HomeMy WebLinkAbout2549 FORDHAM DR - Building PermitsApplicanl lo fill in all spaces except ihose within heavY borcer Iines antl sign all appropriate aeclarations. �
CITY OF COSTA MESA � , • � � ' ' � " � pE IT NO. � - TR.4CT NO. � - LOT NO. '� ' BCD . . � � � - � -� � (;560� 7/27/R4 � -
CONSTRUCTION PERMIT , . . , : ��L}-, �-}Z; - � ' ' • . _ -. , . `� '
Pro�ect Address �O�Y%hQ/n Rd,. � ' . ` � . TVPE OF CONSTRUCTION: r :!v�,W_: � "�ADD rALTERATION REPAIR. � ' � �
ApplicanYs MailingAddress. �26'CO/OOIBI'C!Ql 4✓QV C-M• ii(�i ❑ CONVERSION ❑ DEMOLISH ❑ OTHER� , . - � �� -. " ' '
A.P. #� �Zone•
' � ' � � � .DESGRIPTION OF WORK ,
Owner'sName '�• & P9'S.'C�4d6S- �Phone' 9`7=1Fi1�� . , - � S' Main Building:� � � � ' 'Accessory Building: � � � � Z
�
Address� ��* 2549 For'dhom Rd,y� C_M_' _ • TVPE�OFP,ERMIT ' �GRADiNGT FOUN�ATION' ❑ STRVCTVRAL � � T FrontC, � i � _ � _ � ' N
AfCh/Eng. � ` LitensC No.� ❑',TENANT. ❑ ELECTRICliL ❑ PLUMBING ❑ MECHANICA6 - ' B �Rear •. " �. � . . ' ' " �
Addfe55 ' _ .. . : . . . i �- ❑ OTHER � , - � , : ' `:. . . .. � .. . ' � A ' " _ N �
� C Right � � �� . ` i . - • - G
Contractor's Nam ' ' '�Phone � s��,_,�ss �9 �� PROJECT DESCRIPTION- Sqq FT. OCCUPANCV t ' K' .
� CONST,RUCTIONl'VPE,(-_�� VALUATION$ ��Gl� Left � : ` ' ' R 1
Address(mailingl »F+ r' P�^rr�inl .I./ � ��!'.,c+.,��t-io�.. 0��07 ? � , . S '4 �E
' � ' �nSQQ,� , ' ' " +' ZONE GftADING CU. VDS. ACRES � ping. Ref. # ; ' . Park•Feec .P,� . .� I i'- n
City;License No. -
LICENSEU CONTRACTOR DECLARATION � ' ' .. - . Remarks: � ' 4 � i ' > � � Pdrking R¢q./PrOvid¢d �
I'herebyafiirm that I am licensatl untler provislons oi �Cnarter�9 (commencing i ' ' , �
.vith zection ]000) Of Division 3, ot the Bu5ine55 antl PrOfe55ions Cotle, anC �� ' . , , - � � � A� Use of Building: � �
my license�is in full (orce antl effecL . .
License Class C--� � e � � i PLUMBING ! FEES Planning Notes: .
Date . .�/tn/n�� Sianatu _ _. .. . . . ... � . � . , . . . �
'vORKERS' COMPENSATION�LARATION � � . ' � ;
ereby�affirm that I have a ce ica[e of consen[ to zelbinsure or a certlticate j
Workers"Compensation-Insurance; or a certl(ietl,'copY'�heieof-(Sectlorti- �
J800, Lab. CJ . � � . i � '
Policy No. " �S97Lt � � Company��q.(_fh-' -
q Cerhfietl capy I5 hereby fumislietl.- � E. � (
S� Certl(�etl co�py/ is filed with the nty Bwltling Division.
,U2te 7���yRLf ' Applicant �Crnnl! Rrnc Rnnf�_(`n_� I '
�E%EMPTION FROM W00.KER5'�COMPENSATION�DECLARATION -� +�
(This section neetl not be comD�etetl it the p¢�mit Is toi on¢ huntlretl (5300) o� �
less). I � I i i . I ; �
I certlfy;that .in the performance of the work for�which this permR is issuetl, I
shall�, not employ dny pe�son in any mann¢r 50 �as to becOme subjeCt to the !
