HomeMy WebLinkAbout831 PLUM PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lob nddress: 831 PLUM pL
Suite:
Vicinity: ROOF
Parcel Number: 42245411
Applicant: RANDY NQRLAND
Address: 29622 VIA CEBOLLA
LAGUNA NIGUEL, CA
Owner: VAN DE M�ULEN, BARRY
Address '831 PLUM PL
� -COSTA MESq, CA ,
�
Convactor: NORLAND ROOFING
Address: 29622 VIA CEBOLLA
LAGUNA NIGUEL, CA
Zip: 92677
Arch :
Address:
Zoning:
Phone: (949) 495-2002
Zip: 92677
Phone:
Zip: 926273327
Phone: (949) 495-2002
License: 716786
Eng:
Address:
Phone:
Status: ISSUED
Applied: 11/18/2003
Issued: 11/18/2003
ISSUED BY: �
Phone:
Zip: � License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. EXISTING SHEATHING WILL REMAIN. INSTALL 50 YEAR COMPOSITION SHINGLES AND 30# FELT. 25 S�UARES
INCLUDES ATTACHED GARAGE.
Plan Check:
Permit:
SMIR Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$139.25
$0.63
$0.00
$0.00
$0.00
$139.88
SETBACKS
MAIN STRUCTURE Fron[ 0- 0
ACCESSORY Front 0-0
PARKING Existinq: p
Rear 0• 0
Rear 4 0
Reouired: 0
FEESUMMARY
Calc Valuation: gs,soo.00
Claim Valuation: gs,300.00
PLANNING & ZONING
Left 0-0 � Right
Left 0- 0 Right
Proposed: 0
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-g2)
EXPIRA710N: This permit shall automatically expire and become void if work Is not commenced within 780 days, ar 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, such work must comply with all applicable codes, end all
required Inapections and final approVal must be oblained. Failure to obtain inspections and final approval will result in ihe ezpiretion ot thls partnit.
FOR INSPECTIONS CALL: (714) 754-5626
264&68(BNO)
WORKERS'COMPENSAnON DECLARATON: �
I hereby aHirm under penalry oi per�ury one of the following declaratlons:
❑ I have end wlll malntain a certiticate of consem to self-Insure for workers' compensation, es provitled br by section 3700 0l the Lebor Code, tor the peAormenca ot t�e
work for which Ihis permit is issued.
� I have antl will maintain workers' compensation insurence, a5 required by section 3700 of Ihe Lflbor Cotle, for Ne pedortnance ot ihe work fw which this pertnit is issued.
My workars' compensatlon�uranc�e /ca1rner end policy number ere: yC, ^�
Cartier. '�'-'�P, �--cJrvi 1 Pdicy Num�er: �!J /� � C7 3 J
(This secfion need nat be comp/efed il fhe permit is valuetl af one hundred dollers ($700) or Iess.J
❑ I certity t�at in Ihe peAo of t�e work for which this pertnit is issued, I shall not employ eny person in any manner so as to become subject to the woAcers'
compensetlan laws o e ia, entl egree Ihat il I,Si�ultly8t ome sub�ect to the workers' compensation provisions of Secqon 3700 of the Labor Coda, I shall torthwith
complywithihese sions,�i C' /f� //
Applicent Signature: ��U�/�Ci/�� _�� Date: %�' ��� U 3
WARNINO:FAILURE SE REWORKERS'CAMPENSATIONCqVERA0EI5UNlAWFULANDSHALLSU8IECTANEMPLOYERTOCRIMINNLPENALTIESANDCIViLFWESUPTOONEHUNDRED
THOUSPNO OOLLARE (St W,000), IN A�DITIIXJ TO THE COST OF COMPENSATIIXJ, DNMFGES AS PFOVI�ED FOR IN SECTION 3lOfi OF THE IABOfl CODE, IMEREST, AND ATiORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that I am licens�ed( �untl.ejr p�rovisic
torca end eHect Lic. k_- �eS�.G�L.�L�—
ConireaoYs Signature: G
ot Chapter 9(cammendng with Section 7000) ol Divislon 3 ot the Business and Protessions Code, flnd my license Is In tull
ciess a C3 `j
Date: / /- / k• O'3
CONSTRUCTION LENDING AGENCY:
� I hereby aftirm the� ihere is e construction lending agency for ihe peAormance of ihe work br which this pertnit is issued. (Sec. 3097, Civil Cotla).
