HomeMy WebLinkAbout1590 MYRTLEWOOD ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 1590 MYRTLEWOOD ST
Suite No
Vicinity:
Parcel Nunmber: 13919324
Status: ISSUED
Applied: 02/11/2005
Issued: 02/16/2005
ISSUED BY:lkrt
Applicant: COAST ROOTER PLUMBING HTG & A/C
Address: 17390 MT CLIFFWOOD
FOUNTAIN VALLEY
Owner: DISARRO,MICHAEL D
Address 1590 MYRTLEWOOD ST
COSTA MESA, CA
Phone: (714)241-1414
Zip: 92708
Phone:
Zip: 92626
Contractor: COAST ROOTER PLUMBING HTG & A/C
Address: 17390 MT CUFFWOOD
FOUNTAIN VALLEY
WATER HEATER CHANGE OUT.
AMT
ISSUE FEE
$23.50
Backflow irrigation
$0.00
Backflow Preventer
$0.00
Bathtub
$0.00
Clarifier System
$0.00
i:�onnect (Ice,Soda,etc)
$0.00
--, nits
$0.00
QTY
Phone:
$0.00
Zip:
$0.00
t9ter
$0.00
Drain, Roof
$0.00
Drinking Fountain
$0.00
Expansion Tank
$0.00
Gas Earthquake Valve
$0.00
Gas (1-4 outlets)
$0.00
Gas (Over 4 outlets)
$0.00
Gas Repipe
$0.00
Gas Service
$0.00
Interceptors (Grease, Oil)
$0.00
Interceptors (Sand Auto )
$0.00
QTY
Phone:
(714)241-1414
Zip:
92708
License:
529127
SCOPE OF PERMIT
'FEE SUMMARY
AMT
QTY
AMT
QTY
Laundry Tub / Washer
$0.00
0
Sump Pump
$0.00
0
Landscape Irrigation
$0.00
0
Swimming Pool
$0.00
0
P -Trap
$0.00
0
Trap Primer
$0.00
0
Pressure Regulator
$0.00
0
Urinal
$0.00
0
Process Piping (per 10 ft)
.: $0.00
0
Vacuum Brkr Bkflow(1-4)
$0.00
0
Receptors
$0.00
, 0
Vacuum Brkr Bkflow(5+)
$0.00
0
Septic Tank -
$0.00
0
Wash Basin
$0.00
0
Sewer Cap for Demo
$0.00
0
Wash Basin Set
$0.00
0
Sewer Connect
$0.00
0
Waste and Vent System
$0.00
0
Sewer Private Line
$0.00
0
Water Closet (Toilet)
$0.00
0
Shower
$0.00
0
Water Heater/vent
$12.30
1
Sink, bar
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
Sink, Floor
$0.00
0
Water Service
$0.00
0
Sink, kitchen
$0.00
0
Water Softener
$0.00
0
Sink, service/mop
$0.00
0
OTHER
$0.00
Spa (private)
$0.00
0
VIOLATION
$0.00
Spa (public)
$0.00
0
PLAN CHECK
$0.00
-
REINSPECTION
$0.00
0
TOTAL CALCULATED FEES: $35.80
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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
2"6-46 (6/00)
C
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.
Ihave and will maintain workers' compensation insurance, as required by section 3700 of the LaborCode, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
A-/
_Cartier.^ -<Y `Pot Number: I,
_(This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) y
❑ 1 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 th I she Id become subject to the workers' compensation provislons of Section 370 of the Labor Code, I shall forthwith
comply with these provisions. V
Applicant Signature�Date: 1 Z`( b OS
WARNING' FAILURE -TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIEIS AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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 offeclrbcrq— 7 ClasS —3
D
Contractors Signature: Date: 2 /!n O S'
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).
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).):
❑ 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.).
❑ 1 am exempt under sec. Business and Professions Coda 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 tax 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 (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, 1 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? ❑ 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).
r future e buildin occupant need to file a registration form for acute) hazardous materials? Yes No
..........................................................................P........... ...... .....
2 Does or will the applicant or resent o g p g y ❑ ❑
(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 a
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
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 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
..................................... ............... -... ........................ ........................................................................................................................................... ........................................... ...... .................................... ,.......................... ................ ..............
..................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 Yes LJ No
(Section 65850.2 of the California .
.
Government Code requires that the requested information be furnished on applications for non-residential building permits).
.....................
.........................................................................................................................................................................................................
......................................................................................................I......................
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 SafetyCode).
.......................................... ........................................................................................................................... -........................................... ... .....- ......................... ........................... ...................................................
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? ❑ Yes ❑ 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.
ignature f eg Owner(s) Z /,pate
L_ -� <LOI.Oth!?nzod'Applicant
CODE r. INSPECTION TYPE Q,1TE INfBAL$ CODE INSPECTION TYPE g9IE INTMALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
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
-I-
Applicant to in all spaces except those within heavy border lines and sign all appropriate declarations.
CY;sOF COSTA MESA CONSTRUCTION PERMIT
��filTill
NO '^
PP`R1
�1 /V 9.11
TRACT NO.
LOT NO.
UNIT NO.
