HomeMy WebLinkAbout774 17TH ST - Building Permits;�i,:,:' 17T!? Si'R�R 77L', �7)G t� 778
�17�0 - 11-12-)6 Ind. 31d�. $, 85,EC0.
, 42977 - 12-27-76 . 3'.ton-Elec. Wall Signs 470.
' 489253�2�•81 II,EC NC (bbtor) (776)
�48833.Q�2� �9( ELFr NC IMeter) (�76) �
� 86603 Gazage 5,000.00
s (0'ii3 ; 7 � '
� _ M 52139 / /�/� / _
!O ( (
0
�J
I� OWNER TILLER MASTER & HOONLITE MARINE DATE ��_�_���
� JOB ADDRESS 774 776 6 778 West 17th Street BUILDING PERMIT N0. 4�q»
Q G��,,ERAL CON7RAC70R Owner/Sldr DESCRIPTION of WORK 3 Non-Elec. Wall SiQns
ei�:���. IIb-TI% �_OT TRA[T fIRE 20NE VALUE f 470.00
SUBCONTRACTOR
G�5
LINE � � HOUSE CON.
ROUGM ME�TING AN� �IR WI
TEMPOR�RY SERVICE OR Pol
UN�ERGROUND � iOwER
ROUGH WIRING
STEEL
BONO BE�M [_J 'STEEL REIN�ORCE
SMEATNING
FR�ME �NO FL115MING
P' 'ER. BROWN CO�T
S .TUR�L. FIHAL
ME�TING, VENT., RE�RIG. I
PLUMBING, FIN�L �ND GAS
ELECTRIC. FIN�L
_BUIL01
PflOJECT RODflESS: 7% 6 W 1 7•TH Jr�
OWNEfl'S NAME: MOUNL I=E MAR ZNE
nooness: 776 WEST 1'1TH STREET
COSTA MESA, CA
RPCMIENGINEEN:
RDOHESS:
xec.xo.:
UNIT:
UNIT:
PEPMIiTEE: A—AMES PLUMBING 6 HEATING ( 714 ) 530-2440
nooeess: 10422 TRASK AVENUE
GARDEN GROVE CA 92642
LICENSED LONTNRCTOfl OECIAHATION: I �ere0y atlirm inei I am IicenseU unEer provisions af CnaO�e� B l�ammencinp wil� SecliOn
7000� ol Oivisian 9 of I�e Business an0 Pmlessians CoOe. aM rtry licenu is in IW forte and ettect.
ci,ruc.:006664 sTareuc.:'150307 �wss: C—
�,;�: �Z6 ` q i Si9iumre' _ — —
WOqNEBS' COMPENSRTION DEClAMT10N: I �_ y ailirm thai I have a ce�i�iwle ol mnsent m e�m i icaie oM1ers'
comoenutinn Lns�ce4 ��c�t�ee caw tnereo� �Secuon 7eoo. �ao. �13 / O 1/ 9 2
POLICY NO.: Y EXP. ORTE:
comraxv: REPUBLZC ,�},1
~ Cenitied copy is �ere0y Iumis�eE. l] Cenilie0 rnpy is Ii1M with I�e ciry Building ' isfon
Da�te� �—�� � � � AODlicam:
�fREMPTION iBOM WOflKEBS' COMPENSIITION OECIABRTIO '-�IDis sectun nee0 mi 6e completetl if Ne permi is ior ane hurMred (5700) or less).
I certity I�al in I�e VeAormance Of Ihe work lor whi�h I�is pe�mil is ¢suetl, I 5hall noi employ any Dersan in any manner so a5 to become
subiect �o Ihe Workers' Compensaiion Laws ol Caiilomia.
Date: SignaWre:
NO7ICE: II. alter making Ihis aeclaration, you snoultl Cecome suEject lo tne Workers' Compen5d0on provisions of the La�or
Code. yau musl fonhwittl compty wit� sucA Omvisions or tt1i5 permi� shall be deemed revoked.
CONSTBUCTION LENDING pGENLY: I here0y allirm tAat ihere is a consiruciion IenOing agency tar ihe Detlormance oi l�e work lor
whicn inis nermit is issuetl (Section 3097. Civ. C).