WorkerslCompensation,LawsofCalifomia.� . ' �
'Oate Signature ,
NOTICE: If,'after makin9_thi5 tlecla�atiOn, you shoultl becOme subject to the ,
Workerz"Coinpensation' provisions`ot lthe Labor'Cotle, you' musYtorthwith' ;' -
compty �with- such,provisions�.or.thiz-,permit shall be tleemetl revoketl. !-
CONSTRUCTION�. LERDING."AGENCV' .� :^ � � i -• ' t � .� . �� 'u i '
I hereby'aftirm tha[ tliere is a;construction�lentling agericy for the perforrriance � � 1
ot the jwork �tar whichiChis Dermit��islissuetl'.:(SecHon^3097 Civ. iC.)'.
Lentler'sl Name,+' : ' r .r - ' -
Lentler'S Atltlress' 4 � - ' .
OWNER�BUIIDER�DECLARATION i ` t j .� ' ' �
I.hereby aifirm Ih2t I am'exempt trom thel Cont�actor's Llcense L:aw for,the
following reason (Section ]031:5 Business antl.Professional�Cotle: Any city or �
countv which reauires a oermiflto construct. alter.'ImproVe tlemolish,or'repaiv �.
to i1
thereon
I'am ezempt uutler
, , �
I Drivers'�.rEense or 55 �
•CMF 0865-46 iev. ]/83 �
or
a
e applicanL(or such permit ��• �
irsuant to'the provisions of '
ing with Section-7000) at � - '
-oe that he/shevis exempt � '
.: Any vlolation_ot Section .
'the: aOP�icant tb a civil '
)I. , . i
st witFi wages' as thelr sola ' ,
�is not intentletl or otteretl
d' Cotle:� The Contractor4 � �
rty;who�builtls or improves
or through his o� her own ;
iot intenaetl or offeretl'for � ,
�Itl within one year of com- �
he/she ditl nat buiitl or Im- ��
= � � : � ! - i
rtractinq with licerised conc�G
iness antl Professions Cotlei- -
arv owner ot _Drope�ty� who- i
r such projects with a<on-�
ise Law). i i . t
Preventer . �
Irrigation
i �
�,
,f ."' __�._
loor Sinks
.. i ' i � I
� - � . � � ,
� .� n
� • . � ' r .
-- -" -� � � '
� � ; � _ i � -:1
�. �-.-..: • r �. � c-- t
'�nspection Fee.�. � $25�
�_ �
- - i
e7 � �, . � � �
ating� � 1 I i
em � � Multiple �i
Sewer
Sewer
i
-Sola� Pipin9 �. .. . . _. , ,,
Solar Tank �, � �
Swimming Pool w/Spa' �
Urinal � � �
WaterCloset, �. . � .
Water Heater: • '
,Water`Service - ': �
fa � �
� :7 1 i I
_ � i �`' ' '
' .t
_ I ' ' i
Issue Fee � ��
i �
, i � � �
Automatic Washer '
-0onstruction Pole,Sub.
Cooking Unit'�}"" '
��Dishwasher i
, Dryere �Gas� �Electrii
i
I '
� i. ° r 1_
, ELECTRICAL ; ' .� ,
� ' �Transformer � 15;5
� � ❑ 50 +
� i �
t--� ";--- ,MeterOup to-100�ai
I �Meter ❑over�t00art
' � ,Sub Panel, '' ,r
Fan. 1 Mm
'F.A.'U�.` I ^' ' � ,Inc.
� i Fixtures � i ' ' � Mic
Device eoxes ' . ' � Pol�
- i � Outlets ' � ` � � � Rai
' Switches' ' � •j � � ' Sig
F�,• ��' GarbageDisposal ' ' ' � i.Sta
-�� Generator �0.5 KW �5-15 KW i �Tra
' E
,� $i3 .. � . . . . ._
Hood or Typel, ❑ � � � 7;
Canbpy . Type�ll� .❑ � ;. ,
I : I � ' —
Refrigeration Sys[em '
❑4100,000 BTU ❑100,000 BTU '
System Repai�/Alteretion i ,T i
B. & P. C. t' r this reason , rvepuracc.�81t. ICBO # ; � '
� I- i
� ' ' Heating System & Ducting ` , � �
' . � '.- : . . � � l ; � � � i i
i tnis'appliwtion antl state that the atiove � ,� ❑U700,000BTU 0100,OOOBT - _�. � �
mmpry with'alPcity antl.county'ortllnances"r 'r -" '--� "- - - - - -
nslruttion, tl�hereby authorize repre- � � • ; � , � ;
u n the ab -mentionetl �property ifor ; � • , 1 � � � .�i
� � ' 7�18�84 1 ; i� ; � � t l �
,
" ' + � � Reinspection Fee , $25� � i Issua Fee �j � + 5 3
Builtling;Canary-Applicant;Pink-Accounting;GOltlenrotl=Assessor-- ---- �-- �. .. _.__ _ . � _ _. _ _
PUBLIC SERVICES REQUIREMENTS: I
Zonin9 APPraved BY . . �
Application APPro�ved BY .t � � �
` U
"_ R
. _ E
_ , M '
E �. " N .
