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I CITY OF COSTA MESA
o ' "' BUILDING DIVISION
a'Oani 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
t FOR INSPECTIONS CALL: (714)754.5626
PERMIT NUMBER: B09-00181
PERMIT TYPE B_ROOF2 STATUS: ISSUED -
APN: 43922109 DATE ISSUED: 09/01/2009
ISSUED BY: BJK
JOB ADDRESS: 2636 A ELDEN AV CM Suite/Unit: - A
Vicinity: BLDG A
Squares: 1200 - - - Valuation: $4,473.00
SCOPE OF WORK: REROOF APT BLDG A:T/O 2 LAYERS OF COMP SHINGLES,REPAIR/REPLACE SHTG AS NEEDED,2 LAYERS 15#
FELT,APPLY 30-YEAR CLASS A COMP SHINGLES. PITCH 3:12 1200 SO FT -
• OWNER: ROBINSON,JOSEPH EDWARD TR Address: 315 PIRATE RD Unit:
•
• PHONE: City/State/Zip: NEWPORT BEACH,CA
APPLICANT: MILLER, DAVE Address: 2870 CHIOS RD Unit: :
PHONE: 949-631-1924 City/State/Zip: COSTA MESA.CA
CONTRACTOR: ORANGE COAST ROOFINGLicense No. 434674
Address: 2870 CHIOS RDUnit: , , PHONE: - 949-631-1924 1
City/State/Zip: COSTA MESA,CA 92627 ' . CELL: ,
ARCHITECT: • License No. PHONE:
ENGINEER: License No. _ PHONE:
FEE SUMMARY -
Reroof Plan Check: $0.00
Reroof Permit Fee: $111.25
Reinspection Fee: $0.00 •
Bldg Std Admin Fund $1.00
TOTAL FEES $112.25
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.
CODES. INSPEclioN TYPE DATE INTITIALS CODES INSPECTION TYPE OATF, IN11fALS
1616 Fixed System Final Fire Preventiona 206 Final Mechanical
1266 Pool Spa Final 1208 Final Plumbing
r
200 Final Re-Roof f' 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
1116 SI
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
0 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
performance of the work for which this permit is issued.
c lit_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 wormkers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: rf person is required to descend,will be made in connection with work authorized
Jby this permit,and that no building structure,scaffolding,falsework,o demolition
-Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm
(Tris seabn need nal cemmaereenme pound is valued�C hundredmrs(S100)or less)
2grit Sec 341,Title B.California Administrative Code).
PorlicyNumber: ((7�D1_ US/�1 -0�J mor' o
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify t t in the rformance of the irk for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall I t empl: any person in any ma er so as to become subject such person has a permit to do such work from the division.
tothe workers] laws of Californ'!, and agree that if I should
become subjec,to th.� .rke .' comp'nsafo/.rovisions of Section 3700 of
Applicant's Signature Dale
the Labor Co.', shall rthw'h comp with se provisions.
. Al /^i.�I-0 C7 Division of Industrial Safety Permit Number:
+:
•plint's mature '7 oaten• 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 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 siness and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is i-)fu I force a •effect. j // 2 G a registration form for acutely hazardous materials? ❑Yes 0 No
Licr#-" .4 a A Class# - L_." 3 ` (Section 25533 of the California Health and Safety Code, with some
1 ■ . ?, r`0 4 exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
Pal signer - •. Dare . 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 ❑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 California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 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 ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment 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 )
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 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).
