HomeMy WebLinkAbout2285 FORDHAM DR - Building Permits�
City of CosTa Mesa
�Building Sofefy Deparlment
' P. O. Box 317
Costa Masa, California
CERTIFICATE OF OCCUPANCY
The Building lomted at �a �'*� '�*��•^+ �
has been inspec4ed and found to comply wifh ihe provisions of
for a Group —$�t s� � Occupanry.
�
N° 2285 C
CiTy of Costa Mesa Ordinances applicable ihereto
_ lY� � �j�! : � ��1L'�L :• .v � il..iJR�Fi {P,4Y1i��:
Legal Description �5'°Z�✓�
(See reverse side for Metas and eounds) .
�Building Permit No._�� ElecTrical PermiT No. a%l�A� : plumbing Permit No. ��.���
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. —. required under $ec. 3301 (1) U. 8. C. —
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operafor has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obfained whenever there is a change in:
1) Occupancy classification of a building or portion thereof .�
2) The number of apariments or guest rooms
3) Ownership �
If Group H Occupancy, nvmber of apartmen4s and/or guest rooms as required under Sec. 17050.1 (d), California �
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments_�— and/or guest rooms
IS5UED TO: b� I�g Off' '� Yl�LL_iG¢��2�
� � ���' 9�
Date ��r 1�� ]„r�, •
Yhis Certificafe of Occupancy SHALL BE posfed in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Fo,,,, suss—iM—v-s3—s-s r
�
�I
.— �
v
PflOJECT p0UNE5$:I 2 z 8 5 FORDHAM D�
OWNEB'SNRME: TOBEY, DON D� ��
aooxess: TOBEY BEVERLY J
MANAG�MENT SERVICES
� P O HOX 765
AflCHIENGINEEN: CORONA DEL M%i��CA � 92625 pEG.NO.:
aooness:
UNIT:
uxrt:
` PENMITTEE: DON TOBEY � ( 714 ) 631-7952-
aooxess: z Z 8 5 FORDHAM DR �
COSTA MESA CA 92626 "
UCENSED CONTBRLTON UFCNHFTION: I hereby aflirm ihat I am licensetl un0er pmvisions oi ChaD�er 9(commencing wilh Sec�ion
7000� ol Oivision 3 of Ihe Business antl Pmlessions�Coae, and my license is in lull �orce antl eflecL ^
CITY LIC.: STRTE LIC.: CIASS:
Date: Signa�ure:
WOHNEPS' COMPENSRTION DECLABR710N: I here�y allirm that I have a cenilicate oi consent to self-insure or a certilicate of Workers'
Compensalion Insurance, ar a cenilied coOY �hereol (Section 3800, Lab. C�.
POLICY NO.: E%P. DFTE:
COMPpNY:
� Certitied copy is �ereby furmshetl. ❑ Certilietl copy is �ile0 with �he ciry Builtling �ivisian. �
Oa�e: ApplicanP.
EXEMPTION FBOM WOflNEflS' LOMPENSFTION DECLAflATION: (This sec�ion neetl no� be comple�e0 il�he permi� is tarone hunUred ($100) or less�.
I certily Ihat in Ihe pedormance of Ihe work for w�ich �his Dermil is 35yad. � shall not employ any.�erson in anyimannef so as to become
subject lo orke 5' Gom e ation Laws o� Cali�omia. // /_l /
� )����; i� ` iD t.,i
Date: Signature: [/` � /)
NOTICE: II, after making �his declaration, you shoulU 6ecome suble�� �o ih rkers' Compen n pmvisions of Ihe Lahor
Coae. you mus� Iorihwith comply wi�� such provisions or Ihis permit shall be tleemed revoketl.
CONSiflUCTION LEN�ING RGENCY: I hereEy aflirm thai Ihere i5 a Cans�mt�ion 1¢n0ing agenCy fOf ��e petlormance Of Ihe work lor
whicM1 Rris permi� is issuetl (Sec�ian 3W7. Civ. C).
LENOEfl:
FOOflESS:
OWNEfl BUILOEB OECLABATION: I �ere�y aflirm Ihat I am exempt �mm Ihe Conirac�ors' S�ate License Law fof Ihe followin0 reason
(Sedion 7031.5 Business an0 Professional CoOe: Any ciry of counry whic� requires a permi� �o cons�mct, alter, improve. aemolish, or
repair any sirUtNre, prior Io i�s issuance. also requires ihe applicani �or 5uch permit IO �ile a SiAneA Sia�emenl �ha� Ae/She i5liten5etl
pursuam to the pmvisions al the Comractors' State License Law (Chapter 9(commencing wi�h Section 7000) oi Oivision 3 of ihe Business
and Pmlessions CoOe) or �hat he/s�e is eKempt therefmm and the 6asis for ihe alleged exemption. Any violation of Section 7031.5 by
any applicani lor a permit subjecis Ihe applican� lo a civil penalry of not more IAan five hun4re0 tlollars ($SOU).
I. as owner of ine pmpeny or my employees with wages as iheir sote compensation, will tla the work, ana tne
❑ simcmre is not intenEetl or oifered lor sale �Section 70aa, Business an0 Pmfessional CoOe: The Coniractors' State License law
tloes noI apply �o an owner o� a pmperty who builtls ar impmves �hereon, and who Uoes such work himSelVhersell or �hroup�
his or her own employees, pmvitletl ihat such impmvemenis are not inlenAed ar ofleretl tor sale. IL however ihe 6uiltling or
impmvemen� is soltl wi�hin one year o� comple�ion. �he owner will have �he 6urJen o� O�oving he/she tli0 no� Uuiltl ar impmve
for Ihe purpose o� sale�.
❑ I, as owner ol Ihe prop¢rty, am exclusively conVacting with Iicense0 contmc�o¢ to consiNct ihe pmle�� (Section 7044, Business
antl Pro�essions Cotle: The COn�raCtorS' State License Law Ooes no� apply �o an oWn¢f o� pfODe�Y who �uilds of improves �hereon
antl who coniracls lor such pmlecis with a comracmqs) license pursuam m the Contractars' State License Law�. I am aware
I�al Drooi ol Iheir Worker's Compensation insurance should �e pmvidetl m me.
