HomeMy WebLinkAbout169 MESA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 169 MESA DR Status: ISSUED
Suite: B Applied: 10/05/2001
Vicinity: UNIT 6 Issued: 10/05/2001
Parcel Number: 43922124 Zoning:
Applicant: MILLER, DAVE ISSUED BY:
Address: '
_ - Phone: 949-631-1924
Zip:
Owner:
RICE, THOMAS
FEE SUMMARY
Address
LONG, ROBERT
-
Calc Valuation: 51,643.00
Permit:
NEWPORT BEACH, CA
Phone:
Claim Valuation: $1,643.00
SMIP Res:
2516 CLIFF DR
Zip:
92663
Contractor:
ORANGE COAST ROOFING
Address:
3027 ROYCE LN
Inspection:
$0.00
Phone:
(949)631-1924
Total:
COSTA MESA, CA
Zip:
92627
License:
434674
Arch Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF AND COVER WITH 25 YEAR COMP. NO NEW SHEATHING PROPOSED. WILL REPLACE AS
NECESSARY IF REQUIRED. UNIT B
NOTES:
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
2aa646 (6/00)
FEE SUMMARY
Plan Check:
$0.00
-
Calc Valuation: 51,643.00
Permit:
$60.10
Claim Valuation: $1,643.00
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$60.60
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
NOTES:
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
2aa646 (6/00)
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 sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
w or which this permit is issued.
I have antl will maintain workers' compensation insurance, es required by section 3i�10 of Me i�bor Cotle, for the performance of the work for which this permit is issued.
M work����[[['sss/nom satlon In Orence carne rid oli number are:
Carnor:y p p Policy Number:
(Ibis section need not be comp eted it the p®rmit Is valued et one hundred dol rs ($100) or less.)
❑ I certify that in the perto once oft Work for which this permit is iss d, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of lifomia, a ogre Ihel it sh uld become b)ecI to
the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pr i ons.
Applicant Signature: Data
WARNING: FAILURE TO SE CU ATION IS NLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO IXJE HUNDRED
THOUSAND DOLLARE ($100,00)), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DELL RATION:
I hereby affirm that I am licensed u __p
v' Af 6bap mmencing with lion 7000) of Division 3 of the Business and Professions a�9nd my license is in full
force and effect. Lic. If `Z (p Class x / � '7
Contractors Signature: Date: r
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).
Lenders 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 peark
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's 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 B, 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? ❑ 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 feet of compressed gas at standard temperature and pressure).
.............................................................futu..........................cc......ant......................................istr.........................................-Ily................................teri...........................s.........................................................................
2 Does or will the applicant or present or future builtling occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No
(Section 25533 of the California Health and Salary 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 Leet of
compressed gas at standard temperature and pressure).
..........................................................................................................................................................................................................................................................................................................................................................
3 Does or will the appplicant 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 o. the California Health and Safety Code been fully complied with? E] Yes ❑ No
................................................... ................. ildi.............................................................................................................................................................a............................................................................diff...............
5 Does or will the applicant or present or future building occupant require for the work which is the subject c This aLl Yes
a gertnit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Ves ❑ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
......................-.............................................................. ............................... ....................................... ........... ................................................................................................................. ....__................................................................. ......................
6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? C1 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 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 Calitomia Health and Safety Code Section 42303 been made? []Yes ❑ No
.......................................................................................................................................................................... .......................................
B (II'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. 1 agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHOR ON
0 ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to con ly with all state laws end city ordi rices relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-descri d props y for 'spection purposes. I agree of to Occupy or allow occupancy of any building authorized by this permit until final inspection.
"gnature f Legal O (s) f`N _ -Da
te
_��M , V r th icant l -i Date
CODE 0. INSPECTION TYPE PSIE III6i CODE. INSPECTION TYPE DnTE ItIIIDAUS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa FinalAl, Vi 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Well / r 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address:
169 MESA DR
Status:
ISSUED
Suite:
C
Applied:
10/05/2001
Vicinity:
UNIT C AND D
Issued:
10/05/2001
Parcel Number: 43922124 Zoning:
Applicant: MILLER, DAVE ISSUED BY:
Address:
Phone: 949-631-1924
Zip:
Owner: RICE, THOMAS
Address LONG, ROBERT
NEWPORT BEACH, CA Phone:
2516 CLIFF DR Zip: 92663
Contractor: ORANGE COAST ROOFING
Address: 3027 ROYCE LN
Phone: (949)631-1924
COSTA MESA, CA
Zip: 92627 License: 434674
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF AND COVER WITH 25 YEAR COMP. NO NEW SHEATHING PROPOSED. WILL REPLACE AS
NECESSARY IF REQUIRED. UNIT C AND 0. ATTACHED DUPLEX UNITS.
