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Home My WebLink About771 19TH ST - Building Permits� Aoo�icant to flll In a11 soaees exceo� those witnin heavy bortler Iines ana sign all aoGropriata aeclanUons. . � �� ' CITY OF COSTA MESA _ PERMIT NO., TRACT NO. LO .NO. BLD . N . � ,. � � CONSTRUCTION PERMIT • - ' j ZS�� - � � � � Pfoj¢[t Addr254 �Aw TYPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR �• � 6�n o i. i i n�n'r. � � r+ �-.. AppliCant'S Mailin9 Addre55 �, � Z�K /�/ �"E9L- Sf • .. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, 5y+� � � 2one � ' � . DESCRIPTION OF WORK % Owner i Nxme ��N��C- � � Phone ' „ __ , , S Main Building: � ' - Accessory Building: , 2 Address /g0? �i4Gl.�T e'�%�%r�Na/qLEPS %N•/ � • ' � E' . . � � . , TVPE OF PERMIT `GRADING FOUfJD TION STRUCTURAL T Front � .. ry Arch/Eng. - _ � lirense No., , ❑ TENANT �ELECTRICAL ❑,PLUMBI G ❑ MECHANICAL � B Rear . - . • '. � � Address . ' . ❑ �oTHER , - � A - . N Contractor's Nam w� Phone l�z �O� PROJECT DESCRIPTION SQ. F7. ' OCCUPANCv C Righi � G Addre55 (r` � � � � �i /0/��1' 3r ' � CONSTRUCTION TYPE VALVATION $ g �Left � ' • � ' -• ; E ' ZONE GRAOING CU VOS. ' ACRES p�n9. Ref. # • • Pafk.FeCS $ � ' n City License No. ��y� , � � � - � � LICENSED CONTRACTOR DECIARATION � Remarks: ' � I %,' � � . � Parking Req./Provided � ' � ' -' � I'_hereby a((I�m,(hat I am Iicensetl untlE� provi510n5 Of Charte� 9(commenGin9 , I witn sectlon 7000) ot Dlvision 3 oi the Businezs antl Protessions Cotle, antl ' , � ' � � ' Use of Building: � ' R my Iicense iz in full �orce antl eftec�y ' . , E Llcense Izss � �V c nse No. �0�� , � PLUMBING - FEES P�anning Notes: � M oate �' Sig t e �'�%� - ' ' E ""1RKER5' COMPENSATION DECLA ATION � Bar Sink ShOwers f N �eby atflrm that I �ave a.certifica[e of consent to zelf-insure or a certiiicate Backflow Preventer - Service Sink - - -- �� ' � - � ' T ,Vo�ke�s' Compensation Iniu/ance, o� a certiflGtl CopY �hare0( ($ection S „�a0, Lab. C.) � � Backflow Irrigation Sewer Cap � ' ELECTFICAL ' FEES Policy No. � Company , . - _ 8 Certlfletl copy is nereby turnlsnoa. � � Bathtubs Sewer Connection Automatic Washer � Trensformer ❑ 15-50 KW Certifietl copy is filetl with the city Builtling Division. Date APPlicant � � Clarifiers SolarCollecrors . ConstructionPoleSub. ❑50+KW EXEMPTION FROM WORKERS' COMPENSATION OECLARATION DiShwasher ' Solar Piping ' (Thissection neeA not be <ompletetl if lhe permi[ is for one huntlratl (EI00) or Cooking Unit Meter ❑up t0 100 amps � less). I ce�tify Ihal In the p¢tto�mance o( Ihe work f hich IS p¢�m�t is issuetl, I Drinking Fountains 5013� T2nk Di5hwa5h¢I M2L2f ❑Ov2t 100 emp5 shall not employ any person in any man so 5 o come subJect to Ihe . - ' worker o ep�{�b n Laws of Calltor Floor DrainS Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel Date �y�TJ" Si9nature , - NOTICE: If,iafter-makin9 tnis tleUaratl ou shoultl be me subject to the Floor Sinks Urinal FBn ' ' - Workerz' Compenzation provisions of t e Labor Cotle, you must forthwith Motars �0.1 HP �7 %- 8� comply�with sucn provisions or thls permit�shall be Geemetl revoketl. GasSCrvite Outlets WaterCloSEt � F.A.U. . In0.Solar�9-15'HP016-15+ CONSTRUCTION LENDING AGENCV� I hereby affifm that thele Is a Construction lendin9 a9ency fOr the pelformdn<¢ Int¢fCEptOfS Wdt¢f H¢dt2f FixtUf¢5 of tho work 1or whiCh fhis permlt is issuetl (Section .309] Civ. CJ � MiCrOWdv¢ �entler's Name � Kitchen Sink Water Service ' Device Boxes Pole Light Lentler's Atltlress - • Lavatories " ' " -" OWNER BUILDER DECLARATION ' � ' ' OutlEts Range , I hereby a(firm that I am ezempt from the Contractor'S License Law tor the p—T�a - followin9 reason (Section 7031.5 Buslness antl ProT¢sslonal Cotle: Any city or P ' - Switches Sign� county which requires a permit t0 ConStruGt, ali¢r, improve, tlemollih or r¢pair any stluclura, pflol to It5 ISSudncB, atso fequlles tha appliCdnt fOr such pefmit ROOf Df21f15 CidfbdgE Di5p0581 .Stdnding SCC[iOnS to /ila a 519netl stalement that ne/she I5 Iitensetl pursuant to the provisions of . the Contractor'S License Law (Chapter 9(commencing with 5ection 7000) of 'Sion 3 of the Busine55 antl Professions Cotle) or that he/she is enempt Generator'OP5 KW �5-15 KW �� Trash Compacror •bom anU Ne ba5i5 f0/ the allegetl exemption. Any viOlation of SecUon 1.5 by any aOP��ant for a permit subjects Ihe applitant to a tivil Reinipec[ion Fee �� $$5 Issue Fee $ 3 'G �� • � -� nalty of not mOre than five huntlretl tlollar5 ($500). " I, as owner ot the property or my employees with wages as their soie MECHANICAL Reinspection Fea $y5 .�ssue Fee � ' S 3 compensation will tlo tne work, anE tne structure Is not Intentletl or otteretl � FEES for sale (Secllon 7044, Business antl Protessionai Coae: The. Contractor's PUBLIC SERVICES REQUIREMENTS: - � � • Ucense Law tloes not apply to an owner of a property who bulltls or Improves �Boiler HOod or � Type I ❑. � .