HomeMy WebLinkAbout206 CECIL PL - Building PermitsC17YOF COSTA ME�p
Project Address ���
Applicant's Maili g Atldress
Owner's Name,
ION PERMIT
No.
Applicant to till in ali soaces exceo� ��ose within neavy oorEer Ilnes antl sign ali appropriate Eeclarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO. �
CAntractor's Nam ' �- � Phone ��,.�L��[�
Atldresslmailingl ��066 ��il�'�ir'— �( �y�__
Ciry License No. = ��3 �
LICENSED CONTRACTOR DECLARATION
� hcreby al/irm [hal I am Ilcensetl un4B/ O�ovI510n5 0/ Char[er 9(Commencing
w{th section '/000) ot Dlvision 3 of the Business antl Pro/esslons Code, antl
my �{�¢nse is In I f r antl eil¢�t. -77 .Z
LJcens sa '� i ense rvo. SJ (I �
Dete Sl9natura
W00.KE 5' COMVENSATION OECLARATION
�•areby ailirm that I �ave a certifitalo ol consen t selt-insure or a certlficate
Wo�ke�s' CompOnsation Insu�anc0, Or a wrti Gtl COPy Ihawoi (Soctlon
.+800, Lab. C.%
P Iity No. �JGigZ�3_� Com any S � �,� n
Certl i tl CoOY is �ereby furnlshetl.
Cert etl is tlletl with the tlty Itli g Divis n
D te Applicant
E%EM N F0.0M WORICERS' COMP ATION DECLA A710N
(Thizse lo neeU not be completetl it tne permit Is (or one huntlretl (5100j or
less).
� Cartity that in tha pertormance o7 tne work for wnlch this perm�t Is issuod I
s4all not employ any person In any manner so as lo bemme subjec[ to the
H'orkers' Compensation Lawi'o/ Calilornia.
Date 4gnaturc � �
PoOTICE: If, a(ter making this tleclantion, you shoultl bacome suD�ect to the
H'orkers' COmpensaUOn prOWsiOns OI the �abor Cotle, y0u mUst forthwitll
�4mply with such provl5ions or tnis pe�mlt Shall b¢ tlee�Tetl /evoketl.
CONSTRUCTION LENDING AGENGV '
� hereby allirm that there is a constructlon lentling agency tor the Oerformance
of the work for whicb this permit is is5uetl ($ec[ion 3097 Civ. C.)
Lentler's Ndme
Lentler's Atltlreis
4WNER BUILOEH��ECLARATION '
� nereby aftirm that I am.exempf from th¢ ConVactor's Llcense Law for Ne
�ollowin9 reazon (Section 7031.5 Businezs anC Professional Cotle: Hny city or
countY which reqWrez a pe�mi[ to con5[ruc[, al[¢q iTprove, tlemoli5h o� �epai�
any structure, prbr to its issuance, atso reqWres the applicant for sucn permit
to fil¢ a sig�etl state�hent Ihat �e/she IS licensetl pur5uanl to thp p�ovisiorl5 of
the Contrac[or's License Law (CnaO�er 9(commencing with Section 7000) ot
'Ivision 3 Of the BUSinesi antl Pfof¢S51op5 COtle) of that he/Sh¢ I5 exempt
erefrom antl tne basis for tne alle9etl exemplion. Any violation of Section
J31.5 by any applicant tor a Pormit subjects tho applicant to a civil
�enalty of not moro than five huntlretl tlollars (y500).
I, as owner oi t�e p�operty or my em010yCes wi[h wagei a5 [beir Sole
�OmpenSatiOn, will tlo Ihe work, antl tne structure is not intentloa or oHeretl
for 5aie �Section 7044, Business antl Professional Cotle: T�a Contractor'S
�.icenze l2w tloei not apP�Y �o dn owner Of a property xTo builtls or improves
thereon, antl who tloes such work himzelf/nerself or ihrough his or her own
emPloyeei, prOvltletl that such Improvnments are not intentletl or otferetl 10�
581e. If, hOwever, t�e builtling or iTP�Ov¢ment IS Sold withln onc yoar ot Com-
Gletion, lhe owne� wlll have the burtl0n ot proving h¢/She tlltl not builtl or im-
Orove to� lh! Pu�Oose ot 5a10).
