HomeMy WebLinkAbout2515 BOWDOIN PL - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job nddress: 2515 BOWDOIN PL
Suite:
Vicinily: ROOF
Parcel Number: 14141216
Applicant: LISENBEE, HENRY
Address:
Owner: KRAMER; RITA P TR
Address 2515 BOWDOIN PL
.COSTA MESA, CA
Contractor. , , -
Address:
Zip:
Arch :
Address:
Phone:
Zoning:
Phone: 714-713-9575
Zip:
Phone:
Zip: 92626 �
Phone:
License:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 06/22/2004
Issued: O6/22J2004
Phone:
Zip: License: . License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30# FELT, 30 YEAR FIBERGLASS SHINGLES, AND REPAIR/REPLACE SHEATHING AS NEEDED. 2,500
S.F. INCLUDES ATTACHED GARAGE. � - �
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$125.25
$o.s0
$0.00
$0.00
$0.00
$125.85
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Fronl 0- 0
PARKING Existinq: 0
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
� Proposed: 0,
Calc Valuation:
Claim Valuation
Right 0-0
Right 0- 0
Ss,000.00
ss,000.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
�� EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlona and final approval must be obtained. Failure to ohtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
?446ifi (W00)
WORKERS'COMPENSAnON DECLARAnON: —
I hareby eflirm under penalry ot perjury one ol ihe totlowing tleclarations:
❑ 1 heve end will melntain a certificate oi consent m seN-Insure for workers' compensation, as Drovided for by section 3700 of Ihe Lebor Code, for ihe pedortnance of Ihe
work lor which this permii is iuued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, lor the performance of Ihe work for which Ihis pertnit is issued.
My workers' compensation Insurance carder end policy number ere: .
Cerner. ' Policy Number.
(This secf/on neetl not be comp/eteU iI the permit is valuetl at one huntlred dollars ($100) or Iess.J
❑ I ceRity that in the pedortnance oi Ihe work for which this pertnit is issued, I shell not employ any person in eny manner so as ro become sublect b the workers'
compensation laws ot Californie, end agree Ihat if I should become subject to t�e workars' compensation provisions of Sedion 3700 oi the Lebor Code, I shall torthwith
comply wiih �hese provisions. �
Applirant Signature: Data:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHP1L SUflIECT AN EMPLOYER TO CPIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE L4BOF CADE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm ihat I em Iicensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 oi ihe Business antl Professions Code, anA my license is in full
force antl eNecL Lic. M Class N
Contrectofs SignaWre: Date:
CONSTRUCTION LENUING AGENCY:
❑ I hereby aHirm that thare is a construction lending agency for the performance of the work tor which ihis permit is issuetl. (Sec. 3097, Civil Code).
Lentlers Name: Lender's Adtlress:
SignaNre:
OWNER•BUILDER DECLARATIONS:
Date:
1 hereby eMirm ihat untler penalry of perjury t�et I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professlons
Gotle: Any ciry or county which requires a parmit Io construct, alter, improve, tlemolish, or repair any structure, prior m its issuance, also requires the applicant tor such pertnit
to file e signed statement ihat he or she is licensetl pursuant to the provlslons ot ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) ot Divislon 3 0l the
Business end Protessions Code) or that he or she is exampt therefrom and Ihe basis for the alleged exemption. Any violation oi Section 7031.5 by any ap011cant tor e permit
subjects the applicant to a civil penelry of not more than tive hundred dollars ($500).):
❑ I, es owner of the property, or my employaes with wages as their sole compensatlon, WILL DO THE WORK, and the siructure Is not intendetl or oHered for sale (Sec.
7044, Business and Profassions Code: The Contractors License Law does not apply to an owner of property who 6uiltls or improves ihereon, entl who does such work
himselt or herseN or through his or her own employees, provitled thet such improvemenis ere not intended or oHeretl for sele. If, however, the building or improvement is
soltl within one year ot completion, the owner-builder will have the burtlen of proving Ihat he or she did not build or impmve for purpose of sale.). �
❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business antl Professions
Cotle: The contractors License Law does not apply Io an owner of property w�o builtls or Improves thereon, and who contracts tor such project with a coniractor(s)
license pursuent to ihe Conirectors License Laws.).
