The URL can be used to link to this page

Home My WebLink About3153 CORK LN - Building Permits9 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 3153 CORKLN Suite No Vicinity: Parcel Number: 14163340 Applicant: COOTER, LYLE Address: 12922 HARBOR BL GARDEN GROVE, CA ' Owner: VALDIVIA, HATTIE'E TR Address: , � � 3753 CORK LN � � � COSTA MESA, CA . Contractor: EMPIRE'PLUMBING Address: 12922�HARBOR BL . GARDEN GROVE, CA MECHANICAL PERMIT � •Phone: 714-530-7320• Zip� .92840 Phone: Zip: 92626 , Phone: 714-530-7320 Zip: � � 92840 �. � . � . License: 794154 � SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 INST FAU<100 K BTU ISSUE FEE Insl FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heal Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU ' Refrig Sys >100 k BTU Gas Piping Factory Fireplace " Hood w/Mech Exhaust , VAV Box Vent Fan ! Single Duct Appiiance Fire Dampers , � Smoke Dampers . Inst or Relocate Appl Vent Air Handlers < t0000cfm � AirHandlers> t0000dm - Floor Furnace �- Floor or Suspend Heater � . � Quantity � ' • $23.50 � - � � $14.80 1 $0.00 0 $0.00 0 $C.00 0 . _- . $o.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 �. �- $0.00 0 - � ,. $0.00 �-:..0- : : ��$0.00 0 ' . .. - $0.00 �� 0 �_ � � .$0.00 � �0"`, .' $0.00 0 , $0.00 ' 0 ' Status: ISSUED Applied: 11/07/2002 Issued: 11/07/2002 ISSUED BY: FEE SUMMARY.. .. Repair / Alt Absorbtion Unit Repair / Alt Refrigeratlon Unit Ventillation System Evapowtive Cooler Commercia l I n cinerator Domestic Incineretor Compressors / Absorption SVstems Upto3hp/100kBTU 3Ta15hp/500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers " Upto3hp 3To15hp 1510 30 hp 30to50hp, - Over 50 hp Other Mechanical Fee � Investigation Fee Plan Check Fee Reinspection Fee � TOTAL CALCULATED FEES � .. Quantity =$0.00 0 50.00 0 $0.00 0 $0.00 .0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $38.30 NOTICE:, The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) 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 codas, and all required Inspeetions and tinal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754•5626 2446-06(N00) WORKERS'COMPENSAnON DECLARAnON: "�' I �ereby aflirm untler penelry of perjury one oi the following daclarations: ❑ I heve entl will maintain e cenificata oi consent to seN-Insure tor workers' campensetion, es provided for by section 3700 ot the LaDor Code, tar �he pertortnence of the lw� rk for which Ihis pertnit is issued. �'�I heve an0 wiil meintain workero' compensatlon insu2nce, es requiretl by section 3700 of the Labor Code, for the peAortnance of the work for which this pertnit is issuetl. My workers' wmpensation Insurance carner entl policy num6er are: ^��p �� Cairie_r�,'. �%j�iL��1/1 �c �,,,PolicyNumber.? �� (1hTs sect/on need nat csmp/efed il the rmlt is veluetl a( one huntlred dollars ($100) or less.) �— . ❑ I cenih/ that in Ne peAortnance ot the work for which ihis pertnit is issuetl, I shall not employ eny pereon in eny manner so as to become subject to t�e workers' wmpensation lawg ol Calilomia, entl agree Kat it I shoultl become sub�ect to t�e workers' compensation provisions ot Section 3700 ot the Labor Cotle, I shell forihwith compy wiih these proNsions. . � �O �' AppliCeM•6ignaN�e:, .