HomeMy WebLinkAbout3048 COUNTRY CLUB DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3048 COUNTRY CLUB DR
Suite:
Vicinity: SIDE PROPERTY LINE
Parcel Number: 13917223
Applicant: DE BERNARDE, DARCY
Address: 3048 COUNTRY CLUB DR
�:'�"
COSTA MESA; CA � �
Zaning: R1 R1
Phone: 714-434=6618 �
Zip: 92626-2342 �
Owner: DE BERNARDE, BILL AND DARCY -
Address , 3048 COUNTRY CLUB,DR . , � , — . -
�.;..!-. � � � ` - ' _ Phane. 714-434-6618 .
, , � �COSTA MESA, CA,-. - � � - . � Zlp: 92626-2342
,
Contracror: `OWNER=6UILDER
: �Address: � � � �
-� �� ' � . - Phone:
Zip:
Arch :
Address: � " . ��
, . . � ' . Phone:
License: , 000000 '
Eng:
' �- Address:�.
Status: ISSUED
Applied: O6/21/2004
Issued: 06/21/2004
ISSUED BY: i��
Phone: -
� Zip: � License: License: �
_ . _ SCOPE OF PERMIT _
ADD 98 L.F. X 6' HIGH BLOCK WALI ON SIDE PROPERTY. LINE PER CITY'S�STANDARDS. .� ' �
FEE SUMMARY
Plan Check: . $0.00 Calc Valuation: S�,sso.00
Permit: ' $69.25 ---- -- - -- - - - — - - Claim Valuation: So.Oo
SMIP Res: $0.50
SMIP Com: $0.00 `
Other: � � � $0.00 � � � �
`Inspection: � '� $0.00
� - - . ., � �
. _ Total: � . $69.75 '_ �� ^� ` _ ' - �j': _
� . ,'
- �.
�� �� � �, PLANNING&'ZONING
SETBACKS; � � � ' - - �� � , ;;
MAINSTRUCTURE�Front 0-0�� � _Rear'_:,0-0� � � ` Left� �0-0 � `rRight ��0-0�. ,�" �
_, _ . � , - _ ��
ACCESSORY � Front'- 0- 0� �� Rear 0- 0 � � Left� 0= 0�� ,-� Right � 0- 0 ;��
PARKING Exist n : _� � 0._ � Re uired: _ 0 � � �ProposeA:� - 0 � ' � ; �
NOTES: � - � � ,
. . . -. . . . - , _ .. �
.- ..
NOTICE: The work authorized by this parmit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 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.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
246fi-4fi(6/00�
WORKERS'COMPENSAnON DECLARAnON:
I hereby attirm under penalry of perjury one ot the following tleclaretions:
❑ I have and will maintain e cenificate of wnsent to self-Insure for workers' compensation, as provided for by saction 3700 of the Lebor Cotle, for tha peAormence of ihe
work for w�ich Ihis pertnit is issued.
❑ I have and wiil maintain workers' compensatlon insurence, as required by 5ection 3700 oi Ne Labor Code, for the peAortnance ot the work tor which this permi[ is issuatl.
My workers' compensation Insurance carrier and policy number are:
Cartier: Polity Number:
(This sec(ion need not be complered i! fhe permi! is veluetl a( one hunUred dallare ($100) or Iess.J
�j I certity that in t�e peAortnanca of ihe work tor which this pertnit is issued, I shall not employ any person in any manner so es to become suhject to the workers'
compensation laws ot Ca;lomia, end egree t ai if I s ould 6ecome sub�ect to the workers' compensation provisions of Section 3700 of ihe Labor Cotle, I shall tonhwith
comply with these pr ions.
