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HomeMy WebLinkAbout237 19TH ST - Building Permits .1 yrn CITY OF COSTA MESA 4� 9 BUILDING DIVISION g __ .�. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t j<f ' PERMIT J'+t 1iI,p B04-00416 bu (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa,ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 237 E 19TH ST Status: ISSUED Suite: Applied: 02/23/2004 Vicinity: REAR UNIT Issued: 03/31/2004 Parcel Number: 42540413 Zoning: Applicant: DANCIU, ANGELA ISSUED BY: Address: 2239 MEYER PL Phone: 949-642-6954 COSTA MESA,CA Zip: 92627-2520 Owner DANCIU, GEORGE TR Address ;2239 MEYERPL - Phone: - /COSTA MESA,CA I . Zip: 92627-2520 - Contractor: J) �,_ Address: v , Phone: - Zip: License: . Arch : Eng: DJK ENGINEERING Address: Address: 25102 QUETZAL ST _ Phone: Phone: 949-458-9169 MISSION VIEJO,CA Zip: License: 92692 License: C60033 SCOPE OF PERMIT . CONSTRUCT 391SF DETACHED CARPORT FOR BACK UNIT ON THIS SITE. FEE SUMMARY Plan Check: $90.51Calc Valuation: 56,302.92 Permit: $139.25 - - Claim Valuation: $0.00 SMIP Res: $0.63 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 ` Total: $230.39 PLANNING &ZONING , SETBACKS MAIN STRUCTURE Front 0.0 .Rear 0-0 ' Left 0-0 - - Right 0-0 ACCESSORY `Front - 27-0 Rear 20-0 - Left 5-0 - , Right -,6-9 ' - , ' PARKING Existing: 0 Required: 0 Proposed: " 0 ' , ' NOTES: - - f 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 2446.48(6100) DECLARATIONS 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: Carder: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less,) I certify that in the corn cei of the ork for which this permit is seri,I shall not employ any person in any manner so as to become subject to the workers' compensellon laws pallfo la,and a that If I should beco a subject to the workers'compensation provisions of Section 3700 til me Labor Code,I shall forthwith comply with these pr slops. Applicant Signature: Date: 7-5 )-1-9 WARNING:FAILURE TO SECURE E COMPEN TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THC'ISAND DOLLARE($100,000),IN 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 and effect.Lie.tl Class# 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). Lender's Name: Lender's Address: Signature: Dale: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 for11 suchproject with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am&em under se Business and Professions Code for this reason: /1 Signature: (/� Expires: ) LI Inn i--- Verification 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(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-bullder, 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: 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 Califomia Health end 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). 3 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 and 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 epernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the Califomia Govemment Code requires that the requested Information be furnished on applications for non-residential building permits). ons_.__.._.._._._i_ _ _.__.._ . 