, . . T
olar��9-15 HP 01�6-15+ �
iwave � � • ; �
� � I �
li9ht � � � ' �
e �
; � � � ,
,.,. �
ding Sections ' i �
i Compactor I �
! � . . . , � ' .i
Fee� � � � � ; $' 3 I
i .
� t
D'ate �
� Data �' {�� �
� I s nA�o : /1LV � �
� ' ;SUMMARV OF FEES • � • �
� BUILDING,PERMIT , $ Z7��� SMIP, . � $ �� �S� �
PLAN CHECK � 1 � I
; j $ PERMIT '
;ISSUANCE � $ ' '
' � PLUMBING ' � i$ � � ,4 , i �
' PLAN CHECK ; � $ � � ENERGY�P.C. $ � ,
I ELECTRICAL i � $ � � GRADING � $ � �
� PLANCHECK j � $ � � MICROFILM $ ! �
MECHANICAL ; � ! $ ' � . TOTAL FEE � $ ' Z7 �
� � PLAN CHECK ? , $ ' j ' i � i '
. ' . . . .. .. . .. . . . �-_._. . .' _' . ...� .F � .- . . _ ��. . _. .
r. . , n, . - .. . . . , . . .,
CONSTRUCTION AND PLANNING ' � ` ' • � , . ?00 SPA��
APPROVALS �Permit#� Date• � Inspector .�,APPROVALS Permit# Date - Inspector
1. Terriporary Electrical Service or Pole - 52.'Pool & Equipment Location ' � ,
2. Soif Pipe-Undrgrnd. ' � � � ' . 53. Steel Reinforcement � - „ �
� , 3. Electrical Conduit Utility-Undrgrnd. . � 54. Forms � � - � � � -
' 4. Electrical Conduit-Undrgmd.- � � 55.r 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 Bipe-Undrgmd. -- ' 60.`Backwash.Lines,�P-Trap; O Undrgmd.
10. Structural Floor Sysiem � � �. 67.� 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. RoughPlumbing � - 65.�Electiical-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 Electr�ical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .
19. Rough Heating &!Air Conditioning � FIRE DEPT. REQUIREMENT � �
20. Rough Factory Fireplace ' . � APPROVALS Permit#' - �� .
21. DuGts, in Structure , 70. Underground Hydro -
22. Ducts, Ventilating. � ' 71. Product Piping �Gas' ❑Oil �
23. Ctas Pipe-Rough &�Test ' 72. Underground Flush �
24. FJoof Framing ' -� , � 73. Undergrrid.StorageTank OGas ❑Oil
25. �Hoof 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 FINP,L � �
29. Insulation � . 78. FIRE PREV. FINAL - .
30. Drywall Nailing �� „� � . . ' , � � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat t: � � 79. FINAL INSPECTION �
32. Electrical Power Meter-Final � . • � � S0. FOOD CERTIFICATE ISSUED
'
33. Final Electric ' � � � ' � Notes: � `
34. Final Heating & Air Cond,itioning � ' � � � � � � - �
35. Final Gas Pipe-Test � , - , - • . : ' � � .
36. Hood or Canopy � . � � - . . � � � . �
37. Final Factory Fireplace . � � - . �- � � ' ' ,
38. Final�Plumtiing ' � � � � ' � . '
39. Water Service-Final - � ' � � � ' �
i
40. Gas Service-Final , � , t � . • .� . • . , •
41. Solar pomesticFinal _ � . . � ' �
42. Backflow Preventer � ' ' ' � , � � �
43. Backflow Irrigation ' , • ' � � . ' � � .' � . . , - '
44. ,Landscape Irrigation System � � - � � . .
