HomeMy WebLinkAbout191 MORRISTOWN LN - Building Permits r6 CITY OF COSTA MESA _
BUILDING DIVISION
F i -1, 'DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
kPERMIT
it P05-00852
(714)754-5273 • Fax(714)754-4856 • www.ci-costa-mesa OMBING PERMIT 77'FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 191 MORRISTOWN LN Status: ISSUED
Suite No Applied: 11/09/2005
Issued: 11/09/2005
Vicinity:
Parcel Nunmber: 41916570
Applicant: CANDY NOCK
Address: 11612 KNOTT ST ISSUED BY:
SUITE 217 Phone: (714)895-1246 -
GARDEN GROVE,CA Zip: 92841
Owner: RUSSELL, JOHN K =t
Address 191 MORRISTOWN LN . '
Phone:
' COSTA MESA,CA - Zip: 92626
Contractor NOCK PLUMBING
Address: 1161KNOTT ST
SUITE 217 Phone: (714)895-1246
GARDEN GROVE,CA ' Zip: 92841
License: 707775
SCOPE OF PERMIT
WATER HEATER CHANGE OUT.
.FEE SUMMARY
AMT QTY • AMTS QTY AMT QTY
ISSUE FEE $23.50 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 $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 $12.30 1
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 $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: $35.80
COMMENTS I SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall.comply with all.applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1,12-21-92)
EXPIRATION: This permit shall automatically expire and-become void it work is not commenced within 180 days,or if work is suspended or abandoned
for a period of180days.
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 toobtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448-46(EV00)
WORKERS'COMPENSATION DECLARAT
I hereby affirm under penalty of perjury one of the following declarations:
O 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 forwhich this permit Is issued.
a 1 haj'earid 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.
Mwo s'coompeensatin,Insurance carrier and p Ii number are: n �g�-
Carder: I/ 1 1 Ito kin--)�I l d I 00.
Pokcy� lumber`{160gO )?deo
(five section ed not be comp on if the permit is valued et one hundred dollars($100)or less.)
9 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 S:ction 3700 of the Labor Code,I shall forthwith
comply with these provisions._ /, Cif--
Applicant Si natur /& Oa� ,�-,
APP 9 - Bele'. __ __
w U- TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHAH.SUBJECT AN EMPLOY' MI PENALTIES AND CIVIL FINES UP TO ONE H NDRED
THOUSAND DOLLARE(S160,CW).IN ADDMTION 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 ticens id • 1 a(/• •vi'"•ns of Chapter 9(commencing with Section 7000)of Division e Business a o/Iessions Code,and my license is in full
force,andeffeijalcr'per- Glass M :"
Go• clo Signature: mac•;elan: Dal � � 0
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,CMI Code).
Lenders Name: Lenders 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 and 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).):
O 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 tar 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 drivers license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feel 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(36)Leet 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:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑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? ❑Yes ❑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 then 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 en RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this//placation appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be fumished 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 tor 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? ❑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: Date:
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 property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sian. re Of Le.al Owner(s) D
yAn`d/Or7Autfwdz: •pi�n
war,
00E. INSPECTION TYPE "OATS RALs ' CODE If• INSPECTION TYPE - ' PATE RRB1ALE
1616 Fixed System Final Fire Prevention • • • 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 6-5_n G,
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
4(•`'tw4', CITY OF COSTA MESA
Q: .•• BUILDING DIVISION
1.. : 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT •
E00-00041
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 191 MORRISTOWN LN Status: ISSUED
Suite No Applied: 01/19/2000
Vicinity: 2ND FLOOR BEDRM, BATHRM,&FURNACE AREA Issued: 01/19/2000
Parcel Nunmber: 41916570
Applicant: DINKHA, ZAIA S. ISSUED BY:
Address: 2132 S.GROVE AVE
ONTARIO,CA Phone: (909)278-8019
UNITE Zip: 91761
Owner: RUSSELL, JOHN K
Address 191 MORRISTOWN LN
Phone:
COSTA MESA,CA Zip: 92626
Contractor: BLUE PACIFIC CONSTRUCTION
Address: 2132 5.GROVE AVE
ONTARIO,CA Phone: (909)278-8019
UNITE Zip: 91761
License: 757413
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR FIRE DAMAGE TO EXISTING SINGLE FAMILY RESIDENCE. INSTALL 10
RECEPTACLE OUTLETS&4 SWITCHES.
