HomeMy WebLinkAbout2008 CAPELLA CT - Building Permits •
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CITY OF COSTA MESA
49 BUILDING DIVISION
};� ,,,,•14DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
; /� PERMIT
itbftft et B01-01117
(714)754-5273 • Fax(714)754-4856 • www.ci-costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2008 N CAPELLA CT Status: ISSUED
Suite: Applied: 07/18/2001
Vicinity: HOUSE&ATTACHED GARAGE Issued: 07/18/2001
Parcel Number: 13940209 Zoning: R1 R1
Applicant: GANN, WAYNE ISSUED BY:
Address: 1150 N MOUNTAIN AVE
SUITE 108 Phone: (909)949-4077
UPLAND,CA Zip: 91786
Owner: MIYAZAKI, KAORI
Address 2008 N CAPELLA CT
Phone:
COSTA MESA,CA Zip: 92626
Contractor: W GANN ROOFING
Address: 1150 N MOUNTAIN AVE
SUITE 108 Phone: (909)949-4077
UPLAND,CA
Zip: 91786 License: 656030
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(31 SQ).TEAR OFF EXISTING SHAKES&
RESHEATH 7/16"OSB. INSTALL 1 LAYER OF ASTM FELT UNDERLAYMENT&RESHEATH 30 YEAR COMPOSITION
SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,000.00
Permit: 5153.25 Claim Valuation: $8,000.00
SMIP Res: $0.80
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total:- $154.05
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES: •
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 of 180 days.
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 final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
246-46(flee)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
VIfor which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'ccomppensatlon,Jnsurance carrier and policy number are: 3
Carder: S I is'1 r c•-•—a.c•-•—a...c•-•—a...r ' Policy Number: l 7913 3 1
(This section need not be completed if the permit is valued at one hundred dollars(5/00)or less.)
❑ I certify that in the performance of the work for which this 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 subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thes Isions. R
Applicant Signature: (" / Date: 2 —I v l6
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ni EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am Ilcen ed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and rof cions Code,end my license Is in full
force and effect.Lic.# J Fir, O 3 O Class# C— `tr,
Contractors Signature: fr dfCf.-�- ��
— - Date: —)—) FS -n
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perr+,
subjects the applicant to a civil penalty of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,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.If,however,the building or Improvement Is
sold within one year of completion,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 CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than 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 file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greeter then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code boon fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 end 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? El yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
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 of 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 to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Dale
. 7-IQ—Ot
And/Or Authorized Applic " Date
COPED INSPECTION TYPE PATE lNTDUL1i COM( INSPECTION TYPE PATE ILMALI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final .? 208 Final Plumbing
!o
200 Final Re-Roof —3-o ( U 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
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APPLICATION FOR A BUILDING WIT
a
BUILDI; ' TNa. Electrical CO
Tract yy�Block Lot �•- Permit No. E,
Buil
ing
Address .2. O bU N C4PLZXy c / __�__ A�_ Permit No. re
Cross • echanical .care:n .- a.
Area StreetPermit No. carer.- 0.
0-
609 ff /+si5 S 44,, Ao4l H -
co
co
Owner Ic/0 e'er 13 i%o kr;ti./ Type of Project: a New ❑ Alter 0 Additio
Address S� C. ❑ Repair 0 Co vert 0 Demo 0 Occupancy • t.
City �T Zip Phone A.P. InspSUP.
Dist./
Ins..Area
Architect/ Zone Spl.Pmt.No.
Designer License No.
Setbacks P/L Fro t C/L St. -treat Width
Address
Yards Left Right Rear
City Zip Phone
Eave Prop. Lett Hight F.V.
Engineer License No.
C Parking Spaces Required Provide Covered
Na Address
CO —
City Zip Phone Strutt 1 No.o o.of
Height Storl., amity
u fI LICENSED CONTRACTOR'S DECLARATION Park Fees Yes Fee
m I hereby affirm that I am licensed under provisions of Chapter 9 Required LJ No •
Ed C.T. Receipt
t (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date
Professions Code,and my license is in full force and effect).
License Class___ License Nu ber 2 y/0 3� i
> Date 12_19'0.1 Contractor I,AIN W15�I.4v,w 7 M sc.
E Address Wiz- AVesc..4 CO AV l_ Proposed Use
jy City and Zip CO ROAM- .0E L fr.ry4 Phone 73"_ Ljf p of Structure
w CONSTRUCTION LENDING AGENCY
VI
ti I hereby affirm that there is a construction lending agency for the
0- performance of the work for which this permit is issued (Sec. 3097, Occas
Type Year
Class Const. Year
Lender's Name FRi?r1r_'R5 'a-G
5 Lender's Address P' 0 /3 a is 19 cj' S4N"74 A A-14USE/OCCUPANCY SIZE SD.FT.
J OWNER-BUILDER DECLARATION
• -._ I hereby affirm that 1 em exempt from the Contractor's License Law 1.
