HomeMy WebLinkAbout343 18TH ST - Building Permits1
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� ° CITY OF COSTA MESA
BIIILDING DIVISION � � � �
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.u5
FOR INSPECTIONS CALL: (714) 754•5626
PERMIT NUMBER: 610-00145
PERMIT TYPE B_ROOF2
APN: 42501412
JOB ADDRESS: 343 E 18TH ST CM
Vicinity: DETACHED GARAGE - REAR OF PROPERTY
Squares: 400
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation
ISSUED
05124/2010
BJZ
$4,300.00
SCOPE OF WORK: REMOVE EXISTING WOOD SHAKE SLOPE ROOFS ONLY. INSTALL SHEATHING COVER WITH CLASS A SHAKE
ROOF.
20:12 ROOF PITCH. APPROX. 400 SQ. FEET. DOES NOT INCLUDE FLAT PORTIONS.
OWNER: RIDGEWAY, TDD W TR Address: 1400 W BAY AVE Unit:
PHONE: City/State/Zip: NEWPORTBEACH,CA
APPLICANT: ROGERS, MIKE Address: 17671 METZLER lN Unit: :STE B2
PHONE: 714-969-6053 CitylState/Zip: HUNTINGTON BEACH, CA
CONTRACTOR: COASTA� ROOFING COMPANY INC
Address: 17677 METZLER LNUnit: STE B2
CirylState2ip: HUNTINGTON BEACH, CA
714•842-2830 .
ARCHITECT: License No.
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroo( Permit Fee: $111.25
Reinspection Fee: $0.00
Bldg Sid Admin Fund $1.00
License No.
4L FEES $112.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/11
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays • 9:00 am thru 6:00 pm.
License No. 767366
PHONE: 714-969•6053
92647 CELL:
PHONE:
PHONE:
CMMC Sec. 13-279
iours - Sundays and the following Fetleral
av and Christmas Dav
NOTICE: The work authorizetl by this permit shall wmply with all applicable handicap access requirements under California sfatutes and related
regulalions. (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 for thy vrork authorized under this pertnil to be considered Iegai, such work must comply with all applicable codes, and all
required inspections and final approval musl be obtained. Failure lo obtain inspections and fnal approval will result in the expiration of this permil.
COOE /, ix5retnox Trce pg� � iN7I71RL5 CODEt INSpECPON TYpE o� iH n�
1818 Fixed System Final Fire Prevention 206 Final Mechanical
1288 Pool Spa Final 208 Final PlumEing
200 FinalRaRoof 270 Final Elecirical
201 Final Block/Retaininq Wall 212 Final Fire Prevention
202 Final Faclory Fire Plate pp0 Final Planning Approval
203 Final Sign 222 Final Site
204 . Final Demolition 250 Final BuiltlinglOccupancy
�
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm unde+ penallguf perjury one of the following declaretions:
� I have antl will maintain a certificate of consent lo selbinsure for workers'
compensation, as provitletl !or by section 3700 of the Labor CoOe, (or the
pertormance of ihe work for which this permit is issued.
❑ I have and vrill maintain vprkers' compensation insurance, as required by
sectbn 3700 of the Labor Cotle, (or the peAormance o( the work for which Ihis
pertnit is issued. My vrorkers' compensation Insurance carner and policy
number are: L
Carrier: � i /-�'� �✓ v� ✓
(This sectiwr need nol oe mmdetayOlhe p�eyimAis ✓alued at me nuntlietl tla1WrslS I00) orleu)
Policy Num6ec i �� % 3 `�� _ _
❑ I certify that in lhe peAormance of the work (or which lhis permit is
issued, I shall not employ any person in any manner so as to become subjecl
to Ihe workers' wmpensation laws ot Califomia, and a9ree that if I should
become subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Co , I shall fort�lh compl with these p visions.
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WARNING: FAILURE TO SECURE W ERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU CT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SEC710N 3706 OF 7HE LABOR CODE, IMERES7, AND
ATTORNEVSFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby af(rm that I am IicensBA under provisions ol Chapter 9(commencing
with Section 7000) of Division 3 of Ihe Business an0 Professions Code, antl
my license is in full force and e%ect.
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CONSTRUCTION LENDING AG CY:
❑ 1 hereby affirtn Ihat there is a construction IerWinq agency for the
peAormance of the Hork la wfiich this permit is issued. (Sec. 3097. Civil CoCe).
Lender's Name:
Lenders Address:
Siqnature Da�e
OWNER•BUILDER DECLARATIONS:
I hereby atflrtn that untler penally of perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW tor the followinq reason (Sec. 7031.5,
Business antl Professions Cotle: Any cily or county wl�ich requires a permit to
wnsWct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ne applicant tor such pertnit b file a signetl statement
thal he or she is licensetl pursuant lo lhe provisions of tha Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of Ihe
Business and Professions Code) or thal he or she is exempt therefrom antl
the basis for the alleged exemption. Any violalion o! Section 7031.5 by any
applicant for a permit subjects Ihe applicant to a civil penalty of not more than
five hundred dollars ($500�.�:
❑ I, as owner of the properiy, or my employees with wages as their sole
wmpensation, WILL DO THE WORK, and the sWclure is not intended or
oKered for sale (Sec. 7044, Business and Prolessions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and wfio does such work himself or herself or lhroug� his or her ovm
employees, provided that such improvements are not intended or offeretl tor
sale. If, hovrever, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of proving lhat �e or she
did not Duild or improve for purpose of sale.).
❑ I, as owner of ihe property, am E%CLUSIVELV CONTRAC7ING WITH
LICENSED CONTRACTORS lo con5trucl lhe project (Sec. 7044. Busine55 and
Protessions Code: The wntract� License Law dces not appy to an ovmer of
property who buiids or improves thereon, and who cont2ccs for such project with
a contractor(s) license pursuant (o the Contractas License Laws.�.
❑ I am exempt under sec.
Busfness and Protessions Cotle for this reason:
SiB�amre
305]<6(1ro]�
. .
Owner ID venfieC by tlriver's license. ❑ Ves ❑ No
J ' � �
Driver's License No. Expires:
Veri(wtion of Ovmership by (type of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby cert'rfy that no excavation frve (5) or more feet in depth into wfiich a
person is requiretl to descend, will be made in connection with wnrk authorized
by this pertnit, antl that no builtling slmcWre, scaftdding, (alse�+ork, a tlemolilion
or dismantling thereof. will he more �han Ihirty-six (36) (eet high. (Chap. 32, Grp
2, M 2, Sec. 347, Title 8, Calilomia Adminisl2tive Code�.
