HomeMy WebLinkAbout2160 ELDEN AVE - Building Permits��
PHOJECT RDOflESS: 2 1 6 O ELDEN AV
OWilP'SNAME: H1GH, ROBERT M 'TR
• nooRess: 1230 ANACAPA WAY
LAGUNA BEACH CA 92651 OR
2151 ORANGE �OSTA MESA
645-2800
PqCN/ENGINEEN: HEG.NO.:
ROONE55:
UNIT:
UNIT:
PENMITTEE: C`RANK BROTAERS ( 714 ) 548-5569
aooxess: 126 COMMERCIAL WAY
C,M, CA 92627
LICENSEO CONTflRCTOB DECLi1PATI0N: I nere0y aliinn ��a� I ain licensetl under pmvisions ol Chap�er 9(commoncing wi�h Sectian
7000) ol Oiv�sion 3 of Ihe Business antl Pmfessions Code. antl my license is in �ull lorce an ect.
ciTv 00 9 3 rp ��c.: 9 0 8 6 cuss: C
'I�Date:. � Signa�ure: _
WONNEH$' COMPENSATION OECIANATION: I �et¢ rm IAai I �ave a CertilicalB al LonSenl �o Se14in5ur or a teM1ilitale o� Worker5'
� Compensa�ion Inmeance. or a cenified copY iher ection 3800. LaU. C).
POIICYNO.: ZSS-91UNITU �I E%P.OATE: OlIOSI92
comrnNr: STATE FUND
❑ LeM1iliea opy is nereb fumis�ed. � Ceni�ieE CODY �s il un ine c� Bu/il�Uing Oivision.
Daie: Appiicanc l S � s
E%EMPTION FHOM WONREBS' COMPENSpTION OECIANAT10N: (ThiS 5ectian neeG na� 0e camDletetl iI �he permil is Ior one hunOre � or less).
I cetlily Ihat in Ihe Derlormance ol I�e work lor which I�is Dermi� is is5ue4, I shall nol employ any person in any manner so a510 6ecome
sublec� Io Ihe Workers' Compensa�ion Laws ol Calilomia.
Dale�, Signa�ure:
NOTICE: II, afler making t�is tleclara�ion, you shauld become sublect lo the Worker5' Compensa�ion Diovisions of �he Labor
Cotle. you musi larinwRh comply with suth provisions or Ihis permil sltall Ue Oeemetl revaked.
CONSTNUCTIDN LENOING AGENCY: I here0y affirm ihat inere is a consVuction IenOing agency 1or ihe Dertormance of tne work lor
w�ich Ihis permil is issuetl (Seclion 3097, Civ. C).
LENOEfl:
aoosess:
OWNEH BWLOEB OECLABRTION: I �ere0y affirm Ihat I am exempi fmm t�e Coniractoa' State license Law for ihe lollowinq reason
(Seciion 7031.5 Business and Prolessional CoOe: Any cily of county w�ic0 requiBs a permii to conS�Nci, ai�er, improve, demolish, or
repair any slructure. o�io� to its ¢suance. also repui�es ihe aDPlicant for such permit lo lile a signetl statemenl ihal �e/s�e is licensetl
pursuanllo 1�e provisions ol ihe Contracmrs' State License Law (Chapter 9(commencing vnih Section 7000� af Division 7 af I�e Business
anC Ptolessions COOe) ar t�a� lie/s0eis exemp� ther¢�rom and tne basis �or the alleAetl exemption. Any violaiion al Seclion 7IXiL5 Uy
any applicanllor a permil suhjects ihe aoPlicantto a civil penalty ol nol more inan five huneretl aollars (5500).
