HomeMy WebLinkAbout940 MAGELLAN ST - Building Permits. ;
AD�N650FBNLpIq: 94O MAGEL`�iAN ST�
wn�xsn.weiva,wrw: KELLER, RYAN ;
uooness 940 MAGELLAN' S�T ,
COSTA MESA,CA 92626
663-4489
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UMT:
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APCXRECT OF FNOINEFA: 11G N0:
AXLX.OP FNO.'9 /�DUHE59: UNT: •
c«+rnurarsx.u�: PRO QUALITY PLUMBING ( 714 ) 779-0111
�pnp��{ppgy�y�pq 636 N. TUSTIN AV
,�� OR CA ��, 622416
92667 u�: 603
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�°`ipapBtl�P°`D°'� RODER'P WELTMER
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(5151�ae.WP) WMe-Buikiq 8 Sdery: �reen-�Fb: Gariary-App{�y��: pNAPe.awe:Ookenmd-Nwnor
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO; P 082906
PERMIT NO: P 082906 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
JOH DESCRIPTION : WATER REPIPE SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: X
*it***it+t*******�**********it*�t***�***+�***+t+�*�t�ti��t�t-�t*f[�i��t�t��x�*�r�t*i�*�r*x�*�r**x�+t�r�r****r+�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PAAKING RE(j: PROV; PARCEL: 14133114 ZNE: REF NO:
PLAIVNING NOTES>
i
iE ik �f iF iF 1E 1F if iF if iF IE IE 9E 1E 1E fE 1f iE iE iE iE aE if 1f if �)E 1E IE 1E iE 1f fE 1E IE IE IE iE iE iE fE iE iE iE k 1f fE fF If �E fE if !E if 1E iF 1E 1E iF 1E 1F iF 1F 1f 1E fE IE 1f iE iE ib iE iE 1E iE if iF if ik
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED HY : DATE• �,
T
LEGALIZATION:N
BLDG PMT PLUMBING
PERMIT 8.75
25Y
F£ E S U M M A R Y
ELECTI2IC MECHANIC
.
FIRE
�*�*�*i�*��,�,�*� 11
STRUCTURAL SEGMENT:N
SMIP/RES GRADING
SMIP/NON—RES
PLAN �
ISSUE FEE 22.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 8.75 22.00 . 0.00 30.75 30.75 .00
REVENUE DIVISION TOTALS--> COLLECTED: 30,75 OVEA/SHORT: ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
30,75 '�
K if if if k iE it if iE if k �k if if 1E iE 1E 1ElE 1E �F 1E IF fF 1E fE iE iE 1E 1E 1E IElE iE If 1E 1E1(-if iE 1E 1E M it M if k 1f iE fflF k 1E k ik IE if 1k if 1E fE i! iE 1F iE 1E iE 1f 1F �E ft if if 1k ft iE k iF k
I N D I V I D U A L � F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N� UNIT COST TOTAL COST
PLU ]. WATER RE—PIPE 8.75 8.75
END OF FEES
��� ^
DA1'E - �
�5-14-1997/11:14 Ar�/83C.7a
PEFiP�t I TPr082906
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CONSTRUCTION AND PLANNING POO SPA �
ApPROVALS Permit # Date inspector qppROVALS Pe�mit � Date Inspector
1. Temporary Electricai Service or Pole 52. Pooi & Equipment Location
2, $oil Pipe•Undrgrntl. 53. Steel fleinforcement �
3. Etectricai Conduit Utility-Undrgrnd. 54. Forms
4. E�ectrical Conduit•Undrgrnd. 55. Electricai 8onding
5. Steel Reinforcement 56. Rough Plumbinq & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd,
�. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O U�drgrnd.
10. Svuctural Floor System . 61. APPROVAL TO DECK
7 i. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ' 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing Sys[em - Final
14, qough Plumbing 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar SYstem�Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17, Fough Wiring Sign 68. APPROVED FOR PIASTERING
18. Rough ElectricaLT Bar Ceiling 69. POOUSPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough factoTY Fitepface APPROVALS Permit #
27. _Ducts, in Structure - 70. Underground Hydro
22. Ducts, Ventilating " 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Aough & Test 72. Underground Flush
24. Roof Framing _ 73. Undergrnd. Storage Tank O Gas OOiI
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structuraq & Monocoat - � " 75. Ory Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywal� Nailing � • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL �NSPECT�ON
32. E�ectrical Power Meter�Final 80. FOOD CERTIFICATE ISSUEO
33. Final Electric , Notes: - �
34. Final Heating & Air•Co�ditioning � , s:� S,o� Q Af
� CoP��,�IoN _N_� i +cr" ti,.�-
35. Finaf Gas Pipe-Tes[ �
36. Hood or Canopy � �
37. Finat Factory Fireplace
38. Final Plumbing -
39. Water Service-Final � .
40. Gas Service-Final , � _
41. Splar pomesticFinal '_ -
42. Backflow Preventer
43. 68ckflow Irrigation
44. Landscape Irriqacion System
q5, Spund Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAI PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
5l. CERTIFICATEOFOCCUP0.NCY
No Date
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PP0.IECTRUOflE33: �ir:O MAGELi,AN ST uxii:
OWNFR'SN�ME: JAI\1�L $, +�.HtiASI'YER
�ooxess: RT. 5 BOX 221
GROVP.
OK 74349
tylti)7IIG-7801
jtqflCHlEN01NEEH: [iAVID RICHARD $Fi�N� NEO.NO.: CS IO32
� RDOflE33: SJS PAIiLARINO AV UNIT: LZOZ
COSTA MESA CA 92626
PEflMITTEE: SANINE S. 'PHRASHER ( 918 ) 780—'7801
�oon¢ss: 221 RT. 5
GROVE OK 74349
LICENSEU CONTMLTOfl DECUII�TION: I hereby aKrm that I am IicenSeE unEer prwisians al ChaDjer 9(commencinp wii� Section
7000) ot Oidsion 3 ot t�e Busines5 and Protessions Ca4e, antl rtry license is in lullforce an0 etlecl.
CITY LIC.: ST1�E LIC.: C11133:
Oate: Signature:
WOBKEBS' COMPENS�TION OECLAMTION: I �eahy aflirm that I Iwve a urtifwte of runsent to utl-insure or a certi/icate of Workers
Compensation Insurance, or a certilie0 copy thereof (Section 3800, LaO. C).
PoUCY N�.: IXP. O�TE:
"OMPRNY:
� CertifieA coOY is here6y lumis�ed. ❑ Cetlifietl copy is fleE wdh the dry Builainq Division.
�ate: Fppficant
IXEMPfION FPOM VlOBNEHS' LOMPEMSIItON OECWWTION: (Ilis sectlon nee0 not Oe complete0 il ihe pemtit ¢ for one huMrea (5100) or kss�.
I certiy ihat in Ne pedormance oi [he work for wNch INs permil is issued, I slull not emOby any person in any manner so az to Eecome
sublect m Ne Workers' Compenution Laws of Califomia.
Oate: SiqnaNre:
NO710E: Ii, atter maldnq tNs EeGaa6w, you slioulE Eecome subl� �o the Workers' Compensatlan provisions of the Labor
COEe, you must fort�vmA compty wit� suc� Drovisions or this perrtut s�all 6e tleeme0 ravokeE.
CONSTHUCTION LENOING �GFNCY: I heaby aKrm ihat Nere a a constructlon IenEinO apency for I�e perlormance of the work lor
wnich �his permit is issue0 (�ction 3097, Civ. C�.
�xoee: SKYLIGHTS ARE SNCL"JDED
RODHEBS: jN TH& TOTAL VA�,UATION,
OWNEB BUILOEN OECUMTION: I hercEy amrtn ihat I am eKempt imm tAe Cant2ctors' SWte License law tor Iha tollowinp reasan
(Section 7031.5 Busineu an0 Professioml COGe: My Gry of cowry whic� repuires a permit to constmct, atter, improve, Aemolis�, or
repair any stmcture, D�r ta its iuuanca, alw reQuires I�e apDlium lor such Oermit ro lile a sipne0 statement IAat �Us�e Is Iicansed
pursuant to I�e pmvisions ol Ihe Coniranors' State Llunse Law (Chapter 9(wmmencln0 ��h Sectlon 7000) ot Division 3 of tAe Business
anA Proleuians CoOe) or t�at ANsha is exempt t�emirom anE t�e hasis for the allepe0 eKemption. My violation ol SecGon 703L5 Ey
any aDDlicanl lor a Dermit suhlects t�e applicant to a ciNl Oenalry of nol mom than five �undreE Eollars (SSOU�.
I, as awner of the pmperty or my em loyees wit� wa0es as their sole compensation, will Oa tAe work, and the
❑ swcture is not inrenaeU or otleretl tor sale (��� 7044, Business an0 Rolesvonal CaOe: T�e Contraciors' State License Law
' Aoes not apDly to an ovmer ot a pmDenY w�a buil0.s or ImDroves ehereon, an0 wha tloes suc� work himsell/harself or tArouph
�is ar her awn emDloyees, D��4� ��� wch imprwemenis am not Inten4eE a ofiere0 lar sale. II, however t�e DuilEinp or
impmvement is w10 wii�in one year al completion, IAe awner will Aava tAa Eurden of pmvinq Ae/she Oitl not 6ui10 or improve
tor tAe Durpose of ule�.
