HomeMy WebLinkAbout298 CECIL PL - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Jobnddress: 298 CECIL PL
Suite:
Vicinity: RESIDENCE & ATTACHED GARAGE
Parcel Number: 42608314 Zoning:
npp�icant CARRALEJO, GEORGE
Address: 8218 PEPPER CIRCLE �
Phone: 714-952-4958
BUENA PARK, CA Zip: 90620
Owner: ALLEMAN, JASON J 8 KRISTIN L
Address 298 CECIL PL
Phone: 949-645-6960
COSTA MESA, CA Zip: 92627
Contractor: GEORGE AND SONS ROOFING
Address: 8218 PEPPER CIRCLE
BUENA PARK, CA
Zip: 90620
Arch :
Address:
Phone: 714-952-4958
License: 443547
Eng:
Address:
Phone:
Status: ISSUED
Applied: 0625I2001
Issued: O6/25/2001
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOFI: TIO EXIISTING ROOF, 7/76" OSB SHTG, 1 LAYER 15# ASTM FELT, APPLY CLASS A'TIMBERLINE"
30-YEAR COMP SHINGLES. �
2000 SQ FT
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
I nspection:
Total:
$0.00
$111.25
$0.50
$0.00
$0.00
$0.00
$111.75
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0- 0
PARKING Exfstina: 0
NOTES:
Rear 0-0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Calc Valuation:
Claim Valuation:
Left 0- 0 Right � 0- 0
Left 0- 0 Right � 0- 0
Proposed: 0 "
$4,500.00
$4,500.00
li NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Calitomia statutes and related
'. regulations. (Ord. No. 9248, § 7, 12-21•92)
� EXPIRATION: This permit shall automatically expire and become voitl II work is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order tor the work authorized untler this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspectlona and final epproval must be obteined. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
tusae laool
WORKERS'COMPENSATON DECLARAnON:� �
1 hereby eHirm under penalry of perjury one ol the lollowing deClarations:
❑ I have end will meintain e certificate of consent to sell-Insure far workers' compensetlon, es provided for �y sectlon 3700 of the LeDor Code, far Ne peAortnance of the
woM for which lhis permit is issued.
❑ I heve enC will mainteln woAcere' compensetbn insurence, es requiretl hy Seclion 3700 of I�e Lebor Code, tor Ihe pertormance of the work for which this pertnit is issuetl.
My warkers' compensatlon Insurence cartier antl policy number ere:
Cerder. Policy Number:
(This sectian need nof be ownp/efed ll fM1e permi( Lv v etl et one handretl tldlers (5100) or /ess.)
��BMlythat in the peAormence i the worl or w� h t�is pe 1 I5 ISsueC, I shell not employ eny person In eny menner ao es to becrome subl� �a Ihe workers'
com ensatlon laws at Cell}orp , end eg tha I ahould ome wb�ec� ro the workers' compensetlon proWslon� Secy � Op�of the Lebor Code, I shall forthwiih
comply wtlh ihese proNsi� fi5 / j /
Applicanl SI naNre: Dete: ! Q
WARNINO: FAILUFE TO SEWRE WORI�RS' COMPENSATION OOV E IS UNLAWFUL M1D SNALL SUBIECT Ml EMPLOYEF TO CRIMIN�L PENALTIES AND CML FlNES UP TOONE MUNDRED
T110USAND OOLLARE (f100.000), IN ADOITION TOTHE CQST OF COMPENSATION, DAMA�ES AS PFOVIDED FOq IN SECTION �OB OF THE UBOR ODDE, INTEREST, AND ATTOHNEVS FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby eXirtn that I am Iicensed
torce entl eHect. lJc. M
ConirectoraSigneWre: �
CONSTRUCTON LENOING AGENCY:
of
with Section 7000) ot DlWsion 3 0l Ihe Business entl Professions Cotle, and my license is in full
_ Class a
_ Dete: �
❑ I hereby eMirm Ihat there is e construction Iendinp eponcy tar tha peAortnance o11he work br w�lch I�Is Dertnit is issuetl. (Sea 3097, Civil Cotle).