LENOEX:
aooxess:
OWNEB BUILUEH OECIABRTION: I trere0y aflirm Ihat I am exempi Imm i�e Comractors' SWte License Law lor ine follovnnp reason
(Seclion 7fq1.5 Business ana ProfeSsional COGe: Any ciiy ol c0unry w�icll reqVires a p¢rmit to ConsiNc�, alter, imDrove, Certrolis�, or
repair any SlmtWre. D�ior l0 i6 issuante, a6o mpuite5l�e apWiwni �ot Suth permi� lu Iile a siqneE Slafemeni Ihal he/Sh¢ is licen5¢tl
Dwsuam io t�e D�ovisions ol i�e Coniractori State License law (Ctupter 9(cammencinq vnt� Sectian 7000) ol DMsion 3 0l t�e Business
ana Prolessions Coae) orthallie/5Ae is eeempt tneRirom anU Ihe bas6 fortlle allepe0 e�emption. My vioWtion ol Sepion 7Q37.5 Ey
any aODlicani �or a Oermit SUEjCCIS i�e applitanl to a dvil pendlty 01 Mf mofe ItWn Irve AunAreG AWlars (5500�.
I, as ovmer of t�e pmDeny ar rtry employees vnl� wapes as t�eir mle wmpenutian. will Uo I�e wo�k, antl Ihe
� simaure is rwi imenOeE or oeerea for sate (Sectbn 70ad. Busineu an0 Professional CoUe: Tne Comractors' Stale License Law
Goes not apOh �o an awner oi a pm0erty who OuilEs or improvu IMreon. an0 wlio daes such work �ims¢Il/herult ar IAroup�
�is ar Aer awn empbyees. O�oviEeE Itul suc� imprOvemenis are nol intenE¢G or oflereA fot Sale. II, Mwever tlle huildinq ar
, impmvemenl b solG withm ana year ot compietiw. I�e owner will nave I�e OurOen oi O�ovinA he/s�e Oi0 not GuilE or im0�ove
lor ine OutpOse ol Shce�.
I.as ownerollhe Dropeny. am PcluSively mniractinp wilnikensetl Coniractorsto fAnstruct�he pmiep (Sftlion 71W4. Business
'� an0 Prolessions CoAe: T�e Contrauari S�ate License Law Oces rot appy to an owner ol properry wtq hmlGs or imD� Ihereon
and who COniraq5lo� 5uth D��e[IS wiltl a fAnVaCiOr(5) Ikense pur5uan� lo t�e Conlrati0r5' S�ale L¢enSB Law�. I am aware
��al D��� a� ��e�� WoikeYs Compenutbn insunrKa StqNn ne Orovqe0 �o me.
� I am erempt un0er SeGim: B. 6 P. C.
lor Inis reasan:
pale: �Qxnec
i Oo hereDy cenily �hat I am aware of ana un0erstana tne requirtmenls ol Califomia Health antl Safery Coae Sections 25505, 25533, antl
255JE ana Ihal I or any lulure �uiltling acupant wiIVvAI noi (tirtle one) neeU to fAmpry wittl Said state wdes anE ihe repuiremenls lar a
p¢rmii Ior conslmtli0n Or m04dicalion ��Om I�e An Oualiiy Manap¢meni Oislrid. fleAUenlial con5imtlipn apD��Calions are exemp� �rOm
inese o�a�isians.
, Daie: ' Npplicanl:
� i nere0y cenily �hai i �ave reatl ihis apDlication antl state ��a� �he a0ove inlormation is corr ee to compry with all cii
ord'i cesantlslatelawsrelalinglobuiltlmgcon5lmclionanG�erebyauthor¢erepr .uvesol�hi ' menteruDonl=
oerry Im inspeclion vurpases.
oa�e:;�i o — q / Signa�uro
Oriver's License or Social Secun�y a: �
t6<La6 W�ile—Bwltling; Green—Cotle Enlorcemom: Canary—Ap0licam: Pink—Revenue: Goldenwtl—Assessor
CITY OF COSTA MESA — BUZLDING PERMIT PERM NO: M 05213
PERMIT' NO: M 052139 PLAN CHECR NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE; MEC z PURPOSE: OTH
JOH DESCRIPTION ; REPLACE FAU, 100,000 HTU S{� FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: *
**�r+r**���****�*�****��***x**+t***fc�+r�**�r�r+t***�r�r*���+���r**+r**�r*�*�**�t**�x*x*��*�r**�r
Z O N I N G R E Q U I R E M E N T S .
