HomeMy WebLinkAbout188 MONTE VISTA AVE - Building Permits wr CITY OF COSTA MESA
`,r %, BUILDING DIVISION
1-' ""'�. ') DEVELOPMENT SERVICES DEPARTMENT P98-00347
TA *04
PERMIT PERMIT NUMBER
(714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 188 MONTE VISTA AV Status: ISSUED
Suite No Applied: 05/05/1998
Issued: 05/05/1998
Vicinity: UNITS A, B,AND C.
Parcel Nunmber: 43941116
Applicant GRIMES, FRED I
Address:
Phone:
. Zip:
•
•
Owner GRIMES, FRED I � � `.
Address 202-B 21ST ST - c.. - .. '
E Phone: . .
NEWPORT BEACH,CA Zip: 92663 .
Contractor: -
Address:
Phone:/.
-License:
Arch/Eng: .
Address: •
Phone:
Zip: '
License: -
SCOPE OF PERMIT
CHANGE OUT THREE WATER HEATERS IN TRIPLEX.
FEE SUMMARY - •
AMT QTY • AMT ' QTY AMT QTY
•ISSUE FEE $22.00 Laundry Tub/Washer -.$0.00 0 Sump Pump - $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator .$0.00 0 Urinal - $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) ' $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 . • Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor i $0.00 0 ' Sewer Connect . $0.00 0 : Waste and Vent System $0.00 0
Drain, Rainwater '• $0.00 0 Sewer Private Line - ..$0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower' $0.00 0 Water Heater/vent $33.00 3
Drinking Fountain • $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe i$0.00 0 Spa(private) . $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $55.00
COMMENTS/SPECIAL CONDITIONS
•
,
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
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:
Caller: Policy Number.
(This section need not be completed ll 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'
compensation laws of California.and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),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 I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Uc.4 Class 4
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a 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 driver's license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property lax 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(38)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:
I Will the applicant or present or future building occupant need to file end 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 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 apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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 ❑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: • Dale:
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 prope for ins ction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
at
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODF f INSPECTKIN TYPE DATE INIIUTAALS Coal INSPECTION TYPE DAIS IDLE
1616 Axed System Final Fire Prevention 206 Anal Mechanical
1266 Pool Spa Final 208 Final Plumbing $/(o
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
244846
PROJECT ADDRESS: UNIT:
188 MONTE VISTA AV A/B /C CITY OF COSTA MESA BUILDING PERMIT PERM NO: B 06882C
OWMiR'S NAME: FRED GRIMES
ADDRESS: 202 21ST PERMIT NO: B 068820 PLAN CHECK NO: N GOVT; N SUPP: N
NEWPORT CA 92663
,t CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE; OTH
675-5464
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESTH & REROOF W/COMP , SHINGLES SQ FT: 7, 000
ADDRESS: UNIT:
CLAIM VALUE : 7, 000 , 00 CALC—VALUE: 7, 000 . 00 GROUP OCC ; R-1 /
PERMITTEE: FRED GRIMES ( 714 ) 675-5464
ADDRESS: 202 21ST ST COMMENTS : SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY, 1991 UBC
N.B . CA 92663 *******+r4*TE******TE*******x**************yE**xec*+6*******************x***Tris*******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R EQUIR EMEN TS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.
SETBACK S
CITY LIC.: STATE LIC.: CLASS: EXP :
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
POLICY NO,: EXP.DATE:
• „COMPANY: PARKING REQ• PROV; PARCEL ; 43941116 ZNE; REF NO;
"}'l Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
Date: Applicant' ********************************************************************.***********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(3100)or less). D E V E' L O P M E N T SERVICES R EQU IR EM EN T S
I ubmty that ine e performanceCo ns the work for which this permit is issue of empl y any person in any manner so as to became
subject to I e Workers'Co ,ensation Laws of California. _ n ` ZONING APPROVED BY DATE;
�i7i Signature: e� ��'� BUILDING APPROVED BY : DATE;
I :If.of er aking this dpwith s,you should be this
ispbrml the Workers' empensation provisions of the Labor
ide,you must forthwith comply with such provisions or this permit shall be deemed revoked, `,
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE;
which this permit is issued(Section 3097,Civ.C). ************************************ * ************************* Lit
LENDER: ********************************************************************** ********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 90 . 00 7 0
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 90 . 70 0 . 00 0 , 00 90 , 70 90 . 70 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 90 , 70 KOVER/SHORT• . 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
for the purpose ofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 90 , 00 , 70
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I amt exempt under Section: B.&P.C. ^
Mr thisr pson: p `/ TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
at 9rJ�! J onner: ��'�S SFR 7000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 •
7, 000 , 00
—I-do hereby certify at I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date'. Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinancesand pent laws urses to building construction and hereby out resentatives this city to enter upon the above-mentioned
property for ii sped.n purposes. C/`/-fT/ 01
elite:
` iyg DATE: 09/08/9416TIME: 10:31
TOT 96,?4
V"`: I Signature: •
Driver's icense or Social Security n:
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
COS2,TRUCTION AND PLANNING PO SPA • �-
APPROVALS Permit Date Inspector APPROVALS 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, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, L Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
- I
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63, Heater & Vent-Final
13. Roof Drains 64, Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit •
66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
s 1
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit
21. Ducts,in Structure 70, Underground Hydro
22. Ducts, Ventilating. 71. Product Piping 0 Gas El Oil
23. Gas Pipe-Rough & Test 72. Underground Flush ,
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing
41-14HC/1 64'4.L 74. Overhead Hydro
11 W
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
•
27. Frame and Flashing •
76. Dry Standpipe
28. Lathing& Siding 77- FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30, Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: '
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy •
37, Final Factory Fireplace
38. Final Plumbing ,
39. Water Service-Final
1 40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 0 ,
48. FINAL PLANNING
49- Electric Release to Edison I
50. Gas Release to Southern California Gas Co
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 of, 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 opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the pro-
posed property improvement. j2l Yes 0 No
2. I (have/have not) signed an application for a building permit for the
proposed work.
