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HomeMy WebLinkAbout1984 WALLACE AVE - Building Permits r `p '69 - CITY OF COSTA MESA . 4 6 BUILDING DIVISION . • m' .fir DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER 47 Jai/.a r PERMIT `�; 00-01216 *`OeAO.mm e (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDJob Address: 1984 WALLACE AV Status: ISSUED Suite: Applied: 08/10/2000 Vicinity: FRONT UNIT HOUSE&GARAGE Issued: 08/10/2000 Parcel Number: 42226205 Zoning: Applicant: SHAWN BOULGER ISSUED BY: 21.12 Address: 2851 E. LA CRESTA AVE. Phone: (714)632-1900 ANAHEIM, CA Zip: 92806 Owner: CHI, MARK W TR Address 752 W 19TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: LINNERT ROOFING, INC. Address: 2851 E. LA CRESTA AVE. Phone: (714)632-1900 ANAHEIM,CA Zip: 92806 License: 664319 Arch : Eng: • Address: Address: Phone: Phone: Zip: . License: License: SCOPE OF PERMIT REROOF-T/0,REPLACE SHTG AS REQUIRED, INSTALL 1 LAYER OF 30#FELT AND 20 YEAR GAF SENTINALS COMPOSITION SHINGLES. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,025.00 Permit: $83.25 Claim Valuation: $2,025.00 SMIP Res: $0.50 SMIP Corn: $0.00 • Other: $0.00 Inspection: $0.00 Total: $83.75 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 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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)754-5626 2446-46(6/00) DECLARATIONS (Th n 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 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 1wo(kP s'compensation Insurance carrier and policy number are: Carrier: Vj1!a nOWL ,-LYIS. Co. Policy Number: Lit`1/9'1/87S (This section need not be completed if the 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 provisbons. '� t. " p Applicant Signature: ,. !_ _'3O "-^ Date: 9.(U"V C) WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($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 licgns d under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business ant Professions Code,and my license is In full force and effect.Lic.a CO(9ET Class p Contractor's Signature: Date: 6'/O'00 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: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 tor 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 drivers license. ❑Yes 0 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,Gip 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 e 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 then 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 lime 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 California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building 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? 10 Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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. ignat Of gal wner(s) 3 Date [O.O(J And/Or Authorized Applicant Date CODE r INSPECTION TYPE PAIS INTmAL$ CODEW INSPECTION TYPE DEE MMUL5 1616 Fixed System Final Fire Prevention A 206 Final Mechanical 1266 Pool Spa Final S 208 Final Plumbing 200 Final Re-Roof 4:m04 Are' 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 s, iz SEE _CEIVED lcp�jf7 • COSTA MESA BUILDING DEPARTMENT FIN NC DEPT. P.O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING/17 x BUILDING ��' tsit; ADDRESS (J � ffA[J COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RSA. � / . / RECEIPT NO. 447 SP y'y. /'J OWNER J/-...0////S/ `/�/V//A•/'�/�J^//�-q V SUED MAIL D RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESSa �•� ,'Q -7//-x.1 1'- /(0-//l. 6-5 CITY ga ,9iT l6E[.i ..