HomeMy WebLinkAbout2016 CAPELLA CT - Building Permits;
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noonessa em�wxo: 2 0 1 6 N CAP ELLA CT
OWNER8IUMEIFpqMl: PETTINGILL, ROBERT
.uoness 2016 PJ CAPELLA CT
�OSTA MESA,CA
�vv�. xuura �ooxEts:
JIICHRECT OR FNtlNFEI:
YICN, oA ENO.'S INDPESS:
92626645-7279
CONfNACTqfSNAYE SA I N ROOF I NG
cam�croirs�uuxo 1915 ALABAMA
UNT:
FLOOD: AE-46
ucrn.
UNT:
(714)586-6890
eooxess H. B. CA uc r�o.: 6 2 6 8 3 3
92648 uxT: C
LICENSEO COMRACTONS OECLAP�TION: I hempy ellim uMx penery d per"ryry Nel I em I'sensed uMm Drovuione d Cheqm 9
(mmme�rq �� Seeum )a001 d Gv6ion � d Ihe Busroaa eM Pmlw�'vu CoEa. W m cmx e in htll beea end eMetl.
cmuc.No.:059711/� uc.cuss: C-39 uc.No 2.33 E;CP; 07/95
Dete: i'�S C. � CaNaaar:
OWNEN BUIIDEH OECIANATON: I hareEy etf�m unEer penNy W perjury ihet I em hom Ihe CaMntlae Licenee law tw iM
�dn..�e ��s.a� �a�is e�::�, �e v�d�o". c ae: tin �r a�+mr w�d� �a�.. o�a w�wa. �na. �ao�.
demolch, or repei eiry stiw.Yurc, prior �o il� ewuxx, aho reyui�ae iM applicem la vuch peimu �o fib e sqriad stetemeM thet M or �M
e i��d w�� �o ma no.� a u,. wmm� um�e i.., fcnaa> a(�.�ro wun s.aa, �000l d o"e� a a ib
Butinem end Prdeae'vu CoCa� w Ihei he ar she b examq �Mrelmm enE iM beue la tM e11paC azemqion. My vole�bn ot Sed'on
�adi.s M em wWKw �a a v� �Fa+��• aad'csm �o . da o�eM a na maa �hen (na nunaree eoEan f`�U.
� I.mow'wrdiheCW?�YartryemObfea+x'vhwa�e+mthrdommV�.MiOEONewwk.endNasWCW�acmiinteMed
or aRaredla seb (Seeiwn l0as. Bmmas ard PMe�smeCOJe: The Conirm«e Limnee lawdaea ew� eppty ioen ownerd propaM
.no eui� «mw� �nxam. m,e..+o eo,s.w, wk Fimadr a n�.s «mraph w«ne, own emww�e. wwidad �nm.ud,
improremenb ere rot imaded a WenE la eeb. H. howwar. ihe b ldi�p a vnprovemml e add wilhin ore Yeer d mmdban. �he
owrnbuiHer MA Mve iM burden d V�'�uq he a eM did nd dild a'unpwe Im �he ROP�e d eeb�.
� I. m oxtw d IM V�WaM. em utluaMY caLLraC^0 xVh Smued wtlradaa b caneTid tlp WOPd (Sedvn )014.8u'vme vd
Pmleeaiane CoEe: The Camreaon Licen» law daea mi epply io en owmr d properly xfio WiNa « impvrx thweon erd who
contracta la wrt� pqeCa x<h a mumfa(e) ficemeE qvsueN lo �M Cavre�aa licaua la�.
