HomeMy WebLinkAbout1581 PONDEROSA ST - Building Permits ADDRESSOFBUILGINO: 1581 PONDEROSA ST UHT: CITY OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IFI MOVE MC NEILLY, KATHERINE H ET PERM NO: B 071616
ADDRESS: AL
1581 PONDEROSA ST PERMIT NO: B 071616 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA,CA 92626
APPL.MMIIND ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : TEAR OFF REROOFW/COMP SQ FT: 4 , 000
ARCH OR ENO'S ADDRESS: UI(T:
CLAIM VALUE: 4 , 000 . 00 CALC—VALUE: 4,000 . 00 GROUP OCC: R-3 /
CONTRACTORS NAME:
CONTRACTORSMMID COMMENTS: APPLY 40YRELK COMP
ADDRESS: LIC.NO.: HEdHiHiEeEMib Rb HE9F*'k Rf IH4dFMfE*iHiFiEREM9FiF*RFeEiEiF**9E*hhiEiFM*1Hs%iFRERFih9Hif***dF1F*9H*1HiF3F1E*RF3H*iERF#*RFdF9EiF9FRF49H*dF
UNIT: Z O N I N G R E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under pranaions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.
CRY LIC.NO.: LIC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT. IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I an exempt from the Comradors License Law for the
billowing mason(Section 7031.5 Buskins and Professions Code:Any city or county which requires a permit to coneatict.aver.improve. PARKING REQ: P R OV; PARCEL : 13931211 Z N E: REF NO: ..
demolish.or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he Or She
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than Ave hundred dollen[55000. *****RE iF*alk**********if*****'N'****,.***if**#ff****if iF lir****3F 3 **lE*iF*******Mil 1F11**fir***lkik***
11:1 I.as owner ofthe Properly or my empioyaee with wages as their sole compensation,will iso the work,and the drocture i nix intended DEVELOPMENT SERVICES R E Q U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an Owner of property Q
who builds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such ' ,
improvements
mpro ems'xerin riot intended
Ne dpmv'raip l,e«sale B'.however,
did nott the ming paeovmaplaor Mpco'uryswsold
e waele)one yid completion.
� ZONING APPROVED BY DATE:
owne❑ Las owner of the properly,em exclusively contracting wM licensed contractors to construct the project(Section 7044.Business and BUILDING APPROVED BY : •
Professions Code:The with
aContractors License Law does nor apply to an owner of who Wilds a improves thereon and who / DATE:
❑
contracts for such projects WIIh a Mlmdan(9)licensed Pursuant too an o l e La APPLICATION ISSUED H Y : (C�./ DATE;
lam exempt under Section: _ B.Bner: for this reeeo : elf9E fir*****iH*******RF****9E 3F**HE kale elf if *1Eff iE if lir iF dE 1F#lf if lE if at iF if ji jf iF iFMef aE it iE IEfir1F{E iE if df�F iEif
Date: 3--2,I-f f owns LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of end understand the requirements of Cel/oma Health and Safety Code Sections 25505,25533,and
2553m.end orcon laany or modWitingaathentwltlwCna(dmleahe)need tpient' .haodda asci ante tithe eggfrom thefor
se BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/RES GRADING
a permit forconstrodcnamodifimlbnhanlM A'r eiy anepement District.Redden... -vfoj apV are tieing from these
provisions. J-w(y/1 PERMIT 63 . 00 . 50
Date: 3 -21-73- Applicant: PLAN SHIP/NON RES
WORKER'S COMPENSATION DECLARATION:'hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE
•
❑ Ihave and wilmaintain acenificdeol consent tosef'insure for workers'compensation,as provided for by Section 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID - DUE
the pedom,ahaedthe ors+rfawHah this pemhe is issued.
