HomeMy WebLinkAbout1191 EL CAMINO DR - Building Permits 4 c,~ CITY OF COSTA MESA - Y
4 BUILDING DIVISION'
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..�1 DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
F t % PERMIT
4. �' �#I� B05-00595
(714)754-5273 ••Fax(714)754-4856 • www.ci.costa-mesa.ca.us- DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
BUIJob Address: 1191 EL CAMINO DR Status: ISSUED
Suite: Applied: 04/13/2005
•
Vicinity: ROOF Issued: 04/13/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 14156111 Zoning:
Applicant: FERGUSON, LEW b_•? cji -40(
PP -- '-_c T' %. .-- , r-. ISSUED BY:
Address: 4091 E LA PALMA - - /./ _- —.- �';�-'" -, "`
SUITED ,vim - —II; Phone ((714)6305543"x:-:'
�71a/ U C ( i- >, (._
ANAHEIM CA",( ,,,r i IZip /92807 / / 2.--.....,,T,..--/..-.,
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MALEC, LOUIS B TR', ) — ''ry!� ' / 'N \.�
Address 1197 ELJCAMINO DR, -"-rte..,' '_= _- _`r'-'� , �'--- `x V (�'�`� -
�. / V . .e.,---j-2,--!...(-;?---"'"" Phone: ..•�,`'�..,(k.--,...1 ) vxxA-
- L/ COSTA MESA,-CA - 5 Zip: 92626 \, N . // A/Ay'A
j i C /2..(�i% 'VA { \? -A\V. .
Contractor: MCvCORMACK ROOFING ,�A 2 j -,
�, ,`
/Address:ss: 4091 E.IA PALMA y. '\ \�
' % SUITED%-? ' Phone: (714)630-5543 \-:,,h..A ( ' �
' ' ,ANAHEIM,CA .N'• `
- Zip 92807, � _,___ l • :License: • 043700 _- ' __\ '
/!
'Arch I J 1/f ' (I �_, )-";---.:17-4-7'-: [ 'Eng: N.;":;,A
Address. ', , , ' i -f a;C.';...‘---- -+3'� Address: ti /)I ,
';' f /' ct- - t..:Phohe: - � \--,.r....,�;^.� V Phone., r
- Zip:-, /IC) 2'1,-\ License: A! License: h,,1
ih.
n'. w,7 4.177 7-,w-• !;''' SCOPE OF.P.ERMIT:z: r ' `2� _--
TEAR OFF EXISTING SHAKES.,It INSTALL-1 LAYER OF 30#FELT UNDERI•"AYMENT;IOWENS CORNING 50 YEAR COMPOSITION SHINGLES:26
SQUARES ) :: .:.>:,� _ .. __ ,
1h.-- 7 �� '�_.. ._u...-.. . .. tit-' I M. ;Li:4,1
i i i
� 1 '.,� t r:' N f'�Ir
rr - ti 'teFEE SUMMARY`";ir�) - ,
•
SMIP Res.
Plan'Check �� „$0.00 _ .. . `s � y '�" Calc Valuation / $9,0oo.00:
;� Permit $167.25 - 1 �1� Claim Valuation Ay/ / -$9;00000
\ . `., '$0.90 t _ i ‘. rp '-" /I,
SMIP.Com: �. • $0.00 =�•__- ,' '
•
Other' ,$0.00 ti .. �� > ; 7'f"/ilL�
Inspection ' $0.00 '-J .t t7--4 � // y /
• Total: -1-1168.15 --; t j ` /LitJ i� in, /
//• \�V�C: - `o ' .. . /i '"Gr.., '' /__." 7� /,177
V.\,� i t; AVS 2- 4PLANNING &ZONING °d �/ /(Y
SETBACKS ';,i�_�G"✓��1���'\ , \ ;c-_-c`?� "( ,\ 9_,) j/
MAIN'STRUCTURE Front 6:3b),// /'rRear 0-0- -.' -- -Left 0;-0----- Right�0 0"; 7
ACCESSORY Front 0:0>. !. 'Rear 01 0 t- ,-.2>Left:',C7.0-0 L.-N\\ Right 010:' /
jI i_,
PARKING Existing: 0 ''.Required: 0�- •-'V�, Proposed:`' 0 ,-.-5:' '�
•
•
'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; 12:21-92)
EXPIRATION: This permitshall automatically expire'and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of'180 days.
