HomeMy WebLinkAbout2909 JACARANDA AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.c�.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2909 JACARANDA AV
Suite:
Vicinity: ROOF
Parcel Number: 13928429
npplicane CLAYTON, BILL
Address: 23511 WHITE DOVE DR
LAKE FOREST, CA
Owner: GUY, CLAUDE D
Address 2909 JACARANDA AVE
COSTA MESA, CA
Contrector: SOUTH COUNTY ROOFING
Address: 23517 WHITE DOVE DR
LAKE FOREST, CA
Zip: 92630
Arch :
Address:
Zoning:
Phone: 949-597-0192
Zip: 92630
Phone:
Zip: 92626
Phone: 949-597-0192
License: 737515
Eng:
Address:
Phone:
StaWs: ISSUED
Applied: 01/12/2004
Issued: 01/12/2004
_�
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30 YEAR ASTM, ELK COMPOSITION SHINGLES, ANTIQUE SLATE AND NEW FLASHINGS. WILL NOT
REPLACE SHEATHING. 1,250 S.F. INCLUDES ATTACHED GARAGE.
Plan Check: $0.00
, Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
SETBACKS
MAINSTRUCTURE Fronl 0-0
ACCESSORY Fmnt 0-0
PARKING Existin : 0
Rear 0- 0
Rear 0- 0
Reouired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$z,800.00
S2,&oo.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, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 1 BO 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 Inspectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in Ihe expira�ion of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
2C4&6818'00)
WORKERS' COMPENSATION DECLf,RATION: �
I hereby attirtn untler penalryGS'perjury one of the following tledawtions:
❑ I have and will malntain a certiticate oi consent to seli-Insure for workers' compensetion, as provided for by sectlon 3700 of the LeDor Code, for the peAortnance ol Ihe
work lor which this pertnit Is issued.
� 1'.have end will maintain workers' compenution insurance, as requiretl by section 3700 of the Labor Code, for the pertortnanca ot Ne woAc for which this pertnit is issuetl.
��My workers' comoensation Insurance farrier antl oolicv number are:
section
one
Policy.Number:��7 // %� 7
ar less.)
❑ I certify t�et in the peAormance of Iha work for w�ich this pertnit is issuaQ I s�ell not employ any parson in eny manner so es to become subject lo the workers'
compensetlon laws of Califomla, an0 agree that If I should become suDjac� to ihe workers' compensatlon provislons of Sectlon 3700 0l the Lebor Cade, I shell IOMwith
comply with these provision /
A�pPlirani.SignaWre:� �f/ �� Y— rDe1e:--. i�/ Z�2u0 y
WARNINafFACURETOSECUREWORK RS'COMPENSATIONCOVERAGEISUNLAWFULANDSWILLSU6IECTANEMPCOVERTO'CRIMINALPENALTIESANDGVILFlNESUPTOONEHUNDRED
T/IOUSAN� DOILARE (5100,000�, IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PiiOVIDED FOR IN SECTION 3106 OF THE LABOR CqDE, IMERESi, ANO ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATON:
I em Ilcensed ander provisions of C�epter 9(commendng with Sectlon 7000) of DIvlslon�3.ot.ihe.Business entl Professions Code, enG my licensa Is in full
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that there is a construciion lending agency tor t�e pedormence ol iha woB lor which this permit is issued. (Sec. 3097, Civil Cotle).
Lendel9 Neme: Lender's Atldress:
Signeture: Date:
OWNER•BUILDER DECLARATIONS:
I hereby aflirtn Ihet untler penalry oi perjury ihet I am EXEMPT FROM TT1E CONTHAC70RS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Professions
Cotle: Any ciry or county which requires e permit to consiruct elter, improve, tlemolish, ar repair any structure, pdor to its issuance, elso requires the appliwN tor such permit
to fila e siqned statement ihat he or she Is licensetl pursuent to lhe provlsions of lhe ConirecPors License Lew (Chepter 9(commencing with Sectlon 7000) of Division 3 0l [he
Business antl Proteuions Code) or that he or sha is axempi therefrom anC the basis tor the alleged e:emption. Any violation of Sectian 7031.5 hy any epplicant for a permit
sublects the applicent to a civil penalry ot not more ihan five hundretl dollars ($500).):
❑ I, as owner oi ihe property, or my employees wit� wages es t�elr sola compensation, WIL� DO THE WORK, end the structure is not Iniended or oflered for sala (Sec.
