HomeMy WebLinkAbout1959 ORANGE AVE - Building Permits 11^
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AA. Nit
F CITY OF COSTA MESA
. ► @@ BUILDING DIVISION
F „_, �. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
o rwr PERMIT
01-01803
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1959 ORANGE AV Status: ISSUED
Suite: Applied: 11/13/2001
Vicinity: DETACHED GARAGE Issued: 11/13/2001
Parcel Number: 42603260 Zoning:
Applicant: WRONSKI, PAUL ISSUED BY:
Address: 27121 PUEBLO NUEVO DR.
Phone: (949)458-7556
MISSION VIEJO,CA Zip: 92691
Owner: OEHLERT, EMMETT M TR
Address 1943 SPYGLASS CIR
Phone:
VISTA,CA Zip: 92083
Contractor: TOP HAT ROOFING
Address: 27121 PUEBLO NUEVO DR
Phone: (949)458-7556
MISSION VIEJO, CA
Zip: 92691 License: 648632
Arch : Eng:
Address: - Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING DETACHED GARAGE FOR SINGLE FAMILY RESIDENCE(8 SQ).TEAR OFF EXISTING ROOFING,
INSTALL 2-LAYERS OF 15#FELT UNDERLAYMENT,&REROOF WITH 25 YEAR DIMENSIONAL COMP SHINGLES.
FEE SUMMARY
Plan Check: $0.00 - Calc Valuation: $1,500.00
Permit: $54.00 Claim Valuation: $1,500.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $54.50 •
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
2446413(WOO)
0 'il' 4
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ 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 workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
itlI certify that in the performance of the work for w ' h this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of C fertile an agree that should become subject to the workerscompensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these Imo s. // _/3 Ol
Applicant Signature: Date:
WARNING:FAILURE TO ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 DECLARATION:
I hereby affirm that tam license per ro isjpn f Chapter 9(commencing with Section 7000)of Division 3 of.the Buslnes and_erp(essions Code,and my license Is in full
force and effect.Lic.k A J LCIass
Contractors Signature: Date: /A—/3—r7)
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 perr4
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject Of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? yes No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
• Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pro y for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
A1 natureO Owner(s) Date
� '4 r uthorized Applicant i/Date — -
CODE I INSPECTION TYPE ✓ — DM INTMALS ;ODEI IN5PEC11ON TYPE fall MALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof bcrilf. 210 Final Electrical
201 Final Block/Retaining Wall • 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
•
CITY OF COSTA MESA
440S. BUILDING DIVISION
F ,„ ; ,I 8, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
cif . PERMIT
PERMIT
•
- di* f 601-01802
(714)754-5273 • Fax(714)754-4856 • www,ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1959 ORANGE AV Status: ISSUED
Suite: Applied: 11/13/2001
Vicinity: HOUSE ONLY Issued: 11/13/2001
Parcel Number: 42603260 Zoning:
Applicant: WRONSKI, PAUL ISSUED BY: /
•
Address: 27121 PUEBLO NUEVO DR
Phone: (949)458-7556
MISSION VIEJO,CA Zip: 92691
Owner: OEHLERT, EMMETT M TR
Address 1943 SPYGLASS CIR
Phone:
VISTA,CA Zip: 92083
Contractor TOP HAT ROOFING
Address: 27121 PUEBLO NUEVO DR
Phone: (949)458-7556
MISSION VIEJO,CA
Zip: 92691 License: 648632
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE(12 SO).TEAR OFF EXISTING ROOFING, INSTALL 2-LAYERS OF 15#
FELT UNDERLAYMENT,&REROOF WITH 25 YEAR DIMENSIONAL COMP SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,500.00
Permit: $83.25 Claim Valuation: $2,500.00
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)754-5626
2446.46(6/00)
ift .D'ECLARATIONS •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
9 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 workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less)
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'
-0''compensation laws o mia and agree that if hould become subject to the workers'compensation provisions of Section 3700 o the Labor Code,I shall forthwith
comply with these vlsi s. Ar/
r- Applicant Signature: Af /n v/. Date: /1/3— a
L_ -WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1o0,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am Iicens,Ad ung r.rovii}'ons of Chapter 9(commencing with Section 7000)of Division 3 of the Business and,g?ofessions Code,and my license is in full
force and effect.iLlc-tt T U G f • e'" Class tttQ C 3 7
Contractors Sigriatuie: - ang. . Date: --P/1- /7'01'
1
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a penr4'
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
9 I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need t0 file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 It 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 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si., aturJ4...)f Owft ri1) /f13 0I Date
troll/ ��(/ it —
/ -" n• a: : hona - z
ied A• 'ant iDate• --
CODE It, INSPECTION TYPE PATE INrrIALS CODEC INSPECTION TYPE PATS INTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 1/-27-01 -,�-�_V I'> 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
1/11,1-Et 9
_sj
JOB ADDRESS 1959 Orange Avenue - 00
_BUILDING PERMIT NO. 26150
GENERAL CONTRACTOR Owner-Bu lder DESCRIPTION OF WORK Stge. to Gm-age
AP No. 11$_054_20 LOT TRACT FIRE ZONE VALUE $ 1,100.on
INSPECTIONS I Signature Date GROUP ,T TYPE v ZONE p„1
SUBCONTRACTOR PERMITS ISSUED
G_ I Date I Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.0 M = .