ApPllcant Signature: ����/'-y1-�- � /� A///i1 ! Date: /o—e?� /J '-�
WARMNO: FAILURE TO SEWRE WOWCRpS' COMPENSATION COVERAGE IS IINIAWFUL PND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUN�RED
T110USAN0 OOII.FRE (5100.000),IN AOdfTION TO TME COST OF COMPENSATION, OAMAGES AS PROVIOEO FOfl IN SECTION 31O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm that I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business antl Professions Cotle, anA my license is in full
force end eHect. Lic. N Class N
Contrectofs Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eflirm that there is a construction lending agency for the peAormance of ihe work for whic� Ihis permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lentlers Address:
Signature: Date:
OWNER•BUILDER DECLARA710NS:
I hereby aHirtn that under penalry of perjury that I em E%EMPT FROM THE CONTFiACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business entl Protessions
Code: Any ciry or counry which requires e permit to conslrucL alter, improve, demolish, or repair any structure, pnor to its issuanca, also requires the applicant for such permit
to file a signetl stetement that he or she is Iicensetl pursuant to the provisions of the Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Dlvision 3 ot the
Business and Pmfessions Cotle) or that ha or she is exempt thereirom antl the 6esis for the ellegetl e:emption. Any violation of Section 7037.5 by any applicant for e permlt
subjects Ihe epplicant to a cMl penalry oi not more than five hundred dollars (5500).):
�1, as owner of ihe property, or my employees with weges as their sole compensatlon, WILL DO THE WORK, end the structure is not intended or oHeretl tor sale (Sec.
7044, Business and Professions Cotle: Tha Contractors License Law does not apply to an owner of property who builds or impmves thereon, antl who does such work
himsetl or herself or through his or her own employees, providad that such improvements are not intended or offered for sale. If, however, the builtling or improvemen� is
sold within one year oi completion, the owner-builder will have the burden oi proving �ha� he or she tlid not build or improve for purpose of sale.). �
�I, as owner of the property, am E7(CLUSIVELY CONTRACTING WITH LICENSED CON7RACTORS ro construa the project (Sec. 7044, Business and Prolessions
Code: The contrecmrs License Law does nm epply to en owner of propeny who builds or improves thereon, antl who comracis for such pmJect with e contractoqs)
license pursuant to the Contractors Licensa Laws.).
❑ I am eaem der sec. Business and Professions Code tor this reason:
SignaNre: ./ ii/�l/ // /.!/� Date� -
Owner ID vedfied by d' ers license. ❑ Ves ❑ No Dnvels License No. _ __ Exoires: _/7-6Q
Vedficetion ot Ownership by (rype of daument, I.e. - propeny tae 6i11 or deed): _.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no exwvation Hve (5) or more teet in dep�h inio which a person is required to descend, will be matle in connection with work authonzed by this
pertnit, and that no builtling sWcture, scattolding, talsework, or demolition or tlisman0ing �hereof, will ba more than thir�y-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec.
341, ll0e 8, Calilomia Atlminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require e permit Irom the Division oi Industrial Safery, as notetl ebove, unless such person hes e
permit ta do such work from the division.
Signature: Date:
Division ot Industnal Safery Permii Number:
CERTIFlCATE OF COMPLJANCE AND AIJTFI0RVA710N OF ENTRY: I certity under penalty of perjury ihat I have read this application and state ihat the information given is
correct. I egrae to wmpty with all state laws end ciry or0inances relating to builtling construction, and authorize representatives of t�e Ciry of Casta Mesa to entar upon the
ebove-des ed property to spection purposes. I ree not to occupy or ellow occupancy of any building authonzed by this p/ermil until tinal inspaction.
.�� %i.� /.U/i/%�I� [ � � �2� G,�i
Signawra Of Legal Owner(s) Oate
AnC/Or Authonzed Appliwnt Date
cooe �, ixsrecnoxTvve
7616 Fixetl System Final Fire Prevemion
1266 Pool Spa Final
200
201
202
203
204
Final Re-Rool
Final BIocWRetaining Wall
Final Faciory Fire Place
Final Sign
Final Demolilion
COOE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plum6ing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
FAIE 1t�eLi
•TtRSSKElQiISFQRINFORT4A770NALPURP06tS
ONLY. APPI�GML5RF5ppN51gLEFpRPROVIDWG
AT1 ACCURAlE REP(�FS'Q.1'iA770N OF i}�t PROPFR7Y
IIJ USE TF� SEL�PE AND SIZE DO NOT ODRRSTOND
Wfl'fi 7t� RVtORMAl70N PROVIDID ON7tLLSbil�!i.
A�'PROVED
CITY OF COSTq MESA
PLANNING DIVISION
�JECT TO BLDG. DEPT. REG.
OTE: ADDITIONS, DELETIONc
�__. _
�
�
.
• soun w�uas/�rcrs eetwmv s��• � b� w rmct�rs�ui.�
BE SETBAQC A7IFASI30' FROM FROM PROPER'1Y I.WE
• 90tID WAtSS/FFN�S SfULL NOI ID(�D 7 6' IN F�74liC
N71}�I 100F1t� FAOM PROPERIY LNE �Uf N1t8I�dE).
