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Home My WebLink About2233 STATE AVE - Building Permits aft CITY OF COSTA MESA o qt BUILDING DIVISION =ri ' I cT i• I DEVELOPMENT SERVICES DEPARTMENT PERMIT NU ER V PERMIT '�;''I;-'t e • Existing: 0, Required: 0 Proposed: 0 03-01146 (714)NO '3 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2233 STATE AV Status: ISSUED Suite: Applied: 07/08/2003 Vicinity: ROOF Issued: 07/08/2003 Parcel Number: 42207222 Zoning: ��-� Applicant: ROBIN LEWIS - -- - - - ISSUED BY: Address: 4071 E LA PALMA - SUITE K � ;-' • - Phone: 714-632-3800 - ANAHEIM, CA, !' - Zip: 92807 , - - Owner: PARKER;"JAN'MARINE- . " - Address -'HEADLE . N - - / N . , PEPPERELL;MA Phone: • A / , /174 HEALD ST, - Zip: 01463-1250 Contractor: LEWIS &'SONS"CONSTRUCTION ' Address: 4071 E LA PALMA , SUITE K ;' Phone:' :714-632-3800 • . ANAHEIM, CA - - , Zip: 92807 License: 416525 . .Arch : ' _ • Eng: ' ' Address: . - Address: ' Phone: - - Phone: Zip: . 7 .. License: N -� License: - , - SCOPE OF-PERMIT- -- - TEAR OFF EXISTING ROOF. INSTALL 30.YEAR, COMPOSITION SHINGLES;CLASS A, 30#,FELT AND WILL NOT REPLACE SHEATHING.2,600 `, S.F.-INCLUDES ATTACHED GARAGE. ' - " ' FEE SUMMARY , . .. ` Plan Check: $0.00Calc Valuation: $4,500.00 Permit: $111.25Claim Valuation: $4,500.00 SMIP Res: '. `. $0.50 `SMIP Corn: ''y $0.00 Other ` -$0.00 'Inspection:- ;$0: 00 ' ,Total: ' .$111.75-; - c.. ->A . 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 . 07 0 Right 0-0 ',,,' PARKING Existing: '0N Required: .0 Proposed:. 0 i 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 160 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) WORMERS'COMPENSATION DECLARATION: I hereby affirrn 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: /,,�� Cary � er: //.s tr- - ?a' Policy Number: '% �4✓C ('2 Lova/(This section need not be completed(/rhe permit is valued at one hundred dollars($100)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' compensation laws 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 comply with these pprrovivisisions. ^'� Applicant Signature: !!. � M r Date: z/— "C), WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DO,ARE(5100,030),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licenc9. der 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.# Class# ,(?fS' Contractors Signature: z� n Date: 7 — C�i^-Cr 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 Code). 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:My 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 property,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 driver's license. 0 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 8,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 ❑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 are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-I 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 California Health and Safety Code Section 42303 been made? 0 Yes 0 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. S'gr a Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I, INSPECTION TYPE PEE INTRIALS CODE! INSPECTIONTYPC PAIS rmAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 9-I 5-cs taopl 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 IIIIIIIIII , 0629 8/01 /86 7.81J1L +—w� - Applicant•to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - - - ITN TRACT NO. LOT NO.1 UNIT NO.' - ' (ATV of COSTA r�Mf�3 'CO ST UCT PERMIT Pagia e j I / Project Address ) / � � • I ' • ' • �1 TYPE OF CONSTRUCTION ,U NEW- Li ADD U ALTERATION REPAIR Applicant's Mailim Addr•- s C. / ( /�� __ _ _ _ _ _ A__•P._e - ' • _ ..r-_ _ I / / -❑ CONVERSION' ❑ DEMOLISH ❑' OTHER ' Owner's Name- - Phon •DESCRIPTION OF WORK/USE OF BLDG. - - - w Address • : S Main Building: Accessory Building: I I E , - . Z Arch/Eng.i I I ' License No. TYPE OF PERMIT :El GRADING OUNDATION ❑ STRUCTURAL T Front ; j { D Address •❑` TENANT ❑ ELECTRICAL •, PLUMBING ❑ MECHANICAL B Rear I 1 N CS. I Contractor's Name I# Al . •/I I • Phone 9�nn J I,'O'OTH ER - C Right "` '- ,l PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(mailing) a��r7L I l A - , K ; i - - G : CON STRUCTION TYPE _ VALUATION $ S Left , • City License No. ' • v : ZONE _ ' 'GRADING CU.YDS. - ' ACRES E Ping. Ref.