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HomeMy WebLinkAbout2481 ELDEN AVE - Building Permits 4 �_ir[I! • ^ CITY OF COSTA MESA y, t �-t� BUILDING DIVISION I- DEVELOPMENT SERVICES DEPARTMENT • PERMIT PERMIT NUMBER/ B98-01867 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2481 ELDEN AV Status: ISSUED Suite: A Applied: 10/15/1998 Vicinity: Issued: 10/15/1998 Parcel Nunmber: 43928125 Zoning: Applicant: ELLIOTT, JAMES Address: Phone: -i r;/ l'' - • Zip: i / Owner WENDLER!HARRY ENIS TR ' / - CC-:' Address 18472 DURFEE CIR - ' . /VILLA PARK,CA ` Zip: 92861 \--:A v„SSA Contractor; ELLIOT/ROOFMAINTENANCE �� / . � . Address: 324 S,EARLHAM.ST . „\ .' 't ) % Phone: „714-997-4938 "'\\ / � ,�, ;/ �/-//ORCA /// Zip'92669 ri License:L1465344 'Arch/Eng ./' .�_ - ' I -. v , 1 , . \ 1\'. ' "�Address\ �! - ��'� _ , � _Phone r<, - \. - to _ Zip: �-� : �i ` ( - License: i' SCOPE OF PERMIT \- . .,(1/0 EXISTING ROOF ON UNITS A,B-E,AND F-G OF-AN EXISTING-MULTI-FAM. RESIDENCE., ' ./ <REROOF WITH CELOTEX.PRESIDENTAL SHAKE(COMP.SHINGLE)."ROOF CERT ATTACHED TO PERMITS. 1/4 a _ . .. - - - -- . - - _ . ;, FEE.SUMMARY /1!. • Plan Check: , $0.00 — r` Calc Valuation: $3,015.00 \ Permit: '$87.25 ..... ` - • J Claim Valuation $3,615:00 +SMIPRes: , " $0.50 1 SMIP Com: $0.00 --, q ^y Other: 'x$0.00 Inspection: $0:00 - %,� / Total: - • $87.75 o �" N.tet. • ' -�i- y/< ', _ , V' //,''„ N'.',..,',.'\\,‘„ .. PLANNING'&ZONING = WORKERS'COMPENSATION DECLARATION: , - I hereby affirm under penalty of perjury one of the following declarations: - ❑ I 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: Cartier: 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 se provision //�/ ,, / p Applicant Signature: �� /�ry9Y �.GC/i- .=> CDate: i �) ¶ / r WARNING:FAILURE TO SECT ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENAL S 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 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.# - Class it ���� i Contractors Signature:/ Date! Ern/ ' 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 the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner 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 owner-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 sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): 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,lalsework,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? 0 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 end 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 greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant 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 California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Ls the subject of this application ep0rmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No (Section 65850.2 of the California Government Cale 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 Nee,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(Duality Management District or other air pollution control district or agency is required for 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 ❑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 and 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signa r Legal Owner(s) Date /Op 510 kcfr And/Or Aetna zed Applicant Date CODE L INSPECTON TYPE PATE 18TmAl$ Cara INSPFCTION TYPE DATE It®AIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final pp 208 Final Plumbing 200 Final Re-Roof j//"G- /A 644/� 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 