HomeMy WebLinkAbout953 CONGRESS ST - Building Permits(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lob Address: 953 CONGRESS ST
Suite:
Vicinity:
Parcel Number: 42242307
Applicant: AMARA, MARK
Address:
Owner: HURD, JESS D
Address 953�CONGRESS ST
, � COSTA MESA, CA . �
Convactor: MARKAMARAL ROOFING
Address: 14087 APPLECROSS
HUNTINGTON BEACH, CA
Zip: 92648
Arch :
Address:
Zoning:
Phone:
Zip:
Phone:
Zip: 92627 .
Phone: (714)960-3032
License: 696775
Eng:
�' Address:
ISSUED BY:
Status: ISSUED
Applied: 10/01/2004
Issued: 10I01/2004
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF: T/O COMP SHINGLES, REPAIR SHTG. AS NEEDED, 30 # FELT & 22 SaR'S OF 30YR. GAF COMP. SHINGLES.
FEE SUMMARY
Plan Check: $0.00
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: ' $0.00
Total: $97.75
SETBACKS �
MAIN STRUCTURE Front 0- 0
ACCESSORY Front� 0-0
PARKING Ezistinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation: 5s,aoo.00
Claim Valuation: $3,aoo.00
Right 0- 0
Right 0- 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 1 BO days, or it work is suspended or abandoned
for a period ot 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
requlred Inepeetione and t(nal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaas-as (voo�
WOflKERS' COMPENSATION DECLARATION: ' _ .
I hereDy aHirm untlar penelty of perjury one oi the following deciaretions: � � . �
❑ I have end will meintain e certificate of consent to sel6lnsure for workers' compensetion, as provided tor by section 3700 of ihe Labor Code, for the peAormance ot ihe
work lor which �his permit is issuetl.
❑ I have antl will maintain workers'rnmpensation insurance, as required by saction 3700 of the Labor Code, for the perfortnance ot ihe work for which Ihis pertnit Is issued.
My workers' compensation Insurance carrier and policy number are:
Carrior: Policy Number:
(This section need not be completetl il the permit is, valued et one hundred dollars ($100) or less.)
❑ I�certity that in the pertormance of lhe work for which this permit is issued, I shall not employ eny person in any manner so as to become sublect to the workers'
/compansation laws of Califomia, and egree that if I shouldppcome suDject b Ihe workers' compensation pmvisions of Sectlon 3700 oi the Labor Coda, I shall forthwith
comply with these provisions. //
Appicl antSignature: �uA � i ,_�J/ [\/Date:�i�J /"�Y
WARNING FAIWflE TO SECURE WORKEFS' CAMPENSATION CA RAGE IS UNLAWFUL AND SHALL SU9IECT AN EMPLOYER TO CRIMINAL PENAlTIES AND CIVIL FINES UP TOONE HUNDREO
THOUSAND DOLLARE ($100,000), IN AODITION TO THE COST OF COMPENSATION, DAMhGES A$ PqOVIDE� WR IN SECiION 39080F THE LABOF CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRAC70RS DECLARATION:
aflirm ihat I am licensed under provisions of Chapter 9(commancing with Section 7000) of Division 3 oi ihe 8usiness and Professions Code, antl my license is in full
iyeNec�. Lic. # 77 c�ass �C' ^� 9
ors Signature: �� � / _�_ � fDate: _ /o� /-o y"
CONSTRUCTION LENDING AGENCY:
❑ I here6y aHirtn tha� �here is a constmction lending agency for the peAormance of the work for which �his permit is issued. (Sec. 3097, Civil Code).
Lendefs Neme: Lenders Atltlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby attirm that undar penalry of perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW tor �he following reason (Sec. 7037.5, Business and Professions
Code: Any ciry or county which requires e permit to consimct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requiras the epplicant tor such permit
b file a signed statement Ihet he or sha Is licensed pursuent to ihe provisions ot ihe Contrectors License Law (Chepter 9(commencing with Section 7000) of Divlsion 3 of ihe
Businoss and Professions Code) or that he or she is exempt iherefrom and the basis lor ihe alleged ezemption. Any violalion ot Section 7031.5 6y any applicant for e permit
subjects the epplicant to a civil penalty of not more ihan five hundred dollars ($500).):
❑ I, as owner oi ihe pwperty, or my employaes with wages as their sole compensa�ion, WILL DO TME WORK, and ihe sirucNre I5 not intentletl or otteretl tor sale (Sec.
