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HomeMy WebLinkAbout1586 ELM AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.causNG PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1586 ELM AV Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Parcel Number: 13931215 Zoning: R1 R1 Applicant: JOHNSON, SCOTT ISSUED BY: Status: ISSUED Applied: 05/28/2002 Issued: 05/28/2002 Address: 1824E CARNEGIE AV Eng: - Address: -Phone: 800-707-9420 Address:;- SANTA ANA,,CA Zip: 92705 _. Phone:- Phone:. , . Zip: - ,--License: License. Owner: CHAMBERLIN CHARLOTTE B \ Address ; 1586 ELM AVE SCOPE OF PERMIT - - Phone: SHAKES, ADD SHEATHING, APPLY COMPSHINGLES. i COSTA MESA, CA Zip: 92626 FEE SUMMARY Plan Check: $0.00 "' : Calc Valuation: $5,000.00 Permit: Contractor: 'A-1 ALL AMERICAN ROOFING CO WEST LA INC `i Address: 1824 E CARNEGIE AVE $0.50 -, " - Phone: (949) 250-1221 - Other: - SANTA ANA, CA " Zip:.. 92705" License: 671922- - Arch : .- Eng: - Address: Address:;- ' _. Phone:- Phone:. , . Zip: - ,--License: License. - SCOPE OF PERMIT - - i TEAR OFF SHAKES, ADD SHEATHING, APPLY COMPSHINGLES. FEE SUMMARY Plan Check: $0.00 "' : Calc Valuation: $5,000.00 Permit: $111.25 -' - % ' ` ' " Claim Valuation: ! ` _ S5,000.00 SMIP Res: $0.50 - SMIP Cam: $0.00 Other: $0.00 Inspection: $0.00 Total: - $111_:75 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 0-0 Right 0-0, PARKING Existing: 0 Required: 0 Proposed: 0; NOTES: - 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(6100) 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 Cade, for the pertortnenca of the work for which this permit is Issued. Ck _!_have and will maintain workers' compensation insurance, as required by section x700 of the Labor Code, for the performance of the work for which this permit is issued. y workers' compensation Insurance carrier and policy number are: Carrier: r Policy Number: (This section need not be completed it the permit is valued of 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 Califc nia, and a as that if I should become subject to the workers' compensation provisions of Secti 3700 of he Labor Code, I shall forthwith comply with these provlsio ,�\\­ Applicant Signature: Date: V (� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro vislo of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and affect. Lic. D Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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.). ❑ 1 am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ 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, All 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, 1 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cade 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? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety Cade, 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 Cade 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? ❑Yes ❑ No ...................................................................................................................................................................... . .... ............................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication agermit for such construction or modification from the South Coast Air Quality Management Distinct or from any other air pollution control district or agency? 8 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .............................. ............... -............................ ................. ................. ......................................... ............ -.................................................................. 1111........................ 11...11................. .................... .................... ............................................_.......... 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ 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? [I Yes [I No ...8.......jll yes". allach 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 1 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. Signa Ot al —AncMr Aut5llftcl Applicant d Date CODE E. INSPECTION TYPE PAff INITIALS COPES INSPECTION TYPE BdIE IIS 1616 - Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final/.� 208 Final Plumbing -. 200 Final Re-Roof �—[— '� - 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/Oocupancy Applicant.