HomeMy WebLinkAbout2413 SANTA ANA AVE - Building PermitsI
' CITY OF COSTA MESA
4/ 9 BUILDING DIVISION
Fk' ..4MIA 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
v
PERMIT
M03-00664
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2413 SANTA ANA AV Status: ISSUED
Suite No Applied: 12/19/2003
Issued: 12/19/200
Vicinity:
Parcel Number: 43933209 ISSUED BY:
Applicant: STEVE SCHNIERER r����
Address: 422 JENKS CIR �1 1
Phone: 714-998-430050 '�i
CORONA,CA Zip: 92880 !/
1:0A'tt
Owner: KRESSIN, JANICE MARIE
Address: 2413 SANTA ANA AVE
Phone:
COSTA MESA,CA Zip: 92627-1447
Contractor ALLIED PLUMBING - HEATING -AIR CONDITIONING
Address: 422 JENKS CIR
Phone: 714-998-4300
CORONA,CA Zip: 92880
License:610780
SCOPE OF PERMIT
CHANGE OUT FURNACE
MECHANICAL TO INCLUDE:INST FAU<100K BTU
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
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)
C
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'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:201-‘.. Ameytca I. Policy Number:yv GZq 386 413- I
(This section need not be completed it the permit Is valued at one hundred dollars($100)or less.)
O I certify that in the pe • ince of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws• r allfomia,and,.r, :• • should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these;
Applicant Signature: /a Date: I2/ 9 103
WARNING:FAILURE •SECURE WO' RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED
THOUSAND•• .- t$100,0001.IN••OnTION 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 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.# GAS Class# C.00
Contractor's Signature: Date: 121 i�+�o
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 Cale).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant 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.). '
O 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. ❑Yes ❑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 e,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? 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 0N
(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 Flre
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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (if yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is
correct.I agree to 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.
'-IS.17 ••• : Of Legal Owner(s) Date
/i AM IZ`1cI'o•5
•nd/Or Authorized Applicant Date
CODE I INSPECTION TYPE PTE INTmAL$ PODE( INSPECTION TYPE QAIE RIIm9LS
1616 Fixed System Final Fire Prevention _ _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
\I
, � ADDRESS Of6NLONG: 2413 SANTA ANA AV DMT: CITY OF COSTA MESA - BUILDING PERMIT
tnn"tulEIF1010WN: SUSAN RIEKSMA PERM NO: P 076120
` ADDRESS: SAME
PERMIT NO: P 076120 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.MAIUNGADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH
ARCHRECT OR ENGINEER: UC NO.: JOB DESCRIPTION : C/O DISHWASHER SQ FT:
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
CONTRACTOR'SNAME NOCK PLUMBING ( 714 ) 895-1246
CONTRACTOR'S AMONG 11610 SEABOARD CIR COMMENTS: X
ADDRESS: STANTON CA uc.NO.: 511971 dEiE#REdEdEdEiEiE1EiEREiEiE5EdE1EiEil********fEfEfE+EN:ititlt*lEx+ElEiE1E1E1t1EiEiElEilltltiEiEltiEiE1k1E1EiEitilltiEfEitfEiE3Eftifit1t1t1ffEifiEif
90680 wit ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perryry that I am Premed under provisions of Chapter 9 SETBACK S
(commencing with Section 7030)d Division 3 of the Business and Professions Code,and my license bin full force and effect,
-muCNO.: 050386 UC.CLASS: C-36 LIC.NO.: 511971 EXP : 02/96 MAIN BUILDING ACCESSORY BUILDING
1� _ �jL C � �prfuuMt3/ t� /��RNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
I LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
O R BUILDER DECLARATION:I hereby affirm under pony d perjury that I are exempt from the Contractors license Law(or the
Any15 Business Professions PARKING REQ: PROV: PARCEL: 43933209 ZNE: REF NO:
demolish,or repair any etructure,prior to its issuance.also requires the applicant lar such permit to fib a signed statement Ihet he or ahe
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(oprmnend g with Section 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Code)or the*he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section >
7031.5 by any applicant for apennit subjects the applianlm aavi penally at net maethan foe hundred dollarsMOOD- {(-1E1E1E1E1E1E1f1L-lfifiE****1E1f*1ElEflfElEfElEfE1EiE1ElE'lE1ElE1E1E****IE1EiE1kiE3F1E1k-0E#1EiE1E1E1f1E1fiE1E#fE1EjE1E7E'1E1k1E#1EIh-0EIE1f1L-1 ***
❑ I.es owner of the PeoPenyormy employees with wages as the/sole compensation.will do the work.and the tincture is not intended
or offered for sale(Section 7044.ldBusiness and Professions Code:The Contractors License Law does rot apply to en owner of propend D E V E L O P M E N T SERVICES REQUIREMENTS
who bus or improves thereon,and who does such work himself or handl or through his or her own employees provided than such
improvements are not inierded or reared for sale.It the building or improvement is sold within One year of completion, ZONING APPROVED BY DATE:
wn
oer-builder will have the burden of proving he or she did nor th
build or improve for e purpose of sale).