❑ I am ezempt under sea Business antl Professions Cotle for Ihis reason:
Signawra: Date:
Owner ID verified by tlrivefs license. ❑ Ves ❑ No Drivefs License No.
Veriticetion of Ownership by (type of document, i.e. - pmpeny taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
Expires:
❑ I hereby certify �hat no excavation five (5) or more feet in depth into which a person is required to descend, will be mede in connection with work authorized by this
permit, and that no 6uilding structure, sceHolding, talsework, or demolition or tlismantling ihereof, will be more ihan thirty-si: (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Calllornia Administrative Code).
� As ownerbuilder, I will not employ enyone to do work which would require e pertnit from Ihe Oivision of Industriel Safery, as noted above, uNess such person hes e
parmit to do such work tmm the division.
Signature: Date:
Division oi Indusinal Safety Permit Numbec
CERTiflCATE OF COMPLIANCE AND AllTMORIZA710N OF ENTTiV: I cenify under penalry of perjury that I have read this application antl state ihat �he iniormation given is
correct. I egree to comply with all state laws end city ordinances relating to building consirucllon, and euthonze representatives ot ihe City ol Costa Mese to en�er upon Ihe
ebove-descnbed property for inspection puryosesyragree not to wcupy or allow occupancy of any building euthorized by this permit until tinal inspection.
40oE �.
161fi
1266
200
201
202
203
Fixed System Fifial Fire Prevention
Pool Spa Finel
Final Re-Roof
Final BIocWReteining Well
Final Factory Fire Place
Final Sign
204 Final Demolition
Q� irirmn�s
COOE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elacirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
p73l�liii�ll�.�
DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS '
Street Address: L��!`� �
Bldg. Permit # �1 N 1 '
This Permit #
AP Number:
1. I(we), Vv� �vV � � , declare that I am the Owner of Title of the above
/
referenced real property, and that I(we) hereby authorize:
Name: �� ✓�f � v� Se ��e � Telephone Number:
Street Address:
City:
to obtain pertnits in my behalf, as owner/builder, for
atthe abovereferenced property.
State:
Zip:
2. Should any person become an employee engaged in the improvement ot the property, I(we) shall immediately provide Worker's -
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemniy and hold the Ciry of Costa Mesa and its employees or officers harmless from any claim resulting in damage or �
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of
Print
Signature:
Date:
20_,at
� �2�9//��I2
�� /O
Note: This authorization does rwt grant authorization to perfortn ttie work as owner,
d solely provides tor limited power of attomey to secure this permit in any behaH.
0]�9d6 (rev.t t/00)
California.
�
1
r
Aopliwnt to fill in all spaces exeept those witnin neavy OorEer lines antl sign all aoPropriate Geclarations.
CiTY oF COSTA MESA CO TRUC ION; PER��1J/���T
Project Address �5�� �� T ��-�L J
Applicant'S Mailing F�dre55 /(�
Owner's Name X1�'C�K���� "Phonq��3dJ.:
Address „�eJ'af1�
Arch/Eng. License No.
