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Home My WebLink About376 16TH ST - Building Permits(774) 75a-5273 • Fy�c (71a) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 376 E 16TH ST Suite: Vicinity: ROOF Parcel Number: 42519117 App�icant: WHITNEY, ROBERT Address: P015396 NEWPORTBEACH.CA Owner: HANSON, HAROLD O Address 262 KNOX PL COSTA MESA, CA Contractor. WHITNEY ROOFING Addr055: P015396 NEWPORTBEACH,CA 2ip: 92659 Arch : Address: Zoning: Phone: (949)548-0769 Zip: 92659 Phone: Zip: 92627 Phone: (949) 54&0769 License: 406022 Eng: Address: Status: ISSUED Applied: 10I06/2003 Issued: t01ON2003 Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 30 YEAR COMPOSITION SHINGLES, 15# FELT, AND REPLACE SHEATHING AS NEEDED WITH PLYWOOD, 1/2• OSB. 25 SQUARES FOR TRI-PLEX ONLY. Plan Check: $0.00 Permit: $15325 SMIP Res: $0.78 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $154.03 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Frant 0- 0 PARKING Existinq: o FEE SUMMARY Calc Valuation: S�,�n.00 Claim Valuation: S7,�n.00 PLANNING & ZONING Rear 0- 0 Left 0. 0 Right 0- 0 Rear 0- 0, Left 0- 0 Right 0- 0 Required: 0 Pr000sed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § t, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under Ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspectipna and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2C4&681fl/W) WORKERS' COMPENSATON D�CLARATION: � I hereby aHirtn untler penalty ol perjury ona at Ne tdbwing tledaretions: ( ❑ I �ave antl will maintain e certilicate ot consent to sell�lnsure tor workers' campensetion, es proNded lor by section 3700 of the Lebor CoU tor the peAortnance of Ihe work tor which this pertni� Is issueA. 9 -❑ 1 have and will maintain workers' compensa0on insuranm, es req by section 3700 ot the Lebor Co�e, for the pertortnance ot the work tw which NLv pertnit Ls issuetl. , My workers' tompensation Insura %o6tar �er end oli mumber re: /� Carrier- t� `�/�I/�� . �- PolicyNumber. �i9��i1I % (7N5 secNon neetl nof be completed /f pemut is veluetl ef ine h�nCred dd/ers ($f 00) or less.) , __ . ��' ` ❑ I certity that in Ihe peAortnarrce of Ne work tor t fmit is IuueG shall wt employ eny parson in eny manner so as to 6eco subject to the workera' wmpensatlon laws oi Califomle, and ag�� at il I spp d become su 1 to the workers' compensation provisions oi Sectlon 3700 the bebor Cotle, I s�ell torthwith comply with these provisions. !/ �� Applicant Sgneture: � Dete: WRRNING:FALLAIRETOSEWREWORKERS'COMP 15ATIONCOVE ISUNUWFULANOSWLLLSUBIECTM'EMPLOYERTOCRIAVNALPENAL DpVR NESUPTOONEHUNDRED � TLKKISAND OOLLARE (E100,000), IN ADDITION TO E COST OF 00�.1P��ON, UAMAGES AS PHOVIDED f-0R IN SEGTION 3108 OF THE UBOR E, INfEPEST, M!D �TTORNEYS FEES. / LICENSEDCONTRACTORS I hereby aflirm that 1 flm Iicen: IOrCB end BHBCI. LiG. k_ Comreciors Signature: _ 9 7000) ol DlWsion 3 of the Business entl Prol ssyi ns Cade, a my lip/gnse I5 in full ��• � �CIeS9 p . d'� � �D / Date: � � �-� CONSTAUCTON LENDING AGENCV: � ❑ I hereDy eMirtn that there is a canstruction IerWi� agenry tor t�e peAormance ol ihe work br which Ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lentler5 Neme: Lentlef9 AdGress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I herehy eHirtn Ihat under penalry of perjury thet I em E%EMPT FROM THE CON7RACTORS LICENSE LAW tor �he lollowing reasan (Sec. 7031.5, Business end Professions Cotle: My ciry or counry which reqWres e pertnit to conswct, elter, imprwe, demWish, ar