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Home My WebLink About1579 REDLANDS PL - Building Permits 4f CITY OF COSTA MESA BUILDING DIVISION > � �) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. PERMIT P05-00235 t. 1.114k- \/ (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1579 REDLANDS PL Status: ISSUED Suite No Applied: 04/05/2005 Issued: 04/05/2005 Vicinity: MASTER BATHROOM Parcel Nunmber: 42532141 ISSUED BY: Applicant: HODGE, D J , Address: 1579 REDLANDS PL _ Phone: 310-508-3788 CELL COSTA MESA,CA Zip: 92627-3258 ' , - . Owner: HODGE, DONALD"J & KAMMEH Address 1579 REDLANDS PL - . ' - ' Phone: COSTA MESA,CA Zip: 92627-3258 ' Contractor: OWNER-BUILDER , - Address: _ - Phone: , . . Zip ., License: 000000 • SCOPE OF PERMIT LEGALIZE ADDITION OF 96 SF ADDED TO THE MASTER BEDROOM WHICH ALSO INCLUDES THE REMODELING OF THE MASTER BEDROOM. • 1 WASH BASIN ' REF:B04-00255 __ - . _ - - ' FEE SUMMARY _ AMT QTY _ AMT , QTY AMT " QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump " _ - $0.00 0 Backflow irrigation . $0.00 0 Landscape Irrigation....-- $0.00 0 " Swimming Pool $0.00 0 Backflow Preventer - ' $0.00 0 P-Trap :7-.- • . -$0.00 0 Trap Primer , ' $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal '''/ j$0.00 0 Clarifier System ' $DAO 0 Process Piping(per 10 ft) $0.00 - ..0. Vacuum Bri<r Bkflow(1-4) /" $0.00 0 Connect(Ice,Sgda,etc) $0.00 . 0 'I- ' Receptors $0.00- " 0- .' Vacuum7Brkr Bkflow(5+),' $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin' '$9.80 1 Dishwasher , $0.00 0 Sewer Cap for Demo $0.00 0 --Wash Basin Set $0.00 0 Drain, Floor $0.00, 0 ', - Sewer Connect $0.00 0 • "- Waste and Vent System $0.00 0 Drain, Rainwater $0.00 , 0 'Sewer Private Line" ' $0.00 0 Water Closet(Toilet) " $0.00 0 Drain, Roof ' '.$0.00 - 0' - Shower $0.00 - 0 , Water Heater/vent' $0.00 0 Drinking Fountain . $0.00 ) 0 'Sink,bar - $0.00 0 ` Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00' 0 . Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 ' Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 , Sink,kitchen $0.00 0- -' 'Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop ' $0.00 0 " OTHER $0.00 Gas Repipe $0.00 0 - "Spa(private) $0.00 " 0' • VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 . 0 PLAN CHECK $0.00 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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, 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 2446-46(6620) . DECLARATIONS fl C 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 work 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This ion need not be Completed it the permit is valued et one hundred dollars(5700)or less.) ertify 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 Ntworkers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio ., AepBraalSignetu a CData: 9/5-/r WARNING:FA LURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVERTO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND nOI I ARE(S100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: _ Date: 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:Any 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 end Professions Code)or that he or 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 penalty of not more than five hundred dollars($500).): (1.- ❑ 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.II,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 properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions 4 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 u •• 5. . Business and P of.ss'•ns Code for this reason: [J .-.. — - air E , iv . [° r— //w/y' Owner ID verified by drivers license. A Yes ❑No Oriver's.Cicer se,No. -Expires:. > y 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 B.