� I am exempl untler Setlion: BP.70 4 4 B. 8 P. C.
br ihis reaso ' �
�� �n NO EMPLOYEES f, �
Da�e: � `7Z Rwnec
I do here�y cently ihal I am aware ol an0 understantl the requiremenis of Califamia Healt Safery Code Seclions 2550.5, 25533, and
25534 and tnal I or any Imure builtling occupam will/will nm (cimle one) neetl to camply w 5ai0 slate cotles antl Ihe requiremenis for a
permi� lor cons�mction or motlificalion irom �he Nir Oualiry Managemen� Dis�nc�. flesiden�ial conslruc�ion applica�ions are exempt �rom
�hese pmvisi0n5.
oale'. Avplicanl�
I �ere�y cetlilylha�l have reatlihis applicalion ana sta�e Ihat the aboveinlormation is correc� I agree Io comply vn�� all city and county
orainancesantlstatelawsrelating�oDuiltlingconslmmionantlhere6yaWhor epresen�ativeso�thism� Ioen uDon�heabove-memioned
pmper�y �ar inspect%ion purposes.
J� ` � �_,`�
Oale: /1 / �L— Signamre: �
�river's License or Sociai Security a�
t64L<6 Wh�te—Buileinq: Green—Cotle EnlorcemenL Canary—Aoolican�; Pink—Revenoe: Golaenroa—Aseessnr
CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 05855
PERMIT NO: B 058558. PLAN CHECK NO: "' N GOVT; N SUPP: N
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR '''""' PURPOSE: ALT
JOB DESCRIPTION ; RESHEATH 6 REROOF/1/2"CDX 6 COMP SHINGLE SQ FT; 1,600 "
CLAIM VALUE: 1',600.00 CALC-VALUE: 1,600.00 GROUP OCC;" R-1 '/
-COMMENTS; SMOKE DETECTOR(S) RE�UIRED IN HOME, '
*�r�t�tit�r*�t*iE*iEiE+t�e�e�E+t�e�tit*��iF+t*it** �tiEiE�t*x+�**1E*ir*�t*itriF�t+��tiE*�tatit�t�r�t�Eit�*�tiE�F**�t�t*�Eitit3E**it
'" 2 O N I N G R E Q U I R E M E N T S
" "' S E T'B A C K S -
'_' ' " _. _ _ _ '
------------ MAIN..BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT.:,_,;_-.:,FT;.,- IN.REAR; . FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT;,' ' FT IN' LEFT; FT IN RGHT; ' FT IN
I PARKING REQ• _'" `PROV; " PARCEL; 41905109 ZNE: REF NO;
PLANNING NBTES>.
�,? . . . . l,l .
�iF iF M if if if it iF ik iF k itlt it.if it k it k if if if iFlF iF iF iFik ik iF it ik iE�t 1F iF 1t k iE if iE iE iFlk k iE if kiE if IE �f 1E Ik IE �E �k IE fE �E if iF �F if iF iF k iF k�f if M IElk kif iF k iF
D E, V&!^�L O P M E N T' S E R V I C E S R E Q U I R E M E NiT S
�j�• f.n., •
ZONING'APPROVED BY -' " DATE:
' BUILDING APPROVED "BY : DATE; ,:»
APPLICATION IS3DED BY; , "`-DATE• � ��
3kltlF�tklk�klffF�Fif!l1E16�1E�EiF�flfiffk�f iFik�lfikiEif�F�tif1E if
fFaFk�t3fiFiElF�f�tlFlk�F1E�Fif�k�F�k�F�kikitlfk�kifiFkkifit �F�tikk�fiklFiF�fiF�flFjFltiFiflfitifiEikkiFititiEifltiflFlEiflkiE�iF�F�t3f�F�EiFif�Fikif
LEGALIZATION;N F E E' S U M M A'R Y STRUCTURAL SEGMENT;Y
,'�
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING �
PERNIT 37,00 ,50 -
� '- ' SMIP/NON-RES; `_ ' '
PLAN . ._ . :t
ISSUE FEE-
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS---. > 37.50 0,00 0.00 37.50 37,50 ,00
r'�!
REVENUBLDGVPMT PLUMBING ELECTRIC�MECHANIC FIRE��SMIP�TOT/SGRADING PLAN�CHECK
37:00 .50 "
. . . - . . _ ... �/��
�F �f If 1E 3k iFiklF IE 1f iE 1f if M!k ik iE ik IE 3f iE it iE if iE M�F iE iE iFiF iF iE 1klf iF iE �f if if if �kM if iflE iE ff 1E iE �f iF iflf 1F �f �F �E if if If iE �f 1F 1E iF IF iF if if iE iF IF �f iE if 1Eik iE
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 UNIT COST TOTAL7jCOST
SFR 1600' REROOF"BY VALUE RESIDENTIAL N020NE' " 1',00 1,600,00
END OF FEES . _ ' !',1
i
.�
// ..
6'; i/'
�1 �'L�1215c1-C.OS.2iS�ua c s �-ii '-',5��
CATE: O�i1i!42 7.YE: 14.0�
:r,'Y�1�'�'Cr:�� ''I'•_'-"• '
�1 � i.'..�'-"*.:':.�5 7v_� J . .�
RATCr il9/lilC7 TTl?C+ tG�tlt
CONSTRUCTIOiJ AND PLANNING � � ' � "' " -
-APPROVALS Permit # Date Inspector APPROVALS Permit # , Date Inspector
1. Temporary Electrical $ervice or Pole - � 52. Pool &-Equipment Location
2. Soil Pi�e-Undr md. - 53.�Steel Reinforcement ' ,
Cwi+"T
n
� � Ele�t�ic�al Condt�i{�Stility-Undrgmd. 54.'-Forms .` � '
�' _
i4: £IEc;ai�l CondWal�qdrgrnd. , 55. Electrical Bonding
,.ti,�..� ,-,
�?��Si�el`�Reinforcerye��'� - . - 56. Rough Plumbing & Pressure Test�, G
.,• 4^a�,, - � - J :�.
