HomeMy WebLinkAbout516 VICTORIA ST - Building PermitsWILLARD BAILEY � ' � /' �� �`G� �
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CUST0�1 CRflfT �iflSO��y COnTBflCTORS
275 EAST BAY STREE'i
COSTA MESA. CALIFORNIA
PHONE LIecRTv 8-1264
January 24, 1963
City of Costa Mesa
Department of Building and Safety
�r. Ringham
RE: To Henry �to Bldg located at 516 Victoria
Regarding reports from Twining La s, owing
�� � .
Moz'tor reports i�#ei�v below City Code.�ue to the
fact that Solid Grout was not required, and Job
Engineer approved solid grout, we feel that this
Stxucture is sound and safe, We the undersinged
do here-by except full responsibility for the
safety of the masonry walls
ours truly�tl�f
��.:�2_
\
�ustom Craft Masonry
lst Endorsement ��
. Wayne's Construction
_-�. \
CARL MCINTEE
C.G J.W,Reagan
Gity of Costa Mesa
�c�-"'-�I ,/LiuT6 ,
�
,�� P/e - ALL �-�2so,� i,vuo/f��rr�� .ri«-�r/
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PHOJECi AOOFE55: � 1 6 V 1 C 1�Oh 1 A S T UNIT:
OWNEB'SNRME: MUTO, J�:NNiE ::
nooecss: z q 06 W�hDWARD LN
NcWPOR�' tir:dCH,CA 92660
548-6272
PfltNIENGINEEB: FlAUL M STOKE BEG.NO.: C1'�Az3
nooaess: 3 8 3 7 e; 7 TH S T uxrt:
L.H. CA 90804
PEHMITTEE: �IGNS 6 SERVICES (7141761-87.00
aooaess: 10980 BOATMAN
STANTON ) CA 90680
LICENSEO CONTfiALTON OELLABpiION: I hereGy aflirm itat I a mMer pmdsi0ns 0� C�apler 9(commencing wil� Sac�ion
7000� ol Division 9 ol t�e Business ana Pmlessions COUe, and e�s in full lorce ane eilect.
ciTvuc.:03.57 sTareuc.:439828 ss C4S
Dale; � Signature:
WOPNEPS' C01 PENSpTION DECIAMTION: I herebyallir ihat I tuve GgniliWte of consent to sell�insure or a cehilicate ol Workers'
Compensation Insurance. or a centlied copy inertof (Settion 38U0, l G
eoucrNo.:WZP80557904 exr.oa : 2/O1/93
COMPANY: PACIFIC INS
� Cetli�iea copy is Aereby �umi5hed. � Certilietl COpy' 1 rolA lhe dry BuilJinp Divi5i0n.
aa�e: O ApplicanP
E%EMVfION OM WOPKEXS' COMPENS4PON OECIAflATION: (INS Setidn nee0 no� 0¢ cwnpkt¢G il Nt pPrml i51W one huMleO �5700) Of kiS�.
I cerlily Ihal in Ihe petlarmance ol t�e work for whic� Ihis Dermit is iuued. I stull not empl0y any DeROn in any mannef 50 as �o Cecome
subjecl to I�e WorkerS' Compen5aiion �aws at Calitomia.
Date: Signamre:
NOTICE: IL atter making IAis Ueclaration, you shoultl bewme 5uhjeci m 1he Workeri Campensation pmvisions o� the La�or
Code. you musl tonhvnin compy witn suCn provaidls or iti5 Dertmt ShaO De OeemeC revOkea.
CONSTflUCTION LENOING RGENCY: I �ereCy attirm t�at there is a comlrucGm lentlinp aqency for lhe petlormance 0� IAe work �or
whicn inis permn is issuetl ISection 3097. Civ. C�.
