HomeMy WebLinkAbout897 SENATE ST - Building PermitsmxlEssaemim+c: 897 SENATE ST � uNT:
o�vrrtrrsN,,,eir�o�avx: PALMER, CATHERINE T
��;897 SENATE ST
COSTA MESA,CA 92627
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ARCMRECTOP BlCd1EDi: 11C.M0.:
RpLORENO.'S,100RE55: UNf:
��,�5� NEW�ORRIVERSIDE AV ��14)645-0104
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A0o"� 92663 ��
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LICENSED COMHACTOfl3 DECUXATION: I M�eby ellim uMm qbly d pajury Ihtl I un licanaed �nder po`tioro al Cheps B
(mmmerwi�q wnA Senan lOW d Orvw'vn � d Ne Bus�wm e�M Vmlmw�a CoEe end m lioenn u in /ull lace W Mleq.
cm . �Z9'18� uc.cuss: C039 uc.No.: 5�44�4 EXP; 06/97
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.on�«www.w�a44.�.e.Mr..d�.•�'i�.°�.�awu.r�mn«...: EXPIRES
°eTN 07/01/97
Pdic/ Number:
(11u'e eec(ion need rwt be complefeC! fM1s pemr! ia la one hundied SOIW /S100I a Isn.1
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comv� a saciw, a�ao a me �.ne. ced.. � .m, ub.. po.i.ion..
' $ 6 �t 6 �ww�: ��
e: -
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S�ctlon �)06 0l Ms Lebo� COLs. Infww4 �ntl �ttomsy'� lop.
CONSTNUCTION LENDINO AUENCY: I Iw1eby dl uMer penalry d perjuy ihm iMre u e mnnwian brdirq epem.y Ia tlro
perlwmeMe d ihe xwk Iw xfiiM thu psimY u ueueE lSedion 3081. Gia. CI.
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LENDEP'4 ADDPEA4:
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(5151de.WP) Whn�Buildin08Sefely;Oreeo-Fle;GenW-AppFunt;Pink-Ravenue;Oddeniod-�veanor
CITY OF COSTA MESA — BOILDING PERMIT
PERM NO: B 078914
PERMIT N0: B 078914 PLAN CHECK NO: N GOVT: N SOPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: OTH
JOB DESCRIPTION : INSTALL i LAYER COMP. OVER 1 LAYER COMP. SQ FT: 1,800
CLAIM VALUE; 1,800.00 CALC—VALUE: 1,800.00 GROUP OCC: R-3 /U-1
COMMENTS• 1 NEW COMPOSITION LAYER OVER EXISTING COMPOSITION LAYER
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Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDZNG ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42238602 ZNE: REF NO:
PLANNING NOTES> �
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D E V E L O P M E N T S E R V I C E S R E Q(J I R E M E N�'T S
ZONING APPROVED BY DATE:
HUILDING APPROVED BY : DATE: ���'-�� l �
APPLICATION ISSUED BY: ����;F DATE: \
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LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/RES GRADING
PERMIT 56.75 � .50
SMIP/NON—RES
PLAN �
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL":' PAID DUE
TOTALS----> 57,25 0.00 0.00 57.25 . 57,25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 57.25 �OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/�TOT GRADING PLAN—CFiECK
56.75 ,50
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I N D I V I D U A L F E E B R E A K D' O W N
