HomeMy WebLinkAbout386 RALCAM PL - Building Permits(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.r��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Job qddress: 386 RALCAM PL
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 41917220
App�icant: TOWNSEND, MIKE
Address: 386 RALCAM PL
COSTA MESA, CA
Owner: STARDUST TR
Address 386 R4LCAM PL
ConVactor:
Address:
Zip:
Arch :
Address:
COSTA MESA, CA
Phone:
Zoning:
Phone: 949-548-7300
Zip: 92627
Phone:
Zip: 92627
Phone:
License:
Eng:
Address:
Siatus: 15SUED
Applied: 01/13/2004
Issued: 01/13/2004
ISSUED BY:
Phone:
Zip: License; License:
SCOPE OF PERMIT
REROOF RESIDENCE AND� ACHED GARAGE: T/O EXISTING COMP ROOF, REPAIR/REPLACE SHTG AS NEEDED, FELT PER MFGR'S
SPECS, APPLY "COMP SHINGLES." 24 SQUARES
Plan Check: $0.00
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0. 0
Right 0- 0
$3,000.00
53,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1. 1241-92)
EXPIRA710N: This permit shall automatically expi�e and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all
requlred InBpections and final approvel must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
tmaae �a�uo�
WOflKERS' COMPENSATION DECLARATION:
I hereby eHirm under penalry ot perjury one oi the followinq declaraUons:
❑ I heve entl will maintain e certificete of consent to self-Insure for workers' compensatlon, as provlded for Dy saction 3700 0l the Lebor Cade, for the peAormence oi Ihe
work for whiGh t�i5 permit is issued.
❑ I have and will maintein workers' compensetlon insurence, es requiretl hy section 3700 ot ihe Lebor Code, lor �he pedortnance ot the work for wMch Ihis pertnit is issueC.
My workers' �mpengation Insurence carder antl policy number ere:
Carder. � PWicy Number.
(Thls secfion need not be com0leted i! Ihe permif is valued e( one hundred dollars ($100) or /essJ
�' 1 I certify thet in the pertormance of the work for which ihis pertnit is issued, I shall not employ any pereon in eny manner so as to become suD�ect to the workers'
compensetlon �aws of Califomla,ppp nd egree th¢t II I should 6ecome suDject to the workers' campensetion provisions of Sec�ion 700 ot Ihe Lebor Code, I s�all fonhwith
complywiththeseprpyi�ons.� ��/( -- � � 7
ApD�icam SigneNre: _� IpI niE i'C�l�l...u.,i� Data: � /� �
WARNING: FAILURE TO SEUIRE WORKERS' COMPENSATION COVEFiAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIA4NAL NALTI PND GVIL FlNES UP TOONE HUNDREO
i/K%1SAND OOIUqk (5100,000),IN AODfiIIXJ T0 THE CQST OF WAIPENSATIIXJ, DAM4GE5 AS PROVIOED FOR IN SECTION 31W OF THE LABOR CODE, IMEREST, AND NTTORNENS FEES.
LICENSED CON7flACTORS DECLARATION:
I hereby eflirm thet I am licensed under provisions of Chapter 9(commencing with Section 7000) ol Division 3 of the 8uslness and Pmlessions Code, antl my Ilcense Is in full
force end ettecL LIG. b Class a
Contractols SlgneCure: Date:
CONSTRUC710N LENDING AGENCY:
❑ I hereby eMirm thai Nere is a construction lending agenty tor the pedormanca of the work lor which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: Lentler's Address:
SignaNra: Date:
OWNER-BUILDEH DECLARATIONS: �
I �ereby efllrtn Ihat untler penalry of pehury ihat I em E%EMPT FROM 7HE CON7RAC70RS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business end Professions
Cotle: Any city or counry which reqwres a permit to construct, alter, improve, demolish, or repeir eny structure, prior to its issuance, aiso requires the applicant for such permit
m ille e signed statement �het he or she is Ilcensed pursuent to ihe provisions of ihe Cantrectors Llcense Lew (Chapter 9(commendng with Section 7000) oi Division 3 ot ihe
Business end PrafPssions Code) or ihat he or she is exempt theralrom antl the besis for the elleged exemption. Any vialetion of Section 7031.5 by eny epplicent for a Oermit
sub�ects the epplic9nt to a civil penalty of not more than liva huntlretl dollars ($500).):
�I, es owner of the property, or my employees wilh wages as thair sole compensetion, WILL DO TME WORK, end the structure Is not Intended or oHeretl for sele (SeC.
