HomeMy WebLinkAbout1540 ELM AVE - Building Permits •
. .- . ,r
4<e 9 CITY OF COSTA MESA
• BUILDING DIVISION
F i'____r.,_.ra s) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
f PERMIT
• naTict 6. 05-00381
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1540 ELM AV Status: ISSUED
Suite: Applied: 03/09/2005
Vicinity: ROOF Issued: 03/09/2005 .
Parcel Number: 13930110 Zoning: R3 R3 - _ 1
Applicant: REES, GARY ISSUED BY: 1)(r
I
Address: 126 COMMERCIAL WY
Phone: 949-548-5569
COSTA MESA,CA Zip: 92627
Owner: ULANOVSKY, JACK M TR
Address 2450 MARSEILLES WAY
Phone:
COSTA MESA,CA Zip: 92627-1494
Contractor: G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING
Address: 126 COMMERCIAL WY
Phone: 949-548-5569
COSTA MESA,CA
Zip: 92627 License: 828379
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE-OF PERMIT
TEAR OFF EXISTING ROOF,INSTALL 2 LAYERS OF 151/FELT UNDERLAYMENT;&REROOF WITH 30 YR.TIMBERLINE COMPOSITION
SHINGLES(30 SO).
FEE SUMMARY
Plan Check: $0.00 • Calc Valuation: $6,700.00
Permit: $139.25 Claim Valuation: $6,700.00
SMIP Res: $0.67
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.92
- PLANNING &ZONING
SETBACKS ' - -
MAIN STRUCTURE Front 0-0 Rear - 0-0 ' . Left ' 0-0 Right, 0-0
ACCESSORY Front 0-0 • . Rear , 0-0 Left 0-9 - • Right ' 0-0
PARKING gxistino: o .._Required: 0 ., Proposed: l -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)
IEXPIRATION: 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 I
I 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)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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.
I 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.
—My workers'comp[e(6�sail Insuran rider an policy number are:
1Carrie`rm- J`"( �-9�t� Polis y.Number. Z 6g 2 2,051(This section need-not be completed ll the permit/s valued at 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 California and agree that if I ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provision '7
(
Appllcant'Slgnature: e/ Datet 7 — r 0
V
WARNINO['FAILURE TO SECURE KERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(9106,000),IN ADDITION 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 licmsie ticsunder provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect ticrM— uuu���///cb ?1 7 q `Gass'#• C. 3 ?/
Contractars.Signeture: .t `rzL a
( Z \/ "fly //�.ci (Date: 3 - -
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).
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 end 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 builtling 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 Driver's 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 6,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 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 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 apPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U No
(Section 65850.2 of the California Govemment 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
(II'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 ❑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.
•f g n Date
r(s)
�% 3 - q- � s
. • di rr uthorizadApplicant —Date_
CODE r ' tlf', IPAIS IKIMALS CODE JNSPECTION TYPE "lam INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof ,'1 N"A g .i �n 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 Demolition 250 Final Building/Occupancy
PROJECT ADDRESS: 1540 ELM AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 061711
OWNER'S NAME:ULANOVSKY, JACK M
,f ADDRESS:21916 RAINTREE LN PERMIT NO: B 061711 PLAN CHECK NO: N GOVT: N BUFF : N
EL TORO,CA • 92630
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER:S81-4076 REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/BUILT—UP SO FT; 1 , 470
ADDRESS: UNIT:
CLAIM VALUE: 1 , 420 . 00 CALC—VALUE: 1 , 420 . 00 GROUP OCC: M-1 /
PERMITTEE:CRANK BROS ROOFING CO ( 714 ) 548-5569 ./
ADDRESS: 126 COMMERCIAL WAY COMMENTS : REROOF 400SF GARAGE W/BUILT—UP
COSTA MESA CA 92627 **********,F*****)Ex** **±LSE*x*****iE***************** ****>f+E*FE***x*** x**** •******
LICENSED CONTRACTOR DECLARATION: I hereby affirm '0 I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,
I my license is in full force and elect. SE TB ACK S
CITY a .: 05993 STATE LIC.4 0 8 6 7 7CLASS:
Dat / ) -47 3 Signature: A -a_ MAIN BUILDING ACCESSORY BUILDING
WORK RS'COMPENSATION DECLARATION: I hereb that I have a certificate of consent to self-insure or a certificate of Workers' "RNT: FT IN REAR: FT IN FRNT: FT / IN REAR: FT ' IN
Compensation Insurance,or a certified copy there. non MOO.Lab C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY N0.:2 8 5—9 3 UN I T 22 4 EXP.DATE:0 1 /0 1 /94
CDMPANY:STATE FUND PARKING REQ: PROV: PARCEL: 13930110 ZNE: REF NO:
❑ Certified copy is hereby furnished. El Certified copy l d with th ily Building Division. PLANNING NOTES>
1 ES>
o >Date; 3-F "S Applicant .�( ee ��"f ************.,....*********************-lE*3E**1E***1Exif**#****************,{'*****N***
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit Dior one hundred(3100)or less). D E V E_.L OPMEN T SERVICES / R E Q U I R E M E N,: ".-S
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'CompensatioiiT3ws of California. ZONING APPROVED BY DATE: .
