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Home My WebLink About1000 OAK ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 1000 OAK ST REAR OF SFD 42247304 Applicant: DANIEL BUHRLEN Address: 7921 STARK AV UNIT 1 Phone: 949-274-3905 HUNTINGTON.BEACH, CA r Zip -192647 t Owner:: HUNT, HAROLD, E.TR' .- - - Address' " 3128 LINCOLN WAY- - ',:v�' Phone: COSTA -MESA, CA Zip: 92626 'Contractor: DAN'PROFESSIONAL ELECTRIC SERVICE .. .. i ,Address: 7921 STARK'AV UNIT 1- -.Phone: 949-274-3905 - HUNTINGTON BEACH, CA / Zip: 92647 License: 840214 Status: ISSUED Applied: 06/07/2005 Issued: 06/07/2005 ISSUED BY: y $0.00 `. � - �'' ' FEE SUMMARY - - ::up to 50 kva/kw _ - 0 :Quantity -.�- " -- Quantity ISSUE FEE $23.50 _ $0.00 Temp Dist System / Lighting $0.00 0 f , Temp service test $0.00 - Busway %100 it $0.00 0: , Res. a/c package $0.00 ,.$0.00,x, Standing Section $0.00 0;' New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 %01,' New Res (3+units) �'�, 1 $0.00 0 h ;' ` Transformers up to 1 kva/kw '$0.00 �o,' _ Pool / Spa , SCOPE OF PERMIT1' UPGRAGE ELECTRICAL SERVICE TO 200 AMPS AND ADD'1 OUTLET TO EXISTING UTILITY ROOM - LOCATED IN REAR OF SFD. Lighting Fixts, $0.00 `. 0 . ,:.E - �'' ' FEE SUMMARY - - ::up to 50 kva/kw _ - 0 :Quantity -.�- " -- Quantity ISSUE FEE $23.50 _ $0.00 Temp Dist System / Lighting $0.00 0 f , Temp service test $0.00 - Busway %100 it $0.00 0: , Res. a/c package $0.00 ,.$0.00,x, Standing Section $0.00 0;' New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 %01,' New Res (3+units) �'�, 1 $0.00 0 h ;' ` Transformers up to 1 kva/kw '$0.00 �o,' _ Pool / Spa , $0.00 ,. 0 -! ...... .:up to 10 kva/kw i fi C $0.00 �0- Lighting Fixts, $0.00 `. 0 . ,:.E �, �; - ::up to 50 kva/kw $0.00 �� 0 Recept Outlet's, _' $1.10 ............up to 1100 kva/kw- . _ $0.00 0. Switches 2 $000 -� ' 0'i - - . ..............over 100 kva 6'7,_ , $0.00 0 Non Res Appl. ,.$0.00,x, 0, Low Voltage Equipment -_$0:00,',; 0 / Res Appl j $0.00 �:1\ 0\ ., .-Low Volt Wiring System / Ckt'i�$0 00 �/ -0 Service to 200a ,,,� $3050 , ,-_1:�,\ .� ,Misc, Conduit �' $0.00-, �;0 - Service to 1000a ' . - - . $0;00- - 0 �z `_Misc. Conductor : c -, -$0.00, 0 ' Service over 1000a $0.00 �" - ` .0 Circus,( gen or ride)` suA , /0 Motors to 1 h '$0.00 , 0-_ .. Circus (mech ride,or lights) $0.00 i, . 0 Motors to 10hp A \< $0.00 - / 0 - Christmas Tree Stand - $0.00 i , - "0 Motors to SOhp x $0.00' 0 Fireworks Stand --so.do - 0 Motors to 100hp $0.00 _ 0 , Other Electrical Fee $0.00 Motors over 100hp $0.00 _ - 0 Communication drops $0.00 0 - - - - Investigation Fee $0.00 Sub panel to 200a $0.00 0 - 'Plan Check Fee $0.00 Pole Light Pkg $0.00 0 _ Reinspection Fee $0.00 Sign Circuits $0.00 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(WOO) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Coda, for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers' compensation insurance, Be required by section 3700 of the Labor Cotle, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: (This section nor mplated it the permit is valued at one hundred dollars ($100) or less.) ity that m4Ce perio ance of the work f hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' ' In nation laws of California, and agre t it I she Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forthwith com 'ih 1 si S. Ap' tSl f_ - ..ate:_ W : FAILURE ECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37080E THE LABOR ODDE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR�Tnto; I hereby affirm that I am loans d u der Chapter cornrua cing with Section 7000) of Division 3 of I4e�Business jrd Professions Code, and my license is in full J022212ug-gitLi8rltl� = Class# rectors S g murp OatF ONSTRUCTION LENDING AGENCY: ❑ 1 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 peals for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a GNI 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. ❑ Yes ❑ 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-bullder, 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 certity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ 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 lime during a repand 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). ...__...._......._._..._.._.._...._........_—_....—._..........................ildi....._._..__...._....................................................................................uis.........._._.................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for ecotely hazardous materials? ❑ Ves ❑ 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 I--]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 apenit 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 01 the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................