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Home My WebLink About201 FAIRWAY PL - Building Permits ,51 CITY OF COSTA MESA 4 " BUILDING DIVISION F . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT• ammIT os4. PO4-00363 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 201 FAIRWAY PL Status: ISSUED Suite No Applied: 05/25/2004 Issued: 05/25/204• Vicinity: -der Ar 1 ISSUED BY: / Parcel Nunmber: 43921214 Applicant: SZABO, KEVIN Address: 2737 S CRODDY STE D Phone: (714)241-1414 SANTA ANA,CA Zip: 92704 Owner: SPEAK, ROSCOE BENJAMIN TR Address 206 LILLIAN PL Phone: COSTA MESA, CA Zip: 92627 Contractor: COAST ROOTER PLUMBING HTG &NC Address: 2737 S CRODDY STE D Phone: (714)241-1414 SANTA ANA,CA Zip: 92704 License: 529127 • Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT CHANGE OUT WATER HEATER FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 - -• Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 . 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc)' $0.00 0 Receptors $0:00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin- $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect .$0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial ,. $0.00 _ 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00- 0 Water Service $0.00 .0 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 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 I 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 ,1 work for which this permit Is Issued. pf I 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' ompensation Insurance� 1(l carrier and policy number are; ��`_ ^� Carrier: �TA'C'�r N Policy Number: h (4 �J — V (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) 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 Califor ia, nd agree t I shoulbecome subject to the workers'compensation provisions of Section 3700 of the bor Code,I shall forthwith comply with these provisions. /Iffy L''- c- La Applicant Signature: try' z/ J Date; - 0 WARNING:FAILURE TO SECURE WORKERS VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,(%3),IN ADDm TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.gatu e .52.-5 /2-1 J/ o Classat : s - 7S Co Contractor's Signature: J`f�/./v -�.,NZ� Date: '5- �5- 0� CONSTRUCTION LENDING AGENCY: V' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's 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 en 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 driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel 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 end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires.with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one lime 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 W❑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 an RMPP(Risk Management and Prevention Program for acutely hazarlous 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this geniis/Ilion aEEermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LI 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? 0 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 Ai7 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? 0 Yes 0 No B (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. . ?TT:SI�TfT� egal Owner(s) _ _ ate 0 Li An• •r Authorized Applicant ate x CODE I INSPECTION TYPE PAIS 1ti118$LS PORE t ItISPECTION TYPE PATE Ifs 1616 Fixed System Final Fire Prevention 206 Final Mechanical � �� 1266 Pool Spa Final 208 Final Plumbing 7'r kO-�{ Yl IV 200 Final Re-Roof 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 • w CITY OF COSTA MESA • it ey , BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT tk, PERMIT PERMIT N MBER %bonne t. B98-01630 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 201 FAIRWAY PL Status: ISSUED Suite: Applied: 09/14/1998 Vicinity: Issued: 09/14/1998 Parcel Nunmber: 43921214 Zoning: Applicant: FRED NOLTE Address: Phone: Zip: Owner: SPEAK, ROSCOE BENJAMIN TR Address 206 LILLIAN PL - - Phone: ' COSTA MESA,CA Zip: 92627 Contractor: 10812 LA BATISTA Address: fountain valley,CA Phone: 714-964-0554 Zip: 92708 License: 418550 Arch/Eng: Address: Phone: • • Zip: License: SCOPE OF PERMIT T/OFF&REROOF 1400SF RESIDENCE W/COMP SHINGLES.. / • . v FEE SUMMARY • • Plan Check: $0.00 Calc Valuation: $2,975.00 Permit: $74.75 Claim Valuation: $2,975.