HomeMy WebLinkAbout1624 SANDALWOOD ST - Building Permits •
•
011 CITY OF COSTA MESA
BUILDING DIVISION
>k:� ,i : ' DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
i PERMIT
P03-00482
4eQ,Porio0049.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1624 SANDALWOOD ST Status: ISSUED
Suite No Applied: 07/28/2003
Issued: 07/28/2003
Vicinity:
Parcel Nunmber: 13921207 ISSUED BY:
Applicant: ALAP ASSOCIATES GP
Address: 7338 ETHEL
Phone: 800-444-8865
NORTH HOLLYWOOD,CA Zip: 91605
Owner: COLEMAN, PAULA J
Address 1624 SANDALWOOD ST
Phone:
COSTA MESA,CA Zip: 92626-3721
Contractor: ALAP ASSOCIATES GP
Address: 7338 ETHEL
Phone: 800-444-8865
NORTH HOLLYWOOD,CA Zip: 91605
License: 771905
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
C/O OF WATER HEATER SAME LOCATION.
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 $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 $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(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/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
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:
❑ 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
j work for which this permit Is issued.
CTS<Ihave 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.
zy wrkers'compensation Insurance carrier and policy number are:
Mar: 5�i.�-rip Nu berL.J/G2cy 7 if 74 Ys. f
- kirsiktion eed not be completed if the permit is valued at one hundred dollars($100)or lass.)
❑ I certi that in the performance of the work for which this permit Is issued,I shall not employ any pe in any m er so as to become subject to the workers'
compensation . of California,end agree that if I should become subject to the workers'compensation pr of Section 3700 of the Labor Code,I shall forthwith
comply with these! ovisio s.,,
•.plicant Si. .�J ' Date: )
•-NING:FAILURE TO SECURE WORKERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DO.LARE($100,r00),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I her:• .'Irm that I alicensed under provisions of Chapter 9(commencing with Section 700')of Division 3 of the Business and Professions Code,and my license is in full
(4V Class# C -36
ontractors Signature:
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 tor 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 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).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or 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? ❑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 plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes L7 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 Califomla Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
•
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature.1 Legal Owner(s) ( " Date
- \�
ter,
•n.O : :w'-.R. .nt D e
CODE II INSPECTION TYPE '-_.. ItrrmAL9 CODE INSPECTION TYPE PAIL It�LS
1616 Fixed System Final Fire Prevention 206 Final Mechanical p
1266 Pool Spa Final 208 Final Plumbing $-a1 a
-CD 3 N
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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PER N TRACT NO. • LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION PER IT "� G.1 9 A.P.IP Zone
Project Address /��Y �Jr�y�lyd/�iWOon 4 S • f 1 U Id REPAIR S Main Building: Accessory Building: z
a•-•c_t`// 9- /y'�r'IG[[efer0 0 TYPE OF CONSTRUCTION LJ NEW ❑ ADD ALTERATION Front
Applicant's Mailing Ay�)dr¢ s /� p ❑ CONVERSION ❑ DEMOLISH ❑ OTHER I T O
Owner's Name `�W/ f Phone 413D1/1/91 DESCRIPTION OF WORK/USE OF BLDG. -- _ _ � A Rear N
Address
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING L.} FOUNDATION U STRUCTURAL C Right G
Address ❑ TENANT Cl ELECTRICAL ,�l PLUMBING ❑ MECHANICAL S Left R
Contractor's Nam• . 114 i� ' U0 Ar! Phone '.Lf 'i0 ❑ OTHER 'Ping. Ref.# Parking Ree/aided E
��,�rrinfej PROJECT DESCRIPTION SQ. FT. OCCUPANCY O
Address(mailing) I�-�LfYL�/. �� Planning Notes: -4��(\ M
//'7./ CONSTRUCTION TYPE -- VALUATION $ l:V T
City LLICENSED •CONTRACTOR
10//t31 ZONE GRADING CU.YDS. ACRES 0 - $
LICENSED CONTRACTOR DECLARATION Watt.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full f• - .nd effect. n r L1,7 ELECTRICAL FEES
A License C . r LIc' e No V 0
Date - Automatic Washer Transformer 0 15-50 KW
��� Signature >'��/ � �/ PLUMBING I FEES
\ WORKE-5'C•MPENSATION DECLARATIONBar Sink Showers Construction Pole Sub.
