HomeMy WebLinkAbout101 CLEARBROOK LN - Building PermitsPROJECT A1113RESS: 101 CLEARB ROOK LN UNIT:
OWNER'S NAME: BARBER THOMAS C TR
ADDRESS: 23722 f/IA EL ROCIO
MISSION VIEJO,CA 92691
5868963
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: JORDAN ROOF COMPANY (714)897-6105
ADDRESS: 920 N. TOWNER ST.
SANTA ANA CA 92703
LICENSED CONTRACTOR 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 he se is in full force and effect.
� CITY LIC.: _ 5916 STATE LIC.: 406783 c 39
Date /y Signature: —
WORKERS' COMPENSATION DECLARATION: hereby affirm at ave a t dicate of Consent to sell insure ora certificate of Workers'
Compensation 71appe, gL a,cedgeg Copy thereof (Section 3800. Lab, 68/01/92
J 8 / O 1 / 9 2
1OLICY STATE FUND EXP. GATE: U
OMPANY:
J Certified copy is hereby furnished. tJ Certified copy is hI wn6 th iry//Building Division.
Date: IK Applicant: dL
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This 60hoi not be completed if the permit is for one hundred (5100) 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 WorkersCompensation Laws of California.
Date: Signature:
NOTICE: If after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the pertormance of the work for
which this permit is issued (Section 3097. Civ, D),
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit Io 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/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 Professions 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 live hundred dollars (5500).
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 (Section 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himselVherself 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).
I, as owner of the property, am exclusivelyy contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' Staje License Law does not apply to an owner of property who builds or Improves thereon
and who contracts for such projects with a contractogs) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section: B. 8 P. C.
for this reason.
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health an
25534 and that I or any Injure building occupant will/will not (circle one) need to comply with
permit for construction or modification from the Air Quality Management District. Residential
these provisions.
d Safety Code Sections 25505, 25533. and
said state codes and the requirements fora
construction applications are exempt from
Date: Applicant:
hereby certify Thal I have read this application and slate that the above 'Terms on is correct. agree to comply with all city and county
ordinances and state laws relating to building construction and hereby ant rite re Dr senI byes of this city to enter upon the above-mentioned
property for ins ect n purposes.
Date: �� Signature `+
Driver's License or Social Security Nr
ADDIICant{ Pink—Revenue. Goldenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PER NO; B
PERMIT NO: B 056987 PLAN CHECK NO: N Uj N S ,: N
CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: ALT
JOB DESCRIPTION REROOF W/BUILT UP O/CLEANED BUILT UP SQ FT: 6,750
CLAIM VALUE: 6,750.00 CALC—VALUE: 6,750.00 GROUP OCC; R-3 /
COMMENTS: SMOKE DETECTOR(S) RE?UIRED IN HOME(S)
Z 0 N I N GS E R T E B Q A U C I K R S E M E N T 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
RE • PROV:
PARCEL;
41914123
ZNE; REF NO:
PLANNING
N TES>
90,68 OVER/SHORT: 00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
>
90.00
Ci ,f
iE 4F iE iE iE * iH iE
ie iE iE iE iE iE 1F iE 1F JF iE 9E iF * iF iE i(- k iE i69F lE Ki6 iE * BF iE iF iE it iF IF iF iF iE iF iF fE ie iF
iE it ae if iE 3F * YE if iF BF 9E * iE IE iE OE 9F 4F iF9E iF iE iE BF 3c * iE 9E BIF
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
I
ZONING APPROVED BY DATE: 11
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE.E
*iE 3Eif*jF BE �E BFiE IE iE iE BE**BE iE 9E)f BF iF4 Be 9E 9E 0E BE iE BE SE BF NiE iE iF iF 1FlE)) BE 3F if iE ii iE BE iE jE XE if iF 3F 3f 4Pif lF 9f iE 4f iE#iE*1E )E**'��iE iF iF iF iF 3F OE ii3f iE
LEGALIZATION;N F E E SID M M A R Y STRUCTURAL'SEGMENT:Y
BLDG PMT PLUMBING ELECT IC„ MECHANIC FIRE SMIP/RES, GRADING
PERMIT
90,00'
SMIP/N68ON—R ES
PLAN
ISSUE FEE
BUILDING—DIV—>
PERMIT
;
ISSUE PLAN—CHECK
TOTAL PAID DUE
TOTALS ---- >
90,68
0,00 0,00
90,68 90,68 ,00
REVENUE DIVISION
TOTALS--> COLLECTED:
90,68 OVER/SHORT: 00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING PLAN—CHECK
90.00
Ci ,f
.68
7 1
v
.)E 9E iE 3E iE 3F 1E JE ifi Jk * iE iE iE
iF iE lE iF 3E 9E it iE iE * yE iE iE iF ff BF * iF iF iF 1E iE 3E ik IF * BE iF 4E BE
IE 9F ie BF * iEBE iE fF ie iE 1F 1F 46%iE i5 Bf iE iF * iE 3f iE * * iE iF ie iE Bk if Bf 4F iF
I N D I
V I D U A L '-R. 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
SFR 6750 REROOF BY VALUE RESIDENTIAL NOZONE
END j OF ^FEES
err
1.00 6,750.00
.r
01 00112815-0051.2826, Tii wori5
DATE: 04/14192 TmE: 1::334
CONSTRUCTION AND PLANNING
APPROVALS Permit.# -
�`'r
7D1711InSp6c-tor
-
- , P� & 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
1
9. Water Pipe-Undrgrnd. , "l -��
-
60. Backwash Lines, P Trap, ❑ Undrgrnd..-'.r
10. Structural Floor System
61, APPROVAL TO DECK
11. Property Sewer Line & House,Connection
s
62. Backwash & Receptor -Final
f"
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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning -
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
r
20. Rough Factory Fireplace
21. Ducts, in Structure -
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 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 Coat
4•
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
36. Hood or Canopy-='
37. Final Factory Fireplace
38. Final Plumbing
-
39. Water Service -Final
-
40. Gas Service -Final
,
41. Solar Domestic -Final
-
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
i
51i CERTIFICATE OF OCCUPANCY
No. Date
co
Applicant to fill in all soaves except those within heavy border lines and tion all anoronriate declarations.
0+ -71 -01 -COSTA MESA PONSTRUCTION PERMIT
Project Address ID / C t^IZ agcio G'
Applicant's Mailing Address
Owner's Name . e,+., —Phone
._3rL
Address
7 92 VIA �" nC 1O M �%
Arch/Eng. License No.
Address ���
Contractor's Nam Phon/—`u 7
Address (mailing)A14-- /
City License No.
LICENSED CONTRACTOR DECLARATION
I,hereby affirm that I am licensed under provisions of 'Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
ny license is in full force and effect.
License Class Li cyNa+
Date n -,T" Fe signature -
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -in Sure of a certificate
of Workers' Compensation Insurance,4 or a certified copy thereof (Section -
3800, Lab. C.)
Policy No. Company
eCertified copy is hereby furnished.
Certified copy is filed with the city Building Division. ,
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -
(Thissection need not be completed if the permit is for one hundred ($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 manners as to become subject to the
Workeffs_'Cor�pe llon Laws of Califju
Date/Signature •-�7
NOTICE: Ii, after akIng this declara on, you snduld become subject to the
Workers' Compensation provisions of the Labor'Cotle, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY.'
1 hereby affirm that there is a on struction lending agency for the performance
of the work to [L it is issue. (Setio
cn 3097 Civ. C.)
Lender's Name e� —7
Lender's Address y
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
the Contractor's License taw (Chapter 9 (commencing with Section 7000) of
Division 3 -of the Business and Professions 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
penalty of.not more than five hundred dollars ($500).
LJ
1, 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 (Section 7044, Business and Professional Code: The Contractor's
License Law'does not apply,to an owner of a property who builds or improves
thereon, and who does such work himself/herself-ori hrough 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 com-
pletion, owner will have the burden of proving he/she did not build or im-
prove far the purpose of sale). .-
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply -to an owner of.property who
builds or improves thereon, and _who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware,that
proof of their Worker's Compensation insurance Should be provided to me.,
❑ I am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read this application and State that the above
information is correct. I agree to comply with all city and county ordinances
and State laws relating to buildirig construction and hereby authorize repre-
sentatives of this cit to enter upon the above-mentioned property for
inspection p�u [pgses.
