HomeMy WebLinkAbout914 CEDAR PL - Building PermitsCITY OF COSTA MESA
�5�pMFq BIIILDING DIVISION
>4�� 77 FAIR DRNE. COSTA MESA. CA 92626 •(�74) 754-5273 • Fax (774) 754-4856 •�wnv.ci.costa-mesa.ca.us
°�ab� o� FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: E11-OOQ76
PERMIT TYPE ELEC
APN: 42252220
JOB ADDRESS: :� 914'CEUAR PL CM'"� �'�
vicinity:
STATUS: ISSUED
DATE ISSUED: 04128I2011
ISSUED BY: CAC
Suite/Unit:
SCOPE OF WORK: SUPANEL CAHNGE OUT UP TO 200 AMPS 10 OUTLETS 1 SWITCHE
OWNER: GERLACH, WqLTER W Address: 914 CEDAR PL Unit:
PHONE: City/State/Zip: COSTA MESA, CA
APPLICANT: MICHELLE HARRIS
P H O N E: 7'14.556.'179 Q
CONTRACTOR: T H ELECTRIC
Address: 1060TULAREDRUnit: PHONE: 714.556.1790
City/State: COSTA MESA, CA ZipCode: 92626
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ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $66.10
Reinspection Fee $0.00
TOTAL FEES $66.10
e
Address: 1060 TULARE DR Unit:
City/State/zZip: COSTA MESA, CA
License No. 791459
CELL:
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�NOTICE: The work authorized by this permit shall comply with ail applicable handicap access requirements under California staNtes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
�EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
iequired inspections and final approval musl be obtained. Failure to obtain inspections and fnal approval vrill resWt in the expiration of this permit.
CO�Ep. INSPECTIONTVPE �AiE IN1111AL5 CODEM INSPEC110NTVPE OATE INTPALS
t616 Fixed System Final Fire Preveniion 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical � 1`l '� � �
I
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval _
203 Final Sign 222 Final Site '� '' '
204 Final Demolition 250 Final Buildinq/Owupancy
WORKERS' COMPENSATION DECLARpTION:
I hereby aNirm under penalty o( perjury one of the following tleclarations:
❑ I have antl vnll maintain a certificate of consent to sel4lnsure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
"'�pe ormance of the work for which this permit is issued.
I have and will maintain workers' cwnpensation insu2nce, as required by
seclron 3700 of the Labor Cale, for Ihe peAortnance of the vrork for which this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
n are:
Carrier: �✓`��% � F('J /C% �
s sMun neetl iwt De cnmplefed d t�a permR is valuetl a( one �vntlretl dollars (5100) orlesSJ
P IicyNu er: DDDD -S"S3- Zoa �
❑ I certify that in the peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe workers' compensation laws o( Califomia, and agree that i! I should
become subject lo lhe workers' compensation provisions of Section 3700 of
the Labor Code hall forthwilh comply with these provisions.
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WARNING: FAILURE TO SECURE INORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHAIL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST pF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF 7HE LABOR CODE, IMEREST, AND
ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed untler provisions of Chapter 9(commencing
vnth Section 7000) ol Division 3 ofthe Business and Professions Code, antl
icense " in full lorce.I and teIRect.
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CONSTRUCTION LENDING AGENCY:
❑ I hereby atfrm that there is a construction lending agency tor the
peAormance o( the v.ork fa wfiich this permit is issued. (Sec. 3097, Gvil Cqde�.
