HomeMy WebLinkAbout724 18TH ST - Building Permits� CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ra.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B10-00059
PERMIT TYPE B_ROOF2
APN: 4241741i
JOB ADDRESS: 724 Q W 18TH ST CM
Vicinity: UNIT B ROOF
Squares: 1500
STATUS: ISSUED
DATE ISSUED: 03l0312010
ISSUED BY: RMD
Suite/Unit: B
Valuation: $4,000.00
SCOPE OF WORK: REROOF APARTMENT BUILDING B(UNITS 2,3,4,5). TEAR OFF (E) ROOF MATERIACS, INSTALL BUILT UP
ROOF, HOT MOP ASPHALT, APPROX 1500 SF. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER: HETRICK, RANDAL A Address: P O BOX 1047 Unit:
PHONE: (714) 962-2471 , . � City/State/Zip: TUSTIN, CA
APPLICANT: KIM MCCLAIN
PHONE: 714-897-1780 �
CONTRACTOR: MCCLAIN RppFING INC
Address: 12872 VALLEY VIEW STUnit:
City/State/Zip: GARDEN GROVE CA 92845
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$9725
$0.00
$1.00
$98.25
Address: 12812 VALLEY VIEW ST
City/State/Zip: GARDEN GROVE, CA
STE 33
License No.
License No.
License No. 625013
PHONE: 714-897-1780
CELL:
PHONE:
PHONE:
Unit: :STE 33
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and relaled
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMl7 EXAlRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed 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 fnal approval will result in the expiralion of this permit.
ODE/ INSPEC710NTYPE
1616 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Re�aining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
�RT INTITIALS
� . �
CODEO INSPECTIONTYPE
206 Final MechaniCal
208 Final Plumbing
210 Final Elecincal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
ORTF� NI TfIlALS
WORKERS' COMPENSATIDN DECIARATION: �
I hereby affrm untler penalty of perjury one o( the following declarations:
❑ I have and will maintain a certificate o( consent to self-Insure for workers'
compensation, as providetl for by section 3700 of the Labor Code, (or the
pertormance of the vrork for which this permit is issued.
� I have and will maintain workers' compensation insurance, as required by
s tion 3700 of the Labor Cpde, for the pedormance o( lhe vrork for vfiich [his
pertnit is issued. My workers' compensation Insurance carrier and policy
numher are:
LCamer S� 1� '}�lih.11'>
(rh¢ seIXion neee rror �61e mmp�¢(ed il the pe�mrt is valued at one hundredCopars (5100) o� less.)
_�Policy,Number: I II��(�iC� Zv��
❑ I certify Ihat in �he performance o( the work for which �his permil is
issuetl. I shall not employ any person in any manner so as to become subject
lo the workers' compensation laws of Califomia, and agree that if I should
become subject to Ihe vrorkers' compensation provisions of Section 3700 of
the Labor C de, I hall torthWith comply with ihese provisio s.
��1� 3 I �
App' nlsSigna�ure �Daie�y„
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FIN�S UP 70 ONE HUNDRED 7HOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTOR$ DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapler 9(commencing
with Section 7000) of Division 3 of the Business and Pro�essions Code, antl
my license is in full force antl eftect.
���r,�y SD �� Qei�S �,. 3
j1 n��%—.- 3 e
Conlfa[tor�;SignaWre. (�.Oale^Y��
c��..r�
CONSTRUCTION LENDING AGENCY:
❑ I here6y affrm that there is a construction lending agency (or the
pedormance of lhe vark fa Which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARpT10NS:
I hereby aKrm that under penalty of perjury that I am E%EMPT PROM THE
CONTRAC70RS IICENSE LAW for the following reason (Sec. 7031.5,
Business and Protessions Code: Any city or county which requires a permit to
Construct, alter, improve, tlemolish, or repair any stmcture, prior to its
issuance, also requires lhe applicant for such permit [o file a signed Statement
that he or she is licensed pursuant to the provisions of the Contractors
License law (Chapter 9(commencing wilh Section 7000) of Division 3 of the
Business antl Professions Code) or that he or she is exempt lherefrom and
the basis for the alleged exemption. Any viola[ion of Section 7031.5 by any
applicant for a permit subjects ihe applicant ro a civil penalty ot not more than
flve hundred tlollars ($500).):
❑ I, as ovmer 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 herselt or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the builtling or improvement is sold within one year of
completion, the ovmer-builder will have Ihe burden of proving that he or she
did not build or improve for purpose of sale.}.
❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and
Pro�essbns Code: The contractors License Law tices not apply lo an ovmer ot
pmperty who 6uiltls or improyes thereon, and who contracts for such projeCt with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under seC.
Business and Professions Code for this reason:
305]-06 (3IW)
Owner ID venfied by tlriver s Iicense. ❑ Yes ❑ No "'
Driver's License No. Expires:
Verifcation of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certrfy that no excavation frve (5) or more feet in depth into which a
person is requiretl ro tlescend, will be made in connection vri[h work authonzed
by this permit, and that no building siruc[ure, scaFfdding, falsework, or demolition
or dismantfing thereo(, will be more than thirty-six (36) (eet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title B, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which woultl
require a permit from the Division ot Industrial Safety, as noted above, unless
such person has a permil lo do such work fmm the division.