� ' . - thereon, antl who Does such work himself/herself or tM1rou9n his or har own - ' ZoninB APProved 8y �� Date employ ees, provitletl that sucn improvements are not intentletl or offeretl for C2nopy Type I I ❑ . ,-- f . sale. If, �owaver, [he building or improvement is zoltl withln one year of com- ' Duct - Unde� Ground • Building Appmved By Date pletlon, the owner will have tne burtlen of proving he/she CIE not builtl or im- � - � � ' ' � �rove for tne purpose ot saie). , Duct - Structural . Refrigeration Sys[em Applintion Issued By ' Data LJ I, as owner of the property, am exUuSively contracting with Iicensetl con- ❑4100,000 BTU ❑ 100,000 BTU tractorst8 construcf the oroject ISecelon 70a4, Business antl Professions Cotle: Duct - Ventilating __ SUMMARV OF FEES - The Contractor'z License Law daei not appty to an owner of property who . , x .. . builtls or Imo�oves thereon, antl wno contracts tor such prolects with a con- Exhaust System ❑ Multiple ❑ Syztem Repair/Alteration BUILDING PERMIT $ SMIP;'^` �$ tracmr(s) II<ense pursuant to the Contractor's License Law). PLAN CHECK ' $� PERM�T ❑ I am exempt unaer Section . B. & P. C. for this reason Firepl�Fact. BIL ICBO # - PLUMBING $ ' �SSUANCE $ ' Date � ' Owner Heating.System & Ducting E ' ENERGY P.C. $ ' �0.100,000 BTU �100,0006T PU1N CHECK 25% $ .I hareby certify tnat-I have reatl this application antl state that the abova � Intormation Is torrect. I agree to mmply with all city.antl county ortlinances If1GOmP 8 e ' ' ELECTRICAL $ ?3.�i� GRADWG $ antl-5tate laws relating �to builtlin9 construction, antl hareDy authorize re0re- � 2� ti0 � MICROFILM $ sentatives of this c' t ter . upon the above-mentlonetl ropert for ; � • , St LAN CHECK 50°6 $ Inspactlon pu C��O � � ' � MECHANICAL ' $ / �O Slgnature ' ' ate� ,l e - TOTAL FEE $ {D • . Drivers• Licensa r 55 $ Reinspec[ian Fee $25 � - Y�ue Fe'e� �- $ 3 � PL N CHECK 25% $ .. CMF0865-46 rev.12/83 White-Builtlin9:Canary-Appllcant;Pink�-Acmunting;Goltlenroa-AsSessor � � - " ' ' r� , � CONSTRUCTION AND PCANNING ' POOL 'PA - , � APPROVALS Permii-#� - Date Inepector qppROVALS Permit# ' Date��.lnspecror � 1. Temporary Electrical SerJice or Pole - - , - 52. Pool & Equipment Location � � .` � 2. SoiLPipe-Undrgrnd. ' 53. Steel Reinforcement . � - 3. Electrical Conduit Utility-Undrgrnd. 54.' -Forms �_ � 4t Electrical Conduit•Undrgmd. � 55. Electrical Bonding �- - - r. 5, Steel Reinforcement ,_ � 56. Rough Plumbing & Pressure Test - 6: Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE' ' '� 7. Footings � � , - _ . 58. Electrical Conduit-Undrgrnd. . 8. Foundation • , � ' - �59. Gas Pipe, � Undrgmd., Test'� . � 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, O Undrgmd. _, ' 10. Structural Floor System � 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal - � � 12. Sewer Cap , � 63. Heater & Vent-Final ' . - 13. Roqf Drains �- " � 64. Ptumbing Sys[em - Final � 1"4. Rough Plumbing � 65. Electrical-Final � 15. Rough Electrical-Conduit '. � , 66. Solar System-Final � .-� .- �' � � 16. Rough Electric Wiring: � y�� 67. Fencing & Access Approval � -- 17. Rough Wiring Sign.� • 68. APPROVED FOR PLASTERING 18. Rough Electrical-T�Ba`r Ceiling ; 69. POOUSPA SYSTEMS FINAL � . 1�9.'Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace , APPROVALS Permit # � � I� 21. Ducts, in Structure 70. Underground Hydro _ � � 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil � � 23. Gas Pipe-Rough & Test . ' 72. Underground Flush � � � 24. Roof Framing, � 73. Undergrnd.StorageTank OGas ❑Oil' . , 25. Roof Sheathing - � 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat -- 75. Dry Chemical - � �. ' 27. Frame and Flashing . i � 76. Dry Standpipe � �> 28. Lathinq & Siding �. � 77. FIXED SYSTEM FINAL - - �' n = 29. Insulation � ' ' � � � ' 78. FIRE PREV. FINAL ' � 30. Drywall Nailing . � HEALTH DEPT. REQUIREMENT �7 �"'; ' 31. Plaster Brown Coat 79. FINAL INSPECTION �_ c�, 32. Electrical Power Meter-Ffnal � 80. FOOD CERTIFICATE ISSUED ?' • 33. Final Electric Notes: V� � 34. Final Heating &�Air Conditioning �� ' 35. Final Gas Aipe-Test . �� . � - � . - .' 36. Hood or Canopy , ' . . . � 37. Final Factory Fireplace . � .. - �_ 38. Final Plumbing , � . . � � ' 39. Water Service-Final ' �°� . .. . . - . 40. Gas Service-Final � _ , � � ' , 41. Solar pomesticFinal . : � - - � . ' � 42. Backflow�Prepenter i .� .. E X P I R E D ' , 43. Backflow Irrigation� - � 44. �Landscape Irrigation System . � I�atB �g 45. Sound A[tenuation' ' . � � . - � �. 46. Handicap Regulations � . � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ' � - � �' �' 49. ElecVic Release to Edison j � , � � 50. Gas Release to Southern California Gas Cv � � � ., 51. CERTIFICATE OF OCCUPANCY ' ' No. � -' - � . � Date� � . - J . � ' Applieant lo fill In all iDaces ezeept t�ose within heavY �orCer lines anC sign all aOPropriate Eeclarations. OF COSTA MESA STRUCTION PERMIT Project Addre55 '17 � W �4 4�T� � . . � Applicant's Mailing Address : - � Owner'sNam �]N�ll�1l�-��F � Phone� �uV4'�%! Addren �Cid �7�/QCdL'r t�lifLt 4N''YV'Q�`'S.. �iJc�%t� . ArchlEng..