HomeMy WebLinkAbout3067 MURRAY LN - Building Permits�
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PHOJECT AUGHESS: 3 O E] % MURRAY LN
DWNEN'S NFME:QDDO, ERNEST
AOOPESS:191O SUVA CI
COSTA MESA, CA 92626
FflCNIENGINEEfl:
p00flE55:
uxir: � 1
z,� J
xec.xo.:
UNIT:
PENMITTEE:�7RIMO ROOFING ( 714 ) 841-4456
aooness:17066 PALMDALE SF
HB CA 94627
LICENSED C�NTBACTOB �ECIABATION: I hereby allirm Ihal I am license� unae� pmvisions o� C�aD�er 9(commencing with SeqiOn
]000� ol Dnivon 3 ot t�e Business ana Pm�essions CMe. anA my licen5e is in full lorce an0 ellect.
c�rr uc(�.:0 0 7 6 3 9 STATE LIC.3 3 S 1 z /��m C_l�ASS:�
�a�e:=1' �;`y� SignaWre: '' ��
WOflNENS' COMPENSATION oECLAflATION: I hereby aflirrn ihat I nave a cenilicate of tonsent to sell�insure or a cenilicate ol workers'
Compensalion Insurance, or a ceni�ied copy ��ereof (Section 3800, La�. C).
roucrNo.:0662523-93 EXP.OATE:OSIOZI94
camvaxr:STATE FUND
❑ Cehi�ietl capy is �ere�y lumi5hed. .� Certifiea coDy is bletl with I�e ci�y Builtling Division.
oa�e: �/' f 3� 7 � qppli[anl: '�" �'6Y�i(
EXEMPTIONFPOMWOBNEflS'COMPENSRTIONOECIABRTION: �Thi55ectiannee0notbecamDe��i�I�epermili5lorone�mMretl�5100)orless�.
I certily I�al in I�e �etlormance ol the work for w�ic� I�is permil is issueG. I s�all noi employ any Derson in any manner 5o as �o become
su0jectio I�e NlorkeR' CAmpensation Laws of Calilomia. .
Date: Signature:
NOTICE: II, a�ier making I�is aeclaraiion. yrou Shoultl p¢�Ome SuOjetl b lhe WOrkers' Compensaiion prwisions oi the Lanor
COde. y0u mu51 �orilrvnih CompN �^�� Sut� prONsian9 or ItnS p¢�rtnl SIWII Ue Oeemetl revoke0.
CaNSTflUCTION LENOING RGENCY: I hereoy ailirm that there is a constmction IenAing aAency tor Ine pedormance of the work for
w�icn I�is oeima is issued (Seclion 3097. Civ. C�.
LENDEB:
aooREss:
OWNEB BUILOEfl OECLABATION: I hereby a��irm Ihai 1 am eKemp� Imm t�e ConiractOrs' Siale License Law for Ihe follovnng reason
(Sec�ion 7Q3L5 Business anU Pwlessional CoOe: Fny ci�y of county w�ich repuires a Oermit �o cons�mc�, alter, impmve, tlemolish, or
repair any slmclure, prioi to iis issuance, also reQuires the applicant lor suc� permil ta file a signed slalement �hat helshe is licensetl
pursuanllolhe pmvisions oithe Conlrac�ors' State LirenSelaw�Chapter9�commencing witM1 Seciion 7000)o�0ivision 3 o�the Busness
anE Pmlessions Coae) or Ihal he/she i5 ezemp� theretmm bn� I�e basis lor Ihe aileged e�emp�ion. Any violalion of Sec�ion 7031.5 by
any applicant lar a permil subjecls �he applicant lo a civil p¢nally ol nol more t�an five �undred Oollars (5500).
I. as owner ol th¢ pmpetly or my employees wi�� wages as Iheir sole compen5ation. will tlo ihe work, and the
❑ slmclure is nol intenCetl or aflerea lor sale (Seclion �p44, Business anG Pmlessional Code: The Coniractors' State License Law
Aoes no� apply Io an owner o� a pmpehy w�o Ouilps or impmves lhereon, and who Ooes such wod himsell/hersel� or t�rough
his oi �er awn emDloyees, pwvitletl Iha� such impmvemen�s are no� intentled or ollered lor sale. II, however the �uilding or
imD�ovement is SoIA vnlhin one year a� comDlelion, t�e owner will hav¢ Ihe EurAen of D�ovinp he/she OiU no� Dui10 or impmve
Io� Ine oWpose ol salel.
