HomeMy WebLinkAbout188 BROOKLINE LN - Building Permits •
ADDRESS a WIDNES: 188 BROOKLINE LN mar: CITY OF COSTA MESA - BUILDING PERMIT
OWNERS NAME IF KNOWN: ONGSTAD, CLIFFORD C PERM NO: B 072664
ADORES•: ONGSTAD, ELIZABETH
CRAWFORD PERMIT NO: B 072664 PLAN CHECK NO: N GOVT: N SUPP : N
t88 BROOKLINE LN COSTA MESA,CA 92621
APPL.MAIIRIG ADDRESS: CONSTRUCTION TYPE.: VN PERMIT TYPE: SIR PURPOSE: OTH
ARCNRECT OR ENGINEER: uc.No.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SO FT: 2, 924
ARMOR MS ADDRESS: WIT:
CLAIM VALUE: 2, 924 . 00 CALC-VALUE: 2, 924 . 00 GROUP OCC: R-3 /
Cann CTORSNAID:: STOUT ROOFING INC ( 310 ) 923-6775
caNR.croRAMING P 0 BOX 4309 **** *** ** * ****x* * ***x ) * * *
ADDRESS: DOWNFV CA uONo: 402536 * ** * *** * * ***** * r*** * ***%**z*********Ae*a **************
90241 gen, 7. O N I N G REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby penalty under pely jury Od at I am licensed under provisions Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 d the Business and Prof and my license Sin full • .. •died.
ClrYuc.No.: 059377 uc.cuSS: C 39 uc.N 02536 E4 : 10 95 MAIN BUILDING ACCESSORY BUILDING
// ^ � �/ `{� / �/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dae: La Coaaa Ii✓LP .." LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
IWNER BUILDER DECLARATION:I hereby affirm,under penalty of perjury that I am exempt from the Contractors Lice a Law for the PARKING REQ: PROV: PARCEL : 41916469 ZNE: REF NO;
fdbwi g reason(Section 7931.5 Business and Professions Code:Any city or county which requires a permit to Mer,improve,
demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to fib a signed statement Nat he or
and PLANNING NOTES>
is licensed pursuant to IM provisions d the Contractors License Law[Chapter 9(wmmendng with Section 7000)d Dblskn 3 d ten
Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.Any vitiation 01,
Section > -
7031.5 by any applicant l«epermh subjects the applicant toedvil penally drhd man than five hundred dollars 1$5001). ***********************N************************3E**i(*******N*********7E*****Ih***
I
❑ ,mawnerdthe propenyormyempky.ealhwsgesestMnwleoompenwbn,will dothe work.and NeNmckrebndintendnd D E V E LL O P M E N T S R R V T. C E S R F, f,) U I R F.. M E'. N 'C' S
or offered for sale(Section 7044.Business and Professions Coda:The Contractors License Law does not apply to an owner of propend
who buddy or improves thereon,and who does such work himself or herself or through his or her own employees.provided that such
improvements ere nal intended or offered for sale.ff.however,the building or improvement is sold thinone yeerdcompletion,the ZONING APPROVED BY •
, DATE;
owner-builder will have the burden d proving he or she did not build or improve for the purpose of ace).
o I.as owner of the properly,em exclusively contracting with licensed contractors to construct the project(Section 7044.Business and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who
contracts for such protects with a contractor(s)licensed pursuant to the Contractors License Law). /- y-v �y „/
❑ I am exempt under Section: B.A P.c.,for this reason: APPLICATION ISSUED BY: DATE: 69 L// *-*y/``,f
****************************** * *************************************** *
Date: Owner: LEGALIZATION:N FE SUMMARY STRUCTURAL SEGMENT: Y
I do hereby certify that I am aware of end understand the requirements of California Health end Safety Code Sediora 25505,Pnbt3,and
25534,and wtlarany future building awpwrl will/wdlnot(circle one)need to comply with eaid state codes andthe requirements kr BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit(or construction or modification from the AiZlityIangerhef District.Residential w030uclion appiWiwe are exempt from these PERMIT 54 , 00 , 50
provisions.