REF:600-00075
•
-
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res. a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $11.00 10 up to 100 kva/kw $0.00 0
Switches $4.40 4 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire 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 /
6
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
rk for which this permit is issued.
❑ I ave 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,
workers'compensation Insurance carrier and policy number are: p
fTCarrie. Par Number/
his action need nor be completed if the permit is valued at one hundred dollars($100)or less.)
O 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.
plicent Igna
RNINGrFAILURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND D<11 I ARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm the licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 f,tba-Bu iness and Professions Code,and my license is in full
force and effect. ',LC.# lass
Con s Signature:
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:
hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and 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 then 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 properly, 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. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 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(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,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:
1 Will the applicant or present or future building occupant need to file and 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....... will
eve hazardous
.. r_.
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely 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? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Government 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? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 taws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
niLOrAdthorized Applicarit r..Dated
CODE I/ INSPECTION TYPE PAM )NTRIALS CODE x INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing `_/ n
200 Final Re-Roof 210 Final Electrical /(lee,,
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
2446.46
AD:AIss of BUILDING: . .191 MORRISTOWN LN UMI; _ CITY OF COSTA MESA — BUILDING PERMIT
WETS MUSE IF KNOWN: RUSSELL, JOHN K _ PERM NO: B 073481
ADDRESS: 191 MORRISTOWN LN
COSTA MESA,CA 92626 PERMIT NO: B 073481 PLAN CHECK NO: N GOVT: N SUPP: N
I
APDL.MARDI°ADORERS: CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 2, 999
ARCH.OR FNc.'s kODRE55: WIT: CLAIM VALUE: 2, 999 .00 CALC—VALUE: 2, 999 . 00 GROUP OCC: R-3 /
CNgTRACTORS WE: STOUT ROOFING INC ( 310 ) 923-6775
Ca1TRACTORS MARINO P O BOX 4309 COMMENTS : SMOKE DETECTORS ARE REQUIRED PER 91 UBC
DOWNEY CAmw, 402536 ***********************At DESfiE*AESEAfsHxSEDEAE*�E�E�EAE****AE**�HSHSESE*+fiEAERH+rAE�ESESE�E*�E�E***SERE***iERH**�E
ADDREss. ZONINGI N G REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty. 'ury that I em licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)of Division 3 of the Business and Professio end my license is in full t!LI !Law:th!"
and effect.
creuc.mo.: 059377 uC.cuss: C 39 uc.N•f 125 • E : 10 9 MAIN BUILDING ACCESSORY BUILDING
ate: / �O ' 9Y Contractor: t 1 we- LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
/ OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contra
following reason(Radian 7031.5 Business and Professions Code:Any city Or county which requires a penult to construct,alter.improve, PARKING REQ: PROV: PARCEL: 41916570 Z N E: REF NO:
demolish,or repel any structure,prior to los issuance,also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES) '
is licensed pursuant to the provisions of the Contractors License Law fawns 9(commencing with Section 7000)of Dlvlsion 3 of the > —
Business and Professions Code)or that he or she is exempt therefrom and the basisAr
for the alleged exemption. y violation of Section '
7031.5 by any applicant le a parmf subjects the applicant to a civil penally of not more than live hundred dollars N.500]). ***************.****************************************************************
o 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 D E V E•L O P M E N T SERVICES R E Q U I R E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does riot apply to an owner of property (.,^
who builds or improves thereon.and who does such work himself or herself or through ha or her own employees,provided that such +
improvements rue not intended oraffaredfor sale.f,however,the building orimprovement issold within one year dcompletion,the ZONING APPROVED. BY DATE: _
owner-buikler will have the burden of proving he or she did no(build or improve for the purpose of sale).
o I,as owner of the properly,em exclusively contracting with licensed contractors to construct the project(Radian 7044,Business and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and whoWia/
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law),
o lamexempt under Section: B,APC..for this reason: APPLICATION ISSUED BY: DATE:
********************************* ** *************************** *
Date' Owners LEGALIZATION:N FEE UMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I ant aware of end understand the requirements of California Health and Safety Code Sections 25505,25533.and
25534,and that I or any future building occupant will/will not(circle one)need to comply with said state codes end the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification from the Air u-D ananagement District.Residential construction applicationsare exempt from these PERMIT 54 .00 50
provisions.
