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Home My WebLink About1769 CRESTMONT PL - Building Permitsv (714) 754-5273 Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1769 CRESTMONTPL License: Status: ISSUED Suite: SCOPE OF PERMIT Applied: 09/26/2002 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 09/26/2002 Parcel Number: 42426304 Zoning: Plan Check: $0.00 Applicant: ROGERS, EDWARD Calc Valuation: $4,000.00 Permit: ISSUED BY: Address: 1300 ADAMS AV Claim Valuation: $4,000.00 SMIP Res: $0.50 APT 23C Phone: 714-966-2928 $0.00 COSTA MESA, CA Zip: 92626 $0.00 Owner: ROGERS, GLORIA Inspection: $0.00 Address 1126 W PINE ST Total: $97.75 Phone: SANTA ANA, CA Zip: 92703-4538 Contractor: OWNER -BUILDER MAIN STRUCTURE Front 0-0 Rear Address: Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 Phone: Existing: 0 Required: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF: T/0 EXISTING WOOD SHINGLES, 7/16" OSB SHTG, 1 LAYER 30# FELT, APPLY "30 -YEAR COMP SHINGLES " 22 SQUARES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,000.00 Permit: $97.25 Claim Valuation: $4,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2"646 (6=) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. a Class q Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor($) license pursuant to the Contractors Licen a Law ❑ I am exam er s Business and Professions Code tot this reason: Signature: Date: Owner I 'fieri by driver's license. es ❑ No Drivers License No. �/, �Expires: 'tl Verifcalion of Ownership by (type of do i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................t-o-......................ildi................p-a-i...............................................rati........................................................................................................es.......................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................ ......................................... .......................................................................... -...................................... ............................... ........................... .... ....... ................................ ..................... .................................... ........................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................-................................................................................................................................................................................................................................. .....................-................................................ ..............._.... 4 If en RMPP is presently required, has Section 25534 of the California Health and . .............Safety Code been fully complied with? ❑ Yes ❑ No .............................................................................................................................................................................................................................................................................................................................................................................. 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication appemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on .applications for non-residential building permits). .. .................................................................................................................................................................................................................................................................................................................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .............................................................................. ................................................... ............................ ..................................... ................................... ................................................................................................................................................ ...... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed . by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................... ........................................................................................................................................................................................................................................I...................... 8 (it -yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORMATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur eg ns) Date And/Or Author' EcarT Data CODE 1. INSPECTION TYPE 2AN IN_g1ALSi CODE INSPECTION TYPE INITi1SL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof "i9Z 210 Final Electrical 201 Final Block)Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS `Street Address:: r��O / �i:7Qk/ ��ri1910� eenced real property, and that I (we) hereby authorize: Bldg. Permit # This Permit # AP Number: declare that I am the Owner of Title of the above Name: —Telephone w / l Telephone Number: 717- 0 � Z 9 Z Street Address: #Z3 c. City: e5a0� 014:��06 State: to obtain permits in my behalf, as owner/builder, for 06 1611• at the above referenced property. ei QAN(J. Zip: 9ZG2G 2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Workers Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. 1 agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. 