HomeMy WebLinkAbout2109 MONROVIA AVE - Building Permits�na� isa-az�3 • rax pin) �5aae56 • www.ci.costa-mesa.cBL�ILDING PERMIT 77 FAIR ORIVE, COSTA MESA, CA 92626
JobAddress: 2109 MONROVIAAV
Suite:
Viciniry: ROOF '
Primary Occ: R3 . Type of Conslruction: V-N
Parcel Number: 42245112 Zoning:
Applicant: PETERSON, KIRBY SCOTT TR
Address: 4611 SCENARIO DR
Status: ISSUED
Applied: 10/18/2005
Issued: 10/18/2005
- � -.� . �Phone: �-714-840-4436 ISSUED BY:
HUNTINGTON BEACH CA�s., , - Zip: _928492222E .�
f. s-
� # .-�F r` �, x _
.�
Ownec PETERSON�, KfFZBY SCOTT TR ��'� ��
Address 4611 SCENARIO DR � , ,y - ° �"'� ,
' ��'" ' � � ' 'Phone'" . ��.-'
<'
, HUNT7NGTON BEACH CA'. � 2�p 92649-2222 -'
.� F' ' ' . � i b. ' �� i'
..- �� .` ' . . .. ��.
�ki'� :,..
Contractoi .OWNER-BUILDER
�
Address ' �= ;� "` �� ,c= e '
�
`� Phone: �', ' �
�„
�:� Zip:, License: 000000. - -'�`�" �
. rn- s �.--'.
--Arch : � � - Eng:
Add�ess: ���`-" Address: -
e. _ ' -,a. � . ,�,_ � ,
� s; ;;,��;.. - Phone :� '. ..� - ..
.� . �,., . ..
Zipi�� � � License - ... ...�
.. .. e . - .� - ..
i-
•r�°� T/O EXISTING�ASP
- REPAIR AND REFI
`;<.
a"
`; �. Plan Check: .
Permit :,
SMIP Res
SMIP Com ,
Other ''
� Inspection: <
' �` Totali
'`.
�x
;
Phone.
License
SCOPE OF PERMIT ;' ,
JGLES AND REPIACE W/ASPHALT SHINGLES ON ATTACHED HOUSE AND GARAGE, AP,ROX 17 SQUARES:,,.
4THING AS NEEDED. ' ��� %' � ' � ;`; ���� � n,=
, , � , -_ � _. >-: aa; ,
,, �-
, _ . a< � ..,, �, �. �w �,
t
�,- r ,; FEE"SUMMARY .. � } �. ; �
�- ; ' � ��� � � �� �_ _ `� ; ,, - ' �alc Valuation ; - , gz,soo.00
�,�; __
; tl luation � �? gz,soo.00;
� � _��
� � � =R a �¢ � �
� � 1�= m
��
� > �� ��
s
) :'t_,� � - � � , �,.
�
�� .
5. ��� � � - - _ ��a.
!PLANNING & ZONING
SETBACKS �;` ,:>'
MAIN STRUC7URE � �� �
Front �0 0--- x Rear O�Oi ,f,�� L'e8 0-0 ��_ ";Right„ 0-0�^ -��r- •�
� -_
ACCESSORY. Front 0-0 '� , Resr 0-0 <x Left 0 0 � Right � 0 0� ',���`
� j� i�
PARKING �Exis4na a`- Q,� Reauired , 0 „px, �Pr000sed. =0 - , �
* " . . _ ">'�"'' ... -s,3� R -
-;,a , . - .. . +�. . u � p ;
� �` .&.�. .. . ,5.� .. , . .
. . »�
3 -
.. . � .. - �. .
NOTICE: The work authorized by this permit shall comply with all applicable handicap accass requirements untler California statutes and related
r�gulations. (Ord. No. 92-28, § 1, 12-21•92)
IEXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period o� 180 days. • ,.
I� INSPECTIONS: In order lor the work authodzetl untler this permit to be consideretl legal, sucb work must comply with all applicable codes, and al!
requlred Inepectlona end tlnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
FOH INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARA�ON: � �
I hereby efrirm under penalry of perjury one P� the following tleclarations: � _[ � ' ' , � �
❑ I heve and will maintain a cenificate of consem b seN-Insure for workers' compensation, as provitletl lor by section 3700 of the Labor Code, for the pertormance of ihe
work for which this permit is issued.
❑ I have and will maintain woBars' compe�sation insurance, as requirea by section 3700 oi Ihe Lebor Cotle, for the peAortnance of Ihe work for which this permit Is Issued.
