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HomeMy WebLinkAbout1164 BISMARK WAY - Building Permits CITY OF COSTA MESA • F� !�►)� BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT J PERMIT PERMIT�BER M99-00132 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1164 BISMARK WY Status: ISSUED Suite No Applied: 03/23/1999 Issued: 03/23/1999 Vicinity: HALLWAY Parcel Number 14160101 Applicant: CLARK, WILLIAM Address: Phone: Zip: Owner: CLARK, LORETTA L Address: 1164 BISMARK Phone: COSTA MESA,CA Zip: 92626 Contractor SOLO AIR CONDITIONING - Address: - 6892 CARNELIAN Phone: (909)944-1340 ALTA LOMA CA Zip: 91701 License: 333239 Arch/Eng: • Address: Phone: • Zip: License: • SCOPE OF PERMIT REPLACE EXISTING FAU WITH NEW 75,000 BTU UNIT IN SAME LOCATION. FEE SUMMARY • Quantity Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $13.25 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To30 hp/1,000 k BTU , $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k-BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 • Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $35.25 COMMENTS/SPECIAL CONDITIONS ' 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)754-5826 DECLARATIONS (l Cl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally 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 work for 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'compensation Insurance carrier and policy number are: c� Carrier: � /=G jJ h Policy Number: r77 Q fe 5 -- ? (This section need no be completed If the permit is valued at one hundred dollars($100)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 these pro isiioointss 77 G� q Applicant Signature: ' —Y C��G< Date: • '7 J3j - WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business andprofessions Code,and my license is in full force and effect.Lic.# "3'3 r3 a 3r/ Class# sL�lrii Contractor's Signature: e,e «/' Date: 3--a3.- F7 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). Lender's 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 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 drivers license. ❑Yes 0 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: 1 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? ❑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? 0 Yes ❑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 dr 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). 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 California Health and Safety Code been 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 epplication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government 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 and 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? ❑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. � e O/f/La gal Owner 77 —,� -Date An Or Ablfi zed Applicant v Date CODE I INSPECTION TYPF DAIS IIIDIALS =DE/ INSPECTION TYPE u DATE /1,MimU/9 1616 Fixed System Final Fire Prevention 206 Final Mechanical "r_i^ –99 A)IV 1266 Pool Spa Final • 208 Final Plumbing 200 Final Re-Roof 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 2445-48 • i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. + • CITY0OF COSTA MEI CONSTRUCTION PERMIT • r PERMIT NO. TRACT NO. LOT NO. UNIT NO. • 1 p 532'9(°( 8442 4/II /88 35050 TL Project Address /4 /J,in.,,. (�/1�tA "/�( - ,,11 �� A ACf' ..1•1:311-11" N.)IW _/•%M5-1,26'7G � /.9 TYPE OF CONSTRUCTION L NEW LT ADD Li ALTERATION REPAIR a pplicanf Mailing Addss -.///:41 l )/� �' ❑ El III •\ - `i '! CONVERSION. A.P.qp # Zone Owner's,Name 44 Ser. &, iIC Phone 546-'c' DpES.C--RJFTION OF WORK/USE OF BLDG. • • Addr�,ss 4 it)e 7...e--v(/(-, _, HCl eYt STI Alet (Z 'Q.60g-C AJ; S Main Building: Accessory Building: Z Arch/Eng. - License No. TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front 0 \ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N Address A Contractor's Name IJ Phone CI OTHER C Right ''N 7 PROJECT DESCRIPTION SQ. FT. ' ISM, DCCUPANCv G Address(mailin • g)_ CONSTRUCTION TYPE VALUATION$ I S A"Ts� S Left ' B,' City Li • cense No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided • E Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PPP t1-+.