HomeMy WebLinkAbout1853 ILLINOIS ST - Building Permits / Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 6233 10/29/66
PERT TRACT NO. LOT NO. UNIT NO. 5.00 Ti,
CITY of COSTA MESA nCONSTRUCTION PERMIT i2aCh
Project Address $c2 11_G 14 2 h f r I
Applicant's Mailing Address YY� lghp TYPE OF CONSTRUCTION U NEW L� ADD U ALTERATION REPAIR ir
f,.�/}� �� •i-i!�Mr- ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. + I Zone
Owner's Name _ (, "' ' _ Phone rV���I( /I SI/ DESCRIPTION OF WORK/USE OF BLDG.
Address 1 S Main Building: Accessory Building:
TYPE OF PERMIT L I GRADING r I`OUNDATION U STRUCTURAL E
Front Z
Arch/Eng. License No. y'r T - O
Address . ❑ TENANT ❑ ELECTRICAL LLLKKK PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name �J� ��� /� q'� Phone Qin ❑ OTHER A I
// /'.[.ar/IFI�•ly a +eI Qom" C Right N
•
Address(mailing) (4 fit VA- v PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G
• (1 CON STRUCTION TYPE VALUATION$ $
City License No. 0-735 ZONE GRADING CU.YDS. ACRESRE
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: - PPlanningQing Notes: M
with section of Division 3 of the Business and Professions Code, and • _ -
my license is inn full full •r e nd effect. • T
License ra - I i e 90 I S
Date I IALSigg nature L/%//�. ter P .I. PLUMBING FEES
WORKER ' •MPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate E LECTR ICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink -
3800, Lab. Cy/s p/1, p {� ,s/ Automatic •Washer Transformer ❑ 15.50 KW
Policy No. dt.Qf1"77�5 Company lc" I[/- b Backflow Irrigation Sewer Cap • Construction Pole Sub. ❑ 50+KW
Pertified copy is hereby furnished.
reCer)j if�j'/1$filed with the city d seztiot_jjj Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps -
Date % (Q/aIA' KERSApplicant t bION D lCLARA
X. EXEM TI FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred(SI00)or
less) Dish Washer Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is Issued I -
•
shalt not employ any person In any manner so as to become subject to the Drinking Fountains Solar TankFan Motors 00-1 HP 011/6-B
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
Inc.Solar 09-15 HP ❑16-15+
NOTICE:Compensation
making this ions of
h,you should become subject to the
i Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets 'Water Closet
\ I hereby affirm that there is a construction lending agency for the performance n DeviCa BO%ei Pole Light
of the work for which this permit is issued (Section 3097 JCiv. C.) Interceptors / 'Water Heater e9 - Outlets Range
Lender's Name
Lender's Address Kitchen Sink s Water Service SwitchesSign - '
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,-alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW ❑$-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code). or that he/she is exempt .-
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
enalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 •
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee S 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own Hood or Type 1 '❑ DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements aro not intended or offered for Boiler
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will-have the burden of proving he/she did not build or Im- Duct- Under Ground Building Approved By Date /
rove for the purpose he of sale).p - ]/Z ,
U i,t as toowner the project am exclusively contracting Inti with licensedionode- Duct-Structural Refrigeration System Application Issued By -_!! _ Date'/j�(
hetorst ctor'sconstruct the project foes on 7044,Bto
o antl Professions t Cotle:
The Contractor's License Law does not apply to an owner jofe property who Duct-Ventilating ❑0.100,000 BTU 0100,000 BTU SUMMARY OF FEES
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 Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ ' SMTP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
IDI am exempt under Section B.& P.C.for trait reason Firepl/Fact.RIs. ICBO# Fire Dampers• PLUMBING $ ISSUANCE $ 12
Date Owner Heating System = e Registers PLAN CHECK ' -25% $ - ENERGY P.C.- S - r
I hereby certify that I haverread thismapplication all and state that the above ' 00-100,000 0100,000: - - .
