HomeMy WebLinkAbout406 19TH ST - Building Permits?
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIF DRivE, COs�n Mean, cn aztizti
Job Address: 406 E 19TH ST
Suite:
Viciniry: HOUSE 8 ATTACHED GARAGE
Parcel Number: 42631119
Zoning:
Applicant ALBERTSON, STEVEN MICHAEL
Address: 351 N NEWPORT BL
SUITE 462 � Phone: (714) 850-4166
NEWPORT BEACH, CA " Zip: 92663
owner: EICHLER, ALBERT L TR
Address 406 E 19TH ST � - .
Phone:
COSTA MESA, CA . 2ip: 92627
Contiactoc QUALIFIED ROOFING
Address: 351 N NEWPORT BL
SUITE 462 " Phone: (714) 850-4166
NEWPORT BEACH, CA
Zip: 92663 � License: 517602
Arch :
Address:
Zip:
Phone:
License:
vvvrc vr r
, REROOF EXISTING SINGLE FAMILY RESIDENCE WITH ATTACHED
ROOFING & INSTALL NEW CLASS C FIRE TREATED MEDIUM CEDAR SHAKES.
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.60
SMIP Com:. $0.00
Other. $0.00
Inspection: , $0.00
Total: $125.85
SETBACKS � � �
MAIN STRUCTURE Front 0- 0
ACCESSORY Front _ 0- 0
PARKING Existinq: o
NOTES:
Eng:
Address:
Status: ISSUED
Applied: 10f2312000
Issued: 10/23/2000
�SSUED BY:
♦ ,
• ' I (�'M
�
•
Phone: -
lice�5e:
(18 SQ). TFAR OFF EXISTING SHAKE - �
FEE SUMMARY,
� - � ' � Calc Valuation: s Ss,000.00
Claim Valuation: ,' S6,0oo.00
/
�i;i% ,
-; . �
<. �.ii � " , ,
. - � ��.
Rear 0-0
Rear 0- 0
Re uired: 0
PLANNING�& ZONING � � -- �
: ���/�
Left 0-0 _ ��Right - 0-0 j � , /
Left 0- 0 � Righf '� 0. 0'. .����
PrO�osetl: 0; - ., . "
NO710E: The work authorized by ihis 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 automaticaily ezpire and become voitl if work is not commenced wlihin 780 days, or il work is suspanded or abandoned
for a period of 180 days. '
INSPECTlONS: In order tor lhe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapeetiona and finel 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
tsae-s6 (erool
,
�
WORKERS' COMPENSA710N DECLARATION:
I hereby eHirtn under penally ol porjury one of Ne IWIowing tleclerations:
❑ I have entl will meln�ain e certlficate oi mnsent to sel6lnsure tor workers' campensetlon, as pmvided for by seaion 3700 at the Lebor Code, for t�e pertortnance ot Ne
work for whlM thls pertnit is issued.
❑ I �ave entl will malntein workere' compensatlon Insurance, as required by sectlon 3700 ot Ihe Lebor COGe, tor t�a pedormance of Ne work for which this permit tq Iswed.
My workers' compensetlon Insurence cerrier entl policy number ere:
CaMer. . Paliry Number.
(This sectfai need nof be complefed i! fhe pertnlf Is vel�etl e( me hundred ddlers (S I00) or less.)
� I ierlify that in Ihe peAormance of Ihe work for which tNs permit Is issueq I shall not employ eny person in any manner so as ro becoma subiect to the workers'
�compensatlon lews of Calilomia, and agrea Nat if I should become subject to che workers' compensation Drovislons ot Saction 3700 of the Labor Cotle, I s�all torNwith
tompty with these pr � ions /
A`pPlicant Signature: — �Dete:�( a � Z.3 — ��
WARNING: FNLURE TO SECURE WORKERS' COfdPENSATIpN Ca/EMGE IS UNLAWFUL AND SW1LL SUBJECT AN EMPLOYEFTO'ORIMINAL PENPLTIES AND qVIL FlNES UP TO pJE HUN�qED
THOUSMID DOLLARE (5100.0001. �N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]080F iHE UBOR CODE, IMEHEST, PND ATTORNEYS FEES.