Address �f�
Contrector's Nam P e F.�
Addtess (mailing) '
City License No. 3 ���:.-� —
LICENSED CONTRACTOR DECLARA IOT N
I hereby affirm that.l am licensetl untler provislons oi Charter 9(commencin
with seclion ]000) of Divi5lon 3 of the Bu5ine55 antl Professions Gotle, antl
my license is in tul p+ce�n ettect. w
License ass ' e eru . N �
Date � ���4' S"gn t r � �yeCy�
WORKERS' COMPENSATION D ARATION �
, I hereby affirm that I hdv¢ a c¢rti dte o/ con5ent to Selt-insure o� a certificate
�of Workers' Compensati(o{n Ins�ujrance, or a certi' tl copy'there f(Section
Pol�'�c�Y No. %� / 6J/b �' 6 �ComPanY ' . .
ertifietl copy is hereby furnishetl. 111
Certif' cos y i5 {'r)etl with the city� Itling�vi���
Date �pF�'15 X� Applicant � 6 �y
EXEMPTION FROM WORKERS' COM SATION DECLARATION
�(Thizsec[ion neetl not be completetl i� permil is for One huntlretl ($300) or
less).
I c¢r[ity tha[�in [he performance of Ihe work tor which Ihis pe�mit is i55uetl, I
shall not employ any person in any manner 5o as fo become subject to the
Workers' Compensation Laws of Califomia.
Date ' Signature '
NOTICE: If, after making this tleclaration, you shoultl become subject to the
Workeri' Compensation provisions of the l2bo� Gotle, you must torthwith
comply wlth such provisions or "this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV �
1 nereby affirm tnat theie is a construction lentling a9ency tor ihe performance
ot lhe work for which this permit is issuetl (Section 3097 Civ. C.)
Lentler's Name � �
Lentler'S Atltlress
OWNER 9UILDER DECLARATION
I he7eby affirm�lhat I am�exempt from the Contractor's License l.aw for the
following reasOn (Section-]03L5 Business antl PrOfessional Cotle: Any city o�'
counTy which require5 a pe�mit to conSt�uCt, alt¢�, improve, tlemolish or �epai�
. any's[ructure, prior to i[s issuance, also requires the apP�icant for such permit
I ".'."....__._ _' ._�__. _ •__. ._. _ _ ,
D�vision 3 of the Buslness antl Protessions Cotle) or Ihat h¢/She is exemOt
.-%"hereirom �antl the basis for the aile9etl.exemption. Any vioiatlon of Section
-�:�: 031'.5 by any applicant for a,permit subjects the ,applicant to a civil
`^ enalty of not more than five huntlretl tlollars ($500). ,
� �".'�� I, as owner ot the property or my employees with wagez as their sole
Compensation, will do the wo�k, antl Ihe� st�uctwe is not intentletl o��o(teretl
for sale (Section ]044, Business antl Professional Cotle: The Contractor's'
License Ldw does not appty to an owner of.a property who bulitls or improves
therean, antl who tloe5 such wo�k himself/herselt or through his o� her own
emDloyee5, P�ovitletl Ihat such improvements a�e not intentletl o� otteretl f0/
sale. I(, howeveq tne builtling or improvement Is soltl within one year ot com-
pletion, the owner will have the burtlen of proving he/sne tlitl not builtl or im-
prove for the purpose ot sale). �
❑ 1, as�owner of 4he property, am exclusively cont�acting with IicenS¢tl con-
Vactorsto tonst�uct the proj¢ct ($ection ]044, Busine55 antl P�ofe55ion5 Cotle:
The ConVactor's License law tloes'not aOPly to an owner of property who
builds ar improves thereon. antl wno contracts.for suU oroiects with a con-
tractor(s 'icense pursuane to me ConVactor•s License Law). I am aware that
)�noot o tlieir Worker's Compensatlon insurance shoultl be provitletl to me.
�. L7 I am exempt untler Section B. & P. C. for this reason
Signature
Drivers' L
— Owner
iat I.have reatl this application antl state that the above
�cL I agree to comply with a1l city antl county oralnances
'.ing to buil inq construction, antl M1ereby authorize repre-
city /%o r u/� n�the above-mentiOnetl p�op¢rty fo�
i L] • D'1�� Date�� ��
i335oo3
TYPE OF CONSTRUCTION NEW^— ADD ALTERATION REPAIR
7 0 CONVERSION ❑ DEMOLISH �oTH
CRIPT N OF WOR /U E OF BLDG.
