Loading...
HomeMy WebLinkAbout284 ROSE LN - Building Permits ~n:L'r. CITY OF COSTA MESA 4! BUILDING DIVISION F ,) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 'i PERMIT J 4. E05-00613 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 284 ROSE LN Status: ISSUED Suite No Applied: 06/20/2005 Vicinity: KITCHEN Issued: 06/20/2005 Parcel Nunmber: 42615212 Applicant: JOE SEPIAN ISSUED BY: Address: 5710 KEARNY VILLA RD SUITE 204 Phone: 800-797-8677 SAN DIEGO,CA Zip 92123 Owner: OLSON, TIMOTHY LEROY 4 ��� Address 284 ROSE LN Vo$0 i ,0 f Phone: .,C ' COSTA MESA,CA Zip: 92627 ON • Contractor: CITYWIDE ELECTRIC Address: 5710 KEARNY VILLA RD • SUITE 204 - Phone: 800-797-8677 SAN DIEGO,CA Zip: 92123 License:751371 SCOPE OF PERMIT ELECTRICAL WORK TO INCLUDE:REPLACE 12 LIGHT FIXTURES,6 OUTLETS AND 4 SWITCHES LOCATED IN THE KITCHEN. REF.:E05-00526 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 • Res.a/c package $0.00 - Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0up to 10 kva/kw $0.00 0 Lighting Fixts $13.20 12 up to 50 kva/kw $0.00 0 Recept Outlets $6.60 _ 6 up to 100 kva/kw $0.00 0 Switches $4.40 4 over 100 kva/kw $0.00 0 Non Res Appl $0.00 ' . 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 • 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 , 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 . 0- Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 . 0 - Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 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,§1, 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 order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ©:;. ave and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. y workers'compensation Insurani/carder and policy number are: scare- S �Tf FLe.�U �'PPbIiccy,Number: 00/0 48-1 — a-ooS ection need not be completed It the permit is valued at one hundred dollars(Sr'00)or less.) l'i"'^ ❑ 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provislo s. .� ••'.: Signature: `ACacLI —E / Dere: ,Yo6/Jct /off us.�*c'. •O i ItTARE( SECURE WORKERS'COMPENSATION COV E IS'ONLAWMC AND SHALL SUBJECT I AN SECTION 0 THE AB PENALTIES AND CIVIL FINES OTO ONE HUNDRED �.USAND DOLLARS IS I00,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Divisionthe.Busine s and Professions Code,and my license is In full orae sniet(eet`;Llc.s 7 ( Cla'ar• &5 t' ( 0 'tractors gnaturer"-t".....R J• O• Oate'�-�- 6 / ' _{ . aa.. .. CONSTRUCTION LENDING AGENCY: • ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMslon 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers Ucense No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dlsmantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous ' material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ _... _ _... ... 2 Does or will the applicant or presentntoor future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP H presently required,has Section 25534 of the California Health and Safety Cale been fully complied with? 0 Yes ❑No 5 Does or well the applicant or present or future building occupant require for the work which is the subject of this application appernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). Management _ 7 application,If a permit from the South Coast Air Quality ed by CaliforniaHealthral or and Sr airtpollution control district03beenor agency is required for the work which is the subject of this have all of the disclosures prescribed by Celifoia Safety Code Section 42303 maria? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with at state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signature Of Legal Owne ) Date ,z76 // J . � acyr.agof eAutiforized'A - c r "Date pre..., CODE f j$spECOON TYPE PAIL Int_v'� PQDFE INSPECTION ME PATE SIMS 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing a . 