HomeMy WebLinkAbout188 19TH ST - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
P ITN TRACT NO. LOT NO. UNIT NO.' J•oOO ,TL
aYv�F COSTA MESA C /�jI�ST((RU�CTLION PERMIT �1• a�&�J 2044 ,2/09/87
Project Address i .. -1 '�I^+ 71 �1 /�1 _ *
Applicant's Mails'!!!]]]�jjggg�l�rildddrress rI lG Agn ` �j,'I/ TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION D-REPAIR
i 1 rre - • Phone tt6,O7 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone
Owner's Name 1 1
1/ DESCRIPTION OF WORK/USE OF BLDG.
Address Cl `` S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT El GRADING UNDATION U STRUCTURAL T Front Z
Address ❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANICAL B Rear N
Contractor's Name Phone 0OTHER 1967
,yj/ (pato' Rnkgct.sRight - �kGEiVED FEBN
• Address(mailing) �M aif p.(n_ > �jVW PROJECT DESCRIPTION SQ. FT. OCCUPANCY -
301 �� CONSTRUCTION TYPE VALUATIONS _ S Left G
City License No. r 11 -• ZONE GRADING CU.YDS. ACRES - R
LICENSED CONTRACTOR DECLARATION Ping, Ref. Parking Req./Provided E
I hereby affirm that I am licensed nd.r • • sions of Charter 9 (commencing Remarks: Planning• Notes: I RE FJV w r1 0
with section 7000) of Division 3 • s rl siness and Professions Code,and
1\C�rJ V �,� ' �� M
my license is inf.11 .r eand eff• ' ,I . yQ(1Sg7 •1 WO. T
License Cla s r� _ _>;. d i en No. L� e - .
`b.e Date a•�!a�,e • t e �R���.! • �a _ PLUMBING I FEES •
5.0 WORKER ' C•MPENSATION DECLARATION • •
Bar Sink Showers -
I hereby affirm that I have a certificate of consent to self-insure or a certificateELECTRICAL FEES
-
1, ' Workers' Compensation Insurance or a certified copy thereof (Section Backflow Preventer •
Service Sink
loo, Lab. flyl�1C--r f....,l7Q1QjC{87 -� . Automatic Washer Transformer 0 15-50 KW
'—a Policy No: (�7 ?LFq"T(JS r Com any Backflow lrrigatidn Sewer_Cap' _ Construction Pole Sub. .0 50+KW -
❑ Girrtified copy Is hereby furnish
Gert' ie 's file thQjjty i lyjtigl. QAC Bathtubs - - Sewer Connection - Cooking Unit Meter ❑up to 100 amps
I • Date hf!(6O LL.DECLARA -
EXEMPTION ROM WORKERS CO ENSATION DECLARATION Clarifiers Solar Collectors •
Dishwasher •• - Meter Dover 100 amps
• (This section need not be completed if the permit is for ono hundred ($100) or -
• less). • dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
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 Drinking Fountains Solar Tank Fan '
Workers' Compensation Laws of California. - - Motors❑0-1 HP 011/2-8.
Date Signature ' Floor Drains- Swimming Pool w/Spa -' F.A.U. Inc.-
Solar❑9-15 HP ❑1615+
NOTICE:If,after making This declaration,.youftheshould become subject,torth the -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks UrinalFixtures Microwave
comply with such provisions or this permit shall be deemed revoked. '
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet •
' I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this permit Is issued (section 3097 Civ. C.) Interceptors ) Water Heater a Outlets Range
Lender's Name - , .
Lender's Address Kitchen Sink Water Service Switches Sign -
' OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal •
following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap • Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to Its issuance, also requires the applicant for such permit - Trash Compactor ,
to file a signed statement that he/She Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of ' ' ,•
Division 3 of-the-Business and Professions Code) or that he/she is exempt - - • '
'herefrom and the basis for the alleged exemption. Any violation of Section 131.6 by any applicant for a permit subjects the applicant to a civil •
-natty of not more than five hundred dollars($500). I ' ,
Li I, as owner of the property or my employees with wages as their sole Reinspection,Fee ! $15 Issue Fee $ 3 —
compensation, will do the work,and the structure Is not Intended or offered -• r— - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL FEES -
' License Law does not apply to an owner of a property who builds or Improves -
. thereon, and who does such work himself/herself or through his ur her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 .
