HomeMy WebLinkAbout587 GRAND HAVEN CIR - Building PermitsCITY OF COSTA MESA
�,OSTpMFS,p BUILDING DIVISION
F Ar�'� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wwi.ci.costa-mesa.ca.us
` FOR INSPECTIONS CALL: (714) 754•5626
°^�°fi PERMIT NUMBER: B11-00195
PERMIT TYPE B_ROOF2
APN: 41804115
JOB ADDRESS: 587 GRAND HAVEN CI CM
Vicinity: HOUSE AND GARAGE ROOF
Squares: 2300
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
06/28/2011
RMD
$5,400.00
SCOPE OF WORK: REROOF OVER (1) EXISTING LAYER OF COMP SHINGLES WITH (i) LAYER OF 30 YEAR COMP SHINGLES AND
UNDERLAYMENT ON AN ATTACHED HOUSE AND GARAGE, APPROX 2300 SF. COMPLIANCE FORMS ATTACHED TO
JOB CARD ANp qTY PERMIT.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permif shall not be granted until access to dwelling unit(s) is provided for
verification of the installalion of smoke and carbon monoxide alarms by the City Inspector. See Attachment wllnspection Card
OWNER: HOLLAND, ROBERT B TR
PHONE:
APPLICANT: R4YOS, FERNANDO
PHONE: 310-534-1033
CONTRACTOR: PACIFIC HOMEWORKS INC
Address: 1602 LOCKNESS PLUnit:
City/State/Zip: TORRANCE, CA 90501
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$12525
$0.00
$1.00
Address: 587 GRAND HAVEN CIR
City/Slate/Zip: COSTA MESA, CA
Address:
City/State/Zip:
PHONE:
License No.
License No.
Monday Ihru Friday - 7:00 am thru 7:00 pmv Saturdays - 9�00 am thru 6.00 pm.
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. �
Unit:
Unit: :
License No. 784477
310-534-1033
CELL:
PHONE:
PHONE:
- Sundays and the following Federal
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements untler California staWtes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS; In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration ot this permit.
GO�Er. INSPECTIOHTYPE ORTE IN1111AL5 CODE� INSPEC110NTYPE ORTE INi111AL5
1616 Fixed Sy,tem Final Fire Prevention 206 Final Mechanical
7266 Pool Spa Final �J ���/��� / 20B Final Plumbin9
200 Final Re-Roo/ /\_� 7 7�_ 210 Final Electrical
201 Final Blo�k/Retaining Wall 212 Final Fire Prevention
202 Final Facmry Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Finai �ernoli�ion 250 Final BuildinglOccupancy
• �
WORKERS' COMPENSATION DECLARA710N:
I hereby affirm under penalty oF perjury one of the following declarations:
❑ I have and will maintain a certi�cate of conseN to self-Insure (or workers'
compensation, as provided for by section 3700 0l the Labor Code, (or the
performanCe o( the work (or which thi5 permit is i5suetl.
❑ I have antl will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the wnrk !or which this
permit is issued. My work rs' compensation Insurance carrier and policy
numberare: /� u��
Cartier: � Y
I-� (rn�issedronn teemmpetenkdmepemirtisvaLm{edaronenundrMdamrs(Sioo)o��ess)
PI ,p�icy�Number � �Z V'�'I' O) � 1�"D O
❑ I certify that in the pertormance of the work for which ihis permit is
issued, I shall not employ any person in any manner so as to become subject
ro the wor er ' compensation laws of Califomia, antl agree that if I should
become s j ct to the workers' compensation pmvisions o! Sec�io 3700 0(
[he La r e, shall (orthwith comply with these provisi s.
ppliw 's SignaWre U`�le�
ARNING: AILURE TO SECURE WORKERS' COMPENS TION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I herehy aKrm tha[ I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( lhe Business and Pro(essions Code, and
my licens is in full (orce and ef(ect.
u�✓—u_ , �4��1 a�5u � 3 �
Z �
Co � cmL ignawre -Da�e__�
�
CON TRUCTIO L NDING AGENCY:
❑ I hereby affrtn that Ihere is a constructbn lending agency tor the
peAortnance of ttie work fa wfiich this pertnit is issued. (Sec. 3097, Gvil Code�.
Lender's Name:
Lender's Address:
Dale
OWNER-BUILDER DECLARATIONS:
I hereby aKrm Ihat under penalty of perjury tha� I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Pro(essions Code: Any city or counry which requires a permit ro
construcl, alter, improve, tlemolish, or repair any sWCWre, prior to iIs
issuance. also requires Ihe applicant for such permit to fle a signed statement
that he or she is licensetl pursuant ro the provisions of Ihe Contractors
License Law (Chapter 9(commencing vrilh Section 7000) of Division 3 0( ihe
Business and Professions Code) or that he or she is exempl therefrom and
the basis for the alleged exemption. Any violation ol Section 7037.5 Dy any
applicant (or a permit subjects the applicant to a civil penalry of not more than
five hundretl tlollars (5500).):
❑ I, as ovmer of the property, or my employees vrilh wages as their sole
compensation, WILL DO THE WORK, and the structure is not intentletl or
oKered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not apply to an ovmer of property who builtls or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided that such impmvements are not intended or oflered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burtlen of proving that he or she
tlitl not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to construct lhe project (Sec. 7044, Business antl
Professbns Code: The contractors License Law does nol apply to an owner of
property who builds or improves thereon, and who contracts !or such pmject with
a contractor(s) license pursuant to ihe Conhactors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for ihis reason:
Signawre
305]�46 (3I0])
Owner ID verilietl hy drive�nse. � Ves ❑ No
Driver's License No. Expires:
Venfication of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify thal no excavalion fve (5) or more feet in depth into which a
person is required to descend, vnll be made in connecibn with work authorized
6y this pertni�, and ihat no building s��ucWre, scaffdding, falsework, a demolition
or dismantling thereof, vrill be more ihan thitly-six (36) feet high. (Chap. 32, Grp
2, Atl 2, Sec. 341, Title 8, Cali(omia Atlminislrative Code).
