HomeMy WebLinkAbout1199 DORSET LN - Building Permits •
a
CITY OF COSTA MESA #
oStN MfZAPtillg BUILDING DIVISION
,
I 77 FAIR DRIVt;, COSTA MESA, CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: B11-00012
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 14114110 DATE ISSUED: 01/10/2011
ISSUED BY: KJB
•
JOB ADDRESS: 1199 DORSET LN CM Suite/Unit:
Vicinity: "
Squares: 2700 Valuation: $8,372.00
SCOPE OF WORK: TEAR OFF EXISTING COMP SHINGLE ROOF. REPAIR/REPLACE SHEATHING AS NECESSARY.COVER WITH 30
YEAWR COMP SHINGLES. INCLUDES ATTACHED GARAGE. ROOF PITCH IS 4:12.APPROX 2700 SQUARE FEET.
OWNER: DOW,DEVIN Address: 1199 DORSET LN Unit:
PHONE: _ City/State/Zip: COSTA MESA,CA
APPLICANT: DIAZ, LINDA Address: 1653 1/2 SUPERIOR AVE Unit: :
PHONE: 949-642-7222 City/State/Zip: COSTA MESA, CA
CONTRACTOR: LEE ROOFING OF COSTA MESA License No. 349686
Address: 1653 SUPERIOR AVEUnit: PHONE: 949-642-7222
City/State/Zip: COSTA MESA,CA 92627 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. • PHONE:
FEE SUMMARY •
Reroof Plan Check: $0.00
Reroof Permit Fee: $167.25.
Reinspection Fee: $0.00 '
Bldg Std Admin Fund $1.00 •
•
TOTAL FEES $168.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day, Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE#. INSPECTION TYPE DATE INIITIALS CODE INSPECTION TYPE DATE INIIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re-Roof _> I I? &o) 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
S S
WORKERS'COMPENSATION DECLARATION: . Owner ID verified by driver's license. ❑Yes ❑No - 1
I hereby affirm under penalty of perjury one of the following declarations: •'Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers ci
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 •
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: COO
I 'f'�, f !-r\ person is required to descend,will be made in connection with work authorized
C' A l,I FO Fri y N l S ` 0 - by this permit,and that no building structure.scaffolding,falsework,or demolition
�Carder:� r or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completedatheeperm(svaalued at orhundreddollars($11000\)or less.)
2,Art 2Sec.341,Title B,California Administrative Code).
WialicyNtimbe ( 0
r: "1 — "� l 3 W d I — '
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to`'40 forthwith
workers' compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code, I I forthwith comyA•; •-these prov
isions.
11, V I. I 01 I Division of Industrial Safety Permit Number:
C1wnt'sSign. ire l
�� HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full fo/rce and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No
cic.#---=e'-_ `fol Ce—s—.# C/a�961 (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
contracto 11 Q �Signature CDate—,- 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑ No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
• offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8 (If yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he'or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
Si.-: al Owner(s) Da��trer��
Signature Date (�`( t/ . 1
3057-46(3/07) '•
Sar:
'pplicant \ I(`Dale..�= 1
Prescriptive Certificate of Comps. ,e: Residential . CF-1R-ALT
Residential Alterations (Page of 5)
•
. projecriVnme:" D-----vi r , (�oN —'Cfimate-Zorit t=^.-> I of Stories°'
}LJ thVl lA�ll l_19
TIERS VERIFICATION SUMMARY The enforcement agency should par special attention to Ike HERS Measures specified in this
checklist below A completed and signet!CF-4J(Farm for all the measurer specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for ihia measure.
0 YES 9 NO YES.In Climate Zones 2 and 9-16,ii more than 40 linear feet of new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed pet §152(b)1Dii and the newly installed ducts are to be insulated per §151(f1/0.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed,insulated or sealed with asbestos.
a YES 0 NO YES:In Climate Zones 2 and 9-16,if the existing space-conditioning system (HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§I52(b)IDi.
C]YES 0 NO YES:hi Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed pet §152(b)1E.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
• verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. -
0 EXCEPTION: Existing duct systems constructed,insulated or sealed with asbestos.
Refrigerant Charge- Split System HERS verification is required for this measure. .
d YES ❑ NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil, or the furnace heat
exchangers a refrigerant charge measurement shall be verified per§152(bltF.
•
Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw
The ventilation requirements of§150(0)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.-
- 0 YES 0 NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and.ducting)is i'•
replaced.the airflow and fan watt draw shall be verified ger§l52(b))Ci to meet the requirements of§151(f17B.
Y
i .