OF':Elecv��l UFER Qri�. . 57. APPROVAL TO COVER�GUf�%,F
�7 '•Fr3ocing"5 '� 58. Electrical ConduirUndrgrnd. ^%
: � r,
�.8.'ggunda ion - , 59. Gas Pipe, � Undrqmd., Test �' , �O
�%
T�9. �� er fCpe�Undrgrnd. :'" 60. Backwash Lines, P-Trap, O Undrgmd. ,f �
r;
70. Siructural Floor System � 61. APPROVAL TO DECK . �``
r
i i. Prope�ay Sewer �ine� House Connection �� i 62. Backwash & Receptor-Final � �
12. SewerrCap y � � 63. Heater & Vent-Final '�
13. Roof Drains 'c = 64. Plumbing System � final , ' �/;"
14. Rough Plumbiriq� '� `�-� 65. Electrical-Fina� .
75. Rough Elecv�ca�Conduit . 66.� Solar System-Final • ;'
� 16. flough Electf�cWiring - 67. Fencing & Access Approval
17. Rough Wiring ��n 68. APPROVED FOR PLASTERING
18. Rough Electri �7;T Bar Ceiling 69. POOL/SPA SYSTEMS FINA�
19. Rough Heating & Air Contlitioning F{RE DEPT. REQUIREMENT
20.'�ioU�h Ftact FitePlace ;�:n �L^ 8 O D C* +�:AppRb:VKCS.�a�eriRit # x '�• �
tc S: fc 1- R� ""' 'r i-� m X x 't} H y J 'T x
21.�'�: S'.t � �� TS '!' H '� �2 x� Sv"iQ -r X
u�ts,inStr�Ltucg* � ,,,, ,,.;5 r � ` ;�*x 0. •�dergratind�Hy;g�o � '"
22.�DuCR. Vr]�tibtinq�.; i :JS ?� � S.Lx:t �1. Produc['f�ing Q`�s ❑Uil
!1 Yi� % �C Tit 1 X
23.tGas'Pi e'FiouSh &' st � `" Y P �""� �` - '^ � c ? Gs •-
P- ... � i .nS �. ?� 5 C Cti.sf-72• UndergrotZ,fldFlu`sh�4,, x � �.
24.cidoo�Fr�ning� ^Y i E-�- ••t-�- �:� p e �.xx.S)3.�Jndergrnd'Storage�7a,nk �Gas •�OT '
25. Ronf'Sheathing .�,� � � �"�.:Gl`� ��ti�s7q,�pverheadHydro�'�� x
26.=i�Bar, Cei�ing (Stryoturap &�Aonocoat � ¢� G?�R x 75:t„Dry Chemica� z*- G x
27.'fra e a d Flashirr ` ��c � ^ � �l'� � ` T..�' = ` x c
nJ � A •-� .ri�-�. � X:[ >: .'. ?' 1+ic :c 76:�1Py Stand�i�2 i-S > '� v
' �8. Uyn9;�6i Siding:... i ���= x Z .. ...x .#� 77.� FIXED SYS3ENI-WNALY v � cv''
'T C iC.K C' �-i ^•.• � :•: 'yi] i Y � 1 y`. f1
�29. Insulatiba ,�,; � 78.zFIRE PREV. FINA;k � > >.
... • . %� ..� r.� u y, �:.
C�O. Drywall;6failing �< x. -�. j�t �- HEALTH-OEPTxF�EQUIREMENT
�,31. Plaster Bi}�w .Co��` � � � '' , fi �' � r79 t'FINAL IIVSPUECTIC�N � :• 7 �
fi'c' � .r!r * �, v�.
.�' ,.0 Q ' � 1 !"' � Y, r x: t. T _+ _ .
:�32. Electrical;Power f�eiQnFinal � x;q � x�,80.,�FOOD CERTIFIC%iE ISStIED �
�
33.��EinL� ElgCtriC_. n� -r i S K•� �.,�� �iVo�s: y _�:.� t.� j L„�
T � ,y � , . . '� $ � f�, . .
-34.�Fina�}_'. He�iing� ar�C"onditiom�g� ,^ `,� ,.-,`-�- i �j; � * , j'=
� v Y
35.,Fi�atGasPiO�-Tes'ix,�� -� ,� ! '�x:,:� •`; '-'C t'r `-CL
x • - .:O C.- �t �
� Y 'i _, Lr • x _ `. .
4y,,i6.TFloO�Or.(�,.3noPY[)<� I-r-� a .e,^� i _Et i E S_ '''� .e tC(c+
_ _ _ _ ' ' r ._. r+.
37.�ina'f FaclorY Fir€p'lece � � �.� � :; •T� � ` �� y Z � � ^
S �F S. 1 u.• ` Y.-. 1 ,f1Sw � -
��38. Fingl�,Plumbin9 a �; i � C, ..:x �-; �xm �..