TYPE QTY D E S C R I P T I O N UNjT COST TOTAL COST
SFR 1800 REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
1.00 1,800.00
. CONSTflUCTION AND PLANNIf�G � POOL & SPA �`
� APPROVALS Permit � � Date Inspector qppROVALS Permit # ' Date InspeEtor
1. Temporary Electrical Service�or Pole 52. Pooi & EquipmeM Location
2. Soil Pipe�Undrgrnd. � 53. Steel fleinforcement -.. ,
3. Electrical Conduit UTility�Undr9rnd. 54. Forms _
� I
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding _
5. Steel Reintorcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUN�TE ,
7. Footings 58. Electrical Cpnduit-Undrgrnd.
8. Foundation . �� 59. Gas Pipe, � Undrgrnd., Test ,! �
9. Water Pipe�Undrgrnd. ' 60. Backwash lines, P-Trap, d Undrgrnd. -
a
' 10. Structural Floor System 61. APPROVAL TO DECK � �
i�
11. Properry Sewer Line & House Con�ection 62. Backwash & Peceptor�Pinaf•
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains � 64. Plumbing System � Final �`�
14. flough Plumbing �� 65. Electrical�Final
75. Rough Electrical-Condui[ � 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR� PLASTERING
78. Rough Electrica6T Bar Ceiling 69. POOLlSPA SYSTEMS FINAI.
19. Rough Heating & Air Conditio�ing FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Duas, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe•Rough & Tesc � . 72. Underground Flush
24. Roof �raming � � 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing � . . . 7q, Overhead Hydro
26. T-Bar Gefling (Structuraq & Monocoat • 75. Dry Chemicai
27. Frame and Flashing � 76. Ory Standpipe-
28. Lathin9 & Siding � � 77. FIXED SYSTEM FINAL
29. Insulat�on ' � 7$, FIRE PREV. FINAL
30. Drywal� Nailing HEALT�H DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final 80. FOOD CERTI�FICATE ISSUED
33. Final Electric Notes:
34. final Neating & Air Conditioning '
35. Final Gas Pipe-Test
36. Hood or Canopy ' , •
�
37. Final Factory Fireplace _,
38. Final P�umbing � - �
39. Water Service•Fi�at
40. Gas Service•Final "
47. Solar �omesticFinal �
42. Backflow Preventer g 7��/_ �� � �`,.�
�v �-�
43. BackflOW �rrigation -
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap iiegulations
47. FINAL STRUCTURE & BUILDING �JI //J_ L�/ �'�
v 1-1
48. FINAL P�ANNING
49. Electrie Release to Edison .
50. Gas Re�ease to Southern California Gas Co - __ . .
51. CERTIFICATE OF OCCUPANCY -
No. Date
�o�nessaeu�m+a: 897 SENATE ST
avueTsx,aEiviun,�m: PALMER, CATHERINE T
�,00�ss 897 SENATE ST
COSTA MESA,CA 92627
uv�. �uia+o.00�ss:
urn:
WCXffECT Ofl EM�NN6A: tK. N0:
ARp1.ON BlO.'S �DDXES9: UNT:
���� SKYLIGHT SPECIALTIES (714)645-8645
eam�crorts�uima 660 W 17TH ST
,�p�gg, COSTA MESA 9zbz� CA ��,�, 395537
uNr:
LICENSEU CONTRRCi0fl5 DECLRFAiION: I hamby � uMx pendy d peejury �he� I vn IcanxE uMer praieime d Cluqx 9
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cmuc.No.:02/7�519 uc.cuss: B uc.no.: 3955�1 EXP; 03/97
Dme: �/ // / 30 CoMreew: 7N ( � �7` �/���✓%�.%' PL
OWNEP BUILDEN OELL1flATION: 1 hxeby dfvm uMx perWy tl perjry �Iw I em ammq Imn �M CaGratlm Liwnss lew 1n ihe
IoOowiq �sefon (Setlbn ]W 15 Buenefs ud Pmlenims Cctle: MY M' a muniY MfiiN nCu�w a M��'! to aueVUY. eCs. inVow.
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"unpwanapa ve mi imended v dlertd la sab. !. howwer. �M buildi�p «inpownw e mk willwi ons Ymr W aomdMon. tlr
awiror-0uildar will Mve �M WMm d pwirp M ar ehe tlk iwl Wik a impo.a lor tM puryws ol eeb�.
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canlmcb la adi propa+ rmh e mnredw(s) IceneeE Wnuent to iM CaMreda� �iwnae lax�.
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e prmil lvmrottuctiona modifraliantram�MA'r�arypy�� Oiqnd. Raaide�qiNoonnwion eGOk'm'vnen mamq ham thw
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peconr wEjetl io iM wM1an' comperiamion leMa q Celilanie, uM rse tl I tlauM became abjed lo IM �wlwY
compenee^tb'�n 0 b�� �]00 d �he lebm Coda. I ehell 1 �ml� Ilpes pwia'vn.
