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HomeMy WebLinkAbout756 19TH ST - Building PermitsL (ii4� %$4•$2%3 • F8%(7i4� 7$�i-48$6 • www.ci.coste-mesa.ca.us 77 hAIH UMIVt, GVAIA MC3A� GX tlGOLO ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 756 W 19TH ST 42227121 Applicant PRAUM, STEVE . - . � - �- Address: 1049 MELROSE � � . ' - �- /��%�, -' Phone: (714)231-7501 - PLACENTIA, CA', � � � �, Zip: 9,2887 � , � . �! � " � �- / � � .• A� _ Owner:� , -WATKINS,.HOLROYD W M , Address� r 756 W 19TH ST;; �,', ,.. \ � . � ' � � � '���` Phone: . , . ,,��;, �i , COSTA MESA, CA Zip: 92627 ' i/;-/ , Contractor: ' ORANGE ELECTRICAL CONTRACTORS Address: 1049 MELROSE � . ` PLACENTIA, CA � � ' s -,"Fhone: (714) 980.2300 Zip: �92887 - License: 747129 Status: ISSUED Applied: 06/05/2003 Issued: O6/O6/2003 ISSUED BY: � � � � �, � '�. �'� i �v ��..� � , . � � ����' � � � i �- - � � � � SCOPE OF�PERMIT , � � � � � CONVERT EXISTING OVERHEAD ELECTRICAC SERVICE TO UNDERGROUND,FEED. � , Quantity ` - ISSUE FEE $0.00 � � Temp service lest $0.00 � Res. a/c package 50.00 , New Res (1-2 unils)� , 50.00 0 New Res (3+unils) . $0.00 0 Pool / Spa � � - '� =, 50.00 0 Lighling Fixts " - ,� ,$0.00 0 Recept OuUets `, � $0.00 0 Switches \ ;� � - �$0.00 -. _ 0 � Non ResAppl`'�, � $0.04� ,�� 0 Res Appl \ �: , �$0.00 '- � �, 0 Service to 200a � � - � $30.50 - t Service to 1o00a��. . - �o.00 , � _ o Service over t000a��� .� 30.00 � 0 Motors to 1hp ��. $0.00;�! � . -0 -- MotOrs to 10hp \ '$0.00 �. ��� � i 0 �� � � �� Motorsto50hp ����$0.00_ �� �. 0 -. MOtorS to 700hp �$0.00 � 0 Motors over t00hp $0.00 `� �.- 0 Communication drops $0.00 . � 0 ., . Sub panel to 200a $0.00 \�0 �--� "" Pole Light Pkg $0.00 0 � - Sign Circuits $0.00 0 � FEE SUMMARY � � �, . � Temp Dist System /Lighling Busway I100 ft Standirig Sectlon . Misc Electrical Equipment Trans(ormers up to 1 kva/kw ' . � �� .t .:..:.:.......up l0 10 kva/kw � . � ' ...........:...:.up to 50 kva/kw ' .................uP to.100 kva/kw .....r............over t00�kva/kw .. . � Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit , Misa Conductor ,: � ' � Circus ( gen or ride) , . Cirws (mech nda or lights) � Christmas Tree Stand �� ' � �Fireworks Sfand � ' . � Other NecViral Fee . � � InJestigation Fee ; � � - � - � Plan Check Fee � � -- _ _ .. Reinspeclion Fee Quantity $0.00 0 $0.00 0 - $0.00 0 � $18.20 1 $0.00 0 $0.00 0 ' $0.00, 0 $0.00 , 0 $0.00 � 0 $0.00 0 ' ao.00 �" o $0.00 0 $0.00 0 50.00 . 