' I, as owner ol �Ae O�operry. am exGusNeN conirapinp wlt� Acensetl wntnctors ro wnstrup Ua proleq (Saction 7044, Business
❑ an0 Fra�ession5 CaEe: ihe Contaclors' SWte License Lrx Eaes not apDN a��er ol Draperry who DUACs or improves IAerean
and wAo cantracis tor such pml�ts with a wniractor(s) license pursuant to the Contractors' State License Law). I am awara
ihat proof of t�eir Warker's CompenSaUon insu2nce 5tqulE Ge prOvidEE to me. '
�'C i am aempt unEer Sectian: H P 7 0 4 4 B. a P. C. �
mrmisrauon: ALL WORY. HY OWI3r.Rnn �
\�, �
Date: �� �-y" Q� Owner. t' l, ►-��,
I do �erehy certity that I am awaa oi an0 un0erstantl Ihe repuiremems ol Califamia Healih anA Salery Cade Sections 25505, 25533, and
2553C and Iha� I or any luture Cuildinp oc[upanl rAYwill noi (dryyyd���e one) neeC to compry wit� uiG Slaie COEu anA t�e requiamen�s �or a
permit lor constructwn or moUilication imm ma Nr Uualiry Ma peme�Usirict. HesiAentia consimc'an applications are exempt Imm
these Dmvivons. i � _—
Date: � ^ 7"—r �� � Applirant: —Pd ' ' �
I hereby cenity that I have rea0 this applica6w anE state that ihe above intormation is cortect I apree ta wmply with all ury and counry
ortlinanus an0 sWte laws reWtinp to EulEinp conslrucUon anE nerebyajtAonze representative5 ot th¢ dry to enrer upon the above-mentianeA
proDertY /�or�insOecGon purposeps. ; I �
Date: C�J �Z� ^ 7 � Si9naNre: ll�_ .�
onver's �icense or Sacia� Secudry x: '?
1641<6 W�ite—Buibirg; Green—Cotle Enlorcement; Canery—Ap0licant; Pink—Revanue: fiolEenroO—Assesaor
\
CI'1'Y O"r' COS"iA MESA — BUILDING PERih.�l PERM ht0; HEP U52495
PERMIT NO: BEP 052495 F�"LAN CiiECK NO: U1875—y1 5 GOVT: N SUPP: N
CONSTRUC�'lUlv "iYPE: 5—N PcRMIT TYPE; ELE .PLU STR pURFOSE: �v
.7'OB DESCRIPTLUN ; L�GALI'LE FAN;iLY RM, BATHRM G CLOSaT SQ F?: 481
CiATM VALUE: CALC—VALUE: 33,185.00 GROi]P OCC: R-3. /M—i
�
CONN.::NT'S: SNUKE DETECTOR(S) REQUIkED IN HOME. ;
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7, O N I N G R E Q U I R E N. E N�L�li��� ���v��
S E T B A C K S r.r�-.� e�r�r'r1
------------ MAIN 3UiLDZNG ---------- --------- ACCESSORY�3UZ�DiNC- ---------
rRNT: 14 r'P 6 IN REAR: 9 FT 2 IN FRNi; rT IN RBAR; =T IN
Lc.FT: 9 FT 7 IN RGriT: 6 FT 6 IN LEFT: rT IN RGi[T• t IN
PARKING REp • PROV: PARCEL: 14133� � pE�,Vf�L RE4,�V�R NoENT'S y� 1U
PLANNTNG NOTe':5> =AN,ILY ROOM ADDIT TO THE �(� F�� n BDRN: T,I)DiT ON RT SIDn
> OF EX SFD, 350 SF REA.� Y�Y��R OR; 1°8 s'e PROPOSn'D. P y E
3E 3(� 3e #�Jf� i'r �7E aF ii� ii� iE 3' 1(� 4� i(� i�- ��f jf if iF * lF iF 7E ic �k ic �i� iF i� X� K� R 3c�le 3F 3E �7'r %� 3'r iE if �1F X i� k�(-iF ���lE ii� �( ?F?'r 1E ii��K 1F �F N��7(�'t i� Y.'� iF fF;E ae 1f iF.*� � 1E }} a'. n� 3c 3F
D E V E L U P N, E N T S E%R V Z C � S, h E Q J Z R E ��f E N-T S
7.ONING APPROVED �Y ; ��.'"r � -• DATE: (7 2�/ �(
AUILDING APPROVED BY ; C�_ .i DATE; C7 f�f�
APPLICATSON ISSUED BY: . DATE; —�Qf'
9FdfiFY•iF?riE?FiPR�iFd'ri�ieieifi�oT"RiEk3'r .. w.� ' "ii It � �r w�i7FiFlFii�d'r�ie9E;'r�X�3Eif�.n��3�ie,r.Fii�#
