HomeMy WebLinkAbout883 20TH ST - Building Permits�
JJECT�ODBESS: B83 W 20TH ST
owNexseame: CHANDLER, BONNZE J
nooeess: 883 W 20TH ST
COSTA MESA,CA 92627
RflCN/ENGINEEfl:
ROOXESS:
HEG.NO.:
UNIT:
UNIT:
PE"minEE' pETERSON ROOFING ( 714 ) 979-7111
aooness: 3006 ENTERPRISE p
UCENSE� CONTMCTOq OSupA O MESA at�irm Rw� I am Ik¢iKeJ unCerCD a��s a��pTe� 9 �wmmencinp wi�� Sec�ion
7q10) ol Div.sion 3 0� I�e Bu5ine55 arb PmiMsions CoOe, aM my I&enu is �n �ull la¢e anE elleci.
ciTv uc.: � q STpTE LIC.: 6O % HC�,y;��� ° C— 3 9
Da�e: �a S�pnaWre: � V _ . .
WOBREBS'C APE! ATIONOECIAMTION: I�e�e6yatiirmUWlhaue rtiliWteo�ton5enll�ureoratehilitale0lWOrk¢rs'
Compensalion Insurance, or a ceriilieG COOY ��ereol (Seciion 38 , a. Q.
roucvxo.: 1021355-93 EXP.ORTE: OQ�OSI9�I
comraxv: STATE FUND
❑ Cetlihetl opY is �ereGy Iumishe0. � Ce�ilied coOY is �iled wit� ihe c uiltling Oivision.
Jale: �� Applican�� � /ti'N� C'r �
E1(EMPP Ffl0 OBREPS'COMPENSPTION OECUMTION: Qtut nibe wmpleteGilthepermC aro� hunOrM(St00�orless�.
I[enily �hal in Ihe petlormante ot Ihe work lor w�ic� Ihis permil I5 issuetl. I shall na� employ any Derson in any manner so as lo become
subject to Ihe Workers' Compensalion LaxS ol Lalilomia.
Daie: Signalure:
NOTItE: II, alier maWng Ihis Uetlaraiion, you Sliouk Ge[omt SUGjtti Io I�e WOfkers Comperrsa�bn provigon5 01 t�e LaGor
Code. you musl lonhwith compty witn such pmvi5ions or tlus permi� Shail 6e OeemeG revokee.
CORSTflUtTION 1EN01NG AGENCY: 1 AereDy a�lirm t�al l�ere 6 a cansiruction IenAing aqency lor t�e peAormance o� I�e work �or
wnicn ih¢ De�mn is issueU I�tion 3097. Gv. q.
IFNOEfl:
ADUHESS:
OWNEP BUILOEP OECIABRTION: I �ertEy atlirm I�ai I am exemD� ��om Ihe ConiractOrs State License Law lor tAe lollavnng reasan
�Seaion 7IXit5 Buvness an0 Pmtesaonal CoEe: Any piy ol county wftic� repuires a permil �o wnstruct, alter, improve, GemoliSR or
�eoair any slmcWre. prior lo its issudnce. also repuires I�e appliWnl for suCh permit to lile a sipnea statemenl tlWl �Nshe is litensed
pursuant Io Ihe pmvisions ol I�e Conirapors' State Li�ense Law (C�apier 9(wmmenring with Section 70W) ol Oivisian 3 0l i�e Business
antl Pmf¢Ssioni Coae� a� Ilwl hplshe i5 eRempl Ihe�etmm iM Ne basis IOt I�¢ all¢q¢t C�emD��a�� A^Y �oW�ion ol Set�ion 7031.5 Cy
any aoP�icant lor a Dermit su0jecls Ne appliWnt to a ciWl penalry ol not mort t�an five AunOreO aollars �5500�.
