HomeMy WebLinkAbout2890 CLUB HOUSE RD - Building PermitsAOP�icant to fill in all spaces exce0< lhose within neavy Oortler Ilnes an0 zfgn all aDP�aPriate tleclara[ions.
. EITY OF COSTA;MESA CONSTRUCTION'PERMIT � PERMIT NO. TRACT NO. � LOT NO: UNIT NO.
P�oectAddress 2890 C1ubh0u5e Rd. —30�_$ '
Applicant'sMailingAddress 126 Commercial Wav C.M. 92627 TVPEOFCONSTRUCTION �vEw .A�o ALTERATION REPAIR
, Owner's Name Kel I i-Al len � � Pho�e 646-2752 � CONVERSION� ❑ DEMOLISH ❑ OTHER A p #` , .
Address Q DESCRIPTIONOFWORK/USEOFBLDG. I�Stdll� II�IIt-WP7�Ilt� S MainBuilding:
�� 9 C1Nbhet�s�Rd , G f�1 ��§�6
Arch/Eng. LicenseNo. � TVPEOFPEHMIT GRaoiNG FOVNDATION $TftUCTURAL T Front
Address ' � ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHHNICAL B Rear
Contractor's Name CY'df1IC �31'OS. 'P9. Ph e, 54 = 5G ' O OTHER � � . � � A
Addresslmailing) 126 Commercial, C.M. 9��62Z PROJECTDESCRIPTION �ScI.FT. Z �5O � OCcuPANCv � ' K� Right
CityLiC¢�s¢NO. OOFI9QR � CONSTRUCTIONTVPE�'PS1dP(1t181 VALUATION�S S Left �
ZONE GRADING CU. VDS. ACRES Pln Ref. #
LICENSED CONTRACTOR DECLARATION . 9�
I hereby attirm that I am licensetl untle� provislons of Charter 9(commencing Remarks: � , , Planning Not25:
witn section �000) of oivision 3 0( the Business antl Professions Cotle, antl � -
my Ilcense is in full (orcearv9�qHect. aoOc�� _
�icennse/Class 3� Lice9y� No. ���
Date 2/���7 S' t � ,/ 7 r% 'C.� /� �— .
• 7RKER5' COMPENSATION DECLARATION ' Bar Sink �
ereby affirm that I have a cer[ificate of consent to self-insure oqa certificate
^ � Worker5' Compensation Insurance, o� a certi/ietl copy thereof (Section � gackflow Preventer
V 3800, Lab.,C�i��224-8� � State rU�d
O Policy No. �a Company Backflow Irri92tion
�Certifietl copy is hereby furnishetl. � � ,
Certi p tiletl with the city B Itlin iv ion. Bathtubs ..
� oa�e �pf�%$�5 Appiicant `Cra��C �ros. Roofing Co.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION , Clafifiefs � .
(This section neetl not be mmpletetl if the permit is tor one huntlreE ($100) or �
„ le5s). , DiShwasher� -
I certify Ihat in the performance ot the work;for which�this perm�t is Issuetl; I ' '
shall not employ any pe�son'in any manne� so as to becom¢ SUDject to the D�inking FoUnteins
Workers' Compensation Laws of Califomia.
�ate Si9nature � � Floor D�ains
NOTICE: If, af[er making this tleclaration, you shoultl become subjecl to the
Wo�kers' Compen5a[ion provisions of the Labor Cotle, you must forthwith FIOO�SinkS '
comply with such provi5ion5 0�'. this permlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV � GdSS¢rvicE
I hereGy aifirm that there is a construction lentling agency tor the Oerformance
of the work fo� -which Ihis permit is issuetl (Section 309] Civ. CJ
Lentler's Name ' Interceptors .