Lendefs Name: LenCefs ACtlress:
Signeture:
OWNER-BUILDER DECLARATONS:
Data:
I �ereby eHlrtn Ihel untlar penelry ot perjury that I em EXEMPT FROM TME CONTFiACTOR3 LICENSE LAW lor the tollowing reawn (Sec. 7031.5, Buslness and Professions
Code: Any dry or counry wNch requires e pertnit to construM, elter, imprrne, demolish, or repair eny atrucWre, D�a� to its Issuence, elso requires Ihe ap0�icant tor such permit
to file e slgned statement �het he.or she l5 Iicensad Dursuant to Ne D��S�o�g of Ne Gontractors LJcense Lew (Chepter 9(commendng wiN SecUon 7000) ot Division 3 af Ne
Business end Profeulon4�Code);or,lhet �e or she is exempt therefran and the Easis for ihe ellegetl ezemption. Any Woletlon of SecNon 7037.5 by flny applicem for a pertnil
sub�ecLs the epplicant to e d3il�penelry ot rwt more lhfln frve hundred EWlars (5500).):
r �, i.. �
❑ I, es owner ol ihe property; ar.my emp�oyaes with wepes es their sde compensetion, WILL DO THE WORK, and the strunure is not intentled or otteratl tor sale (Sec.
7044, Business and Professions Cotla: TTe Contractors LJcense Law Ooes not epDN �o an owner of property who bulltls or improves thereon, and who tloes such work
himselt or herself a through his or her`own erriployees, pmvitletl that such ImO�ovemenls ere nol intended or oftereC br sele. II, however, Ue building or imprwement is
sold within one year of completion, Ue owner,=builtler will have the burtlen ol proving t�et he or she did not build or improve for purpose ot seleJ.
❑ I, es owner of Ihe properry, am EXCLUSIVELV CONTiiACTNG WfTH LICENSED CONTiiACTORS to construct the pro�ect (Sec. 7044, Business and Pratessions
COCe: The contradors IJcense law tloes not eppry to en owner ot properry wfw builtls or improves thereon, end who comrects br such prqect with a contractor(s)
license pursuant to the Cantractors License LewsJ.
❑ I em e:empt under sec. Business and Professions Coda for Ihis reason:
Signature:
Owner ID verified by drivers Ilcense.
� YBS ❑ No Driver5 Litenso No.
Vanfication ot Ownership by (type ot doament, i.e. - D�operry tex bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION:
Date:
Fxpires:
❑ I hereby certity Ihet no excavellon Me (5) or more leet in tlept� Into which e pereon is reQuireO to descend, wlll be mede In connectlon with work euthoAzeA by this
permit, and ihet no building struMure, scetfoltlinp, falsework, or demolllion or dismantling Ihereot, wlll be more ihan thifty-six (38) feet hig�. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celilomia AtlmInI5lreMe CoOe).
0 As ov.ner-�uilder, I will not employ enyone to tlo work which woultl require e permit Irom ihe Divislon ol Industriel Sefety, es notetl ebove, unless such person has e
permit to do such work from the tliWsion.
Signature: Date:
Division ol Intlusirial Sefety Pertnit Number.
CERTFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I cenity under penalry of perjury thet I �eve read t�is epplication and state ihet Ihe infortnetion given is
correct. I agree to compy with all siete laws anC dry ordinances releting to Cuil0ing consWctlon, end authodze represeniatives ol the Ciry of CasW Mesa to enter upon the
ebova-despribad propertyjQr inspection puryoses. I egree not to oaupy or ellow occupenry of eny buildlnp euthonzed by t�ls Dermil until final inspection.
COpE I, INSPECTIONTYPE � Qd¢ �$
1616 Fixed System Final Fire Prevention
1268
200
201
Pool Spa Final
Finel Re-Rool
Finel BIocWRetaininp Well
202 Final FeMory Flre Place
203 Finel Sign
204 FinelOemolltion
� Date
A/
Dae
COOE� INSYECTIONTYPE
208 Finel Mec�anical
20B Final Plumbing
210 Final ElectAcal
212 Flnal Fire Preventlon
220 Flnal Plenning ApprWal
222 Final Site
250 FinalBuilAing/Occupancy
�g �
t
CITV oF COSTa MESA CONSTRUcCyTION PERMIT
ProjectAddress a-Qg ��r� �'`
Applicant's Mailing Address \��a�0 �C1f'1C1CLS�f h'
Owner's Nam^e , �211o�a. � �Ls] �S Phone
AddreSt s1Q� C 4-Ci 4 p�' �.
