HomeMy WebLinkAbout910 ARBOR ST - Building PermitsCITY OF COSTA MESA
��pMFS'q BUILDING DIV/SION
't�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wwi.ci.costa-mesa.w.us
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FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: P09-00074
PERMlT7YPE PLUM
APN: 42252317
JOB ADDRESS: 910 ARBOR ST CM
Vicinity: OUTDOORATTIC �
STATUS: ISSUED
DATE ISSUED: O6/16/2009
ISSUED BY: BJK
Suite/Unit:
SCOPE OF WORK: CHANGE-OUT OF WATER HEATER IN THE OUTDOOR ATiIC OF AN EXISTING SFD.
NO OTHER WORK AUTHORIZED WITH THIS PERMIT. � ' i'� '�' �
OWNER: ANDELIN, BAkTON K � �� Address:
PHONE: - � � - City/Stale/Zip:
APPLICANT: EVANS, MIKE � . Address:
PHONE: 949-646-1185 � City/State/zZip:
CONTRACTOR: EVANS PLUMBING INC : ", � . � - ' �
Address: 1720 WHI7TIER - �� -
City/State: COSTA MESA, CA ZipCode: 92627
ARCHITECT: License No.
ENGINEER: �, License No.
- 910 ARBOR ST " ;
COSTA MESA,-CA
1720 WHITTIER� - ..
COSTA MESA, CA � -
__. : _ ' .,,;�
License No. 498867 �.
- PHONE: 949-646-1185
CELL: .
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35.80
$35.80
PHONE:
PHONE:
NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
CODE/. INSPEC110NTYPE �AIE IN7111AL5 COOEt INSPEG110NTYPE DATE IN1111A15
1618 Fixed System Final Fire Prevention 206 Final Mechanical ��
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm untler penalty of perjury one of lhe following declarations:
❑ I have and vnll maintain a certi(cale of consent to sel(-Insure for workers'
wmpensation, as provided for by seclion 3700 of Ihe Labor Code, for the
pertormance o( the work for which ihis permit is issued.
�� I have and vrill maintain v.orkers' compensation insurance, as required by
section 3700 of the Labor Code, for the peAormance of the work for which Ihis
permit is issued. My workers' compensation Insurance carrier and policy
number ar
Cafrier � a7 �^�"a'�'—S
� (ThissertionneetlirotDecnmdpeletlqlhepeimGisvaluetlafonehunCretltldlars($f00)wless.)
Policy.Number: �0 ( � l S3 �
❑ I certify �hat in Ihe peAormance of �he work for which [his permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subjecf to the workers' compensation provisions o( Section 3700 of
the Labor e, I shall hydth co lyipp with these provisions.
(� r'
r lo—(b—D�t.
A70�����'s Signa Wre . �Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVI�ED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby afTrm that I am licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pmfessions Code, and
my license is in full force and effect.
�ic.-.n�`��/`ld'd'�91 / c��ass:��G'3�
C//�t _ _ _ `f� rP—((D—D�
bGomracior's SignaWre �- Da�e"
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn thal there is a consWction lending agency for the
pedortnance of Ihe aork fa wliich this permi� is issued. (Sec. 3097, Civil Code).
Lender's Name:
lender's Address:
Signawre oa�e
OWNER•BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Professions Cotle: Any ciry or counry which requires a permit to
construct, alter, improve, tlemolish, or repair any slrucWre, prior to its
issuance, also requires ihe applicant for such permit to f le a signed statement
that he or she is licensed pursuant ro the provisions of the Contrecrors
License Law (Chapler 9(commencinq with Section 7000) of Division 3 of Ihe
Business and Professions Code) or Ihat he or she is exempt there(rom and
the basis for Ihe allegetl exemption. Any violation of Section 703L5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five huntlred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and lhe strucNre is not intended or
offered for sale (Sec. 7044. Business and Professions Code: The Contractors
I.icense Law does not apply to an owner of property who builds or improves
Ihereon, 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. It, however, the building or improvement is sold within one year o(
completioq 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 CONTR4C71NG WITH
LICENSED CONTRAC70RS to construd the project (Sec. 7044, Business antl
Professions Code: The contractws License Law dces not apply to an owner of
property who builtls or improves thereon, and who contracts for such pmject vnth
a contrac[or(s) license pursuant to the Contractws License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]-4fi�310])
Owner ID verifietl by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (rype o! document, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certiFy that no eacavation frve (5) or more feet in depth into wfiich a
person is required to descend, will be made in connection with work aulhonzed
by mis permit, antl that no building structure, scaffolding, falsework, or demolition
or dismantling thereot, will be more than thirty-six (36) feel high. (Chap. 32, Gry
2, Art 2, Sec. 341, TiHe 8, Cali(omia Adminis[2[ive Code).