❑ As owner-builtler, I will not employ anyone to do work which vrould
require a permit Irom the Division of Induslrial Safety, as notetl above, unless
such person has a permit [o do such work from Ihe division.
ApOlinnfs SIBnaWre oate
Division of Intlustrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or tuture building occupant neetl to file and
certify a Business Plan for emergency response lo release or t�reatened
release of a hazardous material? ❑ Ves ❑ No
(Section 25505 0l lhe Calilomia Health and Safery Cotle requires, vrilh some
exceptions, thal a Business Plan be filed wilb the Costa Mesa Fi�e
Department by every business vfiich has at any one time during a reportetl
year a quantity ol hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressetl gas
at standard temperaWre and pressure).
2. Does ar will the applicant or present or fuNre building occupant neetl to file
a registration fortn for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 of the Califomia Health antl Safety Cotle, wiM some
exceptions, requires regislration with lhe Costa Mesa Fire Department hy
each business which at any one time has on hand a quantity ot acutely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feel of compressetl gas at slandard
lemperature and pressure�.
3. Does or will the appliwnt or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? D �es � No
(Seclion 25534 of tha California Heallh ana Safety Cade provides thal the
Costa Mesa Fire Department may require t�e preparation, certification and
fling wilh the Fire DepaAment of an RMPP by businesses which are repuired
to register acutely hazardous materials with lhe Fire Department.
4. II an RMPP is presently required, has Section 25534 of the Cali(omia
Heallh antl Satety Code been fully canplie0 with? ❑ Yes ❑ No
5. Dces or will the applicant or present or tuture building otcupant require for
the vroB which is Ihe 5ubjecl o( this application a pertnit tor such consWclion
or modi�cation from the Sou�h Coast Air Quali[y Management Dislnct or (rom
any other air pollution control tlistricl ar agency7 ❑ Yes ❑ No
(Section 65850.2 of the Caiifomia Govemment Code requires Ihat the requested
in(ortnation be fumishetl on applications 1a non-residential Duiltling pertnils).
6. Will any part of the faciliry lo be wnstructetl untler this permit be within
1000 feet from lhe outer bountlaries of a school? ❑ Yes ❑ No
pf yes". Ihe taciliry must meet the requiremeN of Sections 25534 and 42303
of ihe Cali(omia Health antl Safery Cotle).
Z If a permit from the South Coast Air Qualiry Management District or o[her
air polNtion control Oislrict or agency is requiretl for Ne vrork whic� is the
subject of lhis application, have all ot the disclosures prescriDetl by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (II'yes", allach certificate of compliance from lhe appropriate air pollution
control oKcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalty ol perjury Ihe
infortnation given above is correct. I agree to comply with all state laws and
city ordinances regardi Hazarclous Materials and Emissions.
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CERTIFICATE OF COMPLI CE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have rea0 this appliwtion and state that
the information given is wrrect. I agree to comply with all state laws and ciry
ordinances relatin9 to building construction, and authorize represenlatives of
the City o1 CosW Mesa to enter upon tha above-described property for
inspection purposes. I agree not to xcupy or allow occupancy o! any huilding
aNhorized by this permit until final inspection.
Si mmre of legal Owner(s� Date
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svu��N� o�v�s►oN
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wonv.ci.cosla-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: 610-00144
PERMIT TYPE B_ROOF2
APN: 42501412
JOB ADDRESS: 343 C E 18TH ST CM
Vicinity: BUILDING C,D,E,F
Squares: 400
STATUS:
DATE ISSUED:
ISSUED BY
Suite/Unit: C
Valuation:
ISSUED
05I2412010
BJZ
$4,300.00
SCOPE OF WORK: REMOVE EXISTING WOOD SHAKE SLOPE ROOFS ONLY. INSTALL SHEATHING COVER WITH CLASS A SHAKE
ROOF.
20:12 ROOF PITCH. APPROX. 400 SQ. FEET, DOES NOT INCLUDE FLAT PORTIONS.
OWNER: RIDGEWAY, TOD W TR
PHONE:
Address: 1400 W BAY AVE
Ciry/StatelZip: NEWPORT BEACH, CA
Unit:
APPLICANT: ROGERS, MIKE Address: 17671 METZLER LN Unit: :STE 82
PHONE: 714-969-6053 City/StatelZip: HUNTINGTON BEACH, CA
CONTRACTOR: COASTAL ROOFING COMPANY INC License No. 767366
Address: 17671 METZLER lNUnit: STE 82 PHONE: 714•969-6053
City/State/Zip: HUNTINGTON BEACH, CA 92647 CELL:
714-842-2830
ARCHITECT: LiCenSe No. PHONE:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$o.00
$11125
50.00
$1.00
2.25
License No.
PHONE:
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3I18I2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
New Years Dav_ Memorial Dav. Indeoendence Dav. Labor Dav. Thanksqivinq Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requirements under Cali(omia statutes and related
regulations. (Ord. No. 92-28, § 7, 72-21-92)
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 applirable codes, and all
required inspections and final approval must be obtained. Failure lo obtain inspections and f nal approval will result in the expiration of this permit.
•CODEt. INSPELTIONTYPE D� IN7171RL COUEt INSPEGTON7YVE UR1F, IN7I71pL
1616 Fixed System Final Fire Prevention ZO6 Final Mechanical
1266 Pool Spa Final 2p8 Final PlumOing
Z00 Final Re-Roof 210 Final Electncal
201 Final Block/Retaining Wall 272 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMP�NSATION DECLARATION:
I, ,h�e��reby aKrm under penalty of perjury one of Ihe following declarations:
�►�;Cf� � nave antl will maintain a certificale o( COnSeni to Self-InSufe (or vrorkers'
compensation, as provi0etl for by section 3700 of the Labor Cotle, (or the
pertormance of the work for which this pertnit is iSsueC.
❑ I have and will mainlain v.orkers' compensation insurance. as requiretl by
section 3700 of the Lapor Cotle, for the peAormance of the v.ork tor which this
pertnit is issued. My workers' compensation Insurance cartier and policy
number are: �'� �
Carrier. �T'( /d��— �"'
(TnisseawrneeErrolpa�yetedGlne �maavalueaatonemmd.eemvars(St00)alass)
�r: !SG -13 �U`
� I certify ihal in the peAormance of the work for which Ihis permit is
issued, I shall not employ any person in any manner 5o as lo Decome subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject lo the vrorkers' compensation provisions of Section 3700 of
Ihe Labor Co 1 shall fo hwit ply with these provisions.