� I em uemq under Saciim: B. 8 P.C.. lar N"v rseaon:
o.�. owiw
1 Co hereby ceniry iMl I un ewere d
25SN, eM Ihel I n ury INuro W iWii
Callorrie Ileelh vd Sdary Cade Saeiom 25505. 2SS]3. eM
iwedy�epmpyyi' veid pele oodm eM �ne reQuircmenb la
a�q'a..Q�� ioruereuempimmlheae
prwisione. y�.��/�
Dele: Z I� � J Md�cW:
7 ' �'
WORKEF'S COYGENSATION OECIAP�TION: I hereby elfim uMer parWly d paryry e d Ne Idbw'vp Eetleretbna:
� I hew erd xil maimen e caNicale d mueru io eatlimun br xaheie' cm�pmwion, u povided lor by Seaion 3]00 d ihe lebor
coe.. i« in� o«io�. a u..on i«.n:U w o� e n,�,ee.
�in.Ve.�e.a�m.�.�onw.•�,o�o���..,�n�.eMsw�arooam.t..ca.cod..a.m.w�«�dine
wak Iw w1iiM thu pe1mn ia iaued. MY waken' cam ambn inwreMe finier ard pdiry number ue:
�,,,;,,: S1�ATE FUND EY.PIRES
ad� r+�mn«: 1 - 10 / O 1/ 9 5
(mia vecrbn n..e nor ae m„�Wsi.e r m. va*�t o ro. w�. nu�d�.e ew.�. Isiwl d rn )
❑ I ro�Ey Nm in ihe pMormerce d IM wwk la xfich �his prmn b iuued. 1 ehell mi empby e�ry penon in enY mevror eo ea lo
became wbjea to �na warMse• mnpe�umion lew� d CeNanie, es I�hauk becmis wbi«t m iha wMen'
compenaetion piovuioru d Sped'/io�n 3�]W ol iha lebor Coda. I ehell l I rdA Now prm�iaione.
Deie: Z^ IS^ Zi Mq'ram:
Wemlrp: FWun ro rcun workwi romoxwtlon cavr�q l� un4rN1, �nd �IWI J1et �n w�v/qw ro eNMiulO�rou enJ
clHl II� �q ro on� h�nrErM �ho�ub dW4n (JI00,0001, M�d0/tlon ro tln cwl of rompxu�W2 Cemsp� �� pvvldM br In
S�ctlon J105 0l N� LaEor Co6, IntruG �d �rtomsy'� fw
CON4TNUCTION LENDINO FGENCY: I hreby e1Nm unMr penaRy d parjuy �lut Ihas u e coneUWon bMi'p q�eiwy br IM
�IBIiOR11B11C8 011�1G MOA�IX W�1If�11�6 (91111� O 691NE (50G1M 3091.�iM.�i�.
LENDEN'S NM1E:
LENDEN'S �DDXE55:
I cenM thm I Ma nad i�u WO�ir.etian end ams Ihet Me ebvn'vdametion e canaa.l epme �o oomPM rmh ell mY enE oouMy ordine�ea
end eteta lexa relmnB w buikvq consfrueion end MnEy euthorrse rapeaenieti+ro d �hie ary lo anter upon �he ebove-mantionad pmpeM
lorirupedion uepoaea. .
Piin
` �—iS �l'�
�me:
ignelur o I ru/A aan
(5151de WP� WhnaE�ikiq 8 Selery: G�eemFb; Caury-Appicenl: Rnk-Rewnw; Oddenro�Asaemw
CITY OF COSTA MESA - BUILDIP]G PERMIT
PERMIT NO: B 071150 PLAN CHECK NO: N
CONSTRUCTIOA] TYPE: PERMIT TYPE: STR
t . t . V 1 J �
i: o -.