� r)!i'+* ��"� • License No. G" 5 �2'8 � . b Addreu T� � Contractor's Nem hane Address (meiling) Ciry License No. . LICENSED CONTRACTOR DECLARATION - � ( hereby aftlrm Ihat l am Iicansetl untler provislons of Charter 9(commenUng ' wlth 5ec[lon 7000) of Divlsion 3 of the Businasz antl Professlons Cotle, antl my Iicensa is in (ull for<e antl affect. ' � Gcense Class llcense No. � Date Si9nature � ' wORKERS' COMPENSATION DECLARATION raby afflrm that I have a certiflcate of consent to self-Inzure or a certillcate Norkers' Compen5ation Insuranca, or a certifletl coDY t„ereof (Sattlon ,.,,00, lab. G.) Policy No. Company , BCertlfletl copy is hereby turni5hatl. . � � Certifled copy is filetl with the city Builtling Divislon, Date APPlicant • EXEMPTION FROM WORKERS' COMPENSATION DECLARATION , (This section neetl not be completetl i! th permit Is for one huntlratl (5300) or Iess). I<ertlfy that in the performance o} t � ork /or which this perm�t Is Issuetl 1 shall� not a ploy ny person in any � nner so to emme �ect to t�e Workers' C m en n Laws of Call r Data Si9natura Workers' Compensatlon provliions oi tna Lnoor coae, you musc wrtnwim comply with such provisions or this Oermlt snall ba tleemetl revoketl. CONSTRUCTION LENDING AGENCV I nereby affirm that there is a con5truction lentling agency for the parformance of the work for whlCtt this permlt I5 Issuetl (Sectlon 3097 Clv. C.) Lentlar'S Name � � - Lentler's AtlCress OWNER BUILDER DECLARATION � I nereby afTlrm that I am exampt from the Contractor's License Law for the followin9 reason (Sactlon 7031.5 Buslnass antl Pro7esslonal Cotle: Any city or cnuntv wnlch rea Wres a oermit to ConStrUct, alter. Imp/ovB, tlemolish or re0dh j'.5 by, any appucant tor �a perm�[ suo�eccs me appncam co a avn alty of not more than fiva �untlretl tlolla�s (E500). I, as owner ot the proparty or my employees with wa9es as thelr sole ipensatlon wlll tlo the work, antl the structure I5 not Intentletl or of/eretl sale (Sacflon 7044, Businass antl Professlonal Cotla: The Contra<tor's anse Law tloes not apply to an owner of a property who builtls or Improvas �eon, anE who tloes suth work hlmself/harsalf or Ihrough his or har own oloy eez, provitlatl tha[ such improvements are not In[enEetl or offeretl tor If, however, the bulltlin9 or improvement is soltl wlthin one year oT com- :Ion, the ownar wlll have the burCen of proving he/sne tlIG not bulltl or Im- ve }or tha purposa of ule). 1, as owner o/ the O�operty, am excluslvely contracting with Iitensetl con- :torstd construct the projec[ (Sactlon 7044, Buslness antl Pro�essions Cotle: i Contrattor's Llcense Law Uoes not apply to an ownar o/ property who Itli or Improves thereon, antl who contracis for such pro�ects with a con- :tor(s) Iicanie pursuant to the Contrattor'S License Law). 1•am exem0� untler Section B. & P. C. /or lhis reason Date � Owner 1 herebvi certlf�at I have-reai � I Si9nature - , _LOrivers'�Llcense or 55 ""-'^^"-<6�Bv.12/83 WhItB-Bulltlln9� �_ TYPE OF CONSTRUCTION NEW ADD ALTERATION LI RE - � Bs i�2o ,�� 7n PAIR ❑ CONVERSION ❑ �EMOLI ❑ OTH��,w DESCRIPTION OF WORK � 'SE �C/ � L�N ��T AT ,�sF.e ; A�fsLt�SA� _ o�a�' i,v TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ P�.VMBING ❑ MECHANICAL ❑ OTHER PRQIECT DESCRIPTION 5�. F7. oCCUPAN v ' CONSTRUCTION TVPE VAlUAT10N $ D ZONE GRADINGGU.YDS. ACRE$ Remarks: , abova 1- mnces L fap10- r v tor 1 Bar Sink ' Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher � Drinking Founteins Floar Drains Floor Sinks Gas Service Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee L, hv —,v � C. " Z - PLUMBING FEES ShoWers Service Sink � Sewer Cap Sewer Connection Solar Collectors �:Soler Piping .�Solar Tank '�Swimmin9 Pool w/Spa Urinel Outlets Water Closet Wacer Heater � Water Service Bailer Duct-UnderGround Duct-Structural � $25 Duct: Ventilating , Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO �k Heating System & Ducting ❑P700,000 BTU 0�700,000 Heinspection Fee - AVPllcant; Pink - Accounting; Goltlenrotl - Assessor $25 laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑6100,OOOBTU ❑100,000 System Fiepair/Alteration , laue Fee $ 3 $ 3 A.P. # � _ S Main Buildin9: E T FrOnt A Rear C Right g Lef[ Ping. Ref. # Parking Req./Provided Use of Building: Planninq Notes: Automatic Washer Construction Pole Sub. COoking Unit Dishwasher . Dryers ❑Gas ❑Elec Fan F.A.U. : Fixtures Device Boxes - Outlets Swimhes, Garba9e Disposal , Generator �65 KW C w ..- � �``.v� ' ' � ;�i..: ---_ � � a � Accessory Building:- _ �ri , `.riC. V`1�i.i.JiU - � -: u 1y� .. I Park.Fees $ . ELECTRICAL � Trensformer ❑ 15-50"KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over100amps Su6 Panel ' � Motors�0-1HP�1X-I — InaSolar 09-15 HP �1i ' Microwave Pole Lighl , � 5+ .Standing Sections 15 KW � Trash Compacmr ^ ' • � 325 laue Fee � $ 3 � PUBLICSERVICES RE�UIREMyErN�TS�: ' -" 1 � 2oninp APProved BY '- �J�.-b�y/�� at � �� Building Appiaved By- j ' �ate Appliption Iuued.By � � ' �ete ' - . SUryp�M� R�V.. �OF FEES - D' BUILDING PERMIT- $ � •�LL SMIP ; $ D•7� �. �yqL. PLAN CHECK � $ 7• 80 pERMIT ' - �PLUMBING $ ISSUANCE $ � PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL . $ GRADING $ ' PLAN CHECK 50%.$ MICROFILM $ � / "� MECHANICAL . $ TOTAL FEE $ SOy '.' . PLAN CHECK 25%': $ O N I N G R E � U I R E E N T ONSTRUCTION.AND PCANNING . POOL 'A __ . - � - _ � APPROVALS ,� Permit# � 'Date �Inspector qppROVALS Permit#' Date Inspector�. �" � 1�.