HomeMy WebLinkAbout3382 FUCHSIA ST - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626
Jobnddress: 3382 FUCHSIA ST
Suite:
Vicinity:
Parcel Number: 41218203
npp�icant: RAMIREZ, AJ
Address: 18032 LEMON � � �
YORBA LINDA , CA
Owner: NEIIENDAM, GEORGE W TR
Address 3382 FUCHSIA ST
COSTA MESA, CA
Contracror SELL ROOFING COMPANY
Address: 18032 LEMON
Zoning: R1 R1
Phone: (714)528-1758
Zip: 92686 �
Phone:
Zip: 92626
Phone: (774)528-1758
ISSUED BY:
Status: ISSUED
Applied: 07I03/2001
Issued: 07/03/2001
0
YORBA LINDA , CA - _ ,
Zip: 92686 ��•License: � 323842 . - -
Arch : . , • � � Eng: . � • ' .-
Address: - , - Address:' � , �
, ; Phone: ._.,,.. ' , Phone: •
Zip:
License:
License: - '
' ' . SCOFE OF.PERMIT.., ' ' " `
TEAR OFF WOOD SHAKE RERSNEATH WITH 1/2" OSB AND INSTALL MOMIERR DURALITE TILE 5.7LBS , IC60# 2656 - .
' __... _ ' _ _ __. _ ... . . ' �;�.
� . __ _. _ , i� �-- _. .
� � w _ FEE SUMMARY , �.-� ��;; � � �
Plan Check: $0.00 -- - -- _'=-` --_- __` _. ,`__CalcValuation: ' Se,000.00
Permit: $125.25 •� -- - -Ciaim Valuation: -� . Ss,000.00
�
SMIP Res: �,' $0.60 � ` %/i ' -'� i �' r
,.
SMIP Com: $0.00 - � ' , `
�i �,;
Other:� �.�.$0.00 �. _ _ .�_ �� ` , �
Inspeation:� $0.00 ' � �!%; � % ���`f
. , � _; . '�� y; � , ` � - � ,/r / i i, �
� � : , 1'�r - f--t: /' i .
- � i _ ,
�Total: � $12585� � "> ��/ � �
l-�_� ". . . i .i `,;.>, ✓/ . /
� .. � . 9„ . . � , V� . ' � U � . .
�'` ; r' ,� �`� � `v � �� PLANNING'& ZONING�, a r%�/!/ _< � ' ,
` � i � , />� i,
SETBACKS`��' /%�;\�'���.' ° '' o � c ..�'��i��� ;\Cj/�,�,
MAIN STRUCTURE Front� � 0=�0 Rear , �0-�0� . �Left + - 0=�0 �'�%� Righf � ` 0-.0.� ' : ��
. i� ` _ � � ��i
. ' _ �; - � , � ; �
ACCESSORY Front � =0-.0 � �� " 'Rear ; 0- 0 _ . Left _ 0- 0 � :' ."� � RighE ' 0- 0- � �.
',� . , � � _, � . ., , �,j� ,
/
PARKING Existing ��0�\ �-��. Required: , 0� � � Proposed , ;0 �� i�' �
. _ . . . . . . . . . . - �- ���.-
,-, _ ' ",- ',
NOTES: - _ ` . - _=:��it�_>„>'��, —
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
i EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
� for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, s�ch work must comply with all applicable codes, and all
required Inspeetione and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
zaae-as (daa�
WORKERS' COMPENSATON DECLARATION: ' ��
I hereby aflirm untler penalry of perjury one of the following dedarations:
❑ I heve end will maintain e certilicete of consent to self-Insure for workers' compensation, as provided tor by section 3700 ot iha Lebor Cotle, tor the performance of the
work tor w�ich ihis pertnit is issuetl.
0� I �ave end will maintain workers' compensetion insurance, es requiretl by section 3700 oi the Labor Code, for ihe peRortnance ol the work for whicli this pertnit is Issued.
My workars' compensatlon Insurance wrrler and policy number are: _
Certier: Policy Number _
(This secf/on need not be comp/efed i! Me pertn/t is ve/ued ef one hundrBO dolla/5 ($700) or les5.)