❑ 1, as awner of [h0 property, am ezUUSively conlracting with IlcCnse� con-
lractor5t0 ConsVuct the prOjatt (Seclion ]044, Business antl PrOfe52ion5 Cotle:
7he Convactor's llcense I�w does not apply to an owner ot property who
4uHtls or improms tnereon, antl who contracts for such projects with a�on-
ka<tor(51 ucense pursuan[ to the Contractor's Lltense Law). I am aware that
proof o( [�Bir Wo�kv'S Comp¢n5atlon insuran[e shoWtl b¢ Provltletl t0 me.
� I am ezempt untler Sectlon , B. & P. C. Ior tbls reason
4ate Owner
�! nereby cortjf)( that I have roaC thls application antl state that tne abovo
5ignaWro 1r'/„
briverz' IJcense or SS'�
� Z g�J� �
TVPE OF CONSTRUCTION NEW ADD %�LTERATION REPAIR
❑ CONVEFSION ❑ �EMOLISH ❑ OTHER q,p #
DESCR7PTfON OF WORK(USE OF BLDG. i .S Main Bu
E
TVPE OF PERMIT GRAOING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ E TRICAL ❑ PWMBING ❑ MECHANICAL �B Retr
PR�OTHER . ��0� p� A
CT DESCRIPTION 5�. FL 26,n,(� OCCUanNCV � K Right
CONSTRVCTION TYPE VALUATION 5��� g LCft
ZONE GRADING CU. YDS. ACRES ping, Ret. ,$
Remarks: �'�L �Ct'� ,[��(�SZ/V` C�' �r PlanningNo
3ar Sink
3ackflow Preventer
kflow Irrigation
3ath s �
�larifiers .
Jishwdsher
Jrinking Foun�ains
=1oor Drains �
=1oor Sinks •
3asService Outlets
Interceptors
Kimhen�Sink � - - -
Lavatories
P—Trap
Roof Orai
Reinspec[ion Fee
Boiler
Dutt� Under Ground
Duct - Ventilating�
Exhaust Sysrem ❑ Muln
FirepllFact. Blt. ICBO 5W
Heating System & Ducting
❑0-100,000 BTU O�
Fae
CMF 0065-46, rev. 30/8< Whlte - Bu1lCing: Canary - Applicant; Plnk - Ac<ounting; GOldenroE - qsseszor
Service Sink
Sewer Cap
Sewer Connection
Sotar Collectors
Solar Piping
Solar Tank
Swim ifig Pool wlSpa
nal ..
ater�Closet �
Wat eater
' � Warer Ser ' e
Aum-Wash
' Laundry Trays
515 Ifsue Fee
MECHANICAL
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑P100,0008T 100,000
Syste pair/Alteration
ire Dampers
$15 I I Issue Fee
f:
Washer
rn Pole'.
Dishwasher \
Dryers ❑Gas C
Fan
F.A.U. •
Fixiure5
Device Boxes
Outlets
Switches
Garbage Disposal
Generator�DO5,
� �
Parking Aeq./Provided
ELECTRICAL
Transformer ❑ 15�50KW �.
❑ SO+KW
Meter �up to 700 amps
Meter �over700emps
15 KW
Su6 Panel
Motors�0.1 ❑1'F,;B
Inc.Sol 9-15 HP p16-15+
i owave
Pole '9ht
Fange
Sign
$tanding $ections
Tresh Compactor
FEES
�� i
Reinspaction Fee 315 Issue Feo $ 3
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
2oning APProved By Date
Building Approved By Data � //
�t"� �
Application Issued Bv Dat
$ 3
SUMMARV OF FEES
BUII.DING PERMIT $ 2$ • GO SMIP $ O• SO
PLAN CHECK $ PERMIT
PLUMBING 5 ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% S MICROFILM $
MECHANICAL S TOTALFEE ,$ 2�• SC7
PLAN CHECK 25% $
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CONSTRUCTION AND.PLANNING POOL & SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit #
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgmd. �� .53. Steel Relnforcement
3. Electrical Conduit Utility-Undrgrnd. � 54. Forms
4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings , -• 58. Electrical Conduit-Undrgrnd.
