HomeMy WebLinkAbout367 18TH ST - Building Permits(714) 754-5273 • Fax (714) 754dB58 • www.c�.costa-mesa.BUILDING PERMIT n FAIR Df;IVE, COSTA MESA, CA 92626
Job nddress: 367 E 18TH ST
Suite:
Vicinity: ROOF
Primary Occ: R
Parcel Number: 4z502229
Applicant: BERBER, ISRAEL
Address: 1615 S MINNIE ST
SANTA ANA, CA
Type of ConsWctlon: V-N
Zoning:
'Phone: -p14)83G83&1
Zip: 92707 ' ..
Owner. CHUANG, THOMAS T TR %TOP REALTY INVESTMENT
Address INC . . � � , - � .
1641 E CINCOLN AVE � - -�Phone: .� � � �
ATTN PETER SU � ' , .� . . �" �Zip: �-928651929 f ' � - .
Contracror: R B-ROOFING
Address: 1615 S MINNIE ST �
; . , SANTA ANA; CA
Zip: 92707� ` �
Arch :
Address: �
Phone:
Zip: � - ` License:
ISSUED BY:
Phone: (714) 83G8384 � ,
i .
°� License: 772680 .^,
� - � � Eng: ' ', .
„ ", - Address: ' � '
Status: ISSUED
Applied: 07126/Z005
Issued: 07/2&2005
Phone:
..` ,:License: � .
� SGVF't UY YtKMI l - � -
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER 30# FELT, 40 YEAR COMPOSITION SHINGLES, G.A.F. TIMBERLINE, AND REPAIRIF2EPLACE
SHEATHING AS NE�DED. 88 SQUARES FOR MULT6FAMlLY BLDG. ' �� '.�.
, FEE SUMMARY �,
Plan Check: $0.00 — _—..... x;Calc Valuation: ' S26,000.00
PermiL 5401.85 ' � Claim Valuation: 526,000.00
SMIP Res: $2.60
SMIP Com: $0.00
Other. $0.00
Inspeclion: 50:00. , .
'
Total: � 5404.45 ;,- � � � � �,
PLANNING & ZONING ;,. ; :
SETBACKS ' . '
. � - ��- —
MAIN STRUCTURE Fmnf . 0- 0 - , . � Rear � 0- 0 �. , ' - " � �Lefl, �0= 0 " � ' Right � � 0- 0,, . ,
ACCESSORY Front� �� 0-�0. Rear : ;0.0 �. .n �Ceft" 0-0 �: Right '�-�0-0 -
PARKING Existinq: 0 ;, Re uired: 0 � -'= Proposedi �!/ 0 .
INOTICE: The work authodzed by th(s permit shall wmply with all applicable handicap access requirements under Califomla statutes and retated
regutat(ons. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This pertnil shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abantloned
for e period of 180 days.
INSPECTIONS: In order tor the work authorized under this permil to be consldered legal, such work must comply with ell eppllcable codes, end all
reQulred Inapectlona and (inal approvel must be obtained. Failure to obtaln inspections and tinal approval will result in the ezplretion of this permit.
FOR INSPECTIONS CALL; (714) 7545628
.,� �a�„�
WOflKEflS' COMPENSATION DECLARATION:
I hereby eNirm untler penelry of perjury one ot t�e following dadaretions:
❑ I have antl will malntein e ceNflcate ot consent to selt-Insure tor workers' compensatlon, es provlded far by sectlon 3700 of tha Lebor Cade, for Ihe peAormence M the
work far wNch NIs pertnit is iuued.
workers' compensatbn In.wrenos, es requlre0 by sectim 3700 of the Lebor Code, tor the pertormence of Uie work Iw whic� Ws pertnit is lssuetl,
tion I nce wrti r flnd poliry number ere: c
--�V Y� P.Wicy�Numbe�i �� �DO/ S 7
npleted i! fhe pe�miNs veluetl el one hundred tlol/ers ($700) or less.)