7044, Busine5s and Professions Code: The Conirectors License Ww does not apply to an owner of property who builtls or Improves ihereon, and who tloes such wo�k
himsell or hersell or ihrough his or her own employees. provided that such improvements ere not intentled or oHered lor sale. It, however, �he building or improvement is
sold within one year of completion, the owner-builder will have ihe burden of proving fhet he or she ditl not Ouild or improve br purpose oi sale.). •
❑ I, as owner oi iha pmperiy, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS m consiruct the project (Sec. 7044, Business and Professions
CoOe: The comractors License Law does not epply to an owner of propeny who builds or Improves Ihereon, and who contracts tor such project with a contractor(s)
license Dursuent to the Contractors License Laws.).
❑ I em exempt Untler sec. —¢
Signature: �'�/'
Ownar ID varilietl by tlnver's license.
Vedtiwtlon of Ownn�ship by (rype of
� Business antl Professions Catle for ihis reason:
Date: i �
Ves ❑ No Driver's License No. Expires: Z �6
it, i.e. - properry tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER71fICAT10N:
❑ I hereby certify ihat no excavation five (5) or mwe fest in tlepth imo which a person is requlretl to descentl, wilf ba metle in connectfon with work euthorizetl by Ihls
permit, end that no building simcture, scallolding, lelsawork, or demolition or dismantling thereoi, will be more than �hirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, 7Ue 8, Calllomla Adminislrative Code).
❑ As ownerbuilder, I will not employ anyone to tlo work which would require e permit trom the Division of Industrial Safety, as noted above, unless such person hes e
pertnit m do such work tmm Ihe division.
SignaWre: Dete:
Division of Indusinal Safery Pertnit Number:
CERi1FlCATE OF C�MPLIANCE IWD AUiHORQATtON OF ENTRY: I certify untler Oenalry of Oe�ury t�at I heve read ihis apD����ion end state thet the infortnation given is
correct. I egree to fAmply with all state laws end city ordinances relating to building construction, end auihorize represeniatives oi iha Clry ol Coste Mesa to enter upon the
ebove-descnbed properry tor inspection purposes. I agree not to occupy or ellow occupency ol eny building euthonzed by this pertnit until (nel inspection.
��g .Ot Legal Own r�s)
AnNOr Authorized Applicant
COOE I. INSVEC710NT'�FE
1616 Fixetl SyslBm Final Fire Preventian
7268
200
201
202
203
204
Pool Spe Final
Flnel Re-ROoi
Final BIocWRetaining Wall
Final Factory F��e Place
Final Sign
Final Demolition
Q�jE IMRIALS
�� �
COOE♦ INSPECTIONTYPE
206 Finel Mechanical
208 Final Plumbing
210 Final Electncal
212 Flnal Fire Preventlan
220 Final Plenning Approval
222 Final Site
250 Finel Building/Oaupency
P� ItIIIDELB
(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
373 RAMONA WY
GARAGE
42531134
Aop�icant: EVANS, DANA BART TR
Adtlress: 373 RAMONA WAY
COSTA MESA, CA
Owner: EVANS, DANA BART TR
Address 373 RAMONA WAY
COSTA MESA, CA
Contractor. O W N E R-B U I L D E R
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors to 1 hp
Motors to tOhp
Motors to SOhp
Motors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Slgn Circuits
Phone: 949-645-8929
Zip: 926273766
Phone:
Zip: 92627-3766
Phone:
Zip:
license: 000000
SCOPE OF PERMIT
REF B02-01625. 1 MISC. CONDUIT.
523.50
so.00
50.00
so.00
$0.00
50.00
$0.00
50.00
50.00
30.00
$0.00
50.00
$0.00
$0.00
so.ao
50.00
50.00
50.00
$0.00
$0.00
$0.00
50.00
50.00
Quantiry
FEESUMMARY
Status: ISSUED
Applied: 10/31/2003
Issued: 10/372003
ISSUED BY:
,�' / J \
� �
�
r� �
i ,_ _:
Temp Dist System / Lighting
Busway/700ft
SWnding Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
.:..............up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kvalkw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conduclor
Circus ( gen or ride)
Circus (mech dde or lights)
Christmas Tree Stand
Firewotks S�and
Other Electrical Fee
Investlgation Fee
Plan Check Fee
Re'rnspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
So.Oo 0
30.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
$18.20 1
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
Np710E: The work authonzed by ihis permit shall comply with all applicable handicap access requiremenfs under Calilornia statutes and �elated
regulatlons. (Ord. No. 92-28, § 1, 7241-92)
EXpIRATION: This permit shall automatically expire and become void ii work is not commanced within 180 days, or if work is suspended or abandoned
for a period ot 180 days.
