HomeMy WebLinkAbout381 SUNRISE CIR - Building Permits•2� Zs,o
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August 29, 1975
Ezami�atio�: SC)$-39�7
COMPRESSION TESTS ON GUIJITE �YIINDERS
Mr. L. E. Sprague
5041 Doanoke Avenue
Irvine, Callfornia92705
PROJECT POOI for Fowler Development Co.
ADDRESS 381 Sunrtse Circle, Costa Mesa
SAMPLE FROM Shallow end, deep end and bond beam
♦PCHIfFCf
FNGIHEE>
MIX
DATE CAST
DATE TESTED
CYIINDER NO.
COMPRESSION
TOTAL LOAD, 1B5.
POUNDS YER SQ. IN
S12E:
COMPLIANCE
CYLINDERS
Gunfte Premix
0-21-75
0-2&-75
�
7-Day
75,000
2,100
6-3/4" x 12-1/4"
MADE !Y
L.E.S.
oisraieuriow
--Lasta Mesa Bidg. Dept.
Suburban Pools
L. E. Sprague - 2
330 � � .. .. ..e.. . ..i .e .� ... .
CONiRPCtOo
Suburban Pools
SOBCONIP4[iOw
Suburban Gunite Co.
SPECIFIED
STRENGTH
CYLINDER SIZE
A-28-75
2
7-Day
45,000
1,465
6-1/4" x 13-3/4"
�EIIVENFO 6Y
Permttk 40296
2,000 psi
0-28-75
4 "HOLD"
3 5 "HOLO"
6 "HOLD"
7-Day
51,000
1>662
6-1/4" x 12-1/4"
9FCFIVFD ON
Da4e 8-28-75
�UI��lf�aP S�:��YY DEPT,
S r P 2 9975
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August ll, 1975' -
Fowler Development Company �
17341 Irvine Blvd., Suite 112
Tustin, Ca'Lifornia 92G80
Gentlemen: ` .
� A building permit has been issu�d Lo Suburban Pools to construct a
semi-private swimming pool on your pLop,erty on Sunrise Cirele.
In order that you ul may be a sufe one.and for the purpuse of
advising you of yout esponsibility regarding the requirements of
the Costa Mesa Municip Code, we refer you to Sec[ion 8107, a
copy of which is attached.
This letter is directed to you in order that you will be aware of
our ordinances und can make a complete safety ;check of your pool
area.
........
' Sincerely yours,
RICHARD HANHART
Building Safety Director
RH:cb
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September
August 29, 1975
Examination: SC7$-392%
COMPRESSION TESTS ON GUiIITE CYLINDERS
Mr. L. E, Sprague
5041 Doanoke Avenue
Irvine, California 92705
PROJECT Pool for Flower Development Co.
ADDRESS 381 Sunrise Circle, Costa Nesa
SAMPLE FROM Shallow end, deep end and bond beam�
♦ACHrtECt
LYGINEFo
comvauoa
Subur6an Pools
suecor+rancroo
Suburban Gunite Co.
SPECIFIED
Permit� 40296
MIX Gunite Premlx STRENGTH 2�000 p5�
DaTE CA57 (3—Zj-75 CYLINDER SIZE
DATE Tesre� a-28-75 0-28-75 8-23-75 9-11-75 9-11-75 9-11-75
CYLINDER NO. . � 2 3 4 5 6
CO MPRESSION 7-Day 7-Day � 7-Day 21-Day 21-Day 21-Day
TOTAI LOAD, 185. 75,000 45,000 51,000 73,500 75,500 77,000
POUNDS Nea so.�N. Z��00 1,465 1,662 2,132 2,365 2,155
�1 - 6-3/4" x 12-1/4" k3 - 6-i/4" x 12-1/4" N5 - 6-3/0" x 12"
SIZEs: �2 - 6-1/4" x 13-3/4'� M4 - G-5/8" x 13-1/4" �'6 - 6-3/4" x 12-1/2"
COMPLIANCE Z�-Day test complies wtth specffications.
