ty Or my 9mploy085 wl[h wages as lh0i� SOIB
compensatlon, wlll tlo the work, antl the strutture Is not Intendatl or otteretl
tor wle (Section 7044, 6usiness antl Pro�essional Cotle: Tha Contractor•5
Licensa Law tloes not aOPly to an owner of a property who builtls or improves
thereon, antl who tloes such work hlmseli/hnrseli or throu9h his or ner own
employoe5, provitlotl Ihat suth Improvem¢nts are noi Intentletl or otferetl for
sale. It, however, lhe builtling or Improvement Is soltl wl(hin ona year ol com-
pletion, t�e owner will have the bvrtlen of proving he/sh¢ tlitl not builtl or I�T-
P�Ove to�the purpose of sale�.
❑ 1, as owne� o� Ihe property, am exeWslvety contracting with licensetl con-
VactOrs l0 con5truct the OrOjec[ ($ection 7044, Bu5ine55 antl Professions Cotle:
The ConVactor's License Law does not ao��Y �o an owner of pro0erty who
b�iltls or Improves thereon, antl who contracts tor suth projects wlth a con-
tractor(il licenze pursuan[ to the Contractor'S License Law). 1 am aware lhat
��oot o! lhelr Workcr's Componwlion in5urance Shoultl be provitled to Te.
❑ 1 am exempt untler Section B. & P. C. br this reason
Date Owner
I Orivers' License
CMF 0865-46, rev. 1
ng construction, a
Remafks:
�
Bar Sink
Backflow Prevencer
=, Backflow Irrigation
-� Bathtubs
Clarifiers . .
Drinking FOui
Floor Drains
FlOor Sinks
Gas Service
In�efCeptOrs
Kitchen Sink�
Lavatories
P-Trap
Roof Drains
�i81nSPBt[iOn' FBB
Outlels
$1$
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. 81[. ICBO #
Heating System & Ducting
❑aioo,000.aru Oioo,000sn
peinspection Fee � S75
Wliite - Builtling; Canary - ApPllcanC Pink - Accountin9: Goltlenrotl - AssesSor
Sblar Tank '
Swimming Pool w/Spa
Urinal
Water Closet
Water'Heater
Water Service '
Auto�Wash
Laundry Trays
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000sTu ❑ioo,000
SVstem Repair/Alteration
Fire Dempers
Registers
Issue Fee
g.
Planning Notes:
FEES
' Auromatic Washer
� ConstructionPOleSub.
' Cookin9 Unit
Dishwasher
Dryers ❑Gas ❑Eleo
Fan
F.A.U.
Device Boxes
OU[IQIS
Switches
Garbage Disposal
Generator �0.5 KW
$ 3 '
� Rainspection Fee
FEES
�DEVELOPMENTSER
Zoning APProved BV-�
Building Approved By
E 3
D295 9/17/85
� Zone
Acceszory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW'
❑ 50+ KW
Meter ❑up to 100 amps
Meter ❑over100amp5
Sub Panel
Motors O0.1 HP O 1 Y, - 6
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light _
- ; Standing Sections
5 KW Trash Compactor
$15 Issue Fee �
6io:c TL
FEES
$ 3
SUfy1�RV OF FEES �D
BUILDING PERMIT $ � �S .�� SMIP ' $
PLAN CHECK $, ZSSOZ � pERM1T
PLUMBING S ' ��UANCE $
PLAN CHECK 25% $ --��— ENERGV P.C. $
ELECTRICAL $ v.00 GRADING $
PLAN CHECK 50% $_ D. 38 ' MICFOFILM .$�
MECHANICAL 5 TOTALFEE $ 67.92
PLAN CHECK 25% $
2
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CONSTRUCTION AND PLANNING � P� & SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date � Inspector
1�iTemporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel�Reinforcement � 56. Rough Plumbing & Pressure Test � '