45. Sound Attenuation ' � � • ' � � .� � . '
46. Handicap Regulations � , . " ' � ' .
�
47. FINALSTRUCTURE&BUILDING .
.3 '
48. Special Requirements Completed � � - � � ' • � ; ' � � �� -
49. Electric Releaseto Edison ' ' � ' ','- -. ' . '� .
50. Gas Release to-Southem California Gas Co :,. .• - . _ '.
51. CERTIFICATE OF OCCUPANCY _ �., . , � .. . ' '' � �
No. Date . ' . � �
f
, COSTA MESA BUILDING DEPARTAAENT ✓
' P. 0. BOX 317
COSTA MESA CALIFORNIA
0
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C•L. OF STREET
' _�iPROP. LINE
�-=--- ,---
I 10 FT. FOR 60 FT. STREET
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PROP LINE �`
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. 0'2 �l19 T'1 �.•
Fi H��CE IEf�T, �
CIfiY OF CO A �IESA
�
MAXIMUM 4 FT. FENCE MAY BE PLACEO ON DOTTED LINES------ I
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES
BUILDING
Mail
TO FlLL
�
��'�/�-� �'" Ph. No.
d-O.— — —Ph. No.��..s�2y 7
��/� �� / %S � � �
City Lic._No. __r� _�1'.-/9 — State Lic. No:—�____
Size of Lot AP No.T ��� /%��/
i
Setbacks: C/L Street �� %� Rear �
Side Yard - Righ eft � � �
` �� 4
Type of Fence T-f� � /.O /%���
I hereby acknowledge that I have read this application and state
that the above is correct and agree to comply with all City Ord-
inances and State Laws regulating building construction.
FOR OFFICE USE ONLY
Permit No.
5593
Received by Date Received Date Issued
� �" �O S% AUG ? d 1957
VALUATION � �
Permit Fee $
$ %�� -�j Plan Check $
TOTAL FEE . $ � —
USE REVERSE SIDE FOR DETAILS
Cf
� PACIFIC I1P"aT�AT,`uER5, INC.
751�'I Anthony Avenue
Gazden Grove, California 926lt1
P.O. Box �28
Westminster, Calif. 92683
State Lic. # �-�� �9� City Lio. # �t�.3
R �oF �osd � �
PLANNING DEPT.
JUfJ 1 ; t`" �
PM
Ah1
7�gi9i10�11�12�1�2i3i4�5�6
,!
City o£ ���R� �C!✓��
Department o£ Building aad Safety
Date ��/' 7
Cuatomer 1Pame 11�!�'�-L�A��
Pexmit No'e. �����
Tqpes of Pexmits ,f�-G��u
Geatleffien:
Pleaee be adviaed Llsat as of ��/7� all work by
Paoific Inetallere, Tssoorporated, on the peffii.t n�bers 13eted above
have been cancelled.
Therefore, Paoific Inetallers, Inoorporated, requeets that the
pe�mits be canoelled ead that all pre-paid Yees be retlmded.
Thie oaaoellatioa notiae ie advice to you that Paoific Inatallere,
Inoorporated, hae no reeponsib�idity -fo�c work acoompliehed uufler
Pe�ite aoted at �55�% .�D-1 /�.�t.� ,
Yery truly youTe,
PACIFIC IIPSTALLERS, INC.
�� �i��
Mauager
PI-26k aev. 3/74
' ��
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
pRIU
i1,M—?-77�;��_:;C'A 01y ,,:>��:ai}�u.r0
APPLICATION FOR STRUCTURAG PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED qTE ISS
BUILDING
AD�RESS
PEIiM1T NO.
OWNER A.P. NO.
MAIL , . BUILOING �
ADDRESS ADDRESS
TEL. TRACT �OT BLOCK
CITV NO.
CON5TFUCTION EW AD A T R PA
LENDER
BRANCH
OW R
ADDRE55 ' VALUE
ARCHITECT TEL. S $
OR ENGWEEfl O _
FIRE
ADDRESS ' ZONE T PE GROUP
APPROVED .� � ��
CONTFACTOR � � • B�' DATE
ADDPESS
TEL. ZONE NO.OF USE OF NEW
CITV NO.
PLANS 'BUILDING
' STATE CITV �'ARDS APPROVED VARDS APPROVED
LI0. NO. LIC.NO: � MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BIDGS. (FROM C/L STREET)
OF LOT ' - NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. SI FT. ' FT.
Separate permits are required for � �. sioe FT. FT.
electric, plumbing and heating work. .
REAR ' FT. FT.
VSE OF BUILDING AND WOPK TO BE PEFFORMED DISTANCE BET. BEf, MAIN &
MAIN BLDGS. ACCESS, BLIX'S.