I, as awner o� Ihe O�operly ar my employees wit� wages as Iheir 5ole compensation, will Oa the work, anA Ihe
❑ stmcmre is not imentlea or oifere0 for sale (Seclion 70aa. Business anG Pmfessional Ca�e: The Coniractors' State Lic¢nse Law
does not apply �o an owner o� a pmperty who builtls or impmves ��ereon, antl who tloes such wark himselflhersell or t�mug�
�is or her own employees, provitletl that such impmvemen�s are no� in�entletl ar offereA for sale. I�, however �he builtlirg or
im0�o�ement is sold wiihin one year o� completion, Ihe owner will have lhe �uraen ol pmving �e/she Aid nol builtl or impmve
lor t�e purpo5e ol sale�.
I. as owner ol tM1e D�openy. am exclusively contracting wi�� licensetl conlraclors 10 cons�mct the Orolec� (Seclion 70aa, Business
❑ anC PwIe55�on5 CaOe: T�e Contraciors' S�a�e License Law Ooes nol apDly to an owner o� pmpetly who Uuiltls ar imprOv¢Slhefeon
antl w�o conlracis for such pmletls wiih a conVaclor�s) license pur5uant Io �he Contractors' Siate License Law�. I am aware
��a� prool oi ��eie Workc(s Compenution insurance s�oultl be proviGed to me.
� I am ecempl un0er Section: B. 8 P. C.
lor I�is reason:
Oa�e: Qw�ec
I Oo nereDy cenify t�at I am aware of antl untlerstan0 t�e reQuiremenis of Cdlilamia Heall� and Sdfery CoOe Sections 25505, 25533, anU
2557A anU Ina� I or any tuture EuilOing occupant will/will nol �circle one) neeG Io comply with saia Slate co0e5 antl Ihe r¢Quiremen�s �or a
permii �or conslmciion or motldicalion imm �he Nir Oual�ly ManaAement Disiritl. Resitlential cons�mtlion apPlications aR exempi hom
Ihese provi5ions.
Odle. QOPlicanl'.
I nereby cerlily I�al I have rea4lhis application and slale Ih�tf�e above iniormatmn is co I agree b comply wilh all cily antl coun�y
ortlinancesanaslatelawsrelalingloDuildingcoretmdionanqlureOyaWharizerepres rv IhiSciryloenteruponlheahove�menlioned
Oaie: ( - / / � !
Drivefs License oi Social Secuniy u:
�6aLa6 W��te—Bwlding; Green—Code Enlorcemenl; Canary—Applicant: Pink—Revenue: GokenroE—Asseswr
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 052932
PERMIT NO; B 052932 PLAN CHECK NO: N GOVT; N SOPP: N
CONSTRUCTION TYPE: PERMZT TYPE: STR PURPOSE: ALT
JOH DESCRIPTION : T/OFF REPLACE W/20YR COMP SHINGLES CLS A SQ FT: 5,335
CLAIM VALUE: 5,335.00 CALC-VALUE: 5,335.00 GROUP OCC: R-1 /
COMMENTS: SMOKE DETECTOR(S) RE�IUIRED IN AOME.