with 5censed
construct
peojed
7044,
❑ msond � xclusivety eLtdewoeronrans wPrdesvons Co :The Contrasts Law noy to on owner aprwlg er imprw«thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(*)licensed pusuenl to the Connectors License Law).
y 6
❑ Iern exempt under Setion: B.AP.C.,for tisreason: APPLICATION ISSUED BY: DATE:
*REi REdEdEREdEdERERE*aEi�+t*i�+Eir Eit�titi(�EitiEtEiPiPiEiEat '^ ° *i�iEiEi�iEIEiE�ExitiE****iE*iEitit*AEiEiEiLir. . .
Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTUR ' SEG ENT:N
I do hereby certify that I atm aware of end understand the requirements of California Health end Safety Code Sections 25505.25533.and
a553i.aothmlaen or modification Widingom thent AiiiSyMangemenCM ne)treedtocanptywfh*eldimecedesende erequiremmtse BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
tor
2permit for 534.end at f or nyblurbuiioccpeAi�y megemeote)nee. to comply cmmad anteion codes n rhe remlNfrom Near
provisions. PERMIT 7,00
Date: Applicant: 25$ SMIP/NON-RES
"'^RKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: PLAN
I have and wig maintain acene o
f'cmconeentloself-insurelor s cornpensaion,as provided for Section B
by S 3700 of the Labor UILE FEE 20 . 00
Code,for the performanceofthew (orwhichthispermiisisue . BUILDING
-DIV-> PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
ork
OIhave and wig mainsail workers'compensation insuranceasAwaked bySetion,3703otheLabor Code,for the performance ofthe TOTALS 7 . 00 20 . 00 0 . 00 27 .00 27. 00 . 00
work for which this perms is issued.My worker'compensation insurance comer and policy number are:
Carrier: STATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 27 . 00 OVER/SHORT: . 00
Pdky Number: D)wC32113100 09/30 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completer:d the panels for one hundred dollen Moo]or ion.) 27 . 00
❑ I tangy that in the performance of the work ler which'his permit Is'issued.1 shell not employ any person in any manner so as to
ome sublet to the workers'asepesanion laws of California. that d I should become gabled to the workers' **************************M iE if lEiflEiklEiEfE1E1(iE1FiE1ElE1E1E1EiEiE141EiEdhlEiklElEiE1EiE1E1EiEiElElEiElE1EiE1EfE1EiE1EiE1ElE1ElE
ronaelgn- 'I-4 sect on 3T/oroame em cane,Isou *wen .. . ...4 -. IND IV IDUAL F E E BREAKDOWN
Al
/ - 2-' — �l APada:
ming:inec to to bund workers'compensation coverage Is addition
e shall subjectmen ation, oalmselpuu/tluand TYPE • DESCRIPTIO N UNIT COST TOTAL COST
tell fines 06 one hundred Interest,
dollars(6rney's f In eWllbn to the cost of compensation,damages as provided for In
Section]106 of Me Labor Cods,Inter st,and attorney's Ms.
PLU 1 DISHWASHER 7 , 00 7 , 00
CONSTRUCTIONicthe LENDING AGENCY: r hereby affirm under 3097, of perjury that there b a construction lending agency for the END OF FEES
performance of work for which this permit is issued(Section 3091.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS: ■■■TTT///
I certify that I have read this application and state that the above information
representatives const.I agree to comply with all city and county ordinances EXPIRE�.0
and state laws relining to building contusion and hereby authorize representatives el this city to enter upon the above-mentioned properly / / .L1
for inspection ^ - - - _
purposes. RON NOCK DATE I�, JS '.C:', �>,4i:: :<
P'd Name DATE. 'I = _
�L/ — Done: / —7---1.....24.
