HomeMy WebLinkAbout266 VIRGINIA PL - Building Permits- CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
RRIP-44 PERMIT NUMBER. B07-00931
PERMIT TYPE _R F
STATUS: ISSUED
1616
DATE ISSUED: 09/12/2007
1266
- -.::TISSUED BY: SOK
JOB ADDRESS: 266 VIRGINIA,PL CMSuite/Unit
`_.
Vicinity: ROOF
Final Fire Prevention
Squares: 2500
Valuation: $8,800.00
i
SCOPE OF WORK: TEAR OFF EXISTING ROOF. INSTALL
1 LAYER OF 30# FELT, 6:12 PITCH; 30 YEAPC I OMPOSITION SHINGLES
AND REPAIR/REPLACE SHEATHING AS NEEDED. 2,500
S.F. INCLUDES ATTACHED GARAGE.
OWNER: MCGRAIL, DOMINICK FTR; -,.
Address:. 266 VIRGINIA PU Unit
PHONE: _
- City/State/Zip: COSTA MESA, CA
APPLICANT: TOM KOZITSKY -
Address: 1511 SBAYLESS ST_ .r Unit:
PHONE: 888-525-5867. ., -.
City/State/Zip: ANAHEIM, CA- -
CONTRACTOR: ALLTOPS INC `•,:-'
_ - _ - License No.:� -:722766
Address: 1511 S BAYLESS, STUnit:
- _ PHONE: - - - - 888-525-5867 - -
C4y/State/Zip: ANAHEIM, CA. - _ -92802
CELL:
ARCHITECT: -
License No. PHONE.,
ENGINEER: -
License No. - - -'-'PHONEi
FEE SUMMARY
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: 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 final approval will result in the expiration of this permit.
CODE A.
INSPECTION TYPE
1616
Fixed System Final Fire Prevention
1266
Pool Spa Final
200
Final Re -Roof
201
1
Final Block/Retaining Wall
202
1
Final Factory Fire Place -
t03
Final Sign
b4
Final Demolition
DATE INTITIALS
CODEC
INSPECTION TYPE
206
Final Mechanical
208
Final Plumbing
210
Final Electrical
212
Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
DATE INTITIAL
WORKERS' COMPENSATION DECLARATION*
I hereby affirm under penalty of perjury one of the following declarations: .
❑ 1 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
��pr�e�rfo-rm�a.n.ce of the work for which this permit is issued.
90:w nave and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
pemtit is issued. My workers' compensation Insurance carrier and policy
number are: �(4�
L��r�-a�r�Ae�r'^'+- AC',
(rhes SecLorr neednofbecomyefeRdfhe rrermdsvdraeCaf one hundredcbaars fsrQg/wfess ./
P tic Number: 000195-0 "
ETE 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 sub' ct to the worke compensation provisions of Section 3700 0(
the Labo e, I shall fo comply with [hese provisions.
Q•/.2_D7
"�. ... ApPlifdnt'95 ture`y '-,`
NTNG: FAILURE TO SECURE WORKERS' COMPENSATION COVEI!tAGE
IS UNLAWFUL AND SHALL SUBJECT 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, 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.
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:
Lander'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.)..
❑ "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.).
U 1 am exempt under sec.
Business and Professions Code for this reason:
"Owner ID verified by dripse. ❑ Yes ❑ No
,. Dnver'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, AA 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.
Appltcant's Signature
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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 wilt 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 California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future budding occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution Control district or agency? ❑ Yes ❑ 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 ❑ 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? ❑ 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.
Sigp re of Legal
Signature Date C/
305]46 (3i0])
- zeC AO of
Date
Date
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 266 VIRGINIA PL
Suite No
Vicinity:
Parcel Nunmber: 42608219
ISSUED BY:
Status:
ISSUED
Applied:
02/20/2002
Issued:
02/20/2002
FEE SUMMARY
AMT,
CITY
Applicant:
STARK, CHRIS, -'
- -
Address:
7229 VARNA AVE-_' '
ISSUE FEE=
$23.50
- -
Phone: (800)444-8865 -
$0.00
NORTH HOLLYWOOD; CA
Zip: 91605
Owner:
MCGRAIL, DOMINICK F TR
Backflow irrigation
Address
266 VIRGINIA'PL
Landscape Irrigation
$0.00
-
Phone: -
-
COSTA'MESA, CA
Zip: 92627
Contractor:
_ ALAP ASSOCIATES GP
P -Trap -
Address:
7229 VARNA AVE., - -`
Trap Primer" .
$0.00
0
Phone: (800) 444-8865
,$0.00 '
NORTH HOLLYWOOD, CA
Zip: 91605 -,
$0.00
-
License: 771905
,Arch / Eng:
0
Clarifier System :'
Address:
0 -
Process Piping (per 10 ft)-
$0.00
0
Phone: --
$0.00
-
Zip: ,
$0.00
- - ---
- License: -
$0.00 -
0".
SCOPE OF PERMIT
$0.00
CHANGE OUT WATER HEATER IN
EXISTING SFD
FEE SUMMARY
Interceptors (Sand Auto ) $0.00 0
COMMENTS / SPECIAL CONDITIONS
TOTAL CALCULATED FEES: $35.80
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) 7545626
244648 (6'00)
AMT,
CITY
AMT''_QTY
- -
'AMT
OTY
ISSUE FEE=
$23.50
., E--_, .-:
LaundryTub/Washer
$0.00
•,- 0_-',
=-Sump'Pump
"$0.00
0
Backflow irrigation
$0.00
,0, -
Landscape Irrigation
$0.00
0
Swimming Pool
/$0.00
0
Backflow Preventer,-
$0.00
•0
P -Trap -
$0.00
0
Trap Primer" .
