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Home My WebLink About980 19TH ST - Building Permits� . p ' j L-� .. .� . � ..� � � T. � CITY OF COSTA MESA " ��` MF — BlIILDING DIVIS/ON _ Ft�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Faz (714) 754-0856 • wvnv.ci.costa-mesa.ca.us �� FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BX09-00236 PERMIT TYPE B MISC STATUS: ISSUED APN: 42253114 DATE ISSUED: 10/30/2009 Zoning: , ISSUED BY: JOB ADDRESS: 980 W 19TH ST CM - Suite/Unit Vicinity: Primary Occ: � ' 32� -' � � �, Const Type :?? SQ. FT: 439 Valuation: $7;076.68 . SCOPE OF WORK: , .. . _ , � 103 SQ FT L�ATTICE AND 336 SOLID COVER PAT10. TOTAL OF 439 SQ FT. ' OWNER: CHARLEY, GENE-A ., Address: 980 W 19TH ST � � CitylState: COSTA MESA, CA . Zip Code: 92627 Phone: APPLICANT; CHARLEY, GENE A Ciry/State: COSTA MESA, CA Phone: 9496777955 CONTRACTOR: ' Address: Giry/State: Zip Code: �.: ARCHITEC7: Phone ENGINEER: � Pfione C; !' `" FEE SUMMARY Building Plan Check:�. Building Permik Electrical Permit: - SMIP Residential - SMIP Commercial Bldg Std Admin Fund TOTALFEES Add�ess: �980 W 19TH ST Zip Code: 92627 Phone License No. L'rcense Mo. - License No. $99.61 $15325 $0.00 $0.71 $0.00 $1.00 . $254:57 - Unit Unit: t� _ Unit: J� Cell: ,,;i Oi�l1. -, r i `..^ . li' . Und: }"%: � y1 `;�NOT�CE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related ; Fegulations. (Ord. No. 92-28, § 1, 12-21-92) �' EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. .' INSPECTIONS: In order (or the work authorized under this permit to be considered legal, such work musl comply with all applicable codes, and all required inspections and final approval musl be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. CppEt, INSPE�770NTVPE URT� INTITALS CO�EC INSPEC110NTYYE D�TE INi171p15 In • ' 7616 Fixetl System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Relaining Wall 212 Final Fire Prevention '"''t 202 Final Factory Fire Place 220 Final Planning Approval 203 FinalSign 222 FinalSite '�204 FinalDemolition 250 FinalBuildincyOccupancy t'��1�� ' i''-. ��ii�t. ' .� WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty of perjury one of the following Oeclarations: ❑ I have and will mainlain a certificate of consent to self-Insure (or vrorkers compensation, as provided (or by section 3700 of [he Labor Code, (or the performance of �he work !or which Ihis permit is issued. ❑ I have and will maintain wnrkers' compensation insu2nce, as required by section 3700 0! Ihe Labor Code, for the pertormance of the vrork for which this permit is issued. My vrorkers' compensation Insurance carrier and policy number are: Carrier: (ih8 sedion neetl irol be wmdefetl d f�e perm� is valued af one hundretlCWlars (Sf 00) or less ) Policy Number: • I certify �hat in the peAormance of Ihe work for which this permit is issu , I shall not employ any person in any manner so as to become subjecl to the workers' compensation laws of Califomia, antl agree that if I should become subjecl to lhe workers' cOmpensation provisions ot Section 3700 of ihe Labor Cotle, I shall forthwith comply wilh Ihese provisions. J� /�� I I u J 1 a_ l �.nv-l.