HomeMy WebLinkAbout2544 COLUMBIA DR - Building Permitsreaecreooxess: 2594 COLOMHIA DR '- • - '` ,� '. uNiT: ' � •
owxee•sxerne:,RONALD;MORRTSS FOX � '�. ; .
�eooxEss: 2549 COLUMHTA DR
; ' 'COSTA' MESA � '
CA 92626 - .
(714)595-7791 . ' • .
�fC�N/ENGINEEB: �� � . �' � `.NEG.NO.: � � ' � �
�� pDOflESS: ` } , ' ,� UNIT: ' � -
• � • .. � .: :
` PE"m°TEE: RONALD MORRTSS FOX ( 719 ) 545-7791 ,
aooeess: ; z 5 4 4• COLUMB IA DR -
COSTA MESA' ' CA 92'626
LICENSEU CON7MCTOB DECUMTION: I hereUy affirm I�ai I am Iicense0 untler piovisions of C�apter 9(commencinq wi10 Section
7000) of �ivision 3 af ihe Business and Pmfessions COtle, antl my license is in full force antl eHecL. , ,
CITY IIC.: � STFTE UC.: ' ' CLIISB: �" ' i � �,
Date: �� SipnaWre: ' � � �
WOAKEAS' COMPENSp710N DEClAM710B: 1 �ere�y atfrtm Mat 1 have a cerliticMe of consem to self-insme or a certAicate N Wolne�s'
�em�ensatian Insurance, ora.cenifie0 copy t�er¢oi (Se��on 3800; Lab. C). � .
� t,�"T�NO.: ' . . . EXP. DpTE: . .
;....iNY: . . �. . ' �, : . . .
„�' "`':nifietl caDY is �eaEy fumished. ❑ CertifieA coDY �s tiled wM� the ciry Buil0in0 Division. '
�♦Uate.. . � ' � ° •ADPlicanL`. , . � •
E%EMFfION FBOM VlOPKEBS' COMPEN311710N OECIAMTION: (ihis section nee0 not be compkte0 il the De�mit is far ane hunUreA (5100) or less�.
I certity that in the Dedormance oi the work tur which tMs permit is issue0, I shall not employ any person in any manner so as to �ecome
subject ro tAe Workers' Compensation Laws oi Califomia, . � :
Date: - " - •"- SignaNre� �- �� � � ^ -- -
NOTICE: II, aiter making this declaration� you Should�0ecome suEieci to the Workers' Compensation provisions oi Ihe Labor�
Catle, you must forthwith camply wlih'suth provi5i0n5 ar t�is permit Shall be OeemeA revoke0. �
CONSTPUCTION LENUINO �GENCY: I here�y aflirm,that)Aere is a consiruction lentling aAency for the petlormance o�the work br
which.tAis permitis issued (Sectlon 3097;;Civ. C). ,� • � .
LENDEN: ' � . , • '
RODflFSS: ' . . .. . .' . . . .
. i . ' � , . - . , .' , .
OWNEP BUItDEP DECUMTION: i �ere6y aKrm iha� � am exemD� �mm itie Caniractors' State License Law far t�e followinA reason
(Section 7031.5 Business ana Pmfessional Coda: Any ciry of caunry which requiresa'permitta wnstmct; alter, improve,-Oemolish, or
repair any stmcture, D�or ro 0s issuance, alm reQuires IAe apD��cant lar such permit ro file a signe0 staiement ihat he/s�e'isi¢ensatl
pursuant to Ihe provisions oi Ihe Cantractors'. State LicePse Law (Chapter 9(commencing wlih Section 7000) of Oivision 3 0� ihe Business
an0 Pmfessions CoOe) ar Ihat he/sha is exemOt IAereirom anU ifie basis tor the alleged exemptionr Nny violation of Saction 7031.5 �y
any ap0licant tor a`permit suhjects ihe aODlicant to a tivil Denalry af nat moie Ihan tive huntlre0 tlollars (5500). . '_�
I, as owner of the DmDenY or my, empIOYees with waAes as iheir sole compensation, bnll Eo the prork, �and thB
it i'' stmcwre is not intentleG or ofleretl for sale (SeGion 7044, Business antl Pmfessional Cotle: The Contractors' State License Law
. �t' Aoes nat appty m an owner of a Dmperty who hmlAs or,imD�aves thereon, antl who'Ooes such work himselt/�erseli or ihmug�
�his or her own emplayees. Drovitletl tAat such impmvements are notinten0ea or offeretl for sale. Ii, Aowever [he huiltling or
improvement is sold within one year oi com0�e�ion, the owner xill �ave t�e bwAen oi proving he/she OiU not huild ar imD�ove
for tho-Puryose of saiel. � , -. , , '
I, as owner oi the D�operty, am exclusively conVactinp witA IicenseA contradars to constmct ihe Drolect (Section 7044. Business
�' antl Pm(essians COEe: The Camractars' State License Law Aces not aDPN �o an owner ol OroOeM wha bml0s or impmves thareon
and who contracts for such proleds wit� a conbacmqs) license pursuant ro Ihe Contractors' State �icenu Lawl. I am awaie
' that Oraai a/ their Worker's Compensation ins��anca sAOWU 6e proNOetl to me' � , �'
�'- I am exempt untler Section: . 8. 8 P. C. '
,
lor ihis aason: � ' � , ,
e.� 4v✓
Oate: � - /���—�� '�Owner.