My workers' compensation Insurence Cerner and policy number ere: .
Cerrier: Policy Number:
(This sectlon need.not 6e crom0�eted i! the pa��� is valued at one hundred dollars ($f 00) or /ess.J
f��F��i lhat in the edormance of Ihe work tor which this ermit is issued, I shall not em lo en �
ty p p p y y parson in any manner so as to become suD�ect to ihe workers'
compensatlon laws of Califomla, and ag�ee that It I should become subject to Ihe workers' compensation provisions of Sectlon 3700 of ihe Lebor CoGe, I ahall forthwith
comply with these provisions. �—^
ApPlicant�S_i�'� g eture�� � Date:.. � ������'��� il
WARNIN�RE TO SECURE WORKEPS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SU6IEGT AN EMP�OVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED
TIqUSAND OOl1AFE (E100.000). IN ADDITION TO TME CQST OF COIAPENSATION, DMMGES AS PROVIDE� FOR IN SECTION 31080F THE 1A80R COOE, IfJrEREST, AND ATfORNENS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm ihat I am Ilcensed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business end Protessions Cotle, end my licensa Is In full i
torce end eflect. Lic. a Class # i
Contracrors SignaNre: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirm that there is e construction lending agency for the performance oi the work tor w�ich this permit is issuetl. (Sec. 3097, Civil Code).
Lenaefs Neme: �endar's Atltlress:
Signeture: Date:
OWNER•BUILDER DECLARATIONS:
I hereby aHirtn that under penalry of perjury thet I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Professians
Code: Any ciry or counry which requires a p�rmit to construct, alter, improve, demolish, or repair any sirucWre, pnor to its issuance, also requires the applicant for such pertnit
to file e signed statement thet he or ahe is IiGensed pursuent ta the provisions oi the Contraaars License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the
Business entl Professions Code) or that he or she is ezempt therelrom and tha 6asis tor the elleged exemption. Any violation of Section 7031.5 by eny epplicent for e permit
fsp6jectadhe appllcent to a civil penelry of not more ihan tive hundretl tlollars ($500).):
;�'�es owner of the property, or my employees with wages as t�eir sole mmpensation, WILL DO THE WORK, antl t�e structure Is not intendeC or oflered for sale (Sec.
7044, Business and Pmfessions Code; The Coniractors License Law tices no� apply to en owner of pmperry who builds or improvas ihereon, an0 who does such work
himselt or herselt or ihrough his or her own employees, provided that such improvemenis ere not intentletl or oHered for sale. If, however, ihe 6uiltling or improvement Is
sold within one year ol completion, ihe owner-builder will have ihe burtlen of proving that he or she did not build or improve for purpose ot sale.). •
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to canstruct the project (Sec. 7044, Business antl Professions
Code: The wniraaors License Lew does not apply to en owner ot proparry who builtls or Improves �hereon, end who comracls lor such project with a comracror(s)
license pursuant to ihe Contractors License Laws.).
❑ I�pt under �ea eusiness antl Protessions Code for this reason:
na rs{�:�?� o
Owner ID veritied by dnvers license. ❑ Yes ❑ Na D� efs LiCense "
Venfication of Ownership by (type of docum6nt, i.e. - property ta�c blll or deed):
CERTiFlCATE OF COMPLIANCE AND AUfHORVJ1T10N OF ENTRV: I caniy under penalry of perjury that I have read this epplicetion end state thet the information given is
correcL I agree to comply with all state Iaw3 entl ciry ortlinances relating to building construction, and authorize representatives ol the Ciry oF Coste Mesa to enter upon ihe
ebove-described propert,y t,or �m ection Du�es. I agree not to occupy or allow occupancy of eny building authonzed by Ihis pertnit until finel inspaction.
���e�s�-� !�'/ s'-�.�D �
,�. Sig,nature,O,f-LB9alOwner(s) � Data�
Antl/Or Authonied AGGlicant Date
7616
1266
200
201
202
203
INSPECTONTYPE
Fixed System Final Fire Prevention
Pool Spa Final .