LfNDFfl:
RUOPESS:
OWNEH 9WLOEB DELIAMTION: I hereby a��irm Itut I am evem0� �rom Ihe ConVatlOrs' State Liume Law lor tM IWlovnnq reason
�Seciion 70.71.5 Business anG Pmiessional Cade: !ny ciry of wuniy whicA repuires a Dermit io consbuci, attei, im0�ove, AemolisR or
Itpdil dny SVUCIu¢. D��Or IO �B iAWnCO. al5p lepuif¢5 I�! ippGtdnl �d SuUi pRm� �0 Id! d LpnCO SIdIGI11t0i IIIdi IIdS�B 6 fitE05¢0
pur5uanl �o I�e pmvisi0n5 al I�e CMlratiars' S�ate License Law I�p�er 9(commendnA w+�� Section 7000� ol Division 3 0l ma eusiness
ana Prolesvon5 CoOe) ot �IWI tR/5tk ¢ exempl tlureirom an0 Ilce Ea5i5 Iw tne ineqt0 e[emption. My vqlati0n ol 5lcti0n 7071.5 Ey
any applicanl lor a permit suGjttts I�e appliunl to a civil penalty ol not rtqre Itwn live nunarEE OOIla6175001.
I. as ormer ol tne o�ooeny or my emWoyees wi�n waoes as ineir sole wmpenution, witl eo �ne wark, ana Ine
'. ❑ SVUCWte 5 nol inkM¢E Or off¢RO fW Sdip (SBCIWn 70AC. Bu9nar anE PrOte55ional Cu0l: T�0 fAnVaCI0r5' $Iai¢ UCCnSB Law
i aoes noi apply la an ovmer of a pwperty who buil0.5 or imprmCs tAerCon, antl who Uaes sucn woM1 himselimersell or inroupn
Ais or her own empl0y¢¢s, proviCeO Nal SUCh unptOvemen6 are not intenGW ar ollerotl lar 5ale. II, �oweve� tM GuilOinp or
improvemen� rs 5d0 xit�in we year o� wmpleiion, l�e Ovmer will have Ne EurOen of DmvinO MJslrc Ai0 nol OuiPo Or imprOva
" lor Ine ourpose af Sale).
I, as awner ol tAe pmpeny, am e.clusivery wmraclinp vnlh IkemeE contractors Io consimct I�e O�oleci (Seciion 7044, Business
❑ aM Prolessions CaEe: The Conuactori Stare Liceise Ww Eces not apqy �o an owner ot propefryMn EinlEs oi im0« ��reon
antl w�o conlracls lor suc� projens wit� a contranor�s) license pursuanl Io ��e Comractors' SIaIO 4C¢n50 Law�. 1 am aware
«� 0��� oi Iheir Worker'S Campensatlon i(aurarrc0 SMuIE be proviEM lo me.
� 1 am erem0� untler Seclion: B. 8 P. C.
tor �nis reasan:
Oaie: Ovmer.
I Qo �ereEy cetlily I�at 1 am awarz o� an0 uMErslanG 1�¢ reQui¢menR ol Calilamu H¢aIIA mG Saf¢ty COGe Sections 15505, 25533, an0
Y55� antl I�al I or any fuiure huilding ouupanl wilVwill nol �GrUe one) neeE Io comDN �'^�� sxiU state co0e5 antl �he ieduiremenls lor a
permil lor conslmciion or mOddiUtim Imm It1elur Ouality ManaAemeni UsMci. P¢Sidenlul t9nstmctidl aODlicalians are evemD� Imm
Ihei¢ pmvisions.
oate: Applitant:
I nere0y cer�itytha�l �avereatllhis aD��ication antl statE
ortlinancei antl slale IawS reWting Io �udaing COn5lmtli0n
pmpetly lorinspection purposes.
