HomeMy WebLinkAbout935 AZALEA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 935 AZALEA DR
$uite No
Vicinity:
Parcel Nunmber: 41221306
Applicant: JOE LARGURA
Address: 17886 LAKE SHORE DR
LAKE ELSINORE, CA-
Owner; DE LA TORRE, MARGUERITE
Aiidress ' 935 AZALEA DR ,�
COSTA MESA, CA
Phone: 800-727-0977
Zip: 92530
Phone:
Zip: 92626
Contractor: ALL STAR WATER HEATERS INC
Address: 17886 LAKE SHORE DR
. � - Phone: 800-727-0977
. LAKE ELSINORE, CA Zip: 92530
- License: 812894
Arch / Eng : l. , , ' ,'
Address:
� ' � Phone: -
_ �_ " Zlp: , � -
_ License: � - .
SCOPE OF PERMIT
�, CHANGE OUT WATER HEATER. ��
ISSUE FE�
Backflow irrigation
BackFlow P2venter �
Bathtub
ClariferSyStem �
Connect (Ice,Soda,etc),
Dental Units '
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
AMT pTY
$23.50 ..' _
$o.00 0
$0.00 0
$0.00 , 0
$0.00' 0
$0.00 , 0
So:oo 0
$0.00 0
$0:00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
Status: ISSUED
Applied: OS/17/2004
Issued: OS/17/20 4
ISSUED BV:
'FEE SUMMARY
� AMT � °��QTY
LaundryTub/Washer $0.00� 0.
Landscape Irzigation $0.00 0
P•Trap � � $0:00 0
.Pressure Regulator $0.00 0
Process Pfping (per 10 ft) �$0.00 0, .
Receptors' $0:00 � 0
Septic Tank �$0.00 0
Sewer Cap for Demo $0.00 0�
SewerConnect �$0.00 0
Sewer Private Line $0.00 0
Shower $0.00 0
Sink, bar $0.00 0
Sink, commercial . $0.00 0
Sink, Floor $0.00 0
AMT
. . Sump Pump . $0.00
Swimming Pool $0.00
� ". Trap Primer � , $0.00
'. Urinal � � � $0.00
� � ,Vacuum Brkr BkFlow(1-4) $0.00
" ; �, Vacuum Brkr Bkflow(5+) $0.00
, , � Wash Basin - i $0.00
� Wash Basin Sel $0.00
Waste and Vent System $0.00
� - Water Closet (Toileq $0.00
, Water Heater ( vent $12.30
_ ��� Water Piping pnst or Rep.) $0.00
Water Re-pipe $0.00
Water Service $0.00
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
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, § 7, 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 ordar for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required lnspectlona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaas�as �a�oo�
i
WORKERS' COMPENSAnON DECLAFiAnON: ' �
I hereby eHirm under penalry oi peryury one of the following decleratlons: . - I
❑ I heve end will mainteln e ceniiicate of consent to self-Insure for workers' compensetlon, es provitled for by section 3700 of the Lebor Code, for the peAormance at the
�., �work for which ihis perinit Is Issued. �
pQ i nave entl will m�intaln workers' compenseNon Insurence, as required hy section 3700 ot the Labor Code, tor the pedortnence W ihe work Por which this permit Is issued.
My warkare1' com��lens�ation Insurence de� and policy number ere: / / // / O �
Cerrier: S/�H Ta-� �v/V� PolicyNumber, !�(D �� y 3
(TTis secHon need nat be completed i1 the permit is velued af one hundretl tlollars ($700) ar less.) � , ' !
