HomeMy WebLinkAbout272 BUCKNELL RD - Building PermitsCI1 t OF COSTA MESA �
CALIFORNIA �2826 P.O. BOX 1200
FROM THE OFFICE OF THE DIRECTOR OF BUILDIN6 SAFETV
Project Address � 72 ✓j�cit,(�C�
Project Name
Ownecs Name Ji9/Y/ ���P�✓` O
Qaners Address a'7 Z ✓� uc%�.o �
O.mecs Telephone C—�6 -- �F7/ Z
��a ���
Perntit # �-0 7 77
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City Use Qily
I � �y�� as Owner, F,�as�or, B�t (strike out all
except one) do hereby attest that �loyment of any person, or persons, is not
anticipated at the time of seeking the abovrreferenced permit. In the event that
any person, or persons, are e�loyed under the prwisions of this permit, I shall
imrediately cause a valid Certificate of Worlanens Cc�npensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my own mst, and to indemnify and hold harmless, the City,
its offioers, agents and/or e�loyees, frcm and against, arry and all liability,
damage, costs, losses, claims and expenses, howscever caused, resulting directly
or indirectly fran, or oonnected with the improvement under this permit.
I further state that I have read and fully imderstand the implications and rr
sponsibilities of the above statements, and will ca�ly with all provisions of the
Contractors State License Iaw found under the Business arrl Professions Code,
Division 3, Chapter 9, of the State of California.
� ���� �
Print N�ne
- � �
Signature
CMF 0777-4fi
/O/2� �FD
Ik3
�.
CITY OF COSTA MESA
CALIFORNIA C2826 P.O. BOX 1200
FROM THE OFFICE OF THE DIRECTOR OF BUILDIN6 SAFETY
Project Address o2/�- /.JUC�Ch�� LC-
Project Name ,��j�r,r n,�. y �o�Pi y��
�
o.mers Name ✓�A R.t e
O,mers Address ,,) 1, /i v c�l Ne LL
Oaners Telephone �"+-/B � �-L 7 /J
Pernut # ��% %%%
�
�Yf� ✓
City Use Chly
I r/JL�iln�n.�,w P.pyl�i�,p�[J1� as Oaner, Contractor, Ager��. (strike out all
except one) do ereby attest that e�loyment of any person, or peisons, is not
anticipated at the time of seeking the abovrreferenced permit. In the event that
any person, or persons, are employed under the provisions of this permit, I shall
urnrediately cause a valid Certificate of Worlrn�ens Co�ensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my cx,m oost, ard to indemnify and hold harmless, the City,
its officers, agents and/or e�loyees, frcm and against, any and all liability,
damage, costs, losses, claims and e�cpenses, havscever caused, resulting directly
or indirectly fran, or connected with the improveirent under this permit.
I further state that I have read and fully imderstand the implications and re-
sponsibilities of the above statements, and will canply with all provisions of the
Contractors State License Iaw found under the Business arr] Professions Code,
Division 3, Chapter 9, of the State of California.
�P%� �, J'�) % C� D I? n F/ /� D
Print Name
�� ii � �p���
Signature
CMP 0777-46
�?—/—�C7
° Date
� _ICATION FOR A BUILDING PERM, _�
BUILDING PERMIT NO. Eiectr�w� m
Tract �� O Block � �ot Permit No. �,
q j Plumbinq , a
Atltlreu �oC. � IJ C_ � ' CI S^ `� �� o
Permi[ No. �
Cross v Mecnanital a
Area Street Q Pormlt No. � �
�,H�e� ' M �O �� rype ot Project: ❑ New ❑ Alter � Atltlition �
Atltlr¢TS � / � ❑ Repair ❑ Convert ❑ Demo ❑ OCtupancy Pml.
CItY � ZIP a6 6 Phone _Y,� A.P. SuP. Dist./
Insp. Area
Archll¢ct/ Zone $PI. Pmt. No.
Oesigner fi L�canse o.
AOtlreu � / h A/� Setback5 P/l Front C/L SL SVeet Witlth
h /1/'1
Vartls Left gh ear
CItY e ZIP Phon y
ave ro�. o g . .
En9lneer Llcense No.
