HomeMy WebLinkAbout1997 CHURCH ST - Building Permits . . J
CITY OF COSTA MESA
o BUILDING DIVISION
F•-'� ,, �) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us
4 �. FOR INSPECTIONS CALL:(714)754-5626
.
PERMIT NUMBER: BX09-00223
PERMIT TYPE B_MISC STATUS: ISSUED
APN: 42626207 DATE ISSUED: 10/26/2009
Zoning: , ISSUED BY: BJK
JOB ADDRESS: 1997 CHURCH ST CM • Suite/Unit:
•
Vicinity: WALL ABOVE GARAGE Primary Occ: Const Type :??
SQ.FT: 192 Valuation: $900.00
•
SCOPE OF WORK:
REMOVE& REPLACE 192 SF WOOD SIDING ON ONE WALL ABOVE THE GARAGE DUE TO TERMITE DAMAGE.
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
OWNER: CRANE, LA DONNA M TR . Address:: 4038 E MAPLE TREE DR Unit
City/State: ANAHEIM, CA Zip Code: 92807-3412
Phone:
APPLICANT: CRANE, STEPHAN D Address: 4038 E MAPLE TREE DR Unit:
City/State: ANAHEIM, CA Zip Code: 92807-3412
Phone: 949-294-4119
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: Unit:
City/State:
Zip Code: Phone Cell:
ARCHITECT: License No.
Phone
ENGINEER: License No.
Phone •
FEE SUMMARY
Building Plan Check: $0.00
Building Permit: •
$35.70
Electrical Permit: $0.00
SMIP Residential $0.00
SMIP Commercial $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $36.70
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.
CODE I. INSPECTION TYPE DATE INTITIAL4 CODE II INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention _
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy ti/i 7/9 1:2-
el ( 1
r
WORKERS'COMPENSATION DECLARATION: Owner ID verified bydrivers license? Yes ❑No
Expires: /�-'.2/—/44
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.iproperty tax bit or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ 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,of demolition
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed'Ihe permit is valued at one hundred dollars($100)orless.)
2,M 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
❑ I 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 Date
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Date 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 ortthreatened
PENALTIES AND CIVIL 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 is in full force and effect, a registration form for acutely hazardous materials? ❑Yes I❑No
Lic.#• Class# (Section 25533 of the California Health and Safety Code, I 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
Contractors Signature Date 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
❑ 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 ❑ 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? ❑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 (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the I
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? ❑Yes ❑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 25531
Cil4 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 0 No
thereon,and who does such work himself or herself or through his or her own 8. (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 under penalty of perjury the
did not build or improve for purpose of sate.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date I
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
0 I am exempt under sec. the information given is correct. I agree to comply with all state Flaws 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 pu po s. I agree not to occupy or allow occupancy Of any building
authorized b th' permit until I 'nspection.
/0 24 07Signal's('o Ovmerls) Date
�T Signature--^ —Date" 'Ca- \I /ons�e /G—i6 —Or
305]46(3t0]) And/or Authorized Applicant .Date
ser BunaNG: 1997 CHURCH ST WET: CITY OF COSTA MESA - BUILDING PERMIT
�owNERNNEIrwwm: CIANE, ARTHUR A
PERM Ni 8 08518
w� ADDRESS CRANE, LA DONNA M
90338 E MAPLE TREE DR PERMIT NO: B 085188 PLAN CHECK NO: N GOVT: N SUPP: N
ANAHEIM,CA 92607
AWL.MARDCG ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: SYR • PURPOSE: O'TH
ARCHITECT OR ENGINEER UC.NO.: JOB DESCRIPTION : TiOFF & REROOF W/COMP. SHINGLE SQ r' [ : 2, 800
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 2, 800. 00 CALC-VALUE: 2, 800. 00 GROUP OCC: R--3 /
CONTRACTOR'S
CLASSIC 17SROOFING ( 714 ) 476-2674
SKY PARK CI COMMENTS: X
ADDRESS: 11t CA Lig,Ng: b92490 irirwirieiFw xxih iF wi:;<ir iew 3e if it it it iE it it it it iFif ir>f iexiexxxwir irxxiF it itllir,rlir iris it ii iiia ii irnir it itlw it lir itirlie lie ie ie yr ii it
92614 um: N Z O N I N GS ERIEEQHU`I RyE M E NI S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaly of perjury that I am licensed under provisions of Chapter 9
ening with Section 7000)of Division 3 d the Business and Professions Code,and my license is in ion force and effect.
