HomeMy WebLinkAbout1025 EL CAMINO DR - Building PermitsApplicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
'COSTA MESA l' PE IT'NO.' TRACT.Np LOT NO.
W,MUICTiON PERMIT S-,342,3 `57�L ;r '
6073 5/1'9/82 25.47 �TL-
r , • t Address L' G TYPE OF CONSTRUCTION--
OWner - AS - Phon '❑ NEW ❑ ADD - XALTERATION
I -Address ID..E] REPAIR Ef CONVERSION, EIDEMOLISH,
'Arch/Eng. -• -- -- _l License No.
❑ OTHER ZONING REGULATIONS
' . A.P. 9f ...I Li'l .� ; %'I -" -•', - - - -�
"Address-'- " ' - �- - --- - _ _ DESCRIPTION' F WORK -
�w' 'ZONE " "" "P LNG. REF. - - --
Contractor TLV E •- ------ --- Phone - 'TYPE OF PER IT' +' -'--'- -- D ._ XMWLDI�,IG
Address--' ' -- -'^-- - -- ---- - - "r;'� 1 ryr SETBACKC LST. PROPS RTV LI NE
❑ GRADING ^ ❑ FOUNDATION - tq STRUCTURAL - $IDE -YARD •-- - -
"LICENSED CONTRACTOR DECLARATION - " "" ❑ TENANT I ELECTRICAL. ❑PLUMBING ❑MECHANIC LEEFT
'I herebyaffirm that I am licensed under +SIDE-YA -
provisions -the
Charter 9 (. and .. l I HT
mencisi with o section r 7000) -of lief , e Division 3 of -the .Business. and ❑.OTHER - 1
'Professions Code, land my license is in full force and effect., REAR YARD (TO 'P/ - "
License Class' - - "-` "- " License No: 1 - PROJECT DESCRIPTION_, - -- _ �,,.� -
} PKGCSPACE REO." ^ ROVIDED
fOate--Signature - '"-- "- •� SQ FT' .15
. " - .'STREET WIDTH -'PARK FEE; -'
WORKERS' COMPENSATION DECLARATION -_ - OCCUPANCY ONSTRUCTION TYPE f ,ZONING APPROVED BY - �� -DATE - ,7Z
I hereby affirm that I have a certificate of consent to self insure. or • VALUATIO ZONE O
certificate -of- Workers' -Compensation-Insurance,•or a.certlfied'--copy. _
Ithereof (Section 3800, Lab, CJ. ' -GRACING CU. YDS. ^ ACRES " .SPECIAL` CONDITIONS: - " - --
,Policy No: _. Company__
Certified copy is hereby_furnished.. __.._ _,_ ._'i. REMARKS: 'I-FIL
Certified copy is�filed with th6 city Building Division.--
+-
XEMection need
n WORKS RS"COMPENSATION DECLARATION -- -- - -
(This section need 'not be completed if the permit is for, one hundred
E1001 or less). _}
I -Certify that in the
work f w h this permit lis Y
issued,- I shall t employ anyany` - er's 'as"tobecome 'UMBING' - PLAN'CHSCK--'-- -- - -LL -''ELECTRICAL- - ---PLAN CHECK'the. orkers'Compena so h, rili - - - _-LL SignaturBATHTUBS SHOWERS'SO FTNOTICE: I after making this tlo you should become bject 4TOl LETS . URINALS - jGENERATOR- -01 KW_1 10KWto the Wor ers' Compensation of the Labor Code,-you'of ust TRANSFORMER.,forthwith comply with such prthis permit shall be deemed LAVATORIES DOUBLE-LAVS - ^- - - ;APPLIANCE-revoked.�._ _ _. CONSTRUCTION LENDING A ^ -'KIT.SINKS'•- -'--^ -DISHWASHERS -' � -- �� MOTORS-�.•�---O-LHP-_3-30HP'---1I hereby affirm that there is a tion ntling agency for the per- SERVICE SINKS. '.c rp SUMPS -'•-^ - -- (INC. SOLAR) _ 30-50 HP 50 * HP_'.' f;
tormance of the work for which this permit is issued (Section 3097
Civ. 2.).
