HomeMy WebLinkAbout910 19TH ST - Building Permits, 1
COSTA MESA BUILDING-SAFETY DEPARTMENT APPL[CA'I70N FOid S�'R[7L7iliR'A�l PERMIT 9,
yP.O.BOX1200 COSTAMESA,CALIFORNIA92626 ��"-- � -
RECEIVED PERMIT 11.1y � 514f 3
For Applicant to Fill in Completely — Use Ink Only ���
BUI�DING � �QST {h A.P. NO. -- �
ADORESS _ /
OWNER OR ADDRE55 v �, � • Sr
TENANT f �
UNIT OR
MAILING SPACE NO.
ADDRE55 � { O(/'C
TR ^ LOT � BLK.
��T� cbs e N�` -yso `
NEW ADD ITER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH
OwNER (�l. A.'G S
ADDRESS USE O /�VC✓ VAWES40_
ARCHITECT TEL. w { ���
OR ENGINEER f����
ADDRESS ZONE TYPbI{s/`� GFOUP
APPROVED /
CONTRACTOR D � BY DATE �,
ADDRESS
TEL.
CITV NO.
STATE CITV F�PPROVEDSETBACKS
LIC. NO. LIC. NO.
SI2E NO.OF BLDGS. (FROM C/LSTREET)
OF l0T NOW ON LOT ( ONT FT.
USE OF
EXI5fING BLDG. C. A/'(i�i
Separate permits are required for L SiDE , FT.
electric, plumbing and heating work. REAR ' Fr.
VSE OF G AND WORK TO BE PEfiFORM D PWNNING ACTION
DATE
APPROVED
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1 heraby ecknowladpe that I hova reatl thle appllcation entl sieta
[hut the above Informetion ia corroct ontl apree to camply with -
ell lews reBuletinp builtlinp eonrtructlon, entl I shell not amploy
any panon In vlolatlon of ihe workmen'e companaetion laws of
tho Steto of Calitornla. QC�O' �
1 hareby certify thet I am properly Iicansetl os a contractor unCar � 5�. FT. 0�
tha Siete of Cellfornia B�sineaa antl Profaeaions Cotla, Dlvlsion 3, TME AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, anC thet sueh Ilcenees era In full force antl effect, or I THE PURPOSE OF FSTABLISHING A PERMIT FEE ONLV:
am axampi from tha provieionsof the State of Callfornie B�sineu VALUATION PE0.MIT FEE E
entl Profasslonz Division 3, Cheptar 9.
�. PLANCHECK E ��
Sipneiure of p�
Parmittae 5 yl Q`� 7qX S �•�
or ,,,� C..l
AuNorizod AOent Date — TOTAL PAI D S �v
50 ; �TL
� f -.:
�osta Mesa Building Department
11t EAST 20th STREET
I _ � COSTA MESA, CALIFORNIA �
� I+'OR A.PPLICANT TO FILL IN
Buiiding � n/ O / �)_
Address { `1TitiL
Costa Mesa, California
Nearest
Cross St. �/���7}+ � ,
Owner y�L.Ot� � . ( 7.,c_�'a e71.c.t '
ress
_L.. City Lic.
Contractoe Y No. �.'a,
Address
Ha
Le I Lot
Description No. �' � � Block Tract,
(Attach Metes and Bounds)
No, of Bldga
Size oT Lot �.r/ �( j% Q Now on Lot
Useof � No.oi I No.�
Existing Bldg. Familles Roo
Seibaek Line from Rear Vard 5
center of street SS side vard $—
DESCRIPTION OF WORH
New I%/I plteratfon I I Addition
Repair I I Moving I I Demolfsh
Building No. oT
•e .'l5x, (�{g�Aooms � storiesi
.terfor Wall /}y-�-' Roof
T hereby acknowled
and state that the a
with all City Ordii
building constructio
5ignature oi
permittee �
Authorized Agt. �
Valu,ation
$ /D 3 £���
FORM Z�4 G-H 2M 5-54
�BPPLICATION FOR PERMIT
�� BUILD�LNG '�
�OR OFFICE USE ONLY
I ec ip� o. _ Permit N�o.