I, as owner ol I�e pm0erty or my emVloyees wit� wapes as t�eir sole compensation, will Uo Ihe work. an� I�e
❑ svucmre is noi intenAeU or ollerea lor ule (SecUon 70i4. Busineu an0 Prolessional COJe: TAe Contractais' S�ala License Law
aoes not aooly to an awner ol a propeny wM10 �uilas ar imD/oves Ihereon, an0 wno aoes sucn woB himselVhersell or IhmuAh
his or �er own employees, pmviaeG I�al 5u[� imDmvemenis are nol inlentleU or otlereC lor u10. I�, however Ihe �uilAing or
impmvemeni is soltl wilhin one y¢ar 01 COmpl¢tion, t�e owner will �ave ihe burEen of piovinp he/She did not build or improvo
brlhe pur0ose o� sale�.
i
I, as owner ol me D�ooeny, am e.clusively tonlraCtinq wilh Iicen5e0 tOniraclars lo tonStrUti I�e prDlet� {SeClion 7044, Bu5ine55
❑ ana Pmleuims COAe: IDe Comrxlors' State License law Eoes not apDN �o an awner af pmpetly wlw buAas or imprwes Nereon
and who comratls �m sut� Dmjecls wii� a coniracloqs�license pursuam lo Ihe Coniracmrs' Siate License Law�.l am aware
�na1 pmof al llrcii WaMee's Compin5alion insuranee SlroulO Oe prpvi02E �o me.
� I am exempl unUer Section: B. 8 P. C.
for iNs reasan:
Daie: Um¢r.
I aa nereDy cendy Illdl I am awaa al anA uMerstana tl�e repuiRmenis ol Calitwnia Mealth aM Salety COGe StttiOns 25505. 25537, ana
2553E anG ttu� 1 or any luture GuilWnp O[cupani vnNvnll no� (ti�de one) neeG to compry vrilh said slate co�es antl l�e reQuirements lo� a
permit lai consimc�ion or mOGi�ita�ion Irom I�e An Ouahiy Managemenl USIncL NeSiEeni¢I fAnAmciion appliWlions are exempl Irom
Ih¢Se pmvisians.
oa�e: Murwm:
I �ere0y ceitity Nal I nav¢ reaG I�is applicalion ana state IIWI lne aGove inlormation 6 corrttt. I aA�¢e lo comply mt� all city a� counly
artlinan[es an0 sta�e IawS reWling �o OWNnq COnsirutqn aM Ilereb/ autinlize repr¢5¢ntativ¢5 oi th6 tiry Io en@r upOn IAe d�Me�men�i0n2d
O�oOerly brins0e uon p rposes. � (
�a�e: d� S Signawr<�(l L(�� � �
Oriver's License or aul 5¢cunty M:
i6a1 e6 W�ne—Buil�mg; Green—CaCa Enlorcemem: Canary—NpP���anl; Pink—Revanue: GolEenroE—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06438
PERMIT NO: B 064386 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: REP
JOB DESCAIPTION : REROOF OVER EXIST,W/FELT & COMP. SHING. SQ FT: 2,800
CLAIM VALUE: 2,800.00 CALC—VALUE: 2,800.00 GROUP OCC: B-2 /
COMMENTS: SMOKE DETECTORS ARE REQUIRED AS PER U.B.C. 1991
it+rit�r�r*�t�*�*rtitft�*r�r***r***+t*+r�+r��t■+t*x�+t**�+tir*�r�**�r**r�***+er***�rrt*�*r**ir�,a**r�rr+r*r
Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGEIT: FT IN
PARKING REQ• PROV; PARCEL: 42251329 ZNE: REF NO:
PLANNZNG NOTES> �'
�
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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 BY DATE:
BUILDING APPROVED BY : DATE: ��
APPLICATION ISSUED BY: DATE:�*�
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LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/RES" GRADING
PERMIT 54,00 .50•
PLAN SMIP/NON.;RES
ISSUE FEE ��'
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID � DUE
TOTALS----> 54.50 0,00 . 0.00 54.50 54.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 54.50 OVER/SHORT: � 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADZNG'PLAN—CHECK
54.00 ,j .50 /�,
i�i4lfMiE�fifkilikitititiF�EkkfklkitNifkMikifilifikkkkiflfl!lfifffkMititlllf7fitMkitMitlflfkMMlE1hMlfifitififiEitklfiflflFiflEkfElEkiF1E
I N D I V I D 0 A L F E 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
SFR 2800 REROOF BY VALOE RE$IDENTIAL NOZONE 1.00 2,800.00
END OF FEES '