200 Final Re-Roof 210 Final Electrical s 6 - !!I 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ..---i• -1. • CITY OF COSTA MESA . <•� �� BUILDING DIVISION °0� PER NUMBER Fi ^ , DEVELOPMENT SERVICES DEPARTMENT PERMIT E05-00526 (714)754-5273 •'Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIRDRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 284 ROSE LN Status: ISSUED • Suite No Applied: 06/01/2005 Vicinity: REAR YARD Issued: 06/01/2005 Parcel Nunmber: 42615212 �� Applicant: OLSON, TIMOTHY LEROY - . ISSUED BY: '"'"f"CD Address: 284 ROSE LN , - _ Phone: , COSTA MESA;CA ( ; Zip 92627 Owner: _OLSON,_TIMOTHYLEROY , Address 284 ROSE LN .,�S .- _ moi , Phone: A . COSTA MESA,CA Zip: 92627 . Contractor: OWNER-BUILDER Address: ' ,. , • r' : 'f 'Phone: _ - - - - ' Zip: License:000000 ' SCOPE OF.PERMIT UPGRADE SERVICE PANEL TO 200AMP • ' - • -' . FEE SUMMARY • Quantity_ -, _ - ' _ Quantity ' 'ISSUE FEE $23.50 - ' - - _- .- Temp Dist System GLighting - $0.00 0 -r Temp service test $0.00 Busway/100 ft ' $0.00 0 Res.a/c package $0.00 Standing'Section $0.00 0 ., • New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 % • - ' New Res(3+units) $0.00 0 Transformers up to1 kva/kw $0.00 - 0 , - Pool/Spa, - $0.00 0 - - - - up to 10 kva/kw Lighting Fixts $0.00 0 " ' up to 50 kva/kw $0.00 " '0 Recept Outlets $0.00 0 - - up to.100 kva/kw $0.00 . 0 Switches $0.00 0 oveu100 kva/kw.. $0.00 / 0 , Non Res Appl '. $0,00:- 'L- . '0' Low Voltage Equipment ..,:,7F.:$0:00 0• Res Appl mob' <. ` o _ Low Volt Wiring System/Ckt,'_$0:00 0 Service to 200a, $30.50' -� 1 _ Misc:Conduit ___:-.21,/$0.00- .0 Service to 1000a $0.00 0 - Misc.Conductor ' -. ' $0.00 , �'0 Service over 1000a $0.00 . 0 Circus(gen or ride) i .$0.00 0- • • Motors to 1 h $0.00 ; '• 0 Circus meth ride or lights) P ( -, i. - $0.00 :0 Motors to 10hp $0.00 0 Christmas Tree Stand. . `, $0.00, .- . 0- ' Motors to 50hp $0.00 0- Fireworks Stand . " -` $0.00' - 0 Motors to 100hp $0.00 - " 0 , 'Other Electrical Fee .-$0.00 Motors over 100hp $0.00 . 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee. -. $0.00 Pole Light Pkg $0.00 0 - Reinspection Fee - $0.00 Sign Circuits $0.00 0 - Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 • NOTICE: The work authorized by this permit shall-comply with all applicable handicap access requirements under.California statutes and related regulations.(Ord.No.92-28,1 1,12.21-92) 'EXPIRATION:-This permit shall automatically expire and become void if work is notcommenced within:180 days,or if work is suspended or abandoned ' fora period of180 days. -INSPECTIONS: In order for the work authorized under this permit to be considered legal,•such.worlcmust-comply with'all:applicable codes, and all . -required Inspections and final.approval must be obtained:Failure to obtain inspections and final approval-will result in the expiration of this permit. !, FOR INSPECTIONS-CALL: (714)7545626 .2446446(WOO) DECLARATIONS c•• WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations:' ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: / , • , Carrier: • Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) O Itertify 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 workers' compensation laws of California,an ee that If I sh9uId become subject to the workers'compensation provisions of Section 3700 of the.15-- WARNING: Code,I shall forthwith Ccomply with these.provisions. �� O� i — 0 1 5 Applicant Signature:•" � :��O(/�// Dete:---•-n WARNING:FAILURE TO SECURE WO E MPENSATI VE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: . ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): _❑.