HomeMy WebLinkAbout998 EL CAMINO DR - Building PermitsCITY OF COSTA MESA
� � �°"'s, BUILDING DIVISION
��� 77 FAIR DRNE. COSTA MESA. CA 92626 •(714) 754-5273 • Faz p14) 754-4856 • www.Ci.costa-mesa.ca.us �
� g FOR INSPECTIONS CALL: (714) 754-5626
°''or,o.ana�✓�'
PERMIT NUMBER: E11-00040
PERMIT TYPE ELEC
APN: 14166528
STATUS: ISSUED
DATE ISSUED: 03/10/2011
ISSUED BY: KJB
JOB ADDRESS: �99.8:EL_CAMINO:DR,CM� Suite/Unit:
Vicinity:
SCOPE OF WORK: RE-SET FIFTH METER AT SITE FOR HOUSE METER USE ONLY TO INCLUDE: LAUNDRY ROOM, EXTERIOR LIGHTING
AND SPRINKLERS. PANEL IS SET UP FOR FIVE METERS. 40 AMP METER. �
OWNER: ROWLAND,GRACEA
PHONE:
APPLICANT: SANCHEZ, FRANCISCO
PHONE: 714-865-3970 .
CONTRACTOR: FDS ELECTRICAL
Address: 7701 WARNER AVEUnit: UNIT E72
City/State: HUNTING70N BEACH, CA
CELL:
v.. . .
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electr'rcal Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
Address:. °/ ROWLAND, B FRANK Unit:FRESNO, CA
City/State/Zip: 6257 N DOLORES AYE
Address: ' ' Unit:
City/State/zZip: � "
License No. 849491
. PHONE: 714-865-3970
" '` ZipCode: 92647 �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
, regulations. (Ord. No. 92-26, § 1, 12-21-92) ,
'-EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
;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 fnal approval will result in the expiration of this permit.
COUEtl. INSPECTIONTYPE UATE INi111AL5 LOOEC INSPELPONTYPE ORTE INiITIALS
1616 Fixed System Final Fire PrA�ention 206 Finat Mechanical
7266 Pool Spa Final 208 Final Plumbing n
200 Final Re-Roof 210 Final Electrical X 3' Z.Z — � � K��
201 Final Block/Relaining 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
. . . ' \
WORKERS' COMPENSATION DECLARATION: �
1 hereby aKrm untler penalry oi perjury one of ine following declarations: �
❑ I have and will maintain a certificate of consent ro sel4lnsure for workers'
compensation, as provided for by section 3700 of the Labor Code, (or Ihe
peAormance of the vrork for which this permit is issued.
❑ I have and will maintain workers' compensalion insurance. as requiretl by
section 3700 of the Labor Code, fw the performance of the vrork !or which this
permit is issued. My workers' compensation Insurance cartier and policy
number are:
Carrier
(TluSsecfionneetlratbecomdet�etla�the/pertMavalue0/a� e oredbalars(St00)wless)
Policy mber X_l�F- I/ n
..i
1 certify that in the pedormance of the ork for which this permit is
sued, I shall not employ any person in any manner so as [o become subject
ro the workers' wmpensation laws of Califomia, and agree that if I should
become subject to the vrorkers' compensation provisions of Section 3700 of
Ihe Labor C�ode, I sha�ll f ^hvnt omply with these provisions.
-- ;�'`�1�� '�-lD' t\
Appliwm's SignaWre Daie
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES 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, IMEREST, AND
ATTORNEY'S 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 antl e(fect.
�ic. tt !� y� Y 4� c�ass tt C—( J
��1/�i '�-1,�-15
COMrac r'S9 naWre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum lhat there is a constructbn lending agency for the
peAwmance of the xqrk fa wfiich this pertnit is issued. (Sec. 3097, Civil Code).