I. as owner ol ��e pwperty, am erclusively conlrac�ing wil� licensetl conlracbrs �o [onslmc� ��e Owlect (Seclion 7044, Business
❑ antl Pmleuions CaOe: i�e Contractors' S�ate �icense Law Eoes not apDly to an ovmer oi pmDetly wM bmlAs or im0�oves lhereon
an0 w�0 Coniratls �Or SUCh pmle��s vnth a Contra(�ot�5�license pursuani Io �he ConVati0r5' State LicenSe Law�.l am aware
I�al prool o� I�eir Wark¢i 5 Compensatian inwrante S�oultl Ce pmvided lo me.
� I am aempt untlee Seaiore 0. 8 P. C.
far Inis reason:
Date: Owner.
I Go hereEy cehi�y Ihat I am aware of anE underStanE t�e requiremenis of Catilomia Healih anC Salery CoEe Sections 25505, 25533, an0
25534 and t�al l or any luture Uuilding ocapant will/will no� (�ircle one) neetl �o [ompty wilh SaiG Slaie cotles and lhe requiremeNs �or a
permi� for con5imction or ma0ilicaiion Iwm ��e Air Ouality Managemenl �iSVicL ResiAenlial cons�mction applicalions are exempt �mm
Ihese pmvisions. ,
�ale'. ApPlicanC
I hereby cenily��al I haveread Ihis appbcation ana Slaiel�atihe a�oveinio�ma�ioni5 correci. I aA�ee �o com0ly wilh all city antl counly
ordinances an0 slalelawsrelalinglo DWleing cons�mclion anq hereby aWhorizereD�esentalives ol 's cily�o enleruponlhe ahove�mentioned
pmperly lor Inspac�inn purposes. /��
yDate: N` � 3� ��'1 Signalure:S"i �
Driver's License or Social Secwiry q:
t6ai�46 W�ite—BmlEing: Green—CaCe Enlorcemeni: Canary—ApPli<anl: Pink—Fevenue: GoWmrotl—Asseswr
— r'rTY OF COS?A MESA — BUILDING PERMIT
PERMIT NO: B 061715 PLAN CHECR NO; N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR
JOB DESCRIPTION
CLAIM VAI.UE:
: T/OFF REROOF W/FIBERGLASS SHINGLES
PERM NO: B 061715
�OVI': ^] SUPP: 13
P[7RPOSE; ALT
SO FT: 3,353
3,358.00 CALC—VALUE: 3,358.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOHE DETECTOR(S) RE�UIRED REROOF 3330SF RESID S GARAGE
*##*�***�***�r#*#+r*��#;�#��r�-#�*� �*��*�*x��**�r#u�*���***�#��** �r �*�#���###�-*�r
Z O N I N GS �RTEBQAUCIKRSE M E N T S��'�E D�i��T� �
------------ MAIN BUILDING ---------- --------- ACCESSORY BU�!��Fib�J---
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT ZN
PARKING RE • PROV; PARCEL; 14104411 ZNE: REF NO:
PL:4NNING N�1'ES>
i ��+
*�x****��*#**x•*�**�******xu*�+e#**rt******��#xxx#**x*�#*�**�r*±r�x�**�*#���s*####�x�*�
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;%% S
. ��
ZONING APPROVEU HY . DATE; �•
3UILDING APPROVED BY : DATE: ti
APPLICATION YSSUED BY• �— DATE,: 13 (�j �
ifif%ifiE�EiEiflEiE#iflfiElE'lEiEfE3EiEiF#i�iFifitli�+.'tiF3FiFiFi'F3Fi�Fi�+.'F3FitfF�t z i�iT%-iF3Ffi#3fi'F3FifiFlt741kiEjt#�)f?E''N�iFityFfelc -iFiFir 1F#if
iF iE iF iE iE ik #ik if 1f iE 1! # iE iE if iE iE iE iF if iE iE 3f if iE iElE it if Ik iE iE iE 3k if iE iE if iE iE iE if iE it iE i(--lf iE iE ib 3E iF iF iE iF iE iF 1f i!� iE if aF if if iE if #�1E,9h �t if iE %� ik ik # if
iEGALI'LATION:N F E E S U M M A R Y STROCTURA�iSEGME[33:Y
RLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 .50'�
� SMIP/NON—RES
PLAN
ISSUE FEE
BDILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID _ DUE
TOTALS----> 63.50 0,00 ' 0,00 63.50 63.50 - ,00
REVENUE DIVISION TOTALS--> COLL'ECTED: 63,50 OVER/SHORT: % .00
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING�PLAN—CHECR
63.00 • .50 '
iE iF iE iE iE 1E 1E if if ?E?E # iE iF-lE iE < 7E ff if if iE if i4 i'r ik iE if if 1E if iE iE �klE 1E �lE iE if if if� if #�)h 1F iE iF if 3E iElE if iF iE iF iE fF iE 1F if # i! iElE iE iE iE ##!E iE # iE±E i61F fE iE it
I N D I V I D U A L F E E H k E A K D O W N i
I �.
