HomeMy WebLinkAbout2969 BABB ST - Building PermitsApplicant to tilPin all soaces except tnose within neavY boraer Iines ana sign ail appropriate tleelaralions.
CLTV OFCOSTA ^M�ESA CO. STRUCTION �R,MIT PERMIT,NO.� � � „ . TRACT NO. LOT NO. UNIT NO.
Project Address S2'-�� � � �- � �
ApplicanYsMaili� A/d�d�ress �-�� � d�� � � �� -
Owner s Name .l�L� � �n�� ��✓Q Phone v ����
Address � � � � � /7' � � � �
ArchlEng. License No.
Address
Contractor's Name Phone
Address (mailing)
City License No.
LICENSED CONTRAGTOR DECLARATION
I hereby afti�m that I am licensetl untler provisions o( Cltar[er 9(commenCing
with 5eclion ]000) of Division 3 of the Business antl Pro(essions Cotle, antl
my license is in full force antl eftect.
Litense Class License No.
Date Signature
W00.KER5'COMPENSATION DECLARATION
`ereby aftirm tnat I nave a certiticate of mnsent to self-insure or a cerUficate
workers' Compensation Insurance, or a certifietl copy thereof (Settion
i0, Lab. C.) �
Policy No. Company
8 Certifietl coOY �s hereby furnishetl.
Certifietl copy is filetl wifh the city Builtling Division.
Oate APplicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if the permit is /or one huntlretl ($100) or
less). -
I certify mat in tne pe�to�mance ot the work (or which thiz perm�t is is5uetl, I
shall not employ any per5on in any manner as to become subject [o tM1e
Worker Compens �Ppq Laws ot Califq{1�ia.
Dale �:'- 'S - d / Signature ,�'/ � � �
NOTICE: It, after making this tleclaration, you sh Itl become s ject to the
Worke�s' Compensation provisions of the Labor Cotle, you must forthwith
comply with such provisions or this permit shall be tleemetl revoked.
CONSTRUCTION LENDING AGENCV
1 hereby afflrm ihat there is a construction lentling agency for the performance
of the work for�whlcn tnis permit is issuetl (Section 309] Civ. CJ
LenAer's Name
LentleYs Aatlress �
OWNER BUILDEN OECLARATION
I hereby affl�m Ihat I dm exempt from the Gont�actor'S License �aw for tne
following reason (Section 7031.5 Business antl ProTessional Cotle: Any city or
county which requires a permit to consGuct, alteq improve, tlemoli5h or repal�
any structure, priar to its issuance, also requires the applicant for sucn permlt
to file a signetl Statement that he/she is licensetl pursuant to the provisions of
the Contractor's License Law (Cnapter 9(commencing with Section ]000) of
^'vision 3 of [he Business and Professions Cotle) or that he/she is exempt
�efrom an0 the ba5i5 for the allegetl ezemption. Any viola[ion of SecHon
1.5 by any applicant tor a permit subjects the applicant to a civil
,alty of not more than tive huntlretl tlollars (y500).
U 1, as owne� of the prope�ly or my employees with wages as [hei� sole
compensation, wi11 tlo the work, antl the sVucture is not intentletl or o(feretl
tor sale (Section ]044, Business and Professional Cotle: The ConVactor's
License Law tloes not apply to an owner ot a properry wno builtls or improves
thereon, antl wM10 tloes suclt wo�k himself/herself o� tnrough hi5 or her own
employces, provitletl that such improvements are not intentletl or otteretl for
sale. If, however, the builtling or imp�ovement is Soltl within one year of com-
pletion, the owner will have ihe burtlen of proving he/she tlitl not builtl o� Im-
prove for the purpose ot 5ale�. -
❑ I, as owner of tlie property, am exclusivety contractinq with licensetl con-
' tractoRto consVuct the Oroject (Section ]044, Business antl Profeszions Cotle:
Tbe ConVactor'S License Law tloes not apply to an owner of pioperty who
builtls or Improves tnereon, antl who contracts tor such projects wltn a con-
tractor(sI ncense pursuant to the Contractor's �icense law). I am aware that
pr t of their Worker'S Compens t' ip5ury_nce Shaultl be provitletl [o me.