� Dele:--.�/ WARN�IN(3: FAICURETO'$ECURE W RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHP1L SUBIECT AN EMPLOYER TO CHIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED T710USAN0 OOl1ARE (5100.OW). IN ADDITION TO THE COST OF COMPENSATIqJ, DAMAGES PS PROVIDED FOFi IN SECIION 3N6 OF THE IABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am licensad untler prov,isic CONSTRUCTION LENDING AGENCV: 9(wmmencing with Section 7000) of Division 3 0l the Business and Professions Code, entl my license is in full ❑ I �ere0y affirtn that there is a construction lending agency for Ihe peAormance ot the work for which ihis permit is issuetl. (Sec. 3097, Civil Code). Lentlers Name: Lentler'S Atldress: Signa[ure: OWNER-BUILDER OECLARATIONS: Date: I hereby aHirtn that under penalry ol perjury Ihat I am EXEMP7 FROM TME CON7RACTORS LICENSE LAW for the foltowing reason (Sec. 7031.5, Buslness end Protessions Code: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair eny strucWre, prior lo its issuance, also requires Iha epplicant lor such pertnit to file e signetl statement that he or she is Iicensed pursuant ro ihe provisions of the Contreciors License Lew (Chepter 9(commencing with Section 7000) oi Didslon 3 of t�e Business and Professions Cotle) or that ha or she is exempt therefrom and Ihe basis for the ellagetl exemption. Any violation oi Section 7031.5 by any epplicant for a pertni[ subjects tha epplicant ro e civil penalry at not more Ihan five hundretl tlollers ($500)J: ❑ I, es owner of Ihe property, or my employees with wages es Iheir sole compensation, WILL DO THE WORK, and ihe siructure Is not intendetl or oNered for sale (Sec. 7044, Business antl Profeuions Code: The Contractors License Ww dces not appty to an owner of property who builds or improves ihereon, and who does such work himselt or herself or Ihrouph his or her own employees, provided Ihat such improvemenis are not intended or oflered lor sale. Il, however, ihe builtling or improvement Is soltl within one year oi comple�ion, the owner-builder will have the burden ot proving tha� he or she tlid not build or improve tor purpose ot sale.). ❑ I, as avner ot the pmperry, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the projeq (Sec. 7044, Business end Prote55ion5 Cotle: The contractors License Lew tloes noi apply to an owner of property who builds or improves ihereon, and who contrects tor such project with e conirector(s) license pursuant to the Comractars License Laws.). ❑ I am exempt under sec. Business anE Protessions Code for this raason: Signature: Date: Owner ID venfietl by tlrivefs license. ❑ Ves ❑ No Drivefs License No. Vedficatlon oi Owners�ip by (type oi tlocument, Le. � properry tae hill or deed): Expires: DIVISION OF INOUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereby ceNiy t�at no e:cavation five (5) or more feet in depih Into which a person is requlred to descend, will be mede in connection with work euthonzed by this pertni�, and Ihat no huilding sWcture, scattolding, talsework, or demolition or dismamling thereof, will be more than thirry-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, CalNornia Atlministrative Cotla). ❑ As owner-6uiltler, I will not empioy anyone to tlo work which woultl require e pertnit trom the Divisian ot Industriel Satery, es notatl above, unleu such persan hes e permit to do such work from �he division. SignaWre: Da�e: Divislon ot Industnel Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTRY: I certity under penalry of perjury thet I have read this epplication and state that the information given is correct I agree to wmpty with ell state laws and ciry ordinances relating to builtling construction, antl authonze representatives ot the Ciry of Costa Mese to enter upon Ihe ebwa-described D�operty for inspection purposes. I egree not to occupy or allow occuDancy of any building euthorized by this pertni� uniil tinal inspeMion. COOE �. INSPECTIONTVPE 7�IE lI�IIlALS 1876 Fixetl System Final Fire Prevention 1268 200 201 202 203 204 Pool Spa Final Final Re-Root Flnel BIocWRetaining Wall Final Factory Fire Place Finel Sign Finel Demolition CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Sita 250 Finel Building/Occupency PA7E It� I!-iy -o � � �nnn[ssovew�wa �1» l.V1tK LN .. . r; oxr�asru�e�va,avx VALDIVIA, HATTIE E TR FLOOi"i: X 46^ wo�ss:3153 CORK LN . COSTA MESA,CA . 92626 546-8090 �vv�. wuuxc �oo�ss •r-\; 1PCNffECTOXENtlNHN: 11C.lq.: APCH OR ENO.'S �WNE55: � UNT: coemiurarsxrye BALBOA ROOFING COMPANY ( 714 ) 631-5051 CONiPACTORSMY11Nfi 600 CLIFF L7R �oopEu:NEWPORT HEACH 'CA �� 714729 92663 UNT: LICENSED COMRACTONSp pDpE�CLAfl�T10N: 1 heregb�y eflim �Mm peneMy M C,p�ed�euryy tqhe.�t 1I(em Icanaed under provisiona d Cheqar 9 m LIC. NO�� " � d�C. CLA53: "�� P C.�NO ''+� 4/ L Ijqanw o in�p �¢a eek qeryf' 9 8 7 Xk' lJZ3 �, o�e yic�� ,�� `� �� OWNEN BUILOEF OECLJ�NATION: I henEy etFrm uMx pMelY d perlNry �hal � em eRemq �mm Ihe ContreUae lirorae Lew lar tM Ilaw'vi0 reesm (Sediwi )031.5 Bue�rou eM Prolmdona Gotle: AnY UY a��Y �� AVuire, e pe�mil b conebucl. eller. impv.e. �moloh, or repei eny sl,uMure, pior to ns asuerKe, elao req�irea �he appliuM lar euch paimit to fib a egneE swement Mm ha u ehe e licenaad punueM �o tM poviabne d Me CaMredore Lica�ea law jChepter 9(mmmenrinp with Sed'an ]OW) d Divbion 3 d Ilr Bu+ima erd Prdmaiona Coda� «thei he or ehe is eaemq �M1�eM1wn eM 1M bmia la �he elbped memqion. My violetion W Seaion )031.5 by eny eppliunl �or e pe�mu wbpda �M epplicen� �o a tivil panelry d ml maa �hen live