HomeMy WebLinkAbout953 DOGWOOD ST - Building PermitsAOD���ant to fill in all spaees exceo� those within heavY Eoraer Ilnes ana si9n a11 aoVroDriate aeclarations.
PERQ015! NIl. _ ., TRACT, NO. LOT NO. UNIT NO.
CiTY 6F'cOS7A S ONSTRUCT ON PERMIT
Project Address }
Applicant'sMailing�l{ldrecs/��/ 9 �
Owner's Name ���(/o/ Phone /
Address ��P'� l �
Arch/Eng. License No.
Address
Contracror's Nam one
Addresslmailingl ' /�
Ciry Licen N P3l��'�
LICENSED CONTRACTOR DECLARATION
I hereby a/firm that I am Iicensetl untle� O�ovi5ion5 of Charle� 9(commencin9
witn section ]000) o/ Divlsion 3 of the Business antl Professions Cotle, antl
my license is in fu ana eftect. �
LlcenSe CI �Ce No. �' �S �7
Date Signature
WORK 5' C MPENSATION DECLARATION
iereby aftirm that I have a cerN/icate of con5ent to setl-insure or a certificate
Worker5' CompensaHon InSurance, or a certili¢tl CO y thereof (Section
'800. `�° �9/93� �' Company
Policy No. �
ertitie0 copy is h¢reby IumlSM1etl.
CerP i c qfn'letl with the tlty BTII✓'
DaIC * APPlicant (�
E%EMP ION ROM W00.KER5' COMPENSATION DECLHRATION
(This se tion nee0 not be comple[etl If tlte permit is for one huntlretl (EI00) or
lessj.
1 certity thal in the pe�lormanGe Ot the wo�k for whith thiz pCrm�t is issuetl, I
shall mt emo�oY any person In any manner so as to become subject to the
WOrkers' Compensation Laws oi California.
Dale Signatura
NOTICE: If, after-makin9 ihis tleclaration, you shoultl become subject to the
Workers' Compensation provisions of lhe Labor Cotle, you must fortnwith
comply witM1 such provisions o� IhiS permlt shall be tleemetl rewketl.
CONSTRUCTION �ENDING AGENCV '
I hereby affirm that [here is a construttion lentling agency for the performance
of lhe work for which this perml[ is issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILOER �ECLARATION
I hereby affirm that I dm oxempt irom Ne Contractor's LI<ense Law for the
fo�lowing reason (Sec[ion 7031.5 Buslne55 antl Professlonal Cotle: Any ciry or
County wniCh r¢qui�es a p¢rmlt lo con5[ruct, alter, improve, tlemoli5h o� re0air
any sVucture, prlor to Its Issuanco, also requires the applicant for such permit
lo file a si9netl 5[atemenl thdt he/sbe IS licensetl pu�suant [o [he.p�ovizions of
Ihe Contractor'S LicenSe Law (Chap[er 9(comm¢ntlng wlth $ection ]000) ot
livlsion 3 of tM1e Busin¢Ss antl Prof¢sslons Cotle) Or that he/she iz exem0�
ierefrom antl the basis for the allegetl exemption. Any violation ot Section
i031.5 by any applicant t0/ a pe�mit subjects Ih¢ appllcant Lo a civil
�� �enalty of not more than five huntlretl tlollars ($500).
I, as owner of tM1e properly or my employees wlth wages as their sole
'. compensation, will tlo the work, ana ihe structure is not Intendetl or ofteretl
Ifor sale (Section ]044, Business antl Professional Cotle: The Contractor's
License l.aw tloes not apPb to an owner ot a property wbo builtls or improves
tbereon, ana who tloes such work nimself/hersetl or tnrough his or her own
employees, O�ovitletl Ibal sucM1 improvemenls are no[ intentleC or otteretl for
sale. II, however, tne bull01n9 or improvement is soltl within one year of com-
O�etion, the owner will have lhe bu�tlen Of proving h¢/Sne tlitl not builtl o� im-
�rove tor the pur0ose of zale).
I, as owner of the properry, am exclusively contractin9 wilh licensetl con-
tractorsto construct tM1e project (Section ]044, Business antl Professions Cotle:
The ConVactor's License Law tloes not apply to an owner oi property who
builtls or improves [hereon, antl who contracts to� suGh OrOjetts witb a con-
traclor�51 Imense pursuant to lhe CoM�ac[o�'S License Law). 1 am aware fhat
proof o( [heir Worker's COmpenSatlon insuranC¢ zhoultl be provitletl to me.
