HomeMy WebLinkAbout2421 MISENO WAY - 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: 2421 MISENO WY
Suite:
Vicinity: ROOF
Parce� Number: TPN00143
App�icant: HANSEN, DUKE
Address: N6646636
Zoning:
, ' Phone: � -
� � � Zip:
Owner: BACK BAY ASSOC/ WEBB PROP. MGMT
Address 960 CALIE AMANECER
Phone:
, SAN CLEMENTE, CA 92673 Zip:
Convactor: ROSS 8 BARROWS INC.
Address: 260 E ALTON AVE
� Phone: (714) 557-7440
, SANTA ANA, CA
Zip� . 92707 License: 327802
Arch :
Address:
Zip:
Phone:
License:
Eng:
Address:
SCOPE OF PERMIT _ .
REMOVE OLD B.U.R. AND INSTALL A NEW 4 PLY B.U.R. ON UPPER FLAT ROOF ONLY.
FEE SUMMARY
Plan Check:
Permit
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$83.25
$0.50
$0.00
$o.00
$0.00
$83.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: 0
NOTES:
a
Rear 0- 0
Rear 0- 0
Required: 0
Status: ISSUED
Applied: 04/29/2002
Issued: 04/29/2002
ISSUED BY: ��
Calc Valuation:
Claim Valuation:
PLANNING & ZONING
Left 0- 0 Right 0- 0
Left 0- 0 Right 0- 0
Proposed: 0
Phone:
License:
52,300.00
82,300.00
NOTICE: The work authorized by this pgrmit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or ii work is suspended or abandoned
tor a period of 180 days. ' .
lNSPECTIONS: In order for the work authorized under this permit to be considered legat, such woAc must compty with all applicabte codes, and all
required inspectlons and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545826
eea�e �avo�
WORKERS' COMPENSATION DECLARA710N: - '
I hereby ettirm under penalry of perjury one of the following tleGarations: �
❑ I hava ena will malntain a ceNficate ol consent to self-Insure lor workers' compensation, as pmvided tor by section 3700 ot the Labor Code, for the pertortnanca of t�e
work for whi[h Ihis pertnit is iuuetl.
[�% I have arW will maintain workere' compensatlon insurance, as required by section 3700 of Ihe labor Cotle, for the peAortnance of Ihe work tor which Ihis pertnit is issued.
My workers' compensation Insuren cerner entl policy number are:
Cerner. _ � ��- �-e �l�y /� Policy Number: Q �"/ L� - C� ZD �%�D � / —
(This secfion need nat be campletetl i/ the pe�mit !s ve/uetl af one hundred dollars (5100) or less.)
❑ I certiy that in Ihe peAormance ot Ihe work tor w�ich this permit is issueQ I s�all not employ eny parson in any manner so es to become sublect to the workers'
compensation lews of Califomia, entl agree thef il I shoultl become subject to the workers' compensation provisions ol Sectlon 3700 0l Ihe La6or Code, I shell lorthwlth
comply with ihese pro n p
Applicant Signature: � � �� Date: L/� Z/— �T .
WARNINp: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL M!D SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DdlARE (5100,000). IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN $ECTION 7/O60F iHE LABpq CODE, INfEFEST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereDy ettirtn that 1 am licensed under pmWsions at Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business and Professbns Code, and my license is in tull
force and effecL Lic. k X o/_ Class x_ G � P
Contractors Signature: Date: �— Z�— 65
v
CONSTRUCTION LENDING AGENCV:
❑ I hereby eRirm lhet there is a consiruction lentling egency for ihe performance of the work br which Ihis pertnit is issued. (Sec. 3097, Civil CoOe).