0, $0.00 0 ' $0.00 0 $0.00 ,-' 0 30.00' ao.00 $0.00 $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requlrements 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 tor a period of 180 days. � INSPECTIONS: In orcler for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end ell requlred Inspeetiona end finel approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of thls permit. FOR INSPECTIONS CqLL: (714) 7545626 zme�e (erool WORKERS'COMPENSAnON DECLARAnON: � I hereby eHirm under penalry ot perjury one oi lhe following declaretions: ❑ I �ave end will maintain e certlllcate at consent to sell�lnsure lor workers' compensetion, es provided lor 6y secllon 3700 oi the Lebor Code, lor the peAortnence of the work lor whiCh this pertnit is isSUBd. � I have arW will malntaln workers' compensetlon Insurence, as reQulred by sectlon 3700 0l lhe Lebor Code, lor �he pertartnance of the work for whlch this pertnit is issued. My workers' mpeQsatlon In�urence cerder and Dolicy number ere: Certier. �YF�1� �N� POIIcyNumEer. ZZ�"Q� (m!s sectton need not be wmp�ered u fne permlt !s velued e1 one nunared dW/ers (S �oo) or �ess.) ❑ I ceNty ihat in the rtortnanca of Ihe work lor whic� ihis pertnit is issued, I shall no� employ any person in eny menner so es to becorne subject to the workers' compensatlon laws GGalito le, end epree thet II I should Decome wb�ect to the workers' compensetlon provlslans ol SecUon 3700 of the Le6or Catle, I ahell forthwith comPN with thesa Pr lp � (� � � Applicem Signeture: �� Date: " - O WARNINO: FAILURE TO SEWRE WORI(ERS' COlAPENSATION COVEfiACaE IS UNLAW FUL M1D SHALL SUBIEC� rW EMPIOYER TO CRIMINAL PENALTIES AND dVIL FlNES UP TO ONE HUNDRED T110USAND DOLLARE (5100.0OO�.IN ADDRION TO TME COST OF COMPENSATION, DMNGES AS PROVIDED FOH IN SECTION 3]080F THE UBOR CODE.IMEREST, P1JD FTTORNEY'S FEES. LICENSED CONTRACTORS DECLARATI N: I hereby eflirm that I am li ns�Q u�}dQj pro ons op�1��y,epter 9(commencing wit� Section 7000) of Division 3 of the Business en0 Professions Code, entl my Iicense Is In full farce end eflect. Llc. p �� 1� L 1 � 11 \1 Cless p ��J ContrectorsSigneture: Date: ��6�- CONSTRUCTION LENDING AGENCY: ❑ I �ereDy etlirtn that Ihere Is e construclion lending epency for ihe peAormance of I�e work tor which Ihis pertnit is issuoA. (Sec. 3097, Civil Code). ' Lentlefs Neme: Lentlefs AAtlreu: SlgnaNre: Date: OWNER•BUILDER DECLARATIONS: I �ereDy aHirm thet untler penalry oi perjury Ihet I am EXEMPT FROM TME CONTRACTORS LIGENSE LAW tor ihe lollowing reason (Sec. 7031.5, Business end Prafessions Cotle: Any Gty or wunry which requlres e permit Io constmct, alter, improve, demolish, or repair any strucmre, pdor to Its luuence, also requires the applicant br such permit ro Ille e slgnetl sietement that �e or a�e Is Ilcensed OursuaN to the provislons at Ihe Contreaore License Lew (C�apter 9(commendnp with Seclion 7000) ot Dlvision 3 of ihe Business end Professians Cade) or Ihet he or sha is exempt therefrom and the besis lor Ihe elleged exemptlon. Any vloletlon ol Section 7031.5 by eny epplicent lor e Dermlt sub�eds Ihe applicant to a civil penalry ol not more Ihen live hundred tlollars (5500).): ❑ I, as owner oi the property, or my employees with wages es their