HomeMy WebLinkAbout2013 FEDERAL AVE - Building Permits • ( M CITY OF COSTA MESA t
''' . BUILDING DIVISION
F( 'i PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
411`'tro..ugoe PERMIT
99-01'012
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2013 FEDERAL AV Status: ISSUED
Suite: Applied: 10/6/1999
Vicinity: HOUSE&ATTACHED GARAGE Issued: 10/6/1999
Parcel Number: 42250315 Zoning:
Applicant: WHITNEY, ROBERT ISSUED BY:
Address: PO 15396
CA Phone: (949)548-0769
NEWPORT BEACH Zip: 92659
Owner: FLETCHER, THOMAS R
Address 2013 FEDERAL AVE
CA Phone:
COSTA MESA Zip: 92627
Contractor: WHITNEY ROOFING
Address: P015396
CA Phone: (949)548-0769
NEWPORT BEACH
Zip: 92659 License: 406022
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE AND ATTACHED GARAGE(12 SQ).TEAR OFF EXISTING COMPOSITION
ROOFING&REPLACE SHEATHING AS NEEDED.INSTALL 1-LAYER OF 15#FELT UNDERLAYMENT&REROOF WITH 3-TAB
20 YEAR COMPOSITION SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,659.00
Permit: $83.25 Claim Valuation: $2,659.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
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
DECLARATIONS Itit
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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
ork 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'compensa, Insurance carrier and policy number are:
Carrier: „.r . Policy Number: 4"/ 60 11L LI 5/
(This sect/on need not be>.mp:ted i/the permit is • e•at one hundred dollars($100)or less.)
O I certify that in the performance of th. 'ork -. whi•• 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, :••agree at it I shou• become subject to the workers'compensation provisions of Section 3700 o he Labor Code, I shall forthwith
comply with these provisions. I (O
Applicant Signature: .e Date: `/ /
WARNING:FAILURE TO SECURE WORKERS'•• - NATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P ALTI AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITI• TO THE MST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE COD ,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under pro . Ion •f Chapte 9 o mencing with Section 7000)of Division 3 of the Business an rofessions Code, ndRrRy license is in full
force and effect.Lic.# 0,0 Class# 3' �,vy/-/—/j7,/
Contractor's Signature: i Ar� Pr Date: �B 9
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 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 toe 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,end 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.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑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 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 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_aermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes 0 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? ❑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 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 •I 0: •• ON 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 st: e laws .nd ci ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspr ion pu •• es.I'eree not to occupy or allow occupancy of any building authorized by this permit until final Inspection.
i
Ignatur:x, 0 ner(s) ' ��,i,
And/'' 'rt'orized Applicant Dale
CODE r INSPECTION TYPE MATE 1NTRIAt$ WOF# INSPECTION TYPE PAIS EMIL§
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / 208 Final Plumbing
Wq c5
200 Final Re-Roof — 0— 1/�4L {[ 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
2446-46
I
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PER IT N_O. TRACT NO. LOT NO. UNIT NO. 8473 8/ 18/64 543 Ti.
Object Address 2013 federal Ave. t I LJ'JO 0
Applicant's Mailing Address 10427 Trask Ave. TYPE OF CONSTRUCTION NEW U ADO U ALTERATION ❑ REPAIR
Owner's Name Dennis Tones Phone
0 CONVERSION ❑ DEMOLISH 0 OTHER A.P.# Zone
DESCRIPTION OF WORK/USE OF BLDG. •
Address 2013 Federal AVP Replace Vater Heat r S Main Building: Accessory Building:
TYPE OF PERMIT L GRADING a FOUNDATION LI STRUCTURAL E Front Z
''•//, Arch/Eng. License No. T 0
Address
0 TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL BB Rear N
Contractor's Name A—PMP q plumhino—uPa 8iim 4bf1-246() ❑ 'OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) 10677 Track Aire n n K G
C O N ST RUCTION TYPE VALUATIONS S Left
I City License No. 6664 ZONE GRADING CU.YDS. ACRES R
M LICENSED CONTRACTOR DELLA: • • . Ping. Ref.# Parking Req./Provided E
cc)
I hereby affirm that I am Ilcens•, under proviL••sof Charter 9 (c•mmen Cing Remarks:
---READY
/1� FOR Planning Notes: Q
with section 7000) of Divisio 3 of the Busine5 and %'o• Code, and j(J`�•AD INSPECT S.
my license is In full fort and -ffett. / T
License Class C-436 ti License- -0307 -
Date 9-1 Sign tury�St.� - —L�� PLUMBING FEES
WORKERS'COMPENSATION •E•LARIeflaN Bar Sink Showers 1 ELECTRICAL FEES
I hereby affirm that I have a ter ificate or onsent to self-insure or a certificate l
f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
.800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. WP84076419 Company Fremont Backflow Irrigation Sewer Cap Construction Pole0 50+ KW
6 Certified copy is hereby furnished. _ Sub.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Out)to 100 amps
Date 9-14—R& Applicant A—pnIPq pinmhi no
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar 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 work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 0o-1 HP 011.5-B
Workers' Compensation Laws of California.