$0.00
0
Bathtub -
,$0.00 '
0 - ' ,
Pressure Regulator
$0.00
0 -
-, Urinal -
$0.00
0
Clarifier System :'
$0.00 -
0 -
Process Piping (per 10 ft)-
$0.00
0
Vacuum Brkr Bkflow(14)
$0.00
0
Connect (Ice,Soda,etc)'
$0.00
_
0
Receptors
$0.00 -
0".
- Vacuum Brkr Bkflow(5+)
$0.00
0
Dental Units
- $0.00
- 0
Septic Tank
$000
0
Wash Basin" '
$0.00
0
Dishwasher
$0.00 ,
0
Sewer Cap for Demo
$0.00
- 0
,' Wash Basin Set
$0.00
0
Drain, Floor
$0.00
0 _
Sewer Connect
$0.00
'0
Waste and Vent System
$0.00
0
Drain, Rainwater
$0.00
0
Sewer Private Line
$0.00
0
Water Closet (Toilet)
$0.00
0
Drain, Roof
$0.00
0
Shower -
$0.00
0 _
"_ Water Heater / vent
$12.30
1
Drinking Fountain
$0.00
0
Sink, bar
$0.00
0. -
Water Piping (Inst or Rep.)
$0.00
0
Expansion Tank
$0.00
0 -
Sink, commercial
. $0.00,
0 -
Water Re -pipe
$0.00
0
Gas Earthquake Valve
$0.00
0
Sink, Floor
$0.00
0
Water Service
$0.00
0
Gas (1-4 outlets)
$0.00
0
Sink, kitchen
$0.00
0
Water Softener
$0.00
0
Gas (Over 4 outlets)
$0.00
0
Sink, service/mop
$0.00
0
OTHER
$0.00
Gas Repipe
$0.00
0
Spa (private)
$0.00
0
VIOLATION
$0.00
Gas Service
$0.00
0
Spa (public)
$0.00
0
PLAN CHECK
$0.00
Interceptors (Grease, Oil)
$0.00
0
REINSPECTION
$0.00
0
Interceptors (Sand Auto ) $0.00 0
COMMENTS / SPECIAL CONDITIONS
TOTAL CALCULATED FEES: $35.80
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) 7545626
244648 (6'00)
DECLARATIOMS
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
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 wo .s, om e s tion I e arner and licy number are:
CiMIr;. "///� 79' Policy
-Arlssection need not be completed if fh t Is Jalued at one hundred dollars ($100) or less.)
❑ 1 certify that in the perforrnanc f r 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 C that it I should become Subject to the workers' compensation provisions of Section 3700 of the bor Code, I shall forthwith
comply with these pro to
Applicant Signatu s:_-- .flete - �L
R:
G`FAILURE TO SECURE WORKERS' SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed and r provitst.0 Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profess s Cp and my license is in full
tpme an—d�Hecl blcc». Class#,
ContractolsSlgneN'rei Date:- k'
CONSTRUCTION LENDING AGENCY:
❑ 1 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: Lenders 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).):
❑ 1, 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. It, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's 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:
❑ 1 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 B, 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? ❑ Yes ❑ 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 forth for acutely hazardous materials? ❑ Yes ❑ 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).
I
......................._................................................................... ............... ... ...................................................................................................................................... ................................................................................. ................ .....................................
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.
................................................ _............. _...................... _.....I...........-.....................................................
..........................................................................................................................................................................................................................
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 a plication a.LPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 1J Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
............................................................................................................................................................................................................................................................................................................................................................................................
fi Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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? ❑ 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:
CERTFICATE 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 andcity ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection p sas. I e roe not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S e I O er(s) Date
�:�ih�Ilfdl dant: i •� _t`.`-:.:..-'...
CODE f. INSPECTION TYPE PATE INIRIALS CODE# INSPECTION TYPE Peg 1NTMAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 200 Final Plumbing - 3 -�, -oa EN-/_
200 Final Re -Root 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
-OWNER SMITH. D. R.
3-11-59
BUILDING PERMIT NO.
PRE._ ONTRACTOR nomar niu.taerS, Lnc. VALUE $ 12,927.00-
_
LOT_ _ _ TRACT FUZE ZONE DESCRIPTION OF WORK Res. w Det/Ear
GROUP I & J TYPE V ZONE R4 PLAN NO. 87!
1 ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
/ I I I DATE I NUMBER
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8 700
COSTA MESA BUILDING DEPARTMENT
- P. O. BOX 317
COSTA MESA. CALIFORNIA
FORAPPLICANT TO FILL IN
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FINANCE DEPT.
CITY OF COSTA, MFS FOR PERMIT
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- COSTA MESA. CALIFORNIA ,
FOR OFFICE USE ONLY
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RECEIPT NO.
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-
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-
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_
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SETBACK LINE FROM
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DAT
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DESCRIPTION
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PLAN
NENI ✓IALTERATION 1 11 ADDITION
REPAI.. MOVING DEMOLISH
SIZE
DING if NO. OF
ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF BUILDINGEW� .�dZJ e�0
6 d 0 1 4io-,C �' ct
I HEREBY ACKNOWLEDGE TM AT HAVE RE4D TH 15 APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL purpose of establishing a permit fee only.
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION.T
VALUATION PERMIT FEE $
SIGNATURE OF
PERMITTEE
.PLAN CHECK $ 'ISS
AUTHORIZED AGENT TOTAL FEE $
V9NF