TYPE QTY D E S C R I P T I O N UNZT COST l.r:OT�LT, COST
SFR 3358 REROOF BY VALUE RESIDENTIAL NO'LONE 1.00 ` 3,358,00
£ND OF FEES �
�;
01 00137141-00137142 T�] T 63.50
DATE: 04/73/93 TItIE: 12:25
.�
CONSTRUCTION ANp PLANMNG
APPROVALS Permit �
1. Tempo�ary Elecv�cal Se�vice or Po4e
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Uti4ty•Undrgrnd.
4. ElectriCal Condwt�Undrgmd.
5. Stee1 Reinforcement
6. Electrical UFER Grnd
7. Footings
8. Foundation
9. l'Vater Pipe-Undrgrnd.
70. Structu�al Floor SyStem
11. PropertY Sewer Line & House Connection
12. Sewer Cap '
t3. Roof dta�ns
14. Rough Plumbing
75. Rough Electrical-Condult
16. Rough Electric Wiring
17. Ro�gh tVir�ng S�gn
18. Rough Electrical�T Ba� Cellmg
79. Rough Heaung & A�r Cordrc�onmg
20. Ro�gh ract��Y F�rep!ace
21. Ducts, �n Structure
22. Oucts, Ventilating
23. Gas Pipe�Rough & Test
24. floof Framing
25. Roof Shcathing
26. T�Bar Ce�hng IStructurail & 7fonocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulat�on
30. Drywal� Naihng
31. Plaster Brown Cqat
32. Electr�tal Power N3eterF�nal
33. Pinal E�ectriz
34. Final Heating & Air Conditioning
35. Finai Gaz Pipe�Test .
36. Hood or Canopy
37. Fina1 Factory Fireplace
38. Final P�umbing
39. LVater 5erv�ce-Final
40. Gas Service-Final
At. Solar pomescicF�nal
42. Backfl0++'+ Preventer
43. BackfioW Irrigation
44, Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINALPLANNING
49. Efectric ftelease to Ediso�
50. Gas Release to Southern California Gas Q
51. CERTIPICATE OF OCCUPANCY
No. Dete
Date
0
POOL & SPA
Inspector aQpROVALS Permit,� Date
52. Poot & Equipment �ocat�on
53. Steel Reinforcemrnt
54. Forms
55. Electrical Bonding
56. Rough Pfumbing & P�essure Test
57. APPROVAL TO COVER�GUNITE
58. Eloctrvcal Cordurt�Undrymd.
59. Gas P�Re, O UrCrgr�d.. Test
60. 8ackc✓ash L�nec, P�?raG. �1 t%r.i47rntl.