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OCT 0 g 1993 D
CITY OF COSTA MESA
�.!;ONSTRUCTION AND PLANNiNG
APPROVALS Permit #
1. Temporary Electrical Se�vice or Pole
2. Soi� Pipe-Undrgrnd.
3. Electrical Conduit Li�litY�Undrgrnd.
4. Electrical Condurt•Undrqrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8, Foundation
9. Warer Pipe-Undrgrr.d.
10. Structural Floor Svstem ` �
7 7. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drain: �
14. Rough Plumbing
75. Rough Electriwl-Condwc
16. Rough E�ectric Wiring
17. Rough 6Niring Sign
18. Rough Electrical•T Bar Ceiling
19. Rough Heating & Air COnditioning
20. Rough Factory Fireplace
27. Ducts, in Structure
22. Ducts, Venti�atin9
23. Gas Pipe�Rough & Test
24. fioof framing
25. Root Sheathing
26. i-Bar Ceiling (Str�ctura�l & Mor,ocoat
27. Frame and Flashing .
28. Laihing & Siding
29. Insulation _
30. Drywall Nailing
37. Plaster Brown Coat
32. Electrical Power A7eterF��nel
33. Final Electric
34. Final Heating & A+r Cortditioning
35. Finat Gas Pipe-Test
36. Hood or Canopy
37. Finai Factory Firepiace
38. Final Plumbi�g
39. 4Vater Service-Final
40. Gas $ervice-Final _
41. Solar pomescic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape irriqation SYstem
45. Sound Atcenuation
46. Handicap fiegulations
47. fINALSTRUCTURE&BUILDING /E
48. FINAL PLANNING
49. E�ectric Release to Edisa�
50. Gas Release to Southern Catifornia Gas Co
51. CERTIFICATE OF OCCUPANCY
lo. Date
Date
POOL _ 'A
Inspector pppROVALS Permit �
52. Pool & Equipment Location
53. Steei Reinforcement
54. Forms
55. Electrical8ondmg
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER�GUNITE
58. Electrical Conduit�Undigrntl.
59. Gas Pipe, O Untlrgrnd., Test
60. Backwash Lines, P�Trap, � Ur.drgrnd.
67. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent•Final
64. Plumbing System � Final
65. Electrical�Final
66. Solar System�Final
67. Fencinc� & Access AnP�aval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #`
70. Under�round Hydro
71. Product Piping C]Gas OOii
72. Underground Flush
73. Undergrnd. 5rorage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXEDSYSTEM,FINAI.
78. FIRE PREV. FINAI
HEALTH pEPT. REQUIREMENT
� 79. FINAL INSPECTION �
80. -FOOD CERTIF_�CATE ISSUED
Notes: r�� /� �0 6/ w i.e' �
Date �Inspector
'�i
Applicant to fill In all spaces exce0� t�ose within heavy Go�Eer Iines an0 sl9n all approoNate aeclarations.
p`' PER NO. TRACT NO. LOT N0. UNIT NO.
