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HomeMy WebLinkAbout718 20TH ST - Building Permits� GOUNCY OF ORANGE BUILDING DEPT. 636 No. l3roadway Santa Ma, Cali(omia Phone: KI 2-6211 ,\ Application for Building Permit AND FOR A Certificate oE Use and Occupancy Permit No....a'�.._�.t�.! .`...._ .� Date.....P....�.�.��f.;/�/ ....--'----'--...._---..... OWNER'S NAME...../C/..9�/_I� h` � Y/il Y_��L� : �tI.C1.Cl..-- ..................... PHONE:-----.1.l1....ON L.�.. .....,.. .. MAILING ADDRESS........�I. ��...0 '.�. �.T .....��.....�..... �.!.�F E'........... CITY---...l•..O.S Tf�/ i/ L S�iQ- --..._. ^/' / � ,/ Name...(.l!.L?.��T.l ..................'-"'--'- ........ ..._...---.. ........... Name .... �./.t�/✓%/��..........�!�.�A�---�-l-�---""----"'--...."-'--...... (Archi[ r Enginccr) (Contractor) Address Ciry S[ate Lic. ] Phone..... PROPOSED USE:..:.;�/W`��NN�.. � __'_.." .................. .... ......... 2. JOBLOCATION----�I�...".�..?'�:. . y���./.!�> �. �'." (House No.) _ �j�V`'� (Namc of Stree[) 3. LEGALDESCRIPTION: Loc.�:/_�_?..Q ..................... f( Address City . State Lic. N / n O �X��.���� �«a����� ....................... - ----........,.._ ._ __........_. �j �c..-----�--- ..--.�_...-- �0.5� /%%FS /,� c_._.'..__.' ..............._.'._.._'..'..'."._."'."'_ _..........._. (Town or School Distric[) / � ....._....----------- Tract...--------LP- /'–' ............... (Me:es and Bounds Dcscnpnon—Use reverse a�de o orm) 4. CO��LOT�� � 1 INTERIOR LOT (� tr�TjHROUGH LOT ( ) SLOPE OF LOT ( ) a� ��1OV 9(j ✓� P i. SIZE OF BLDG.:�e. �EA :............. .... ..... .....SIZE OF LOT:.....[. V-.-X- �°�-.�_----AREA:.--_4�--�- 9-�----_ ��d �=�Y07oo "�� �i`r� �/ � i. . �HEIGHT OF BLDG.: ...- .................:..._-------....CEILING HEIGHT:...._..---._'--.-----...........NO. OF STORIES.---.�-.--_--.--------------- �� o 7. NO. FAMILIES---,.----�------------------------=---Size of Smallest Eedroom:--.-L-.`�-�.-----_-_-----.--.... Size of Kitchen---_---QXI.D.---_.--__ �rJiioM . -S-/DI�¢ ,Q 8. EXTERIOR WALL CONSTRUCi'ION :Le�...".s:?.Y.:!!?P..��...........INTERIOR WALL COVERING......1!_.!LA.�TF� .. , (Frame. Smcco. E[c.) �. %.. �.. / �(PI cer-Drywall, E[c.) A SLTBACKS: Front Yard Fro % enter Line of Strcct ......................l.. ..... ..�.�.... c-.-----.--__------------------.----.------......----...-- i � Nearest Side Yard.....�5........Rear Yard...�.�.l...d.r ..............Distance in Feet Betwecn Bldgs. on Same Lot....___......1�����.. 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND� s�E OF EACH. ll � � �� I l. For (a) Footing: Width.........��'� :........... .............Depth in Ground.••••h—.....----....-----Width of Wall..._.........._...-----"----- Accessory h v c� �. Bldgs. and h Size of Studs:....`.11.1..........5 aci❑ /.�D........:'CC Material of Floor_........._,'-_ .................._....__.... Similar � ) P 5 ............... Scracmres: (c) Si:e of Floor Joists:.........'.l�.........�...�.....Spacing ........................................:'CC (d) Size of �� "CC I2. VALUATION OF P� POSEDYWO�iK: Inc ding all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal �......�!.JO � �// ' � ...... � 1PJ'-�J" • 13. I HEREBY CERT[FY THAT TO THE BEST OF MY KNOWI.EDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL' CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Signcd Plans Filed:....