Signature of Owner y rs�rry odor
(5151'46 WP) White-Building A Safely;Green-Fle:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
II
' CONSTRUCTION AND PLAN:-..4G POOL & SPA
e
XPPROVALS 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 _
r6. Electrical UFER,Grnd. 57. APPROVAL TO COVER-GUNITE
=.7. Footings - 58. Electrical CondpitUndrgrnd.
8. Foundation - a 59. Gas Pipe, O Undrgrnd., Test
. 9. Water Pipe-Undrgraii. - 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
14. Rough Plumbing“ n 65. Electrical-Final
e
15. Rough Electrical-Conduit -. 66. Solar System-Final
16. Rough Electric Wiring _ 67. Fencing & Access Approval
u
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & AirF Conditioning _ t r t _ E r- Fj3BE DEPT..REQUIF EMENT „
20. Rough F4rtoryr Fir { ace • K ' * _ - -'APPIT_OV-AL,SZ�, Pit #
21. Ductsiin Structure •• • - S F.
- • 70. "Onderg'rourtd F1ii4dro ,
22. Ducts Ver tilating-:fi L _ r. 71. Produot Piping laGas 0 Oil
23. Gas Pipe-Rough& Test = * ' 72. Underground Flush ; r,
24. fioof-Framing.. x - r p• 737. Undergrnd.Storage.Tankt0Gas ❑Oil
;yam j;
25. RoofSheathing % r - _'y 74:' Overhead Hydr ,.., . g
26. T-Bar`Ceiling (StructVral) & Moird8oat 7�. Dry Chemical r,- s ~ 1 .� ""!;
1
I
27. Frame anchFlashing ,1 _ ..... ... •' ='t 76. Dry Starg{pipe e • ": _ -
t v 3
:28. Lathing&•5idin i i ,-E t 4.` •- -' - ``
_ 9 � rs� 77 FIXEDS�S`TEM'F�NAL .. �.
29. Insulation- _ . 78 ,FIRE PREY. FINAL '
30. Drywall Nailing e _ - � ."...J.,.: "IiEALTH DEPt. REQUIREMENT
31. Plaster Brown .Coat - r 4.: .., 79. FINAL INSPECT FON ;
_
"32. Electrical Powel- Meter-Final t n: • 't C18d' FOOD CERTIFICATE ISSI;JED
r t•l
• 33. Final Electric !X Notes: "t .4 "• ` _
'34. Final-Heating•& Air Condttionirg= `• ` c•' '• !I.
,
35. Final Gas Pipe Test : - - + ' - ^I - C'
- -
•
36. Hood_or Canopy - ' ,"c
r. :o • ',
Th
,37. Final Factory Fireplace r - . - _ -
- 38. Final:Plumbing ` . F- _
39. Water-Service-Final r y ._ '; ti z
.40. Gas Service-Final - ' * CT; ,*
. fr - r r r F • _ * •-
4.
'°41. Solar Domestic-Final; " - - ,r r �. .
x 42. Backflow Preventer c • - 'F' ., r-":1 -
43. Backflow Irrigation i " - - r s '
y r i-i
44. Landscape Irritation System , '` - '` ' tv r_
%. Sound Attenuation : .. - h .; - a, -
•
46. Handicap Regulations _ r. A : .:
47. FINAL STRUCTURE & BUILDING _. .�
48. FINAL PLANNING -% _ - `... 4
49. Electric Release to Edison , . .` ` •- - ,
.
50. Gas Release to Southern California-Gas Co `4 ' - J
51. CERTIFICATE OF OCCUPANCY ''-
No. Date
ADDRESS OF BUILDING: 2413 SANTA ANA AV LINT: CITY OF COSTA MESA — BUILDING PERMIT
OWNER'41kllE IF MOM SUSAN PIEKSMA ADDUEss: 241.3 SANTA ANA AV PERM NO: P 077579
PERMIT NO: P 077579 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: 0TH
ARCHITECT ON ENGINEER: UC NO.: JOB DESCRIPTION : C/O WATER HEATER SQ FT:
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMPACTORSNOME:NOCK PLUMBING ( 714 ) 895-1246
CaBUACTORSMMIRIG 11610 SEABOARD CIR COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
ADDRESS: STANTON CA uc.No.: 511971 ********N-****SERE -*iERF*******SE+ESE+E*TE**RE**RE****K-x-K-RE-RE******x***RF*******Ac-*RF***N-RF*SEi'E*i'E -
90680 DMT: Z ON ING REQUIR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby dl:m under Penally el perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Divhion 3 of the Business and Professions Code,and my license bin lull force end effect.