NOTES:
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
taae46 (au)
FEE SUMMARY
Plan Check:
$0.00
Calc Valuation: $3,999.00
Permit:
$97.25
Claim Valuation: 53,999.00
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$97.75
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
NOTES:
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
taae46 (au)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have d will maintain a certificate of consent to self-tnsure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
W90ecr which this permit Is Issued.
I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this Permit Is issued.
My p works /`cora en tion Insure /vm.7r�mar an oll number are: ^ �-
Cartier/Y G f,t�� Polity r. Numbe"2&T-
(This
2 J - GiA C
(This section need not be completed if the pemut ued at one hundred dollars ($100) or less.)
❑ I certifythat in the pe rmance i the work for which this pomill is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensallo I laws o alifomi and 7 ree that 1 should baa me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with Ihess iSims.
Applicant Signature: Dale:
WARNING: FAILURE TO S!1064SCAPE SA N Gd IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECL ATION:
I hereby affirm that I am Ilcens e/ ry s ter 9 ( mencing h Section 7000) of Division 3 of the Business arhd Proks!iJ ns 0ede, and my license is in full
force and effect Lic. N "G Class a (�
Contractors Signature: Date:
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).
Lenders 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 o1 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 pem+'
subjects the applicant to a cM1 penalty of not more than five hundred dollars ($500).):
❑ 1, 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 awn 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, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Prolessions
Code: The contractors License Lew 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: Data:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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, This 8, Celifomle Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a Paul from the Division of Industrial Safety, as noted above, unless such person has a
pernit 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? ❑ 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 o1 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 hezareous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code, with soma exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity o1 acutely hazardous materiels equal to or greater than a weight at 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will thea plicant or present or Futuro building occupant need to prepare en RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ t�0
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling 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 Sefory Code been fully compiled with? ❑Yes ❑ No
5 Does or will the applicant or present or future building occupant require for the work which Is she subject of this a plication eEEermit for such wruwaion or modification
from the South Coast Air Quality Management District or from any other air pollution control district or egencyt � Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building pernils).
...................._.............._.... _........ _.._....____............................__._�._...... _...... ........___
6 Will any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
(It 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.................................. __....................................... _.—_"""-
7 11 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 proscribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.........__.._........_..__.......__..__ .___.__._..._............... ___.._....
—
8 (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certity 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 erify
omunder penalty of perjury that I have reed this application and state that the information given is
correct. I agree to ply with all state laws and city ordinances rale g to bulltling construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described p party for in, ection urposes. I agree not to occ or allow occupancy of any building authorized by this pernit until final inspection.
S natur 1 Legal O ner(s) r /7\ Datg�
d/0r A t zed A ice // if Date'
CODE I. INSPECTION TYPE 2AIE Itffi!DL$ CODE INSPEcnom TYPE DAIS NTITA45
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1208 Pool Spa Final y� 200 Final Plumbing
200 Final Re-Roof /.� 210 Final Electrical
201 Final Blocu Retaining 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mssa.ce.us 77 FAIR DRIVE, COSTA MESA, GA 92626
BUILDING PERMIT
Job Address: 169 MESA DR
Suite: A
Vicinity: 173 MESA (FRONT); 169 A MESA IS 2ND UNIT
Parcel Number:
43922124
Zoning:
Applicant:
MILLER, DAVID
$0.00
Address:
3027 ROYCE LN
Permit:
$83.25
Phone: (949) 631-1924
SMIP Res:
COSTA MESA, CA
Zip: 92627
Owner:
RICE, THOMAS
$0.00
Address
LONG, ROBERT
Other:
$0.00
NEWPORT BEACH, CA
Phone:
Inspection:
2516 CLIFF DR
Zip: 92663
Contractor: ORANGE COAST ROOFING
Address: 3027 ROYCE LN
Phone: (949)631-1924
COSTA MESA, CA
Zip: 92627 License: 434674
Arch
Address:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 11/21/2000
Issued: 11/21/2000
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF FOR 169 MESA UNIT A (IS 2ND UNIT IN BACK OF 173 MESA DR). TIO, REPAIR SHTG AS NEEDED, 30#
FELT, APPLY 25 -YEAR "TIMBERLINE" GAF COMP SHINGLES. NEW FLASHINGS.