Signature /`/• .t/I a/ .et,O..s .� Date%
9345 1.0/03/84
5.00 TL
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION L REPAIR
.❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG:
•
Service Sink
A.P.# Zone
-
S
"
Main Building: Accessory Building: '
TYPE OF PERMIT LJ GRADING _ ❑ FOUNDATION 0 STRUCTURAL
'❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO. FT.I OCCUPANCY
CONSTRUCTION TYPE VALUATION $
• ZONE- GRADING CU.YDS. ACRES
T
Front
B
A
Rear
C
,
Right
KLeft
$
'
Ping. Ref. # Parking Req./Provided
Remarks: -
Planning Notes: -
FEES
Sink
Backflow Preventer
Service Sink
Backflow Irrigation
Sewer Cap
BUILDING PERMIT
Bathtubs I j
Sewer Connection
'SMIP
Clarifiers
Solar Collectors
Dishwasher
Solar Piping
.
Drinking Fountains
Solar Tank
$
Floor Drains
Swimming Pool w/Spa
PLAN CHECK
Floor Sinks -
Urinal
'ENERGY P.C.'
_
I Gas Service LfOutlets
Water Closet
2
Interceptors •
Water Heater '
$
Kitchen Sink -
Water Service
$
-Lavatories•
P -Trap
'Roof Drains
MECHANICAL
$
TOTAL FEE
$
Reinspection Fee'
$15
Issue Fee
$, 3
• MECHANICAL
FEES
Boiler
Hood or Type 1 ❑
Canopy Type 11
CElDuct-Under
Ground
Duct - Structural I
Refrigeration System
❑0-100,000 BTU 0100,000 BTU
Duct - Ventilating
Exhaust System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
❑ 0-100,000 BTU ❑ 100,000 BTLI
I-
Drivers' License or SS # I I Reinspection Fee
CMF 0865-46, rev. 4/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
$15 1 1 Issue Fee
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures -
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 00.5 KW 05-15 K
ELECTRICAL
Transformer ❑ 15-50 KW
1150+KW
Meter ❑up to 100 amps
Meter Dover 100 amps•
Sub Panel
Motors 1:10-1 HP ❑1'/: - 8
Ina Solar 09-15 HP E116-
Microwave -
Pole Light
Range
Sign
Standing Sections
W Trash Compactor
Fee 1 $15 1 1 Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved.By
Building Approved By +
0
FEES
$ 3
Z
O
N
I
N
G
R
E.
Q
M
T
S.
•
SUMMARY OF FEES
BUILDING PERMIT
$
'SMIP
$
PLAN CHECK
$
PERMIT
.
PLUMBING
$
S-..Lc:D ISSUANCE -
$ .
PLAN CHECK
25%'
$
'ENERGY P.C.'
$
ELECTRICAL
$
GRADING
$
PLAN.CHECK
50%
$
MICROFILM
IS
MECHANICAL
$
TOTAL FEE
$
PLAN CHECK
25%
$
'!
�
(CONSTRUCTION AND PLANNING
• `'APPROVALS -Permit #
Date
Inspector
� POOL & SPA_ -
APPROVALS Permit #
Date-
.
Inspector
. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil pipe-Undrgrnd. -
53. Steel Reinforcement
• 3. Electrical Conduit UtilityUndrgrnd.
54. Forms
-
4. Electrical Conduit -Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement r,, - -
56. Rough-Plumbing & Pressure Test'
-
: 6. Electrical UFER Grnd. -
57. APPROVAL TO COVER-GUNITE
f-7. Footings
58. 'Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 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
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
APPROVALSPerm it,,+
20. Rough. Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro.
22. Ducts, Ventilating
71. Product Piping 0Gss El Oil
23. Gas Pipe-Rough & Test
72. Underground Flush a-
24. Roof Framing -
73. Undergrnd.StorageTankkOGas 0Oil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
i
28. Lathing & Siding
77.' FIXED SYSTEM FINAL
29. Insulation
78.- FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter-Final
80:FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: '
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test.
36. Hood or Canopy
37. Final Factory Fireplace
-.
38. Final Plumbing
39. Water Service; Final
40. Gas Service-Final
-
41. Solar Domestic-Final
'
42. Backflow Preventer
43. Backf low. Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
-
46. Handicap Regulations
-
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
,
49. Electric Release to Edison
- -- -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,
No. Date
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N? 2274 C
P. O. Be. 317
Costa Mesa, California
The Building located at 101 C1ea^bpp k Lune - Unita A, B, 8t C
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group W Occupancy.