C park n9 SPaces equ re rov e overe
n Atlaress
m CItY ZiP Phone Struct No. ot No. of
Heig�t Storles Family
� LICENSED CONTRACTOR'S DECLARATION Park Fees ves Fee
� ReqWretl No ��T. Recoipt
m I hereby affirm iha[ I am licensetl untler provisions of Chapter 9
t (commencing wifh SecHon 7000 ot Division 3 of the Business and Zoning Approvetl By: Date
Profxssions Cotla, antl my liconse is in tull force and effecil.
?� Licanse Clas� Licenso Number �
T Datn Contrector Misc.
E Address �000setl Use
ot Structure
jy City entl Zip PhOne
v� CONSTRUCTION LENDING AGENCV
� I hereby et}irm that thera is a construction lending agency tor the
? performanco of tha work for which c�fs permix is issuetl (Sec. 3097, Occ. TyOa Cotle
' Civ. CJ. Class Const. Vear
d Lender's Name USE/OCCUPANCV SIZE SQ. FT.
C Lontler's Atltlrase
'� OWNER-BUILDER DECLARATION
r I haroby affirm that I am exempt from the Conttactor's License Law 1� /
1O tar the followin0 reeton:
� l� I, os owner ot tha property, o� my employees with wages as their 2.
� sole compenution, will tlo the work, and the struc[ure is not
r intentleG or ofteretl forsele, 3
� ❑ 1, as owner of tho properry, am eaclusively con[rectin8 `�+��h
licensetl cOnbactOrs t0 cOnshuct the prOject.
� ❑ I em ezampt untlar Sac. , B&PC for this reason 4�
m
a Data Ownar
E WORKERS' COM7ENSATION DECLARATION Total Valuatlon
� 1 hereby affirm Iha[ I have a cartificata ot consent to ulf-insure, Encroachmenl Permit Requlretl ❑ Yes ❑ No
or a cnrtiticata ot Workers' CamOe�sutfon Insmance, or a certitietl
C Copy [hBreOt. Gratlln9 Pmt. GraEing
� Policy No, CompanY Repuiretl ❑ Ves ❑ No Pmt. No.
�a ❑ CertiFiad copy is heraby furnishetl. Rou9� Gratlin9 �
6 ❑ Cer.ifiad copy Is tiletl with Omnpe County, EMA. qpprovetl by: Date A
a Daxe Applicant 3
CERTIFICATE OF EXEMPTION -
FROM WORKERS'COMPENSATIONINSURANCE Z
(This sac2ion nood not be complatetl if pe.mit is for $100 or lessl. C
1 tartity that in the periormance of Ma work tor which this permit is Q
issueA, I shall not employ ony porson in any manner so us to become �p
subjact to tha Workers' Componsetion Laws of California. � PERMIT FEES
Date Applicant I'
NOTICE TO APPLICANT: H, aftar making this Certi(ica[e of SVuctural $ Plan C�eck $
Exemption, yoo shoald become suble�< <0 2ha Workers' Compensation
rovislons of the Labor Code, SDecial
p you must torthwith comply with such Electrical
provisions or this permit shell ba tleemetl revoketl. S Invest. a
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE plumbing $
THAT THE ABOVE INFORMATION IS CORPECT. I AGREE TO
COMPLV WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBV AUTH- Mechanical $
OR12E flEPRESENTATIVES OF THIS COUNTV TO ENTER UPON
TNE A VE MENTIONE ROP FTV FOFi INSPE TION PUR- pre-Gratle
� 5 �� f���� / l6 InsPection S
eJ Pre-Gratle Permit
igna e of Applicant or Agenc
All spaces within this box murt 6e completed to process Plan Izsuance
Check BY: AOProvetl:
lMY UJJJ-9b (CWLtl) IBV. b/CU
�
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�ooeFssaam�owo: 272 BUCKNELL RD uxT:
araexsruYeivaiarr+: CORDEIRO, SAMUEL F TR
.00�ss: 272 BUCKNELL RD
COSTA MESA,CA 92626
642-7404
1PPL. Y/JIING AOONESS
umxrtEc. on �++m+�n: uc xo.:
41CM OX ENO: S ADDIiESS: UNT:
ca+m�crarsru� ORANGE COAST AOOFING (714)6 1-1924
LONfO�CTOR5YY1W0 3027 ROYCE LN
,�� COSTA MESA CA ��; 434 74
926 7 u�:
LICENSE� COMH�CTOFS DECLAF�TION: I hweby efl'rm uMv pe y d perju I em I' wWs p' d Gheqa D
(earvnencnY rm� Beelian ]000) tl Orvubn 9 W ine &uiebae aM PN Code. 4wnw u' IuY aHea.