- TEL. ADDREISSG /n1V , W&/f c e / ARCHITECT '`I' _ LIC. COSTA MESA, CALIFORNIA OR ENGINEER C. ADDRESS £ 3 ZIRE AO CILIC 2 0 iE / ji, ,Y in, E i GROUF CONTRACTOR. .AIulI e� :. i �.-_ O.- •.i..�., .. A !a, & .„Va �I /t ADDRESS�Qj� L� TEL NA. AP'ROVE cW T /��] L QPy, ;E�rrLSxxy T1A MESRj .-�(� LEGAL LOT l'!'� ! W/ 11�Y ♦1.V V. � �REG. DESCRIPTION NO. ��BBLOCK TRACT SUBJ E(. • A.P. NO/IS '��2�J S' I w �/ /�� SIZE .C<'� J NO.GF BLDGS .� BY �/�/_let DAT / OF LOT ..1 9v NOW ON LOT A— PLAN 1.:;H. USE OF EXISTING BLDG'e SETBACK LINE FROM / <� . • CENTER OF STREET +(rtEA /0 SIDE YARD RIGHT J , ' LEFT 72 9 t DESCRIPTION OF WORK • NEW 1...,..JALTERATI ON ADDITION REPAIR MOVING VIII DEMOLISH BUILDING ✓ NO.OF . SIZE / �� ROOMS 7 STORIES / EXTERIOR tWAL Il7e 4Q- ROOF COOV EftING �`.(/.O.ti COVERING USE ONEW, EW : � (/ t(BUILDING 4:7 2a SC' - J I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND , STATE THAT THE ABOVE IS"""�����}}}.}}}.RRECT AND AGREE TO COMPLY WITH ALL �O O J ^ / CITY ORDINANCES ANDD LA _ REGULATING BUILDING CONSTRUC- SIGTIONNATUR������ VALUATION PERMIT FEE S _ PERMITTE' s 6ola o - PLAN CHECK S 7 AUTHORIZED AGENT / TOTAL FEE S a 7^ "BMF • -OWNER ANDERSON, Harold DATE 10-16 ,7 JOB ADDRESS 19814-C Wallace St. BUILDING PERMIT NO. 5882 uN_y��$AIA5ONTRACTOR Bomar Builders VALUE $ 6.200.00 o. J LOT 3 TRACT 612 FIRE ZONE DESCRIPTION OF WORK Residence w/att Garage. _. _ JP I & J TYPE V . ZONE Rh PLAN NO. 5901 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED CDATE NUMBER- ' Trenches Forms Steel 2,/6 ec /0-g a :s 7 Floor System Steel Reinforce Chimney Re-Rod - . ._.- Bond Beam ...,.C. Gl1G.•e-6Q // -/.- $ f Frame and Flashing g..--"4"1 ,,2 --a-C1, / Lathing, lit( Out)( cis,--e---g. /,�,- I "/-7 Plaster, brown coat - $✓t.4 '/$--31--t Underground soil /8- W/G Pipe Tfst(A i b.'}Bd ei Top Out Yt1 Pis 7L#1.S%.t Furnace )Y1 I/it-S ii.i}-a% OWNER ANDERSON, Harold • DATE 10-16-57 ._ JOB ADDRESS 198k-B Wallace St. BUILDING PERMIT NO. 5880 GEN RALONTRACTOR ROmar Builders VALUE $ 6,200.00 lirta2-55LOT 3 TRACT 612 FIRE ZONE DESCRIPTION OF WORK Residence w/att Garage. k JP I & J TYPE V ZONE Rh PLAN NO. 5902 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel &j£ /�1'JY Floor System Steel Reinforce Chimney Re-Rod A � � r C . Bond Beam `.er//v.'N.-Q i/' /J -47 Frame and Flashing g/P- ? /'_-1 S`t e Lathing, In( Out ( e..--e--E ,a-7-.•i? Plaster, brown coat sf.t-E %a-if-.1-P Underground soil U/.& MPG Pipe Telt /S /6.1,4417 Top Out / Lnn.t,SC //'Sa=s-9 Furnace VC,7,, � -3 1,l''}-f`'$/ t-• T. Zh.O.2t /d -au-6-7 /41% Gas Vents tyt....c,,,-(3,Pe?l✓. / .io-St /al<2(a ✓ Rough Plumbing ' AA I/-Yd=3 _sat_ i—2 — -le''. Cesspool Septic Tank Prop. Swr. Line .--House Con. cr-St.thikli ,v/la/s-7 TI a a J Ott 4`9, ((F 6 3 -F- //969. Sprinkling System f g Final /V(//-C /-2-9-4- F. ..ing Fixtures, Final .h/a f /-7-4-SFS ' Final Gas Test r— r4/ 7 /s— Mk av-s;Y ll Construction Pole f7 4 Underground Power `` yu /�� p� ` IIS 'Rough Wiring . " f/�2O-J/he -t.ta - Cir---.�L-t".. //-54-67 N3-6.873' t,' „l �fJ _. Fixtures, Final • $ 2 1^ /(--41S 77 (,I /1 IVB /!