HomeMy WebLinkAbout746 HUDSON AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 74fi HUDSONAV
Suile:
Vicinity:
Parcel Number: 14153207
Applicanr. VU, KHANH
Address: 746 HUDSON AVE
COSTA MESA, CA
Owner: VU, KHANH
Address 746 HUDSON AVE
ConVactor.
Address:
�
Arch :
Address:
COSTA MESA, CA
Zoning: R1 R1
Phone: 714-863-2801
Zip: 92626
Phone: 714-863-2801
' Zip: 92626
Phone:
License:
Eng:
Address:
Phone:
Status: ISSUED
Applied: 04/21/2003
Issued: OS/09/2003
Phone:
2ip: License: License:
SCOPE OF PERMIT
REPAIR 2,040 S.F. FOUNDATION FAILURE FOR AN EXISTING SFR. SOME MINOR FRAMING REPAIR INCLUDED WITH THIS WORK ALSO.
Plan Check: $32029
Permit: $492.75
SMIP Res: $3.50
, SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $816.54
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$35,000.00
$35,000.00
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.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspectlons and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiretion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�
WORKERS' COMPENSATfc�N DECLARATION: '� � "
I �ere6y aNirm under penalry oi perjury one of the following declarations /
❑ I have end w�ll maintain a cenificete of wnsent to setl-Insure for workers' compensation, es provided br by section 3700 of ihe Labor Code, for the pertormence of the
work for w�ich this permil Is Issuatl.
❑ I have end wi�l maintain workers' compensalion insurance, as requiretl Uy section 3700 of Ihe Lebor Code, lor the perfortnance oi the work for which this permit is issued.
My workero' Gompansatlon Insurance carrier and policy number ere:
Carriec Policy Number.
(This secfion neetl �of be complefed i! the permit is velued et one hundred dollars ($100) or less.)
,� �� I certify ihet in the pertormance oi the work for which this permit is issueq I shall not employ eny person in eny manner so as to become subject to the workers'
compensetlo0 lews ol Celilornie, a �gree at t I hould become blect to Ihe workers' compensetion provislons of Section 3700 of the Lebor Catle, I shall forihwith
comply with ihese provisions./,A� //'
Applicant Signeture: . /'I A:O � ��� Dare: � 'S� �/��'/ % /�C �
WARNING: FAILURE TO SECURE WO AP NSATION COVERAGE IS UNLAWFUL M!D SHALL SUBIEGf !W EMPLOVER TO CRIMINAL PENALTIESAND CIVIL FINES UP TOONE HUNDRED
THOUSAND OOLLAFG (5100.000�, IN AODITION TO �iE COST OF COMPENSATION, �AMAGES AS PFiOVIDED f-0R IN SECTION 31080F iHE LABOR CODE, IMEFEST, ANO ATTORNEY'S FEES.
LICENSED CONTNACTORS DECLARA710N:
I hereDy aMirm that � em licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Protessions Cotle, end my license Is in full
force and eHect. LIC. M Class s
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirr� thet ihere is a construciion lending egency for the peAormance of lhe work tor which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lentlels Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm t�et under penalty oi perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or county which requires e permit to constmc6 alter, improve, tlemolish, or repair eny sWcture, pnor to ics issuance, also requires the epplican� lor such pertnit
to tile e signed stetement t�at he or she Is Ilcensed pursuant to the provislons ot Ihe Contractors License Law (Chapter 9(commencing with Section 7000) ot DlNslon 3 of the
Business en0 Prol@ssions Gode) or thai he or she is exempt therefrom end Ihe 6asis for the allegod ezemption. Any violation of Section 7031.5 by any epplicant for e permit
subjects the eppllcA�� to e civil penalry oi not more than five huntlred dollars (5500).):
❑ I, as owner o� the pmperry, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe sWcture is not Iniendetl or ofleretl tor sele (SeC.
7044, Busine95 end Professions Cotle: The Contractors License Law does not apply to en owner of property who builds or improves ihereon, and who tloes such work
himself or heYself or through his or her own employees, provitled ihat such improvements are not intendetl or oRered for sale. If, howeveq the building or improvement is
sold within ono yoar ol completion, the owner-builder will hava the burden of proving ihat he or she ditl not build or improve tor purposo ot sale.). �
�I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the projed (Sec. 7044, Business antl Prolessions
Code: The contracbrs License Lew tloes not apply to an owner of propetly who builds or Impmves Ihereon, and who coniracts for such project wlth e contrector(s)
license pursua�� to Ihe Contrectors License Laws.).
