The URL can be used to link to this page

Home My WebLink About3054 COUNTRY CLUB DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT Job Address: 3054 COUNTRY CLUB DR Suite: Vicinity: RESIDENCE ANp ATTACHED GARAGE Parcel Number: 13917201 Zoning: R1 R1 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07/27/2004 Issued: 07/27/2004 App�icanr. CHURCHILL, R. A. __ .. - ISSUED Bv: Address: 4425 FOREST GLEN RD ' � � " �"�� " � - � - � i�i� - . _- - . - � - -, Phone: �(714) 974-0456 � �� ANAHEIM,CA,�rj �� _� � � Zip: 92807 , � � � � , /. ' " � , , . � . , i . owner. MAHGREFTEH, SHEMUIL TRs -- � _ . �` �� ' �� ;;� Address 3054,COUNTRY CLUB DR _ "-� � ' �� /�,� . � r - \ i�� \ '�� ) � '�� ` - "'"Phone: '- };\ > \ �.� :��\ /, j; COSTAMESA,CA - � Zip: 92626 �--,`-�� " � � �\;\ � , , , � ,. ,i � .�-:�� /,' /� \��A "�� /,'.` � . `-A � �, > A: :�' Contrac�or. �CHURCHILL'CONTRUCTION '�� ' �' ,,'l `.;;\� ,� ,�� , , Address: 4425 FORESLGLEN RD ` > � `� - � ,A� . Phone:, Q74) 974-0456 �� ,.,,� -, , -'. � � . ' �� , ANAHEIM, CA • �V. � � � .' ' '�,,�� y �� . � � Zip:..' 928W�� ' License: 660990 � � ` . �.�'� `i' '.�;�,�� " � � � \ . Arch. - , .. . Eng: - `�� _ ,:� l .' ., - ' . . , -.� ,� Address: . � , � �.�� a -" . _ . _ Address:-- �� - , , � � , � ,r . � � Phone: " ' � -- . � - - ' Phone: � � -- � � ; 1 . . , . �� . ,, _ . �� , �� -' � A� ' � � - �� i �Zip: �. , . ,� License: . Licen'se: , . � . � • - � � � � � SCOPE OF PERMIT - _ �., � � � � , � ' - �-, - '� TEAR OFF ROCK ROOFJNSTALL BUILT UP ROOFING: INCLUDES AFfACHED GARAGE. , � � � .. , , _...-". -. `-�.- '.': �. . ,r _ .�..._ , ` � � � ' FEE SUMMARY � � � � - � =, Plan Check: � $0.00 �. Calc Valuation � S5,seo.00 Permit: �'�� $125.25 - - - — � �� '' Claim Valuation. � � �SS,sao.00�� SMIP Res:�' � $0.60 - �.. ,:- .,. ✓ - ' „. • � ��SMIP Com. ' ,�� $0.00 � �' � -�'� � � � ,�� Other, $0.00 � __� � �/%� ' f �� .�n`spection-� �,A$0.00 �� \ , A \ .. , �//� i' ' / �,.� , , ��. « . i ��. . ' r� , , a - . � ,�9: A � � ,-.SOtal: $125.85 ' �`� � �,r i ;� �`�l , - -� < r�.. . , . _ ,.�j �1. r, �� ,, .. , ';. .. - ,�_ .�� , `,�� i � `; � � `PLANNING & ZONING � r� � �i , i / � " ' o . <',/ �</�� SETBACKS �A ' � ,� � � MAINSTRUCTURE`Front 0-0 � :Rear, ,,0�0"�� "Left� 0 0_-- �, �RighL 0�0��`� �� A - / , �v._•- .�c�:_-p _�'��i ��,� S%� %%f � tA ACCESSORY �F ont , 0 0 ; � � /;Rear 0 0� - � Left. - � 0 0 � ,.., Riglit � 0= 0 %�� , _, � r��j�, � ��/ PARKING ExishnA: �0 � � Required: � 0 ' � � �Proposed:�� `� 0 � -- . ,.i� % . .. .. � - , . , - ,. .%�� NOTES: , ,- !