sole compensetlon, WILL DO THE WORK, and the structure is not in;erWed or aMereO for sele (Sec. 7044, Business and Professions Cotle: The Contrectors License Law tloes not eppty lo an ownar of praperry who build5 or improves Iheraon, and who does such work himself or harseN ar ihrough his or her own emplayaes, pravitled that such improvements ere not intended or ottere0lor sele. If, however, the building or improvement is sdd within one year of completion, Ihe owner-builder will have.iha burden at pmving ihat he or she tlitl not Duiltl or improve for puryose of sale.). � ❑ I, as owner of Ne D�Werry, flm EXC WSIVELY CONTRACTING WfTH LICENSED CONTAACTORS to construcl the pmjed (Sec. 704a, eusiness entl Professlons Coae: The cantraciws Licensa Lew tloes not eppy to en owner oi pmperry who Dullds or impmves thereon, end who conirects for such prqect wlih e contrectar(s) license pursuant lo Ihe Contrectors License Lews.). ❑ I em exempt untler sec. Business en0 Professions Code for ihis reason: Signeture: Date: Owner ID veAlied by tlrivefs license. ❑ Ves ❑ No Drlvera License No. VeAficatlon ol Ownerehip by (rype ol tlocument, I.e. - property tax blll or tleetl): OIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: Expires: ❑ I hereby certiy Uet no escavatlon tive (5) or more teet In depth Into whlch e person Is requlred to tlescend, will be mede in conneclion with work authorizetl by this permit, antl that no building structure, sceMdding, talsawork, or dertwlitlon w dlsmflntlinp ihereof, wlll be more t�an Ihirty-six (38) feet Ngh. (Chap. 32, Grp 2, An 2, Sec. 341, Ttle B, Califomia AdminislretNe Code). ❑ Aa owner-builtler, I will not employ enyone lo tlo work which woultl require e pertnit iram the Division ot Industdal Safery, es notetl ebove, unless such person has e pertnit ro tlo such work Irom Ihe tlivision. Sipnature: Date: Divlsion ot Indusirial Safery Pertnit Number: CERTIFlCATE OF COMPLUWCE AND AUTNORVA710N OF ENTAY: I certity untler penalry af perjury t�et I heve �eeA this epplicetion and stete Ihet the inlortnation given I9 cortect I epree to compty wlth ell stete laws and city orGinances relatinp to Guiltling construction, end authodze representutivos of t�e Ciry of Coste Mese to enter upon t�e above-described prope tor inspeCtion purposes. I egree not to occupy or ellow accupency ot eny building euthonzed by Uis pertnit unlil final inspectlon. Sig tu Of Lepel Owner(s) Date �'� -4 �0'1 nd/ u odzetl App��canl Date COOE I. MSPECTIONiYPE � PAIE Ii�LS 1616 Fi:ed System Final Fire Preventlon 1266 Pool Spe Final 200 201 202 203 Flnel RaRoof Flnal BIocWReuininp Well Finel Facrory Flre Place Finel Sipn Z00 Finel Damditlon COOE 1 INSPECTION TTPE 208 Final Mec�enical 208 Final Plumbing 210 Final Electriwl 212 Flnal Fire Preventlon 220 Finel Planning Approval 222 Final Site 250 Finel Building/Occupflncy �g. /!