HomeMy WebLinkAbout258 SHERWOOD ST - Building Permits Iicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
QTY OF COSTA MESA CONSTRUCTION PE I PERMIT NO. TRACT NO. LOT NO. UNIT NO. - 4708 12/28/64 '�•;de('j� V
a 5 51�eewfan(� S"\- , —�' 7'LS ,
•
•Project AddressLI I
Aptplicant3UslailinQAddress - - TYPE OF CONSTRUCTION' NEW U ADD LI ALTERATION LI REPAIR - Al''
` P_` ! 'q^ r e--r.G�6�s ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Zone
Owner's Name O P1'�'d0 rlRett glt)Phone 7Y0- `�+ DESCRIPTION OF WORK/USE OF BLDG. L.0M`P-Skit Eao IML •
Address . MC-- S Main Building: Accessory Building: - -
•( Arch/Eng. ' License No. • TYPE OF PERMIT ❑ GRADING LI FOUNDATION ❑ STRUCTURAL E Front -- Z
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Address �' 1l (�� �s (� , ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name 7f. �e4.4 Pell — Phon$crh9/S rI ❑ 'OTHER A - I
V) -��/� PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right _ . N
Address(mailing) - 3 �_=v �Q()�(��� w�� '
1 p CONSTRUCTION TYPE VALUATION$ S Left, R
(t„ City License No. ACTOR Seo ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided - E
-'J LICENSED CONTRACTOR DECLARATION - _
Thereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /l ^7 Q C� PlanningNotes: I Q
\ With section 7000) of Division 3 of the Business and Professions Code,
and P/{ /� <J T� M
my license is in full force and effect. '/r y9O 7 . ' s
I License Class t�—( License No. _
bate I 272-2 Signature Ca.-Ca.'K:.edA�r�/�— • PLUMBING FEES
l- \ WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Secti nBackflow Preventer Service Sink - '- -
3800, Lab. C.) ' - ' Automatic Washer Transformer 0 15-50 KW
Policy No Wog--00-;9,342' Company rteetvniriS Backflow Irrigation Sewer Cap ,
Construction Pole Sub. 050+KW •
_,Swertified copy is hereby furnished.
Certified copy is filed with the l vision. Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
Date APPI rM d L'
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers i 01,.. Solar Collectors 6 Dishwasher 4 Meter Dover 100 amps
(This section need not be completed if the permit is fon one hundred($100)or q - - _ ' '-
less). Dishwasher ' / Solar Piping r7...-- Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I '
shall.not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan '
Workers' Com pensation'LaWs of California. Motors 0.1 HP ❑1 4-B l
. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. - •
NOTICE:If,after making this declaration, you should become subject to the Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - - - Fixtures
comply with such provisions or this permit shall be deemed revoked. • Microwave
CONSTRUCTION LENDING AGENCY • - Gas Service Outlets• Water Closet Device Boxes • Pole Light
•
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors •
Water Heater Outlets
Lender's Name - _ - - Range
Lender's Address • Kitchen Sink - . Water Service '
OWNER BUILDER DECLARATION - • - Switches Sign ,
I hereby affirm that I am exempt from the Contractor's License Law for the ' Lavatories - ' Auto-WashGarbo a Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or i g P oral
;Standing Sections
•
county which requires a permit to construct,alter,improve,demolish or repair P—Trap • LaundryTra s '
any structure, prior to its issuance, also requires the applicant for such permit Y Generator 005 KW 05-15 KW Trash Compactor
to file assigned statement that he/she is licensed pursuant to the provisions of - Roof.Drains -
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of -
•Division 3 of the Business and Professions Code) or that he/she is exempt - •
therefrom and the basis foe the alleged exemption. Any violation of Section - . '
7031.5 by any- applicant for a permit subjects the applicant to a civil •l • '
enalty of not more than five hundred dollars($500)..