cmuc. .0 59 uc.cuss: C 39 u N.: 43 6 EXP: 06/97
�
7ns: �`�� CaNroUw:
OWNEfl BUILDEN DECIAR�TION: I hereby effirm uMer penetly d perjury Ihel I em exemq han iAe CoMredon lioeiue law Iw �he
Idbx+q �sesan (SeUb� ]O�t.5 Buv'vw�s eM Pralmeune Cada: AnY cnY a�mY �� nVuiree e perm� to ooroWn. Mer. imDrove.
Gemdoh, ar reper eny etrvcture. pior io in uaerKe, ebo requires Ihe eppliuni la wch peimn �o fib e aq�wE stetemeM Ihet he a eM
ie licenaed punuen� io tM provisima d Ne Contreaon Lieenae lew �Cheqx 9(mmmerieep xith Seeion )000) W Diveian 3 d ihe
Buviiwae eM Prdmaiaw Gode� « �het he a she ie exemq iM1aeM1am eM Ilw Eaio /a ihe eAeped uemqion. Nry vub�ion d Seeun
)03t.5 b/ enY eVd�v^t la a pertn� wbjaqs �ha epplicem io e dvil penehy d na mae ihenlra lwMrtd da0en �5500�.
❑ i.a.�ameww�r«mr�dm+e+...nw��ina:.dso�v�+��+.wmmue.wicd,e����e�,aw�eee
a Mmed br veb (��b^ ]�. Buvrou aM Prdesvone Code: The Camrtlon Liueua law doea m� epplyto en ownr W propary
wM bulde or inV�*s �hxean. mW x}w dme suM work Hmeetl a hene� a Nraph hb a her own a^O�Wbe. V'a+� �het vuch
impovemeNa ara m� inieMeE aWmad lor eele. Y, however, iM buikinp ar'vnpovanaM b wN wilhin aa yeer d canplNion. �hs
o.�«-wum, w�u ne.ro m. w� a wame na o, .ne e�a � n��m a�wa+�� m. wmo.e a�1.
❑ �. e� wm« a ine wwem. ��au�rveN oomree�a �n �ioan.ee cmveaaa ro oumw me wd� eseeon �a+. a,.in...�e
Prdeuims cab: TAe CaNreCaa l'cenm law Aoee M MW/ lo en oMner a V�W�Y Mo N�ds « inG�'e �hasan end Wn
mnveea la aN p9ea� xvh e mMreCale) Icereed Wnueni io iM Contrepas Limnsa leW.
� I em e�emq uMu Seclion: B. 8 P C., Iw ihis raeeon:
ove: o,.�e,:
I Eo heieby canM ��� ewue ol ud undenleM �he reQuiremema W Cellom4 WMh eM Sdaty Code Saaiae 255U5, ?Sit'1, enE
255J1. erd Net I a ury Muro buildinp ooapeni will / MI iwl (dicb arol � io canp/y wY� uid Yeb aodas eM IM rpuimnann b
aDe��famrowpionamodSmianhan�M�r �a�y vaGmimiGmria.ReddemelodmrveionWV�iauenexemNtmmihaa
wwimn+.
Dab: �OW�
WOflKEN'S COMPd4ATI0N DECL�N�TION: 1 Mraby elfirm under penMy d prhvy un d Yr b0ow'up Eetluatnm:
� I M1me vd xil meiMen e cMifcele W ooneenl lo eaH�inw�a M xakme' wmpemelian, o po.idsd fM b� Semon 3)00 d IM leba
cad., i« in. peno�.z. a m. w� i«.d:on in�, ��u �. ��ed.
❑ in...wwme'va.:�.w�.n•�va+moninw,a,ce.asmc���abrs.aiona�ooau»t..nc.coe..a.m.vwa�dm.
