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HomeMy WebLinkAbout211 ALBERT PL - Building Permits OWNER SIMMS_,_RUTH R. - DATE 10-23-61 JOB ADDRESS 271 Albert Place BUILDING PERMIT.NO. 15572 GENERAL CONTRACTOR Owner-builder VALUE $ 15,015.00 AP No. 118-123-08 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Res.w/att.gar. - `L'CTIONS Signature DATE GROUP I gr j TYPE V ZONE R-1 r C %-,'- , SUBCONTRACTOR PERMITS ISSUED Gas A r' / ` DATE NUMBER Water • - y^ /$ /4-Aec' Rough Corn. Ref rig. 0 Air Cond. ❑ Rough Heating _ ^� L;r• ,r _ w.�+ I{4 1/�_yd A C. 2,-f-6I _ooJ 7V Rough Plumbing �1/� %MZ�y,_/, b�3v=CL-3. 52.3-1. _ Q-� Miscellaneous ✓ _ Y` .s erg " y� d d� u+rw y l yL�r __ 3.37 Prop.Swr.Line p-House Con. t.Swr. ❑ C fticiut_ - -d----• /01G9.- f[%o . �✓�t'p� Sprinkling System �/f l�(6 Construction Pole \ b Underground D Power ❑ _ Rough Wiring ?ce /2.'2f1dJI44Ln. .. eL ctii� . i 2 -V-G I /6 • triTrenches 0 Forms 0 Steel Reinf. 0 . ($ 4 ff.-X i ;f . Floor System Bond Beam 0 Steel Reinforce 0 Sheathing i2 !77 Lo_ ,"2' — .- G, I Frame and Flashing 7J/ M. a— - C Z-- Lathing — In Q' Out fn� / P. -'r, brown coat O.' P2') o. / 31 — C, 2.-- . . ❑ Air Cond. ❑' Final t F.,....mg, Final 1, id 3' ��y0�*, 'ig �- �Y Plumbing Fixtures, Final if + ��-F-�1" - �1 "Final Gas Test / 3-- ti Z////// ,7 '5Electric Fixtures, Final `'' _ i Building, Final /CM , ..2ke D / P , OCCUPANCY ii c, V FORM B04-5M — 7.61 HOW FOR SPECIAL REQUIREMFNTS'� ( 15572 OWNER ELBIS, Ronald DATE ..`10-3-62 JOB ADDRESS 211 Albert Pl. BUILDING PERMIT NO.17962 GENERAL CONTRACTOR Automation Pools VALUE $ 2500.00 AP No. 118-123-15 LOT TRACT FIRE ZONE DESCRIPTION OF WORK ftrt.Swim Pool `ECTIONS Signature DATE I GROUP J TYPE III ZONE R-1 S PERMITS ISSUED Gas /1_ 7_4.,j SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating �- Rough Plumbing .11 G�� /O-.f-6-it �3GaS7. Miscellaneous tag°, kW. .//'7-v= /7,4G Bcene..tJ %O'p-_� ,36SZ'r— Prop.Swr.Line 0 Ho a Con. 0 St.Swr. 0 -1 Sprinkling System Construction Pole Underground Underground `C/ Power ❑ L 7-I- //_ fibe,. _ Rough Wiring V1/4- s a , 1 n / /0-9-'2, /3 fr6- Trenches Lt- Forms 0 Steel Reinf. l /a he- /Q-SG✓_�.r s Floor System r (,yl� Bond Beam A/ Steel Reinforce-- Fie( /D-151-r✓� U}(J� Sheathing A Frame and Flashing vel Lathing — In 0 Out 0 F' mr, brown coat I 0/U / ( �/ . 0 Air Cond. 0 Final 666✓✓✓— I7 v z �� h....ang, Final 1 {,, PlumbingFixtures, Final �_ 4 i f `.f Final Gas Test /..5)--- l � j d ��q l L Electric Fixtures, Final '/ 2 9�:Ct,1., ''/�' Building, Final PAA .7.-.22„/i OCCUPANCY I � FORM BU4-5M — 7.61 HOLD FUR SPECIAL REQUIREMENTS 1 7047 OWNER BRR, William DATE 10-17-75 ' 1 JOB ADDRESS 2n Albert Place BUILDING PERMIT NO. 40735 GENERAL CONTRACTOR Owner/Bldr. DESCRIPTION of WORK Legalize Room Addition 1 A' '1. 118-123-20 LOT TRACT FIRE ZONE VALUE $ 3,760.00 II .iCTIONS Signature Date TYPE V GROUP I ZONE R-1 SOIL SUBCONTRACTOR PERMITS ISSI4ED GAS Date Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND n POWER ❑ ROUGH WIRING AC A9-L"L-Z5 Heating and Vent. TRENCHES 0 FORMS 0 STEEL REINF. f FLOOR SYSTEM BONO BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER, BROWN COAT S' -URAL, FINALUT Hh.!I HE. .40. VENT., REFRIG. AND A.C., FINAL (jiuy.4..- 10-1?. 