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
• ,prove , the owner will-have the burden of proving he/she did not build or Im- Duct- Under Ground Building Approved By Date; '
er
prove for the purpose of sale). -_ >7//(/a 1
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Chat
tractors to construct the project (Section 7044, Business and Professions Code:
• The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU - SUMMARY OF FEES
builds or Improves thereon, and who contracts for such projects with a con •
-
tractors) license pursuant to the Contractor's License Law). I am aware that 'Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ •
proof of their Worker's Compensation insurance should be C.
ovided to me. PLAN CHECK $ • PERMIT
PLUMBING $ S L
. 0 I am exempt under Section - B.& P. for this reason Firepl/Fact.Bit. ICBO# • Fire Dampers ISSUANCE $ -
Date •
Owner Heating System& Ducting Registers ENERGY P.C. $
❑0-100,000 BTU ❑100,000BT� PLAN CHECK .25% $ - .
I hereby certify that I have readthis application hand state that the above GRADING $ -
In d stat is correct. agreebui toicomply cost with all dy and county ordinances ELECTRICAL $ ,
and state laws relating tot building construction, andhereby authorizeer repre- PLAN CHECK 50% $ MICROFILM $ OO
• •
sentatives • thi city to ter upon the above-mentioned property for _
i Signatur
Ire / - / / TOTAL FEE $
Drivers' is /ALLA -a./
rola Reinspection Fee $15 - Issue Fee $ 3 PLAN CHECK 25% $' •
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location-•%
a
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding c .
5. Steel Reinforcement 56. Rough Plumbing & Pressurelist
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GRNITE
7. Footings 58. Electrical Conduit-Undrgrncp '.!
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Testi!
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-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, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 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
29. Insulation 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:4 3.7 7 Y71 Fc J.� i/Re
34: Final Heating & Air Conditioning ,02r- er ,Lf
35' Final Gas Pipe-Test y�/%6" icc
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing •
•
39. Water Service-Final ,
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
•
45. Sound Attenuation
46. Handicap Regulations
•
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA E CONSTRUCTION PERMIT MIT_ NO., TRACT NO. LOT NO. UNIT NO,
COSTA,* �}��y IT NO. A.P.qW Zone
Project Address / F. // ' •' _ /r�
/'�`r QST U Ir.r . S Main Building: Accessory Building:
Applicant's Mailing Addresst(� / / T. t t /Z �"�/ p YPE OF CONSTRUCTION NEW U Air ri±� •LTERATIO trap, - PAIR E Z
Owner's Name .�, .Su AAA Phone6 —07S0 ❑ CONVERSION CI DEMOLISH ❑ 0TH - T Front 0
Address /f 7 E_ oat_ Crczfr.f1. nes,i DESCRIPTION OF WORK/USE OF BLDG. I B Rear N
I C Right , N
Arch/Eng. License No, TYPE OF PERMIT U GRADING 0 FOUNDATION ❑ STRUCTURAL G
Address P V �� q��C ❑ TENANT ❑ E CT.ICAL 0 PLUMBING ❑ MECHANICAL S . Left R
Contractor's Name P'A/ S EM-'4 Phonel i / ❑ OTHER 1G •• - •• Ping. Ref.# Parking Req./Provided E
Address Imailin )"Yr7/fil`iI6NC/1Cf1 a rG _r40/-1 e. PROJECT DESCRIPTION Sre. TIONS N9 �-s PlanningNotes: O
g (� l .t r� CONSTRUCTION TYPF •VALUATIONS •� fpV M
/ O 1 T
City License No. - ` ZONE GRADING CU.YDS. ACRES S.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9(Commencing ((�� s. dd(�� `�11 n
with Section 7000) of Division 3 of the Business and Professions Code, and Remark/f 70W- Os2 «wee xes mss//'1 ertatsa ICF Qa-fl
my license is in full force and effect. / �y �1,,,,,.,�y ,,�/' (,�d Ho .1•Pi �qT ELECTRICAL FEES
License Clas e_,-- • / L.•nse No:-16(OY'e r.S/}/2 `-a rreb SH.s4yCa /f.f Am/
Date '^ ',C: - Signature A<i .4a-.ems . PLUMBING Mil."'FEES Automatic Washer Transformer 0 15.50 KW
0 50+KW
WORKERS' COMPENSATION DE LA:4eConstruction Pole Sub.TION Bar Sink Showers •
I hereby affirm that I have a Certificate of consent to self-insure or a certificate _-
Unit Meter Dupto 100 . s
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking p
0, Lab.
