HomeMy WebLinkAbout2925 BAKER ST - Building Permits" ..,t.. nc rncTA AeFSC
ParcelNumber: 13926210
npp�icant SELL, RON
Atldress: �8032LEMON
YORBA LINDA , CA
owner: KHALIL, HUSSAIN A TR .'
Address 25231 BARENTS ST '
LAGUNA-HILLS, CA �
Contradoc SELL ROOFING COMPANY
Adtlress: 18032 LEMON � �
YORBA IINDA , CA %., . '
. ZiP: 92686 .� � %
Zoning: R1
Phone: 714-528-1758
Zip: 92686
Phone: 714-495-5707 �
, Zip: 92653 �
Phone: 714-528-1758
License: 323842
ISSUED BV:
..���� . Eng. ,
Address: � Address: �
Phone: - � Phone:
Zip: License: � " License: .
SCOPE OF PERMIT "
TEAR OFF (E) ROOF MATERIALS, INSTALL 2 LAYERS OF 30# FELT ON A 4:12 PITCHED ROOF AND REROOF W/EAGLELITE CAPISTRANO TILE
5.5#PSF pCBO# 4660 ) ON AN ATTACHED HOUSE AND GARA6E, APPROX 2,700SF. REPAIR AND REPLACE SHEATHING AS NEEDED. "
FEE SUMMARY
Pian Check: $0.00 . - Calc Valuation: $8,soo.00
Permit: $167.25 y.' _ `'� Claim Valuation: Sa,soo.00
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.89
$0.00
$0.00
$0.00
$168.14
SETBACKS
MAINSTRUCTURE Fron1 0-0
ACCESSORY Fron1 0-0
PARKING Existin : o
PLANNING 8 ZONINC
Rear 0- 0� Left 0. 0
Rear 0•0 Lefl 0-0
Re uire : 0 Pr000sed: 0
'�
Right 0-0
Right 0- 0
NOTICE: The work authorized by this permit shall comply with all applicable handica0 accass requiremenls under Califomte statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21'921
EXPIRATION: This permit shal{ autanatically expire and beCome void if work is not commancad wilhin 180 days, or it work is suspendad or abantloned
for a period ot 180 days. with all a lirable codes, and eil
INSPECTIONS: In order tor the work authorized under this permit to be co�idered legal, such work must comply PP �
requfred fnapeetions and tinal approval must be obtained. Failure to obtain inspections a�d final apDroval will result in the expiratlon ot thls parmit.
FOR INSPEC710NS CALL: (714) 754-SG28
2ea�<e (6�Oo1 .
WORKERS'COMPENSATON DECLARAnON: �
I hereby eflirtn unCer penelry ot per�ury one of the tollowlnp declaratlons: �, � -�
❑ i heve end will melntain a certiflcate of cansent ta selt-Insure for workars' compensetlon, es provlded tor by sectlon 3700 of the Lebor Code, lor the pertortnence of ihe
work tor w�ich Nis pertnit is issued. �
❑--I�have and,will m'nteln warkers' compensation Insurence, ulretl by section 3700 ot Na LeUor Code, for t�e pertortnance of Ne work for whkh this pertnit is Issued.
iMy y�orkers' n 7nsurence carrV�� patky n r ere: �
CeMar:� � � POIIcyN� umCei:�� �Q� ��O�S�
�mis secuo� � or ne cawierad u �na �;r �s �mea er a�e nunarea aa�a� �a ioo� o� iess.� �
❑. I cently Ihet in ihe peAormance oi tha work for wMch tNs pertnit b issued, l shell not emplq any person in eny manner w es to become suD�ect to the workers'
compensalion Iaws ot Califomle, B epree ih ii I shoul becane 5ublect �o Ihe workers' compensalion provlslons o} Section 3700 of Ihe Lebof Cade, l shall torthwflh
. comp� ly with t� sa Provlsions. � � !,_� �
A'pplicant Sipneture: fliC DAt�: - %
WARNINO: FNLUqE TO SECURE WORI(ERS' COMPENSATION COVERAOE IS UNLAW FUL AND 5 WLLL SUBJECT AN EMPLOVER TO CRIMINAL PENRLTIES AND CNIL FlNES UP TO ONE HUNDRED
THOUSAND DOIipRE (5100,000). IN ADDRION TO THE COST OF �AIPENSATIIXJ, DMMOES AS PiiOVIDED FOR IN SECfIIXJ 37080F THE LABOR WDE.IMEREST, M!D ATTORNEI"5 FEES.