Lentlers Name: Lentlers Adtlress:
Signature: Date:
OWNER•BUILDER OECLARA710NS:
I hereby ettirm that under penalry ol per�ury �hat I em EXEMPT FROM THE CON7RACTORS LICENSE LAW lor Ihe following reeson (Sec. 7031.5, Busineu antl Protessions
Cotle: Any Gry or counry which requires e permit to consiruct, elter, Improve, tlemolish, or repair any siructure, prior to its issuance, elso requires the epplicant lar such pertnit
b tile e signetl stetement ihet he or she is Iicensetl pursuent to the D�o��slons ot the Camrectors License Lew (Chepler 9(wmmencing wlth Section 7000) at Dlvislon 3 of the
Business end Protessions Code) or thel he or she is exempt therefrom end ihe basis for che allege0 anemption. Any violetion of Sectian 7037.5 by eny applicant for e pertnit
subJects the applicent to a civil penelty of not more than five hundred dollers ($500).):
❑ I, as owner ol ihe property, or my employees with wages es Ihelr sole compensation, WILL DO THE WORK, antl tha sWcture Is noI In�ended or oHered tor sale (Sec.
7044, Business and Professions Cotle: The Conirectors License Law does no� apply lo an owner of property who huilds or improves ihereon, and who does such work
himself or herselt or Ihraugh his or her own employees, provided Ihet such improvemenis ere nat intenaed or otfere� for sale. II, however, Ihe 6uilding ar Improvement is
sold within one year of complelion, ihe ownerbuilder will hava the burtlen of proving thet he or she did not 6uild or improve for purpose oi sale.). �
❑ 1, as owner of ihe proparry, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the pro�ecl (Sec. 7044, Business end Professions
Cotle: 7Te contrac�ors Ucense Lew does not epply to an owner ol properry who builtls or improves thereon, and who conlracts br such pwject with e contrector(a)
license pureuani to the CoNractors Licanse Laws.).
❑ I em exempt under sec. Business and Professions Cotle br this reason:
Signature: Date:
Owner ID veritied by drivets license. ❑ Ves ❑ No Drivefs License No.
Vorificalion of Ownership by (type ot tlocument, i.e. - property tex blll or tleetl):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTIFICATION:
❑ I hereby certify thet no e:cevetion tive (5) or more feet In depih into which a person Is requiretl Io Oescentl, will be mede in connection wi�h work authonzetl by thls
pertnit, antl that no building 51ruCture, scaHolding, falsework, or demolition or dismantling thereoi. wlll be more ihan thirry-six (38) faet high. (Chep. 3.2, Grp 2, An 2, Sec.
341, lltle B, Calitomia Adminisiretive Coda).
❑ As owner-builder, I will not employ enyone to tlo work which would require e permit irom the Division of Intlustrial Salery, as notetl above, unless such person has a
pertnii to do such work from the tlivision.
Signature: Date:
Division oi Intlustrial Sefery Permit Number.
CERTIFICATE OF COMPLIANCE AND AUTHORVATION OF EMAV: I certity under penelty ol perjury that I have read ihis ep0�ication entl state thet Ihe informetion qiven is
correct I agree to comply wlth all stete lews entl city or0inances relatinp to builtling consiructlon, entl euthonze representetives ol the Giry oi Coste Mesa to enter upon Ihe
ebove-tlescribed property for inspection purposes. I egree not to occupy or allow occupency of any 6uilding aulhorized by this permil until tinal inspection.