information is correct. I agree to comply with all and county ordinances ELECTRICAL : $ ' GRADING $
and state laws relating to building construction,and hereby authorize repre-
sentatives of this city to enter upon the above-mentioned property for
inspection p s /'7/�` MECHANICAL • $
• Signature 1 _ • . .A ..- / / Date 1D�0!/r �/I - - r ti
TOTAL FEE $ �•��
Drivers' License or 55
CMF 0865-46,rev.-10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor /'
I
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# 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, 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
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas El Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas O 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:s/24/d 7 tc,c'r Ca40. L.C13
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing G///17 L$4)
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. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY i
No. Date
•
r
; -J
I-• PROWNE ' NA
M1853 ILLINOIS ST
S:ADDRESS: UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 057570
AD
OWNER'S PAUGH JERRY REYNOLD
ODRESEss: 1853 ILLINOIS ST PERMIT NO: B 057570 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: ( 714 ) 556-7932 REG.NO.: UNIT: SQ
ADDRESS: JOB DESCRIPTION : T/O EXISTING & APPLY COMP SHINGLES FT: 3, 600
PERMITTEE CLAIM VALUE: 3, 600. 00 CALC-VALUE: 3,600. 00 GROUP OCC: R-3 /M-1
ADDRESS: GREAT WESTERN ROOFING ( 714 )738-5848
pj�77jt2�TT0�F5p11 S(�BERKELY CI COMMENTS- SMOKE DETECTOR(S) REQUIRED IN HOME.
DfldECiARAf@H: T ********iE********************* *******lfikit♦E**4*************************if*ik******
LICENSED CONTRACT T INeby atfirm that I am licensed under prroovisio92632
n 2 Chapter 9(commencing with Section Z ONING
/
R EQU I R
E M E N T S
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect.
SETBACKS
CITY LIC.: 05/.2 LIC.:
gntu38 C_ om /
L //�
Caw. C �
MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm=nil haveacenil:. �of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.ora certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 0 5 4 8 3 9 4-91 EXP.DATE: 11 /01 /92
COMPANY: STATE FUNIL, PARKING REQ: PROV: PARCEL: 13904203 ZNE: REF NO:
❑ Certified copy is hereby furnished. L)( Certified copy is fit city Building Division. PLANNING NOTES>
// / >
NW ` 9� Appgwm:J �J�L/ - *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECUBATION: (This sedion n • 01 he completed if the permit is for one huored(S1 W)or tess). DEVELOPMENT SERVICES REQUIREMENTS
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 Calilomu. ZONING APPROVED BY . DATE:
Date: Signature:
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : / DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. k
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: # 4* ,*r / / DATE• e -. .3-
,/
which this permit is issued(Section 3097.Civ.C). *,***,***,**,*.K,*,***.********* * ** * * **,***, *********************4* **
LENDER: ***************************************** '************************ ***********
ADDRESS: LEGALIZATION:N F E E S U M MVA R Y / -STRUCTURAL, SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason ✓ '
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63. 00
repair any structure.prior to its issuance,also requires the applicant for such permit to lite a signed statement that he/she is licensed d �� 50
pursuant to the provisions the islets'State License Law the 9(commencing with Section 7000)of Division 3 of the Business _ > • SMIP/NON-RES
and Professions Code)or that he/she exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN _. / ,.
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(MOOT ISSUE FEE - _
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK 1 7. / TOTAL - PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 63 . 50 0. 0 0 0. 00 : ' 63. 50 - 63. 50 . 00
does not apply to an owner of a properly who builds or improves thereon.and who does such work himself/herself or through ) '
his or her own employees.provided that such improvements are not intended or offered for sale.If, however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: '.. 63. 50 OVER/SHORT• 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63. 00 `r i`n . 50-1
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon - r
and who contracts lar such projects with a contractors)license pursuant to the Contractors'State License Law)-laza-aware *************************************,**,*****,** *********************************
that proof of their Worker's Compensation insurance should be provided to me.
I N D I V I D U Alt ' P E E B' R E A K D O W N
•
LIam exempt under Section: 8.&P.C. i.•
for this reason: ; • ✓
TYPE QTY D E S C R I P T I O,N' - UNIT COST TOTAL COST
4.ID
Ddo hereby cenifythat lam aware of and understand the requirementate: s of California Health and Safety Code Sections 25505,25533,and SFR 3600 REROOF BY VALUE RESIDENTIAL "NOZONEE 4. " 1 . 00 3, 600. 00
25534 and that I or any future building occupant wildwill not(circle one)need to comply with said state codes and the requirements fora END OF FEES / ,-- y
'
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
,-„„•,
these provisions. ! ^.)