Applicanfs SgnaWre
Division of Industnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file antl
certify a Business Plan for emergency response to release or ihreatened
release o( a hazardous material? ❑ Yes ❑ No
(Seclion 25505 0( the Calitornia Health and Safery Code requires, with some
exceptions, that a Business Plan be fled wi[h 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 grealer than a weight ot
500 pounds, or a volume of 55 gallons, or 200 cubic feet oF compressetl 9as
at standard temperature and pressure).
2. Does or will the applicant or present or fuWre building occupant need to file
a registration fortn for acutely hazardous matenals? ❑ 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 [ime has on hand a quantity of awtely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume o( 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 ro
prepare an RMPP (Risk Management and Preven�ion Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code pmvides that the
Costa Mesa Fire Department may require the preparatioq certification and
filing with the Fire Department o� an RMPP by businesses which are required
to regis[er acutely hazardous materials vrith the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safety Cotle been fully complied with? ❑ Yes ❑ No
5. Does or vnll the applicaM or present or future building occupant require for
Ihe work which is Ihe subject of this application a permit for such constmction
or motlifcation from the South Coast Air Quality Management Dislrict or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Cotle requires thal the requestetl
information be fumishetl on applications for nomresidential building permils).
6. Will any part of ihe faciliry to be constmcted under ihis permil be wi[hin
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes", the facility mus[ meet the requirement of Sections 25534 and 42303
of the Calitomia Health and Safery Cotle).
7. If a permit from the Soulh Coast Air Qualiry Management DisMct or other
air polWtion control districl or agency is required for the work which is the
subject of this application, have all of the discbsures prescribetl by California
Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No
8. pt "yes", attach certifcate of compliance from the appmpriate air polNtion
control oKcer).
CERTIFICATE OF COMPLIANCE I certify that under penalry of perjury the
information given above is correct. I agree to compty with atl state laws and
city ordinances regartling Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application antl state that
the information given is correc�. I agree to comply with all 5tate laws and city
ordinances relating to building construction, and authorize represematives of
the Ciry of Costa Mesa to enter upon the above-descrihed pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorizetl by this permit until fnal inspection.
�S naWreofLeqalOvmer(s) �al
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MCfi!�'PWlprueCAPPlican�i�-.. �s`yte�,,,,`
' ` CITY OF COSTA MESA
0 MFq BYILDING DIVISION
�
>� � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • w�wv.ci.costa-mesa.ca.us
:
°.���� FOR INSPEC710NS CALL: (714) 754-5626
PERMIT NUMBER: 610-00060
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 42q17411 DATE ISSUED: 03I03/2010
lSSUED BY: RMD
JOB ADDf2ESS: 724 C W 18TH ST CM
Vicinity: 6LDG C, ROOF
Squares: 1500
Suite/Unit: C
Valuation: $4,000.00
SCOPE OF WORK: REROOF APARTMENT BUILDING C(UNITS 6,7,8,9). TEAR OFF (E) ROOF MATERIALS, INSTALL BUILT UP
ROOF, H07 MOP ASPHALT, APPROX 7500 SF. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMI7.
OWNER: HETRICK,RANDALA
PHONE: (714) 962-2471
APPLICANT: KIM MCCLAIN
PHONE: 714-897-1780
CONTRACTOR: MCCLAIN ROOFING INC
Address: 12812 VALLEY VIEW STUnit:
City/State/Zip: GARDEN GROVE CA 92845
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bidg Sld Admin Fund
TOTALFEES
$0.00
$97.25
50.00
$1.00
$98.25
Address: P O BOX 1047
City/State2ip: TUSTIN, CA
Address: 12812 VALLEY VIEW ST
Ciry/State2ip: GARDEN GROVE, CA
STE 33
�icense No.
license No.
License No. 625073
PHONE: 714-897-1780
CELL:
PHONE:
PHONE:
Unit:
Unit: :S7E 33
NO710E: The work authorized by this permit shall comply with all applicable handicap access repuirements under Califomia slatutes and related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply wilh all applicable codes, and all
required inspections and final approval musl be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
w�E ixsrecnpxrre o� INTRIALS coDE� �xsvecnoxrrre onrg ixnnu
7876 Fized System Final Fire Prevention 208 Frnal Mec7ianical
1288 Pool SOa Final 208 Final Plumbing
200 Final R�.Roof Z(J 210 Final Electncal
201 Final Bip�k/Retaining Wall 212 Pinal Pire PrevenGon
202 Final Factory Fire Place 220 Final Plannirg Approval
203 Final Sign 222 Fina15ite
20a Final Dgmolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION: ,
I hereby aKrm under penalty of peryury one of the following tleclarations:
❑ I have antl will maintain a certificate of consent to self-Insure lor wnrkers'
compensation, as providetl for by section 3700 of the Labor Code, tor the
peRormance of ihe work for which this pertnit is issued.
