HomeMy WebLinkAbout889 WILSON ST - Building Permits(714) 754-5273 • Fax (714) 754-4856
�
CITY OF COSTA MESA
BI/ILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
JobAddress: 889 W WILSON ST
Suite:
Vicinity: HOUSE & ATTACHED GARAGE
Parcel Number: 42239101
BUILDING PERMIT
Zoning:
Applicant: COOTER, LYLE
Address: 7472 SLATER AVE.
CA . . Phone: p14) 842-9122
HUNTINGTON BEACH ' Zip: 92647
Owner. HAILEY, JEFFREY TODD
Address 889 W WILSON-ST '
CA-�". ' Phone: p14)548-2313
/� COSTA MESA Zip: 92627 �
Contracroc -' RISDALL ROOFING & CLEANOFF SERVICE
Address: J472 SLATER AVE. �
� � CA , . Phone: p14) 842-9122
� � HUNTINGTON BEACH
Zip:� 92647 . License: 625753
Arth :
Address:
Phone:
.... .. . Eng:
Address:
NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 08131/1999
Issued: 08131/1999
Phone:
Zip: ' License: �� License:
� �� �� � � SCOPE OF PERMIT
. ' REROOF EXISTING SINGLE FAMILY RESIDENCE & ATfACHED GARAGE (18 SQ). TEAR OFF EXISTING COMPOSITION
, . SHINGLE ROOFING 8 INSTALL 1l2" OSB SHEATHING. INSTALL 1-LAYER OF 30# FELT UNDERLAYMENT 8 REROOF
WITH 20 YR. COMPOSITION SHINGLES.
� Plan Check:
' Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$97.25
$0.50
$0.00
$0.00
$0.00
$97.75
SETBACKS �
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
Rear 0-0
Rear 0- 0
Reauired: 0
FEE SUMMARY
,
PLANNING 8 ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc valuation:
Claim Valuation:
Right 0- 0
Right 0-0
ss,ioo.00
$3,100.00
n
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Californie statutes and related
regulations. (Ord. No. 92•28, § 1, 1241-92)
EXPIRATION: 7his permit shall automatically expire and become void if work is not commenced within 180 �days, or if work is suspended or abandonad
for a penod of 1 BO days, ,
INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepeetlona end flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
,
�
WORKERS' COMPENSAnON DECLARATION: �
I hereby eflirtn untler penalry of perjury one of the following decleretions:
❑ I have and will main�ain e certilicate of cronsent to 5eN-Insure for workers' compensation, es provitletl for by section 3700 ot Ihe LaDor Code, for the peAortnance oi the
work tor which this permii is issuetl.
❑ I have and will mainlein workere' compensation Insurance, as required by sectlon 3700 of tha Lebor Cotle, tor the peAormance ot the work for w�ich Ihis permit is issued.
My worker5' compehsalion InSurence carrier end policy numbar are:
Carner: tiil Lll �d l��J- Policy Number. � Gz ���S 65 ^
(This secti�ed not be campletetl il the permit is velued et ane hundred dollare ($100) or /essJ
❑ 1 certify thal fn Ihe peAormanca of Ihe work tor which Ihis permit ls Issued, I shell not employ eny person in eny manner so es to become subject to the workers'
wmpensation laws of Califomia, ena egree thet It I shoultl becoma subJect to the warkers' compensatlan provisions of Section 3700 of Ihe Lebor Cotle, I shall forthwith
comply with these p(ovisio s. a
Applicant Signature: � Date: O �� % 9
WARNING: FAILURE TO SECUR�WORKERS' COtAPENSATION COVERAOE IS UNLAWFUL AND SHALL SUflIEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOILARE ($100,0�1. IN A�DITIqJ TO THE COST OF COMPENSATION, DNMGES AS PROVIDED FOR IN SECfIIXJ 3'lOfi OF?HE LABOR CODE, IMEREST, AND ATTORNEVS FEES.
LICENSE� CONTRACTORS DECLARATION:
I here6y attirm �hat I em liCensetl untler provisions of Chepter 9(commencing with Section 7000) ot Division 3 of Ihe Business antl Protesslons Coda, end my Iicense is In lull
force and eflect. Lic. N .�+ZS �� � Class x !� . 3 9 L �. 9�
Conlractors5igneWre: � Dete: � � / q' 9
CONSTRUCTION LENDING AGENGY:
❑ I hereby aHirtn Ihat tnere is a construction lending egency for Ihe peAormence oi Ihe work tor w�ich ihis permit Is Issuetl. (Sec. 3097. Civil Coda).
Lender's Name: Lentler's Address:
Signeture: Date:
OWNER•BUILDER DECLAAATIONS:
I hereby eflirtn ihat under penelty oF per�ury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he tollowing reason (Sec. 7031.5, Business antl Profession5
Code: Any ciry or counry Which requires a permit to consiruct, elter, improve, demolish, or repalr eny siructure, pnor to its issuance, also requires the epplicant for such permit
to file a signed stetement that he or she is licensetl pursuant to the provisions of the Contractors License Lew (C�epter 9(commencing wlth Sectlon 7000) ot Divislon 3 of the
Business antl Protessions Code) or Ihet he or s�e is e:empt iharefrom and the besis lor the elleged ezempNon. Any violetion of Section 7031.5 by any epplicent for e permit
sub�ec�s the appllcent lo e clvll penalty ot not more ihan flve huntlred dollars ($500).):
❑ 1, as owner o� ihe prPperly, or my employees wilh weges es Iheir soie compensetlon, WILL DO THE WORK, and Ihe structure Is not intentletl or oHeretl for sale (Sec.
7044, Business antl Professions Code: The Contrectors Licensa Lew tloes not epply to an owner of property who builtls or improves thereon, entl who tloes such work
himself or herself or ihrough his o� her own employees, provitletl ihat such improvements ere not Intentle0 or oflered for sele. If, however, the building or improvement is
sold within one year of comple�ion, �he owner�builder wiil heve Ihe burden of proving Ihet he or she tlitl not build or improve for purpose of saleJ.
❑ I, es owner of lhe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and ProFessions
Cotle: The contracto�s Ucense Law does not epply to en owner of praperty who builds or improves iheraon, antl who contracis tor such prqect with a coNractor(s)
license pursuant to ihe Contrectors License Laws.).
❑ I am exempt under sac.
Signeture:
Owner ID venfied by dnvers license. ❑ Ves ❑ No
Business entl Protessions Cotle tor this reeson:
Venfication of Ownership hy (�ype of document, i.e. � property taz blll or deetl):
Dnver's License No.
Date:
Expiras:
DIVISION OF INDUS7RItJ. SAFETY PERMIT CER7IFICATION:
❑ I hereby certily that no excavation flve (5) or more teei In tlepth into which a person is requiretl to descentl, will 6e made in connectlon with work authorized by ihis
permil, end thet no b�iltling structure, SceHolding, felsewo�k, or tlemolition or dismentling thereol, wlll be more than thirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
347, Titla B, Celifomia Atlministwlive Code).
❑ As owner-6uiltler, I will not employ enyone to tlo work which would require a permit Irom t�e Divlsion ot Industriel Safery, as noted ehove, unleu such person has a
permit to do such work ��om ihe tlivision.
Signature: Dete:
Division oF Industnal Satery Pertnit Number:
CEATFICAiE OF COMPLIN:CE AND AUTHORIZATION OF ENTRV: Vi certity under panalty ot pe�jury that I hava read this eppliption entl state ihat tha intormation q"rven is
wrrect. I agree to comply wlth all state laws end ciry ordinances ralatinq to building consWction, and euthorize reprasentalivas ot tha Ciry of Costa Mesa to enter upon Ihe
above-descdbetl property iPr inspection puryases. I agrea not ta occupy or allow occupancy ol eny builtling euthodzatl by this pertnit until 11na1 inspectlon.
COOE �. INSPECTIONTYFE
1616 Fixed System FInP� Flre Preventlon
1266 Pool SDe Finel
200 Finel Fle-Foot
201 Finel BIocWRetaining Wall
202 Final Fectary Fire Place
203 Final Sign
204 Final Demolition
2446e6
Qe�€ u�i
COOE I INSPECTION TYPE
206 Finel MeChenical
20B Final Plumbing
2t0 Final Electrical
212 Final Fire Prevention
220 Finel Planning Approval
222 Finel Slte
250 FInelBuiltling/Occupancy
Date
� 7 r �!`�
Date
PAIE � 1t�1ALS
AOP�icant lo till in all Spaces excepl thoze wil�in neavY Gortler linez anE si9n all aDP�opriate tleclarations.
R.T}rY OF COSTA MESA CONSTRUCTION PERMIT . PEFMIS.NO. ._, . TRACT NO. LOT NO. UNIT Nh
c�!'tv,`zc,�r�5oN C`�l� `
. ProjectAddress p� �
Applicant's Mailing Address
Owner's Name pD�alv li�iU G,� (Zo N S�'R phone (a5� -�.9'a7
Address ��—/ `"�I//`�'! �jO/Y �;/`fj � 'r'�,�(e��l
Arch/Eng. License No.
Address
Contracmr's Nam hone
Address (mailing) ` �%�-P�L�'� �—
Ciry License No. '
LICENSED CONTRACTOR DECLHRATION .
1 hereby aiti�m that I am licensetl untler provislons o( Charter 9(commenGinq
with sectlon 7000) ot DiviSion 3 of Ihe Business antl Profezsions Code, antl
my license is in full torce antl effect.
Licenze Class License No.
Date Si9nature
WORKERS' COMPENSATION DECLFRATION .
' hereby aifirm tnat I have a certifica[e of consent to self-insure or a certificate
' Workers' Compensation Insurance, or a certifietl copy thereof (Section
,800, Lab. C.)
Policy No. Company '
BCertifietl copy is hereby fumishetl. � �
Ce�tifietl copy is filetl with the city Bulltling Division.
EXEMPTION FROM WORKERS-COMPENSATION DECLARATION
(This section neetl nat be compietetl if the permii is for one huntlretl (g100) or
less).
I certify lhat in [he perfo�mance of the wo�k for which this permk is i55uetl, 1
shall no�Plo�P� 9 in any m ner��� t�me subject to the
Workers• cqmpen C Laws of califo ��
Date Si nature
'NOTICE: a te makinq this tleclaretion, you shou d b ome subject to the
workers' Compenzatlon provisions of Ihe Labor Cotle, you must forthwith'
comply wilh such provl5ion5 or �this p¢rmit shall be tleemetl �evoketl. �
CONSTRUCTION LENDING AGENCV ' '
I hereGy afOrm that [here is a mnstruction I¢ntling aqency to� ihe perfoimance
of the wo�k tor whicn this permit is issuetl (Section 309� Civ. C.)
Lender's Name
Lentler's Atleress
OWNER BUILDEN bECLARATION
I hereby afflrm that 1 am exempt from the Contractor's License l.aw for the
following reason (Section 7031.5 Business antl Pro(es5ional Cotle: Any city or
caunty whlch requires a permit to const�uct, alter; imprOve, Oemolish or repait
any s[ructu�e, p�ior lo its issuance, also requires tM1e aOP�icant for such pe�mit
to tile a signecl Statement tM1at M1e/she is licensetl pursuant to the 0/ovisions ot
the Cont�a<tor'S License Law (Chapter 9(commencin9 �+��h Section �000) of
(=�,yision 3 of the Business antl Protessions Cotle) or that he/she i5 exempt
`�'.'�',iefrom antl the basi5 for the allegetl exemption. Any violation of Sectlon
i�3=;.(i1.5 by any applicant for a permit subjects the applicant to 'd civil
�.k;,e'fialtv of not more than five nuntlr¢tl tlollars (5500). �
1, as owner of,the property or rs
�,p�� will do the work, antl t
a'T i�nr.rinn �044. 9usiness antl
�Lltense' Law tlaes not apply to an owner4f a property wno bullds or improves
thereon, antl wM10 tloes such wo�k him5elf/herself or through his or h¢r own
employ¢es, Provitletl [hat suth improv¢ments are no[ Intentletl or offeretl for
zale. Ii, however, the builtling or improvement is soltl within one year ot com-
pletion, tne owner will hav¢ Ihe burtlen of proving h¢/She tlitl not builtl or im-
prOve for [M1e purpo5e ot sale).
❑ I, as owner of the property, am exclusively tont�acting with IicenSetl com
Vactonto [onstruct the 0/oject (Section 1044. Business antl Profe55ions Cotle:
The ConVactor's License Law tloes not apply io an owner o( property who
builds or improves thereon, antl who conVacts So� SucM1 projects with a mn-
tractor(s) litense pursuant �lo the Contra[tor's License Law). I am aware �tM1at
proof of tbeir Worker'S Compensation insu�ance shoultl be provitl¢tl to me.
�1 am eaempt untler Seclion C. t i son
Oate � Owner '
I hereby certify that I have reatl thi5 appiication antl state tnat t�e above
intormation is correcL I agree to comply with all city antl county ortlinances
antl sta[e laws relating,to builtling construction, antl hereby authoriie �eDre-
sentatives oi tnis cit o enter ppypon Ihe above-mentionetl propert f.or
inspection poses. � ' — /�
Signature oate
Drivers' License or 55 � �� � � �
TYPE OFCONSTRUCTION LJ NEW L� ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH R
DESCRIPTION OF WORK/USE OF BIDG. �
TVPEOFPERMIT LJGRADING�FOVNDATION IJSTRUg'fURAL
❑ TENANT ❑ ELECTRICAI_ LUMBING �MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq. FT. oCCuvANCY—
CONSTRUCTIONTVPE VALUATION 5
ZONE GRAOINGCV.VDS. ACRES—
Remarks:
Bar Sink
eackflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers .
Dishwdsher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service .
Interceptors
Kitchen Sink , .
Lavatories '
Roof Drains
Outlets
Reinspection Fee � � $15
Duct- Under Ground
Duct - SVucNral
Duct - Ventilating -
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting '
�6700,OOOBTU 0100,000
Reinspection Fee . ( 315
CMF 0865-46, rev. 10/84 White - Builtling; Canary - APplicant; Pink - Accounting; Goltlenrotl - Assessor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
. Solar Coliectors _
Solar Piping -
Solar Tank
Swimming Pool w/Spa
Urinal
Water Clout �
Water Heate� '
Water Service
Auto-Wash �
W undry Trays
laue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑ 100,000 BT
System Repair/Alteretion
Fire Dampers
Registers ,
Issue Fee
FEES
a
A.P. #
S Main Building:
E
T Front
A Rear
C Ri9ht
K Left
S
Ping. Fef. #
Planning NOtes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasfier
Oryers ❑Gas ❑Electric
Fan .
F.A.U.
Fixtures
Device Bozes
Outlets
Switches �
Garbage Disposal
Generaror �65 KW �5-75
7616 6/16%86 j,00 TL
' -- Zone ��Y.,
Accessory Building:
Parkiny Req./ProvideJ
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up [0 100 amps .
Meter. Dover 100 amps
Sub Panel ' - -
Morors O0.1 HP O1 h- 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light .
Range
Si9n
; Standing Sections
I TI25h COrtlpdCtOf
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
$ 3 I
�— Reinspection Fee $75 Issue Fee $ 3
FEES
DEVELOPMENTSERVICESREQUIHEMENTS:
Zoning Approved By Date
Building Approved By Date
Application luued By ' ,� Date��
SUMMARV OF FEES
BUILDING.PERMIT $ SMIP . $ �
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $ '
PLANCHECK 50% $ MICROPILM , $ f7 /-��-
MECHANICAL $ � TOTALFEE � $ ..[�LtG—
$ 3 PLAN CHECK 25% $ -
CONSTRUCTION ANDPLANNING
APPROVALS Permit #
7. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation �
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
72. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Elecirical�T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing �
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
47. Solar pomestic-Final
42. Backflow Preventer
43. �Backflow Irrigation
44. �L'andscape Irrigation System
45. Sound Attenuation
46. Flandicap Regulations
47. FiNALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
� 50. Ga,s Release to Southern California Gas Co
5l. CERTIFICATE OF OCCUPANCY
Vo._._.-- . . Date .__.__
POOI PA •
Date Inspector p�ppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
67. APPROVAL TO DECK
62. Backwash & Receptor�Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping � Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION �
80. FOOD CERTIFICATE ISSUED
Notes:
Date I Inspector I
owrveR PHILLIPS� Chester B. � DATE 6-29-54 �
JOBADDRE88 889 893 Wilson BUILDING PERMIT NO. 3rJ8
GENERALCONTRACTOR HiC�COT'J� HORI85
6,739.00
��. AP# 115-0�1�-6 e�ocK TRACT Residence
GROUP I TYPE V ZONE R�1! FIRE DISTRICT #36% �
I PERMITSISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE I Nl1MHER
Footing Trench i���G Z
Foundation Forms and Grade to Garape
�
Final
Ser" Tan
La a �.
Plumbing, Final, Fixtures Complete ��y $� GQr�aGC y�
Plum6tna.FinalGasTest �5- .a �� -'G� Q :�'4� .
Form Ll0 G-H lAt 12•68
�Costa Mesa Building Department ` APPLICATION FOR PERIV�IT .: �
117 EAST 20th STREET 36"7 B U I L D,� N G__ •� ���.
COSTA MESA, CALIFOHNIA � " y.
� FOR OFFICE US� ONLY '�
FOYZ Ag'PLICANT TO FILL IN � Fte i o. Permit'No. '
a��ia�� ; '��� ��_
Addre ��'�jiY9�0II �" � '.
Costa Mesa, C&LYOPIIlfl . Recelved by, oate rtedd. oate Issued
Nearest
� � ��9�s�
W
Arohitect or
Engineer
Address
Deuription � No.
(Attaeh Metes and
s�:� m �oc 99'
Use of
5D'
I:[�^1
errng�
Use of New
Costa Mes
City Lic.
>MESd No. 220
; B1vd.,Costa Me:
I Block I Tract �5 �
%��U�1—�o
No. of Bldgs.
1� Now on Lot I10I18
INo. of I No. of
F.amilies Rooma
Rear Vard
Rooms
& I Ra
Addition
Demolish
Stories
' A�'L1// L S a ��
Mesa, California
Nearest
Foundation Location
Forms, Materials,
P hereby acknowledge that I havc rcad this Application
and sta[e that the above is correct and agree to comply Lath. Ext.
with all City Ordinances a d S(ate �;aws regulating
bui)ding construction. ��?�O ! n Plaster, Int.
Sfgnatureoi
Permittee Plaster, Ext.
Authorized Agt. Masonry Reintorced
Valuation Permit Fee $
� 6739. � P�an Check $ Bond Beam
$ Total aU
Fee $ �� � FINAL
�o�m zoa c-e �nf iz-sa
�,. i . ,^, —,�---_-- . . �
�' .� . -
, ;� , o - - _.. .
a, � _ ._.
.� . J . ._. _. , •
Z;'O "' ' . . i a. . . '
4 � -
• 0. L
� - a
. ; ;�., . • � — — -- - . _ - . - '
. . � . .. - . � _ , � _ . . , • �
' � -- � . ° � . . . .
• 1
� . � , " � i . � • _,— . - _ .' _ " ' . .
- " _ ' .
�- J \� • � .
� � . � � ) . . . . _ . . . .
: ._ __'� - l .. ��'..' . . _-_.. . '
- - - ' . . i: - � , -
' � � ' - , ' - ' : � .
� � . Street -- � ` . . , ' , .
. . ..- . . ._ . . ...
. . - . - � ' _ . ' i ',- , � .
- PLO� PLAN ' - _ _---. - � -_ - .
- Show Iocation and�distances irom '_ �
.. pro{e�rf? line and between buildings. - � .
, �(S'�i . . ' . . . . . . .
.,�5.-. .. . _ 1 . .:
��_ � .. � � - i�l�`�.7. o . . . . .. . . . . . .
..--_ ..._.`'t?L' ,�i �i .C..".. ' ` .' _.. _
.: . . . ,`�j.�.... . . � . _._"" ., .
f _� ,
� ;` V�
�� 1
__,�a'} �ie . _ ' ' . .
� �� �- . . .. _ -
. . ' � . r•� . ' .
� ' � �- �-t �• 1 ' � � �
/��
" _ ". . . ' \ � . r
1
� r • r � _
3��;��g- �
OWNER . ROESER, DONALD DATE AUG 1) 1964
son
CONTRACTOR
VALUE
SUBCONTRACTOR
PERDiIT NO.
�' 228�q
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 91] C08TA M86A� CALIFORNIA
For Appllcant to Fill In Completely
TYPE OR PRINT
i�oiNo�9� �/J•�L(/iL.:p/)!
]RES9 �
COSTA MESA, CALIFORNIA
� MAIL
ADDREDS �-
--
CITY
STATE --TEL.
LI0. NO. NO.
SIZE
OF LOT J O
useoF /�OMF.
EXISTIN6 LDO.
BETBACK LINE PNOM /lI
�
DESCRIPTION OF WORK
ROOR
1 HENEBY ACRNOWLHO�B THAT 1 XAVB pBAt) }NI8 APPLIGTION .
AND 8TAT8 TXAT TX8 ABOVG 18 CORH6CT ANO AORE¢ TO COM.
PLY WITH �LL C�TY OR�INANC89 AND BT/�Tq uW8 P60ULATINO
em�o�rvo coHeTrturn
SIGNATUREOP ./ ��aP�C/V
PERMITTE �Y
AUTHORIZED A6ENT
FEE RECEIVED
p�G 17 1964
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMR
BUILDING
For Office Use Only
BY
— ' I NO.OP
PLANB
YAR�3 APPROVEO
MAIN BUILDIN6
VAR. JC
eu��oi
�
6 6HALL BE LE59
YARD9APPROVED
ACCESSORV BUILDIN6
DATE
a
BC. FT. �
rrie AMOUNT BHOWN UNOER VALUATION 19 POR Txe F
PUNPO86 OP EBTABLIBHING A pBqMIT FHH ONLY. Q
VALUATION m
PERMITFEE $ / � a
�
$ ' � e
/ >