Lentler's Atltlress ' Kitchen Sink
OWNER BUILDER.bECLARATION
1 he�eby aftirm that I am exempt trom the Contractor's Li[en5e Law to� the Lavarories
following �eason (Settion ]031.5 Busine55 antl PrOfessional Cotle: Any city or
county which �equire3 a Oe�mR to construct,:alter, improve, tlemolish or r¢pair P-Tfdp �
any sVucture, prior to its issuance, also requi�es the applicant Por suGh pe�mit
b file a signetl statement [hat he/She is IicenSetl pursuant to the provisions of ROOf D�ainS �
e ConVactor's License l.aw (Chapter 9(commencinq witb Seclion ]000) of
' vision 3-of� the Business antl Profesnons Cotle) or [hat he/she is exempt - . -- .
erefrom antl the basis for tM1e allegetl exemptlon. Any vlolation of Section
i031.5 by any applicant �or a permlt subjects [he applicant to a civil '
�enalty of not more than five huntlretl tlollars ($500). :
LJ I, as owner of tM1e property nr my employees wi[h wages as their sole ReinspeG[ion' Fee
compensation, will tlo the work, antl the strutture is noi in[entletl or ofteretl
for sale (Section ]044p Business antl Professional Cotle: The Contractor's ,
License Law tloes not apply [o an owner of a property who builtls or improves
�hereon, antl wM10 tloes such work himself/herself or tM1rouqM1 M1is or her own ; goiler '
employees, provitletl tnat such improvements are not intenaed or of(eretl for
sale If hawever [he builtling or imp�ovement is soltl within one yea� of mm-
� �PLUMBING .
' Showers � . ' '
Service Sink � _
Sewer Cap
rSewerConne on .
Solar Co cmrs ' �
_ Solar ioinq �
Outlets
�
$15
., pletion, the owne� will have the burtlen of proving he/She Citl not builtl or im- Duct - Unde� G�Ound �
p�ove for the pu�pose of sale).
❑ I, a5 owne� of the property, am exclusively contracting with licensetl con- Duct-$t�uctu131
tractors to mnstruct the project (Section 7044, Business antl Professions Cotle:
The �ConVaGtor's License Law tloes not appty to an owner oLproperty who DuCt - V¢OtildLiOy
builtls or improves thereon, antl who contracts tor such projects with a com �
ildCiOf�S1 IIC2052 pursuant to�the Cantractor's LIC2052 Law).1'am aware tnat , ExhaustSystem ❑ Multiple
proot of'their� Worker's Compensation insurance, shoultl be provitletl to me. _
❑ I�am exempt untler $ection ' 8. & P. C. for this reason Eirepl/Fact. Blt. ICBO �k
� ,
Date Owner � Heating System & Ductin
I hereby certify�that'I have.reatl this application antl ztate that the atiove ❑0-100,OOOBTU �1 ,000
intormation is correctYl agree to comply with all city antl caunty ortlinances - ' �
antl state lawrrelating to builtlin9 �onstructlon, antl hereby authorize repre-
sentatives of this c' to enter upon t above-mentlonetl Property tor
inspection purpos n - qp �p� ' � ' '
Signature �. " Date � GO o
Orivers' License or 5�� ��— • Reinspection Fee
CMF 0865-46, rev. 10/84 - White - Builtlin9; Canary - ApplicanC Plnk - Accounting; Goltlenrotl - Assessor
�diar Tank �
Swimming Pool w/Spa
Urinal '
Water Closet
Water Heater �
Water Service,
Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Jfype I I ❑
4efr� eration System
aioo,000sTu ❑ioo,000
System Repair/Alteration
F ire Dampers
Registers � . �
$ 3
- ' i
' . $15 Issue Fee , $. 3
n
6158 9/28/87
" '28.66 T�
+ ' Zone ' ,
Accessory Building: '
, Z
O
- N
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� G
R
� � Parking Req./Provided . E
Q
� ' M
T
J � . - S
Automatic Washer .
Cons[ruction Pole Sub.