❑ I certity ihat In the pertormance of ihe work for which this permit is issued, I shell not emplay any person in eny manner so es ta become subjed to ihe workers' �
compensetlon lews � alttW� ie, and egree that If I should become subJect to ihe workers' compensation provisions of Section 3700 of he Lebor C tle, I shell forihwith
comply with th provisi As. � +� �� I
Applicent Signature: Dete: �
WARNINO:FAILUFET CUREWORKERS'COMPENSATIONCOVERAOEISUNLAWFULANDSHAlL5U91ECTANEMPLOYERTOCRIMINALPENALTI SANDCIVIL NESUPTOONEHUNDRED
TMOUSAND DOLLAR ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SELTION 3]W OF THE LABOR CAOE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: I
I hereby�aHirtn thet I em licensed der provisia9� of Chepter 9(commencing with Sectlon 7000) oi Divislon 3 of tha Business entl Profes ions Code, end my license Is In full
force end.etfed_,Lic. # �� �� 7� Gless # r� 3�
Contractofs Signeture: Dete: S'� � 7'� Q.�
CONSTRUCTION LENDING AGENCV:
❑ I hereby eftirm ihat there is a construction lending agency for the peAormance of the work tor which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lenders Neme: Lendefs Atltlress:
SigneNre: Date: �
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn thet under penalry of per�ury that I em EXEMPT FHOM 7HE CON7RACTORS LICENSE LAW for the follawing reeson (Sec. 7037.5, Business and Protesslons
Cotle: Any city or County which requires e permit to construcL alter, improve, demolish, or repair eny structure, prior to its issuance, also requires ihe epplicant for such pertnil
to file e signetl stetement that he or she Is licensetl pursuant to the provlslons of the Contredors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of the
Business end Professions Code) or thet he or she is exampt therefrom and the basis tor the elleged ezemptlon. Any violetlon of Section 7031.5 6y any epplicent for e pertnit
sub�ects the epplicant to e clvil penalty of nol more ihen five hundred dollers ($500).): �
❑ I, es owner of the property, or my employees with weges es their sole compensetlon, WILL DO THE WOHK, end the structure is not intended or oflered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves Ihareon, and who tloes such work
himself or herselt or ihrough hls or her own employees, provided ihet such improvements ere not Intendad or oHered for sale. If, however, the builtling ar Improvement is
sold within one year of completion, the owner-bullder will heve the burden of proving that he or she did not build or improve for puryosa of sele.). � I
❑ I, as owner of ihe properry, am EXCLUSIVELV CONTRACTING WITFi LICENSED CONTRACTOHS to construct tha project (Sec. 7044, Business end Professions
Code: The contractors License Lew tloes not apply to en owner of property who builds or Improves theraon, end who contracts for such project wlth e contractor(s)
licanse pursuanUo ihe Contractors Llcense Lews.). �
❑ I em exempt under sec. Business and Professions Code for this reeson: �
Signature: Date:
Owner ID verified by dnvers license. ❑ Ves ❑ No Driver's License No. Ezpires: �
Verificetion of Ownerehip by (type of tlocument, i.e. - property tax blll or deed): (
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION: �
❑ I hereby caelfy thet no excavetion five (5) or more teet In depth into which e person is required to descend, wlll be made in connection with work eutharized by tFiil
permit, and �hat no building siructure, scaftolding, telsework, or demolition or dismantling ihereof, wlll be more �han thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, SeC.
341, Title 8, Celitomia Administrative Code). I
❑ As owner-bulltler, I will not employ enyone to do work which would require a pertnit from the Division of Industnal Safety, es noted ebove, unless such pereon hes e
pertnit to do such work irom the division, i
Signature: Dale: �
Division of Indusiriel Sefery Permit Number: �
HA2ARDOUS MATERIALS AND EMISSIONS CERTIFICATION: '
1 Will the epplicant or present or future buliding acupant need to file and certiy a Business Plen for emergency response to release or ihreatenetl releese of e hezertlous
metetlal? ❑ Ves ❑ No '
(Section 25505 of the Califomie Heelth and Sefery Code requires, with some exceptions, tha[ a Business Plan be filed with the Coste Mese Fire Department by every
business which hes et eny one time during a reported year a quantlty of hezardous materials equal to or greater ihan a weight of 500 pounds, or a volume of S5,gallons,
or 200 cubic feet of compressed gas at standard tempereture and pressure). �
... ......................i...............
.....................................................................................................................................................................................................................................................................................:................. ........... ......... .......... ....
2 Does or will the applicant or present or future building occupant need to tile a regisiration form tor acutely hazardous materiels7 ❑ Ves ❑ No
(Sectlon 25533 of tha Calitomia Heelth and Sefety Code, with some ezceptions, requlres regislratlon with Ihe Casta Mesa Fire Department by each business which at any
one tlme hes on hend e quantity of ecutely hexardaus meterlals aqual to or greater ihan e weight ot 500 pounds, or e volume of 55 gellons, or 200 cubic feet of
campressed ges et stenderd temperature end pressure).
