HomeMy WebLinkAbout336 17TH ST - Building PermitsCITY OF COSTA MESA �
.
BYILDING DIVISION -
a
: 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.p.us
�, � FOR INSPECTIONS CALL: (774) 754•5626
4��'P
PERMIT NUMBER: BX08-00175
PERMIT TYPE B MISC STATUS: ISSUED
APN: 42501102 DATE ISSUED: 06/10/2008
Zoning: , ISSUED BY: RMD
JOB ADDRESS: 336 E 17TH ST CM .� `- � i ,��, ._:Suite/Unit:
Vicinity: PARKING LOT _�1 x�-'LL _ Pnmary Occ �:� ;=„ Const Type :??
SQ. FT: 0 %�u' ==,—Valuatioo:�:: ; � � 5800.00'i , -"�`t =`• ,
F� -
SCOPE OF WORK: '�' ` }
LEGALIZATION OF A 5' HIGH PCY WOOD'SIDING,TRASH ENCLOSURE WITH GATE FOR'A COMMERCIAL PROPERTY. REF#
C08-1187 .�y �_,� , <.' � , .
,,;:_ - >���y' . �„�:: , ,
` : , �. ,,� .
OWNER: SAl'TLER, ROBERT',LTR;`�, Address: 544 HAZEL DR '�.:, Unit
City/State: CORONA DEL'MAR;,CA:�;� Zip Code: -- 92625 '
Phone: �� ,- - ;,:>,...- � - � , .,i: .
, ' i. , -r r: .,� �.. � � ' . . . i ,,, �
APPLICANT: DEYDEN;�MARK �'- " Address> 1707SAMAR�DR� -� � � UniC
Ciry/State: COSTA MESA, CA, ,, �„,! , r'� ' Zip Code: '' 92626 , ,
Phone: 714-434-4927 : . � �..' ' '� _ . � � . " .
Address:
City/State:
Zip Code:
)R: MARK DEYDEN� DEVECOPMENT � � _ � ` � � �r �.' � License No. �"� 325027 �� ���
1707'SAMARDR � .;�- '� �`�� - � � � � � � ' - � � " '
COSTA�MESA;,CA ,, ,_ i :,
92628 ';, � ' Phone � ` 714-434-4927 � � � �
4i. .
ARCHI7ECT: 'r;, ` ����'� � °'-' , ..,�-���-:�.. License No '..
Phone : �
ENGINEER: „ � ,��;� , ,'g License No �
Phone
' `,�, -ti +�
� �' '' � � �`w%PEE`SUMMARY ��'�� , , •' ��
Building Plan Check � - ' $0.00
� Building Permil``.' - �-.- �' '� "'�''�''� $32'.65 � ; '
' Electrical Permit: �''''; � �;`��'i:`_,�, _ $0.00 - . �'-�
SMIPResidential ;'�,-,,�, '„"'y:,:�;;`_ �0:00 ',`r, ;.�,:%
. SMIP Commercial - - ' -� � $0.50 �
, TOTAL FEES �- . ;�; $33:75 --'.-
u' r..
' Cell:
Unit:
NOTICE: The work authorized by this permil shall comply with all applicable handicap access requiremenls under Califomia statules and related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE'OR DATE OF LAST INSPECTION. ' �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
WOE/, INSPECTIONTYPE
7818 Fixed System Final Fire Prevention
1268 Pool Spa Final �
200 Final Re-Roof �
207 Final BIocWRetaininp Wall
202 Final Factory Fire Place
203 FinalSipn
204 Final Demolition
on�
INTIMLS GOOEA INSPEC710NTYPE - .
� 208 Final Mechanical �
208 Final Plumbin9
' 210 Final Electrical
'212 Final Fire Prevantion
� 220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�T$ ' IN7IML5
I.r�L�i% ��"�
WORKERS' COMPENSATION DEC111RATION: .
j hereby aKrtn under penalty of perjury one of the i�...,.�nng tleclarations:
❑ I have and will maintain a certifcate of consent to sel4lnsure�foi workers
compensalion, as provided tor by seclion 3700 of the Labor Code, for the
peAormance of the vrork for which this permit is issued. • �
❑ I have and will maintain workers' compensation insurance, as required by
sectbn 3700 0( ihe Labor Code, for the peAormance of the 0.nrk for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are: ('',�Y
Carrier. ✓ � n � � �NN�
(TliissMunnee0notbetqnp�ele/0�lN�eperm/ly��reluedefinehuiMretlWlars(E100)alessl
P.olicy.Number. �n�V7/)�! /
p�--��
❑ I certi(y Ihat in the peRormance of the work tor which thi5 permit is
issued, I shall nol employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
ihe Labor Code. I shall f hwith mply with these provisions.
,�h�/�„1- - •�- �i /o o�
Apdiranl's'SIB��ure � Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEV'S FEES.
LICENSEO CONTRACTORS DECLARATION:
I hereby aKrtn that I am licensed under provisions of Chapter 9(commencing
vrith Section 7000) of Division 3 of the Business and Professions Code. and
�y license is in full force and eRect. ��
�Lic'#'��3�7i�� JZ% p Cll— ass #. J �
� �///��.,C_ r--li������
Tranor's ipnaWre '---� D= ��
CONSTRUCTION LENDING AGENCV: �'
❑ I hereby af(vm that there is a constructbn lending agency fa the
pertortnance of the v,ork fp which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Address:
Signaiure '
OWNER-BUILDER DECLARATIONS: 4
I hereby aKrtn that untler penaly of perjury tha`t I am E%EMP7 FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5,
Business and Professions Cotlei Any city or county which requires a permit to
construct, alter, improve, tlemolish;> or repair any slructure, prior to its
issuance, also requires Ihe applicant for sur� pertnit lo Ne a signed slatement
that he or she is licensed pursuant to; he provisions of the Contraclors
License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt tharefrom antl
t�e basis (or the alleged ezemption. Any violation of Section 7037.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
five hundred dollars ($500�.�: f
❑ I, as ovmer of lhe property, br my employees with vrages as their sole
compensation, WILL DO THE WORK, and ihe structure is not intendetl or
oHered for sale (Sec. 7044, Business and Protessions CoCe: The Contractors
License Law dces not apply to an owner of properry who bvilds or improves
theieon, and who does such work himself or herselt or through his or her own
employees, provided that such improvements are not iMended�or oNered foi
sale. If, however, Ihe building or improvement is sold vrithin one year of
completion, ihe owneo-builder will have the burden, of proving that he,or she
did not build or improve for purpose of sale.). '
❑�. I, as ovmer of Ihe property,.am�.EXCLUSIVELY CONTRACTING WITH
LICENSEU CONTRACTORS to construcl the project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not appty to an ov+ner of
property v+ho builds or improves thereon, and who contracls for such project with
a contracta(s) license pursuant to the Cont2ctors License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
• • SignaWre ,
]OS]<6�]ttN)
Owner ID venfied by driv� ise. ❑ Yes ❑ No " �
Driver's License No. Ezpires:
Verification of Ownership by (lype o( document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certdy that no excavation frve (5) w more feet in tlepth into which a
person is required to descen4 will be made in connection with work authorized
by this pertnit, and that no building stmcture, scaftdding, falsework, a demolition
or tlismantling thereof, will be more than thirty-s6c (36) teet hiqh. (Chap. 32. Grp
2, Art 2. Sec. 341, Tide 8, Califomia Administ2tive CoOe).