Sprinkling System --
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole —
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches & Forms q Steel Reinf. 0 tra,.¢ 9-,9-6-G
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing 'y"' 4-26-66 =
Frame and Flashing 9-77--a.
Lathing— In 0 Out,rr'. (p- „- a 49,
Plaster, Brown Coat /
Structural, Final Elec .c
He ",g, Vent., Refrig. and A.C., Final 01int/Ia' 31E4131'
P; Ing, Final and Gas Test 0
Electric, Final SA 25.
Building. Final , , K.2.5.47
26150 SEP 13-66 00 314A3_****13.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
• P.O. BOX 1205 COSTA MESA, CALIFORNIA 9262E -
•
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT : BUILDING
/� For Office Us* Only
7. BUILDING 195-7 /y
J ADDRESS ( r (V - /actin NO. PERMIT NO.
(CALIFORNIA
COSTA MESA. (C
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CONTRA •R �' T,
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DESCRIPTION O
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NOTE: NO CAVE OVERHANG SHALL BE LESS THAN
4 STATE0. ` EI — 80'TO BIDE B REAR P•L.
Ft SIZE L/V / 1� -i " I NOW r LOT nixes. ALLOWED (U.B.C.REQUIREMENT)
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• USE OP //r� /I• _ YARDS APPROVED YARDS APPROVED
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SIZE / 0/I I(/ ROOMS I STORIES / ' C.V.P.# APPROVED f
EXTERIOR WALLY' I ROOF COVERING .. *YFROV[�4 DATE 9//F/�O
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USE OF BUILDING AND WORK TO BE PERFORMED p,
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I HERESY ACKNOWLEDGE THAT.I NAPE READ THIS APPLICATION d. THE AMOUNT SHOWN UNDER VALUATION IE POR THE G
AND STATE THAT THE ABOVE IR CORRECT AND AGREE TO COW PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
• PLY WITH ALL CITY ORM/NAMES AND STATE LA REGULATINGVALUATION 00 D
BUILDING CONSTRY N O
SIGNATURE OF PERMIT FEE $ 9 W
.s PERMITTEI 0141.44440.P y'1`T '• ��/
,- _f PLAN CHECK s -613I*.
�i. AUTHORIZED AGENT ,. SO
TOTAL FEE $ i�J
NGE COUNTY BUILDING DEPARTMENT
636 NorthBroadway
SANTA ANA, CALIFORNIA APPLICATION FOR PERMIT IT
BUILDING
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
RECEIPT N PERMIT NO.