❑ As owner-builtler. I will not employ anyone to do work which woultl
require a permit from Ihe Division o( Industrial Safety, as no[ed above, unless
such person has a permit to do such work from the division.
Appl¢anfs SignaWre Date
Division o( Industrial Safe[y Permil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupan[ need lo file and
certify a Business Plan !or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Seclion 25505 0( the California Health and Sa(ely Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantiry ot hazardous materials equal to or grealer lhan 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 fle
a registration form for acutely hazardous materials? ❑ Yes � No
(Section 25533 of ihe Califomia Health and Safery Code, with some
excep[ions, requires registration with the Costa Mesa Fire Department by
each business which a[ any one time has on hand a quantity o( acutely
hazardous materials equal to or greater Ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas al standard
temperaWre and pressure).
3. Does or will the applicant or preseni or future builtling occupant need ro
prepare an RMPP (Risk Management antl Preven�ion Program for aculety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safery Code provides that Ihe
Costa Mesa Fire Department may require lhe prepara[ion, certifcation antl
fling with the Fire Department ot an RMPP by 6usinesses which are required
to register awtely hazardous materials with the Fire Depariment.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Heal[h an0 Safety Cotle been fully complietl with? ❑ Yes ❑ No
5. Does or will lhe applicant or present or future building occupant require for
the work which is the subject of this application a permit for such constmction
or modification irom the Soulh Coast Air �uality Management Dislrict or from
any other air pollulion control district or agency? ❑ Ves ❑ No
(Section 65850.2 of [he Califomia Govemment Code requires that ihe requested
infortnation be fumished on applirations for nomresidential building pertnits).
6. Will any part of the faciliry to be constiucted under this permit be within
1000 feet from the outer boundaries of a school? ❑ Ves ❑ No
(If'yes", Ihe facility must meet the requirement of Sections 25534 and 42303
of the California Healm and Safely Code).
7. if a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is requiretl for the work which is the
subject of this appliwiion, have all of ihe disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (I( "yes", attach certifcate of compliance from the appropriate air polWtion
control offcer�.
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 o( perjury that I have read this application and state that
the information given is correct I agree to comply with all state laws and city
ordinances relating ro builtling construction, and authorize represenlatives ot
the Ciry of Costa Mesa to enter upon the above-described property tor
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
SlgneWreofLeqal ner�s) Date
�//i �C �G�---- lo-ll0-0%
-�rAu�nonzeDAppliran��� Da�e �
, •. � :ia.t . . _ y,
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 910 ARBOR ST
Suite:
Vicinity:
Parcel Number: 42252317
Applicant: LANGDON, JOSEPH
Address: 16312 ALINGTON LN
HUNTINGTON BEACH CA
Owner: MANDELIN, BARTON& GINA
Address 910 ARBOR ST
CM, CA
Contractor: JNL ROOFING
Address: 16312 ALINGTON LN
Arch :
Address:
HUNTINGTON BEACH CA
Zip: 92649
Phone:
Zoning:
Phone: 714-536-1816
Zip: 92649
Phone: 949-631-2718
Zip: 92626
Phone: 714-536-1816
License: 648337
Eng:
Address:
Status: ISSUED
Applied: O5/17/2000
Issued: OS/17/2000
ISSUED BY: ( / 1' �
Phone:
Zip: License: License: ,
SCOPE OF PERMIT
TEAR OFF EXIST. COMP, INSTALL 30LBS FELT UNDER 40 YEAR COMP. i550SF TO INCLUDE ATTACHED GARAGE.
Plan Check: $0.00
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
5z,soo.oa
sz,soo.oa
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 ot 1 BO day5.
INSFECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectiona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
: ►.i..+�--'
WORKERS' COMPENSATION DECLARATION:
I �ereby attirm under penalry of perjury one ot iha tollowing tleclarations:
❑ I have and will maintain a certificate ot consenl to seN-Insure for workers' compensation, as provitletl for by section 3700 of Ihe Labor Code, for ihe peAormance of the
work tor which this permit is issuetl. �
❑ I have antl will maintain workers' compensation insurance, as required by section 3700 of ihe labor Code, for the peRortnanca of the work for which Ihis permit is issued.
My workers' compensetion Insuranca carrier and policy number are:
Carner. Policy Num6ec
(This secfion need not be comQleled ilme permit is velued et one hundred dollars ($100) or IessJ
a I cenity ihat in the pe ord
� compensation laws oi ali(
CO OVI i0
pplicant SignaWre:
WARNING PAI SECUR
DOLLARE (5100. , I /
LICENSED CONT�R OA&9E
I hereby � ihat I am licensetl
lo nd BffBCL Lic. # �
d the work tor which this pertnit is issued, I shell not employ any person in any manner so a to become sublect to the workere'
�,ntl agree that if I should become subjact to the workers' compensation provisions of Section 37 � ot th Labor Cotle, I sheli torihwith
COMPENSATIONWVERAGEISUNLAWFULANDSHALLSU&lE PLOVERTOCRI INALP�T����I�ESUPTOONEHUNDiiED
JTOTHECOSTOFWMPENSATION,DAMAGESASPROVIOEDWRINSEGTION3] � THELA90RfADE,I�YTEREST,ANDATTORNEV'SFEES.
\TION:
provisions �Chap�r 9(commencing with Section 7000) of Division 3 of the eusiness and Protessions Cotle, antl my license is in full
CONSTRUC710N LENDING AGENCV: �
❑ I hereby attirm that there is a consiruction
Lender's Name:
Signature:
a9ency tor the peRormance oi �he work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lentlels Adtlres5:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirtn that under penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires a permit to consiruct, alter, improve, demolish, or repair any stmcNre, prior to its issuance, also requires ihe applicant tor such permit
to file e signed statement ihat he or she is licensed pursuant lo the provisions of tha Contractors License Ww (Chapter 9(commencing with Sectlon 7000) of Division 3 of the
Business and Professions Cotle) or ihat he or she is exampt therefrom and the basis tor Ihe allegeG exemption. Any violation oi Section 7031.5 by any applicant for a permit
subjects the applicant to e civil penalry of not more then five hundred dollars ($500).):
❑ I, as ownar ot Ihe property, or my employees with weges as their sole compensation, WILL DO THE WORK, antl the structure is not intentled or oflered for sale (Sec.
7044, Business and Professions Cotle: The Contractors License Lew tloes not apply to an owner of property who builds or improves ihereon, and who tloes such work
himself or hersalf or through his or her own employeas, provided thet such improvements are not intended or oftered for sale. If, however, the building or improvement is
sold within one year oi completion, the owner-builder will have ihe burden of pmving that he or she tlitl not build or impmve tor purpose of sale.).
❑ I, as owner of ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRAC70RS to construct Ihe project (Sec. 7044, Business antl Professions
Code: The contrectors License Law does not apply to an owner of properry who builds or improves thereon, antl who conirects for such project with a contrector(s)
license pursuanl to the Contractors License Laws.).
❑ I am ezempt under sec. Business and Professions Code for Ihis reason:
SignaWre: Date:
Owner ID verified by drivers license. ❑ Ves ❑ No Driver's License No. Expires:
Venfica�ion of.Ownership by (type of tloamen�, i.e. - property taz 6ill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: �
❑ I hereby certify ihat no excavetion tive (5) or more feet in tlepih into which a person is required ro descenq will be made in connection with work authorizetl by this
permit, and tha� no builtling structure, scattolding, falsework, or demolition or dismantling thereof, will be more Ihan ihitly-six (36) feet �igh. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner�builtler, I will not employ enyone to do work which woultl require a permit from lhe Division of Intlustrial Safery, as noted above, unless such person has a
permit to do such work from the division.