repair eny strucWre, pdor to i45155uance, elso requires the appUcant lar such pertnil to file a signeA statement the� he or s�e Is Iicensed pursuent to the provisions ol the Contrectors License Law (Chepter 9(commendng with Section 7000) of OMsion 3 af Ihe Business end Prolessions Code) or lhat he or she is exempt cheretran and Ne besls for the allegetl exempilon. Any WWatbn ot SecUon 7031.5 by eny applicam for e permit subjects Iha aODlicant to e civil penalry of no� more than five hunAred Aollare ($500).); ❑ I, as owner oi Ihe properry. or my amployees with weges es their sda compensation, WILL DO THE WORK, end the structure is not Intentletl or ofleretl tor sale (Sec. 7044, Business and Professions Cada: The Coniraaars License Law does not appty to an owner ol proparry who 6uilCs or improves thereon, enC who daes such work himsalf ar herself or thraugh his or her own employees, provided that such improvements ere not inlended or oMeretl lar sele. It, however, the builtling or impravement is sdd within one year ol completion. Ihe awnerbuilder vrill have�ihe burden ot Droving thet he or she did not build ar improve for purpose ol sale.). � ❑ 1, as owner of �he properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo con5truct the project (Sec. 7044, Business antl Pmfesslons Cotle: The contractors License Law does not apP�Y �o en owner of pmperty who builds or improves thereon, end who contracts for such project wit� a contrectoQs) license pursuant to tha Contractors Licensa Laws.). ❑ I em exempt untler sec. Business ana Professions Code lor this reasan: Signature: Da�a: Owner ID veniieA by tlrivefs license. ❑ Ves ❑ No Drivefs License No. Expires: Vedficatlon oi Ownership by (ryqe W tlacument, i.e. - properry tvc bill or deed): DIVISION OF INDUSTRIAL SAFETV VERMR CERTIFICA710N: ❑ I hereby ceNfy Ihat no excavation INe (5) or more leet In depth Into which e person is required to descend, will be made in connection wlth work euthorized by Ihis permit, and that no building siructure, scaHdding, lalsework, or demolition or tllsmentling thereol, wlll be more Ihen Ihlrry-siz (36) feet high. (C�aD� 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Adminislrative Cotle). ❑ As owner-Duiltler, I will not empby enyone to do work which would requlre a permit Irwn ihe DMslon ol Intlusirial Sefery, es notetl ebove, unleu sucl� person lia.s a permit to do such work irom the tliWsion. Signeture: Division ot Industrial Safery Permit Numbar: Date: 1 W III Ihe epplicant or present or tuture WIItlIng accupent need to Ille enA certity e 8usineu Plen tor emergency response b releeso or threatenetl release of e hererAous meterial7 ❑ Ves ❑ No (Section 25505 0l the Calilomle Healt� entl Safery Cade requlres, with some excopiions, I�et e Business Plen be liled with the Cwte Mesa Fire Depariment Dy every business which has el eny one time during e reporteC year e Quanlity of herartlous meterials eQuel to or greeter Ihan e weight oi 500 pounds, w e vdume o155 gellons, Wes or wm tne appucam or presem or mwre (Sectlon 25533 of the Calitomia Heelih e� S one time hes on hund e quentiry o1 ecutety CORio�955etl gas at sfendattl IempBreWre efitl or wm tne moucam or upant need to file e registretion lorm for ecutely hazertlous materials7 �J Yes �J No wiN some exceptlons, requires raplslrellan wllh (he Cosia Mesa Flre Depertment by eech buslness which et eny melBriel9 eqU01 to or greater Ihen e weight ol 500 pounds, or e vdume o1 55 gelbns, or 200 cubic teet o1 axupant neetl to D�epare en (Sectlon 25534 ot the Califomia Health end Salery Cotle proviAes Ihat the Coste Mesa Fire Depanment may require the preperatlon, certiliwtion and tiling wlih the Fire Depertment ot en RMPP by buslnesses which are required to register ecutely hazertlous matedels wll� Ihe Fire Dopertment. ..