HomeMy WebLinkAbout487 FLOWER ST - Building Permits�I
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PN0.IECTROOflE55: �IB I FLOWER ST
OWNEfl'SNAME:I,ORETTA BEACH .
, aoosess:487
FLOWER ST
COSTA MF.SA, CA 92627
(714)548-3890
UNIT: --^
0
/y�N/ENCINEFfl: NEO.NO.:
�` �DONE53: ' UNR:
�� PEflMITTEE: ROSS 6 BARROW5, INC. ( 714 ) 557-7440
��� AODNESS: 26O E. ALTON AV ---
, �SANTA ANA CA 92707
j UCENSED CONTMC70B OECLAIL1710N: I hareby aHirm ihat I am Iicense0 unAer pmvisions ol Chapter 9(commencinq with Section
7000� of OiNsion 3 ot tAe Busines5 anG Pmlessions CaOe. anG my licensa is in tull rorca ana effecl. �
cinuc.:�?0924 sr�reuc.:327802�f �cu : .-39
Date: l2'y �9 . Signawre��u�
WOBNEBS' COMPENSRTION OECIAMTION: I Aere6y attirm Ihai I have a cenifiwte of consent ro sell-insure ar a certificaie of Workers'
Compensation JnSyran� qr y cerWietl copy tAeaof (Section 3800. LaD..C� � 0 1/ 9 0
roucxno.:STATE1FUND �P�p� U
COMPANY:' hS �
� Cerlitietl coDY �s Aere6y tumished. [9 CeNfieO co✓py is %fi d vnN Ne ' BuIIdNO �sion.
oa��-5l �% ancr��! `�a � ��r -�_
F%EMPfION FPOM WOPKEXS' COMPENS�TION oFtlAP.1TI0N: (ill¢ uction nee0 mt be mmplete0 il the perimt is fa are hu�reU (5100) ar less�.
I cellify Ihai in Ihe pertormance o� lhe work tor wAich tl1i5 pefmit k issueE, I sliall not ¢mpby any person in any manner w as to become
sublectro the Workers' CamOensation Laxs af Califomia. ,
Date: Signature:
NOTICE: II, afler makn0 �Ak EecWratlon, yrou sMWU Uecame suDlect m the Workers Compenutlon provisions oi the La6or
CoOe, you must forthwith comDry with sucA D�avisions or tMs permil shall De EeemeO revokeO.
CONSTBUCTION LENOING �GENCY: I hereby attirm tAat thea is a wnsiruction lenainp apency for Ne petlormance of t�e work far
which ihis Oermitis i55ueE (Sectron 3097. Civ. C).
�xoee: `
eooeess:
OWNEP BWlDEB OECIAMTION: 1 hereCy attirm ihat I�m exempi imm t�e Contractors' Sute Licenu Law lar the I011owin0 mason
(Sec�ion 7631.5 Busineu antl Protessional CoOe: My dry ot wunry wAkh requims a permR to canstruci. alter, improve, demalis�, or
reDair any stmcWra, prior to its issuance, atm requires tlre apDfwnt br sucA permit ro lite a 51pneC statement ihat he/she is licensed
pursuant ta t�e provisions ol t�e Cantacrors' State License Law (ChaD�er 9(wmmencing with Seclion 7W0) al Division 3 oi t�e Business
antl Protessions COAe) or that he/s�e is eeem0� Nerelmm anE ihe basis for IAe allepeE exemptlon. My NOWtion al Section 7031.5 by
any aoD�icant tor a permit suh�ects tne appliwnt Io a civil Denalry of nat more Inan fiva nundred Oollars (5500).