S E T B A C K S �
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
�FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ� PROV: PARCEL: 00000000 ZNE; REF NO:
PLANNING Nf)TES>
j .
ih af 1E �t iF iF iF it iFik jf if aE iF iF M 3f if iF if iE if iE iE iF if iE if iE 3E �F aE IE aE iE jk iF iF iE it if iE 1E iE if iF iE it iE aEiE �1E iP iE iE iF iE iE iE 3E 3E iE �E jE if iE if if iE iE iF �F IE k iF aF if iE if
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED HY ;
APPLICATION ISSUED BY•
r�r�r**��x*�r******�**�t�**
iP if if if If iF if k iE af iE it �f iF �E if ?E 3E 3f iE IF 34 iE iE iE iF !E �t iF if iF iF k if * IE iE if if iE �f IE iE iP iF �lf'if lE if
LEGALIZATION:N F E E S U M M A R'
BLDG PMT PLUMBZNG ELECTRIC MECHANIC
DATE:
DATE: �S�"Z �
1FaE1FiFiEaEaFlE iia4
iE iF if �f af iF fF iE )f iF �E if iF 1F aE if IE iE 1f iR
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
PERMIT 9'15Y SMZP/NON—RES
PLAN
ISSUE FEE 15.00 '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 9.00 15.00 . 0.00 24.00 24.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECH
'� 24,��
ih iE iF iF iF it af If iF i! If �f iE iF iF if IE ik �k aE if iF 3f iE if iE 1E iF iE k iE if if 1E iE 1f if 1F if iF iE ik k/F 1E 1f 1f if iE,k iE 1k iE ik 1E if iE if iF 1f if 1E fE jE If iF iE if 1f �E jE iE IF if if if i6�1F it
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
MEC 1 INST FORC—AIR/GRAV FURN �<= 100 K BTU 9.00 9,00
END OF FEES
\
Y,
�
^L aecv;,?s-n��?�7�� -���, t
DATE: OS/2�/F1 ;:i^,E: ;. ,,-•
:.�
.,
CONSTRUCTION AND PLANNING %� POOI :PA ,�
APPROVALS Permit # _ Date Inspector qppROVALS Permit # Date .Inspector
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. $oil Pipe-Undrgrnd. , 53. Steel Reinforcement
.3: Elec[riwl 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. APPROVAL TO COVER�GUNITE �
7. Footings . 58. Electrical Conduit-Undrgrnd.
�, 8.•Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Stiuctural Floor Svstem 61. APPROVAI 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
74. Rough Plumbing 65. Electriral�Final
15. Rough Electriwl-Conduit 66. Solar System-Final �
16. Rough E�ectric Wiring 67. Fencing & Access Approval
17. Rough Wiring 5ign 68. APPROVED FOR PLASTERING
. 18. Rough Electricsl�T Bar Ceiling 69. POOL/SPA SYSTEMS FiNAL
19. Rou�h Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT
20.� Rough Factocy Fireplace . ' - • �APPROVALS��' "Permit #
�
21. Duc(s, in Structure. .. J0. Undergnound Hydro
22. Ducts, Ventilating � �. 71. Product�Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test � . 72. Underground Flusti '
24. Roof Framing � -_ - ' 73. Undergrnd'.StorageTank OGas ❑Oil �
25. Roof Sheathing ' . ' � ' � �74,- Overhead Hydro-
26. T-Bar Ceifing (Structural) & Monocoat - 75. Dry Chemical '� �
27. Frame and Flashing � �- •. ; 76. �Dry Standpipe "„ . � � �
28. Lathing & Siding � : u � • � 77. FIXED SYSTEM FINAL :
'29. Insulation � ' 78. FIRE PREV. FINAL � �
30. Drywall Nailing • � HEALTH�DEPT•. REQUIREMENT
31. Plaster Brown Coat ,, � 1 , J9.� FINAL INSPECTION �,
32. Electriwl Power Mete[•Final � f �� � ' 80.. F000 CERTIFICATE ISSUEO
'. =i . 3 �� /lo�-'<z�at� y- ��
33. Final Electric - ' Notes: Z
34.-Final Heating & Air Condi[ioning, '' �vf !`� G� . � � . . -
35. Final Gas Pipe-Test '�- ,' /, � _ • ' � _ '
36. Hood or CanopY � - . _ �
37. Final Factory Fireplace - I�/` '
I f .