�:39. Wat'�r Se7vice-Finalt � . i 'u i --.� � � .l �-�:T.' -_ .�: ;)
- m r s � :� :r, � � y t� x 5
;40. Gas Service�P�nal � - " �
-D � '✓.' v, � Y ...... . . .tl L '
. � •' iT. '1�.e'tr S ti lT I �'t'.: rt .'Ji �.:N x
J1. Solar pomestic-Fini1 S •• .. ... 1 _.-i <.�
�` ' 7 I -�/. �_ �v ;�L
t m ']O .T
-42.=$ackflov�`�CPreventer` { 'V �` = {� 'y ��� � T �'
�_ r, �J r I Ix �;' tt 7:. , t�
� -
43. Backflovr,lrrigationk � s`ss � * , � cc =c. �< ^ ��
Y tx < ac ,J ¢
� �� YmS > .r..x _ .0 F � �
,r44. Landscape IfLpatio� SystemLL;,.,. ,� :� v v O.� -•� x ;t'. ?� ,.C:; �s J ti o
,
;A5.:Sou�d AttenLatiorn r-x:- !T' _-�'. - E- -�z:xC? � H ^'�- �6 x �
,� w -� . �n r:• t .t l. :JG
`46. ;Handicap R2gulatioiSs `~ � � "' � � ��-: x � ;[ •S O�^ S � �
47.�IN`�L STRtdCTURE & BW��DING ,�/ �,� ��� - ^ iucS ���
� �r`�f�"' t". i
48.�FINflL PLAIVNIN('y i F t� h' ^s ( �'' i; i-q e=i �. > �- ••
:.�
�49.: Elect�ic Release to Edison � �: .�,�' � ; S / L, < � „
« t .r� .. ; �'
°50.SGas_sele�Tse to Soufjiem Califor ia Gas Co ': i\��«� _ oa: x; .. ��/
1�^ � �.' Y.. y 7 i'J Y �✓Y
.51. CEFj,TIFICATE Of CCUPANC x z K�, t; .� .� s• ��
No. Date - _ -
.. �. . _ i _ _. __ _ . _ _ -� � - - Applicant to lill in au sDaces ezceDt those within neavY ooraer Iines antl zi9n an appropriate aeclarations. - � - ' . - ' - - 62gJ �jI2BI BS
` , . s�: .� "s.o6 . T�
� CITY OF-COSTA MESA CO ST CTION PERMIT . ' � PE IT NO: . TRACT NO. � _LOT NO. ' UNIT�NU:.• � - , . � t- � �v c • � :., , �'"=� � '" � � F'� . � .
. , , . , ' , . � ., f r . . .
. 'Project Addiess . ` . ' . • - � � - - ' ' � ' • . '- � �. . - -
• ;AppliCant'S Mailing ACldre55 � � . � '. � ' TYPE OF CONSTRUCTION - NEW ` ADD � ALTERATION REPAI R '
�/y�^ S ❑ CONVERSION'❑ DEMOLISH ❑ OTHER q,p, # � � ' � ^ ' _ " ' ' � ZOne
� Owner's Name ��/)���// y�1-�� " ' Phon� ' �DESCRIPTION OF WORK/USE OF BLDG. - � � - �
A'ddress _r..eLA1► � �� - ' i ` � ' -� ' ! � S Main Building: Accessory Building:- �
� Arch/Eng. License No. TYPE OF PERMIT GRAoiNG � OUNDATiON ' S7RUCTURa� ' T Front`; � ' _ - - � _ % � p.
FYddress ' ' � 0 TENANT ❑� ELECTRICAL��UMBING 'O MECHANICAL � '- 6 Rea� � P - - " �' N'
COnt�aCtol'S Name hone � � �OTHER' ' , � ' ' ' '� A . , " . , . . : , � �
PROJECT DESCRIP710N 5c?. FT. oCcucarvCv C Right _ . ' G
Address (ma I' g) � � � - K � , . : '.
? � � . CONSTRUCTIONTVPE 'VA�UATION$ g Left � . , - �•1 � : R .
City,LicencPNo - ZONE GRADINGCU.Y.DS.' ACFES � ' ' - � r '
LICENSED CONTHACTOR OECLARATION " ` ' . � Ping. Ref. # . Parking Req./Pro'vided� ' � E` i
I hereb affirm thai I am licensetl untler rovi5ions of Charter 9� commencin .� ' '^ � • ' � � � ' a �
Y P ( 9� Remarks: Planning Notes: R � i' _ M'
with SeCtion ]000) of �Divislon 3 a! the Bu51ne55 antl Professions Cotle, antl ' T
my licenze is in full � antl effec[. � � � ' " ' ' � ^ � - � �.
License C } � J ' e s � � � � -
Date Signature� { (
�JRKERS CO PENSATION DECLARATION ' ' B2r Sink '
�ereDy affirm tha[ I have a certificate of ronsent to sethinsure or a certiflcate .
of Workers' Compensation Insurance; or a certi iea-mpy there i(Section ' �- --:-
3800, Lab. q.�^ nQ�/^� �h�� r,. BackflowPrCv¢nter
Polity No. rV�/OY � Company . Backflowlrrigation �
rtifietl copy I5 hereby furnishe0. � �
(� Cer[i ' y etl with the cityj „ i Divi � . � BdthtUbS . .
1 - Date Applicanl��� - . .
/� EXEMPTI N OM WORKERS'�COMPENS� LHRAT�. __._ Cl2�ifi¢f5.. _ . _
UO (Thissection nee not be completetl if the p¢rmit is fo� one huntlretl ($300) or
less). � . � � Dishwasher ' .
I certify'that�in the performante of the wo�k fo� whlch this p¢rm�t i5 is5uetl, I
shall not em0loy any pe�son in any manner So. as to become subject to-the � D�i�king FOUntains
� Workers' Compensation Laws of Gali(omla: • � . '
. Da[e Siqnature � � � Floor Drains .
�NOTICE: If, afte� making this Geclaratlon, you ShoUltl become subject to tlte .
, Workers' Compensation provislons'oPtM1e' Labor Cotle, you must forthwith ' � Floor�5ink5 � �
` comply •with suth provisions or� this pe�mit' snall be� tleemetl revoketl. � �
CONSTRUCTION LENDING'AGENCV ' ` � � GasServiCe ��ut12t5
I hereby aifirm lha[ there is a construction lentling agency (o� the performance -
of the wark for .whicb this permit is issued-'(Section 3097 qv. C.) Interceptors - � �
Lentler's Name
Lenaer's atlaress - � Kitchen Sink � ' ��
OWNER BUILDER pECLARATION ' � ..; { . . ' t
I nereby affirm tliat I am exempt from the Contractor's License�Law for,the Lavatories' � ' " �
following reason (Section ]031.5 Buslness antl Professional Cotle:.Any,2ity or
county which requires a permit to construct; alter, improve, tlemolish o� repai�? P=TfOp . .