1 �
TVP OF ER GRAOINGn FOUNDATION STRVCT RAL
❑ TENANT ❑ ELECTRICAL y�PLUMBING ❑ MEGHANICAL _
�T DESCRIPTION Sa.F
STRUCTION TYPE
ONE GRADI
Remarks:
PL
Bar Sink
Backflow Preventer
Backflow Irrigation
Dishevasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Serviee
I nterceprors
Kitchen Sink
Lavatories �
P—Trap
Aoof Drains �
Reinspection� Fee
L VALUATIO
V O5.
ShOWers
Service Sink �
Sewer Cap
Sewer Connection
Solac Collecmrs
Solar Piping
Swimming Pool w/Spa
Urinal
�Ut12t5 WdtCf CI052L
Water Heater
Water Service
- , Auto-Wash. �
$15
Duct- UnderGround'
Duct - Structurel
Duct- Ventilating
Exhaust System ❑ Multiple
Firepl/Fact Blt. iCBO # .
Heating System & Ducting
❑0-100,000 BTU 0�100,000
peinspection Fee
55 � � �
White - Builtling: Canary - Applicant; Pink - Attounting: Goltlenrotl - Assessor
$15
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Register5
Issue Fee
A.P. �
S Main B�
E
T Front
B Rear
A
C Right
K
g Left
yJnB. Ref. #
FEES Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage�Disposal
� � Generator �0.5 KW 05-'
$ 3
FEES
$ 3
Zone
Parking
ELECTRICAI
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100_amps
Sub Panel .
Motars067 HP OLh-8
InaSoiar �9-15 HP �16-15+
Microwave � .
Pole Light
f I Standing Sec[ions � -
5 KW' � Trash Compactor
� Rainspection Fee '$15 � � luue Fee
DEVELOPMENTSERVICESREQUIREMENTS: �
Zoning Approved By
Building Approved By
Aooli�ation Issued Bv
FEES
$ 3
N
1
N
G
R
E
Q
M
T
$.
SU—MM7ARV OF FEES ' �'p
BUILDING PERMIT $ y 2 � SMIP ,$ O
PLAN CHECK � $ PERMIT ' -
PLUMBING $ ISSUANCE $�
PLAN CHECK 25% $� ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ ___�
S
MECHANICAL $ TOTAL FEE $ ��_
PLAN CHECK 25% $
I
O1 �OU12663-DOD126bS T�7T , 72,50,_
p�n_��^iste *.�ne=-09:3i '
�'t j ' '
���� v POA SPA �i:
CONSTRUCTION AND PLANNING •�.�
APPROVALS Permit# Date Inspector � AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole ?.'� 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. � , I ��� ,� 53. •Steel Reinforcement� , ,� �•
3! Electrical Conduit�Utility-Undrgrnd�. �' ,_ 54. Forms � �,�
4'.Electr,ica�l Conduif=_U�nHr,grnd. � /' � . 55. Electrical Bonding � -�� �
.� ,-i
5! Stee� Reinforcem nt� '� �� . 56. Rough Plumbing & Pressure Test �.
; 6. Elecf ical UFER �rnd67 � �`' 57. APPROVAL TO COVER-GUNITE -'I "j
� :
i _.:.
' 7: Footings � �•,/I � J '-.,`i ;' 58. ElectricalConduit-Undrgrnd. , ��;��
K .
8. Foundation t�,,;i � _ <� 59. Gas Pipe,-� Undrgrnd., Test� . ,. ��
9. Water Pipe-UntJrgmd. •� �. �,� ;^� 60. Backwash Lines, P-Trap, O Undrgrnd. ' '����
10._ Structural Floor 5ystem J,�� ,�s' ", I 61. APPROVAL TO DECK ,;
11.,Property Sewer lahe,& HouseConnection + q�� 62. Backwash & ReceptorFinal
12: �Sewe� Cap �`� J:I � �� 63. Heater & Vent-Final �
. { � `_.� �-' .