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WARNING: FAILURE TO SECUR WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL ANO SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LA80R CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRqCTORS DECLARATION:
I hereCy affirm that I am ticensed under provisions of Chapfer 9(commencing
with Section 7000) of Division 3 of the Business an0 Pmfessions Code, and
my license is in full force and eftect.
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Contract
CONSTRUCTION LENDIN AGENCY:
❑ 1 hereby affirtn [hat there is a conslruction lentling agency for the
peAormance of the work fa which this permit is asuetl. (Sec. 3097. Civil Code�.
Lentler's Name:
Lentler's Address:
Da�e
OWNER-BUILDER �ECLARATIONS:
I hereby affirm t�at unCer penalty of perjury mat I am E%EMP7 FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions CoOe: Any ciry or county which requires a permit to
wnsWct. alter, improve, demolish, or repair any sWcture, prior to its
issuance, also requirps Ihe applicant lor such permit to fiie a signed statement
lhat he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Oivision 3 of the
Business and Professions Code) or lhat he or she is exempt therefrom and
the basis for lhe alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecls lhe appliwnt to a civil penalry of not more than
five hundred dollars ($500).):
� I, as owner ol the property, or my employees with wages as their sole
wmpensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply to an owner of property who builds or improves
thereon, and who does such work himself or hersell or through his or her own
employees, provided (hat such improvements are not intentled or offered for
sale. If, however, Ihe building or improvement is soltl within one year of
compleGon, the own0r-Duilder vrill have the burden of proving that he or she
did not Duild or improve for purpose o(sale.).
❑ I, as owner o( the property. am E%CLUSIVE�Y CONTRAC7ING WITH
LICENSED CONTRACTORS to construct lhe pmjecl (Sec. 7044, Business and
Professions Code: The conlractors License Law tices not apply to an amer of
property wfio builds or improves lhereon. antl wfio contracts for suc� project with
a conlracta(s) ticense pursuaN to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Protessions Code for this reason:
Sig��i��e Daie
305]-a61�])
Ovmer ID verifietl by tlriver's license. ❑ Ves ❑ No
Driver's License No. Expires:
�
Venfication ot Ownersnip by (lype ot Cocument, i.e. - property tax bill or deetl�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
� I hereby cetldy that no ezcavatbn frve (5) or more feet m depth into wfiich a
person is requiretl to descend, will be matle in connection wiih worlc authorized
by this permil, antl that no builtling sWCWre. staffdtling, falsewprk, p demolition
or dismantling thereof, will be more than lhirty-sa (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Tdle 8, Califomia Adminisl2tive Code).
❑ As ovmer-builder, I will not employ anyone to do work which would
require a permit fmm the Division of IndusMal Salery, as notetl above, unless
such person has a permit to do such work from the tlivision.
ApplionlS SignaWre
Division o! Induslrial Safely Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or PoNre building occupant neetl to file and
certily a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 0! tha California Healih and Safery Code requires, with some
exceptions. thal a Business Plan be fled vrith the Costa Mesa Fire
Department by every business which has at any one lime during a reported
year a quantily of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 qallons, or 200 cubic feel of compressea gas
at starrdard temperatme and pressure).
2. Does or will the applicaN or presenl or fuNre building cecupant neetl to fle
a registralion form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, wilh some
ezceptions, requires registralion with Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quanlity of aculely
hazardous materials equal ro or greater than a weight of S00 pounds, or a
volume o( 55 gallons, or 200 cubic �eet of compressed gas at stantlard
temperalure and pressure�.
3. Does or will the applicanl or present or future Duiltling occupant need to
prepare an RMPP (Risk Management and Preven[ion Program for acutely
hazardous materials)? � Yes ❑ No
(Section 25534 of the California Health antl Safety Code provides that the
Costa Mesa Fire Department may require ihe preparation, certification and
fling with Ne Fire Department of an RMPP by businesses which are requiretl
lo register acutety hazartlous materials with lhe Fire Depariment.
4. If an RMPP is presently required. has Section 25534 of the Califomia
Health antl Safety Code been (ully wmplied vnth? ❑ Yes ❑ No
5. Dces or will the applicant or present or fWura building occupant require for
I�e vrork which is the subject o( this application a pertnit for such wns[roction
or modification fmm the South Coast Air Qualily Managemen[ Oistrict or from
any other air polWtion contml tlistrict or a9ency? ❑ Yes � No
(Section 658502 of the Calilomia Govemmen[ Code requires [hat the requesled
information be fumished on applications for rwn-resbential builtling permits).
6. Will any part o( the tacility to be constructed under lhis permit be vrithin
1000 feet from the outer bounaanes of a school? ❑ Yes ❑ No
(If'yes", the faciliry musl meet the requirement ol Sections 25534 and 42303
of tha Califomia Health and Salety Cotle).
7. If a Dertnit from the South Coast Air Qualiry Management DisMcl or oiher
air pollulion control district or agency is required for l�e work which is lhe
suDject o! this application, have all of Ne disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes', atlac� cenificate of compliance fmm lhe appropriate air polluUon
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is wrrect I agree 10 wmply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
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CERTIFICATE OF COMPLIANCE ND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state [hat
the infortnation given is wrrecL I agree ro comply with all state laws antl city
orainances relating to building conswction, antl authorize representatives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I a9ree not to occupy or allow occupancy of any building
authorized by Ihis permi� until fnal inspection.
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(714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mese.�.�pLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 343 E 18TH ST
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42501412
Applicant: KIM. JOO
Address: �4037GARFIELDAV
SUITE L
PARAMOUNT.CA
Owner: RIDGEWAY, TOD W TR
Adtlress 1400 W BAY AVE
Zoning: R2MD R2MD
Phone: 562-630-7795
Zip: 90723
Phone
� NEWPORT BEACH, CA � Zip: 92661-1023
Contractor: ALL SEASONS HOME IMPROVEMENT
Address: 14037 GARFIELD AV
SUITE L Phone: 562•630-7795
PARAMOUNT,CA
Zip: 90723 License: 815910
Arch :
Address:
Phone;
Eng:
Address:
Status: ISSUED
Applied: 11I13/2003
Issued: 11/13/2003
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
�TEAR OFF EXIS7ING SHAKE ROOF. INSTALL OSB PLYWOOD AND FELT, COVER WITH 30 VEAR COMP SHINGLES. INCLUDES ATTACHEb
GARAGE.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
$0.00
$125.25
$0.59
$0.00
$0.00
$0.00
Total: $125.84
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
FEE SUMMARY
Calc Valuation:
Claim Valuation
PLANNING & ZONING
Rear 0- 0 Left• 0- 0 Right 0. 0
Rear 0- 0 Left 0- 0 Right 0- 0
Re uired: 0 Pro osed: 0
$5,860.00
$5,860.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutas and relatetl
regulations. (Ord. No. g2-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspendetl or abandonetl
for a period of 180 days,
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and al�
requlred Inepeetions and tinal epprovel must be obtained. Failure to obiain Inspections and final approvai wili result in the expiration of thls permit.