❑ I am exempt untler Seclion B. & P. C. lor this rea5on
Oate Owner
I h¢reby tertify that I have reai
information is correcL 1 aqree to
and state laws relating to builtlin
sentatives of ihis city to enter
inspettion purye5D5. A//� /ff
state that the above
TYPE OF CONSTRUCTION LJ NEW LJ AD� LJ ALTERATION LYREPAI R
❑ CONVERSION ❑ �EMOLISH ❑ OTHER q p �t
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TYPE OF PERMIT GRADIrvG OUNDA710rv STRVGTURFL T Front
❑ TENANT ❑ ELECTRICAI PLUMBING ❑ MECHANICAL A Reaf
❑ OTHER
PROJECT DESCRIPTION SQ.FT. OCCUPANCV C Right
K Left
CONSTRUCTION TYPE VALUATION 3 $
ZONE GRADING CU. VUS. ACRE$ P��9, R¢f. #
Remarks: Planning Notes:
Preventer
Irrigation
Dishwdsher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspec[ion Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ Multiple
Firepl/Fact.6lt. ICBO �1`-
Heating System & Ducting
❑0.100,000 BTU 0100,000
Drivers' License or 55 � —�---- I I Reinspection Fee I $15
CMF OB65-46, rev. 10/84 Whito - Builtling; Canary - Applicanh, Pink - Accountin9: Goltlenrotl - Assessor
$hOWEfi
Service Sink
Sewer Cap
Sewer Connection
Solar CollectOrs
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto�Wash
Issue Fea I $ 3
Automatic Washer
Consvuction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generamr �US KW �5-15
Zone
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL
Transformer � 15-50 KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over 100amps
Sub Panel
Morors DO-1 HP 01 %- 8
Inc.Solar �9-15 HP �16-75+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
� Reinspection Fee ' $15 Issue Fee
IANICAL FEES
ypcl ❑ DEVELOPMENTSERVICESREdUIREMENTS:
Hood or T 2oning Approved By
Canopy Type II ❑
Building Approved 8y
Fiefrigeration Sys[em
Oaioo,000aTu ❑ioo,000
System Repair/Alteretion
Fire Dampers
Registers
laue Fea
$ 3
FEES
$ 3
� SUMMARVDF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ � �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING S
PLANCHECK 50°,6 $ MICROFILM $ r
MECHANICAL $ TOTALFEE $ c"� �
PLAN CHECK 25% $
Z
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N
I
N
G
R
E
�
M
T
$
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit�# Date Inspector p�ppROVALS Permit# Date Inspector
9
1. Temporary��ectrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Condui[ Utility�Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 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, O Undrgrnd., Test.
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK -��
};�
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Finat7
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final �
75. 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 �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathin9 74. Overhead Hydro
26. T-Bar Ceiling (Svuctural) & 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. REQUIRENIENT ��
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 � ' r'
i •
37. Final Factory Fireplace � � ' �
38. Final Plumbing Gl��,.a'� L��� , �' , � '
39. Water Service-Final � �:� '
� 40. Gas Service-Final , _ , .,j �
• 41. Solar pomestic-Final ' • A . •
42. Backflow Preventer ' . -
• ' n
� 43. Backflow Irrigation '� � � !'J
. ✓ c
44. Landscape Irrigation System � ' • +tf
� �
45. Sound Attenuation � - • , �
46. Handicap Regulations - ' , . ty�
47. FINALSTRUCTURE&BUILDING - � �
i
48. Special RequirementsCompleted � •. , e -
49. Electric Release to Edison •
� ,�
50. Gas Release to Southern California Gas Co ��,
51. CERTIFICATE OF OCCUPANCY � �
No. Date ,
� -� �
_ .��
C�
(�-L
AO��icant �o fill in,all sDaces excepti�hose within neavY OorCer lines antl sign all apOroOriate pecla�ations.
CI�T�1� CnF COSTA ESA C TRUCTION PERMIT PERMJ,TiNQ_ __ _ � TFACT NO. LOT NO. UNIT NU.
' PrCject Address � ��/� I li -
�ApplicanYsMailing1A.dIdpres�s �`.1� Te Q�irnSZ '�%!�
Owner's Name —W-�-��=-� Phone b�lr�s�
Address ����
Arch/Eng. �icense No.