[� I have and will maintain workers' compensation insurance, as required by
sectbn 3700 of the Labor Code, for the peAortnance of tha work for wfiich this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Garcier: S��"(� �i��
(ThiS seqbn neetl nd pe compele0 A!ln�e �penrN is vahxtl af one nuntlretl WMars (410�) aless )
Pol•i_cyNumber: I7�>7�DC vtilU
❑ I tetlify that in the pertormance of tha work for which this pertnit is
issuetl, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws o( Califomia, and agree that if I should
become subject to Ihe workers' compensation provisions of Section 3700 of
the Labor Co.dp, I shall forthwilh comply with these provis ons.
�K��-- 3/r o
APW�C�'S79�lure Ddt�.
C�-T
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDEO FOR IN SECTION 3706 OF TNE L480R CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn Ihat I am licensed under provisions of C�apter 9(commencing
with Section 7000) ol Division 3 of the Business an0 Professions Code, and
my license is in full force and effect.
���. � . = ut ' ���¢G3�
' '1�—�- 3 3 i�
Gm�2c(—pr's Signawre ��
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKum that there is a constructbn lending agency lor Ihe
peAormance of the xork la wfiich this pertnit is issuetl. (Sec. 3097. Gvil Cotle).
LenCer's Name:
Lender'S Address:
SigreWre Daie
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that untler penalty of perjury that I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5.
Business and Professions Code: Any city or county whicn requires a permit to
CAnsWct, alter, improve, tlemolish, or repair any slfucture, D�or to its
issuance, also requires the applicant for such permit to fle a signed stalemenl
that he or she is licensed pur5uant to Ne provisions ol the Contractors
LicenSe Law (Chapler 9(commencing wii� Section 7000) o( Division 3 of lhe
Business antl Professions Code) or ihat he or she is exempt Iherefrom and
the basis for Ihe allegeC exemption. Any violation ol Section 7031.5 by any
applicant for a permit subjects the applicaN to a civil penalty of nol more than
five hundred dollars (5500).):
❑ I, as owner of the property, or my employees vnth wages as their sole
wmpensation, WILL DO THE WORK, and the sWcture is not intended or
offered for sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
Ihereon, and who does such work himself or herself or thmugh his or her own
employees, provided that such improvements are not intended or oBered for
sale. If, however, the building or improvement is sold within one year of
completion, the ownerbuilder will have the burden of proving thal he or she
did not builtl or improve for purpose of sale.).
❑ I, as owner of �he property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to constmct Ihe project (Sec. 7044. Business and
Professbns Code: The conlractors license Law dces not apply to an ovmer of
property who Duiltls or improves thereon, and who cont2cis fa such project with
a concractor(s) license pursuant to the Contractors Ucense Laws.).
❑ I am ezempt under sec.
Business and Professions Code for this reason:
�
Owner ID verified by driver s license. � Ves ❑ No
Driver's License No. Expires:
Venfication of Ovmership by (type of document, i.e. - property tax bill or deetl�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavalion (rve (5) or more feet in depth into wfiich a
person is required to descend, will be made in connectbn with wark authonzetl
by this permit, antl Ihat no builtlinq structure, scaf(dding, falsexork, a tlemolition
or dismantling thereof, will be more than thirty-siu (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Ttle 8, Cali�omia AdministraWe Code�.
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Satety, as noted above, unless
such person has a permit to do such work from the division.
p7d�nnYs Sipnawm Date
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant need to fle and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous matenall ❑ Ves ❑ No
(Section 25505 of the Califomia Health and Safery 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 reportetl
year a quantiry of hazartlous matenals equal to or greater than a v+eight of
500 pounds, or a volume o! 55 gallons, or 200 cubic leet of compressed gas
at stantlard IemperaWre and pressure).
2. Does or will the appliwnt or presenl or future building occupant need to fle
a registration foim for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safety Code. with some
exceptions, requires regiSValion with lhe Cosla Mesa Fire Department by
each business which at any one time has on hand a quantiry 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 wmpressed gas at slandard
temperaNre antl pressure�.
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous malenals)? ❑ Yes ❑ No
(Section 25534 0! the Califomia Health and Safery Code provides that the
Cosla Mesa Fire Department may require the preparalion, certification antl
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 presenUy required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or presenl or fuWre building occupant require !or
the work which is lhe subject of Ihis application a pertnil (or such consWction
or modification from the Soulh COast Air Qualiy Management DisMct or (rom
any other air polWtion conUol distnct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment CoCe requires that the requested
in(ormation be lumi5hed on applicalions (a non-residential buildirg pertnits).
6. Will any part of the faciliry lo be constructetl untler this pertnit be within
1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
pf yes , the facilily must meet the requiremenl of Sections 25534 antl 42303
of the Califomia Health and Safety Code�.
Z It a pertnil from the South Coast Air Ouality Management District or other
air pollution conVol tlistricl or agency is required for the work which is Ihe
subject of this appliWtion. have all of the tlisclosures prestribed by Califomia
Health antl Sa/ety Cotle Section 42303 been matle'7 ❑ Yes ❑ No
8. Qf yes", attach certifwte ol compliance from Ihe appropriate air polWtion
control oKcer�.