0 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 8 (If yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for control officer
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty 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
❑ 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
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND •UTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have ead this application and state that
0 I am exempt under sec. the information given is correct. I agree t. omply with all state laws and city
ordinances relating to building constructio and authorize representatives of
Business and Professions Code for this reason: the City Cos . Mes. to enter upon e above-described property for
inspectio • •s. I a.ree not . occupy.r allow occupancy of any building
authorizeythis •ermit ntil final nspectio-,
tree QC Ms) //',�Dale
Signature Date ��• W �1 a I- O9
3057-46(3/07) 6
A..i. .horized'Applicanl ..Dale.-
CITY OF COSTA MESA
4r ; BUILDINGr DIVISION
F i I DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER
t, PERMIT 05-01966
'e
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cgOILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2636 ELDEN AV Status: ISSUED
Suite: B Applied: 11/012005
Vicinity: ROOF Issued: 11/012005
Primary Occ: Type of Construction: V-N
Parcel Number: 43922109 Zoning:
Applicant: MILLER, DAVID
Address: 2870 CHIOS RD n,, „�-�
Phone: (949)631-1924 ISSUED BY: 040
COSTA MESA,CA Zip: 92627
Owner: ROBINSON, JOSEPH EDWARD
Address TR
NEWPORT BEACH,CA Phone:
315 PIRATE RD Zip: 92663
•
Contractor ORANGE COAST ROOFING
Address: 2870 CHIOS RD
Phone: (949)631-1924
COSTA MESA,CA
Zip: 92627 License: 434674
Arch : Eng:
Address: Address:
Phone: ' Phone:
•
Zip: License: License:
SCOPE OF PERMIT
I/O EXISTING ROOF AND INSTALL 2 LAYERS OF 15#FELT AND REROOF W/30 YEAR COMP SHINGLES ON HOUSE ONLY, 12 SQUARES,UNIT
B(MFR).REPAIR AND REPLACE SHEATING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 • Calc Valuation: $3,000.00
Permit: $83.25 Claim Valuation: $3,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other $0.00
Inspection:• $0.00
Total: $83.75
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
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: 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
2448-46(6/00)
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 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.
j]�beva and wtl maintain orkers'corn Ilon insurance, required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
y warygs'y6hlpens ion Insuran eon and policy her are: ��—p F�
Carder �(J/gyp Mintier-a )-- —
(RJJJII ''sectlon need not be •late a If the r Is valued at hundred dollars(5100)or less.)
•t�.Lcanity that in the• onne a of th ork r which th permit is Issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation la . :f Calif la,an a r hat if I sh become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
Comply with then p ovislo .. / �+1
Ap nt I nature: Date: ,l / -" O tr
WARNING:FAILURE TO S CURE WORKERS'COMPENSATION VERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLoyER-TOC�f WNAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAt ES AS PROVIDED FOR IN SECTION37013OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DLARATI+N:
•
I hereby affirm that I,arjl.Uc=•s, �Slerpr,r' hapter 9(comm./ ng with Section 7000)of Division 3 of the Business and ok}ssi r Code,end my license is In full
forceVal effp Nor#' -17 ' • / Class C 7
toff/actors S'igneryra / Ivw .—• bate. i_f+o�
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,CMI Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 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 toe 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 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:
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 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 filo 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 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 Califomia 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 ll en RMPP Is prosentty required,has Section 25534 of the Califomia Health end Safety Code been fully complied with? 0 Yes 0 No
.__.. present
_jest of _._ .r._.._.. �.
5 Does or willo the CoasttcAir or QualityiManagement or n building occupant at require for the work which di the soof this�e�pppllestlon aUpBrit for such construction or modification
from the South Air District or from any other air pollution control district or agency? U Yes u No
(Section 65650.2 of the California Government 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 ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_. f_ _ .._ _ ...__ s.._......_.__.._._
7 If a permit than the South Coast s Quality ed by CaliforniaHeat or Sr err po control district3 agency is required loon the work which is the subject of this
application,have all of the disclosures prescnbed by Califole 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 ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given Is
correct. I agr to co ty wit all state laws and city or ances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-desc' prop for I spection purposes.I agr not to occupy or allow occupancy of any building authorized by this permit until final inspection.
