HomeMy WebLinkAbout2970 JAVA RD - Building Permits—_
�I
�oopFssaeu�omn: z970 JAVA RD
ONNERSxIYEIi MONICA SAINT
�ooxEu:CAMPOHASSO, JOE
2855 FAIRVIEW RD #B
SANTA ANA, CA 92704
dVPL. YARPlO WOPESS:
dNCXffECT ON ENfdlHA:
RCIL OR ENQ'S MOXE53:
cwrx�cTars ru�:
CONiRAttOR3 YYfIINi
ADDRE55:
ue Na
u�: CITY OF COSTP MESA - BUILDING PERMIT
PERMIT NO: H 080086 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: STR
VNT:
U11T:
UCENSED CONTPRCfOfl4 DECUPATION: I husby dlim uMs paaly d pajury Nn I un IiroroeA �ads p'wn'vn d Clrpr 9
(canms�n8 xU� Senion )000) d Divieion � d the BuuMaa vd Pralm�bra COEe. eM mY 4oeew e in hA taro uq eMW.
cm uc. No.: uc. cuss: uc. No.: E XP :
pma: GmMmdar.
'IWNEN BIIILDEP DECLANATION: I haeEy elfum unEer pmWy d pei�vy ihet I em exemq Imn �M Cavrrfon lioeene lew Ip tM
Ilowip reemn (Setlbn ]W t.5 &n'v�e�s end Advaions Gods: Am ciY w oowiY xfiitl� iaVu'um e D�Y to mewcl. etls.'vn0�w+.
amd'eR a repai vry evuraun. prior m ea evww. ebo'pium �M epp4m'u lor uU� pmN to fib a dpmE qelemeM tlut M a Ne
m iK«e.a w�� m m. w�+• a �» comm�. w.o.e �. �cnaaa v t�«�a wan s.a� �000� d o�e� a a m.
Bumea vd Rdanbm CoMI a �hm he a ehe u memW iherohan uM �M buis /a ihs albpeE azmMion. My vidmion M Seaun
N31.5 by eny epplimni lor e permil subpda tM epplicem to e dril peneAy d na mon ihen Ms huNred EoOen �SS00��.
�] I. m ow�ar W Ilw CWaM or mY emMdl� wIh wepea av IMi ade oomOMeelbn. willEo iM wwk, aM �hs etruclun's m� inteMeE
a ollered lar eeb (Secibn ]Du. Bue'vwv vd Protasmane Cods: Tha Camreqan L'vua law Aom nd eppyto en awfwr d p1apary
wAo buila w inVp'+s� �nereon. md wfio Em� ��cn xak limeetl a Mnd a �MauW he a Mr mm emWvlw. pa'� thel ach
impowinew ue nd Wended a dlend la eab. tl.lrowewr. tM WJfirp a inp�w�aman u wtl wuhm aw Yeer d mmpluion. tM
ownerbuo�er xi0 heva tM hiMen d pwi�q M or Me NC nd duM n"unqova la tM puepo�s d Ws).
❑ I. o ow�r a ine o�M..m s�dus+eN awracno wah &enasd convana. a m�mec Ws www (swon rou. as'u�ess ew
Pmfamau COEa: TM Caqredas licmm lew does nal eWN b en owiw d O�WMY Mc bu0d� a mPa'r �Iwaon ud vrho
coNrxb fa vh pqwa wph e amreeoe(e) Gcamad Wnuem io iM Cont�mae linma lew). •
❑ I em/ /ss�emp un^C�a Se(c�lion/: B. 6 P.C.�. t' Arsse/a��n:' 1' �1' �y•
Dela: 1 V •� L• 1�O Ownx: �/1 , W YlJ-�A/ /\�
i ao n.�nr �r uw i.m...a.e a�a �.�a�.�.�e in. ���n w c.uo� H..nn .m sdw cme s.em. uws. us�..d
usaa..m mm �«env naure bwltlim �.;n � wil na (G.cb m.) �e.d �o camcN.nn .eia nn. oodu ene �n.'eQuimmam tar
eP�larmrolvaunumodfretionhum�Ml�i�iy enpamaXOipria.RadEml�aMiueianeDD�iweusazemphanNma
po+isbns.
om.: �vq�'am:
WOFKEN'S COMPENSATION UECLAF�TION: I MreW effi�m uMer pa�uliy d perjury ar d Ms blloxi�p Eetlermum:
� I luve aM rnl meinien a wMFaa d mnml to �slliv�ns br xakee' wmpemetion. ro po+idsd Iv by Sedion 3)OU d �M LeEu
c�. �� m. o.rt�. w m. �x ia w�n �n�. o�,a A 4.�d.