❑ I certlly Ihal In the pertarmarrce ol the work for whlch Ihis pertnit is IuueA, I shall not employ eny person in eny manner so es to Decome su6�ect to Ihe workere'
compensetlon lews ot Cellfomla, and egree thet II I shoulA becorne sub�ect ro the workers' compensatlon pravisions of Section 3700 of the Le�or Code, I shall fwihwlth
compywiththase r 'ons.
npqken,�s�e�e,—�d� 1 d/�� �'�e�a:'�•�%' ��—/7 S
r
VIMMN(i'PAICDRE TO SELURE WORKERS' COMPENSITION NVERA(3E IS UNUWFl1L AND SHALL SU91ECf AN EMP�OYER'Tp CHIMINAL PENALTIES AND GVIL FlNES UP TO ONE MUNDRED
TKKISAND DOl1ANE (f100.000),IN ADOfTION TO TNE CW^T OF COMPENS4TION, UAMAGES r1S PflOVIUED FOR IN SECiION 3'!OB OF THE IABOR CODE, INTEREST, P1JD ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereDy eNirm t�et I flm II n ryjovjl lon�y9f Chepter 9(commendng with Sectlan 7000) of DlNsion 3 oi Ihe Busin e� rofessions Code, antl my license lq In tull
Ia�caaiW'aflecl:Cic.—q"�'s���oC.b X� . � GClass.5�� rS �%
Contreaors Slpnature:�g � 6�-1„ ��(�6.� '��- 7' � �i=�L �
CONSTRUCTION LENDING AGENCY:
❑ I hereby eltirm that t�ere is e construdion lending egenry tor Ihe peAormance of ihe work lor whlch Ihis pertnit is issued. (Sec. 3097, CiNI Code).
Lentlefs Neme: Lenders AtlAress:
Signeture:
oa�a:
OWNER-BUILDER DECLARATIONS:
I hereby aHlrtn Ihet under penalry ot perjury thet I am EXEMM FROM 7HE CONTRACTORS LICENSE LAW to� the following reason (Sec. 7031.5, Business entl Protesslons
Code: Any Gry or counry which requires a pertnit to canstruct, alter, improve, demolish, or repair any sWCNre, pdor to its Issuance, alw reduires the epplicant tor such permit
ta tile e signed statement Ihat he or she Lv I�ensed pursuam ro the proNsbns of Ne Contractors License Lew (Chapter 9(commencing with Sectbn 7000) of DMsiw 3 ot Ne
Business entl Professions Code) or Uat he or she is e:empt Iherefran end the basis for the elleged exemptlon. Any Woletion of Section 7031.5 by eny epplicent for e pertnit
sub�ects the epplicent to e cMl penalry of not more then frve hundretl dollars (5500).):
❑ I, es owner o1 Ihe properry, or my employees with weges es Iheir sde wmpensation, WILL DO THE WORK, antl ihe structure is not Intended or oHeretl tor sale (Sec.
7044, Busine5s and Professions Code: Tha Contractars License Lew does not appty to en owner ot property who Duilds or improves ihereon, and w�o does such work
�Imseli or hersetl or ihrough his or her own emplqrees, D�ded that such improvements are not intenCed or oflered tor sale. If, however, t�e builtling or improvement is
soltl within one year of completion, the owner-builder will have the burden of proving that he or s�e ditl not build or improve for purpose o1 sflle.). '
❑ I, es owner of the properry. am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prqect (Sec. 7044, Business antl Professions
Code: The contraqors License Law tloes not eppty to an owner ol property who builds or Improves ihereon, and who contracis for such pro�ed wilh e crontredor(sj
license pursuent lo ihe Cantradors License Laws.).
❑ I am exempt under sec. Business and Professions CaAe lor ihis reason:
Signeture: Date:
Owner ID vanfied by drivels license. ❑ Ves ❑ No Drivefs License No. Expiras:
VedBcetlon oi Ownershlp by (type oi tlocument, i.e. - property tac DIII or Aeetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON:
❑ I hereDy certity t�at no e:cavation tive (5) or more teet in depih into which e person Is reqNred to descend, wlll be meGe In conneMlon with work aut�wized by this
pertnil, entl that no Guiltling siructure, scaflWdinp, telsework, or demolitlon or Cismantling thereof, will he more then thirty-six (36) leet high. (C�ep. 3.2, Grp 2, An 2, Sec.
341, Tilla 8, Califomia Atlministretive Cotle).