CYLINDERS
MaDE er DEIrvfNED !v NECEiVED ON
�.E.s. ��➢d�.�Y�P S,'-!FE�Y �JEPI�. a—ze—�5
DISIVUUiION '��n -5y' n
F' c) �97;
Cos[a Ptesa Bldg, Dept. ` ""
Suburban Pools
L. E. Sprague - 2
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eooRrssaeu�owm 381 SUNRISE CI
wlxeasru�eiva�awra HACK BAY VILLAGE OWNERS
�oopEss ASSN
, 381 SUNRISE CIR
COSTA MESA,CA 92627
Vtt. WIW101WPESi
�xcxrtEn on Exrn+�:
�N NOP!
RCN OR ENR'S ADDPESS:
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ADDRE55:
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LICEN4ED COMF�CTONS OECLAFRTION: I heraby eflim uMs perely d pmjury Ihe� I em fcmaaE ivWer prwiriwn d Cheqa B
�o�m«,aro .nn s.nm �aooi a a�� a a� a��., �a a�d.,.a., code..m mv �o.�,. e� wo a� �e.n.a.
cm uc. No.: uc. cuss: uc. No.:
OWNEP BUILDEN UECLRN�TION: I hereby �rm uMer qne1Y d parjury ihet I em eaemq Imm iM Comraam Lioenes law la tlr
Idpx�q reewn (Sepbn ]W t.5 Bua'vwaa vd Prolmabru Code: Airy ciy a munry whidi rpu'vae e pamn �o canWr�. Mer. imprv.a.
Aemd'eh, w repv vry ai�ucturo. q'n lo ita ieuuwe, abo �uim ihe epd� ta wc� pamC lo fib a eqiwd sWemml Mtl M a�M
n IioeroaE puiweni to the poveuru d Ne Conlrepan Licenae lew ICheqer 9(�meno�p xil� Sedian 1000) W Oila'nn � d ihs
B�nirca vd Rderoiom COEeI a Intl he n ehe is memq iherNmm erd tM basa In the elbped awemqion. My vdetun d Secion
Ri1.5 by eiry epplicen� lor e permn wbptl� �M epd�� �o e ail peruM1y d'al mare �Mn f've huiMrtE ddlen �fSW��.
�] I, ee owner M Iha proparly or my empbyeee wilh wepee ev Ihe'v ede mmpanmibn, will Eo ihe wak, enE IM el�uclure e nd imenEeE
a ollered for Wa (Seciion ]OIa, Bumneee end PMaationsCab: TM Contrepwe Liceroe lewdoee roi epplyto en owner d papMy
wla WiEe w in0�� �ha�^� ���^^ auch v.ork Nmeell w MnN or Mraph h'o a Mr ovm employeee, qaviEW IMI wc�
improromeMs ere nd inleMed Q otleieE la eale. ll. however. IM Euikinp a inpovaneN e wltl Milhin one Y� d oomplelun, tM
owror-0�itler witl hew �he Wkm d pwinp M a ehe did mi buiM m imprwa la IM qvpma M dal.
� 1. u owner d IM peopery. em eatluuvaly ooniredip vrilh liee'meE eonVeevore ro oonatrutl iha qoptl (Seuun'lM�. Bwiross md
Proleaeiom CoEe: The ComreCon L'<mee Lew doee �ql epply b en ovmer d piape�y who Wikt a impwee Ihaaon vM Mp
comncb Iw vuM D�ojede wilh e wmredor�e) Icemad punuent to tM CaMredae Liceroa Lex�.
� lemsyyy���^^^/VW MxSx/iJJ�'��^^: B;BP.C..brlNa��e[e�/�� � �. �J// /� ,���� �
Deu: �/� ' � Oxner: I / `wGtfdt.r� /1 • •E'^G� �'"��
1 do haeM canM tlW I em ewere M eM uide�eienE Na nqwnmerca d Cellarca IIuEh enE Se1wY Cods Senom 25505. ?551'!. enE
t55�a. aM Net I«enY �� ��irp ooarpant xill / wil mi (aic4 wr) �d lo camply wih aeid pate wOse xk iM �pui�aneme b
aWrmnlnmuhucibnamod'iliceiionhaniMAi u�CTiy�enepemsMDi¢trirl.Reeidmtialoonqrutlnne00�imeene�emqhamRws
p�:,�..