❑ I am exempt
Signature: ^L
Business en0 Prolessions Coda for this reason:
Owner ID veriti nve s licanse. �Ves ❑ No
Venlicetion of Ownarship by (rype ot tlocu t, i.e. - property ta: bill or daed):
DIVISION OF INDUSTRIAI SAFE7Y PERMIT CERTIFICA710N:
Date: `�/�
Driver's License No. �% (� �' �
Expires:
❑ I hereby ceniry that no excava0on fve (5) or mora teet in depth into which e pereon is requiretl to tlescend, will �e made in connection with work authonzed by �his
permit, and thet no building structure, scaffolding, talsework, or demolitlon or dismantling ihereof, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Ari 2, Sec.
341, Tltle B, Celifornie Adminisirative Code).
❑ As owner-builder, I will not employ anyone m do work w�ich woultl require e pertnit Imm the Division of Industrial Safery, as notetl a6ova, unlass such person has e
pertnit to do such wark trom t�e tlivision.
Signature: Date:
Division of Indusirial Safery Permit Number:
CER7IFICATE OF C�MPLIANCE AND AUiHORIZA710N OF ENTHV: I cenity under penelty of perjury t�at I have reatl this application end state that the Informetion given is
wrrect. I egree to comply with ell state la�+s end ciry ordinances relating m bulldinq construc�ion, end euthorize representatives of the City of Costa Mese to enter upon Ihe
ebova-described proPe for' s ectio ses. I gree not to occupy or ellow occupancy ot any building authonzetl by Ihis permi� until finel inspection.
��'�'��� 05 -09 a3
� SigndWreQlLagal-Owner(s) Date '
And/Or Authorized Applicant Date
LOOE1. INSPECTIONTYPE P� IMrtI�lS
7616 Fizetl Syst�m Final Fire Prevention
1266
200
2�t
202
203
Pool Spa F��el
Finel RB-RPo�
Final fllock�Aeteining Wall
Final Fectory Fire Place
Final Sign
204 Final Demolition
COOE I INSFECTION TYPE
206 Final Mechanical
20B Finel Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Finai Building/Occupency
P� II�LLS
�
�� �b' (� %��eC� �uu�C�f� �Q<idie�it
OWNER-BU[LDER
VERIFICATION
A city br county, which is rcyuired to give notice pursuant to Section 1983Q shall attach to such noticc, and,
as a condition precedent to issuing a building permit, require the completion and require the retum of, an
owner-builder verification.
Attention Property Owner.
An bwner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and re[urn this infortnation in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permiL No building permit will be issued until this
verifica[i n is received.
I. I personally plan to provide [he major labor and materials for cons[ruction of [he proposed
2.
3.
property improvement. �f Yes ❑ No
I(have/have-ncu) �,�� signed an application for a building permit for
the proposed work.
I have contracted with the Collowing person (firm) ro provide the proposed conswetion:
Name
Address
Phone (
City Sc�„J�a /T�`+�
ConVactor's Lic. No.
4. 1 plan to provide portions of the work, but 1 have hired the following person to coordinate,
supervise and provide [he major work:
Name
Name
10a246 IAFV. 9I9B)
Address
Phone (
City —
Contrac[or's Lic. No.
1 will provide some of the work but 1 have conVacted (hired) the following persons to
provide the work indicated:
Address
Phone Type of Work
I hereby affirm [ha[ I have received a copy of [he information set forth in Section 19830 of the Sta[e
of Califomia Health and Safety Code and have completed [he above information to the best of my personal
knowledge, in compliance with this State law.
Name: I /��i'�l /���/ � • V �
(Printed or Typed)
OR S.S. #
Date: l _l � — l/ % —d
For more information call City of Costa Mesa Building Division at (714) 754-5273.
1002Jfi (REV.998)
1
�
�
Applicant to fill In all s0aees except those within heavy borCer Iines antl si9n all approDriate tleciarations.