13:. Roof Drains ': ��, ,.� � �, 64. Plumbing System - Final ..
14� 1 Rough Plumbipg •�/.�{ �• i 65. Electrical-Final :.
15. Rough Electrical'Co`nduii -� 66. Solar System-Final . � •-
76; Rough Electric Wiring� ,+ . , 67. Fencing & Access Approval ,'
77, Rough Wiring Sign���% 68. APPROVED FOR PLASTERING
18. Rough Eiectrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditipning � FIRE DEPT. REQUIREMENT .
20. Rough �actor �Fireplace �! ' APPROVALS Permit #
21. Ducts�, in Structure �� 70. Underground Hydro �
22. Ducts,:Ventilau�g Gj ,� ' 71. ProductPiping.OGas ❑Oil _
23. Gas Pipe=Rough•&�Test ��'��% - 72. Underground FIusR
24. Roof Fr�ming ' i;' 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing �� -;'� Z� 74. Overhead Hydro
26. T-Bar�Feiling (Stru�tural) & Monocoat , 75. Dry Chemical �
27. �Frame�ar�d Flashi g � 76. Dry Standpipe � -
28. Lat i�t'�� 77. FIXED SYSTEM FINAL
h �g & Si�ling �
29. Insulation� y � 78. FIRE PREV. FINAL
30: Drywa�Il�Nailing �••S' � HEALTH DEPT. REQUIREMENT
. �
� �� � 79. FINAL INSPECTION
37. Plaster Bi�own Coat, �` . �.'
32. Electrical Power Mete'r-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric "� • �: Notes: � .
'34. Final Heating & ,�i� Conditioning � � � _ - �
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 pomestic-Final � . '
42. Backflow Preventer � . � � �1,� 1_•
43. Backflow Irrigation ' _ , � � '
j..
n�
44. Landscape Irrigation System • � ' I
45. Sound Attenuation
46. Handicap Regulations '!
47. FINAL STRUCTURE & BUILDING � . �./ . • • -
48�. Soecial Requirements Completed , � '
49. Electric Release to Edison �i"
. �:
50. Gas Release to Southern California Gas Co �
f, l l .i
51. CERTIFICATE OF OCCUPANCY � ;� r
No. � Date � �q�
,.i tF * 1 . . � , �.i z ',5 : . . ,_ _ ',
4 yr
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,
. • .City;�P•fana�er =< . ,'+ ; , .;; ;, a � _ , , .
%City;bf Costa Mesa ' �' - . `
. 'S.. . , 4 , 1
'' =�`' NOTE RECEZVP.D LR4*� tir. Arth�Surul,it�ar , ,' r; � K, µ' ,;�' � b `". .
? _ .
` ` �2�15.. Botadou,=� , , r ': ; �.-. ,
_ � ; . _ , rC5mb�dge. �states- u , ' `'� �' � . - .
� « . ^� T Costa :�Iesa �aZi.f rnaa .,. , , :'� # ' � a -
� � .� •9 k. x:,� � i .�f .
:r �p ,. � �. "�� r ' .� -' :" .. • ':' .'F. . a ,�'. _ t -�t- .', r 't},:.� s "
•: S�BJECT+: Canoiit , sidE�a'caLL.s �i.r: frorr� of 515, flo�:�do4 n.�: :,� �;i:nDpcetion,
� ,. '-x, , .made .of `sidew at `2515 Bowd 11:15 ,17:e45��nti; :u 1?�59. � -'''
. , � , ,�. .� . �
. • t. . • i � . � -.: '.A '= . � 40• . .'. . �,' ' ' J^i
�'>" A: NOTEs . T3+see �^_a.^em�y.men d ng',block fenc �ob at nbevo acdress =.utnessed ,
� �� � " .. � •'� ihi spec�tion. � w- ' - � - -
.. � •,-, : , : - � : w , -:, �. , ` ' � -, F
,.� , '.•� s.. . .