I nature Of Legal r(s) Date
gODE I, NISPFCTION TYPE PAIL ltllfALE CODE( INSPECTION TYPE PATE MALS
1616 Fixed System Final Fire Prevention L
206 Final Mechanical
1006 Fool Spe Final 20 Final Plumbing200 Flnel Re-Root 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
CITY OF COSTA MESA
BUILDING DIVISION
) " ,I DEVELOPMENT-SERVICES DEPARTMENT PERMIT MBER
:4 •• PERMIT 5-01967
"+a warm
(714)754-5273 • Fax(714)754-4856 • www.ci-costa-mesa.cBILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2636 ELDEN AV Status: ISSUED
Suite: D Applied: 11/01/2005
Vicinity: ROOF Issued: 11/012005
Primary Occ: Type of Construction: V-N
Parcel Number: 43922109 Zoning:
Applicant: MILLER, DAVID
Address: 2870 CHIOS RD /n,�
- Phone: (949)631-1924 ISSUED BY: �r��
COSTA MESA,CA Zip: 92627, '
Owner: ROBINSON, JOSEPH EDWARD
Address TR
NEWPORT BEACH,CA Phone:
315 PIRATE RD Zip: 92663
Contractor ORANGE COAST ROOFING •
Address: 2870 CHIOS RD -
Phone: (949)631-1924
COSTA MESA,CA
Zip: 92627 - License: 434674 - -
;Arch : Eng: - - - -
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
T/O EXISTING ROOF AND INSTALL 2 LAYERS OF 15#FELT AND REROOF W/30 YEAR COMP SHINGLES ON HOUSE ONLY,12 SQUARES,UNIT
D(MFR).REPAIR AND REPLACE SHEATING AS NEEDED,
FEE SUMMARY " ` •
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $83.25 Claim Valuation: $3,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: • $0.00
• Total: • $83.75 •
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 "
•
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: 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
2446-46(64q)
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 self-Insure for workers'compensation;1s 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 ma• ' • ars'•. pensation lnsu : •',: required by A,. . 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'co •• :Bon Ins arca carder and•% umber are: r
Carder: ( .••••• !^ 13- a `-' __
t . /`_ z Policy Number:
(This section need not be••, •feted I he permit Is =fed at one•r dred dollars($100)or less.)
J certdy.tai in the pe •rman : .f the work for hich this••' it is issued,I shall not employ any person in any manner so as to become subject to the workers'
/�/�mpensation law '' allfom: an. agree th• III shou come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
/ co ____
r comply with these• stens. r
Applicant Signature: 1 A. - G[Date: _ Y f1—/– 5C
pee
WARNING:FAILURE TOS . RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND COLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS CLARAT N:
I lyerah_nand Met.l.8m linen do e IWf�o( spier 9( renting with Section 7000)of Division 3 of`rte Beniryss enQ,Proffe n ode,and my license is In full
forbear effect/<Uc It •� (/f f Claw-Mt' Cr /
Centre'o fgnature: /t �\ i] L ate: —_____y/„.4_ ,24--..
_r
L1 /l i!
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: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 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,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 e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety 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 end 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 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 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication aggermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? fj Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 WIII any part of the facility ticbe constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(if yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
__. _g____ .._ err _
7 If a permit fromn the South Coast Air QualitycedManagement al or dSr air pollution control district3 agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Californiala 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 AUTHORIZA N 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 mply with all state laws and ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-d cribed p rry for inspection purposes. gree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatu Of Leg naris) 1/J Date
I Or ' ed Applicant ---gyp (� —/ ^��(Date
900E a INSPECTION TYPE PATE 18DD9k5 QQPPH INSPECTION TYPE f2All MALI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final r"'zT 208 Final Plumbing
i
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
p ' 4I CITY OF COSTA MESA
4 BUILDING DIVISION
> 'factj„ zDEVELOPMENT SERVICES DEPARTMENT P IT NUMBER
F1 ....�.1”
PERMIT
1111.51111 .-`+Pa.mm 606-00420
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2636 ELDEN AV Status: ISSUED
Suite: E Applied: 03/21/2006
Vicinity: RESIDENCE E ONLY Issued: 03212006
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 43922109 Zoning:
Applicant: MILLER, DAVE t e
/
Address: 2870 CHIOS RD
Phone: 949-631-1924 ISSUED BY: /14
COSTA MESA,CA Zip: 92627
Owner ROBINSON, JOSEPH EDWARD
Address TR
NEWPORT BEACH,CA Phone:
315 PIRATE RD Zip: 92663
Contractor: ORANGE COAST ROOFING
Address: 2870 CHIOS RD
Phone: 949-631-1924
COSTA MESA,CA
Zip: 92627 License: 434674
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF RESIDENCE UNIT E ONLY:TAD EXISTING COMP ROOF,REPAIR/REPLACE SHTG AS NEEDED,2 LAYERS 15#FELT,APPLY"30-YEAR
CLASS A COMP SHINGLES."12 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,311.00
Permit $111.25 Claim Valuation: $4,311.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
- Total: $111.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front ,0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit Shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646(e/ea)
DECLARATIONS'
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Vitthaveand will aint 'n workers' pen lion Insurance,as required by section 3700 of the Labor Code,for the performance of the wo or which this permit is issued.
WWO1j$�$' pen ation Ins Ione car r and policy number are:
(This section no not be omelet If the permit Is valued one hundred dollars(5100)or less.)