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $75.25 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 Existinq: 0 Required: 0 Proposed: 0 NOTES: • 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 DIEtLARATIONS • WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: - - '- ❑ I 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. ❑ I 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 wo ers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This ct/on need not be completed If the permit is valued at one hundred dollars($100)or less.) I certify that In the perfo ce e work for which this permit Is Issued, I shall no thploy any person In any manner so as to become subject to the workers' compensation laws of C ' ml d agree that if I should become subject to the wo rs'compensation provisions of Se tion 3700 of the Labor Code,I shall forthwith comply With these p o s J/ Applicant Signature: Date; 7 Litt( WARNING:FAILURE TO CURE W RRERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE 100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. UCENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Sec on 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect tic.# vim , Class 4 C /7 c� ��Contractor's Signature: r.r, Date:err , CONSTRUCTION LENDING AG' CY: ' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,CMI Code). Lender's 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(3500).): ❑ 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 driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: El I 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)feel 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 e permit to do such work from the division. Signature: Date: Division of Industrial Safely 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 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be flied 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? 0 Yes 0 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 an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia 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 Safely Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a,�ppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes 0 No (Section 65850.2 of the Califomia 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? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 if 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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 end 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 tr 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-de rrproperty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Aer "Sarre Of Legal Owner(s) Eate r— �' dJOr Authorized Applicant " Date INc2EDIONTYPE DATE iCAlS ggDEt IN,SPFCTION TYPE USE EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �LI 208 Final Plumbing 200 Final RlocklR / 210 Final Fire Prcal evention 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 2446.46 OWNER SPEAK, MR. & MRS. R. DATE - 3-14-60 JOB ADDRESS 201 Fairway Pl. BUILDING PERMIT NO. 11559 GENERAL CONTRACTOR Fortune Sidra. VALUE $ 1,250.00 AP. No.119-122-14 LOT TRACT FIRE ZONE DESCRIPTION OF WORK 2 Car Det. Gar. INSPECTIONS DATE I GROUP J TYPE V ZONE 11-1 UT-aerground Soil U.G. Water PERMITS ISSUED ;rgiound Gag — — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas _ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole . Underground Power r� // • Rough Wiring /I�y, Tj X.Ze/ //07.2he) 1,-24,3,=4,Trenches r/ Forms Steel , y r;a- 3 --- .t 6 0 Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing A , V/(c- 1 i 5- -- 6 O Frame and Flashing jg . 1.