HomeMy WebLinkAbout2546 OXFORD LN - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2546 OXFORD LN
Suite No
Vicinity:
Parcel Nunmber: �4137929
Applicant: WILLIAM O'ROURKE
Address:
Owner: O'ROURKE, WILLIAM P
Address 2546 OXFORD LN
Conhactor:
Address:
Arch / Eng ;
Address:
ISSUE FEE
Backflow irtigation
Backflow Preventer
Bathtub
Clanfier System
Conned pce,Soda,elc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Dnnking Fountain
Expansion Tank
COSTA MESA, CA
PLUMBING PERMIT
Phone: 432-1236
Zip:
Phone:
Zip: 92626-6123
Phone:
Zip:
License:
Phone:
Zip:
License:
Status; ISSUED
Applied: 12/04/2003
Issued: 12/04/2003
ISSUED BY: S/�\
SCOPE OF PERMIT
INSTALL A SINK IN BREEZEWAY, WATER REPIPE, ADD A SECOND GASLINE TO EXISITNG
FIREPLACE.
AMT
$23.50
50.00
ao.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 Landscape Irrigation $0.00
0 P-Trap $0.00
0 Pressure Regulator $0.00
0 Process Piping (per 10 ft) $0.00
0 Receptors $0.00
0 Septic Tank $0.00
0 Sewer Cap for Demo $0.00
0 Sewer Connect $0.00
0 Sewer Private Line $0.00
0 Shower $0.00
0 Sink, bar $9.80
0 Sink, commercial $0.00
Qn
0
0
0
0
0
0
0
0
0
0
0
1
0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1d)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
water Closet (ToileQ
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$O.OD
$0.00
$9.80
QTY
0
0
0
0
0
0
0
0
0
0
0
0
1
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No, g248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPEC710NS: In order for the work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and all
required Inspectiong and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (774) 7545626
zaassa ��vao�
WORKERS'COMPENSATON DECLARATON: �
I hereby eXirm under panalry of perjury one of the lollowing tlecleretions: '
❑ I have end will melntain e certificate ol consent to self-Insure tor workars' wmpensatlon, es proNtled for by section 3700 ot the Lebor Cotla, for the pertormence of the
work lor which ihis pertnit is issued.
❑ I �ave and will maintain workers' compensation insurence, es reduired by sectlon 3700 of Ihe Lebor Code, for the pedormance of Ihe work lor which this pertnit is Issued.
My workere' wmpensation Insurance carner and policy number are:
Carner: Policy Number.
(Tbis secfion need nof tle completed il the permit Is valued et one hundred dollers ($ f00) ar IessJ
❑ I Certily lhet in the performance of the work for which this permit is issued, I bhell noI employ eny person in eny manner so es to become sublect to ihe workers'
compensetlon laws ot Califomla, and egree Ihet If I should become sub�ect to iha workers' compensation provislons of Sectlon 3700 of lhe Lebor Code, I shall forthwith
compty with these p�ovisions.
Appllcent Signeture: �ete:
WARNINO: FAILURE TO SE�1RE WOPKERS' COMPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBJEGT PN EMPLOYER TO CPIMINAL PEMALTIES ANO CML FlNES UP TOONE HUNDRED
T110USAND Dq1ARE (510�.�1. IN ADDITIdJ TO THE CQST OF COMGENSATION, DPMAGES AS PROVIDED FOR IN SECTION 3]O60F THE IABOfl ODDE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn that I am licensed untler provisions at Chapter 9(wmmencing with Section 7000) of Division 3 of the Business end Professions Code, and my license Is in full
brce end eHecL Lic. M Cless x
Contractor's Slgnature: Date:
CONSTRUCTION LEND�NG AGENCY:
❑ I hereby ettirtn that there is a consiruction lentling agency for the pedormance of the work lor which Ihis permit is issuetl. (Sec. 3097, Civil Code).
Lender'S Neme: Lender'S Address:
Slgnature: Date:
OWNER•BUILDER DECLN�ATONS:
I hereby aRirm that unde� penelry ot perjury (het I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Busineu end Profeulons
Code: Any ciry or counry which requires a permit to consirucL alter, improve, demolish, or repair any structure, prior to its issuance, also requires the epplicani For such permil
to lile e signetl statement ihat he or she is Ilcensed pursuant to ihe provisions of the Coniractors License Lew (Chapter 9(commencing with Sectlon 7000) of Divislon 3 ot Ihe
Business and Pmfeuions Code) w that he or she is exempl therefrom and Ifie basis tor ihe efleged exemption. Arry v�olalion N SeMion 7D�1.5 by eiry appVicant for e pertnit
sublects tha epplicant to a civil penalry of not more than tive hundred dollars ($500).):
❑ I, as owner ot Ihe propeny, or my employees wlth weges as their sole compensation, WILL DO 7ME WORK, and Ihe siructure Is not intendetl or oHered for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does not apply to en owner of properry who builds or im0�oves thereon, and who does such work
himself or hersell or through �is or �er own employees, provided ihat such improvemenis ere not intended or oflered for sale. If, however, the builtlinq or improvemen� is
sold wiMin one yed� of completion, the owner-builder will hava the burtlen of proving �hat he or she did no� build or improve Por purpose ol sale.). �
❑ I, es owner of tha property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business and Professions
COGe: The comrac�ors License Lew does nol epply �o an owner of property who bullds or Improves Ihereon, and who contracts for such project with a contraaor(s)
license pursuenl to the Contractors License Lews.).
