HomeMy WebLinkAbout920 CAPITAL ST - Building PermitsPPOJECi POOflE55: 9 z O C/iP 1�1 AI. $ T
�WNEP'SNAME: �URICA JERKO TFl
aoon��. 9z0 CA�ITOL ST
Q COSTA MESA,CA
ANCMIENGINEEfl:
noosess:
uxir:
92627
flFG.NO.:
uxit:
PEHMITTEE: HILL Mt150NRY ( 714 ) 691-0967
aooness: z619 W EDINGER C-1
SANTA ANA CA 92704
LICFNSED CONTNRCTON UECLAPATION: I �er¢Oy a�lirm Ilut I am liceniea unGe� provKions oi ChaDtet 9 �commencinp wit� Sec�ion
7000� ol Drvision 9 0l I�e BuSiness an0 ProfesS�ons COUe, an0 my license is in tull Iorce anU eifeci.
cirr uc.: 01319 9 sTaTe uc.: z � 8 9 S q �� e/us-s—: �(�' �� �/„/
�e: �`Z. —/� 9�_ signawre: �.!/l-�+G-._%V"✓
WOflKEflS' COMPENSRTION DECLAPa710N: I nereoy allirm tlWt I nave a cenilitate al con5enl to selbinsure or a ceniliCate oi woher5'
Comvensation Insurance. or a certified coDY �nereof I�tion 3800, LaO. C1.
Paucrxo.: 0539j1]OOO1Z40 E%P.ORTE: OS/O1/9�I
camraxr: STATE FUND�
� C¢rti�iea taDY �5 �e�¢by Iumi5�e0. q.i Ceniliea coDY �s IAeO mt l�e dry Building Divisian.
.a�e: �� ^ /�' �y Applitant:, ����
EXEMFfIONFflOMWOPNEflS'COMPENSIITIONOEQAMTION: (Iliosect%iniree0nolEecompleteGilllrepttmili5foroneMiMaC�S100�a1e55�.
I cetlAy t�al in I�e Deriarmance ol t�e work tor w�i[� Ni5 permii is i5we0. I stwll nat ¢mDloy any person in any manner so az Io Uecome
sub�ecl Io IAe Workers fAmDenSaiion LawS of Cdlifomu.
Date: Signature:
NOTICE: II. al�er maWnA �NS Cetlatation. you StwuW bewme SUGI�� �o IAe WOrk¢rs' CAmp¢n5atian O�m'isions a� Ih¢ la0or
CoOe. you must lontrmt� comOhl m�� suc� provisWs ar INs perrtpl 51WII Oe UeemeE revOk¢d.
CONS7flUt71UN LENUING �GENCY: I OereCy aflitm IIIaI itlert is a CORSINction IenEinq agenty lor ��e pedormance ol Ihe work lor
wnich tnis Oermil is asuee (Section 3097. Civ. CI.
LENOEfl:
AODNE55:
OWNFB BUILOEN OECUB,ITION: I AereUy affirm Itut I am aemD� ��om Ne Cantracrors State �kense Law lor I�e lollowinp rtamn
�Seclion 7Q71.5 Business an0 PmleSsional COde: Any ciiy ot tAunly w�iU repuirts a Oermit �o conSlNtl, alie�, imD�o�e• damolish, or
rtoai� any stmcmre. Drior io ns issuance, also repares tne avo:��� �or sucn permit to IAe a signeE statement Itwt nds�e i5 Iicense0
oursuant to ine o�ovisions ot tne Contractars' State License Law (Ctwpter 9(commencinp wiln Section 7000) of Oivision 3 af ine Business
an0 Piolessians Catle� ar UWI �¢/s�e is exem0� t�etelrom aM tlle Ed561w Itrc allepeE erem0�b�� �Y �olaiion ol S¢[ti0n 7031.5 6y
any ap0lican� �or a Oermi� 5u�lecl5 I�e apD���ni lo a civil p¢naliy al iroi more tlun �ive IlunOreO Oallars (5500�.
