HomeMy WebLinkAbout3136 SAMOA PL - Building Permits CITY OF COSTA MESA
O Te I% BUILDING DIVISION
f,' '% (1, 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
' .." PERMIT NUMBE ';O QIP& V
PERMIT TYPE ELEC STATUS: . FINALED
APN: 13915410 DATE ISSUED: 11/15/2010
ISSUED BY: KJB
JOB ADDRESS: 3136 SAMOA PL CM Suite/Unit:
Vicinity: DETACHED SHED
SCOPE OF WORK: LEGALIZE MISC ELECTRICAL FOR A DETACHED SHED. 1 SUBPANEL,7 LIGHTS,5 OUTLETS, 1 CIRCUIT FOR
WINDOW MOUNT NC
REF:C10-1657
OWNER: TROM,STEPHEN J Address: 3136 SAMOA PL Unit:
' PHONE: 714-546-4721 City/State/Zip: • COSTA MESA,CA
APPLICANT: TROM,STEPHEN J Address: 3136 SAMOA PL Unit:
PHONE: 714-546-4721 City/State/zZip: COSTA MESA,CA
CONTRACTOR: License No.
Address: Unit: PHONE:
City/State: ZipCode: CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $86.50
Reinspection Fee $0.00
TOTAL FEES $86.50
•
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 S. INSPEC11ONJYPE DATE INTITIALS CODE O INSPECTION TYPE DAT INPTIAIS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing '
200 Final Re-Roof 210 Final Electrical X sf.1•I t R^N—Ito-0
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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑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
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be compered d the perms is valued at one hundred collars($100)or less.)
2,Art 2,Sec.341 Title B,California Administrative Code).
Policy Number:
❑ 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 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 forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Dale 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 ❑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 ❑No
Lic.# Class# (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
contractors 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,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? CIYes ❑ 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? ❑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: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? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 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? ❑Yes ❑ 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).
❑ 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 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
am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
IDproperty,I, as owner of the
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
CI 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 permit until final inspection.
Signature of Legal Owners) Date
Signature Date
3057.46(3/07)
And/or Authorized Applicant Date
j CITY OF COSTA MESA
4 BUIiDING DIVISION
• r'rrj„ DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
F i 'r' 1
�a PERMIT B05-01517
•
4(bfrPosno`IP
(714)754-5273 • Fax(714)754.4858 • www.cl.costa-mesa.®WILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92628
Job Address: 3136 SAMOA PL Status: ISSUED
Suite: Applied: 09/06/2005
Vicinity: HOUSE AND GARAGE ROOF Issued: 09/06/2005
Primary Occ: R1 Type of Construction: V-N
Parcel Number: 13915410 Zoning: R1
Applicant: TIM MCCARL
Address: 126 COMMERCIAL WY IeI
Phone: 949-548-5569 ISSUED BY: I[[YI"A��V Jl
COSTA MESA,CA Zip: 92627
Owner: TROM, STEPHEN J .
Address 3136 SAMOA PL R R 1 P
• Phone:
COSTA MESA,CA Zip: ,. 92626
Contractor: G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING
Address: ,126 COMMERCIAL WY _ -
Phone: 949-548-5569 -
COSTA MESA,CA
Zip: 92627 License: 828379
Arch : - Eng: •
Address: • Address:
Phone: - Phone:
Zip: a License:, , License:
•
SCOPE OF PERMIT
T/O EXISTING COMP SHINGLES AND REPLACE WITH NEW CLASS A,30 YEAR COMP SHINGLES ON DETACHED HOUSE AND GARAGE
(APPROX 24 SQUARES).WORK TO BE DONE CONCURRENTLY ON HOUSE AND GARAGE.REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00Calc Valuation: $5,657.00
Permit: $125.25 • - Claim Valuation: " 55,657:00
$MIP Res: $0.57
SMIP Com: $0.00
Other: $0.00 -
Inspection: $0.00
Total: $125.82
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 Califomla 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
244646(S
DECLARATIONS '
WORKERS'COMPENSATION DECLARATION: -y
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.
/-Yh
ave and wit 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.
.JJJ• My workers. oma nsatlon Insurance carneQand policy number are:
Carle \�-}-.J r f��1 L1 A Policy Number:...p7 V 997 _z C 6.r
I frh s'sectionll a not be complete it the permit is valued at one hundred dollars($100)or less.) C s•,.