Cooking Uni[
D ishwasher
Dryers'OGas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
y� ELECTHICAL � ,
Transformer:� 75-50KW
` �50+KW
Meter ❑up to 100 ampsY
i
� Meter ❑over100a ps
Sub Panel . �
Motors �� HP � 1%- 8
Inc. S ar �9-15 HP 016-15+
Pole �ight
swrccnes Sign - �
Garbage Disposal Standing Sections
Generator �0-5 KW �5-15 KW Trash Compacmr
Reinspection Fee � � $15 luue Fee
DEVELOPMENT SEFiVICES REQUIREMENTS:
Zoning Appraved By
Building Appruved 6y � �—_, ��� ;��
BUILDING PERMIT $
PLAN CHECK $�
PLUMBING � 5
PLAN•CHECK .25% $-
ELECTRICAL - $-�
PLAN CHECK 50% $�
MECHANICAL � $
� , PLAN CHECK 25% $
FEES
0
�
$ 3
=5 v 6 �i
SMIP .. $
PERMIT
ISSUANCE $ _ _
ENERGY P.C. $ -, ,
GRADING; $
MICFiOFILM 5 _�—_
'1 Q /:,/
TOTAL FEE $ �
CONSTRUCTION AND PLANNING � � POOL & SPA � .
APPROVALS �Permit# Date�� Inspector �� pppROVALS Permit# ��' Dafe' Inspector
1.'Temporary Electrical Service or Pole , 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd: �� 53. Steel Reinforcement - � ,
3. Electrical Conduit Uiil,iiy-Undrgrnd. � 54. Forms . ,
4. Electrical Conduit-Undrgmd. � • 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-Undrgmd. ,
8. Foundation � �. - - 59. Gas Pipe, O Undrgrnd., Test � .
9. Water Pipe-UndrgmdC.-� � �� • 60. Backwash Lines, P-Trap, O 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 SY,STEMS FINAL ,
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace � � ;APPROVALS � Permit# _ .
21. Ducts,in Structure 70. Underground Hydro' '
22. Ducts, Ventilating '. 71. Product Piping 0 Gas ❑ Oil , ,
23. Gas Pipe-Rough & Test '` �Y1..-Underground Flush �'
24.. Roof Framing _ � �. �73. Undergrnd, Storage Tank O Gas ❑ Oil,
25. Roof Sheathing , � " :74.,-Overhead Hydro - � -
26. T-Bar Ceiling (Structurap & Monocoat ' 75lD{y,Chemical �_ •
27. Frameand Flashing , • � �76. Dry:Standpipe ` ' '. �
28.�, Lathing & Siding � ' 77, FIXED $.L%,STEM FINAL . ,
29. Insulation � . ' 78.' FIRE PR�EV. 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 ' ' � - . r.
35. Final Gas Pipe-Test " . � �
36. Hood or Canopy . ,
37. Final Factory Fireplace � . �
38. Final•Plumbing ' , � � ' � �
1.
39. Water Service-Final � � f � ,
40. Gas Service-Final - . �
41. Solar pomesticFinal , � . � �
42. Backflow Preventer �
.43: Backflow Irrigation e - � �
44. �Landscape Irrigation System- � - � '
45. Sound Attenuation . � . � � � .
46. �Handicap Regulations � � . � � � ,
47. FINAL.STRUCTURE & BUILOING �l b � �' .
48. Special Requirements Completed . . �
49. Electric Release to Edison � -� � � '
50. Gas Release to Southern�California Gas Co � ,•
51. CEFTIFICATE OF OCCUPANCY „
No. � Date � _ . . . •�
APPLICATION FOR A BUILDING P. .IT
BUILDING PERMIT NO. Eiectr�cai Qo
T/act Block Lot Permit No. �
Bull�in9 ^ " /') � . � � O� � PlumDln9 6
Atlaress - ` "I � � � Permil No. �
Cross Mecnanlcal y
Area Street Permit No. �
m
�"i
Owner � �v^,(�-��2�1 �IL TyDeoF oject: ❑ New ❑ Alter ❑ Atltlitlon
� •
Atltlress t, � �� �,� — i v (� ❑ R air ❑ Convert ❑ Demo ❑ Occupancy Pmt.
d
Suo. Dist./
CItY ZIP Phone A. . InSP. Area
Archltecl/ one Spl. Pmt. No.
OM(gne� Licens¢ No.
Se backs P/L Front C/L St. Street Witlth
Atltlress
Var Lett Right ear
City Zip Phone
. ave o�. e i9 . .
« Engineer Li.anse No.