if1f3f1E}if3(�iEi(�iE1FiFiF3(�3ElEIF1aiE+flflFlfiElf;'riEiFlf�iE?fieiE?EiF3bil�9fiEY�iFjFii 1F�1fiE?faele7fifM�Y�aF}:IF,f�iEY.1�.N.N-uaEiFjE+Ei?3ie}'r>ii�Y.�if##iF
LEGALIcATION;Y F E E" S U M M A R Y SIRUCTURAL S;.GN.ENT;Y
• �
BLDG PMT PLGMBING ELECTRIC MEC3ANIC F7RE SMIP/RES �GRAllING
PERMIT 621.U0 12,U0 36.OU:' 3,32
25$ SOt c • S,`4IP/tvOiv—RnS
PLAN 403.65 •
ISS[IE FEE 3. 00 15. 00 �
BUILDING—DIV—`r PERMIT ISSUE PLAN—CHEGA TOTAL PAiD llUE
'COTALS---�—> 672.32 18.00 ZO1'.A� 892.15 892.i5 .00
REVENUE DIVISTON TUTALS--> COI.LECTED:'' 69U,32 OVER/SHORi: ,00
BLDG PM'f PI,IJMBTNC: ELECTRIC MECHAjJiC �; F.'IAE SN�TP/TQT GR?lI)1NG PY,AN—CiiECK
67.].00 15.00 S1.OQ ' 3.32
, .'
#' �lE �k �le # lE �lE 4( �iE% �lE iF �1E� lE-t2 )f �lf af iE�i(� �Y, }�%iE �lE �Y # lE�1E iE iE i(� r ii )E }; di if k 1E dE ic ie �%�if iE if� 1E �K df 1E �iF lf ic 3F iE x�Y Yf if �M iE iE �Y 1( �� ie�� i( k.If .}:..K 4P �E :Y��M �% iE
I N D I V i U U A L F.:E E. S R E A R D O W N
TYPE QTY D E S C R I P T I O N „ [INIT COST TOTAL COST
SFR 481 AWE—TYPE V—WOOU FRAME .' —GOOD 69.�0 33,189,00
F,I�E 6 rIkTURES, LIGATING 1 ST ?0 EA. ,15 4
ELE 12 R�CEPT/OUTLET 1 ST 20 EA, ,'75 9.OU
ELE 6 RECEPT/SWITCH 1 ST 20 EA, '75 4,5U
PLU 1 BATATliB 2,00 2 00
FLU 1 TiiASH BASIN 2.00 2.00
PLli 1 WATER CLOSET (iUI:,ET) ' 2,OU 2.00
END OF F L.r,S
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CONSTRU�I�ION-AND PLANNING.. PO�_ d SPA
APPROVALS Permit r# Date Inspector AppROVALS Permit # Date Inspector
�. .
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � ,
v
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcemen[ 'i � -
i
3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �' ,. ^
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Founda[ion 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�7rap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing System � Final
74. Rough Plumbing 65. Electrical�Final
15. Rough Electrical�Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structura�) & Monocoat 75. Dry Chemical
27. Frameand Flashing 76. Dry Standpipe
26. Lathing & Sidin9 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing 4 � HEALTH DEPT. REQUIREMENT
31. Plasier 8rown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' :y 0. FOOD CERTIFICATE�ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning +
35. Final Gas Pipe-Test � � �/ �y�
_�3-�f/lyr�
36. Hood or Canopy . �
37. Final Factory Fireplace "�'-
i
38. Final Plumbing i.(i/Q� (k� �� �
39. Water Service�Final ' � �� � ��
�
40. Gas Service-Final �� �
41. Solar pomesiicFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDING � . �
48. •F-IiVAL P�RNNiNG�l y" % i,� Y 6,Sa�9'�IZ �
49. Electric Release to Edison -,', �`
50. Gas Release to Southem Califomia Gas Co �! �-•
51. CERTIFICATE OFOCGUPANCY
No. " - Date
CITY OF COSTA MESA
BUILDING DIVISION
CERTIFICATION OF SKYLIGHT INSTALLATION
Property P.ddress C/ i�v M�GE�G %� � `S T
Owner _TfJN�IJ F � /!/�/TS/lL��
Contractor
State Contractor License Number �
ri
Permit No. �EP.s3-y�.S
Classification �/1�
1 hereby certify that I have installed, or caused to be installed, an approved listed skylight I.C.B.O.
