HomeMy WebLinkAbout1985 CHURCH ST - Building Permits t aCITY OF COSTA MESA •
i '"-':x„ BUILDING DIVISION
i '; 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
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J. riqk FOR INSPECTIONS CALL: (714)754-5626 .
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PERMIT NUMBER: BC08-00523
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_RRIP DATE ISSUED: 10/31/2008
. ISSUED BY: BJK
JOB ADDRESS: 1985 CHURCH ST CM Suite/Unit:- -
APN: 42626209 Zoning: -
Vicinity: DUPLEX '.'i: Primary'Occ: R-3
Const Type: V-B SO. FT: 0 Valuation: $2,800.00
SCOPE OF WORK: REMOVE'EXISTING,WOOD STAIRS AND REPLACE WITH NEW STAIRS WHICH ARE STEEL FRAMED WITH
PRECAST CONCRETE STEPS AND STRINGERS.
OWNER: MAMISHIAN,DENISE M,,;:.,;` " • Address: .0.O PREFERRED MGMT ATTN NOEL UTTER Unit: SANTA ANA,CA
Phone: ' '^ City/State/Zip: ,2101 E 4TH ST SUITE 250 8
APPLICANT: JAMES BANKS. '� )) - :,- : Address: 3201 W IMPERIAL HWY -' . . ' Unit: :UNIT 109
Phone: 323-819-7735 . i , ' . City/Stale/zZip: INGLEWOOD,CA
CONTRACTOR: B AND P BUILDERS License No. 659841
Phone: 323-319-7735 ` Address: P 0 BOX 512016Unit: '
Cell: City/State: INGLEWOOD,CA ZipCode 90303
ARCHITECT; License No. . • - PHONE: • .
ENGINEER: COOKE AND ASSOCIATES License No.S1597 _ PHONE:310-608-5408
COMBINATION PERMIT FEE SUMMARY
4 Ali. '. •
Building Plan Check: . $54.11
Building Fees: •
$83.25
Ip Electr cal Fees: $0.00
Mechanical Fees: • $0.00
. •
Plumbing Fees: $0.00 •• .
SMIP Residential: , $0.50 - -
SMIP Commercial: $0.00
•
TOTAL FEES: $137.86 •
"Refer to fee receipts for all fees paid for project . 4 . .•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: 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.
F,QgfI MO M a 121TE MEM 1 COOS/ INSPECI1ON TYPE PAIS . INTIMI
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical •
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Anal Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy •—)
WORKERS'COMPENSATION DECLARATIO• . . . Owner ID verified by do cense. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
•
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the 1
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I ' •
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into Which a
number are: 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
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This seam neednot be compered/rhe perme is valued at one hundred collars($700)or less.) 2 Art 2Sec.341,Title 8,California Administrative Code).
Policy Number: I
❑ As owner-builder, I will not employ anyone to do work which would
.6)12---Certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should '
become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Dale
t Labor Code,I shall forthwith comply with these prow slops. J
3/ cO Division of Industrial Safety Permit Number:
en,_
Appliranrsgnatur� Dale r HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND MIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license
//iss� /(�/�in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No
clic.# CNS —/ Class# ` (Section 25533 of the Califomia Health and Safety Code, with some
- 3//6 exceptions, requires registration with the Costa Mesa Fire Department by
4C ' each business which at any one time has on hand a quantity of acutely
• Contractor's Signature - Date - - s 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No ,
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
• 4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish. or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance.also requires the applicant for such permit to file a signed statement ($eCtion 65850.2 of the California Government Cade requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ,0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No
thereon,and who does such work himself or herself or through his or her own B (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that Linder penally of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ 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 Signature Dale • '
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize-representatives of
Business and Professions Code for this reason: 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. .
Signature of Legal ate
SignatureDateDale il 3/
005746(]/Oil An /or Authenzed Applicant '.-Date
ADDRLSfl4LN : 1985 CHURCH ST Wit CITY OF COSTA MESA — BUILDING PERMIT —
OWNER'S PLUM 1FKNOWN: PENJOYAN RICHARD G TR _PERM NO: B 084341
ADDRESS' 17321 ROB ROY CIR `
HUNTINGTON BEACH,CA 92647 PERMIT NO: B 084342 PLAN CHECK NO: N GOVT: N SUPP: N
1
IL, APPL.MMLDIGADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: OTH
• ARCHITECT ORNetaIEElb LK.No_ JOB DESCRIPTION ; T/OFF RESHAETH & REROOF W/COMP . SHINGLES SQ FT: 2, 900
k'eN.OR EMI ADDRESS: WIT:
CLAIM VALUE: 2, 900 . 00 CALL—VALUE: 2, 900 . 00 GROUP OCC: R-3 /
CONTRACTOR'S RALE
CONTRACTOR'SMNIRC COMMENTS; SMOKE DETECTORS ARE REQUIRED
ADDRESS MHO.: **Stir;t***4********Ae*********,E*****x*******x*;E*****yl**** *******SE*********St******
RLI
OMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby
affirm under penalty of perjury that I amlicensedunderprovisions d Chapter 9 SETBACKS
(commencing with Section]000)dDavison 3 d the Business and Prdtesstions Cade,and my license is in hit force aeffect.
