HomeMy WebLinkAbout3416 SANTA CLARA CIR - Building Permits.
CITY OF COSTA MESA
BYILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax p74) 754-4856 • wv+w.ci.costa-mesa.ca.us
FOR INSPECTIONS CALI: (714) 754-5626
PERMIT TYPE B_ROOF2
APN: 41206147
JOB ADDRESS:
Vicinity: ROOF
Squares: 0
PERMIT NUMBER: 609-00227
STATUS:
DATE ISSUED:
ISSUED BY:
3416 SANTA CLARA CI CM Suite/Unit:
Valuation:
ISSUED
10/15/2009
RMD
$5,985.00
SCOPE OF WORK: TEAR OFF (E) ROOF MATERIALS, INSTALL A 28# CLASS "A" FIBERLASS BASE SHEET, INSTALL TWO LAYERS
OF 11# PLY HOT MOP AND 1 LAYER OF CAP SHEET ON AN ATTACHED HOUSE AND GARAGE, APPROX 20
SQUARES.
OWNER: GOULD, LESLIE ANNE
PHONE: 714-545-2808 .
APPLICANT: DIAZ, LINDA
PHONE: 949-642-7222
CONTRACTOR: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AVEUnit:
City/State/Zip: COSTA MESA, CA 92627
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspedion Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$125.25
$0.00
$1.00
$126.25
Address: 3416 SANTA CLARA CIR
City/State/Zip: COSTA MESA, CA
Address: 1653 1/2 SUPERIOR AVE ''
City/State/Zip: COSTA MESA, CA
License No.
License No.
PHONE:
License No. 349686
949-642-7222
CELL:
PHONE:
PHONE:
Unit:
Unit: :
NO710E: The work authorized by this pertnit shall comply with all applicable handicap access requirements under California statules and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
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.
O�DE�. INSiECPONTYPE DRTE INIIIIRIS OER INSPECTIONTYPE OATE INTITIAL
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Ra-Root ��� � 270 Final Electriwl
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/OccuOancy
WORKERS' COMPENSATION DECLARATION: "
I hereby affrm under penalty of perjury one of the following tleclarations:
❑ I have and will maintain a certifcate of consen� lo self-Insure for workeis'
compensation, as providetl for by sec[ion 3700 0( the Labor Code, for the
performance of the work (or which this permit is issued.
❑ I have and will maintain wnrkers' compensa[ion insurance, as required by
section 3700 of the Labor Code, for the pertortnance ot the work (or which this
pertnit is issued. My workers' compensa[ion Insurance carrier and policy
numberare:l�,�{�� � t��
r`'". J 1�� 1 �1
Carner
(This sec(bn neetl no( be mmpleted �(he pe(rm�R is valvetl at o�n1e hundred j ollars (5100) oi less )
Pol Number. �UO� 22-T7 � ZvU G
❑ I cehify ihat in the peAormance of the vrork (or which this permit is
issued, I shall no[ employ any person in any manner so as �o become subject
ro the workers' compensation laws of Califomia, and agree that if I should
6ecome subject l0 1 e workers' com a sation provisions of Section 3700 of
the Labor , I ha I forthwith con� Ny h ihese provisions.
U � �U `�
/ pyCanl's n ure Udle
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, II�fTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby a�rm that I am licensed under provisions o( Chapter 9(commencing
with Section 7000) of Division 3 0( the Business and Professions Code, and
my license is in full force and eHect.
���: #,.� U `b lo �` # C3�1
�~ �U� ��'��
� �y2brls�5� lure �Date- �
CONSTRUCTION LENDING AGENCY:
❑ I hereby aRirtn that [here is a consWction lending agency for the
peAortnance of the wurk fa which Ihis permit is issued. (Sec. 3097, Civil Code�.
Lender's Name:
Lentler's Address:
SignaWre Date
OW NER-BUILDER DECLARATIONS:
I hereby affrm that under penalty of perjury thaf I am EXEMPT FROM THE
CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any ciry or county which requires a permit to
construct, alter, improve, tlemolish, or repair any stmcture, prior to its
issuance, also requires the applicant for such permit to file a signed slatement
Ihat he or she is licensetl pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of �he
Business and Pm(essions Code) or tha[ he or she is eaempt therefrom antl
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
fve hundretl dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl the strucWre is not intended or
oftered for sale (Sec. 7044, Business antl Pro(essions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided ihat 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 Ihe 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 consWct the project (Sea 7044, Business and
Professions Code: The contractors license Law does not appty to an ovmer of
property who builds or improves thereon, antl who coNracts for such projecl vrith
a contracior(s) license pursuant to the Con[rectors License Laws.).
