HomeMy WebLinkAbout1597 PONDEROSA ST - Building Permits CITY OF COSTA MESA
• ,°y1,. BUILDING DIVISION ��
ri
4. DEVELOPMENT SERVICES DEPARTMENT
d� PERMIT PERMIT NU BER
• 898-01343
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1597 PONDEROSA ST Status: ISSUED
Suite: Applied: 07/27/1998
Vicinity: Issued: 07/27/1998
Parcel Nunmber: 13931207 Zoning: R1 R1
Applicant: CIMARUSTI, JASON
Address:
,' Phone:. 800-400-7692
- Zip:
Owner: TUCKER;NATHAN A , -
Address 1597 PONDEROSA ST -_ -
/7,11%/7\ / _ Phone:
/ COSTA MESA,CA i Zip 92626
i// \ 7.-''' - ---
Contractor:" N.ROYAL-ROOFING CO.
Address: 135W.SANTA'FE �N
�� ,y - .
j/ 2. i/..%� Phone: 714-449-7750
/ �r„
/., / ,in,FULLERTON,CA Zip92832
/ :�,
rv/ ,/ License: 678705
Arch/Eng `✓' � '.. ,-- :t:
�
Address: '/'i -' -
f, A ," -- `Phone:_ - .
- Zip: •
:K. - License: ,
_ A _
i: SCOPE OF PERMIT ,
c // - ,,T/O EXIST ROCK AND REROOF W/ ,.SAME. --. r - •." '
. , .i- -
FEE SUMMARY
,Plan Check: , $0.00 - -- Calc Valuation: $5,000.00
`, Permit $99.75 - -- ' ' Claim Valuation: $5,000.00
'`SMTP Res: ', $0.50
,SMIP.Corn: ,$0.00 -
v Other: • \.,$0.00
Inspection: . ` $0.00 - :
� y, ,
Totali $100 25.
.,
N
` - ' PLANNING &ZONING
�1/ ��,�
SETBACKS` - ,� _ ,
MAIN STRUCTURE Front '0;Q - - Rear 0-0' ` - - Left 0-0 Right '0-0 "
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0.0
PARKING Existing: '0 Required: 0 Proposed: 0
NOTES: ,
4.
9
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
fora 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, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
I •
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
for which this permit Is issued.
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'�cyp�TIpensation Insurance carper and policy number are: /' .,/ /
Cartier: r / rd,I IA Policy Number. /CZ Lc 37I2751
(This section need not be cordplefed if the purr?*is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,end agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
ih these Prov '§-—7
re: n C� i Date: / —1'C<
A FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND COLLARS( ,000),IN ADDfTION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that 1 am licensed old&provisions ciLChapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full
force end effect.Lic.N COO
A '7 0 Class N 6.
actors Signa J�`
: r -..�_/ Date: r ,' //
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:My city or county which requires a permit to construct,alter,improve,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
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 five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business end Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes LI No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air(Duality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) �-Y ate
kd/OCr Authorized Apph nt CJL- Date `JE,
=DLL INSPFLTION TYPE 111 DATE DMIIAl. CODE( INSPFTInN TYPF DAB INTIDASS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
PROJECT ADDRESS: UNIT:
OWNER'S NAME: 1597 PONDEROSA ST
11
4.-- CITY OF COSTA MESA — BUILDING PERMIT PERM NO; M 065769
ADDRESS: TUCKER, NATHAN A
1597 PONDEROSA ST PERMIT NO: M 065769 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE; OTH
ARCH/ENGINEER: 545-0205 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : CHANGE OUT FORCED AIR UNIT SQ FT:
PERMITTEE: CLAIM VALUE; CALC—VALUE: GROUP OCC : R-3 /
ADDRESS: ANAHEIM HTG. & COOLING ( 714 ) 772-96991418 S . CENTRAL PARK p q COMMENTS : NO 'B ' PERMIT INVOLVED,
ANLT-TFTM ('Tdk' dfi AQ *****iFititiEieifififiE#iEit9EiFiEif-lEiFifiFkitjEititiEiEiE9ljE-1t3tiEiEjEififitjEiEiFif-113t�fiEititiFjF*jtjf9tifiFjEitifiFdFaF#ifiFififjFiEjE****
LICENSED CONTRACTOKD and I hereby affirm that I am licensed under isi fCna r 9(commencing with Section
7000)of Dives n f the Business and Professions Code.and my license is in full force and effect. ZONING R EQUIREMENTS
CITY LIC °`( srarE uc.: 59484
3 CLASS: C S E T B A C K S
Date: Signature:—( `^'��es( MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: (hereby affirm l have a certifical sent self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.CL LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: W C 2 3 6 6 4 7 EXP. DATE:
07/01 /94
COMPANY: PACX
NAT
...