PURPOSE: OTH
JOH DESCRIFTION ; T/OFF SHEATH S REROOF UI/COMP SHINGLES SQ FT; 8,000
CLAIPI CTALUE: 8,000.00 CALC-VALUE: 8,Q00.00 GROUP OCC: R-3 /M-1
COMMENTS: REROOF 3500SF RESIDENCE, SMOKE DETECTORS REQUIRED PQE�Rpy p9/�1U�HC,�-* }-���
«+rr*r*+r�r**�*�*+�.�r*�*+r****+r*+c**�*+�+�+�********�«�c*+��*�*r��r�c;�****xVIVI�JI�C � �^�` '�r 1
Z O N I N GS ERTEBQAUCIKRSE M E N T S C 1 Cl, V��,yy�
------------ MAIN BUILDING ---------- --------- ACCESSOAY BUILD����� i�
FRNT: FT IDl REAR; FT IN FRNT; r^T IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARFiING REp� PROL'; PARCEL; 139902Q6 ZNE: REF NO:
PLANNING NdTES>
1
*�rir+t�*��*#*�t*+r**�r�r*+�a��-+o�ticr�****+tiFit*+t**�tir+rir��w-*+c-*u�:�.t**ir-�*a�**�r�e+rir**ac**r+f+�+�-�ac+Fa��*+�,�+t+a
U E V£ L O P M E N T S E R t� I C E S R E Q U I R E M E N T S
ZOAIING APPROVED BY DATE;
BUILDZNG APPROVED BY : DATE;
APPLICATION ISSUED HY: DATE:Z - L��
if if if4 if if !F iE 4 1E if M lfif if if�lf iE 1f ik ?f jf . . 1E iR if iE iR iE if iF iF if s f��Fa iF
if jf ifif aE aE ifiklf iE if M 4 k% MM #' if if 1E iE if iE if iE M M if iE aE V if 1f af MiE-1! V iM1iF if 1t +f if +fjf 1k if aE 1E a: fF�f if ?E kif 1F M iR if +(�if ft iE af +f if +f if iE i4iE if if #F af iF
LEGALIZATION;N F E E S U M M A R Y STROCTURAL SEGMENT:Y
BLDG PMT FLUMBING ELECTAIC MECHANIC FIRE SMIP/RES GRADING
PERPIIT 99,00 ,gp
PLAP7 SMIP/A70N-RES
ISSUE FEE
bUILDING-DIV-> PERMIT ISSOE PLAN-CHECK TOTAL
TOTALS----> 99,80 0,00 0,00 99,80
PAID DUE
99.80 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 99,80 OVER/.SHORT; ,00
BLDG PMT PLOMBIA7G ELECTRIC MECHANIC FIRE SMZP/TOT GRADING PLAN-CHECF;
99.00 .80�
i
il�lf k1f if # if iE 1f i! k if if Mif 1F M if ?f 1f tf 1klfif iFM 1f 4jf 1E M 1f if iF if iF fE if if M M it if if iF'k if 1f if if V1` :k k i41fM jFifif jf ik if if 1f 1f iF i! 4+t +f if iE iF ifif df if if
I N D I V I D U A L F E E B R E A K D O 4? N
TYFE QTY D E S C R I P T I O Al []NIT COST TOTAL COST
SFR 8000 REROOF HY VALUE RESID£NTIAL NOZONE 1.OQ 8,000,00
END OF FEES
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JAT:E� O2i?5I9$ TIt9E: iS:4°
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9?,30
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit *r Date Inspector qppROVALS Permit # Date Inspector
1. Temporary E�ectrical Service or Pole 52. Pool & Equipment Location � + �
2. Soil Pipe-Und�grnd. 53. Steal ReinForcement �•
3. Electrical Conduit UuGty�Undrqrnd. 54. Porms r '
4, Electrical Conduit•Untlrgrnd. . 55. Electrical Bonding . �
r
5. Steel Reinforcemenc 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footinqs 58. Electrical Conduit-Undrgrnd.
6, Foundation 59. Ga: PiAe, O Undrgrnd„ Test
9. bVater Pipe-Undrgmd. •, 60. B�ikwash Lines, P�Trap, � Undrgrnd.