❑ I certify that In the orman of th work or which t permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws Califo ,an agr hat If I Cho d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these o sions.
4 signature: Dale. 2I-�
WARNING:FAILURE TO SECUR WORKERS'COMPENSA ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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 ATTORNEYS FEES.
LICENSED CONTRACTORS DEC •RATION:
I hereby affirm that I am I V :•,u y'': pr• -• s of Chapter 9 mmencing with Section 7000)of Division 3 of It�he. usiness Prof s s Cale,and my license is In full
force and effect. _ A ' I CIe9s J
Contr�eoto s Slgnatl7[e� , \ v ,Rate;• 3-) 1-a G
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: 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 driver's license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,I.e.-properly 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 thirly-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 tiled 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 and 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 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 a plication a ermit 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 Code requires that the requested information be furnished on applications for non-residentlal building permits).
8 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 penally of perjury the information given above is correct. I agree to comply with all state laws end city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF C MPUANCE 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 ag e to ply wit all state la s and city orc nances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-descri pro rty for i crection pu .. .s.I agrec not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S!na• re Of L:.al Owners 3 _Date
A ,., •. 1 . :nY- dearer-'
CODE 1 UIBPECTION TYPE !ME INIAD t.$ ;ODE. INSPECTION TYPE geIE !MALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 3:Z 7-6 E.R_ 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
' Costa Mesa Building Department i APPLICATION FOR PERMIT
P. O. Box 317 BUILDING
• e COSTA MESA, CALIFORNIA 3430
FOR OFFICE USE ONLY- ' '
FOR APPLICANT 1.9 / TO LIN Receipt No. Permit No.
Building (� tp �c, �'1 9 7
,� 8-z•2� I
/C�ostayMesa, California Received by (Date Rec.'�d.. ' (1}I �/D to Issued
/�/
Nearest /1 / j)X 7/Ij/�` f'd / ' �� v' �I 1_ i/3 -`1 t�
Cross St. /j�/..C. /Lr--4/ �L� Building .t._ ..�--,, �f IN ‘
Owness i �l��R C+t y I '
Mailer / /�4�n" " �" 4s-�� : ' Costa Mesa,.Cal fbrnia
Address �L ! �✓ Nearest-- --'� .
Tel.- •• _s Cross St. 1 '_ I
City No. ,� � D '26neC� /�I No.of I I Type "; I Group
Architect or Lic. /9 (7 No.of -- v t
Engineer • 3-,q €-,cd No. Approve I. 1,
iA I by ., __ t Date
Address wN City Lic. l _ ' o TIONS -;1
Contractors Ne. .APPROVED I
Address I I
Legal Lot jj�ryry/� CITY OF COSTA MESA
Description I No. 4 Block I Tract.9 PL:.NT:INC DEPT "
I _ SUBJECT TO BLDG. DEPT. REG. t
(Attach Metes and Bounds)1 J ® g, ., I
\/ No of Bldgs /� /� (/
Size of Lot 6 d ^ ads Now on Lot _ t .�JO' DATF / - D
Use of i I No.of I No.of B p_I,AN T:C >r
Existing Bldg. Families Ropm G)
Setback Line from -r_'y/ _ Rear Yard _
Center of Street fro_
'fr iV - —Side Yard'- - V , j
DESCRIPTION OF WORK
•
New I I Alteration I Addition I ;
Repair I I Moving I( I Demolish I
Building y No.of
Size �0'r I- .J ROOmst4 (,/s rSfo ies � ' I
Exterior Wall Roof O•4fr , `—
Covering I Covering APPROVALS r
Use of New e,. �V,\ �-' ' ` ' V t) Foundation Location Inspector Date
Building
Forms,Materials,
/�y,.(y} i�J�� Under-Pinning
•
-,Sa o' YA-3\ .-1.„TsS14-(.4.1,17 s _3., _! FamiFirengBoltsStops,
•
Braeci ,
I hereby acknowledge that I have read.this Application
and state that the above is correct and agree to comply Lath.Int. "
with all City Ordinances and State Laws regulating 11
building construction. Lath.Ext.
Signature of
Permittee oft
/%`�-�'Y�ItL? Plaster,Int
Authorized Agt Plaster,Ext
Valuation Permit Fee $ Ce -- Masonry Reinforced
G(12;--• Plan Check$ Bond Beam
$ V Total �q •••
Fee $ (7i FINAL "1'
rnou fnn In..% O. P_&S -
.
