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Home My WebLink About885 MAGELLAN ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 •�+�ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESn. Gn 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Ownec Address Contractor. Address: 885 MAG�LLAN ST REAR OF RE&IDENCE 14132208 BISHOP, ROBERT 5552 AMADOR AVE WESTMINSTER, CA RABALAIS, PATRICIA WIMER TR COSTA MESA, CA 885 MAGELLAN ST BISHOP ELECTRIC 5552 AMADOR AVE WESTMINSTER, CA Phone: (714)893-0130 Zip: 92683 Phone: Zip: 92626 Phone: (774) 893-0130 Zip: 92683 License: 763795 SCOPE OF PERMIT CHANGE 100A PANEL TO 200A SERVICE FOR AN EXISTING SFR. t SERVICE TO 200A ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3+units) Pool I Spa Lighting F�cts Recept Outlets Switches Non Res Appl Res Appl Service ro 200a � Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 523.50 50.00 80.00 50.00 50.00 50.00 50.00 50.00 $0.00 $0.00' , ' 50.00 $30.50 50.00 50.00 50.00 50.00 , 50.00 50.00 ' - 50.00 $0.00 50.00 50.00 50.00 SO.OP 50.00 �uantiry 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft � Standing Section Misc Electriwl Equipmen� Transformers up to 1 kvalkw ................up to 10 kva/kw .................up to 50 kvalkw .................up to t00�kvalkw � ..................over 100 kvalkw low Voltage Equipment Low Volt Wiring System / Ckt - Misa Conduit = � � Misc. Conductor " Circus ( gen or ride) � � Cirws (mech ride or lights) � Chnstmas Tree Stand � Fireworks Stand � - Other Eledrical Fee ' � - "" . Investigation.Fee � - Plan Check Fee Reinspection Fee Status: ISSUED Applied: 04I73R007 Issued: O4173I2001 ISSUED BV: Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 , $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 % $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E54.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall compty with all applicabla handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 9248, § 7, t24t•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abantloned for a period of 180 days. INSPECTIONS: In order for ihe work aulhorized under this permit to be considered legal, such work must comply with all applicabie codes, and ail requlred Inepeetions and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaaae (emo) WORKERS'COMPENSATION DECLARATON: � I hereby ettirm under penalry of perjury one of ihe fWbwing declarations: ❑ I heve end wlll mai�tein a certiflcata of consent to sell�lnsure for workers' compensatian, es pmvidetl br by saction 3700 ot the Lebor Code, tor the pertormance oi the work for which this partnit Is issuetl. ❑ 1 heve entl will main�ein workers' compensatbn Insurance, as required by section 3700 0l fhe Labor Coda, for the pertortnance of the work tor which Ihis pertnit Ig issued, My workere' wmpensatlon Insurence carner and poliq number ere: Cerner: Palicy Number. (This sectlon need nat be �p�efed i/ t6e pemut !s ve/ued e( are �undrod dollars (5700) or less.) �I certity Net in the pe�tom+e�e oi Ne eew��oAc tw whkh thts penntV is 4ssueA,1 sheN irot employ any person Vn eny manner so es to bemme sub�eq to ihe workers' compensetlon laws ol Celitomla�qntl ree at ii I shoultl Ceco s,�e workers' compensation provislons ot Sactlon 3700 ot the labor CoUo, I shall foMvrith comply vrith these proNsions. �� 1 / / ApplicemSipneture: ��+�� Date: �! � �/d I WARNINO: F�ILURE TO SE4�1FE WOR RS' GYNAPENSATION ODVEMOE IS UMAWFUL D SHALL SUBIECf AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FlNES UP TOONE HUNDRED THOUSAND DOILARE (5100,�I. IN