❑ i n.�..m.0 meime:�.oi+en� mmw�o� inw�enn. m r+aw.e M sw:,, aroo a m. �.no. coee. ar me v.k�m.nw a ��r
wak ta xhirh tM pamd'n ueued. My waMon' mmpeiumbn'nwrairw mrriw aM po4cy numbr ue:
c�«:
' Poliry Number:
Rn;: seniw� �e.d,wr ne comabroe r rn. v�x ie ro. oim nu�d�.d ewrm.ls�ool w�ea..�
� I ceniy thm in Ihe pMormeMe d iM woek Ia whch �hie pmmn h ipued, I Mdl mi employ any pe�son in ury menrar eo n to
becoma abjw io iM v.wkva' canpeneelbn kvn d Celibmie. eM pree Mtl il I 4�wk becane wb�af to IM woN.r�'
wmpenaetion qwiaions d Seuian 3)OD dtMleborCode.lehelllonhwilA ooenp�y wilh Nose piovisime.
ode: rowKw:
W�m/np: Fallun ro��cun woAren' compruatlon cw�np� l� unl�wN( �n� �IWI �pcf �n �mp/oysr ro cNMnl pm�Mp �ntl
dvll flMa up ro me �u�Jretl fhouuntl dollan (S10QOW), M sOtl/Hon ro M� cosf ol romp�f/on, denwp�s u provbW br In
9�cXon J106 0l Ms Lebor COM, /nfxs�t, and eMrnsy'� Iw.
CONSTFUCTION LENDINO AOENCY: I hereby alfirm under panaM1y W perNN �� �ham Ie e mnqivann Wdinp epency tor the
ipaAormv�ro W the work lar wt�ich �he peimi h neued (�� �). C'v. CI.
LENOEH'S N4ME:
LENOEF'4 AUDHE55:
I wnM tAm I heve reeE Ihb epqir�ion eM ams ihel Ihe ebwe inlametbn ia conecl. I pree lo canply xith eA ay eM muniy ad'vwvs
eM etate lexa releinp la build'vp canslrudion eM Mreby euiharrze rtqeeemetivea d Ihu ary to enter upon iM eboue�mmluneE p�ape�ry
lar inspeuion purposea .�n.�r. w rv ro. ��' ^�
MONICA ��., �� �
�/yj�� �,{��/� Vnnl Neme 1 /��/
` / I"`� 1�A � Dma:10'��• I
Sp�ure d Ownerl ✓RppifanNLmlratla
(5151J8 WP) WI�no-BuilEvq 8 Selaty: oreemFb; Cerary-Rppirnni; Pink-Rwenue; pdden�o�Maeawr
PERM NO: B U80086
GOVT: N SUPP: N
PURPOSE: OTIt
JOB DESCRIPTION : T/OFF SHEATH 6 REROOF W/COMP SHINGLES SQ FT: 7,700
CLAIM VALUE: 7,700.00 CALC-VALUE: 7,700.00 GROUP OCC: R-3 /
COMMENTS: REROOF 2600SF RESIDENCE W/COMP, SMOKE DETECTRS RE UIRED PER 94UBC
**��r**it�x-x�*i�*i�*****+rx�**x�*+t*ft*****x�*x�**+�****x�*x�*�tf�****r**x�*� �
Z O N I N G R E Q U I R E M E N T S�•-t��L�����
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY B IG �N����� ---
FRNT; FT . IN REAR: FT IN FANT: FT IN REAH: FT IN �
LEFT: FT . IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING RE[): PROV: PARCEL: 13925104 ZNE: REF NO:
PLANNSNG NOTES>
�
M iE 1! if iE 1E iFlf 1E if fE if iE if 1E iE �E 1F 1F 1E 1E iF �E 3E iE iE fE fE fE 1E 1E 1E IE 1E 1E 1E iE iE fE fE 1E iE 1E 1E 1! fE 1E iE 1E 1E IE 1F k iElE 1E 1E fE !E if 1E �E ff iE If iE 1F iE �t iE iE fE iE IE iE �E IE 3E 3f
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY: Z1Fr}
iE iE �E 1E 1E if 1f !f !F!E !f if iE �F �E 1E ff 1F iE 1f 1ElE
LEGALIZATION:N F E E S U M M A A Y
DATE;
DATE: I(�"�-� �4
iE �E iE'N' 1klE iE iE�-iF�F1El6
STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/RES GRADING
PERMIT 137.25 77
SMIP/NON-RES
PLAN
TSSUE FEE
BUILDING-DIV-> . PEHMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 138,02 0.00 0.00 138.02 138.02 .00
REVENUE DIVISION TOTALS--> COLLECTED: 138,02 OVER/SHOAT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
137.25 .77
iE �E iE 1E iE iE �E iE iE iE fE iF 1E 1E iE IF iE iElf 1E iE 1E if !E 3f k if 1E 1E iE iE iE iF iE iE 1f 1E 1E 1f �E If iE 1f k if 1E iE iE k 1E iE �F 1E iF 1f 1f ff if 1f if 1E 1E if 1E iE 1f 1f iE 1E �k 1f IE 1E 1f iE �E iE 1f 1E
