HomeMy WebLinkAbout1127 CHARLESTON ST - Building Permitspiv
CITY OF COSTA MESA
`ggtN Mg -4,q BUILDING DIVISION
iA 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www costamesaca.eov
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2� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BC12-00339
f0
011 TYPEMechanical
PERMIT TYPE: 13COMBO
STATUS: ISSUED
Sub Type: RES—ALT
DATE ISSUED: 06/0412012
0,1
ISSUED BY: KJB
EIC
Pool Spa Final
JOB ADDRESS: 1127 CHARLESTON ST CM
Suite/Unit:
APN:- 14169208 Zoning:R1,
/�1
Si:
Final Re -Roof
Vicinity:
Primary Occ:
ConstType:V-B SQ. FT: 0
Valuation: $8,500.00
Itt
SCOPE OF WORK: NON-STRUCTURAL KITCHEN REMODEL. SCOPE OF WORK TO INCLUDE: NEW CABINETS, COUNTER
TOPS, TILE, DRY WALL REPAIR, 1 HOODlW DUCT, 10 OUTLETS, 4
SWITCHES, 1 ICE CONNECT, 1 DISHWASHER, 1 KITCHEN
SIN. NO NEW LIGHTING, NO GAS PIPING, NO WINDOW CHANGES.
t_ -
OWNER: SMITHERAM, DAMON
Phone: 714-546-8575
r..
APPLICANT: NISSAN,VERED
Phone: 818-220-8452
CONTRACTOR: NOVEL REMODELING INC
PPronw 855.4855 56-6835
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMTP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
"Refer to fee receipts for all fees paid for oroiect
Address: 1127 CHARLESTON ST Unit:
City/State/Zip: COSTA MESA, CA
Address: Unit::
City/State/Zip:
License No:908461
Address: 1015 GAYLEY AV Unit:SUITE 223
City/State: LOS ANGELES, CAZipCode90024
License No. PHONE:
License No. PHONE:
$0.00
$167.25
$38.90
$34.15
$52.90
$0.85
$0.00
$1.00
$295.05
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
thru Friday -7:Oo am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
ai.
-iOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
gulations. (Ord. No. 92-28, § 1, 12-21-92)
RPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
.NSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
t5@quired inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
LODE 1
INSPEFixed TION PE OATS INImALS
f0
011 TYPEMechanical
A L�
616
System
Fixed System Final Fire Prevention
206
Final
Final Mechanical
,g66
Pool Spa Final
208
Final Plumbing
/�1
`200
Final Re -Roof
210
Final Electrical,.-/
�0;1
Final Block/Retaining Wall
212
Final Fire Prevention
'iC
2((2
Final Factory Fire Place
220
Final Planning Approval,
Final Sign
222
Final Site
is
�03
204 -
Final Demolition
250
Final BuildinglOccupancy
J///�
✓
lid
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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',,�p �/j�
Carrier: 5'{11'! �t ( �
(This se Ixre neednot t completedirthe Pemrrt Is valued alone hundreddollars($100)orless.)
Policy Number: J Q'��Q3y'
❑ 1 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 ipws of California, and agree that if I should
become sub teaL4,a4e workers compensation provisions of Section 3700 of
the Labor ode, I I fart t comply with these provisions
Apph;wR_Ls&gnature - Wto
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($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 and Professions Code, and
my license is infull fol`rce�, and � act.
Lic. # vl Class #
Cpnlraclor's 9 na re �'
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:
Lender's 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 tothe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3057-46 (3107)
Owner ID verified by driver a ttcense. ❑ Yes ❑ No
Driver's 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.
Applicant's Signature
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 ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fled 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? ❑ 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 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).
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? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ 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? ❑ Yes ❑ 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 ❑ 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.
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.
Segal wn ate
L
Andlot utnonzed pplieant pan
.mORESS Of BWLMNG: 1127 CHARLESTON ST
ONN.ITSAIME IF MIOwN: LESPIER, MANFRIDO
ADDRESS: COSTA MESA
1127 CHARLESTON ST
751-4510
NFL. "UM AUOREss:
M1C"RECT OR ENfd M
ARCR. OR ENG'S ADDRESS:
uM:
FLOOD: X 47
UM:
CONmAcrOR's"AME: CENTURY ROOFING COMPANY (714)968-3233
cONfRAcmR"mxIdxO 8662 DOLPHIN DR
AODREw: H . B . CA ua "O.: 674019
92646 UW
LICENSED COMRACTORS DECLARATION: 1 thereby affirm under penalty of pajay that I are licensed under provisions of Chapter 9
(commandrg with Semon 7000) of Division 3 of the flue. mrd Prefesakxe Code, and my how. b in fun face end e"ect.