� �--� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Seclion 7000) ol Division 3 0( lhe Business and Professions Cotle, antl my license is in full force and eflect. Lic. # . ._. . Class # Gomractor's SignaWre CONSTRUCTION LENDING AGENCY: ❑ I hereby a(frm that there is a construction lending agency for the peRoimance of Ihe work (or which this permil is issued. (Sea 3097, Civil Code). LenOer's Name: Lentler's Atltlress: SignaWre �a�e � OWNER-BUILDER�DECLARATIONS: I hereby affirm lhat unaer penalry of perjury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any cily or county which requires a permit to constmct, alter, improve, tlemolish, or repair any stmcWre, prior to its issuance, also requires the applicant for such pertnit to file a signed statement that he or she is licensed pursuant b the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for lhe alleged exemption. Any viola[ion of Seclion 7031.5 by any applicant for a permit subjecis the applicant to a civil penaly ot not more than fve hundred dollars ($500).): ❑ I, as ovmer of the property, or my employees wilh wages as their sole compensation, WILL DO THE WORK, and the stmcture is not intendetl or oRered for sale (Sec. 7044, Business and Protessions Code: The Contraclors License Law does not apply to an owner of properry who builds or improves thereon, and who does such vrork himself or herself or through his or her ovm employees, provitled Ihal such improvements are no[ intendetl or ofleretl for sale. If, hovrever, the building or improvement is sold within one year ol completion, the owner-builder will have the burden of proving that he or she did no uild or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH I NSED CONTRACTORS ro construcl Ihe project (Sec. 7044, Business and Pm/essions Cotle: 7he contractors License Law dces not apply to an ovmer ot property who builds or improves Ihereon, and who cont2cts for such projecl with a contracta(s) license pursuant to the Contractors License taws.). ❑ I am exempt under sec. Business and Professions Code (or this reason: ��`� ��/3a/s9 ,�S6mawmr i e� 305]-A6(3I0]) �"`-"- / �� . M. , Owner ID venfied Dy driver'Slicense. ❑ Yes ❑ No Dnver's License No. Expires: Verifcation of Ownership by (type of tlocument, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certify that no ezwvation Frve (5) or more feet in depth into wfiich a person is required ro descend, will 6e made in connectbn with work authorized by this permit, and that no building structure, scaf(dding, false�+ork, a demolition or dismantling Ihereof, will be more than thirty-six (36) feel high. (Chap. 3.2, Grp 2, M 2, Sec. 341, TM1Ie 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone ro tlo work which would require a permit from the Division ot Industrial Sa(ety, as noted above, unless such person has a permit to do such work (rom Ihe tlivision. Appliwnts Slgnature Dale Division of Industrial Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neetl to file and certify a Business Plan for emergency response to release or Ihreatenetl release of a hazareous matenal? ❑ Yes ❑ No (Seclion 25505 0( the Califomia Heallh antl Safety Code requires, with some exceptions. that a 8usiness Plan be filed with the CosW Mesa Fire Department by every business which has at any one time dunnq a reported year a quaNiry of hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl temperature and pressure). 