HomeMy WebLinkAbout301 19TH ST - Building Permits ' J CITY OF COSTA MESA
,y ' :: BUILDING DIVISION
``�7 ..�, 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • .ci.costa- s . .
tr.��� FOR INSPECTIONS CALL:(714)754.5626 -
PERMIT NUMBER. BC08-00319
PERMIT TYPE: B_COMBO STATUS: ISSUED '
Sub Type: RES_ALT DATE ISSUED: 07/09/2008
ISSUED BY: YH
JOB ADDRESS: 301 E 19TH ST Cit.:. i Suite/Unit:
APN: 11725424 .Zoning:, ,
Vicinity: Primary 0cc: U
Const Type: V-B • SQ.FTi ' 0 Valuation: $300.00
SCOPE OF WORK: DEMO BATHROOM IN EXISTING 3-CAR GARAGE (REMOVE BATH/SHOWER 8 TOILET), REMOVE
PARTITION WALLS, RETURN GARAGE BACK TO ITS ORIG. INTENDED CONDITION-UTILITY SINK TO REMAIN. .
REF:C08-1421
OWNER: GERARD,JOSEPH'S ' ; - `: :"'Address: 2255 TUSTIN AVE - -, . • ' Unit:
Phone: • City/State/ip: NEWPORT BEACH,CA " '• .' „,.nn,a i ry
APPLICANT: GERARD.JOSEPH S .-. -. Address: 2255 TUSTIN AVE . Unit: :
Phone: 949 795-6723 : City/State/zZip:• NEWPORT BEACH,CA
CONTRACTOR: _ License No.
Phone: ;:_.Address Unit. - • ,
Cell: ;v City/State: _ - ZipCode
ARCHITECT: .. License No. PHONE:
ENGINEER: . License No. PHONE:
COMBINTATION PERMIT FEE SUMMARY .
Building Plan Check: $0.00 - ' '
Building Fees: $23.50
•
Electrical Fees: $0.00 =
Mechanical Fees: • $0.00 . - ”-
Plumbing Fees: . 443:10 , . .
SMIP Residential: . $0.50
SMIP Commercial: $0.00
TOTAL FEES: $67.10 •
**Refer to fee receipts for all fees paid for project i!CI 1 c
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92.26,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
SAGE L (II 2 il—ME OIL Mai coon INSVF0nON mit MTh IN1111AL6
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pod Spa Final 208 Anal 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 /�'1—//. X222 Final Site
204 Final Demolition f>4 - j� Ll�fr3ZIUTI IRS 250 Final BuildingfOccupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drie. ..:ease. 0 Yes 0 No `'
I hereby affirm under penalty of perjury one of the following declarations: •Drivers License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
•
performance of the work for which this permit is issued.
O 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed the perms is valued al one hundredddam(Sldo)or 2,Art 2,Sec.341.Title B,Califomia Administrative Code),
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safely,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if 1 should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (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
Contractors Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which thus permit S issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ElYes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If yes',the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
-I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
-compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
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 8. (If yes",attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ ['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 Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
7/07 grown egaall Owner(s) 7/00Date
6(3 ) Signature • �/i�`„Jli' sC �, e
And Authorized Applicant to
PROJECT ADDRESS: 301 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 061566
OWNERS NAME: GERARD JOSEPH S
ADDRE5S: 301 E 19TH ST PERMIT NO; B 061566 PLAN CHECK NO; N GOVT: N SUPP: N
COSTA MESA,CA 92627
CONSTRUCTION TYPE: 5 N PERMIT TYPE: STR PURPOSE: ALT
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : REROOF W/BUILT—UP SQ FT: 4, 800
4, 800 . 00 GROUP OCC; R-3 /M-1
ADDRESS: UNIT:
PERMITTEE: CLAIM VALUE: 4, 800 . 00 CALC—VALUE;
CONSUMER SERVICES ( 714 ) 754-1533
ADDRESS: 1260 LOGAN AV A-3 COMMENTS: SMOK DETEC PER SEC 1210 ' 91 UBC,
UBC REROOF
EROOF 3000SF RESID & GARAGE
COSTA MESA CA 92626 ######*****# EtFF########### t#########*###f ## t# r# Ex#####y8VV t
VT1LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMEN
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect.