/1•' Q�� ADP��cant to flll In all spaces withln heavy borCer lines ana sign all aporoorlate ECUantions. CITY OF COSTA MESA PERMIT Nn. � , TRACT NO. .,LOT NO. BLDG. NO. .' CONSTRUCTION PERMIT NI % �O � � � ' Addrpss Arch/Eng. � Address Contracror \ Address � LICENSED I nereby af( mentfqg wl Aolesslons Litensa Clas Date� WORKERS' I harebv af ` j'. _.1�1'� . - TYPE OF C�O�/NS7RUCTION PhanO ' ❑ NEW Ll ADD ❑ ALTERATION ' � ❑ REPAIR ❑ CONVERSION ❑DEMOLISH LiCenSe NO. � OTHER DESCRIPTION OF WORK �, • » �, j..l� p Phone( � �^�'' TVPEOF�PERMIT ' '� �Ui, �= � r' � i^��.`•CY ❑ GRADING ❑ FOUNDATION ❑ STRVCTURAL ITRACTOR DECLARATION ❑ TENANT ❑ ELECTRICAL OPLUMBING �iIECHAN hat I am IlcansoG untler provlsions o/ C�artcr 9(com• . . �ct(on 7000) o( Divlsfon 3 0/ the 9us(ness antl ❑ OTHER l, antl my Ilcense Iz In fu❑ force antl e/i ct. ' ' . . aJ-3-��L�� PROJECTDESCRIPTION . " Bn5 No. .. — Slgna[ura C � � / � 50. FT. � '• . . APENSATION DECLARATION ' OCGUPANCV_CONSTRUCTION TVPE that I hdve a CerUticale Of ConSent t0 self-InSure or d VAIVATtON ' ZONE �rker5' COmpensatiOn InSurance, or a Certifietl copy . jB�O 1.�4. C�. /� , 1� GRADING CU. VDS. ACRES 9 Y S � t -t• ��V No. Y('_ � Q� ComPanY f.i7� —^.� l.'F.."i rtifietl copY �s hereby furnishatl. . . REMARKS: .. - ' . ,ar(ifietl copy is tiletl with the Nty Builtling Dlvislon. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (Thiz section neetl not be completetl it the permit Is for one huntlretl . _ , _ _ SS3001 or less). � �� ' � � � cert(fy that in the.pe[(OrmanC¢ oi the work fo� whith this pe�mil is issuotl, 1 shall not emPloy any person in any manner so as to become PLUMBING'r �� - PLAN CHECK '' subje« to the Workers Compensation Laws of Calltornla. . . . .. Date Si9nature BATHTVBS SHOWERS NOTICE: If ai[er makM9 tbls tlaUaration, you shoultl become subjett ' TOILETS URINALS' l0 the WOrkeR' COmpOnsaUoO provl5ions Ot �he Ldbor COtle; y0u mUSt torlhwith compry with such provisions or lhis permit ihall De tleemetl �VATORIES DOUBCE LAVS - fGVOkQtl. - � . . CONSTRUCTIONLENDINGAGENCV � KIT.SINKS - �� -DISHWASHERS I hereby atfirm that there Is a construction lentling agenCy for tne por- SERVICE SINKS ' SUMPS -' '-' ' formanta oi ihe work for whl�h [�is Dermit is Issuetl (Section 3097 'Clv.'C,J;' ' " ' "' " ' ' - FLOOR SINKS ��� � FLOOR OR?iINS Lontlnr's Name Lontlnr's AtlCress DRINKING FOUNTAINS � �� ' � OWN@R BUILDER DECL'ARATION' ' "' ' - INTERCEPTORS � � � CLARIFIERS � I herepy affirm that 1 am exompt irom the Con[rac[or's License Law for tho /oilowing reason (Section )031:5'Businoss�antl Prolessions Cotle: SWIMMING POO�� ' P TRAP ' Any tlty or county which reqWres a permit lo construct, alter, improya, tlemolish or repair any structure, prlor to Its issuance,also re- y./qTER SERVICE' qWrez the appiirzn[ tor suth perml[ to file a slgnetl statemen[ that ho 'I5 