LICENSED CONTRAGTORS DECLARATION:
I hereby aXirm that.l.am,licensed underF rovisions of Chapter 9(commencing with Section 7000) ot Division 3 0l Ihe Business antl Prolessions Code, end my license Is In tull
torce entl ettecL Lic. q ��'�J � 7' b a% Class a� (i' 3�
co; traaors'stgn�e:- � - 1— _ De�a: / o— L''� — O"�1
CONS7RUCTION LENDING AGENCY:
❑ I hereby aKrm Ihat there is e wnstruction lentling agenty tor the petlormance of ihe work tor which this pertnit is issuad. (Sec. 3097, Civil CaOej.
Lendafs Name: _ _ _. LenOefs Address: _. __
Signawre;
Date:
OWNER-BUILDER DECLARATIONS: '
I �ereby eNirm ihal unAer penalry ot perjury thet I em E%EMPT FROM TME CONTRACTORS UCENSE LAW br the tollowing reason (Sec. 7031.5, Business end Pmfessions
Cotle: Any,ciry,or counry which requires e permit to construct, alter, improve, tlemolish, or repeir eny siructure, prlor to its Issuence, also requires the eDPlicant tor such permit
lo file a signed'sletemem thel he or she is Ilcereetl pureuent to the pmvlsions of the Contranors Lkense lew (Chepter 8(commendng wlth Sectlon 7000) ot Divlsion 3 ot t�e
Business and Prulesslons Cafe)�a, tAet he a sne is exempt therelrwn and the besis fw t/1e alleged exemptinn. Any v'wlalion W$eclion 7031.5 by any applicant lor a permit
subjects the epD���nt to a civll penalry of not rtrora than tive hundretl tlollers (E500).):
�
❑ I, as owner ot Ihe property; or my employees with wages as their sole wmpensation, WILL DO THE WORK, antl Ihe siruqure is not imendad or oNeretl tor sa�e (Sec.
7044, Business and Pmfessions Cotle: The Contractors Ucense Law dces not apply to an owner of properry w�o tuilds or improves thereon, and who does such work
himself or be�sell w Ihrwigb his a her own employees, provided �hat sucb improvemenLs a�e not imenCed a oHered !w sale. I1, however, the builUirg or improvemertt is
soltl within one year ot wmpletion, the owner-Cuilder will have Ihe burden of proving Ihat �a or she did not Euiltl or improve tor purpose ot sale.).
❑ I, es owner ol the property, am E%CLUSIVELY CONTRACTING WITM LICENSED CONTqACTORS Io conSlruci �he projB�M (Sec. 7044, Business and ProlBssions
Cade: The cronirectors License Law does not eppty to nn owner ot propeny who �uilds or impraves Ihereon, entl who contrects tor such project wl(h a comrector(s)
license pursuan! to tbe Conbactors license Laws.).
❑ I em e:ompt under sec.
Signature:
Owner ID verified by Arivefs license. ❑ Yes ❑ No
BuSinoss and PrOfeuions COOe tor this rea5on:
Vedflcetion of Ownership 6y (type ol tlaumenL I.9. - propeRy lex bill or tleed):
DI4ISION OF INDUSTRIAL SAFETY PEqMR CEHTFICATION:
Drivel9 Llcense No.
Date:
Ezpires:
❑ I hereby certify that no excavatlon fve (5) or more leet In tlepth Into which a person Is requiretl ta descend, will be matle In connectlon with work aufhorizetl by this
permit, and that no building siruclure, scaHdding, falsework, or demditian or Gismantlirg theraof, will be more than Nirty-sirz (36) feet high. (C�ap. 32, Grp 2, An 2, Sec.
341, Title B, Celilomia Atlminisiretive Code).
❑ As owner-builtler, I will not employ anyone to tlo work which woultl raquire e pertnit trwn the Division of Indusirial Satery, as notetl ebove, unleu such person has e
pertnit to do such work irom the division.