Date: Applicant PLAN SMIP/NON RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE
r] Ihave and will maintain acertificate oconsent losell-insure for workers'compensation.esprovided for by Section 3700othe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
ode,for the performance of the work for which this pennfisissued TOTALS > 54 . 50 0 .00 0 .00 54 . 50 54 . 50 . 00
have and wit mainxkv workers'compensation insurance,as required by Section 3700 of the Labor Code,ler the performance of the
work for whkA thio permit is issued.My wpryan'9grppepsAL'gRinwrence carder and policy number are: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: . 0 .0
cam° SO4[4i196400004687 10/19 /95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Policy Number.
(This section need not be completed if thepemtk is for one hundred dollar 1001 or less.) 54 .00 . 50
❑ I certify that in the performance of the work for which this permit' ed.I shell not employ any pe in any manner so as to
ome subject to the workers compensation of Calif. c • agree that I should bac subject to the workers' *******************************************************************************
co action 7� of SSeectiioon 3700 Code,I ., P, 'h Mose• • / I ND I V I D U AL F E E B R E A K D O W N
1 Date: �/ �// APptirant: �/J7(j�/I ! 'a
Warning:Failure to secure workers compensation coverage Is unlawful,and shall subject an employer to a nal penalties and TYPE QTY DESCRIPTION UNIT COST TOTAL COST
civil fins up to one hundred thousand dollars($100,000),In addition to the cost of compensation,dense - as provided for In
Section 3706ofthe Labor Code,interest and attorney's fees. SFR 2999 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 2, 999 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that then u a construction lending agency for tie END OF FEES
performance of the vs*for which this petmt is issued(Section 3097,Civ.C),
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application end state that the above inform«ion is cored.I agree to campy with all dry end county odinerru
and stale laws rel«'ng to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property
1°'ina°°°i°n pu`°oa°'. �y,,zT ENE BURFORD /�y" /� xy�
Signature
ilio/3 Print erne •
v I//Jv /J� r
?(*.
� , •ate: !/ (/" - 01 O0187153-001871.9 T0T54.5t�sgn«areaown«iAgenvnvpwnutorhnact« DATE! 07/28/95 TIME: 09:2,`i
15151-46.wP) While-Building 8 Safety:Green-FileCanary-Applicant:Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNIIv., ,OOL & SPA
0 AFrROVALS Permit# Date Inspector APPROVALS ` Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. a., 53. Steel Reinforcement •
;3.•$lectrical Conduit UtilitY-Undrgrnd. 54. Forms C '
_. z •
7-' 4_ lectrical Condoit.thrdrgrnd. 55. Electrical Bonding T
'
:5;$reel Reinforcement 56. Rough Plumbing & Pressure Test :.
<_ IIectricalUFEBGrnd. 57. APPROVAL TO COVE R-GUNITE ,=
=7-..;Footings 58. Electrical Concuu: Undrgrnd. '
C
Foundation - 59. Gas Pipe, 0 Urrd?grnd.,Test -
.
• 9r, Water Pipe-UndAjd.. 60. Backwash Lines,-Trap,-0 Undrgrnd.
10. Structural Floor System (' , 61. APPROVAL TO. ECK C
11. roperty Sewer Line & Houseconnection 62. Backwash & Receptor-Final
1
12.Viewer Cap .- .. 63. Heater& Vent-Final
13. Roof Drains - . 64. Plumbing System - Final .,
14. Rough Plumbing! a 65. Electrical-Final t •
15. Rough ElectricatCoi+duit 66. Solar System-Fana.l
16. Rough Electric;jlirinp' -• - 67. Fencing & AcdaYs-Approval .
17. Rough Wiring Sign 68. APPROVED F'D� PLASTERING '
g
18. Rough Electrica;T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning -.?1;
r Ce: _ F`RD.