LenOer's Name:
Lender's Address:
Dale
OWNER-BUILDER DECLARATIONS:
I hereby aKrtn thal under penalty of perjury tha[ I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following fea5on (SeC. 7037.5,
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 applirant tor such permit to Poe a signed statement
that he or she is licensed pursuaN to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or [hat he or she is exempt lherefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecls the applicant to a civil penally ot not more than
flve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucWre is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contreciors
License Law does not apply to an ovmer of propeAy who builds or improves
thereon, and who does such work himself or herself or Ihrough his or her ovm
employees, provided that such improvements are not intended or offeretl for
sale. If, however, the building or improvement is sold vnthin one year of
completion, the ovmer-builder will have the burden of proving that he or she
did not builtl or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to consWct the project (Sea 7044, Business and
Professbns Code: The contractors license Law dces noi appty to an owner of
pmperty who builds or improves thereon, and who contracts fw such pmject with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
Sr8^aWre
905]�a6�J/0])
Owner ID verified by driver's license. ❑ Yes ❑ No
Dnver's License No. Expires:
Verificalion o( Ovmership by (type of document, i.e. - property taz bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certrfy [hat no excavation frve (5) or more feet in depth in[o wfiich a
person is required ro descend, vnll be made in connectbn with v.ork au[honzed
by this pertnit, and that no building strucWre, scafidding, lalsework, or tlemolition
or dismantling thereof, will be more than thirty-soc (36� feet hgR (Chap. 32, Grp
2, An 2, Sec. 341, Ttle 8, Califomia Atlministrative Cotle).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit (rom [he Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
ApPlicanfs5ignaWre , Dale
Division of Industrial Safety Permit Number:
HAZAROOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or fuWre builtling occupant need lo file antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 ot the Califomia Health and Sate[y Cotle 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 tluring a reportetl
year a quantity of hazardous materials equal to or greater than a weiqht ot
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standartl temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration (orm for awtely hazartlous materials? ❑ Yes ❑ No
(Section 25533 0! the Califomia Health antl Safery Code, wilh some
exceptions, requires registration vrith the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous ma[erials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressetl gas at standard
temperaWre and pressure).
3. Does or will the applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevention Program tor acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Calitornia Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparatioq certifcation and
filing with the Fire Depariment o/ an RMPP by businesses which are required
to register acutely hazardous matenals with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of �he Calitomia
Health antl Sa(ety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or (uture building occupant reqUife fof
the work which is lhe subjecl of lhis appliwtion a permit for such construction
or modifcation from the South Coast Air Quality Management District or from
any other air polWtion control district or agency? ❑ Yes ❑ No
(Seclion 658502 of Ihe Califomia Govemment Code requires Ihat the requested
infortnation be fumished on applications for non-residential builtling permits).
6. Will any part of the taciliry to be constmcted under Ihis pertnit be vrithin
1000 feet from the outer boundades of a school? ❑ Yes ❑ No
Qf yes", Ihe faciliry mus� meet Ihe requiremen� of Sections 25534 antl 42303
o( the California Heallh and Safety Code).
7. If a permit from the South Coast Air �ualiry Management DisMct or omer
air polNtion control district or agency is required (or the work which is the
subject of this application, have all of the tlisclosures prescribetl by Califomia
Health and Sa(ety Code Section 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certificate ot compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury lhe
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certity under penalty ot perjury that I have read Ihis application and slate ihat
lhe in(ormation given is wrrect. I agree to comply with all slate laws antl ciry
ordinances relating to buildinq construction, antl authorize representatives ot
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by Ihis permit until fnal inspection.
Signawre of legal eqs) Da�e
���/ 3' � d'( �
�And/orAu Onzed pplicanl Dale
Applicant to till in all
GTY OF COSTA MESA '' ''veRmir Nc
CONSTRUCTION PERMIT Pir��7
Address
ly� Arch/Er
� � Address
t
License No.
within heavy GorEer lines antl.sign all app�oDriate tlecla�:
L -"' TRACT NO. LOT NO. �BLDG.
�
LICENSED CONTRACTOR DECLARATION �'
I hereby affirm that I am Iicensetl untler provizions of Charter 9(com-
mentln9' with sectlon ]000) o� Divi5lon � 3 ot the Business antl
PrOfessions Cotle, antlJ my IiC¢ns¢ is in full fOrG¢ antl ef(ect.
License CIaSs � �� � License No � ,�
Date �-�' -3 ' Siqnature �' � � �
WORKERS'COMPENSATION�ECLARATION �
I hereby aftirm that I have a certiticate of consent to seli-Insure or a
certiflcat0 of Worker5' COmpensation Insurante, or a Certifletl-copy
thereot (Sectio�738 6� b. CJ. �/ ��
�Iicy No. �' r' ���� Company "�A�/f/ Ln�s
�ertitietl copy is hereby furnishetl. � -
Certi�ietl topy is filatl with tne city Builtling �ivisian.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sectlan neEtl.not be Complet¢tl if th¢ permit is for.one.huntl�etl
($100) or less).