TOTALS----> 63 . 50 0 , 00 0 . 00 63 . 50 63 . 50 . 00
❑ I have and wig'mental 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 caner and policy number are:
Caner: REVENUE DIVISION TOTALS--> COLLECTED ; 63 , 50 OVER/SHORT; . 00
Policy Numbs BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK
(This section need not be completed it the permit is for one hundred dollars(S100l or less) 63 . 00 . 50
•--+ cenry that in the performance d the work for which this permit is issued,I..:I act employ any person in any manner iso es to
become subject to the workers'compensation taws o California.and y4 Hl should became subject to the workers' 1f If1EMlE1ffFlElElfjFiFiE1f#iFAt1F1E)fiF#if IEhElFfEfEi(-3FiFiFlFjf#i11FiE****M1FffiflfifiFifiEitiflflE#1EffifififiF****#ikiflEiEMIEiEif1F#ffif
compensation provisions of Sadiron 700 of the Labor Code.I shall lonh ',T Na vu
Gj //""" .
INDIVIDUAL F E E BR EAKDOWN
re---- Date , e�y�6 Applicant: 'I�` , ^a
Weming,Fsluntnacure workers'conparsadoncovarage leu P�l,and shall slb/ect an employer to criminal pantltip and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(510L,000f,In addition to the cost of compsnsacosL damps aa provided ler in
Section 37Osof the Labor Code,Interest,and attorneys fees. SFR 4000 ALTER BY VALUE RESIDENTIAL NOZONE 1 , 00 4 , 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 this permit is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances
-, end state laws relating to building construction end hereby authorize representatives of this city to enter upon the above'mentoned property
la inspection purposes.
•i' 7)6
�
�ce -
�/Z- l. Dole: Ll! S • 01 00173669-00173670 -vol.- 63.50 J
"'� r gnature of Owse�ge rAppkcamUContrada DATE: '7 r
(5151-ee.WP) White-Buildig&Safey:Green-Fle:Canary-AppM:ent:Pink-Revenue:Goldenrod-Assam®n
.
CONSTRUCTION AND PLANNING POOL & SPA .
* APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole i 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement ,
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
- 4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding ,
i
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
h ,1
•- 6..;Flectrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE �
..7. Footings 58. Electrical Conduit-Undrgrnd,
I
8.-Foundation 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. -60. Backwash Lines, P-Trap, 0 Untlrgrnd.
10. Structural Floor System ' -'• 61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection 1 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 I
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 - ' : y ?. • ` APPROVALS - Permit# .
21, Ducts,in:Structure . •• _ -I' 70. Undergr&und Hydro •
22.Ducii, Ve'ntila'ting. ., ' ,-, . - - . - 71. Proddct Piping 0 Gas ❑Oil
23. Gas Pipe-.Rough 84-"Test _ : - ; 72. Underground Flush' •
24. Roof Framing' -. - - 7. , - 73. Undergrnd.StorageTank 0 Gas 0 Oil
25. Roof,Sheathing .. 3 h..' fy . _ 74. Overhead Hydro 2-
26. T-Bar Ceiling (Structural) & M000coat - _ - - 75. -Dry Chemical
27. Frame and FI@shing. - ,. • 76. Dry Standpipe - _
28. Lathing & Siding . • .- - " 77. FIXED'SY.STEM FINAL
' 29. Insulation . - 78. FIRE PREV. FINAL -
30. Drywall Nailing 21 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat : - i. , 79. FINAL INSPECTION
32. Electrical Power Meter-Final i ' 80: FOOD CERTIFICATE ISSUED
- 33. Final Electric - Notes:
. 34.,Final Heating& Air Conditioning-. .
I,.
35. final Gas'Pipe_Test ; - . .. .