I Oo here6y cetliTy Ihat I am aware oi and un0erstanE tPe requirements of Califomiz HealtA and Satery CoGe Sections 25505. 25533. anG
25534 anOltut I or any iNure huilding occupant will/will nat (circle ane) need ta compry wit� saitl state cotles an0 the,requirements for a
permit for consimction or mo0ificatian imm the Nr Qualiry Manapement Oisinct Resitle � I consim tion applications are exempt Imm
tAese pmvisions. . � , . � ✓ . '.
/� �N/
Oa�e:' �T-9� � 'ApPlicanC - � -
. I herehy ceRity that I �ave reatl ihis aDP�ication antl state that the ahove information is correct. I A�ee ta comply witA all ciry an0 caunry
orGinances anG sWte lavrs relatinp to EuilGinp mnstmpion antl �ereby aN�oriie represen[atives af ' cdy� n Ihe aOovEmention¢4 -
propeM �orinspeCtion purposes� �
Oate:'��—�� ._ y9nature: � .
'�� ��nver:s License ai Social Secunry ' ' /
____
—�_�`CaEe Enlorrome�l Cenery—ApP��cenp'Pink—Revenue; GOltlenroE—Assessar "
( _ , :`
� . . . • . . . � _ . �, ; _ ,- _ .. ��
' . • ' CITY OF COSTA MESA - HUdLDING'PERMIT' � PERM NOr' B��O,4�,r�_,
` , '�'" - , . - . : - ;; , .
�PERMIT Nq:.'B •..097040 PLAN CAECK NO:;03695-90 S_. �,GOVT:`N'SUPP�: N
'•CONSTRUCTION TYPE:;S-N . PERMIT�TYPEr STR.�• � ,'.,.PURPOSE: OTH� �.'
JOB DESCRIPTION i 115 LIN FT OF' CMU WALL'@ MAX t6,','•HIGA� ! SQ FT: ,.�11;5� "'�
. . . . . • . .. � . .. , �; � .
�CliAIM VALUE: . � . .: CALCrVALUE: 2;,:300.00 'GROUP OCC:�.R-3'. �/�
COMMENTS:�SMOKE DETECTOR(S) RE(�UIRED IN HOME:� •� '� �':
ititit**it***�x**�r*�rx�r�ritititx*x��r�r**� *�rx�r�ritit*it�rx**�r*�*�*aix**.�r�r*ie*�r�ritit�itx�ar**�r*�*�**�r*x�
, ' Z O N I N'"G. R E Q U I'..R E M.E N T S • ' .
t S E T H A C K S •"
'--------=---,MAIN BUILDING ---------- --------- ACCESSORY.BUILDING --------- '
FRNT: 10 FT IN REARi FT ' IN .FRNT: ,FT IN REAR: FT IN'
LEFT: FT �IN RGHT: 5'FT IN LEFT;' ` FT � IN RGHT: FT IN'
PARKING REQ• �2 PROV; 2 PARCEL; 41913102 ZNE: Eil REF NO:
PLANNING�NdTES> APPROX. 115 LIN. FOOT HLOCK WALL WITH'NO WALL ABOVE� � '� '
> 30 INCHES WITHIN-FRONT 10'FT. OF SETBACK. '"'
**�******��r*�r�r*�*�r****x��r**�rx�**�r**x�r�r*at***��r*�*�r**x+t����r�r*�rx�r***x��**�rx��r�r*x��*�*�r*
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: O '
HUILDING:'APPROVED BY : � , DATE: �/ ,
' , . � � .