CITY UC.No.: UC.CLASS: LIC.NO.: EXP ; MAIN BUILDING ACCESSORY BUILDING
Date: Contractor FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the Contractors Lome Law for the
'lowing renin(Section 1031.5 Bmkrss and Professions Code:Any ay Of county which requires a pens*to canted.Mer.improve.
nosh.orrepa:enysaadme.°dar to its issuance,also requires the applicant for permit such pee a signed sadism he or she PARKING RE • PROV: PARCEL : 00000000 ZNE: REF NO: c,
licensed pursuant to the provisions d the Contractors License Law(Chapter a(commencing with Selo 7000)d Division 3 d the PLANNING NOTES>
Business and Professions
Code)or the he or she is exempt therefrom and the basis for the alleged exemption.Airy d violation Section > t
7031.5 by any applicant for a permit subjects the applicant to a civil penally of nmore then the hundred dollars($5000. '
asawsgr of propenY or my employees with wages aslhei vole compensation,willb Na wok.and structureisnd Intended ********************************************************************lt**********
I,
or Meredbr sale(Section 7044.Business and ProfesssionsCoda The Contractors License Lew does not apply to an awver of properly DEVELOPMENT SERVICES R E Q U I R E N E N' T S
who builds or improves thereon,end who does such work himseh employees,herself or trough his or her own employe .provided that such .r`„
improvements we no.intended IN offered for sale.If.however.the building or improvement is sold within one year d completion,the
owner-builder will have the burden of govingheorshe did not build orimprove for tnepurpose dsale). ZONING APPROVED . BY DATE:
❑ I,as owner of the properly.am exclusively contradihp with licensed contractors to conatrud the project(Section]D44,Business and
Professions Code:The Contractors license Law does no.appy to an owner of property who beads or improves thereon and wino BUILDING APPROVED BY :
DATE: /2 '
-. tracts for such projects with a c ontrectorle)licensed Pursuant to the Contractors License Lew).
■ • ex. qunderSe an:15- B.AP.C.,bhue APPLICATION ISSUED BY- '� DATE; 21121
the .m,dcdEomawannand Safety cobs.domz5sos,u533.and LEGALIZATION:N F E E S U M M A R Y STRUCTURAL S. GMENT:Y
'1 and the I«any future building occupant will/will not(circle One)need to comply with said state melee and the requirements for
apermt for construction or modification from theAi infer ampement District.Residential mheltWion ap°fatlione areexemg fromtMee BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES" GRADING
provisions. PERMIT 74 . 75 . 50
Date: Appian: SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm wear penalty of perpey ate of the following dederelions: PLAN
ElIhave end via m.i,taoacertificate ofcoreemM;mun
toee 'rWorkers'compensaon.asproidedforbySwion3700etteIshor ISSUE FEE
Code.for theperformance eMwork for whimwspemmiiseued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ Ihaw.andwumaintain workout'camperreaihberra srsopiwdbySection One dteLabor Cole.for thpeforonaadle TOTALS----> 75 . 25 0 . 00 0 . 00 75. 25 75 . 25 . 00
won for which this penes is issued.My workers'compensation insurance irk(and policy number are,
Carrier: REVENUE DIVISION TOTALS--> COLLECTED : 75 . 25 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed r the perm*is for one hundred doll=/5701 or Asn.) 74 . 75 . 50
❑ I Wily that in the perlamencs of the work for which this penrat is issued.I'ha not employ any per on in any manna ee as to
become subject to the workers'compensation laws d California and agree the i I ehadd become subject to the workers'
r w compensation prvmvnd9aditn 3]W dthe labor Code.l Moll forthwith oomph well those Provisions.
*******************************************************************************
'4.Oaie App&art_ INDIVIDUAL F E E BREAKDOWN ,
Warning:Faure to secure wodvee'conpeuafiun coverage Is unbw/u(ey shall subject to d
c an employer ln*niet
Pelfiee and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST '
dell fines w to one hundred thousand dollars(sloo,wel In add/don to the cost of conpetsaders damroaa as Provided for In
Sectionrothe Ime.