❑ As owner-builder, I will not employ anyone to do work which woultl
require a permit (rom Ihe Division of Industrial Safety, as notetl above, unless
such person has a permit to do such work from the division.
Ap0licanl's SignaWre
Division of Industnal 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 maleiial? ❑ Yes ❑ No
(Seclion 25505 of the California Heallh and Safety Cotle requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Depanment by every business which has at any one time dunng a reported
year a quantity of hazardous materials equal ro or greater lhan 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 applicaM or present or future building occupant need to (le
a registretion form for aately hazardous matenals7 ❑ Yes ❑ No
(Seclion 25533 of the Califomia Health and Safety Code, with some
exceptions, requires reqisVation with the Costa Mesa Fi�e Department by
each business which at any one time has on hand a quantity o( acutely
hazardous materials equal ro or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
temperature and pressure�.
3. Does or will the appliwnt or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provides that the
Cosla Mesa Fire Department may require the preparation, certifcation and
filing vnth the Fire Department of an RMPP by businesses which are required
to regisler acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Cali�ornia
Health and Safety Code been tully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or fuWre builtling xcupant require tor
Ihe wnrk which is the subject of this application a permit tor such wnstruction
or mo0ification (rom the Soulh Coa51 Air �uality Management DiSMct or (rom
any other air polWtion wntrol dislrict or agency? ❑ Ves ❑ No
(Sectbn 65850.2 of the Califomia Govemmem CoCe requires that the requested
informalion be fumishetl on applications fa ron�resiCential building pertnits).
6. Will any parl of ihe facility to be constructed under this permit be within
7000 feet from the outer boundanes ot a school? ❑ Ves ❑ No
Qf'yes", [he (acility musl meet the requirement of Sections 25534 and 42303
of [he Califomia Heal[h and Safety Code).
7. If a permit fmm lha South Coast Air Qualiry Management DisMcl or other
air pollution control district or agency is required for the work which is the
subject of lhis appliwtion, have all of the disUosures prescnbed by Calitomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No.
8. Qf'yes", attach certificate o( compliance from the appropriate air pollution
control oKcer). . . .. . , _ . .
CERTIFICATE�OF COMPLIANCE: I certify.that under penalty of perjury;lhe
information given above is correct. I agree to comply wilh'all sWte laws and
iiry ortlinances regarding�Hazardous Matenals anC Emissions.' �� •�
, , SIBnaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION�OF ENTRY: I
certify under penalty o! perjury thal I have read this applicalion and state thal
the infortnation�given is correcl I agree to comply vnth all state laws and city
ortlinances relating to building construction, antl authorize representatives of
the Cily of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
�9Ag�aNre o�i Le�g/al pwneqs) / a�e
/ �.//Lr//�l.G'c� r` /d` o�
� /orAUNonzeOApplicant �Dal �
\._ .
I �
` . . ' f�-. ..
(714) 754-5273 • Fax (774) 754•4856 • www.ci.costa-mesa.BUILDING PEf2MIT n FAIR DRIVE, GOSTA MESA, C;A 92626
�ob Address: 336 E 17TH ST
Suite:
Vicinity: GOMMERCIAL BLDG
Parcel Number: 42501102
Applicant: COON, ROGER
Address: 11782 REVA DR ^
GARDEN GROVE CA
Owner: SATTLER, ROBERT L 7R
Address 544 HAZEL DR
CORONA DEL MAR, CA
Contrecror: R C ROOFING COMPANY
Address: 1'1782 REVA DR
GARDEN GROVE CA
Zip: 92640
Arch :
Address: � ,
Phone:
Zip:
License:
Zoning:
_ - ISSUED BY:
Phone: 714-534�205
Zip: 92640 . . ,
Phone:
Zip: 92625
Phone: 714-534-6205
License: 456490
Eng:
Address:
Status: ISSUED
Applied: 06/06I2001
Issued: O6/O6/2001
Phone:
License:
�'� j ; "' SCOPE OF PERMIT_ , 't,•
REROOF: REMOVE ALL BUILT-UP ROOFING (13'SQUARES)�& REROOF WITH HOT�MOPPED CAP SHEETS. 70 SQUARES OF �
PITCHED ROOF APPLY 30 YEAR COMP SHINGLES. � .-� �� - "
TO7AL:23SQUARES � � , �
" -.- �. "�_ � . ` �� . � . .
� ;.- --- �-�—FEESUMMARY.�`=_- _ �
Plan Check: $�AO '�' Calc Valuation: ; 5¢,000.00
Permit: $125.25 � � , Claim Valuation ; � � �gs,000.00
SMIP Res:� � $0.60 � - -` 'r. �; � ,, ` �
SMIP Com: � `��$0.00 , ,�� � �
Other. ' $0.00 -,":'� - . � '!��
Inspection: $0.00= �`r--:�- � ,-"i � . �
� � � _ - � -, �cr., -,,; �
Total: 5125.85`•'��. � � � � � � . �. �;%�,
� , �� � _ � � � s;;�„ �/ii � , /
— � � � ��� �� . �� ��'�/ /7�: '�, �
• � '� " . ��i�, ����;, , PLANNING & ZONING��� ,��� "-�'
\ � � �� �__ _ ,i �`%;
� � �, � // �
SETBACKS � � ` ;�� i.� .�, _ _ -' �� ,� - ,�
�
MAIN STRUCTURE Front . .0 �0 \ ' ��� ; Rear ' 0- 0 , Left _ 0-.0 �, ` � �� Right+ - 0-,0% '
� ,1, � �,� �_ 1 � � //� /
ACCESSORY Front �0- 0� �� �Rear 0- Q. . Lefl 0- 0-�, � Right �� � 0- 0
��\��, �_ i; , ;\� -, , � �-"' -
-� ` � _ %i�.
PARKING Existinq: 0 ��Reauired:- 0�- _ _ Pronosetl:��.-:0'i'��-!
NOTES: — — --�- ----- -
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 72-27-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not Commenced within 180 days, or if work is suspended oi abandoned
for a period o( 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all
required �nspeetlona and finel approval must 6e obtained. Failure to obtain inspections and final approval will resufl in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
z.a.o-co larwl
WORKERS'COMPENSAnON DECLPAAnON: ` .
I hareby eflirm untler penalty of DeQury one ot the tollowing declaratlons: '„
❑ I heve entl will melntaln e certiFlwte of consent ro setl-Insure br workers' compensation, es provided tor by sectlon 3700 ot the Lebor Cotle, for iha peAormence ot Ihe
work for whic� lhis pertni� i5 issuetl.
� I have end will maintain workers' compensation Insurance, as required by section 3700 ot the Labor CoGe, tor the performence of the work fo� which this permit Is Issuetl.
My workers' compensation Insurance cerriar antl policy number ere:
Cerrier. Poliry NumDer: _
(This secnon need not be comvleteC i� the permit is velued et one hundred daiers (Stoo) oNess.)