CITY OF COSTA MES C NST U TION PERMIT B�' "'"""' "-' -- -�--- '""" ""'
Project Address � �� �N _ �
AppliCanYS Ma'''ng A dress S TVPE OF CONSTRUC ION NEW ADD ALTERATION REPAIR
A '� ❑ CONVERSION ❑ DEMOLISH ❑ OTIj€R
Owner'�Nam�` �r�� 1 Pho e Q DESCRIPTIQ OF K/U$� OFBLDG. �A�P ��—�--
Address Sa�� �'� (`�'"' �+�v� �' S �,I/�'��e �
Arch/Eng. Lice�s¢ No. TVPE OF PERMIT�� GRAOING FOUNDATION STRVCTGRAL
Addr¢55 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
Con[ractor'SName �d^ PhOne Q% ��OTHER `
Address (m '�' � 2 'G ll�,�� ,Cbd6S PROJECT DESCRIPTION 5�. FT. �7 _6b OCCUPaNCv (.�
' ���.2� CONSTRUCTIONTYPE yN VALUATION$ �aQO
City LitEn52 NO. ZONE GRADING CV. VDS. ACRES
LfG�L4J5ED CONTRACTOR DECLARATION
1 hereby affirm that I am litensetl untler prOvislons Of Chartet 9(commencing
witn zection 7000) of Division 3 ot the Businezs antl ProfeS i ns Cotle, anQ
my licenze is in full I�`aqQef�ct.^ �[[F/
License/�` I � �� p!�� \�� I�:fJTq T V/
Date�7�e Signafure-7`LY"�^'9
WORKERS'COMPENSATION D6CLARATION
I hereby aHirm tnat 1 have a certificate ol consent to self-insure or a certi(Icate
' Workers' Campensation Insura�nc/e, or a cerfi ' wpy thereo� (Section
��OY Nao. C-N OQD S Zi / Company �I�
�Certifietl mpy is �ereby furnishetl. ,
Cer tie ca y is�y�p with tbe tiryj�' �iltl n�g Divi¢i �
e � a Z APPlicant—'�G '
E%EMPTION FROM WORKERS' COMPENSATIOry DEGLARATI N
�(This section n¢¢tl not be complet¢tl If the permit is fo� one nuntlretl (E100) o�
less).
I c¢rtify thal in Ih¢ Perto�mance oi the wo�k tor wqich this pe�m�t is ISSuetl, I
zhall not employ any person in any manner so as (p become subject to t�e
WOrkers' Compensation Laws ot California.
Date Si9na[ure
NOTICE: If, after making this tleUaration, you sho�IC become subject lo [ne
Worke�s' ComPenSation provi5ion5 ot Ihe Labo� Cotle, you mu5t tOrthwillt
complY �+'��h suc� provizions or this permlt s�all be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby af(irm that there is a construcHon lentling ag¢nty for the performance
Ot the work tor which this permit is issuetl (5¢CtiOn 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDEH DECLARATION
I nereby atiirm thal 1 am exempt from tne Contractor's License Law tor tna
following reasOn (Settion 7031.5 Business antl ProtesSional Cotle: Any tlly or
county which �equires a permit to con5[�uct, aRCr, Improv¢, tlemoli5h O/ �epair
any structure, prior to its issuance, also requires Ne applicant for sucn oermit
to file a s y�etl statem¢nt thal he/She I5 licensetl pyr5uant to th¢ prOvi5ion5 Of
the ConVactor's License Law (Chapler 9(CommenCinq with SeGtion 7000) Of
Oivision 3 of the Business antl Professions Cotle) or that ne/she is exempt
'=reirom antl tne basis for the allegetl exemp[ion, qny violation ol Seclion
t1.5 by any applicant for a permil subjec(s ttte appli<ant to a clvil
idl[y of n.rt more than (ive huntlretl t1011a�s ($500J.
LJ I, as owne� ot Ihe pro0erty or my employees with wa9¢5 as lhelr sole
Compen5ation, will tl0 tlle work, antl the Stluctule i5 not in[entletl OI otfefetl
lor sale (Section 7044, Business antl Pwfessionai Cotle: The Contrattor's
Li<ense Law tloes not apOty to an ownar ot a ptope�ty who builtls or improves
[hereon, antl who tloes such work bimself/he�selt pr tM1rOugh hls or h¢r own
¢mployees, provitletl ihat such improvements ara not intentletl or oHcretl for
5al¢. 11, however, Ibe builtling Or improvement i5 Sq10 within one y¢ar 01 com-
pletion, ttte owner will have Ihe burtlen of prOving he/sne tlItl not builtl or iT-
prove forthe purpose oisale).