C1 uc. 0.:059104 LIc.cAss: C39 L'�a"o.' 674019 EXP: 05/96
Date: � (b � Comractor: "�
0 R BUILDER DECLARATION: I hereby affirm under purely d perjury Thal am exempt Irem t mredore License law la me
.lowing meson(
7031 S Baanesa mrd Profeaebns Code: AnY cry a many whits reRuires a psrtnit to oonsWct, aka, impova.
demolsh, a repo any structure, pia to as issuance, also reeuims the epplimnl for such parmil to fib a signed! eteterowl new he a she
is licensed pumuanl to the povisions of mo Comrades Ucense law (Chapter 9 (commencing with Section 7000) of Dbbion 3 of the
Business and Professions Cadet or Chet he or she is exempt therehom and the basis for the alleged exemption. My viordion of Section
7031.5 by any applicant for a permit subjects the applicam to a civil parelty of not more then We hundred dollen ISSOOj).
❑ I, as owner of the popuny a my employees with wages as their sole compensation, will do the work, end the structure o not intended
m Offered he sale (S fion7011, Business and Professions Code: The Contractors License Iaw does not apply to an owner of prep"
who builds or m,uo, ea thereon, and who does such work Nmse" or hemell or through he m her awn empleyeas, proyided Ihel such
tmpavemems we no, intended or offered for sale. 1, however. the Widiw or knprovemem m sod within are your of completion, the
osm.4ho lder will have the Wman of posing W or she did not WiM or impose for the Pumoee of sale).
❑ I, as owner of the popery, am exdusHey conimdkhp wilh Iiconaed cmmeclom ro construct 144 propd (Section 7044. Business and
Professions Code: The Connectors Licsnee law dose est appy to on owner of Isop" who Wills a tmpwee thereon end who
congacta for such projects with a cunlredor(s) licensed pursuant to the Contrectas Lienee Law),
❑ I am exempt under Section: B. 8 PC.. ler this reecon:
Dere: Omer:
I do hereby wif, that I am aware of and undemtand the mcairements of Calepnia Neelh and Safety code Sections t5505. 25633' end
25531, end that I or my More Wilditg aapars will / wgl not (circle aro) need lO campy, wlh sok sate codes end the requirements ler
apemdtfamaetmdionmmndlfcetionhomthe Aran an surnantD W. Reaidemid construction appfutiatn w eaanpt from theme
povisions.
Date: Appldem:
WORKER'S COMPENSATION DECLARATION: I hereby infirm under peromy of perjury, one d the following dedaretions:
❑ I have and will manumn a oedificete of movers to selinsure for workersoompenaebn, as pwided for by!3wew 3700 of the labs
code, for the p.rformahca of the work for which this pamn Is sewed.
❑ I have end will maintain wakes' ampensation iroumee. es required! by Section 37W of the labor Code, ler the performance of IM
work for which this permit is issued. MY waken compensation insurance cornier end policy number are:
Carrier.
Policy Number:
I'm afros need nos bs completed! the permd u ler one hundred dollen (41100) a loss.)
1 remly that in the pedo.anne 0 the work ler which this perms is ueuel. I shell M employ any, person in any manner so es to
subject to the workers' cohnpenseion Iowa of CelRania, and agree the d I ahoum become subject Io the warless'
ton pnwition. of Sedan 3700 of the labor Code, 1 onhwsh aanpy with those poviwons.
D a —1 b -as Appricare:__
W.. wortas' mmpauatlon covsngs Is un/swNl, and shell aub/acf en smploya ro cdminel penaMu end
Ins hundred ehousmar debrs (41100000), In addldon Is wire coat of ron(vaMafbn, damepu as provided ler In
CONSTRUCTION LENDING AGENCY: I hereby affirm under penely a parlay that there is a conemctlon lending agency ler the
porlmrs ire of the work for which the Permit is iaeued (Sadie, 3097, civ. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify shat I hove read this epgiceion and state first the shove information le correct. I an. to mmpy with all city ad county ardirencae
end sae laws mWhg to Winning construction and hereby authorize repesentetves of this dry to eater upon the above mentioned Ivo,cany
for Inspection purposes.
RICHARD STERNBERG
Print Nems
_ Date:
(5151-16.WP) Whne-Suiidvg A Saldy: Grae1-Fre: CanWdpplicent: Pink -Revenue: Galdemod-Aa..