I certify that in the performance.of the work for which this permit Is
issuetl, I shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of Callfornia. ' .
Date Signature
NOTICE: If aite� making thls tlecla�ation, you shoultl bemme 5ubjeCt
to th0 WOrkGrS' Compen5ation proJiSions of the Labor Cotle, you must
forthwith comply witb such provisions o� tltis pe�mi[ shall be tleemetl
revOk¢tl. � - -
CONSTRUCTION LENDING AGENCV
I hErGby afflrT that there is a con5t�uction lentling agency for the per-
formance of tne work for which this permit is issuetl (Section 3097
Civ.,C.l.. . _ . _T,�-'� .-3-- .. _n, _ .. ' _... '•..G\
Lentler's Atltlress:" - '
tM1e following reason (Sectlon �031.5'Business a0tl "Professlons CODe:
Any city or County which require5 a permit to construct, dlter,
improve, tlemolisn or repalr any structure, prior to its i55uance, also re-
quires the applicant for such permit to tile a Signetl statem¢nt that he
is licensetl pursuanl [o the provisions of the Contrattor'S Cicense L:aw
(Chapter 9(commencing with SeCtion ]000) of DiviSion 3 of [he
Business antl Prolession5 Cotle) Or that he Is'exempt theretrom antl tM1e
basis for the alle9etl exemption. Any violation of Section ]031.5 by
y aOPllcani fo� a permit subjects the appllcant to a"civil penalty
not more tnan five huntlretl tlollars ($500).
._.] I, as owne� of the property, or my employee5 with wa9e5 as their
sole compensation, will tlo.the work, antl_the structure is not intentletl
O( offereC for SdIQ. ($CCII00 �044, Business antl Protesslons Cotle: The
Contrdctor's License Law tloes not apply to an owne�.of a p�operty
who builtls or Improves thereon, antl who tloes such work himself or
through his own employee5, provitletl that such improvements are not
in[entletl or o/(e�etl for sale. If, howeveq the builtlinq o� improvement
ii Soltl within one-year ot completion, the.owner will.have the burtl¢n
ot proving he tlitl not builtl or improve for [he purpose of sale).
❑ I;'as owner'of-the`prOperty, am"¢xUuSively contrac[ing with
licensetl contrac[ors to construct the project.(Section 7044, Business
antl Professions Cotle: The Contractor'sLicense Law tloes not apply to
an owne� ot 0/operty who builtls o� Improves Ihercon, antl who con-
Iracts from SucM1 projects with a conbactor(s) lic¢sn¢tl-pur5uant to
tne Contractor's License Law).
❑ I am exempt untler Seciion B. & P. C. for this
reason' -
Date � �� � - Owner � � -
1 hereby Certifyihat I have reatl this applicdtion antl stat¢ Ihat tne above
informalion is mrrecL I agree to comply with all city antl munty
ortlinances antl state laws relating to const�uction, and hereby dutho�ize
representaY4e o! this city to enter upon the above men[ionetl
property.�r�nspection�pu�po}es. d . .� . � „�.
TVPE OF CONSTRUCTION
❑ NEW ❑ ADD ❑ ALTERATION
�O REPAIR ❑ CONVERSION ❑DEMOLISH.
❑.OTHER
DESCRIPTION OF WORK .
TVPE OF PERMIT � - � - �
❑ GRADING ❑ FOUNDATIO ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL�PLUMBING ❑MEGHA�
❑ OTHER
PROJECT DESCRIPTION ,
SQ. FT. .
OCCVPANCV_CONSTRUCTIONTVPE
VALUATION ZONE
GRADING CU. VDS. ACRES
REMARKS: ' -
PLUMBING ,'� PLANCHECK '
BATHTUBS SHOWERS
TOILETS URINAL"5
LAVATORIES OOUBLELAVS`
KIT.SINK$ � � DISHWASHERS
SERVICESINKS � .SUMPS '
FLOOR SINKS�. r C' F1.00R DRAWS
DRWK�NG FOUNTAINS • -
INTERCEPTORS � CLARIFIERS
SWIMMING POOL � P'TRAP ' ' " "' ' '
WATERSERVICE � ALTERATION � �
GASSERVICE OUTLETS �
WATER HEATERS BTU OUTPUT
SEWER CONNECTIONS - �
SOLAR TANK �COLLECTOR5�4� �.