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Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT ZN REAR: FT IN FRNT: FT IN REAR: rT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV: PARCEL: 92613203 ZNE: REF NO:
PLANNING NO'fES>
i
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.=T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY; ��--
if iE iF iE iE iF k iE iE if If IE i(� 1F if iF ik 3EiF iF 1E iE'�Fif3f7FiF3FiFiFif�iF�fiFiiaFiF 3E �F7FiF±FiF'iF if'iE�F
iFikiFiEiFiPiflfiEiElEiFlfif�ibifiEiF3EiFikififiEiEi6lF�fifiEiEiEiEiEififiEifiEiEiEiFib�E iF1EiE
LEGALIZATION:N F E E S U M M A R Y
HLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 81,00
PLAN
ISSUE FEE
DATE:
DATE: `1-���
iFiFiElEjEitafififjFiE7F'. iE#
iE IE 3E 3E a! iE aE 1E if iE �1F aE.iE if if IE iE if iE IE 3F iE iP
STRUCTURAL SEGMENT:Y
FIRE SMIP/R53 GRADZNG
SMIP/NON-RES
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 81.53 0.00 0.00 81.53 81.53 ',, .00
REVENUE DIVISION TOTALS--> COLLECTED: 81.53 OVER/SHORT: .00
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING P,LAN-CHECK
81,00 ,53 -'
;
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I N D Z V I D U A L F E E B R E A K D O W N '
TYPE
SFR
QTY D E S C R I P T I O N UNIT COST TOTAL COST
5335 REROOF BY VALUE RESIDENZAL N020NE 1,00 �.'i; 5,335.00
END OF FEES
% I !'• V
01 QQOS2434-0�04Z'.3i '� �o�� ,'7..5:
DATE: �7/I�l91 TIrE: i'_:CS
! /
• CONSTRUCTION AND PLANNING POOI � oPA �
�APPROVALS Permit# Date Inspector qppROVALS Permi*# Date Inspector
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . " 53. Steel Reinforcement
3. Electrical Conduit Utillty-Undrgrnd" 54. Forms '
� 4. Electrical Conduit•Undrgrrid. .- 55. Electrical Bonding -
� 5. Steel Reinforcefnent 56. Rough Plumbing & Pressure Test �
� 6. Electrical UFER Gmd. . 57. APPROVAL TO COVER-GUNITE �
. 7. Footings •; i' � , � 58. Electrical ConduirUndrgmd. •
8. Foundation � : ' � 59. Ga: Pipe, O Undrgrnd., Test �
9• Water Pipe-Undrgmd. . . 60. Backwash Lines, P�7rap, O Undrgrnd, .
10. Structural Floo� Svstem 61. APPROVAL TO DECK
1 t. Property Sewer Line & House Connaction 62. Backwash & Receptor-Final
12. Sewer Cap � � 63. Heater & Vent-Final '
13. Roof Drains '. 64. Plumbing System - Finai
i
14. Rough Plumbing 65. Electrical-Fina�
15. Rough Electrical-Conduit � 66. Solar System�Final
16. Fough Electric Wiring 67. Fencing & Access Approval .
77. Rough Wiring S�gn 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 Firep�ace - f - ' APPROVALS ' Permit # �
21.�Dutts,inStructuie� � .� - � � 70. UndergroundHydro �
22. Ducts, Ventilatinc�. � �� r71. ProducY�Piping OGas ❑'Oil
23..Gas Pipe�RougN & 7est " - 72, Undergroy�d Fiush � �
24. Roof Fcaming - - , * �- '73. Undergrnd.SmrageT�hk OGas ❑Oil
25. Roof Sheathing ' - '. �� � . 74. Overhead Hydro� �� �
26. T�Bar Ceiling (5crucwrell & Monocwt � - �- 75. Dry Chemicaf , -
�
27. Frame and FlashingF ,' , 76. Dry Stand,pipe � .� �
28. Lathing & Siding � ' _ ' ' 77. FIXED SYSTEM FdNAL
'29. Insulation ' �' �� : � • 7$, F�RE PREV. FIN,4L . �
30. Drywall Nailing -� � HEALTH:OEPT: REQUIREMENT
-31. Plaster Brown Coat � - � ,' ,79. FINAL INSRECTION �
. 32. Electrical Power Meter.�Final � ' i 80. �FOOD CERTIFICATE ISSUED
. 33�Final Electric , ' � � � Notes: ' � . -
.34. Final Heating-& Air.Conditioning . ' � • � • �• .
35. Finai Gas Pipe-Test .. �� ' r . , � ' '
36. Hood oi-CanopY � � � � `'
37: Final Factory Fireplacc � ' ' " � ; ; '• ,� ' �
:�
38. Final Plumbing - � , � �4,/ -- . -
`39. Water Service•F�nal- ' �
.� . _
40. Gas Service•Final , �, . . ' � � ' - ' �
- �41. Solar pomestirFinal ' ' � t �
42. Backflow Preventer i C� .
43. Backflow Irrjgation _ • ' � '
,44. Landscape Irriaation System� �� , • . � � .-
' 45. Sound Attenu2tiort ' _ , . ' ,
'46. Handicap Regulations � � ", � .