❑ I certify that in the• ormance 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 lif•Imp,and e that I should become subject to the workers'compensation provisions of Section 370q of the Labor Code,I shall forthwith
comply with the v.lo I
Applicant St Signature: 0i . Date: LI o
WARNING:FAILURE TO - U• WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL'
1/
NAL'PENALTI S AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S •r••q,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
T--' Class'Y>*�' — "i `J
force and effect.-11er N
`Cont orsSlg anan ture: ����5 - Date:J 9 / C. / n
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: Lenders Address:
re: .•+v".".1 -SLK Date:
IR-BUIL, DEC •.; : ONS:
I h y affirm t unde •; al • ;lentil/la-
erju at I a 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,prier 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 then 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,em 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,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 Safely,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 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? ❑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 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 Quality Management District or from any other air pollution control district or agency? Yes 0 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 part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safely 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.
2 rIgnat f Legal ner(s)itt
Date
Md/Or Authorized Apo.cant--- ,.•-- Date _�--
CODE! INSPECTION TYPE pAL INTUALS CODE( Iff$PECRON TYPE PAIS INTRWL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final
— C� 208 Final Plumbing
�`
200 Final Re-Roof � 210 Final Electrical
201 Final BloctdRetaining 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
OWNER DE bflYJUVU, NONALD DATE "-."
JOB ADDRESS 3136 Samoa Fl. BUILDING PERMIT NO. 39910
GENERAL CONTRACTOR Owner Bisir. DESCRIPTION of WORK Add Fireplace
F3 AP No. 139-154-10 LOT TRACT FIRE ZONE VALUE $ 1,000•00
G
`INSPECTIONS Signature Date TYPE 1n GROUP J ZONE R1
ra SOIL PERMITS ISSUED
GAS SUBCONTRACTOR f
Dote Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. fl
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE _
UNDERGROUND LI POWER 0
ROUGH WIRING- Heating and Vent.
u
TRENCHES FORMS IR. STEEL REINF. g- R _C rj-2-J7
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND F�
FLASHING- •
L
LATHING - IN OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST 7
N.
399 / sW11 30-75-0U1069* ****10.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
ke P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
P !CATION FOR BUILDING PERMIT
For Applica to Fill in Completely l V BY DATE RECEIVED pIATE ISSUE
BUILDING '? // �/�// ,, AT/]I//is f•9 _^f�L
ADDRESS )." /Ne//i (YL/yCG !w '7
A.P.NO./3Y /4514—/O PERMIT NO.
OWNER 6I-o N//GD Ci.- Sr G/,�.Yo �f
ADD ? A z / ADDBUILRESS SNG 3/3� SAM° 4- //ia(P.
Ztuts; ADDRESS I3 �( �GG``'�� ��ss
0.0 CITY (bU 5%Y, f't`S J9 NOL 97i'7s TRACTp23,�,3 LOT/) /. BLOCK
ZZ Q NEW ADD ALTER REPAIR MOVING DFMOI ISH
LN
O(t) LENDERRDTIDN
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am D,p x
J cn BRANCH Ie�ALI3 S/�P11.s-/
J0 OWNER 117
a W ADDRESS �/� meld ry�.s
m m ARCHITECT p� TEL. USE/a'^So mel 62cM S /on '/
J N OR ENGINEER Map-- NO,
Ua FIRE T
w m ADDRESS ZONE TYPE �aROUP .
,Lt.„, APPRO E �s C
W Z CONTRACTOR / - /� i /j�'
By LI/• DAT 0-7J
—I O • •
03
J¢ ADDRESS
W W r— ZONE D NO.OF • USE OF NEW
Z k- CITY NO. /\ / PLANS Ar BUILDING
'-1� �r j,,all-
TE4c C.—
W 0 )STATE XITY YARDS APPROVED YARDS APPROVED
j O t lIC.NO. IC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE IND.OF BLDGS. (FROM C/L STREET)
OF LOT NOW ON LOT 2- FRONT FT. / T.
USE OF 1
EXISTING BLDG. yE� R•_SIDE FT. FT.
1
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE\ ♦ I FT.
U EXTERIOR WALL ROOF \O\yyfJ\ r
COVERING COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
CL
a MAIN BLDGS. ACCESS.BLOCS.
< n /1 VAR.+ DATE
O AU/LN(r R Qie4 E` S" -ICo. C.U.P.# APPROVED
f /� �• r1 /� 02),
�7 ---
CO X9-5 1J/lroce.I/101 OW PG/QYf., L —BY ROVED(.I.Iel CA DATE V-36 /.,S
0 /N Liv. nM
FSTA7o
V f
I 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 e
I— any person in violation of the workman's compensation laws of
to the State of California. TAX w
2 I hereby certify that I am properly licensed as a contractor under SO.FT. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, end that such licenses ere in full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; C
am exempt from the provisions of the State of California Business VALUATION �'✓
and Professions Code, Divisio 3,Chapter 9. O os
PERMIT FEE $ N
n 3
Signature of// �r` r� m
Permittee ! /4-12.*,,,--- $ PLAN CHECK $ e E
�Authorized Agent u.
