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Home My WebLink About1104 VALLEY CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1104 VALLEY CI Suite No Vicinity: Parcel Number: 42203107 Applicant: JIM WAYNE.EICHAMN,EMPIRE PLUMBING HEATING & A/C Address: 12922 HARBOR BL ' SCOPE OF,PERMIT = J ` 80,000 BTU FURNACE. Yl f $OD� 0 _ 30 To 50 hp-/ / 1,750 k BTU - �� Phone: 714-530-7320 GARDEN GROVE, CA- Zip: 92840 - Inst FAU >100 k BTU \ $0.00 Repair/Alt Cooling/Heat, $000 Inst / Rep. Recess Wall Htr,$0 00 \�$o Owner!'/ NEEDHAM, PATRICIA E /` 00 Refrig Sys >100,k•BTU �j�� rim Address: -VALLEY CIR% Gas Piping �� vv� %� $0 00 11104 $0 00 t $0.00 VAV Box ��$0 00 ' Phone: Appliance COSTA MESA. CA Zip:.. 92627 Smoke Dampers $0 o0 Inst or Relocate Appl Vent Contracfo>JIM WAYNE EICHAMN EMPIRE PLUMBING HEATING & A/C / i $0.00 Air Handlers > 10000cfm j / Address: ,12922 HARBOR,BL Floor Furnace $0.00 Floor or Suspend Heater -'Phoria:. (714) 530-7320 GARDEN GROVE, CA-�- Zip: , 92840 ' ! License: 652877 _ I Arch / Eng : - `, //Address:,; _ Phone: - �' !- • '/ -...Zip_,. License: SCOPE OF,PERMIT = J ` 80,000 BTU FURNACE. Quantity Status: ISSUED Applied: 01/30/2001 Issued: 01/30/2001 ISSUED BY: Repair / Alt Absorbtion Unit 1- -Repair/Alt Refrigeration Unit 0 Ventillation System 0 EvaporatiGe.Cooler, 0 .tt' Commercial. Incinerator; ' 0' Domestic Incinerator VO �0 %- � ,�� Compressors /Absorption Sy 0�- i , "Up to3hp/700 kBTU%� �/ \SQL Yl f $OD� 0 _ 30 To 50 hp-/ / 1,750 k BTU - �� x$0.00/0' $0.00 J 0 6' - ISSUE FEE ., �- \ .. $23.50 Inst FAU <100 k BTUs\, ; $14.80 Inst FAU >100 k BTU \ $0.00 Repair/Alt Cooling/Heat, $000 Inst / Rep. Recess Wall Htr,$0 00 \�$o Refng Sys <100 k`BTU /` 00 Refrig Sys >100,k•BTU �j�� $000 Gas Piping �� vv� %� $0 00 Factory Fireplace\// Hood w/Mach Exhaust, $0 00 t $0.00 VAV Box ��$0 00 Vent Fan / Single Duct "I --, $0 00 Appliance ��: . o.00 Fire Dampers -. $0:00 Smoke Dampers $0 o0 Inst or Relocate Appl Vent $00 Air Handlers < 10000cfrn $0.00 Air Handlers > 10000cfm $0.00 Floor Furnace $0.00 Floor or Suspend Heater $0.00 Quantity Status: ISSUED Applied: 01/30/2001 Issued: 01/30/2001 ISSUED BY: Repair / Alt Absorbtion Unit 1- -Repair/Alt Refrigeration Unit 0 Ventillation System 0 EvaporatiGe.Cooler, 0 .tt' Commercial. Incinerator; ' 0' Domestic Incinerator VO �0 %- � ,�� Compressors /Absorption Sy 0�- i , "Up to3hp/700 kBTU%� �/ \SQL Yl f $OD� 0 _ 30 To 50 hp-/ / 1,750 k BTU - �� x$0.00/0' $0.00 J 0 6' - $000100 $0.00 so o69 o' _ Boilers':- $0:00 0 �. 0 -. Up lo3hp " /.! �0 '�:��\ V0 �`� ` , 3 To 15'hp./ 500'k:BtU' " �'� 0$600 =15 To 30hp7 1 000 k BTU C%�'$0.00 __ ,0 � _ 30 To 50 hp-/ / 1,750 k BTU - �� $0.00 6' - Over 50 hp /, Over '1,750 BTU �� $0.00 �0 -,' -- _ Boilers':- �. 0 -. Up lo3hp " /.! $0.00 ,/ 3To�15 hp - -� �/ $0.00 � o 15 to 30 hp - $0.00 0 �_ .�30 to 50 hp $0.00 0 - - - - Over 50 hp $0.00 0 Other Mechanical Fee 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 COMMENTS / SPECIAL CONDITIONS 0 0 0 0 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, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration. of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446<6 (6100) DECLARATIONS C WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations:- ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 5_ have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. —My workers' compensati,,o{� Insurance mer and policy number are: Cartier:""'"~ t ,t9'Tl Policy Number: `(This section -need not be completed if the permn?is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 700 of th§§§ Labor Code, I shall forthwith Ap comply- with,these provisions ^ ` / U Applicant Signature: �Q/ �9 WARNIN11 G: 0: FAILURE TO SECURE WORKERS' 66MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO (!RIMI PENALTI AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that.l.am licensed under rovisions of Chapt_er�9 commencing with Section 7000) of Division 3 of the Business and Professions Cade, end my license is in full force and effect. Lic. N ` � / / class a,+ �' _ 7 6 G- 2 Contractors.Signature: !-Date:- 2 (3 7— CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions Of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 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).