Signeture: Dete:
Division ol Industnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CER7IFICA710N:
1 W ill the applicani or present or futwe building occupant need to file and certiry a Business Plan for emergency response to release or Ihreatenetl release of a hazardous
matenal? ❑ Ves ❑ No
(Sec�ion 25505 of the California Heaith and Safety Code requires, with some exceptions, Ihat a Business Plan be filed with ihe Costa Mesa Fire Department by every
business which has at any one time during a reported yeer a quantiry of hazardous ma�erials equal to or greater ihan a weight of 500 pounds, or e volume of 55 gallons,
or 200 cubic feet ot compressed gas at standartl temperature and pressureJ.
— '__ . .... _ ...... .............. ' _............ . .................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Ves ❑�No
(Section 25533 of ihe Califomia Heelih and Safery Cotle, with some eaceptions, requires regisiration with ihe Costa Mesa Fire �epartment by each business which at any
one time has on hand a quantiry oi acutely �azartlous matenals aqual to or greater �han a welght of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot
compressed gas at stantlartl temperature and pressure).
___—_—_.... .......__ .....__,. .............. .__..
3 Does or will the applicant or present or future building occupant naed to prepare an RMPP (Risk Management and Prevention Program for awtety hazartlous materials)?
(Section 25534 of tha California Healih and Safery Cotle provides ihat ihe Costa Mesa Fire Departmem may require Ihe prepara�ioq cetlification and filing with ihe Fire
Department of en RMPP by businesses which are requiretl to register awtely hazartlous materials with the Fire Depanmem.
_ ---.._.._._.._..__.....____........
4 Ii an RMPP is presently required, has Section 25534 of Ihe California Healih and Safery Code been fully complied withl ❑ Ves ❑ No
' _—.... ._._.._____...__'...___.......__.._......___......_...___..._......_.._...._._.......___.__....._._.' ............................
5 Does or will tha applicant or present or tuWre builtling occupent require tor the work which is Ihe subject of this a plica�ion a parmi� tor such conStruCtion or motliticaiion
from t�e South Coast Air Oualiry Management District or irom any other air pollution control district or agency7 � ves u No
(Section 658502 ot the Califomia Government Code requires that the requestetl inlormetion be fumishad on applicetions for non-residential builtling permits).
6 W ill eny part ot the facili�y to be cons�mctetl untler Ihis permit be within 1000 fee� irom lhe ou�er boundades of a schooll ❑ Y85 ❑ No
pf'yes", the facility must meet the requirement oi Sections 25534 and 42303 of iha Califomia Health and Satery Code).
7 It a pertnit irom iha South Coesl Air Qualiry Management District or other air pollution control disirict or agency is required for ihe work which is ihe subject of this
application, have all of the disclosures prescnbed by CaAfomia Health and Safery Code Section 42303 been made9 ❑ Ves ❑ No
— __._.._ .. ...... ........... .. ............_. . ...__....... . ......_._. ..........__.
B (If'yes", attach certificate of compliance irom the appropnale air pollution conirol oHicer).
CERTIFICATE OF COMPLIANCE: I cenity that under penalry oi perjury the intormation given above is correcL I agree to comply with all state laws antl city ordinances
regartling Hazartlous Materials and Emissions.
SignaWre: Date:
CERTIFICATE OF C AN E D AIJTHORIZA710N OF ENTFiY: I cetlity under penalty of perjury Ihat I have read this application and s�ate that the information given is
correct. I agree to mply 't state laws and city ordinances relating to building consimction, and authorize representatives of ihe City of Costa Mesa to enter upon the
a6ove-described pr erry fo i ection puryosP= � aoree not to ocapy or allow occupancy of any building authorizetl by t�is parmit until Bnal inspection.
C� �. INSGELTION TYPE
1616 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201
202
203
204
244636
Final BIocWRetaining Wall
Final Factory Fire Place
Final Sign
Final Demolition
INTfI1RL5
CODE♦ INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
OATE TI RLS
_ - i��.�o
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR APPUCANT TO f/CL /N COMPLETELY
TYPE OR PRINT
BUILDING �/' A��G/�, J/I'
ADDRE55 O
COSTA MESA, CALIFORNIA
uc.
cJ�,
LEGAL LVI
oescrsiviiorv NO. BLOCK TR C'�
�A.P. NO. I I � �l-�/
SIZ■ E I P f �, i1 � I NO.OF OL�GS.
u
rweer REAR YARO
ILEFT � 121GHT
DESCRIPTION OF WORK
�EXTERIOR WALL
COVERING
P]�SW�IF9:1
TO BE PERFORMED
1 HEFEBY ACKNOWLEDGE THAT � HAVE REAC THIS APP4CATION
ANO STATE THqT THE ABOVE 1$ CORRECT AND AGFEE TO COM-
pLY WITH ALL CITY OROINANCES PND STATE LAWS REGULATING
BUIL�ING CONSTRUCTION.
