HomeMy WebLinkAbout2192 RURAL PL - Building PermitsV ; :
CITY OF COSTA MESA
aF' BUILDING DIVISION
>`4 ,!' 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.0ov
F' '
'4. FOR INSPECTIONS CALL:(714)754-5626
b.•'00®rrt; PERMIT NUMBER: BC12-00496
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 02/01/2013
ISSUED BY: RMD
JOB ADDRESS: 2192 RURAL PL CM ' - Suite/Unit:
APN: 42612138 - Zoning: , ,
Vicinity: Primary Occ:
Const Type:V-B SQ. FT 366 Valuation: $33,818.40
SCOPE OF WORK:ADD 366 SF TO A 1 STORY SFD.WORK TO INCLUDE THE EXTENSION OF AN EXISTING BEDROOM AND
ADDITION OF BATHROOM WITH1 VENT FAN,.16 LIGHT FIXTS, 14 OUTLETS, 11 SWITCHES, 1 BATH TUB, GAS OUTLETS (1-4),
1 SHOWER, 2 WASH BASIN, 1 WATER CLOSET, 1 WATER HEATER, RELOCATE WATER MAIN VALVE, RELOCATE GAS
PIPING.
I
•
OWNER: SAFARIK,JEFFREY T Address:,--2192 RURAL PL Unit:,
Phone: 949-645-2250 City/State/Zip:" COSTA MESA,CA
APPLICANT: ANTIMIE, MIKE r Address: Unit::
Phone: 714-240-4890 City/State/Zip:
CONTRACTOR: ABG COSTRUCTION AND RESTORATION " - A . •
License No:704335
Phone: 714-240-4890 Address:2330•HARBORBLVD Unit:
Cell: City/State: COSTA MESA,,CAZipCode92626
ARCHITECT: HANNAH,SHAUN . ' - License No.C27959' PHONE:949-515-8692
ENGINEER: License No. - PHONE:
COMBINATION PERMIT FEE SUMMARY - -
Building Plan Check: -, .' , $313.72
Building Fees: '$482.65
Electrical Fees: - $68.60 - . , -
Mechanical Fees: • . $30.75
Plumbing Fees: • $108.05 .
SMIP Residential: $3.38
•
SMIP Commercial: x.$0.00 - . -
Bldg Std Admin Fund $2.00 .
TOTAL FEES: $1,009.15
--Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays:
New Years Day,Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE
INSPECTION
COD
INSPECTION TYPE
1616 N. Fixed System Final Fire Prevention DATE INTRD\LS 206E Final Mechanical ATED..2 p INnTIAet
1266 Pool Spa Final 208 Final Plumbing 7 TT � yp
200 Final Re-Roof 210 Final Electrical •
S.• / - -'A 3 7
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 S.
7 . 3 *4' ta.
i . 1t
WORKERS'COMPENSATION DECLARATICO Owner ID verified by dScense. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend, will be made in connection with work authorized
/(3 by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: �E '�„ or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need be be completed if the panni/is valued at one hundred dollars MOO)or less.) 2,Art 2,Sec.341,Title B,Califomia Administrative Code).
Policy Number: / 0tio /R(, -2-013
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety, as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of Califomia, and agree that if I should
become subject to :: work- compensation provisions of Section 3700 of Applicants Signature Date
the Labor Code�. fo r h comply with these provisions./
7—C---- /1/ 3 Division of Industrial Safety Permit Number:
Applicant's Signature Dat HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions,that a Business Plan be filed with the Costa Mesa Fire Department
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: volume of 55 gallons, or 200 cubic feet of compressed gas at standard
I hereby affirm that I am licensed under provisions of Chapter 9(commencing temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force'and
/effect. ' a registration form for acutely hazardous materials? 0 Yes ❑No
Lia# �� H Class# cetio 25533equ of the r tion iHealth and Safety Code, with some
�y 3 exceptions,requires registration with the Costa Mesa Fire Department a each
business which at any one time has on hand a quantity of acutely hazardous
contrac rs Sign arra :ate 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
CONSTRUCTION LENDING AGENCY: pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑Yes 0 No
Lender's Name: )
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
. OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
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 (Section 65850.2 of the California Government Code requires that the requested
Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business information be furnished on applications for non-residential building permits).
and Professions Code)or that he or she is exempt therefrom and the basis for 6. Will any part of the facility to be constructed under this permit be within
the alleged exemption.Any violation of Section 7031.5 by any applicant for a 1000 feet from the outer boundaries of a school? ❑Yes ❑No
permit subjects the applicant to a civil penalty of not more than five hundred (If"yes',the facility must meet the requirement of Sections 25534 and 42303
dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
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 8. (If"yes", attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). 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
❑ +.I am exempt under sec.