__ ..................._....._'_"'........ " ""'_._........_..__........................_._.__.... _._'__ _— 4 tl en RMPP is presently requiretl, hes Seciion 25534 of tho Celitomie HeaIN entl Salery Code boen hlly complie0 with7 ❑ Ves ❑ No ................_.__......_......_" _"'__.................._....._.._.................................................."""_""_._..._._.__..—._ 5 Does or will fhe applicent or present w luture buliding occupent require lor Ihe work which is the subject ol Ihis e�pplication a pertnit lor such constructlon w modilication tmm Ihe SOulh Coest Air Ouality Menagement Distdct or tmm any other air polWtion wntrd distdcl or egenc�? IJ Ves L,J No (Seclion 65850.2 of lhe Calitomia Govemment Code requires that lhe requested intormelion ba tumishetl on epplicailon5 tor non-resi0ential bullCing pertnits). ...._ ..............__"...._._.._. ..___._......_..........__...._........_......_._............. _. —. 6 W ill any pan of Ihe tauliry to ba constmcted under this pe�mit be within 1000 feet irom ihe outer bountlades ol e school? ❑ Ves ❑ No Qt �es', Ihe tacilily mus� meet Ihe reQuirement ol Sections 2553n an0 <2303 ot Ihe Calllomia Heelt� entl Safey Cada). ... . .. . . ... ................_....__.......'—_._....._._...__...__"'_"".........._._.__............................_................................__....._.._...._.......__.._...—_'._.....'_'._....._.._"""'__'_" .................... ......... ... . P Y N 7 If e permit frwn ihe South Coest Air Oualiry Management Distdct or other elr pollution control district or egenq is required for Ihe work which is Ihe subject of this applicatlon, have all ol the disdosures rescri�etl b Calitomla Health antl Sa1e Cotle Sectlon 42303 Eeen matle? � Ves ❑ No .................._......._......_............"—_""'.....""'..__...__..._..._......_—._...............__..........................._._.........................................................................._.............._........._........�_.__......_ 8 (If'yes', anach ceniticate of compliar�ce irom Ihe apvro0�ate eir pollutian rnntml oHiceQ. CERTIFICATE OF COMPLIANCE: I certify Ihat u�Wer penalry ot perjury Iha inlormetion given abova is correct. I egree to comply with all state laws antl city ordinflnces regartling Hazardous Materials and Emissions. Slgnature: Dete: CERTIFlCA7E OF COMPLIANCE AND correcl. I agree to compty with ell steh ebove-desCribed property br in5pg�i CODE �. INSPECTONTYPE % 1616 Fixetl System Final Fire Preventlon 1268 Pool Spe Finel 200 Flnel RB-Rool 201 Finel BIocWReteining Well 202 Finel Fectory Fira Plece 203 Finel Sign 204 Final Dertrolition TIW7�OF EMAY: I certity under penalry ot perjury that I heve reatl this applicaGon anE state Ihet Ihe inlortnalion given is ty ortlinances relating to builCing wnswction, end au�horize representatives ol t�e Ciry ol CaSte Mesa lo emar upon the agree not to o�ipy ar ellow occupency ot any building euthodzed by this permit ur�til linel in� pection. �g �� '� UL �'✓A COOE 1 INSPECTION TYPE 206 Final Mec�anicel 208 210 212 220 222 250 Final Plumhing Finel Electdcal Finol Flre Preventlon Finol Plenning Appravel Final Sile Finel Building/Occupency PAg