Oele: ��/�� ACdiceM: � .
W�mlrp: Fe/lun ro uc�n worten' mmpwetlon coverap� �� ��pM/y1, �IWWII Wdact an employ�r ro cNm'nl p�rWtlp �M
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S�ctlon 9RI6 0l M� L�Doi CoW, /nfxnt, end ettomry'� /�u.
CONSTtiUCfION LENqNO �OENCY: I haeby elfirtn unAp paWry y pyj�y t1W �lan e e mmivaion bMvp ppiq br tlr
plf�qTBIK! G� 1�! MOII( �IX W�1lfh �h6 pl1111� C 6AIBd ($Od411 809i, CiM. Ci�.
LENDER'S NMIE
IENDEN'S �DDNE55:
1 ce�M tha I lime ned Ne eDdica4on W qeb thet Ne ebo+e iMamelion u conad. I e0�ea to comPN rrilh aA d1Y eM oouay oMiiwm
xM etals 4ws rNmip b huJdiq consbwion eM Mreb�' eNMr¢a rapesentetrvee d �hu dry �o oma upon IM ebo.e�meMioned papeny
""'petl10""'°°'°' RICK SCHAEFER
Pnnt Neme �
/ Dma: �� �
SiB�durc d Owibr/RpeMApO` �✓�on�reda
(5151�B.WG) WAile-Buldiq 8 Sefery:OrearFle; Cenery-Appicent: Rnk-Rswnue:lialdenm�Avsavor
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: B 078934
PERMIT NO: B 078934 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : INSTALLATION OF 2 SKYLIGHTS ICBO #2469 SQ FT: 495
CLAIM VALUE: 495.00 CALC—VALUE: 495.00 GROUP OCC: R-3 /U-1
COMMENTS: INSTALL SKYLIGHTS / NEW ROOF REF PERMIT B-78914
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Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BOILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL; 42238602 ZNE: REF NO:
PLANNING NOTES> , .,
> ;.
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
ZONING APPROVED BY DATE: :.+
BUILDING APPROVED BY : DATE; '�
APPLICATION ISSUED BY: �.U�,,� DATE: �L�F�����
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LEGALZZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE—� SMIP/RES GRADING
PERMIT 21.00 • .50
PLAN .; SMIP/NON—RES
ISSUE FEE `
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL �'�" PAID DUE
TOTALS----> 21.50 0.00 0.00 21,50 .`.^,21.50 .00
AEVENUE DIVISION TOTALS--> COLLECTED: 21.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT� GRADING PLAN—CHECK
21.00 .50'
� . T
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I N D I V I D U A L F E E B R E A K D O� W•N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 495 ALTER BY VALUE RESIDENTIAL NOZONE 1;00 495,00
END OF FEES '
�
' CONSTRUCTION AND PLANNING POOL & SPA
• APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector -
1. Temporary Electrical Service or�ole 52. Pool & Equipment Location " �
- i
2. Soil Pipe-Undrgmd. .. , 53. Steel Reinforcement
3. ElectriCal Conduit Utility�Undrgrnd. 54. Forms -
� 4..ElectriCal ConduiFUndrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. ' 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgmd.