-38. Final Plumbing � . ^ '
39. Water Service-FinaP • �{� : '' � • � �
.. 40. Gas Service�Final , , � , � � � , � � �
41. Solar pomestirFinal � _ • - '
42. Backflow Preventer � , �. �
43. Backfiow Irrigation• ' � ' '
44. Landscape irriaation Sysrem . • - . ,
:45..Sound AtrenuBtion � ' • , •
46. Handiwp Regulations = ' ' . , � . .
47. FINAL STRUGTUFiE & BUtLDING , . . -
48.'FINALPLANNING � � ' ' , v!� • �
�.,
49. Electric Retease to Edison � "� ` � �
50. Gas Release to Southern California Gas Co � �l ;� _ . �
51. CER.TIFICATE OF,OCCUPANCY ; , -
No. Date � �
� .
AOYllcant to fill in all spaees e:eeo� ��aw wit�in neary OorEer Iinea anG dgn all aDP�ooriate tlecl
CITY OF COSTA MESA, ; ' �._ PEFiMy�,NO./ TRACT NO. �-LOT NO.� B .
CONSTRUCTION PERMIT. ' ' � , (� —(p lo D' t� —IOg�
AppliCent'S Meiling Addlei5 �� � � � ' T�PE OF CONSTRUCTION : NEW ADO : ALTERATION , �REPAIR
Pfoj2CtAddferi-��_��� �� � ��T� �rp' �' �+� _ � QONVERSION `� DEMOLISH ❑ OTHER" _
Owner'z�Neme'�^�4.•' K�u�g�N PhOne• �� .DESCRIPTIONOFWORK k VC'
, .. � . I ' ✓I.d�� � . ' .
Address '. ' 1 : � - . • . � .
�2�`���'r�L� ' TYPEOFPERMIT' �GRADINO� F NDATION ,STRUCTURAL � ..
Arch/Eng,r,'1(lr=•iK�n�"T �T--T LICen50 NO.� ' ���❑ TENANT O ELECTHICAI �, PLUMBING ❑ MECNANICAL �
Addleu ' • ❑ �OTHER � � ' � . ' ' - - . .
Contiector's Nam W � � hone � � ' ' PROJECT DESCRIPTION� Sa! F7. "� oCCuan�rlcv� ��� p�-'
AddreSs��A1811ing) ' " • , � � ' ' � CONSTRUCTIONTVP ;VAIUATION�$'J/fJiTT/-
' ' -- � � � � ZON� ` GFA�INGCV.vDS. � �AG 5
License No - - � ' ' ' - � �
LICENSEDCONTRACTORDECLARATION �•�. ^ ' ' � Remarkr. G _ 3�,.$2 /�z l �5 � .Ik'-SO•
1 hereby affirm that 1 am Ilcensatl unOer proVi11on5 oi�Chafter 9(COmmBnting � .