�any structure, prior to ils:issuance, also requires the applicant for such permit ,
' b(ile a signed statement that ne/she is licensedpursuanl to the provisions of ,Roof Drains �' .��
ie ContractorY �icense Law (Chapter.9 (mmmen<ing with Section ]000) of
Ivision 3 ol [he Business antl Profe55iOn5 Cotle) or that he/Sh¢ is ezempt 1 � � �.� �
nerefrom antl the basis for Ihe allegetl exemption. Any violation oi Section � , .
]031:5 by. any applicant tor a permit subjects the applicant to a[ivil , . '
�enalty ot.not more than five hUntlretl tlollars ($500). '
I, as owner of the prope�tyio� my employee5 with wagez a5 their sole � Rei�spectiOn FBa �$15
<ompensation, will tlo the work, antl the structure is'not intentled or of(eretl '
for sale (Section 7044, Business an❑ Protessional COGe: The Contractor's •
License Law tloes not apply to an owner ot a property wno builtls or improves
thereon, antl' who Ooes such work him5elt/herself or thtouqh bis or her own � �, , , ' �
employees, provitletl that suGh improvements are riot intentleC or offeretl for BOi12� �
sale. It, however, lM1e builtling o� improvement is soltl within one year of com- , -
. pletion, tbe Owne� will; have the burtlen ot proving-be/she tlitl not builtl or iT- DuCt - UndE� Ci�OUnd
prove for the�purpose of sale). ' �
❑ I, as;owne� ot the property, am exUusivety mntracting with licensetl con- D�Ct - St�UCtu�dl ,
tractorsto mnstruct the project (Section 7044, Business ana Professions Cotle:
The.Con[ractor:s. License Law tloes not apply to an owner of properry wM10 Duct - Ventilating ` �'
builtls or improves thereon, antl�who contracts tor such projects with a mn-
tractor(sl license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ MWtiple ❑
proof of their WorkeYs Compensation insu�ance 5h0ultl be provitletl to me. _
❑ I am exempt untler Section � B. & P. C. tor this reaion � Flr¢pl/FaC[. BIt. ICBO # '
Date owner' ' ' Heating System & Ducting � •
� I' ner`eby certify tnat I�liave reatl tnii application ana state that the atiove ❑4100,000 BTU �100,0006T1
' informa[ion is correct. I a9ree to comply with all ciry antl.county ortlinances �
antl state laws relatingito builtling const�uction, antl he�eby autho�ize re0�e- � ,
sentatives of this� c' to enter upon [he above-mentionetl Ipropert .for , , ' ' ! �
inspectlon Dur s
Signature : • ' Dat ' r ' �
Drivers",License od55 � • �� �� � ; { Reinspactian Fee $15 .
CMF OB65�46, rev. 10/84 White - Builtling; Canary - Applicdnt Pink - Accounting; Goltlenrotl - A5585m�
Showers �
Service Sink �
Sewef Cap� � �
Sewer Connection
Solar Collectors - �
Solar Piping:
Solar Tank : '
Swimming Pool w/Spa
Water Closet �
Water Heater - `' '
Water Service � .
Auto-Wash �
, Laundry Travs � .
Issue Fee' . '
� FEES
1 �
Automatic Washer
Construc[ion Pole'
Cooking Unit ':
- - - - Dishwash�er � ;,,
Dryers ❑Gas �
Fan ' V
F.A.U. .
Fixtures
' Device Boxes
Hood or Typel ❑
Canopy Type II ❑ � •
Refrigeration System ..
❑0-t00,000�8TU ❑100,OOOeI
System Repair/Alteratlon
Fire Dampers
Registers ' .
� ' ! �
i
� Issue Fee � _
. $ 3
FEES
�
� �
• ELECTRICAL
S
i
� , FEES i
Transformer CJ 15-50 KW �,
�ub. � ❑ 50+KW ,
Meter ❑up to 100 amps �
- - -- -Meter �over 100amps=- �
Electric Sub�Panel � .
� ' � Motors00-iHP�1'/:-'8 �
! Inc Solar. �9-15 HP 016-15�
' � ' Microwave � '
� Pole Liglit �
� � Range ! • _ �
Switches �
Garbage Disposal � � '
Generaror DO-5 KW 05-15 KW
Reinspectian Fee $15
DEVELOPMENTSERVICESREQUI
Zoning Approved By
Building Approved By , �
Standing Section:
Trosh Compactor
luue
, � SUMMARV OF FEES •� .
' BUILDING PERMIT � $ ' SMIP � , $ � �
PLAN CHECK � $ PERMIT � � i � �
1
� PLUMBING ' $ �� ��SSUANCE � $ � , �
I PIAN CHECK 25% $� ' ENERGY.P.C. �$ �
, ELECTRICAL ' $ , ' � GRADING �$ � � �
� PLANCHECK W%� $ � � . MICROFILM , ^a � .
' MECHANICAL , S � TOTAL FEE � $ � ' �
PLAN CHECK ?5%I$ ' � � � � � I
. . . ' .'1 .._. . . : .
' CONSTRUCTION AND PLANNING � PG 9 SPA -
' Date Inspector � Date Inspector
APPROVALS Permit # APPROVALS Permit #
1. Temporary Electrical Service or Pole' _ 52. Pool & Equipment Location�
2. Soil Pipe-Undrgmd. .' - 53. Steel Reinforcement . '
3.'ElectricalConduit-Utility-Undrgrnd. � - 54. Forms
4.^Electrica6Conduit-Undrgrnd. 55. Electrical Bonding � '�"
5�. Steel Reinforcement . - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE .
7.-Footings - ' - 58. Electrical Conduit-Undrgmd. � �.
8. Foundation . � -, 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. •- . �.. 60. _Backwash Lines, P-Trap, � Undrgrnd.
10. Stcuctural Floor 5Ystem ; 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 -
i6: 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 & A�r 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. Storage Tank O 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 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 • � , L� ' �
" (v- b
39. Water Service-Fin81 � -� ' �
l
40. Gas Service-Final '„'r.,; � �
41. Solar pomesticFinal a � _ - � '
42. Backflow Preventer � --' � '
�„ , ,
•�43. Backflow Irrigation - -
�
y44. Landscape Irrigation System �,.