SOLAR PIPING SVS. � '
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU
ANDDVCTING 100,000+gTU
f3EFRIGERATION 0-100,000 BTU
SVSTEM 100,000+BTU
BOILERS BTV
SYSTEM REPAI R, ALTERATION
EXHAUSTSVSTEM MVLTIPLE
4760 2%22/83
�� - — --
ZONING REGULATIONS
ZONE
REAR VARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
ZONING APPROVED B�
SPECIAL CONDITIONS:
�ELEC7RICAL'
REF. �
PROVIDEO
•� PARK FEE $
DATE
PLAN CHECK:
GENERATOR 0-1 KW_ 1-10 KW _
TRANSFORMER
APPLIANCE - 10-50 KW_50 + KW _
MOTORS 0-1'HP_1-30 HP _
(INC.SOLAR) � 10-SOHP SO+HP_
FIXTURES OUTLETS SWITCHES
, 5.00 • T
" . I.,
GAS TUBE SIGNS" - . - -
POLELIGHT$ "' ' ' -'-" - - ""'-" "
�'POLES METERED •SUB � �
PANELS MAIN -' 'SVB - '
SERVICE' - ' "'- ' ' AMP '
� - ISSUE FEE - � ' " "- ' '
J 'APPUCATION.qPPROVED BV -- '- DATE
� � SUMMARV OF FEES, , �
"�BUILDING' -
PERMIT $ � SMIP ' $
,PLAN CHECK _S PERMIT,
�P�UMBIN�O� � 65UANCE 8�
" ' GRA�ING E'
PLAN CHECK $ . ,
ELECTRICAL $ � � $ ,
PLAN CHECK '$ ' MICROFILM $��
MECHANICAL $- TOTAL FEE $ .:J' �`T%
LE55 AD-
PLAN CHECK E VANCE PC E_ "
Drivers' License or 55 � �: �.-��" '{ �- •� �� ' ISSUE FEE �
CMF0865�46 Whi[e-Builtling;Gnary-Applicant;Pink-Acmunting;Goltlenrotl-Assessor ����/7y / �L.�%`�G�'iiC
FINAL FEE E s, �
CONSTRUCTION AND PLANI
APPROVALS Permit #
1. Temporary Electrical Service or P
8. Foundation
9. Water,Pipe-Undrgrn
10. Structural Floor System
11. Property Sewer Line & House
12. Street $ewer Connection �
13. Rough Plumbing
14. Rough Electric-Conduit
15. Rough Electric-Wiring �
16. Rough Heating & Air Conditio
17: Ducts, in Structure
16. Ducts, Ventilating .
19. Gas Pipe-Rough & Test
20. Roof Framing -
21. Roof Sheathing �
22. � Frameand Flashing
23. - Insulation - ' .
24: Lathing & Siding �
25. . Drywall.Nailing
26. Plaster Brown Coat �
27. Electrical Power Meter-Final _
28. Final Electric •
29. Final Heating & Air Condition
30._ Final,Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final -
37
' 40. Electric Release to Edison
41. Gas Release to Southern California
, 42. CERTIFICATEOFOCCUPANCY
No Date
m
�1�
ti. • � � POOL.& SPA .- .
Date Inipector qppROVALS �' permit# � Date Inspector
.�
� � 43. Pool & Equipment Location• • �
44. Stee� Reinforcement � �
45: Forms
46. Electrical Bonding -
47. Rough Plumbin & Pressure Test '
� 48. APPROVALTOCOVER-GUNITE �
• 49. Electrical Conduit-Undr m. � � -
50. Gas Pioe. ❑ Undram_ Test
' ' S." Plumbinq Svstem - Final
- � �56. � Electrical-Final
- 57. Solar System-F.inal '
. encing & Access Approval
. APPROVED FOR PLASTERII
60. POOL/SPA SYSTEMS FINAL
NnTFc• .. .
0
a
� l�9873
s
� '��JSTA MESA BUILDING-SAFETY DEPARTMEt�(T
P. O. BOR 8f] COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
�. � TYPE OR PRINT
'eui�oiNa El CamiRO IJriVe
ADDRESS T .� � A. 'I: �11
. COSTA MESA, CALIFORNIA
� M�:,o�fla 25�.F: �]_7th St.. Suite G
STATE TEL.
LIC. NO. A n� ' � NO. S3IR0
SIZE � I NO.OPBLp03.
OF LOT 7 �.� O� � rvoW on �oT
USE OF
EXISTING BLDO.
