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Home My WebLink About1059 CONCORD ST - Building Permits(714) 754-5273 • Fax (714) 7544856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1059 CONCORD ST Status: ISSUED Suite: Applied: 06/07/1999 Vicinity: HOUSE & GARAGE Issued: 06/07/1999 ParcelNunmber: 14165212 Zoning: R1 R1 ISSUED BY: Applicant: SWORD, LARRY Address: - Phone: Zip: Owner: CLARK,' -JAMES R TR, Address ADEN, GERALD , COSTA MESA, CA - Phone: - is 1059 CONCORD.- Zip: 92626 Contractor: SENTRY ROOFING CO , Address: 3364 NEVADA AV 92626 Phone: 714-751-7663 .. C.M. , .� Zip: ., License:, 487659 Arch Eng: Address: '. Address: ., - Phone: - - Phone: Zip License: Zip: License: SCOPE OF PERMIT ' REROOF - T/0, INSTALL 7/16" OSB BAORD, 1 LAYER 30 # FELT & ELK PRESTIQUE COMPOSITION SHINGLES & NEW ` BUILT UP ROOF OVER FLAT AREA. , FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,878.00 Permit: $137.25 = Claim Valuation: $7,678.00 SMIP Res: $0.79 SMIP Com: $0.00 - Other: $0.00 Inspection: $0.00 Total: $138.04 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right -0-0 , ACCESSORY Front , 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this 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 if work is suspended or abandoned for a period of 180 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 required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 DECLARATIONS ORKERS' COMPENSATION DECLARATION: .. hereby affirm untler 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. ❑ 1 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: Carrier: ,. Policy Number: (This section need not be completed if the permit Is valued et one hundred dollars ($100) or less.) W�I 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 laws of California, and agree that if should bee me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pr visi Applicant Signature: r� N Date: WARNING: FAILURE TO SECURE WORK S' COMPS SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3108 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi/mess WW PP fessions Code, and my license is in full force and effect. Lic. k `TO l0 Class k 2 `�f Contractor's Signature: Data ; CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Cade). Lenders 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 to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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. Signature: Date: 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 filed 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 en RMPP (Risk Management antl 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 a plication 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 jJ 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 It 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. Signature: Date: 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. net Of Legal0 er(s) J o� D A rAuthori Applicant gate CODE INSPECTION TYPE p9iE INTITIA CODEINSPECTIONTYPE PATE MALS 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof L GYUT� 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244646 CITY OF COSTA MESA PLA"-IING DEPARTMENT A.P. No. 1111 rrr1 Bldg. Permit No., PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address tn�a r0mmn.r1 rncr4 ff'ZA rAi TFnDNTA Owner's Name RF R R! CANNON Bachelor or 1 - Bedroom Units 2 - Bedroom Units 3 - Bedroom Units $25.00 = 525.Q0 @ $40.00 = $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = Total number of Dwelling Units 1 Total Fee S25.00 Planning Department Approval Date gg ? Park Area No. 1n By_W.L.D. oim Applicant's Signature ~ - -I— CITY OF COSTA MESA PLANNI' DEPARTMENT ?F-77P,p—<000011448 ** * *25.00 A.P. No. Bldg. Permit No PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address Inr.cs,rorrror rCOCTA rircn rAl tt:nn•TA Owner's Name oc V. r•< r.nIInra Bachelor or 1 - Bedroom Units i @ $25.00 2 - Bedroom Units 3 - Bedroom Units @ $40.00 = @ $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = Total number of Dwelling Units I Total Fee r2; OO Planning Department Approval Date I ..r 7-) Park Area No. in By :�.! . 