EEPT..�tEOUIpEMENT _
20.52,otigh F.T4to ! FIFe lace . 5 r• c ;, s J?:r. ' APP O C Z mit # - ^ -
21. Duds, intru:tu6E* " " ^'S * S T 70_Z1nde� a�fd hydro
22.i)ucsf, Vehtil5tinr7� ; C c ;; ti. - 71. ProdtrcePipinpr F g C--Gas ElOil _
23.Gas Pipe--Rouuh & Test :T.-I- T+ x C G;, ' 72. Underg tu�bd E'tash`
24.'RodFrmin ' �s i -: * ✓ G r ^ > -+c
9 * * -, .7,-..,. * . 7,I4. Undergrnd.Stor, e-Tanrc OGas d'Oil
25. RociaSheathing =*. '¢ QLD/ 74::3-.0- verhead Hydiiier. 1.
26.-T-Ba&4?Ceilin (Stnc�`ural) &- 8..4iictoat * G " ri* }' -1 `- ' c;
9 # x p* 7§.�rY Chemical r-., s
x .0 :L oz ..
27.1ra5eaed Flashings =X^ * cif > �* 76. Dry Sta $.ipe'W :. _ ,j
28. Lathing & SittingS.r oma-- : z i • ,f. 75. FIXEDSSTFINA-. -
29. Insulation' • n%* _, * -----
' . FIRE PREY. EIEEZAL ;' - ^
t- 30. Drywall a(aillTfg �-`. c l� x r, ", EoREACf-1 DE(T REOUIQ;EMENT
t: 31. Plaster B,rtjwcCoaf* S .T`.-i- M 79. FINAL;iNSPECF(ON -
32.1,lectrical"Powe-r Me`[eF=rinal ' e " 1: •. 4 FOOD CERTIFICATE ISSUED
33.Dinah Eleciri�+ --* ?; I * I y I. rK Motes: '" .-t r; * ' cut°'
" ^ ''';'.--42:- .. "- * - .. = c. r..a C_____ '1-
1
--S
r 34.(Ping He'$}ing"_& /{"ity FnZiltionir�g= q * , I 1 . * ,_ - rd x r
n m�
35.IFina1 Gas'jPipe:Te7tsc ,_gay •• s: - 1 I t* _ ,^.0 :.:-i r -?
--s i I.
y : ] `T
- 36. Hood or'CanoPY ~x �, i a--i * :*; <� 1 .. .
1 37.'Final-Factory Firepince '� --+ Nan* "•- a td
' 38. FinPl bin = " v x . fR S !-m
L: -- ,. ...) M r. ....T� T - v
39- Water Ser,vice;Finat. s r GI u > a . 5
40. Gas Service-Final ; to 5' -t t4 r' ._ "`
XcX • > _ . - to * 4 't r t.
41. Solar Do'rnestic•Fin$ jr,^ I Ir r• -DC * r
6 _ n�
i - r : '. , -
42. BackfloW.Preventer* _ x• • t. C, >- '
2 * i. - * - ri :'C;- - , _ -.
T :i` X n- ._- -
43. Backflow Irrigation, r . .; * Cl. 4e ..
r - co * ^ n c
:414. landscapeIrTigatioifSystem�"t7'� • IV -' L* - i1 n: ". t c
c R P- 7,-- ". * Q a. c':
* E nl Oa: * .
-45.Sound Atteriu'ation _� •• •• ` v a r•. m* ` - d• mac'• '
(46. Handicap-Regulations C * j a n r•S '
417.'FINALSTROCTUI{E & BUI L"DI NG •.K t a, * F-
!! 3 IT
" WC-) _
48.FINAL PLANNING:' .- '• "t I V y - rn < ;
9.Tlec,6c Release to raison 4c a •t-; ,• It
-S0.:Gas Release to Southern California-Gas Co h tr t- G - 0 * 0 -
-51. CERrIFICATE OF OCCUPANCY * N C.