❑ I em exempt untlef e Business antl Protessions Cotle for this reason:
,.� Signature: / oate: 12r�f-03
Owner ID verilietl by tlriVefs license. ❑ Ves� ❑ No DnverS License No. l Expires: II • IW • n�
Veritication ot Ownership hy (rype ot document, i.e. - property taz bill or tleetl)�.
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICA710N:
❑ I hereby certiy Iha� no excavatlon five (5) or more teet in deplh into which a person Is requlred to descend, will be made in connectlon with work authorized by this
permit, entl Ihat ntl building siructure, scaflolding, fal5ework, or demolition or Cismantling thereof, will 6e more then Ihirry�six (38) teat high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title 8, CeOtOmia Adminis[rative Cotle).
❑ As ownerbuilder, I will not employ enyone to do work w�ich would require a permi� trom tha Division of Indusirial Safety, es notetl above, unless such person hes e
pertni� to do such Wark fmm ihe division.
Signature: Date:
Division oi Indusirial Sefey Pertnit Numher:
CERTIFlCATE OF COMpL�ANCE AND AUTHORIZAl10N OF ENTTiY: I certity under penelty of perjury that I have reatl this epplication antl staie Ihet ihe iniormatio� given is
correct. I agree to comply with all slete I s end city ordinances relating to builtling consWcilon, end authonze representatives ol the City ot Cosla Mesa to enter upon Ihe
above-tlescnbetl proper(�' 1griRjR��an �i poses. I egree not to occupy or allow occuDancy ot eny building authonzed by this permit until final inspaction. /
Antl/Or Authodzetl Appllcant
COUE �. INSPECTIONTYYE
76�6 FIxeO System Final Fire Preventlon
1286 Pool Spe Final
200 Finel Re-ROof
201 Final BIocWRetaining Wall
202
203
�3:ii
Final Fectory Fire Place
Final Sign
Final Demolitian
QdIE 1tIIID,lfl
COOE� INSYECTIONTYPE
206 Final Mechanical
20B Final Plum6ing
210 Finel Electncal
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Date
Q�Tf. It�E4fl
lL Z3 -03 �
:.
:..�
C''.�t�y o� L'',Qa.ta. ��a �u�;�� D��
OWNER-BUILDER
VERIFICATION
A city or county, which is rcyuired to give notice pursuan� to Section 19R30, shall attach to such noticc, and,
as a condition precedent to issuing a building permit, reyuire the comple[ion and require the rewrn of, an
owner-builder vcnfication.
Attention Property Owner.
�
An 'owner-builder' building permit has been applied for in yuur name and bearing your signature.
Please complete and re[um this information in the envelupe providcd at your earliest opportunity tu �vciid
unnecessary delay in processing and issuing your building pennit. No buildine permit will he issued until ihis
verification is received.
1 personally plan to p vide the major labor and materials f'or conswdion of the pruposed
property improvement. Yes ❑ No
2. I(have/have noq _
thc proposed work.
signed an applic.uion for a building permii fur
.l. I h�rvc contractcd with thc following persun (�im�) to providc Ihc proposed conswction:
Name �
Addresti
Phone (
Ciry _
Contraciur's Lic. No.
4. 1 plan lu provide portinns of the work, but I h�vc hired thc fullowing person to coordina�c,
supervixe and pruvidc the major wnrk:
Name
Address _
Phone ( )
City _
Contractor's Lic. No.
5. I will provide some of �he work but I iiave conVacted (hired) Ihe following persons to
pruvide the work indicated:
Name
iMp�a6 (REV 9I98)
Address
Phonc Typc of Work
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��SCTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
2546 OXFORD LN
14137329
WILLIAM O'ROURKE
Owner: O'ROURKE, WILLIAM P
Address 2546 OXFORD LN
COSTA MESA, CA
Contractor.
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+unils)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motors to 100hp
Motors over 700hp
Communication drops
Sub panel to 200a
Pole Light Pkg
SERVICE UPGRADE TO 200AMP.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantiry
Phone: 432-1236
Zip:
Phone:
Zip: 92626-6123
� Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 R
Standing Section
Misc ElecMcal Equipment
Transformers up to 1 kva/kw
.................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Winng System / Ckt
Misa Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Inves[igation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 12I04/2003
Issued: 12/04/2003
ISSUED BY: ��
Quantity
$0.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00' 0
$0.00 0
$0.00 0
$0.00 0
$0.00 ' 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
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 antl become void Ii work is not commenced within 780 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
requlred 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
2468-46(fi/00)
"7
�
WORKERS' COMPENSA710N DECLARATON: -
I hereby aHirm under penalty ot perjury one of ihe following declaretions:
❑ I have and will maintain a certificate of consent to self-Insura for workers' compensation, es provitletl for by section 3700 of the Labor Cotle, for the peAormance of the
wark tor w�ich Ihis permit is issued.
❑ I have entl will mainta�'y� workere' compensation insurence, as requiretl by section 3700 of the Lebor Code, tor the pertortnance of ihe work for which ihis pertnit is issued.
My workers' comper�6ation Insurence carner end policy num6er are:
Carrier: Policy Num6er.
(This section need not be completed i! fhe permit is velued at one hundred dollars ($100J or less.)
❑ I certify that in ihe performance oi the work for which Ihis pertnit is issueQ I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Californie, antl agree thai it I shoultl become sublect to ihe workers' compensation provisions oi Section 3700 of ihe Labor Code, I shall tonhwith
comply wilh ihese provisions.
