HomeMy WebLinkAbout413 MAGNOLIA ST - Building Permits�
PHOJECT AOOFESS: q S 3 MAGNOL IA ST
G ,OWNEfl'SNAME: RAINES RICHARD D
,�d?< aooxess: 413 MAFiNOLIA ST
`•_� COSTA MESA,CA
RF�HIENGINEEP: �754�69S—OO49
AOONESS:
UNIT:
92627
flEG.NO.:
UNIT:
PEflMIiTEE: GREGG THOMAS ROOFING ( 714 ) 841-2290
aooness: �925 STARK STREET 5
HUNTINGTON BEACH CA 92647
UCENSEO CONTBACTOfl UECLAflpTION: I �ere�y alfirm Ihal I am Iicen5e0 un0er provisions ot ChaO�er 9(commencing wiih Seciion
7000) of DMsion 3 ot �he Business and Pmiessions Code. and my Iicense is in full force antl etlec�.
cirruc.: p42632 STATELIC.:SO4H%S c�ass: C39
oate- /�— � 'g/ Signaiure'. _ T��
WOPNEPS' COMPENSPTION OECLAFATION: I hereby a�ivm �hat I have a cetliN e consen� to sell-insure ar a certilicaie of Worker5'
Compensa�ion.lnsurance, or a cetldie0 coOY �hereof (Sec�ion 3800, Lab. C).
voucvNo.: 1105719-91 E%P.UpTE: SI�OL�9Z
comraxv: STATE FUND
7 Cenified copy is hereby IumiSAetl Q Cerlibe0 coDY is tiled with the ciry Building Division.
Date:. ��' O— 1� ApDlicant: � T�
EREMPTIONFBOMWOBNEH$',COMPENSATIONOECLAPRiION: �Thissectianne no� e[ompleteAi��hepermili5foronehunAre4�$100�ar1e55�.
I cenily Nat in ihe oedormance ol Ine work for which this permit is issuee, I shall nol employ any person in any manner so as to become
subleci lo Ihe Workers' Compensalion Laws ol Calilamia.
- �a�e SignaWre: �
NOTICE: If. aller making this declaraiion, you should become�sub�ecl �o the Workers' Compensation pmvisians o� Ihe La�or '
CodeJyou musilorlhwrth COmply wi�h SUth provision5 or �his permi� shall De Oeemea fevOked.
CONSTflUCTION LENOING AGENCV: I hereby affirm thal ihere is a constructian lentling agency for roe pedormance ol ihe wark for
which �his permit is issuetl (Seciion 3097. Civ C) �
LENDEfl: THIS PERMIT INCLUDES
' ADOXESS: BOTH HOUSE S DET. GARAGE!
OWNEX BUILOEfl OECLAflATION: I hereby allirm ��at I am exemp� �rom �he Contracmrs' State License Law for lhe following reason
(Seclion 7031.5 Business antl Pm�essional Cotle: Any ci�y oi couniy which repuires a permi� to cons�mct, al�er, impmve. demolish, or
repair any s�mcNre. prior to its i55uance, also reQuires Ihe applicant for SucA permit �o �ile a 5igneA�s�a�emenl that he/5Ae is licensetl
pursuam to Ibe pmvisi�ns ol Ihe Comracmrs' State License Law (ChaO�er 9(commencing wi�h Sec�ion 7000) o� Division 3 01 ihe Business
antl Pmlessions Catle) ar Iha� he/she is exempi therelmm an0 Ihe �asis br �he allegetl exemption. Any viola�ion af Section 7031.5 6y
any applican� �or a permi� sublecis ��e applicant la a civil penalty of nat more �han �ive hunOred dollars ($500�.