huMred ddlen �SSOOj�. � I. av ownar dtha propenY ar mY �WoYba �h wapea es Ihei mle wmpanveton. will Eo iM xwk. eM iM MiucYuro b ml intenEed w oRered la eele (Section ]Oi4. Buvnms end Pro/eevMs Code: The CONrmaa licenee Law doea np Appty loan ow�rord qopMy � wM Wide a inprmm ihereon, aM nho daea nuM xvA MmwM or hene! or ihraph h6 a her oxn employw, qovided thal wch imprwemenla era nd inleMeE a dlered I« aeb. M, howa�er. �M buiMiip a inqwemem ie aoN wnhin ona yeer d mmd��. �ho owr�ar-buiker will heva ihe buNen W povi�p M or aM db �u buik a improve la �M purpoee d ade). ❑. I. ee omrr d �ha P�Y. � extlusi+ely contreq�p W�h IicenseE con4xtas to conmud the pmjM (�� )�. Buai�e erd Prolaeaione Code: Tha Conlreclan licansa Lew doea mt eppN lo en ownu d papeny v.Ra Wiks or impovm �hneon eM Mq conVecb lor wM prqada wnh e wnireea�s) Icemed Wnuem lo tM Comreqma Licenae Lew�. � I em eRempt mMei Seciion: � B. 8 P.C..1« �hb raeaon: . ' . Dete: OwnM� 1 do hereby cMily ihel I em eware d eM uMantarM the roq�iremams d CelRomie Noellh and Sdety Gade Soqiom 25505. 2%33, eid 25530. eM 1l�et I ar eiry tulure Wiki�q o¢upeM xill / wil iwl (acb aro) iwed lo comply wIh aeM ele�e catla eM iM iepuiremeMe M e permn lormnnrucion a modifi�iwhaniM�iawity .�aMOe�t Oistrie. RevdpnW mna�ueun �ppiediwro en usmq fmn �heee vo+rs�«n. oe�a: Aod�� WORKER'S CONGENS�TION DECL�RATION: I MroEy e1R� urdsr peraliy d perjury om d the Idbvnrq dedarticm: ❑ I �me eM wil meiMein a cenifcma d ooneent lo eell�ineure Iw xwken' compen�etion, n pwided tor by Sedion 3)00 d iM LeEor coae.la tne ve�laiwic. d fi. w�xta wFicn 1ms od^^^»;°"'w. }4] I hew eM wil meinten v.aMaia' wnpenation imuranw. ee roVuimtl by Se�fim 3]00 d Ihe leEor COEe. M tM peNormenro W IM .�n ��.n� m�. w�n m�.�e. Mr.a�as�,f'�'1°iE"'"P'�g""""^ aw� ��m�,..a: E X P I R E S � PWry Number �a� `� 8=3�+1 � i i+i .^. 6� 01 / O 1/ 9 9 (TM1is section neeE iror be comderod / tMV�k is lar one „�Mro! ddlers l.flaol m Isv.l . � I cenly tMi in iM peRorme�e d the w«k lor xfich Ihie pa�mn ie iaeueE. I ehell iwl emplq eny penan in eiry menner m ea to become aubl� lo iM xnrken' compenaeiion lewe � Celitanie, end epiea Nm R I ehouM bawns wbpd �o ihe xorkers' compens/mion prvriaiare ot Seabn 9100 d ihe lebor Code, I ehell lonhwilh oom wM Ihaae � 7 oeia: '�llb ��l$ nod��: ��t_ -a .- Q-4_ , Wamlrp: Fe/lun ro ucun roAxi wmpmutlon rov�rPW �� 1, endshsll wbJset en smp/oysr b eNMnsl psneMu and e/Hl Hnsi up ro ons hwdrerl fhouuM Je/Mn IS10qOWA M eddltlon ro tln rost o/ romperwfbrq Gmps� u povltleG br In Swtlan 3)OB ol tln LWorCOW, Inbns4 antl attornsyY �� • CONSTNUCTON LENDINQ pGENCY: I hxaEy elfi'm wder peraM1y of parjury ihet �here ie e conetrudion brkinp epency br the peAormerwe W IM xnM la which ��b Varmi ia ewed (Sedun 309). C'v. CI� . • LENDEH'S NMIE: " . .., . LENDEP'S A�DHE%: , I cenily thet I heve reed Nis eppliwian enE slete Ihet IM ebo'�s inlammion ia corraq. I epree �o mmply wuh all