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Home My WebLink About954 CORONADO DR - Building Permits(,OSTN RIF'r9 i �O, :t . . � � J. �a+�w�w �' � 1 qTY OF CO �' � MESA sun��N� �ris►oN 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www costamesaca.qov FOR INSPECTIONS CALL: (774) 754-5626 PERMIT TYPE APN: 14155103 Zoning: R1, PERMIT NUMBER: B MISC STATUS: � DATE ISSUED: iSSUED BY: BX11-00326 ISSUED 10/24/2011 RMD JOB ADDRESS: 954 CORONADO DR CM Suite/Unit: Vicinity: REAR OF PROPERTY Primary Oca Const Type :?? SQ. FT�. 0 Valuation: 51,000.00 SCOPE OF WORK: ALTER/REPAIR OF AN EXISTING 6' HIGH WOOD FENCE POOL ENCLOSURE LOCATED AT REAR OF PROPERTY. WORK TO INCLUDE THE ALTERATION/REPAIR OF EXISTING POTS, SLATS AND RAILS. FENCE IS APPROX 70 LF. POOL FENCE RE�UIREMENTSATTACHEDTOJOBCARD. f%ilk G�I'p�� OWNER: BLACKMAN, DARIN R Address:: 954 CORONADO DR Unit City/State: COSTA MESA, CA Zip Code: 92626 Phone: 714-241•1927 APPLICANT: BLACKMAN, DARIN R City/State: COSTA MESA, CA Phone: 714-241-1927 Address: City/State: Zip Code: ARCHITECT: Phone ENGINEER: Phone OWNER•BUILDER FEE SUMMARY Building Plan Check: Building Permit: Electrical PermiC SMIP Residential SMIP Commercial Bldg Std Admin Fund Address: 954 CORONADO DR Zip Code: 92626 Phone $0.00 $38.75 $0.00 $0.50 $0.00 $1.00 �icense No. 000000 License No. License No. Cell: Unit Unit: TOTAL FEES $40.25 HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. SaNrdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays: New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksqivinq Dav and Christmas Dav NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must compty with all applicable codes, and all required inspections and fihal approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit. CODEp. �NSPEC710NTYPE D� IN1111RL O�DEO INSPECTIONTYPE � INTITIRLS 1676 fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Finai Electrical 201 Fina1 81ak/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �+�y 204 Final Demolition 250 Final Building/Occupancy /�G !J � WORKERS' COMPENSATION DECLARATION: � I hereby aKrm untler penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of conseN �o sel/-Insure tor workers' compen5ation, as provided for by section 3700 of t�e Labor Code, (or Ihe performance of lhe work for which this permit is issued. ❑ I have and will maintain wOrkers' compensation insurance, as required 6y section 3700 of the Labor Code, (or the peAormance o( lhe vrork for which this permit is issued. My vrorkers' compensalion Insurance carder antl policy number are: Carrier: /This secMn nttaY rwl �e wrtyYefeqOMeyemM is vahxH el ma �urdretl WBars (f100) a kss J Policy NumDer: [� I certify that in the pertormance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become suhject to lhe workers' compensation Iaws of California, and agree that if I should � become subiect to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith �omply wilh these provisions. ��..� �.(�� IUIZvIZJ1I Applicanfs SiB�aWre �ate WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS� (3100,000). IN ADDITION TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEC710N 3706 OF 7HE LABOR CODE, IN7EREST, AND ATTORNEY'S FEES. LICENSED GONTRAC70RS DECLARA710N: I herehy affrm that I am licens2d under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe 8usiness and Pmfessions Cotle, and my license is in full (orce and effect. Lic. # Class # ContraaoYs Signawrp Da�e CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn �hat there is a wnsWction lending agency for the peAortnance of the vrork for which (his pertnit is issued. (Sea 3097, Civil Coae). Lenders Name: Lender's Address: SignaWre Date OWNER-BUILDER DECLARA710NS: I hereby aKrm that un0er penAlry of perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pmfessions Codp: Any city or counry w�ich requires a permit to consiruc�, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit to f le a signed statement that he or she is licensed