❑ As axner-bulltler, I will not employ enyone to tlo work which woultl requira e pertnit tram tha Divlsion ot Indusirial Setety, es notetl ebove, unless such person hes e
partnit to Oo such work from the division.
Signeture: Date:
Dlvision of Industnel Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOROA710N OF E1lIAV: I cenify under penelry oi perjury ihat I have read this applicetion end state that Ihe Infortnatlon given is
cortect I egree lo comply with ell state laws end Gry orOlnences relatinp to building construction, end euthodze representatives of the Ciry ol Coste Mesa to enter upon the
ebove-tlescnbed property for inspeciion puryoses. I egrea not to acwpy or allow occupancy of eny buliding euthorizetl by t�is pertnit until tinel inspection.
COOE t. INSPECTONTYPE
1818 Fixed System Final Fire Preventlon
1288 Pad Spe Final
200 Flnel Ra-Roof
201 Finel BIocWRetalning Well
202 Final Fedary Fire Place
203
204
Finel Sign
Finel Demolition
Q� ��
/�' °=ie�2G - � 5
�oa�a
CO�E� INSVEGTIONTYPE Q�jF ��$
208 Finel Mochenlcal
20B Finel Plumbing
270 Finel Electricel
212 Finel Fire Preventlon
220 Finel Plenning Approval
222 Final Slte
250 Final BulldingiOccupency
CITY OF COSTA lnnE$Pr
Project Address ;7 6 %
Applicant's Maili Address
Owner's Name
Address C
Arch/Eng.
Address
No.
AVD�icant to till in all spaces ezcept those within �eavY borEer Iines anC sign all approD�iate tleelaralians.
�
Contr�Or�y,ya � � - C3� '�
Address (mailing' � � / �
City License No
LICENSED CONTRACTOR DECLARATION
Y hereby affirm that I am Ilcensetl 4ntle� p�ovi5ion5 of Charte� 9(commencing'
�with Section ]000j of Oivision 3 6f the Business antl Pro(essions Cotle, antl
;my license is in t orc a tl effect. ��
'Licen�eq Cla5$ ` ' Li en
�aiD�q ."�'I/j. 6 59 YP fO iv�I
WORKERS'-COMPENSATI N DEGLARATION �,
I hereby aitirm that I nave a certificgte o� mnsent to selt-insure or a certiticate
` Workers" Compensation Insurance, or a certifietl copy thereo (Section
90,,Ly a��b ��f..) . �� �J �< �`- /
ticY�N�.�-.•6�(1_LL(y�6��1� ���2i!/�
�. Certifietl c py i` hereby tumisnetl. �
Cert"f tl py is 'letl with Ihe city Bujl�ing Di ' ion./�. �-
Date J�-`�a �t. APPlicant .// /r..��
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(TM1issection neetl not be Completetl if'the permit is for one huntlretl ($100) o�
less).
I certity Ihat in the Oe�tormance oP the work to� which this perm�t iz issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensafion Laws ot Calitomia. �
Date Si9naturQ
�NOTICE: If, aiter making t�is tleclaration, you shoultl become subject to the
Workers' Compensation provi5ions of the Labor Cotle, you must forthwith.
compty wi[h such provisions o� thi5 permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCY �
I hereby af(irm that there is a con5truction lentling agency to� the pertormance
ot the work for which tbis parmit is i5suetl (Section 309] Civ. CJ
Lentler's Name
LentlCl'S Atltll¢TS � - '
OWNER BUILDEN DECLARATION
I hereby affirm that I am exempt hom the �Cont'ractor's License �Law for the
tollowing reason (Section 7031.5 Business antl Pro(essional Cotle: Any city'or
munty which �equires a pe�mit to con5truct, alter, improve, tlemolish or repai�
any Structure, prior to it5 i55uance� also requires the applicant tor suclt pe�mit
to file a Signetl statement tnat he/:he is licensetl pursuant to the p�ovisions o/
the Contractor'S Litense Law (Chap�er 9(commencin9 with Section ]000) ot
Division 3 of the Business antl Professions Cotle) or that ne/she is exempt
^erefrom antl the basis for [he allegetl exemption. Any violation of Section
'LS by any,applican[ tor a permi[ subjects the applicant to a<ivil
' llty of not more than five huntlretl tlollars ($500). -
� _ I, as owne� o� the property Or my employees with wa9es as their sole
compensation, will tlo the work, antl'the structure is mt intentletl or offeretl
for sale (Section 7044, Business antl Professional Cotle: Tne Contrac[or's'
License Law tloes not apply to an Owner of a property who builtl5 0� im0�ove5
thereon, antl who tloes such wo�k himself/herself o� in�ough his o� her own.