Arch/Eng. � � ' License No. ' .
Address' (^ p�p ����
Contractor's Nam %• S T o 0`10..�7--�i7
Address (mailingl �� ��(���0�-n�'�
City License No. �a�`� �
LICENSED CONTRACTOR DECLARATION ' �
I hereby atfirm [hdt 1' am'licensetl untler provisions of Charttr 9(Commencing
with section 7000) of Division 3 of [he Business antl Profe55ion5 Cotle, ana
� my license is In full rce ana ettect. p
L:icanse Cla �' Ice a No. � 3��� l
Datc� Signature ��
'N00.KER5'COMPENSATION DECLARATIO ' �
�hereby aftirm that I have a tertificate ol consent to selM1insure or a certificate
uf Workerz' Compensation_ Insurante,� Or 5 certifietl cOPY tnereof.(SectiOn
3800, Lab. C. ��� A �,`C� � -
voncr No. lool�ql3 comcaoy s - �>
C¢rtitietl copy is hereby tumishetl. i
Certlti C y.i filpy �he city Bw}�%in ivi�l'Q� '
Date�� Iicant ' r _� � ` � . �
.EXEMPTION F OM WORKERS' COMPENSATION OEGLA0.ATION
(This seclion n¢¢tl not be completetl it the p0rmit Iz fo� one hund�etl (5300) or
less). �
I ce�tify that In the performance ot the work tor which [hIs permit is•Issuetl, I�
shall not employ any person in any manner so as to become subject to the '
Workers' Compensation Laws of CalifOmia. '
Da[e Signatur¢ '
NOTICE: H, after making rois tleclaratlon, you snoWtl oecome subject to the
Workers' Compensation provisions ot the Lnbor CoOu,-You must forthwith
mmply �witb such O�ovision5 or tltls pe�mit shall be tleemetl revok¢tl.
CONSTRUCTION �EN�ING=AGENCV - �-
I hereby affirm tnal [here is a wnztructlon lentling a9ency for the pertormance ,
ot Me work tor which this permit is issuetl, (Se<tion 3097 Civ. CJ
l.entler's Name �
LPntler's Atltlress � - �
OWNER BUILDER DECLARATION-� - �
I hereby aiflrm thdt I am exempt froT [he Conlractor's License Law for th¢
f011owing rea5on (Sectlon ]031.5 BuSinesS antl Pro(essional COtle: Any city or
countv which requlres a permk to construct, altar, improve, aemolish or repair
a
P
7ivision 3_0� tne Business ana vroressions eoae7 or mai ne�sne is exemp�
.he�efrom antl Ih¢ ba5is (or t�e allegetl exempHon. Any violation'of Sectlon
'7031.5 �,by any applicant tor a permit subjeClS [he applicant to a civil ;
��enalty of not moie than tive huntlretl tlollars (5500).�
I; as owner of the property or my employees with wa9es as their sole'
'compensation, will tlo the work,antl the structure is'not intentletl or offeretl
for sale (Sec[ion�7044, Business antl Profezsional Cotle: The Contractor'S
Ucense Law tloes not apply [o en owner of a properry wno builtls or improves
t�ereon, antl who aoes sucn work himself/hersell or tnrou9h his or her own
employees, provitletl that such improvemen[s are no[ intentletl or oftereC for
Sale. If, how¢v¢r, the DUIltling o� improvement i5 SOItl wl[hIn one year of mm-
plelion, the owner will have the buraen oi proving he/she tlitl not ouiitl or Im-
�rove for the purpose of sale).
I, as owne� ot the proper[y, am extlusively contraGting with Ilcensetl con-
vactors to construct tne project `Section ]044, Businass antl Profassions Coae: �
. The Conlractor's �icense Law does mt apply to an owner of property who
Duiltls or imOroveS Ih¢reon, antl who cont�acts-fo� SUCM1 prOjectS with a con-•-
tra<tor(i1 Iicense pursuant�[o the Contractor's License Law). I am aware t�at
proof ol [helr WOrkeYs Compensation in5uranCO shoultl be prOvitlea to me.