VAF.# DATE '
C.U.P.� APPROVE�
APPROVED
I hereby acknowled8e that I have reatl this application antl state .
that the above Information (s cortect end aB�ee to comply with
all laws regulating building construction, antl I shall not employ
any person in vlolation of the workman's compensation laws of
the State of California.
I hereby certlfY that I am properly Ilcensed as e conttactor untler SQ. FT.
the State of California Business entl Profassions Cotle, Divlsion 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR
Chapter 9, antl that such licenses are in full force antl affect,'or I THE PU(iPOSE OF ESTABLISHING A PERMIT FEE ONLV:
em ezempt from the provisions of the State of Callfornia Business V ALUATION �-0
antl Protessio Code, Divislon 3, Chapte� 9. PERMIT FEE $ �
PLAN CHECK $
Signature of
Parmlttae $ � TAX $
'
Auth iz AgenT TOTAL PAID $ ��
OWNER pTTG�� �ART.T(1N E.=
JOBADDRE55 2549 Fordham Driv
GENERAL CONTRACTOR R. M. Wil
A�,��J�o. 4 - 'l} LOT 1
'-: �-`"�";� ;..� C T I O N 5
GA�
WATER
ROUGH PLUMBING
PROP. SWR. LINE HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONOITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUN� � POWER �
ROUGH WIRING
TRENCNES � FORMS � STEEL REINF.
FLOOR SVSTEM
BON� BEAM STEEL REINFORCE
SHEATHING
FRAME nN0 FLASHING
LATHING — IN OUT
PLASTER, BROWN COAT
STo���TURAL, FINAL
F ', VENT., REFRIG. AN� A.C., FINAL
P. NG, FINAL RN� GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
DATE
BUILDI
RIPTION of WORK p
ZONE VALUE
)UP J TYPE
SUBCONTRACTOR
28482
-
COSTA MESA BUILDING-SAFEiY DEPARTMENT
P.O. BOX 7200 COSTA MESA� CALIFORNIA 82620
For AppllcaM ro Ftll In CompleNly
TYPE OR PRINT
oR�a �S�ir� F�-��/�a�
COSTA MESA, CALIFORNIA
Tasw (;�)Y`�T/I71 ��Gt SfP��
� /S
�A7N., i C ra/
� 66TBACK LINH PROM
DESCRIPTION OR WORK
W.� �
,PLY WITX ALL
oUILO1N0 CONI
� AUTMORIZ[D AO[N'[
�. O�
)OMH
ROOP
n�vs
J
APA 22=fi��A001279 �*****3.00
A►PLICATION FOR PERMR
BUILDING
For Offin Ure Only
B PROV[D //`�/� l� DAT6 �/ � L
/
ZONING
QJI—� NO. 0/ U�t 0I N[W �
�` �uxs ' evao�qa
D[YCRIRION"" �/ �� \ � " � "
� P. �o. /Y/— 3 � 3 _ y�
N0T6: NO EAVE OVERHANO BMALL EE LE86 THAN
YARD8 MPROV eD
MAIN BUILDIN6
VAR. �F
YARDB MPROV BD
ACC6880RY BUILDINO
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rr.
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eer. MwiN a
ACCES9. BLD08.
DAT6
APPHOVHD
...�e y-12 '�o�
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BQ. Ff. �
•xc �wounr axoww uxoea vww�nox �e voa n�e �
►YRPO![ O� ftTApLIGMINO A P6RMIT P6H ONLY. �
v�wwnoN nn �
/� PERMIT FE6 V � �
�,S �— — o
: w
Mesa Building Department
P. O. Box 3!7
FOR APPLICANT TO FILL IN
� z549 FORDHAM DRIVE
Costa, Mesa, California
Owner COLLEGE PARK No. 2
Mail
Address 2� �6 �O, MAIN 5T.
Tel.
CItySANTA ANA. CALI F, No. K
Arohitect or Lic.
Address
ContracMi
Addreu
Legal
Descripti�
(Attach M
Size of Lo1
4se of
Existing B
Setback L
Center ot !
1
New
c�er
C o rvo.
Lot
No. 31 Block
x
Rooms
I Roof
B
Addition
Demolish
�7
:�PPLIGATION FOR PERMIT �
��?s BUILDING '
FOR OFFICE USE ONLY
I Receipt No. I .Permlt No.