I ame -- J - • -- - - -` "- - -' - 1, FLOOR -SINK$ -- ' --"FLOOR DRAINS" "` - - 'FIXTURES -- -OUTLETS .SWITCHES
-. - ---- - I
,Lender's N - 1 -
_
Lender's Address -" _ DRINKING -FOUNTAINS -GAS -TUBE SIGNS-- "-
,OWNER BUILDER DECLARATION-
:1
ECLARATION -- •- - ---- ----• INTERCEPTORS' - -" CLARIFIERS " "'-" `� 'POLE -LIGHTS. ---- - - - - j
:I hereby affirm that I am exempt from the Contractor's License .Law for ' -
the following -reason (Section 7031.5 Business and Professions -Code:- -'SWIMMING POOL -- ---PTRAP - - - - - - . - _
Any city or county which requires a permit to construct, alter, ,. ^f" POLES - METERED -'- 'SUB
Improve; demolish or repair -any structure, prior to its issuance; also re-- - WATER SERVICES '-" "ALTERATION- - --- PANELS------ MAIN---
quires the apoicant for such permit to file a signed statement that he -
is licensed `
pursuant -to to the provisions 17000) factor's License Law- " -
(Chapter 9 (commencing with Section 7000) of Division 3 of the GAS SERVICE _ -' OUTLETS ;x '^;�-'-' j' - ,SERVICE -;AMP-
Business and-Prolessions Code) or that he is exempt therefrom and the WATER HEATERS- -BTU OUTPUT
basis for the alleged exemption. Any violation of Section 7031.5 by '���
,�pplica nt for a• permit -subjects-the applicant to a civil- penalty- --SEWER CONNECTIONS - ' - --- - ----- - _-.
..::t more than five hundred dollars ($500). �` (�• -"`- �- --� - "
+..
as owner oftne property, or"my employees'with-wages'as'their- '"SOLAR TANK--' r' --COLLECTORS- -- '
sJ.' compensation, will do the work, and the structure is not Intended
or offered for sale.'(Sectior77044, Business and Professions Code: The
' SOLAR -PIPING SYS. ISSUE FEE - -- - - - ,pp
'Contractor's, License . Law does not applytoan owner of a property
who builds or improves thereon, antl who does such work himself or ISSUE'FEE�'---' "-"- "" -ti - APPLICATION APPROVEDBY --_ -_-DATEs.' ,
.through-his,own employees, provided that such improvements are not _
intended or offered for sale.'If; w
hoever, the building or improvement' - MECHANICAL PLAN CHECK _f - - ' - - "- t
is sold within one year of completion, the owner will have the burden - SUMMARY,OF FEES nrl „ r• {
of proving he did not' build or improve for the purpose'of-sale): - - - -' '- -- - - -- -- - -1 - - ;BUILDING
HEATING SV5TEM 0-100,000 BTU - )PERMIT $._1 �t_�V ._1�SMIP _ $
10-1, as. owners of -the -property,- am -exclusively contracting with. qND-D VCTING-----^--11----- - -. -_r '
licensed contractors to construct the project (Section 7044, Business 100,000 +gTU - l- -`
t (PLAN CHECK' -
PERMIT, -�
'and -Professions -Code: The Contractor's License Law does not apply to _._ ISSUANCE'
an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU -T • PLUMBING $
tracts -from such -projects with a. cont ractor(s)-licesnedpursuant .to. _SYSTEM- - I..- _ _ _ _ `' `GRADING"t S,
.the Contractor's License Law).300,000'+ 13TU -- - ) PLAN CHECK $
❑'I am:e zein plunder Section'-' - - B: &-P. C: for this - - -- - - '--F/�=� it _ - _. $
BOILERS BTU 'EL'ECTRICAL $'
treason-- - { PLAN CHECK- $ -- 'MICROFILM: $' •r
Date Owner SYSTEM REPAIR, ALTERATION [ _ TOTAL. FEE $'^
1 - - - (MECHANICAL$ - -- - _
:I hereby certify that I have ad this application and state that the above EXHAUST SYSTEM MULTIPLE LESS AD- ' rJ
informati- 's correct. - agre - mply-with-all city and county - .PLAN CHECK- $' - -LANCE - $
ordina as an state law rela co struction, and hereby a thori a
represe tativ of'this r�ty to r upon -the "above -m do tl' - ', J.
