HomeMy WebLinkAbout135 MORRISTOWN LN - Building Permits 4�051gitFS,4 CITY OF COSTA MESA
c'4SV CALIFORNIA 62626 P.O. BOX 1200
F1 et.ewistifiri, IF
v • FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY •
Project Address ( 3f /1//Otitt5 174pcv4) LA/ Permit
4 #4O 0
Project Name MFAt/ f7ap/Rca Type�p
Owners Name /Q� 1L/Ul P-8 &. //i ni `l/7!—
Owners Address / 3S /001(e/3 -414-1") City Use Only
Owners Telephone s*it-
JEge2, . as Owner, Contractor, Agent (strike out all
except one') do ereby attest that employment of any person, or persons, is not
anticipated at the time of seeking the above-referenced permit. In the event that
any person, or persons, are employed under the provisions of this permit, I shall
immediately cause a valid Certificate of Workmen Compensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my own Dost, and to indemnify and hold harmless, the City,
its officers, agents and/or employees, frau and against, any and all liability,
damage, costs, losses, claims and expenses, howsoever caused, resulting directly
or indirectly frau, or connected with the improvement under this permit.
I further state that I have read and fully understand the implications and re-
sponsibilities of the above statements, and will comply with all provisions of the
Contractors State License Law found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
42.2 7,4A/E3
Print/Name
/o' 7-/- 80
natu Date
CMF 0777-46
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA PER"J�IT NO. TRACT NO. LOT NO. BLDG.NO.. 2242 6/14/6/4 :IOU T
CONSTRUCTION PERMIT r i36D a Z
' Project Address l4' S /'YIOnRI'ShCUn IH TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION U REPAIR
Applicant's Mailing Address . ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name '' /I -- y4-39.2 DESCRIPTION OF WORK
/ Phones S Main Building: Accessory Building: Z
AddressT 0
TYPE OF PERMIT U GRADING ❑ FOUNDATION 0 STRUCTURAL T Front N
Arch/Eng. License No. _- _ - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N
Address z�t� L /y / / ❑ -OTHER
Contractor's Name/72911 r/�- On&r '-'<,z„Phonpe 17‹,,-,Z10.5. PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G
Address(mailing)p .' /1IH �i �' �Xt/Jw�' til Q^�7i/ CON ST RUCTION TYPE VALUATION$ $ Left E
City License No. & ' ZONE GRADING CU.YDS. ACRES Ping. Ref. # Park.Fees $ 0
U
LICENSED CONTRACTOR DECLARATION Remarks: - Parking Req./Provided -
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing q
with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: E
my license is In full force and effec
Ucens lass — LK: se No. i PLUMBING FEES Planning Notes: E
Date '-.• "' 'L signature A -- ,./- .'. i''
WORKERS'COMPENSATION DECLARATION Bar Sink Showers T
1 hereby affirm that I have a certificate of consent to self-Insure or a certificate Backflow Preventer Service Sink S
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES
Policy No. Company
BCertified copy is hereby furnished. . Bathtubs Sewer Connection Automatic Washer Transformer 0 15.50 KW
Certified copy Is filed with the city Building Division.
Date Applicant Clarifiers Solar Collectors Construction Pole Sub. 0 50+KW
•
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIONDishwasher Solar Piping Cooking Unit , Meter Otto to 100 amps
(This section need not be completed if the permit is for one hundred ($100)or
less). k
Drinking certify that in the performance of the work for which this permit s Issued I Dr9 Fountains Solar Tank Dishwasher Meter Dover 100 amps
shall not employ any person in any manner so becomes IGC tot •
--
Worker���000ggqemrm�ppnon Laws of Califor Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Date Le`/teing Signature ��hi �// �ubjb .t
-
Worke er a m this tlecla ion,you sh uta become subject to he Floor Sinks -Urinal - Fan Motors 00.1 HP ❑1'h-8
Worke s' Co pensat on provisions of the Labor Code, you must,forthwith '
comply with such provisions or this permit shall be,deemed revoked. Gas Service Outlets Water Clo;et '
F.A.U. Inc.Solar 09-15 HP 016.15+CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance Interceptors ' Water Heater •(�'- Fixtures :Microwave •
of the work for which this permit is issued (Section 3097 Civ. C.) ' /
Lender's Name - - Kitchen Sink Water Service Device Boxes Pole Light
Lender's Address. Lavatories
OWNER BUILDER DECLARATION - . Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the P—Trap reason (Section 7031.5 Business and Professional Code: Any city or p Switches Sign
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 Roof Drains - Garbage Disposal Standing Sections
to file a-signed statement that he/she is licensed pursuant to the provisions of - -
the Contractor's License Law (Chapter 9(commencing'with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt - ' .- Generator 00-5 KW 05-15 KW Trash Compactor ,
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 Reinslaection Fee 'I -$25 Issue Fee $ 3
penalty of not more than five hundred dollars($500).
