HomeMy WebLinkAbout354 16TH ST - Building Permits:
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Memorandum
To: Development Se�vices
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From: Dusty Bent, Treasury Management
Dete: October 27, 2003
Re: RF,TURNCD CI IECK
The followin� check did not clear the bank:
Lynch & Pike Roofing -�161.75 - Amowri now due �186.75
Please discontinue inspections for Pennit B03-01655 Cor 354 E 16`� SL witil pa}mient has been
received by this office.
Should you have any questions, please contact me at X5072.
,�
2100
Date: 09-30-2003
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92629-1200 �
DEVELOPMENTSERVICES DEPARTMENT
Transaction Receipt
ACTIVITY NUMBER: 603-01655 TYPE: Re-Roof
SITE ADDRESS: 354 E 16TH ST
Unit / Suite
APPLICANT: PIKE, GARY
P O BOX 6099
FUILERTON,CA
92834
714-553-7663
OWNER: DINWIDDIE, EILEEN H TR
CONTR: LYNCH & PIKE ROOFING
P O BOX 6099
FULLERTON,CA
92834
714-553-7663
STATE LICENSE 403576
CITY UCENSE 8L004001
07/31/2002
TOTAL FEES: $111.75
TRANSACT. AMOUNT: $1'11.75
BALANCE: (PERMIT FEES) �0.00
PAYMENT METHOD: Check
NOTATION:
TRANSACTION RECEIPT DETAIL INFORMATION FOR TREASURY:
2000 Building Permit Fee 0300 $111.25
Builqing SMIP Fee 0340 $0.50
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KJC
SEP 38 2883/9:24 AM/f 111.75
RCDTq:Al-8121873
BB888835471
Building Division (71a) 75a5273 • CoCa Enloument (714) 756�5823 • Planning Division (774) 7545245
FAX (714) 7514858 • TDD (776) 754S2a4 • wv.w.fltosW-mesa.n.us
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��ia��sa-s2�a • Fax(7/4)754-4856 • www.c�.cosca-mesa.cg�ILDING PERMIT
Job Address: 354 E 16TH ST
Suite:
Vicinity: R�SIDENCE AND ATTACHED GARAGE
Parcel Number: 42519101
Applicant: PIKE, GARY
Address: P O BOX 6099
FULLERTON,CA
Owner: DINWIDDIE, EILEEN H TR
Address 19791 HARVARDAVE
I RV W E, CA
APT 311 B
Contractor: LYNCH & PIKE ROOFING
Address: P O BOX 6099
FUILERTON,CA
Zip: 92834
Arch :
Address:
Zoning:
Phone: 714-553-7663
Zip: 92834
Phone:
Zip: 92612-4649
Phone: 714-553-7663
License: 403576
Eng:
Address:
77 FAIFi �RIVE, GOS IA MtSA, GA 92626
Status: ISSUED
Applied: 09/30/2003
Issued: O9/30/2003
ISSUED BV:
�+�41g��
T� 3.q,b
�A'�
Phone: Phone:
' Zip: License: License:
SCOPE OF PERMIT
-� TEAR OFF EXISTING ROOF. REPAIR AND REPLACE SHEATHING AS NEEDED, COVER WITH FELT AND 30 YEAR COMP. INCLUDES
ATTACHED GARAGE.
Plan Check: $0.00
Permit: $111.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
Rear 0- 0
Rear 0- 0
Required: 0
FEESUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
$4,500.00
Sa,soo.00
NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-2fl, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within i BO days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspeetlons and tinal approvel must be obtained. Failure �o ob�ain inspections and final approval will result in the expiration ot this permi�.
FOR INSPECTIONS CALL: (714) 7545626
zaawe �s�aa�
WORKERS' COMPENSATION DECLARATION: �
I hereby aflirm under ponalty ol perjury ana a} the lollowing tleclaratlons:
❑ 1 �eve entl wlll malnlain a certiticele ot �on50nt to 5ell-Insure for woBors' compenselion, es provided lor by section 3700 of Iha Labor Cotla, tor the pertarmence oi Ihe
wark lor which this pertnit is issuetl.
