HomeMy WebLinkAbout3252 DAKOTA AVE - Building Permits'1 ->
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INSTALLATION SNFORNiATION
ENGIf�ERING DATA
HOT I�ATER
New
Retro ,
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Wife�.J �� �7K. Phone H�5� a��3 W 1ST -�S .3zU
iG City���l%�-l�`3%� Zip /���
- sman�'!�'��� Contract Total $� �Gj7' Cash Fin/
No. Of people in family � No. of Bdrm��
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Tota1 gals. used daily � L1
No. hot water tanks Gas Electric
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Conventional tank sizes �l% �1`Y�
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Conventional tank Iocation �"��`�
Roof type �, Condition ��
Height �STZrK�/ Pitch �l�L �� Facing ���
Attic: yes_no )iS=Att/ic access '
Open Beam: yes_no✓ - / (
Electrical�outlet from Storage fi� ft.
Round trip pipe run: _
Solar loop %(� ft.
Tank crossover ;S'U- ft.
Storage tank location �i�'�f.e�
SPECIAL COPIMENTS:
cor�orrErrrs
Panels/type � �
9 : '
Storage tank � � gal_
Pwnp�, 1/20, 1/12hp
Control: Normal ./
Diaital
Racks degree
Pipe run loop
Crossover
Conv. tank g _ 4a1.
Enclosure w/slab
--._ _Tank���platform �
Electrical upgrade-"
Bypass single
_ ouble
SALE PREVIEW
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H300 8'-3'
Ha00 8'-2'
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Al] S 7'-8'
All E 7'-8'
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INDUSTRIES
1044 W h'a�de Ave., Sunry.�ale, CA 944%, 408/733-4444
COLLECTOR PiOUNTIPJG DATA
ANGLE CLIPS
SUPPORT ASSEtdBLIES
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LEGEND \
1. Cold Iu 8. Check Valve
2. To Solar 9. No. lOL TLP Relief
3. From Solar �talve
4. Hot Out 10. No. 71 Air Vent
5. To Saci:-Up 11. Collector Sensor
_ I+'ater Heater 12. Tank Sensor Drops
6• P�p To Bottom of Tank
7. Control _
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Applicant to (ill in all spaces eacev< those within heavy boraer Ilnes anO sign all aoV�ooriate tleclarations.
CITY OF COSTA MESA CQ\�\$ TR�,UCTION �R6M1T I
Project Address ��SZ L13��0� C—M . 1
�Applicant'S Mai � Address S�^1 F
Owner'snlame �_.��^� �'-r"'-�� ��hone 75N IRUg'
.Address Z'�5 �- l���OT/a � G'GI�Ti� /�'I�S/�
iArch/Eng. License No.
Address
Contractor'sNam��L��^��� Phone
Address (mailing)
City License Na.
LICENSED CONTRACTOR DECLARATION
1 M1ereby affi�m that I am licensetl untle� provi5ion5 ot Chartet 9(commentln9
with section 7000) of ivision 3 of the Business antl Professions Cotle, antl
my license is In tull t r tl eitect. ,
License Clazs License No.
Oate Signa[ure
'�OftKERS' COMPENSATION DECLARATION
iereby affirm that rI] shave a certificate oi consent to self-Insure or a certiticate
� Workers' Compe ation Insurance, or a certifietl copy thereof (Section
3800, Lab. C.) ��
Policy No. �v � Company
8 Certitietl mpy is hereby furnishetl.
Certifietl copy is filetl with the city Builtling Division.
Date Applicant
EXEMPTION FFOM WORKEWS' COMPENSATION DECLARATION
(Thissection neetl not be complet¢tl if tbe permit is tor One huntlr¢tl ($100) or
less).
I certify ihat in the pe�formance of the work fo� which thi5 perm�t is issuetl I
snall not employ any per5on in a ner so a5 to bec0 e subjec to t�e
Worker5.� Co pen tion Laws of Cali nia.
oate ?t � ��• R� Signatur � �
NOTICE: If, atter making this tleclaratie shoU15LD mme sub ct tne
Workers' Compen5ation provisions ot the Labor Cotle, you must yt with
comply witn sucn provisions or tnis permit shall be tleemetl re0oked.