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? ❑Yes 0 No (Section 25505 of the California 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished 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 0 No (II yes",the facility most meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality 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 an city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purp s.I l ree not to occupy or allow occupancy of any building authorized by this r until final inspection. SigetDlbvayetwner(s)__-. � �Date--N.. And/or Authorized Applicant Date CODE f INSPECTION TYPE DGTF INTITIAIS LODE r INSPECTION TYPt DATE INTIMLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �/ 1266 Pool Spa Final 208 Final Plumbing (4 -05— M. 200 Final Re-Roof 210 Final Electrical 201 Final BlocldRetaining 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 �r • n CITY OF COSTA MESA 4 BUILDING DIVISION F ., `) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT r / B04-00255 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.1§01LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1579 REDLANDS PL Status: ISSUED Suite: Applied: 01/27/2004 Vicinity: MASTER BATHROOM Issued: 04/05/2005 Primary Occ: R3 Type of Construction: V-N Parcel Number: 42532141 Zoning: Applicant: HODGE, DJ Address: - ISSUED BY: i Phone: , 310-508-3788 CELL Zip: Owner: HODGE, DONALD J & KAMME H Address 1579 REDLANDS PL Phone: • COSTA MESA,CA Zip: 92627-3258 - Contractor: OWNER-BUILDER Address: Phone: , , Zip: , :License: •000000 - -. , • • Arch : _ Eng: Address: ' - Address: - Phone: - Phone: , Zip: License: ' License: SCOPE OF PERMIT LEGALIZE ADDITION OF 96 SF ADDED TO THE MASTER BEDROOM WHICH ALSO INCLUDES THE REMODELING OF THE MASTER BEDROOM. - - !- - - ._ ' FEE SUMMARY ', Plan Check: $117.81 ,_ Calc Valuation: '$9,870A0' ' Permit: $181.25 - Claim Valuation: - $o.00 SMIP Res: • $0.99 SMIP Corn: $0.00 Other: • $181.25 - - Inspection: $0.00 , Total: - $481.30 • '/ ,, , PLANNING &ZONING SETBACKS , - - - MAIN STRUCTURE Front 0-0 Rear 10-0 Left '16-0 Right - 0-0 , // ACCESSORY Front 0-0 ' . Rear 0-0 Left 0-0 ..' Right- ,. 0-0- /— PARKING ,PARKING Existing: 0 Required: 0 Proposed: 0. NOTES: KUBOT_BJ 08/24/2004 PERMIT EXPIRED 7/25/04; PER BDM, 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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, 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 2446-46(6/00) DECLARATIONS L n (l - o 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 work 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: ion need not be completed if the permit is valued at one hundred dollars($100)or less.) .ircertily 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' (This compensation laws of California,and agree that if 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fbrthwlth comply with these provisions. Applicant Signature: _ Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I art'licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class a Contractor's Signature: Data 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:Any 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.Any violation of Section 7031.5 by any applicant for a permit Osub' s the applicant to a civil penalty of not more than five hundred dollars($500).): 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. r 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 �T 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.). `+S 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 un 3rec. !," Business and Pro ssionn Code for this reason: / signatures–'r P— iAtayti oLfudy /dh G/TcOJ D 4/ S S Ovirier ID verifie by drivers license. to 0 No r �iv ens& o a a girt., -2jr(–d–of Verification of Ownership by(type of docum t,i.e.-properly 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 Cale). ❑ 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ul Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished 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? 