HomeMy WebLinkAbout923 DOGWOOD ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 923 DOGWOODST
Suite:
Vicinity:
Parcel Number: 42252205
Applicant: JUREKOVIC, CHARLOTTE
Address: 120 BROOKLINE LN '
COSTA MESA, CA
Owner: WILLIAMS, LEWIS KAY TR
Address 923 DOGWOOD ,
COSTA MESA, CA .
Contracror. JUREKOVIC BLDG CO
Address: 120 BROOKLINE LANE
COSTA MESA, CA
Zip: 92626
Arch :
Address:
Zip:
Zoning:
Phane: 949-650-3382 HOME
Zip: 92626
Phone:
Zip: 92627
Phone: (714)540-5417
License: 548410
Eng:
Address:
Phone:
License:
ISSUED BY:
Slatus: ISSUED
Applied: 06/26/2003
Issued: 09/26/2003
Phane:
License:
SCOPE OF PERMIT
ADD 1,292 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD 654 S.F. TO 1ST FLOOR, ADD A NEW 2ND STORY (638 S.F.), AND REMODEL
KITCHEN AND ADD LAUNDRY ROOM IN (E) SFD. ADD 151 COVERED PORCH AT FRONT.
CONVERT 2 BEDROOM, 1 BATH S.F.D. TO A 5 BEDROOM, 3 BATH S.F.D.
REF: ZA-03-51 -
40% OPEN SPACE REQ., 63% PROVIDED.
MAX. BUILDING HEIGHT: 23' -
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
inspection:
Total:
$762.42
$1,172.95
$13.18
$0.00
$0.00
$0.00
$1,948.55
FEE SUMMARY
PLANNING & ZONING
Calc Valuation: 5i3t,aia.s2
Claim Valuation: So.00
I 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, 72-21-92)
E%PIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a penod 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 Inapectiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2aasws �aroo�
WORKERS'COMVENSAnON DECLARATON: ' �
I hereby affirtn under penalty of perjury one ot the following declarations:
❑ 1 heve antl will melntaln e cenificate ol wnsent to self-Insure for workers' compensation, es providea tor 6y section 3700 0l the Lebor Cotle, tor ihe pertortnance ot Ihe
wark tar which t�is permit i5155uetl.
❑ 1 have and will maintain workers' compenution insurance, az required by seaion 3700 of �he Lebor Cotle, for Ihe peAortnance of ihe work for which this pertnit is issueC.
My workers' compenselion Insurance carrler and policy number are:
Carner: Policy Number.
(This section need nof be crompleretlll the permit is velued et ane hundred dollers (5100) or /ess.J
�I cerlily ihat in the pedormance al ihe work tor which this pertnit is issued, 1 shall not employ any person in any manner so as to bacome sublect to Ihe workers'
compensation laws of Califomia, and egree 1he1 if I s�oultl become subject to the workers' compensation provisions oi SecOon 3700 0l the Lebor Code, I s�ell forthwith
comply with these �� isions. �,.(.—('�
APGlicantSignawre: �YA�.YL(.Li�,Y.�A/•��11%7'� Date: ���//�3
WARNING: FAILURE TO SECURE WORKERS' COM5 1/SATIdJ COVERAGE I5 UNLAWFULlWD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000�, IN ADDITIqJ TO TME CAST OF CAMPENSATIPY, DANAGES AS PROVIOED FOR IN SECTION 3]OB OF THE LABOR CODE, IMEREST, ANO ATTORNEV'S FEES.
UCENSED CONTRACTORS DECLARATION:
I hereby ettirm that I em
lorce antl eHec�. Lic. x_
Contractor's Signeture:
of Chapter 9(commencing with Section 7000) oi Divislon 3 0l the Buslness and Professlons Code, and my license is in full
Cless N �
AAL 11�1Y/C� Date: �I � O'�
CONSTRUC710N LENDING AGENCY:
❑ I hereby aHirm thal Ihere is e construction lentling aqency for ihe pertormance ot the work for which ihis pertni� is issued. (Sec. 3097, Civil Code).
Lendefs Nema: Lenders Address:
Signature:
OWNER•BUILDER DECLARATIONS:
oate:
I �ereby aMrm thet under penelry ol perjury t�et I em E%EMVT FROM TT1E CONTRACTORS LICENSE LAW for the following resson (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires a pertni� to conslrucL alter, improve, demolish, or repair any strucwre, pnor to its issuance, also requires ihe applicam for such pertnit
to file e signad stetement thet he or she is Ilcensetl pursuant to the provisions of tha Contrectors License Lew (Chepter 8(commencing with Seqlon 7000) of Division 3 of �he
Business entl Pmtessions Code) or thet he or she is exempt theretrom and Ihe basis tor the ellegetl e:emption. Any violation oi Seaion 7031.5 by any eppliwnt for a pertnit
subjects the applicent to a clvil penalry of not more then five huntlratl dollars ($500).):
❑ I, as owner of ihe properry, or my emplayeas wlth wages es ihelr sole compensatian, WILL DO THE WORK, end lhe structura Is noI Intended or oHeretl for sale (Sec.
7044, Business and Proteulons Code: The Contractore License Law dces not apply to an owner ol property who builds or improves ihereon, and who dces such work
himselt or herself or through his or her own employees, provided ihat such improvements era no� Iniended or oflered for sale. If, howevar, the building or improvement is
sold within one year ot completion, the owner-6uiltler will have �he burden of proving iha� he or she tlid not build or improve lor Durpose of sala.). •
❑ I, as owner oi Ihe property, em EXLLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 70d4, Business antl Professions
Code: The coniractors License Lew tloes not epply to an owner ol property who builds or Improves Ihereon, and who comracts tor such projea with e coniractor(s)
license pursuent to the Contrectors License Laws.).
❑ I am exempt under sec. Business and Professions Cotle for this reason:
Signature: 1,,� Date:
Owner ID verified by dnvar's Ilcense. yC.I Ves ❑ No Driver's License No.
Venficetlon oi Ownership by (type ol docu em nt, i.e. - property tax 6111 or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICATION:
Ezpires:
❑ I hereby certiy Ihat no excavetion tive (5) or more feet in depth into which a person is requiretl �o descend, wlll be made in connection with work authonzed by this
permit, end thet no building structure, scaHoltling, falsework, or demolition or dismantling �hereof, will ba more ihan ihirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title B, Californla Administrative Code).
❑ As ownervbuilder, I will not employ enyone to do work which would require a parmit from the Division of Indusiriel Sefety, es notatl above, unless such person hes e
permit fo do such wark from the division.