10. Structural Floor SYstem ' , 6,7'. APPROVAL TO DECK�
11. Property Sewer Line & House Connection 62 Bockwash & Receptor�Final
12. Sewer Cap 63� Heater & Vent-Final �
��
13. Roof Drains � 64'. Plumb�n� SYstem - Final �
14. Rough Plumbing 65. Electrical-Fina� �
15. Rough Electrica�-Conduit 66. So�ar SVstem�Final
76. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough t�1liring Sign 68. APPROVED FOR PLASTERING
18. Rough Elecirical�T Bar Ceiling 69. POOL/SPA SYSTEA9S FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough FactorY Fireplace APPROVALS Permit #
21, Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventil8ting 71. Product Pipin9 �Gas ❑Oil
23. Gas Pipe•Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing L^���r �(�/� 74. Overhead Nydro
26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemicai
27. Frame and FlBshing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIflE PiiEV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE 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. lVacer $ervice�Final
40. Gas Service-Final
41. So�ar pomest�c-Final
42. Backfiow Pre�enter
43. Backflow Irrigation � ..2-gC L _ � �� ���
J �W r�
44. Landscape Irripation System H,r,�, !'. �/„ ,// �,_ ��L_
7f+`Y-a l.wa_
45. Sound Attenuation
46. Handicap Regulations
47, FINAL STRUCTURE & BUILDING �_ 3� gW�L
48. FINAL PLANNING
49. Eiectric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICA7EOFOCCUPANCY
No. Date
,1PPLICATION FOR A BUILDING PE�.�IIT
y3 y9 BUILDING PERMIT NO. Eiecc.iwi W
TiaCI BIOCk Lol � Permlt NO. ,
d
Builtlin9 �O/� .I ����_ � �� D�O Plumbing ��
Atlaress N Pormit No. �
Cro55 Mec�aniwl d
Area Street Permll No. ?�
m
Owner r TyDa of Pro�ech ❑ New ❑ Alter ❑ Atltlitlon �
i'ta�3�./�T 3 ,
Atltlress ReDalr ❑ Convert ❑ Demo ❑ Occupancy Pmt.
S �l /1
cur C(�5 �9 yI k" z'p9� t zGPhone A P. 5 sP. area�
Architect/ �l Zon SPI. Pmt. Na.
Desi9ner (�!' �ense No. � Q 30
Atltlress Setbacks P/L Fronl C/L SQ Streot Witlth
�iv VbGiYU v�
Vartls e t R g� ear
Citv p pW� Zip xL7j�hone67�-3
ave ro�. e ig . .
r Engineer � Licanse No.
� " Ik ng SpdCGi Gqu fa fOvl e over8
y Atltlress
m ��( ZI Phone St�uct No. of No. of
Y P Hei9ht Storles FaTily
� LICENSED CONTRACTOR'S DECLARATION Park Feas ves Fee
m I hereby atfirm that I em licansatl untlar provisions ot Chapter 9 Requiretl No C•T� R¢<eIP�
t (commencing with Seciion 7000 ot Division 3 of tha Business anC Zoning APProvetl By: Date
.. Profassions Code, end my lir,ense is in full torce antl effactl.
^�y� Licensa Clas= '� y�0 3 0 []—� ���ense Numbar _�'+ �%� � 3�
�. �ate - Con[ractor �p�?��� u//1%i�./�uisrni✓% MiSc.
E Address��2 /9✓O G �o /� V��/ Propotetl Vse
�y, City and Zip C�ONi9 17/SL IN /x�_PhOno � 7-%�3f�� of StrUcture
v� CONSTRUCTION LENDING AGENCV
� I hereby affirm that there is a conattuction lendin8 agency for the
d performance of the work tor whic� rhis parmix is issuetl (Sec. 3097, �ct. TYPe Coee
' Civ. C.1. /� � Class Const. Vear
y Lentler's nlame �J'�'S�� USE/O UPANCV SIZE SQ. FT.