2446-48 t"Il ,,, r i CITY OF COSTA MESA \....._� '�_�� BUILDING DIVISION 4 1 ' DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER 698-01868 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2481 ELDEN AV Status: ISSUED � ' R Suite: Applied: 10/15/199 Vicinity: 4 FLEX UNITS B,C,D,E Issued: 10/15/1998 Parcel Nunmber: 43928125 Zoning: Applicant: ELLIOTT, JAMES . Address: . ' ' Phone: ' ' ' - - Zip: - • - L . Owner WENDLER; HARRY ENIS TR Address 18472 DURFEE CIRC- i Ate• • /VILLA PAR_K,CA Zip: 92861 A- - . Contract/or':- ELLIOT,ROOF:MAINTENANCE Address: 324 5 EARLHAMST 'v;�., ; ,�' =i -'� Phone: 714-997-4938 - "� Zip 92669 - - ,, License* -465344 Y I 1 -Atch/Eng: - Address: ' - -� • , . �'� , "Phonn e:_ - :" Zip: - • License: V ' .- SCOPE OF PERMIT / ' '.T/0 EXISTING ROOF ON UNITS.A,B-E,AND F-G OF AN EXISTING MULTI=FAM. RESIDENCE. REROOF WITH CELOTEX PiRESIDENTAL SHAKE(COMP.SHINGLE)."ROOF CERT ATTACHED TO PERMITS. • - , ,, FEE-SUMMARY/;—, - Plan Check: i $0.00 - — L / -Calc Valuation: ' $12,057.00 Permit: ,$199.75 / Claim Valuation: $12,057:00 SMIP Res: $1.21 - / , SMIP Com:- '$0.00 .— - —, r N;Other: $0.00 Inspection: , $0.00 A . - ' Total: $200.96 " \ . PLANNING"&ZONING,-: < � SETBACKS " ' i MAIN STRUCTURE Front' 0-0 ' ' Rear . 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0;0 Rear 0-0 Left • 0-0 - ' , Right ''0-0 PARKING Existing: 0 Required: 0 Proposed: 9 , NOTES: 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)754-5626 WORKERS'COMPENSATION DECLARATION: p I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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: Cartier: Policy Number. (This section need not be completed If the penult 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 prow ns. /� ) Applicant Signature: �/p2 (Det/ jO// y /7e WARNING:FAJILURE TO URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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.p. Class'# Contractor's Slgn�t a Q7✓y ig 4 T�4r - Dye /D//7c/9 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). Lender's Name: Lender's 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 the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner 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 owner-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 sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): 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? 0 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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of acutely 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). 3 Does or will the applicant 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 California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ID Yes ❑No (Section 65850.2 of the California Govemment 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 Califomia Health and Safety Code). 7 if a permit from the South Coast Alr Duality Management District or other air pollution control district or agency Is required for 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 and 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. re Of Legal Owner(s) Date i„ , a " - / 11 ,7 And/Or Authorized Applicant Date CODE INSPECTION TYPF • gaTE EMUS CODE. INAPEOTION TYPE DAIS IK®ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final !' 