❑ I have flrM wlll mainWin workers' wmpen5atlon InSure�o, requlretl Ey settlon 3700 0l Ne Lahor Code, for Ihe peAortnence o� No work for whith fhis pertni( is jssuetl.
My workers' compa ation In ura ce carner antl� D% r are:
Cartier. � � Al Pdi�y Numher.
(T/lys sectron need na�'�e mmpleted d fhe pertnlf is va. eC af on hundred tlollars ($100) or YJss.) ♦
'�Lmtlity thet in t�e pedartnance ot the work for wl ch this pertnit is issued, I ahell not employ erry person in any manner so as to become subjoct to the workers'
V �pmpensetlon laws af Calllom' , and agree t�at II I should becoma sub�ect to t�e warkers' compensatlon proWsiau oi Sectioa3� of the bor Cotle, I shall tort�wil�
mmply wilh the56 provi /�//�/ lil �� y/��
AppllrantSlgnaNre: ��F� y./in Date: ✓`-'� �
Ql
WAfiMN(3: FNLUPE TO URE WORKERS' COA1P $qTIpN CpVEqqpE IS UNUW FUL M1D SYULL SUBJECT AN EMPLOVER TO CRIMINAL PENRL S AND L FlNES UP TO IXJE MUNDRED
i1KK1SM1D DOIURE (5100.0OO�.IN AUIXiION TO THE WST OF COMPENSATION, Dr1MAGE5 AS PROVIDED FOR IN SECTION 37080F TME UBOR CODE, IMEREST, AND ATTpRNEV'S FEES.
LICENSEDCONTRACTORS DECLARATION:
I hereby attirtn thet I em licensed under provisions at Chapter 9(commencing wilh Section 7000) of DiWsion 3 oi the Business and Professlons Gode, end my Ilcense is in full
lorce entl ettacL Lic. p Class» .—. � 1
Gomrector's Signature: � /. Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eflirm that there is a construction IenAing agency tor the paAormance of Ihe work tor which Ihis permit is issuetl. (Sec. 3097, Civil Codo).
Lentlels Namo: Lontlefs Aatlrass:
Signature:
OWNER-BUILDER DECLARA710N5:
Date:
I hereby eflirtn thet under penalry ot perjury thet I em E%EMPT FROM TME CONTRACTORS LICENSE LAW tor t�e fdlowing reason (Sec. 7037.5, Bu51neS5 end Profession!
Cotle: My dry or counry which requires e permit 10 canswct, elter, improve, demdish, or repair eny swcwre, prior to its issuance, also reqWres I�e epplicant lor such OertnP
to lila e slgned statemenl Ihat he or she ISllcgnged pursuent to Ihe pravisions ol the Contrectors License Lew (Chapter 9(commencing with Secllon 7000) oi DlNslon 3 of Ihe
Business entl Professions Catle) or thet ha Or sha is exempt Iherelrom end the besis for the elleged exemption. Any Woletian ot Sactlan 7031.5 Dy any appllcant tor e pertnt
suDjects the epplicam to e civil penalry of nol more than Iive �untlretl tlollers ($500).):
❑ 1, as owner of Ihe properry, or my emplpyees with wages es their sde wmpensetion, WILL DO THE WORK, antl the structura Is not intendetl or oNeretl tor sele (Sec.
7044, Business and Professions Cotle: The Coniractors License Lew does not flppty to an owner of properry who bu7ds or impmves thareon, entl who tloes suc� work
himsetl or hersetl or �hrough his or her own emplqrees, provided thet such improvements era not intended or otfered for sala. If, however, the building or improvement is
sdtl within one year ot completbn, the owner-builder will have'the burden ol Drovi� that he or she did not build or impmve tor purpose ol sale.). '
❑ I, as ownor of the properry, am E%CLUSNELY CONTRACTNG WI7H LICENSED COMRACTORS ro consiruct the project (Sec. 7044, Business entl Protessions
Catle: The contractors License Lew tlogs not appy to an owner ol property who bulltls or Imprwes thereon, and who crontracts tor such pm�ect wlth e �pnirector(s)
licanse pursuant to the Cantractors License Lews.). '
❑ I am exempt untler sec. Business antl Prolessians Cotle for this reason:
Signeturo: Date:
Owner ID vonflod by drivers Ilcense. ❑ Ves � No Drivors License No.