• I, as•owner of the'property or my employees with wages as their sole MECHANICAL --- - Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered + FEES
for sale (Section 7044, Business and Professional Code: The Contractor's ' PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or Improves Boiler Hood or Type I 0 .
thereon, and who does such work himself/herself or through his or her own
Ground ,
Zoning Approved By - Date
employees, provided that such improvements are not Intended or offered forCanopy Type II 0 -
sale. If, however, the building or improvement is sold within one year of com- Duct-Under • Building Approved By Date
pletion, the owner will have the burden of proving he/She did not build or Im- . • '
prove for the purpose of sale). Duct-Structural Refrigeration System - , Application Issued By 922? -Date
U I, as owner of the property,am exclusively contracting with licensed con- ❑0-100,000 BTU ❑100,000•BT(1
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES ,
The Contractor's License Law does not apply to an owner of property who -
builds or Improves thereon, and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration • BUILDING PERMIT $ SMIP• 1 $ . .
tractors) license pursuant to the Contractor's License Law). PLAN CHECK $ I PERMIT
❑ I am exempt under Section B. P.C.for this reason Firepl/Fact.BIt. ICBG# PLUMBING $ „,,S#. Od ISSUANCE $
•
Date OwnerHeating SystemDucting
& • PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that-I-have read this application and state that the above. 00-100,000 BTU 0100,000 BTL. GRADING $ •
information is correct. I agree to comply with an city and county ordinances ELECTRICAL $
and state laws relating to building construction;antl hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of t . totanteupon the above-me Cloned pr•perty for
Inspection �rjj ' / f- MECHANICAL $
Signature _.iii ��rs.-_ Dat TOTAL FEE $ c
Drivers' License or 55#
Accounting:Goldenrod -Assessor
,CONSTRUCTION AND PLANNING POOL&SPA - - . , 4
Date Inspector - - :, Date Inspector,i .
APPROVALS Permit# APPROVALS Permit#
- 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - - -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • •
3. Electrical Conduit Utility-Undrgrnd. - , 54. Forms - - - ' r
• 4. Electrical Conduit-Undrgrnd. - 55: Electrical Bonding • -
5. Steel Reinforcement 56.. Rough Plumbing & Pressure Test • r
6. Electrical OF ER 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, 0 Undrgrnd. - ..
10. Structural Floor System - 61. APPROVAL TO DECK • : - ..
11. Property Sewer Line & House Connection ' 62. Backwash &,Receptor-Final 4-
12. Sewer Cap r 63. Heater & Vent-Final • - '
13. Roof Drains . • 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final '
15. Rough Electrical-Conduit 66. Solar Systern-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 • ' ' ,
19. Rough Heating & Air Conditioning FIRE DEPT.,REQUIREMENT • ' • !
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro I 1
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil '
23. Gas Pipe-Rough &Test 72. Underground Flush, ' •
J •
24. Roof Framing . . • 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
_ 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical i
27. Frame and Flashing 76. Dry Standpipe - ,
28. Lathing & Siding , 77. FIXED SYSTEM F,INAL - ' I '
29. Insulation - 78. FIRE PREY. FINAL •
30. Drywall Nailing HEALTH DEPT. REQUIREMENT i
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 111
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 j////dr ' (,SD - i
39. Water Service-Final .
40. Gas Service-Final -
41. Solar Domestic-Final • • - - - . - ' '
42. Backflow Preventer •
43. Backflow Irrigation - •
44. Landscape Irrigation System - I' `
45. Sound Attenuation - '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING -
48. Special Requirements Completed
49. Electric Release to Edison - - i '- ; .. .
50. Gas Release to Southern California Gas Co .
.