7044, Business and Professions Gode: The Contractors License Law does noi apply to an owner of pro0erty who builds or improves thereon, antl who does such work
himself or herself or thmugh his or her own employees, providetl ihat such improvements are not intended or oNered for sele. If, however, tha buildinq or imDrovement is
sold within one year oi wmple�ion, the owner-builder will have lhe burden ot proving that he or s�e did not build or improve tor purpose oi sele.). '
❑ I, as owner ot the property, am EXCWSNELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe pmject (Sec. 7046, Business antl Protessions
Cotle: The coniracbrs License Lew does not apply to an owner of pmperty who bullds or improves thereon, antl who coniracts tor such project with a coniredor(s)
license pursuant to the Contractors License Laws.).
❑ I em exempt untler sea Business and Professions Code tor this reason:
Signalure: Date:
Owner ID venfietl by drivers liCenSe. ❑ Ves ❑ No Orivers License No.
Verification oi Ownership by (type of document, i.e. - property tax �ill or deatl):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby cenify that no excevation flve (5) or more feet in tlepN into whlch e parson Is requlred to descend, wlll be made in connection with woM authodzed by Ihis
permit, and that no building structure, scattolding, falsework, or tlemolition or tlismantling Ihereof, will be more ihan thirty-six (36) feet high. (Chep. 32, Grp 2, An 2, Sec.
341, Title B, Celifomia Adminisiretive Code).
❑ As owner-builtler, I wlll not employ enyone to da wark which would require a pertnit Irom the Division of Intlustrial Salery, es notetl ebove, unless such person has e
permit to do such work Irom tha division.
Signeture: Date:
Divisian of Intlustrial Safery Pertnit Number.
CEHi1FlCATE OP COMPLIANCE AND AIfiHORVATiON OF ENTAY: I certi(y under penairy ot perjury ihat 1 have read ihis epplication and state ihat t�e information given is
correct. I agree to comply with ell stete laws end ciry ordinances relating to builtling conswction, end euthotlze representatives ol t�e Ciry ot Costa Mesa to enter upon the
ebove-descnbed propeny for inspection purposes. I egree not to acupy or allow ocapancy ot any building authorized by ihis permil until final inspection.
tooe �, iNsveenoNrrve
1676 Fiaetl System Final Fire Preventlon
1266 Pool Spa Finel
200 Final Re-Roof
201 Finel Block/Retalning Wall
202 Finel Fectory Fire Place
203 Finel Slgn
204 Finel Demolition
�. i .nn.
�. • i1✓i
cooe� insvecnoNTrre
208 Final Mechenical
200
210
212
220
Finel Plumbing
Finel Elactrical
Final Fire PrevenNon
Final Plenning Approval
222 Final Site
250 Final Building/Occupancy
PdIE ItiiIDlLS
2509 JACARAPtDA AV
GGY CiAi7DE D
290� JACARANDA AVE
COSTA MESA,CA 92626
979-5969
sec.xo.:
UNIT:
UNIT:
PEflMITTEE: GAIiClA MASONRY CUNST ( 714 ) 999-9363
nooxEss: zS7.0i MARGC3ERTTE PKWY 105
MSSSZON VZESU CA 92691
LICENSEO CONTBACTOP oECIAPAtION: I hereby attirm ihat I am Iicense0 un0er pmvisions ot Chap�er 9(commencing with Section
7000) ol Div��sion 3 0l �he Business and Pmlessi s Catle, antl my license is m fullforce and eilecL �
cirr uc.: 0 5 3 3 5 8 STRTE LIC.: � 616 0 cuss: �, z g
Oale: (,- �b- R SignaWre:
WOBKEflS' COMPENSATION OECLABATION: I hereby a�li ai I �ave a certititaie of consen� Io sell-insure or a Ceni�icaie of Workers'
Compensa�ian Insurance. or a cetlilietl copy ihereof (Sec�ian 3800. LaU C�.