36. Hood or Canopy - 4 _ T
37. FinaCFactory Fireplace-• - . ' - .
38. Final Plumbing - '
• 39. WateF Service:Final ' - - '
40. Gas Service-Final - - '- 1 ,„ . •
41. Solar Domestic-Final :,. -
42. Backflow Preventer •: -
43. Backflow Irrigation.; ; p ; .,
•44. Landscape Irrigation System I ., '
45. Sound Attenuation' - ....
r ;
46. Handicap.Regulations - - _
47. FINAL STRUCTURE & BUILDING 44' k `^�(,_ • 1-
48. FINAL PLANNING u� w '
49. Electric Release to Edison •• "
50. Gas Release to Southern California Gas Co - •
51. CERTIFICATE OF OCCUPANCY •
No. Date
DECLARATION OF AUTHORITY Bldg. Permit # �7 / 16
FOR AGENTS OF PROPERTY OWNER This Permit #
TO APPLY FOR PERMITS
/5cf/ pail)VE2or4- Cosi/{- MEM (A
Street Address AP Number
1. I (we), 34E 0;0.2,4-esel , declare that I am the Owner of Title
of the above referenced real property, and that I (we) hereby authorize:
Src uC Fi5 z y 832-7 V23
Name Telephone No.
St O —ger>. AKJ ,tc-
/�/ F // Street Address 5 /�/ '"�
6Ps !1 GL Cot r PZfOa d
City State Zip
to obtain permits in my behalf, as owner/builder, for -4Loq �.ry
(
at the above referenced property. (/
2. Should any person become an employee engaged in the improvement of the property, I (we) shall im-
mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties as a result of work authorized
by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this . 3 no, day of 1/4l?m-r.e-k. 19 fS , at , California.
hinZS& Lep.r2V �'Ja ceA 23 / 9 Q,5"
Printed Name Date.)
74.4
"Signature
NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
NOTARIZATION REQUIRED •
0779-46(Rev.2191)
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 6010 2121 /85 5.00 1.1
CITY OF COSTA MES CONST U TION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO, • L
Project Address ?�$1f1A� R U I'
,. TYPE OF CONSTRUCTION U NEW ADD LI ALTERATION U REPAIR
Applicant's Mailing Address S2 C !
Lap& d Phone El CONVERSION 0 DEMOLISH CI OTHER A.P.# Zone
Owner's Name DESCRIPTION OF WORK/USE OF BLDG. •'
Address S Main Building: Accessory Building:
Z
Arch/Eng- ` ! / //� License No.'
o. • TYPEOFTENANT PERMIT ❑ GRADING O.FUMBIN TION ❑ STRUCTURAL - T Front O
Address GJ/J�� /�� 0 OTHER ,❑ ELECTRICAL Lh}LUM GING ❑ MECHANICAL B •
Rear . N
Contractor's Name I/""11 l��{' Pion
` �f� �L jj�2 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K C Right N
G Address (Tailing)gebta !'� CONSTRUCTION TYPE $ Left - • G
' City License No. X073 - ZONE VALUATION$ _
`h D CONTRACTOR DECLARATION GRADING CU. ACRES R
LICENSE Ping. Ref.# Parking Req./Provided E
V I hereby section
7 that I am licensedion under provisions charterro9(commencing Remarks. /J/rl/t/� �"�ord 0
with section affirm of m ic3 of the Business and hters(c Code,and !!! ]!3. ��I Planning Notes: M
my Ilcense is in if ce and effect. 4 l T
•
License Class License N a/ - ' S.
Date • Ot f— Signature� PLUMBING FEES •
WOR EPS' COMPENSATION DECLARATION Bar$ink Showers
I hereby affirm that I have a certificate of consent to self-Insure or a certificate ....• ELECTRICAL FEES
of workers' Compensation Insurance„or a certified copy thereof (Section -
3800, Backflow-Preventer - - Service Sink
Lap. C.) N i�,/d - Automatic Washer - Transformer 0 15-50-KW - -
No.e ev company ��'l/l'/4I. • Backflow Irrigation 0 50+KW
Policy9a Sewer Cap Construction Pole Sub.