I, as owner ol Ihe property or my employees wilh wages as �heir sole Compensaiion, wili do Ihe wo�k, and ��e
❑ s�mcWre is nol intenAed or oileretl lar sale (Sectmn 70aa. Business antl Pmiessional Code: The Contracmrs' State License Law
Oaes nol ap01y Io an owner o� a proDerty who builas or impmves tM1ereon, antl who does such work himsel�/herseli or �hmugh
his or her own employees. provide0 �hat Such impmvemenls are noi intended Of o�lere0 lor Sale. I�. however t�e OuilOing or
impmvement is sola within one year of completion. �he owner will Aave ihe burden of O�o�ing he/she Uid not buila or impmve
lor �he purpase of sale). '
1, as owner ol t�e pwperty, am exdusively contracting wi�h licensed coniractors to consimct the pmlact (Section 704a, Business
❑ andPr01e55i0n5COUe: TheConVat�ors'SfaleLicenSeLawdoesnotapPly�oanownerolproDeMH'hobuiltlSorimproveS�hEreOn
antl who coniracis for such pmlecis wiM a conirac�or�s) hcense pursuan� ta t�e ConVac�ors' Sia�e License Law),I am aware
� Ihat proal o� their Warker's Compensation insurance 5�ou10 be O�ovitled to me.
�� I am e.empt under Seclion'. B. 8 P. C.
lor Ihis reason'.
Date- Ownec
I Ao herehy ceni�y Nai I am aware of and unaerstantl Ihe requiremems oI Cali�omia Heal�h anA Safely COAe Sec[ions 25505, 25533, anA
2553a ana �hat I or any iWure building ocapani wilVwill noi �circle one) nee0 to com0ly wi�� saitl s�a�e co0es an0 t�e requiremen�s for a
Oermil �ar cons�mction or modificalion imm Ihe Nir Oualiry Managemenl �isVict. Fe5i0ential cansimclion applications are exempt Imm
ihese pmvlsian5.
�ale: ApPlican��,
I heieby cetlity Iha� I �ave reatl ��is applicatmn antl siate thal Ihe a�ove in�orma�ion is rorrecL I agree �o comply with all ciry antl couniy
ortlinances antl 9ate laws relaling lo builtling consimcl�on an0 hereby au�horize represen�atives of this ci�y Io enier upon Ihe above�menlionetl
n�aPenv im insneaion purpases. /
oate: // -� — �% / Signamre� T� t
ori�er s License or Sociai Secudty a:
t64��q6 W�nte—Builtling; Green—Cotle Enlo¢emen�; Ganary—AppOcanl', Pink—Revenue; Goltlenmtl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05501
PERMIT NO: B 055013 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: AL7'
JOB DESCRIPTION ; T/O EXISTING ROOF/APPLY NEW FIBERGLASS SQ FT: 4,000
CLAIM VALUE: 4,000.00 CALC—VALUE: 4,000.00 GROUP OCC; R-3 /M-1
COMMENTS: SMOKE DETECTOR(S) RE�UZRED IN HOME,
�r��e�r�e*�*�r*�����t*��t***�t��r�r�t***� r�r�+��e�r+t�e+t*�t�t*�t*�t*�r***��r�e�*�r+t�r**�r�r**�r**+tx�*x***�r**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K 5
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT ZN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT II`1
PARKING REQ• PROV; PARCEL: 11733203 ZNE: REF NO:
PLANNING NtSTES> ' '
�
if iE iE if �f iF If M iF k 1E �FiF iE iE iE �f iE it iE iP iE k iE iF aE M iF iF iF iF iF iF�f if if iF if iE iE aE iF K ik iF a! �f iE if iF if �E It i4 if iF 1E if if iF ii if fk iE iF iF �F iF iE,iF it iF 3F �F 3F iF iF iE iF
D E V E_ L O P M E N T S E R V I C E S R E Q U I R E M E•N!rT, 5
ZONING APPROVED HY DATE: :"`'
BUILDING APPROVED BY ; � �l� , _,, �� DATE;;' �
ik iE iE if if iE ik IE IE �EiE �E iF iE iE iF 3f iF iE 1f iF iE ff iE if iF 1PiE if �F if fF if if �F �F 3t IF iF �f �f IF iEl�Tf 1f �Fltif lF�F
LEGALI2ATION;N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 63.00 '
PLAN
ISSUE FEE
if if �f iFiE 1f iF iE 3F fF iF if iF iE if iF �k iE iF 1E iE iF iE iE �E
� STRUCTURAli SEGMENT;Y
FIRE. SMIP/RES GRADING
.�SQ
SMIP/NON—RES
HUILDING—DIV—> PERMIT ISSUE PLAN—CAECK TOTAL � PAID DUE
TOTALS----> 63,50 0.00 0.00 63.50 63.50 ,00
REVENUE DIVISZON TOTALS-->� COLLECTED: 63,50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
63.00 .50
iF 1F if iE if iE iE iE iE ik IF iF ik 3f M 1F M iF if ik %3f i! iF if iE if iF iF iF iF ik iF iFiF iF fE if iF 1f iE iF iF iF iF iE iF iF df IE if 3F if iF 3E ik if iElf if 1F iF iF iF af iE 1f if IE aE iE �E iF iF iF 3{ �f iE iF
I N D I V I D U A L F E E B R E A K D O W N
TYPE
SFR
{jTY
4000
D E S C R I P T I O N
REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
i'.00 a,000,00
C! GOi�:�Gd—OG1(i1867 �'��'i 5,-.s.r:;
�ATE: 11/481�'1 TINE: 1��GG
r � (
CONSTRUCTION AND PLANNING �_ . POO ;PA -
�OVTS Permit� Date Inspector AppROVALS Permir# Date Inspector
1. Temporary Electrical Serviee-or Pole �� � 52. Pool & Equipment Location . �
2. Soil Pipe-Undrgrnd. �c - 0�2 ' 53. Steel Reinforcement �
c•.
r ,
�, �'wE(�ctrical Conduii�lity�tlAdrgrnc}��Y � � " �54. Forms � �
�»4:;EIeCtrisal CondUJt�kJAdrgrnd. � " � - �55. Electrical Bonding - � �
'� �..
� �.�
�5 S(�el R2inforceiaei�{� `"b �' �6. Rough Plumbing & Pressure Test �'
S��EfEctrical UFE�fAiui. ;_7. APPROVAL TO COVER�GUNITE re �
=}=`�oq tin"s ='1 �D °J � ^58. Elec[rical Conduit-Undrgrnd. 2
•-.�: �C C9i :L•fr, (�
``� iEoundation �xn � ' � 9. Gas Pipe, O Undrgrnd., Test , `
�.'
(-1� Water Pipe-Und7l,�,F'rad. � � 60. Backwash L.ines, P-Trap, O Undrqrnd. �c
10. Structural FIoo�System �f w �' �. �1. APPROVAL TO DECK �
11. Pr�sperty Sewer Lin�& Hos�se�Connection r�� v62. Backwash & Receptor�Final %
•o r � .-
12. S`ewer Cap �� n' �� � - �3. Heater & Vent-Final . ,
73. Root Dreins �c j' . 64. Plumbing System - Final
14. Rough Plumbirt§� �' �'� � 65. Electrical-Final .'
�
75. Rough Electri •Conduit � 66. Solar System-Final '
76. Rough Electric'Wiring . � , 67. Fencing & Access Approval
17. Rough Wiring �jgn . 68. APPROVED FOR PLASTERING �
18. Rough Electrica�'�T 8ar Ceiling 69. POOLlSPA-SYSTEMS FINAL
19. flough Heating & Air Conditioning ' "� ''" FIRE DEPT. RE�UIREMENT � -' '
� a;+mi-- :� M r o�
20.t*Ro�h f��.3cto F�place i c:rf� d"i f � D`-� ��i.1PPROV/XrS%,^.�erinit # * `� �*'
