HomeMy WebLinkAbout1053 SAN PABLO CIR - Building Permits •
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
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tIT!h,OSTAMESA CONSTRUCTION PERMIT PE err O. Sg�3 TRACT NO. LOT NO. UNIT NO. 5673 10/21/86 . IB•5D
- Project Address 1053 San Pablo Cr. C.M. 92626 • Cz r� I2t LI
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Applicant's Mailing Address 126 Commercial Way, C.M. 92.627 TYPE OF CONSTRUCTION Li NEW ADO *ALTERATION U REPAIR '
F nrg h M, ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.¢S _ Zone
Owner's Name —P�.,� -Plat l s Phone 979-1 377 DESCRIPTION OF WORK/USE OF BLDG. res. - Remove flat roof,
Address 1053 San Pablo Cr •
,_C.,rl. 92626 apply 3-ply fiberglass system w/hot aphalt & rock._ S Main Building: Accessory Building:
• Arch/Eng. License No. - TYPE OF PERMIT ❑ GRADING LJ FOUNDATION LJ STRUCTURAL T Front o
Address - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL A Rear N
Contractor's Name Crank Rt-MS ROnfi rigPhone 54R-5569 CI OTHER C Right N
Address(mailing) 126 Commercial Way, C.M. 92627 PROJECT DESCRIPTION SQ. FT. 1 750 OCCUPANCY single K g G
CONSTRUCTION TYPE residential VALUATION$2 198 OO $ Left •
City License No. OOS993ZONE GRADING CU.YDS. . ACRES R
LICENSED CONTRACTOR DECLARATION • - Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: O
S with section 7000) of Division 3 of the Business and Professions Code,and - M
Or my license is in full force and effect. , —_ T
License Win • a License No S
L....)
Date 'yU - " Signature W'_ �/ - �/`��>7� PLUMBING FEES
WORKERS'COMPENSATION • ILA ATION
I hereby affirm that I have d trite of consent to self-insure Or a certificate
Bar Sink
of Workers' Compensation rants, or a certified copy thereof (Section 3800, lab. C. 0 15-50 KW
Policy No. Wp85362466 Company Fremont Indemnity114b___IIIirnL. ■
P Certified copy is hereby furnished.
,Certifi is I d with the city BuildilcTTh•.I siR ,,,(� 11 .
Date ION FRO fig Applicant /�� '4�^� I
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION IIEJt1wr
Meter ■.• • 11 amps
(This section need not be completed if the permit is for one hundred($100) or
less). Dishwasher Solar Piping Dryers OGas 0Electric Sub Panel
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 • I
Workers' Compensation Laws of California. Motors
Date Signature Floor • II .
NOTICE:If,after making this declaration,you should become subject to the Inc.Solar
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater
Lender's Name Outlets ' Range
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or Lavatories • -
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry
any structure, prior to its issuance, also requires the applicant for such permit Trays Generator ❑0-5 KW❑5-15 KW Trash Compactor
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
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 Reinspection Fee I $15 Issue Fee •
compensation, will do the work,and the structure is not intended or offered Reinspection Fee $15 Issue Fee - $ 3
for sale (Section'7044, Business and Professional Code: Tho Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon,
mep ogees provided�hat such mprovementsearelfor not Intended hish offinera for Boiler Hood or Type I ❑wn DEVELOPMENT SER VICES REO UIREMENTS:
' sale. If, however, the building or Improvement Is sold within ono year of com- Canopy Type II 0 Zoning Approved By Date
pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground .Building ApIssued By Date
prove for the purpose of sale).
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By . Dat: i ®�)(�
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-110,000 BTU 0100,000 BTU SUMMARY FEES
builds or improves thereon, and who contracts for such projects with a con- CO
tractor(s) license pursuant to the Contractor's License Law). I am aware that ,Exhaust System 0 Multiple 0 Systl Repair/Alter. 'on BUILDING PERMIT $ -o _
SMTP $ -
proof of their Worker's Compensation insurance should be provided to me. ••• PLAN CHECK $ PERMIT
,
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers . C S i PLUMBING $ ISSUANCE $
Date Owner ,
= • Registers =0a • —.