208 Final Plumbing 200 Final Re-Roof i 1 6—9 EP (6/ 'c, 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 Flnal Building/Occupancy 2446-48 ' ` - \—/ CITY OF COSTA MESA mar a�,� BUILDING DIVISION t' - 8 ' DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER 698-01869J (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2481 ELDEN AV Status: ISSUED Suite: �� Applied: 10/15/1998 •B Vicinity: CDE, F.&G OF.2479 481 ELDEN-) Issued: 10/15/1998 Parcel Nunmber: 43928125 Zoning: Applicant: ELLIOTT, JAMES Address: , , Phone: Zip: Owner: WENDLER, HARRY ENIS TR Address 18472 DURFEE CIR , A' ; = Phone: _ - - , ' \`. \ \ / VILLA PARK,CA Zip: 92861 / " ' Contractor? R ELLIOT OOF MAINTENANCE ' Address: 324 S EARLHAM-ST , , yam`. - Phone: , 714-997-4938• �=;' Zip' 92669 Licenser:465344 'Arch/Eng: Address: /" - �. Phone: _ r _ . . Zip: License: SCOPE OF PERMIT / ,T/O EXISTING ROOF ON UNITS A,B-E,AND F-G OF AN EXISTING MULTI-FAM. RESIDENCE. • REROOF WITH CELOTEX PRESIDENTAL SHAKE(COMP.SHINGLE). ROOF CERT ATTACHED TO PERMITS, • FEE SUMMARY , . , Plan Check: $0.00 Calc Valuation: $6,028.00 Permit: $124.75 . ,' ,' Claim Valuation: $6,028.00 SMIP Res: $0.60 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.35 PLANNING&ZONING, . - ' SETBACKS MAIN STRUCTURE Front 0-0 - . Rear 0-0 Left 0.0 Right 0.0 • ACCESSORY Front 0-0: . Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sett-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 onInsurance workers'compensation ice c nae run policy n,m required are: by section 3700 of the Labor Code,for the performance of the work for which this pertnitvs issued. My workers'compensation Insurenco tamer and policy number are: Carrier: Policy Number: (This section need not be completed i/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: //�arer'0j ,g oecc /Date: /��/��(f,� WARNING:FAILURE TO SEW RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EAPLOVER TO CRIMINAL PENAL. ES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. UCENSED 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 lull force and attach.Lis. /Class# Contractors Signature: ,s4m,z� !2 74_0,„,...— ! Date: / 0/15/ // f 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 DMslon 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 the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner 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 owner-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 UCENSED 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 sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.•property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: In 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 Safely Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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? 0 Yes 0 No (Section 25505 of the California Health and Safely 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? 0 Yes 0 No (Section 25533 of the California Health and Safety Cade,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 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). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑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 an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Cale been fully complied with? 0 Yes 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°permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes Ll No (Section 65850.2 of the California Govemment 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? 