HomeMy WebLinkAbout999 TRENTON WAY - Building Permits� __. . ►
7. o � CITY OF COSTA MESA
, _ BIIILDING DIVISION �
: DEVELOPMENT SERVICES DEPARTMENT
J�� PERMIT PERMIT NUMBER �
698-01650
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 999 TRENTON WY
Suite:
Vicinity:
ParcelNunmber: 14105238
Applicant: ALAJOKI, JOHN
Address:
owner: TUCKER, PETER
Address 999 TRENTON WAY
Contractor:
Address:
Arch / Eng :
Address:
COSTA MESA,CA
BUILDING PERMIT
Zoning: R1 R1
PhOne: 949-830-1283
Zip:
Phone:
Zip: 92626
Phone:
2ip:
License:
. Phone:
Zip:
LiCense:
SCOPE OF PERMIT
T/O EXIST AND REPALCE i/2 CDX 30LB FELT AND 30 YR COMP.
Plan Check: $0.00
Permit: $112.25
SMIP Res: $0.54
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $112.79
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Required: o
FEE SUMMARY
PLANNING 8 ZONING
Left 0- 0
LeR 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0- 0
Status: ISSUED
Applied: 09/15/1998
Issued: 09/15/1998
$5,400.00
$5,400.00
EXPIRATION: This permit shall automatically expire and become void il work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
� requlred Inepectiona end final approvel must be obtained. FaiWre to obtain Inspections and (inal approval will result in ihe expiration of this permit.
FOfl INSPECTIONS CALL: (714) 754-5628
WORKERS' COMPENSATION DECLARATION: � �
I hereDy aNirm untler penalry ot perjury one of ihe following declarations:
❑ I have entl will maintain a cetliticate of cronsent to selFlnsure for workers' compensation, es provitled for �y section 3700 oi the Lebor Cotle, for ihe perfortnance oi ihe
wo ich this pertnit is issuetl.
I have antl witl maintain workers' compensation insurance, as required by sedion 3700 of the Le6or Code, for the performance of ihe work for which ihis pertnit is issued.
My workers' compensation Insu ce carr,�}—f'gnd policy numbar are:
Carrier: ` I - Policy Number: �� �U�C��lS �75�
(This section need not be comp/eted il the permit Is valued at ane hundred dollers ($100) or /ess.)
❑ I certify that in the peAortnance of the ork tor which ihis permit is issued, I shell not employ any person in any manner so as to become subject to the workers'
compansation laws ot Calif ia, and eg e that If I shoultl become subject to the workers' compensation provisions of Sedion 3700 of the Lebor Cotle, I shell fotlhwith
co h thesa provisi 5 �
Ap � ant Signatur Data: � ��' �
W O SECURE W RKE ' CA! ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVEP TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDPE�
TilOUSAND DOLLAPE ($100,000), IN AODITION TO TME COST OF COMPENSATION, OAhL1GES PS PROVIDED FOR IN SECTION 3]O60F THE LABOR COOE. INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTPACTORS DECLARATION:
I hereby affirm that 1 am licensed upc er p1D�isL
force andslfact Lic. #
9(commencing with Section 7000) oi Division 3 of ihe Business end Protassions Coda, and my license is in full
Class #
Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm ihat ihere is a construction lending egenty for the perfortnence of ihe work tor which this pertnit is issuea. (Sec. 3097, Civil Code).
lentler's Name:
SignaWra: _
OWNER-BUILDER OECLARATIONS:
Lentler's Adtlress:
oate:
I hereby aflirm ihat under penalty of perjury Ihet I am EXEMPT FHOM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Cotle: Any ciry or counry which requires e pertnit to construct, aiter, improve, demolish, or repair any structure, pnor to its issuance, also requires tha applicant for such permit
to �ile a signad statement Ihat he or she Is licensed pursuant to ihe provisions of ihe Conirectors Licensa Lew (Chapte� 9(commencing with Sectlon 7000) of Division 3 of the
Busineu and Professions Code) or that he or she is exempt Ihereirom end ihe basis for Ihe alleged exemption. Any violetion of Section 7031.5 by any applicant for e pertnit
sublacls ihe applicant to a civil penalry ot not more than fve huntlretl dollars �$500).):
❑ I, es owner of the property, or my employees with wages as their sole compensatlon, WILL DO THE WORK, and the structure is not intended or ottered for sale (Sec.