Signature: Data:
Division at Indusinal Sefery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF EMRV: I cehity untler penalry of perjury ihat I have read this epplication end state that ihe infortnation given is
correct. I egree to comply with ell stata lews end city ordinences rela�ing to �uilding construction, and autharize represantatives of ihe Clry of Coste Mesa to enter upon Ihe
ebove-descnbed properry lor inspection purposes. I egree no� to occupy or ellow occupancy of eny building authorized by ihis permit until finel inspection.
COOE �, INSPECTIONTYPE Qaj[ INIRIRLS
1616 Fi:etl System Finel Fire Prevention
1266 Pool Spa Final
200 Finel Re-Roof
201 FIneI BIocWRetaining Well
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolition �
9/�.L �o�
at
COpE 1 INSPECfION TYYE
208 Finel Mechanicel
200 Finel PlumDing
210 Finel Elecincal
212 Finel Fire Preventlon
220 Final Planning Approvel
222 Final Site
250 Final Building/Occupancy
�g �
_'� �
July 24, 2003
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CA�IFORNIA 92628-1200
DEVE40PMENTSERVICES DEPARTMENT
Jim Jurerovic
120 Brookline Lane
Costa Mesa, CA 92626
RE: MINOR DESIGN REVIEW ZA-03-51
923 DOGWOOD STREET, COSTA MESA
Dear Mr. Jurerovic:
The minor design review for the above-referenced project has been completed. The
application has been approved, based on the following project description and
findings, subject to the conditions set forth below:
PROJECT DESCRIPTION
The applicant is proposing to expand an existing 1,225 square-foot, single-family
residence by adding 638 square feet on the second floor. The second floor
expansion consists of two bedrooms and a master bathroom. Access to the second
floor is via an interior stairway.
The homes abutting the property are one story. The second floor is setback 27 feet
from the east (left side) property line, 59 feet from the south (rear) property line, and
10 feet from the west (right side) property line. Privacy impacts on the adjacent
residential properties from proposed second story windows will be minimized because
there are no direct lines of sight from the proposed second story windows into the
first floor windows of the surrounding residences.
r.
The intent of the minor design review process is to ensure that scale and massing of
proposed second-story construction is compatible with the neighborhood, as well as
the existing design of the residence. The addition conforms to all development
standards and the residential design guidelines. The second-story area is approximately
52% of the first floor. Minimal architectural articulation on the west (right side)
elevation is somewhat offset by a raised band between the first and second stories.
The addition has been designed to be physically and architecturally compatibie with
neighboring uses, and is well integrated into the architecture of the existing
residence.
Building Division p14) 754-5273 • Cotle EnforcemeN (714) 754-5623 • Planning Division (714) 754-5245
fA% (774) 754-4856 • TDD (714) 754-5244 • www.ci.casta-mesa.ca.us
m
July 24, 2�03
ZA-03-51
Page 2
Code allows an exemption from parking requirements for an existing residence with
nonconforming parking if it is determined that the existing structure(s) on the lot,
precludes reasonabte compliance with the parking req�irements. Code requires a 2-
car garage and two open parking spaces; only one open space can be provided. The
site precludes compliance with the parking requirements because of the placement of
the detached 2-car garage at the rear of the property, and the 13-foot separation
between the garage and the main house. Because the garage is nonconforming with
regard to side and rear setbacks (1.5 feet on the side, 3 feet on the rear) there is no
room to expand the paved area for two non-tandem spaces in front of the garage. It
is staff's opinion that it would be unreasonable to apply the 2-car open parking
requirement in this case, and the 80 foot depth of the driveway leading to the
detached garage is adequate to accommodate two tandem vehicles. As a result, no
parking impact is anticipated as a result of the proposed addition.
FINDINGS
A. The information presented substantially complies with Costa Mesa Municipai
Code Section 13-291g)121 in that the proposed project will not be detrimental to
the health, safety, and general welfare of the public or other properties or
improvements within the immediate vicinity. No parking impact is anticipated
with the parking exemption from the required number of open parking spaces.
The recommended conditions of approval will ensure that the construction will
not be materially detrimental to the health, safety and general welfare of the
public or otherwise injurious to property or improvements within the immediate
neighborhood. Granting the minor design review wiil not aliow a use, density or
intensity that is not in accordance with the general plan designation for the
property.
B. The proposed project complies with Costa Mesa Municipal Code Section 13-
29(e) because:
• The proposed development and use is compatible and harmonious with
uses on surrounding properties.
• Safety and compatibility of the design of the buitdings, landscaping, and
other site features including functional aspects of the site development
such as automobile and pedestrian circulation have been considered.
• The project is consistent with the General Plan.
• The planning application is for a project-specific case and does not
establish a precedent for future development.
C. The project has been reviewed for compliance with the California Environmental
Quality Act (CEQA�, the CEQA Guidelines, and the City environmental
procedures, and has been found to be exempt from CEQA.
D. The project is exempt from Chapter XII, Article 3, Transportation System
Management, of Title 13 of the Costa Mesa Municipal Code.
July 24, 2003
ZA-03-51
Page 3
CONDITIONS OF APPROVAL
Ping. 1. Street addresses shail be displayed on the fascia adjacent to the main
entrance or front door in a manner visible from the public street.
Numerals shall be a minimum 6 inches in height with not less than '/�-
inch stroke and shall contrast sharply with the background.
2. The conditions of approval for ZA-03-51 shall be blueprinted on the
face of the site plan as part of the plan check submittal package.
3. New and existing construction shall be architeciurally compatible with
regard to building materials, style, colors, etc., to the existing
residence.
4. Construction, grading, materials delivery, equipment operation or other
noise-generating activity shall be limited to between the hours of 7
a.m. and 8 p.m., Monday through Friday, and between the hours of 8
a.m. and 7 p.m., on Saturday, Sunday, and Federal holidays.
Exceptions may be made for activities that will not generate noise
audible from off-site, such as painting and other quiet interior work.
Eng. 5. Maintain the public right-of-way in a"wet-down" condition to prevent
excessive dust and remove any spillage from the public right-of-way by
sweeping or sprinkling.
CODE REQUIREMENTS
The following list of federal, state and local laws appiicable to the project has been
compiled by staff for the developer's reference. Any reference to "City" periains to
the City of Costa Mesa.
Ping. 1. All contractors and subcontractors must have valid business licenses
to do business in the City of Costa Mesa. Final inspections, final
occupancy and utility releases will not be granted until all such
licenses have been obtained.