with'sectlon.7000) ot Divislon 3 oi the Business anE Professlons CCEe, antl . . ' . '
myJicanse Is In full force anG�etfect. : ' `„t � � �
iJBense Class' ' � Ucanu No:' � � ' PLUMBING , � ""'
Data � • Si9nature � -
k��ORKERS' COMVENSATION OECLARATION ' � � ' � Be! Sink I ' . � ��� �P � j
:y'}*.'�,"ara0y affirm.tnat 1 hdva a.certifiwta ot consent to self-Insure or a certificate- • � gackflow Preventer" i` -Sewer Conne2tion' � "
Workars' Compensstian Iniumnce„ or'.a cartliletl caDY ��areoi (Sactlon -
��00, Lab. C.) . . ! i� 1 � � � i ' Beckflowlrrigation � � Solar"Collectors. •� ' "
PoIICY No. � ' � • CompanY � �' ' . . . . . _ ..: _ _ '
8 CartHletl coDY �s eeraby Turnishetl. ' ':.� . � 1, i ! � . Bathtubs J Solar Piping { . � � •�
Certi/latl copy Is /11e0 with t�e city BUIItlIng,Dlvislon.j
Date � Applicant ' f' � ' ! . ' Clerifiers SolarTank � •�
EXEMMION FROM WORKERS' COMPENSATION �ECLARATION f ' Di5hw35hE�' ` � ' Swimmin POoI W/Spe-•
1 ssj55ec9ion neetl'at be tom0�etetl 1} the�permlTiz for one;hunAretl (5300) or ' � • � —•� 9 �� ' ;
I�certHy;that in tha partormance'of the work tor�which tlild perm�t is Issuetl I � Drinking Fountains � Urinal^� '�'� �, �
.. .. r e...�in.. anv mrmn �n anv mannwr cn az tn hacnme tuhiect te t�e � - � -
a If; aftar makin9 this Geclaa
' Gompensatlon provislons.o
wlth sUch ,pfOv751on5 �Of � �
7UCTION LENDING ACE�
affirm that there is a constrw
work fot� whlch:t�Lt�De[�
Name 'YL���
��.'AtlEreu' � t - ' �
.BUILDER DECLARATION
alfirm that I am"exempt frc
efrom an0 lbai bd51T fo� the �
.1:5 by any appliwnt Tor a
alty of not more than frve hun
�, as awnar of�[he.proPerty
ipansallon will tlo tha work;
sale (Sec�lon 7044', Huzlnes!
ansa Law Ooes not aDD�Y to an
reon, antl who tloes"zucti woi
aloy eas. ProviOetl tnat such irt
�. I/, howeuer, the builtlin9 or
:IOn, tne Owner wlll have tha 1
ve lorlhe Ourpose of sale)�.
I, as owne� of the property, a
:toRto <onstruct-the'Droject. .
i Contrattor•s Gcense Law �
Itli or improvai' [hereon, antl
:tor(s) Ilcense pursuant to tne i
i am eaempt ur�'d�sect o�K
,a • _�r_�„�' own r
ereby-certiy-tOat-I� have rea
nmatlon ii correct. I agrea to
I,state laws relating to builtlb
IdtIvBS O/ I1�15 �City: S en r
J8CU0�1 DUf�ISE�.� � � � _
- , i �
ontractor's Licenie law for tne
1 Professlonal'Cotla: Any clty o�
tlter Improve; tlemolishior repalr �
res t�e aDP��cant for such permit
�eC pursuant lo the�provislons of
mencin9�wi[h Sectlon.7000) of '
Otl0) O� that he/sheisiexempt .
ptlon. Any. violatlon-of SecHon
�Jacts the applicant to a tivil ,
(SSOOj. { . .
lovees wit� waaes as their sole :
re noc mtanaea or onerea ror
IS soltl within One year•of com-
�Ing he/sha tlitl not buile or im- �
contracting�with!licentetl con- t
Busineis antl Profeulons Cotle: J
to an owner of property who �
' for such projetts with a com �
ican;a Law):.
� P. C. tor this reason �
�,
t anE itate that [ha above"�
cityantl county ortllnances
n,�antl hereEy authorixe rapre-
bove-mentioneE property for
� � � .� . .� G �f !
Floor Drainzt �
Floor Sinks '- - '- �
Gas Service � �Outlets - �
Interceptor5 � "
KitcheniSink: �� i � �
l:a'vatories • � .,' � -�
P-Trap - "
Roo£Diains - 4 . � �
Showers : �•� � ' �
Servite Sink: -v '� ;
I
Boiler �. ' r� '
Du'e4'- UndecGround '
Dutt-Strucmrel 1 �
Duct:.Ventilating_:. i_._
ExhaustSystem ❑ Multi�
Firepl/Fact. BIt. ICBO #
Heating System & Ducting
❑at00,000�BTU �100,0
� �
Hood oi Tvoe 1 ❑'
x � Ddvers' Litense Or SS � '� '- �(��� � � ��"y'""
� . -
CMF 0865-46 rev. 12/82 White - Builtling: Gnary - APO���nt; Pink - Accounting; GolGenrotl - Assessor
Water qout
WaterHeater,- -- -�
Watei Service � _ '
r .