Iicahse0 pursuan[ to tbe provislons of che Contractor's Ucense law GAS SERV ICE (Chaptar 9(commencin9 wlth SecOon �000) af Division 3 of the Busln@ss antl Professions Cotle) or'that'he is ezem0< <hcrefrom antl the yyqTER HEATERS - ba^� br the alle9etl exemp[lon. Any violaclon ot Sec[lon �031.5 by - 'pptlwnt for a- permit subjects the appltcant to a�civil'panatty -SEWER CONNECTIONS Lt more than live huntlred tlollars (E500). , a5 owner of tfie prop¢rty, o� my emPloyeei wlth �vages as �t�eir � SOLAR TANK ` sol¢.<pmpen5ation, will tl0 the work, antl the 5[�uctu�e is no[ Intentl¢tl or OHeretl tor sale. (Sectlon 7064, Business antl Prot¢SsiOnS Cotle: TOe $OLAR PIPING SVS. .Conb9ptor'S Licenz¢ Law. tloe5 not.apply Io.dO Owne� o/ d Property , w110 4uiltl5 Or imp�ove5 [h¢�eon, dntl wno tlOes sucn wOrk himsell Or � ISSVE F.EE ls solq within one y¢a! of cOTpletlon, tne ownel.wlll naye [ne oWaCn 01 proving hG Oitl not bulltl or ITprove lor th¢ purpos¢ oi wle). ❑ I,- as own¢r O� tha � prOpBrty,- aT exClusivBly -confractin9 �wilh IiGlnsCtl Cont�aclors to Conil�utt [he projoCl (SCction ]044, Busin¢St dntl PrOfMsionS Cotl¢: Tho Con[raCtol'S ILic¢n50 Law tl005 not apply [o an owner o� property who bulltls or Improvas theroon, antl who coo- Iracts���oT sUch'projacl5-wilh a ContraCtOf(s) IlCesnBtl�pursUanl to tho COntractm's License Law). - ❑ I�am ezemp[ unAer Seclion '�B. & P. C.�for this reason - Dato pwnor thdt 1 have reatl thii appllcatlon antl Stat6 that lhe above wrrecL 1 agrea to comply witn all tlty antl county �tate lawi relating to conStruCliOn, antl h¢reby authoritB of this Uty to enter upOn tha a0ove mentionatl is t �pJ�r.p,osez. �rx^.ul.oi - - - oete 1-�-�i3 OUTPUT . _ECTORS' ' � '" ' MECHANICAL v�Ara CHECK HEATING SVSTEM 0-300,000 BTU_ AND DVCTING '- �Q0,000 t BTU � REFRIGERATION 0-]00,000 BTU_ SVSTEM � ' ' - - - ' 100,000 + BTU _ BOILERS BTU SVSTEM REPAIR,ALTERATION EXHHUSTSYSTEM MVLTIPLE Drive�s• License or 55 x �{ ' ' ISSUE FEE -� GMF 0865-46 White-BWttling; Canary-Applicant: Pink-Accouniing; Goltlenrotl-Assessor 2715 I/07/33 REGULATIONS ZONE PLNG. REF. � REqR VARD (TO P/L) - PKG.SPACE REq. PROVIDED STREET WIDTH � PARK FEE E ZONING APPROVED 8V SPECIAL CONDITIONS: 'ELECTRICAL - ' ' PLAN CHECK II.OG TL TRANSFORMER 0-1 KW__ 1-10 KW APPLIANCE 10�50 KW�50 + KW - MOTORS ' Od HP_1d0 HP (INC.SOIAR) � �10-SOHP SO��+ryp . . 'FIX7URE5 " OU7LET5 SWITCHES � " GAS TUBE SIGNS � POLE LIGHTS ' " ' ' ' - - PANELS " ' MAIN ' SVB' SERVICE' ' ' ' AMP . � '- "�'� ISSUE FEE- -'-" ' ' ' ' - ' P.PPLICATIOMAPPROVEDBY ' - - DATE � � � SUMMARYOFFEES., BUILOING - -- � - PERMIT $ SMIP 'S PLAN CHECK 5 PERMIT PLUMBING § - �SSUANCE E� PLANCHECK .y � GRADING' E ' ELECTRICP.L $ " s , PLAN CHECK - g ' � MICROFILM E� _ MECHANICAL 5� TOTAL FEE E' � PLqN CHECK � � LE55 AD- � ,' � 3 VANCE'PC � S FINHLFEE E_L.