- ❑ 50+KW
I hereby affirm that I have a certificate of consent to self-Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter pup to 100 amps
30, Lab. h nq r� Backflow Preventer Service Sink
.N/HOI�Q7 s /41444/ Dishwasher i Meter Dover 100 amps
rolicy No. CompanyBackflow Irrigation Sewer Cap - -
ertified copy is hereby furnished. Dryers ❑Gas,'❑Electric —' Sub Panel
Cer(j�f �ggqq I filetl with the cit I 1 Bathtubs Sewer Connection
Date "s/ -//�'�/ Applican� Fan Motors❑0-1HP ❑1X-8
E%EMP ION ROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors -
(This section need not be completed if the permit is for one hundred ($100)or F.A.U.
less). Dishwasher Solar Piping Inc.Solar 1:19.15 HP 016-15+
I certify that in the performance of the work for which this permit Is Issued, I Fixtures l
shall not employ any person in any manner so as to become subject to the Drinking Fountains - Solar Tank r'% Microwave '
Workers' Compensation Laws of California. Device Boxes ,J Pole Light
Date Signature Floor Drains Swimming Pool w/Spa9
NOTICE: If,after making this declaration,you should become subject to the Outlets
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencIng with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee
'.refrom and the basis for the alleged exemption. Any violation of Section - $ 3
11.5 by any applicant for a permit subjects the applicant to a civil
.laity of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
Li I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 9 Zoning Approved By Date
compensation, will do the work,and the structure Is not Intended or offered - -
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date
License Law does not apply to an owner of a property who builds or improves /�
thereon, and who does such work himself/herself or through his or her own Application Issued By 1/I / Date (40/2--Al
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ 7`r
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System
tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 0o-100,000 BTU 0100,000 BTU PLUMBING $ St- S OD ISSUANCE $ 9
builds or Improves thereon.and who contracts for such oroiects with a con-
tractor(s) license pursuant to tne Contractor's License Law). i am aware that I Exhaust System ❑ Multiple 0 ! System Repair/Alteration PLAN CHECK 25% $
ELECTRICAL $ _ ENERGY P.C. $
proof o their Worker's Compensation insurance should be provided to me. GRADING $
❑ I am exempt under Section B.8 P.C.for this reason Firepl/Fact.Blt. ICBG* Fire Dampers MICROFILM $
System9
Heating & Ducting Registers 5
PLAN CHECK 50% $ C
Date Owner MECHANICAL $ TOTAL FEE $ ert
I hereby certify that I have read this application and state that the above 00100,000 BTU 0100,000BTL
information is correct. PLAN CHECK 25%I agree to comply with all city and county ordinances - $
and state laws relating to building construction,and hereby authorize repre-
sentatives of this city to enter pon the above-mentioned property for
inspection pu ../ / / —
Signature /_ /�`�'�� ' '
.L:..,.. J� ,4'j
-0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor .. ' '• T�i..:a. • 'T.
CS
CONSTRUCTION AND PLANNING POOI WA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
.1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4..Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER-Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation • 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
•12. Sewer Cap 63. Heater & Vent-Final
13. Roof-Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
C.17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
118. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
'79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 6//(()-Q Z-160
39. Water Service-Final -��
40. Gas Service-Final
41. Solar Domestic-Final C1
42. Backflow Preventer
--J
43. Backflow Irrigation~;
44. Landscape Irrigation System -y
45. Sound Attenuation
46. Handicap Regulates
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY j
No. Date -'
OWNER Rf1SST,ARR T.AND CO, DATE 7/9/59
JOB ADDRESS 16211 Sandalwood St. BUILDING PERMIT NO. 9863
GENERAL CONTRACTOR Dike && C____ol aw3roawro a, nom. VALUE $ 1)41552•00
AP. No. LOT 215 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK Res. w att. gar.