7044, Business antl Professions Code: The Coniractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work
himself or herself or ihrough his or her own employees, provitled that such improvemenis are not intended or ottered for sele. I(, however, the building or improvement is
sold within one year of completion, ihe owner-builder will have �he burden of proving iha� he or she did not build or improve for purpose of sale.). '
❑ I, as owner of the propetly, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to conslmct ihe project (Sec. 7044, 6usiness and Pmfessions
Code: The comractors License Law does not apply to an owner of pmpetly who builds or improves thereon, and who contracls for such pmleq with a comractor(s)
license pursuant to the Contractors License Laws.).
❑ I am ezempt under sec.
Signature:
Owner ID verilied by driver's license. ❑ Ves ❑ No
Business and Protessions Code tor ihis reason:
Ventication oi Ownership by (rype of document, i.e. - propeny tau bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N:
Driver's License No.
Date:
Expires:
❑ I here6y certify ihat no excavation tive (5) or more feet in depih into which a person is required to descenq will be made in connection wifh work euthorizetl by this
permit, end that no huilding structure, scaHolding, falsework, or demolition or dismantling ihereof, will be more Ihan thirty-si: (36) feet high. (Chap. 32, Gry 2, An 2, Sec.
341, Ttle B, Calitornia Adminis�rative Cotle).
❑ As owner-�uiltler, I will not employ anyone to do work which would require a permit from the Division of Indusirial Safety, as notetl ebove, unless such person has e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I cenity under penalry of perjury ihat I have read this application and stale ihat the informaUon given is
correct. I egrae to comply wit� all s�ate laws and ciry ordinances relating to buiiding coreWdion, antl authonze reprasentatives ot ihe Ciry ot Costa Mesa to enier upon the
ebove-described property for inspection purposes. I agiee not to occupy or ellow occupancy oi any building authorized by this permit umil final inspection.
COOE�, INSPECTIONTYPE
1616 Fizetl System Final Fire Prevenlion
1266 Pool Spa Final
200 Finel Re-Rooi
201 Final Block/Retaining Wall
202 Final Factory Fire Place� "
203 Finel Sign
204 Final Demolition
PeI€ INTRIALS
—�-0
CODE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 final Planning Approval
222 Final Site
250 Final Building/Occupancy
Date
PAIF INIRIRLS
Pfl0.1ECTp00BESS: 9S� CONGRESS ST
OWNEX'S N�ME: B ILL FiOLLAND /J
. �ooaess: SAME � (.� — ? l2 7
COSTA MESA
CA 92627
�flCH/ENCINEEP: .� 1��� 4$— 7 1 � 2 . flEG.NO.:
aooeess:
UNIT:
uxit:
PEeMIrrEE: AMR E ( I 1 A) 9 3 7— O 1 O 1
• noowEss: 620 N ECKIiOFF S't
ORANG�. � CA 92668
LICExSE� CON7BRCTOB OECLAMTION: I Aereby aifiim ihat I am licensetl untler pmvisions of C�apter 9(commencinA ��h Sec[ion
70W) of Division 3.0� Ihe Business and Pm�essions Cotle, an0 my license is in lull force antl eHec�.
cmuc.:099126 srneuc.:473092 cus$$$:� /y/J
Oate: ' ' Signature: � ��" � �
WOPNEBS' COMPENSFTION OECUMTION: I �ere�y attirm [ha[ 1 have a ceniticate of cansent to self�insure or a cetlificaie of Workers'
Com�ensation Insurance, or a cetlifietl copY thereoi (Section 3800, La6. C�.
�xo.: RMWCl.17.7532 EXP.OATE: J�1IOZ I9O
�r�xx: NATL UNION FZRE
Certifietl copy is hereby lumishetl. ❑ Certifietl copy is filed with the ciry, u,,,i���ld///in/p �ivisio .