POLICY NO.: EXP. OPTE:
COMPANY:
� �] Cetlilietl copy is hereby fumished ❑ Certifie0 copy is filetl wilh �he ciry BuilOing Oivision.
�ale: Applicant
E%EMPTION FBOM WOPKEPS' CUMPENSRTION OECLABATION: Qhis 5¢clian nee0 nol �e compleietl il Ne permif is �or one hunOreU �5100) or less�
I cetlily Iha� in the per�ormance ol �he work lor which Ihis per � 5 is5ue0. I shall not employ any person in any manner so as to �ecome�
su�lecl Io IA Wor4/e�rs C/q,mpen5aiion Laws 9f Califomia J
�a�e'. � `�J � RI � d Signa�ure:
NOTICE: I�. a�ter makmg this tleclaraiion, you should sublec� to Ihe Workers' Compensa�ion pmvisions o� Ihe Labor
Cotle. you mus� fotlhwil� comply wi�A such pmvisions or �his permit s�all be deemetl revokeU.
CONSTBOCTION LENOING AGENCY: I here0y aftirm ihat there is a conSVuc�ion lentlinq aBency lor Ihe De�ormance o� the work tor
wAich �his oermi� is i=suetl (Seciion 3097, Civ. C�.
LEN�EN:
ADOflESS:
OWNEB BUILDEN OECNBRTION: I hereby attirm ihat I am exempt tmm the Caniracmrs' Staie License Law br ihe lollowing reason
(Sec�ion 703L5 Busmess antl PmlessionA Coee. Any ciry of caunly which requires a permit �o consimc�, al�er, impmve, demolish, ar
repair any slmclure, prior lo i�s�issuance, also reQuires Ihe applicant �or such permi� to �ile a signed statemen� �ha� helshe is licensed
pursuanl lo the provisions o� �he ConUac�ors' S�a�e License Law (ChaO�er 9(commencing with Section 7000) of Division 3 ol ��e Business
antl Pmiessions Code) or Iha� helshe is e�empi Ihereimm and Ihe �asis for �he allegea exemp�ion. Nny viola�ion ot Seciion 7031.5 by
any apPlican� tor a permi� subjecis ihe aDDlicanl �o a civil penaliy ol no� more than live �untlretl tlallars ($500�.
1. as owner o� ��e pmDeriy or my employees wit� wages as �heir sole compen5ation, vnll do Ihe work. antl �he
❑ stmcWre is not intenaetl or offered for sale (Section 70aa. Business antl Pm�essional Code: The Cantrac�ors' Slale License Law
d0e5 not appry �o an owner Oi a property who builtls or imDmves ihereon, antl who doe5 5uch work himsel�/hersell or �hmugh
his or her own employees, OmviOetl ��al such impmvemenl5 are not mtentled or o�lered lor sale. I�, �oweve� �he builtling ar
impravement is soltl wi�hin one year o� completion, Ihe owner will �ave �he burtlen ol pmving he/she did no� �uiltl or impmve
� lor Ihe purpose o� sale�.
I, as owner of ihe pmDerty, am e�clusively coniracting with licensetl contractors to consimct the D�olect (Section 7044, Business
❑ and Pmfessions Catle'. The Contractors' State License Law Ooes nol appty �o an awner o� pmperty who builAs or improves thereon
antl who contracts lor such D�olecls with a contracloqs)license pursuan�lo Ihe Conlractors' State License Law�. I am aware
lhal pwof ol �heir WorkeYs Compen5ali0n insurance ShoWa �e D�oviaed �o me.