Dma: Mp�c+m:
WOFKER'3 COMVEN4�TON OECLARATION: I hxehy dhm uMr penetly d pepsy one d Ne bOvwnp Jedratun:
� Ihe�audrrilmeiMeinecMEctladmben�loeMimu2lvwakere'mnpenWion.mpwidaElab/Se'Jim3lWaflMlebv
coe.. �u �ne o«tmnence d �n..,vn �ar w�:cn mia o�il ro muea.
❑ in...ae.u�m��iw.•�w�wo���,��.m�.wa.enrsae:�a�aoame�coe..wm.wn«�w�o.an.
work la r,fiiN N'v V� "s ieutl. MY waMrs' m�paumion i�wuan.a wr's vd V�Y rvvnber era:
c.m«
aa:.r M,mc«:
(TM1is aectivn rieed rrotW canV�eC I tMV�! u Iw orro h�MreE Edkrs /31001 a bn.)
� I eenly iMl in �he peAamerca d IM wak lor whk� Ihia pemd'm iaeued, I aMll nal empb� em� penm in mry menmr �o n lo
becmn wEjea io tM xorbre' compevetian lev.a N CeNanie. end p�ea thm E I ehouM beeoms eubpe to tM warbn'
�w��� wa++�. a snao� s�oo a m. i.no, croe. i.nw �o�m.en m�,oN •.w n..e wo+�a.
Weminp: Fs/lun ro �seun wohxi rompNueHan eovsreW l� unlewNl. mJ aNll udJeet en wrrployw ro eAMNIp�n�Mu �nJ
c/v/l flrNs W ro aie h�mdrM IMuurM Eollen fSIOqOWA In edtllHon ro Ms cwt o/ comperuafron, tlenupu �a provldtl ror In
S�ctlon JlGB o/ M� LeDoi Coh, Infwuf, enC ettomeyl ha.
CONSTPUCl10N LENDINO �UENCY: I he�aby eHvm uMer pereXy d per'puy tAm ihae b e canMrudian bnd'mp q�swy br IM
peRamarm W IM xork la whiN Ihe pe'ml b ewed (Seaun 3U9]. Cir. C).
LENOEfl'S NAME:
LENUEP'S �ODFE59:
I unily ihet I heve meC Ihb epdtid� eM mms ihet IM ebove udormtlion u conatl. I epise lo camply wil� all ary eM couMy admemm
enE elete bws nlmip to buJEip conmuaian ud MreEy au�horce repreaentetira d �M my io amar upon ihe ebo.a�men�orr� poperty
�'��'°�0�� SUSAN ALLISON
` �'/.�o
� Dete:
K.ailrativ
(5151d6.WP) WlNe-Buildip d$efe�y:0ieei�Fb: Cenvy-�ppfraN: Pink-Rawnie: GokenmJ-Mwen
PERMIT NO: SB 079336
CONSTRUCTION TYPE: PERMIT TYPE: STR SIG
7.SSF NONILLUMINATED GROUND SIGN
CITY OF COSTA MESA — SIGN PERMIT
PLAN CHECK NO: 03610-96 S
JOB DESCRIPTION ,
PERM NO: SB 079336
GOVT: N SUPP; N
PURPOSE: OTH
SQ FT:
CLAIM VALOE: 450.00 CALC—VALUE: 450.00 GROUP OCC; H /
COMMENTS: "BACK HAY VILLAGE—SUNRISE CIRCLE" 3.SFT HIGH GROUND SIGN
��r*itiE**it�r*�e+rit**itit*ftitit�*itx�ir�it�t�x��r�r�t+r*atiE�ritetx�*�*it*�r*it*�tit�e�it�rit*�it*itit�**+Eitx��t***it*�+��
S I G N I N F O R M A T I O N
DISTRICT: 1 TYPE: FREESTANDING ILLUMINATION; NON CATEGORY: NEW
DIMENSIONS; 1FT 08IN X 4FT 06IN AAEA: 7,SOSQFT LETTER HT: 6
STREET FRONTAGE 1: 220.00 STREET 1: 'LUSTIN AV
STREET FRONTAGE 2; 0,00 STREET 2:
PARCEL; 43915146 ZONE; R2—MD LOCATION > FRONT: X REAR:
BUSINESS NAME: BACK HAY VILLAGE > LEFT: RIGHT: �
O T H E R T O T A L S G A O U N D S I G N'.