No. Date
•
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA-MESA�'_ t PERMIT NO. TRACT •
NO: LOT NO. - BLDG.NO. T - - - - 677 - •ASO' � 4 --, r
CONSTRUCTION PERMIT •J r (l4-8''(p ?ell ' •
TI
Project Address 42/ 'O//t4ay=J 7&t/ L✓ TYPE OF CONSTRUCTION. Li NEW ❑ ADD.-❑ ALTERATION ❑ REPAIR. • •
' - ` e
/ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Applicant's Mailing Address /.�.`.� 1...,-1•410.4 id A,P.#. I Zone, _
1 ' DESCRIPTION OF WORK •
Owner's Name fit- �/} ��Q +' ✓ Phone/� ��, - S Main Building: •- Accessory'Building: Z+
• Address 5�0//P - - E ` • O
TVPE,OF PERMIT ❑ GRADING-r-r�`�.FOUNDATION ❑ STRUCTURAL T Front - N
Arch/Eng, License No,- " ❑ TENANT ❑ ELECTRICAL LJ PLUMBING ❑ MECHANICAL -. •
B Rear, •
• -
Address - - . . ❑ 'oTHER - - '_ - A � ' - - . - •
N
-� ` X71 C Right I • + - G
- _ Contractor's Name/Z° 4/'r15/� �/7//inb nh7 Tlr°Phone�7-t -• 9f-70 PROJECT DESCRIPTION SQ:FT. OCCUPANCY K - - R
Address(mailing) X533 GV .4/� CO/•,,..) - CONSTRUCTION TYPE ' VALUATION$ S Left - •.
E ,
�J�O ZONE GRADING CU.VDS. "ACRES Ping. Ref.# Park.Fees $' 0
City License No.
— LICENSED CONTRACTOR DECLARATION - U
Remarks: Parking Re• q./Provided 1
Q I hereby affirm that I.am licensed under provisions of'Charier 9(commencing • • •_ • - R
•with section 7000) of Division 3 of the Business and Professions Code, and • -. ' Use of Building: _ E,
•
',C-'?4y license is in full Nrce anp effect.
-
"�,cen Class - (� Lice se N� / PlanningNotes: M
PLUMBING •' FEES ,
'7ate -c-11 _IS/ Signature V. ✓- .. E
Bar Sink Showers I N
WORKERS'COMPENSATION DECLARATION - T '
I 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.) ��K}i _r ; Backflow Irrigation Sevaer Cap 1 ELECTRICAL FEES
Policy No. VV,f 40 ' Company/ &Q✓Gr 1,4/6 - - - -
0,-certified copy is hereby furnished. • - Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50 KW
ILS Ce�{{Jifie SPX Is filed with the city dtling D" islpJ� '
Date"/'L Applican' Y r1 ff-pf�3-�+� Clarifiers Solar Collectors I Construction Pole Sub• . 50+ KW •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION- - 1 - _
(This section need not be completed if the permit Is for one hundred ($100) or Dish washer - • Solar Piping '" - Cooking Unit 'Meter [hp to 100 amps - I
less)" DrinkingFountains - ,
I certify that.In the performance of the work fso as t M1 this permit actt Issued,I Solar Tank I ' Dishwasher Meter Dover 100 amps' - •
shall not employ any person in any manner so as to become subject to te , -
Workers' Compensation Laws of California, Floor Drains Swimming Pool w/Spa' Dryers ❑Gas ❑Electric Sub Panel '
Date - Signature ' • • ' I
NOTICE:tf,'after making this declaration,you should become subject to the Floor Sinks ' , Urinal , Fan' Motors❑01 HP 01'/x-'8
•
Workers' Compensation provisions of the Labor Code, you must forthwith' - -_ _- - "- - - .. -- - - .
comply with. such -provisions or -this permit shall be deemed revoked. Gas Service Outlets, - Water-Closet - ' . . - F.A.U. Inc.Solar 09-15 HP 016-15+
CONSTRUCTION' LENDING AGENCY' i - - "
I hereby affirm that there is a construction lending agency for the performance Interceptors - Water Heater , , ea Fixtures : - Microwave
of the work for which this permit is issued:-(Section 3097 Civ. C.) •
• Lender's Name - - ' Kitchen Sink " , , Water Service - Device Boxes I Pole Light '
Lender's ,Address - - -
OWNER BUILDER DECLARATION ' - . ' Lavatories - Outlets ' ' - Range ' '
,' 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 I P - Switches•• ' Sign � ' ,• '
•°litunty which requires a permit to construct,alter,Improve,demolish or-repair • - -
d'Sy structure, prior to its issuance, also requires the applicant for such permit Roof-Drains , Z 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 - • - Generator 00-5 KW ❑5-15 KW Trash Compactor •
Division 3 of the'Business and Professions Code)"or that he/she is exempt - - ' - p '
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 Reins action Fee I ' $ 3
.LJenalty of not more than five hundred dollars($500). p 1 '$25. Issue Fee '
I,'as owner of thei property or my employees-with wages as their sole J MECHANICAL Reinspection Fee I ' $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'sPUBLIC SERVICES REQUIREMENTS: 1 '
License Law does not apply to an owner of a property who:builds or Improves Boiler ' Hood or Type 1 0 ••
. •
thereon, and who does such work himself/herself or through his or her own ; . Zoning Approved By or
Date '
employees, provided that such improvements are not intended or offered for Canopy Type II! 0 .