'•45. Sound Attenuation . - `'� � , , � �
,.�n46. Handicap Regulations . . ,
d47. FINALSTRUCTURE&BUiLDING -
�48. Special Requirements Compfeted � ' , �
49. Electric Release to Edison �- .
50.GasReleaseto'SouthemCalifomiaGasCo � ,
'b1. CERTIFICATE OF OCCUPANCY _ - � .
0
No. � Date � �
��
�:
i
Applicant to fill in all sDaces except those within heavY �ortler lines antl sign all aOVropriate tleclarations.
;ITYOFCOSTAMESA CONSTRUC,TfIONPERMIT . PERr!TNp.fy�,,� TRACTNO. , LOTNO. UNI�N� •
PrQjectAddress ��fOT��/lCcM� 1
Applicant's Mailing Address � �/�__��Ae� C�
Owner's Namej / � Phone
Address �s[ ��� LiS''���pt�! �
Arch/Eng. � �icense No.
Address �� �p ��.
Contracroi's Nam �i r0��'0 �honell T�=uaL<'
Address lmailingl c��r ?�iCl� �.q�S�a- �G� -
City,License No. — �� � � �2 �
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl under provisions ot Charter 9(commencing
with section 7000),oi Oivision 3 ot the eusiness antl�Pro�essions Cotle, antl
my license is in f II forte and eftect. - ���I p
Licen �Clasi � C LicenSe,No. :�o
�ate Si9nat
"�'ORKERS'COMPENSATION CWRFTION
ereby affirm that I have a ce ificate of mnsent to self-insure or a cerlificate
Workeis' Compensation Inmrance, or a certitietl copy thereoi ($ection
..d00, Lab. ) . .u. I, r/�_ .}
Policy No.�/�_ Company Shs• ��.//GYV�S/
eCertitietl copy is'hereby furnishetl. '
Ce� ifietLcop filetl with'the city mg Di]VT�on� - � •
Date ��� � �� � Applican ��f� �1 /�
EXEMPTION FROM WORKERS' CO ENSATION DECLARATION
(Thissection neetl not be tomple[¢tl' [he permit is for one huntlretl (E100) or
less).
I certify that in tM1e performance Of th¢ work tor which tM1is perm�t i5 issuetl, I
Shall not employ any Oe�son �in any manner So a5 to become'subject to the
Workers' Compensation Laws o( California.
Date Signature' '
NOLICE: If, after making. this tleclaration, you ShOUItl become subject to the.
Workers' Compen5ation Orovisions of the L�bor Cotle, you must forthwith
comply with such provi5ion5 or. thi5 pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereCy afflrm that there iz a mnstruction lentling agency tor the performance
of the work.tor which this permit is issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler'S ACtl�ess . � .
OWNER BUILDEN �ECLARATION � t
I hereby atfirm that I am exempt trom fhe Can[ractor's License Law for the
following reason (Section ]031.5 Business antl Professional Cotle: Any city or
coun[y which r¢quires a permif to const�uct, alter, improve, tlemolish or �epai�
any strutture, pNo� to its issuance, also requires the applicanf tor such permit
to file a signetl statement tha[ he/she is licensetl pur5udnt to the provisions of
�.he Contractor's License Law (Chapter 9(commencin9 witn Section 7000) of
:y�',"/ision 3-bf the Business�antl P�ofes5ion5 Cotle) or tnat-he/she�is exempt
�'�'31f5 by anyhapp�icant�rfoM1ea��permit%s OPe ts theYapplicant to e�c�ivl
enalty of not more than five huntlretl tlollars ($500). � '
1, as owner of the' property o� my employee5 wlth wages as thel� sole
compensation, will tlo che work, antl the struccure is not intentletl or�ofieretl
tor sale (Section 7044, Businesz •antl Pwfessional Cotle: The Coniractor's
License Law tloe5 not apply to an owner ot a property who builtls o� improves
Ihereon, antl who tloes sucn work himself/herself or thwugh his or h¢r own
employees, provitleC that such improvements are no[ in[entletl or otfered tor
sale. I(; however, the builtlinq or improvement is soltl within one year of com-
o�etion, the owner will have the burtlen oi provin9 he/she ditl not builtl or im-
prove for the purpose of sale). � �
❑-I, as owner of the pro0erty, am exclusively contractinq with licensetl con-
tractorsto construct lhe project (Section ]044, Business antl�Protessions Cotle:
The Contractor's Litense l2w does not appty�,to an owner of�property who
builtls or,improves thereon, antl wM10 mntracts for such proJects wiih a con-
t�actor(5) license pursuant to the ConVacto�'S License Law). 1 am aware thaY
proof of their Wo�keCs Compensation insurance shoultl be provitletl to me.
❑ 1 am exempt untler Section B. & P. C. for this reasom
Date Owner • �
I hereby certify that'I have reatl�this application antl state that the above
information is correct. I agree to comply with all tlty antl county ortlinances
antl state.laws relating to builtling construction, and hereby authorize repre-�
sentatives of N?is city, to� nter upon the above-mentionetl property for -
insoection o �rP �5es. _ /j � �f
Signature ��y+ �n/ • �e'�+J Date��
..
Drrvers"Lm se or 55 � —
CMF 0865-46, rev. 10/84 White
Canary - qppliGant; Pink - Accounting;
' �
TVPE OF CONSTRUCTION I_I NEW U ADD LI ALTERP.TION LI REPAIR
❑ C@NVERSION ❑ DEMOLISH ❑ OTHER � A P #
DESCRIPTION OF WORK/USE OF B�DG. � ' �
' S Main Building: �
TYPEOFPERMIT GRnoiNG FOUNDATION STRUCTURAL , � T Front .
❑ TENANT ❑ ELEGTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf
❑ OTHER %�
PROJECT DESCRIPTION � 5q. FT. oCCUVArvCv C Right �
K �eft
CONSTRUCTIONTVPE - � VALUATION$ � $
. ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: ' . ' ' ' . ' PI2n010j NOteS: ''
. � , �
m��n i _
:flow Preventer �
;flow Irrigation
tuhs
fiers. ,
Wd5f1E( .
king Fountains
�r�Drains '
�r Sinks
Service Outlets
Kitchen Sink i_. �. .
