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Home My WebLink About120 CLEARBROOK LN - Building Permits 4C•�w9 CITY OF COSTA MESA ^� BUILDING DIVISION Y 41,,,,,, ,� DEVELOPMENT SERVICES DEPARTMENT PER NUMBER �1 i ) PERMIT 02-00712 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 120 CLEARBROOK LN Status: ISSUED Suite No Applied: 11/25/2002 Issued: 11/25/2002 Vicinity: EXTERIOR CLOSET : • Parcel Nunmber: 41914109 ISSUED BY: � Applicant: CHRIS POWCH-' - • 7 Address: 307 E CHAPMAN 1 ,. - r Phone: 714-532-6274 / l - ,-, , ORANGE;CA , '-Zip: 92866 _ / �� - I--; -,N'\<.-,..,\ Owner.. �VANDER-HORST JACOB TR '''..',*‘-';''.:H' , / / / . . , ,\ - \' . Address X7857 CAMINITO�EL ROSARIO ', , -=1 Phone: , LA JOLLACA Zip: - 92037-3514 N �' ) ; t .. yA i _ Coritractor: CONSOLIDATED PLUMBINGAND HEATING ^.j!: , %Address: 307 E CHAPMAN. - - �,- .� - Phone: 714-532-6274 -r;; ORANGE,CA Zip: 92866 �1'. `� ` H License: 396851 (- vim,. - �l ` - ,Arch / Eng: /'- -r,_:-,-r tem ;:.7. ' 1_ ,,A ,� - Address: . - ._ . -. ,l":��. _ << - -- --' ' i - • , - Phone: ti.. , _ ,� :.- �, ,vn,. Zlp:- li... ;i,;� r� • �� , _License: - - i _ f SCOPE OF PERMIT i,' i 1 ,PLUMBING TO INCLUDE: 1 WATER HEATER LOCATED IN AN EXTERIOR CLOSET. i -;FEE SUMMARY %,�/ \. c/ AMT . QTY -;'1 AMT .+-QTY :74/j - /AMT QTY ISSUE FEE ; $23.50 Laundry Tub/Washer $0.00 '0 -. _Sump Pump `, ' / x$0.00 0 Backflow irrigation i ' $0.00 ' 0., -- Landscape Irrigation $0.00' '0 - --Swimming Pool- ` i,$000 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 ;Utinal�`%2, $0.00 0 Clarifier System \ - A '$0.00; 0 Process Piping(per 10 ft), $0:00 0 Vacuum Brkr,Bkflow(1-4) $0.00 0 Connect(Ice,Soda;etc) N. $0.00'1 0 - Receptors- , $0 ;00 ' 0 = ,-Vacuum-Brkr Bkflow(5+) 50.00 0 Dental Units \, x$0.00, V ,0,' , Septic Tank '- . $0.00 -0 ' Wash-Basin/ " // $0.00 0 Dishwasher `, $0.00 -' 0 Sewer Cap for Demo $0.00 ..0•,,•., N ,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. -- '$0.06 - 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 fl • Ifl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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. W 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'compensatlo Insurance carrier and policy number are: /� [�p Carrier: STATE 1tA.1C) 'tJ Ci C,tt r / Policy Number: I 25 S —J O -98 (This section need not be completed if the permit is valued et one hundred dollars($100)or less) O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p Bions. Applicant Signature: Date: /1-' 45-0 2 ✓ WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($l W,WU),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed and provisions of Chapter 9(commencing with Sectio (10)of Division 3 of the Business and Professions Code,and my license is in full force and effect.tic.A 39 S I / Class% C'Zo - C.3 Contractor's Signature: � /l Date: yL 0O 12/3//2 COO CONSTRUCTION LENDING AGENCY: ❑ 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 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: ❑ 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)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? 0 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? 0 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 hes 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 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? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggemit 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 LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Wilt 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 California 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 California 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 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 01 any building authorized by this permit until final inspection. Si.nature Of L. _ ner(s) C Date 7-- And/Or And/Or Authorized Applicant Date CODE 6 INSPECTION TYPE ALIS E MALE EODEI INSPECTION TYPE ZEE Ita1II18& 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing tl' 1 -O9- 13ev 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well _ 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 ADDRESS OF BUILDING: 120 CLEARBROOK LN 0MT: CITY OF COSTA MESA — BUILDING PERMIT CWNER'SNAMEIFCICWN: VANDER HORST, JACOB PERM NO: B 076303 ADDRESS: %MASKIEWICZ, LEONARD 607 S WILLOWSPRING DR PERMIT NO: B 076303 PLAN CHECK NO: N GOVT: N SUPP : N ENCINITAS,CA 92024619-452-6391 ' p! AWL.MAILING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH • ARCHITECT ORENGNEER: UC.NO.: JOB DESCRIPTION : T/OFF & REROOF W/BUILT—UP SQ FT: 6, 080 "t ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 6, 080 . 00 CALC—VALUE: 6, 080 . 00 GROUP OCC: R-1 / CONTRACTOIrsNAME: CRANK BROS ROOFING CO ( 714 ) 548-5569 CONTRACTORSMMUNG 126 COMMERCIAL WAY COMMENTS: REROOF 3000SF TRIPLEX W/BUILT—UP ADDRESS: COSTA MESA • CA uc.NO.: 408677 *************************************K-K-it*N-********x**x- -FEREK-***it-*at-*** -**atx*****Rt* 92627 LINT: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under pe,, y of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Prof. :', . s Code.and my license is in full Force and effect. CrTY LIC.No.: 005 93 LIC.CLASS: C39 0'. 0.: 408677/ EXP: 06/96 MAIN BUILDING ACCESSORY BUILDING P� w---9•1‘. FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN sett L Contractor �- _ — �1 LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under pe perjury that 1 am exempt from the Contractors License Law for the Following reason(section 7031.5 Business and Professions. y et),or county whim rewires a Permit to construct alter.improve. PARKING REQ: , PROV: PARCEL: 41914109 Z N E: REF NO-t_? demolish,or repair any structure.pea to its issuance,also the applicant to tile a signed statement that he or she , is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES> 1 Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Airy violation of Section , >. 7031.5 by any applicant for apermit subjects the applicant toe civil penally ci not more than lye hundred dollen)SSWI). ******************************************************************************* o I.as owner of the property or my employees with wages as the:sole compensation,will do the work.and the structure is not Intended D E V E z L O P MEN T SERVICES REQUIREMENTS or offered for sale(Section 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 he or her own employees,provided that such improvements are not intended or offered for sale,tt,however,'he building or'mproveined is sold within one year of completion,the ZONING APPROVED BY DATE: owner-builder will have the burden of proving he or she did no build or improve for the purpose of sale). • ❑ Las owner of the property,am exclusivery contracting with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED B Y DATE: 4T Professions Code:The Contractors License Law does not apply 1.0 an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). a , ❑ tam exempt under Sedan: B.BP.c..for this neaam APPLICATION ISSUED BY: DATE: 2:4 ' C. ** Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL' SEGMENT:Y I do hereby certify that I am aware of and understand the requirements of California Health and Safely Cade Sections 25505,p5513,end 25534.and that I or any future building occupant will/wll not(circle one)need to comply with said,tele codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit for construction or modification from the Ai QualityManagement District.Residenliel construction applcatiareareexem from these provisions. PERMIT 90 . 00 . 