❑ 1 am exempt untler 5ection 8. & P. C. for this reason
Date pwner
1 have reatl this application antl state that the above
I agree to�Gomply wi[h all cIty dntl county ortlinanCes
�to builtling construttion, antl hereby authorize repre-
� to re�nter y�pon the above-mentionetl property for
Si9nature ��`\11�
Drivers' License or % �
CMF OH65-46, rev. 4/84
icant to fill in all spaces except thasa within heavy bortler lines ana si9� ail aporoo��ale aeclarations.
PERMIT NO. , TFACT NO. LOT NO. � UNIT NO.
TVPE OF CONSTRUCTION LI NEW _QQADD LI ALTERATION LJ REPAIR
❑CONVERSION ❑DEMOLISH Qo'rHER _ q,P,#
DESCRIPTION OF WORK/USE OF BLDG.
� ' S Main Buildi
TVPE OF PERMIT GRaDING FOurvDATlOnI ❑$TRUCTV RAL T Front
❑ TENANT . ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
❑ �OTHER, . �' C Rlght
PROJECT DESCRIPTION 54. FT. ocCuaANCv - K
'CONSTRUCTIONTVPE � VAWATION$ g Left �
ZONE � GRADING CU. VDS. ACRES � p�ng. R¢f. #
Remarks: � , � Planning Notes:
$ink
Preventer - - ServiceSink' -
Irrigation Sewer Cap
Sewer Connection
� $O�dI COIICCtOfS
'� Solar Piping
Floor Drains '
Floor Sinks
Gas Service , �
Interceptors '
Kitchen Sink �
Lavatories. .
P—Trap
Roof Drains -
Solar Tank
, - Swimming Pool w/Spa� �
- Urinal �
utlets Water Closet " '
' Water Heater �
Water Service
Reinspection Fee . ` � $15
i
Boiler
Duct - Under Ground � �
Duct-Structurol �
Duct - Ventilating .
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. IC80 #
Heating System & Ducting � '
❑P700.000 BTU 0100.0006T
Reinspection Fee � $15
WM1ite - Builtling; Canary - AppIIWn[; Plnk - AGcounting; Goltlen�otl - A55e55or
��
i ' •
� Issue Fee - ' '
iANICAL
Hood or Typel �
Canopy 7ype I I ❑
Retrigeration System �
❑aioo,000sru ❑ioo,000sT
System Repair/Alteration
Issue Fee
Automatic Washer
Construction Pole Sub.
Cooking Uni[
D ishwasher
Dryers �Gas ❑Electric
Fan
F.A.U.
FixWres� - - � - -
Device Boxes
OuUets
Switches
Garbage Disposal �
Generator 00.5 KW �5-75
1746 II/06/84'
- Zone
Accessory Building: '
Parking Req./Provided
ELECTRICAL
Transformer � 15-50 KW
❑ 50+KW
Meter LJup to 100 amp5
Meter ❑over100amps '
Sub Panel
Motors�0.1HP�1X-8 �
Inc.Solar �9-75 HP �16-75+
Microwave- � �
Pole Light �
Range
Standing Sections
Trash Compacmr
c.00 T(,
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$� Heinspection Fee $15 luue Fee 5 3
FEES
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved ey Date
Building Approved By Dete
Applintion Issued By Date ��
! � $ 3
SUMMARV OF FEES '
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $� ISSUANCE $�
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ � .GRADING � $ ,
PLAN CHECK � 50% $ MICROFILM $ � T
MECHANICAL' • $ TOTALFEE $ ��v
PLAN CHECK 25% $
°' CONSTRUC710N AND PLANNING - � ' ` � • PO� & SPA
,APPROVALS �Permit# Date Inspector p�ppROVALS Permit# ;Date Inspector
•-1. Temporary Electrical Service or Pole , , 52. Pool & Equipment Location -
�2. Soil Pipe-Undrgmd. ' 53. Steel Reinforcement '
3. Electrical COnduit Utility-Undrgrnd. . 54. Forms .
' 4. Electrical Conduit �Undrgrnd. � ,' 55. Electrical Bonding
.5. Steel Reinfarcement � ; - 56. Rough Plumbing & Pressure Test • .
