HomeMy WebLinkAbout313 17TH ST - Building Permits , , . _
CITY OF COSTA MESA
44;04- BUILDING DIVISION
c 4,�ii •ii PERMIT NUMBER
F I „hi.m„� I DEVELOPMENT SERVICES DEPARTMENT
i PERMIT
4.4w/ B01-00179
(714)754-52733 • Fax(714)754-4856 • www.ci.cosla-mesa.tl.UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 313 17TH PL Status: ISSUED
Suite: Applied: 02/07/2001
Vicinity: 12-UNIT APARTMENT BUILDING Issued: 02/07/2001
Parcel Number 42501112 Zoning:
Applicant: BAERG, HAL ISSUED BY: •/
Address: 10 MORNING DOVE
Phone: (949)661-2156
LAGUNA NIGUEL,CA Zip: 92677 ,
Owner: BAERG, HAROLD JR & KATHY
Address 10 MORNING DOVE '
Phone: (949)661-2156
LAGUNA NIGUEL,CA Zip: 92677 ,
Contractor OWNER-BUILDER
Address: ,
Phone:-
Zip: License:- 0
Arch : -. Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING 12 UNIT APARTMENT BUILDING(65 SO).REROOF.WITH 15#FELT UNDERLAYMENT 8 25 YEAR,
COMPOSITION SHINGLES OVER EXISTING ROOFING.
' FEE SUMMARY
Plan,Check: $0.00 Calc Valuation: sa,aoo.00
Permit: $111.25 ,/, Claim Valuation: j , $4,500.00
SMIP Res: $0.50
•
SMIP Com: $0.00 '
Other: $0.00 / - -
Inspection: - $0.00 - '
Total: $111.75 ,
PLANNING &ZONING /77,
SETBACKS - - . - / i'�
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 - Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left I 0-0 Right ,0;0
PARKING Existing: 0 .. ,, ,...
Required: 0 - , • Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)7545628
2446-48(IWO)
1
-
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: •
I hereby affirm under penalty of perjury one of the following declarations:
❑ t have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL NW SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.a Class a
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: - Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects',esubjects the applicant to a civil penalty of not more than five hundred dollars(5500).):
I "'I Iowner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,:Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the ower-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under s=. - _ Business and Professions Code for this reason:
1( Signature: -< 4 _
( Expires:�zA-o
Verification of Ownership by(type of document,i.e.-property tax bill or deed): l
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
___._..__ . __ _ _ hazardous
materials)?
Does or will the applicent or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
...._ _.... l_..__.__ th.___.... __.
4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LI No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required tar the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application end state that the information given Is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pr..: .r i spection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Al a /� ,7-O(
Sign Legal Owner(s)-----
_ GDete--�
And/Or Authorized Applicant Date
CODE 1 INSPECTION TYPE PALE irmw,s SODS t INSPECTION TIPS PAIS MALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 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
PROJECT ADDRE: 313 17TH PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 061655
AgDR
OWNER'S NAME:MONTERY PROPERTY MANAG
Ess: 16601 GOTHARD PERMIT NO; B 061655 PLAN CHECK NO; N GOVT; N SUPP; N
H,B .
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: DEM
t ARCH/ENGINEER: flEG.NO.:
ADDRESS: UNIT: : SQ
JOB DESCRIPTION DEMO POOL 2 APT COMPLEX FT:
PERMITTEE: CLAIM VALUE: 1 , 000. 00 CALC—VALUE: 1 , 000 . 00 GROUP OCC: R-1 /
ADDRESS:RON PECA LANDSCAPING ( 714 ) 557-5488
1062 SAN PABLO ' COMMENTS : X
;OCTA MESA CA 91.46 ********k*************************************RERt�F#�E+E************* ** **** *****
LICENSED CONTRACTOR DEC ATIDN: 'here y affirm that f.•• .•under p• • o sorer 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code. .• my licen • l in I orce di• •ffect.