• ae PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this applicali nd st a that the above00-100,000 11110 - 9111 ELECTRICAL $ GRADING $ - -
information is c•����{{{{,,,, 1. I agree t0 Comply with ly an County Ord loances .
and state laws r •ng to building construct and he by authorizeer repre-
sentatives
epro- Date _ _ _ S PLAN CHECK 50% $ MICROFILM $
and iof th Ityng enter opo th e- lonetl properly for
Inspection puree •� MECHANICAL $ - _ - Q
Signature G. Date TOTAL FEE $ 8 •��
Drivers' Lic-dor SS# — — 3(1/71/A6 Ill Reinspection Fee $15 111 $ Issue Fee $ 3 III PLAN CHECK 25% $
C\ CMF 0865-46,•. 10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
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CONSTRUCTION AND PLANNING POOL & SPA ,
Date Inspector Date Inspect
APPROVALS Permit# - APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 1
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 1
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -- \
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 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
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14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. 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-Bat 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
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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 - - •
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation ,
44. Landscape Irrigation System
45. Sound Attenuation
. Handicap Regulations
(.8"ii
NALSTRUCTURE & BUILDING /�w4 �f4ecial Requirements Completed '6' /
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co i i
51. CERTIFICATE OF OCCUPANCY r /
No. Date /
I
I PROJECT ADDRESS: 1053 SAN PABLO CI NIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 0231,
OWNERSNAME: GREEN RICHARD S
,•J. 4 ADDRESS: 1053 SAN PABLO CIR PERMIT NO-: B 052231 PLAN CHECK NO: N GOVT: N SUPP52. N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
850-9747
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESHT. REROOF W/LITE TILE SQ FT: 3, 450
ADDRESS: UNIT:
CLAIM VALUE: 3, 450 . 00 CALC—VALUE: 3, 450 . 00 GROUP OCC: R-3 /
PERMITTEE: CALTON ROOFING ( 714 ) 662-0779
ADDRESS: 3009 COOLIDGE COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
+Ir
COSTA MESA CA 92626 **************** e******)' * ******BETE**********************TE*•*TFle3A*************TE*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force anddeelect. SETBACKS
CITY LIC.: 051149 STATE LIC.:587704 ._ Cjj���ss�(�3 l //
�mJ•
e: ' Si—" I Signatuie: � MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that have acendicate of consent to sell-insure oracendicale of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
Compensation Insurance. or a certified copy thereof(Section 3800,Lab.Cl
POLICY EXP. DATE:
COMPANY: PARKING RE PROV: PARCEL: 41206117 ZNE: REF NO:
❑ Cerlilied copy is hereby famished. 0 Certified copy is filed with the city Building Division. PLANNING N TE$>
>
*************-N****M*********************************+(************N.*************
Date: ADDlicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(3100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued.I hall no mpfoy a person in a Boer so as to become
subject to me Workers'Compensation Laws of California. �,j� / ZONING APPROVED BY DATE:
5• ^ aft ` y you7 l F/ BUILDING APPROVED BY • DATE
NOTICE:IL atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor '
Code.you must fonhwilh comply with such provisions or this permit shall be deemed revoked. -- Y - 37—.3/—74C
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: I - DATE:
which this permit is issued(Section 3097.Civ.C). ***.*.*.*.**.*'**********************•********* .***********'****i('***.**4********* ***
LENDER: *************WS****************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 63 . 00 ,50
ep
rair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed $MIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business p
LAN
and Professions Code)or that he/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). ISSUE FEE •
as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 63 . 50 0 • 0 0 0. 00 6 3 • 50 '63 . 50 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himselllhersell or through
his or her own employees,provided that such improvements are not intended or offered for sale.If, however the building or REVENUE DIVISION TOTALS--> COLLECTED: 63 . 50 OVER/SHORT• 00
improvement is ofsallee sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
mr me purpose of (. 63 . 00 . 5 0
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business -
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law).l am aware *************************'**'**'*****'****'***'****'******'IF'***************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C. .