6 Will any part of the facility to be constructed under this permit be within 1000 feet-from the outer boundaries of a school? -In Yes 0 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 Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",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`COMP • CE ANDAUTHORIZATION OF EP Y:I certify under penalty of perjury that I have read this application end state that the information given is correct.I agree(Nom* th all state 1 s and city ordlnano6s relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described roperty to pection pu v.I ag not to occupy or allow occupancy of any building authorized by this pe t until final inspection. Sign.' re Of Legal ner(s) ate And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE MALE QOM t INSPECTIONTYPE RATE MALS 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 .Ma/Dg fP CITY OF COSTA MESA 4 a', BUILDING DIVISION >%,'� '.4 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER f t .,,...”,_yr, I PERMIT � 04-00002 ds* (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 237 E 19TH ST Status: ISSUED Suite: Applied: 01/02/2004 Vicinity: RESIDENCE ONLY • Issued: 01/02/2004 Parcel Number: 42540413 Zoning: i Applicant: DANCIU, ANGELA ISSUED BY: nt Address: 2239 MEYER PL ie Phone: 949-722-6989 COSTA MESA,CA Zip: 92627-2520 Owner: DANCIU, GEORGE TR Address - 2239 MEYER PL , Phone: . COSTA MESA,CA Zip: 92627-2520 Contractor OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : _ Eng: Address: Address: Phone: Phone: Zip: . License: License: SCOPE OF PERMIT REROOF RESIDENCE ONLY:T/O EXISTING COMP ROOF,REPAIR/REPLACE SHTG,2 LAYERS 15#FELT,APPLY"20-YEAR COMP SHINGLES?800 SQ FT FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 • SMIP Com:. $0.00 , Other: $0.00 , Inspection: $0.00 - , Total: $69.75 . , '.. PLANNING & ZONING , SETBACKS , MAIN STRUCTURE Front 0-0 Rear -0-0 Left 0-0 Right 0-9. . ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 _ PARKING Existina: 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 244646(WOO) DECLARATIONS 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. 0 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 carder and policy number are: Carrier: Policy Number: (TMs section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify sari in law01 Call mlce of the work for which this permitecIs issued,I shall not employ any o in any manner so tion becomef the subject to the, shall comply with hlaws ro sin.mi: and: roe that it I shqultl become subject to the workers'compensation provisions of Section 3700 of Labor Code,I shall forthwith comply with these provision . -1 —W'n Applicant Signature: Date: ! o WARNING:FAILURE TO SECURE WORK'•S'++ PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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.tic.4 Class N 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). Lender's 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 end 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 cMt penalty of not more than five hundred dollars($500).): td 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.). • O 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 a under sec. Business and Professions Code for this reason: r� q .� Signature: �^ ` Expires: /I- /1 0 f Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that n0 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 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: 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)... a — ._ __...._ . 2 Does or will the applicant or present or future buil0ing occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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). 3 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 0 N (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? 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes 0.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? 0 Yes 0 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 SouthCoast Air Quality Management District or other air pollution control district or agency Le required for the work which Is the subject of di. application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (if yes;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 COMPLIANCE MD 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. \gnatu Lege Owner(s) 8 1q -A,.