C Lendar's Address
J OWNER-BUILDEH DECLARATION
� 1 hereby affirm thet I am eaempt from the Contrector's Liceme Law ��
tO for the tollowing reamn:
� ❑ I, as oviner o� tha property, or my emplOyeet with wages as iheir 2.
� sole compensation, will do tha work, antl t�a structure is not
� intantled or ottaretl (or sale.
3.
� ❑ 1, as owner af Ihe propar[y, am axclusivBly con[racting wi[h
licensed contractoro m wnstruct tha project.
� ❑ I am ezempi �ndar Sec. , B&PC for this reawn 4'
m
n �ete Owner
E WORKERS' COMPENSATION DECLARATION Total valuation
� I hereby atfirm that I have a certificeta of ronsent to selt-insura, EnCroatltment Pelmit ReqUlretl Ve5 ❑ No
or a certificate of Workers' Compensstion Insuranca, or a certitietl
C copy thereOt. G�atling PmL G�dtling
� Policy No. Company Requlred ❑ Ves ❑ No Pmt. No.
�y ❑ Certiiied copy is hereby tumished. Rou9h GraCing �
6�(:artifia cop isfiletl with (i�i��rosyrG� Q,�iTy q� . �
APProved �y: Ddte
a Date // Z APPlicant vzL� 3
CERTIFICATE OF E EMPTION
FROM WORKERS'COMPENSATIONINSURANCE Z
(This section neetl not be camplu�etl if permit is for $100 or lessl. C
1 cmtity that in ihe per(Ormance of the work fOr which tMis permit is �,
issuetl, I shall not employ any porson in any mennor so as to becomo PERMIT FEE$ �
subjec[ m the Workers' Compenwtion Laws of California.
DBta Applicant
NOTICE TO APPLICANT: If, after making this Cert!ficate of Struttural E Plan Check b
Exemption, you shoultl become subjact to tha Workeri Compensation
provisionz of the Labor Cotle, you must torthwith comply with such Electriwl SPe<ial
p�ovisions or this permi[ shall be tleametl revoked, a InveSt. E
I CEFTIFY THAT I HAV[ READ THIS APPIICATION AND STATE p�umbin9 $
"fHAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLV WITH ALL COUNTV ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBV AUTH- Mechanlcal 5
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MENTIONED PROPERTV FOR INSPECTION PUR- pre-Grade
P�O /F6���� � �/^ ,z �^ y6 Inspettion s
ryQ O
Signacure'of Applicant or Agent Oa[e Pre-Gratle s Permit
Rec. No. 15sue
�AR ,��1�ipu�,a�
All spaces within this boz must 6e rnmpleted to rocess P�dn luuance
P Ch¢Ck By: ApprOv¢tl:
CMF 0335-46 (BU-28) rev. fi/80
.PPLICATION FOR A BUILDING PE,..AIT
BUILDING PERMIT NO. Eiectr�wi �,..�; po
Tract 3 9 Block lot � Permit No. �.
Atl'tl�ress Q/� � C �' �l�C' � Pe�rmlbt�No. �O 6( 2 �
D
Cross Mechanical I � a
Area COS � � Stree[ M ���- Permit No. / ,O a
m'
owner ��3� � �b �i � 7vpe ot aroie ❑ rvaw ❑ Aiter ❑ Atltlitio �
Atltlress � ��, ❑ Repair Convert ❑Demo ❑ Occupancy mt.
Sup. Dist./
City ZIP Phone A�P� Insp. Area
OM ginert/�, /�R VN�nse No. 2 �Q 30 Zone Spl. Pmt. No.
Setbacks P/L F nt C/L St. Street WiEln
AGtlress
Vartls Le t igh ear
CItY ZIO Phone .
ave o�. e i9 . .