TOTAL FEE $ /0
OWNER SUWERLAND LAND CO. DATE 2_28_57
3f �"
JOB ADDRESS rr
-Samoa Place BUILDING PERMIT NO. #4484
GENERAL CONTRACTOR Owner Bldr. VALUE $ 11,424.00
LOT 332 BLOCK TRACT 2353 Single Res. w/det. gar.
GROUP I & J TYPE V ZONE FIRE DISTRICT h537
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Footing Trench !�'g' ":24g 4 �- 'Y
Foundation Formst��7and Grade to Garage / /
Rough Framing X11 (p -7 f
Plumbing, Rough to Slab 3 ryy-,7 jr / trz4 3- /- -7 eOf C5 ..e"
Plumbing, Rough Complete VL4 S g- I-s 7 _ ��'"'"" __
Temporary Pole .
Wiring, Rough JUN 5 1957 VGb C , irIyf_. ..,_a.3 -5
7 9/ 7Y/ ✓
Heating,Rough . VAa3 6-q-Y7 %-__ 5-a-7-s7 9t/92 ,✓
Heating, Final PK C5 /O-/s=•/) 7
'
Sewer, Housa,5 Sewer,St. fih J-/-,S '-2S-S7 e C.../.../1...-... ,/. _ .-7 ,3 • Y-r7 / '/J c
k
Septic Tanor Cesspool _ /1 6
Lathing, In Out -- 6 ,�-5
Plastering 4 r7 ' • ' ' t
Plumbing,Final,Fixtures Complea3 /42-/J=J7 // 11/
Plumbing,Final Gas TestIs }C'S 0../..s=07 ` -�� /�' )%(
Wiring,Final ' ^^ L r A -le ar/ e — / G
Occupancy ✓/L �_ „, ia.Ft -J,
FORM 210 3M 10.55
•
4537
FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT FINANCE DEPT.
P.O. BOX 317
COSTA MESA. CALIFORNIA CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ADDRESS rC- ? Samoa Place BUILDING
COSTA MESA. CALIFORNIA • FOR OFFICE USE ONLY
RECEIPT NO. PE4I4 34.
OWNER Summerland Land Co. P (�
MAIL RECEIVED BY DATE RECEIVED pE
A SI SSUED
ADDRESS 112 . So. Beverly o � -,2d'-.( 7 i t° z 8 195
T Angeles, TEL.Crestview BUILDING
L
CITY os ngeles, Calif. NO. 5-8828ADDRESS
ARCHITECT LIC. COSTA MESA. CALIFORNIA
OR ENGINEER Williams NO.
,os
ReverlJ T
ADDRESS 11211 So. Beverly-Los Angeles FINFIREE
C` ZONE NO.OF
Jummerland Land CITY LIC. PLANS TYPE GRO P
CONTRACTOR CO. NO. 61.845 • V
1124 So. Beverly TECs estview APPROVED
ADDRESS jOo Anrvol Fa 1 CAS 1 fNO. 5.—.x828 BY DATE
LEGAL OT 1 2353 CORRECTIONS
LNO. 112 BLOCK TRACT
DESCRIPTION
A.P. NO.
SIZE NO.OF BLDGS,
OF LOT 6000 NOW ON LOT none
USE OF
EXISTING BLDG.
SETBACK LINE FROM rr
CENTER OF STREET hn 1 REAR YARD lc I —
SIDE YARD RIGHT .251 LEFT Al
DESCRIPTION OF WORK
NEW X ALTERATION ADDITION
REPAIR MOVING DEMOLISH
BUILDING
SIZE 1316 NO.OF
ROOMS 6 STORIES 1
EXTERIOR WALL Stucco ROOF
COVERING &. Siding COVERING Rock
USE OF NEW
BUILDING Single Family Dwelling
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY W'TH ALL
CITY ORDINANCES TATE LAWS REGULATING BUIL NG CONSTRUC.
TION. �J �J VALUATION PERMIT FEE $ 26.00
SIGNATURE
PERMITTEE OF fiVcf ///�/� �11ti
• l // /o G // PLAN CHECK S 14.00
AUTHORIZED AGENT .. / ) TOTAL FEE 5 L2.00 ,,emir
96851 /09/80 48.00 TL
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLI ATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 _
REC D V PERMIT N° 49477
For Applicant to Fill in Completely
—UUse
Ink
Only
BUILDING
ADDRESS 3rl SLI/OA.P. N
y
/
LS
V�g
/O
OWNER OR
TENANT ON I��S re- ABUDIDLRDEINSG 3p
UNIT OR
MAILING
SPACE NO.