Vedlicetlon ol Ownership by (type ot dxumenc, i.e. - pmperty tex bill or tleetl):
OIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
Expires:
❑ I hereby certify Ihet no excavation five (S) or more feet in Oepth into which e person Is required to descend, will be made in connection wllh work euthorized by Ihis
permit, antl thei no building strucWre, scattoltling, lelsework, or tlemolition or dismamling ihereof, will be more than ihirty-siv (36) teet �ig�. (Chap. 3.2, Grp 2, An 2, Sec.
341, Title B, Calitomle AdMnistretive Catle).
❑ As ownervhulltler, I will not employ enyone to tlo work which woultl requlre a permit from the Division of IntlusMel Sefe�y, es notetl ebove, unless such pereon I�s e
permit ta do such work Irom t�e division.
Signatuie: Dale:
Di�rision of Intlu5lnal Sefery Permii Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORIZATON OF EMRY: I cenity unAer penelry ol perjury that I have read this apDliwtion antl state Uat tho inlormation given Is I
wrrect. I agree to wmpty with all steie laws and ciry ortlinances relating to building conswction, and authorize representatNes ot the Ciry of Costa Mesa to enter upon Ihe
ebove-described property for inspedion purposes. I agree not m occupy or ellow ocw0enty ot eny building authwized by ihis permit uNil linal inspection.
COOE I, INSPECTIONTYYE
1616 Fized System Finel Fire Prevention
1266 Pool Spa Finel
200 Finel Re-Rool
201 Finel Block/Retaining Well
202 Finel Fectory Fire Place
203 Finel Sign
204 Finel Domolitlon
� _ 1 .111 .
/�7/i �W
COOE I INSPECl10N T1PE
206 Flnal Mechaniwl
208 Final Plumbing
210 Final Electrical
212 Final Flre Prevention
220 Flnel Planninq Approval
222 Flnal Site
250 Final Building�Occupancy
PAIE It1�Lfl
PHQIECT AD�NESS: 3 S Q E 16 TH 3T
owNrnsxnme: EILEEN DIMWIDDIE
nooaess: 431 GLOUCESTER
COSTA MESA
CA 92627
pNCHIENGMEEfl: � 7 S�I J E 9 S� i 9.�.. 3
aooRess:
flEG.NO.:
u"�' A6 B
uxrt:
PEp""TTEE: EILEEN DIMWIDDIE (714)645-2423
aooness: q 31 GLOUCESTER
COSTA MESA CA 92627
LICENSEO CONTPAC70B oECIANaTION: I nere�y allirm thal I am licensea untle� D�avisions of Chao�ar B(tommencing wilA Seclion
70001 ot Divsion 3 oi �he Bwiness antl Pmfesvans CoOe. anA my license is in full lo¢e an0 ellecl.
LITY IIC.: STPTE LIC.: ClASS:
Oate: SignaWre:
WOBHEflS' COMPENSATION OECLABATION: I hereGy alfirm Ihal l have a certilica�e ol con5en110 selbinsure or a certilicatC oI Workers'
Camvensation Insurance. or a cenilie0 copy inereof (Section 3800, �ab. CI.
POLICV NO.: EIIP. ORiE:
LOMPANY:
-� Cenifie0 copY is hereUy furnisAeG. ❑ Cenilied copy is liletl with the city Building Division.
Oa�e: ApDiicanC
E%EMPiION FBOM WOFKEflS' COMPENSPTION OECIAPATIOk QhiS sec�ion neeA not be complete0 i� the perm� is �a ane huMrtd (5100) or 1e55�.