CITY .NO.: 00p558 UC.CLASS: C--39 LIC.NO.: 692490 EXP; 12/97 -••---- MAIN BUILDING ACCESSORY BUILDING --
I al
�/� PANT: F' IN REAR: FT IN F'RNT: FT IN REAR: Fi 1N
Dale: (� I� Contractor: (j�L�S�C �UT�� LEFT: Ff IN RGHT: FT IN LEFT: FT iN RGHT: Fl 1N
OWN BUILDER DECLARAT ON:I hereby affirm under penally of perjury that I am exempt front the Contractors L w for the
I reason(Section7031.5BusiessandPdes5ion5Code:AnycityorcountywhiichrequimapermittocawWd,aaa improve. PARKING REV: PAiiV: PARCEL: 42646207 `LNE.: REF NO:
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 PLANNING NO l ES>-
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the „-
Business end Professions Code)or that he or she is exempt therefrom end the bads for the alleged exemption.My violation of Section .... ...... .... .........._.. ...........
7x31.5 by any applicant fore mit sageda the nand to a civil d not more then five hundred dollars ....... ...................... ........... ........................... ..... .......
permit applicant penally Ij$GGII. xxit iaxxai It icx fit'x ie 9txxxxxx'llxxxxxxx hT'xXYPxxxxxx xx xxxx'hx'xx hxxx xx'h 9lxxxx hxxx xx h'h.N'hY1-x x'hhh ii e:.
❑ I,asowturd the property or myemployees with wages as their sole compensation,will do the work,and theslmcture is not intended D E V 1'.:—L O P M E N T E R V I C E S k E Q U .1 k E M E N `.L--'S
or offered for sale(Section 7044,Business end Professions Code:The Contractors License Law does not apply to an owner of popery
who builds or knproves thereon.and who does such work himself or herself or through his or her own employees,provided that such
improvements ere not intended or offered for sale.If,however.the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE: '
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). _
- _ —._
❑ I,as owner of the prpeM.anexduaiveNcniradingwitttoontractorstoconstrwhobupd(Section 7044,eonandend BUILDING APPROVED BY : DATE: :s./
Professions Code:The Contractorsswitha License Law does 1101 apply to an owner d properly who buitle or improves thereon and who - .e
contracts for such praise's with a contradods)licensed pursuant to the Contractors License Law). .....r. •,. -
D
❑ item exempt under Section: B.AP.c..f01 this reason: APPLICATION ISSUED BY: � �— ATE: •i >rsh .
it ii irxir ii irwir it sFiaxa'ifiixxiF#ie ieisxxxx xxxiax xis irxxxxxxxxxh# x xx- x'h Rxx xiF it ii ie iEl iFxhkh JF xir+i
Data Owner. LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y
I do hereby certify that I am aware of and understand the requirements d Caliomia Heal h and Safely Code Sections 25505,25533,and
25534,and Ma for any future building occupant win/wil not(circle one)need to comply with said state codes and the requkemete b BLDG PHI PLUMBING ELECTRIC MECHANIC FIRE SMI&/RES GRADING
a permit ion mrulrudbnormodifimion from the Ai anageteenl District.Residentimmnmmdion eppkmiosare exempt from these
provisions. PERMIT 74 . 75 90
SMIP/NON--RES
Date: Applicant: PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one or the following dededions: ISSUE FEE
❑ Ihave and will maintain acartes dconsent tosellimure for workers'compensation,asprovided krbyRadial 3700dthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN--CHECK TOTAL PAID DUE
Code,for the performance d the work for which this permit is issued. TOTALS- - > 75 . 25 0. 00 0. 00 i . [5 75 . 25 . 00
u
I have and will this e r workers'eed MY workers'
s'tinsurance.es required inert by Section 3703 of the Labor Code,for the performance of the
', work for whits this panne is issued.MY workers xm inau[eln patder and policy number aro: _ _ - _ ,_ COLLECTED:
__ _ _ ..
Carrier °fir w�dr. Exr1REs REVENUE DIVISION lUTALS--> t,OLii;t."lE0• (5. 25 OVER/SHORT: vu
Policy Number w96c.151693 12/31 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/'iOT GRADING PLAN--CHECK
(This section need not be completed I the puma is for one hundred dollars(3100)or less.) 74 . 75 . 50
❑ I eerily that in the perp m ance of the work for which this permit is issued,I shall not employ and person in and manner so as to
. ..Sf. . . .fWWS..
become 811bjaYtothe workers'compensation Jawed California.and agree H191HIehpUM become subject to the workers' xltxxit 1R 1t 1exxxxx xxx x xxxx xxxx'hxxxxx'h 'Rxxxxxxx xxxxxxlFx One*Rll'Rxxxx9l'xhrt'x xxx'Rx hfex'h
...,p,naatian d Section 37C0 d the Labe code.I with cost with those - INDIVIDUAL F E E B k E A K D O 14 N
Date: 10 Applicant: CC55 C �'ivt�
I TYPE QTY D E S C t( I P T I O N UNIT COST 'TOTAL COST
Warn! .:Figure to secure workers'compensation coverage Is unlawful.and shell conic an employes to arta Wes and
cit res up to one hundred thousand dollars lofog000A In addition to me cost of compxuetlon,damages as for In
don 3706 of the Labor Coda Wheal,and attorney's fess. SFR 2800 REROOF BY VALUE RESIDENTIAL Nl:lZONE 1 . 00 2 , 800.00
- CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of penury that there is a construction lending agency for the END F FEES
performance of the work for which this permit is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and male that the above information is coned.I agree to comply with all city and county ordinances
and state laws relating to building construction and hereby authorize representatives of this dy to enter upon the above-mentioned property
for inspection purposes.
MANNA MARKS 18-13-1997/84:18 DM/f75.25
print N. . - RCPT8:81-8813791
/ 7 L(�` Dae: 1o\t3 `ell PERMIT:985188
Signature o e . . tractor
(5151-a6.WP) White-BuiM, . - :Green-Flo:Canary-Applicant Pink-Revenue:Goldenrod-Assessor
'
CONSTRUCTION AND PLANNING . JOL & SPA
-/► Date,APPROVALS Permit# - Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole - '52. Pool & Equipment Location •.
.
2. Soil Pipe•Undrgrnd. • - 53. Steel Reinforcement •
'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 58. Electrical Condui`t�-Undrgrnd. ,
8: Foundation -• 59. Gas Pipe, 0 UndPgrnd.,Test i
9: Water Pipe-Undrgrnd._ 60. Backwash Lines,P.-Trap, 0 Undrgrnd.