sale. If, however, the building or Improvement is sold within one year of com- ' Duct-Under Ground ' Application Approved By .
g Date
pletlon, the owner will have the burden of proving he/she did not build or im- '
LJrove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By f"I Date- ,-
I,as owner of the property, am exclusively contracting with licensed con- DO-100,000 BTU ❑100,000 BTU
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 - BUILDING'PERMIT
builds or improves thereon, and who contracts for such projects with a con- ' $ SMIP - $
P Exhaust System 0 Multiple 0 System Repair/Alteration - 2' J
tractor(s) license pursuant to'the Contractor's License Law), 1 PLAN CHECK $ PERMIT
•
0 am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO•# - PLUMB!NG 67-0e1 . ✓,ISSUANCE - $
Date Owner Heating System& Ducting 1 PLAN CHECK $ ENERGY P.C. • $ '
I hereby certify that I have read this application and state that the above 000.100,000 BTU 0100,000 BT i ELECTRICAL GRADING $ '
'information is correct. I agree to comply with all city and county ordinances , -' - . $ $
and state laws relating to building construction,and hereby authorize repre- , - PLAN CHECK MICROFILM _ •
sentatives of this'city to ent upo the above-mentioned property 'for $ ,
inspection p rgoses. - O'/ MECHANICAL $ TOTAL FEE $ S �`"v
Signature�(//Y+l -.//ei,t Date i .�"3 ' O 7-
Drivers' License or 55# Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK i $ ' '
CMF 0865-46-rev- 7/83 -•White-'Building;'Canary-Applicant;'Pink=Accounting:Goldenrod-Assessor - - - ' - -- . .. . -- - --- - - ---. " - _ •_ ...--_. . .. -
•
• • CONSTRUCTION AND PLA�yNI..,, JOL&SPA
APPROVALS . Permit# - �td 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, O Undrgrnd„Test
9., Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, d Undrgrnd.
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 & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T gar 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 0 Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing ' , - - 73. Undergrnd.Storage Tank O Gas 0 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. 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 tf/Z]/09if Lep
39. Water Service-Final
40. Gas Service-Final - -
41. Solar Domestic-Final '
42. Backflow Pfeventer
43. Backflow Irrigation '
44. -Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations •
•
47. FINAL STRUCTURE & BUILDING - - -
48.' Special Requirements Completed ••
49. Electric Release to Edison -
50. Gas Release to-Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
- - -
No, - Date ••,'
•
•
OWNER SAN VISTA BUILDING COMPANY DATE 6-1-64
JOB ADDRESS 1•1 Morristown -e BUILDING PERMIT NO. 2226
GENERAL CONTRACTOR same VALUE $ 13,895.00
AP No. LOT 211 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK res Watt gar
II ;CTIONS Signnattuuree D T _ GROUP I&J TYPE V ZONE RI
Son 1 SUBCONTRACTOR PERMITS ISSUED
Gas DATE NUMBER
Water
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heatingumi I z � �4��9 _?- 3S i3
Rough Plumbing A M , f (o V(o / — 'r
Miscellaneous 6,
Prop. Swr. Line 0 House Con. 0/St. Swr. 0 "1..1 V .i (/*,,,C 64,„q07:,. I;lli1'
S tinkling System • !,
Construction Pole r
Underground 0 Power 0
RoughenWiring. 0 /�w ,7/` b7 �-rr Q ._ SEP 1 1964 Q h 1
Trenches C� Forms [g' Steel Reinf. Q/. /`
Floor System /
Bond Beam 0 Steel Reinforce ❑ 'a 4t' s/0//,(4 Planing Dept
Sheathing fll 5; ztc'S
Frame and Flashing - 4,,.. 7 a 6 SV -
Lathing — In lam'Out,moi / c 79 69: Innis s
131 'r, brown coat ' me.- by e e zt
F, . 0 Air Con. ❑ Final l
Heating, Final i.- .