......................................................................................................................................................................................................................................................................................................................................................................:.....................
3 Does or will the epplicant or present or future building occupant naed to prepere an RMPP (Risk Management and Prevention Program for acutely hazardous meterials)7�
❑ ves ❑ No
(Sectlon 25534 of the Califomia HeaAh and Sefety Code provitles that the Casta Mesa Fire Department may require ihe preparation, cenificatlon antl tilinq with the Fira
bepartment of en RMPP by 6usinesses whic� ere required to register ecutely hezerdous materlals with the Fire Depanment.
.................................................................................................................................................................................................................................................................................. ....................... ............................................._:.....................
4 It an RMPP is presently reQuired, has Section 25534 of ihe Celifornle Health end Satety Code been fully complied with7 ❑�Ves ❑ No -
............................................................................................................................................................................................................................................................................................................................................................................................
5 Does or wlll the applicant or present or future building occupent require tor the work which is ihe subJect of this a plicatlon e Permit for such construction or modHicatlon
from Ihe Sauth Coest Alr Quality Menegement DisMct or irom eny o�her alr polluiion control district or egency7 � Ves LJ No '
Sectlon 658502 of the Celifomia Govemment Code re uires thet ihe re uesled informallon be furnished on a lications tor nomrasidentiel bulltlln ermits �
( Q' 9 PP� 9P )� �
......................................................................................................................................................................................................................................................................................... ....................... ...................................................................
6 Will any pert of the feciliry to be consiruc�ed under this permit be wlihin 1000 feet from the outer boundanes ot a school? ❑ Yes ❑ No
(If'yes", Ihe facility must meet the requirement of Sactions 25534 entl 42303 of the Calitornie Health end Satety Code). �
............................................................................................................................................................................................................................................................................................................................................................................................
7 If e parmit from ihe South Coast Air Quallry Menegement Disirict or other eir pollutlon conlrol district or egency Is required for ihe work whlch Is Ihe sublect of ihis
eppllcation, heve all of the dlsclasures prescdbed by Celifomla Heallh and Safery Code Sectlon 42303 been mede? ❑ Yes ❑ No j�
..:.........................................................................................................................................................................................................................................................................................................................................................................................
B (If "yes", atlach certificete of compliance irom the appropriate elr pollution control otficer).
CERTIFICATE OF COMPLIANCE: I cedity that under penelry ot perjury the information given above is correct. I egre6 to comply with all state laws end ciry aitlinances
regarding Hezardous Meterials entl Emissions. �
Slgnature: Date: �
CERTIFlCATE OF COMPLIANCE AND AIJTHOf717J1TON OF ENTRY: I certify under penalty of per�ury that I have read this epplicetion and state that the infortnetion qiven is
corred. I agree to comply with ell stete laws and ciry ordinences relating to bulltling construction, and authonze representatives of the Clty of Costa Mesa to enter upon the
above-descnbetl property for inspaction puryoses. I agree not to occupy or allow occupancy of eny building eulhorized by lhis permit until finel in9peCtion. i
I
ture Of Legal Owner(s) e '
�- �--- �� `� X '
AndiOr Authorized Applicant Date ,
COUE �. INSiECTIONTVPE
1616 Fixed System Finel Fire Prevention
1266 Pool Spe Finel
200 Finel Re-Roof
201 Finel BIocWReteining Well
202 Final Factory Fire Plece
203 Finel Sign
204 Finel Demolition
PAIE UiIQIA65
�
COOE� INSYECTIONTVVE
206 Finel Mechenical
20B Final Plumbing '
210 Finel Electricel
212 Finel Fire Preventlon
220 � Final Planning Approval
222 Final5lte
250 FinalBuilding/Occupency
•7d1 Gllur_14-
�i� e.r��
(714) 754-5273 -• Fax (714) 754-4856 • www.cl.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 935 AZALEA DR
Suite: ,
Vicinify�. ROOF
Parcel Number: 41221306
Zoning: R1 R1
Applicant: PETERSON, ERIC
Address: 1653 SUPERIOR AVE . " , , . . � � - � .
,.. . Phone: (949)642-7222
COSTA MESA; CA �� . Zip: 92627 � �
i . - .
owner. DE LA TORRE,,MARGUERITE
Address 935 NZALEA DR �, � . �
, , � , . _ _ ' , .
r .