67. APPROVAL TO DEGK
62. BackSvash & ReceptorFin:,i
63. Heater & VenbFlnal
6A. Piumbing System � F�nal
65. Electrlcat�Fina1
66. Solar System�Final
67, Fencin� & Access APproval
68. d.PPROVED FOR PLASTERf\G
69. POOL�SPASYSTEA1SFINAL
FIRE DEPT. REQUIREMENT I
APPROVALS Permit,'r
70. Undergrauntl Hydro
it. ProductPipin90Ga5 C=OiI
72. Underground Flusi�
73. Undergmd. Smra9c Tank O Gas � O�i
f�! 74. Overhead HYdro
h(�-
75. Dry Ghem:cal
76. Dry Standp�pe
77. FIXED SYSTEP.A FINAL
78. FIRE PREV. FI?;A� _�_
HEALTH DEPT. REQUIREP.4ENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUFD
Notes: �CIO d a. e_ �Y�t-L'
SAtO
y
Inspector �
i
Applicant to fill in all ipaees exce0< ��ose within �eavy Gortler lines ana sign all avVroOriate aeclantions.
CIT1rOF COSTA MESA CONSTR UCTION PERMIT PER N�/ TFACT NO. LOT NO. UNIT NO. A P# Zone
Project Address 3ri1�7 � /� � e f1' . S Main Building: Accessory Building:
AppliCant'S Mailin Addf2S� S -/YI 'C�.— TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E Z
Owner'S Name (�����'� �P E/ S"c�—!/�5 � CONVERSION ❑ DEMOLISH ❑ OTHER ' 7 FrOnt �
Address
.SA-M'� Phone DESCRIPTIONOFWORK/USEOFBLDG. A Rear N
TVPE OF PERMIT GRA�ING FOUNDATION STRUCTURAL I C Right N
Arch/Eng. Licenu No. K �
Addre55 ❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL g� Left R
Contractor's Nam ,/ � l Phone �'�THER Ping. Ref. �`- Perking Req./Provided E
Address (mailingl'��/{! _,�+1 � `e � PRQIECT DESCRIPTION 5�. FT. OCCUPANCV planning Notes: M
CONSTRUCTION TVPE VALUATION $ T
Ciry LicenSe No. ZONE GRADING GU. VDS. ACRES $,
LICENSED CONTRACTOR DECLARATION
1 �ereby affirm tbat I am Iicensetl untler provisions o( CM1arter 9(commencin9 Remarks:
WIIh SCCL�00 J�OQ) O} D�V�S�OfI 3 Of II18 BUSI0055 dOd PIOfC55�0lIS COdB� dfld
my license is in full torce antl effect. ELECTRICAL FEES
License Class �lcense No. PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW
Date Signatu�e
WORKERS' COMPENSNTION DECLARATION ConStruCtiOn PoleSub. � 50+ KW
I be�eby affi�m Ihdt I have a Certlficate of consenl to selbinsure o� a ce�tl(Icate Bar Sink ShOWC�S �
oi worken' compensation Insurance, or a certltietl copy thereoi (Soction BackflowPreventer ServiceSink CookingUnit Meter ❑upto100amps
3800, Lab. C.)
Poiicy No. Company Backflow Irrigation Sewer Cap Dishwasher ; Meter ❑over 100 amps
eCertifletl copy Is hereby fumishetl. DryCrs ❑Gas ��Electric Sub Panel
Certifi¢tl copy IS flled with the city Builtling Dlvlsion. 62LhtubS Sewer Connection
Oate Applicant Fan Motor5�0.1HP01`h-8
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Cleflfi¢�5 $018f COII¢Ct0�5
ississection neetl not be completetl If the oermit is for one huntlretl (5100) or Dishwasher Solar Piping F�A•U� Inc. Solar 09�15 HP �16�15+
I certify tha[ in tbe performance of the work for which this Oerm�t is Issuetl, I
shall not emv�oy any person in any manner so s to become subject to the Drinking Fountains Solar Tank Fixtures Microwave
Workers' C ns G �Laws oi Calityyn i
Date �5l9nature SJ4� � Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: It, atter ma ng this tleclaratlo you shoultl ecome subject to the Outlets Ran e
Workers' Compensation provislons ot t Labor Cotle, you must torthwith Floo� Sinks Urinal 9
comply wi[h suc� p�ovision5 or tttis p¢rTlt shall Ge tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV GasSelviCe Ou[let5 WatefClOset SWitCheS �� Sign
1 he�eby aifirm Ihat the�e IS a con5t�uttlOn I<n0ing agency fo� tne per(ormdnt¢ �
ot the work for which tnis permlt is issued (Section 309� Civ. CJ Interceptors Water Heater Garbage Disposal Standing Sections
lPnaer's Name
�entler's Atltlress Kitchen Sink Water Service Generator 045 KW �5-15 KW Trash Compacror
OWNER BUILDER DECLARATION
1 hereby dHirm Ihal 1 am eaempt frOm the Con(racto�'s LicenSe I..aw fo� the Lavatories AutO-WeSh