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
Business and Professions Code for this reason: inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature eget s) Date
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Signature Date r,ACNh Applicant Da •
3057-46(3/07) , I '
2( 4Z R, - t - P___
Sp�� /� ryes-� �j��, # 12_ l2-c°70gq(0 i �. iln': ..
L%A I W �i.i• tthn 6(7/13 --sip St. LUC# 818157 .4111
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CERTIFICATE OF INSULATION 1
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The undersigned certifies that ce 12..T Pt i ,,,i-E c 11 Fiberglass insulation has been installed in accordance with the s�
manufacturers recommended application of the product.
ONFACED KRAFT FOR FS•25 BLOWIRCWOOL R.VALUE TIIIt7c}IESS
Walls W 0 ❑ 0 0 R— 13 372_
Ceilings a 0 ❑ ❑ ❑ R-13 /
0 10
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Floors a- 0 ❑ ❑ ❑ Y.— (o' 1 Li a
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Title 24 - Caulking ®'"' o
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PO \ r\ , CDS a 1esa . co . �2-- � 2
Job Address City, State, Zip
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A I( 3 i/Yolliat °Lo°L n r n3- ! 1 - 201.3
Signature Title Date
Keep this certificate with your other valued papers. if you ever sell this property, this certificate should be passed on to-the
purchaser. T
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14. ' MF CITY OF COSTA MESA
44a9,
BUILDING DIVISION
f•.T-.- ,•• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1 'rte% • PERMIT
ar
�• B01-00841
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.causNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDIJob Address: 2192 RURAL PL Status: ISSUED
Suite: Applied: 06/06/2001
Vicinity: Issued: 06/06/2001
Parcel Number: 42612138 Zoning:
Applicant: COFFY,BRIAN ISSUED BY:
Address: 2428 NEWPORT BLVD#5
Phone: (949)722-8846
COSTA MESA,CA Zip: 92672
Owner: SAFARIK,JEFF
Address 2192 RURAL PL
Phone: 949-645-2250
COSTA MESA,CA Zip: 92627
Contractor: THE ROOFING SPECIALISTS
Address: 2428 NEWPORT BLVD#5
Phone: (949)722-8846
COSTA MESA,CA
Zip: 92672 License: 734068
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
T/O EXISTING BUR, INSTAL 2 30LB FELT AND 30 YEAR COMP.SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,305.00
Permit: $111.25 Claim Valuation: $4,305.00
SMIP Res: $0.50
SMIP Corn: $0.00 -
Other: $0.00
Inspection: $0.00
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Total: $111.75
•
PLANNING &ZONING
•
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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
2446-46(6/00)
•
DECLARATIONS f t
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 workecccrs' pen tion suran carrier and policy number are:
Carrie: r (t ( i J //" % Policy Number: -4 5-r O
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for ch this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cel mia,and agr a If I should become subject to the workers'comps ation provisions of Section 3700 of the Labor Code,I shall forthwith
ase pro . I s. 6 _ a J
p Ilcant Signature: .. •
`
W FAILURE T( SECURE WORKERS'CAM NS ST O COMPENSATION,
IS UN,DWFULAMAG AND SHALL IDED SUBJECT I AN SECTION
EMPLOY THE AL PENALTIES ANDADEN rUPO N ONE'SHUNDRED
THOUSAND DOLLARE R1oo,o001,IN ADIXiION T E COST OF COMPENSATION,DAM40E5 AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereb :• .t I am licensed under provisions of Chapter 9(commencing with Section 7000)of•ivision 3 of the Business and Professions Code,and my license is In full
I• : • • :'act.Lia `"r IG • Class# ----___S-35
Cont :ctor's Signet :. — _L. a' Date: (o- (y"O(
�-
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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,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.).
O 1,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 License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License 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 dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
O 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 ❑No
(Section 25505 of the Califomia 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 0 No
(Section 25533 of the Califomia 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 and 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 apermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Govemment 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? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Califomia Health and Safety Code Section 42303 been made? ❑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 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.