2. Does or will the applicant or present or future building occupant need lo fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Healih antl Sa(ely Code. wilh some exceptions, requires regis[ration with [he Costa Mesa Fire Department hy each business which at any one time has on hand a quantity of acutely hazardous materials equal ro or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic fee[ of compressed gas at standard temperature and pressure�. 3. Does or wiu the applicant or present or (uture building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials�? ❑ Yes ❑ No (Section 25534 of the California Healih and Safery Code provides that the Costa Mesa Fire Deparlment may require the preparation, cenificalion antl filing with ihe Fire Department of an RMPP by businesses which are requiretl b register awtely hazardous materials with the Fire Department. 4. I( an RMPP is presently required, has Section 25534 of the California Health and Safely Cotle been fully complietl with? ❑ Yes ❑ No 5. Does or will I�e applicant or present or future builtling occupant require for the vrork which is the subject of this application a pertnit for such consWction or motlification from the South Coasl Air Quality Management District or from any other air polWtion control disMct or agency? ❑ Ves ❑ No (Sectan 65850.2 ot the Calitomia Govemment Code requires that the requesled infwmation be fumishetl on applications for noo-resitlential building pertnits). 6. Will any part of the facility to be consWcted under Ihis permit be wilhin 1000 feet from the outer boundanes of a school? ❑ Ves ❑ 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 Qualiry Management District or other air pollution control district or agency is required for the vrork which is the subject of this application, have all of the disclosures prescribed by California Health antl Safety Code Section 42303 been made? ❑ Ves ❑ No 8. Qf "yes", attach certificate of compliance from the appropriate air pollution control oKcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the infortnation given above is covecL I agree to compty with all state laws and city ordinances regarding Hazardous Materials antl Emissions. SignaWre Daie CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalry of perjury thal I have read [his application and state that the inlormation given is correct I agree ro comply with all state laws and city ordinances relating to builtling consWction, and authonze representatives o( ihe City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building aulhorize by this perm/'it, /until f n I inspection. n.� ./ Ut�,� �, �� 6 a �9I(7N51ur 'o: _29310�er.(i� C"�Dat Anabr Aui�onzetl Applicanl JobAddress: 980 W 19TH $T Suite: Vicinity: ROOF PrimaryOcc: R1 Parcel Number: 42253114 npp�iwnt: TAM NGUYEN NOUDEN Address: 14641 BROMLEY STREET WESTMINSTER, CA Owner: CHARLEY, GENE A Address 980 W 19TH ST - Type of Construction: V-N Zoning: COSTA MESA, CA � � Contractor: DISCOUNDT ROOFING „ Address: � 14641 BROMLEY STREET - ' - . "" - �� WESTMINSTER, CA -� ' Zip: 92683 - � � Arch : Address: . .ZiP� . . , . . Phone: License: Phone: 714-721-4149 Zip: 92683 Status: ISSUED Applied: 09I012005 Issued: 09I072005 ISSUED BY: � Phone: � Zip: 92627 , .,� R1. , P , .. ..... �„ Phone: 714-721-4149 ' License: 860452 � � - � Eng: Address: ' �, - . _ _ . �: _ ; . :. � ., ' . I� - _. ' Phone: . �License: s�urt ur rtecmi i TEAR OFF EXISTING COMP SHINGLES, INSTALL 3Q# FELT UNDERLAYMENT AND 30 YEAR COMP SHINGLES ON EXISTING HOUSE AND DETACHED GARAGE. APPfiOX 28 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. HOUSE AND GARAGE TO BE DONE ' CONCURRENTLY. � " � � FEE SUMMARY � Plan Check: ` $0.00 " Calc Valuation: S3,eoo.00 Permit: , $97.25 � ,,. Claim Valuatiorr ss,soo.00 SMIP Res: $0.50 SMIP Com: $0.00 Other. $0.00 Inspection: $0.00 Total: $97.75 s - PLANNING 8 ZONING SETBACKS . , .. MAIN STRUCTURE Front 0. 0 '� -= Rear 0. 0' ;� Left `` 0. 0 � Right 0- 0 ACCESSORY fronF.- 0.�0 � � �Rear - ;0-0 - , � Left � 0-0 ` � Righ� . 0.0 PARKING Existin : 0� Re uired , 0 ,-Pr000sed: '�0y . _- �r<M ' � - _ .s: ;... , �;_ � � � -_..1 �_ �y, NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requlrements under Calltomia statutes and related regulatlons. (Ord. No. 92•28, § 1, 12•21•92) EXPIRATION: This permlt shall automatically explre and become vold if work Is not commenced withln 180 days, or If work is suspended or ebandoned for a period of 180 deys. INSPECTIONS: In order for the work authorized under this permlt to be considered legal, such work must comply with ell applicabte codes, arW ell requlred Inapectlone and flnel epproval must be obtained. Failure to obtain Inspections and final approval will result in ihe expiretlon of thls pertnit. FOR INSPECTIONS CALL: (714) 7545628 � WORKEHS'COMPENSAnON DECLARAnON: I hereby affirtn under penely of per�ury one of t�e following dedarations: ❑ I have end will mainiein a cenificate ot consent to setl-Insure 1or workers' compensation, es proNded for by saction 3700 0l tha Lebor Code, tor Ihe perfortnence of the �wwk lor which Ihis pertnit is issuetl. �I�have and will malntain workers' compensatlon inwrance, es required by sectlon 3700 of the Lebor Cade, for Ne pertortnence of the work for whic� chis pertnit is issuetl ber are: .N� run�� Po�� i830S�i�- oS nundred dollars ($100) or less.) ❑ I certity ihet In Ne Dertormanca ol the work tor w�lch Ihis pertnit Is issue4 I s�all not employ eny person In eny menner ao es to become subjed to the workers' compensatlon lews o1 Celifomia, en0 epree Ihe111 I shoulE b come sub�act to the workers' compensallon provisions of Sectlon 3700 of Ihe Lebor Catle, I shall forthwith comply with these provislons. /1/1� ��: /� O� Appticent�Stgnetuie: ��/ V �t �Dele^'...` � / WARNINO: FAILURE TOSEWRE WORKE0.S' OOAIPENSATION COVERA6E IS UNLIWFUL AND SHRU. SUBJECr AN EMPLOVER TO CRIMINAL PENALTIES PND GVIL FlNES UP TOONE MUNDRED THOUSAND DOLURE (5100.OD0�. IN ADDRION TO THE CO6T OF COMPENSATION, DAhL1OE5 AS PROVIDED FOR IN SECTION 3]OB OF TME LABOR COOE, INTEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTOHS OECLARATION: I herebv ettirtn Ihat I am Iicensed under orovisia CONSTRUCTION LENDING AGENCV: 9(commenpng wlth SeMion 7000) of DlWslon� oi�tha Buslness entl Protessions Code, entl my Iicense is In full Class p � C�ete:"� � C) \ ❑ I hereby ettirm thet Ihere is a construction lending egenry tor t�e peAortnance ol the work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lenders Address: Signeture: _ Date: I �er Ihat u�enalty�er-t�at I�XEMPT FROM THE CONTRACTORS LICENSE LAW lor the following reeson (Sec. 7037.5, Business end Professions Code: An or cou hlch rA4llfGes a