IIIIID�Li -i � � OWNEfl'S NRME: 376 1�6TH PL nooaess: S�EOND ARMSTRONG �• RPCMIENGINEEB: 5 4 a— 8 1 4 a nooness: NFG.NO.: uxir: H uxiT: PEqMinEF' RAYMOND ARMSTRQNG ( 714 ) 548-8148 aooness: 376 E 16TH ST H C.M CA 92fi26 LICENSEO CONTflRCTOfl OECUbATION: I �ere0y allirm that I am licenud unUer pmvisions ol C�apler 9(commencinq with Section 7000� ol Division 3 0l i�e Business anU Pmfeuians CaOe. an0 my Ikense is in tull force anG efiect. GTY LIC.: STpTE LIC.: LlASS: Date: SiAnature: WONREflS' COMPENSRTION OECLAflFTION: I hereby a�firm ��at I �ave a cenificate ol consen� Io sel4insure or a cehificaie o� WOMers' Compensalion Insutance. or a certilietl copy Ihereol (Section 3800. �ab. C). POUCV NO.: E%P. DRTE: CeNIieU copy is �ereEy lumishetl. ❑ CenilieE copy is liled wi�� t�e ciry Builtlinp Uvision. �ate: Applicam: E%EMPTIONFflOMWOflNEflS'LOMVENSIITIONOECUNATION: (ThisseqionneetlnmGecomplereOi�IAepermi�is�oronehundreA�$100)arless�. I cerlily Ihat in Ihe pedormance of ��e work lor w�ich IAis pe�mil is isSued, I shall not employ any De�son in any manner so as to become Su�le�� o t�e WOrk¢rs' ComDensalion Laws 0� Calilomia. / Daie: � ' � `� " 9 2 SignaNre: ��/ ?+�A �-a—�-C NOTICE: II, alier making Ihis aeclaration. you snoultl beco e subiect to ihe Worker5' fAmpensation Dmvisi s af the Labor Coae. you musl lonhwith comply witA such orovisions or Ihis petmi� snall be tleeme0 revokeE. CONSTNUCiION LEN�ING RGENCY: I hereUy ailirm Iha� there is 3 tOnSimClion IenAing aAenty tor �he pertormante ai �he woB �Or which Ihis permil is issuetl (Seclion 3097. Civ, C). LENOEfl: aooness: OWNEH BlIILOER OECLABATION: I her¢by allirm Itlal I am exemp� �rom t�e CAnIraC�alS' State License Law for me follovnnp reason (Seclion 70.31.5 9usines5 anU Pmtessional Code: Any ciry o� coun�y which reQuires a permit to consiruct, atlef, improve, tlemolish, or repair any simcmre, D�ior lo i1s issuance. alsa requires Ihe ap0�ican� lor such permit ta file a sipneA statement t�at he/sAe is licensetl pursuant to ihe pmvisions oi t�e Comramors' Slale license Law (Chap�¢r 9(commencing wi�h Section 7000) of Division 3 0l the Business an0 Pmlessions Code) or Ihal helshe is exemD� �herelmm an0 I�e �asis �ar �he alleged exemplion, Nny uiala�ion o� Section 7031.5 by any applican� �ar a permit su6lec�s Ihe applican� Io a civil penally o� nol more Ihan live huntlretl tlollars (E500). I. as awner ol Ihe pwpeny or my employees with wapes as iheir sole comoensalion, will do tAe work, antl ihe � stmcwre is nm inlen0etl or otferea for sale (Sec�ion 7044, Business anA Pmfeuional Cotle'. ihe Cantraclors' State License Law tloes nal ao7ty to an owner al a pmpeny who 6uilas or imD�oves thereon, and who aoes such work �imsell/�erself or Nmugh his or ner own employees, O�ovitlea Ihat such impmvemenis are not inteneea or otlereE lor sa�e. If, however ihe building or improvemenl is soltl wilhin one year al complelion. �he owny� will have Ihe burEen o� O�ovinA �e�she tlitl noi builtl or impmve br the purpo5e ol sale�. I,as ownerolihe propetly.am eKclusively conlrac�ing wiU lipensed contrac�ors�o consiruc�the pmject(Section 70a4, Business ❑ antl Pmlessions Cotle: The ConVaclors' S�a�e LitenSe Law tlpes not apply t0 an owner 0� property who bUiltls or imO�Oves �hereon ana wno conVatis lor sucn prolects witn a toniractor(sl lico,nse pursuanl to ihe Coniractors' State license Law�.l am aware Ihai prool al I�eir Worker'S COm0en5aii0n insuranCe S�ou10 be prouid¢tl ro me. � I am eKempi under Seclian: B. 8 P. C, lor