SIGNATURE OF?� / �A=`QR^
PERMITTEE r� ---
AUTHORIZED AGENT
c�.
� i: . �_
� ��.
���,ECEIVED -
FINANCE DEPT.
���y OF COSTA MESA ;`•
APP ATION FOR PERMIT ��,
BUILDING ^`
t.
fo,e oFficF vsF oacy �
I RECEIPT NO. I��P���VQ
V
RECEIVEU BY I DATE RECEIVED L DATE ISSUED
c//U �i1�/�e"a .�J-T.
COSTA MESA, CALIFORNIA
� ZONING
/ / INO. OF USE OF NI
pLqN9 � 6UILDING
YARDS
REQUIRED
(CENTER LINE 6Tq
s
FT. I N.
THE �MOUNT BHOWN UNDER V�LUATION IS FOR THE
PURPOSE OF ESTABLISHING q PERMIT FEE ONLY.
VALUATION
PERMIT FEE S �j% �
y�� �
$ PLAN CHECK $ ��
TOTAL FEE $ 07 �
GENERAL COl
ar. Nu. 115-1
1' '�CTIONS
OCCUPANCY
LOT
'J. -
MAY 1 1 1960
12-22-59
VALUN: � '+`^�•"v
CT FIRE ZONE DESCRIPTION OF WORK onv, or o Ga�
oAre I GROUP J TYPE V ZONE R-1
---I SUBCONTRACTOR I __ PERMITSISSUED__
Form 410-SM-il-59 S-B P 11160
ORANGE CQUNTY BUILDING DEPARTMENT
636 North Broadway . . � �� ..
� SANTA ANA, CALIFORNIA
APPLICATION FOR PERMIT
"� �-� •���-�-�-WC--�-
FOR APPLICANT TO fILL IN � -F.OR_OF.F.ICE.USE.ONLY____ ;
{ i� RECEIPT NO:• PERMIT NO.
BUILDING cJ10 Arbor �t• f - �� y�1C;
A�ORESS �S`�-I • ' �/U L1
SCHOOL DIST. ♦ RECEIVEO BY�� DATE OF APjL. DATE IS6liED -
Oft TOWN JOB YA MBBa /n� .
NEAREST �(�j / },. � 3 NOV S;j95� �
CROSSST. M[]71POOi8 A Ve. //"�,•� /' � �
��T� BEVER�Y NILLS Np�� CR. 54
ARCHITECT,.pA1N Si MCKERRACHER No��SY. 64
ENGINEER l.
AODRE55 zjjO E, WALNUT S7.. PASADENA
TEL. 1.
CONTRACTORNFMP/1RT V��TA CO�NO. CR. S+4
ADDRE55 6 W LSX�RE BLVD. BEV.HIL
LEGAL / BLOCK � 7� G
DESCRIPTION LOT NO. �ZO
fATTACH METES & BOUND51
TRACT
SIZE OF LOT 66 X � �0 I NOW ON LOT9 O
USE OF NO. OF NO. O
EXISTING BL�G. Fqnfi�iEs ROOM:
DESCRIPTION OF WORK
NEW I%� I�+LTERATION I I ADDITION
REPAIq I I MOVING I I DEMOLISH
BUILDING NO. OF
SIZE �O� 5Q.fTROOMS S STORIES�
WALL I ROOF COMPO
COVERING STUCCO COVERING r�q�N/.�
USE OF NEW
BUILDING RESIDENCE _ptt_�Bx�D�
I HEREBV ACKNOWLE'JGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
ANO AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGl1LATING BUILOING CONSTRUCTION.
SIGNATURE OF
PERMITTE /�
AUTHORIZED AGUn . /A. .
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