Appliwnt Signeture: Date:
WARNING: FAILURE TO SECUFE WORKERS' COMPENSATIQV GOVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENPLTIES AND CIVIL FINES UP TO qJE HUNORED
THOUSAND DOLLARE (5100,000), IN AODITION TO THE COST OF COMPENSATIIXJ, DAMhGES AS PROVI�ED FOR IN SECTION 3]O60F THE LABOF WOE, IMEREST, AND A7TORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I em licensetl untlar provisions of Chepter 9(commencing with Section 7000) of Division 3 of the Business entl Professions Coda, and my license is in full
force and ettect. Lia u Class N
ContractoYs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm ihat ihere is e consimction lending egency tor ihe pedormance of the work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirm Ihet under penalry of perjury that 1 am E%EMP7 FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Protessions
Code: Any city or county which requires a permit m constmct, alter, improve, demolish, or repair eny stmcWre, prior to its issuance, elso requires the applicant for such permit
to file a siqned statement that he or she is Ilcensed pursuant to Ihe provisions of the Contractore License Law (Chepter 9(commencing with Seclion 7000) of Division 3 of lhe
Business and Professions Cotle) or ihet he or she is exempt therefrom and the basis tor the allegetl exemption. Any violation of Section 7037.5 by any applicant for a permit
subjects the applicant to e civil penalry of not more than tive huntlred tlollars ($500).):
❑ I, as owner of the property, or my employeas with wa9es as their sole compensation, WILL DO THE WORK, antl Ihe structure Is noi intendetl or ottered tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work
himself or �erself or ihrough his or her own employees, provided ihat such improvements ere not intended or oHeretl for sale. It, however, the building or improvement is
sold within one year of completion, the owner-builtler will have the burden of proving ihat ha or she did not build or improve for puryose of sale.). '
❑ I, as owner of tha property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct tha project (Sec. 7044, Business and Pmfessions
Code: The contractors License Lew does not apply to an ownar oi propeny who huilds or Improves ihereon, and who contracis for such project with a contrecior(s)
license pursuant ty,�he Coniractors License Laws.). / ,
❑ lam
Signature:
Business antl Professions Cotle for this
Owner ID verified by 4riveYs license. ❑ Ves ❑ No
Venfication of Ownership by (type ai dowment, i.a. - property tax 6ill or deedj:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Driver'S License No.
Date:
Expires:
❑ I hereby ceriify that no excava�ion five (5) or more feet in tlepth into which a person is required to descentl. will be made in connec�ion wiN work authorizad by Ihis
pertnit, and ihat no buildinq structure, scaHolding, falsework, or tlemolition or dismantling thereof, will be more Ihan ihirry-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Californie Adminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require e permit from the Division of Industrial Safery, as notetl above, unless such person has a
permit to do such work irom Ihe division.
SignaWre: Date:
Division of Intlustrial Satery Permit Number:
CERT1flCATE OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I certify under penalty of perjury Ihat I have read this eppiication and stete that ihe IMormation given is
correct. I agree to pl with I tate laws and city ordinances relating to builtling consiruction, end authorize representatives of Ihe Cliy of Costa Mesa to enter upon ihe
above-descrip � e :tion purposes. I agree not to occupy or allow occupancy of any building authorized by ihis Oermil untii final inspection.
In / Iz-a_a� �
And/Or Authorized Applicant
COOE �. INSPECTION TYVE
7616 Fixed Sys�em Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Roof
201 Finel Block/Retaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
pSjE IM1711L5
CODE I INSPECTION TYVE
206 Final Mechanical
20B Final Plum6ing
210 Final Elecirical
212 final Fire Prevention
220
222
250
Final Planning ApOroval
Final Site
Final Building/Occupancy
PAIF I[�{�"
1 �
�,A
`
C'',�t�y o� L.ovta ��leva �u�:�duuy Du.� ". . :
OWNER-BUILDER
VERIFtCATtON
�
A city or coun�y, which is reyuired �o give notice pursuant tu Section 19R30, shall attach to such notice, and,
as a condi�ion prccedent to issuing a huilding permit, require the completion and require the rctum of, an
owner-buildCr vcri�ic:uion.
Atlentiun Pmperty Owner: � .
An 'uwner-builder' building permit has becn applieJ fur in ynur namc und hearing your sign�lure.
Please complete and retum this information in the cnvclupc provided a� yuur earliest opportuni�y lu avuid
unnecessary dela}' in prucessfng and issuing yuur huildin�, permii. N�i buildin� nennil will be issued un�il this
verificatinn is rec�ived.
I personally pl:m io p�vidc Ihc major lahur �nd matcrials fur cunslruc�ion of lhc pruposcd
property improvemenL Yes ❑ Nu
2. I (hnve/have nut) _
Ih� prnp�iscd worA.
signcd an applicalion for .i huilding pertnit G�r
3. I h;n�r cun�ractrd H�ith ihc fullnH�ing persun (tirml tu pruvidc thc propused conslruclion:
Namc
�
Adclrcs.s _
Phona l )
City _
Contr;�nur's Lic. Nu.
I plan io pru��idc puniuns uf ihc ��•urk. hut I ha�•r hircd ihc fullowing prrson io cnurdinatc.
supcn�isc :md pruvidc thc m:ij�x �cnrk:
U,unr
Addresti
Phone (
City —
Contractor's Lic No.