47. FINAL STRUCTURE & BUILDING g'-(� 4� "(,U , S.- /�?._C'/'/ SwtA�j/��L` O�`
, - � � J �I � Gc ���� /
48: FINALPI.ANNING `�
49. Electric Release to Edison �.-,
50. �Gas Release to Southem California Gas Co � '� � �
57. CERTIFICATE OF OCCUPANCY • . ..
No. Date
CITY OF ^7STA MESA
PAn__ FEES
Fee Payment Receipt
Project Address .�/ ��n� 1 l///-'► G
A. P. No. �� —�75— � l
Building Permit Nu. � ll`�i 3�' �`
Owner's Name
Mailing
FEE
�1° U40
Park Area � 'S
Single Family ' No. of Units @ 5338.27 =
Multiple Family •• No. of Units .�— @ S238J8 =
//�3. 9d
Total Fee /93:9�
Planning Department Approval Date By ��!/�..�./���
_� ' t�
Applicant's Signature ��n'�-� �-'J /�4 /
/
• Clty Ortlinance 72•44 n�. (�
•• City Ortlinance �2-45 � LqU' �=ry �
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' 38363 - � � --
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
� For Applicant to Fill in Completely
RE
OWNER . � � A.P. NO. �
MAIL / (�' J9 qDIDRESS /G
ADDPES �� L��j,p. �itcC
a U � TEL. N£�
pTV � No. y',�.,j.,�p TRACT
~ Z CpN$YRUCTION W
ON LENOEF
O. p]
J � BRANCH ' , /
J � OWNER %♦
a w ADDAESS
�:...
�,�.-�-�� �.- oo �e�> ��: ����.s�
N FOR BUILDING PERMIT
DATE RECEIVE nero icci i
00 J � c!N/T ,
m ARCH�TECT TEL. S
J N OR ENGINEER
V FIRE
W � ADOFESS ZaNE I
d w APPROVED
w Z CONYRACTOR 8V �' �C
J Q
m Z
J � ADDHESS
w W TEI. ZO NO.OF
ZF CITY NO. P�� c
w � STATE CITV VAROS APPROVED
j O LIC. NO. �IC. NO. MAIN BUILDING
512E / / NO.OF BlDGS. (FqOM C/L STR T)
OF LOT GN �� S�b� � NOWON LOT RONT . J�
USE tlF � //
EXISTING BLDG.
F SIZE OF � � NO. OF � ��
Z NEWBLDG. X ROOMS STORIES L.SIDE ` FT.
E%TEF�OR WAIL ROOF
V COVERING LLGGO COVERINGG REAR G F7.
J USE OF BUILDING AND WORK TO BE PERFORMEO DISTANCE BEf.
a MAIN BLDGS.
a
Q � � VAR.-rW
O C.U.P.qW
F APPROVE �
N
Z
�
VI herepV acknowledBe thet I hava reotl this applicntion entl s[ota
� Met tne ebove informetion is correct ond nproe ro comply wit�
� all Iews reguletinp builtlinp concvucNon, antl I shell not employ
F any pBrmn in violation of the workmen's compenuNon laws of
y the StOta of California.
? I heraHY certify that 1 em Properly Iicencetl es e contractor untlar SQ. FT.
tha Staie of Cali(ornia Businesz antl Profefatons Cotle, Divisicn 3, TNE AMOUNT SHOb
Chepta� 9, end that such lieenses are in full force antl etfaci, or I THE PURP06E OF E51
em ax9mpx from the Drovisions of the State ot California Busineu VALUATION
antl PrOfessions Cotle, Oivizion 3, Chapter 9.