❑ As owner-builtler, I will not employ anyone to do work which would
require a permit from the Division of Indusirial Safery, as noted above, unless
such person has a permit to tlo such work (mm lhe tlivision.
AppliwnCs SgnaWre
Division of Industrial Safe�y Permi� Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will fhe applicant or present or luture builtling occupant neetl Io file and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Seclion 25505 0( the Califomia Health and Sa(ety Code requires, with some
excep�ions, that a Business Plan be filed with the Costa Mesa Fire
Depanment by every business which has at any one time during a reported
year a quanliry ol hazardous materials equal ro or greater than a weight of
500 Oounds, or a volume of 55 gallons, or 200 cubic leel of compressetl gas
at standard tempereture and pressure).
2. Does or will Ihe applicant or present or fuWre building occupant need lo file
a registration (orm for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0( the Calilornia Health and Safery Cotle, with some
ezceptions, requires registration with Ihe Costa Mesa Fire Depatlment by
each business which at any one time has on hantl a quantity of acutely
hazartlous materials equal ro or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaNre and pressure�.
3. Does or will �he applicaM or present or future buil0ing occupant neetl to
prepare an RMPP (Risk Management and Prevention Prog�am tor acutely
hazartlous materials)? ❑ Ves ❑ No
(Section 25534 0l the Califomia Health and Salety Cotle provides that the
Costa Mesa Fire Depariment may require Ihe preparation, certification and
filing wi�h Ihe Fire Departmenl ol an RMPP by businesses which are required
lo register acutely hazartlous materials with the Fire Department.
4. II an RMPP is presently required, has Section 25534 of the Califomia
Heal�h antl Safely Code 6een fully Complied vnlh? ❑ Ves ❑ No
5. Does or will the applicant or present or fuNre building occupanl require for
Ihe wnrk which is the subjec� o! ihis application a permit for such construction
or modifiwtion from the South Coast Air Ouality Management Districl or !rom
any other air OOIWtion control districl or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that the requested
infortnation be fumishetl on applications for non-resideniial buildinq pertnits).
6. Will any pan ol the lacility to be conslructed untler this permit be within
1000 feet from the outer pountlanes of a school? ❑ Yes ❑ No
Qf yes", Ihe laciliry must meet lhe requirement o( Sections 25534 antl 42303
of the Califomia Health and Safery Code).
7. If a permit Irom Ihe South Coast Air Quality Management District or o�her
air pollution control district or agency is required (or the work which is Ihe
subjecl of this application, have all of the disclosures prescribetl by California
Health and Safety Code Seclion 42303 been made? ❑ Yes ❑ No
8. (I( "yes", attach certificate of compliance from the appropnate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
in(ormation given above is correct. I agree to compty wiih all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
Oa1e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state thai
the information given is correcL I agree to comply with all state laws and city
ortlinances relating to building constmction, and authorize representatives o(
the City of Costa Mesa to enter upon the above-tlescrihed property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by this permit until final inspection.
Signature oi Legal Owner(s)
AnNorAui�ze4Appllwn� Date�
ADP��eant to flll In all spaees axee0t l�ose wlt�in �eavy Cortlar Ilnaa anG s18� all aDproortate Oeclaratlons.
, CITY OF COSTA MESA PE� T NO. � TRACT NO. 'LOTG70. � , BL . . ' �
CONSTRUCTION PERMIT _ � � � �'
ApplicanYs Mailing Address �� � �` � ' v •' � TYPE OF CONSTRUCTION NEW � ADD ALTERATION REPAI R ' �.
VrojectAddreu -SB� ��%�RNO N/a✓�N GQC• ` ' �' �.,`' ❑ CONVERSION ❑ DEMOLISH OTHER ' . �-
�'V hOna ���'7 DESCRIPTION OF WORK ���-e� �`�- � -- ti � �
Ownar's Name . �
Address� - $�� ���v� ��'� ��' 7yP�E OF PERMIT� �j ORADING FOUNDATO❑N STRUCTURAL � A. P.Me ''
I
� A� h/E - Licenu No � � �
29:" '7/?q�.j:
�
Ilo3C T:
fC ng. � TENANT ELECTRICAL PLUMBINQ .MECHANICAL PLNG. REF.9W • , o"'""""' , ' �
� Addfess� � •. • ' ' ❑,�OTMER � - � ' � � � TO BUILDING ' � - ' REAR VAflD (TO P/U
�\ Contrecror'sNem I sp''tI1ROfIVIC-e�RF� ohone �"u'� PRWECTDESCRIPTION' S�.F7.� '� occUaqNCv —�� R E v i E -
�S�F^�l�/+�H�CAL(�/y �Ili�� G/�^�j�/ CONSTRUCTIONTVPE - � VAWATIONS LEFTSIDEVAflD � , RIGHTSIOEVAqD �� ' � '
Atltlress (meil' g) _ . . ,
i � .'� g^�,^�. . ZONE '' GPADIhG CV.YDS. ACRFS PKG. SPACE flEQ. PROV IDED
Cicense No. � ' � . �
IICENSED CONTRACTON DECLARATION • ' Remarka � � �� �STREET WIDTH ' � ' �' PARK FEE $ '
1 hereEy affirm thet I'am Ilcen560 untler provislons of Charlar 9(commencing , , , . . , ,
wit� sectlon 7000) of Dlvislon 3 of the Buslnett anG Professianf o, anE . � ' - ' � SPEtlAL CONDITIONS: ' ' ' � - '
my Ilcense�is In full f r a anq�eHact. f .�"3 i ,
', Llcenu lass � � ' � �� o. � � � � PLUMBING � ' ; ' . '
Date ��S 51g at tl � . , .