CERTIFICATE OF COMPLIANCE: I certily lhal under penalty of perjury the
information qiven above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certiry under penalry of perjury ihat I have read ihis application and state that
the information given is correct. I agree to wmpty with all state laws and ciry
ordinances relating to building consWclion, and authorize representatives of
lhe City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any Duilding
authorized by this permit until final inspection.
Sipnewre ol Lepal Ovmeqs) ale
$i9naiure Da�e ��,`� 3�
305]�a6�Y0])
qn�.AU��O/i2l11 AGd�Cdnl Ddtl+ �
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(714) 754-5273 • Fa�c (714) 754-4856
Job Address: 724 W 18TH ST •
Suite: A
Viciniry: UNITA
Parcel Number: 42417411
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
npp�icant: FUNKE, KENNETH P.
Address: 18567 PLUMOSA ST.
FOUNTAIN VALCEY, CA
Owner: HETRICK, RANDAL A
Address F.O. BOX 1047 . �
" TUSTIN, CA ' "
Contrecmc FUNKES ROOFING
Address: 18567 PLUMOSA ST.
FOUNTAIN VALLEY,CA
Zip: 92708�,
Arch .
Address: - , � . , "' .
�
BUILDING PERMIT
Zoning:
.Phone: p14) 964-7171
Zip: 92708
Phone: (714)962-2471.
Zip: 92781 ..
Phone: (714)964-7171
License�� 348877 �
Eng:
� ' �� Address:
.�
PERMIT NUMBER
�-00207
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 02/17I2000
Issued: 02/17/2000
ISSUED BY: '
� Phone: ., Phone:
' Zip: � ' ' .. license: License:
. SCOPE OF PERMIT
• REROOF, SINGLE FAMILY RESIDENCE (14 SQ) OVER EXISTING LAYER OF WOOD SHINGLES -(UNIT A). RECOVER
OVER EXISTING ROOFING WITH CLASS -A- 25 YEAR COMPOSITION SHINGLES (SUBJECT TO PRE-ROOF INSPECTION). .
FEE SUMMARY
� Plan Check: $0.00 � — ,— Calc Valuation: 52,000.00
Permit $69.25 " � Claim Valuation: Sz,000.00
SMIP Res: • $0.50
SMIP Com: $0.00 -
Other: $0.00
Inspection; $0.00 �
Total: $6975
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front-. 0-0
PARKING existinq: o
Rear 0- 0
Rear 0- 0
Reauired: 0
PLANNING & ZONING
Left 0- 0 Right 0- 0
Left 0. 0 Right 0- 0
Proposed: 0
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 penod of 1 BO 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
requlred inepectlona 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) 7545626
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirm under penalry of perjury one ot Ihe following declarations:
❑ I have end will maintein a cartlficate ot conseni to selt-Insure for workers' compensation, es provided tor by section 3700 ot the Labor Cotle, tor the pertormance of Ihe
work for which Ihis pertnit is issued. �
❑ I have end will maintein workers' compensation insurance, as required by secGon 3700 of Ihe LeDor Cotle, for the pertormance of ihe work tor which this pertnit is issuetl.
My workers' compensetion Insurence carrier entl policy number are:
Carrier: Policy Number.
(lhis section nsed no( be cromp/eted il lhe permit is velued et one hundred dollars ($700) or /ess.)
thet In ihe pedormance of the work for which Ihis permit is issuetl, I shell not employ eny person in any manner so as to become subject to ihe workers'
�ation laws of Califomia, antl egree ihat if I shoultl become subject to the workers' compensetion provisions ot Section 3700 of the Labor Cotle, I shell fohhwith
Applicen 'gnature� �r�T . -��_-�,[-� � a e: =� — 2E'O �
ARNING: FAILURE TO SECURE WOHKERS' COMPENSATION WVERAGE IS UNLAWFUL AND $MALL SUBJECT AN EM MINAL PENALTIES ANO CIVIL FINES UP TO ONE HUNDRED
THOUSAND OOLLARE (5100.000). IN AOOITION TO THE �5T OF �MPENSAiION, OAhNGES A$ PflOVIOED FOR IN SECTIQV 3106 OF THE LABOF CODE, IMEREST, AN� ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirtn th licensetl under rovisions of Chapter 9(commencing with Section 7000) ot Division 3 usi�ess antl P�pfessions Cotle, and my license is in full
torce and eHec Lic. a r/ ��8 � r • lass # r C- 37
r.�mr.�. �n,.e� � � � .- -Y ��— .tr.��a� 2' (7 —ZClO
CONS7RUCTION LENDING AGENCY:
❑ I hereby ettirtn that there is e consiruction lending agency tor the peAortnance ot the work tor which this pertnit is issued. (Sec. 3097, Civil Code).
Lentler s Nama: Lendefs Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Oate:
I hereby ahirm ihat under penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business antl Protessions
Cotle: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any sWcture, O�or to its iuuance, also requires ihe applicant for such permit
to file a signea statement Ihat he or she is licensed pursuant to Ihe pmvisions of Ihe Coniractors License Lew (Chepter 9(commencing with Section 7000) of DiNslon 3 of ihe
Business antl Professions Cotla) or ihat he or she is e:empt therefrom entl the basis tor the elleged exemption. Any violation of Section 7031.5 by eny applicent br a permit
sub�ects the epplicant to e civil penelty of not more than five hundretl tlollars ($500).):
❑ I, as owner of the pmperty, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and Ihe slrucWre is not intended or oHered lor sale (Sec.