�...e...I�.3..�_S �....------------------ ............. By:. FEES: Bldg. Permit • 5........� Plan Check - $.......... Total . . . 5......... Receipc No. - 7.� Paid to • - . Da[c .........----------...__...,Jr...�. !M-2.'JI FOR DEPARTMENTAL USE ONLY ���v GROUP....�.. . _ .............. --- .. ... �. �.......-- TYPE ...... .......................... 41,_D^� DIST. : .... 7� ... MAP......._ ........... ...�....... �.. .... SHEET NO......I .. ............. DATE. S'..�..�..�.� � ............. (Auchonzed Agen[) �" �CH�Ec/CKING BY APPLICATIOrrfl.u.LiJ HEALTH ............................ � FIRE ZON[NG - ------._...... _- PLANS AND -- AR HAL----------------... SPEC'5.-------- --..........✓. CORRECTIONS VFRIFIFiI ✓ IN STATE -- ........------........ ENGINEER CAL------ ------------ �-- -- ---.. DV� � � I� 7 . CITY OF COSTA MESA BUILD/NG DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ExlsUnq: 0 Required: 0 Proposed: 0 (714) 75a-5273 • Fax (714) 75a-4856 • wvnv.ci.costa-mesa.ca.us BUILDING PERMIT Jab Address: 718 W 20TH $T Suite: Vicinity: RESIDENCE ONLY Parcel Number: 42225110 npp�icant: MILLER, DALE Address: 13781 NEWHOPE ST GARDEN GROVE, CA Owner: KAHRE, MARTIN H Address 17226 DANBURY AVE HESPERIA, CA Contractor: DALE'S ROOFING Address: 13781 NEWHOPE ST GARDEN GROVE, CA Zip: 92703 Aroh : Address: 2oning: Phone: (714)534-6398 Zip: 92703 Phone: Zip: 92345 Phone: (714)534-6398 License: 503508 Eng: Address: Phone: NUMBER 843 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 11112/2002 IssuOd: 11/12I2002 Phone: Zip: License: License: SCOPE OF PERMIT REROOF RESIDENCE ONLY: T/O EXISTING ROOF, INSTALL NEW B.U.R. 13 SQUARES Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Exis6nq: o NOTES: Rear 0-0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0- 0 Righl 0- 0 s2,soo.ao s2,eoo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes antl related regulations. (Ortl. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become vold it work is'doticcjmmencedWithin»780 days, or il work Is suspended or abandoned for a pariod of 1 BO days. • �� ' INSPECTIONS: In order for Ihe work euthOrized under this permi� �o be considered legal, such work must comply with all applicable codes, antl all requlred Inepectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 �a� ��� WORKERS'COMPENSAnON DECLARAnON: — I hereby eHirtn under penalry oi perjury one ol the Idlowing tledaretions: ❑ I hava antl wlll maintain a cenifiwte of consent to salbinsure tw warkers' compensation, es proWtletl br by sectlon 3700 ot t�e Lebor Code, tor Ihe pertortnence ot Iha j�ork for which this permit I5 issued. � I nave antl vn'll maintain workers' compensatlon insursrce, es required by section 3700 0l Ihe Lebor Cotle, far the perfortnance of Ihe work for whlc� Ihis pertnit is iSsueC, My workers' compeyns�atlon Insurence ca end policy num�er are: �� y/Y�� CerAer. �'�f'%-/T �v'�'� POIICyNumber: (Th/s section e not be crom0leted i/ the permi(!s velued ef one hunEreO dW/ars ($100) or less.) ❑ I certily thet in the perlormance of t�e ork lor which is pertnit is Issuetl, I shall not employ eny person In eny menner so es to become subject to Iha workers' compensation