❑ I, as owner ot the property, am exclusively contractin9 with Ilcensetl con-
traclors to construcl the project (Section ]044, Busine55 and Protessions COtle:
The Contractor's License law tloes not apply lo an owner ot property who
builtls�or imorove5 thereon. antl who contracts lo� such oroie<ts with a<on-
tratior(s) license pursuan[ to cne ConVacior•s Lic@nse Law). I am aware that
proof of their WOrkePs Compen5a[ion Insu�ance Shoultl be P�ovitl¢tl to me.
❑ I am exempt untler Section B. 6 P. C. for this reason
G2tv� Owner -
I hereby certity that I have reatl tnis apPlication antl state that the above
Intormation is correct. I agree to comply with all ciry antl county ortlinances
antl state laws relatin9 to builtlinq construction, aqtl hereby authorize repre-
5¢ntdtives of t� to ente! up9 vp-mentlonetl ploperty fOr
inspection pur 5. � � ���
Signa[ure � oate O— �
Drivers' Lica.._, or 55 � — � �- � � _
OB65-46, rev. 5/88
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service OuUets
I nterceptors
Kitchen Sink
Lavarories
P—Trap
Foof Drains
Reinspection Fae
$15
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exheust System ❑ Multiple �
Firepl/Fact. Blt. iC80 �k
Heating System & Ducting
❑o�i oo,000 aTu � i oa,000 sr
Reinspection Fee � $15
White - Builtling; Canary - qpplicanp Pink - Accounting; Goltlenrotl - Assessor
P
Showefs
Servite Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tra'ys
Isue Fee
Hoad or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBTU
System Repair/Alteration
Fire Dampers
Registers
Issue Fea
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
S . Left
Ping. Ref. #
Planning Notes:
FEES Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwa5her
Dryers �Gas ❑Elect
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �
Zone
Build
Parkin9 Req./Provided
N
1
N
G
R
E
�
M
T
S.
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter ❑up ro 100 amps
Meter ❑over 100amps
Sub Panel
Motors O47 HP �1'r5 - 8
InaSolar 09-15 HP �16-15+
Microwave
Pole Light �
Fiange
I I Standing Sections
5 KW' I Trash Compactor
Reinspection Fee $15 luue Fea
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
FEES Building Approvad By —
$ 3
SU ARV OF FEES
BUILOING PERMIT $ 6L SMIP
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROfILM
MECHANICAL $ TOTAL FEE
PIAN CHECK 25% $
FEES
$ 3
$ a�
Q' ��.fl_j`r;7—J�0�7%�� !�'f1 �
GA7'= �_';'i0iG9 T1fii: __ :
. 1� - S . `t . . .
.
CONSTRUCTION AND PL�ANNING !; P��� 'A � �
� Date Inspector - . Date `� Inspector
APPROVALS Pi<rmit �� APPROVALS Permit # 1
_�
1. Temporary Electrical Service or Pole � 52. Pool & Equi�ment Location
2. So� Pipe-Undrgrnd. � • 53. Steel Reinfarcement ��+�
i' �
3. Electrical Conduit Utility-Undrgrnd. '' �� 54. Forms ,�
��
4%Eleci�ical Conduit-Undrgrnd. ' ,{. 55. Electrical Bonding �}
�
5r.SteeltReinforcemenP, , - �� 56. Rough Plumbing & Pressure Test "�
6. Electrical UFER�Grnd.'; 57. APPROVAL TO COVER-GUNITE �
- �
.9,.Footipgs ��� ,��� ��� ,�!'� 58. Electrical Conduit-Undrgrnd. �
�
8��Founilation � cc , � ;� 59. Gas Pipe, O Undrgrnd., Test �• �."r
.
9� Water Pipe-Undngr�d. � �? � � 60. Backwash Lines, P-Trap, � Undrgrnd. ;�
10. Strucmral Floor System i�i • '/ 61. APPROVAL TO DECK
11. Property Sewer Line'& House Conriection � �� ' 62. Backwash & Receptor-Final
�� i . ��.