-propert for inspe o pur
'Signature at - - - FINAL FEE $ I
Driven' Lie Tse or S$ _ - -- --" ISSUEFEE--__- _ ._ _ _•. _. -• _ - ,-
CMF 0865-4 White-BuiWng;,6anary-Applicant; Pink -Accounting: Goldenrod -Assessor
CONSTRUCTION AND PLANNING
Date Inspector
APPROVALS Permit #
POOL & SPA '
• Y9ate, _ Inspecto
APPROVALS Permit # ,
1.
Temporary Electrical Service or Pole
43.'
Pool & Equipment LocafW-' •"- -- - -' -- -= -
2.
. SoilPipe-Undrgrn _ _
--•
44.
Steel Reinforcement
3.
Electrical.Conduit Utility-Undrgrn -
.. 45.
Forms -
4.
Electrical Conduit-Undrgrn._ - _ - - - - --•
-'46.'-'=Electrical
Bonding - - - -
5.
Steel ein orce - .�
47.
Rough Plumbing & Pressure Test -
6.
Electrical UFER Grn
48.
APPROVALTO COVER-GUNITE
7.
Footings
49.
Electrical Conduit-Undr rn '
- 8.
Foundation •-- - -- - - _
50.
Gas Pipe, ❑Undr rn; Test" -
4- - 9.
Water- Pipe-Undrgrn - --
51.
_Backwash Lines P-Tra ' ❑ Undrqrn - -
10.
Structural. Floor System .
52.
' APPROVALTODECK ' ' ' -.
11-. -
-Property Sewer Line•& House. Connection
53.'--`Backvvash•&'Rete tor -Final.
--12.
-Street-Sewer-Connection.- -- - - -
54.
Heater &Vent -Final -
.1.3._
Rough -Plumbing. f"
-
14.
Rough Electric -Conduit "- .' -" "-^-
'S6.-
Electrical -Final -`- -
' 15.
Rough Electric -Wiring - 'C - -'
57. -Solar System -Final
16:
-'Rough Heatirig &'Air Conditioning •- - - - -- -�- -
-
encing & Access Approval .
- 17: --Ducts,
in -Structure.
9PPRDVED.FDR,PLA$TERING -.
- 18."
19.
20:
Ducts, Ventilating- -• '- - -_
GasPipe-Rough'&Test ^+ -; - -
Roof.Framing - - - -- - - - - - -
60.
- - ---- ----- ••- ... _
POO L/SPASYSTEMSFINAL..,'1:
-
21:
221
Roof Sheathin - - - - - --- -
Frame and Flashing
- -- -' -� -
"NOTES:.t�'o: - ..
23:
Insulation - - - --- -- --.--- -
-
, 24.
Lathing& Siding-
-25.
Drywall Nailing-
ailing
26.
26.
Plaster Brown Coat
27.
Electrical Power Meter -Final - - _ • -
- -
- 2&.
-Final'Electric- - -- - -- (o-/
29'. - Finall Heating'& Air'Conditioning-
' 30'.
Final,Gas Pipe -Test
31.
Final'Plumbing
:. _32..-'
Water Service -Final
1 - 33.`
'Gas Service -Final' - ---'
'
34.