0 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 for 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 reed this application and 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Sig fur SX Legal Owner(s) Date v y�r,/a— Sig )0,3/1D And/Or Authorized Applicant Date cook F, INSPECTION TYPF Odff ICMLS =DU INSPECTION TYPF OAR gllmAL$ 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final p �,/ 208 Final Plumbing 200 Final Re-Roof G-'i 1 6-H.�1� 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 2440.48 w DEPARTMENT 636 North Broadway L" \_ SANTA ANA, CALIFORNIA r. , i '1 I- .., L'Re 1 G �, L� AllikadtatIMSCEltral FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY E��L� ^RECEIPT NO. PERMIT-NO. BUILDING /"�� 41).C nµ// , i� /) rr `� D -O 3 • -' ADDRESS / g/ '/ ✓ L C/X 7 0 SCHOOL DIST, n Q /TA q/1/_-� OR TOWN ,�/,n ` s /A AI /�/ T�A� RECEIVED BY DATE R,({E�CD. pi- ISSUED CROSSST. /r7 O/)/ 6�/II1 VJST .Ja- ^ L4`/T 1�• 5 /7!/ -.131 nI -y/ S3 OWNER //"/ I�' J"f- N � /C�J`S O A� C ADD ESS ) HO / /lea G ADIDLRESS a��S L-- L'V N J -I/ F.. SCHOOL DIST. CN[. /j/� t� �1 OR TOWN Q. />' � �^�' CITY Co sr-79- ///G j rT NO. ��- NEAREST t, // 4; CROSS ST. p1/ V�[Q,GLti ARCHITECT OR LIC. ZAtjENO. OF I 1-W I GROUP .„. ENGINEER NO. LA PLANS / / d-J ADDRESS ��//1I APPROVEDIy{7A ,14 DATE / A2(/1 l DNTRACTOR JAI II IJ E-� NO. BY U •//^^ � - CORRECTIONS ADDRESS / J •yt DESCRIPTION I LNO. 1i11'f I BLOCK I TRACT �/CO • .( I IATTACH METES a BOUNDS) ., / �/ NO.OF SLOGS. Q :i[i� SIZE OF LOT Fib/ X 3os' I NOW ON LOT - I USE OFNO. OF NO. OF EXISTING BLDG. I FAMILIES I ROOMS > ' SETBACK LINE FROM: r REAR YARD 7-00* 04 CENTER OF STREET SO SIDE YARD C t At DESCRIPTION OF WORK - D (�/// I NEW I • ALTERATION I I ADDITION I O 4 D REPAIR I MOVING I I DEMOLISH I 'I:; r BUILDING .•.. ;:26,% SIZE / 7 V R / STORIES �� 'ate.'^ EXTERIOR WALLS/D/A! 4 •h I ROOF U Li atiL /'b .+c. COVERING A It IC, COVERING WOO Ai(11.0 L •T r L I < OIFNGNEW Rt_' S /De me en �- •. D 11, oe 4 Q F-/ E- D A-P-A C G" ,,.. .'',- APROVALS - FOUNDATION: LOCATION INSPECT•- DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS, I: APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING /ice • //- -$)? .EV AND AG E TOTCOMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. !`- /- I-$ AND ST//!q((� 61}y.,(r REGULATING BUILDING CONSTRUCTION. BRACING. BOLTS `/` � Sl +I/ a IC Oi 11�"� �.f/�J /'///'� /wI LATH. INT. W D r-2..-5 6IGNATURE OF • / , ! .� " ,(/� .� , LATH. EXT. I'Yl ei/� -6 -•sy PERM ITTEF NNN ///��, !� \'�✓�•L•'A PLASTER, INT. UTHORIZED ACT. PLASTER. EXT. _ Ul T(}p�/4 PERMIT FEE 330 `MASONRY REINFORCED I•• �3 PLAN CHECK 93�•(�'S FEE ' OND BEAM [/�}I AL '.J FINAL W 9 3 '(J -S,\ M E3.30459 A � _ A -- I D AUG 20.-53 . _ t . . Z w .. PAID -' • 6 ' I .- - .. � . o 0- o. o . - u e - a . C^ . - . • • • STREET- - -- PLOT PLAN Show location and distances from - property line and between buildings. • - - • . • - I 1 w .• COSTA MESA BUILDING DEPARTMENT j P. J I I /' i/ r `- o - `- �5— ` 1 O. BOX 317 ! 5661 COSTA MESA CALIFORNIA FOR APPLICANT TO FILL IN C.L. OF STREET- I • I BUILDING ADDRESS gr// "+' __....----PROP LINE I Owner @k - � /•j€ fl —'-- -- r — — I2T.F611T. re FT \ `� (�/7 10 FT. FOR 60 FT. STREET���50 FT. STREET I 1 I Mail Address City e .9xWyEa°" Ph. No.': ti 1) 7 . I • Contractor /'o'n`e'✓ Ph. No. Address ® 50F'�IF FRON • '��f ®� '� OF PROP.I City Lic. No. _ State Lic. No. 150 FT„ CITY OF COSTAMESA 1- tai - • w Size of Lot S 94 No. PLA[vitif�:G DEPT. w� _ F SUBJECT TO l LOG. DEPT. REG. e w W \ CO Setbacks: C/L Street 4-0,/ 0 %'EJP CCY /� Ai L. Ia^ -9 _ J IX LL Side Yard - Right /r? /' Left 0 -<+.