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and coma /
Name: vis DO cd i Signature:
r
CompanyI _ 'peri Ih\ Date: 0 ) tV\ i
!
Address I i if Applicable O CEA or❑ CEPE tr
(----.
\I PS 3 t I (9- L-f � (Certification i!):
Gity/State/Zip: �� -r�ttt� �� Phone: 1
�J
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions.Code to accept responsibility for the building design identified on
tbisCenificate of Compliance.
il
• I certify that the energy features and performance specification::for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. It
•
• The building design features identified on this Certificate of Compliance are consistent with the information provided to tlocumen I this: �'" J
building design on the other applicable compliance forint,worksheets, calculations,plans and specifications submitted to the enlbreement
agency fon approval with this builihng permit application.
Name-. Signature:
Company: Date:
Address: License:
t
City/State/Zip: ( Phone:
t
Tar assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-$31/11.
Itegrsvrauon A'unrbe It cgt.,n-awnr bale/Tillie: HERS Provider:
2001:Residential Compliance Forms August 2000 r`
Prescriptive Certificate of Complia..ee: Residential ; CF-1R-ALT
' Residential Alterations (Page 1 of 5)
ject.Namc:_ DK. j N( D0 CIinmtF Zbn"e t7) 14 of Siories .,
'' //II ll (1 1 t
General Information
Site Address: I Q Q QEpC er L.N ( Enforcement Agency:
L Date: 0 I , I /1 I + _
Building Type D Single Family 0 Multi Family Circle the Front Orientation:N,E,S, W,or degrees_ 7
Project Type: 0 Alterations 0 Envelope 0 Fenestration 0 Roof 0 HVAC
Conditioned Flooi Area(CFA): Replacement or Change Out 0 Duct Replacement 0 Water Heater '
1L.-
NOTE: This fern is nor to he user!,far Newly Constructer)BuildingsorAdditions — tInsulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below)
=Assembly Alteration -
D Opening of framed cavity alone-Alterations that involve the opening of the framed cavity of a wall,ceiling, or,floor must install the �' 1
mandatary minimum insulation value per§150 for the altered assembly. Fill in Columns A-C and enter mandatory insulation value in Column H.
D Replacement of entire assembly-Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C. Fill in Columns A-J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A B C D E . - F G _ H I J
Proposed S`cNc1e Standard Values Froni JA4 Table •
Framing Thickness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly
ID' or Type' and Size2 or Other'' facto? Numbers R-values R-Value7 Cell Values U-factor'
Note:For furred assemblies,accounting for Continuous Insulation P-value,see Page JA4-3 and Equation 4-1. For calculating,furred walls use the Mass and
;Furling Construction table below.
I.For Tag/ID indicate the identification name that matches the building plans.
2,Indicate the Assembly Name or we:Roof/Ceiling, Walls.Floors, Slabs, Crawl Space,Doors and etc...lndicate the Frame type and Size:For
Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc...see JA4 for other possible frame type assemblies.
3. Enter the thickness_for mass in inches or Spacing between frarning members enter; 16"or 24"0C;or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel,Logs,Straw Bale Panel and etc....
9.Based on the Climate Zone;enter the Standard U-factor from Table 151-B, C or D for each different assembly Name or type.
5.Enter the Table number that closely resembles the proposed assembly.
6. Enter the R-value dot is being installed in the wall cavity or between the framing; otherwise, enter "0".
7. Enter the Continuous insulation R-value for the proposed assembly; otherwise, enter "0",
d'.Enter the row and column of the U-factor value based on Column F Table Number and enter the Assenhl*U-factor in Column J
9.The Proposed Assembly LI-factor, Column J. must be equal to or less than the Standard U-factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Only
A B C D 1 E F G H I J K L I 1W
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
Joint Appendix Table 4.3.5,4.3.6.4.3.7 Joint Appendix Table 4.3.13
vif I.
t Y v
rg
U o o 4< U
tf% tC.L �` in
U..
Assembly a' j c t"' n c „„•m A v _ Final
- " - l Assembly
Mass Name o: .I A4 b& , �: .g m a m w o 't m v a=
Thickness' Type= Number' < ° w u` - r` - a. C _ w C ' u-faces," Comment _
I-
l I I I I
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
Prescriptive Certificate of Complia 1esidential CF-1R-ALT -
Residential Alterations � ' (Page 3 of 5)
Project-Name: Climate Zone 4 #'of Stories
ROOFING PRODUCTS(COOL ROOFS)§151(/)12
When the area of exterior roof surface to be.replaced exceeds more than 50%of the existing roof area, or more than 1,000 ft', whichever is
less,the new roofing area mist meet the roofing product"Cool Roof'requirements of§152(b)1Hi,152(b)1Hii, or 152(b)IHiii.