I am exempt untler Section �� -5 U B. & P. C. to� t�is reason
�
�ate - - Owner
I hereby certify ihat I have reatl tnis applicat on antl state t t the above
information is correct. I agree to compry with all city antl coun y ortlinances
antl state laws relatin9 to builtlinq construction, antl hereby authorize repre-
sentatives of this •c'ty to enter i}� n the above-mentionetl property fo
inspe<tlon pJyq ose � /� J�' Y�Mtr � /�
Signature /(//�l+L%%j(.f`.( c,�r-�• O �O�'3"
Drivers' Li� Se or 55� ,
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESC�iIPTION O,F WORK/USE OF B�.DG.
TVPEOFPERNFI�! I.JGRADING LIFOVNDATION I.��TRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL '.
❑ OTHER
PROJECT DESCRIPTION Sq.F7. oCCUVANCv
CONSTRUCTIONTVPE ��� VALUATION$ I�.�ri
20NE GRADING CU. VDS. AC E5�$
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor $inks '
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof Drains
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank .
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
FEES
Reinspection Fee � $15 I I Issue Fee I $ 3
MECHANICAL � FEE
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl7Fact. elt. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,000 BTI
Hood�or Typel ❑
Canopy Typell ❑
Refrigeration Sys[em
❑0-100,000 BTU ❑ 100,000 BT
System Repair/Alteration
Fire Dampers � -
Registers
peinspeMion Fee � $15 � � Issue Fea � $ 3
CMF 0865�46, r¢v. 10/84 White - Builtling; Canary - Applicanh Pink - ACCOuntlng: Goltlenrotl - ASSe55or
A.P. #
S Main Building:
E
T Front
6 Rear
A
C Right
S Left ij
Ping. Fef. #
Planning Notes:�
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers OGas ❑Electric
Fan
F.A.U. �
Fixtures
Device Boxes
Outlets
Switches
Garhage Disposal
Generator OO-5 KW OS-�
Fee
0741 12/03/87 ;
.- Zone
� Accessory Building:
' Parking Req./Provitled
ELECTRICAL ^ �
Transformer ❑ 15-50 KW
� 50+ KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors DO-1 HP � 1%- 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light ,
Range
Standing Sections
5 KW Tresh Compactor
$15 luue Fee
DEVELOPMENT SERVICES R
2oning Approvetl By
Building Approved By �
SUMMARV OF FEES
�F�LBUILOWG PERMIT $ - S�- UV SMIP ,
PLAN CHECK $- ��- 3 r PERMIT _
PLUMBING � � $ ' ISSUANCE
' . PLAN CHECK 25% $ ENERGY P.C.
ELECTRICAL � $ � GRADING
PLAN CHECK 50% $ MICROFILM
. MECHANICAI $ . TOTAL FEE
PCAN CHECK 25% $
50odu TL
Z
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G
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M
T
S
FEES
$ 3
elZ-3's�
e� 2—�—f7
�.e_J 2-3-fc7
s .5 d
$
$
$
g �O� $S
CONSTRUCTION AND PLANNING � POOL & SPA
APPROVALS Permit #• Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. %' . 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 Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. -- 60. Backwash Lines, 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 Electrical-T Bar Ceiling ' 69. POOUSPA SYSTEMS FINAL '
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
�
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro r -
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil •
23. Gas Pipe�Rough & Test 72. Underground Flush �-
24. Roof Framing 73. Undergrnd. Storage'f ank O Gas ❑ Oil �
25. Roof Sheathing 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 7S. FIRE PREV. FINAL �-
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICAT 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 pomestic-Final � �
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscape�lrrigation System _ ,
45. Sound Attenuation .
46. Handicap Regulations '
47. FINALSTRUCTURE&BUILDING � .
48. Special Requirements Completed
49. Electric Release to Edison • -
50. Gas Release to Southern California Gas Co • �, �'
51. CERTIFICATE OF OCCUPANCY - � . (
No. Date � ' "
AOP��cant lo fiil in all spatts except Mose within heavY �ortler linos ana sign a1l approvriate tleclantions.