Lender's Name: Lender's Address:
Signatura: � Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn that under penalry ot perjury thet I em EXEMP7 FROM 7ME CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Protessions
Code: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repeir eny structure, prior to its issuanca, also requires ihe applicant For such pertnit
to lile a signetl statement that ha or she is Ilcensed pursuant to the provisions of Ihe Coniractors Ucense Law (Chaptar 9(commencing with Sectlon 7000) of Division 3 ot the
Business end Professions Code) or that he or she is exempt t�ereirom and the basis for Ihe elleged eaemption. Any violetion ol Sectlon 7031.5 6y any applicant lor e pertnit
sub�ects the epplicant to a civil penalry of not more Ihen five hundred tlollars ($500).):
❑ I, es owner oi Iha properry, or my employees wi�h weges es iheir sole compenselion, WILL DO THE WORK, antl the struaure is nat intended or olfered for sale (Sec.
7044, Business and Professions Code: T�e Contraciors License Law dces not apply to an owner ol properry who 6uiltls or improves ihereon, antl who does such work
himself or herself or t�rough his or har own employees, pwvided that such improvements are not Intended or oHered for sale. If, however, ihe builtling or improvement is
sold within one year of completion, the ownervbuilder will have ihe burden ol proving Nat he or she did not build or improve for purpose ot sale.).
❑ I, es owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo wnstmct the project (Sec. 7044, Business and Professions
Code: The Contrattors License Law doe5 noi epply Io en owner of property who builtls or Improves iheraon, and who confrects lor such project with a contractor(s)
license pursuaN ro the CoNractors License Laws.).
❑ I em exempt untler sec.
Signatura:
Owner ID venfietl by dnver's license. ❑ Ves ❑ No
BuSiness end Professions Code for ihis reeson:
VeAfication oi Ownership by (type of daument, i.e. - properry tax bill or deetl):
Drivels License No.
Data:
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N:
❑ I hereby certify ihat no exwvation tive (5) or more tee[ in tlepth inm which e person is required m descenq will be matle in connection with work authodzed by this
permii, antl �hat no builtling structure, scattoltling, falsework, or demolition or dismantling �hereof, will be more then thirry-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec.
341, Title e, Celilomia Adminisiretive Code).
❑ As owner�builaer, I will not employ anyone to do work which would require a permit irom the Division of Indusinal Safety, as no�ed ebove, unless such person has e
pertnit to tlo such work from �he tlivision.
Signeture:
Division of Industnal Satery Pertnit Number:
Date:
CERTIFICA7E OF COMPLIANCE AND AllTHORIZA710N OF ENTAY: I certify under penalry of perjury Ihat I have read ihis epplication entl state ihat the informa�ion given is
correct. I egree to comply with sll state laws en0 ciry ortlinances releting to building consWction, end au�hotlze representetives of the Ciry of Costa Mesa to enter upon Ihe
above-described property tor inspection purposes. I egree not to occupy or allow occupency ot any building authonzed by ihis pertnit until finel inspection.
SignaWre Of Legal Owner(s) Date
I o��/n-� C./ Z 9-aF-
A'nNOr Authonzed Applicant Date
COQE t. INSFECTIONTYPE
161fi Fiaed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
BflIE iarmn�s
GOOE� INSPELTIONTYYE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220
222
250
Final Planning Approval
Final Site
Final BuildincyOccupancy
PAg It�EL$
0
0
flOJECi AO�FESS: 2 4 z S M I SENO WY
�OWNEP'S NpME: JUERGENS CHAALES H
nooxess: 2421 MIS�NO WAY
COSTA MESA,CA 92627
APCNIENGINEEH:
HEG.NO.:
UNIT:
AOOXESS: UNIT:
PEHMITTEE: BRAHMA HERD ( 719 ) 699-2976
RDOflE55: Z8811 MODJESKA CYN RD
SILVERADO CA 92676
LICENSEO CONTHpCTOB UECLABATION: I hr�5ere�y ai�irm ihat I am licensetl untler pmvisions oi Chap�er 9(commencing with Sec�ion
CITY,LICDiyjsipn3 p17pe„BusinSTRTE ��g �Csjpns ��.@ntl my license is S tuCll tor�e na erteXP : 1 Z/ J 9
Ub1UbU U1 tl ��
�e: �_Z" 2—� "�I � si9namre:
W EHS' COMPENSR710N DECIAPptION: I hereDy affirm inat I ave a cenilicate of consem m self-inmre or a certificate of workers'
om0ensaiian Insurance. or a certibetl copy thereol (Section 3800. Lab. C�.