12 SQUARES
NOTES:
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) 7545626
244646 lerool
FEE SUMMARY
Plan Check:
$0.00
Calc Valuation: $2,081.00
Permit:
$83.25
Claim Valuation: $2,081.00
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
NOTES:
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) 7545626
244646 lerool
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 Cade, for the performance of the
work for which this permit is issued.
I have and will maintain workers' compo motion insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued.
My workers' compensatio9.1"urance c frier and policy number are: _
Carrier: = �, / Policy Number: � --3� PT
(This section need not be completed 11 the permit is v uetl of one hundr dollars ($100) or less.)
❑ 1 certify that in the perform nce of t ork f which 1 panni ssued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of C omia, a gree t If I sh uld be sublect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pro S.
Applicant Signature: Date:
WARNING: FAILURE TO SE E WO ERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA N:
I hereby affirm that I em Ilcen
near
f hepter (common n with Section 7000) of Division 3 of the Buslnes rid ons Code, and my license is In full
force and effect. LIO. k Class k1
Contractor s Signature:44 L4 Date: r�/ — — a C%
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: Lander's 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 contractors)
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 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, An 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? ❑ 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 feet of compressed gas at standard temperature and pressure).
....................................................___.....ni..............._._............._................g......................nae-......................................._....................................................................................................e.........................._............_......_..._...............
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous meteriels7 ❑ Ves ❑ No
(Section 25533 of the California Health and Safety Code, with some excepllons, 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 matenals) e
❑ Yes ❑ fPo
(Section 25534 of the California Health and Safety Code provides that the Costd 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 ❑ 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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).
......................................................................................................................_...his,........._.................................................................................................................................................................................................................._..................._....
6 Will any part of the facility, to be conslmcted under this permit be within IIXXI feet from the outer Oountlafies of a school? ❑Ves ❑ 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? ❑ Yes ❑ No
........................................................ ............................................... ......................... .... ........... ...... .................................................................................................. .................... ......................................................................................................... _......
e (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 AN AUTHORQATION OF Y: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to c ply with II ata a laws en city ord1% c s relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described pr c cry for ecti n purpose . I agree n F occupy or allow occupancy of any building authorized by this permit until final inspection.
S natu Of Legal Ow ars) Date
r Aigloozied Xplificant Date
CODE 1. INSPECTION TYPE gdjE INTIMeLS CODE. INSPECTION TYPE PATE ItilIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �%J / 208 Final Plumbing
200 Final Re-Roof � �(� 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
July 7, 1978
f
CITY OF COSTA MESA
CALIFORNIA 92626 P.O. BOX 1200
FROM THE OFFICE OF THE PLANNING DEPARTMENT
Mr. Tom Rice
1228 Rutland Road, Apt. No. 6
Newport Beach, California 92663
SUBJECT:: 169 AND 173 MESA DRIVE, COSTA MESA
Dear Mr. Rice:
This letter is to confirm our telephone conversation in which I advised you
that the properties at 169 and 173 Mesa Drive are separate parcels and can
be treated as such for purposes of development and/or sale.
In 1964 a court order required combination of these two parcels. Rather,
the owner paid a fine and the court closed the case. Thus, there is no
longer a legal requirement to combine these parcels.
Please forgive my delay in sending this confirmation. I hope it has not
caused you any unnecessary inconvenience.
Sincerely, ////''
'Z��L
Millie Kandler
Assistant Planner
MK:ks
c
77 FAIR DRIVE (714) 656-5245
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA ESA UCTION PERMIT
Project lSJdress
Qlpplicadt's Mailing dr s 3'O
Owner's Name�-• Phone
Address
Arch/Eng. License No.
Address �q�j�
Contractor's Nam - hone%tel-ice-2
Address (mailing) /,5 ,� /LIA16 ANA a/ 9�0/
City License No. 15 g3
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
�". section 7000) of Division 3 of the Business and Professions Code, and
nse is in full f e a/nd/e_ffect. J �/
Li can/ r -+"G % Licfysefjlj s0�/
Dat Signature
WORKERS' COMPENSATION DECLARATIONr
' hereby affirm that 1 have a certificate of consent to self -insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
00, Lab . C.) O
Policy ab _ Company M41"'i .7W.sv
ertified copy is hereby furnished.