CLASS:C_3o -- S E T B A C K S
CITY UC.:pq46 , TATE LIC.:4243
Dater Signature:_ — —s . r e MAIN BUILDING
•
ACCESSORY RgL9UV
ED
WORKERS MPEN
ATION DECLARATION: I hereb . gm at have a certificate of consent to self-insure or a;•dicate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
Compensation Insurance.or a certified copy there. Section 3800,Lab.C). LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
POLICY NO.: XP.DATE:
COMPANY: PARKING REQ: PROV; PARCEL; 11725424 ZNE: REF NO;
• '❑ Certified copy is hereby furnished. 0 •i' -d copy is filed with the city Building Division. PLANNING NOTES>
Date: Applicant: #fE##)E#########IE#fFKif###3e%fF#7e#####k###############IE#x####1F*****#1E#####!E .##3E######
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be c'r pleted it the per,( for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N T' _S
I cenity that in,a performance 0f the work for which this permit is issued.I shall m mploy any f, on i'any manner so as to become -
subject to th orkers'Compensation .ws of California. ; ZONING APPROVED BY •
• DATE;
' Date: are' 3" Signature: i a or
T/ Nr • V.after ma g this.claration,you become subject to the workers'Compen Orpwsions of the Labor BUILDING APPROVED BY : i / DATE; '�
ode. ou must forthwith comply with such . . ions or this permit shall be deemed revok . c
rNST'.CTION LENDING AGENCY: hereby rlhal there is a construction lending agent r the performance of the work for APPLICATION ISSUED BY: 2 Ik y '� - DATE; D I^�( r 9
hich is permit is issued(Section 3097.Civ. *************n***w***********#** a**,ex*x x' ****#**##*#aex -rt#*###*##-3(-*Y## # �###
LENDER: *****)e********************************* #Y************* ****************##****
ADDRESS: LEGALIZATION; N F E E SUAMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 00 . 50
repair any structure.prior to its issuance.also requires the applicant for such permit to fife a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($5001. ISSUE FEE:
I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING' DIV > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(tection 7944.Business and Professional Cede: The Contractors'State License Law TOTALS----> 72 . 50 0 . 000 . 00 72 . 50 72 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through r '
his or her own employees.provided that such improvements are not intended or offered for sale.If.however the building or
' improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED • 72 . 50 OVER/SHORT: 00
for the purposeol sale(. . BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 • , . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for Such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware {(.*#.N.#q.Y.{(-##!e###1E######w*i***********$i************** **********###-lE**************
that pmol of their Worker's Compensation insurance should be provided to me. IND IV I D U A Iii FEE BRE AKD OWN
o I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 4800 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 800 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and —END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: J
I hereby certify that I have read this application and state that the above information is correct.I agr• o comply with all city and county
ordinances and stale laws relating to building construction and hereby authorize represer ives of thi I to enter upon the above-mentioned
properly for inspe ion pun oses. • . i
n I
Date: 3 / 93 • • no•'.Signature: - .
Driver's License or Social Security a: -
1641-46 White—Building:Green—Code Ent tem r:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor •-"-
-."11111111.1111t
CONSTRUCvTION AND PLANNING POOL„ SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service,or Pole .; 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Sleet Reinforcement
3. Electrical Conduit Utility-Uhdrgrnd. - 54. Forms 4.
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVE R-GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
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 DGas DOid
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank D Gas D 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: .776-- ...a4 actor 1167
f 3 '2
34. Final Heating&Air Conditioning
35. Final Gas Pipe-Test
36, Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing • I
39. Water Service-Final
40. Gas Service-Final
41, Solar Domestic-Final , '
42. Backflow Preventer' - -
43. Backflow Irrigation,"; 'l
44. Landscape Irrigation System
45. Sound Attenuation' ' . �
46. Handicap Regulations: '•
47. FINAL STRUCTURE &BUIILDINGr
48. FINAL PLANNING-LI /���
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�;" KLULIVLU
�" 20991
r NOV 14 1963
FINANCE DEPT.