POLICY NO.: E%P. OFTE:
COMPANY:
❑ Cetlifietl coOY is hereby lumishetl. ❑ Ce�i�iea capy is �ileA with ���Builtling Divisi
oa� 1 ���� c7 � noor�a�c�/%/%..�.1 ___•_
EMPTION FBOM WOBHEBS' COMPENSpTION OECIAPpTION: Q�is seciion neetl no� be comple�ea il �he De�mi� is forone huntlre0 �$100) ar less�.
I certily �hat in Ihe pedormance oi ihe work tor which �his permit is issued I shall no� employ any person in any manner so as �0 6ecome
subject Io I�e Workers' ComDensa�ion Laws of Califomia.
�a�e: Signa�ure:
NOTILE: II, afler making I�is tleclaration, you s0ou10 Oecome su0lact ro ihe Workers' Campensation pmvisions oi the La6ar
Cotle. you mus� lo�hwit� comply with such provisions or �his permi� shall 6e Oeemetl revoketl.
CONSTHOCTION LENDING AGENCY: I hereby atiirm thal Ihere i5 a ton5lmttion lentling aAenCy tort�e pedormante o� Ihe wofk fof
w�ic� I�is permi� is issuetl �Section 3097. Civ. C).
LENOEX:
aoonEss:
OWNEfl BUIIOEB OECLANATION: 1 here�y a��irm I�ai I am ¢xempt trom Ihe ContraClOrt' Stale License Law tor tAe followinA �eason
(Sec�ion 7031.5 Business and Pmiessional Cotle: Any city of coun�y which requires a permit �o conSlNct, alier, improve, tlemolish, or
repair any slmcture. prior �o ils issuance, also reQuires lhe applicani lor such pe�mi� �o �ile a signed statemeni Ihat he/she is licensetl
pursuant to Ihe Dmvisions ol ihe Contracmrs' Stare License Law (Chapter 9(commencing with Section 7000) al �ivision 3 of ihe Business
antl Pwfessions Catle) or I�al he/She is ex¢mpt �here�ram antl �he 6asi5 for ihe allege0 exemp�iaa Any violation Of Settion 703L5 by
any app6can� �or a permii suble��s I�e ap0lican� Io a civil Denalry of no� more �han tive hundred Oollaro (5500).
I, as owner at �he pmDehY or my employees wi�h waAes as Iheii sole compensation, will tlo �he work, and Ne
❑ Stmt�ure is noi inrenaed or 011efed br Sal¢ (Set�ion 70a4, Bu5ine55 antl Pmfessional Cotle: The ConiraCtofs' S�a�e Litens¢ Law
Does noi ap01y to an owner ol a pmpeny wtw builtls or impmves Ihereon, anA who does suc� work himselUhersel� or �hmugh
his or her own employees, provitletl Iha� suc� improvemenis are no� imended or oi�ered for sale. It, however the huilAing or
impmvemen� is sold wi��in one year o� comple�ion, the owner will have the 6urden oi OrovinA he/s�e tlitl no� 6uild or improve
�or Ihe purpose ol sale�.
I, as owner ol the O�openy. am exclusively conlractinA with Iicense0 conlractors to constmct �he pmlect (Sec�ion 7044, Business
❑ and Pmiessions CoGe: The Coniractors' S�a�e license Law Does nat appty to an owner o1 pmDerry who 6uilas or impmves ihereon
antl w�a cantractsior suc� pmlect5 wii� a coniractor(s�license pursuantlo Ihe ConVactors' State License Law),I am aware
I�at pmat af �heir Worker's Compensa�ion insurance shoWd �e pmvidetl �o me.
