HomeMy WebLinkAbout2869 BALLOW LN - Building Permits_i
PflOJECT AOOflESS: Z 8[ 9 BALLOW LN
OWNEX'$NAME: �[fjTSUSHI, KENJI�
noosess: HATSUSHI YUKIE
2869 BAL�OW LN
COSTA MESA,CA
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` AflCHIENGINEEfl:
pU0PE55:
uxiT:
92626
pEG.NO.:
lIN1T:
• PERMITTEE: SCOTSMAN ROOFING ( 714 ) 776-9209
FDDflESS: %SS S. DICKEL $T
ANAHEIM CA 92805
ULENSEO CONiFACTOfl OEClABl1TI0N: I hereby aflirm ��a[ I am licensetl under pwvisions o� Chapler 9(commencing wi�� Seclion
7000) oi Oivision 3 otlhe Business and Pmlessions Code, and my license is in Wllforce antl efiect.
cirruc.:054940 STATEIIC.:SH39I7 cuss: —39 —
oate: $'Z� �I Z Si9namre.
WOBKEflS' COMPENSATION OECLABATION: I �ereby afiirm tha I ave a cetlifica�e ol consen� �o sel4insure or a cehifica�e o� Workers'
Compensalian Insurance, or a cehihed copy ihered (Section 38 . Lab. C�.
PoLILY NO.: EXP. OATE:
COMPANY:
❑ Ceni�iea copy is �ereby fumislted. ❑ Cehilied copY is filed with the ciry Builtling �ivision.
Oate: ApplicanC
EXEMPTION FPOM WOBHENS' fAMPEN5RTI0N OECIANRTION: (This sec ion neetl nol De completetl il roe permi ' forane Aunered (5100) or less).
I ceriify Iha� in Ne peAormance of �M1e work for which �his perm is is ed I 5hall noi employ an Derso i any manner so as to 6ecome
subiea to ihe Workers' Compensation laws ot Caiifomia.
Oate: � L� � Z— Signalure:
NOTICE: I( al�er making ��is Oeclaration, you shoul0 be e suble�� �o ihe WOM1ers' Compensation pmuisions o� the Labor
Code. you must lonnwith comply witn such pmvisions his permit shall be deemetl revokee.
LONSTflOLTION LENUINC RGENCY: 1 hereby affirm Ihat ihere is a constmction lentling agency for ihe DeAormance of the wark for
which �his Dermil is issuetl (Seciion 3097. Civ. C�.
lFNOEN:
aooness:
OWNEB BUILOEH �ECIANATION: I herehy aflirm �hat I am exempt tmm �he ConVac�ors' Siate License Law loi Ihe tollovnng reason
(Semion 703t,5 Business anU Pmlessional Catle�. Any city ol counry w�ich repuires a permil to cansVuct, alter, impmve, demolish, or
repair any simc�ure, prior �o its issuance. also requires Ihe applicani for such permi� [o file a signed s�a�emen� ��a� �elshe is licensed
pursuanl to t�e pmvisions of ihe Comracmrs' S�ate License Law (C�apter 9(cammencing with Section 7000) oi Oivision 3 of ihe Busineu
antl Pmfessions Code) or ihat helshe is exempt Iherefmm and ihe basis Ior the allegee exemptian. Any violation of Seclion 7031.5 by
any applicant for a Dermit suUjecis the applicam ta a civil penalty af not more than five hundred dollars (5500).
L as owner oi Ihe Dmpeny or my employees with wages as their sole compensation, will Oa ihe work, an0 the
❑ simmure is not imended or offerea lor sale 15edion 7044, Business antl Pm�essional Code: The Con�rac�ors' S�a�e License Law
aoes not apply Io an owner o� a pmDerty who builtls or impmves tnereon, an0 who tloes such work �imselNherself or �hmugh
�is or her own employees. pmvided that such improvemenis are no� intende0 ar oifere0 for sale. If, however the buildinA or
impmvemenl is sald wi�hin ane year o� comple�ion, �he owner will have Ihe hur0en of pmving h¢/she tlitl noi build or imD�ove
lor �he Ourpose of sale�.