SIB�oNre of //��' ,/ � � �
Permittee lS' -i�! g�QOO
A�thof��atl Apent
VALUE
—iY—
USE OF NEW
BVILDING �'aN�
VARDS APPRO'
ACCESSORV BUI
BET. MAIN &
/
V �
O
IN UNDER VALVATION IS iOR �
ABLISHING A PERMIT FEE ONLY: Q
m
PERMR FEE $ �
� ]
m
PLAN CHECK S �- E
`O
u
TOTAL FEE $
P.i �:
. 3g (o • � ���?� 17-7���.,,.001335 �= �� � 17!�.�0
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COSTA MESA BUILDING-SAFETY DEPARTMENT
f.V.OV/� 1
PP IC TION FOR BUILDING PERMIT
For Applicant to Fi!l in Completely
FE I D V DATE RECEIVED DATE ISSVEO/�`
BVILDING '//O ELQE�% G — 4�7V�
ADDRESS �'•/l!/
' PERMIT NO.
OWNER � �� A.P. NO. ��
MAIL ADIDRE S �1(J O L�OE�
ADDRESS
TEL. TRACT LOT BLOCK
CITV NO.
CONSTRVCTION �'" A p'
LENDER �
BRANCH
OWNER �
AODRE55
I VALUE
ARCHITECT TEL. S / $
OR ENGINEER
FIRE
ADDFESS ZONE TVPE GROUP"
APPROVE
CONTflACTOR BV DATE � '
AODRESS
TEI. �ONE NO.OF USE OF NEW
CITY NO.
FLANS BUIIDING
STATE CITV �'AFlOSAPPROVED VARDSAPPROVED
LI4 NO. LIC. NO. MAIN BUILDING ACCESSOPV BUILDING
512E NO.OF BLDGS. (FROM C/L STPEET)
OF LOT NOW ON LOT FRONT FT. FT.
USE OF
ExtSiiNG BLOG. T FT
S�ZE OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE FT. FT.
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
VSE OF BUILDING AND WORK TO BE PEFFOFMEO DSTANCE BET. gE7. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
VAR.� DATE
C.U.P. # APPROVED
A%'ROVED
I hereby ecknowledga thet I have teetl [hls aOP��cetlon end stetu
that the above information is correct antl apreo to comply wiM
all laws regutating builtlinB conztruction, antl I shall not amploy
ony parwn In violetion of the workman's compeneation laws of
Ne Sto[e of Calitornie.
I hereby certify that I om properly licensetl es e contrector untler SQ. FT.
the Stote of California Businass nntl Professtons Code, Divisicn 3, THE AMOUNT SHOWN UNDER VAI.UATION IS FOR
Chap[er 9, antl Nar such licenses are in full force entl atfect, or I THE PURP06E OP ESTABL6HING A PERMIT FEE ON�V:
em ezempt trom tl e provisions of the Stata of Celifomie Busineza VALUATION
entl Protessians Cocie, Division 3, Chopmr 9. PERMIT FEE $ '��
Sip^eture of
Permittee $ PLAN CMECK 8
Authorizetl Aeent TOTAL FEE 5 �
1 �
3836�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
�
"t��-�-����;,'.00 28s-� 19.�.
;�.�: � ;:
ON FOR BUILDING PERMIT
BVI4DING �/�/��. � � �,
ADORESS �
OWNER ' A.P.NO.,/U—O�S�
P.DDRE55 � Ay ADIDFIE S /�I(0(/ �,
MAIL
Z NEculWR
W W TEL TRACT , Gl/
aU CITV NO.� .], OQ
HZ
Z Q CON5TAUCiION '/" A � P
0 N LENDER
am
J � BRANCH
J N OWNER �� � ' �
m J A��PESS
J m ARCNITECT TEI. SE 2
a OR ENGINEER N .
V � FIRE i
wa ZONE TVPE
¢ AD�RESS
aw
w Z APPROVE
J O CONTFACTOR BV
m Z
J Q ADDAESS
� W TEL. ZON PLAILLS ^
Z � CITV NO. o�
W � STAYE CITV VARDS APPROVEO
j O �IC. NO. LIC. NO. MAIN BUILDING
SIZE NO.OF BLDGS. (FROM C/L STREET)
OF LOT �� X I NOW ON LOT RONT FT.