LICENSED CONTAACTORS DECLARA770N:
I flm Ilcensed under �mdslonsRf G�pp1859 (commencing with Seccion 7000) of Divislon 3.of�t�e euslness and P�otess��atle, and my Iicense Is In NII
CONSTRUC710N LENDINO AGENCY:
❑ I �ereby effi(m (haI Ihere is e constNction IerMing egency tor t�e pertormance ot the wotk tor whlch thfs pertnit Is issued. (Sec. 3097, Civil Code).
Lender's Nema: Lentler's Atlaress:
Signeture:
Date:
OWNER-BUIIDEH DECLARATIONS: �
I hereby eNirm that untler penelry of per�ury that I am EXEMPT FHOM THE CONTRACTORS LICENSE LAW for Ihe fdlowing reason (SecJ031.5„Business entl Protesslons
Cotle: My dry �r wunry which requires e permit ro construct, alter, improve, demollsh, or repair eny aWCNra, priar to its issuance, elso reqWres �he applicant for such pertnit
ta flle e signetl gtetement thel he ar s�e Is licensed pursuent to ihe provlslons of ihe Contreaors License Lew (CheOter 9(cammencing wlth Sedion 7000) ol Divislon 3 of the
Business end Professlons Cade) or ihet he or she is ezempt therelrom entl the besis for Ihe ellegetl ezemptlon. Any violation of Section 7031.5 by eny epplicent for e pertnit
sub�ecls ihe epplicent to e clvll penelry of not more Ihen flve hundred dollars ($500).):
❑ I, es owner of the property, or my employees wlth weges es thelr sole compensatlon, WILL DO THE WORK, end the structure ls not IntentleG or oMered for eale (Sec.
7044, Business and Pmfessions Cafe: The Contradors License Lew tloes not epply to an owner ot properry who builds or improves therean, end who does auch work
hlmselt or herself or �hrough his or her own employees, providetl Ihat such improvements ere not intendetl or ottered far sele. I�, however, t�e bullding or Improvement is
sold wlihin one yeer ot completlon, ihe owner-builder wlll have the Durtlen ot proving that �e or s�e tlitl not build ar imprwe for puryose ot sele,), •
❑ I, es owner of lhe O�Werry, am E%CLUSIVELV CONTRAC71N0 WI7M LICENSED CONTfiACTORS to wnstruct the proJect (Sec. 7044, Business end Profeaslons
Code: 7he contrecrors Ucensa Lew does not apply to en owner of proDerty who bullds or Improves thereon, entl who contracts for suc� proJect with a contrector(s)
Ilcense pursuant to the Contrectors Ucense Lews.). �
❑ I em exempt untler sec. Business and Prolessions Cotle for this reason: �
S'rgnatme: Date: �
Owner ID vedtied by tldver's Ilcense. ❑ Vas ❑ No Ddvels LJcensa No. E�Wlres:
Veriticatlon of Qynership by (type ol tlocument, i.e. - property tac 6111 or tleetl):
DIVISION OF INDUSTRIAL SAPE7Y PERMIT CER7IFICATION:
❑ I hereby cartity ihat no excevetlon flve (5) or more leet In tlepth Into which e person Is required to descentl, wlll De made in cannection wlt� work euthodzed by this
permit, end thet no bullding structure, scaHolding, lalsework, or demalition or tlismentling thereot, will be more than thirry-slz (38) feet �iph. (Chap. 32, Gry 2, Art 2, Sec.
341, Title B, CalHomla Adminis�retive Code).
❑ As owner•builder, I wlll not employ enyone m do work which woultl require a permit (rom the DiWsion of IntlusMal Safery, es notetl ebove,.unless such pereon has e
permit to tlo such work trom the division. i
Signature: Data: '
Division af Indusinal Safary Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOHQATION OF ENTAY: I cenity under penalry of perjury Ihat I heve read this eppliceiion antl ste�e �hat the iniortnallon given Is
cortect. 1 egre4 to comply wlth ell stete laws end ciry ardinances releting to Guiltling consWction, and eut�odze rapresentatives of Iha Clry ot Coste Mesa to enter upon ihe
ebove-tlescribed properry for inspection purpases. I egree not to occupy or allaw occupency ot any Duilding authonzed by this permit until final inspection.