MUC.NO.:O5 6 LIG.CLASS: C-36 L1C.NO.: 511971 ��2 /97 MAIN BUILDING ACCESSORY BUILDING
J p�_ � FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
c.a. Y� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
NER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contradors License Law for the
follewvg reason(Section 7031.5 Business and Professions Code:Any Cay or county whim requires a permit to(unlink alter,improve. PARKING REQ: P ROV: PARCEL: 43933209 Z NE: REF NO:
demolish.or repair any structure.prior to es issuance,also requires the applicant for such permit to Ne 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 PLANNING NOTES>
Business and Professions Code}or that he or she S exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant fore panne subjects the applicant to eavfpenaO of not more than fere hundred dollars(S500]). *******************************************************************************
❑ I.as owner of the properly«myemployees with wages as their sole compensation,will do the work,and to structure is not intended D EVEL OP MENT SERVICES R E Q U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Coda:The Contractors License Law does not apply to an owner of propend Q
who bolds or improves thereon,and who does such work himself or hersel or through his or her own employees,provided that such
improvements me not intended or offered for sale.I,however,the building or improvement is sold within ore year of completion,the ZONING APPROVED BY DATE:
ownerboilder will have the burden d proving he or she did not build or improve for the purpose el sale).
❑ I,as owner of the propM.am exclusively contractile with licensed ccovacton to construct the project(Section 7044,Business and
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY DATE:
contracts for such projects with a mntredor(s)licensed pursuant to the Contractors License law).
❑ lernexempt under Section: B.AP.C..for this reason: APPLICATION ISSUED BY: DATE: f • 7
Dat Gamer: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
1 do hereby certify that 1 am aware of end understand the requirements of California Health and Soley Code Sections 25505,25533,end
25534.and that I or a
y future bulk:ling occupantwill/will
of(circle to mpywiltaidddewdaundthe
TeMebr
pensfor nsbvcdnot moeibmtbn thheAi eeod i i esii ntyl nstrudsit epcoreli exempt erom Nps BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provision. PERMIT 7 . 00
Date: Apprean: 2 5% SM I P/NON—RES
',ORKER'S COMPENSATION DECLARATION:I hereby aunder penalrp
penalty peay one d the following dedications: PLAN
affirm
ISSUE FEE 20 . 00
I hese and will mainnn auatCate of corned lo sell-Insure ler waken?compensation.as provided for bySectiond n 3700 the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Cede.for nom
n.pe .pewthe work for which m .e
spenhsued. TOTALS----> 7. 00 20 . 00 0 . 00 27. 00 27 . 00 . 00
I have end wit mainlen workan'compensation insurance,asrequired by Section 3700 d the labor Code,for the performance of the
work forwhch this permit Id issued.My wwksti compensation Insurance carrier end policy number are:
Caner; GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 27 . 00 OVER/SHORT: . 00
Policy Number. NWf/113100 09/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed I the permit is for one hundred dolsa 01001 or less.) 27 . 00
❑ I ceniy that In the performance of the work for which this permit le Issued,I shall not employ any penman In any manner so elf ict
become subject to the worked'cameennlion lawn d Cafdornis,end d I butane abject to the workers *******************************************************************************
compensation io"n)of Section 3700 of the labor Code.I shall t ply with IND I V IDUAL F E E BR E AK DOWN
Dat Q! % Applicant:
w Imp:Failurefee«ure workers'contpereedon caverns Isunlawful,andaleil subject an employnromlmrnelpenalties and 'TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
viI line Lo to one hundred thousand dollars(S1040O0),In addition to the coat of compensation,
damages as provided for In
SaeDon3705olthe LaborCods,mnnr,
interest romayafete. PLU 1 WATER SERVICE 7 . 00 7 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097,Cl,,C).
LENDER'S NAME:
LENDER'S ADDRESS:
I ceniy that I have read this application and state that the above information is correct.I agree to comply with at city end county ordinances EXPIRED RED _
end state lows relating to building construction end hereby authorize representatives d this sstyto enter upon the above.mentioned property - _ _ __
for inspection purposes. —019. 1.-v\.)`^' (�= '''J_i: '.. v�r,l.: l•n' _ .