=� _':�,- -, . ,��i ��a, , . � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes antl related regulations. (Ord. No. 92-20, § 1, 12-21-92) EXPIRATION: This permit shall automatinally expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. - ,- . lNSAECTIONS: !n order �or the wo�k auttrorized under this permit to be considered legal, such work must comply w'rth all applicable codes, and all required Inspections and final approval must be obtained. Failure to ob�ain inspections and final approval will result in the expiration of this permit, FOR INSPECTIONS CALL: (714) 7545626 2446-4fi (N00f WORKERS'COMPENSAnON DECLARAnON: � I hereby aHirtn under penalry of perjury one of the followinq declarations: ❑ I heve antl will meiNain e certificate ot consent to selFlnsure br workers' compensation, es provided for by sectlon 3�00 0l the Labor Code, tor the peAormance ot ihe work for which this permit is issued. ave entl will maintain workers' compensation insurance, as requiretl by section 3700 of the Lebor Code, for the pertortnance of the work tor which this Oermit is Issued. My workers' compensation Insurence cerrier entl policy num6er ere: Carrier: ��" � PolicyNumber: (This secfion need not be completed il the permit is velued et one hundred dollars ($f00) or less.) ❑ I certify Ihat in the peAormance of ihe work tor which �his permit Is issuetl, I shell not employ eny person in any manner so as to become subject to �he workers' compensetlon lews of Celifornie, antl egree that if I shoultl become subject to Ihe workere' compensatlon provislons of $$$ectlon 3700ppp t t�e Labor Code, I shall forihwith comply with Ihese provisiqr� �, — � /��/ `� AppliceniSigneture: �� Dete: I �� I WARNING FNIWRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHRLL SUBJECT AN EMPLOYER TO CRI�.IINAL P NALTIES AND CI IL FINES UP TO ONE MUNDRED hKK1SAND DOLLARE (5100,000). IN ADDITION TO THE COST OF CAMPENSATION, OAMAGES AS FROVIDED FOR IN SECTION 3)Ofi OF TME LABOq WDE, IMEPEST, AND ATTOqNE1"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensed under Drovisions of Chapter 9(commencing with Section 7000) of Division 3 ot the B force end ettect. Lic. # 60�/�(O Class N ContrectofsSignaWre: _ Date:_ CONS7RUCT10N LENDING AGENCV: � antl Professions Code, antl my license is in full _ .- zo . ❑ I hereby aflirm Ihat ihere is a construction lending agency tor the pertormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lentler's Address: SlgnaNre: oate: OWNER-BUILDER DECLARA710N5: I hereby aflirm thet under penelry of perjury ihet I em E%EMPT FROM THE CONTRAC70RS LICENSE LAW for ihe following reason (Sec. 7031.5, Business entl Protessions Code: Any ciy or counry which requires e permit to construct, alter, improve, demolish, or rapair any stmcture, prior to its issuance, also requires Ihe applicant for such partnit to flle e signed sletement lhat he or she Is Ilcansetl pursuent to Ihe provisions oi ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) o} Divislon 3 of tha Business end Professions Code) or thet he or she is exempt Iherefrom antl ihe basis for the alleged exemption. Any violatlon of Section 7037.5 by any epplicant for a permit subjects ihe applicant to e civil penelry of not