2. Approval of the zoning action is valid for one (1) year and will expire
at the end of that period unless building permits are obtained and
business comme�ces or the applicant applies for and is granted an
extension of time.
3. Development shall comply with all requirements of Section 13-32,
Title 13, of the Costa Mesa Municipal Code relating to development
siandards for residential projects.
4. Ail new on-site utility services shall be installed underground.
5. Installation of all new utility meters shall be performed in a manner so
as to obscure the installation from view from any place on or off the
property. The installation shall be in a manner acceptable to the public
utility and shall be in the form of a vault, wail cabinet, or wall box
under the direction of the Planning Division.
July 24, 2003
ZA-03-51
Page 4
6. Any mechanical equipment such as air-conditioning equipment and
duct work shall be screened from view in a manner approved by the
Planning Division.
Bldg. 7
Eng. 8
9.
10
11
12
13
Traffic 14
Fire 15.
Comply with the requirements of the Uniform Building Code as to
design and construction.
At the time of development submit for approval an off-site plan to and
grading plan to the 8uilding Division that shows sewer, water, existing
parkway improvements and the limits of work on the site, prepared by
a civil engineer or architect. Construction access approval must be
obtained prior to building or engineering permits being issued by the
City of Costa Mesa. Pay off-site plan check fee to the Engineering
Division. An approved off-site plan and fee shall be required prior to
engineering/utility permits being issued by the City.
A construction access permit and deposit of 5350 for street sweeping
will be required by the Engineering Division prior to the start of any
on- or off-site work.
Submit required cash deposit or surety bond to guarantee construction
of offsite street improvements at time of permit per Costa Mesa
Municipal Code Section 15-32, and as approved by City engineer. Cash
deposit or surety bond amount to be determined by the City Engineer.
Obtain a permit from the Engineering Division, at the time of
development and then construct P.C.C. residential sidewalk per City of
Costa Mesa standards, including four (4) feet clear around obstructions
in the sidewalk. See Costa Mesa Municipal Code Section 13-72.1 for
available options.
Remove non-approved items out of the parkway and landscape per the
City's Streetscape and Median Development Standards, Section 3.0.
Reconstruct any damaged public improvements as needed to construct
new sidewalk at proper finish grade.
Applicant is hereby advised that construction of a new public sidewalk
as required in #11 above may require removal of a City parkway
treels). Removal of trees from the public right-of-way cannot be
permitted without approval from the Parks and Recreation Commission
and compliance with mitigation measures as determined by the
Commission to relocate the trees and/or compensate the City for the
loss of trees from the public right-of-way. The approval process may
take up to three monihs, therefore, the applicant is advised to identify
all trees affected by the proposed project and make timely application
to the Parks and Recreation Commission to avoid possible delays.
Provide an approved smoke detector to be installed in accordance with
the 1997 Edition of the Uniform Fire Code.
July 24, 2003
ZA-03-51
Page 5
SPECIAL DISTRICT REQUIREMEN7S
The requirement of the following special districts are hereby forwarded to the
applicant:
Sani. l. Developer shall contact the Costa Mesa Sanitary District at (949) 631-
1731 for current district requirements.
School 2. Pay appiicable Newport Mesa Unified School District fees to the Building
Division prior to issuance of building permits.
State 3. Comply with the requirements of the California Department of Food and
Agriculture (CDFA) to determine if red imported fire ants (RIFA1 exist on
the property prior to any soil movement or excavation. Call CDFA at
(714� 708-1910 tor information.
Upon receipt of this letter, your project has been approved, subject to the above-
listed conditions. A copy of the conceptually-approved plans is enclosed. The
decision will become final at 5 p.m. on July 31, 2003, unless appealed by an
affected party or by a member of the Planning Commission or City Council.
If you have any questions regarding this letter, please feel free to contact the project
planner, Mel Lee, at (714) 754-5611, between 1 p.m. and 5 p.m., Monday through
Friday.
Sincerely,
� ���
PERRY L. VALANTINE
Zoning Administrator
Enclosure: Conceptually-approved plans
cc: Engineering
Fire Protection Analyst
Water District
Building Division
Carita Williams
923 Dogwood Street
Costa Mesa, CA 92627
pt4) �5a-5273 • Fax (�t4) 75a-aess • www.ci.costa-mesa.ca.us 77 hAIM UHIVt, GVJ IA MtSA, GA tlLtlZb
Job Address: 923 DOGWOOD ST
Suite No
Vicinity:
Parcel Nunmber: 42252205
Applicant JIM UREKqVIC
Address: 120 BROOKLINE LANE. -
COSTA MESA, CA
Owner: WILLIAMS, LEWIS KAY TR
Address 923 DOGWOOD
COSTA MESA, CA
Contractor: JUREKOVIC BLDG CO
Address: 120 BROOKLINE LANE '
COSTA MESA, CA
Arch / Eng :
Address:
PLUMBING PERMIT
Phone: 949-650-3382
Zip: 92626
Phone:
Zip: 92627
Phone: 949-650-3382
Zip: 92626
License: 548410
Phone:
Zip:
License:
Status: ISSUED
Applied: 10/14/2003
Issued: 10/t4/2003
ISSUED BY: �
SCOPE OF PERMIT
ADD 1,292 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD 654 S.F. TO 1ST FLOOR, ADD A
NEW 2ND STORY (638 S.F.), AND REMODEL KITCHEN AND ADD LAUNDRY ROOM IN (E) SFD. ADD
151 COVEREb PORCH AT FRONT. REF.: 803-01097
CONVERT 2 6EDROOM, 1 BATH S.F.D. TO A 5 BEDROOM, 3 BATH S.F.D.
PLUMBING Tp INCLUDE: 1 BATHTUB, 1 DISHWASHER, 1 GAS (1d OUTLETS), 1 LAUNDRY
TUB/WSHER, 7 P-TRAPS, 2 SHWOERS, t KITCHEN SINK, 1 WASTE, 7 VENT SYSTEMS, 2 WATER
CLOSETS AND 1 WATER PIPING.
AMT
ISSUE FEE $23.50
BackFlow irrigation $0.00
Backflow Preventer $0.00
Bathtub $9.80
Clarifer System $0.00
Connect (Ice,Soda,etc) $0.00
PEE SUMMARY
QTY , AMT QTY
� Laundry Tub / Washer $9.60 1
0 Landsrape Irrigation $0.00 0
0 . P-Trep $68.60 7
t � Pressure Regulator $0.00 0
0 ' Process Piping (per 10 ft) $0.00 0
0 Receptors $0.00 0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-0)
Vacuum Brkr Bkflow(5+)
AMT QTY
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241�92)
EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspendetl or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes; end all
required Inepeclions and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of:this peimit.