USE OF
EXI5T�NG BLOG. g
� SIZE OF a NO. OF
Z NEWBIDG. ROOMS STORIES L.SIDE FT.
a EXTERIOR WAL ROOF
V COV�RING G U COVERING REAR FT.
J USE OF BUILDING AND WORK TO BE PEfiFORMED DI5TANCE BET.
a MAIN BlDGS.
a
Q VAR. #
O C.U.P. q}s
� APPROVE
�
Z
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VI herOby acknowlatlga that I �ave reatl this epplication and steta
= that ihe ebova information is correct antl agree to comply wlth
� all IaWs ragulaNng builtli�p conctructlon, and I shall no2 amploy
� any person in violation of the workman's comp¢nsatian lawz oi
y the S[ata of Celi(omia.
? 1 �ereby certity thai I am properly Iicensetl as a convactor vntlar SQ. FT.
the State of Callfornia Business and Profassio�s Coda, Oivisicn 3, TME AMOUNT SNOWN UI
Chapier 9, antl that such licenses are In (ull forca and effect, or I THE PURP�E OF ESTABLI'
am e%empt from the provisions ot t�e Slete of California Businass VALUATION
and Profassions Cotle, Divislon 3, Chaptar 9.
ERA
SiB^aNreof �jl� �_�/• _ / �%
Permittea �r ff'�«��1 $ ,j'�� p�p,�
��
Autho��iatl Agant
TOTi
�
USE OF NI
BUILDING
VARDS
BET. MAIN &
ACCFSS. BLDGS.
DATE
APPqOVED
'_� � —/L�
♦�v m
�M O
�--ca�
ATION IS FOR
AIT FEE ON6Y: a
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COSTA MESA BUILDING-SAFETY DEPARTMENT
i Fat�
�ri 17-7���.:_.001334 �,::>x::3R.0
P.O. BOX 1200 GOSTA M65A, GAUFORNIA 9Z626 `
A PLI A ION FOR BUILDING PERMIT
For A,oplicant to Fill in Completely
REC IVE B DATERECEIVED DATEISSUE
BUILDING /-- G�
ADDRESS G E - 4-
PERMIT N .
OWNER � � A.P. NO.
BVILDING � / Q � , �
MAIL ADDRESS ��
AD�fiE55
TEL. TRACT LOT BLOCK
CITV NO.
CONSTFUCTION W ADD A
LENDER
BRANCH e '
OWNER A N E �
ADDfiESS VALUE
ARCHITECT TEL. S 2 � S
OR ENGINEER
FIPE
AOORESS ZONE TVPE GROUP
APPRO V E
CONTRACTOR BV � DATE '
ADDRESS
TEL. 20NE NO.OF USE OF NEW
CITV NO. PLAf�S BUIIOING
STATE CITY �'ARDSAPPROVED YARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUIL�ING ACCESSORV BVILDING
SIZE NO.OF BLOGS. (FROM C/L STREET)
OF LOT NOWONLOT RONT FT. FT.
USE OF
EXISTING BLDG. 5 FT FT.
SI2E OF NO. OF
NEWBLOG. ROOMS STORIES 1.51DE FT. FT.
EMERIOR WALL ROOF
COVEPING COVERING flEAR FT. FT.
USE OF BUILOING �+ND WORK TO BE PERFORMEO DISTANCE BET. BET. MAIN&
MAIN BLDCS. ACCE55. BLOGS.
