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HomeMy WebLinkAbout223 16TH ST - Building Permits w4u ADDRESS: 223 E 16TH ST UNIT: FRONT CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 046991 OWNERS NAME: ALAN BALDWIN Lg,r;h: ADDRESS: 437 PRINCETON, C.M. - __---- PERMIT NO: B 046991 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH 979-8277 : ARCHIENGINEER: REG.NO.: JOB DESCRIPTION REROOF 1500SF W/2 PLYSHEET, & EMBED GRAVE SQ FT: 3, 015 ,ADDRESS: UNIT: CLAIM VALUE: 3,015 .00 CALC—VALUE: 3,015 .00 GROUP OCC: R-3 / j PERMITTEE: CRANK BROTHERS ( 714 ) 548-5569 • e ADDRESS: 126 COMMERCIAL WY COMMENTS: ' C.M. ' CA 92627 *********************+FSE***�r�k*�k*ater�E�H�H******�k�r***************thVImC .UC 1 CV 1 VR UCENSED CONTRACTOR DECLARATION: I hereby affirm that am licensed under provisions of Chapter 9(commenting with Section Z O N I N G REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.a my license is in full force and effect./ S E T B A C K S QUIRE D CITY UC.: 005993 STATE UC.:O CLASS: RE Date: --l7 7J ( sionatur. ( MAIN BUILDING ACCESSORY BUILDING WORKE S'COMPENSATION DECLARATION: I h• 4'. it hat I have a certificate o consent to self-insure o . •ificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensationsr c c ed copy • co Section 3800,Lab.p. LEFT: FT IN RGHT: FT IN . LEFT: FT IN RGHT: FT IN POLICY NO.: 4 0 9 EXP.DATE: V 1 /01 /91 COMPANY: STATE PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: • 0Certified copy is hereby furnished. Certified copy i filed with d ddi 'Division. PLANNING' NOTES> 'A/l— /0 ( the C4t> gkfAC f ( ***************************************************Sfif****************,E********* z: Applicanntt'-� i�0 i /�/ EXEMPTION FROM WORKERS'COMPENSATION DELI, 11 : hi .on need not be completed if the permit i : . a hundred .1Do)or less). ' DEVELOPMENT SERVICES R E Q U I R E M E N 1 T S ' I certify that in the performance of the work for is is permit 1.ued,I shall not employ any per .• .•'manner as to become ..„ subject to the Workers'Compen tion Laws o ifomia. • ' a ZONING APPROVED BY DATE: '" Datesignaturu: BUILDING APPROVED BY NO ICE:If,after making this declaration,you shoal a subject m the Workers'Compensation provisions of the Labor DATE: Code,U you must NG G with such prit • n r this permit shall be ending deemed revoked.f ^CONSTRUCTION this LENDINGeAGENCY: hereby Civ.affirrd t there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE; j{LF• —f�i1t0 which this permit is issued(Section 3097,Civ.C). ***************************************** * ********************.*** +�* ** ***. LENDER: ********************************************************************3e,'BF********* ADDRESS: - • LEGALIZATION:N F• E E S U• , M MARY STRUCTURAL SEGMENT:Y OWNER.BUILDER DECLARATION: Ihereby affirm that l am exempt from the Contractors'State License Law for the following reason • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 63. 00 . /' 5 0 repair any structure,prior to•its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed ( ' SMIP/NON—RES pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by , any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE •., • • I, as owner Of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> ' PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE •❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—--—> 63 . 50 0 .00 0 . 00 63 . 50 63 . 50 ' . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himset/hersell or through ' his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 63 , 50 OVER/SHORT: 00 improvement Is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose ofsale).. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I ' ' 63 . 00 . 50 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *********************************************.********************************** that proof of their Worker's Compensation insurance should be provided'to me. I N D I V I D U A L ✓ F•E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. , c for this reason: TYPE QTY DESCRIPTIO N h UNIT COST TOTAL COST Date: Owner: SFR • 3015 REROOF BY VALUE RESIDENIAL J NOZONE 1 .00 3, 015 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES' 25534 and that I or any future building occupant wlll/wlll not(circle one)need to comply with said state codes and the requirements for a • permit for construction or modification from the Air uality Management District.Residential construction applications are exempt from , f. these provisions. Date: Applicant: - ' ������000000 yyyy • 1 I hereby certify that I have read this application and state that the hove iteinformationnist correct.I.l is el e u with ityov and county �, ordinances and state laws relating to building construction and her authorize representatives of this el a upon t hove mentioneg / 1,r property for inspection purposes. •/ Date: �—/ / -- / a Signature: j- ' Driver's License or Social Security x: •1841.48 White—Bulldino:Green—Code Enter a nt:Canerv—Aopilcent:Pink—Revenue:Goldenrod—Assessor 01 00058652-00058653 TOT 63.50 DATE: 04/17/90 TIME: 09:16 CONSTRUCTION AND PLANNING POOL A APPROVALS --Pefmit# • Date Inspector APPROVALS. Permit # Date Inspector 1. Temporary Electrical Sere or Pole;o - 52. Pool & Equipment Location • 26SoiI Pipe-Undrgrnd.., - r�,r<,•r • 53. Steel Reinforcement . _1 -Electrical Conduit•IJtility-Undrgrnd'. 1 54. Forms , ``e49Electr eal CondtiPUndrgrnd.. -y • 55. Electrical Bonding S sSteel Reinforcement - 56. Rough Plumbing & Pressure Test ro 6r Electrical UFEf3_.Grnd. 57. APPROVAL TO COVER-GUNITE 1"7.gootings 58. Electrical Conduit-Undrgrnd. 1.4 E. 8..Foundation < 59. Gas Pipe, 0 Undrgrnd., Test -o 9.SWater Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System .. . 61. APPROVAL TO DECK 11. Property Sewer Line.& House Connection . 62. Backwash & Receptor-Final 12..Sewer Capo, :� 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ' 16. Rough Electrie_Wiring67. 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. BEQUIREMENT L -) t`* A n ';0 n . n >• tr20�_Roogh Ecto-r!y Fieplace ,i*7 Q'7 a. V ;i „y , -APPROVLS. _Permt # •5 * ` _ 21t-Ducts, iWStruct cm <H *• n ty - Jr" # ?70. Undergidund Hydro * t x . t�S '- S tz4 r; 1 me ' m 22-0ucts, Vent`atirig, Cd * V `r r �.,a- t; r.71. Product-f;fping EF,as f7Oil 23"Gas_Pipe;Rough &Test TM ate]^ * ,• . S ^.r r a 72, Underground Fi 1V t * E^ 5 24tRoo`f Framing F ' YF F * + /7-...^ . • * S..73vy Undergnd.Stora+^� ankO Gas El : 25. Roof Sheathing s c, '1 ' 4. 14. --, 25. a j ^.i' >: 74-.)Overhead Hydro, » 26''T Bar Ceiling (Structural) &=Mdaocoat '' 7 Of f: 755 Dry Chemical 7 * �-' t7 P !. a > r C7 # ...� * tri 27.fFrame and Flashing i r >, T.* 4- 76. Dry Standpipe Fv *.r. nt 9 ^28. Lathin :& Sidin `'C * =: .. ` l T * Cr 9� 9 s, ` ,;:;31..E..,± J x ' � tf, � 77.1 FIXED $YS`f'E(vJ iF1NA6- " n �, sem; ", •• •• � +. r . i ^29. Insulation •• S x � 4• w 7$r FIRE PREY. FI: * : Q " 30. Drywal1Nait ng t ,y i '�`*y .'�. S 'FIEALTIFiDEPT. REQ it RIMENT 531. Plaster Brown Coat. S -T A I Ca * r79. FINAL INSEECTION * y "32?Electrical Power Mxter-Final; 4 CO * 180TFOOD CERTIFICATE I$SUED c .,. * I * v ,-1 C moi, rr e ' ;: 1 :T # i9 F 4 •� 1t 4- .•r i33SFirral Electric * z1 < * i 1: * Nates: 5 ^!m * '-1 0 r;m ... - 1. �n 4 4 '- w• I1 `Y J C.. ?;'34fFin-1 Heating& Air Conditioningz * I a v felite_tt7 35.'17., Final Gas Pipe-Test; �, .. w H if. x �D._ 1�.