1 declare under the penalty of perjury that the foregoing is true and correct. Executed this i # day of U _ 20 Ot , at � � , California. Print Name: 473 Signature:Yj Note: This authorization does riot grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 077946 lrev.11ro01 1 PROJECT ADDRESS: UNIT: OWNER'S NAME: 1769 CRESTMONT PL ADDRESS: ROGERS SIDNEY ALLEN 1769 CAESTMONT PL COSTA MESA,CA 92627 ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: GLORIA ROGERS (714)835-1220 ADDRESS: 187q•66T� p9p CRRpEEqSSyTMONT PL nn 99 99�� LICENSED CONTRACTOR"DEC ATIONMWr y affirm that I am licensed under, NAisionsUl Ch3pler 9 (commencing with Section 7000) 0l Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: EYP: Dale: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereat (Section 3800. Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Candied copy is filed with the city Building Division. Date: Applicant I certify that FROM WORKERS'COMPENSATIONof the work DECLARATION: mil(This section e need not be completed my p Dson isis ln4nor fosse certify that in the performance of the work Int which this permit is issued. shall not employ any person p in armor so as to become DaI to the Workers' Compensation Laws oI Calilornia. D t '/ \ii� Sipnatur —NOTICE: II. alter making thia tledaration, you should become subject to the WorkersGoIrpensation4fovisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Prolessional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therelrpm and the basis lar the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the properly or my am levees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' Slate License Law does not apply to an owner of a property who builds or improves thereon. and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. �. I am exempt under Section: B, 8 P. C. for reason: BF7044 �t �qs� f�BY OWNER'S SON Date' _I—_(y( I / Ow __ do hereby cemfy that I am aware of and understand the requirements of California Health and Safety Code Sectio 05, 25533, and 25534 and that I or any luture building occupant willlwill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Cuality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and stale that the It Iormat ion is correct. I agree to co be all city and county ordinances and stale laws relating to building construction and here ulhowe repr at as of tfir to ent nlhe above-mentioned property for inspeOion rposes. Signature'. Drivels License of Social Security #: 1541.46 white—Building: Green—Cotle Entorcemenr. Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 07017; PERMIT NO; E 070172 PLAN CHECK NO: N GOVT': N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION ELECTRICAL SERVICE UPGRADE TO 100 AMPS SQ FT: CLAIM VALUE; CALC—VALUE; GROUP OCC; R-3 / COMMENTS: UPGRADE ELECTRICAL SERVICE FROM 40 TO 100 AMPS 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 FP,NT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN PARKING REQ: PROV: PARCEL; 42426304 ZNE; REF NO: PLANNING NOTES> D E V E L O 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 ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE; APPLICATION ISSUED BY: . DATE: /7 1( LEGALIZATION:N F E E S U M 4 A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 18.50 50t SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL ' PAID DUE TOTALS ---- > 18,50 15,00 0,00 33.50 33.50 •00 REVENUE DIVISION TOTALS--> COLLECTED: 33.50 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 33.50 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 I P T I O N UNIT COST TOTAL COST ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18.50 18.50 END OF FEES 01 00172736-0017278E TO T ?3.50 DATE: 12/05)94 TIPIE: 15:43 • CONSTRUCTION AND PLANNING APPROVALS Permit # • Date Inspector rtiOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6, Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, O Undrgrnd., Test 9, Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final ' 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas CJ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Flaming 73, Undergrnd. Storage Tank O Gas G Oil 25. Roof Sheathing 74. Overhead Hydro i 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Goat 32. Electrical Power Meter -Final 33. Final Electric I 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - 36. Hood or Canopy 37. Final Factory Fireplace -. 1 38. Final Plumbing 39. Water Service -Final 40. Gas Ser vice -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation i 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison .. 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date California All -Purpose Acknowledgment State of California County of cr-c O_ --g e -- On personally appeared, G Llpersonally known to me- or- m before me, a�J a, Seo Carel NAME OF NOTARY PUEUC A �A I�OG�.rS i �proued to me on the basis of satisfactory euidence to be the person (10 whose name (V) .s0 aW subscribed to the within instrument and acknowl- edged to me that As / she thQ executed the same in it:�, her t1�'!t - authorized capacity (t @, and that by her fr&signature () on the instrument the person (9), or the entity upon behalf of which the person (F) acted, executed the instrument. Witness my hand and official seal. OPTIONAL V, SIGNAT UREOFNOTAWPUBUC Though the information below is not required bylaw, it may prove valuable to persons relying on the document and prevents fraudulent reattachment of this form. Type or Title of Document Capacity Claimed By Signer OA- A -V4 Vr �Indiuidual(s) TITLE OR ME OF DOCUMENT ❑ Corporate Number of pages: Imei ❑ Partner(s) ..................... ❑Genera! Date of Document: ••••••......*......*....*•... • ...