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N ONIT COST TOTAL COST
SFR 7700 REROOF' BY ��ALUE RESIDENTIAL NOZONE
END OF FEES
1.00 7,700,00
O1 00217634-00117685 TC1T 138.02
DRTE: 10/22/95 TI11E: 10:2E
.I.-_
CON5TRUCTION AND PLANNING P� & SPA
APPRDVALS Permit # Date '�Inspector AppROVALS Permit # Date Inspector
1. Temporary Electriral Service or Pole � 52. Pool & Equipment Location ,
2. Soil Pipe�Undrgmd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms i
� 4. Electrical ConduibUndrqrnd. ' 55. Electrical Bonding '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVEfl�GUN17E
7. Foot�ngs 58. Electricat Conduit-Undrgmd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. 60. Backwash �Ines, P�Trap, O Undrgrnd.
10. Struetural Floor System 61. APPROVAL TO DECK
1 t. Property Sewer Line & House Connection � 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64, Plumbing System - Final
14. Rough Plumbing � 65. Electrica6Final .
15. Rough Electrical-Conduit 66. Solar System�Finai
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sig� 66. APPROVED FOR PLASTERING
78, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. RE�UIREMEN7
20. Rough Factory Fireplace APPROVALS Permit #
21. Oucts, in Structure 70. Underground Hydro
22. Ducts, Ventilating � 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Tesi 72, Underground Flush
24. Roof Framing L b' 73. Undergrnd. Storage Tank O Gas O Oil
25. Roof Sheathing 74. Overhead Flydro
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 PflEV. FINAL
30. Drywalt Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED
33. Finai Electric � Notes: �
34. Final Heating & Air Conditioning �i �`� �� �,.h,fi�,,,(,,, �
, ' �•- •- i
35. Finai Gas Pipe•Test �
36. Hood or Canopy �
37. Finat Factory Firepiace.
38. Final Plumbing
39. Wate� Service-Final .
40. Gas 5ervice-Final
41. Solar pomestic-Finai
42. Backflow Preventer
43. Back{low Irrigation -
44. Landscape Irripation System
45. Sound Attenuation
46. Hand'icap Re9ulations
47. FINAL STRUCTURE & BUILDING B,3�7 �
48. FINAL PLANNING
49. Electric Reiease to Edison ,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Qpril 28, 1970
Mr. Edwin Patnton
2970 Java Roed
Coata b6esa, CaltPornis
Dear Sirs
A buildiag permit has been lasued to Antho� la to c�etruct
8 priv8te swi�ning pool on Your propartY.
In order that your pool wi21 be s afe ane and for ths giu�ose
oY advieing you oP your responsibility arding the requirements
oP the Coeta Mesa Municipal Code, rre rePe ou to Section 8107, a
copy of which ie atttche8.
Thie letter ie directed o you in order that you will be arare
of our ordinaacea nnd can make camplste aeYety check of your pool
8rea.
Sincerely yours , -- -- - ---�_
RIG4iARD EAIiHART
8uilding 8e�tety Director
RB:cb
Eac. 1
a
/i . "
`t
�
H. V. LAWMASTER & CO., .C.
7940 MAIN STREET — STANTON, CALIFORNIA 70CM5-4U3AE_003
828-8040
XXX
Field Data on Test Specimens Core Concrete Gunite Grout/Mortar�
Groject Edwin Painton Pacl Permit No. 31758
Project
Lxation 2970 Java Rd. Costa Mesa, Calif.
Contrattor A�thony Pools Architect
Location in Sirudure Engineer
Date Moulded 5/15/70 No of Specimens
Slump Specimens Marked
Spxified Strength at 2B - days 2DIlLLP.$.I. Mix Designation
Age to be tested�_Z_days�l;@_days days days
r.