� . � ` . i
; .i : � . �.
{ - � r .. '
. , � Reinspeccldn�Fee
< < laue Fee „ �
❑O�t00,000BTU ❑100,0008TU
1 1 1 I •
� , ' �
f � �
�...__.._1.-.i. � '
1 � ' �
� . Reinspe,etion Fea�
• 2 �SSUB FBB 1 .
' ' 4 .
.,. � C � • _ �
A. P: ,r '-tZ4' . C76I — I.
PLNG.flEF.�4h �R'�J' �
TOBUILDING �l7���i1 �
PROPERTV LINE G. '
LEFTSIDE VAflD%-�'�D��r��
_PKG.SPACE FiEQ.a� -r �
STREET WIDTH .
Autamatit
Dryers ❑Gas� �EI
Fan
F.A.U. �. �
Fixtures � , _.
Device Boxes
Outlets
A
5849 3/17/$3' -
i ' ' •
iNE . 1 Y LlD " '
BUILDING � ���
SFTBIi�i I`/1 CT � .
_AR VA'RD (TO P/L) = '�
GHTSIDEVARD -O�,
PROVI�ED (...1,-�'�
' • 'PAflK FEE $ �=
�PECIAL REQUtREARENT
N
f� �
ECTRICAL �
Meter _�over_700 amps�_
Sub Panel' � � �
;Sub Pola � . � '� ;
.InaSolar �9-15HP,�.1
•Microwave ����
t �
�Pole�,Light � �
�
'Range . _
�Si9n: � � . .
�.1
• 5wrtcnes � , � • Trash Compactor � � � �
, ! Gar6age�isposal ' ' � ' � I
Generator, OO-5 KW �5-15 KW � ' � ' , '
Trensfarmer ❑75-50KW ? i I � �
$15 � �5U 1 KW. . , Reinspection Fee $75
Meter ❑up to 100'ampi �laue Fee. � ' S�3
S 3 2onin9 APProved BY f ' � Date � .
� � i , '
Applimtion Approved By ate
:r
' Application Issued By ' Date
� ' MMARV OF FEES ; t � �
.BUILDING PERMIT $ �' `S� � SMIP , � $ O'SO 1
;PLAN CHECK' ' ?ERMIT � I '
'PLUMBING ; $ ' ' ISSUANCE i $ i
� �PLAN CHECK: ; $+ . 7 � GFADING i $
t .ELECTRICALj $ � ' ' ! ' I $ � �
1 i t � MICROFILM
,PLAN CHECK . $ .
� ;MECHANICAL � $� i TOTAL,FEE: � ` �^ '
$15 � � ipLAN CHECK. � $ � LESS • �
� , � . ADVANCED PC - $ �
S 3 . . . ' � • t ? FINAL FEE • . "
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COSTA MESA BUIIDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, LALIFORNIA 92626
For Applicant�[o �il'I,�i� Completely — Use Ink Only
BUI�DING � t,,
ADDfiESSa.� i�j Y�(�lL 1'� J=µ �~�
owNea GiCTNt"i2 J� iCIJVDSoN
"�iA A!�+ I� � �Lr� 41 i �15 o rJ
MAIL /
A��RE55 IOII GLiFF 1x1.1Y��
s ' TEL.
CITV NC�1�OQ�� %ji��G{�: p�p,
BFANCH
ADDFESS
ARCHITECT �O �
OR ENGINEER f�
ADDRESS L�L�Z�j
CONTRACTOR
AD�RESS 2� Tj�
��T� SA �?A
STATE
LIC.NO. 'L�3
512E
OF LOT
USE Of
�'��./'C�F��I T N����'j'D�"
'%L(.�aCl� lA.l,
�Aa:2�,�e.
G'� �}T�ST. Sw�T�e, i2.S`
TEL.
i3 J A� No. 541-167
, � LICVNO.lOII Z
INO. OF BLDGS. -/
NOW ON LOT /VopJ
Separate permits are required for
electric, plumbing and heating work.