✓.. ff/p4 a, �'i`` r l /I it ::36. Hood or--Canopy n I co" o t. n j ,g 4 = t no a 'l c C rr7 * n 1 Sri J w 4 + [r: ":o * tr: m �37.:Firia] Factory FirePlacex 1 0 �: I 1V* * 4.&:,w& fe •. ck?..Lete4.e fp, .'t� "� It 0 V Firia1 Phimbing * 'n i I 0 # k- # C CC * ' ^ 39. Water Service;FinaI; z * _; l * ., * s m n `-40. Gas Service-Final a ti <o-,to S * :T: I i 4u £ * F,41. Solar Domesiic-FinelS t.4 •• * r I P. ; �" `+ 4 710 Cr 1. CD ^42. Backflow Preventer, Cu * j I It w 5-E-' • 4 d .l * r-' r., 44-1 ■ ..r * * a; mor.) a- E- i anon t's 4: * * cc.t- , 4 •- 43. Backflow Ird9 * tC f• * U i * ;a - 'x:44. Landscape Irrigation _ SysteniwM " L 4 * '• C t'! -' rs•0 * to 0 ter•"- n .`r c v'r: r i �. F 'o otc * x F z45CSound Attenuatio '...-11'7:.„E".. tr' * z i-.7.1 E-' i-,x * 1 --, u<'Q a 4 4 m m* * a' tr <._ F•v a c-, . , e " `- •_46.•Handicap Regulations 1r 5 * * * C x -S Oo - Yr, _ Yr 47=FIN;AL STRUCTU E & BUILDING a N`-' 4 48._FINAL PLANNING . - E- ;^ a, cu ! '* * q "ri <, :c w 1.. -, _ • ... i l n I; '49 JEIe'ctric`,Releaseto'Edison i i * 1 I P; W r ,n -' "' a-50SGas_Release to Southein'California Gas Co is 1 s k -, -, J • <=M * O , ' - ,. x .• c Oo Ct * N c --51. CERTIFICATE OF/OCCUPANCY - * * - 0 To a - No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MASA CONSTRUCTION PERMIT - PERp NO. TRACT NO. LOT NO. UNIT NO. A.P.# Zone Project Address 2^ 3 A a 93 vYJ-3 �` Z� sr / r' r 1 S Main Building: Accessory Building: .Applicant's Mailing Address 963/ CA/)Fc w. /7 • CS- TYPE OF CONSTRUCTION LJ NEW U ADD U LTERATION U REPAIR E Z Owner's Name --RAI Li)4.)24 Phone 3Z9-9AV El CONVERSION ❑ DEMOLISH WQTHER E E ' T Front O ��3—/�Zsl D SCRIPTION OF WORK/USE OF BLDG. 12EPM lash A Rear N Address M a• S TYPE OF PERMIT S GRADING U FOUNDATION U STRUCTURAL 1 C Right N Arch/Eng. License No. �y K G Address ❑ TENANT El ELECTRICAL LTJ.PLUMBING ElMECHANICAL $ Left R Contractor's Nam /OVAL _Pl...mt.. Phone n1/41.5-17 El OTHER FE 'Ping. Ref.# Parking Req./Provided E Address(mailing) 51(23/ S/7 r2 FI it/ /-i • q. PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: 0 S,Sb/z� CONSTRUCTION TYPE VALUATION$ T City License No. ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: 1 with section 7000) of Division 3 of the Business and Professions Code, and O` my license is in full force and effect. S/7S/_/ ELECTRICAL FEES ,L� Licens''e//Class cense No. 5 Ute Date 7".D,c-f Signature _ ' ! PLUMBING FEES Automatic Washer Transformer 0 15.50 KW WORKERS'COMPENSATION DECLA RA 0 ._ Bar Sink Showers Construction Pole Sub. 0 50+ KW ` I hereby affirm that I have a certificate of On nl to self-insure or a certificate of workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps II '0, Lab. C.) �y"� .cy No. en'07ti ! Company SrATe F4.1/r, Backflow Irrigation Sewer Cap Dishwasher Meter (Dover 100 amps LJ Certified copy is hereby furnished. Dryers ❑Ges ❑Electric Sub Panel (� Ceryl d cgp i fled with the city B ilding Division Bathtubs Sewer Connection Date V 2‘ Applicant Fan EXEMPTION FROMWORKERS'COMPE - DECLARATIONClarifiers Solar Collectors - Motors❑01 HP ❑1%-8 (This section need not be completed If the •er.. is for one hundred ($100)or less). Dishwasher Solar Piping F.A.U. Inc.Solar 08.15 HP 016.15+ I certify that in the performance of the work for which this permit is Issued I Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. Pole Li ht Date - Signature Floor Drains Swimming Pool w/Spa - Device Boxes h•.;• g NOTICE:If,alter making this declaration, you should become subject to the e Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Outlets I Range comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet _ Switches Sign I hereby affirm that there Is a construction lending agency for the performance Garbage Disposal of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater g p Standing Sections Lender's Name Lender's Address Kitchen Sink / Water Service a DO Generator 00.5 KW 05.15 KW Trash Compactor OWNER BUILDER DECLARATION • I hereby al firm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • following reason (Section 7031.5 Business and Professional Code: Any city or • county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she Is exemptReinspection Fee $15 Issue Fee S 3 therefrom and the basis for the alleged exemption. Any violation of Section 1 '31.5 by any applicant for a permit subjects the applicant to a Civil salty of not more than five hundred dollars($500). . DEVELOPMENT SERVICES REQUIREMENTS: I, as owner of the property or my employees with wages as their solo Reinspection Fee I $15 Issue Fee S 3 Zoning Approved By Date compensation,( will 0 the work,and the structure Is not Intended retract offered '� / i for sale (Section 7044, to a Business and Professional Code: The o or of f reMECHANICAL FEES. Building Approved By Data_ '/y,/"'.'(`'"rt�_b///�-(/] License Law does not apply to an owner of a property who builds or improves s r. // thereon, and who does such work himself/herself or through his or her own - Application Issued By Deco_'/ employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 - SUMMARY OF FEES ' Diction, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration SystemPLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00100,000 BTU ❑100,000 BTU PLUMBING $ 5-0 0 ISSUANCE $ builds or improves thereon,and who contracts for such oro sects with a con- - tractors license pursuant to me Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $ ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG dk Fire Dampers MICROFILM $ — PLAN CHECK 50% $ Date owner Heating System& Ducting' Registers MECHANICAL $ �'1/� I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL TOTAL FEE $ 5 f/(/ Information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city • enter upon the above-mentioned property for Inspection pu poses. ,/Z`�rs.�' - _. Signature _ i ...s:../ Date ! '/ Drivers' License ri .� Reinspection Fee $15 Issue Fee 5 3 = _ _ q 1 y _ " 0865-46,rev. /8: White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor i • -. .. ro,:J. L. I iii-. --r•+L • CONSTRUCTION AND PLANNING ry • POOL! A APPROVALS Permit Cate Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement / .3. Electrcal Conduit Otility-Undr rr3d. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel'Oginforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER'Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings .. • 58. Electrical Conduit-Undrgrnd.• 8;;Foundation 'V. / j;, 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgi-nd. 60. Backwash Lines,P-Trap, 0 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 14. Rough Plumbing: 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16. Rough Electric Wiring 67. Fencing & Access Approval .1 =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# o 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank U Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-BanCeiling (Structural) & Monocoat 75. Dry Chemical 27. Frame-,and Flashing 76. Dry Standpipe • 28. Lathing & Siding 77. FIXED SYSTEM FINAL a 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. PlastenBrown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED It 33. Final Electric Notes:k.e7.n t-ior2Eaoc{, tC.(..) 