� 1 am e�empl un0er Seclion: B. 8 P. C.
for ihis reason:
Oale: Owner
I Oo hereby cer�ifY �hai I am aware ol and unders�ana the requiremen�s o� Calilomia Heatlh and Safery Cotle Sec�ians 25505, 25533, ana
25534 anA Ihai I or any fuNre builtling occupan� will/will noi (circle one) nee� �o campty wilh saitl s�aie cotles an0 �he requirements �ar a
permit for cons�mclian or moailication �mm Ihe Air Ouali�y Managemeni DistricL Resitlen�ial consimction applicaiions a�e e�emD� irom
ihese provisions.
�a�e'. ADPlicanC.
I hereby cetli�y Iha� I �ave reaa Ihis applicatmn nd slale
ordinances and slate laws relating lo buil0ing c stmction:
pmperly lor inspec�ion purposes.
�ale: � O�� SignaWre:
od�er's License ar Soclai Securiiy e: �-� � ] �
Ihe abave inlorma�ion is correcL I aA�ee �o compty wilh all cily antl
?re0y aNhorize repre5enia�ives of ��is ciry ro enter upon the ahove-me
164bG6 White—Builtlinq: Green—Code Enlorcemen�; Canary—ApplicanC Pink—Revenue: Goltlenrod—Assessor
CITY Ur COSTA MESt� — BTITiDING PErZMtT
PERMIT NO: B 052355 PLAN CHECK NO: U2019-91 S
CONSTRUCTION TYPE: PERMLT TYPE: STt"t
JOB DE�CRIPTZON : 70LF-6FT HIGH CITY STANDARD BLOCK WALL
CLAIM VALUE: 1,400,00 CALC—VAi,UE: 1,400,00
Pr.RM NO: B U5235_
GOVT: N SUI'P: N
PURPOSE: OTH
SQ rT: 1U
GROUP OCC: R-3 /
CUMMENT'S; X
# ib if -1C ff aE )F 3E 1F if �lf �M' 1E �N� iF 3f iE iE 3F # iE �% iF iP iF k ie iE �14 N��� k iF i(� iE 1F K� )(- 3E A� ii� fF 3E if lG�7e iF,Y� iE �IE 1(� j'r X� if� lf d4 k� �i(� K� lE �i� �lE if dE 3[� N� IF iE IF jF ff if iF K� M= Y,- i(� iF iE
� `L U N 1 N G R E Q U T R E N E N T S
S E T B A C K S
------------ MAZN BUILDING ---------- --------- ACCES"SOKY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; 93 FT IN REAR: FT It1
LErT; FT IN RGHT; F'P IN LEFT: . rT iN RGHT; cT Itv
PARKii�IG RE4• PROU� PAF2CEi• 13928929 ZNE: R1 REr NO•
PLAISNIVG �Iti'I'F.S> 70 L,r, OF 6' HIGH HLOCK WALi TO BE PLACED IN5IDE OF TiTE
> REAR PROPERTY LlNE. �-
*��rru**�**�����*�x***���*�c�**x�*�x�xx�**��*x�•x-�**x�����*;��x-*xx-�xx�*�x��*�rx*��*�r�-
D E V E L O P M E N T S E R V i C E S R E Q U Z r�t E M E N T S
ZONING APPROVED BY � W� �� DATE: ( I �l_�.