Solar Domestic -Final "" " "'
-
1 35.'
Landscape Sprinkling System-` -
36.
Sound Attenuatidn-
37.
Handicap, Regulations "`' " --_
-
- • > - -
38.
FINAL STRUCTURE & BUILDING 7 -
' 39. -
Special Requirements Completed
40..
Electric Release to Edison
- -
41.
Gas Release toSouthernCalifornia Gas Co.
L�2-CERTIFICATE
OF OCCUPANCY
'No. Date
:.... ..
I
Ap Pl i cant to fitl1n, - ......heavy
border lines and sign all appropriate declarations. —
CIT -Y OF COSTA=MESA: - - - -- --�; -C ----�r,-
PERMITNOi
TRACT NO
LOT Np,
BLDG. NO. -
- - - -
- - -
CONSTRUCTION PERMIT
Project Address D-
TYPE OF CONSTRUCTION NEW - _ ADD LTERATION REPAIR,
-
^�
Applicant's Mailing Address "56 "F
❑' CONVERSION ❑ DEMOLISH
❑ OTHER [.
A.P. # / - _ I "....
Zone-
'*
Owner's Name - Patrick FOl t6ne • � phone! 842-5909
� DESCRIPTI N OF WORK
$
Main Building:' '
ACce55o y Bu ip g
Z
- -
�NTEX�O
Address .17220 Newhope #226, Fountain Valley
❑
UFOUNLION 16STRUCTURAL
E
Front
O
N
TYPE OF PERMIT GRADING
T
I
- License No.'
1 •❑TENANT ❑ELECTRICAL ❑PLUMBING
❑MECHANICAL
B
I'
❑ OTHER
° ` - ii �.
A
Rear
-
N
Address -
�" ractor's Name t1fPhone
PROJECT DESCRIPTION 5G. FT.�—.OCCUPANeCY
K
Right -
g
i
R
Address (mailing) - - -
- -
CONSTRUCTION TYPE JL
•
1 VALUATION $ '•G�
$
Left
-
E
l
-
ZONE GRAOINGCU.YDS.
ACRES'-
Pl ng. Ref. #
Park, Fees $ �=
Q
City License No.
i
U
LICENSED CONTRACTOR DECLARATION -
Remarks:
Parking Req./Provided
I hereby affirm that I:ahi licensed under provisions of Charter -9 (commencing
and
c
Use of Building:--
- -
I '-
E
with section -7000) of Division 3 of the Business and Professions Code,
I
••„ •
I
my license is in full force and'effect.
•
Planning Notes:
-
-'
M
License Class License No.
PLUMBING
FEES
E
Date Signature
•ION
Bar Sink
Showers - i
+
I
'
T
WORKERS' COMPENSATION DECLA'RA
'p y,ereby affirm that 1 have a certificate of consent to self -insure or a certificate
Backflow Pre`venter
Service Sink •
!
$
orkers' Compensation Insurance, or a certified ,copy thereof. (Section
Lab. C.) ;
Backflow Irrigation
Sewer Cap 1 -
I ELECTRICAL
'!'
(FEES
Policy No. - - Company
8 Certified copy is hereby furnished. ` I ' I
Bathtubs . I I
Sewer Connection_ '
Automatic Washer
•Transformer ❑ 15-50 KW
Certified copy i5 filed with the'clty Building Division.
1
Clarifiers
Solar Collectors ^
Construction Pole
I i ❑ 50,+ KW
I I
Date Applicant I
n
Sub.
.EXEMPTIOMFROM WORKERS' COMPENSATION DECLARATION
(Thissection need not be completed if the permit,is for one hundred ($100) or
--
Diher' h
swas,' -' -
Piping.
