HomeMy WebLinkAbout152 19TH ST - Building Permits -rr{,
CITY OF COSTA MESA
BUILDING DIVISION
0. • rir DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER
v. 1 PERMIT
11. .t: B04-00371
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 152 E 19TH ST Status: ISSUED
Suite: Applied: 02/17/2004
Vicinity: RESIDENCE AND DETACHED GARAGE Issued: 02/17/2004
Parcel Number: 42603101 Zoning:
Applicant: MOREAU, JAY ISSUED BY: ._;#0;it
Address: 1117 COUNTRY CLUB LN
Phone: 909-280-9668
CORONA,CA Zip: 92880
Owner: DONALDSON, COREY M
Address 1927 HARBOR BLVD#610
Phone:
COSTA MESA,CA Zip: 92627-7600
Contractor: JAY'S ROOFING
Address: 1117 COUNTRY CLUB LN
Phone: 909-280-9668
CORONA,CA
Zip: 92880 License: 512051
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
• SCOPE OF PERMIT
REROOF RESIDENCE AND DETACHED GARAGE:REROOF OVER 1 LAYER OF EXISTING COMP, 1 LAYER 15#ASTM FELT,APPLY"30-YEAR
GAF TIMBERLINE COMP SHINGLES.2500 SO FT
FEE SUMMARY
Plan Check: $0.00 - - - - Calc Valuation: $3,350.00
Permit: $97.25 Claim Valuation: $3,350.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00 - •
Total: $97.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or If work Is suspended or abandoned
fora period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5826
2446-48(6/00)
,
DECLARATIONS •frF` -"
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need nor be completed if the permit Is valued at one hundred dollars($100)or less.)
0- 1I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, •nd agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. _/ - 0
Applicant Signature: - Date:
ii
WARNING:FAILURE TO SECURE WO', 'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(Si 00,001),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force 0nd effect.Lia.til .S a ,I Class I C J
Contractors Signature: r6' 4.111.111r Date: • 9 —17'-0 '
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
�........�___.._._..__ -..._ ._ _____ _-
3 Does�r will the aplicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes —0-No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yet,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air QualityManagement District or other air pollution control district or agency is required for the work which is the subject of this
application,have ell of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If Net,attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ar.....---
1,2„,ffiature Of Le wner(s) oC _D¢1B O Lf
And/Or Authorized Applicant Date
cOOE; INSPECTION TYPE all KEW COOP I INSPECBON TYPE BM =Aka
•
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 7 �!/ 208 Final Plumbing
200 Final Re-Roof 1- .—ZY '6 / ��a- 210 Final Electrical
201 Final Block/Retaining Wall 212 . Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
4BUILDING DIVISION
>. ..a DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER
1.
,etnrpri
t PERMIT 1411 .
.4: _ I B02-01519
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 152 E 19TH ST • Status: ISSUED
Suite: Applied: 09/19/2002
Vicinity: Issued: 09/19/2002
Parcel Number: 42603101 Zoning:
Applicant: DONALDSON, COREY M ISSUED BY:
Address: 1927 HARBOR BLVD#610
Phone: 949-631-7222
COSTA MESA,CA Zip: 92627-7600
Owner: DONALDSON, COREY M
Address 1927 HARBOR BLVD#610
Phone:
COSTA MESA,CA Zip: 92627-7600 .
Contractor:
Address:
Phone:
Zip: License: .
•
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE 9'GARAGE DOOR AT REAR OF PROPERTY TO CONFORM WITH AREA NEED FOR PARKING REQUIREMENTS. FRAME IN AN
EXISTING DOUBLE GARAGE DOOR TO ALLOW FOR A SINGLE GARAGE DOOR.ABANDON ILLEGAL UNIT AND CONVERT BACK TO A ONE
CAR GARAGE.OK FOR BATHROOM TO REMAIN
PER PLANNING.WORK DONE IN COMPLIANCE WITH NOTICE AND ORDER FOR CODE ENFORCEMENT CASE CO2-2818.
FEE SUMMARY
Plan Check: $25.19 Calc Valuation: $1,000.00
Permit: $38.75 Claim Valuation: Stamm
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $64.44
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 • Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244648(Sre0)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as uired by section 3700 of the Labor Code,for the performance of Neo fpor www this permit is kared.