10. Struaural Floor System 67. APPROVAL TO DECK . �
11. PropertY Sewer �ine & House Connection 62. Backwash & Receptor•Final
12. Sewer Cap � 63. Heater & Vent-Final
73. Roof Orains - 64. Plumbing System • Final
14. Rough PVumbing " 65. Electrical�Fina1
15. fiough Electricai•Conduit 66. Solar SYstem�Final
16. Ro�gh Electric Wiring 67. Fencing & Access Approval '
17. Rough Wiring Si9n � , 68, APPROVED FOFi PLASTERING
18. Rough Electrical-T 8ar Ceiling 69. POOLJSPA SYS7EMS FINAI
79. Rough Hea[ing & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit �
21. Duas, in Structure, . 70. Underg�ound Hydro
22. Duns, Ventilating � 77. Product Piping OGaz ❑Ofi
23. Gas Pipe•Rou9h & Tesc 72. Underqround Flush
24. Roof Framing 73. Undergrnd.StorageTank GGas L.lOil
25. Roof Sheathing , 74. Overhead Hydro
26. T�Bar Ceiling (Structurall & Monocoat 75. Dry Chemica�
27. Frameand Flashing �g..� ����Ory Stendpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulat�on 78, FIRE PREV. FINAL
30. Drywal� Nailing � HEALTH DEPT. RE�UIREMENT
31. Plaeter Brown Coac 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. Hootl or Canopy . .
37. Pmat Factory Firepface , '
38. Final Plumbing � • _ .
39. Water 5ervice-Final - � �
40. Gas Service-Final '
41. Solar �omestic•Finai
42. BackflOW Preventer �
43. BatkflOW Irrigation g�1Z�Q/,� �,� �� �j/ �l(.,� I�-
� (��� ( b'.� .�L/�
44. Landscape Irrigation System ��� ��r -��,� (��
45. Sound Attenuation � �
� 46. Handicap Regulations
47. FfNAL STRUCTURE & BUtLDtNG gi ft,_cl+d �w[�
GI
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to $ou[fiern Califomia Gas Co
51. CERTIPICATE OF OCCUPANCY
No. Date
��� 0
�,r>ec���rir_s
�y
C�SS ��1 O,G
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PP- I w� �� ��Si�a eWc� e
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-�C,rs,�c�r�� ...
DIVtSION OF BUILDING SAFETY
cirr o� cosra nnESA
APPROVED
�, W£S� . —o� � - 7 - 9�
This set ot Dlans and sD�anons MUST be kepl on thb job at e� �
end it � unlavrtul ro make any changes or altetatian an sam�wi�l wtBl10 . _
The s[amDing of this Dlan an0 SDecifiCatials SFWl NI
a ro be an aDproval ot the violation ot arry prov�imis
Mesa Ordinance ar�d�a Stata 1aw.
rnese o�-� �a Pe�"a sha0 expire hy umimuon ami ne
the bui�dhig or work is nol commenceC and maintalnad
�d) within 180 days ol issuance,
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3160 Inciinado • San Ctemente • CA 92673 •(714) 361-9233 • FAX (714) 493-1
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CITV OF COSTA MESA
PARK FEES
Fee Payment Receipt
Projec[ Address ?C % / ' !� % 7 �� �
A. P. No�J'`� —�C� — D��O�� O��
Building Permi[ No. `7" �7 �/ �iD ' Tn%� J
Owner's Name
Mailing Address � �
FEE
Single Family *
Multiple Family **
Planning Department Approval
Applican['s Signature
� Clty Ortlinanca 72-44 �
•• City Ortlinante 72-45
•*• City 0.esolutlon 74424
Whlte - Planning; Cana�y - Plannlnq; Pink - Financa; GOltlen�oC • Appllcant
�
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N° � 142
Park Area . 1_
No. of Units �-- @ $ass.2o = 91a. ��o
No. of Uni[s @ $321.32 =
Total Fee � v
CMF 0174-26
C,OV ���VV�
' YALPIGtt� t,acnerine �^�� � [� ib
10B ADDRESS 897 Senate Street BUILDING PERMIT N0. 42043
�INSPECTIONS
soi�
� 1�GA5
SWnTER
�ROUGN PLUMBING
PpOP. SWR. LINE Q V
� SPRINKLING SYSTEM
MISCELLANEOUS
ROUGN HEATING AND A
SUBCONTRACTOR
UNOERGROUNO �J POWER U
ROUGN WIRING �_ MeatinG and Venr.