ADDRESS ) 3S^ � Q�y-
LOT BLK.
Nes,
9�4�f�Lry /
CITaDSy— NEW ALTER REP,•I R MOVING DEMOLISH
CONSTRUCTION f
LENDER //�..z
BRANCH u —
OWNER • F/S
ADDRESS C V 1-UE
ARCHITECT TEL. USE �^�•r•�4i
OR ENGINEER NQ. � -- L ��y��®
ADDRESS ZONE / ITYPE% GROU {J--
APPR VED �� / /�Q
CONTRACTOR BY DATE `/
ADDRESS it 6Inrte-+
CITY NO.
i-i STATE F0 / RO VEEDD�SETAAICKS�/^ /
g - LIC. NO. LIC.NO. 'J/ON C.) S REETZ �/�
W SIZE INO.OFBLDGS. �•kPFi C
4 OF LOT NOW ON LOT FRONT —
USE OFCA (((� I t�
EXISTING BLDG. R.SIDE FT.
IR.
Separate permits are required for L.SIDE aa(-_'
L1 electric,plumbing and heating work. REAR -
fy USE OF BUILOIN ND WORK O.BE PERFORMED
E.. PLANNING ACTION
DATE
O ��
a /. \� APPROVED
[�
��`/'IW 1 APPROp�D6`�l DATE/ ! JS�
x !l f J �//
IQ r
4 I hereby acknowledge that I have read this application and state n
CG that the above information is correct and agree to comply with / ,.,
4 all laws regulating building construction, and I shall not employ (—/ -ter // Z- s
Z any person in violation of the workman's compensation laws of m
S the State of California. 7
lifar
3 I hereby certify that I am properly licensed as a contractor under SO. T. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR B
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: �"
am exempt from the provisions of the State of California Business VAL A ION 0�•'
p tf i roe PERMIT FEE $ ��`TTTiii
and Profession de, Division 3,Chapter 9. //VSA
tv //�) �'e PLAN CHECK $ . tav .n
Signature of � % $ A /n•
Permittee //
or '9� �
Authorized Agent Date TOTAL PAID $ O-� $S Ot
9684 1/09/80 38.00 TL
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLI TION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
REC PERMIT NB . 4 . 4 7$
For Applicant to Fill in Completely—Use Ink Only
A DBUIDRESS 13 !�- Q • A.P.NO. ,
BUILDING
OWNER OR 0 / /7—&-/CAL / ADDRESS Q i
6 N
TENANT - F�� �- Ali)
UNIT OR •
MAILING
ADDRESS 3 6� ;_ + / . SPACE NO. LO BLK.
42-
CIT 10-• 75 V 1cFs ' - NOy 29 VrayTyt / /ER RE IR MOVING DEMOLISH
CONSTRUCTIONNEW 111 YYYLLLTTT
LENDER
BRANCH . I /
OWNER O /t) r,_ i /---F" /I!'D
ADDRESS /--VVALUE f/"
ARCHITECT TEL. USE ' I) O '� $ (�,
OR ENGINEER NO. '/�`1� /
ADDRESS ZONE / VPE GROUP
APPROVED //()/90
CONTRACTOR ✓{�WI v //.//. '//1 BY
DATE 7
ADDRESS V .t.�
/J//J T
CITY / O.
Fi-iSTATE CITY APPROVE T ACKS /
LIZ.NO. LIC. NO. / ‘ X,meq/
_
s (FROM /LS REP' I {'J.////
SIZE
OF LOT • • • ROM
.2 USE OF �) r
Ca EXISTING BLDG. R SIDE -7 FT..7C CJ Q/Pr G�
I Separate permits are required for L.SIDE 7 Fr. L�
G electric,plumbing and heating work. REAR Fr-- __
Imo., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
.2 •
0 / DATE
Q (I — APPROVED
>1
CP2ittigsrirAPPRCnis,12W
IXC. 1 hereby acknowledge that I have read this application and state n
that the above information Is correct and agree to comply with „
L all laws regulating building construction, and I shall not employi•
TQ
Z any person in violation of the workman's compensation laws of /Z- ` e
W the State of California. -
I hereby certify that I am properly licensed as a contractor under, _ / SQ. F . ry
the State of California Business and Professions Code, Division 3, ---THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: "'
am exempt from the provisions of the State of California Business VA „ATION �� PERMIT FEE E lOXC
and Professions Code, Div' ion 3,Ch ter 9. '-t"-. 0111 �+
PLAN CHECK E 27o
re
Signature of Q L.,
Permittee ` $ TAX E f SC
Or .1q• 191� 0
Authorized Agent Date I • TOTAL PAID E