Dfor the following reason:
C
0 I. as owner of the property, or my employees with wages as their 2.
sole compensation, will do the work, end the structure is not
t intended or offered for sale.
« 3.
3 ❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project.
0 I am exempt under Seciv . . B&PC for this reason a•
a Date Owner Total Valuation
E WORKERS'COMPENSATION DECLARATION
8 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Req ilrotl 0 Yes 0 No
or a certificate of Workers' Compensation Insurance, or a certified
c copy thereat. Grading Pmt. Grading
6 Policy No. _Company Required ❑Yes ❑No Pmt. No.
a 0 Certified copy is hereby furnished. Rough Grading
Q 0 Certified copy is filed with Orange County, EMA. N
Approved by: Date
Date Applicant 3
• CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE Z
(This section need not be completed if permit is for $100 or less/.
I certify that in the performance of the work for which this permit is 3
S
subject I shell not er ' o anympe ation in any manner isos as to become PERMIT FEESco
subject to the Workers'Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers'Compensation
Sprovisions of the Labor Code, you must forthwith comply with such Electrical $ vest.
I $
provisions or this permit shall be deemed revoked. Invest.
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE PlumDin. $
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY RUTH- Mach- ical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-,.rade
PGs ,-jetntsenot
/2
^/y.ra ms.ecngn $
Signature Applicant or Agent Date Pr-o.. rad Issue No. $ issPeue
R $
Print Applicant's/Agent's Name
All spaces within this box must be completed to process plan I Issuance
Check By: Approved:
CMF 0335-46(BU-28)rev.6/80
OWNER RICHARD, JOHN DATE 12/19/80
JOB ADDRESS 2008 N. Capella Court BUILDING PERMIT NO. 51161 IGENERAL CONTRACTOR Larry warlaumont DESCRIPTION of WORK Fire Damage Repair _
P No. 1 39-402-Oo LOT r7 TRACT FIRE ZONE VALUE $ 31 mon on
INSPECTIONS Signature Date r TYPE GROUP ZONE R-1
IP
PERMITS ISSUED
cns SUBCONTRACTOR - I
Date Number I Signature
TER Plumbing
ROUGH PLUMBING
f ROP. SWR. LINE Q HOUSE CON. ❑
SPRINKLING SYSTEM
nMISCELLANEOIS 1 St 29A4..2...,747 ,_b5 1.4p..y
ROUGH HEATING AND AIR CONDITIONING ORe- /- 741
TEMPORARY SERVICE OR POLE
'UNDERGROUND [1 POWER ❑
ROUGH WIRING )Q( /,fl-X( 1111 Heatingpp �i� � and Vent. n I^
TRENCHES d FORMS 0 STEEL REINF. t/,/CLPJ.ftAilrY .a FIG I I d 153*".----
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n �
SHEATHING O2 C`/��,�'( J -1/99/
FRAME AND FLASHING -. (1;
a' / .]fr
^ ^
LATHING — IN L I OUT �� / A �GI
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING. VENT., REFRIG. AND A.C., FINAL ¶4.0 1'3'41 ( �n)utl (-I(,.$1 Lf.8Lh
PLUMBING. FINAL AND GAS TEST El
ELECTRIC, FINAL /II& q-/-£7
BUILDING, FINAL 'Cr/ I2-JF
/
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..
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ' •
RECEI V B IP�RMPT !0,! ,se 9P 17 It
For Applicant to Fill in Completely — Use Ink Only N° 511 6'1"
BUILDING --Gt0Z
ADDRESS ...2,OO� /t) CAf/.G L L� A.P. NO. 1
OWNER OR .�{{ n �/ ADDRESS p2OO? 41, //pet t
TENANT �/O NAJ /11/0N4/ UNIT OR
MAILINGen
ADDRESS
ADDRESS A SPACE NO.
S/J M TR.NO. LOT �-y� SLK.
w� TEL. ^/ „ q_ -/
CITY CoC'„/J „..p, ,s-3,..$ NO. G7�-3)AO
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER Arai ih•- -=_=_
BRANCH FjerifriCryS / AFU
' hoA-II/G[r
OWNER /{ �.,G Vd it ti 1C �
H2.L
_�j
ADDRESS f b Qa q T / (-Q $4. 't4 AN VALUE
ARCHITECT TEL. USE E
OR ENGINEER NO. Q
ADDRESS ZONE 1ek ITV PE GROUP
CONTRACTOR .44xRr W mum bs ..mg& APPROVEDVEDATE
ADDRESS Telf 2 4 V6 c...DO 4 t'1F
TEL. . ,
CITY nee MA 11L 4 'n”? NO. fr/1.5-5.1/4-
APPROVED
1.5-5. Q
STATE ^ CITY APPROV1ED—SF,TBAC
LIC. NO. 2y /O JQ LIC.NO. U.o't
SIZE NO.OF SLOGS (FROM Ch.STREET)
0. OF LOT NOW ON LOT / FRONT FT. _
Q USE OF Q
N EXISTING BLDG. l f1 S A.SI0F FT,
rn
I-1
Separate permits are required for L.SIDE FT.