Date Signature Floor Grains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration, you should become subject to the Inc.Solar ❑9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
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 2.01 Outlets
Lender's Name Range
Lender'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 LavatoriesGarbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap
any structure, prior to its issuance, also requires the applicant for such permit Generator 00-5 KW 05.15 KW 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
'herefrom and the basis for the alleged exemption. Any violation of Section
1031.5 by any applicant for a permit subjects the applicant to a civil -
enalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 —
compensation, will do the work,and the structure is not Intended or offered — - — - Reinspection Fee I $15 Issue Foe $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's 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:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I
sale. If, however, the building or Improvement is sold within one year Of com- Canopy Type II ❑ Zoning Approved By Date
elation, the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground Building Approved By Date
trove for the purpose of sale). yy,,,mss/J��I q,
U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By �� + • Date Imo_
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law ,
sloes not apply to an owner of property who Duct-Ventilating ❑0-100.000 BTU 0100,000 BTU - SUMMARY OF FEES
builds or Improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT ' $ SMIP $
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# / PLUMBING - § 5.00 ISSUANCE $
Date `Owner Heating System& Ducting PLAN CHECK 25% $ • ENERGY P.C. $
I hereby -rtify that I hav rea• a•- ic. on and state t at the abbve DO-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
inform. on is correct. I ag a to comp) wi all city and c•. • or•in..ces
and 5 e laws relatin• Midi g co• r than, and hereb. a ho epr>� MICROFILM $
senta Ives • thi •y to ente u'' a ..•ve-menti•- pr.,./ PLAN CHECK 50% $
insp-ctii n '�, . Y^ / MECHANICAL $ TOTAL FEE $ 5.00
Drivers'Sir£cense o -/ /.aticer Reinspection Fee • $15 Issue Fee $ 3 v PLAN CHECK 25% $
CMF 0865-46,rete' 84 White-Building:Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
!CONSTRUCTION AND PLANNING POOL _SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole I 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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrndt 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-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 ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) inocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding - 77. FIXED SYSTEM FINAL
rr
29. Insulation s 78. FIRE PREY. FINAL
30. Drywall Nailing • HEALTH DEPT. REQUIREMENT
cs
31. Plaster Brown Coat79. FINAL INSPECTION
32. Electrical Power Meter-Finales 80. FOOD CERTIFICATE ISSUED It
33. Final Electric 6 Notes: 9 A/- cfr' hn � lc,/QJ., mea Yd
34. Final Heating & Air Condition hg Qf,�j/
•
35. Final Gas Pipe-Test 1/43/er GE,- CE
IA
eo , f,� �7/l i
36. Hood or Canopy i /a••/IC /yo 1941641 z. L•G
37. Final Factory Fireplace �Y
38. Final Plumbing �/� tfiran tt
39. Water Service-Final l �p
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 .
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER ,
DOUGHTY, L. &' 1S. DATE 9-24_76
JOB ADDRESS 2013 Federal Avenue BUILDING PERMIT NO. 42721
,GENERAL CONTRACTOR Standard Ameriran Rldre DESCRIPTION of WORK Add Lndry.Rm./Remodel Kirrben
4cx0o. 115-472-15 LOT TRACT FIRE ZONE VALUES ii0 • ,
CTIONS Si.nature Date TYPE V GROUP I ZONE N
soli SUBCONTRACTOR r
AGAS Date Number Si.nature
W AT ER Plumbin.�
ROUGH PLUMBING jjj
PROP. SWR. LINE HOUSE CDH. I /SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ■ POWER !ROUGH WIRINGHeatin• and Vent.
TRENCHES ■ FORMS I. STEEL REINF. j%Fd/Y�:vrdia
"FLOOR SYSTEM Gam .. I.BOND BEAM ■ STEEL REINFORCE ■ �� �
SHEATHING �i /9rFi
FRAME AND FLASHING iNS75f,
LATHING — IN OUT ■ -
PLASTER. BROWN COAT r
'TURAL, FINAL Ir
H. .NG. VENT„ REFRIG. AND A.C, FINALFrAllte
S All» 2Ir
PLUMBING, FINAL AND GAS TEST ■ Ev y Ip't:fl_►j OM IIMMICIWA
f BUILDING. FINAL ` � /i/Z7'
p
y
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h COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PP KATION FOR BUILDING PERMIT
N.
For Applicant to Fill in Completely
'1 �J /� Ad RE E V DATE RECEIVED E S E
BUILDING
ADDRESS 02O/ 3 E</--4E AL //II L/
OWNER L • Y�'. 46el6he y A.R.