•1` AuthorizedApplicant -f2/'To Date` GOOF r. INSPECT10NTYPE 2J1IE MOM gOOE( INSPECTIONTYPF. 2631 1011613 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof /,/7 t0Cl/ arAa 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 11f 7 CITY OF COSTA MESA •-' • fr BUILDING DIVISION F4 er.A DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER proMa PERMIT ta. 111.4 4 ro e B04-00415 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 237 E 19TH ST Status: ISSUED • Suite: Applied: 02/23/2004 Vicinity: FRONT RESIDENCE Issued: 03/31/2004 Parcel Number: 42540413 ' Zoning: Applicant: DANCIU, ANGELA ISSUED BY: Address: 2239 MEYER PL Phone: 949-642-6954 COSTA MESA,CA Zip: 92627-2520 Owner: DANCIU, GEORGE TR ' Address ,2239 MEYER PL / • Phone: .A COSTA MESA,CA Zip: 92627-2520 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch-: Eng: DJK ENGINEERING Address: Address: 25102 QUETZAL ST Phone: Phone: 949-458-9169 MISSION VIEJO,CA Zip: License: 92692 License: C60033 SCOPE OF PERMIT- ' CONSTRUCT 351SF DETACHED CARPORT AT FRONT UNIT ONSITE. • • FEE SUMMARY Plan Check: $81.41 • Calc Valuation: $5,658.12 Permit: $125.25 — - - Claim Valuation: $0.00 SMIP Res: $0.57 •SMIP Com: $0.00 • Other:, $0.00 • Inspection: , $0.00 • Total: , $207.23 - - PLANNING &ZONING SETBACKS , - ' ' - - MAIN STRUCTURE'Front 0=0' - ' Rear 0-0 Left ,0-0 - " _ Right 0-0 ACCESSORY Front 27-0 Rear 27-0 Lett 5-0 Right "0-0 PARKING Existing: 0. Required:. - 0 ` Proposed: _ 0 NOTES: - ' - 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 244646(6/00) • ce DECLARATIONS ' - ti . 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: Cartier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) LEI 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' A.lv compensation laws of Call mla,a agree that If I shouldme subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr vision . ;r2 t /, Applicant Signature: Date: `/ • • WARNING:FMLURE TO SECU ENSATION WV RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), MON TO THE COST 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.Lic.# Class# Contractors 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). Lender's 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 s )acts 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.). KI,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:Th co tractors cense 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 pLlr'sue t to the ntractors License Laws.). 0 I am exe pt un r sec. Busingss and Professions Code for this reason: Signature: Date: r Owner ID verified by d er's lic se. ❑Yes 0 No Driver's/ 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(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 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: 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 then 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). 3 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,codification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II 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 a this application a_permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? CI 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? 