# 'Parkin "Re /Provided LICENSED CONTRACTOR DECLARATION ) w p g q Q ' I hereby affirm that I am licensed untler'provisions of Charter 9(commencing Remarks:• - '✓��1 !If'/�I� A - ' /44p; -/�y( yl �it Planning Notes: - • , with section 7000) of Division 3 of the Business and Professions Code, and ��fl///'(y((,/I L' y L.9 't//.)0_-_[ • my license is in f •I f: and effect! t •�(� ,aJ 1- . • - '7 LicensCSlas • ce seas• l 1.1 r - - - m • - . . . ., • S, r' Date /^ INA! Signature Kirin .W /_, i '! 1. . PLUMBING I FEES _ ' ; . I - • - • to; WORKERS'COMPENSATION DE LARATIONm. ori ' ' -t - r - - ELECTRICAL, - I • 'FEE$ X I hereby affirm that I have a certificate of consent to self insure or a certificate Bar Sink I . • , i 'Showers r j , j of Workers' Compensation Insurance, or a certifi Copy thereo (Section - ��aaa ] Backflow Preventer ; - 'Service Sink' - ' 3800, Lab'. pe qv/-r�/ / /^,/(IC - Automatic Washer I Transformer 0 15-50 KW Policy No: (,� '{'/ 7 • Company i- /E�"� Aackflowilrrlgatwn: ' 'Sewer•Ca • - - - - -1:1159+'KW _ - hfietl copy is hereby furnishetl, - p CopStructiOn POI¢Sub. -- Cert' ie o s filed with the city I on ; Bathtubs _ • Sewer Connection i - I - �./ Cooking Unit- - - Meter.Dun to 10. . Dale !nifON 7 Applicant A"/ /�- - _ - - ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' Clarifiers 2. ! 'Solar Collectors- - Dishwasher ' Meter ❑over 100 amps, , (This section need not be completed if the permit is,for one hundred ($100) or - • - less).• I I Dishwasher - _ ' _ • ' Dryers ❑Gas QElectric' -Sub'Panel , ' ' I -- 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 Drinking Fountains Fan • ' Motors❑0-i�HP ❑1'/x-B' Workers' Compensation Laws a California. • , . .., _ II• Date i - Signature _Floor Drains I . ' • • ; ' F.A.U. ' , - ' ' Inc.Solas 09:15 HP 016,15+ _NOTICE:If,after makingahis ation,.you should become subject to the --- • Workers' Compensation provisions'of the Labor Code, you must forthwith Floor Sinks I Fixtuf¢s I comply with such provisions or.this' permit shall be deemed revoked. I Microwave CONSTRUCTION LENDING'AGENCY Gas Service • Outlets • Device Boxes Pole Light , I • • I hereby affirm that there is a construction lending agency for the performance 9 of the work for which this permit•-is issued (Section 3097 Civ. C.) Interceptors { • • / I 3 Lender's Name Lender's Address - • - ._ Kitchen Sink . _ .1 . OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - I ! , I. Garbage Disposal Standing Section's • following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap r enerator •a any structure, prior to its issuance, also'requires the applicant provisions It to file a signed statement that he/she is licensed pursuant to the provisionof Roof Drains ' • the Contractor's License Law (Chapter 9i(commencingg with Section 7000) of ' ( I I there rom and the Business-andaProfessions Code) or that he/she is exempt - - - - ' therefrom and the basis for the alleged'exemption. Any violation of Section I I • I 7031.5 by any applicant for a permit subjects the applicant to a civil • I Uenalty.onot more-than rive hundred dollars($500). - f • LII I. assowner of the propertyrtyoror my employees with wages as their sole • Reinspection-Fee I $15 'compensation will do the work, and the structure I5 not intended or offered - Reinspection Fee I;$15 Issue Fee : -.