HUZLDING APPROVED BY : DATE:
APPLICATION ISSUED HY: DATE: ��
aEiFlFiFifiFifiEiE-IEiFififiElEif3EiEiF3f3EiF . ie . it�iE+�3f�X�aFa(�i��#3't if3F
iP iE iE �F iE i4 i4 iF if iP iE iF iE i(� ii ie fE if if 1f iF IE 3E iF iE iF iE iE fE iE if 1E iP ie iE iE iE iE 3E iE iF iF ik i(-i(� iF if #� k k f iP 3i� 3i if li 3f a4 iE iE 3'r 3E a't i(� iF 14 if iE X-ii� 3f ii ie 3E i(� iE 3E iE #
LEGALIZA1ION:N F E E S T] M M A A Y STRUCTURAL SEGMENT:Y
BLDG FMT. PLUMBING ELECTRIC MECHANlC FIRE SMIP/RES GRADING
PERMIT 33;00 ,;0
SMIP /NON—s�tES
PLAN 21.45
r55UF. FEE
BUILDING—DIV—> PERMIT ISs'UE PLAN—CHECK TOTAi. PAID DTIE
TOTALS----> 33.50 0.00 21,45 54.95 59,95 ,00
REC�ENUE D.IVISION TOTALS--> CQLLECTED; 54.95 OVER/SAOR7": ,OU
BLDG PMT PLi7MBINC ELECTRZC MECHANIC FTRE SNIP/TOT GR�DING; PLAV—C'rTECK
33,U0 ,50 21.9�
iF �lf fE-?h iF i(� i( �F IE �lE k iE 1F )E �1E lf� iE %ii� iE )F IF iF iF iE lelE )f 3f �N� If i(� if %� 1F if �1E 1(� iE iE a�F �lf 1F �f k 1@ if 3E if� iF %if M� %� 1E 3f 36 X� iF i't 3i� K� �E iE #f 1e If 1F 3E ?f fE �E 3e le )'- K�?E -%
I N D 1 V I D iJ A L r H E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAi, CO:,T
SF'R 70 R£S—CUNCRETE HLOCK WALL / Fi, 20.U0 1,4UU.U0
ENll OF FEES
i2 T�:�l%y�SiG'l{'�L�i"'.�'��i "
?r".E: I:�,1V�91 ��.. ._ ...
�1 `� �—
i ��
C�
CANO PLANNING
Permit #
:rical Service or Pole
2, Soil Pipe-Undrgrnd.
3. Elec[rical Conduit Utility�Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. 5[eel Reinfotcement
6. Electrical U�ER Grnd.
7. Footings
8. Foundation '
9. Water Pipe-Undrgrnd. �
10. Structural Floor System
11. P�operty Sewer Line & House Connection
12. Sewer Cap
73. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electricai-T Bar Ceiling
19. Rough Heating & Air Condi[ioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rou9h & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling IStructural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31 . Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or CanoPY
37. Final Factory Fireplace
38. Final Plumbing �
39. Watec Service-Final
40. Gas Service-Final ,
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation SYstem
45. Sound Attenuation
46. Handicap Regutations
47. FINAL STRUCTURE & BUILDING
48. F�NALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Q
51. CERTIFICATE OF OCCUPANCY
Date
Date
POOL YoPA
Inspector qppROVALS Permit # Oate Inspector
� 52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
�q�v' � 56. Rough Plumhing & Pressure Test
57. APPROVAL TO COVER�GUNITE
�10✓� 58. Electrical Conduit-Undrgrnd.
• 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, � Undrgrnd.
61. APPROVAI TO DECK
62. Backwash & Receptor�Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar SYstem-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. FiEQUIREMENT
APPROVALS Permit #
� 70. Underground Hydro
77. ProductPiPingOGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas Q Oil
74.-Oyerhead Hydro
� 75. Dry Chemical '
76. Dry Standpipe .
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
' HEALTH DEPT. REQUIREMENT
� 79. FINAL INSPECTION
�80. FOOD CERTIFICATE ISSUED
Notes:
�� � �.OnI Cj
�..
U/� ���117
�
Gity of Costa Mesa Buildinc
HV ___�_� DATE i
i"E; � PLAi�IS NIUST BE ON JOB AT ALL
nl�� ��•�aNG'tS WITHOU�P�10� �PS �'U.
i�i �° =UA�':CE OR GRAN i G OF A aERAIIT GF
�� /r.:: ANO SPEI;IFICA7lO�dS SkbSLL NOT 6E CONS
�' �? � i;H, OR AN APP90V4L OF, ANV VIGiAT!
