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Home My WebLink About3017 WARREN LN - Building Permits CITY OF COSTA MESA • t? ^, BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT u 7 PERMIT PERMIT NUMBER B98-01722( (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3017 WARREN LN Status: ISSUED (4.'V p5 Suite: Applied: 09/24/1998 Vicinity: Issued: 09/24/1998 Parcel Nunmber: 14116416 Zoning: R1 R1 Applicant: MILLER, DAVIE Address: Phone: Zip: • Owner: HOSKINS, CLIFFORD H Address HOSKINS,AMY P COSTA MESA,CA Phone: • 3017 WARREN LN Zip: 92626 Contractor: ORANGE COAST ROOFING Address: 3027 ROYCE LN. Phone: 631-1924 COSTA MESA,CA Zip:' 92627 License:- 434674 Arch/Eng: - . _ {� Address: Phone:_ �" . . Zip: _ . License: SCOPE OF PERMIT REROOF OVER EXISTING 1 LAYER OF COMP. INSTLL 25 YR COMP.SHINGLE,ROOF CERT. ATTACHED TO PERMIT. • FEE SUMMARY, t Plan Check: $0.00 • - Calc Valuation: ' $3,196.00 Permit: $87.25 - • - - ' ' Claim Valuation:, $3,196.00 SMIP Res: $0.50 _ f SMIP Corn: $0.00 = '_ Other: $0.00 Inspection: $0.00 • Total: $87.75 - • 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: EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora 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 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 workers'compensation Insurance carrier and policy number are: Carrier: I Policy Number: (This section need not be cot plated i e penn is valued t one hund dollars($100)or less.) ❑ I certify that in the pe E•rmanc of the ark for wh' h this per t is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws •f I aliforni and ag ee that if I hould Ito e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply-with these p • Bions. (J 3-- �p Applicant Signature: (pat,. 7 2 J 71' _--- WARNING:-FAILURE TO SE RE WORKERS'COMPENSATION GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND on I ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMA S AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DE• •RAT I : I hereby affirm that I am license• der isions f Chapter (comma ' g with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Q Contractor's Signature: Date:- C d—3—C••2- 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 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.). O 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 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,Grp 2,Art 2,Sec. 341,Ttle 8,Callfomia 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 California Health and Safety Code been fully complied with? ❑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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ 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? 0 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•ollution control officer). CERTIFICATE OF COMPLI•NCE:I certify that under penalty • perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Mate 'Is and Emissions. Signature: I I I . Date: CERTIFICATE 0 •OMPLI• E AN• AUTHO- 'TION OR 7.. -Y:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree t' omply all st- e •ws . d city ordin• es relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri••d • •party f• nspec o •urpo • I afire= o to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Ownelf Date And/Or Authorized Applicant 'Date CODE I INSPECTInN TYPF DATE IN®9L4 DDDEt INSPECTION TYPE DAME =ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final •1j Q /��[/ 208 Final Plumbing 200 Final Re-Roof lA f7''90 (�+,:€1 210 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 2446-46 a • � �f CITY OF COSTA MESA ;411. ;y -A, BUILDING DIVISION �. _ DEVELOPMENT SERVICES DEPARTMENT 04— 4freabordno 414. PERMIT PERMIT NBER B98-01745 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3017 WARREN LN Status: ISSUED Suite: Applied: 09/28/1998 Vicinity: Issued: 09/28/1998 Parcel Nunmber: 14116416 Zoning: R1 R1 Applicant: HOSKINS, CLIFFORD H Address: HOSKINS,AMY P COSTA