READY MIX PLANT AGGREGATE SOURCE
Weather Condition 1 Yd.
Cement Monolith Type I�II Cement, Ibs.
Admix Sand
Specimens made by #4
Data by r"r 3
Delivered by #2
Date Delivered #
REMARKS: L,li� (j `�% ' / � Water, Gals.
Lab. No.
Date of lest
Specimen Dimensions
Area
Ultimate Load
Lbs. per sq. in.
H/D Corrected
FORM M - O15
70D83 70884
7 Day Test �
5/Z2
5.89X 5.93X
27.25
38,000
7oea5 7ae66
7 Day Test �
5/22 b f�
5.77X 5.73
27.b2 26.15 25.79
31�DD0 33�000 55,000
1.122 1.261 2,132
70�87
�ay Test
_Yd. Batch
15�040
80,000
�� � �/____=��_
BUILDI G SAFETY DEPT,
JUN 1� 19i0
y,� PM
; �f,9�11,i1,12,I�2�3i4y5]s
26.15
58,000
2,217
RCE#6207 Ct: t�.l r�i,.•-, T(o-L�� ...
70888
Day Test
27.25
60,000
2,201
CIT � OF CDSTA MESA
CALlFORNIA 92a16 r.0. tOX 1200
FROM TME OFFICE OF TME DIRECTOR OF BUILDINO SAFETY
Project Address Z�( -] (� `��q-v (A Q �.
Project Name
Owners Name T✓t ivi i-G \'�. G�-;.�,2'T
ONmers Address Zq 'j U Slq i/ v� ��.�si.s� l�5 i�i�
o.mers Telephone ��% 5 l -( �f-3� �'€' • �/-F(�.-�Z_3Z
peimit # 500 < <I-
'L!t
City Use Q�ly
I �Sv4un�=�5 TG�ul�-i as Owner, Contractor, Agent (strike out all
except one) do hereby attest that a�lo}mpnt of any person, or persons, is not
anticipated at the time of see�cing the above-referenced permit. In the event that
any person, or persons, are e�layed under the prwisions of this permit, I shall
imrediately cause a valid Certificate of hbrlanens Cort¢�ensation to be filed with the
Costa Mesa Buildirg Division.
I agree to defend at my own wst, and to inde�ify arcl hold harmless, the City,
its offioers, agents and/or e�layees, fram and agairvst, arry ard all liability,
damage, c�ts, losses, claims and expenses, howscever caused, resultirg directly
or indirectly fran, or oonnected with the improvement under this permit.
I further state that I have read ard fully �mderstar�d t
sponsibilities of the above statements, and will ca�ly
Contractors State License Iaw found under the Business
Division 3, C�apter 9, of the State of California.
�F4w�as iCC;Gs92�T
Print Name
i� ��?/J?�6� �.�ACOs.A%
Signature
CMF 0777-46
ie implications and rr
with all provisions of the
url Professions Code,
G % C�O
Iht
OWNER ppINTON, EDWIN DATE 4-27-70
JOB ADDRESS 2970 Java Road BUILDING PERMIT N0. 31758
'GE�1Oo�� rn��Tonrrno . .. _. . nocr�o�or�...�_.�.�....� -
�iN��
\soi�
ROUGH PLUMBING
PROP. SWR. LINE �
SPRINKLING SYSTEM
GI
UNOERGROUND � POWER
ROUGH WIRING
TRENCHES U FORMS U STEEL REINF.
FLOOR SYSTEM
BONO BEAM STEEL REINFORCE
SHEATHING �Vrt j__Q O�' �
FRAME ANO FLASHING
LATHING - IN [1 OUT n
Pl"-�ER, BROWN COAT
5 iURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AN� GAS TEST �-'
ELECTRIC, FINAL
BUILOING, FINAL -
RE ZONE VALUE:
SUBCONTRACTOR
Z .
a CWj
FZ
2 �
O �n
�a m
J ^
i5_�
1•m
J Q
U Q
Z �
W
aw
W Z
J Q
m Z
J �
W W
O=
Z�
w�
N �
70
H
z
Q
i•
, 31758
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. eOX 7200 COSTA MESA. CALIFORNIA 92626
iPA Z%'%nPA'❑OO�SS�'X ****34.50
CMS4
ForApplicant to Fill in Comp/etely APPLICATION FOR BUILDING PERMIT
BUILDING ; RECEI.'C�%� DAyE�ECf�fV� D T ISSUED a
^ ' � y � ��7-�
ADDRESS V H['VA RD
P MIT NO.