7,-jy4ay— PLUMBING, FINAL AND GAS TEST n 666 ELECTRIC, FINAL gIG A9'Ly-?5 RIIII DING FINAL Pi/' In-2�K-2ti •S MAIN OFFICE ! BRANCH OFFICE -4 R 1695 WEST GAYLORD ST.,-P 0. BOX 9065A 1519.0 NORTH HARPER ST. ' LONG BEACH 10. CALIFORNIA SANTA ANA, CALIFORNIA HEMLOCK 5-7693 JEFFERSON 12065 SPRUCE 56526 JEFFERSON IQ096 JACKSON 73691 Twinin . Laboratories of cSoui`fiEzn dalifotnia, £ne. Inspection and Testing Engineers Soil Foundation Analysis • Chemical Analysis INovember 7, 1962 GUNITE REPORT OF XXXCOMOX TEST CYLINDER Examination No. SC62-2972 For - J. M. Henley Project 16 x 32 POOL FOR ROBT. ELLIS 211 Albert Pl. , Costa Mesa Sample from Deep end Center Line - 48" below Top StEnbistoot Eng. Robert Parlee Contractor Automation Pools - 6338 Dale, Buena Park Mix 4-1/2 - 1 2,000 psi - 142 sax cement 30 tons sand Water, gal.;'sk. cement liMIGE Size 12 x 6-1/4 Date cast 10-10-62 Date tested 10-17-62 11-7-62 Cylinder No. 211 211 211 "HOLD" COMPRESSION TEST 7 Day 28 Day Total load to destruction, lbs. 55,000 63,000 Pounds per square inch 1,658 2,�3o a 9 IQ "IteN Cylinder made by J. Henley At 11101/ CQ 9 CO Cylinder delivered by J. Henley City I0 1962 _ N Cylinder received on 10-12-62 S etlildi g Qep�3a acs Henley - 3 Note: 26 day�t et complies with speciica ' M \ Aosta a Poolsi \Costa Mesa City Bldg. Dept. SA Lab ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS. AUTH RIZATION FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS, OR EX. TRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS, THE PUBLIC AND OURSELVES. ADDRESS OF BUILDING: 211 ALBERT PL LINT: CITY OF COSTA MESA - BUILDING PERMIT OWNERS NAME IF MOM: AXTON, JEFFREY J PERM NO: B 075462 ADDRESS: WILCOX, AXTON PAMELA M 211 ALBERT PL PERMIT NO: B 075462 PLAN CHECK NO: N GOVT : N SUPP : N COSTA MESA,CA 92627 • APPL.MAIIINGADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STA PURPOSE: OTH g ARCHITECT()BEWARES: UC.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLES SQ FT: 2, 568 ARCH.OR ENG.'S ADDRESS: LINT: CLAIM VALUE: 2 , 568 . 00 CALC-VALUE: 2, 568 . 00 GROUP OCC : R-3 / CONTRACTORS PLUM: SUNNI ROOFING ( 714 ) 650-1366 CaNTRACTOITSMMUPC 236 VICTORIA ST COMMENTS : SMOKE DETECTORS REQUIRED PER 91UBC, REROOF 1400. [ ADDRESS: COSTA MESA CA uC.NO.: 570720 **************** '**+E****-********+E* '**** '***** '*********'+('* j� 'i.ii +��. OR 92626 MT: Z ONING REQUIREMENTS E� LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty d tensed perjury that I em under provisions of Chapter 9 SETBACKS REQUIRED EQU IR E (commencing with Section 7000)of Division 3 of the Business end Professions Code,end my license is in full force end effect. ��` EEE EO CITY LIC.NO.: 065147 LIC.CLASS: C-39 UC.NO.: ? EXP: 06/96 MAIN BUILDING ACCESSORY BUILDING ........,,A,4.441i \ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN fDae: /2 •�/•cjl Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN WNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the Owing reason(Sedion 7031.5 Baseless and Professions Code;Any city county which requires.penile tomnafruct.alter,improve. PARKING REQ: - PROV: PARCEL : 42607307 ZNE: REF NO: modish,or repair any structure,prior to its issuance.aeo requires the applicant for such permit to fib a signed statement that he or she - S tensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section]000)of Dvebn 3 of the PLANNING NOTES> Business end Professions Coder or that he or she is exempt therefrom end the basis for the alleged exemption.My violation of Section > 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more thanlwe hundred dollars M.5001). jE1E3E1E1fiE9fiEBE1EiEfEiE#dPaElE1EUEiE1E3F3ESEjF7EfE1E1E1E3ERE)EIEIElElElE1E1f3EiESElE3Ei(-IEiElf3(****1ElE3EfEjESf#IEiE3E*3fiflfifiFlE-%*dE*#)(-REiE