c ified copy is hereby furnished. �_
e Pi1�y5p d with the'city l ivision. Bathtubs - , Sewer Connection • Cooking Unit Meter pup to 100 amps
Date APPlican
EXEM TIO FROM WORKERS'COMPENSATION DECLARATION ' Clarifiers Solar Collectors '
(This section need not be completed if the permit is for one hundred($100)Or Dishwasher ' Meter Dover 100 amps
less). Dishwasher Solar Piping Dryers ❑Gas, ❑Electric Sub Panel
I certify that in he per •rmance of the work for which this permit Is issued, I ,
' shall not empl•- any •e •n In any manner so as to become subject to the Drinking Fountains Solar Tank Fan
Workers' Co ••=•sat Ht-.4,8- of California. Motors' ❑0.1 HP ❑1Yh-8
Date gnature Floor Drains Swimming Pool w/Spa
NOTICE:- .after eking this declaration,you should become subject to the _ F,A,U. Inc.Solar ❑g-15 HP X16-15+
—
Workers'. Com• sation provisions of the Labor Code, you must forthwith Floor Sinks- - '
I withpermit shall be deemed revoked. Urinal Fixtures -
comp Y such provisions or this - Microwave
CONSTRU ,ION LENDING AGENCY - -i---Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby aft m that there is a construction lending agency for the performance 9
of the w•rk for which his a it is Issued (Section 3097 C . C.)
Lender's Interceptors Water Heater c2—.—•• Outlets Range
-
Lender's Address /fra�� Kitchen Sink .-
Sign
OWNER BUILDER DELLA' ATION 'Water Service Switches ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal 'Standing Sections
following reason (Section 7031.5 Business and Professional Code; Any city or
county wnich requires a permit to construct,alter,improve,demolish or repair P—Trap .05-15
any structure, prior to its issuance, also requires the applicant for such permit Generator -5 KW KW
II• to file a signed statement that he/she is licensed pursuant to the provisions of _ Trash Compactor
the Contractor's License Law(Chapter 9(commencing with Section 7000)of Roof Drains )
Division 3 of the Business and Professions Code) or that he/she is exempt - _ '
therefrom and the basis for the alleged exemption. Any violation of Section _ • -
7031.5 by any' applicant for a permit subjects the applicant to a civil - - - .
enalty of not more than five hundred dollars($500), -
OUI, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 - _
compensation, will do the work,and the structure is not Intended or offered -
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL Reinspection Fee $15 Issue Fee $ 3
License Law does not apply to en owner of a property who builds or improves FEES
thereon, and who does such work himself/herself or through his or her own n DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler . Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
',tenon,' owner will have the burden of proving he/she did not build or im- Duct-Under Ground
rove for the'purpose of sale). Building Approved By r]/� Date.
Salo 1, as owner of the property, am exclusively contracting with licensed con- _.Duct-Structural Refrigeration System Application Issued By �---Q. Date /���//dq
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for'such projects with a'con- -
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensa ion I surance should be provided to me. Exhaust System 0 Multiple❑ ' System Repair/Alteration BUILDING PERMIT $ •
SMIP $
❑ i am exempt under Sectio, B.& P.C.for this reason Firepl/Fact.BIL ICBG# • PLAN CHECK $ ' PERMIT
PLUMBING $ „5.----• ISSUANCE $ '
Date 0 er �� Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C. $
1 hereby certify that I have read this application and state that the above ❑0.100000 BTU 0100,000 BTL 'GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
andstatelaws relating to building construction,and hereby authorize repre- MICROFILM $
sentatives of. this cit to a ter up the above-mentioned pope ty Jnr • PLAN CHECK 50% $ GPO
Inspection purpos
SignatureDat MECHANICAL $ tTOTAL FEE $
Drivers'4icense or 5S# — • Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNING- - I POOL&SPA
APPROVALS Permit# ' 1 Date Inspector APPROVALS Permit# Date inspector
1. Temporary Electrical Service or Pole
I 52.- Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • , ..