❑ I certlly t�at In the pertortnance of ihe work tor which thls permit is I55ueO, 1 shell not employ any person in eny menner so ea to becoma subjact to the workers'
crompensetlon laws of Califomia, d egree that it I ould becoma sub�ect to t�e workers' wmpensatlon proNsions o1 Sectlon 3700 of the LaDor Catle, 1 shall forihwlth
cnmply with these provisions. [/.,� /' �Q
Applicant Slpnature: Date: v— � �
WARNINO: FAILURE TO SECURE WORKERS' � ENSATION WVEMCaE IS UNUWFUL AND SiUL15UB1ECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE �5100,OOp�, IN qDD1T10N TOTHE 00ST OF COMPENSATION, DAhUGE$ 0.5 PROYIpED FOH IN SECLION 3TW OF TME UBOR CADE, INTEREST, AND ATTORNEI^5 FEES.
LICENSED CONTRACTORS DECLARAnON:
I �ereDy eNirm that I em Ilcensed under provisions of Chapter 9(commencing with Section 7000) of Divislon 3 of the eusiness an0 Professions Code, antl my licanse Is in full
lorce entl ettect. Lic. k Cless q
Contreaors Signeture: � Dete: " �
CONSTRUCTION LENUING AGENCY:
❑ I here6y aHirm that Ihere is a cons�Nction lentling agency tor t�e Oedormance of the work br w�ich Ihis permit is issued. (Sec. 3097, Civil Code).
Lentlefs Name: Lender's Atltlress:
Signature: " Date: -
OWNER-BUILDER DECLAfiA710NS:
I hereby eflirtn thet under penalry o1 perjury Ihet 1 em'EXEMVT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions
Cotle: Any clry or counry which raquires a pertnit to construq, elter, improve, demolish, or repair eny structure, prior to Its issuance, also requires Ihe appliwnt for such permit
to file a signed stetemem thet he or she is Ilcensed pursuant b the provlsions ot Ihe Cantrecrors Ucense Lew (C�aD�er 9(commencing with Section 7000) of Dlvlslon 3 of Iha
Business end Protessions Gode) or that he or she Is exempt t�eretrom and Ihe basis tor the ellagetl e:emption. Any Wolation of Saqion 7031.5 by eny epplicaN for e pertnit
sub�ecta the ap0�lcant to a civil penelry o� not more than tive hundred dallers ($500).):
❑ I, es owner of ihe property, or my �mployees wlth wages es thelr sole compensation, WILL DO 7HE WORK, entl t�e siructure Is not intendetl or oHered tor sela (Sec.
7044, Business and Professions Cade: The Cantracmre License Law does not apply to an owner of property who builtls or improves Ihereon, and who does such work
himsell or herself or thraugh his ar her own emplayees, provitletl �het such Improvements ere not Intended or otteretl lor sale. If, however, the 6uilaing or improvement Is
sold within ona yeer ot completion, the owner-builder wlll �eve the burden of proving ihat he or she did not build or improva for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTFAC70RS to construct t�e prolect (Sec. 7044, Business and Professions
Code: The contractors License Lew does not epply to en awner ot propeny who builds or Improves t�ereon, and who coNrec(s for such pmject with e coniractor(s)
license pursuant to ihe Contractor3 License Lews.).
❑ I am exempt untler sea Business end Professions Cotle tor this reason:
Signeture: Date:
Ownar ID verifiad by dnvers license. ❑ Yes ❑ No Dnver's License No. Expires:
Vedticatlon o1 Ownerehip by (rype of dacument, i.e. - pmperty ta�c bill or tleed):
DIVISION OF INDUSTRIAL SAFE7V PffAMR CEqTFICATION:
❑ I hareby certity ihat no excavetion frve (5) or more teet In depth Into which a pereon is requiretl lo tlescend, will be maOe In connection with work authonzetl by Ihis
permit, antl thet no Duiltling strucW�e, scaHoltling, talsework, or tlemolition or dismanfling Nereot, wlll be more than thirry-slx (36) faet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Tltle B, Califomia Atlminisiraih'e Cotle).
❑ As owner-bullder, I wlll not employ anyone to tlo work which would require e permit from the Division of Indusiriel Sefery, es noted above, unless such person has e
pertnit to do such work Irom Ihe diVision.
Signature: Date:
Division ol Intlustnal Safary Pertnit Numbar:
CERTIFlCATE OF COMPLIANCE AND A�JTMORIZATION OF ENTRY: I certity under penalry of perjury that I have read this application and stale ihat the inlormation given is
correct I egree Io comply with all stete laws end city ordlnances releting to builtling consiruction, and authodze representetives ot ihe Ciry ot Costa Mese to enter upon ihe
ebove-described property lor inspection purposes. I egree not to occupY or allow occupency of any building authorized by t�is permit un�il final inspection.
�Sig re Ot Legel Owner(s) Date
�� �' - 6-a �
And/Or Authonzed Applicent Date
COOE �. INSVELTONTYPE
1616 Fixed System Final Fire Preven�ion
7266 Paol Spa Finel
200 Flnel Re-Roof
201 Final Block/Fletaining Wall
2�2 Final FaGlory Fire Place
203 Final Sign
20d Finel Demolilion
�. 1 .1�11:
�/167�, �
COUE� INSPEGTIONTYPE
206 Flnel Mechanlcal
20B Finel Plumbing
210 Finel Electncal
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final BuildinglOccupancy
D�E 1[�ELS
1�
(714� 754-5273 • F8%(714) 754-48$6 • www.ci.wsta-mesa.BUILDING PERMIT �� FP`IH UHIVh, (:USIA MtSA, GA'J26Lti
.lob nddress: 336 E 17TH ST
Suite:
Vicinity: SKYLIGHTS
Parcel Number: 42501102
npplicant: DEYDEN, MARK
Address: 1707 SAMAR DR
COSTA MESA, CA �
owner: SATTLER, ROBERT L TR
Address 544 HAZEL DR
CORONA DEL MAR, CA
Zoning:
ISSUED BY:
Phone: (714) 434�4927
Zip: 92626
Phone:
Zip: 92625
Contractor: MARK DEYDEN DEVELOPMENT
Address: 1707 SAMAR DR
COSTA MESA, CA
Zip: 92626
Arch :
Address:
Phone: (714) 434-4927
License:" 325027 �
Eng:
Address'
Phone:
Status: ISSUED
Applied: 07/16I2001
Issued: 07I162001
Phone:
Zip: License: License:
. , ' SCOPE OF,PERMIT . � ' �
, REMOVE 8 REPLACE 2 EXISTING SKYLIGHTS WITH 3 NEW SKYLIGHTS'(BRISTOLITE - ICBO #ES-2469).
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other.
Inspection: ;
Total:
$0.00
$44.85
$0.00
50.50
$0.00
$0.00
$45.35 : �
FEE SUMMARY !
__--- " " � _ � Calc Valuation: �
� � � ,; � '� - � Claim Valuation: ,��
;,; ,
, _ , !� �.
- -_ _� ;,>�,
ir') /
.,;: , � _
, � '
� .;�� �_
` `, , � �' i� .
�.' '�� ������ �� .
\ � AA- ' �
SETBACKS ..� � : /, i �� �����,. " ���
MAIN STRUCTURE Front 0- 0 �,, Rea? ��0- 0'
; ,
ACCESSORY Front 0.0 � �'. , Rear '0.0
PARKING Existinq: �0'�� �_ ReaWred: .0.
