HomeMy WebLinkAbout337 BROADWAY - Building Permits_ ,... . �
� GTY OF COSTA MESA _
;` BUILDING DIVISION ���_
L: r � � DEVELOPMENT SERVICES DEPARTMENT
� PERMIT PERMIT NUMBER
��� A0
Bsa-oiass
(774) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 337 BROADWAY
Suite:
Viciniry:
Parcel Nunmber: 11725227 �
Applicant RON PECA LANDSCAPING
Address: 8202 PENNINGTON
HUNTINGTON BEACH CA
Owner: NORDLUND,MARCIAYTR
Address 5710 SEASHORE DR
� NEWPORT BEACH,CA �
Contractor: RON PECA LANDSCAPING
Address: 8202 PENNINGTON
BUILDING PERMIT
Zoning:
Phone: 714 969-4919
2ip:
Phone: . .
Zip: 92663
92646
Status: ISSUED
Applied: 0 8/1 711 9 9 8
Issued: 08/17/1996
` Phone: 714 969-0919 •
HUNTINGTON BEACH CA . Zip: 92646 .
License: 335018 - �
Arch / Eng : � � - , . �
Address: ' � � � . �
- � ' . � � "Phone: . .
Zip.
� License: , .
SCOPE OF PERMIT
48 LF OF 6' HIGH BLOCK WALL ALONG REAR P/L AND AROUND REAR DRIVEWAY OF RESIDENCE.
Plan Check: $48.59
Permit: ` $74.75
SMIP Res: $0.50
SMIP Com: 30.00
Other: �0.00
Inspection: $0.00
Total: $123.84
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Fmnt 0-0
PARKING Existinc 0
NOTES:
Rear 0- 0
Rear 0- 1
Required: 0
FEE SUMMARY
PLANNING 8 ZONING
Left 0- 0
LeR 0- 1
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0. 0
Right 0- 7
sz,soo.00
$2,500.00
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all
requlretl Inapeotione end final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration ot ihis permit.
FOR INSPECTIONS CALL: (774) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby eXirtn untler penalty of perjury one of the following declaretions: " ' `
❑ I heve end will maintein a certificete of consent to self-Insure for workers' compensatlon, es providad for by section 3700 of tha Lebor Code, for the peAormence of the
wark for which this pertnil is issuetl. '
❑ I have end will meintein workers' compensetion insurence, as required by seclion 3700 of tha Labor Cotle, for the perfortnance of ihe work tor which Nis pertnit is issued.
My warkers' companse�ion Insurance cartier end policy number ere:
Cerrier: ' � Policy Number;
(This s' neetl not be completed i/ the perm/t is valued af one huntlred tlollers ($f 00) or /ess.)
I certify that in ihe�rlo an f ihe work ich this permit is issuetl, I shell not employ any pereon in any manner so as to become subject to the workere'
compensatlon la s of Califomie, e d agr hat if s iould become suhJect to ihe workers' compensation provisions of Sectlon 3700 ot the Lebor Cotle, I shall forthwith
�M th e provisions. �i� �r � �-J
pplica Slgnalur Date: (J
0: FAILURE T CUR KERS' COMPE N COVERAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
T}IOUSAND DOLURE (5100,OW), IN ADOITION TO THE WST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 37060F THE LABOR CODE, IMEREST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm that I em
fo[Ce and eflect Lic. # ..
9(commencing with Section 7000) of Division 3 ot the Business end Pr9tessions Code, and my license is in full
Class q �--
Date: —/% —
CONSTPUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a consWction lending egancy tor the pertormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lentlers Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aHirtn ihat under penalry of perjury ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Pratessions
Cotle: Any ciry or counry which raquires a pertnit to construct, alter, improva, demolish, or repair any stmcWre, prior to its issuance, also requires Ihe applicent for such pertnit
to file e signed stetement that he or she is licensed pursuent to ihe provisions of ihe Conirectore License Lew (Chapter 9(commencing with Section 7000) ot Division 3 of the
Business entl Professions Code) or that he or she is exempt iherefrom end the basis tor the alleged exemption. Any violation of Section 7031.5 Dy any applicant for a permit
subJecis the applicant to e civil penalry ai not more ihan five hundred dollars ($500).):
❑ I, es owner oi iha property, or my employees with wages as their sole compensation, WILL DO TME WORK, and Ihe siructure is not Intended or oHered for sale (Sec.