FOR INSPECTIONS CpLL: (714) 7545628
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WORKERS'COMPENSATIONDECLARATON:
I hereby aHirtn under penalry ot per�ury one ot Ne tollowing dadaretlons:
❑ 1 �eve end will meintaln e ceNlicete ol consent to selt-Insure tor workers' compensatlan, es proviAetl for Dy sectlon 3700 ot Ihe Lebor Cade, for Ihe pertortnence of ihe
ork lar w�lch thls partnit is issuetl.
I have end will main�in workers' compansation insurance, as requiretl Dy sectlon 3700 of ihe labor Code, ta the perfortnance ot the work for whidi ihis pertnit is issued.
My warkero' comp sation Insurence carrier end policy number are: /� •
Cerrier. �7�„fn . �c•�s.,�} (._ �C . var , .J,. � � � Policy Number. �-Ss - on � �a 6 I
(Thls sectlon need nof be crompleteh!! Me pelmlNs veluee ar one hundretl ollers 5100) oi less.)
❑ I ceN1y thel In the perfortnance ol the work for which this permit is Issued, I shell not employ eny person in eny manner so es to become subject Io ihe workers'
compensation laws of CalHamle, end apree thei tl I s IC become sublect to Ihe workers' compensetlon provislons of Sectlon 3700 ot Ihe Labar Cotle, I shall tonhwlih
�.-comPy wit� ihese pmvisions.
_ApplkaM�Sipnature:- /��� Dete: �� /�.j �O�
WAfiNINO: FNLURE TO SECURE WOHNERS�COMPEN$AT1pN ERAGE IS UNUWFUL M'D SHML SUBJECT lW EMPLOYER TO CRIMINAL PENPLTIES PN� pVIL FlNES UP TOONE MUNDRED
TMOUSrW D DOLUflE (5100,000), IN ADDITION TO THE COST OF COMPENSATIIXJ, DAM4GES AS PRO'JIDED FOR IN SECTION 3]OB OF THE L1BOti CODE, IMEREST, AND FTTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirtn Ihat I am licensed untl§,r 4roNsions of Chaptar 9(commendng wlih Sactlon 7000) ot Divislon 3 01 tha Business and Pmfessions Code, anA my license is In tull
lorce end enect. uc. » e4� I S �1, Class a C—.�i `r
CoNrector's Signeture: E, �Q Dete: � I �� /,., �
CONSTRUCTON LENDING AGENCY:
❑ I hereby eflirtn Ihat there is e cons�ructlon lentling agenty tor Ihe peAormence ot the work for which ihis pertnit is issuoA. (Sec. 3097, Civil COtle).
Lenders Name: Lentlefs Atltlreu:
SignaNre: Date:
OWNER-BUILDER DECLARATIONS:
I hereCy eNirm ihat untler penelty of per�ury that I em El(EMP7 FROM THE CONTRACTORS LICENSE LAW lor the tollowing reasan (Sec. 7031.5, Business enA Protessions
Code: Any ciry or county which requires e permit to consiruct, etler, impmve, demolish, ar repeir any sWcture, pnar to ita issuence, also requires the eppllcem tor such pertnit
to file e signetl stetement thet he or she Is Iicensed pursuant to Ihe provlsions ol the Contrectars License Lew (Chepter 9(commencing with Section 7000) of DlWsion 3 of the
Business and Professions Cada) or thet he or she Is exempt therefrom ena the besls tor the elleged exemption. Any Wolatlon of Sectlon 7031.5 by any epplicent far a permit
su6fects thB eDP�iCent to e Civll penelty of nol more lhan five hundred d011ers ($500).):
❑ I, es owner ol Ihe propany, or my employees wilh weges as thelr sole compense�lon, WILL DO TME WORK, antl the atructure Is not intentleG or otteratl tor sale (Sec.
70C4, Business end Professlons Cotle: The Contractors License Law does not ep01y to an owner ol properry who builds or improves Ihereon, end who does such work
himsetl or herselt or through his or �er own employees, pmNded that such Improvemenls ere not intentled or ottered for sale. If, hov,•ever, tha building or improvement is
sdd wlihin one year ot completion, the owner-Duiltler wlll have the burtlen of Droving that he or she ditl not build or improve for puryose of sale J. •
❑ I, es owner of Ihe property, em EXCLUSIVELY CONTFiACTING WITH LICENSED CONTRACTORS to construct Ihe pra�ect (Sec. 7044, Business entl Professbns
Cotle: The coniractors License Lew tlaes not epply to an owner ol pmpeny who builOs or improves Ihereon, antl who contrects br such pro�ect wit� e coNractor(s)
license pursuam to ihe Contrectors License Lews.).
❑ 1 em exempt under sec. Business antl Pmlesslons Code for this reasan:
Slpnature: Date:
Owner ID verHied by tlriver's license. ❑ Ves ❑ No Drivers License No. Ezpires:
Verlficatlon of Ownership by (type ol documenl, i.e. - property tex 6111 ar Ueetl):
DIVISION OF INDUSTRIAL SAFETV PEHMI7 CERTIFICATION:
❑ I hereby cenify Ihat no excsvetion flve (5) or more feet in depih imo which e person Is requireA to tlescentl, wlll be made in connecqon with work euthodzed by Ihis
pertnit, end that no building siructure, scaHoltling, talsework, or demolition or dismanUing ihereof, will be more then thirry-si: (36) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Adminisiretive Coda).
❑ As owner-builtler, I will not employ enyone Io do work which would require e pertnit irom �he Divislon ot Industriel Selery, as noted ebove, unless such person hes e
pertnil to do such wark trom Ihe division.