I, as ownerol [he pmDehy. am exclusively coniracting with licensed coniractors to consimct tAe pmle�� ISection 7044, Business
❑ antl Pm�essions Cotle: The ConVactors' State License Law tloes not apply �o an owner o� pmpe�y who builtls or improves [hereon
and who con�racts �or such pmlec�s with a contraclor(5)license pursuant�o �he Contrac�ors' Sta�e License Law),I am awate
Iha� pwol ol ��eir Worker's Compensalion insurance 5hoN4 �e proviAed Io me.
� I am e.empl unaer Section: B, 8 P. C.
lor Ihis reasOn:
�ale: Owner
I tlo �ere�y cenify Ihat I am aware of an0 un0ers�antl the reQuiremen�s of Calibmia HeaI�A anA Sa�ery CoOe Seciions 25505, 25533, ana
25534 and Ihal I or any WNre �utlaing occupanl will/will not (circle one) need �o comply with saitl s�a�e codes anA the requiremenls for a
permi� br conslmclion or motlificalion imm ihe Fir Oualily Management District. FesiOential constmction applications are exemD� ��om
ihese pmvisions.
Oa�e: Npplicanl:
1 hereby cetlity t�at I Aave reatl Ihis aDVlica�ion and sta�e Ihai the above inlormation is correci. I agree �o comDty wi�h all ci�y antl tounty
ardinance5antl5talelawsrelating�abuiltlingconslmc�ionanehereby utharizerepresen�atives Ithiscil enterupon�hea�ove-menlioneA
pmperiy lor inspection puQrposes.
"�aie:�����1 � Signature:
Oriver's License or Social Securi�y a: �]
16<L46 White—Bulitling; Green—Cotle Eniorcement: Canary—ApplicanF Pink—Revenue; Goltlenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 0 8'7 0
PERMIT NO: B 058740 PLAN CHECK NO; N GOVT: N SUPP:
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/O SHAKES,RESHEATH S REROOF"TIMHERLINE" SQ FT: 5,900
CLAIM VALUE: 5,900.00 CALC—VALUE: 5,900,00 GROUP OCC: R-3 /M-1
COMMENTS; SMORE DETECTOR(S) RE�UIRED IN HOME, c�,AQ���F ���R
*�t�r*�t+r�r�r*�t�r�r**�t*�r**�t�t�r�r�r***�r*�r ***�r�r****�***x*+t*�*�r�r�r****i'Jt1M ��� * *
Z O N I N GS ERTEB�AUCIxRSE M E N T S REQUIRED
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGAT; FT IN
PARRING REQ• PROV; PARCEL; 14157213 2NE; REF NO;
PLANNING Nt3T'ES>
:i
*�e*�******�*��+�***+�+��**�,����*���e�***�***�«*�*�**�*�� *���� ��+��***�r��� ���*�,�*��**�x
D E V E. L O P M E N T S E R V I C E S A E Q U I R E M E N"1` S
ZONING APPROVED'BY DATE; �1
BUILDING APPROUED BY ; DATE: -';�
APPLICATION ISSUED BY; � DATE; 5,,i
****�r***�rx��r�r+r*��r�r**�x�* �r�***�r**x�r�i��Q������r*
iEitr�E�EiF�EiE1E�liE�EkiElElE1EiE�klE!l1E1EiF�fiEiFiEiEiFiE�EififiEiFiF3EiEiFiFiEj�iFiEif 1filiffEil�EillEifikiEiEiElfiE1lif�fikiEiEit.�EiflEiEiElEiliE3FiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL' SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES•' GRADING
PERMIT 81,00 ,59
SMIP/NON-RES
PLAN �
ISSUE FEE
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID -%'
TOTALS----> 81,59 0,00 0,00 81,59 81,�9 D00
REVENUE DIVISION TOTALS--> COLLECTED: 81,59 OVER/SHORT: ,00
BLDG PMT PLOMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
81.00 .59 �;
�r
iF iF �If if !! it �E �! If iE 1E 1F �FlE iE it if iF IE iF iE if if if if iE iklt �E IF ik ik �lk 1F If iF iF�F �! 3k iF �1F iE if iEi43E it iF iE fE 3E ik iFik 1E 1E iF 1E if it if iE 1E it IElFik if #�iE �1F if 1E iF if �F 3t iE
I N D I V I D U A L F E E B R E A K D O W N '��
%'
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
(:r
SFR 1500 ALTER BY VALUE RESIDENTIAL N020NE
SFR 9400 REROOF BY VALUE RESIDENTIAL NOZONE
� END OF FEES
y'�� cD�c pLy s�
�
1.00 1,500,00
1,00 •'' 4,400,00
.�
l � _ ':,',_ .' , _ . , ,.�•! ,
CONSIIUCTI@N ANp PLANNING P00� � SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Oate Inspector
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil_Pipe�Undrgrnd. -. 53. Steel Reinforcement '
3. Elearicai Conduit lRility-Undrgmd. �, 54. Forms � -
�4�Electrical Conduit•lJncirgrnd. 55. Electrical Bond�ng �
c 5. Steel, Reinforceme[�t 56. Rough Plumbing & Pressure Test .