Lender's Name:
Lender's Adtlress:
SignaWre
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of pery'ury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe (ollovnng reason (Sec. 7037.5,
Business and Pro(essions Code: Any ciry or county which requires a Dermit to
construct, alter, improve. tlemolish, or repair any stmcture, pnor to its
issuance, also requires lhe applicant for guch pertnit to file a signed statement
tha� �e or she is licensetl pureuant t0 the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Cotle) or that he or she is exempl [herefrom and
the basis for the alleged ezemption. Any violation of Section 7031.5 by any
applicant for a permil subjects the applicant lo a civil penalty ot not more than
fve huntlred dollars ($500�.):
� I, as owner of Ihe propeAy, or my employees with wages as their sole
compensation, WILI DO THE WORK, antl the structure is not intended or
oHered for sale (Sec. 7044, Business antl Professions Code: 7he Contractors
License Law does not apply to an ovmer of property who builds or improves
ihereon, and who does such work himself or herself or through his or her own
employees, provided that such imp�ovements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
complelion, the owner-builder will have (he burden of provinq that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRAC70RS lo conswct the project (Sec. 7044, Business and
Pro�essbns Code: The contractors Licen;e Law dces not apply to an ovmer of
pmperty who builds or improves thereon, and who contracts tor such projecl with
a cmtractor(s) license pursuant ro the Coni2ctors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signawre Da�e
305]�a6(3/O))
Ovmer ID verified by drive. .. iicense. ❑ Yes ❑ No
Driver's License No. Expires:
Venficalion of Ownership by (ype of document, i.e. - property taa bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excava[ion frve (5) or more feet in depth into which a
person is required to descend, will be made in connection with v.vrk aulhorizetl
6y this pertnit, and that no building structure, scaFfolding, (alsewnrk, or tlemolition
or dismanlling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry
2, Ari 2, Sec. 341, Ttle 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do work which vroultl
require a permit from the Division of IndusVial Safety, as noted above. unless
such person has a permit to do such work from the division.
Appl¢anfs SIB^a�ure
Division of Indusirial Safety Permi[ Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe appliwnt or present or future building occupant need to file antl
certily a Business Plan for emergency response to release or Ihreatened
release of a hazardous material? � Yes ❑ No
(Seclion 25505 0( Ihe California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Cosla Mesa Fire
Department by every business vfiich has at any one time during a reported
year a quantity of hazardous materials equal to or greater Ihan a weight ol
500 pounds, or a volume of 55 gallons, or 200 cubic feet ol compressed gas
at standartl temperature and pressure).
2. Does or will the applicant or present or luture 6uilding ocCupant neetl lo file
a registration form for acutely hazardous matedals? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Sa(ety Cotle, with some
exceptions, requi2s registration with the Cosfa Mesa Fire Departmenl by
each business which at any one [ime has on hand a quantiry of acutety
hazardous materials equal lo or greater �han a weigh� of 500 pounds, Or a
volume of 55 gallons, or 200 cubic teet of compressed gas at standard
tempereNre antl pressure).
3. Does or will the applicant or presenl or future builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Cali(omia Health and Safety Code provitles thal the
Cosla Mesa Fire Department may require the preparation, certification and
filing with the Fire Departmen[ of an RMPP by businesses which are requiretl
[o register aculely hazardous materials with the Fire Departmenl.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safety Code been fully complied vrith? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require (or
the work which is the subject of this application a permit for such construc�ion
or modifcation from the South Coast Air Qualily Management District or from
any other air polNtion control district or agency? ❑ Yes � No
(Sectbn 658502 ot the Califomia Govemment Code requires that the requestetl
infortnation be fumished on applications for ran-resitlential Duiltling pertnits).
6. Will any part of the (acili[y to 6e consWctetl under this permit be within
1000 feet lrom the outer boundanes o( a school? ❑ Ves ❑ No
Qf "yes", Ihe facilily must meet [he requirement of Sections 25534 and 42303
o( the California Heallh and Safety Code).
7. If a permit trom the South Coast Air �valiry Management District or other
air pollution control district or agency is required for the work vfiich is the
subject of Ihis appliwtion, have all of the disclosures prescnbed by California
Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
8. Qf'yes", attach certificate of compliance from Ihe appropriate air polNtion
contml offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is cortect. I agree to comply vnth all slate laws antl
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state Ihat
the in(ormation given is conect. I agree to wmply with all state laws and city
ordinances relating to building construction, and auchonze representatives of
the Ciry of Costa Mesa ro enter upon the above-tlescnbetl property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by this permit until Mal inspection.