employees, provitletl that sucn improvements are not intentletl or oReretl for
I It however the bull0ing or iMprovement is sola within one year of com-
_ �1 ac�7i� � � . � _ _ . __.
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHE�R�'
DESCRIPTION OF WORK/USE OF BLDG. �_
TVPE OF PERMIT caaoiNG FOUNDATION STRUCTURn�
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq.FT. oCCUaANCv
CONSTRUCTION TVPE VALUATION $
ZONE GRADING�CU.VDS. ACRES
Remarks:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Intercepmrs '
Kitchen5ink' �
Lavatories �
P-Trap '
Roof Drains
Rainspection Fee
Outlets
$15
Sd C. � .
pletion, tne owner will have the bi�rtlen o( provin9 he/she tlitl not builtl or im- Duct - Under Ground
prova for the Ourpose of sale). -
❑ I, as owner of the property, arp exclusively contracting with licensetl ton- Duct - S[ructural �
tractors to construct the oroject ISection 7044, Business antl Professions Coae:
The� Contractor's License Law does not apply to an owne� of praperty who Duct - Ventilating '_ � �
-builtls or improves thereon, antl who contracts for such projects with a con- '
tractor(sl license pursuant to tne ConVacmr's License Law). I am aware tnat Exhaust System ❑ Multiple ❑
proof o( tM1ei� Worke�'S Compensy[ion insu�ance Shoultl be provitletl to me.
❑-1 am exempi untler Sectlon � B. & P. C: for this�son Fi�epl/Fact. Blt. ICBO #
I havA reatl this
I agree to comp
to builtling con
�� Heating Sysrem & Ducting
above �� -/ �0.100,OOOBTU�l00,0006Ti
Sentat� e5 of this t e er upOn the ove-mentionetl p�ope�ty toj�
- in5 tion pu�0 � D�.� tl�i
� �'� Da� d�� O
Drivers' License or 55 ��. � �/ � Reinspection Fee
CMF 0865-46, rev. 10/84 White - BWltling; Canary - Applicant Pink - Accounting; Goltlenrotl - Assessor
$15
r:
Showers
Service Sink "
Sewer'Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service '
Auto-Wash
'rays ' �
Issue Fae $ 3
A.P. #
5 Main Buildi
E
T Front
6 Rear
A
C Right
K Left
S
Ping. Ref. #
Plannina Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW �5-15
9441 12/30/86
Zona
Accessory Building:
ELECTRICAL ,
Transformer ❑ 15-50 KW
❑ 50+KW
Meter LJup m 100amps
Meter ❑overi00amps '
Sub Panel
Motors O0.1 HP O7 %- 6
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
' Reinspectiam Fea $15 ' .'I luue Fee
iANICAL FEES �
Hoodor T ,DEVELOPMENTSERVICESREQUIREMENTS:
ypel ❑
�Canopy Type I I ❑ Zoning Appraved By
; Building Approved By l�
Refrigeration System �
❑0.100,OOOBTU ❑100,OOO�BTU
System Repair/Alteration -
Fire Dampers n
Registers � �
��
laue Fee ; I,$ 3 I -
�
, 9.Of1 TL
Z
O
N
I
N
G
, R
E
Q
M
T
S
FEES
$ 3
$UMMARY OF FEES �
BUILDING PERMIT $ ' SMIP $�
PLAN CHECK $ � PERMIT� ,
PLUMBING . $ � ISSUANCE $
� PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL ! $ GRADING $�
PLANCHECK 50% $ MICROFILM' $'
MECHANICAL ' $ � TOTALPEE $��
f PLAN CHECK 25% $ ' � ; .
