HomeMy WebLinkAbout959 MAGELLAN ST - Building Permits�
�
CITY OF COSTA MESA
t � T°"'F, BUILDING DIVISION
F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.us
" FOR INSPECTIONS CALL: (714) 754-5626
'`�'�°�°^°"° PERMIT NUMBER: P11-00084
PERMIT TYPE PLUM
APN: 14133403
.�"';: j.—�er---"_,'�n"„Sh %�'4j.',"�;p;' :YitJ^-'.:.
JOB ADDRESS:�959'MAGELL�AN:ST!C_ �M„"���
Vicinity:
SCOPE OF WORK: REPALCE INTERIOR SEWER LINE.
OWNER:
PHONE:
APPLICANT:
PHONE:
KAY. PATRICK OIIVER
RICK GUEVARA
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
0 411 812 0 1 1
CAC
Address: 959 MAGELLAN ST
City/State/Zip: COSTA MESA, CA
Address: 215 S PRIMROSE ST
City/State/zZip: ANAHEIM,CA
CONTRACTOR: RICK THE HAPPY PLUMBER License No. 759839
Address: 215 S PRIMROSE ST PHONE:
City/Slate: ANAHEIM,CA ZipCode: 714-635-07 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PIAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$48.15
$48.15
� '�A V �4 tr
NOTICE: The work authorized by this p@rmit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 7, 72-21-92)
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 fnal approval will resull in the expiration of lhis permit.
CO�E N INSPECTONTYPE OAIE IN7171AL5 LOOEM INSVEC110NTYPE DATE INTITIALS
i616 Fixed System Final Fire Prevention 206 Final Mechanical �/�
1266 Pool Spa Final 20B Final Plumbing X�"��"ll //1 P�GN��
200 Final Re-Roof 210 Final Elecincal
201 Final Block/Retaining Wall 212 Pinal Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Fina15ign 222 Final Site
204 Final Demolition 250 Final BuilOing/Occupan�y
WORKERS' COMPENSATION DECLARATION: � Owner ID verified by tlrie�.
I hereby a/firm under penalty of perjury one of the follovnng tleclarations: Oriver's License No.
iicen�� Yes ❑ No
Expires:
❑ I have and will maintain a certificate of conseN to sel4lnsure for vrorkers' Verifcalion of Ownership by (type of tlocument, i.e. - property tax bill or tleed):
compensalion, as provided for by section 3700 0l the Labor Code, for Ihe
per(ormance of the vrork for which this permit is issued.
I have and will maintain v.orkers' compensation insurance, as required by
s tbn 3700 of the Labor Code, for the perfortnance of the wnrk !w wfiich [his DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
pertnit is issued. My workers' compensation Insurance carrier antl policy ❑ � hereby certi/y that no excavation frve (5) or more (eet in depih into which a
�be are: 1 person is requiretl to tlescend, will be made in connection with wnrk authorized
�Q J'--(e ���n,{— /� / ��a ^�I �` � by this permit, ana Ihat no building strucNre, scaltdtling, false�wrk, a demolition
( p1'�� L/ } or dismantling thereof, vnll be more than ihirty-sa (36) feet high. (Chap. 3.2. Grp
T pnneetlrpfhemndefetldt�epertnfavaluetlalonehuMretltloEarsl5100/arless.)
/ /� n 2, Fvt 2, Sec. 347, Ttle 8, Calitomia Administ2tive Code�.
olic umh .!� (�1� � C � O� Z— �'
❑ As owner-builder, I will not employ anyone to do work which woultl
certify thal in the per(ormance of the work for which this permit is require a permit from the Division of IntlusMal Salety, as noted above, unless
issuetl, I sh not��¢�^^^ ploy any person in any manner so as to become subject such person has a permit to tlo such work from lhe division.
to the vror s' c�pensalion laws of California, and agree that if I should
become ject the workers' compensation provisions o( Sec�ion 3700 of qpplicanfs SignaWre Da�e
the Lab r o 0�I shall hvrith comply wilh lhese provisi s. `�I
�- Division of Industrial Safety Permit Number,
pliranc ' nawre Da�e HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE �� '+��II lhe applicant or preseM or fuWre building occupant need lo file antl
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL �erti(y a Business Plan for emergency response lo release or Ihreatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑ Yes ❑ No
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that 1 am licensed under provisions of Chapter 9(commencing
with Sect'on 7000) of Division 3 of the Business and Professions Code, antl
i is in full (orce and effect.