COUE I, INSPECnONTYPE
� 1616 Fixetl System Final Fire Preventlon
1266 Pool $pa Final
� � 200 Flnal pe-Roof
',201 FIneI qlocWReleining Well
T I �2
1203
Final Factory Fire Place
Finel $ign
204 Final bemolition
UATE �jQ�i
. i Y,� ��
CO�EI INSPECTIONTYVE
208 Final Mec�enical
208
210
272
220
Final Plumbing
Final ElecMcal
Final Fire PrevenUon
Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
' QAg ItlI�Lfl
�
ADD�ieanl to fill In all spaces execOt Ihose within heavv borEer Iines anE sian all aoorooriate tleclar2tions
�,�,��'J,�,4.� d"3aR?_ i
� CITY OF COSTA MEpSA ' CON,$�� ION PERMIT • P IT TRACT NO. LOT NO. UNIT N0. , , � 4i-i I 1� I c �,�o�,.,
Roject Address �702r l6 � �' �� 3 �� 3 S� 0 3 � . . ; . � -
Applicant's MailinTg A�d�dress'I�✓_3��.�V���� �« TVPE OF CONSTRUCTION rvEW aDD nLTERATiON REPAI R
�/� C/HfC/� --_� Phone � CONVERSION ❑ DEMOLISH ❑ OTHER ' q,p,# ' �• � Zo�e
Owner's Name DESC TION OF. Wf�K /lJ$EQ F,Ej LDG. �' ��
Address %li�R�,/ ' �[a(K' [SLC�K� AL S Main Building: Accessory Building: �
Arch/Eng.,S�q���� License No. � TYPE OF PERMIT GRADING ❑ FOUNDATION STRVCTVRAL T Front Z�"'j � p
❑ TENANT ❑ Et_ECTRICAL ❑ PLUMBING ❑ MECHANIGAL ' 6 N
Address _ � �,/ ' � Rear � (' �
Contractar'sNamep��q�/�_F�i�• ' Phone,?/Y���>Sy PROCTDESCRIPTION lR.1FT. OCCUVANCv � .0 Right t 1� � N
Address (mailing) Po� .i% �.�L ,/ - K , G
� . . , � CONSTRUCTIONTVPE VALUATION$_'� g Left �' r� . ' R
City �iCense No. ZONE ' GRADING CU. VDS. ACRES p�ng. Ref. �i-` � • Pefking Req./Provided ; � � E
LICENSED CONTRACT00. DECLARATION
I h¢rCby affirm that I am IicenSeU untle� provisioq501 Chdrter 9(commencing qemarks: � Pldnni0g NOt¢5: �
with 5ection ]000) oi Division 3 of the Business antl Professlons Cotle, antl �^ x M
my Iicense is in f II force ana eftect. ' 7,G�,{�., ' � - ' � . . . � T
LicenSe C�I �Ss�� �'�"��.q iFens< No. � 0� 00 . S
Oate-��/��sLi� Si9nature ' PLUMBING • ' - FEES'
WORKERS' COMPENSATION DE 63� $ink $hOw¢�S
I hereby attiim that I have a certific ' consent �o self-insure or a certificate �- - ' . ELECTRICAL � �- FEES
oi Workers' Compensatlon Insurance, or a'certifletl copy thereof (Section BackflowPreventer ServiceSink • �
3800, �ab. c.) � '� Automatic Washer , Transtormer � 75-50 KW -
P,.$licy No. C�037�i// Company C�� � Backflowlrrigation SewerCa � . '� 50+KW
`� I� Certitietl m , P�� � ' Construction Pole Sub. � ,
�Y is hereby futnishetl.
� IJ Certifietl copy is tiletl with'the city Builtling Di�ISion. B2thtub5 � Sewer Connection COOking Unit Me[er �up LO 100 amps �
� Date Appllcant Clarifiers
m EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Solar CollectOrS- Di5hwa5her ' - Meter povef�100 amps '`
\ (Thi55ection ne¢tl no[ be comD�eteO it the permit is for One huntlretl ($100) or Di5hwd5her . - , , .