� Parkin9 Spaces eq re rov e overe
p, Atltlress �
m Cit 2ip Phone Struct N. of No. of
Y Height 5 orlel Family
� LiCENSED CONTRACTOR'S DECLARATION aark Fees Ves Fee
m I horaby affirm that I am licensed under provisions oi Chapter 9 Requiretl No C. . _ Receipt
(commencing with Sectlon ]000 of Division 3 of tha 8usiness and
« Zanin9 AP�rovetl BY: Date
Professions Code ntl my license is in.tull torce antl�ct). �9.
.7� License Gass_�_ License Numbor �f� /
> Date ___ Convactor�n � C' ��'I�^ wIS i Mlsc.
llf '�c �
E Address�_ 1 �"�'� ot Structur�ee
j� Ciry anA Zip Phone
h CONSTRUCTION LENDING AGENCY
� I hereby aftirm that there is a construction lending agency for tha
a parformance ot the work for which this permit is issuetl (Sec. 3097, �cc. YPe Cotle
' Civ. C.). ^
Class onst. vear
C Lendor's NameT `, �e� � USE/OC PANCV SIZE SQ. FT.
Lantlar's Atld�ass' �
'� OWNER-BUILDER DECIARATION
y 1.
I hereby affirm that I am exempt trom the Cantractor's license Law
A tor the following reawn:
� ❑ I, as owner ut t�e property, or my employoes with wages as their 2.
sole compensat{on, will tlo the work, antl the structure is not
t intentletl or ofteretl for sale.
a� 3,
3 ❑ I, as owner of Ihe prOperty, am exclusively contracting with
licensed contractorsto consvvc2ihe project.
w ❑ I am exemp[ vnder Sec. ,�B&PC tor this reason 4�
d
a Da2 _Owner .
E WORKERS' COMPENSATION DECLARATION Total valuation
� I hereby atfirm that 1 Fava e certificate ot cunsent to self-insure, Encroachment Permit Requ�reG ❑ es ❑ No
or e certificate of Workers' Compensetia 1 surance, or a certifietl
C �oPY thareof, '^1 ( G�atllnq Pmt �atling
� Policy No. �� v Company � ��'�^^'�' ` ReqWretl ❑ Ve5 ❑ No mL No.
�a ❑ Certitietl copy is hereby turnishetl. TM O� � M Rou9h Gratlin9 �
aa ❑ Certifi co isfiled with Owe � ,� ��
AOProvetl by: Da[e
Date �� Z Applicant 'n ��� �� 3
CERTIFICATE OF EXEMPTION
FFOM WORKERS'COMPENSATIONINSURANCE Z
(This section neetl not be completetl if permit is for $100 or less). �
I certify ffiat in the performance of the work tor which this permit is 3
issued, 1 5hall ot employ any person in any manner so as�ecome �
subjec t h rkers' Compen ts@ ign La of,Califpcaa� . PERMIT FE �
�v ` x
Dat Q APPlicani -'�� � � C
NOTICE TO APPLICANT: It, after making this Certificate ot 5[ruttural S Plan Chetk $
Exemption, you shoultl become subject to the Workers' Compensation
provisions of the �abor Cotle, you must torthwit� comply with such E�Q�t�i�� SPecial
provisions or this permit shall be daemed revoketl. - b Invest. $
I CERTIFY THAT I HAVE FEAD THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing E
COMPLV WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBV AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON
THE �M�JJ/ IONED PROPERTV FOR INSPECTION PUR- pre-Gratle
POSE . _ ��i � �C�, -
/-�—i'=�� Pre-GraGe Permit
S�gnatu ot Applicant or Agent � �
��
All spaces within this box must 6e com leted to process P�an _ � Issuance
P Check By: ApProvetl:
CMF 0335-08 (BU-28) rev. 6/80
OWNER QAMPRFTT � W. T. DATE ;;_10-2-E)2
JOB ADDR�5S Q$q0 ClubhOUSE Rd. BUILDING PERMIT NO. 17959
GENERAL CONTRACTOPyOritiri2ri't31 CO17St. VALUE $ 97.00
AP No139-392-03 LOT TRACT FIRE ZONE DESCRIPTION OF WORKQOIM1.B1k.W811
INSPLCTIONS
OCCUPANCY
0
DA'I'E � GROUP ,7 TYPE TTT ZONE
SUIICONTRACTOR
�! . 17959
CQSiA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX S17 COBTA MEBA. CALIFO:ZNIA
For Applieanf +o Fill In Complefely
TYPE OR PRINT
BUILDING ,
ADDRESS �
COSTA MESA. GALIFORNIA
A1 MAIL
FE RECEIUED
ocr a �ss2
FINANCE UEPT.