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LII STATE 9 CITY ////J YARDS APPROVED YARDS APPROOVV EEDI/Jt,[s0 /
In CC LIC. NO. .coS%o LIQ N 51 MAIN BUILDING ACCESSORY BUIL I 's"'t•t(/� /
0 0 SIZE / / NO.OF BLDGS. (FROM C/L REET)
OF LOT //O X 4 7 I NOW ON LOT / FRONT T FT. FT.
USE OF /- /�
EXISTINGOFBLDG. S. F. , l. r- R SIDE T. FT.
I— SIZE OF p[1!// 7 /• //NO.OF `��/
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STORIES / L.SIDE T. FT.
U EXTERIOR WALL ./� ROOF COM
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_ COVERING � !/���� COVERING / REAR '/ PT. FT.
J USEyyIOF BUILDING AND WORK TO BE SPEERFORM�E/p n/ DISTANCE BET. BET.MAIN&
Rail / /41/4/4/1 y icn, tFr] I I G!T•r/r/ MAIN BLDGS. ACCESS. BLDGS.
n� ,roxrL �y t If VAR.# DATE
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I— APPROVE // � ff /•!CSV— a— /./
CO _HV l/(f� DATE ! 7
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VI hereby acknowledge that I have read this application and state
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
CO the State of California. • / m
5 Z I hereby certify that I am properly licensed as a contractor under SQ. FT. O
the State of California Business and Professions Code, Divisicn 3, T E AMOUNT SHOWN UNDER VALUATION IS FOR 5 •
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: rt
am exempt from the provisions of the State of California Business
and Professions Cnrie Division 3,Chapter 9. VALUATION a y co
PERMIT FEE $ O N
D
Signature of p/, �//�
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Permittee $ 30Vie ENq�'. ..&"---
PLAN CHECK $ �(n
`\ Authorized Agent
TOTAL FEE $
OkANGE COUNTY BUILDING DEPARTMENTi I . APPLICATION FOR PERMIT
636 North FOy BUILDING
/ -+ , "� SANTA ANA,, CALIFORNIA
FOR, APPLICANT TO FILL IN FOR OFFICE USE ONLY
RECEIPT NO. RM IT NO.
BUILADDRESS 2013 Federal Ave. (.h 1`(�/ 233 a
SCHOOL DIST. RECEIVED BY DATE OF�. DATE ISSUED
OR TOWN
NEAREST -27-n ` -2-f-n
CROSS ST. 19th.St. / ,,(�-/
BUILDING V 0/ '2 redier et/ 11re�
OWNER BANNOCK HOMES INC. ADDRESS` J
MAIL 9361 WI LSHI RE BLVD. OR TOWN IST. coQ
ADDRESS ` 4f'
TEL.,.. NEAREST
CROSS ST. el"
BEVERLY HILLS NO. CR• /7 - --/-44--`
ENGINEERTCAIN & MCKERRACHER NOSY. 64891 ZONE NO. OF TYPE GROUP
f�Q PLANS I
ADDRESS211 O E. WALNUT ST. , PASADENA SETBACK LI ooM CENTER OF ST. 55
TEL. REAR YARD s u. 1- SIDE YARD 111 55 RI
1TRACTOR NEWPORT VISTA Co.NO. CR. 54361 APPROVED
BY DATE
ADDRESS9161 WI LSHI RE BLVD., BEV.HI LLS
LEGAL CORRECTIONS
DESCRIPTION I LOT NO. 419 I BLOCK 1 712
(ATTACH METES & BOUNDS(
TRACT
. F B
SIZE OF LOT 67 x 110 I NNOOWOON LDLOTGS.O
USE OF I NO. OF NO. OF
EXISTING BLDG. FAMILIES ROOMS
DESCRIPTION OF WORK .
NEW I X I ALTERATION I I ADDITION I O
C)
REPAIR I I MOVING -1 I DEMOLISH D
SIZE NCS NO. OF L�� f
SIZE IO34 $Q.FT ROOMS 5 STORIES 1 /
WALLROOF COMPO
COVERING STUCCO I COVERING SHINGL ES
USE OF NEW
BUILDING RESIDENCE
APPROVALS
FOUNDATION: LOCATION INSSPEE�CTOR DATE
I HEREBY ACKNOWLEDGE
I
HAVE READ THIS FORMS,
APPLICATION AND STATETHAT THE ABOVE IS CORRECT _ UNDER-PINNING NALS �{'%-/ -ld-.�3
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS, /J/� //{ � '-,''
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING, BOLTS ///��>�/�/j�Ip� //�� 4'
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SIGNATURE OF N °PORT VI ST LATH. EXT. //�35 d` /f-6113'
PERMIREE /J y� !/ _
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FEE �7/ BOND BEAM
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FEE / FINAL �� /
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