Duct - Under Ground
Project Address 1590 MYVtlewood
!
!
Duct - Ventilating
SUMMARY OF FEES _
�`
BUILDING PERMIT $ 2 1'�C] SMIP $
PLAN CHECK $ PERMIT
ISSUANCE $
Exhaust System ❑ Multiple 13
System Repair/Alteration
Applicant's Mailing Address ���Comme Commercial b4a�f C.M.
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
�
same
11 CONVERSION
❑ DEMOLISH OTHER _
A.P.
#
Owner 'sN ����Y���1 Lilly Phone 979-45
6
D SCRIPTION OF�yyO
/USE F G.
��ass oft �i�erg s ng es
S
Main Building:
Address 1990 Mrvtlewood, C.M.
I�e-roof W1tC1
ass
ET
Arch/Eng. License No.
TYPE OF PERMIT
Ll GRADING FOUNDATION STRUCTURAL
Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
Address
❑'OTHER
A
Rear
Contractor's Name Crank BYO. Bf_q, Phone 548-5569
C
Right
126 917tTg11[ Way, Costa Mesa 92627
PROJECT DESCRIPTION SO. FT. X671 OCCUPANCY
K
Address (mailing) TC'lal
resicien�l 3,57=-e—
Left
CONSTRUCTION
TYPE VALUATION $
S
City License No. O
ZONE
GRADING CU.YDS.' ACRES
Ping. Ref. �
LICENSED CONTRACACTORR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
Remarks:
Planning
Notes:
with section 7000) of Division 3 o the Business and Professions Code, and
my license is in full force and effect.
License Clas — License 4 7
Date Signatur
PLUMBING
FEES
IORKERS' COMPENSATION CLARATION
Bar Sink
Showers
. hereby affirm that I have a t' icate of consent to self -insure ora certificate
of Workers' Compensation n ranee, or a certified copy thereof (Section
Backflow Preventer
Service Sink
Automatic Washer
3800, Lab. c
Cub Houle
Policy Company -
Backflow Irrigation
Sewer Cap
Construction Pole Su
Certified copy is hereby furnished.
Certif'ed yn is (ileo. with the city Bkilding Ovion.
l;ral'llC J:Sros. Rooflna CO.
Bathtubs
Sewer Connection
Cooking Unit
Date 7�T-l�t� Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
Clarifiers
Solar Collectors
Dishwasher
(This section need not be completed if the permit is for one hundred ($100) or
Dishwasher
Solar Piping
Dryers ❑Gas ❑EIS
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
Drinking Fountains
Solar Tank
Fan
Workers' Compensation Laws of California.
. Date Signature IFloor
Drains
Swimming Pool w/Spa
F.A.U.
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
Floor Sinks
Urinal
Fixtures
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Gas Service
Outlets Water Closet
Device Boxes
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors
Water Heater
Outlets
Lender's Name
_
Lender's Address
Kitchen Sink
Water Service
Switches
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
Lavatories
Auto -Wash
Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, Improve, demolish or repair
P—Trap
Laundry Trays
Generator 00-5 KW
any structure, prior to its issuance, also requires the applicant for Such permit
file a Signed statement that he/she is licensed pursuant to the provisions of
Roof Drains
:e Contractor's License Law (Chapter 9 (commencing with Section 7000) of
,ivision 3 of the Business and Professions Code) or that he/she is exempt
r herefrom 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
-
of not more than five hundred dollars ($500).
$ 3
Jenalty
I, as, owner of the property or my employees with wages as their sole
R¢inSpection Fee
$15 Issue Fee
compensation, will do the work, and the Structure is not intended or offered
Reinspection Fee
for sale (Section 7044, Business and Professional Code: The Contractor's
d not a 1 to an owner of a property who builds or improves
MECHANICAL
FEES
8102 2/gib/81, c705J TL
Zone
Accessory Building:
2
O
N
1
N
G
R
Parking Req./Provided E
D
M
T
S
ELECTRICAL FEES
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors ❑ 0.1 HP ❑ 1 W- 8
Ina Solar 09-15 HP 016.15+
Microwave
Pole Light
Range
Standing Sections
SKTrash Compactor
$15 I, I Issue Fee 1 $ 3
L cense La OCS pp Y
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 improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project' Section 7044, Business and Professions Code:
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. '
tractor(s) license pursuant to the contractor's License Law). I am aware that
proof o their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Boiler
Hood or Type I ❑
Canopy Type 11 ❑
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date
'L 2
Application Issued By Date_
Duct - Under Ground
Duct -Structural
Refrigeration System
❑0.100,000 BTU ❑100,000 BTU
Duct - Ventilating
SUMMARY OF FEES _
�`
BUILDING PERMIT $ 2 1'�C] SMIP $
PLAN CHECK $ PERMIT
ISSUANCE $
Exhaust System ❑ Multiple 13
System Repair/Alteration
Firepl/Fact. Bit. ICBG+
Fire Dampers
Date Owner
1 hereby certifyyy...fthat 1 have rea.