BUILDING 1 7 � /� _ (2.5y is 1 7
ADDRESS / (�/Y��a_�- //X I ✓C
SCHOOL DIST. j - CEIVED BY DATE RECD. ATE ISSUED
OR TOWN `/� `��
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ADDRESS / SCHOOL DIST. �-
OR TOWN
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ARCHITECT OR LIC. ZO E NO. OF I TYy� I GR
ENGINEER NO. L/`L PLANS /�/y/ n
ADDRESS . APPROVED ?.Q
/ LIC. BY DATEN
1NTRACTOR NO. • CORRECTIONS
ADDRESSLEGAL LOT
7
DESCRIPTION I NO. 9 I BLOCK I TRACT/I t
(ATTACH METES & BOUNDS)
SIZE OF LOT 6/X ODG/ / MNOW. OF ON
BLLOTS. 0 a
USE OF / I NO. OF I NO. OF
EXISTING BLDG. FAMILIES ROOM
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SETBACK LINE FROM: se REAR YARD S "/
CENTER OF STREET SIDE YARD /
DESCRIPTION OF WORK 0
NEW I ;%'/I ALTERATION I I ADDITION I • °
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APPROVALS
FOUNDATION: LOCATION INSPECTOR I DATE
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS FORMS. MATERIALS, 0 • /@
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING J� - I ' f.J•
���.
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. ('j
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING. BOLTS �//�'.J�t
,O LATH. INT. ��/��
SIGNATURE OF /- /� r LATH. EXT. ./2,' //-/,
PERM ITTEF �%I �'L^k
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PLASTER. INT.
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PLASTER, EXT.
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PERMIT FEE S/ MASONRY REINFORCED
VALUATION $ / s o PLAN CHECK S 3-
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COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT
636 North, ALIFORy
BUILDING
SANTA ANA, CALIFORNIA
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
RECEIPT PERMIT NO.
BADDRESS ' V UD DI `� a_. Z i
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SCHOOL DIST. ((JJ
OR TOWN •••- RECEIVED DATE RECD. DATE ISSUED
NEAREST ' ^ y £?D' NGqS7
/A" ��„� Y -��
CROSS Si. to !l ���"'YYY}}} , U
OWNER 11 ADDRESS q,//
MAILSC- tIOIJ [.I�l u lid,
ADDRESS OR TOWN OOL IST A 11^
CITYCOSTA MESA, CALIF. NO. NEAREST Ojtree
CROSS ST.ARC
ENGINEERNO.
OR LIC. O. OF I TYPIE I GROU
NO. CCC/// I PLANS SI/
ADDRESS
APPROVED ��j i
A7CU11VC NI. nuLJl LIN i1 . Lie BY DATE JJJ
I `NTRACTOR 1So ` 1T Sa NO.
nODRE55
COSTA MESA, CALIF. CORRECTIONS
LEGALLOT 4Q' I (i
DESCRIPTION I NO. I• BLOCK I TRACT /r/�d
(ATTACH METES a 4OUNDSb
61 /X / I/) I NO.OF BLDGS. 72)SIZE OF LOT NOW ON LOT
USE OF �� I NO. OF I NO. OF
EXISTING BLDG. FAMILIES ROOMS
SETBACCENTERKOFINE STREET 1OM: )2 3 SIAR YARD fi 5-
DE YARD
DESCRIPTION OF WORK - $
NEW I )K I ALTERATION I I ADDITION I - Z
D
REPAIR I I MOVING I I DEMOLISH I _ _ _ r
BUILDING B i NO. OF
SIZE CO 0� ROOMS / STORIES / /1
EXTERIOR WALL Lryf- _ ROOF /�� /w/ /
COVERING II'_CCOOV—ERING✓,-7,-,A ..g ,_-_.......,,r �-
"SE OF NEW (J 'Vj //
'LDI NG `�rty�®
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APPROVALS
FOUNDATION: LOCATION INSPECTOR DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS, �it� 11/1 ;J •
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APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING /�/
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME
BR: FIRE
ACINGSBOLTS 13 /y45, 14.
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
/JM 1 LATH. IIT.
SIGNATURE OF /w {7- / 1 _ LATH. EXT. 3 J1,rs3
PERM ITTEF VVV---/I' I 0 ' r
i PLASTER. INT.
•
AUTHORIZED ACT. PLASTER. EXT. / �J
PERMIT FEE S ir MASONRY REINFORCED
VALUATION $
9 20 0 PLAN CHECK S I/ BOND BEAM �/�� �< �J
Sank FEEAL s ` / FINAL r 5 �3 J
SM 9-90.99 I
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PLOT PLAN . 71
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. property lineand between buildings. - `
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