•• 11 Limited F-1Attorney-in-Fact Signer(s) Other Than Named Above: ❑ Guardian/ Conservator A- I � ❑ Trustee(s) ❑ Other: Signer is Representing: Nameof Pe,s ft) > Enlityr..) Farm S law AIM Mad Centers 0 (IredepeMently Owned A Operated Frarehise)1-80x989-6145 DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS I 6 Bldg. Permit # This Permit 1&6 w /� S;,,-- "4, 4,- _. �7Z703 Street Address AP Number (we), ��7 Q,�/_!"rs� S declare that I am the Owner of Title of the above referenced real property, and that I (we) hereby authorize: Name Telephone No. to obtain permits in my behalf, as owner/builder, for CLc>✓127fle L �G%��//G� (/y�rt�•ea+�i! at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall im- mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, 1 understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. 4. * I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. 1 declare under the penalty of perjury that the foregoing is true and correct. Executed this n day of i41� 19Z, at California. Printed Name Date NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. NOTARIZATION REQUIRED 077946 (Rev 2/91( "X, 4 OWNER P(N Mq. J0SRPH" DATE JOB�DDRESS 1769 Crestmont P1. BUILDING PERMIT NO. 2372 GENERALCONTRACTOR Homes VALUE S 9.000.00 LOT 36 BLOCK TRACT 2584 Residence w/att gar. C rRn1IP I h J TYPE V ZnNF +41 FIRE_ DICTRIC.T 2181 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trencl - L��y,,;' Foundation Forms and Grade to Garag Rough Framing 6147 �J Plumbing, Rough tc Slab Plumbing, Rough Complete ,�� .i�- - �, �`'J�,p ��i -� « sz-2 S6Z-'---� Temporary Pole ,eC Wiring, Rough ��% Heating, Rough 2 ' S E'er _, yam„ 6JY1111A4 G Y' Aa- pAn-S. ra // 8 He�, Final Sewer, House Sewer, St.', (!n �, 'T �- 30-, q 7 Septic Tank or Cesspool / Lathing, In -2-S-6 ou Plastering Plumbing, Final, Fixtures Co fete Plumbing, Final Gas Test Wiring, Final 1/ 401 /.-. -1' J ' (- fVIM 01 'h Occuoancv _ -.1lflr FORM 210 3M 10-55 Costa Mesa Building Department p APPLICATION FOR FLKmiT 111 EAST 20th STREET 2381 BUILDING 1 COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY _ Receipt No. Permit No. Addrengss _ ddre0 Crestmont Pl ee Costa Mesa, California Re eived by 1 Date Rec'dd. `�/�-`�� - Date Issued ssued �- // Nearest Cross St. Shalimar Drive Building Address Owner Joseph Rogers Costa Mesa, California Mail Address 799 W. 17th Nearest Cross St. Tel. City Costa Mese No. Li 82987 Zonep �" No. of I Plans I Type J� Architect or Lie. Engineer No. Approved by Date Address 2156 Npt Blvd, Costa Mesa CORRECTIONS City Li Contractor HickoryHomes No. 91} Address 2156 Npt Blvd Costa MesaLego1. l Description Lot I No. 6 I Block I Tract2584 (Attach Metes and Bounds) No. of Bldgs. Size of Lot 60 X 101. I Now on Lot 0 �'. O Use of No.of No.of Existing Bldg. Families I Rooms L1 Z Setback Line from t Rear Yard Center of Street 50 Side Ya 1 _ 11 fu:, 1 D r DESCRIPTION OF WORK New X I Alteration I Addition I (10�/ /j� i+nC�YA AA OA Repair I Moving I I Demolish I ve e e a vv,.iI n Iuee_vn Bull ding No. of 1 Size 112 sq' Rooms 5 Stories Exterior Wall Roof CoveringrQWd/StL1CC0 Covering hvy shake - APPROVALS UseofNew W /' Building residence W A77 ITRIp qE -- Foundation Location Forms, Materials, Under -Pinning Inspector p Date Frame: Fire Stops, Bracing, Bolts Lath. Int. I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply with all City Ordinances and State Laws regulating building construction. Signature of Permittee Authorized Agt. Lath. Ext. Plaster, Int. Plaster, Ext Masonry Reinforced Bond Beam ValuationP rmit Fee $ o O Ian Check $ a o $ 9 000.00 Feel $ 33, O O FINAL FORM 204 G -H 2M 5-54 PLOT PLAN Show location and distances from property line and between building& i rCli it �'fDi.OST=•11CIT •L 1)l � lr. C .. 'lv J _ J- o a L IL p a Street PLOT PLAN Show location and distances from property line and between building& i rCli it �'fDi.OST=•11CIT •L 1)l � lr. C .. rCli it �'fDi.OST=•11CIT •L 1)l � lr. C .. OWNER ROGM, JOSEPH W. " DATE 11-29-60 JOB ADDRESSres mon 1. BUILDING PERMIT NO. 13329. VALUE AP. Nolt0–lUU–t! LOT TRACT FIRE ZONE DESCRIPTION OF WORK ReD.FireDam.t-'},t. INSPECTIONS DATE I GROUP I & J TYPE V ZONE Underground Soil U.G. WateI --— SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. _ Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches Forms Steel " Floor System Steel Reinforce Chimney Re -Rod Bond Beam Sheathing Frame and Flashing — — Lathing, In 1C Out V 9 1-" Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final Building, Final OCCUPANCY I1 Form 210-5M-1159 5-B P - 13329 G`OSTA MESA BUILDING•SAFETY DEPARTMENT P. O. BOX 317 COSTA MEGA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDING ADDRESS /� - D COS A MESA CALIFORNIA F E RECEIVE® NOV 2 91960 INANCEnCDEPT. APPLICATION FFOtt"PERMITSA BUILDING For Office Use Only r RecelPr No. ITS OWNER S 1 CT MAIL RECEI.VI(P Y DATE RECEIVED I DATE I SUE ) ADDRESS ��-.7. -/0 G //- x 1 TEL. BUILDING CITY NO. ADDRE66 !/ /�/ ARCHITECT TEL. COSTA MESA, CALIFORNIA OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP n CONTRACTOR A A, APPROVED BY A0A DiI-Y6 ADDRESSD 22 Alo S ZO NI G NO. OF UBE OF NEW CITY — LEGAL PLANS BUILDING /�1� STATE TEL. LIC. NO. NO. DESCRIPTION /p V l J SIZE NO. OF BLDGS. OF LOT NOW ON LOT A. P. NO. USE OFYARDS EVES EXISTING BLD APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.) CENTER OF STREET REAR YARD FRONT FT. IN, SIDE YARD I LEFT (RIGHT R. SIDE L. SIDE FT. IN. .FT. IN. DESCRIPTION OF WORK I ALTERATION I ADDITION I NEW{1 REAR BYPROVED FT. L IN. D E 4 �� /y�� MOVING AIR I I II DEMOLISH I BUILDING NO. OF SIZE ROOMS STORIES EXTERIOR WALL ROOF I COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED 1 WREDY ACK?46WLEDGIVTHAT 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 VALUATION {I(% BUILDING CONSTRUCTION. SIGNATURE OP PERMIT FEE S 1 PERMITTE 7 8 PLAN CHECK $ � {� AUTHORIZED AGENT !/�[`/'�/ D{ TOTAL FEE