I, as owner ol ine pmverty or my emVloyees wiln waAes as Ineir SOIe wmDenSation, vrin da Ihe woM1, ana IAe
❑ s�mcWre is not intentleG ar allered for sate (Sectwn 70a. Business an0 Pmfessional COEe: T�e Contractors' State License Law
aas not appty Io an owner of a pmpeny wtp ouBOs ur improve5 inereon, an0 wlq Oces such wOtlt nimsell/Aerself or ihrou0h
'� nis o� hei own emDloyees, provitle0 itut suc� imOrwemen6 am noi imenGeO a allere0 lor sale. II, �owever IAe builUinq ar
� imOmvemeni i5 5010 wil�in one y¢ar oi [Ompleiion, I�E ovm¢r wi0 �ave i�e Durden al O��np hU50e OiG n0i Euiltl ar impmve
for Ihe ourpose al Sale).
I.as ownerotthe O�openy, am excluvvely conVaciinp wil�license4 wnlrac�orsio wnslmcli�e O�ojecl�5ec�ion 70a4, Business
❑ anE Prolessions CaCe: T�e Comrac�as' Slate Liceme Law Gces mi apply to an owner ol properry wla EuiMs or improves thereon
antl who conVacis lor suc� pmjecls wiln a contratloqs�license oursuanito I�e Conirac�ors' Slaie Licensn Law�.l am aware
Ihal prool ol �heir Wark¢i 5 Compet5afi0n irtturante Stpu10 Oe ymdGM Io me.
� I am exemD� unae� Senian: B. 8 P. C.
lor ihis reason:
oate: Owoer.
I tlo heieby ceNly t�al I am aware ol anG unG¢rslanU I�e repluremeni5 01 Cd6lorni2 Meall� antl Sa�ety C04¢ Seciions 25505, 25533, antl
25574 an01�a1 I or any Iuiute EuilOing oCapanl wilVwill not (titGe one) neeA �o compty wi�h Saia slate co0e5 and ��e �epuirements �or a
permit �or con5imclion or moEiliWtian Imm I�e Air OuaOty Marupement Usinct. fleSiGentul COnitmciion aDDlications are eKempt Imm
IheSe D�ovisi0n3.
Ua�e: Applitanl:
I hereDy ceridy Iha� I �ave reatl Ihis ap0lication and state �ha� ��e a0ove intormalion i5 [orrecl. I agree lo comply wiih all city antl counry
ordina�es antl slate Iaws reWling lo EuiWmg fAnsirutti0n arb hereRy autlptize re0�e3entathe5 al INS uty to enter upon Ine above-mentianetl
pio0erly loi inspeciion purposes. /f� � ��
_ oaie: I � ^ /S f'"��_ Siynamre: ��� � / i�-/��/
Driver's License or Social Security •: �
16ai-a6 Ydhue—Bmltling', Green—Cotle EnlorcemenC Canary—ApO�icanl: Pink—Fevenue: Goltlenrotl—Assossar
CIiY OF COSTA MESA - BUILDING YERMTT YEltt9 NO: 5 OE,53:i
PERMIT NO: B 065341 P1,AN CHECK NO: 04922-9J S GOVT: t] SUPF: ,�l
CONSTRUCTION TYPE; V-N PERMIT TYPE: STR PliRPOSP': Ct�;J
JOB DESCRIPTION ; CONST. 54LF OF 6' HIGH HLOCK WALL SQ FT: '�!
CLAIM VALUE: 1,500,00 CALC-Vf1LUE: 1,Of10.00 GROUP OCC: R-j /
COMMENTS: CONST, 54LF BLOCK kALL HETU7EEN 920 6 926 CAPITAL
i���#x�+r*��-x�x#it��t�tfr*x�#��t�r�t-+r*#w**�###,r�r�wit�t�r�tit�#�*�#w***r�#*a.��u�t**�-**�;�#x�+c�x-n �e: �.. ;.