7044, Business and Professions Code: The Contractors License Lew does not apply �o en owner of property who 6uiltls or improves t�ereon, and who does such work
himsetl or herself or thmugh his or her own employees, provided ihat such improvemenis ere not Intended or offeretl tor sale. If, however, the huiltling or improvement is
sold within one yeer of completion, ihe owner-huiltler will have the burden of proving thet he or she ditl not build or improve tor purpose of sale.).
❑ I, as owner of ihe propeny, em EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to consiruct Ihe project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner oi pmpeny who builds or improves ihereon, and who coniracis for such projact with e contrector(s) •
license Dursuant b the Contrectors License Laws.).
❑ I am ezempf unAer sec. Business end Professions Cadelor th(s reason:
Signature: Oate: ,
Owner ID venfietl by tlrivefs license. ❑ Yes ❑ No Dnvers License No. Expires: �
Venfication of Ownership by (type ol document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby certity that no ezcavation five (5) or more teet in tlepth into which e person Is required to deuend, will 6e matle in connection wit� wark authonzetl by this
permit, entl tha� no building structure, scaftoltling, falsework, or demolition or dismantling ihereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Titla 8, Celitomia AOminisirative Code).
❑ As owner-builder, I will not em0loy anyone to do work which would require e pertnit from the Division of Industnal Safery, as notetl above, unless such person has a
permit to do such work trom the division.
Signature: Oate:
Division ot Indusirial Safery Permit Number:
ICER7IFICATE OF COMPLIANCE AND AU7HORIZATION OP ENTRY: I certity under penalty of perjury that I have read this application antl state that the informetion given is I
correct. I agree to comply with all stata laws and city ortlinances relating to building constmction, and euthorize representatives of �he City of Costa Mesa to enter upon the
aDove-described property (or inspection purposes. I agree no� �o occupy or allow xcupancy of eny bulltling authonzed by this permit until tinal Inspection.
COOE �, INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Roof
201 Finel Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition '
2668a8
➢ATE IMITIALS
� �
z-n
COOE� INSPECTIONTYGE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Pinal Site
250 Final Building/Occupancy
p� INTRIRLS
AODlleant to flll in a1l soaees except those within heavy Doraer lines anC sign all aooroDriate aeclarations.
cITY oF cOSTA MEsa CONSTRUCTION PERMIT
Project Address -k4 W. 1 8 th ST .
Applicant's Nfailing Address 126 Cot�m�ercial, C.M. 7
Owner's Name Dr. Randal Hetrick Pho�e 62— 81
Address 9851 Biq SI.tY Dr. � H.B. 92648
Arch/Eng. Licenu No:
Address
Contractor's Name CYdrik--EirOS Rrx if � n� �'nphone 54R—SSFii
Address�lmailing) 7�� �'(1yt7TQ.SE'�"l� Z^T3��.�..� C�rLSta Mr�aa 9iFii%
Ciry License No. �nTao�
LICENSED CONTRACTOR DECLARATION .
I hereby aftirm Ihat I am licensetl untlet O�ovisioni o1 Charter 9(comT¢ncin9
with seclion ]000) of Divizion 3 oi [he Busine55 antl Prot sions C tle, antl
my license is in /uil,to�� ana ettect. S6
License Class �- Licen
�ete Si9nature
WORKERS' COMPENSATION DECLARATION
I hereoy attirm that I have a certl/icate ot consent to self-insure r a cerlificate
�( Worken' Compensation Insuranc¢, or a certl(letl copY thereof (Sectlon
800, La�, �cr-�I
�olicy No"^^'l�Z Company HOR72.
�Certifietl copy is hereby fu�nishetl.
Certitiep c�op,� �i filetl with the city Builtlin DI islon.
Date �/�"V11� aooiica�t C��n� �3r0�. ROOf1nC�
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sec[ion ne¢tl not be compleletl if the permit is tor one huntlre0 (§100) or �
iess)
1 certify that in the pertormance ot the work tor wNch this perm�t iz 6suetl, I
s�all not emplOy any person in any manner so a5 lo become subject to the
Workers' Compensation Laws of CaliPornia.
. Date - � Signa[ure
'NOTICE: Ii, aiter making this declaration, you snoultl become Subject to the
Workers' Compen5ation provisions of the Labor Code, you must tortnwith-
comply with such provisions o� tM1is pe�mit Shall be,tleemetl revoketl.