Address
�
Contracmr's Nam Phone � -
Addresslmailingl_ r .�� #
City License No.
LICENSED CONTRHCTOR DE LHqqT10
I h¢reby attitm thal I am lic¢nsetl untler provi51on5 oi Charter 9(commencinq
with secfion ]000) of Divfs(on 3 of the Business antl Profess(ons Cotle, antl
my license is in /ull orc C eftect. �%a �OJ
Licenz las LiGenso No. L�
Dat¢ ' . Signatur
WORKERS' COMPENSATION D C�ARATION
I hereby at(irm that I have a certificate of consen to �:H-Insure or a certHicate
o/ Workers' Ciompensation Insurancc, or a certi ' copy thereof (Se<tion
3000, Lab.�5r.3�1d--`-g-p-� �[2✓ Q ��'%�^'1N..�.r
Policy No. Company
Certitietl copy is hereby fumisbetl, �� �
ert"(ietl p Is �1 with the city B il i IvlSion.
ate APPlican
EXEMP ION FROM WORKERS' C SATIO LARATION
(This seclion neetl not Ee compleletl If [he p¢rmit Is o� O e nuntlretl (E100� o�
less).
I ce�tity tha[ in the petformant¢ Of the wo�k tOr whicn this pe�m�t i5 izsuetl, I
snall not employ any Oerson in any manner so as [o become SUDject to the
Workers' Compensation Laws ot CalifOmia.
Date Si9nature
NOTICE: N, after makln9 this tleclarg(�on, you shoultl become subject to the
Workers' Compensalion provi5ions Of lhe Labor Cotle, you mu5t /Orthwl[h
comply with such prOvizions or this pe�mit shall be tleemetl �evoketl.
CON57RUCTION LENDING AGENCY
1 herety afti�m lhdt there is a con5tructlon lentling ag¢ncy for [he performance
of [he work ror wbich thi5 PerMi( is i52uetl (Section 309� Civ. C.)
Lentler'S Name
Lentler's Atltlress
OWNERBUILDEN bECLARATION
I hereby aftirm that I am exempt irpm Ihe Contractor's Llcense Law for the
following reason (Sectlon 7031.5 BUsiness antl Prote55ional Cotle: Any cily or
county which requi�¢s a p¢rml[ to cbns[�ucQ alt¢r, ImprOve, tlemolish Or �e0alr
any structure, prlor to itz issuance, also requires the applicant tor such permi[
to file a zignetl SldteTen[ [Ilal he/sh¢ i5 IlcenSftl pulsuant to tM1¢ PloviSiDns of
tne Gontractor's License Law (Chapter 9(commencing with Section ]000) o(
Division 3 of lhe Business antl Prof¢ssions COtlC) o� lhal he/she i5 exempl
therefrom antl the basis tor tM1e alloqetl exemptlon. Any violation oi Seclion
' 7031.5 by any applicant for a Permi[ subjects [Ito applicant to a civil
�enalty of not more [han five hunGrCtl tlolla�s (5500).
I, as owner of tM1e property or my employees with wages as thoir sole
Compensation, will do the work, antl Ihe st�uciure is nol Intendetl or ofteretl
for sale (Section �044, Business antl Professional Cotle: The Contractor's
License Law tloes not apply ro an owner ot a p�oper[y who builtls or Improves
lhereon, antl wM10 tloes such work himself/h¢rz¢H o� ihrou9h his or hCr own
e.mn�oyees, proviaetl tnat such improvements are not intentlea or ofteretl for
sale. If, however, Ibe builtling or improvement Is Soltl wilhin one yea� of cOm-
pletlon, tne owner will have lhe burtlen of provin9 ne/she tlid not bulltl or im-
�ove for Ihe purpose ot sale).
I, a5 owne� of [he property, am exclusively contracting with liconsetl wn-
tractorsto con5[ruct th¢ projecl (SeCtion 7044, Business antl Profe55ion5 Code:
The ConlractoYs License Law doe9 not apply to an owner of property who
builtls or improves lhereon, antl wpo coniracts fo� such piolecls with a con-
t�actor(s) I¢ense pursuant to lhe COnlractor's License Law). I am aware that
proot of tM1eir WorkeYs Compensa(ion insu�anc¢ shoultl be O�ovltletl to me.