GOUE �. INSPEC710NTYFE
1876 Fixetl System Final Fire Prevention
1286
200
201
202
203
Pool Spa Finel
Final Re-Root
Finel BIocWRe�aininq Well
Final Faciory Fire Place
Final Sign
20C Final Demolition
PAg II�JA4S
� �y
Date
�/'/�'c)�
Date
COOE 1 INSGECTON TYPE
206 Final Mechanical
208 Finel Plumbing
210 Final Electricel
212 Flnel Fire Preventlon
220 Final Planninq Approval
222 FinalSite
250 Final Building/Occupancy
Q� I[i�4S
PN0.IELTROUflE55: ({3S PLUM PL
OWNEN'SNRME: ENACHE POPP
� aoosess: LILLIANA POPP
831 PLUM PL
' COSTA MESA,CA
, 548-6109
AflCHIENGINEEfl:
aoon[ss:
UNIT:
92627
NEC.NO.:
uxrt:
PEHMITTEE: ENACHE POPP ( 719 ) 548-6109
aooncss: g31 PLOM PL
C,M. CA 92627
LILENSED CONTHACTON DECLANATION: I �ereDV af�irm Ihai I am licensed untler pmvisions o� ChaD�er 9(commencinB wilA Seciion
7000� oi �iNsian 3 0l lhe Business antl Pmlessions CoOe, ana my license is in lull brce anC eHact.
CITY UC.: STFTE UC.: CLASS: EXP ;
Oate: Signalure:
� WOBREBS' COMPENSpT10N UECIANFTION: I hereby alfirm t�at I �ave a certificate of consent m sel4insure ar a cenilicate oI Wofners'
Compensation Insurance. or a tertilietl copy thereof (Seclion 38011. Lab. C�.
j VO�ICY NO.: E%P. DFTE:
COMPANY:
� Ceni�ietl copy is hereby lumis�etl. ❑ Certilietl copy is lilea wilA ��e city Builtling Division.
Oare:
Applicant:
ESEMP710N FNOM WOflRENS' COMPENSATION DECIABAT10N: (This seclion neeE nol Ge campleietl il �he permi� istor one hunAreO (511p) m less).
I ceriify I�ai in �he pedOrmante o Ihe work lor whit� ��is permi� is rssyqtl I 5�all no Dloy any erSon in any mannef 5o as to became
ect to �ne wo� er ',JC(pmve iion laws ol Calilomia. /J/j� /
Dat : ID V SiAnaiure: / /�-��Q �����
NOTICF. 1. alter maki iAis Aeclaration, you shoNA come subjec� to tne Workers' Compensa ovisions oi tAe Lahor
COUe. you musi farlhwiN comply wit� suc� pmvisions ar �his permii S�all Ge UeemeO �evoketl.
CONSTflUCTION 1EN01NG RGENLY: I �ereby afiirm t�al th¢re is a consimttion lentling apency lor ihe petlormance of the wod lar
w�ic� ihis permii is issuetl (Section 3097. Civ. C�.
LENDEfl:
pODPESS:
OWNEfl BWLDEB OECIABRTION: I �ere�y aflirm I�ai I am 2Kem0� �mm Ih¢ fqntratlors' State License Law Ior ihe following reason
(Seciion 7U31.5 Business an0 Professional COGe: My ciry ol couniy whic� repuires a permit �o wn5lmci, al�er, impmve, Oemalis�. ar
repair any stmcture. Drior lo ils issuance. also reQuires t�e applicanl for SucA permii Io lile a signed 5tatemeni tha� he/she is litBnS¢G
pursuam m t�e pmvisions oi t�e Comracmri S�ate License law �C�apter 9(commencing wit� Sectron 7000) of Division 3 01 ihe 9usiness
anG Pmfesvons Cotle) or I�at �e/she is erempl ��erelmm and Ihe basis �or ihe allepe0 exem0�ion. Any Nolation o� Settion 7031.5 Ey
� any applicant �ar a Oermii suDjects Ihe applicani Io a civil Denal�y ol not more than five hundrea tlollars (5500�.