�-� Pfione:� -
/ �.. ; -• . � • _
f� i COSTA MESA,"CA�- ' - " Zip: 92628
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Contractor. ��LEE ROOFING OF COSTA MESA .
; Address; 1653 SUPES210R AVE
Status: ISSUED
Applied: 08/06/2003
Issued: OSl�6l20�3
ISSUED BY: � `--�
\.
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� , ' . �'„ ,." Phone:.. (949)642-7222 ;�.ti`A ,' , ��, �
' � � �� COSTA MESA, CA � , - � - �
. Zip: 92627 ' License: � 349686 � ' � ` - -
� < ,
Arch,: � " , � . Eng: � � _ . '
Address: , , -; .�, . � � • AddFe'ss: � �- �
� � _' , .. : Phone: . - � � � - - � . - - - � Phone: � �
!� - _ ' � , ` � , .
, -_
'� Zip: � - � ' - Cicense: � , License: � .
TEAR OFF EXISTING ROOF. INSTALL 1/2"OSB SH
�. INCLUDES ATTACHED GARAGE. ' � ' � '
�
Plan Check: % $0.00 _ _� _
Permit: $167.25
�' SMIP Res: � � $0.88
SMIP Com: ` .$0.00 '
Othec: • $0.00
��Inspection': ' '� $0:00
, � ���
�� �TotaL• - � -$168.13.
;,.
a�.vr� vr r�rtnn i �
HING; 30# FELT; 40'YEAR, ELK, CLASS A�, COMPOSITION SHINGCES. 35 SQUARES
FEE_SUMMARY � � � '
� �� � � , • �� Calc Valuation: � , ,� �$e,eao.00;
SETBACKS, � . � ,
MAW STRUCTURE- Front 0-0 � � Rear
ACCESSORY Front-. 0-0 � �: Rear
PARKING Existin i�� 0_� Reauired:'
�
, . . . '•. ,.
PLANNING & ZONING
0- 0�� � Lefl Q- 0 �
0• 0 LeR 0, 0 ".
0
Proposed:. 0,
,. �
Claim Valuation: ,� Ss,aao.00
_ �' ��
;�; ,
!' „ l,
, � :
. . � , ,
� ., � �
� Right . - �_ � � . �" , ; % ,
�.
Right�. '0-0,',-�;;.
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NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements untler California statutes and related
re9ulations. (Orcl. No. 92-28, § 1, 12-21•92)
E%PIRATION: This permit shall automatically expire and become void if work is not oommenced within 180 tlays, or if work is suspended or abandonetl
fof a perlal of 180 days.
INSPEC710NS: In order for ihe work authorized under this permit to be considered legal, such work must comply with ell applicable codes, and all
requlred fnepeetlons antl flnef epproval must be obtained. Failure to obtain inspectfons and Final approval will result in ihe expiratlon ot ihis permil.
FOR INSPECTIONS CALL: (714) 7545628
I •
WORKERS' COMPENSATION DECLARATION: . , ✓ �j
I hereby eflirm undey�enelry of,perJury one af the following declaretions: � . �
❑, I have entl will melntaln e certificete of consent to self-Insure for workere' compensetion, es proNtled for 6y sedion 3700 of the Lebor Code, for ihe perfortnence of the
work for whiCh thi9 permi� Is i9sued. !'
� I have antl wlll malntaln workers' compensatlon Insurenca, es required by sectlon 3700 of the Lebo� Cotle, for the peAortnance of Me work for which this permit Is Issued.