PARKING REQ: PROV: PARCEL : 13931207 ZNE: REF NO:
0 Certified copy is hereby furnis ed. Certified coppyy^iis tryilleed with the city Builyding Divi/siioon� PLANNING NOTES>
trate: /9// Applicant: • 1 '•Q • ���✓ )
•
*******************************************************************************
EXEMPTIA FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is(or one hundred($100)or less). DEVELOPMENT SERW ICES REQUIREMENT S
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. •
Dale: Signature: ZONING APPROVED BY : DATE;
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ''' DATE: q I(� U
CONSTRUCTION perm LENDINGeAGENCY: 7. Cby affirm that there is a construction(ending agency for the performance of the work for APPLICATION ISSUED B Y: /'` DATE: ,L( I l `
which this permit is issued)Section 3097.Civ.CI. **a(..x..***!(,K..***if,if,i[.i(,.x..N,i(.I(.i(.if.****.x.***4i,if******** *****,***,1F*******,IF*,)F*****,)F,)f* iE#jE**L* 1,***
LENDER: ****************************************1 **************************************
ADDRESS: LEGALIZATION : N FEE ' SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: hereby Cd : ot I ao exempt from theContractors'a permitloe stnse Law for imthe
ve,oreason
r BLDG PMT PLUMBING ELECTRIC ' MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 structure,
o and Pissuance. Code: Any city county which requires a fieto construct,alter, demolish,coed
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 9 . 00 •
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN .
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DI V—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law
TOTALS----> 9 . 00 15 , 0 0 0 , 00 2 4 , Q 0 2 4 , 0 0
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through00 ,
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 24 . 00 OVER/SHORT: 00 t
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business '2.4 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law). I am aware p. V
That proof of their Worker's Compensation insurance should be provided to me. ****************************************ff**************************************
❑ (am exempt under Section: B. a P.C. INDIVIDUAL F E E BREAKDOWN
for this reason: TYPE QTY DESCRIPTION ' UNIT COST TOTAL COST
r
Date'. Owner'.
I do hereby certify that(am aware of and understand the requirements of California.Health and Safety Code Sections 25505.25533,and MEC 1 INST FORC—AIR/GRAV FURN '<= 100 K BTU 9 .00 9 , 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END '.OF FEES
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
,
Date: Applicant:
I hereby 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 and state laws relating to building construction am ereby authorize representatives of this citytoe •m the above-mentioned
property for inspect n aur see. �-
•
4 '1 Di 0015-n2(-r015t021 TOT 24,00;
Date' ! f 9� Signal e: • ATE: 14i/15/Y4 TIME: 14:46
Drivers icense or Social Security 4:
Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL PA
l Date Inspector Date Inspector
APPROVALS Permit 0i APPROVALS Permit 0
1. Temporary Electrical Ser-:ice or Pole - 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement --I
3. E:ctr-ct i Conduit hr'ht Uner rnd.
y- g 54. Forms
• 4. Elcctr.cal Condvt-Undryrr.d. 55. Electrical Bonding I
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
3. E' P ,^•-rd. 57. APPROVAL TO COVER-GUNITE �
7. Foornire 58. Electrical Conduit•Undrgrnd. ,`- j
Fotrriction - 59. Gas Pipe, D Undrgrod.,Test
9. V.etr Pipe-Undrgrnd. r ' 60. Backwash Lines, - rap, -' Undrgrnd.
10. S:ructoral Floor System ' , - 61. APPROVAL TO DECK f
11. Pruptr:'; Se:rer Line & Ho..,e Conneet.on _1
62. Backe:ash & Ret.aptorF mal
i.'. Sewer Cop __- -r` / - ' -+-
- '1 63. Heater & Vent-Final -
Hitt Drains v' • 64. Plumbing System - Final j
g �-.- 65. E:ectrical-Final .•r
is. Rough Electrical-Conduit 66. Solar System Final +, -�
'E. A,,.•)" Iectr'c l"'ir ng . -
67. F-cnci»g & Accsem: Approval
R:cgh ': ring Sign 68. APPROVED FOR PLASTERING
18. Rough Electricai T Bar Ceiling I 69. POOL/SPA SYSTEMS FINAL - !
'S R_u.,h Hoa ina & Air Condi,iening EIRE DEPT. REQUIREMENT
:LO. Pr-!r F. ctory Fireplace - APPROVALS Permit
21. D..c'r in Structure 70. L'ndergroLrd Hydro ----�
'- -- -aa- --� "'
22. Duut,, k'rt.
n 'atny ��-•- 71. Product Piptny a Gas L T Oil
23. Carr Pini.-Rough & Test - --- - ---i
72. Underground Flush
.4/. .Fact �_m•^-y - - J - /3. Undergrnd.Storage Tank E Gas .;0:
"J. Roc,: imi tth,rg . . 74. Overhead Hydro
2e. T-Bar Cr'!'.ng (Str,.cturell & t onocoat • _ 75. DAY Chemical I
-- - ----- - - - -- - -1--- --- - -- ---- ---
F ii -v Fie-. ng - - -- _. 76. Dry Sundt:-e .- . '
-�
28. Lathing & Siding 77. FIXED SYSTEM FINAL -
'!9. Insu'c•,cn - 78. FINE PREY FINAL
f 33 Dryc,ai .t'aa-,ng �_ i1 _ IL HRALTH DEPT. REOUIRE: ,$:!T
;1. Plastc. blown Coat _ - - I -1 '9. FIVAL INSPECTION - _--- ----- ----
32 Eir-r ,c- Po.-er ilateriFirai - Ir 80 F^OD GER-rir-IC/1.TE 'SSLED
1 33. Final Electric . , - I Moths:
34. F"'a' HeatingAir ��'7 -_�,L� � /. 1 /��'
itia
I 33. Fina' Gas Pipe-Tett t,Z_.-1Z-Z.--is-t.
-
�36. Hoed o' Canopy ----- - _ --- ----- • -- ---- - - -- - .
Firer)37. ;',.-Li ..dori' -P aca
i
83. Fnai P umping
F23. S v e Final
43. Gas S,.rrce-Finel --- I ---- --- - - -----
'.1- Solar Domestic-Final _- _--_---
. n. Bsdc'I,,.: Fr evantar I . •
13. Sacl.ficiti Irogat.on �--+---- ---- - _--
4',. La-' ape Re irrigation System __.___ �._-_ _--.____ _. ___
43. Soiled .�tter+at.un --- - -
--
- - - - -- --_
4$. 11..o
clic,r;ap Regulations ----I ---- --- --
i 7. F!r'A._ STRUCTURE & BUILDING ---- - - ------ --- ------- - ---
5 F!hir.L FLANh!IP!G --- -- •
-
- -------- -----. - -- - --
r:9 Electric Release to Edison
- I
6C. Gas Re;ease- to Souths•n Calitornra,Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date I - -- - - -- - - _-
1 i
UWNLN TUCKER, NATHAN WAle 0-114-09
JOB ADDRESS 1597 Ponderosa Street BUILDING PERMIT NO. 30650
GENERAL CONTRACTOR Wayne Howard Inc. DESCRIPTION of WORK add famrm. to res.
AP No. 139-312-07 LOT TRACT FIRE ZONE VALUE $5,520.00
a INSPECTIONS Signature Date GROUP I TYPE V ZONE Hl
SOIL PERMITS ISS ED
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 ❑ POWER E /
ROUGH WIRING a f/(c".'fi�l Heating and Vent.
TRENCHES a FORMS a STEEL REINF. fC .14-3p_C
FLOOR SYSTEM 2R-76 7
BOND BEAM [ STEEL REINFORCE n AlHEATHING -[ Q.Ac-(c
FRAME AND FLASHING J� P-/6
LATHING — IN OUT Pit_ p-' 9-3e.
-
PLASTER, BROWN COAT ,P39*— 01-%
STRUCTURAL, FINAL , lectric
HEATING, VENT., REFRIG. AND A.C., FINAL a-nAs:, r 9-16-67 .5.44/.--
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL I ;C•Z/- p
/
6 /
BUILDING, FINAL -Z21,7
, -ivAd
30650 PAID
COSTA MESA BUILDING-SAFETY DEPARTMENT AIX; 14-6901$1,00 691* ****U8.00
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BY DATERECEIVED DATE IS U D
BUILDING ' c7;14/- i9 p./ 6 7
ADDRESS 1597 Ponderosa StreetI/ TTT
PER Ir N
OWNER Nathan Tucker A.P. NO. 139-312-07 3 a
MAIL BUILDING597
1 Ponderosa Street
Z
ADDRESS 1597 Ponderosa Stneet ADDRESS
a.f..) CITY Costa Mesaa NOLLI Li 545-0205 TRACT 3487 LOT 73 BLOCK
ZC CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOLISH
—m LENDER Security Pacific Banko X
D BRANCH Huntington Beach
fn OWNER Nathan Tucker
a LU m _I ADDRESS VALUE
m ARCHITECT TEL. )SEadd family room $ 5,520.00
OR ENGINEER Wayne Howard, Inc. NO.