$ 3 I for sale (Section 7044,' o ss and Professional Code: The Contractor's MECHANICAL i ' FEES ' s • • License Law doenot applyly tto an owner of a property who builds or improves _ , . thereon,.and who does such work'himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: ; employees, provided that such improvements are not intended or of offered for Boiler - . Hood or Type I 0 , ' , ' I •sale, If, however, the hav ng'or improvement is sold one year of com- Canopy Type II ❑ • Zoning Approved By - - Date .prove , the owner will have the burden of proving he/she did not,build or im- Duct-Under Ground • _ - Building Approved By I -- 1 Date - prove for the purpose of sale). 1 _ 1 I- ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural i Refrigeration System; ' , Application Issued By ' '^' I �� ' Date , ' tractors tract struct the project (Section'7044,Business and Professions Code: - • The'Contractor's-License Law does not apply to,an owner of pr .who ' Duct-Ventilating , . ❑0=100,000 BTU 0100 000 BTU I - - SUMMARY OF FEES with a I • builds or improves thereon, and who contracts for such projects with a con- - - -, I - , 1 tractor(s) Ocense pursuant to the.Contractor's License Law)'. "am aware that ' - BUILDING PERMIT - $- SMIP $ Exhaust System 0 Multiple 0 ;�- System Repair/Alteration. - $ '1O� ' PERMIT _ ' proof of their Wor ken's Compensation insurance should be provitletl,tome. - _ - PLAN CHECK I 7 0 I am exempt under Section - e.& P.C.for this,reason Firepl/Fact.Blt. ICBG# Fire Dampers - PLUMBING _ - $_ ISSUANCE $ ' Date - - - owner' Heating System&Ducting - Registers - j __ PLAN CHECK 25% $ -ENERGY P.C. $ _ • I hereby certify :that I have read this application and state that the above ❑o-100,000 BTU 0100,000 BTU - , ELECTRICAL $ information is correct. I agree'to comply with all city and county ordinances - - - • - - and-state laws relating to building construction;and hereby authorize repre-. . . i •• - ' PLAN CHECK '50% $ ' • -MICROFILM $ _ - y- 1IS sentatives this city to enter upon the above-mentioned property /for - . - ' : - ' MECHANICAL $'- V 'inspection /J{ - • ' �� i TOTAL FEE $ /V' Driverurllc nse r' s/ /. //' Date? 4 " p .. Drivers' icense or S 111....- Pink -Accounting; Goldenrod - Assessor _ '� -• 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-Undrgrrid. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . ' • r r 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding r C 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE • e 7. Footings • 58. Electrical Conduit-Undrgrnd. • . . •c . c 8. Foundation• .. 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. • - . ,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 1 63. Heater & Vent-Final ' 13. Roof Drains - 64. Plumbing System- Final ' 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 • a 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 01 23. Gas Pipe-Rough & Test 72. Underground Flush - 24. Roof Framing -• 73. Undergrnd.Storage Tank'❑Gas DOH ' 25. Roof Sheathing ' 74. Overhead Hydro. . 26. T-Bar Ceiling (Structural) & Monocoat 75„ Dry Chemical . 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL • 29. Insulation 78. FIRE PREV. FINAL - 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . . . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:r .7 .. '(� / - ' . 34. Final Heating & Air Conditioning L p44 �. ,zo, z tet/ L/,P Z41 /.'llfe 35. Final Gas Pipe-Test - Q 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. Backflow Irrigation - - _ • I.44.'Landscape Irrigation System - ' ' 45. Sound Attenuation • 46: Handicap Regulations " 47. FINAL STRUCTURE & BUILDING " •" - - 48.,Special Requirements Completed - ' • 49.