TRENCHES FORMS STEEL REINF. � L�j� .��. �-
FLOORSVSTEM , � 7�I � ti"Y.r'�"
SXEAiHING
FRAME RNO FLASHING
..... ,..�... — ��. t_ l
PLASTER. BROWN COAT
PLUMBING. FINAL
ELECTRIC, FINAL
BIIILOING, FINRL
; : * 4.2043
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant [o Fill in Completely — Use Ink Only
BUIIDING � �
ADDRESS c
owwsa � �(,{'n
MAIL
ADDRESS
TEL.
CITY NO.
CANSTRUCTION
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ADDRES:
ADDRESS
CONTRACTOR
A�DRESS
CITV
STATE
LIC. NO.
S12E
OF LOT
USE OF
TEL.
TE�.
NO.
CITV
LIC. NO.
INO. O LBF�DGS.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PEfiFOF�
I hereby acknowledge ihat I have read this application antl state
that the above information is cor�ect antl agree to comply with
all laws ragulating builtling construcHon, and I shall not employ
any person in vio�eNon of the workman's compensation laws of
the State of Celifornia.
I hereby certify tnat I am pro0erly Iicensetl as a contractor under
She State of CalifJrnia Business and Protessions Cotle, Division 3,
Chepter 9, and that such licansas ara in tull force antl atfect, or I
am exempt from che provistons ot the State of Callfdrnie Business
antl Professions Cotle, Division 3, Chapter 9.
+ 1 %
Stgnature of � '-� �/ , �
Permittee LI�I l-/.�T.-C..�-L� � 7 ��-�"-L/
Authorized Apent
��v � ,-�r,��:°00 � sGa �: t,: s �:+5.5G
FOR STRUCI'URAL PERMIT
DATE RECEIVEO r�eTc iccucn
OWNER
FIRE
ZONE
APPROVED
ZO ' / NO. OF
� PLANS
VAROS APPFOVED
MAIN BUILOING
(FROM GL STR- ET)
VA�UE
l .��^//
V ROVP .
DATE � � i(O -
USE OF NEW / ' �,
BUILDING ��A+LJ
./ ;�
REAR �FTCO
DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLD
VAR.# DATE
C.U.P.3{+' APPROVED
N
n
m
i
:
SQ. FT. a
THE AMOVNTSHOWN UNDER VALUATION IS FOR m
THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONLV:
VA�VATION �/� PERMIT FEE $ • a
�{ ' (/� PLAN CHECK $ o
/�J/ �� LL
$ V(/ TAX $ J/� �
U
TOTALPAID $ �fS�
�niv�rt LLHKt bU.ILU
JOB ADDRESS g97 �
GENERAL CONTRACTOR
AP No.115-600-01 l
�INSPECTIONS -
501 L
GAS
WATER�p�� miM�
ROUGH PLUMBIN /
PROP. SWR. LINE Q HOUSE C
SPRINKI.ING SYSTEM
MISCELLANEOUS
ROUGH HEATING RND AI0. CPNC
TEMPORARV SERVICE OR POLE
UNOERGROUND I—I POWER I
TRENCHES LJ FORMS L
FLOOR SVSTEM
BONO BEAM T EL I
SMEqTHING- Yd.{
FqAME AN� FLASHING `
LATNING — IN OUT
PLFSTEft,BROWN COAT
STRUCTURAL,FINAL
MEATING, VENT., REFRIG. i
PLI1M01NG. FINAI RNO GAS
ELECTRIC, FINAL
INV
STEEL REINF.
A.C.. FINAL
unit �z_Z9_75
BUILDING PERMIT N0.
L�
SUBCONTRACTOR
�
,
,. �ti916
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFOFNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BVILDING 1�/.� � �. .1 i
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MAIL P� /? ? n /
ADDRESS � /�/ Ox t)/ L�
TEL.
CITY ��s' � � NO. ,
CONSTRUCTION
LENDER
BFANCH
ADDFiESS
ARCMITECT TEL.
OR ENGINEER Gi�/A • D 7 �J� NO.�
ADDRESS ((�lf� /y, %�� "� -� �f j
CONTRACTOR �eA�9� ii.SCA/'iw-%%
ADDRESS
CITV
STATE
LIC. NO.
SIZE
OF LOT
USE OF
CITY
UC. NO.