� I am eeempl unaer Seclion: B. 8 P. C.
for �nis reason:
oate: Owner
I do hereby certify ihal I am awa�e ol antl unUerstantl ��e requiremeNs oi Califomia Heal�h antl Sa�e�y Coae Seciiore 25505. 25533, antl
25534 an4lhai I or any �Wure Guilaing occupanl willlwili not (circle one) neetl to compty wiih sai0 state cotles and �he requirements lor a
permil lor cans�mclion or motlilicaiion irom Ihe Air �ualiry Managemenl �isiric�. Fesitlen�ial cons�mc�ion applications are exemp� imm
ille5e provi5i0n5.
�ate: Apvlicant:
I �ere�y cerlily I�at I have reaa IhiS aDPlitaiion antl slaie t�at I�e abov¢ intormalion is Corfet�. I agre¢ Io ComDly wilh all ciry antl counry
ortlinantes antl s�aielaws relalingto builtling consimclion and hereby aulhorizerepresenlatives o��his ciiylo en�erupanthe a6ove�men�ionea
propetly fo� inspeclion purpases.
License or Social Secunry x.�
Signalure:
t64ba6 W�ite—Bulltling�, Green—Cotle Enlorcemem; Canary—ApplicanC Pink—Revenue; Goltlenrotl—Assessor
_\ CITY OF COSTA MESA — BUILDING PERMZT ,
PERMIT NO: B{" �07/D563 PLAN CAECK NO: N , ,
CONSTRUCTION TYPE PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION ; T/OFF S REROOF W/BUR SQ FT; 800
CLAIM VALOE; 500,00 CALC—VALUE; 800.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOAS REQ PER 91UHC
+r***�r*+�ir+t+�**x��t*+rx��rx�+r�r*+r***+r*r��r**�rar*�r*+t�tar+a��*+r�r+�+t*�r***x*+�*�r+��*�r**-x��r*��r�r*+�*�e***�r*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR• FT IN FANT; FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT ZN RGHT: FT IN
PARKING RE�• PROV; PAACEL; 43914319 ZNE; REF NO:
PLANNING N 'PES>
i
et*iririr*ititit�r*�rit*itjt*�*ie�r�ritir+titrit*atat�r�t�rat***�cit*at�r*�tit*�ratr�r*�r�tar�ririr�rx�***at*itit****it�t�rat�rat�t
D E V E L O P M E tJ T S E R V I C E S R E Q 0 I R E M E N T S
ZONING APPROVED HY DATE:
HUILDING APPROVED BY : DATE: "
APPLICATION ISSUED HY; ��i '` DATE: Z/ �l�
�r*+t****�rit�r�t�r*r��t******�i��F�*'�r��r3F��r�iF���r'�����t*r**ir**�r** * * ** I
it�tit�r�**it****�tit*it*itrit*ititat*��r****�ritat*�r�tiF�r�at�tit*itft�t**x�****rit**�r*r�rit*ie**atat*ar *�et*it*x�
LEGALIZATION;N F E E S U M M A R Y STRIICTUAALISEGMENT;Y
BLDG PMT PLUMBING ELECTRIC M£CHANIC FIRE SMIP/AES GRADING
PERMIT 21.00 SO
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 21,50 0,00 0,00 21,50 21.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 21,50 OVER/SHORT; 00
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CAECK
21,00 ,50
1f if * ff !f 1f !F %if M if 1t 1E if i! 1F if M if 1f 1P 1E jF M 1E if if if M it %if iE it M 1f if M 1E 1f 1E iF if if �E If M if it if iF M if M if If if if if if M if 1f 7f if 1F if if if iF if if �E ff aE iE if 1F iF