-c-6-- I to r---- PLAN TECH. 6� O O Type of Fence �tA� r✓a9 tL EY QR PROP. LINEN _0 0 3Ofi-V y x.30 /c O. O' F:1; I hereby acknowledge that I have read t is application and state ci J m that the above is correct and agree to comply with all City Ord- j tilt. 1 inances and State Laws regulating building construction. J f \ \1 10 of Permittee t FSignature T I Agent 37 6 IN. �( FOR OFFICE USE ONLY T. FW 40 z � FT 1 JPermit No. 3 d '' I s 0 60 F ST. Received by Date Received Date Issued Ka. ' t r, I`50 Ft ST. Y i t- t a • 1 i — PROP. LINE t`- - � — _ _ EC I � D VALUATION 7u -- - of 1 9 f1/ Permit Fee $ = • 2 -FIN d° E PsA $ � Plan Check $ C.L. OF STREET` iF COS TOTAL FEE $ MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- - --- - MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS CEM oc CCuS1A ?Aram _______ • .44317 /0/".20 JUL 11 1977 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 � AP For App' n din Completely—Use Ink Only PUCATION[FOR'STR9 , • L ' ' ' IT � RECEIVED BY DATE RECEIVED --DATE ISSUED BUILDING G it ///s/ ADDRESS t -c'* A'n C- 26 t/ A P NO//9 9422 a PERMIT NO. OWNERTL 5 ,c{,�'`a 7 MAIL !�' �J /1 BUILDING r /Q/ / ', i���//�/ ADDRESS, /� �-/�/,t ray,.et' nW/_ 'ADDRESS ' Q CITY�/G/J/J6/e /� eiepo 7 NOTELs«(jl? - TRACT Soo •I•TIj�P BLOCK • CONSTRUCrIOIV! • NEW ADD'ALTER REPAIR MOVING DFMf1I LSH LENDER G/aG 'frcF, 1/ • BRANCH / OWNER s L• 641r� ADDRESS y� / r OARCHITECT R ENGINEERR,`/9- P/�saTOFi= NOLL �'O.S�J VS���/JJ./ �� • LU$ � / /� t FIRE AD DR ESSNZ-$'-/V. N b--'r//QT //jA/4 ?ONE TYPE GROUP Jff APPROVED CONTRACTOR/5-4.6W r�r/�ei/Yc 7- . _J\ BY DATE ADDRESS/A/ F ARY1vd/- fl'-•:/o NO.OF /� // CITY/J'��jt NO PLANS02. BUILDINGS/��G W/�/J� STATE ro�i�A� CITY� ���� YARDS APPROVED YARDS APPROVED /(((///J~' 'f•' LIC. NO./ f7'7'7 LIC. NO. SSOf'V MAIN BUILDING ACCESSORY BUILDING SIZE _ NO.OF BLDGS. (FROM C/L STfl EET)_ / u CY OF LOT I NOW ON LOT FRONT /0 FT. �ier4/jam FT. Q USE OF / N. EXISTING BLDG. �0//96 Zee, .-r`' R.SIDE ‘.6--FT. FT, V) � F Separate permits are Iequired for L.SIDE 37 FT. g71r/..,// ��r FT. C electric,plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& ' < MAIN BLDGS. ACCESS.BLDGS. eCI VAR.# DATE 2 ( MkiS- 6U/rs/ 4A diff Eat C.U.P.# APPROVED .A22HOYEr� p,-- ��y ,r� ��e% a OLD FOIA SUEZ ALT L'QUIREMENTS w 0 I hereby acknowledge that I have read this application and state r. o a that the above Information'is correct and agree to comply with m Cl. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of / //.,s the State of California. 2 CPC FT. 96o • 24'' N r. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m lO Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a ,\ am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ ` and Professions Code, Divisi n ,, .pter :, /J �/ n Signature of ,/ PLAN CHECK $ /571I m /�.- // u.o� Permit-tee `J �� $ / OOO TAX $ 4B U w. Authorized Agent TOTAL PAID $ /44.23 444� PAID `/�///'j SEP 12-77e00 491 0***215.00 • COSTA MESA BUILDING-SS/AFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Complete) — Use Ink Only ��� (�� '�N` RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING ''�j'C!z//K//J/`N•ss�_ ADDRESS , L PERMIT NO. OWNER A.P.NO. /!/�7 MAIL BUILDPERMITNG a�'�� e G---ea,a, ADDRESS TEL. TRACT LOT BLOCK CITY NO. CONSTRUCTION NEW I ADD ALTER I REPAIR MOVING DEMOI ISH LENDER BRANCH ^v^ / / s i i OWNER " l • L+ , - / ADDRESS VA / E ' - ARCHITECT TEL. USE $ OR ENGINEER NO. FIRE ADDRESS y�J// ///�/� ,/�/y/�7-/- , / ZONE TYPE GROUP �J`LrZE tyf{^�'�4!C'!