CONSTRUCTION LENDING AGENCV' -
1 hereby aifirrp that there is a construccion lentlin9 agency for lhe performance
of [he -work ior whiclt tnis permi[ is Issued (Section 3097 dv. C.)
tpnCer's Name
Lentler's AdOreis _ .,
OWNER BUILOER DECLARATION � '�
I hereby affirm Ihat I am exem0< from the Contrac[or'S LicenSe �aw tor Ihe
followinq reason (Section �031.5 Buslness antl Professional Cotle: Any ci[y or
county which requires a permR to construct, alteq Improve, tlemolish or repair
any st�ucture, priOr to its isSuance,'also �equlres the applicant for such permit -
f0 file a siqnetl stalement [hat he/she Is IicenSetl pu�suant [o the provisiOns of
t�e Contractor's L�tense Law (Chapter 9(commencln9 with Seclion 7000) of
Dfvision 3 ot Ihe Bu5ine55 antl Pwfessions Code) or that ne/she is exempt
�herefrom and ttte basis for Ihe alle9etl exemption. Any violation ol Section
�31.5 by any ap0lican[ 10� a Pe�mit Subjects the applicant t0 a civil
nalty of not more than five huntlretl tlollars (y500).
.J I, as owner ot the: pro0erty o� myemploynns with wages as lhair sole
compensation, wlll tlo the work, antl the structuro is not intentleC or o(teretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
�� License Law tloes no[ applY �o an'owner of a property who builtls or Improves '
thereon, antl who tloes such work himself/herselt or through nls or her own
employees, provitletl that such Improv¢ments ara not intentletl Or oiteretl tor
sale. If, however, the builtlin9 or improvement is soltl within one year of com-
pletioq the owner will have th¢ burCen of proving he/she tlitl not b W Itl or im-
��ovG to�the purpose ot sale). �
I, as owner of Iha property, am exclusively conttacting with IiCensetl con-
Vactorsto consVuct the proiect (Section �044, Business antl Protessionz Cotle:
The Contractor's License l.aw does no[ apply to an owne� of property who
builds or 'mproves lhereon, antl who conGacts fo� suCh projects with a con-
tractor(s} licens¢ pursuant �to IM1e Contractor'S License law). I am aware that
proot of Ihelr Worker'S Compensatlon insurance shoultl be P�ovidetl to me.
❑ I am exemo� unaer Section B. & P. C. �or this reason .
Date Owner _
I hereby certify that I� have reatl lhis
IntormaHon is mrtecL 1 agree to com
antl state la elating to builtlir}g c n
sentatives 'tn s citv to enW u or
InsOection p
Signature
Drivers' Lic or'S5 �
ication 'antl state tnat the above
[ry d�� C��y dpd C0llfltY Old�lldllCES
:i�n, anG hereby autnOrize re0re-
bove-mentionetl property for
TYPE OF CONSTRUCTION LI NEW U ADD pCJ AI.TERATION LJ REPAIR
.❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/US� OF.BLDG.
TVPE OF PERMIT LI GRADING L.J FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. 1600 oCCUaANCV�
CONSTRUCTIONTVPE Z�]�'�7'LtS VALUATION$ ��7ftft
20NE GRADINGCU.YDS. ACRES—
Sink
<flow Preventer
kflow Irrigation
Drinking Fountains
Floor Droins
Floor Sinks
Gas Service
Inrerceprors
Kitchen Sink
Lavatories
P—Trap .
Roof Drains �
Showers
Servite Sink.
Sewer Czp
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Wdt2f CIOSQL '
Water Heater -
Water Servi
Auto-W esh
Q
R
Reinspeetion Fee ` $15 I I Issue Fee I $ 3
. MECHANICAL FEE
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple �
F irepl/Fact. BI t. 1 CBO #
Heating'System & Ducting
❑ 6100,000 BTU � 100,000 6T
Reinspec[ian Fee � $15
CMF 0865-46, rev. 30/B4 White - Builtlin9: Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Assessor
Hood or Type I ❑ '�
Canopy Typell ❑
Refrigeration System
❑4100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
i
Issue Fee ' � $ 3
.P. #
S Main Buildi
E
T Front
A Rear
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Si
Cooking Unit
Dishwasher
Dryers ❑Gas ❑EI
Fan
F.A,U.
Fixtures
Devite Boxes
Outlets
Switches
Garbage Dispoul
Generaror 00.5 KW
Fee
7712 2/19/85
- la'no0
Accessory
Parking Req.]Provided
Zone •
. Z
O
N
1
' N
G
R
E
�
M
T
5
ELECTRICAL
Transformer ❑ 15-50 KW - �
❑ 50+KW
Meter ❑up to 100 amps �
Meter ❑over 100 ampi.'.
.SubPanel -
Molors�P1 HP�ih�6
:Inc.Solar �9-15 HP �i6-75+
Pole Light �
Range
$i9l1 �
; Standing Sections '
5 KW Trash Compactor
$15 � � luue Fee.