�,�,, �c-3S
re -- ` Da f
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a constructbn lending agency for the
peAormance o( the v.ork for wfiich this pertnit is 55ued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm 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 wunry which requires a permit to
conswct, alter, improve, tlemolish, or repair any strucWre, prior �o its
issuance, also requires the applicant for such permil to file a signetl statement
that he or she is licensed pursuaM to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0! the
Business and Professions Code) or [hal he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7037.5 by any
applican� for a permit subjects the appliwnt to a civil penalty of not more Ihan
fve hundred dollars ($500).):
❑ I, as ovmer o( the property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and the structure is not intentled or
oflered for sale (Sec. 7044, Business and Pro(essions Code: The Contractors
License Law does not apply lo an ovmer of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or oftered for
sale. If, hovrever, the building or impmvement is sold within one year o(
completion, the owner-builtler will have the burden of proving that he or she
did not builtl or improve for purpose of sale.�.
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business and
Pro(essbns Code: The contractas License Law does not apply to an owner of
property vfio builtls or improves thereon, and who contracts for such project with
a cont2cta(s) license pursuant to the Cont2clors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3osi-as c3ro��
(Seclion 25505 0l l�e Califomia 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 Ouring a reported
year a quantiry of hazardous materials equal [o or greater than a weight of
500 pounds, or a volume ot SS gallons, or 200 cubic feet ot compressed gas
at standard temperaWre and pressure).
2. Does or will the applicant or present or fuNre building occupaN neetl to file
a registration form for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 0( the Califomia Health and Safery Code, vrith some
exceptions, requires regislration with the Costa Mesa Fire Deparlment by
each business which at any one time has on hand a quantity of acutely
hazartl0U5 matedals equal t0 or grea[er than a weight Of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at standard
temperaNre and pressure).
3. Does or vnll the applicant or presen[ or fuWre building occupant need ro
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials�7 ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery CoCe pmvides that the
Costa Mesa Fire Department may require the preparation, certi5wtion antl
filing witn the Fire Department o( an RMPP by businesses which are required
to register acutely hazardous materials wilh the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Salety Code been (ully complied vnth? ❑ Yes ❑ No
5. Does or will ihe applicanl or present or future builtling occupant require for
Ne work which is the subject ot Ihis application a permit for such conswction
or modifcation from lhe South Coast Air Qualily Managemenl District or from
any other air pollution coNrol disMct or agency? ❑ Yes ❑ No
(SeCtion 658502 of Ihe Califomia Govemment Cotle requires that the requestetl
infortnation be fumished on applications for non-residential building pertnits).
6. Will any part of the facility to be consWctetl under this permit be wilhin
1000 feet fmm the outer boundanes o( a school? ❑ Yes ❑ No
(If yes", Ihe facility must meet the requirement of Sections 25534 antl 42303
of Ihe Califomia Health antl Safety Cotle).
7. If a permit from the South Coast Air �ualiry Management DisMct or other
air pollution contml disMct or agency is required for the v.ork which is the
subject of this application, have all of the tlisclosures prescri�etl by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf 'yes", attach certifcate of compliance from Ihe appropnate air pollution
contml oKcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury Ihe
intormation qiven above is correct. I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials antl Emissions.
SignaWre Daie
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi�y under penalry of erjury that I have read this application and state that
the information given " correcL I agree to comply with all state laws and ciry
ortlinances relating bui�ding c nsWc[ion, and authonze representatives of
Ihe City of Costa�' e5a to e ter upon the above-described property (or
inspection purpo� s. I agree n � to occupy or allow occupancy of any building
authorized by t' pertnjf until al inspeclion.
.1 �
CITY OF COSTA MESA
`�,��pMFs'q BIIILDING DIVISION
i�g 77 FAIR DRNE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • vnvw.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
'`°^�°'''' PERMIT NUMBER: P11-00073
PERMIT TYPE PLUM
APN: 14133403
JOB ADDRESS: 959 MAGELLAN ST CM
vicinity:
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit;
ISSUED
04/07/2011
KJB
SCOPE OF WORK: R�PAIR PRIVATE SEWER LINE INSIDE THE RESIDENCE. APPROX 35 FEET OF SEWER LINE.
OWNER: KAY,PATRICKOIIVER Address:
PHONE: 714-241-1G14 City/Slate/Zip:
APPLICANT: SZABO, KEVIN Address:
PHONE: 714-24�-1q14 City/State/zZip:
CONTRACTOR: COAST HEATING AND AIR
Address: 17392 MT CLIFFWOOD CI
Cily/State: FOUN7AIN VALLEY, CA ZipCode: 92708
ARCHITECT: License No.