Certl!^dj c is rq`r� with the city In Isi
I /mss`vs Applicant -/SL
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Th is section need not be completed if the permit is for one hundred ($100) or
Tess).
I certify 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.
Date Signature
'NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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 (Section 3097 Civ. C.)
Lender's Name
Lender's Address
A&Lfff? BUILDER DECLARATION
by affirm that I am exempt from the Contractor's License Law for the
'
ing reason (Section 7031.5 Business and Professional Code: Any city or
lwhich requires a permit to construct, alter, improve, demolish or repair
,fructure, prior to its issuance, also requires the applicant for such permit.
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
s-;,refrom and the basis for the alleged exemption. Any violation of Section
by any applicant for a permit subjects the applicant to a civil
;;'`tatty of not more than five hundred dollars ($500).
lJ 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 (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/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 com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove efor the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License taw does not apply to an owner of property who
builds or improves thereon, and _who contracts for such projects with a ccn-
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read this application and state that the above
information is;correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentativesof. t Is city to ent r u on the above-mentioned property for
inspection p
Signature Date u0"
Drivers' License or SS
0
9036 2/10/96 eC iL
TYPE OF CONSTRUCTION LI NEW L-1 ADD LI ALTERATION LJ REPAIR
FEES
❑ CONVERSION ❑ DEMOLISH ❑ OTHER —
A.P.#
Zone
DESCRIPTION OF WORK/USE OF BLDG.
'
S -
Main Building: '
Accessory Building:
Backf low Irrigation Sewer Cap
TYPE OF PERMIT El GRADING FOUNDATION STRUCTURAL
/
❑"MECHANICAL
T
Front
Cooking Unit '._ Meter ❑up to 100 amps '
Z
O
L:1 TENANT' El ELECTRICAL lJ PLUMBING
B
Dishwasher Solar Piping
N
[_1 OTHER -
A
Rear
Floor Drains Swimming Pool w/Spa
I
F.A.U. Inc.Solar 09-15 HP ❑16-15+
C
Right
Fixtures Microwave - -
N
PROJECT DESCRIPTION SO. FT. OCCUPANCY
K
Interceptors Water Heater
A 0d
G
CON STRUCT ION TYPE VALUATION$
$
Left
Lavatories Auto -Wash
R
ZONE GRADINGCU.YDS. ACRES
Ping. Ref. #
Parking Req./Provided
E
Roof Drains ..
Planning Notes:Remarks:
O
M
iv
T
S
PLUMBING
FEES
Bar,Sink Showers
ELECTRICAL FEES
Backflow Preventer Service Sink
$15 Issue Fee
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. ❑50+KIN
Backf low Irrigation Sewer Cap
1ANICAL
Bathtubs Sewer Connection
Cooking Unit '._ Meter ❑up to 100 amps '
Clarifiers Solar Collectors
Date
Date
Dat
Dishwasher Meter ❑over 100 amps
Dishwasher Solar Piping
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar Tank
Fan Motors ❑0-1HP Ell X-8
Floor Drains Swimming Pool w/Spa
SMIP ,
ISSUANCE
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE
F.A.U. Inc.Solar 09-15 HP ❑16-15+
Floor Sinks �. Urinal
Fixtures Microwave - -
Gas Service Outlets Water.Closet
Device Boxes Pole Light
Interceptors Water Heater
A 0d
Outlets Range
Kitchen Sink Water Service -
Switches Sign
Lavatories Auto -Wash
Garbage Disposal Standing Sections
P—Trap Laundry Trays
$ 3
Generator 00-5 KW ❑5-15 KW Trash Compactor
Roof Drains ..
Reinspection Fee 1 $15
Duct- Under Ground
Duct - Structural
Duct - Ventilating I
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
❑ 0-100,000 BTU ❑ 100,000 BTi
Reinspection Fee 1 $15
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Issue Fee
I $ 3
Reinspection Fee
$15 Issue Fee
$ 3
1ANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By 'M
-
Date
Date
Dat
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
1_10-100,000BTU 13100,000BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$
$ _.