VAR. # DATE
C.U.P.� APPROVED
APPROVED
I hareby ecknOwlBtlBB thet I hnve re¢tl [his application antl stete
that [ha nbova infolmation is correct antl a0rae to tomply wi[h
all lews roguletlng building constru<tion, entl I shall no[ amploy
any porson in v101at�on of tha workmen's compensa[ion lews ot
the Stem of Calitomla. �
I hereCy cer[ify thot � am proporly licensed a3 a cOnRactO� untla� $Q• FT.
tho Stnto ot Cnlifornio B�siness antl Professians Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOq
Chapter 9, antl that cuch licenses ete in tull forca antl atfect, or I THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am nzempt from u�e provislons o( the Stam of Colifornia Buciness � �
VALVATION
entl Protossions Cnue, Oivision 3, Chapcer 9. �
PERMIT FEE S !
SIB�nture af �
Pormittoo $ PLAN CHECK $
i
Autharizetl Apent TOTAL FEE S �
+ 39215
� COSTA MESA BUILpING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNfA 92626
For Applicant to Fillin Completely
BUILDING `'� ^,
ADDRES �/
OWNER �' �
MAIL r. .-i/Sl. -if• �s.
P�,� ,�:� r
'1N 13-7�x�;;�,.QO 443'� *;:' 17. �
APPLICATION FOR BUILDING PERMIT
RECEJV�'.j'18Y iAT ��EI� VF�D ��T���V
�� l �
— AHS ��I PERMIT NC
�r� �
!, <J �J�YF�I (_1✓e�
Z__ __' __
a U GTV N�j 5- U TR �
Za CONSTRU N W AD
O N LENDER
d �
J � BPANCH
-� N OWNE
m � ADDRESS /
ARCHITECT n• TEL7w ' $ G � (,
J a OR ENGINEER �(-( i'C
N q �) �� � /n�
w� ADDRESS � Q,} cIi(�KO(. �� Z�NE T
d W APPROVED
w � CONTRACTOR BV
J
my y
J � ADDRESS S� //
W W TE ZO NO.OF
Z� CITY NO. P�'�
w d STATE CITV YAflOS APPROVED
j O LIC. NO. IIC. NO. MAIN BUILDING
SIZE / / NO.OF BLDGS. (FROM C/L STREET)
OF LOT L�G l�{p NOW ON l0T L FROM F'
USE OF Q C
EXISfING BIOG.�P S FT.
F" SIZE OF NO. OF (� {,/ I� �
Z NEWeLDG. ROOMS STORIES L.SIOE `� FT.
Q EMERIOR WALL ROOF S
V COVEFING COVERING REAR f�.TI
J U E OF BUILDI ND WO K TO BE PERFORMED OISTAN ET. �+
n' MAIN BLDGS. t/
C.
Q / VAR.#e
� "� C.U.P. #
y /��' Sj]- L� ' / APPROVED �.
Q"� L
z
0
U1 hereby ecknowledBe that 1 �ave reatl this epplication entl state
� that the above informetion is correct and ugree to comply wit�
� all laws ragulating building construction, and I shall not amplay
F eny person fn violation of [he workmen's eompansation lews of
y the State of Celifornia.
ZI hereby ce�tity that I am ploperly licensetl as a contvactor untla� SQ. FT.
t�a State ot Californta Business antl Professio�s Cotla, Divlsicn 3, THE AMOVNT SH04
Chaptar 9, and that such Iicenses ara in full force and effect, or I THE PURPOSE OF ES
em exempt from the provlsiO�s of Na S[ata of California Bucinezs VALVATION
entl Professions Cotle, D visio� 3, haPter 9.
Sipnnture at �
Permittoe $ � 0�� ��
♦%
Authorizetl Agent
JSE OF NEyV / /
lU1�DING �n
VARDS APPROVED
AC E SOPV BUILDII
�- 1� a ,
L
BET. MAIN & /J
ACCESS. BLOGS.�
DATE
APGROVED
--__11_i 2--
\ / ��
\ Tnx� �a
O
VALUATION IS FOR '
A PERMIT FEE ONLY: Q
E $ � � r'
/' 7
K 3 . �l E
$ l(o, 5'p s
LL