��«���'�p��MY��'S'I�ATE� FUND ����m�Y� EXP RES
c�«
vorn. M,mn. — O 1/ 1/ 9 7
(Thia sedian need rat 6e ttmpleretl / Ne pemil is M one hundrad dWbn / OJI w be�
� I centy Net in Yro peAmneica M iM wh M whch Ihb peimG b d. I aAel 1 em� oy mry n erty m n io
w�. .,a�+ �e �ne �.� �wenae�ia, m.w d c.w .�,d .e� a i owd w4«� �o won�e�.•
can ion Vf��^sbn d Seeion 9100 d iM Wwr Code. I slWl aN � oom ' h Y
Date: � ' �l� � Applrant:
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: H 079466
PERMZT NO: B 079466 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF 6 REROOF W/COMP SHINGLES SQ FT; 4,669
CLAIM VALUE: 4,669.00 CALC—VALUE: 4,669.00 GROUP OCC: R-3 /
COMMENTS: REAOOF 2800SF RESIDENCE W/COMP
��**x�x **��*x�x�***�r� ***�*�+�*****� **�+t*+�� *��*��*���*���*�����r�rt**�**+�*x��+�**�r+r*� � �*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT ZN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REp • PROV: PARCEL: 14141119 ZNE: REF NO:
PLANNING NdTES>
i.
�Ih iE iE iE 1E iE fI� if 1E IE If iF iF 1f k IE iE 1E 1E iE if iE 1E'lE iE IE 1E 1E 1E 7E 1E iE 1f 1E 1E 1E iE �lE iE iElE IE iE 1E'IE �E 1E 1E 9E iE �E fE if' 1E 1E 1E iE 1E iE �f 1E IE 1E iE iE 1Elf ik iFiE jF iE if iFlf if i(� ik iE
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 M E N*-T S
ZONING APPROVED BY DATE; '%+
HUILDING APPROVED BY : DATE; -''
APPLICATION ISSUED BY: �—+�t DATE: �-I3 6�
itiFikirrtifiEit161EaE1EiEiEiEIEiEiEiEiE�E1E3F7FiF{F7FiFiFiF3F�FiFiFiFiF�F7FiFTF3fTFTFTF7F'iFXF?�iF7FiFTF7F'iFiF�t-iFi�i�if�-** * x��r* �ti�
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 99,75 50
PLAN SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 100.25 0.00 0.00 100.25 100.25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 100.25 OVER/SHORT: ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
99,75 .50
1E 1E if IE 1f iF iE iF ff 1E 1E 1E fE iE �E fE fE if 1E iE if iE iF if if if 1f !E 1F if if 1E ik if if iElE if if �E 1E 1F 1E 1E 1ElE 1ElE iF i(� 183E 1! iE iE 3E if if if� fE if !k if� 1E ik * iE iE 1E iE 1E �F iF if 1E iE iE 1E 3E
Z N D I V I D U A L F E E B R E A K D O W N
W�ml�p: FeNun ro ucun woh�n'rompxuetlon mrorap� b unls , enEWll �L/�ct en wrip/o�w ro MMroI p�neNu enE TY P E �{TY
Gvll nnu �q ro om hindrM fhouun0 tlolkn (S1oo,aoo). In eMltlon m M� cwt ol ronpaueWrt e+�p� �� PA�bed br In
swuon a�a5 0� ms iaeor code, Int�ut �nd ercurnsy i�«s. S FR 4 6 6 9
CONSTNUCTION LENUINO AGENCY: I MreEy elfirm under panely al peejury tM1m �han e e mn¢��utlion Mrdinp qpM.y br tM
peAamenm M Ihe xwk la whitli Ihe permi u oeued (SeGian 9091. Civ. C�.