7044, Business and Protessions Code: The Contraaors License Lew tloes not apply to en owner of properry who huilds or improves thereon, and who does such work
himself or herseli or ihrough his or her own employees, provltled that such improvemenis are not intended or oflered for sale. If, however, the bullding or Improvement is
sold wit�in one year ot completion, the owner-builder will have the burden ot pwving that he or she tlitl not buila or improve for puryose ot sale.).
❑ I, es ownar of iha property, em EXCLUSIVEIV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contrectors License Lew does not apply to en owner of property who builds or improves ihereon, end who contracts for such project with a contractor(s)
license pursuant to tha Contrectors License Laws.).
❑ I am exempt untler sec. Business and Professions Coda for this reason:
Signature: Date:
Owner ID veritied by driver's license. ❑ Ves ❑ No Driver's License No. Expires: �
Venficatlon of Ownerehip by (rype�ot tlocument, i.e. - properry tax bill or daed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certlty Ihet no excavation five (5) or more feet in depih into which e person is requlretl to tlescen4 will be matle in connectlon wlih work authonzad by Ihis
permit and Ihet no building slrucNre, scaffolding, falsework, or demoiition or dismantling Ihereof, will be more than thirty-siz (36) feet high. (Chep. 32, Grp 2, Ar12, Sec.
341, T�le 8, Celifomia Administrative Code).
❑ As owner-builtler, I will not employ enyone to tlo work which woultl require a pertnit irom t�e Division oi Intlustrial Satery, es noted above, unless such person has e
pertnit to do such work irom the division.
Signatme: Date:
Division of Intlustriel Safety Parmit Number.
CERTIFlCATE OF COMPLIANCE AND AUfHORVATION OF EMAY: I certify under penalry of perjury thet I have reed ihis application and state ihat the infortnetion given is
corred. I agree to comply with all state laws end ciry ordinances relating �o building construc�ion, end euthorize representatives ot tha Ciry ot Costa Mesa to enter upon the
above-described pmperty For inspection purposes. I agree not to occupy or allow occupancy of eny building authonzeC by ihis permit until tinal inspedion.
�flQ�j, INSVECTIONTYPE
1616 Fi:etl System Final
1266 Pool Spe Final
200 Final Re-Rool
201 Final Block/Retaining Wall
202 Final Factory Flre Plece
203 Final Sign
204 Finel Demolition
2446 48
QAg It�dlS
r(}p[1 INSFECTION TYPE
206 Finel Mechanical
208 Finel Plumbing
210 Finel ElecMcal
212 Final Fire Prevenlion
220 Finel Planning Approval
222 Finel Site
250 Final BuildinglOccupency
� ��
Date
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• � �i
(714) 754-5273 • Fax (714) 754-4856
CITY OF COSTA MESA
BU/LDING D/VISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Job Address: 999 TRENTON WY
Suite:
Vicinity: SIDE WALL BEN/EEN RESIDENCES
Parcel Nunmber: 14105238
Applicant: TUCKER, MIKE
Address: 9414 TRENTON WAY
FOUNTAIN VALLEY
owner: TUCKER, PETER
Address 999 TRENTON WAY
COSTA MESA,CA
Contrector:
Address:
Zip:
Arch :
Address:
Zip:
Zoning: R1 R1
Phone: 714-593-3135
Zip: 92708
Phone: 714.540.2041
Zip: 92626 .
Phone:
License:
Eng:
Address:
Phone:
License:
PERMIT NUMBER
699-00026 �
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: �i/OS/1999
Issued: Ot/OS/1999
Phone:
License:
SCOPE OF PERMIT
66 TOTAL LIN FT OF 6 F7 HIGH RCMU WALL ON SIDE OF SFD SHARED WITH 995 TRENTON (ON PL). TOTAL LENGTH
INCL. 4' RETURN TO 999 TRENTON WITH A 3' GATE.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$29.74
$45.75
$0.00
$0.00
$0.00
$0.00
$75.49
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existina: 0
NOTES:
Rear 0- 0
Rear 0. 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0. 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0. 0
Right 0. 0
$1,320.00
so.00
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a pariod 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
requlred inspactlona end tinal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATION DECLARATION:
I hereby eHirm undar penalry of perjury one ot the tollowing tleclaretions:
❑ I heve end will maintain a catlificete oi consent to selt-Insure for workers' compensation, es provided tor by section 3700 ot the LeDor Code, lor the pertormence of the
work for which ihi5 permit is issuetl.
� I have and will maintain workers' compensation insurance, es required by section 3700 of the Lebor Code, for the pertormance of the work for which Ihis permit Is issued.