10. ',Su Floor SystemT. -
tr - 61. APPROVAL TO DECK
11. Property Sewer Line.& House'Connection . . : 62: Backwash & ReiCeptor-Final ,
12. Sewer Cap - . . • ' 63. Heater & Vent-Final - -
13. Roof Drains • - 1
-64. Plumbing System - Final,
14. Rough Plumbing1 '65. Electrical-Final .
15. Rough Electrical-Conduit • 66. Solar System-Final
I
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 SY$T.EMS FINAL
- 19. Rough Heating &'Air Conditioning ^ r - FIRE DEPT. REQUIREMENT
_ e
20.'Rough Facto4y F ;enlace S , r _ -I „ r '-) APfia, ..•S� _ Permit# ;
21.1'Ducts, in-Strupture r i _ ^ •-+'� '7 70.-Undergroyncl Hydro
22. Ducts, Ve�ntifjting' ' c' ` s ,-, 'y : -- 71, Product'Pi'pingrOFGas O Oil
23..Gas.Pipe.rRough &Test S r ,:, : -4.. ...4r 72. Undergrdund Huth- t - C
Y
24.1Roof Framing r - - r a - . , .I- 73. Undergri1d.Stgi' e Tank 0 Gas O'Oii
25. Roof Sheathing _ */0-7/4-1.7 4-4 ' 79.-Overhead Hyd '' '
Cr
26. T-bar Ceiling (Structural) &Vloiiocoat a •� ? : 11 '; 75.-Dry Chemical,., �, r "' 7
27. .Frame and Flashin i. r _ r ' - '' yStandpipe-. .ii- '�
9 >a 76. Dr x ✓
28. Lathing& Sitting . _ - - -- 7:7,. FIXED $YST%rcFINPyL-• r
.. : - -- - ,t lr. 7 L
' 29. Insulation _ -, n 78. FIRE PREY. FINAL R ,r
30. Drywall Nailing r Ir! 'HEALTH DEET-REOUIREMENT
- 31. Plaster BiownCoat` i '- r `: { {` r 79. FINAL INSPECTION •, - - _
32. Electrical,Power Meter;Fnal. - s I t1 • 80. FOOD CERTIFICATE rs ED
33. Final Electric, cr, r *i f a + - -.I r a
j Dotes: r r, r.
34. Final Heating;& Air.Conditioning? - t i .' S. - = _ ?
35."Final GasiPipe-Test-t . •- ; a �, r nt r,
36. Hood or Canopy , Y 7 . ' 1 kr t.. `it. . '
., 37.-Final Factory Fireplace --7 71 - " ' c ,.1 "
n _
V t
38. Final Plumbing i: t 'J.. -' 5
39. Water Service:Final- I 11 N .- ^ i. ^ -
40. Gas Service-f=inal . K •; < ^
41. Solar Domestic-Final =- •' - .s '
42. Backflow Preventers . " C -
--43. Backflow Irrigation• - , ,
.
44. Landscape Iriigation System, ra _1 - _ . r '•
"45'. Sound Attenuation - ,t . ' rf
45.Hand'+cap Regulations -, - _
1 d _ -,
47. FINAL STRUCTURE & BUILDING `/ - _
i�n�91 _
48. FINAL PLANNING - =
49., Electric Release to Edison r 4 _ - a'f
i.'.,
5d. Gas Release to Southern California Gas Co c l • ; _ .. - ^ ' ''`
'tali y .
I 5V. CERTIFICATEOF'OCCUPANCY n, r `.3''
No. Date '
•
PAID .
}kSOCT —6-77asa00 314* ***197.70
,4
447/9 , a, 4c.. - 4t
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completelly —Use Ink Only �j / AP I A[7y�ON FOR STRUCTURAL PERMIT
ADDRESS igen
1� o '/twit
gy VNIrti 3 EC I ELi/}fr Dy4T ---/I FEDI DATI2nISSUED�
BUILDING fir - L/Y/. 6 �-/ 6/��Ll Ffy7T
ADDRESS.*;ii-rf, napex er R tv . BUILDING v/i�te/cJ� /�,/Mj�.J,j /�e rt_
MAIL ,s� ADDRESS 4t c-IfLi /�/ot '9 .A�'e
CITY f7eWP f CO*. NOOISCas-r TRACT LOTµ/1 BLOCK4
CONSTRUCTION - I NEW ADD ALTER REPAIR MOVING _ DFMOI ISH
LENDER \/ 11 y »
BRANCH /� WOO '. x01-44-°
OWNER,Iy f]n� ?Mgr •
ADDRESSARCHITECT
�ays // s�_py�/�� f �ssss��������'t `T.�( y�� VALVE/
OR ENGINEERCritn e•$SEI /r{.. l�4NO �ieSy I USE rsr1' Imo//fJ ' N 6 gi_a
�,� �}���qq�
ADDRESS / /7N./IGVYezefl EWO. ZONE lig ta
P. GROUP � �J
��� APPROVED DATE 72 //`-R9
CONTRACTOR BY
ADDRESS
TEL. 2ik NE NO.OF USE OF NEW ssy..��s���...