•PIiIAIPtCSs Si ci�alk 3�" to 3 5/�° thiekasmeaaured by ru7.e. Concret,�a �
,.,`, `� ; ��' v,po °ed:,wer 'sma,ll`clodsg: rot .fine;graded earth. � ��arth, ' .:_ ' �,#
' -i . =hea - adoba';f311 .upon• natnra2 .heao� adobe `soi1- �ith Colichi.. , �
. �; . :. �in ,greEt �nbunts�:ursleTnenth, .` .{Colichi of tre Kao7.i,ne fata= '
, .
•. ; '' ily, _eTay of•`.nure i9hite sutistanee: ):. A1T, 0ery expansiv4 Y '; ; .
' � �. ! S�� ' '� . . 4 . � [ I, % , ,
� � 1 .�i't D a ! � � � .
c, i y ' � �i�, z «� { �r:r � �' .� . .
.^': . , 1.' , ` ''' � „ . ` '.:r�.
. , . : C,- �, -�,� " ',. . :t..' � .. :� .��-.. .:. . : . : .
,�Concrete ueed:in tho 2500 h1ocK at Bowdoin'_aQpears to be..without`§t"reugth' {
easy to break: ttp �ith' small liammer. t,.c'• K�. .�• ,. _ ,
, _ ... -�.. L> ; . ` ., . .' - :: . . ; . _ - � r� - . : . >. , - . .
.. : �. . -. , - •' .� , . , . . . .
` ..Somo rock used-;in the `concpete.mix a ' •
. � ppeEirs to'.be oS decompo'sed material3. :`
. •(Note' two`_of;samples� have. used'brsck contents.`) Sand� u3ed"in :tho, con— , r'.; .
' ,�'�-crete mix appears t'o•hAve a lot�oF Firiea:,:Sand also has a hi�n'glisben ,: ','�;
; :ratc�. . , : ,
�. .. . . . � 3' � .
� '• '�'( ?� -. q r 3y'S "J .�' �i
� � �� .. [ h �� r''�'� y ,"_ . _ •'' '.. .' .I. , ii ! f- ._ �
�_ ,"Fron samnles taken, tho.concrete'seems;to hove.been poured r3ther than �'�.
^.p].aced...� In ,c�y opinior� too inuch <water. uoect, resulting in the "lose of.' ,�� ' ' �
r
„�coheaian. The contractor has, re�lacod mua11 sections` of : sidetialk at ; , .�,� `
'� <. 'the 2>00.blOCli.On.Bo{td0�..� ;; ; , � �y ,',.fi .�`< , ,
a: � .r . . , �. ' � . � , . ..
. ` - �. ."., :t , .. .� -..;, „ ,. „ � :;��-
- "i;t� _:..4 ..._ ,' .: ..� ��. � '.:.� : ,' . tj<. ,: - _
It is t��
. rt�y opinion that �the _sideualls on' DoHdm.n.w111 break,uo in"titae t� ,"
�`-. and=will�;have to b`e;replacc�3 in. seciiona, ; The• sections thfit�ure re ,': ,:'�° ', -.,
placed' moet liko7,q v�ill.`•be�o£ ,'a' baLtQr ;qua3a.ty in materials.., ' G',�; ti,..', ';
� _ .: 8 .. �-0." 3� ' ' �' r,. '-,
. F . � . � . t .1. .
Y • • t` . [ � 1 � •, 1 .
F . �" %'L�.CtlflO�. B1T3��0@ z.. � ��7� ,
, . ° , eu�aine o�ricia�. 4 ; , : ` � `, t�.` �. # �
. r�/an � � � _ ' . . ' '.
: ; . . .. � ti .