G electric,plumbing and heating work. REAR FT.
IW„, USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
xt
O /t DATE
'� gcJL..n Ire eQ Ic APPROVED
xt
> APPROVED
}-1 / L /C.L. / -el�J/� _ay t WIZ DATE t2irl1 C>
DG
tY
0A
. I hereby acknowledge that I have read this application and state 4.1N
I34 that the above information is correct and agree to comply with
A. all laws regulating building construction, and I shall not employ s
Z any person in violation of the workman's compensation laws of 2
lid S the State of California. m
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. N
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 end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempt from the provisions of the State of California Business e
VALUATION PERMIT FEE $/as r
and Professions Code,Division 3,Chant r 9. Cr el
PLAN CHECK E /5 �— ^
Signature of (sv tv /� o
Permittee OZ'N'� / `^��"+'^�` 5 v TAX ar rl $ 7.7 U
or (31
1 _ u
Authorized Agent Date TOTAL PAID - ...
2 —
1 1��l7 .z
G
OWNER RICHARD, JOHN DATE 10-3-17
JOB ADDRESS 2008 N. Capella BUILDING PERMIT NO. 44756
GENERAL CONTRACTOR George A Punier DESCRIPTION oIWORK Familyroom Addition
AP No.139-402-09 LOT TRACT FIRE ZONE VALUES 3.500.00
INSPECTIONS Signature Data TYPE GROUP - ZONE R-1 _—
SOIL ISSQED
GAS SUBCONTRACTOR Data Number umber I
Signature
WATER Plumbin•
ROUGH PLUMBINGff-'�1
PROP: SWR. LINE lJ HOUSE CON. El
4SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONDITIONING • �
TEMPORARY SERVICE OR POLE _
UNDERGROUND ill POWER 0 /� �'I // \j I I\ I Mai— 11 I
ROUGH WIRING I�,� C, /1-21-11 I Heatin• and Vent.l, %\ II eI,i I� I_
TRENCHES 0 FORMS a STEEL REINF. u C� /F.2 n Irl, I \�sI 1 A I
FLOOR SYSTEM "� • - `t= L...=I
BOND BEAM STEEL REINFORCE A�`' —_I
SHEATHING ric�rim�I�i• ���r —I
FRAME AND FL ASHIN �:ft��V{��/�C—���^�-�`nnalnardL21(af�0 Pa=I
LATHING -_ I N (ice OUT II�u,/l�r y��7y Aria-ail-CrI
PLASTER. BROWN COAT �.{Wlrfe/!•CU•
STRUCTURAL. FINAL EEli=HEATING, VENT., REFRIG. AND A.C., FINAL Sid �/( ( l(-A-771/3/74
PLUMBING, FINAL AND GAS TEST fl d\
ELECTRIC, FINAL ��/4 y„�
ELECTN FINAL
/4 t,�r1Jw)
-C/ t PAID
.1/
44756 OCT -3-77c�jA00 063* ***x42.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIjj y�. HATE RECEIVED �'[EUFD�
BUILDING� 0 ^^J � 4PELGA �� �(S1!//j (/�/ ,77'
ADDRESS `/O
y-0,2 PERMIT NO.
OWNER 450(-1 it.) 12t L � e a p A.P. NO. Is O
MAIL ,/� BUILDING �
ADDRESS ca-0 O8 AI , (,ti- Pf.LLA ADDRESS 040051 A.) .6 PI 2
LG4
TEL. ) TRACT 43 41 LOT s BLOCK
CITY tocr4 M *'TS NO. ,.S 767/'37
CONSTRUCTIONt0 �. NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER N I---
BRANCH BRANCH
OWNER JUHIw.) 21cHq-Q0
ADDRESS
VALUE
ARCHITECT TEL. USE (Zccs/ D't'Jc-e S
OR ENGINEER /J D r.I Ifi NO. ----
FIRE
ADDRESS /t ZONE r/TTYYPEE GROUP 2^/ 1)
CONTRACTOR Co SQO-6-€ /�-�.r ,O, LM/Y rZ ByPROV EO /L% ✓V DATE/D /- [�/
ADDRESS ,- Dar j94crR4 Pc ,
TEL. ZONE / NO .OF USE OF NEW�flI
CITY (-0C7-A '1if—le - 16432 PLANS Z BUILDING G��
4 NO. SS •
F STATE / / 7/ CITY O°8 /3 YARDS APPROVED YARDS APPROVED
LIC. NO. /OCJ CO b / LIC.NO. / MAIN BUILDING ACCESSORY BUILDING
a. SIZE I / pp 4 NO.OF BLOTS. FRONTM
C/L STREET) / p2 % pe-
d OF LOT Is<2.,Ay �Q ere/ .(7 .7LI NOW ON LOT / FRONT 3 Y FT. /V/ /l' ,f��
a
USE OF /'r /,,j'�C,
EXISTING BLDG. S f rl(...-L(!! 2S, R"SIQE ,97/ //'t Y) FT,
'Si
FQ Separate permits are required for L.SIDE (J FT. FT. .