7. pin. Applicant's Signature � 1 PROJECT ADDRESS: 1059 CONCORD ST UNIT: OWNER'S NAME: ADEN ADDRESS: 1059 CONCORD ST COSTA MESA,CA 92626 751-2675 ARCHN:NGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: NOCK PLUMBING (714)895-1246 ADDRESS: 11610 SEABOARD CIR STANTON CA 90680 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenting' ith Section 70001 0l Gnomon 3 of the Business and Prolessums Code, and my license is in full lorce and effect. CITY LIC.: 050386 ��p STATE LIC.: 5 1 1 9 7 1 CLASS: C— 3 Date '1.��(;�L.( Signature; _ _ _ _ — WORKERS' COMPENSATION DECLARATION: I hereby athrm that l have a certificate of cons I to sell insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 3800. Lab. C). 13 CeNG.: 116799290 EishledE: 03/01/92 COMPANY: STATE ❑ CertiliM Copy is hereby furnished. � Certified copy is IAeO the cityBuiltlm 'vision. 'Oatei ,1_�-V_/ / Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: ThmsectionneN otbeconpill the pont i5 for one hundred ($100) or less). I certify that in the performance at the work for which in* permit is issued, I Shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: IL after making INS declaralkin. you should became subject t0 the Workers' Compensation provisions of the Labor Code. you must Iorlhwith Comply with such provisions on INS permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby alums that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the ContractorsState License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to is issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors State License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Processions Code) or that he/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 penally of not more than five hundred dollars ($500). 1,as owner of the properly or my em levees win wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Ecclum 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a properly who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve for the purpose of sale). 1, 0s Owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Cade: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contraclar(s) license pursuant to the Contractors' State License Law). I am aware Thal proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. B P. C. lot this reason: Date: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant wAOwill not (circle one) need to comply with said state codes and the requirements for a permit for construction at modification from the Air utility Management District. Residential construction applications are exempt from mese provisions. Date. Applicant: I hereby cenily that I nave read this application and state Ihal the above information is correct, I agree to comply with II city and County ordinances and state laws relating to building construction and hereov author@e represen awes of this city to enter upon above mentioned property for inspection Purposes 'Date L&�e_6_( Signature. Driver's License or Social Security .: 1641-46 While—Bwding, Groan—Coco Enforcement: Canary—Applicant: Pink—Revenue; Gowunrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 