Check applicable alternative or exception below if the roof alteration is exempt front the roofing product "Cool Roar requirements. Note:If any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Eminence requirements for roofing products•in_�
§ll (i)me no/applicable.Do not fill able below. _ _—
ol Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
ool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
an 51b/ft2.
Alternatives to§152(b)1Hi and §152(b)Hii,Steep-slope roof(pitch>2:12)
iO Insulation with a thermal resistance of at least 0.85 hr.ft'°F/Btu or at least a 3/4 inch air-space is added to the roof deck _ )
over an attic;or c'--
❑ Existing ducts in the attic are insulated and sealed according to§151(010;or
❑ In climate zones l0,12 and.13,with l_ff.of free ventilation area of attic ventilation for every 150 ft of attic floor area,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
❑ Building has at least R-30 ceiling insulation;or
❑ Building has radiant barrier in the attic meeting the requirements of§151(02;or
❑ Building has no ducts in the attic;or
❑ In climate zones 10, 11, 13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to§152(b)1Hiii,Low-slope roof(pitch 52:12)
❑ Building has no ducts in the attic.
Other Exceptions
. ❑Roofing area covered by building integrated;photovoltaic panels and solar-thermal panels are exempt from the below Cool Roof criteria.
.0 Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft is exempt from the below Cool Roof criteria.
- Note:If no CRRC-1 label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise,
Check the applicable box below if Exempt from the Roofm Products"Cool Roof'Requirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number' _ <- 2:12 >2:12 < 51b/ft2 > 51b/ft2 Types Reflectance3'4 Emittance SRI5
-
❑ ❑ 0 0 ❑4
❑ ❑ ❑ ❑ ❑4
❑ 0 0 0 04 .
0 0 0 ❑ 04
•
0 0 0 0 ❑4
—
I. The CRRC Product ID Number can be obtained front the Cool Roof Rating Council's Rated Product Directory at www.cool roofs.org/nroducts/seorcir.nhn
2. Indicate the type of product is being used for the roof top,i.e.single-ply roof asphalt roof metal roof etc.
3. If the Aged Reflectance is not available in.the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation(0.2+0.7(pi„tnat-0.2)to obtain a calculated aged value. Where p ii the Initial Solar Reflectance.
4.Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value kr using the S10- Worksheet at httn://www.energy.ca.eov/itle24/and enter the resulting value in the SRI Cot above and attach ucapy of
the SRI- Worksheet to the CF-lit.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in§118(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other
•
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms ' August 2009
OWNER SACT ETP, G. A. DATE 9-4-62
JOB ADDRESS 11 rsett,ysn@ _ BUILDING PERMIT NO. iui4s
GENERAL CONTRACTOR Osniep-B1d. VALUE $ 300,00
AP No. LOT 36 TRACT 4395 FIRE ZONE DESCRIPTION OF WORK Pvt.B1k.Wall
INSPECTIONS Signature DATE GROUP J TYPE III ZONE R-1
j -- - - SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Winer
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating --�
Rough Plumbing
Miscellaneous
Prop.Swr.Line ❑ House Con. ❑ St.Swr. ❑ _
Sprinkling System
Construction Pole
Underground 0 Power ❑
Rough Wiring
Trenches ly-' Forms 0 Steel Remf. Ly -errye(01- 4'.
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster, brown coat
Refrig. ❑ Air Cond. ❑ Final
- -- --ing, Final
thing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final 12 P A.r-
OCCUPANCY
177113
FORM 13L14-5M — 7-61
17743 FEE RECEIVED
`COTTA MESA BUILDING-SAFETY DEPARTMENT SEP 4 1962
P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT.
- For Applicant to Fill In Completely APPLaingl!WRER Mt
TYPE OR PRINT BUILDING,
BUILDINGG G �.�./
ADDRESS / I / / /) ./Jill/ 16t-1-t—`,-
COSTA MESA. CALIFORNIA For Office Use Only
Q� yI (\�'A / RECEIPT NO. PEM et
' OWNER A61 •--TJ 1.. (4. I
MAIL y^� RECCEIIIVVED BY DATE RECEIVED DATE ISSUED
.. ADDRESS�y 97, J�/C2_,d-t ti ti_ E//,1 9-if- )-- q.' �y
TEL. BUILDIN ) yy^^//
CITY 'i,. L / Lam_ NO. • ADDRESS
I /q(/ L ,r�(Fi _t
ARCHITECTTEL. - COSTA MESA. CALIFORNIA
OR ENGINEER =--moi- NO.