7044, eusiness antl Protessions Cotle: 7he Contrectoro License Lew tloes not apply to en owner of property who builtls or improvas thereon, and who does such work
himself or herselt or ihrough his or her own employees, provitletl ihat such improvements are not intended or offaretl tor sale. If, however, ihe building or Improvement is
soltl within one year ot completion, the owner-builtlar wlll have Ihe burdan of proving thet he or she did not build or improve for purpose of sale.).
❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct �he project (Sec. 7044, Business end Professions
Cotle: The coniractors License lew does not apply to an owner of properry who builds or improves thereon, and who coniracts tor such project with e contractor(s)
Iicense pursuant to ihe Contractors License Laws.).
❑ I em ezempt under sec. Business an� Protessions Code for this reason:
Signature: Date:
Owner ID venfied by dnvers license. ❑ Yes ❑ No Drivers Licanse No.
Venficetion of Ownership by (rype of document, i.e. - property tax bill or deetl):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certily Ihat no excavation flve (5) or more feet in tlepih Into which a persan Is required to descend, will be mede in connecHon with work aulhonzetl Dy this
pertnit, end that no building structure, scaHolding, falsework, or tlemolition or dismantling Ihereoi, will be more ihan ihiny-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, Galifomie Administretive Cotle).
❑ As owner-builder, I will not employ anyone to do work which woultl require a pertnit irom Ihe Division of Indusirial Satety, es noted above, unless such person hes e
permit to do such work trom the division.
Signature: Date:
Division of Industrial Safety Permi� Number:
CERT F COMPLI AND AUTHORI2ATON OF ENTRY: I certify under penalry of perjury thet I have read this application and stete thet the information qiven is
ct. I egr to c y w II stete lews and ciry ordinances relating to building constructlon, end euthorize representatives ot the City of Costa Mesa to enter upon the
above-de ed operry for i pection purposes. I agree not to occupy or allow occupancy of any building authonzed by t�is permit until final inspaction.
CODE 1. INSPELTON TYPE
1616 Fixed System Final Fire Prevention
7266 Pool Spe Final
200 Final Re-Roof
201 Finel BIocWRetaining Wall
202 Final Fectory Fire Plece
203 Finel Siqn
204 Final Demolitlon
2d48d8
QAff U17IDEL5
�L7—^t� _ — '
��'— ( "�e � %l�
Date
CODEt ixsveenoxrrve
206 Finel Mechanical
20B Finel Plumting
210 Finel Eledncal
212 Final Fire Prevention
220 Final Plenning Approval
222 FinalSite
250 Final Bullding/Occupancy
Qdg It�LS
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��'�n.���
CITY OF COSTA MESA
PLANNING DIV.
SUBJECT TO BLDG. DEPT. REG.
gy� DATEg/���
'�- NOTE
A� g1E ppPROVED BY THE PLANN�r �ID VIS ONLL
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� T Y PI CAL f�� CONCRETE BLOCK FENCE
Cement Coping Optional �
Channel Block With 1-3/8�
Ho�i:ontal Top ot all
Fences
For Fences 5' or Lsu
Vert. Bars 3/8"¢ at 4' -0" O.C.
For Fences Higher 7han 5'
Ven. Bars 3/8"� at 32" O.C.
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall
Conform to Sec.A-75-39
A.S.T.M.
All Steel to be Lapped
24" or to Code
NATURALGRADE
TWO 3/8'"O BARS
CONTINUOUSTOP
a BOTTtlPi1
HOR7ZSTEEL MUST BE TIED IN
PLACE AT TIME OF TRENCH
INSVECTION.
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GENERAL- NOTES
MORTAR:
GROUT:
COPING:
CONCRETE
One Parf Plastic Cement, and
Three Paris Sand
One Port Cement TMee ana
One Holf Poris S�and
One Part Cement, Three
Parts Sand
We�l Mized 1:2-I/2:3-I/2
Max. of 7-I/2 Gollons of
Water Per Sack of Cement
GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLSAND AHEASOF HONIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN &
FREE OF ALL MORTAR DEBRIS, ETC.