-• ; ,tds•+ c yN 10/_ `rcf Planning Notes: • Ni with section 7000) of Division 3 of the Business and Professions Code, and �r\\��'' T1�1. loll. 1, ' "l C J my license is in full force and effect. - • $ License Class License No. - - - . Date Signature PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that 1 have a certificate of consent to self-insure or a certificate - _ _ _ of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ' 3800, Lab. C.) I Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW, . 8 Certified copy is hereby furnished. • Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers - Solar Collectors Dishwasher i Meter- Cover 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 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 Drinking Fountains Solar Tank • Fan. Motors 00-1 HP 01%-.8 Workers' Com penpsation Law f California. -- _ - • Date A//!//z2 M ature WPECa,� �p Floor Drains' 'Swimming Pool w/Spa - F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE: I ,of er making this declaration,you should become subject to the ' Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY Gas Service Outlet Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance Y . • of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater • Outlets • Range Lender's Name - •. Lender's Address . _ ' Kitchen Sink / , Sign- Water Service Switches - - OWNER BUILDER DECLARATION I hereby affirm that (tam exempt from the Contractor's License Law for the Lavatories Auto-Wash `_ Garbage Disposal Standing Sections ' following reason (Section 7031.5 Business and Professional Code: Any city or county which requiresla permit to construct,alter,improve,demolish or repair P—Trap I LaundryTrays Generator ❑0-5 KW ❑5-15 KW • any structure, prior to;its issuance, also requires the applicant for such permit y Trash Compactor -to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • V,,,.-9-..the Contractor's License Law (Chapter 9 (commencing with Section 7000) of ' '`Division 3 of the Business and Professions Code) or that he/she is exempt - .. - • - • 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 pPp any of not more than five hundred dollars($500). II $ 3 • `/��I, as owner of the property or my employees with wages as their sole Reinspection Fee E �15 ' Issue Foe 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 Zoning Approved By • Date pletien, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground prove for the purpose of sale). • `Building Approved By /'s - �I\Date �S —4v�Q 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Date `YJv 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 ❑0-100,000 BTU ❑100,000 BTU SUMMA Y OF FEES /;p builds or improves thereon, and who contracts for such projects with a con- _ //�� tractor(s) license pursuant to the Contractor's License Law). I am aware that - BUILDING PERMIT $ '3 -- SMIP $ V proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK $ PERMIT Y ❑ I am exempt under Section B.& P. C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ • (Date �//(.4�$! Owner Z.. •. gee -r f 'i/ Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ - Ill hereby certify that I have read this application and state that the above - 00.100,000 BTU 0100,000BT ELECTRICAL $ GRADING $ - Information is correct. I agree to comply with all city and county ordinances rsand state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ ' MICROFILM $ - sentatives of. this.city to enter upon the above-mentioned property for - • - - ,�� inspection purposes. �— y; nn / C Signature .0 (p.tP.(fQ. 7C/ (:� mate '�//r/gy MECHANICAL • $ TOTAL FEE $ �l 0-4865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor ' 1 POOL & SPA • CONSTRUCTION AND.PLANNING - *,�zt:�, PDate . Inspector Date Inspec\ . ArROVALS Permit# APPROVALS Permit# 1.