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Home My WebLink About758 HUDSON AVE - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 758 HUDSONAV Suite: Vicinity: Parcel Number: 14153210 Applicant: NGUYEN, LONG PHAN Address: 758 HUDSON AVE COSTA MESA,-CA " Owner: NGUYEN, LONG PHAN Address 758 HUDSON AVE � COSTA MESA, CA� - Contractor: O W N E R-B U I LD E R Address: Zip: Arch : Address: i Phane: Zoning: R1 R1 Phone: 714-546-3743 Zip: 92626 Phone: Zip: 92626 Phone: License: 000000 Eng: Address: Stalus: ISSUED Applied: 11/21/2003 Issued: 11/21/2003 ISSUED BY: C Phone: Zip: � License: License: SCOPE OF PERMIT �, TEAR OAFF COMP. SHINGLES INSTALL 30 YEAR COMP. SHINGLES WITH 30 LB FELT. ' �jL CE'�'�( � S�. � � _. ., � . i _ FEE SUMMARY ' Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $125.25 $0.60 $0.00 $0.00 $0.00 $125.85 • PLANNING & ZONING SETBACKS MAINSTRUCTURE Front 0-0. Rear 0-0 ACCESSORY Front 0- 0 - Rear 0- 0 PARKING Ezi_stinq; o Required: o NOTES: Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Ss,000.00 Claim Valuation: Ss,000.00 Right 0- 0 Right 0- 0 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, 1241-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned Por a period of 180 days. � '•. . ' r� �, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetions 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) 7545626 �aaaae �e�ao� WORKERS' COMPENSATION DECLARATION: � ' 1 hereby eftirm under penalry of perjury one of the tollowing tleclarations: ❑ I have entl will maintain e certificate of consent to self-Insure for workers' compensetlon, es provided for Dy section 3700 of ihe Labor Cotle, for the peAortnance of the work for which this pertni� is Issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Lebor Code, for ihe pertortnance ot the work tor which this pertnit is issued. My workers' compensation Insurence carner and pollcy number ara: Carnar. ' Policy Numbec (This section need nof be comp/efed i! fhe permit is valuetl et one hundred dollers ($100) ar less J ❑ I cetlity Ihet in the paAormenca of the work for which Ihis permit is issuetl, I shall no� employ any person in any manner so as to become subject to lhe workers' compensetion laws of California, and agrea that if I should become subject to the workers' compensation provisions oi Section 3700 ot the Lebor Cotle, I shail forthwith comply with these pmvisions. Applicent Signature: Date: WARNINO: FAILURE TO SEW RE WORKERS' COMPENSATION WVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED THOUSAND DOl1ARE ($100,000), IN ADOITIIXJ TO THE COST OF COMPENSATION, DAM1KGES AS PROVIDED FOR IN SECTION 3lOfi OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I here6y aHirm that I am licensetl untler Orovisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Code, and my license is in full force entl ettect. Llc. # Cless # Contractofs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm Na� �here is a construction lending agency lor the peAortnance of ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lenders Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby aHirtn ihat under penalty of perlury that 1 am E%EMPT FROM THE CONTRACTORS LICENSE lAW tor Ihe following reason (Sec. 7031.5, Business antl Professions Code: Any city or county which requires e permit to constmd, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file