I, as owner of ihe o�ooeny or my employees witn wages as tAeir sote campenution, will do tAe xrork, and ihe
❑ stmcmre is not inrenAetl or offeretl for sale (Seciion 70a4, Business anC Pmlessional Cotle: T�e Cantracrors' State License Law
Ooes no� apply to an owner ol a DmOerly who Guilds or impmves thereon, an� who Aaes sucA wark himsell/hersell or �hmuAh
his or Aer own empl0yee5. pmviOeA �ha� SUCh imprOv¢menis are nol intentl¢d Or aflered fOr sale. If, �Owever thE huildinA of
impmvement is sold wi�hin one year ol complelion, ��e owne� will �ave �he �urAen o� pmving Ae/she Oitl no� buila or impmve
�or Ihe Durpose ol sale�.
,�,/ I, as owner oi �he pmDehY. am e�clusively conlractinA wi1� licensetl coniracmrs m constmc� �he O�aie�t (Section 704d, Business
L? antl Pro�¢55ion5 Cotle: The COnlraci0r5' Slaie Li[ense Law tl0es n0� apply t0 an Ownef of proDertY'/�'ho bUAas Or impmv¢S lhefe0n
anU who coniracis �or such Dmlecis wiih a conirac�m�s) license Du�suanl to �he ConVacrors' Sla�e License Law�. I am aware
that prnnl of Iheir WOBer's ComDensalion insurance s�oula he Omvidetl to me.
� I am eKempl unAer Section: B. 8 P. C. q
�or ihrs reason: � / �� ,( �
ale'. Y O � � Ownec ��%`.lY �1�3'S%%�
I ereD cerlify �ha i am aware oi ntl untlerstanG i�e reQuiremenis ol Califamia Healih an0 Safet Code Sectians S�i' 25533. an0
53C an01ha1 I or any IUWre builAinp occuDan� will/will not (circle one) need to comply wi�� 5ai0 5ta codes antl the reQuiremenis lor a
peimil lor consimclmn or motlili�a�ion tmm IM1e Air ualiiy Manage�ni Oistric�. �Oential canstr�ii'on aDDI �a�ions are exempl �mm
�e'. G�.� APPlicanC •�___ • ..
I he�eby cetlilyMai I haveleaa t�is ao7licatian an0 s�ale t at t�e a0ove inlormalion is carrect. I agree to c999���ppply vn�h all cily anE fAunry
o�Cinarces ann stale laws relaling �a builtling mnsimclion an0 here amMr¢e repr ntames oi ihis ciry to ghtejuDon ihe above�mentionetl
Drop¢tly Iorin50etlmn purp es. ✓
�Oat � �� $ignatur' a���
4river's Lice e m So �a� Securi�v
�6<t�06 `Nbne—Bml�ing: Green—COEa Entorcement; Canary—Ap0licanl: Pink—Pevenue: GolaenraE—Fssesmr
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: M 069664 PLAN CHECK NO; N
CONSTRUCTION TYPE; PERMIT TYPE: MEC
JOB DESCRIPTION ; ZNSTALL F,A.U. UNIT LESS THAN 100KBTU
CLAIM VALUE:
CALC—VALUE:
PERM NO; M 06966
GOVT; N SUPP: N
PURPOSE: OTH
SQ FT;
GROUP OCC: /
COMMENTS: INSTALL F.A,U LESS THAN 100K BTU
�t*+r��r�t*itritx«�t*�tit;e�rr�x�r**�t**x�*******it�t**�t�r*�r*****�t�t*�**r****�t�t*+t****w*x�rrw*�t*****