I, as owner al t�e Draperry br'my employees vrith wapes az tAeu sole comDenution, will Ua Iha work,.and the
❑ SINCN�O i5 OOI 10t¢nd¢C 0� OflE�¢tl 10� Sa10 (SCc6on 70Cd, Buvness antl Professional CoOe: The Conlraciors' Sta�e license Law
Aoes not aDPN �o an owner nl a DmOerty wlio Eullds or im0�'es ihereon, anC wlio Eoes such work Aimsell/herull or t�mup�
his ar her own emDlayees, D�ah0e4 IAat suU� improvements aa not intenOeE or offereE br sale. Ii, haxever iha bulidinp or
Improvement is sold within one year of completlon, t�e owner will luve Ihe burAen of provinp he/sAe Oi0 not bui10 or improve
� lor tAe DurOase ol sale�. , �
I, as owner ot tAe D�o�rty. am axclusively contractinp wit� Iicense0 contractors to constmct the D�oject (Section 7044, Business
❑ anA Pmlessions Cade: The Contactors SWte Licensa law Oas not apDN �o an mmer of 0�7erry who hutlAs or impmves tAerean
an0 wAo contrads lor suc� D�ol�� ��h a coniractor(s) licenu Oursuanl to the Contnctors' Siata License Law). I am aware'
Inat proof olthcir Woher's ComOensatlon insurant¢ S�ou10 L! proviUetl Io me. .
� I am exempt under Sectlon: 8. 6 P. C. ' �
lor ��is reuon:
Oate:
Owner.
I Eo �emhy certiy ihat I am aware of anE unGerstand tAe requirements of CalAamia Healih antl Safery Cotle Sectians 25505, 25533, ana
25534 anG IAat I of any lutua OuilOinB a�upani wllVxiil nm (d¢lE onE) nte0 io Comply witA saiU 5�]�e to0e5 antl ��B fequiram¢nis for a
permit far consimcilon or mo0iliwtion imm the Nr Oualiry ManaOement OlstncL Hesltleniul wnsvuction aDP�iwtions are exempt Imm
Ihe50 prOvisions. �
�ate: � ApD�icant
I herehy certity tAat I have reaC tAis aDP���tion anC state that t�e ahove informatlon is wrrecL I aAree ro wmpty vntA ail city an0 cdunry
oltlinanCes anG Slaie Wx5 2Wflnp t0 EuiWinp CpIStNtG011 an0 ht2Dy aIMOri2¢ r¢p25EntatlV¢5 0� th15 tlly �o enlef upOn Ihe d00vEm¢nlbn80
pmperty far insDection purD�es. // ,��/
Daie: 1/�— / ' �� Signalure: � �/ �'�C✓ '��
Oriver's License or Socia� Securiry a:
�Ba�-a6 White—BuilEing; Green—COEe Enlorcamant; Canary—Applican4 Pink—Revenue; GOIEenratl—Assessor
CITY OF COSTA MESA — DUIT.DZNG L�ERMIT PERM D10: B 0q5245
P�RMIT NO: H 045245 PLAN CHECK NO; N GOVT: N SUPI?; N
CONSTRUCTION TYPE: 5—N PERMI'f TYPE: STR PURPC�SE; ALT
JU� DESCRIPTZUN : RE—ROOF W/C.LASS A FIBERGLASS SHZNGLES SQ ET: 3,900
CLAIM'VALUE: J,900.OU CALC—VALUE: � �,900.00 GROUP OCC: R-3 /
CqMMENTS: RESID�NTIAL RE—ROOF ONLY.
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Z O N I N G R E Q U I R� M E N T S
S E 7' H A C K S
------------ MAIN BUILDING ----- ----� ----. --- ACCESSORY BUIL�llING --------
FRNT: FT IN REAR• FT IN ERNT• FT � IN REAR: FT IN
LEFT: FT 'IN RGIiT: FT TN LEFT: PT IN RGHT: FT IN
PARKING REQ; PROV: PARCEL: 17.7]421A 7.NF.: REL•' NO:
PLANNING NUTES>
? .