APPLICATION ISSUED BY: � DATE;
iE1EiEikdFifiE�Fif�flflEit3kiEiFitilifikiFiF �tifMftif�tiEiEiEik if3f. .
iFiEiFiEifififikif�fiEitiEiEifil3tifiEitiElE3EiEiEiFitilikiFibiEililikififiF*lkifdEiE iliEififiFiEifiEiEifkiFifiEifififiE�kiFlfiEiElEiEltiEltiE�EiFikiE�t
LEGP,LIZATION:N . �� F,E.�E, S U M. .�A R�Y: � STRUCTURAL SEGMENT:Y '
t�
BLDG PMT_ PLUMHING ELECTRIC�"iMECHANZC ' FIRE SMZP/RES GAADING
PERMIT 54.00 F �', -. ` 50 � ,
PLAN �, `35.10 ' . �:• � 4 - - , ' SM3P/NON-RES
ISSUE FEE . . ,,.. �, r�. ."•. � .
BUILDING-DIV-> PERMIT ISSUE PLFiN-CHECK `' TOTAL PAID .DUE
�TOTALS-=--> 54.50* 0,00 35�,10 i' 89.60� 89.60 .00
,REVENUE DIVSSION'TOTALS-->. COLliECTEDi { �8'9.60 ,OVER/SHORTr ,00
�:BLDG PMT PLUMHING ELECTRIC MECHANIC R3AE SMIP/TOT .GRADING PLAN-CHECK
54.00 ' ' • � ; .50 35.10
, , . �' � �
iE iF iFlE it it jE iE 3E M if i! iE 1E ik iF 1E iE if iE iE it 1t iF iE iE it i! iE ik if if iF iF"iE if iE ik iF ik'iF iElE �F iE;! dE �t if 1E iF jk iF iE iE�iP iE iE iElf iE if iE iE iE 3E iE iE iF iF if iF iE iE if IE iE if if
I N D I' V,I D U A L F E E:^,B��R E A R.D O W N '
� . � . � 1' ' N ' .
TYPE QTY D E S C R I' P T I O N • • :UNIT COST"� TOTAL COST
SFR 115 RES-CONCRETE;BLOCK�WALL '�' �../.'FT. � 20.00 2,300,00
END OF;; FEES �'' � �
. , .. .. . . -_. _ . � . . �' � ' • . . ..
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. . � - .._ . �, .f . �' �\��, � . ,� '
� !� . �
y . . {�
U ,i,
. _ . .. oi 000ssits' 000svi2b T��►�� 9s.00
r,�TF: oa,,.9;9n �1nr: �r,:^,e
�STR�TION AND PLANNIN� ; ..= ., _ . F L SPA . ' � . -
APPROVALS '� Permit #� . Date Inspec[or Date Inspector:
APPROVALS . Permit #
�1. Temporary Electrical Service or Pole • � -� 52. Pool & Equipment Location .:< �
r'
.2_�Soil;Pipe-Undrgmd_� - ' � . _ 53. Steel-Reinforcement ' � '� � � "•r �
�?lt3FElectrical Conduit'Utility�Undrgmd. � 54.. Forms - � - .. • �� � A, iy'" '%�
G:rn.-- rra.-. �/ /
�(`i�9-.� 6 f . - . ' �/ f i_ ��:
`-4.-Electr,ical Cond�it-Undrgmd. � . - � 55. � Electrical Bonding , ,,
: �:5.'Steeh�ReinforcemenC " - �j�'fp �ui '56. �Rough-Plumbing & Pressure Test� � �v
tin.-,n} :-•�-:n;
S;6�ElecviwlUFEA�Gind. � � � : 57. APPROVALTOCOVER�GUNITE '"
L
.;�7::Footings �-u'•,-+ �ti'-�� 'q/� 58. Electrical Conduit-Undrgmd.. �
��$ �Foundation ,,, � � - ' S9. Gas Pipe, O Undrgmd., Test °'
��9. Water Pipe-Und�gmd. � 60. Backwash Lines,P�Trap, �� Undrgrnd.