61 Date: Applicant: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following dedarati ns: PLAN -] I have and will maintaina certificate of consent to self-insure nsure for workers'compensatioas pro ded for by Section ion 3700 d ,Labor ISSUE NGE Code,for the performance of the wokfor which this permtisissued. BUILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE . QI have and wil maintain workers'compensation insuranoe.as required by section 3700 of the Labor Code,for the performance of the TOTALS > 9 0 . 61 0 . 0 0 0 . 0 0 9 0 . 61 9 0 . 61 00 work For which this permit is issued.My workers compensation insurance carrier and policy number are: Canon: icycy 4}kn7Tyg},!�F_'UND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 90 . 61 OVER/SHORT: . 00 Policy Number: J ]—q SUNTT224 01 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need nor be complexed a the permit is for one hundred dollars/1100)or less.) 90 . 00 . 61 ❑ I certify that in the performance of the work for which this pewit is iss shell not employ any person in any manner so as to become subject to the workers compensation laws of Califemia and ree thin B I shoo subject to the workers' ******************************************************************************* corn Ppytsar n p`'oqftion ion 3700 of the Labor Code.I shall fon h campy with th / Mons. INDIVIDUAL F E E B R E A K D O W N Date: 5_k1.- Applicant: A Warning:Failure to secure wafters'compensation coverage la 1,and shall subject an employer to criminal penalties and TYPE QTY D E $ C R I P T I O N UNIT COST TOTAL COST civil Nis up to one hundred thousand dollars($10G000), n to rhe cost of compensation damages as provided ler In Section 37Osplthe LaborCode,Interest,and arcpmeyal SFR 6080 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 6, 080 . 00 • CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury thin there is a construction lending agency for the END OF FEES performance of the work for which this permit is issued(Section 3097.Cie.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and mate that the above information is correct.I agree to comply with an city and county ordinances end state laws retatig to building construction and hereby authorize representatives of the city to enter upon the above-mentioned property for inspection purposes. JIM CRANK Pere N' 01 011115'."95::-•00199957 TOT 5'0.41 • Ale Date �4.--471 DATE: 021(M/9:; 7?mE± 33:59 It.' .'jli , store d enUApplrant/Contrector `�(5151-40.W W While-Building&Safety:Green-File;Canary-Appmant:Pink-Revenue:Goldenrod-assessor + \.. ' . , CONSTRUCTION AND PLANNING /00L & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector r . r - r ' 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location' . 2. Soil Pipe-Undrgrnd, ' rI , 53. Steel Reinforcement • •- .:_Electrical Conduit Utility-Undrgrnd. - 54. Forms • _ 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • i r , 5. Steel Reinforcement- 56. Rough Plumbing & Pressure Test _6: Electrical UFER.Grrid. - 57. APPROVAL TO COVER-GUNITE • •',, t7.,Footings ` 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test - :,Water Pipe-Undrgrnd. " _ ✓ gr " 60. Backwash Lines, P-Trap, 0 Undrnd. - 10:.Structural Floor System . - 61. APPROVAL TO-DECK,- -:, ) 11. Property Sewer Line.& House:Connection 62,. Backwash & Receptor-Final _ • 12. Sewer Cap i . 63: Heater 8t"Vent-Final • 13. Roof Drains - • - 64. Plumbing System - Final ! , t 14. Rough Plumbing 65. Electrical-Final r ' • 15, Rough Electrical-Conduit , : - • 66. Solar System-Final, ' 16. Rough Electric Wiring67. Fencing & Access Approval , 17. Rough Wiring Sign 68. APPROVED FOR-PLASTERING • ,. 18. Rough ElectricahT Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL - ' 19-. Rough Heating & Air Conditioning' - FIRE_DEPT. REQUIREMENT . 20. Rough Factory Fireplace , _.