�r**�+�*x*��***�*�r�;���c*�*�*x�r+r*�*�r�*x�x�*�r*���r����**x�*���**����**���x���±r*�*��c��*�
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 APPROVF.D AY : . _____ ___ __ DATE: .`
BU7LDING APPROVED BY. : __ �' ' DATE:
APPL'ICATION ISSOED BY: C�� DATE: ���
it*ftitiE*it��itit�t�tit*iEfEititiE*�c�it�i t t v iF'i e. 3Fi�'iFiF3F" iFiFiF'�taEitiEx�itiE�:-i6iE '3F�t�t
*�r**+�+���x**���*�r+�**x**����r�r*�r�***�**�*���r**xi ��r�r*����***�*�*x*��*+��r*;�**+�*�r�*�**
LEGALIZATION:N F E E S 0'M M A R Y STRUCTURAL SEGMfiNT:Y
➢LUG PMT PLUMBING LLECTRIC MECHANIC FIRH SMIP/RES GRADING
rr•.xMr.T h�.00 .so
- ' SMIP/NON—RES�
PLAN
rssoc r�E
AUIL�DING—DIV-> PGRMIT ISSUE PI,AN—CHECIC TOTAL� PAID DUE
TOTAI,S----> '63.50 0.00 0.00 63.50 63.50 _00
REVENUE llIVISION TOTALS--? COL�LECTGD: 6J.50 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC M�CIiANIC FIRE SMIP/TOT GRADING PLAN—CHECK
�3,'�� . . .��
.� 9E iE iE IElE iF k iklF it if iE iE k ik �klE iE iF iF if iE 1E ik 3f if iF iE iE iE !E iE k iF iF ff iE !f it 1E IF iE if !f # if� ik iF iF It%iF ik iE iE k iE �E ik iE 1E k iE if iElF 3E iE iE %iE iE if !f 3f # k�E
I N ll I V I D U A L F E E � R E A K�D O W N
TY.PE QTY D E S C A I P T I O h] UDIIT COST TQTAL GOST
SFR :)900 RERO�F L�Y. VALUE RESIDGAIIAL MO'LONE 1.00 3,900.00
ETID OF FEES
01 OD048872-�U043873 T 4 T 63.50
DATE: 12/04/89 TIME: 1?:55 �
0
�" . f �/
CONSTR.�� �AND PLANNING . POO� a SPA �
' APPROVALS Permit# ;{Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole - 52.� Pool & Equipment Location
2: Soil Pipe�Undrgrnd. ; 53. Steel Reinforcement ��
3. Electrical Conduit Utility-Undrgrnd. 54. Forms .
-4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding �
, 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Elecirical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings � �' 58. Electrical Conduit�Undrgrnd.
8. Foundation . � . 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. • � 60. Backwash Lines, P-Trap, � Undrgrnd. •
10. Structural Floor System ��� 61. APPROVAL TO DECK �,
11. Property Sewer Line & House�Connection ' 62. Backwash & Receptor�Final �
12. Sewer Cap 63. Heater & Vent-Final t�
13. Roof Drains 64. Plumbing System � Final ��
14. Rough Plumbing 65. Electrical�Final �
15. Rough Electrical�Conduit 66. Solar SYstem-Final
i 6. Rough Electric Wiring 67. Fencing & Access ApP�oval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING .
18. Rou9h Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ._ FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace _� �. APPROVAL�S � Permit #
21�. Ducts,in Structure ' �� 70. Underground Hydro
22.Ducts,Ventilating 71.ProduccPipingOGas ❑Oil
23. Gas Pipe�Rough & Test � _. , 72. Underground Flush
24. Roof Framing � � 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing . 74. Overhead Hydro ,
26:�T-Bar Ceiling (Structural) & Monocoat �. 75. Dry Chemical �
27. Frameand Flashing - 76. DryStandpipe ,
28. Lathing&Siding � - � _. � � � 77. FIXEDSYSTEMFINAL
29. Insulation � . - 78. FIRE PREV. FINAL ' ��
:
30. Drywall Nailing _ - �' � HEALTH DEPT. RE�UIREMENT
31. Plaster Brown Coat �•' 79. FINAL INSPECTION '
32. Electrical Power Meter-Final - S0. FOOD CERTIFICATE ISSUED
33. Final Electric � � � �f� �, � Notes:
34.. Final Heating & Air Conditioning , , � .,
35. Final Gas Pipe-Test �' � ' � � '
'.t'
36. Hood or Canopy ' - ' '^d , _. � �
37. Final Factory Fireplace � - � - .
38. Final Plumbinq � - � �
39. Water Service-Final . ' � .
� 40. Gas Service-Final , . _ ` . _
41. Solar pomesticFinal ' � �� -
42. Backflow Preventer ' ' .. . - .
43. Backflow Irrigation � � � � - . _�
� 44. Landscape Irriga[ion System �, � , . , ' .