Use of Building_ Triplex residence 17ith attached _
Legal Description 141-343-3
(See reverse side for Metes and Bounds)
Building Permit No. 22832 Electrical Permit No. 23265 Plumbing Permit No. 44083
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C.
required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments_ _ and/or guest rooms
ISSUED TO: Building Official
_Clearbrook Lam Co>Cpozation byJ���
Date 9i 1965
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Fore, 13U34—tM-11_63_s_13 r
X3665
COSTA MESA BUILDING SAFETY DEPARTMENT
P.O. BOX 917 COSTA MESA, CALIFORNIA
M4,4
In Complete
RIN
BUI
bv
ADD
ALIFORNIA
OWN
MAI//ADD/(.
FEE RECEIVED
MAR 1 ii
TTFyIIN11A��CCNCIl!!E��QQ��D� M.
APPLIC YN0POR`PEI *ESA
BUILDING
For Office Use Only
I RECEIPT NO. I PERMIT NC
ARCHITECT r•
BY,� DATE I '
OR ENGINEER NO.
ZONING d�emv
ADDRESS ---
ONE
NO. LAOPr-��
PNe /
pip
USH OP NEW
BUILDING
CONTRACT R a
LEGAL
DESCRIPTION L
ADDRESS / 64
A. P. NO.
-
CITY
NOTE: NO PAVE OVERHANG SHALL BE LESS THAN
STATE TPL
I
90' TO SIDE a REAR P.L.
LIC. NO. L
EAVES
ALLOWED (U. B. C. REQUIREMENT)
SIZE c� No. of BLDDe.
/ I
OF LOT NOW ON LOT
'YARDS APPROVED
MAIN BUILDING
OAPPROVED
ACCCgSS OOq IN6
USE OF.
EXISTING BLDG.
(FROM C/L STREET"
��
1 �
SETBACK LINE FROM h Z--
FRONT —
1' 1.
CENTER OF STREET REAR YAR
Pr.I it
1'I
I
R. SIDE
FT.
SIDEYARDI LEFT
RIGHT
L. SID
DESCRIPTION OF WORK
REARDIST
NEWALTERATION
ADDITION
BET.
BE T. MAIN @
_I
GS.
MAIN SCESS.
MAIN BLD
ACBLDGS.
REPAIR
MOVING
DEMOLISH
VAR.#
DATE
BUILDINGNO.OP
SIZE ROOMS 'DRIES
C. V.P.
APPROVED
EXTERIOR WALL ROOF
APPROVE
,--(
COVERING "' ERING--"
BY
DATE �P
USE OF BUILDING AND WORK TO BE PERFORMED
ur-
N
60. FT.
�
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION Ie FOR THE
F
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
C
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGUI.ATING VALUATION •�
m
BUILDING CONSTRU N. /
N
C PERMIT FEE S Cil
0
SIGNATURE OF
G
PERMITTE S�
PLAN CHECK 5
F
AUTHORIZED AGENT
TOTAL FEE
22832 '
r,0STA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA, CALIFORNIA
COSTA MESA.' CALIFORNIA
DESCRIPTION OF WORK
IHEREBY ACMOWLEDGE THAT 1 HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVQ IS CORRECT AND AGREE TO COM.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. -
SIGNATURE OF
PERMITTEE
^
FEE RECEIVED
'AIJG 17 1964
rr FINANCE DEPT.
APP[R79NCP TAPMW
BUILDING
For Office Use Oniy
RECEIPT NO.
PERMIT NO.
RlCIIV Y
RHC
DATE ISSUED
9
BUILDING
ADDRESS
FIRE4„1
.ZONE TYPE
GROUP
,APPROVED
BY •
DATE
ZONING '
20
NO.OFUBEOP
NEW
i
PLANS
BUILDING
/EGAL\ /,/
LEHCRIPTION
A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
90' TO SIDE 8 REAR P. L.
EAVES
ALLOWED
(U. B.C. REOU IREMENT)
YARDSAPPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
(FROM C/LSTREET) -
FRONT^ �''F'I'.
FT.
R. SIDE '/( x+1'.
FT.
L. SIDE "�F'r. -.
FT.
S
1�12AR FT.
Ff.
DISTANCE BET.
BET. MAIN
MAIN SLDGS.
ACCESS. BLDGS.
VAR. #
DATE
C. U. P. #
APPROVED
I.
APPROVE
tt^'
y-.
BY
DATE L'�%��
" ` ('(
THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
PERMIT FEE
e�I
117
$
PLAN CHECK .//
�LL�r
TOTAL FEE