ITY OF CO3TA MESA.
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
HEClIPT NO. , PeRMIT Ns.�
�_ TEL. -- BOILDING f
NO. ADDRE68
_ TEL. -�' COSTA MESA.
ADDRESS - I ZON I NG
Z NO. OF U8E OF ❑
C��'y � � !- I PLANB I BU�LDING
LIC.rNO.� 4 NO. `� � DESCR�PTION � �/��
SIZE I No, OF BLDce.
OF LOT NOW ON LOT / A. P. NO. � �
USE OF . YARDS EVES
EXI6TING BLOG. APPROVED ALLOWEC
9BTBALK LINE FROM rC� ICENTCR LINH BTJ
CENTER OF SRiEET U`J REAR YARD O FRONT �—}T�'
SIDE YARD I LEFT / I RIGHT D' R. SIDE FT.
DESCRIP IOtd OF WORK
:RIOR WALL R
!RING C
OF BUILDING AND WORK
I HEREBV ACKNOWLEDGE THAT I XAVI
AND 6TATE THAT THE ABOVE IB GORF
PLY WITH ALL �� 9RqINANGEB AND
BOrtDiNO CONB �Tl�!
, AUTHORIZED AGENT
APPROVED
�o� ( �/ lo�
THIB APPLICATION THE AMOUNT BXOWN UNDER VqLUAiION IB FOR TH6
0 A6R , O COM- pUPP09E OF EBTqBL18HIN0 A PERMIT pEE ONLY.
W9 EO UTIN6
VAWATION �
� �/ PERMIT FEE $ /�
$ y (� Q � PLAN CHECK $ —�
� .C�: 'i 1�� ��
1 SY- SYG �U 1 l
INSPECTIONS
SOIL
GAS
W ATER
ftOUGH PLUMBING
PROP. SWR. LINE � HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UN�ERGROUNO � POWER �
ROUGH WIRING
TRENCHES Qn FORMS � STEEL RE
FLOOR SYSTEM
BON� BEAM � STEEL REINFORCE �
SHEATHING
FRAME AND FLASHING
LATHING - IN � OUT /n,'
PLASTER,BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FI
PWM9�NG. FINAL AN� GAS TEST I-I
BUILDING PERMIT N0. 296�2
< Add Rumpus Room to Res.
VALUE$ (,874.00
SUBCONTRACTOR
� 29662
.. COSTA MESA BUILDING-SAFETY DEPARTMENT
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P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicanf to Fill in Completely
ADORESS ZB7O C�/�B ��.�//SL� IC�D
OWNER �O/�I �A7/z�LTIS
ADDRES5��9p [ ,L�/�Q J�(�'y� �f%
/� �A✓ TEL.
CITV G�JC7-a /Y/L•s'%i NO.'
CONSTRUCTION �_ �/D N/.O.
LENDER �%' �� v
BFANCH —
ADDRESS �
ARCHITECT � TEL.
OR ENGINEER NO.
CONTFACTORvOS IDG_ C. l/�OIiIIfS
ADDRESS !/jZ�J`J L/��S�C/�' �C_
G
/]� TEL.
CITV _OSTIQ ///PS� N���!
STATE CIT V
LIC. NO. �7�¢/ LIC. NO.
J
SIZE � NO.OF BLOGS.
OFLOT �r/j y//j/� INOWONLOT
EXISTING BLDG. ,�JI.!/ P��/.
SIZE OF ni/ r' �.�� NO.