signed statement ihat he or she is licensetl pursuam ro the provislons of Ihe Contrectors License Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 oi the 8usi ss antl Professions Cotle) or that he or she is exempt therefrom and the basis tor t�e alleged exemption. Any violetion of Section 7031.5 by eny applicant for a pertnit su ects Ihe epplicant to a civil penalry of not more ihan five hundretl tlollars ($500).): I, es owner ot ihe property, or my employaes with wages as their sole compense�ion, WILL DO TME WORK, entl the siructure is not inlended or oHered far sale (Sac. \ 7044, Business and Prolessions Code: The Coniractors License Law tices not apply to an owner ot property who builds or improves thereon, antl who tices such work himseN or herself or ihrough his or her own employees, providetl ihat such improvements are not intended or oXered lor sale. It, however, the Duiltlinq or improvement is sold within one year of completion, ihe owner-builder will heve.the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, es ownar of the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions Code: The coniractors License Lew does not apply to an owner oi property who builds or Improves ihereon, and who contracis tor such project with a contrecmr(s) license pursuant to the Contractors License Laws.). ' untlersec. ID veritietl by dnvefs license. �Q'es ❑ No Business and Prolessions Code for ihis reason: Vanfication ot Ownership by (rype of document, i.e. - pmperty taa bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: No. ❑ I hereby certity that no excevetion five (5) or more fee� in depth into which e person Is required to descend, will be made in connection with work authonzad by ihis permit, and ihat no building stmcWre, scaHalding, felsework, or demolition or tlismentling ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Ttle 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ flnyone to do work which would require e permit trom the Division of Indusirial Safery, as notad ebove, unless such person hes a pertnit ta do such work from ihe tlivision. SignaNre: Da�e: Division oF Intlustnal Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EMRY: I certity under penelry oi perjury lhat I have read this epplication and state that the infortnation given is correct. I agree to comply with all stete lews and city ordinences relating to buildinq consimction, and authorize representutives of the City of Costa Mesa to enter upon ihe ebove-descnbed propeAy for inspection �pu �� e not �o occupy or allow occupency of eny building authorized by this permit until final inspection. /�---� ��/ N n�l 21 — 0 3�—' 1 Sign ure Ot L r s) D AnNOr Aufhonzed Applican� Date CODE �' INSPECTIONTYPE � 1616 Fixed System Final Fira Prevention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final BIocWRetelning W ell 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition QajE INiliUlS u � L i. COpE� INSPECTIONTYPE 206 Final MeChaniCal 20B Final Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 222 250 Final Planning Approval Final Site Final Building/Occupancy PAIE II�EL3 DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Permit # This Permil # Street Address: ��J � 6�CI �y��{ , AP Number: 1. I�(vie), lsihl Pn �hr� ��a 6�.. e�{� , declare that I am the Owner of Title of the above � �'� —T <7 � referenced real property, and that I(we) hereby authorize: Name: 08� S��1STeGJ I Telephone Number: ��t-I 'Z q� �7� �l 3 Street Address: Z �l � S V�/ • �ALL �. � - Ciry: •��'-'A�`z I IM State: C�' • Zip: �12�Q�{ to obtain permiLs in my behalf, as owner/builder, for � Q— atthe above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workers Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree lo indemnify and hold the City of Costa Mesa and its employees or o�cers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penally of perjury that the foregoing is true and correct. . Executed this day of 20 _, at , California. �rint-Name� L�� [2l� 1 1 L1 U�.� F.c� �Signature>' ��-(��I.t b�.i.i.0 ` �:..� Nnil 2 n — 2� Note: This authorization does not grant authoriza6on to perform the woAc as owner, R solely provides for limited power of attomey to secu2 this pertnit in any behalf. 0779-C6 (rev.11/00) � Applican[ to fill in all ipaces except those witnin �eavy borEer Iinas antl sign all appro0�iate Oeclarations. CITY OF COSTA MESA CONSTRUCTAON PERMIT P MIT O TRACT NO. LOT NO. - UN1=NU. , Project Address � - n n �� u'� � `�� Applicant's Mailing Address �� Owner's Name �• �Phone.�3 Address �{ � Arch/Eng. License No. Address Contractor's Nama ��L�I $ r Phone Address Imailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affi�m that 1 am Ilcensetl untler p�ovi5ion5 of Cha�[e� 9(commencing witn section 7000) ot Division 3 ot t�e Business antl Professionz Cotle, antl my licenzc is in full (orce antl et(ect. License Class �icense No. Date Si9�ature �RKERS' COMPENSATION DECLARATION ;reby atfirm tnat I havo a certiBcato of mnsent to self-insure or a certificate . Workers' Compensation Insurante, or a certHieO copy thereof (Sectlon 3800, Lab. C.) Policy No. Company BCerlifieC coOY �5 hereby fumishetl. Cer[ifiea copy is filetl with the city Builtling Dlvision. pa[e APPlicant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnis section neetl not be completetl il the permit is for one huntlrea (5100) or Iess). I certity that in the oerformance ot the work for which this pe m�t Is Issuetl I Shall not employ any per5on in any mannet so as to beco Fub�ect to t{te Workers' o pe s o•Lawsof Cali . • Date Signature NOTICE: 1, atte making this tlecla�abo , you Shoultl ome Sub' ct to Ihe Wo�ker5' Compensation provision5 ot [¢ LdbOr COtle, y0u mu torthwith Compty with �su[h prOvi5ion5 Or tnis ermit snall be deemetl revokCtl. CONSTRUCTION IENDINC. AGENCV I hereby af9�m thaf th0re I5 a consV uctlon lentling dgency for the performance of the work far ich this permil i5 i55uetl (Section 3097 Civ. C.) Lentler's Name ��L42L4� - Lentler's AOtlrezs � OWNER BUILOER �ECLARATION I hereby aHirm that I am exempt from the Con[�aclo�'S LICenSe Law to� tbe following reason (Section 7031.5 Business antl Professional Cotle: Any city or county which requires a permit to construct, alter Improve, tlemolish or repalr any structure, prior to Its issuance, also requires the aoolicant tor sucn permit to file a signetl statemen[ that he/she is licensetl pursuant to [he provisions of �e Contractor'S LiCense Law (Chapter 9(comm¢nCing witn Section ]000) ot vision 3 of the Busine55 antl Protesslon5 Cotle) or [hat ne/she is exempt krefrom antl'tM1e basis for [he allegetl exemption. Any vlolatlon of Section /031.5 Dy any applicant for a permi[ subjects [he applicant to a Civil Q�enalty of not more tM1an five huntlretl tlollars (5500). � � u I, as owner of the property or my employees with wago5 as [hel� sole compensation, will tlo the wo�k, antl the st�ucture is not intentletl o� offeretl for �sale (Section 7044, Business antl Professlonal Cotle: The ConVactor`s License Law tloes nol ap01y to an owne� of a proporty who bulltls or imOroveS thereon, antl who tloes su<h work himseli/herseH or throu9n his or her own employees, provitletl that such improvemenls are not intendetl or offeretl fo� sale. It. M1owever, th¢ builtling or Improvemen[ Is 5oltl within One yea� of com- pletion, the owner will have the burtlan Of prOving hC/she tlltl not builtl Or iT- �rova for the purpose oi sale). I, as owner ot the properiy, am exclusively contracting wi[h Iicensetl Con- tractors to Wnstruct the Oroject ISecllon ]044, Business antl Professions Cotla: The Contraclor's License I..aw does not apply to an owner of properry who builtls or Imp�oves tM1er¢on, antl who contracts br such projects with a con- t�actot(51 I�cense pursuant [o the Cont�acto�'S License law). I am aware tbal proof of fheir Worker's Compensalion insuranG¢ Shoultl b¢ providetl ro me. ❑ 1 am exempt under Section B. & P.'C. for [his reason Date 35op 55 TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � DES� RypTIqy OF WORK/�s Ec� c�. DG. ` � �L ,L"i,+n�- 6�L�aL.'�F+�. oue�G S� TVPE OF PE IT�GR��VNDATION STR CTVRA ❑ TENANT ELECTRICAL PLVMBING ❑ MECNANICAL ❑ OTHER PROJECT DESCRIPTION Sc�. F7. oCCUaAIyF CONSTRUCTIONTVPE �- VALUATIONS � RS ZONE GRADINGCU.VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Clarifiers� - Dishwasher Drinking FOuntains Floor'Drains FlOor Sinks Gas Service ; Outlets Kitchen Sink - Lavamries � �—Trap Roof Orains Reinspection Fee $15 Duct - Under Ground Duct - Structural Duct - Ventilating ExhaustSystem ❑ Multiple❑ Firepl/FacL BI[. ICBO # Heating $ystem & Ducting ❑ 4100,000 BTU � 100,000 �T �Signature Date�U/d�d b I I-- — Drivers' Lic nse or 55 # Reinspection Fee CMF 0865-46, rev. 10/84 White - Builtlinq; Canary - Applicant; Plnk - Accounting; Goltlenrotl - Assessor 315 Showers Service Sink Sewer Cap Sewer Connection ' � Solar Collectors _ Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash Issue Fee Hoodor Typel ❑ Canopy Type II ❑ Re(rigeration Sys[em Oaioo,000eru ❑ioo.000aru System Repair/Alteration Fire Dampers Registers luue Fee EES ' $ 3 5 3 A.P. �A`- `y'/ S Main Buildi E T Front• ( B Rear A C Right 'L' SLeft 5 Ping. Ref. # Planning Notes: i. Automatic Washer' Construction Pole $� Cooking Unit Dishwasher Dryers �Gas ❑EI Fan F.A.U. Fixtures Device Boxes Outlets Switches - Garbage Disposal Generator �0�5 KW 0 �i8901 12/18/B6 , Zona Parking Req./Provided ELECTRICAL ' Transformer ❑ 15-50 KW ❑ 50+KW ' Meter ❑up to 100 amps Meter �over100amps Sub Panel .. ' Momrs � 0� 1 H P � 1 X� 6 Inc.Solar 09-15 HP �16-15+ Microwave� ' Pole Light' Range Standing Sections 5-15 KW ' Trash Compacmr � Reinspection Fee � $15 DEVELOPMENTSERVICESRE ( ZaninB APPraved 8y Building Approved By BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL � PLAN CHECK 25% $ luua Fee 305.77 TL 2 �L o N I — N G R E . Q M T $ FEES � � $ 3 FEES . SMIP $ �7�i PERMIT ISSUANCE $ ENERGV P.C. 5 GRADING 5 MICROFILM $ 9 TOTA�FEE 5 �7�5.