45. Sound Attenuation . � • . �
46. Handicap Regulations - , - : ' _
47. FINAL STRUCTURE & BU�LDING ��� 8y �'�! � -
t
48" FINAL PLANNING �- � ' •
/
" 49. Electric'Release to Edison % ; � �
.� . .
�' 50.'Gas'Release to Southem California Gas Co �� .
51. CERTIFIEATE OF OCCUPANCY
No. Date
TYPICAL
Cement Coping Ootional
Channel Block With 1-3/8
0 Horizontal Top of all
Fences
For Fences 5' or Less _-
Vert. Bars 3/8" 0 at 4' -0" O.C..
I For Fences Higher Than 5'
Vert. Bars 3/8" 0at 32" O.C.
Fill Cells Solid With Grout
' WhereSteelOccurs
Reinforcing Steel Shall
Conform to Sec.A-15-39
A.S.T.M.
All Steel to he Lapped
. 24" or to Code
NATURALGRADE
TWO 3/8" 08AFS
CONTINUOUS TOP �
& BOTTOM
ALL STEEL MUST 8E TIED IN
PLACE AT TIME OF TRENCH
INSPECTION.
6�� CONCRETE BLOCK FENCE
' 1.0 =_}=,1 . C . ' . y
. UI�.�� ,p .
� I I
I.11 . � . e . .s '
F�--WIDTH TO 16� O.C. �
��- SEE CHART �,
.o� �� s� BELOW o�' oe., ���
L _
�
�
GENERAL- NOTES
MORTAR: p�e part Plasfic Cement, and
Three Paris Sand
GROUT: One Part Cement Three and
One Half Ports S�and
COPING: One Part Cement, Three
Parts Sond
CONCRETE: Well Mixed 1:2-I/2:3-I/2
Maz. of 7- I/2 Gallons of
Water Per Sack of Cement
GROUT MAV BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLSAND AREASOF HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN &
fREE OF ALL MORTAR DEBRIS, ETC.
PROVIDE CLEAN-0UT AND INSPECTION
HOLES AT THE BOTTOM OF CELLS CON-
TAINING VER7ICAL REINFORCEMENT.
BONDSSHALL BE PROVIDED BY LAVING
BLOCKS IN STRE7CHER COURSES SO THAT
VERTICALJOIN7SALTERNATEIN EACH
COURSE.
DEPTH OF EARTNTCOTH
I/3 THE HEIGTH OF FENCE
BELOW BOTTOM OF FOOTING.
SCALE: i/2�� = I�
FOOTING REQUIREMENTS CHART
WALL HEIGHT . . . . . . . . . . .6�. . . . . . . . . . . . 5�. . . . . . . . . . . . 4� . . . . . . . . . . 3�
WIDTH . . . . . . . . . . . . . . .14" . . . . . . . . . . .14" . . . . . . . . . . . 12". . . . . . . . . . . 12��
THICKNESS . . . . . . . . . . . .10'�. . . . . . . . . . . .10" . . . . . . . . . . . 8". . . . . . . . . . . 8 ��
DEPTH OF EARTHTOOTH . . . 24�� . . . . . . . . . . .20�� . . . . I6��. . . . 12��
SPACING OF EARTHTOOTH. . 12' . . . . . . . . . . .14� . . . . . . . . . . . 16'. . . . . . . . . . . 16�
OWNERS NAME: �//.<"� Ll�G`//ff ('ZG.�-1a5C1+' _
City of Costa Mesa California ��B ADDRESS: _y�Z �BW�`P�C_r!• _____
� PERMIT NUMBER:_'/'/')
Building Department SIGNATURE: �✓�� �Y�t���_ _ _ _ _ _
1'ORM CU21-BM-x
� �����
�1� Qf COSTA MESA
FLA�:t�?NG DEPT.