dy eM munry ordinenme enE stele levn releinp to buikvp conavwbn end hereby eNlarrta repeaen�eMee d ihe tlry b anter upon IM ebwe�memioneE properly ��^so°"�°^W��.TIM WOODALL tN �� \ , � , oe�a: 7/ � LL� � sre�m�re a o�ine«�unws� ��aa � _ (5151dB.WP) Whus9vildip 8 Sdery; Greeo-Fle: enery-Ao �um: Pink-Revenue; (3olEenroC-Avaeawr __ ,. CITY OF COSTA.MESA_- BUILDING PERMIT PERMIT NO: B 087591 PLAN CHECK NO: N CONSTRUCTION TYPE: V-N PERMIT TYPE: STR �� PERM NO: B 087591 GOVT: N SUPP: N PURPOSE: OTH SOH DESCRIPTION : T/OFF SHEATH & REROOF W/COMP SHINGLES SQ_FT: 4,200 CLAIM VALUE: 4,200.00 CALC-VALUE: 9,200.00 GROUP OCC: R-3 / COMMENTS:.REROOF 2200SF RESIDENCE W/COMP, SMOKE DETECTORS REQ PER 94UBC x�**�t****�t*�t�****�************x��t*�t***�****+t��t�t***�*�t*+�+�*�t*�******�c�****�****** Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- -=------- ACCESSORY.BUILDING --------- FRNT: FT IN REAR: FT IN F'RNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT , IN RGHT: FT IN PARKING REQ: PROV; PARCEL: 14163390 ZNE: REF NO: PLANNING NOTES> ' ' j- . . 1E ik 3E iE iF iE iE if ik iF fF iE 1t iE iE iE iE 1f iE #' 1E 1f �E 1E iE jE iE �f 9E iE iF �F iE if iP �E iE if !E iE if iE iE iF �t iE 1E iE �F'1f iF iF if iE 1E 3k i! it dE iE iE iE iF 3E 3F iE iE jF if iF if if iE iE jE iE iE iE iE ' D E V E.L U P M E N T S E R V I C E S R E Q U I R E M E N T S K. � ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION I$SUED BY: DATE: �'�� CC� iE iE jE if aE 9f 3E ik iE if aE if ik iQ if iF iE iE jE 3F iE'1F 1E aE jf fE iE iE iE'IE')E 3Ei�"A��F�1E �)E LEGALZZATION:'N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMbING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 99.75 .50 SMIP/NON-RES PLAN ISSUE FEE � BUILDING-DIV-> PERMIT IS5UE PLAN-CHECK TOTAL PAID DUE TOTALS----> 100.25 0.00 0,00 100.25 100.25 .00 REVENUE DIVISION TOTALS--> COLLECTED: 100,25 OVER/SHORT: .00 bLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 99.75 ,50 �1E �F iF iklE iE iE 1E iE iF 1f if # 1F 3F iE 1F if 1f �1E iF iE iF if iE fE 1f if 3F 1k �E dE iE iF 3E if iE iE iE if it jf iFlF dE 1E iE 1E jE if iFlF 3f 1E aF 1f 1f 3E df �E iE jE 1E iE iF it iF iE 3E jE iE iF jF �E iE if �F fE 3E I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R 2 P T I U N UNIT COST ' TOTAL COST SFk 4200 REROOF bY VALUE RESIDENTIAI; NOZONE 1.00 END UF FEES t EX�'��D � � DA'c� 6 a6 0 A 4,200.00 �4-96-1�98/12:18 R?(/61B9.25 RCPT�:�I-@221959 PEkFlIT:087�'3i �,. ,� CONSTRUCTIONANDPLANNING� �'� _ . P��"'`-`�'+SPA � APPROVALS Permit � Date Inspector, � AppROVALS Permit � Dace inspector 1. Temporary Electrical Service or,Pole ; . � ' 52. Pool & Equipme�t Location' . . � 2. Soil Pipe,Undrgrnd.. " . - : � 53. Steef Reinforcement � . _ 3. Electrical Conduit Utility=Undrgrnd. - � 54. Forms ,: � - . � � � . 4. Electrical Conduit�Undrgmd. � � �.55: Electrical Bonding � ' 5. Steel Reinforcement ��56. Rough Plumbing & Pressure Test 6. •Electrital UFER Grnd. � � . . 