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dale: Owner: SFR 3450 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 3, 450. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES
25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. /
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and stale laws relating to building construction and hereby authorize repreS6.+fives of thi icy to enter Non e above-mentioned
property Ior inspection purryposes. // '
i,-----r-
Date: Sr SI ' E—/ Signature: i/ ./.I. -_i S r G. nUtt-c.34.-7.1,215.;51-
5y.__i`ES,S.T' __ _ _ '
Drivers License or Social Security if: GAT:: C: "1."7 -_i;E: _ - ,
164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
A
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QONSTRUCTION AND PLANNING POC._ a SPA
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-Undtgrnd. . . 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER 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, 0 Undrgrnd.
1 10. Structural Floor System ' ' - 61. APPROVAL TO DECK
11. Property Sewer Line & HouseConnection /, '
62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
i
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
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. 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 i 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
"
25. Roof Sheathing -,F--1( Pk . 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 ;-4 • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat' • ' . 79. FINAL INSPECTION -
32. Electrical Power Meter-Final - • .80. FOOD CERTIFICATE ISSUED
. 33. Final Electric i '• �; Notes: ,
34. Final Heating& Air Conditioning I - �
35. Final Gas Pipe-Test +,
36. Hood or Canopy I "- i, - • .
37.-Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final '
•
40. Gas Service-Final .
• 41. Solar Domestic-Final
42. Backflow Preventer,
43. Backflow Irrigation
.44. Landscape Irrigation System t�C/.-Gt(.. , 7a,0iar del (94‘
45. Sound Attenuation - a eel/
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING 6,-/y-qt Get?6'
48. FINAL PLANNING './
49. Electric Release to Edison i + •
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY
ko
Date 1
OWNER SELTZER FRPRISES - C. M. DATE 9-26-69
JOB ADDRESS 1053 San Pablo Circle BUILDING PERMIT NO. 30871
GENERAL CONTRACTOR Same DESCRIPTION of WORK Residence WjAttached Garge
AP No. _ LOT 16 TRACT .638 FIRE ZONE VALUE $ 22.034.00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-1
GASSOIL MS2c !7a SUBCONTRACTOR Date PERMITS ISSUED
I Number I Signature
WATER( q M 54y .7/ P mbin•.
ROUGH PLUMBINGr�� NIS't- i—Id
PROP. SWR. LINE [{OUSE CON. TI/ /i s1 -2Q P / MI eltrAWA
SPRINKLING SYSTEM !-
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING 4,15. r `• 7V
TEMPORARY SERVICE OR POLE
UNDERGROUND U POWER 0
_.._
ROUGH WIRING r�r� L ki2,20 • Hearin• and V t.
TRENCHES Ki FORMS Ei STEEL REINF. E s- - -
FLOOR SYSTEM 4,/_/e9-70 i M _/i -) i%
BOND BEAM n STEEL REINFORCE n '.
SHEATHING (BAtY S,24 -919
FRAME AND FLASHING . . ii 6 la
LATHING — IN r1 OUT I f h' & 34.,tr, o
nn
PLASTER, BROWN COAT 01 pailZO
STRUCTURAL, FINAL ��j E ct)iic� ) f
HEATING, VENT., REFRIG. AND A.C., FINAL A.1 S /O 11 -Z, L _lay , t{/, 6'3-7Q 3lig/
PLUMBING, FINAL AND GAS TEST n AA c4J Z-7(•V /
ELECTRIC, FINAL ` •ZZ •7p
BUILDING, FINAL S � 7)
50871
MOV 12-69Cg5ROO 404* ***I 24.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
R ECE,Ij D�yTE E/ I DATE ISSUED
BUILDING 1053 San Pablo Circle [U %/67� SEP 2 6 1962
ADDRESS
PERMI.
OWNER Heltzer Enterprises-Costa Mesa A.P.NO. 'iII /
MAIL BUILDING r
ADDRESS sizm
740 No. La Brea Ave. ADDRESS `D,,J L
i v CITY L. Zid
L.A. Calif. NO. 937-2171 TRACT 6638 LOT 16 BLOCK
1— Z
2 < CONSTRUCTION
United California Bank NEW DD I ALTER I REPAIR I MOVING f1FMnI LSH
1— LENDER 111
am Main Office
0- BRANCH
Q w 6th and Spring, L.A. OWNER
t
CO —I ADDRESS �Q VALUE �/) �t
J Q OR ENGINEER Frank Gonzales NO
Frank USE / /r Slit 0e/
Za 1336 E. Chapman Ave. Orange, Cs... FIRE / 0.�/ Q�
W 2 ADDRESS ZONE TYPE / GROUP !J'/(//J"
0.1.9
W Z CONTRACTOR George J. Heltzer & Assocs. APPROVEDPRDATE
J Q
OD Z same as above
J Dc ADDRESS
W W TEL. ZONE INO.OF USE OF NEWsingle Fant.