•
JCOSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BO%917 COSTA MESA.CALIFORNIA FFt
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING �f L El Street For Office Use Only
ADDRESS ]01 . 19th i
RECEIPT NO. P RMIT NO
1T COSTA' MESA. CALIFORNIA • l/
RIICFIVII
OWNER L.�.I�Pwman
RECEIVED- // 6/S- p /pA I SU • n
MAIL BUILDING 0901 e !I/OJ/1/� /„ /7/ �^
ADDRESS '701 92 SAntp Ann J 7n ADDRESS /,/
FIRE
TEL [ ZONE - TYPE- GROUP
/4/
CITY Santa Ana,CF�lif. NO.3ltbc) i5O
ARCHITECT TEL. APPROVED
/Y./.J1I' DATE I// �I
di
OR ENGINEER Owner NO. v/ ONING
AL 188 IO / J NO.OI I USE OP NEW A.JJ��0
PLANSa BUILDING idM
CONTRACTOR Owner ht�1 l d er• LEGAL het 1 77P // Oi 1�
ADDRESS DESCRIPTION ,L
CITY A.P.NO.
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE TEL 90'TO SIDE a REAR P.L.
LIC.NO. NO.
EAVESSIZE `
OF LOT 50r x- 1_, A I NO.OF BLOCS.NOW ON LOT Z ALLOWED (U.B.C.REQUIREMENT) _`\\F
S
USE OF YARDS APPROVED YARDS APPROVED
MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. GarAfTfr (FROM C/L STREET) q-5-- fi
SETBACK LINE FROM
CENTER OP STREET 50 T REAR YARD 20 t PR9NT PT. Pr.
��}
ttt
1e elll
AYARD I LEFT I RIGHT R.SIDE FT. FT•
EDESCRIPTION OF WORK L.SIDE FT. �� FT. /
N " x '
ALTERATION ADDITION REAR FT. !z Fr.
�- DISTANCE BET. BET.MAIN S of %/l/
REPAIR MOVING DEMOLISH MAIN BLDG$. ACCESS.BLDG
- VAR.#. DATE
BUILDING NO.OF
SIZE ROOMS 1 STORIES 1 C.U.P.# APPROVED
EXTERIOR WAI ROOF APPROVE. /J / /
COVERING B COVERIN' S G' - i . - -Y iw / r E DATE �/ /3 fS
USE OF BUILDING AND WORA TO BE PERFOR ED / IP fr
St.nragP a G d -e d 7O y a/' •
N
SO.FT. G
I HEREBY ACKNOWLEDGE THAT I HAVE READ TWO APPLICATION TMH AMOUNT SHOWN UNDER VALUATION IS FOR THE 5
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY ORDINANCES A D STATE LAWS REGULATING VALUATION ` d
BUILDING CONSTRUCTIO _
SIGNATURE OF int"/ _ PERMIT FEE B
�rm
PERMITTEE r /LK J /53 r o 0
$ G
5.--o L
AUTHORIZED AGENT TOTAL FEE $ /3. /
I
Costa Mesa Building Department APPLICATION FOR PERMIT
r P. O. Box 3!7 42(18 BUILDING 1
COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN 1 Receipt No. I Permit No.
Builn
Address 30/ r /fes' T oT T/o? J
Costa Mesa, California 'Received Date Recd. DIssued /
Nearest - 1 � /^ � ' Xi'�jate x,27 S.-"e)
Cross St.Cat �S� Yt_ ",--74—a--9 Building / -� �/ -sr...,,,
_ Address 7 �/ _
Mall ..j "r��e/G,Cl���� Costa Mesa, California
Add ressJ0/ f`. �5'f S,7-.. Nearest - -+ r
Tel. Cross St. �F} /.jl'rY
city(06 r/, hZLrfgI. No,/�/.�/� Zone II No.of I Typs/-+ . -G up 3-9
Architect or Lic. Plans /
Engineer No. iti
Ap-rove + liS�
by I " ,�¢ rj 1,�T�.�}J�,� , Date..
