HomeMy WebLinkAbout1723 SAMAR DR - Building Permits 010
,� • CITY OF COSTA MESA•
064 *AFS.•
� BUILDING DIVISION
fRf j 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
� •
FOR INSPECTIONS CALL: (714)754-5626
ditb,•°'°ofi PERMIT NUMBER: BC07-00379
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_RRIP DATE ISSUED: 12/14/2007
ISSUED BY: RMD
JOB ADDRESS: 1723 SAMAR DR CM Suite/Unit:
APN: 13927309 Zoning:R1, ,
Vicinity: MASTER BEDROOM AND BATH Primary Occ: 7
Const Type: V-N SQ. FT: 240 Valuation: $25,000.00
SCOPE OF WORK: 240SF EXPANSION OF (E) MASTER BEDROOM/BATH AND ADDITION OF A STORAGE AREA AT THE REAR
OF AN EXISTING SFD.ADDITION IS ONE STORY. 1 EL FOR NEW A/C, , 1 200 A SERVICE, 12 LIGHT FIXTS, 15 OUTLETS,7
SWITCHES, 1 SHOWER, 1 TUB, 1 WATER CLOSET, 2 WASH BASIN, 1 WATER HEATER, 1 FAU < 100 K BTU, 1
COMPRESSOR TO 500K BTU, 1 ALT/REPAIR COOUHEAT.
OWNER: BENNETT, LLOYD A Address: 1723 SAMAR DR Unit:
Phone: f City/State/Zip: COSTA MESA, CA
APPLICANT 801).4)-1- u.0 0�0 Address: Unit: :
Phone: I � City/State/zZip:
CONTRACTOR: OWNER-BUILDER License No. 000000
Phone: Address: Unit:
Cell: City/State: ZipCode
ARCHITECT: WARREN C PITT ARCHITECT License No.C13718 PHONE:714-963-9337
ENGINEER: MARGARITO CASTILLO License No.S4808 PHONE:562-961-5600
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: $254.31
Building Fees: $391.25
Electrical Fees: $150.65
3
Mechanical Fees: $74.15
Plumbing Fees: $82.30
SMIP Residential: $2.50
SMIP Commercial: $0.00
TOTAL FEES: $955.16
—Refer to tee receipts for all fees paid for project
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: 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 TYPE DAM DUMB CODE 4 I/4PE6110N TYPE OAT v Q Ix AL
1616 Fixed System Final Fire Prevention 206 Final Mechanical V/lir! /
1266 Pool Spa Final 208 Final Plumbing C
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Signm 222 Final Buil
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION:'' Owner ID verified by driver es ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver:s.License No. ( Expires:— t ib \ \
❑ I have and%MIL maintain a certificate of consent to self-Insure for workers' Verifliation of Ownership by(type of document,i.e.-property'taxbill or eed):
compenszjion, 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 carder 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
by this permit,and that no building structure,scaffolding.falsework,or demolition
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp
(This segue need nal be completed 4the perm4 is valued et one hundred sooners(S100)o)less.)
2,Aril Sec.341,Title 8,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
j"l_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
Gig's d, 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 California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code,I shall orthwith comply with these provisions.
\ L� k 1\ �-A Division of Industrial Safety Permit Number:
tcSignawra __� L -_,s HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILUTtE 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? 0 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
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard 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 0 No
Lic.# Class# (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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and 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,CMI Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(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? 0 Yes 0 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:My 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? 0 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 (Section 65850.2 of the California Government Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits).
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
O 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 Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If'yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
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.
C C NSED"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
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: 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 't until final�ins p ichor.
�>, Date
�� L� Mr A tom- \y Q /-'S ture of Legal lJwnertsi Date
3057.48(3/07r �—_--
-
And/or Authonzed Applicant Date
•Opp MFS
49 CITY OF COSTA MESA
'04 1^9a P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
f�/f l--rte._ w'.
. ,, avriarturana 0
'e d' DEVELOPMENT SERVICES DEPARTMENT
N ba./
fpRPOGNiE0)9:
New State Law:
Swimming Pool Safety Act of 2006 (Assembly Bill 2977)
Effective January 1, 2007
California Health and Safety Code Section 115928 "(d) Whenever a building permit is issued
for the remodel or modification of a single family home with an existing swimming pool
toddler pool, or spa, the permit shall require that the suction outlet of the existing swimming
pool, toddler pool, or spa be upgraded so as to be equipped with an anti-entrapment cover
meeting the current standards of the American Society for Testing and Materials (ASTM) or
the American Society of Mechanical Engineers (ASME)."
Address/Permit Number
Permit Applicant or Contractor's Affidavit (Please check appropriate box):
❑ There is an existing swimming pool, spa, or toddler pool on this property. I will
install an anti-entrapment device that conforms to this law, and I understand that the
installation of this device is required prior to final building inspection approval.
g_ There is no swimming pool, spa, or toddler pool on this property.