S. I will pr�rvide s��me �( Ihe work buI I iurve cuntr.icted Ihiredl Ihc following persons tu
pru��ide ihe wnrk indicmed:
Nemc
ifu?.aq �REV 99P1
Address
Phonr T�pc of 1��ork
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��DING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2546 OXFORD LN
Suite:
Vicinity:
Parce� Number: 14137329
Applicant: ZAIDI, SYED
Address:
Owner: OROURKE, WILLIAM
Address 2546 OXFORD LN
Zoning:
Phone: 714-404-9752
Zip:
Phone:
COSTA MESA, CA Zip: 92626
Contractor: PRECISION CONST & ROOFING
Address: 1115 EL CAMINO
COSTA MESA CA
Zip: 92626
Arch :
Address:
Phone: (714) 404-9752
License: 658880
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 10/O6/2000
Issued: 70/06/2000
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF, INSALL ROCK AND HOT MOPPED ROOFING PER CODE. INSTALL 5 SKYLIGHTS PER ICBO #
2469 STANDARDS. NO CUTTING OF ANY RAFTERS OR JOISTS PROPOSED. ROOF PITCH IS 2 IN 12 PER APPLICANT.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
I nspection:
Total
$90.51
$139.25
$0.65
$0.00
$0.00
$0.00
$230.41
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$6,500.00
$6,500.00
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 ii work is not commenced. within 180 days, or if work is suspended or abandoned
for a period of 780 days. '" '�
INSPECTIONS: In order tor ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will resutl in the expiration of this permit.
FOR INSPECTIONB CALL: (714) 7545626
2ane-ae (�voo1
WORKERS' CON,YENSATI9N DECLARATON:
I hereby eHirm untler penalry ol per�ury one ot Ihe following tleclaralions: � �
❑ I heve end wi�l meintain e certificate of consent to self-Insure for workers' compensation, es provided tor 6y section 3700 of �he Labor Code, for t�e pertormenca ot ihe
work for which t�is pertnit is issuetl.
❑ I have flnd wil� maintain workers' comp sation insurance, as required by section 3700 0l Ihe Labor Code, for the peAortnance of tha work for whi� h this pertnii is issued.
My workers' Compensa[jOp jpsuranc ariie+ enA policy number ere: .�(�,, `
Cerner. ��V � �i UV �
Policy Number.
(This secfion need �at be compfBfed i! M e ermit is velueC af one huntlred dollars ($100) or Iess.)
❑ I certify that in the perfo nce of e work for which this permit is issued, I shall not employ any person in eny manner so as to becom ubject ta the workers'
compensetion �aws of C I r e, antl egrea thet It I shout0 becoma sublect to Ihe workers' compensation pmvislons of Section 3700 f the Labor Code, I shell forthwith
comply wit� tpese provi / T�� /�
•App wnL�gnature� J Date: u
WARNING FAILURE TO SECAHE WORKERS' CAMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBIECT AN EMPLOYER TO CFIMINAL PENALT ES AN CIVIL FlNES UP TOONE HUNDRED
T/IIXISAND OOLLARE (E100,000), IN AD�ITION TO iHE OOST OF COMPENSATION, OAMAGES 0.5 PflOVIDED FOR IN SECTIIXJ 3lW OF THE LABOR CODE, INTEREST, AN� ATTORNE`fS FEES.
LICENSEO CONTPACTORS DECLARATION:
1 hereby atfi�m that � am liceaseA undar provisi<
force antl eflea. LiG. N- 1�
wiN Section 7000) ot Division 3 ot the Business and Protessions Coda, antl rtry licanse is in tull
— Cless #
Date: D � %rC
CONS7RUC710N 4ENDMG AGENCY:
❑ I hereby alfirm ihat ihere is a construction lending agency lor ihe perfortnance ol lhe work for which t�is permit is issuetl. (Sec. 3097, Civil CodeJ.
LenOefs Name: Lenders Adtlress:
Signature:
Data:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn Ihat under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business end Protesslons
Cotle: Any ciry or counry which roquires a pertnit to construct, elter, improve, demolish, or reDair any structure, prior to its Issuance, also requires tne epDlicant far such pertnit
b tile e signed siat�ment that he or she Is Iicensetl pureuant to the provisions oi Ihe Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Didslon 3 01 the
Business and Professions Coda) or that he or she �s exempt therefrom and ihe besis for ihe elleged ezemption. Any violetion of Section 7031.5 Dy eny epplicant for a permit
suDjects the applicant to a civil penalty ol not more than five huntlretl tlollars (5500).):
❑ I, as owner ot the property, or my employees wlih wages es their sole wmpensation, WILL DO THE WORK, and the structure is not intended or oHered tor sale (Sec.
7044, Busine5s antl Professions Code: The Contractors Licensa Law dces not appty Io an owner of property who builtls or impmves thereon, antl who does such work
himseN or herself or ihrough his or her own employees, provitled ihat such improvemenis ere not intendetl or oHered for sala. N, howaver, �he building or improvement is
sold within one year of completion, the ownerbuilder will have the 6urden of proving t�at ha or she tlitl not build or improve for purpose ol sale.).
❑ I, as owner of the property, em E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business end Professions
Cotle: The coPtrectOrs License Law tloes not epply to an owner of properry who builtls or impmves thereon, entl w�o contracis for such project with e coniractor(s)
Ilcense pursudnt to iha Contwclors License Laws.).
❑ I am exempt Untler sec. Business and Professions Cotle for this reasan:
Signeture: Date:
Owner ID veritied by dnvers license. ❑ Yes ❑ No Driver's License No.