0 Yes 0 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 Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (if"yes",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 COMPLIANCE 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 end city ordinances lating toa building construction,and authorize representatives of the Cityof Costa Mesa to enter upon the above-described pr or inspect' urposes.I agree not ax:upy or allow occupancy of any building authorized by thispprmit until final inspection. r Si ure Of Legal Owner(s) \ Date And/Or Authorized Applicant Date COPE/ INSPECTION TYPE ON INTInAL$ CODE( INSPECTION TYPE RATE 1IIT1IIAI& 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 555/A �m� P PP V i . Applicant Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. �4 15 2/13/-85 CITY OF COSTA MESA �zONSTRUCTION PERMIT PERMIT.P/7516) �N7O- I/\7 - TRACT NO. LOT NO. UNIT NO. Do 0.'1 11 . Project Address /237,F: -/9 TM si. . . - `t' / lJ-/O c - - .i , Applicant's Mailing Address • ' TYPE OF CONSTRUCTION U NEW `U ADD Li ALTERATION $ REPAIR , ' - - ,e' q n ❑ CONVERSION '❑ DEMOLISH ❑ OTHER q•p•# Zone Owner's Name _ r . E T -� Phone-�.. . D CR IPTION OF WORK/USE•OF BLDG. /1 -PLI}CE DEFFCT lrL • Address ,23 4, /9 re -s • _ S L iNC -S Main Building: • • Accessory Building: , - - ' Arch/Eng. 0/6 - License No. I • _TYPE OF PERMIT• ❑ GRADINGIIppII LI FOUNDATION LI STRUCTURAL T. Front O ' Address Ill ❑ ELECTRICAL NI PLUMBING ❑ MECHANICAL B Rear N 'Contractor's NamF--- - Phone ID -OTHER - A .^1 PROJECT DESCRIPTION 50. FT. • OCCUPANCY C Right I •N 'Address(mailing/ - O//1 • CON STRUCTION TYPE • VALUATION $/Oa' S Left I - r ; G City License No. - _ ZONE GRADING CU. ACRES ' - R LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E i I hereby affirm that I am licensed under provisions of Charter-9 (commencing Remarks: r Planning Notes: , G 'with section 7000) of Division 3o the Business and Professions Code, and •- M my license is in full force and effe t. I _ - T License Class ! D e License'No. , • $ Date - - Signatur6 • - PLUMBING FEES I • WORKERS'COMPENSATION EC LA RATION Bar Sink - Showers - ELECTRICAL 'FEES 1 hereby affirm that I have a certificate of consent to self-insure or a certificate •' - If Workers' Compensation Insurance, or a certified copy thereof (Section- - i •- A Backf ow.Pfeventer Service Sink 3800, Lab. C:)' - ' • "" , Automatic Washer - Transformer 0 15-50 KW - t - - - w -- Policy No. Company Backflow Irrigation Sewer Ca 0 50+ KW ' • P Construction Pole Sub. 8 Certified copy is filedhereby te furnished. - • - - Certified copy 15 filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Dun tO 100 amps Date Applicant • - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION. Clarifiers - . Solar Collectors Dishwasher Meter Dover 100 amps '(This section need not be completed if the permit Is for one hundred ($100)or - - - less). • Dishwasher Solar Piping Dryers ❑Gas .❑Electric rSub Panel I certify that in the performance of the work for which this permit is Issued, I ' 'shall-not employ any person"in any m ,anner so as to-beco•'e subject to the Drinking Fountains Solar Tank Fan - Wor s' C e cation Laws of Cali • ,n1, a Motors❑41 HP ❑1'F,-6 . Date ' 9gnat ure - I -% ✓ Floor Drains ! Swimming Pool w/Spa , F.A.U. 'NO CE:I of er making this declaration,you should'•.come ubject to the - • Inc.Solar ❑9.15 HP,01645+; ;Workers''Compensation-provisions of the Labor'Co. , you must forthwith ' Floor Sinks - _ ,. Urinal -- _ -_ _ - _ - _ _ comply with such provisions• or, this permit s - I be deemed revoked. Fixtures I . - Microwave . I - .CONSTRUCTION LENDING AGENCY • -. - i Gas Service Outlets _ Water Closet Device Boles Pole Li ht I hereby affirm that,there is a construction lending agency for the performance - - - 9 . of the work for,which this permit is issued (Section 3097 Civ. C.) ' ' Interceptors Water Heater Outlets ' Lender's Name - - Range ' Lender's Address ' • Kitchen Sink. ' :, _ , Water Service ' . _ Switches OWNER BUILDER DECLARATION - • ` = ° . . Sign I - I hereby affirm that I am exempt from the Contractor's License Law for the • Lavatories Auto-Wash . • Garbs a Dis oral following reason (Section 7031.5 Business and Professional Code: Any city or - .