-Electric Release to Edison 50. Gas Release to Southern California Gas CD 51. CERTIFICATE OF OCCUPANCY ' J No. Date \ '' • 1 5%:. , FEE RECEIVED 12522 ,jA_L� JUL i isso i COSTA MESA BUILDING-SAFETY DEPARTMENT 'FINANCE DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely . APPLICATION FOR PERMIT TYPE OR PRINT BUILDING sT91-C- BUILDING ADDRESS 2233 — -- Avenue a 756 COSTA MESA. CALIFORNIA For Office Use Only I RECEIPT NO. PERMIT NO. OWNER Columbia Homes, Inc. ADDRESS 1533 Baker Street i• JCRCBY DATE 7VZ BUILDING CITY Costa Mesa NOI?C191151 ADDRESS ARCHITECT Carlson 8C. TEL. COSTA MESA, CALIFORNIA OR ENGINEER ... NO.LE97747 ADDRESS Garden Grove Calif. FIRE 1 f D - ZONE TYPE v `GROUC6,l� ' , CONTRACTOR & ColegroVe, The. APPROVED DAL, L�, �, 1 Bl kP TE ADDRESS 15'3 Baiter Street ZONING /��/�y� A U/, NO.OF UBE OF N J ,I/I1 CITY CO$ta Mesa, Calif.1 { /. I PLANE'\/BUILDING Y ucNO. 167293 No: K191151 LEGAL (II Lot 21,lTr. 3717 6/ DESCRIPTION • 1, SIZE 1 NO. OF BLOBS. OF LOT 60 x UI NOW ON Lotnone A.P.NO. C.A�./x-err‘.A- ,-- USE OF YARDS EVES EXISTING BLDG. 11O11P APPROVED ALLOWED SETBACK LINE FROM601 (CENTER LINE ST.) . CENTER OF STREET AI?i REAR YARD FRONT 1)._. FT. IN. SIDE YARD I LEFT 51 I RIGHT 5I R.SIDE (5 FT. IN. DESCRIPTION OF WORK L.SIDE 4.5 FT. IN. NEW I X II ALTERATION I I ADDITION I REAR r 0II FT. IN. REPAIR II MOVING I DEMOLISH BYPROVED / / f/ I) DATE --? -ICU BSIZE 1758 1758 Sq.ft.ROOMS 10 STORIES 1 Y �(� EXTERIOR WALLROOF COVERING StUCCO I COVERING comp.rock USE OF BUILDING AND WORK TO BE PERFORMED multiple family dwelling with attached garage (two Living units) Gar. 420 so. ft. Plan BR I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION VALUATION SIGNATURE OF (.....--/E7 PERMIT FEE $ 37.00 PERMITTEF / / �p-� N s 17,92600 PLAN CHECK $ 18.50 w AUTHORIZED AGENT Dike & Col ove, Inc. 555.50 1 E TOTAL FEE $ 0 OWNER JOHANSEN, Sigvart DATE 4-3-62 JOB ADDRESS 2233 State Ave. BUILDING PERMIT NO. 16863 GENERAL CONTRACTOR Owner-Builder VALUE $ 550.00 AP No. none LOT 21 TRACT 3717 FIRE ZONE DESCRIPTION OF WORK Add Pat.to Res, INSPECTIONS Signature DATE GROUP j TYPE V ZONE R-2 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line ❑ House Con. D St.Swr. 0 Sprinkling System Construction Pole Underground ❑ Power ❑ Rough Wiring Trenches 0 Forms ❑ Steel Reinf. ❑ � � Ste' ..- (�_�-� L, Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing _ Lathing — In ❑ Out 0 Plaster, brown coat Ref rig. 0 Air Cond. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final y✓ - .— ) ?— OCCUPANCY FORM BU4•5M — 741•• 16863 16863 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.APR.3 1962 P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA 0 For Applicant to Fill In Completely APPLICATION FOR PERMIT , TYPE OR PRINT BUILDING ADDRESS .22 33 Stale Arte COSTA MESA. CALIFORNIA For Office Use Only /� RECEIPT NO. PreVV3 OWNER S/ Ira rt foAanxe�jn /� 1 f /V ADDRESS 2_33 State ,c -c_ /i, RECEIVCD Q� I RE EIV a-te. 7/ CITY Costa P)CS4 - • NoJgif-SYTSI ADDRESS s//�� 33 ,� '�� ARCHITECT • TEL COSTA MESA. CA !FORMA OR ENGINEER Owner NO. YA ADDRESS FIRE ZONE TYPEGROUP CONTRACTOR Own cr APPROVED ^'}/ 2......---.BY DATE / ADDRESS ZANING ZO1J�r y I NO.PLANS v OF ' /I USEBUILDING OF NEW , CITY ( ' STATE TEL. LEGAL LIC.NO. NO. DESCRIPTION L 01- 2/ rr. ,3 'I i 7 SIZE I NO. OF BLDGS. OF LOT NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG APPROVED ALLOWED SETBACK LINE pR , (CENTER LINE STJ /////� CENTER OF BTREE' hie REAR YARD(eV t FRONT G// VET.t IN. SIDE YARD I LEFT SFr RIGHT s-ft V�y-/� R.SIDE o �(pf. � � IN. DESCRIPTION OF WORK �/ L.SIDE F/SI' N. NEW II ALTERATION I I ADDITION I /1 REAR y FT. IN. REPAIR I II MOVING I 0 DEMOLISH I APPROVED tiA./1/2 ,/I E ,/ 3 r/ + ' BUILDING p' y / NO. OF /`JVJ T C SIZE S X 2G ROOMS STORIES EXTERIOR WALL I ROOFA/4 n1 COVERING COVERING I USE OF BUILDING AND/WORK Tp BE PSSFORMED PQt/O A U(/ r--(7 / co 1-- .S I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POP THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CI ORDINANCES AND STATE LAWS REGULATING BUILDING CDNB /f�� VAL ATION t SIGNATURE 0 %�L _'� ic(/ ra PERMIT FEE 5 „Vj PERMITTEE m �— S C PLAN CHECK $ 4 AUTHORIZED AGENT ri ' TOTAL FEE $ ) 4