up mss�. Solar Pipirig _ Dryers �❑Gas ❑Electric Sub Panel
I certity that in t e perto�mance of tM1e wo�k (o� �+'hlch, thi5 pe�m�t is lssuetl, I �
� shall not employ person in any manner so as to become subject to the Drinking Fountains ' Solar Tank � Fan � Motors �P1 HP �1'h- S
WOrke�s' Compensab ldws Of Califomia. �
�Date Si9naWre � Floor Drains ^ Swimming Pool�w/Spa F.A.U. ' '
NOTICE: If, after makin nis tleclaration, you shoula become subject to the Inc. Solar 09-15 HP 016-15+
Workers• Compensation p Jisions of the Labor Cbtle, you must forthwitti FloorSinks Urinal Fixtures
\ comply with 5 cM1 prov1510 or IhiS permit Shall be tleemetl revoketl. � ' MiC�OWdV¢ '
CONSTRUCTIO LENDING AGENCV GaSServiCe ODUeIs WaterCl05et � DeviceBoxeS
I hereby affirm't t tnere Is a mnstruction lentling agency for the pertormance ' � Pole Light
of the work f which Mis permit is IssueC (Section 309] Civ. CJ IntefCeptofs Water Heatet OuLICts �
Lentler's Name � Range . .
Lentler's Atltlress -� Kitchen Sink � _ � Water Service _ Switches _. . - - — - Sign ' • -
OWNERBUIL�ER�O CLARATION � � " '
I hereby aftirm that,l dm exempt from the Contractor'S LlcenSe Law for the L2vdtOlieS AUtO-WdSh � Ga�b2 C Dii OSdI^ �
. following reason (Sectlon 7031.5 Business antl Professional Cotle: Any tltyor _9 P Standing Sections
county which requires a permlt lo construct, altef. Improve, tlemolish or repair P-Trap Laundr Tra s
any structure, prior to its issuance, also requires [he applicant tor such permit Y Y Generetor �0-5 KW 05�15 KW
to iile a signea statement tnat he/she is licensetl pursuanf to the provisions ot i Trash Compactor
th¢ Coniracror'S LicenSe Law (Chaptet 9(commeP�in9 witb Section ]000) ot ROOf DrdinS . .
DiviSiOn 3.of the Buslnesi antl Prate55ion5.Cotle) or that he/she is exempt _ _. . .
[hcrcfrom antl the basis tor Ihe allegetl exempti0�� A�Y ��olation of Section ' -�
7031.5 by any applicapt tOr a pe�m�t subjec[5 tha applicant to a civil '
�e0dlty ot not more than five hundretl dollars (gS�DI• 3
1, a5 owne� ot,the p�oPe�ty or my employCes with wd9e5 as their sole ReinSpBctlO� FEB $15 ISSuO FBB $
comDensation, will tlo tne work, antl ihe structuie ii not intentl¢tl or ofteretl -
for sale (Se<tion 7044, Business antl Professional Cotle: The Contrattor's � MECHANICAL Reinspection Fee $15 laue Fee . � $ 3
License Law tloes not apply to an owner oi a property who builtls or improves FEES �
thmeon, antl who tloes such work himseli/herseli or mrough his or ner own - - , DEVELOPMENTSERVICESR UIREMENTS: �
employees, provitletl that such ImOrovements are not Int¢ntletl or offeretl for BOiI¢f • HOOd O� Typ2I ❑ -. � �w /1�7�/ ��
sale. It, nowever, the builtling or improvement is soltl wlthin one year of mm- Canopy Type 11 ❑ - Zoning Approved By ( c(P � �Date " ��
pletlon, the owne� will have ihe bu�tlen of prOvin9 he/S�e tlItl not builtl or im- �UCI - Und¢� GfOu�d ' ' a� �
_ prove tor tne purpose of sale). ' � Building Approved By — Date
❑ I, as owner ot the properiy, am exclusively contractin9 with Iicensetl con- Duct - Structural Refrigeration System App�ication Issued By - '
t�actors td const�uct the project (Section ]044, BUsiness antl Protessions Cotle: —^ " Dete
The ConVador' �icense Law tloes not apply to an owner o( prooerty who Duct - Ventilating ❑0.100,000 BTU'�700,000 BTU . SUMMARV OF FEES
builtlz or imp�ov tM1ereon, antl who wntracts fo� such projec[5 with a con- . _ .
trattor(s) imense rsuant to the Contractor's Li�ense �sw). 1 am aware t�at � Exhaust System ❑ MWtiple ❑ System Repair/AI[eration ^ BUILDING PERMIT $ SMIP '� $ �•�
proof ot their Wo er's Compensation insuranc¢ shoultl be provl0etl to me. PLAN CHECK $ �2 • � PERMIT
❑ I am exempt untle ection B. & P. 0.�or this reason Firepl/Fact. BIt. ICBO # ' Fire Dampers '� PLUMBING _$ �SSUANCE $
Date owner Heating System & Ducting Registers �� pLqN�CHECK 25% $� ' ENERGV P.C. $�
1 hereby certity ihat I nave read this application antl stato that the above ❑0.100,OOOBTU �100,0008T ' � ' GRADING �$.