ENGINEER: License No.
0
959 MAGELLAN ST
COSTA MESA, CA
17392 MT CLIFFWOOD CI
FOUNTAIN VALLEY, CA
License No. 777970
P H O N E: 7'I 4-24'I -14'14
CELL: 714•241-7103
� PHONE:
PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$48.15
' $48.15 „
����� � �
DATE: (S�(�.
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES'180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
7NSPEC710MS: In order for the work authorized under this perm'rt to be cbnsidered legal, such work must comply with all applicabie codes, and atl
required inspections anq final approval must be obtained. Failure to obtain inspections and fnal approval will resWt in lhe expiration of this permit.
CODEt. INSPECTIONTYPE DATE INTITIALS CO�EI INSPECTIONTYPE �AiE INTITIRLS
ifii6 Fized System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electriwl
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Pla�¢ 220 Final Planning Approval
203 Final Sign 222 Final Si�e
204 Final Demoli�ion 250 Final Builtling/Occupancy .
�/ —.
WORKERS' COMPENSATION DECLARATION:
I hereby a�rm untler penalty of perjury one of the following declarations: �
❑ I hav nd will maintain a certifcate o( consent to self-Insure for workers'
compe a�ion, as provided for by section 3700 0! the Labor Code, for �he
ance of the work for which this permil is issued.
I have and will maintain wvrkers' compensation insurance, as required by
eciion 3700 of the Labor Ccde, for the pedormance of the wnrk for which Ihis
permit is issued. My workers' compensa�ion Insurance carrier and policy
number are:{� (�
-arner . .{ �S�—R-'�1 �— `I�vO1NC.'� WMPA.Ni
(7his setlbn neetl nol �e mmpleled AMe perm� is val�ep a( one hundred Dollars ($f00J a less )
�m r.- I� C-C (� U 1��D03
❑ I certi(y �ha[ in the performance of the work for which [his permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Calitomia, and agree that if I shouid
become s bj ct to [he workers' compensation provisions o( Sec�ion 3700 of
Ihe L b Co e, I shall forthwith comply with these provisions. f
'���I
p icanFs Si§Naluie=' DatE-:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER 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, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTR4CTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( the Business and Pro(essions Code, and
my license is in full force and eNect.
� �� • as=#-C-36 C-2�
� ir
qs.5i9��ure � a e .
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that ihere is a construction lending a9ency for ihe
peAormance of the wvrk fa which this pertnit is issued. (Sec. 3097, Civil Code�.
Lendei s Name:
Lender's Address:
Date
OWNER•BUILDER DECLARATIONS:
I hereby a(firm Iha[ under penalty of perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe (ollowing reason (Sec. 7031.5,
Business and Professions Cotle: Any ciry or counry which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior b its
issuance, also requires the applicant for such permil to fle a signed statement
that he or she is licensed pursuant to the provisions o! the Contractors
License Law (Chap[er 9(commencing with Section 7000) of Division 3 0( the
Business and Professions Code) or ihat he or she is exempt therefrom and
the basis for ihe alleged exemption. Any violation of Sec[ion 7031.5 hy any
applicant for a permit subjects the applicant �o a civil penalry ot not more than
fve huntlretl dollars (5500).�:
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the stmcture is not intendetl or
oBeretl for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
lhereon, and who does such work himself or herself or ihrough his or her ovm
employees, provitled that such improvements are not intended or offered tor
sale. If, however, the 6uilding or improvemenl is sold within one year of
completion, the ownerbuilder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to construct Ihe project (Sec. 7044, Business and
Pmfessions Code: The conhactors License Law does not apply to an owner of
pmperty who builds or improves Ihereon, and who contracts for such project vnth
a contractor(s) license pursuant to Ihe Cont2ctors License Laws.).
❑ I am exempt untler sec.
Business and Professions Code for �his reason:
305I�46(3/0])
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership 6y (type of documenl, i.e. - property tax bill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certrfy that no excavation (rve (5) or more fee[ in depth into which a
person is requiretl to tlescend, will be made in connectbn vrith work authorizetl
by this pertni[, antl that no building structure, scaffdding, falsework, or demolition
or dismantling thereof, vrill be more than ihirty-six (36) /eet hiqh. (Chap. 3.2, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division o� Industrial Safety, as noted above, unless
such person has a permit lo do such work from ihe division.
ApphwnYs 9gnaWre
Division o( Industrial Satety Permit Numbec _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or WWre 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 0( the Califomia Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Depariment by every business which has at any one time during a reported
year a quantity ot hazardous materials equal to or greater than a weight ot
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperaWre and pressure).