INSPECTIONS . _?p_S-g DATE GROUP T Rt .1 TYPE V ZONE R1
Underground Soil /Vytr U.G. Water M-45- s--?-cg PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER _
Overhead Water and Gas 7
Rough Heating ,ly{$ i-�SqV _y,f"�/�4�Cc,�-(nr 1.2 2-)4o-f? �t QV
Rough Plumbing j S /o-/-SZ1 �'�.n 3 p��yt�/ 7-.`L 4-S? c2 D/s6 ✓
Miscellaneous \C A
Prop. Swr(_Line Ha�e Con. St. Swr. f(�1d'/5TH (1J,1,�,, ,k, - 7/T u1.fl /Cr y
Sprinkling System
Heating, Final (.
Plumbing Fixtures 1/A. fJl
Final Gas Test p r .- 1.-1 9 .• Y/ —r
Construction Pole /
Underground Power
Rough Wiring n-Z±i 9i10'SPi . . valV/1...n4 j - v-/4/-s-9 /D/,5'js/'
Trenches/I Forms/( Stee1.fi�g-5-Sy
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam -
/� -
Sheathing /I !/ -6-9
Frame and FI shing (b9/JL O 6-
Lat.hing, In Out /i' 9d /0-79-64
Plaster, brown coat Pa a-9-59 . '
Plumbing Fixtures, Final J`eI/
ElectricuildiFixtures, Final /�
Building, Final f/
OCCUPANCY I I
Form 410-3M-4-59 9863
" 9863
' "4 ` „JL 131959
COSTA MESA BUILDING-SAFETY DEPARTMENT 7-111rinc ncaT
• P.O,BOX 317 COSTA MESA, CALIFORNIA I -f11 ��`� L., i.
EOR APPLICANT TO flit /N COMPLETELY ` APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
*. BUILDING
ADDRESS 1624 Sandalwood St.
COSTA MESA,_ACALIFORNIA EOR OffICE USE ONLY
OWNER Rosslane Land Co. F I RECEIPT NO. I PERMIT 00.
MAILp ] i/ �Cij
ADDRESS 419 E. 1/th St. RECEI D BY I DATE RECEI OA-/�✓-
TT-�AA 7-9 !fJ ✓
CITY Costa Mesa TryLn81159 BUILDING
AObRESS
ARCHITECT Carlson& LIC.• COSTA MESA, CALIFORNIA )
. OR ENGINEER Middlebrook NO.
ADDRESS Garden Grove . FIRE
ZONE
Dike & Colegrove, Inc. STATE 167293 APPROVED _1/. I II7_ 9 ATE 7-11 31
GCONTRACTOR LIC.NO. I 1J [[//''b�1(7 �p,`JD
• ADDRESS 419 E. 17th St., Costa MesaZONING
• LEGAL LOT 215 A,p22 ' ZONE^ NO.OF .r. USE OF NEW - ,[K
•
DESCRIPTION NO. BLOCK TRACT ',�11 / I PLANS PI__ BUILDING /vd'I
Cl/
APPROVED
A.P.NO.
BY DATE
SIZE NO.OF BLDGS. EVES
OF LOT 60 x 102 I NOW ON LOT none;' REODU RED ALLOWED
USE OF • E., (CENTER LINE ST.)
EXISTING BLDG. : FRONT 0 FT. IN.
- SETBACK LINE FROM
CENTER OF STREET 54' REAR YARD 25' I. R.SIDE S FT. IN.
•
SIDE YARD I LEFT 5) ' 1RIGHT 5' . L.SIDE J gEar FT. IN.
DESCRIPTION OF WORK q
REAR +1 D FT. IN.