�ENOEP'9 NAAIE: f�
LENDEP'S ODOpE%: I I
ihetl
DAV�TD M�ILL
camM/ wiln all M' W mun7 adinerim�
mux upon tM eEmro-men�ionad popery
o�,: �1— l
(5/51de.WP) Whita-Buildvq d Sefety; GreeirFlle: Canery-Appirant: Rnk-Revanue; Oakeneo�Rzeevar
D E S C R I P T I O N
REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
�
UNIT COST TOTAL COST
1.00 4,669.00
Oi 00214E69-OQ21<870 TUT 100.25
�,:;DATE: 09/13/95 TIHE: ID:2S
�
!-'-:
CONSTRUCTION AND PLANN�,,,. JOL & SPA '
APVROVALS Permit # Date Inspector qppROVALS Permit # Oate Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,
2, Soi� Pipe-U�drgrnd. 53. Steel Reinfoccemertt • �
3. Electrical Conduit Utility•Undrgrnd. 54. Forms .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �� ,
5. Steet Rein(orcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE -
7. Footings 58. Electricat Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwaeh �ines, P�Trap, � Undrgmd. �
10. Structural Floor System ' ' 61. APPROVA� TO•DECK_ '
11. Property Sewer Line & Hou:e ConneMion 62. Backwash & Receptor�Fina� ,
12. Sewer Cap ' 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing Syscem - Flnai
14. qough Plumbing 65. Electrical�Final
15. Rough Electrical-Condu�t i 66. Solar System�Final ,
16. Rough Elettric Wiring -- � 67. Fencing & Access Approval .
17. Rough Wiring Sign 68. APPROVED FOR PLP.STERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Undergroupd Hydro
22. Ducts, Ventilating 71. Product Piping O Gas O Oi�
23. Gas Pipe-Rough & Test 72. Underground Flush
24. RoofFraming - 73. Undergrnd.StorageTankOGas OOiI
25. Roof Sheathing �'-/�_g/ �� 74. Overhead Hydro
� W
26. T•Bar Ceiling (Structurai) & Monocoat 75. QrY Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � . 77. fIXED$YSTEM FINAI
29. Insu�ation - 78. FIRE PiiEV. FINAL .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Bro�vn Coa2 79. FINAL INSPECTfON
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED
. 33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas P�pe-Test
36. Hood or Canopy
37. Final factPry Fireplace
38. Final Plumbing
39. Water Service�Final '
40. Gas Service-Final '
41. So�ar pomesticFinal = - '
42. Backflow Preventer -
43. Batkf�ow Irrigation ,
44. Landscape ��rigation System
45. Sound Attenuation
46. Handicap Regulations ,
47. FINAL S7RUCTURE & BUILDING q�`9=Qi /w�
c W �c
48. FINALPLANNING '
49. Electric R¢�ease to Edison
56. Gas Retease to Southern Ca4itornia Gas Ca
51. CERTIFICI+TE OF OCCUPANCY
No Date
/�
RACTOR Wilcon AcnnriatPs DESCRIP
-i9 LOT TRACT FIRE Z01
7NSPECTIONS
soit
'cns
W ATER
'ROUGM PLUMBING
PROP. SWR. LINE � HOUSE CON. �
SPHINKLING SYSTEM
MISCELLRNEOUS
ROUGN MEPTIMG r1N0 nIR CONOITIONING
REMPORRRV SERVICE OR POLE
JINOERGROUNO � POWER �
ROUGH WIRING
TRENCHES FORMS STEEL AEINF.
FLOOR SYSTEM
BOND BEAM ❑ STEEL REINFORCE ❑
SMEr1TMING
FRAME RNO FLASMING
LATHING - IN n OUT �]
PLASTEH, BfiOWN CORT
STRUCTURAL. FINAL
MEATING, VENT., REFRIG. �N� A.C., FINr1L
PLUMBING, :�NAL RND WS TEST I�
EIECTRIC, FINAI
UNIC
SUBCONTRACTOR
.
,�` � 42198 f":?3-79,�"—a{.003361'� �u•::.'�.5�
� COSTA MESA BU�LDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
A LI AT ON FOR STRUCTURAL PERM►T
For Applicant to Fill in Completely — Use lnk Only
J/ REC I D DATE RECEIVED TE SSUED /
BUILDING �! �� UG/�IiP� � � V
ADDRESS L
�./j I ERMIT O.