My work� co'mpensatlon I surance car er end pallcy number ere: ��p� �
Cerrier� ✓�—Ef �v�n PolicyNumber:� �2�Q�� �^oC3.:��� i
(7his sectlon need ndt be completed �ll the pe�rmft s veluetl ef one handred dollew ($f00) or /ess.J , �
❑ I certity thet in the peAorme e of thf e work fo7w ich thls permit is IssueQ I s�all not employ any peraon in eny menner so es to become sub�ect to the workers' I
compensation lews of Cellf renda het it hould become sub�ect to the workers' compensatlon provlslons al Sectlo 700 of the Lebor Cade, I ahell torthwlih
comply wNh these pm '� I
_Applicent SlgnaWre: � �'Dete: i
WARNINO: FAILURE TO SECURE WORKERS' CqAPENSATION COVEFUOE IS UNLAWFUL AND SHFLL SUBIECT AN EMPLOYER TO CRIMINAL E TIES AND CML FlNES UP TO ONE MUNDRED
hIWSAND DOLLARE (5100,000�, IN ADDITION TO hIE COST OF CAMFENSATION, DAhU1OE5 AS PROVI�ED FOR IN SEC(ION 3708OF THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTAACTORS DECLAHATION: � �
I hereby afArtn that I em Iicensed under rovislo W Chepter 9(commencinp w%h Seclion 7000) of Didslon 3 qf the Buslness d Profeulons Code, end,my Ilcense is in full
force end etted. Lic. k_ 1 r_, Cless k_
ContrecroYs Signeture: Date: �� �
i
CONSTRUCTION LENDINO AOENCY: �
I
❑ I hereby aflirtn ihat there Is e construction lending egency for the peAortnance of the work for which this permit Is issued. (Sec. 3097, Civil Code).
Lendera Neme: Lenders Atltlress: �
SigneNre: Dete: i
OWNEH-BUILDEH DECLARATIONS: � �
I hereDy elfirm thet under penelty af per�ury thet I em EXEMPT FROM THE CONTRACTOHS LICENSE LAW for Me following reason (Sec. 7031.5, Business end.Professlons
Code: Any ciry or county which requires e permit to construct, alter, Improve, tlemUlsh, or rapeir eny strudure, pdar to its issuanCe, elso reqWres the epplicent for sucNpertnit �
to file e signed statement thet he or she is Ilcensed pursuent to t�e provislons ol the Contrectors Llcense Lew (Chepter B(commencing wlth Sectlon 7000) of Dlvision 3 of the
Business end Professions Code) or thet ha or she is exempt therefrom end the besls for the elleged eaemption. Any vloletion of Section 7031.5 by any epplicent for e pertnit
subjecis ihe epplicent ta e Civil penelty of not more than flve hundred dollers ($500) J: . �
❑ I, es owner of the property, or my employees with weges es their sole compensetlon, WILL �0 TME WOHK, entl fhe sirucNre Is not intentletl or oHered for sale (Sec. '�
7044, Business and Prafesslons Code: Tha Contrectore License Lew does not epply to an awnar ot property who builds or Improves thereon, and who tloes such ivork
hlmseN or herself or through his or her own employees, providetl Mat such improvements ere not Intandetl or oHered for sele. If, howaver, the building or improvement is
sold within one yeer of completion, the awner-builder will heve the Durden of proving thet he or she tlid not build or improve for puryose of sale J. �� �
❑ I, ea owner of ihe properry, em E%CLUSIVEIY CONTRACTING WITM LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions
Cade: The contreqors License Lew tloes not epply to en owner of properry who bulltls ar Improves thereon, end who contreds for such projed with e contreqor(s) .
license pureuant to the Contractore License Lews.). . I
❑ I am ezempt under sec. Business and Professions Code for Ihls reeson:
Signeture: ' � Dete: I
Owner ID vedfled by tldveYs Iicense. ❑ Yes ❑ No Dnvers Ucanse No. � � Ezpires: I
Vedficetlon of Ownerehip by (type of document, I.e. - pmperty tex blll o� deeG): � � I
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby cenily thet no excavetlon five (5) or more (eet In depth into which e peraon is required to descend, wlll be mede In connection with work euthonzed by thil
permit, end thet no building siructure, scettolding, felsework, or demolition or Alsmantling ihereof, will be more then thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, lltle 8, Califomla Administretive Code). � '
❑ As owner-6ullder, I wlll not employ enyone to tlo work which would wqulre e permit from the Didslon of Industdel Sefety, es notetl ebove, unless such persoln hes e
� permit to do such work from the division. �� �'
SlgneWre: , Date: I
�. I
Dlvision of Industdal Safety Permit Number,
CERTIFlCATE OF COMPLIANCE IWD AUfHORVA710N OF EMFiY: I certify under penalty of perJury Uet I have reed this eppliceUon end state that the Informetlon given Is
correct. 1 egree to comply with ell atete laws end ciry ordlnences releting to building construqion, end euthorize representatives of the Ciry of Coste Mese to enter,upon ihe
ebove-descnbed pro e for inspectlon purposes. I egree not to occupy or ellow occupenq ot eny building euthadzed by this pertnit until finel inspectlon: �� �
. �
ne elOwner(s) . ete �
�s�b/�r� 3 �
horized ApDlicant � Date
CO�E L INSVEC110NTYPE - ,.