information is correct. I agree to comply with all clty antl county ortlinances ' - S 1- " ELECTRICAL � ,,$ ,
antl s[ate laws relating to building construction, antl hereby authorize repre- - � � . . '' - MICROFILM $. � ��
sentatives of t enter upon the,abo�e-mentionetl propert �or � PLAN CHECK 50% $. pp
inspection pu � ' � ' ' ' � MECHA'NICAL $ ' TOTAL FEE �$ aU • 8Z -
Signature Daie l� Reinspection Fee � .'$75 laue Fee . ..$• 3 . PLAN CHECK 25% $ ' �� '�.
Privers• License or 55 � -
-- -—.uebp�vo, �ev. io/nV wm[e - tlu�la�ng; Canary -/♦Pp��can[: nnn - qcwunung; Wo�a9nroo - Hs5¢ssor
CONSTRUCTION AND PLANNING POOL & SPA '
APPROVALS �Permit# Date Inspector AppROVALS Permit# Date Inspector
�
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , t
2. Soil Pipe-Undrgrnd. � � . 53. Steel Reinforcement i,
' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � �
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.�- . 57. APPROVAL TO COVER-GUNITE ;.'
7. Footings � � S�'(z�L (( yj �p,� 58. Electrical Conduit-Undrgmd. �'� -"�
8. Foundation - 59. Gas Pipe, O Undrgrnd., Tesf �•.
9. Water Pipe-Undrgmd. . 60. Backwash Lines, P-Trap, 0 Undrgrnd. ��
10. Structural Floor System ��^ 61. APPROVAL TO DECK '��. � ���
11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal , _ -" '"
. *.
. ��� .
12. Sewer Cap 63. Heater & Vent-Final f�S;_ . � '.v�
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough EleMric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign � ' 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# __
21. Ducts, in Structure . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test � � 72. Underground Flush
24. Roof Framing �� � � 73. Undergrnd.StorageTank OGas ❑Oil "
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 ' 77. FIXED SYSTEM FINAL '
29. Insulation � 78. FIRE PREV. FINAL fi
30. Drywall Nailing HEALTH DEPT. REQUIREMENT .
37. Plaster Brown Coat . 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •
33. Final Electric ' � Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy
i
37: Final Faaory Fireplace � . -
38:�Final Plumbing i - -
39. Water Service-Final , . �''� _ . �
40. Gas Service-Final � �
i.
�41. Solar pomestic-Final � '�
! P.
42. Backflow Preventer `
`4
43. Backflow Irrigation � � _ � "�� � ..
�44. .Landscape Irrigation System � � �� � : `. �, ' �
45. Sound Attenuation ' � . - � �'
46. Handicap Regulations� •� . r�
i ,-
47. FINALSTRUCTURE�&BUILDING � �D _ ' �' . ';y
. 4-
48.���Special Requirements Completed � ' . � � � � . �
49. Electric Release to Edison '�'
. ; ��
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,r
No. -Date � - �' � 'f
i r
JDB ADDRESS Z9ZS naker Street
GENERAL CONTRACTOR AirVent
AP No. 139-262-10 LOT 1
,INSPECTIONS
,soi�
,GAS
,WATER
ROUGH PLIJMBING
PROP. SWR. LINE � HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUNO � POWER �
ROUGH WIRING
TRENCHES FORMS � STEEL REINF.
FLOOR SVSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME ANO FLASHING
LATHING - IN OUT
PLASTER, BqQ�M1'N COAT
STRUCTURAL FINAL
NEqTING, VENT.� REFRIG. qN0 F.C.. FINhL
PIUMBING, FINAL AND GAS TEST n
C
DATE �_
BUILDING PE
SUBCONTRACTOR
l03
2�>�, 1�L'�3�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIp
fOR APPL/CANT TO f/LL /N COMPLETELY
7YAE OR PRINT
BUII.DING 2925 BoKF� 5''T,
ADDRE55
COSTA MESA, CALIFORNIA
OWNER����'�I �N/LST C d '
ADDftESS S i��d C�AJTid
TEL.
GITV � NO.
ARCMITECT LIC.
OR ENGINEER NO.
P
� �«ae.m...� I u°T I O
512E � 3. G3 k98Z �QQ��/ NO.OF BLDOB.