Sign qNeo�legal. .mer(s) Da�e
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AnE r A�onxM AG 6tan1 �Dale '
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 914 CEDAR PL
Suite:
Vicinity: ROOF
Parcel Number: 42252220
Applicant GERLACH, WALTER W
Address: 914 CEDAR PL
COSTA MESA, CA
Owner: GERLACH, WALTER W
Address 914 CEDAR PL
COSTA MESA, CA
Contractor: OW N E R-BU ILDER
Address:
Zip:
Arch :
Address:
Zoning:
Phone: 949-54&7052
Zip: 92627
Phone:
2ip: 92627
Phone:
License: 000000
Eng:
Address:
Status: ISSUED
Applied: 12/08/2004
Issued: 12/08/2004
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Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30# fELT, 30 YEAR COMPOSITION SHINGLES, AND REPAIR/REPLACE SHEATHING AS NEEDED. 22
SQUARES INCLUDES ATTACHED GARAGE.
Plan Check: $0.00
Permit: $11125
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
Rear 0-0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
Sa,aoo.00
sa,aoo.00
NOTICE: Tha work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
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 1 BO 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
requlred Inspeetlons entl flnal epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
zaae�ae �aroo�
WORKERS' COMPENSATION DECLARATIbN: � , w �
I herehy ettirtn under penalry of perjury ona ot the tollowing tleclaretions' �
� I heve entl will maintein e cenificate of wnsent to self-Insure lar workers' compensetlon, es pravided for by section 3700 0l tha La6or Code, for Ihe peAortnance of Ihe
wark lar which this permit Is Issued.
❑ I have flntl will melntein workers' compensatlon insurance, as requlred by secUon 3700 al Ne Lebor Cotle, tor the performanca of Ne work fa which �his pertnit is issued.
My workere' compensation Insurence wrrier and policy number ere:
Cerrier:
ef one
or Iess.J
PoliCy Num�ec
�� certity thel in the pedormanca ol the work for which ihis pertnit Is issued, I shall not employ eny person in any manner so es to become subject to the workers'
compensetlon laws of Californla, end egree ihat if I sh uld become sub�ect to Ihe workere' compensation provisions oi Sectlon 3700 of t�e Labor Catle, I shall forthwith
comply wit� t�ese pro isions.
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ING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNII FlNES UP TOONE HUNDRED
THOUSAND OOLLARE (5100,000), IN ADDITION TO TME COST OF CAMPENSATIQV, DAN.4GE5 NS PROVIDED FOR IN SECTION 3]OB OF THE LABOR WDE, IMEREST, AND FTTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I �e�aby efllrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Code, and my license is in full
force end eflect. Lic. N Cless N
ComracmYs Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eRirtn that there is a wnsiruction lentling agenty for Ihe pedormance of the work for w�ich Nis pertnit is issued. (Sec. 3097, Civil Cotle).
Lendefs Nema: LentleYs AOOress:
SigneWre: Date:
OWNEF•BUILDER DECLARA710NS:
I hereby eNirtn thet under penalty of Derjury that I am EXEMPT FFOM THE CONTRACTORS LICENSE LAW tor the lollowing reeson (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry which requires e permit lo construct, alter, Improve, demolis�, or repair eny stmcture, prior to its luuance, elso requires Iha epplicant tor suc� pertnit
to lile a slgned statement Ihet he or s�e Is licensed pursuant to ihe pmvislons of the Contractors License Law (Chapter 9(commencing with Sectlon 7000) ol Division 3 01 the
Business and Prolessions Code) or that he or she is exempt lheretrom end the besis for ihe allegetl eaemption. Any violation of Section 7031.5 by any eppliwnt for e pertnit
ubj ts the applicant to e civil penelry ot not more than tive hundred tlollers ($500).):
I, as owner of the pmperty, or my employees with weges as ihelr sole compensailon, WILL DO THE WORK, entl the slrucWre Is not intended or oflered for sale (Sec.