Verifitation of Own6�ship by (Iype oi documenl, i.e. - praperty lez bill or deetl):
Expires:
DIVISION OF INDUS7RIAL SAFETY PERMI7 CERTIFICATION:
❑ I hereby certiy Ihe� no eacevetion tive (5) or mora tael in tlepih into which e person is required to descen4 will ba metle in connection wlt� work authorizetl by this
pertni�, antl ihet no building struc�ure, scaHolding, telsework, or demolition or dismantling ihereof, will be more lhan Ihirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Celifornia Adminisirative Code).
❑ As owner-builder, I will not employ enyone to do work which would require a pertnit fmm the Division af Industnal Safery, es notetl ebove, unless such pereon hes e
pertnit to do such work irom the divisian.
SignaNre: Date:
Division of Indusinal Safery Pertnit Numbar:
CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTAV: I cenify under penalry of perjury that I have reatl this epplication and stata that the infortnation given Is
correct. I agree to comply with ell staie laws en� ciry ortlinances relating to building consiruction, and authorize representatives of Ihe Ciry of Casta Mesa to enter upon ihe
ebove-descnbed propeny for inspection purposes. I eqree not to occupy or aliow occu0ency of eny building authonzed by l�is permit unlil finel inspection.
yQ1jf�, INSPfCTIONS'�PE
7616 Fixed Systam Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-RJot
201 Final BlocklRe�aining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demdition
PAg UI��S
/O^Ig--c� �
/ b � at
� Date
CApEt {NSVECTIOMTfPE
206 Final Mechan�wl
20B Final Plumbing
210 Finel Electdca�
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupency
�.� .mi.:
� �
?d1�5/290� i4:?7 939-�74-1336
� ' �re c i 5f v-�. �aa�tn�
__�._____._____� � �� �
TAYLAR AND ASSOC
�i
�..,c i(9—',;75l—Z331
__ �.--.-.-.
30T30
_-5� 1i �
. y ,�...-._�.
�,
-- --. --- __-_.-�--- --..._...---- _ __..--�---------_--.. __�.�.�.�fi' _.------
Yt �—B�l[�,ik;�i-0�- �i• Jil.i�sl>;� ,Ar-F i �----
---... ..._..�---..�__. � sfD_1-- .�-�tr,
' GB J� crrY c�F:CCSTF, MESA
_.. ..__.. ._--..._ ..__...L .._.._........._agG�'L- __.__....___ ...._�.��e..a�r.r:.II..—___..�—
� c� 6Z�
. _. ..----- -----._._ ----_ __ ---- rn_ �^ ��
�---- - - __.
This set of plans xnd specJiG3! ufi5 i:i�{ �B 4eFi Ofl (h,IS �C; JI 3II �G?c5 3: A il is tl�� �'+n.
_..._.__._ ...--�-. ....__.. .----....,._.. . _.,.... ......._......��:aerychar:�scra4c�rai�,-c��;rsw�hn�ur.:anaeacis�matremlt:sJ,h�:6?�aSrl.G�'�----....
anda'afely,Ci;•�::� Cc=.ta�;ic�. .
..... . .._.,....._......._ ... ....... ........___. ._._ ..._ _.... 1heslamEnngotHrsplanardsp:�i;eauort�6FPLI:JGTb�i•>atc.pe.rmAortaheanappruvaL_.._....
� �of the violation cf sny pro�+isiar.�� nf 30:; Ci�t +�1 C.c=�a � 1�� � Jrdinance anNor State law.
. . . . ............... _......,....._ . .. ,......, , ...._ .._ _...,
....,. _
ffies='pGris'an�pqm;itsh'aGe�ireu�;imnctionzi::'�ex^�r�-:andYoidiFihebu� ing.�r..,—_......
work is not comm . se9 ani! .<;ata�v.r �ci!va ��er L:C ;3G� Idi -rrr �i:. :;� :. :� of issuance.
PAGE 01
nr-�Essaeunara: ZS4f QXFORD LN '
owi:�SwwEiFa�av�+ HURGE, ERNESTINE A
woniss:2546 OXFORD LN
COSTA MESA,CA 92626
wr�. wuuHc �ooxesx
uNr:
1XCHRECTOXFNtlNEEfl: IJC.N�.:
ANCN. OP ENQ'4 ADDRESS: UNf:
coeire�cTarsru�: LEE ROOFING ( 714 ) 642-7223
� cam�crarswuiwa 1653 SUPERIOR
,mnxess COSTA MESA CA uar�o.: 349686
92627 uxr:
UCENSEO COMRRCTOfl4 DECL�flAT10N: 1 Mreby efltrm uMs penetly d perjury iMt I em licensed u�Mer prmieima d Gheqar 9
(mmmmriiq hilh Secibn 1a00) d Diriaun � d ihe Buri�wn eM Pmlmeian Cade, enE my lioeme o in lull face and aNed.
�ic.no.:028751 uacuss: C-99 uc.No.: 349686 EXP: 03/97
�p�pWlil BUILUEN DECIARATON: I Mreby etFrtn uMm penely d per1N^/ OW I em axemq Imn tM Comreaae lioeiue lew la IM
. lylbxiq renwn (Sad'pn ]W 1.5 Buaiima eM Proteavme Cade: My rly n cvun7 �✓� nVu"vas e pem�il to canWcl. Ms.'vnprow.