Date' Signature: a
NOTICE:If,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: / 1.-" 01
Code.you must forthwith comply with such provisions or This permit shall be deemed revoked. r 1 I /
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the pedormance of the work for APPLICATION ISSUED B Y: DATE• 'r 41 3 `/ p
(3
which this permit is issued(Section 3097,Civ.C) *************M****-************************** a*********x-***********� irr**ic**-x-****
LENDER: ************************M******M********************************* *************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 35 . 00 . 50
repair any structure.prior to its issuance,also requires the applicant for such permit to lite a signed statement that he/she is licensed _ s,1I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business •
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN ____�--
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTAL S————> 35. 50 0 . 0 0 0 . 00 35. 50 35 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his ro herm owntisemployees. provided that mpl improvements me are note the bd or offeredofprovingfor she/. If, nothowever build
buildingor
or REVENUE DIVISION TOTALS--> COLLECTED: 35 . 50 OVER/SHORT: . 00
improvement or hof sold withiner,one year of completion.limp the entsr will have the burden forhe/sheldid not r she improver DIVISION
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 35 . 00 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon r
and who contracts for such projects with accntractor(s)license pursuant to the Contractors'State License Law).l am aware ****************************M*****************x********************************
That proof of their Worker's Compensation insurance should be provided to me INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner SFR 1420 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 420 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533.andEND OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
•
permit tat construction or modification from the Air Duality Management District.Residential construction applications are exempt Irom
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that •a above information is corn . ogre to comply 'th all city and county
ordinances and state laws relating to budding construction and•'by authorize representati oft - icy to enter .on he above-mentioned
property I t inspection purposes.
Date: 3-77 signora; A •----"S DATE0104/13/9Q137132 TOT
TIflE: 11:44 35.50
Driver's License or Social Security a:
164146 White—Building;Green—Code .cement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
CONSUUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date Inspector 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•Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
•
8. Foundation - 59. Gas Pipe, 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
I
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
20. Rough Factory Fireplace APPROVALS Permit #
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 O Gas O Oil
25. Roof Sheathing 9Q� 74. Overhead Hydro
26. T•Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding I 77. FIXED SYSTEM FINAL
29. Insulation i 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 I .
43. Backflow Irrigation
44. Landscape Irrigation System •
45. Sound Attenuation •
•
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING Lf ize i I -
- -f
48. FINAL PLANNING
49. Electric Release to Edison V
50. Gas Release to Southern California Gas Co •
51.-CERTIFICATE OF OCCUPANCY •
No. Date
•
• 11139 FEE RECEivtu �.
COSTA MESA BUILDING DEPARTMENT I . - IL,. _ sY-
1 6 ..
.P.O. BOX 317 FINANCE DEPT.