USE OF BUIL�ING ANO WORK TO BE PERFORMED
�... �.. ...CN50..... ....., .iu�..
JkN 20-69PA��OO 605� �**�52.50
cresa
APPLICATION FOR BUILDING PERMIT
:EIVEDBV DATERECEIVED DATEISSUED
� o— i-.2o_/„c
A.P. NO.
BUILDING
ADDRESS _
FIRE
20NE
APPROVED
ZON — NO.OF ,
PLAN$ �
VARDS APPROV ED
MAIN BUILDING
VAR. vk
C.U.P.�
APPROVED
VALUE
�i ��
—
PE GRO'
DATE
USE OF NEW
BUILDING
VARDS AF
ACCESSOR'
BET. MAIN &
I hereby acknowledge that I have reatl this application antl state
that Me above information is correct and agree to comply with
all laws regulating builtling construction, antl I shall not employ
any person in violation ot the workman's compensation laws of
the State of California. � �
I hereby rertify ffiat I am properly licensetl as a contractor untler SQ. FT. o
the State of California Business and Professions Code, Divisicn 3, THE AMOVNTSHOWN VNDER VALUATION IS FOR �
Chapter 9, antl that such licenses are In full force entl etfect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONIV: m
am exempt m the provisions of the State of Galifornia eusiness ¢
VALVATION
antl Pro ssions ode, Division 3, Chap2er 9. (, m
PERMIT FEE S�b� � O G N
Signat re of � 7
Permitte i ` '� � $ �� � �� P�,qN CHECK $ / I �� E
7
Authoriz Agent L �
TOTAL FEE 5 d�� S� LL
OWNER �p� C, �ggiQt, Jg, DATE 11/24/80
JOB ADDRE55 2890 Clubhouse Road BUILDING PERMIT N0. 51061
N o.
ROUGN PLUMBING
PROP. SWR. LINE � HOUSE CON.
SPFINKLING SVSTEM
MISCELLANEOUS MyaLa*�b�
FOUGX HEATING ANO AIR CONOITI
TEMPORARY SEPVICE OR POLE
UN�ERGROUN� �I POWER �
ROUGH WIRING
'�FLOOR SYSTEM
�BOND BEAM nn" STEEL
��SNEATHING p�e{3Q (�{)(�
FFAME AM0'F AS�IMI S.'Y
LATHING — IN � I OUT I �
PLASTER, BROWN COAT
STRUCTURAL, FINRL
HEATING. VENT., REFRIG. FNO A.C., FINAL
PLUMBING, FIN4L RN� GAS TEST �
ELECTRIC,FINAL
BWL[yING, FINnL Q
FIRE ZONE
SUBCONTRACTOR
��-��� � �� � r��� �� �
� � � �. �� � �, �- i�``°� �-
� � ��� $�
' COSTA MESA BUILDING-SAFETY DEPARTMENT
' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant ro Fill in Completely — Use Ink Only
BUILDING `2 �C//1 ���� LiA��j�
AOORESS p \/ J7v
.OWNER OR \TU:�11` % C � ^.�,2 f2 iC�k
TENANT �
ADDRE 5 �&CfO �y6 QV�I� '
/l A TEL.
CITV c G..1�- f�'� �51, NO.
BRANCH
ADDRESS
ARCHITECT TEL.
CONTRACTOR • �` ti2�i �{2 U,�,...��
� ADDRESS •' V � � : i 'v ✓L
TEL.
CITY �` � � NO.
F STATE CITV
� IIC. NO. � L U0. NO.
SIZE � 1 � NO.OF BLDGS.
4 OF LOT �J �' o NOW ON LOT
a USE OF
-� EXISfING BLDG.
y
� Separate permits are required for
� electric, plumbing and heating work:
� USE OF BUILDING AND WORK TO BE PERFORMED
F
Q
a �/CA 4� E cV a� r'1
� � � �lii: !n�. � �i� 1 .(7L
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APPLICATION
4EC BV
A.P.NO. SG
BUILDING -�
ADORE55
UNIT OR
SPACE NO.