Date: � �� � ` �D APPlicant �����"� . � .
IXEMPfION FflOM WONKEPS' COMPENSRTIOX OECUMTION: (iNs sectian necd not be mmDle�eO il Ne permi� is tar one Aundrea (E700) or less�.
I tertity Nat in Ih¢ p¢dormance O7Ihe work lor which thi5 permi� is i55ued, I 5�all not employ any person in any mannef 5o as �o beCome
su6ject to the Workers' Campensation Laws oi Califomia. �
Oate: Sipnature:
NOTICE: Ii, aiter making this Ueclaration, you shoNd become suble�� �o the Workers' Compensalion Omvisions oi Ihe La6or
Cade, you must forthwit� comply witA such pmvisions or ihis permit shall be Oeemed revaketl. •
CONSTBUCTION LENOING RGENCY: I here�y aflirm that there is a consimction lentlinp agency for Ihe petlormance of Ihe work lor
wAic� �his permit is issuetl (Section 3097, Civ. C).
LEHOEH:
' ROOflESS: ' " -
; CITY OF COSTA MLSA — BUILD7NG PERMIT PERM D10: B 046%41
PERMI'1' T10: B 046"741 FLAN CHLCIS T10: N GOVT: rl SUPP: N
CONSTRUCT'ION- TYPF: 5—DI PERMIT TYPti: STR PURPOSF.: 01'ff
JOB DESCRIPTION . INSTAI.L EXT, VI�]YI, SIDING (ICHU# 3663) $Q FT: 15,250
CLAZM VALUF.: ]5,250.00 CALC—VALUE: 1.5,250.00 GROUP UCC:.R-3 /
COMMENTS: SM6KG DETErTOR(S) RE(�UIRED IN HOME.
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�, Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAItd HUILUING ---------- ----—--- ACCESSORY'BUILDIDIG --�------
PRNT: fiT IN RF.AR: FT IN FRD1T: FT IN RL•:AR: FT IN. ,,
LEFT: F1' IN RGAT: FT' IN L�F".t: FT IDI RGHT: FT IN
PARKIr1G REQ: PRUV: PARCEL: 42424129 ZTIE: REF' NO:
FI,ANNING D10TE5> .
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D E V E L O P M G N T S E: R V I C E S R E Q U I R• F. M E N T S '
7,ONING AFPROVED BY
HUiI,DING AFPROVED BY :
APPI,ICATIObI SSSUED BY.:
iFifiE3E�lE1E-0fiElf�lEi(-3E�EifiF�FifiF�lEiFiE1f�;Fi� Eifi�E-iF
1EiE1(-ifitk#iE�%iE3EiFifjE%�3Fitif�lEiFiflEiEifiEiEifiEiEikjEiE#�lE�1F�EK- 1E3E�1(-3f
I,EGALIZATION;N ' F E E S U M,
OWNEB BUILOEB OECLAM710N: I herehy attirm t�at I am exempt irom t�e Contracrors' State License Law far Ne followinq reason ' B LUG PM T PL UMB I NG EL ECTR I C
(Section 7031.5 Business anU Professlonal Co�e: Any ciry oi county wAich requires a permi6to constmct, alter, improve, Oemolis�, or P L•:RM I T 17 �l . 0 0 � ' �
reDair any simcNre, pnor ta its issuance, also reQuires t�e ap0licant for suc� permit to file a si0ne0 statement that he/s�e is licensed �
pursuant m Ne pmvisions of tAe Contractars' State Licensa Law (Chapter 9(commencing wiN Section 7000) ol Division 3 oi the Business
ana Pmfessions Code) or ihat he/she is exempt tAe�etram antl Ihe hasis tor tAe alleAetl exemD��on. Any violation oi Sectlon 7031.5 hy PI,�iI�
any applicant for a permit suUlecis Ne applicant m a civil Oenalry of not more than five huntlre0 tlollars (5500). I SS UE FF.,E
I, as owner of the pmperty or my emplayees wii� wages as their sole compensation, will do the wark, antl ihe B�)II.nING—DIV�-?