//` / n(( 1V - -OCCUPANCY MFhc /-29-5'7 / (lir r Form 210-5M-1-57 / 880 f !) 5' 0 FEE RECEIVED 'COSTA MESA BUILDING DEPARTMENT • / 0 /419 P.O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. FOR APPLICANT TO FILL IN APPILIICPfr iA1443' PERMIT `_ _ /., /, BUILDING COSTA MESA. CALIFORNIA I FOR OFFICE USE ONLY /Q �• ♦ i _/ RECEIPT NO. AY , A/ aAT- RECEIVED MEW • Iillill 111 4._at Anlilla ARCHITECT LIC. OR ENGINEER NO. COSTA MESA. CALIFORNIA ' FIRE / ADDRESS ZONE IF (y / • • Al - /i SEI. are P Lll _ '+ 11" Ara LEGAL I• EGARIPnorygni C BLOCK / �' Rd CO':'C I•� al PLA NNING DEPT. SIZE • �S,/ ca !f'� ' •UBJ ECT TO :LOG. DEPT. REG. - OF LOT i R A ate L l ' AaAn= • SETBACK LINE FRO .i / '��I ,CLAN TCGH. 1 ` - - CENTER OF STREET `- IMMIIIMInan DESCRIPTION OF WORK NEW EMBI■ . REPAIR ■ MOVING ■I DEMOLISH . nay EXTERIOR COVERING WAL .2 F _ " USE OF NEW ' /'+ BUILDING • 'C # C' , A. • a ✓ aS A-/ / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND \� STATE THAT THE ABOVE IS -•-'E T AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND S GULATING BUILDING CONSTRUC. a TION. - VALUATION o� SIGNATURE •a PERMIT FEE $ / 0 ' PERMIT ' 1itat(_ / TOTAL FEES V•` AUTHORIZED AGENT i -a OWNER ANDERSON. Harold DATE j0-16x7 JOB ADDRESS ' 198k-A Wallace St. BUILDING PERMIT NO. 5881 GENERAL CONTRACTOR Bomar Builders - VALUE $ 6,200.00 17r. lk1••j LOT 3 TRACT 612 FIRE ZONE ' DESCRIPTION OF WORK Residence Watt garage L 1P I & J TYPE V ZONE flit PLAN NO. 5900 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel 4-tri( // -/ -$7 Floor System Steel Reinforce Chimney Re-Rod Bond Beam _$4ctt/4.-4-....a P/ '"/2 l Frame and Flashing ./.;mob 1/-1.10-:C7 Lathing, InS14, Out X 4- — i -Aa-f3 Plaster, brown coat 0)--- -'S 1,ry-V-9.'7 • Underground soil /4/' WIG Pipe TIe^s-tp.C. /D--),p-5'7 Top Out 14\ //-.243-57. J. Furnace 12 74_ d_ 1a.iy 1/.. ..b-r77 L.S .4iihX L /O 7,$ -.24 -57 (13 - ✓ Gas Vents P.gy,w,�,�pp- HGF•, - t - i0 —6't /2 I i 2 . Rough Plumbing Y}7PiS //'2.0-.57 L.7-y/ii3O S. /0.-2fo-57 //375✓ Cesspool Septic Tank ,•.�pg A'��. Prop. Swr. Line 0-House Con.' D. r. /Z/p f 7 /3 oaa.u.tµ,_ ( s.frar 7 1 / '( (. ) Y- //46`7 y_ ;!,xling System ,„,`t ' Pig Final Mit /-2.9-4" ' i '' Pidgning Fixtures, Final MFFS' /-29 sr Pinal Gas Test /s MH-S /-29-1P' `1'" ' t' Construction Pole ('C / ..Underground Power 9' - '_ Rough Wiringf ....2 0.1 . •-'-(2c- 1/- -S ,. JC '' t i', Fixtures, Final ' r'" —./J'1' b _ Yr n !OCCUPANCY Mf,'S /-29 S7 Form 210-5M-1-57 5881 I - �� FEE RECEIVED :_, s )z ,; COSTA MESA BUILDING DEPARTMENT FINANCE DEPT. P.O. BOX 317 CITY OF COSTA MESA COSTA MESA, CALIFORNIA FOR APPLICANT/� TO FILL IN APPLICATION FOR PERMIT BD I LDING1/29fr , /4/1 BUILDING ADDRESS //�`JJ ccs 666/'/L� ' COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY ,t( / 101 ` 4 44 RECEIPT NO. - IT O. OWNER pC�-(/6,�//�'• CCC ' • i MAIL RECEIVED BY DATE RECEIVED ADDRES7 ' -d _•/ice ;6) /0-17---J NM"7 Q qy//�� _�J, TEL BUILDING / 95Y c �c/d // CITY ,//yam/ NO. ADDRESS (�V ( (+�CC. I. ARCHITECT T Y LIE. OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE ADDRESS ZONE ' O CONTRACTOR, L J.ITV NO 6,,3 / ZONENO.OS TTYPE GRO P ADORE : . J APPROV.• ,.