.. 1
•
Mr 1 ,, n
�C)�bo�‘ � :I
a ,i _ _ J
•
•
ri
a` $c 1�. = .1 1 !• 1 i }k
!1'-,c .'o GA nt . , ti .. . 7...\. . \ 1
, '.,ray . \ -
z }>
. .
.
•ti ",i. : - ;,
- • \ .. '
Street -- - ` .
=1 •
PLOT PLAN .
Show location and distances from .,..= w e r'/C-Ceir ct-c-z.c
c.
!on property line and between buildings.
l
- _ S r0 Js-• /.6- r-,07 Ca.;1,L �.
CD
f
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.tit
I .. . .
• ,
u
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N \.:,.
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t•
19221 FE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA.CALIFORNIA MAR 2 9 1963
FINANCE DEPT.
For Applicant to Fill In Completely APPLICOifvttriItffKESA
TYPE .QR PRINT `BUIL ``NG
/IE /�r r/
For OfRfice
pFUOe Only PERMITF
NO.
ADDREISS .'?a��i 6 /�✓G� �/✓
COSTA MESA, CALIFORNIA '
RECEIVED B' OAT]g8 -O . /Z U$/,L / (p
OWNER . a- -e 4/Oahe-tic
NG
MAIL J ////JJ// ADDRESS
ADDRESS 7/J ✓ iv4ye.,,P/'/L`P
ALJ FIRE 1 /
CITY �� ✓♦ N$08.%tC�-'�y� 2 ZONE TYPE leg GROUP
ARCHITECT - TEL. --� APPROVED //'}�
OR ENGINEER NO. BY ( /'. DATE
ING n,
t fra
ADDRESS ONE /I ND.DF^ USE OP;TWA/ �O JJ
� /) �j 1.....„,
PUNK BU I LDI NO Il!`y/
CONTRACTOR mere "!/fie iOl// s
/ // ,,/ y �J DESCRIPTIOLEGAL N Pot �-o�' 39 f R 3`I 6
ADDRESS ./.11-6-‘2 N/v Jp a, /3%/8 /')
CITY C........0•-5.-eta /v�Psq A.P.NO. I f i -U 60 _ v7
STATE ��77 // TEL. �/ .LLQ J //
N3OTE: NO
SOIDE a REAR P.LERHANG SHALL BE LESS THAN
LIC.NO.//J2JO 171 NO. ,t/G�.Y2 O
EAVES
SIZE S^ //]� V //C0"� NOW ON LOT Z ALLOWED (U.B.C:REQUIREMENT)
OF LOT (/� (/ ^ (Ob
YARDS APPROVED YARDS APPROVED
USE OF TJP,J ./Q/s t `tor_�� MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. lC C. J � (FROM C/L REET)
SETBACK LINE FROM /� // -LJ FRONT FT. FT.
CENTER OF STREET � & �V - REAR `�
SIDE YARD I LEFTS'S':O'L I RIGHT �„J /�L/ R.SIDE FT. FT.
DESCRIPTIONESOF WORK L.SIDE 3 FT. FT.
NEW CALTERATION _ ADDITION REAR /9 FT.� FT.
/
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.SLOGS.
BUILDING C.......#1•10.OF VAR.# DATE
SIZE .LT(.0,4, 7ROOMS I STORIES / C.U.P.# APPROVED
EXTERIOR WALLe.// ,�II ROOF APPROVED I, �rI ///�� 3 _ Q-/ /(1
COVERING , Xl/l4/ COVERING /���'� BY W{/// DATE "r {OJ
USE OF BUILDING AN ORK TO BE PERFORMED *e. C,T1"
.7LA//eV It ,Ccnz'b/ ///l/ ' -v / ,(
/
5 .5-4) S Q.FT. / 9 X". sV / a�W�
I tt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE E
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. 0
-
PLY WITH ALL CITY HARMERS AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRU ION G
eitI PERMIT FEE $ .30 wDSIGNATURE OF R
PERMITTEE ^ ✓ _D _
• $ / PLAN CHECK $ /�
O
•
AUTHORIZED/ T Y6'_ °'
alma TOTAL FEE 5
•
19222 •
FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT• p�
P.O.BOX 917 COSTA MESA.CALIFORNIA - MARN2+99 n19�6p3
For Applicant to Fill In Completely APPLICATTII�Oci T 'P[O�RN'ERLIFIPT.