Dela: Applicant: PLAN SM I P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby atoms under penalty of perjury one of the following dedareiors: ISSUE FEE
❑ Ihave and elmaimanacortical.ofonewtoself-insure for workers'canpnemion.asprovidedfor byRadice3700of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOAPAID DUEcode.fothepedwneweoteworkfowhichthispemiti.Mued. TOTALS-- -> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 00
I have end Ma mantan workers'compensation insurance,es requitedthe by Section 3700 of the Labor Code,for performance of the
work for which
this permit is issued.My workers' • rowans carter and poficy number are:
Carrier; �tl0 EXPIRESREVENUEDIVISION TOTALS- > COLhLECTF.D • 54 , 50 OVER/SHORT• 00
porky Number. 0449400004687 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM.IP/'COT GRADtNG PLAN-CHECK
(This section need notbecampletedithepom.dktoehundred&dars($lXJarrss) 54 . 00 . 50
❑ I eerily that in the pedomance of the work for which this permit is I shall employ anonn any manner so es to
become subjectthe metiers'to rs'compensation laws California and ashould ould subpdn * * * * **** *1**it******* * ******* ********************* *** ******************* * *********
campensar p,oviskips of 3700 of the Labor Code.I forth a those . I N D .T. V I D U A L F E E BREAKDOWN
Date: ( '{i its Applicant)
Warning:Failuretosecure workers'compensation coverage is unlawM,and still subject en employer to ad nal penalties and TYPE QTY DESCRIPTION UNIT COST TOTAL COST
civil tines up to one hundred thousand dollars($lODOOOA In add/don to the coat of compensation da as prodded for In
Secdon 3706o the Labor Coda,,interest,end attorney's fees. SFR 2924 REROOF BY VALUE RESIDENTIAL NO7.ONE 1 . 00 2 , 92.4 . 00
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have reed this application and state that the above information is coned.I agree to comply with all dry end county ordinances
and stale laws relating to building construction and hereby authorize representatives of this ally to enter upon the above'mentioned property
for inspection purposes. D ENE BURFORD
I 01 00133452-001E3453 TOT '•4.`.
Pdc e ... . • // Q
k' �y ode: ! 0 %�`/� DATE; 0E/05/95 iIl1E? 10:40
Signature d.cwaer/Agend ... radar
(5151<9.WP) White-Buildip&Safety:Green-Fle:Canary-AppFint:Pink-Revenue:Goldenrod-Assessor
}
CONSTRUCTION AND PLANNINu .j.rOL& SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
1
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
•
3. Electrical Conduit Utility-Undrgrnd. 54. Forms f •
4..Electrical Conduit-Undrgrnd. 55. Electrical Bonding r
5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE {
7. Footings58. Electrical Conduit-Undrgrnd. -
8. Foundation ' . 59. Gas Pipe, 0 Undrgrnd.,Test r
9. Water Pipe-Undrgrnd. 60. Backwash Lines;P-Trap, 0 Undrgrnd. '
10. Structural Floor System •
61. APPROVAL TO DECK "
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ; •
12. Sewer Cap 63. Heater & Vent-Final •
13. Roof Drainsr 64. Plumbing System - Final -
.
14. Rough Plumbing ,f 65. Electrical-Final f
15. Rough Electrical-Conduit 66. Solar System-Final ,
16. Rough 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 F ' APPROVALS Permit# ,
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product-Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test _ 72. Underground Flush
24. Roof Framing . • 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing a-/q--14-G 42 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 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ,
34. Final Heating & AinConditioning •
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final' . - ,'
•
40. Gas Service-Final •
41. Solar Domestic-Final -
42. Backflow Preventer
43. Backflow Irrigation .
-44. Landscape Irrigation System '