Z O N I N GS ERTEB�AUCIKRSE IA E N T S
------------ MAIN BUILllING ------ — — --------- ACCESSORY BUILDZNG --------
FRNT: 57 FT 6 IN REAR: FT IN FRNT: FT IN REAR: FT Ii:
LEFT: FT IN RGHT; FT ZN LEFT: FT IN RGHT: FT IU
PARKING REt�: PAOV: PARCEL: 42238112 ZNE: R1 REF �10;
PLANNING UOTES> CONSIRUCT 45 LF OF 6' AIGA BLOCK FIALL -
>
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D E V E L O P M E N T S E R V I C E S R E Q U I R E A; E N T S
ZONING APPROVED BY �/C(��R DATE: 12- _IS 1,
BUILDING APPROVED BY : ��` DATE: �2 _JS _ �?
APPLICATION ISSUED BY: l,d1,� DATE: �Z J� ��
*#r�*�tx�#*#*�*r�u�t*ir�*3t** x wl��+�ie�'��rB�iFiF��'SF3F - u� �r: Kx*�;:�*�ctsu�`� :-, � s.r,e K
**#�it�#�#�**�**��**�t*�tx�#�tir*�t*-ft3t***�t�x-***#�t��t#�#��*�-irit��#tc**�:�»*#u�+e*+�*�:+fu*a�w��t n+:x
LEGALZZATION:N F E E S U M P7 A R Y STRUCTURAI„SEGfiE,7T:Y
BLDG PWT PLUMBING ELECTRIC MECHANIC FIRE 5,1IP/RE5 �RIaLIUG
PERMIT 27.00 ,5p
SM.iP/iVOtv-RE5
PLAN i7.55
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK
TOTALS----> 27.50 0.00 i"1.55
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
27.00
TOTAL � PAZD DuE
45.05 45.05 .00
45.OS OVER/SHORT: • .00
FIRE SMIP/TOT GRADING FLAN-CHECK
.50 17.55
I �1(�1FififiEMiE*iE1FitlFiFiE#ififlfiFifit#ikifiFifiFif#ik#iliEiEil�iE�1E1EiE#iE##ifi(�if�%iF�%•ifif�iM1ife�#it#iEiF�K#i4iF++###R�+t9F#k#siFt�itY�t
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 5 C R I P T I O N UNIT CO�ST TUTAL COS?'
SFR 54 RES-CONCRETE BLOCK Y]ALL / FT
END OF FEES
20.00 1,080,00
�
1
oi ooi��s�,-coi�zas: r _��
DRTE: i2�r�•o;� ??f;c• :0'lE
�•.: . r,.-,
,
, `
_ CONSTRUCTIONAND'PL`APINING� f;� � ' ` �
- =, AFd?OVALS Permit# ' ' � �Date_ �..
S� � . `, . `' � •_ ' _ . � - � ��..
:� 7. Temporary Electrical Service cir.Pole i�.' ���..
, 2. Soii Pipe-Undrgrnd. � i � �" •
3. Electricai Conduit Utiiity�Undtgmd. _ �-� _
� 4. Electrical Conduit-Ur.drgrpd�:' �
� 5. Szeel Reintorcement �� . -- �Z_�b,:c�3
6. Eiectrical UFER Grnd. � . � ' '
i
7. Footings -' ' • �;,.i(,1'Gt3
8. faundation " � � 1. � _ �.a
t��;-" - �.i
9. N,'ater Pipe-Undrgmd.� -
. , � 10. Structural Ftoor System •' •�'� .- .. � � Y
'
11. Property Sewer �ine €i Nouse,Co.�nection ' _
, � 12. Sewer CaP �', -
� 13. P,o�ns � � /i � ' <,�� •
(,,
' 14. Rough Plumbing ' ' - � ' -
75. Rough Electrical-Conduit � � .
i -
}�� i6. Rough ElecVic Wiring'- ` -
' i 17. Rough 4Viring Sign _ '
18. Rauyh Electrical�T Bar Ceiling � .
"79. Rough Heating & Air Conditioning ' � "
20. Rough Factory Firepiace � �
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Test
24. Roaf Framing
� r 25. Root Sheathing
26. T-Bar Celling (Structural) & Monocoat
� � 27. Frzme and Flashing .