I certily ihat in ihe petlarmance oi the work for which ihis permi� is is5ue0. I shall not employ any person in any manner so as to become
suGlact to Ihe Workers' Compensauon Laws ol Calilomia.
�aie: Signalure:
NOtILE: Ii. alter making tAis Aeclaration. you should Decome suUlect to the Workers' Compensation prwisions ot t�e La6or
Coae, you musifonhwitn comoly with such omvisions orinis oermit snall ee Ceemed revoke0.
CONSTPUCTION LENUING RGENLY: 1 �ere�y aifirm roat ihere is a conslmction lending agency lar the Oedormance ol the work for
wnicn this permn is issuea �Section 3097. Civ. C).
LENOEN:
aooness:
DWNFfl BWLOEfl OECLARATION: I nere0y alfum Ihal I am exempl lmm I�e Con�raciors' Siaie License Law far t�e lollowing reason
�SetiiOn 7Q31.5 Business aM Pmlesvonal COEe: My Ci�y of toUnly whith r¢Quir¢5 a permi� Io cans�mt�. al�¢r, impmv¢, demoliSA, Of
repair any siructure. Oiior to ils issuance. alsv reQuires Ihe apDlicant �or such permil lo lile a SigneO Slalemenl tha� helshe is IicenSetl
purSuanllo I�e pmvisi0n5 0l lhe Canlractors' S�ate License law (C�apter 9(commencing vni� Seclion T000) oi Oivision 3 of i�e Business
antl Pmiessions Coae� o� tAai �elshe is exempt �ne2imm an0 t�e basis br I�e alleAeE exem0�ion. Any Nolation ot Seclion 7031.5 by
any applicani lor a permit Subleci5 Ihe apPi¢ani lo a civil penalry ol no� more Ihan live hundred Oollars (5500).
❑ I, as owner ol Ine pmperty or rtry employees with wages as �heir wle comDensation, will tlo ihe wark, and ihe
sirutlure is nol imen0e0 or oliered for sale (Section 70aa. Business an0 Pmfessional Coae: T�e Coniractors' Stale License Law
Eoes not applyto an awneroi a D�ope�Y who bwltls orimpmves Ibereon, antl w�o tloes suc� work �im5eli/�e�seli o�IhrouAh
hi5 ar her own emplayees, pmviA¢� Iha� SUth impmvements are nol in�entle0 or otlet¢C lor sale. 1�, however the huilAlnA or
impmvem¢nt is sdd �d�Ain ane y¢ar ol completion. I�e owner vnil have IAe 6urden ol pmving he/she did noi builA ot impmve
tor Ne purpose of sale�.
I, as owner o� t�e pwpehy, am ex[lu5ively conlracling wi�h licensetl mrana o canstmct role�� 45ection 7044, Business
❑ ane Prolessions Code: i�e Comracmrs' Slale license Law does n apON �o a ovmer ot pmpeM ''w �mlds or impmves Ihereon
antl who conlracls lar suc� O�ole��s wi�h a conlracior(5� license ursuant ihe Coniractor ' Sta Li[ense Law�. I am aware
Ihal proo� o� I�eir Work¢�'S Compensa�ian insufance ShoUld be p ieetl me. �
� i am exempi unoer sxiion: B p 7 0 4 G 8. B P. C.
mrmrsreasoo: NO CONSTRUC'fYON ��
oate: .3=�_� �' �ne .
I tlo Aere�y cenily I�al I am awaie al anU un0ers1an0 1he requiremeBls of Califomia Health anG Sa�ery Code Sections 25505, 25533, antl
2553d anU I�allo� anyluture �uilamg occupanlwilllwill not (circle onepire comply vnih 5ai0 slale co0e5 anU Ihe iepuirements lor a
permii lor tonSimt�ion or modili[aiion imm Ihe Air Ouahry ManaAe 5lrici. 'Oenlial tonSlmCiiOn apDlitalion5 are ex¢mp� trom
IheSe piovi5lon5.
Dale: NO�licanl'.