I
45. Sound Attenuation
46. Handicap Regulations - - I
47. FINAL STRUCTURE & BUILDING /i /; qc 414-/-*
48. FINAL PLANNING / -!
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. —
PE IT NO TRACT NO. LOT NO. UNIT NO. T BB 7/.')/ 1 I
CITY 0'r COSTA M/��/${�7 C/(�]NSTRJC IQN PER IT — 2D /26 `�/s/,b /Ob
Praect Address //'(J /_-��TOK f6. �• `'a ` 0 /
fore
_i TYPE FCONSTRUCTION NEW m'-ADD U ALTERATION REPAIR •
Applicants d rres _ �+ i _ r'</ C::74/9
L / ('p
Mailing //������rr / ( J CONVERSION ❑ DEMOLISH ❑ OTHER -T- A,P-# T l9 //n(4. •x(07 I Zone -R3
Owner's Name AZ E2 • 5--Z/9/Cr Phone 22--6p///7• DESCRIPTION OF WORK/ :- OF BLDG!-��1✓E'�( COUe/ - l
44,
/T S 10 / .c- , 0.5-D •,.., ewe. S Main Building: Accessory Building:
Addresses• -f •^Jc/C
/ d eft Cr/id/et/6-7 �. • .E / Z
Arch/Eng. `ci �L !'e"/'v'c-`/Liic nnsse)No. / TYPE OF PERMIT, -,l I♦ GRADING . FOUNDATI ON�,1 STRUCTURAL T Front O
Address 70 �rF 4 ° cel// 'S �- �2oo ❑ TENANT Ln ELECTRICAL -E PLUMBING lJ MECHANICAL A Rear N
// ❑ OTHER I
Contractor's Name suC f' c/�Phone Sy0-6//7 - C Right N
Address(mailing) , '- .-e /-.L/f/ Jam. PROJECT DESCRIPTION SO ���� occuvANcv K Se, K Left / G
CON STRUCTI ON TYPE VALUATION$ 'i/•'SB / S R
City License No. ZONE GRADING CU.YDS. ACRES g Pg lc — 73 gReq./Provided
LICENSED CONTRACTOR DECLARATION Ping. # /T Q �l Parking �x� ,, E
I hereby affirm that I am licensed und- prov-ions of Charter 9 (commencing Remarks: Planning Notes: C b2 etec.o � L TeC..C. M
with section 7000) of Division 3 of B mess and Professions Code, and /+ [-- (� Qss Ar s�1�
my license is in full force and effect
/ P` , sits-- es� S' ��Jf G{.11fla ItC � S
Con T
License Class NO. - /
ate Signature .- PLUMBING /�
-
ORKERS'COMPENSATION DECL• -A ION Bar Sink • Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-Insure or a certificate
of Workers' Compensation' Insuranc-, or a certified copy thereof (Section 1
3800, Lab. C.) Backflow Preventer Service Sink 4:- - Automatic Washer Transformer 0 15-50 KW
Policy No. Company . Backflow Irrigation Sevver CO . Construction Pole_Sub. 050+KW
Certified'copy is hereby furnished.
— Certified copy is filed with the city Building Division. Bathtubs Sewer Connection - Cooking Unit Meter ❑up to 100 amps
Date Applicant - -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar COilecto�s Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or - -
less). Dishwasher -Solar Piping . Dryers ❑Gas ❑Electric Sub Panel
I certify that ' tha performance of the work .hi, thi •- It is issued, I ,
shall not e .day .ny person in any mann-C./ b- •• a subject to the Drinking Fountains Solar Tank / Fan Motors❑0-1 HP ❑1%-8
•
Workers' •mpe• . ion of Californ' l Or
Date Signature • Floor Drains Swimming Pool w/Spa • t F.A.U. Inc.Solar ❑9-15 HP 016-15+
'NOTI :If, . ter making this declara ion,,yo• houlr bec• e subject to the -
Work- s' C• pensation provisions of the .•or ...de, you must forthwith Floor Sinks Urinal - Fixtures }
•
comply wi h such provisions or this permit 'hall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet •
Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater 5 Outlets ' Range G
Lender's Name �/(( �) rr� ee
Lender's Address "vONe Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION - — _ Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal I Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or '
county which requires a permit to construct,alter,improve,demolish or repair P—Trap LaundryTrays
Generator 0-5 KW
-,any structure, prior to its issuance, also requires the applicant for such permit - 5-15 KW Trash Compactor
•#y,o file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains •
'•`TT:he Contractor's License Law (Chapter 9 (commencing with Section 7000) of ,�t`f
`:'Division 3 of the Business and Professions Code) or that he/she is exempt - /' • 'J � /�� t >/ ��
.therefrom and the basis for the alleged exemption. Any violation of Section .
7031.5 by any applicant for a permit subjects the applicant to a civil
„penalty of not more than five hundred dollars($500). •$-3 _ -
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work, and the structure is not intended or offered - . Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional'Code: The Contractor's — • MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own Hood or TypeDEVELOPMENT SERVIC,5$pIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler I 0 Ov/K�, �-.wN (�
sale. If, however,the building or Improvement is sold within one year of com- — Canopy Type II 0 Zoning Approved By `� Date'
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date 7ZQ
pr Ov r the urpose of sale
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System / •-Application Issued By /Tb Date 7,/ /,(01_
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who '/ Duct-Ventilating 00-100,000 BTU. 0100,000 BTU 2 to - SUM ARV OF FEES
builds or improves thereon, and who contracts for such projects with a con- ' 0jh
tractor(s) license pursuant to the Contractors
License Law). I am aware that Exhaust System ❑ Multiple 0 System.Repair/Alteration - I BUILDING PERMIT $ � • r0
•
proofSMTP $ V
proof of their Worker's Compensation Insurance should be provided to me;
_
0 I am exempt under Section 5. &'P.C -. th' reason Firepl/Fact.Bit. ICBO# Fire Dampers - PLAN CHECK $ 3�+•72. ' PERMIT
/� / _ PLUMBING $ S.00 ISSUANCE $
Date 4�'/d'•S owns - a Heating System& Ducting, Registers / D.