more ihan five huntlretl tlollars ($500).): ❑ I, as owner of the property, ar my employees with weges as their sole compensetion, WILL DO THE WORK, and ihe siructure Is not intendetl or oHered for sale (Sec. 7044, Business end Professions Code: The Contractors License law does not apply to an owner of property who builds or improves thereon, and who tloes such work himselt or herself or through his or her own employees, provided ihat such improvements ere not Intended or offeretl for sele. If, however, ihe builtling or improvement Is sold within one year ot completion, ihe owner-builder will heve the burden of proving ihet he or she did not build or improve for purpose of sale.). � ❑ I, es owner of the properly, am E%CLUSIVELV CONTRAC77NG WITM LICENSED CONTRACTORS lo constmct the project (Sec. 7044, Business and Professions Cotle: The comrectors License Lew tloes not appry to en owner ol propeny who bulltls or improves thereon, and who comracts tor such project with a contrecror(s) . license pursuant to ihe Contracbrs License Laws.). ❑ I am exempt under sec. SigneNre: Owner ID verified by dnvers license. ❑ Ves � No Business end Professions Code for this reason: Verification of Ownership by (type of tlocumen6 i.e. - properry tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: Dnver's License No. Da�e: Expires: ❑ I hereby cenify that no excavetion five (5) or more feet in tlepih into which a person is required to descend, will be made in connection with work euthonzetl by ihis permit, and that no building structure, scaHoltling, falsework, or demoli�ion or tlismanUing ihereoi, will be more ihan ihirry-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sac. 341, Ttle B, Calitomia Atlministra�ive Cotle). ❑ As owner-buildar, I will not employ enyona to tlo work which would require a pertnit from the Division of Industnal Satety, as noted above, unless such person hes a permit to do such work irom the division. Signeture: Date: Division of Intlustnal Satery Permit Number: CERTIFlCATE OF COMPLIANCE AND AllTHORIZATON OF ENTFiY: I certify under penalry oi perjury Ihat I have read this application and state that the infortnation given is correct. I egree to comply with all stete laws entl city ordinances relating to builtling construc�ion, and au�honze representatives ot ihe Ciry of Costa Mesa to enter upon ihe above-descnbed property for inspedion purposes. I agree noj.to occupy or allow acupancy of any building authorized by Ihis permit until final inspection. � i ature Of Legal Owner(s) And/Or Authonzed Applicant tooe�, iNsveenoxrrre 7616 Fixed System Final Fire Prevention 1266 200 201 zoz 203 Pool Spa Finel Final Re-Rooi Final Block/Retaining Wall Final Factory Fire Placa Final Sign 204 Final Demolition P� INTRIALS COUE♦ INSPECTIONTYPE 206 Finel Mechenical �20B Flnal Plumbing 210 Final Electrical 212 Final Flre Prevention 220 Final Planning Approval 222 Final Slte 250 Finel Building/Occupency \ /- �� `'4: =1 - . - . -� .. .. ApplicaM to fill in all spaces except those within heavy,Eortler lines an0 sign all aOCropriate Oeclarations. . Ci7Y oF COSTA MESn ��^C_ONS RUCrTItON PERMIT , ProjectAddress3�sy IA��H.'