OWNER , COr`���rQ p..P. NO. � (
MAfI_ BUILDING �7 ��7 {Z��� ��•
ADDRESS SQIN� ADDRE55 ti / i.i��
CITV
� �L` NO.,J/d^'� TRACT LOT� BLOCK
CANSTRUCTION W p' A� P
LEN�ER
BRANCH -%
OWNER � O�'`'�'rW
ADDRESS
VALUE
ARCHITECT L u NEL S a $ S�O �
OR ENGINEER S71 �
FIRE
ADORESS ZONE VPE GPOVP
CONTflACTOR y�/ O�SUK J�tSSdGa, ByPROVED DATE (,( �2��
ADDRESS ��DD �77�'���I�
n-. ' TEL. !,, ZONE NO.OF USE OF NEW�
CITV (, (,Iv1� F NO.s3 �6w P�'� BUILOING
L C NO.�S�!'�� LICyNO. vMA NSBUIIDINGD ACCE SORV BUOILOING
SIZE NO.OFBLDGS. (FROM /LSTREET)
OF l0T NOW ON LOT RONT FT.
VSE OF
(�
EXISTING BLDG. —/ FT. D FT
/ /—,/ �
Separate psrmits are required for L SIDE ' FT. v Fr.
electric, plumbing and hea[ing work. '�
REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFOFiMED OISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCE:S. BLDGS.
��/ VAR.qW DATE
f� UIf� `�/•—' C.U.P.q{5 MPRpVED
APPROVEO � l,j,� �'1 � ! ..
�f � !i l.V
1 hareby acknowletlge ihat I heve reatl Nis applieetion and state
that tha abova Inform51ion is corract and agrea to comply with
all laws regulating buildin8 consttuction, entl I shall not employ
eny person In vloletion of the workman's compen5ation laws of
the Stete of Celitornie. r vX ��j
I hereby certity that I am properly licansetl as a eoniracior under SQ. FT.
tha State of California Business and Professions Cotla, Division 3, T E A OUNT SHOWN UNDER VALUATION IS FOR
Chepter 9, end Mat such licenset are In full force antl aftect, or I THE PURPOSE OF ESTABLISHING A PERMIT F E ONL :
am exempt from t ovisions of the Stete of Celi4ornia eusiness VALUATION �
and Professtons tle, ivision 3, Chapter . PERMIT FEE S
SIB^etura ot � PLAN CHECK S
Permlttea �` 5��Q r TAX b S�
Authorizetl ABent TOTAL PAID $ �j�
OWNER �p�EIRO, S $ J
10B ADDRESS 272 Buclrnell
GENERAL CONTRACTOR Owner-
AP No. 141-411-19 LOT S1
INSPEGTIONS
SOIL
cns
w�TER
HOUGM PWMBING
PNOP. $wR. IINE Q HOUSE CON. �
SPRINKLING SYSTEM
MiSCELL�NE0U5
ROUGH NEaTING �ND MR CONOITIONING
TEMPORnRV SEPVICE OR POLE
UNDCHGROUND � POWER �
ROUGN WIRING
TRENCMES FORMS STEEL REINF
FLOOR SYSTEM
BON� BE4M � STEEL REINFORCE n
�jSNERTMING
�FRAME �NO FLqSHING
' LRTMING - IN OUT
(. PLnSTEP, BRO'MN COAT
"1 STRUCTUR�I, FIN�L
�HEATING, VENT., REFPIG. ANO A.C., FINAL
PLUMBING. FINAL �ND GAS TEST n
a EIECTRK, FINAL
DATE
BUILDING
WORK
FIRE ZONE VALUE
TYPE GROUf
SUBCONTRACTOR
��
�.r COSTA MESA BUILDING-SAFETY DEPARTMENT
i P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to FHI in Completely — Use [nk Only
BUILDING �] �/
ADDRESS pl / � /VC
OWNER OR
TENANT yA
MAILING `� � J JG C �
ADDRESS �rL C(
( oC�r_ MiC A- NO.`,5���•S�
CITY
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BRANCH '�'
ADDRESS
ARCHITECT 1 T �
ADDRESS aaa7 /K��l�NL i�
CONTRACTOR lJ�,(,)�V2�/'/�/Vr�-A�!/'
ADDFESS ''�
TEL.
CITV — NO. �'
STATE C IT V
LIC. NO. ' LIC. NO.
SIZE NO.OF BLOGS. /
OF LOT NOW ON LOT
VSE OF
EXISTING BLDG. ��5� ��e�B��
Separate permits are required for
electric, plumbing and heating work.