57: APPROVAL TO COVER�GUNITE • � 7. Footings 58. Electricai Cqnduit-Undrgrnd. '� ' 8. Foundation � .- 59, Gas Pipe, � Undrgrnd., Test� '. , . , � 9. Water Pip¢-Undr9rnd. . . 60. Backwash� Lines, P-Trap, � Und�gmd. �, 10. Svuaural Floor System - � 61. APPROVAL TO DECK � 1 i. Property Sewer Line & House Connection ". �� , 62. Backwash & Receptor-Final 12. Sewer Cap � � 63. Heater & Vent-Final � 73. Roof Drains � ., 64: Plumb�ng SYstem -'Final � 14. Rough Plumbing - . 65. Electrica6Final ti ,. • 15. Rough Electrical-Conduit � _ 66. Soler System-Final � t�' _ �. 16. Rough Electric Wiring � - - 67. Fencing & Access ApProval � � 77. Rough Wiring Sign � �68. APPROVED FOR PLASTERING - 18. Rough Electrical�T Bar Ceiling � �� .� � � 69. POOL/SPA SYSTEMS FINAL � . �79. Rough Heating & Air Contlitioning_ - - � FIRE DEPT.'REQUIREMENT - ' 20. Rough Factory Fireplace APPROVALS . Permit �p 21. Dutts, in Struaure � ' 70. Underground Hydra 22. Ducts, Ventilating � . � 77. Product Piping � Gas OOiI 23. Gas Pipe-Rough & Test - � 72. Underground Flush� 24. Roof Framing � 73. Undergrnd. Stotage Tank O Gas ❑ Oil 25. Roof Sheathing .. j� 74. Overhead Hydro 26. T-Bar Ceiling (SV�cturatl & Monocoat , �5. Dry Chemicaf - � 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding ' 77. FIXE� SYSTEM FINAL �� , 29. Insulation � . ' 78. FIRE PftEV. FINAL ' . - 30. Drywall Nailing HEALTH DEPT.�REQUIREMEN � 31. Plaster Brown Coat . 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 80. fOOD CERTIFiCATE ISSUED � °f� t 33. Final Electric Notes: � - "' t 34. Fina� Heating & Air Conditioning � • ' � ' � � 35. Final Gas Pipe;Test � . � � , - 36. Hood or Canopy - 37. Final Facto�Y Fireplace . � - •� . - 38. final Plum6ing � � � � ' 39. Water Service�Finai ' � � ' 40. Gas Service•Final � - , - � � ' 41. So�ar pomesticFinai - • '_ � ' 42.'Backflow Preventei , , 43. Backflow Irrigation .. � . 44. L.andscape Irrigation SYstem , . - � � 45. Sou�d Attenuation � ' ' � . 46. Handicap Regulations . . 47. FINAL STRUCTURE & BUILDING - 48. FINAL PLANNING • 49. Eiectric Rele�se to Edison • , 50. Gas Relea4e to Southern Cafifornia Gas Co ' � � 51. CERTIFICATE OF OCCUPANCY No Date OWNER pqI,D2V1A c� DATE 5-17-77 JOB ADDRESS 3151 Cork Lane BUILDING PERAIIT N0. WS ROUGH HEPTING �ND AIR CONOIiIONING ;? UNDERGROUNO L� POWER U �ROUGM WIRING TRENCHES qM STEE�1 �FLOOR SYSTEM �BOND BEAM STEEL REINFORCE SHEATMING FRAME AND FlqSMING LATHING - IN n ( PLASTEP, BROWN COAT STRUCTURA�, FiNAL MEATING. VENT,, qEFRIG. ANO A.C.. FINAL ANO GAS TEST I� BUlLDING FIRE ZONE SUBCONTRACTOR F � � Q � h .�1." F Ci F a c .-1 Q � �' a a w w O a a Z W x 3 � f "988 c+.� COSTA MESA BUILDING-SAFETY DEPARTMENT � P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING �� _ . �_ _ OWNER MAIL ci-rv .