%2/6.11rTEL / 0 /,1. j N• J - A/ BY ,fi fists, •ATE / 0 ( LEGAL LOT I / CORRECTIONS DESCRIPTION NO BLOCKj( TRACT/. / A.P.NO. /IS`-3'f . ) "— VV// WE ////� NO.OF SLOGS.OF LOT (pX�9(J NOW ON LOT {� {,f •. y USE OF 7 /J �A �}y�'ry EI 1 {7B' �I/ EXISTING BLDG. i Fj� Y �V ETTACIt LINE FROM / I FFi2-7TT,q� TGf CITY OF CDSTA MESA CENTER OF STREET O (�C'/(4T'REAR YARD .' r� %/! PL•,NPcIIt, DEPT. Elf SIDE YARD RIGHT / LEFT / / SDBJEC' D BLDG. DEPT. REG. DESCRIPTION OF WORK. 1/ '' a/i'` DATE " NEW ALTERATION ADDITION • BY---- ar REPAIR y/ MOVING I DEMOLISH 5 ZIEDING"/�I[��, NO.OF 4Z ROOMS STORIES / COVEREXTERIOR ING WALa%_r. ROOF , SLI' COOFRING de I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICCAATION AND 02.0 ©A/ STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL _ VVV CITY ORDINANCES AND,„.1.0' REGULA INT BUILDING CONSTRUC• .4.... a SINN 4 i�e� VALUATION SIGNATU" / PERMIT FEE S /�-�� PERMITT- ./�e $ aZOO — PLAN CHECK $ C/ ^ AUTHORIZED AGENT !/!,_ TOTAL FEE $ . n7.-7 - v91T OWNER BOREHARDT. HAROLD•J. DATE 11-It-5Lt JOB ADDRESS 198)t Wallace Street BUILDING PERMIT NO. 693 ( RAL CONTRACTOR Owner-Builder VALUE $ 1,5141.00 LOT AP.115-3b2-35 BLOCK TRACT Bedrooms & Garage GROUP 'J TYPE V ZONE R14 FIRE DISTRICT 695 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench t5kC , -PE-. Foundation Forms and Grade tooGarager/6 / -11„.73 7- Rough Framing £-I-( 1/"/4"S • Plumbing,Rough to Slab Plumbing,Rough Complete Temporary Pole yl Wiring,Rough g-1-( i�M-PT dzof,,,ttt/" ,a.a - / - - 1/43-7/ Heating,Rough Heating, Final S,. .. E Tank or Cesspool Lathing a--"n `/9: • - Plastering b ef: / a- Plumbing,Final,Fixtures Complete ,+G Plumbing,Final Gas Test jy,j LL � Wiring,Final d4�Ce /3'i—s, Occupancy ' kc. 2-/735 ‘ Norm 210 GH 11,,1 12-53 . - Costa Mesa Building Department q APPLICATION FOR PERMIT L y COSTA MET AL FORNIA STREET 695 ILD N G i FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN _ . Receipt No. Py Address /9y, w1.LA,lGF 5/ 31(c3 b Costa Mesa, California Received by Date Rec'd. Date Issued NearestI I /-�'(j.�5 j" Cross St. - Building / A' Address owner /1i9 Own„ ©.Lp V O 0Be!/Af/DT Costa Mesa, California Mail Address/f6.,{/ pw//Lines 57 Nearest Tel. °: Cross St. • No. Aggro EArchitect ngineer or j.�i/V.�jQ r dr- Plans Type ej I Group by "'11RY lDate d Address CORRECTIONS City Lic. Contractor a w/VCR No. - • Address Legal Lot I Tract I Description I' No. Block (Attach Metes and Bounds),17/81i/f 5 j yo2 3C - SAA .t IH; T _-"� Size of Lot 631 .A 190 I Now of Bldgs. 0/F/. •� i�IJ No 77 Existing B1dg.�/fr//,VL I Families I R0000mr mi o J 6 Setback Line from y'/ Rear Yard p•r,9. . • J 3 - 1"54 Center of Street .7 Y Side Yard / 96 /`' DESCRIPTION OF WO= `,Ia• OF CESTA MESA New I I Alteration I I AdditionX. - - ,•., 1T1 Jt9 Repair , I I Moving I Demolish - - Building a Jf a// No.of oX ' / Size /AA(apq,Ro Ws Stories - Exterior Wall �Y 'CRoof Covering Walla - Covering 80MP APPROVALS Use of New p �i Building ,/f' /fro m 5 t- efd d 4.` y Foundation Location Inspector Date /7 ✓Ali ' - Under-orins, inning Is, `5. i Under-Pinning /S—x yL r .• Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application ,, Lath. Int. �. ii-, �J and state that the above is correct and agree to comply Lath. Ext f' I f ,e/ et' with all City Ordinances and State Laws regulating building construction. Signature of Plaster, int. Permittee // v/...--"4. Plaster,Ext Authorized Agt. • Masonry Reinforced Valuation j Permit Fee $ if Plan Check$ .----- Bond Beam 5. I S,4 - Total —�- f7�,1 -'7�J�~ Fee $ FINAL FORM 204 G-H 2M 5-54