Signeture: Date:
Division of Industrial Salery Permit Numbar:
CERTIFlCATE OF COMPLJANCE AND AUTNORVA710N OF EMRY: I certify under penalty of perjury that I have read this epplication antl stete ihet Ihe infortnation given is
Correct. 1 egree to wmpty wlih ell slate lews end ciry ordinances reletlng to bullding Consiruction, end euthonze represematives of the Ciry ot Cwte Mesa ro enter upon ihe
ebove-descnbed properry lor ins0ection purposes. I agree not to occupy or ellow occupancy of eny buildng euthorized by this permit until Mel inspectim.
SignaWre Ot al Owner(s)
�
AnNOr Authorized Ap011cent
[i•77�1�I:F'17ti1G79i17�
1816 Fixetl System Final Flre Preventlon
7298 Pool Spe Final
200 Flnel Re-Roof
201 Final BIocWRetaining Well
202 Flnal Fectory Fire Place
203 Final Sign
204 Final Demoli�on
p�iE 1tQIIlAL9
I� �3 / oz,e
Data
COOE 1 INSiECTON ME
206 Finel Mechenicel
208 Finel Plumbing
210 Finel Electrical
212 Finel Flre Preventlon
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupency
PAIE It�LB
., `� � �
� Q ,
o. �
>
f
J
��� �
(714) 754-5273 • F� (714) 754-4856
Job Address: 343 E 18TH ST
Suite:
Vicinity: HOUSE AND GARAGE
Parcel Number: 42501412
npp�icant: BRIAN ANDERSON
Address: 1218 E POMONA ST
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
SANTA ANA, CA
Owner: HARTE, DOROTHY M TR
Address 19775 PLEASANT VIEW DR
' GROVELAND, CA' �
Contraaor �'A 1 ALL AMERICAN ROOFING
Address: 1218 E FOMONA ST
SANTA ANA, CA
Zip: 92705 -
Arch :
AddreSs:
Zoning: R2MD R2MD
Phone:' (774) 543-5400
2ip: 92705
Phone:
Zip: � 95321
Phone: (714) 543-5400
License: 693307
.... � -- Eng:
_ " Address:
•Phone: "
2ip: , , � License:
:
,�
?RMIT NUMBER
B99-01843
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 7 1/1 811 999
Issued: 11118/1999
ISSUED BY: ��
SCOPE OF PERMIT
" REROOF - TIO, USE EXISTING SHTG, INSTALL NEW TORCH DOWN SINGLE PLY MODIFIED ROOF.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation:
Permit: $9725 > , � �. Claim Valuation:
SMIP Res: $0.50 _ -
SMIp Com: $0.00 - - ` '
Other: $0.00
Inspection: $0.00
Total: $97.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
PLANNING 8 ZONING
Left 0- 0 Right 0- 0
Left 0- 0 Right 0- 0
Proposed: 0
Phone:
License:
$3,200.00
$3,200.00
NOTICE: 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
tor a period of 180 days. '' ' .
INSPEC710NS: In order tor the work aothonzed under this permit to be considered legal, such work must compfy with all applicable codes, and aIl
requlred Inepeetione end final epprovel must be obtained. Failure to obtain inspections and tinal epproval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�WORKERS' WMPENSATION DECLARATION: �� '
I hereby aflirm untler penelry ot perjury one ot i�e lollowing declarations:
� I have end will maintein e certiticate of consem to self-Insure for workers' compensation, as pmvided tor by section 3700 oi Ihe Labor Code, tor Ihe pertormence ol tha
work tor which t�is permit is issuetl.
�" I have end will maintein workers' compensetion insurance, as repuired by sectlon 3700 of Ihe Lebor Code, for tho peAormanw of Ua work tor whic� lhis permit Is Issuod.
My workers' �mpgnsetipn Insurepce carde� end policy number are:
Cerrler (iYl 1 CL� f�(lC� �-�C i✓�S PoIlcyNumber. Nl�J 1�7�%lo�'Os
(Thls secNon need nat be crompleted il the permi( is velued et one huntlred dollers (5100) oi less.)
❑ I certlty thet in ihe pertormence of the work for which Ihis pertnit I5 issued, I shell noI employ eny porson in eny menner so as ta become subject to tho workers'
compensetim laws ot Calitomia, and egree that If I shoultl �ecome suD�ect to the workers' compensation provlsions ot Sectlon 3700 of the Labor Cotle, I shall torthwith
comply wit� Nese provi � ns.
ApplicaniSignelura: rQ..-�.. � �OQ:,rw_ Dele: ��� �����
WARNING: FAILUFE TO SEd1RE WORKERS' ODMPENSATION WVERAGE IS UMAwFUL PND SW1LL SUBIECf AN EMPLOVER TO GRIMINNL PENNLTES PND CML FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100.0OO�.IN ADDITIIXJ TO THE C0.ST OF COMPENSATIIXJ, OAM1WGES AS PROVIOED FOR IN SECf10N 3lOeOF THE IABOR CODE, INfEREST. Ml� ATfORNEY'S FEES.
IICENSED CONTRAC70RS DECLARATION:
I hereby aHirm that I em licensad untler provisions of C�apter 9(commencing with Seciion 7000) of Division 3 of ihe Business and Pmfessions Code, antl my licensa is in full
force end eNect. uc. a o c�ess a (', 3�
Contrectors5ignawre:' ,2CG41/�� Date: //'/f/�i%
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirm that there Is a constmction lantling egency lor the peAormance ot the work tor which this permit is Issuod. (Sec. 3097, Civil Code).
Lentlefs Nema: Lenders Address:
� Signature: Date:
OWNER-BUILDER DECLARA710NS:
I hereby eHirtn that untler penalty of perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reeson (Sec. 7037.5, Business enC Professions
Code: Any ciry or counry which requires a permit to wnstruct, alter, improve, demolish, or repair any strucWre, prior to its Issuance, elw requires the applicant for such permit
to tile e signed statement Ihat �e or she is licensed pursuent to t�e provislons ot Ihe Contractoro LJcense Law (Chepier 9(commencing with SecUon 7000) of DlNsion 3 0l the
Business and Pwtessions CoOe) or that ha or sha is exempt thereirom end Ne basis tor t�e allegetl exemptlon. Any Wolatlon of Section 7037.5 Dy any applicent lor a pertnit
sublects tha epplicant m e civil penalry of not mora than five hundred dollare ($500).):
❑ I, es owner oi the property, or my employees with wages as their sWe compensatioq WILL DO TME WORK, and the structure is not intendetl or oHeretl for sale (Sec.