CONSTRUCTION LENDING AGENCV �
I hereby aHirm tbat there is a construction lentling agency for the per(ormance
of the wo�k tor whicn thi5 permit is issuetl (Section 309] Civ. CJ
�Lentler's Name
Lentler'z Atltlress
OWNER BUILDER DECLARATION
I hereby affirm ihat I am exempt from the Contractor's License Law for the
(ollowing reason (Section ]031.5 Business antl Professional Cotle: Any city o�
��^county whicn requi�es a permit to construct, alt¢r, Improve, tlemolish or repai�
'�, any sVucture, prior to its iszuance, also requires the applicant tor such permit
I to file a signetl statement that he/she is Ilcensetl pursuant to the provisions of
':,:�e Contractor's License Law (Chapter 9(commencinq witn Seccion 7000) ot
;.vi5ion 3 of [M1e Busine55 antl ProfezSiOns Cotle) or that he/she is exempt
-,;ierefrom antl the basis for tne allegetl exemption. Any violation ot Section
���7031.5 by any applicant for a permit sublects the applicant to a civil
enalty of not more than five huntlretl tlollar5 (5500). �
� I, as owner of tM1e property or my employees with wages as their sole
mmpensation, will tlo lhe work, antl the structure is not intentled or offeretl
for sale (Section 7044, Business anG Protessianal Cotle: The Contractor's
�icense Law tloe5 mt apply to an owne� ot a property wno builtls or improve5
tnereon, anC who tloes such work himself/herself o� th�ough his or he� own
employees, provitletl that suclt improvements are not in[entletl or ofieretl �or
sale. If, howevEr, tM1e builtling or impravement I5 soltl within one year of cOm-
plelion, tne owner wiil M1av¢ [he burtlen of p�oving he/she tlid not bulitl o� Im-
prove for the purpose ot sale).
❑ I, as owne� o/ the prope�ty, am ¢aclusiv¢ly cont�acting with IlcenSetl Con-
vactors to construct the proiect (Section 7044, Businesz antl Protessionz Cotle:
The Contractor's License Law tloes not aOPly to an owner of property who
builtls or imoroves thereon, antl wno conVacts for such oroiects with a r.on-
tractor Lcense pursuam ro me Contractor�s License Law). I am aware that
pro o their Worker's Compensatlon insu�ance Shoultl be provitletl to me.
1 am exempt untler Section� B. & P. C. forrthis reason
'IS•4 0 [ ''' � \`'
I hereby certify that I have reaa..[nurapplicatie�Ydntl state tha[�ne above
iptormation is co�rect. I agree to wmply with all city antl county o�0inance5
antl State laws relating to builtlin9 con5truction, and he�eby authorize repre-
sentatives of city to enter upo the above'�^ entio�netl properry for
inspection p se . �{�� S ,�^
Signature � � � � —�—"^� . �
Driv¢r5' Lice fe-orSS � ���
TVPE OF CONSTRUCTION LJ NEW LJ ADD LI ALTERATION �I REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH • � '
DESCRIPTION OF WORK/USE OF BLDG. �}=S/L�f T�F � �
TVPE OF PERMIT LJ GRADING �J FOUNDATION L�STRVCTURAL
' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
OTHER
PR ECT DESCRIPTION Sc?. FT. S oCCUaarv v ��
CONSTRUCTION TYPE �� /V VALUATION $ B d
ZONE GRADINGCU.VDS. AC ES
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Baihtubs
Clarifiers -
Dishwasher -
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories �
P—Trap
Roof Drains
ReinspeMion Fee $15
Boiler
Duct- Under Ground
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Pact BIt. ICBO �k
Heating System & Ducting
❑ ai oo,000 aru � i oa,000
Fiainspection Fee � $15
0865-46, rev. 5/88 White - Builtling; Canary - ApplicanL Pink - Accountin9: Goltlenrotl - Asseszor
Showers
Service Sink
Sewer Connection
Solar'Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto Wash
Laundrv Tra'vs .
Issue Fea
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteretion
Fire Dampers
Registers
laue Fee
A.P. qp
S Main Buildi
E
T Front
6 Rear
A
C Right
K
g Left
Ping. Ref. #
Planning Notes:
FEES Automatic Washer
Construction Pole Sub.
Cooking Unit
D ISh W25f1Qf
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fiztures
Device Boxes
Outiets
Switches
Garbage Disposal
Generemr �65 KW C
Fee
Zone
Accessory 8uilding:
2
O
N
i
N
G
R
Parking Req./Provided E
Q
M
T
S.