Address RRLCTIO'' S 11
City LIc. +„ s
rtracto0/. ,(r/e.CTS" cc No. b?}!ii C Or (_�...5 +. .:tom•',4t
A
Address 7/o Lcs'/SL✓ 0-.2,-4 ",,,, r/ - ...
Legal Lot ��� �.+ r ^
Description I No. / I Block Tract ��
(Attach Metes and Bounds) f i7^ ,Qs�-c2 $1' CO. L ffi D 1Sr ' �'
` o.of Bldgs PLAN Ta . \ C
Size of Lot lJ 0'%!• ` 4 NNow on Lot ♦ a - - --
Use ofy� I No.of No.o 'ppg + 9
Existing Bldg. /Car/VP,c -I Families I • . - . ; ,• .:�W o
Setback Line from Rear Tar, T fl a' f r "
Center of Street 9 Side Yard • , • +'� 'z : y
DESCRIPTION OF WOR$L; , 6" • ? ,l
AlES- GO.
New I /j Alteration I Addition I
+
it I
Repair I I Moving I Demolish I '.:.;', -
;^„ v2V- -A ," 1a-/7
BuildingNo.of .. ir.�.. .._,. ,.��6'tl(:'••�•. n
Size Rooms Stories -----,------
'"' tenor Wall I Roof —
ering Covering APPROVALS
-.,e of New GGG // Foundation Location Inspector Date
Building cj��%%y �.e�o� Forms,Materials,
S oc/E 01y-r// . 3--1/-,5e2/ye Under-Pinning
Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application
and state that the above is orrect and agree to comply Lath. Int.
with all City Ordman nd State Laws regulating
building construe ' Lath.Ext.
Signature of ����if -n Plaster,Int.
Permittee
Authorized Agt. Plaster, Ext.
llC
Valuation fncheck $ BoJJ
mit Fee $ .^ Manforced
/$ Sa e /y'
$ / � FINAL
FORM 204 10.55 D.P.fl S.
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Street '
/0 .i
PLOT PLAN
Show location and distances from
property Tina and between buildings / L
7
to f 32133
AUG -4-705f 00 123* ****52.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECE V • B i DATER CEIVED •.
TE ISSUED
d U O.
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ADDRESS ----- ZONE TYPE GROUP •\ _
WZ _ APPROVED DATE ' ft-7o
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W W TEL ZON NO.OF0? USE OF NEW z �"
Z 2 . CITY /.. ,.../ ss. ..i NO. SJ 'SLC- PLANS d LDI Lx..i " Q
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- STATE CITYrlJP3_iJJ;f.LYJaP
YARDS APPROVED
twn LIC.NO. .5-0 y r LIC.NO. • ACCESSORY BUILDING
U SIZE NO.OF BLOCS. �^yfJ i /
OF LOT •5Q X I3 i1 I NOWONLOT 9...- �7cr _ J FT.
USE OF
EXISTING BLDG. CO (�•tju,fL e5. R SIDE /th T. `/ FT.
I- SIZE OF l t NCi. F �� .
Z NEW BLDG. /Y X 3 S RO MS . -- STORIES I L.SIDE LiFT. • FT.
EXTERIOR WALL/•/- ROOF n
_ COVERING .,/tiiv[s�sjY COVERING REAR ao
V F FT,
J USE OF BUILDING AND WORK TO BE PERFORM D DISTANCE BET. BET.MAIN&
0-CL /� MAIN BLDG. ACCESS.BLOCS.
VA
O olap-p tZM,,•- t 4:3094/1
:3 CURP.# APPROVED
I•" V_", APPROVED
!A BY !�� /L/' ^DATE 7 �/,
Z /
UI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, end I shall not employ
I- any person in violation of the workman's compensation laws of
Sc
fn the State of California. /�r
Z- I hereby certify that I am properly licensed as a contractor under /H �/0 SQ. FT. r. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, andethat such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: o
CC
am exempt from the provisions of the State of California Business
VALUATION �+�}V N
andnProfessions/Code, Division 3, Chapter 9. o o PERMIT FEE $3 J N
Signature of f - — E
Permittee /� �J �Y/(l $ 4 g‘O PLAN CHECK $ /7 s0
/ /s' u.
Authorized Agent TOTAL FEE $ A G