TYPE O PRINT EctiaiRb COSTA MESA
BUILDING / /fi • For Office Use Only
ADDRESS 2436 //./E� ,_re RECEIPT NO. PIRMIT^NO. ,
JCOOSTA MESA. CALIFORNIA I92/2
OWNER -/\'r✓C �C/��'Pnr'� RHcey4 Y DATA RECEIVED_o ,i-TaAsau�
�/7 /, yz-"P`//e BUILDING G H' 9 t0
MAIL //"// ADDRESS
ADDRESS ��/J i
/ /` $.U� 7jZONE TYPE GROUCITY ( . /✓/' NO. � �/�
APPROVED
//�
ARCHITECT TEL. -�• gy / DATE
OR ENGINEER 1--- NO. /
NING
ADDRESS 11
0
...67a2291403"
•
'/ PNLAO.NOP ) ) BUUBEILODPINNG !r
-
CONTRACTOR Ck�e ecA t° LEG /{1 /��1 �] �,'/1 'J(' /
`/ �j LEGAL Ilio .` ^a f 37 I R 30 �7
ADDRESS/�J�61,72. NPL(/0QrY.�14V� DESCRIF119 V' /� Lys.{
CITY / O. CC, ✓/tetra. . a. A.P.NO. jIQ.t --- (-) .1v dNOTE: NO EAVE9.
STATE �iC) O %T/ NO.11//6..6-103 o so-TO SIDE 18 REARWP.L ERHANG SHALL BE LESS THAN
LIC.NO CC7. JX
SIZE 7/7, -��X /i �./ Now ON LOT 2 EAVES'
OF LOT JK/ 4'>(� /7l/NO.OF BLESS. ALLOWED (U.B.C.REQUIREMENT)
USE OF y.,/ ✓r �j YARDS APPROVED YARDS APPROVED
EXISTING aLa.-SW*/f tO✓Qg'"C MAIN BUILDING ACCESSORY BUILDING
O
/p)" (FROM C/LSTREET)
SETBACK LINE FROM 00 r � iyF� FRONT . /A FT. FT. •
CENTER OF STREET I GAR YARQ`Iat
,(r`�� [�^
SIDE YARD I LEFTS 'ge I RIGHT V / R.SIDE Cr. FT.
DESCRIPTION''''
�ESCRIRIPTION OF WORK L.GIDE ,T 1,FT. FT.
NEW ��ALTERATION ADDITION REAR le. --FT. i. FT.
/ DISTANCE BET. BET.MAIN @
REPAIR MOVING /){ MAIN SLOGS. ACCESS.BLOCS.
DEMOLISH
S ZE�ING 7CI� 9/�/ROOMSNO.OF - / STORIES / C.U.P.# APPROVED
EXTERIOR WA ROOF �� "APPROVED /11 '0
^^
COVERING _ d COVERING . C /C BY / DAT- . i
.USE OF BU IDI GAN WORK TO BE PERFORMED '
I/ / SD SQ.FT. Set 'i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE E
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m
BUILDING CONSTRUCTION. / PERMIT FEE $ 0..--. H
SIGNATURE OF i /� m
PERMITTEE e.."..;
�� ///'� ] -$ /5
°451.- L k Cl. �� p
AUTHORIZED AGENT �I�-GC Ur/ ✓ I.
. TOTAL FEE $ 75-'---
19223• FEE RECEIVED
J MAR 2 5 1963
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.Box 917 COSTA MESA,CALIFORNIArr FINANCE DEPT.
For Applicant to Fill In Completely APPLICATIoNYFOR P RMIT MESA
TYPE ORPRINT BUILDING
,.
C For Office Use Only
ADDRESS C(p o E/ltfie/ . rt
RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA 19223
RECEIVEP�BY DA 8CEIVED+� DATE ISSU
OWNER „ ar/C Anis e"r'� /� h� 5-9-403
BUILDING
MAIL
i ADDRESS
MA7/7 / // G1/44.0tt:'
FIRE
�/
/ O. A// Nom• ZONE TYPE ✓ GROUP
CITY C. /I T OU
ARCHITECT _TEL. APPROVED /-/�I DATE / /PI.