❑ I certiy that in the pertortnanfyq� the wo r which this pertnit is issued, I shall not employ eny person in eny manner so as to becrome sublact to the workers'
compensation laws of G lif6mig/entl � ea t�a 'i I should become su6ject to the workers' compensation proNsions of Section 3700 of the Labor Cotle, I shell forthwlth
wmply with these pr sian /
Apv��rant slpnemre:� oate: % /6 �/[7 /
WARNING: FAIWRE TO S RE ERS' COMPENSAiION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CFIMINAL P NALTIES GVIL FlNES UP TOONE HUNDRED
THOUSlW D DOLLRRE (S1Y10.000). IN AODRKKJ TO THE COST OF COMPENSATION, OAMAGES AS PROVIOED FOR IN SECiION 3lOfi OF THE IABOq WDE, ItJrEREST, AND ATTORNEY'S FEES.
LICENSEDCONTRACTORS
I hereby eHirtn that I em licey .
force end eflec�rLlc:.M� /
Chapter 9(commencing with Section 7000) of Division 3 ot the eusiness g�rofeSA�0.5 Code, entl my license Is in tull
Class N� � � 3 /
o i :-. �7 U3 �
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a consiruction lending agency for the pertortnance oi the work for which ihis pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereDy flNirm thet under penalry ol perjury Ihat I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business entl Professlons
Code: Any ciry or counry which requires e pertnit to construct, alter, improve, demolish, or repair eny swcWre, prior to its issuance, also requires the applicant for such permit
to file e signed statement that he or she Is Iicensetl pursuant to the provisions of ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) ot Didsion 3 of ihe
Business and Professions Code) or that he or she is exempt therefrom and ihe besis tor the alleged eaemption. Any violation of Semion 7031.5 by any epplicaM tor e pertnit
subjecis the epplicant to a civil panalry of not more than five hundred dollers ($500).):
❑ I, as owner ot Ihe property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl t�e siructure is not in�entled or oHeretl for sale (Sec.
7044, Business and Professions Cotle: The Contractore License Law does not apply to an owner ot properry who 6uilds or improves Ihereon, end who tloes such work
himsetl or herselt or ihrough his or her own employees, providetl that such improvemenis are not intended or oflered for sale. If, however, the buildinq or impmvement Is
sold within one year ol completion, Ihe owner-builtler will have the burtlen ot Oroving that he or she did not build or improve tor purpose of sale.).
❑ I, es owner af the properry, am E%CLUSIVELY CONTRACTNG WITM LICENSED CONTRACTORS to conslruct Ihe project (Set. 7044, Business end Profession5
Code: The contractors License Law tloas not apply lo an owner of property who builtls or improves ihereon, antl w�o coniracis for such project with a contrector(s)
license pursuani to the Contractors License Laws.).
❑ I em e:empt under sec. Business and Professions Cotle tor this reason:
Signe�ure: Dale:
Owner ID verified by dnvers license. ❑ Ves ❑ No Dnvels License No. Expires:
Venfication ol Ownership by (rype of documeni, i.e. - properry taz hill or tleed):
DIVISION OF INDUSTRIAL SAFE7V PERMR CERTIFICATON:
❑ I hereby cenify that no excavation five (5) o� more teet in depih into which e person is require0 �o descend, will be matle in connection with work euthorizetl by Ihis
permit, and thet no building sWcture, sceflolding, talsework, or demolition or dismantling ihereoi, will be more Ihan ihirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Ttle e, California Administretive Gode).
❑ As owner-bulitler, I will not employ enyone to do work which would require e permit from the Division ot Industnal Safery, es noted ebove, unless such person has a
permit to do such work fmm the division.
SignaNre: Date:
Division ot Indusirial Safety Pertnit Numbec
CERTIFlCATE OF COMPLIANCE AND AUT}IORIZATION OF EMRV: I cenity under penalry of perjury ihat I have read ihis application and state ihat the informetion given is
wrrect. I agree to comply wilh all state laws and ciry ordinances relating to building consiructioq and authonze representatives of ihe Ciry of Costa Mesa to enter upon ihe
ebove-described D���nspection purposes. I egree not to occupy or allow wcupancy of any building authorized by this permit until final insDection.