,�aT-'�OFCo.�,�MESn/ C�OiNSTR CTIOQN P RMIT
t Project Address 1� ls 7 //Ap£y� �
ApplicanYs Mailing Address Z- �r �_'.�y,/< �d / . /Y+/i
Owner's Name �/� /�^ � 7�, /� in--/fbhone S�lCiii/il�
� Address Z�'� 9�¢��.�-� t'/. eT 7-�n �f w
Arch/Eng. � �icense No.
Address
Contracmr's Nam Phone �
� Address (mailing)
� City License No.
LIGENSED CONTRACTOR DECLARATION
I hereby atfirm [hat I am licensed untler provisions of Charter 9(commencin9
with section ]000) of Division 3 o the Business antl Protessions Cotle, antl
y license is in full torce antl etiect
LICE052 CId55 _ �IC2f15C NO.
Date �'a�a+ �a
W00.KER5' COMPENSATION DECLAftATION
hereby af(irm [hat I have a tertifitate of consent [o self-insure or a tertiticat¢
f Workers' Compen5ation Insurance, or a certi(i¢tl coOY thereof (Section
.800, Lab. C.)
Policy No. Company
eCertifietl copy is hereGy fumiSM1etl.
CertiTietl copy is tiletl with the city Builtling DIvlSion.
oate AOPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(TM1issection neetl not be cortipletetl if the permit is tor one huntlretl ($100) or �
less). .
I certify that in the pertormance of the work fo� whi[h this perm�t is issuetl, I
sM1all not employ any person in any manne� so as to become subject to the
workers• Compensation Laws ot Calitornia.
ate Si9nature
'NOTICE: If, afte� making this tleclaration, you Shoultl become Subject to the
Wo�kerz' Compensation provision5 of Ihe Ldbor Cotle, y0u must forthwith
comply with such p�ovisions o� this Oe�mit shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV • -
I hereGy attirm that there is a construction lentling agency for the pertormance
ot the work for which this permit is i55uetl (Section 309� Civ. C.)
Lentler's Name
Lentler's Aatlress
OWNER BUIL�ER OECLARATION
I nereby at(irm that I am exempt irom the Contractor's License Law for the
followinq reason (Section 7031.5 Business antl Pro(essional Cotle: Any city or
munty wM1ich requires a permit to construct, alteq improve, tlemolish or repair
any structure, prlor to its issuance, also requlres the applicant tor such permit
to tile a signetl statement that he/She Is licensetl pursuant to the provisions o(
the Contractor's License Law (ChaOter 9(commencinq witM1 Section ]000) of
Oivision 3 of the Business antl Professions Cotle) or that he/she is exemp[
ierefrom antl the basis for ihe allegetl exemption. Any violation of Sectlon
031.5 by. any applicant for a permit subjects the applicant to a civil
�nalty of not more tnan five huntlretl tlollars (5500). '
1, as owner of the proper[y or my employees with wages as thei� sole
compensation, will tlo [he wo�k, antl the st�uclure is not intentletl or otferetl
tor sale (Section 7044, Business and Professional Cotle: The Contractor's
License Law tloes not apply to an owne� of a property wM10 bui105 or improves
thereon, antl who tloes such work himself/herzelf or through his or her own
em0loyees, providetl tM1at such improvements are not'intentletl o� otfered fo�
sdle. If, howeve�, the builtling or improvement is Soltl wi[hin one year o/ com-
pletion, the owner will have tM1e burtlen of provinq he/sM1e tlitl not builtl o� im-
p�ove forthe purpose of sale).