~I as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt der sec. Business and Professions Code for this reason: .f �0/� Signature:- _ Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 Na (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). - 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification , from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all tate laws and cit dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propen s tion purpoy_ roe not to occupy or allow occupancy of any building authorized by Ihi�per^it until i_nalinspectio �nature.O1.L/g//QI s).'� /hob/(at (/hs� And/Or Authorized Applicant Date CODE 1 INSPECTION TYPE ' ' -' - PAIS INTITIAL$ SODE#' INSPECTION TYPE' ' ' . . PATE ItlIIDEL$ 1616 Fixed System Final Fire Prevention ' 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing —/�� 200 Final Re-RoofRia- ' . . 210 Final Electrical - „rs/ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place220 Final Planning Apprdval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy OWNER DIKE & COMMOVE / DATE 12-15-55 JOB ADDRESS 28b Rose Lane BUILDING PERMIT NO. 2165 GENERAL CONTRACTOR Dike & Coleerove VALUE $ 8,000.00 LOT 20 BLOCK TRACT 2562 RPSidel rp & Garacp • u.•OUP I & J TYPE V ZONE Rh FIRE DISTRICT 2188 • PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench 4-E /2-.28 Foundation Forms and Grade to Garage Rough Framing � :ad,-/ 6 2_a Plumbing,Rough to Slab ;I/I ,, ,,//��w��r/_j_ }, Plumbing,Rough Complete /Ll,(/� - Y - .-.4,-. ' -07dp, 71ce Temporary Pole Wiring, Rough /- 3/ -SIC, eteg,e-> -„•J /--.2.0-C.C. /Q// '�� b Heating,Rough �A Heating FI 01jil ....e.....e. -VI-Leask,- -.4.--....t /-y N(-. /c2- -r Veto/ Sewer, W. " "ii - Sewer,St. ANt.->inY a -a7 Q-cG _ Wog C 4 Septic Tank or Cesspool Lathing, In Out/ 8,,In 2„-V- I P Bring P. .gybing,Final,Fixtures Co . •tete nr - -4 - / S yy�' Plumbing,Final Gas Test/ + ee ' — T�' ArY , ��7 14//g Wiring,Final at -- 3 , _ Occupancy W .-,-$L tosta Mesa Building Department APPLICATION FOR PERMIT 111 EAST 211th STREET 2188 BUILDING I COSTA MESA, CALIFORNIA J FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN I Receipt No. I Permit No. Building n / é r 284. Rose Lane c Costa Mesa, California . �-er Received by Date Recd. Date Issued Nearest ( _1/47- /C -J /0f7 -iS --SS Cross St. 21st St. & Orange Ave. Building/ Address Owner Dike and Colegrove Costa Mesa, California Mail Address 419 E. 17th St. Nearest Tel. Cross St. City Costa Mesa No.Li. 8-1159 Zone No.of Type ,/ Group Architect or Lic. �V- I Plans! � -17`.1 Engineer Carlson & Middlebroctko. Approved ' by Date Address Garden Grove CORRECTIONS City Lic. tractor Dike & Colegrove No. 2707 Address 419 E. 17th St., Costa Mesa LegalLot I Description I No. 20 I Block I Tract 2562 (Attach Metes and Bounds) TO ))/ : \\ I \ I --'.`, No.of Bldgs. 1 r v �._. L_-; 1 ., Size of Lot 82.51 x 741.1 I Now on Lot none I , -/_ 0 Use of No.of ,I No.of 1 a; Existing Bldg. none I Families -4 Rooms 5—z Setback Line from Rear Yard 37.51 / DEG 1D ��00 2 Center of Street 501 Side Yard 8,1.1 -Is y DESCRIPTION OF WORK r ni nr nnt'rn nn�cn m • New I X I Alteration I I Addition I b11 1 VI VVV 11• III•s-v1 Repair I I Moving I I Demolish I Building No.of Size 981L so. ft. Rooms 50 Stories 1 ring Fr. Stucco I Covering Comp. — APPROVALS of New It ..,lding Single Family Residence & Garage FoForms,undationMateriLocation Inspector Date Under-Pinning Plan l'JR Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int with all City Ordinances and State Laws regulating building construction. Lath.Ext. Signature of Dike and Colegrove Permittee /1 g Plaster, Int. Lur Authorized Agt. d7 C. " Plaster,Ext. Valuation Permit Fee $ 0 O' 0-O Masonry Reinforced Plan Check$ JP 0-0 $ 8000.00 '' , Total Bond Beam Fee 0-0 FINAL PRAM 904 S-AP 91W RA5 411 c y • 0 ` a COSTA- PFC 15-55Pflaesr, ?21;a n..4-1*70 nri _ b • Street 1 11. PLOT PLAN Show location and distances from property line and between buildings. • .— r - _ _ a - v• ..+ •