0 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 Quality 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 Catitornle 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 an ity ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purp I ree not to occupy or allow occupancy of any building authorized by this perm'eun'I final inspection. Sigriatu're LegD '"•W / fr lS2dte.] And/Or Authorized Applicant Date CODE I INSPECTION TYPE QATE INTITIALS CODE( INSPECTION TYPE ME INIQISL} 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 /, 6// ‘41441‘ 204 Final Demolition 250 Final Building/Occupancy 'I' '99 CITY OF COSTA MESA '�_ e'�`�G_ BUILDING DIVISION , .l .'„ ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT YE05-00287-"�a� (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1579 REDLANDS PL Status: ISSUED Suite No Applied: 04/05/2005 Vicinity: MASTER BATHROOM Issued: 04/05/2005 Parcel Nunmber: 42532141 Applicant: HODGE, D J • - ISSUED BY: /f' Address: 1579 REDLANDS PL . , -/ Phone: 310-508-3788 CELL - COSTA MESA,CA - Zip 92627-3258 , . Owner: HODGE, DONALD J & KAMME H _ Address 1579/REDLANDS PL - • - ' Phone: COSTA MESA,CA Zip: 92627-3258 , Contractor: OWNER-BUILDER . Address: - "' . .Phone: " ' Zip: . . License: - SCOPE OF PERMIT LEGALIZE ADDITION OF 96 SF ADDED TO THE MASTER BEDROOM WHICH ALSO INCLUDES THE , REMODELING OF THE MASTER BEDROOM. - - - - / - - ,-- 4 LIGHT FIXTURES,6 OUTLETS,2 SWITCHES " REF:B04-00255 , - - - -FEE SUMMARY - Quantity Quantity -- ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 , Temp service test $0.00 Busway/100 ft, • $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 '- - New Res(1-2 units) $0.00 0 _ • -Misc Electrical Equipment • $0.00 . 0 / . - New Res(3+units) $0.00 0 -- Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 t - . up to 10 kva/kw $0.00 " "`" 0 " Lighting Fixts . $4.40 4 - up to 50 kva/kw _ $0.00 0 / , , , Recept Outlets up to 100 kva/kw ' .$0.00 0 Switches $2.20 . 2' over 100 kva/kw ",.$0.00 , 0 Non Res Appl $0.00 , 0 Low Voltage Equipment .. '. $0.00" ' 0" - Res Appl ' , $0.00. , '0 - Low Volt Wiring System/Ckt.• $0.00 .0 Service to 2004 $0.00" 0 •" Misc.Conduit - $0.000 Service to 1000a N 1, $0.00 ,' - 0 Misc.Conductor - $0.00 ' 0 Service over 1000a ' ' $0.00, . 0 . Circus(gen or ride) , $0.00 . '- .0- Motors to 1 hp $0.00 ' 0 Circus(mech ride or lights) ' 10,00' ' 0 Motors to 10hp $0.00 . ' 0 Christmas Tree Stand "$0.00 ' 0 Motors to 50hp $0.00 - 0 , Fireworks Stand - , .$0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee " . - . $0.00 Motors over 100hp • $0.00 -0 • , Communication drops $0.00 0 Investigation Fee $0.00 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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, 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 2446-46(6/00) DECLARATIONS f f J 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 work 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'compensation Insurance carder and policy number are: Carrier: Policy Number: (This sect/on need not be completed if the permit is valued et one hundred dollars($100)or less.) 5....- 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 Califo ' ,a agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fbrthwlth comply with these provisi 4- y '�S- WARNING:FAILURE TO SECURE W RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT ANE ER TO CRIMIN L P NALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class a Contractor's Signature. Date. 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:Any 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.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars($500).): f!�'..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. F' 7044,Business end 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 properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions 4 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 7 r c. Business ardirofr�ssions Code for this reason: &Oatuseik'---,%', WJA 1 r c2' (o9/rk Date y y r ri Owner ID verified bydriver's license. Yes ❑No/ D'ver'e Li_cense. 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,Tee 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 Yea 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 Califomia 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? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a.aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished 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? 0 Yes 0 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 Quality 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 AUTHOR •TION OF ENTRY:I certify under penalty of perjury that I have read this application and slate that the information given is correct. I agree to comply with all state laws : ' city dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection pyi.I ee not to occupy or allow occupancy of any building authorized by this permit until f al spection. Signal''',•!INV w'ner(s)..,-,_ .r t And/Or Authorized Applicant Date 1 CODE 0 INSPECTION TYPE OATS INTRIALS CODEI INSPECTION TYPE DATE gamma 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �,/ /�may 200 Final Re-Roof 210 Final Electrical 114: 5— &7 201 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 ADDRESS OFBL5LaNG: 1579 REDLANDS PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT l Ovessws AmsnmT: EISENDRATH, FRANK A TR /" PERM NO; B 077018 ADDRESS: 104 KINGS PL • • NEWPORT BEACH, CA 92663 PERMIT NO: B 077018 PLAN CHECK NO: N GOVT: N SUPP : N 548-6680 APPL.MAIUNGADDRESS: CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: OTH ARCHITECT ORENaNEER: UC.NO.: JOB DESCRIPTION : T/OFF & COVER W/BUILT=UP SQ FT: 3, 300 ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 3, 300 . 00 CALC—VALUE: 3, 300. 00 GROUP OCC : R-3 / CONTRACTOW6 NAME: BURR ROOFING ( 714 ) 548-2965 CONTRACTOBSMuuUNO 711 WEELO DR COMMENTS: REROOF 1700SF RESIDENCE COSTA MESA CA sac635586 *******************>E***** ****RE+P**********TE>EBS�r**�r****>E ****TE******x************ ADDRESS: 92627 UC.NO.: ZONING REQUIREMENTS DM' SETBACKS LICENSED CONTRACTORS DECLARATION:1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commenting with Section 7000)of Division 3 of the Business and Professions Code and my Manse is in full force and effect. CTrYLIc.ND.: 011621 LIC.Cuss: C 39 LIC.NO.: 3 6 EXP: 09 /96 MAIN BUILDING ACCESSORY BUILDING / FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: /-Z�l^�4 canned«: 6 LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,alter,improve. PARKING REQ: PRO V: PARCEL : 42532141 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 PLANNING NOT E S> • f is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000) Divisiono ion 3 the Business end Professions Code]or that he or 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 oil penalty of not more than five hundred dollars155001). ******************************************************************************* ❑ I.fie owner ol the property or my employees with wages as their sole compensation.will do the work.and the structure i not intended D E V E L OPMENT 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 properly r„ who buids or improves thereon.and who does such work hmsel or herself or through hi or her own employees,provided that such improvements are not intended or offered for sale.4,however.the building or improvement is sold within one year ol completion,the ZONING APPROVED BY DATE: / owner-builder will have the burden of proving he or she did not build or improve for the purposed sale). ❑ I.as owner of the property.am exclusively contracting wish licensed contractors to construct the prolect(Section 7044,Business and BUILDING APPROVED BY : DATE: Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon end who contracts for such projects with a mntraaor(s)licensed pursuant to the Contractors License Lew). - CT ❑ I am exempt under Section: B.SP.C.,for mimason: APPLICATION ISSUED BY; / DATE: ille ********************************************* W. ****************** *** Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby candy that I am aware of end understand the requirements of Caluomia Health and Safety Code Sections 25505,25533,and 25534.and thea I or any future building occupant will/will no.(circle one)need lo comply with said stale codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a perish for construction«modification from the Air QualtyManagement District.Residential oonstmcton applications are exempt from these PERMIT 63 . 