❑ I am exempt under sec.
Business and Professions Code (or this reason:
]051-a6�310�)
Owner ID verifed by drivei o iicense. ❑ Yes ❑ No �
Driver's License No. Expires:
Verifcation o( Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUS7RIAL SAFEN PERMI7 CERTIFICATION:
❑ I hereby certrfy that no excavation frve (5) or more (eet in tlepth in[o which a
person is requiretl to descend, will be made in connec[ion with work auNorized
by this permit, and Ihat no building s[ructure, scaflolding, (alsework, or demolition
or dismantling thereof, will be more [han thirty-six (36) fee[ high. (Chap. 32, Grp
2, M 2, Sea 341, Ttle 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
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.
ApPhcanl'S Signature
Division of lndustrial Sa�ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or presen[ or Wture building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, wiih some
exceptions, that a Business Plan be fled with the CosW Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantity ot hazardous matenals equal to or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic teet of compressetl gas
at stantlartl temperature and pressure).
2. Does or will Ihe applicant or present or tuture building occupan[ need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires regis[ration with lhe Costa Mesa Fire Department by
each business which al any one time has on hand a quaNity of awtely
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
temperaWre and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management antl Prevention Program tor acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code pmvides [hat the
Costa Mesa Fire Department may require the preparation, certifcation and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 0( the Calitomia
Health and Safery Code been fully complied vrith? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre buiiding occupant require for
the work which is lhe subject of this application a permit for such construction
or modifcation fmm fhe South Coast Air Qualiry Management District or from
any other air poilution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Calitomia Govemment Code requires Ihat ihe requestetl
in(ormation be fumished on applications (a nomresiden[ial building pertnits�.
6. Will any part of the facility ro be constructed under this permil be within
1000 (eet from Ihe outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", the facility musl meet the requiremenl of Sections 25534 and 42303
ot ihe Califomia Health antl Safety Cotle�.
7. If a permit fmm the South Coas[ Air Quali[y Management Distric[ or other
air pollWion control district or agency is required for Ihe work which is Ihe
subject of this application, have all of lhe tlisclosures prescribetl by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Q( "yes", attach certificate of compliance from the appropriate air pollution
contml of(icer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correct I agree to comply with all state lavrs antl
ciry ordinances regarding Hazardous Materials and Emissions.
SignaNre �ate
CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry o! perjury that I have read this application and state that
the information given is correct I agree to comply with all slate laws and ciry
ordinances rela[ing to building construction, and authorize representatives of
the Ciry o( Costa Mesa to enter upon the above-tlescribed property for
inspection purposes. I agree not to occupy or allow occupancy o� any building
authorized by this permit until fnal inspection.
Signat e� legal Ovmeqs)� Oa�
l U• I�'i5�i
/ r Jtf�Crv[e Appiicant�-^^' L�[We
AVP�icant to fill in all spaees exceot tnose within heavY eortler Iines ana sign all aoP�oprlata
:I�Y OF COSTA ME A (JC'ON TRUCTION�P/�ERMIT d PERMIT NO. ,� TRACT NO. LOT NO. UNIT NO.
Project Addr¢ss � �+' � � �� �/� / � �r/7 . �
Applicant'sMailingAddress�0. 3oy6 oR.t�e ���a2[�6�657
Owne%/TVame 6GOf�%a Ci1rN1l( Phone��y
Addr�s 3G/�6 S/4'Nfu GG•4rc�.
Arc�/Eng. I✓ �Ne License No.
Address �jt�o� ��
Contractor's Nam C � � Phone _T���
Address Imailingl 'V •C a 6 C7 Q C 9 6
Ciry License No. J 3� 7
LICENSED CONTRACTOR OECIARATION
1 hereby affirm lhal I am IicenSetl untl¢r provi510nz Of Charte� 9(comm¢n<ing
with zection 7000) ot Divislon 3 of ine Business antl Professlons Cotle, antl
my license Is in tull force Pa tl e11Scb,
Licenze Class v J 7 / � t� n e No. e �
Date � V=�� _� Signature _
WORKERS' COMPENSATION DECLARATION
1 hereby aifi�m lhdl I have a certificate of COnsent lo self-in5ur¢ Or d CCrtIflGate
Workers' Compensa�Jtion Insurance, or a cerUfietl coypy Ne}�reof (Section
0, Lab. C.)j/p cJS S� �" �rA /Q r�1%��
licy No. `7 � Company
�Certifietl copY is hereby lurnisnetl. �
Certifietl copy Is filetl wilh the city Bul g I ion.