FOR INSPECTIONS CALL: (714) 754b626
2466d6 (BNO)
WORKERS'COMPENSATON DECLARAnON: � �
I hereby ettirtn under penalry ot perjury one ot the tollowing tleclarations:
❑ I have end wlll mainteln a certilicate of consent to setl-Insure for workers' compensation, es pmvided tor by section 3700 0l ihe Labor Cotle, tor the pertortnance of the
work lor which this pertnit is i55ued.
❑ I have antl will mainialn workers' compensali0n Insurance, as requiretl by section 3700 of t�e Labor Cotle, far Iha petloimanca ol Ihe woB for whkAi ihi5 permit is issued.
My workers' compensation Insurence carrier entl policy number ere:
Carrier: Polity Number:
(This seclion need nof be comp/efed il the permit is valuetl a! one huntlred dollars ($100) or Iess.J
� I cenity that in the pedormance oF ihe work for which ihis pertnit is issueq I shall not employ any person in eny manner so es to become suhject to the workers'
compensation laws af Celitomia, antl egre aat If I should become subject to the workars' compensation pmWsions ot Section 3700 ot the Lebor Code, 1 shall forthwith
comply with thes m iepns. � O _ I I_ O^
C.
Applican� Signeiure: Deie:
WARNING: FAILUPE TO SE R WORKERS' C M ENSATION COVEMGE IS UNLAWFUL AND SHALL SU9IECT PN EMPLOYER TO CRIMINAL PENALTIES PND GVIL FlNES UP TO dJE HUNORE�
TMOUSANDDOLLARE($100, �, NADDITION T ECASTOFCAMPENSATION,pAMAGE5A5PROVIDEOFORiNSECTION3]O60FTHElABORfAOE,IMEREST,qNDATTORNEYSFEES.
LICENSED CONTRACTORS DECLARATION:
I heraby eRirm �hat I am license underf�rov'sions of hapter 9(commencing with Section 7000) of Division 3 of ihe Business §pQ Professlons Cotle, antl my license is in full
force and eHect. Lla N v � a Class k ��
ComractorsSigneture. � Dete: —D�i
CONSTRUCTION LENDI AGENCV:
❑ I �ereby aNirm Na� �here is e consiruc�ion lentling agency tor Ihe pedortnance ol the work br w�ich Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lenders Name: Lender's Address:
Signflture: _
OWNER-BUILDER DECLARATIONS:
Date:
I hereby eHirtn ihat under penelry of perjury t�et I em E%EMP7 PROM 7HE CON7RACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair any sWcture, prior to its Issuance, also raquires Ihe applicant tor such permit
lo lile e signed s�atement Ihet he or she is Ilcensed pursuant to the Orovisions ot the Contractors License Law (Chapter 9(commencing wlih Section 7000) of Division 3 of the
Business and Protessians Cade) or that �e ar she is e:empt t�eretmm and Ne basis for the alleged exemption. Any violetion ol Section 7031.5 by any eppliwnt for a pertnit
subjecls ihe apDlicent to e civil penalry ot not mora Ihan five hundrad dollars (5500).):
❑ I, as owner ol the property, or my employees wilh wages as their sole compensation, WILL DO TME WORK, antl the structure is not Intendetl or oXered for sale (Sec.
7044, Business and Prolessions Code: Tha Contractors License Law does not apply to an owner of property who builtls or ImO�oves ihereon, and who dces such work
himself or herself or ihrough his or her own employees, providetl �hai such improvements ere not Intende0 or oftered lor sale. It, however, ihe building or improvement is
soltl within one year of completioq the owneo-builtler will have the burden ot proving iha� he or she did nol build or improve lor purpose ol sele.). '
❑ I, as owner oi the property, am E%CLUSIVELY CONTRACTINC WITH LICENSED CONTRACTORS to construct the projact (Sec. 7044, Business entl Professions
Code: The cromractors License Lew does no� appty Io an ownar of property who builds or Improves Ihereon, end who wmracts for such project with a contractoqs)
license pursuant to the Conlractors License Laws.).
❑ I em exempt under sec.
Signa�ure:
Owner ID verified by tlriver's license. ❑ Ves ❑ No
Business antl Professions Code for this reason:
Venticetian of Ownership by (type at tlocument, i.e. - praperry tex bill or deed):
DIVISION OF INDUSTRIAI. SAFETY VERMIT CERTIFICATION:
Driver's License No.
Date:
Expires:
❑ I hereby certity that no excevetion five (5) or more feet in depth into which a person is required to descend, will be made in connection with work euthonzed by this
permit, antl ihat no building siructure, Scallolding, falsewoB, or demolition or tlismantling theraof, will be more than thirty-si: (36) faet hiqh. (Chap. 3.2, Gry 2, Art 2, Sec.
341, Ti�le 8, Celitomia Atlminisiretive Cotle).
❑ As owner-builder, I will noI employ enyone to do work which woultl require a permit irom the Division of Intlustnal Sefery, es notetl above, unless such person hes e
permit to do such work irom the division.
Signature: oate:
Division ol Indusinal Safery Permi� Number:
CER77FlCATE OF COMPLIANCE AND AIJTHORVJITON OF EMAY: I certify under penalry ol perjury that I heve reatl ihis epplication and state �hat ihe information given is
correcL I agree to comply with all s�ate lews and ciry ortlinances relating to builtling consiruction, and eu�hodze represematives of ihe Clty of Costa Mesa m emer upon Iha
ebove-described property lor inspectiorypurposes. I agree not to occupy or allow occupancy ot any Duilding authonzed by ihis permit until linal inspection.
yooe �. in�rs�noxttre \/ D�E INTIIIALS
1616 Fixetl System Final Fire Prevemion
1266 Pool Spa Final
200
207
202
203
204
Final Re-Roof
Final BIocWRetelning Well
Final Fectory Fire Place
Finel Sign
Final Domolition
ua�a
Io-►4-03
Date
CODE1 INSPELTONTYVE
206 Finel Mec�anical
208 Finel Plumbing
210 Final ElBctrical
212 Final Fire Preventlon
220 Final Plenning Approval
222 Final Site
250 FinalBuilding/Occupancy
➢�E L�LS
� .. Y Y �t►�I
(714) 754-5273 • Fax (�ta) �sa-ae56 • www.ci.crosta-mesa.ca.us 77 hAIH UHIVt, GUJ IA MkSA, GA tl2tiZti
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applirant:
Address:
Owner:
Address
923 DOGWOOD ST
4Z252205
JIM UREKOVIC
120 BROOKLINE LANE
COSTA MESA, CA .