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 fk li //� 40. Gas Service-Final . /{/tel 41. Solar Domestic-Final 42. Backflow Preventer I .1, 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison • t 50. Gas Release to Southern California Gas Co -' 51. CERTIFICATE OF OCCUPANCY K"t ' No. Date COSTA MESA BUILDING DEPARTMENT / I 5791 1 1/44/2b---) P. O. BOX 3I7 COSTA MESA CALIFORNIA FOR APPLICANT TO FILL IN C.L. OF STREET----- I v� C /� T1' �•`/,ce7" I I STREET----- BUILDING ADDRESS �sC 2 •'/3 ), �/ �— ROP. LINE _ _ _ I Ownerl/���P t �" ��17 G ��, y� it -- 0 FT-FOR. r - -{� 12 FT. 6 IW PbR —f 1\ I y Q'�` No /TTTf 10 FT. FOR 60 FT. STREET I FSO FT STREET Mail yAA//ddres / I I I CityJ, / Ph. Noel c?- 4 d I • I Contractor C) CU yi e y--. Ph. No. I I I I Address 50 FTI IF FRON City Lic. No. State Lic. No. IOF PROP. F / 50 FT, w / 17—'� / y1 / to A w . Y ` m Size of LotV�O X/s� AP No ."i 1- , wI i t- Setbacks: C/L Street 1/4'5%-0/ Rear• I w ZI m ii J ¢ LL Side Yard - Right ea Left o • ,,� y r�-- -- CC C Type of Fence / Ur'��S-} f 2 j �:cr7?o ac-Z ; c ALLEY OR PROP. LINEN al p 'Dk‘ Y/ i /) �/lk M a -I I hereby acknowledge that I have read this application and state I� w , J L 1 I that the above is correct and agree to comply with all City Ord- 1 j N g 1 J finances and State •ws regulating by+ing c•. - ruct/n. iii 4)\ c C ° F 0.� I Signature ( ` / / I ® vi Q� \ 10 I of Permittee *� I Cd; V m C‘ - AgenI ., o in I I FT 6 fql F 5- ‘s1 ' Z \• I :II FOR OFFICE USE ONLY wJ� V w a . I FT • ///" /j,c Permit No. .2.) cry".1...t 3° 60 F ST. Received by Date Received Date Issued r t t r 7- 4 - s 7 9-i6 -s7 I50 T.FST, t J t rl PROP LINE LL _ R CEI,. Ea VALUATION \� t- 1�---- y-- - m - � - - - - - � /4q2/ Permit Fee $ FIN RNC= DEP / 1 9 - $ ') 1 n Plan Check $ -' C.L. OF STREETS a CITY OF OSTA N SAI a TOTAL FEE $ 1 MAXIMUM 4 FT FENCE MAY BE PLACED ON DOTTED LINES --- --- MAXIMUM 6 FT FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS • " 4838 . COSTA MESA BUILDING DEPARTMENT FEE/// ,^REnCEIV/E/D�] S. (/�/ P.O.BOX A L //�/// // I VI( "i !�/�/ . COSTA MESA, CALIFORNIA I/`- `-1 `'i1 FOR APPLICANT TO FILL IN APP FINANCE DEPT. p7�3 �IlyeragjpFry[E6p PERMIT BUILDING E 1 ` Th St BUILDING ADDRESS C t7 COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY 0a X l/ ^9 tire.; RECEIPT NO. yff NO. OWNER N^ ADDRESS?92 8 .../y/ ht RECEIVED_ / '-E RECEIVES 7 O♦_E�is U> ED MAIL .�LB.BY /y(���`1lyyy IV J(//fDA CITY i/e Lupo F-7" Qeaeh TNO. 4i-F-‘23--IIADD EISSaI. e-/o OR Gh NO. LIC. OR ENGINEERCOSTA MESA. CALIFORNIA OOath'h e. 1 FIRE ADD ZONE ZONE NO.OF TYPE GROUP O wrier CITY NO. PLANS /J CONTRACTOR NO. /}��/ P g TEL. BYPROVED Ay17 7 ADDRESS NO.LABYP A�71 DATE _ LEGAL LOT CORRECTIONS DESCRIPTION NO. BLOCK TRACT jA� ��`II'��p, Qfl A.P.NO. / / 2 _ ./ yt,/.-A3 A PROVE ■�■ SIZE t NO.OF SLOGS. p ■ OF LOT .'SOX 15 D NOW ON LOT h v n P. CITY • - �/ USE OF ©STq MESA EXISTING BLDG. P1-1' • ?I. _. SETBACK LINE FROM zr //y� �y�J��S/ '8'IEGT CENTER OF STREET Yl/ REAR YARD C�'� ^ 6LDG. DEPT. REG. VVV' ' / SIDE YARD RIGHT /� LEFT 4BY DA DESCRIPTION OF WORK ' PLAN TECH. NEW X ALTERATION I ADDITION • REP/ MOVING I DEMOLISH BUILDING /G "' K.A1OOOOOO NO.OF SIZE l s8 - ROOMS STORIES / A EXTERIOR WA /1 ROOF ''') D (� A-� COVERING - iuee o COVERING Cn) m {/Dy , O / / l�- .,a.c., USE OF NEW / ( ` J /J BUILDING . . .e, , ,.�/� / G ea y /CFS/ 2 As FEW) 1 SSr u 13, j le HEREBY 'ACKNOWLEDGE THAT I HAVE READ THIS APP CAT ON AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO C PLY /TALL CITY ORDINANCES AND STATE LA 'EGULATIB DING O TFUC- TION. �/ VALUATION SIGNATURE OF • PERMIT FEE 5 3 �� PERMITTEE • /`7 7 _.S /, 77. _ PLAN CHECK S / AUTHORIZED AGENT / T TOTAL FEE 5 / — `e'