pertnit to consWct, elter,'unprove, tlemWish, or repair any structure, prior to its fssuence, fllso requires the epplicant tor sudi permit to lile e sig stetemeM ihat he or she is Iicensed pursuant to Ne O�a��ons of Ihe Contracrors License Lew (Chapter 9(commenGng with Section 7000) of D'Msion 3 ot tha Businass end Professions Code) or that he ar she Is exempt therefrom entl the Dasis lor the alleged exemption. Any Wolatlon of Section 7031.5 by eny epplicant for e pertnit su6jects the apDlicant to e cMl penalry of no� more than fiva hundred ddlars (5500).): ❑ I, es awner af Ihe property, or my employees with wages as t�eir sole compensation, WILL DO 7ME WORK, and the structura Is not InlentleC or ottereC lor sale (Sec. 7044, Business and Professions Code: The Contractors Llcense Law does not appty to an owner ot properry who builEs or Improves thereon, and who tloes such work hlmself or herselt or ihrough his or her own employees, provided that such improvements are not Intendad or oNered lor sale. tl, however, the builOing or improvement is sold wiihin one year of wmDletion, the axnerbuilder will have the burden ot proving ihat �e or she did not builtl or improve for purpose of sala.). � ❑ I, es owner ot the properry, em E%CLUSIVELV CONTAAC7ING WI7H LICENSED CONTliACTORS to construct the pro�ect (Sec. 7044, Business antl Professions Cotle: The wntrectors License Lew does not eppty to en owner oi property who hullds or Impmves t�ereon, end who wntracts for such pm�ect wlth a coniractoqs) license pursuent lo the Cantrecbrs Licanse Lews.). ❑ I am exempt untler sec. Business and Professions Code tor t�is reason: Signature: Date: Owner ID varilied by dnvers Iicense. ❑ Ves ❑ No Dnver's Licensa No. Expires: Verification of Owners�ip by (rype of document, i.e. - properry tax bill or deed): _ DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereDy certlly Ihet no excavetlon Ilve (5) ar more teet in depth into which a person Is requlred to descend, will be matle In connectlon with work euthonzetl by INs permit, end Ihat no building struCture, scatlolding, felsework, ar demolition or dismantling ihereof, will ba more ihan thirry-slz (38) feet high. (Chap. 32, Grp 2, Art 2, SeC. 341, Title 8, Celifomla AdminlstratNe Code). ❑ As owner-builder, I will not employ enyone to tlo work which would require e pertnit trom the Dlvision of Indusiriel Selety, es notetl ebove, unless such persan hes a pertnit to tlo suc� work Irom the dFrision. Signature: Date: Division ot Intlustdal Satery Permit Number: CERTIFlCATE OF COMPIIANCE ANU AUIHOROJITON OF EH1AV: I certity under penelty ot perjury �hal I have reeC this epplicetlon end stete thet Ihe Inlormation given is correct. I egree to wmply wl(h ell state laws end dty ortlinances relating to building consiructlon, and euthorize representetives oi the Clry of CaSte Mesa to enter upon the ebove-descnbetl properry lor inspection purposes. I egree not to occupy or allow occupency of eny building euthodzed by this permit until finel inspectlon. GOUE I. INSPEC710NTYFE 1618 Fixed System Flnal Flre Prevembn 1288 Pool Spa Finel 200 Final Ro-Rool 201 Flnal Black/Relelning Well 202 Flnal Fectory Flre Place 203 Fina15ign 204 Final Demolllion PdIE Q�dLi COOE� INSFECTIONTYPE 206 Final Mec�anical 208 Finel PlumDing 210 Final Electrical 212 Finel