3. I have contracted with the following person(firm)to provide the proposed construction:
Name
Address City
Phone ( ) Contractor's Lic. No.
4. 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 City
Phone ( ) 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 Safety Code and have completed the above information to the best of my per-
sonal knowledge, i �corr/�jianc ith thisoState law. 0 l/
Signed: _}}-- /��f// 7A4.4o�� Date: -A4 I �! Y
Name: CY` e e L/ Y' ) 7'7i e �'
(Printed or Typed)
C.D.L. # or S.S. #
754-5273
100246
•
OWNER KOLCO CONSTRUCTION CO. DATE - 5-33.-62
JOB ADDRESS 188 Monte Vista Ave. BUILDING PERMIT NO. 17167
GENERAL CONTRACTOR Kolco Const. Co. VALUE $ 24950.00
AP No. 119-070-63 LOT TRACT • FIRE ZONE DESCRIPTION OF WORK Cspt. 3 cars
INSPECTIONS Signature DATE GROUP J TYPE V ZONE R-2
SUBCONTRACTOR
PERMITS ISSUED
Ga„ DATE NUMBER
Water
Rough Corn. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing •
Miscellaneous ,/
Prop.Swr.Line 0-House Con. ❑-3t:Swr. ❑ —< }, a�X ��. 7/ 6S�&t j t((.
Sprinkling System /..Ad
Construction Pole
Underground U Power ❑
Rough Wiring ti_
Trenches U Forms U Steel Reintjti/y/C (-.- !/-
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing AnI a- 7- 9-- C ]—
Frame and Flashing '(yy)e 7--
Lathing
-Lathing - In ❑ • Out ❑ 1 F644 p�� 4 -> -
Plaster, brown coat /? m t, 9 -
P "-gig. ❑ Air Cond. U Final
1 .ng, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final ����"Q
Building, Final ea" (�_Z -&2. •
OCCUPANCY /1dg r, o f GCCOC--
FORM 5114.5M - 7-61 M'MI Ano SARCTAT. RPnTTIRE 1Y1b'
' _ E EE RECEIVED
17167 Cum ��� MAY 2 81961
COSTA MESA BUILDING-SAFETY DEPARTMENT r FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
/y 8 /, '-"'� v
TYPE OR PPRIIN-T '! BUILDING
ADDRESSBUILDING • " ` /
COSTA MESA. CALIFORNIA For Office Use Only
// • ( d-. RECEIPT NO. I pyTV
OWNER ��-C.PiLI / /// ITV
6 I
MAIL 333 // - i� RE IVED BY DATE RECEIVED ,�I PATE ISSUED
ADDRESS .`']�) ,/y� I I ,� �� XBUILDING .ye-0**I/A. 3y1 1962
CITY
/�� NO (/ ���(Z ADDRESS / 2L //LQZ(_(p. 7 a r0.- or '
ARCHITECT TEL
OR ENGINEER ' NO. - COSTA MESA. CALIFORNIA
ADDRESS FIRE
(y�. //�/ /n• �,, - ZONE QTYPE GROUP`
CONTRACTOR /lie-l•C-0 eltnii (Al' APPROVED /'/ DATE / Z
ADDRESS w lJ N/17N�G
ZONE /NO.OF USE OF NEW
CITY - - a . PLANS �I BUILDING +v
STATE ' ('I TEL. V ` !!! P,1 S '-( S" (LOT- g I
LIC.NO. t_l/.J ..9�l' NO. LEGAL {�!!l('"���J .yp /
DEBCRI PTI ONY w I �YJ (-. r>4257-1R.• ,6
SIZE62 .&C /\ (7 S Inc. OF BLOPl
OF LOT NOW ON LOT V A.P.NO. I 9- C"7 --' ( S .