SlgnaWre: Date:
Division ot Industriel Sefery Parmit NumDer:
CERTIFlCA7E OF COMPLJANCE AND AIlTHORIZATON OF ENTHY: I certity untler penalry of parjury that I have read NIs appliwtion entl state ihet the intormetion qiven is
conect. I egree lo Comply with all steie laws end ciry ordinances relating to bulltling conslrucUon, ana suthorize representetives oi the Ciry of Costa Mese to enter upon Ihe
above-d cngs �bedpryperty t�y�spec ion Pu serpp s. I agree not to occuPY or allow occuGanry of any building euthonzed by this Permit until final insPection.
�.1 /\/1 I I /_1 'H"x- / 6 - L 3 -6-C�
- V t V`vf._;_ / \.r.n-+�
Signature Of Legal Owner(s) Date
COOEI, INSPECTONTYVE PAIE V�LS
1616 FI:eC System Flnal Fire Preventlon
1266
200
201
202
203
Pod Spe Flnel
Final Re-Roof
Finel BIocWReteining Wall
Final Factory Fire Place
Final Sign
204 Final Demolilion
�DE I INSGECTION TYPE
206 Final Mec�antcal
200 Finel PlumOing
210 Final Electdwl
212 Finel Fire Preventlon
220 Final Planning Apprwal
222 Final Si[e
250 Final Building/Occupanry
� ��
Aoo�icant to fill in all zo��es except tnose within neavy Dortler Ilnas ane sign a11 aoVroD/iate aeclaratlons.
CITV OF COSTA MESA CQNSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NU.
� Prolect Addrec� S��G �. i�� r E 33"'�3 �"
Appliacnl�5 Mailing AddreSS -r�4H � ` TVPE OF CONSTRUCTION _ NEW ADD /�.LTERATION REPAIR
Om/ner'S Name ��-���li L. F 14J-1�. �Z �hOnP!�!� �✓%yr � CONVER90N ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
Adtlres �M�^
ArCh/Eng. License No. _
Adtlress
Contractor's Nam _Phone
Address (mailingl
City License No.
LICENSEO CONTRACTOR OEC A ON
1 hereby affirm Iha[ I am licensetl under provision5 of Charte� 9(CommenCing
wlth Section ]000) of DlviSiOn 3 of I118 81151f1055 dfld PrOfession5 Cotle, dntl
my license Is In lull force antl eftect.
lJSense Class License No.
Da�c Si9�ature
WORKERS' COMPENSATION DECLARATION
� nereby atBrm tha[ 1 have a cerUficate oi consent to sell-Insure or a cartlticate
� Workers' Compensation Insurance, or a cartitied copy tnereof (Soction
.DO, L2b. C.)
Policy Na. Company
BCertitietl copy is hereby tumishetl.
CertitieG cooY �s filCtl with the city Builtling Division.
Da�¢ Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completea if [he permil is for ono huntlretl (5300) or
less).
I Certity Inat in [he perfo�mance Ot the work lor whicp this pe�T�t I5 issuetl, I
511811 nOt efOplOy any p8lSOn IO any m8n ef 50 as t b¢cama Su4ject to the,
WOrkers' Fompe sation Laws ot Cali(or J
Ddte �� � �'�Y 519nature A •' _Lfe1.l_��
NOTICE: 1�, diler making tnit tleclaration, you shoultl become sublec[ to the
W4rkers' CompCnSatlon provision5 of lhe Wbor Cotle, y0u mUSt (orthwith
COmpry "/��h SUch p�ovi5ion5 or this 0¢rmit shall be tleemeC rovoketl.
CONSTRVCTION LENDING AGENCV
1 pereby aiflrm tnat there is a construction lentling agency for Ne pertormance
o( Ihe work for which [hls permit is issuetl ($ectiOn 3097 Civ. CJ
l4ntler's Name
L@ntler'S Htltlreis
OWNER BUIL�EH OECLARATION
I hereby aHirm that I am axempt trom lho Contractor's License Law 1or the
t011owin9 reason (Seclion 7031.5 Buslnoss antl Profezzional Cotle: Any city or
�buntY wnicn requlres a permlt to construct, alter improve, tlemolish or reoair
any sVucture, ���o� �o its issuance, also reQWr¢5 t{�a applicant tor such permit
t0 1lle a SI9noC 5tatemCnt Ihdt ne/She I5 IlCpnsed pursUan[ to lh¢ provi51on5 Of
the Contraclor's License Law (Chapter 9_(commencing witn Sectlon 7000) of
DlvisiOn 3 ot Ihe Bu5ine55 antl Profession5 Cotle) o� lhat he/she iz exempt
'•ere(rom antl the basfs tor the alle9etl cxempUon. Any vio�aUon oi Sectlon
31.5 by any appliCan[ for a Pe�mfl subjects tM1e aPPlitdnt to a civil
.nalty ot no[ Tor¢ than fiv¢ nuntlretl tlolldrs (E500).