• olicy No./0144 7-0 Company ...7r l< f,-U Backflow Irrigation Sewer Cap Dishwasher Meter (Dover II amps
Certified copy Is hereby furnished.
Q0Cer[I ' rpEy y� d with the city B "ding Div! Bathtubs Sewer COnn¢Ctio
�- Dryers ❑Gas ❑Electric Sub Pan:
W Date tl D D Applicant Fan Ms .rs 00.1 HP 0114-13EXEMPTION FROM WORKERS'COMPS TION DECLARATION Clarifiers Solar Coltec . $
(This section need not be completed if the permit is for one hundred ($100) or - F.A.U. nc.Solar ❑9.15 HP 016-15+
less), Dishwasher Solar P": ng
I certify that In the performance of the work for which this permit is issued I Fixtures '
r- shall not employ any person In any manner so as to become subject to the Drinking Fountains So .r Tank Microwave `
Workers' Compensation Laws of California. Device BoxesPole Light
Date Signature Floor Drains wimming Pool w/Spa _
NOTICE: If,after making this declaration,you should become subject to the - Outlets Range
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. _
$witches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign
i hereby affirm that there Is a construction lending agency for the performance '
of the work for which this permit is issued (Section 3097 CIV. C.) Interceptors Water Heater Garbage Di •.sal Standing Sections
Lender's Name p -
Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031,5 Business and Professional Code: Any city or
county which requires a permit to construct,atter,improve,demolish or repair P-Trap Laundry Treys
any structure, prior to its issuance, also requires the applicant for such permit -
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000) of -
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
"-4refrom and the basis for the alleged exemption. Any violation of Section ,
VF1-40,5 by any applicant for a permit subjects the applicant to a civil -
alty of not more than five hundred dollars($500). 3 DEVELOPMENT SERVICES REQUIREMENTS:
L 11, as owner of the property or my employees with wages as their sole 1 Reinspeetion Fee $15 Issue Fee $ Zoning Approved By Date
compensation, will do the work, and the structure is not intended or offered •
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved BY Date
License Law does not apply to an owner of a property who builds or improves r!-- �.sr
thereon, and who does such work himself/herself or through his or her own ` Application Issued By �.r ` IT Date_ �}18
If i
employees, provided that such improvements are not intended or offered for Boiler Hood Or T .: I 0
sale. if, however, the building or improvement is sold within one year of corn- — Canopy ype II 0 SU ARV 0 FEES 5711
pletion, the owner will have the burden of proving he/she did not build or Im• Duct-Under Ground • J LJ
move for the purpose of sale). - BUILDING PERMIT $ , SMIP $
LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Re geration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's license Law does not apply to an owner of property who Duct-Ventilating W4100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con-
tractor(s) license pursuant to tne Contractor's License Law). I am aware that • I PLAN CHECK 25% $ ENERGY P.C. $
f1Exhaust System 0 Multiple • System Repair/Alteration IL GRADING $
proof o their Worker's Compensation insurance should be provided me. ELECTRICAL $
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG dk Fire Dampers PLAN CHECK 50% $ MICROFILM $ //1�a
Date owner Heating System& Duc ' g Registers MECHANICAL $ (f�3�
I hereby certify that I have read this application and state that the above 00-100,000 BTU P 100,000 BT TOTAL FEE $
information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws ting to eliding construction, and hereby authorize repre- —
sentatives of city nter upon the above-mentioned property for
Inspection p sei. 6. e^a
Signature ICLv Date n O •
Drivers' Licen r SS# � Reinspection Fee I $15 Issue Fee $ 3
_
0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor DA E: DLZ7p-79 TIME: 13 32T .�.t'�
DATE: DS/D,,/89 TIii,_. 13:32
- . 41
1 ' . ,
.