�- — �t�c - F� - - - - . . _ _ _ _ CONSTRUCT�ON AND PLANNING / � �OOL & SPA '� '� "�' � APPROVALS Permit# �1�� Date Inspeaor qppROVALS . Permit# ' Date Inspector 1. Temporary Electrical Service or Pole •�;. � 43. Pool & Equipment Location '� � Soil ipe-Un rgrn • 4 . Steel Reinforcement • � • ' - • 3. Electrical Conduit Utility-Undrgrn ' • 45. Forms 4. Electrical Conduit-Undrgrn 46. Electriadl Bondin . tee ein orce � 47. Rou h Plumbin & Pressure Test � ' � . 6. Electrical UPER Grn ' " 48. APPROVALTO COVER-GUNITE -'- - �� � - � 7. ootings � 49. Electrical Conduit-Undr rn 8. Foundation ' - 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ' � ndr rn ' • 10. Structural Floor System - 52. APPROVALTO DECK ' " �' 11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final 12.. Street Sewer Connection � 54. Heater & Vent-Final � 13. Rough Plumbing ' ' - ' � � - ' '� � 14. Rough Electric-Conduit �56. Electrical-Final � 15. Rough Electric-Wiring � � 57. Solar System-Final " 16. Rough Heating & Air Conditioning - encing & Access Approval ' ' 17. Ducts in Structure. APPROVED FOR PLASTERING � 18. Ducts, Ventilating ' 19. Gas Pipe-Rough &�est • 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathin - � � . • 22. Frzme and Flashin NOTES: 23. Insulation ' � 24. Lathing & Siding - � - - - - 25. Drywall Nailing - • � � 26. Plaster Brown Coat � � 27. Electrical Power Meter-Final : � � � � � � 26. Final Electric - 29. Final Heating 8rfe� �� e�- -9� 30. Final Gas Pipe-Test ' � 31. Final Plumbing - 32. Water Service-Final � � 33. Gas Service-Final - �� � � - 34. Solar pomestic-Final ' � � � 35. landsca e S rinklin S stem ' � �� 36. Sound Attenuation - � 37. Handicap Regulations . 38. FINALSTRUCTURE&BUILDING 39. Special Requirements Completed � 40. Electric Release to Edison - - 41. Gas Release to Southem Califo'rnia Gas Co. � � �� 42. CERTIFICATE OF OCCUPANCY • _ _� - ' r.� i •-No Date , "•' ' • ' . - - . :ti , . � ,;;. •.,;:;;];� �' � ' .; ��- ��`�ti+' ' � � , '.r ,..- 'j• i ,' �. ..?}; ' O ' 3 �_ ;:-: ..,. i,:"�::';: � , I ,�,�:. :., �c� � �:;:, :.,;-; . f M ;`{. . ! � i , � �'. i . . � �� I 23 0 ' � �..,._...-__..._.,.. __i_..._ �r.. • ri - : _.._ _..._�, 20 __.._._._ . ___.� �.r �: + .,:: ; ,� I � ; ' � .. � ! . ��511 .�f�i't��:�.�' , t 1' +:J . . .. z� ., , % ' . , � .�'.�; • %HK,fi.Kf" �i°u-' ::.'._:';:; . �` "'t'�`_�;e'�,>,�� � � v�:. . :a. 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S�RVFY oF : 7_ o W. 19�'ti STQFET, �05 � A rn�SA, c.�. �E�A� 'OESCRt'P�'IoN w'EST -rj0 F�E�CO� TH� �AST lOD �F_ET OF LOTS 39 {. 4-O, Ci�bCK E, 'C12AL"r N°• �IZ M.M. 2 O� i-Z R'Eco�D�,; oF -� ORANUF COUNTY� Cq, ,C�1 cM : n w I 1 J Q f M 0_ _ : j � ;.'\a c h � � �' y I� I'i 9 1, so oo; J w � 0 I o �0 r r � ZO � E� S-'rtiEE'1- W �E�R-.StC.TtON � FF.�-LS oti! MPNH{C��, F �-��f;'�. P'ER uTy ?