USE OF ti YARDS EVES
EXISTING BLDG APPROVED ALLOWED
SETBACK LINE FROM -- (CENTER LINE ST.1 pD 77��--
CENTER OF STREET REAR YARD FRONT a 9 FT.'• tt ../ it IN.
SIDE YARD I LEFT I RIGHT R.SIDE / 3 FT. `�T" IN.
DESCRIPTION OF WORK 7
L.SIDE FT. IN.
y-
NEW I xI ALTERATION I II ADDITION REAR / L EL. --____IN. '
MOVING I ( DEMOLISH BYPROVED-Q /aa hM DATE��� --
REPAIR "V� "V, /v
NO. OF
SB ZIELDING 0X(5 ROOMS p ST RIES HOLD FOR SPECIAL REQUIREMENY'i'
•
EXTERIOR WAL4" I'COVERING /`� ; Q
ROOF
COVERING 3..--6, C / eFry,/ foY
USE OF BUILDING AND WORK TO BE PERFORMED
I HEREBY ACKNOWLLDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUC ON. ..; VALUATION
SIGNATURE OF �n// t•(0/,�Q441)- �te PERMIT FEE S
PERMITTEE N
$ PLAN CHECK $
AUTHORIZED AGENTa �. u
TOTAL FEE I.
ert
�' FE,_ RECFivEC
171F9 fil/� --7 MA(281361
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT,
For Applicant to Fill In CompletelyCITY Of COSTA MESA
PP APPLICATION FOR PERMIT
TYPE
OR PRINT g. /7�^3.{I'` �✓ BUILDING
ADDRESS /BUILDING ep � v.T ✓/ 1/e
COSTA MESA CALIFORNIA For Office Use Only
�/% /- 6014-11:0-
MAIL
�1/_�_-, -f I RECEIPT NO. P�I�IT .19
OWNER ge 6014-jl., // (./
MAIL (J 7� RECEry BY DDAN R CEI/ygo/Ip/'OATS ISSUED
ADDRESS
/T'7/b�f/J / .�J G /, ) p II ., ,-,- �E -e17/P11AY 3 1 1196 ?
CITY ( � /7/ TNOJ'IO PI�42 ADDRESS / O 6 //G/�N V-,G B-'K
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NO.
ADDRESS FIRE
�J ',,,j/�/^'l /A• � ZONE /I TYPE GROUP -0/
CONTRACTOR /[N + L e-10 ' APPROVED ��Y. DATE I 6
ADDRESS Sa-Rn.1 V ONING /J
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ICM
I NO.OP I USE OF NEW T�
CITY /, Z PL
AANB BUILDING l
STATE / C rJ TEL. �— LEGAL R 4:5 i S C L'Cr1 ✓, „.
LIC.NO. [/('H�VIZE ( NO. DESCRIPTION p n 4{ , L D-740 i,-o I IR 1 R) "I(�
OF LOT �_ -^ I2/ rb I NO. OF BLDGB. �( `/ `� //`/inn
t L, NOW oN Loi L1 A.P.NO. j( 9 ^' �J 7 `�'_'. ..-7 \ Y N`,
USE OF YARDS EVES
EXISTING BLDG. • APPROVED ALLOWED
SETBACK LINE FROM , (CENTER LINE ST.) v
CENTER or STREET REAR YARD FRONT OBJ / y-1�>v4 ''_LY IN.
I 7 SIDE YARD I LEFT RIGHT R.SIDE FT. IN.
DESCRIPTION OF WORK L.SIDE n FT. v IN.
NEW I x II ALTERATION I II ADDITION I REAR 7 ( FT. 7v IN. '
REPAIR I II MOVING I I DEMOLISH I BYPROVED ct/���� DATE /f'//'`
BUILDING pp NO. OF7 4
SIZE J(ob 4, ROOMS /J STORIES / HOLD FOR SPECIAL RFQIIIRPnnFN'rc-
EXTERIOR WALL{-J" ROOF Q
COVERING Yl COVERING �/al Set, / Ci'/h.f ICI
USE OF BUILDING AND WORK TO BE PERFORMED
i 951 /414.6 2C4- % zso r o.-.5 a .
3lic . c:Vtel '676°-e
/...{{QLL���fff(((//////qqq Oc o t,
I HEREBY AC�V�DGE HAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT HE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCT • . // VALUATION �f
SIGNATURE OF 2 3r II£d1c_t,I.c m PERM IT FEE $ J1�./,5-0
PERMITTEE $ 0/ 7l) .?if._ PLAN CHECK $ 4/.2. 7,5-4
AUTHORIZED AGENT TOTAL FEE $/ D,"2 LL