�Fi C�F CqRTNTCOTH
i/3 iHE HEiGTH OF FENCE
B��OW BOTTOM OF FOGTiNG
SCAI.E: I/2��= I�
FOOTING REQUIREMENTS CHART
� WA_�L HEIGHT 6� � 5 � 4� 3�
WIDTH 14��� . 14�� ... 12��. 12��
THICKNESS 10��� . . . . . . . . . .10�� . . . _ _ 8�� 8�.
DEPTH OF EARTHTOOTH 24°� 20" 16" 12"
SPACING OF EARTHTOOTH. 12' f.. 14' ... 16' 16'
City of Costa Mesa,
Building Departmeni
h'_evr�eo �-�ov, e2
California
r�
'HOJECT AODflE55: 3 3.I ���ADwAY
�OWt'EP'S NAME:
'��FODflESS: I\ORDi.:�ND� �.�UCts L
NORDLUND, N.F�FtCIA Y
S"I10 W OCEAN F�ONT
NEWPORT BEACH,CA 92663
AHCH/ENGINEEP: 7 z 3— 4 1 2 1
FOUPE55:
HEG.NO.:
UNIT:
uxiT:
PEHMITTEE: AOLOTIN BROS. ROOFING ('714)843-6330
PDONESS: I9OBZ CRYSTAL ST
HliA',TINGTON HEACH CA 92648
LICENSEO CONTHACTOH OECNflRTION: I hereby affirm Iha� I am licensetl untler pmvisions oi Chap�er 9(commencing with Sec�ion
7000) ol Orvision 3 of the Business antl Pmlessions Code, and my license is in full force and eifect.
CITYLIC.: U3HS0% sTnTeuc.:347940 ciass: C—q9 --
�alel _ ' Signalure' _ �_
WOFNEflS OMPENSPTION DECLANATION: I here0y allirm �hai have a cenilicale o� consen� �o seli-insure or a certi�icaie of Workers'
Compensalion Insurance. or a cer�ibe0 topy ihereo� (Sec�ion 3800. La�. C).
voucrno.: i13"7068-91 E%P.ORTE: OI�OL�92
comrnxr: STATE FUND
❑ Cenilied copy is hereby fumished. � Ce�ifieU copy is filetl with tAe city Bu/ilO�ing oivision. �—J/��
oate:�'�a�•`N( aPPlicant��—`d—`—F]'�—�✓v
E%EMPTION FHOM WOXRENS' COMPENSNTION �ECIAflRTION: (This sec�ion nee0 no� be tompl¢tetl i� the permit is lor one hunOreO ($100) Or less�.
I cerlify iha� in the petlormance ai Ihe work lor wAich this Dermi� is i55ue0, I shall not employ any per5on in any manner sa as to become
sublecl to Ihe Workers' Compensatmn Laws of Calltomia_
Oale: SignaNre:
NOTILE: It, atter making ihis aeclaraiion. you shoultl become subject to �he Workers' Compensation pmvisions oi the Labor
Cotle, you mu511ohhwi�h tompiy wilA SUCh pmvi5ion5 Or I�is permil Shall he tleeme0 revOketl.
CONSTPUCTION LENDINC AGENCY: I here�y aflirm �hai there is a cons�mction lentling agency �or �he De�ormance a� the work tar
whic� ihis permil is issued (Seciion 3097. Civ. C).
LENDEX:
aoosess:
OWNEB BUILOEH OECIAHpT10N: I hereUy affirm �ha�lam exemp��mm Ihe Conlractors' S�ate License Law forihe following reason
(Seclion 7031.5 Business and Pmlessional Cotle: Any ciiy of counly which requires a permit lo consVucl, alter, improve, demolish, or
repair any StmcWre, priar to ils issuance, also requires ��e applicant tor such permit to �ile a signed Sla�ement �Aal �e/s�e is licensed
pursuant lo Ihe D�ovisions ol �he ConVanors' Staie License Law (C�ap�er 9(commencing with Sec�ion 71100� oi Oivision 3 0l IAe Business
anU Professions Catle� or ��at he/she is ¢�emp� �here�mm and Ihe Uasis br ��e allegea exemption. Any Nola�ion ol Section 7031.5 by
any aDPlitanl �or a permit subletis Ne applitan� ro a Civil penalry oi na� mOre than live hundre0 dollars (5500).