COSTA MESA. CALIFORNIA CITY_
F
FOR APPLICANT TO
TO FILL IN APPLICI ION�FOR MESA
ABUILDINGDDRESS 1540 ELm AVE- c( a' - BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
Kenkol Investment Co. RECEIPT NO. PERMIT NO
, OWNER - . ///kf9
MAIL • RECEIVED BY DATE RECEIVED DAT ISSUED
ADDRESS 1555 Placentia milli /n- c
- _J �7_,yc=y 7 /,Q /7/i7
TE
Newport Beach L II 6-3227 BUILDING
CITY NO. ADDRESS
ARCHITECT � uLIC.E
OR RITENTER IC. COSTA MESA. CALIFORNIA
FIRE
ADDRESS ZONE
• ��r CITY LIC ZONE NO-or
TYPE / GROU,Pry`/./
CONTRACTOR K. W. Koll N04316 7/ {/ `LKL e
ADDRESS 1555 Placentia T1i Fairview-3227 APPROVED DATE !' nTTTnai
��'
LEGAL LOT j A C I F • coaRC�TtONea/
DESCRIPTION NO. + V BLOCK ...TRACT
A.P.NO. (� J �r,](j i/.� % • �I S .9 — 6
SIZE 50 'x( 1 'l l ) NO.OF SLOGS. 0 �.. ]I ^• rl
OF LOT NOW ON LOT I���L�l/.� 'I • 6
USE OF ('') /
EXISTING BLDG. – Y / S /
SETBACK LINE FROM �� /J1 / I
CENTER OF STREET (/ REAR YAR ! �V Zd- / ' j S
SIDE YARD RIGHT 2.-4 LEFT 5 :/�
DESCRIPTION\[, OF WORK
NEW /\I ALTERATION ADDITION
REPAIR MOVING DEMOLISH
BUILDIN COO NO.OF / �J
SIZE Q"V ROOMS /�S STORIES
EXTERIOR WALLCT 0f� ROOF ,/�.
COVERING JI�GL tf COVERING ,7J^//)'V17
USE OF NEW ? ` , � y� �Ll'
BUILDING 7�f ( ��/X, Cir � �--�J�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND •
•
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES ANO STATE LAWS REGULATING BUILDING CONSTRUC•
TION. VALUATION
SIGN UR OF PERMIT FEE $ A/ OO
PE' ITTE n
��//�J PLAN CHECK S 2/��. h� (/
AUT ORI GENT'. `r"\ 1 a $ �I��� TOTAL FEE S ',gad V ‘edr
• ;,. l � � 9 S=EE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT :-C--) i-6 -6v
P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE( DEPT.
FOR APPLICANT TO FILL IN COMPLETELY APPLICATIONrJFORJAPERMIT
TYPE OR PRINT BUILDING
BUILDING 1540 Elm Avenue
ADDRESS
COSTA MESA. CALIFORNIA fOR OFF/CE USE ONLY
RECEIPT NO. PERMIT NO.
OWNER Kenkol InvestmentyCo. • • I a 1.4.1..,
g
ADDRESS ' 1555 Placent is - RECEIVED BY DATE RECEIVED Ji•' uISSUIs^B
e,7- . I / -L-4 eI
CITY Newport Beach TN'6 322BUILDING /5-4/ , /Dyne , /.S . .
3227 ADDRESS c L�`r
'ARCHITECT LIC:•
OR ENGINEER • NO. COSTA MESA. CALIFORNIA
•
ADDRESS /La {`. FI ./
I�9 A ZORENE TYPE (/ GROUP
CONTRACTOR K.W. Koll LIC.NO. APPROVED 1ATE r
ADDRESS 1555 Placentia ZONING
LEGAL LOT E (T�jairview ZONE NO.OF / USE OF NEW
DESCRIPTION I NO. to"" BLOCK TRACT ,I / PLANSI /(/r I BUILOING�- �/ ��
- BYPROVE/.V_ /- t /�
/-I/.- —��J
/� DATE
SIZE 50 -x 143 I NO.OF BLOCS. 1 YARDS (HVES
OF LOT Triplex
NOW ON LOT REQUIRED . ALLOWEDUSE OF /f
EXISTING BLDG. (CENTER r FRONT LINE Bl%rt) •� (11/4(}----Ig---et-IN,I /``G,LIN!
CENSETTTER OFACK I STREETNE M existing REAR YARD 15+ R.SIDE L/' ,,C*-FT. / lam✓ IN.