Fire Prevenlion 220 Finel Planning Apprwal 222 Final Slte 250 Finel BuiltlingiOccupenq r,;osta mesa Buuding Dep ��g �P B U i L D,� N G�� r�' 111 EA&T 20th STREET �� '� � COSTA MESA, CALIFORNIA FOR APPLICANT TO FII.I. IN FOR OF'FICE USE O1VLY I Recnfnf No. I Pw.mif N Costa Mesa, California Nearest oi Lot (r� 7� � � D I Now o oi No. 01 �ting Bldg. Famiil iack Line irom ss Rear ter oT Street Side DESCRIPTION OF W � I I Alteretion I air I I Moving I I ding No. ot ` �� 2S X" <ig Rooms Addition �� 31_I� i� � Date Rec'd. Date IssuW �-�3 J� Address Costa Mesa, California Cross � Date CORRECTIONS ,.. � CoveNng [��...,.�? APPROVALS Foundation Location I Inspecto Forms, Materials, Under-Pinning Frame: Fire Stoos. I hereby acknowledge that I have read this Application `a`��. ��`. and state that the above is cotrect and agree to comply Lath. Ext. with all City Ordinances and State Laws regulating building construction. Signatureof q/ � Plaster, Int. PeYmittee �� Plaster, E�A Authorized Agt. Masonry RE Valuatfon PermitFee $ 1 � Plan Check $ 5 Bond Beam $ � /O� J � Feeal $ � � � FINAL �� . .. .. . ' ._ S +� h . ^ ... i . � ' ; . � . . y � ...:Z.F.• . . . _ . , _. .. � t. � � 1`, ..� .. .. ' . _ "" _ _ � +' 1 " _ a - , . . � . � _" . . �"�_ � • . ' . _ _� _ . � � . •,� � " _ �_`_� _ _""_ . � � ` "__""' '_ _'. __"__ _'__ ___.___....fC.�"_'i-=____' . .�., . ' ' u A _.. . . ' . r. � i , : . , �:6•�� `� " ' . . . . . . � � � �� •. .o_ .. _' . � _ 3 �! c, . rna•,�' '-L� - � .i,' IG �.. . b•,.. � . n�c+. �'�'' v:f . ..t31� _ "'_"".' ,. --T�� :� .. ..-,�.a_'_�__' � Show Ioqation and distances irom.. ' �� ' ,• "� ��,' � ' 1 , I property j�ne and between buildings: „ , , - ��_ ; �,� r �- .�r . . � . _ . . . �_ 1 '.. __., i '_ ' _ . . . . _ ., - �"�� ' �" � ' , '� � . . � . . . '�.� , .. ��t. , , .. ,.._� �. _. b .... 1 � .. O 1. �.nl L".' � � . � , ••t�'�•v r , �. � . . . ,. . . :t � � . . . . .. ''.\. , .�.1 '�..... , \ ' � . � � 1 .. t 1 ' - � .' r; � . i.. .. � �,r�(�r; COSTA MESA BUILDING-SAFEiY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applieant to Fill In Complefely TYPE OR PRINT ■ MAIL ■ STATE COSTA MESA. CALIFORNIA TEL. NO. ' Q �� FEE RECEIVED . QCL861961 FINANCE DEPT. 6 � CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING Fon Office Use Only RECEIPT NO. I �g S EC VED BY Uq E RECE�VE� Dp E � I 16-��_�� % RE'ss 9' �� w 19 — S� COSTA MESA. CALIFORNIA I FIRE / IDNE �"'/` I�r� N Q w BYPROVED DATE / O >� s; ZONING ZONE I NO.OF UBE OF NEW� C8A �— I PLpN9 Z I BUILDING TEL.) C % LEGAL 3�Y •/1 / I NO./. / y 5 1. % oeecxipriorv � � �o. oF a��s. _ .roi _ , y v.,w..N,.,. �-- .__.._ -iis— USE OF GAQ/�+"U � EXISTING BLDG. 66TBACKIINE FROM � yZ � REAR YARD CeNTER OF BTREET SIDE YARD ILEFT � O' IRIGHT � DESCRIPTION OF WORK ,� a x a �' ROOM! WALL 7/ _ / ' ROOF ■ USE '1 � IC£NTER LINE BTJ I q 30 3 '� 1 HEREBY ACKNOWLEO6E THAT 1 HAVE REAO THI6 APPLIGTION THE AMOUNT BHOWN UNDER VALUATION IS FOR THE AND eTATE THAT TH6 ABOVE IS GORRECT ANP AGREE TO COM- pUPP08E OF E9TA9L19HING A PERMIi FEE ONLY. PLV WITX A O INANCEe AN� BT E L�WB REGULATIN� Bu1Lo1No NSTR N. VALUATION �j SIGNATURE / {�� PERMIT FEE $ J% � PERMITTE ��' C�j/ $ / �� , PLAN CHECK $ • � AUTHORIZED AGEN7 `� TOTAL FEE �— ,� . ' _" 22506 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BO1C 7200 � COSTA MESA� CALIFORNIA 926Y6 Fo� App/icanf Po F711 In Camplefoly TYPE OR PRINT AD ao e�ss U U'� f .