� I, as owner of tpa pmperty or my emp�oYees wiN wages as their sole
compensatlon, will Co tne work, antl the struc[ure is not intentletl ar offeretl
ior sale (Saction 7044, Business antl Protessional Cotle: The Contractor's
�ic¢nse iaw tloes not app�Y �o an owner o! a property who builCz or Improves
lhereon, and wno tloes su<h work himself/herself or through AI5 0� hOr own
Bmployees, provitletl [nal SUCh Imp�ovemonl5 are not inlentletl or ofle�¢tl fo�
sale. It, howavar, tne bulltling or improvomont is soltl withln ono year ot com-
Dlation, lh0 own¢i �+III have the burtlen Of p�Oving hC/She tlitl nol builtl or Im-
Drove tor tpa purpose olsale).
❑ I, as owner ot [he D�oOertY, am exclusWary mntractin9 with Ilcen5e0 con-
IldClO/5 t0 COI15IfUCl lhC D�OjBCt ($lCLIOf1 7044, BUSiO¢55 dOtl Pf01¢SSIOnT COtlB:
7he Con[ra<tor's License law does mt dpPly [o an owner Ot property who
builtls o� improves thereon, antl who mnt�acts for Sucn p�ojeCts wlth a con-
tractar(s1 ucense pursuan[ [o the Contractor's �icense Law). I am aware [hat
br00} O( thelr WotkeYs COTP¢nsatlon inzurante Shoultl be provitle0 t0 me.
� � am exempt untler Section B. 6 P. C. for this reason
'� , _ i. . .
j Date�rt��-�YY Owner �w. � � �
I nereby certllY Ihat 1 have rcaa lhis apv�iwtion anC
i�MorTaUoO Is <oiieGl. I d9rca to compty Wlth all tlty a
'dntl stata laws rclaling to bulltlinq construcUon, antl h�
Sentatives ot tNs city to enter upon the above-me�
�nspection Ourppses.
Si9natu�" / i '.l -. L—/��
Drivers' Litense or 55 � �
repre-
v tor
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTVRAI.
❑ TENANT �.ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5(i, FT. OCCVVANCv_
COfJSTRVCTION TYPE VALUA710N §
ZONE GRADINGCU.VDS. ACRFS_
Remarks:
Sink
kflow Preventer
iflow Irrigation
king Fountains
rt Drains
rc Sinks
Service Outlets
Kitchen Sink
Lavatories �,
P-Trap
Root Drains
Reinspection Fee � $15
Boiler
Duct � Under Ground
Dut[ - $tructural
Duct - Ventilating
Exhaust System ❑ Multiple �
Firepl/Fact. Blt. ICBO #
Heatin9 System & Ducting
❑0-100,000 BTU 0100,000BT
Reinspection fee � S16
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant: Pink - Accouniing: Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar 7ank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
water Service
Aulo-Wash
Issue Fae
Hood or Typel ❑
Canopy Type I I ❑
Re(�igeratian SVs[em
Oaioo,000sru ❑ioo,oaoeru
System Repair/Alteration
Fire Dampers
Regizters
Issue Fee
9
A.P. $
S N1ain 8�
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. yp
Aut0018iiC W85h2f
Construction Pole Su
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Eli
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generamr �0.5 KW
9856 ti/r7:�/�, , � f.� . I I
Zona
Accessory Building:
Z
O
� N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
ELECTRICAL
Transformer ❑ 15-50 KW
❑ $O+KW
IMeter up to 700 amps
' Meter �over 100amps