THIS ACTIVITY . 7.SOSQFT OVERALL HEIGHT: 3FT 2IN
THIS SITE . 7.SOSQFT GROUND CLEARANCE: 18FT— OIN
ITEMS OF INFO : 1 PLANTER AREA: LS,.00SQFT
ITEMS FOR ACTIVITY: 1 BLDG SET BACK: 20FT,
COPY VERBIAGE : BACK HAY VILLAGE — SUNRISE CI �
PLANNING NQTES:
iE 1E 1E 1FlE iE 1flE ik IE 1E iElf iF iE 9F'lElF iE 1E iE 1E 1E iF 1F 1f 1E iF 1E iF 1E iF 1F i81E If If 1E 1E 1E i! iE iE If 1FlE iflf 1E iEk 1h 1E �E 1E iE iE k if 1E If if 1f 41E 1E 1E fE 1f 1! 1E 1E i! 1ElE 1E iE'Ik 1f
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 HY W�� DATE: � �Jb :e
BUILDING APPROC�ED BY : DATE: � .
APPLICATIqN ISSUED BY
****��t***x�*�**�**�x��*
LEGALIZATION•N
HLDG PMT
PERMIT . 21.00
PLAN 13.65
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK
TOTALS----> 21.50 0.00 13.65
REVENIIE•DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
21 00
%6
STRUCTURAL SEGMENT:Y
SIGN SMIP/RES GRADING
SMIP/NON-RES
.SO
35A1D D00
iHORT: ,00
GRADING PLAN-CHECK
. .__ 13.65
1E 1E �E 3f 1f IE 161f !E 1F if iE if 1E if 1E 1f iE if if 1E 1E 1E 1E 1E 1f if 16 iF 1f 1f 1E iF 1f 1E 1E K if if 1E iE IE 1P 1E �E 1f 1E 1E if if if 1f 1F iE fE1E 1f iE iE 1E iE 1E iE 1E 1E 1F ik 1f if ik f@ iF ik fE 1E iE 1E iF 3t
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
NO FEES WERE SELECTED FOR THIS PERMIT
C(k(J57RUCTION AND PLANNING POOL & SPA
APVROVALS Permit # Dete Inspector AppROVALS Permit # Date InspeclSr
,
7. Temporary Electrical Se.Jice or Pole q' 52. Pool & Equipment Location
i
2. Soil Pipe�Undrgmd. -• � 53. Steol fteinforcement
's3. Electrical Conduit Utilitv�Undrgmd. " 54. Forms '
'-�_4; Electrical Conduit�Undrgmd. 55. Electricai Bonding '
' 5. ;Stegl Reinforcement 56. Rough Plumbing & Pressure Test
' 6. Efectricat UFER Grnd. 57. APPROVAI TO COVER�GUNITE
�-7. Pootin9s �/� CJ�.�'/ ��� 58. Electrical Conduit-Undrgmd.
� Y/
��B. :Foundation 59. Gas Pipe, O Undrgrnd., Test �
�-9. Water Pipe�Undrgmd. 60. Backwash �ines, P-Trap, O Undrgrnd.