� � COSTA MESA, CAUFORNIA OWNBR ! A �% /C /% �� MNL it V .. . � . _ . .� re�. oP�or ) /G' U8H OP EXIBTIN� BLDO. O Y6TewcR Lln[ IROY arr _ ��F � <�e2T I R�oM /.2 �eT DESCRIPTION OF WORK � �1 H6P60Y ACRNOWL6OOR TMAT 1 HAV� RG�_TX�G APPLICATION AHD BTATH TXAT TM8 AlOVB It COpR6R�AND AORHt TO COY- PLY WITN ALL �OItf11t1G0 AND eTATi LAWp RWYLATINO EIIILDINOCON9}RU ea ii// � AYTHORIZiDAO[IiT FEE RECEIVED .1UN 25 1964 FINANCE. DEPT. APPB�T%(TI�N Q�iPRB�M�A BUILDINf3 For Off)ce Uss Only 11[C[ITNO. �6RMITj{O. W ZONIN(i , r" 3 � MO. O! YY[ OI M[W � � �LAN� OY�LDINO �cn�mon �0 � � % 4- � � � �/ 2 A.P.NO. / / ) � �� r="�_ NOTB: NO[AV60V[RHAN68HALLD6LC88THAN 80' TO BID[ 0 RHAR P. L savea ALLOWHD fl1.B.C.REOUIRHM8NT7 YARDBAPPROVBD YARDBAPPHOVHD MAIN BUILDINO ACGES80RY BUILUINO VAR.OF ecr. MwiN a wcceas.e� DATB ♦ \ a m — � � - � eo. rr. ` 3s Fo x TN8 AYOUNT BNOWH UNDBR VALUATION le FOR TX8 i PYRPOOH OP UTABLIBNINO A P¢RMIT FHH ONLY. 3 VALUATION �� iJ , �i � �� PERMIT FEE � � s 6� w ti 1Q � ' TOTAL FEC i� V � �— ;399g8 � �"� • '#AY 19-75�M�.:,00 747x *�**24.50 COS7A MESA BUILDING-SAFETV DEPARTMENT ' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 AP IC TION FOR BUILDING PERMIT For Applicant to Fill in Completely R E E DATE RECEIVED DATE ISSUEO� BUILDING d ` �% L' (� �/C AODRESS 0 :J' OWNER �1 � F/� I�r%a„� A.P.NO. � � O�— L� P R N.O ! MAIL �(� {� BVILDING Q�O � . /Q �L �L Z ADDFESS �J 0 � ��C/I/ V / ADDRESS i �� / / 6 U CITY ^�� /i1P,r�7 NOL ,3 ,1 a, / TRACT I��Z LOT � BLOCK f- Z Z Q CANSTRUCTION ' O� LENDER M. / O/� a m f� / ��i � J 7 BRANCN U/I (� F�2, m� r(/ J N OWNER � Q ADDRESS ��/ � AflCHITECT TEL. $ / //�-C �/YI/g A`U$ /5�� n� � � OR ENGINEER � V Q FIRE w K ADDRESS ZONE T E GROUP !� a W � � APPROVED � JO CONTRACTOR � �� .p BV � DATE�' m Z i J � ADDRESS W w TEL. �ONE D NO.OF USE OF NEW Z= CITV NO. /� � P�� BUILDING r � STATE CITV VARDSAPPROVED VARDSAPPROVED y Q LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING � �� SI2E '7 NO.OF BLDGS. (FROM C/L STFEET) 1 1 OF LOT / X/ �J- O NOW ON LOT z ONT FT. FT. '�i. EXISTING BLDG. J7� i�•�Q �F �jy G\' � F � S12E OF NO. OF Za NEW BLtlG. FOOMS STORIES L.5 T. V EXTERIOR W!+LL ROOF COVERING COVERING REA FT. F. �.- J USE OF BUILDING AND WORK TO BE PERFORMED DISTAN E BE . 6ET. MAIN & MAIN BLDGS. ACCESS BLDGS. VAF.� D.�.TE :C-e / /1 A 0.U.P.� qPPROVED � � ~ / APPROVED Q •pI _ _'7 ` y i'hPO �:C/J —2 . r �i Z ' O UI heraby acknowledga thet 1 have reatl this applicetion antl stata �A,�E � that the ahove intotmattnn ii cor�ect entl agree to comply wiih � � all lews repulatin8 building constt�etion, antl I shell not amploy � any persP� in vtolaiion of the workman's compensation lews ot � q tha State df Celitomla. � m ? I hereby certity ihat I am properly Iicansetl as a conttector untler S�. FT. O the Stata ot California Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VAL 5 FOR Chepter 9, antl the[ such licenses ere in full forca antl attect, or I TNE PVFPO6E OF ESTABLSHING A PERMR FEE ONLV: � am axemp�-f�om the provisiOns ot the Stete ot Cellfornle Business ¢ antl ProflsSioni�Co e, Divisio , Chapter 9. VALUATION � q�r—� m � PERMIT FEE $ � SiBnstnr �of i- �-� /!� /.� �[ m Parmlttee $ /�`J� PLpN CHECK $ F // o` Autharizatl A9ent // // C- � LL TOTAL FEE $