� 10. Structural Floor System� . � 61., APPROVAL TO DECK
11. Property Sewer Lirie'& House Connection . 62. Backwash & Receptor-Final - ^� .
12. Sewer,Cap a• � � - 63.�Heater & Vent-Final "! � ' �'
' •.13. Roof Drains .� � �- ' � 64. Plumbing System - Final �� �' � )� -
.-� i
� � �.
�-�1�. Rough Plumbing - 65. Electrical-Final �
15. Rough Electricel�Conduit , . 66. Solar System-Final v
16. �Rough Elearic,Wiring -, 67. Fencing & Access ApProval
17. Rough Wiring 3ign - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19..�Rough Heating &.Air Conditioning � �� FIRE DEPT._REQUIREMENT ,L
t i N � i'+. 1 i" :.' C I: L-t E K X'"' �T
1 t' 1 ] ):: t•J.?i �� # � J U'b ) T ,^.'1 if�'�'1
.20.,Rough Factq`y Ftreplace i g�:, :zK t, ,; t., c�r� a-APPROVALS,i:.,FPer`mit # � _
,21 �Du'.•s, in StrScttx,e' � ".. .. ;�_' `- � �-+�* r -= ' c,-•n�--i �;; -
S n v$ i Sy 7 ti n* ;; �70. Underground HyBro ,.
1'� -" i 1 lJ � � C.t. i. �' ' ..> : � t
22;,Ducts, Ventileting;a; .�.. ;� x� c �:, n;.��'�: 277. Product�Piping OGas ��Oil
23.•Gas-Pipe-Rough &.Test ' � �''%`= � ^'� a' '� �* W -�7y, Under iou�d Flush�a X � "
r. m r.. n. x ��,^ m ��n ;: cr c-� c r.: -; 9
�.0 '� ' - i%s. . 1 F' c-. .. i- a- 7 :J " M� �: c
24. Roof Frami�ng p� p. 7 ;-i:x ,� f•73�Undergrnii Storage Tank O Gas ❑ Oil
25. Roof Sheathing T7�� �"�`" � >�ti� � 74'�O'verhead Hydro�, w
.-� � :� �� �r r� z .v u. . S � �.�
I + T� n� � ..ry.15' a 'i�ti Y" f^ . �✓ ^ M1 H C..' O'.,
�� 26�T-Bai Ceiling IStcticturaq &'Monocoat,-, , i, ,�, �., ^ p,; � 75s•Rry Chemical p_j ' ,� ,,
27::FrameandFlashm' �t.'�^ ^'���cT - a*a: : - - :�:�_ =� +u .: --
9' _, „ ,_.;�,-�, 76. Dry StandP�Pe G;� ;,-� v
�,'_28^Lytfiing & Sidingj� "` C�;:;, ,;j";: � � ��� ��. \�fK y�.. 77o-�-, FIXED SYS7EM F'INALX -, ^� •`'
s
�29. Insulation ^k J s "-'`�''� � �� � �� � 76�FIRE PREV. FINATL �' J ^ �
n: r r n 'a c l �'.` A y; .n 1 .r.
�'30. Drywall-Nailing ���,,; p� ��;��;., ',�� ,f!� 7� Y � HEALTH'-'DEPT�R�QUIREMENT
��37. Plaster 8rown�Coat' S i M�*' * � ;'I � � :79.�FINAL INSRECTION � � '-o
. � ,t r-� c r, o_ -,
.y r ,.. ,- ,'y n i � - � . . � ro , i' . � .: � :� ,- , %. -.
,"�32._Electrical Power Nle�ter-Ftinali * /, j �;,,� �' 80:,FOOD CERTIFIEATE ISSUED;., �,
� � � . �,,. i �_��•�� ..�: i .
�33�Finel Electrio -W t*; � 4,.Q"`� � '� � X�Notes: -- rv�
.-,. _ .1�- ;. �- � � , � � l:e �� '�! d
�-34rFinal Heating & Air'^Conditionii�g� r'�":'�' i. �� `: S C%x i. S' �iC .