NO.OF BLDG
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
1 haroGy eeknowlWpa t�et I hwa r�atl this epD�lcetlon and stete
thn[ Me ebove informetlon la <orrxt end aprae io comply wiM
all lew� rpuletlnp bulldinp conttruction, end I Nell not �mploy
any parwn in violation of Ns workman'� compenuUon lew� 01
Me Stats of Celifornle.
I �araby certlfy that I em proparly Iic�na�tl ea a conVactor under
ffia Stece o1 Cellfornie eudn�u antl Profmion� Catl�, Dlvldon 3,
Cheptar 9, entl thet tuc� Iie�nr� ara In lull tore) antl etfxt, or 1
em oxampt }rom M� proviaion� of tha Stato of 5lifornla Bu inew
entl ProfoOlon� Cod� Ivid 3, Chepnl 9.
Sipneturo oi
Permitta�
Authoriz�tl �nt
7
PAIC
`3�C —1-7�c�sa�� 057� *,r+r��l.;�
APPLICATION FOR STRUCTURAL PERMIT
NECEIVEDBV DATERECEIVED nercicciicr
BUILDING
AODRESS
r
PE
BLOCK
�
���PLANS � I BUILDING� ��� �
�ARDSAPPROVED VARDSAVVROVED
MAIN BUILDING ACCESSORV BUILDII
VAR. f
c.u.v. r. S =
FT
HPPROVED IO—`
TME AMOUNTSHOWN UNDER VALU
TNE PURPO6E OF ESTABLl5HIN0 A GERA
VALUATION PERMIT FEE 3
PLAN CMECK f
S �� �O� TA% 3
TOTALPAID S
.. � 9/�
COSTA MESA BUILDING-SAFETY DEPARTMENT
V.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING ! q _ ,
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NO.
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ADORESS
ARCHITECT
nooAess /a g� N. %77.r�e..:.� S% • U�..
CONTRACTOR y/� �i� ir���
ADORESS ��L � % ��s
TEI.
CIT��M_� NO.��f
STATE / CITV
LIC. NO. � p LIC. NO.
SI2E � � v /n �) NO.OF BLC
OF lOT �� NOW ON LC
�
USE OF
EXISTING BLDG.
Separate permi[s are required for
electric, plumbing and heating work.
USE OF BVILDING �+ND WORK TO BE PEPFORMED
, n s • . i
/
,�r,z�-�S�M�:OOioF9 �***139.00 �
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BV DATE RECEIVED nnrF iscuec
BUILDING
ADDRESS
OWNER
FIRE
20NE
APPROVED
NE NO.OF
PLANS
VARDS APPFOVED
DISTANCE BET
MAIN BLDGS.
VAR. alE
C.U.P.�
APPROVED
1 hareby ecknowladBa thet I hevo �eatl thi� eppllcatlon antl stnte
that Me ebove InfPrmntlon B Corfeti end eprae to comply wiM
ell laws rae�ia�i�a bulltlinB �onsvucNon, entl I s�ell not employ
any Darwn in vlolPtion ot the workmen's compenxilon lows oi
Me Steie Of Calitof��e.
I ha�eby certity thBt I am p�oDe�ly Ilcensotl es a cOntract0� untle� S�
the Stata of CeI1foM�o Business entl Profassions Cotle, Dlvlsion 3, THE AMOU
Chapter 9, antl the� such Iic nses are in full force antl affxt, or 1 THE PURPO'
am ezempi from H+�Provjs�nsof tha5tat�of Celiforn siness VALUATION
end Professions Co DYi fon 3, C/ho�� .�
9
SIB�atura of ��
Permlttee !� 5
VALUE
5
0
GROVP
DAT �� —
�
�F NEW
)IN
�ROS A7PROVED
BEf. MAIN &
N
n
w
i
m
m
VN UNDER VALUATION IS FOR m
'ABLISHING A PERMR FEE ONLY: �
PEhMIT FEE 5 d
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m
PLAN CHECK E m
0
TAX E LL
E
U
TOTALPAID E