RON NOCK DATE— \V3 IN LVE; : :rl
Prim.. 9/
t�gnature d e _. Date: J�/ef / t�
p
(5151 de WP) White-Building.Safely;GneemFle;Canary-Appicant;Pink-Revenue;Goldenrod-Assessor
_SP
CONSTRUCTION AND PLANNING - POOL & 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-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, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60, Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System J 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 j
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
� L
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •YI
27. Frame and Flashing - 76. Dry Standpipe
t:-ti
28. Lathing& Siding 77. FIXED SYSTEM FINAL ••�('�
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT \=71
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. Backf low Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date
ADORESSOFBMLDNO: 2413 SANTA ANA AV UNT: CITY OF COSTA MESA - BUILDING PERMI1
OWNER'S NAM IFKNwm: NUEBERT, ED PERM NO: B 08529e
ADDRESS 2413 SANTA ANA AV
COSTA MESA,CA 92626 PERMIT NO: B 085296 PLAN CHECK NO: N GOVI: N SUPP: N
645-5764
ANPL.Mul1N0 ADDRESS: CONSTRUCTION TYPE: 5-N PERMIT TYPE: STE PURPOSE: OTH
)
ARCHITECT OR ENGINEER. UC.NG: JOB DESCRIPTION : T/OFF & REROOF W/COMP SHINGLES SQ FI: 3, 900
ARMOR ENG'5 ADDRESS: ORT:
CLAIM VALUE: 3, 900 . 00 CALC-VALUE: 3,900 . 00 GROUP OCC: H-3 iU-1.
coxmAC:CRSPLuCE: DEP INHO ROOFING ( 714 ) 632-7663
A cannaowskumm 2832 OLIVER AV COMMENTS: REROOF 3600SF RESIDENCE W/COMP SHINGLES
ADDRESS ORANGE CA mw, 683894 ********4**;t;:;t**; *;E*;E;t;r*****x;t;E;t****;E;:;t•*************;t************************x;e
92665 wn ZONING R E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)el Divebn 3 d the Business and Professions Code..•••. y kerne o in IW(once and
:RY uc.NO.: 48874 uc.cuss: C-39 LIC. 6,f89 /00 MAIN BUILDING ACCESSORY BUILDING
�i Date w��3/k-? / ��CJ FRNT; FT IN REAR: FT IN FART: FT IN REAR: FT IN
Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby atfrmm under penally• •-'ry that I am exempt tan the Contractors License Law 1«the
fdfow:g reason(Section70315 Buenas*and Professions Code:Any cityor county which requires aPermu to Wnsaa,alter,improve, PARKING REQ: PROV: PARCEL: 43933209 ZNE: REF NO:
demolish,or repair any structure_prior to is issuance.also requires the applka l for such perms to file a signed statement that he or she PLANNING NOTES> �)
provisionsis licensed pursuant to the d (commencingthe Contractors License Law(Chapter 9(commencing with Section 7000)d Division 3 of the .
Business and Professions Coded or that he or she is exempt thresher',and the base for the alleged exenW ion.Any violation of Section r) ..
7031.5 by any applicant for epermb subpds the seafront to adwl penalty of not more than the hundred ddlen(i50oD. ***************,******************************iE*************iF********if**********
❑ I.anomie d the 003Perly«rev ensgees with wages as moi cite compensation.MD do the wale and the structure is not intended D E V- E L O P M E N T SERVICES R E LI U I R E M E N •'1 S
or offered for wile(Section 7044.Business and Professions Cods:The Contractors License Law does not apply to en burnerof property _ •
who bolds a inpe aves thereon.end who dosuch work himself a herself or through his or her own employees.provided that such - .