51. CERTIFICATE OF OCCUPANCY
No. • Date - - - .
ai
ROJECT ADDRESS: 135 MORRISTOWN LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069493
I OWNER'S NAME: HAM, CLYDE C
I ADDRESS: 135 MORRISTOWN LN PERMIT NO: B 069493 PLAN CHECK NO: N GOVT: N SUPP: N
s COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR • PURPOSE; ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; T/O RESTH & REROOF W/COMP 6 HOT MOP SQ FT: 2, 508
ADDRESS: UNIT:
CLAIM VALUE; 2, 508 , 00 CALL—VALUE; 2, 508 , 00 GROUP OCC; R-1 /
PERMITTEE: STOUT ROOFING, INC. ( 310 ) 923-6775
ADDRESS: 9700 WASBURN RD COMMENTS; REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DET, REQUIRED
�r
DOWNEY CA 90241 *�t*****4********yr****EE�P�t�c�r�Er****B ***************************** ***wit****+r*sr*ar*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIR EMEN TS
7000)of Division 3 at the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITYLIC.: 059377 STATELIC.: 402536 cuss: C-39 EXP: 1 /95
Date: nIAL4
Signature;-7, MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPE SATION DECLARATION: I hereby affirm that 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 In nce or a certified copy thereof(Section 3800.Lab.C] LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: 5ur822699 EXP.DATE: 05/19/95
COMPANY: AIG PARKING REQ: PROV; PARCEL; 41916270 ZNE: REF NO;
❑ Certified copy is hereby furnished. nC Certified copy is filed with the city Building Division. PLANNING NOTES>
�-1(/^'/^1 �///�/ >
Date: /J 0/_ f Applicant: / 4/1' (/�V `� *******************************************************************************
EXEMPTION SROM W RKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N '.T S
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. ZONING APPROVED BY - •
DATE:
Date. Signature:uBUILDING APPROVED BY :
ode.NOTICE:If.alter making this ywith
declaration. hu shouldo become i spermit the deemed rempensation provisions of the Labor DATE:
Cade.you must forthwith comply with such provisions Or this permit shall be deemed revoked. C �j
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: D J "�
which this permit is issued(Section 3097.Civ.Cl. *****************************ki iE** *********************************
LENDER: ***************************** (E*************************************** *** ***
ADDRESS: LEGALIZATION;N E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that I 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 54 , 00 5j 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 PLAN SMIP/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
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 property 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 Prof essional Code: The Contractors*State License Law TOTALS S ----> 54 , 50 0 , 00 0 ,00 54 , 50 54 , 50 , 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 • 54 . 50 OVER/SHORT
improvement s sold within one year of completion,me owner will the Damen of proving he/she did not build or improve
fororthe purpose enoss sf sale).
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 5 4 0 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property 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 am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 •
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 2, 508 , 00
25534 and that I or any future budding 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 Quality 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 intormation is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city 10 enter upon the above-mentioned
property for inspection ur/pasees. 01 00170505-00170506 TOT 54.50
Date: IV�QT) 6N Signature: .4 114 DATE: 10/28/94 TINE; 12:28
Dnver's License or Social Security q: (
1641-46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
t
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
•
c'-
2. Soil Pipe-Undrgrnd. ; j 53. Steel Reinforcement
3.-Electrical Condit Qtility-Undrgrnd:' 54. Forms
v
4:ielectrical Conduii ndrgrnd. 55. Electrical Bonding
S.
'- 5:ISt-eel Reinforce'rnent 56. Rough Plumbing & Pressure Test -
. jE eectrical UFEB:Ornd. - 57. APPROVAL TO COVER-GUNITE
n 7.,-,Footings 58. Electrical Conduit•Undrgrnd.