. `'LV6 ' , ApplicanYs Mailing Address SA ME � � � Owner'sName MY /hA{��fC C''fEC� Phone � � Address SA M F � Arch/Eng. N'd �6- License No. � Address �- , Contracror'sNam SE�Ur� � � Phoneq7io��/2 Addresslmailingl�Z�:�•SA"' /qqb S��- %:/��M �27a� City License No. �d3 O� � ' LICENSED CONTRACTOR DECLARATION - 1 hereby af�irm that I am licensetl untl¢r provisions of Chartet 9(commencing � with section ]000) of oivision 3 of the Business antl Professions Cotle, antl my license is in 1u11 force antl efiect. 2¢� 2 ZZ Cicense CId55 - SCO� ' oate �n •r - 5'9 t � WORKERS' COMPENSATION DECLARAT ' ' hereby aftirm that I have a certificatE of consent�[o self-insure o� a certificate e Workers' Compenwtion Insurance, or a certitietl <opy thereof (Section �� .00, Lab. 0. ^ 1 _ A- Policy No. 7�y�T�� Company�Q�� 0�� ❑ Certifietl copy is hereby fumishetl. �1 Certifie co}� filetl with the city B ng Di 5' � Date�A��^O � qpplicant �� EXEMPTION FROM WORKERS' CO� NS�ECLARATION � (This section neetl not be com0�etetl if the pe�mit Is tor one huntl�etl ($100) o� less). I certify that In tM1e perPo�mance ot tne wo�k fo� wM1ich this pe�mi{ is issuetl, I sball not employ any pe�son in any manner so as to become subject to the Workers' Compen5ation LawS of CalifOrnia. Date Signature � NOTICE: If, aiter making lhis tleclaration, you shoula become subject to the Workers' COmp¢nsation provisions of the Labor Cotle, you must torthwitM1 [omply with such provisions o� this pe�mit shall be tleemetl �evokeG. GONSTRUCTION LENDING AGENCV ' I hereGy atfirm that tnere is a construction lentling agency tor the oertormance . of [he work for which thiz permit is issuetl (Section 309] Civ. C.) Lentlet'S Name Lentler's Atltlress- OWNEii BUILDER'DECLARATION I M1ereby'atfirm that� I-am exempt trom the Gont�acto�'S License Law for the , followin9 reason (Section �031.5 Business antl Professional Cotle: Any city or county which requires a permit ta construct, alter, improve, tlemolish or repalr any structur¢, prior to its issuance, also require5 the appli<ant tor Suth pe�mit to file a signetl statement that he/she is licensetl pursuant to the provisions of the contractoCs License Law (Ghapter 9(commencin9 with Section 7000) oi . Division 3 0( the Busines5 antl Professions Code) or that he/sne is exempt '�eietrom antl the ba5i5 for the allegetl exemption. Any violation of Section )31.5 by any applicant for a permit subjects the applican[ to a civll endlty af not more than frve huntlretl tlollars ($500). � ��I, as owner of the oroperty or my employees with wa9es as their sole .. compensation, wili do'the