8. Foundation ' S9. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
73. 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 Approyal
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING _
}$. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAI
79. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21, DuCts, in Structure 70. Underground HYdro
22, Ducts, Ventilating - 71. Product Piping �Gas ❑Oil
23, Gas Pipe-Rough & i'est 72, Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro -
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 Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: . ' �
34, Final Heating & Air Conditioning �
35. Final Gas Pipe-Test .
36. Hood or Canopy � .
37. Final Factory Fireplace
�38. FinalPlumbing �,
3g. Water Service-Final �
40. Gas Service-Final
41. Solar pomesticFinal � �
42. Backflow Preventer ',
43. Backflow Irrigation -
44. Landscape Irrigation System � �
45. Sourid Attenuation .
46.^Handicap Regulations ,
47.FINALSTRUCTURE&BUILDING �
48. SPecial Requirements Completed
49. Electric Release to Edison - ,
50. Gas Reiease to Southern California Gas Co
51. CERTIFtGATE OF OCCUPANCY ,
No. Date � � ,
.+ �
(714) �54-5273 • Fau (71a) �5a-4B56 • www.cl.costa-mesa.ca.us // tAIM UFIIVC, GVJ IA MCJH, GH tlLOZO
`E�UIL'DING PERMIT
JabAddress: 206 CECILPL
Suite:
Vicinity:
Parcel Number: 42607326
npplicant: GOODGAME, JACK
Address: 16631 KE7TLER LN
HUNINGTON BEACH, CA
Owner: DEATS, DOUGLAS
Address 27902 VACATION LN
HUNTINGTON�BEACH, CA .
Contracror. ' SIERRA ROOFING CO
Address: 16631 KE7TLER lN
Arcft :
Address:
HUNINGTpN BEACH, CA
Zip: 92647
Phone:
Zoning:
. ISSUED BY:
Phone: (714)847-1773
Zip: 92647
Phoqe:.
Zip: : � 9264&8242
Phone: (714)847-1773
License: 511172
Eng:
Address:
Stalus: ISSUED
Applied: 02/O6/2004
Issued: 02/06/2004
Phone:
Zip: License: � License:
SCOPE OF PERMIT
REMOVE EXISTING ROCK ROOF. COVER WIT BUILT UP ROOFING. REPAIR/REPLACE SHEATHING AS NECESSARY.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$� � i.zs
$0.50
$0.00
$0.00
$0.00
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY �Front 0-0
PARKING Existinq: ' p
NOTES:
Rear 0- 0
Rear 0. 0
Re uired: 0
FEESUMMARY
PLANNING 8 ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Righl 0. 0
Right 0. 0
$4,648.00
54,648.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under Calitomia statutes and related
regulatfons. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permlt shall automatically expire and become void if work is not commenced withln 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the Work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetlons and final epproval must be obtalned. Failure to obtain inspections and final approval wlll result in the expiretion of this permit.
FOR INSPECTIONS CALL: (714)>54-5626
2aae-ae �emo>
D_E_C-LAR/ITi10NS
WORKERS' COMPENSATION DECLARATION: - � —
I hereby ettirtn under penalry of perjury one of tha tollowing tleGaretions: '
❑ I have end will maintein e certilicate ot Consent to sell-Insure lor workere' wmpensetion, es provitled lor by sectlon 3700 of tha LeDor Cotle, lor the performence ol the
ark for whlch ihis permit is Issued.
I have and will malntein workers' Comper�5auon InsurenCe, a9 requlred by Seclbn 3700 0l Ihe L9Dor Cotle, for Ne peAortnante ot �he work for whitl� Nls permit Is Issuetl.
- My workersr' m�m eGnsetlan Insurance cerder entl poliry number ere: �� 1�.
Cerrier. �%7 �/— /tVy� POIIcyNumDer. ���0�
(This section need nof be comp/etetl i! the permil ls valued a( one hondred dollers ($100J or /essJ
❑ I certity t�at in Ne pedortnance of the work for which Ihis pertn' s issuetl, I shall not emp�Jy qny person in eny menner so es to bewma subject to the warkers'
compensetbn laws of Calllomia, entl e rae thet II I s oultl b e sub�ect to Ihe worken' comµ�n.s�etlon provislons ol Sectlon 3700 0l tho� e, I ahell forihwlih
compty with thase provLs' � d� � �% //
Applicant Signature: Gr" lX Dete: C_ �\� r
WARNINO: FNLURE TO SEW ORKERS' ODMpENSATION COVEM E IS UNLAWFUL AND SH�LL SUBJECT AN EMPIAVER TO CRIMIWIL PENALTES AND CML FlNES UP TO ONE HUNDRED
TFIOUSAND OOLLARE (5100.000), IN FDDITIIXJ TOl}IE COST OF COMPENSATION, OAMAGES AS P(iOVIDED FOR IN SEGTON 31O60F THE UBOR CO�E, INiEFE5T, AND FTTORNEY'S FEES.