Sub Panel
Motors � 0.1 HP � 1 X- 8
Inc. Solar �9�75 HP �76-15+
Microwave �
Pole Light �
Range
Sign
Smnding $ec(ions
KW Trash Compactor
FEES
s 3 I'S— r�
Reinspection Fee $15 Issue Fea .fr-9�
FEES
DEVELOPMENT SfRVICES REQUIREMENTS:
Zoning Approved By Date
Buildine APProved qy Date��
Applintion laued BY DataJ �� LY�
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $ �
PLAN CHECK $ PERMIT
PLUMBING § ISSUANCE $
PLAN CHECK 25% 5 ENERGY P.C. i
ELECTRICAL $ � GRADING S
PLANCHECK 50% $ MICROFILM $ _�_
MECHANICAI. $ TOTAL FEE $ �_
S 3 PLAN CHECK 25% 5
EONSFRUCTION AND PLANNING - " POOL & SPA
� ! Date Inspector AppROVA'LS Permit # Date Inspecmr
APPROVALS Permit #
1.'Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgmd. `. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROV'AL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
$. Foundation �� � 59. Gas Pipe, O Undrgrnd., Test
t
9. Wafe� Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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 Elec[rical-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 � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Struoiural) &��Monocoar - • y- . 75: Dry Chemical .
27. F�arne.and Flashing 1 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PFiEV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT 1
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final �Q-� 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 pomestic-Final '
42. Backflow Preventer ' ,
43. Backflow Irrigation __
44. Landscape Irriga[ion System , . '.
45. Sound Attenuation � .
i
46: Handicap Regulations ., ` � -
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed _
49. Electrie Retease to Edison '
50. Gas Release to Southern California Gas Co �
-51. CERTIFICATE OF OCCUPANCY
No._�-� . Date
`
.� � 4360
r
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31]
_ . COSTA MESA, CALIFORNIA
FOR APPLICqNT TO FILL�pIN
BUILDING 1�(J /. �/- � (A � (� _ �
OWNER
COS7A M�SA. CALIFORNIA
. -{- f'. � , _ �_
FEB -7 � � 2.0 0� � s-z�o-i . 0 D
�.
r'
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
pECEIPT NO. /PE/NMIT NO.
T � Q
RECEiVE� BY DnTE RECEIVEO OnTE ISSUED I
TEL. BUILDING
CITY NO. ' ADORE55
ARCHITECT LIC.
OR ENGINEER ,�,��+�.t No. COSTA MESA. CALIFORNIA
FIRE
ADORE55 ZONE
ZON£ NO.OF TYPE GROLP
arr uc. P�.Ns
CONTRACTOR NO. G �
ADDRE55 �� ` ��`�. TNO. �5��' OYPROVED DATE �
LEWL LOT 1
oEScnivnorv NO. � BLOCK .TRACT �Z`
A.P. NO. J S/ G
SIZE � � NO.OF BLDGS.
OF LOT (/ 1 X 1 1 S�� �ow o� �or �L
USE OF {� JJ
EXISTING BLDG. 1�� �y„�,y�pti..'-
SETBACK LINE FROM � �/ � �
CENiER OF STFEET 6 Q REAR rnrio � y.O
SIDE YARD�-.- -- - RIGHT �' LEFT ( O,
�- ' DESCRIPTION OF WORK
NEW ALTERATION I ADDITION
REPAIR I IIMOVIN6 DEMOLISH
BUILOING NO.OF
SIZE ROOMS STORIES
[%TERIOR WALL � � ROOF
COVERING � COVERING Q1/y
�„« ,.� .,�,., .. .. . n .. /I
TO G. DEPT. REG.
./'� � �.