Date: SignaWre:
Driver'S license or $ocial Secunty k' � (�
maiion is conecL I aAree lo comply wilh all city anE county
flpfC5t0�dlivGt011114 OIyIOEfIIEfYp011ihE dUWO�IfIC�li011CU
i64t-a6 WOite-Bwldmo�. Green-Code Enlo¢emenL Canarv-Aoolicanl: Pmk-Revenue; ol4enro0-Assessor
CITY OF COS'1'A M�:SA - SIGN YERNI'i PERM �UO: •ikF 059/3�
PERMIT NO: SBE OS9734 PLAN CHECK NO: 09227-92 S GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMI9' TYPE: EL�. STR SIG l+JxPOSE: AD�
JOH DESCRIPTION : 15SF LUMINATED N.ONUMENT SZGN SQ FT;
CLAIM VALUE: 1,250.00 CALC-VALUE: 1,250.00 GROUP OCC: d-7. /
COMMENTS: "NAPA-N.ACHINE SHOP SERVICE" �:'r�E SIL1 N
#rtce��**##uit*#*tru###�it*####�#u�#�e#*x���r�+r##ce##irstittrir�rttr#�rtu�tt�tt##tt�#*###�*�::�� ��cir
S I G N I N F O R N, A; I O N
DISTRICT; 2 TYPE: MO�IUMENT ILLUMINATION; iNT CATtGORY; Nr:W
DIMENSIONS: 3FT OOIN X SFT OOIN AREA: 15.00SOr'T C,ETTER HT: 10.� IN
STREET FRONTAGE i: 51,00 STREET 1; C�iCTORIA
STREET FRONTAGE 2: 0.00 STREET 2;
PARCEL: 42220322 ZONE: C1 LOCATION > FRONT; X REAtt:
BUSINESS NAME; COSTA MESA AUTO SUPPLY > LEFT; RIGHT;
O T H E R T O T A L S G H O U N D S I G N
THIS ACTIVITY . 15,005 FT OVERALL HEIGHT; �FT OZN
THIS SITE Si.00S�iFT _- GROUND CL�AkANCE; 2F'1' 013�
ITEMS OF iNFO 6 PLANTER AREA; 15.00SQFi
ITEMS FOR ACTIVITY; 2 BLDG SE9' HACH; SONT
COPY VERBIAGE ; NAPA MACHINE SHOP SERC�ICE
PLANNING NOTES:
ifiE#iE�EiE�1E##ifiEii�34ifiE#iEiE#ifiElFif#1E###aFifiE#iFi}�FiEififiE#ihlkffiF#i(�ibif#N�#3k�lt�lf%�#Ik##iEIE##!E###iPif�##iEififi(�iE#if#
D E V E L O P M E N T S E.R V I C E S R E Q J I R E M E N: S
ZONING APPROVED BY . G�'E. DATE; I�
HUILDING APPROVED BY
APPLICATION ISSUED BY:
iFiEiE###�f#if##�)e3E#fEielEltfE##iE3F
LEGALIZATION;N
F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERNIT 31,00 15.00
508
ISSUE FEE z0.15 15.00
DATE: /
DATE• �(7 1 S 1-
3Fif'iF#N-itiElfiF#fEiFi( ##
STRUCTURAL S'EGN.EU:;Y
SIGN SMIP/RES GKADING
i5.00
SMIP/NON-RES
.SO
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL YHID DLr:
TOTALS----> 61.50 15.00 20.15 96.65 96.65 .00
REVENUE DIVZSION TOTALS--> COLLECTED: 96,65 OV�R/SHORT; ,00
BLDG PMT PLOMHING ELECTRIC MECHANIC SIGN SM1P/TOT GRADING PLAir ChECK
31.00 30.00 15.00 .50 2U,15
1E iE �E iE 3E iF�lFit iF N� K� K lE%�lE �IF �1e�� iF iE ii if It it aF ## N# if iF �lE �IF 1E �K 1E 1h iE lE iE 1E �k 3E if iF It �1f �lE i( k if #�% IE �k lE k IE 1E # 3F ## 1C iE N 3E X�X if #�lC #�1E ##% x' if
I N D I V I D U A L F E E B R E A K U O W N
TYPE �fY D E S C R I P T I� N UNIT COST TOTAL COS';