• 53. Steel Reinforcement
3. Electrical Conduit Utility,Undrgrnd. 54. Forms •
4. Electrical Conduit;Undrgrnd. 55. Electrical Bonding ' , -
•
5. Steel Reinforcement - - 56. Rough Plumbing& Pressure Test - . .. -
6. Electrical UFER Grnd.
; 57. APPROVAL TO COVER-GUNITE - 1
7. Footings , , - 58. Electrical Conduit-Undrgrnd. • ,
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test _
9. Water Pipe-Undrgrnd. • r 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System • r- 61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection -i - 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 ]2.sUnderground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil -
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & 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. Drywall NailingHEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric , Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy - -
37. Final Factory Fireplace y
38. Final Plumbing - t�//jr/ - C6'
39. Water Service-Final.
40. Gas Service-Final
41. Solar Domestic-Final
42, Backflow Preventer
43. Backflow Irrigation -. - . -
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING I •
48. Special Requirements Completed •
49. Electric Release to Edison • - -
"
50. Gas Release to Southern California Gas Co , , . ,
51. CERTIFICATE OF OCCUPANCY - -
No. Date
1YJH19PM.LIV, II. Al. 1,11... rrw
JOB ADDRESS 1 81 'onderosa treet BUILDING PERMIT NO. 2 40
GENERAL CONTRACTOR Owner-Builder DESCRIPTION OF WORK Bedroom and Patio Cover •
AP No. 139-312-11 LOT TRACT FIRE ZONE VALUE $ 3 ''500.00
INSPECTIONS Signature Date GROUP I TYPE V! ZONE R-1
Soil _ / PERMITS ISSUED
Gas SUBCONTRACTOR I Date I Number I Signature
Water Plumbing
(f
Rough Plumbing lu -nPfl -1ttcnM'.n i1-V-61, 42r?O Mc
Prop. Swr. Line 0 House Con.0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole I _
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches Iiiij Forms ® Steel Reinf. p IJy C/y3%[
Floor System A'jji9 66-j/46
Bond Beam 0 Steel Reinforce 0 -','
Sheathing y"b!• q-70 -66
Frame and Flashing � X0-1 /p/
Lathing—In p Out p Rr) '-Y J - ���
Plaster, Brown Coat 4- 11--5--F o -
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final _ aurnoA,- ,&i cQ4i.., 9-0-66 .927S
Plumbing, Final and Gas Test 0 6.-2.3-4*,
Electric, Final :t
Building, Final _�� ,s
C-� • 25540 !CITY OF GUS IA MESA
OSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APR 4. 1966
For Applicant to Fill In Completely APPLICATION FOR PERMIT
•
pig .,.
TYPE OR PRINT Si. rd1 1 c \nl
BUILDING /3 t/ rorideco;0. ' 6P�0/iHi f%
ADDRESS L� fJl�
RECEIPT NO. PERMIT NO.
COSTA7MESA. CALIFORNIA
P. A . / [ 4 111 ` �. li. , D
is OWNER !�// SANH'1 Art Q(.40 (-� BU1 • •G f c) 2 "'0' —i
D
ADRESS /�O / Pant CYO1G LS. _ ADDRESS• FIRE
�.
,(.J TELr� 7 p� ZONE TYPE GROUP jl
:' CITY CUT (Arc_ NO.J�S J�/Oeit-
: �����J?1c71DATE
/�/
ARCHITECT �I f T8L p� ) APPROVED ER CR.V ✓' � /+(^• ANOS�Fb=1//0�
NING
: ADDRESS
ZON{� NO.OF USEOFN[W _ T�
LK 1 PLAN[ BUILDING EWA,aye
CONTRA •R - `( at)__a
ADPRHDS DES /DESCRIPTION lY 9) 7-ft-• r U1+y�
'
' CITY A.P.NO. / 7— 3/ D-— //
I NOTE: NO NAVE OVERHANG SHALL BE LESS THAN
STATE TEL 80•TO SIDE a REAR P.L
LIC.NO. NO,
• /� NO.OP BLDG[. ALLOWED (U.B.C.REQUIREMENT)
. OF LOT /J X /do I NOW on LOT /
USE OF / YARDS APPROVED YARDS APPROVED
.' EXISTING BLDG. Pit.c'E..Lc a. MAIN BUILDING ACCESSORY BUILDING
'(FROM C/L - R )
SETBACK LINE FROM FRONT / • 1 /•
' CENTER OF STREET REAR YARD .
r• RIGHTSIDE YARD I LER.SIDE SR.
c. R.