�%J CONSTRUCTION ANDPLANNING � POOL&SPA APPROVALS Permit #� Date Inspector pppROVALS Permit # Date In'spector 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, O Undrgrnd. 10. Structural Floor System 61. APPFOVAL TO DECK i t. 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 Appioval 17. Rough Wiring Sign - 66. APPROVED FOR PLASTERING - 18. Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning , FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd.StorageTank OGas ❑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 39. Water Service-Final 40. Gas�Service-Final 41. Solar pomestic-Final 42. Backflow Preventer . 43. Backflow Irrigation 44. Landscape Irrigation SYstem 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING ��87 Q�. , 48. Special Requirements Completed , 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 57. CERTIFICATE OF OCCUPANCY No. Date RICHFY, �Iy�P z_��F V�11�LR JOB ADDRESS 758 Hudson Avenua BUILDING PERMIT N0. q��a GENERAL CONTRACTOR Jon Bouchard 8 Assoc DESCRIPTION of WORK �A7'b. I- 3- LOT TRACT PIREZONE VALUES 10 000.00 ��I! .CTIONS ` ' Signar�m Date TYPE V GROUP i ZONE R-I coii . ecn..�tc ��.��. GAS W ATER ` ROUGH PROP. SWA. LINE �J HOUSE CON. L,J I'V v-. "'r^T'T LING SvSTEM ... ��I .• MISCELLANEOUS � � 1� ROUGH HEATING AND AIR CONOITIONIN�i �' TEMPORARY SERVICE OR POLE UNOERGROUNO � POWER � ROUGH WIPING TRENCHES FORMS STEEL REIttP FLOOR SYSTEM BOND BEFM �J STEEL REINFOR�E � SHEATHING FRAME PND FLASNING LITHING — IN � OUT P PLASTER,BROWN COAT ST" 'URPL, FINaI HE 0. VENT., REFRIG. AND A.��. FINAL RACTOR _ _ . . `�� 4I259 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Far Applicant to Fill in Comple[ely — Use Ink Only BUILDING ..�� // � ry OWNER MA14 TEL. CITV `.GStI� MC S Ci NO. CON5TRUCTION �,�_ BRANCH ADDRESS ARCNITECT CONTRACTOR 1J � ' � �/.1� � s:_�=_L ADDRESS /0�'3 '_ � - � r. E CITV C� � (J' �J � (� NOL ' � STAYE _ CITV LIC. NO. LI0. NO. {y SIZE / � NO.OF BLDGS. o. OF �OT ]� NOW ON LOT � USE OF EXISf �NG BLDG. y FSeparate permits are required for � electric, plumbing and heating work. [."�.� USE OF BUILDING AND WORK TO BE PERFOAMED Q a �G� V�n 1 t OCl Yy1 N/ ,J c�� ;. !/ G d u.� a w Ff� �7�`�'�.'`�'-101� tE�� ..y'{D APPLICATION FOR STRUCTURAL PERMIT FiEC TE D E ISSUE[ ' � ID - A.P. NO. � I� 5�� l_O PERMIT NO. BUILDING rJ�/' �`T�'' ` `, ADDRESS /�� A.l V OWNER FIRE ZONE APPROVED NO.OF / PLANS � VAROS APPROVEO MAIN BUILDING (FROM Gl STREET) DI5iANCE BET MAIN BLDGS. VAR. # Li55'— BLOCK ,�1P.' 1 VALUE � � / g � O GROUP � DATE `IO- i� 1V� m USE OF NE � BUILDING Q YARDSAPPROVED `^ ACCESSORV BUILDING \/ � BEf. MAIN & ACCESS. BLDGS. DATE APPROVED lIGTFL�� I � � 1 her9by acknowledga that I �evo reatl this application and state � thet the ebove Intormation is correct antl agrae to comply with a all laws regulating building consttucNon, und I shall not amploy Z any person in violation oi tha workmen's compenmtion laws oi � the Stata of California. �O x 3 I heraby certify that I am properly licansetl as�a contrecror under SQ. FT. tha State of Cellfornle Bustness entl Protessions Cotle, Oivision 3, TNE AMOUNT SHOWN UNOER VAIUA Chepter 9, antl thet such Iicenses are in tull force and eftect, or I THE PURPp$E OF ESTABLISHING A PERMI am exempS from the provisions ot the State of California eusineu and Pfofessions /C/ode, Divis� n 3, Chaptar 9. VALUATION PERMIT FEE S // / � PLAN CHECK S Signatura o� (/ A��/ � S 0� D0 0 Permittee J" // 1- �"L�(it� TAX 5 AuthOrized/neant TOTAI.PAID b n m dq m O N�+ 7I \ • IS FOR rp ONLV: � a � I�QD � O I,ot 55 . T � � � `�� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 CO8'TA MEBA. CALIFORNIA For Applieanf fo Fill In Complefely TYPE OR PRINT BUILDING � Sg ADDRESS COSTA MESA. CALIFORNIA TT2UfDOi't B2L'C17 155$ Placentia Aee �?