SIDE YARD I LEFT 161 I RIGHT 8' L.SIDE /UFT. IN.
DESCRIPTION OF WORK r 4
X REAR 15 FT
. I.�LUI. 70 `(% IN.
NEW I II ALTERATION I II ADDITION I x
REPAIR 1 II MOVING 1 II DEMOLISH I .. '
BUILDING 4.....NO_ OF .
SIZE 520 S S . 1 vpOMS 1 STORIES 1 '
EXTERIOR mikkk ROOF •
COVERING z idiAC CO COVERING Rnnk
USE OF BUILDING AND WORK TO BE PERFORMED
Attached garage
Add -to Permit No. 11139 •
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 FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAW REGULATING
BUILDINGa TRUCTION.
/ VALUATION
SIGNATUR ! ' i . PERMIT,FEE $ 4.D0
PERMITTRT 590.00
__
$ PLAN CHECK $
AUTHO- AGENT 4.00
TOTAL FEE $
.7- 36570
PA.�
COSTA MESA BUILDING-SAFETY DEPARTMENT •rl? -2-73F-A1U00 070 *****5.50
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - .
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEIVED V DATER CEIVED DATE ISSUED
BUILDING p� a� 5--/-73 2
ADDRESS -a/ t `/Q in.Al 4VL.- ,5--A 7J
/-�j q_ _ PERMIT a,,
OWNER r'�fAA.JC Hr W09/i/?I5 . A.P. NO/3/ /O/ ERMIT /!l
MAIL �/ BUILDING /E`�o L'/M //moi •
Z ADDRESS /) yQ G�/✓1 4.✓L— p �� ADDRESS /J�.�- Gam'/ A-
a O CITY e O fD At r J7 - • NOL 7 TEL. ..,
Ur; TRACT-�'�t���/ LOT/0 BLOCK(
ZZ NEW ADD ALTER REPAIR MOVING DFMOLISH
4 CONSTRUCTION
O N LENDER 'V
aco
J D BRANCH , _ /
Jin OWNER . �� /S�I"
CO J ADDRESS /�(�J�,, VALUE /� � �
-CO ARCHITECT TEL. USE /7 Cly✓ $—2 LI Cly
OR ENGINEER N .
U to Q
FIRE //�
W K ADDRESS ZONE /TYPE /V .GROUP
a W APPROVED/144k .�
W Z CONTRACTOR in is iVL/ BY DATE -73
Jo
mZ
-Ti cc ADDRESS
W W TEL. 20NE NO.O,,F�J USE OF NEW /D
o=Z 1- CITY NO. � PLA M BUILDING N���/
wO STATE CITY YARDS APPROVED YARDS APPROVED
N fl: LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
00
SIZE iNO.OF BLDrTC. (FROM C/L STREET)
OF LOT J NOW ON LOT FRONT FT.
USE OF �¢.y�
EXISTING BLDG. R SIDE FT. /V(/ FT,
I- SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES _ L.SIDE FT. FT.
C.
<)
WALL ROOF /
COVERING COVERING . REAR FT. `J FT.
J USE OF BUILDING AND WORK TO BEi (�RME DISTANCE BET. BET. MAIN&
y p 0 c -t L�ZIZo MAIN BLDGc, ACCESS.BLDGS.
Q VAR.# DATE
O C.U.P.# APPROVED
I- APPROVE -/}2
CO —BYin DATES: -7
Z
0 • STATE
I hereby acknowledge that I have read this application and state it + .Y
f~) pit
D that the above information is correct and agree to comply with
-
CC all laws regulating building construction, and I shall not employ
I- any person in violation of the workman's compensation laws of
N the State of California. m
ZSO. FT. •
9
I hereby certify that I am properly licensed as a contractor under O
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION.IS FOR .
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: W
am exempt from the provisions of the State of California Business ([
VALUATION y
and Professions Cnce, Division 3,Chapter 9. / k..)PERMIT FEE $ '/ w
• J
Signature of r - m
Permittee /civ �.LBA^1- $ OV PLAN CHECK $ E`o
Authorize Agent ` ��D ' TOTAL FEE $ �/ �— LL