- \_1/4-0'Y t) r-ce- ��� --c—c.
Name (please print)
Signature/Dat,
•
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)754-4856 • TDD(714)754-5244 • wvnv.ci.costa-mesa.ca.us
4L0 M 9 CITY OF COSTA MESA
BUILDING DIVISION
F• -, caiwria" DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
S Irr4a PERMIT
1603-00060
e4.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1723 SAMAR DR Status: ISSUED
Suite: Applied: 01/14/2003
Vicinity: ROOF Issued: 01/14/2003
Parcel Number: 13927309 Zoning: R1 R1
Applicant: TROY ALEXSON ISSUED BY:
Address: 1653 SUPERIOR AVE
Phone: (949)642-7222
COSTA MESA,CA Zip: 92627
Owner: BENNETT, LLOYD A
Address 9723 SAMAR DR , "
Phone:
COSTA MESA,CA Zip: 92626 -
. N
Contractor: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AVE
Phone: (949)642-7222 ,
COSTA MESA,CA .
Zip: 92627 License:' 349686 .
Arch : Eng: - -
Address: .. Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT- -
REMOVE EXISTING ROOF.INSTALL 2 LAYERS OF 15#FELT E
UNDERLAYMNT.;#40 YR ELK;CLASS A COMPOSITION:SHINGLES.32
SQUARES. .. . . ._
FEE SUMMARY
Plan Check: $0.00 — _ - Calc Valuation: $5,900.00
Permit: $125.25 _ % Claim Valuation: $5s00.00
SMIP Res: $0.59
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.84 -
e
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
•
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
2448-46(WOO)
DECLARATIONS I I
WORKERS',E.6MPENSATION 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.
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 wor rs'co pensati Insur nce carrier and policy number are: '^�
Carrier: Policy Number: 6 Z6 9J- -�/
(This section need not be completed i1 the permit is valued at one hundred dollars($100)or less.)
❑ 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 Cali nia,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 "H _p —>
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WOR RS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Mt EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 Pssions Code,and my license is in full
force and effect.Lic.# Class# 6'— 3
Contractor's Signature: Date: / �c/ G 3
l
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).
Lenders 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 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 License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivers 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,Gry 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 appl'cant 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? IC 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 hag 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 is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 a lication a,aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? L-I Yes LI 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? ❑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 California Health and Safety Code Section 42303 been made? 0 Yes ❑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.
S` to O/ eget Owner(s) Date/
An u orized Applicant / Date / t
;ODE I PISPECTIONTYPF PEE Itam9L8 CODEC INSPECTION TYPE BAIL 1HI16L5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing _
200 Final Re-Roof 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 7 T
204 Final Demolition 250 Final Building/Occupancy
I OWNER MC COY, Robert R. DATE 7-1h-75
JOB ADDRESS 1723 Samar Drive BUILDING PERMIT NO. 40253
v GENERAL CONTRACTOR Owner/Bldr. DESCRIPTION of WORK B]ACl[wa].1
I-. AP No. 139-273-09 LOT TRACT FIRE ZONE VALUE $ 660.00
2 INSPECTIONS Signature Date _TYPE III GROUP J ZONE R1
SOIL SUBCONTRACTOR PERMITS ISSUED
GAS _ Date Number Signature
WATER Plumbing L._ ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. n
SPRINKLING SYSTEM
MISCELLANEOUS _
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE _
UNDERGROUND 7 POWER qu
ROUGH WIRING t2J,Ff6'I57P-,_ Heating and Vent.
TRENCHES n FORMS n STEEL REINF. E_
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING _
FRAME AND FLASHING,40�.� - '_�-
LATHING - IN n OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL p Electric n ,/
HEATING, VENT., REFRIG. AND A.C., FINAL OtKr„yL(6-�cL� `-( .^!S 3/R 2S7"�
PLUMBING, FINAL AND GAS TEST n n _
ELECTRIC, FINAL ACS (�J'i3.71
BUILDING. FINAL II/r/'w& !• an r
A
• 4 PAILU c ts:'t **
* ➢11 1 LI-75LA(•0013 ,O- 7. 50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
•P•LI ATION FOR BUILDING PERMIT
For Applicant to Fill in Complete/ R_�
/� /J �T" DATE�]FOR BUIBUILDING ,
ADDRESS I or G J �LiMA, - /�/--- • -19 -7S
OWNER /C. 74'6/e A' 9/�C` O/ A.P.
BUILDING 1 -1 q�Il//_�C-j3 _c( PERMIT(NCO.