CONSTRUCTION AND PLANNING POOH Pp'
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
•
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,
2. Soil Pipe-Undrgrnd. I • 53. Steel Reinforcement ,' •s i -
? Conduit Utility-Undrgrnd: •'; - 54. Forms
4.-1Eleclrical Conduit-Undrgrnd. 55. Electrical Bonding
5: Steel,Reinforcement• 56. Rough Plumbing & Pressure Test - 'I
'
•
6..Electrical OFER'Grnd. 57. APPROVAL TO COVER-GUNITE 1 1
7. 'Footings' _ 58. Electrical Conduit-Undrgrnd. , ; ,
8: Foundation 59. Gas Pipe, 0 Undrgrnd., Test ,
9. Water Pipe-Undrgrnd. I 60. Backwash Lines, P-Trap, 0 Undrgrnd.
1
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line'& House Connection - 62. Backwash & Receptor-Final
12. Sewer.Cap - 63. Heater & Vent-Final
13. R "oof Drains 64. Plumbing System - Final
14. Rough Plumbing- 65. Electrical-Final 4
15. Rough Electrical-Conduit 66. Solar System-Final
r
.16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
.18. Rough Electrical-T Bar Ceiling 69. POO USPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in StructureI 70. Underground Hydro
•22. Ducts, Ventilating : 71. Product Piping OGas ❑Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush ,
24. Roof Framing 'i, ' 73. Undergrnd.Storage Tank 0 Gas 0Oil,`
25. Roof Sheathing - - 74. Overhead Hydro i
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical /
27. Frame and Flashing 76. Dry Standpipe ,f
28. Lathing& Siding • 77. FIXED SYSTEM FINAL
29. Insulation ,7 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
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace ' ,
38. Final Plumbing •
39. Water Service-Final
40: Gas Service-Final
41. Solar Domestic-Final /
42. Backflow Preventer - ' I
43. Backflow Irrigation /
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations ' '
47. FINAL STRUCTURE & BUILDING r - yit) _.912.2_,48. Special Requirements Completed 4,' cfC ,
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ' •
51. CERTIFICATE OF OCCUPANCY ' I
No Date •
Costa Mesa Building Department Q /APPLICATION FOR PERMIT
ac
A. ' 111 EAST 20th STREET Les ✓ BUILDING
1
COSTA MESA, CALIFORNIA
` FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
_ Receipt No. Permit No.
Building
Address •XXXX . 188 E 19th St /`{a o
.Costa Mesa, California Rued by Date Recd. Date Issued
‘--4---4----6 —,-e-J r—
CrossSt. Orange Ave Budd
Address
Owner Max V. Pope. Inc . Costa Mesa, California
Mail
Address 407 Boise Ave , Nearest
Tel. Cross St.
City Alsw nnrt. RParih No. LI8-2281 Zone I No.of I Type . / I Group
Architect oLie. Plans V
Engineer No. Approved
by Date
Address CORRECTIONS
kr
WPopeCity Lie
1513
i ntractor Max W. No.
Address Set me v �d,/tie�...� / Ile
Legal Lot {i at
Description I No.Wet. I Block T t
(AttacbiMetes and Bounds) Over , ��
No.of Bldgs.
Size of Lot 58.9 'x130[ I Now on Lot 0 � �
Use ofNo.of No,of - se
Existing Bldg. O . I Families I Rooms
Setback Line from Rear Yard 3b t
Center of Street 50 t Side Yard 5 I 1
DESCRIPTION OF WORK - r---
-
New I X I Alteration I I Addition I - _ , , .