I azure Of Legal Owner(s) ate
6- 6-0
A 9r ALiFottzad App kart Date
CODE I INSPECTION E ( PEI INSTAL* CODE I. INSPECTION TYPE MI itrmAL4
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 6"rTb-r'4£ 210 Final Electrical
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
•
. .
COUNTY OF ORANGE .
BUILDING DEPT. Permit No 3 2 991
636 No. Broadway Application for Building Permit
Santa Ana, California
Phone: KI 2-6211 AND FOR A •
Certificate of Use and Occupancy
Date d -- g — c-S--7:72
1. OWNER'S NAME - —— er —r..--, PHONE:4,--.'''•••? i a_tj
MAILING ADDRESS 4/4-0"--r, 5 3 a CITY ."--'1.-fl-7--a--, 44e
NameC....azt-fremei- - • 4/ Name 24-0. ac-/ 047‘;4"Cd—V
(Ar-ch' ect or En neer) • (Contractor)
Address C- - .. -i Address
City --a`-'1--.4 --es---/ 214e
City
State State
Lic. No. Phone Lic. No. - Phone, / 2 a : j
. -
PROPOSED USE: _ _C -t.---ircs - g9 1441- 1 Grair .
2. JOB LOCATION a I c aish_cla S
(House No.) (Name of Street) (Town or School District)
3. LEGAL DESCRIPTION: Lot I 4:2 Block Tract / 5L-02-
(Metes and Bounds Description—Use reserse side of form)
4. CORNER LOT ( ) INTERIOR LOT ( /) THROUGH LOT ( ) SLOPE OF LOT ( 6.-I
-Ft•Jo 4 G ,,, go 'dm k..t-
5. SIZE OF BLDG.: 5.52k3..3...AREA• G• 3 LI SIZE OF LOT:0 3 — )(QC.....AREA: -262_0_,€2___
o- .6o ) 03
6. HEIGHT OF BLDG.- / i ' CEILING HEIGHT- g' / ,, NO. OF STORIES /
7. NO. FAMILIES . / Size of Smallest Bedroom- _of 0 Size of Kitchen: 70
8. EXTERIOR WALL CONSTRUCTION• -7,".tact0-2-4-&— INTERIOR WALL COVERING .
(Frame, Stucco, Etc.) (Plaster-Drywall, Etc.)
9. SETBACKS: Front Yard from Center Line of Street .c .. 1-67 '
•
Nearest Side Yard =-5 Rear Yard (546 Distance in Feet Between Bldgs. on Same Lot
W. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
.11. For (a) Footing: Width I 4 Depth in Ground I .2.- Width of Wall __C
Accessory
Bldgs. and
(b) Size of Scuds: -----------------------Spacing ../ 4 "CC Material of Floor
Similar
Structures:
(c) Size of Floor Joists: r:, / b Spacing ) 1:::, "CC .
(d) Size of Rafters: c2--Y-te Spacing _ .4,4 "CC
12. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, paint-
ing and sewage disposal $ 437,9-erftS2' 7.,—Ce:20, 010
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN
THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL
LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Plans Filed:., / 5-0 qtifwner
aa
/kiLez(o ) i itzeio
By•
(Authorized Agen
FOR DEPARTMENTAL USE ONLY
FEES: CHECKING BY
Bldg. Permit - $ / r 0-ro GROUP1 APPLICWON-.77_Th2, HEALTH
Plan Check - $ 3 -es-tr. TYPE ..____ FIRE
Total - - - $ 2.e,-/• On) DIST. " 21(e/ '7,;/
r sPpLEAcN AND:-/ ,..." MARSHAL
Receipt No. 4--.2....-Ir4-- MAP f_l_ , STATE
Paid to - SHEET NO 4
CORRE NS ") ENGINEER
Date i ..re VERIFIED CAL
Hr
PERMIT IS`l r pAily:DONO , Ail—, COUNTY EU LCV NO
li‘ISPI-OF4
DATE._ el/ .
..a)
- - , v -- DEPUTY
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5M-7-50
e4)
•
METES AND BOUNDS DESCRI6 iN: •
10. 20 3I0 4,0 5I0 610
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IOWNER HENDRTCKS, JAMES DATE 3_27-68
JOB ADDRESS 2192 Rural Place BUILDING PERMIT NO. 28342
sc\GENERAL CONTRACTOR Wayne Howard, Ulc. DESCRIPTION of WORK rInt.Alter.of res.