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee ' $ 3 • •
compensation, will do the work,and the structure Is not intended or offered -
for sale (Section 7044, Rosiness and Professional Code: The Contractor's MECHANICAL Reinspection Fee ! $15 Issue Fee $ 3
• FEES
' License Law does not apply to an•owner of a property who builds or Improves
thereon, and'who:does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 ZoningApproved
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 pP By Date
' pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By .,` Date
prove for the purpose of sale). r/� m /[/
❑ I, as'owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By rt.../• / Date AA- ;4 16
' tracors to construct the project (Section 7044,Business and Professions Code: '
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU ,
builds or improves,thereon.-and•who contracts for such projects with a con- - SUMMARY OF FEES ,
tractor(s) license pursuant-to the Contractor's License Law). am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration - BUILDING PERMIT $ $MIP• $
' proof oftheir Worker's Compensation insurance should be provided to me.'- CHECK $
• ❑ I am exempt under Section B.&P.C.for this reason Firepi/Fact.BIt, ICBG# Fire Dampers PL PLUMBINGAN C $ /' 0 ei PERMIT
ISSUANCE ' $
•
Date Owner' • Heating'System& Ducting Registers yy ENERGY $
PLAN CHECK 25% $ P.C.T r O 1
i I hereby certify_that-1'have read this application and state that the above - ❑0.100,000 BTU 0100,000 BT - GRADING $
information is correct. I agree to comply with all city and county ordinances _ ELECTRICAL $
and'state laws relating to building construction,and hereby authorize repre- MICROFILM $ •
sentatives of this'city to enter upon the above-mentioned property for PLAN CHECK 50% $
inspection_.„+,,,g4. - TOTAL FEE $ p
•
Sig ectI0 all, ��b• i Date 12,27 '.ct • MECHANICAL $ 3,oa
Drivers' License or 55 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25%
CMF 0865-46,rev.10/84 White - Building; Canary Applicant; Pink -Accounting; Goldenrod -Assessor
4 i
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CONSTRUCTION AND PLANNING . •• - POOL& SPA
fi Date - Inspector Date Inspector
APP• ROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location. ' - .
•
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. ' - 54. Forms
4.,Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding -
5. Steel Reinforcement - - 56. Rough Plumbing'& Pressure Test
-6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd.
. 8. Foundation - • . 59. Gas Pipe, ❑ Undrgrnd.,Test .
^9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd.
1610. Structural Floor System
1
. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
2. Sewer Cap 63. Heater & Vent-Final -
3. Roof Drains • 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final. ..
16. Rough Electric Wiring - 67. Fencing & Access Approval •
'
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING
' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19..Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Duds,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 PREY. 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. Final Plumbing •
39. Water Service-Final -
40. Gas Service-Final • ,.,/
41. Solar Domestic-Final . - Q/pts G� ..
42. Backflow Preventer. , (�['
43. Backflow Irrigation - - -
44. Landscape Irrigation System '
45. Sound. Attenuation
46. Handicap.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 •. ' . _
}T.I. - Date^ • . ,
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- • - — _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
PERMIT NO. ` ^ TRACT NO. LOT NO. UNIT NO.
ICITv OF COSTA MEA �1CONSTRUCTION PERMIT b /S A.P.# - Zone
oo{?et-Address `?,P J t�woo D S Tr _
R 1 0 6J/ S'7 / S4�Ta f &A. TYPE OF CONSTRUCTION U NEW LI ADD LI ALTERATION REPAIR S Main Building: AccessoryA. TYPE O•
i.cant's Mallin Address t t E Front Z
Owner'd Nar•�e t 016 AT /- i glee G"Fl" `y1- f69a ❑ CONVERSION Ill DEMOLISH ❑ OT • T O
� r• Phone• / DESCRIPTI OF WORK/USE OF BLDG :r (�lL �� 4 B Rear N
Address eLLC3NcteLroot _iCOCrnflle'SA_.. g/Tf O a.-'NAwe-CC C�tiehe fT/n•C.- . A . - - I
Arch/Eng. License No. TYPE OF PERMIT El GRADING El FOUNDATION U STRUCTURAL C
Right •
G
Address h e ❑ TENANT ��'Iy'''�'_ECT ICAL ❑ PLUMBING ❑ MECHANICAL S • Left R
Contractor's Nam �� ,rsrt'1 1 *-S C Q0PI"St' Phone S�)99/ ' ❑ OTHER (GC 06 C e Ping. Ref.# Parking Req./Provided IE
PROJECT DESCRIPTION SQ. FT. S 0 O OCCUPAYQ
Address
cens(mailing/ O• iEX �7 A VP��� •A l.,,'Q ' Planning Notes: M
3 a y/ CONSTRUCTION TYPE VALUATION$ .17t--4---- T
City License No. O A? ZONE _ GRADING CU-YDS. ACRES
LICENSED CONTRACTOR DECLARATION S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in f or , effect. ELECTRICAL FEES
i
Lice x-4,la icons. oh' S - Q
• RSignature _a�' i �� PLUMBING I FEES Automatic Washer Transformer ❑ 15-50 KW
i"a-
Date
WORKERS'COMPENSATION D- • RATION Sink Showers • Construction Pole Sub. ❑ 50+KW
I hereby affirm that I have a certificate of consent to self-Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.)
Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
8 Certified copy is hereby furnished. Dryers ❑Gas ❑EI¢Ctflp Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors _ Fan Motors 00-1 HP 01%-8
(This section need not be completed If the permit is for one hundred ($100)or Dishwasher F.A.U. Inc.Solar 09-15 HP 016-15+
less). Solar Piping
I certify that in the performance of the work for which thl permit Is issued, I Fixtures
shall not employ any person in any man r so as t be esu ct to the Drinking Fountains Solar Tank Microwave'
Work Consa(fr Laws of Cali /y
Date �gP�
se -OQ Signature �q Floor Drains Swimming Pool w/Spa Device Bgzes Pole Light
NOT CE: If,after making this declaration,you s o d ec e subject to the Outlets Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range
comply with such provisions or this permit shall be deemed revoked-
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet • Switches -'-H - Sign - 2¢
I hereby affirm that there is a construction lending agency for the performance Garbage Disposal of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater 9 p Standing Sections •
Lender's Name _ .
Lender's Address • Kitchen Sink Water Service , - t^ Generator 00-5 KW 05-15 KW - Trash Compactor •
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • - -
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Treys- t - s i, --
any structure, prior to Its issuance, also requires the applicant for such permit -: '
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of ^
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee
$ 3
therefrom and the basis for the alleged exemption. Any violation of Section -
7031.5 by any applicant for a permit subjects the applicant to a civil ..
enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
LI I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 35 '
compensation, will do the work,and the structure is not intended or offered _ Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved ByDate_
License Law does not apply to an owner of a property who builds or improves o- _ __thereon,
__ _.._ a�
thereon, and who does such work himself/herself or through his or her own Application Issued By nate • C
Adr
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ SUMVY OF FEES
pletion, the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground a
prove for the purpose of sale). BUILDING PERMIT $ •00 SMTP $ .
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System _ PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100 000 BTU ❑100,000 BTU p UMBtNG $ ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con- ENERGY P.C. $
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System frepair/Alteration P N CHECK 25% $
proof o/ their Worker's Compensation insurance should be provided to me. 1. • EL CTRICAL $ GRADING $
o I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers • • MICROFILM $
Date Owner Heating System& Ducting Registers EXP RED PLAN CHECK 50% $
•I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BT li1CU1111JIt: ��tiaFS MECHANICAL $ TOTAL FEE $ l0 IS D
information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws rel ing gto II mg construction,and hereby authorize repre-
sentatives of t ci to r upon e above-mentioned propertyri. Sig _�_s�--
inspection ses /Jj,^1.4 (]ate `
Signatur •
Reinspection Fee $15 Issue Fee $ 3 01 00015587-00015588 Tp T 63.50
0865.46,rev. 5/88 White - Building; Canary - Applicant: Pink - Accounting:Goldenrod - Assessor DATE: 09/28/88 T1fJE: 10.02
t
L,G_NSTRUCTION AND PLANNING POOL & SPA •
tPROVALS
Permit .,'? Date Inspector Date Inspector
.Y t, APPROVALS Permit#
1. Temporary Electrical Service or Pole r, 52. Pool & Equipment Location
2. Soil Pipg-Undrgrnd. 53. St el Reinforcement / f
3. electrical Conduit Utility-Undrgrnd. 54. Forms -.
{ 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Rejnforcement. • 56. Rough Plumbing & Pressure Test 7
6: Electrical UFER'Grnd. • 1 57. APPROVAL TO COVER-GUNITE
7.;Footings I -• • ,X58. Electrical Conduit-Undrgrnd.
I.) 8.-Foundation ;! (/ 59. Gas Pipe, 0 Undrgrnd.,Test
9; Water Pipe-Undrgr d. 9 � 60. Backwash Lines,P-Trap, 0 Undrgrnd. 5.. 1
•
10. Structural Floor System 61. APPROVAL TO DECK •,t
11. Property Sewer Line & House Connection i 4-- 62. Backwash,& Receptor-Final
12. Sewer Cap •
;• . , r. 63. Heater & Vent-Final ' *= •
-
i
13. Roof'Drains • : 64. Plumbing System - Final , •
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit t 66. Solar System-Final •
.16: Rough Electric Wiring 67. Fencing & Access Approval
u "
1.7•. Rough Wiring Sign 68. . ,P:ROVED FOR PLASTERING
,T8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS.FINAL
:19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
•1 `20. RoughFactory-Fireplace APPROVALS, Permit#
_ t
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23.•Gas Pipel-Rough'& Test 72. Underground Flush
- I 24. Roof Framing 'v I -73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemi,cal