ELE 1 5�:�7p�C�lEDINE LIGHT SYS ON 1 BR CIRC 55.00 IS.00
{ plete !nsp�t� END OE' FEES
� �'� S�g d�� .._- . , . . . _
7 t',�. -
.,,
/
CONSTRUCTION AND PLANNING
APPROVALS Permit 1''r
1. Temporary Electrical Service oi Pole
2. Soil Pipe-Und�grnd.
3. Electrical Conduit Utility•Undrgrnd.
4. Electrical Conduit�Undrgrnd.
5. Steel Reinforcement
6. Eiectrical UFER Grnd.
7. Footings
B. Foundation �
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
73. Root Drains
14. flough Plumbinq
15. Rough Electriwl-Co�duit
76. RoughElectricWirin9
17. Rough Wiring Sign
18. Rough Electriw6T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
27. DuMs, in Structure
22. Ducts, Ventilating
23. Gas Pipe•Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T�Bar Ceiling (Structurall & Monocoat
27. Frameand flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrital Power Mecer�Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Finai Factory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final '
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas G
No. Date
POO. PA
Date Inspector AppROVALS Permit #
52. Pool & Equipment Location
' 53. Steel Reinforcement
54. Forms
55. Electrical6ond�ng
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVEF-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
61. APPflOVAL TO DECK
62. Backwash & Receptor�Final
63. Heater & Vent•Final
64. Plumbing System � Finai
65. Electrical�Final
66. Solar Svstem-Final
67. Fencing & Access Approval
68. APPROVED FOR P�ASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
0
Oate � Inspector
70. Underground Hydro
77. Product Piping O Gas ❑ O�I
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
7. FIXED SYSTEM FINAL
i8. FIRE PREV. FiNAL
� � HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
0. FOOD CERTIFICATE ISSUED
Notes:
. BUILDING SAFETY DI
P. O. Boa No. 317
Costa Mesa, Califoroia
CERTI
Building Permit
Use of Buildin�
Ttie building
��T: � Nd�lggg c
Date �"'.�� !O i // "' �
CI1'Y OF COSTA MESA
°ICATE OF OCCUPANCY
�j ab ,
ZElectrical`Permit No:�OQ� Plumbing Permit No �
LegalDescripNoSL�l..YM�GXA/.INYlrI.(N�-CJlv//�JTri.l,ri0 /�7//J��7J �/
(See reverse side foc Metes and Bounds)
has been inspected and found to comply wi t provisions of all City of Costa Mesa Ordin-
ances applicable thereto for a Group �Occupancy.
ISSUED T0:
City Buildin O�ffic�i j1
—+LL'�O� of Buil g� By h�n .�/Y✓Ki--1' . /.i�1/�i�%(/
CC: p Orig��in�l—Owner ❑ 7st copy--Gas Co. ❑ 2nd copy—Ediso�Ca� ❑ 3rd copq-�F51e
Form 208 3-B P'1D6 1-W
✓
: .�
.
. CITY OF COSTA MESA
Building Safety Department
Application for permit for the fabrication and erection
of awnings, advertising signs or devices.
Building Site
Name of Lec
Conira
ArchiTect or
Engineer_
LOCATION
18626
���t
.�
City
Siate License
No�� = /3G�-Si �/
Phone Q/P �3�%d
DESCRIPTION
Description of awning, advertising sign, or device:
Awnings canvas � metal � Width: ft. in.
Length: ft, in.
Ground Sign Projection Sign � Roof Sign � Wall $ign � Metal Letter Sign �
Banner �� Canvas Sign � Gas Tube Eleciric Sign (Sub-section 1.44, Ordinance 313) �
Combination Sign � Special Device (other) � Explain:
Two copies of plans and specifications shall be submitted wifh application for permit for each sign. Plot on
plan sheets proposed location of sign and locations of all other signs at site. Minimum size sheets musf be 18"
by 24" and non-erasable.
plf wifhin the 10-foot area of front property line, owner is to sign written agreement with ihe City.
Size of Sign - Thickness ft. �in. Height�fr. �in. Lengfh ft. in.
Weigh �b Ibs. Height above grade�ft. in. Projectiorr � J ft. in.
The undersigned hereby agrees to fabricate and erect awning or advertising structure within the intent and
meaning and in stricf accordance with the provisions of Ordinance 95, Ordinance 313 (Electrical Ordinance of
the City of Costa Mesa), and all amendments thereto.
ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICANT. ALL FOOTING, FRAMING AND ELECTRICAL IN-
SPECTIONS SHALL BE CALLED.
Signaiure of
AuthorizeiJ
Recd. by �
n\rm 214-1M-11-6�S-B P
� The amount shown under Valuafion is for the purpose oi
establishing a permit fee only.