INSPECTIONS: lit order.for the-work,authorizedmnder this:permit.to:bevconsidered legal,.such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR'INSPECTIONS'.CALL: (714)754‘5626'
2446-48(6/00)
I
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: t' '
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of.the
work for which this permit is issued.
❑rl have an will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
,triMy work 'com/p�ennssatioRtn re ce Older an policy numb are: A, �,V�j t 1 ,A `'� /+�, /yam
Camel Y; ,I nil/vvu�� 1 iAA .7,ten� o Q w/It,c� 11 !v 1 {-�• . .,.Number:�l!✓l..DSV I O I l i1�(A /
\[Ttiis action nook(be Completed if the permit is rued at ne hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' -
compensation law of C. ornia,and agre' hat N I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comely with th: ovis;. ^ `
pllcantsldn3tufe:. r-^ a ' I •i Date:- :,..R .L1• 0
WARNINGFAILURE T•SECU' WORKERS'COMPENSATION i E G IS UNLAWFUL AND SHALL SUBJECT AN EMPtQv€R TO CRIMINAL' E TIES AND CML FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE( 100,.r r•IN ADDITION TO THE COST OF P• E TION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby afftrm.thatt am Heeled n r ovis sof Chapter 9(commencingwith Section 7000)of Division 3 of the BusinessAnd of i•n e,and mylicense Is In full
,,...,--;,--N--.„. 5i,w
forceandd ffecL.Lic q - 1' V A � //���� Clensft7'-t 'e`-
Co to, Signn re'676.41,^ t •➢A 1L lU1NV� oate _
J T
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,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 applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes Ii No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
.
Ignature Ot egad Owner(s) �
'�-
g2)
� �
rNOr vino zed pPlicanl`a:+'+t__ .. _ Dat -.._
INSPECTION TYPE,. . ' '- ' MTh ' - 1NIRULS " CODE It 'INSPECTION TYPE •- : gltlE - IT�Lfi
1616 Fixed System Final Fire Prevention • 206 Final Mechanical , -
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root • ZCi'I�7 Gw - 210 • Final Electrical .
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place' ' 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition250 Final Building/Occupancy • - ,
la-
per""'R CITY OF COSTA MESA
4 BUILDING DIVISION
r,,..�r ,i DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER, ia
o PERMIT
`fi B05-00595
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1191 EL CAMINO DR Status: ISSUED
Suite: Applied: 04/13/2005
Vicinity: ROOF Issued: 04/13/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 14156111 Zoning: I
Applicant FERGUSON, LEW ISSUED BY: --(A-IJ
Address: 4091 E LA PALMA
SUITE D - - Phone: (714)630-5543 •
ANAHEIM,CA - Zip: 92807
Owner: MALEC, LOUIS B TR
Address 1191 EL CAMINO DR
Phone:
COSTA MESA,CA,- Zip: 92626 ' _ „
Contractor: MC CORMACK ROOFING ,
Address: 4091 E LA PALMA '
SUITE D' , Phone: (714)630-5543 ` , `
ANAHEIM,CA - .
Zip: 92807 -License: 643700
-..
Arch : Eng:
Address: - - - Address:
Phone: Phone: •
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING SHAKES, INSTALL-1 LAYER OF 30#,FELT UNDERLAYMENT,&REROOF WITH GERARD METAL SHAKES-ICBO NER
423-1.4 LBS(26 SQ). -
. FEE SUMMARY
Plan Check: $0.00 , - - s9,
Calc Valuation: 000.00
Permit: $167.25 - Claim Valuation: $9,000.00
SMIP Res: • $0.90
SMIP Corn: $0.00 • - .
Other: $0.00
•
Inspection: $0.00 ' , ' .
Total: $168.15 ,:
PLANNING &ZONING _ , ,
SETBACKS ,
MAIN STRUCTURE Front 0-0 . Rear b-0 Left 0-0 Right . 0-0 ,
ACCESSORY Front 0-0 Rear 0-0 Left , 0-0 Right 0-0 .