TR.No,�,. f +
N�
I�
LOT �"%
VLTER IRE�PAIR
APPROVEDSETBACKS
�t(f'9TY•"""••••h99':04� '=TL.:
N° 51061
� Q
v }} o u,i �
BLK.
MOVING DEMOLISH
�ti^a�22icK SrZ �
VALUE$/ �O�
GROUP � �+
�are �/�Z BJ
' �/
REAR rJ FT.
PLANNING ACTION
DATE
APPqOVED
�''� A��iED� .,,�r ,..r� /��
QI hereby acknowledge that I have reatl this application end siate �
y� that the ebove information is carrect and egree to comply with
�+ all laws regulating buildin0 constructlon, entl I shall not amploy �
z any person in violaiion of the workman's compensation laws of :
� the State of Californle. �'] �
3 1 hareby certify thai I am properly licensed as a contracmt ander � v SQ. FT. �
the State of California Business and Ptofessions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, antl that such licensas are in full force and effect, or I THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONLv: �
am exampt from the provisions ot the Stat¢ of Califo�nie Business VALVATION PERMIT FEE $ v
entl Professions Code, Division 3, Fhapte� . 08 �
�� J � / PLAN CHECK S� '� o
Si natura ot ��////���/// ���((���/// �1
Permlttee _Tl -. �—_ / $ /� �t�y�1 TAX 5 . Q� U
or L � ��
Auffiorized Ageni Date TOTAL PAID �Q , A
. � - � �� �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COSTA MEBA. CALIFORNIA'
F.or Applicanf _fo Fill In Complefely
TYPE OR PRINT
nooaess 289a � C u/, J yse i�oac/
COSTA MESA. CALIFORNIA
OWNER /
MAIL ___ ],pS3 MIIIOTCS DI'1V@
mar'Construct
Minorca Drive
Costa �flesa
197838. Na:Ki 9-0395
� X ZOO I NOW ON LOTB O
uec c�r — — —
6XISTING BLOG
88TBACK LINE FROM ��
DESCRIPTIOfV OF WORK
I X II ALTERATION I II ADDITId
�i� nmovirvo I IIUEMOLISFI I
�5O . ROOMS � STORIES 2
WALL W�OCL I ROOF Shake-rock
Stl1CCO COVERING ' '
I�LDING AND WORK TO BE P� FORMED
Single family resid�ence and
attached garage
1 HBPEBY AGKNOWLEOGE THAT 1 XAVE REAC TXIB APPLIGTION
AND BTATE TXAT THE /�BOVE IB CORRECi ANO A6RE¢ TO LON-
PLY WITH ALL CITY O NANCEB ANO 9TATE IAWB R80UI.AT�NO
BUILDINO CONBTRUGTI f
31GNATURE OF en C�RFT (Y(1TJiPANY
A AUTHORIZED AGENT
FE� RECEIVED
�,�/ �1AN 3 iSS2
`�� FfNANCE DEPT.
CITY OF COSTA MESA
APPLICATION ,FOR PERMIT
BUILDING .
For Offiee Use Only
RECEIPT NO. .9 ��Eq.l.Q�N�
aVV
•� I D/�R�/�'V�WMNAnE is79n'�
J
BUILDING
ADORESS
COSTA MESA. CALIFORNIA
FIRE / � I
ZONE TYPE [� GROUi9\G
APPROVED
BY DATE
ZONING
ZONB NO. OP U6H OF NHW s'H
�_/ IPLANS � 6UILDIN6 W/d�
LEOAL L ot g �--R y3�/
D66CRIPTION
A. P. NO. _
YARDS EVE6
APPBOVED ALLOWED
(C6NTCH LIN[ 8T.1
FRONT �'� FT.
R. SIDE / `� FT.
L. SI�E � FT. �'
REAR � � FT.
APPROVED
ev W X°.lg,s „.. oarF � Z Z 7
THE AMOUNT 6HOWN UNOER VALUATION IB FOR TH¢
PURP08E OP, EBTABLIBHING A PERMIT FEE ONLY.
VAWATION {/.
!� PERMIT FEE $ ! � �
$ (/' �'/ �� � PLAN CHECK $ .� � —
TOTAL FEE S �.�'