10. Structural Floor SYstem �'� 61. APPROVA� TO DECK
t i. Prqperty Sewer Line & House Conneciion 62. Backwash & Receptor�Final ��
"12. Sewer Cap � 63. Heater & Vent�Finai
13. Roof Drains . 64. Plumbing System - Final
14. Rough P�umbing � 65. Electrical-Final
15. Rough Electrical-Condu�t .- 66. Solar System-Finai
16. Rough Electric Wiring � 67. Fencing & Access ApProval • �
17. Rough Wiring Sign f$, AppROVED FOR PLASTERING r�
18. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEft�S FINAL
19. Rough Heatin9 & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace.-. _' _ �,•_" . APPROVALS, Permit# -� I
c _ . '
27. �Oucts, in Structure '' �:'� _7'�'� - ' '" - " ` - `• � '
.. 70..Underground Hydro:
22. rDucts. Ventilating- +. - _ .71. �Protluct�PiPing Q.Gas t7 Oil
23. Gas Pjpe-Rough & Test ' , - '- '' ' '�� _7q,"Upd�rgrovnd Fiush.• . __ :�,: �
24.�Roof_Framing. , ._ ��_ � � ;;-�%: ; - � �73. UnAt!rgrnd.StorageTank OGas OOiI
25. Roof $heathing ' ? � ' � � 74, Overhead Hy_dro ' � � "
26. T-Bar Ceiling (Siruciurail.& Monocoat - J5. Dry Chemical• . �-
27. Frame and Flashing ' _ - „' '� � 76. _Q�y Standpipe � - _
28. Lathing&Siding_ rt'r '..' .._. . 77.��FIXEDSYSTEMFINA�Lr � -
29. Insulation � �'X' `' � 78. ��REPREV.FINAL �
30. Drywall Nailip9 -' - � - - _ . � :+ � HEALT,H DEPT. REQLi1R�EMENT•
' 31. Plaster Brpwn.Coat '- ' 79. FINQL INSPECT.IQN � - _
�
? - .
�, 32.-Electrical-Power Meter�Final _' - x� 80. F,opq�CERTIFICATE ISSUED �-
� _
, 33..Final Electric, ' _ ' Notes;�; �`�`i � .
34. Final�Meating'& Air.Conditioniny�� �'� �- .. �'` _ -�
35. Final�Gas:Pipe.Test ' " _ � ` _ ` ;
�_
36. Hood ar.CanoPY • K ` u ; :. � �' - ' • -
� 37. �Finai �aciorv FireP�ace "` = �- -
- � �� � � . - ---
38. Final.Plumbin9 l . � . -. -�.. , � . :• - ' . -
39.•Water Service�Fineh k � • " ' F ` �•: ' �
� - - . _ - - -:� r.� . �
40. Gas $ervice-Final � " " �, i� •. - -� �; �' � , , � .
� 41. Solar pomestic-Pinaf .. ' - � � -_ �
*� �. - _ "
42. �Backflow Preventer ` �' ' - ' ' � x � � ! . - :" `
.. _ . L
43. Backflow irrigation : . -''�: ' , . � '• ' �- •
- -� .
tiY' I -.
�44. Landscape Iriipatio'n',System' - �� .. .. , _ - - -
'45. Sound Attenuation• � ^ ' � - ' � � '-+ =` - -•�; '
s _ ' ' i '
46. �HandicaP Regulations . .' .� .. - - . �. ' .. _ _ , .. .. .
47. FINA4STRUCTURE&BUILDINt/��'( -Gi�3�'� ���/ ' �� � c _ ;-
r �L
48. FINA4PLANNING, - - ' -• . •
�
49. Electrie Release to Edison , ' -
i a�
50. fias Release to Souttiern California Gas Co "' � .
51. CERTIFICATE OF OCCUPANCY � , -
NO Date
� OWNER
JOB ADDR
�GENERAL
AP No. ],l
�INSPECTIf
Pool LocTat
Forms 1
Main Drai�
Steel Reint
Elec. Bond
Approval to Cover _
Underground Electric<
Gas Piping Test r�
Filtering System Li es
Backwash Lines and R
Electrical Final �_
Heater and Vent Final
Filter System Final _
C�c�
Backwash and Recep. Final �-G i
C......:.�� C:�..1 � \� 11
DESCRIPTION of
FIRE ZONE
DATE 7_21.