Soar m
P gt' -' -'}
-
- -+-- •--•- -• --
Cooking Unit-` - 'Meter' ❑up to 100 amps- -
- --
less)
I certify that ,in the performance of the work or which t is➢ n it is ii55ueQ I I
-
Drinking Fountains
9
Solar Tank _! _
I
Dishwasher
Meter ❑over.100 amps
'
shall not employ any person in any m er o•as clime eH'tPthe
workers Co pen o ws of or
Floor Drains i
Swimming Pool w/Spa:
Dryers ❑Gas ❑Electric
Sub Panel -
r
•
Datern- tSi ture
--
.
-
NOTI 1 e aki g this declaration,' ou shoultl ecome subject to the
his
FIdOr Sinks
Urinal i J
Fan
IMotors 00-1 HP Ell %-8
Workers' Compensation provi sio n5of :the bor-Code, you must forthwithcomply
with Such provisions, or this. permit; shall be, deemed revoked. I
Ges Service Outlets'
Water Closed •„ �.
r
FSA. U.
Solar;❑9-15 HO ❑
I
CONSTRUCTION; LENDING�,AGENCY. �. �_ t; -r'
_
_
-
.Inc.
I
1 hereby affirm that there is a construction le, ding agency for the performance
Interceptors ,' I
Water Heater,
_
Fixtures' -
-
Microwave
of the .work ,for which this permit isilssued,-(Section;3097 Civ: C.)•
- -
'
•
Lender's, Name — - - ^ '
- i Kitchen Sink. -..
-Water Service ` 1
-
Device Boxes',
Pole Light
•
Lender's Address:
OWNER BUILDER DECLARATION i -
,
Lavitorie5' i __
Outlets '-
Range I
I hereby affirm that I am`exempt from the Contractor's License Law for the
' - --
P -T ,
raP
' -
,
following reason (Section 7031:5 Business and Professional Code: Any city or
-
_
Switches
Sign
'
county which requires a permit to construct, alter improve, demolish or repair I
any structure, prior to its'- Issuance, also requires tete applicant for such permit
� -
Roof Drains
- 'v
Disposal`
$tandirig Sections
-
•to file a signed statement that he/she is licensed pursuant to'the provisions of
-
.'Garbage
the Contractor's License Law (Chapter 9 (commencing with'. Section 7000) of
_ I -
-
'Generator ❑0.5 KW 05-15 KW
'Trash Compactor ( -�
'
Oivision 3 of the;Business and Professions Code) or, that he/she is exempt
-
-
,
irefrom and the basis'fothe alleged exemption. Any -viola ion of Section
r
_
'
r
, •-; I�., ,
I I
31:5 by any applicant tor. a, permit: subjects the ,ap pllcant to a civil
nalty of not more than five hundred dollars •
Fee
. $25�
• Issue Fee
$'3
•
,($500). ,-
7&.1, as owner of the - -
CReinspaction
-
Reinspection Fee,1
$25 Issue Feel
I
, $ 3
property'
compcocatien, will do the work, and the,structure is not intended or offered
t _ .. MECHANICAL
-
-FEES
-
I
.,
for sale (Section •7044, Business and Professional Code- The Contractor's
License La w.tloes not apply to an owner of a property wh o,builGs or improves
Boiler
-
Hood or: Type I ' ❑
-
- PUBLIC' SERVICES REQUKIR�EM IN
- - '-
��
�t�qA 4�' '
�';
thereon; and who does such work himself/herself or through his or her awn
'- -
Canopy Type 1 ❑ '
--,t'� I L
Zoning Approved By
ti�y Data
-
employees, provided that suchlimprovement5 are not intended or offered for
sale. If, however, the building or improvement issoldwithin one year of com-
Duch- Under Ground I
_
-
'Application Approved -By
Date
Ab
pletion, the owner.will •.have the burden of proving he/she did not build or im-
trove,for the purpose of sale). .