OF LOT � Now oN toT
USE OF
EXISTING BLDG. �y
BETBALN LINH PROM J(" A. S �
e>xicw ov e[iwE¢T rT RFOR YORII
ILEFT O I IRIGHT J 1
DESCRIPTION OF WORK
NEW II /�4TEHATION
REPAIR I ,/�IIMOVING
BUILDING / O /l 7) NO.OF
� L
1 HERE9Y AGRNOWLE�GE THAT I HAVE HEAD THIS APPLICATION
AND 8TAT6 TMhT E ABOV�� ECT ANi�D AGN_EE TO COM�
pLY WITH AL Y HOINANC ST GULATING
BUILOINO C STR ION.
SIGNATUR OF /� /, /� iyy.� �
AUTHORIZED
FE� f�EC�9�l�� �
FINANCE DEPT.
CITY OF COSTp MESA
APPLIGATION FOR 'PBRMIT
�' BCJILDING - - ,. _ �
FOR OFf/CE USE�ON[Y
RECEIPf NO. � P6BNIi_NO.
COSTA MESA, CALIFORNIA
ZONING
ZS] El I PL/�N9 /f I BUEILO MO
�, � �
APPROVED r,'1 �
BY W V DATE
lal
TXE AMOUNT BHOWN UNOER VALUATION IB FOR THE
' PUPP08E OP ESTABLISH�NG A PENMIT FEE ONLY.
VALUATION � A J
5 /�!, PERMIT FEE S y
(//� PLAN CHECK $ � /
T07AL FEE $ 'S 7 �-
Res.
w! . � 34922
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COSTA MESA BUILDING•SAfETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
_�.,-�.".`:'00 174 = :���r:rr8.06
APPLICATION FOR BUILOING PERMIT
For Applicant to Fill in Completely
FECEI_ q�V D�A/TE CE�E�D- DA.TE ISSUE7
BUILDING � "1 r� � RKC� ST • / / / )�'�
ADDRE55 Dl•]
OWNER F4 � A• k A N L� L A.P. No. 3-a �- � o P�M% �7 ��
MAI L BUILDING
ADORESS � �S � AK E IZ �+ODRESS /
CITV C OST M�S TEL. TFACT LOT O� BLOCK
NO.
CONSTRUCTION
LENDER �
BRANCH � i
OWNER �
ADDRESS � VALUE
ARCHITECT TEI.. 5
OFi ENG�NEER
FIRE
ADDRESS 20NE TYPE GROUP
Pt �R-V EN qPPR�VED
CONTRACTOF BV DATE "
ADDRESS' gQq S,I� C ES E 1`
TEL.�j ZONy/J�� NO.OFl�� USE OF N
CITV � E� NO. J'0 66 •� P�� / BUILDING
f
STATE CITV . �'ARDSAPPROVED. YARDSAPPROVED
LIC. NO. '� O� O� LIC. NO. MAIN BUILDIfYG ACCESSORY 8UI4DING
512E � NO.OF BLDGS (FROM C/L STRE T)
OF LOT �� � (� NOW ON l0T I M FT.
VSE OF
E%ISTING BLDG. FT
NEWBLOG�''�, �� ROOMS STORIES ' L SID fT. FT.
EXTERIOR WALL ROOF -
COVERING COVERING � � REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFOFMEO DISTANCE BET. BET. MAIN &
MAIN BLOGS. ACC65. BLDGS.
VAfl.qW DATE
P � V c C.U.P.qy. APPROVED
APP� �_ _
1 hereby acknowlatlBe that I havo raeC Nis application end siete $TATE
Mat the above intormetlon is corrett entl apreo to comply with
all laws reBuletin9 builtling construction, entl I sholl not employ
any person In violation of Ma workman's compensallon lew� of
ffie Stata of Califomie. / m
w
I hereby certify S�at 1 am proparly Iicansetl es e convee[or untler SQ. FT. o
�
tha Stata of Calitornia Businesg entl Profeuion� Gotle, Dlvisicn 3, THE AMOUNT SHOWN VNDER VALUATIO �
Chapter 9, and that such lieeng¢a ara in fult torca antl effect, or 1 THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
em ezempt from the provisiont of the Siate of Cellfornie B�siness ¢
VALUATION �— �
antl Professions CoG Divislon 3, Chapcer 9. Q v PERMIT FEE $ ]
Sipnatura ot � '^ � i— m
Permittae �, C�C./I.IL �/�� $�0� PLAN CHECK $ E
`o
A�thorizetl Apent � LL
TOTAI FEE $