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type Of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................to--......................ildi...................................d.t....file........e.gi.........,...............................ut-e-i..............................................O.............................................................................................. 2 Dces or will the applicant or present or future building occupant need to fele a registration form for acutely hazartlous materials. ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to Or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................... 3 Dces or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? [I Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................................................................................................................................................................................................................... ............................. ..................................... -......................... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑ No ..................................il"F............................................................................. ildi...........................................................................................................................................................................................................................................difi................ 5 Does or will the applicant or present Or future building occupant require for the work which is the subject of ? a plication appermii for SUCK construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................................................................................................................................................................................................................................................................................................................................................................................. 6 Will any par of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......................................................................................................alit........................................stri.........................................................................istr............................._.........................................................hic,..................................................... 7 a a permit from the South Coast Air Duality Management District or other eir pollution control district n agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made? [3 Yes ❑ No .......................................... .......ertiific.................. ..............................................................................11ut................trol................................................................................................................................................... ............................................... 8 (II yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: - Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until f' at inspection. Signature Of Legal wner(s) Date ) Aqcvor Atilithdril%rApplicant, 'Data CODE0. INSPECTION TYPE per" INRfiALS CODE. INSPECTIONTYPE aR �, 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Relaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA `F BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER / B98-01849 ✓/ (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1104 VALLEY CI Status: ISSUED Suite: Applied: 10/13/1998-J" Vicinity: Issued: 10/13/1998 Parcel Nunmber: 42203107 Zoning: Applicant: VAUGHT, MILTON Address: NOTES EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 75CS626 -Phone.--' -- - '� Zip:, _ Owner: NEEDHAM7PATRICIA.E ! �� Address 1104 VALLEY CIR \ ��(�i ! `• Phone:, COSTA`MESA;CA .. Zip 92627 _ i Contractor i/ VAUGHT ROOFING Address: 6231. Flaxmin'D�;� 1?'„!� i Phone: 714764-0297 Ap��AA�✓ "'�� ,','Huntington Beach Zip-', 92646 \,x Licensee828955 /AFch/Eng ' ' :•Address ,.