�s'_ _ APPROVED — CDNTRACTO BY DATE ADDRESS ZONE INO.OF USE OF NEW TEL. PLANS BUILDING CITY NO, F�.r STATE CITY YARDS APPROVED YARDS APPROVED C LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING IU SIZE INO.OF BLDGS (FROM C/L STREET) 0. OF LOT NOW ON LOT FRONT FT. FT. Q USE OF „N. EXISTING BLDG. R.SIDF FT. FT. un (-1 Separate permits are required for L.SIDE FT. FT. ,i electric,plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED MAINDISTANCEBLD BET. BET.MAIN& Q� ^•/ /,' �`i MAIN BLDGS. ACCESS.BLOCS. r=. Cl ���ei T�� ��/�r�/ VAR.+ DATE Terre/ APPROVED a - APPROVED P. r_BY DATE ..7 CC Al 0 I hereby acknowledge that I have read this application and state n DL that the above information Is correct and agree to comply with m 0. all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of o the State of California. I hereby certify that I em properly licensed as a contractor under SO. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In lull force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E /�N J rin and Professions Code, Division 3,Chapter 9. / p ��J.(rri PLAN CHECK E cn o Signature of Permittee $ TAX E 2 u U Authorized Agent TOTAL PAID E / nss. Jo/,fe4 3q 1ITv 0T COSTA �,,24 EkkliSA -t 18 J U L 14i971 i. fir 1 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 .tl —/g/ //�� APE LICtATION2FORSLTIWI�CTURAL OCT For Applicant to Fill in Completely —Use Ink Only /U - AT I OD r RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING &COEA/ //ye— /i2o� Z ADDRESS '•T7 �'J nPERM T412. Q OWNER /RI • S ie.,/joie) A.P.NO.//19- 29a2—;••25I V t/ ` A BUILDING ho �K�V�//SOI OZ MAIL DDRESS � �j�� / ADDRESS 1(_A)^-'/�91 c 'ZO/�ZOZ TEL. TRACT- r 0L T BLOCK CITY CONSTRUCTIONNEW ADD ALTER RFPAIR MOVING DLI FMOSH LENDER rA/ - /rima \/' BRANCH ,J(` L OWNER - ' ADDRESS /VA UE ARCHITECT TEL. W $ OR ENGINEER4a/s4 .ESA-To rCiG NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR nFP e••—•/71,77,4 r - BY DATE ADDRESS - c TEL. ZQp( E a� NO.OF USE OF CITY NO. R PLANS BUILDI ��/jy,��_/ F STATE CITY YARDS APPROVED YARDS APPROVED �(/�J'� gLIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING izl SIZE NO.OF BLDGS. (FROM C/L STREET)''77 / o. OF LOT I NOW ON LOT FRONT /0 FT. 711-(frl FT. G USE OFcin r EXISTING BLDG. R.SIOF t_J FT. L FT. un Separate permits are required for • L,SIDE •-57 FT. albYf FT. electric,plumbing and heating work. REAR jd FT. 7/gif7 FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN Si MAIN BLDGS. ACCESS.BLDGS. "1 Sidit/f1J W/rN bA4/46ES c U.P.�k DATE �} APPROVED APPROVEla n f�a '' —RY-- PKT.K- -g� e 1OLD FOR SPECIAfl1Qi) IG>rN I I8 O. I hereby acknowledge that I have read this application end state � 94 that the above Information Is correct and agree to comply with m IY all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of a Q 14 I the State of California. 5-,as.. //fl f7 m 3 I hereby certify that I am properly licensed as a contractor under FT. ''// G�✓ti w 11/4 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m N Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: u Ih am exempt from the provisions of the State o • fornix Business VALUATION PERMIT FEE $ end Professions Cod v I a• . . Q` m �� PLAN CHECK $ ��•QLJ m Signature of • e Sc Permittee a -- - — S /2B/ MO TAX S .I �� LL U Authorized Agent - TOTAL PAID S?p?e 8z_ r 7T5/d SEP 12-77PAIDao 490 v*** e" CRSA 329.