information IS pO rect. I agree to
and state laws/ r ating to builtlm
sentatives of t s city to enter
this
nosen
property
Heating System & Ducting
130-100,000 BTU ❑ 100,000 BT'
Signature ✓ — / — v l ua,, I I Reinspection Fee I $15
Drivers' nse or SS
CMF 0865 , rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - ASWSSor
Registers
PLUMBING $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ -
MECHANICAL $ TOTAL FEE $ 27-.5
PLAN CHECK 25% $
Issue Fee
$ 3
CONSTRUCTION AND PLANNING
�t APPROVALS * Permit #
Date
Inspector
F _ & SPA
APPROVALS Permit #
Date
Insper.Tor
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 LIFER 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
.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
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas 0 Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0Oil
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. Irisulation
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
kNotes: G O
34. Final Heating & Air Conditioning
JL�OQwWJ.� ea./ �ayt.(itiv� �
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
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. FINA4STRUCTURE&BUILDING
FS
48. Special Requirements Completed
-
49. Electric Release to Edison
-
-
- -
lease to Southern California Gas Co
F51.CERTIFICATEOF OCCUPANCY
Date
OWNER ADAMS ACRE, INC. DATE 6-3-59
JOB ADDRESS 1590 Aitlew BUILDING PERMIT ATO. 9413
GENERAL CONTRACTOR Dike & Colegrove VALUE S 1 ,52.00
AP. No. LOT TR -FACT eoe FIRE ZONE DESCRIPTION OF WORK Re9.W/att.Gar.
INSPECTIONS /(� Sfi
DATEI
GROUP �` TYPE ZONE' 1
Underground SoilWater
i-
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gas
DATE
NU_ MBE_R__
Overhead Water and Gas
Rough Heating
Rough Plumbing
Miscellaneous
-4/-511'
—S�%
SY11_j6c���% q -,. 5 1 •
,(' �- .:-lr
_--
[•-`57-'�
_.1i / -—
Prop. Sw . L H_ e Con. St. Swr.
G "5
=- ,%.�
�T
l—•33ii r_ — .
Sprinkling System
Healing, Final
�
Plumbing Fixtures
Final Gas Test/
Construction Pole
Underground Power
Rough Wiring r
G Wt,
7-/5--S-9
Z/�9- i
Trenchese,$_q lForms'� Steel '
Floor System'
'
Steel Reinforce Chimney Re -Rod
Bond Beam
Sheathing
Frame and Flashingk—te—
Lathing, In f- Out
Plaster, brown coat
Plumbing Fixtures, Final /yl-ir
Electric Fixtures, Final
Building, Final
OCCUPANCY
Form 210-3M-4-59
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA, CALIFORNIA
F
PP[/CANT to flit /N COMPLETELY
TYPE OR PRINT
COSTA MESA, CALIFORNIA
JUJ 3 1959
F!N,1,NCE DEPT.
APPLICATION FOR PERMIT
BUILDING
fm Off/Cf m ONLY
RECEIPT NO.
PERMIT NO.
OWNER Adams Acres Inc•
I
E. 17th St.
RECEIVED BY
DATE RECEIVED
DATE ISSUEDT
AMAIL DDRESS]
s
-� I
Costa ,,a TEL cf
CostMesa
BUILDING
CITY NO. O
ADDRESS
ARCHITECT Carlson & LIG'
COSTA MESA, CALIFORNIA
OR ENGINEER NO.
Middlebrook
ZONEe
�}—
ADDRESS
group
Ga I dwi Grove n
Colegrove� Inc.LCTNO. 167293
APPROVED
CONITPACrz.A
DATE
ADDRESS 419 E. 17th St. Costa Mesa
ZONING
LEGAL
I LOT
1
?022
ZONE
NO. OF
IPLAN6
USE OF NEW
(BUILDING
DESCRIPTION
NO. 1/{
1
BLOCK TRAQZ^'
APPROVED
A. P. NO.
BY
DATE
.)
SIZE60 107
NO. OF DGS.GS.
YARDS
EVES
OF LOT VV X
Now oN LOT WGnFl
REQUIRED
(CENTER LINE ST.)
ALLOWED
USE OF
EXISTING BLDG. none
FRONT
FT.
IN.
SETBACK LINE FROM �]
261
i
CENTER OF STREET 81 REAR YARD
R. SIDE
FT.
IN.
SIDE YARD ILEFT 51
(RIGHT 1
(
L. SIDE S
FT.
IN.
DESCRIPTION OF WORK
��
REAR
IN
NEW Ix II ALTERATION I II ADDITION I
REPAIR I II MOVING II DEMOLISH
BUILDING NO.OF
6 1
SIZE 1 ROOMS STORIES
EXTERIOR WALL
ROOF
COVERING StIl co
COVERING Shingly
USE OF BUILDING AND WORK TO BE PERFORMED
Single
attached double garage.
Flail 1�mlft.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION
IS FOR THE
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COM-
PURPOSE OF ESTABLISHING A PERMIT
FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.
VALUATION
F
SIGNATUREO
PERMITTEE
PERMIT FEE S
JL_ 00
.•WW
S 14j.552
/l
PLAN CHECK S
17.00
TOTAL FEE 5
52.00
AUTHORIZED AGENT D