• VERQ�Y DSfAN� FROM CURH 1V PROPEI[fY UNE
ANDgiOWONPlAN. VFRiFTGYIONFROM7NEQ!'YS
@IGQJffitWGDIV�ON6REQUIRFD. GIJ.(l1�i754.A1�
DIV.
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QropoSea\ F+.
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30�18
Coun�t'y
�Ikb
RE40ENCE
8
CITY CF COSTA E;
�APPROVi U
This set c' �I� :; eri+ �, z iLc:
make any :na�; -, a; acw� 1ron
and Safery. C�� ci C:; �- 7e��
The stam-ir ; �;,,� -, :� - : .
of he violai�on cl z y;�.,,�„
Th se plans and per �:� s! a1; e
wo isnoteommem dar'me
l90O�Q
,�
,
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— - - �--�-2.a' f�o.,+
se+back
Cou►�-I-►-�� ��kh
_ STR ET
0
-----;_� �e � �
ons MUSi te kept on ihi jch ell !i�-a� a, ;; p�� un wlul �
or,samzwi�outwri�en r,ii�s,�nfrcm,ireln�sionof uildng
_'_...:,,.,:,n: JOi� hel„-.�ermit�r�bean
; c° a-;, ,rv of os;:� �A�a� ' Proval
�- �^,nance � iclor St le law.
'_��' ��'��,a:�en a d b �me ;� and void i the bui: ing or
_ �car:e=erlgC�,l3ftl'�dfhin180 ysofis ance
RC90EMQ �
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D r;v� i
BLQCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION
TYPICAL 6�� CONCRETE BLOCK FENCE
CmneM Coping Oplione� �
ChannclBbck With 1�3/8�
HP�itontal Top ol all
Feneef � ' _ � -
- , j�
For Fences 5' or less -'� �, r,
VeA. Bars 3/8"� at 4' �0" O.C. !
For Fencea Higha� Than�S':� ^ �
Ven. Ban 3/B"� at 32'�D.C.'�
Fill Cells Solid With GrouY'� �- •-
Whe�eSteelOewrs �,, '` �"
Rr.�plo�cing Sl�el Shall � � � �'
Conbrm to Sec.A�15�39. „ � '
A.S,T.M. -' ' •
All Steel to be LaOpad� ' ��
24" or to Code ,
NATURALGNADE�_
TWO 7/B"O BARS
CONTINUOUSiOV
6 BOTTOM
HpO1Z.5TEEl MUS7 BE TIfiOIN
FL4CE AT TIME OF TqENCII
INSPECTION.
::
y�
�
r�
; 'r o
a
' } a� Q
� C j
.Y
� �t a
�S�
� �u 4
-i t u
,ti �.� 4
� u Y
J
�i,
F-�KIDTH ' `
� SEE CNART
� � BELOw
WIDTH
THICKNESS
DEPiH OF EARTHTI
' SPACING OF EART
14
10"
2 4"
IQ'
� a , .
�
. •
e
•
�L, a
2..
RE�UIREMENTS CHART
14-
10"
20"
14�
BUILDING DIVISION
GENERAL- NOTES
MOFtTAH; pne Parf Plasfit Cemenf, and
7hree Parts Sand
GROUT: One Po�t Cement �Thee a�E
One Half Po�ts �and
COPING: One Part Cement, Three
Parts Sand
CO^ICFETE: Weil Miaed 1:2-I/2:3-�/2
Mo� of 7-I/2 Goltons of
Walsr Per Sock of Ceme��
GROUT MAY 8E POUREO FNOM �NE TOP
OF iME FENCE INCElLS WMERE STEEI
OCCURS.
CELLS ANO AREAS OF HOR120NTAl REIN
FONCEMENT SNALL BE CLEAR, CLEAN 6
fREE OF ALt MOpTAp DEBRIS, ETC.
pEo��� L{' [qqTMTCOTH
�/i ��iE HEIGTM Of �ENCE
��IOW BOTTOM OF �OGTiNG
SCALE: I/2° = I'
12'
9'
16"
16'
iz
8"
12"
16�
�' 2
�2 sA
z��� � ��T
�,_"� 1 i � �°2
TESTING
�.. . .
,. ., . , �: .
Laboratories "f ���«tr��,� ���z<<f�,z,�«r, rr,r�.