6� Eiedrical UFER Grnd. - 57. APPROVAL 70 COVER�GUNITE
7:.�Fodtings - - 58. EleCtricai Cqnduit-Undrgrnd.
_� $. Foundation ,. _ _. 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgrnd. �- 60. Backwash Lines, P-Trap, � Undrgmd.
10. Structural Floor System ` , 61. APPROVA� TO DECK �-
t t. Property Sewer Lirt@ & HQUse Connection ' 62. Backwash & Receptor�Finai
12. Se�N�r Cap . �, 63. Heater & Vent-Pinal _
13. Roof Drains �'- J f� 64. Plumbing System - Final ,
r.
14. Rough Plumbing ' , - .. 65. Electrical-Pinal
15. Rough Electrical-Conduit 66. Solar SYstem�Final
76. Rough Electric Wiring 67. Fencin9 & Access Approval
77. Rough Wiring Sjgn 68. APPiiOVED FOR P�ASTERING
78. Rough Electrical�T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating�& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory F_ireplace � r S ' �� - ' � < !(�ppROVA�S Permit # .
.�.� fi t.' ' t
27. Ducfs, in-Structure�: - �' . :70. Underground Hydro .
22. Ducts, Venti2ting. � � • r � � r71, product:Piping CiCxas O,Oii
23.'Gas PipE�Rough & Test � L � • �� �r _7Z, Under9round Flusk . ��
J
24. Root Framing : [-" • ' = : � ! ' -73:"Undergrnd. SrorayeT$hk �1 Gas� OOiI �
�w � i � -, .
25. Roof Sheathing '" - r-'27..�Z �yv 4. Overhead Hydro � � .
26. T�B�r Ceiling (Svuctu�aq & Monocoat _ � - _ 75: Dry Chemical '
27.,FrameandFlashi�g �,_ ' ' 76: 17ryStandpipe
28. Lathing& Siding ��' ' J��r �� . � 77,-" FIXED SYSTEM FINAL` '�
'29. Insulation . ; � � ' ' 78vFIRE PREV. FINAL . �
30. Drywall Nailing � ' Y HEALTH_DEPT•. REQUIREMENT
.31. Plaster Br,own Coa,t y �" _79:`FINAL INSPECTION
, 32. Electriral Power Mete[�Final �SO.�FO00 CERTIFICATE ISSUED
33. Final ElectriC � ' TNotes: � �
34. Final Heating& Air.•Conditioning, � i/ �: . , - , _ , ,
35. Pinal Gas Pi�3'e-Test' . - ' .. ' �' -
36. 'Hood or Ganopy � - - � , . � -. - .
37. Final Factory Firepfare ` . . �� . '
+
38. FinalPium6ing � �.: � � � . -
39. Water Service=Final � � � �
- 40. Gas Service-Final � �, , , ` - ' _ �
41. Solar pomestioFinal � � ' � "
42.'Backflow Preventer � � � � � , - • i : �
43. Backflow Irrigation,V„ � � . ,
R4. Landscape Irripallo� SYstem . . . ,. . � . � . - .