- 9 P Standing Sections 1 county which requires a permit to construct,alter,Improve,demolish or repair P-Trap ' LaundryTrays ' - • any structure, prior to its issuance, also requires the applicant for such permit y Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains Re PL,9 !EI)eFt L'TIVE —� 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 - /•�3 / �N� al O0 031.5 by any applicant for a permit subjects the applicant 'to a civilV i. ei • penalty of not more than five hundred dollars($500). ' - ; /W�I, -as owner of the property or,my employees-with wages as their sole Reinspection Fee $15 Issue Fee $ 3 s compensation; will do the work, and the structure is not intended or offered - 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 or 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 I I ❑ •• . 1 Zoning Approved By Date ) pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground; r Building Approved By I rove for the purpose of sale). Date D r U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural I Refrigeration System •� s Application ISSUed By Date - • ' 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 1 00-100,000 BTU 0100,000 BT-U I ' , builds or. improves thereon,and who contracts tor.such projects with a con- SUMMARY OF FEES r tractor(s) license pursuan't'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 provided to me. - r PLAN CHECK - $ ' • PERMIT • • o ham exempt under Section B:& P.C.for this reason Firepl/Fact.BIt. ICBO# Fire Dampers ' ' PLUMBING $ CO 0 ISSUANCE $ Date • Owner ' Heating System& Ducting Registers ' ENERGY P.C. $ ,I hereby certify that I.have read this application and state that the above 00-100,000 BTU 0100,000 BT - PLAN CHECK 25% $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ GRADING' $ and state'laws relating to building construction, and hereby authorize repre- , MICROFILM .5 r sentatives of this city to ent-r 'on the above-mentioned prop•rty for ' ) PLAN CHECK 50% '$ • Inspection p r.•se . / • 2 / r r MECHANICAL $ TOTAL FEE $ S6 C/ Signature //�' i !l_/ / `v Date SS r ' • =MF 0865-46,rev. 10/84 White - Building: Canary •Applicant; Pink -Accounting; Goldenrod - Assessor .. - s - _ __ ' 1 . , . , - - POC,-6r SPA . - -` _CONSTRUCTION AND PLANNING : - _ ' APPROVALS Permit# • Date ' Inspector ''-APPROVALS Permit# • - Date Inspector 1. Temporary Electrical Service or Pole ' . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' 53. Steel"Reinforcement - ' f 3,• Electrical Conduit Utility-Undrgrnd.. ; 54,i Forms - 4..Electrical Conduit-Undrgrnd, . 55. Electrical Bonding • ' 't5. 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, 0 Undrgrnd,,,Test . , 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. r 10. Structural Floor System - 61. APPROVAL TO DECK _ , _ q11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final. - .12. Sewer Cap - ' 63. Heater &Vent-Final • . _ ., 13. Roof Drains 64. Plumbing System- Final r . ' . • 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 i - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1 • . ' 19. Rough Heating & Air-conditioning r 0 FIRE DEPT. REQUIREMENT • 20.• Rough Factory Fireplace ' , APPROVALS Permit# 21.,Ducts, in Structure ' 70. Underground Hydro • . • 22. Ducts, Ventilating 71•. Product Piping 0 Gas0 Oil t • 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 c. 28.' Lathing & Siding 77•. FIXED SYSTEM FINAL ' L 29. Insulation - ' • 78. FIRE PREV. FINAL . • 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat ' • 79. FINAL INSPECTION - . 