VALUATIp.N Permit Fee $ �-
��1� ��
� �� $ �Q L� Plan Check $
pats�.�� Total Fee $ � �-
� F E RECEIVED
JAN s o 1963
FINANCE DEPT.
FORC�Trxi� ifs"�S�'}.i�ESA
Date Issued � -�— �� Permit No.
Fire Zone ype Group
Approved by Date/�r'_7T'—
rZONING L�^-t- F �-F. ,
Zone `- � Use of Bldgs. C%' '� 6
r-- ° �
A. P. No.—I /S �. �iC�� `— � �
Bldg. Site Address �� `�' �� � ��-�} � �- %�
/
Legal Owner Q '.��-'�-'�. ,�J
�' Y
Address ' .. _ _ �� ��� • `f
City �L�'�.� �'Li J'+'L Phone
Yards Approved.
Large Sign in excess of 8 sq. ft. Setback from center line
of street to front property line ��t. in.
From property line to edge of sign ��. in.
Side Yard Setbacks: �--�'�
Left Side � � h. in.
Right Side
Building Line Setback from
center line of street
Area of Sign
Height above Grade
Projection
Awning Size-Width
Length
Awning Height above Grade
�_ft. in.
5 r, ft. in.
�fT.�in.
_�ft. in.
� ft. in.
ft. in.
ft. in.
ft. in.
Projection ft. in.
Location and size C,�.\ �/ I.��,, �L
approved by ��T �l ��!� `� v--�
"V �.; 1,1�
_ ..
�
.
OWNER M[J'P0, Heri2y DATP 10-25-62 � \
JOB ADDRESS Sl(i Victnria Rt_ I3[IIi.DiNG PERMIT NO. 1f�4
aP No.iiS-o93-19 Lar
INSPECTIONS
TRACT
� Signaturc
C�
VALUG S 20.00
FIRG 7.ONI's llGSCRIPI'ION OF WORK DEIIIOliSh
DA'CE � GROUP I TYPG V 7.ONE
SUaCONTRACTOR
owNER n�mm�_ x
JOB ADDRF.SS--' ��
GENERAL CONTRACTOR
nr rro.115_093-19 LOT
INSPECTIONS
eua . sm —
DATE
p� 1S VALi7E 3 101.00
TRACT FIRP ZON� DliSCRIPTION OF WORK dEID.
Signature DA7'E GROUP S TYP� v ZONE C
PFRp1ITS I
SUACONTRACTOR —T :
l
,� 16412
COSTA MESA BUILDINGSAFETY DEPARTMENT
P, O. BO% 917 C06TA MEBA. CALIPORNIA
For Applieanf fo Fill In Completely
TYPE OR RINT
.�i ' .
BUILDING
ADDRE89
COSTA MESA. CALIFORNIA
� MAI
■ S{ZE
� 86TBALK L�NH PNOM
TEL. BUILDINf
NO. ADDRE65
YEL. ;
NO -
FIRE
ZONE
APPROVE
BY
�, r :o�E �
TEL. �Q��
NO. I oescx�nr��
` NO. OR B1D68. .7
DESCRIPTION OF WORK
WALL
FEE RECEIVED �
FEB 14}962 � ' t
fINANCE DEPT. 1:
APPId�{�T(�t��� Q�$$AIT�
BUILDING
For Offiee Use Only
aece�vT. Ho. rersD�7 H�i. �
COSTA MESA.
LANB BTJ
APPROVE�
ZONING
ov uee or n
NB �� BUILDINO
5—oy3—
�
I�HBREBY ACKNOVILEDOE TXAT 1 HAV2 ReAD TNIB APPLIGTION TH8 AMOUNT BXOWN UNDZR VALUATION IB POR THE
AND BTATH �NAT TH8 ABOVE 18 CORPEGT AIJ� AGREE TO COM- p�pp088 OF 88TAHL18HiN6 A PERMiT 4EE OHLY.
