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Home My WebLink About1616 SANDALWOOD ST - Building Permits • CITY OF COSTA MESA 4 aIIsit BUILDING DIVISION >y(40,141171M;,4r . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 I PERMIT • J Rano a`' /P01-00200 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 1616 SANDALWOOD ST Status: ISSUED Suite No Applied: 04/10/2001 Issued: 04/10/2001 Vicinity: Parcel Nunmber: 13921209 ISSUED BY: Applicant: EASTMAN, RONNIE Address: 7229 VARNA AVE Phone: (800)444-8865 NORTH HOLLYWOOD, CA Zip: 91605 Owner: HUTCHINS, C EUGENE Address 1808 KINGLET CT Phone: COSTA MESA,CA Zip: 92626 Contractor: ALAP ASSOCIATES GP Address: 7229 VARNA AVE Phone: (800)444-8865 NORTH HOLLYWOOD,CA Zip: 91605 License: 771905 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGEOUT FEE SUMMARY AMT QTY AMT QTY - AMT QTY ISSUE FEE '. $23.50 laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool /j$0.00 0 Backflow Preventer :,$0.00 0 P-Trap $0.00 0 - Trap Primer; " $0.00 0 Bathtub $0.00 0 - Pressure Regulator $0.00 0 Urinal 7/ $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 fl) $0.00 0 - Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflovi(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0- Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0- Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater I vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS I SPECIAL CONDITIONS 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 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'compe insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. C_rrier: rkers'compensationvInsure ce artier and policy number are: - y �O��CiL��,,,,, % Cardec • / /4E7! Cpolic .Number.. 't/`v �V71 t(This section need-not be completed if the permit is valued at one hundred dollars($100)or less.) O 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 iff I ul become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these vlsl ` ' Applicant'Signature: . ..-l� r Data: - "7 l(�A5 WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P LTIESAND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens d rovis' of Cher 9(commencing with Section 7000)of Division 3 of.the Business and rofessions Code,and my license Is in full force and effect.Llc.M 0 Class A- J Contractor's Signature: �� j jDate: 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 ne 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. 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,California 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 presst 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 IJ 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 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 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 Califomia 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 application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes A 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? 0 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 Califomla Health and Safety Code Section 42303 been made? 0 Yes ❑No B (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. Si. '- eOf s . Date And/Or•uthorized Applican ///DD • CODE r, INSPECTIONTYPF Pa' INTmAL5 CODE• INSPECTION TYPE PALE INTRIAL$ 1616 Fixed System Final Fire Prevention • 206 Final Mechanical (� ^^ pp 1266 Pool Spa Final 208 Final Plumbing r'zE-ss'CA. EW 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 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA 4 BUILDING DIVISION o > %� 4 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER Ft 0. PERMIT • '%%o '1 . • -^ B02`00030 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1616 SANDALWOOD ST Status: ISSUED Suite: Applied: 01/08/2002 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 01/08/2002 Parcel Number: 13921209'. - Zoning: R1 R1 - Applicant: BURR, STEVE - ISSUED BY: —7414L—' Address: 711 WEELO DR - ' - Phone: (949)5482965 COSTA MESA„ CA:- - ' Zip: 92626 Owner HUTCHINS;C,E_UGENE , ' - Address 1808 KINGLET CT - - - Phone: - /COSTA MESA,-CA.