�p =p�. <� . ]7�0 P�ooO?i `/'A'• . '.O�'G B�^.Cr CALiE 4C50I . ,7i31 :iu-)355 . Ri�l oib-tDab . �/iq� em.e9�[
. 't=.dC�- o=�iCzs -
5•�� ,. '�, °j aD0? b`� ��' x<SS�,so - c n.. : O 9v..;
vi.�v�:c.s�� �� ��' .-, . ,e,..�c� ..uRul�m.n_e
`ti��'
;�
October 18, 1977 Examination: SC77-5695
COMPRESSION TES75 ON GUNITE CYLINDERS
Mr. Errol F. Heesch
12921 Aspenwood Lane
Garden Grove, CaliFornia 92640
PROJECT 1'00l for FRAIdK CORAY
ADDRE55 3048 Country Hills Drive, Costa Mesa
SAMPLE FROM Gunite SW].[Il[(17.t1g POOL
�NCNrtECI
FHG�NE(e
nvx
DATE CAST
DATE TESTED
CYIINDER NO.
COMPRFSSION
TOTAL LOAD, LBS.
POUNDS YER SO. IN
SIZE:
COMPIIANCE
CYIINDERS
CONiNPCiOR
Irvine Pools
SUBCONIRACiOR
Grove Gunite Co.
SPECIFIED
4� to 1 STRENGTH
10-T-%% � CYLINDER SIZE
10-17-77 10-17-77 10-17-77
1 11 111
10-Day 10-Day 10-Day
41,000 42,000 u7,000
1,580 1,620 1,810
Nos. 1,11 & 111: 5-3/4" x 12"
MaOE BY DEIWEFfO BY
Ray Heesch
�nr+�eunor+
E. F. Heesch - 2
Grove Gunite Co.
�Gesia Mesa Blg. Dept.
2,000 p9i
ntc[iv¢o or+
10-13-77
�-Z���IIVEIA
QC I �+`� lti((
�hCL.L � �.�G.c.
._. �r r., ti -i e ..., i� _� _, . m� ._ �o�,t� . . � . > ...� � ,. *.o...o� _ic.:�o.. o• c..., At�oAis co�.c�.�zmNs oa „
c� 4 �� r � . .�. ... .f" � ���� ... �f ..�. .. . � rvc �v�un.v. � � r�tL�l �up'!C'�O'� :O C�if� 5 ..�f PV�I�C �nD O��SfI�'ES
� o�� �� ���
�� Zq ..� ,.
_`�`` ' `��� Tvriniaq Labo�a#ories �f =����t�L�11 ��=��f��,=«�� �,��.
2�� /°2
� � ?.O BOX <1 •?310 AI4PORi v✓AY . LONG 9EPCH, CAIIF. SOBCI .(113� i26-3755 . �213� 636�2386 . �714� 828�6432
A�ntiG� OFFlCES: �
7ESTIN6 i.i..ou�,.�ea,.�.s�,��� �- No�o..,,.�a��er.:����q .
s,.�an�a c,n,o.„,c��o, �"�� „*: nso,a�.don.,_v.o.e�..�
`P1' � �F'� i
p��� Sli4L<5 g La�9 Pmch, CeIR >p901 �ip� p16�1195
Tw'_� "� �
Y
October 27, 1977
October 18, 1977
Examination: SC77-5695
COMPRESSION TE5T5 ON GUNITE CYLINDERS
Mr. Errol F. Heesch
72921 Aspenwood Lane
Garden Grove, California 92640
PRaEcr Pool for FRAN CO AY
ADORess 3048 Country rive,,Costa Mesa
SAMPLE FROM Gunite SW1till�Jlqg POOL
♦PCHRECL
ENGINEEo
MIX
DATE CAST
DATE TESTED
CYLINDER NO.
COMPRESSION
TOTAI IOAD, 1B5.
POUNOS F'ER 50. IN
SIZE:
COMPLIANCE
CYLINDERS
4� to 1
CONiRACtON
Irvine Pools
SUBCONIRAROR
Grove Gunite Co.
SPECIFIED
STRENGTH 2�000 p9i
10-7-77 CYLINDER SIZE
10-17-77 10-17-77 10-17-77 10-27-77 10-27-77 10-27-77
1 11 111 Ip V VI
10-Day 10-Day 10-Day 20-Day
41,000 42,000 47,000 68,000
1,580 1,620 1,810 2 620
�
Nos. 1,11 & 111: 5-3�4" x 12" 5-3/4"x
12-1/8"
20-Day test complies with specifications.