1 32.,Electrical Power Meter-Finals . , 80. FOOD CERTIFICATE ISSUED . 33: Final ElectricNotes: ` ( & recc.c. Req. GED. . 34. Final Heating & AirConditioning . 35. Final Gas Pipe-Test 1 ;War - • -I _ 36. Hood or Canopy , , 37. Final Factory Fireplace ; - - 38. Final Plumbing - ' : 39. Water Service-Final 40. Gas Service-Final . *sit- cry) • - , 41. Solar Domestic-Final - - - - • - I42. Backflow Preventer , ; , • • - •• - _ _ , 43. Backflow Irrigation ; I - 44. ,Landscape Irrigation System, 4 - 45. Sound Attenuation i -i 46. Handicap Regulations ; I . 47. FINAL STRUCTURE & BUILDING • -. I 1 48. Special Requirements Completed , • , - 49. Electric Release to•Edison i I t i 50. Gas Release to Southern California Gas Co 1 I ( - . I 51. CERTIFICATE OF OCCUPANCY , - I • --- - - -- t--` - i �- '• No. - Date I _• ' . l i !1 . ,' 11009 FEE I r - ,EIVE i.qOSTA MESA BUILDING-SAFETY DEPARTMENT Edo tI),P.O.BOX 317 COSTA MESA,CALIFORNIA FINANN CE DEPT. CITY OF COSTA MESA FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING DS X 3 1 V , !4e•-.±-,- g't, . .. AD EIS /// COSTA MESA. CALIFORNIA • FOR OFFICE USE ONLY �J 1 f j' - RECEIPT NO. I11 iPui1 NO. s OWNER R T VC t1 L �j 1:4 k. C,/'[` MAIL 2 3 7 t 14 Lt. RECEIVED BY �T� RECEIVED �E ye;757 ADDRESS Sit �/� t r E� �- I u sc Ft '( / O/Yr_0 / �O- / • CITY C 0 9 ` ti 14 -e_•S TNO./t1c g'-IS q =Tow Q 37e /,9, r ARCHITECT LIC. COSTA MESA. CALIFORNIA OR ENGINEER NO. FIRE ADDRESS ev.� ' .�' ZONE ( TYPE k/e •GROUP CONTRACTOR O _. ..ivy • LIC.NO.TBY R�����J�� .DATE Van ADDRESS _ • Z6NING _./) LEGAL 117101.. OT ^/ y/yq Cie 20N(p•/�/ . / NO.OF UUI OP NEW ...L� DESCRIPTION NO. 7-19 )- - p/]L �//� BLOCK TRACT • ,/t "Y IPLAHB I BUILDING /,y. A C\� A.P.NO. I/ / - / / )- - j//1 APPROVED It .BYc%') D��.� �jTATE //... .24,,_07 , lll./1%^F.l'y� _ ` V SIZE .�Vt !/g f 36 • O I NO.OF YARDS NOW ON LOT6 REQUIRED �/ F/// ALLOWED L4 //q OF LOT !J 7 USE OF (CENTER LINE ST.) �. EXISTING BLDG. /] til FRONT 71 FT. I SETBACK LINE FROM L ? f REAR YARD/�(! R.SIDE & FT. got Y'a-,. .� CENTER OF STREET J V !: t f SIDE YARD (LEFT RIGHT '.i L.SIDE a FT. IN. DESCRIPTION OF WORK' «ff �/` REAR @� IN. NEW I ALTERATION I I ADDITION V REPAIR I I MOVING II DEMOLISH I - S ZIE DING / I P1• ROOMS - Iq STORIES I �I 27 EXTERIOR to D COVERING Ve r /O �/ COVERING USE OF BUILDING G AND ORK TO BE PERFO ED / ,i�/•N,+Y_'�-+- ,USS_ - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT ESTAB UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONS TION. •{y�/ _ VALUATION .J1 �+{ SIGNAERM TURE E u�t'W t �Q p/f PERMIT FEE $ vr-� $p'- 70 PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE $ c2 9148 SEE RC Eii.D LISTA MESA BUILDING-SAFETY DEPARTMENT - dAPK 215 1959 eVelr- P.O.BOX 317 COSTA MESA, CALIFORNIA �TFINANCE DEPT. ESA FOR APPLICANT TO fill IN COMPLETELY APPLICATION�FOR PERMIT TYPE OR PRINT BUILDING AB DDREISN: 23-7 & / 5' '� s T COSTA MESA, CALIFORNIA _ FOR OFFICE USE ONLY r) oWNE eK • cw RECEIPT NO. I 1. 48 A l� MAIL ADDRESS307 E1 /9 A S r 45Y D/, flECE j I88U' (- /•y/ ` I / L� CITY / ��1q. J�,( .L S ADDRESS /�/j w/ �/J �CSr rw) /"/CJ•I . 1� w ADDRESS L J L // \\` ARCHITECT fff/// LIC. OR ENGINEER NO, COSTA MESA. CALIFORNIA ADDRESS FIRE L tr�C' group �,CDI/�}J Q V ,C-� ZONE /J )) p/ cTfSyLT/OF��i'S 7�/�LDPsL��NTQ!/1' BYPROVED t a�^C DATE ..z/?/,.- ADDRESS ADDRESS 20 V 4�c- 7N/ //K -r-e-r ' 6 ZO1N .IG LEGAL I LOT �J I a l ZONE I` / I NO.OF 2 I UBE DI NEW / , DESCRIPTION NO.. "" +f BLOCK TRAvC7/ , APPROV y PLA�j O N Bu1LDlrvc l// ` 1 A.P.NO. // /- >�1/ /iy+�yp17 BY E// «///iIV✓i f�(NJVN>'///�iJyJL-/Z�) DATE VI(P-d)/ _ OF LOT SIZE S/V/`ta// / JO D II I NO.OF NOW ON LOT6 2_ YARDS EVES SSS...