CI7 '�OF COSTA��3 CO �I��', W�.+CT N PERMIT � Sg y q,P, qy� zo�a
Project Address �7�j�+�p �% . S Main Building: Accessory Building:
}4ppliCen�'S Mailin AddrC`5 TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E FfOnt Z
❑ CONVERSION ❑ �EMOLISH ❑ OTHER ' T O
Owner's Name Phone��—o3�, DESCRIPTION OF WORK/USE OF BLDG. A Renr N
Address
Arch/Eng. License No. TVPE OF PERMIT GanDiNG FOUrvoATIOr� 57RUC7URA� � K Right G
Addre55 \ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g Lef[ R
,, , ` ❑ O7HER Ping. Ref. qW Parking Req.IProvided Q
Contractor's Na � /2.5-�-�-[Clione PROJECT DESCRIPTION 5q. F7. oCCVaANCv
Address (mailing) � � r8 ('�(Jo$ � ��_✓_4� �� Planning Notes: M
D�IlJLLC � CONSTRUCTIONTVPF VAIUATION$
City Li<Cnsa No. � 1 ZONE GRADING CU. VDS. ACRES
LICENSED CONTRACTOR DECLARATION S'
1 here�y attirm t�at I am Iicensetl untler prOviSiOni o( Chdrt<r 9(commendng Remarks:
�WIIh SeCIiOn 7000) Of DiviSlOn 3 OI ihe BUSin¢55 dntl PfOf¢SSiOni COtle, dntl
my Iicense is In ul ce antl eftect. ELECTRICAL FEES
�License I LI a �
Date Siqnature �j� PLUMBING FEES Auromatic Washer Transformer ❑ 15-50 KW
� WORKERS' COMPENSATION DECLARATION , Conitruction PoleSub. � 50+ KW
� 1�ereDy al/irm that I nave a certifirvte of consant to SelHnsure or a certlflcate Bar Sink Shawers
vorters• Compenution Insurance, or a certlnetl <opy tharem (5ectlon Backflow Preventer ServiceSink Coeking Unit Meter �up to 100amps
Polity No: h'96� Company D �� Backflow Irrigation ��,,�e� �yp Dishwasher Meter ❑over 100 amps
Certifietl copy is hereby fumisheU. �)
Certiti tl copy �/I etl witn tne city Builqi g I r o./ _/ 7 Bathtub5 SewEr Connettion Dryers ❑Gas ❑Electric Sub Pan21
_ Date�=�_=��_ ApO���ant—� ���� ��
EXEMPTION FROM WORKERS' COMPENSATION D ARATION
Clarifiers Solar Collectors Fa� Motors �61 HP � t Y, - 8
(ThiSu'C[iOn neetl not be com0�etetl I( the pe�mit IS 1or one huntlmtl (E300) or F.A.U. Inc.Solar �&75 HP �16-15+
less). Dishwasher Solar Pipin9
I certiry Inat in the performance oi tne work for whlch tnis perm�t is Issuetl, I Fixtures '
shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank MicrOwave
Worker5' Comp¢nsation Laws af Califarnia.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: If, atter making this tleclaratlon, you shoultl become sub�ect to lhe Outlets Ran 2
Workers' Compensalion Orovislons ot tne Labor Cotle, you must forthwith Floor Sinks U�inal 9
Compty wi�h suc� provl5ion5 or thi5 pB�mit Shall DG 080m<d tnvOkotl. '$witChES
CONSTRUCTION IENDING AGENCV GesSeNiCe Outlet5 WetefCloset 5�9�
I nereby af(Irm that there I5 a constructlon lentlln9 agency for Iho parformanco
ot tno work for which this permit is issuna (Sectlon 3097 Clv. C.) Interceptors Water Heater O Garbage Disposal Standing Sections
Lentler's Name
�enaer's aaaress Kitchen Sink Water Service Generator �65 KW 05�15 KW Trash Compactor
OWNER BUILDER DECLARATION r,.