. + ` . . . . , . . . . . . . �
' CONSTRUCTION AND PLANNING pppL ° �op �� - --
� , Oate Inspector - Date Inspec{or
.APPROVALS Permit # - APPROVALS Pei.. _. #
� j
'�`l.'Temporary Elec4rical Service or Pole .. 52. Pool & Equipment Location
�� 2. Soil Pipe�Undrgr:nd. � , ' 53. Steel Reinforcement ,�
3:.�Electrical,Conduit�Utility-Undrgrnd. � 54. Forms �
. . '�' ;
4. �,Electrical Conduif=Undrgrnd. �!�� , " 55. Electrical Bonding � � r.' .
5.;SteelfF�eihforcemen$�,: .,%�.' 56. Rough Plumbing & Pressure Test ; .. � rj
6.'Electr•icaIUFER�Grnd:, - 57. APPROVALTOCOVER-GUNITE - - � .,",
' ,
� � 7..•FooFings , 58. Electrical Conduit-Undrgmd. : �:/� i�
.•,
' �'8. Fo�ndation '� ''� �, 59. Gas Pipe, O Undrgrnd., Test %% -. � ��'
� '
9!Weter Pipe-UndYgrnd; " � � � �
� �� i 60. Backwash Lines, P-Trap, � Undrgrnd. �ir;
10 j�Structural Floor System �� :' 61. APPROVAL TO DECK '
11:'Prope,'r,.ty Sewer Line:& House Co.nnection �� 62. Backwash & Receptor-Final - �
' �.
r
12. Sewer.Cap i�:� �� �' � 63. Heater & Vent-Final � � �����
;
� ^ ✓.
13i RooYDrains '�,�;i., � t /� � 64. Plumbing System - Final � �i' -.
14. Rougti Plumb�ng�: i ' �� 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar System-F.inal . .
16. Rough Electric Wiring 67. Fencing & Access Approval ..
17. Rough Wiring Sign' 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling , 69. POOL/SPA SYSTEMS FINAL �
- 19. Rough Heatin9 & Air Co�ditioniag FIRE DEPT. REQUIREMEf�IT -
20..Rough FactorY Fireplace �"'�' APPROVALS Permit # '
21. ;Ducts, in Structure � 70. Underground Hydro �
22. Ducts, Ventilating � i 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test : � - 72. Underground Flush � � - -
''�:o
�24.-Roof Framing ' � . 73. Undergmd.StorageTank OGas ❑Oil � �
25. Roof Sheathiog � � �. ;�� 74. Overhead Hydro .
�- 26. T-Bar Ceiling (Structural) & Md"nocoat 75. Dry Chemical
27. Frame�and Flashing � 76. DrY Standpipe �
,
28. � Lathing & Siding %� 77. FIXED SYSTEM FINAL
29.'Insulation � � � 7S. FIRE PREV. FINAL
- 30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION -- . -
� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .
33. Final Electric - Notes: �/3/ �G � j ,��
� is
34. Final Neating & Air Conditioning � ��
.2G V% �GEC� A8 ��r.2. &03'9 UMG LFu/
35. Final Gas Pipe-Test . � � . � � ' .
36. Hood or CanopY � . �
37. Final Factory Fireplace . . '
38. Final Plumbing � -� � '
39. Water Service-Final � � �
40. Gas Service-Final ' - ,
41. Solar pomestic-Final �
42. Backflow Preventer ' � ��
43. Backflow Irrigation • � �
44. Landscape Irrigation System -
45. Sound Attenuation -
" 46. Handicap Regu�ations . - � �
47. FINALSTRUCTURE&BUILDING . ' � .
48. Special Requirements Completed' ,
49. Electrie Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY . , .
No. � Date -� -
,
�.
";� ` 183
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX J77 C08TA MBBA. WIIFORNIA
For Appl?eanf fo Fill In Complefely
TYPE OR PRINT
BUILDING � % w �Q
ADDRH88 k-'�
COSTA MESA CALIFORNIA
� MAIL
TEL.
■ 6TATE
NO. OP BLD08.