PARKING Existing: ''0; - Required: 0 Proposed: 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, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period 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 inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
r WI.
DECLARATIONS (l (l
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I ve and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
_ _mark for which this permit is issued.
(have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
M wo,rN�e^rscompensation Insurance carne nd,�f Ilcy number are:i. —+,,�,,,�
Cerner: !kta^-Ti•.,.._a...ret_ dA �""'��•/`-t C-t PdC iry.Nirvlber: 0-PC01OI OW 0}.6.700
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Calif ,and a that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall forthwith
(l�[ 'I comply with these provi ' . Y q
inatitzr
WARNNIN( FA1L'U E T SE E WORKERS'COMPENSATION ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAPENALTIES AN/�L FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that� I am licensed nder provisions 9(commencing with Section 7000)of Division(ol-the.Busiir ess and Pro[essionnss C e,and my license is in full
force and effect.tf&G.L- -a /}� Class.ay C3
Contraul a-- c:79;4-.Aa-
. 1O C'? W G S —
CONSTRUCTION LENDINGDIGAGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,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 applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document.i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division,
Signature: Date:
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Seolion 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (II yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
na Of Legal Ownegs) Date
�_•
��_ e)V/3/o sr
:r.i•Sed Applica•f L_DaI1__
LODE I INSPECTION TYPE RATE .I A. CODE I INSPECTION TYPE PAR tNTMALS
1616 Fixed Syst=-I Final - ention 1 206 Final Mechanical
1266 •••I Spa F�=I ,� r'. ' _, 2� Final P. •Ing
200 nal Re-R..f / A • Fin; Electrical
201 F al Bloc •Gaining , a yl 2 Fin.l Fire Prevention
202 Fi :I Fa•cry''e Pla.: car/ 220 • --.. ..pprova
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - --- -- -- - --- ---
PER IT NO. TRACT NO. , LOT NO.. UNIT NG.
Iclri�oF COSTA M� /,f NSTRUCTION PERMIT ' ".J, �a�$� • • , •
.4:,ProjedAddress / f tt. Oq/.(/O DA" • _ (-5 . - L 5886 1 2/ 1 6/85 150.50• IL
(•Ap •plicant's Mailing-Address/ 'WO. •1 ''J_ TYPEOF CONSTRUCTION - U NEW' U'ADD U ALTERATION U REPAIR : - - " - - ,
• `Y OW f' //15 Phone t7t• ❑ CONVERSION Q DEMOLISH ❑ OTHER q.p•-# - - Zone
Owner's Name. ��(/y /�,,� DESCRIPTION OF WORK/USE OF BLDG. � �/
Address �/7j '� rq7-/� •V /AG - t�-'/��/f� S Main Building: • Accessory Building: _
Arch/Eng. JW�f� • License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION IJ STRUCTURAL E Front • ;, Q
Address - I ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - B Rear N
Contractor's Name Phone - . ❑ OTHER / I
-
• Address(mailing) • PROJECT DESCRIPTION SQ. FT. r/7f '/'- OCCUPANC j�} /''/ C Right •
N
l���lll CONSTRUCTION TYPE VALUATION S. ( S Left • R
City License No. ZONE GRADING CU.YDS.• ACRES •Ref.# ParkingRe Pr E
LICENSED CONTRACTOR DECLARATION Ping. Req./Provided
•
.1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: , '
Planning Notes: •
- _ M
with section 7000) of Division 3 of the Business and Professions Code,and' - - T
my license is in full force and effect. • _ -I
-License Class - - License No. - S
Date ' Signature •• . PLUMBING FEES• ,
WORKERS''COMPENSATION DECLARATION Bar Sink Showers• , •
' - I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL • FEES
', Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - Service Sink
00, Lab. C.) Automatic Washer Transformer '0 15-50 KW '
.tlicy No. Company Backflow Irrigation - , 0 50+KW •
8 Certified copy is hereby furnished. g Sewer Cap Construction Pole Sub.
Certified copy is filed with the city Building Division. Bathtubs SewerConnection CookingUni[ Meter pup to 100 amps --
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers $alar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that In the performance of the rk for which this permit is issued, I
workers'
rs' employ any person in any er so aytO gecom subject t0 the Drinking Fountains ' Solar Tank p■ Fan Motors 00-1 HP ❑1 h'-8I
Datrke �C'mp}n-r Laws of Calif a- �,( /�,
$ /B A"7 Signat urs �.h z/ {'lam Floor Drains Swimming Pool w/Spa F.A.U.