# 2 �{.� on the roof of above subject address. That I have re-fabricated the roof to the standards
of the industry and in accordance with Chapter 32, 34, 52 Appendix 32, and Section 1704 of the latest adopted edition
of the Uniform Building Code as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation
instructions of the manufacturec The integrity of the area worked on is as good or better than the rest of the existing roof.
� I further certify that I am the owner of the property. (Owner-Builder permittee only).
❑ 1 further certify that I am:
❑ Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation ,
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make
this certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, afler submittal of form to lhe Building
Division for acceptance.
Received by Building Division
BY:
1029�a6 WOite-City: Canary-0wner, Pink-ConVactor
Compa Co ora Name
Atldress
�,� � �-Z �/-9�
Signature Date
� , � , TN,�/��'�E�2
PrinteC or Iypetl name
ROO. COVERIiVG CERTIFIC fION � �
Permit No. .(7�{���"-!!-�
Property address � �"�� �- /T�� — �T
Owner �/9N7 ��� �/`�/�/Lsr�.��
Contractor � �/�
State Contractor License Number m�� Classification O/�
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the 1979 Uniform Building Code, as
amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
�I further certify that I am the owner of the property. (Owner-Builder permittee only).
I further certify that I am:
❑ Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, i am empowered to
make this certification, which shall be binding on all successors or assigns of the company or corporation.
1 shall deliver a copy of this Certification to the above listed owner, after submittal of form to the
Building Division for acceptance.
Received bY Building Division by:
Initia'�I � � /�� a��
Si9nature Date
� , � Tii,�fl rf��/2
Printed or Typetl Name
Space for No W rial Statement lor aut�DrizeE oHicer or agen� �
CMF 0990�46 Whife - Builtling Div.: Canary - Contrattor, Pink - Owner
. ��3� ��:
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA, CALIFORNIA
For Applicanf fo Fill In Compleiely
TYPE OR PRINT -
BUILDING
ADORESS
GOSTA MESA CALiFORhf1A
OWNER Mesa Del Mar Develo nt Co.
ADDRESS 3800 E. �'.08
arrCorooa del Har Nd7R 34220
ARGHITECT TEL.
p TEL.
O d -SB'� I NO.
/. p�. � I NO. OP OLDGB.
86TBACK LINC FflOM /� � f I
CHNT¢rt on siwaF'� .yl REAR YARD
SIDE YARD I LEFT S' I RIGH7 ,
DESCRIPTION OF WORK
BUIL�ING NO. OF
SIZE ROOM6
EXTERIOR WALL IROOF
COVERING GOVERIt
U3E OF BUILDING AND WORK TO BE
� �HEREBY�CKNOWLEDO6 THAT I HAV6 qEAD
D HTA THAT THE ABOV¢ 18 GORRECT AI
PLY WITN ALL CIN D NC69 AN--�
OUILGINO CONB�U O .
SIGNATURE OP
PERMITTE
/
AUTHORIZED AGENT
_ r r• r
� c�� �%��8�d�,��
G-�,���C�� L�cr'T.
�a t 6�-1, PL►�u �3y'pF CO3TA MESA
APPLICATION FOR PERMIT
BUILDING
Fo� Office Use Only
rteceirr Ho. .geer�r rva
-4Cr ��{.: )�
rsecgr.{go ev o�T¢ necuveo oere iesueo -
!� r I�,� -7-4 �� � OEC 2 0 i8�'�
0o e�ss 940 Ma¢ellaa Street
COSTA MESA. CALIFORNIA
FIRE
ZONE TYPE V GROUP�7
APPROVED
BY DATE
ZONING
ZONC I NO. OP I UBE OP N[W /•
_ R-1 PLAN6 2 au��oiNo W &tY.
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���'^���^ TX8 AMOUM 6NOWN UNDER VAWATION IB POP THE
Ee TO�CAM- pUPP088 OP ¢BTABLIBMIN6 � P¢RMIT FE¢ ONLY.
aeouunno
VALUATION `,
PERMIT FEE $ �7• o-�7 N
q "p � a
$ /� 6 �O• � PLAN CHECK $ � /, (Tp �