-
ADDRESS ' FIRE I
ZONE . g. TYPE Ad GROUP
r
APPROVES; I� l _ ./ V
CONTRACTOfi • .1,/ L�.� (��� Vim• BY I , I, Gil ' /D�.ATE d
•
ADDRESS � ---7 •
///'��1 ' ZONING
.� ZONEIR,_ i I NO.OP ' /SSE OF NEW C \sD"
CITYI�(, PLANS V BUILDING
L 'L
STATE TEL. LEGAL to r 3% ,`R y 35C
LIC.NO. ��TT NO. / DESCRIPTION
SIZENO. OF SLOG .
OF LOT j,2X 63. 'S 7X PO. 17I HOW Ox LOTS
A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. L L.C-1 APPROVED ALL ED
SETBACK LINE FROM •���'f I (B - `l SIDE (y(�
CENTER OF STREET ' C / ,1'REAR YARD 0 FRONT- sr Art C. CUL Iib }C.-
2 //
SIDE YARD ILEFT IRIGHT V ' R.SIDE fl FT. IN. '
I DESCRIPTION OF WORK 2- IN.
L.SIDE FT.
NEW X I ALTERATION I II ADDITION I REAR O FT. `/INT
REPAIR I MOVING I DEMOLISH I BYQPROVEP�� DATE /- V .
BUILDING NO. WW
• SIZE ROOMS STORIES
' EXTERIOR WALL 1 ROOF S
COVERING COVERING
•
USE OF BUILDING AND WORK TO BE PERFORMED
` 43— ,(F�n�e 4 - /y . yr
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 OP ESTABLISHING A PERMIT FEE ONLY.
I
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF
l % �y�/ PERMIT FEE $ J COQ
PERMITTEE f JJJ �`V n
$ 300,00
PLAN CHECK $ —
F
AUTHORIZED AGENTce
TOTAL FEE - 3/D u
Lor 36 TRACT 4395�'`t� RECEIVED
• 16311 • JAN 3 1 1962
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE
P. 0. BOX 317 COSTA MESA. CALIFORNIA
y • CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING ///+5 Dors L Ica
ADDRESS 7 r{/ (-
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. PERMIT NO.
OWNER K '& K DEVELOPMENT Co., INC, I WA !
MAIL 555 _ - RECQIVED BY /TE [3 f.'6� Q� T
ADDRESS PLACENTIA AVENUE /C/� 1�'J'Y6 JA�31 1962
CITY NEWPORT BEACH TNO. MI 6322- BUILDING
3 ADDRESS
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NONE NO.
ADDRESS FIRE '/ t=-42 0Il
ZONE TYPE // GROUP �1.
el
CONTRACTOR K. W. Ko LL APPROVED
AP DATE
ADDRESS 1 555 PLACENTIA AVENUE ZONING • .
CITY NEWPORT BEACH ZONER_/ NO.OF I USE OF NEW si:9 9»
PUNS BUILDING w/a„er "”,
STATE TEL. LEGAL / `� /
LIC.NO. 1 195 NO. M I . 63227 DESCRIPTION 1�" 3 t� 7R y3 9-Y
SIZELOT X5.37 X /��"' I NO. OF BLOGB.
OF Now ON LOT O A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. NoNE APPROVED ALLOWED
SETBACK LINE FROM //,/0 REAR YARD /7/ FRONT R LINE ST./‘ y FT. ---
IN.
CENTER OF STREET 'Ji/)[
SIDE YARD I LEFT c
14/
lif)/RIGHT � R.SIDE /0 FT. IN.
DESCRIPTION OF WORKy
L.SIDE S- FT. IN.
NEW I X If ALTERATION I II ADDITION I REAR /7 FT. -
/IN.
REPAIR I LOVING I DEMOLISH I BYPROVED (V /A9ge_6 DATE I/3o/6Z
BUIL IN /O2/5y ft NO. OF / /'
SIZE /je .Vr44if ROOMS (p STORIES ' 1
EXTERIOR WALL ROOF gO/Y/fio /
COVERING STNCCOICOVERING ,..51/2/.017/e, / /J /V5-t°
USE OF BUILDING AND WORK TO BE PERFORMED // .,
SINGLE FAMILY RESIDENCE WITH _ C/
//(.�
ATTACHED GARAGE-
PL
ARAGE 6
PLAN II 4/Q
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 FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF ��L /� �� _ PERMIT FEE $ . ?'S
PERMITTEP / Allf�TY`��� el
$ /�/ �� _ N
io
PLAN CHECK $ /F7p SO N
AUTHORIZED AGENT TOTAL FEE $ c a`r C-a 0