•.2-7e_ 3 — Z S-— a I -,er In Out at A O ,er, brown coat ,yy`/c- Li-— '71^ (o D Plumbing Finall Electric Fixtures, Final I IY(� („ 1 2 Building, Final e pie-- 6 — 3 2-6d --- 6.45) ya'f,Ce , OCCUPANCY I V/ N Form 210-5M-11-59 S-B P 11559 • 11 559 FEEk RECEIVED CITA MESA BUILDING-SAFETY DEPARTMENT 5 - o P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely CIT" QrAPPLICAgIbN IEQRI PERMIT TYPE OR PRINT BUILDING ADDLRDEG 20J 5AIpgn1 PI COSTA MESA. CALIFORNIA For Office Use Only OWNER AIR,R1 G/kes 1e -9/0 EA / �t RECEIPT NO. I PERMIT NO. MAIL ` 2 n �/// a DATE RECEIVED 17.7E IBB /F ADDRESS 7dd0/ 7/9/e/1.1/4 I .3-r// (("O , G/,f/ G! TEL. CITY a'sr/n �e5�_ NO. BUILDING q X /1I. ADDRESS o�-�� QJC{eir—alt�/./ 04V ARCHITECT SAS T TEL.j(t COSTA MESA. CALIFORNIA OR ENGINEER S�IU NO.ILC: -� ADDRESS 122/2 Cov 7 „ea F, FIRE / ZONE TYPEi3ROUI ,)/CONTRACTOR ��jjCC/ // ,, JJy/ BYPROVED /L� EIt5j I ADDRESS /.Jp /2 (_(JE�O/t:/ /v4/N I� ZoNING A.L • / O,1,9/�O"th NO.OF UBE OP NEW Ir A-/.� CITY v` J , PnLANEq T /, BUILDING STATE /9oZSG. TEL �ry ,( LEGAL y� {L ✓^ ��C LIC.NO. NO. ��/J SY- DESCRIPTION lea Jli- OIZE I NO. OPLOTS. // ( )-i --/g OF LOT NOW ON LOT A.P.NO. USE OF /S_ /9 e ��.� ve APPROVED ALLOWED DS EVES EXISTING BLDG, G L. ��YC� SETBACK LINE FROM iO (CENTER 4N8 BT.) CENTER OF STREET REAR YARD FRONT (9 FT. A, IN. SIDE YARD I LEFT ® /b I RIGHT S - R.SIDE [a- / FT. IN. DESCRIPTION OF WORKFT. IN. L.SIDE 16 �,, �� NEW I ALTERATION I II ADDITION I REAR FT.r/Lal a IN. REPAIR I IMOVING I II DEMOLISH I APPROVED Lf I /1) DATE J9 - SUILDING 2a X�7.J NO. OF ROOMS / STORIES / ✓ 1J�•V�� SIZE G G � COVEREXTERIING OR WALLS', O'I COVERING SH/415'LE USE OF BUILDING AND WORK TO SE PERFORMED n i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNTSHOWN UN�(G VALUATIONIS FOR THE PURPOSEE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS ADULATING BUILDING CONSTRUCTIO ///yyy��{ ALUATION SIGNATURE OF ( 0 0 R PERMIT FEE $ n PERMITTEE JL/ �` f �- y.'/ $ /.;I/ PLAN CHECK $ /- AUTHORIZED AGENT /� eg TOTAL FEE $ ' y OWNER SPEAK, MR. R. • DATE 3-30-60 JOB ADDRESS 201 Fairway Pl. BUILDING PERMIT NO, 11664 GENERAL CONTRACTOR Fortune Bldg. VALUE $ 1,674.00 Al'.No.119-122-11t LOT TRACT FIRE ZONE DESCRIPTION OF WORKAlter Gar to Den INSPECTIONS DATE I GROUP I TYPE V ZONE H-1 14.1erground Soil U.G. Water _ — SUBCONTRACTOR PERMITS ISSUED lyiground Gas DATE NUMBER OSSihead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring /11 I47 4-99-6b rc' - " 'Z-27-‘o /222.c r/ Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing 'f,% • f'Je— S—,3— (mo o L ung, In Out Wt.'s, brown coat 1$--/07e- 4/--sz -( e Plumbing Fixtures, Final Electric Fixtures, Final n ii rr. Jr. ,_ Building, Final 'Y"i) / I /'it" OCCUPANCY Form 210-5M-11-59 S-B P 1166}. 11664 FEE RECEIVE® C STA MESA BUILDING•SAFETY DEPARTMENTmeg,. .1513c/bo P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF E For Applicant to Fill In Completely APPLICATION FORTA PERMIITT TYPE OR PRINT BUILDING �j //� ''1/�/� BUILDING ADDRESS (rot A741/AZ/J41 R. COSTA MESA. CALIF RNIA For Office Use Only RI RECEIPT NO. I PERMIT 0 OWNER /. I - _ -� �1 MAIL n Mir�i BY DATE RECEI/y_eD D �0 L'D ADDRESS / i _ ' / ([ I3�`�d '�L�'d ' /y TEL. BUILDI G /� // p CITY (,o rd /�aA. NO. ADDRESS LQ/_7 Q-Ch-e dLt 7 r"--a',--- ARCHITECT ARCHITECT //77 ^�/,r TEL COSTA MESA. CALIFFRNIA OR ENGINEER hPd alsr/y.� NO. FIRE 1 V ADDRESS /,,, / r.oaJ//�/'d 4�/J� =ONE MJ PE GROUP p//q'/[//I CONTRACTOR .FAewwrNE !JU/LQE�s APPP \ /� DATE g /l�{� ADDRESS /1 9/2 /.ou..1117B, L..Qi1PE * ✓ ZONING1Apr CITY e),/e-614-19r �/�� ZQIfIM1� r I NO.OF . y USE OP N8/ /Ay q liJ\ ( TI po,.N/Sµ..`)F/7 I BUILDING r STATE TEL CENO. /LI(/•.'�S Z� NO. !"G /� \ DESCRIPTIOGAL N 1 (J � I / f.9 ` I NO. OP BLOTS. �j + .1 -� . / OF LOT NOW ON LOT Z A.P.NO. PJ 7 USE OF fJ��zO��C� YARDS �� I. EVES EXISTING BLDG. Fv _ APPROVED ALLOWED SETBACK LINE PROM (CENTER LINE BT) CENTER OF STREET REAR YARD FRO �,/},%�J� FT. IN. SIDE YARD I LEFT I RIGHT � ^ t R. ID i .f1�.L FT. IN. DESCRIPTION OF WORK DE 1� °i `� o~t-s 6OI N NEW I II ALTERATION I L. ADDITION I REAR a FT. IN. REPAIR I II MOVING I II DEMOLISH I APPROVED ( i BYDATE 'J L/' SIZE BUILDING /d k /L . ROOMS / STORIES �+ r t-iY/ J ` / EXTERIOR WALL I ROOF eo r.L�� COVERING STOa'a COVERING ,$ USE OA BUILDING AND WORK TO BE PERFORMED {//4..77A-lie 7d EFT:' 1C pA' . e+ 6fA e sc Th DDIt1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULA MO BUILDING CONSTRUCTION. VALUATION uV SIGNATURE OF /{�{//,/7 i� �(/'��l ' PERMIT FEE $ PERMITTEE -A'�"s -� / /// GO e $ PLAN CHECK SIC 4 AUTHORIZED AGENT • TOTAL FEE S - t 0 u