.7678 , Fixetl System Final Fire Preventlon '
7288 PoolSpe Flnel
200 Flnel Re-Roof
201 Finel BIocWRetelnlnp Well
202 � Finel Fedory Flra Plece
203 Finel Sign
204 Final Demolition
I�L\1�18nYIdF9
i� �
�
COOE � INSVECTION TYVE
208 Finel Mechenicel
208 Flnal Plumbing
210 Flnel Electdcel ,
272 Finel Flre Preventlan
220 Finel Plenning Approval
222 Final Site '
250 FlnelBullding/Occupency
�`�� 3 G.�
301 A
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING
ADORESS 935 Azalea Costa Mesa
OWNER Larwin Southern Calif., Inc.
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ciTv Encino, California No`" 986-889
CANSTRUCT N
�Fti�FA arwin Southern California. Inc.
ADDRESS Encino, California
AfiCHItECT Larwin TE�'273-4464
OF ENG�NEER NO.
aooaess 9100 Wilshire Blvd., Bev. Hills
CONTRACTOR Larwin Southern Calif., Inc.
ADDRESS 16255 Ventura Boulevard
TEL.
ciTv Encino, California No.986-8890
LIC. No. 191311 LICVNO. �1
512E NO.OF BLDGS.
OF LOT NOW ON LOT
USE OF
EXISfING BLDG.
SIZE OF NO. OF
NEWBL�G. �9H7 RpOMS STORIES 1
EXTERIOR WALL ROOF
COVERING StllCCD COVERING O700d shingle
USE OF BUILDING ANO WOFK TO BE PERFOflMED
residettce with garage
I hereby acknowledge that I have reatl this epplication antl state
Shet tha abova information is correct antl aBree to comply with
ell lews ragulatinq builtling construction, antl I shall not employ
aay person in vblatioa of ihe workman 5 compflnsatba laws of
the State of California.
I hereby certify that I am propeily iicensetl as a contractor ondar
the State of California Business antl Protessions Cotle, Divfsicn 3,
Chepter 9, and that such licansas are in full torce and effect, or I
am exempt from the prqyi3� s of the State of Calitornla 'ness
antl Professions Cotle, �v'4io 3, ChaP �.
SlBnatura of `�
Permltte¢
SC 12
Authorizatl AOent
PAt.i ;r:Y:Y / i
�i�l 17-7����1�.001614 �� 19�.5�
APPLICATION FOR BUILDING PERMIT
BUILDING n
ADDRESS y�
TRACT
FIRE
ZONE
APPROVED
-%� � iy,
PERMI,
a /e,s
LOT BLOCK
}, c�. , zN�
VALUE
20NE NO.OF USE OF NEW
�� PlANS z eUIIDING �
�ARDSAPPflOVED VARDSAPI
MAIN BUILDING ACCESSORV
(FROM GL STREET) C /�
FF(lNT �.'�l CT [ HLC9i/E/E
BET
#
THEAMOUNT
THE PURPOSE C
VALUATION
'�+�J11 LY�r �O
BET. MAIN &
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r ��ry�R i,atcwur sw2�xrr cALIF. �n�E 7-17-74
ji JOB ADDRESS 935 �$lea Ave. BUILDING PERMIT N0.
Y GENERAL CONTRACTOR DESCRIPTION �f W(IRK es.w a , ar.
.
n_
smi
GAS
PROP. SWR. L�NE �' HOUSE CON.
SPRINK�ING 5�STEM
MISCELLANEOUS
ROUGN HEATING ANO AIR CONDITI
UN�ERGROUNO U POWER
ROI/GH WIRING
STEEL REINF.
STEEL REINFORCE
FRAME AN� FLASMING
LpTHING - IN OUT
PLASTER, BROWN COAT
TURAL, FINAL
H, .ING, VENT., REFRIG.