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: B 073147
PERMIT NO: B 0731.47 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/O RESTH & REROOF W/COMP SHINGLES SQ FT: 6,075
CLAIM VALUE: 6,075.00 CALC-VALUE: 6,075.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTORS REQUIRED PER 91UBC
Z 0 N I N G R E Q U I R E M E N T S
S E T B A C K S
------------
MAIN
BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT:
FT IN
REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
LEFT:
FT IN
RGHT:
FT IN
LEFT:
FT
IN RIGHT: FT IN
PARKING
REQ:
PROV:
PARCEL:
14169208
ZNE:
REF NO:
PLANNING
NOTES>
I D U A L F E E
B R E A K D O W N
TYPE QTY
D E S C R
I P T I O N
>
TOTAL COST
SFR 6075
REROOF BY
VALUE RESIDENTIAL
NOZONE 1,00
6,075.00
END OF FEES
D
E V E L O
P M E N
T S E R V I
C E S R
E Q U
I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY DATE: �j
APPLICATION ISSUED BY:� DATE:F�#
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL S GMEIIT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 90.00 61
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING -DIV->
PERMIT
ISSUE PLAN -CHECK
TOTAL PAID
DUE
TOTALS ---- >
90.61
0.00 0.00
90.61 90.61
.00
REVENUE DIVISION TOTALS-->
COLLECTED:
90.61 OVER/SHORT:
.00
BLDG PMT
PLUMBING ELECTRIC
MECHANIC
FIRE SMIP/TOT GRADING
PLAN -CHECK
90.00
,61
###############################################################################
I N D I V
I D U A L F E E
B R E A K D O W N
TYPE QTY
D E S C R
I P T I O N
UNIT COST
TOTAL COST
SFR 6075
REROOF BY
VALUE RESIDENTIAL
NOZONE 1,00
6,075.00
END OF FEES
MOKE DETECTOR
REQuiRF.Q , _
T4QJ1
JUL 1 0195 "`
1NN. OF COSAN
1.1
CONSTRUCTION AND PLANNING
4 r APPROVALS Permit #
Date
Inspector
P0. & SPA ,
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pate
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 LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60, Backwash Lines, P -Trap, [il'Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK t
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
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Duces, Ventilating
71. Product Piping 0Gas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 7"K�
q�
(GWAL
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 & Air Conditioning
a
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
�•Lr. hOC GP/-^
--�
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
-
t
47. FINAL STRUCTURE &BUILDING�C4,---
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
_
2!333
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING 'I
ADDRESS
COSTA MESA, CALIFORNIA
OWNER
MAIL
4L_ _[ ■
v
FEE RECEIVED
JAN 1 7 1984
FINANCE DEPT.oz,)
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
BY
I RECKIFP NO. 1 PERMIT NO.
ZONING
NO. OR UD
PLAND
.UGI,
SIZE pp--��
OF LOT \J
e
No. OF BLDGB.
NOW ON LOT
ALLOWED
YARDS APPROVED
DEMOLISH
USE OF
EXISTING BLDG.
L
MAIN BUILDING
SETBACK LINE PROM
CENTER OF ETREET
n
,
REAR YARD``
FROMC/L EET)
FRONT
R.SIDE rFT.
SIDEYARDI LEFT
DATE
RIGHT J
l�
RNO.
'V STORIES
DESCRIPTION
OF WORK
L. BIDE Fr.
PJ
SHALL BE LESS THAN
(U. S. C. REQUIREMENT
YARDS APPROVED
ACCESSORY BUILDING
REPAIR
e
MOVING
18 FOR THE
I
DEMOLISH
I
DISTANCE BET.
MAIN BLDGB.
BET. MAIN B
BET.ACCESS.MAI SLOGS.
BUILDING
1/��
orOOMS
-AN CHECK
VAR.#
DATE
SIZE
l�
RNO.
'V STORIES
)TAL FEE
C. U.
APPROVED
EXTERIORWAkL
ROOF
APP Qy
A
1 t e (!l
�•
COVERING S w G
'e_
BY_ _ 1
DATE
USOOF BUILDING AND WORK TO BE PERFORMED
1 HER88Y ACKNO
AND STATE TH THD
PLY WITH AL CITY Ofl
BUILDING CO STRUCTI<
61GNATURE F
PERMITTE
AUTHORIZED AGENT
HAVE READ THIS APPLICATION
BCT ANO AGREE TO COM -
AND TATE LAWS REGULATING
THE AMOUNT
PURPOSE OF
VALUATION
0
- O
e
DER VALUATION
18 FOR THE
INS A PERMIT
FEE ONLY. O
0
=RMIT FEE $
N
7 0j
-AN CHECK
�J )
)TAL FEE
Irf25320
iLOSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1277 COSTA MESA, CALIFORNIA 925M
For Applicant to Fill In Completely
AP�
TYPE OR PRINT
BUILDING I1� / GY�,aR✓�iO`�-I
ADDRESS
COSTA MESA, CALIFORNIA
ARCHITECT L P09 1 � � NO.