00 . 50 provisions. Dat': Applicant: SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedarmiors: ISSUE FEE ❑ I have and veil maintain a certificate of consent to sethineure tor workers'compensation as provided for bySection 3700ofthe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Cade,for the performance of the work for which this permit is issued. TOTALS----> 63 . 50 0 . 00 0 . 00 63 . 50 63 . 50 . 00 L-G Sv2 1 have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the ooh for which this permRiissued.Mvw«ker� symsder and policy number are: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 63 . 50 OVER/SHORT: .00 Carrier:i1016530-95 07/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK Policy Number: 63 . 00 . 5 0 is section need not be completed y the permit is ler one hundred dollars/4100)or less.) L] I oeniy 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 o California, ee that if 1 should become cubed to the workers' ******************************************************************************* compensation provisions o the Labor Code.I o isns Section 3700 n h those provisions. INDIVIDUAL F E E BRE AK D OWN Date: 9—2 --q.6 Applicant: (�—_ Warning:Failure to secure workers compensation coverage is unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars(4100,0001,In addition to the cost of compensation,damages as provided for In Section 3706 of the Labor Code,Interest,and attorney's/ws SFR 3300 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 3 , 300 . 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 compy with all city end county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter open the above'mentioned properly for inspection purposes. STEVE BURR Di 00:03;? ','r2P"♦;: `'(;? -. PnrdName /A 0tTf' 04'1r ," lAII[. G' :Lt1 �••, J `7 Des -�- Signature d Owner/Agent/Applicant/Contractor (5151-46.WP) White-Building S.Safety;Green-File:Canary-Applicant;Pink-Revenue:Goldenrod-Assessor -, • CONSTRUCTION AND PLANNING POOL 'A APPROVALS Permit Date Inspector APPROVALS Permit - Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool& Equipment Location' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrrid. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing &Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. r 60. Backwash Lines,P-Trap, Cl'. Undrgrnd. 10. Structural Floor System 61.. APPROVAL TO DECK - 11. Property Sewer Line & House Conriection 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 OGas OOil 23. Gas Pipe-Rough & Test _ 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 41-3-3.6 /Q 1.4.,_24. 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 Nailing HEALTH 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 - • 38. Final Plumbing - 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 9.jp_Q/ &„k_ 48. FINAL PLANNING / ll1r� 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date OWNER MARNELL, JQE DATE 11-20-59 JOB ADDRESS 1579 Redlands Fl. BUILDING PERMIT NO. 9077 1, IN I�CONTRACTOR Mort. Int. Block VALUE $ 192.00 Vo. vv LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block Wall -UP J TYPE III ZONE Rit PLAN NO. 9077 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel 4 7 7• t✓q Floor System ` Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil W/G Pipe Test • Top Out Furnace Gas Vents Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. F 'ding System d Final I._ -tang Fixtures, Final Final Gas Test Construction Pole Underground Power Rough Wiring Fi Fi Ctures, na( „/ + C^/��7/ OCCUPANCY � '/I'r Q�p ' � /s-f//7/5-, Form 2t0-5M-1-57 ifss �'(J 9077 ��:1 FEE -RECEIVED . I -2_0 .Stf •1 L'.- COSTA _COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING • BUILDING ADDRESS 4-(#7 7 "r;el (I 1( I)l (//S . 2I, COSTA MESA. 'CALIFORNIA FOR OFF/CE USE ONLY `�/♦ RECEIPT NO. PCFWMIT NO'.7 OWNER /f1 Q / Q rn� II F7 e,7 MAIL / RECEIVED BY OATS J RECEIVED___.7i DATE ISSUED ADDRESS Sm /'7) (/ �nyvq, / o20 - 17 %'->,,-1577 /� tin / I(j BUILDING CITY \ b g.4-n ty�ri I C SA . NO..