-',Temporary ElectricalService or Pole • 52. Pool & Equipment Location ‘ ` \ 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement u 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 58. Electrical Conduit-Undrgrnd. 8. Foundation. I: i ; , - 59. Gas Pipe, D Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ 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 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 is'{ 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .. 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro r- 22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil. 23: Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing _ ` 73. Undergrnd.Storage Tank DIGas 0 Oil 25. Roof Sheathing - 74, Overhead Hydro � . 26. T-Bar Ceiling (Structural)_& Monocoat 75. Dry Chemical . 27. Frame and Flashing . 76. Dry Standpipe �`i • --- i 28. Lathing & Siding 77. FIXED SYSTEM FINAL . 29. Insulation 78. FIRE PREY. 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 - ' : I Notes: � t, 34. Final-Heating & Air Conditioning - 35. Final Gas Pipe-Test 36. Hood or Canopy • d7. Final Factory Fireplace • 38. Final Plumbing . - 39. Water Service-Final. , 40. Gas Service-Final • • 41. Solar Domestic-Final 42. Backflpw Preventer I" • 43. Backflow Irrigation , i 44. Landscape Irrigation System . , 45. Sound Attenuation . . 46. Handicap Regulations - - 47. FINAL STRUCTURE & BUILDING 48. Special. Requirements Completed " 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co . 0 ' 51. CERTIFICATE OF OCCUPANCY . • No. £' Date " - _ . CITY OF COSTA MESA BUILDING SAFETY DIVISION Date: 'S0 G/a5 NOTICE o Stop Work 0 Correct Work Job Address �/(0 Y / i-smA#C.c Permit Number {I/� ,'2 94'f CX \ 00. Lrvi;pc /7Nt1 -Jozg,, CAD1 y ICTi gftecig,ps W/ 00-04-9 re0r)re6c 4 IQ segO,W A. nit Pflug- 5,72o Ce ,DErcc!n Inspector's Telephone Hours: 7:00 - 7:30 a.m. 3:00 - 4:00 p.m. 0 Correct & Proceed Inspector's Office Hours: 3:00 - 4:00 p.m. Inspection Request: 754-5626 .42 / V kiadica 754-5627 Division Inspector10Qf 75-11 St i CMF 0383-48,rev.4-1-87 Tel. OWNER •NEWPORT HOLES INC. DATE 7-9-62 JOB ADDRESS 3103.-Van Bruen -i-v0. //, ,L/ .r?�?/� �„ UILDING PERMIT NO. -, 175105 GENERAL CONTRACTOR S. V. Hunsaker & Sons, VALUES 15:Lin.00 AP No. LOT 149 TRACT 4653 FIRE ZONE DESCRIPTION OF WORK ReS/Att.Gar. INSPECTIONS Signature DATE GROUP Tp I TYPE V ZONE R-1 Soil j C 7-Art&? SUBCONTRACTOR PERMITS ISSUED Gas DATE NUMBET Water Rough Corn. Refrig. 0 Air Cond. 0 -- Rough Heating il,•/,/' FTC,a_ '/ Rough Plumbing /, S ?Pant e- •— � 'c'�--/oy- IO3 il Miscellaneous 574.47,...,0_,,A_ te 9 r9/-C.2.,_ �y/o',�t Prop.Swr.Line 5-House Con. [}St.Swr. 0 //�iG z_ e- - .-- W/d-/G"1-1 us--4- Sprinkling System 0 Construction Pole rev Underground 0 Power E /_ // _ Rough Wiring ✓� 1 • ?/ e*,91c�i ,SLE y4te D'a2/�.x s. 7aZ✓• Trenches 0 Forms 0 Steel Rem£. 1 1 *no /- jz/ - C. a--- Floor iFloor System Bond Beam ❑ Steel Reinforce 0 _ Sheathing /A'/°1/! X^30-61 Frame and Flashing /(1 sia. 9-6--b) Lathing - In ©- Out O.--- sf'e'1,�/ 9-/T-(2 . Plaster, brown coat R.1X6L /n-30-6Z. Refrig. ❑ Air Cond. ❑ Final Heating, Final A/WS- ///43 y Plumbing Fixtures, Final /"// 7, /o / Final Gas Test /5- /S/7- //-//i72-- Electric Fixtures, Final g//" Il-2.t-6 .0- B ui l d i n g, Building, Final ?7-/- /,_ /_.e y.. OCCUPANCY tile //_1e-C _ • -FORM BU4•5M— 7.61 1/510 F �� � ���� . FE RECEIVED :.', JUL I 0 7952 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 317 COSTA MESA, CALIFORNIA FINANCE DEPT, For Applicant to Fill In Com lef CITY OF COSTA MESA PP P APPLICATION FOR PERMIT . TYPE OR PRINT • - • 7 7 BUILDING BUILDIN VAgraszt N B R-. I' ADDR / lo . ` A. CALIFORSIA For Office Use Only 1/1-k/ �'T I RECEIPT NO. •, OWNER a 7L/ - ' MAIL // '— • RECEIVE• BY DATE RECEIVED DATE ISSUED ADDRESS /A/ 2 Lq/. LL ' '/'I - % /� �Y TEL. BUILDING /// 7 //J , CITY r/ ,' /� NO. - ADDRESS ((Ti lf- i(.V'^'^' ARCHITECT 1j I TEL .y COSTA MESA, CALIFORNIA OR ENGINES p/,Qr//LLfai,t'F/Y� NO.