45..Sound Attenuati;o� �.� -' ' ' � ' ' � �
-t
'46. Handicap. Regulatibns;� � . � � ;� J - y� �- /
47. FINALSTRUCI`�;3RE"�,BU(LDING ` ��� � 6 '-� � �/�_ u.� � `��/
� r.�w V d� jAr-
48. FINAL PLANNM}G ;,;' � . i � I t '
�
-49.. Electric Release�x�`E i'son I I� �• - - �
c �
50.,Gas.Release to �wthem California Gas Co �j. .., •
51. CERTIFICATE.OF OCCUPANCY . , � •.
No. Date
�
Applicant to fili in all soaces except tnosa within heavy bortler lines ana sign all avPropriate aeclarations.
CITY OF COS7A MpES/Ap C NSTRUCTI/ON �PERMIT
Project Address �UL9 / �2��04% LY✓
Applicant's Mailing Address � � � ✓ �c—
Owner's Namen q n ��/ � Phone N%'�-3[ir3
Address d�� / `� Q--'f-E�Tw '�-ti�
Arch/Eng License No.
Address ,[—�--.�"����
Contractor'sNam Ss ¢ .}- honeU.t,�_/—�zt�
Addresslmailingl ��� ��/ �'�/dN - � � 9a7o7
Ciry License No. ��0 9� /
LICENSED CONTRACTOR DECLARATION
1 hereby affi�m that I am IicenSetl untler p�ovisions of Charte� 9(wmmencing
with section �000) oi Division 3 ot the Business antl Professions Cotle, antl
my license is in full for an ftect. 2
Licensse� CI ���� licen e Na. U o
oate[���' fy 5'g t � ��� ����
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I nave a certiticate oi consent to self-insure or a certHicate
of Workers' Compens5[ion Insurance, or a certifietl copY tM1ereof (Section
3800. Lab. C��� 3 1�/ ��
Golicy No. (� ��l Company
❑ Certifietl copy is nereby furnished. � J�f � \
D�, Cer��etl [{�qY �L��IPtl wAPPI cant�N� %9 D'vision. ����-,�_ '
pL f1 /
EXEMPTION FROM WORKERS' COMPENSATION DECLAHATION
(Thissection neetl not be completetl if the permit is for one huntlretl ($100) or
less).
I cer[ify that in tne performance oT the work fo� which this p2rm�t is issuetl, I
shall not employ any person in any manne� so as to become subject to the
Workers' Compensation l_aws of California.
Date Si9nature
NOTIGE: It, after making this tleclaration, you shoultl bewme subject to the
Worker5' COmpensation provisions ot the Labor Cotle, you must torthwith
rompty with sucb provi5ion5 or this pe�mit shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV �
I hereby afflrm that there is a construction lentling agency for the performance
of the work for which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name
�entler's Atltlress
OWNER BUILOER DECLARATION�- �
I hereby affirm that I am exempt from the ContractorY L.icense Law for the
following reason (Section �031.5 Business antl Professional Code: Any city or
county which requires a permlt to construct, alter, improve, tlemollsh or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signetl statement that he/she is Ilcensetl pursuant lo [M1e p�ovi5ion5 of
the Contractor's License Law (CnaOter 9(commencing with Section ]000) of
DiviSion 3 of the Busine5s antl Professions Cotle) or tM1at he/she i5 exempt
therefrom antl Ihe ba5i5 tor the allegetl ¢xemp[ion. Any violation of Section
]03L5 by any applicant for a permit subjects the applicant to a civil
�enalty of not more ihan five huntlretl dollars (§500).
I, as owner of lhe prop¢rty o� my.employees wlth wages a5 their sole
compen5afion, will tlo the wo�k, antl the st�uctu�e i5 not intentletl o� offeretl
for sale ($ection ]044, Business antl Professional Cotle: The Contractar's
License l.aw tloes not appty to an owner Of a property who builtls o� improve5
[hereon, antl who Aoas such work himselt/ne�selt or throu9h his o� her own
e.mployees, provideA that sucM1 improvements are not intentletl or oTTeretl for
SaIE. It, however, Ihe builtling or improvement i5 soltl within one year of com-
pletlon, the owner will have the burtlen of proving he/she Gitl not builtl or im-
prove tor the Ou�DoSe ot sale).