Enginrer License No. -
CParkinq SPaces equ r< �ov e overe
a QddfC55
m City ZiP Phone Struct No. o( No. ot
Height Stories Family
� LICENSED CONTRACTOR'S DECLARATION Park Fees Ves Fee
� Requirea No C.T. Receipt
m I herehy atfirm that I am liconsod untler provisions ot Chepter 9
t (eommencing with Sectlon 7000 of Division 3 of the Business ontl Zonin9 /�GP�oveO ey: Date
r Protessions Cotla antl my license is in full force antl effettl.
� �icense Clas� d^ � Litense Ivumber � y� � 3
> Date Contractor I/9/�/�Y �-'�A1Q�AL�M�N7 Misc.
E nm.�: U� 2 /� Vc�G RDe /1 V{? a000sea use
�y City and Zip�A�?ON� U/%G nr�R rno�e 6.'71^3d[�' °t svuceure
« CONSTRUCTION LENOING AGENCV
d I hereby affirm that there is e tonstr�ction Ientlin8 egency for tha
a pertormance of the work tor whic� this permit is issuad �Sec. 3097, �tc. Type Cotle
Civ. C.1. Class Const. Vear
C Lender's Name ��/� N � USE/OCCUPANCV SIZE SQ. FT.
lentler's Address
J OWNER�BUILDER DECLARATION
y 1.
I �areby atfirm that I am exempt from the Conttactor's Licenae Law
� for tha following reason:
� ❑ 1, es ownar of tha property, or my amployees with we8os as their 2.
sola componsation, will tlo tha work, antl the atruc[ure is not
r intended or offerxl for snle. 3
� ❑ 1, as owner of [he prOperty, am exclusively contrectin8 �+'ith
licensed contractors to conrtruct the project.
�m„ ❑ I am axempt under Sec. ., B&PC for this reemn 4•
w
a �ete Owner
E WORKERS' COMPENSATION DECLARATION Total Valuatlon
� 1 hereby atfirm xhat I hevo e cortifi�ete of consant to aelt-insura, Encroachment Pormlt Requlr tl ❑ ves ❑ No
or a certiticate of Workurs' Compensation Ins�rance, or a certifietl
Cm copy [hereof. Gratling Pmt. G�aCln9
y Policy No Company Requi�ed ❑Yes No Pm[.No.
�a ❑ Cortified copy is heraby furnished. Rougn Gratling �
C ❑ Certitiad co y is filed wi[h O�rnngq C�, EMA.� � / m
a ADP�ovetl by: Da e
Date ' ' � APOlicant ,� ?�✓ w,I� 3
CERTIFICATE OF EX PTION
FROM WORKERS'COMPENSATIONINSURANCE Z
(This saction ne�d not be completed if permit is tor $100 or less). �
I cartify that in the performanco ot tho work for which this permit is 3
(ssuetl, I shall not employ any porsOn in any manner so as to betome m
sub�ect to the Workers' Compensetion Laws ot Calitornia. PERMIT FEES
Datu Applicant
NOTICE TO APPLICANT: If, after making this Cer[ificate of S(ructural Plan Check E
Exemption, you shoultl Oacoma subjact to the Workers' Compensation
provislons of tha Labor Cotle, you must torthwith comply with such ElectHwl y SPecial s
provisions or this permit shall be tleamed ravoketl. Invest.
I CERTIFY THAT I HAVE READ TNIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO P�umbing S
COMPLV WITH ALL COUNTV ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTV TO ENTEfl UPON
TNE ABOVE ME TIONED PROPERTV FOR INSPECTION PUR- pre-Gratle
P�S �i �,Z � �9� y6 Inspettion S
�'°'"�� �� Pre-Gratle Permit
Signat�re f A,p�pIlicant oIr ABe�� Date R¢c. No. E Iszue f
�fl��� W�%�!�/Q ��`4 0/✓�
Prini ApplicanYs/AgenYs Nama
All spaces within this box must be completed to process P�an Issuance
Chetk By: Approvetl:
cmr WSD-9b �tlU-Ltl� rev. e/nu
� OWNER
JOB AC
GENER
'� INSPECTIONS `
� Pool Location
<.� Forms
� Main Drain
Steel Reinforce
Elec. Bond �
Approval to Covcr
Underground Electric _
Gas Piping Test
Filtering 5ystem Lines _
Backwash Lines and Recep.