;�'mdsh, a rapei eny svuctwa. pm io ne'vauenro, ebo requires IM epplimnl la wch pmdl lo fib a e'rywd eltlement Uut M u eM
�6:=�ironseE punuent io iM praa»iom d Na Lonirmae licenae lew ICMqer 9(oommendnp wil� Sedion 1000) d Div'sion J d tlr
-��ama eM Prdeaoru CoEe� a ihn he ar �e n e�emq �Mehan vM Ihe bmb la Ihe dbped ssamqun. My violelion d Setlun
]031.5 Ey eiry epplicem la a permil wbpde IM eppli�am to e dnl paroM1y d m� mon ihenlve hunEmE Edlen �fSW��.
� I. m owner diha poGeMw mY emOM�a xvh we0a+n ihai ede camVensetion. r.11 do Ns woM. erd Ns eMKYun e nal iMended
aoRerad fareeb (Se Yion ]Oas.Bmrev erd VMmsauCoda: TMCanlretlas licertie lewdoea ml xVCNto an anrr d popairy
wla WiEa a inP�+m IMreon. eM who does au h xak IimrM «Mnd «Nrwqh Ae a M own em0��. pw� IM wch
impovemend ue nd imeMed a a11meU 1« eeb. X, Mwmer, iM Euitli�q a inpovemeM u ealtl wilhin ans yaer d canpletbi. tlw
oxmarbuitlar till heve �M burden d provinp he w eM1e did iM Euik a impv+e la IM Wryoee d eebl.
� I. m o�mer d IM paperry. em e�chnivef/ aomretlip Mil� littnaed canlreclm lo mmtrW Ns pqetl (�4^ 10U. Buamees W
�
PMessiona Gode: The Comredav Licenx lew doee nol e00N b en ohner W D�W�Y xho builds a Impw'w �haeon ud Mn
eonnaem lor wN prqeqa wuh e mMrodm(e) lieemad Wnuent ta tM Comreqors Lieanaa lew�.
� I am ezemq uMr:acuon: B. 8 P C., br Ne iee�an:
I do haeeby eenEy Nm I am aware d eM uMx1e�M ihe myui�mmmd d CeBanie NeeM ud Sdaiy Code Sauian uws. 2551�. end
]5534. eM ihe� 1 n ury Mun Nikup ocaWant will / wil ml (�b aw) � to canply w1h eeiE eleb wdm md �Ir ieRumn«m b
aWmmloromsWCYionamodifWionhanlMAiaw yTl�vupemem0ipria.H�ddeMilmntlrutlonWO�iomeroaumqhamUaes
a�.
Dme: ApW�eM:
WOPKEN'S COMPENSATON DECL1N�710N: I hareby elfimi uMx pwully W pe�ury ane d Ne IoOowiip Eedutliom:
� Ihareeedxilmantenem�ifratedwneentioeett♦nwreMxwkan'eanpamation.npovidediabySerJion910Dd�Mleba
COJe, tar IM pertamerca d the wvk Ia wlich Nia pemm is iseued.
.n I hma uM vril meiMen v.oM1ei+' mmpen�elion inwreM.e. m ism�iied by Seqian 3)00 d Ms lebor Cada. br IM perbrmencs d IM
n' ..an��«�.nw��w.p.mmaa.�a.uv��"STATE � FUND ����um�u• EXPIRES
c�«
va�N�me«: — 06/30/97
i mis seeiar neea m� ae mn'Waree � ine oa+�x w ro. on. n��dne dd�ers R+ool a w.�
� I cerl!/ �I�q in the pMomarra d ihe wwk for xfich thie peimit u oeuW. I alull nd mmploy erry penon in ury manmm eo m lo
bacoma wbjed lo ihe xvrkere' compense�ion lavn d CdAaniq eM ap�ae Nm d I ehouM become eubjaf to IM xakon'
cwnpanaeiion prouiwsb'ns d Sadion 3]00 d IM lebor CoEe, I ehdl IqrlhMh com ihma pmvi '
�� �'Y ��i__ �vwicenc //` �. �•
�
W Inp: FeNuis ro securoTiro�lron'rompxuetlan rovsnps l� unlewNl, end �h�/l subJ�ef �n xnploysr to cNminel pmalUu mM
uHl nriu up ro ww nwared rMuuntl do/l�nlSt00.0WA �n eMJltlon ro M. cost ol rompxuerron, Grrrpu u provMNlw In
Sxtlon 9)(I6 0/ Ms Lebor Cods, Infenst, erM etfomsy i les�.
CONSTIIUCTION LENDINO AOENCY: I MreEy eifirm under penalry d perNrv �� iMra b e mntlrud'nn WWinO eperwy br �hs
perbrmerce M �he v.ork lor whid� �ha pefmt ie uwad (SeGbn 309]. CH. C).
LENDEX'S NAME: �
IENDEP'S ADDFES4:
I cerlity Ihet I heve reed Ihis eppliceiion eM mma ihet IM ebaw iMormetion ie conae. I piae to rompy wil� all dry enE caunry adinericee
end etme lexs relminB �o buiMvp eonavuaion aed haraby eWMrrze rapreeanlalivee W Iho dly to emm upon ihe above�mamunaE pmpeM
t«ms�+�o��w�s.WILLIAM HARDIN
�
(5151-/B.WP)
oma: /?-..Z,, i 6
Whna-Build'eq 8 Setery: Green-Fle; Cenery-Appfirani: Rnk-Revenw; (3okenroFAeeeeeor
CITY OF COSTA MESA — BUILLIING FERM.T.7'
_ . PERM NO; B 0806fS3
PERMIT NO: B 080663 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: C'—N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION _: T/OFF S REROOF W/HUR SQ FT: 2,650
CLAIM VALUE: 2,,650.00 CALC—VALUE: 2,650.00 GROUP OCC: R-3 /U-1
COMMENTS: X
at��*�r********�**�***+��it�**iE�*+�+�*+��xieitxitit��*iFx��r�r*+��r*+��it+�x�*itft*et+rx*ie�t**�*�ie��at**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: PT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ; PROV: PARCEL: 19137329 ZNE; REF NO;_.