IN$pECTIONS: In order (or the work authorized under this permit to be considered legal, such work must comply with all applicaDle codes, and all
requlred inapeetlone and flnel epproval must be obtained. Failure to obtain Inspections and Final approval will result in the expiratlon of ihis pertnit.
FOp INSPECTIONS CALL: (714) 754-5628
�».o-w �aw�
WORKERS' COMPENSATION DECLARATION:
I heraby eHirm under penal�y of perjury ona ol the following dederations:
❑ I heve entl wlll mainteln a certiflcate oi consent to selbinsure tw warkers' compensatlon, es provided for by section 3700 0l the Labor Code, br tha pertortnance of the
work for w�iGh this permit Is issuetl.
❑ 1 have end wGl maintain workers' compensation insurance, as rgquired by section 3700 W tha La6or Code, tor Ihe peAortnance of the work fw wMch thiy permit is issued.
My workers' �mpensatlon Insurenca carrier antl pollcy numbar ere:
Cerder, Pollcy NumCer.
(Thfs sectlon need nof be comple(ed il fhe permit is velued al one �undred dollers (j 100) or IessJ
❑ I certify t�et i� the pertortnence ot lhe work �or w�ich l�is pertnit is Issued, I shall not employ eny person In eny mannor so as to Gecome suGloct to Ihe workers'
compensation laws ol Celltomia, and egree lhat II I ahould becoma su6�ect to the workors' wmpensetlon provlslons ot Sectlon 3700 of the Lebor Code, I s�all forthwith
comply with ihese provisians.
Appllcant SignaWre: Date:
WAANINCi: FAILURE TO SEIXJRE WORKERS' ODMPENSATION COVEMGE IS UMAWFUL AND 5 WLLL SUBIECT AN EMPLOYER TO CRIMINAL PENPLTIES AND CML FlNES UP TO ONE HUNDHED
THOUSAND DOl1ARE (5100,000), IN M�rt1IXJ TO TME CAST OF COMPENSATION, DAMAGES AS PROVIDED fOR IN SECTION 3]080F TME LABOR CODE, IMFAEST, PND �TTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettlrm Ihat I am Ilcensed untler proWsions of Chapter B(commencing wit� Sealon 7000) ol Division 3 of the Business end Professians Cotle, and my license Is in full
brce entl aHect. Llc. x Class M
ContrectoYs SlgneWre: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hareby aHirm Ihat there is e conswaion lentlinp egency for the pedortnance of the work lor which Nis Dermit is issued. (Sec. 3097, Givil Cotlo).
LenOere Neme: Lentlefs Adtlress:
Slgneture: Date:
OWNER-BUILDEq DECLARAT10N5:
I hereby eHirm thet under penalry of perjury that I em EXEMP7 FROM TME CON7RACTORS UCENSE LAW tor the lallowing raason (Sec. 7031.5, Business antl Professions
Code: Any ciry or Nunry whic� requires e permit to consiruct, elter, impmve, demolish, ar repair eny strucWre, pdor to ils issuence, also requires the eppliwN tor such pertnit
to Illa e signed stetement that �e or she Is licensed Dursuent to the proNsions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 01 Ihe
Business antl Professions Code) or Ihet he or she is e:empt Iherelrom end tha �asis for ihe elleged exemption. Any violetion oi Section 7031.5 by eny epplicant for e pertnit
subjeas the applica�� �e e civll penelty of not more Ihan Me hundred dollars (5500).):
❑ I, es owner ol the properry;�or my employees with weges es their sWe compensallon, WILL DO 7HE WORK, entl the strucwre Is not Intentled or oflered tor sale (Sec.