�LL� q /� REQUIRED ALLOWED USE OF 1/ �e 4/s //i/ • O R C (CENTER LINE ST.) T EXISTING ` "' �C ""YY� '[/\ FRONT 3—D FT. IN. SETBACK LINE FROM , �L'3w CENTER OF STREET REAR VA R.SIDE IN. SIDE YARD I LEFT/7 F/ I RIGHT 45.-3/4 L.SIDE FT. IN. DESCRIPTION OF WORK q Z REAR s-. 4- FT. /0 IN. NEW I ALTERATION I II ADDITION I REPAIR I II MOVING I IINO.OF IDEMOLISH I SIZE BUILDING ROOMS STORIES STORIES / EXTERIOR WALL` „`COVF ' / n/ COVERING ISM, ROOF RIN ROQ IC- USE OF BUILDING AND WORK TO BE PERFORMED slams Y - ,.), , y =7 Q ? I HEREBY ACKNQWIEOpE THAT I HAVE READ THIS AOPLICATIN AND STATE THAT THE/ABOVE S CORRECT AND AGREE TO COM THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 'PLY WITH ALL CITY INAN ES AND-ATATE_ WS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONS U ION. C VALUATION i� SIGNATURE L-i/ // / PERMIT FEE $ L„ ,_ PERMITTEE aI TI $ V� I PLAN CHECK $ //• AUTHORIZED AGENT , ' TOTAL FEE $ 3'7 t, V J----ft... COUNTY OF ORANGE ' ' . BUILDING DEPT. 3 Permit No /3143 ,, • 636 No. Broadway Ai. .ication for Building P mit Santa Ana, California Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy Date . 1. OWNER'S NAME /J" Et"f� ��• ece--, v PHONE• MAILING ADDRESS..ay ?-57 . -5� -l%.l� -STj �JCITY o -4 �%� 5 Name Name d=am /54�f ?4t€55 5"��0,7-/ �• (Architect or Engineer) ./ �-(Contractor) / Address Address.., c27_9.--2/dJi° 21/Zee is CGP- ' City . _ City ,4C -,Es — 'r'd , State State ---,/,-,7 Lic. No. Phone Lic. No.../l' 76- ' Phonatelllt PROPOSED USE: .L1I2247, �0.. T--ac/-e--"--1,/H�.S77 -"--.se!27-__'estenyeas -///10-es .G' 2. JOB LOCATION 217 .�//ST/p-Ti_�._1-____—f_4-T'- J (House No.) (Name of Street) (Town or School District) 3. LEGAL DESCRIPTION: Lot a �.o� Block 1:12 Tract s9 (Metes and Bounds Description—Use reserse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( v)' THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG.: ._................___.....AREA• SIZE OF LOT- AREA: 6. HEIGHT OF BLDG • CEILING HEIGHT- NO. OF STORIES 7. NO. FAMILIES Size of Smallest Bedroom: Size of Kitchen: 8. EXTERIOR WALL CONSTRUCTION• INTERIOR WALL COVERING (Frame, Stucco, Etc.) (Plaster-Drywall, Etc.) 9. SETBACKS: Front Yard from Center Line of Street Nearest Side Yard Rear Yard Distance in Feet Between Bldgs. on Same Lot 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 11. For (a) Footing: Width Depth in Ground Width of Wall Accessory Bldgs. and (b) Size of Studs: Spacing "CC Material of Floor Similar Structures: (c) Size of Floor Joists: Spacing _ "CC ' (d) Size of Rafters: Spacing "CC 12. VALUATION OF PROPOSED VO • clu g a bor,plu bing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal .- ... _. .__ PPS 13. I HEREBY CERTIFY.THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. r — co Signed- Plans Filed• (O Q �j. (Aut prized •e.•t) FOR DEPARTMENTAL USE ONLY FEES: U / CHECKING BY rJ l ,si 0----- Bldg. Permit $ GROUP _ a .__. APPLICATION HEALTH Plan Check - TYPE �,. _- FIRE ZONING MARSHAL: Total - So MAP PLANS AND -- Receipt No. - - -.# SPEC'S STATE Paid to SHEET NO e=47 ' CORRECTIONS ENGINEER Date _'2•_a 't�2._t_ VERIFIED CAL r 1A' n'JNOHUE CO I:NTY BU LD NC o /— f1 t PERMIT I.S{JI3D•BY: r t.SP:cTOR ' r -j s 7 .�, t. DATE t� l 1 sr- P „ Y 5M-7-50 V' METES AND BOUNDS DESCRIPTION: • • -• - . IO 2O 3k 4k 51Q 6o 1 OPIghli 1 1111011111. 111111"1 : I 1 I ELI= "- - limas, i - N _ - - -',_1 omml_ 11 111 1 _ ,_ 1 1110111 allarr I I -1 111111 I 1 11111111111E I I --‘. IIIIIIIIIIII I phippm T dbmondm 1 _ A A_ i 11 1111111111/111 111111101111 IIIIIIIIIII III 111111111111111111111111111111111111N - -111111111111111111111111111111111 I 1 --oc - 1 I Hum mom nom! ! 1 1111111111111111111111111111111 iiiiiiiiiiiiiiiiiil co.