�*No. 61195 No: rii 6-32z7 SIZE I n� I NO. OF BLDGB. OF LOT [�(! X/OO�i!O / NOW ON LOT USE OF NOIIB EXISTWG BLDG. 6QTB/�LK LIN6 PPOM /� / �j CeNTett oF BTReeT (,� REAR YARD 7 / � 61OE YAR� I LEFT � RIGHT � DESCRIPTION OF WORK .. I x II..__....,,,...I II.��._.�.. BUILDING Ntl. OF 1 81ZE RO�M6 7 STORIES EXTERIOR WALL I ROOF j'%OOd shingle COVERING COVERING USE OF BUILDIN�G.ANn,wogg y BE PERFORMEO �i te ramil xesidence aad � EE RECEIVED ��' MAY 17 iSo9 FINANCE OEPT. CI i Y OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only � RECEIPT NO. I •9 PENMI'I�NO{ BUILDING ADDRESS COSTA MESA, CALIFORNIA APPROVED ZONING ZONE I NO. OF I USE OP NEW / � R�1 PLANB 2 BUILDING k a't�' LEGAL LQY SSf �SC4� J�vO DEBCRIPTION � � cee�arert urve sr.� I XERHBY AGKNOWLCD08 THAT i HAVE READ TH�6 APPtAGT10N AND BTATE THAT THE ABOVE IB WpHECT AND AGR6E TO COM- PLY wITH ALL GITY OADINANCER ANU BTATE LAWB pEGU{ATING 9UIIDINO CONBTR/VC]TI/OJN. //�} 81GNATURE OF/ �// •�%yj �//_ _ ) � AUTHORIZED AGEN7 EVES rlb. G� THC AMOUNT BXOWN IINOER VALUATION IB FOR THE PURPOBH OP EBTABLIBHING A PERMIT FEE oNLY. VALUATION ^� PERMIT FEE $ J�� 5 �jjh Ca $ , v`� PLAN CHECK $ /�^� / j TOTAL FEE �cl��l! ,' �-i2s¢ �FR , o-�s�;�°o0 3s�E �� 52.no COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX1200 COSTAMESA,CALIFORNIA92626 A CATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use [nk Only RE ED B DATE RECEIVED DATE ISSUED BUI4DING �� n� �U�'7/ AD�AESS IX / b OWNER CL— � �� . PERMITNO. A.P. NO. MAIL . BUI�DING (� r�� AD�RESS ADDRESS v � �� ' TEL. � TRACT LOT BLOCK CITV ' NO. CONSTRUCTION EW ADD A TER R PA M LENDER BRANCH �J Cr� OWNER •"L j YJE ADDRESS /y�/ VALUE ARCHITECT TEL. USE � r)� $ � pq NGINEER NO. FIRE ADDRESS ' ZONE TVPE GROUP APPRO ED CONTRACTOR BV DATE ADDRE55 ' TEL. ` ZONE \ NO.OF USE OF NEW CITV � NO. P�� . BUILDING � STAtE CITV VARDSAPP.ROVED VARDSAPPROVED �IC. NO. O ' LIC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM C/L STREET) OF I.OT NOW ON LOT ' FRONT F7. FT. USE OF i EXISY�NG BLDG. R 51 E FT� FT. 1 Separate permits �are required for �. sioe FT. �•. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WOFK TO BE PEflFORMED DISTANCE BET. BET. MAIN & MAIN B�DGS. . ACCESS. BIOGS. . VAR. # , DATE C.U.P.# APPflOVED APPROVED I hereby acknowledge that I have read this application antl state � that Yhe above information is correct antl apYee to comply with all laws regulating builtling conrtruction, antl I shall not employ anY person in violation of the workman's compensation laws of ffie State of California. , I her�by certify that I am properly licensetl as a contrecmr under - SQ. FT. the State of California Business antl Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in tull force and etfect, or I THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONIV: am exempt from the provtsions ot the State of California Business VALUATION PERMIT FEE $�� antl Professions Code, Division 3, Chapter 9. PLAN CHECK $ Signa�ure of � Pe�mittee $ TAX 3 AuthPrizedAgent TOTALPAI� $ 2 °,