[, fill in all spaces except those within heavy border lines and sign all appropriate declarations. EK$ CONSTRU ION PERMIT Project Address + PERMIT NO. TRACT NO. LOT, NO. UNIT NO. CITY OF COSTA M $0 Elm MJl'- L Applicant'sMaili Address Owner's Name e(p A � Phone6G1_i p45 Address 15,5b rMlJC l[tt �4 f r Cyt 0.SCt-- Arch/Eng. License No. Address Contractor's Name Q rSI , Ant P 'T Phone 3 p a Address (mailing) Sere i0. .a . City License No Vq__,At 1 D LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the usiness and Professions Code, and my license is in f I r and effect. f� Li cen ass Li s Oo. —h Date Signature WORKERS' COMPENSATION DEC ARATIO ' `ereby affirm that I have a certificate of consent to self -insure or a certificate Vorkers' Compensation Insurance, or a certified copy thereof (Section 0, Lab. ) g (���� Policy No. 1017— Company Certified copy Is hereby furnished. Certfti �d�or�fjtlSfiletl with the city Bui in ivision- ate / Applicant EXEMPTION FROM WORKERS' COMP SATION O C` A ' ION (Thissection need not be completed if the permit is for one hundred ($100 r less). certify that in the performance of the work for which this permit is i ed I shall not employ any person in any manner so as to become subj to cite Workers' Compensation Laws of California. Date Signature NOTICE: If, after making'this declaration, you should becom subject to the Workers' Compensation provisions of the Labor Code, yo must forthwith comply with such provisions or this permit shall b deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending age y for the performance of the work for which this per 't is issued ection 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATIOiT 1 hereby affirm that I am exempt from th W Contractor's License Law for the fol/bbuilding ing reason (Section 7031.5 Busines antlkencing sional Code. Any city or coty which requires a permit to cons ct, aprove, demolish or repair antructure, prior to its issuance, al requippylicant for such permit to e a signed. statement that he/sh is It,Qant to the provisions of thontractor's License Law (Cha er 9 (com with Section 7000) of Diion 3 of the Business and pfessions Code) or that he/she is exempt from and the basis for (h allegetl'e xemption. Any violation of Section .5 by any applicant fo a permit subjects the' applicant to a civil [y;of not more than fiv unfired tlollars ($500).as owner of the'pr erty or my employees with wages as their sole coensation will do th work, and the structure is not intended or offered forale (Section 7044 Business antl Professional Code: The Contractor's Lise .Law does not ply to an owner of a property who builds or improves thon, antl who d s such work himself/herself or through his or her own emoyees, provide that such improvements are not intended or offered for salIf, however, a building or improvement is sold within one year of com- plen, the own will' have the burden of proving he/she did not build or im- prfor the p pose of sale).❑ as owne of the property, am exclusively contracting with licensed con- traors to c struct the project (Section 7044, Business and Profession$ Cotle: ThContr tor's License Law does not apply to an owner of property who bus or proves thereon, antl who contracts for such projects with a con. traor( license pursuant to the Contractor's License Law). I"am aware that prf f their Worker's Compensation insurance should be provided to me. m exempt untler Section B. & P. C. dor this reason I hereby certify that I information is correct. I t and state laws la ng t sentatives of s ily inspection our se Signature Drivers' Licenle or SS W CMF 0865-46, rev. 10/84 Owner have rea. tate that the above d county ordinances :by authorize repre- ionen. p\ropert�X�ff Date 1 M 311330 TYPE OF CONSTRUCTI ON L1 NEW LJ ADD L—I ALTERATION LJ REPAIR ` ❑ CONVERSION ❑ DEMOLISH ❑ OTH�% DESCx[iIPT,1QN OF WORK/USE OF BLDG. TJ C(VAC� ir. a TYPE OF PERMIT LJ GRADING LJ FOUNDATIONI LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING yam. MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATIONS ZONE GRADINGCU.YDS. ACRES Remarks: .FEES Bar Sink - Showers S 3ackflow Preventer Service Sink Cooking Unit Backflow Irrigation Sewer Cap Front Bathtubs t Sewer Connection B A Clarifiers Solar Collectors - - N I Dishwasher Solar Piping Right "" '- - Drinking Fountains 'Solar Tank S Floor Drains Swimming Pool w/Spa G R Floor Sinks Urinal E Gas Service Outlets Water Closet Q M Interceptors Water Heater T S Kitchen Sink - Water Service Generator 1:10-5 KW 05-15 KW Lavatories Auto -Wash BUILDING