CITY NO. 1�� ,GP PLAKS BUILDING ys{,, 4i I)/L.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
Lit SIZE NO.OF BLDGS. q.. (FROM C›STREET) /
S OF LOT 147:::) ,( 40'� INOW ON LOT Z/ FRONT %v FT. FT.
Q USE OF
co EXISTING BLDG. R.SIDE 4ys 0 FTC`/.4
FT.
cn
F•1
Separate permits are required for L.SIDE 6 FT. FT.
electric,plumbing and heating work.
ai REAR 1704/ FT. FT.
i.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& •I
Q< MAIN BLOCS. ACCESS.
Q Q ACCESS.BLDGS.I
DATE
Q /s
C pgrRi '1 -7-0111 CURP.#�L-7J�I�Q APPROVED %�Z/77
viakoinb' �ROVE./,er , DATEJ ^7^ 77
a
w
0 I hereby acknowledge that I have read this application and state n
Oe that the above information is correct end agree to comply with m
no all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of 51.
5W the State of California. ' •772A-:. FT. 7/Z7 N
I hereby certify that I am property licensed as a contractor under41414:1�� M
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m 1
Chapter 9, and that such licenses are In full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: NJ N.
am exempt from the provision of the State of California Business a (�I
and Profession e,Div slOi 3, hapter 9. VALUATION PERMIT FEE E N -
Signature QQq��� PLAN CHECK $ /go 5- u.(�
Permittee �/
.4...._____, S/o 3/� TAX $ vM.^ J! a\�1\
AuthorizedeAgent TOTAL PAID $/97. 7 0
4477
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
AP LIGATION FIAlgTRUC' U�RALSPERMIT 293o00CKT0
For Applicant to Fill in Completely —Use Ink Only A -
[/J
IV Y DATE RECEIVED ATE ISS ED
BUILDING ']
ADDRESS Jell �C I- S-� - t� �� I I�?-1
OWNE E I ECID—=`h/ 2A PfPr–rsl A.P.NO. PE T„,I Ot ei
Ati / /
MAIL BUILDING 'IG '��l C n c4
ADDRESS ADDRESS N
TEL.
CITY NO. TRACT I. LOT BLOCK
CONSTRUCTION N _ALTER IRFPAIR MOVING DEMOI ISH
LENDER 1 `' /.p�,,
BRANCH OWNER JMi'Jkk T r rarr-
ADDRESS /x'1.1 .y /r��y� /1�' UE
ARCHITECT TEL. USE r Jt113 1 s--s V I � s
OR ENGINEER NO.
FIRE II ''
ADDRESS 0 ZONE TYPE GROUP I7'
APPROVED
CONTRACTOR (91JUI\..07 BY DATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
CITY NO.EPLANS BUILDING
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLDGS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
4 EXISTING BLDG. R.SIDE FT. FT.
to
E-1
Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.Ci REAR FT. FT.
[W-, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QMAIN SLOGS. ACCESS.'SLOGS.
..d VAR.# DATE
"IIS
C.U.P.# APPROVED
7 APPROVED
>. RY DATE
.a
C4
W
0 I hereby acknowledge that I have read this application and state �
C$ that the above Information Is correct and agree to comply with m
G. all laws regulating building construction, end I shall not employ
Z any person In violation of the workman's compensation laws of
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 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 n e�,,[[
and Professions Code, Division 3,Chapter 9. px�g'f ,n
In
PLAN CHECK $ n
Signature of c�[,\(' C
Permittee $ j�J� TAX S 2
/�/
Authorized Agent TOTAL PAID S /1_9
y