following reason (Section 7031.5 Business ana Professional Code: Any city or
'Gounty wnlcn requires a oermit to constru<t, alter, Improve, demolish or repair P—Trap Laundry Trays
any structure, prior to il5 ISSUance, a150 r¢quires the applicant tor Such permit
ro flle a signetl statement that he/she Is Ilcensetl pursuant to the provisions o( Roof Drains
the Contractor's License law (Chap[er 9(commencing with Sec[ion 7000) of
Division 3 0( the Business antl Professions Cotle) or tnat he/she is exempt Reinspeetion Fee $15 ISsue Fe6 $ 3
therefrom ana tne ba5i5 tor lhe alleged exemp[lon. Any violation of Settion � �
7031.5 by any apP��cant 1or d Petmil Subjects the applicant t0 a clvil
�enalty of not more lhan five huntlretl tlollars ($500). DEVELOPMENT SERVICES REQUIREMENTS:
LJ 1, as owner of lhe prooerty or my employees with wages as their sole Reinspac[ion Fee $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will tl0 Ihe work, antl the st�uctu�e is not intentleG o� ott¢r¢tl
tar sale (Section 7044, Business and Protessional Catle: The Contracror's � MECHANICAL FEES Building APP�oved By Date
Litense Law tloes nol dPO�Y �o an Own¢r ot a propetry who builtls o� imprOves
thereon, antl who tloes suCh wo�k himself/herself o� through M1is o� h¢r Own HOOd O! Typ¢ I ❑ %�PPIICetiOn ISSUBd By Det
employees, provitletl that such improvements are not intentletl or offeretl for Boiler
sale. Ii, howeveq Ihe bulltling or improvement is soltl within one year ot com- Canopy Type I I ❑ SUMMARV OF FEES
pletlon, [be owner will nave tna burtlan of provin9 he/she ditl not builtl or im- DuCt - U�d2� GrouOd
pr ve tor the purpose of sale). BUILDWG PEflMIT $ SMIP $
I, as owner oi the property, am ezclusively mntractin9 with licensetl con- Duct - Structurel Refrigeretfon System PLAN CHECK $ PERMIT
V ctor5 f0 ConsHuct lhe pro�ect (SeGtlOn 7044, Business antl Pro/e55ion5 Cotle:
The Contracror's License Law tloes not apply to an owner of property who Duct - Ventilating ❑0.100,000 BTU ❑100,000 BTU PLUMBING $� �SSUANCE $
builtls or Improves lhereon. antl who Contract5 fo� such oroi¢Cts with a r.on-
tractor�s I�cense pursuanc to �ne Conttacrors License Law). I am aware tnat Exhaust System ❑ Multiple ❑ Sysfem Repair/Alteration P�N CHECK 25% $ ENERGV P.C. $
proof o� their Worker's Compensation Insurance shoultl be provitletl to me. ELECTRICAL $ GRADING $
❑ 1 am exempt untler Section ' & P. C. tor this reason FirepVFacL 81t. �CBO dk Fire Dampers MICROFI LM $
��CkP�n�_, PLAN CHECK 50% $
oate [��— �� O , C(�-�—^ Heating System & Ducting Registers MECHANICAL $ TOTAL FEE $ %. ��
I hereby certity that I have reatl this application antl state that lhe above ❑o-1W,0008TU 0100,0006T
intormation is mrrett. 1 a9ree to compty witn all tlty ana counry ortlinancez PLAN CHECK 25% $
antl state laws relating to builtling conitructlon, and hereby authorize repre-
sentatives of t��'s ciyp, t ent n ne above-mentlonetl property tor
Inspection purp6se�. (S/' n� � Date �// 7��%
Signature _T�y% u— Reinspaetion Fee S15 laue Fee 3 3
�rivers' �Icense or ss � Ol 00048502-000<8502 TO T 7.00
ne�re >>i�oiQo TTM[. �o.�o
0065-46, rev. 5/98 Whit¢ - BWltling; Canary - ApO�icani; Pink - ACCOunUng; GOiaenr00 - ASSesSo�
r
,� CONSTRUCTION AND PLANNING POOI & SPA
i
APPROVAIS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
.. 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . �
• 5.' Steel Reinforcement 56. � Rough Plumbing & Pressure Test '
6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
� 7. Footings ' 58. Electrical Conduit-Undrgrnd. • ,
8.� Foundation ` 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgmd. "
10. Structural Floor System 61. APPROVAL TO DECK
11.. Property Sewer Line & House Connection . 62. Backwash & Receptor-Final
12.--Sewec Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final .