ADDrt10N TO THE WST OF OOMFENSATION, DAMAGES A$ PROVIUED F-0R IN SECfION 3108 OF THE LABOR CODE. IMEREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby effirm ihat I am Iicensetl under proNslons ol Chapter 9(commencing with Section 7000) ol Dlvislon 3 0l the Business entl Prolessions Cotle, entl my license is in full force end eflect. Llc. x Class a Concractofs SigneWre: _ - � �T_ Date: �-i l9 � CONSTRUCTION LENDING AGENCV: ❑ I hereby aMirm that there is e consiruction landing egency lar the poAormence of Ihe work tor which Ihis permit is issuetl. (Sec. 3097. CiWI Code). Lentlers Neme: Lender's AGdreu: Signeture: Dato: OWNER•BUILDER DECI-�7AT10NS: I hereby aHirm t�et under penelry o1 per(ury lhat I em EXEMVT FROM 7ME CONTRACTORS LICENSE LAW tor the tollowing reeson (Sec. 7031.5, Business entl Professions Catle: My dry or counry which requfres e permit ta cansWcL elter, Imprwe, tlemdish, or repair eny siructure, pnor to Its issuance, elso requires the epD��ent tor such pefmit to lile e signetl statemem �hat �e or she Is Iicensetl pureuant to ihe pmNsions oi Ne Contractors Llcense Lew (Chepter 8(commencing with Sectlon 7000) ol Division 3 of the Business and Pmtessians Catle) or thet he or sha is azempt tharefrom end tha besis Por the elleged exemptlon. Any Nolatlon ot Section 7031.5 by eny epplicent for e pertnit sub�ects the ap0�icant to a �ml penalry of not more than INe hundred dollars (5500).): ❑ I, as owner ot tha pfopeny, w my employees wtih wages as their sWe compensation, WILL DO THE WORK, end the structure is not intendetl or oriered for sale (Sac. 7044, Business and Protessions Code: The Conirectors Ucense Lew tloes not apply to an owner oi propeny who builtls or improves thereon, and who tloes such work hlmsell or herself or through his ar har own employees, provlded that such improvemenis are not Intended or oNered br sele. If, however, the builtling or impmvement is soltl wit�in one year of completion, the owner-builder wiil have ihe burden of proving Ihat he or she did not builtl or improve for purpose of sale.). ❑ I, as owner af the property, am E7CCLUSIVELV COMRACTING WRH LICENSED CONTRAC70R5 to construct the prolect (Sac. 7044, Business entl Professions Code: The comraciors Llcense Lew does not appty to an awner al pmperry who builds or Improves Ihereon, and who contracis lor such project with a contraaor(s) license pursuant to /he Contractors License Laws.�. ❑ I em exempi under Sec. Busineu antl Professions Cade lor this reason: SignaWre: Date: Owner ID verilied by dnvers license. ❑ Ves ❑ No Drivers License No. VeAiicetion ol Ownership by (rype af tlacument, i.e. - property tax blll ar tleeA): Expires: DIYISION OF INDUS7RIAL SAFETY PERMIT CERTiFICATION: ❑ I hereby certify thet no excavellon Ove (5) or more leet in tlepth into which e person is requiretl to descentl, will be mede in connection with work authorizetl by Ihis pertnit, end Ihat no builtling siruaure, scafloltling, lalsework, or demolition or dismantling thereol, will be more �han thirry-six (36) feet high. (Chep. 32, Grp 2, An 2, Sec. 341, Title B, Calilom�a AtlministretNe Coda). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permli Irom the Divislon of Industnel Setery, es notetl abova, unless such person has a pertnit to do such wa�k �rom lhe tlFrision. Signature: Dato: Divlslon ol Indusirial Satery Permit Number: CERTIFlCA7E OF COMPUNICE AND AUTHORPATON OF EHfRV: 1 cenity under penelry of perjury tTat I �ave read ihis apptication and state ihat the intormatlon given is correa. I egree to wmply with ell state laws end ciry ordinances rela�ing to building consWction, end au�hoAze reprasentatives ot Ihe Ciry of CasW Mesa to enter upon the ebove-descnbed property for Inspectlon puryoses. I egree not to occupy or allow acupency of any building euthorizotl by this permit until finel inspection. G Sig�etur al Owner(s) ,!!, j]�te O I Y� ,s AnNOr Authod Applicam Pate COUE 1. INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention 7288 Pool Spa Final 200 Finel RB�Rool 201 FIneI BIocWRetain�ng Well 202 Final Factory Fira P�ece 203 Finel Sign 204 Final Demoliiion PdIE 1t�T .3 COOE� INSYECTIONTYPE 206 Finel Mechanical 20B Finel Plumbinp 210 Flnel Eleclrical 212 Final Fira Preventlon 220 Final Plenning Approval 222 Final Site 250 Final Building/Occupency QdIE cmuu�. (714) 754-5273 • F3% (714) 754-4856 • www.CI.COSte-mB58.Ce.Us 77 FAIH UHNE, GO51 A MtSA, GA 9'lti"Lti BUILDING PERMIT JobAddress: S85 MAGELLAN ST Suite: Vicinity: ��. Parcel Number: Applicant: Address: 14132208 Zoning: R1 Rl FAUBERT.BRAD Phone: Zip: Owner: RABALAIS, PATRICIA WIMER Address TR COSTA MESA, CA Phone: 885 MAGELLAN ST Zip: 92626 Contrector: STAR COURSE ROOFING CO. Address: 8902 SAILPORT DR Arch : Address: Phone: (800) 854A011 HUNTINGTON BEACH, CA Zip: 9264E2664 License: 532778 Phone: Eng: Address: ISSUED BY: Status: ISSUED Applied: 07/17I2001 Issued: 07/17/2001 Phone: Zip: license: License: SCOPE OF PERMIT TEAR OFF EXISITING SHAKE ROOF. INSTALL SHEATHING, 30 YEAR COMP SHINGLES. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0- 0 PARKING Existin : o NOTES: Rear 0. 0 Rear 0. 0 Required: 0 FEE SUMMARY Calc Valuation: $2,sso.00 Claim Valuation: az,sso.00 PLANNING 8 ZONING Left 0. 0 Right Left 0. 0 Right Proposed: 0 0- 0 ao NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calilomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automaticalty 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 woAc authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell requlred Inapectiona end tinal epproval must be obtatned. Failure to obtain inspections and final approval will result in ihe expiration ot th(s pertnit. FOR INSPECTIONS CALL: (714) 754-5626 2d4Bd8 (fl�00) WORKERS' COMPENSA710N DECLAqATON: ' I hereby aflirm under penalry of per�ury ona ot t�e lollowing dedarations: ❑ I have end wlll maintaln e ceNlicete oi consent to self-Insure for workers' compensation, es provlded br by section 3700 0l the Lebor CoAa, tor the pertortnance of the �work for which this pertnit Is issuetl. � ..� hava ena wlll meintein wwkers' compensetlon inwrerxe, es requiretl Dy SecUon 3700 0l ihe LEbor CoAe, lor Ihe OeAortnanca of the wark for which ihis pertnit is issuetl. My workers' compensetlon �nsurance cartler and pdicy number ere: Certier: Policy Number. (This section need nof be ownplefetl i! fhe pertNf 15 velued et me h�ndred ddlars (5100) or less.) ❑ I certity Ihet in Iha poAormancay M e work tor whi this permit is issued, I s�all not employ eny person In eny manner so as to become subject to the workers' compensetlon laws ol Celi �rttfe d egree a I shoulA become sub�ect to the workers' compensetlon proNslons ot Sectlon 3700 oi Ne Labor CoEe, I shall torNwitb �moiyw�m mase v�ome �. � I ��p � 7 I Applicant Slgnature: Date: WARNINO: FAILURE ORKERS' COMPENSATION COVEMGE IS UNLAW FUl AND SHALL SUBIECT AN EMPLOYER TO CRIMIN�L PE TIES M10 VIL FlNES UP TO ONE MUNDRED TKKISANDOOIURE ,000),IN�DDfi1pJTOTHECDuTOFODMPENSATiON,DPA41GE5ASPROVIDEDFIXiINSECiION�IOBOFTHEUBORCODE,INTEREST,AN�ATTORNEV'SFEES. LICENSED CONTRACTORS I hereby aHlrm that I um Ilcensed u pro ' hepte (commencing with Section 7000) of Divislon 3 oi Ihe Buslness antl Professions Code, entl my Ilcense Is In lull torce and etlect. Llc. p Class s Contrectofs Signeture: Da�e: CONSTRUCTIO END GENCV: ❑ I heroby eNirm Ihet ihero Is e conslruction lending egency br �he Dedormence ol Ihe work tor which this permit Is issuod. (Sec. 3097, Civil Cotle). Lentlels Neme: Lender's AUdress: Signeture: OWNER-BUILDER DECLARATIONS: Dete: I hereby effirtn Ihet under penelty ol perjury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Iho following reeson (Sec. 7031.5, Buslness entl Professions Code: Any city or county whic� requires e permit to consWct. alter, improve, tlemolish, ar repair any sWCWre, prior to iIs Issuance, elso requires the epplicant for such partnit to file e signed statemem thal he or she is licensed pursuant to the provtsions ot the Contrecrors IJcense Lew (Chepter 9(wmmendng with Section 7000) oi DNision 3 ot ihe Business end Professions Gode) or that he or she is exempl therefrom antl che basls for t�e alleged exemptlon. Any vloletlon ol Sectlon 7031.5 by any appliwnt for e pem+: sub�ects the epplicant to e civil penelty of not more then frve hundred dWlars ($500).): ❑ I, es owner ot the property, or my employees wl�h wages es their sole compensation, WILL DO 7HE WORK, antl ihe structure is not iniended or offeretl for ule (Sec. 7040, Business end Protessions CoOe: TTe Contradors License Law does not appy ro an owner of pmperry who builtls or improves thereon, and who tloes such work himself or herself or through �Is or her own employees, Orovided Ihat such improvements are not Intended or oHereO for sale. If, however, ihe buildinq or improvement is sold within one year ot wmpletion, ihe owner-builder will have the burden of proving t�at he or she did not build or improve for purpose ot sale.). ❑ I, as owner of the properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct t�e pro�ect (Sec. 7044, Business and Professions Code: The contractors LJcense Lew does rwt eppty to an owner ol property w�a builds or Improves thereon, antl who conireds lor such pmject with a coniractor(s) license pursuant to the Contracbrs License Wws.). ❑ I am exempt under 5at. Signature: Owner ID verilled by tlnvers Iicensa. ❑ Yes ❑ No Business and Profession5 CodB tor (hi5 ree5on: Verificatlon of Ownerehip by (rype af tlocument, i.e. - property taz bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION: Driver's License No. Date: Expires: ❑ I hereby certify thet no axcavetlon frve (5) or more feet in tlepth into which e person is requlred to dascend, wlil be made in connection wlih work euthorized by tNs permi�, and thal no building simcture, sceMolding, felsework, or demolition or dismantling I�ereol, will be more then ihirty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TIIIe 8, Celifomle Adminlstrative CoCe). ❑ As owner�builder, I will not employ anyone to do work which would require e permit Irom the Dlvislon ol Indusirlal Sefety, es noted ebova, unless such person hes e permit to do suc� work Irom Ihe tlivision. Signeture: Dete: Divislon ol Intlusirial Sefery Pertnil Number: CERTIFlCATE OF COMPLIANCE AND AUTNORIZA710N OF EN7AV: I certity under penalry of Oer�ury thet 1 �eve rea0 this applicaiion and state that Ihe informatlon given Is correct. I egree to wmply with ell scate laws enA city or0inances relating to building consWction, end euthodze representetives of the Ciry of Coste Mesa to enter upon the ebove-descnbed property tor inspecti , e to occupy or allow occuDancy of eny 6uilding emhonzod by lhis pertnit