❑ I, as owner of the property, am exclusively contractinq with licensetl Con-
tractorsto construct the project (Section ]044, Business antl Professions Cotle:
The Contractor's License l�w does not apply to an owner of property who �
builtls or improves thereon, antl who conVacts tor such pYojects with a con-
tractor(s) Ocense pursuant to-the Contracto}'i License Law). I am aware that
proof of their Worker's Compensation insu�ance shoultl be provitletl to me.
❑ I am ezempt untler Section B. & P. C. for Ihis reason
Date Owner
I hereby certity that I have reatl this appliwtiOn antl state that the above
iniormation is correct. I agree to como�Y �+�th all city antl county ortlinances
antl state laws relatin9 �o builtling construction, and hereby authorize repre-
sentatives of this city to enter upon the above-mentionetl property for
inspection purpOses. _ A
Signature //����_�ie.�l�.�/N"` Date/Z��_L�L[/
Drivers' License or 55 � � /
TVPE OF CONSTRUCTION Ll NEW U ADD LJ ALTERATION LJ REPAIR —
❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p#
DESCRIPTION OF WORK/USE OF BLDG. . .
S Main Building:
TYPEOFPERMIT GRADING ❑FOVNDATION ❑STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Reaf
❑ OTHER A
PROJECT DESCRIPTION SQ. FT. OCCUPANGV C Right
K Left
CONSTRUCTIONTVPE VALUAT.ION$ $
ZONE GRA�ING CU. VDS. ACRES p��g, Ref. #
Remarks: . Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtuhs
Clarifiers
Dishwasher
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service OuUets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspectian Fea � $15
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heating System & Ducting
❑ ai oo,000 eTu O i oo,000 eT
Reinspection Fee � $15
CMF 0865-46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrod - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
AutO-Weih
laue Fae
Hood or Typel ❑
Canopy Typell ❑
Refrigeretion System
❑0-100,000 BTU ❑100,000 BTU
System Repair/Alteration
Fire Dampers
Registers . .
laue Fee
FEES
$ 3
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
471D 12/281�4
Zone
' ' Accessory Building:
Parking Req./Provided
� /
ELECTRICAL
Transformer ❑ 15-50 KW
O 50+ KW
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW �5-15 KW
Meter LJup co 100 amps
Meter ❑over 100 amps
Sub Panel
Motors �0.1 HP 01 % -'8
Inc. Solar'09-15 HP �16�
Microwave � �
Pole Light
Range
Si9n
;Standing Sections
Trash Compactor
� Reinspection Fee '$15 � � luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Appliration Issued By p
700U TL
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP' $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ •iJ� GRADING $
PLAN CHECK 50% $ MICROFILM $ /y
MECHANICAL $ TOTALFEE $ -�i'0�
PLAN CHECK 25% $
Z
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_LI'
' CONSTRUCTION ANDPLANNING POG SPA
�RAPPROVALS � Permit# Date Inspector AppROVALS Permit# Date Inspector
a� Temporary Electrical Service or Pole � 52. Pool & Equipment Location
/2. �Soil Pipe-Undrgrnd. 53. Steel Reinforcement
t
3. Elt;ctrical Conduit Utility-Undrgmd. � 54. Forms
.4. Electrical Conduit-Undrgmd. , 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE .
7. Footings - 58. Electrical Conduif-Undrgrnd.
'8: Foundation 59. Gas Pipe, � Undrgmd., Test -
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrrd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final -
- 12. Se�ver Cap 63. Heater & VenbFinal
13. Roof Drains � 64. Piumbing System - Final
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduii 66. Solar Sy3tem-Firta) .
i6. Rough Electric Wiring .' 67. Fencing & Acceu Approroel
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 OGas ❑Oil -
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . 73 Undergrnd. �Storege Tank O Gas ❑ Oil. .
25.'Roof Sheathing � 74. Overhead Hydro � - �
_ 26. T-Bar Ceiling (Structura0 & Monacoat - 75. bry Chemical
27. Frame and Flashing • ' - 76. DrY Standpipe . ��
� 28. Lathing & Siding ' � - - 77. � FIXED SYSTEM FINAL
- 29.•Insulation " 78. FIRE�PREV. FINAL .� .