PLANNING NOTES> �
i i
ik i41t fk ik 1E 1E iE 1E iFlF iE iE 1E iE iE 1E 1F 1E k 1E iE'lF'lElE'lE iE 1E 1E 1E 1ElE if iF iF iE If if iE iE 1E 1E iE if iF 1E iE'k iE 1f 1f 1f ik iE 1f if 1f 1f 1f-i(� 1E iE �f ff fF IE iE iE iE iE iE iE'k if iE iE ik fE k
D E V E�L O P M E N T 5 E R V I C E S R E Q U I R E M E N�,T S
ZONING APPROVED BY . DATE: '
BUILDING APPAOVED BY : DATE:
APPLICATION ISSUED BY; �/,�• DATE: '� Z
iE11�1E1EiE1EiF1fIFiFikiflEiF'if1E1E1E1EiE1EiFifSf��f3Fi�F{F�F�f�F{F if�F����iEif1E7E1FiEiFiEiE% 1Elf�
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 74,75 50
PLAN . SMIP/NON—RES
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 75.25 0.00 ` 0.00 75.25 75.25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 75.25 OVER/SHORT; ,00
BLD74PM5 PLUMHING ELECTRIC MECHANIC FIRE SMIP/TO�T GRADING PLAN—CHECK
iE 1E 1F �E iE 1E 1E 1f 1E 1E 1E ff iE if 1E i! 1E IE iE1E if iF iE iE 3E iE 1E if iE 3E 1E iF if iF 1flE 1Flf 1E 1E 1E1E 1f 1E 1E 1k ik 1EIE 1E 1E iE 1F 1E 1E iE 1! 1! i(' 1E 1F 1E 1E 1E iE 1E ik 1f If 1E iI� 1E 14 iE iE iE iE 1E'1E
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2650 REROOF HY VALUE RESIDENTIAL NOZONE 1.00 2,650,00
END OF FEES
`�� 4
a
� �.