improvements are not intended or offered tor sale.N,however.the bugdinga improvement is acidwbhin one year Of mmplaon,to ZONING APPROVED •BY DATE: i•
owner-builder wall have the burden of proving he or she did not build a improve for the purpose of eels). •
❑ I.asownerdthe property,amexclusively mmraeigwith Seemed contractors tocoming thePrNaa(Sediom7044,Buabenand BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does rt apply to en owner of prapen)!who builds or iatove thereon end who
contracts for such projects with a aonradons)licensed pursuant to the Contractors License law). `8 t ,
Ellamexempt lndrSection: B.a P.C..tor thisreason: APPLICATION ISSUED BY: DATE:
*************************ss***********ar******* *******aur*************w****as***
Dale Owner: LEGALIZATION:4 F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby ceetily that I am aware of and understand the requirements of California Health and Safety Code Sections 25605,25533,end
25534,ed that l«any boon Wilding occupant will/wit nOl(circle one)need le comply wkh sent rete code and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction a modification from the Ar shy anapemenl District.Residents°Wtlndon appicat a are exempt hoe these
provisions. PERMIT 87. 25 I . 50
Data: Applicant: SM I P i NON-RES
PLAN •"�
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury One of the following declarations: ISSUE FEE �•
❑ I have and vril=into,a certificate al consent to selVinsure for workers'compensalion.a Prodded lor bY Section 3700°I IMI-nbcF BUILDING-DIV-.> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,r«the eedomemce tithe wakfa which this pelmbb issued. TOTALS----> 87. 75 0 . 00 , 0 . 00 87. 75 87. 75 . 00
1-1 I have and wit maintain woofers'c mtensatin insurance.as required by Section 3700 d the Labor Code,for the performance of the
h' soak/«whidhmieparmNbbeaed.Mvw«kra'compensation insurancecarrierIreradpokcymumMrae. EXPIRES REVENUE DIVISION TOTALS--> COLLEC• TED: 87. 75 OVER/SHORT: . 00
•
Cartier:
Policy Number: HL1-V48V751 05/01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(Thu section need not beranpetedithe peni is for one hundred dinars iSlgol or A.J 87. 25 ^ 1'' . 50
o I canary that in the performance al the work for whkh this hemnb is issued,I I note • _- ' manna so as to •I
bbecome empemat�p000alhea ofrkers'c ill taws Lehr of C' forth ,. that if I . .. ' become • to the workers' *******************************************************************************
/O 7 Cr , �y revisions. INDIVIDUAL F E E BREAKDOWN
Data: / App
Warning:Failure to aacureworkee compensation coverage la unlawful,and shall at/eel en employer toalMrel penalties and TYPE QTY D E S C R I P T I O• N UNIT COST TOTAL COST
chill Does up to one hundred thousand dollars(3104000),In addition re Me Wal of commination,damages as provided for In
Section 3706 of Me Labor Code,Interest,and attorneys fes. SFR 3900 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 900 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the prtS is issued(Section 3097,Cl.C). • -
LENDER'S NAME:
LENDER'S ADDRESS:
I candy that I have read the application and dale that the above information a correct.I agree to comply with all Sty and county ordinances N'
and stale laws relating to building construction and hereby authorize representatives d the city to enter upon the above-mentioned prepare/
f«irep'di°_.... , ON DEPT
18-17-1997/12:88xPTV:81-0814974
Date; (u��/q7 PERMIT:085296
Signature of OwnerlAOenvAppicant/Contractor
15151-0e.WPI While-Building 8 Safely:Green-File Canary-Applicant;Pink-Revenue:Goldenrod-Assessor
'Th
. :,..
CONSTRUCTION AND PLA, jING J PQOL & SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
c
2. Soil Pipe•Undrgrnd. - 53. Steel Reinforcement ,
. E 3. Electrical Conduit,Uiility-Undtgrod. 54. Forms • . • r
r
' r4: 'Electrical Conduit,Uhdrgrnd. • - 55. Electrical Bonding _
it
'';S ,Steel Reinforcement 56. Rough Plumbing & Pressure Test
.• 6. Electrical UFEFFCrnd. 57. APPROVAL TO COVER-GUNITE
"-'7p -f=ootings 'z 58. Electrical Conlin,Undrgrnd.
8; Foundation V a' .1.., •••• 59. Gas Pipe, O Undrgrnd., Test_
- n np
-r S; Water Pipe-Undrgrnd. 2 60. Backwash Line?,P-Trap, 0 tndrgrnd.
10. Structural Floor System 61. APPROVAL TO BECK
n „
11.-33roperty 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`. T; . 65. Electrical-Final . -
15. Rough Electrical-Conduit
' F}1t66. Solar System- s1i.„2
, .
16. Rough Electric lyirin J.:" 67. Fencing & Accs'sApproval •
17. Rough Wiring Sign _ 68. APPROVED F4115,'PLASTERING •
-
18. Rough Electrical:T Bar Ceilirig' - - 69. POOL/SPA SYdIEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
• r _• �• - r r In -e r :7 -,p - ;X a 1-4 .1
20. !Rough Fi,ctory Fiieblace i '=tTl x ? a ? ,J '"' t < APPr1OV i -7 T.
