HomeMy WebLinkAbout1377 GARLINGFORD ST - Building Permits ADDRESS OFBUILMO: 1377 GARLINGFORD ST UMT' CITY OF COSTA MESA - BUILDING PERMIT
. tTYNEIPJN.WEIFlew.nhSIPAm IOSANA FLOOD : X 46 /PERM NO: B 0743001
ADDRESS: 1377 GARLINGFORD ST
,, � COSTA MESA, CA 92626 PERMIT NO: B 074300 PLAN CHECK NO: N GOVT: N SUPP : N
9576050
APPL.M/UIING ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT ORENGNEER: UC.NO.: JOB DESCRIPTION : T/OFF RESHEATHING/REROOF W/ COMP SQ FT: 2 , 000
ARCH.OR ENG.'S ADDRESS: UNT:
CLAIM VALUE: 2, 000 . 00 CALC-VALUE: 2, 000 .00 GROUP OCC: R-3 /M-1
CONTRACTORS NAME:
CONTRACTORS MMUNG COMMENTS : SMOKE DETECTORS REQUIRED IN EVERY BEDROOM/ HALL PER UBC
ADDRESS: UC.NO.: +P**x******iEie*****4Eie******ie***************iE****TEiE*****->EiE**********ie*iE*******+E+E**
LIMY ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Nim under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 d the Business and Professions Code,and my license is in full force and effect.
CITY LIC.NO.: LIC.CLASS: LIC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT • . IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Cont18dor: LEFT: FT IN RGHT : FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the
following reason(Section 7031.5 Business end Professions Code:Any city or courtly which requires a permit to construct,alter,improve. PARKING REQ: P RO V: PARCEL: 14102108 Z N E : REF NO:
' 'emoleh,or repair any structure.poor to its issuance,also requires the applicant for such permi to file a signed statement that he or she
PLANNING NOTES>
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the
-fusions and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section >
7031.5 by any applicant for a permit subjects theapplrant to a del penally ot net more than fee hundred ddlen[S5C01). *******************************************************************************
0 I,as owner of the property or my employees with wages as IMF sole compensalioe.will do the work,and the structure is not intended DEVCLOPMENTSERVICES REQUIREMENTS
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply loan owner of property .
who builds or inproves thereon,and who does such work himself or herself or through he or her own employees,provided that such P` .
' improvements are not intended or offered for sale.B.however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
V owner-builder will have the burden of proving he Of she dM not build or improve for the purpose of sale).
°)SS I,as owner of the property,am exdusively contradng with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY
Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who DATE:
contracts for such projects with a comrseor(s)licensed pursuant to the Contractors License Law).
7 I/
m
laexempt under Section: B.S P.C.,fa reason: APPLICATION ISSUED BY: • DATE: .''7i..7---' P"—
16 Data: a•"` 610 �/F LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y
I do hereby certify that I am aware of and understand the requirements of California Health end Safety C e Sections 25505.25533,and
needapeme forthatlaanyfmarsnrildinhmtheAiig/wHnd(dmleone) to comply wane°idddepaaJand
eesemaitfromthse BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
2534.aaohatI oranamoeifmlin occuMAr l'wi arsgemmuDistrict toeidmply witconsadisnapcfmMand to he requirements
forr
provisions. PERMIT 45 . 00 . 50
Date: Applicant: SMIP/NON-RES
PLAN "
WORKERS COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE
0 I have and veil maintain a certificate of consent lo seff-insure for workers'compensation,as provided for by Semen 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Case,larthe performance athe work for which the permit eissued. TOTALS----> 45 . 50 0 . 00 0 . 00 45 . 50 45 . 50 . 00
o I have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.My workers'compensation insurance carder and policy number are:
Carder: REVENUE DIVISION TOTALS--> COLLECTED: - . 45 , 50 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
his section need not be completed d the pariah is for one hundred dollars($1001 or less) 45 . 00 . 50
•
V. I certify that in the performance of the work for which this permit is issued,I shell not employ any person in any manner so as to '
become subject to the worker;compensation laws of California, and agree that H I should become(subject to the workers' *******************************************************************************
compensation provisions of Section 3700 of the Labor Code,I shall f hwhh campy with those provisions.
C/N INDIVIDUAL F E E BREAKDOWN
Date: Applcenl: / ' V' re
Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject en erne/ to-criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil Ones up to one hundred thousand dollars(S100,000),In addition to the cost of compensation,demagog as provided ler In
s«tioarosofthe Laborcode,Interestand egorne efees. SFR 2000 ALTER BY VALUE RESIDENTIAL NOZONE 1 .00 2, 000 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the permk is issued(Section 3097,Civ.C).
LENDER'S NAME: •
LENDER'S ADDRESS:
I certify that I have read the application and state that the above information is correct.I agree to complywith all city and county ordinances /T
and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property 1`//
for inspection purposes. r
MOSES SIPA DI 0019C'12-C0190717 7O?' ;"j
Print Name DATE: 0'7,/72/!'5 e r1G-- ; .
ft(Q A `!�"' Date: ..D:-.
Signature of owner/Agt' o red
1 (5151de.WP) en
While-Building A Safety;Green-Fee:Canary-Appirant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POO' ,P.A
` 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 I
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
•
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 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
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. POOL/SPA 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 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing Cl de .C•i() 10-2-5j w`_ - 74, Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat �7 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77, FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. 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: r fi
34. Final Heating& Air Conditioning ¶ - , '1„ /
/V )
35. Final Gas Pipe-Test A /b �5�•'-b s; f) cc fp (21 15
•
36. Hood or Canopy I
37. Final Factory Fireplace p
38. Final Plumbing /oh`/% �( ��r�' 7
"
39. Water Service-Final 6666
40, Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
T
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING Ga ll _0 64/
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the pro-
posed property improvement. g Yes 0 No
2. I (have/have not) 44 signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm)to provide the proposed construction:
Name
Address_ City
Phone ( ) Contractor's Lic. No.
4. I plan to provide portions of the work,but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address_ City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted(hired)the following persons to pro-
vide the work indicated:
Name Address Phone Type of Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my per-
sonal knowledge, in compliance with tha State law.
)C Signed: Ain G' j-e Date: '3'2z'fS _
Name: MOSES 5i P4
(Printed or Typed)
C.D.L. # or S.S. #
754-5273
1042-48
Building Materials RkEa.
2075 NEWPORT BLVD., COSTA MESA, CALIF. 92627 5481128
MASONRY SUPPLIES. SAND, GRAVEL. 549.3327
STONE BLOCK 8 BRICKS
City of Costa M. a ;;;;;;,.;;,,s O..NI.
DATE 19---
THESE PLANS Must E ON JOB AT ALL TIMES
M KE NO CHANGES V ITHOUT PRIOR APPROVAL
0 DEPT.
THE ISSUANCE OR GRANT NG OF A PERMIT OR APPROVAL
o PLANS A..P IrICaTIO 2 A. LL NOT BE CONSTRUED
E A PER 1 iOS, OR . t APPRU.`L OF. ANY VIOLATION
Ur ANY 0. .- :30. 'U ;HL. CODE. NO PERMIT PR JJI
St WING TV WYE AUiHOHII IC VIOLATE 1r1�CE L YIi 1....ca j,.J
PE VISIONS OF THIS 'COOL rJLL BE VALID. CEP IN SO �f� �'lll
FA AS THE WORK OR USE W. ICH It AUTHORIZES IS LAWFU21
THE ISSUANCE OF A I E.MIT BASED UPON AN
SP'CIFICATIONS SHALL NOi r t.:6'T 'HI BUILDi ^FFI
FR IM THEREAFTER REQWRiU 1^. GM .,T;ON IIIERRO'.
IN SAID PLANS A::L SPECI:1 :ADL-C OR FRuM PREVENTING
BU (DING OPERATIC`:. BEING :ARR.LO ON THCC`.UNDER WHEN
IN VIOLATION OF TB.: CODE OP Cc AND/ OTHER ORDINANCE
OF THE CITY 1
'3 . ) e5 -3,
P_ERMIT N0,
oS IOS A A w'
PLANN NG DEPT.
/'' 'rSUBJECT TO BLDG. DEPT. REQ /G��
BW W(?/.c..-- DATE.uJa/ `_ 2T O�rii
DIRECTOR OF PLANNING .
V
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OP9SX'41
5it f-og
•
, OWNER HARBOR HALL OF FAME HOMES, INC. DATE OCT 1 6 198.1_2_.r.,
J' ADDRESS 1377 GarlingfOrd St. BUILDING PERMIT NO. 23099
G. .IRAL CONTRACTOR Lifetime Residential Bldg. Corp. VALUES 1,000.00 "Relocate
AP No. 1141-021-08 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Move-In Res.&At
INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE Rl Gar.
Soil _ PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water •
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating
Rough Plumbing j., _ -ri • ./.._22224,X
Miscellaneous
Prop. Swr. Line C7 House Con. '1St. Swr. ❑ /r, fl • __ _ei✓t4_ /72 14 s- ' e/ _
Sprinkling System / lyl�i
Construction Pole _ _
Underground 0 Power 0 •
Rough Wiring , n ' - - 403,f1 ,2 3 7/
Trenches RE, Forms L Steel Reinf. Kg4rg ,r//y49
Floor System
Bond Beam 0 Steel Reinforce 0
S' •king
t e and Flashing
Lathing—In 0 Out.p
Plaster, brown coat
Refrig. 0 Air Con. 0 Final
Heating, Final _
Plumbing Fixtures, Final •
�'LS/Vff✓/LR�CtJS- _y:tG=+t
23099 FEE RECEIVED
•COSTA!MESA BUILDING-SAFETY DEPARTMENT OCT 16 1984
F.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE1DEPT.
For Applicant to Fill In Completely APPLICAGI& l
4` bic9 41r ESA
TYPE OR PRINT BUILDING
BUILDING, For Office Use Only
ADDRESS 1377 Garlinaford St.
RECEIPT NO. q P MITy;p
COSTA MESA. CALIFORNIA OC 077
REC6 Y /0/TO IVt iA�T[y,/ySU _ J
OWNER Harbor Hall of Fame Homes, Inc. ////((((/iGGG- /T/
MAIL BUILDING/5 , Al//i
ADDRESS P.G. Box 2066 ADDRESS i �f'
NOW ON LOT • YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE FROM [O. REAR YARD 28, FRONT FT. FT.
CENTER OP STREET 5 //
SIDE YARD LEFT 6' I RIGHT 5$ R.GIDE C,FT. FT.
DESCRIPTION OF WORK L.SIDE ' L--FT. PT.
I REAR If&Fr. FT.
NE' ALTERATION ADDITION
DISTANCE BET. BET.MAIN B
MAIN SLDGS. ACCESS.BLDGS.
REPAIR MOVING X DEMOLISH
BUILDING NO.OF VAR'# DATE
SIZE 1650 ROOMS 11 STORIES 2 C.U.P. . APPROVED
EXTERIOR WALL, ROOF APPROVED
COVERING azUCCO COVERING Shin•le j 7 .) o
USE OF BUILDING AND WORK TO BE PERFORMED �•If,
Single Family Dwelling
.7kji4G .;:e....-0 -
I HEREBY ACKNOWLED ITHAT I HAVE R • THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE _
AND STATE THAT THEABOVE I- RR' D AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY O DI ANC • • LAWS REGULATING VALUATIONm
DUILDING coNSTR I pERM1T FEE $ N
SIGNATURE , LEOja
PERMITTEE ,l -1 ^
Si AIM .- PLAN CHECK S c
2 ALO `
AUTHORIZED AG EN TOTAL FEE 5
SOWNER SANCHEZ, LORENZO DATE 9-18-73
.:1;,..10- ADDRESS 1377 Carlingford BUILDING PERMIT NO. 37291
:G. IAL CONTRACTOR Owner/Builder DESCRIPTION of WORK Patio Cover
i--);AP No. 141-021-08 LOT 9 TRACT 4355 FIRE ZONE VALUE $ 1,200.00
^INSPECTIONS Signature Date GROUP J TYPE V ZONE RI
v Sou. PERMITS ISSUED
,GAS SUBCONTRACTOR
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent.
TRENCHES 0 FORMS 0 STEEL REINF. 0A
7 Q 9„4,21-7i
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRA"E AND FLASHING
Li a - IN f] OUTf
PLA..I ER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL naa ^4y/n/_
BUILDING, FINAL '
• 37�0 E PAID
00 597* ****18.50
S.P 18 73�ME,
COSTA MESA BUILDING-SAFETY DEPARTMENT
p.0.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
,., / RECEIVED BY Di Ec IVED DATE ISSUE/DD-7
BUILDING 13. 7/� ���rs.^rc.c-r/Y[�OC 1 q-/�� /J
ADDRESS ((/ (/� / "-7
O / f•J CIiNc.%:&:_ BUILDING0.
��I �O'��_CelPE RANT LJ I
OWNER OO ` (' j
MAIL Z ADDRESS I3t ? VA1LLWL TD
ADDRESS // r /, i�.„.j( ea //ggf� �{
0• U CITY ( J4 rte(/^ Q / / NO. S'QS'CCfl TR ACT�3(S LOT / BLOCK
ZZ
< CONSTRUCTION NEW ER ADD A1TER REPAIR MOVING PFMOLISH
O N LENDER
0. m
J-n
BRANCH
OWN
ADDRESS
t W VALUE /��
J Q ARCHITECT TEL. S 0 L-pl f�� L/ 5 //J/Yj!
OR ENGINEER NO
UQ ^ /, FIRE
W K ADDRESS (�J //'-'� ZONE TYPE GROUP l
aW
W Z APPROVE•
J Z CONTRACTOR BY DATE 7-47 7-3
coZ
J cc ADDRESS
W W ZO NO.OF USE OF NEWt7Af � T
Z H CITY NO.TE ( PLANS Z BUILDING �:-Or`lv`-'
U LCL
STATE CITY YARDS APPROVED YARDS APPROVED
NTL LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING _
D S12E NO.OF BLOCS. (FROM C/L STREET) /J�
OF LOT I NOW ON LOT FRONT FT. {'c t I FT.
USE OF
EXISTING BLDG.D/ /` R.SIDE FT. I ` FT.
NO.OF
Z NIZE OP EW BLDG. C� T 6 ROOMS STORIES L.SIDE FT. S FT. _
U EXTERIOR WALL ROOF ryry�,,// yy,�gqyypp,,��,s..,,��
COVERING COVERING !i/LIv-.y _REAR FT. /B FT.
I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
m MAIN BLDGS. ACCESS,BLDGS.
VAR.* DATE
O AM? ()Sten-- C U.P.# APPROVED J,R
U) —BPPROVED/. b*/ HATE / _7 1
Z W I�
0
U I hereby acknowledge that I have read this application and state STAT�I
D that the above information is correct and agree to comply with /U
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
Cr) the State of California. / /,m' — Co
Z I hereby certify that I am properly licensed as a contractor under bit SQ. FT. ,I, o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER ION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: b
am exempt from the provisions of the State of California BusinessCC
VALUATION ^^^��s
and Professions Code,Division 3,Chapter 9. J J co
PERMIT FEE S P
Signature of I//�� �Q /' CL co
Permittee .K. fre_G-Ore, el LGLr?/�l S/� 120 / PLAN CHECK S s/'/ E
�(J� f•-(f0� o
Authorized Agent ` r IL
TOTAL FEE S
OWNER L, SANCHEZ DATE 11-13-79
jr ADDRESS 1377 Gar ingford BUILDING PERMIT NO. 49164
L .:RAL CONTRACTOR Owrter/Builder DESCRIPTION of WORK Masonry & Wrought I ron Fence
AP No. 141-021-08 LOT 9 TRACT 421 FIRE ZONE VALUE $ 1200.00
INSPECTIONS Signature Date TYPE GROUP ZONE 111
SOIL PE-MITS ISSUED
GAS SUBCONTRACTOR
Date ( Number Signature
WATER -4 Plumbing
ROUGH PLUMBING I^�
PROP. SWR. LINE LJ HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND E POWER Ej
ROUGH WIRING ^ Heating and Vent.
TRENCHES - !/FORMS STEEL REINF. -Q1.gQ ' ll w 12„..„4„, - jHV?( ((ctlfrL(. IQ I_(fl_a�
FLOOR SYSTEM _ XPIRED
BOND BEAM rl STEEL REINFORCE ni
'MAR !plate Inspections
SHEATHING
FRAME AND FLASHING cancer I /
L G - INr ^I OUT LI Date /-2 -411—R/ Sz
BROWN COAT
STRUCTURAL. FINAL Electric
HEATING. VENT., REFRIG. AND A.Cf.-, FINAL
En PLUMBING. FINAL AND GAS TEST E I
ELECTRIC FINAL •
BUILDING. FINAL
... p37 11 / 13/79 18.50 TL
f.
-
&OSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
�rC0 ERMIT N° 49164
For Applicant to Fill in Completely — Use Ink Only �/� �[
BUILDING q A� A.P. NO. �I-1 L„/ 21 —Q (J ,//
ADDER SS/�//• ADDRESS V377 �r)11/1�/'--0
OWNER OR / BUILDING
TENANT r.-r.rtNj/7 /5:227/4/..---
MAILING
O 4 UNIT OR
MAILING SPACE NO.
ADDRESS
TR.NOyL1
LOT 9 BLK.
CITY '�[�� TNEOs-wcig2
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH
OWNER (Mitt A //tt
ADDRESS VALUE 2
ce aria
ARCHITECT TEL. USE $ /
OR ENGINEER NO.
ADDRESS /a ZONErp. . (TYPE GROUP`� �J Q
CONTRACTOR, r r.f Jaa../z AB
{�L�Ji(� DATE /1-1 J 7 /
ADDRESS /
TEL.
CITY NO.
F STATE CITY APPROVED SETBACKS
LIC.NO. LIC.NO.
SIZE NO.OF SLOGS. (FROM C/L STRE ET) _ frJW
S OFLOT NOWON LOT FRONT Nf�'A'_I"I//IIJ{/USE OF
ca EXISTING BLDG. _H.SIDE T
SA
F Separate permits are required for L,SIDE FT.
L1 electric,plumbing and heating work. REAR FT.
La
I- USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
-Crf3
1/7 F / iii d /c /
AATE
APPR
APPROVED
CROVE� /�
). l�e r1J� DATE )f
/13171
,J Off"Fiera
yr
A. ch
0 I hereby acknowledge that I have read this application and state
that the above information is correct end agree to comply with
0. all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of a
GU= the State of California. m
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempt from the provisions of the State of California Business VALUATION �s e
and Professions Code, Division 3,Chapter 9. PERMIT FEE $ / `� Co yr
Signature of en
/)//(/'
041, PLAN CHECK $ 6 ice o
Permittee V -/�+-r/Le $ 77 S TAX $ So
LL
Or
y u
Authorized Agent Date TOTAL PAID $ ; s-O