BUILDING PERM
K Semi-Pvt.
VALUE $ S,OOf
SUBCONTRACTOR
Plumbing
-7S 1�7�0
' ' ' 4�29ta,:
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.p. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicant to Fill in Completely
vA'�001952< *xt�59.G0
III; 21-75pta•
APPLICATION FOR BUILDING PERMIT
FE V BV DATE ECEIVED p TE ISSUI
BUIIDINti S Z.a/
ADDRESS �
OWNEF A.P. NO.
//9-3� - 7�-1 PE �
MAIL BVILDING ¢(/ '
�55 ADDRESS ,Jv( GiNP� J�P� Ci/'(�` ,r
Z . ADDR
a U CITY �� TEL. TRACT3�Ft3.3
NO,
~ Z Cpry${pUCfiON W A i
O� LENDER
am
J � BRANCH
J � OWNER
m J ADDRESS
Ja ORENG�NEER / � �II TEL. S
� N
V FIRE
W¢ AODFESS �DIO O %) L �ONE T� P
aW
APPROVE
W Z CONTRACTOR 4 O O B�
J Q
m Z /�
J � ADDRESS � (.��YFE
W W TE Z�NE (A� NO.OF
Z� CITY ��/] N � /� 'Z PLP'NS
y� l�C. NE�QO�Q � � S� UCVNp. VMAIDN 8 ILO�ING
�� SIZE NO.OF BLOCS. (FROM C/L STREET)
OF LOY NOW ON LOT FRONT FT.
VSE OF � �
EXISTING B�DG.. T �.
F� SIZE OF NO. OF "%'
Z NEWBLPG. ROOMS STORIES L.SIDE FT.�
a EXTERIOR �'V�+LL ROOF
�% COVERING COVERING FEAR FT. �
J U OF BU1LDIN ND ORK TO BE PERFOFMED DISTANCE BET.
a
a Mnw s�aas.
Q .�l OOI VAR.iW
O C.U.P.gW
yAPPROVED � •�•
Z
0
� 1 hereby acknowledge �hat 1 have read this aDP���atian end siete
� ihat the above intormatian is corract antl aB�ee io comply with
� ell laws regulatin8 builtling co�sttuction, entl I shall not amploy
F any Derson in violallon of the workman's compensation laws of
y the StatO ot California.
Z� hereby cartify that I am properly licensetl as a contractor untler S�. FT.
the Stata of California Business and Profeuions Cotle, Divisicn 3, THE AMOUNT SHOWN
Chaptar 9, and that such licenses are in full force and eftect, or I TNE PURPOSE Of ESTAE
am exemPt from the provisions of the Stete of California Business VA�UATION
antl Prafessions Cotle, Divislon 3, Chaptar 9.
(�/ � �(,J Pf
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� COSTA MESA BUIIDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
For Applicant to Fill in Completely
BU�LDING � � •
ADDRESS 1 C/
OWNER )'/7I.UI��C. /l��f����%�i/%/
� Q Gi�u!_ � �..� ,
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APPLICATION FOR BUILDING PERMIT
ED B�' DpTE REGEIV nnTc �cci u
A.P. NO.//"��
BUILDING
ADDRE55
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'� a OF ENGINEER /ii . �/� N
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CL ADDRESS ZONE T
a w APPROVED
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Z= GITY � NO. � P��
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WO STATE CITV VAROSAPPROVED
y� LIC. NO. LIC. NO. MAIN BUI
�� SIZE NO.Of BIDGS. (FROM C/L ST
OF LOT ��7 NOW ON LOT D RONT
USE OF
EXISTING BIOG.