I, as owner o� the DmDeny or my employees wi�h wages as ��eir sole cumpensaiion, will Oa Ihe work, and the
❑ slmcture is not intendea or oileretl lor sale (Section 70aa, Business antl Pmfessional Cotle: The Comractors' State License Law
aoes no� apply to an owner ol a pmvehY who builtls or impmves ihereon, and who tloes such work nimselllhersell or tArough
his or her own employees. O�ovitled �ha� such impmvements are noI inlende0 or oife�etl for sale. I�, however Ihe 6uilding or
improvement is sald within one year ol comple�ion. ��e owner will have the bur0en of proving he/she tlid no� buil� or impmve
�or iha purpose a� saleJ.
I, as ownerolthe prope�y,am excWsively coniracting wiihlicensetl tontrac�orsto con5imc��he prole�t(Sec�ion 704A, Busine5s
❑ and Pmlessions CoOe: The Comractors' State License Law tloes not appry m an owner of proDe�Y who builtls or impmves thereon
antl w�o conlracts for such O�ole��s wi�� a conVacioqs)license pursuantto Ihe Contractors' Sia�e License Law�. I am aware
Ihat pmol oi Iheir Worker'S Compensation insurance 5hou10 6e pmvidetl �o me.
� I am exempi untler Section: B. 8 P. C.
fo� I�is reazon: �
�ate: Owner
I do hereby ceni�y �hal I am aware o� and untlers�antl �he reqmremems o� California Healih antl Sa�ery Code Sections 25505, 25533, and
25534 anA Ihal I or any future builOmg occupant willlwill not (circle one) need ta comply with sai0 state coUes and Ihe requirements for a
permi� �or cons�mciion or moddicalion hom Ihe Air �ualiry Managemen� �islricL Residenlial consime�ion ap0lica�ions are erem0� <<om
IhQSC pfOV15i005.
Oale', Applicant:
I hereGy cerlAy Ihal I have reatl Ihis applitalion and Slate that the abOve ini0rmalion is carrecl I agree �o romDly wi�� all Ci�y and counry
�o inancesand5�a�elaw5relatingtobuiltlmgcon5�mctionantlherebyaWhorizereprese la�ivesof�hisci�yto teruponlheabove-men�ianetl
perly �or mspeclian purposes.
Oate� �.�__ Signamre: \ _ v
Onver's Lmense or Sociai Securiry p�
164La6 W���le—Buileling; Green—Cotle EnlorcemenL Canary—ApPlicant: Pink—Revenue: Goltlenrotl—Assessor
CITY OF CO�'PA MESA — BUILDING PER;:1T PERN, NO; H 053470
PERMIT NO: B O53470 PI,AN CHECK NO: N GUVT: N SuFP: N
CONSTRUCiION TYPE; V—N PERN,IT TYPE: STR FURPOS�: AL'P
JOB DESCRIPTION : T/OrF R£ROOF W/CLASS A CO,�P SQ FT: 4,000
CLAIM VALliE: 4,000.00 CALC—VAI,UE: 4,000,00 GROUP OCC: R-3 /
COM�;ENTS; SN.OKE DETECTOR RE�UIRED IN T'HE IirJME
*���x*x�*a��:#�#�#�***���*x#� x;��*�rt�#�x*�x�*�cx***x�*�*t��x�*xx•�������c��**��e�*�xaix
7, O N I N t� R E Q iJ 2 R E M E N T S
S E T B A C K S
____________ • • ___—_._ C _________
N. i U. Z ---------- -- ACCE.,SORY HUILDING
FRNT; FT IN �EAR• FT I13 FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEF'I': FT IN RGHT: .-^T IN
PARKl'NG REO: PROV; PARCEL: 1177.5227 'lN�; RE:F NO:
PLANNIivr N(STES>
�
i4 iF iF if ##i Ib iE # �E'R k if �F ?F 1(• iF it iF?E iF iE if �f iE If if if r'r ii a iE iE # if � Yr lE i't K� ih if iE IF iE iE iF }#E iE 1Fif If� iE i;'lf Y'� if !f� 36 �k ## iF iE *�k if �i?� ie 1h i'r ii� i't iE ic #� IE #