OWNER IDWIN PAINTON q,P, NO. �� �"/- O�/ _/
ADDRESS SAME BUILDING 'ZC�'rU JAVA RD
AODRE55
TEL. TRACT�3o U LOT / BLOCK
CITV NO.
CpNSTRUC710N W AD P
LEN�ER Cash �.
BRANCH
OWNER ��'�N PAINTON
AODRE55
ARCMITECT TEL $1'nIli pool VALUS '26�0 ��
OR ENGINEER C• Adams N
FIRE
ADDPESS ZONE TYPE GROUP
CONT:aACTOF�nt11OTlY POOZS BYPROVED DATE '�2• '�
ADDPE55 $ 1 Firestone �1.�%d.
TEL. �ONE NO.OF �j USE OF NEW
CITY Cj t NO. S� Zu — P���T BUILDING P�.�
STATE �7 CITV VARDSAPPFOVED VARDSAPPROVED
LIC. NO. 1901/� LIC. NO. MAIN BUILOING ACLESSORV BUILDING
SIZE NO.OF BLDGS. (FROM C/L SYREET)
OF LOT �� 6 NOW ON LOT ROM FT. FT.
USE OF � _
EXISTING BLDG. 'J FT
S12E OF NO. OF
NEWBLDG. ROOMS STOfl�ES L.SI E FT. FT.
EXTEflIOR WALL FOOF
COVERING COVERING REAP FT, FT,
USE OF BUILOING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BlDGS.
PRIVATE S41II�I POOL IN REAR c u P�w AwROVED
OF SIPIGLE F'AT�fILY D[�l�LLING �'ROVED � � �_7
I hereby acknowletlBa [hat I have reatl this applicacion antl stece
that [he ebove informatio� Is correct antl agrea to tomply wlth
all laws ragulatl�B building construction, antl � shell not employ
any parson in violation o� tha workmen's compensetSO� laws of
[ha State of Calibmia. �
I heroby cer[iW thet I am proparly Ilcensetl as a contrector untler S�. FT. O
the Smta of California Businesa entl ProfessiOns Cotla, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS fOR
Chepter 9, and that such licenws ere in tv0 torce antl ef+ett, or I THE PURPOSE OF ESTABl,15HING A PERMIT FEE ONLV: Q
am exempt from t�o provisions of the Sca�e of Celifornia Business VALUATION
antl Professions Co Di islon 3, ChaPter � J O H
VERMIT FEE $ � ]
Sipne[ura of 'LbQn � UV �/' � Q m
Parmittee S PIAN CMECK 5 E
� `o
A�thofizetl A ant LL
9 TOTAL FEE $ �� �S
OWNER
JOB AC
DATE
IJX?9i1;G1
i o. 139-251-04 LOT 11 TRACT 3380 FIRE ZONE VALUE S19 370,00
INSPECTIONS Sianeture Date TVPE 5 GROUP T .
c�s
W �TER
ROUGX PLUMBING
PPOP. SWR. LINE r� HOUSE CON.
SPPINKLIHG SVSTEM
MISCELlRNE0U5
ROUGH HE�TING AND �IN CONDITIONING
TEMPOH�RY SERVICE OR POLE '
UNOERGHOUND � POWER �
ROUGX WIRING
TRENCHES _f FORMS STEEI REINF.
FLOOR SYSTEM
BON� BE�M � STEEL REINFOFCE �
$MEATHING
FRAME AN� FL�SNI
IRTHING — IN OUT
f TER. BROWN COAT
:TURRL, FINAL
HEnTiNG. VENT., REiRIG. �NU A.C., FIN�L
PlI1MBiNG, FINAL �ND G�5 TEST rJ
ELECTRIC,fIN�L
BUILOING. FIN�L
SUBCONTRACTOR
y� .v�.�C'� 7 f � �� � G �y'
� �-g h ���
F�
C
[al
a
a
H
y
2
F
�
Li7
..1
Q
7
.r.l
C
W
a
O
�i
a
Z
W
3
EOSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING /J��O Td�.d �(�
ADDRESS L• L)/1 R
OWNEROR �p�CS T�C�lw��1�Z �
TENANT ��
ADDRE 5 Z� / Ci V A�T ��
��T� eoSTi4 n,�rFs� No '(i¢_6-G�
BRANCH
ADDRE55
ARGHITECT TEL.
ADDRE55
CONTRACTOR � � ���
ADDRESS
TEL.