7044, Busine5s and Frofesslons Gode: The Contradors License Law does noi eppty to an owner ot pmperty who builds or improves thereon, antl who tloes such work
himsetl or helself or thioug�_tu's oo-her own mployees, provitletl ihat such impmvements are not intendetl or oftered lar sale. If, however, the building or improvement is
sold within o e year oi complelion; the � builder will have ihe burden of proving Ihat he or she did not 6uild or improve for purpose ot sale.). '
❑ I, es owner I t� roperry, em E%CL I LV CONTRAC7ING WITH LICENSED CONTRACTORS to construct Ihe projeci (Sec. 7044, Business ena Pmfessions
Code: The onira rs Ucense La oe no� epPly to en owner ol property who bullds or impmves ihereon, and who coNrects for such pra�ect with a contrecror(sj
license pur uant to e Coniracto Li nse Laws.).
❑ I am exi
Sipnalure: _
Owner ID ven
Vedficatlon of
DIVISION OF
untler s. � r' Business antl Professions Cotle br �his reason: -� ia�,���5
Date/
ry ef lice ❑ Ves ❑ No Drive/s Licen Expir :-�
rship b(type ot tlocument, i.e. - pro0erry tex blll or deed):
SAFETV PERMIT CER7IFICATION:
❑ I hareby celY�ai no excavatfon five (5) or more teat in depth into which e person Is requiretl lo tlescend, will be mede In connection wiih work authodzed by this
permit, and Ihat no builtling slrucNre, scattol0ing, falsework, or demolition or dlsmentling thereof, will be more than Ihlrry-six (36) fee� high. (Chap. 32, Gry 2, Art 2, Sec.
341, 71t1e B, Gelifornia Atlminisirative Cade).
❑ As awner-builtler, I wlll not employ enyone to do work which would require a permit Irom the Divislon al Industriel Selety, es noted ebove, unless such person hes a
permit to do such work Irom Ihe division.
Signature: Date:
Divislon ol Induslnal Sefery Pormit Number.
CERTIFICATE OF COMPLIANCE AND AUTH TION OF ENTAY: I certify under penelry of perjury that I have read thls epplication and state that the infortnation given is
correct. I eg to comply wlth all state le e ciry ortlinancas relating to builtling constmction, antl authodze representetives of I�e Ciry ot Costa Mesa to enter upon lhe
ebove-tles bel�Dmperty for Inspection es. I egree not to occupy or allow occupanry of eny building authorized by this pertnit until tinel inspection.
COOE �.
1618 Fixed Syst Finel Fire Prevemlon
1288 Pool Sp Inal
200 Finel Re-Raoi
201 Finel BIocWReteining Well
202 Final Fectory Fire Plece
203 Finel Sign
204 Final Damalitian
�g ��
CODEt INSPECTIONTYPE
206 Finel Mechanlcel
20B Finel Plumbinp
210 Finel Elec�rlcel
272 Finel Fire Prevention
220 Final Plenning Approvel
222 Final Site
250 Final Building/Occupency
� �
Z� ��
y Cuunty of Orange
Building Deparfment
Room 322
Court House Annez
Senta Ana, Cali{ornia
Phone: KI 2-6211
APPLICATION' FOR
PERMIT
��
/ �.�/
PHRMIT NO. � �� U � �
r
� � (9�L2
1. OWNER'S NAME ��P� /`� �`�'o�sfp�q �X" 5��. c PHONE: �P���� �a/r7
MAILING ADDRESS �{2Fi—� � % � Sf— CITY c � � � ��p � �
(Streee or P. O. Box No.)
(Arc6i�ecv or Hngin«r)
ADDRESS
NAME _rG.mv QS LZ�%rlo
(Conm«or o� BuiWecl
ADDRESS —
CIT'Y CITY
S�acc I,ic. No. Phon� Scate Lia No. ��,��� Phone
Z. JOB I.00ATION�B� � �')G��ti.,� /�� Cos�c lfo r�
(Hwu No.) (N.me of SnesO -• (Tawn or School Districe)
3. LEGAL DESCRIPTION: LoL �� � Block Tracr �-� �w�' '�
4. Mcets and Bound, Description — Use Reverse Side of This Form.
5. CORNER LOT () INTERIOR LOT (� T'HROUGH LOT () SLOPE OF LOT ��'''P�
THIS AFPLICATION CANNOT BE PROCESSED UNLESS LEGAL DESCRIPTION
IS ACCURATE AND COMPLETE.
6. PROPOSED WORK: New Building (✓f Ncw Seruccure
Alterations ( ) Move ( )
7. PROPOSED USE
( ) Addicion ( ) Repair ( )
Demol}sh ( ) Conversion ( �
.