Pinal Re-Rooi
Final Block/Retaining Wall
'Final Fectory Fire Place
Final Sign
204 'FinalDemolition�
QdI€ UiIIDA�fi
1�����p� �iL
- • r
CO�EI INSiECTONTYPE
206 Final Mechanical
20B . Final Plumbing
210 Final Electncel
212 Finel Fire Prevention .
220 - Final Planning Approval � �
222 Final Site . ,
250 'Final Building/Occupenq
�� °� �� �?2eQ�t �'u��e�us� �iuCQiac�
OWNER-BUILDER
VERIFICATION
Address: � ` D'� /-�' �N/ "8 U�� �U� �2 �'�% Permit #:
�
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as
a condition precedent ro issuing a building permit, require the completion and require the retum of, an owner-
builder verification.
Attention Property Owner. �
An bwner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and retum this infomiation in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No buildine permit will be issued until this
verification is received.
1. 1 personally plan ro provide the major latior and materials for construction of the proposed
property improvement. � Yes ❑ No
2. ] (have/have not) _
[he proposed work.
signed an application for a building permit for
3. I have contracted with the following person (firni) to provide the proposed construction:
Name
Address
Phone ( )
City _
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 die major work:
Name
Address
Phone (
City —
Contracror's Lic. No.
5. I will provide some of the work but I have contracted (hired) the followit�g persons to
provide the work indicated:
Name
1042a6 (Rev. 1 VO4)
Address
Phone Type of Work
[ hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of
Califomia Health and Safety Code and have completed the above infortnation to the best of my personal
knowledge, in compliance with this State law.
Signed:� d-'�l��� Date: lD— ��"2�(�✓�
Name: Kj/{B/ �,. ��'%L �/1�
(Prinled or Typed) '
c.D.�. # ox s.s. a /
For more information call City of Costa Mesa Building Division at (714) 754-5273.
10A2d6 (Rev.11104)
��
ntSA CONSTRUCTIQN PERMIT
ct'Address2lok Men�ro✓;A CesG �bl�sq �
• rpplicant's Maili g.A(.d,_dre s "�
Owner's Name �A" •�� �` ^' N' Phone 3 �-Z'�13
Address -sA"'� � ' '
Arch/Eng. , License No.
Address
Contractor's Name Phone
Addreu (mailing) - R
City License No.
LICENSED CONTRACTOR �ECLARN ION . ' �
� I hereby al�irm that I am licensetl untler provisions of Charter 9(commencing
with section �000) oi Oivision 3 of ihe Business antl Professions Cotle, antl
my license is in fullr(orce antl effect. -
License Class � License No.
Date Si9nature
WORKERS' COMPENSATION DECLARATION '
,'.hereby aifirm that I have a certificate ot consent to sel4insure or a certificate
/'�'-Wo�kers' Compensation� Insurance, o� a�certl(ietl copy thereo( (Section
;:"+)0, Lab. C.)
�Volicy No. ^ "� • ' • Company '
BCertifietl copy is hereby fumishetl. '
Certifietl copy-ii•(iletl,with the city Builtlin9 Division.
Date APplicant �
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl it tne permit is tor one huntlred ($300) ar
less).
I certify that in Ine pe�fo�mance ot the work fo� hiqh tM1iS pen9i " tl, I
snall not employ,any person in any mani r as t6 y come the
Workers' Co p at_ ws of Califor / '
Dat� � - Signatu '
�NOTI : If, aiter-makin9 this tleclar ti ,= �Spu tl ecome su j t to the
Workers"'Compensation provisions f the La�r Cotl , you ust orthwith
comDb �✓�th such, provi5ion5 or this pe�mit shal bC tleemetl revoketl.
CONSTRUCTION LENDIN6 AGENCV
I herety affirm that Nere is a<onstruction lentling agency tor the performance
of the work for which this p¢rmit i5 issuetl (Section 3097 Civ. CJ
� �entler'S Name
Lentler's AOtltess
OWNER BUILDER �ECLARATION �
\ �
/�Dolicant to fill in all spaces except thoze witnin heavy �r0e� Iinci an0 si9n all a00ro0riate Aeclarations.
PER IT i� � � qC�� ' ,.,. LOT NO. UNIT NO; ,
�/ c�
. TVPE OFCONSTRUCTION � NEW .ADD� ALTERATION REPAIR
❑ CONVERSION ❑�DEMOLISH ❑ OTHER �
DESCRIPTION OF O /USE OF BLDG. �s'tiTaLin�/�_� tij C
yQ R�o �WaCtn l�L�C�/3,�y- ¢'��
�TYPE.OF�PERMIT GRADING ❑ FOUN�ATION STRVCTURAL ,
��� O TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL
❑ OTHER. �
PROJECT.DESCRIPTION 5c1. F7. ocCuvANCv�� '
CONSTRVCTION�TVPE VALUATION'd'� F�JJ�
ZONE ^ GRADINGCU.VDS. ACRES �
I hereby afiirm that I am exempt from the Cantractor's License �aw for the
following:reason (Sec(ion ]031.5 Business antl Professional Gotle: Any city or
wunty which requires a permit to construct, alter, improve, tlemolish or repair
any structure, prior to its issuance, also requlres the appiicant for such permlt
to tile a signetl statement that he/She i5 IicenSetl pursudnt 20 the pfovisions of
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
�„',7ivision 3 of the Bu5ine55 antl Profe55ion5 Cotl2) or'that he/sne is'exempt
.';.`;.::� refrom antl the ba5is for the alleged exemption. Any violation ot Section
.�.F�.'71.5 by any applicant for a permit subjects the applicant to a civil
�e;}�`,,,-a'�alty of not more than five huntlretl tlollars (5500).
�...�-.....,...... ..,,...._ .._.... -.._ ..._ _..__._._ ._ ..,,. ...._.."' " "._"
- for�sale (Sectlon 7044, Bu5ine55 antl.Professional Cotle: The Contractor'S
License 1„aw does not apply [o an owne� ot a p�ope�ty who builGs or imp�oves
thereon, antl who tloes SucM1 wo�k himself/herself o� through his or h¢r own
' mployees, provitletl that Such improvement5 are not intentl¢tl o� of(e�etl fo�
sale. If, however,-Ihe builtlin9 or improvement is soltl wlthin one year oi com-
pletlon, the owner will have the burtlen Ot proving he/she ditl not builtl or im-
��Ove torthe purpo5e of Sale).
1, as owner ot the property, am exclusively contracting with licensetl con-
tractorsto constructthe project (Section ]044, Business and.Professions Code:
The Contractor's License Law tloes not apply to an owner of property who
buiitls or improves thereon, antl who contracts for such projects with a con-
traCtor(5) license pursuant.to tbe ContraCto�'s,License Law) I am awar tha{
proof of'their Worker's Compensation insurance shoultl be �{ ovitle me.
❑ I am exempt untler Section � B. & P. �./p is r ason
nave read'
agree to c
o builtling
to enter
Remarks:': r ( N �C/c
f l� OK\
Bar Sink +
Backflow Preventer --
� Backflow Ir�i9ation .,
Bathtubs � �
Clarifiers �
Dishwashe%
� Drinking Fountains
Floor �rains
Floor Sinks . �
Gas Service - Outlets
Kitchen Sink
Lavatories '
P-Trap
Roof Drains �.
Reinspaition Fea $15
Boiler
Duct - Under Ground i
� Duct-Structural
Duct - Ventilating �
' Exhaust System� ❑ Multiple ❑
FirepVFact. BIt.,IC00 #
Heating System & Ducting
� ❑ 0.100,000 BTU � 100,000 BT
LSiqnature 'r _ oate (D 1 LUI 0C1 peinspection Fee
Drivers' License or 55 �
��';M\5-46, rev. 30/B4 White - Building; Canary - Applicant; Pink - Accountln9; Goltlenrotl - Assessor
$15
VShowers � I
Service Sink � '
Sewer Cap � �� � '
� Sewer Connection ' -
Solar Collecrors - � .
-SolarPiping � -
Solar Tank
Smfmm n Pnnl yJ$py - �
Uf1f121
' Water Closet �
Water Heater .
Water Service'
Auto-Wash .
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
iefrigeration System
r.
�0.100,Ot008TU ❑100,000
System Repair/Alteration �
Fire Dampers ; ���.OR��
Registers `� �
— f��
Issue Fee
$ 3
FEES
$' 3
A.P. # IG�
S Main Buildi
E
T Front L
B Fear �
A
C Right_ -
g Left 'P �
Ping. Ref. #
Planning Notes:
r
� f ,
�
Auromatic Washer ,
Construction Pole Sub.
Cooking Unit '
Dishwasher �
fan
F.A.U. - _- ;
Fixtures
Device Boxes
Outlets
Switches • �
Garbage Dispoul
Generator �0.5 KW
9
!. .. . 1
�8361 �6/26/86 �
, . _ � � ' ' � Zone
Accessary Building: '
ELECTRICAL '� - ,
. . Transfofiner O 15-50 KN
❑ 50+KW,
Meter ❑up to 100 amps
. MeLBi ❑Ov21 lOO aTpS
�� aw- enei : � �
, Motors�0.lHP�ih-8 �
� InaSolar �9-15 HP �i6-15�
Microwave �
Pole Light �
Ranna �
c
5KWI �
I Reinspectian Fee � I $15
DEVELOPMENTSERVICESRFA;
2oning Approved By L�
Building Approved By �
`Sign ' '
Standing Sections
Trash Compactor
�
Issue Fee
—
NTS:
40:25 'TL
Z
` O
� N
I
N
� G
R
E
Q
M
T
S
$ 3
' �T SU R FEES-
�
- BUICDINGPERMIT '$ SMIP, � ' • $ �"S �}
�i
PLAN CHECK � $ PERMIT. ' � , ' +;
PLUMBING $ ISSUANCE $
� `� PLAN CHECK 25% $ �. ENERGV P.C. $- ' �
�-ELECTFiICAL � �$-
(� GRADING� $ ' X�
PLAN CHECK 50% $ MICROFILM $ .-�,��J.� �,���✓ ��
ME�HANICAL $ TOTAL FEE $ ' ' ��
P�AN CHECK � 25% �$ � ' � �
POO L & SPA
CONSTRUC710N AND PLANNING . . �U
Date Inspector � Date, � Inspector
�APPROVALS ' Permit # . APPROVALS Permit # j
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. Elecfrical Conduit-Undrgrnd. � , 55. Electrical Bonding- . ' �
5. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test � , y
6. Electrical UFER Grnd. '� 57. APPROVAL TO COVER-GUNITE
7. Footings ' ' 58. Electrical Conduit-Ur}drgrnd. m
8. Foundation �� ; 59. Gas Pipe, � Undrgmd., Test � �
9'. Water Pipe�Undrgrnd. • - 60.- Backwash Lines, P-Trap, � Undrgmd. •
. 10. Structural Floor System' ' � , 61. APPROVAL TO DECK � �
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 8i Access Approval.
17. Rough Wiring Sign - �68. APPROVED FOR PLASTERING �
� 1�8. Rough Electriral-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL .�
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 O Gas ❑ Oil � ,
23. Gas Pipe-Rough & Test � `72. Underground Flush . ,
24. fioof Framing �73. Undergrnd. Storage Tank � Gas ❑ Oil _
25. Roof Sheathing 74. Overhead Hydro �
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 PREV. FINAL .�
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaste'r Brown Coat .� 79. FINAL INSPECTION ' ,
' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
�� 33. Final Electric � Notes: 7 L S% t/�i�y� (/� �
34.' Final-Heating & Air Conditioning� ,
' 35. Firial GasePipe-Test �
36. Hood or Canopy , , �
' 37. �Final Factory �Fireplace � . - . '�
38: FinaFPlumbing ' " i!. . � ;
� 39. Water Service-Final . - �
40. Gas Service-Final - . � �
41. Solar pomestic-Final � � . •
'42. Backflow Preventer ' � '
�'43. Backflow Irrigation - . ; � .
44. .Landscape Irrigation System ' � � �
�
i45. Sound Attenuation- • � ;g '
e
46: Handicap Regulations E X P I R • � �
A
� 47.�FINALSTRUCTURE&BUILDING' � �V . . � � �
�
.48. fSpecial Requirements Completed' �� Slg _ •
i�49. Electric Release to Edison _
,�+.
�� 50. Ga's Release to Southem California Gas Co . '� "� �
� 51. CERTIFICATE OF OCCUPANCY . � '
No. Date
OWNER BECK ALFORD J. � DATE 12-28-59
JOB ADDRFSS 21n9 Mnnr�via Ave_ BUILDING PERMIT NO. 1 7
ecnoNs � oprE I GROUP d TYPE � ZONE
SUBCONTRACTOR
L
OCCUPANCY
Form 410—SM-11-59 S-B P . . - 1117G
. 11.�t`:2
C��A MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317' COSTA MESA. CALIFORNIA
FOR APPC/CANT.TO f/LL /N COMPLETfLY
TYPE OR PRINT
ADDRESS � /U / C�1C/ Ol/
COSTA MESA. CALIFORNIA
_'.'..__ .d i �%i%? %% - . � _ /S�� ('
'AOORE55 �/ / � /yD �^//O/ �
I��r� SAN C9BA/EL- T��TL�239
ARCHITECT � LIC.
OR ENGINEER �L� NO.
CONTRACTOR
ADDRE55
LEGAL ILOT
' oEscniPnoN I NO. „! � I BLOCK � TRAC
"T' y�
A.P. NO. �y� � �l �' . '`
, SIZE 11... .( •. w' I NO. OF BLDG9.
� SETBACK LtNE FHOM
ILEFT IRIGHT
DESCRIPTION OF WORK
BUILDING . NO.OF /
SIZE ROOMS r
EXTERIOR WALL ' IROOF ' '
COVERING COVERING
USE Oj�BUILDING Ap�D �Q(ORK TO BE P
1-HERE6Y qCKNOWLEDGE THpT 1 HAVE NEAD THIS APPLICATION
ANO�STATE THAT THE ABOVE IS COFRECT ANU qGREE TO COM-
PLY WITH PLL CITY ORUINANCES PND STATE LA/WS REGULATING
BUILOING CON6TRVGTION. /^/ I�' // �
fiL�Y'O �/1 i '`�A //
SIGNATURE OF O�p`�K
PERMITTEE
AUTHORIZED AGENT
��E REC�ti���
_� /�—��/�/
INANCE DEPT,
APPL�E{ATIOIY�CF��2 N�FRM IT
� � BUILDING
FOR OFf/CE USE ONLY
I �RECEIPT NO. I_ PERMIT NO..
� i � j %3/�u,t�.�.<.G�..
COSTA MESA, CALIFORNIA I
ZONE NO.OF
R I PLANS
/ \
APPROVED /
BY f
YARDS
REOUIRED
(CENTER LINE 6T.) �
FRONT . �C%V ,
R.SIOE��1vi' �
_I BUILDING
' /'
/b�.
�s/�, — -F
THE wMOUNT BHOWN UNDER VPIUATION �5 FOR THE
PURPOSE OF E9TABLISHING A PERM�T FEE ONLY.
VALUATION �7 '
' PERMIT FEE $ Or- —�
999 � L/
$�D%I� PLAN CHECK $ �'
v
T_ AL FEE $ �-
OWiaER PC7b?ERS . C . C _
BUILDING PERR3IT NO.
VALUE
�YP.`Iro: " LOT TRACT FIRE ZONE DESCRIPTION OF WORK FE3RCe
( 'IP TYPE ZONE PLAN NO. �i7B2
INSPECTIONS I DATE I SUBCONTRACTOR I DATE
Test
�
coat
PERMITSISSUED
0
F
W
W
K
F
y
�
o,
JI
F T. I ST.
COSTA MESA BUlLDING DEPARTAAENT ' �
P. 0. BOX 317
GOStA MESA CALIfORN1A
C.L. OF STREE
" �iPROP. TINE _
r 10 FT. FOR 60 FT. STREET
�
�
I
I
:
,� Z
N�
IW
�a
��
�d
61
/I
ZI
_ — —J�1
a
\AL�,EY QR PR P, LINE i al
,''�
� '� � 1
,
� L i ��'w � �
a � � �. I
� � �' 10'
� h 6
V�� � FT '
� � �
�y G O
o�� q� I
\ • u '' � g I
N a �
� �, m I
� �
PROP LINE �'
—��--=--�-----
C.L. OF STREE
� �
i
- � ------�
i
�+�
F-
W
W
K
F
N
�
0
J
ci
ao
FT ,
60 FTl ST.
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES------
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES
5'�82 �
I I
FOR APPLICANT 1"O FII.L IN
BUILDING ADDRESS a l G�/yo/vpll di /t
Owner ��, � • �o � ER S
Mail Address
City _@�S r/t _ tii .FS/-� __Ph. No.�/-�U 3%�_
Contractor ���'-���No.
Address
City Lic. No. State Lic. No. _
— - - �Q �-- ��- - - - - - - - - - - - -
Size of Lot'�+` X'�� AP No. �� �' ���— ��'
O �/
Setbacks: C/L Street—�U'� Rear ��
O //
Side Yard - Right Left �/
Type of Fence �f1-%/�%// Li'"' �� leu� �
�1�
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 / /L� _
by
FOR OFFICE USE ONLY
,5 G y,L
9-�3�s� I 9-i3
VALUATION
Permit Fee
J �—
Plan Check $
TOTAL FEE $ .2 _ �
USE REVERSE SIDE FOR DETAILS
ORANGE COUNTY BUILDING DEPARTMENT • APPLICATIOM FOR PERMIT ,
. ' . 636 North Broadway ' �a �O '
_, SANTA ANA, CAUFORNIA . --- - -�����- . �. p��-�° --- - - �