. 30. DrYWall Nailing , HEALTH DEPT. REQUIREMENT
31.�Plaster Brown Coat 79. FINAL INSPECTION .
32. Electrical Power I�leter-Final � 80'. FOOD CERTIFICATEiSSUED
- 33. Final Electric � � � � Not�s: _ ' ' � �
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 pomesticFinal � � - � � '
42. Backflow Preventer . � , � '� . � - � .
43. Backflow Irrigation �. � - �
44. Landscape Ir[ipation System � � . . �
45. Sound Attenuation . � - � ' - � � �
46. Handicap Regulations . � . . �
47. FINALSTRUCTURE&BUILDING � �
48. Special Requirements Completed
49. Eler.tric Release to Edison - , � �
'' 50. Gas Release to Southern Califomia Gas Co � -
51. CERTIFICATE OF OCCUPANCY
, I No. Date " ' - �
WET.COME '.lOMx's
JOBADDRES3
GENERALCONT
L�,. %
GROUP I�& J
INSPECTIONS
Footing Trench
Foundation Forms
Rough Framing
Plumbing, Rough t
Wiri
Heating, Final
VSewer, House E
5� ': Tank or C spool
L, ng, In 1
Plastering
Plumbing, Final, Fixtures
Plumbing, Final Gag Test
Wiring, Final
Occupancy
FORM 210 3M 10-v5
Babb �treet
Welcome Homes
TRAGT 2896
V ZONE 1�
DATE I SUBCONTRACTOR
St• �� .Cd�C !ii I'
-[v9'�� ��
olete�� ��-- '—" ��—
�yYLBS / 1'Y�.i \ /ii' /
�-18-,�6
BUILDING PERMIT NO. 3015
VALUE $ 9�600•�
�$ingle Res. w/att gar.
FIRE DISTRICT 3077
PERMITS ISSUED
DATE � NUMBER
� Costa Mesa Bnilding Department APPLICATION FOR PERMIT
� • P.O.Box3�� 3(?55 BUILDING �
� �� COSTA MESA, CALIFORNIA
. FOR OFFICE USE ONLY
FOR APPLICANT TO FII.L IN Receipt No. I � rm�t rvo.
eui�aing o'�.yh O i5
Address ^ ��Babb Street
Costa, Mesa, California Receive ny Date pRec'd. Date Issued
Nearest a` 'J �O ��� ������
CrossSt. r'o5't Building
Address
Ownerti"relco�r�e Fi�*�s, inc. CostalVlesa,California
Address �� titie�``�minster Ave.� Nearest
Cross St.
Y;estminster T0��7es. 5711
City No.' Zone ;/ I No. of I Type :/ Group.7-�,
Architectar Lic. `r Plans V �
Engineer No. Approved
6y Date
o,ddress CORRECI`IONS
�''elcom� iioire s Inc.NoY Lic. �.7Q
Contracto� • �
Address 6628 YCestminster Ave., �,��� �/`�(��1\� e�I ZC,.^�
Legal Lot I 2 6 '� � �_`1 .': �� C:��i u i, �j •�
Description I No. % I Block � Tract � _
i_-1 �.« I
\'-�
(Attach Metesand Bounds) ;,;:'Y � f{ 'iG!:�;
No. of Bldgs
sizeofLot 5�X1�2 I NowonLot None
O
l�seof I No.of I No.oP x
Existing Bldg. NOrie F�amilies Rooms nIT/ n.- __ (�
Setback Line from Rear Yard . �' d tl �, ���� � f' �"' ��•Y� �
Center of Street 5� Ft• Sida Yard Ft. Z
D
DESCRIPTION OF WORH - �
New I I Alteration I I Addition I
Repair I I Moving I I Demolish I
Building No. of
size 27x1{0 Rooms ii stories 1
Exterior Wall I Roof ,.