.i;: FFi(;'���SIONSOFI'H!SCCi)F.N�FEAMITPRCS
UTFI.'Jbi�v I�O V!OLnTF: Oq CANCEL THf PROV;
'OLi" :.: d;.L (ff: VALID [XCc"� 1 Ip! SO FAR A$ THE
' IiiCH il AUTHORIZE5IS IAV.f UL.
�Ic�,�cc,� (I
�C � ���
�� ��, y
;�
�}"UU��
�
1ES MAKE
OF DEPT.
PROVAL OF
FD'f0 BE A
OF ANV OF
NG 70 GN[
�S OF TFiIS
HK OR USE
7k,E :SS:_41NC[ OF A PEF7:di'f [ih5[(i :1PJ� PL:;PiS AND
'�Cli H:A140NS SHAIL NO!' PREV[1''( TH[ BU��OING OFFIC�AL
•',f ;! IE NtAFI ER AEOUIRMG 7HE[ CJPR�C7I�JN OP ERROHS YJ
:'!ANS I1tiU SFFC,IF�rn��i+.�� �
"'��' ^"' "., i.ino BEi^K' CARHIEU ON 7NEREUP�Eh' WHEN
o� rr;is co�E oa eE
�= ! �
f���F �A�N 1��
�l 4
�> .��a�,
� -�1,yti
�-f
Wvo�
f�N�e
—t NOTE
pDDITIONS, DE! ETIONS, OR CORRECTIONS SHALL
BE APPROVED 3Y THE PLAtJi�IiVG DEPARTNIENT
r� qo a� s�
�PPROV�D ''�
CITf OF COSTA MESA �
� PLANNING DEPT•
euuccr ro ew�+. o�*. �o.
C����/
�er�
� Or IUJN7qq J�.
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e
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PARTY WALL 11GREBMENT
��T�.RIZATIOPd
. REQ��RED ��
7HIS�AQtEPa�TP. �de and entered 3nto this day of
� by and betvees �O F� �l/ C�/
hereir�after referred to as •GAND OFE�t'. and F�/'/`Ci � ���/� � Q: t�So�l
hereinafter referred to as 'AG7AC�TP PROPFRTY Rd�t•.
It ia hereby agreed that a party vall vill be consttucted on the
property line betvc�s
U
�908 F1�d��s
in the City of Coata [sesa, Caaity of Orange, State of California� as per
map reoorded in Hook , Page of Pliscellanea�s Maps, in the office
�i h� �tu�ty Recxrde� O? a:i8 Camty. :!�e partx �aa 1 shali te ,�rc,; rte� t�
encroarh
IIi wI�:SS F�RHOF, the parties have entered into this Agree�ent the
day and year first above vritten.
� :,�� .....�:.;
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' t�iqna e
� �q,v �i° u �/
tsame a or Pru► ed-""t� j
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`II! Mutua�gtor.
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South Evere, , 8519 Evergreen Way
Financial Center P.O. Box 2285
Everett, WA 98203
State of Washington County of Snohomish
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Signed or attested before me on __2l0�'_'_ day of _7y,ne______,
1991 by _Ee_rt�l _ �.laltry__�w�Kso�_
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Nota�y Puhlic in and for t
State of Washington. 1
Residing in _F�2e�a.w��__ W �___
Commission expires �1Y�1,_I�,Lg��_
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Telephone:
(206) 355-5812
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 GOSTA MESA. CALIFORNIA
FOR APPUCANT TO F/LL /N COMPLETECY
TYPE OR PRINT
BUILDING
ADDRESS 2 Jacaranda Avenue
COSTA MESA, CALIFORNIA
OWNER Adams Acres, Inc.