My workers'compensation Insurapc1 ca>,rl. and policy nu ere:Sr
Cartier: -V/�I /p�aT/ /YI]5 1"`"-'.• Policy Number: !/
(This don need not be completed it the rmit valued at a hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Calif a,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisio /± �/`-f1n /1
Applicant Signature: .4C) _ I(�/7�r N_J'( /1 Date: g --0C-9N
WARNING:FAILURE TO SECURE WORKERS'COMPENSA COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COS OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.UC.I Class U
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exemperider sec. Business and Professions Code for this reason:
Signature: t !{ _
Expires: 111 Allah
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation Me(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). __
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
es or will__... Prevention Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LI No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility tole constructed under this permit be within 1000 feet from Ne outer boundaries of a school?❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Duality Management District Or otherair pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penally of perjury the information given above is correct. I agree to comply with all state laws and dry ordinances
regarding Hazardous Materials and Emissions.
Signature: Date: -
CERTIFICATE OF COMPIJANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I ee to comply with all state la s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-d ori party�tlpLpCy�\Aarr ffoorr1 ins ion ry ses.t agree not to occupy or allow occupancy of any building authodz�d�y this perpi til fin jspgcyon.
ignature O egal Owner(s) / .....-
Date
AndrOr Authorized Applicant Date
000E I INSPECTION TYPE RAE 11111261.1 MP I 16SPECTION TYPE RATE MLE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign - 222 Final Site ,/
204 Final Demolition 250 Final Building/Occupancy /0742- ail
• YAi-
43783 777,7 OC 1117 : ****5!.A i
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
AP LI A ON FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
i( /� �y / �I REC V V D TE EC V D 'DATE ISSUED• /J
//ADDRESS 152 8 ` 1 4A sr..QF[ / yr-as-7-� i7i-I%�d f- 7
/OWNER .TAME? paaidps A.P.NO. Of P11.//f ''/
BUILDING r _//9' (`7
MAIL ADDRESS i 4f .J
ADDRESS
TEL. Adt-We 4> MG7E1 peg
CITY I NO. TRACT LOT �/A BLOCK
CONSTRUCTION NEW ADD ALTFR REPAIR (MOVING DFMOI ISH
LENDER /,/lI �s
BRANCH OWNE\JAME. S nira/ps
ADDRESS /W� �/ V UE is./a
ARCHITECT TEL. USE 2 �J'L//✓1
OR ENGINEER NO /.,�
FIRE {/��
ADDRESS ZONE TYPE GROUP
APPROVED /h/ 7
TEL.
CONTRACTOR T�;�INEn RUlLDE� BY �d DATE �4r
ADDRESS ZONE NO.OF USE OF NEW /R-z1 PLANS BUILDING
CITY NO. 4.............l f�
f*" STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING \
LTA ZE NO.OF BLOTS.
(FROM C/LST REST)
IL OF LOT I NOW ON LOT FRONT"/6 F]fLL---, FT.
Q USE OFell /-/
.-.
EXISTING BLDG. R.$I FT, FT.
toCI r i.
F SepaIate permits are required for L.SIDE 01O 6 FT. FT.
electric,plumbing and heating work. •'� �/
10 REAR fi_J FT. FT.
F USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& I
'C ) � n / /�q MAIN BLDGS. ACCESS BLDGS.
VAR.* DATE
a / (JA//T OVE,2 UQ{:N C.U.P.45 n /] APPROVED
‘7-29C97/�7
> ��/!�'ROs�VED�G/J� D �`{1J_/ ATE ( —2��/
Lat7 ' 4101D—En 'S1tp/E\�1A1— UIRE
0 I hereby acknowledge that I have read this application and state ����, t,
n
C6 that the above information is correct and agree to comply with m
6. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
2m
the State of California.