pUrsuant to the provisions of ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Protessions Coqe) or that he or she is exempt therefrom and the basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant (or a permit suDjecis ihe applicant to a civil penalry of not more than fve huntlred dollars ($500).): ❑ I, as owner of the properry, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and the siruciure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply tq an owner o( propeAy who builds or improves thereon, and who tloes such wbrk himself or hersel( or thmuqh his or her ovm employees, provided that such impmvements are nol intended or offered for sale. If, however, lhe building or improvement is sold wit�in one year of completion, lhe owner-builder will have the burden of proving that he or she d1id not build or improve tor purpose of sale.). u I, as owner ot the pmperty, am E%CLUSIVELY GONTRACTING WITH LICENSED CON7RACTORS to construct the projeci (Sec. 7044, Business and Professions Code: The wntrectors License Law does not appN lo an owner ot property who builds or improves Ihereon, and who contracts tor such prqect with a comractor(s) license pursuaM to the Contractors License Lavrs.). ❑ I am exempt under sec. Business and Professions Code for this reason: �o-,-, � i�/zti�zdil SignaWm �ate 305]-46(3/0]) Owner ID verified by driver�nse. Yes ❑ No �river's License No. Expires: Verifcation of Ownershlp by (rype of document, i.e. - property �ax biil or tleed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I here6y certify that no excavation fve (5) or more feet in depth into which a person is required to descend, will be made in connection with vrork authorized by ihis permit, and Ihat no building siructure, scaflolding, falsevrork, or demolition or dismantling thereof, will be more lhan thirty-six (36) feel high. (Chap. 3.2, Grp Z, Atl Z, Sea 347, 7ifle 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which woultl require a permit (rom the Division of Industrial Safery, as noted above, unless such person has a permit to do such work from ihe division. ApPlican[s Signamr0 �ate Division of Industrial Safery Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will Ihe applicant or present or fuWre buildinq occupant need to file and certiy a.Business Plan for emergency response to release or threatened releaseOf a hazartlous material? ❑ Yes ❑ No (Section 25505 of the Caiifornia Health and Safety Code requires, with some exceptions, tbat 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 weiqht of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaNre and pressure). 2. Does or will the applicant or present or (uture building occupant need to fle a regisiration form for acutety hazardous materials? ❑ Yes � No (Seclion 25533 0( the Califomia Health and Safery Code, with some exceptions, requires registration with the Cosla Mesa Fire Department by each business which at any one time has on hand a quantiry of acutely hazardous materials equal to or greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard temperature and pressure). 3. Does or will the applicant or present or fuWre building occupant need ro prepare an RMPP (Risk Management and Prevention Pmgram for acutey hazardous materials)? � Yes ❑ No (Section 25534 of lhe Califomia Healih and Safery Cotle provitles that the Costa Mesa Fire Department may require the preparation, certification and filing with lhe Fire Department of an RMPP by businesses which are requiretl to register acutery hazardous materials with the Fire Department. 4. If an RMPP is p�esently required, has Sec�ion 25534 of the California Health and Safery Code been fully complied vr�th? ❑ Yes ❑ No 5. Does or will the applicant or present or fuNre building occupant require for �he work which is lhe subject of this appliwtion a permit for such consWction or modi(cation from ihe South Coast Air �ualiry Management District or from any other air polWtion con(rol dislricl or agency? ❑ Yes ❑ No (Seclion 65850.2 of the Califomia Govemment Code requires that the requested information be fumished on applications for non-residential building pertnits). 