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100amps
Meter ❑over100amps
Su6 Panel
Motors OO-7 HP O1 h- 8
Inc Soiar �9-15 HP 016-15+
Microwave
Pole Light
Range
Standing Sections
5�15 KW Trash Compactor
$15 luue Fee
$ 3 . DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved 8y
FEES � Building Approved By �
��� Appiiwtion Issued By
$ 3
SUMMARV OF F
, � BUILDINGPERMIT $ �3•dC�
� PLAN CHECK $
PLUMBING $
- PLAN CHECK 25% $
ELECTRICAL $
' PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
FEES
$ 3
SMIP $ ����
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $
TOTAL FEE $ �3 , .�
a� ca7aio�+_-caoYia,= -�� Y .-,.�
B�`•�c': Oo; 2�ai;,4 1Il:�`. .ua iu
� �
CONSTRUCTION AND PLANNING � P� � SPA
APPROVAL$ Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement �'� t
3. Electrical Conduit U[ility-Undrgr`nd. ��� 54. Forms ��
4'.'Electrical Conduit-Undrgrnd. .( 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
�6. �Electrical UFER Gmd. ` 57. APPROVAL TO COVER-GUNITE � ' �
�
7:'Footings �� '1 58. ElectricalConduit-Undrgrnd. �
8. Foundation � � 59. Gas Pipe, O Undrgrnd., Test i-
9, Water P,ipe-Undrgrnd. 60. Backwash Lines, P-Trap, � 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 , r._
13. Roof'Drains "f' ��� 64. Plumbing System - Final .
14..RoughPlumbing , 65. Electrical-Final �
15. Rough Electriral-Conduit ' 66. Solar System-Final
`'6? Rough Electric Wiring 67. Fencing & Access Approval
17�. Rough Wiring Sign 68. APPROVED FOR PLASTERING
t.
18. Rough Electrical�T Bar Ceiyng 69. P00 VSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
i ',
20. Rough Factory Fireplace " APPROVALS Permii #
��:
21. Ducts, in.Structure �y 70. Underground Hydro
r
22. Ducts, Ventilating . v 71. Product Piping O Gas ❑ Oil
�
23. Gas Pipe=Rough &•Test � 72.•Underground Flush
24. floof F�aming _� ^ 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing �' %� .'L� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &.Monocoat � 75. Dry Chemical
��
27. Fraine 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 Coati� � 79. FINAL INSPECTION
32. Electrical Power�Meter-Fine ; 80. FOOD CERTIFICATE ISSUED
33. Final Electric V �P N
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final FactorY Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final �,
41. Solar pomes[icFinal �
., .
42. Backflow Preventer J! ' ' .
�'�
43. Backflow Irrigation i • �'
44. Landscape Irrigation System ' �
45. Sound Attenuation ��'��'
46. Handirap Regulations '
47. FINAL STRUCTURE & BUILDING � _
48. Special Requirements Completed
49. Electric Release to Edison -�
:.
,�, . . .
50. Gas Release to Southern California Gas Co � .
.
51. CERTIFICATE OF OCCUPANCY - �'
. ' 'I
No. - Date �'� -
AVo���ant to fill in all spaces wltnln heavy Uoraer lines ana sign al1 aporooriate declarations.
,_�)T:'"OF�COSTAMESA• PE ITNO. TRACTNO. LOTNO. BLDG.NO.
CONSTRUCTION PERMIT �� ,�,3 7
Address
Address
Contractor
LICENSED
�' TVPE OF CONSTRUCTION
Ph - NEW ❑ ADD ❑ ALTERATION �
REPAIR ❑ CONVERSION ❑DEMOLISH
License No. ❑ OTHER
DESCRIPTIqN OF� WOR
untl¢r prOvislon5
�ivlslon 3 of
ise is in full
��` ^�Si9naWre `^- - ^^�'
COMPENSATION DECLARATION
irm [hat I have a cerllflcate of ConSent to Selt�InsWo or a
f Workers' CompenyaUon I,n;uranca, or g certlfied copy
POIICY No-v` � � TQ_1D31pPanY '� �-'
❑ Certltie0 Copy is hereby furnishetl. �� �
�titletl copy is filetl witn the clty 8uiltling Div s on. Y
EXEMPTION �FROM WORKERS' COMPENSATION DECLARATION
(Thls section neetl not be compla[etl if the permil is for one huntlretl
SS100) or less).
certi(y tM1at In th¢ per(ormance of the work fo� whlch this permlt I5
issuetl, 1 shall not emPloy any person In any manner so as to become
subjact to the Workers Compensation Laws of Callfornla.