WILLIAMS, LEWIS KAY TR
923 DOGWOOD
COSTA MESA, CA
Convactor. JUREKOVIC BLDG CO
Address: 120 BROOKLINE LANE
ISSUE FEE
Temp service test
Res. a/c package
New Res (1•2 units)
New Res (3+uniLs)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors l0 1 hp
Motors to 10hp
COSTA MESA, CA
Phone: 949-6503382
Zip: 92626
Phone:
Zip: 92627
Phone: 949-650-3382
Zip: 92626
License: 548410
Status: ISSUED
Applied: 10/14/2003
Issued: t0114/2003
SCOPE OF PERMIT
ADD 1,292 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD 654 S.F. TO 1ST FLOOR, ADD A
NEW 2ND STORY (638 S.F.), AND REMODEL KITCHEN AND ADD LAUNDRY ROOM IN (E) SFD. ADD
151 COVERED PORCH AT FRONT. REF.: 803-01097
CONVERT 2 BEDROOM, 1 BATH S.F.D. TO A 5 BEDROOM, 3 BATH S.F.D.
ELECTRICAL TO INCLUDE: 30 LIGHT FIXTURES, 55 OUTLETS, 20 SWITCHES, 2 MOTORS TO 7 HP
AND 1 SUB PANEL TO 200 AMPS.
$23.50
$0.00
50.00
50.00
50.00
50.00
$29.30
$47.55
$22.00
50.00
$0.00
50.00
40.00
30.00
$9.50
50.00
Quantity
0
0
0
30 .
55
20
0
0
0
0
0
2
0
FEE SUMMARY
Temp Dis1 System / Lighting
Busway /100 R
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up l0 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Cirws (mech ride or lights)
Christmas Tree Stand
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
80.00 0
$0.00 0
$0.00 0
S0.0o 0
$0.00 0
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, 1247-92)
EXPIRATION: This pertnit shall automatically expire and become void it work is not commenced wlthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permil to be considered legal, such work must comply with all applicabla codes, end all
required Inapeetlons and (inal epprovel must ba obtained. Failure to obtain inspections and linal approval will result in the expiration of /th�is.permft�
FOR INSPECTIONS CALL: (714) 7545626 Cf
244&46 (8100)
WORKERS'COMPENSATON DECLARAnON: � �
I hereby attirm under penelty of perjury one of the following declarations:
❑ I heve ana will maintain e certilicate oi wnsent to sell-Insure tor workers' compensetlon, es provitletl tor by section 3700 of the Labor Code, for t�e peAormance af the
work for whiCh IhiS pertnil is issuetl.
❑ I have and will maintain workers' oompensa�on insurflnce, as requireG by sectlon 3700 of Ne tabor Code, for the pertortnance of tho work lor which this pertnit is issueA.
My workers' compenSaUon Insurance carder entl pdiry number are:
Carrier: Pdicy Number.
(Thls sectlon need nat be comp/etetl i! Ne partnif /s velued af one nurrtlretl tlW/ers (S I00) or /essJ
�I I Certify lhat In ihe pBAortnento 01 Ihe work lor hicti this permit ls issued, I shall not employ any person in eny manner so es to becarne su�ject to t�e workers'
�/compensation lews ol Calitomia, enA egree t t I I should become sub�ect Io t�a workers' compensation pmvisions ol Section 3700 ot the Lebor Cotle, I s�all lonhwith
compty with Ihese pmvi n. 1
A�IIcenl�6ignature`: Date: • 1 �^ ��" O 3
WARNING: FAILURE-TO SECU ORKE0.5' CO EN ATION COVEMGE IS UMAWFUL AND SHALL SUflIEGT AN EMP�OVER TO CRIMINAL PENALTIES ANO CML FlNES UP TOONE HUNDRED
TIIOUSANO OQLAfiE (StOD, , I ADDfiION TO OF COMPENSATION, DAAIAGES AS PROVIDED WR IN SECTION 31O80F THE LABOR COOE, INrERE5T, AND FTTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
9(commencing with Section 700% of Division 3 o11he.Busines�s„Qntl Protesslons Code, end my license Is in lull
anao�: u�: » —
CONSTRUC710N LENDING AGENCV: `�
❑ I �ereby eflirtn Ihat Ihere is e canstruqion lentling egency for Ihe peAormance ol tha wark lar which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lenders Neme: Lendefs Atltlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby effirm ihat under penelry of perjury that I em E%EMPT FROM THE CON7RAC70R5 LICENSE LAW for Ihe following reeson (Sec. 7031.5, euslness enE Protessions
Cotle: Any ciry or counry whiU requiros e permit co construc6 alter, improve, demolish, or repair any strucWre, pnor to its issuance, elso reduires the epplicam for such pertnit
to file a sipned Statement Ihat he Or She IS IIcBn50C Dursuent to t�e O�ovi51on5 oi Ne Conlraciors License Law (Chapter e(wmmencing wlth Settlon 7000) oi DlNsion 3 of t�e
Business entl Protessions Code) or thet �o or s�e is e:empt iherofrom end the besis for ihe elleged ezemp�ion. Any violation of Section 7037.5 by eny epplicant tor e pertnit
subjecis the applicant to e clvil penelry of not more than five huntlretl dollars ($500).):
❑ I, as owner ot t�e property, or my employees with wages as t�eir sole compensation, WILL DO 7HE WORK, and Ihe siructure Is not intendetl or ottered tor sale (Sec.
7044, Business end Professions Code: The Con�rectors License Law dces not apply to an owner ot propehy who builds or improves thereon, and who does such work
himself or herself or ihrough his or her awn employees, proviaatl that such improvemenis ere not in�ended or offered tor sele. If, howevar, Ihe huilding or Improvemen� is
sold within one year ol completion, the owner-builder will have the burden oi proving ihat �e or she tlitl not 6uild or improve tor purpose of sale.). �
❑ I, as owner of Ihe properry, am E%CLUSIVELV CONTRACTNG WIT}f LICENSED CONTHACTORS to construct I�e project (Sec. 7044, Business and Protessions
Code: The contractors License Law tloes no� eppty �o an owner ol pwperry who bulltls or Impwves thereon, end who con�racts br such pro�ect wlih e contrector(s)
licensa pursuant to the CONrectors License Lews.).