rD s+ t'Cr c�+ x 7�.r.f: �:2:, p7�= �-. * c
21:�Du�Is, i�,.Str:ictu� :r t�~r �.S r S v t�*:r ^ 0. luader ... �7 o � �
9(Qq�r� HY.c3*
22. DucYa, Vdnti� in 'r� � CJ:S :R � S Qf* X. i. praduc� ��ing CfL.�s �il
23.�, asrPiPe;�io�h &'�est � `�; x cr --rx y. ;» i C^ Y� t� �
�' �-+ � :T7S x� S �S O!�'k . 2. Undergrotmc� Flµt.t�;,.p •, r., �
24.�Ao� Frami g S'� t�F+ •�� x? �^ .^ y� ry3.=ilndergm�Stora '- ank �Gas ❑ C3i1
25. RoCf SFt�thing l� y n' X M .7 J N:i.:t C� �Fo a.
r !*f * �C v � :F �� ? p;x a 4; erhead }�iYdro� *
26?T�&a� Ceiling (StaDczural) &.�Renecoat ?' J � C7 [~q•x Y, 75� ry Chemical '7 ��-+ V .X
�' m
27.�Frat*�e a�d F�ash� ma� x_, � �* 76�Q^iY Stan��e �` ' S n� o
� m* - c ca *.
� . LL, � � . �-.: _:., . . . "
t-28. lai�in9� Sidin9:�� r� ^�y;C t� x£ ..� ..ri. x 77HFIXED 9�&TEIVG�NAL?� � t*'
�29. Insulati�'h c �* 'r' � •• �' � W,. `� ( {- � 7g�FIRE PREV. FIf}i� R � �� y
n30. Drywall.'OIaiYC�q �� �� �K ':• s Y: r HEALT.H�9EPT.;.F,i�EQL�l7R�P/IENT
r .� .�
y
,�31. Plaster �2owraCoi�# S i!r'[r � l � , t�; 9"FINAL Ifd`�`P-ECTI�TI K� a�
;-32t.�ElectricalPower� eae7JFinali� r *ti �k:K �$O.�rF00DC FiTIFI�EISSUEDr �
! ..
533.�in�j El�tri'c� .��i* b? � � M'n ,i�j._ �. r 'No�s: � `�� � ,_ „ �
... :L' [n
�y34� Fin�,l H�e,�ating:& �rnCo'nditi�'�gg-,, �� �r/ �. F iz � ;�;c -n S CO
r w
i35:,�`Fina1 G�}, Pi�-Te�§k.. ns� "� *� I � y '' �V [aS x. rr 50
v!-� y Fln
�36. Ho�il oy�CanoPYp� ,7 i tT"" -, _. n � ij � c:, s:. ^,o �� .rt � �t,r
� y
'�7.�Fin`dl F��ory Fi��al� � si•:. :� ? [n 1 ' ;!;` . 3: C: M ^ny
?: � FH w .4' i '!. !Y3' :_: :ti N
�-38. Finpj Plumbing .r ,J i �� � � : z �-+ � ¢+ p
C39. Watfi S'ovicej inaly, � i 4' Y I 'j -* n �etzf x x ^ .
: q i � 7. �
iAO. Gas Ser�e- nal '* i � '� "' � ' � ' "
�� .� � v: � �[rt*' S s t�7 . x Ow r�N x.
rA1. Solar po�,✓MesttcFinalS ^: , * U ' � ,. '� `t.'-' ^r-1 .t
:« v^ ,o � •fi x �
' 42.`�ackflo�Preventer* � t'' � a f �, �. � � :�
W N � W� tr. ? F • Y V 1�
43. Backflow Ir �atiorrrt- `� =5 � "� * ' ��"d '" � '^
, � »: t�� :K :r. -.� � .
v �, x: :e x � a,� �,
��A4. Landsc4ee lyigatio� Systerr�m,� tX n: [n 'J � �:x * �J N :z:� x� nJ o
�45.CSound ActerlLaciork ���- i^ �� s. H '� �:Y �. '� •= �-: sw ��t � � .
m '_' i. in [it fn C' S "_ • :`O ::
.. ..
t.. l C s ir, . � i � r,.�� ••�-.
546FNandicap, ROgylatic�is �.,� C, y :y » �r .� ^;� S k
47,�FIfttAL STR�CTURE & BUl1DING � '` � •'�� = � »
� . � � f. '/��'� � � . i L" :} �-� .
48.�-�� IKAL PI_AI�ININ� I rr�r. � [� .. u . ' .. y
.� .� i i-� i' .+ :t3 � ��{�. 7: �7 b7 S, * E d.