_........................................._....................................................................................................................................................__........................................__.. ................. ................_............_............__.............._ ..... Y tY P ... 8 Will en Den of the fadli 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). ..... _....... _.......... ........... .._....................................................... ........................................................................... ............ ................................. ...................................................................................................................... _.............................. _........... 7 If a ppeermit from the South Coast Air Quality Management District or other air pollu0on 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? ❑ Yes ❑ No ...._........_........_..................ertiific..._............_.............._.............................................................................n'ti..............er)........................................................................_........................................................................................................ 8 (If W. 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: ,PSFFRlTE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I a e to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Masa to enter upon the "escnb property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signal f Legal Own p� .�Dater t/� � C) onYed App ipifnt,--'� �Date)♦p;;„�iY.� CODE I. INSPECTION TYPE PATE ILLS CODE# INSPECTION TYPE PATE jNTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing a2L 200 Final Re-Roof 210 Final Electrical %. (/%�a�•{,/t, 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demollt on 250 Final Building/Ocoupency, (714) 754.5273 • Fax (714) 754-4856 • www.ci.costa-mesa.9diLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1000 OAK ST Status: ISSUED Suite: Applied: 08/18/2003 Vicinity: ROOF Issued: 08/18/2003 Parcel Number: 42247304 Zoning: Applicant: MICHAEL BURKE -_ ._. ISSUED BY: Address: 1653 SUPERIOR AVE i Phone: (949) 642-7222 COSTA MESA, -CA', /� " Zip: 92627 Owner HUNT HAROLD E TR Address 3128 LINCOLN WAY )�,� is '-Phone ___ ) � � •_ �.�� 1COSTA MESA; CA �_" J Zip 92626 Contrr'actor. ��LEE'ROOFING.OF COSTA MESA /Address:_ 1653 SUPERIOR AVE Phone: (949) 642-7222 COSTA MESA, CA � Zip: 92827, License: 349886 ,� Eng Arch,: ' Address a�. .-�_r„ -... Addiess: Phone:, _ Phone: _ !vZip: License: License: OF -PERMIT �I TEAR OFF EXISTINGIROOF. INSTALL 30# FELT; 30' YEAR:COMPOSITION SHINGLES; -AND REPLACE SHEATHING'AS;NEEDED. 17 SQUARES TEAR \,INCLUDES ATTACHED GARAGE. i `'. FEE SUMMARY \Plan Check: ',,w $0.00 __ " _ -_' _ , Calc Valuation —$3,710.00, Permit:, Claim Valuation:$3,710.00' ,x$97.25 >SMIP Res: $0.50�� 'SMIPCom:�$0.00 \_ VN$0.00 J/ Other. "Inspection. ` $0.00 V �� i Total: ; $9715 PLANNING"&ZONING SETBACKS��; MAIN STRUCTURE"Front '0-0 Rear 0-0'----.. Left 0-0".-' - `� Right 0,0,= Front,. ACCESSORY 0-0 j' Rear 0-0 . _ Left - 0--0 .' Right0- 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 wdrk 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. 2446-48 (6=) DECLARATIONS WORKERS' COMPENSAAON DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is Issued. My workwmpensa�Ion Insuranfy��i, carrier rid polity number are: } Cartier. �Yl�C COh•1>0 anLZ� Policy Number: 61202-0 (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 cerfity that in the performance of the work for which this permit is Issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and a that If I should become subject to the workers' compensation provisions of Section 3700 1 the Labor Code, I shall forthwith compiywiththese r I -Applicant Signature: Date: WARNING: FAILURE TO SECURE ORI R MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100, , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. Lic. N Class p. GLT 2 Contractors Signature: Date: O CONSTRUCTION LENDING ENCY: ❑ 1 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). Lander'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 w herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. It, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification o1 Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby car ity 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, faisework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-bulider, 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 cortify, a Business Plan for emergency response to release or threatened release of a hazardous motorial? ❑ Yes ❑ 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 Leet of compressed gas at standard temperature and pressure). 2Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials?.....❑ Yes............❑ 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 Q o (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 19 Presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..._........._.......__........,-......._........._.........__....__........... _................... _.................. _.......... ............. ____.................. _............... _........... _............ _....... _......... ......... .............. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? u 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). ...._..........._........_.....,._........._..........._.........._.........._.._—____....................................ithi.....__......_..........................................................................._-hool..................-._.............._............_._........._.........._........._..........._..... 8 Will any pan o1 the fecllity to be constructetl under this permit be within 1000 feet from the outer boundaries of a school? ❑Vas ❑ No (If ._. yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...... __......_ .....___.....__......_.......__........._.........._............._..__..__..__............................................................................................._.._....................... ___................ _............. _.............. __.................. __... ....... _............ _.... 7 If a pemi1 from the South Coast Air Quail ry 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 Cade Section 42303 been made? ❑ Yes ❑ No ....................... ..........................................................................................................................................................................................................................................................._......................................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: i certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. - Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is cored. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignetu Legal tTvner(s) ate - 9-4 5FA D And/Or Authorized Applicant Date 516 BATE 18TIDdLS COPE? INSPEOTON TYPE L1fajE pig Fixed System Final Fire Prevention 206 Final Mechanical Pool Spa Final 208 Final Plumbing -. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Relalning Well 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 ORANGE COUNTY BUILDING DEPARTMENT , 636 North Broadway SANTA ANA, CALIFORNIA ene Aero!nAUT rn eut lu APPLICATION FOR PERMIT FOR -OFFICE USE ONLY -___ rV•\ •1••Y•VI1•\• •V • •� ( RECEIPT NO.a NO. ADDRESS 1000 Oak Street 1 ✓PERMIT SCHOOL DIST. OR TOWN Costa Mesa RECEIVED BY, DAT OF ADPL. DATE ISSUED ' V NEAREST Ave* CROSS T. State je/ BUILDING -� 1 OWNER SHAWNEE MOMES1 INC. ADDRESSAl _11 L WILSHIRE BLVD. 1 AMDDRESS 9363 OOR TOWIDIST'-�� CITY BEVERLY HILLS TECR. 4 61 NEAREST j� I I CROSS ST. 1 1 ARCHITECT OR TEL, p ENGINEER GAIN & MCKERRACHER NO. SY 648x1 ZONE (NO. OF T PE //%/ ,PLANS I 77/�,_ GROUP 1 I `Y CJs 2110 E. WALNUT ST. PASADENA ADDRESS r SETBACK LINE CENTER OF ST. TEL. REARWARD - .SIDE YARD 7210' CONTRACTOR NEWPORT VISTA CO NO. CR. S436i ADDRESS 9363WILSHIRE BLVD, BEV.HILLS APPROVED BY • � DATE O / CORRECTIONS', LEGAL I 67 1712_ DESCRIPTION LOT NO. BLOCK (ATTACH METES & BOUNDS) TRACTNO. V OF BLDGS. 65.5 X 110 I 0 SIZE OF LOT NOW ON LOT USE OF I NO. OF I NO. OF EXISTING BLDG. FAMILI Es ROOMS DESCRIPTION OF WORK NEW xx I ALTERATION I I ADDITION I A O REPAIR I I MOVING I DEMOLISH I B Z D NO.OF 0.FT. ROOMS rSIZE 1034 3STORIES f WALL ROOF COMPO COVERING STUCCO COVERING S1i1 uCLE$ USE OF NEW ,�0arport BUILDING RESIDENCE Att/ _ j W.s/!s / vn -1'/ - APPROVALS FOUNDATION: LOCATION INSPECTOR DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS, APPLICATION AND STATE THAT THE ABOVE IS CORRECT R UNDEPINNING AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. BRACING. BOLTS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH. INT. `• J SIGNATURE OF NEWPORT VI A LATH.EXT. PERMITTEE PLASTER.INT. AUTHORIZED AG PLASTER, EXT. Y� $ 4830.00 P. C. S MASONRY REINFORCED ` - FEE / 5 BOND BEAM VALUATION FEE // FINAL