I nereby af/lrm inat I am nxempt I�om tho Coniractor'S Llconso Law for thu Leveto�ies Auto-Wash
following reason (Sectlon 7031.5 Business antl Profaisional Cotla: Any city or
county whlch IeQuirei a pelmll t0 ConSlruct, alter, Irtlprove, tlemollSh Or repall P—TfBp LBUOdIy TI8Y5
any slructu�e, Orlor to Its I55udnCC, also �equi�ai tha aOP���an� (or suGh pa�mlt
to file a signed slatemenl Ihat �u/she is liconsotl pursuant to lhe provisions of Roof D�ains
the Contractor's License Law (Cnapter 9(tommantlng with Sectlon 7000) of '
flivi5ion 3 o� tho Bu51no55 antl Protessions CoOo� o� tha� hc/Sho Is exampt RBinSpBttiOn FBB $15 ISSUB FBB $ 3
relrom antl Ih¢ basi5 lor ihe allegeE exOmptlon. Any v101dtion ol SOCtiOn
'�1.5 by any applicant for a permit sub�ecti Iha aOPllcant lo a civil
.iaity oi not more than fivc huntlrotl tlollars (E500). DEVELOPMENT SERVICES RE�UIREMENTS:
❑ 1, as owner of tne properry or my employoos witn wages as their solo Reinspeetion Fea $15 Isue Fee g 3 Zoning Approved 8y Date
comp¢nSatiOn, wlll tlo tM10 wofk, dntl the StruCtUle I5 not IntOntlCtl ol olfel8tl
for sale (Sactlon 70aa, Business antl Professional Cotle: The Conlractor's MECHANICAL FEES ,,. BuildinB APProved By Date�
License l.aw tloes not apply to an owner ol a property who bulltls or improves
tM1crcon, antl who tloei Suth wolk hlTselt/hOrs0lt ol throu9h h15 of hel own BOiI¢I HOOd Of T ¢ I ❑ Applit'ation ISSUBd By D8t
empioyee5, provitlea that sucb improvoments are not Inlentlotl or ol/eretl tor YP �
sale. It, however, lhe bulltling or improvoment is soltl wilnln ono year ol com- Canopy Type II ❑ SUMMARV OF FEES
pletlon, Ihe owner will hava lhe bUrCen Oi Proving h0/Sho tlitl nol builtl o� Im- DUCt - UndC� i�irouOd
prove ror me purpose oi salc). BUIIDING PERMIT $ SMIP $
❑ I, az owner ol Ihe property, am exclusively contractln9 with Iicensetl con- Duct -Structural q¢frigeration System } pLAN CHECK $ PERMIT
tldClOf5l0 COOSI�UCt lll! p�OleCt (Saction 7044, Buslnas5 anG Prolessions Cotle: �
The Contrac[or's Utense �aw does not appry to an owner of property who Dutt- Ventilating ❑0.100,OOOBTU ❑100,000 BTU PLUMBING $ 0 ��UANCE $�
builtls o� ImDroves lhereOn. antl w�o <ont�act5 IOr such orolect5 wlth a r.on-
tractor�s Lcense pursuam w ene Cantracrors Llmnse Law�. I am aware tha[ ExhauSt $ystem ❑ Multiple ❑ System RepaidAlteration P�N CNECK 25% $ ENERGV P.C. $
proof o� Ih¢ir Worker's Comoensation insurance shoum be provitletl to me. ELECTRICAL. $ GRADING $
❑ I am exempt untler Sectlon B. S P. C. lor thls reason Firepl/Fact. Blt. �CBO dk Fire Dampers �- MICROFILM §
PLAN CHECK 50% $
Oate Owner Heating SyStem & Ducting Re9ister5 MECHANICAL $ / � a
I here�y certify that I nave reatl this application antl state mat tha above ❑0.100,000 BTU �100,0008 TOTAL FEE $
In(ormation is correct. 1 agree ro comp n al1 city ane county ortllnan<es PLAN CHECK 25% $
antl state IPws re��buil g stru lo�reby authorize epre-
sentativ¢5 OI tllis c y e pOn 8 dDOve-mBntiOnetl PI ty fOr
insptGtion urpos
Signature / Date
Drivers' License or 55 $ — Reinspection Fee $15 laua Fee $ 3 r, j�}�� �2 �� q.�� c -`-
�,i1.14 �'�'. � .
0865-46, rev. 5/88 - White - Bw in9: ana y- A nh Pink - Accoun[ing: Goltlenrotl - Asse55or 4��': �'�, �L: �� T����� �`_ �y;
. _ , .. _ ,.. .