3sal .Lorcae.' .cattorney's
.wlen SFR 2900 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 900 . 00
• CONSTRUCTION LENDING AGENCY: I hereby elfirm under pemly of perjury that there is a construction lending agency for the
pedonnance d the work for which this permit is issued(Section 309],Civ.C). END OF FEES
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and state that the above information is correct.l agree to comply with all thy and county ordinances
end stale ion relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly
for inspection purposes.
PEGGY PENJOYAN 88-21-1997/11:22 Afl/$75.25
Pdn •., RCPTR:61-N611156
- ..al Date: Imo\ I�� PERMIT:084342
rSignature e r/ gent/ - : UContrect
(5151-46.WP) White-Buildig A Safely Green-Rle;Canary-Appitcanl;Pink-Revenue;Goldenrod-Assessor
CONSTRUCILON AND PLANNING . i� PM, :SPA
APPROVALS Permit# • Date Insdector % APPROVALS Permit # Date Inspector
• 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location •
+ 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement r
3. Electrical Conduit Utility-Undrgrnd. . 54, Forms
4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding ,
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. .
8. Foundation .. 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. -- • 60, Backwash Lines, P'Trap, 0 Undrgrnd.
10. Structural Floor System 61, APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - .
12, Sewer Cap _ 63. Heater & Vent-Final •
13. Roof Drains , ' 64, Plumbing System -Final
14. Rough Plumbing . 65. Electrical-Final , - .-
. 15. Rough Electrical-Conduit 66. Solar System-Final • •
16. Rough Electric Wiring 67. Fencing& Access Approval . •
17. Rough Wiring Sign , 68. APPROVED FOR PLASTERING. '
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
' 19. Rough Heating &'Air'Conditionirig ' .- - FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush
24, Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 I '- 78, FIRE PREY. FINAL
•
30. Drywall Nailing • HEALTH DEPT. REQUIREMENT'
31. Plaster Brown Coat 79. FINAL INSPECTION •
32. Electrical Power Meter•Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric - Notes: .
34. Final Heating& Air Conditioning •
35, Final Gas Pipe-Test
36. Hood or Canopy .
37. Final Factory Fireplace • ,
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer . .
- 43. Backflow Irrigation 1
44. Landscape Irrigation System .
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING 9-2S-g7 amp
48. FINAL PLANNING y (!J_2' •
49i Electric Release to Edison
50. Gas Release to Southern California Gas Co
' 51: CERTIFICATE OF OCCUPANCY :- •---
No. Date
WNER GRAY JOHN A. DATE 5_11-78
OB ADDRESS 1985 Church Street ��f74 £ BUILDING PERMIT NO. 45627
ENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Duplex w Garage ( 1
AP No. 118-012-12 LOT TRACT FIRE ZONE VALUES 82,000.
SPECTIONS Signature Date TYPE V GROUP I ZONE R-2
DIL 541547 SUBCONTRACTOR PERMITS ISSlED
AS
_ Date Number Signature
WATER t1► 'A Plumbin• •
ROUGH PLUMBING I IS 1114 :A ry
PROP. SW P. LINE • HOUSE CON. . era / , e�7IDICIlib]"Y. _
SPRINKLING SYSTEM ' I
MISCELLANEOUS (�,. ye(,�_� Q/
ROUGH HEATING AND AIR CONDITIONING 1 -- {)'AI'JTi a
TEMPORARY SERVICE OR POLE
UNDERGROUND • POWER U
ROUGH WIRING aralligfaran Heatin. and Vent r •
TRENCHES If. FORMS Pte- '�e� E. r .A 'S Ia1`y 4 Win..
FLOOR SYSTEM .OfrelfrinfT
_IAMMASFAVIIMIMMit . `lI Er '
BOND BEAM • STEEL REINFORCE NI 'E��j�`.1(���s�:a lj
�`-j�� d',
SHEATHING A1"MEWS% ==
FRAME AND FLASHING =rgit13lC�2
LATHING - IN .� K
OUT K✓� pAI`•.
PLASTER, BROWN COAT ���A
STRUCTURAL, FINAL /"') ,�J
HEATING. VENT„ REFRIG. AND A.C., FINAL r�/0 'o (e S4SLA � ��
: r ��� l A1Jtkar
PLUMBING. FINAL AND GAS TEST IIS f/~ -�
ELECTRIC, FINAL _ a
BUILDING. FINAL a OZ.�� - •
-<r
J 27 /d/ d- 20/
•/ COSTA MESA BUILDING-SAFETY DEPARTMENT • 6920
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 131 a 24 T(
APPLICATION���qqqFOR:STRUCTURAL PERMIFF3I 024 TL
For Applicant to Fill in Completely — Use Ink Only REcv ,.• .E I
,. . DATE_ISSUED
BUILDING + /n _ ae
r�ADDRESS • � •
V• •. •. .