:.49:Jfleo4ric Release to �Edison �� � v f w£. � � - i x- •� c
S' w �{ �%-R.i n <f •�: :i� O
I '� :t � t� 1. 'Y. v O ' :i �.
v`50:�Ga5yRel�selo Sout�hem Calijy[nia Gas Co ;� � (, y_ �� r. o;;� ,. �� ,
51. CEfi",fiFICATE OF:OCCUPA(VCV r. � x ;; �.y� ;� : �- ;j
No. Date
M�IN OF�ICE
1835 N'EST GPYLU�O ST.. — p.0. BO% 9095
LONG BEFCH 10, C4lIFOftNIT
HEMLOCK 5->493
SPHUCE 5�2081
T�erinsn�
� �
'
Txaminatiou No.
Projcct
Sam}�le from
Architect
Contractor
iA1ix
\V'ater, gal./sk. cement
Sizc
��.1[C CBSL
llate testect
a , ' L
BNANCH OFFICE
ISId.D NORTH H/�RPER ST.
$ANT.� RNR. CALIFORNIA
JEFFEFSON 1�20a�
JEFFER90N I-3098
April 27, 1961
G[3NITE
REPORT OF TEST CYLI1'DER
SC61-2572
Cyli�ider �'o.
CO�IPR]:SSION T1ZST
To[al load to destruction, Il;s.
Pounds pec squ2re inch
Cylinder n�adi; by
Cylinder delivered by
C}'lirider received on
cc: Miller Residence
Coral Pools
Costa Dtesa Bldg. Dept.
SA Lab
E. ?9ILLP,R RESIDENCE
413 E. P9agnolia, Costa r•lesa, Calif.
Gunite Swim Pool
Coral Pools - 2342 9. Main, Santa gna
64 x 12-3/8
3-30-61
4-6-61
1
7 Days
62,000
2,ozo
4-27-61
2
28 Days
89,000
2,900
Van Roy - Gunite Crew
Van Roy
3-31-61
znla, �nc.
� lG �°
���� �
.��'.-: � nA � �
.�� �/��"''
wLL REPORTS ARE Sll9MRTEO h5 THE CONF�OENTIAL PpOPERTY OF CLIENTS, ApTHOflIZqT10N FOR PUBLICATION OF OUR REPOflTS, CONCLIl810N3. Oq E%�
TftACTS FFlOM OR REGAR�INc TMEM IS liESERVEO PEI:OING OUR WR�TTEN SPPFOVAL n5 h MUTUAL PROTECTIOX i0 CIIENTB. THE PUBLIC ANO OURSELVES.
i
' OWNER Miller, �Sl.'18
� JOBADDRE83 �3 Ma�f1�
GENERALCONTRACTOR
�o�+PJi 117-332-3
GROUP J
iNSPECTIONS
Footino TrenCh
roundation Forms and Grade to
Rough Framing %Lu%
Plumbing, Rough to SIa6
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough 'L
Heating, Rough
Heating, Final
Sewer
Septic Tank or Cesspool
Lathing t� �'R� °JC i•7 a y
Plastering
Plumbing, Final, Fixtures Compl
Plumbing, Final GasTest
Wiring, Final
Occupancy
Fotm L10 G-H 1M 12-68 '
BLOCK
�
V �•—�: ZONE R�L
DQ�E I SUBCONTRACTOR
�
BUILDING PERMIT NO. 273
VALUE $ 3,000�00
Residence addition
FIRE DISTRICT �83
I PERMITSISSUED
DATE I NUMBE
Costa Aiesa Building Department �� APPLICAA,TION FOR PERMIT
� 111 EAST 20th STREET _B_V_I. �.D.,I�.�..G�.. .._�._�t
r'� COSTA MESA� CALIFORNIA . - --
� FOR OFFICE US� ONLY ' ._; �
FQR?iI'PLICAN'�' TO FILL IN � ; Receipt No PermiU o. j
9 � � �
_wdaress �( -3 1 a ►�_olt d� ; � - � � � � °1 �; : '
Received�:by Date Rec'd. Date Isaued j
Costa 1VIesa, C ifornia ; ; � / ;
Nearest � � v _ /' �
Cross St {% V Building ;
Add�ess � � — N � � O L ! ,(J - �
Owner � egJJS��/e�. � CostaMesa, California ' �
Mai� ' � � '
Address �{' 3 [I� a 4 n oI� i Nea'res! ' 1
Tel. Cross St. ' , � '
City �OS �� �h QS d No. � � g �/ J]S Zony,� . � I No. of I Type ./ i Grpu �+
Arohitector Lic. 7� Plans V
Engineer ' No. Approv d � !