Nis reason: Oaie�. (O _ � / ' 9 Z- Ownee I tlo here�y cenily Ihat I am aware ol and untlerslana Ihe repuiremeng ol Calibmia Healt� ana Safery Code Sections 25505, 2 533, antl 2557A and I�ai l or any INure building occupanl will/will no� (circle one) neeA Io camDly vn�� uid sta�e codes an4lAe requiremen�s for a Oermil lor consimclion or mo0tlicalion Imm �Ae Air Ouali�y Managemenl Disintl. FesiOential conslNction apPlica[ions are exempi from Nese provisian5. / / oate: G —/ �f — 9 L AOPlicanl: �2vn ( .cn�4�'.te�..n _ I here�y [etlily Ihal I �ave ieaU Ihis applicalion antl Siale Ihai Ih aU4�is correci. I agree to comply with I city and counry ordinances and slate laws relaling 10 builAing consimclion antl hereby aWhoriie represenlalives ol lhis ci�y to enter upon ihe above-men�ionetl proOe��Y �or inspection purpases. ;7 ��/)� �c/ _. oaie: G`�5 — 4 2 Signalure' /` � "u�'Y✓J/l/�4-r-Y � � Oriver's Lirense oi Social Secmity a: � �qppl¢anL Pink—Revenue; Goltlenroa—Asseswr CITY OF COSTA MESA — BUILDING PERMZT PERM NO: EP 05789 PERMIT NO: EP 057898 PLAN CHECK NO; N GOVT; N SUPP; N CONSTRUCTION TYPE: PERMIT TYPE: ELE PLU PURPOSE: OTH JOB DESCRIPTION : GAS 6 ELECTRICAL LINES FOR PORTABLE SPA SQ FT; CLAIM VALUE; CALC—VALUE: GROUP OCC: / COMMENTS• AHOVE GROUND PORTABLE SPA *�r*��rx ��*�***��r* x�*�e��******��r*�**�*x**�t**�**�***�*+t*�e*�rt�****x-*�*��**�***�x*+�* Z O N I N G Ei E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDZNG --------- FRN'T: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: F'T IN PARKING RE(� • PROV: PARCEL: 00000000 ZNE; REF NO: PLANNING NiST'ES> ) �. it iF if iE 3E iF iE if iF 1E iF 1E�F 1E IE 1E 1E if 1E if iE �IE 1E �E �F iE if If iE if iE if iE 7f k if iF iF iF3E if if af i! iF kiE jE 1F iE iF k k if iE aF iF iF iE 3E iF ik iE 1E fF aE iF ik 1E k iE jE jE if 1E IE ii 1! iP 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 HY DATE: AUILDING APPROVED HY : 'i �� DATE; APPLICATION ISSUED BY: � S�� DATE: �o ( lfifitifiEiElEiflfiFlEiEiEifiFaEififikiElFlF�FiFiETf'if'iiiF7F�Fif3F7fiFiFif7Fff%3F iFiFifiFTF�iFififififkififiFiEif ifiF 1E 1E 3E iE IF 1E 3F iE fk if� if -1f iE iE il� aE k!t It� 3k 1E if 3f !E 3k If if iE il� if 1F if iE M ik iF if iE if� 1E iF ik k if iF ik if } 1E iFiF ik )f #� # if it iElk if IF Ik if ib iF 3F i41f ik iE 1t �k Il� if if �Ih * if * LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2�5= �11 75 �08 SMIP/NON—RES PLAN ISSUE FEE 3,00 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 13.75 18,00 0,00 31.75 31.75 .00 REVENIIE DIVISZON TOTALS--> COLI;ECTED; 31.75 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR 5,00 26,75 � 1E if if if iF i't 3f 1f iE iF1f iF iF �lf 1f if iF k iF 3f iF �E iF 1E iE 1flE i! if k iP iF k iE 1E it 1t iF if iE 1E iE iF if iE iF iF iE it iE iF if IF itif if if iP �F 1f iF k!E ik if �E if �F if i4 iF iF M� 1E if iE jf iE iF I N D I V I D 0 A.L F E E B R E A K D O W N t. TYPE QTY D E S C R I P T I b N [7NIT COST TOTAL COST ELE 1 RECEPT/OUTLET 1 ST 20 EA, .75 ,75 ELE 1 MSSC CONDUIT NOT LISTED REQ PERMIT 11,00 11.00 PLU 1 GAS PIPING SYS OF 1 TO 4 tSUTLETS 2.00 2,00 �END OF FEES f' a :. CON?iRUCTiON ANDPLANNING APPROVAL5 Permit # i. Temporary Elecirica� Service or Pole 2. Soil Pipe-Undrqmd. 3. Hectrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. . 5. Steei Reinforcement � 6. Electrical UFER Grnd. 7. Footings . 8. Fo�ndation � � 9. Water Pipe�Undrgrnd. 