OR ENGINEER T:L.. � ( /SWIr ✓ i
NING
ADDRESS _
Zno_.1....___I
NO.OF I BUYS
OP NSW I
��e�/Ke {�>�//� —I{11A PLANS Y/Lot-2g
(//�
CONTRACTO�R/�`_/ '/ )/////`'���J{///��� /�///��/y DESCRIPTION o0 R L..\' \ J g i-V\ 1 1 / t
/`i 67 ./2 4'1 L N'�� DESCR ttt
CITY (2r�T?Q ,-1 SCC ( .q/I rte]
A.P.NO. �1 q - O I/O rU r
CITY l S(
/(�p /-� p l// r �/ NOTE: NO EAV OVERHANG SHALL BE LE 8 THAN
LIC.NCS9 a -6 O/NQ./t '� os O sr TO SIDE a REAR P.L.
EAVES
812E �J62 .9/ V ?- oNOW ON LOTS Z ALLOWEDYARDS APPROVED (U.S.C.YARDS APPROVED
NT)
OF LOT `7 (G'(/O
USEOF ��Ic/ 47 ASS MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. G/� c- �(� ,I
CENTERSETBACOP NE FROM { 6e Z1 REAR YARD / / 1 FRONT(FROM C 0...
� FT. T FT.
CENTER OF STREET ! .[/• 4U'.N! IA
?/"/ .1 R.SIDE ,/ FT. FT.
SIDE YARDI LEFT V l% I RIGHT L�
DESCRIPTION OF WORK L.SIDE 3 t r. FT.
NEW ALTERATION ADDITION REAR �� RT. NQ FT.
' DISTAN[[[CE ET. V' ! BET.MAIN&
REPAIR • MOVING DEMOLISH MAIN SLOGS. ACCESS.BLOCS.
BUILDING 2,37/ ,//NO.OF VAR.JC DATE
SIZE 4% 'r�7 ROOMS ' STORIES/TO / C.U.P.�j APPROVED
EXTERIOR WA ` e 1 COOO&R I NO /S OC/C APPROVED (A4/0
DATE 3 -� ��o
COVERING G
USE OF BUILDING AND WORK TO BE PERFORMD /
dui/i0 -C4- i ,cto,n 11/ dn O , I ; �"
SC.FT. 7 yv QG . S Y/' C%/ N.P
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE S
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.. 0
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. V I^ H
PERMIT FEE $ I
SIGNATURE 01249c?^ ���r /� ep
PERMITTEE C C-V G $ i SO�r" PLAN CHECK $
AUTHORIZED AGENT !�_
0c
TOTAL FEE $ J
19274
FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT MAR 2 9 1963
P.O.BOX 317 COSTA MESA,CALIFORNIA (`�TFIIN(A�FNCEEC�D�EPT.
For Applicant to Fill In Completely APPLICATIccL "FOR I�ERMIT` MESA
TYPE OR PRINT BUILDING
BUILDING p / ^ / p !-L/0 E,/ For Office Use Only
RECEIPT NO. PERMIT NO.
COSTA MESA• CALIFORNIA 3LQ dREC[ Dy/I Fly- �D/
OWNER ��/ �V,e1,5 tr4- C/" - 4" - 'J3
BUILDING
MAIL 7/7 �I//j /l-e`/ C ADDRESS
ADDRESS / / "r//`C/�/[-/ _
/J FIRE II
P
1-2./Vi. 6,0 V4e?cl ZONE TYPE ', GROUPS i'
No /!r/ Y
APPROVED i ,./ ,/
��� BY DATE NING
n I PLAN[ I BUILDING • ^
CONTRACTOR �//5,0e //�//-.e , Jcif�////�/e ,I �y
ADDRESSSS/44e7 �z Ja 670✓G /. ) /SdDERCR IT ON '1V ! of 3Q 14)3'2‘
OITY `(%S&'O APCCC A.P.NO. I CQ -07Q - O L7
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE j/9 7 JNO �'2: 5T 93& SO"TO SIDE @ REAR P.1�
LIC. E !� ,{'/.U6.6-4
/'�Ir/NO or suwa. a
(ot J O
MOT- /(/CX 6.6(�"r No•
w ON EAVESHD (U.B.C.REQUIREMENT/
USE OF 9 y.� YARDS APPROVED YARDS APPROVED I
EXISTING BLDG. /e'PS/dt°f-fG S MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACKF Se PROM J96Pe FGAR YARD/�/ FRONT Cq FT. '^'1a/ PT.