Date Si9nature
NOTICE: If aft¢r making th15 tleclaration, you inoultl becomo sublec[
to the Workers' Compensation provislons of the Labor Cotle, you mus[
forthwith comply with suth p�ovi51on5 0� tM1is pmmlt 5M1a11 �e tleCmCtl
revok¢tl.
CONSTRVCTION LENDING AGENCV
I nereby affirm [hat there Is a construction lentling agency tor the per-
formance of Ih¢ work fo� Ich this permi[ is ISSUCtl (Seclion 309]
Civ. CJ. �� A
Lentler's Name ��--
Lenaer's Atlaress
OWNER BUILDER DECLARATION '
I hereby affirm [hat I am exempt from thE ConlydC[Or'S LicenSe Lnw br
the following rea5on-(Section 7031.5 Business antl Professlons Coae:
Any city ot munty which �equiies a permil to construct, al�er,
improve, tlemollsh o� repair any slruClure, prior [O IfSlssuanCe, also r¢-
quires the applicant (or such Dermit [o file a si9�etl sta[ement that M1e
is Iicensetl pursuanl to [he provl5ion5 of the Conlractor'S License Law
(Chapier 9(commencin9 w�th Section ]000) of Division 3 of the
6usinesz antl Prolessionz Cotle) or [nat M1e is eaempt Iherefrom antl lhe
basis for tM1e allegetl exemption. Any violatlon oi Sec[lon 7031.5 oy
any applicdnt for a pe�mit SUDjettS [h¢ applitdnt to a clvll pendity
of not more than five huntlretl tlollars (y500).
❑ 1, a5 own¢� ot lh¢ Oroperty, o� my employ¢CS wiOt wages ai thEir
sole compensation, wlll tlo the work, antl tbe structure is not intentletl
or oiteretl for sale. (Section 7044, BuSiness antl Rolesslons Cotle: TM1e
Contractor's License Law tloes not apply to an owner of a property
wM10 builtls o� improves thereon, antl wito tlOes suGh work himself or
through hls own employees, provitletl thal such Improvements are not
Intentletl or ot(e�etl �or sal¢. tl, howeveq thG builtling or improvem¢nl
is soltl within one year o( completion, [he owner wlll have tne burtlen
o/ proving ne tlitl not builtl or Improve /or the purpose of sale�.
❑ I, as own¢� ot the propor[y, am ezclusivoly contracting with
IlcenSetl mnVaGtors to wn5t�uct the ptojett (Settion ]044, Busin¢zs
antl Professions Cotle:'The Conlractor's Licensa Law tloes not appty to
an owner of Orope��y wno builtls or improves tnereon, antl wM10 con-
t�acl5 from suGh projecls with a ContraG[Or(5) IiG¢Snetl pursuant lo
tne Contractor's License Law).
❑ 1 am ¢xem0� untl¢r Sectlon B. 8 P. C. lor l�is
reason
Date Owner
that I ttave reatl this application antl state chat the above
correcl. I agree to comply wl[h all tlly antl Counry
�a[C I�Y+s �¢lating t Co�St�uctlon, antl h¢reby autho�izC
f �[tyS'�ity to ter upon the above mentionetl
TVPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUGTURAL
❑ TENANT .C�ECTRICA LUMBING '❑MECHAI
/ �
Q OTHER
54. FT. "r L/ �' v - v�-�-v -
OCCUPANCV_CONSTRVCTION TVPE
VALVHTION ZONE
GRADINGCU.VDS. ACRES_
REMHRKS:
PLUMBING . PLAN CtiECK
BATHTUBS SHOWERS
TOILETS URINALS
LAVATORIES DOUBLELAVS
KIT.SINK$ DISHWASHERS-
SERVICESINKS $UMPS
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTRAP
WATERSERVICE AI.TERATION
GASSERVICE OUTLETS
WATER HEATERS BTU OVTPVT �
SEWER CONNECTIONS - �
SOLAR TANK � z COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU_
AND DUCTING 100,000 t BTU_
REFRIGERATION 0-]00,000 BTU_
SVSTEM 100,000+BTU_
BOILERS BTU
SYSTEM REPAIR,ALTERATION
EXHAVSTSVSTEM MULTIGLE
-. 3028 8/07/81 15050
ZONE
REAR YARD (TO P/L)
PKG. SPACE RE(9.