DESCRIPTION OF WORK L.SID 5—R.4 R.
i
r •NEW _ ALTERATION ADDITI•N
• REPAIR GLOVING - DEMOLISH
BUILDING HOOP ; �
SIZE ROOMS STORIES
APPROVED
EXTERIOR WALL ROOF APP • SD
:. COVERING I COVERINGDATE 6 .0
a
faELd Cover'
/ o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .; THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AO • COM• PURPOSE OF ESTABLISHING A PERMIT FE[ ONLY. LIS
. PLY WITH ALL CI• • CAS AND STATE LAW EGULATING ' VALUATIONI`+ -•-••-••, DN
• PERMIT REE /v I
AUTHORIZED AGENT 4 "
s � TOTAL FEE ♦ SD 4.
10746 FEE RECEIVED
t.. STA MESA BUILDING-SAFETY DEPARTMENT `.tJ j,_419
P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
fOR APPLICANT TO FILL IN COMPLETELY APPCJiebafictifiSikMEMERmIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1581 Porhecosa Street p
COSTA MESA. CALIFORNIA FOR OFACE USE ONLY
OWNER Knightwell Land Company I RECEIPT NO. IIT NO.
MAIL RECEIVED,g.Y� DATE RECEIVED II DATEISSUED
ADDRESS 419 E. 17th Street I jf-y T9 Mw 1952
CITY 9osta Mesa, Calif. TNaLI 81BUILDING
159 ADDRESS
ARCHITECT • Carlson & LIC. COSTA MESA. CALIFORNIA
OR ENGINEER Middlebrook NO.
Garden Grove FIRE
ADDRESS ZONE TYPE if GROUP 'J9
Dike & Uolegrove, Inc. STATE APPROVED
CONTRACTOR LID.NO. J.07293 BY DATE
ADDRESS 419 E. 17th Street, Costa Mesa ZONING
LEGAL I LOT 69 3487Z��'/ NO.OF •� USE OF
DESCRIPTION NO. ] BLOCK TRACT \ / I PLANS . I BUILDINGOFN
A.P.NO. BBYPROVED /./ /) DATE lir) T
SIZE 1 NO.OFO BLD YARDS U iii"•— EVES
OF LOT 75'x 100 NOW ON LOG,PJone REQUIRED ALLOWED
USE OFNone (CENTER LINE ST.) l
EXISTING BLDG. FRONT 5 FT. IN.
SETBACK LINE FROM JJJ
CENTER OF STREET 53' REAR YARD 221 R.SIDEFT. IN.
/ n
SIDE YARD I LEFT 101 I RIGHT 5l L.SIDE / '/ FT. IN.
DESCRIPTION OF WORK [
REAR FT. IN.
NEW I X II ALTERATION I II ADDITION I
REPAIR I II MOVING I I DEMOLISH I •
BUILDINGNO.OF
SIZEE 1647 ROOMS STORIESShakE
EXTERIOR WALLROOF
COVERING StUCC COVERING Shake
USP. OFUILDING AND WORK TO BE PERFORMED a/ / 0.
Single family residence with9/
attached garage
Plan X 760 D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION./''/ VALUATION
PSIGNATURE ERMITTEE OF -�v ��0�� PERMIT FEE $ 36.00
$ PLAN CHECK $ 18.00
Dike & C egcrove Inc. 16 862. m
AUTHORIZED AGENT b ) _ TOTAL FEE $ 54.°°