/�
Received by Da Rec'd. Date Issued
� f I�-z3tS
Building
Address
Costa Mesa, California
Oate
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.b I Covering nip,�,,.� APPROVALS
Foundatlon Loeation Inspector
Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
that I have read this Application tath. Int.
ve is rnirect and agree t0 rnmply Lath. Ext.
ues and State Laws regulating
�, ' ..,g� -� Plaster, Int
��
_ r. Plaster. Ext
Total yy
Fee $ � � �—� F
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� PLOT PLAN - - - . . - , . =. ^i : -- - -
� Show location and distances'from � ^� �"��' % � ' � � + ��
; property line and between buildings. . . ;�� , ..�n . - -
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. eOX 1200 COSTA MESA. CALIFORNIA 92626
M h� R��-I r� l��r
APPLICATION FOR STRUCI'URAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE PECEIVED DATE ISSUED
BUILOING O S
ADDRESS
- PERMIT NO.
OWNER D� A.P. NO.
MA I L ' BUILDING
ADDRESS D • ADDRESS
TEL. ��'s TR� 9^�• LOT 9L0 K
��T� e o sT �,g,(� NO.
CONSTFVCTION W A A P
LENDER
BRANCH
OWNER
ADDRESS VALUE
ARCHITECT TE�. SE S O
OR ENGINE R N
FIRE
AD�RESS ZONE TVPE GROUP
�/ � APPROVED
CONTRACYOR '� P Nl BV DATE
ADDRESS
TEL. Z�NE NO.OF USE OF NEW
CITV NO.
PLAfS BUILDING
STATE CITV VARDSAPPqOVED VARDSAPPROVED
LIC. NO. L10. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLDGS. (FROM C/L STREET)
OF lOT NOW ON LOT ROfYT FT. FT.
USE OF
EXISTING BLDG. S F
SBparate permits are required for �. SIDE FT. FT.
electric, plumbing and heating work.
REAR FT. FT.
USE OF BUI�DING AND WORK TO BE PERFORMED DISTANCE BET. � BEf. MAIN &
- MAIN BlDGS. ACCESS. BLDGS.
� VAR.�+ DATE
C.U.P.�W APPROVED
APPROVED
I heraby ack�owletlea thot I have reatl thle oppllceHon antl ctete
that the eba�e informatlon Is correct and aprae to comply with — —
all laws reguleNng buildinB conrtruction, entl I shall not employ
any perwn I� ��olation of Me workman'a eompenaallon lawe of
Ma STata of Cnlffornia.
1 hereby certify that I am proparly Iicensatl as a contracior untler SQ. FT.
tha Stete of Cellfornia Businesz anC Professions Cotle, Diviaion 3, THE AMOUNT SMOWN UNDER VALUATION IS FOR
Chapiar 9, a�tl that such Ilcensas ere in full force antl effact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ON�Y:
em exempt from She p�ovlslona ot the Steta of California Businass VALUATION PERMIT FEE $
end ProfasslO�s Cotle, Dlvlsion 3�hepter 9.
S(gnatura o R/�/�� ,�/ PL.°.N CHECK S
Pelmlttea� ��v v:�� � 7lJ� $ TAX $
v \
Auiharixed ABent TOTAL PAID E
� 1PPLICATION FOR A BUILDING PEP-'IT Q, P�
r�
BUILDING PERMIT NO. Eie<t.ica� m
Trac[ Block Lo� . Permlt No. �
Bulltling /� f� �7— . Plumbin9 �
Adtlross y�� G✓.CS %– �Y —j �iB5T1 �Gf/r , vermit No. � �e
Cro55 ��/��� Mechanital 6
Areaw{5T .Sf� Street O�QOV�� PormltNo. a
'm
Owner P�d– � L�s Type of Project: ❑ New ❑ Alter ❑ Atltlition M
AEtlress �O wQ �� ❑ Repalr ❑ Convert ❑ Demo ❑ Occupancy Pmt.
Clry � ,� ZI09Z(ea {j Phone �YG.-�r /{.�'. nsp. A�rea/
Architact/ � 2one' SPI. Pmt. No.
Daigner L�cens4 No.
Atlaress Setbacks '-' P/l Fronl C/L St. Street WiAth
Clty � Z�P Phone �'artls Le t igh ' ear
� ave ol. e i9 . .