STREET WIDTH
IAL CONDITIONS:
REGULATIONS
PLNTGp. RgUEFL. �
PROPE�RTYNLINE
PROVIDED
PARK FEE S
ELECTRICAL PLAN CHECK
GENERATOR p.l KW_1-30 KW _
TRANSFORMER
APPLIANCE 30-SOKW SO+KW_
MOTORS 0-1 HP 1-30 HP _
pNC.50LAR) � 10-50 HP 50 + HG _
FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
PANELS MAIN SUB
SERVICE �' F
APPLICATION APPROVED BY
SUMMARY OF FEES
BUILDING
PERMIT S SMIP � E
PLAN CHECK S 1+ PERMIT
PLVMBING g�I1 /ISSUANCE E
GRADING S
PLAN CHECK E��)
ELECTRICAL S �L S
PLAN CHECK $ - MICROFILM E
MECHANICAL $ TOTAL FEE E
LE55 AD-
PLANCHECK- $ VANCEPC E
'._'-.., ..�..`--�( jy'✓LT "�l " / !Zl—V� FINAL FEE E
Siqnature �� )�--/--� Da(e_C�L.�
Drivers' License Or 55 # %� / �-/ �'.� �SSUE FEE --
CMF 0865-46 Wnite-Builtling; Canary-Applicant; Pink-Accounting: Goltlenrotl-AsSessor
�
CONSTRUCTION AND PLANNING POOL & SPA _ �
APPROVALS Permit# Date Inspector qppROVALS Permit,# Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location ' � ' • !
Soil ipe-Un rgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn �• � � , 45. Forms
4. Electricai Conduit-Undrgm � .f - ° . 46. •Electrical. Bonding �
. tee ein orce 47. Rough Plumbin & Pressure Test � ''� `
6. Electrical UFER Grn � 48. _APPROVALTO COVER-GUNITE �' '' '
7. Footings 49. Electrical Conduit-Undr m
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn � ' 51�. BackwasN Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVALTO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
2. Street $ewer Connection 54. Heater & Vent-Finab
13. Rough Plumbing � - ' � '
14. Rough Electric-Conduit �56. Electrical-Final '
15. Rough Eiectric-Wiring - 57. Solar System-Final
16. Rough Heating & Air Conditioning � encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing " �
21-. Roof Sheathin � .
, 22. Frame and Flashin NOTES: . ,
23. Insulation �
24. Lathing & Siding �
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final "
?6. Final Electric
19. Final Heating & Air Conditioning.
30. Final Gas Pipe-Test
31. Final Plumbing '
32. Water Service-Final � �
33. Gas Service-Final •
34. Solar pomestic-Final U 8/
35: Landsra e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison -
41. Gas Release to Southern California Gas Co. �
42. CERTIFICATE OF OCCUPANCY .
No Date , , . •
, ..� .
OWNER MC CARDLE, DIANE J.
JOBADDRESS 3252 Dakota Avenue
GENERAL CONTRACTOR pwner/Bldr.
AP No.139-067-08 LOT 65 TR
INSPECTIONS Si�
SOIL
GAS
I �VIATER
ROUGH PLUMBING
�PROP. SWR. LiNE Q NOl15E CON. �
SPRINHLING SVCTGM
POUGH MEFTING AN� AIR CONDITIONING
` T[MPORnFY $�qVICE OR POLE
dUNOERGROUND � POWER �
ROUGH WIRING
TRENCHES � FOfiMS � STEEL REINF.
FLOOR SVSTEM
BONO BERM STEEL REINFORCE �
SHEATHING
FRAME AND Fl,qSHING
�ATHING - �4 I-I Ol1T n
PLASTER, BRO'NN COAT
STRUCTURPL, FINAL
HEATING. VENT., REFFIG. ANO A.C., FINAL
PWMBING, FINq� ANO GAS TEST n
ELECTRIC. FINAL
Oiiillliuf. FINpI
722 FIR
DATE 10-2-75
BUILUING F'tKMI I fVU.
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SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADIDR ES532 52.�ZD 9� oTA -�, /�i
MAIL
CITV L!�7(�j / / 2�/�' NO�
CANSiRUCTION �_ d �
LENDER
BRANCH �'
ADDRESS
ARCHITECT TEL.