USE OF BUIIDING AND WORK TO BE PERFORMED
I hereby acknowletlga that I have reetl this application antl sta<e
that the above information is corract and egree to comply with
all laws ragulating buildin8 �onsttucNon, entl I shall not employ
any pereon in violation of the workmen's compensation laws of
the State ot Caliiornia.
I hereby certlfy ihat I am proparly Iicensetl as e convactor untlar
the StaSe ot Californie Business entl Professions Cotle, Division 3,
Chapter 9, antl that such licenses are in full force antl effect, or I
am ezempt from the O�ovisions ot the State of Celifornfa Businass
antl Professions Cotle, Division 3, Chapter 9.
(((��� �
Signatureof � � _ _n_ ��,
Permittee nnn nsw 4 ��'IGG�L
or `� p ^
AuihoNzetl ABent Date �� — � ' O `l
R
:�T�}. PEti�ttT 6
-
N° 50777
A.P. NO. I � I I � l I
BUILDING q�� Q
ADDRE55 L �[J
UNIT OR
SPACE NO.
TR.NOO.^ LOT ��/ I
ai
W ADD ALTER REPAIR MOVING DEMC
� ,
OWNER S �• O 'r�
USE�� ^y� � VALUE �
A1.. �..W.. .i �CC�.`� $ c
r� �)
J(lNF G TVPF � f,ROl1P f�
-APPROVED
BV
APPROVEDSETBACKS
(FROM C/L Fy
RONT
R. SIDE 3 U Fr.
L. SIDE L �FT.
REAR FT.
PLANNING ACTION
DATE
AP7ROVED
• ��T� ���/
56 TL'
m
�
i
m
/ �f m
! /i� SQ. FT. �
7
THE AMOUNTSHOWN UNDER VALVATION IS FOR m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: �
VALUATION PEftMIT FEE $ � OO '^
m
PLAN CHECK $ 2 00 0
g���O TAX S � � U
TOTAIPAID $ . CfA
. ;:� ��s�
COSTA' MESA BUILDING DEPARTMENT
P.O. BOX 31�
COSTA MESA. CA4IFORNIA
FOR APPLICANT TO FILL IN
ADD EI55 � /2 �11C813C11 flAl.
COSTA MESA. CALIFORNIA
MAIL 1555 Placentia
ADDRE55
CITY Newoort Beach ri$1. NO. MI 6
ARCHITEQ �c�i LIG.
OR ENGINEER NO.
ADDRE55 9$jne
coRrkn�cfo�011 COI1st. CO cirv No 1217
TEL.
ADORE55 89IRC NO. HHIIB
LEG�L LOT �
DESCRIPTION �.fQ�
A.P. NO.
size 62 x 100.Q8
OF LOT
USE OF
E%ISTING BLDG.
SETB�1GIt LWE FROM �
CErviEa OF STREET
�SIDEYARD RIGHT
NO.OF BLOGS.
FEAR VPRD 25'-6��
�EFT 6 •
DESCRIPTION OF WORK
NEW g ALTER/TION ADDiTION
REPAIR � � MOVING II DEMOLISM
SIZIE�ING 1/� _ r�o ROOMS 6 STORIES
O G
EXTERIOR WALL ROOF LOy �
COVERING StUCCO COVERING u �r
USE OF NEW n.._e�_..�� o. ..41 ............
Plan 1—G
�-i�ls , �-'
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. PERMIj�Nj�
O�TE ISSl1EO
.ix �c i�—h—.airee
1T
BUILDING
ADDRE55
COSTA MESA. CALIFORNIA
APPROVED
BV
CORRECTIONS
under valuation is for the
1 NEREBV •CRNOWLEOGE TMiT 1 MwVE BE�O TNIS �PPLIC�iiON nND
3TATE TM4T TME /� VE I$ COPREGT �NO iGflEE TO COMV�Y WITM RLL purpose of esCablishing a permit fee ony.
CITV ONOININCES D$T.�TE lAW FEGUL�TING BUILOING CONSTRUC�
non. ^ , VAWATION
SIGNATURE OF '{'/ PERMIT FEE S
<.r_.6 �f
PERMITTEE 15,967�00 pLAN CHECK $ �"�O
g
aiirwnwi>cn r.rvr TOTAL FEE 5 S7 5(1 `�i