Plumbing Fixtures, Final
Final Gas Test/c- % y
Electric Fixtures, Final -.,C f,_
Building, Final / �J t/ j /s� ,49,
OCCUPANCY _ r - a '
Form BU9—SM-3-63-_5-B P _- ____ _ — ...ewes A T nvnT TTDFRAFNTS
0.271-i3FEE RECEI V tD
COSTA MESA BUILDINGrSAFETY DEPARTMENT
P.O.BOX 917 COSTA MESA,CALIPORNIA 'NnN/�� rM Y 1 9 M
\ For Applicant to Fill In Completely APPLICAT[tYN,AN P WWERNMjN . OW
TYPE OR PRINT CWIi1uBFNBOSTA MESA
BUILDING OJ /7�q 1�"" For Office Use Only
ADDRESS / // i////}/I/j,(,(jw•wl do--.2_
RECEIPT NO. '22,63
COSTA MESA, CALIFORNIA
RECE
Y D�MSE / DATE ISSUED
. '�/ -eIIN 1 10 F4
OWNER Spti U L & 0._,Q
BUILDING
ADRESS IA) C• 5 r% SQADDRESS
CITY j9/ g // ;11- //4I
ZONE TYPE V_ GROUt�1/-1
APPROVED
ARCHITECT A//�y7n TEL41�(gt / BY DATE
OR ENGINEER ' / NO. L}7D/ O
ADDRESS...? 3 �Z- �/ ���y(/����zt_ ZONING
Y Y+R�'--' NO.OP UEEOFI]/p)�
Ste-, 1) .S.- '043 I PLAN j RUILDIN6L/ JWl_
CONTRACTOR / j� (� \\nl�hl C�11y�1- /4"O_ •_//_ �L L // ov ///���'//� n
ADDRESS //{���(O [-J O Yk LDESCRImON ytrAC 6/6O t ais
CITY VI fl /( A.P.NO. i / .� �� T
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LSIC.NTATEO. eG I9 1 6(1 2-- No•A D3 7/t'2• 30'TO SIDE @ REAR P.L.
SIZEI,I�� �/ y EAVES
OF LOT eL4D JI I/ O I NO.OF SLDGT. ALLOWED (U.B.C.REQUIREMENT)
NOW ON LOT O
USE OF �I^ YARDS APPROVED YARDS APPROVED
EXISTING BLDG. - / /Or t - MAIN BUILDING ACCESSORY BUILDING
/. (FROM C/1..�8TREE1')
SETBACK LINE FROM / 0 FRONT tCL�I PT. Fr.
CENTER OP STREET / REAR YARD I /�+,'
SIDE YARD I LEFT C) I RIGHT Q IR.SIDE l /FT. FT.
DESCRIPTION OF WORK L.SIDE O FT. Ff.
Iel
NEW ^ ALTERATION _ ADDITION REAR 0 FT.
�/ FT.
DISTANCE BET. BET.MAIN e H
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. t
BUILDING qq NO.OF re(
ii1/ /7l & ^ VAR.# DATE iiiK
SIZE 0,1 ROOMS ,7 STORIES , C.U.P. APPROVED W
EXTERIOR WALL % ROOF I,y l/- APPR(JrV i (( T —
COVERING SXAh[.1.f7 COVERING.Yl�J-1J�- BY I p )4 •I•� DATE ,) V er
USE OF B ILDING ND WORK TO BE ERFORMED ((( V
-I/ j/a,4Ia0.FT. ,,go D LI-•
_
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN TINDER VALUATION IS FOR THECL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABSHINO A PERMIT FEE ONLY. Q
ISH
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONST ION. N
SIGNATURE OF j/� ///'''��I I(!�f PERMIT FEE $ a. .6-6 m Q
PERMITTED $ / . cp '� -LAK EC, p
AUTHORIZED AGE V / Coy �� I` n
4 TOTAL FEE $ " ` �� 1�1Yi