_, Pnrmit# ,t '„
21.Ducts,in Structure ;: '1 �;-s ¢ s Ij -I r S 1-r t_
- _ ..t _ , _ k �� r _ 70:-UndetSjl'�u�d dro
22. Ducts, V'e!ntilating-' '
3 1 � u r l 7 R ` w •'J la e �; 71. Prodiigt1riningrriGas 0 Oil
7 • r )p ,-.4.1, _J ; 1 ' J'J
23. 7:ras ipe Rough &Rest 1 ' 7 r 1:1 C a - 72. Undergl0und FPutha s 1�
~24.'1RoofFraming' .^ r " i > Jr .s 4.1.• -S 71 UndergrRd.Stfie7anD Gas OOil
e W.
f 2 J
25. Roo.Sheathing �,k 7G'..,;Overhead HydD a
26.1--Bat Ceiling (Structural) & IG1ono oat ` D 1- •ti r ? k -1 7 '7.
.. .. 1: > r ?+j 'J n �•S�.-,;Dry Chggtical R m
27.'�rar e a Fla hin t Z k � r,4. t S Ti -7
i .r5 ,'. JrC'>; t IT .N 'v t 76. Dry StacciPlpe-.
, 28. LatRing& Siding Y P '`lam .t. ` --- i, lc FIXED YSTE FIN 1L_ '•
' 29. Insulation . -r t: D ,5 - 1' o I r 78. FIRE PREY. RINIL r '1, > N
v r. S , . i. n e -' _
' 30. Drywall Nailing k F ~ 1(y '� ;11-EALT31 DE I REQUI8EMENT
31. Plaster B1own,Coa; I:, 5 1 r v. I rr IT, 79. FINALIJJSPEC1-5}ON is '' • D
- 32.ElectricaPPower tvleter,Final t ti k4' 801 FOOD CERTI]C°ATE PSSUED
33.;,Fm&LElestric., t t Notes: r
34. Final;Heating& Air CCon.ditioni,6g5 I 1 Ik .ep p`T -4effinlit a s/c! e'
35. 'Final'Gag;Pip€�Te$'. 'F _a ' 1" �T-'-'1 t ' -
36. Hood or canopy µ r 'D ' r_- , .r. I l% X :E - i• ` T'
-, tir t 1 K Z• 5 f
37. Final Factory Fireplace _ S'` e '.1 - k
- -, .� r I I ri. _
38. Finat.Plu_otbing a •• K " ' f* `
.+_ w - t R i Fti y r
39. Water SeThice-Fina: U .- ' Ik ` 1 '` 1 5.-.-
-
-
6 $ K : I. l to r - t
n
', 40. Gas Service-Final p .,7 r �. TI 1 „ r
41. Solar Domestic-Final S -1 •• a I I` ?." -
42. Backflow Preventers - ,-, k - ' is - K 7 rl
R -
43. Backflow Irrigation r t ; D e ,
Y - t F
-. c - t r. .- . 3 -
44. Landscape Irr,1gation System; : ,7 _ 7 :- ,,; 11 C i k ti D
J_- _ n .. S - <- - - -
-45. found Atten iationl - - r ° " '
• T. - •. - a ' Ti Tt Ya - a, • H R
46. },landicap,Regulat,ons _ D _ ,. z _ ry u S
47; FINIAL STRUCTURE & BUILDING 3
l e ? -q7 u�y T
48. FINAL PLANNING; . I i IK - Ti .... x y
_ _ I. . - 11 •_ -r•
-
R ( t _ _ . .
49, ...Electric Release to Edison .� .
'50. Gas Release to Southern California Gas Co - t !• - -i - • ^ - -
'51. CERTIFICATE OF OCCUPANCY' t' t , 5 ,T' D - r. -_--.
No. Date
OWNER - T,FF' _ROBRR.T - ' - DATE 1-ii-57
JOB ADDRESS 2!113 & 2415 Santa Ana BUILDING PERMIT NO. ##177
GENERAL CONTRACTOR Armadge, 1ric. VALUE $ 13,040.00
AP119-1140-46
LOT 112 BLOCK TRACT 300 Dup. Watt. gar.