Duct -Structural
Refrigeration System
plication Issued By
Apia
+
Dat
LJ I, a5 owner of the propart Y,am exclusively contracting with licensed con-
Professions
Duct - Ventilating i
❑0-,10Q000 BTU 1_1100,000BTU
-
- SSU
OF FEES
tractors to construct the project (Section 7044, Business and Code:
Contiactor's_License Law does not apply to an owner of property who
.
'BUILDING
hMARV
V OJ :
�
O
.The
bmltls,pr.im roves thereon and who contracts for such Projects with aeon-
P � l 1
M �I � �I�
Exhaust System ❑ u by a ❑'
_
$ stem R -
y epair/Alteration
, i PERMIT i
SMTP $ -
•�
tractor(s) pursuant to the Contractor's License Law); i
❑Liam Section C. for this
,
- ' )LAN CHECK �! $ �!�•
SD PERMIT
exempt under reason
tl,.mTempt ,.
Firepl/FacL.Blt. ICBO,# i
•
PLUMBING ! ;'$ •
J,
-ISSUANCE $ ,
Date Owner
Heating System & Ducting
9 Y 9
i
,� I
'PLAN CHECK
ENERGY P.C. $
t
1 hereby ertif that 1 have reatl thi application d s -that the above '�
information is correct. I agree to an county ordinances
❑0-100,000 BTU 0100,000 BT
-. -
- - -- - -
_
ELECTRICAL , $ '
GRADING $
-
comply with all city
and -state laws relating to buildingryo ns ruct(��d' hereby authorize repre-
_
_
i1
MICROFILM $
)
I-
PLAN CHECK $
sentatives of'th is o e po t1>"ab.v entioned property ,for
inspection our es '�
1 4
t
MECHANICAL.- ! $
- TOTAL FEE $
//
-
Signature _ Date
I
Reinspection Fee '
$25�
Issue Fee
$ 3
a-- - i
PLAN CHECK $
Drivers' License or,55 i,
•CMFOS65-46 rev, 7/83 r•W-BulCpplicant;Pink -Accounting;
Goldenrod-Asse;sor _ ..
- .- __:. _. l-,
_.r .. _-l_._ .. _ ..
_ •- --.. ,_„- f[ pi_..... -.
�-•
FM
Y
CONSTRUC�ONfjj\ID PLANNING
APPROVALS', Permit# _ Date716spector
POOL PA
APPROVALS Permit#'
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
^
2. Soil Pipe-Undrgrnd. '
53. Steel Reinforcement
3.^Electrical Conduit Utility-Undfgrnd.
-
54. Forms
4. Electrical Conduit;Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
-
56. Rough Plumbing & Pressure Test
i ' -
6:j;EI ectrical UFER'Grnd.
-
_57. APPROVAL TO COVER-GUNITE
7. Footings -
.58. Electrical Conduit-Undrgrnd.
8. ,Foundation
-
- .
59. Gas Pipe, 0 Undrgrnd.; Test
9. -Water Pipe-Undrgrnd.,
,
-60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK_
11.115roperty 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
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
APPROVALS Permit #
-20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
-
22. Ducts, Ventilating
71. Product Piping 0 Gas OOil
23. Gas Pipe -Rough &'Test
72. Underground Flush -
24. Roof Framing
73. Undergrnd. Storage Tank OGas 000
25. Roof Sheathing
74. Overhead Hydra
26. T -Bar Ceiling (Structural) & Monocoat
75.Dry Chemical
'
27. Frame•and Flashing a4 T- ot)b
:(:55
x
'76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL -
30. Drywall NailingS
C
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power'Meter-Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
t�z, -�'�p
37. Final Factory Fireplacet.nDr�.
to
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
CJ
41. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation
'
44. ,Landscape Irrigation System
'
45. Sound Attenuation
..
46. Handicap Regulations
47. FINAL,STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
-- -- .'