I N D I C� I D U A L F E E H R E A IC D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
'ISFR 800 REROOF BY VALUE RESIDENTIAL N020NE 1,00 800,00
END OF FEES
o� oa��<z27'007.7422P r�� r 2�.sa
D�;E: ±2/2?/44 TS11E: 11:�4
POOL & A
. COfVSTRUCTiON ANO PLANNING � �
APPROVALS Permit# Date inspector AppqOVALS Permit# Date lnspector'
i
t. Temporary Electncal Serl�ce or Pole . 52. Pool & Equipmen( Locacion 1
2. Soii Pipe-ilndrgrnd, �� 53. Steel Reinforceme�t I
= ;;;3;���jectrical Con¢uir+JiiGtv-Undsgrnd. � 54. Forms i
�
-��A,electrical ConduityJndrgrnd. � 55. Electricai Bonding �
r
;-;`,i,y;�ree! ReinforcerrtaR[ 56. Rough Plumhing & Pressure Test - i
n 6,�,�lectricai UF��'R-Gmd. = 57. APPROVA� TO COVER�GUNITE ��
�Y7.. Footings ' ,,� 58. Electrice� Conduit�Undrgmd. "
�•-�r Foundation � , ' 59. Gas Pipe, O Untlrgmd., Test � �
?9. 4Vater Pipe�Undrmd. - 6Q. Bar_kwash Lines, P�Trap, Q Undrg: nd, (
10. Structural Floor.SYstem � 67. APPROVALTO DECK j
71. P�operty Sewer t�ine & Ho�use Connection 62. Backwash & Receptor�Final i
12. S wer Cap _ .,, 63. Heater & Veni-Final �
73. Roof Drains ` �'? 64. Plumbiny System � Fina3
14. Rou�h Plamliing i .. � 65. Electrical�Final �
15. Rough Electrical�Condult-• 66. Solar SVstem-Final �
z '
16. Rough Electrii'W�ring �� ' 67. Fencing & Access ApProval �
i
17. Rough Wi�ing Siyn �� 68. APPROVED FOR PLAS7ERING j
18. Aough Electncal�T Bar Cei�ing 69. POOL/SPA SYSTEhlS FINAL '
19. Rough Heating ffi Air Conditioning FIRE DEPT. REQUIREMENT �
- - � C� -.�C1t� t �� �
2Q'� R�gh;f'actory �i?Ypiace � �'� � --' � � '� ' * �APPF�Vxy ���"a PUmit # ` " ��� '
:i s* i *• r,,r, o� +. � ti.k`�=. -.-----;-
:. �. . -• r. , - �
21-;�Ducu, in SVVcture , •• �• �r<: ; _ �-+* r �i 70. •Undergdo'ufiEl H�dro k
�- e , r i
22,.Du�>.s, �?enti a2iR�.' ' 10=' � ' ` :` : � • � `
� ,�1 j _i � � �, . . � 71. Product', �%ing (�'�as i� Oil ;
23:�Gas,P�p��ftoygh &tTest � ,,; �• > ;� �. ;, s . � 7Z. Undergroiind F•Fnsoos -
24`Rooi Framing 5 ` � �"r' "R ; =' �� �, � � ' � � 7�!� Undergm'��c.Stora�T�nitOGas ❑Oil
•-� , - '
25. flc:qf S4ieathing �r . � •i �v �Q�{t+� � . 74`):LDverhead Hydr6.'�-- I
26-T•Hkr Ce�iing (Structurali �.t�tQnbco�t ' �" � �^' ' 75;. pry Chemical ^ ` -' `' °� �
-,. < : , -i >• +. . �_�. .�� + �i
27t; Frame aDd Flashing °�.- r r�_ + .0 �• 76J Dry StarndpiPe t-a, �+ y � �'i �
-�28. Lethin�$ Sitling � �� �F�F _ £ <: "� �"�* ! 77.� FIXED SYST��FINA�. -; .-� � �
'•1 ' �5:.� � fy •• •• I D� ) . F U
' 29. Insulation ''. �� f- _ •. , j ,.t M 7&: FIRE PREV. FI�NA� 7: y
- -" w . �� ...
'30, Drywall,Na�'ing %'" , u 4, � 1, � t ,'H,�AlTF3�DEPT.�REQUIR�MEN7 �
I s r:� c .