•
'NOTICE: If,after making this declaration, you should become subject to the _ Inc.$Olaf ❑8-15 HP ❑16-15+
Workers'.Compensation provisions of the Labor Code,you must forthwith Floor Sinks - Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
• CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet
I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for -which this permit is issued (Section 3097 Civ. C.)
Interceptors Water Heater.. Outlets Ran
' Lender's Name 9e
Lenaer's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION - ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories • Auto-Wash Disposal Garbage
following reason (Section 7031.5 Business and Professional Code: Any city or ;Standing Sections •
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - Generator 00-5 KW 05-15 KW
any structure, prior to its issuance, also requires the applicant for such permit t Y Trash Compactor
to file a signed statement that he/she is-licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000) of .
Division 3 of the Business and Professions-Code) or that he/she is exempt
theref m and-the basis for the alleged exemption. Any violation of Section -
Y by ,any applicant for a permit subjects the applicant to a. civil
,"':.Ity of not more than five hundred dollars($500). -
;I, as owner of the property • .. ••• _:. •- . their ale I Issue Fee $ 3
'h will do the work,and the structure is not intended or offered Reinspection Fee I $15 Issue Fee • $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's I MECHANICAL FEES
. License Law does not'apply to an'owner of a property who builds or improves _
thereon, and who does such work himself/herself or through his or her.own . . DEVELOPMENT SERVICES REQUIREMENTS: 1
employees, provided that such improvements are not intended or offered for Boiler' . , ' ' Hood or Type I 0 '
sale. If, however, the building or improvement is told within one year of com- , Canopy Type II 0 ® Zoning Approved By • Date '
pletion, the owner will have the burden of proving he/she did not build or im-, Duct-Under Ground' Building Approved By n Date' • I
Lirove for the purpose of sale). J/IS/ /
I, as owner of the property,,am exclusively'contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Date /.Z /WA
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ' ❑0-100,000-BTU ❑100,000iBTU SUMM RY FEES
builds or improves thereon,and who contracts for such projects with a con- , pc //,,
• tractor(s) license pursuant to the Contractor's License Law). I am aware that - ' BUILDING PERMIT $ /-31 SMIP • $ f�V
Exhaust System ❑ Multiple ❑ System Repair/Alteration `
• proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT'
0.1 am exempt under Section B.8...P.C.
for this reason 11. Firepl/Fact.Blt. ICBG# . ■ Fire Dampers •PLUMBING $ ISSUANCE $ -
•L‘ i- -E���5 Owner • ,Heating System&Ducting Registers ; •- ® PLAN CH CK 25% $ i ENERGY P.C. $
I hereby certify that;1 have read this application and state that the above • 00-100,000 BTU ❑100,000 BT •
information is correct: I gree to comply with all city and county ordinances ELECTRICAL $. GRADING $ ,
and state laws relating building construction, and hereby authorize repre- ■ N PLAN CHECK 50% $• ' MICROFILM $'
se atives of this c\ty to enter po the above-mentione property for -
' i pectlon purposes. / I \ MECHANICAL ,,ll
ignature 'Date%-7G"F� $ • TOTAL FEE $ ��•SC.I
vers' License or 55# $15 Issue Fee r $ 3 PLAN CHECK' 25% $ • I I
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor \
CONSTRUCTION AND PLANNING :POOL!' 'A-
•
--
` 4 APPROVALS Permit# Date Inspector APPROVALS Peri....# - - Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' .