Date� Applican[ ✓u�
EXEMPTION F OM WORKERS' COMPENSHTION DECLARATION
(Tnissection neetl not be completetl ii the permit is tor one huntlrea (E100) or
lesz).
I certify lhat in [he performance oi [he work tor which this p¢rTl{ is issuetl, I
shall not employ any person in any manner so as to becomo subject to the
Workers' Compensation Lawz ot CalHomia.
Date Si9nature
NOTICE: It, after making thi5 tlecla�alion, you shOultl Decome subject to the
Workers' Compenzation provisions o( the Labor Cotle, you must �orthwith
comob with sucn provisions or this permit shall be tlaemetl revoketl.
GONSTRUCTION LENDING AGENCV
I hereby ai(irm that there is a consV uction lenaing a9ency tor lha per(ormance
o( the work for which [M17� �¢rmlt is issuetl (SeCtion 3097 Clv. C.)
Lentler's Name � ��
Lentler's Atltlress �
OWNER BUILDER DECLARATION
I hereby affirm lhat I am exempt from tne Contracror's License Law tor the
tollowin9 reason (Section �031.5 Business antl Professional Cotle: Any city or
county whicb requi�es a permi[ lo Cons[�uct, al[C/, Improv0, tlemoli5h O� repai�
any structure, prlor to i[s Issuance, also requires the applicant tor su<b permit
to file a signetl statement tnat he/sne Is licensetl pursuant to the provisions of
the Contractor's Licenze Law (Chapler 9(commenUng with Section 7000) of
pivision 3 of the Business antl ProteSsions Cotle) or [hat M1e/she is exempt
.efrom an0 lhe basis for the alle9etl exemption. Any violation o/ Sec[ion
1.5 by any applicant tor a permit subjec[s the applicant to a civil
�alty ot not more than five nuntlretl tlollars (5500�.
LJ I, as owner of tM1e property or my employeos with wages d5 thoi� sol0
compensation, will tlo the work, antl the structure is no[ inlendetl or offeretl
(or sale (Section 7044, Business antl Professional Cotla: The ContraGior's
LicenSe law tlo¢5 not appty to an owner of a property who Cuiltls Ov Improve5
thereon, and who tloe5 Su<h work himself/he�sell or througM1 hI5 or M1e� own
employees, provitletl that SUCh improvemenls ure not intentlatl or offoretl for
sale. If, however, the bulltling or improvement is soltl wlthin one year of com-
pletion, Ihe owner will have the burtlen ot provin9 he/she tlitl not builtl or Im-
prove forthe purpose otsale).
❑ 1, as owner of the property, am exclusively contracting wlth licensetl con-
l�aclorz to con5trutl the projec[ (5¢Ction 7044, Business and Profe55ion5 Cotle:
The Contractor's License Law does not apply to an owner ot property who
Cuiltls or improves thereon. antl who conVacts for such oroiects with a con-
tractor(51 hcense pursuane [o [ne ConVactor•s �icenu Law). I am aware tna[
proot of tbei� Wo�ker's COmpensation Insu�ante ShoWtl be provitled to m¢.
❑ I am exempt untler $ection B. 6 P. C. for this reason
TVPE OF CONSTRUCTION IJ NEW U ADD LJ ALTERATION IKJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH/y/R �
DESCfiIPTIONOFWORK/USEOFBLDG. /L'�—✓��
TVPE OF PERMIT ❑ GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELE/ �CTRICAL ❑ PIr.UMBING ❑ MECHANICAL
❑�OTHER ' I�Q Q �� r Pn q ♦
t7.7+�� p� �_
PROJECT DESCRIPTION 5. FT. 0 ±w.� �3 oCCUaarv V '
CONSTRUCTIONTVPE 'e �F � VALUATION$ '�'�'
ZONE CU. VDS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Batkflow Irrigaiion
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drair.s
Reinspection Fea � $15
Boiler
Duct - Under Ground
Duct - Strucmral
Duct - Ventilating
Exheust System ❑ Multiple
Firepl/Fact. Blt. IC80 #
Date Owner Heatin9 System & Ducting
I he�eby ce�tify that I have reatl Ihls appliCation antl state that [he above ❑Q10�,ODOBTU �700,0��
information is correct. I agree to comply wi(h all city antl county ortlinances
antl Slat¢ laws �elating builtlin9 �o on, dntl h¢r¢by autho�Iie r¢pre-
Sentdtives of this city t0 e er the dDOve-mentionitl prop¢rty tor
InSpection pu�pase5. Q /
Si9nature . �'� \ Date
Dr{vers' License or 55 � Reinspection Fee
0865-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Accounting: GoltlenrOtl - A55es5or
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Wacer Heater
Water $ervice
Auto-Wash
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. aW
S Main Buildi
E
T Front
B Rear
A
C Right
K
g Left
Ping. Ref. #
Plannin9 Notes:
Auromatic Washer
ConStruction Pole Sub.