� -
NOTES: �` " �
4NNING'&ZONING ;/i .j � ��
-� �iji j l i;
� „ "„ _i/� " / ��" `.�/�. ,�
�Left — 0=0 �- - Right! �0=0�� �'- � ,
��� �
Left , _ 0- 0 ', -� �� Right� �� �0- 0 ; ,
_;'..-_ - _ . ; ij
� , , _ �� ,,�
Pmposed: _ 0' " �; %
�,�' ,
_ - _-- - , r-. . �
St,zoo.oa
at,2oo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire antl become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: �n order for the work authonzed under this permit to be considered legal, such work must comply wilh all applica6le codes, and all
requlred Inspectiona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaaee ls�ool
WORKERS'COMPENSATON DECLARATON: '
I hereby elTirm untler penelry of parjury one of the fWlowing dedaretions:
❑ I heve end wlll maintflfn e cenificate of consent to selt-Insura tor warkers' compensation, es provided for by section 3700 at Ihe LeDor Code, lor the pertormance af ihe
work tor which Nis permit Is IssueO.
❑ 1 have end will meintein wakers' compensatbn inwrence. az requUetl by secUon 3700 of Ne la6or Cotle. tw Ne peAormar�ca of Ne xrork ta whifi� t7us permit Ls Lswed.
My workers' compensatlon Insurance cartier entl poliq numDer ere:
Cartier. Policy NumOer: _
(lhis SecNon need nof be �npleted I/ fhe perm/f!s velued et me hwWreO ddlers ($100) w IessJ
_[v I.certly t�at In t�e pertortnance of Ihe work for which Ihb pertnit is issuetl, I shall not employ eny person in any manner so es to become sub�ect to t�e workera'
compensetlon lews ai Calilomie, enC egree Nat It I s�ould become sub�ect to the workers' compensatlon provislons ot Sectlon 3700 of the LeDor Cotle, I shall IoMwIU
comOA'�with t�ese ProNsl /�
� � m SigneWre: �� -�Gh��✓-l�, � Date: 7 ��� — � �
WARNINO: F�ILURE TO SEWRE WORKERS WMPENSATION COVEM�E IS UNLAWFl1L AND SMALL SUBIECT AN EMPLOYER TO CRIlANAL PENALTIES AND CML FlNES UP TO ONE NUNDpED
THOUSAND DOLURE (5100,000), IN ADDITION TO THE ODST OF WMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE UBOR ODO� INTEREST, M!D ATTORNEY'S FEES.
LICENSED CONTRACTORS DECIAHATON:
I hereby eHirtn thell.em Ilcensed under prodsions ol Chapter 9(commendnp with Section 7000) of Dldsian 3 af Ihe.Business end Pmfesslons Code, entl my Iicense is in lull
rorce eno eNect. ��c. a'�l 3Z5� �- a qass�_� J�
CONSTRUCTON LENDING AGENCY:
❑ I hereby ettirtn the� Ihere Is e wnslruclion lending apenry tor the pertormance ol the work for w�ich this pertnit is issueO. (Sec. 3097, CIWI Code).
Lender's Neme: Lendefs Atltlress:
SlpnaNre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eNirm tha� under penalty ol per�ury Ihei l em EXEMPT FROM THE CON7RACTOqS LICENSE LAW far tne following ressan (Sec. 7031.5, Business entl Professlons
Cotle: Any ciy or counry which requires e pertnit Io construct, elter, improve, demolish, or repeir eny strucWre, pnor to its issuance, elso requlres the eppliwnt tor such permit
m Nle e signed stetement Ihat ha or she Is Ilcensed pursuant ro che provislons oi Ihe Contractors LJcensa Lew (Chapter 9(commendng with SecUon 7000) ol DMsion 3 ot ihe
Business end Professlans Cade) ar thet he or she Is exempt therefram end the besis for the alleped exemption. Any vialation oi Section 7031.5 by any applicant for a pertnit
subjects tha appllcant to e cfvil penalry of not more then fNe hunGretl Oollars ($500).):
❑ I, as owner of the property, or my employees wlth weges es their sde compensation, WILL DO THE WORK, end the structure Is not intendetl or oHered lor sale (Sec.
7044, 8usiness end Protessions Code: The Contractors license Law does not apD�Y �o an owner of property who builtls or improves thereon, and who does such work
himself or herself or throug� his or her own employees, O��ded that such improvemenis ere nat intended or oNeretl for sale. II, however, the building or improvement is
sold within ona year of completion, the owner-Dullder wlll have ihe burden of proving that he or she did not Duild or improve tor purpose ol sale.J.
❑ I, as owner of the properry, am E%CLUSIVELV CONTF7ACTNG WITH UCENSED CON7RACTORS to consiruct the pmject (Sec. 7044, Business antl Pmfessions
Code: The contrectors Lkense Lew does not eppty to an owner ot properry who builds or improves thereon, end who comrects lor such pro�ect with a conirecroqs)
license pursuant to the Conirectors LJcense Laws.).
❑ I em exempl under sec.
SlgnaWre:
Owner ID veritietl by tlriver'S Ilcense. ❑ Yes ❑ No
Business and Prolessions Code tor this reason:
Venficetion ot Owners�ip by (rype ot documem, i.e. - properry tax biil or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFlCATION:
Oriver's Liten50 No.
Date:
Expires:
❑ I hereby certlty thet no exwvatlon five (5) or more teet In tlepth Into which e person is raquired ta descend, will be metle In connection vnih work eut�odzed by tNs
perml6 end that no building struMure, scaMdtling, talsework, or tlemditlon or Cismaniling thereol, will be more than Ihirty-six (38) feet high. (Chap. 3.2. Grp 2, Art 2, Sec.
341, Tltle 8, Celilomle AtlminlstreiNe Cotle).
� As ownar-Duilder, I wlll not employ anyone to do work which would require e permit irom the Division oi Industnel Sefery, es notetl ebove, unless such person �es a
permlt lo tlo suc� work Irom the division.
Signature: Date:
DlWslon of Industrial Salery Pertnit Number:
CEHTIFlCATE OF COMPLIANCE AND AUTMORVATON OF EMRY: I certify under penalty of perjury that I have read Ihis flpD�ication and steie Ihat the Informetlon given is
correci. I egree to compty with ell stete Iews end Ciry ordinances relating to building construdion, entl authonze representatives of the City of C0.5ta Mese to emer upon the
ebove4escriDetl propeM 1ar Inspection purposes. I egree not to acupy or allow occupanty oi any building authorized by this permit until linal InspecUon.