70. Structural Floor System 71. Property Sewer line & House Connection 12. $ewer Cap 73. Roof Drains ' 14. Rough Plumbing - 15. iiough Electrical-Conduit 76. RoughElectricWiring t7. Rough Wirir�g Sign 18. Rough Elecuical�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. Root Sheathing 26. T�Bar Ceiling (Structuraq & Monocoat 27. frame and Flathing 28. Lathing & 5iding ' 29. Insulation � ' 30. Drywall Nailing � 31. Plaster Brown Coat 32. Electrital POWer Meter�Final 33. Finai Elec:r�c 34. Final Heating & Air Conditioning. 35. Finai Gas Pipe-Test 36. Hood or Canopy ' _ 37. Final Facto�Y Fireplace ' 38. Finai Plumbing 39. Water Service�Final 40. Gas Service-Final 41. Solar pomestic-Finai 42. Backflow Preventer. 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Att¢nuation: 46. Handicap Regulations - 47. FINALSTRUCTURE&BUILDING 48. FINAL PLANNING 49. Electric Retease to Edison 50. Gas Release to Southern Califomia Gas Cc Date Date POOL � A. Inspector AppROVALS Pe�mit # Date Inspector 52. Pool & Equipment Location 53. Steei Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAI TO COVER-GUNITE 58. Electricai Conduit�Undrgmd. 59. Gas Pipe, � Undrgrnd., 7est 60. Backwash Lines, P�Trap, � Undrgmd. 61. APPROVAL TO DECK 62. Backwash & ReceptorFinal � 63. Heater & Vent-final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final � 67. Fencing & Access Apnroeal 68. APPROVED FOR PLASTERING . � 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground�Hydro � 77. Product Pipin� ��Ga's U Oil 72. Underground Flush � - �73. Undergmd: Storage Tank � Gas ❑ Oii �74. "Overhead Hydro 75. Dry Chemical ' 76. Dry Standpipe 77. FIXEDSYSTEMFINAL 78. FIRE PREV. FINAL ' � HEALTH DEPT. REQUIREMENT � � 79. FINAIINSPECTIO.N i - � � 80. FOOD CERTIFICATE ISSUED � Notes:(��7.�tjZ_ No OA�.(lOM��-LEF7'�a0�C0-'C.FD �� u 0 G s � - CITY OP COSTA MESA SERVICE REQUEST & PUBLIC ASSISTANCE FORM � Da[e / r ^�� C.illcr's Name Nature ol' Reque,t: (loca[ion, type. s rity) �/ I� �� 37G � /,�'-� S7" - �� ' Referred Person Receiving Call _ ;e::�-.:._ Time Phone .-7,�/� ' �� T � . ,�a ._. � Call back � �d� Service Onty � Information Only � '." .,.,.. ';F:;i c-cn.,.,T , . . _a,.. �.k....-::S•:. . .. .. . ?...�: .t.^t^' rv *..-r,}^Yy/uF'� ..'"=:.:r "y,� ' ' _ . _ _ ' . . � _ - �_.F ' " �� /) �j� �O�W.y, Y I�a�S� �!!�� ,A. , `ww� G.-., _& � .. � �.. } . , � i � �ro,� , ��'��.t- )�'+'kY� . _ . , C '� . ,Y . . . . ti., . e; 5} .. , y, q. i° .. � S M ��%�.��O��IIi�� . -� � � ,'y du � ., i , ; ,� . , . , ... � ., . .. . . . .. � . <. � � . . L. • • � . ��. �.+ s�. �„p �,a r�q+i''�,� ,' . . . ', ,�� ra� � -:;�i .y / - Z;i-;'7G � _ - ': b. �, . .. � .. . _ " ' . . . . .. . . . .+•.:. ' � -;�' . .. . , � '-'y . . . ... . . . ' .. �iW Sk . , i. .: . � ' *4.�; . . . . . ,.` � y�+i: s. ! "p � .,. . d�i.� . . . 1r .. :, . ' � .. , . . - � '� ?3'i . :r:. , � ^. . y y . w . °�.� . .. . . . . �.. :• �' c' � . � ' . .�;WY,po� :r,--, P" or P1ace BUILDING PERMIT NO. DESCRLPTION OF WORK F FIRE ZONE VALUE Date GROUP TYPE SUBCONTRACTOR OWNER ADDRESS DATE BLIILDING PERMIT NO. GENERAL CONTRACTOR hlgrSh211 Bldi'S. VALL[E $ 1�200.00 AP. No. LOT $ TRACT 33ly5FIRE ZONE 3 DESCRIPTION OF WORK PPt., G3T'ag5( (="'�UP J " TYPE V ZONE PLAN NO. In�PECTIONS DATE I sUBCONTRACTOR PERMITSISSUED � � � �_ DATE NUMBER coat i•• �--�- OWNER r.prtt.r� rnarc�ra rrn,rcenrg.� Tur � DATE 9=l�-58 �— los a.DDaEss 376 - 16th Place BUQ.DING PERMIT NO. 7��q GENERALCONTRACTOR T. P. Gregg VALLIE$ 13�%6'T,00 AP. No. LOT g Txa.cr 33lir, rme zoxe DESCRIPTION OP WORK Dunlex Ii..,PECT10N5 I DATE I gUBCONTRACTOR I DATE NU 6rown mat Gas Tcst