work, antl the structure is not intentletl or oiteretl fOI SdIC ($2C[IOl1 J044� BOSIIIBSS hcld Professional Cotle: The COOIIdCLOf'S License Law does not appiy to an owner ot a property who bulltls or improves the�eon, antl wha tloes such work himSElf/herself o� th�ough his or her own employee5, provitletl Shat such improvements a�e not intentletl o/ o(fe�eC for � . sale. It, howeveq the builtlln9 or improvement is soltl within one year of com- ple[ion, the owner will M1ave lhe burtlen of proving he/she tlitl not bulltl or im- ptove tor the purpose of sale). � ❑ I, as ownet ot the proDerty, am exclusively cont�acling with licensetl con- ' tractors to construct the projec[ (Section 7044, Business antl Pwfe55ions Cotle: The Contractor's License Law tloes nobapply to an owner of property who builtls or improve5 thereon, antl who contracts for zuch O�oject5 with a con- , tractor(5) li0ense pureuant to the Cantrattor's License Law). 1 am aware that proof ot thei� Worker's CompenSatlon insu�ance shoultl be provitletl to me. ❑ I am exempt untler Section 8. & P. C. tor this reason Date owner. I heveby certify�that I have reatl this application antl state that the�above information is Conect. I agree to comply with all dty antl county o�tlinances antl state laws rela to f' tling mnstruction, antl hereby authorize repre- Sentatives of this c' y t r u the abovE-Tentionetl p�operty fo� inspeGtion pur 5 - �+ Siqnature . Date�� ^�' O 7 .Drivers' License or 55 �y �-- P MI NO TRACT NO. ,' �L'9T NO. UNIT NU. �3 b6 c7Z TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R � ❑ CONVERSION ❑ DEMOLISN ❑ OTHER A P # _ , , ' DESCRIPTION OF WORK/USE OF BLDG. -�"ES(�OF ciLG� TENr tl � n R rn n 1` -. . � ' S Main Buildin9: . TVPE OF PERMIT � LJ GRADING LI FOUNDATION LJ STRUCTURAL �❑�TENANT ❑ ELECTRI AL ❑,PLVMB/Iry- G❑ M HANI L � OTHER ' rE r�� tiJ-� ( Z S §� PROJEC7 DESCRIPTION SQ. FT. S � � �— oCCUaArvCv� � CONSTRUCTIONTYPE F rpp ��, VALUATION$ 00 ZONE ' GRADINGCU.VDS. AGRES_ Remarks: . Sink Preventer Irii9ation . . Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories . P-Trap Roof Drains Reinspection Fee $15 Boiler _ Duct- UnderGround Duct - Structural Duct - Ventilating Exhaust System � Multiple Firepl/Fact.8lt. ICBO # Heating System & Ducting � ❑ 0�100,000 BTU O 100� peinspection Fee � $15 CMF 08fi5-46, rev. 10/gq White - Builtling; Ganary - Applicanh Pink - Accounting; Goldenrotl - Assessor Showers ' • � ServiceSink � � SewecCap , . Sewer Connection ' Solar Collect � � ' Solar Pi ' g � Sol ank wimming Pool w/Spa Urinal Water Closet ' Water Heater Water Service - Auto-Wash Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Retrig¢ration System ❑0-100,OOOBTU ❑100, �Sys[em flepair/Alteration Fire Dampers Registers Issue Fee E T Front 6 Rear � A _ . . C Right K Left S - Ping: Ref. # Planning Notes: Automatic Washer Constructiou.Pole Sub: Coaking Unit Dishwasher _ Dryers.