CONTRACTOR � �
ADDRESS
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
SIZE I NO.OF E
OF LOT NOW ON
USE OF
Separate permits are required for
electric, plumbing and heating work.
USE OF BUIIDING AND WORK TO BE PERFORMED
I �ereby ecknowletlge thet 1 hava reatl this application and state
that tha ebove info�mailon Is correct entl aB�ea to comply with
ell laws reguleHng builtling construction, end I shell not employ
eny perwn In vlolatlon of the workmen'a compensation laws ot
the Stete ot Californle.
I hereby certify that I em prOperly Iicensatl as a cOntractOr untler
the State of Californie Businass antl Professions Cotla, Division 3,
Cheptar 9, antl thai such Iicansea ere in full torce entl effeet, or I
am exempt from the provlslons of the Stete of Celifornle Business
nnd Profa551ons COtle, DlvislOn 3, Cheptar 9.
Sipnature o1�� �� � N �// / I.0 //�%�I ��
Permittee 'l/�� r / I` �� l
Authorizad ABent
A.P. NO
BUILDING
ADDRES:
FIRE
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Pai� a::r:;...
l:.T -2-75�F�,; 00 119" -]?.5C
FORSTRUCTURALPERM[T
DATE RECEIVED DATE ISSUE❑
,o -2-
h i A � n� PERMIT NO.
NO.OF h I USE OF
BLOCK
VARDSAPPROVED I VARCISAPPROVED
MAIN BUILDING ACCESSORV BUILOING
VAR. #�'
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DATE
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THE AMOUNT SHOWN UNDER VA�UATION IS FOR m
THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV:
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VALUATION PERMIT FEE E 2 �
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$ �� � PLAN CHECK y o
TAX E �� �
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TOTALPA�D E �/ (/
��OWNER Fp[TLISIdER, GERALD
� JOB ADDRESS 2 ota v
�GENERAL CONTRACTOR �,�3g
a !iP No.l3. _�o6�z"fl$ LOT (5
\� INSPECTIONS
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\ WATEft
�OUGH PLUMBING
PROP. SWR. LINE � HOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROWH MEATING AN� AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUND � POWER �
ROUGH WIRING
TRENCHES FORMS � STEEL REINF
FLOOR SYSTEM
60N0 BEAM ❑ SYEEL REINFORCE n
SNEATHING
FRAME ANO FLASHIN(3
LATHING - IN n OUT n
PLASTER, BROWN COPT
STRUCTURAI, FINAL
HEATING, VENT., REFRIG. ANO A.C., FINAL
PLUMBING, FINAI ANP GAS TEST n
ELECTRIC, FINA�
BUIL�ING. FINAL
DATE 7_1_6g
BUILDING PERMIT N
SUBCONTRACTOR
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COSTA MESA BUILDING-SAPE7Y DEPARTMENT
P.O. BOX itW � COSTA MESA. CALIFORNIA 91626
For Applimnt to Fi11 ►n Completaly
TYPE OR PRINT
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BUILOINO CONBTRUCIIQII. � � �
SIGNATUREpp ����
PERM1TT6e--- �
AUTHORIZiD AGQNT
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VALUATION �� �- �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 817 G08TA MEBA. CALIPORNIA
For Applieanf +o Fill In Compleiely
TYPE OR PRINT
ADDRE68 3252 Dalcota Avenue
COSTA MESA. CALIFORNIA
■ ARCHITECT
TEL.
FEE RECEIU�D
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(,APPLIC}A�ION��-�OR �PERMIT
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FIRE
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COSTA MESA. CALIFORNIA
TYPE � GROUPO
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none
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SIZE 1 HS f ROOMS 6 STORIE6
EXTERIOR WALL STU CCO I COVERI WOOCI Sh� S
COVERING
USE OF BUILDING AND WORK 70 BE PERFORMED
SINGLE FA L
and Attached Gazage
Plan 3-A
1 HEPCBY ACKNOWL6DOH THAT i MAVB RSAD THIB MpYWT10N {Ng �MOUM BXOWN UNOER VALUATION IB POR THE
ANO BTATE TXAT'TXB ABOV4 �8 GOPHEGT AND A6RE8 TO COM- pypp09E OR 88TABL18HING A PERMIT F[E ONLY.
PLY WITX ALL GIiY OfiDINANCEB O BTATH WB RHOULATNO
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SIGNATURE O PERM17 FEE $ J� `
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AUTHORIZED AGHNT ___ __ _ q—�Y
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