6/SD.FT. ..,3-::: ✓`r7 sj'��[/ .:
I hereby certify that I am properly licensed as a contractor under
ry
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: b
am exempt from the provisions of the State of California Business VALUATION rt
and Professions Code,Division 3,Chapter 9. PERMIT FEE $ m
PLAN
Signatu / � � / /• .JC{/CiL_.[JL $���n� TAX CHECK $ Qi- tat u
Authorized Agent ��V/��+eee//a) TOTAL PAID $C .� G /
,. all.11111111111Pir r.
428.7.3cr 12-7F,r---On 732 : ***,..*5.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
P 1C TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
_ L.P. N0// 6v
DATE RECEIVED DATE ISSUEDABUDIDLRDEINGIS� 1- Pi-
CA . it /2-7 Arcs 0 / PERMIT NO.OWNER ? SCJ') V ) /Y }�MAIL 5 -yyUILDIN
DDRESS/ C�' rS�
ADDRESS ✓ ° S ��11SS/���� (%r JCITY C IV I TE
NOIS)) / TRA'CT'g /� 1-0Ti7c2... BLOCK
CONSTRUCTION Ow/ye /7 NEW ADD ALTER REPAIR MOVING DEMLISt1..
LENDER L�VL� DEMO
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BRANCH ^� OWNER M !
ADDRESSARCHITECT•-}�+ �7� L c ttl _ VALUES ,1"0-
OR ENGINEER
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USE t/ LJ
ADDRESSLO SS E. �•�//~" wt4 Y . Cb" . ZONE ',OPE
, jI ,s YPE GROUP w�-�/s
CONTRACTOR OW0 642_
APPROVED
�1 tp// DATE `y ', ier �p
-_ VVV��-OOO
ADDRESS 20NE/n/ NO.OF USE OF NEW
CITY NO.TEF ' PLA) BUILDING �
F. STATE CITY YYARDS APPROVED YARDS APPROVED ��-
LIC.NO. ... LIC. NO. MAIN BUILDING ACCESSORY BUILDING ��•
SIZE NO.OF BLDGS. (FROM C/L STREET)
0. OF LOTS,. 5>L 13E-1 0� �NJOW ON LOT 2 FRONT FT. I FT.
USE OF
N EXISTING BLDG. / I • la/V 1 f / /t- B._SJpE
9/1- .i i / '
9 Separate permits are required for L.SIDE J /1 Fi'
C electric,plumbing and heating work. REAR ,f I$/ t FT.
k7 USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET. MAIN&
Q' MAIN BLDGS. ACCESS. BLDGS.
0
Q 0g10-0 LAS N ��CtS J ( �1G� C UDP,qW DATE
_APPROVED
>'„ `J- RYV,p#PRO / DATE lD�/� ��
$$
Iii
0 I hereby acknowledge that I have read this application and state n
n
that the above information is correct and agree to comply with
co
-1 all laws regulating building construction, and I shall not employ HOLD EOR SPECI U., REQUIREMI%1V'P5
Z any person in violation of the workmen's compensation laws of 2
the State of California.
3 I hereby certify that I am Properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that s enses are in full ce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; n
am exempt from pr isions of the of Cali •w a Business VALUATION 9
PERMIT FEE S
and Profess Coda (vision 3,Ch er 9, n
Signature o r//' _ PLAN CHECK $ rn0
Permittee `�� - $ Qp.r TAX $ �T 2
(/ V U
Authorized Agent TOTAL PAID $ .S 57
287.2 'PT 1?-7177.X ./ 731 ' -1:1" `2I.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA.CALIFORNIA 92626
A L A 'ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
/j� GRE V DATE RECEIVED s FTSE 1$SUEED
BUILDING 2 1.�. ' 1 V ST /•.M. / V-/2_,-7
ADDRESS l._ /�\
OWNER����,t�H M A.P.NO. //�-,5/- 0/ PERMIT NO.