CII.as owner of the property or my employees with wages as their sole compensation,will do the work,end the structure is not intended DEVELOPMENT SERVICES REQUIREMENTS or offered for sale(Section 7044.Business end Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,end who does such work himself or herself or through he or her own employees,provided that such - improvements ere not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the ZONING APPROVED' BY DATE: owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). o I.as owner of the popery,em exclusively contracting with licensed contractors to construct the projed(Section 7044.Business and Professions Code;The Contractors License Law does not apply to en owner of progeny who builds or improves thereon and who BUILDING APPROVED BY : DATE: • contracts for such projects with a contractor(s)tensed pursuant to the Contractors License Law). '- ❑ lamexempt under Section: B.A P.C.,for this reason: APPLICATION ISSUED BY: DATE : , 2- el Dela: Owner: ****)E*******iFiElfiElEiF1EiE****1fiEl(--IE****)E3ElE1E* **M-iE* i(- *1PifiE***If9EiE****)EiE**)EIE * * c** LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby certify that 1 am aware of and understand the requirements of California Health end Safety Code Sections 25505,25533,end 25534.end that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a perms for construction or modification from the Ai QualyManagement Distad.Residential construction appfcaliuu are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 54 . 00 . 50 Date: Applicant: • SMIP/NON-RES • WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN n o l have and wid maintain a certificate of consent to self-insure for workers'compensation,as provided for by Sen 3700 of the Labor ISSUE N G- ] Code,(«the performance of the work for which this permit is lessee. BUILDING-DIC > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE 4 Ihave and will mantainworkers'compensation insurance,as required bySection 3]00of the Leber Code,for the performance dtM TOTALS 54 . 50 0 . 00 0 . 00 54 . 50 r . 54 . 50 00 work for which this permit Is issued.My workers'compensation insurance carder and policy number we: Carrier: STATE. FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT: . 00 Policy Number: 1117517-45 06 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be completed V the perml is for one hundred dollars($1001 or inn 54 . 00 .•50 o I certify that in the performance of the work for which the permit is issued,1 shall not employ any person in any manner so as to becomeaubpd tvithe workers'compensation the Labor California, andagreethatB hose become subject to the noire' dE)f)F iP iE iE*iE�E iE BE*1E iE jE iE*jE 9E 9E jE 9E 3EfEiE 1E**iE)E iE 1E iE iF 9E 9E 9E iE 9F 9E lE iE iE M-iE BE iE i(-1E lF*iE iE 4E iE 4E iE RE AE if if)E*1E iE 9f iE ib if lF 9F lE 9E)E lE)f)E')E)E -.--)S Dale: compensation provisions d Sed ]00 d the labor Code, shell wh7�m w; ,those provisions. INDIVIDUAL F E E BREAKDIOWN Warning:Failure ftsecure scoters'compensation coverage Isunlit and dashall subject anemployer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars($100,000),In addition to the cost of compensation,demegss as provided for In Section s]afi of the Labor Code,Interest,and edomey'e fees. SFR 2568 REROOF BY VALUE RESIDENTIAL NOZONE ,. 140 2, 568 . 