28. Lathing & Siding
29. �nsulation . � �
30. Drywall Nailing �
31. Plaster Brown Coat ,
32. Electrical Power Meter'rinai- �
33. Fina1 Electric ' �
34. Final Heating & Air Conditioning '
35. Final Gas Pipe�Test 4-
�36. Hood or Canopy
37. Final FactorY Firepiace
38. Final Plumbing
39. Waier Service-Final
I 40. Gas Service�Final
41. Solar pomestic-Final
42. Backflow Preventer �
43. Backfiow Irrigation ,
' 44. Landscape Irrigation System .
- 45. Sound Attenuation
46. Handieap Regulations, �
47. FINAL STRUCTURE 3� BUILDI�G �-� 9Cf
48. FINA� PLARiNING
49. Eleciric Release co Edison '� .�-
50. Gas Release m Southam California Gas Cn �
51 CERTIFICATE OF OCCUPANCY
PUOL .'A
Inspecior RPPROVALS Permit #„ a � Date
'''S2.,Pool&�EquipmentLocatiori, _� -
53s5teel Reinforcemznt -
� 54.'�Forms � � -'
�� � 55. Electricat Bonding
;'�,.� 56. Rough_Plumbing�& Pressure Test
' � 57. APPROVALTO'COVER�GUNITE
�L✓�. 58. Electrical Conduii��Undrgrnd.
"� 59. Gas Pipe, D Undrgr�d.,�Test �
. � ;' 6Q.,-Back"wash Lines, P-Trap, I�=Undrgrnd.
61. APPROVALTObECK. ',; -
� ` 62. yBackwash & Receptor=Final
. 63._Heater_& Venf�F.inai ' .
, ,. _ 64. Plumbing $ystem - Fin3� "�_ .
- ��t 65._Etectricai-Final�:' �
- 66. Solar Svstem;Fina� •
67. Fencing & Access Approva�
' 68.-APPftOVED FOR PLASTERING -
�- 69.:'POOL(SPASYSi;£P�1S�INRL �
` � - FIRE DEPT. REQUIREMENT + -
. APAROVALS Permit #
70. Underground Hydro
77. Prodi�ct Piping O'Gas ❑Qil
72. Underground FWsh �
73..Undergmd. Storage Tank �� Gas ❑ O�i
7A. Overhead Hydro
` . 75. ❑ry Chemical
76. Dry Standpipe
77. FIXED�SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL iNSPECTION , �
- 8D. FOOD CERTIFICATE ISSUED
_ Nates:
.y
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No. Oate .! �`
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�Inspectoi
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�Y
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-�y � I APPRQ�ED
---�-
ADDiTIDNS, D� r, �,���N'�
BE APPRO'd� �E ThtJ, OR CORi?ECTIONS SNALL'
�fl c,�
���1 �D'gj PtA;`,lr�ii;V� DEP�,RTPdENT
� c� �.��Il�
� c�tv c' �.�n t��Fa-,z
{ :.'_':: '.: ��. Cr; T.
� m�i:'LCz TJ ."Ju. G57T. CE
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L1Y,.� �ti.„,-D:47E.._�1;5 �l3
ORtECfQT OP GiqNNINO
REfID[NCE
Permit # t34� � 4�i
TFIIS f�U � �4i! ,' 4"COMPANY
n� � � ^�' �TS
IIESIDLNCf
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RE8IDEMCE
�a�
�
G���- SfREET I� �
C+ty of Costa t�esa C3ui�c�ing Dept.
BY _P�C DATE �S� 19 �7
THESE PLANS MUST BE ON J0�3 AT ALL TIMES AqAKE
NO CHANGES WITHOU? PRiOR APPROVAL OF DEPT.