- . ' Zip: 92626 - „ , Contractor: STEVE BURR," Address:, 711 WEELO DR - Phone: (949)548-2965 , COSTA MESA, CA - . . Zip: 92626 . License:: 635586 - - Arch : -"- . Eng: .. Address: - - . Address: „ Phone:. Phone: N, / License: 'License: / . SCOPE OF-PERMIT_, r T.-: REROOF:T/O 2 LAYERS OF ROCK,REROOF WITH 2LAYERS OF15#FELT,25-YEAR FIBERGLASS"TIMBERLINE GAF" SHINGLES.2500 SQ FT _FEE SUMMARY Plan Check: $0.00 7- --- . - - - -- - - ,": - - - Calc Valuation: $4,000.00 Permit: $97.25i - Claim Valuation: $4,000.00 SMIP Res: • $0.50 • SMIP Com: $0.00 Other $0.00 " Inspection: $0.00 Total: $97.75: .. PLANNING'S,ZONING SETBACKS ` N / . MAIN STRUCTURE Front 0-0 Rear 0-0. -Left 0-0 Right " 0-0 " ACCESSORY Front -0-0 • - -Rear 0-0 . , Left . 0-'0 - Rigli 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) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 w ers'compensation Ins rance care r and policy number are: J /' �"// Carrier: 54 o-4-- l/L 4 Policy Number: 6 Z 6- 7 -T y (This section need not be completed if 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 Californi ,and a r t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro 1 ( l Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THS COST OF COMPENSATION,DAMAGES As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provision of Chapter 9(commencing with Section 7000)of Division 3 of the Busines and Professions Code,and my license is In full force and effect.Lic.a - Class N C Contractor's Signature: r Date: / ._ 1 Q 7 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 fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O 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 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,California 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? ❑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 present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 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 ❑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 Air Quality Management District or from any other air pollution control district or agency? 13 Yes 131 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? 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? ❑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 co ply with all ' and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-deer inspect rposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signal f Legal Owner(s) ODat, S-(-�v lSv trC / — And/Or Authorized Applicant Date gOQE I ffISPECTION TYPE DATE Itl1IDa6S CODE! INSPECTION TYPE OATS lNTm LS • 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 204 Final Demolition 250 Final Building/Occupancy OWNER ROSSLANE LAND CO. • DATE 7/9/59 JOB ADDRESS 1616 Sand. wood S BUILDING PERMIT NO. •8. _ GENERAL CONTRACTOR Dike & Colegrove, Inc. VALUE $ n42552.00 AP. No. LOT 213 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK Res. Watt. gar. INSPECTIONS ?.. /-gam DATE I GROUP I & J TYPE V ZONE RZ. Underground Soil /14gtU.G. Water Mk 7- 5-47 PERMITS ISSUED Underground Gas SUBCONTRACTOR DATE NUMBER C;="'head Water and Gas _ rei- Heating /WS"g•-.2-9.-S* 1 17. . /!J Rough Plumbing /Q-/-,�Sf iW...tie.O tem-2...0 2.--z.24.7-i,s-9 / Miscellaneous _ Prop. SwrtIdne H6it,s Con. St. Swr. ei �, — )'/'� oiS ll I r C G 11) Sprinkling System �� _ ��77 b Heating, Final k I, t 6 Plumbing Fixtures (�d/ s' 0 Final Gas Test /,C%�� i-ir B Construction Pole Underground Power Rough Wiring ' -/-20, 5i' na r ;i„e i,/?i g/G/-C-t/ /1/4-11-- Trenches( /./.cam/✓Trenches( Forms/f Steel /i' f-3-n Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing v ,ll -7-/-5.9 Frame and Flashing �J 7-f�--7-y Lathing, Ing Out J? '1 - IC`--93-O4J Plyter, brown coat /NV- //-el-5-9" P'%°fi.'hing Fixtures, Final A !