V. �S - .� r-�* tti �.� 'i•,^. !.� �1 ,{: c 7J i c-`� . �
•35%-FinalGarPipe�Test9:.�w ^'7•i#H.A~! ��/.. - . --� -•` �' ��:
;� � O��-O:. �.,, �.: 6w6�
� ; 36. Hootl or�CanoPY�'�: �~ r[n-� r:i x c� /,�1 ' ..e F_ �. !�-, ;; r
S ;t ,.�'..1: Cl I �t�7 `-'.�i"t ".�4� �'f�� ;n ..:o a:,r. -
'Y-.37.�Final Factory Fireplacex : -;-+i� �3� •� � � � i ��.F'�' � s�� /� _'. H
Y � ..fa i' . �L
I) '38.,_Final PI`umbing 'K T � �-'�;;' � ' �' a: `A � -
� ... � :,� �~'-� • i . n � , - . Msv! � �1/rt,G '�Lt/'6�'
,., , � , ,_ " . . .. ' . �
I� �'�39.iWater Service�Finalw, � i ���,;»; cC � � `�� W r L, y � � -
?;40. �Gas Serv`{ce�Final � " C�� r' `-" "" '' 1 � P` x OG �"�'ti " -"
;✓ s fl F F � n7 �' :K. � � aa r F• O � k Q '
=41.`"$olar pomesi cFinal' �,; �� j�r �'F ' ( pe s. ��;+- .�� �� ,.�g Q
�
42. Backflow Preventer-� � ti � - I � k� � -: �y =+ • + : �
C� .K nJ ��l-AH ' ..� •�R .� � h: �.i -_ •J. �GU
' r" x G; 7 1 '� ' - ^ � c. �. .* �,; ~ ..
� 43. Backflow�lrtigationk y : ,; ,- � �: :� ;.� � :g n .
- r T n :.
� .^44. Landscape lingation Systerr����_ `�l w�� ^ L'�`r * S v r� ��� * a� C
-r t: :T7 :� Y Q C '4;W r" a L +.J'T� M S i+
.. � - k H-:.F TC� � .� L� �� ;-�A, ..:1 �� �. W �..V
� �45 CSound Attenuatiom . .. � �; ;r. ;.} r.-,�: .� �-. �n � • �. � �,�
t:46'Handicap�Regulations r' �i�7 `'^ *' `r � •S �o S }�
r 1� 'i: C . I � i I Y t, '$ !i; ^J (.'� iJ .}
1i47.`FIAI,AL STRUCTURE & BUI�LDING ��� � ;��'(j�' ` �' "''� _� � ^
� 48.�FINAL PLANNING' i �^`' � r;' " .{ y�!,Y �, ; ^ :� t} c, * � ��
� "
"49 �'�Eleciric.Release to Edison � X • � •f /�i� .� " .; � ^ " '
� ' ' � �% 1 r: io r, °7 • �"^+ :��
"50 =Gas'.Aelease to Sou[hem CaliforniA Gas Co � ��� (j ';iF"' X �" '" '=' ' �_� • ra '
.�_ a. x =# • S ::;0 C�r-. :d O
�51. CERTIFICATEOF�OCCUPANCY "" �� ��-� � � - -
No. Date
>
TYPICAL 6�� CONCRETE BLOCK FENCE
Cement Coping Optional �
ChannelBbck With 1-3/8�
Morizontal Top o1 all
Fences .. — .•- . —... -• __.
For Fenees 5'+or Les�
Vert. Ban 3/8" � at 4' �0" O.C. �
Fo� Fences Higher Than 5'
Vert. Bars 3/8"� at 32" O.C. �
Fill Celh Solid With GrouL ��
Where Steel Occurs
Reintorcing Steel S'nall
Conform to See.A-15-39
A.S.T.M. •
All Steel to be Lapped
24" ur,to Coda '
NATURAI GRAOE--�_
TWO 3/B"O BARS
CONTINUOUS TOV
& BOTTOM
HORI=.STEEL MUST BE TIED IN
- VLACE AT TIME OF TRENCN
-• INSPECTIGN.
� �
• 'I�� �
� Z . . _..