❑Gas �Elec Fan F.A.U. Fixtures Device Boxes - Outlets . Switches � ' '" Garbage Disposal y Generator �0-5 KW C 6899 10/06/87 � _ .' _ _ . Zone. Accessory Buildin9: . � ELECTRICAL � � Transformer ❑ 15-50 KW � , . �_� 50+KW � � Meter ❑upm�100amps �� - Me[er .❑ovei 100 a - Sub Panel . Motors 1 HP 01 X- 8 . Inc. lar �9-75 HP 016-15+ Pole Light Range Standin9 Sections 5 KW Trash Compactor $ 3 I �— Reinspection Fee $15 luue Fee FEES DEVELOPMEN7 SERVICES REQUIREMENTS: , 2oning Approved By Building Approved By ' Appliotion luued By / � � $ 3 BUILDING PERMIT $ �v '�- PLAN CHECK $ PLUMBING $ - PLAN CHECK 25% $ . �ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL . $ "PLAN CHECK 25% $ 25:50 TL Z O N I N G R E Q M T $ FEES $,3 SMIP _ $_ � PERMIT ISSUANCE $ ENERGV P.C. • $ GRADING � $ , MICROFILM . $� TOTAL FEE $ � �.CONSTRUCTION AND�PLANNING � • � � - . ; POOL & SPA � � APPROVALS �'Permit # �Date - Inspector� ' AppROVALS Permit # ' i Date Inspector n 1 1�. Temporary Electrical Service or Pole � � 52. Pool & Equipment Location � � ' 2. Soil Pipe-Undrgmd�. ' � 53. Steel Reinforcement ; 3. Electrical Conduit Utility-Undrgmd. � 54. Forms � . ' � � � , 4. Electrical Conduit-Undrgrnd. � ' 55. Electrical Bonding ' . 5. Steel Reinforcement� 56. �Rough Plumbing & Pressure�Test � 6. Electrical UFER'Grnci-' 57. APPROVAL TO COVER-GUNITE 7. Footings - ' � � . � . 58. Electrical Condyit ,Undrgrnd. - 8. Foundation �� ' .' 59. Gas Pipe, O Undrgrnd., Test , � � 9. Water Pipe-Undrgrnd'� � - 60. Backwash-Cines; P-Trap, O Undrgrnd: ' 10. Structural Floor System ' � 61. APPROVAL TO DECK ' . � � 11. Property Sewer Line�&'Fiouse 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 Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL Ih '' 19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT �•�� , ' �- ° 20. Rough Factory Fireplace APPROVAL:S Permit# �.� .� - " 21. Ducts, in Structure ; 70. Underground.Hydro . � ' •'� 22. Ducts, Ventilating , i . 71. Product:Piping � Gas ❑ Oil ' r v �' % � r 23. Gas Pipe-,Rough & Test 72. Underground Flush � �, � 24. Roof Framin � � � �' 9 . � 73. Undergmd._StorageTank �Gas ❑Oil � .,, �; 25. Roof Sheathing 74lOverhead Hydro' �� .-�' � 'w r 26. T-Bar Ceiling (Structural�� & Monocoat _�75'. Dry Ghemical � 27. Frame and Flashing � .' 76. Dry Standpipe ��'��' 28. Lathing & Sidinga " ,� � 77. FIXED SYSTEM FINAL ' � 29. Insulation � 78. FIRE PREV. FINAL '�' 30. Drywall Nailing HEALTH DEPT. REQUIREMEIVT t r1 31. Plaster Brown Coat � 79. FINAL INSPECTION � � �� ,� �32. Electrical Power Meter-Final � 80. FOOD CERTIF.ICATE I UED .; � t� 33. Final Electric �� . , � � . Notes. � � 34. Final _Heating & Air Conditioning - � . -'4 `. ,�,� 35. Final,Gas Pipe-Test _ _ . _ ' ' t"�� ' 36; Hood or Canopy � ' R i 37� Final Factory Fireplace• . N V` ' 38. Final Plumbing � � � ' .0 _ ''" � z. � �' - -.r 39. Water Service-Final � . - � ' '= � - '�' � '� y � � �� 40. Gas Service-Final - : . .' f' : .,, � -•. ' e.. 41. Solar pomesticfinal � � , � � �>�' � �, - '' ;.