UILD{NG AND WORK TO BE PERFORMED
I hereby ecknowletlga thut I have reetl ihis application antl state
ihat tha ebove Iniormetion is corract and aprea to comply wlih
nll laws ro8uleting building conrtruction, antl I shell not amploy
eny pe�son In vloletion of tha workmen's eompensation laws of
the Stata of Californie.
l herebY cenify thaf 1 am p�OPar1Y ��caocad as a contrecmr uoCer
ihe Stote ot Cellfornie Business end Professions Coda, Division 3,
Chapter 9, entl that such Itcensas are in i�ll force antl etfact, or I
am axempt from tho provisions ot the Steie of Callfornle Business
end P�ofesslona Cotle, Diviston 3, Chapter 9
SlBneture of
Permittee
Auihorizetl Aoeni _
��R -5-76PAILOO 225'r� u� � 17434
��,�.
APPLICATION FOR STRUCTURAL PERMIT
BLOCK
ED
� E C,'P PL4NS �, I BUILDING EW�.D6. T
YARDSAPPROVED YARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDING
DISTANCE BET.
BET. MAIN &
gIOLD FOR SPEC AL RE UIREMENTS ^
m
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m q
SSQ. FT. '� O
THE AMOUNT SHOWN UNDER VALUATION IS FOR m�
7HE PUFP06E OF ESTABLISHING A PERMIT FEE ONLV: � �,/�
a 1\ �
VAIUATION PERMIT FEE E h\ V
m
PLFN CHECK S m QQQ
? ���OO TAX E , U �
TOTALPAIO E
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4iM ?_�t-76���=003833 o*w = L59.G0
COSTA MESA BUILDING•SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFOANIA 92626
APPLICATION FOR STRUCfURAL PERMIT
For Applicant to Fill in Completely — Use h Only
RECEI QJI/ D E RE =F �
BUI4DING � � ��L' - 2 � �
ADOAESS n' �
�f�� 7•-/�[ E2 •/V y(,0` PEFMIT NO.
OWNER
/V f� J 1� A.P. NO.
BUILDING
MAIL ADDRESS
ADORESS
TEL. TRACT LOT BLOCK
CITV NO.
Cpf.KjTRUCTION D A R PAI
LENDER
BRANCH
OWNER
ADDRESS VALUE
ARCHITECT TEL. $
OR ENGINEEF
FIRE
ADDRESS 20NE TVPE GPOUP
APPROVEO
CONTRACTOR � BV DATE
ADOAESS
TEL. ZONE NO.OF USE OF NEW
CITY NO.
PLANS BUILDING
STAYE CIT�' '�ARDSAPPROVED VARDSAPPqOVED
�IC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLOGS. 1FROM C/L STREET)
OF LOT NOW ON LOT RONT FT. FT.
USE OF
EXISTING 6LDG. S F
Separate permits are required for L. SIDE FT. FT.
electric, plumbing and heating work.
REAF FT. FT.
USE OF BUILDING AND WORK TO BE PERFOflMED DISTANCE BET. BEf. MAIN &
MAIN BIDGS. ACCESS. BLDGS.
// V��J� �U i C URP. yW APPFOVED
APPROVEO
I hereby acknowletlpe that I hava raetl thi� appliceilan and stete
that tha obove Informetion ia cor�ec[ entl eBree to comp�y with
all laws repulating builtling conctruction, entl I shnll not employ
any darson in violatlon of ihe workmon's compenution lawz of
tha Staie of Californie.
I herBby certify ihet 1 am properly Ilcansed as B contracior untler SQ. FT.
t�e Siete of Calitornie Businesa antl Profasstona Catla, Divisian 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chepier 9, antl thet such Ileenws ara In full forca entl effect, or I THE PURPO6E OF ESTABLISHING A PERMIT FEE ON�V:
am e%ampi from tha provisions of the Stata of Callfornia Businesz
VALUATION PERMIT FEE 5 �Q
and Professions Code, Division 3, Chnptar 9.
SlBnature of / P�N CHECK S ��
Parmlttee S TAX S
AuthOrizotl Agent � TOTAL PAID E O