PERMIT P. Trap Laundry Trays -SMTP - Roof Drains Reinspection fee �- $151, I Issue Fee I $ 3 J MECHANICAL FEE Boiler Hood or Type I ❑ Duct - Under Ground Canopy Type 11 ❑ Duct - Structural Refrigeration System Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU Exhaust System ❑ Multiple ❑ System-Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers gH sting System & Ducting Registers l 0-100,000 BTU 0100,000 BTL 6YJ Reinspection Fee . I $15 I I Issue Fee White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 1303 12/110/87 24.00 TL A.P. # - - Zane S Main Building: Accessory Building: Cooking Unit E T Front Z O B A Rear N I C Right "" '- - N S Left G R Ping. Ref. # 1 'Parking Req./Provided E Planning Notes: Q M Sign T S Standing Sections Generator 1:10-5 KW 05-15 KW ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps , Dishwasher - Meter El over 100 amps Dryers ❑Gas ❑Electric - Sub Panel Fan Motors ❑0-1,HP Ell ''A-8 F.A.U. - Inc. Solar 09-15 HP 1:116-15+ Fixtures Microwave ' Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 1:10-5 KW 05-15 KW Trash Compactor • Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS:, - Zoning Approved By Date Building Approved By Date Application Issued By - -5Y2 DateB ' SUMMARY OF FEES BUILDING PERMIT $ -SMTP - PLAN -CHECK $ PERMIT • PLUMBING $ - ISSUANCE $ PLAN CHECK 25% $ ENERGVP.C. $ ELECTRICAL $ GRADING . $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $�� Y� TOTAL FEE $ __2Af_(IQ PLAN CHECK -25% $ CONSTRUCTION -AND PLANNING APPROVALS Permit# Date Inspector POOL &SPA - - APPROVALS Permit# - -Date Inspector 1vTemporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. :54. Forms t - 4. Electrical Conduit-Undrgrnd. i 55, Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure.Test - 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE t 7. Footings 58. Electrical Conduit-Undrgrnd. 8.' Foundation 59. Gas Pipe, 0 Undrgrnd., Test y 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. Electr'ical-Final - 75. Rough Electrical -Conduit _ 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing &Access Approval 17. Rough Wiring Sign - 68: APPROVED FOR PLASTERING ' 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL t 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 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas 0Oil 25. Roof Sheathing - 74. Overhead Hydro - f 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 PREY. 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. Fina Heating & Air Conditioning Zs'4g 4 CO - 35. Final Gas Pipe -Test i 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 i 7' - 144. Landscape Irrigation System { 1 :45. Sound Attenuation _� , • - t' I 46. Handicap Regulations 47. FINALSTRUCTURE & BUILDING - ,,��. �: �- •;. _ t 48. Special Requirements Completed K, vi 49. Electric Release to Edison 50.,Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date - X - MAIN OFFICE 1535 WEST GAYLORD ST.. - P.O. BOX 906$ LONG BEACH 10, CALIFORNIA HEMLOCK 3.7493 SPRUCE 62081 Twznina Examination No. Project Sample from Architect Contractor Mix water, gal./sk. cement Size Date cast ab®rat®riss BRANCH OFFICE 1514-D NORTH HARPER ST. SANTA ANA. CALIFORNIA JEFFERSON 12043 JEFFERSON 12046 Of cSoutfip to Bali f oznia, Ynr. November 29, 1960 GUNITE REPORT OF XNEMM TEST CYLINDER SC60-872 For - M. Anuszkiewicz 1586 Elm, Costa Mesa, Calif. GUNITE SWIM POOL South wall at deep end Swan Pools 1-4 6 x 12 11-1-60 Date tested 11-8-60 Cylinder No. 8 COMPRESSION TEST 7 Days Total load to destruction, lbs.. 23,000 Pounds per square inch 815 Cylinder made by Carl Moseley Cylinder delivered by Carl Moseley Cylinder received on 11-2-60 11-29-60 28 Days 17,000 # 655 DEC 1 18Cu B uildlnOva Mesa 59'] of * Note: Cylinders appeared to be damaged in field cc: M. Anusziewicz City of Costa Mesa Swan Pools - 12691 Harbor, Garden Grove Carl Moseley - 3235 Nebraska P1„ Costa Mesa SA Lab _ ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS, AUTHORIZATION FOR PUBLICATION OF OUR REPORTS, CONCLUSIONS. OR EX- TRACTS FROM OR REGARDING THEM 15 RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTIOM TO CLIENTS. THE PUBLIC AND OURSELVES. December S, 1960 Costa Mesa Euilding Department 595 W. 19th Street Costa Mesa, California Attention: Mir. Eingham Dear Sir; In regards to the faulty cylinders on the guriting of our Swimming Pool, we feel that the gunite job was adequate. Swan Pools, Inc. has designated and given us a 10 year