6._Electrical UFER Grnd. 57. APPROVAL�TO COVER-GUNITE ,
7. Footings• ' _ �„ 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. . . 60. Backwash Lines, P-Trap, O Undrgrnd. -
10. Structural Floor System � 61. APPROVqL 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 �
i8. Rough Electricai-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL
� 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '
20. Rough Factbry Fireplace APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating . � 71, Product Piping OGas ❑Oil �
23.'Gas Pipe-Rough & Test , 72. Underground Flush
24. Roof Framing � 73. Undergrnd.StorageTank �Gas ❑Oil
25. floof 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 �' � y,/ �`' 79�PINAL INSPECT�ON
� ...�.
� 32. Electrical Power MeterFinal ^l) ?-'�`� •:'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. Final Plum6ing . , �
39. Water Service-Final � ,
40. Gas Service�Final � •
41. Solar pomesticFinal � � '
42. Backflow Preventer •
- 43. Backflow Irrigation. ;; $-.�. -,- ,. �
44, .Landscape Irrigation System �
45. Sound Attenuation
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING � � .
48. Special Requirements Completed � , �
49. Electric Release to Edison � �
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date •
OWNER �'j"PER�'IEL
JOB ADDRESS
GENERAL CONTRACT01
AP No. '1 3-�
INSPECTIONS
SOIL
GAS
WATER
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE
SPRINKLING S�STEM
MISCELLANEDUS
ROUGN HEATING ANO AIR COP
TEMPORARY SERVICE OR POl
UNDERGROUND ❑ POWER
ROUGH WIRIN�
TRENCHES �. FORMS �
FL000. SYSTEM
BONO BEAM � STEEL ftE
SHEqTHING
FRAME ANO FLASHING
LATHING - IN [� OUT �
PLASTER_ BROWN COAT
Charles
il Place
ING
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING FIN/L AND GAS TEST ❑
ELECTRIC, FINAL
DATE �_3_
BUILDING PERI
DESCRIPTION of WORK Slump
FIRE ZONE VALUE $ 300.
GROUP J TYPE III
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COSTA MESA BUIIDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant ro Fill in Completely REc eo DA�ne�'veo
BUI�DING DATE ISSUED
ADDRE55 � �/
_ � � — 0 � PERMIT NO.
OWNEH A.P. NO.
MAIL BUILOING ^
ADDRESS L-' ADDRESS d �
TE L. ��
CITV NO. I� TFACT� �� LOT j� BLOCK
CONSiRUCTION
LENDER
BRANCH
OWNER G `
ADOPESS � V LUE �D�
ARCMITECT TEL. S
OR ENGINEER
FIRE
ADDRESS ZONE TVPE GROUP
APPROVED
CONTRACTOR BV DATE
ADORE55 ° �
TEL. ZO l' NO.OF USE OF NE
CITV NO. P�`� i^ BUILDING
STATE CITY �'ARDSAPPROVED VARDSAPPROVE
LIC. NO. LIC. NO. MAIN BUIIOING ACCESSORV BUIIDING
SIZE NO.OF BLDGS. IFROM C/L STREET)
OF LOT NOW ON LOT ONT FT. FT. �
VSE OF / ��
EXISTING BLDG. F !
SIZE OF NO. OF -
NEW BLDG. ROOMS STORIES L. SIO FT. — �
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WOpK TO BE PERFORMED DISTANCE BET. BEf. MAIN &
MAIN BLDGS. ACCFSS. BLDGS.
VAR. iW DATE
�� C.U.P.qs APPROVED
APPROVED
I horeby acknowlatlpe that I have reatl this aOPlication antl rtete
that the ebove Information is corract antl agree to comply with
ell laws repuleting bulltllnB �onstruction, anC 1 shall not employ
any Oe�snn In violation ot Ma workman's compenSaNOn laws ot
tha Smta ot Calitomla �
i
I heraby cartify that I em proparly licanzatl as a contrector untlar SQ. FT. �
[ho Sta[e of Callfornia Busineu end Profeuions Cotla, Dlvisicn 3, TNE AMOUNT SHOWN UNDER VALUATION IS FOR
Chepter 9, end that sut� lieensas era In full torce anG effect, or I TNE PURPOSE OF ESTABL6HING A PERMR FEE ONLV: �
em ezampt from tho provisionz ot tha5tata of Callfornla Busineu VALVATION
antl Profassions Cotlo, DWislon 3, Chepter 9. � �
� PERMR FEE 5 !