OR ENGINEER
ADDRESS -3I
V
A). 1/,-=,e
RKm SY
[I�
CONTRACTOR A
1 Q. ' 1/ V -J
I
ADDRESS/1, XO
rY �. IYI H
////J1
-'.;c -A .rrT-g
CITY Iq
FIRE
ZONE GROUP
LIATE
C. No. II?6,�
TEL.
NO,
SIZE
OF LOT (f ^
Z
NO. of OLD".
NOW ON LOT
USE OF
EXISTING BLDG.
�• ���
FLANS �/
KETSACK LINK FROM
ceNTER of HTRSKY
LEacnlmon./�0%
REAR YARD
SIDEYARDI LEFT
A. P. NO. G - U
I RICHT
DESCRIPTION OF WORK
NEW
ALLOWED (U. B. C. REQU I REMENT)
T[RATI N
YARDS APPROVED
AD IITI N
REPAIR
.(FROM C/L
MOVING
FRONT
DEMOLISH
BUILDING
SIZE
NO. OF
ROOMS
STORIES
EXTERIOR WALL
I ROOF
PT.
1 HEREBY ACKNOWLRDOH THAT 1 HAYS READ WIG APPLICATION
AND STATE THAT THE ABOVK IS CORRKCT AND AORKK TO COM.
PLY WITH ALL CITY OROINANCKS AND STATK LAWS RKOULATINO
BUILDING CONSTRUCTION.
SIGNATURE OF O�-,�/�
PERMITTEE- _.
AUTHORIZED AO[HT
CITY OF CIS [A MESA
Rb A 11966
3
RECRIPT NO.
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S
ER EMBREY, GEORGE
DATE 5-23-74
AP No.141-b92-00 LOT TRACT FIRE ZONE VALUE S ,00.on
INSPECTIONS
Signature Date
TYPE V GROUPZONE
GAIL
SUBCONTRACTOR
_
PERMITS ISS ED
GAS
Dote Number Si nat u.
WATER
Plumbin
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER F]
ROUGH WIRING
Heatingand Vent.
TRENCHES FORMS STEEL REINF.
FLOOR SYSTE 1
BONO BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT
PLASTER, BROWN COAT
IL
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING. FINAL
We C i
JOB ADDRESS 1127 Charleston Street BUILDING PERMIT NO. 25320
GENERAL CONTRACTOR Air Vent DESCRIPTION OF WORK Sunshade Structureg
AP No. — — LOT TRACT FIRE 'LONE VALUE $ 492.00
NSPECTIONS
Signature
Date
GROUP J TYPE 1V ZONE R-1
soil
PERMITS ISSUED
SUBCONTRACTOR I Date I Number Signat
Gas
Water
Plumbing
Rough Plumbing
'
Prop. Swr. Line 0 House Con. p
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground ❑ Power p
Rough Wiring
Heating and Vent.
Trenches:0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster Brown Coat
Structural, Final
Electric
Heating, Ventand A.C., Final
Plumbing, Final and Gas Test ❑
Electric, Fina
Buildine. Final
138449
..,YPA,
?77Lt.,_.Q1
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
FOR BUILDING PERMIT
For Applicant to Fill in Completely
LCAON
RE EIDATE
RECEIVED DATJEE
BUILDING r
ADDRESS I1-Ct4AR 7 �1
OWNER n
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NO. (— I f� —0 PER
MAIL ��s I �sDING
ADDRESS 112.7 Ct'T/'1-f�-LCA �N `a -r.RESS
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USE OF BUILDING AND WORK TO BE PERFORMED
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DATE
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C.U.P. qW
APPROVED
APPROVE
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hereby acknowledge that I have read this application antl state
D
that the above information is correct and agree to comply with
cc
all laws regulating building construction, and I shall not employ
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any person in violation of the wprkmar' s compensation laws of
2L0 {f
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the State of California.
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I hereby certify that 1 am properly licensed as a contractor under
o1
SO. FT.
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THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses era In full force and effect, or I
THE PVRP06E OF ESTABLISHING
A PERMfT FEE ONLY:
m
am exempt from the provisions of the State of California Business
antl Professions C �e Division 3, Chapter 9.
VALUATION SAL
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PERMIT FEE $
Signature of
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Permittee
PLAN PLAN CHECK $
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Authorized Agent G
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TOTAL FEE $