Z N'EW BLDG. �'� � ROOMS / STORIES / L SIDE
Q EMERIOR WALL // ROOF �f%%J
�% COVERING GLO COVERING S REAR
�l USE OF BUILDtNG AND WORK TO BE R RMED OISTANCE BET.
a / MAIN BLDGS.
a
Q VAR..$
O C.U.P.iW
r APPROVED
N
0 LD R SAECIAL
UI heraby acknowletlBe [het I have reatl this application antl imte
� that the above Information is corract end aprea to comply wIN
� all lews reguletin8 builtling conscruction, antl 1 shall not employ
F any permn in violetion af Me workmen's campensacion laws of
y Ma State ot Californla.
? I hefeby certity that I em prape�ly licansetl as e contractor untlar S�
tha $tate ot Californie Business antl Professlons Cotla, Dlvislcn 3, THE AMOV
Chapter 9, and ffiet a licenses ere in tull forca an tfect, or I THE PURP0.'
em ¢zempt frOm t pfo Isions Ot tha Siato Cal nia Businesa
and Protessions tle, Oi i6ion 3, CM1 ptar VAIUATION
Sipnature of �
Permlttee 5 ��
Authorizetl Apent
0
LOT BLOCI
D EtJ. .TA.IC
VALUE
�
l� GROUP
DATE ('"I�
VSE OF NEW �
BUILDIN
VARDS APPROV EC
ACCESSORV BUIIDI
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BET. MAIN &
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DATE
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iHING A GERMIT FEE ONLY: Q (�
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COSTA MESA BUIL ING-SAFETY DEPARTMENT
P.o_ BOX 1200 COSTA MESA. CALIFORNIA 92626
P•'.iL
'+.�Y-1-7`r.vs�0� 060 v�:�.�1l6.E0
APPLICATION FOR BUILDING PERMIT
For Applicant to ill in Cnmpletely
RECEIVED BY DATE RECE{VEO DA7E ISSUED
BVI�DING �
ADORESS •
PERMIT NO.
OWNER A�P• N��
MAIL BUILDING
ADDRESS ADDRESS
TEL. TRACT LOT BLOCK
GITV NO.
CANSTRUCTION W
LENDEP
BRANCH
OWNER
ADDRESS VAIUE
AflCHITECT TEL. S $
OR ENGINEER N .
FIRE
ADORES6 ZONE -TVPE GROUP
APPROVED
CONTRACTOF � BY DATE
AD�RESS
TEL. ZONE NO.Of USE OF NEW
PLANS BUILDING
CITV NO.
STATE CITV VARDSAPPROVED VARDSAPPROVED
LIC. NO. �IC. NO. ,MAIN BUILDING ACGESSORV BUIIDING
SI2E NO.OF BLDGS. (FROM C/LSTREET)
OF LOT NOW ON LOT FROfYT FT. FT.
VSE OF
EXISTING BLDG. S FT
SIZE OF NO. OF
NEW BLDG. ROOMS STOFIES L.SIOE FT. FT.
EXTERIOP W�+LL ROOF
COVERING GOVERING REAR FT. FT.
USE OF BUI�DING AND WOFK TO BE PERFORMED DISTANCE BET. BEf. MAIN &
MAIN BIOCu. ACCEu.S. BLOGS.
VAR. # DATE ,
C.V.P.�W APPqOVED
APPROVED
I hereby bcknowletlga that I have reatl this application antl state
that the abova intormation is cOrrect antl eprea to comply wlth
all laws re9uleting builtlin8 construction, antl I shell not employ
any persoP i� violation ot the workman's compansation laws of -
ihe Steie of Celifomia.
1 hereby cartity that I am properly licensetl as a contrector untler SQ. FT.
the State ot Celifornia Business and Professions Code, Oivisicn 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR
Chapter 9, antl that such licanses ere ln full forca anG eftect, or I THE PUflP06E OF ESTABLSHING A PERMIT FEE ONLV:
am exempt.from the provisions of the Stata ot Celifornia Businacs V ALUATI ON /�
and Professions Code, Division 3, Chapter 9, PERMIT FEE $ • V
Sie�ature Of �.�.
Permittee $ � PL4N CHECK $
Authorizeai P.9ent �
TOTAL FEE S /
i