MESA,CA Phone: 3017 WARREN LN Zip: 92626 Owner: HOSKINS, CLIFFORD H Address HOSKINS,AMY P COSTA MESA,CA Phone: - 3017 WARREN LN Zip: 92626 Contractor: Address: Phone: Zip: License:- Arch/Eng : • Address: - Phone:" Zip: License: SCOPE OF PERMIT INSTALL THREE 22"X 38"SKULIGHTS, NER#216. FEE SUMMARY Plan Check: • $0.00 Calc Valuation: $1,500.00 Permit: $48.50 - - ; j Claim Valuation: $1,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 - Inspection: $0.00 Total: $49.00 • 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: • 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 DECLARATIONS I 1 I e • WORKERS'COMPENSATION DECLARATION: \, I hereby affirm under penalty of perjury one of the following declarations: t ❑ 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: Carrier: Policy Number: (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 provisions. Applicant Signature: Date: 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 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 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.Lic.4 Class 4 Contractor's Signature: Date: 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 for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit cfs the applican o a civil anally of not more han five hundred dollars($500).): as owner he prope ,or my employe with wage s their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 1, 044,Busi and Pr essions Code: Contracto cense Law does not apply to an owner of property who builds or Improves thereon,and who does such work Himself or erself art ugh his or her n employeg provlded that such Improvements are not Intended or offered for sale.If,however,the building or Improvement Is "�I sold with' one year !completion,th wner-bull will have the burden of proving that he or she did not build or improve for purpose of sale.). 6as o er of th property, am E LUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: a contr ctors 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 Cont ors License Laws.). 94/I am exem de c. 12 Lill Business and Professions Code for this reason: p Signature: Date: I/2b/� U Owner ID by driver's license. ❑Yes 0 No Driver's License No. / Expires: 9/2-Z/efl-- 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,end 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,Tale 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 hes 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 then 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 0 N (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 ❑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 ❑No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residentlal 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? 0 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 ❑No 8 (If Nes',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. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date COOSL INSPECTION TYPE DATE IXIMALS COOF t INAPFCTION TYPE UM BEMIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof - 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 -21—f Oa p M-00- 244646 OWNER College Mesa Co. DATE 9-15-55 JOB ADDRESS 3017 Warren Way BUILDING PERMIT NO. 1809 GENERAL CONTRACTOR The Hale Co. VALUE $ 6,000.00 LOT 70 BLOCK TRACT 2341 Single residence ,3ROUp I TYPE V ZONE 1114 FIRE DISTRICT #1825 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench S/g-f r-aa-Jfr Foundation Forms and Grade to Gara e Rough Framing „ L.2-I" , Plumbing,Rough to Slab-Ate`. r' /V-3 Plumbing,Rough Complete )L /S.-).-41—__ .,ems--,, '" L___ Temporary Pole .��'V �,, Wiring,Rough + 9 ✓ i: qt.