( v1 CONSTRUCfION BRANCH ADDRESS ADDRESS �� TEL. NO. TE L. TEL/. CITV�jR�DC�.1 /r�iC01/C N�[�%�." STATE ", CITV LIC. NO. 2'? ��s K LIC. NO. SIZE � iNO.OF8LOG5. OF LOT NOW ON LOT USE OF E%ISfING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUIIDING ANO WORK TO BE PERFORMED I hereby acknowlatlg0 thet I have featl this application antl stata ihat the above informaSion Is correct antl agree io comply wit� ell laws repulatin0 building consttuction, end I shell not employ any person in vlolatlon of the workmen's compensailon laws ot the Stete of Californla. I here0y certify thet I am properly Ilcensed as a contrector untlar the State of California Business and Professlons Code, Dlvtsion 3, Chapter 9, entl mai such licenses are In full force antl effect, or 1 am exempt from the provisions of the State of Californla Business antl Professlons Cotla, Divlcion 3, Chapter 9. SIB�a<ure of O � a��/� Permlttae �/� \_ AuthOfized Apent . ' �dY 17-77FFI��Q 805# *�*�30.50 CM$ APPLICATION FOR STRUCTURAL PERMIT RECEIVEDBV DATERECEIVED nersiccimn A.P. NO. /7 BUILDING ' ADDRESS ` TRACT VARDSAPPROVED MAIN BUI�DING VAR. # C.U.P. �W THEAMOUNTS THE PURPOSE OF VAWATION - �, �� J $ BLOCK VALUE USE OF NEWG�w.GR�/Z BUILDINGq�� VARDS APPROVED AC/CESSORV BUIL/D�ING �/ J � / IT. L - � � _' & DATE APPROVED JN UNOER VALU 'ABLISHING A PERI PERMIT FEE S TAX E TOTALPAID E N � � m i m m � m b a N m ro 0 � U OWNER HAHk30H HALL 0 JOB ADDRESS 3153 Co GENERAL CONTRACTOR Li AP No. LOT 7 INSPECTIONS OCCUPANCY+. 0 ry TRACT INC. DATE NOV 3 0 1962 � BUILDING PERMIT NO. ntial Bld . Cor , vnLu��l5.00 3 FIRE ZON� llESCRIPTION OI�' WORK . DAT�^ GROUP IgJ TYPE V ZONE YPRMI'. �� SUI3CON1`RACTOR T,�:,,�— i Att.�ar. .- = 18322 COSTA MESA BUfLDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MESA. CALIFORNIA For Applieant fo Fill In Complefely TYPE OR PRINT BUILDING 3is3 �YI{� �q ADORE65 �l 2 � COSTA MESA. CALIFORNIA owNea xaz'bor Hall of Fame Homes Inc. ADDRESS P�� BO.4 2066 Jamison "D'� St.. TuBtiII 2131 So. Artesia $8IIt3 iIIIA FEE RECEIVED d90V 3�; )gG� ; Lot 72, Tract 435 -IN�O� �� CITY Of COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RHCEIPT �o. ��.,3 .�oy RECE D BY O R6 IVE � I OATe�IBBUlD �� I�.�4% LI ��vr S 0 i962 COSTA MESA, GALIFORNIA ZONING � NO. OF U88 OF NHW [� Purve "euamNc . � � No. 208676 No. j{I 9—zZ��i �ec�� OEBCRIPTION BIZE CO�� NO. OP BIDOB. OF LOT � �NOW ON LOT O p, p, NO. USE OF "'NORB EXI&TING BLDG. APPROVED ALLO C6MER OF'NBTRCETM 5�� REAR YARD 28'�`�, FRONT L1Ne �*•Sp FT. SIDEYARDILEFT lr%1 IRIGHT �1 R.SIDE � FT. DESCRIPTION OF WORK L. SIDE �S�—_ FT. NEW ' I XIIALTERATION I IIADDITION I erno Z P v�r � BUILDING _ i�. �. NO. OF AND I HEPE9Y AGKNOWLEOGfi THAT 1 HAVE READ THIB APPLIGTION AND BTATE THAT THE AB E I6 CORRELT AN� AGREH TO COM- PLY WITH ALL CITY O NCES AND BlAT¢ LhWe GULATING BUILOINO CON9TRU L . //��//'�lJ SIGNATURE OF , . 1 '� _n �_ � e AUTHORIZED AGENT 0 � n q � i �E AMOUNT 6H0 J� UNOE �L�ATION 18 FOR THH PURPO6E OF EeTqBLIBNING A PERMIT pEE ONLY. VALUATION r PERMIT FEE $ �J 7�- $// �� PLAN CHECK $ �a' V � F iOTAL FEE �'S� 4