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill Completely— Use Ink Only 02 RECEIVED BY GATE RECEIVED DATE ISSUED BUILDING /O/ J ADDRESS ��� Akio -'42 ! R� PERMIT NO. OWNER , .I z. • / " A.P. NO. // / MAIL BUILDING ��! l� 0—,,6/� ADDRESS ADDRESSa ,�/}ynn/'•7rlit/ TEL. TRACT LOT BLOCK CITY NO. CONSTRUCTION NEW I ADD I ALTER I REPAIR MOVING DEMO'ISH LENDER BRANCH ,J / , OWNER e L ADDRESSU - V ARCHITECT TEL. USE $ OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR r_ I ' .,Id4 4/, A,-- - /_,// /a BY DATE ADDRESS ZONE IND.OF USE OF NEW TEL. PLANS BUILDING CITY NO. F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING lil SIZE 'NO.OF BLOCS. (FROM C/L STREET) o.. OF LOT NOW ON LOT FRONT FT. FT. a USE OF .p.. EXISTING BLDG. R.SIDE FT. FT. y (—I Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. 7 REAR FT. FT. 'J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Q< MAIN BLOCS. ACCESS.BIS. ni �/ / VAR.sfb DATE L•�- C.U.P. APPROVED a APPROVED } _RY DATE a W A. I hereby acknowledge that I have read this application and state n X that the above information is correct and agree to comply with m ax all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of m 33W.• the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m 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 VALUATION PERMIT FEE S j4�-o O and Professions Code,Division 3,Chapter 9. n PLAN CHECK E en o Signature of al Permittee S [/�/ TAX E LL f u Authorized Agent TOTAL PAID $ CITY OF COSTA MESA • . 44319 6 JUL 14 1977 , - COSTA MESA BUILDING-SAFETY DEPARTMENT ��.(/ P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 AP CATIOSIFOA S1'RWCTURAL an For Applicant t in Completely— Use Ink Only // � /� RECEIVED BY DATE RECEIVED DATE ISSUED BU LDIN ADIDRESS •• ELetaI C' I/! A GJ n PER I Itl y OWNERAC:-�. Cil//�'j0 A.P.NO// -0 —,-25— OWN BUILDINGDDn �'/ O /en "A/I MAIL - ADORES Q ADDRESS TEL. TRACT 3Q /Jn 1 ' c -off BLOCK CITY NO. CONSTRUCTIONr NEW I ADD ALTER REPAIR (MOVING DFMDI LSH LENDER CA / -- f6-„ Xe BRANCH OWNER i().4�.. 5 h.:iv - / VA E OR ENGINES ARCHITECT As it, Pa1=S,r a�%= NOTE` USE One- Leta $ FIRE U ADDRESS ZONE TYPE GROUP / CoAPPROVED CONTRACTOR/%L01=r r0/t STM LBY DATE ADDRESS . TEL. ZOyY� PLANS NO.OFrai USBUILDIE ONF NEW (��'/ CITY NO. K 7 F^' STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING w SIZE NO.'OF BLDGS. (FROM C/L`STREET L OF LOT NOW ON LOT FRONT V O FT. L�� FT. Q USE OF // us EXISTING BLDG. R.SIDE S FT. 6 FT. CI) • /f 7 Separate permits are required for L.SIDE / 4 FT. ?I b✓YJ FT. - electric,plumbing and heating work. D 1 / Q - REAR /0 FT. 1✓7Nill FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& -= 4 MAIN BLOC'S. ACCESS.BLOCS. e DATE (NE°d/P' WI"V AA 46E VAR. APPROVED v„�. 9 /y RovEo/!�n -- _OATS- J- -0 1 w ROI D FOR SPECIAL REQUI EMENTS 0 I hereby acknowledge that I have read this application and state It, r. 04 that the above information is correct and agree to comply with a e all laws regulating building construction, and I shall not employ >: SI Z any person in violation of the workman's compensation laws of • e xthe State of California. //.�f Q I hereby certify that I am properly licensed as a contractor under ��voo SQ. FT. ice (1�✓� w• t�- the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m '/l Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: b am exempt from the p Oslo o the ace of California Business VALUATION PERMIT FEE $ a and Professions Cod D v n C pter . J. Signature of PLAN CHECK $ MO./0 0 1 Permittee /�'/ $ g� ,co TAX $ 2s 7� U. U till Authorized Agent TOTAL PAID $ /Q QIB2. /I • PAID ` '� • ,t�51�y SEP 12-770.0 489 E.4***154.00 COSTA MESA BUILDING-SAFETYLJDEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely— Use Ink Only R{{,�//rs A /J �/.y RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING—ADDRESS 1ig ' // r //.JL� 7( OWNER I 1/i . /1 ' J��,/�PE//R//M/�I�T�/N O. /,t, A.P. NO. a4/8J Q.