Sipnat�re ot �n ) �
Permittoa n� t�- �/Y({/ S �vO PV1N CHECK S
V
AuthorizBtlAOent s� �
TOTAL FEE 5
OWNER SUTTERF�LD, Charles M. et al DATE 4-21-71
JOB ADDRESS eci ace BUILDING PERMIT N0. 32975 �
GENERAL CONTRACTOR er- r. DESCRIPTION of WORK Res.w att.Raraae
GAS
ROUGH PLUMBING
PROP. SWR. LINE � HOUSE CON.
SPRINKIING SVSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONOIT
TEMPORAFV SEFVICE OR POLE
UN�ERGft0UN0 � POWER �
ROUGH WIRING
REINFORCE
SHEATHING
FRAME AN� FLASHING
LATHING - IN �� OUT
PLASTER,BROWN COAT
SUBCONTRACTOR
J
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�. .�
_� :��g75
� COSTA MESA BUIIDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
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for Applicant to F/// in
BUILDING � � �
ADORESS
OWNEfi (��
MAIL
ADDRESS �
CITY
CAN5TRUCTION
LENDER
BRANCH
ADDRESS
ARCHbTECT
OR ENGINEEfl
ADDPESS
CONTRACTOR
ADDRE55 7,
CITY /� ��
STATE6
LIC.NO.g.��_ /��� 5 D�
[i—
51ZE � � �� Q ,
OF LOT
USE OF
E%ISTING BLDG.
SIZE OF NO. OF
NEW BLDG. f±00MS
EXTERIOR WALL ROOF
COVEFING COVERI
USE.OF BUILDING AND WOFK TO BE
TEL..�
No. S3 6-
TE
CITV
LIQ NO.
INO.f OF B�DC+'
NOW ON LOT
I hereby acknowletlge thet I hava reatl this oOP��cetion antl siate
thet ffie ebove intormation is correct and agree m comply wiffi
all laws regulating buildin8 construction, antl I shall not employ
any person in viola[ion of the workmen's compensation laws of
the State of Celitornia.
I hereby certity ffiat I am proper�y �{�anseG as a conbactor untler
the State of Celifornia Business ahtl Professions Cotle, Divisicn 3,
Chapter 9, entl thet such licenses are In tull forca antl effect, or I
am ezempt trom tha prOvisiOns o} the $tate of CalitOrnia Business
antl Professions Code, Oivision 3, Chapter Q9. �
Signaturaot/, //��'�.� __iC/ �•—// �i//
Permittee � /f L��tXad 7
Auihorized ABent � �
vn�a # **,�
APR 21-71 ��SA001023 111.G0
' �� �
APPLICATION FOR BUILDING PERMIT�
RECEIV D D TEFECEIVE4 DATE�jED
—r 3 i / 7
A.P.NO. IU��� _Q� ERMITNO.
BUILDING .i') � �i` � _ �
ADDRESS �f �
t l � Q/
TFA T �LbT BLOCK
W AD P
ow en�e , �P
� (� VAWE /`"
S � � $
FIRE �
ZONE TVPE GROUP
APPPOVED U
gy DATE
1��
Z NO.OF USE OF NEW
PLAfS BUILDIN ���
VARDSAPPROVED VARDSAPPFOVED
MAIN BUILDING ACCESSOFV BUILDING
(FROMGLSTREET)N �-•. .-.. �Y�{�.Q�
d-e-�v'-c'
RONT FT. FT.
FT. FT.
L. SIDE �J � FT. L
RFAR JI FT. �'/ FL
VA
S
QE7ANCE BET. BEf. MAIN & y
IN BlOGS. ACCESS. BLDGS. �7
1'.�P,�aF��'�/_3Z APPROVED�—z'2-7I a
��% 1
R �E (J` � -� - 'Yi
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a
y
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'L,C�I-;--�-��` ' �
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3o-v sa.FT. "�d / o;
THE AMOUNT SHOWN UND�F VALUATION IS FOR �
THE PURPpSE OF ESTABLISHING A PERMIT FE� ONLV: ¢,y
�UATION GI ��^ N �
PERMIT FEE S � ^/ ]
✓ F. �..v m�
PLAN CHECK $ ��� E Q
/ ' � �D/ TOTAL FEE § I/ / � C�— LL/
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