I here0y c¢tiity Ihai I �ave r¢a0 INS applicaiion an0 Slait Ihal l
ortlinances anA slaie laws rela�ing to Duildmg cons�mction a
pmper�y loi inspeciwn purposes.
oate:$=LI�� Signatu �
Driver's �mense ar Socia� Securi�y %�
lo camply wiN all city and coun�y
�oentepupon��eabove�men�ionetl
. �
164t-a6 White—Bmleing; Green—Cotle Eniorcemenc Canary—A�Olicanl; Pink—Revenue: Gddenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: ZB 05130.
PERMIT NO: IB 051303 PLAN CHECK NO: N GOVT; N SUPF: Y
CONSTRUCTION TYPE: 5—N PERMZT TYPE; OTH STR PURPOSn: OTH
JOB DESCRIPTZON : COMPLIANCE/TNVESTIGATE GRADING PROBLEM SQ rT:
CLAIM VALUE; CALC—VALUE; GROIIP OCC: R-3 /M-1
COMMENTS: WATER FLOW PROBLEM/OWNER NEEDS ADVICE.
�? �(� X if iE ih iE IE Ik IE iF i!� if iE iF If Ibif !k iF if N� iE iF If �(� 1f !F iF iE aF if le 1(� iE IF le iE If 1(� iF �E �Y #%� 7h �Y,� kl6lf i!� f41k 3F lE 1E If IE # IE if- If 1F IF IE af 3E 1! If 1f f6 # if 3F �F Y.� iF iF
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 BilILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT TN FRNT; FT IN REAR: FT TN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ• PROV: PARCEL; 42519101 ?.NE: REr NO:
PLANNTNG NO'I'ES>
i
iE #f if iE iE iF If �F IF aF M K it i' if ff ?f iF K if� iF N� #F 7F ih if # if iF �1F 7E if % 1E iE 14 �f if ?E iF i6 i4 if N� �4�1(• �f �1f � k if if 1k if N� iF iF } iE ## 1t if )f 7E iE i!� If d!�.� # iF'�S �3E i%!B If �Y )f
D E V E L O P M E N T S E R V I C E S R E Q J I R E M E N.T S
ZQNING APPROVED HY llATE:
BUILD.iNG APPROVED BY ; DATE: '
APPLICATION ISSUED BY: DATE; �3 //
iEiEiElfiFififiEY�i'EiFiP3!�ifififihiFafiFi4Y.� � . r . iPiFlfI6iE�f�YiFiF3f lF�F
IfiFiflflEaciFiEkiFlEi'rif�i�iPiEif*iflf#iflfN�iF1EY.�iElElfif3f3fiFiFi4�1f .1f .iF ifiF�YlFiFifl4iFififiEiElFiEfFiEiEV.�Y.�iElbiEif3E3FIFjf�EjciEi(�Kafx
I�EGALI2ATION:N F E E S U M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC F.IRE SMIP/RES GRADING
PERMIT 30,00
SMIP/NON—RES
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PI.AN—CHECK TOTAL PAID DilE
TOTALS----> 30,00 0,00 0,00 30,00 30,00 ,00
REVENUE DIVISZON TOTALS--> COLLECTED: 30,00 OVER/SHORT: 00
BLDG Pt�iT PLUMSING ELECTRIC MECHANZC FIRE SMIP/iOT GRADING FLAN—Ci-IECK
30,00
#F ?F Y 1f )f if �f iE iE 1F iE-1F 3f #E 3E �f iF iE # 1f �M iF if iF iE iE M aE fE 1f IF i! #� iF iE jF iF �E IF iF iF a�. �k i!� Y.� ?E %� #E if !E IF i?� if iE iE ±f iE'i. if if 1E � l'r lE ��E iF if +E �c ib?f � a. �Y iE � i41f
I N D I V I D U A L F c 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
INS 1 BUZLDING RE—INSPECTION FEE 30,00 30,00
END OF FEES
�
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�
CONSTRUCTION AND PLANNING POOL ,PA
' APPROVALS Permit # Date Inspector AppROVA�S Permit # Date Inspector
y ,
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location � -
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinfortement 56. Rough Plumbing & Pressure Test
6.� Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, � Undrgrnd.