Lavatoiies . �
P—Trap
Roof.Drains � �
_ -_
Reinspection Fee $15
Boiler �
Duct� Under Ground
Duct-Strucwrel - '
Duct-Ventilating � � �
Exhaust System � � Multiple
Firepl/Fact. Blt. ICBO #
Heating SYstem & Ducting
❑0-100,000 BTU 0100,000
Reinspection Fee I $15
nrotl - Assessor
FEES .
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 ' $ 3
FEES
Hood or Typel '❑ ,
i
CanOpy , Type I I ,�
Refrigeration System ,
Oaioo,000sru ❑ioo,000
System Repair/Alteretion -
, Fire Dampers
Registers _
Issue Fee -
"U
-$, 3
' ' 9io5 � E7osiei
20ne
` � Accessory Building:
' 1
� Parking Req./Provided
Automatic Washer � �
Construction,PoleSub.-, �
Cooking Unit ,
D ishwasher
Dryers ❑Gas ❑Electric
ELEC7RICAL � -
Transformer ❑ 15-50 KW �
' ❑50+KW
Meter ❑u'p ro 100 a'mps � .
Merer ❑over100amps
Suh Panel :
� Momrs�0-1 HP �1'/a-8 •
F.A.U. �' Inc.Solar �9-15 HP �16-1!
Fixtures �
Device eoxes
OuHets
$WitChES -�
Garbage Oispoul '
Generator �0�5 KW 05-15 KW
IReinspection Fee
—
DEVELOPMENT SER
Zoning Approved By _
eui�ding Approved By
Appliwtion luued BY_
Pole Li9ht
Range '
Sign
i -Standing Sectionf
Trash Compactor
$15 I I luue Pee
—
REQUIREMENTS:
' 3o4tl
2
O
N
I
N
G
R
E
Q
M
T
$
FEES �
= � ss.l
Date
—Date�_,..�_
' _ �. /M.` X-7
. - . ", SUMMARV OF FEES . ' -� ; , .
BUILDING PERMIT - S._ SMIP $ �
PLAN CHECK � $- PERMIT �
- PLUMBING � $ �SSUANCE S
� PLAN'CHECK 25% .$ � ' � ENERGV P.C. �$ �
. • ELECTRICA�L . '$ �� ,�GRADING; ;$._
PLAN CHECK 50% $ MICROF,ILM $ '
MECHANICAL � . $ � TOTAL FEE $. ��
PLAN CHECK .25% $ ' � -
CONSTRUCTION AND PLANNING _ � . , POOL & SPA . - � •
APPROVALS Permit�# Date Inspector qppROVALS Permit# Date Inspector
, ; .
1.-Temporary Electrical Service or Pole ' � 52. Pool &�Equipmerit Location� �
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement � �
3. Electrical Conduit Utility-Undrgmd. + 54. Forms �-
4. Electrical Conduit-Undrgmd. � 55. Electrical Bonding ..
5. Steel Reinforcement 56. Rough Plumbing & Pr`essure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings � . , � � 58. Electrical Cond'uit-Undrgrnd. �
8. Found'ation `� ' � • ��59. Gas'Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgmd. . .. -. 60. Backwash Lines, P-Trap, � Undrgmd.
• 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. POOVSPA 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 � 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 RTIFICATE ISSUED
33. Final Electric �� es: _ - � '
34. Final Heating & Air Conditioning - - - � � !� �
35. Final Gas Pipe-Test
36. Hood or Canopy . , �
37:�Final Factory Fireplace . _ , i �,
38�. Final Plumbing ' ' • �
39. Water Service-Final . . • �
40. Gas Service-Final � , . 'y "
41. Solar pomestic-Final � . i , , , . �
42. Backflow Preventer � ' � - � � '
L43. Backflow Irrigation ' � ' _ , ' � •
'�44. Landscape Irrigation System � � - � • _ � � � ; : � . � ' � �
�45. Sound Attenuation ' � i t+': t'��" •
46. Handicap Regulations � - � . � - r � �
47: FINALSTRUCTURE&BUILDING , � � - � �' . ,.
. '��
48: Special_RequirementsCompleted " � i ' �
49. Electric Release to Edison � . � ,
50. Gas Release to Southern California Gas Co .. .
51. CERTIFICATE OF OCCUPANCY � - - - a. .
;�
No. Date
DESCRIPTION OF WORK
SUBCONTRACTOR
� � 23?5 i
`EOSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 91], CpgTp MEBA� CALIPONNIA
For Applicant !o Fill In Completely
TYPE OR PRINT � �Q
BUILDINB / � �
ADDftE55 Er
COSTA MESq, CALIFORNIA
OWNER � � �(J �T '
M��o�aa9r�i�'�.�.An�o� �n � �r !b
CITY t�r C�STA fl9ESA
MAR 19 1965
PPLIC� F�R
'BUILDIAG'-
Por Office Use Only
RCC61R NO. Ir^f PHRMI'I
oY DAT9�R�[C[I C�p �
�� -" ZONH NO. OF - OSE OP NB 1
� ' PLANH � 'BUILDINa r/
��
CONTRAGTOR �]
� . �eont � V "�? " � J F-7�
. ' DEBCR�RION ••Ii�
ADDREBS
. ,'-'� � � A. P. NO. L O ^ �-L '
CITY
NOTE: NO EAVE OVERHAN6 SHALL BE LESB THAN
STA9 - - , 30^ TO SIDE 8 REAR P. L
LIC. NO. NO. .
'/� EAVE6
SIZE No. oP B�.nOey' ALLOWED fU. B. C. RECUIREMENT)
OF LOT � I Now oN lAT N
` . YARDSAPPROVED YARDSAPPROVEO
USE OF ' MAIN BUILDIN6 ACCESSORY BUILDING �
EXISTING BLOG. 07�3� '
�y (FROMC/ BTREET /�/���
BETBACK LINE FROM � � J. � FRONT FT. � FT. 2Y-'�' �
CENTER OP BTREEI . REAR YARD w ..