THE ISSUANCE OR GRaN';NG OF n. pERMII Q�i APPROYAL OF
PLANS ANU 9VEGFICAI IGiJS SrIALL iiOl BE- CONST FUFp �O 5E A
PERMIT FOR, OR AN APPRCVFt G" ?"" dIQLA7IGN Ov" ANY OF
THE PROVtS10NSOF TNIS CGS'ic. i�.:.�' P;=:i::l ` PRESUtdMiG i0 31VE
AUTFIOFITY TO VIOLATE OR CFui ;.'_ �i�d_ PROV�,�6;:i 'vF'HiS
CODE SHALL BE VALID EXCGPT !IV : O FAH AS 1 H� 11'OFK ON USE
WHIOIi 6 AUTNORIZES IS tAW f Ui.
THE ISSUANCE OF A PE�iM�i 3ASE0 UPON PiANS AND
SPECIFICA710N5 SHAI.L NOT PF7CVENT 7HE BULDttJG GFFIC�AL
Pfi�M THEREAFTER FE�UIRING THE CaRFiECTION QF [HRORS lN
SAID PLANS AND SPECIFlCATIONS OR FROM PREVENTING
BU�LDWG OPERATIONS BEING CaRAIGD THEP.EUNDFR WHEN
IN VIOIATION OF THIS COQE GR OF nNV�SHER Ofit"�N4'iCE O�
�hiE CI7Y �
�I
IIEfIDEMCr �
�
W
W
�
N
I
Cement Coping Oot�anal �
Channel Block With 1-3/8�
Horizontal Top ot all
Fences
For Fences 5' or Less
Vert. Bars 3/8"�i at 4' -0" O.C.
For Fences Higher Than 5"
Vert. Bars 3/S"� at 32'" O.C.
Fill Cells Solid With Grout
W here Steel Occurs
Reinforcing Steel Shall
Conform to Sec.A-1539
A.S.T.M.
All Steel to be Lapped
24" or to Code
NATURALGFADE
TWO 3/B"Q BARS
CONTINUOUS 70P
& BOTTOM
HORIZSTEEL MUST BE TIED IN
PLACE AT TIME OF TRENCH
INSPECTION.
TYPICAL
E
�
�
0
H
D ' • �
I�l
. F--�WIDTH
� SEE CHC
� BEIOW
D I'.
6�� CONCRETE BLOCK FENCE
NG REQUIREMENTS CHART
GEfVERAL- NOTES
MORTAR; p�e pa�t Plastic Cement, and
Three Parts Sand
GROUT; One Part Cement Three and
One Half Parts S�and
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Well M�aed 1:2-I/2:3-I/2
Mnx. of 7- I/2 Gollons of
Wafer Per Sack of Cement
GROUT MAV BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLSANO AHEASOF HOH120NTAL REIN-
FORCEMEN7 SHA�L BE CLEAR, CLEAN &
FREE OF ALL MORTAH DEBRIS, ETC.
"H OF [4RTHTCOTH
V3 ir1E HEiGTH OF FENCE
�LOW BOTTOM OF FOGTiNG
WIDTH . . . 14" . 14" . . . 12". .
_. . .
THICKNESS . . . . . . 10'�. . . . . . . . _ . . .10° 8'�
DEPTH Of EARTHTOOTH 24" 20'� 16" ...
SPACING OF EARTHTOOTH. 12' . . . 14' . . . . . 16'. .
City of Costa Mesa, California
�� �uilding Department
k:EV.�ED NOV.62
SCALE: I/2��= I�
12..
8„
I2"
16'
CA�IFORNIA ALL-PURPOSE ACKNOWLEDGEMENT
� STATE OF CALIFORNIA
COUNTY OF G� cs �n y�/eS
On ia -ia - 93 before me,
DATE
NAME, TITLE OF OFFICER - E.G.,'JANY DOE. NO7ARV PUBLIC'
personallyappeared, 1� pl0(�S H. LU9//��4N/
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(9j whose name(s} is/are
subscribed to the within instrument and acknowledged to me that kie/she/tHey executed the same in kislher/tMeir authorized
capacity(ies), and that by Misiher/their signature(s}on the instrument the person�, or the entity upon behalf of which ihe
person(a}-acted, executed the instrument.
WITNESS my hand and official seal.