My workers' compensation Insurance cerrier end policy number are:
Cartier: Policy Number:
(lhis sectbn need nat l� �p/eted il the permit is velued at one hund�ed dollers ($100) orlesS.J
❑ I certify that in ihe peAormance o( Ihe work for which this permit is issued, I shell not employ any person In eny manner so es to becoma subjact to the workers'
compensation laws of Celifomia, and agree ihat if I should became suDjact to the workers' compenselion provisions of Sectlon 3700 of the Lehor Cotla, I shell torthwlth
comply with these provisions.
Applicent SigneNre: Dete:
WARNING: FAILURE TO SECURE WORKEFS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TOONE HUNDRED
THWSAND DOLLARE (310p,ppp), IN ADDITION TO THE COST OF ppMPENSATION, �AMAGES AS PROVI�ED FOR W SECTION 3]OB OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRAC70R5 DECLARATION:
I hereby elfirm thet I am licensetl under provislons oi Chapter 9(commencing with Seciion 7000) of Division 3 of the Business end Professlurs Code, end my Iicense is In full
force entl ettect Lic. a Cless N
Gontrecbfs Signeture: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby alfirtn ihet Ihere is a construction lending egency for Ihe peAormence of the work for which this permit is issuea. (Sec. 3097, Civil Code).
Lender's Neme: Lantler's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn ihat untl�� penelty ot perjury that I am E%EMPT FROM TME CONTRACTORS LICENSE LAW for Ihe following raeson (Sec. 7031.5, Business end Profeulons
Code: Any ciy or county which requires a permft to consiruct, elter, Improve, Eemolish, or repatr any sWciure, pnor lo iis issuance, afso reputres Ihe eppflwnt for such permlt
to file e signetl statement Ihat he or sha is Ilcensetl pursuent to the pmvisions of the Gontrecbrs License Lew (Chepler 9(wmmencing with Section 7000) ot Divlsion 3 ot the
Business and Professiqns Code) or Ihet he or she is exempt iherefrom and ihe besis for ihe elleged exemption. Any violation ot Section 7031.5 by eny epplicant for e permit
subjects the epplicant to e civJ penalty of not more ihan five huntlred dollars ($500).):
❑ 1, as owner ot the property, or my employees with wages es their sole compensatlan, WILL DO THE WORK, en0 the structure Is not intended or otteretl for sale (Sec.
7044, Busineu antl Professions Cotle: The Contractors License Law does not apply Io an owner ol properry who huiltls or improves thereon, and who does such work
himself or herselt or through his or her own employees, provlded that such Improvements ere not Intentled ar affered for sale. II, however, the 6ulltling or improvement is
sold within one year ot completion, the owner-builder will �eve ihe burden oi proving that he or she did not bullA or improve lor purpose o� sale.).
�. I, es owner ot the properry E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Pmfessions
Cotle: Tha contra s Lic s Lew tloes not epply to an owner of properry who Dullds or improves thereon, antl who contrects tor such proJect wlth a coNractor(s)
license pursua o e C tr tors License Laws.).
❑ I am exemp p Business antl Professions Code for this reason:
Signature: � ,//
E:pires: ,� a o� �
Verificetion of nership by (rype of document, i.e. - properry tac Uill or deed): �
DIVISION OF INDUS7p1pL SAFETY PERMR CERTIFICATION:
❑ I here6y certity that no excavation Ilve (5) or more feet in dept� into which e person Is require0 to descand, wlll be metle in connection with work authorized by this
permit, antl Ihat no builtling siructure, scattoltling, felsework, or demolition or dismentling thereof, will be more then thirry-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Titla B, Celifomia Atlministretive Cotle).
❑ As ownerbuildeq I will not employ enyone to do work which would require a pertnit trom the Division ot IntlusMel Salery, es noteC ebove, unless such person has e
pertnil to do such work from ihe Oivision.
SignaWra: Date:
Division of Industriel Safery Pertnit Number:
1 Will Ihe applicant br preseni or future building occupant need Io file and certity a Business Plan lor emergency respunse to release or ihreatenetl release ot a �azardous
maieflal? O Yeg ❑ No
(Section 25505 of the Celitomia Health end Safery Cotle raquires, with some exceptions, that a Business Plan be tiled with the Costa Mese Fire Depanment by every
business which has at any one time during a reported year a quentiry ot �ezerdous meterials equel to or greater than a weight oi 500 pounds, or e volume oi 55 gallons,
or 200 cubic feet of compressad 9as et standaN lemperaWre and preuura).