05227 PERMIT NO: P 052276 PLAN CHECK NO: N GOVT: N SUPP: N ONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH JOB -DESCRIPTION CHANGE OUT WATER HEATER SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: SMOKE DETECTOR RE?UIRED IN THE HOME aFTE 1E IEx%iEkiE iF 1F%+F ar. 1F TF 3E IF #jE iE +e RF aE %iE Y9F%?F aF iF AE iF iE 1F*aE%lE#h%TE 1E a(-iP+E%aF iE%K-?F aE 9F Tf TE iFY1F 7F*IF iE+f TF iE-lE%%i(T4 v,. aE 1F dE%% 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 RGHT: FT IN PARKING REQ: PROV: PARCEL: 14165212 ZNE: REF NO: PLANNING NOTES> > %iF iE 9E aE it iF+E 7f 9f 9E 1E%%TF%%#+E % IF >E # k of IF iF %iF yE BF'K' iF 9E *%9E iF%iF 9E # %aE iF XF 8!•-3E TF 9F iF% ie 1F of %±F?F aF aE iF % !E # aF %# # iF %iE%%iE iE% %# RE 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: APPLICATION ISSUED BY: � DATE:/ iE'3E*iF#9E iF i('iM1 9F iE iF>!'IF?E*%#?(-iE#iEi�i'�F''R'T• �%iFl��ir iFTi'iiF£F3F iF iE'1E K'iE iE iE iF iE iECAc�iEu #%%X•%aF iF+E iF SF 9E%iEN%%iF yE>FiE%kN•%iF iF lk lE TE iFiF 9F K1F aE 16k%K•% E iE aF 9E iE 1E%aF 9F-Y.iF aE#%iE%a!%aE %i69F IF iE%%TE IE iE%TE iE TFY9E 1F ie LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 225% SMIP/NON—RES PLAN ISSUE FEE 3.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 2.00 3.00 0,00 5.00 5.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 5.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5.00 iE iF iF iF aE%TE iE*%iE ib%iF k9F%•%%3E*K***%aF*3P IF**IF#**K.*IF1F*1E%***aF*iF*1F%*8F***TF**9E IE%**%iE !<-%%%1E 1F%iE%iE%9f 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 PLU 1 WATER HEATER AND/OR VENT 2,00 2.00 END OF FEES 01 Z5rZ?E32—Cr029632 T'—:-7 _)A E: C5'14/G1 '(IrE: .21" CONSTRUCTION AND PLANNING APPROVALS Permit # '- y.. Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd, 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 l 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. Ducts, Ventilating - 71. Product Piping O Gas OOil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O Oil 25. Roof Sheathing 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 I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 1 79. FINAL INSPECTION 32. Electrical Power Meter-Final •- 80. FOOD CERTIFICATE ISSUED 33. Final Electric :-;• Notes: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test rt 36. Hood or Canopy 37. Final Factory Fireplace 38. Final PlumbingLrM 39. Water Service-Final 40. Gas Service-Final j 41. Solar Domestic-Final j 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING ' 49. Electric Release to Edison _ 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF.00CUPANCY No. Date OWNER GANNON, R. E. d E. M. DATE 4-26-72 JOB ADDRESS 1059 Connnrd Strout BUILDING PERMIT NO. 34616 do No. 141-651-12 LOT TRACT FIRE ZONE INSPECTIONS Si nature Date GROUP I d J TYPE V ZONE R-1 .SOIL SUBCONTRACTOR _ PERMITS ISSUED GAS Date Number Si nature WATER Plum bi ROUGH PLUMBING J. I PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER 0 ROUGH WIRING 10-7 Heating and Vent. TRENCHES ORMS STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING .yLy1 _ Z -x- LATHING — IN OUT LATHING PLASTER, BROWN COAT STRUCTURAL, FINAL tr' HEATING, VENT., REFRIG. AND A.C., FINAL _ PLUMBING, FINAL AND GAS TEST �. ELECTRIC, FINAL 1�.'} _7. 