• PLAN CHECK 25% $ Si)
ENERGY P.C. $
I hereby certify tha h. e/�is a•plicatio• an- tat: hat the .•ove ❑0-100,000 BTU 0100,000 BTL - ELECTRICAL $ �'a0 GRADING $
aindr state lan ws corr.- I '•r' ding c' stru• ,/ an• het n-by authriz ordinancesrer-- • �' b�MICROFILM $: '
PLAN CHECK 50% $ �•
inspection
sentatives of y/�• -rater yon �•• above-mentioned pro.qty -•r -- 3
inspection p - MECHANICAL $ • 00 SO
Signature ��A -y/ • Date }5� TOTAL FEE $ !'
Drivers' cense or S# �[ � ,S Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ O.Sb /12..SZ
CMF 0865-46,rev. 10/84 White - B {ding; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNINI L.&SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
' T
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 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
7. Footings 3/._41z1 -
C3/._41z17 .r4� )J. 0'1_58 . Electrical Conduit-Undrgrnd. .
V
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final -
15. Rough Electrical-Conduit ,,�f 66. Solar System-Final
16. Rough Electric Wiring "J:^'� ��(("/(gj/�// 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 *OrfS tat . FIRE DEPT. REQUIREMENT
20! Rough Factory Fireplace (,( APPROVALS Permit#
211: Ducts, ic Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping IA Gas 0 Oil
23. Gas Pipe-Rough & Test /// 72. Underground Flush
24. Roof Framirig /g94 / �i ii 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing sJ/n'4.94„,, 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Moriocoat ���/// 6� y 75. Dry Chemical
27. Frame and Flashing ,j1 j � rb_ ,f�/ 76. Dry Standpipe
28. Lathing& Siding ! 77. FIXED SYSTEM FINAL
29. Insulation 4 78. FIRE PREV. FINAL
30. Drywall Nailing IM- (4.44dHEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat- J99/g{ Owl 79. FINAL INSPECTION
32. Electrical Power Meter-Final ! /80. FOOD CERTIFICATE ISSUED
33. Final•Electric1��/ .��/ Notes:
34. Final Heating & Air Conditioning Jo 7$C get i z iy/gr leof an-7i •• . (ztv e2o,T/35. Final Gas Pipe-Test /
36. Hood or Canopy
37. Final Factory Fireplace /�
38. Final Plumbing 1�/7g((ie
39. Water Service-Final
40. Gas Service-Final r,
41. Solar Domestic-Final
42. Backflow Preventer -
43. Backflow Irrigation .�
44. ,Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations //22����
47. FINAL STRUCTURE & BUILDING kJ 7,/aarej-/,r{,/iGf'�'
48. Special Requirements Completed jj�, ��--cc�� _
TPL5Oil
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
:
No Date
•
OWNER _SAN VISTA RTTTI.nTNCr_C.OMPANY DATE 6-1-6+
JOB ADDRESS_18_T3rnnkl m e 7.ane BUILDING PERMIT NO. X05 _
GENERAL CONTRACTOR RRme VALUE $ 1%895,00
AP No. . LOT ln5 TRACT 160 FIRE ZONE DESCRIPTION OF WORK 'PPR vlatt Err
INSPECTIONS Signature DATE GROUP TR.T TYPE y ZONE Rg33
PERMITS-ISSUEDSoilGas /�� etSUBCONTRACTOR DATE NUMBER
Water , aril, 0 �/
Corn.Rough Co . R fri6. ❑ Air Cond. ❑
Rough Heating iJ y//G SAM 3 S'� '
Rough Plumbing 5: e W 1 4 d d_ , ,� z/;� -/- - -- 0
Miscellaneous QQ /rfJ"" �'
Prop. Swr. Line ❑ House Con. Pit. Swr. ❑/;4 /jd�� uvL.t ( . DR-: 9 1963 . lo'
Sprinkling System J'�- MI Y
Construction Pole ai
Underground ❑ Power 0
Rough Wiring lA„freer SEW . ? ' TA7/ b
Trenches 0 Forms 0 Steel Reinf. 0 Amnon
Floor System id, crater • Co,'
Bond Beam 0 Steel Reinforce 0
Sheathing j�17 0 9 �. I .1
Frame and .as ng / /(� I /Y/
Lathing — In. Out Q g 6r '/� a Wr i
Plaster, brown coat / o. c���/JK t` '
Refrig. ❑ Air Con. ❑ Final ��
Heating, Final 4" ?Of
4� '
Plumbing Fixtures, Final 01$ , s-f IT
Final Gas Test/5544 �j d
Electric Fixtures, Final _ i •I. hi
Building, Final ✓C /a 114
�r//
OCCUPANCY - !c' //- � I
Form BU4--5M-a-sa-s-B P 1-ii7LID FOR UHCTAT. RPM TTRFMPMTS
,. .. 22205 FEE RECEIVED
/AY 19 1s
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING /A.