50. Gas Release to Southern California Gas Co
I _
51. CERTIFICATE OF OCCUPANCY
No. Date
: •'
1 248 5
MESA BUILDING SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 926M
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_ 33955
'COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
DU13-�!Lcs.`bo 59?.* *.'**3[1 0
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APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BY
DATE RECEIVED
�
DATE IS�S+U En
2 ••�J"/
DING / /%'��
ADDRESS ! Z L -fT"'t
71BUILDING
/ / /'
PERMIT NO.
OWNER /
A. P. NO. (J
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��}} ��JJ /v
MAIL
ADDRESS q 4- Obi A Sr
ADDRESS/e!, L -Q '
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TRACTk;JdVO`
LOT -1 BLOCK
CITY F, -SA Plpl. �$`�
A D
CONSTRUCTION
LENDER QVo1JE
BRANCH
OWNER
ADDRESS
V LUE �
$
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CONTRACTOR �E.L,K
BY DATE/ ��
ADDRESS
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NO. OF
pLA�
USE OF NEW r
BUILDING
' TEL.
CITY NO.
IIJJ
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
(FROM C/L STREET)
'
SIZE NO. OF BLDGS.
OF LOT NOW ON LOT
ROM FT
FT.
USE OF
EXISTING BLDG.
FT.
SIZE OF NO. OF
NEWSLDG. ROOMS, STORIES
L. SIDE FT.
FT.
EXTERIOR WALL
ROOF
-COVERING
COVERING
REAR FT.
FT.
USOWINWT
DISTANCE BET.
BET. MAIN&
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MAIN SLOGS.
ACCESS. BLDGS.
VA.
ATE
N STEL TER )O T7 (J S
CP. #
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APPROVED
T/AIG STb 62 1,
APPROVE
e DATE /.Z /z_7/ z_7
1 hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any. person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Divisicn 3,
Chapter 9, antl that such licenses are in full force and effect, or 1
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION
and Professions Code, Division 3, Chapter 9.i
'
PERMITFEE $ ,
PLAN CHECK $
Signature of
Permittee
I..r�
$ r V
Authorized Agent
TOTAL FEE $ 4•
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COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR-STRUCTURALPERMIT1 7a 14 `'TL
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 t - Cjou/ J/ UU/ uu
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For Applicant to Fill in Completely — Use Ink Only
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,BUILDING
ADDRESS C-L.6AVIt{v.10
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A.P. NO.
BUILDING
OWNER OR``''�� p �
TENANT 'VJ(' L,iLCOS1QjrI,-
ADDRESS
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UNIT ORMAILINGN
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SPACE NO.
ADDRESS
TR fj.�2 LOT
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BLK.
TEL.
CITY Uti yq- IvLkE ,Oj NO. d+,) -3.i
NEW ADD LTE REPAIR
MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH
>
OWNER .4
ADDRESS
VALUE D
USEply$
ARCHITECT - TEL.
OR ENGINEER
V
ADDRESS
ZONE YPE GROUP
APPROVED.
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CONTRACTOR
BY DATE
ADDRESS
TEL.
CITY NO.
STATE - CITY L [�
APPROVED SETBACKS
LIC. NO. LIC. NO/_/7 If�'
SIZE
NO. OF BLDGS.
(FROM C/L STREET)
OF LOT
NOW ON LOT
RONT F
USE OF
EXISTING BLDG.
R- SIDE
Separate permits are required for
L. SIDE -
electric, plumbing and heating work:
REAR -FT.
USE OF BUILDING BE PERFORMED
PLANNING ACTION
`ANDnWO�.RRK�rTO
('Ll IJ
APPROVED
APPROVE
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
�.,u
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
wKl
•�
O SO. FT. Ae
the State of California.