-6• Electcical UFER Grnd. 57. APPROVA� TO COVER-GUNITE
J. Footings 58. Electrical Conduit-Undrgrnd.
• 8. Foundation 59. Gas Pipe, O Undrgrnd., Test �
- 9. Water PiPe-Undrgrnd. " 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurel Floor System • 61. APPROVAL TO DECK
11.� Property Sewer Line & House Connection 62. Backwash & Receptor-Final
.-12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System - Final +�
14. Rough Plumbing� 65. Electrical-Final
15. Aough Electrical-Conduit 66. Solar System�Final
r76' Rough Electric Wiring �p 2; �J' �1 �` 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
� 18. Rough Electrical-T Bar Ceiling ,� 69. POOUSPA SYSTEMS FINAL
�, 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
� 20� Rough Factory Fireplace � APPROVALS ' Permit #
27. Ducts, in Structure �' . 70. Underground Hydro
22. Ducts, Ventilating ,,,` � 71. Product Piping � Gas ❑ Oil
� 23. Gas Pipe<Rough & 7'e'st � - _ ' 72. Underground Flush
24. Roofframing . ' 73. Undergrnd.StorageTank�Gas ❑Oil
� 25. Roof Sheathing �• d, 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frame ahd Flashing � �� �(� 76. Dry S[andpipe .
28. Lathing & Siding �b ,.� �� 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing , � �j � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �p � � 79. FINAL INSPECTfON -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' ' Notes:
34. Final'Heating & Air Conditioning - �
�
35. Final Gas Pipe-Test � -
36. Hood or Canopy ' ' .
37. Final Fac[ory Fireplace �
38. Final Plumbing , . , , '
39. Water'Ser.vice-Final � - � .
40. Gas Service-Final ,
41. Solar pomeiticFinal � , , . . ,
42. Backflow Preventer � ��, ; , � .
43. Backflow Irrigation ' . ., � '' ��
44. Landscape Irrigation System' � '
45. Sound At[enuation � : -
46. HandicapRegulations ' � ,�� �
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed. � �
49. Electric Release to Edison � �-•
50. Gas Release to Southern Cafifomia Gas Co �
51. CERTIFICATEOFOCCUPANCY �
No. Date � "� � `��
r
Project Address
CITY OF" CTA MESA ND --- 282
PARn FEES
Fee Payment Receipt
� /�� /9�� s�
A. P. No. �,(�/�-�
Building Permit No. � �� % �
Owner's Name r�"JE�2 L`'� �Ai�UPdZT-
Mailing Address 9D /�i0 1��/� ��. S'K.� ��� �
FEE
Single Family ' No. of Units
Multiple Family '� No. of Units
Planning Department
Applicant's Signature L_J�)SiF,bb
� Clty Ortllnance 72-44
'" Qty OrOinante 72-65
••* City Rnolutlon 74120
W�ita - Planning; Canary - Planning; Plnk
@ $455,20 = �
@ $32132 = .2
Total Fee 9 n2 �/ Q�
BY ,
Flnance; GOICenroA - AGPllcant GMF 0374-26 I � 1 �� 1
�( R-r 1�
'' �t� 43.7.94
_ - - - - �-6
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
�
For Applicant to Fill in Completely — Use Ink Only
RE
BUILDING �/ � /,' r���`+}� //�.�_
Af]ORESS (e 1 1 J 1. (
OWNER ��� w,No�e.r€�
MAIL q� /�
ADDRESS / D � DOJE/l �Q, .�/4�
� TEL.
CITV �6jti(pp2`i"�c�,�IC�/.�i%'(,(/fNO.
BflANCH
ADDRES:
CONTRACTOR O(.�1A�t�JZ LGR RE�LCLW
ADDRESS Vy E. I o RJT l�� •
TEL.
GTV NO.b y._
� LIC.No. aq73o LICYNO.
W SIZE S. r,�a90 � NO.OF BLDGS.
�. pF LOT NOW ON �OT
a USE OF
„�. E%ISTING BLOG. /4C
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FSeparate permits are required for
� electric, plumbing and heating work.
�.�., USE OF BUILDING AND WORK TO BE PERFORMED
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FORSTRUCTURALPERMIT
A DRESS f�3 C�/,
A
/� OWNER �
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60 5
FIRE
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�. APPROVED
• BV
2 NE NO.OF
PLAKS
YARDSAPPROVED
MAIN BUILDING
(FROMC/LSTREF�T) f
OM FT.
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T
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L. SIDE FT
/
REAR FT.
�ISTANCE BET.
MAIN BLDGS.