. _ !' (� � 'i' . .� .�; � ',� M
. � . _.. . ' � • � _ _ e � . ..,V. .. ,. . . . . • . ' � . .�� . . � ....1 .. . . . . . �.r� . . *� . _
ONN�R
DATE
JOB ADDAESS �C���,y�{ n p-� ar.p BUILDING PERMIT NO. � nRl Fi __
GENERALCONTRACTOR $Q}�}pr Bil _ VALUE $ �nQ�nO _
AP. No. LOT �TRACT FIRE ZONE DESCRIPTION OF WORK hl nek raal l fonr
INSPECTIONS � DATE � GROUP
�
as
In
SUBCONTRACTOR
1 �i_•
:` 1G��.�
COSlt4 MESA BUILDING-SAFETY DEPARTMENT
� P.O. BOX 377 COSTA MESA. CALIFORNIA
fOR APPUCANT TO f/Ll /N COMPLETELY
TYPE OR PRINT
BUILDING i . � - - `
ADDRESS � J , n
COSTA MESA, CALIFORNIA
�u�a\I
TEL.
arr i' . 7�� AS@ No.
ARCHITECT ' LIC.
OR ENGINEER NO.
�ecn� LOT I
OESCRIPTION NO. /1` / BLOCK
SIZE � �[ j � INO.OF BLOGS, /
OF LOT � /` � NOW ON LOT
USE OF ILYfJ' ,�':�^" Ll.iiG�G � C)i/iC�,
EXISTING BLDG.
SETBRGK LINE FROM �/ /(
CENTEF OF STFEET SD � REAR YARD �(,/
SIDE YARD ILEFT — G� IRIGHT ���
� DESCRIPTION OF WORK
NEW � I II ALTERATION I II ADDITION I
REPAIR I IIMOVING I IIDEMOLISH I
BUILDING � NO.OF
S12E ROOMS STORIES
EXTERIOR WALL IROOF
' COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMEO
� � � � � ��� ��
����/r-G�,��i r�„��
/`� �R "
I HEfiEBY ACKNOWLEOGE THAT I HRVE � EAD THIS APPL�CATION
ANO 6TATE TXRT THE ABOVE IS CORRECT RNO AGREE TO COM-
PLY WITM ALL CITY OftDIN ES ANO SiqTE LAWS REGULqTING
BUIL�ING CONSTkUCT10 .
P RMnITTEE �F �eln�/f: NJl�
AUTHORIZED AGENT
FIRE
ZONE
ZONE/�
FEE RE�EIVED
�� �,. �Z _,-- �
FINANCE'DEPT.
APPL��T(f �I�(�2�F�2M IT
BUILDING
foR afficF usF oNcy ,
I � RECEtPT NO. I P� t�T1
�/C
IVM Y I �� R�'3' I D�
/
COSTA MESA. CALIFORNIA
TYPE GROUP
DATE
ZONING
NO.OF USE OF NEW ��-�
I PLANS .� I BUILOING �V`��
�Jti
1./' ( IIGTF // �..
(CENTER LINE 6T.) /
FRONT � FT. T IN.
R. SIDE FT. ✓ IN.
(c � -Z�.t: I_ c:�n/-�-,.-�_
LSIDE FT. V IN/
e�.e �. G ,..
THE AMOUNT 6HOWN UNDER VALUPTION IS FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
PERMIT FEE $ �
/� � �
$ yD ✓ �J PLAN CHECK S �_
TOTAL FEE $ � ��
OWNER StJf9
JOB ADDRESS
FIRE
INSPECTIONS I DATE
SUBCONTRACTOR
In
DATE
PERMIT
OCCUPANCY I I I I
Form 410—SM-11�59 S-B P 1'L8(2
� i.. � � � 28ii2
�£ �-_
C09TA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA� CN-�RORNIA
For Applicant fo Fill In Complefely
� TYPE OR PRINY
BUILDING Jl i^r r �12 .,. _.. � n 1
COSTA MESA CALIFORNIA
MAIL _ ^� O I �
AODRESS .
TEL.
CITY � NO. j�
ARCHITECT TEL.
TEL.