I hereby certify that I am properly licensed as a contractor under
THE AMOUNT SHOWN UNDER VALUION IS FOR
frT
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or 1
THE PURPOSE OF ESTABLISHING A PER FEE ONLY:
am exempt from the provi ions of the State of California Business
VALUATION
PERMIT FEE $
and Profess n ode, Divi 1 h 3, C a er 9. (
• _
PLAN CHECK $ 2
Signature of
TAX $ O>
Permlttae
/ / �j /
$ 6 v
or
TOTAL PAID $
s Ill
Authorized Agen Date
/
23310
COSTA MESA BUILDING -SAFETY- DEPARTMENT
P. O. BOX 317 COSTA MESA, CALIFORNIA
F
or Applicant toFill In Completely
TYPE OR PRINT
(/7
COSTA MESA. CALIFORNIA
IN MAIL
N.-^HITECT TEL.
U
STAE LIC.T-NO. Z2 2-/ t N2.43 G` J O
SIZE., NO. OF BLDOe.
OF LOT NOW ON LOT
USE OF
FROM
DESCRIPTION OF WORK I i
/I I mOVlnO I' II Yt MOLIH
NO. OF
ROOMS STOR
WALLIROOF
COVERING
ILDING ANO WORK TO BE PERFORMED
I HEREBY ACKNOWLEDGI, TIAT i HAVEREAD THIS
AND STATE THAT THE ABOVE IE CORRECT AND AGREE TO COM.
PLY WITH ALL CITY OR�pyy��ANCEB ND HT T6y.�W8 ReGULATINO
BUILDING CONBTRUGTrON] i �/A //
I AUTHORIZED AGENT
FEE RECEIVEV
JAN 6 1965
FINANCE DEPT:
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only -
RECEIPT NO. I _ PERMIT NO.
BY
ONE I NO. OF USK OF NEW
A 1 I PLANS II I BUILDING IYV'�✓MANO'
LEGAL
OVERHANG SHALL BE LESS THAN
YARDSAPPROVED I YARDS APPROVED
MAIN BUILDING ACCESSORY BUILDING
IOM C/L STREET) _
'DISTANCE BET. BET. MAIN e
MAIN BLDGS. ACCESS. SLOGS.
' VAR.# DATE
N
SQ. FT. 4
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
VALUATION - m
PERMITFEE $
$
00 m
�—� ANC
O
43 3i
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDINGI n% F—L C,4'�Jt1N(1
ADDRESS
OWNER �.1 AC KIS
MAIL
IL I 0 �1
MAFSA 1 )L.
y y A
CONTRACTOR
I
TEL.
CITY
NO.
CONSTRUCTION
TELA
LENDER
NO.
STATE
LIC. NO.3
CITY
3 -S LIC. N
BRANCH
[ARCHITECT
NO. OF BL
ADDRESS
I NOW ON LO
TEL.
CONTRACTOR
I
-v
ADDRESS
Z— i�� t
.y-{��
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TELA
CITY I
NO.
STATE
LIC. NO.3
CITY
3 -S LIC. N
SIZE
NO. OF BL
OF LOT "'
I NOW ON LO
USE OF
Separate permits are required for
electric, plumbing and heating work.
BUILDING AND WORK TO BE PERFORMED
=df,t ILL O^
R -9-77�4- 00 57. 5.5G
FOR STRUCTURAL PERMIT
DATE RECEIVEDW naTF iAAnFr
EMCIAOWI==FAWW /II
OWNE
FIRE
ZONE
APPROVED
ZONE' NO. OF✓
PLANS
YARDS APPROVED
VALUE
USE OF N
BUILDING
YARbl
BLOCK
8
FT.
I hereby acknowledge that I have read this application and state
p(,
that the above information is correct and agree to comply with
p+
all laws regulating building construction, and I shall not employ
z
any person in violation 'of the workman's compensation laws of
the State of California.
3
I hereby certify that I am properly licensed as a contractor under
SQ. FT.
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION
Chapter 9, and the such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE
am exempt from a provisi ns oft a { California Business
VALUATION PERMIT FEE $
and Professions C
�Oner9.
PLAN CHECK $
Signature of U`-�
Permittee
$ S U// TAX $
J C/
Authorized ABent
TOTAL PAID $