12. Sewer: CaP ` ' ;i'; 'r ��' % '
� :�,.y � !�� .�. 63. Heater & Vent-Final
13. RooR Dreins ;� 'y" .�� 64. Plumbing SYstem - Final <<'
14. Ro'ugh Plumbing '� %� 65. Electrical-Final ���
:. . ^% �Y
15. Rough Electrical-Conduit 66. Solar System-Final
.16. Rough Elearic Wiring 67. Fencing & Access Approval
17, Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough EI'ectrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
�19. Rough Heating & Air Condifioning FIRE DEPT. REQUIREMENT
20.� Rough Factory Fireplace � APPROVALS Permit #
21, DuCts,�in Structure - 70. Underground Hydro
22. Ducts,_Ventilating ' 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test �, 72. Underground Flush
24. Roof Framing i'�; .ti ' 73. Undergrnd.Storage7ank �Gas ❑Oil �
25. Roof Sheathing ' - , 74. Overhead Hydro
26. T-Bar:Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame�and Flashing ,� � 76. Dry Standpipe
28. Lathing & Siding �-. 77. FIXED SYSTEM FINAL
29. Insulation � �i-� 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 Conditioqing
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 pomestic-Final
42. Backflow Preventer 'a �
43. Backflow Irrigation . , � -
44. Landscape Irripation System �
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING 7 � ,('
48. Special Requirements Completed � e_� ��.-t . /
49. Electric Release to Edison `<.
50. Gas Release to Southern California Gas Co : e
�
51. CERTIFICATE OF OCCUPANCY �
No. Date "' �
owrrEx �ER, Tom E.
JOB ADDR�SS 7 Hud50]
GENERAL CONTRACTOR pi
nr No. 141-532-07 Lo'r
7 'ECTIONS
80�.
1
_
TRACT FIftE ZONE
� Signature � DATE GROUP J
nATE 7-16-62
BUILDING P�RMIT NO. 1
VALUE S 'j0�+.00
DESCRIPTION OR WORK a
TYPE V 7.ONER-1
SUHCONTRACTOR
� - " I �560
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MHBA. CALIPOi2N1A
For ApplJeanf io Ffll In Complefely
� TYPE OR PRINT
COSTA MESA. CALIFORNIA
TEL.
i., ._., i I�o. oP a�aa.
FEE RECEIVED
JUL 1 6 196p
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
aecerv�er I � =i
L- '/
COSTA MESA.
FI
ZONING
2 �� I NO. OP I UBE OP I.
PLANS �j BUILDING
L80AL � . •� � 1 �,
BBiBACK LINH FRON f�wQ� / IC8NT6R LIN6 9T.)
CBNTER pp BTryEET • REAR YARD � I ppONT
/ / /
SIDE YARD ILEPf S RIGHT Q� R.SIDE
DESCRIPTION OF WORK ___
BUILOING / / NO. OF
81ZE ZS�C SO� ROOMS
GO ER'ING WALL N A I ROOF
COVERi1
U6E OF BUILDING AND WORK TO BE
I HHRHBY ALKNOWLBDOB TNAT I HAVH pBAD Try18 �PPLIGTION
AND BTAT¢ THAT THH ABOV6 19 CORPER ANO AORBH TO COM•
PLY WITH ALL CIiY ORDINANG88 A O HTATB LAWB R80ULATINO
9UILDINO CONBTiUR1oN.
81GNATURH OP��� Q�`
PERMITIEF �
AUTHORIZEO AGENT
-53�-
EVES
TX8 AMOUNT BXOWN �)NOBq VALUATION IB FOR TXE
PURPOBe OP 88TABLIBHIN6 A pEflMIT FE6 ONLY.
VALUATION /`
"�' PERMIT FEE S C�—�
$ �y/
X PLAN CHECK $ �—
�
TOTAL FEE S �--
0
OWNER HAj
JOA ADDR�5S
AP No. LOT
I '�CTIONS
Y 'cr, brown coat
1 g. p�Z
Healing, Rinul
Plumbing Rixtures,
Final Gus Test
Electric I'ixtures, F�.
Building, Pinul
OCCUPANCY
FOftM BU4 � SM - 7�61
nATr 10-11-61
BUILDING PERIIIT A'O.
TRACT 350o PIRE 'LONF DCSCRIPTION OP WORKY
� Signature DA'PG GROOP TYPE 7.ONE
PIi R D71
SUBCONTRAC9'02 n�.�.�,—r
- .� :���U
COSTA MESA 9UILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 COBTA MEBA. CAIIFORNIA
For Appliconf fo Fill In Complefely
TYPE OR PRINT
COSTA MESh CALIFORNIA�
�— _ 1
S
1 ARCHITECT
61ZE
OF �OT
USE OF
EXISTING BLDG.