LIGENSED CONTRACTORS DECLARATON:
I hereby aHirtn ihat I am Iicensed untler provisions of C�epter 9(co mencing with Section 7000) of Division 3 ot the Business entl Prolessions Catle, anA my license is in full
fOfCe flntl BftBCL Lic. M Cless p
Contractors Signature: . Dete: � �
v
CONS7RUCTON LENOING AGENCV:
❑ I hereby attirtn that t�ere is a construction lendinp epency lor the pedormance ot ihe work for which Ihis pertnil is issuea. (Sec. 3097, Civil Code).
Lentlefs Name: Lendefs Address:
Signeture:
OWNER-BUILDER DECLARAiIONS:
Date:
I here6y eHirm Ihat under penalry ol per�ury Ihet I em EXEMPT FROM TFiE CONTRACTORS LICENSE LAW lor the lollowing reeson (Sec. 7031.5, Business end Protesslons
Cotle: My ciry or county w�ich requlres e petrnit to consiruct, elter, Improve, tlemWlsh, or repeir eny structure, pnar ro its issuance, also requires the applicant for suc� pertnit
to file e slgneA statement that he or she is Ilcensed pursuant to Ihe provisions of the Contractan Llcense Lew (Chepter 9(commendng wlth Sectlon 7000) ol Dlvision 3 of the
Business and Professions Gale) or that �e or a�e is exempt t�erefrom and the besis for the alloped e:emptlon. Any Wolation of Seclion 7037.5 by eny epplicant for e pertnil
subjects Iha epplicant to a chril penelry af not more thfln flve �undred ddlars (5500).):
❑ 1, as owner ot the properry• or my emplqyees with weges es their sote compensallon, WILL DO THE WORK, end the shucNre Is not intendeA or oReretl Mr sele (Sec.
7044, Business antl Professions Code: The CoNractors License Law tloes noI appy lo en owner ot pmperry who bullds or improves thereon, and who does such work
himself or herself or through his or her own employees, D�etl that suc� imprwemenLs are not intended or afleretl tor sale. If, however. the building or improvement is
sold within one year of completion, the pwner-builder will �ave ihe �urtlen ol proving that he or she did not build or impmve for purpose d sale.). '
❑ I, as owner ot the properry, em EXCLUSIVELY CONTRAC7ING WfTH LICENSED CONTAACTORS lo con5truct t�e project (Sec. 7044, Busine55 end Profe55ions
Cotle: The contredors lJcense Lew tlo9s not apply to an owner oi pmpeny w�o bullds w improves Ihereon, end who contracls tor suU pro�ect wlth e comrector(s)
license pursuant to tha Contranors License Laws.).
❑ 1 em exempt untler sea BuSiness end Protession5 CoOe for ihis reason:
SignaWra: Dete:
Owner ID venlied Dy drivers Ilcense. ❑ Yes � No Drivefs license No.
Verilica6on of Ownership by (type ot tlocument, i.e. - pmperty tau blll or deetl):
Explres:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certity ihat no excavetion flve (b) or more leet In tlepih Inio which e person is required to descentl, wlll be made in Connection wIN work euthorizetl 6y ihis
permit, enC t�at no builtling structure, scailolding, lalsework, or tlemolition or dismantling thereof, wlll Oe more Ihen Ihirry-six (38) leet hfg�. (Chep. 32, Grp 2, Art 2, Sec.
341, Tltle B, Califomia Administwtive COtle).
❑ As owner-builder, I will not employ anyone to do wark whlch would require a pertnit trom Ihe DlWsion ol Indusiriel Sefery, as noted ebove, unless such person �es e
permit to do such work trom Ne tlivision.
Signature: Date:
Division oi industrial Satery Permit Number:
ICERTIFlCATE OF COMPLJANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury thal I have reatl this epplication end state that the Infortnetlon given Is I
cortect I egree ta comply with ell stete laws antl ciry ordinences releting to bullding constructlon, entl emhodze representa0ves ol �ha Ciry o1 Costa Mesa to enter upon I�e
ebove-tlescn6ed properry lor inspection purppses. I egroe not to occupy or ellow occupenty oi eny building eutharized by this pertnit un�il linel inspection.