�CCNSTRUCTION AND PLANNING . �pr ;pq
. APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. E�ectrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
5. Steel Reinforcement 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, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O 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
73. 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
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79� Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20' Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling IStructural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:�-Z{o-�f,p �,�',/Lyy�GT l�7�� �,-S
34. Final Heating & Air Conditioning ZQ 3 U�i - L��
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final FactorY Fireplace
38. Final Plumbing
�r
39. Water Service-Final �T7
40. Gas Service-Final �
41. Solar pomestic-Final, r� 1
42. Backflow Preventer � I �,
43. Backflow Irrigation ; �
44. Landscape Irrigation•SYstem
45. Sound Attenuation" . .j
46. Handicap Regulatio�
47. FINALSTRUCTURE&BUILDING
'48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co " '
51. CERTIFICATE OF OCCUPANCY -,
No. Date � � '
OWNER CHANDLER GARTH & BONNIE DATE
JOB ADDRESS i W. 2Oih St. BUILI
c
4.
Form
SUBCONTHACTOR
; �.��`'�" Zo s
CO�TA MESA BUILDINGSAFETY DEPARTMENT F E E 9R,�� E I V E D
P.O.BO%�f] G08TA M69A.CALIPORNIA
AU6 1
For Applicant to Fill In Complafoly APPIICATION FOR PERMIT
� TYPE OR PRINT FINAN(1Ev�OfiR� �
ADDRESS J �• OL� /J c CITYf4�F�6'3fA�1iffS94� "
RHCHIrt'NO. .�UT�.3 y
COSTA MESA, CALIFORNIA
1 � DD'��7��3 A�7e—eb 3.
OWNER V '�� %7 / L�. J J `/
MAIL (i /,' � ADDRE88 , �J - � N O ��JY,
ADDR6II8 � "✓•�� S�� '
CITY C �S� '� NO.C�/�✓� ZONH E GROUP
APPROVED „Il�i�% / .
ARCHITECT ^�� THL. BY DATB 6 i
ORENGINEER N . �
ZONING --
ADDRESS
2o�Ny no. oI uYQO� n[W � O✓
I.(�/ �LANf � �UILDINO S�O
�I
CONTRACTOR -
�ea„� Lo�se/ T/P /7/z
ADDRESS � �� DSecrtIMf�ON
A. P. NO. �I-r— 7 O 3 — Z/
CITY �
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL � 90" TO 81DE @ REAR P. L.
LIC. NO. NO.
6 9 ' � ��� / EAVE9
SIZE I no.o�eLDae. ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOw ON lAi
USEOF �— YARDSAPPROVED YARO9APPROVED
EXISTIN6BLDa. G O%� MAINBUILDINO ACCESSORYBUILDING
( FROM GL STRfiET
6ETB�CKLINEPROM / FRO T�Q Fr. r� , L/rye FT
C6NT6q OF eTaec'r REAR YARO �/� r
� / R'//TiC� �L YX��t��
SIDfi YARD I L6FT RI6FiT R. BI RT. FT.
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DESCRIPTION OF WORK L.81D �-firr.� Z srr-r.
NEW ALTHRATI N ADDITION
eene�'/%r� 73 �rJ�T.d��-r. �i
DIBTANC6 B6T. BET. MAIN Q
REPAIR MOVINO DBMOLIHH MAIN BLD 9. ACCES3.BLDOH.—�
BUILDIN6 /��(/ NO.OF / VAR.�C DATE ��
SIZE ROOMS BT RIQB C.U.P. �— APPROV6D
EXTERIOR WALL�p COVERIN6 ��'ROVb�� pATfi 8�A/Gv�
COVERING
U9E OF BUILOIIiG AND WORK TO BH PERFORMED
✓ if'i�/9%.t f aBB` ����
n
6Q. Ff. �
I HfiREBY �CKXOWLiDaB THAT I HAVt RBAD TH�9 APPL�C�TION TH8 AMOUNT HXOWN UNOER VALUATION IB POH TH8 z
ANO 6TRTE THAT TX[ ABOVH IB COqpECT AND AOREB TO COM. PURPOBE OP 86TABL19HIN0 A PERMIT FEB ONLY. �
PLY WITH ALL CITY OFOINANC88 AND 9TAT[ LAWB PHOULATINO ypLUATION • m.
em�o�No coNSTauR�o . � PERMIT FEE $ Li �
SIGNATURE OF � O m
PERMITfE ` s�DOd /
¢
AUTHORIZED AGENT
6� "
TOTAL PEE $