MAIL
ADDRESS /723 52214'& ae - ADDRESS 17TXJ14MhR OR
LilZTEL. ,/ ,Ltl U
O. U CITY e7(0.5--n? "-/F<A NO.s-4 6-UV/ TRACT J/� 1 LOT 3 BLOCK
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Z ct CONSTRUCTION NEW �SDD ALTFR REPAIR MOVING I1FMOI CH
O—N LENDER O&A/E�. 1//
0 CO /�1rJ/,, /A' -
J D BRANCH �i--• //' GING• Y
J N OWNER
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OR ENGINEER OL,tI/I�EtPi
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LU / ' s APPROVE. I / ad
W Z CONTRACTOR LI - '� - v BY `L// -- DATE
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03 Z •
J cc ADDRESS
W w TEL. ZONE NO.OF •� USE OF NEW ////, / JJ
0= R PLANS BUILDING {•
q
ZH CITY NO.
W-O STATE CITY YARDS APPROVED YARDS APPROVED
NCC LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING -
7 0 (FROM C/L STREET)
SIZE I NO.OF BLOCS. D
OF LOT NOW ON LOT FRONT FT. I S FT.I /11P bhp.,
USE OF ,/ r
EXISTING BLDG. I"Q/LfE R.SAIF FT. iireS `ST/»T.4 4.- 1
I— SIZE OF NO.OF 3FT
Z NEW BLDG. ROOMS STORIES L.SIDE FT. /7y1�L n't -
Ca.) EXTERIOR WALL I ROOFI� I O fjs-•j-
COVERING COVERING REAR FT. dtr) DGf
-J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1
a MAIN BLOCS. ACCESS.BLOCS.
Qy-- VAR..qW DATE
a CO Co el-C-7— Y�i�0 C.U.P.# APPROVED
to Szo ,C �9G,L 6 / O •� �V ROVED y DATE ^T�I4—7S
0 f W I f'L) . A_
VI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with ✓`
cr all laws regulating building construction, and I shall not employ
I— any person in violation of the workman's compensation laws of t
y the State of California. /a ,/ TAX co
w
Z I hereby certify that I am properly licensed as a contractor under F/A, ---LLLOiI FT. O
the State of California Business and Professions Code, Division 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: 2
am exempt from the p-•visions of the State of California Business VALUATION �/ m
and Professionsj•ivision 3,Chapter
��/ /��,/✓1 PERMIT FEE $ C'
Signatu • �� ��'JT` D
E
Perm' _!/ �/ $ add
PLAN CHECK $ `o
Authorize• Agent ` ttt{{{xxx U/,/7 /� LL
TOTAL FEE $
11288 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 211960
P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT,
FOR APPLICANT TO FILL IN COMPLETELY AppuguvrwcoscmgmfmIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1723 Samar Drive
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
Kenkol Development Co. , Inc RECEIPT NO. it�ti10S.
OWNER C�
MAIL 1555 Placentia RECEIVE rDATE RECEIVED /ID�AT_E ISSUED
ADDRESS I �'��'-6 0 I JAN 2 1 7960
CITY Newport Beach T LMI 6322 BUILDING
ADDRESS
ARCHITECT LIC.
OR ENGINEER NO. COSTA MESA, CALIFORNIA
p
ADDRESS
FI E H IL 1 .
NE TYPE GROUP U
CONTRACTOR K.W• Koll L CT NO.^ .1195 APPROVEDBY DATE
ADDRESS 1555 Placentia, Newport Bc ZONING _
LEGALI LOT I152Q ZONE NO.OF USE OF NEW [Geo` Y
DESCRIPTION NO. 3 BI-OCK Ylo. PLANS BUILDINEGS W ) / Yn
. BYPROVED . �i I // _ ril-� �f//`40
w '
DATE
' SIZE 74.13x99 irreg I NOW ON LOTS O YARDS VES
OF LOTREQUIRED ALLOWED
USE OFnone (CENTER LINE ST.) f
EXISTING BLDG. FRONT L `" FT. IN.
• SETBACK LINE FROM J 5O' 28) C
S
CENTER OF STREET REAR YARD R.SIDE FT. IN.
SIDE YARD (LEFT 5 ' (RIGHT 5' L.SIDE C . IN.
DESCRIPTION OF WORK �//
REAR '7"KFT. IN. 1
NEW IX II ALTERATION I II ADDITION I /
REPAIR I II MOVING I 0 DEMOLISH I
BUILSIZE
MMnn1800 sq '�jI OMS aF 6 STORIES 1
COVERINGOR COVERINGI ROOF COVERING Rock
USE OF BUILDING AND WORK j BE P RFO D -
Singse-Fame y xeSiaence
and Attached Garage
I HEREBY ACK.- EDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLYDING CITY --OINAN- A D A D
AND STATE AT T ABOVE $fA A D AGREE TOCOM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
ULAV✓l�EGULATING
BUILDING ONSTR CT •N.
VALUATION �J //
SIGNATOR OF PERMIT FEE $ J J —
PERMITTEE ly/ __
$ PLAN CHECK $ L��/[,
"-'
AUTHORIZED AGENT TOTAL FEE $ �-+