COOE 1. INSPECTIONTYPE
1616 Fixetl System Final fire Prevemion
1266 Pool Spa Final
200 Final Ra-Rooi
201 Final Block/Reteining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
DATE urtrtin�s
n-�1-o1 ra
7�
�
COOEA INSPECTIONTYPE
206 Final MecheniCal
208 Final Plumhing
210 Finel Electrical
212 Final Fira Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Q� INTRULS
'--
�I
PFl0.1ECLn0UflE5S: 'j j8z =TJCH�.CA 5T
.�_0.YNEA'SNFME: j�jEIlENDAM GcORGE W TR
aooxess: �3$2 FvCA�IA ST
COSTA MESA,CA 92626
(714)549-9334
APCN/ENGINEEX: NEG.NO.:
AODflESS:
uxir:
UNIT:
PEBMITTEE: F.XCEL ROOfiING ( 71 4) 965--03 i 4
aooRess: 9331 I,ITC:fic.T.ELD DR
HliNTINGTON BEACH CA 92646
LICENSED CONTflPLTOP OECLABATIUN: I hereby alli�m Inai I am licensed u er Omvisions o� C�apier 9(commencing wi�h Section
7000) ol Oivision 3 0� �he Business and Pmlessions CoOe, and ense is � �ull lorce a etlecl.
ciTruc.:p�'77�q $TPTELIC.:SS23�P c s: �?
oaee: _S— � 7^�j'L Signamre. CO
WOBKEHS' COMPENSRTION UECIABRTION: I hereby affi I aue a cenAicate of consem m self-insure or a certificale of Workers'
Compensalian Ins�rance, or cer�iti¢tl topy �h¢Bo� (SeC�iOn 00, lab. C�).
POUCYNO.: it�19�$3-91 P.ORTE: U6IOSI92
COMPANY: STA 1 E L UND ,
7 Certified coDY is hereby fumishetl. � CeNfietl copy i I 4 wit� he ciry Lild' g Division.
Oate: � � 7' � t ApDlicanC
E%EMPfION FflOM WOBHEBS' COMPENSIITION �ECIAflFTION: is seciion neetl not be cample d ii Ihe permi� is for one huMrtH (b100) ar less�.
I cehity tha� m Ihe perlormance o� t�e work �or which t�is it is issue4 I shall no� em0loy any person in any manner so as lo hecome
suble�� �o ��e Workers' Compensaiion Laws oi Califom .
Oa�e: Signalure:
NOTICE: II. afler makmg Ihis declara�ion. you ShOuld beCome SUble�� �o the WOrkers' Compensa�ion pmvisions o� Ihe La6or
Cotle, you mus� lotlhwi�h comply wi�h such pmvisions or ��is permit shall be tleemetl revoked.
CONSTNUCTION LENOING AGENCY: I hereby a��irm that �here is a ConSimCtion lentling aAenty lor ��e peAormante oi Ihe work �or
w�ich Ihis permil is issuetl (Sec�ion 3097. Civ. C).
LENDEH: '
pOUflESS:
OWNEH BWlOEfl OECIAflPTION: I hereby aflirm �hai I am exemp� Imm t�e ConUactors' S�a�e License Law for ��e following reason
(Sedion 7Q31.5 Business anU Professional Coae: Any cily o� counly which tequires a permit to constmc�, al[er, impmve, tlemoli5h, or
repair any s�mclure. prior t0 ils issuance, al5o requires the apD�iCani �or Such permii Io �ile a Signe� 5latemen� Ihal he/She i5litensetl
pursuant Io Ihe Drovisions ol Ihe Contractors' Sta�e License Law (Chapter 9(commencing vnih Section 7000) oi Division 3 ot Ihe Business
and Pmlessions Catle) ar �ha� he/she is e�emp� Iheretmm antl ��e �asis lor ��e allege0 exemption. My vialalion o� Section 7031.5 Dy
any aDPlicanl for a permit subjects �he apDlicani [o a civil penalty of no� more lhan tive hundred tlollars (8500�.
I, as owner oi t�e pmperty or my employees vntA wages as �neir sole compensation, will tlo t�e work, antl ihe
.❑ stmcWre is no� intendetl or otleretl for sale (Section 70Aa, Business an0 Prafessional Cotle: The Contractors' State License Law
eoes not aoDly Io an owner of a propehy who Duilds or impmves ihereon, anA who Ooes such work himself/herself or ihmugh
his or Aer own employees, pmvi0ed Iha� such improvements are not intended or offereU for sale. If, hawever ihe huiltling or
improvemen� is sold wilAin one year of comple�ioq IAe owner will have Ihe 6urAen of proving Ae/she Oia no� builtl or impmve
for Ihe purpose o� sale�.
I, as owner of Ihe pwpehy, am excWsively coniraming wiih licensea conlraciors lo cons�md Ihe prole�� lSedion 7044, Business
❑ antl Pm�essions Cotle�, T�e ConVactors' S�ale LicenSe Law aoes nol apDly to an owner of Oropehy who builtls or improves thereon
antl who caniracls tor such pmle��s wi�� a comracior(s) license pursuant �o Ihe Contractors' Sia�e License Law�. I am aware
thal prool of I�ei� Worker'S CamOansation insurance shoultl be provitletl lo me.
� I am exempl untler Sedion: ' 8. 8 P. C.
for this reason:
Da�e'. Owner
I do hereby reni�y Iha� I am aware o� antl un0ers�anJ Ihe requiremen�s o� Calibmia HeaIN anU Sa�ety Cotle Seclions 2550.5, 25533, and
255� antl �hat I or any lulure buil0ing ocapant will/will not (circle one) need Io comDly wi�h saiJ 51aie codes antl ��e �epuiremen�s fot a
permi� lor conslmclion or motlification Imm ihe Air Oualily Managemenl DiStrici. flesiden�ial consimction apD�icaiions are exempi tmm
Ih¢SE pfOVi510115.
Date: ApplicanL _
Ihereby cer�i�y�hat I have reatlihis apPlicalion antl sla�e�ha� I�e
ortlinances antl slatelawsrela�inglo building tonstmclion and herel
O�aPeriy far'mspection purposes.
�a1e: f a7 � Y Z Signalure:
Omer's License or Socia� Secuniy a:
I6a1-4fi While-6wl�inp; Green—CaEe
is correc� I agree �o comply with all ciry anU counry
��ES �IhiS CiIyIO Q��Cf11POfIlhC dbOVE-RI¢II(OfICA
Canary—!oolicanl; Pink—qevenue: Goltlenrod—Asxessnr
CSTY Or COSTA MESA — BUIi,DID!G PERiHIT P�RN NO, B OS�151C
PERMIT NO; B 057510 PLAN CHECK NO: N GOVT; N �UPP: Ai
CON5TRi1CTION TYPE; 5—N PERN,3T TYPE; STR PU�POSE: ALT
JOB DESCRIPTION . i/O WOOD SHING / APPLY 'CEM WOOD' S:IARc SQ :T: 12,OOU
CI,ASM VALUE: 12,OOU.UO CALC—VALiIE: 17.,OU0,00 GROGP UCC: R-3 /M-2
COMMF.:NTS; YER ICBO#43i2
d(� �N� X �F �� 1( �� M� �lf iE �IE �1E � �% � iE iE i( �X� k ��c �li� ie i(� 3! �1E 9E �?E 1f � �ic �1F �lE �N� %di �F dFY- �3E if )f % iE if � 1E �%if� �k �?F �k �% if� 1F�If iE i4dE iE �)f �K �X� jt..YC..k dE K� iE iE �k �� �7c �IE % 1F'r( �)f ��
7, O N.F N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ----------- --------- ACCESSORY BTJIi�DING ---�------
FRNT; FT IN REAR: F'P IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT LN RGHT; FT IN
PARKING R£O� PROV; PARCEL: 412].8?.03 ZNE; REe 1.�0;
PLANNIhG NlSTES>
+�f �
3F �IF i6 3E If ik if 761E )f iF IE K� )f %'r Y.� 7f iF lE if jF �7E if iE iE 3F 3F iE iFlF i(• iE �1k dE ik If if if %if if iE if 3F iE 3f �7f M� 1£-!E!f 1F iF �M'# ## fE 1E 1E iE if if �f 3(� 1f� iE �N� 1Fif ik?P �f 3f IF ic 1E 1E 16 it
D E V E� L O P M E N T S E R C� I C E S R E Q U I R E M E N'b,`1' S
,
A„
'LONING APPROVED� BY . DAT'E; ��r'
HUILDING AFFR9UfiD BY : DATE; ,.��
APPLICATION ISSUEP BY; y/ln DATE• o� Z%� Z�
if fE M iE IF iF 3F iF IF iF 1E ii� iP iF�iP � iFiE ih iE iF iF �e xTr���t�i�"�F iF��'Tc iF3F7F iF iF�F �F ifiF 37iF�ii�iF-£Tr )E if �% it i(� ii� %� �3i iF �fFiF� R' �+i� � iE
aF 1E fF ikif iE if 3f IE iE if iE iF iC� IE �)E iE 1F lE iF ik if �E 3E iE if iC� �F iE 3f iF #S-iE iF iE iE l4 aE If %� iE fE 3E #� iE IE ie �%� ic i(� ii-iF iF ii� iF iE )k 1E 3F 3E ?E ?4 i4 if iF K� il� ii i!•%� 3e iF ?E it'.t iE i(• 3i� X�
LEGALI7.ATION; N F E E S U,V N A R Y STRUCTURAL SEGMc,!�T; Y
BLDG PNT PLUMHING ELECTRIC MECHANIC cIRE SMIP/RES GRADING
PERMIT 1J5,00 1.20
SMIP /,ION—R&S
PLaN
IS5UE rEE
BliZLDING—DIV—> PERMIT ISSJE PLAN—CHcCK TOTAL PAID DUE
TOTALS----> 136.20 0.00 U.00 136.20 136,20 .00
REVENi7E DIVISIUN TOTALS--> COLLECTED; 136,20 OVER/SHOR7': .UO
BLDG PMT' PLUMHING ELECTRTC MECHANIC PIRE SMIP/TOT GkRDIN{� PLAN—CHfiCK
135.00 . 1.20
iE if if il� 3f 1F �F iE lE iE-� ib%iE iE iP iE �Jh iE it !f ie i4 iE * ff iE�E ?F aE iE iF iE 1E iE 1(� #F if iF i(- i(� �Jf �)F i(� )h.}. iE i'r �If iE IE iElF it� iF iE-!!� iE iE fE 1E ii Ik * 3F �IF ib 3P 3F ii�lE iF aF ii� jf 3E �3(� ?e 3F
i N D I\T I D U A L F E E H R E A R D O W N
TYFS QTY D E S C R I P T I O N U1.IT COST TOTAL COSi
SFR 120D0 REROOF RY VALi7E RESIDEI�TSAL N07.ONE 1,00 12,000.00
END OF FEES
+�i dai�s�ss-eo�z�34 ����` �-�,.��
DATE: 0.,/2i14? TIflE: i1:5?
� -
-� CONSTRUCTION AND PLANNING � _ POOt oPA .
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
�� ;
� 1: Tempor8ry Electrical Service or Poie .- - 52.-Pool & Equipment Location � '
•L
2. Soil Pipe-Undrgrnd. . - 53. Steel Reinforcement � ,
3. Elettric�l Conduit Utility-Undrgmd. �" 54.-,Forms '
4. Electrical Conduit�Undrgrnd.' � 55. 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. Foundaiion • .,' 59. Gas Pipe, Q Undrgrnd., Tesi �
9. Water Pipe-Undrgrnd. `- ' �'- 60. Backwash �ines, P�Trap, O Undrqmd._ � �;
- J. ' o
10. Structural Floor System, ��� % 61. APPROVALTO DECK ��
1 t. Property Sewer Line & House Connectiori '� 62. 8ackwash & Receptor�Pinal ��
� z• Se�ve� CaP % 63. Heater & VenrFinal �
13. fioof Drains � � 64. Plumbing SYstem - Final �
14. Rough Plumbi�9 65. Etectrical�Fina1
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 Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Cond�tionin9 FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVAIS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergmd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 6 L�LYy �� 74. Overhead HVdro
I
26. T-Bar Ceiling (Structuraq & 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. Drywali Nailing , �, HEALTH DEPT. REQUIREMENT
31. Plaster 6rown Coat � 79. F�NAL INSPECTION
32. Electrical Power Meter-Final �'. 80. FOOD CERTIFICATE ISSUED
33. Final Eleciric i � Notes:
34. Final Heating & Air Conditioning `�
35. Final G85 Pipe-Test i� '�
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service•Final
40. Gas Service•Finai �
41. Solar pomestic-Final �
42. Backflow Preventer
43. Backflow Irrigation
44. landscaPe Irrfgation System
45. Sound Attenuation
46. HandicBp Regulations
47. FINALSTRUCTURE&BUILDING l2j,QL �Q
t
48. FINAL PLANNING
49. Electric Release to Edison -
50. Gas Release to Southem California Gas Co � ,
51. CERTIF�CATE OF OCCUPANCY
No. Date
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0.__ I���
IAT N0. S
nnDxEss 3 " �
DATE
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tzact has been completed and its streets
accepted by the City of Costa Mesa.
The under igned, by executing this agreemen:, acknowledges that
,r(3ae-�i[E-they) ftses.er+were)� advised that this tYact has
not been given inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surecy bond.
The undersigned agrees to indemnify and hold the City hatmless from
any claim reaulting in damage or pereonal injury to the undersigned by reaeon
of the aforementioned uncompleted condition.
RECEf VED
C►iY 0� C05TA MESA
PI eyN�VG r�o7.
JAN 2� 1973
AM
7�8�9�ID�lli12�1�2i3�4�5 6
�
BY G%�' � 6%'� 1/, ��
Developer and/or-authorized
representa[ive
BY ��� ��%
" Lender
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159
3518.2
COSTA MESA BUILDING-SAFETY DEPARTMENT
3OLCRP•�• BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Comple[ely .
ADIOFESS ��L�SZFuchsia StT i
OWNEfi 'd. SO. CZllf. IRC.
MAIL _ "__ ' � . _ '
CITV
CONSTRUCTION
BRANCH
ADDRESS
ARCHITEI
aooaess
CONTRACTOR
ADDRESS
CITV
STATE
LIC. NO.
S12E
OF LOT
f.. Inc.
Encino, California
LARWTN No`273-44
9100 Wilsh.ire B1vd.Bev.
Larwi.n So. Calif., Inc.
16255 Ventura Boulevard
Encino, Calif. No`.986-88
1913�1 LICVNO. B�1
NO.OF BLDGS.
�]0 x i nn � I NOW ON LOT n
SI2E OF . . NO. OF � �
NEWelOG.19H7 ROOMS STOF
EXTERIOF WALL ROOF ��T
COVEFING SCUCCO COVERIN(3'�OOd S
USE OF BUILDING ANO WORK TO BE PERFOFMED
1 heteby acknowledge the� I have read ffiis application antl state
that ffie ebove intormation is correct antl agree to comply, wiM
all laws requlating builtling �anstruction, and I shall mt employ
any person in violation of ihe workman's compensation laws of
the State of Califomia,
I hereby certify Mat L am property licensetl as a contrector under
the State ot California Bug{ness antl Professions Code, Divisicn 3,
Chapter 9, and that such licenses are in full force and etfect, or I
am exempt from the provisions ot the Staie o( California Business
antl Professions Cotle, Division 3, Chapter 9.
Sig^atura ot
Permittee ��%%Z.�/ D. DOW11S
Auffiorizetl Agent .
PA10 r.. **�
4Ui, 15-77_�n�.�001707� 154.3�!
APPLICATION FOR BUILDING PERMIT
'EI`VE� BV DATE RECEIVED DATE ISSU
1 �/ �- 1 f�..'1/1 o-.
A.P. NO. �
BUILDING
ADDRESS
OWN
w
FIRE
ZONE NO.OF
�, PtANS
YAROSAPPROVED
DISTANCE BET
MAIN BIDGS.
VAR. #
C.U.P. #
APPROVED /
FOR SPECiAI,
O /
_ PERMI��I,�
h
F4 Gi-1 sli� S`T
. ING.
DATE� � � C —
USE OF NEWS(/y F9'.
BUILDINGw���r p
VARDSAPPROVED
ACCESSORV BUILDING
BET.I
ACCE!
DATE
m
b
SQ. FT. o
THE AMOUNT SHOWN UNDER VALUATION IS FOIi j
THE PURPOSE OF ESTABLISHING A PEFMIT FEE ONLY: m
¢
VALUATION / �
, � PERMIT FEE $ ' �
J
$�/y �%y� � � E
% aVv PLAN CHECK $
�� 2 °
1. ` �
TOTAL FEE $ .J