', eUB)fCT YO 81DG• OEFT' REG.
� 5 / t 3�B.J.
1 BY GLti� �, DATE.......__._..-�-
D{RECTOR Of 4�NN1N6
1. { ;r, �� ' s
- � , '�r ��.� :�_ '���
CNy of Coste Mesa Building Dept.
THESE PLANS MUST 9E ON JQB AT All TIMES
MAKE NO CHANGFS WITHOVT PRIOR APPROVAL
Oi DEPf.
THE ISSUANCE Oft GRFN7ING Of A PERMIT OR APPR�VAL
OF PLAdS AND $VECIfICAT10NS SHkLL NOT 8E CONSTRUED
TO BE p PEflMIT FOA, OR AN APPROVAL OF, ANY VIOLAiION
OF ANY OF THE PROVISIDNS Of THIS CODE. NO PERMfT PRE�
SlJMIN6 TD GIVE AUTHORITY TO VIQLATE OR CANCEL THE
PROVISIONS OF THIS CODE SNAII BE VALI�. EXCEPT IN 50
FAR AS THE WORK OR USE WHICH IT AU7HORlZES IS IAWFUI.
THF ISSIIANCE �F A PERMIT BASED UPON PLANS ANO
ISPECIFlCATIONS SHALL NOT PREVENT THE BUILDfNG OFFIGlAI
� FROM THEREAFTEfl REQUIflING THE CORRECTIOf� Of ERRORS
IN SAID PtANS AND SPECIFICATtONS DR FRON, PREVENTING
B61lDiNG OPERATIOYS BEING CARR�[D DN THEREUNDER WHEN
IN VIOIA7IpN OF 741s CODE OR OF ANY OiHER OR�INANCE
QF1HEfd'C8.'e.A .-�
e
0
�A�
RESIOENtE
_ �G_ ��_STREE� -
STRUCTURAL APPROUAL ONLY
$EPARATE PERMIiS ARE REOUfR�D
FOR ELECTRICAL, PLUI:�SI:-�r,
HEATING, UEfVTfLAtiiVG ANO
REFRIGERATION WORK
Permit # -518�I
THIS NU�16ER MUST ACCOMPANY
ALL INSPECTION REQUESTS !�
FOR BUILDIYGS 4VHERE PERSONS ARE TO �
BE EMPLOYED, V�E SUGaCS( T4AT THE �
STATE OF CHLI'rOF(11a plt/lSIQN OF
IhDUSTRIAL SAFEiy �� CGiQSULTEU FOR �
ADDITIDNAI REQUIRE�viENT�.
APPLICATION FOR A BUILDING PERf�T
rract eiocw �ut BUILDING PERMIT NO. �`,°n`;i ry�o. �
� /� L (Q a
Plumbinq
Aqdr�ess � Permit No. �p
D
Crosz �'�°��^�v� a
Arp,� Street C yy� ���y� � Permlt �
lL[_�c�C ._
Owner �Q! TyDe oi Projecl: ❑ Nev.'\ Al�m ❑ AGditiOn �
cqLc
A9tlrezs � ❑ ReDair ❑ Converl Demo ❑ Occuoancv vmt.
Suo. D�st./
CitY Zip Poor�l�3 A.P. InsD. Area �
qr�nit¢ct/
Gpsigner L�cense No. 2one SD�� Pmt. No.