�t:� So.00, — -- --�----- So•oo' ,.. �o•oo' - - ;�.00' < 10 I o 'AS O I O o��'� � 11^ q� ��n i%. _ 5O °p _�� 330 •OI' M. �330� REC.� - - �---- _ - . AL�S ou NIAU1-iOI�E, E:Ti16. P'ER CIT`/ T1F�; 30, Ii0 u So•oo' O AS M o v°�. O% q �o oo' � � ;., �. " ' � 9 i�i rj j k=��T � -O 1N"D�CA�CES SF.T �G Nq�L !'rAC.� RCE, 3p4o I ���r2s�c--r�o�., Ta��s OU MANHO�.E��S-n'3. 'P E� C� � y -T i � ,�, @a tN'D�CATES SET �.tT 2cE, gp¢O� �v a-r�v 2 23 �3 � L .' �...c.r-�u� LE�F c. F�SHER R,�-.'E 3o4p: � �-��� i ass i :,. , �� . : ,.,- COSif+ MESA BUILDING-SAFETY DEPARTMENT p. O. BO% 817 CO6TA MHHA. CALIFORNIA For Appiieant +o Fili In Complefely TYrFE OR PRINT BUILDING L' /C %�N� �"r, ADDRHS`3 J [' COSTA MESA. CALIFORNIA FEE RECEIVED fEa 1 1 3��r3 FINANCE DEPT. ' CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only NECeIPT NO. � PE1�ITjNQ./ H6C61V�eY BUILDING ' A MESA. CAUFORNIA C 20N NO. OF . 1 C � � PLAN9 NO. �l� O��IY I LEOAL CI un oeecn�vriBF �� SO'X �`/' NOW ON LOT� I — A. P. NO. BLD �'ARDS APPROVED N6 PROM I / (CBMTBR LINH BT.) srRHeT REAR YARD (O� FRONT � I �eFr 3 1" O I I I RIGHT S/ �/I R. 6IDE DESCRIPTION OF WORK , BUILDING IS X� 1'p/ ROOMS SIZE EXSER{OR WALL ROOF COVERING UCG COVERII USE OF 9UILDING ANO WORK TO BE A2C . C d , �� G� �, / 1 M[RHT' ACKNOWLBD06 TXAT 1 HAV6 RCAD THIB MPLIWTI ry AND 9TAT8 TH�T TX6 ABOVB IB CORMLT ANO AOR88 TO COM- PLY WITN ALL CISY OitO1HANCCB ANO B[ATB UWB �tHOVLATlN6 BUILD�Ntl CONBTRIIC{lpN. _ . � � AUTHORIZED AGENT INING ��� 9�' USE OF N • B�ILDING A 3y��ro gu�'� !�/•' S� EVE$ ALLOWED ��� � II �� �T✓ h1 r l b �� FT. � II /FT. I II OATF 1 � I I�. rxe AMOUM BHOWN YN�ER VALUATION 18 FON TN! PUFtP086 OR 6BTABLIBHING w PERMIT PEE ONLY. VALUATION f (�(J PERMIT FEE $ � � $ /�OD � PLAN CHECK $ �/ �a l I - , , 27435 COSTA MESA BUILDINCrSAFETY DEPARTMENf Q.O. BOX 13W COSTA MESA. CALIFORNIA VtLtO For Appllconf ro Fl11 In Completoly TYPE OR PRINT a����No Th, �� . ADDRE88 COSTA ME8A. CALIFORNIA owHen / i �%2 C S MAIL 7i(� (�/iI�'/�^' )T' �OORHHd J � � I NO. 0/ �LDO�. o¢rewcrc un� r�or 7 CHM6n op m1[R Z N[AR Y / �/ / SIDB YARD LBRT � RIOXT S�' DESCRIPTION OF WORK �17 BUILDINO 1 HERmY ACKNOWL6pOR TMAT 1 NAV6 AND BTAT6 TXAT TMe AGOV[ 1� CORR! PLY WITX ALL CITY O NANC[� AND 1 EUILUINO fANsiRY BIGNATVR80P � / � PERMITfG AUTNOl1IZQD AO[NT I1UG � �'�%CNSkQO ���.-. :::•:;: �3� ^C APPLICATION FOR PERMR BUILDINCi for Olflca Uw Only 11[C[II� NO. ■ S 2 ZONING � � ZON[ NO.OI YitOIN[W C �' �un�'y ew�mHo "°"� 6'02 �af-3j �urc >�'6�L nucnimon A. P. NO. /� �� �y� S b NOTQ: NOHAV60ViRHANOBHALLB8LH8HTHAN LO' TO HID6 4 RBAR P. L BAVPA �t�OWBD .<U.B_G_REOUIRHMHNTI- YARDBMPROVHD YARD9APPROVHD MAIN BUILDINO ACGEB80RY BUILDINO // �vwn. tC G.LLP_ owTe ,� , a 10LD FOR SPECIAL REQUIREMENTS �? PA 2��� ' � Z �ec. rr. a n�� �rour�r exowH UND81i VALUATION �e �on rr�c � FlJRPo66 OP fRABLIBNINO A PERMIT �H8 ONLY. VALUATION � — � PERM IT FEE s '�jp � �% �/ /02 — w TOTAL FEH � � �