MODE BY DEIrvERED BY
Ray
oisraieunon.
E. F. Heesch - 2
Grove Gunite Co.
>esta Mesa Blg. Dept.
Heesch
20-Day
58,000
2,050
6"x12"
0.FCEIVED ON
10-13-77
�lE C r.Y v �ID.
o�-� 3a,�t917
20-Day
59,000
2,375
5-5/8"x12"
�������
... F« � " , 9 � ,5 .� .- .. �,.; .� H��E�.. o, �. ��.s .�...�� �.,.o� .�A ,�a�,�.,,o� o. o�o AEPoa,= �o�«�s�o.= oA �.
•�. ��s � � � .. �� ,. , .. .� � s Fryr�,Eo P� �o t<, � o .. .,. } ,=�.vo;,, .s , .._.��.� �r,orcc:�nw ro cucr-s �..c voeuc .�o ooAsc�vcs
�
te.i� � �^:� ' _}V a .hl �t,}�y f rb �'+�Y � -tr :(�, S � ' t i' `• � � � e
� 'r � ., i1�r 4<.+ 5 ? h r:.,;"N� i t 5.s ;r�i����7�r �Y .j„ . �'" J ."4'- w� . _
) k i h� A . . L f ..'�,'� � . .. . .� . _ ), � �.
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� *�� *,T `'��I .� �,;� : � > �` �CITY �bP-COSTA MESA� s
" '' .,�ay8�(,G+U.r,i>rt,`r�I �.%un:J�.h Buil:ding `�# _ DEPARTMENT _ ; `�:.�^�'.;
� � s _.`'i' �Y �Y� ..r,j..P.d(iTE99 ��i fi-..- a; OF �`b -s-.
� ���� P/ 7�' �' h - : '='�" � -. ' � T�:BUTLD G=.SAF TY -- "� , � �'�
�..�_ � -� "llnlX �l�G�/c'./7�' ��_'� Ocmer ' +,�r ' : _ :.4'',�,
' � � �_ '' � _ . .-, _ '} L _ .
�- - %Rfl�n,r� �J,}L.5 � � Contractor - �Regi ered D ty�Building Inspector
I `
�. . ; �.. .-. .- Certific te,.of -Compliance ` _ -
,
�,.� �' � `- V' � �
j :;� - �ti�.A�n_T �'��71Cf7-�' Address -. " .�`..�[7_fr�_ �, _�.,
� '�� - ` -.; _ Permit�4 ' ��� Date ��: �` Date of this Cer-tificate� >- -
� 7�{ �✓4G,o[o- Number ��`.� '.Issued' :
� - .
. � - - To the Director of Building Safety: �- _ . . � . -- � � _�
� � : I hereby certi£y that the following portions of work on the buildings
� _ at the above.address which required continuous inspection and which I was�:
- employed to inspect, were inspected by me and comply with [he provisions�- .
� - � � �of the Building Code applicable thereto. � . - �" - - �
_ , � , . . . � - •, _".
��� 1)_ � Concrete . " . � - .�3) � Welding � . 5)� Special Cases
i
' - � 2) � Masonry' ,_� 4) Re3nforced Gypsum � � � �
� � . Swimming Pool Size �G �'��'L �' Gunite i/' � Hand Pack � �
. �-.. � Sacks Cement �Tons - of Sand �-�' � . . � . _ �. �
' . ' _ Approximate % of water in aggregate � ' - �-,��� : . � �
�' This report_ covers work compleEed during week ending --���.���% -
�Sµ,
REPfARKS - , �� �., _ -. - .. � ,
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• i �� _ ..�;�,, ..-REGISTE •D EP TY ILDING INSPECTOR �
� ' � . " � . . Name_-�iza�c� f %�E�3'tf/ `
o �' - // `s
_ . � r�„ z. „... . . ,_ 'AddLB39 �(�ll')c'7�') /��1fJr_ ' ..
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-Laboiatory : uy�j�;�/y , r ' ::Telephone �-�` . �.3�3:% .G-�.15"'
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fill in Completely — Use Ink Only
ADDRESS 3048 Country Club Dr. ��
OWNEF Coray� .� M•
.i�
MAIL 3048 Country Club Dr.