❑ I am exemDt untler Settion B. & P. C. for this r¢ason
Date owner �
I hereby certi(y that I have read Ihis
information is mneCt. I a9ree to comp
antl state laws relating to builtlin9 con
sentatives oi th15 city to enler uppr
ins0eclion pur se . �
$igndtu/e
Drivers' L� e se S�
IF 0865-46, rev. 30/84 WM1it � Iltlin
] state that tha above
antl county ortlinances
iereby authorize repre-
!ntlonetl Property lor
TYPE OF CONSTRUCTION LJ rvEW LJ aoD LJ ALTERATION lJI'nEPAi R
❑ CONVERSION ❑ DEMOLISH ❑ OT R A p #
DESCRIPTI N OF WORK/ S OF BLDG. �
�f_� (' �P �,G4'G �1'Qih y O� S Main Bu
TVPEOFPERMIT GRAOING FOUNDATION RVCTURAL T Front
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL A Rear
❑ OTHER
PR0.IECT DESCRIPTION SQ. FT. OCCUPAN2CV qqq C Ri9ht
CONSTRUGTION TVPE VALUATION $_._J �� g �ef�
ZONE GRADING CV. VDS. ACRES p��y, Ref. �k
Remarks: Planning No
Bar $ink
Backflow Preventer
Backflow Irrigation
rinking Fountains
loor Drains
loor Sinks
25�2fVICQ QUI�CLS
Kitchen Sink
Lavarories
P-Trap
Roof Drains
ReinspeMion Fea
Boiler
Duct � Under Ground
Duct - Strucmral
$15
Exhaust System ❑ Multiple
Firepl/fact. Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU �100,000
Reinspection Fee
Canary - Applicanh Pink - ACCoun[ing; GoltlenrOtl - A55¢s5o�
$15
P
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
FEES
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage DisUosal
Generaror �0-5 KW C
9823 5/03/e'.
Zone
Parking Req./Provided
ELEC7RICAL
Trans(ormer ❑ 15-50 KW
❑ 50+KW
Meler �up m 100 amps
Meter ❑over700amps
Sub Panel
Motors �0-1 HP �i %� 8
Inc.Solar 09-15 HP 016-15+
Microwave '
Pole Light
Range
Standing Sections
5 KW Trash Compactor
Reinspection Fee $15 Issue Fee
�ANICAL FEES
Hoodor T DEVELOPMENTSERVICESRE�UIREMENTS:
VPeI ❑ Zoning APVrovetl By
Canopy Type I I ❑
_ Building Approved By y�Y
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
System Repair/Alteration
Fire Dampers
Registers
Issue Fee � S 3
��o�J� ��
�t.
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUMMA V OF FEES �/�
BUILDINGPERMIT $ i���0 SMIP $ �� `�
PLAN CHECK 5 PERMIT
PLUMBING $ ISSUANCE 5
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL S TOTAL FEE $ ��
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Sieel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 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, O Undrgrnd., Test
i . i'
9. Water Pipe-Undrgrnd'. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 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
i 6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL i I
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 O Gas ❑ Oil � �•�
23. Gas Pipe-Rough & Test 72. Underground Flush '
;���
24. Roof Framing 73. Undergrnd.StoregeTank OGas ❑Oil •�
25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,
27. Frame and Flashing ' 76. Dry Standpipe . � 4
28. Lathing & Siding 77. FIXED SYSTEM FINAL -
29. Insulation 78. FIRE PREV. FINAL .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT x
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 -- .
. . , i'
, � 37. Final Factory Fireplace . � ` ' • "
"38. Final Plumbing � �- '. �
' 39. Water Service-Final � � �. '
i �
� 40. Gas Service-Final , � �-
41. Solar pomes[icFinal � ' , �, I 1
� 42. Backflow Preventer � '
. ., .