SETBACKS
CITY73 maSTATE uc.:3350A8 ss 27
/ Date 7 `� Signet e: MAIN BUILDING
ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: Inereb .11irmthat t•. eacertifica• rconsenttoself-insure oracertificateofWorkers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereot(Se • -.rt.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ• PROV: PARCEL: 00000000 ZNE; REF NO;
0 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: *************************************iy ' . ************************d1;6*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: this . need be • 'toted if the permit i5 for one hundred(5100)or less). DEVELOPMEIT G " ., ICES R E Q U I R E M E N"" S
I certify that in the p¢dorrnance of me work for winch thi remit is l�r'.. hag not mroy any person in any manner so as to become t.
wejem vmr rs'Compensation Laws of CaSmr•a. ZONING APPROVED BY
„_]s Date: 7q `S signal re: /`—' • DATE: r
/ NO ICE:I///.alter making this declaration,you s •uld beco •subjec • •'Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply with such prove : . is permit s .11 be deemed revoked. p
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; ��— DATE• 4 �•� / 1
which this permit is issued(Section 3097.Civ.C). ********************** �� _ * .. ******,*_***I.***********
LENDER: ****************************.. yt********************************************
ADDRESS: LEGALIZATION:N E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 25. 00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by PLAN .- — 50
any applicant for a permit subjects the applicant to a civil penalty of not mare than live hundred dollars(5500). ISSUE FEE - •
_-
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE 'PL'ANt C ECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors State License Law TOTAL S—--—> 25 , 50 0 . 0 0 ✓ 0. 00' 25 . 50 25 . 50 , 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through ,• -
his or her own employees.provided that such improvements are not intended or offered for sale.If.however the building or , x ,
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED ; 25. 50 OVER/SHORT, ,00
mr the purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADNG PLAN—CHECK
I.as owner of the property.am exclpsively contracting with licensed contractors to construct the project(Section 7044.Business 25. 00 / h . 50
0
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ••'/,•i
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State license Law).l am aware ************************************d******************************************
that proof of their Worker's Compensation insurance should be provided to me.
IND I V I D U A L• !F E E BR EAK DOWN
❑ I am exempt under Section: B.8 P.C. I /,
or the reason: TYPE QTY D E S C R I P T I O. N e UNIT COST TOTAL COST
Date: Owner: /; /
I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and NO FEES WERE SELECTED FOR THIS PERMIT
25534 and that I or any future building occupant willwill not(circle one)need to comply with said state codes and the requirements for a
r
permit for construction or modification from the Management District.Residential construction applications are exempt from .1Airuality
these provisions.
•
Date; Applicant: • A i
I hereby certify that I have read This application and state th. ' . •' ormatio,'s.inn!.I agree to comply with all city and county . O, �" t )
ordinances and state laws relating Co building construction i hereby.y}rize�r-se I.ryes of this lily to enter upon Ino shove meetioned
471 APR 7 1993 r'
property lot ins coon p ;poses. / ,�'g
r
Date: � 7�9-3 Sign fire CITY. OF COSTA MESA
Driver's License or Social Security•:
;64,46 While—Building:Croon—Cade Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL PA
APPROVALS Permit# Date Inspector APPROVALS Permit i/• Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Sod Pipe-Undrgrnd. . 53. Steel Reinforcement
3, Ebctrica! Conduit Utility-Undrgrnd. 54. Forms 1
I
4, Electrical Condi it-Undrgrnd. 55. Electrical Bond-mg
5. St,i,:, R-_inforcement 56. Rough Plumbing & Pressure Test li
I 6. E actr:c! UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, 0 Undrgrnd.
r-
10. Structural Floor System 61. APPROVAL TO DECK
, 11. Property Sewer L'ne & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains
� 64. Plumbing System - F,nal
14. Rough Plumbing 65, Electrical-Final
15 Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Routh Fcctory Fireplace APPROVALS Permit -;'
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0G..s 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 GasOil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding . i 77. 'FIXED SYSTEM FINAL
29. Insulation ' I i 78. FIRE PREV. FINAL
I
30. Drywall Nailing -1"�1„.__ HEALTH DEPT. REQUIREMENT
31. Paster Brown Coat I 173-.--.FINAL INSPEC7I0N _ `� - f
.� JI
32. Electrical Power Meter-Final 4 80. FOOD erTIFICATE ISSUED
33. Final Electric / bi Notes: ? tee.., /,�� f j'.
34. Final Heating& Air Conditioning �� Il
35. Final Gas Pipe-Test .f fi
36. Hood or Canopy f ,!h
37. Final Factory Fireplace I1'
'i •
38. Final Plumbing j i 1 i
39. Water Service-Final I_�
40. Gas Service-Final
41. Solar Domestic-Final I
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 4��//J�c JO IQ
48. FINAL PLANNING L /J
49. Electric Release to Edison i ' •-
50. Gas Release to Southern California Gas CO
51. CERTIFICATE OF OCCUPANCY
No. Date .
11FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 317 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
2TYPE OR•PR T BUILDING
ABUILDING
DDRESS 3/✓ 17 / / 1�,�
COSTA MESA. CALIFORNIA "fes For Office Use Only
'.I C`,/� 1 RECEIPT NO. I PERMIT NO.
(.Alia E. if4 Atm c /� // 36/
ADDRESS/IfMAIL
C 0 5 K '/ e.A. z-- D R RECE V6 BY DA RECHIV D DATE ISSUED
s b DAT,a� a-%.i=60
•
BUILDING �j �7� 4
CITY i-() L l� �/Q•TQ AT (y 217, ADDRESS . /J Y/
IARC"^TECT TEL. COSTA MESA. CALIFORNIA
Ill INEER NO. �f
DDRESS FIRE IJ GROUP it
,() ZONE TYPE. /)
1ONTRACTOR L�W'IC IEk �U j L- Q cI� APPROVEDBY rig y/--DATE��V /
ADDRESS NING 11.a•, ,
ZONE I NO. S 2 use or NEW
CITY L) •�_ PL{/A�NB r p I/gU1LOIH0 h\(((([[{('j
STATENO. TEL. DE_8CRIPIION--f.�l /LC 1/-l tl �1 IV 4f�
LIC. '7 NO. /I
OF LOT/co X ( 2- I NOW ON LOTNO. OF S 10 -)-,(1- 0 Cn d-0 7
A.P.NO.
USE OF Mt CT PLE �- /v/LY YARDS EVES
EXISTING BLDG -! r q APPROVED ALLOWED ,(�( . ?,
SETBACK LINE FROM 1 ! / REAR YARD`O / (CENTER LINE ST.) nlifiN
CENTER OF STREET {J FRONT A C FT. C�1 I / IN.
SIDE Y2RD I LEFT• l I RIGHT y •R.SIDE S FT. IN.
DESCRIPTION OF WORK L.SIDE /FT. IN.
NEV //
I II ALTERATION I II ADDITION I REAR a q •S FT.C1).. 4 Peg�\/11l I N. �-
REPAIR I II MOVING I III-DEMOLISH I APPROVED Cu )
l,'q' {DATE \ - 11\.. -
8 ZILDING/7 -E G•K!ED ROOMS ',IL.
STORIES �d_02..„`A/ I6-too V`� 111kkkJJJ
EXTERIOR WALL91v L L p ROOF '/ L vd ij 5- i
COVERING 7l COVERING I�1) 1< ] J� y
USE/COF BUILDING AND WORK TOBE
/PERFORMED /J 3 8 A/�,,
V , (k AU,M 0.-tit,
v —"�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP CATION_ THE AMOUNT SHOWN U DER VALUATION IS FOR THE
AND STATE THAT THE A VE IS CORRECT AND AGR TO CO
PLY WITH AIL CITY O INANCES AND STATE LA GULAT O PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING GONBTRUCD NI / VALUATION �/3.
ERMIT FEE $ ✓ J o
SIGNATURE OF _/ /1 `�CII 41� �.T a N
PERMITTEE ✓} lVr�- ..ate / D 7J R
S PLAN CHECK S qi / �ti
Z
AUTHORIZED AGENT
TOTAL FEE S 5. ✓`I2
i---EE RECEIVED
- 911 f�6? S/-3/i, o
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. ick
P. 0. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE O/R PRIN���IT BUILDING
BUILDING ,7/.••3 / /% P-
ADDRE68 COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. I PERMIT NO.
OWNER
MAIL .2%
/ 3 /211 /�� RHCHIw I DIyTs .5e1 D �j BB 4
ADDRESS i+/� /_ /�J
CITY (�O'4�G� '/�L(f l NO//��/AS UILDING 1 q ,7 pi
ART' -'TELT .,J TEL.
OR HNEER I NO. COSTA M SA. CALIFORNIA
/ ♦�// (J FIRE
ADDRESS �d der-e#• ZONE TYPE GROUP //;;
CONTRACTOR �_O/. (((/// APPROVED DATE ,/ i[/
23 /� /'� BY
ADDRESS YL� „nics�r+-. . v/ • NING
��yy � ��yy ZONE �{r' NO.OP USE OF N
CITY �'��_r4, "Z a/-i� /-` PLANS BUILDING// •
/y-/� /� /
LIC.NO. 9,//r NO.ATE TEL.Xi 'S 7330 DESCR / 5T I Y/ I •�.67c
DESCRIPTIO f I
SIZE J a ` NO. OP OS. / /j IT �/]
OF LOT /O O J( 127 I S O NOW ONB LOT Z A.P.NO. / / 7 , �/ v 4 I-o 1
USE OF � YARDS EVES
EXISTINGBLDG, [/0_ � APPROVED
ALLOWED
SETBACK LINE FROM J (CENTER UNE ST.)