�31. Piaster'�row� C6ai ; i rt. • ; . } ;� 79.� FINAL I�P!$9ECTtQN � `• ��r �
__�--"_�_- i .. . �-�_� .., . ,
�32tiElectrie3l Powzn7tA2terFinat y"� I "���80tiFO0D CERTIF4.L{dTE I�S`UEDH �, j
�,,33rFi�ei El�cvic , � � • :� � � �u � � � N4se:_j1 Z��"1_;- �� � i
-• � ` '� ' � . ' •
,, . , . . . : , �
i;34:.Firzal Neetirrtj&:Air Conditioning. `� *� I� r E`� ' r " -i-, �
- - � 1� . 1'1'1, %H �S?-ffA%do�l '/�/�( F�l/���!/ �
� 35i'-�Pin3? G'dS Pi -T85� `? ;. � ' ` ' _ : � • . � �fr-}-ir
'� �-,' �, j: x �:� � 1:._. * 59/�i-'� K d���/-�
c��,-�Sv. _
.i36f�Hoed or CanoPY ' '�� � <:' -1 •�. r C� I .la : ��%d�f� ���J � OsiJ� f.� Y "'�-� ��
- r- . ^ � r n .:� r
y > �, , ..f.. ° . `' � I . . �1= `� iC � �Ya�^ ,
,� 37':;,Finqi Factory Fireplace,. �, ��r..�' .yY' �. I
� - � � 1
,-+38. Fi�7'dl Plumbing . � � - ' i ' ii ,� ;. �@/v. ,��T '' 'n i
��39. Water Serviqe�Finat � 1� ; ... I I * } . �� _ r - ` . v
J
. . • !� f �I • . • • _�l � �
_;;40. GasService-F��al . : �;;rn� S �'n � • J�-� �'- •
ir i . �,:; • •'�
1-41. Solar pomei icFir;al�� � � " ' -} ( � �' ' ` v '"' °
C n; t � s. . �i_� n ,;*; �� �
,42 "Backflow Preventec � n; r ��� � � �e �c- • 4 : •
a itv K F
43. Backflow iri5�qatio; �;`�-• r �. �� � Q Hc � Ci , - i
x . .: . ` .` =.
n;44. Landscave lirigation System�bi�: v: T1 `v' c? O.t � ro n� a�:b :' '; o I
-* ^ v x r n r.- <.
�45�Sound Atterivatio�l v°;`" �" ' r F H E�r = �� r+ ;`a: �:-^ � i
^{ • 4 i•1 �i� ��}xi f' r� C ?r!_1 t '.
=�46.. Handicap Regulations i `) � � , � �' ��; •� C+:` +
- .. .. M � �n,i� � i
- T �P,� l h „�.'s:
47.`-'PINpL STRUC7URE & BURDING " 4,
.: � * ' i ::' i
48_�FINAI PLANNING i F�... ��� � ;�j�•y a :*i � � G, �
± ' e t : i .n
=49:'ElectricReleaseto�dison • � I�� . � - _�
1� i � t
, � _.
�;;50._•Gag,Release to SauiMem Calefw,nia Gas Co � I � ;� � -� '_+ • 1;i + ^, •
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� 51. CERT�FtCATE Q�OCCUPANCY '" < ;� r " - ■ '
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
AD'DRESS ���I / � I S �N �
OWNER �jHj��`I'� �ve2 �JC.JS
MAIL
ADDRESS J �Z� ��Se"� �
CITY ����,q �'Csi: NOL � ��c
CON5TRUCTION �
LENDER N O!'-�.
Y
BRANCH
ADDRESS
ARCHITECT G%,� /'.�V�nEOL.S���
OR ENGINEEIi ��-�'
ADDFESS I��% � U V�Q' \ �
1 � N � �- L
CONTRACTOR ,�'�/�/��OA
—�c
ADDRESS
TEL.
CITV NO.
STATE - CITV
LIC. NO. . LIC. NO.
S I Z E NO. OF BLDGS.
OF lOT NOW ON LOT
USE OF
EXISTING BIDG.
Separate permits ace required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOFMED
�L
vaie . i::rx;:
GCT 14-77���S;,DO 761=• S4.S0
APPLICAT[ON FOR STRUCTURAL PERMIT
RECEIj/Ep . DATERECEIVED �pTp�. iirn
A.P. NO. `y�.