7044. Business and Professions Cotle: The Comrecrors License Lew tloes not appty to en owner of properry w�o builds or improves thereon, and who does such work
himsalt or herselt or Ihrough his or her own employees, D�ovided ihet such improvements are noI intended or oflered tor sale. If, however, the building or improvement is
sold within one year of completion, iha owneo-builder will have the burtlen of proving that he or she tlitl not builtl or improve tor purpase of sale.).
❑ I, as owner oi t�e property, am E%CLUSIVELV CONTRACTING WITT1 LICENSED CONTRACTORS to consiruci Ihe pro�ec� (Sec. 7044, Business end Protesslons
CoOa: The contrectors License Law tloes not epplY to en owner oi property who builtls or improves thereon, antl who conbacts for such projaq with a con�ractor(5)
license pursuant to the CONrectors License LewsJ.
❑ I am exempt under sec. Business end Professions Code for this reason:
Signeture: Date:
Owner ID verifieA Ey tlrivars license. ❑ Yes ❑ No DriverSliten5e No.
Veritication ot Ownership by (type of document, i.e. - property tax bill ar deed�:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Expires:
❑ 1 hereby certity t�at no excavation live (5) or more teei In tlepth into which a person is repuired to descend, will be made in connection wit� work authorized by this
permil, end that no builtling struciure, scaHolding, telsework, or Oemditlon or tlismantling thereol, will be more than thirry-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec.
347, Tltle B, Calilomia Atlminisirative Code).
❑ As owner-builtler, I will not employ anyona lo Oo work which would require a permit from t�e Dlvision of Industrial Safety, es notetl above, unless such person �as e
permit to tlo such work irom the division.
Signaiure: Dale:
Division of Industrial Sefery Permi� Number:
CEFiT1FlCATE OF COMPLIANCE AND AUTHORIiATON OF ENTAY: I ceNty untler penalty of perjury ihat I heve road this epplication and slate that the inbrmatlon givon is
correct. I egree to comply with all state laws antl ciry ordinences relating to �uiltling canstruction, end euthodze representetives ot Ihe Ciry ol Costa Mesa to enter upon the
ebove-tleuribed pro0erty lor insDection purposes. I egree not to acupy or ellow occupency of any builtling eut�orized by Ihis permii until linal inspection.
SigpaWre Of Legal Owner(s) Date
/�i/�i�� .rwi�lJ./.QA7�� �/����%Cf
And/Or Authonzed Applicant Date
CODE Y. �xsvetnoNTvve
1616 Fizad System Final Fire Prevention
12fi6 Pool Spa Final
200 Final Ra-Root
201 FIna181ocWRetaining Wall
202 Finel Fectory Fire Place
203 Finel Sign
204 Finel Demoli�ion
ta4&48
P9IE 1t�AS$
�
yQOE I INSVEC710N TYPE
206 Final Mechanical
200 Final Plumbing
270 Final Electrical
212 Finel Fire Prevention
220 Finel Planning Approval
222 Final Slte
250 Finel Bullaing/Occupanry
P�¢ INTRIRLS
'i� � 20572
,�N,p .,:
` .COSTA� MESA BUILDING-SAFETY DEPARTMENT
P. O. BO%91! C09TA MHBp, CALIFORNIA
For Applicon► fo Fill In Completely
7"1'PE OR PRINT
ADDRE55 4 �'. 1(J't]Z S't.
COSTq MESA, CALIFORNIA
MA�L 4 E. 18th Street
ADDRESS
..__i_ .. . THL.
� USE
�S
LI
LIN! PHOM �y /
�F eTRE[T / K7 REAR �
RDI LfiFT -' / I RI6HT
DESCRIPTION OF WORK
� BUfL�IN6
TO B6
i�
1 HEREBY �CKNOWLEDO6 THAT 1 NAVe RBAD TNIB APPLICATION
AND 6TRTE TH�T.THe ABOVH IB COqqECT ANO A6pEH TO COM�
FLY WITH ALL CITY ORDINANCBD ANO iTAT[ {.�W9 p60ULATINO
BUILDINO CONBTR ItlN. e.�}/ /�%']
SIGNATURE OP J � �/
PERMITTE �y
AUTHORI�VA6ENT � `
\ � \i
FEE RECEIV�D
EP 1 6 1963 �m '
FlNANCE DEP�.
APRI�AfjU1lD� ��T
�i g
For Offica Usa Only
R6C81IT NO. P6PMIT NO. . .
ONR n I �LAN9 2 I lYILDP
G (��
teo�� f .."%` � '1
YARDBAPPROVED
MAIN BUILDING
�A� BELEE9�AN �
fU.B.C.REQUIREMENT) "(
YARD9APPROVED
ACGESSORY BUILOING �
" � fi
REAR FT.�
,[
DISTANCH BET. BET. I
MAIN BLD08. ACCE
YAR.JR DATE
YH! AMOIINT BNOWN UN�EP VALIIATION 18 FOR TN8
PURPOSH OP HBTABLIBHINO A PEPMIT FEE ONLY.
VALUATI ^��J �
PERMIT FEE $ �O� �
� a-a
� $ G �J.`.A1 �LAN CHEGK $ ��
�� �/
TOTAL FEE • �
��'° :3b634
� COSTA M�SA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
,,,,r,�-,3�"`.Uoo �o��: ��::::::�9ra
I ATION FOR BUILDING PERMIT
� DATE/% CEIVED DATE IS�{ll
7 73 A �
OWNER J T j' U e A.P. NO. ZT ��
Z .
ADDRESS v du e✓ �+DIDflIE S � � G
W W TEI� !_ TRACT�
�.0 CITV ryp, 10
Z
CONSfRUCTION Q f/ W AD
O N LENDER � -J �
am
' J � BRANCH
J N OWNER \ � L
mJ ADDRE55 �
J Q ARCHITECT �/ L� C�1� s TEL. S
N OR ENGINEER / N
V Q FIRE
W� ADORESS Q ,e ✓� � ZONE VPE
aw
W Z APPROVED
J O CONTRACTOR BV
m Z �������//
J� ADDRESS ���'Vi"`�r/ ✓
W W TEL. 20NE NO.OF
Z� CITV NO. P��
w� STATE ') Q'7 • CITV �ARDSAPPROVED
j O LIC. NO. l� (� LIC. NO. MAIN BUILDING
SIZE NO.OF BLDGS. (FROM feX EET)
OF LOT NOW ON LOT FROM •-
USE OF �
EXISTING BLDG, FT.
F� SIZE OF NO. OF o
Z NEW BLDG. ROOMS STOFIES Z L SIDE D FT.
U EMERIOR WAL� ROOF %� ��
COVERING COVERWG :�EAR �FT.