� _ '. APPROVALS,..Y.Per'.tnit# t. - _ 21. Ducts, in Structure •t • - 70. 'Underground Hydro 22. Ducts. Ventilating'.'It 71. Product Piping O Gas 0 Oil 23. Gas Pope-Rough & Test •1. - 72. UndergrOund Flush- 24. Roof-Framing' - '/` . 7t Undergrnd.Star-age Tank.0 Gas ❑Oil 25. Roof Sheathing _ 2 7-4`_ 1 ci4L - 74. Overhead Hydro $, 26. T;Bar Ceiling (Structural) & Monocoat ' '•• ' 75: Dry Chemical - 27. Frame and Flashing - '- 76. Dry Standpipe , r. 28. Lathing& Siding ' 71., FIXED SY.STEM%FINAL , 29. Insulation 78 FIRE PREY. FINAL r 30. Drywall Nailing : ,_ _ -HEALTH;DEPT.REQUIREMENT •31. Plaster Brown,Coat • '1_ • - . 79. FINAL INSPECTIONw 4 _ .432. Electrical Bower Meter-Final - '80: FOOD CERTIFICATE ISSUED -33. Final.Electric - Notes: _ -- 34. Final-Heating& Air Conditioning ' 35. Final Gas Pipe:Tesi •- 36, Hood or Canopy _ •' - _ ' La.. . 37. Final Factory Fireplace . - 38. Final Plumbing '' ' 39. Water Service-Final . . 40. Gas Service-Final - ` -41. Solar Domestic-Final ,_ i , . u 42. Backflow Preventer ' : 43. Backflow Irrigation ,' - - . - ' 44. Landscape Irrigation System - - ' .•••, - < _ 45: Sound Attenuation , -_ . .. - •J 46. Handicap Regulations .. j - 47. FINAL STRUCTURE & BUILDING 2-'Y-% 64J44i ' - 48. FINAL PLANNING ' - - ' a 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 No 2189 C P. 0. Box 317 Costa Mesa, California The Building located at • _ e • _-.,._ _---' : has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group H 4 J - Occupancy. Use of Building Triple= uith attached Garage Legal Description 241-31s3-03 (See reverse side for Metes and Bounds) Building Permit No. 02820 Electrical Permit No. 23253 Plumbing Permit No. W17.e6 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— 3 and/or guest rooms ISSUED TO: Building Official eg �.an _.,q.t. .. .r. ..,t by %.s Date retch P5, 1965 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed 1_2(except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Fora.131734-1ns_11-63—S-B P 22Q0 . FEE RECEIVED • .g AUG 17 1964 - COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX SIT COSTA MESA,CALIFORNIA CITY OF COSTA MESA For Applicant t,� Fill In Completely APPLICATION FOR PERMIT TYtOWR PRINT BUILDING noosEss /q��^ , %- For Office' Use Only �� k-- "` RECEIPT NO. 0IpITQ.- 1. SSJ( U COSTA MESA. CALIFORNIA • RECEI A BY •A ED DATE ISSUED q I / EiI OWNER Cita ARA i1OG Ai I�U.Ve CMDF DRR 7iO4/ ' BUILDING �' AD RESS/O t L _• • :e MAIL ADDRESS �y `� - 4 FIRE "2 1 I +-T TELCITYre(.f//TO/c'T�R.e ACh • N -i9..- a* ZONE LJ TYPE GROUP I"( ARCHITECT //__ i/ " TEL. , APPROVED DATE OR ENGINEER AA.�I•AN 41-US N°467 A-'70/0 ' , SV32- - ZONING / ADDRESS •A- • I -/' It e • :' i e./641 ZO NO.OF USE OF NEW PLANS I BUILDING II/ r DESCL IDESCRIPTION I .. - 'CITY• O • AoRT Re Ach • A.P.NO. ' / y I 4 I ,s, NOTE:'NO EAVE OVERHANG SHALL BE LESS THAN LIC.NO./ 0'/ r NO. to/ 3—''Jo2 /�D ' SIZE // y• I ' NO.OF BLDGS,' B. 1 A OF LOT��Fj CO ,\it y NOW ON LOT r' YARDS APPROVED YARDS APPROVED '\ A USE OF - G 'Q EXISTING BLDG, Q (FROM C/L REET) es CENTESETBACK LINE FROM . - . a U R OF STREET ,3O REAR YARD IFT.R.SIDE CC / SIDE YARD LEFT JO I RIGHT 6 DESCRIPTION ,OF WORK AC ,W NEW ALTERATION _ ADDITION Plaz DISTANCE BET. , BET.MAIN 6 ' REPAIR MOVING • DEMOLISHMAIN BLDGS. ACCESS.BLDGS. CE BUILDI e q 4 .,pNO.OF •f� DATE / tO G SIZE /0/.4 x39.9 ROOMS > 'STORIES / C.U.P. APPROVED , EXTERIOR COVER NGWA I I COVVERING - A •C ' - • DATE ( / / Q ' : . '� .� 1 .eta]. 0_,,,,,,,s, • , , IV A 97 SD.FT. r •ie. a % a / T AI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE , F AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. , O t PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m j BUILDING CONSTRUCTION, • SIGNATURE OF PERMIT FEE $ ✓ j PERMITTEE 26/1/ >..a/ G F • \ $ AUTHORIZED AGENTA91 I` ' l_4_..."--4*------- I TOTAL FEE - � IJ