❑ I, a5 owne� of the property, am exclusively Cantracting with licensetl con-
tractors to conSGu�t the project (Section ]044, Business antl Professions Cotle:
The Contractor's License l.dw tloes mt apply to an owner of property who
builas or improves thereon, antl who contracts tor such projects with a con-
tractor(s1 license Oursuant�to the Contractor's �icense Law). 1 am aware tnat
proof of their Worker's Compensation insu�ance Shoultl be p�ovltletl to me.
❑ I am exempt untler Section B. & P. G. (or tM1is reason
Date Owner
1 he�eby certify that I have reatl thi5 appliw[ion antl state that the above
iniormation is correct. I agree to comply with a11 city antl county ortlinances
antl state laws relating to builtling construction, antl hereby authorize repre-
sen[atives of this city to enter upon the above-mentionetl properry for
inspection purpo s. � �/
Signature . � �� ��f«�.� Date���[_��
orivers' License or 55 � � ! �.������
� t 5 S 2-
TYPE OF CONSTRUCTION NEW ADD AL ERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER - �Q �c1��- qp.#
DESCRIPTION OF WORK/USE OF BLDG. =ri9fR�1 S Main Building:
E
TVPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTV RAL T Front
❑ TENANT ❑ ELECTRICAI' ❑�iPWMBING ❑ MECHANICAL A R¢af
❑ �OTHER �.Q' �yvN� C qight
PROJECT DESCRIPTION so.� �( � nrri ipnryr_Y K
CONSTRUCTIONTVPE VALUATION$� g Left
20fVE � GRADING CU. VDS. ACRE p�ng. Ref. #
Remarks: Planning Notes:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ai oo,000 aTu O � oo,000
Reinspection Fee � $15
CMF 0865-46, rev.4/84 White - Builtlin9: Canary -Applicant; Pink - Accounting; Goltlenrotl -Assessor
$hOw¢f5
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimmin9 Pool w/Spa
Urinal
Water Closet
Water Heater
Warer Service
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Issue Fee
FEES
$ 3
FEES
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A, U.
Fixtures
Device Boxes
�
Swimhes
Garbage Dispoul
Generator �0-5 KW �5-15 K
9374 10/�3/84
� � Zone
�ry Building: -
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW _
❑ 50+KW
Meter ❑up ta 100 amps
Meter ❑overi00amps
Sub Panel
Motors OO-1 HP O1 %- 8
InaSolar �9-15 HP �16-15+
Microwave ,
Pale Light
Range
Sign
' Standing Sections �
'N Trash Compactor
Fee �$15 � F �uue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zonin9'APProved By
Building Approved ey
Aooliwtion Issued Bv ����
9. B�l . T�.
FEES
$ 3
Z
O
N
I
N
G
H
E
Q
M
T
S.
' p�+ , SU ARV OF FEES
� "" BUILDING PERMIT $ -flO SMIP $ � �
. PLAN CHECK $ PERMIT
. PWMBING $ ISSUANCE $ �
�� PLAN CHECK 25% $ ENERGV P.C. $
' ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ ��
PLAN CHECK 25% $
CONSTRUCTION AND PL'ANNING '� POOL & SPA
APPROVALS permit# Date Inspector p�ppROVALS 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
5. Steel� Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � ' 57. APPROVAL TO COVER-GUNITE
7.�Footings � - 5S. Electrical Conduit-Undrgrnd.
S. Foundation � � 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structural Floor System .� . 61. APPROVAL TO DECK
11. Property Sewer �ine & 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 ElectricWiring 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. flough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Veniilating � 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test ', 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �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 78. FIRE PREV. 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: �f�
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �,�(
36. Hood or Canopy � �. � � ��
37. Final Factory Fireplace � L ��� •
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final ,
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation , . .
44. �Landscape Irrigation System
45. Sound Attenuation �
46. Handicap Regulations
47. FINALSTRUC7URE&BUILDING �,��
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. ' Date
. g�� �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX S77 C08TA MEBA. CALIPORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
■ MAIL
■ SIZE
COSTA MESA. CALIFORNIA
Corona del Mar, CaliPornia
n0. OP
BBTBACI( LINB FROM [
ceni�p oP e1ReeT O� V�� REAR YARD
SIDE YARD I LEFT � I RIGHT �
DESCRIPTION OF WORK-
■ a�
-j�i�Xr'f II
WALL _ y
NO. OF
i.eow�
FEE �RECEIVED
Lot 54, Tract 201�� Plan BR
.�� FINANCE DEPT. �EP 11 »g�
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Gnly
N¢CEIPT NO. P6NMIT NO.