27. Frame'arid Flashing 76. Dry Stand• pipe
,. m
28. Lathing,& Siding 77. FIXED SYSTEM FINAL .t+ ..
.1
29. Insulation 78. FIRE PREV. FINAL
•
. 30. Drywall Nailing I HEALTH DEPT. REQUIREMENT .^
31. ,Plaster Brown Coat- 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric 5 Notes:
? 34. Final Heating & Air Conditioning s'/1 •
. 35. Final Gas Pipe-Test e
.1: 36. Hood or Canopy / -'
37. Final Factory Fireplace ' I. • e 1
' 38. Final Plumbing
39. Water Service-Final t
I _
•
40. Gas Service-Final
a.
41. Solar Domestic-Final e• ..
.} 42. Backflow Preventer . .-4`
43.-Baclflow Irrigation :.` -,
EXPIRED
44. Landscape Irrigation System • loco ple'te Inspections
45. Sound Attenuation �'9Ss g-i..-
46. Handicap Regulations • pa1e ` s
i
147. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed '
49. Electric Release to Edison . . _ - -i
50. Gas Release to Southern California Gas Co ,1 ''
51. CERTIFICATE OF OCCUPANCY _ ' r
No. Date -1?. ,
UWNtK i''1NItUJAN, Hobert & .loan UAIt .$-1S !.i
' JOB ADDRESS 258 Sherwood Street BUILDING PERMIT NO. 36214
- I GENERAL CONTRACTOR Owner-bldr. DESCRIPTION of WORK Patio Cover
AP No. 118-143-15 LOT 10 TRACT 3289 FIRE ZONE VALUES 1,200.00
INSPECTIONS Signature Date GROUP J TYPE V ZONE R1
ev,sott_ SUBCONTRACTOR PERMITS ISSI4ED
GAS Date Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent.
TRENCHES CK FORMS T6 STEEL REINF. 9 of-lite -it;73
FLOOR SYSTEM tt��
BOND BEAM n yTEEL REINFORCE n
SHEATHING
. FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
STRUCTURAL. FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL �p`_
BUILDING, FINAL " J7,4SC Y Gc73
PAU/ 0 435" ***,:18.50
-"4- "A9 13-73(7 o
I 3(? 14
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A LI A ON FOR BUILDING PERMIT
For Applicant to Fill in Completely
y/��/ ¢ REC V DATE RECEIVED DATE ISSUED
BUILDINGADDRESS ape i'F1'wry,.t.✓ Afs.-1 � 3 _�3^� 3�I -�
�yD^ A.P. NO. Of—/43-/s I PERMIT NO.
OWNER ' P A.d..-1* /(/'JI.'�,s_-'A MAILV LL -/}�' ADDRESS 5$ SA endow/ 54 •
Z ADDRESS �,.r,Th?Q(p d,uJ-p�s,.Q AQ(lt ^^JJ�•�QQp
0_U CITY �t, Gt✓ ND. Stalls(;Ill La TEL.
TRACT .bLO7 I LOT/U BLOCK
Z Q CONSTRUCTION NEW ADD ALTER REPAIR (MOVING OFMOI ISH
O u LENDER )%
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JV) BRANCH e // V J n F'
J N OWNER /`G OU /h n�4rl�
c0 W ADDRESS .�•//7t tf
mm ARCHITECT TEL. USE r/>-///7 �VE�VALU$ /�/J�
J< OR ENGINEER NO. /�M1�
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Q FIRE
w< ADDRESS ZONE E GROUPAPPROVED4/4L
CONTRACTORBV DAT ��
02 /
J 2 ADDRESS01 L0 yJ /
0= CITY NO. ZONE L/ (PLANS NO.OF�, BUILDING 4.USE OF NEW h0 6j�r/r-
TEL.
2f
-O STATE CITY YARDS APPROVED YARDS APPROVED
N X LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
DO SIZE rNO.OF BLDGS. (FROM F_.//L''S``TRE''ET)''
OF LOT NOW ON LOT FRONTG(�acrAteC' tet/ FT.
USE OF
EXISTING BLDG. R.SIPE FT. FT.
I- SIZE OF 9//�� ,ty� �.�J`�,Q yJ
Z NEW BLDG.�`v X(J /�LLGRptd �� STORIES L.SIDE 3 i FT. + FT.