>
a
i�
W O
Z ~
W n
LL —
� ..
on �p
. F�-�-WIDTH
p " SEE CH4RT
!� BELOW
oL
WIDTH
THICKNESS ' . . .
DEPTH OF EARTHTOOTH
SPACING OF EARTHT00T
�r
�.
�. � •
� . _
•
GENERAL- NOTES
;'Y z�. �,,, ., �5 pMORTAR; • pna Part Plasfic Cement, ond
's "-' ': � .i T�I��E POfiS Sond
'-X GROUT;; One Purt Cemenf Tnree and
_ . .,; � One Holf Parts S�and
' �'COPING: One Part CemeM, Three
- ��' "-• �• Parts Sand
' ' `'� =" '� =CONCFiETE: Well Miaed C2-I/2:3-I/2
MaK. of 7-I/2 Golfons of
�` . Walar Per Sack of Ceme�t
`.- -�__':�.'
. ~_��GROUT�MAV BE POURED fROM THE TOP
OF THE•FENCE IN CELLS WHEHE STEEL
OCCURS.
CELLS AND AREAS OF NOH120NTAL REIN-
FORCEMENT SHALlBE CLEAR, CLEAN 6
i. FREE OF ALL MORTAR DEBRIS, ETC.
i. _
Z..
NG REQUIREMENTS CHART
.
DEPTH GF E4RTHTCOTH
V� TNE HEIGTH OF FENCE
BECOW BOTTOM OF FOGTiNG
SCALE: I /2'� = I'
14' . --14 . :_::�. 12� . . 12"
I O'� �. I O^;_..�..___—_ _ T�� 8" 8 X
24° 20" .. . � "� 16° . 12"
12' -14� . . . � k � 16'�. . 16�
City of Costa- Mesa, �alifornia
Building Department '
wevrsen Nov. ez
� ROVED �
� � pp COSTA MF,S�` �
p�pNMINd D�•
� Tp Ypp. DQ1• lBD�
a� �,q�
sY � „°��_+
,d�P �`J� // � � . i , r3to� �-Q
P
Permit �## �8 `f 7� Yv
THIS NUMBER MUST ACCOMPANY
ALL INSPECTION REQUESTS
N�IE
ADDITI:�;::, Df! ki I^ i" 0? CD�FECTIONS SHALL
Bt AP: �._.... '.?" � ,_ i _,,.. .i�::� ��E?ARTMENT
p��- 3a��
•[t10tMCf
�[�IY[MC[
, .�` ,�' '� ,'' �
City of Co�sta Mesa Buiiding Dept.
BY ��/��—/---'_" DA7E�19�c..
THESE PLANS MUST BE ON JOB AT AlL iIMES MFKE
NO CHANGES�WffHOUT P�IOF APPRO Al UF DEPT.
fOR50R AN HPPROVAI
pVI510N50F 1NIS CODE.
JRItt TO VIOLP.Te DA CL
N LL BE VAUD, EX�`nN�
11TA �'"
� ISSUANCE OF < PE�
=ICPTIONS SHaLL i C'. 4
THERE�FTtR REOU'i :f `
?L?� ANG 5PH t
�tNG��10RrCl�S H : W G
C!
�:,iT�ON OF 7H5 C ^vF <
�3 r A STREET s � r 1�� � _
F A PERMIT O P.PFkO`JAL OF
, NqT BE CON T'nUEU b RE n
, ANY VIOIA'f N OF ANY OF
O PERMR PRE`. JMING TO GNE
:EL �HE P4U� SIONS (SF tNiS
50 FAR FS TF : WOHK OR USE
BO.SED
raT TH£
IGNS �
'aRH�Cv C)!�
: GF ANY O'
V PLF^�5 t.ND
DIFIG QFFIQA:
; vp ERKOR� �N
•q PREVENT�NG
REUNDER wNEN
ORUINANC` �f
,.
;i .
PARTY WALL AGREEMENT
7ffiS AQ2L�TP, �de and entered ' to this �� u day of
�� 9� , ���t,�, ��D
, �/ �/
hereinafter referred to as "LA6ID Ofd�R", and �v � L N�. /C��� L S
hereinafter referred to as 'AIL7ACPalP PROPFR77C Ofd�R".