Electrical Final
Heater and Vent Fina� _
Filter System Final
Backwash and Recep. Final
�.� I� .. ._
DATE
FIRE ZONE
SUBCONTRACTOR
Electric
Plumbing
GNl
�
�C.SQ 6
P.11u
fFP —3-75�F,5.�0 119 = *'�* �23.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIV ER CEIVE E 5
BUILDING • �
ADDRE55 , .�
/JQ ERMIS NO.
�/ A.P. NO.IV � - _ I'�I �•.
O W N E R /CQ d� . O/� IL�
BUILDING /�
ADDRESS �D�� �(/• C�� ���� �+DDRESS(/CO'� �
� > NOL If TFAC • LOTJ 7 BLOCK
CITV CJS
CONSTRUCTION W /aDD ALT R P
LENDER v
/�
BRANCN
OWNER � %��
ADDRESS
VALUE "'�
ARCHITECT TEL. SE $
OR ENGINEER
FIRE
ADDFESS ZONE TVPE ROUP
�l /) _ APPROVED
CONTRACTOR � `� � .(� ., p.. ✓ B�' DATE �
d� �
ADDflESS . S L�. � ` '
Z E NO.OF USE OF NE
CITV Q JJ `j- � NOL -�CG D P�� BUILDING
STATE CITV VAFDSAPPROVED VARDSAPPROVED
LIC. NO. � 3U�. �IC. N MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLDCaS. (FROM C/L STftEET)
OF LOT NOW ON LOT � ROfYT FT. T
USE OF
EXISTING BLDG. IDE FT. T
Separate permits are required for �, SIDE Fr.
electric, plumbing and heating work.
I7EAF FT. FT.
USE OF BVIIDING AND WORK TO BE PERFOIiMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCES,S. BLDGS.
VAR. # DATE
QU.P.� APPROVED
APPROV
I haraby acknowledga that I have read ihis uppllcaiion antl state
that tho above informetion Is corract entl aB�ae to comply with
all laws reeulating building consttucNon, entl I shnll not employ
nny person In violatian of the workmon's compensation laws ot
the State of Californla.
I hereby certify that I am properly licensed es e cantrector �nder SQ. FT.
the State of Callfornia Business entl Profeszlons Cotla, �Iviaion 3, THE AMOUNT SHOWN VNDER VALUATION IS FOR
Chapter 9, antl that such licenses are in tull torea antl etiect, or I THE PUfiPpSE OF ESTABlISHING A PERMIT FEE ONLV:
am azempt from the provisions ot the State ot Calitornia Busineu VALUATION PERMIT FEE E
end ProfeSsio Cotle, Division 3, Chapter 9.
Sipnaturaof� /� .�JJ) i�� "/ /�oO PLANCHECK S
Permittee �� ��� ifLA%%` 5 � Tqx s �
Auihortzed ABent TOTAL PAID E �
.
r
A}
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COHTA MEBA. CALIFORNIA
For Applfcani fo Fill In Complefely
TYPE OR PRINT
BUILDING � o'� �' T� �'T �949
ADORESB �Z,O / > ^�tti �r eII �o4Y%
COSTA MESA CALIFORNIA
cirv ['n
STATE i
use oF
EXI6TING BLDG
BBTB�CK LINB FROM
� BUILDING
OF BU
[J
�'�� �����A���
� MAR 2 issa
l �I�ariil;'t� DF��.
�7T( `Ql� '��A `'h
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
ev
DATE 186UED
BUILDING
ADDRE65
COSTA MESA. CALIFORNIA
APPROVED
e�A D,e. ZONING
nnG%� ZONE NO.OF UeE OF N¢W Sn� a
C"r• R�I I PUNe � I BUILDING wlaN <
TEL. �% LEGAL
N0• C`� �� DE6C0.1PTION �� � �� T�P y 3y %
I NO. OF BIDG9..