� Temporary Electrical Service or�Pole 52. Pool & E ui ment Location � �' . i . ,, , . 9 P - . �� 2. Soil Pipe-UndFgrtid. . - . . - � 53. Steel Reinforcement ' � - ! � � 3: Electric��l Conilu i Utility-Undrgrnd. 54. Forms - � " -� 4. Electrical Eonduit•Undrgrnd. � ' 55: Electrical Bonding " ,- , 5. Steel Realnfor�err�onf � � � -� �� 56. Rough Plumbing & Pressure Test ' � �• ' . �`� , ' , yy.I; 1 _ .. 6. ElEctrical UFER-Gr�d. � � 57. APPROVAL TO COVER-GUNITE � ' ' y�.-; 7. F.poting'S '� � F' , . 58. Electrical Conduit-Undrgmd. " ' - ' 8. F6undation , ��i � '' 59. Gas Pipe, O Undrgrnd., Test' _. �--' �� 9. Water. Pipe,Undr,�rri�l. . , : 60. Backwash Lines, P-Trap, � Undrgmd.. .� 10. Structural Floor Syitem �- - ' 61. APPROVAL TO DECK � - 11 . Property.SewGr .•ine & House Connection , 62. Backwash & Receptor-Final • • ' ' � 12. Sewer fap; �i ';� , ' - � 63. Heater & Vent-Final � • . , 13. Roof Drains tit�. �ti � 64. Plumbing Sys[em - Final � �_ � 14. Rough�Plumbing " = 65. Electrica6Final - � - - 15. Rough Electrical-Conduit -'. . - 66. SolarSystem-Final �; � ' ' 16.`Rough Electric Wiring : � 67. Fencing & Access Approvai � . - - � " 17t Rough Wiring Sign-' - 68. APPROVED FOR PLASTERING �- � +18:.Rough�Elgctrical=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, Vehtilating ,�''�' ' � 71.� Product Piping OGas ❑Oil � � 23..Gas Pipe-�?ough & Test ' .., 72. Underground Flush 24:�_Roof Kraming'%4� `� �1 �� ,\ 73. Undergrnd.StorageTank �Gas ❑Oil 25. ,Roof Sheathing ' '� � b i ' � �yt, 74. Overhead Hydro 26: �T-Bar Cejling (Structural) &'Monocoat , 75., Dry Chemical - ' �� 27. F�ame,9nd Flashing ', � 76. Dry Standpipe � 28. ;Lathing'.�,Siding ' 77. FIXED SYSTEM FINAL � ' 29. tlnsulation - - ' - � 78. FIRE PREV. FINAL � � � 30. Drywall Nailing ".j HEALTH DEPT. REQUIREMENT � 31. Plaster:Brown Coat,;: 79. FINAL INSPECTION 32. Electrica4Power Mete"r=Final i 80. FOOD CERTIFICATE ISSUED : 33. Final Electric � � ' Notes: � � �{-3- us S 7- Co Sv r 34. Final Heating & Air Coriditioning 4 Z�('S`i � I 7H fF 35. Final Gas Pipe-Test �� . �' � � ' � 0 TN O . 36. Hood or Canopy' � �� --�� - - - '� � 37. Final'Factory Fireplace, ' ' - _ 38. Final P,lumbing � - ' � � av n 39. Water Service-Final�' _ �� y�� Zy 40. Gas Service-Final � �•I 41.SolarpomesticFinal . . � . . -- y! �RL �� o�/� ,cU o� 42. �Backflow Preventer � , • _ G,�, • ' 43. Backflow Irrigation � . " 44. .Landscape Irrigation System ; . _% t � � 45. Sound: AuenLation� _ � � � � � � . 46. Handicap Regulations �� , �� o � 47. FINAL STRUCTURE & BUILDING � D� �Y vge 46. Special Requirements Completed� _ � ' 49. Elec4rie Release to Edison � . . � ._ ', ' � . 50. Gas Relea'se to Southern California Gas Co , � • �' 51.CERTIFICATEOFOCCUPANCY�� - ' - ��` INo. - . Date _ . . . - • � . I Applicant to fill (n all spaces eacept I�ose CITY OF COSTA MESA � ' � '� . CONSTRUCTION PERMIT ' ' Project Address u' T ' � Applicant's Mai�`�iq' yAd�dress 1� � , Owner'sName �`�'� "—L�N��r�� Phon �� Address, � ' : ' � _ r�22� Arch/En9:.�� '�'�' A 3-O t License No. Address �G L/a �iFG ��1'C�'"�—" �r' �-a"'T� Contractor's Nam �1� ' �'�Phone Address,lmailing) , . _ Ciry License No. , LICENSED CONTRACTOR DECLARATION I hereby.atfirm that �I em Iicensetl untler prov75ions of Charter 9�(commencin9 with section 7000) of DivlSion 3 of the Buslness ana Vrofe55ions Cotle, antl , my Iicenie�is In fuil force antl.effect. ' ' ' License Class License No. Oate Si9nalure , �'ORKERS'COMPEN$qT�pN DECLARATION p�q ptreby aftirm tnat I have a certlticate o( consent lo Self-Insure or a certificate :�.;f,^Norkers' Compensd[ion Insurance," or a certttted copy l�ereof (Sectfon _�UO, Lab. C.) . , ' Polity No. Company CertifieE <opy is hereby furnishe0. Certifietl copy Is filatl with the city Builtling DIVISion. Oate Applicant . EXEMPTION FROM WORKERS' COMPE ATION DECLARATION (Thizsection neetl not De completetl H the eimi[ Is (or one hundretl (5300) or less) 1 ce�tify [hat in [he pe�to�manca o( Ihe o k fo� whlCh [his pe�m�t i5 issuetl, I shalb not employ any.person In any a er so as come subject to the Wo�kers' f e P q�w5 Of Calit r . Date __J��_Si9nature �. NOTICEelf,iafter aking this tl¢Clata sh I b me� Subjecl to the Workerz' Compensation provisions of fhe bor Cotle, you must (orthwitn compty witlt such'pYovisions or tM1is permit snall' be Ueemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby af(irm Ihat thare is a wnstruction lentling a9ency for tha performance of the wark for which�ihis permit is issuetl (Section 3097 Civ. C.) Lenaer's Name Lender's Adtlres� OWNERBUILDER DffCLARATION ' � � hereby atflrm that I am enempt from the Contractor'S Licensa Law for tha following redson (Section 7031.5 Business antl Profe55ional CotlO: Any city Or county which rtquires a permit to COnstru<i, alter, improve, tl¢molish Or repair any structura, prlor [o I[s issuance, also requlrei tho appliwnl tor zuch permit to 1lle a Si9netl statement that he/sha is Iitensotl pursuant to the provislons of the Contractor'S LlcenSe Law (Chapter 9(rommencing with SecHon �000) of �-•Ision 