[�J]��I:F'77��IIi�7711]�
1616 Fiaed System Final Flre Preventlon
1266 Pod Spa Final
200 Finel RB-Roof
20t Final Block/Retaining walf
202 Final Factory Fire Place
203 FIneI5lgn
204 Finel Demoiltion
�� �
2 � 11/ � Lla�
Da�e
f�f� INSPECTIONTYPE
206 Final Mechanical
208 Finel Plumbing
270 Finel Electrical
212 Final Flre Prevention
220 Final Plenning Approval
222 Final Site
250 Final Bullding/Occupency
PAIE It{�LS
�OWNER HERTZ, Stanley M.
JOBADDRESS 20 B Cecil P1
GENERAL CONTRACTOR Owner-P
AP No. 11 -0 2-11 LOT
INSPECTIONS
SOIL
GAS
W ATER
ROUGH PLUMBING
PROP. SWR. LINE � HOUSE CON. �
SPRINKLING SVSTEM
MISGELLANEOUS
ROUGH HEATING AND AIR CONOITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGH WIRING
TRENCNES � FORMS � STEEL REINF.
F�OOR SVSTEM
BON� BEAM ❑ STEEL REINFORCE r]
SHEATHING
FRAME ANO FLASHING
LATHING - IN n OUT n
PlASTER. BROWN CONT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. ANO A.C., FINAL
PLUMBING, FINAL AN� GAS TEST n
ELECTRIC, FINAL
6UILOING, FINAL
DATE . 12-1-70
BUILDING PERMIT NC
:SCRIPTION of WORK Blockwall
RE ZONE VALUE $ 700.00
GROUP J TYPE III
SUBCONTRACTOR _ PE
OWNER �gl+Z gTANT.F.y DATE
JOB ADDRESS 206 Cecil P1ace BUILI
AP No. ug_�3_pq LOT �]
INSPECTIONS
SOIL
G AS
W ATER
ROUGM PLUMBING
PFOP. SWN. LINE Q HOUSE CON. �
SPRINNLING SYSTEM
MISCEI.LANE0U5
ROUGH NEATING ANO AIR CON�ITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUND � POWER �
ROUGH WIRING
TRENCHES ORMS STEEL RE
FLOOfl SYSTEM
BONO BEAM � STEEL REINFORCE �
SHEATHING
FRAME ANO FLASHING
LATHING - IN n OUT �
Pl/.STER, BNOWN COAT
STflUCTUHAL, FINAL
MEATING, VENT., REFqIG. ANO A.C., FI
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING, FINAL
SUBCONTRACTOR
= "`, _ �865 t
� COSfA MESA BUILDINGSAFEfY DEPARTMEM
P.O. BOX 1200 COSTA MEBA� CALIFORNIA B2l7D
For dpp(icaM fo FI►1 In CompiN�fy
�t-,8 TYPE OR PRINT
cui�ina . �
ADDFBaa
COSTA MESA. CALIFORNIA
NO.Ol6LU06.
DESCRIPTIOPf OP WORK
NO
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lUILDIMOCONBiNURIOp. _ // �
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APPLICATION FOR PERMtT
BUILDIN6
For Offlc� Um Only
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
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CHSA �.00
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEI ED BV DATE RECEIVED DATE ISSUED
BUILDING t' �z� / +� Z
ADDRESS E G �� � '� I�
OWNER (/� I£ `- -�- A.P. NO. IIU� Z' � PERA'1y��� •
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ADDRESS �C%(y '- C�C � /� �+�DRES�( ��ri��G
CITV �� �� NOL� '� TRACT LOT BLOCK
CANSTRUCTION W ADD A P
LENDER O ✓r� �y ✓/t.
BRANCH
OWNER �
ADDRESS �j J �� p/ q
ARCHITECT TEL. - S/v V^ � 0 �^��LUS 0 N
OR ENGINEER N .
FIFE
ADDFESS 20NE /T�Y.�PE GFOUP
APPROVED // ' ATE/��I�/ �
CONTRACTOR B`� v
�s�
ADDRESS
TEL. ZON, l O.OF E OF NEW � � �
CITV NO. �`� PlAKS . BUILDING �.