CENTER OF STREET REAR YARD /13 FRONT ,'5DT. If IN.
SIOE YARD LEFT G , II RIGHT (fes i R.SIDE // FT. 8-8-4-• IN.
_ DESCRIPTION OF WORK / � IN.
L.SIDE C' FT.
NE, I XII ALTERATION I II ADDITION I REAR / q FT. IN5
REPAIR I II MOVING I II DEMOLISH I B,PROVED /J ," t2 DATE S �J
BUILDING yy 3 NO. S •�/ t -1
=E
/Z./a e ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF INCA AND WORK TO E PERFORMED
/Sly`)
r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
HE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNTE SHOWNSTAUNDER VALUATIONMIIS POR ONLY.PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF
A� �I PERMIT FEE $ ��
t Dn / N
IG NITTEF/ 7/fl/
$ PLAN CHECK $ •--- ti
E
AUTHORIZED AGENTa
N TOTAL FEE 5 A.5.---
- 1 I I N0V 19-69PCNSAq'B00 850* ****22.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
CALIFORNIAP.O.BOX 1200 COSTA MESA,C92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
�,/Q jy r C RECEI DATE RECEIVED' DATEl/7-t
ADDRESS 3/31BUILDING �/7r//�/_���J ISL.- /9P/ - ` //YYYY//11 !/!i ,///!!77//GL/�r y�6
OWNER C I Lcl . 6 , 111 RN1 A.P.NO. `/7 /r PERMIT , I
MAILADDRESS • '- Lam-' l7LYr PL . ADDRESS BUILDING ��� z Sc
1 U CITY Co}/ /J ref_, NOL a f. TRACT / LOT a BLOCK
ZZ '
Q CONSTRUCTION ,t/ NEW ADD • REPAI- MOVING nFmni ISH
- •
• m LENDER NO/YtP • q
_17 BRANCH / / ` /
-. OWNER
ADDRESS ��qn VALUE ` �)
J Q ARCHITECT TEL. USE //40 $ ��,J DC/
to OR ENGINEER NO. r f/
Z Q FIRE
Ill CC ADDRESS ZONE TYPE V GROUP
0. 11,-I
APPROVED
W Z
W Z CONTRACTOR an/S (/0 ST BY DATE
CO Z /
W cc ADDRESS 3,2f- W.. Pa,/ ., CrOAS !T'r✓y
TEL. ZONja�y C NO. USE OF NE
O= l/��� A PLANS BUILDING
ZI- CITY LOq CAL2 NO. W'32bO _ ✓/./)�^�(h
W O STATE CITY YARDS APPROVED YARDS APPROVED
to CC LIC. NO. /3g G B- y LIC. NO.�J .29 MAIN BUILDING ACCESSORY BUILDING
7O (F ROM C/LST EET) .,
SIZE NO.OF BLOCS.
OF LOT NOW ON LOT FRONT /FT.T. FT.
USE OF
EXISTING BLDG. R SIDE FT,
I" SIZE OF NO.OF i
Z NEW BLDG. ROOMS STORIES L.SI ) IT. FT.
U EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
MAIN BLOCS. ACCESS BLDGS.
C
0 A �J� • 7a 1207 C.U.P. DATE
O c- /' P An- (/ // / C.U.P.46 C�/ ,�//p/_� APPROVED p /9
Z ROVEr.C��AI_JL�t _DATE //-'/ /'d
•
O /
oI hereby acknowledge that I have read this application and state
D that the above Information is correct end agree to comply with
CC all laws regulating building construction, and I shall not employ
F any person In violation of the workman's compensation laws of
N the State of California. co
m
ZI hereby certify that I am properly licensed as a contractor under SQ. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY;
am exempt from the provisions of the State of California Business tC
VALUATION
and Professions Code•Division 3,Chapter 9. /5--- m
PERMIT FEE $ w
/r� 7
Signature of �J `T co
Permittee 1�3 G5-0(� PLAN CHECK $ /�✓ [/ E
o
c e72,30 LL
Authorized Agent TOTAL FEE $