until linel inspection. CQ�E I, INSPECTONTYPE 1616 Fi:ed System Final Fire Preventlon 1266 Pool Spe Finel 200 Final Re-Rool 201 Finel BIacWRelelning Wall 202 Final Fectory Fira Place 203 Final Slgn � I[� 8 /-oL � Ila � bo�`e D te CO�E I INSPECTION TYVE 208 Flnel Mechenlcal 20B Flnel PIum6ing 210 Final Elatdcel 212 Final Fire Preventlon 220 Flnal Planning Approvel 222 Final Site 204 FlnalOemolltion 250 FlnalBuiltlinglOccupency Decem�r 12� .1963 Fh'. Wllliaa Bax'ada 885 14eBo11an Aveau� ' CosLa F��sa, CsliTornia , Dea,r Mr• &3red.z: - Ea ensWer to ynur telephone requast for a xeport oP �r pection of 3Rair "uater-vnder-the-ho�uee" problem, I vail. cu�eeL tw th. e to alleviate tl�e prob].em� As there seems• to be qutte an aaou3t oY r�e e seeping in by ' r�y of the sever ditch, tais ditCh cauld dug oub to t. sever 1lae and r�filled vrith good earth, � 11 teaiped, fr 3� house faundatioa, around the ces�er lirte� aad exEerxl ont •irom the undutlon at lepst three feet. • Secovdly, pr e EQve troruah � to d3vert the c�ater Prom airo�und the houEx itself, e^pec ly !n the area 4 the front entrancr. I eincerely hope that if these su�eotions aze carrYed out your probleas �Ytl]. 9e eolved. to e Qreat e:.terrt. � Very tPu.ly yqiY6, MICF�AF�, BINGHAM Bulldin3 Offlcieil $Y xoy R. Ei1CkE0a] Deputy Build3ng Official RRE:cs OWNER ST. SYR� E. JOB ADDRE55 5 Mage] GENERAL CONTRACTOR D. � �. - 2- LOT Ih... ECTIONS SOIL GAS W ATER ROUGH PLUMBING PROP. SWR. LINE � HOUSE CON. � SPRINKLING SVSTEM MISCELLANEOUS ROUGN NEATING AND AIR CONOITIONINi TEMPORARY SERVICE OR POLE UNDERGROUNU � POwER � ROUGN WIRING TflENCHES � FORM$ � STEEL R FLOOR SVSTEM BOND BEAM ❑ ST�EL REINFORCE SHEATHING FRAME ANO FLFSHING LATNING - IN n OUT ❑ Pl "�ER, BROWN COAT 5 lURqL, FINAL MEAiING. VENT., REFRIG. AN� A.C., F PLUMBING, FINAL AND GAS TEST n ELECTRIC, iINAL _ BUILDING, FINFL Date DATE 0 SUBCONTRACTOR Z . aU Z ZQ O v~i am J � � -w J Q U � Za W � aw wz J � m z J � W w � _ Z � W � �O i�' Z Q U Q 0 H N Z O F— U � � � N Z , . ��98 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX1200 COSTqMESA.CALIFORNIA92626 For Applicant to Fill in Completely BUILDING ir, 'S !'�• .• . � . . OWNER � G� T �a S�� MAIL � ADDRESS �,y; _ �� p� TEL. CITV NO. BRANCH �V V � A�ORESS ARCHITECT �� NEL. OR ENGINEER ADDRESS +�i-0 % <�j,_ � AV � � rJ CONTRACTOR D . L� . �ti.0 '{.�� ADDFESS '�% �Z� � (�J . �� S � , (1 TEL. CITV a� c�.+�� A.�; �! N�:C�L STATE n � , � O �. CITV LIC. NO. .�� C � LIC. NO. SIZE � NO. OF BLC OF LOT I NOW ON LC USE OF EXI5iING BLOG. � � � • SIZE OF ^ NO.OF NEW BLDG. +1 ROOMS STOF EXTERIOR WALL ROOF COVERING COVERING USE Of BUILDING AND WORK TO BE PERFORMED unR 3n-7�P"-1Q00 803 �=**�*5.00 crsa APPLICATION FOR BUILDING PERMIT RECE B D�$E FECEIVED DATE ISsul ADDRE55 � �, TRACT � Z W ADD A X OWNER � - C v SE FIRE 20NE T APPROVED ev ZO NO.OF � °�"'s v VARDS APPROVED DISTANCE BET MAIN B�DGS. VAfi. # C.U.P.� I hereby acknowletlge that I have reatl this application antl state that the above intormution iA correcc and a8/ee to comply with oll laws reBulating builtling cOnstruction, and I shall nOt emplay any pe�son in viola[ion of [he workman's compenzation laws ot 2he S2ate of Califomia. / G� I hereby certify chot I am proparly licensed as a convactor untler O the State of California Business antl Protessions Cotla, Divislcn 3, THE AMOI Chapter 9, and t�at such licenses are In full torce antl effect, or I THE PURP( am ezempt from ffie provisionsof Ne Ste[e of California Business VAIUATION antl Professians Cotle, Division 3, Chapter 9. Slgnature ot `'�� - �� F ', , ^ r� ^ Permittee "ti �� § � [� L^ Authorized Agent V� P — � 7 PE DATE ��. E OF N ��/ ILDIN VAROS APPROVED CCESSORY BVILD7IJG BET. MAIN & ACCE55. BLD DATE APPROVED O '� 0 JN UNDEP VALUATION IS FOR � 'ABLISHING A PERMIT FEE ONLY: ¢ � m PERMIT FEE 5 � 7 m �PIAN CHECK $ -- E 0 � � LL TOTAL FEE $ j , . . �3� �� G�OSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA. GLIFORNIA For Applieanf io Fill In Complefely TYPE OR PRINT AO RES6 886 Maaellaa �tT08t COSTA MESA. CALIFORNIA OWNER �8a Del Mer Develo ment Co. MAIL . _ _ � AP �ECf del Mer coase TEL. 6 �� E�E0�/�:'� �EC 9 1960 Lo t- S 3, ��,�t,�iVAl��D�'?T. APPLICATION FOR�PERMIT•9ESA BUILDING For Office Use Only RECEIPT NO. P£AfM�Ii/J NOq. � a �1�2•L4� reEczjxe_o er I oyt§�lec�{veq DI 1?El.r2 i� 19h� (/ t / J / �� 3�220 ADDI 3422� FIRE ZONE R-1 LEGAL COSTA MESA. CALIFORNIA ZONING xo. oF uee ov nuwe 7 au��niN OF LOT O� S�• I xo. OP etnae. NOW ON LOT a p, p. NO. USE OF YARDS EXI6TING BL�G APPROVED 6ETBACK LINH PPON � � (CENT¢R LINC BTq ceMen OvsTrteer S REAR YARD FRONT / � SIDE YARD LEFT RIGHT -� R.SIDE DESCRIPTION OF WORK . _,__ S ZE DING/n pd x� ROOM'. O� / EXTERIOR WAL ROOF GOVERING COVE USE OF BUILDING AND WORK TO' APPROVED 0 A none . EVES F. I HEREBY ACKNOW�-B�OH TX�T I HAV6 RBAO THI APPLIGTION THE AMOUNT BHOWN UNDEP VALUATION �8 FON THE ANO BTAT¢ THAT iME 00V6 �B COHRE4T AND pHE TO COM- PUiiPOBE OF EBTAOLIBX�N6 A PERMIT FEE ONLY. PLY WIiN 6LL C17Y C 1 CE9 AND AT6 6 RH6ULATNG BOIlLINO CONBTNU ON VALUATION 61GNATURE OF �j PERMIT FEE $ ��. O O PERMITfE ` � $'�, l3 0• oo PLAN CHECK $ �7• D � AUTHORIZED AGENT (� TOTAL FEE J I' D O , � ' . Sti COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FO STRUCTURAL PERMIi" ' P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 �' g� � �� SO TL RECE PERMIT j�TO � � For Applicant to Fill in Completely — Use Ink Only 1�� ^ ADIDRESS �DS M 1pC LL�rr%� A�P� N�' ` Z2 �O ` {_ OWNER OR /' R �/A' V/�' I S ADDRESG � AJ \ TENANT (� / E� UNIT OR R� MAIIING SPACE NO. W � ADDRE55 QS �vt�1�G�LL�a � T� LOT � BLK. CITV�S /��G,�A NOL O'�� CLOENDEq�ION O`' NEW ADD ALTER REPAIR MOVINGDEMOLISH �v BRANCH /'�, � /' OWNER L A�DRESS ' ALUE ARCHITECT TEL. USE . E� (iD,d OR ENGINEEfl ADDRESS 20NE YPE � GROUP CONTRACTOR E I % Pt LAIS ByPROVED DATE II l7 Z ADDRESS 88S M�t6�[,�a� TEL. cirv �i(�jTA E No. /%Q'.$�S i� F STATE CITV APPROVEDSETBACKS LIC. NO. LIC. NO. � SI2E NO.OF BLDGS (FROM C T) 0. OF LOT NOW ON LOT I RO a USEOF S�N��E FAM, R25117E+�.rc � ExISnNGBLDG. %i /t AGF�EC� f��t � FSeparate permits are required for L SIDE �� Fr. 0 electric, plumbing and heating work. REAR Fr. � VSE OF BVILDING AND WORK 70 BE PERFORMED PLqNNING ACTION � DATE a � , APPROVED � APPROV 9 _ ? "� r � � � w �� 1 hereby eeknowlatlBe that I hevo raetl this epP��ation entl rtate � that Na abova information is correct enG aprae to comply with a all laws ragulaiinp builtling eonrtruction, antl I shell not amploy Z eny permn In vloletion ot the wbrkmen's compensaHon lews of ;! W the Stete of Celitornle. ,: ,� x SQ. FT. m I hereby certlfy tnat I am properly �icensetl os e eonirector untlar � the State of Calitornla Business e�tl Profasslons Cotle, Dlvlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chaptar 9, entl [he[ s�eh licencaa g�e in full force and effeei, or I THE PURPO6E OF ESTABLISHING A PERMIT FEE ONLV: � am exempt from tha provlsions ot the Stato of Celifornie Buslnass VALUATION PERMIT FEE S .00 u4i entl Protesslons Cotla, Oividon 3, Chopter 9. � SiBnatura of� . PLAN CMECK S , Q� o Perm�`ttee 7 �Q S��QD � TAX 5 �, � V Authorized ABent Date � TOTAL PAID E� �