8ET8AGK L1NE PROM '
CENTER OP ➢THEQT L{(1 � � REAR YARD LO'
SIOEVAROI LEFT Zn� -I R16HT S�
DESCRIPTION OF WORK
5 ZE�1N6 S �� X 7� � ROOMB BTORIfiB 2
E%TERIOR WALL -I ROOF
COVERIN� i.11CCO COVERIN6 shin �.(.'
U960FBUILDIN6AfiDWORKTOBGPfi FO D
t n]PX
1 HER6BY ACI(NOWLEOOH THAT 1 HAVE READ TNIB APPLICATION
Arvo eTwie THAT THE ABOV6 IB COppECT ANO AQAB� TO COM-
PLY WITH AlL CITY OPDINANCB9 ANO 8TAT8 LAWB q8pU1.ATING
BUILDING CONBTRURION.
SIGNATUREOF HYCROfT TERRACE, iNC.
PERMITTE
y/J < •
AUTHORIZHD A6ENT dl • � '
FEE RECEIVED
�iUN 10 ,g
FINANCE D��T.
���pFO€AQ�F{p��RMIT
BUILDING
For Office Use Only
fl[CEIPT NO. � H
APPROVED
YARDSAPPROVED
MAIN BUILDING
`�
VAR. JC
use oF rui
am�o�rvo
SHALL BE LESS THAN
(U. B. C. REpU1REMENTI
YARDSAPPROVED
'ACCESSORY BUILDING
�ATE
�fXH �MOUNT 9XOWN UNDQR VALU�TION 18 FOP TH8
PUAPOBE OF HBTABLIBHINO A PERMIT FEE ONLY.
VALUATION 2
PERMITFEE $ //'D/�
$�i��6 0:
t ir/1 I
0
I
�
H
Z
w
�
w
a
�
a
ud
�
.7
d
:.�
W
d
�
�
0
�1.�
Q
Q
.'%.
�COSTA MESA BUILDING-SAFETY DEPARTMENT
6315 4%06l79 5.50 TU
.viF+ \
APPLICAT[ON FOR STRUCTURAL PERMIT A ��
r.v.oa�n icvv �.w�nin�on.�.n� ainrvir�acv�v R CE PERMIT J\/�.��': �� 1M,
For Applicant to Fill in Comple[ely — Use Ink Only t�
ADIDRESS �9� ,(�`c�Y)")/!00 L,OS/oi Q,SO � A.P.NO. `y � � '
n,///� BUILDING U�
T�ENANT�R O[(JpQY��aCQ/�. /�Q((f n� ADDRE55
VNIT OR �,L
MAILING / SPACE NO. ,1f—�
ADDRESS��O A y }Q(, {� h �
n�/ /� TR.NO. LOT � BLK.
CITV I.OS(o� � lPSL� . ` NOL�'%1e1� '
NEW ADD REPAI0. MOVING OEMOLI H
CANSTRUCTION n/
LENDER ix
BRANCH (��1 ,/qIn �,
OWNER ��ev.
ADDRESS �V E �J
ARCHITECT �/ TEL. USE � v
OR ENGINEER N
ADDRE55 ZONE TVPE GFOUP
APPROVED /
CONTFACTOR BV DATE � 4F � '
✓
ADDflESS
TEL. '
CITV NO.
STATE CITY %�PPROVEDSETBACKS •
LIC. NO. LIC. NO.
SIZE NO.OF BL�GS. (FROM C/L ST�E.T)
OF LOT NOW ON LOT FRONT � FT.
USE OF /{����A� J L
EXISTING sLDG. � F
Separate permits are required for , . �. sioe //7
electric, plumbing and heating work:
REAR FT.
USE � UILO G AND WOFK TO BE PERFOFMED PLANNING ACTION
_ �X" DATE
�.� � APPROVEO
APPRO
��.