laws ol C' la, en gree thet If ultl become suD�ect co the workers' wmpensetion provislons ot Sectlon 3700 of the Lebor Cotle, I shall fort�with comply with these proW ions. ApplicanlSigneWre: Date: �� ��� 'Z 0 WARNING FAILURE TO SEWRE WORNERS' COMPENSATION COVERAGE IS UNUWFIII AND SHALL SUBIEC� rW EMPLOVER TO CFIMINAL PENALTIES M1D pVIL FlNES UP TO ONE MUNORED TMWSAND OOLLARE (5100,000�. IN A�pT10N TO TNE COST OF COMPENSATION, OAMFOES AS PROVIDED WR IN SECTION 3]OB OF THE LnBOR CODE, IMEREST, AND AiTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirtn t�at I em brGO Bnd BflBCi. Lit. M_ Contrectors SigneWre: of Chapter B(commencing with Section 7000) ol Division 3 of Ihe Business and P fessions CoCe, and my license is in tull C1899 M _ �'� � �i, oate: //`/�-�� CONSTRUC710N LENDING AGENCY: .. ❑ I hereby eflirtn Iha� Ihere is a construction IenCinp agen�y tor Ihe peAormenco of Ihe work br w�ich ihis Oermit is issued. (Sec. 3097, CiNI Cotle). Lentler'9 NemB: LentleYs AAtlress: Signature: Dete: � OWNER-BUILDER DECLARATIONS: I here6y eHirtn thet untler penalty oi perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor Ihe following reason (Sec. 7031.5, BuSiness and Professions Cotle: Any city or wunry which requires e permit b consWct elter, Improve, tlemolish, or repair eny strucWre, pdor to ils issuence, elso requires the applicant for such pertnit to file e signed statemen� that he ar she La Iicensetl pursuent to the provisions ol the Gontractors License Lew (Chepter 9(commencing wil� Secllon 7000) ot Oivision 3 of the Business entl Professians Cotle) or t�et he or she is exempt t�erelrom entl the Casis for the alleped e:emption. Any violetion of Section 7031.5 by any applicant tor e pertnit sublects Ihe eppliwnt to e cNil penalty ol not more than tive huntlretl tlUlare ($500).J: ❑ I, as owner of Iha properry, or my employaes wlih weges es Iheir sole compensetion, WILI DO TME WORK, entl the structure is nat Inlentletl or oHered for sale (Sec. 7044, Business antl Professions CoAe: The Coniractors License Lew does not epply to en owner ot property who builtls or improves Iheraon, and who tloes such work �imsetl or herself or thmuqh his or �er own employees, provided that such improvements ere not In�entled or oflered for sele. It, however, the building or imprwement is soltl within one year ol comD�etion, the owner�builtler will have ihe burden ol proving that ha or she tlid not build or improve for purpose of sale.). ❑ I, as owner of the property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projact (Sec. 7044, Business end Pmfess(ons Cade: The contradors License Lew does not epply to an owner al pwpeny who bulltls or Improves thereon, antl who contrects tor such pro�ect with e cantracror(s) licensa pursuant to tha Cantractors License Lews.). ❑ I am exempt untler sec. Busineu and Pmfessions Code lor this reeson: Signatura: Date: Owner ID verified by ddver'91iCense. ❑ Ve5 ❑ No Drivefs Litense No. Vediication of Ownership by (type ol tlwumem, i.e. - properry tez bill or tleetl): Expires: DIVISION OF INOUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity �hat no excavaGon Nve (5) or more Ieel In deplh Into which e pereon Is required to tlescend, wlll be made In cannection wi�h work euthodzed by