61DE YARO I LEFT - I RIGHT ' � Q, R. BID C� PT. � F7.
' DESCRIPTION OF WORK �. s�oe Rr. � Fr.
N /' ALTERqT10N � DEMOL 8H REAR FT. Ff.
DI87'ANCE BEf. BET. MAIN B
REPAIR MOVINp MAIN BLDG8. ACCESS.BLOR9.. ,
BUILDING . NO.OF ��#S'���� � DAT6
SIZE kOOMB - 8TOR188 � G. U. P.JF ���� APPROV6D ' �
EXTERIOR WA L ROOP /� APP V6 ('� / ^' '
COVERING COVERIN6 S!T BY '� a LY � DATE ��O�
USE OF BUIL G A OqK TO BE PER ORME¢^ . G ���
c
_�•er. 5$ .L�-xds=zirr,w
'i.Z Z sa?Fr. Z � ( m
I HEREBY ACKNOWLEO6E THA} � qpVH'PEAO TXI9 APpLICAT�ON TH! AMOUNT BHOWN UNUEH VALUATION �9 FOq THE z
AND 6TATE THAT TH ABOVB �B COpRECT ANO AOREB TO COM� PURPOBE OF 68TPBLIBHINO ♦ PEPMIT FE6 ONLY. p
PLY WITH ALL Cii qO�NANCgB ANO BTATB LA 8 OULATINO yqLUATION �y., �
BUIL�ING CON 10 - ptiJ g H
SIGNATUR O PERMIT FEE $ I� j �
PERMITTE m
$ ��76.� �, E, � o .
AUTHORIZED AGENT �j �`
TOTALFEE l+
= �3� s 2.
-�OSTA MESA BUIIDING-SAFEfY DEPARTMENT.
P.O. BOX 9f] p08TA M6BA. CALIPORNIA
For Applicanf ro Fill In Completely
' � TYPE OR PRINT
B���o,Ne z
ADDRESS
COSTA MESA, CALIFORNIA
■ A" '`TECT
STATE �—TEL. ' -
LIC. NO. ��`///... �1 NO. �
SIZE J� / y C' I NO.OR BLDOB. /
OF LOT �` �� J NOW ON LOT (
USE OF
�EXISTING BLDG. �
BETBACK LINC FROM ' Q
CENTER OP BTREET REAR YAR
61DBYARDI LEFf . ���I RIQHT —�
DESCRIPTION OF WORK
BUII�INQ
SIZE ��
EXTERIOR WALL
GOVERING
USE OF BUILDING
I HEHEBY'ACKNOWLEO�
•ryO STATE THAT iHE
PLY WITH NLL CITY
amtoirvo corver
SIGNATUREO -
PERMITTE
AUTHORIZED AGENT
- �C9TY �T ��S�A P��SA
MAR 2y 1965
APP ICABUlf91NOy7�P��
F ce—tlse'
P8C[I�TNO. I PEpMITNO.
2
FIRE
LEOAL
�{������t�
>.No. /i s— /3 a—/� — -
fE: NO EAVE OVERHAN6 SMALL BE LES9THAN
' TO SIDE @ REAR P: L
'ES
.OWED (U. B. C. RE�UIREMENT
YARDSAPPROVEO YARDSAPPROVED
MAIN BUIlDINO ACCESSORY BUILDIN6
..- .. . - VAR. ii
9TORIEH'� C. U. P.
` „�PR9:
BY
V P'T.
d ���
DATE
�S
�
I XAVB PEAD THIB APPLIUTION TME AMOUNT HXOWN UNOER V/�LOATION IB FOR THE F
COPRECT A AOqEE i0'COM. PURP09E OF ¢BTABLIBHINO A PERMIT FQE ONLr. a
i AND 8 9 R60 INO VALUATION � �'�
. ,�y., 0
�� . �Y PERMITFEB $ � � j
/'') j m
• $ ;/O/�1 PLANCHECK $ �
�` v � �
- � TOTAL FEE
' 24921
� COSfA MESA BUILDfNG-SAFETV DEPARTMENT
P.O. BOX 720! COSTA ME9A. CALIFORNIA B262E
For AppllcaM ro F111 In Compleroly
TYPE OR pRINT
\DDR6iY .2„2 k.� "k'nR � �.g�
COSTA MESA, CALIFORNIA
W MAIL
STATE
LIG. M
6IZE
� BUILDINO
NO GP
�poM
18af R6AR
LCRT R10lR
uEscwrr�oN oF wowc
C6T� 0 C S r� E�� SA
NOV 19 1965
ArPLICATION FOR PERMR
FO�fui� �
� eici�rt no. � �[11MIT NO.
wnm� r
NO. 0/ U�[ OP NiWf� �
■LANI � 'OYILDINO (��[�Q
L6YAL
.YARDBAPPROVED
� MAIN BUILDINO
(FROM C/LBTRRQT)
–/_sb—/�
I SHALL BH Ll88 THAN
fU.B.C.RBqUIR6M8NT1
YARD9APPROV6D
ACC6880RYBUILDINO
,
N R�,R a �. � �
oier�Nce aer. eer.
H � MAIN BLDOH. ACCE.
IVM. � , DAT6
ti , C. . /� APPRi
�. �r1�R[]V�I A 1
1 X6R6lY ACNNOWL[DO� TUT.1 X�V6 R�AD T11I� A�►LIGTOf1
AN� 6TA1E TXAT'IiR ASOVi IB CORR�C': ANG AOp6[ YO COM.
PLY WITX ALL CITY ORDINANCf� Ary0 OTAi{ GW/ p60YIATiNO
auLLo�xo coHecpue}3A. ..
sr w- 7�/ . u��� DATQ 1/— %��
a
�
sc. rr. �
rne �wouwr sxowN uHomi v��uwnoN �e vox rwn �
►URP086 OF fRAGLIlXINO A P6XMIT F6H ONLY. �
VALUATION � p
PEHMITFBB �
, �5�� E
� w
TOTAL P66 � �