Cooking Unit
Dishwasher
Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0-5 KW
2one
8
ELECTRICAL
Transtormer ❑ 15-50 KW
❑ 50+KW
15KW
Meter LJup to t00amps
Meter ❑over100amps_
Sub Panel - _
Motors �0.1 HP � t Y. - B
Inc. Solar �9-75 HP �16-15+
Microwave
Pale Li9ht -
Range
Sign
Standing Sections
Trash Compactor
� Reinspection Fea �$15 I I luue Fee
$ 3 DEVELOPMENTSERVICESREQUIqEMENTS:
2oning Approvad By
FEES Building Approved By � �
$ 3
BUILDINGPERMI7 $
PLAN CHECK $
PLUMBING 5
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
O
N
i
N
G
R
E
U
M
T
5.
FEES
S 3
FEES
SMIP $ . SY%
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING $
MICROFILM $
TOTALFEE $ �a3•S'�
�a �c:;�.:--��;�.; - �:-- . -
J` ... iLi �J �FI , . _ -�_ �.
t I,
„ CONSTRUCTION ANDPLANNING
� � .
APPROVPICS Permit #
��
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd. . .�
3. Electrical Conduit Utility-Undrgrnd�.
'
4��IecVical Conduit,-Undrgrnd.
5!'Steel Reinforcemen4� ,f .)
6,�Electrical UFER�Grnd �� �'`�
7. Footings � �
� r
8. Foundation x :
. i
9. �Water Pioe-Undraind: `�
10.',Structural Floor System •
11.,Property�Sewer Line & House Connecti
�
12. �Sewec Cap / : •� �'
13;:Roof Drains ' �'
'r
14'"Rough Pluinbing"( %, �
15. Rough Electrical-Conduit
16.� Rough Electric Wiring
7 �� Rough Wiring Sign _
1-8., Rough Electrical-T Bar Ceiling ;� �
19.� Rough Heating & Air Conditibning
� ..
20� Rough Factory Fireplace .;� -=�
�
21. Ducts, in Struciu�e �; �
22. Ducts, Ventilati� � J�
23. Gas Pipe-Rough & Test'� "
,�
24. Roof Framing � i � � ` '�
.1' , ..�.� i
25. Roof Sheathing; ,: : � �
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing - , �
28. Lathing & Siding:� "
•'�' . V
29. Insulaiion � •
�'
, _
30. Drywall Nailing .- �; ,'
31. Plaster Brown Coat
. i -1- /�
�
32. ElectricalPowerMeter-FinaCy ��
. � t
33. Final Electric ;�
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Tesi
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service�Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern Catiforn+a Gas
51. CERTIFICATE OF OCCUPANCY
Date
r~G ,� G
iC j
Date�
.
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Inspector
APPROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. FIPPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. S[orage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
0
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Date �Inspector
a.
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OWNER HELTZER ENTERPRISES-COSTA MESA DATE q_Z6-69
JOB ADDRESS 3416 Santa Clara ;�ccle BUII ^'NG PERMIT N0. 30901
GENERAL CONTRACTOR Same ! E'a DESCRIPTION of WORK Racidnnce W/Attachrd Qxragi
APNo. LOT 4g TRACT 6638 FIRE ZONE VALUE$�q_563_00
GAS
WATER
PROP. SWR. LINE �[J HOUSE CON.
SPRINK�ING SVSTEM
ROUGH HEATING ANO AIR CON�ITIONING
UN�ERGROUN� ❑ POWER
ROUGH WIRING
BONO BEAM ❑ STEEL PEINFORCE
SHEATMING
ME ANO FLASHING
NING - IN Ol1T
STER, BROWN COAT
UCTURAL FINAL
HEATINC
PLUMBII
ELECTRI
BUILOIN
VENT., REFRIG. AN� A.C., F
, FINAL AND GAS TEST
FINAL
FINAI
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA. CALIFORNIA 92626
'�OU t?_-69PA���00 438# ���152.25
CMSA
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
BUILDING f7ECE D TERF�C V D SEP z�G 1969
ADDRESS 3416 Santa Clara Circle �'
.�— PERMI�TN9.(�
OWNER Heltzer Enterprises-Costa Mesa q,p, NO. .S�.I�'P� 1
MA�� BUILDING � /%/
ADORESS 740 No. La BTEd AVE. �+DDRESS 7
CITV I+.Ei. Calif. No��93 -2171 TRACT 6638 V �or46 BIOCK
CONSTRUCTION United California Bank W Aoo n
LENDER
BRANCH Main Office
nooaess 6th and Spring OWNER i/
VAWE ry cj�
ORENGINE R r'. Gonzales NE�. 532-687 5 � 5..'Z oiro
FIRE /�[
nooaess 1336 E. Chapman Ave.Orange,Cal. zoNe TVPE GROUP l/
coNrancror�eorge J. Heltzer t4 ASSOCS. ByPROVED DATE
ADDRESS Same dS above
TE� ZONE NO.OF USE OF NEW II$ e
dTV NO. [u P�� 't BUILDING REH. W BCC. •L.