UBE OP
E 18TIN0 BLDG
86iBACK L1N8 PROM
DESCRIPTION OF WORK
■ EXTBRIOR WALL
�// � %/. /,` f( f ,
1 XHRBBV ACKNOWLeDGB iHAT 1 NAVB RBAO i1118 APPLIGTION
AND BTATC THAT TX8 ABOVe IB COPAER ANO AORE6 TO COM-
PLY WITH ALL CITY OPCINANCH6 AND BTATE UWB R80ULATNG
BUIIDIHO CONBTRUCTSON. J _
AUTNORIZED AGENT
FEE RECEIVED
'� DEC g �ys2
�FINANCE DeEPT.
APPLiC�ATION'POR �IT ♦ (�
�' �� BUILDING �/�
\ �
For Offlee Use Only VA�
RBCHIPT NO. /!{q��� \ `
1 � �V `�
RECHIV O BY OA PHC6IVHO OAT6 I6BUHD
� /�.�=y-d�' /�-/�'-�.�-
BUILDING
ADDREbB
COSTA MESA. CALIFORNIA
APPROVED �'�� %Z��
ZONH/^'/ NO. OP U8H OP NeW �JAJ � T3
''C� � PLAN9 � I BUILD�N k1�7/ � �� — P'l �
Y I ��
LOAL �PI'".[IGHTf. PD6�Z l,�T /L6
oeernipr�o /
A.P.NO. II / ��i--/V
YARD6 EVEfi
APPROVED ALLO ED
ICeM[R uN[ BTJ �� FT. r•I �� IN. I � '
FHONT /�'
R. 61 DE �7'
L. SIDE ��O FT. ^ IN. �
REAR I Q FT. �' IN f� �
�
a
w
�
�
c�
i•
���f �� -, �i30 °. ,y�
,
TNE AMOUM BHOWN UNDHR VALUATION I6 IOR THe N
PURP098 OP 88T�BLIBHINO A PeRMIT RB8 ONLY. 'O'
VALUATION µ,
�� // PERMIT FEE $ �i � o �
S/'^ ^� x
S� l V PLAN CHECK $;`�✓
S
¢
iOTAL FEE '� �
n
C
� ' 83
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. 60X 917 COHTA MEBA. GL�PORNIA
For Applieant fo Fill In Complefely
TYPE OR PRINT , f
IADD E'68 36 � � �p � '/1µ� v
I COSTA MESh CALIFORNIA
181ZE
� SHT9ACK LINE RROM
TEL.
NO.
TEL.
OF WORK
FEE RECEIVED
�EC 5 1962
FINANCE DEPT.
CITY OF COSTA MESA
� � APPLICATION FOR PERMIT
BUILDING
For Office Use Only
xsce�vr Ho.
ev o� pece�veo owre �eaueo
� ��_</-t .�_�n_i
COSTA MESA
FIRE
ZONE
APPROVED
SON6 � � I NO. OP � I U88 OP N8W
� �eaw� N1�1 .I�GTi . ({�o'
D88CR1 PTION
�' '� �V � �
A. P. NO.
�� YARDS EVES
APPROVED ALLOW'.
/ �� (cCHNTLR LIN6 BT.1 / i^ ... �
�
NEW I IIALTERATION I IADDIiION I REAR �� FT. ��( ' IN. {—
REPAIk I IIMOVING I IDEMOLISH I BYPROVE DATE L` �!'
BUIL�ING NO. OF
SIZE ROOMS STORIES � ��
EXTERIOR WALL ROOF .�
GOVERING COVERING
USE OF BUI}.DING AND WORK TO BE PERF M U
� Gll � �
_.�
_ Y .��a - �3or� � ;
I HEREBY ACKNOWL¢OOe TXAT 1 H�VB RGO TH�9 MPLIWTION Tqg �MOUNT BHOWN UNOHR VAWATION 18 POR TN6 �7
AND BTATe THAT TH8 ABOVB IB CORRBGT ANO AOREH TO fAN-
PUPP09[ OP E6TABLl9HIN0 A PEqMIT PEE ONLY. r
PLY WITH ALL CITY OHGINANCEB AND AT6 UW6 R80UlATIN� Q
BUIIDINO CON9TRUGTIO � � VALUATION /
SIGNATURE OF ��(( PERMIT FEE S ��I., �=-
PERMITTE � /3��J.-�( ���J "pr:
S �'/ 1 PLAN CHECK $ � ^O'
/
AUTHORIZED AGENT TOTAL FEE / i � s
4
- � 183�2
COSTA MESA BUILDINGSAFETY DEPARTMENT
P. O. BOl( 917 C09TA MBBA. GLIRORNIA
For Applieanf fo Fill In Completely
TYPE OR PRINT
ADDRE168 3 / C / � �
COSTA MESA CALIFORNIA •
TEL.