NEW I XII ALTERATION I II ADDITION I
; REPAIR I II MOVING II DEMOLISH
SIZE
GING 1450 ROOMS 6 STORIES 1
EXTERIOR WALL ROOF
`• COVERING StuCCO COVERING shingle
USE OF BUILDING AND WORK TO BE PERFORMED `
Single family residence with
attached garage.
Ple.0 140B
•
` I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS _
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 CONSTRUCTION.
, VALUATION
SIGNATURE OF `�// e.„ ww $34..00
PERMITTEE (' "� /Y�
AUTHORIZED AGENT Dike & olegrove, Inc. : 51.00
.
`Xerox copies: 2972 Jacaranda, 2973 Te • \`1629 Sandalwood, 1616 Sandalwood
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FORSTRIICTTIJRAJ.PERMIT 66.5D Tl_
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
_ .. --`.: RECEIVED 11 PERMIT N- 5Q424
For Applicant to Fill in Completely — Use Ink Only c (A4 e
sr
BUILDING • -,
�/ se_ A.P. NO. 3 O. r ' /
ADDRESS L �) 17 )- ,ten C
tet. BUILDINGS/ y y.
/
OWNER OR — q Z ` 0 ADDRESS i
TENANT ,/ C/ Ti ' ii' A/ r')/ Fr if
1''
MAILING ` t I - / .4 UNIT OR
ADDRESS i ' h `SJ 'i. SPACE NO../ab • y / J-J..(s.
-Cl 5indic\r _ tNO:•-s X1.1- t. T3;. • ^ ; •7 z BLK.
C / ^A NEL. - �' -al .
•• CITY l CT ION /!/G �i/t _ NO.
CONSTRUCTION 14..
NEW • •D ALTER REPAIR MOVING DEMOLISH•
LENDER
BRANCH L
�. `'- OWNER . V` .L *i-'-s ' R
t ADDRESSII� VALUE /
ARCHITECT TEL. USE (.3/041R, Wad/ 57050' .
6 OR ENGINEER NO. -�• .m l -. .ter r .. a..._ ......
ADDRESS ZONE A — TYPE GROUP
CONTRACTOR 0 75
APPROVED
Ere IP
DATE 7 2-25
ADDRESS /�(.'.:"l L
' TEL. . L',i /
/ CITY NO. / / / /s)'t')L'
F a STATE CITY , APPROVED SETBACKS j
G - LIC. NO. LIC.NO. I c
CC - SIZE NO.OF BLOCS. .,1.4S!.---C/L STREET) t-,-
L d OF LOT NOW ON LOT g FRONT FT. '._�I'
< USE OF all.s
V' r EXISTING BLDG. /�
rn I R.SIDE F , ��
F- , Separate permits are required for F L.SIDE t �T:-
electric,plumbing and heating work. // ,�
! -EA'R// I FT.
L7 1 USE OF BUILDING AND WORK TO BE PERFORMED 5 .PLANNING ACTION
..1 I 2// zi7/ _vn i'.° I , DATE
APPRO a / 7
< a
� r ScI_ APP-QVEo ., 0
G'� r. .,r CJuJ ' .1..
m •
0 I hereby acknowledge that I nave read this application and state
,✓ that the above information is correct and agree to comply with
C. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of m
the State of California. / _�/ L:FT �O�Gv'
• I hereby certify that I am properly licensed as a contractor under la D
s� -frQo.
• the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Cl
Chapter 9, and that such licenses are in full force and effect,or I : THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: b
• am exempt from�ehe,provisions oft State of California Business c T
end Processions title, Division 3 C apter 9. i VALUATION PERMIT FEE 5 ��, v,
(----.274/
�/ 7 e
Signature of ��/ PLAN CHECK b 2 2- L
— V _/ o
Permittee �' ' ✓/)•�% 5 los h -�-- TAX 5
•y or / 9A• wt� L/ coV
Authorized AgentntJ'Dale • _ - - TOTAL PAID S 6 .S V