❑ I am exempt untler sec.
Signawre:
Owner ID veniietl by tlrivefs license. ❑ Ves ❑ No
Business and Pmfessions Code tor ihis reason:
Veritica�ion oi Ownership by (rype oi tlacumeN, i.e. - praperty taz bill ar tleetl):
Dnver's License No.
Date:
Eapires:
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
❑ I heraby cenity that no excevetlon five (5) or more teet in Cept� into w�ich a person is required to descend, will be made in connection with work euthorized by this
permit, en0 that no builtling structure, scaHoltling, telsework. or Aemolitlon or dismantling t�ereof, wiil be more �han thirty-siz (36) feet hig�. (Chep. 32. Grp 2, Art 2, Sec.
341, Title 8, Celitomia Administretive Code).
❑ As owner�Duiltler, I will noi employ enyone ta do work which would reduire e permil Irom the Division ol Industrial Selery. es noted above, unless such person has e
pertnit to do such work tran the division.
Signeture: Date:
Division ol lndusidal Sefery Permit NumDer.
CERTIFICATE OF COMPLIANCE AND AUTHORVATION OF EMRY: I ceNty under penalry of perjury that I have read this epplication and slate that the inlortnation given is
correct. I agree to comply with ell state laws end dry ordinances relating to building conswction, antl autnonze representetives ol t�e Clry of Costa Mesa to enier upon the
ebove-tlescnbed D�aPeny lar inspeclion puryoses. I agree rwt to occupY or ellow occupanty of any builtling authorized by this permit until finel inspection.
tooe �. uhe�n4n.� �, ueg u�
7676 Fixetl System Final Fire Preventlan
1266 Pool Spa Finel
200 Final Re-Root
201 Final BIocWReteining Well
202 Final Factory Fire Place
203 Finel Sign
204 Final Demdltlon
COUE1 INSPECTONTYPE
206 Finel Mechenical
208
210
212
220
10-14�b3
Finel Plumbing
Finel Elecidcal
Finel Fire Preventlon
Final Plenninp Approval
222 Final Site
250 Final Building/Oaupency
PAff Itii�LB
(774) 75a-5273 • Fax (7�4) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Jobnddress: 923 DOGWOODST
Suite No
Vicinity:
Parcel Number: 42252205
Appli�nt: JIM UREKOVIC
Adtlress: 720 BROOKLINE LAME
COSTA MESA, CA �
Owner: WILLIAMS, �EWIS KAY TR
Adtlress: 923 DOGWOOD "
COSTA MESA, CA
Contractor: JUREKOVIC BLDG CO
Adtlress: 120 BROOKLINE LANE
COSTA MESA, CA �
MECHANICAL PERMIT
Phone: 949-6503382
Zip: 92626
Phone:
Zip: 92627
Phone: 949-650-3382
Zip: 92626
License:548470
ISSUED BY:
Status: ISSUED
Applied: 10/14I2003
Issued: 10/14/2003
SCOPE OF PERMIT
ADD 1,292 S.F, TO EXISTING S.F.D. WORK TO INCLUDE: ADD 654 S.F. TO 7ST FLOOR,
ADD A NEW 2ND STORY (638 S.F.), AND REMODEL KITCHEN AND ADD LAUNDRY ROOM IN (E)
SFD. ADD 151 COVERED PORCH AT FRONT. REF.: B03-01097
CONVERT 2 BEDROOM, 1 BATH S.F.D. TO A 5 BEDROOM, 3 BATH S.F.D.
MECHANICAL TO INCLUDE: 1 INST FAU < 100K BTU, t GAS PIPING, 1 HOOD W/MECH
EXHAUST, 3 VENT FANISINGLE DUCT, 1 APPLIANCE, AND 1 INST OR RELOCATE APPL VENT.
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >100 k BTU
Repair / Alt Cooling/Heat
Inst / Rep. Recess Wall Hv
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplgce
Nood w/Mech Exhaust
VAV Box
Vent Fan I Single Duct
Appliance
Fire Dampers
Smoke Dampprs
Insl or Reloca[e Appl Vent
Air Handlers < 70000cfm
AirHandlers> 70000cfm
523.50
$14.80
$0.00
$0.00
$0.00
$0.00
so.00
$6.15
S0.00
310.65
$0.00
521.75
310.65
$0.00
$0.00
510.65
50.00
50.00
Quanlity
1
0
0
0
0
0 �
1
0 '
t .
0
3
�
0
0
7
0
0
FEESUMMARY
Repair / All Absorbtion Unit
Repair / Alt Refrigeretion Unit
Ventillation System
Evaporetive Cooler
Commercial I ncinera lor
Domeslic Incinerator
Campressors / Absomtion Systems
Upto3hp/t00kBTU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Quantity
50.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
50.00
0
0
0
0
0
0
0
0
0
0
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ortl. No. 9248, § 1, 12-2t-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a period oi 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 Inepectione antl final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permit: �
FOR INSPECTIONS CALL: (714) 7545626 �
2dlWB (�)
WORKERS'COMPENSATON DECLARAnON: � �
I hereby aNirm under panalry of perjury one ol the lollowing tleclaretions:
❑ 1 have end will maintein e cenificate ot cansent to selbinsure tor warkers' compensation, es provided for by section 3700 0l tha Lebor Cotle, tor t�e pedormance of Ne
work tor which thls pertnii is issuetl. �
❑ I have and will maintain workers' oompensatlm insurence, es requlred by sectbn 3700 of che Lehor Catla, tor lhe peAortnence oi tha wwk tor whirli this pertnit is issued.
My workers' wmpensation Insurante cerder entl poliry number are:
Cerrier: Policy Number.
(Tbis sec0on need no( be completed /l fhe pemut (s vsluetl et one hunEred dW/ars (5100) oi less.)