C URP. q� �L! � �
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7
L�O�,�I BLOCK
� VALUE '/ �
§ L
GROVP
DATE �� / �
USE OF NE
BUILDING
VARDSAPPR ED
ACCESSORY BUILDING
&
� 1 hereby eeknowleEpa thet I hava raetl t�l� eppllcatlon and ateta /�
(y� thet the ebova Informetion Is eorract en� apree to comply with
� all lews ropuletinp buiitlinp conrtruction, antl I shell not employ /I �
z any perwn In vlolatlon o1 the workman'e companeaTion lew� of c p d
� Me Steta of Celifomle. HOLD FS��S�GC�NL�
3 1 hereby canify that I em proparly Ileansetl as a contractor unGer -
the Smte of Californla Busine�s enA Protouion� Cotla, Dlvlaion 3, THE AMOUNT SHOWN UNDER VALU
Chaptor 9, entl that tut� Iicenaas ere In full force entl effxt, or I THE PVRPO6E OP ESTABL6HING A PERI
em axampt from Ma Orovi�lons of the State of Callfornie Busineca VALUATION PERMIT FEE E
end Professlone Ivl�ion 3, Chepter 9. —
Sipnatura t i /J / PLAN CHECK S
Permittae - S /� � (Q0� TAX E
Authorize0 Apent TOTA PAID 5
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TION IS FOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only R
BUILDING 63 w. / *� c_ �u
ADDPESS —
OWNER ��NovRfc P'
^ (� �� -(.�_ B
ADDRESS O( OV �J�. J"wl ���v p'
CITV � � �..lPa�i� �H� (�/NN`�OL.�Yf�,� �
��'4 �t 7'Yy==�D 550^ �:-*::39.t9
;�,�.
FOR STRUCI'URAL PERMIT
3 w.
���
BLOCK
GONSI HUI:I IUN � � � fP`
LENDER
BRANCH L[1fJ f�
V(p (O ` lc3LYO L.r� � OWNER
ADDRESS V UE
ARCH�TECT ` ' TEL.[ qy S � LMOR,Y T�
OR ENGINEER � "r�m7(N v ' / 060 \
� / FIRE �G�
ADDFESS /�/ D �. O /M�EL�� Z�NE VP GPOUP -.I �
1 Q� C�/�T.CO. APPROVED �. ��J M
CONTRACTOR C�J^i<7Z BV DAT Z� �, �
ADDRESS�D�` , p�-J/ C-� ,/ .��Y
/` � TEL./ ZON n .OF . USE OF NEW
CITV Lpf � NO.pY� 3 p( � BUILOING S
F STATE CITV 1'Afl�SAPPflOVED VARDSAPPROVE
LIC. NO. �97� LIC. NO. MAIN BUILDING ACCESSORV BUILDING
� SIZE / NO.OFBLDGS. (FPOMC/LSTREET) / !A
G+ OF LOT S a O NOW ON LOT FRONT FT. '� �/FT. ��j
a USE OF � / � / , A�
� EXISTING eLDG. LO E f. FT
V1 I
FSeparate permits are required for L. SIDE FT. FT.
Q electric, plumbing and heating work. �REAR FT. F. `'
W USE OF BUILDING AND WORK TO BE PERFORMEO
F DISfANCE BET. BEf, MAIN & � //
qMAIN eLOGS. ACCESS. BLDGS
; �y,� /a VAq.qW DATE
a C.•� ?/%'l2A�� C.U.P.# PPPROVED .
�'„ ���/DIZ RSfF EakC APPROVE �
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� I hereby acknowledpe (hai I have �ead this appllcetion antl rtete �
a thac the ebove Informaiion Ic cOrrect entl ap�ee to comply with �
ell lewa re9�latlnB buildinp conatruction, antl I shall not amploy �' �j,
z� e�Y Pa.w� �� ��o�et�o� o, �,a workmen'e compensetlon �ew, of OLD FOR SPECI L R- IRL,..C-d�T �
the Stata of Californie.
3 I nareby certify that I am properly Iicansetl es e eonttector under SQ. FT. j��
t�e Stnce of Cellfornla Busine�s enC Grofession� Cotle, Olvlzlon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOFi p�
Chepter 9, entl Mei euc� Ilcenses are In tull forca antl affect, or I THE PVfiPO6E OF ESTABLISHING A PERMR FEE ONLY: � �
am exempt from iha provlflona of the Staie ot Californla Business
VALUATION PERMIT FEE § a �
antl Professiona CoCe, Divislan 3, Chaoter 9. � m
q PLAN CHECK E .O'( "�
siu�a��,a o, �/ �J �
Permlttae $ TAX S � 7 Q
F
U M
AuthorizetlApent TOTA�PAID S ���
i�
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFOHNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING ��/ � � j /�� �� —
ADDRESS �O
OWNER r W .Q$�
MAIL
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CITV N f!