Repair I I Moving I I Demolish I
Building No.of
Size 1513 sq I Rooms 6 Stories 1
r-terior Wall I Roof
I •ring Stucco I Covering Shakes APPROVALS
e of New
Building Res & attached gar . Foundation Location Inspector Date
Forms,Materials, z
Under-Pinning -.
J.
isiG3p Jou. Frame: Fire Stops,
9 OO.Q , 4,4 1, Bracing,Bolts n
C 0
Lath. Int.
I hereby acknowledge that I have read this Application N a
and state that the above is correct and agree to comply Lath. Ext. n n
with all City Ordinances and State Laws regulating
building construction.
Plaster, Int Ln
Signature of w
Permittee rrZ
e r Plaster,Ext.
Authorized Agt. �� *
Masonry Reinforced *
Valuation , Permit F $ 3 0 w
Plan Check$ S Bond Beamtidi
$ I �'/ 7i� Total 5._)--!! '
Fee $ FINAL o
FORM 204 a-M 214 5-54
.
0 The NW'ly. 58;9. felt of the.'SE'1y '
151 .40, feet• of the SW' ly- 130'.13 feet
a0 of Lot 172, Newport Heights .
•
•
•
1 _
i
-
Street • 9',i inT -. •r. .
. i .T
PLOT PLAN
Show location and distances from -
property line and between buildings. �� ,., i, ,• ,�� •
- —_ --- - __ -
r f _ •
- .. • —v. a __ __ _ '.
• , - • .
.i '
i . i.
FELE RECEIVED
14534 MAY 18Mel
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. 0. BOX 317 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT cBUILDING
wDDREBsG
BUILDIN ' g 6 EAST I ci fy J�1
COSTA MESA. CALIFORNIA For
111Office Use Only
MRS . MERLE L I RHCHI PT NO. I, APERMII NO.
OWNER E . K L.LO K
MAIL ` CrCEIv/E�p BY DATE RECEIVED�yI' H ▪ U/H2O
ADDRESS IiA ERSr I e' I, !��- I .-- ,'i'- o -I• yl
TEL.1,1I,ER ry BUILDING
CITY CO STA mess eiik'f NO..•- fry , ADDRESS
ARCHITECT I
TEL-
OR EER • COSTA MESA. CALIFORNIA
NO. -
ADL..CSS FIRE `/
��}-y,,p ////�� ZONE � � TYPE r GROUP 1�=J /
CONTRACTOR (iZ�-v//,(/I/ ._J(� BYPROV��(ff1J fy DATE 57/I.- (p/ \
ADDRESS �/�'� ZONING
ZONE NO.NO; USE OF NEW
CITY (/ �j ./ 1\\txtrkird.
I PLANE I�DDUfII L�BINNO T
STATE Se
//1 1 NO. ssi
DKSCRIPTI 'V�"�\\ L j�,..,� DI)LIC.NO. J ` J Rt f y-1
SIZE I NO. OF BLOCS. / !i (�I � os / — 2 Li
-i-'
OF LOT NOW ON LOT A.P.NO. SI-JT
USE OF11 MYARDS EVES
U
EXISTING BLDG. OA- T APPROVED ALL9WED
SETBACK LINE FROM 10ENTBR UNE ST.)
CENTER OF STREET REAR YARD FRONT jIN.
/�
SIDE YARD I LEFT I RIGHT R.SIDE /T'IFT. W( �lam ' IN.
DESCRIPTION OF WORK L.SIDE moi/(�� FT. IN.
NEI"' I ' "// //ALTERATION I II ADDITION I" REAR + / j FT. /� IN.