CITY NO.
STATE CITV
LIC. NO. LIC. NO.
OF LOT I G(� X� I NOW ON
USE OF /r
EXI5TINGBIDG. .Si�L�.t !^v¢'FN W�l
Separate permits are required for
electric, plumbing and heating work.
I hareby acknowledBe that I have reetl thls eppllcation entl stete
that the ebova Information Is corract and agree to comply with
all lews reBulatinp builtlin8 �onctructlon, antl I eholl not employ
any person in vlolation of the workmen's compansetion lews af
the State ot Calitornie.
I hareby cartlty that I am properly Ilcensetl as a eontractor unCer
the Stata of California Business and Professions Cotle, Division 3,
Chepter 9, antl thet such licensas ara in full force entl effect, or I
am exempi from the prOvisions ot the Stete of Californle Businesa
and Professions Cotla, D'vislon 3, Chapter 9.
Signeture of
Permittae � A � U-
o,
Authorized pant Date
APPLICATION FOR STRUC71lRAL PERMIT
RECE PERMIT 4w,(0/p�50024,�� ,36 T�,
1�
A.P. NO. `�%�— � �
BUILDING � � O
ADDRE55
UNIT OR
SPACE NO.
TR.NO. LOT . �/ BLK.
NEW ADD ALTER REPAIR MOVING DEMOlISH
OWNER
�SE�«.. l�.d�G�4ow �EE�937o
��
ZONE TYPE � GROUP �
APPROVED Z
BV DATE
APPROVEDSETBACKS
(FROM C/L�EET)
M FT. U�'
� ' ��� 5,0.�
L SID ��'4�L rV I'^�C'J/
REAR ,/�� ,�'�
GLANNING ACTION
DATE
APPfiOVED
APPROVED �..._ /. � .l . _z. �a�n
THE AMOUNT SHOWN UN�ER VALUAT
THE PUFiP�E OF E5TABLISMING A PEFM�T
VALUATION PERMIT FEE S
PLAN CHECK S
5 ��/ 37O Tax a
TOTALPAID E _
m
• C
i
m
2 N
7
IS FOF ol
ONLV: �
�. O N
r `^
0� m
0
►, 3 �
=. • �- .
COSfA MESA BUILDINGSAFETY DEPARTMENT
P. O. BOX 917 CO8'�A MESA. CALiFOBl1(A
For Applieanf fo Fill In Complefely
/� TYPE OR PRINT
BUILDING � C-
ADORE55 �� � �� ,
COSTA MESA. CALIFORNIA
■ MAIL
■ SIZE
■ BUILDING
No. op BIDGB.
I8 PROM / � l7 �
;TR¢gi (G(J REAR YARD � �
� % /
� I LEFT �O RIGH7 �v
DESCRIPTION OF WORK
: AND WORK TO BE PERFORMED
.c ,—u..�i.. �i .a:r�,
�EF R���IU�.�
�� OEc > >sso
FINANCE DEPT.
riTY nf CnSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO. I PCFMIT NO.
� 3 3s`S"
GY DATE RECEIVED DATH IB6UEO
/.� .� /i'.� � _ ia� � //_ � . �
COSTA MESA. CALIFORNIA
FIRE
ZONE T
APPROVED
BY
2
ZON6 I NO.OF
I�' PLANB
LEOAL r�. / //
DEBCRIPTIO��LR.;n
A. P. NO.
YARDS
APPROVED
ICHNTBP LIN6 9TJ �
FRONT
R.SIDE I
L. 61DE �
REAR �
US[ OF !
BUILDINO
EVES
ALLO
6 �r
w
0
G7/.!
1 HEREBY ACKN�W��GB TM�T 1 XAVE qEAD Try1g APPLIGTION TXE AMOUM BHOWN UNUER VALUATION 18 FOR TNE
•ND 9TAT¢ THAT THE �BOVe ib CORRECT ANO AGftEE TO COM-
PUPPOBE OF EBTABLI6HIN6 I. pENMIT FHH ONIY.
PLV WITH ALL ��1'1' Oi1DINANCEe AND BTATE LAWB HEGU TINO
eU1LOIN0 CON9�UrnON l/ i VALUATION
BIGNATURE OF ' / / , :/f �� . '� /� ^ (/L" PERMIT FEE $ �/ �--
PERMITTE .• . _// �y/ �/ j
/ �j , � $ ��, - � PLAN CHECK $ � O � :J �
AUTHORIZED A�'.�'1i /�' ^�, /�,/. /
iOTAL FEE a O �