STATE CITV �'AROSAPPROVED VARDSAPPROVED
LIC. NO. zOlO9H LIC. NO.170 MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLDGS. (FROM C/lSTREET)
OF LOT NOW ON LOT ROM O FT. FT.
USE OF /
EXISTING BLpG. T. FT
S12E OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE FT. FT.
EMEiiIOR WAIL ROOF /
COVERING COVERING REAR FT.(7 FT.
USE OF BUIIDING AND WORK TO BE PERFORMED DISfANCE BET. BET. MAIN &
MAIN BLDGS. ACCFSS. BLDGS.
Residence with attached garage C URP 9W APPqOVED
Plan No. -46&— jy- PP7ROVED D
I hereby acknowletlge ihe[ I have reatl this application antl stata
chax tha above information is correct antl agrea to comply with
all laws regulating builtlln8 const�uction, antl I shall not amploy /��C `S _�
eny person in violatiOn Ot tha wOrkman's cOmpensntiOn laws Ot
the Sxaca of Celibmia. a_ �� �
Ll� ��O gQ. FT. � O
I hereby certity that I am properly licensetl as e contractor untler
tha State ot Calitornia Business antl Protassions Cotla, �Ivisicn 3, THE AMOUNT SHOWN UNDER VALVATION IS FOR '
Cnapter 9, and Net such licenses are in full toree and effact, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV: Q
am ezempt from the provlsions of tha Stete of Cel(fornia Buslnass
VALUATION
entl Professlons Cotle, Divi Ion 3, CI ter 9. /'7 / m
PERMIT FEE $ �
J
Signatura ot 3� — m
Permittee $ / PLAN C ECK $ E
Autho�izetl Agant �J �J � �' 7 LL
O�'i� L�J TOTAL FEE $
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COS7A MESA. CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BV DATE PECEIVED DATE ISSUED
BUILDING 'a
ADDRESS
PERMIT NO.
OWNER A.P. NO.
MAI l BUILDING
ADDRESS ADORESS
TEL TRACT LOT (p BLOCK
CITY NO.
CAN5TRUCTION W A A
LENDER
BRANCH
OWNER
ADORESS VAIUE
ARCHITECT TEL. S $
OR ENGINEER N
IRE
ADDRESS ZONE TVPE GROUP
APPROVED
CONTRACTOR BV DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
CITV NO.
PIAKS BUILDING
STATE CITY �'ARDSAPPROVED YARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
S12E NO.OF BLDGS. (FROM C/L STREET)
OF LOT NOW ON LOT ROfYT FT. FT.
USE OF �/'
EXISTING BLDG. 7 FT
SIZE OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE I FT. FT.
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILOING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BlOGS. ACCFSS. BLDGS.
VAR. #` DATE
' J C.U.P.qp APPROVED .
� �i` � APPROVEO T
V (/
�
I hereby acknowledBe that I hava reatl this application antl stete
that Me above information is correct antl eB�ee to comply with
all laws regulaNng builtling consb�ttion, entl I shall not employ
any person in violaiion of ihe workman's compensetion laws ot
the State of Calibmla. m
e
I hereby certify that I am properly licensetl es a conVector untler SQ. FT. o
the State of Californie Business antl Professions Code, Dlvtslcn 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR �
Chaptar 9, antl that such licanses ara in full torca antl attect, or I THE PUFPpSE OF ESTABLISHING A PERMIT FEE ONLV: m
am ezempt from the provisiOns ot [he S[ate of CalifOrnla Business Q
antl Professions Cotle, Divisian 3, Chaptar 9. VALUATION W
PERMIT FEE $ �
]
SiBnature ot m
Permittee 5 PLAN CHECK 5 E
`o
Authorizetl Agent LL
TOTAL FEE $