�/ i /, .^”" . _" ' `A''r,( u . - i "P_hone - r� >>tl r Zip. .�.. License: ` � � l SCOPE OF PERMIT \ _ / 1• (T/O EXISTING & REROOF.WITH COM P..SHINGLE,:ROOF,CERT ATTACHED TO PERMIT. \\� FEE SUMMARY Plan Check $0.00 �,;^; , r— /''• '�! g _.Calc Valuation $6,518:00 1- Permit- ".'$124.75 - —` -Claim Valuation $6,518.00 SMIP Res: .10.65 _ SMIP'Corn 11$0.00 i '. Other. ` Other: `•.10.00 Inspection: 10.00 Total. $125140" r` `PLANNING 8 ZONING SETBACKS MAIN STRUCTURE front 0_'Q - Rear L0- 0 i Left 0-0 Right ". 0= 0 ACCESSORY Front '0- 0__ �� - Rear 0-0 Left 0-0 Right 0- 0 PARKING Existing: 0 'Required: 0 Proposed: 0 NOTES EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 75CS626 WORKERS' COMPENSATION DECLARATION: / I hereby affirm under penalty of perjury one of the follo g declarations: _ ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3701 of the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carder and policy number are: Carrier: Policy Number (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the dortormance f the worl%-for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws o e i , a r that I fjould become subject to the workers' compensation provisions of Sectiol� 3700,,,000f the Labor Code, I shall forthwith comply wird these pro io / JD % /_; Applicant Signature: Date: ✓�// !!!//G/ - WARNING: FAILURE TO SECURE WORKERS' COMPEN ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR TION: 1 hereby affirm that I em li sed un r p visio of Cha er 9 (commencing with Section 7000) of Division 3 of the Business nd Pr essions Code, and my license is in full force and effect. Lic. a / Class k �T Contractors Signature: Date: 22, Z.—, CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by cinvers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cade, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_Epermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes J No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................................................................................................................................................................................................................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? El as ❑ No .................................................................................................................................................................................................................................................................................... e (If yes", attach certificate of compliance from the eppropnete air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above- ascribedprop rty for inspection purpos s. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. JSi ma r Legt7 r(s) 16 Date And/Or Au o zed plicantTl' Date CODE -# INSPECTION TYPE - QM RfITTlAL6 COOF INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ , 208 Final Plumbing 200 Final Re -Roof B Z 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 28116 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 - COSTA MESA, CALIFORNIA VAN For Applicant to Fill In Completely PE OR PRINT ILDIN04e 2r& DRESS ' /� COSTA MESA, CALIFORNIA - TEL sae � 7 x o z %< % % noRorloLDG Q/pq/ OF LOT USEOP - i1/O^%C EXISTING BLDG. v YETBACK LINK FROM O / �O/ CENTER OF STREET ✓ RMAR YA D ( 81DW YARD LWFT RIGHT ((J DESCRIPTION OF WORK BUILDING mom �,l/ 1y'13 I HER BY ACKNO DOE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE EB CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND STA WS LA ✓RKGUTINO BUILDING CONSTRi� /j� ,Y SIGNATURE OF i AUTHORIZED AQWNT JM116-68=0 574* 94.50 APPLICATION FOR PERMIT BUILDING For Office Use Only APPROVED V RY 1'IATP ZONING ZONK NO. OF UKK OF JIM PIAND OU ILDINO 9 LEGAL 7 ,- 8- , A. P. NO. NOTE: NO WAVE OVERHANG SHALL BE LESS THAN BO' TO SIDE a REAR P. L— EAVES ' EAVES ALLOWED (U. B.C. REQUIREMENT) YARDS APPROVED YARDS APPROVED MAIN BUILDING-- ACCESSORY BUILDING (FROM C/L 8TR6 / PRONT FT. R. SIDE 62FT. FT. L.SID PT. Fr. VAR.* V- �y `(`71 DATE P4 HOLD l'JO SQ.Fr. y' oa I o THE AMOUNT BHOWH UNDEA VALUATION Is POR T u PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION ^7 PERMIT FEE PLAN CHECK S L) TOTAL FEE S