( /i)I 7 ADDRESS ARCHITECT LIC. •OR ENGINEER NO. COSTA MESA, CALIFORNIA n ADDRESS FIRE type zo group 2 2� / COi. 2�-/7 ZONE �iY CONTRACTOR /279 d. f/yr-). %lhei ItL C NO. 7,,,--g APPROVEDSTATE DATE ADDRESS 2,/s ..4.14 -4,or i.'.g. Crn. ZONING LEGAL LOT b CRA 77 ZON7:\-) I ND.OF USE OF NEW DESCRIPTION I NO. .� I BLOCK 'GRAN / ` �/ PLgN/S�/) BUILDING A.P.NO. // "7— /— BYPROVE/I .. <X DATE y_-7-L')-)�/ SIZE Al �� x G ND.OF BLDGB. YARDS LL// ` EVES ' OF LOT ] /J /\ A J ��O NOW oN LOT REQUIRED ALLOWED USE OF -r (CENTER LINE ST.) _ EXISTING BLDG. FRONT NFT. - IN. SETBACK LINE FROM 5---0 / ' ` REAR YARD CENTER OF STREET R.SIDE FT. / IN. SIDE YARD LEFT --- I RIGHT /11 L.SIDE -----' FT. IN. . DESCRIPTION OF WORK REAR �_ FT. IN. NEW I VII ALTERATION I II ADDITION I ' REPAIR II MOVING I II DEMOLISH I BUILDING NO.OF SIZE' ROOMS STORIES EXTERIOR WALL IROOOFRING F COVERING USE OF BUILDING AND WORK TO BE PERFORMED ]//hlk. ill*11 - A " ri /d, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. VALUATION SIGNATURE OF PERMIT FEE $ 0, GQ----0 PERMITTEE tzg $ /�� aPLAN CHECK $ AUTHORIZED AGENT TOTAL FEE (717. 41-17 OWNER YORNELL, JOE DATE 8_8_55 • JOB ADDRESS 1579 Redlands Pace - BUILDING PERMIT NO. 1624 ERAL CONTRACTOR Mortarless Int. Block Co. VALUE $ 798.00 AP #117-221-20 LOT 20 BLOCK TRACT 1267 Block Wall GROUP J TYPE V ZONE R4 FIRE DISTRICT #1647 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR rrDATE . NUMBER Footing Trench �f/t 8-/S—C Foundation Forms and Grade to Garage .1ucvi/ (1) t j U-- Mar j�,n/22 Rough Framing (7 c .0 (—O s—_ (7 . '),_ Plumbing,Rough to Slab `J Plumbing, Rough Complete Temporary Pole Wiring, Rough _f I Heating,Rough ��t/�t/�/�� r� Heating,Final �%a" / , c -, House Sewer,St. c ITAI 1/4 Tank or Cesspool ( / / - 'Man // Lathing, In Out L WQ / MT I Plastering Plumbing,Final,Fixtures Complete r, r Plumbing, Final Gas Test Wiring,Final / I _ Occupancy • Vnrrn 9111(3_H 1 Sf10 1-5F Costa Mesa Building DepartmentAPPLICATION FOR PERMIT 111 EAST h STREET / ,g 6 7 ;u I ` D I N C' 1COSTA-M ESALIFORNIA .i `2 J FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN Receipt No. Permit No, Building / ccrfff `��7 ' ,-, . _ _ �,[ Address 4J 7: � .t_52.a-u-}-o ,R , Jr, -- , . /6 / Cos Mesa, California Receiv d by Date RecSI Date Issued s OSS/ I Jr ' " Si / . G_ Nearest I d !J Cross St.',/6 Building /--p-�G, // Address / iC.- Owner 40 o , n 2 II - Costa Mesa, California . Mail Address f '.�`7 9 _A p,,, .„.�.)•.e CC, Nearest 4 Tel. Cross St. Cit o.Gte- "'..e-&-- No. Zone�p No.of T �.�.e� Group r Architect or Lim /L� I Plans y�i�+ id Engineer No. Approved by Date Address .2 CORRECTIONS Contractor A/} C No. Llc.J� S7 __ __ - / Address ry I J i- . c, 'YT-• Lel LoI De cr ption I Not 1-a I�1Block {, I Tract/37 (Attach Metes and Bounds)/1 P1'//7-2.2 i -a0 �A No.of Bldgs Size of Lot mot/The Sd��'rt Now on Lot / y�ia 'r19 Imo`.. \. Use of No.of No.of Tv: C1i., it, A Existing Bldg. ieQ.Q/. I Families I Ro ms f �`�� B Setback Line from (.1 Rear Yard .. _ - - CenterofStreet '30/ Side Yard 34 - _ ti ,�,F5 D DESCRIPTION OF WORK •- - '" New I Alteration I I Addition I - . Repair I I Moving I I Demolish I Building / No.of - _ Size 02/3 Go QQ&Rooms Stories Exterior Wall I Roof — Covering Covering XIS APPROVALS Use ofNew Z i a • a-7 c>"" r v h (h r/FYS p Buildingr 0 , , Foundation Location Inspector Date 11 Forms,Materials, u )�P i? . Under-Pinning 6 // C Fra aci ame: Fie Stops, I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath.Int. with all City Ordinances and State Laws regulating building construction. Lath.Ext. Signature of � Permittee ‘ N1..D . • Plaster,Int. • Authorized Agt. - Plaster,Ext. �, Valuation .. Permit Fee $ 6'00 Masonry Reinforced Db . . Plan Check $ '— Bond Beam $ 7 0' e Total 1 ..-., . . Fee $ ‘•-O-O . FINAL RM 204 S-nP 2M 8-55 • -4leg u `/ J o c. ',COSTA a a o AJG -B-55PUiar4l13ffk 6.00 /a „ 1\ fib ds$. -J) / 1 - - r -- - 1 --. is PLOT PLAN - - ' - Show location and distances from - property line and between buildings. 4,.. . - i • • __-