6. Will any part of the faciliry �o be constructed under this permii be within 1000 feet from the outer bounqanes of a school? ❑ Yes ❑ No Qf "yes", the (aciliry must meet the requirement o( Sections 2553a and a2303 of the California Heal�h and Safeiy Cotle). 7. If a permit from the South Coast Air Quality Management Disirict or other air polWtion contml district or agency is required for the work which is the subject of this application, have all of ihe disclosures prescribed by Califomia Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No 8. Q( yes", attach certifcate of compliance from lhe appropriate air pollution contml oKcer). CERTIFICATE OF COMPLIANCE: I certiry thai under penalry of perjury ihe iMormation given above is correcL I agree to comply wilh all state laws and ciry ordinances regarding Hazardous Matenals and Emissions. Oale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penalty of perjury ihat I have read this application and state �hat the information given is correcL I agree to comply with all state laws and ciry ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa to enter upon the above-described property for inspec�ion purposes. I agree no� to occupy or allow occupancy of any building authorized 6y this permit until final inspection. `�„ - �C _�t— i u/z v�zo l I SignaWreotLegalOwner(s) Oate MNor Authorrzetl ApP�iram � : .. ..... ...... . .'. � �.. ...' p . p � - .... . � v n P 7'-- � � u, �T � �� - . K � i iV . •�,��2Y+ �i f i '4 '� ' S1 t i �p,��±'� �'�'L ,, `� � �v� � ��r�'� q �4�� . .S��J�r �� #� .YIf' �� K �. � ,,,� � � � �, ,� �,V � � 1 + �7�� ' p ` r �,ZV4i� �y. 4 1y �/� � U� 4� � � ` Y 5�i J/ ��y �" � f' "� Il y��y� f W 3,�� l�! :"��4 .' b;I �� Ji� ri'� _ 1 .l �e�� ' {�yf� '}��t Y :I IP {��y �A r; 'T �t 1 ,� � ai Jy' � �-��,`��1'G��j�'/',s� .. � �i �,'��Vy v � �� .- ;-r��+v..�i,r.,if.`r � i � r�fcyJ� " , � 7,�`•p��,�' �i'�! .. � ��8/ � � •r�� , ' �•�+4J� ^ � P�i %�•• rt•• �o'-�y J �•�''� 'L '� �1�� w�'� ��;.r� " �' y�. ^ 4�t��l�:� ,. �f�� ' �� j � 5 � .y� � • ` �r ��/ G �� . . �f .ffr y� .. f� -�'�y ��"�£.. � •��; � � J F. � r . �", �.. �!�'t ��' .S p�{tiyy�td� P+,'C.',i . :�t.. � _', _ �, � . 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I - �� \ U � �- 3 �� , I ��lf {j � '}��r , R �. � ,,.� ( j y��..,k.,`�� ;. ::, {� ^}%. �_ ,,�,�*.�..�.,� _ y-_� � . 4 �� , �;�- ``,�, .-j � �� ,-`��? � � �, y��t r, . �' � o ti � � s„� -�. �f � ' �' ,ct � A'' ,�i}' : � . ..� r. .:.��. rry.�,P�ik`1.,iJ�� ` [2 �y � �'I lb�,-.�� it1 \ '. r��+ � � ..,.'��. ' �� . + F�� 'iL4�•,Y� ��1��y !.G . #�`' }I� r + M•-.�``�...w � � ') - �� . �'"� � R' � Fi � �M.. .4t� '4 - _ . �. ' l � T�1 _ � h. . �� .�� G1 c� t. ,�v a e�" �'�« u� �"``� � � ' r` �f �f�� O yR4.3i. � � .:y`:> � � r .a �; � � � , .� � � �_�1 City of Costa �l�lesa �uiCding l�ivision 77 Fair Drive, Costa Mesa, CA 92626 osta Mesa 714-754-5273 / Fax 714-754-4856 OWNER BUILDER VERIFICATION Permit # �� Disclosures 8 Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at 95U Co�on>.1., �r�ve (',nFa V�1.s� ( 4l 9 zb2(_ We are providing you with an Owner-Buiider Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. each statement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- uilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 0.\�h 2. I understand building permits are not required to be signed by property owners unless they are rEs�ponsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �,�3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ,�5. I understand if I employ or otherwise engage any persons, other than Califomia licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. �6. 1 unqerstand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �,--7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a Ilcensed general building Contractor. 