2. Does or will [he applicant or present or (uture building occupant neetl to fle
a registretion form (or aculely hazartlous materials? ❑ Yes ❑ No
(Seclion 25533 0( the Califomia Health and Safery Code, vnth some
exceptions, requires registretion with Ihe Costa Mesa Fire Department by
each business which a� 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 standartl
temperaNre antl pressure).
3. Does or will Ihe applicant or present or (uNre building occupant need to
prepare an RMPP (Risk Managemenl and Prevention Program for acutely
haZard0u5 material5)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Deparimenl may require the preparation, certificalion and
filing with ihe Fire Department of an RMPP by businesses which are required
lo register acu[ely hazardous materials with lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 0( Ihe Califomia
Health and Safery Code been fully complied wi[h? ❑ Yes ❑ No
5. Does or vnll lhe applicant or present or tuture building occupant require for
the vrork which is Ihe subjec� of this application a permit for such construction
or motlifcalion from lhe SoWh Coast Air �uality Managemenl District or Irom
any olher air polWtion control disUict or agency? ❑ Yes ❑ No
(SecCwn 658502 of Ihe California Govemment Code requires [hat Ihe reques[ed
infortnation be fumished on applicalions for non-residential building pertnits).
6. Will any part o( Ihe facility to be constructed under Ihis permit be within
1000 teet (rom the outer boundaries o( a school? ❑ Ves ❑ No
Qf "yes", the facility must meet the requirement of Sec[ions 25534 and 42303
o( Ihe Califofnia Health and Safery 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 tlisclosures prescribetl by California
Health and Sa/ery Cotle Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certificate of compliance from the appmpnate air polNtion
control offcer).
CERTIFlCATE OF COMPLIANCE: I certify that under penalry of perjury the
in(ormation given a6ove is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y under penalry ot perjury that I have read this application and state tha[
the infortnation given is correct. I agree to comply with all state laws antl city
ortlinances relating to builtling cons[ruction, 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 builtling
authorized by ihis permit unlil final inspection.
� Sipnamre r[egai Ovmer(s� Da�e /
�7� �' � �I
A " 'JAul�o`nzeOAppl¢anl Date
! ��
� CITY OF COSTA MESA
REFtlND REQIlEST FORM
From: ❑ Finance Vendor #:
p[� Building Safety Permit #: � I I- OO G� 3
� Planning Amount: $ ��_ ��
❑ Public Services
❑ Community Services Date: �.I �.� I I
Name and addr6ss of applicant: t`�"�� � 1`l ����
� 7�J`i0 M� � cL\F �� UU (_� C� 2� ,
�� � ,.�T � �uy � o�.� F �c . � A �12� ��
`,� ,
Phone: �� � "\��J�i'"O�D ZC�
� � I ��
ApplicanYs Signature Date
REAS�NFOR REFUND:
J�� c+a-� ��� i� � � NsP��� o� ��E�� cL
APPROVALS:
Finance:
City Manager: _
2i01�2� MW ONLINE
BUII.DING PERMIT NO.
G�NGRAL CONTRACTOR Dja,CCO COx'p. VALUE $ 171 25.00
AP No. LOT 51 TRACT 426o RIRG ZONP D�SCRIPTION OP WORK P06 W 8tt gRT'
INSPECTION5
C
W a�er
OCCUPANCY
DA7T � GROUP 1�d TYPE � 7.ONG
i
SU�3CONTRACTOR
�� � . 16649 FEE RECElVED
J , � M 7 196� 51 - Tract 4260
COSTA MESA BUILDING•SAFETY DEPARTMENT ��,�nI,CE D��. plan 300-B
P. o. BOX 9,� C08TA MHBA. CALIFORNU ��TY OF CUSTA MESA
For Applicanf fo Fill In Compleiely APPLICATION FOR PERMIT
TYPE OR PRINT gU1LDING
BUILDING
ADDftESb
COSTA MESA. CALIFORNIA FOi Offlce US@ oll�y
niesa Del Nar �evelo tt10IT( aecs�wr xo. ,yaqwr,i
; 3800 E. Coast Ei�hrrav
I war -ecr C 1ifT 0
ti8C81VBD BY
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e Ave. Downe FIRE
ZONE
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STATE _.... _ .. __ _ TEL. __ _
NO. OF
USE OF RiOne
EXISTING BLDG
S6TB�CK LIN6 PROM r�
CeNTeH oP BTReeT 711 � REAR YARD ��
SIOE YAHD ILEFi �� IRIGHT ��
DESCRIPTION OF WORK
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COSTA MESA. CALIFORNIA
iesuen
7 �iii�
ZONING
ZONB I NO. OF I US8 OF NHW "� �i
� � / PLAN9 2 BIIILDINO � ) �
�
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USE OP BUILDING AND WORK TO BE PERFORMED
i� n le f P- � v � �p 2TE2 61t $
wfattached garage �z�e n tyla3 S.F.