It is hereby agreed that�a party rall vill be constcucted on the
property line between a�s��- C.7�.U}'I �( J} 7% IL ((�1- �'D��/
in the City o� Costa Mesa, Coimty of Orange, State of California, as per
map recorded in Book �, Page3��f Miscellaneou.s Maps, in the office
of the Coimty RecoLder of said Co�mty. 7t�e party wall shall be �*r+; ttz� to
encroach
IN WI7S�.R5 W�dtHOF, the parties have entered into this Agreement the
day and year �irst above vritten.
u • , i:�•
�s�� c'a�u ��3 �� a�� c��
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G ag l/� b`1 ��f � C� l�
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A�� 1 � �sso ��R 1 � �sse
f:r�ti)cL«�,� :.,�r�:�YZ.^�,i�N
, � � > ��
Sig ure ��
�%1/LL�I�/ � /v/Ll���-S
Name Ryped or Printed
�ay ���z� �
� � `� � yC �6
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the pra
posed property improvement. �' Yes ❑ No
2. I(have/have not) �{(�✓F signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address
Phone (
City
Contractor's Lic. No. _
4. I plan to provide portions of the work, but 1 have hired the following person to coortlinate,
supervise and provide the major work:
Name
Address
Phone (
City
Contractor's Lic. No..
5. I will pro�ide some of the work but I have contracted (hired) the following persons to pra
vide the work indicated:
Name
Address
Phone Type of Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above informa[ion to the best of my per-
sonal knowledge, in compliance��y/►�th�� t71/yis �S'tate law.
Signed: Y`�" �1 01F �ate: � `� %�
Name: ��t-Q �1��( C �_
(Printed or Typed)
C.D.L. il or S.S. #
AP R 1 9 199�
�OWNER FOX, M. R.
� GENERAL
� AP No. l
� INSPECTI
SOLL
�GAS
� WATER
ROUGH PLlll
P ROP. 5 W R.
ROUGH HEATING AND AIR CONDIiIONING
TEMPORARV SERVICE OR POLE
UN�ERGROUND ❑ POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF.
FLOOR SVSTEM
BONO BEAM [� STEEL REINFORCE �
SHEATHING
FRAME AND FLASHING
LATHING - IN n
PLASTER, BROK'N COA'
STRUCTURAL, FINAL
HEATING. VEN7., REFf
PLUMBING, FINAL AN❑
ELECTRIC, FINA�
BUILDING, FINAL
DATE
lUP .T TYPE
SUBCONTRACTOR
o r.over
� F
35379
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SFP � �'7�PAIOOO �%7 E`.QU
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �
- A C ION FOR BUILDING PERMIT
. FarApplicant to Fill in Completely REc ev E ECE VED D T ISSUED
BUILDING ,� � � ib � - /.- � 7Z,
ADDRESS
� . ' PEFM T NO. �
OWNER M . ♦ I� O � . A.P. NO. � ' � � �7i
q BUILDING � �
ADORESS pL � („L 'K � � �+DDiiESS � �{7l� � �� a �
i Jj
i ' . TEL. TRACT�� LOT� 7 BLOGK
cirv �p � a No.
CANSTRUCTION W A P
LENDER
BRANCH
�j�/ .�
' OWNER/�/:
ADDRESS ' VALVE `/�'�/j
ARCHITECT TEL. � S � Q 'te� '$ v/ f��
h
OF ENGINEER N .
FIFiE ��.
ADORESS. ZONE ' TVPE ROUP �
APPRO V E
CONTRACTOIi W • �f BV DATE
ADDRESS SS �\@, ZONE NO.OF USE OF EW a- `J
CITV � NOL I P�� � gU1LDl �„�
STATE ' '- � CITV �ARDSAPPROVED VARDSAPPROVED �
�IC. NO. LIC. NO. MAIN BUIIDING ACCESSORV BUILOING
SI2E NO.OF BLDGS. (FROM C/lSTREET)
OF LOT NOW ON LOT FONT FT.
USE OF �
EXI5TING BIDG. F . FT �
SIZEOF �✓�.1 -0 O.OF
NEW BLDG. � � ROOMS STORIES L. SIDE FT. F
EXTERIOR WALL ROOF � 3
COVERING COVERING REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED DI5TANCE BET. BET. AIN &
' MAIN BLDGS. ' ACCE55. BLDf'�S.