DESCRIPTION OF WORK
7 � NO. OF
ROOMS
G1LiO IRDOF
YARDS
APPROVED
(CENTER LINe eTJ
FRONT �S—
R. SIDE �
L.SIDE �
REAR � Z • � 7
0
7
,TE 2'Ii
i HEREBY ACKNOWLLD68 iXAT 1 HAV@ q6AD TXIS MPLIWTION qF{¢ AMOUNT BHOWN 11NDER VALUAT�ON IB FOR TH¢
AND BTM1T¢ TH�T �M6 ABOVE I6 CORPEGT AND AGREE TO COM- pUflP08E OF EST�BLI9HING A PERMIT FHE ONLY.
PLY WITH ALL GITY OflDINANCE3 AND BTATE lAWB REGULATING
6u�Lo1Na coNBTRucT�oN. VALUATION �/j�
I ATURE OF ^ PERMIT FEE $//'�
E 17TE $�� f /7 �— pLAN CHECK $ / % —�
V /
AUTHORIZED AGENT / _ __ _ �,�J _
� COSTA MESA BUILDINGSAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERM[T 72�57 TL
P.O. BOX 1200 GOSTA MESA, GALIFORNIA 92626
RE E PERMIT � ' '
For Applicant to Fill in Completely — Use Ink Only N� 5108 0
ADDRESS f-.D�h N CAPFLcA C� A.P.NO. �� �
BUILDING n O� /
OWNEROR /� ADDRESS.L �lJ
TENANT /(O/3L� 'f UNITOR
ADDRESS �J y.� � SPACE NO.
`� �- T LOT BLK.
TEL.
CITV G'Q � �(.J� /9 NO.
EW ADD ALTER EPqIR MOVING DEMOLISH
CONS�RUCTION ��S I
LENDER
BFANCH
OWNER �S'
ADDRESS USE �- � �'�l�UE§��
AflCHiTEC7
OR ENGINEER L L✓ �.LAU 0 =.3
ADDRESS 6 �Z �U ��/ /JO ✓I� ZONE TVPE � GROUP ���
CONTRACTOR � BVPROVED DATE /� ZS�J
AODRESS
TEL.
CITY �O ON� I �[ /�/ NO. �JS" J�I�
STATE CITV APPROVEDSETBACKS
LIC. NO. � a a LIC. NO.
SIZE NO.OF BLOGS. (FROM C/L STF E
OF LOT O J( � C7 � NOW ON LOT RONT
USE OF l
EXIS7ING BIDG. l �
l
Separa[e permi[s are required for �, sioe Fr.
elec[ric, plumbing and heating work. � !/
REAF F .
USE OF BVIIDING AND WOFK TO BE PERFORMED PLAN NG ACTION
^[ DATE
U J �� £ APPROVED
OO �Z AP V /
I hereby acknowledge thet I huve reetl this epplication and stete
Shat the ebove infarmation is corract and ap�ea to comply wlth
all laws regulating building consiruction, entl I shell not employ
any person in violation ot the workman's compensation laws ot
the State of California.
1 he�eby cerUfy that I am p�operly licensetl es e contractor under SQ. FT.
the Stata of Celifornia Buziness enA Protesslons Cotle, Dlvlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and tha� suc� litenses are in full torce antl effect, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV:
am exempt from the provisions of the State ot Celifornia Buslness
and Protessions Cotle, Division 3, ChaOter 9. VALUATION PERMIT FEE b , 00
Signatvre oC___T�A+" / �/ �� /f PLAN CHECK S � O�
Permittee �n� Np 5� GOD TAX E D,s
Authorized Agant Date // — Z �^// a /
TOTAI PAID E Z. S