AP No.118-033-18 LOT 16 TRACT 1462 FIRE ZONE VALUE $ 3,500.00
INSPECTIONS Signature Date GROUP I TYPE V ZONE R-2
SOIL SUBCONTRACTOR PERMITS ISSUED
GAS Date Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER O �/�/�
ROUGH WIRING I1O5 4L7o'&a Heating and Vent.
TRENCHES 0 FORMS 0 STEEL REINF.
FLOOR SYSTEM
BOND BEAM E^I STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING / i �� �
LATHING - IN' OUT I,•t�1� L'
PLASTER, BROWN COAT r__-
STRUCTURAL. FINAL /����.(� ��
HEATING, VENT., REFRIG. AND A.C., FINAL /ttxG(/NireriJ __gPe.A 4z-?-a
PLUMBING, FINAL AND GAS TEST n /
ELECTRIC, FINAL 4'6;05 '�1r)/� 7-6`/
nry
BUILDING. FINAL /7//5 /24-7-
c, 93 (SI PAiB
_�_ MAR2100 585* ****22.50
COSTA MESA BUI00 'a�.I tTY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 82626
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 9 For °Elko Use Only
ADDRESS 'z i 2- - 2u 12/3-L P L .
RECEIPT NO. ep1241
COSTA MESA. CALIFORNIA C—�K/Y
RECEI ISP D ER CEIVED DATE ISUED
OWNER ATQtu65 iTISAJo2/c S f'{D}� 7-
BUILDING a/7a (L.?( - y� a8
MAIL (�a.K_ _I ADDRESS A0)
ADDRESS/
CC,
// Cp�(c- FIRE 3
CITY C.C,04 A9£S� NO 3 Sty 1 APPROVED
`��TYPE�JGROUP '7/{J
ARCH) AP•PROVED ,75X DATE g- 2/ i
OR E�NGIN��—� NO• ZONING 2(G
ADD RBBe -�/ (.�
,O C - '�1 ,/ ONE / PLANS�,j USILDIN EW ��,�
CONTRAOTOR/_141//14 J / ret/C-C. � /5 ....--.4 .0„..
. �-�G.2.—
ADDRESS
LEGAL
ADDRESS x7/4- /tlos C�^re-44rL D�CRIRION r �j r J
CITY S44 ),2 4rJ� A.P.NO. I I O —1
STATE �-/ TEL, NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.NO. "2-/e ES ZZ` NO. `�`;�- 67/8 90.TO SIDE SREAR F.L.
EAVES
SIZE V NO.OF OLD ALLOWED <V.B.C.REQUIREMENT)
OF LOT 6O /� //0 NOW ON LOT
YARDS APPROVED YARDS APPROVED
USETE ONG BLDG.F SNCL E ;aware L', :A'"JCt - MAIN BUILDING ACCESSORY BUILDING
EX / (FROM C/L STREET)
SETBACK LINE PROM -•
CENTER OF STREET —`(" REAR YARD SC' FRONT FT.�,�i/ PT.
SIDE YARpI LEFT 5.- RIGHT S
I R.SIDE PT. V PT.
DESCRIPTION OF1WWORRK L.SIDE PT. eV- FT.
NEW THRATION ADDITION REAR FT• FT. -
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH I MAIN BLDG/3. ACCESS.SLOGS.
BUILDING NO.OF VAR.JC DATE
SIZE ROOMS STORIES C.V.P.# APPROVED
EXTERIOR WALL I ROOF APFRpy�D
COVERING COVERING 4Y �0 V„ Q. DATE J ��
USE OF BUILDING AND WORK TO BE PERFORMED / G
'ILL 4 ,t/-6,L4neta.S .2-4/7-6.G/o.c 9
AkS'Pi• ,Qgrc1CDt.L (P/AJtfA/(o !f'zcs!) 5t dO.FT. it
1 HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE C
AND STATE THAT THE ASOVS.IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATINS VALUATION.AYtiv T
BUILDING CONSTRUCTION. PERMIT FEE S /51
or
OF,/OF / -�} /J/) —PLAN CHECK S 7.5n W
AUTHO572
RIZED
)ZED _GENT gip/ TLI4,5 7 ./moi)
AUTHORIZED AGENT ��/ TOTAL FEE #C29 5.1e
O8