86TBAGK LINB PROM
FEE RECEII/ED
ocr � 1 a�,
FINANCE DE�1'. bl,�-
CITY OF COSiA MESA
APPLICATION FOR PERMIT
BUILDIPIG
For Office Use Only
pECE1PT NO. I PCRMIT N
HECfiIV� V I DA��ECE%ED �f D^T
� /(/
, BUILDING �'i 1,� 1 � �
ADDRE65 ( 7 r� (�
COSTA MESA. CALIFORNIA
NO. OF BLDO6.
DESCRIPTION OF WORK
NEV I�ALTERATION I II ADOITIO
REPAIR I IIMOVING I IIDEMOLI:
BUILDING NO. OF
SIZE ROOMS STOF
EXTERIOR WALL IROOF
COVERING COVERING
USE O UILDING AND WORK TO BE PERFORMED
� , .
/. v i'�n/ i� uy
ZONING
Z / I NO. OP � I�6E OF NEW
� PLANS ' 1/�BUILOINO
r I
LEGAL I y �'� L G
�'AROS
APPROVEO
(CENTGP LIN¢ eT.l
APPROVED
EYES
'J �v
L�I
I HEPHOY ACKNOWLCPGe THAT 1 HAVE ReA� THIB �PPLIWTION }He AMOUNT BXOWN UNUER VALIIATION �8 POq�TM¢
ANO BTATE TH�T THg ABOVB IB CORNHCT AND AOREe TO COM- pURP09H OF fieT�BL19HIN0 I. PEPMIT PEE ONLY.
PLY WITX ALL CI ��O�INANCEe A O BTATE W9 RSGUTATINO
BUILDIN6 CON GTION. � VALUATION
SIGNATURE OF PERMIT FEE $ �
PERMITfE�L ,(yy
�_ $ �(/ D � PLAN CHECK $
AUTHORIZED AGENT � ,�.
iOTAL FEE
F
0
LL
Lot 52 �F:���➢ �
' ' 4 �;���
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C09TA MEBA. CAL�RORNIA
For Applieanf fo Fill In Complefely
TYPE OR PRINT
COSTA MESA CALIFORNIA
OWNER $ W g Construct'o Co
MAIL
AODRE68 1555 Placentia Ave.
TEL.
CITY � N '
ARCHITECT TEL.
OH :INEER NO.
ADD1(E6S
CONTRACTOR K.SI. g011
ADDRESS
��.�, NewPort Beach
STATE TEL.
LIC. NO. NO.
812L h/// ./ . �� �. 1 i� . _ I NO. OF BLDOB.
FIRE
ZONE
APPROVED
ZONB
R-1
L80AL
F�� RECEIVEU
�NY 171Su1
�fINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
NEGEIPT NO. PHRM�T NO.
BY OATB HECEIVED OAT�18��
I r���_ / � I � /� _ � /
CASTA MESA. CALIFORNIA
ZONING cinnl 4um
rto. or n use ov new a
PLAN6 G OUILDINO W/ gyt �i�
BHTBACK LIN6 FPOM � � J (CCNTHR LIN6 BT.)
CeNTHR Ov siRcei D� REAR YARD FRONT L �
C I / /
SIDE YARD I LEFT ✓ RIGHT / v R. SIDE
DESCRIPTION OF WORK c
shingle
Attatched
I H6H8BY ACKNOWLEDG[ THAT 1 XAVE IiEAD THIB MPLIWTION
�ND BTATB THAT THe ABOVB 19 CORflECi AND AaREe TO CON-
PLY WITH I�LL CITY Of1DINANCEB AND BTAT¢ LAW9 ft¢OULATINO
BUILDINO CONBTRU/C]TION/.f
816NATURE OP / / // , , � ���__ _ _
�AUTHORIZED AGENT
4'
TH6 AMOUM BXOWN UND¢R VALU�TION I6 VOR TN[
PUPPO6E OP H6TABLIBNINO � PERMIT FHe ONLY.
VALUATION �j'r
i PERMIT FEE $ J J —
S/�" �v ' PLAN CHECK S/� S� o
F
C
TOTAL FEE iS� Q