HomeMy WebLinkAbout1071 SANTA CRUZ CIR - Building Permits l
• CITY OF COSTA MESA •
cool kw BUILDING DIVISION
9Q
P• '-Ala 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
vFOR INSPECTIONS CALL:(714)754-5626
.
PERMIT NUMBER: BX10-00069
PERMIT TYPE BMISC STATUS: ISSUED
APN: 41206130 DATE ISSUED: 04/30/2010
Zoning: R1, ISSUED BY: KJB
JOB ADDRESS: 1071 SANTA CRUZ CI CM Suite/Unit:
Vicinity: Primary Occ: Const Type :??
SQ. FT: 0 Valuation: $1,500.00
SCOPE OF WORK:
REPLACE SIDING ON FRONT OF RESIDENCE AND ON THE GARAGE. MINOR STUCCO REPAIR WHERE SIDING IS BEING
REPLACED. NO HOA PER OWNER. MISC TRIM WORK.
OWNER: GUINA, RICK Address:: 1071 SANTA CRUZ Unit
City/State: COSTA MESA, CA Zip Code: 92626-1618
Phone: 949-338-6420
APPLICANT: GUINA, RICK Address: 1071 SANTA CRUZ Unit:
City/State: COSTA MESA,CA Zip Code: 92626-1618
Phone: 949-338-6420
CONTRACTOR: License No.
Address: Unit:
City/State:
Zip Code: Phone Cell:
ARCHITECT: License No.
Phone
ENGINEER: License No.
Phone
FEE SUMMARY
Building Plan Check: $0.00
Building Permit: $54.00
Electrical Permit: $0.00
SMIP Residential $0.00
SMIP Commercial $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $55.00
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Satrudays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal Holidays:
New Years Day, Memorial Day, Independence Day,labor Day,Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE I. INSPECTION TYPE DATE INTITIALS CODE I INSPECTION rrpg DATE INTRIALS
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 �7 u�/'�.�,, �,r,
204 Final Demolition 250 Final Building/Occupancy /-/4-m 6�'1*91 412)
f .
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive...License. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,cr demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp
(T ' section need not be comdetedIthe penny is valued al one hundred do8ars(Sted)orless) 2 Art 2,Sec.341,Title B,California Administrative Code).
Poli Number:
0 As owner-builder. I will not employ anyone to do work which would
I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
Issu , I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Dale
the Labor Code I shall forthwith comply with these provisions
JDivision of Industrial Safety Permit Number:
Appecam's Signature rate HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
• ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lit.# Class# (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct. alter. improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No
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 (Section 65850.2 of the California Government Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes" attach certificate of compliance from the appropriate air pollution
employees. provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
complet n, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did no uild or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
I. as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
IC' NSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contracto(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described properly for
inspection purpos s. I agree not to occupy or allow occup.ncy of any building
I` authorized by this mit until final inspection. f
v Signatu of Legal Owner(s) / Date
Signature Dale
3057-4613/07) ' / And/or Authorized Applicant Date
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO, 6638 DATE October 8. ;970
LOT NO: 29
ADDRESS 1071 Santa Cruz Circle
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
John E. Stone (was or were) Carolyn A. Stone advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map vas approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
BY 1-0:4—,f
.i/4
er
rch / o Stone
7'727 one
rP BYDeveloper cauthorized
representative
BY
Lender
CITY O MESA
•
4 BUILDING DIVISION
}•;�x ..41 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
/
. �f PERMIT
+ B01-01233
ePoRmso
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1071 SANTA CRUZ CI Status: ISSUED
Suite: Applied: 08/08/2001
Vicinity: • Issued: 08/08/2001
Parcel Number 41206130 Zoning: R1 R1
Applicant: NARKHAN,GREG ISSUED BY: 01-L--
Address: 15201 PIPELINE LN#A
Phone: (714)936-5908
HUNTINGTON BEACH,CA Zip: 92649
Owner: LEE;ALICE
Address 10751 ROCKHURST AVE
Phone:
SANTA ANA,CA Zip: 92705
Contractor: CONSUMER SERVICES
Address: 15201 PIPELINE LN#A
Phone: (714)936-5908
HUNTINGTON BEACH,CA
Zip: 92649 License: 676090
Arch : Eng:
Address: Address:
Phone: Phone:
•
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF WOOD SHAKE INSTALL 7/16"OSB, 1 LAYER 30 LBS FELT AND 30 YEAR COMP. SHINGLES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,000.00
Permit: $97.25 Claim Valuation: $4,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
•
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
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)
DECLARATIONS I ..