PLY WITN ALL CITY OPDINANCEB AND 9TATH LAWB REGULATiN6
Bu1Lo�No coNeTRuciloN. VqLUATION
SIGNATURE OF . �` 1� f�� � PERMI7 FEE $�_
PERMITTFi /L/
Q/ $ 'f(/ � PLAN CHECK S �'
AUTHORIXED AGENT�� J � �
TOTAL FEE
o�vNr•.x cosmn MEsa auto rarts �"¢ ���
GENERAL CO]
AP No. ]15-0
INSPECPIONS
coat
LOT TRACT rIRE ZONP
�Signature� DA7`P GROUP
NO.
VALUG
DfiSCRIPTION OF WORIC$leC.Gz'nd
TYPE ZONE
SUBCONTRACTOR
�'
'�i _
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. CAIIPORNIA
For Applicanf fo Fill In Compleiely
TYPE OR PRINT
Aoo e's"s 516 Victoria �
GOSTA MESA. CALIFORNIA
ORCENGI EER n• J• P.eagan ;;o: 959
ADDRESS 542 W. 19th. 8t. C.Mesa
CONTRAGTOR j"iAV178 Construction L'O
..onR�� 2o3a Placentia Ave
NO. OF BLDGe.
IY l.'i.ri I v..,., .... �.,.
U8E OF
EXISTING BLD�
BBTBACK L�N6 FROM
� I LEFf ' (i � RIGMT 23 � 8(�
DESCRIPTION OF WORK
�
IXTERIOR
COVERINC
USE OF Bi
I HEREBY ACKNOWLED66 THAT I HAVE P¢AD TX19 APPLIGTION
AND BTATE THAT TXE A80VE 19 LOPRECT ANO AORBE TO COM-
PLY WITX /�LL CITY OHGINANCEB AND BTAT¢ L.�W9 pBGYLATINO
BUILDINO CON9TRUGi10N. /�
SIGNATURE Op /1 A
�^^'. � ���! .,.., ' �
+ u- �CT 2 5 1 ,.�
.� � FIhAi`�CE DEP�
C;1Y OF COSTA P.1�SA �
��
APPLICATION FOR PERMIT
euauiN�
For Offtce Use Only
REC81Pi NO. PERNIT NO.
BUILDING �/ �'��.� � � I.
ADDRESS �O '��,`[
COSTA MESA. CALIFORNIA E¢, _ �
i O
ZONING
zoxe I rvo. op � I uae o> �
C'_ Z runs aunniNo
�aaw� Rsr �-yy' 28 �s
DEBCRIPTION
a. P. Ho. ��.s�— a93 — /�
YARDS EVES
ccexren uHa er.>
FRONT �0"�' FT. � v/G
R. SIDE Z 3 FT. �
L. SIDE � � FT. ^��
..�... .�� __ ��
�G (/1 PS, � / O
/r.�tqy
-�w
IO/,.1/CL
—/�� �
TH¢ AMOUNT BHOWN t1N�ER VALUATION 19 FOR THe
PUitP08C OP EBTABLI9HIN0 • PHRMIT FEE ONLY.
VALUATION
/��^..� __ PERMIT FEE $ S /
N .c/
$ / PLAN CHECK $ rtSi.�i
Z
C
O
n
- isoss
CbSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. CALIFORNIA
For Applicanf fo Fill In Comple+ely
TYPE PR PRINT
COSTA MESA. CALIFORNIA
OWNER ienry Muto
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USE OF
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DESCRIPTION OF WORK
BUILDING NO. OF
81Z6 ROOMb STOF
EXTERIOR WALL ROOF
COVERINCe GOVERING
USE OF BUIL�ING AND WORK TO BE PES2FORMED
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N FINANCE DEPT.' i
CITY OF COSTA MESA` ��
APPLICATION FOR PERMIT
suau�N�
For Offiee Use Only
COSTA MESA. CALIFORNIA
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APPROVED
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I HEREBY ACKNOWLEOOe THAT � MAVE H¢AD TH18 APPLIGT�ON THE AMOUNT 9HOWN UNDER VALIIATION IH FOR TME
ANO BTAT¢ THAT THE ABOVE I6 CORPECT AN� A6REC TO CON- pURP08¢ OP EBTABLIBHING N PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCE9 AND BTATH LAW9 R6G11LATIN6
BUILDINO CONBTRUQION. - VALUATION
SIGNATURE OF , � ,(� P6RMIT FEE $ � ^
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