❑ simcture is not intentle0 or ottered for sale (Section 7044, 9usiness anA Pmiessional CoOe: The Contracmrs' State License Law 'j'QZ' j;r, $,--- —? .
,tloes not appry to an owner of a pmpeM who Uuiltls or improves thereon, anA wha tloes such woB �imseli/herseli orlhroup� �
his or her own employees, D�oNEed t�at such improvements are notintentled or ottere0 far sale.1/, however the 6uilAing or
impiovement is sald within one year ot completion, ine owuer will nave Ine �urden o� pmvinA he/sne tlia not builtl or improve ��F: V�.NU�. Ti I i� I$ I
for ihe Ourpose of sale�. . • HI.tDG RM7'
I, as owner oi the DmOeM. am ezclusively contracting with Iicense0 coniractors to constmct tha pmject {Section 70A4, Business � ��� �� �
❑ antl Pmfewions CoUe: ine Contactors' SWte License �aw Aoes not aD�N �a an owner ot propeM �o DUA0.s or impmves t�ereon �
an0 who coniracts for such Orolects vnt� a coniractoqs) liiense pursuant ro tAe Cantractors' State License Law). I am aware **.7�.7� 7p *.� �. ***{p **
that proof oi Iheir Worker's Compensation insurance should be pmvideA to me. '
� I am e�empt un0er Section: B. 8 P. C. , , �
�orihisreason: � � TYPE Q1'Y
Oate: �`'"1ef� SFR
I Oo AereUy certity �ha� I am aware oi an� untlers�and the requiremen�s of California Heal�� anA Sa�e�y Code Sactions 25505, 25533, antl �
25534 and tha� I or any fuNre builtling accupanl vnIV=11 no� (cirtle onq neetl �o comply wii� sai0 s�ate codes and the reQuiremen�s for a
permit for constmctbn ormo0ification imm Ihe Air Oualiry Management District. ResiOenlial constmction applications are exempt tmm
�hese pmvisions.
�ate: ApPlicant: '
I hereby cenity tha� I have rea0ltlis aDPlica�ion antl s�ate that I�e ahove informalion is correct I agree to comply wi�� all ci�y and counry �
ordinances antl state lavrs relatinq to UuiiEinq constmction an0 �ereq� authorize representatives oi this ciry to enter upon ihe above-mentionetl - -
pmperry forinspection purposes. �////�p�/
Date: � f-� � � �(�, Signature: �%�� � / �N ;
Dn�er's License or Sociai Secunry x: � �
1641�48 W�ite—Builtling; Green—COCe En�orcemen�; Canary—Applicant; Pink=Revenue; GOIEenrotl—Assessor '
�JiS�
----------� DATE: -----------
---- DATL: --------�"�
--- DATE: �€�����✓
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A R Y � ST'RUCTURAL SEGMENT:Y
CHArITC FIRE SMIP/RF.S GRADING
' �_ � x.�%
sMi�iNoni-xEs
PFRMIT ISSUF. F'LADI—CEiECK TOTAL � PAIll UUE •
172.07 0.00 0.00 172.07 172.07 .00
CiN TOTALS---? COT�I,F.CTF.D: 17?..07 OVER/SHQRT: QO
PLUMBI.NG ELECTRIC MECHANIC F:LRE SMTP./TOT GRRDIDIG PLADI—CHF.CK
' t.oi
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I N D I �� I i) U A L F L: E D ft E A K D O W N
1
D E i C R I P T I O PI UD1IT COST TOTAL COST
AL7'LR BY VP.I.UE RE.iIDErITIAI, riozoniE i. o0 9 5, 250. 00
END OF FEF.S �
\\
�
01 OOQ57332-00057333 T4]T 27?.07
'DATE: �3/29/9d TiME: 13:s7
i _
CONSTRUCTION AND PLANNING' �� P SPA
APPROVALS Permit # Date � Inspector AppROVAIS 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. .
S. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System � 61. APPROVAL TO DECK
11. Property Sewer Line & House Connectiori 62. Backwash & Receptor-Final
12. Sewer Cap . � 63. Heater & Vent�Final
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final � '
15. Rough Electrical-Conduit � . 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access ApProval �
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. 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 Pipin9 O Gas ❑ Oil
23. Gas Pipe-Rough & Test '- � _ 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage�Tank O Gas ❑ 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 ,� � HEALTH DEPT. REQUIREMENT
31. Plaster Brown'Coar ' `'� 79. FINAL INSPECTION �
v; -
.32. Elecirical Power MeterFinal �� 80. POOD CERTIFICATE ISSUED -
' �.
33.. Final Electric � Notes: -
34. Final Heating�& Air Coniiitioning � ����� ' .
35. Final Gas Pipe-Tesi � ' <<`,'
36. Hood or Canopy ' �'�r �.' � : -
37. Final FactorY Fireplace •
38. Final Plumbing , ��; � - . . . . : '
39. Water Service-FinaL � �� - '
40. Gas Service-Final � - � . . �
41. Solar pomestic-Final � ( �3 �-�� ( ,
. .. L..�- C� Q
42. Backflow Preventer . , � � (,�,�.
43. Backflow Irrigation . - �
44. Landscape Irripation SYstem , . - �
45. �Sound Attenuation • � �
46. Handicap Regulations ,� - �
47. FINALSTRUCTURE&BUILDING t 3�...�� (Q(,�G'�
48. FINAL PLANNING „�) .
49. Electric Release to Edison �.'.� - •
50. Gas Release to Southern California Gas Co _.. � ,
51. CERTIFICATE OF OCCUPANCY _ '
No. Date �
.... .. Mui i,u1YlL; w i ie �nm
JOB ADDRESS q5� Con� er ss ;
GENERAL CONTRACTOR q7�lied
APNo. ��5_�qZ_O7 LOT 107
INSPECTIONS
SOIL
GAS
WATER
ROUGH PLUMBING
PROP. $WR. LINE Q HOUSE CON.
SPRINKLING SVSTEM
MISCEL�ANEOUS
ROUGH HEATING AND AIR CONOITION�NG
TEMPORARY SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGN WIRING
TRENCHES �/FORMS Q�STEE4 REINF.
FLOOR SYSTEM
BONO BEPM ❑ STEEL REINFORC�
SHEATHING
FRAME AND FLASHING
LATHING - IN OUT
PLASTER, BROWN COAT
STRUCTIIRAL, FINAL
MEATING, VENT., REFRIG. ANO A.C.. F AL
PLUMBING, FINAL ANO GAS TEST
ELECTRIC. FINAL
11-1y-b0
DING PERMIT N0.
SUBCONTRACTOR
' PA70 � ,k^** �
r 793�Z NOV 18-68cMs:00 a�z t�.5c,
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
Fo�Applicant to Fillin Completely qECEI eo ev DATE R cei ED
BUILDING � � - DA����UE�
ADDFESS // (pg'
OWNEF / f A.P. ND. J" - U P� �O
MAIL BUILDING
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u1 W .rE� NE NO.OF ,, / USE OF NEW
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w � STATE CITV �'.4RD5 APPROVED VARD APPRO D
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SI2E NO.OF BLOGS. ��py�nn+�+� �A'�
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� SIZE OF OOd / NO.OF / / � ��
Z NEWBLOG. ROOMS STORIES L.SIDE FT. .�l FT.
a EXfERIOR WALL ROOF ASP%�!I l ..j
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a USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
a MAIN BLDCS. ACCESS. BLDGS.
Q � - VAR.,$ DATE
O j C.U.P.� APPROVED
yAPPROVED �
Z
�
UI hereby acknowletlge thai I have reatl this application and state
' � that the above information is correct and agree to comply with
� bll laws re0ulacing builtling consiruction, and I shall not employ
F any person in violation of the workman's compensation laws of
(q the State ot California. �,/ � �
(%
Z I hereby certity ffiat I am properly licensetl as a contracior untler SQ. FT. o
tha State of California Businesz antl Protessions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOfi �
Chapter 9, and that such licenses are in tull torca antl etfect, or I THE PUPPOSE OF ESTABLISHING A PERMIT FEE ONLV: v
em ezempt from the provisions of the Staie of Celifornia Business Q
VALVATION
antl Professions Code, Division 3, Chapter 9. i4�11 N
PERMIT FEE $ (/ �/ ]
Signature of �./ —/ �v1 m
Permiitee �/� � �" I l• � $��3 v,� P�qN CHECK S E
� o
LL
Authorizetl Agent TOTAL FEE $ .�
a:
UA I t 12-10-biS
BUILDING PERMIT N0.