�
8. SIZE OF BUILDING -��X �¢ AREA �/-a— SIZE OF LOT f`�x /'�.T AREA_7_i�_
9. CEILING HEIGHT_� TOTAL BUILDING HEIGHT �� NO. OF STORIES �
I0. NO. LIVING UNITS +� 4_ SIZE OF SMALLFST BEDROOM � k SIZE OF KITCHEN�XL2�
11. EXTERIOR WALL CONSTRUCI'ION: Brick O Concrete Tile O Monolithic Concrete O
CVood Frame (✓S Steel Framc ( � Concrete Frame ( �
12. WALL COVERING: Wood O Metal ,( ) Smcto (.� Other_ �
13. FRONT YARD SETBACK FROM CENTERLINE OF STREET �if �/
14. DISTANCE TO PROPERTY LINE: Side Yacd �� / Rear Yard �f �/ _
15. SHOW ON PLOT PLAN EXISTING BUILDINGS NOW O[V LOT, STATE USE OF EACH.
16. DISTANCE IN FF.ET FROM PROPOSED BUILDING TO NEAREST EXISTING BLDG.�
l7. VAWATION OF PROPOSED WO�RK; Intlpuding All Labor, Plumbing, Efectrical Wiring, Heating, Firo Sprink-
11-6-A-0-1� o 0
ler� Pai6tin„ Scwa,�c Disposal $ �� P-0"d �
18. I I-F�REBY <:ERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION
IN THIS APPLICATION IS CORRECI' AND THAT THE CONSTRUCIION WORK WILL CONFORM
TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE
THERETO. � �
FOR DEPARTMENTAL USE ONLY
19. GROUP TYPE � DISTRICT MAP__�� NO. �_
PERMIT FEE $ /�% RECEIP.T NO. � a�-3 PAID TO 7'+L� �� DATE ���� -{b
CHECKING FEE $ RECEIPT NO. �D T-O� nA'rF
JUN 1 5 1950 ��. UJ'�UH�! COUNTY BUI�DING
PERMIT GRANTED 19 �--.�c lL_ r iN�p�rrpg I
PLANS CHECKED BY
APPROVED BY:
HEAI,TH DEPT.
STATE FIRE MARSHAL
STATE DIV. OF HOUSING
eM—�z..s
County of Orange
.Building Department
Room 322
Court House Annex
$an#a Ana, California
Phone: KI 2-62�1
APPLICATION `FOR
PERMIT
P6RMIT NO. C1 d �� � �
_ .�.��.� , 195�2
1. OWN6R'S NAME �P� /�'l �O�-SfPi� �'- sv� 5_ pHONE: P4 n.? lo-�¢,
MAILING ADDRESS �CG F �_�� y- C1TY �-sfG /�7Psa
(Stneo or P. O. Boz No.)
(Arthivact or fi�inur)
ADDRESS
CI7'Y
NAME�P �S �"e 60 ✓�
Ico��o� o� e��m.��
ADDRESS —
CITY
Scatc Lic. No. Phone S[ate Lia No. �L���GO phon�
2. JOB LOCATION 3�(� /P4„��'�%T /�� G o tf �� c�
(Houw No.� (Name o�.Sveet) (Town or $chool Disvice) /
3. LEGAL DESCRIPTION: Lo� �'� � Blod- Tract—/��8
4. Meets and Bounds Description — Use Reverse Side of This Form.
5. CORNER LOT () INTERIOR LOT (✓j THROUGH LOT () SLOPE OF LOT
THIS AFPLICATION CANNOT BE PROCESSED ULVLESS LEGAL DESCRIPTION
IS ACCURATE AND COMPLETE.
6. PROPOSED WORK: Ncw Bailding (✓j New Structure
Alterations ( ) Move ( ) `
7. PROPOSED USE:
( ) Addicion ( ) Rcpair ( )
Demoluh ( ) Conversion ( )
�.v.�� 1
. i
8. SIZE OF BUILDING—L8�2 AREA 3Gc� _ SIZE OF LOT�X /'�.r AREA_783a
9. CEILiNG HEIGHT TOTAL BUILDING HEIGHT /2 NO. OF STORIES—�_
]0. NO. LIVI[VG UNITS SIZE OF SMALLEST BEDROOM SIZE OF KITCHEN
1 L EXTERIOR WALL CONSTRUCTIOIV: Brick O Concrete Tile O Monolithic Concrete O
Wood Frame (✓f Sceel Fnme ( ) Concre[e Frame ( )