'� I tertily thei In the peAormance ot t�e work for rhich this permit is IuueA, I shell not empla/ eny person in eny manner so es to 6ecome subjed to tha workers'
compensetlon laws ot Call ia, entl egree th 1 if I shoultl 6ecome sub�ect to Ihe workera' compensation provlslons ol Section 3700 0l the Lebor Cotle, I shell torthwith
comply with these vis' �
AppllcaN Slgnature: Deta: �I �— I�— ��
WFRNINO:FAILURETOSECUR W RKERS'COMPEISTIONCOVEM�EISUMAWRILANDSHALLSU91ECiANEMPLOYERTOGRIMINnI.PENALTIESANDGVILFlNESUPTOONEHUNDRED
TMOUSRND DOLLARE (5100,000) IN ON TO TH OF COMPENSATION, DMNGES AS PfiONDED FOR IN SECTION �OB OF THE IABOR CODE, INTERESi, AND ATfORNEYS FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby eMirtn that I em IicenseA un r p ' k
lorce ena enea. uc. a
Conirectors SlgneNra: —
wiih Sectlon 7000) at Division 3 of Ihe Business �Protessions Code, and my license Is in fu0
Class a
� Date: In - ^ O3
CONSTRUCTION LENDINO'AGENCY: V
❑ I hereby aHirtn Ihat there Is e constnxtion lending egency lor the peAormance ol ihe work br which this pertnii is issuetl. (Sec. 3097, Civil Code).
Lenders Name: Lendefs Address:
SlgnaNre:
OWNER-BUILDER DECLARA710NS:
Date:
I hereby aflirm ihat untler penelry ot perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW br ihe lollowing reeson (Sac. 7037.5, Busineu flntl Professions
Cotle: Any ciry or county whic� reQuires e permit to construct, elter, improvo, tlomolis�, or repair eny strucWre, prior to i�s Issuence, also requires the applican� for such permit
to file e signetl stetement that he or she U Ilcensed pursuam ro the pmWsions of t�e Conireccors License Lew (C�epter 9(commendng with Section 7000) af Division 3 of the
Business and Prolessions Code) or thet he ar she is exempt Uerelrom and Ihe basis for the allegetl exemptlon. Any violation of Seciion 7037.5 by any appliwnt for e pertnit
suDjects the applicant to a cidl penalry ol not more Ihen live hundretl Aollars ($500).):
❑ I, as owner ot Ihe propeny, or my employees wlih weges as Iheir sole wmpensation, WILI DO THE WORK, entl the structure is not Intended or oHeretl for sale (Sec.
7044, Busineu and Professions Cade: The Contractore IJcense Lew tloes not eppty �o an owner oi property who builds or improves thereon, anO who does such work
himselt or herselt ar through his ar her own employees, provided Ihet such impmvements are not Intended ar oHeretl lor sale. It, however, the building or impwvement is
sold within one year of completion, Ihe owner-builtler will heve the burtlen ot Droving Ihe� he or she did not buiid or improve for purpose of saleJ. �
❑ I, as owner of Ihe properry, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cotle: The contractors License Law does no� apply to en owner ol property who Duiltls or Improves iheraon. entl who contracis for such proiect wiih a contractor(s)
licen5e pursuanl to Ihe Contractors Licensa Lews.).
❑ I em exempt under sec. Business antl Professions Code lor Ihis reeson:
Signature: Date:
Ownor ID verifietl by advels license. ❑ Ves ❑ No Dr'rvefs License No.
Verilicatlon ot Ownership by pype oi tlocument, I,e. - properry tax bill or deea):
Expires:
DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATON:
❑ I hereby certity that no exwvetlon flve (5) or more leet In Eepih Into which e person is required to dascend, will te matle in connectlon wiih work euNonzed by Ihis
permit, end thet no building structure, scalloltling, lalsework, or demolllion or dismentling thereol, will ba more than thirty-siz (36) leet hig�. (ChaD� 32, Grp 2, Art 2, Sec.
341, Ti�le B, Celifomie Atlminisirative Cotle).
❑ As awnar-builder, I wiil not employ anyone to do work which would requlre e permlt twm Iha Division ot Indusirial Selely, es noted ebove, unless suc� pereon �as e
permit to tlo suc� wark trom the division.
Signature: Date:
Division of Induslrial Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOROA710N OF ENTAY: t cenity under penalry ol perjury that I have reatl this epplicetion and state that Ne infortnation given is
correct. I egree to comply with ell state laws end dry ortllnances relating m building consWction, antl eut�onze represematives ol the qry ot Costa Mesa to enter upon ihe
ebovetloscribed property tor inspectjeq purposes. I egree not to occupy or allov.• occupency ot eny building authorized by this permil until final inspectian.
COpE I. INSGECTIONTVPE v
1616 Fiaetl System Final Fire Preventlon
1268 Pool Spe Final
200 Finel Ro-Roaf
201 Finel BIxWRotaining Well
202 Final Fectory Fire Plece
203 Final Sign
204 Finel Demolitlan
(0�14-��
Date
Q� �$ f�Qj�j INSPELTIONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel Elecldcal
212 Pinel Fire Preventlon
220 Final Plenning Approvel
222 Final Site
250 Final Building/Occupency
� � w♦„�� .
� \ ♦
OWNER PF.RRY\ T._ R' � vT / DATE �_�n_CC - ��
ADDR
BUILDING PERMIT NO.
GFNERALCONTRACTOR �,mpp�$��q��qp VAWE $ 9'jEj,QQ
Lti Y Q91 BLOCK TRACT 17� � $nCI.OSP C3I'�OI't
GRCUP Z RL J TVPE V ZONE R�. FIRE DISTRICT �S7(i
PERMITSISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE I NUMBER �
Footing Trench
Foundation Formsand Gradeto
Rough Framing _
�
Heating, Final'
Sewer, House Sewen
A 'c Tank or Cesspool
L �ng, In Out
Plastering
Plumbing, Final, Fixtures Corr
Plumbing. Fin�al GasTest
Wiring, Final
Occupancy
—v,.�..�in.r c�_icnn.i_��_
l C3�st� Mesa Bnilding Department APPLICATION FOR PERMIT
111 EAST 20th STREET ���` g U I L D i N G '
� COSTA MESA� CALIFORNIA
�'Ogt OFFICE USE ONLY
FOR APPLICANT TO FILL IN Recelpt No. Permlt No.
Bu�Iding /S 6 /
Address Q
Costa Mesa, California Receiv by Date Rec'd. Date Issued
Nearest �l� �' J` �
CrossSt 0 Building
Address
Owner � Costa Mesa, California
Mail
Address W O Nearest
n' Tel. Cross St.
C��Y CO.�"i"i% /1I�•5%] No.,Li .�ab4a Zone I No.of I Typc Groyp.