00 CONSTRUCTION LENDING AGENCY:1 hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES 1 performance d the work for which thispermit is issued(Section 3097.Cb.C). ' ' LENDER'S NAME: LENDER'S ADDRESS: • I certify that I have read this application end sate that the above information is correct.I agree to comply with at city and county ordinances 4r , end state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property ., ,f for inspection purposes. • ,t /! JIM GOULD / /v' not Nene 1 vA( fly - - Z • 7/y C1 '111175i .° nk9 ,7 1 Date: . • _- Si sure d /Agent/Applicant/Contractor i(if : �'�_ i' 1' (5151-4QWP) White-Building 8 Safety;Greer-RI.;Canary-Appicard;Pink-Revenue;Goldenrod-Assessor _ I , CONSTRUCTION AND PLANNING PL & 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 r _ 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, V 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 0 Oil 23, Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas ❑Oil 25. Roof Sheathing /2.-"St95- &l titC 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE 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. 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 - /2„_//--?5"-- S - / „__� JLe 43. Backflow Irrigation ( r+[ L J �'c�`"sr�� 57440G � 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Handicap Regulations 47. FINAL STRUCTURE & BUILDING (_Z--t 6(u6 48. FINAL PLANNING L 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date ' Pat,. . - �n73m "CT 17-75c„, 00 701'.: ?-s:*-70.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A LCA ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only /�T� J // RE 1 E Y DAT;R�CEI E DATEnISSUED ADDRESS // 4L7 �/ �L7 L '/rrVt ly-/7` f� .s y7 / A.P.NO.1I �- •_3- O PERMIT NO. OWNER '1., �A/F�/Y/ fre . MAIL ADDRESS rj 5' r ��j. BUILDING 2 / ADDRESSA L - „, CITY Oaf n_e75, � NOLfjo � � TRACT ?�� 'LO 3�5 BLOCK CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH OWNER Ai* 29Ra./ Aht/s-z_ ADDRESS L L/� / 4VALUE ARCHITECT TEL. USE 44N/77a* $ 817‘544111 OR ENGINEER NO. FIRE ir ADDRESS ` ZONE /yYPE AlVD ATGEER CONTRACTOR! BYPROVED / /u./ 7_ , ADDRESS �— + ZOry{�7 NO.OF mss/US SP yE 2C�L/� TEL. /.� / PLANg BUILDING CITY NO. F. — STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ' ACCESSORY BUILDING (FROM ET) L OF LOT NOW ON LSIZE NO.OF OT FRONT L:n`"FT. FT. Q USE OF / ,p-{/� a EXISTING BLDG. R.EIDE JFTFSA FT, (01 FSeparate permits are required for L,SIDE (L FT. FT. G electric,plumbing and heating work. REAR � 4.c�i c$ FT. W USE OF BUILDING AND WORK TO BE PERFORMED `DISTANCE BET. BET.MAIN& MAIN BLOCS. ACCESS.BLDGS. / s Q .�.t3-ra,4/tsI-Lp 1/2C4LJ C URP.# ^ �J/,yes APPROVED ^7 /y //© I710./ `aY ROVE Y/� ///\ 7 G DATE /(_/-p - 75 a C'' / w a I hereby acknowledge that I have read this application and state n r. 06 that the above information Is correct and agree to comply with m $1+ all laws regulating building construction, and I shall not employ . Z any person In violation of the workman's compensation laws of the State of California. �� I hereby certify that I am properly licensed as a contractor under SO. FT. — w the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESiAg[16NIN(�ALaERMIT FEE ONLY: v. am exempt from a provisions of the State of California Business VALUATION ���f�� a and Professions;oEe, Division . Chapter 9. re PERMIT FEE $.,57�- Signet- /� aO PLAN CHECK $ /'• �D- O Permitte. n� .—/44/1 ✓I/L� --'-v. $ 3760 TAX $ d'd IL • ,5 2 U Authorized Agent TOTAL PAID $7 6 3--b If-E..