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 erformance of the
work for which this permit is issued. L
(�[ 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 workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($1 00)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'
cornpensatlnn I-ws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
m• with these• •visions.•
••plicant Signature: �� ta4X.Q •: : .d'
- ING:FAILU: CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SW IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
•owl,. i• RE($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SE ON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CO : • •RS DECLARATION:
I here. = ed,under provisions of Chapter 9(commencing with Section 7000)of Division • ' . s loess and Professions Code,and my license Is in full
• •=and effect.Lic.p - 7- . S-D Class a C3-
ontractors Signature. r• - Date: . AS
•NSTRUCTION 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,CMI Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that l am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following mason(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 properly,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 ❑No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 6,Califomla 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 end 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 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 ere required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application anermit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 0 Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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(Duality 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yet attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penally 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 Of Legal Owner(s) Date
L �Q�✓ c/• /a1
ppAttlThigized pp icant� v\Date'--
;ODE G tySPECTIONTYPE ;ODE( INSPECTION TYPE / \ PATE MEALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical t\ J
1266 Pool Spa Final c� ,qf 208 Final Plumbing
200 Final Re-Root o t 7 III t/L�� 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 HELTZER ENTERPRISES-COSTA MESA DATE 9-26=69
JOB ADDRESS 1071 Sant f J ,ruz Circle BUILDING PERMIT NO. 30884
GENERAL CONTRACTOR S DESCRIPTION of 1, .K Residence W/Attached Garage
AP No. - LOT 29 TRACT 6638 FIRE ZONE VALUE $ 24,636.00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-1
SOIL M511 I-7a SUBCONTRACTOR PERMITS ISSUED
GAS ��r(ii
Date Number Signature
WATER L4 41 i-L-f1-•70 A PI binq
ROUGH PLUMBING /r'f S 6.12--re �f rJ ![ p �/ /1-� 1p S7/0!
PROP. SWR. LINE ®HOUSE CON. At s 4, /7--ia (/f ��lJCf.f L�!/- Ap j7e2 ,�5 gi(4'�
SPRINKLING SYSTEM (/
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING ms(e-`7O
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER U
ROUGH WIRING^ e tri 7-70 ! Heating and Venter r�
TRENCHES 'Cl FORMS r] STEEL REINF. �I ,�,,//r� /�//4� -c- 70 / i-z--j[L /1Ale�ei� .Ja� / o 4L ,i
FLOOR SYSTEM teig V' v-, -TD :Pic cos// fi-ii L• �% *7-073-,77 `J/, -
BOND BEAM n STEEL REINFORCE n �t r, i
SHEATHING 6/ jeffl
7�
FRAME AND FLASHING ri j
LATHING - IN A OUT U5l Z 7)�/'r;a,
PLASTER. BROWN COAT ate S//S-/'e
STRUCTURAL, FINAL -may op
HEATING, VENT., AND A.C., FINAL -• /e;Ath 'L.(/t. /.��j-7/, ,piv.,/ 1—
PLUMBING, FINAL AND GAS TEST P- 7,--Z71 K /
ELECTRIC, FINAL %- o. u
BUILDING, FINAL ( S-�0
n• J884 PATO
COSTA MESA BUILDING-SAFETY DEPARTMENT '.OV 12-69�pSA00 421+ *133.50
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
/gI/ DATE IS U
ADDRESSUIL 1071 Santa Cruz Circle RE �/- q,�. ? _SEP L b tog
Heltzer Enterprises-Costa Mesa _� PERMIJ A
OWNER P A.P. NO. ;I'll/���`i/
MAIL BUILDING /0 y/` a V
ADDRESS 740 No. La Brea Ave . ADDRESS //
0 U CITY L.A. Calif.Breaz TRACT 6638 LOT 2- BLOCK
I- Z
Z < CONSTRUCTION United California Bank NEW TER REPAIR MOVING OEMfs LSH
O N LENDER
a m Main Office
J D BRANCH �/J-
m J ADDRESS 6th and Spring, L.A. OWNER / N VALUE,, / (lC
_•colc AORENGINEER Frank Gonzales NOL532-6878 s� / sa�/'lo�fo^�
UN FIRE ,/ I i \'/
W� ADDRESS 1336 E E . Chapman Ave. ,Orange, Cal FIRE TYPE // GROUP'"- �C//i/J
a W APPROVED
LU Z CONTRACTOR George J. Heltzer & Assocs. BY DATE
J Q
CC,Z
J cc ADDRESS Same as above
W W TEL. ZONE NO.OF USE OF NEWSingle Fam.
Z. CITY NO. B7 PLANS 7 BUILDING RPR. oar,.sen.
W STATE CITY 1707 YARDS APPROVED YARDS APPROVED
NCC LIC.NO. 201098 LIC. NO. MAIN BUILDING ACCESSORY BUILDING
D SIZE NO.OF BLDGS. (FROM C/L STREET)
OF LOT INOW ON LOT FRONT go,. FT.
USE OF
EXISTING BLDG. R SIDE /17 FL FT.
I- SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE y FT. FT.
taEXTERIOR WALL ROOF
.)
_ COVERING COVERING REAR 1 OFT. FT.
-I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
CL
a MAIN BLDGS. ACCESS.BLOCS.
Q RESIDENCE WITH ATTACHED GARAGE VAR.* DATE
C.U.P.qW APPROVED
O PLAN NO. 22 403 APPROVED //
co „FLY WLD DATE 10/7 / h y
04770
VI hereby acknowledge that I have read this application and state
✓ that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
F, any person in violation of the workman's compensation laws of
to the State of California. • ` fd ���� 7r3r Io
ZI hereby certify that I am properly licensed as a contractor under / SO. FT. U_ O
the State of California Business and Professions Code, Oivlsicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR •
Chapter 9, end that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: g
am exempt from the provisions of the State of California Business CC
VALUATION to
end Professions Code, Division 3,Chapter 9. ('
PERMIT FEE S /y' ry
Signature of / (� /'3`� PLAN CHECKS '7 ,.`� 6) E
Permittee S / YY//
/33 sap
Authorized Agent u
TOTAL FEE s �