'2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms - • - .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -
a 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, 0 Undrgrnd.;Test - •
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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
16. Rough Electric Wiring 67. Fencing & Access Approval • - .
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING-
18. Rough Electrical-TBar Ceiling 69. POOL/SPA SYSTEMS FINAL -
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -
20.-Rough Factory Fireplace APPROVALS Permit 4 •
21. Ducts,in Structure 70. Underground Hydro
22. .Ducts,.Ventilating 71. Product Piping 0 Gas 0 Oil ,
23. Gas Pipe-Rough & Test ' • 72. Underground Flush - - -
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas D on-
25. Roof Sheathing 74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & 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. 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 -
37. Final Factory Fireplace • .. - '
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final '
42. Backflow Preventer - -
43. Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation . - . - •
46: Handicap Regulations
47. FINAL STRUCTURE & BUILDING /9/Rea QS .'
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co
51..CERT!F ICATE OF OCCUPANCY •
No. Date •
- CITY OF COSTA MESA -CCC T\CV L=r.-L� -
6388 - - �}� FEB 8 1962 --
Building Safety Department 1 / J`
�� �J FINANCE DEPT.
Application for permit for the fabrication and erection /V: % V" CITY OF COSTA MESA
of awnings, advertising signs or devices. / `
LOCATION FOR OFFICE USE ONLY
Cali l2/eft
1962
Building Site Address II 1 St C4 1NO apio - Date Issued `L Permit No./�`�
Name of Leasee /WACC0 ro,PPDR.4T/oA Phone NE 6044 Fire Zone a Group
Approved b Date
Contractor -CAP Tn. 6/6N Co • State License No.
ZONING
address .Z 7 f T- �. S'7tC -City nS4N7L9 4/Y/4 Phone k'/ 7 2 6/ 2 Zone / Use of Bldgs. - "/'
',Redor A. P. No. g2t-7_c—"->L. �n3 " �2' ii-D"p!
3ineer State License No. (Si - /
Bldg. Site Address /I 9/ Si �"G'->zM Jr
address City Phone
DESCRIPTION Legal Owner -"--��-
Description of awning, advertising sign, or device:
Address
Awnings canvas ❑ metal ❑ Width: 4 ft. in. Length: e it. — in.
City Phone
Ground Sign Cgl Projection Sign n Roof Sign 0 Wall Sign ❑ Metal Letter Sign ❑
Yards Approved.
Banner 0 Canvas Sign Li Gas Tube Electric Sign (Sub-section 1.44, Ordinance 313) ❑ Large Sign in excess of 8 sq. ft. Setback from center line
Combination Sign ❑ Special Device (other) n Explain: of street to front property line -10 ft. in.
From property line to edge of sign / ft. in.
Two copies of plans and specifications shall be submitted with application for permit for each sign. Plot on Side Yard Setbacks:
plan sheets proposed location of sign and locations of all other signs at site. Minimum size sheets must be 18" /
by 24" and non-erasable. Left Side (,O, Sft. in.
/ If within the 10-foot area of front property line, owner is to sign written agreement with the City. Right Side / 7 ft. in.
--of Sign - Thickness ft. in. Height Gr ft, in. Length e-1 Building Line Setback fromft. _ in. center line of street .5 S ft. in.
Weight lbs. Height above grade C ft. ' in. Projection ft. in. Area of Sign - _ft. in.
The undersigned hereby agrees to fabricate and erect awning or advertising structure within the intent and
Height above Grade ft. in.
meaning and in strict accordance with the provisions of Ordinance 95, Ordinance 313 (Electrical Ordinance of - g
the City of Costa Mesa), and all amendments thereto. Projection ft. in.
ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICANT. ALL FOOTING, FRAMING AND ELECTRICAL IN-
SPECTIONS SHALL BE CALLED.
Length ft. in.
Signature of The amount shown under Valuation is for the purpose of
Awning Height above Grade ._ ft. in.
Permitee '�q. establishing a permit fee only.
\ o Projection ft. in.
Authorized Agent CaR-crR Sion[ Co VALUATION Permit Fee $ 2- r 41-c7 a--- 6
Location and size
/ $ Plan Check $ �" approved by U/ �
Recd. by ‘e Date ���'(O �� I Total Fee $ a -� Date r— 3/-4'2'
Form 219-1M-11-CO—S-8 P
Ot 2
lkT�►ininq Laboratories , c�outJzv1 C of
A, OZ o a E o¢nla, fine.