^a .• . C G 'VAR.# �ATE -
�- C.U.P.� APPftOVEO
APPRO ED
I hereby acknowl¢dge that I have read this aDP�ication and stete S
that the above information is corract and agree to comply with
all laws regulating builtling consttuction, antl I shatl not employ ,O
�any person in violallon of the workman's compensaiion laws of .
��the State ot Califomie. /r • �( °
�� u
I hereby certify that I am prop¢rly licensetl as a coniractor untler SQ. FT. ��
'the State of Californ(a eusiness antl Professions Code, Divisicn 3, THE AMOUNT SHOWN VNDER VALVATION IS FOR
�Chap[er 9, antl thet such licenses are in full force antl effect, or 1 THE PURPO6E OF ESTABLISHING A PERMIT F E ONLY: a
am ezempt from the provisions of the State ot CalifOrnia Business �
antl Professions Code, Division 3, Chaptar 9. VALUATION , � d
PERMIT FEE $ �
SiBneture ot '�( //��/�� �, . °
Permittee � . �� . CJ CiC $ / // / . PLAN CHECK"$ E
, l74�" �../ �
Authorized Apent �
TOTAI FEE $
� �:
COSTA
��s�.
MESA BUILDING DEPARTMENT
P.O. BOX 31J
COSTA MESA, CALIFORNIA
� • -, �.
_�'_,. �1.��.iL.ab J ��
z(�.�� y
Fift"r`:CL t t T.
�J�V Q;= ��c':n !.l_cy
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ADORE55 2 Colwnbia Drive: BUILDING .
� COSTA MESA. CALIFORNIA . FOR OFFICE USE ONLY
RECEIPT NO. PERM�
OWNER Mesa Hi hlands nc "�
MAIL RECEIVE� BY OATE RECEIVEO PTE I55
1555 Placentia. �, — �� g j'��g
ADDRESS
CITY yye �I'y B ach VcIL• TNO. r'�I p� ��7 ADDRE�SS '
ARCHITECT 9&➢18 ��c. , .COSTA MESA."CALIFORNIA �
OR ENGINEER� � NO.
FIRE
ADDRE55 � 9$j�jQ ZONE
CONT }}J� l.T�jY�)d Iioll Const� COFITY NIO. 1�7 10NE p�1N$ TVPE GROVP
ItA V
ADDftE55 .$$iRe NO. S$jQe. BPPROVEO DATE
�E�^� LOT r
n CO-. R�EC .IONS -q ; �
oescaivnorv NO. S9 e�OCK TRACT 2OG� R •{'� � (� •. � �1 .1
A.P. NO. �� N,�J L.CJ� i. ` .� _�J
slzE rvo. oF e�ocs. +K'^;y 'tj', �``i 'r� 'S I �;�'; i/ �' e'1
OF lOT 70 x 90 ��ow o� �or o �.� u.. 1 7�'
115E OF , oy\: � 8 4f'3 •
EXISTING BLOG. �
SETB4CK LINE FFOM 1
cErvrEA or srn[[• SO REAR VARO y�
SIOE YARD RIGHT �O LEFT �O vA� ,YQ S arFROVED
DESCRIPTION OF WORK
NEW A. ALTERATION ADDITION
REPAIR MOVING �EMOLISH
BUILDING 1611 �.yC'O RO MS O STORIES 1
SIZE
E%TERIOR WALL C� ROOF L i
COVERING 9tuCYtU - COVERING 1101rLRO
LJ�SE OF NEW
0u,�o,N� Residence & att. garage
Plan 1-H
I HERE9V RCKNOWLEDGE THAT I MAVE REhO THIS APPLICGTION 4ND awrt un er vafuation is for tAe
ST/�TE TMAT TME R90VE IS CORRECT NNO AGREE TO COMGLV WITM RLL
CrtY OR�INANCES A STATE LAWS REGULFTING 6UILOING CONSTPUG
iioN. VALUATION "'O°� �• O :y,
SIGNATURE OF � " � PERMIT FEE g� OCO
PERMITTEE 15 967�vV 17�J�
) PLAN CHECK $
$
AtJTHORIZED AGENT TOTAL FEE $ 'z� Q �