Z O N Z N G R E Q U Z A E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN AEAR; FT IN FRNT: FT ZN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ; PROV; PARCEL: 92295411 ZNE: REF NO;
PLANNING NOTES>
�
ik it if if 1f 1f M if i4 iE iF i! k k ih ff M iE if if if iE iE %%if iE ik if if if if it if if if it iF iF k i! iF if ik M iE iP if k iE iE if it it if if if iE 1f it iF if iF if i! iF if 1F if if if ik if if i� i: i! M iF
D E V E L O P M E N T S E R`l� I C E S R E Q U I R E M E N T S
ZONING APPROVED BY ,
HUILDING APPROVED BY ;
APPLICATION ISSUED HY;
�t*********if*i��fit******�t3FiFTEiF�tiF��F3FiFiFiFiF'�'�- �ciF#3Fi�#iFiF?Fir�i�
iE i! %fE if if M if 1f if 1E jf iF if ff ft 1E iF iE iE IF iE 9E �F if i� 1E ff if if if 1f iE M jE 1E if if if 1f 1f If iE K if if �F if iF if iE if k if M �f if if
LEGALIZATION;N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
PERMIT 9.00
� 25R
PLAN
ISSUE FEE
BUILDING—DIV—>
TOTALS---->
PERMIT ISSUE PLAN—CAECK
9.00 15.00 0.00
REVENUE DIVISION TOTALS--> COLLECTED;
BLDG PMT PLUMBING ELECTRIC MECHANIC
-� 24.00
E���I;
DATE;
DATE;
DATE: 6 `
ifaf if if iF iF iF jf {f if
ifit If if if if% M iFaFM ifif r itif if if if
STRUCTUAAL EGMENT:N
SMIP/AES GRADING
SMIP/NON—RES
TOTAL PAID DUE
24,00 24,00 ,00
24,00 OVER/SFIORT; .00
FIRE SMIP/TOT GRADZNG PLAN—CHECK
lkififMlfkjfifiklf�fitlFifififlFk�flfifififM�fifMaFM#41fit1E4ikMlFfEffihiFkiFififiEitifiEiflfifitlfiE�fiEffifMifififk41t1hifif*ifMfflflffFM1l1f
I N D I �' I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T S O N UNIT COST TOTAL COST
MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9,00 9,00
END OF FEES
; ��� � ,
OCT 2p 1994 �
U
�rlTY Of COSTA MESA
,
.,
CONSTRUCTION AND PLANNING POi,.. & SPA �
APPROVAIS Permit # Date ��Inspector qPPROVALS Permit ?� Date Inspector
1. Temporary Electrical Service or Poie 52. Poo4 & Equipmeat Location �
2, Soil Pipe-Undrgrnd. 53. Steel Reiniorcement
3. Electricel Conduit Utility�Undrgrnd. 54. Forms .
� 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
5. Steel Re�nforcemenc 56. Rough Plumhmg & Prenure Test --.
6. E�Iectrical UPER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Pootings 58. Electricai Conduit•Undrgmd.
8. Foundation 59. Gas Pipe, l� Undrgrnd., Tesc
9. Water P�pa-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurai Floor System 67. APPROVALTO DECK �
1 i. Property Sewer Line & House Connection 62. Backwash & Recepior�Final '
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains � � 64. Plumbing Sys[em - Final "-
74. Rough Piumbing � 65. Electrical-Final "
15. Rough Electrical�Condult 66. Solar System-Final �- .
7 6. Rough Electric Wiring 67. Fencing & Access Approval � � .