3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2 �8. I understand as an Owner-Builder if I sell the perty for which this permit is issued, I may be held liable o any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in fhe workmanship or materials. '7�/�9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. �� 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: 11. I agree that, aS the party legally and financially responsible for this proposed construction activity, I will bide by all applicable laws and requirements that govern Owner-Builders as well as employers. bt,ti 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the infdrmation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owne� and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property owner ��- I�`�',_�� Date: � lo�zy �z,�r � T Note: The (ollowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized qgent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification accepta6le to the agency is required to be presented when the permit is issued to verify the properfy owner's signature. Property Owner's Signature: Date: 3148-30 CALBO Jan 1, 2009 OB Packet template 2 Of 2 a � H. V. LAWMASTER & CO., INC. � � 7940 MAIN 57REE7 — 57ANTON, CALIFORNlA 71 CMS-62�AAR-p02 � 828-8040 � XXX Field Data on Test Specimens Core Concrete Gunite Grout/Mortar� Project Swim Pool John Xowar Permit No�J'S�� Project L«ation 954 Coronado Dr. Costa h7eso ContracTor Anthony Pools 6D996 Archited Locafion in Strudure Engineer Date Moulded 9�11/71 No ot Specimens 6 Slump Spec'rmens Marked Speciiied Strength at 28 . days �Q—P.S.I. Mix Designation Age to be tested Ldays 2E days day's days READY MIX PLANT AGGREGATE SOURCE Weather Condition Cle r 1 Yd. _Yd. Batch Cement Monolith Type Cement, Ibs. 13Il_sks— Admix Sand 34 tons Spetimens made by r4 Data by Jack Hub6erd ; 3 Delivered by ,yr2 Date Delivered # REMARKS: Water, Gals. ,,, ,,, ,�,,,,, � R �rrv t�Pf1T Lab, No. Daie of iesT Specimen Dimensions Area Ultimate Load Lbs. per sq. in. H/D Corrected FpRM M - O15 712280 7 Dav Test 9/18 S.B9 X 72.25 27.25 55,500 2,037 RCE�r�6207 FOR 712281 7 Day Test 9/iB 6.05 X 12.125 28.75 63,500 2.209 SEP 2 2 1971 712282 712283 712284 712285 7 DaY Test Dav est 9/18 5,89 X i 27.25 56�50� 2.073 f �[.�LG�c�-•-.-_ � �01-""--�--- 1� AuguBt 2if 17�� Mr. John Toner , . � y 954 Coronado Drive , . , . Costa Mesa, California , . Dear 81r: - ,. � . . A building pezmit has been.ise� to'Antho�y Pools to construct a private swi�ing pool on your property. � In orfler that your 1 will be a safe one and Por the purpose of advising you oP yoia respon ility regard3ng the requirezrtenta oP • the Costa Mesa M.unicipal Code, we refer you to Section 8107, a copy of which is attached. � This lette s directed to you in order that you will be ar�are of our ordinences an an meke�a complete safety check of yrour pool arett. • RH:dh Sincere�y yours, RICHARD AANHART Building Safety Director , -� C I T Y 0 F C 0 S T A M E S A CALIFORN7A P.O. BOX 317 From the OfYice of the Planning Depertment March 1, 1962 Mesa Del Nlar Development Compaqy P.O. Box 215 Corona Del Mar�, California ggr�c Gentlemen: The City of Costa Mesa wishes to advise you that in revis3ng street addresses, the numbers listed below were changed; � i,ot 96, Tract 4285 see below Old Address 945 Coronado Drive New Address 954 Coronado Drive For your convenience we are listing the agencies below that we will notify of th3s change. In addit3on to those listed, you may des3re to not3fy your correspondents of the change. Your cooperation in this matter ia appreciated. DL:rlb Very truly yours, W. L. Dunn, Director of Planning ��, � By: Dave Leighton, Planning Technician cc: Southern California Edison Company Southern Counties Gas Company Costa Mesa County 4later District Pacific Telephone Company U. S. Post Office County Clerk (4) Public Works Department Engineer;.:;g Department. Building Safety � File � Inarlvertently Ipts 52 and 96 of Tract 4285 were assigned the same number "945" u •\�OWNER TOD �j J08 ADDRESS �GENERAL C01 AP No.l� INSPECTIONS . �s ROUGN PLUMBING ��"J PROP. SWR. LINE QJ SE CON. SPRINKLING SYSTEh� MISCELLANEOUS ROUGH HEFTING AND F CONOITI TEMPORARV SERVICE OR POLE UNDERGROUNO � POWER � ROUGH WIRING FLOOR SYSTEM � BOND BEAM Q TS SHEATHING FftAME ANO FLASHING ^ 1 1 P�PSTER, BROWN COAT STRUCTURAL FINAL REINF. FINAL ve DATE 8-24-7i BUILDING PERMIT N0: 33550 SUBCONTRACTOR �r � a 335�0 COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 120p COSTA MESA. CALIFORNIA 92626 Z . a cwj Z Z Q H d m J � J N Q W m J J m Q U N Za W ¢ d W WZ �p mz J � W ly� o= zF w° N � 70 auc2�a-��;5�0(lie�,hn u-{:�3',50 APPIICATION FOR BUILDING PERMIT For qpplicani to Fill in Completely RECEIVED BV DATE FiEGEIVED D TE ISSUED ADDRE55 954 �OROIdADO DR � — � .�`f'7/ PERMIT�l O. OWNER '� T T j� A.P.NO. �I�SSI��3 �5�'$� MAIL BUILDING ADDRESS C ADDRESS 95 CORONADO DR TEL. TRACT 2 L0T9 BLOCK CITY NO. CONSTRUCTION W A P LENDER CASH � BRANCH OWNER ADDRESS '� ' "`� VALUE 1� ARCHITECT TEL. S Su7IM POOL,r $ Z1yOO�OO OR ENGINEER N FIPE ADDRE55 S FIRESTONE BLVD� ZONE TVPE GROUP CONTRACTOR �Q� ]�� BYPROV � Q �( �y,) DATE ✓ � � � 5ar1 r�sToxE si.uD. �•/ ADDRESS ZONE NO.OF USE OF NEW GITY SO GATE Na�3P 32210 e-� v�a.rs 'l. eui�owc S(MN �L- STATE ry� CITY �'ARDSAPPROVED VARDSAPPROVED LIC. NO. Z9O1/7 �IC. NO. MAIN BUIIDING ACCESSORY BUIIDING SI2E NO.OF BLOGS. (FROM C/L STREET) OF LOT NOW ON lOT FRONT FT. FT. W VSE OF ��m n�n �7 FT E%ISTING BLDG. � �u�u lIl1SL 5 FT. SIZE OF NO.OF NEWBLDG. ROOMS STORIES I.SIDE FT. 3� FT. E%TERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BEf. MAIN & MAIN BLDGS. ACCESS. BLDGS, VAF. # DATE C.V.P.# APPROVED APPROV � i hereby acknowledga thet I have raetl this application antl state that the ebove inFormetion is correct untl eBree xo comply with all lews regulatlnB builtlinB construction, and I shell not employ nny Derson in vialation of tho workman's compensation laws of tha Smte of CelifOmia. I hereby certify chai l em properly Ilcensetl as a conttactor untl¢r SQ. FT. the S2ate of CalitOrnia Businezs antl Protessions Code, Divisicn 3, THE AMOUNTSHOWN UNDER VALUATION IS FOR Chapter 9, and licenses are in t ce antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: em exempt m the prpvisions ot iheS ce of �lifornia Businesz VALUATION antl Protes ons Cqtle, Division 3, Chep r 9. PERMIT FEE $ a3 � � I, Signatu�e f �� y.�0 � QQ // �� Permittee $ PLAN CHECK $ � �/ �� / ,/ �� Authorizatl ABant �� ca'✓�/'..�« � TOTAL FEE $�'+'� . ::A � �- e; r-:, �,� �� COSTA MESA BUILDINGSAFETY DEPARTMENT P.�.O. BOX 917 COBTA MfiBA. CALIPORNIA For Applieant fo Fill In Complefely � . u _rr ._ Dri MESA. CALIF 1 Mar Deve Lot 96 Tract 4285r�Y�n 33��r�V�� `1/ SEP 6 t969 j� FINANCE DEPT, CITY OF COSTA MESA TEL: "--' BUILDING cin Corona del Mar No.3-4220 ADDRESS ARCHITECT TEL. �T1012 OR ENGINEER 'M3CC0 COY NO. n AODRESS 3300 E. Coa.st Highway FIRE ZONE GONiRACTOR M2CC0 COT�7. APPROVED BY ADDRESS 3800 F. oast Ai hwa. c�Tv Corona del Mar zoN��/ STATE 988U8-SB-1 rE�.Oriole 3-4220 �EGAL LIC. NO. NO. oeecrtiriion BIZE� 651� S• �'• I NO. OP BLDG�ane OF LOT NOW ON LOT w e u.. none IL�G. 6 PPOM rrweeT L9 � REAR YARI I5'3" I LEFT RIGHT DESCRIPTION OF WORK I X II ai rcoer�nu I II enn�r�n 81ZE�ING S9'9"x50' Ro°om°s 6 E%TERIOR WALL W�� ROOF C COVERIN : SYUCCO ICOVERING USE OF BUILDING ANO WORK TO BE PE. APPLICATION FOR PERMIT BUILDING For Office Use Only RECEIPT NO. � P,EP BY DATE 198UED COSTA MESA. CALIFORNIA ZONING NO. OF ��U6E OF N PLAN9 BU�LDINO ICHNTER LIN6 BT.) 24 , FRONT S 6 5 ' �.•— R. SIDE L. SIDE � � e�.e Z 3 1 �� I H¢REBY ACKNOWLEC6E THAT 1 HAVE READ TX19 MPLIWTION TNE AMOUNT BHOWN IINDEH VALUATION IB FOq THE ANO BTATE TH/T THH ABOVE I6 GOfiRBGT AND AGREE TO COM- pURP08¢ OF EBTA6LIBHING A PERMIT FEe ONLV. PLY WITN ALL CITY ORDINANCE9 AND BTATH LAW6 R64ULATNO BU�LDINa CON6TRUCTION. VAWATION SIGNATURE sa. Del r Develo ment CO. PERMIT FEE $,�.5 � PERMITTH % yI�' $ 15 , 326 . 00 PLAN CHECK $ � BY• J,., i.._..._./�D _