AMAILDDRESS SA1M BUILDING /� I� yc
j/L,^ L/,�7 7 ` ADDRESS A /1
CITYG I I Y \ r NE4r1S 2311 /��CT 1 LS r OOTI7� BLOCK
CONSTRUCTION o'�A 'r NEW ADD AL. R PAIR MOVING DEMOLISH
LENDER IVBvC- �/
BRANCH /__
ADDRESS OWNER jOn4 MAit'Ow-gri
ARCHITECT T`z,pG— TE L.1_13....y5en Q nv VALUE I4/n
01
OR ENGINEER I. •-..E F../Srgt�p NO. MO f �J�I 1.....-GROttPagi-
ADDRESS (iaS7 C - 0,0-TH Y1 C,Dl� . FIREisJ� �/f20NE VPE � /�CONTRACTOR L'JWQEI(, BVAPPROVED �/ DATE t-7
IN
ADDRESS a - 20 NO.OF.....2.... USE OF NE �e
TEL. p 2 IPLANS� BUILDING
9/—
CITY NO.E /� \
f $TATE CITY YARDS APPROVED YARDS APPRO ED
LIC.NO. �+ LIC.NO. MAIN BUILDING ACCESSORY BUILDING \
W 512E x j� NO.OF SLOGS.q (FROM C/L STREET) \�\O
(i OF LOT s 5 13 '�t Q NOW ON LOT V - FRONT -----Fr. FT. ...•-'----.-
<
Q USE OF �1•��� �
ca EXISTING BLDG. AF-S1 iEAJ 0AL
R.SIDE 4f �•
-
Ca
I-. Separate permits are required for i L.SIDE at, . PL FT.
C electric,plumbing and heating work. _REAR 7FT6// FT. /
ILI
Q U i O r NG WORK TO BEPEODF L- MAIN SLOGS. ACCESS. BLOCS,CE BET. BET. MAIN& ...-7
/� //
OP +y�� /r/,-7s-s� /+ • VAR.# DATE
'� tc[(N‘ CLi Wt vIYsIZ(� C.U.P.•>W APPROVED
-C
re -ZThPT ( 1 s[ . Cie)
APPROVE �7 7L
1' Q C�7'Gf(-rim t ✓ �Ol�j[71j E (��}blJ �.1' ATE /���d / '6'—
r /r'a rot P tJ V /4 s q a ir7X nara /
O I hereby acknowledge that I have read this application and state �y 'n
yr that the above Information Is correct and agree to comply with !//4 f do C
D• all laws regulating building construction, and I shall not employ m
Z any person In violation of the workman's compensation laws of H/1j,8
Sthe State of California. 0.00 r��SPECIAI, RE E'
pV V SO. FT. QUIREMP1L1 a+
I hereby certify that I am properly licensed as a contractor under ,S
the State of California Busln: end Professlo . Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR to
• Chapter 9, and that such •enses are I f • ce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT P� "'
am exempt from the • •visions of thj of Canto ••la Bus ness !/ 'a
�i VALUATION PERMIT FEEV
and Profasalons •r�Divlslon 3,C•Ar 9, // $ h
PLAN CHECK Sen. iti
o
Signature o �r o
Permittee ���-x / �: -..LI $ / av TAX E //3�y u
Authorized Agent TOTAL PAID S 2-/.
Na `
�fe37g3
PR 2q-74 0(1 e 684 d-K'<:. 1 Oi'^G
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
/ APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Co , letely — se Ink only
4 = ,� RECEIVED BY DATE RECEIVED DATFVSSU D /
BUILDING ' Y LL/l[ (^J _
ADDRESS /�i ,// •/
/ n P ,
OWNER % A.P. NO. �I
MAIL BUILDING /0;2
ADDRESS ADDRESS / . /7 ,,r-
•
TEL TRACT I LOT BLOCK
CITY NO.
CONSTRUCTION NEW )ADD( ALTER (REPAIR (MOVING DEMO( LSH
LENDER
BRANCH i
OWNER Agirr/ r '
ADDRESS J ri
ARCHITECT TEL. USE ��'/‘ V LO"ay./L
OR ENGINEER NO.
FIRE
L ADDRESS ZONE TYPE GROUP
[//a�,/J�f/ t APPROVED ,(�
CONTRACTOR — /'C����'r� BY DATE — V
ADDRESS
TEL. ZONE NO.OF USE OF NEW
'• CITY NO. PLANS BUILDING
F STATE CITY YARDS APPROVED YARDS APPROVED 1
gLIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING _••••.....t.
i SIZE NO.OF BLDGS. (FROM C/L STREET)
0.. OF LOT NOW ON LOT FRONT FT. FT.
a USE OF
Esa EXISTING BLDG.