��r S n Ta
LIG.rNO. U NO. J� �� I
SIZE NO. OP BLD09.
OF LaT � Q �% �A n wew nu � em
I SHi9�CK LINB P110N
I�F7' J/ll I RIGHT/D
DESCRIPTION OF WORK
WALL
0
I HBPECY ACKNOWLHD68 TXAT 1 HAVB RBAD TXIB MPLIGTION
AND BT�TH TMAT THe ABOVB IB CAHRBCT AND AORHB TO COM-
PLY WITH ALL CIN OROINANCEB AHO 9T�TH UWO Ii80Ul.�TINO
BUILpINO CANBTA�� : )��
SIGNATURE OF �� �
PERMI7TEF I GC/
AUTHORIZED AGENT
FEE RECEIVED
DFC 5 1�2
� FINANCE DEPT.
ITY OF COSTA MESA
APPLICATION FOR PERMiT
BUILDING
��or OHIee Use Only
rsece�rt Ho. r�gw�
� ��
j/t/ I �/^��1-�.� owTe �e!
/D - /
COSTA MESA. CALIFORNIA
ZONB NO.OP i
� PLANe S
teow� /
oescnirtio4 Q� 1
A. P. NO. �I / �-�
YARD9
APPROVED
ICBNT[R LJN[ BT.) ,/1
FRONT I%
R.SIDE /IJ
L. 6IDE � n
RFAR `./ v
L
f�howre�'� —%"`L
IING -
�UH8 OP NHW � ('(.0
a�,���o,
t � �
% + //J
EVES
�Rz.p.._., s ` �.(� - �S�,G�
TH6 AMOUNT 9HOWN UNDBp VALUATION IB POR TXH
PUIIP086 OP l9TAGLIBNINO A PBRMIT PH6 ONLY.
VALUATION J�
PERMIT PEE $ �(l�.
5��� ��" PLAN CHECK $ !`,• �
t • , 195�4 FEE RECEIVED ��
,�
•�OSTA MESA BUILDING-SAFETY DEPARTMENT ,�py 2 7 1963
P.O. BOl[ ]17 COHTA MH9A, GALIRORNIA
FINANCE DEPT.
For Applicant to Fill In Completely APPLIC ���1�E�
TYPE OR PRINT LDI G
For Office Use Only
BUILDINO / � �
AD�RECB / O �� q[C6�Pf NO. PEq IT O�
COSTA MESA. CALIFORNIA
P[C[IV[DOY DAT{p6C81V D Ig OBp� �\ .�_
. �/! � � p �.
OWNER
MAIL BUILDINO �
ADDR688 O I S U S6 E � A N� ADDRESB
^ FIRB \
THL. 20NE TYPH 'OROUP
c,rv ? u.7 u N C No.
ARCHITEGT �� � TEL. � BYPROV[D DATE \
OR ENGINEBR NO.
' ZONING
ADC 3 / /
NO.OI U860PN[W
I PUNO BU�LDINO
CONTRAGTOR /
[` L[owL O �% ('
ADDRH88 JQ �f �� � e o[ccnlmo v
S � A. P. NO. ' �' �
crrr
�j NOTE: NO EAV! OV BRHAN6 BHALL BE LEBH THAN
�LTG.TNO. O Q H�� 90"TO8IDHQRHARP.L.
8AVE8
81ZE O ' j NO. 0I aLoOe. ALLOWED f U. B. C. REQl11REMENT)
OF LOT nOw aN LaT
VAROBAPPROVED YARDSAPPROVED
USE OP MAIN BUILDIN6 AGCESSORY BUILDING
E%ISTINO BLOO.
( PROM C/L STREET)
B6TlACK LIN6 F110M FR NT FT. Opi',
ceHTex oP et�[R RHAR VARD
HIDBYARD LHPT - RI FiT R.BICH PI'. ��
DESCRIPTION OF WORK L.6IDH vr. --fT'
. _._.._..-- --.. __.......... _
REPA. I 6 DEMOLIBH MAIN BLO68. ACCESS. BLOGB.