La.1 EXTERIOR WALL / ROOF
_ COVERING COVERING REAR 56 FT.4- _ FT.
J US OF B ILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a y /�
CL �j, . /3u ) `�lp� /I Q Ai p� MAIN BLOCS. ACCESS. BLOCS.
Q / VAR.# DATE
0
C.U.P.# APPROVED
I— APPROVED •�
C/3 RY /a Lp (�f l=, _DATE 33//
Z
O atr 6
UI hereby acknowledge that I have read this application and state /
r that the above information is correct and agree to comply with
cc all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of SSG
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•
V) the State of California. m
%yam
le
Z I hereby certify that I am properly licensed asa contractor under SQ. FT. o
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
rc
em exempt from the provisions of the State of California Business
and Professions a,Di VALUATION
Division 3,Chapt r 9. // m
_ GvV PERMIT FEE Cl$
Signature of ` \ Li �� m
Permittee - ti vv I $f`i� PLAN CHECK 6 E
Authorized A:'nt /L'Z/ �� o
u.
... TOTAL FEE $/
.
1C--) 144-41 %) 1l co- Ay :. k
COSTA MESA BUILDING-SAFETY DEPARTMENT FI\!'(I"C,:. ..:EPI.
P. O. BOX 917 COSTA MESA. CALIFORNIA \'
CITY JF 1,JStt; 1.-i-5r,
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE ORff// P�RIN'T.p (� BUILDING
BUILDING ADDRESS !�1) ��C/�L%\,{{.IA r'(V
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. PERMIT NO.
OWNER ?oLC.e.seicke:r 11o'..es Z..c..- /5(ci V/
MAIL 'i RECEI�FD BY DA RECEIVED DAT,Bu,l81Ug 19 i�
ADDRESS 1bOO w• Gawk P[w.l- il! t!c-b/I M T
QQ TEL. 1 BUILDING
CITY �.�7. NO.M►iE1 b55 ADDRESS
ARCHITECT TEL. ` COSTA MESA. CALIFORNIA
OR ENGINEER SO\V'/.e_ NO.
FIRE
ADDRESS .�� - ZONE TYPE GROLJ7-
CONTRACTOR OW Wt.,' - .411:" -Y AP -9 i-I I DATE 5 I 6 /
ADDRESS ZONING
_ -J I vvu+s7 I �a �Ho a ��I Q�'
CITY
STATE TEL. ... LEGAL yI
LIC.NO. NO. DESCRIPTION I 5-1-11,5-1-11, ��/, L /0
OF Sox �5O ra`. I NO. OP SLOG .NOW ON LOTS Q A.P.NO.
OF LOT
USE OF YARDS EVES
EXISTING BLDG, APPROVED ALLOWED
SETBACK LINE FROM \ / \ (CENTER LINE ST.)
CENTER OP STREET 55REAR YARD OtaFRONT 6..CPT. IN.
SIDE YARD I LEFT 51 I RIGHT 5' R.SIDE ,��FT. IN.
DESCRIPTION OF WORK c FT. IN.
L.SIDE
NEW I 5( II ALTERATION I II ADDITION I REAR /'{� 1111
f,1 FT. C �/�I/N.
REPAIR I MOVING I II DEMOLISH I ABBYPROVE A DATE PA- 4/
BUILDING '` NO. OF �'( I�
SIZE 1990 g,u j.} ROOMS / STORIES L
EXTERIOR WALL _''V'"� ROOF �.9MAkB. t �.
COVERING ,�.wA,Ea I COVERING `rl��ylq,P,. ..---
_
� R --/f194:1
d
USE OF BUILDING AND WORK TO BE PERFORMED J /��V/�/�y! _/7y'13?
y,'
S\t..q>e. tA.Aw1\I ItS�CNGe. A VO.✓bQ42__ 0.�0.LnteE.
aura e_ — Mod.e.1 2D 440 ss. CA.
I HERESY ACKNOWLED E THAT I HAVE R THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE OV IS CORRECT AND AGREE TO COM-
PLY WITH ALL CITY/0 IN ES AND ST WS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
C
BUILDING CONSTRUCT( N. VALUATION
SIGNATURE OF j iC�(7" • �/ PERMIT FEE $ L3?"--I N
PERMITTEF l /
3-020
�j B
$ J PLAN CHECK $ / / 57. 46
AUTHORIZED AGE K
TOTAL FEE $ .t+Le'u