I hereby acknowletlge that I have �ea this application antl state °n'
that the above (nfo�mation is corract and agree to comply with
all laws regulating building consttuction, antl I shall not employ �
any pe�son in violation of the workman's compensation laws of d
the Stata of California.
m
I hereby certity that I am prope�ly licensetl as a contractor untler SQ. FT. �+
the State of California Business antl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOft ro
Chapter 9, and that such licenses are in tull torce and effect, or I THE PURPOSE OF ESTABLISHING A PEFMIT FEE ONLV: �
am exempt f�om the p�ovisions of the $tate of CalitOrnia Business VALUATION PERMIT FEE �
antl Professions C/g/tle, Division 3, Chapter 9. $ m
Sig^ature o��, _ _ // �l-C��� � PLAN CHECK $ `^
0
Permittee KYL.�pp (� l ` $ �P TAX S � U
or i/� /_ _ �/ / �
Authorized Agent Date `T ��� � TOTAL PAI O $ CJ�
..�,
�
(� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
■ ADOFESS �%Ll.:� (-[]1Yn//J(J iFY"C�O�I/i/ `//u-�/
F
C
OW.
a
h
h
F
L�
W
F
C
..l
a
>
�
x
�
o.
O
�i
a
z{�
T.
3
ciTv C�'S1
CONSTRUClION
BRANCH
ADDRESS
ARCHITECT
ADDRESS
CONTRACTOR
ADDRESS
CITV
STATE
LIC. NO.
S12E
OF LOT
USE OF
J
TEL.
NO.
CITV
UC. NO.
3LDG. �[.S� '
Separate permits are required for '
electric, plumbing and heating work: �
UILDING AND WOFi.K TO BE PERF9RMEC
�
I hereby acknowletl8e thet I have read this-application antl steta
that tha above information is correct antl a0rae to comply wlth
all laws reguleting building construction, and I shall not employ
any perwn in violatlon of the workman's compensation laws of
the State ot California.
I hereby certify that I am prope�ly Iicensetl as a contractor under
tha State of Californie Business antl Protessions Code, Division 3,
Chapter 9, and thai sueh licenses are in full force antl ef7ect, ar I
am ezempt from the provisions ot the State of California Business
antl Profassions de, Division 3, Chapter 9.
Signamre ot � y���` � J _
Permittee L ( /L (� `-�� �'
or ./_/�7%
Authorized Agent Date �7 ��
•�6314 4/Ofi/79
�b3'I'4 G%Ob%79
APPLICAT[ON FOR�pLIJC'�Q$�,41P�
EI PERMIT /j�'.�,.��r1
T{
A.P. NO. ��-I I ���
BUILDING��� �/ �
ADDiiE55
UNIT OR
SPHCE NO.
TR.NO. LOT
NEW ADD ALTER REPAIR
USE
APPROVED
APPROVEDSETBACKS
(FROM C/L STREET)
PLANNING.ACTION'
BLK.
MOVING DEMOLISH
D
VALUE Aj�w�
DATE
DATE
APPROVED
/.
8.50�,�
8.50Ci�
� IQ r
P
C
i
a
m
54. FT. �`+
7
THE AMOUNTSHOWN UNDER VALUATION IS FOR m'
THE PURPOSE OF ESiABLISHING A PERMIT FEE ONLV: e
VALUATION PERMIT FEE $ v
� 4 N
O � PLAN CHECK $ - o
� Q �/ TAX 4 `S� �
v �r� U
TOTALPAID 8 � �4/
City of Costa Mesa
Building Safety Department
P. O. Box 317
Costo Meso, Califomiv
CERTIFICATE OF OCCUPANCY NO
� •
The Building located at ���+- CQ7B�Il0 Dii11B. 1iL1bB lis H� C� BII8 D
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group � Occupancy.
Use of Building fo�u�lex resideace with Qttached psxr�ge _
Legal Description � �99 ��� 5�u
(See reverse side for Metes ond Boundt)
Building Permit No. 1�3 Electrical Permit No. 2��3 Plumbing Permit No. �� _
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. . required under Sec. 3301 (7) U. B. C. —
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occ�pied
untilthe owner or operotor has been issued a valid certificafe of occupancy by the enforcement agency.
(b) A new certificate of occupancy shali be obtained whenever there is a change in: -
1) dccupancy classification of a building or portion thereof
2) TNe number of apartments or guest rooms
3) O"+nership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17p50.1 (d), California
Adminis}rative Code, TiTle 8, ChapTer 9, Article S.
Number of apartments_ 4 and/or guest rooms
ISSUED TO: Building Official
$ycraYt 7'erl8ces $Ca�te$ bY�'L'6T/''"�/ � :�:%�z'%�%�� _
Date �1 '�� l�:F
Yhis CertificaYe of Occupaney SHALL BE posfed in a conspicuous place on the premises and SHALL NOT BE removed
excepf by the Building Official of the Cify of Costa Mesa under Sea 306 (e) U.B.C. Fo�,,, svaa—iM—ii-sa_s-s r