r _ / /�; I ,
Date: Applicant: c L - � ,
I hereby certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ri
ordinances and state laws relating to building construction and hereby authorize representatives oft ' 'yea ente •in the above-mentioned ' I /• _
property faripapection purposes. ,�— 'i _ ' '
// /n . -
•
-eats_ - 2 e( 2 Signature: 4,2"/%..Z 497 '
Driver's License or Social Security x:
1641-46 White-Building;Green-Code EntorcemenC Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
_ CONSTRUCTION AND PLANNING POOL &SPA
\i- APPROVALS Permit# Date Inspector APPROVALS Permit # _ Date Inspector
1. Temporary Electrical Servi`ee or Polos,1 52. Pool & Equipment Location
Iv. Jt-
2. Soil t Pipe-Undrgrnd. - .ate 53. Steel Reinforcement
n .r • • -23-4.-
w33 I4triC'al Condga UTlity-bndrgrndy ' 54. Forms
j-4;,Elettrieel Cond v.U: irgrnd: i a 55. Electrical Bonding
..1 r.• It elft
' 4 I Fteinforcei &? "Cx 56. Rough Plumbing& Pressure Test
-n.-
46cgle'ctrleal UFECi 6rn�dd.�
.- ro 57. APPROVAL TO COVER-GUNITE -
-r.rr- - n P-`C• .,
3: tingf Y 58 . Electrical Conduit-Undrgrnd. 't
-NIrtf_oundation x>.; n'• 59. Gas Pipe, D Undrgrnd., Test .-
-01'7,1-
-01' t_ -.
''' Water Pipe-Und 'id. 60. Backwash Lines,P-Trap, 0 Undrgrnd. ,
•y
1t Structural Fioo&SSystem • ... ' 61. APPROVAL TO DECK
v .->
•
11. Property Sewer Linr& Hone Connection 62. Backwash & Receptor-Final '
t ct -,
12. S ger Cap a. n y 63. Heater & Vent-Final
13. Roof Drains r. 64. Plumbing System - Final
14. Rough Plumbir,1&,� r'' '
"x, 65. Electrical-Final
15. Rough ElectricatConduit 66. Solar System-Final
16. Rough Electrics firing 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough ElectricajT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
n i %`_ TG .. 1. W 4- - a- Y-'t F S
20.tCtouu"'h Factory Ftrkplace . L;tn i..4 -2 :a 0 0 :rr t APPROVA'CS-00? ermit # • _ f
r. C ' ;:* t c--n r.ct * S N r"..-rt
- :C �!i ti'- •r- '� is . .1.
21.}Duct`s, in�tr Ctu a :- ''J -t 7 7 • d �? S" 7v2 :r F to
• t-!S S" .. :-'t . f0. Uridergreupd*Hydo
x - .. r
22. Duca, ventilating-. ':S ', : ;;CV -•
,-, .� ,fa r, n .r ,.-; d t_r y , t. Product P irig GrCias ❑Oil
23.r.. as Pip 7Rough &•test 1 u: t' i• - Y r- r IT'
' t.r- `• -
ei- 1 tn5 t: to d tit G> ;22. Underground,FNur.>r _
�+ •. t= 00 -' . .. t�
24.ciocs Framing. 5:4 • - . ••.f 431 > C s _ .*+ .- 3.trUndergrnd'Storag�tJaYnk c3 Gas -DOW
25. RotiSh�a'thin - ` S N '1,. r !n 0 N+: * -o
g tn>• -CC ,vs X74 :Overhead Hydro'
26.-T-Ball Ceiling (Structural) &Sllonocoat * v r.O 7 to a' 75.=Dry Chemical * -. _ u:
27.."Fra e a d Flashiit ' `� x V 'D • t. t G: S sc
i v ,Lt- tr4f' 'DIX tC r •,• :b+ t. 76.t1:2‘1 Stant `iL,.° F.tD ,. fl
i-48.`�Latng SidjngE-< ^_�C:t tt S. •• ••t * 77.crFIXEDSYSTENI'- NAL' "'
'29. Insulati i " ccx ' ^' r t"' I I '' a
�., ,S l: r A 78.`kIRE PREV. FItJA� x � x
vt .
tux , , , a I- r
CO. Drywall,Nailiag -. I e. a: r. HEALTH:IfEPT. REQUIREMENT
i
'31. Plaster BFowr�Co'kyt,:« S ! ••••.-r y r 79. INAL If } PECTI
Ji y Tv: L. t' *»-: ttrc * L ...-• •r.
If
::-22. lectrica(Power Meter:Final I _ x N t. * 0.;FOOD CERTIFICATE ISSUED
,F. 1; � ` to 4. * t'NOU:'s: r? 2tit 4i
t
ij4.efin4.Heating t A'ir Condjtioniq ;a' x , (/ s' rtX w CC
tr.: , .� , // r,
35.;..inai'Ga3 Pip2:Tes ? in) t. t: C r t''.1�/y.r/72 ?
i_ nn • r. !•. v: •-a l ,r. # 1= ,LO C / a
t,36.' 1ott?orrbanopy .+.c ;7<_ i ta•• -- �. , , I [tr.