- 1796? OCT 3 1962 .. COSTA MESA BUILDING-SAFETY DEPARTMENT [[ {���`np��77pf P. O. BOX 317 COSTA MESA. CALIFORNIA rI1V„1� ��'For A lieanf fo Fill In Com lefel GR R # a,PP P Y APPLICATION FOR PERM TYPE OR PRINT BUILDING BUILDING (/ /2 BU COSTA/////��TMESA. CALIFORNIA For Office Use Only q ) I RECEIPT NO. .PERMrTQ:. 7'- OWNER dsic/ 'e /// `/ / _ MAIL ^ ,, e / RECEJTED BY DA C IVSD DA ISSUED ADDRESS XLH L-c/ 7f I D /0!.3-4 'J - - TF BUILDING CITY NO. ADDRESS • ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINE NO. _ ADDRESS a FIRE / AP' / ZONE yTYPE/ GROUP ,(//j l CONTRACTORy/' % L(/ BYPROVEI /�/y DATE /O/ % - CI ADDRESS (J 3 - • �K/6 ZONING ZONE NO.OF 2 BUUSIELOOIFNONEW A a-O `CITY ri PLANS TEL. LLCTNO. lAVp / YNO. (/06 DESCRIPTION ear 47/1- 313 / fr SIZE CESEOF LOTpS- )/MiJo, iS 1 NNW OOFNELLDOaTe. A.P.NO. / / ((r-- /,2 3 -45- USE OF .� - e- YARDS lh T J3 -ALLOW D a cY(O EXISTING BLDG. �l/f!/r-�F-�r. APPROVED ALLOWED SETBACK LINE PROM /// // / (CENTER LINE ST.) �j /' CENTER OF STREET )'� f0 REAR YARD' FRONT .2 / FT. W IN. 1 SIDE YARD I LEFT /2 I RIGHT 9 R.SIDE ? FT. /J// IN. DESC P ITION OF WORK L.SIDE (I ON FT. (O IN. . NEW IALTERATION I II ADDITION I REAR U FT. IN./ ` REPAIR I H MOVING I I DEMOLISH I FROVEOait 0 DATE BY CI' 3-6 BUILDING / 2 M1/ NO. OF _ �r7-/ SIZE WA X.3 Y ROOMS STORIES HOLD FOR SPECIAL RE2UTPrikA hits EXTERIOR WALE ROOF /� COVERING COVERING lyt 0,,;_” G(J II USE OF BUILDING AND WORK TO BE PERFORMED �t�/,r�'L4 ><,Lso�-ate / - /� IV/ tr 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 LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE O --' - ' ' _ ) PERMIT FEE $ /.2 PERMITTEE . �//'�'�'�" (,j/.- N //y $ PLAN CHECK 5 4 AUTHORIZED AGE [.' a,619O ��rId TOTAL FEE $ 0 15572 FEE RECEIVED • COSTA MESA BUILDING-SAFETY DEPARTMENT SEP 27 '" f i. P. O. BOX 817 COSTA MESA. CALIFORNIA FINANCE DEPT. Applicant to Fill In Completely CITY OF COSTA MESA For A PP � P Y APPLICATION FOR PERMIT TYPE OR PRINT BUIDDLDRESSING ,31/ �� -� BUILDING A COSTA MESA. CALIFORNIA For Office Use Only ��By /' T RECEIPT NO. PERMIT NO. OWNER V !\ .5.../W� C MAIL RECEIVE. BY .ATE R£CEIV-D DATE ISSU D ADDRESS /. 1O/ O S /e- /Zc/ 7 y' ��. " ).I b ---- lo/ TEL C BUILDING it CITY I-C/S /116N K 1 roc c NO.L[�[�/ / ADDRESS O / / ; //.. ARCHITECT TEL OR ENGINEERS U GSi &i 1`10/2/,4 7/22 1 COSTA MESA. CALIFORNIA10 FIRE ADDRESS S/Jds. 14r/-IO/L/ IL b ZONE TYPE Y GROU7 L,414 CONTRACTOR(a.1.2-(a.1.2-‘14( APPROVED BY cyDA/2Fl > ADDRESS - • NING Pt.... 9-- ` ZONE ki 1 I NO.OF 1 USE OF NEW CITY I/ PLANS BUILDING -// STATE / TEL. LEGAL //,�((,,''//�� �V LIC.NO. NO. DEBCRIPTIp1T�`ZJit. /3) I SIZE /rp y t 1 a NO. OF BUDGE. / / ¢ / OF LOT J V A Aso/ NOW ON LOT A.P.NO. 1/ I) '- / >3 8- USE OF YARDS ' EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM cc( (CENTER LINE ST.) CENTER OF STREET 3 REAR YARD/T FRONT �~D FT. IN. SIDE YARD I LEFT r / I RIGHT 5/--/ R.SIDE 57T. IN. DESCRIPTION OF WORK L.SIDE T. N. Cl/ NEW I HI-ALTERATION I II ADDITION I REAR ✓ Q FT. IN./ IIMOVING II DEMOLISH I BYPROVED// - DATE /O-)3- I,/ REPAIRI y / N / (% SIZEDING3` X Ito ROOMS b STORIES i EXTERIOR WAL1`�,//J ROOF COVERING / //" COVERING U/ I(o 1° `HOLD FOR PECIAL REOUTRFMrN`t'C USE OF BUILDING AND WORK TO BE PERFORMED / a ( .p, ,.n Sq , 6G,.L _ I HEREBY ACKNOWLEDGE THAT I .yam 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 LAWS REGULATING BUILDING CONSTRUCCTTION. /� /- VALUATION c OD SIGNATURE OF f[_ //�J, (----- w —.- PERMIT FEE $ J ;21 PERMITTEF �"1ll„ii / 0 ��// $ /G- / —1 PLAN CHECK $ J7 AUTHORIZED AGENT / V' J �T, O TOTAL FEE V� y