Legel Owner(s) Date
7 /G--bi
�nxed n���e�, i ,�__� �.oa�
COpE �. INSVECTONME Q�jE II�EL$
1618 Fl:ed System Flnal Fire Prevention
1268
200
Pool Spe Final
Final Re-Roof
400E� INSPECTIONTYPE
206 Finel Mechenical
208 Final Plumhing
210 Final Electrical
201 Flnal BIocWReteining Well 212 Finel Flre Prevention
202 Flnal Factory Fire Place 220 Finel Planning Approval
203 Final Sign 222 Flnal Site
204 Final Demolitlon , . 250 Finel Builtling/Occupancy
� u�s
�
I'
I�
�ooxEssaem�aw: 336 E 17TH ST
"""E"s"""E"'°+a`":ROBBERT SATTLER
"��"�544 HAZEL DR
DEL MAR, CA
�ooness:
AXCXrtEtTOXFNOPlEEN:
r
VNi:
760-1944
uu w_
UNT:
carim�crarsw,�MARK DEYDEN ' ( 714 ) 934-4927
ca+m�croasr,uwn 1707 SAMAR DR
�ooxFss:C.M. CA uexo.: 325027 �
92626 uxr:
LICEN9ED COMRRCTONS DECLAH�TION: I �ereby eflim under penMy d perjury ihe� I un Ilceneed uMx prantlone ol Chaplx 9
(eommandn0 �h Sac�bn ]000) W Diviebn 3 0l Ihe Businan eM PMaeelom Cods, eM my licenro ie in lull brta uM aMW.
cmuc.No.020955 uc.cuss: uc,r+o.:325/0� 7 �% EXP: 12/96
om.: �—/v-9G camreea� ! iu>�-"--�-
�
OWNEF BUILDER OEC�ARATION: 1 MiWy elfirm uMer penaly d perWry �M I am saemp Imm tM Comwm l'xeiue Lew ta ihe
tdbwip ramon (�� ]0�1.5 &nnn� eM Pedmb�s Code: AnY ery n oounry wfikF �epuim� e pmnG to aon�truet. Mx.'unprove.
Nmdsh, or �apei eny sVucluro, prior lo ib eeuerce, eho nquine IM epplimM la ach peimil to fils e Np�wd �iNemsn� Net M or ahe
� IiceneM Wnuenl to ihe yowiam d IM Gomreaoro liuma lew ICMqm B(mmmenenp wilh SoCion 1000) a�'eion 3 d the
Buviroa eM PMwiona CoAe� or Ihtl M n Me e memq �Mreham and ihe besi� fa Ns ellped pemqion. My vioW on d Setlion
)031.5 by ury epplirant tor a permn wEjxU IM apd� �o e anl penelry ot na mpa tAen INs huntlnE Edlen �55001).
� I, si owror ol iM properly or my empbyeee wYh weges es Ihei eob wmpenWion, xill do the xoA, eM Na el�uclun n �wl in�e�Med
w Mered I« eeb ISecWn ]oN.Budroa vd PMessions Code: The Cantradae lkama Lewdom mi nVONtoan owrier d propefry
wlp WiGs «inprwm �M�em. aM wfio Ams eucM1 xak Hmsatl a henetl a Mraqh he or Mr oxn ampbyaae, prnkeE �Mt wch
impv.emmua me rd iNeMed a dlemE la eeb. tl, howe.er, �M Wiltliep a inpo.emam e edd xnhin aw yaer M eampblbn. ihe
owror-0uilder wll hew iM buMen d pwiiq M or aM d'd rw ddd or "unpro-.a lar IM qrtpme W eW).
� 1. n mmer tl tM O�W�Y. vn u�bdvMY ooM�r.1nY wrth 4enssd caVraclws b munw Ne V9e� (SaYion )OH. Busimaa eM
PMwmao Code: The CWreem l'<mm law dom m� +WN b an owiw d PW�Y Wa bwlC� a impv+a ihmsan and who
eonuxn iv wdi VaMn+ wuh e mqemMa) IieemeE P�� �o �M Canradm Lim�ua lawl.
� I em awmp under Ssction: B. 8 P G.. br thu rwaon:
Dals: ��
I Ao I+ereby canity Nel I em ewme d uW uMen�eM tlre requiremenb d Gd/wnie HSNh eM Selety Code SeUbne 25505.25533, eM
255�4, enE Ilw 1 a vry M1nure Wikiip a¢vpani will / will irol (dreb one) neetl lo compy wih �eid ame oodee eM the repuiroments br
epermiilamneliuclionwmodifratbnhani�aRr ue�y aregementDiwna.ReeiEsnlielconet�ud'anepplraiionsereuemqtromNeae
wariaione.
Dela: ADDlir.ant
WONKER'S COMPFNSATION DECL�RITION: I MreDy affirm u�Mer penally o1 pmjury ma d iM /dbwiiq detlermiona:
� I heva eM wil meinien e eenAieete d wnem to sMireure M wakeie' eanpeiuelian. m pewidetl la by Sedion 3)00 d �M lebor
Cada.la IM perlarmeece d �hs xak Irc Mie� �his peimil b iaaued.
� I M1ew eiM vril meinleii v.orken' mmpemeiun imuev�. b repuired by Satlim ])00 d tM labat Cade. la IM perlmmenee d tM
wM lor whidi Mis permil ie usued. MY ��� �Pe�� imurenca rertier artl poliry numMr ua:
Certier:
Gdicy Number.
mis eeaiar neea n« ne canob�ee � �m w^^x is ro. a» nuMnd ewlers Is�ool o, bx,.)
}�] 1 mnh �� in iM peAamerce d the work br v.hch �ho permit o beueE. I ehell np mmpby erry prwn in em/ menrwr eo m lo
ber.ame wEjea ta iM worMn' can0��ion lewa d ceNamu. vd euree tlw ! I ehauk Eemnw abjod to �M xwlan'
�v�� wa+•o�+ a s.a� a�ao a ms �m. coae. i.nen ionn.nn,om .nn pow�n.
om.: G— %/ v�% � �odsw: �� r
W�minp: F�Uun ro ue�n wAraa'rompwuetlon cwarep� Is unMHul. �nJW/l a�Ohef+n wriploysr ro WMmI pxuMp aM
GW Iln�s W ro am �uWM fhouaud ddl�n (S10q000A N MJ/tlon b IM cwt o/ romprwlbM1 Camep� u povMeC br In
Sxtlon �1a6 0l fM LWor CoJs, Imenst, uW elromyi lea.
coNsrnurnoN ��oiNo naeNcr. i naeny ��,�m� va�.ev a��y inm m.a a e�Na� ie�a��u w�v ro. �
peAaemaMe W �M work la whidi �h'v pemiY ia eeued l5adion 309). Civ. G).
LENDEH'4 NAME:
LENDEN'S RDDflE55:
I ce�iy �hei I heva neE ihis epplicUion erd elele �hei the above iMormetion b caneq. I pres to canpy wiih ell �y eM oounry adinenms
eM eime lewa roletng lo buikvq canwudion end Mreby eu�Mrixe repreaanietivm d ihb ary lo enter upon t�e aEwe�moniioned propeM
�«��'°��°��O�MARIC DEYDEN .
�/% ///��� P'iNema
f " / A"'-� � De�e: �/ O/ 9%
/ SpneNra N'Owner/ApenVRpphrenUConiraaa
15151d6.WP) WM1na-BuildvpBSeletY:OreemFle:Cenery-Applrant:Pink-Revenue:Oddenro�Maeaeor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: P 077646 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU
JOB DESCRIPTION : PLUMBING FOR WATER SERVICE
PERM NO: P 077646
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
AIM VALUE: CALC—VALUE: GROOP OCC: B /
MMENTS: WATER SERVICE REPLACEMENT WITH BACKFLdW DEVICE
�*+r�r*x�x�*�r*x��*x x ***x **�rt�r*x�rx�x��r*x�x�+t+titx�*x�*x��r*�x���+t*+t�r+tx x�*�*x��rx��rit*x ***�**�x *�***
Z O N I N G A E Q U I R E M E N T S
S E T B A C K S.