written guarantee on the structure of the swimming pcol. We are confident that. Swan Pools, Inc., will stand behind their Guarantee. Therefore if Mr. Goldner of Swan Pools, Inc., feels that it is not necessary to take a core check on the gunite, then we are satisfied. Sincerly, eike nuszkz Marie Anu cz l/ 9 RECEIVED tN DEC1 195u o City of Costa Mesa Building Dept. SWAN December 8, 1960 Dear Yr. Bingham; ORANGE COUNTY DIVISION 12691 HARBOR BOULEVARD . GARDEN GROVE, CALIFORNIA Phone JE 4.2331 JE 4.2332 I am quite sorry that we have caused you any problems due to the damage of the gunite cylinders on the job at 1586 Elm Street, Costa Mesa. I am quite sure that the reason for the low reading on these cylinders was due to the damage caused to the cylinders. Swan Pools, Ac., will definately stand 100% behind the gunite job as will the sub_ccntractor, b?eptune Gunite Company. Enclosed you will find a letter signed by Mr. and ;sirs. Anuszkiewcz to the effect that they are satisfied to continue using the pool with out a core check. JG/ms Sincerly, J Goldner n Fools, We. T_ Dun m' of unci? L:i�; a oep"6"S 'COMPLAINT INVESTIGATION Received by Made by: DixeEiena: Notate obt Action taken: � r Complete: Yes Complainant Yes By: Interviewed: No ' / No Da /'Date • �� z'b. No u IPA-,z4l L <:� W'' I iwc' COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA T TO f/LL /N COMPLETELY YPE OR PRINT BUILD[AD7DRESS1/586Elm Street A MESA, CALIFORNIA FEE `RECEIVED FINANCE �y DEPT. APWff0TIfflTK IYICSHp ERMIT BUILDING foR Off/CE 11SE ONLY Knightwell Land Company RECEIPT NO. Iw OWNER I1LI ElJR V �YD�O. D f� E. 17th Street RECEIVfiD BY_ I DATE RECEIVED I DA;EIBSUED��C AMAILDDRESS 419 JJ 619. Costa Mesa, Calif. TNo 181159 BUILDING CITY ADDRESS ar On APLIC. COSTA MESA, CALIFORNIA C GINEER n NO. Garden Grove FIRE 7L A, -..ESS ZONE TYPE GROUPIJ Dike & Colegrove, Inc. STATE2 1 167293 APPROVED CONTRACTOR LIC. NO. BY DATE 419 E. 17th Street ZONING ADDRESS LEGAL LOT 89 Q p J4O7 ION NO. OF I I OSE OF NEW DESCRIPTION NO. BLOCK TRACT ( / PLANS LBUILDING APPROVED A.P. NO. BY / DATE SIZE 1 1 100 I No. OF BLDcs. Non( FO YARDS % £VEV OF LOT 7 X Now Loi REQUIRED ALLOWED USE OF None (CENTER LINE ST.) EXISTING BLDG. FRONT FT. IN. SETBACK LINE FROM 501 251 CENTER OF STREET REAR YARD R. SIDE FT. N. SIDE YARD ILEFT 101 (RIGHT 1 L. SIDE �] FT. IN. DESCRIPTION OF WORK REAR FT: IN. N' X I ALTERATION I ADDITION REPniR I MOVING I DEMOLISH DING 1647 NO OF 7 SIZE ROOMS STORIES EXTER 'OR ROOF WALL Shake COVERING COVVERING USE OFB UILDING AND WORK TO BE PERFORMED USE O;Sin e family residence with A attached garage I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONETRUCTI N. VALUATION SIGNATURE OF PERMIT FEE S 36.00 PERMITTEE - PLAN CHECK S 18.00 Dike & legrove, LnC. L $ 16,862 AUTHORIZED AGENT � TOTAL FEE S 5400 x_2901 lCrOSTASA BUILDING -SAFETY DEPARTMENT X 317 COSTA MESA, CALIFORNIA FOR APPL/Car TO flu /N COMPLETELY TYPE OR PRINT OBUILDING ADDRESS 1586 Elm St. 1 I COSTA MESA. CALIFORNIA IowNFR Mike Anvezkuwicz -!� FEE RECEIVED tyr SEP 261961 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING W WWI USE MY HECK]" NO. PERMIT NO. MAIL 1586 Elm St. RECEIVED BY GATE RECEIVED I DATE 189UED ADDRESS (-,�/-Hp .;E Costa Mesa TELK �Roq BUILDING / \� CITY N05 ADDRESS O L 114 ITENCT C.Thoms On Ic 6239 COSTA MESA, CALIFORNIA OR^ EERG. NO 15262 � Canada Glendale 8 FIRE type group AL.. .-SS / Swan P001S NTo148509 eYPROVED CONTRACTOR LIC ATE 13336 Ventura Van Nuys NING ADDR ESB G LEAL LOT Q �/ � 1-348, ZONE I NO. OF I U5E OF NEW DESCRIPTION NO. TRACT PLANS BUILDING , //BLOCK A. P. NO. C(� _- APPROVED BY ✓ DATE SI '7 X lOO I ND OF BLDGS. 1 YARDS E LOT f NOW ON LOT REQUIRED ALLOWED USE OFh&ttach agar (CENTER LINE ST.) EXISTING BLDG.ouse FRONT FT. IN. SETBACK LINE FROM CENTER OF STREET REAR YARD R. SIDE FT, IN. 71 I SIDE YARD LEFT 21 RIGHT L. SIDE � FT. IN. DESCRIPTION OF WORK REAR 1--IS7 FT. IN. Nf X ALTERATION I ADDITION REP..IR I MOVING I I DEMOLISH BUIL NO. OF SIZE 36 ROOMS STORIES EXTERIOR WALL (ROOF COVERING COVERING USE OF BUILDING AIJD WORK TO BEP FORMED private swimming pooh I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP II CATION THE AMOUNT SHOWN UNDER VALUATION 15 FOR THE AND STATE THAT HE AS VE IS CORRECT ANO AGRE TO COM PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL GT, ORD E. N0 STATE LAWS OULATING BUILDING CON a VALUATION OF j / I / PERMIT FEE $ E J �r /1� $. 700 PLAN CHECK $ S 1 AUTHORIZED AGENT TOTAL FEE $ g� /.c'