« Engineer Ucens9 No.
c
ar ng Spaces epu re rov e overe
p, AtlGress
m City ZiP Phone Haiqht $�oles Fami�ly
� LICENSED CONTRACTOR'S DECLARATION Park Fees Ves Fee
m 1 he�eby affirm 2hat 1 em licensatl untl4r provisions of Cheptar 9 peQulretl No C.T. Ratelpt
L (commencing with Section �000 of Divis�on 3 ot the Businecs and Zonin9 ApProvetl BY: Da[e
♦. Professiona Cotl¢, antl my license is In full torce antl effect).
?� Licensa Clas Licansa Number
> Dete Convactor MISC.
� Atldress Propose0 Usa
of Structure
jy Ci[y entl Zip Phune
N CONSTRUCTION LENDING AGENCV
°� I herebV aftirm �2hat thera is a connruction lantling egency tor ihe
a pertormance ot the work for which this pe�mit ia issued (Soc. 3097, ��c. Type Cotle
' Ci¢ QI. Class . Const. Vear
y Lender's Name USE/OCCUPANCV SIZE S�. FT,
C Lentlar's Atltlress
� OWNER-BUILDER DECLqqqT10N "
r I hareby affirm that 1 am exempt from t�e Contractor's Licanse Law 1�
1O (o[ the followin8 reason:
n t� I, az ownur of the Oroperry, or my amp�oyeas with wa0es es their 2.
� �sole componsation, will do the work, antl the shucture is not
�t„ intendod or offered for sale.
� ❑ I, aa owner of the property, am ex��usivaly contracting with 3'
licensetl cOntractors t0 cOnstruct the project.
d ❑ I am e empt untler Sec. Q&GC for thiz reazon 4'
m �i—/�' b')
Q Oet Owner
E WORKERS' CO NSATION qECLAR TI Total Valuallon
� I hereby aftlrm that I have a certiticete ot consent to self-insure, Encroachment Permit Requlretl ❑ Yes ❑ No
or e cer[iticeto ot Workera' Compansatioq ��surance, or u certitieC
Cm topy theraof. G�ading Pmt. G�atling
y Policy No. Company Requl�etl ❑ Yes ❑ No Pmt. No.
�a ❑ Cartitied copy is heraby furnishod. Rough Gratlin9 �
G ❑ Certified copy Is filetl with Orange County, EMA. �
a Data qpp�i�a�� APprovetl by: Date
3
CERTIFICATE OF EXEMVTION
FROM WORKERS'COMPENSATIONINSURANCE Z
c
(This section'nead mt be mmple[atl ii permit is tor $100 or less). 3
I cartify [hat in the pertormance of the wOrk tor which this parmit is Q
issuetl, I shell not employ any peraon in e�y mannar so as to become �
subject to the Workers' Compensation Laws of Californie. PERMIT FEES
Dace Applitent
NOTICE TO APPLICANT: If, aftor making this Certitica[e ot SVuctural S Plan Check E
ExampUon, you should become sublect to [�e Warkeri Compensation SPecial
prOvisions of the Labor Cotla, you must torthwith comply with such Electrlcvl E ��VeSt 3
prOvisions or t�is permit shell be deametl revpkatl.
1 CERTIFV THAT I HAVE READ THIS ACPLICATION ANO STATE plumbin9 S
THAT THE ABOVE INFORM1IATION IS CORRECT. I AGREE TO
COMPLV WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTIpN, AND HEREBV AUTH- Mechanical E
ORIZE REPRESENTATIVES OF THIS CQUNTV TO ENTER UPON
T OVE MEN=IONED P P FTV FOF INSPECTION PUR- pre-Gratle
SE . i � InsPaction ' E
a u e t App icant or A nt � Pre-Gratle 5 Permit s
9 Rec. No. �ssue
��kf �l�l�/,� L/�'S
Print App icanYs/Agenl's eme
All specos within this box must be wmpleted to proees� Cneck By: Aperovea:
�
� 910 w. 19=�1 ST. (95�) ,
Completed �
;� � ...51463 s-aas�eac�o co�r-a�—IA �b_
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