'ORKEPS' COMPENSATION tlECLARATION � , ', ' ' Bar Sink Sewe� Cap� , ELECTflICAL -
�
� lreby atfirm that I have a tertlilcata of consent to selfansure or a certlficxie � g9�kflow Preventer_ . _ SewCr COnn2ction' . Automatic Washer � Meter ❑over 10b amps , '
Workers' Compensatlon Ins�rance, or atertlfieE'"coDY thereot (Secti n — '" " ' " ", _ '-' " _ '
� 3800, ub. C.) ' � P Backflow trrigation � Solar Collectors Construction Pole ,
II Sub Pane(
I � PoIICY No. ^/70�c �O% � ComPanY �4r. (�SroP[ s �kx�.rl' . ... _ . ! - . �.. .
� _ • , . � - ' , • � Cooking Unit �Sub Pole ' . ' .
� Certifiatl copy is nere�y turnisnetl. � - . � 88thtubs � $olar Piping ; . � ,
��Ceru n qpy k i led witn ehe�city utlin Dlvis(on. / - Dishv.rosher ' - Motors 0-t'HP ❑ 1 b$ �-
� Data J-�� -�� Appii�ant �£�J '3 S ��+�1+� O�RY L'c7 '� ' Clerifiers � � Solar Tank :� . � : � Oo ' r � . ,
"EXEMPTION.FROMWORKERS'COMPENSATION'DECLARATION '�� - Dishwu5h2� ' • ' Swimmin PooIwIS ' ' Oryers ❑Gasj,�Electric�• �� (Inc:Solar'09-15HP 076=75+ ' �
�(T�issectlon neatl not ba comple�ad if tha permit Ii Tor ane huntlretl (5300) or � 9 Pa � � -
. less�. . . , . 1 . : ' � ' ' , Fan; � . ' i Micmwave . • . .
� 1 certl/yYhat in Ihe partormanc9 ot [he work tor whlch this permR is IssueO 1 D�inking Fountains U�inel_ �• � �
3 shall not amploY any person In any manner so �as to becoma subject to t�a , � � •
Workers', Com ensatlon. Laws oi Ca��fomla.. ' Floor Dialnsl 1 F.A.U. � � 'Pole Light
v Wate. Cioset 4 �
Date ' �Ignatdre ' ' ' � ,
� NOTICE: If, after making this tl9��aration, you shoultl bacome suDject to the _. . I Floor Sinks ; � Wat2� Meater. � ' Fiztures �Range �
Workersl Compensation provislons o/ the Labor Cotla, you must Porthwit� , , ' . .' . . � � . 1
�'comply Wlth,sUc�'p�OVI51oni o� IIIISLPBfI11II�511dII bn:EeGrt�¢O rovOketl: . � � - � :. J DeviceBoxes � . , � �
CONSTRUCTION,IENDING A�'+ENCW, , " � , '�GesServlCe'� Outlets;' WeterService �, t ; Sign' � �
I nereb aftlrm t�at Ihere I5 a'coPstrutUon IenOin a enc for the er/ormance ; . �. Outlets � � � .
y 9 9 v C Interceptors � !� . Standing Sections 1 �
af t�e work for pI �'ih1s Permit�_is'issuetl (Section 30B7 Clv. C.) - . - . , '
� �/(�ti1t�� • : � - � � � � Switches � . � Trash Com actor �
' Lentler'si Name• _ Kitchen Sink' . � 1 P
� I�nUer'S AUEress � ' ' ' ' ' ' •
i � � � , . - � - % Lavatdries- � _ , ' ^ � Garbage Disposal � r � .
OWNER BUILOER DECLARAYION � - � � � � A
, I nereEy'•a/firm�tnat I am exempbfrom t�e Con[ractor's'Licensa Law (orthe j ` - _ , . , ' ' ' ,
' following reasan (Sa<tlan 7031.5 Busineu antl ProtesslonaPCoan: Any Uty or- � P-Trap� . _ . Generetor �0+5 KW 0545 KW - '
� county whi<h reqWres a permit to consVuct, atter improve, tlemolish or, repalr � . ,, � ,.- `�� Transtormer � � 5-50 KW ' � '
any structure, prlor to Ils Izsuan�e, alm reqWroz t{�e aDPli<ant foi such permit � ROOf. D�ains �. -." �
to /ile a 5ignetl StdtamenG.thdt ha/sh¢ IS Ilcensetl pursuant to the prOviSiOni o/. r ,, , . � ,' • . ❑5U+ KW' �
e Contrattor'S'Ucense Law (Cnapter 9(commenUng with 5ectlon 7000) of , � • �Raintpeetion Fee • � §7$�
`�`� ion 3 of the Buslness ana, Rolesslons Cotle) or that ha/s�e Is-exemo� Showers ', � . � Reinspaction Fee :$7$� `'
e,i`tfrom and t�e ba5is for [hB a11e9eE axemptlon. My v101atlOn ot 5ectlon -, ,_ , , . , Merer ❑up to 100 amps ' �
y,.3`1.5 by, any aOP��cant for: a� permlY subjetts tha • a0�llcant--lo a civil • � ... ' - �. � '�155ue Pee � � .�� 3
�enalty of not more than five.hunCreC tlollars (E500�. - _ , . Service Sink � . �- - � �� - .
LJ I,; as.oviner of the property or my emo�aYees witn wages as thelr sole laue Fee � ? 3( / Ia�inB APVrovad By Daro
'� cbmponsaHon will �tlo tne work� anG theStructura'iz not intantlatl or offe�aC � � � � • ' MECHANICAL . � • . " �
^ Applirrtion Approved By �� Date
for sale �Sec4�on 7044, Busina5s antl Professional Cotle: Tne Contractor's ,
License Law tloas not apply to,aP ovJner ol a prooerry who bulltls or imProves goilec ,� ��" • Refrigeretion Systtrti ' �
thereOn, antl wh0 Uoes such wtlrk nimzell/�ersel/ ar t�rougn bls or har own '�- ^ • �
employ ees, provitlatl that such,If�Drovement5 are.not IntentleE or offeretl tor ' � � � • ❑0.100,OOOBTU ❑100,OOOBTU
sale. If, howaveq the bullCing of ImDrovement is soltl witnin ona yeaKof com- ' Duct'= UndeqGround� ' . A
pletlon, tha owner wlll nave iha burtlan of proving Ile/she tlitl nol bulltl or Im- - .
�roveforthe vurpose oi sale). � � � . ,. , . � � Ouct- Structural , System Repair/Alteration � ,
lJ 1, as owner of tbe property, am excluslvely contracting wIM Ilcensetl con- �� I
. t�dCtorSto const�uct the project (Sect�on ]044, Buslne55 antl Profa55Io05 Cotle: � Duct - Ventilating � ; _ � � � . . •4
� The-Contractor'r IJcanse -Lnw does not apply�to an ownerof property who ' , .
� builtls or improves'tnereon, antl who mntracts for such pro)acls with a con- ` . Exhausf System ❑ Mulciple ❑� . . � . .'.'
tractor(s) Ilcense pursuant to the Contractor'S LI<ense l_aw): � � � �
❑ I am exempt untler Sectlon B. & P. C. (or thls reason FirepUFact, Blt. ICBO # ' � � ! v
Oate� � '- Owner•• i Heating,SyStem & Ducting '� ( � ! , ' Y
I_hereby cartify that I �ave;reatl this�application anC state,that_tne aoom_ _ 04100,OOOB7U,�100,000 __ �. ,, _,._ �
Informatlon is mrrect. I�a9rea t0 comply with all cltyantl county ortllnances -
antl state laws rel rr�g to buil0in9 construction, antl �ereDy authorize *epre- . Hood oi 7, e I ❑. '
sentatives ot'thi � ty-f en �� n the above-menUonetl propertY tor Cano . TVPeII ❑ Reinspection Fee ' $15
Inipettlon pU/po e� , . , � �s -
Signature Date • � �� ,
; Re isters ' � Issue Fee S 3
` Driverz' License or 55 � 9 t
CMF 0865-06 rev. 12/82 W�Ite - Builtling; Canary - ApO���ant; Pink-- Actountlng; Goldenrod'- Assessor ' �' - - - ' " -" -- ' ` "'" " ' ' "
� � ������ 1
APPlication laued BY ��� . i Date a. Cp-�
i , , � SUMMARV OF FEES � :
. �
' 'BUILDWGPERMIT $ ' f SMIP : � $ �
�PLAN CHECK� ' $ PERMIT i � �
�P�UMB�NG ��� � • ISSUANCE, � $ ' ' ' '�
. PLAN CHECK � $ -�c���' . GRADING $ � � ! �'
ELECTRICALt � $ � ' � , $ I, . �
PLAN CHECK - $�, � �� MICROFILM '� $ �'
MECHANICA� ' ' � TOTAL FEE� $ i
$
PLANCHECK $� ' �� � � LESS �� . ' /� �
� . � , ' ADVANCED,PC � $
� i
� / � : FINAL FEE �� , $ �
_'" . .. . .:' / "^ . . .. . . ... " ' _ . ' "_ " � - . .
? ; CONSTRUCTION AND PIANNING' , - - - ' ' � �. ?�Q SPA � _
.`.Date� � � InsP�or� .. � . - _ " . . Date . Inspector
•_ APPROVALS--' Pe�mit�h �� - ' � � �APPROVALS Permit�
- - � _
_ �L �Temporary Electrical Servi�e or Pole � • . , � 52. Pool ffi�Equipment Location _ - � �
: ��2.� Soil Pipe-Undrgrnd�. �- ` � .." .� 53. Steel Reiriforcement - � " '
_, _ .
- .3.�Electrical Conduit Utilitv Undrgrnd. - � . � 54.rForms' � . � _' � � � _ -
z[4.�Elec[rical Conduit-Undrgrnd., '. t`� - =55. Elec[rical Bonding
;5. Steel Reinforcertient , � ' - � . .56. Rough Plumbing & Pressure Tesr
h6. Electrical UFER Grnd.. ? � - �, '= � ' 57. APPROVAL TO COVER-GUNITE
7.�Footings i � , , �� � �� , . , •58. Electrical Cpnduit-Undramd.� •,
8. � Foundation �� �' "� `' ' - 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgrntl. ' .' ' 60. Backwash Lines, P-Trap, � Undrgrnd. �
10.�Structural Floor System �� 61. APPROVALTO DECK
11., Property Sewer Line & House Connec[ion . '� ` 62. Backwash�& ReceOtor-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�- f-� -� , ' �- ; - i- � -66. Solai SYstem-Pinal � . ' - , -�- ' - � �
a 16. Rough Electric Wiiing . .- " "� .� . :�67�. Fencing &�Access Approval � - � • -,
' 17.'Rough Wiring.Sigri' ' ' �� ;'�` � � � _ � 68. APPROVED'FOR PLASTERING � •
18. Rough Electrical-TBer Ceiling ;. �;�-' :69. POOUSPA'SYSTEMS FINAL
� 19. Rough Heating & Air.Conifitioning , � ' _ , � � � � �, � � FIRE DEPT. REQUIREMENT, � � �
d _l i _
20. Rough Factory Fiieplace ! �i ,' . � , � � ' APPROVALS Permit # � ' ' '
i
21."�Ducte;�in�Structure ' � � �, - ' � . � ' � 70. Underground Hydro ' '
,
� 22..Ducts,�Ventilating � �: ; ( � � � �71, prod'uct�Piping�OGas ❑Oil ' .
� 23. Gas:Pipe-Rough & Test`' � � � 72. Underground Flush . . �
24. Roof Framing ,' • �I._ -� I I �. ' 73. Undergrnd. Storage Tank O Gas ❑ Oil
25.,� Roof Sheathing � � � � I , � ' ' ' � ' - � , 74. Overhead Hydro
� 26.'�T-Bar Ceiling-(Structuraq,i& Monocoat � �� � 75. Dry Che'mical � '
�27. Frame.and=Flashing � � �,� ` ! � � , � 76. Dry Standpipe� �. � -
26.�' lathing &�Siding •, i � . � � � , 77. FIXED SYSTEM FINAL ' .
�
29. Insulation= . � � � � . , � � �. ' � i � 7g, FIRE PREV. FINAL �
=�30..Drywall Nailing ' � � � ' . � ' � Notes: O r - 4, /7¢ �f T • .
� 37:�PlastenBrownCoat � � � , , i � � ' - ��j'�3 �
32.�Electrical Power Meter-Final � � � '' -�'E„Co� /�j�f p�,�•T tt
33.� Final Electric i • � � � � ' � � C�J ^ ew �.li
34. Final'Heating & Air Conditioniog � � i' � ' � � � �
1 �
35. Final Ga's Pipe-Test ._- � :� , . .`o �.; . � i � .. � '
36. Hood or, Canopy��� ` - � :_ i . � � � ' . ! , . . • � . � �
37. Final,Factory Fireplace � � � , � i � _ � ' �
36. Final Plumbing� � ' � ' ` r� � ' � � � ' �
39. Water Se�vice-Fina.l � ! � 7 � � , ' . .
i• •
i � � 1 f'� , i ., � .
40. Gas Service-Final � � . .
' 41. Solar pomestic=Final ; ' � � � _ _ i _� _ _ _ _ _ .: _ , .
�
� �
42. Backflow P.reventer ,' ,� • .
�� I ' _ " _ _ 'i_.� ' '
r� . �
43. Backflow Irrigation,l � � '
n
44. LandscaPe Irrigation'SYstem� � � � I - . . n . - �. � . �
45. Sound�'Attenuation; � '� � �. � _ ' ;. , . � � - � '
46. HandicapRegulations' � ' ' ' ' � �� '� ' � ' ' ' ' . ,
,
47.�FINALSTRUCTURE,&BUILDING• � � � - � �� i ' ' ' � � � � � � , �
�
48. Special Requirements �Completed - � I � i � '
49. Electric Release to�Edison i ; '_ _� . _ ..; .' _� . . ' .
50. Gas Release'to Southem Glifornia Gas Co � �
�• � , � „ �.
51. CERTIFICATE OF OCCUPANCY b ; _ ! '_ t _. .- _..�� _ - . . . .
No .� � � � �Date � � � .
« � � 1.. __i � �
��r
PflOIECT RUDNE53: S 8% GAAND HAV EN C I
owNEx•s xnMe: R. H. HOLLAND
c - ^o���� SAME AS AHOVE
714/5q0-0304
ANLMIENGINEEfl:
�OONESS:
PEO.NO.:
uxiT:
UNrt:
PEpMmEE: R. B. HOLLAND (719)540-0304
nooness: 587 GRAND AAVEN CI
COSTA MESA CA 92626
IICENSEO COMMCTaB OECUIUTION: I hereGy attirm that I am IicenSeE unUer povisions oi CAapter 9(wmmentin0 ��h Sepiun
700� of Division 3 oi Ne Busineu yid Pmiassions CaGe, anG my ticense k in lull �orw an0 eflect.
CI7Y uC.: 3TATE 11C.: LLA&%:
Oa�e: Slpnature:
WOBKENS' COMPENSIITION OECUp�710N: I �ere�y atlirm I�at I have a cerlilicate ol mnunt to selbinsum or a certiticate at Warkers'
. Compensation Insurance, ar a cenilieU copY ��ereol (Section 3800, laG. C).
IPOl1CY�N0.: E%P. DRTE:
COMP►NY:
` Cenilie0 coOY � hereby fumisry�p, ❑ Cenifietl wpy is filetl witn tne dry BullAinp Oivision.
Date: ApWfcanl:
IXEMPf10N FIIOM WOBIfFNB' COMPENSITON OECUMTION: (�lis seclian �reeE imt be canDleleO il NB permit is fa me �un7reE (5100) a less�.
I ceNty chat in the pertmmance ot thu wprk (or wMch this permit is issueA, ! snNl �m mploy any person � arty mamxr w u ro Gecoma
suGlect ta Ih WOM1e ComOensatbn Laws oi Califomu. /� ,n
/ A/L
Date: 7 � Slpna�u2: ��->
�—
NOTICE: II, a fer makinB �his tl¢�laration, you s�ou10 Eecame su�ject to the Workers' CamDenution D�ovisions ai IAe Lahor
COAe, you mu5tiorthwilh wmply wlt� suc� provi5ions ar ihis permit Shall 6e OeemeO revoked.
CONSTBIICTION 1FN01NG AGENCY: I �ereDy aKrm Itut Nem ¢ a wnsiructwn lending a0ency for IM pedormance of Ne vrork for
w�ic� ��is perm0 i5 issuea (Section 3097, Civ. C).
IFNOEN:
nnoxess:
OWNEB BUIIDER OECIAMTION: I here0y attirm that I am exem0� ��am tha Coniractors' State License Law lar IAe followinp reason
(Section 7031.5 Business and Prote�ional CoEe: My ciry ol counry wliich requires a permit ro construct, atter, impmve, demolish, or
repair any stmcture, prior to ds i55Uance, also reQuir¢5 the aDPlicant for sucA permit ta file a sipnatl statement that he/she is licensetl
W i n f the Co ' n w �a ter 9 commencin wit� Sectian 7000 af �Ivision 3 of Ihe Business
pursuam ro the pm s o s o qiractors' Stata Lice se La (C D ( 7 1
anA Pmtessions CoOe) or that twJSAe is exempt t�ealmm antl Ihe basis for Ihe allepeE exempiio . My Nolation of Section 7031.5 hy
a Ilcam �or a ermit su6 ects t�e a licant to a civll na�ry ot not more ihan live Aallan (SSOU)
CITY OF COSTA MESA — BUiLDING PERMIT PEF�M NO: B 047910
PEAMZT NO: S O47910 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
I
JOB DESCRIPTION : REROOF/ASMOVE SHAKE & REPLACE W/COMP. SGZ FT; 4,700
CLAIM VALUE; 4,700.00 CALC—VALUE: 4,700.00 GROUP OCC; R-3 /
COMMENTS:
x��**x�*�**�*�rfti��e+�***�r*******�*�e**��*�;r*�r***�ex��r**�r�r�t�x*�r*���e*�t*�r�t*�*+�**+�f���**�***
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 kGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 41804115 ZNE: REfi NO:
PLANNING NOTES>
>
if iE iE iE iE iE if iE �E ik iF iE itlEdF iEit-iF iE iE jE iE it ik 3E iF iE 3E jE 3E if dF �)E if if iF iE it ik iF if iE iE if i! if if� iF iE if iE ff iE iE iE iE iE iE iF if 1E �F �f iF it iE if� iE iF it3Fif-iE iF if iF iElf iE
D E V E'2, 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
y,
ZONING APPROVED BY DATE:
BUILDING APPRO��ED BY : DATE:
APPLICATION ISSUED BY: �/ DATE; % a—%�9�
iFifiEiEiEiEiEiE�Eif�iFiti4iF�EiE�IEjFIFi4ifiE3F�'iFiF' iEdF%iE9EikiEjEiEiE �ii3FiEiE
ik if iE iE �E 3f if fk if iE'E if iElE iE * 3E ik M 1f ik iE iE iE if iElt if 3E if jf iE ik iE iF iE af 1E M if aE iE iE if iE if iF 3E iE if if ik dE iF iE iE i(� if iF if if df iE iE i4 3E iE iF 3E Tf iE iF iE iE if IF iF iF iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72.00 SO
SMIP/NON—RES
PLAN ` ��
any DP V I PD Pe . ISSUE FEE
i, as owner at tne pmperry my em b� wn, win ao me wor�, anu itre BUILDING—DIV—> PERMIT ISSOE PLAfI—CH£CK TOTAL PAID DUE
I� stmcma is not imenden ar anerea ecuon 70an, euuness ann Pmteuiona� Code: Tne Coniractars' S�ate License Law TOTAL S----> �7 2. S � �. 0 0 �. 0 � 7 i, S � 7 2. S � . � �
- tlo¢s'rot apDN �o an axner of a D�DenY � �udM1s or imD�� I�ereon, anU wtp Eoes suc� cmrk Nrtaell/�ersell or thmuph
� �is or her oxn employees• OroviUeO ttwt SucA imprwemen6 are not intenEeE or oifere0 lor sale. If, liowever t�e 6uilGinp or R E V ENUE D I V I S I ON TOTAL S--> COL L$CTED • 7 2. 5 0 OVER / SHORT • � �
improvementiswltlmtMnoneyearolwmpletlon,theownervnll�avetheburdenoiproNn0�U5�e�iUnotbuiltlorimprove $LDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRI�DZNG PLAN—CHECK
tor Ihe puryose al sale�. ,
I, as awner ot Iha DmDerty, am axclusively contractinA with IicanseU coniraciors ro constmct tha Droject (Section 7044. Business 7 z. � � ' • . S �
❑ anOProtessiansCOEe: Tt�e�(ractore'Sta[eLicenseLaw0oe5rrotaPDNtoanownerotproperty who�wlasorimDrovesthereon *************�**********,�*******************,***�***************�_**************,f
anA w�o contracts lor such pmlects with a contractor(s) license pursuant to the Coniractars' Stata Lmense Law�. I am awam
mat Droof ol meir Warker'; ComDensation insurance shouia be Dmvmee m me. I N D I V I D U A L F E E a R E A K D O W N
� I am exempl unOer $ectiaq: B. 8 P. C.
lor tAis r mn: �
Data: a d Owner:
1 Oo �ereEy rtiry tha i am awam ol anE unEersuna tAe requirements oi Calilamu HeaM ana Sa�ery CaEe Secpons 25 05, 25533, anE
2553d and I�at I or any fuWre builC��p acupanl wiltlwill nm (circle ane) neeE m wmply with uid sta�e cotles antl t�e repuirements lor a
permit for cansiructbn or mo0if¢atbn tmm the Nr Waliry Manapement Distnct. fleSiEential wnsWctim applications are exempt irom
Ihese pmvisions.
Oate: ApDlicani:
I hereCy certiy that I Aave rea0 t�i5 appllauon an0 state Itut tha ahme information is wrtect. I apree m comDly wlth al anE
ordinancesanOstatelaxsrelaLnqroDuilEinpconsWcuonanEtreaUyautlqnzeapresenUtives fNaciryloenteruponth o-me
ompeny for in «ion rposes.
IOaie: ` 4 SipnaNa:
orivers [ nu or ' secorib x:
18a1�18 W�i1�Builtlifp; Greeq—�qpq Enlorcemam: Canery—PpO�icenl: Pink—Revenue; GolOenroO—Asaeuor
TYPE
SFR
QTY D E S C R I P T I O; N UNIT COST
4700 RERUOF bY VALUE RESIDENIAL NOZONE 1.00
END OF FEES
�\
5
TOTAL COST
9,700.00
O1 0006393Q—000639E1 TIoT
DATE: 06/?8/40 TIME: 05:2°
�
'2 °:�
CONSTRUCTION AND PLANNING POO :PA
,QPPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
i.. Temporary Electriwl Service or Pole 52. Pool & Equipment Location �
2. $oil Pipe-Undrgrnd. 53. S[eel Reintorcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. fiough Plumbing & Pressure Test
6. �lectrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Foo[ings 58. Electrical Cpnduit-Undrgmd.
8. foundation 59. Gas Pipe, � Undrgrnd., iest
9. Water Pipe-Undrgmd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVA'L TO DECK �
,
17, property Sewer Line & House Connection 62. Backwash & Receptor-Final �
� Z. 5e"ie� CaP 63. Heater & Vent�Final ,
13. Ftoof Drains 64. Plumbing System - Fina�
74, Rough Plumbing 65. Electrical�Final -
15. Rough Electrical-Conduit 66. $olar System-Final
16. Rough Electric Wiri�g 67: Fencin9 & Access ApProval
i7. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceilin9 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Fough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
�
24. Roof Framiag 73. Undergrnd. Storage Tank � Gas ❑ pil
25. poof Sheathing` 74. Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 1
27. Frame and Flashing 76. Dry Standpipe
28. 4athing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSNECTION
32. F.IectricaV Power Meter-Finai 80. FOOD CERTI ICAT SSUED
33. Final Electric (� - Notes: G � �
34. Pinal Heating & Air Conditioning :
35. Final Gas Pipe-Test ��
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
� 42, Backflow Pre�enter
43. Batkflow Irrigation _
44. Landscape Irrigation System
45. Sound Attenuation '
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �0 � �i
48. FI�IALPLANN4NG �
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co /
5L CERTIFICATE OF OCCUPANCY
No. Date �
OWNF[i nva.ui�iiv a ovivo� vnvnvr. D,y� i-c.. v�
�S1 JOB ADDRESS z'ari aven irC E ' BUILDING PERMIT NO.
GENERAL CONTRACTOR Tahitiari POO1S DESCR1PT10N OF WORK pyt. S�7i.m POOl
AP No, LOT 13 TRACT 5 9 F1RE 'LONE VALUE $ 29 5• 00
I' ECTIONS i Sienature I Date � GROUP .T TYPE III ZONE R1
SUBCONTRACTOft
�
�
244��
COSTA MESA BUILDING-SAFEiY DEPARTMENT
P. O. BOX 91] COBTA MpBA, CALIPORNIA
For Applicant To Fill In CompleTely
TYPE OR PRINT
BUILDINO ��9�� ��N (�l
ADDRESS c
COSTA MES , CqL FORNIA
OWNE Sd� �Ioe �u
ADDRE53/� l �� Il� � � �
�.� 1 �ML� s �/�, TEL.
�3 �
✓-1 i vr r S -
�c�n� .S
NO. OP BLO00.
6ETBACK LINE FROM
CENTER OF BTREET ' REAR
SIDE YARD LEFT I RI6HT
DESCRIPTION OF WORK
'BUILOIN6 NO.OF
SIZE ' ROOM9
EXTERIOR WALL I ROOR
� HEPEBY ACKNOWLEOO�THAT 1 XAVp qgAD TX�PLI'WTION
/�NO BTATE THAT THE ABOVE 18 COPRECT ANO A E TO LOM.
PLY WITH wLl CITY OROINANCEB ANO BTAT6 LAWB R80ULAT�NO
BUILOINa CONST� N.` . � � �� ���
PERMI�TTEE � O� ���`�
AUTHORIZEDAGENT _f
arY �� ��s;A ��s�
.,-�
JUL �� 1965
RHCHIpT NO.
DAT[ P[ClIVB
ZONING
s r NO.OP uae
� vurvs auu
NOTE: NO EAYE OVER
90' TO SIDE @ REAR F
EAVEB
ALLOWED
VAR�3APPROVED
MAIN BUILDIN6
VAR. $R
C. U. P.
APPROV
HOLU
/TXE AMOYNT BHO�
PIIRPOSE OF E8T i
VALUATION
a��s °
OATE186UED
�d-�o.
SHALL BE LES9 THAN
r
(U.B.C.REOUIREMENT)
YARDSAPPROVEO
ACCESSORY BUILDIN6
/�/
� 7 �.
� / . b
BET. MAIN @
AGCE55. BL[
DATE
VALUATION IB FOR TME
A PERMIT FEE ONLYu.
IT FEE ' `
....�,... a n �
P"
Forms
UA1'Y: G-LS-00
OF WORK
VALUE
,T TYPE
SUBCONTNACTOR
� 7���� I
_ COSYA )+iE5R DtilLDINGSAFETi'! D'cPARTAhEhi7
P.O. 00% 1:OD GOSTA MESA, CALIKORNIA 821i6
"�._'t'�:'..'"..u� �9�'"+3.u:..� �m, �..:..LY�:.C.'..� �"
For kp;�lic�r�1 tc f1U fn Comple!o9y
i ru i-TYPL•t OR PRINT//.,. ,,,._�, i:U�
CALIFORNIA
tAA1L
�
SA7'E
NO. OM OLOR�.
USE OP
EXISTINO DLD6.
OGTCAGK L�H6 �ROM
o�sc�ua��o�s a� �s����
ROOF
FEe z3-��„S.,00 �,aa ��� . u�7-
A.PPI!CATION POR PERMiT
eunQa�ce
Fo: Of7ico Use Only
a:cm�-r �<o. I ,. r
� ��cV�icV
NO.O} y9C
�' �uNa '1/ am�
o�iscatrrion L C'/ ) / ) `(y- � ! b - ( 6�'
A. P. NO. �71✓��J ' 1����_rl�l
`[
NGTE: NO BAVE OVSRHANG S4ALL DE LESBTHAN
YARGIIAPPROVED
N.AIN DUILDIN6
t-�. z
YARDS APPROVEO
ACGESSOR:'BUILDIN6
DATE
I�;.� U560F6U1{.DI\�}AKDN'ORICTOBEPERRORMEp �� �j �I� � r� a
1 � � �
/� �/l/ G
I /,i�."'t�/�M/ .✓iLG��/E� �i'nTL��.... t d
I , ��e �
I 44. PT, o .
1 HERL2T AG%KO\'lLtCOE CqAT i HAVQ R3A7 :NIC APPLiCAT�OY THQ At(OUNT DHOWN t1NO-R YALUATOK I6 POR TN6 i
AHD 6TAT6 TNAT TNII AGOyG .9 WRR�^.T�/�Yy�AOftEL TO COM. PURPOefi Os CgTA0L16HIN0 A PERMIT F'6C OKLY.
PV! N'ITH ALL CtJY OjfDjNANCTJ. AND LSA Gy� 1VD RCJULA:lVO
I � ButLo�uo CON9:aUGT oH. / VALUATION �� —/`r�� F
I � SIGNATUREOR (Iv �� �' . � �'ERMITF'E S .—^_ G
� PERMl7TH ` � '— G o
� � y�� k C EC 5 �"
AUTHGR.ZED ACQNT . �C� F, �
Ib. . , 3`2=.'�1 -., ur .T��_,n"^"e.:.�1 w7v�.,.°"^�!2;!±1�^P�.Sfi,"a�^iL'+� TOTAL FF_E a/ �
-_ 24 I 9i3
�COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BO% 9f] COBTA MEBA, CALIFORNIA
For Applican► fo Fill In Completely
TYPE OR PRINT �
eu��oma '��/�J
ADDRESS 1l O / C
COSTA MESA, CALIFORNIA
� 70
'7
TEL.
G' X 1
N�L� y
TEL.
NO. OF BLOOB.
6ETBACK LINE PROM {�
CENTEROFBTREEf �o ` REAR
i
SIDE YAR� LEFT � R16HT
DESCRIPTION OF WORK
BUILDINO f'�� G" NO.O
512E = d ROOM
EXTERIOR WALL,,rI% ��� I � CO�
COVERIN6 S
USF�.QF BUILDING AND WORKTO
/
c�rr E � ��� �ti
MAY 24 1965
flHCE1P� NO.
ADDRE53 �� `
FIRE �-
s�.
NO,
�
ZONING
Z��PLFNe / � BU LO XOI . I' ` � y�
1� /� �A� /\
�o.� 1—o T i 3 7"rc S—� � R
DE➢CRIIf10N
A. P. NO. l TL `��/'— � .
NOTE: NO 6AVE OVERHAN6 SHALL BE LE55 THAN
90" TO SIDE @ REAR P. L.
EAVES
ALLOWED �U.B.C.REQUIREMENT
YARD3APPROVED YARDSAPPROVED
MAIN BUILDINR ACCESSORY BUILDIfJ6
� VAR.SF
y � C.O.P_
OATE
- --- a
0
�
O
�
� 77 so. Fr. f Z �
1 HEREBY ACKNOWL6006 THRT 1 H/�VB READ TH�9 APPLICATION THE AMOUNT BHOWN IINOER VALUATION IB POR TH8 F
ANO eT�TE TXAT THE ABOVE IB CORRE ANO �OREE TO COM- PURPOSE OF fiBTAeL16HIN0 A PEqMIT FE8 ONLY. p
PLx WITH ALL CITY ORUINANC68 ANO AT8 I.AW9 RBGUL�TINO VALUATION `� DO m
eu�L�iNacorveiRU oN.. / PERMITFEE $ !� �
PERMITTE E OR q. 1 r ��� �� �] ^ (� / pv m
� ' f / / � 71/ AN CHECP( $ �O a
OC f� o
AUTHORIZED A6H I / � � O C� � 4
TOTALFEE O
,. 24533
ICOSTA MESA BUILDING-SAFEfY DEPARTMENT
P.O. BOX 917 COHTA MESA, CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
AD�RE 9 � AGG/�I '
COSTA MESA, CALIFORNIA
Y MAIL
TEL.
-la/.'�/S�ri'8/No' �If 32/!
���O / � I No. oP aLOaB.
�. -NOW ON LpT
_ /i�1 � _. � / .� /�i�_ _ !� �
0 SETBACH L�NE FROM
DESCRIPTION OP WORK
� LI&E OF BUIIDING AND WORKTO BE
n�� -
i HEREBY ACKNOWLEOOB THAT 1 H/�Ve PEAO TH�e APPLIC�TION
AN� STAT2 THFT THE ABOVE I6 CORRECT ANU A6RE8 TO COM.
PLY WITH ALL CITY OR�INANC68 ANO BTAT e RfiOULATINO
aUILU1N6 CONBTRUQION
SIGNATURE OF
PERMITT
AUTHORIZED A6fi � /�'
�
CITY �f C�ST� i�ESA
AUG 9 1965
For Office Use Only
NO. OP II6E OF NI
PLANB �/ OUIL�INO
LeOAL
NOTE: NO EAVE OVERHAN6 SHALL BE LE85 THAN
90" TO SIDE @ REAR P. L. '
EAVES
ALLOWED (U.B.C.REqU1REMENT;
YARDSAPPROVED YAROSAPPROVEO
MAIN BUILDIN6 _ ACCESSORY BUILDING
VAR. SR
DATE
� �� Q �
N
8�. �. 0
TXe AMOUNT BHOWN UNDEF VALUATION IB FOR THe F
PUflPOSE OF E9TABLI8HIN0 A PEAMIT FEE ONLY. �
VALUATION �7 OO m
PERMIT FEE $ OL I �
�
)m./ m
$ M LA C E ` v p
.5 %(�. 3 � _
TOTALFEE S �
�'