' b ' Date :
dress 4 � COIIZRECTIONS 1 i
City Lic. p
ontractor �Fi . SQ�[g�a No. �� i � i 1
/ �
Address ,�� f -ST. _san e.d � �
Legal Lot � .._ -� j
Des tion I No. �,3 � B�ock I Tract i T ,— •
( I
(At�"etesandBounds) Il�j- 332 -� 3 ,_ j � �
` i i
ti Y � No. of Bldgs. � � � i
Size oT Lot � 7%( � 251 Now on Lot ( �--- -- -- -� p
Use of Q �� No. of No. of � ' 70
Existing Bldg. {�t5- I F.3milies � I Rooms S — �
Setback Line from ,�� Rear Vard ----"'��-�"�✓ � -"' �� Z
Center of Street Side Yard ' � � y
DESCIZIPTIONO&'WORK '""'' "��� '``' �
New I I Alteration I � I Addition !~ �"�.. �.•: ......�V• ......
I
I .�y�n.�...w. .., ' Fy:� :: i:...-.- .
Repair I I Moving I I Demolish �
'= Buflding No.of
' e �� �� � Rooms S Stories I —
erior Wall Roof '
vering �j�VQ(,'O I Covering ._P tw�r.,� ApPROVALS
Use of New � � Foundation Location Inspector D�ate
Buiiding es_►_d_e_ti,c..C. �''' Forms, Materials,
l%v �'] �Z.� .� � Under-Pinning .
-1—� —� Frame: Fire Stops,
Bracing, Bolts
Lath,lnt.
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath. Ext. '
with al] City Ordinanccs and State Laws regulating
building constru 'on.
Signatureof � � Plaster,lnt.
Permittee _ _ Plaster, Ext.
AuthorizeA Agt. Masonry Reinforced
Valuation Permit Fee $ / v
$ �f, �� Plan Check $ / Q Bond Beam
. v Feeal $ � �/ FINAL
1%orm '204 iG-H IM 12-63
... : , ;. . .
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a' � ._ . . _.. . � _ , ..
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� o _..._ . .. . ... .. . . �
LL � '
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� ; •'�:. . , . , _ , . ._
. . 1_ :5�� ° . r r , . . • _. •�• �
' -' ' .. . . _ _ .. � `r/;� �. . . .. . . .
C" ' _..._'__'___ .. " _" _ ". . .. ' . .
.. . ..... . _sr "_ " . _ '..1�. -" .
: j: ' �
. . ' _ _' _ _ _ _. � __ _ ' . ' - , _: _ "_'
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NOUSE CON.
ROUGN HERTING �ND �IR C01
TEMPORRRY SERVICE OR POL
UNOERGROUNO � POWER
FOUGM WIRING
REINF.
BON� BERM SiE REIlFORCE
SMEPiNING �,a� ����.� �
FRnME �ND FLRSNING 7—
LiTNING — IN rI OIIT �i
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VENT.. REFRiG. nN0 �.C.. FIN�L
FINRI
DATE
BUILDING PERMIT N0. k(��7�
SUBCONTRACTOR
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CP�TA.MESA BUILDING-SAFETY DEPARTMENT
.P. . BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fill in Completely — Use Ink Only
BUIIDING i .. .. _ _ ' A'%
OWNEfl
MAIL
CITV
CANSTRUCfION ��
LENDER
BRANCH ��
ADDRE55
CONTRACTOR �rxO�.� �
ADDRE55
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
SIZE NO.OF BLDGS.