� � - - �. � � �. nA2. Backflow Preventer " � � ti , ��`�� • � v ^43. Backflow Irrigation ~ . '}%" � " "� _ ' i �1i ; t44�Landscape Irrigation System � . . . ' - � •� � � � + � > _"; ;. � . ' � ,45. �$ound Attenuation . . ^ ' ^ �, _, � .`" t J ../, < - � 46. Handicap Regulations " � c . �. 47. FINALSTRUCTURE&BUILDING p �P, ' . 'v r�• ;, cu � � . � /4, i d� ' ;� �d'3 . ,, . � 48;= Special Requirements Completed � ' �� ,,;�, ' � ; j �- � ' ul :� . '?e 49. Electric Release to Edison ,�. "t .+ `� �50. Gas Release to Southern California Gas Co " � � i ' ' 51. CERTIFICATE OF OCCUPANCY , .. /` No. Date _ _ ' � . - . ( � �1 \ t �l . �.,�. _s � - - - . . . ,., . � . � . .. _ . . . ^� MiIN OFFICE IE99 WEST GATIOFp ST.. — P.O. BOS :•OOi LONG BE/CH 10. CiL1�ORN�4 HEMLOCH 5-:A33 SURUCE $.og2e �ccncov -.aee� Twzn�� Examination 1Vo. Project Sample front ?i a K.. . �,. ,.,� � ';�. ..�r .�;_ `, ,� ' "� , � �� BRANCH OFFICE % 191�-D NORTM H�RFEN ST. 9ANT.� ANA. C�LIFOPNIA � �... JEFFERSON 1�20C� JEFFENSON 1.20<6 4� o� eSouf�Zezn �aLi�o¢nia. �nc. a �eptember 12, 1961 GUNITE I{EPOR'i' OI� � TEST CYLINDER SC61-4057 For: Clyde Johnston Pools - 1521 N. Tuetin, Santa Ana, CaLif. WM. AICKOCK RESIDENCE - 3054 Country Club Lane, Coata Mesa G�nite Swim Pool Architect Contrac[or Clyde Johnston n�lix �Vater, gal.!sk. cement � SIZE 5-3/4 x 12-1/2 Date cast 8-15-61 Dutc tested g-22-61 Cylindcr No. 1 COi�IPRG5510N '1'1;S'1' 7 days 1bta1 loc�d to dcstruction, ]bs. 30,000 Pounds pet�tiquarc"inch 1,155 Cylindcr roadc by Cylinde� delivered by Eylli�d�:r rc�etved on cc: Hickock Costa Mesa Bldg. Dept. Johnston Poola SA Lab Gunite Crew Bzadnack 8-16-61 x�h� ;n 9-12-61 2 28 days 48,500 2,042 8-29-61 �,a� 3 I!� day �! � , QDO � 1,650 ii€4 i� 196ti � ��yDBp�tgs8 ��u... �3 ��./4- ' ♦LL REPORTB aqE SUBM�TTEO ci TIIL CONGIDENTIAI PNOPERTY Oi C4ENT5, RVTHOpIZRTION FOR PUBLICNTION OF OUR FEPONTS. CONCLUSIONB. Oq EA� TPARS FqOM OH RCGAH�iNG THEM IS PESEFVED VEN�ING OtIR WHITTEN APPflOVAL /.9 A MUTU�L PROTEQI011 TO <LIENTS. TNE PUBLIC 1N0 OURSELVEB. JOB ADDR�5S nnT� tl-p-61 ✓ BUILDING PFRMIT NO. l K(17h GENERAL CONTRACTOR Clyde JOhRStOri POo15 VALUE $ 3_}000.00 � wr No. 113-562-1 LOT TRACT P'IRli ZONE DESCRIPTION OF WORK Pvt. SW]Irl p00 INSPECTTONS �Signature� DA'1'li � GROUP TYPE 7.ON� SUBCONTRACTOR T OCCUPANCY .��., �.. �.5i3'��o COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MHBA. CALIFORNIA For Applicant fo Fill In Complefely TYPE OR PRINT ADORE55 3 O� 4 � C 1.f •\ T Y N;i J L COSTA MESA.� CALIFORNIA OWNER �� CO C. MAIL q ADDRESS 3 0 � � �O �%'�'� �2 `�' V � CITY `• C S i�t ,�� fGS w EL. NO. []RCFN�NFFR `\tfb2C� JCI��CCCl..r NO�� -yy�� s 1 i �11 A`'^ .,� 1 LW/-1 FEE RECEIVED �1 AUG 2 196.1 S fINANCE DEPT. CITV OF COSTA MESA APPLICATION FOR PERMIT BUILDING Fo� Offiee Use Only rseceiar No. rertn�ir xo. /,:`o '! � RECEIVED BY OAT¢ RECEIV} � DATE IBBU[D ew�_ ii`_'1 -C. � � �f -� __L J.13�OA i,Ja� "�.