OWNER vht GRAY A.P.NO. i 'Vl Z— / _fye�
_
MAILy� • /
ADDRESS • L el •te i J D s�s s•Z
/1�s�//��,,tt�� IIIDCL. ((����t r� TEL. 77 i+rl int.
CITY llfai/1A DCL. I•'I R�NO' &,7J �� �
CONSTRUCTION ri V llI^ I
LENDER
•
BRANCH f /
ADDRESS ''\\yy����yy �f111
/ L
ARCHITECT 'h oppls" eI O15 TOL /I0X:p21 �/ S..w �!i. / Jr, // / -.
OR ENGINEERIMEMIr7 ' ^ �j ,/I
ra
ADDRESS 17�, 7 LA en, F {'. , s
s�
APPROVED
CONTRACTOR (DLIDk)ee ) BY DATE
ADDRESS ZOqp�65.,x, NO.OF USE OF NEOQ>>
TEL. K'� IPLANS BUILDING 1Y
CITY - NO. 2
1-1 STATE CITY YARDS APPROVED YARDS APPR ED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
iy SIZE �/q NO.OF BLDGS. (FROM C/L STREET/
C• OF LOT 5A k � !V NOW ON LOT O -•NT '�I FT. FT.
Q USE OF L�-
4, EXISTING BLDG. ' ; R.SIDE v FT. FT.
C
Separate permits are required forL.SIDE /4 FT. • FT.
Fr
electric,plumbing and heating work. /r•�
IO REAR p/' /FT. FT.
(Ai USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
<1 ' MAIN BLOS. ACCESS. SLOGS.
o
J co/ S71�L ^.TIO N ?)-� VAaC
C.U.P. /K�7Aeb' DATE
APPROVED/044124-i 2
Q
^
7 U] .-0..•J(.J P/.�1A • �Nom/✓ •
APPROV ✓R DATE it—is
V
c4 ; HOLD FOR SPE IAL REQUIREMEN S
0 I hereby acknowledge that I have read this application and state
N
B$ that the above information is correct and agree to comply with m
p+ all laws regulating building construction, end I shall not employ
i
z any paten In violation of the workman's compensation laws of - /f
f
S3Wii the State of California. 13527 Q.FT. 753 44- a 4V
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 re ,
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m {s'nJ
am exempt from th. • •• eons of the State of California Business VALUATION PERMIT FEE $
and Protonic -•de, • Biol.,- ,Chapter 9. Ni
El PLAN CHECK S ^l
' Signature •f O, n
Permittee ..."/" re,Th1 ' $ na 000 TAX $ e 7, 2 IyVsq(•�
`� U
Auth atl Agent TOTAL PAID $ / /
y 171-6-4A7
j COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 0813 - 5/11 /76 251 ,OU TL
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only 7
RECEIVED BY I DATE RECEIVED DATE IS$U O�
BUILDING ,/ ' /✓� !// O(/
ADDRESS / j CI �/ .(/[ r z�/, /Q/�Q/ P
OWNER KA ' . / A.P.NO. ////�� L> /,I
MAIL ADDRIESS /, In/ /r .Ao At
ADDRESS PPP��—
TEL.
CITY NO. TRA LOT BLOCK
CONSTRUCTION NEW 1jR, REPAIR MOVING DFMOLISH
LENDER
BRANCH OWNERm '
ADDRESS VALUE
ARCHITECT TEL. USE $ �'T
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
V!i/1 ` '���/Jio BYPROV ED
CONTRACTOR (E'A BY DATE
ADDRESS ZONE INO.OF USE OF NEW
TEL. PLANS BUILDING
CITY NO.
f" STATE CITY YARDS APPROVED YARDS APPROVED
gLIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
11.1 SIZE INO.OF BLDGS (FROM C/L STREET)
ig. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
,N. EXISTING BLDG. R.SIOF FT— FT.
U)
FSeparate permits are required for L.SIDE FT. FT.
G electric,plumbing and heating work. REAR FT. FT.
1—: USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QMAIN BLOCS. ACCESS.BLDGS.
'
9147 1 VAR.#G.U.P.# DATE
'err
APPROVED
a
APPROVED
}.1 BY r1ATF _ O
.
0
I hereby acknowledge that I have read this application and state
X that the above information Is correct and agree to comply with I4' all laws regulating building construction, end I shall not employZ any person in violation of Ma workman's compensation laws of S the State of California.I hereby certify that I am properly licensed as a contractor under SQ. FT.the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT EE ONLY:am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E5 and Professions Code, Division 3,Chapter 9. PLAN CHECK E 'Signature of Permittee
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TOTAL PAID
Authorized Agent $ tee