BY
COSTA MESA, CAUFORNIA
tvcr✓ ran�i��
ZONING c
NO. OP U96 OF NEIV
PLANB � BUILDINO ��
!� l-i Z�C."� `Y
YARDS EVES
APPROVED ALLO
, ICHNTeR LINH BTJ
FRONT � FT.
R. SIDE S FT.
L. SIDE % FT.
_ REAR ��/ � Fi �
_ 9
'j .
467 5 F
476 S F
�
l
w/attached garage Covered Porch etc. 38 S F
I H¢REBY ACKNOWlPO68 TXAT i HAVE RlAD TH18 APPLIGTION }ryQ AMOUNT 6XOWN UNDER VALUAiION �9 FOR TN!
AND BTATE TX�T THE ABOVE IB CORR¢CT AND AOREE TO COM- pURPOBE OF E9TABLIBHIN6 A PERMIT P6E ONLY.
PLY WITH ALL GIiY ORDINANG69 AND STAT6 LAWB FIHOULATNG
Bu1tolNo CONBrnuci�ON. VALUATION /
SIGNATURE OF � :'ERMI7 FEE $ �Y� `-
PERMI7TE [ (�
� �� �� � � �� $ �.V �OH��OO PLAN CHEGK $ � O �
■ AUTHORIZED
<';, � 24953
r-.
' COSTA MESA BUILDING-SAFE'IY DEPARTMENT
,,, P.O. BO% 1200 � COSTA MESA. CALIFORNIA 926IE
For Applican! fo F711 In Completaly
TYPE OR PRINT
BUILDINO i'[S6 %V/a(,Lp(,J LA/�N C /�hi
ADDRESG '
COSTA ME3A, CALIFORNIA
F�
0
�WKcs(2 — �uicO���Z
xo. or
397'�'i ioia`e
APPROV[D
�.ew�
CITY OF C;���A MESA
NOV 30 1965
11[C61r! NO.
cwre��
ONING
NO.O� UY[O�N[W
•un� 'Y euLLmNo -
' `��/�—/.i
NO SHALL B8 LE88 TNAN
� YARDBMPROVED YARDSMPROVHD
USEOR �i� S MAINBUILDINO ACCEIIbORYBUILDINO
EXISTIN� BLDO.
�( FROM C/L YTR6
ccrewcKuncreor Aj JA(HEL1 w� Q��
cerrte�e o� cT�[[i RiAR Y D� T' FRONT PT.
�I � r�
HID6 YA D L[R 5 1' � RIOHT -3 �' Q� R. DID[ �5 RT. FT.
DESCRIPTION OF WORK �. a�os 5 rr. ___ _ rr,_ __
�B=LDINO/A �. �8 ROOMB ��
0
CEOVERIN6Wi.JtODi N I COVERINO
USH OF BUILDIf�Y AND WORK TO 86 PiRP
vwx.#
ON� C.•u.P.
0D7� �oe�n�
� c^ev,Tr,ou^vwi.eoos rxwr � X�VQ RHAD TM�e wvPLIC�T;ON
AND BTAT6 THAT TM6 I100V6 �� CORRBR�AN� I10R6i TO COM.
PLY WITX ALL CITY OqDINANC�f AND RI1T{ UWt R�OYLAi1N0
BUILDINOCONBTNYRIp/ N. n
/ nA � � � Y
� AUTHORIZiDAG[NT
DATE
OT �I/L� DAT6 . U L
Qon � � �
�
320 �.�. �
0
TH6 AYOYNT BNOWH UNDHR VALUATON I6 FOR TXB j
■YPV006 OP [BiABL18HIN0 A PEPMIT F88 ONLY. 5
VALUATION mV �pp �
q PERMIT FEE
g,'lr�d� 7'�� w
TOTAL FEE $ � �
V W1VL' K
JOB ADDR
GENERAL
%
Final
or
�
BUILDING
VALOE
GROUP I TYPE
SUBCONTRACTOR
ZONE