U Q FIRE
w CC ADDRESS ZONE TYPE
� GROUP
a IL APPROVED � � O /'/—/
J O CONTRACTOR Wayne Howard Inc, BY
�✓ DATE O 7 !O
CO
4 rm ADDRESS 1116 N. Harbor Blvd.
CI= TEL ZONE I PWS 'J USE
NEW
F��R
Z CITY Santa .Ana No.531-6718 R- G- *hi.t_
STATE CITY YARDS APPROVED YARDS APPROVED
inn CC LIC. NO. 208220 LIC.NO. MAIN BUILDING ACCESSORY BUILDING
D O (FROM C/L TR ET)
SIZE NO.OF BLDGS.
OF LOT 75X100 NOW ON LOT 1 FRONT 4#45T.T. Tlf:1- FT.
USE OF /
EXISTING BLDG. residence R.SIDE �v FT. FT,
I— SIZE OF t II t ft NO.OF
2 NEW BLDG 4 X22 6 ROOMS 1 STORIES 1 L.SIDE 4 FT. FT.
U
EXTERIOR WALL stucco ROOF compn
_ COVERING COVERING shingle
REAR (P FT. (O FT.
.J USE OF BUILDING AND WORK TO BE PERFORMED
CL 1 add ismi ly room to residence DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS.BLOCS.
Q VAR.* DATE
O C.U.P.qW APPROVED
~ APPROVED / L_/!t/—(7
En _BY LG"f" Z1� _DATEO
0
UI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
I— any person in violation of the workman's compensation laws of
the State of California, fa
o
? I hereby certify that I am properly licensed as a contractor under /0? SQ. FT. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ,
Chapter 9, and that such licenses are in full force and effect,or I THE PURP06E OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of the . e of CaliforBusiness 2
•tei 9. VALUATION oO
and Professions Code,piv"-_ PERMIT FEE $ 32•�� N
as
D
Signature of '01 , „� Ip
Permittee $ 5,520.00 PLAN CHECK $ 16.00 E
`� o
Authorized Agent 8 00 LL
TOTAL FEE $ 08
' 10750
FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT ii_ y_�_5
P.O.BOX 3I7 COSTA MESA. CALIFORNIA ^1TF�INANCE pEpT
FOR APPLICANT TO FILL IN COMPLETELY APPLIHA4&K ,WRQ$MIT
TYPE OR PRINT BUILDING
BUILDING 1597 Poierosa Street
ADDRESS
COSTA MESA, CALIFORNIA FOR OFF/CE USE ONLY
RECEIPT NO. 40 1.7e#1010.OWNER Knightwell Land Company
MAIL 419 E. 17th Street RECEIVED BY I DTE RECEIVED I DATE ISSUED_
ADDRESS i� KNIT Sd/ p111V (j 195B
CITY Costa Mesa, California TNO.LI 81159 BUILDING
ARCHITECT Carlson & LIC, '
OR ENGINEER NO.
COSTA'MESA. CALIFORNIA
niddlobrook
Garden Grove FIRE ( i--09,--
ADDRESS ZONE TYPE // GROUPb9
Dike & Colegrove, Inc. STATE APPROVED
CONTRACTOR LIC.NO.167293 BY DATE
ADDRESS 419 E. 17th St., Costa Mesa ZONING
LEGAL LOT 3487 .0 1",/ NO.OF I USE OF NEW M
DESCRIPTION NO. 73 BLOCK TRACT /' PLANS
n (y.BUILOING U�-/
A.P.NO. APPROVED (, /,// /Y� 1 I� •�
BY W /�J11�Ctr.�•'/� DATESIZE /J
OF LOT 751 x 1001 I NO.OF BLDG9Jone REQUIRED `VALLOWED
NOW ON LOT1
USE OFNone (CENTER LINE ST.)
EXISTING BLDG. FRONT <-3 FT. IN.
SETBACK LINE FROM
CENTER OF STREET 531 REAR YARD 261 R.SIDE FT. IN.
SIDE YARD LEFT 101 I RIGHT 51 L.SIDE 10 FT. IN.
DESCRIPTION OF WORK
REAR y, '
l
4... FT. IN.
NEW 1 XII ALTERATION I ADDITION I
REPAIR 1 (MOVING 1 I DEMOLISH
4
BUILNO.OF
'SIZE DING 11180 ROOMS 6 STORIES 1 i,d3
EXTERIOR WALLStUCCO (ROOF .....„--,9a' t- B
COVERING COVERING Rock
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence with
attached garage
Plan 730 A
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURTHE E OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.
VALUAT10 �/7
SIGNATURE OF (.---19 _ . 3 6 PERMIT FEE $ 35.00
PERMITTEE i
$ PLAN CHECK $ 17.50
AUTHORIZED AGENT Dike & Col grove, Inc. 52.50
TOTAL FEE S