W
electric,plumbing and heating work. ^^ a /
REAR 0. 6 FT .FT. 6 FT.
l.„ USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
DGS.QMAIN BLDGS. ACCESS. BL
VA
DATE
::71 ��L/ ra OW .0UP.# APPROVED
>, AP ROVEICaio �, , DATE /0- Z— 77
a
w
A. I hereby acknowledge that I have read this application and state N
N
C4 that the above information is correct and agree to comply with m
0a all laws regulating building construction, and I shall not employ s
Z any person in violation of the workman's compensation laws of y
SSW the State of California. /�{/
I hereby certify that I am properly licensed as a contractor under r T/' SQ. FT. N
the State of California Business end 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 ESTABLISHING A PERMIT FE NLY: -
to
am exempt from the rovisions of the St of California Business VALUATION PERMIT FEE E 2a
and Professions Co 'vision 3,Chapt� q _ 0 in
m
//'�rg�^// _ J PLAN CHECK $ / n in
o
Signature of 61„.e., /J �
Permittee $ /S SQ 0 TAX $
O LL
✓ A/ e� U
Authorized Agent ` TOTAL PAID E l/�ZI.Q
' t6547
EEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT ; NM
R2 1952
P. O. BOX 317 COSTA MESA. CALIFORNIA fIAhCE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING Z-0.1 St rieWer- 4-344 BUILDING
ADDRESS z �/
'zoo or74 Ca .et Cer.T
COSTA MESA. CALIFORNIA Y For`Office Use Only
OWNER C'L-JE r 7e'sI I RECEIPT NO. PERMIT NO.
/�CMAIL r- 16547
ADDRESS �/.. 59' //M4ee/'g he. RECEI Y ` GATE R fEIV-/4...... OA tB BIUED 'n-2
CITY c ,O.Srfr " E-S,V, {F/'L/P,NO�/',03,7s ADDRESS K/T f��f .J` �fl� J
ARCHITECT EL. COSTA MESA. CALIFORNIA
OR ENGINEEE/Rt.---Avci- yGricivS eimotc/IES oS?3 �'// syn
ADDRESS (j 1//-(JJ xrgrELL/9 les / taivein FFIREE TYPE GROUP •
Y '
CONTRACTOR f/w6%e:os 1/9/VD n. APPROVED
/ /�// BY DATE
ADDRESS /.6 S3 / //NOkieA- /)o. ZONING
ZONE NO.OF USE OF NEW -n7 -7-M
CITY �o$ory4 MEs/a /IApG/rp- ,�/ IpUNS I BUILDING2
IN .a/p it 9qr
LIG.TNO. /(� // //- ILI // /O3 /r LEGAL La Y- S'7 Te\ 9 3 �/ �I
DESCRIPTION
SIZE �J �' NO, OF BLOCS./
OF LOT / O X 9O NOW ON LOTA/ep/6 A.P.NO.
USE OF YARDS EVES
EXISTING BLD. APPROVED ALLOWED
SETBACK LINE FROM ry /�p]ttl 0
(CENTER LINE ST.)
CENTER OP STREET G REAR YARD R7 FRONT 2._ FT. ---
IN.
SIDE YARD I LEFT S I RIGHT / R.SIDE ? FT. IN.
DESCRIPTION OF WORK L.SIDE FT. IN.
NEW Ix II ALTERATION I II ADDITION I REAR 2 3 FT. _ IN.
REPAIR I II MOVING I II DEMOLISH I APBYPROVED Aden
DATE Z/ie/i L
BUILDINGE /6 /7• NO. OF
SIZROOMS STORIES
EXTERIOR WALL Wood ROOF IVOOJ' �' 7,--/COVERING !/ 00I COVERING SNAKE'
USE OF BUILDING AND WORK TO BE PERFORMED '
S/NGLs ; LVf'
gu/ -sib -Nee , J C
•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIGTION 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 ''
SIRE• • .TUOF PERMIT FEE $ i
P ` o
RIEF - $a /7 2. PLAN CHECK $ /9 _p
OZED AG: T CieCjieg•--G. - 2 2
TOTAL FEE -