�I dt _ ✓s.t �/4-. MAIL BUILDING v J i' ADDRESS ADDRESS TEL. TRACT LOT BLOCK CITY NO. CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMO!LSH LENDER BRANCH �/n OWNER 71 . L • 1 / 4 / ADDRESS ••• III • .7E r---- ARCHITECT TEL. USE $ re OR ENGINEER NO. FIRE ADDRESS - ZONE TYPE GROUP 1 •L APPROVED _ CONTRACTOR / / B'TI `BV DATE ADDRESS TEL. ZONE NO.OF USE OF NEW CITY NO. PLANS BUILDING • — STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING Is SIZE NO.OF BLDGS. (FROM C/L STREET) 0. OF LOT I NOW ON LOT FRONT FT. FT. Q USE OF # EXISTING BLDG. R.SIDE FS. FT. co) Separate permits are required for L.SIDE FT. FT. ai electric,plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& —' 'IC MAIN BLDGS. ACCESS.BLOCS. VAR.+ DATE asC.U.P.# APPROVED > rutte.„ APPROVED )1'1 —ELY DATE .-1 gj sm. pI hereby acknowledge that I have read this application and state n c„ that the above information is correct and agree to comply with m M all laws regulating building construction, and I shall not employ i• Z any person In violation of the workman's compensation laws of o Fit it the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, DIvision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o 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 a VALUATION PERMIT FEE $ �I and Professions Code, Division 3,Chapter-9. , 1 at PLAN CHECK $ az Signature of. /} 0 Permittee $� 2 TAX $ 11. U Authorized Agent TOTAL PAID $ /SSG • 44954PA10 NOV —t-77c„Sa00 017* *****5.50 / COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 AP LI 1 AT ON FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only ; REC r :D = DATE RECEIVED TE SUE BUILDING ( i ADDRESS � L �� � $ 5,4/P� BUILDINGA.P.NO.fiet l 016/�2 E M T NO OWNER MAIL r7/1 �j L /�� '/7 ADDRESS‘_. / Z 3AC 5,4E P P� ADDRESS #t(s/� P /rp `:2 �/ TEL. TRACT 6 /I LOOT II] BLOCK CITY/Me,60 .-T 13sAre9 NO. IFl CONSTRUCTION I/ NEW I ADD I ALTER I REPAIR IMOVI [: own ISH LENDER \//\ BRANCHrI��n • OWNER Q] UE I P l ADDRESS VAL 1 4r 53.3 j ARCHITECT TEL. ,'f $ • OR ENGINEER NO. r FIRE ' ADDRESS ZONE TYPE �ROU.frP- APPROVED CONTRACTOR KM (,4z-1'i e2'&R.jj, BY DATE ADDRESS_!' 1.l a - /� J TEL. ZO 9 4 NO.OF al USE OF N ) CITY tjArdeaF, t0--- NO&`Crl`GO PLANS BUILDING /J F STATEq C L CITY YARDS APPROVED YARDS APPROVED gLIC.NO( (9�]l-.Lg LIC.NO.fay ; (FROMAINM C/BSTRE TG) ACCESSORY BUILDING I.14 SLOGS.NO.OF BLDG L OF LOT NOW ON LOT ` FROM /,� Q USE OF �Q� y EXISTING BLDG. R.SIDE FT. FT. .vA F.' Separate permits are required for L.SIDE Fels ...,C...--...,C...-- A` FT. electric,plumbing and heating work. O_ REAR FT. FT. USE OF BUILDING A'� OBE PERFORMED MBBET. BET.MAIN \--/MAINAIN BLOLO CS. ACCESS.BLOD CS. C.U.P.' DATE C.U.P.qW APPROVED Q }. FIT / t/6/p GATE �r - /� 7E2 4/ /7�11\/e'N W p I hereby acknowledge that I have read this application and state in r. IX that the above Information Is correct and agree to comply with m e all laws regulating building construction, and I shell not employ Z any person in violation of the workman's compensation laws of g the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. rmv the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m 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 VALUATION PERMIT FEE $ ID 0n? 1 and Professions Co e, Division 3,Chapter 9. , �s / 3� m ea Signature of / L (' 4� ` PLAN CHECK LLo Permittee .014-", ! $ TAX $ �•s� IL Author d Agent TOTAL PAID $, 51 S v