$ p( O'{J
$
$
$
$
$
SMIP ,
ISSUANCE
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE
$
a 1
•$
$
.$
$
$
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
CGSISTRUCTION AND PLA IING 1
Date
APPROVALS Permit #
Inspector
POO ;PA
APPRO .LS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
'
3. Electrical Conduit Utility-Undrgrhd.
54. Forms
.4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
' 5. Steel'Reinforcement• -
56. Rough Plumbing & Pressure Test
6• Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
'7: Footings -
-
58. Electrical Conduit-Undrgrnd.
'
8."Foundation - '.
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
-
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping [:]Gas ❑ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling'(Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
-
42. Backflow Preventer -•
-
43. Backflow Irrigation
44. Landscape Irrigation System'
45. Sound Attenuation ,..
46. Handicap Regulations
47. FINAL STRUCTURE & BUI'LDING
48. Special Requirements Completed
49. Electric Release to Edison
1
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. Date
-
-
16243
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
Ila TYPE OR PRINT
BUILDING ESA
ADDRESS ' T• '.i
DUL-
COSTA MESA. CALIFORNIA
F RECEIVED
JAN 2 5 1962
FINANCE DEPT.
APPLICATIONGIbROFE A MESA
BUILDING
For Office Use Only
S I �Q
RUCEIPT NO. 1 (]'E�}/�O.
D�i.��
WNER I•{
AIL /-1 �'1 O , 1r�I OOn
[ADDRESS
RECV BY OpTE REC6IVEO DATE ISSUED,
7
/�"'Z$ �Ey/Z,y,
` L 1V �r r ,V
(f�
—J,/AJ��'%
L.
CITY C NO.
D r� �j
ADDRIL IING
e / •7 1it3
ARCHBU
ITECT ♦
No. I/(1�6J"O
s COSTA MESA. CALIFORNIA
OR ENGINEER ELi�LJ
ADDRESS
FIRE
ZONE TYPE
APPROVED
BY
GROU
/1
DATE J
CONTRACTOR
ZONING
ADDRESS
I.� OF NEW
ZONE '^l .1
CITYUSE
PLA0 BUILDING
LEGAL S �7
DescRlPrloN
LIC.TNO. V L, 50 23 No
-r'
NO. P BIDGe.
i
OF LOT
NowOON LOT
A. P. NO. '—
.....
USE OF
EXISTING BLDG u W
YARDS
APPROVED
EVES
ALLOWED
SETBACK LINE FROM
ICE— -RE —.1
�1
CIINTER OF STREET REAR YARD
FRONT
FT. V-C4'L •IN.
SIDE VARD I LEFT
I RIGHT
R. SIDE Z�F7.
IN.
DESCRIPTION OF WORK
/)
L. SIDE
FT. N.
D
NEW I ALTERATION IIADDITION
``/JJ
REAR •i
FT. IN.
REPAIR II MOVING I II DEMOLISH
r y�
ABYPROV D j 11 \CNV
•+V
DATE��
I/
BUILDING 8�l� RI NO. C I
SIZE JJ S .%STgORI/ES
IRI(-�OOMS
WALL ��V�'`•M.COVVERING
COOF
OVERING 'KJL•'�`
O1 a I
dd
USE OF BUILDING AND WORK TO BE PERFORMED
,,•, r �
V�N ^ VWGL�ilal-�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ASOVEJ& CORRECT AND AGREE TO COM.
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLV WITH ALL CITY ORDINAN LAWS REGULATING
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
'
tr.1
BUILDING CONSTRUCTION
SIGNATURE OF
PERMITTE
(j QO
L� V
qq •hI
PERMIT FEE S
a
S
PLAN CHECK S
AUTHORIZED AGENT
J
TOTAL FEE J 0
16,244
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDIN
ADDRESS C S 9 D /
COSTA MESA. CALIFORNIA
FEE RECEIVED
J�i!4N 2 5 1262-
FlfV1ANCE DEPT,
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
L
RECEIPT NO.
�PBR
OWNER S o,eE //✓E
(/(f/V I
MAIL [� p�
0
RE�1V D BY D/�T8 RECEI}'!D
Dy`OT+iE ISSUED
I ,-
ADDRESS /V l�(I
(p /'oZS'/p �/
CITY
//
NO. 1 /O�
BUILDING �y p
ADDRESS J
�//` 'I
SffO/PEN/VG'
No.