7044, Business antl Professions Code: The Comracbrs License Lew does not apply to en owner ot property who builds or improves thereon, entl who does such work
himself or herself or through his or her awn employees, provided thet such improvements ere not intended or offered for sala. If, hawever, Ihe building ar improvement is
sold within one yeer ot completion, the ownervbuilder will heve the burtlen of pmving Ihat he ar she ditl not Ouild or Improve for purpose oi sala.). '
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to consWct the O�oject (Sec. 7044, Business and Professions
Cotle: The comrac�ors License Law does not apply to en owner of property who bullds or Improves Ihereon, entl w�o contrecis lor such pro�ect with a coniractor(s)
�,,,�icense.pursuant to t�e ConiraUors License Laws.).
under
Business entl Professions Coda tor this reason:
_ �
Owner ID venfied5y tlrivar's license. ❑ Yes ❑ No �
Vedlicatlan of Owners�ip by (rype of dceument, i.e. - properry tac bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATION:
❑ I hereby certlty ihat no excavelion five (5) or more feel in depth into which e person is required to descentl, will be mede in connection with work euthonzed by this
permit, antl t�at no building strucWre, scaifoltling, falsework, or demoli�ion or tlismantling Ihereof, will be more then Ihirty-six (38) leet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Tltle B, California Adminisiretive Code).
❑ As owner-builder, I will not employ anyone to do work which woultl require e permit from Ihe Division of Intlustnel Sefery, es noted ebove, unless such person has e
permit to do such work irom Ihe tlivision.
Signature: Date:
Division of Industnel Satety Pertnii Number:
CERTIFICATE OF COMPLIANCE AND AUT}IOHI2ATON OF ENTAV: I certify unCer penalry ot perjury that I have read Ihis epplicalion end state that tha intormation given is
correct I egree to comply wl�h all stete laws antl ciry oMinances releting to builtling conswction, end euthodze representatives ot the Ciry of Caste Mesa to enter upon Ihe
above-describ d roperty t i pection p ses. I agree not to acupy or ellow occupency ot any building authorized by this permit until final inspection.
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�;StgnatureOfLegalOwner(a) ����-�� L=�D'at�- ,
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And/Or Amhonzad Applicam Date
COOE 6 INSPECTONTYPE
1616 Fizetl System Final Fire Preventian
1266 Pool Spe Final
200 Final Re-Roof
201 Final Block/Reteining Well
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition �
pA� It�IS
COOE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecincel
212 Final Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final Building/Occupency
PdIE II�AL$
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OWNER ZENOR� KER't°II'P"� Rc DOROTHY . }�' DATE 9-3-5�
]os ADDxEss 911� Cedar Place BfIILDING PERMIT NO. 7J�82
GENERAL CONTRACTOR pymep VALIIE $ 450.00
11 P o LOT j06 TRACT 1712 FIRE ZONE DESCR[PTION OF WORK Patio Roo£
GROUP T TYPE V ZONE R-1 . PLAN NO.
RMITSISSUED
INSPECTIONS . � DATE � SUBCONTRACTOR
coat
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COSTA MESA BUILDING DEPARTMENT
P.O. BOx 31�
COSTA MESA, CALIFORNIA
�, FOR APPLICANT TO FILL IN
MAIL
ADDRE55 �
ciTv C,„$
ARCHITECT
OR ENGINEER
/'7 �. C OA/C / //
COSTA MESA. CALIFORNIA
Ceda R Y/ A� e
M e s a TNo: L.; -Y 6G/9
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NO.
CONTRACTOR Lf
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LEGFL LOT
ocscRirriov NO. 3 �
A.P. NO.
SIZE �
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USE OF
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SETBFCN LINE FROM
CENTER OF STPEET �
CITY LIC.
NO.
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MOW ON LOT
I 'f REAR YARD �
DESCRIPTION OF WORK
NEW ALTERATION I ADDITION
REPAIR MOVING DEMOLISH
BUILDING�� �/ / D NO.OP
SIZE ��Q ROOMS I STORIES (
EXTERIOR WALL�� _ ROOF /Y _ • '
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fIN",";CE D�PT.
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APPLICATION FOR PERMIT
BUILDING
FOR OFFICE; USE ONLj(y a,�,
COSTA MESA. CALIFORNIA
� ' ATE ! �
RECTION
PLANIvING D�=pT.
$TwTE TH<T THE �BOVE I$ CORRECT �NO �GNEE TO COMPIY WITM Rll
GTV OHDINSNCES LNO STnTE LwWS REGULwTING BUILDING CONSTXUU
TiON. VALUATION
SIGNATURE OF ��'`�''�� PERMIT FEE S
PERMITTEE �A � ! � L�
� 1�� ,( O PLAN CHECK $
S ✓
AUTHORIZEO AGENT r� TOTAL FEE 5
� VOMI
ORANGE COUNTY BUILDING DEPARTMENT
_� 636 North Broodwoy �
SANTA ANA, CALIFORNIA .