............................................................ . ........................................................................................................................................ .........................................................
2 Daes or will lhe applicant or present or future DuilCing occupant neetl to fle e registretion fortn far ecutaly hazertlous matenels7 ❑ Yes ❑ No
(Sectlon 25533 ot the Califomie Healt� entl Safery Code, with some exceptlons, requlres regisiretlon with the Costa Mesa Fire Depertment by eech business which et eny
one time hes on hand e quentiry o� acutely hezertlous meterials equal lo or greeter Ihen e weigh� oi 500 pounds, or e volume ol 55 gallons. or 200 cubic feet of
compressed gas at stantlerd temperatura and pressure).
..................................................................................................................................................................................................................................................................................
3 Does or will the applicam or present or tuwre building occupant need to prepare an RMPP (Risk Menegement end Prevention Program for acutely hezardous matenals)9
❑ Yes ❑ NO
(Saction 25534 of the Celifomia Heelth antl Safery Code O�ovides that the Costa Mese Fire Depertment may require the preparetion, ceeifiwtion antl filing with the Fire
DeOertment of en RMPP by businesses which ere requiretl lo register ecutely hazardous matenals with the Fire Depertmenl.
. .. . ..................................................................................................................... .....................................................................
4 It an RMPP is preSenily requlred, has Section 25534 of the Calitomia Heal�h and Sefery Gotle been fully complied wl�h7 ❑ Yes � No
(If "
I I e
or will the applicant or D�esent or tuture building occupant reQuire br the work which is the subjact ol this ap plicatian a Partnit lor such consiruction or
he Souch Coest Air Queliry Menegement Distqct or tmm eny other air pollution coniml disMct or egenq7 ❑ Ves ❑ No
on 650502 bf ihe Califomia Govemment Code requires thal ihe requestetl infortnetion be lurnishad on epplications lor non-resitlential building permits).
............................................................................................................................................................................................ ................. ..................................................
eny pan of Ihg taciliry to ba consWcted under this permit �e within 1000 feet imm the outer bountlaries ol e uhool7 ❑ Ves ❑ No
es , the tecility must meet the raquirement ol Seaions 25534 end 42303 ot the Cefifomia Heelih an0 Safery Coda�.
...................................................................................................................................................................................................................................................................
permit tram the South Coast Alr Oualiry Manegemem Distdct or ather air pollutlon conirol tlistdct or egency is required 1or the wark which is the suD�ect ot thls
icalion, heve 911 ot the disclosures prescribad by Califomie Healih enC Safery Cade Section 42303 been metle7 ❑ Yes ❑ No
...................................................................................................................................................................................................................................................................
es", attech certiticate of compliance trom the eppropriate air pollutlon conirol oNicer).
ITIFICATE OF COMPLIANCE: I certity that untler penalry of perjury t�e iniortnation given ehave is carrect. 1 eqree to compty with ell state laws antl ciry ordinences
ading Herardous Materials and Emissions.
Signature:
Date:
CER7IFlCATE OF COMPLJANCE AND AUTHORIZA710N OF ENfRY: I certify under penalty ot perjury that I have read this epplication and stata thet t�e intormation given is
correct. I agree to comply with all state lews and city ordinences relating to building conslruction, end euthonze representelives of Ihe City of Coste Mesa to enier upon the
above-tlescnbed proy9rty tor inipection purposes. I egree not to occupy or allow occupancy of any builtling authorized by Ihls pertnit until final Inspection.
CODE t. INSGECTONTYPe
7676 Fixetl Systerq Final Fire Prevention
7266 Pool Spe Finel
200 Final Ra-Roo�
201 Final BiocWRetaining Well
202 Final Fectory Fire Plece
203 Final Sign
204 Final Demolition
2aa6-d6
Pd7E It�ElS
-/ !3-�' ��.�'-
/ 5 ��i DB1B
Date
eooe� wsvetnowTvve
206 Finel Mechenical
20B Final Plumbinp
210 Final Electriwl
212 Final Fire Preven6on
220 Finel Planning Approvel
222 Flnal Site
250 Flnal Building/Occupency
DECLARATION OF ��vTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
� I -1 IC..�T6fJ �✓ �_ __
Street Address i ;
v
Bldg. Permit #
r
This Permit # _
AP Number
1. I�we), 1�T�' T� � , declare that I am the Owner of Title
of the above referenced real property, and that I(we) hereby authorize:
�1�� TC�iL
Name
�� �- l..fl'�lab
Street Address
�
to obtain permits in my behalf, as ownerlbuilder, for
at the above referenced property.
�f��VI �
Telephone No.
%G
2. Should any person become an employee engaged in the improvement of the property, I(we) shall im-
mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties as a result of work authorized
by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this � day of
P�r� -����
�v�
� 19 —i 1, at 7��n, Califomia.
�I�I�y
Date
NOTE: This authorization does not grant authorization to pertorm the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
Y _ �.J�
0779d61Rev. P/91�
DIVISIuc: Jh s..;���lvli SAFBT�'
��pppROVED�
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d n ot airy i
ilese p� � P�
��w. � -^� r,aim�d
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and becare m� md vdd N 9ie bu� w
r UBC 4� (�'�^ tE0 daYs of �'
ecs�ocMcc
— �.��� ���
CI7Y 0� COSTA MESA
PLAiVNING DIV.
SliBJECT TO BLDG. DEPT. REG.
BY
�csiocMct
� � �
_ IlG1��bN _ W tY STREET
� - —
■[siocrcc
�
SURVEY OF LOT LINE
MAY BE� RE�UIRED
11[f10[NC[
tl,
F
W
N
N
TYPICAL 6�� CONCRETE BLOCK FENCE
Cement Coping Optional —�
Channel Block With 1-3/8�
Horizontal Top of all
Fences
For Fences 5' o. Less
Vert. Bars 3/8"yS at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/8"� at 32" O.C.
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall
Conform to Sec.A-15-39
A.S.T.M.
All Steel to be Lapped
24" or to Code
NATURALGRADE
TWO 3/8"4 BARS
CONTINUOUS TOP
& BOTTOM
HOR7Z.S7EEL MUST BE TIED tN
• ,.P,LACE A7 TIME OF THENCH
;y-E q, i INSPECTION�• - + �.. _
_ y._ .ir..�, _.. J
a s. ' '',
�.. .a�.:.,U.r�i " ''F' �n
I�.,. �'.. 1- Gi•',•i•. . • `
aN - ._u�:�:�4�e .- 1� �..V�'..��.'...'_;
� � �.ry�<:;< <-�s :��.,
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on
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9 BELOW
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, -^',;`. ;���: L';�:d,..P�.7U1Uli.^.r i..,
' -iyNl`:. ��-J.OJJb�I' _
':U.ii"Y!r.
ING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR: pne Parf Plastic Cement, and
Three Parts Sond
GROUT: One Part Cement Three and
One Hali Parfs S�ond
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Wel I M+xed 1:2- I/2: 3- I/2
Max. of 7-I/2 Gol;cns ot
Water Per Sack of Cement
GROUT MAV BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLS AND AREAS OF HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN &
FREE OF ALL MORTAR DEBRIS, E7C.
H OF E4RTHTCOTH
i/? 7HE HEiGTH OF fENCE
BELOW BOTTOM OF FOGTiNG.
WIOTH � . . . . , 14�� , 14�� . . . 12��.
� 3�iTHICKNESS 10�� . . . . . . . . . . .10° . . . 8"
t
"'�l`;�''DEPTH,�OF'�EARTHTOOTH , 24" 20'� . . . 16°.
�)�/1'�:r .. . . .
� SPACIN'G`OFy�;EARTHT00TH. . 12' 14� . . . 16'
City of Costa Mesa, California
Building Department
!�F`:.�EP NoV.82
SCALE: I/2��= I�
12..
12,�
16'
Lot 16 28743
COSfA MESA BUILDING-SAFETY DEPARTMEPR
P.O. BOX 1200 COSTA MESA, CALIFORNIA B2E20
For Appllm�ri to Ffll In ComplN�ly
TYPE OR PRINT
ui�o�No G�CI C, '�iSn,.Tcrn � A �Ol,�-.
DDREIIY
COSTA MESA. CALIFORNIA
6i MAIL
1-V70V
NO. O� pLp00.
/
P�erns�rr �� RQARYM oZ .�,
�7 � ` /
RD L6RT �/ RIQHT �
DESCRIPTION OF WORK
x .. �e._..... � �� ....,m.....
NO. OP
�RO�OMB
F ROOP
1 H6PRGY ACKNOWL�DO[ T11AT.1 NAV6 II�AD TMIt M�LIGTON
AN� BT�T6 TNAT TXi AGOV�,IO CORR[R ANO AOII[[ M COY.
PLY W1TM AlL CITY OROINANC�i AqD RAi[ LA1M� 11[OYLATNO
GUILDINOCONBTpUCT10M. �
PHRMITTB :� �
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