COSTA MESA. CALIFORNIA
OROENGHITE EER
ADDRESS
FIRE
ZONE TYPE GROUP H
APPROVE /
BY DATE
a .'/V ^
CONTRACTOR
(� '�,•r
O' ^�
ZONING
ADDRESS O
O /
ZON 1N0. OF SE OR NEW
/ PLANS BUILDING
LEGAL 7
'71—p
'y
C �,/'�(�
�) /
CITY C/
STATE
LIC. NO. NO
- oT /
DESCRIPTION
` _0
A. P. NO. L lj
SIZE
LL``
OF LOT ' O •�
No. oP BLDGB.
Now ON LOT
USE OF /
�/ �C
BL(i O'�L
DS EYES
pppROVEDALLOWED
EXIST( NG BLDG. 'q
`
SETBACK LINE FROM .•� /� I
B
G
(CENTER LIN! ST.)
CENTER OF STREET �/
REAR YARD V
FRONT IT.
I
I
1
i I(R.
SIDE YARD LEFT
RIGHT
SIDE FT. IN.
DESCRIPTION OF WORK
L. SIDE FT. IN.
NEW I 1�ALTERATION I
(ADDITION 11
2 - FT. IN. -
REAR
APPROV l y� DATE • / '
/
'
REPAIR II MOVING I
(DEMOLISH I
BUILDINNO. OF '
G
S d
SIZE ROOMS
STORIES.
��LII
WA4vy�//�*-(-i
Rock
'L
OVERIING COVOERING
d-
USE OF BUILDING AND WORK TO BE
PERFORMED
O'
[516,11•L
i Zr
/ c%ZZ IA;
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT ARD' -AGREE COM-
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CI INANCEO-ANO-
-TO-
REGULATING
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
L�"S
BUILDING CONS I
SIGNATURE OF
PERMITTERS
/y; �
n
PERMIT FEE S
13
`�7Q�Q
PLAN CHECK S
9
AUTHORIZED AGENT
TOTAL FEE .7 J
33
s 16245
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
11-9 TYPE OR PRINT
COSTA MESA. CALIFORNIA
Rt KtULI v Lu
r/ JAN 2 5 1962
FlNANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RCHV80 BY I /A �`Z j DE E�
ADDRR�EES/SOy�
35 COSTA MESA. CALIFORNIA
WANT
/-,2s1-G
BUILDIN "1NO.MS IS I
SIZE ROOSTORIES
EXTERIOR WALL ROOF
COVERING COVERING hl
USE OF BUILDING AND WORK TO BE PERFORMED 17
W 4 C
i
ZONING
ADDRESS
ANO BTATB THAT THE ABOVE IH CORRER AOREB TO CAM•
PURPOB[ OF
EBTABLIeHINa A PERMIT
F88 ONLY.
PLY WITH ALL CITY ORDINANCES AND RA R[OULATINO
VALUATION
ZONE Z NUNS
�1�'GB
N ix
CITY
ryaPERMIT
V I.� i
WIP
e/
STA TE IQ
2 $
q .TEL.
a3 /� 0
l
t[aAL
�I <
LIC. NO.
1
1.7
NO.
DH iPTION
SIZEl/�
�•
`L
I rvo. OF 0=5. 1
OF LOT D S
O O
NOW ON LOT
A. P. NO. '•
- 6 r
USE OF
1T
YARDS
EVES
EXISTING BLDG l�
` UJ
APPROVED
ALLOWED
SETBACK LINE PROM�J
CENTER OF STREET
(
3
REAR YARD 1
(CHNTHR UNC 9T.1 '7
FRONT 7 FT.
ILEFT
I
C I
I
I3
3
SIDE YARD
RIGHT V
R. HIDE
( F
DESCRIPTION
OF WORK
/-,2s1-G
BUILDIN "1NO.MS IS I
SIZE ROOSTORIES
EXTERIOR WALL ROOF
COVERING COVERING hl
USE OF BUILDING AND WORK TO BE PERFORMED 17
W 4 C
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I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPUGTION
THE AMOUNT BROWN U ¢R �ALUATI N I8 FOR THH
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PURPOB[ OF
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PLY WITH ALL CITY ORDINANCES AND RA R[OULATINO
VALUATION
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SIGNATURE OF
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AUTHORIZED AGENT
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