4< d('A' I ' P.O. BOX 47 . 3310 AIRPORT WAY . LONG BEACH, CALIF. 90801 • 1213) 426-3355 . 1213) 6361386 • 1714) 828-6432
1.-__...........�_...._._. ERANC.OFFICES:
TESTING 1514.D Nook Harps Sereno (-4 7 Non D.n,unlw T.alne
San An..C.111c,n1.911o) • P.O.80.0
(711)5)1.2045 F I,.I,/I Long Bach,C•111.90801 121)1 616.2)86
June 8, 1977
Examination: 77-3034
•
GUNITE
COMPRESSION TESTS ON cQkkC CYLINDERS
Robert C. Bennett
•
9130 Cedar #3
Bellflower, California 90706
. PROJECT SWIM POOL
ADDRESS 1191 El Camino Dr. , Costa Mesa, California
SAMPLE FROM Two from shallow end, two from deep end, two from bond beam
ARCHITECT CONTRACTOR
Madrid Custom POOLS
ENGINEER SUBCONTRACTOR
J. M. Reagan . Enterprise Gunite
SPECIFIED
MIX 4.2 - 1 STRENGTH 2,000
DATE CAST 6/1/77 SLUMP
DATE TESTED 6/8/77 6/8/77 6/8/77 •
CYLINDER NO. 1 2 3
COMPRESSION 7 days 7 days 7 days
•
TOTAL LOAD, LBS. 85,000 84,000 85,000
•
POUNDS PER SQ. IN. 3,005 2,970 3,005
COMPLIANCE 7 day tests comply with specifications.
MADE BY . DELIVERED BY RECEIVED ON
CYLINDERS Steve Bennett 6/2/77
DISTRIBUTION:
Robert C. Bennett - 3 •
.Costa Mesa Bldg. Dept .
•
•
•LL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS. AUTHORIZATION FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS.
TRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS, THE PUBLIC AND OURSELVES.
330-12
'CITY OF COSTA MESA
- BUILDING SAFETY DEPARTMENT
Registered Deputy Building Inspector — Certificate_ fiof Compliance
Date of this Certificate vv7✓6 // /9'77
Building Address //9/ AZ �949//✓9 l�P /csTa��A
Owner ..Z40‘1/5.
/ /�c
Contractor,//"/$c4,4-7 /-//.47.72 17'LS
Address /,A�g5i1i9. /67�G
P^•mit No. ' (39 7 Date Issued �4y/// /777
RECEIVED
To the Director of Building Safety: jUi( 3 a An
I hereby certify that the following portions of work on the buildings at
the above address which required continuous inspection and which I was
employed to inspect, were inspected by me and comply with the provi-
sions of the Building Code applicable thereto.
[ I Concrete [ [ Masonry [ ]Welding
�g
[ I Reinforced Gypsum [ fifikttt00
Swimming Pool Size y'5D"I/ji€ t(Tunite "H- J '[' ] Hand Pack
Sacks of Cement //I Jr Tons of Sand Ys—
roximate percent of water in aggregate er/o.y
This report covers work completed during week ending [4/8-7/977
REMARKS: /�
A6//r/-'d erf/Y6 / DONZ/iA'G /�_ p�rsi'n
"eg(stered Deputy wilding Inspe for
/A//Li4C/t fv/vi%B Cyd
Name T
g/t€/C*..iA. PA/7 s/9ra -
�Elv 7 .ey pe—A.
Address,/30�i/A P '�3
77'
3 ,��, �JJ. �y , 47e
Laboratory 2 /�/� y _Z'4.ZUPAc�elephone/ivy
CMF 0406-46 (BU 6)
601 7% 11 /79 36.50 TU, "
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT -- ,
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
REC Y PERM T D rer
For Applicant to Fill in Completely —Use Ink Only
,BUILDING � A.P. NO. / ! ` _ a
ADDRESS 1
/7/ LU//(4✓ON
re �//�
OWNER OR Irv/ f n/�^/�� ADDBUILDING
RESS if �+C� (.��s.L�r brr
TENANT /�, l /V/tel L.�-
UNIT OR
MAILING SPACE NO.