JERAL CONTRACTOR p�er-B�lder DESCRIPTION of WORK �,eRal,ize Patio Addition
No. iis_zqz_n� LO7 im TRACTiA72 FIREZONE . VALUEE1.000.00
YNSPECTIONS
� SOIL
GAS
W qTEli
ROUGH PLUMBING
PROP. $WR. LINE Q HOUSE CON. �
�SPqINKLING SYSTEM
MISCELLANEOUS
ROUGH NEATING aN� AIR CONOITIONING
7EMPORARY SERVICE OR POLE
UNDERGROUND � POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF.
FLOOR SYSTEM
BOND BEAM ❑ STEEL REINFORCE ❑
SHEATHING
FRAME AND FLASMING
LATHING - IN n OUT n
PLASTER, BROWN COAT
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.6. BOX 1200 COSTA MESA. CALIFORNIA 92626
DEC 11-68P? �,00 571 �***�t`�•��
[p5t
APPLICATION FOR BUILDING PERMIT
For Applicant to Fi// in Comp/etely
flEC F4 BV D T RECEIVED DATE ISSUED
ADDFESS ��� C.O/✓ G� S`S J / � � / � /�L
P
OWNER /y J� � .y�✓!J- A.P.No. /5 -3 3= .
Mq � L t�J /� (� 6UILDING
ADDFESS i�/ (O Z�If J� ADDRESS
TEL. TRACT LOT BLOCK
CI7V OS'� e /p NO. �'
('ANSTRUCTION W A
l@NDER
BqqNCH
OWNER
/aDDRESS VALUE
�+pCHITECT TEL. S $
Oq ENGINEER N
FIRE ��
AODRESS ZONE TVPE GROUP
APPROVED O„G
CqNTRACTOR pw.ve �e BV DATE �-I �
A4DRESS 'J � O � f �J � �
�p TEL. ZO NO.OF USE OF NE
`O �/' �y�C1•/�' N� � / 7 � PLANS BUILDING
Clrv ��iiy � , L
STATE �J � CITY �'ARDS APPROVED VARDS APPRO ED
LIC. NO. / U IIC. NO. MAIN BUILOING ACCESSORV BUILDING
SIZE NO.OF BLDGS. (FROM C/L STRE T
OC LOT NOW ON LOT ONe fiONT FT.
USE OF �
EXI5TING BLDG. FT
SIZE OF - NO. OF
N�W BLDG. ROOMS STORIES L. SIOE FT. FT.
EXTERIOF WALL ROOF -f-
COVERING i/e • COVERING AS/ �'L • :aEAR /FT. ` FT.
USE OF BUILOING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
/ VAF.iW DATE
j 0, /4e �• C.V.P. q� APPqOVEO
APPROVED l
V
� hereby ecknOwledge thet I have reatl [his application entl ste[e
thgt the abova intormation is coneti antl epree to Comply witb
ell lews reguluting builtlin8 consvuction, antl I shell npt employ
eny Oerson in vlolatlon ot iha workmen's compensation laws of
i�e Stata ot Celifomla.
I hereby carN(y ihat I am pro0arly Ilcenmtl es a contracror untlar SQ. FT.
the Stata of Celifarnia Business entl Profaulonf Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, entl thet such lieenws ara In full force antl aftoet, ar I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV:
em exempt trom t�e provisions ot thaState California Buelnasz VALUATION
a�tl Protassiona Coae, Divislon 3, Chapter 9 (f�1 PERMIT FEE $
/
Slgnatura of
Pe�mittea ����% $ �UDD PLAN CHECK $ —_
A�ithorizatl ABent TOTAL FEE ff �
I QRANGE COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT �
636 North Broadwar � � � � � � � �
� / SANTA ANA, CALIFORNIA
PLOT PLAN
Show location ond distances from
property line and between buildings.
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