�• FIRE /`,�' ZONE ...-re O�+-V_S'i4w.. R 4� S APPF LIC.TNo.E-��S-�IoI'1� J NO. �� :► "•:�e HIZE / �! I NO. OP 6LDG8. OP LOT �3�X. �'ic'.� .�%/ NOW ON LOT USE OF /_ EXISTING BLDG CeiJC_1:.. �+�+e1 Vl'\(Z( S6TBI�GR LIN6 PROM '' GBMER OP BTREET � Z a-1 REAR YARD �C 81OE YARD I LEFT \� I RIGHT 'Z2, DESCRIPTION OF WORK STORIES WALL IROOF COVERII I�LDING AND `WORK �O BE . �, . .,�. i! � : . cosra Mesa. ZONING ZONEn✓' I pUN9 //"-I Bl1�LDINOeW �O O L�- ��L DE6CRIPlION �/ l � � � � " � / � � A.P.NO. I��— � ��—[ YARDS EVES APPROVED ALLOWED (CEN'IER YNC 9TJ )I �l {/ �(� �jf� GfitIIJT • / FT �•�L/1 � IN. �--1- r �7 I HEREBV ACKNOWLEOGE THAT 1 HAVE RCAD TH18 APPLIGTION ANO eTATE THAT THE ABOVE IB CORRELT AND A6 TO COM- PLY WITH ALL CITY ORDIN,�, CE9 AND BTATE.LAWB�R O TING BUILD�Na CONBTRUCTON \ �`\ \^ `=a:c`�,�,�,,...� u..,t� t SIGNATURE OF �� AUTHORIZED AGENT � TNE AMOUNT SHOWN UNDER VALUAT�ON IB POR THE PURPOBE OP EBTABLIBHING A PERMIT FEE ONLY. VALUATION Qy PERMIT FEE $ i Q' N �� o= o S 3 OQO � PLAN CHECK $ S I P! � TOTAL FEE � LL . ��_ � �� r�� Ee��v�o COSTA MESA BUILDING-SAFETY DEPARTMENT �J� y,�� _ 6� P. a. aoX s„ COBTA MEBA. CALIFORNIA FiNANCE DEPT. For Applieanf io Fill In Compleiely APPLICATION��FOR�PERIZ�IT� MESA TYpE OR PRINT � BUILDIN6 noo e�s"s 3054 Country Club Drive � �� COSTA MESA. CALIFORNIA For Offite Use Only ftECE1PT NO. P NMI NO. owwER Jemaica Construction Co. �/ ��,j� MAIL � RE�VEO 9Y I DATEjECEiV�O I niA1E�ty16�UED�CO ADDRESS 120 Bermuda Drive �. u /� TEL. KI — gUILDING CITY . V�.S'tci D4e�a NO. Q ADDRE55 ARGHITECT �e�e��d�0n � TEL. R COSTA MESA, CALIFORNIA OR ENGINEER NO. ADDRE55 Corona Del it4ar- F�RE � ZONE TYPE GROUP ' `�'� � � � APPROVED CONiRACTOR � BY ' DATE ADDRE85 3120 Bermuda Drive ZOIdING ¢� COr.SI�C� Mesa ��N NO.OF USE OF NEW Q�'jj' I PLAN9 � BUILDING �� / LIC. NO. ��0�� T O. �� 5-9967 LEGAL DESCRIPTION 61ZE, T NO. OF BLDG6.One /�1 T/� OF LOT LJ NOW ON LOT� q, p. ry0. .L �/C USE OF NOne ' YARDS EVES EXISTING BLDG. APPROVEO ALLOWED 68TBACK LINB FROM C/1 � � (cenrex urae er.� CEMER OP BTREET JV REAR YARD FRONT �FT. IN. SIDE VAR� I LEFT �` _ I RIGHi � t R. SIDE � SFT. IN. DESCRIPiION OF WORK ___ ,�__ __ SIZE �C. ROOM6 STORIES � � EXTERIOR {.- ROOF � COVERING (JG COVERING' G USE OF BUILDINC AND WORK TO BE PERFORMED Sin�le faL-�il dwellina� � � � 3_ � . . 1 HERHBY AGKNOWLEDGE YMAT 1 HAV6 REAO TX18 APPLI'WTION TXE AMOUNT 6HOWN UNOER VALUATION IB FOR THE AND eTAT¢ TXAT THE ABOVE 19 CORRECT MND AGHEE TO COM- PUFIP08E OF E8TF6LI6HING R PERMIT FEE ONLY. PLY WITX ALL CITY OPOINANCE6 AND BTATE LAW9 PE6UUTING BUILDINO CONB CTION. . VALUATION '/ SIGNATURE O PERMIT FEE $ T�' �� PERMITTE � $ sZ�j �/�� PLANCHECK $ 'Z�' � AUTHOR2ED AGE - G D d�O TOTAL FEE