12. WALL COVERING: Wood O Metal ,( ) Stucco O Other_ ��
13. FRONT YARD SETBACK FROM CENTERLINE OF STREET �'R�—r' ,P�'L�.G1L��
, / /
14. DISTANCE TO PROPERTY LINE: Side Yard � � Rear Yard
15. SHOW ON PLOT PLAN EXISTING BUILDINGS NOW ON LOT, STATE USE OF EACH.
16. DISTA[VCE IN FEET FROM PROPOSED BUILDING TO NEAREST EXISTING BLDG.�
17. VALUATION OF PROPOSED WORK: Including All Labor, Plumbing, Elcccrical Wiring, Heating, Fire Sprink-
lers,�'�inting, Sewage. Disposa! $���� � ,�2�6 �� / • �
18.
I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION
IN THIS APPLICATION IS CORRECI' AND THAT THE CONSTRUCT70N WORK WILL CONFORM
TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE
THERETO. „ �
Plan Filed.
i
Datc
FOR DEPARTMENTAL USE ONLY
l9. GROUP v TYPE � nISTRICT MAP C� NO. ���
PERMIT FEE $ � RECEIPT NO. � � � i PAID TO ��-«% DATE � - � � " ��
CHECKING FEE $_
PERMIT GRANTED�
PLANS CHECKED BY
APPROVED BY:
HEAITH DEPT,
STATE FIRE MARSHAL
STATE DIV. OF HOUSIh1G
IIM-13��9
OWNER
AP. No.
DATE
BLIILDING PERMIT NO.
FIRE ZONE
TYPE V ZONE R�i PLAN NO.
tNSPEC7iOIYS I DATE I SUBCONTRACTOR ' ___ PERMITS ISS
i
brown
Final Gas Test
A
-: . -- �, � � 6886
' .. •f _
COSTA MESA BUILDING DEPARTMENT
P. o. eox 3 i �
COSTA MESA. CALIFORNIA
FOR
TO FILL IN
auILOING "�O/� /1 /7� `!7/•� / /
ADDRE55 rJ
COSTA MESA. CALIFORNIA
MAIL
AD�RE55
CITY v S
ARCHITECT
OR ENGINEER
ADDRE55 -
fONTRACTOR
lEG/�L LQT
DE9CHIPTION N�.
A.P. NO..��� hZ �pZ^
SIZE { ,% �
OF LOT e/
USE OF
E%ISTING BLOG.
/�� '
TEL.
NO %,
LIC.
CITY LIC.
NO.
TEL.
NO.
�
J � NO. OF 9LOG5.
SEiBdCic IiHE iROM ` I
CENTEN OG STNEEt v� REAR YARO �
SIDE YARD ftIGHT / ' /-. LEFT ��c��U ,
NEW
iREPAIR
DESCRIPTION OF WORK
ALTERATION ADDITION
MOVING DEMOLiSH
/ NO.OF
y7 ROOMS � STORIES
'EXTERIOR WALL �� ROOF �/ ,./ M
COVERING /.GCC(%D COVERING /j0/ /%O
..USE OF NEW :/ __ . _ A11 i�1 i T i.. �
,'�� ��C�i�l��
� -,._5 � � �
�IINANCE DEPT.
APPLICA�T�IO^N FOR PrE�RMIT
� BUILDING
FOR OFFICE USE ONLY
flECEIPT NQ �PEFMjj��
YQ
R V!D BY �1TE RECEIVEO yP I55
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A DD EI55 J O (� �\ d � d M I' �
GOSTA MESA, CALIFORNIA
FIRE �
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i��.-:N�r{C{G DL-Pl'.
Y
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I
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I NEREBY �CNNOWLE�GE TH�T I MnVE XEAp THIS .�PPLICI.TION /�ND �
STnTE TH,�t THE �BOVE IS CONRECT �ND �GPEE TO COMPLY WITX 4LL
CITY OROINANCES I.ND $T.�TE L/.WS REGUL.�TING BUILOING CONSTRUC-
riorv. VALUATION
SIGNATURE OF PERMIT FEE $ `� �
PERMITTEE C�
g���%'� PLAN CHECK S 6��
�
AUTHOqIZED AGENT TOTAL FEE 5 � "��
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