WNSTRUCfION
BRANCH
ADDFESS
ARCHITECT
CONTRACTOF
ADDRESS d
qTY G
STATE
UC. NO.
SIZE
OF lOT
USE OF
TE L.
NO.
L.
TEL.
NO. i
CITY
LIC. NO. I�(i
NO.OF BLDGS.
NOW ON LOT
Separate permi[s are required for
elec[ric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOR�
I hereby eeknowledpa that I hava reetl this eppllcation end stete
that tha abova informetion is corract an� aB�ea to comply with
ell laws .ao�ia<i�e o�uat�s �oonr��cio�, aoe i snan not employ
eny Oerwn in vlolailon of Me workmen'� compenmtlon laws ot
Me Stero of Californle.
I �areby certity that I am pravarly Iicensatl e� a eontractor untlar
tha Smta of Celifornle Busineu and Profeuions CoGe, Dlvislon 3,
Chapnr 9, entl t�at �uch Iicensea ere In full foreo end atfxt, or I
am exampt from the provisions of tha State of Callfornie euslneu
entl Profeulon� Cotla, Divislon 3, Chapter 9.
SIO�ature ot \ _/ ��
Permittea e.Ja....1�J �,..----
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aumori:ea nqent
SEP 23-77Pato001180# *��*25.25
CMSA
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APPUCA'CION FOR STRUCTURAL PERMIT
RECEIVED BV DATE REGEIVED �eTF iscucr
�
BUII.DING
ADDRESS
TRACT
FIRE "
20NE
APPROVED
YARDS APPF
MAIN BUIL
FROM C/L STF
VAR. qW
LOT
OF � I USE OF
BEf. MAIN
�
DATE
APPROVED
APPROVED
THE AMOUNT SHOWN UNDER VALU
THE PVRPOSE OF ESTABLISHING A PER�
VALUATION PERMIT FEE E
A�f PLAN CHECK E
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TOTALPAID S
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COSTA MESA BUILDING•SAFETY DEPARTMENT
P. o. BOX 817 C08TA MEBA. GA�-�PGRN�A
For Appliednt to Fill {n Completely
TYPE OR PRINT
BUILDING / � C�-
ADDRE6S ��
COSTA MESA CALIFORNIA
OWNER � � � � r < F � S4<<�
. ,.� � .
,
■ ARCHITECf
'LICTNO.p�.�//�' ('�P NO.
81ZE .�-w �. 6�_, r I NO. OP BLDG9.
98TBAGR LING PROM
CBNTHR oP BTHC6T REAR YARI
SIDE YARD I LEFT I RIGHT
DESCRIPTION OF WORK
BUILDING e NO. OF
81ZE ROOMS STOF
EXTERIOR WALL ROOF
GOVERING COVERING
USH OR BUILDING AND WORK TO BE PERFORMED
i HEPEBY ACKNOWLE06H THAT I HAVB
ANO BTAT! TH ABOVE IB CQF�RF
PLY WITH ALL CITY O INANC68 ANO�
BUIlDINO CON ULTIO r
81GNATURE OF `
PERMITTE
AUTHORIZED AGENi
tl�'�� ���i�����
�.) �-�-��
FINAIVCE DEPT
APP�FI,CZA'�IONa�OR ���RMIT
BUILDING
For Office Use Only
REG6IPT NO. PlPMIT
er e�re xecerv n w �e
'r/ � 3-�-�� , � �/
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COSTA MESA. CALIFORNIA �
APPROVED � �A� /�L �
BY Z�ING P
zoHe �/ I p�e � ( BUILDINOEW �
LEpAL �"� . / �� / �^ , /,� �
oescairriow�--A'{�" i O/�f'�r
A.P.NO.�/L�— d�1/� �
YARDS EVES
APPROVED ALLOWED
(ClMCR LINe 8TJ _ � /�'�Q �T"
�
MPLJWTION THE AMOUNT BHOWN UNDER VALUATION 16 FOR rHe
ICE TO COM- pUIiPOBE OR EBTABLI9HING A PEPMIT FEE ONLY.
R80YtATINO
. VALUATION � —_
��„� PERMIT FEE $
N
$ ��� � PLAN CHECK $ �
/ z
TOTAL FEE CO- �
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