3 of the Buglne55 antl ProfessiOns Cotle) Or that h¢/she i5 exempt efrom antl tne baSis tor the allegetl exemption. qny violation' of Sectlon .1.5 by any applicant for a permit subjects the SpD��< <o a civil nalty of not more than tive huntlretl tlollars (5500). -� � 1, as owner o( thb Vroperty or my employees with wages as their sole wmpensation, will Ao the work, antl the structure I5 not intenCetl or offeretl for ule (Section 7044, Business antl• Professional Cotle: The� Contractor'S License Law tloes not applY to an owner of a property who builtli or Improves tnereon,�antl wno �aoes such work hlmself/herseH or tnrough his or her own ¢Tployee5, pYovltletl thdt such improvements are nOt int¢ntlBtl or offeretl for ule. It, however, the builtlin9 or Improvemant Is zoltl within one year of com- pletiOn, tha owner wlll nava the burGen ot proving he/she tlitl not Dulltl or im- �fove for the purpose ot 5ale). I, as owner ot the property, am excluzively contracting with Ilcensetl con- trattors tb construct tAe project (Section 7044, Business antl Rofessions Cotla: The Contractor's License Law doe5 not apply to an owner o( proPerty wh0 , bullas or imoroves thgreon, antl who contracts for sucn projects w�th a con- Vactor(s) license pursqant to the Contractor's Ucense Lawl. , ❑ I am exempt untler 5¢�(ion B. 6 P. C. tor this reason Date - Owner • ' I hereby.cerUty M ��nave�reaa [his application antl state [naEthe above , In70/matlon Is Co�� ct,/I ag�ee to cOmply with all city antl countY artl��ances ann'state laws rel tino to bulltllnYionstwction, antl hereEv authprl�e rffpre- /79/G2loG$' 2 TYPE OFCONSTRUCTION ❑ CONVERSION ❑ DE • DESCRIPTION OF WORK �eavy Oortler Ilnes antl si9n all a JO. LOT NO. �l�%Ux .fdar- 7 a / aeclarations. J REPAIR TVPE OF PERMIT' LI GRA�ING LI FOUNDATION LJ STRUCTV RAL ❑ TENANT ❑,ELECTRICAL ❑,PLVMBING ❑ MECHANICAL �'�OTHE(3 � � � ' PROJECT DESCRIPTION Sq. F7. ' � OCCUv,arvCv� CONSTRUCTION TVPE VALUATION S 20NE � : GRADINGCU.VDS. ' 'ACRES_ Remarks: � � " �%j .� / / ?� ff' C^ , . , . Bar Sink Backflow Preventer Backflow Irrigation Clarifiers o�:n�:ne� Drinking Fountains Floor Drains Floor Sinks - Gas Service Outlets Sink Roof Drains Shawers Service Sink - - " Sewer Cap Sewer Connection � Solar Collectors ' Solar Pipin9 Solar Tank Swimmin9 Pool w/Spa Urinal Water Closet Water Heater WacerService Reinspec[ion Fee � $25 � � Issue Fee ' � $ 3 Boiler Duct - Under Ground Duct - Structurel Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/fact. BIL ICBO # •, Heating System & Ducting 06100,000 BTU � 100,OOOBT Si9na[ure �' / \ uate�lt� ' I I peinspec[ion Fee D i s' Ll<e s CMF 0865-46 rev. 12/$ White - Bulltlin9: ��ary - Appliwnt; Pink - Accounting: Goltlenrotl - Assassor $25 Hoad or Typel ❑ Canopy Type I I ❑ OO,OOOBTU ❑100, :m Repair/Alteration Issue Fee � � $ 3 ' , .. A.P. dh S Main Building: E � ., . , T Fmnt - � A Rear ' C. Right K Lett S Ping. Ref. # Parking Req./Provided UseofBuilding: � Planning Notes: �� ,Automatic Washer � Consbuction Pole. . Cooking Unit .. . Dishwasher Fan F.A.U. Fixtures Device eoxes Outlets Switches Garbage Dispoul Generator �45 KW 05�15 � 7850 4/02/84 Zone Park.Fees $ � n 23.00 TL 2 O � N I N . G : � , . R � Q . U � ' I R E � E • T ELECTRICAL ' Transformer ❑ 15-50 KW � ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps { Sub Panel . ' � Moror5�0.1HP01X'-8� > Inc.Solar �9-15 HP �16�15+ � Microwave Pole Light Fiange � Si9n Standing Sections � Trash Compactor ES ' � Reinspeaion Fee I$y5 � Issue Fee I $ 3. I PUBLIC SERVICES REDUIREMENTS: • , Zoning Approved ey Date Building Approved 6y ' � Date Appliption laued By % nat� 2 A� ' � SUMMARV OF FEES , BUILDING PERMIT $ SMIP �$ ' � PLAN CHECK $ PERMIT - � � PLUMBING $ ISSUANCE '$ PLAN CHECK 25% $ ENERGV P.C. $ � . ELECTRICAL $ � GRADING, $ � PLANCHECK 50% $ MICROFILM �$ ` MECHANICAL $ ��p7qLFEE $� � PLANCHECK 25% $ `��O'U . . , �3 � � •CONSTRUCTION AND PLANNING � . POOL �A �'%APPROVALS = Permit #m-��6 � Date � Inspector p�ppROVALS Permit # � Date Inspector _, i.; � . .. � � � 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2: Soil Pipe-Undrgrnd; � � �' 53. Steel Reinforcement �' � 3: �lectrical Corid'uit Utility-Undrgrnd. ' 54. Forms . � � � - �, 4. Electrical Conduit-Undrgrnd_ . " 55. Electrical Bonding - _ . � � . 5. Steel Reinforcement - � 56. Rough Plumbing & Pressure Test ' 6: Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE . 7. Footings � � ' � 58. Electricaf Conduit-Undrgrnd. � 8. Foundation '�� ' 59. Gas Pipe, � Undrgmd., Test - � . 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd. . 10. Structural Floo� System 61. APPROVAL TO DECK � � � 71 . Property Sevter Line &�House Connection 62. Backwash & ReceptorFinal . ,� 12. Sewer Cap �i ', , �63. Heater & Vent-Final ' . 