10. Structura� Floor System 61. APPROVAL TO DECK
71. Property $ew6� Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System � Final
14. Rough Plumb'�ng 65. Electrical-Final .
75. Rough Electriwl-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 Heatin9 & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' APPROVALS -Permit #
27. Ducts, in $tructure 70. Underground HYdro
22. Ducts, Ventilating 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test , . 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI �
25, ftoof Sheathing . � � �. 74. Overhead Hydro -
26. T-Bar Ceiling IStructural) & Monocoat - 75. Dry Chemical
27. Frame and Flbshing .. _ 76. Dry Standpipe �
28. Lathing & Sid�ng . � 77. FIXED SYSTEM FINAL
29. Insulation - � � 78: FIRE PREV. FINAL
30. Orywall Nailing � . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat , ,79. FINAL INSPECTION �-
32. Elecvical Power Meter-Final �.� .80. FOOD CERTIfI.CATE ISSUED
33. Final Electric � � -� Notes: " .
34. Final Heating & Air Conditioning � . •
35. Final Gas Pipe�Test - � , '
36. Hood or CanopY � " .
37. Final Fattory Fireplace ' � ';� �
38. Final Plumbin9 •- •
39. Water Service-Final , ' '
-40. Gas Service-Final , , . �
41. Solar pomest�cFinal "
42. Backflow Pre�enter �
43. Backflow Irrigation
44. Landscape Irfi9ation SYstem � ,
45. Sound Attenuation �
46. Handicap Reg�lations �
47. FINAL STRUCTURE & BUILDING �j ( �'�- . �
46.�FINA�PLANNING , �
. 49. Electric Release to Edison - ';
50. Gas Release to Southern California Gas Co ,
51. CERTIFICA7E OF OCCUPANCY
No Date
. 4896 ZZ'� '�� • �° V� �
� �; F�RECE1VED
COSTA .tiIESA BUILDING DEPARTMENT
- P.o.eox 3i�
COSTA MESA. CALIFORNIA fINANCE DEPT.
i
FOR APPLICANT TO FILL IN AP�$�1�,�(�I �2 PERMIT
BUILDING � � �1 � . BUILDING
ADORE55
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
OWNER
CITY S� G
ARCHITECT
OR ENGINE
ADD. �
LEGwL L(
OESCRIPTION N�
A.P. NO. �
SIZE
OF LOT
USE OF
E%ISTING BLDG
SETBI�CK LINE FROM
CENTEw OF STREET
1� v
/�� TNO i �J'S � � A❑
LIC.
NO.
FII
ZO
^ � �T� ���. � 7 L =a
NO.
1 TEL. t.-...._ AF
�..v� .li NO .IJ.�S� BY
BLOCK T
� _ �
/NO.OF BL�GS. O
NOW ON LOT
/ REAR YARD .✓ S 1
SIDE YARD � RIGHT � LcFT �
DESCRIPTION OF WORK
NEW ALTERATION I A�pIT10N
REPA MOVING I DEMOLISH
BUILDING/I��j' ���'� NO.OF
SIZE F-�i} �I.i,t� ROOMS , STORIES �
E%TERIOR WpC� � ROOF )
COVERING y/�f.G�vC%/u COVERINGL���7}7�j,��."�-
USE OF NEWJ/ � I� I � . � �. I i
COSTA MESA, CALIFORNIA
DATE � � �C� ��"
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CITY OF STr r co ESA
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SUBJEC� TO G. DEFT. REG.
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I M[REOV PCHNOWI.EO E TMAT I MRVE REA� THIS RPGLIC4TION PND
SiPTE THAi TME PBOVE IS CONNECT >ND wGNEE TO COMPLV WITM nLl
CITY OR�INANCES /�NO STFTE l.PWS/REGUI.ATING BUILOING CONSTRUC-
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SIGNATURE O� PERMIT FEE $
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AUTHORIZED AGENT TOTAL FEE S
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