43. Backflow Irrigation .`� � , ; . ;
44. Landscape Irriqation System ' � • ' ` � . �
i
45. Sound Attenuation �- . ,. ; � � i, �
I
46. Handicap Regulations � . i �
47. FINALSTRUCTURE&BUILDING �D �� ' � ' �
48� Special Requirements Completed . ' ' '
'49. Electric Release to Edison � ' " � `
50. Gas Release to Southern California Gas Co - j' ��,
51. CERTIFICATE OF OCCUPANCY �
No. Date � �" �
- \ •
,` \
OWNER HpY. LEIIp
JOB ADDRESS q5� Dc
GFNERAL CONTRACTOR
'� �� 115-492-11
IN�PECTIONS
SOIL
GAS
WATER
ROUGH PLUMBING
PPOP. SWR. LINE � MOUSE (
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND FIR CON
TEMPORARY SERVICE OH,POL
UN�ERGPOUNO � POWER�
IiOUGH WIRING
TRENCHES FORMS
FLOOR SVSTEM
BOND BEAM ❑ STEEL RE
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT r
P� 'ER, BROWN COAT
5 fURAL, FINAL
HEATING, VENT., REFHIG. ANI
PLUMBING, FINAL AND GAS TI
ELECTRIC, FINAL
BUILDING. FINAL
REINF.
A.C.. FINAL
DATE
)UP J TYPE
SUBCONTRACTOR
ERMIT N0.
^ E '� �� 28766
� COSTA MESA BUILDINCrSAFE7Y DEPARTMENT
P.O. BOX 1200 COSTA ME.4A. CALIFORNIA 9262E
For ApppcaM to Fql In Comple»ly
TYPE OR PRINT
COSTA
6£TBACK LINE PROM
CALIFORNIA
O� . I NO. O! OLO00.
N�W GN 1 AT
DE56RIPT{ON OF WORK
WALL
1 X6IlGpY ACKN WLiDO[ TIAT.1 NAV6 M�AO TNIO I1P�LIGTION
/�NG HT�T6 iNA �i}�6 weOv[.�e COMR6CT ANO AOp6[ TO COY.
Plr WITH wLL TY OpDINANCB� AND RAi[ I,AYW p{OYLATINO
6UILDINO CON RIONa� T
� AUTNORIZiD AO[NT
1p126-6��2218' ��*�***6.(i0
p. q��
[
MPLICATION FOR PERMR L
BUILDINfi
For ONIu U» Only
eccnrt no. �eair Ho.
ZONING
c xo. or uaa o� Nnv
_ � �uxs1/ euitoixa
A. P. NO. I� S ��F 9 oL ��
NOTE: NO BAVH OVERHANO BXALL Bfi Ll88 THAN
YARD9 MPROVED
MAIN BUILDINO
vwn. #
�!
YARD9APPROVHD
ACCE&SORY BIIILDIN6
DATB
TX6 I�MOYM BXOWN UMO[R VI�LUI�TOH 19 POq T1@
PURP09[ 0/ �dlABYOMINO A P6pMiT P88 ONLY.
VALUATION �
PERMIT FE6
�� �_
O
/ c _i
OWNER jjAY, WI�i. G. � DATE 1�--26-7r�1
JOBADDRE88 95'i Doewood Street BUILDINGPERMITNO. %35
GENERALCONTRACTOR Owner-Builder VALUE $ �.�32�.0�
��. 297 e�ocK TRACT 1712 Living Rm. ,Inclosed Carport
GROUP I TVPE V ZONE Rl FIRE DISTRICT %LIC�
INSPECTIONS DATE SUBCONTRACTOR I PERMITSISSUED
DATE NUMBER
FootingTrench �' � - �4i-
Faundallon Forme and Grade.to Ganae
Plumbing, Rough to Slab
Plumbing, Rough Comple
Temporary Pole
Wiring, Rough
Heating, Rough
. Heatinp, Final
Sewer
S•-- "c Tank or Cesspool
L ng
Plastering
Plumbing, Final, Fiutures
Plumbing, Fi�l Gas Test
Wiring, Final
Occupancy
N'orm '1I0 G-H lAt 1&68
i••"-I�
Costa Mesa Building Department ��APPLIpCATION FOR PERIVIIT
. S' t" 111 EAST 20th STREET p U I L D��� N G 9
�'..� COSTA MESA, CALIFORNIA
OR OY�`Y'ICE USE ONLY '
FOR APPLICANT TO FILI. IN rtece�Pt o. Permit No.
Building � � I �1� �
Address �l
osta. Mesa, ' ornia �ReceWed y '!a Rec' Date Issue�
Nearest ��G�� . a6 - //_a��
Crou 3t. Building `r � ' /
Address S � � (�.�a d
Owner COSii3� M0 � B,�OTllla.
Mail n � � �
Address 7 Nearest A , .
■ Contractor
■ Size of Lot
New
Repair
Buflding
rty Lic.
�MD/7l ��/.