D E V�, L O F,M E N T S E R V I C E S R E Q U T k E,y E N, • T S
'LONING APPROV$D HY DATE; �
BUILDING APPROVED BY : DATE; �+
APPLICATION ISSUED 3Y; ��'/ • � UATE• �j�Zv�(�
iEifififie�Ex'iEillfi(jf�.ltieif'ltaf'ifal�{it . ' h it' '� ieiEiE3FiE;Fie��lEialr�3��i�iF
if ## 3E iE jE iE �1f if i(� �lE i(� ih #�K ib # iF iE iE;E iF if Ii-�K iF 3t k i4 it 1F i:1E #F if ft?f if #i(� 3t� it �E # iE �1F 3E ii lE fbiE i'r }E� iF k ic it iF iF �k �:� iF it-�)E K� 3� iF M-,!t R#f i% i!� il� i6 �H- 3c #'� ih
LEGALI'lATION;N F E B S U M M A R Y STRUCTURAI, SEG,'✓,ENT:Y
BLDG F'N.T PLJPFBING ELECTR3C N,ECHANZC FI�E SA/IP/�ES. GRATJINC
PE:RMIT 63,00
PLAN
ISSLTE EEE
�UIrDING-DIV—>
TOTALS---->
PERMI: ISSlin PLAN—CHECK
63.�0 0.00 0.00
.50
SN. Z P /NOt�=R�S
��
TOTAL PAID , DUE
63.50 63,50 ,' ,00
REVENUE DIVISION TOTALS--> CpLI,ECTED• 63r50 OVERI�HORT• 00
$LDG PMT PLiJMBING ELECTRLC 1�1GCHANiC FTRE � STSIP/TC)T GRADING PLAiV—CHt:C�(
63,00 ----�_� ,50
if if ?f iE if If i4 iE i(' � if i{. iE if le iE iti iF # if iE 1f'K' ii' if ii' 3f iF i4 �IF 7F ie' ii jF iE?•.'if ii' 1i' iEY.- ib'1f if fF 3F if')F-K ii-?F if ?'c 1F K' ?t 7i� 3E iF } 3e ie�Y iF K 1e?f i!- �'3E ii i? ii' ii i."k ib 1f >
I N D I V I D U A L F E: E B R E A K D O�I N ,
TYPE QTY D E 5��, R I P T I O N UNZT COST ,.TOTAL COST
x �.
SFR 4000 REROOr dY VALiJE RSSSDFNTIAL T'OZONa 1,OU � 4,000,00
EI�U OF FEES
F
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�� t7�J�c1e._.�f.�IrY�..-f '__'�',_
n^,TE� oai^�i:�: r.._� .i;x;
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� ONSTRUCTION AND PLANNING POOL �A
�APPROVALS Permit#-.,-- ,Date Inspector qppROVALS Permit# Date InsQe�.c,or
�1�
1. TemDorary Electrical Service or%Pole 52. Pool & Equipment Location \�
2. Soil Pipe-Undrgrnd. �� '--' 53. Steel Reinforcement
3. Electrical Conduit Utility-Undr9rnd. 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
J. Footings � 58. Elec[rical Conduit-Undrgrnd.
8. Foundation �\ ;' ; 59. Gas Pipe, O Undrgrnd., Test '`'
9. Water Pipe-Undrgrnd. �' � � 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Structural Floor SYstem ",; '? 61. APPROVAL TO DECK -'
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
� •r�"
12. Sewer Cap ��'� f,:" 63. Heater & Vent-Final �
T�
13. Roof Drains • � 64. Plumbing System - Final �;�
14. Rough Plumbing � ��.� 65. Electrical-Final �" .
75. Rough Electrical-Conduit`-.�: t 66. Solar SYstem-Final '�
76. Fough Electric Wiring � 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. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Under9round Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing �=���� %(f/ 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 i�' S0. FOOD CERTIFICATE ISSUED
33. Final Electric , -� . Notes:
34. Final Heating & F.ir Conditioning �"
:i
35. Final Gas Pipe-Test
36. Hood or Canopy
i �
37. Final FactorY Fireplace '
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. F�NAL STRUCTURE & BUILDING ��.LT �L:% .�Z� /'�.��_ S��pG�
-e
48. FINAL PLANNING r �ev�
�
49. Electric Release to Edison � -
n -.