J VS OF BUIL� T
VALUE
USE OF NEW �j V�/
BUIIDING
VARDS APPROVED
ACCESSORV BUILDII
ING AND ORK O BE R O ED DI5TANCE BET. BET. IN & \
a -� MAIN BLDGS. ACC . BLDGS.
a
a C UpP. � Z.� "73• 33 APPROVED ��7 � 7�
N APPROVED /
F.
Z
0
VI haraby acknowledge Nat I have read this ap0�ication antl stete�
� that tha above i�formetion is correct end apree to comply with
� all laws reguloBng butltlin8 consVuction, entl I shall no2 employ'
F any person in violetion of the workman's compensation laws of
y Me State af Capfomia.
ZI hereby carNty that I om properly licansatl as a connactor untler� SQ. F
Me State of Californie Business antl Professtons Cotla, Divisicn 3, - TH AMOUNT
Chapter 9, antl th c 'canses are in tull torce entl effect, or I� THE PURPOSE (
am exempt from he prov' ions ot t e ot Calitornia Bustnass VALUATION
antl Protassions C cie, Div sion 3, Ch er 9.
$Ipnature of ,�` �/ �/l/�
Permlttee $ �� �
_thorizetl ABent /
1
�
��/' m
b
0
VALUATION IS FOR �
A PERMIT FEE ONLV: m
¢
m
: 5 �
'7 _ m
K S E
`o
$ LL
1
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Z .
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am
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J'�� 3663�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFOHNIA 92626
For Applicant to Fill in Completely
BUILDING /D �
ADDRESS r � L
OWNER � ✓ei.(� T
MAIL ^'
ADDRESS Z !/ K-
TEL.
CITY M � NO.
CONSTRUCTION is I _
BRANCH
AODRESS �
ARCHITECT y /.(J
(lF FN(:INCFF I
CONTRACTOR ��,
ADDRESS ��
TEL. •
CITV NO.
STATE 7 ^1Q C7/'i CITV
LIC. NO. C.� l( � r IIC. NO.
SI2E i NO. OF BIOGS.
OF LOT NOW ON LOT
VSE OF
EXISTING BLDG.
S12E OF NO. OF
NEW BLDG.� ROOMS STORIES
EXTERIOR WAL1�J/ � ROOF ��'�t r ��
COVEFING J�(/G(..(f COVEFING %%/t/�� �
USE OF BVILDING AND WORK TO BE PERF RMED
I hereby acknowlatlBa chot I have rentl this epplication antl stam
that tha abova IMormetion is correct and a8ree ro comply wiih
all lows reBulo[Inp builtlinp cOnsiruttion, entl 1 shnll not employ
any person in vloteiiOn Ot the workman's compensa[ion laws ot
iho Siate Of CBIitO!llla.
I hereby certlfy [hut I am ptoparly Iicense0 az a conttector untler
the State of California Business antl Profeuions Cotla, Oivisicn 3,
C�apier 9, antl th c ' ensas are in e antl atfact, or 1
am exempt tron t�e provi ons of de ate of alifornia Business
anG Profassions Cr. e, Div' on 3, C ept 9.
Slpnatura o(
Pe�mittee
Au[horizatl ABant
PtiIC
,,,� 1�r73�M� 00 803'+ ':=«•::15.00
TION FOR BUILDING PERMIT
A.P. NO. � I / �
BUILDING
AODRESS
TRACT .�
OWNER
FIRE
ZONE
APPROVED
ZONE NO.OF
PLANS '
VARDS APPFOVEO
VALUE �
5
GROUP �
DATE �p' \�
t
USE OF NEW
BUILDING ' � ('�1
VARDSAP7ROVED 1`
2
BEf. MAIN & '2 O
ACCE�. BLDGS. J
DATE � �' � 3
APPROVED
�
m
�
SQ. FT. o
THE MOUNT SHOWN VNDER VALVATION IS FOR !
THE PURPO6E OF ESTABLISHING A PERMR FEE ONLV: ¢
VALUATION m
PEPMR FEE 5 �
LJ m
5 �� PLAN CHECK $ E
� LL
TOTALFEE S
+N. .
� COSTA M
P.O. BOH
F�
BUILDING
ADDRESS
OWNER
MAIL /�
Z ADOFESS L
W W �j
d U GTV L
�- Z
Z Q CONSTRUCTIO
ON LENOEF
am
J � BRANCN
J N
m J ADDRESS
J m ARCHITECT
a OR ENGINEER
U Q
w � ADDRESS
aW
W Z CONTRACTO
J Q
m Z
J � ADDRESS
wW
� CITY
Z H
w � STATE
y � LIC. NO.
70 SI2E
OF LOT �
USE OF
EXI5TING BLD(
F 512E OF
Z NEW BLOG.
U EXTERIOR WAI
COVERING
J USE OF BUILI
3b636 .�.Y,��-,s�"s°00 sa4:= -:;.:•�43.11
DING-SAFETY DEPARTMENT
STA MESA,CAIIFORNIA 92626
PPLICATION FOR BUILDING PERMIT
�t fo Fillin Completely R CE VE BV DATE RECEIVED D%� E ISSUEO.
�� � � , Ctl�l, l/ % - - /"S�-%
l M TNO
UH A.P. NO. -a�Y � � 3
BUILDING
1 � , ADDRESS 3 � �
TEL. (� TRACT 3 LOT BLOCK
NO. �j��J
W
.
� OWNER � SU �
VALUEn �q�
� TEL. S $ !/��'�/V
N
"'[Lf Q-�(/P. FIRE
ZONE TVPE GROVP
APPROVED � DATE �� 6' �%' �
BY
�� " \
TEL. ZONE NO.OF USE OF NEW `SiN 6E,F �
NQ �, PLANS � BUILDING � � ` �
��
CITV �'ARDSAPPFOVED VAR V
�IC. NO. MAIN BUILDING CCESSORV BVIL ING �
NO.OF BLDGS. IFROM CC/L STREET) -�
, NOW ON LOT qONT �7 O FT. FT
�5 � Q T
NO. OF
ROOMS STORIES L SIDE S FT. T.
ROOF
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WORKTOBEBEPFORAAED �, _ ,.��-....�..�e�r , orr..��.�n.