77. Rough Wiring Siyn 66. APPROVED FOR PLASTERING �
18. Rough �learic2l-T Bar Ceiling 69. POOU'SPA SYSTEM5 FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. RE�UIREMENT
20. Rough Factory Fireplace � � APPROVAtS - Permit #
21. Outcs, in Structure ', � , 70. Undercround Hyclro
22. Duas, Ventilating � 71. Product Piping 17 Gas G Oi�
23. Gas'Pip¢�Rough & Test � . . . "72, Underground Flush�
24. Roof Framing . . � � - 73. �Undergrnd. Storaye Tank O Gas ❑ 0�1
25. Roof Sheathing - �� � 74. Ooerhead Hvdro I
26. T-Bar Ce�ling �Structuraq & OAonocoat . . 75.'Dry Chemicai '
27. frame and �lashing -, � 76. Dry Standpipe ; " .
28. Lathing & Siding • . 77. 'FIXED SYSTEM FINA� �
29. Insulation "' 78. FIRE PREV. FIi�AL
'30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plasrer 9rom�n Coat �. 79. FINAL INSPECTION (
32. Electric2l Power MeterFinal �80. FOOD CERTIFICATE ISSUED .
33. Finai Electr;c ' . Notes:u-�S�¢, �•�L_Q�_ _
�34. Final Heating & Air Condrtioaing l� , .
35. Finai Gas Pipe-Test
36. Hood or Canopy , . ~J �
37. Final Fac:ory Fireplace � ' ' �
38. Final Plumbing � . .
39. Water Service-Final ' � . . i•`*-".-"''� ..^ �
i
40. Gas Service-Final � . " � ,
t-:
41. Solar DOmestioFinal - i' •f ;. I- ��
42. Backflow Preventer ' ', . .•tit` . " •�-'
43. Backfiow Irri9ation � � "-� � • �'� � "-�
44. Landscaoe trrigation. SYstem . �'� �' � "�
>. •.
45. Sound Aitenuation � � • - � � �.� "' �`'��
• t. . �--g :'
46. Handicap Regulations � ' � , � � "�
47. fINAL STRUCTURE & BU�tDtNG --
48. PINAL PLANNING - - .
49. Electric Release to Edison "
r
50. Gas Release to Southem California Gas Co
51. CERTIGICATE OF OCCUPANCY - _
No. Date
OWNER BUSHLING, George A. `/ DATE 6-25-$Lt
JOBADDRE33S3�. PZl1IR PZ• BUILDINGPERMITNO. jµB
G�"EHALCONTRACTOR Or,mer-Huilder VALUE $ 1�2QQ.QQ
�LOT 75 BLOCK TRACT i7m3 Conversion
GROUP '' J TVPE V ZONE R�1 FIRE DISTRICT 1�358
INSPECT�ONS I DATE I_ $UBCON7RACTOR PERMITSISSUED
f DATE � NUMBER
Footing Trench �J',c�
Faundation Forms and
Plumbing, Rough to Slab
Wiring, Rough
Heating, Rough
'Heating, Final
Sewer
S� �Tank o�r Cess�p-o�ol�
La.��mg �,(.e.�e.t�es
Plastering
Plumbing, Final, Fixtures
Plumbing, Final GasTest
Wiring, Final
Occupancy
Fbrm 2l0 GH IN 1&69
Costa Mesa Building Department APPLICATION FOR PERMIT
i '�- 117 EAST 20th STREET �8 g U I L D,t N G �
�, --�-. COSTA MESA� CALIFORNIA
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
Rece/ipJt N� %. Permit No.
Addre�� 'S L - �� '-1 7 � ��
Costa Mesa, Ci8�I1fOPII18� Received by ate Re d. Date Issued
-� --- �-ir.�
Costa Mesa, California
/ - - l.o i�e. � .�c+ �one rve. ot � ype� I u
hitector Lfc. � Plans �
�ineer S ��- — No. Approved
b Date
�''`�' -- CORRECTIONS
Gty Lic.
lot !� �, � /I.Rt� i �M�t�ii � 0 •�
No. %7 I B�ak — I Tractj ��
�nd 9ounde)
I No. oi Bldas . � �
or
No. of
erior
1
Addition
APPROVALS
/ Frame: Ffre Stops,
Braeing, Bolts
I hereby acknowledge that I have read Uus Applicatfon Lath. Int.
and state that the above is correct and agree to rnmply Lath. Ext.
with all City Ordinances and State Laws regulating
building construction.