B.=Foundation "j. - 59. Gas Pipe, 0 Undrgrnd., Test
' 9'Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
`10, Structural Floor System ,•.i 61. APPROVAL TO DECK - 1
11. Prtperty Sewer Line,& Hgyse Connection 62. Backwash & Receptor•Final 1
12. Sealer Cap - - 63. Heater & Vent-Final
sr a, _
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 i
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
_t _
20 Rough FictorN Fireplace .- -• Er r t APPROVALS' Permit#
21 Ducts,int Str�ir;tucex F; '**` j ; ; - 70. Ubderrg ound Hydro a ,1
22. Ducts, ‘I+ientilating.x - • * r';71. Product`Piping ElGgs 0,00
231-Gal•Pipet'RougWiest Test 'r ",` ` _,72 Underground h
F liJ
'
24:,Roof Framing t v c
a _73'xUndergrnd:Storaemank'0 Gas 0 Oil
-.
25. Robt Sh athing D 7 $61T7 ' ;443)0:, "74; �Dverhead Hydro-,r' -
26 -Bar Ceiling (Str`uctural) &'wlonocoat -
'u ,1 ri
. ' • i 75c'Dry Chemical J '
O - -
27, Frame and Flashings 'v,i,z, 1-2 ` " 76t Dr Stand"i' a '- , ' '! ,
.28, Lathing& Sidings; ; L =t.y t' is * ^ - - •• - + 77..-FIXED SYSTEMI FINAL tri
29. Insulatiq?t , .-1x '. ' " .- : *1 ,: x 78.;-FIRE PREV. FINAL _ r ..
I' ''r t i.J . _ 1 ' ' L 'J )
:"30. Drywall-Nailing n i , It 1 H.EALTH,DEPTt REQUIREMENT
•
.31. Plaster Bsown Co2-t* rt „ * I I - (s ; 79.1.-FINAL INSP-ECTIQ;N t
-V Bs
� h ' -E-- r R ♦ .y,�-'_ • •
--.32..,ElectricitbPower MeterFinal, ♦u I t • „80, rFOOD CERTiFICAI E ISSUED
a
33`final El�ctrc- f' s r '1 ' -I, k '-Nous: `1': - :r,
,, ,
Ai '� . -- - - ,• _ 13. 1 _
;34.-Final Hednngy& Air,Cor;d.itioni�g:• a 1 I - -, (,.^ _
35."Finai Ga3 Pipe-Test r 33 ' r' 'T? " 1' - •
,36- IHood or-Canopy y', - . -, a F , I its - r x' -. • --
r-
-37J-Final Factory Firepl_.
ace � S a, a' T' 1 l 'V s : 1 • ,
t- 4 i x
r
-38. Final Plumbing xi* ,� - I h s _ -. . -,
39. Water Service-Final* : f x . L" 4
''40. Gas Ser vice-Final'. rt r i It '
`41. Solar Domestic-Final ,. ,: • :. * -E.i '
)t, I 1 I.
t.
42. 'Backflow Preventer 11 , . e . s
e n i. . I
43. Backflow Irrigatio't ; - a _ - • 1
-*- - . r * * 01 - -
-$44. Landscape Irrigatiop System,;;'17; : - ;•1 i 7 -
45. Sound Attenuation
' ) `.,n:. ' _ ti -+ • 1 7; .y =4- r;
.46.'Handicap_Regilations '�
i t dr a: 70
,47.:EINALSTRUCTURE & BUILDING ..o-l•rry4 f' ..4L; "t="'
48..-FINAL PLANNING; " , ; ., I =? .
;49.•Eletiiic Release to Edison o ` 1 - - '
,_-r;.
_50.-Gas Release to Southern Californie,Gas Co : I ( -_ ,
51. CERTIFICATE OF OCCUPANCY s ) .
No. Date
UWNkat Lattll VSO111 Dui.Lulllg leV• DATE
JOB ADDRESS 135 Morristown Lane BUILDING PERMIT NO. 27185
GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION OF WORK Res.watt.gar.