this permil, antl lhai no bullding stmcwre, scaMoltling, falsework, or tlemolllion or Oismantling Ihereol, wlll be more than t�irty-si: (38) feet high. (Chep. 32, Gry 2, Ar12, Sec. 341, Tllle B, Californla Atlminlslretive Cotle). ❑ As owner-bullder, I will not empioY nnyone to do work which wauld require e permlt Irom �he Divislon ol Indusirial Safety, as noted a�ave, unless such person hes e permlt ta da such work Irom Ihe dlWslon. Signature: Date: Division ol Industrial Sefery Permit NumDer: CER7IFlCATE OF COMPLJANCE AND AUTHORIZATION OF ENTAY: I cenity under penalry of perjury t�at I have read this application end state [hat the inlormation given is wrtect. I agree to compty with ell state lews entl dry ordinances relating Io bullAing consWction, end authodze represenletives ot t�e Ciry of Costa Mesa to enter upon Ne ebove-0escribad propeny for inspection purposes. I agree not to occupy or ellow occupency al eny buildinp euthonzetl 6y this permit until finel inspection. �atyre galOwner(s) D7ate . n / . �� �.�'v� r A thodzeC Applican� Date COUE �. INSPECTIONTYPE 1616 Fi:ed System Flnal Fire Prevention 1288 Pool Spa Final 200 Final Re-Root 201 Finel BIocWReteininp Well 202 Final Fectory Fire Placo PLiF It�LS /�Ie ,r�2 �dE COUE 1 INSPECTION TYPE 208 Finel Mechanicel 20B Final PlumDing 210 Final Electdral 212 220 Finel Flre Prevenlion Final Plenning Approval 203 Finel Slgn 222 Final Site 20C Finel Domolition 250 Finel 8uliding/Occupency � �� JOB ADDRE8S %�8 W ; GENERALCONTRACTOH � �oT AP# 115-3lt. J INSPECTION$ Foundatfon Forms and Wiri Ro Sewer � Plum6ing, Final, Fixtures Plumbing, Final GasTest Wiring, Final Occupancy I+orm '210 GH 1M 12•68 $t.• Owner-Builder BLOCK v DATE .,. ✓ ` 8UBCONTRACTOR DATE 6�3�54 � BUILDING PERMIT NO. �79 VALUE $ 8��� Garage & Storage FIRE DISTRICT �279 PEHMITSISSUED DATE I NUMBER � �CT 1 01955 JAN 10 1956 7J%iw f3 i y!i � � �,,�,�(' y,�.� /r�, �.� ��-��� f'.�,;�„� ,�z�dr' ,e-�.t ,a..c.��-e��y,�`-�. �n�� Costa b�esa Building Department APPLIDCATIOIV FOR PERDiIT -. 171 EAST 20th STREET � p U I.L D�I� �.G �.._ � -� COSTA MESA, CALIFORNIA � - - - i'OR APPLICANT TO F`ILL IN , �OR:OFFdCE USE ONLY . Reeeipt No. Permft No. e���d��9 `%/� sT .Zo _ � � � "tl I 27q Address - Costa Mesa, CaLf017ll& Received.by I Date /Ree'd. Date Issued ' Nearest /ir��G�% ��{ " � / �� �� 6- 3.>l� CrossSt. /%Cy �r.��2r Building ; /� �..l, J : Address ' o�•VX " �Owner �'fg�� A-rfiYE ' Costa Mesa,, California ' Mail /J � Address f %1li0✓� Nearest �/ ' 7e1. „�— Crosa9t. ( C\ 'A� (1 �(% <� � �. Gty �'� �No. Zone`��I Plans�����ITYPe'� i GrouPl�� Architect or Lic. 1� p Engineer No. Approved ' � ; ' - h Date ' - i . nddre� , CORRECTION � ' . City Lic. ntractor No. r i + Addreu Legal Lot�,o /� � 4escripUon � No.�7Y{�0 I Block � I TraCt y/i� -D- - - , - (Attach Metes and Bounds)/Y ��S �'jC/ �/ - _70 k /� 7 �No. oi Bldgs. A Size of Lot Now on Lot � � ��'1 . -- � Use af No. of No. ot •� — �;� 9 Existing Bldg. �jj/%%� I Familiee �I Rooma� � Setback Line from � Rear Vard rDS� �3� �- r (�Q� Z Center of Strcet Side Vard 1 �o D DESCR ON OF WORH v, ' r New I�Alteretion I I Addition I Repair I I Moving I Demolish I e . Building � No. of Size o�G k tltl' � eooms �, Stories / �teriar Wall I Rooi � � ierin9�7'UCte �'a�a, Covering _Q��L% APPROVALS vse of New /'� � Foundation Locatian Inspeetor Date Buildin9 Y9JPI� �£ OC S%O�fICTL Forms, Matertals, Under-Pinning ' Frame: Fire Stops, BraCing, Bolts � Lath.lnt. f hereby acknowledge that I have read this Application and state that ihe above is correc[ and agree to comply Lath. Ext " with all City Orclinances nnd State I.aws regulating building construction. //� _•="r Signature o� // Plaster, Int Permittee � Plaster, Ext. Authorized Agt. Masonry Reinforced Valuation Permit Fee $ �� � (� �J Plan Check $ i/� ^ Bond Beam $ �00\� Total �'1 n ^ FINAL Fee 3 / Vunn 1�Id (:-H IM 1'L-LJ � . � J '.I .' I "' _ . . I �'$' +� � i , f��r4"� ' !'�-_i .' � ✓: ., y, i�t.t - , ' .; ; :' Street :� .R. _.. ;�, ;s� o � ��. . � � _. _ � �Cl _ `�-;..a . � d a` � , �, '-•\�1a ' \i.;11.'.��,�.,� �� \ _ � 1�'.�\i•, . '\ \' • `\ 1 a ...�4�� , ` .. t , .i�`. \�q.a�` �. ^ yhow location and distances from property line and between buildings. . . , a: . � � ._ . '�� � �,�.�.. . ' . �� � ...� � m t _i \C.y. :`�... . . '—•� , � '� . � . . . - . , C.. _ _ . , '� . �t _, , a ; , :� a OW NER K�Ff MARTIN H. . � DATE 6-4-56 . ..�� JOB ADDRES3 718 west 20th �'treet BUILDING PERMIT NO. 3145 GENERALCONTRACTOR V�U�7�U4/ VALUE$ Z �aluation �BOO.00� � 39-4o BLOCK C TRACT 612 Gara�e and Storase GROUP J TVPE V ZONE R11 FIRE DI6TRtCT 3173 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER Footing Trench Foundation Forms antl Grade to Garage Rough Framing Plumbing, Rough to Slab Plumbing, Rough Complete � Temporary Pole � Wiring,Rough / � ,j( �j-x,Q�l� Ej— �,� 3 Heatino. Rouah Sewer, House Sewer, St. Septic Tank or Cesspool � ,9, �� X � ouc Pla tering �% Plumbing, Final, Fixtures Complel Piumbing, Final Gas 7est Wiring, Final Occupancy FORM 210 3M 10-v9 � Costa Mesa Building Department „ P. O. Bo: 3!7 COSTA MESA, CALIFORNIA FOR APP CANT TO FILL IN 3uilding � - y]��� �C \ddresa ,� Cy,sta Mesa, California i nrteci or Lfc. iineer � No. Iress Cfty Lic. t�aCtor Na_ :G} � 1'/ . n I No. of Bldg: SizeofLot �.t � / NowonLot l�se of No. of Existing Bldg. O� e Famiiles Setback line from /// Rear Vard I 119ovin9 � � Demolish � �/�No.of p� � Rooms v`� Stories � . I Roof 6ui�cltng �/�"/'�Y C O�J�'+�' � AAI ..� ' �#� I hereby acknowledge that I have read this Applicatlon and state that the a6we is correct and agree to comply with all Clty Ordinances and State Laws regulating bullding construc ' �✓ 3lgnatureM � . /J,�,�y� Permittee Y Authorized Agt Valuatlon � �7 .�y -Permit Fea $ •✓ / �� Plan Check $ � $ O U Total Fea �t � d APPLICATION FOR PERIVIIT BUILDING � FOR OFFICE USE ONLY Reeeipt No. Permit No� 3%�S Received-hy Date Rec'd. Date Issu d �,.� 6 '�—s—� • .�— cj-S Builtling Address Costa Mesa, California Nearest Cross St. �YJ?if�11'La1 CORRECTIONS APPROVALS Foundatfon Location Inspector � Date Forms, Materials, I Under-Pinning Frame: Fire Stopa, Bracina. Bolts Ini ExL O a L) 2 D r PLOT PLAN Show iocatlon and distances Trom property line and between buildinpa � : COSTG ���r:-4-�cPD�,ES:; �;�n� -.�:,:..,,3.^� CONTRACI'OR C^'lUP I�r.