SlgnatureM � Plaster,lnt.
Permittee
Plaster, EM.
Authorized Agt `
asonry Reiniorced
Valuation Permft Fee $ �
$ ��� Ci Plan Cheek $ �� Bond Beam
Total p
Fee $ 1 l FINAL
O
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„ rt � • � PLO'.C�P,I�1�I'd'E ir�
Shot�� : ' i ��'
tv�'Ioca`i ol o�a',d distances irom
property line and between buildings
.. . �.. ' .
�
" ORANGE COUNTY BUILDING DEPARTMENY APPLICATION FOR PERMIT
��" � SANTA ANAh CALIFORNIA � � B� I L D I N G �
.�:i .�:.;•.. _....
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use [nk Only
BUILDING 8 LLn 4
ADDRESS
e
OWNER B � �
MAIL (J� �U�'j% POG� G�/I �{p
ADDRESS
/� �J TEI.�.y�
CITV//KTlS Gy%/SG NO;J'fR �.
BRANCH
ADORESS
SEP 12-77cnsa�\Z+� ��**72.63
APPLICATION FOR STRUCTURAL PERMIT
R E C��B V � I,..C� !1 /�'15U%
A
ARCHITECT � � • / TEL. /�j_�p' S R� -`^n' �
ORENGINEE d�� ��
ADDRESS S� �/G��f/� • C 9��2�+ FIRE
ZONE TVPE GROU
APPROVED
CON'fRACTOR QU�NL�%Z � �L �. BV DATE
ADDRESS - � �
TEL. ZONE NO.OF USE OF NEW
CITV NO. ' P � BUILDING
.�-� STATE � - CITV ' VED � PPROVED
LIC. NO. � LIC. NO. MAIN BUILDING ACCESSORV BUILDING
i (FROMGLST T)
{cl SIZE '%� I30 ��Q K�cl NO.OF BLDGS / I/ %�
o. OF LOT NOW ON LOT / ONT C FT �
a VSE OF � a
.,�. EXISTING BIDG.
F
y �
F� . Separate permils are re.quired for L. SIDE FT. �� U� cL
� ' electric, plumbing and heating work. REA �/�
i �`t�' / , FT
USE OF BUILDING AND WORK TO BE PERFORMEO DISTANCE BET. BET. MAIN &
Q�` � Cf"' Lr� MAIN BLDGS. ACCESS. BLDGS.
VAR.54'+ � DATE
, �— %j/J y= — /v%✓ C.U.P.qW '�' ' 'APPROVEOw�'
Q
�. ND �– - f �'ROVE _ _
a I �/ (�ry � I/ � � .
2�
W
� I ha�eby eeknowletlpo Mat I h a read ihis applleetion antl sieto
a that tho ebove Intormation I correct and epree to comply with
a ell laws ropulatlnp builtlinB �onrtructlon, entl 1 chall noi amploy
�eny perwn In vloleilon of Ne workmen'e eompansation laws ot
y. the Stata of Celifornia. 3 0
3 I horoby eertify that I am properly Iicansetl es a conttector untlar SQ. FT.
t�e Swta of Calltarnie Buainess entl Profeulone Code, Divlalon 3, THE AMOUNT SHOWN UNDER VALUATIO�
Chepter 9, end that such Iicenses ara In full foree anC afiaet, or 1 TNE PURPOSE OF ESTABLISHING A PERMIT F
am nxempt irom the provislons of the Stam of Celifornla Buainesa V ALUATION PERMIT FEE E
antl Professions Cotla, Divlalon 3, Chapwr 9.
Sipnoturaof � G� "�s�/ OO PLANCHECK E
. �000 �
Pormittao 6 � $ TAX 5
Authorizotl Apent TO7AL PAID 3 �
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