---------- MAIN BUILDING ---------- ------�'-- ACCESSORY BUILDING ---------
NT: FT IN REAR: FT IN FRNT: � FT IN REAR: FT IN
FT: FT IN RGHT; FT IN LEFT: � FT IN RGHT: FT IN
RKING RE(J: PROV: PARCEL: 425011 2 ZNE: REF NO:
ANNING NOTES> r,
�
1E i! fE 1E iF ik iF if 1E 1f iE 1k 1E 1E 1E 1E if iE 1E 1E'lE 1E 1E 1E1Elk ik 1E 1E Ik 1k iE 1E IE 1E iE 1E Ik 1k 1k k!E 1E 1E iE'iE1E 1E if If 4 iE ff 1k if 1E iE 1k If� 1E 1E 1E 1f 1E 1E iF i! 1k 1k 1k 1E iE'IE iE 1k ik if
D E V E L O P M E N T S E R V I C E S � R E Q U I R E M E N T S
�
ZONING APPROVED HY .
BUILDING APPROVED HY :
APPLICATION ISSUED BY
iE If IF 1E if 1E 1f if ik ik 1E 1E 1E 1E 1E 1E ik fk iE 1E 1f
DATE:
DATE:
DATE: f IO''�{p
iElfiFiElEikiEiE 1EIE
LEGALIZATION:N F E E S U M M A R� STRUCTURAL SEGMENT:N
i ��
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING
PERMIT 24.00 .r �r
253 „ �✓. SMIP/NON—RES
ISSUE FEE 20.00 rv �� �''
BUILDING—DIV—> PERMIT ISSUE PI:AN-CHECK TOTAL PAID DUE
TOTALS----> 24.00 20.00 � 0.00 44.00 44.00 .00
REVENUE DIVISION TOTALS--> COLLECTEDt: 44.00 OVER/SHOAT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIG FIAE SMIP/TOT GRADING PLAN—CHECK
44.00 � � N
1FIEk�E1ElEikifl(�lf1f1f1fiElEififlifhlElE�EiEiElE1f1(� 1E1fiE1E1f1fifiElflf�lEiElklflEifif1f1E1FiF%1E1E1E1EfF1EiE1E1E1E1E1E1E1ElE1E1EiEiElEiEf('ifiEklE
I N D D U A Ln �F, E E B R E A K D 0 W N
TYPE QTY D E S �R I P T N!f � UNIT COST TOTAL COST
PLU 1 WATER SE VI ���;� 7.00 7.00
PLU 1 BACKFLOW ENTER "� -',!_' 7.00 7.00
PLU 2 VACUUM HR /BACKFLOW PROT. 1 TO 4 5.00 10,00
END OF FEES
�
��
. y
�i n..-,9"r.- _ ..v,i:'• 1�F_':. •�+-'�-
l �AT�� t`v 1L'' .._�i i�t}.
CONSTRUC710N AND PLANNING POO. ;PA
ApPFiOVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
�
1. 7err)porery Electrical Service pr Pole 52. Pool & Equipment Location
2. �joil. Pipe-Undrgrnd. o � 53. Steel Reinforcement
��`-�r ���Ftrical Conduii�;tlity-UnilPgrnd. . 54. Forms -
,n4�Electrical Conduit:4Jndrgrnd. 55. Electrical Bonding
•���,�StP�el Reinforcem�gbi 56. Rough ?fumbing & Prenure Test
�
d6.-�IectricalUFEFbGU�d. 57. APPROVAITOCOVER-GUNITE -
�� 7w Footingz cr, 56. Electricai ConduirUndrgmd.
. ��
��";�8. Foundation �; 59. Gas Pipe, O Undrgmd., Test
9. Wa�er Pipe�Undrgrnd. -� 60. 8ackwash lines, P�Trap, � Undrgrnd.
10. S�u+ctural fioor System 61. APPROVAL TO DECK
11. Property Sewer Line:& Housa.Connec2ion 62. Backwash & Recepior�Final �
7
12, Sewer Cap ' . 63. Heater & Vent•Final
13. Roof Orains ^ , 64. Plumbing Syscem � Final �
74. Rough Plumbing`._ y X � 65. Electrical�Final
15. Rough ElectricaL•Conduit .. 66. Solar System•Final
16. Rough Electric Vdiririg " �
,� 67. Fencing & Access Approval
77, qough Wiring Sig'n �„ 68. APPROVED FOR PLASTERING
18. Rough Electricai�T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL
19.6oughH�ating,&AiS.Conditionuag. a� x� v. 5n �e;A �FtRE,@EAT.�AEQUIREMEIVT ^
n
c*� �n;�G m � >
20. Rou�h FaCtory. Fi4eplace ' `F �' } =�' *^ �� , -APpi�V�'F�&�� Pe.mit # � - -
21. Duct�r, in�Structur�' ; .. .• � ': _ _, �=+' ,
S r 70. fklndergroundl Hqdro F
22. nuct�s; Ventilat(ngi,:* �'� ;t ^ � �� �r'' 71. Produ`PiPing 0`�as f'�Oil �
23. Gas P e-�Rough &�T"st -' � * "' C "' � - �� i � • , � �
P � G i;n,, �.� tr; tr � t , 72, Unde�grp`uqd FJush x >�
24. Roo�Framing Y: � 4� > �: +-•� � 7g;; �ndergrrZtl.Slo�ayETanl%�Gas ❑Oil
r '
25. Roof�Sheaihi�g ' _ "'� y "? �-;* 7: Overhead Hydrp:r• k
26. LBai•CeiFng (StruCLarai) & Mp1TcTtoat '= r v "��' 7,��,. Dry Che ic I�- - i �''
-r .. �:� n 4 � C: r:'
. 27. Fram�and Flashiri�g K �� ^ a P y }� R �p' ,F�•' ;- � ��
� . 76. Dry Sta ipe
�28. Latliing �Siding i�.c � � cF C 7� � I' 77? FIXED SY3TtTNI��1AlA� "� ';.rit.
_ 29. Insulatio� ��.',;' S .. r ; � Iy� 7�;FIRE�fiEV. FiP�AL � `+ � ^�
J 30. Drywall Nailing _>' � • Y t- � K�' so� ^fb+EALTH��DEP ,'rREQUIR" _1�NT
� � 31. Plaster Biown�Coai * � , �� �� � �,� ' � 79. PINAL IAjSPECT�i; N � p , _ �
___.>
t 32. �Jectricat�'ower Mecer�Final � r V i ��. �� 8Q7 FOOD CERTIF�'� AT I�S�ED�� R
= 33. �na�Elec.tric�: r n x� i •.:�+ c�'.',� * .:.. � �� Ndtes: �, ,T,+ � % " , _
.. . -13 '��_,-,.� ro- � etni�-�J
+34. FinarJ-leaiing=& Ai� Eqr, itioning` �y :; � � �:; c ^r' `Z r �!��.,c n/� �17'/
._. .. ._ :. --� r t / 7LL�G�%.i1,-; !L7`�J�(�._��/�^`-�
35. Fjnal Gay_,Pipe�Tesz�� `� . .. .'.K ", � � _�� � ;y -.,�' .� Q�i�t
r- .:. ... `'�' : � _ N_�t-� �i..-
' _, •` r � a :- :a
'-" 36. Hood;or CanoPY �'s Cl i�5: cn x� ' �'
�
_37. Final'FaciorY Fire��se, ' " - . , "� �' _ �.: _n.