15. fiough 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 Co�di4ioning FIRE DEPT. REQUIREMENT
2Q� Rough Factory Fireplace =� APPROVALS Permit #
21. DuCts, in Structure '' 70. Underground Hydro
i ,
22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test !�� 72. Underground Flusti
24. Roof Framing ; 73. Undergrnd.StorageTank �Gas ❑Oil �
25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical ..�
27. Frame and Flashing • �.. 76. Dry Standpipe 1�,
28. Lathing & Siding � � 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFIGqTE 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 �2. (��
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation � �
44. Landscape Irrigation System �
45. Sound Attenuation �
46. Handirap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison -.
50. Gas Release to Southern California Gas Co ' �
r
51. CERTIFICATE OF OCCUPANCY - �
No. Date ,
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return oi, an owner-builder verification.
Attention Property Owner: •
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportuniry
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
I personally plan to provide the major labor and materials for construction of the pro-
posed property improvement. ❑ Yes ;� No
2. 1 (have/have not)
proposed work.
�� I have contracted with the tollowing
Name ��'P 7� /YI 'P YC e i
signed an application for a building permit for the
to provide ttie
.. _ -�
Address�U� �T �/✓r^(-�✓' City Fd2�n.'f'i4in/✓/�L(n,/ ('/�
Phone (''f �� 9��/ -���- Z Contracror's Lic. No.,��s�a 9
� I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address
Phone (
City
Contractor's Lic. No..
5. I will provide some of the work but I have contracted (hired) the following persons to pro-
vide the work indicated:
Name Address Phone Type of Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Satety Code and have completed the above intormation to the best of my per-
sonal knowledge, in compliance with this State law. �
Sighed: �'-- Date: f �^ ��—�1
Name: � L C— /l�
( rinted or Typed) �
C.D.L. # or S.S. # . (�. � ,�� %
754-5273
,o.:.e
COLLr,CE 2�'Srl COi:FANY
ADDRESS
COr17'RACTORThe Hale
AP. No.
GROUP
INSPECTION6
coat
DATE 9/
BllILDING PBRMIT NO. %S
VALUE$ 12
DESCRIPTION OF WORK Sin
TYPE V ZONE R1
DATE
SUBCONTRACTOR
PERMITS ISSUED
. � �7����
.,.
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 31�
COSTA MESA. CALIFORNIA
FOR
3UILDING
4DDRE55
TO FILL IN
COSTA MESA. CALIFORNIA
OWNER COLLEGE MESA COMPANY
MAi
no[
2277, Brookhurst Station
,
. ..� n � .. V ..� u � �.+ �. �
�- ,
, �f SI?�
�_... . ._ _�;'
:,,, -
...-- - r:,:,°,�.�� . _. ..
APPLICATION FOR PERMIT
� BUILDING
FOR OFFICE USE ONLY
RECEIPT NO, pEFMIT NO.
cirv Anaheim rNo: KE 3-3161 qooREss
4RCHITECT BulOt� QUl$ eY N'o: RE 7191 COSTA MESA. CALIFORNIA
DR ENGINEER and C1arK
____ __ __ . ..� .. _ . FIRE
�ONTRACTOR 1[72 11&1
ADDRE551��� W.LlII
LEGHL
OESCRIPTION NQT �O�
an -
A.P. NO.