For Office Use Only
ADDRESS // a.,2_ RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA 22901[']•
�j.., (� RECEIV Y DATE gCVED DATE ISSOEOd LI
OWNEN�-fM UASti� `�J� Jr--/V—6V JIIN 1 196.4
ADD / F J ! A R ADDREBUILDSS
W
ADDRES`S /�n7(J / } /T yj Q�JFIRE
�T+
CITY � 1R" ' • / N( %/O ! ZONE TYPE GROUP 1 �'�
APPROVED
ARCHITECT A��/ TE� BY DATE
OR ENGINEE V ?Ztvn_t_ ja, NO. 00/0
�l�32 (//fJ tp0n 1e
New P ZONING
ADDRESS „Q[L ((//,////���
// y�' ,..�•� /q s.
ZQfiry NO.OF,!"V USE OFIN
CONTRACTO/R/ i /l) (U I(�\l R �I��`C Ls�IwU,L ���P...///UNs//�^�`//)1 `/^B/D(ILDItyO, /�^, _At .
ADDRESS / / L 4 6/ /, ) T s ' / DESCRIPTION / V`!/�C ON/�`I /OLS—
CITY
�
CITY A( / /9- / / /�/,// �J/. �j/J/per/ A.P.NO. /`f/ '- 3 7 ; - I
1 ( `/7( �- NO- / 7(y/j//(� 3 //
NOTE: NO EAVE OVERHAN
G SHALL BE LESS THAN
STATE TEL. SO"TO SIDE O REAR F.L.
EAVES
LIC.NO.
SIZE V 70 NO.OF 111.005. ALLOWED (U.B.C.REQUIREMENT)
OF LOT go .l I 111.005.NOW ON LOT 0
YARDS APPROVED YARDS APPROVED I~
USE OF _ MAIN BUILDING ACCESSORY BUILDING 1
EXISTING BLDG.
(FROM C/L�$TREET)
SETBACK LINE FROM /L J / FRONT k`S FT. FT.
CENTER OF STREET / V REAR YARD• I
SIVE YARD I LEFT D I RIGHT 0 R.SIDE ��},)FT. PT.
DESCRIPTION�' yyOF WORK L.SIDE SFr. FT.
8
NEW ✓W ALTERATIQN ADDITION REAR FT. Fr.
IVr DISTANCE BET. BET.MAIN a
MAIN SLOGS. ACCESS.SLOGS.
REPAIR _ MOVING DEMOLISH ._ •
BUILDING 33 NO OF R / VAR.# DATE w
SIZE aO x ROOMS/7 r1STTORIES a C.U.P.# APPROVED /( /
EXTERIOR �,k�I COVERINGC7//Ns{J� AaPRO ��Q, DATE Cr'(,� V
COVERING -� D. "•'_ _ \,
USE OF BUILDING AND WORK TO BE PERFORME {,,
(� �V{� W
G!/ l 0�1 D* 477 s0 Fr7r�0 cc
�r
I HEREBY ACK • LEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SH / N UNDER VALUATION IS FOR THE
AND STATE THAT E ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATIONBN
BUILDING CONS 'U ION.
7//�--_ 1
SIGNATURE OF ' .. PERMIT FEE $
PERMITTE LL _/-/�C/v �/ 6
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