�C�1 /irOt3/ ,, 0 ADDRESS2-12-1 FIRE fro A/Aq/'✓/ 3I / .5A/{-/1A /P///'A ZONE TYPE V/ GROUP.�C / , CONTRACTOR C , `i, AJ(/,t/SA x>F8 ('s O/y.t APPROVED DATE ADDRESS /.cr $S A I3A-M f 4pc,- ZONING CITY D t,(/'' ' • so- ./� h 77/ ONla —� PLANS a I BU LDING (We LIC.NO:/"'q / Z y TNO. �./// �7.76/ LEGAL 44- y 9 7>f I/‘I-r-&� DESCRIPTION SIZELOT 6 ./1\6c ✓ /(/V/ 0 NO..OF B /�LDGS. OF NOW ON-LOT ( 1 A.P.NO. USE OF YARDS EVES EXISTING BLDG. - APPROVED ALLOWED SETBACK LINE FROM H (CENTER LINE ST.) CENTER OF STREET �� REAR YpARD—� FRONT ��-s_FT. IN. SIDE YARD I LEFT /-' // I RIGHT / o / I R.SIDE /Q FT. ^— IN. DESCRIPTION OF WORK L,SIDE FT. 6 IN. NEW I VALTERATION I II ADDITION 1 REAR 2_7 7 FT. IN. REPAIR I I MOVING I DEMOLISH I , APPROVED /.fi DP T DATE 7/C/�L BUILDING' y NO. OF \/ �iL V' Y SIZE ' U�'` ROOMS / STORIES , EXTERIOR WALLS/4'GCJROOF `(7/1/Da • COVERING 9//J //V S I COVERING r //(oO L� f{ f USE OF BUILDING AND WORK TO BE PERPGRMED. -s 1--E- - /y,1 /91:4/-e7.--.40-; .r - - - , /3719A/ 9 9 C ',. • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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.�UjAr-----1-7,.--41. 0._ VALUATION . ,�'^ SIGNATURE OF� / �/(+� h 41. !l O. h' /y/ PERMIT FEE $ CJ� PERMITTEE tom/ ��� """ �f ii,.o� sS $/✓� / // PLAN CHECK $ ��S AUTHORIZED AGENT! , .J/ I/ TOTAL FEE Sr)J✓ toAU;ftd � \05-5 3/9/&6-S l4 JUL 1 3 1964 OWNER CLARK - J. L. DATE JOB ADDRESS Bi&inark Way BUILDING PERMIT NO. 22593-- GENERAL CONTRACTOR Owner-Builder VALUE $ 530.00 AP No. 17+1-601-1 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORKDet. Patio \�' INSPECTIONS _ Signature DATE GROUP J . TYPE V ZONE R1 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Com. Refrig. 0 Air Cond. 0 Rough Heatin_ Rough Plumbing Miscellaneous Prop. Swr. Line 0 House Con. .❑ St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power 0 Rough Wiring Trenches p Forms 0 Steel Reinf. ne 1//(r/6f Floor System Bond Beam C] Steel Reinforce 0 Sheathing Frame and Flashing Lathing— In ❑ Out 0 Plaster, brown coat Refrig. 0 Air Con. ,❑ Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final _ Building, Final f� fi/Co/s OCCUPANCY Form BIR- 5M--3-63—$-n P 22941 >• FEE RECEIVED 22593 JUL 14 1964 'COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. 1 P.O. BOX 1201 COSTA MESA, CALIFORNIA 9282E - CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING p For Office Use Only BUILDING //6 (I/ 1J is may K um (/ ADDRESS R¢cnrr no. N COSTA MESA. CALIFORNIA (�� / 1 K EEC .Y /3 iv 7 MS E6 owneR c/, i. , C Q Y BUILDING � y,��� // ,/ / / /6 / $AAA�121 9) rani �I IP 7 B l Llt �L Y I\ Way ADDREp4 f ^�'-� �+ FIRE 3 { GROUP J cm., ( _o G t4 A7 e S 4 No S'/6.i 62� ZONE ��// �� ARCHITECT TEL �� BYPROVERI� 1 Ai/•ATE-7 -17 i OR ENGINEER `-- NO. [[��//// .� ZO Ai/ k--. ADDRESS ^ W / �/I PLAoP 5UI DPW.�L'��\ ,p yr... .. �l,C` PLANS DUILDINQV� ,4.� coNTRACTOR (�LC7 /U (\ �1, _ G-ADDRESS - 17.1 D¢SCRIRIoN - 7' S' Ter Y113(,,,, n'nf CITY �- ' A.P.NO. <) I °" �\J( . . I NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL SO'TO SIDE a REAR P•L LIC.NO. NO. EAVES SIZE ,L ,�/ NO.OF SLOGS. . ALLOWED (U.B.C.REQUIREMENT) OF LOT ^/l I NOW ON LOT YARDS APPROVED YARDS APPROVED USE OP � MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. • (FROM C/L STREET)��J^ _ 98TBADK LINE FROM FRONT FT, Q ' FT. CENTER OF STREET REAR YARD SIDS YARD I LEFT 1 RIGHT n.won / VPT. FT. DESCRIPTION OF WORK L SIDES Fr. Fr. NEW ✓ ALTERATION ADDITION REAR 3 PT. FT. DISTANCE BET. BET.MAIN e REPAIR MOVING DEMOLISH MAIN BLDOS. ACCESS.BLDOS. BUILDING NO.OF VAR.# DATE SIZE ROOMS STORIES C.U.P.# APPROVED //. CEO ERINGWALL I ROOF COVERING PYFRcev VW" �/ -//2' " cf USE OF BUILDING AND WORK TO BE PERFORMED Zji • W • Detach ed P h0 Lavey I SQ.FT. 1 I HEREBY ACKNOWLEDGE TNAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE c..:: AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDI AND STAR WS REGULATING VALUATION / Ly[. p __- BUILDING CONSTRUCTIO /; SIGNATURE OF 7`- ///' �A PERMIT FEE 5 Rl PERMITTED J3 // E $ 3 3D PLAN CHECK S W AUTHORIZED AGE // TOTAL PEE S