OF LOT 6SX�LS I NOW ON LOT 2
USE OF
EXI5TING BLOG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO 8E PERFORMED
1 heraby acknowlatlge thet 1 have reatl this epplication antl stata
that the above information is correct antl agrae to comply with
all laws regulating bulltling conso-ucNon, entl I shall not amploy
any person in vlolation of the workman'S compensation lawa of
the State ot California.
I hereby cettify that I am p�oparly licensed as a eontractor untler
tha Stete of California eusiness and Professions Code, Divlsion 3,
Chapter 9, and that such Itcansas are in full force and effect, or I
am exempt from Ma vrovisions of the Stat¢ of Callfornia Business
anA Professions Cod/e, fDlvision 3, Chapter 9.
SIB�eture of .`��% / ���� ,
Permlttae ��ilY�
Authorized Agani
�:4269 9%Q5%7B
APPLICAT[ON FOR STRUCTURAL PERMIT
EC Fp DATE RECEIVED nnrv icciioo
O 3I PERMIT NO.
BVILOING
ADDRESS
OWNEP M-�L.iC,GIA..p•(, I�Q.VY�i,p
/�.n� � / � VALUE
�E Hi . �••� s OOG
FIRE
ZONE TVPE 'GROVP
APPROVED /�
RV . DATE `7 � S�
ZONE rj/ PO��
/G
VARDSAPPROVED
MAIN BUILDING
(FROM C/L STREE,T)
FEAR �� i
DISiANCE BET
APPROVED
THE AMOUNT SI
THE PURP�E OF
VALUATION
$�OQOOo
lJ
USE OF NEW FHm
BUILDING �.��
VAROS APPROVED
BET. MAIN
ACCESS. BL
DATE
APPROVED
72.63�
n
m
>
u
m
N
JN UNDER VALUAT�ON IS FOR m
ABLISHING A PERMIT NLV:
n
PERMIT FEE S � O O �
m
PLAN CHECK $ "�
0
TAX $ LL
F
-U
TOTALPAID $ �,
i•4ILLER� E.'
INSPECTIONS _ ^ ^ I DATE
.�I T
SUBCONTRACTOR
OCCUPANCY
DATE
BUILDING PERMIT NO
form 210-5M-11-59 5-B P _ ,_, j.�y],7.7
.
,� 1��.'i':
COSTA ME3A�i11LDING-SAFETY DEPARTMENT
P. O. BOX 81] COBTA MESA. CALIFORNIA�
For Applicanf fo Fill In Complefely
TYPE OR PRINT
COSTA MESA CALIFORNIA
■ BTATE
� HBTBACK LINB FPOM
F�ME R�C�����
�,�5 MAR 2 31;g1
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
PECE�PT NO. PPnRMIT NO.
BY
BUILDING
ADDRES6
COSTA
NO. I S/�7'J y LEGAL
OEBCR
NO. OR BIdGB.A
G? NNOW O/N� LOT '.i� A p �
Y.[M_/! I .....�
DESCRIPTION OF WORK
WALL ROOF
COVERING
IILDING AND WORK TO BE P6RFORMED
ZOPIING �
NO. OP y/ / �IBE OF N
PLANe // BIIILDING
v
M r�ts3 � rp
� 7 — 352-
EVES
(CENT¢F LINC BTJ
�
I HERBBY ACKNOWI.ED08 THAT 1 HAVE REAO TH18 APPLIWTION � TX! FMOUNT 9HOWN UNDER VpLl1AT10N 18 FOR THE
AND BTATE THAT THe ABOVE IS CORRECT AND AGREB TO COM-
PURPOBE OP ¢BTqBLIBHING p pERMIT FE6- ONLY..
PLY WITH ALL QTY Q�INANGE6 ANO BTATE LAWB RE6ULATINO
Bu1Lo�Na CoxeTrtuGn N. $�A� �� �p pERMIT FEE $ J'^ ,
eIGNATURE OF
PERMITTE � � J � f r •
PLAN CHECK $ �
AUTHORIZED AGENT ___ _ � ,