ADDRESS 1 7/5 45* Ita/70 ,18, �/(� TR.NO LOT 1O BLK. /
CITY �S ^(( �� �5� N(1 3:3 /p0 NEWI�• ADD ALTERI REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER /t/c.741;..: ^ u a
BRANCH ` `t �. l4-age
OWNER /I. ‘14-age-Co
ADDRESS c VALUE /,.�{OQ
ARCHITECT TEL. USE / tlA q ., $Z�v{�
OR ENGINEER NO, r J1'�r�.r�' 11�
ADDRESS ZONE R. 1 TYPE GROUP`7O
/ Q
CONTRACTOR A/40/. ' _ 4,604 Z BYPROVED DATE (/� 7
ADDRESS
TEL. /
CITY NO.
F^ STATE CITY APPROVED SETBACKS
LIC.NO. LIC. NO.
(FROMW SIZE `/ / NO.OFSLOGS. FRONT /L '� BEET) 4„/'�
0. OF LOT St) X / NO. ON LOT / FROM FT. Y
y • USE OF /( ..I6 � 4LUNG
EXISTING BLDG. r' 'V/ 4VL R.SID
vs fig):
FSeparate permits are required for . , T, ^/`
6 electric,plumbing and heating work: : •R Fr. iDt 1'
I„. USE OF BUILDING AND WORK TO BE PERFORMED • •NNING ACTION
Q
CI
.1 WS/f4-Z1 %0L 52Z*R /%41n,& DATE
APPROVED
Q
7 7�//./% ABY ROVI/4V/\ ' , DATE / —1/79
a
L..,
0. I hereby acknowledge that I have read this application and state n
Q4 that the above information is correct and agree to comply with
M. all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of
-S the State of California.
m
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. N
(
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro I
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE/I,ONLY: e I
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 2 !. di el
and Professions Code, Divis' 3,Chapter 9.
Signature of lir TLL( Bo PLAN CHECK $ ! Z. OO o
Permittee /= $ 2,00 TAX $ • $.1 u
or i/ 7 + -
Authorized Agent Date TOTAL PAID $
fffPPP • YYY ,
43954 ..•GU
4-•
"M 11 77c�.OQ 52L,.r ..: , IIv.�G
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A L ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
Q /• �/ R I E Y DATE RECEIVED di/
IS$UE Z
BUILDING j 7 // �/ �tl �.il/}Cl d'�r• vi// ! y
ADDRESS / 1 �y /, ,s'6 / - /G
�1v/A�1 /) PERMIT NO.
OWNER 4.0 U l S / Io /E (_ A.P. NO.
MAIL • /^ BUILDING
ADDRESS CLO VW/ .. 3"- .; ADDRESS iv
11N/per /y.
CITY Co 976> /'� TE L.4.n TRACT NO 7 LOT /G BLOCK! I- g d NO. V 9 . 1fria
CONSTRUCTION A' NEW^/ADD ALTER REPAIR) MOVING DEMOI ISH
LENDER /r'
BRANCH y�
OWNER In u)3S / `Cl/P L.
ADDRESS (�/1 /J
ARCHITECT , �//1 / TEL, ) USE ( /h(4 L- a^ ,��,7- VALU$ / G�
OR ENGINEER d, LU • '/"'/$1 �'YtJ TEL. ��+•�^� ! /�(/�.• (d
FIRE
ADDRESS t/,// fi / Ca 1'///)t' £/,�/,y.7I / ZONE //A PE GROUP
CONTRACTOR / Ir1,•j i ii ` „,/ 1i#'v -5
APPROVED`%� DATE(; /' 7 7.
ADDRESS HBO / t e4jet)/Ilr! / (: e. -
CITY `"�.J/VY-ii�t_ ar(,g TEL. C'1y//x ZONE t-�`I NO.OF . USE ON NEW iP4
)) ,,ll v /�/ PLANS BUILDING (� q
— STATE ] j7 CITY YARDS APPROVED' YARDS APPROVED
LIC.NO. 3l. ! des J LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZEL NO.OF BLDGS. (FROM C/L STREET)
4 OF LOT 79 X /l J I NOW ON LOT i FRONT J FT, _ t/0 FT. _
'IC USE OF
EXISTING BLDG. e../Jr L• 4 R.SIDE FT, J 2 I FT.