CENTER OP BTR88T j/!J `
SIDE YARD I LEFT L„� (� / I RIGHT L-=/ / R.SIDE crIT. FT.
DDEESSCRIRIPTION OF WORK L.HIDE �1 FT.
W.
NEW _ - ALTERATION _ ADDITION REAR I�FT. FT.
DISTANCE BET. BET.MAIN 8
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDING`' ANO.OF VAR.# DATE
SIZE 2 ,39 ROOMS STORIES / C.U.P.
APPROVED
EXTERIOR WA �vPROVV � /COVERING KLCOI COVERING /(06/C SYATE 3- )--f-63
USE OF BUILDING AND WORK TO BE ERFORMED
wet, ,PPw tcy7
� a '4 .g
S 80.FT. ) 9G �.. �. A1C. 'Cr •
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE [•
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 0
BUILDING CONSTRUCTION,
PERM IT FEE $ 30--
SIGNATURE OF /7/) /
PERMITTEE��� `/� gcae_� PLAN CHECK $ /� C
C $ ✓✓
AUTHORIZE AGENT �-' - V5-
TOTAL FEE $ /�J "'�
r tt [(LUtIYLD
19225 MAR 2 9 1963
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O.BOX 317 COSTA MESA.CALIFORNIA CITY OF COSTA MESA
S
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
^ ^ L ..t1-0
r ' n / For Office Use Only
BUILDINGa NJ ((/
ADDRESS RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA
OWNER A /` //dl./,/��/-7�e RECEIVEkr gE- DAT8p8/163V5D " --r-Ca3
�/� '//� BUILDING /7 7�L
ADDRESS 7/7 / %47` Kerne ADDRESS
/ /� /IO FIRE /
CITY c L•1/✓I• Ifs ZONE TYPE r GROUP
t.7�C�X ' APPROVED
ARCHITECT TE6 BY �` r DATE •/ J_
OR ENGINEER- NO. _ I
KING !/
ADDRESS ZO NO.OF SE xB L Eu�D NE�a/V"
919
CONTRACTOR l/ x/42/1.y�0rt,' �ui��.. �'._ t N5 /�� 6 �`
ADDRESS ��(J Z / Sfe (//�(�iraa DESCRIPTION I/1U IJ1. La t- 3g fi a(' 316
CITY CO 5-Zee? / /C cc {/ A.P.NO. / l"/ roaQ a /
NOSPATE /�^� //•J /7/NO �// �O3 ZOT TO SIDE: NO E @fREA1R PVE H OVERHANG SHALL BE LESS THAN
LIC.N CU' (/U
VES
SIZE a �-- // /-r-IPNO.OP BLOCS. ALLOWED (U.B.C.REQUIREMENT)
OF LOE ��fLJ OD /� CrL� CA NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OFO � •.f MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. /t{�S/L/ C
/ f (FROM C/L SET)
SETBACK LINE FROM L �/ FRONT / FT RT.
CENTER OF STREET //u PL, REAR YARD�'L
SIDE YARDI LEFT . 4' I RIGHT LS-- / R.SIDE 5 FT. Fr.
D/ESJCRIPTION OF WORK L.SIDE
(�3 61-r. Fr.
NEW _ AALTERATION _ ADDITION REAR y3 FTved FT. 4
DISTANCE BET. BET.MAIN&
REPAIR M�JQ�V/INO DEMOLISH MAIN BLOCS. ACCESS.BLDGS.
9REDINGe� rJ7 /ROOMS STORIES / C.U.P.# / /I APPROVED
EXTERIOR
/q�
CXTERIOR WALLL��..��'///��-- ROOF APPROVED I� �{ �// (y�� / { ' r� I
COVERING �GC�CL� COVERING ���C' BY L/1/{/l(� T J
USE OF BU)LDIN AND WORK TO BE PER RMED
,a///ifs eeJ ..r."sif/i/
(5--S SO.FT. , acx•-•44-e . sfv°eel.a
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE f
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. 0
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. PERMIT FEE $ 30 H
SIGNATURE OF ��2�,��6L q
PERMITTEE
$ �06 PLAN CHECK $ AC, .1
0
AUTHORIZED AGENT l +6-_i x
• TOTAL FEE $