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Appraved By
Building Approved By —_�_�
�SUMMARVOF
. BUILDING PERMIT $ �(� •OO
PLAN CHECK $
� PLUMBING $
PLAN CHECK 25% $
E�ECTRICAL $
PLAN CHECK 50% $
� MECHANICAL $
PLAN CHECK 25% $
0
FEES
$ 3
SMIP $ 'S�
PERMIT
ISSUANCE $
ENERGV P.C. • $
GRADING $
MICROFILM $ '1 '
TOTAL FEE $ J.�_
CON5TRUCTION AND PLANNING POOL 'A . -
APPROVALS Permit# - Date Inspecfor. AppROVALS Permit# Date Insper,ror
� 1. Temporary Electrical Service or'Pole 52. Pool & Equipment Location -
2. �' il Pipe-Undrgrnd. 53. Steel Reinforcement - -
3. Electrical Conduit Utility-Undrgmd. .54. Forms
4. Electrical Conduit-Undrgrnd. � • . 55. Electrical Bonding -
5. Steel Reinforcement - - ' 56. Rough Plumbing & Pressure Test �
-..6. Electrical UFER Gmd. � � � 57�. APPROVAL TO COVER-GUNITE
. 7. Footings ' .58. Electrical Conduit-Undrgrnd. �
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
� 9. Watet Pipe-Undrgrnd. , � 60. Backwash Lines, P-Trap, � 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. Rougl�-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 OGas ❑Oil
23. Gas PiPe-Rough & Test 72. Underground Flush •
24. Roof Framing , �� 73. Undergmd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
- 26. T-Bar Ceiling (Structurel) & 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. Drywzll Nailing • , ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final , ' 80. FOOD CERTIFICATE ISSUED •
33. Final Flectric Notes:
34. Fi� J ating & Air Conditioning � ' �
35. Final Gas Pipe-Test � � � .
36. Hood or Canopy ' _
37. Fioal Faaory�Fireplace - �
38. Final Plumbing ' �
39. Water Service-Final '
40. Gas Service-Final
41. Solar pomesticFinal ' . ' ,' _ .
42. Backflow Preventer � � - �
43. Backflow Irrigation - �
44. .Landscape Irrigation System � �
45. Sound Attenuation �
46. Handicap Regulations , �
47. FINA4STRUCTURE&BUILDING ','� ' � . � , �
48. Special, Requiremenfs Completed , �, � ' • '
49. Electric Release to Edison : � - ,- - � - - - �. , -
50. Gas Release to Southerri California Gas Co , � � �
51. CERTIFICATE OF OCCUPANCY ' . � ' _ ' .
No. ' � Date ` , � ' . � , . " � .
City of Costa Mesa
Building Safefy Deporfinent
P. O. Box 317
Cwta Meso, California
- -►:
CERTIFICATE OF OCCUPANCY N� 2032 C
The Building located at '�1 li. 1$th 6t. i B1dR. B� UriibO 1 LO �I
has been inspected ond found to comply with the provisions of all Cify of Costa Mesa Ordi�ances applicable thereto
for a Group N F• T Occupancy.
Use of Building Fbtu'-P1er. Reaidence with Deteaheci Garat�e
Legal Deuription�, p.��> >n�+-�.�.
(Sae ravene sida for Mafes and Bounds)
Building Permit No.�i ��I � �' Eledrical Permif No.� plumbing Permit No. �k2%i8S
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. • required under Sec. 3301 (1) U. B. C. _
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging ho�se shall be used or occupied
until the owner or operator has been issued a valid certificafe of occupanry by the enforcement ogency.
(b) A new certificate of occ�pancy shall be obtained whenever there is a change in:
1) Occupancy classification of a b�ilding or portion ihereof
2) The n�mber of apartmenfs or guest rooms
3) Ownership
If Group H Occupancy, number of aparimenis and/or guesf rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title S, Chapter 9, Article 8.
Number of apartmenis �Y' �4� ond/or guest rooms
ISSUED TO:
�:7::t� 1 i1:4V:� N'
Date- Gv� L.� 1QF11
This Cerfificafe of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of ihe City of Costa Mesa under Sec. 306 (e) U.B.C. Fmm sosa-�M-ii.av-s-a r
City of Costa Mesa
Building Safety Deparfinent
P. O. Boa 3l7
Co�ta Mesa, Californio
CERTIFICATE OF OCCUPANCY N� 2031 C
The Building located at 'j%��: l�. lQhh E�trCft�,� Bld. C. UIIlE6 ) LO a _
has been inspected and found to comply with fhe provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R Occupancy.
Use of Building Fbuz'u��! ReB�detlti[i7. Apnx'tntent Bu11di►U�
Legal Description A- pa�7-l�i-20�3-�1i _ _ _ _ __
(See wverw aida for Metea and Bounda)
Building Permit No. Z a� S.$� Elecirical Permit No. �2�Ii0 plumbing Permit No. ��
Ploor Load Signs have been installed as Room Capacity Signs have been instaled as
req�ired under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. —
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate oi occupanry by the enforcement agency.
(b) A new certificdfe of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a 6uilding or portion thereof
2) The n�mber of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as req�ired under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartmenis—�33r �4� and/or guest rooms
ISSUED TO: Building Officiol
ILAP(I� iL�RitlCii bY ��Y l�' 7 �
Dare Auauet :1. 198►
This CeMificate of Occupancy SNALL BE posted in a conspicuous piace on fhe premises and SHALL NOT BE removed
except by the Building Official of the City of Cosfa Mesa under Sec. 306 (e) U.B.C. For,,, soat—�m—ii-ea-s-s r
' FEE RECEIVED
� ;t 2 I 480
' COS'TA MESA BUILDING-SAFETY DEPARTMENT JA H 2� 198
'�P.O.BOX31] C08TAMEHA.CALIFORNIA FINANCE DEP�.�
��j� �����TA MESA
For Appllcanf ►o Fill In Complefely I AP A R PERMR.