FOR APPLICANT TO PILL IN
eui�oiNc gII q14 Cedar Place
ADDRE55
ORHTOIyNDIST. COBta 1'le0a
NEAREST i
CRO55 ST. �Dijj�O�Iy$ AQe�
OWNER CHOCTAM HONES� (NC,
MAIL
nooREsS 9363 w��sH,Re BIVD.
TEL, r1'�/�
cirv BEVERIY HILLS No. CR. �y o
ARCHITEGT,oAIN S�. MCKEpRACHERT�+o�SY. E)�IS9�
ENGINEER l.
nooqess ?�jO E. WALNUT ST.� PASADENA
TEL.
CONTRACTOF�jFVPORT VISTA co. �o. cR. �4�6�
ADDRE55 6 WILSHIRE BLVD. BEV.HILLS
LEGAL I �OT NO. ��Jp BLOCK � 7� 2
DESCRIPTION
IATTACH METES & BOUNDS�
TRACT
SIZE OF LOT O9 %� � �O I NOW ON LOT �
USE OF NO. OF NO. OF
EXISTING BLDG. Fevu�es I ROOMS
DESCRIPTION OF WORK
NEW I x I ALTERGTIt'IN I I CI'IIIITIf1N I
6UIL�ING NO. OF
SIZE �OZ� SQ�FTROOMS 5 STORIES
WALL I qOOF COMP�
COVERING STUCCO COVERING 4N��
useoF New RESIDENCE
BUILDING A f* (�nnnn
APPLICATION FOR PERMIT �
��'�����
FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
3S� ,S/ ➢7 a
%Y DATE OF APPL. DATE ISSIiED
��� �- ��3 NGV 5 1953
SCNOOL DIST.
N E F jOy1� C
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORM5,1
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-P�
ANO AGREE TO COMPLY WITH ALL COUNTV ORDINANCES FRAME: FIRE
BRACING
AND STATE LAWS REGULATING BUIIOING CONSTRIJCTION.
LATH. I IJT.
SIGNATURE OF NE i PORT V 'CO. LATM. E%T.
PERMITiE
AUTHOHIZED AC_. � �. ��� PLASTER. INT
a 4830.00
VALVATION
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PLASTER, E%T
C. E 'Z MASONRY RE
s I T BOND BEAM
6 � FINAL
APPROVALS
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Costa Mesa Building Department APPLICATION FOR PEIthIIT
P.O.Box3�� .��qg BUILDING �
I � COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
F'OR APPI.ICANT TO IN Receipt No. Permit N�
Addresa �� L �✓A/�� ( �
/
Costa, Mesa, ria�li0l7ll8 Received 6y / Date Rec'd. /D�ate Issut
Nearest � 3 / �d-��
Cross St. Buil ing
"/R�",7., ���0/� Address
Owner %(
or
Contraetor
�ot
Size oT Lot (9 �
4se ot �
Existing Bldg.
Setback Line trom
1•.'F111
I hereby acknowled
and state that the a
with all City
bWlding construc a
9lgnature of
Permlttee
Autho�Ized A
Valuatlon
� �
S
-
NM 204 IO�M1S D. P, e$.
U Costa Mesa, Cahfornia
Y � Nearest
Tel. Cross St.
No. Zone No.of Type Group
Lic. I Plans I
No. _ Appro ed �
p� Block
Q
No. of
C� Nowt
� No.of
Famil
/7 Reai
it/i 31de
SUBJECT TJ 6LUG. UEF'T. REG.
Addition
�_ APPROVALS
Foundation Location Inspector
Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracina. Bolts
have read this Applicatlon
orr0ct and agree to cOmply Lath. In
nd State Iaws regulating
( � Lath. E:
° Plaster,
{� Plaster,
PermltFee $ pzj � Masonr
Plan Check $ � eond 6�
ToSa �
Fee $ � � FINAL
O
A
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Z
D
r
Show lowtlon and distances Trom
N
� property line and between buildings
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