Covering S'�1.1CC0 Covering �roC(�. APPR,Q�1���`
Use of New
Building Sir�le fanlly residence and FoundationLocation Inspector � Date
Forms, Materials,
two car ra�o attaohed. under•Pinniny
-� (� Frame: Fire Stops�
Bracing, Bolts
I hereby acknowledge that I have read this Application
and state that the above is correM and agree to comply Lath. Int.
with all City Ordinances and State La s regularing .
huilding con�[Fuctign. Lath. Ext.
Signatureof j l
Permlttee � Plaster, Int.
Authorized Ag r� plaster, Ext.
Valuatlon.�a �L' Permit Fee $ �i _ Masonry ReinToroed
Plan Check $ / ;r� � gond Beam
$ �, O Total -y
Fee $ J � -� FINAL
FORM 204 IO�SS D. P. 8 5,
PLOT PLAN
Shaw locatlon and disCances from
property Ilne and between buildinga
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GAS
WATER
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CON�ITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUNO � POWER �
ROUGH WIRING
TRENCXES U FORMS U STEEL REINF.
FLOOR SVSTEM
BONO BEAM � STEEL REINFORCE ❑
SHEATMING
FRAME ANO FLASHING �
LRTMING - IN n OUT n
P' 'ER, BROWN COAT
fURAL, FINAL
Hc..� ING, VENT., REFRIG. AN� R.C., FINAL
PLUMBING. FINAL AN� GAS TEST n
ELECTRIC, FINAL
9UIl01NG, FINAL
SPECIAL REOIIIREMENTS
UAIC
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SUBCONTRACTOR
4221�
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completety — Use Ink Only
BUILDING � �
ADDRESS
i
OWNER i �
MA�L
ADDRESS
/ yy) TEL.
CITV / �///. NO.
BRANCH
ARCHITECT TEL.
OR ENGINEER NO.
ADDRESS
F���.
^'!' ?R�76�..�.0039F3;r i: : � `• *u.
APPLICATION FOR STRUCTURAL PERMIT
EC I�BV � Z�1Z�0 LA.�E-1�Ei
BUILDING
ADDRESS
FIRE
ZONE
APPROVED
ADDRESS .,3 ,_J. /�.
TEL.t NE NO.OF USE OF N
CITY � NO..,J3/- /�.2p � P�� � BUILDING - �,y
F STATE CITY YARDSAPPROVED VARDSAPPROVED
� IIC. NO. LIC. NO. MAIN BUILDING ACCESSOFV BUILDING
(q SIZE NO.OFBLDGS. (FRO C/LSTREET)
� OF lOT NOW ON LOT FRO FT. FT.
a USE OF �
„�y EXISTING B�OG. I E� FT. FT.
y '1
FSeparate permits are required for �. s�oe FT. PT.
Welectric, plumbing and heating work. REAR .� FT. FT.
[.. USE OF BUILDI D WOflK P RFORMF� DISTANCE BET. BET. MAIN &
QQ GC MAIN BLDGS. ACCESS. BLDGS.
VAR. # DATE
� C.U.P.# APPROVED
a /� , b
� A R ED .y_ r
�.. l.
�
Ki
W
Q 1 hereby ack�owledge that I have reatl this application antl state �
N
y� that the ebo�a informeiion is correct entl agree io comply with
m
4 all laws reBulatinp bullding constructian, antl I shell not amploy
Z any person i� �iolation of Me workman's compensation laws of m
� the State of California. -
m
3 I hereby cartify ihat I am ptoperly licensetl as a contractor untler SQ. FT. ry
the Staie of California eusinass and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOP m
Chapter 9, antl that such licenses a in full fo�ce antl atfact, or I THE PURPOSE OF ESTAB4ISHING A PERMR FEE ONLV: �
am exempt trom the provisian eSiata of Californta Business VALUATION a
and Professio�s Co , Divisio apter 9. PERMIT FEE $ ��� N
m
PLAN CHECK $ �---- �^
Signature of / /�Q �
Permittee - $ J^ �^_ TAX § O LL
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Auth A9eni TOTALPAID E