R.SIDE F2, FT.
..
-
H Separate permits are required for L.SIDE FT. FT.
G1 electric,plumbing and heating work. REAR FT. FT. _
W USE OF BUILDING AND WORK TO BE PERFORMED '
H DISTANCE BET. BET. MAIN&
�Q
/ (// MAIN SLOGS. ACCESS. SLOGS.
�r / VAR.aW
C.U.P. L DATE
4 _ APPROVED
7 / J APPROVED
rd _BY DATE —
W
W . . .. -
0. I hereby acknowledge that I have read this application and state 0
n
yr that the above Information is correct and agree to comply with m
01 all laws regulating building construction, and I shall not employ
Z any person In violation of the workmen's compensation laws of m
Sthe State of California.
I hereby certify that I am properly ficensad as a contractor under SQ. FT. H
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 0
Chapter 9,and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of California BusinessVALUATION PERMIT FEE $ v
and Professions Code,Division 3,Chapter 9. tos; in
n
PLAN CHECK $ rh 0
Signature of ` V.
Permittee
47, TAX $ l' f
D /-
Authorized Agent TOTAL PAID $ , ewe I
S. 6487 --
"il7 __Pm
OSTA MESA BUILDING DEPARTMENT . (3/1/VV i
P.O. BOX 317 (�fan(`• (I��
COSTA MESA. CALIFORNIA Vv�„i..\1 CIO.
11 ri
FOR APPLICANT TO FILL IN APPLICATION' 'FORcnPERMIT
ADD ESSi5z E 1gm St- BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
{/ � ,Q.�_ •
RECEIPT NO. PERMIT B{O..
OWNERi���ArIV4 / 1�,z�. .use ; • ✓ Y [A/ .
ADO // / / i / rA . 5. -
RECEIVEDDATE RECEIVED T�1 ` j ^
ADDRESS S G / ✓ 3 6 "�( (� // J
/. T TEL. BUILDING /3 '2 z / 9 ^ n�
CITY '1�M NO. ADDRESS
ARCHITECT ^^� LIC. h
OR ENGINEER n_.Q • NO. COSTA MESA. CALIFORNIA r P.
I
7
CITY LIC. �
FIRE C
ADDRESS ZONE
20 . NO.OF TYPE GROUP
/[ PUNS Z_
CONTRACTOR •4(,(/I�r R NO. fr �// �
TEL. APP ROY£ -3/47t
../
_ADDRESS NO. iii. BY �,pr/rCr DATE J/4/ ,
LEGAL LOT / �f / CORRECTIONS
DESCRIPTION NO.,�.//iZ BLOCK .."TCT
A.P.NO. //J -..O .5-7_, D / 1
OIF
SIZE
/3 X 5'!.3 NO.OF NOW ON LOTS APPROVED
USE OF J �" � CITY OF ,STA MESA
EXISTING BLDG.RQR,p�(� _ jJ �A.�/gyp.{ .. !I�,.:N I.�Y E•EPT. VV �_
SETBACK LINE FROM C OD h) T TO • DG. DEPT. REG.
CENTER OF STREET XF� REAR YARD C e `
z ti
SIDE YARD RIGHT 13.-/- LEFT /0 I-
DESCRIPTION
DESCRIPTION OF WORK BY /" Y '~ DAT
PIAN TcC�"i/' f
•
NEW ALTERATION ADDITION
•
REPAIR MOVING DEMOLISH .
SUILDING /a/8 DNO.OF
SIZE A� INT• ROOMS I STORIES
EXTERIOR WALL. ROOFE4GG/ T
COVERING 01 QO . COVERING I rI 9 fLy
.Q /y/t//�����'/,/I
USE OF NEW 5 'To AX96-5. oct (/�/ '
BUILDING 4:
`La /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUE.
TION.SIGNATURE ';,{'/,,•_'-''�-',/ VAL TION 1 PERMIT FEE $ et-C)O 'f
'^� V �/ -
SGNATTEE � / -Ate. Z
+c9O PLAN CHECK $
AUTHORIZED AGENT TOTAL FEE $ ,9Ars