GROUP I & J TYPE V ZONE W.I. FIRE DISTRICT 4211
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
_ DATE NUMBER
-
Footing Trench n r - 7
Foundation Forms and Grade to Garage '9
Rough Framing 4✓�+ 5 IS(r ;,
Plumbing, Rough to Slab ' _ /TI 65 9--/9 J7 c J -„y., it' s„ , i-751-,S7 7 "77/9 ,
Plumbing, Rough Complete kite-5 3,11-57 ”"-r/,, 7i��„„_ /-195-7' 7 7/e
Temporary Pole
Wiring, Rough MAR 2 : 1957 VCBaft a cyc. . • 3`o'17-S7 9 676 / ...-7-.,/Heating,Rough WLC-S ,kr,,.1er /-/V-S7 77/F ./-
Heating,
/Heating,Final /s1AAS ?-3'-57
..91-we r, Hous ;,,.4t�/9 er,St. NAIS G-2-&-Sp e_ v_e_ e-> _-/3-57 /o a./3
Septic Tank or�esspool p'f 4#,,S :07,2,6 Sl .
. e ... 57,AL jr,.) 6- /3-S- 7 /dal ?
Lathing, In ouout &'X-k //•-- -4 /
Plastering N. gal1 r :f : •?
Plumbing,Final,Fixtures Complete 7//5 7-3-5 7
Plumbing, Final Gas Test /S- /fl 71-5 7 ��/�l e -irt S 2
Wiring,Final _ MAY 0 1957 V►g> C_C'[-�C
Occupancy Ails 7-.3-5”
FORM 210 3M 10.55 14177
,Costa Mesa Building Department APPLICATION FOR FEISMIT
P. O. Box3!7 4911 BUILDING 11
-COSTA MESA, CALIFORNIA
•
FOR APPLICr#TO FILL IN FOR OFFICE USE ONLY
r( �J Receipt No. Permit No.
BuilinAddress$/SS L j Q ;tl r Sri 7 7
Costa Mesa, California Received by Date Rec'd. De
aIssued
Nearest ��� /03 - 3/-SG tEt,' �
Cross Std Building
Address 01 C1/ 3 Sia sz/f rim
Owner
Mail C Costa Mesa, California421....e_
U Nearest
'''�/��� � Tel. Cross St.
'y am !"'�"� No. Zone H4I No.of I Type Group
:hitect or Lic. �-J Plans
Engineer No. Approvedb • Date (/�/
Address J, CORRECj�IONS
ContractoyyCity ' xt, No.
Address/ 7 D 2. /!. �`n1L�L i, u V u
Legal Lot I MF—CITY OF COSTA A
Description I No. // lock I Tract
- PLANNING DEPT.
(Attach Metes and Bounds) // 7—/1/4". '/J4 SUBJECT TO BLDG. UEFT. REG.
/) No.of Bldgs.
Size of Lot /x/5-0 .4211 Now on Lot a /
Use of No.of No.of BYfrS • ' DATE PII— ' m
Existing Bldg. I Families I Rom / PLAN 'i_yr; B
Setback Line from %Rear Yard 2
Center of Street 0 Side Yard ./ ,5, 3-) D
DESCRIPTION OF WORK&6,)Sr
f
- 'w 14-1 Alteration I I Addition I
Al t=0
Repair I IMoving I I Demolish I n
Buildi ( / No.of t-4
Size / X�� Rooms / Stories / i-e.
Exterior Wail._ I Roof --
Covering �/(.tArC�f�p Covering . • APPROVALS •
Use of New/ / I Foundation Location Inspector • Date
Building i ! _..1��/, . Forms,Materials,
/Orad Under-Pinning
Frame: Fire Stops, CO
Bracing,Bolts
0
I hereby acknowledge that I have read this Application
0
and state that the above is correct and agree to comply Lath. Int.
with allCity Ordinances and S ate Laws regulating . Al
building construction. " Lath. Ext.
Signature o i •
Permittee �W �`�"' Plaster, Int
Authorized Agt. Plaster,Ext. a
Imo'
Valuation Permit Fee $ 3 a — Masonry Reinforced W
Plan Check$ // 6 — Bond Beam
$ /3, Qvp ' Feel $ 0n— I FINAL v
a
FORM 204 10-55 O.P.&5.
O.
a
a
• ,
Street . .
PLOT PLAN
Show location and distances from
property line and between buildings.
W
a
C7
G
111
O
•
at
W