� �v
�, �
1 HEPEBV RCKNOWIEOGE 4T I H VE FEA� THIS LIC/TION TNO
STRTE TH/�T TXE PBOVE IS RRECT 4N0 AGREE TO"COMPLY WITH ALL
CITY OROINANCE$ I.ND $TiTE LRWS REGIILwTING BUILDING CONSTRUC-
T�ON. � � VALUATION
SIGNATURE OF PERMIT FEE $
PERMITTEE � �/
�[�D _ PLAN CHECK b
. � �/
AUTHORIZED AGENT TOTAL FEE $
� �err
.
t 96613
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOl( 917 GOBTA MP$A. WLIROMIIA
For Applieanf fo Fill In Compleiely
TYPE OR PRINT
ADD E153 T� � �, /� d 'fr
COSTA MESA. CALIFORNIA
OWNER A .�� 6��rfc��
ADDRE69 �O E F. � ` ,� Sr,
C"o.tr,4 r�Er.4 Neo`:6�cis�
c�rr
—t3U�tDE
SRE /� �' IZ ./ / 7� I No. o� Btoce.
OF LOT P (O NOW OH LOT
USH OF
E%16TING B OG
86T9AGK LINB PROM
I�EFT ' - IRIGH7
DESCRIPTION OF WORK
NO. OF
� EXTERIOR WALL
JILDING AND WORK TO BH PERFORMED
inF dRri1 —f�2viCc
1 H[PBBY ACNNOWLeDP6 TXAT 1 NAVB R[�G TXIB A�PLIGTION
AND 9TAT[ TXI�T TX6 ��8 IB COPRCCT AND AOR66 TO COM•
PLY WITX ALL CITY Op��MAMBB �NO 9TATQ lAW6 1180ULATNO
BUILOINO WNBTRUGTIDN.
SIGNATURE OPQ��� X �%,1����
, AUTHORIZED A6ENT
-
FEE RECEIVED
�� JAN p 1962
° FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMiT
BUILDING
For Offlee Use Only
COSTA MESA. CALIFORNIA
/
NO. OP ^ I UB8 OP N
PLANB �[ BUILD�NO
L66AL
fC[NT[R LJN6 BTJ
�,�
THQ AMOYM BXOWN UNO6P VALUATION 1! POR TH8
PUPPOB{ OP, 68TAGL18NIN0 ♦ P6RMIT P68 ONLY.
VALUATI {.V
PEftMli FEE S I�� �1
� r� � N
/ ^ �, ` o
$ �%/ /�{// PLAN CHECK S J
o<v vv �
TOTAL FEE � �
LL
�
COUNTY OF ORANGE
BUILDING DEPT.
636 No. Broadway
Snnw Ana� Californiu
Phone: K[ 2-6211
Arplication for Building r armit
AND FOR A
Certificate of Use and Occupancy
Permit No.-_-,��,��`5 _�
Dace----'----/O'-�� ��--------`-------
I. O\Y�NER'S NAME.----------".-.`'G_5�---0/`__lf.Q_q-.P....�_C(..�'�c�S .............------------ PHONE:�f1cGv.11--Co.i%�%
/ / .✓J
MAILING ADDRESS-----Llv..�a.-----...L------�7--�----�---------------------��--..CITY._�1fli.----�../.PS4t_—_
Name ..
Address
Ciry -.-- .
$tace
Lic. No.
(Amhirecc or Engincer)
Phone
Name.__ .-�%'_ t0_ c_././-�...J�.OI.S/f?/.rJ..._�--��i1.s
/ (Contracmr)
Add«ss __LG.S...--_-.E...---./.%��---------------------------
City --- �`1-�¢--- / f P$.�j ---- ..
$tate p / ,p
Lia No. ��/..�`..C�.Q---fJ,-�._.. Phone
PROPOSED USE:----C���-�.G�-----�y�_.�..�'------ ._ --------....- -- - --
2. JOB LOCATION...-------�dGa--------- F-----..__I'Jl,--�/�.------- ---------�-------..__C�_Q_STtP_._LvI.E�S..EI-------------
(House No.) (Name of S[reet) (Town or School Dis�rict)
3. LEGAL DESCRIPTION: Loc---------7/-------------------Block-----------�---..._..--------------._Tracc _/��fj1
--- -----------
(Metee and Bounds Descriprion—Uu ceserse side oE form)