� 847B�GK LIN!'PROM
OP BID48.
DESCRIPTION OF WORK
IIIMOVING I IIDEMO
JG ��V 9 (� NO. OF ' "
� I� �� ROOMS Sl
)R WALL IROOF'
NG COVERING
BUILDING AND WORK TO BE P6RFORM
I HEREBY ACKNOWLEDGB THAT 1 XAVB RH�� TM�6 APPLIGTION
AND 6TATE THAT TXE ABOVE 19 CORRECT AND A6REE TO GOM-
PLY WITM ALL C TY ORDINANCEB I�jo BTATE LAWB REGULATIN6
lUILDINa CON�UGTOy. ' 1. � �= .
71 I/ n � A
HIGNATURE O R7L]Il% 1 ��� ��
PERMITTEF �����q_�V. f�6A3 �1
AUTHORIZED AGENT
� -
FE�RECEIVED
��s—�o-sc�.
E ' fIPIRNCE DEPT.
A7PL'IC�TR7NT�O�REf ERMIT
BUILDING
For Office Use Only
er
�S"/ S ✓�%�V�CF�
CASTA MESA. CALIFORNIA
APPROVED � A � OeTF 9/�S /
Bv /i
ZONE � I puNB � I BOILDINGEW
LEGAL '�{- O ,
OE9LRIMIo / /\
A. P. NO. I I. J� .'7 �.) "�
� FT �
; r�;,.=.1.�.ai-�2ovEa y-�,=�-
TXE AMOUNT 9HOWN UNOEH VALUATION I6 FOR THE
PURPOBE OP E9TqBLIBHING A PERMIT FEE PNLY.
VALUATION
�.�/`�-' ! /" PERMIT FEE $ �`=.
$ PLAN CHECK $
�%6'U ��
, : ._ g���
,..
CCJ�TA MESA BUILDING DEPARTMENT
P. O. BOX 31] �
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
I BUILDING
COSTA MESA. CALIFORNIA
MAIL 1555 Placentis
ADDRE55
c�r� N ort Beach Cal. T�o MI 6—
ARCHITECT SSIf1B LIC.
OR ENGINEER ' NO.. '
�-r� R�c��vED
tL:^` APR 21 10�9
FINANCE �EPT.
c�rr aF c�s�.a r.��sq
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NC
nec[iveo ar
COSTA MESA. CALIFORNIA
FIRE
ApORE55 � $aiile n ZONE
K. 47? Koll.Const. Co• CITV LIC �211, �O�E Z
CONTRACTOR NO.
TEL �� APPROVED
AODRE55 .S'AR�P. • NO. SH7I:8 0�"
LEGwL' LOT
OESCRIPTION NO.
A.P. NO.
S�ZE 60 x 102
OF LOT
sc.encrc �irvc rwom
CENTER OF STREET
NO.OF 9LOG5.
riow orv �or
REAR YARD
DESCRIPTION OF WORK
NEW p ALTERATION ADOITION
REPAIR MOVING �EMOLISH
SIZIE�ING 1611-[,20 . RSoMS 6 STORIES
E%TERIOR WALL ROOF
rnvcoiur A'f.11RCl1 COVERING Wf)fN� C�'ll
IUSE OF NI
BUILDING
Z
CORRECTIONS
I HEREBV RCKNOWLEOGE TH�IT I MhVt Xt.�� TXI! AY✓LiCnliVn wrvu
$TFTE TH4T THE R90VE IS CORRECT AND /GREE TO COMPLV WITX 4LL Purpose of estiblishing a permit te� onty.
CITY OflDINPNCE AND $T4TE L<WS REGULATING BUII�ING CONSTFUC� .
iiorv. VALUATION �}
SIGNATURE PERMiT FEE S JS�OO
, PERMITTEE
' 15,967�0� P�AN CHECN $ 17�50
� C
AUTHORIZE GENT - TOTAL FEE $ S��J� ��M� �