� Q d
Received hy Date Rec'd. Date Issued
�iV�'lm � 11 � 11-Sb l2 -//-S�.
Building
Address
Costa Mesa, California
Nearest
Cross St.
CORRECTIONS
a
APPROVALS
Frame: Fire Stops,
I hereby acknowledge that I have read this Application
and state thak the abave is correM and agree to rnmply Lath. Ink.
with all Clty Ordinances and State Laws regulating
bullding construCtion. Lath. Ext.
Signatureot '
Perm�ttee HARBOR CONSTRUCTION C0. p�aster,�nt.
Authorized Agt Plaster, Ext
Valuation Pe�mit Fee $ "' Masonry Reinforced
Plan Check $ � �
Bond Beam
g I I �200. Total !,
Fee $ '7� FINAL
am zoa' io.se o. v. e s.
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'r
2
Ti
�
GAS
W �TER
NOUGH PLUM9ING
PROP. SWR. LINE HOUSE
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR C01
TEMPORARY SERVICE OR P01
UNDEHGROUND � POWEi
ROUGN WIRING
TRENCHES� FORMS
FLOOR SYSTEM
BOND BEAM � $TEEL RI
SNEATHING
FRRME AND FLASHIN
LPTMING - IN OUT
PLASTER, BFOWN COr1T
STRUCTURRL, FINAL
NF i, VENT., R�FRIG. AI
DATE
SUBCONTRACTOR
, - � g�'i
' . COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING �
ADDRESS TC' i1R
OWNER I\I I� �ONI�I G^Jl1�AS
MAII
' ADDRESS .C/� h
TEL.
CITY � :�TI- 1 �L-:�I+ NO.R �—V�
CON5TRUCTION �
LENDER ' I/ n1�= �
BRANCH
ADDRESS '
ARCHITECT TEL.
-.�__ - ___ _ _
�s�/o //-7G
APPLICATION FOR STRUCTURAL PERMIT
EC�IV�D BV IL��/�///J OI�E ��U/
/J L/1
C A7T
BUIIDING .
ADDRESS
OWN
IOTJ/ I BIOCK
FIRE
ADORESS ZONE TVPE GROU
APPROVED
CONTRACTOR . lf..,.'�� }� $1 ��(��� BV DATE
ADDRESS J��.,� 2��Sj�ljl� A1 L
TEL. / ZO NO.OF USE OF N W
CITVC; [' �� NO.Cp��)'-�y�3S� PLANS BUILDIN
F STATE . CITV �' DS APPROVED VARDS APPROVED
� LIC. NO. �� . LIC. NO. � MAIN BUILDING ACCESSORY BUILDING
{z� SI2E ` NO.OF BIDGS. (FROM GL ST E T)
L OF LOT � �('J �� NOW ON LOT FRONT T. F
� USE OF
EXISTING eIDG. L�� � L�CL SI E T. ' F
�
FSepara[e permits are requiced for �. sioe J FT. � F
Q . electric, plumbing and heating work. REAR � F // F
W USE OF BUILDING AND WORK TO 8E RFO ED
F DISTANCE BET. BET. MAIN &
Q MAIN BLDGS. ACCESS. BLDGS
� VAR. # DATE
a� � C.U.P.� APPROVED
� APPROVE 7
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.�
m
W
0 I hereby ecknowletlge that I have reatl this appllcation and state �
a that the ebove info�metton is corract and agree to comply with
a all laws reguleting building consttucNon, entl I shell not employ
z any person in violation of the workman's compensation laws of �
� the State of California. ' ' �
3 I hereby cartity that I am properly licensetl as a contractor under � a• SQ. FT.
tha State of California Businass and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUA'
Chapter 9, and that sueh Iicenses are In full force end effect, or I THE PVRPOSE OF ESTABLISHING A PERMI'
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $
antl Protessions Cotle, Division 3, Chapter 9.
� // / // y � PLAN CHECK $
Signature of // ` ��' � / / / / T �
Permittee �//// � / �7}.��Y'.�/� L/ $��� TAX E
Autho�i Bent / TOTALPAI� $ -
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OWNER
10B ADDRESS
GENERAL CONTRACTOR
BLiILDING PERMIT NO.
VALL[E
AP. No. LOT 31 TRACT 272C FIRE ZONE DL�SCRIPTION OF WORK Grape Stake F.ence
TYPE
PLAN NO.
`ECTIONS I DATE I SUBCONTRACTOR I DATE PERMITSNUMU ER
coat
5593