Lot
No. �� 81ock Tract/�
and Bounda)
r�/VVV No. of Bldga
�p NbW on Lot �
INo.of No.o1
Families oomi
om - Rear Vard
[ Sfde Vard
CR ON OF WORH
IAlteratlon I I Addition
IMoving I I Demoflsh I
No. ot
X � � Rooms Stories
� aor
overing�
. � _ .
���`� ,�� _ .
I hereby acknowledge that I have read Uvs Application
and state that the above is crorrect and a ee to comply
with all City Ordinances and State ws regulating
building const ctio .
Signature of
Permittee �
Authorized Agt.
Valuation Permit�Fee $
$ �� n /7 / Plan Cheek $ � O
o�'
Total
Fee S Q. D �
1 FONM 204 �-X 2M 3-54 ,
!j ! � Plans
Approved
.
APPROVALS '
Faund'ation Loeation ^ •i Inspectoc , ,. .. Da1
- Forms, Materials. ' "
�Under-Pinning
Freme: Firo Stops,�' • � � � .
Braeing, Bolts �
Lath.'Int: � �' '. . � •, � � ,
.i.*:i i ; ,.,-��C'' : 1.
Lath. Ext. �
Plaster, Int �- �
Plaster, ExL
Mawnry Reinforced
Bond Beam
FINAL � ���'—
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'��_,I.�PLOTPLAN _ _ ._. .. _ _i "_ _
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Show locatlon and distances �from . . • " �
� property line and between buildings. , ,_ � • �
, � �- .. � . , - .
� Do You carry:Workman's-Compensation ,,,�, �
Insurance4� . � Yes �... ,�N��,:.�
I am avra�e of Provision 3700�q"f the State �"'
I,abor Code which requires every employer
to be insured against liabil ty for -. - - -- - -
� workman's gnsa�ion. ..; '' . ,
-7�
Si�ue.d.: -
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.(�tAY�IGf COU�N6 N B h IB D aNG DEPARTMENT APPLICATION FOR PERMIT �
- � �ti SANTA ANA, CALIFORNIA � � I � D � � �
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
AooREss 953 Dogwood 3t. 3��� .j /� b�
SCHOOL DIST. COBtB Meea RECEIVED BY �ATE OF APPL. D/TE ISSIiED
OR TOWN
�aoss sT. Re ublio Ave. �. ���1—a� NOV 5 1953
OWNER [HflfTAV HOMEC INf_ ADORE55 ���__ ___
MAIL 9363 W,�sH�Re�BLYD, SCHOOLDIST. Q_ _/�
ADDRE55 pR TOWN L�j�d�7"'0.�
BEVERIY ILLS TEL. R• 5�6� NEAREST /E�f��i�G✓G�C.�-ai
QTY NO. CROSS 5T.
ARCHITECT,.pf� TEL. ZONE O F TV�Pi.�� GROUP
ENGINEERl.A1N B� MCKERRACHER NO. SY�6489� AA� I'PLANS I ��/ I /�..T
� ��� i�
nooRess 2j�O E, WALNUT ST PASAOENA � �
SETBACK LINE F CENTER OF ST.
TEL. 1. / REAR YARD � SIDE YARD �Q ��_ _
CONTRACTOR NEWPORT VISTA CO.NO. CR��430� qppROVE //_�-�
BV ' DATE
nooaess 9 63 WIlSH�RE B�VD.� BEV.HILL4 �
LEGAL n CORRECTIONS .�
OFSC.RIPTI[]N I I OT NO 2Y7 RI OGK � 7� 2 f
ATTACH METES @ BOUNDSI
NO. OF
�G. FRNILIES
DESCRIPTION OF WORK
I X I ALTERATION I I A�
BUILDI
SIZE
USE OF NEW
BUILDING
C
I HEREBY ACKNOWLE'JGE THAT I HAVE READ THIS
APPLICATION ANO STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITM ALL COUNTV ORDINANCES
AND STATE LAWS REGULATING BUILDING CONSTftUCTION.
SIGNATURE OF
PERMITTE
AUTHORIZE� AGp/l,_
VALUATION
��
5 �+u3o.00 P. �. : i —
FEE /(F -
f
FEE I�'
APPROVALS
f10N: LOGATION INSPEC'
M5, MATERIALS, /J ,p�
ER-PINNING �(� r7
FIRE STOPS. J1' r
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