,. v,� .. . � �: rt � Fr � � �' _ ;
�38. Final=Flumbing _;-,. • 7 �- j �( �kr' i-+ " 'r _
r. a.
.39. Water Service�Final ' * -" I ' ' � ''
r-. .. r.-� �, . r� 'r.
;'40. G9s Service-Final �� � `F.�� �K �- � - _ y c
I h Y
-41. Solar pomesticFin"�I" � tT� t ^ , K '" �- ` ° ' -
- �J k � � ,t H C:% #
42. 68ckflow Preventer ��'., �; �,�� �`.., �fi M n;p i�-
43. Bdckflow Irriqation �" �' J � n� '� ' � �' Y " -,;, ,
,. � a; r * t. v �`
"4„'q, 6andscaPe.IrriQatiorqSYstem = ��e�:, m ' Q � � t ' " T 4 J+� ' S �-- ` - �
45. Sound Atteni�ation" • -• * ` T � T'� � 7 � `�" • '�"" w
F- � a: c � C.. .� �. J • r,
Q¢. H8ndlcap�Regulation5 _ . S � �x 'a O J �. �
47. FINA'L STRUCTUflE & BUILDING x �" j � : � ^ ,k � '��' �
48. F�INF,tI P�ANNING � .�� .0 �V f �A_ e; r� iu S �
!49. E�Iectric Release to Edison � X I x.; � � � V `
r ax i ��
50. Gas F�elease to Southern Califbrnia�Gas Co Y � '* � ^ - "r� � � _' _
�
y
51. CERTIFICATE Of OCCUPANCY
No Date
osF-sz .,_ �
� ��� �-{�- 8'�- �
C46TA cIIESA BUILDINGSAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
RECEIVEOBV PERMIT �TO 4962U
ForApplicant to Fill in Completel — Use Ink Only ���
.9UILDING %� �� � St SM C q'p' NO. � �� +
ADDRESS � I•�
� w ��T � /� �`� BUILDING7�� � �I1 �� f
OWNER OR' y �� ADDRE55 7 V I
TENANT
ADDRE55 S� �'�,(��(� Dp SPACE NO.
;� TR�� LOT '2 BLK.
�iT� �p/�o�J 1J3L Noi's�%-7 zq
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONS7RUCilON
LENDER {� �
BRANCH OWNER ��LLZ� r �/ 1 `�.K.
ADDRESS VALVE
OR ENGINEER �� � /✓ S!P s TE .(! D, USE S
Q
ADDRESS � 'r ZONE TVPE GROUP
CONTRACTOR �jP,�P'� DATE �
ADORESS 5y,� �T �r�
CITV �� O`(� NOL Q.%%ZR
F STATE CITV APPROVEDSETBACKS
UC. NO. UC. NO.
{y SIZE y NO.OFBLDGS (FROMC/LST EET)
0. OF lOT S� I� � � � NOW ON LOT � OM FT.
� USE OF
EXISTINGBLDG. ���Lf3 �G.�%
� I
FSeparate permits are required for L SIDE Fr.
0 electric, plumbing and heating work: REAR F.
�,W. USE OF BUILDING AND WOflK TO BE PERFORMED PLqNNING ACT O
Q
OATE
� APPROVED
¢
� APPROV D �
r
�
z
w
�a I heraby acknowledge ihet I have reatl this application and state �
that the ebove informatton is eorrect end eB�ae to comply with
�. all laws repulaiinp building eonrtrucNon, antl I shall not amploy
Z any parson in v101atlon of the workman's companaeNon lawc of m
W tha Stete of Celifornla. ' -
,Z m
3 I hereby cerHfy thei em proparly Iicensatl ez a contrector untler SQ. FT. �
t�e Siate of Celifor Bustnass Profesziona Cotle, Olvlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, antl the uch licen s re In f rce end effact, or I THE PUFiPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am axempt fr0 pravisio s t tha t0 o Cellf ie Business q
entl Professlon e, Dlvisl , Ch 9, VALUATION PERMIT FEE E (� m
Sipneiura of PLAN CHECK $ i6 , DO �
%� LL
Permittee $ /� V TAX $ , � f
or V u
� AuthoNzed Apent Date TOTA� PAID S ✓
�g Sa
- �' �* - �2��.
C.�OSTA MESA BUILDING DEPARTMENT
P.O.BOX 31]
COSTA MESA, CALIFORNIA�
FOR APPLICANT TO FILL IN
COSTA MESA, CALIFORNIA
O W N E R � f'/ljl��
� � Ll�
ADDRE55 � �
r
TEL.
CITV� �Z� NO
ARCH ITECT .��J ��1L (/. Li C.
OR ENG�NEER �l�✓C ✓A�^----- NO.
�
A. _55
CITY LIC. �._
CONTRACTOR — � - -"yL(, . NO.
TEL. �-
ADDRE55 �� NO.
LEGAL LOT
OESCRIPTION NO. BLOCK TRACI
A.P. NO. I /� �
SIZE ��'` No.oF atocs.
OF LOT v � Now oru �or
USE OF
EXISTING BLDG..
SETBACK LINE FROM /
Cervi[R oF siREEi �� J f�L� REAR VAR�j��
'SIDE VARD �RIGHT � yj� LEFT �if
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
eosrn �
�EC 7 5-SEPDaEsr 2u4a *��*�2.OQ
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
�CEN�E� BY OnTE RECEI�V .pi OATE ISSUEi
��' m_,__ ����3'S i %3--/S�-S
i
BU1 DING
ADORE55
COSTA MESA, CA�IFORNIA
FIRE
ZONE
BV � /�" (!�ls��J�� DATE _�,
i
�����'�'�t�-
CITY 0 .. I �
�v � PT.
SUB!,�CT TO ' G. DEPT. REG.
� l�- �
BY qN TeCH.
.� � l,t/r d ( G"/.vd toc.l
RE f MOVING DEMOLISH "C IdC'e •CYpi2 dn
Bl11LDING NO.OF
SIZE ROOMS STORIES I�i il /// /dI� Y
WALL
HEFEBY SGRrvVWLCUY[ Mn"
STAiE TNAT TME PBOVE IS CORRECT
CITY OROINPNCE$ ND STnTE La�NS
TION. /� / •
SIGNATURE OFr/ �(//�;
AUTHORRED AGENT
/NOOLJ /N C�}CIS I
/' S. I=. d w f I��
c�
The Amount shown under valuation is for the
�is nvvuunoH <Ho PUfpOSC 0 E$�3 IS
TO COMPLY WITH PLL
Q1S�LOING CONSTRUC�
�� VALUATION ,` �
PERM�T FEE $ �� v
$ /] 3�, � PLAN CHECK 5
/ J TOTAL FEE S pL, �� �°'��
� 90�.3'
COSTA MESA BUILDING DEPARTMENT
P. O. BOX 31�
COSTA MESA. CALIFORNIA
���� ��C�iV��
flNANCE OE�PT�
nRV AL f`.RQTA MFG
w. • -^-'- `----
FOR APPLICANT TO FILL I APPLICATION FOR PERMIT
Aoo E'S5 G E '� s BUILDING
�
COSTA MESA. ALIF �NIA FOR OFFICE USE ONLY
PECEIPT NO. Pfj1MIT NO.