co
Pal Separate permits are required for L.SIDE 2 1 FT.
welectric,plumbing and heating work. REAR FT. / FT.
i-, USE OF BUILDING AND WORK TO BE PERFORMED • DISTANCE BET. BET.MAIN&
QMAIN BLDGS. ACCESS.BLDGS.
diet) /'` VAR.# DATE
a, SWJ?, I _ C C.U.P.# • }�^ APPROVED
____By
/I1�//< DATE •S - 1 y` 7'
y ....Y..YY"`
a I
a0 i hereby acknowledge that I have read this application and state n m s
rg that the above information is correct and agree to comply with J
0. all laws regulating building construction, and I shall not employ
x
Z any person in violation'of the workman's compensation laws of
I' 1
W the State of California.
S
I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m I
Chapter 9, and that such licenses ere in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F ONLY' n
$ v
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE
and Professions Code,Division 3,Chapte 9' Q nl
g f// / ��. _PLAN CHECK $ �/� o
-,N/ ar 0 N
Signature of u,
Perm MOO $ TAX $ 60 t
U
Authorized Agent _ TOTAL PAID $6 d. ,
Plan 14,-,AR FEE RECEIVED
. ii
1 - 16191 ' . Parcel B
COSTA MESA BUILDING-SAFETY DEPARTMENT A FN'.. 150.1 2
1
I P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE ���1 •• l.' ��
CITY OF COSTA MESA .
For Applicant to Fill In Completely APPLICATION.FOR PERMIT
TYPE OR PRINT BUILDING
Tor UILDING 119/ F�J (-.b w .
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. PEP 1T N
OWNER Mesa Del Mar DevelopmentTT� Co., I I 71,.TT I
ADDRESS 3800 E. Coast Highway RECEIyED BY I gATB/R.. _ /GATE IBBUHD a-
cme
K l S i / i5 Z/
Corona Del Mar NoOR 3-h22( BDDRESS
ARCHITECT Cliff Olsten TEL MESA. CALIFORNIA
OR ENGINEER & Assoc NO.WA yp-122
ADDRESS 90251 E. Florence Ave.,C2050r3 FIRE
ZONE TYPE GROUP �=- 1
CONTRACTOR Macco Corporation BYPROVED DATE
ADDRESS 3800 E. Coast Hiiway ZONING
CITY Del Mar, Calif.
ZONE _I NPOO.OS USE OF NEW S' 7,-,m,
ppp Corona I I BUILDING Wi y,� R
TEL.
LIC.NOATE 98VOH SB-1 NO. OR 3-14220 DESCRIPTION `
LEGAL
�n y 0 pa,,«
SIZE oL r 78:....-#11/4 //0 NO. OF BLDOS re
OF LOT 8635 S.F. NOW ON LOT None A p NO (1 /_ ' 4 1/7/6 a.
USE OF YARDS EVES
EXISTING BLDG. -None APPROVED ALLOWED
SETBACK LINE FROM r I' (CENTER LINE ST.)
CENTER oP STREET 551 REAR YARD)4011011 FRONT -ms's FT. IN.
SIDE YARD I LEFT 71.4H ! RIGHT 91611 R.SIDE 9 FT. 6 IN.
DESCRIPTION'OF WORK• - L.SIDE FT. IN.
NEW I X II ALTERATION I II ADDITION I REAR 410 FT. /0 IN.
REPAIR
�1 II 'II MOVING II DEMOLISH I BYPROVED . �R� ��
� DATE / 16
IZ
SELf?61,x711211 (ROOMS 6 STORIES 1
EXTERIOR WALL _ ROOF Built up �"
COVERING WOOd 8C-Stu C.®/ERING Compo & Rock • •
USE OF BUILDING AND WORK TO BE PERFORMED
Single Family Residencte .Tiring Area 1702 S.F.
W/attached garage. Garage II 163 S.F.
35=-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE'AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. - VALUATION
SIGNATURE O PERMIT FEE $
PERMITTEE ° Del 4._ Development Co,. �- N
BY / / �/ $ 18,1167.00 PLAN CHECK $ ��—
AUTHORIZED A. Illilapf� ��'� �________ n C
... - - TOTAL FEE $ 57000 10
LL
L\