7i�0O [�///�f (SEAL)
NOTARY U C SIGNATURE
OPTIONAL IN
TITLE OR TYPE OF DOCUMENT
Shelly J. White
V Comm.A995070 (;,�
c' HOTAPYPUBUC-CALIFORNL�
6 L09 ANOELES CAUNtY I/
Comm. EcO��os May 7E, lYY7 �
DATE OF DOCUMENT ia — 08 —9 � NUMBER OF PAGES One
SIGNER(S) OTHER THAN NAMED ABOVE _,�/o oi/,�i S.•gnc ! S
,�
ALL-PUGiPOSE ACKNOWLEDGMENT
State of `
�/l�ijv'O. J
County of
On /�-���5'T qefore me, �
personal ly
(name, title of officer),
— OR — r�-pFoved to me on the basis of satisfaciory evidence
to be the person,(sj�whose name�(s3-�/are-subscribed to the within instrument and
acknowledged to me that he/s7�efthey executed the same in his het/theiL authorized
capacity(iea}; and that by his�herkkeir signature�(sj-on the instrument the person(aj, or the
entity upon behalf of which the persor�(ej�
t...... _____ _ acted, executed the instrument.
�A�!�Ei� B. DANDY
�;,!a = GiDh�:',r1. Sf004942
`6�. ••
y��� ,: 'j r,�rns�:v�J��-ci,u:�arrw
`'-,,,,`-�'��'.�.r� C,:'',.^:u�^_AUi:�lY
Y ��' %y
�. ,- r.yccr,r,. r?_.s=�r.ze,�ea�
CF 7911 (8�91f jRS: 2. 8j
WITNESS my hand and official seal
Sig
CAPACITY CLAIMED BY SIGNER
� WpNpMyS�SIGMNGFOqWESEIF(INEMSELVES
� ��c�sj nnE�s�
p Pu��nrn
P/JiiNEFSNIP
OAiTCflNEY-
IN�F�Ci PIiINCIPAyS�
p musree�si
iflllST
❑ rn"�n .�.�,�
ENf1TYpF5�qEPflESENiED
EMITY�ES)flEPPESEMED
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this �� day of
�C�� , by and between �lr�,r's.[% ��).-��.�–r.�� •
hereinafter referred to as "LANDOWNER;' a �_���� tt �1.�_L�^ �LCt��
(1
h�reinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between
�
�� a
a7
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book — , Page — of Miscellaneous Maps, in the office of the County Recorder
r
of said County. The party wall shall be permitted to encroach � �?� �Qii� �
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER
���� ����
(Signature)
JERKo F3u�;,c.4
Name (Typed or Printed)
ADJACENT PROPERTY OWNER
/_��/_y`_�l,CG��'i�
(Signature)
�
.DoioR�S �,_Lu�./. i��✓�
Name (Typed or Printed)
,
:
1 a.o c� �� A� s- 9a� c�,•�+-� s�-
(Address) n�STi� �IESf1�CA 9��.� (nddre5s� � oSf'R- l�'�e.$r} C/�- 9,?6�-�
C�
NOTARIZATION REQUIRED
1905 a6
BURICA. �erry /-y-/b
JOB ADDRESS 9Z0 Canital Street BUILDING PERMIT N0. 42257
AP No.
SUBCONTRACTOR
GAS
SWR. LINE � � HOUSE CON.
ANO RIR CONDITIONING
UNOERGROUNO U POWE0.
ROUGH WIRING
FLOOR SYSTEM
80N� BEAM � STEEL REINFOflCE
SHEATHING
FRAME ANO fLASHING
PLASTER.BROWN COnT
HEFTING, VENT., REFRIG. ANO A.C., PINAL
PLUMBING. FINA� ANO GRS TFST
ELECTRIC, FINnL
BUILOING, FINRL
CPLfIAI RFlIIIIRGM�MTC
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� 42257
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Comple[ely — Use Ink Only
BUIL�ING �( �. }
Af]nRFSS ��1. O � bdl �i�
OWNE
MAIL
CITY ��
CANSTFiVCTION
LENDER
BflANCH r
ADDRESS
CONTRACTOR
ADDRESS Z
CITV ��
STATE �
LIQ NO. "� �
SI2E
OF LOT
USE OF
L.