-cStr_. �f____ • /1 -/-rt- /7 2--z �e- • Heating,Rough / / n Heating, Finalt,Q,Yi-» /6- 7-.Tr 3 D 7 SS----- / Sewer, House) /„}'S//eater,St. Oeterf-K_i, ed //a2-s-s— _4A77 Septic Tank or Cesspool r Lathing, In/2-A,j/( OutX mg, /a-7-4:!4,! Plastering ' £S1} ,i - <. Plumbing,Final,Fixtures Com w J Plumbing,Final Gas Test /.0 ,�«['1 = ACM%. _ 21/115Wiring,Final 4' - ` e Occupancy I Costa Mesa Building Department APPLICATION FOR PERMIT 111 EAST 2th STREET rY ~' COSTA MESA,gCAL FOR�NIA 182 BUILDING 1 FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN I Receipt No. 1 PermjtONo. Building 0ajj// Address 3017 Warren Way Costa Mesa, California R`e�ce9 by Date Recd. Date Issu d Nearest 7� - I t/.3'S l 1 SEP 1 51955 Cross St. Baker Avenue Building/ Addres Owner College Mesa Company Costa Mesa, California Mall Address 8002 Central Avenue Nearest Tel. Cross St. City Garden Grove NoLE 9-2158 Zone/2 I No.of I Type / Group Architect or Lie. Plans Engineer Davis & Quigley No, C-1790 Approved by Date Address 43 Malaga Cove Plaza,Palos Verdes CORRECTIONS City Lic. Contractor The Hale Company No. 3422 Address 8002 Central Ave. , Garden Grove Legal I Lot 70 I Block I Tract2341 Description No. (Attach Metes and Bounds) No.of Bldgs, Size of Lot 7$49 NoWo n Lot None 0 Use ofNo.of INo.of _ zi Existing Bldg. I Families Rooms G1 Setback Line fromRear Yard 401 Z Center of Street 551 Side Yard R 1 D DESCRIPTION OF WORK New I X I Alteration I I Addition I Repair I I Moving I I Demolish I Building No.of - Size 1181 Rooms 5 Stories 1 Exterior Wall Roof — Covering Stucco I Covering Rock APPROVALS Use of New Foundation Location Inspector Date Building Single family duelling with Forms,Materials, attached garage. Under-Pinning U, Frame: Fire Stops, in Bracing,Bolts `n I hereby acknowledge that I have read this Application o and state that the above is correct and agree to comply Lath. Int mho with all City Ordinances and State Laws regulating building construction. Lath. Ext nI9 Signature of T HALE CO : ► v Permittee Plaster, Int �o Authorized Agt. Q, ;l /e' :° r LA-- Plaster,Ext :> SILVIA LARDNER " Valuation Permit Fee $ �i Q Masonry Reinforced .. 0 0 Plan Check$ 3 ' Bond Beam W $ i Total Fee $ o�3 FINAL o FnfM 204 S-MP 2M 6-55 -4 C N a _ o. ., L. a. Street PLOT PLAN Show location and distances from property tine and between buildings. - .-- v OWNER PORTINEJ MRS. MARY C. 0 DATE 3-2947 JOB ADDRESS 3017 Warren Lane BUILDING PERMIT NO. #4779 GENERAL CONTRACTOROY1ner Bldr. VALUE 3 213.00 AP113-264-16 'LOT BLOCK TRACT Cement Block Wall GROUP TYPE ZONE FIRE DISTRICT h812 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench Foundation Forms and Grade to Garage Rough Framing Plumbing,Rough to Slab Plumbing, Rough Complete Temporary Pole Wiring, Rough Heating,Rough Heating, Final Sewer, House Sewer, St. Septic Tank or Cesspool Lathing, In Out _ Plastering Plumbing,Final,Fixtures Complete Plumbing,Final Gas Test Wiring,Final Occupancy eC- - • S 7 FORM 210 3M 10.55 4779[] _ . ;; H, �; c _, �. , <. -4812__ - ,�a; .%r:�sr Mt 5. /y/.1,e71 e-, Eo.e ri,✓8 I`• - '' • ?.al.:. A 2r3:is 3.c4/) b✓g,C<e .✓ LA.✓E !! 101 b:'k ats €- - .1 for c0a St,1 1 City Cos r. ._ei 9r_ h. Poo/c;-‘76.5-7 I �5i c n q . iT- r eF^.rT4. ;•c r e _. -, ! — i� r ! Contract:3i °Wr✓5 t. is .¢ Address ly ! `'I City ISc� o� e o o� - - W z, I Size of iot/o3, -x/�-AP# - /o9 l� get r 4 $ 0' + Setbacks C tree o6 ea�i7- • ! if . . of prop, 1 Siam Yard = Right Lefe -/ fl i.j .I ( ! TYPe of Fence G EM e.✓ r etoc& i - - - I hereby acknowledge that I ha4rt ' g' 4 I` a this application and state that the C E ALLEY OR PROP, LINF� -- - C / b w f- ,} ' above is correct and agree to comply I- _I w with all City Ordinances and State ! 4,• � 1 N I '� r Laws regulating building construction° II 1 E. E", 0 ! 0 Signature to m a W I of Permitteew� e.-. 4L-'.- It: Agent -P a h.f N j < o LLI E- FOR OFFICE USE ONLY, N. �jvic7o GI ,,. r O Z..._ z ,� -!„ U l mPerraiy79 1U- Z 0 �i.1......_ < e . a }} •to vI Da Iss .d3NF1 ,ft' 't� v D OVALUA IONa. Permit Fee $ �,1 - m Pian Check $q. 1 u j $ �; i a — TOTAL FEE e a — 1 I ! I 3; + it I -- - - - - --I t - "` - - - - - - FIN'NCE D PT~f �\ %- - cd. 0 COSTA MESA i' -` "10-x. ',' •�.q - alaced on snl{d. - _ .._..-_ I ( . v