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UI �eraby ecknowletlBa that I have reatl [his application end itate - $jP
� that the above info�maiion is correct antl agree to comply wiSh�
� all laws regulatinp builtling cOnstruc[ion, antl I shell not employ
� any peraon in v(olatiOn of SM1e workman's compensation lawa ot �
� m
y Ma Ste[B of CalilOmia. _ j �y
zI haro0y certity thot I am properly licansatl as a conttector unEer� SQ. FT. — o
thn Stata ot Calitornia Businezs antl Protessions Code, Divisicn 3, � T E AMOUNT SHOWN UNDER ALUATION IS FOR �
Chnpter 9, antl thac su 'eenses are In full torca antl affxt, or I� THE PURP06E OF ESTABLSHING A PERMR FEE ONLV: m
em oxompi iro . provi onz of the S e ifornia Businass ¢
entl Protessiona r��a, Di sion 3, Chapt r. VALUATION fp
/ PERMIT FEE $ �
�
S19^atura of /� Q E
Parmittoa $ / h�� PLAN CHECK $
!" % u
Authorizatl Apant TOTAL FEE $
. , . � ' :38254
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. eOX 1200 COSTA MESA, CALIFORNIA 92626
APP I T i
For Applicant to Fill in Completely qECEI e v
BVI�DING r-h'
ADDRESS
OWNER SQ�P✓(� ` A.P.NO. '
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y K LIC. NO. LIC. NO. MAIN BUILDING
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VI hereby acknowletlBa thot I havo reatl [hie opplicetion antl smte
� that tho nbo�e intormation is corrac[ antl aproe to comply wlth
� all laws regulatinp builtlinp consvucNon, antl I ahall noi amploy
F eny persOn in violation oi tM1e wOrkman's compensetiOn lawf of
y tho Stare of Celifomla. w�
z I hereb certlf thet I am ' F�����
y y propeNy Iicensetl aa a tonSracSo� untlor
Ne Stere ot Cal(fornia Buzinass entl Proteu(ons Coda, Oivisicn 3, THE AMOUNT SHOWI
Chapter 9, and ' enses ere In full farca antl atixt, or 1 ITiE PURPOSE OF ESTP
am axempt iro . tl'e ptovi ons of th $ te o CalifarNa Bvsiness
antl Professions Cr� e, Diviston 3, Cha t 9. • VALUATION '
F
sie�ature of �/
Petmittee $ � P
/�� .SlJO D �
AUNorized Apent (/j/ 1
Qlr1
�
DATE
USE OF NEW
BUILDING
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DATE
APPHOVED
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� P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
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ARCHITECT
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ADDRESS
CITV
STATE
LIC. NO.
SIZE
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USE OF BUILDL
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TEL.
NO.
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NOW ON LOT
/ �/��`-l. t�CJY ��
� NO.OF
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= /uCI <,C.SLr
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a�R—a-�a�"„�`.00 267.: �+,=u;r�;5.50
A PLI ATION FOR BUILDING PERMIT
RE � DATE FECEIVED DA E IS U
. �..
(!
A.P. NO.I/ / ZT✓' O r, P��� �
ADDRIE S 3 Y3 �/ 8' `'� ��
TFACT J � / LOT / BLOCK ^
OWNER
FIRE
20NE
APPROVED
oe�N �% GlN�JXfL�11L
VALUE �Q
N�A.O _ S
ZONE NO.OF
PLAf�LS
VARDS APPflOVED
MAIN BUILDING
(FROM C/L STREET)
VAR. #
C.U.P. 5Y�
APPfiOVED
I hureby acknowletlBe ffiot I have reutl this applicaiion antl stata '
that the above information is correct antl agree to comply with
all laws regulating building construction, antl I shall not employ
eny pe�son in violetion of the workman's comp¢nsation laws ot
Ma Stata ot Calitornia.
I hereby certify that I am properly licensed as a coniractor untler SQ. FT.
tha State of California B ss and Protessions Cotle, Divisicn 3, THE AMOUNT SH(
Chapter 9, antl that ch lice es are in tull f rce and effect, or I THE PURPpSE OF E
am exempt fro . •e Orovisi s of the e of alitornia Business
antl Professio Cnue, Oivi ' n 3, Chap 9. VALUATION
Signature ot /� ^ q �
Parmittee $ ��(/U
v
Authorizetl Apant
DA
USE OF NEW
BUILDING
VARDS APPROV ED
DATE
APPROVED
♦
/ �
0
VALUATION IS FOR �
A PERMR FEE ON�V: m
¢
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m
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COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
- For Applicant to Fil1 in Completely
rAD1DRESS �/� ?J V ��
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FOR BUILDING PERMIT
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y � � / � �A BUILDING
w �/` ADDRESS �
� TEL. pq
NQ TRACT � (J / LOT BLOCIC
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OWNE��N
��n VA�VE
TEL. L �A�. $
NO.
FIRE T �
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APPROVE � / 1" � `(�
..�_ 7> �. ., av A oAre �
7EL. ZONE �p ^ P�rO�F� USE OF NEW
NO. �� � BUILOING
CITV VARDS APPROVEO YARDS AF
LIC. NO. MAIN BUILDING ACCESSOR'
NO.OFBLOGS. (FROMGLSTREET)
NOW ON LOT FRONT O FT.
F SIZE OF NO. OF
Z NEWBLDG. ROOMS STORIES .SID O
U EXTERIOR WALL FOOF
COVER�NG COVERING REAR O
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET
a MAIN BLDGS.
a
Q /Z � /irq� � VAR.�W
� /� `�v � 1 `�-- C.U.P. qW
N 6' �j ` DC LC �—�� APPROVED �
Z
O
~ I hareby acknowletlBe thpt I have raetl thiz eppliceNon antl rtata
� thet ffie ebove info�mation is corract entl eB�ea ro wmply with
� ell lawa regulotin9 buildinp conscructlon, antl 1 sholl not employ
F any parwn in violelion of [ha wo�kmen's eompensallon lawt oi
y Me Ste[e af Celifornia.
Z1 �ereby cerHfy MaC I em prOperly Iicensotl as a<onvector untler S
the Stata o4 Celifom(a Busiaess a�cf Professtons Cetla, Olvisicn 3, TH6 AMOI
Chapter 9, and t Iiconses era In full force entl affact, ar t TNE 7URPC
am eaempt fro tha pro Isions of ha Stete Ca�ifornla Busineia VALUATION
and Protasslonf de, D i+lon 3, C pter .
Slpnature of `
Pormittea T § p"�
Author{xatl Apent
BET. MAIN &
�
STATE �
_�
�
�..� — - w
0
VALUATION IS FOR � _
A PERMIT FEE ONLV: Q
(��
E $ V ! rmi
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m
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