13. Roof Drains�., � , 64. Plumbing System - Final - � 14. Rough Plumbing' � 65. Electrical-Final - � � 15. Rough Electrical-Conduit , � � . - �� ,- i � - 66. Solar System-Final , �- "�,--' � 16. Rough: Electric Wiring � 67. Fencing & Access Approval �., -- � � 17. Rough Wiiing Sign' 68. APPROVED FOR PLASTERING ' � 18. Rough Electrical-T Bar Ceiling 69. �POOL/SPA SYSTEMS FINAL � 19. Rough Fieating & Air Conditioning � c�rb� �j� FIFiE DEPT. REQUIREMENT '� � 20. Rough-Factory Fireplace � APPROVALS Permit# � �� 21. Ducts, in Structure - � � � 70.. Underground Hydro .. � ' 22.. Ducts�,Ventilating :4 71. Product Piping O Gas � Oil ' 23: Gas Pipe-Rough & Test � 72. Underground Flush ' 24: Roof F�aming , _ 73. Undergrnd. Storage Tank' O Gas. � Oii= � � 25. Roof Sheathing , � 74. Overhead Hydro � ' 26. T-Bar Ceiling (Structurap & Monocoat � � 75. Dry Chemical 27.� Fcame and Flashing �' . 76. Dry Standpipe . . - 28. Lathing & Siding ' , , 77. FIXED SYSTEM FINAL � � 29. InsulaYion - '' 78. FIRE PREV. FINAL ' - : 30. Drywall Nailing ' � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' � 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED - �_ 33. Final Electric Notes: . ' 34. Final Heating & Air Conditioning f 35. Final Gas,Pipz-Test ' � , � 36. Hood or Canopy ' - ; � - ' ' . . 37. Final Factory Fireplace - - - - - 38. Final Plumbing , � 39. Water Service-Final ' � � 40. Gas Service-Final ` • , . 41. Solar pomesficFinal ! ' � � � -- ' . � 42. Backflow�Preventer � � �� 1 43. Backflow Irrigation � - � 44. .Landscape Irrigation SYstem � � � ' �� j 45. Sound. A[tenuation , '. � ' 46. Handicap Regulations , ' � � 47. FINAL STRUCTURE & BUILDING ' i 48. Special Requirements Completed' , � i � ' 49. Electric Release io Edison � � � � � ^ 50. Gas Release to Southern California Gas Co �- � c 51. CERTIFIGATEOF�OCCUPANCY ' No. � '�'' �Date � .- ' - - -' . _ . . . . . . , . , AOP��cant to CITY pF COSTA MESA � ' . ; CONSTRUCTION PERMIT . . - ' Project Address W � �% � F+PP�icant's iling Addreu .'�4� g yA4i�y �C44w.if2BA-f . Owner's Nam ��-,6:pE%i �� hone G{� ��GQ � ) � Address r�'r � ArchlEng. Licenu No. Addr@Ss. � ' - � . Contractor's Nama Ska"✓� �a[✓��'� Phone Addrpu (mailing) ; '. � . . � , C'rty License No. � LICENSED CONTRACTOR DECLARATION ' I h¢raby a7firm that I am Iltansetl untler prOvi5ion5 ot Charter 9(comTBnCing with �«�on 7000) ot Divislon 3 ot the Business antl Professions Cotle, and my IIC¢n5G Is In lull fOrce antl B1fEct. • . � Ucen� �lass License No. - Date Slgnature wORKERS'COMPENSATION DECLARATION veby afBrm that I havo a cartliicate of consent to self-Insuro or a cerlifl�ate WOrkerS' CompBnsatiOn Insurdnce„ or a Certlfietl copy thBreof (SOCtiOn _,.00, I,.ab. C.) PoIICY No. Company ,� Certifietl copy Is hereby (urnishea. ' Certifietl copy is filetl wit� the ciry Builtlln9 Divlsion. , � �. Ddte_ Appli<ant EXEMPTION FROM WORKERS' COMPENS TION DECLARATION (Thiss¢ction nootl not be tompletetl if tne p mit is for ona huntlretl (5300) or Icss) I certify tnat in Ihe oarformante o( tne 10/ wnlCh h15 pCr �t Is ISSuOtl I shail not e loy an porson In any m so as oma ubjntt to t�e Wo�keK' S ws ol CalitO/ Date _ �_Signature NOTIpE: N,�af[er making this tletlaraUon, you shoultl be< e subject to the WOrkp/5' COfOPenSdtiOn Pfoviilons ot thC LdDof COtla, yoU mu5t foftllWlth comply witn such provizions or ihis oarmit shall be tlaemed revokea. , CONSTRUCTION LENDING AGENCV I hereDy aifi�m tM1at therG is a const�uction I¢ntl(ng agen<y for the perfOrmance of tqe wOrk (or which�Ws permit is IsSuetl (Sectlon 3097 Civ. C.) LenEpr'S Name ��; �0. I..entl¢r's Atltlrass OWNER BUILOER DECLARATION I ho�pbv atflrT tndt I am exempt f�om thu Contreclo�'S LIC¢nse Law for the ,a.5 oy any appl�cant ior a permrt suO�ec[s ina appuCani io a avu �nel�y ot not more thdn fiva hunOretl tlollari (5500�. �, as awner ot the property or my emPloyees with wagas as thalr sole compensation, will Co the work, ane the struclure is not IntanCetl or o/faretl for zxie (Sectlon 7044, 8usfneii antl P�olessfonal Cotle: The Contractor's Licenu Law tloes not app�Y to an owner ot a property who Ouiltls or improves thereon, anC who tloes such work hlmself/herself or through hit or her own amploy eas, prov106tl that such Improvements ara not IntentleE or offeretl for salo. 1(, �owever, the bulltling or Improvomont Is soltl wlthin one year o/ com- pletlOn, t�o owner wlll have th0 burtlen Of prOving he/Sho Cltl not build or Im- �rov0 for tho purposa of ule). �, as owner o1 the property, am ezclusivaly tontracting with Iicensetl con- Vactbrs tb wnstruct t�e project (Sectlon 7 Business antl Rolazslons Cotlo: T�e Contra<tar's Ucense Law does na pply to an owner oi property who bulltls or Improves thereon, anC w�o nt cts for such projects with a con- tractor(s) Ilcensa pUrsuant to the Cont 's License Law). ❑ 1 am exemot untler Saction �& P, d. for this reason Data " � � - � /'� Owner n all Spdcef except tTow wit�in �eavy EorEer Ilnas anE sign all,approD��te Gaclaratbns. O. , TRACT NO. LOT NO. �, LD . � „ . YYYI 12"/b I I TVPE OF CONSTRUCTION N� . ❑ CONVERSION . ❑ DEMOLISH DESCRIPTION OF WORK TVPE OF PERMI7 LJ GRADING • ❑.TENANT �ELECTRICAL -Q •OTHER PRQIECT DESCRIPTION Sq:FT._ CONSTRVCTION TVPE - VALUATION S � GRADINGCU.VDS. A( J ADD I.J ALTERATION LIREPAIR OTHER" � ' � � .