OF LOT J 1 X 9H
USE OF
E%ISTING BLDG.
SETBACN LINE FROM
CENTER OF STPEET
VARD
VEW
��T� �o`: 7350
KE 3-3161 PPPROVED
BV
TRACTZ671
NO.OF BLDGS
IOW ON �or � None �
SO� REAR YARD Zf%�
RIGHT il� LEFT H�
DESCRIPTION OF WORK
%� ALTERATION ADDITION
4EPAIR MOVING OEMOLISH
BU�LDING 1253' -Liv. NO.OF
size 440' -Gar. aooms 5 sroRies 1
EXTERIOR WALL iY00F
=OVERING SCllCCO GOVERIN�,'OIIIPO
JSE OF NEW Sin ledwellin � w att. ara e
3UILDING g g / g g
TATE THPT TME nBOVE t5 CORRECI 4NO AGREE TO COMPLY WITH 4LL
ITV ONOINFNCES RND STPTE L4W5 REGVL>TING BVILOING CONSTRIIC�
�°" COLLEGE MESA COMPANY VAll1ATION
s�cNnruR�.�y: The Hale Company,Gen.�rtner
$ 12,890
.AIJS I. . _ / /
v
DATE �
CORRECTIONS
PERMiT FEE $ .3O.OQ
PLAN CHECK S iS. OO
TOTAL FEE $ L}S.00
�a.�
°: I
OWNER GOELLER� DONALD D. DATE 1y-21-59 .
10B ADDRESS 3�b7 Afurray Ln, ' BUILDING PERMIT NO. 90H�
INSPECTIONS
brown toat
Ninal G�s Test
Better Bilt Fence Co.
vacu6
TRACT PIRE ZONE DESCRIPTION OF WORK
YPE III ZONE Fl PLAN NO.
DATE SUBCONTRACTOR I
DATE
650.00
Block Wall
PERMITS ISSUED
I NUMBER
.mi�
` 9�8�
`COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA, CALIFORNIA
fOR APPUCANT TO f/LL /N COMPLETELY
TYPE OR PRINT
� MAIL
TEL.
NO.
�_�.n�:��Y-y
DESCRIPTION I NO? I V I I BLOCK I��
A.P.NO. u/�� � -J ���! (
SIZE �J� J I� I NO.OF BLDGS.
OF LOT /� /� NOW ON LOT
SET9ACN LINE FNOM /( � (/
C6NTER OF 6TREET �V � REAR YARD
SIDE YARD I LEFT � 6� I RIGryT -��
DESCRIPTION OF WORK
n�asc.»E-�:i
NO. OF
�E� RECEI�ED
L�.. _� � _.S 1 �� �
FIWANCE DEPT.
APPLI�AT`1'IOFV CFOTF� PPERMIT
BUILDING
FOR Off/CE USE ONLY
I ftECE1PT NO. I PEFMIT I
�
BUILDING
A�DRE55
FIRE
COSTA MESA. CALIFOR
tYi� �G �'�P
ZONING
NO. OF /j USE OF NI
PLANS ^1J BUILDING
(CENTEH LINE ST.)
FRONT
R.SIDE
<�� DA�TE
r E�uF �
ALLOWED
��
I65UED
J / � .
E%TERIOR WALL IROOF
COVERING COVERING
USE OF�UIL ING AND WORK TO BE PERFORMED .
/.S'8- Y�- S3 cow..
" �c CUa.G/
' v` � `� ✓�'
I HEREBY ACNNOWLEDGE THAT I HAVE READ THIS APPLICATION
RND STRTE THAT THE ABOVE IS CORflECT .�NO PGPEE TO COM- THE�RMOUNT SHOWN UNDER VALUATION IS FOR THE
pLY WITX ALL CITY ORDINANCES ANO STATE LAWS FEGIILATING . PURP08E OF ESTPBLIBHING A PERMIT FEE ONLY.
BOIL�ING CON6TRIlC���� VAlUAT1ON
SIGNATURE OF PERMIT FEE $ RU
PERMITTEE � � �'U -
$ D� PLAN CHECK $
AUTHORIZED AGENT ' TOTAL FEE $ ��