TYPE OR PRINT ,yy BUILDING
A ' � For Office Use Onl
BUILDIN6 .�7 •• /� •• �� 1 I g � ��/• y
AODRE55 i rr l/�
R8C61PT NO. P(J1�.
COSTA MESA..CALIFORNIA ,y �
P6C[IV DG /D P[ IV� A�
OWNER L � GT� I C ' ,
al n 1 BUIL 6 , �
ADOREBH �- O Y� % 7 �' W• � I 1�.0 r� ADDR �
ARCHITECT -�AA'1E1 �CAULEP ."'"" APPROV[D �/CJ � `
! TEL�3 //�/ . BY DATE �
OR ENOINEHR a. N a e
/ L ONIN(i �
ADDRESS %� J 7� (j h�.ZD (7�CC/F BL ✓D,� i
. ZONy NO.OR UY60FN[W
� ` l� % PI.�XH CYILDI (�(,µ,�� � �
CONTRACT R a � E /L/J .BS � ^�-
L6oAL �^ 1 �j . r, � �- 1 �-W1
ADORHiY 7�U �I• L/�GOL� DeeC111Pilon PI. ,•.t��A v� - �
CITY �/f �/fJ ' A.P.NO. ' I1/� —� I �
NOTE: NOEAVEOVERHANOSHALLBELEBSTHAN
STAT6 TEL. � G 90^ TO 81DH 8 REAR P. L
LIC. NO. N. %L � I/ O 'Z C� C�(it11-�Q �
ewves �, i
OF LOT J .3BO � �o. oP eLooe. ALLOWED (U. B. C. REGUIREME�ur� 11
Now oN toT ��I!/g yAROB MPROVED YARDS APPROVED \� �
USEOF - MAINBUII.�IN6 ACCESSORYBUILDIN6 �•-�
EXISTIN6 BLDO.
(FROM GLSTREHT) y
elTEACK LIN6 PROM ' � FR NT FT. � FT. (�V
CENTBP OR 9TRE[T RfiAR YA
8ID8 YARD LEFT ' I RIOHT
R.81D8 � tT. FT.
DESCRIPTION OF WORK L.81D6 / Y. �.
NEW I— OVE gTl N— DEMOL SH RHAR iT. Ff. �' ,' \
DI6TANGB BET. BHT. MAIN Q `�
REPAIR I MAIN BLDGb. ACGESS. /BLD 8. l �^
BUILDIN6 NO.OP / ^ VAR.$C ��t'S� DATE b�� �+3 Q
61ZE ROOMB (J ST RIfiB ` C. U. P. APPROVED U
EXTERIOR WALL ('CCb ROOF TJ APPRO W
COVERING ODd COVERINO ��/)� r (Mn.w� cnr ��-5�-6 0-
US6 OF BUII�IfiQ AND WORK TO BE PERFORMED / �
( O
� �
�3/D� C� � ! Q
�� DF _ ,e 80. �. �G . o 0
1 HHPEBY ACKNOWLEOOB TXAT 1 HAV¢ pEAD TXIB APPL�GTION TH6 AMOUNT SHOWN UNOEq VALUA O IB FON TNE � _
AND BT�TB TMAT TH8 �BOVe 19 COqq6CT �NO AOqEE TO COM. PUPP088 OP 88TABLIBMINO A PE F¢e ONIv. p
PLY WITH ALL CITY OqO�NANC6B ANO BiATB LAWe RBOULAT�NG ypLUAT10N 1�'�
BUILOINO CONSTRUCTION.
PERMITTE E�P �P J '. / yPERMIT FEE _ S /�� ` m
$f / I`� •� I C EC O\ fJ / V 0¢
AUTHORIZBDA66NT J S SA a
TOTAL FEE � ��
� . �
CQSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9�7 C08TA M66A. CALIPONNIA
For Applicant to Fill In Completely
�TYPE OR PRINT
�
BUILDINO ^
AOORESS . �d �' �• —
COSTq MESA, CALIFORNIA
� ARCHITECT "rRM�
■ US80F
J•
�
� . F E R��EIVEU
(,� � JAN 2 4 1964 �
rdc� FINANCrEn DTEPI, °
I APPLIGQIIj.%NQFOR`PERh117'�SA ,
BUILDING
Fo� Office Use Only
RBC61'T NO. � P2NMIT.NO. /
' n tnr --�VE �j.u0 Z�IING-.7�"n,�--..
ZON � NO. 01 Y8E OP N W µ �
-� �- PLANB � I CYILDIN I I•-I I
r'u.nt F v I �-O �2 /� 1' ( w��w�/-"-
D88Cpl'1'10 �S/1 TJ �i �
8'O I �iJCO C./�/ / 'l`/ "
N F . A. P. NO. I I b��V i—�� �
2� V NO. // b— EJ I7 U NOTE NO BAVE OVERHANG BHALL BE I.ESB THAN
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