�FOVNDATION LISTRUCTURAL �PLVMBING Q MECHANICAL � r Remarks: - . � ' u 8ar Sink 8ackflow Preventer ' 8ackflow Irrigation Bathtubs Clarifiers Dishwashar Drinking Founteins Floor Drains Floor Sinks Gas Service Outlets �nterceptors Kitchen Sink lsvatories P-Trap � Aoof Drains Reinspection Fee $25 Duct - Under Ground Duct - Structural Duc[- Ventileting Exheust System ❑ Multiple FirepUFact. BIL ICBO # Heeting System & Ducting ❑6100,000 BTU �700,000 Drivers' �I<nnsa ar 55 I I Reinspeetion Fee •I $Q5 CMFO865-46 �av.12/83 ApplicanqPink-AccounUn9;GOltlenroE-Assessor - 0 Service Sink '-' ' Sewer Cap Sewer Connection Soiar Collectors Solar Piping Solar Tenk Swimming Pool w/Spa Urinal Water Closet Water Heater Water Servica Isue Fee $ 3 Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System Oaioo,aooeTu ❑100,OOOBTU 3 System Repair/Alteration e�a. orc��f i JP� I� . Issue Fee E 3 A.P. � S� MainBuilding: E T Frant • ARear C Right � S Left Ping. Ref. � . Parking Req./Providetl Use of Building: Plenning Notes: Automatic Washer _ Cooking Unit Dishwasher Dryers OGes ❑I Fan F.q.U. Fixtures ' Device Boxes Switches Garbage Disposal Generetor �0.5 KW 6671 �'4/ 1.6/84 , b2.25' TL i , - -. IZOne �. NCcessory Building: . Park.Fees $ � � - . ELECTHICAL , Transformer ❑ 75-50 KI ❑ 50+KW 5 KW F Meter Oup to �700 emps Meter �over 100 amps . Sub Panel �Molois�0�1 HP�1%-8 " Inc.Solar �9-15 HP �16-15+ �� Microwave Pole Light Range Sign Standing Sections Trash Compactor � Reinspection Fee I$25 I Issue Fee PUBLICSERVICESREQUIHEMENTS: � 2oninp Approved By 8uilding Approved By S3 " SUMMARV OF FEES � BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT , PLUMeING $ �� UANCE ,$ PLAN CHECK 25% S 2• S ENERGV P.C. $ ELECTRICAI $ GRADING S PLANCHECK 5096 $ �,., �— MICROFILM $ MECHANICAL � $ ��' �� TOTAL FEE $ Z' zs PLAN CHECK 25% $ N"� �I.� , • - Z O N 1 N G R E O U � H ''CONSTRUCTION AND PLANNING POOL �A - _ _ , ��j -��/� 'Date - Inspector � Date ; Inspecmr � APFROVALS � Permit # APPROVALS Permit # _ � •, . . " 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '<< i: - �. 2. Soil.Pipe-Undrgrnd.' � � � � � � 53. Steel Reinforcement . ^ >� � �` � ; 3. Hectrical Eonduit Utility-Undrgrnd. 54. Forms - . •�r�� 4�. Electrical Conduit-Gndrgmd; - 55. Electrical Bonding � 5. S[eel, Reinforcemeqt � - ' '56. Rough Plumbing & Pressure Test � , �� ,,y %� 6r Electrical UFER G�nd. , 57. APPROVAL TO COVER-GUNITE '�% •�-,� �, ,:. 7. Fnotings . " � _ , . 58. Electrical Conduit-Undrgrnd. ` ��. �,r� ; . � J 8. FDundation �� ' �'. 59. Gas Pipe, O.Undrgrnd., Test - .� .^ t - - 9. Water Pipe-Undrgrnd. � ; 60. Backwash Lines, P-Trap, O Undrgrnd, j";� �: . 10. Structural Floor $ystem � �,�; 61. APPROVAL TO DECK �'�', 11. Propgrty Sewer Line & House Connection :1' 62. Backwash & Receptor-Final i �� - 12. Sewei Cap - 63. Heater & Vent-Pinal . � 13. Roof�D"r�ain's � ' . , � - 64. Plumbing System - Final � _� ' 14. Rough.Alumbing � • � ' 65. Electrical-Final � � - ';d . 15. Rough Electrical=Conduit - - , 66. Solar System-Final � - -'- - . - r 16. Rough Elec[ric Wiring � � 67. Pencing & Access Approval �"` - 77. Rough Wiring Sign ' - 68. APPROVED FOR PLqSTERING ',18. Rough Electrical-T Bar Ceiling, 69. POOL/SPA SYSTEMS FINAI � � � 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 OGas ❑Oil ' • ' 1 � 23. Gas Pipe-Fiough & Test �' ' 72. Underground Flush ' �� 24. Roof Framing � � 73. Undergrnd. Storage Tank O Gas ❑ Oil _ , � 25. Roof Sheathing . 74. Overhead Hydro � � ' � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical _ - � 27. Frame and Flashing , • � , 76. Dry Standpipe _� �' 28. Lathing & Siding _•� 77. FIXED-SYSTEM FINAL � � .7 29. .Insulation �, � � � ' 78. FIRE PREV. FINAL . �• � � � � � `HEALTH pEPT. REQUIREMENT � ! . 30. Drywall Nailing � . ,�31. Plaster Brown Coat �� ' 79. FINAL INSPECTION , 32. �Electrical Power Meter-Final ' 80. FOOD CERTI�ICATE ISSUED �' - = 33. Final Electric Notes: ,y �� ;y � r 34. Final�Heating&'AirConditioning � o � � i -. � 35. Final Gas Pipe-Test � � �� 36. Hood or Canopy � - ' � - 37. Final Factory� Fi�eplace . � - ' ,' . � � � � 38. Final Plumbing � � , . � 39. Water Service Final ; � j_�:� � � � - 40. Gas Service-Final • ' � � " � � 41. Solar pomestic-Final ' , ' � � � , � 42. Backflow1Preyenteri � , 43. Backflow%Irrigation� �� . 44. Landscape Ir�igation SYstem - 45. Sound Attenuation � � ' � • 46. Handicap,Regulations , ! � � 47. FINALSTRUCTURE&BUILDING - � ' � 48. Special Requirements Completed 49. Electric Release to Edison � - , � 50. Gas Release ro Southern California Gas Co , . 51. CERTIPICATE OF OCCUPANCY - No. � .� :. � _ - Date - ' - � � � ,�� 20385 GOSTA MESA BUILDING-SAFEfY DEPARTMENT P. O. BOR 917 COHTA M68A. CALIFORNIA For Appllcant to Fill In Completely TYPE OR PRINT A�DRE58 W. 1 th St• COSTA MESA, CALIFORNIA Te�. ■ ARCHITECT D PTewport Hlv_d.' Mesa. Calif. �� X eb6$ 2� office EFT �y�� I RIOHT DESCRIPTION OF WORK NO.OP ROOMH 1 6TpR1E9 1 ■ EXTERIOR 1 X8RlBY ACKNOWLEOOe TNAT 1 N11VH RPAD TX�B APPLIGTION •ND BTAT6 TXAT TH8 �BOVB 18 COPRECT ANO AOq68 COM- PLY WITH �lL C�TY ORDINANC89 ND BTAiB LAW9 8 LATINO BUILDINO CONBTRU SIGNATURE OP �. PERMITfE AUTHORI2ED AGENT FnE/�E RECEIVED �1V0 S �OU�1 APF'�I �ERMR �bY � � 49�$ � LEOAL � �^ � DEBCNIYlION F-d �� I � � `� , � �6?