REP....<
II MOVING I II DEMOLISH I BYPROVE- . LADATE __ MCC
BUILDING
SIZE (% " // I NO. OF
1S 4 ROOMS STORIES -
EXTERIOR WALL I ROOF k'
COVERING COVERING SA4 'L
USE OP B ILDING AND WORK TGRE PERF RMED
/2777., et t/r' CO G G .Pr.S•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONS UCTION. VALUATION JJ
SIGNATURE OFTe /[� C>^ PERMIT FEE $ s� `
PERM ITTEP C (,/ � � e' / 0N
/ / $ PLAN CHECK $
AUTHORIZED AGEN Lor /( (//✓'/',(�"�1 ,r E
TOTAL. FEE S 0
VI" 27Q
73 •
P Sab ' MAR 17-71crA+sn00 452* ****61.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Appp/can(t to Fill in Completely/� Vy� RECE V D V DATE RECE'jJVED D/{gq�,//�'E IS D
ADDRESS t a. Ai, � l nsu\ \11� St ^i / -,... 7/
` P RMIT •
OWNE' .�, A �rU 1lT A.P. NO. p _Os/_ n 3
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ADDRESS VAS)
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ADDRESS/ O
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0.0 CITVC�, MeS TEL. •' rr TRACY I. I p�'OTT/� BLOCK
I� NO.
2< CONSTRUCTION ` ` NEW ADD • TER ; P• - MOVING DFMOI ISH
ON LENDER �r
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J 03 BRANCH til
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JN OWNEF�C/i77P5 Vie i N
4 • ADDRESS VALUt E'
ARCHITECT en' ' TEL. S 5 ASO
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ai `t OR ENGINEER -Y. A
FIRE ' „/
WQ ZONE TYPE if GROUP a7
< ADDRESS ��
d uJ APPROVED n
W Z CONTRACTOR BY (J y1 DATE -2" ay \
mL. 1x ADDRESS :Er., •�-yC
W W ZONE NO,OF USE OF NEW rtf `7' Ca!"---.'!]i CITY NO. &7 PLANS?' BUILDING T"� co'V
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LUO STATE CITY YARDS APPROVED YARDS APPROVED
to CC LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
D 512E 1 // 1 11 NO OF BLDGS. (FROM C/L STREET) / /' tl
OF LOTSAUSE OFmx ` - , INOWONLOT I FRONT v CfFJI?, /£OFT. 1 634. �
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EXISTING BLDG.K�rrk� u12_ R SIDE O ,7 FT. 4 FT.6 r/ . `�
I- SIZE OF , .tet°x ocu-OHNO.OF rFT.NEW BL ' -OOMS STORIES I L.SIDE U FT. / FT.
Q EXTERIOR WPPLROOF nn G p /I
V COVERING:ZJ�iCC� COVERING sit REARS L FT.S -! FT.
J I U- 5� OF 8xl�41�N, �O��A,N\Q WO RrK�Tj]s6 PERF_ OF�•1EDt DISTANCE VMAIN BLDGST ACCESS. BLDGS. A£Elt/P�L
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O q�/'-I��/-����,,PA-14�1y.]�� T .o�t::-.c�117'Id\.IFJ/f1]1_d CC.UU.P.# APPROVED / �1
CO 1�1\7'sVU\V\\ \V throe_ Oct ArsR�CYGV{{''g�l�s t fr� 14
DATE 0 — / / -7/
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0 mil . ,� Jai a\x. fir` o�>L 1. 9 ; ( 1ntio. • �• SfLuaN °_.:_
UI hereby acknowledge that 1 have read this application and state jYO g_ 1� f `.,, ` __ j'/ ,,
= that the above information is correct and agree to comply with v//�� I (•f/�-"•-+'�•L' -Y---
CC all laws regulating building construction, and I shall not employ .y
I- any person in violation of the workman's compensation laws of ll 3 — /,�--7i
the State of California. / re
zI hereby certify that I am properly licensed as a contractor under ��4 •SO, FT. (p�3o
the State o alifornia Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER LUATION IS FOR 5
Chapter , an that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING( PERMIT FEE ONLY:
CC
am axe pt fr m the provisions of th State of California Business
VALUATIONa
and Pro ssion Code Division 3,Chap 9. b C9
PERMIT FEE $ z ry
O
Sign atur of !Ico
Permittee .Q 5 -� PLAN CHECK 5 2-0//V E
F
Authorized Ag nt ��� TOTAL FEE $ U.
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