S_ •,. ,no.. -7-- ♦ , . i
7.(inaVFaetory FirViiiptex i Sir o I:. sal I !r X 5 ,l4r�i moi_ ,.r�-$,9�GL
�
38. Final Pl gybing r �:u j ti * i tt �� S /
.59. WatCt Serfrice-Final* I .. t. i ( r C' -t r. - r r
r to a >: I r tC ti a '>•
ti ti' r +. t.•
�{]0. Gas Ser e-oval t ,..(intr., S t. ,n , t air -1 IV_ �__;
, ^: : e Piet Ol
41. Solar Domestic-Final s •• • 0) t R' .,
v .r t v x. 'r. .-5C .._.C: x eiyiet
'142.backflow Preventer`r t' x `t I f` * '7. -•
43. Backflow Irrigations -...i t: * 4,, / et y ,`' " 4' .. --
i. �� t s ` `ff _d::-.%amu I.�► r 7L
'�4. Landsc a KY atioq Syste 'T t 'C y
tit a- .rig my r^. o: !' l'1 C C: t �x N N '__. - . . .7
C:. a C ,t' >.
�5. Sound AtteIIta[ioni • '- Y 1. ' i4 . C' ._ ti; f
•� m -� .. .. s n rn .n:i ..r Kms. .c
0 -•NandicaP RegYlatio s rC-• C .` ..r •' "i. , S ,C r
47. FINAL STRUCTURE & BUILDING
27.
. ;-�. ...-
to it 1 * .•48.fIh{'AL PLANNiNGy: ; F ci tr -r . -;
. 9.eEleetric'eleyse to Edison i w- t; + i• i,; I -.. t
• n •7 i J
t.50. Gas,pel2'ese to Sout�ern Calitornie,Gas Co r; i s - '� o-- C
S I IS a. c• O • O'._ •7 •
: i. CERTIFICATE OFpCCUPANCN ,; y t No . w - n
No. Date
� o�o FEE RECEIVED
MAY 1 6 1960
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
• P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING
BUILDING
Do ENS
S 1653 Tl l i nois St.
COSTA MESA. CALIFORNIA For Office Use Only
Inc. RECEIPTNO. I 1 4tiaO
OWNER Vermont Avenue Land Co., • °
MAIL REC:rfrlY DATE RE I HD DATE ISSUEDy b
ADDRESS 419 E. 17th St. ,�_/ �%Elaf 6� MAY 1 7
CITY (Theta Mesa . NEOL161159 ADDILRESS
G
ARCHITECT Carlson & TEL. COSTA MESA. CALIFORNIA
OR ENGINEER . Middlebrook NO.
ADDRESS Garden Grove FIRE ' / y/- (J�
T_ ZONE TYPE Y GROUP Ji-
CONTRACTOR
/ }f -
CONTRACTOR Dike & Col egrove, Ino. APPROVED DATE U
ADDRESS 419 E. 17th St. ZONING Singl fun.
(�
Mesa R ZONE NO.OF USE OF NEW
cm(cm( Costa -1 I PLANE 2 BUILDING (]/ att Bar
LICTNO. 167293 NEO. Li. 8-1159 EGALIPTION Lot 62, Tr. 3648
SIZE I NO. OF BLDGB1
OF LOT 61' x 1001 NOW ON LOT hone A.P.NO. None
USE OF YARDS EVES
EXISTING BLDG, None APPROVED ALLOWED
SETBACK UNE FROM (CENTER LINE ST.)
CENTER Op STREET 521 REAR YARD 251 FRONT _L FT. IN.
SIDE YARD I LEFT 51 I RIGHT 51 R.SIDE C FT. IN.
DESCRIPTION OF WORK ----
L.SIDE �jFT. IN.
NEW I XII ALTERATION I II ADDITION I REAR ' 2);5 FT. IN.
REPAIR I LOVING MOVING 1 N II APPROVED DEMOLISH I BY IN. L.i/. DATE 5-13-60
BUILDING NO. OF
SIZE l/150 sq.- tBOOMS 6 STORIES 3.
EXTERIOR WALL I ROOF
COVERING ST ren COVERINGCOIID.& Rock
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence vrith
attached, garage. Plan 40AR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION VALUATION
SIGNATURE OF `'fl/ Y / ,..0•-•--- PERMIT FEE S 35. H
PERMITTEEo_
$ 15,045. PLAN CHECK $ 17.50 II;
AUTHORIZED AGENT Dike & 0.4 egrove,
Inc. Z
TOTAL FEE $ 52.50 0