50. Gas Release to Southem Califomia Gas Co ��
51. CERTIFICATEOFOCCUPANCY
No. Date
OWNEA LUCAS, MR & MRS. PAUL E. DATE 12-8-60
dOR ADDRESS �x'08 W8y V2. BUILDING PERMIT N0.
GENERAL CONTRACTOft '1'rie 1Sllnriel UOT'p. VALUE $ ii�o�
AP. No. 117-2 2-27 LOT TRACT FIRE ZONE DESCRIPTION OF WORK
INSPECTIONS /�//�Id I DATE I GROUP & TYPE
SUBCONTRACTOR
OCCUPANCY
Form 210-SM-11-59 5-B P
�/
.. - 1�`�`� ��EE RECEIUE�
COSTA MESA BUILDING DEPARTMENT • Nou29� U�/�(/�
❑.o.eoxen
COSTA MESA. CALIFORNIA FINANCE �DEP .p�
FOR APPLICANT TO FILL IN y APPLI�:I�T�I�N'�C7'�FPERMIT
ADDREI55 g �R �/ � BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
owNERMr.Mrs. Paut R, Lucas
RECEIVl� BV DPTE RECEIVEO OFTE ISSUE
AooREsS 337 Broadwa �/— � —6 /o`s� �'— J
cirv Costa .Mesa Cal If. TNo:M�6 2640 nooaes"s .3.3
oR NGiNEER none NIo. COSTA MESA. CALIFORNIA I
FIRE
ADDRE55 ZONE
ZONEq NO.OF TV y� ,011
PLLNS
�o�rAA�roR�he Kunne I COt�". No 830 / 1 QL �
2156 Newpor (vd, 7E� o '
A�DRE55.. NO. O 227+1 BYPRovE DATE s
LEGFL � LOT � �Y H 1 S, CORRECTIONS 3 �
DESCPIPTION NO. BLOCK ACT /�_�
A.P.NO ` 5�—� � I Q' �
OFZLOT75'� X(22 5 �o.oF BLDGS. I (� ; � f /� �/
HOW ON LOT ��� b
EXISTOING BLDG. S I F�I I� DW Y Y Ga r S � �, //
SETB/CK LINE FROM � / /%
CENTER OF STFEET REAR YAR� I S /� � Q� �
SI�E YARD RIGHT5 � 6' LEFT 5�(� ( �
DESCRIPTION OF WORK
NEW J( ALTERATION I AOpITION ��`�1�� A \ I
� �-,d� �Si •d,�.
REPAIR MOViNG DEMOLiSH ,�� �y\\�� p"/ � e��
S ZIEDIN ROOMS y STORIES ' � V `�C W�'i.� G,�j�`� O
EXTERIOR WALL ♦ ROOF q�� ;OB�+V �
COVERING S 1 UCCO COVERING Rock \ y�_�
USE OF NEW � \ s�g�� OP�w
BUILDING S
D�/�� PX r ATT (�/�/PS � �FcN. d,�
�� ���under valuatio`n i> for th?
-1 MEREBV ACKNOWLEpGE THAT I HRVE FEAD THIS FPPLICl�T10N qN� ��rPose o�es'ablishing a pG�m�L ee ony.
.,STTTE THAT THE 4BOVE IS CORFEQ 4NO iGREE TO COMPLY WITN ALL
CITV OROINANCES AND ST4T WS REGl1LATING� IL NG CONSTRUC-
riorv. � VALUATI ON
SIGNATURE OF � /_ � I I 6 I O PERMIT FEE S�g�
PERMITTEE
� �/ ' 14,
PLAN CHECK $
$
AUTHORIZEO AGENT • TOTAL FEE $ � f� �'��