BUILDINO NO.OP VAR•# DATE
SIZE ROOMS 6TORIHB C.U.P. APPRpVHD
E%TERIOR WALL ROOP APPROV6D
COVERING COVERINO BY DATE
BHOFBUILDINGAP/OWOflKTO HPHRPORM D �
PP// C UIKI �
i � U �/
i 30�' o
ac.
1 XBRHBY �CKNOWL8DO8 TNAT HAV6 ReAD TNIH �PPLICATION iMe �MOUNT OXOWN UNDBP VALUATION 18 FOq TX8 =
AN� BTATB THAT TNB ABOVB COpqBCT �NG AOpHH TO COM• IYRP08t 01� 89TAOLIBXINO A PBqMIT F88 ONLY. Q
PLY WITN �LL CITY OflDINAN 8B AND eT�T[ LAWY H[OYL�T�NO yALUATION p
BUIL�INO CONB UCTION, I- H
PERMIT FEE
61GNATUREOP. . � /�� m
PfiRM1TT6 y
s =
AUTHORIZ6D AGeNT 3 �_
a
TOTALFEE $
os esa g epa ent
� 117 EAST 20th STREET
/ COSTA MESA� CALIFORNIA
FOR APPLICANT TO FII.L IN
B���d��s .�L` ,t=i� -
wadress
. Costa Mesa, California
Nearest � � �"'
Cross SL
Owner �/0 NH /-- /c�CfQ �
Mail ,�1 �1
Address �/.�' /�L�l!'% fJtfi�
City /�%{w%)t��e�'{p(/ No. t% .Z/,
Arohitect or � / Lic.
Engineer _�G/� No.
Addresa ,/ p /��
City LIc.
� •actor �I iwlt� PN No.
Address
/APPLICATION FOR PE �
3� - BUILDING
FOR OFFICE USE ONLY
I Receipt No. I Permit No.
�a7�
Received by Date Redd. Date Issued
�.�v�c' / � i 6 ' d 6 I / _o� �o –� (.
ilding
dress
Costa Mesa, California
arest
oss St.
ne No. of Typc Group
�n'Z PPans ✓ T
proved
Date
CORRECTIONS
Size of Lot � Now on Lot �'oH�' ���1,, /�� _� ' O� � I
Useof ' No.of No.ot ,���
ExistingBld . I FamillesCl Rooma � " `��'r' �
Setback Line from Rear Vard 11�N '�+ U�J� �
CenterofSt�cet /Ie SideVard " Z
DESCRIPTIONOFWORH �nr_C �
� . . Q .. 1V►�-"•
New I� Alteretion I I Additlon I (�� �C v–
v••
Repair I Moving I I Demoilsh I
BWlaing �' K G h�o.of /
Size Z Rooms Stories
ExteAor Wall Roof �p� —
c -ing- . /+f% covering ApPR�j7���`
l J New /1� ,sL Foundatlon Loeatian Ins ector Date
8uudin9 /CO//Co'�fL'i✓L4� J/�rIZJ< Forms,Materfals, P
Under-Pinning
Frame: Fire Stops,
Braeing, Bolts
I hereby acknowledge that I have read this Applicatlon
and state that the above is correM and agree to comply Lath. Int.
with all City Ordinances and State Laws regulating
building con5tiuction. Lath. Ext.
3ignatureof
Permittee M-- Plaster, Int.
Authorized Agt. Plaster, Ext
Valwatlon Permit Fee $ (i • c� Masonry Relnforced
$ '�7� (iQ Plan Check $ gond Beam
SV ' Total / p � •
Fee $ b , '— FINAL ^
FORM 204 5-BP ZM 6-55 /'
iLU1L i1.A N
5how location and distances from
� __ _ property Ilna and between buildings:
. � L ' 1�` .,. .. ^ . .. � . . .
. . � 9C"_'...'if i . _ ".._' _. .
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- . -- JiiY 26,�Cp co� �`"i� � n:^r,rc�,z
-._. ._.- . 4 i�ryf..,A. #. !a 6.��
M1
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