AP No, 141-701-03 LOT 266 TRACT 5160 FIRE ZONE VALUE $ 17,64n.on
INSPECTIONS I Signa ure Date GROUP I & ,7 TYPE v ZONE p...1
Soil tI PERMITS ISSUED
Gas i : SUBCONTRACTOR Date I Number I Signature
Water tig_6417.S'7�3-c.7 ' - • ' lumbin �A
Rough Plumbing Iii 154xi.lot.•geliif.406-7947 1,r a/9�
Prop. Swr. Line 0 House Con.21-- S 7 -,i -la 7 U
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning 4,-11-5 If^ 4'-67
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring ri e. , `6'fl z 7 ,i-Ieatin and Ven,t,yy
Trenches [m Forms :i Steel Reinf. .l i4,;,,. - --6 eP,f Tt ft/i}' I'"/S'- 7 -('7.2
Floor System aaQ fri G YY
Bond Beam 0 Steel Reinforce 0
Sheathing i mm e-". / 6
Frame and Flashing' / , e, k
Lathing — In [Q/ Out Cfr.. ` Q- 74"
Plaster, Brown Coat C- - ,zq " 7
Structural, Final ec/1yn
Heating, Vent., Refrig. and A.0 aI / Ciire lle"�)IG jet„,,J.i..r. g-/,-67 Irni
-Plumbing, Final and Gas Test
Electric, Final to A /p.y6
Building, Final A yA q- to
PAID
21 tS JUN 19-67cnsnOO1628n ***85.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92020 .
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING �3 S 'YLNt For Office Up Only
ADDRESS RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA 2',1
Gc
SEC[tt DA /9.- 7 "ATEIA ---OWNER
U ibuetii. cb6
BUILDING
ADDRESS
/��2.�✓J.1MAILc q ,.`1. 0444404
' ' 04. \�.4.. e^° FIRM ADDRESS
/ - ��////��
CITY 0&La Pi-AO NO`2f./<4S46 ZONE V ,,'/�TjYP ORO�UP // 7
ARCHITECT /� 7H / DYPROVHD �[/ /�q�DATEt 2IO/r''-/7k—/
OR ENOINgIW l.Y tt Np.47 2_3-122k, f' / ./
/V'/� [� ,I{''^�O�/��� ZONING
ADDRESS ( D " \ /7/ /4�U�^L —)zo
NO.OP USE OF NEW/
CONTRACTOR C A FL-`" I _,I �1 / �a J" '
(� LEGAL 1. .Y-aepic l rp-drS/Gn
ADDRESS �•(r�C �t.ac..- DEacRIrttON rte,lL
CITY O S.w4,X A.P.NO. I L l— 0 1-0 3...
NOTE: NO EAVE OVERHANG SHALL.BE LESS THAN
STATE TEL SO'TO SIDE&REAR p.L
LIC.NO. NO.
EAVES
SIZE OT ZO 'X I L7 NO.OF BLOCS. O
NOW ON LOT ALLOWED (U.B.C.REQUIREMENT)
OP L
YARDS APPROVED YARDS APPROVED
USE OF
EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACK LINE FROM �.��- FRONT CJ �. NT.
CENTEROF STREET REAR YARD
SICE YARDI LEFT I RIGHT R. ID C') FT.
DESCRIPTION OF WORK L.SIDE O FT. PT.
NEW i..,^ ALTERATION
ALTERATION ADDITION REAR PT. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLDOS. ACCESS.BLOCS.
BUILDING^ ' I NO.ON VAR.# ,/ DATE ` �/
SIZE d{7 r(� ROOMS STORIES C.V•P.# a- ( T 4/ APPROVED (O"( O-c 3
EXTERIOR WA.&���I�� ROOF (�I�1.�����- APPROVjp' n / 6 ���777
COVERING ( UFU-tlNl1 COVERING jpTSY LA1'•Pe (V' DATE LD `b
ueEoy6�IILDInoAff7WORKT09cPgRf,�/��O�RME/D)/) HOLD FOR S Er 1s REQUIRE 1 N/ a.
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I HERESY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SH UNDER VALUATION IS FOR THE
AND STATE THAT TNEwD OVE.IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH AU.CITY ORDINANCES AND STATE LAWS REGULATING VALUATIONA
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BUILDING CONSTRUCTION. VALUATION
SIGNATURE OFCa'Ei� 0( PERMIT FEB $ .71
PHRMITTHr /J/ ��� a// i]D,— PLAN CHECK $ c29/3-6 W
AUTHORIZED AGENT ]n'i/ -d
TOTAL FEE $ V.//.J