PWMBING, FINAL ANO GA'_
ELECTRIC, FINAL
BUIl01NG, FINAL
FI
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. 80X 1200 COSTA MESA, CALIfORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING a35 �zA�eia D�2•
ADDRESS
OWNER G�J'Ft(a�, �E- L/�- 7bt�\��,
MAIL cy35 /-���e.� a�,
ADORESS
TEL.
cirvCosiA h�SA No.545-73
CONSTFUCiION
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BRANCH
ADOFE55
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CONTRACTOR /—`NT��•o r�`"� DV O� S
ADDRESS �1�<<�• Cn�N
CITV �^IV �US 1�"'
STATE
LI4 NO. IGjU� 1�
SIZE
OF LOT
USE OF
r PF"'OQ 773�k �`�:t:r3b.50
" T 20-75�M�
FOR STRUCTURAL PERMIT
v — �_
A.P. No. yiz — 2�3 ^ 06 ERMIT NO�
BUILDING ��� � Zq C�•q �
AODRESS
TqACT /J� / LOT 10 J� BLOCK
NEW A R P
�
OWNER G�G1461= � G L�' I OI�
��<F SP�+ �A��$ �Goc
FIRE
DATE
ZONE p NO.OF USE OF NEW
NOL��S�U� /� I P�� � BUILDING
CITV �AFDSAPPROVED VARDSAI
LIC. NO. MAIN BUILDING ACCESSOR'
NO.OFBLDGS. (FPOMC/LSTREET) �O-
NOW ON LOT FRONT FT.
Separate permits are required for
electric, plumbing and heating work.
UILDING AND WORI� T E,.REPFOR�
I hereby acknOwledAe thet I heve reetl this appllcation and state
that the ebove Informatlon is correct antl aB�ee to eomply with
all laws ragulating building construction, entl I shell not employ
any person in violatlon of iha workman's compensation laws of
the Stata ot Celifornle.
I hereby cartify that I am proparly licensetl as a contrector untlar
ihe S<ete of Californfe Business and Professions Code, Division 3,
Chapter 9, antl thet such Ilcenses are In full forca end effect, or I
am enempt from the provisions of the Steta of Ilfornia Buslness
end Professione Cotle, Oivis)ion 3, Chapier 9.
SIB�atureof / ���
Permittee
Authorized Agent .
DISTANCE BET
MAIN BLD(iS,
VAR. #•
�APPROVEDC
THE AMO
THE PURP(
VALUATION
FT, � I
GS.
�ZD
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n
m
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m
N
�ATION IS FOR m
MIT FEE QNLV: _
PERMIT FEE 5
PLAN CHECK $
TAX E
TOTALPAID $
0
LL
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OWNER �
JOB ADDRESS
S� �°NERAL C0�
do. 1F12-e
INSPECTIONS
Pool Location .
Forms
Main Drain _ _
Steel Reinforce
Elec. Bond _
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines _
Backwash Lines and Recep.
Electrical Final
' �er and Vent Final _
Fucer System Final
Backwash and Recep. Final
Fonrinn Finnl
Drive
T
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F
DATE
BUILI
SUBCONTRACTOR
Electric
Plumbing
,�
CIi JF COSTA MESA REQUEST FOR OCCL .JCY
TRACT N0. r�✓ �
IAT N0.
ADDRESS ��� l�d��i
DATE � ✓ V'���
The developer of the above entitled tract desizes to sell the above set
forth lot prior to the time that the tract has been completed and its streeta
accepted by the City of Costa Mesa.
The undersigned, by executing thia agreement. acknowledges that
(he-ehe-they)_��2�iwas or were) L(�-�E� • advised that this tract has
not been given final inspection nor has it been accepted by the City of Coeta Mesa
ae having complied with the conditions of approval which were imposed by the City
at [he time the final tract map�was approved.
The City assimmes na liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to'indemnify and hold the City harmless from
any claim resulting in damage or pereonal injury to the undersigned by reason
of the aforanentioned uncompleted condition.
, BY /V'^„"ii` ' � /v+ �4�""'`
rchas
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` sx /,t:�.LC?�-[:c:l= .L'1lL�c ,-2�`�-���
Developer and or authorized
representacive
BY � r
_ d..GG.�(�` �L lc��-2..
Lender
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