4. CORNER LOT ( ) INTERIOR LOT (�) THROUGH LOT ( ) SLOPE OF LOT ( )
5. SIZE OF BLDG.: _.�Q.. �'_.,20-..AREA:_..�lo.D_..�_.•_.SIZE OF LOT: �p1. y_/Z�AREA: %��/ �_:._____..._.
/
6. HEIGHT OF BLDG.: .__._.__.__.L.. ._..__._____.CEILING HEIGHT:...____ _____________________.__.... [VO. OF STORIES ._�____._____._._
7. NO. FAA7ILIES _..._..___-_-'--.--___----"__-..Size of Smallest Bedroom: ------_'_'_--------------_ Size of Kitchen: _......_--__----------------_-
8. EXTERIpR WALL CO[VSTRUCTION:__��!lLGQ._-.._.._.I[VTERIOR WALL COVERI[VG.___�-__.__,._.__._..._.._.
� (Frnme, Stucco, Etc.) � (Planscer-Drywall, E[c.)
9. SETBACiCS: Front Yard from Center Li�e o£ Strcet--------"'--""-------------'__–_-_–�Y�_�_�""_---------------'--_-"'_"-_-------"_'-'
� .
/ � � i
Nearest Side Yard...�___.__.__._.Rear Yard.._.-a�......._._..Distance in Feet Betwcen Bldgs. on Same Lot ___.e%.Q.._..._..... _. __.._'.
IG. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
,/ . • ii / 7
11. For (a) Footing: Wid[h...._.._ly�.�._ .............Depth in Ground...._�L.._...__..._.__..Width of Wal(....(/..._ ...__.__._
Accessory - $ a �
Bldgs. and b Size of Studs: __________________..._..__., cin CC Material of Floor ._..G..m
Similar ( ) P 8--'---'------'-----------.._" �✓C--• ----
$tructurea: '
(c) Size of Floor Joists: --`--'-' ............._-.--------.Spacing -----..."----'----. _._._----_•�CC
(d) Size of RaEters: -"----'-------------'-`-...--._"_"_'.Spacing ---
iiLKy
12. VALUATION OF PROPOSED WORK: Includinp all labor, p�umbing, e�ectrita� wiring, fieating, fire sprinklers, paino
in and sewa e dis osal Qa �
S S P �--- -�0--�-------------------------
-
13. I HERE�Y CERTIFY THAT TO THE BEST OF MY K[VOWLEDGE AND BELIEF THE INFORMATIO[V I[V
THIS APPLICATIO[V IS CORRECT AND THAT THE CONSTRUCTIOLV WORK WILL CONFORM TO ALL
LAWS OF THE COUNTY OF ORANGE A[VD THE STATE OF CALIFORNIA APPLICABLE THERETO.
'_Signed:.__. _ _ __ _ `�/-"'_��D'�e.�. �__��t�ef�cs_______________.
__ __.__
Plans Filed: -_- N � —�a � n¢�)
--/ -'--�--' ---'--'.-'---"-'-----------_"-- -
BY'-------'--- -��--�J---- - ' - ------ - -
- � - ----- - - ---� -'----------'..--'-----`-----------'-'
(Au[horized Agent)
FOR DEPARTMENTAL USE ONLY
FEES: '/
Bldg. Permie - �---'f�-ad
Plan Check . �"�
$--�
Total - - .
$-"--'---� ---`
Receipt No. - - .._.___ .._. Z:
Paid ro - - _---�---- _Ce
Uate .__ ........_"'_"-"--""' -11." "�2-
DATE------ -- --- -------------- --
9M-]-00
GROUP----� ---� ----- ----
7'YPE.--------�-------------
DIST. /�
MAP-------...�l.:G _...-------
SHEET IVO._---�----------
- CH�G BY
APPLICATION _,_____.... HEALTH _.,
FIRE
ZONIIVG.----� MARSHAL..-------------------
PLANS ALVD
SPEC'5......-------------- ------ STATE --� - ----- -�---------�- ---
CORRECTIONS EIVGILVEER
VERIFIED----------------_. CAL.----------------------------
PERMIT ISSUED BY:
, C(^ [� ' CUtLOING
. l�(. !.. � � J' ..�:=_�..TOR
, � DEPUTY � ln,. .
// V
7