Setbatks /l FroN GL SL SVeet W�Oth
AdG.ess
VarCs Lel� ignt ear
Ci{y 21D �One
ave o�. < �9 � �
Enqineer LJcenu No. - - - - " - ' ' '
� rk nq pa�a's aOwre ovi e overe
gAtlOress
m Ci� Zip P�one Sttucl Na. OI No. ol I
y Heiq�t Stories Famtly �
q LICENSEO CONTRACTOR'S DECLARATION vark Fees ves � T Recei t I
m � ner�by afli.m rhat i em licensed untler p.ovisions of Cnepnr 9 Requlretl No P
Y (Sommencinp with. Se<tion 7000 of O�vision 3 of Tpe 8osin�ss antl Zonin9 App�OveC BY: Date �
Proinsioes Cotle, an my licensa is in 1u11 lor<e entl eHecJp.�
7� Licenu Clas ly e�nse Num�ier ��(' ��5 � I
> Dete �" — ConvaCm
//�t�i �FdBff7jXGZS Misc. I
E Atltlr.ss �� 7 �—+��LT�cN��['.J �oDosea use i
LL CitYantl�i�� .�A /�9nQne G�{��7� ol5iructure i
�+ CANSTRUCTION LENDING AGENCV I
d ' �erebv effirm ilw� tbere is a consvuction iantling egency 1m �he
d Perto.mance of the wo�k fo. wnic� tnis oermlt Is issuatl ISe�, 309], Occ. TyDe Coa (
' Civ. CJ. aass Conz�. ve �
y Lentle.'s Name t1SE/OCCUPANCV S7ZE SQ. FL I
C Lenpe�'s Atltlress I
J �
OWNER$UILDER DECLAHATION � I
� I hareby atfirm that I em e�empt irom the Convector'S License Lew
W bf�� tM1s iollowinq raeson:
� U 1, as owne� ot i�e properry, or my employ�es wi�h wages es t�eir 2. I
fplp COmpMtatioo, will Co t�< wOrk, entl t�! [��uctu�e i[ 00�
r ;} imentle� or oftv qtl �O� SLIB. 3
� �J I •s owns� Of the plOPerty, em eacluiiv[ly cOnVlciinp witb
� IiC!l15Bd Wf1V2CiO�i 10 COnTbpCt tf�E pf0)lCt.
� ! em ea�mpt untle� $e[. , B&PC �or this r�sson 4'
a Oei. Gwner ,
Total Valuation i
E WORKERS' COMVENSATION DECLARATION ^ I
� I h�raDy Wirm tM1ai I heve a u.Hlicete ol ronsem to self-in�ure, Encroachmenl Permil Requlre � Ves L No
or e certificate ot Wcrkers' Compenuuo� Insarance, or a cerriliee
�' copy tnmeol. Gratling PmL f�1 Graaing
S Poli:y No Compeny _ Reqw.ea LJ ves rvo vmt. No. �
❑ COrtifiltl ropy i� ��reby furnishetl.
Rou9n Gratlinq ' 'O
Q ❑ Certifiatl coov ii filetl with Oranqe Cuunty, EMA. ApOroveE by: Da�e �
Det• ADPliceni 3
CER7IFICATE OF EXEMP710N
FROM WORKERS'COMPENSATIONINSUqANCE Z
IY�if wction neW not ba compl�taa if permi� is io� 5100 0� less).
c
� cwtity tMt in ihe p���orm�nce o1 tM1a work ior w�ic� t��s parmi� is 3
�iswtl, I M��I nOt �mploy eny O n in eny r�uw�¢F to es t0 become ,�
subj�ct t th yVqrhari Compen 'o Lews m Ca fo�nia �d FE MIT FEES �
Det •Y��•S/ qPGlicent �
NOTICE TO APPUCANT: 11, �f)er nukinp 2��s Cntificaie o� SVuclwai f Pbn fhecw 3 �
Ea�mpiion, you s�oultl Oecoma wb�b io tA� Workwy' CompanuUon C_nl I
PrOvialons ot tM �ebor Cotle, you must fort�wit� romply wit� wc� �
ElecViWl S � �S� S
Provisiona or Mia Owmit f�ell Oe tl�amad r�voked.
� CERTIFV TMGT I MAVE READ THIS APVL�C�+TION AND STATE
TMAT TME ABOVE INippMATION IS CORRECT. I AGREE TO qumDing S
COMVLV WITH 4LL COUNTV ORDINANCES AND STATE lAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBV AUTH� ���enical S
QR12E REPRESENTATIVES OF THIS COUNTY TO ENTER VPON
T ABOVE MEN ONED �qOVEFTY POR INSPECTfON GUR� pr�.GraEe
E . • 1����'// Inipection s
l� Re•Gretle ppr n
Sipnetvra� PClicenr or Apant Dala Rec. No. f Iis e s
/�c1�G �aBE�9/�� S
vbn Is uance �
AU splca witAin this box must b complsiwl to prnqu C�eck By: pro�ea: +
CMF 0335-46 (8U-2B) rev. 6/80
CITY DF CUSTA MESA
CALlFORNIA 02628 P.O. BOX 1200
FROM THE OFFICE OF THE DIRECTOR OF BUILDINO SAFETV
Project Address /7�g % �GduiE•E� sT.