STATE CITV �/a:�DSAPPROVED VARDSAPPROVEO
LIC.NO. �IC.NO. MAINBUILDING ACCESSORVBVILDING
SI2E NO.OFBLDGS. (FROMGI.STREET) -
OF LOT NOW ON LOT OM � FT. FT.
USE OF A^
EXISTING BLOG. � FT.
SIZE OF NO. OF
NEWBLDG. ROOMS STORIES L SIOE FT. FT.
EXTEFiIOfi WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BVILDING AND WORK TO BE PEFFORMED DISTANCE BET. BET. MAIN &
MAIN BLD('aS. Ap�E$S, gLDGS.
�� / � VAR. # DATE
/ C.U.P.$ APPROVED
/� 1 _ APPROVED" /L./'�u
/� / MJ
I hereby acknowletlge thet I have reatl this eOPlication antl state
ihat the obove informacton is wrrect antl e8ree to comply with
all laws regulating builtling construction, and I shall not amploy
any pe�son in violation of the workman's compensation laws of
the Statt of California.
I hereby car[ify xha[ I am properly licensetl as e coniracmr untler SQ. FT.
ihe Staie ot California Businass and Protessions Cotle, Dlvtslcn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chap2er 9, entl that such licenses are in (ull torce antl attect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempt from the ravisionsof iheStete of alitornia Business VALVATION
entl Professions Co e Divisfo , Chapt f 9. PERMIT FEE S I�
sie�ei�•o m �_
Permhtee $ n� PLAN CHECK $
� r �
Authorized Agent TOTAL FEE $
. ,J
' � 'r- �951 �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR /APPUCANT TO F/LL /N COMPLfTELY
�%(O Ay-a TYPE OR PRINT
BUILDING �D /�- � . / `�
ADDRE55 C'i P p i ��
COSTA MESA. CALIFORNIA
ARCHITECT �q p� LIC.
OR ENGINEER fTANt'P J.7ti��U/�qr/ NO.
ADDRE55 Q pr.� F+LAC^
� STATE 9 ,J
CONTRACTOR �� � (pq�� . LIQNO./7J1.
ADD E55 �S �y O� /�c.. ri L� �r� /Is� T
�[c�t I LOT %/ r� I ��
�ESCRIPTION NO. ,�/ BLOCK R /
n c un %/ J �. _�_�iy ^' 32.� L.
SIZE ' NO.OF OLDGS.
OF LOT S�X ��O now orv �or
FSE OF � AJn �I�S i
YICTINf: RI Ilf:
I SETBACK LINE FROM
DESCRIPTION OF WORK
NEW I' ` II ALTERATION I II ADDITION
REPAIR I II MOVING I II DEMOLISF
BUILDINGID� p�/6//ROOMS � STORIE
SIZE df! If
EXTERIOR WAL�[ ROOF �j �
COVERING c7"J7/LCp COVERING /TOG
USE OF B�LDING,AND WORK TO BE PERFORMED
I MEflEBY ACIfNOWLEOGE TH�T I HNVE READ THIS NPPLICATION
AND STATE TNAT THE ABOVE IS CORHECT qNO NGF6E TO COM�
PLY WITH ALL QTY ORDIN/�NCES �NO ST6TE L�W9 RE6OLATING
BWL�INGCON TRUCTION. �. /^ I
SIGNATURE O `'! � � �
PERMITTEE
AUTHORIZED AGENT
�' K � � ��i�i�i8 C1t�l
fi�ANCE DEPT,
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FaR officF usF oNcr
I RECEIPT NO. I PEGMIT
COSTA MESA. CALIFORNIA
FIRE ;/
ZONE �- �� �
APPROVED /
BY d/h-'� DATE (O
ZONING
ZONE I NO.OF I USE OF NEW /�
� PL/.NS � BUILDING /1-n _
ILoq
A�PPROVED / DATE S��J
YAROS EVES
REOUIRED A�LOWED
ICENTEF LINE STJ ' �
FRONT ,1 � FT.
REAR
FT. M I N.
�
L.°.
�'�ZxZ � yzt
�f �a.�� Z��'
T
THE �MOUNT SHOWN UNDER VALURTION IS FOR THE
PURPO6E OF ESTA9LI6MING A PEfiMIT FEE ONLY.
VALUATION "' � /J—�
PERMIT FEE $ �
/� F
PLAN CHECK 5 � O �
$�� 5� � TOTAL FEE S � S b