ADDRESS
CITY Costa Mesa �T,o`� 5573769
CONSTRUCiION
BRANCH
ADORESS
OREN INE R J:P.Anderson No`546-8581
ADDRESS 4500 Campus, Newport Beach
CONTFACTOR Irvine Pools �
nooaEss 4301 B1Y'Ch St.
c�Tv Newport Beach No` 5�7-1021
LIC. No. 281951 � uc�No. 6888
OF LOT 496 SC�. ft. NOW ON LO S
USE OF
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOR�
I hereby acknowledge ihat I have raed ihis application antl state
that ihe above information is correct antl agree to comply with
all laws reguleting builtling consttucNon, antl I shall not employ
any perwn in vlolation of the workman's compensation laws of
the Stata ot California.
I hereby cartify that 1 am proparly licensetl as a contractor untlar
the Stete of Cellfo�nis Business and P�ofessions C de Division 3,
Chapier 9, and that such licenses are in �full foroe and effect, ar I
em exempt from the provisions of the State of Ca'fo� ia Business
antl Professions Cotle, Divislon 3, Cha tp er 9.
� �i
SlBnatura of ����� ��
Parmittae U � �
Authorizatl Aeent �
Pplv 48.50
SEP -6-77cMSA00 248� ***+T
APPLICATION FOR STRUCTURAL PERMIT
RECEIV�� DATERECEIVE� D I UEj
�� r
AD1DRE s 3048 Coun
FIRE
APPROVED
ARDS APPROVED
DISTANCE 8ET
MAIN eLOG$.
VAR. #
Club Dr.
BLOCK
DATE
VARDSAPPROVE
BET. MAIN &
ACCESS.BLD
DATE
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
VALUATION PERMITFEE $ •OG
$ �DOO � TAX CHECK $ OG
♦ �Q
TOTALPAID $ � G
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STA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX �17 C08TA MEBA. CALIRORNIA
For Appliean+ fo Fill In Comple+ely
TYPE OR PRINT
AODRE6S 3048 Country Club Drive
- COSTA MESA CALIFORNIA
OWNER Jamaica Construction-Co.
MAIL � ' 3120 Bermuda Drive
ADDRESS
�,T„ Costa�{ iVteys�a No: Y'I �
'41TECT e�eT�.Xa XY.... TELnp � G
Corona Del Mar
� �.
ADDRE6S 31c0 Bermuda Drive
�,n Costa i�esa
&TATE 18O1S6 TEL. �'KI �_(� %
LIC. NO. O. 7
61ZE (/J� /`/ /� NO. OP BLDC
OF LOT l. /� l � NOW ON LOl
'e BLDG Tdone
YN6 FROM y �//
p g�gy 52 � 4' � REAR YARD �.�[h
R� I LEF7' 1S ` I RIGHT [n /(p L�
DESCRIPTION OF WORK
I/� II e� rroer�nv I II ennir�nv I
/��� ROOF I''
VVL(,/ COVERING W �
AND WORK TO 9E PERFORMED
a EE �dt��iVEC�
.�� 4- �� -c� a
FINAI�CE DEPT.
C1TY OF COSTA fl�ESA
APPLICATION FOR PERMIT
BUILDItdG
For Office Use Only
FECEIPT NO. Pe
RECEIVED BY DATE RECEIVED DATE I65UEO
�,,.,.-.-e� �-�--��-'60 .�at,� � a aa�
BUILDING
AD�RESS
COSTA MESA: CALIFORNIA
ZONING
ZONE �!�/ � NO.OF ll6fi OF
Itt PLANS B111L�IN
�,�
LEGAL
( � (CENTER LINE BTJ
�
a—
1 HHREBY ACKNOW�OGE THAT 1 XAVE PEAD THi9 APPlAGT10N
AND BTATE THAT THE ABOVG IS CORRECT AN� AGRlE TO COM-
PLY WITH ALL CO'Y OPDINANCEe AN� BTATE LAW9 R¢6ULATING
BUILo�NO C�`TRUCTION. /�i' � p n
/ 1 //
■ AUTHORIZED
APPROVED
T2
�p� O�A�TE 7 `
1/ ///
THE AMOUNT BXOWN UNOER VqLUAT10N I6 FON THE
PUPP08E OF EBTpBL19HING � PERMIT FEE ONLY.
VALUATION
PERMIT FEE $ ��' �O
$ •� ��/ yD[�'` PLAN CHECK $ � /' �
i Z O�O