Arohitect or Lic. Plana
Engineer No. Approved
b Date
Address ' COYLREC'1`IONS
� City Llo.�
ContracMr ��Gfnrtf./z�/hQ��,No:
�
Address
De cr pHon I No. � 7� I Blxk � Trac�t /��
(Attach Metesand Bounds)
/ � i No. of Bldgs
SizeaiLot (�6 x��Q I Nowon Lot /
UseoT � No.of ' No.of
Existing Bldg. NQ �JS E I Famlllas I Rooma S
Setback Lfne from Rear Vard 1,�
Center of Street �X Side Vard /�
DESCRIPTION OF WORH
New I I Alteration I Addition I�
Repair I I�Moving I I Demolish I
Bullding `� �� No. of /
Size 7jr�r � Rooms � Stnries
cover�ng I coveriny E APPROVAI.S
Use of New
Building ,�' d Foundation Lxation Inspector Date
Forms, Materials,
Q Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
I hereby acknowledge at I have read tlils Applicatlon
and state that the above is correct and agree to comply �ath. Int
with all City Ordinances e Laws regulating �
bullding construCtio . Lath. Ext
Signature
Permittee � Plaster, Int
Authorized Agt. Plaster, Ext
Valuation� �� D� Pernfit Fee $ •� Masonry Reinforeed
� Plan Check $ /. O � gond Beam
$ Total . B
Fee O FINAL
FnRM 204 S-SP 2M 6-65 � f/�� B �
�1
PLOT PLAN
ShoW location and distances from �
property line and between buildings
Y �)
r ,,`
nI�?rl•°]SP�COSTA7�pa t.�.y�r.��ln�
0
OWNER WILLIAMS, L. Kay DATE
1
L
� WRTER
�, ROUGN PLUMBING
PROP. SWR. LINE Q MOUSE_COM.
�SPRINNIING SYSTEM
MISCELLANEOUS
ROUGH MERTING ANO �IP CONDITI
SVSTEM
ME FNO FLASHING
IING - IN � f
TER. BfiOWN COAT
BUILOING, FINRL I /QL I��1�
SUBCONTRACTOR
PE
,ti . 't G
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applican[ to Fill in Completely — Use Ink Only
AODFESS "J�( �� c(J�(/%)y-(�.
r�--
�// ��y(' �/ J
OWNER CY /l�i/ L�/�� r.� � -.r
ADDWESS ry :i -y /il
� �//�� � TEL./,,� �
CITV �MAA_ fJ7//i/. . �Ol NO•/lW
ITECT ' TEL.
PA�p {.;; � �li-�
�r,i -4-�F�d-=.00 158" ,b.SC
APPLICA7lON �OR STRUCTURAL PERMIT
A.P. NO.
BUILDING
ADDRESS
ED
VALUE
AODPESS
TEL. Z�N NO.OF USE OF NE
CITV NO, — P✓�� BUILDING
F STATE CITY �'AROS APPROV ED YARDS API
I.. UC. N�. LIC. NO. MAIN BUI�DING ACCESSORV
R' (FROM C/L STREET)
{i] SIZE NO.OF BLDGS
�. OF LOT NOW ON LOT RONT FT. F
a USE OF
^ EXISfING BLDG. -�,
F� � �
Separate permi[s are required for L SIDE Fr.
� electric, plumbing and heating work. REAa FT. F
� VSE OF BUILDING AND WORK TO BE PERFORMED
F OISTANCE BEf. BEf. MAIN &
Q� , MAIN BLDGS. ACCESS. BLOG
/ � �'/ VAR.�W DATE
', - i T C.U.P.yp APPqOVED
� �� APPROVED /�'
}
..1
CX
W
� I harabV ecknowlatlBa that I heve raatl thia applleation end stata
a thnt tne abova Informotion is cor�act antl epree to comply with
d all IaWs rapulatlnp builtlinB conrtructlon, antl 1 ihnll not employ
Z any pe�con In violetlon of sha workmen's componteNon laws ot
� tho Stata af Californle.
3 I herabV canify t�at I em properly IlcanmE as a conttactor �ntler � S�. FT.
tha Stete oi Callfornla Butlness antl Profenlons Coda, Dlvision 3, TNE AMOUNT SHOWN UNDER VALUA
Chopmr 9, end thet such Ilcanwa ara In lull foree entl effect, or 1 TME PURPOSE OF ESTABLISMING A PERMI
nm exempt from the provlslons of the Smta o(Calffornle Businau VA�VATION pERMIT FEE S
and PrO�essiona Cotla, Divifio� 3, Cheptar 9.
� �/ PLAN CHECK E
SIO�eN�a oi �f^ ���g-�,
ParmlHae �C ,��?2L 5 •✓ V 4, TAx E
Authof��atl ABa^t TOTAL PAID E
n
m
i
m
N
IS FOR m
ONLV: —
b
�� V '
�
� �, m
n
— o
.5�t+ f
u
OeANGE COUNTY BUILDING DEPARTMENT
., 1 636 North Broadway , . .
SANTA ANA, CALIFORNIA
FOR APPlICANT TO FILL IN
SCHOOL DIST. COBYiA Meea
OR TOWN
NEAREST
�Rass ST. Monrovia St.
OWNER CHOCTAW HOIIES� �NC.
nooRe559�6� WILSMINE BLVD.
cirv BEVERLY HILlS No� CF.
enRicia��e ri.Al�! S� MCKERRACMER Ncei�' SY.
ADOftE55
nooAess9363 w,�sH�aE BIVD.� @EV.yILLS
LEGAL np 7 o
DESCRIPTION LOT NO. G7� . BLOCK � f� G
IATTACH METES @ BOUND51
TRACT
SIZE OF LOT
66 iI � � � I NOW ON LOTg O
USE OF I NO. OF I NO. OF
EXISTING BLDG. F�v.iu[g ROOMS
DESCRIPTION OF WORK
NFW I X I e,TCOeTI„u I I wnn,_,,,u I
�
WALL STUCCO I R�aF
COVERING COVE
USE OF NEW RESIDENCE
BUILDING _ At�
I HEREBV ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
ANO STATE LAWS REGULATING BUIIDING CONSTRUCTION.
SIGNATURE OF �NF�ORT VI STA C
PERMITTE
AUTHORIZED AG n • -� ' � - � —
b 48j0.00
VALUATION
��
APPLICATION FOR PERMIT �
B V������ � � � -
.FOR OFPICE USE ONLY
RECEIPT NO. PERMIT NO.
� 3 SL� Si BS S
BV DATE OF APPL. DATE 1554ED
�/� y � NOV 5 1953
UILDING
DDRE55
�Hoo� oisT.
P. c, s ]� � MA50
Fee /t� —
s BOND
FEE I L � FINAL
CORRECTIONS
RIALS,
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