Goeered Forcl; 3b 3.F,
i HEPEBY ACKNOWLEDOE TXAT I HAVB fiEAD iH�B APPIJGTION 1H8 AMOUNT 6HOWN UNOER VALUATION 18 POp TXH
AND BTATE THAT TH8 ABOVE IB LORPELT AND AGREE TO COM• pUflP08E OF EBTABLI9HINp A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANLE9 AND 9TATE UW9 REGULATINO
auIIDINo CONBTRurnoN. VALUATION �� �1
SIGNATURE OF r� PERM17 FEE $ r�— -�,(
.._.. r�_� r..e...., r._,.�"'..'a n'
$ 17��LH�OO IPLAN CHECK $ /
� AUTHORIZED
SUBCONTRACTOR
or
Y�C�l�i�l
. 24460
COSTA MESA BUILDINCrSAFETY DEPARTMENT
P.O. BO%91] COSTA MHBA. CALIFORNIA
For Appliconf fo Fif! In Compfetely
TYPE OR�PRINT
LDIN6 � / M � � //��v �
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COSTA MESA, CALIFORNIA
■ ARGHITECT
srare
uc. No
SIZE
OF LOT
USE OF
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JUL 26 1�
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NOTB: NO EAVE OV ERNANO SHALL BE LE68 THAN
YAROSAPPROVED I YARDSAPPROVfiD
MAIN BUILDINO ACCESSORY BUILDIN6
REAR FT. �
D16TANCE BET. BET. MAIN
MAIN BLDG9. AGCES9. BI
VAR.SC DATE
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TN8 AMOUNT BNOWN UNOHP VALUATION 19 FOH TN6 =
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TOTAL FEE $ ��
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ROUGH NEPTING r1N0 /IR CONOITIONING
TEMPORARV SERVICE OR POLE
UNDERGROUND � POWER �
ROUGH WIPING
TRENCHES FORMS STEEL RE
FLOOR SYSTEM
BONO BEnM � STEEL REIN�ORCE [
SHE�TNING
FRAME AND FLASHING
LATHING — IN rj OUT ❑
PLRSTER,BROWN COFT
STP"�TUR4L, FINAL
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORN�A 92626
Fur Applicant to Fill in Completely — Use [nk Only
BUILDING //��/J ///_ J/ �
OWNEF VV l vIIJi%i%n/�%S
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LENDER __ __ _ _
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NOW ON LOT
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Separate permits are required for
electric, plumbing and hea[ing work,
BUILDING AND WORK TO BE PERFORf.
� � 1. _ i. /
PAID ��.�0
..�Y 15-77�vs�0� 867�* **�*
FORSTRUGTURALPERMIT
DATE RECEIVED D E ISSUE
/
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BUILDING
ADDRESS
FIRE
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APPROVED
ZONE ' NO.OF r
PIAPiS�
YARDS APPROVED
MAIN BUILDING
(FROM GL STREE71�
OISTANCE BET.
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VALUE `
S
GROUP ��
DATE `
USE OF N
BUILDING �(�'�� q
VARDS APPROVED
ACCESSOFiV BUILDING
DATE
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I haraby aeknowletlBe ihai I �s�e �ead ihia appllcation antl ztnta
that the ebove Intormation is corract e�e ee�ae to comply with
ell lewa regulatlnB builtlin9 conmuction, and I shall no[ amploy
eny perM� in violatlon of the workman'� compensatlon lewe of
Ma Stnt6 of Califomie. �
1 hareby cartHy t�et I am propetly Ilcensetl aa a contrector untler SQ. FT.
Me Smt! of Celifornia Busineu anE Profeuions Coda, Dlvision 3, THE AMOUNT SHOWN UNDER VALU
Cheptm 9, antl IfcePsas ere in t�ll foreo entl e4fxt, or 1 TNE PURPO6E OF ESTA8L6HING A PERI
em exempt fr m the prov sions o/ tha Smta of Callfornia Buainasa
VALUATION PERMIT FEE S
antl Profdaslon Cotle, Dlvlsion 3, Ch pter �
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SlpneturB of � `f
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