TEI.
33
LIQ NO.
NO.OF BLDGS.
NOW ON LOT
Separate permits are required tor
electric, plumbing and heating work.
UILDING'AND WOFK TO BE PERFORMED
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n� va�� �,: :r:.-:r,
i -9-�e�,..-no 90� . ho.5c
APPLICATION FOR STRUCI'URAL PERMIT
ECEI E RE V D =��[(��
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C
A.P. NO.
BUILDING
TRACT
�
YARDS
MAIN
VAR. qIE
C.U.P.qW
�
DATE
USE OF
BUILDING
YARDS A7PROVED
BEf. MAIN &
■1:�
I hereby acknowledpa that I have r�atl ihis eppllcetion entl state
that the above intormetlon is correct and egree to comply with
all laws repuletlnp builtling construction, antl I shell not employ
ony parwn in violatlon of the workman'a eompensation laws of
tha State of Californla. /�'
I hereby certify that I am properly Iicensetl as a conttactor untler 7 D SQ. FT.
the State of Celifornle Business and Profeaalone Cotle, Division 3, THE AMOUNT SHOWN UNDER VALV
Chapter 9, end thai cueh licanses ere in full force antl eHect, or I THE PURPOSE OF ESTABLISHING A PERI
am exempt trom th¢ provisions of thB State ot California Business VALUATION PERMIT FEE $
and Prof¢ss(ons Cotle, Divis{on 3, Cheptar 9.
Signaiure ot�^ ,�, �. l/ /: �S� �//J � PLAN CHECK S
Permlttae �� �'� � �� $ / ODO TAX $
Authorized Agont � TOTAL PAID E
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7
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C�OSTA MESA BUILDING DEPARTMENT
P. O. BOX 31]
COSTA MESA. CALIFORNIA
FOR APF
BUILDING [%.yD
AODRE55 �
COS'
OWNER J� . I
MAIL
AODRE55
ciTr �J/ �
ARCHITECT
OR ENGINEER '
GIInRFCS �
CANT TO FILL IN
�iT�-G
MESA. CALIFORNIA
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i �
TEL
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� LIC.
NO.
,� CITY LIC. �
NO
E TEl
NO.
IEGAL �LOT ��J %
oesce�PrioH ryp, ( (�
A.P. NO.
S��E �3 � x /O Z
OF LOT
USE OF ,�
EXISTING BL�G.
scrancrc �irvc rAo �
CENTER OF STREETM
rvo.oe e�oes. O
now orv �o•
SIDE YARD RIGHT � � LEFT / (,/ /
DESCRIPTION OF WORK
NEW ALTERATION AODITION
REPAIR MOVING DEMOLISH
BUILDING �J NO.OF
SIZE //�IJ ROOMS SSTORIES
E%TERIOR WAL ROOF p %
COVERING U COVERING v !�
�\) .L.� e��/ / �
6UElDFNGEW.1!%�/� /�i�/iIL� ///'I��A/.
FEE RECEIVED
mar 2 i is5a �
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
eeceivr no. P
ECErvED BV_ �ATE RECEIVED pA��UEO
BtJ I LDI NG '
AooRE55
COSTA MESA. CALIFORNIA
FIRE
ZONF
zorv�c
_1'
APPF
BV
CORRECTIONS
% �f'J(/ —
HEREBV ACKNOWLE�GE THAT I MqVE REl�D TMIS APPLICATION AN�
STATE TMAT THE RBOVE IS CORRECT Arvp AGREE TO COMPLY WITH nLl
CITY OROINANCE$ AND $TATE LA 5 REGVLATING BUILDING CONSTRUC-
TION. � VALlJAT10N �
/ PERMIT FEE S �
SiGNATURE OF ;�
PERMITTEE //
� / �D7 — PLAN CHECK 8 ��
AUTHORIZED AGENT TOTAL FEE $ ,3�
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