MAIL �,9 Fi• l�t.rl Jt•
ADDRE55
CITY VOSti3 Piesa TNo:LI87159
ARGHITECT Carlson & LIC.
& Colegrove�2nc. STATE 16q29
LIG. NO.
419 E. 17th S�.� Costa P•fesa
� LEGAL
SIZE �IO x 93 NO.OP BLOG6.
OF LOT � NOW ON LOT
USE OF
E%ISTING BLOG.
,SEfBACK LINE FROM �L• •
IIEFT 5�5� IRIGHT 5�
DESCRIPTION OF WORK �
FIRE
_ .
, . � ,7 .'�'s59 - ..
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APPLICATION FOR PERMIT
BUILDING
FOR OfF/CE USE ONLY
1 nsceivr Ho. .N 1nenM}n
COSTA MESA. CALIFORNIA
r�e� "�. �D.,,,D—V �I
ZONING
ZONE NO.OF USE OF NEW
� 1 PLANS �T I OUILDING
� ^{'
BYPROVED / p�/ J y
/^ / .J/ DATE r/
YARDS EVES '
REOUIRED ALLOWED
ICENTER LINE 8T.) �y�
FRONT � V FT.
R.SIOE � FT.
REPAIR 1 IIMOVING 1 IIDEMOLISH 1
S ZIE DING 1601 ROOMS V STORIES 1
EXTERIOR Wk�uCCO I ROOF rock
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Sin le famil residence trith
attached garage.
I HEHEBY AGKNOWLEOGE THRT I HNVE REAU THI6 APPLICNTION
AND 6TATE THAT THE ABOVE IS CORNECT ANO AGREE TO COM- THE AMOUNT BHOWN UNOER VALUPTION �8 FOR THE
PLY WITH ALL CITY OftOINANCES ANO STATE LAW9 ftEOULATING PUAPOSE OF ESTABLIBHING q PERMIT FEE ONLY.
DUILOING CONSTflOC ION
VALUATION
P RMITTEE OF �� r PERMIT FEE $ 3S�OO
� $ 15� 92g PLAN CHECK $ 17� 5�
AUTHORIZED AGENT D].�Ce & Colegrove, I17C. TOTAL FEE $ 5z� J`�
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INDIVIDUALACKNOWLEDGMENT
State of Californ1'a
Councy of �lrange s.s.
On this 19th day of �Une , in the year 19_�, before me, I i ntt� Canrha�
a Notary Public in and for the Orange County, personally appeared Wayne L Biil k 1 a�r anri lnan �y ,
❑ personally known to me � proved to me on the basis of satisfactory evidence
to be the personls) whose name is subscribed to this instrument, and acknowledged that the.� executed
it.
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P-169 12-82 (REV.)
WITNESS my hand and
Notary Public in and for the Orange �unty an
Mycommissionexpires �uly 17 �g 92
v
.
PARTY WALL IIGREBM6NT
�
�pT�RIZATIOid
. R�Q�!IRED Y
2tiiS � ACi2[:�1P. �de and entered ir�to this _��_ day of
�� _ �99/ , � a�a eec,+ee� J �a n C-,iu�! .
hereinafter referred to as 'iAND OFII�II'tt'. and �//J/JJ9 %//�L �/ �P���/
hereinafter referced to as •ALITACPNt PROPFRTY Ofd�l2•.
It is hereby agreed that a party'vall vill be oonstructed on tt►e
property line betveett
/'Q �"ICL'Q
ago � �%d�os
in the City of Oosta t�fesa, Camty of Orarge, State of California, •as per
map recorded in eook . Page
_of Miscellaneous lia�s, in the office
::i 1+E ^ounty Rec�cdc� of a=i� camtq. ',he party �a11 sna13 ��m3.�re� to
�croac�
IN WI��SS f�RHOF, the parties have entered into this Agreement the
day and year firat above vritter.
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OFFICIAL SEAL
LINDA Sp►�H�
Notary f�upllc.�litomip
owwae couNrv
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