OWNER � � L� J
REC !O BV [�aTE RECEIVED OATE 195UED
MAIL
ADDRE55 � —
TE BUILDING r^1 � �
CITY N qDDRE55
ARCHITECT LIC.
O� �GiNEER No. COSTA MESA. CALIFORNIA
' FIRE
AL..rtE55 ZONE
CITY LIC. ZONE PLO1N5 TYPE GnOVP
CONTRACTOR NO. �'
TEL. APPROVED
ADDRE55 NO. BY OATE
`Ec"` �or /`1 �' � CORRECTIO I
oEscaivnov NO. BLOCK TRACT
A.P. NO. 1 � � N I ��
SIZE /., �Q NO.OF B�DGS.
OF LOT o/ O Now orv �oi
USE OF (
E%ISTING BLDG.
SETB�CR LINE FROM
<[rvi[n oF s1n[[r REAR YPRD
SIOE YARD RIGHT LEFT
DESCRIPTION OF WORK
NE' ALTERATION ADDITION
REFn�R MOVING DEMOLISH
BUILDING NO.OF
SIZE ROOMS STORIES
E%TERIOR WALL ROOF
COVERING COVERING
USE OF NEW
eUILDING
•� 7 (✓ ( �
y.
1 HEXEBY .�CNNOWLEOGE TN�T 1 H�vE RC.�O TNIS APPLIC�110N ArvD
STATE TM1T TNE PBOVE 1p CORRECT AN !�GflEE TO ffOMP�Y WITN ALL purpase of esiablishing a permit f�e �nl�.
CITY OflOINaNCES ANO $T�TE L�W6 NE ULATING , ILOING CONBTRUC�
iiON. VALUATION �
SIGNATURE OF � PERM�T FEE $ �.
PERMITTEE
PLAN CHECK 5
$ ' 1� o��
AUTHORIZED AGENT TOTAL FEE S �O
�awr
. . .- ��5� JUL 31 1959
. . �Ii+�;'�';;� ,_PT.
COSTA MESA BUILDING-SAFETY DEPARTMENT � -,: , �„ ,
P.O. BOX 317 CO$TA MESA. CALIFORNIA �
fOR APPUCANT TO f/LC /N COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING � � / � f � ��'���L
ADDRESS C STA MESA. CALIFORNIA ��i
,` , `� fo,e offic� usF oNcy
OWNER VCD� (T • SAr ,�'��\ SO� I ftECEIPT NO. I PERMIT NO.
ADDRESS f' SAP��I�C �.�- R CEIVED 0Y I AT HEC%ED DATE ISSUED �
!/
j TE�� BUILDING � ' '(�
CITY � OA l�s NO. qDDRESS
AACHITECT r' � � ua COSTA MESA, CALIFORNIA
�,NGINEER ` NO.
ADDRE55 d�(J � N� �?ORT' �j L FIRE �'/ /
I ZONE TYPE GROU/PJ ��'
� F I�PM�LCTNO. I�('Y.� BYPROVED �� DATEU
CONTRAC70R � � � �
ADDRESS /'
� � n.�, ti�naar L< ONING �
LEOAL ILOT �� �p ZONE NO.OF U8E OF NEW
UE9CNIPTION NO. IBLOCK \ ITRACT� �,�IP�'ANB IBUIL�ING p �
A.P. NO. I I� �� �' I u BYPROVED DATE � � /
SIZE O f' r IHo.ov e�oae. D ypRDS EVES
OF LOT I How oH �or REOUIRED ALLOWED
USE OF „r ICENTER L�NE ST.) •
EXISTING 6LDG. FRONT SD Ff. IN.
SEfBwCK LINE FROM . �y
cENTEn OF siREEi � REAR YARD R. SIDE tJ Fi. IN.
SIDE VARD �LEFT � �RIGHT O L.SIDE �� Ff. IN.
DESCRIPTION OF WORK REAR d"' Fr. iN.
� I�� II ALTERA'��pN I II ADDITION I r'lC/' ` - .1t,�( '/ �
REPAIR n I IIMOVWO I IIOEMOLISH I
BUILDING / O� NO.OF � )
SIZE �L ROOMS STORIES �� n
EXTERIORWALLflf.`�ICOV�ERING �^"��'V / <�CJ' � iS_LJ I
COVERING v
USE OF BUILOING AND WORK TO BE PERFORMED _�/
i
F' CE v� �D��; G- ,: :`1rt,�v_ , p�
I MENEBY ACKNOWLEOGE TNAT I HAVE READ TH18 RPPLICATION 7HE AMOUNT BNOWN UNDER VALURTION IB FOR THE
AND BTRTE THAT TNE ABOVE Ig CORRECT AND AGREE TO COM� pURPO6E OP EBTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINpNCPS AND TATE LAWB flEGULATING .
BUILOIN6 CONSTHUCTION. /l1 VALUATION Y5
SIGNATURE OF _ J � ��, J(�� PERMIT FEE $ Jv ,
PERMITTEE
� $ / � (/ n /�., PLAN CHECK $ � �. .S�
� )-V
`RIZED AGEN TOTAL FEE S ,SO
`
�..
.. (�V 1 VV
�
- COSTA AAE5A BQILDINCrSAFEfY DEPARTMENi
P.O. BOX 7'1� COSTA MEBA� CALIFORNIA 926M
For AppllmM ro FIII In ComplsMly
TYPE OR PRINT
�ocReac o��� C: . � / � �/ %
COSTA MESA. CALIFORNIA
Z
STATE
USEOP
E%IETINO BLDO.
eCt¢ACK l{N6lROY
BV
SEP 25-68�NSp00 761 0**�*�6.OG
ArPLICATION FOR PERMR
BUIlDIN6
ior Ofiln Urs Only
11[C[II� NO. �I
_�� n
I�O �6��� ��V
ADDR
>� O�- `yL�r�p ZONt TYP OROUP L
,�L B PNOV6D � DATB ��(G
ZONING
zoHa wo.o► usao�Hcw
Y ruru ew�oiHo
- tJ/ L.DL-'
L[DAL
O[IICR�RION Z O .l
A. P. NO.
NOTH: NO EAV 8 0V8RHANO SHALL �8 LL'89 TMAN
_�- eo• TO HID6! REAR . L.
IPJ1VE8 I
NO.OIpLp30. . �t_�tfwnn (O.B.C.IiEO1JIREMfiN1
DESCRIPTION OF WORK
WALL
1 X611[pY ACKNOWL�DO[ Tf1AT.t MAV6 RND TMIt AP►IJGTON
AND BTATQ TNAT TN[ AGOV[ IH COHR6G1' AND AOR6[ TO CAY-
PLY WITM A�L-CITx 011OIMANCO AryD �TAii L11W/ 11[OYMTN6
em�mna coNerquCr�ory „ „
AUTHORIZ[C AO[NT
YAflDB MPROV HD
MAIN BUILDINO
!OM GL 8TR[BT)
v�n. t!
YARDBAPPROVED
ACCH880RY BUILDINO
owTa
;;:
_ r � , , a
m
�
ec. rr. �
TX[ AMOUM iXOWN UNO6P VALUATON IH POR T118 �
PYRPOC[ 0I fdTMY8NIN0 A P6RNIT PB6 ONLY. �
VALUATION '
()O PBRMITFEH '�Q� m
s��+iDO� �
TOTRL PEH (� i O O