BUILDING i
A�DRE r5S1
TqACT
FIRE
ZONE
APPROVED
—/�l— ��l7 PERMIT NO.
Z��l yI�S'�b u
3 LOT BLOCK
R R PA R M
�L �`'S j v �G�
�S� �`�i
TVPE GROUP
DATE
ZON NO.OF�
� PLANS
VARDS APPROV ED
MAIN BUILDING
(FROM C/L STREET)
� 1 �A� o#
I he�eby acknowletlge thet I have reatl this application and state
that the abova information is correct and agree to comply with
all lews repulating building consSruction, antl I shall not employ
any pereon in violation o4 the workman'S compensation laws of
the State of California.
I hereby certify ffiat I am properly licensetl as a contrector onder Sn•
She Staie of California Business antl Professions Cotle, �ivision 3, THE AMOUN
Chapter 9, and that such licenses ara in full force and effect, or 1 THE PURPOSE
am exempt from tha provlsions of the State of California Business VALUATION
antl Profasslons Co i i on 3, Chapter 9.
$IQf18SUfB Oi f ����f
Permittee 1/� � $ g�i
✓
Authorized Agent
USE OF �
BUILDING
ROVED
FT. FT.
BET. MAIN &
ACCESS. BL�GS,
DATE
APPROVED
o _ _ _ �/��!/
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!N UNDER VALUATION IS FOF m
Ag��SHING A PERMIT FE NLY: �
PERMIT FEE $ p
I N
n1
PLAN CHECK $ � 0 O
TAX $ /S� �
TOTALPAID $ D
oWNER m'� & SHIELDS Development Co.,Inc.
JOB ADDRESS �1 Miseno
GENERAL CONTRACTOR myle & Shleld6 Dev.CO.,I
IP•"^ECTIONS
S
Gas
DATE
UP jPS,j TYPE
SUI3CONT1iACTOIt
�
OF WORK
ZONE
3
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�COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 917 C09TA Ml6A, CALIFORNIA
�
For ApplicanT to Fill In Completely
TYPE OR PRINT
eui�owa +��
ADDRESS
COSTA MESA, CALIFORNIA
4100 W. Commonwea���ie
Same
u nwci.
une pnorn
r ernesr 2 O� SO � REAR YARD
RDI LEFT �� I R16HT �
DESCRIPTION OF WORK
r USEOFBUILDING
I NERE6Y ACKNOWLHOO[ TN�T 1 HAV6 READ THIe APPLIWTION
AND 9TPT6 TNAT TH[ ABOV[ 19 COqqECT ANO AORHH TO COM�
PLY WITH ALl <ITY ORDINANC[Y AND iTAT[ UW9 R¢ODUTING
BUILOINOCONBTFUCTION. �'
1
SIGNATURE OF� �
PERMITTEF C �^ ��
0
AUTHORIZED A6ENT r� '�j��ll
FE RECEIVED
cJJid 3 1563
• INANCE DEPT.
APPLICATION"FOR'Ye�t�TA MESA
BUILDING
For Office Use Only
118ClI�T NO. PlpM�TyQ`
ly/
ir owre necerv o ra i sue
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ZONIN6
rvo. o uee on He ��
�un� euaniH
CNIRION Lot 125, Tract 3433
�. NO. �
fE: NO EAVE OVERHANG SHALL BE LES6 THAN
' TO 91OE 8 REAR P. L.
'ES
.OWED <U. B. C. REQIIIREMENT;
YARDSAPPROVED YAROSAPPROVEO
MAIN BUILDING ACCESSORY BUILDING
VAR.12
TXH AMOUNT 8H�!
POPPOSB OP 8�j
VALUATION
$ /9s� `°
DATE
0
�� q ' "
m
UNOER VALl1ATION �8 FOH THE y',
IBHIN� A P6qMIT FHfi ONLY. Q
Z � 0
PERMITFEE S �✓ �
�
c�t m
✓�
PLAN CHEGK $ / 0
TOTALFEE $
9f� s-� "