� /�b4 6 EiS=clic Fixtures, Final Building, Final /R OCCUPANCY ��p1 Form 210-3M-4-59 9865 COSTA MESA BUILDING-SAFETY DEPARTMENT JUL 1 3 1959 P.O.BOX 317 COSTA MESA, CALIFORNIA I eP1P DEPT. DEPTj. ,9. . .,(' ' I. ":n,. fOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BADDDINCI1616 Sandalwood St. . COSTA MESA. CALIFORNIA fOR OFFICE USE ONLY Land Co. RECEIPT NO. I PERM 4'ly OWNER 1Rosslane lrtnQd C `(JlIC`7j n AMAILDDRESS 419 E. 17th St. p ( ,ECFIVED BY I OATff[ECEIVED I 7—DATE ISSUED 9 CITY Costa Mesa TNO. 14181159 B}y\IDLRCEL 7 /C/_/ '�-q 5 ADDRESS ARCHITECT Carlson & LIC. COSTA MESA, CALIFORNIA OR ENGINEER NO. Middlebrook FIRE ADDRESS Garden Grove ZONE Dike & Colegrove, Inc STATE 167293 APPROVED . CONTRACTOR LIC.NO. BY DATE ADDRESS 419 E. 17th St. , CostaMesaZONING LEGAL NOT 213 2822 ZONE NO.OF USE OF NEW �'1 I I DESCRIPTION NO. BLOCK TRACT n PLANS BUILDING /R A.P.NO. BYPROVED)A_� /Q/ ('I_ ATE 7-13—sem/ SIZE L^ No.OF BLDGS. YARDS YV /� �7E'V/E'SD OF LOT 60 x 102 Now Dry Loi none REQUIRED ALLOWED I USE OF (CENTER LINE ST.) EXISTING BLDG. FRONT -.S.-"0 FT. IN. SETBACK LINE FROM CENTER OF STREET 50' REAR YARD 29' R.SIDE .5 FT. IN. SIDE YARD (LEFT Stn (RIGHT 51 L.SIDE .5'-- FT. IN. DESCRIPTION OF WORK • REAR FT. IN. A NEW I X II ALTERATION I II ADDITION I REPAIR I II MOVING I II DEMOLISH I S ZIE DING 1450 50 ROOMS 6 STORIES 1 EXTERIOR WALStUCCO COVERING rock COVERING USE OF BUILDING AND WORK TO BE PERFORMED Single family residence with attached garage. Plan 140 AR s I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTIO '/^� VALUATION SIGNATURE OF � rLI PERMIT FEE $ 34.00 PERMITTEE -I $ ' )552 PLAN CHECK $ 17.00 . AUTHORIZED AGENT Dike I e & Colegrove, nc. TOTAL FEE $ 51.00 • • • . Xerox copies: 2972 Jacaranda, 2973 Teakwocg., 1624 Sandal .. , 1616 Sandalwood COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FORcTRIIrTT.RI-PERMIT 64 SD TI P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVED B fillYPERMIT - 'TC � � � � • For Applicant to Fill in Completely — Use Ink Only _. .,,�. -N BUILDING . / - / h s7 A.P. NO. ,....„2 � ' • ADDRESS L �r %, /7.- /! 7. ....el �/ BVILDIN�// 1'cJ OWNER OR ADDRESS TENANT - �� 'tel"! A / UNIT OR q ADDRESS //MAI LI NG d. SPACE NO./KII- ' / .tom Y ' ` ,7 TEL. 9 /✓-5. a, •T BLK. CITY . ,c mr < 70 - t NO. G Q, C � CONSTRUCTION is NEW D ALTER REPAIR MOVING DEMOLISH LENDER 2 I} P BRANCH A OWNER • V•• 4.C.A'Yti ' Afl- ADDRESS CC /2 1_ ''L(JI ARCHITECT TEL. Y USE I3/ock. w/ I VALUE S 0.-C - • OR ENGINEER NO .?'t• :-._ ._./. / ��.. .. ADDRESS ZONE /� ( ITYPEysPJ GROUP fit /; APPROVED ��X() CONTRACTOR (/ ` BY -"— \ DATE 7 24, ADDRESS �e< . f L4/. TEL. /. ' // CITY NO. / /Gat/f' 1••• ...- ... STATECITY APPROVED SETBACKS G LIC.NO. LIC. NO. I -c G SIZE NO.OF BLDGS . (FROM C/L STREET) ' L OF LOT NOW ON LOT FRONT FT. 7 NSir' Q USE OF I�j"i V4 .. EXISTING BLDG. &SIDE FT. 'j-ti%' - Separate permits are required for L.SIDE Ir„I"--.- -, o electric,plumbing and heating work. _/, i -� 0 vi %% FT. I• USE OF BUILDING AND WORK TO BE PERFORMED .PLANNING ACTION 'C r. 13DATE 777 { IC�C (...i..,.// _ �� v�i'C"I APPRO 7. +� v7 APP SJVED �L L .}.1 kr '� 5 `°t -vpv rc Or'J. RYc /S �r C-6> DATE // C / I- / / y, S pI 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 employ Z any person in violation of the workman's compensation laws of 1, the State of California. 4 �''7 0 ✓ / ' -&C FT, / f��6•/ N I hereby certify that I am properly licensed as a contractor under D the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR EC Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ia am exempt fro Provisions of t a State of California Business v VALUATION PERMIT FEE S LA( ---"— N and Profession ode,Division 3,C apter 9. n �/ PLAN CHECK b 2 2 ^_ 2 Signature of `� , L 7 / / $ / e. Perminee �' • ✓JIB" •Nr 7�S /h .� TAX S • �/, Authorized Agenor t Date 7/_�`(7wt, t/ (((/// , U IOTA!PAID S 66 COJ