34616 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely TEL. NO. 7^V ,0011 a6* ****57.53 APPLICATION FOR BUILDING PERMIT RECEIVED JY LDING RESS Q� ER TER CEM' IL RESS �f Z W W/1_UY ZI-STRUCTIONNDERtl dZ LIC. NO. —7 24-71 L. SIDE FT. on J NCHNRESS PERMIT NO. A.P. N co JmHITECTQENGINEERNQWitRESS rADDRRESS tai EXTERIOR WALL BUILDING WZTRACTORO ADDRESS O� Z COVERINGA J9,,e RESSO J CL F-- VZ DISTANCE BET. WOTEN2 TRACT NO. that the above information is correct and agree to comply with SIZE OF LOT /I (J be TEL. NO. 7^V ,0011 a6* ****57.53 APPLICATION FOR BUILDING PERMIT RECEIVED JY ZONE / D TER CEM' DA E ISSUED YARDS APPROVED YARDS LIC. NO. —7 24-71 L. SIDE FT. C/L STREET) ~ / PERMIT NO. A.P. N W tai EXTERIOR WALL BUILDING ROOF ADDRESS O� LSD COVERINGA J9,,e REAR FT. J CL USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & TRACT ,/ that the above information is correct and agree to comply with LOT BLOCK NEW ADD V1 I ALTER F REPAIR MOVIN'Q L OWNERG the State of California. Z I hereby certify that I am properly licensed as a contractor under S THE AMOUNT SHOWN UNDER V A yALu$ Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A am exempt from the provisions of tt tate of California Business FIRE Oe7 ZONE TV APPROVED 11) TEL NO ZONE / NO. OF PLANS SE OF NI BUILDING CITV I YARDS APPROVED YARDS LIC. NO. MAIN BUILDING ACCESS( L. SIDE FT. C/L STREET) ~ NO. OF BLDGS.%FROM B INOW ON LOT FRONT FT. I- SIZE OF / �' NO. OF Q / Z W NEW BLDG. ! ROOMS STORIES L. SIDE FT. APPROV ~ APPROVE W tai EXTERIOR WALL Z ROOF _ COVERING LSD COVERINGA J9,,e REAR FT. J CL USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & 1 MAIN BLDGS. ACCESS. Q �I D VAR. * DATE O !2C.U.P.+ APPROV ~ APPROVE W RY Z d D O C~.7 I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with cc all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of (n the State of California. Z I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER V the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A am exempt from the provisions of tt tate of California Business and Professions Code Divi 3, a er 9. VALUATION PERMIT FEE Signature of Permittee /b PLAN CHECK Authorized Agent � �- i TOTAL FEE STATE FA b 0 ON IS FOR FEE ONLY: W ¢ m J M m E h,Y o I LL :. 1990 _.....,_.,-..,..._.._,........-._ COSTA MESA BUILDING -SAFETY DEPARTMENT FEE P. O. BOX 517 COSTA MESA, CALIFORNIA RECEIVED dU N 1 1 1963 For Applicant to Fill In Completely APPLICATION FOR PERMIT FINANffiL6W. TYPE OR PRINT C1Tfo01°�T#'M E?Rly ABUILDING DDRESS ZO q[CHIPT NO. COSTA MESA. CALIFORNIA _PE O - -��----��----....•-_._...,�_ _ _ ` R[C[IVK7 pAT R=CH V[D DATE IS ED OWNER l� L/•{[I I 1q f O MAIL �� BUILDING ADDRESS ADDRESS FIRE TEL. / ZONE TYPE GROU CITY Q NO. (a'� GA APPROVED ARCHITECTTEL BY DATE OR ENGINEH NO _ / ZONING �`,.-rte O J J ADDRESS Y / ZONE NO. OF USH OR NSW Sing /� R. E. Ande n ,Eonstructi o. PLANS SU ILDINO CONTRACTOR L lab e Lot Tract 4536 ADdk§Q . j DESCRIPTION . �ahei A. P. NO. norie T9 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL. LIC. E N j �_ _ 90" TO SIDE S REAR P. L. EAVES SIZE / NO. OF SLOGS. ALLOWED (U. B. C. REQUIREMENT) OF LOT e NOW ON LOT YARDSAPPROVED YARDSAPPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L RHHT) SETBACK LINE FROM j / FRONT �~ FT. FT. CENTER OF STREET REAR YARD �I �` R. SIDE FT. FT. SIDE YARD LEFT RIGHT b / .� DESCRIPTION OF WORK L. SIDE FT. Fr. 33G" NEW ALTERATION ADDITION REAR FT. FT. DISTANCEBET. BET. MAIN e MAIN LDGS. ACCESS. BLDGB. REPAIR M VI G DEMOLISH VAR.# DATE BUILDING NO.OF SIZE J U)KY fROO MB STORIES C. U. P. APPROVED EXTERIOR WALL ROOF F APPROVED 6-6-6 3 COVERING LCo COVERING W. L. D. DATE USE OF B ILDIN AND WORK TO BE PERFORMED $$ 60. Fr. G I HEREBY ACKNOW OH H H [ READ T APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE z ANDSTAT S THAT H A V R AN ORfi[/TO COM- PU RPOB[ OF ESTABLISHING A PERMIT FES ONLY. O PLY WITN ALL IN C A R[OULATING CO BUILDING N N VA LI TION /� R ` (, / PERMIT FEE S PLAN r, ECK $�}" SIGNATURE PERMITTE �% I/ /aQ� AUTHORIZED AGENT ys- L 5-6 TOTAL FEE $ O J