ZH CITY NO. PLANS 2 BUILDING Res. w/att.Gar.
W O STATE 201098 CITY 1707 YARDS APPROVED YARDS APPROVED
NCC LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDGS. (FROM C/L STREET)
OF LOT NOW ON LOT FRONT 5-0 FT. FT.
USE OF
EXISTING BLDG. R.SIDE ,_.CT. FT,
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE 5 1 //' /
J FT.cit....------ FT.
VEXTERIOR WALL ROOF
_ COVERING COVERING REAR 2.0 FT. FT.
-J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
0-
a MAIN BLDGS. ACCESS. BLDGS.
Q Residence with attached garage VAR.# DATE
o C.U.P.# APPROVED
N 4O2 APP
ROVED WLD DATE /o/47 /6y
o J
C~.1I hereby acknowledge that I have read this application and state
D that the above information Is correct and agree to comply with
ct all laws regulating building construction, and I shall not employ
F„ any person In violation of the workman's compensation laws of ���
H the State of California. / Sv ��9 ////Y 0
I hereby certify that I am properly licensed as a contractor under T/ SQ. FT./ /� 0
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT S OWN 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: b
am exempt from the provisions of the State of California Business a:
and Professions Code,Division 3,Chapt r 9. VALUATION /�`O O n
PERMIT FEE $ (f.--/9e 3
Signature of ccnc//��1 77771111 .s� 0 m
Permittee $ate/ 113aft PLAN CHECK $ / /`�� E
Authorized Agent ` 025. 5—o 2
TOTAL FEE $ / -
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant To Fill in Completely APPLICATION FOR BUILDING PERMIT
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING
ADDRESS / O //�/s1 C ...4, / )f(f le, tc-r)
PERMIT NO.
OWNER A.P.NO.
MAIL BUILDING
Z ADDRESS
ADDRESS
W W TEL.
D.Z CITY NO. TRACT CiC.j A I LOT /4 BLOCK
Z
Z Q CONSTRUCTION NEW ADD ALTER REPAIR MOVINFI nFMDI LSH
Z
ON LENDER
am
_ID BRANCH
_I(/) OWNER
CD—I ADDRESS VALUE
ARCHITECT TEL. $
J N 10
OR ENGINEER NO. N.
Z< FIRE
¢ ADDRESS ZONE TYPE GROUP
O. W APPROVED
W Z CONTRACTOR BY DATE
J Q
CO
J EC ADDRESS
WW TEL. ZONE INO.OF USE OF NEW
Z= CITY NO.
_ PLANS BUILDING
N
W STATE CITY YARDS APPROVED YARDS APPROVED
to Q LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
n SIZENO.OF BLDGS. (FROM C/L STREET/
OF LOT NOW ON LOT FRONT 5—OFT. FT.
USE OF
EXISTING BLDG. R.SIDE -FT. FT.
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE '2-) FL FT.
VEXTERIOR WALL ROOF
_ COVERING COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED
d DISTANCE BET. BET.MAIN&
CL _MAIN BLDGS. ACCESS.BLOCS.
0
Q VAR.sR DATE
C.U.P.* APPROVED /\I
Z � L/oY APPROVED �A //�
DATE r ,y/ 2`�
0 YY d/Y
C~.1 I hereby acknowledge that I have reed 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
CO the State of California. 0
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, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: t
am exempt from the provisions of the State of California Business m
VALUATION
and Professions Coda,Division 3,Chapter 9. 03
n
PERMIT FEE $
D
Signature of m
Permittee $ PLAN CHECK § E
O
LL
Authorized Agent TOTAL FEE $