� A. P. NO. I�! ' � NOTE: NO EAVE OVERHANG SNALL BE LEb9 THAN 90' TO 81DE @ REAR P. L. YARDS MPRO V ED MAIN BUILDINO VAR. SC YARDS APPROV ED ACGESSORY BUILDIN6 DATE a 80. P'1. b TX¢ AMOUNT BHOWN IINO¢R VALU.�TION 19 POR TX6 = PURP08E OP E9TABLIBHINO • P5HMIT PE8 ONLY. � VALUATION n �... N (J�J PERMITFEE S j Q � m 3/7 � w c c o il`i ` - TOTALFEE $�L� -:�. 26187 ^E05fA MESA BUILDINGSAFE(Y DEPARTMENT P.O. BOX 1200 COSTA MESA� CALIFORNIA 02E29 Far ApplitaM fo FIII In ComplNely TYPE OR PRINT wncaenn ��1 1 w 1�l�' S�" ' COSTA MESA, CALIFORNIA owr�en''CL��cbN '$. � UNc_A*1 wooR i-I l �% \�I`�' �' C�.bG�r a M� r�,s a " rrtY ranL 1/ C 1 U' w...±n — 'j3 :.. .1 c�.rt. � sr�re re�. o► DESCWPTIOW OP WORK I BUIlDINO SIZE BXTERIOR WALL Bt 3 c-n�v G tw �-� � '� �c i s�r n.i F 1 N6R6oY 11CRNOWLCOO[ TNAT.1 MAVR pYD ♦ND BTAT[ TMAT TM6 AG01R,1! CORR[CT A! PLY WITN ALL CITY O 1 App /TAT{ OYILDINOCONlTRY'� � �, 810NATURE /.� AVTHORIZ�D AO[N'[ SEP 23-66 00 597A}**�*18.00 ArPLICATION FOR PERMR BUILDIN� for OHIca Us� Only � 11[C[IR NO. _ �I ZONIN�i pP/� I NO.OF Y�[OIN � ruxs � ' eu�to�Ha� �l v i 1 f1oN��12 40 1 %� 1 N.�� T`�Pi(i ,. I �C� -- O 1! l� 7 io ewve overeHwNo aHwu ee �ase Tww YARCD MPROVCD MAIN BUILDINO VAR. �j iN[ AYOYNT �M< MIRPOGi OI ff VALUATIOfl' � s� � 7� ,, � � <U.B.C.pEQUIREM6NT) � YARDB APPROVHD ACCHS80RY BUILDIN6 � PT. \��' // � � �. � �� rr. rr. BET. MAIN Q ACCESH. BLD08. DATB a Ie FOR T11Q � Pi! ONLY. i z � �, Bp E u. � $. mo � � Custa Mesa Building Departrr►ent ��PpPLICATYON FOR PERIVIIT 1 � 1�11 EAST 20th STREET � a B��`D ��.� G..,� .,._ _ 9: . COSTA MESA, CALIFORNIA , rl � FOR OFFICE USE ONLY ' . FOR APPd.ICANT TO FILL IN rtece�pt o. Permit No. , naare�s8 7 `�'/ % / 9 �Sf � � �� 3 6 � CiOSt& MCS3� Ci8��01'IIl$ g�Re�ce�ive by. Date Rec'd. Date Iseue Nearest ' L(iGld � a � �.� d�f� /—/3=,�: CrossSt. OC /%'i Building f . Add�ess Maller ��a p� ,� �� , rs� 0 5,' ' Costa Mesa, California � � Address �% �%� (N �Ej rA � / Nearest � ' ' `y Tel. ,{� Cross St. • City `�c� f', / G .i��fQ,4�'v No.�,j%y/ / Zone �' I No. of�_Q� Type I Group� , Arohftector � Lic. Plans � � a I � Engineer �` No. ' Approved � b 7 oate � / 3-J Addresa ' - �" ' ' � CORI&ECTIONS \� �,,�t1 City Li_c,� � , � _ v+ �ntraCtor ��{l-/kN No. ' � � � Addreas W Y^I ' ' �� , Legal Lot �/V(�SR __ i , � ' �. Description � No. �fJ� I B�ock � Tract • i � (Attaeh Metesand Bounds) i ' � . � � No. of Bldga , . � � Size of Lot �j �X .� �JO I Now on Lot - '- " - � ' ' — - �--- ' - ' O Use ot /� I No. of Na. oi • , c• i� 70 � Existing Bldg. ,+'Jn ,.ryp,r, FamiliesJ I Rooms � � � SetbackLinefrom � � RearVard /33 � �-'- � ' � _Z Center ot Street J� Side Vard /�,G � y DESC ON OF WORH ��`�" L" r I `� New I Alteration I ! Addition �� Repair I I Moving I I Demolish I ° Bullding / i/ / No. of r Size � �� Rooms � Stories � 'rterior W 16 Rooi ,� ;verin9 �%/�.,�� I Coverin9 C/p�/�� Fn V�,� ilsc of New � Foundation �o t �.�te Building � �'1� �' �� 6 �,l� a -� Forms, Materials, h ' � � ^ � Under-Pinning � Frame: Fire Stops, —�— Bracing, Bolts Lath. (nt. . �.i hereby acknowledge ihat I have read this Application and state that the above is correct and agre2'to comp]y �ath. Ext. with all City Ordinances an�tate Iaws_regulating , building construction. Si nature ot Q�/ ) � J 'Q Plaster, Int. Pemittee •-� /-o��-�' . / 1f97%ZCI�� . -..� - Plaster, Ext. . • Authorized Agt. • Maunry�Reiriloreed Valuation Permit Fee $ e o„ ///�� Plan Check � / �• Bond Beam $ t,/ �G� Total � � � �Fee $ D � FINAL � Porm 20d G- lAf 12-53 � . � � C J 0 a` 1 � - % \ 1tl ' ' Strcet I � • ` "_ _, � � � PLQT,PLAN -- '_ . � . . �_. ' �. � �Show Iocation,and distanees irom . property line and between buildinga.. , -- -i. . . . ' �.. • i. i! '7�.. � , . . .. - , .��+ O o. o �. a ,.- . I . � - . _ .V . . ._ _ . ' " — ' ' �. ,, ,'�'�� 5842 ' x�rEE RECEIlIED COSTA MESA BUILDING. DEPARTMENT F� �j e� 3� ��-` �'9"�' p.0.8�X 31� COSTA MESA. CALIFORNIA �IP� FINANCE DEPT. FOR APPLICANT TO FILL IN APPLI'C:TA i`1VN'S�O'R'SPERMIT nooRE'ss � � BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY ' RECEIPT NO. I�O. OWNER i (+ {�, MAIL +� �. A C' I RECEIVEO BV D/�TE RECEIVEO D�TE ISSIIEi ,._. CITV \ Ci� ARCHITECT OR ENGINE AOD. .SI l. � F . O `� TNO.`_t �� ADD E155 / I �� ,J/ • ��c. COSTA MESA, CALIFORNIA n /'!O. FIRE ��• ZONE � ITV LIC. ZONE� ^' PO,N$ " T'YPI ADDRE55 � NO. LEGAL LOT �� OESCRIPTIOM NO. BLOCK T A.P. NO. �G V �� SIZE .� � NO.OF BLDGS. /'% OF LOT �� Ow ON LOT �� USE OF �_ EXISTING BLDG. $ETBACN LINE FROM . I* � � { c[rvica Ov sinE[r � O REAR YARD (j � - Y SIDE VARD RIGM7 l LEFT DESCRIpTION OF WORK NEW ALTERATION ADDITION � REP�. MOVING DEMOLISH BUILDING ' �} �(� � � NO. OF � SIZE v� i ROOMS STORIES E%TERIOR WALL (i00F COVERING COVERING USE OF NEW ' + ^ BUILDING Q 1�0� `-� G h � A . .. APPROVE �G //_ BV /rJ/i OATE C�� r CORRECTIONS CITY Oi= �� . �. SUB)ECT TO � I MENEBV �CRrvpwLCVa�e nAT MnVE REwo STaTE TR�T TME �80VE IS COPRECT wN0 /�GREE TO COMPLV WITM tLL CITV OROIN/�NCES 6ND ST/.T[ ��µ5 REGUL/.TING BIIIIOING CONSTRUG norv. f�`..J (''� yqLUATION i PERMnITTEE OF """'—` � �� _ g17, 9�0- AUTHORIZED � MESA ! t G PERMIT FEE S � PLI1N CMECK S � TOTAL FEE S ` � �SZ�1� w,