�; '� ,. �,1996 ,�,
OF COSTA MESA �
CfiY /
l
--�
CONSTRUCTION AND PLANNING POC SPA �� `
�
APPROVALS Permit # � Date Inspector AppROVALS Permit # �� Date I�nspector
7. Temporary Eiectrical 5ervice or Pole 52. Pool & EquiPment Location.-
2. Soil Pipe�Undrgrnd. ``. �� 53. Steel Reinforcement . '
3. Electrical Conduit_Utjlity�Undrgmd. � 54. Forms �,� �
4. Electric5l Conduit�Undrgrnd. - 55. Electricai Bonding �
5. Steel Re�nforcement �, 56. Rough Plumbing & Pressure Test � ;
6. Electrical UFER Grnd. - 57. APPROVALTO COVER-GUNITE i'•
7. Footings '" 58. Electrical ConduiFUndrgrnd.
�8. F'oundation : 59. Gas Pipe, O Uniirgrnd., Test � •
9. Water Pipe�Undrgmd. 60. Backwash Unes, P-Trap, � U�Jrgrnd.
10. Structurai Floor SVstem � 67. APPROVAL TO DECK �
11. Propertv Sewer �ine & House Connection 62. Backwash & Receptor-Final ; �
12. Sem�er Cap � • 63. Heater & Vent-Pinal
73. Roof Drains ' 64. Plumbing SYstem � Finai
i
74. Rough Plumbing � 65. Electrical�Final
t
15. Rough Electrical-Conduic 66. Solar SYstem-Final -
16. Rough Electric Wirin9 _, - 67. Pencing & AccQss Approval ; .�
17. RoughWirin9Sign 68. APPROVEDFOR-PLASTERING
78. Rougfi Electrical-T Bar Ceiiing 69. POOL;SPA SYSTEMS F�NAL
79. Rough Heating & Air Condrtioning FIRE DEPT. REQUIREMENT i
20. Rough Factory Fireplace ' - � ` � � APPROVAIS Permit # +
� - -
27._Ducts, in Struciure � � r � _� 70. Underground Hydro i
22.Ducts,Ventilating _ � � 71.ProductPiping'O'G.s ❑Oil
23. Gas�Pipe-Rough & Test � ' �' �_ 72, Underground Flush
24, Roof Framing - � ' 73. Undergrnd. Storag� Tank O Gas O Oil
25. Roof Sheathing � -�-�� �(,�/,�/i 74. Overhead Hydro � I
N
26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical �
27. Frame and Flashing _ _ 76. Dry Standpipe ,
28.-�Lathing & Siding � : _ - � 77. FIXED�SYSTEiN F�NAL
29. Insulation �_ - 78. FIRE PREV. FINAL �
30. Drywail Nailin9 ` -• -HEALTH OEPT: REQUIREMENT
37. Piaster 6rown Coat 79. FINAL INSPECT.ION '. '�
32. Electricel Power Meter-Final � � - 80. FOOD CERTIFICATE bSSUED
33. Final Electric ' " ' �� ' ' Noter. _ � x T
34. Final Heating & Air Conditioning�_ " . ���-?.�.� '(�.iZ •
35. Final Gas Pipe�Tes2 � _ • � � - ' " '
36. Hood or Canopy _ �
37. Finaf Fectory Fireplace � - �
38. Final Plumbing ' � � `, • � -
39. Water Service-Final . :
40. Gas Service-final ' . - -.
41. Solar pomesticFtnal . � � . �
- �
42. 8ackfloW P�evenrer � ' ' �
43. Backfiow Irrigation � . . .- -� '
44. LandscaPe Irrigation System-. ; _ - - � : ' - .
45. Sound Attenuation . - � " '
46. Handicap Regulatio�s - , ' ' ' � - -.. � _ � ,
47. FINALSTRUCTURE&BUILDWG l .. �j Cp(,� _
48. FINAL PLANNING �
49. Electric Release to Edison . -,
50. Gas Release to Souther� California Gas Co , "
51. CERTIFICATE OP OCCUPANCY _ , . �
No. Date ,
OWNER COLLEGE PARK '- DATE 1P-u_rj(�
JOBADpRESS 25ly6 Oxford Lane BUILDINGPERMITNO. #LO6I1
GENERALCONTRACTOR HBPUOT CORSt, CO• VAWE � ZZ�OO�OO
LOT 15 BLOCK TRACT `2%26 Res, tr/det. gaT.
INSPEC710NS
Footing 7rench
Foundation Forms and Grade to
Rouah Framina
Plumbinp, Rough to SI
Plumbiny, Rough Com
Wirir
Heati
St.
.nk or Cesspool
In Out
Plastering
Plumbinp. Final. Fixtures
DATE SUBCONTRACTOR —
'� s%
�/J /
S 8�� —
3-� •
S".Y7 `,!/,r�%-. %.: •'1.. .S�d, � 2
195T V B11...2�.,i .�.�.� �
S'_S'i �i�u..,,.. .. � o n�[.� _._.. �' -
Wiring, Final 'f :j� �
OccupanCy �'7 a- 7�
FORM 210 3M IO�vS •
PEflMITS ISSUED
I NUMBER
, osza iraesa nwiaing Lepar�ment
� '� 171 EAST 20th STREET
'��J'l COSTA MESA, CALIFORNIA
I FOR APPLICANT TO FILI. IN
Costa Mesa, California
Nearest
CrossSt H ARBOR BLVD,
Owner COLIEGE PARK No. 2
nrcm[ecc or uc.
Enginter No.
'dreu
City Lic
�ontracto� qRBOR CONST,CONo. �
Address $eME
Legal I Lot �
Descriptlon No. � 5 Block � Ti
(AtWch Metes and Bounds)
No. of Bldga
Size oi Lot (� I X I 05 Now on Lot
Useof � No.of
Existing Bldg. I Families I
Setback Line from Rear Vard
Center of Street 5 � Side Vard
Alteration I I Addition
Stories
U5e of NeW V y
Buflding RESIDENCE �L DETACHEO
Forms, Materials
G A R A G Under•Pinning
Frame: Fire Stops,
Bracing, Bolta
I hereby acknowledge that I have mad Uils Applicatlon
and state that the above is rnrrect and agree to comply Lath. Int
with all City Ordinances and State Iaws regulating
building construction. Lath. Ext.
Signatureof
vermittee HARBOR CONSTRUCTION CO3 p�aster,�nt.
Authorized Agt. plaster, Ext
Valwation Permft Fee $02Lp/-- Masonry Refntorce
I I� 200 . Plan Check $� 7 �� gond Beam
$ Tota I
Fee $ �� FINAL
FORM 204 S-BP 2M 8-55
HY'YLdIiA'1'1V1V rvn rr.am�ui
a�n� B1916.D�NG '�
FOR OFFICE USE ONLY
Recefpt No. Permit No.
� �
Received by Date Rec'd. DaM Inued
- �iY�%._ I � - / `S� / a--/ / 'S �
Butlding
Address
Costa Mesa, California
rovW
APPROVALS
��
8how Iooation and disYances from
;.' property Ilna and between buildinga
n
i
�
i -
G .
N
O
O
tn
0
N
�S
c �
.�
s
OWNER
GENERAL CON7'RACTOR
AP. No. LOT ZS
INSPEC710N&
Cias
VALL[E
TRACT 2726FIRE ZONE DESCRIPTION OF WORK
Swc•
DATE � SUBCONTRACTOR
PERMIT
F
w
W
C
f
N
COSTA MESA BUILDIPIG DEPARTMENT
P. 0. BOX 317
COSTA MESA CALIFORNIA
STREET
C.L. OF STREE
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES------
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES
�
OVED
� �y S 7
�. . •
APPLICANT TO FII.L IN
BUILDING
Mail Address ��
City �6-`5�� /�� Ph. No.
Contractor �S�.�T%�i�bS ph. No.� �5�25�;�
City Lic_No.—�� State Lic. No. �.SS���
Size of Lor AP No. ?�� ��T ��
Setbacks: C/L Street _�� � Rear �
Side Yard - Righ} v Left �
I hereby acknowledge that I have read this application and state
that the above is correct and agree to comply with all City Ord-
inances and State Laws regulating building construction.
Signature
of Permittee
VALUATION
FOR OFFICE USE ONLY
-a-D-�� � I AUG 2 0 i957
Permit Fee $ /x '–"�
� I Plan Check $
TOTAL FEE $ �
USE REVERSE SIDE FOR DETAILS