Project Name
/
• � � ��. �
� L ��.
Owners Address L,/�� �LpLrJ�,� s�%
O�mers Telephone �yQ .��5"iQ
��t � .�/ � �
�YPe _ ���L��
City Use Only
I %�v__ ___�DdEilt/(IS as OwwerT Contractor, Ager�- (strike out all
except oneS � hereby attest that employment of any person, or pexsons, is not ,
anticipated at the tiune of seeking the above-referenced pecmit. In the event that
any person, or persons, are e�loyed under the provisions of this pezmit, I shall
inenediately cause a valid Certificate of Wor]anens Compensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my cxan �st, ard to indemnify and hold harmless, the City,
its officers, agents and/or e�loyees, fron and against, arry and all liability,
damage, costs, losses, claims and expenses, howscever caused, resulting directly
or indirectly fran, or connected with the improvement under this permit.
I further state that I have read and fully imderstarr3 t
sponsibilities of the above statert�ents, and will ca�ly
Contractors State License Law found under the Business
Division 3, C1�apter 9, of the State of California.
Jo�� �,eoR�ti/vs
Print Name
�
S ature
CMF 0777-46
ie iunplications and re-
with all provisions of the
�nd Professions Code,
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Ik�te
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ii�"°��EcnoNs
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GAS
WATER
ROOGH PLUMBING
PROP. $WR. LINE
SPNINKLING SVST
ROUGH MEATING ANO RIR CONDITIONING
UNOERGROUNO U POWER
ROUGH wIRING
REINF.
80ND BEAM [, SiEEL REINFORCE
SNEATHING
FRRME ANO FLRSHING
LPTHING — IN i
PL"�TER. BROWN COAT
iURAL, FINFL
HEniINq VENT.,REFR
PLUMBING, FINAL ANO
ELECTRIC, FINAL
BUILOING, FINAL
I:D1L��]C[�x:7u1��;N1
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
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ForApplicant to Fil/in Completely APPLICATION FOR BUILDING PERMIT
�/ fJ / Cy RECEI DATE FECEIVED DATE ^I7SSUE
ADIDRESS Ta �OV✓['nR �J � —!
OWNER �ORG�� BG�GN A.P. NO. r�' J�Z '/ � PERM 9.
AODRESS / � D V✓G � ADDRESS ��j � '�LOWEI� aj (� .
TEL. TRACT 1' �`I LOT I p BLOCK
CITY C.�. .� I NO. �
CAN�RUCTION —�—�• W A /a
LENDER �
BRANCH �'�t�
OWNER
ADDRESS ���
VALUE %
ARCHITECT �/ TEL. ./�� S $ `
OR NGINEER NO.
FIRE
ADDRESS �Z'' ZONE TYPE GROUP
CONTRACTOR CR�Frt��—E C d/VS /�l � ByPROVED DATE — —
ADDRE55 �3� a/�,rTN�� /JV ZONE NO.OF USE OF NEW LOC/t
CITV NOL 64�� P�� 2 BUILDING (,�
STATE j�o.66o LICVNO.�Q�j �ARDSAPPROVED YARDSAPPROVED
LIC. NO. MAIN BVILDING ACCESSORV BUILDING
$12E I ry i NO.OF BLDGS. (FROM C/LSTREET)
OF 40T S' '22, SO NOWONLOT RONT FT. 2� � FT.
USE OF A.
EXIS"�ING BLDG. �� S lY- T D FT
SIZE OF NO. OF
NEWBLDG. ROOMS ' STORIES L.SIDE�-FT. �-H FT.
EXTERIOR WALL FOOF
COVERING COVERING REAR � FT. CH FT.
USE OF BVIIDING AND WORK TO BE PERFOfiMED DISTANCE BET. BET. MAIN &
MAIN BLDCS. ACCESS. 6LDG5.
3�G ' 0 ,I /� (� CO/YC. BGX• C URP # APPROVED
�/(/�J L APPROVED �7� � ��` Q- '�y
L p — i
1 heraby acknowletlge that I heve read this application antl state t
ffiat the above information is correct antl apree to comply wiffi '� �
all lews regulating buildin8 construction, entl I shall not employ � �
any person in violation of the workman's compensation laws of
ffia 5iate ot Calitomia. .r� /
I hereby certify that I am proDerly licensetl as a contractor under SQ. FT. „d
the SSate of California Business antl Professlons Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOF �
Chapter 9, and t�e[ such licenses are in full force antl effeci, or I THE PURPOSE OF ESTABLLSHING A PERMR FEE ONLV:
am exempi trom t�e pravisions ot the Stete ot California Business VALUATION � �
and Crotessions Codo, Di�ision 3, Chapter 9. �—
�� � � � OO PERMIT FEE $
Signa�ure of //�'/� �.��// ^_
Permlttee !`F� �/' Wf�Q $ P�„qN CHECK $
Authorizetl Agent �O
��
TOTAL FEE $
OWNER LpgE
JOB ADDRESS
G�uERAL CON
i o. 117—
INSPECTIONS
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W FTER
ROUGH PLUMBING
PROP. SWR. LINE
SPRINKLING SYSi
MISCELL4NEOU5
ROl1GH HEATING RNO r11R CONOITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUN� � POWER �
ROUGM wIRING i
r]BONO BEnM �{JI STEE� REINFORi
� SMEATHING
FRAME ANO FL45HING
NLFTHING — IN � OUT n
�P 'ER, BROwN CORT
'� 5 ,TJRAL,FIHnL
a-
MEnTING, VENT., REFRIG. AN� A.C.
PLUMfiING. FIN>l NN� GA$ TEST �
ELECTRIC. FiNAI
DATE
BUIIDING PERMIT N0.
SUBCONTRACTOR
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COSTA MESA BUILDING:*.��.''FETY DEPARTMENT APPLICATII,.. rOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA Nff��71, CALIFOHNIA 92626
RECEIVEOBV P�[jLv11T i:r.. n / /
For Applicant to Fill in Completely — Use Ink Only
BUIIDING �J A.P. NO. t -
ADDRESS (J , �
BUILDIN
OWNEROR A�DRES
TENANT ,��
UNIT OR
MAILING ��� ��/ 7L� SPACEN .
ADDRE55 /'y
�—fi�7� %///�1/_/�
BRANCH
ADDRESS
ARLMITECT � TEL.
CONTRACTOR
ADDRESS
,�/ TEL./
CITY Msr/`I SA_ NO.(pyG
STATE CITY �/'
LIC. NO. C LIC. NO/�Y
SI2E NO.OF BLDGS
OF LOT NOW ON LOT
VSE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WOfiK TO BE PERFORMED
..
0
ADD
OwNER
USE
� � APPROVED SET8ACK5
I hereby acknowletlBe that I have reatl this application and siate
that tha above information is correct antl a8rea to comply with
all laws re8ulatln8 building constr�ction, antl I sha�l not amploy
eny pel90n in violation of the wo�kman's compensetion lews of
Me Siate ot California.
I hereby certity that I am properly licensetl as a contrecior �nder
the Steta of Californie Business antl Protessions Cotle, Division 3,
Chaptar 9, antl t�at such licenses are in full force antl affect, or I
em axampt trom ihe provisions of the Steie of Calitornia Business
antl Profassions o Division 3, Chapte 9.
Signatura ot '
Parmlttea
o, �'=�C�'—�I
Authorizatl Agant
F,E'v �B ��v � v S
PLANIVING ACTION
VALUE
E
THE AMOUNTSNOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION OG PERMITFEE E � ��Q
5�o PLAN CHECK S !'a. �O
$ a TAX s
� TOTALPAID E
P
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