�PECTIONS Gas Test DATE VALUE DESCRIPTION OF WORK TYPE ZONE DATE I BUBCONTRACTOR I DATE G- ar_ PERMITSISSUED I NUMBER Costa Mesa Bnilding De�eartment :�PPLICATION FOR PERIVIIT . . ' P.O.Boz3�� �2�? BUiLDING ' " COSTA MESA, CALIFORNIA FOR OF'FICE USE ONLY FOR APPLICANT TO FILL IN Receipt No. Permit No. B���m�9 D -��� Address Costa Mesa, California Received by ate Rec' j Oate Issued Nearest - � 6-�S =� CrossSt. C'iyiLl.. Builtling Address Owner � ye-- M,,,, , _ , �., Costa Mesa, California ArchitectoP � En9ineer � Address � ttractor Address � Legal Lot p� Description No�/ (Attach Metes and Bou� of New Repair Building Size �-terior �erin{ _ae oi N Alteration Movfng i � No. of CC No. :k 1.,, I Tract f( �s--ay�- i No. of Bidga Now on Lot No.oT II No.ot Additiun� I Demolish I ' Stories ! PL> frvt�; n. =1 b l,� �V� � � � 't. : - .= � r p � t '� �Pfr ^� '�1 : t , s : s APPROVALS in Location I Inspecto Materials, I hereby aEknowledge that I have read thls Applicatlon and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating bullding construction. 'I /J Lath. Ext Slgnature ot:7,.� /1�� // ,� Permittee �CL/��L��vr" Plaster, Int Authorized Agt Plaster, Ext Valuation Pe�mit Fee $ % Masonry Reinforced $ j J �% h 0 i Plan Check $ r ga�d Beam (O /A Total �9 Fee $ U1 I FINAL Date i6, � �• � PLOT PLAN 6how Iocatlon and distancea from property Iina and between buildings � ; 3'>>"c - `�'� . ,,� ;� :� 1 . ��1 \ 'll'rll cosr- 9'S��pNEsr, "4�� .. •.,�i 77.�n i� � a�� , � tiC� J•1���1� . � \� i. \ \� �-'� .,\: '(,'�1 � �� �i� �J��`� fi�,� J..i a 1 �i\X�\c\ � � ',�� ,����. ��' V� � �.r' � t r ''� �, .• �. - � � �� : :.: .,\ � �.�. � c tI; ,..t� � r � • "r.�� � > > ��'L. , � ,� ,,�,� a; � ,;�,,,_�. � , . , . . _:��� s� ,�,�c• OWNER KAHRE� M. DATE Q-19-S$ IOB ADDRESS 7l A W_ �Rth St _ BUILDING PERMIT NO. 6�t112 E R CONTRACTOR �OwrieT-BuildeT VALUE S ---- �A . o. LOT 3B &'I'RAc'r 612 FIRE ZONE DESCRIPTION OF WORK Duplex-0ontinue Wo�.1C_. �2 P"'IIIP I. -�TYPE �V ZON$ RLt ' PLAN NO. � e O❑ 8l7fil �3' IhoPECT10NS I DATE I SUBCONTRACTOR I DATE PIRM'TSNUMBER caat Gas J ' 64�2 f� COSTA MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN BUILDING AODRE55 OWNER aTv L. ARCHITECT OR ENr,INE A�D. �5 J- C� COSTA MESA. CALIFORNIA ? �q� �- n � TEL. NO. � LIC. NO. LIC. NO. �� TEL. ADDRE55 NO. LEWL CE' DeSCAiPTOrv NO? y`� f� BLOCK C TRACT A.P.NO. S— � / // SIZE '� NO.OF BLOGS. OF LOT C � now oru ioi USE OF • r � EXISTING BLOG. L.�. C( $ET94CK LINE FROM �`� � C � CENTEP OF 6TFEET 7 ftEAR V RO SIDE YARD , RIGHT �EFT � / DESCRIPTION OF WORK NEW � ALTERATION ADOITION REPA. MOVING DEMOLISH BUILDING4a � �� NO.OF` SIZE /�Q ROOMS STORIES EXTERIOR WAL ROOF (� `S/ COVERING C(� , COVERING �, USE OF NEW BUILOING I�.�l � ^h �� � - i . �/� � � �� U��i� ��'u�rv�lLl� � _ i�-s8 v�. G;`:;::,i>� C��'J. C�7 (:i C��.� �'�'`�r APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY FECEIPT NO. /PE�R/MI�T /N�O%.� l0 % T`�/ ECEIVE'D BY OATE RE/Cf�EIVEfi �D1LTE ISSUED ��� �w �{Y�`1 Ni / �� �� BUILDING � nooRess COSTA MESA. CALIFORNIA FIRE APPROVED BY OATE 2 CORRECTIONS ti�� 3�-y� HEREBY C NOWLEDGE TMPT I M1VE FE40 THIS tPPLICRTION FND STnTE TMnT TME aBOVE IS CORRECT FNO r1GFEE TO COMPLY WIiM wLL CITY OR�INLNCES INO $T>TE L�W$ FEGVL>TING BUILOING CONSTRVC� TION. ^_ SIGNATURE 6�i�/^ �/ • �j �� PERMITTEE � � � � AUTHORIZED AGENT CITY � -f'ti SUBJECT BYr�r,�T.� :1 ^:`ESA 7€�?'S� D'cPT. REG. ✓ /�'✓✓Y+k VALUA ION � MiT FEE S '��/// . _ PLAN CHECK S $ L'�"'��C1 TOTAL FEE 5 �L"'�' veMr �: