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Home My WebLink About334 19TH ST - Building Permits.L raecr aooxess: 3 3 4 E 19 T H S? awxEx•sx�Me: MILOSAVLJEVIC, BRANISLAV ^oopEss: MILOSAVLJEVIC, SLAVZCA Q965 SHERINGTON PL #K313 NEWPORT BEACH,CA 92663 (714)646-6292 '�RCNIENGINEEfl: qE0.N0.: aooaess: uxn: uxrr: r�pMiTTEE: JOHNSON' S ROOFING ( 714 ) 971-7911 nooeess: Z301 BERN LANE � SANTA ANA CA 92706 LICENSE� fANTMC70B OEQAMTION: I heahy aflirm ttat I am IcenseG under Orovision5 at Clwpter 9(wmmendnq xit� SecGon 7000) of Divisiw 3 0l Ihe Business an0 Professions CoAe, and my Ikenu ¢ in lull force an0 eifM. ciTruc.:038434 srnreuc.:458855 a �$$ C-39 Data: 9=�.�_ �� Si9nature: /I•�I.��._ WOHKERS' COMPENLITION DEClAN11TI0N: I Aereby aflirm itwt l tu a artificate ot cansent to ull�nsurt or a cerlitirata a1 Workers' ComOe��ian Insuance, or a cenified coQ [nereot 1Seclion 3800, LaO. C). �crxo.:28b9000003�4 exr.oen:01/O1/91 �;;-xruir: STATE FUND �` -�CertifieA mpy is �ere�y tumisheE. m CertifieE copy u file0 /wi�t� Ne ciry BuilOinp Olvision. Oate: �{ —��" � v Applicant: " ' "' � ocunenox mmn wowuxs� canr[xs�nox o[cwuTrox: Rns saom reea � x cano�� n me cemm o mr me nweree giml m ical. I certity Ihat in t�e Dertarmance ol the waM lar which this permit is i5sce0, I sl all not emDloy any person in any manner m as to Eecome suDlect to the Woders' Campenution Laws at Calilomia. Date: SiAnatua: MOTICF: tt, atler maWng IAis UeUaation, you ShoulE hecome 5u0ject to tlre Wakers' Campensatlon Drovisions oi t�e LaDor Cade, you mus� Iort�vntA comply with such Drmdsions or tNs permi� shall Ee EeemeE rewke0. CONSTPUCTION 1FN01X6IGENCY: I �ett6y allirm tAat t�ere's a consirucGm lentlinp apen�y lar Ihe perlarmance of Ne xaM lor whk� IN5 Perrtut 5 issue0 (Section 3097. Civ. C1. lEMOEH: RDOIIE83: ' OWNFP BIIILOER OEClAMT10N: I heaUy affirtn tAat I am exempt irom t�e Con�actors Slate License Law tor t�a followinp reason (Section 7031.5 Business anU Protessional COCe: My ciry oi counry wAich requires a Dermh lo wnstruct, alter, ImOrova, EemolLsh, or ' repair arry swqum. Dnor lo ils issuance, also requires tl�e apDliant for SucA permit to file a siqne0 statement IMt �eJshe ¢ Ilwnse0 pursuant ro Ne pmvisions ol tM Contradors' Slata Licenu Law (Ctupter 9(commencin0 ��n 700�) ot ONisian 3 0l Itre Business antl Prafestions Cotle) or tlwt �e/s�e is exempt Nerefrom an0 Ne �asis for t�e alleqe0 exemption. My violaUon ol Sectlon 7031.5 Gy any appliwnt �or a permit su6lects ihe aDDlicanl to a civil penalry ol not mom I�an frve AunOreE Oollars (5500�. I, az awner oi Vce property ar my emp loyees rritn xapes u itrcir sde cance��n, witl do tne xrork, an0 Ne � swcture ¢ not inten0e0 or oifere0lor sLa (Secuon 7001. Business an0 Prafessional CaOe: Tne ConVactors' SWte Licerrse Law tlas not appry ro an ovmer ol a propeM � huilds or improves iherean, an0 wAa Aow such woIX himsell/herself or Ihroup� ' his or her own em0loyees, proviEed I�at suc� imprmemen6 are not intenUeJ or atleretl tar sale. I/, however Iha huilUinO or 'imD��ement 6 sWE wi[hin one year of completlw, Ne owner will have the 6uNen ol proNnq hdstie AIO not UuiIE m Imprave • for the W� af sale�. ' I, as owner ol tha propeM, am ezclusiveN contactinA m�h licensed contractors to wnsiruct �he Drojaq (Sectbn 7061. Businett ,❑ anG Prolesslons Code: The Contrzctors' �tate License Law Oces not apply lo an owner ot Drope�1y wM bmlEs or Improves IAereon � antl wln conirazts for suc� pml�s with a contrzctor(5) Ikense Oursuam to the Cont2ctors $WI¢ LiceRSB LdW). I 2111 dwdfe tAat praof ol their Warker's Compensation insuaxe ShoulC Ee proviEeO to me. � I am exempt unUer Sedion: B. E P. C. tar Inis reason: Dah: Oxnec I tlo Aereby cehiy t�at I am aware ai and untlerstan0 IAa requirements of Calilomia Mealt� anE Safery Cotle Sections 25505, 25533, an0 25534 anE I�at I of any �Nure builOinp OCCupant vnlVvnll noI (tifde one) neeOlO COmply wiih SdiO Staie m0e5 antl I�e repuirements �Or a ce�mit for consVuction or mo0ifiwtion imm ihe Nr Oualiry Manapement Dktrict. flesiCential constructlon appliwtlons are exempt Imm �hese Ormisions. Oate: � Ap0licant: I hereby ceNry that I have aaE tNs appliwtion anC state ttwt Ihe �Uove intormatqn is mrrect. I apree to compy wii� all ciry an0 counry oNinances anC state Wxs reladn0 �a �uilEinp construcuon and AertEy aWrorire represemaGves ol tha dry lo enter upon t�e above�mentloneE pmDeM �or inspectian Duryoses. /�/1 Date: �— �� — 9� SiOnature: _,�( / d� oriver's License or Socia� Secunry x: � 164148 W�ite—BUIIEirg: Grea�COEe Enfacemenp Canary—Applicem; Pink—Ravanue: Gdtlenro0—Aeaeaaor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: B 048946 PLAN CHECK NO: N CONSTRUCTION TYPE: 5—N PERMIT TYPE; STR JOB DESCRIPTION : REROOF W/CLASS A 30YR COMP PERM NO: B 098946 GOVT; N SUPP: N PURPOSE: ALT SQ FT: 2,200 CLAIM VALUE; 2,200.00 CALC—VALUE: 2,200.00 GROUP OCC: R=3 /M-1 COMMENTS; SMOHE DETECTOR(S) REI�UIRED IN HOME. . x��r+r�**�*��r*�r*x�r�r*��r��r+rx*�r*�r�r�* ��r��r*�r*+��r*+r�r*�rx�+r*��r*�+�*�rx+r*+�***;�***x+��*****�r �� Z O N I N G R E Q U Z R E M E N T S S E T B A C K S ------------ MAZN BUILDZNG ---------- --------- ACCESSORY BUILDING --------- FRNT: FT 'IN REAR: FT IN FRNT: FT IN R£AR: FT IN LEFT: FT ,-IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL; 42629112 ZNE; REF NO; F�LANNING NLSTES> > _ i! iE if 1! k iF it it dE iF fE iklf �E dElE iE i! 1k ik it iE if iF iE it if iE if if if it ik ik iF iE iE if iF ik ik iE iE if iF iF if iE iF it if ik jF if it iF if ik it iF 3E if iE iF 3f iE iF iF iE ik 1F jF 3E it �k if jE iE iE D E V E 7, 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 : _ ��_/)/JA_ _ ___ _______ DATE: _ APPLICATION ISS.UED BY;�� !� �� DATE; ��/ iEiEihiEikiEifiEikiEitiFikiFjEiFiti(�iEiEiFiE tiF�';F', s�. ri ! 7F'�F'i�i� iFihiFiF*�lEiFiF�lkiFit E�iFitiE ifiElElEif9Eififkik3flkitM-3f�t1tiE3fiEif�)kiEifk�EiliEiEiEitiEitikiEiFifiEi6iE�FitiF tiFi4ititifiFiFiEilititiFifititififitiF3EiEiEiE�lEiEitlk3FitiEiPitiE�F LEGALIZATION;N F E E S�U M M A R Y STRUCTURAL_$EGMENT:Y . . iR- BLDG PMT PLUMBING ELECTRIC ,MECHANZC '.� FIRE SMIP/RES,� GRADING PERMIT 54,00 • �_ 50' ti, '�� SMIP/NON=AES PLAN . „ .. ISSUE FEE - ,!, '� I.. BUILDING—DIV—> PERMIT ISSUE P�AN-CHECK �� TOTAL PAID � DUE TOTALS----> 54.50 0.00 0�00 , 54.50 54.50 � .00 REVENUE DIVZSION TOTALS--> COLLEC'�ED:, 54.50 OVER/SHORT: � 00 BLDG PMT PLUMBING ELECTRIC MECHANIC• FIR�E SMIP/TOT GRADING PLAN—CIiECK 54.00 ;- ,-; , � .50 �t if jE iE jt i! iE iF ik i(� iE iE it iF iE it it ik iE ik ik iE it if it �1E iF iE if if it if� it 1F iF iF ik it'i! i6# i(� 3t if it iF iF il i�' ik i4 iE if it iE iE iE i(� iF it �E iE iE �1F iE �E i! iE iE iF iF if iE iE iE iE iE iE 3f I N D I V I D U A L�, F.�j,'E H"'R'E.A R D O W N TYPE QTY D E S C R I P T I O N,' ` UNIT COST TOTAL COST SFR 2200 REROOF BY VALUE RESiDENIFiL NOZONE 1.00 :2�;200.00 END OF.'FEES �' . � � ' � . . �. ,; -f � . r ./ • � r� � � �� , „ r $C r , L P 11 1990 j� � �3 ��o`� ` — �b� CITY OF COSTA NiESA C�'G �1�� C CONSTRUCTION ANDPLANNING APPROVALS Permit # Date _ .�. 1. Temporary Electrical Service or Pole � 2. Soil Pipe�Undrgrnd. � . 3. Electrical Conduit Utility-Undrgrnd. ' 4. Electrical Conduit�Undrgrnd. 5. Steel Reinforcement 6. Electrical U�ER Grnd. . 7. Footings 6. Foundation 9. Water Pipe�Undrgrnd. � 10. Structural Floor System . � 11. Property Sewer �ine & House Connection 12. Sewer Cap 13. Roof Drains 74. Rough Plumbing 15. Rough Elect�ical-Conduit i6. RoughElectricWiring • 17. Rough Wiring Sign 18. Rough Electrical-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. Roof Sheathing Y � 26. T-Bar Ceiling (Slructural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coac 32. Electrical Po�'er Meter�Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Servic¢-Final 40. Gas Service�Final 41. Solar pomesiic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape irrlaatlon System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Rele2se to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICA7E OF OCCUPANCY Date P. & SPA Inspecto� qppROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement - 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER�GUNITE 58.� Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test • 60. Backwash Lines, P�Trap, O Undrgrnd. 61. APPROVAL�TO DECK�• 62. Backwash & Receptor�Final 63. �Heater & Vent-Final 64. Plumbing SYstem � Final 65. Electrical�Final 66. Solar System-Final � , 67. Fencing & Access ApProval 68. APPROVED FOR PLASTERING 69.•POOL/SPFiSYSTEMSFINAL � FIRE DEPT. REQUIREMENT APPFOVALS Permit # 70. Underground Hydro 71. ProductPiping�Gas OOiI 72. U�derground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Gf,. �j_Qe � L .. � � __ . 0 Date � Inspector ApPlicant to ftll in all CITY OF COSTA ESA CO S RU TIO,+V PER IT OL�� -Project Address 3�� ' w °�-� ��C SNE�-r�(�I'oN Pt-K-3��s Applicant's Mailing Addre s Ow�er's Name �/,� L1 S.I�JI L.OSAyI�JEV) C a1hIone � Address (��sT"^�S`�I�Of'� PL—{�'3 N�Po�i .�J�IJ� 1 Arch/Eng. _ License No. a�J Address Cqntracror's Nam.��Phone Address (mailing) Ci�V License No. LI�ENSED CONTRACTOR DECLARATION � ryereby affirm that I am licensetl untler Orovislon5 of Cnarter 9(commencing �yith sectlon ]000) of Dlvision 3 of the Business antl Profes5ions Cotle, antl my Iicense is in full (orce antl effect. License Class L�cense No. Date Si9nature WpRKERS' COMPENSATION DECLARATION � hereby atiirm that I have a certificata o/ consent to zelPinsure or a ceriiticate -WOrkers' Compan5ation Inm�ance, o� a ce�tltietl coOY �nereof (Section 00, Lab. C.) , - Po��CY No. Company Certitietl copy is hereby furnisheA. CertNietl copy is filetl with the c{ty BWltlinq Divlsion. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLA0.ATION (TNS section neetl not be complet¢tl il the pe�mlt IS (or one huntlretl (E300) o� les5). " ��ertify that in lbe perfO�mance of the wo�k for which thl5 Pe�m�t i5 i55uetl, I sha�� not emp�oy any.person in any manner so as [o becoma ¢ubject to the Wtl�kers' ComPenzatiOn LawS o( Calltomia. Da�e Slgnature NtlTICE: If, af[e� making thi5 tlecla�ation, you ShoulC becOme subj¢ct to thB WO�kers' ComDensatlon provi5ion5 Of the l.abOr Cotle, y0u must forthwith coinply with such provlsions or this permit shall be tleemetl revoketl. CQNSTRUCTION LENO�NG AGENCV . ' I hCreby aftirm that there �s a constructlon lentlin9 a9ency for Iha performance ot Ihe work fOr whiGh th15 permit is i51Uetl (Sectlon 309] Civ. C.) Lentler'S Name Lentler's Aatlress , OWNER BUILDEN DECLARATION I Pereby affirm that I am exempt irom the Contractor's Ucense Law for the following'reason (5¢ction �031.5 Businass antl Professional Cotle: Any city or counly which r¢quires a permtt to construct, alter, improve, tlemolisn or repalr anY structure. Prlor to its issuance, also reQWres the applicant for suth permit {o file a signetl sWtemenf that he/she is li[ense� Pu�suant [o tne provisions ot the Contractor's Ucense Law (Chapter 9(mmmen<ing with Se<tion ]000) of O��SiOn 3 0( the Busin¢zs antl Professions COtl!) or that he/she is exempl ♦from ana me basis tor the allegeE exempllon. Any vfolation of Seciion .5 by any applicaqt tor a pe�mit subj¢cts tM1e aOP��an[ [o a clvll F� .Ity of not mor¢ than tive huntlr6tl tlollars (5500). u 1, ds owner o( the Ovoperry Or my employeCS with wag¢5 as the�r sole compensation, will tlo the work, and the structure is not intentletl or off¢retl fof 3ale (Section 7044, Buziness a�tl Protessional Cotle: The ConVactor's . License ldw Coes not app�Y to an owner of a prooerty wlto bullas or imDroves the�eon, antl who tloes Such work nim5elf/h¢rs¢I/ or throU9h his ot he� own ert�Ploy ¢e5, prOvltled that such imp�ovements ale n0[ intentletl or otteretl for sale. If, however, the bui�din9 or imProvement is soltl withi� one year of com- plCtion, the o`�+ner will have the burtlnn of proving he/she dltl not build or im- Ove for [M1e PufDose ot Sale). �� I, as owner o1 the prOperty, am exclusively contractlng wi[h II<ensetl cOn- trd«oR lU coOstfuct the O�oject (Seclion ]08A, Business and P�otessions Cotle: TFIe ConVactor'S License I�w a0es not apply to an owne/ of prOperty who bu��tls or improves thereon, antl wno mntracts Ior such projects witn a con- , ira«or�sl imense pursuant ro thc Contractor's �ic se Law�. I am aware that . prDOf of Iheir Worker's Compensation insurant houltl be provitletl ro me. �� ❑ I am eaempt untler Settion - B. 8y P. C. fm this reason �a�e 'iL('�'7 —�_ Owner " I nereby cerU�Y Ihat I pave reatl nis a icatlon antl state hat y e a�ove intormation iz co ect. I a'9,r,e��e o omp� �th all city antl county�6rtlinances anA state IawS�ting t��ptlin9 COn ruction, antl he�eby autho�ize rep�e- .eeean�e. ,. ��., rn. �m roa anove4nentinnetl mooertv for Dr��er5' CMF 0865-� except those within �eavy Eortle� Ilnes anG si9n all apPrOpriate tlecle�ations. TRqCT N�O. LOT NO. UNIT NO. 11 tt'• TYPE OF CONSTRUCTION LI NEW L� noo ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BL�G. — ALTEFATION LJ REPAIR TYPE OF PERMIT �-1 GRAOING LJ FOUNDATION L75TRUCTURAL ❑ TENANT Q ELECTRICAL ❑ PLUMBING ❑ MECHANICAL O OTHER PROJECt DESCRIPTION Sc3. FT. oCCUPANCv � CONSTRUCTIONTVGE V VALUATION$� 20NE GRAOINGCU.YDS. AGRES_ Remarks: PLUMBING Shnwers Preventer Service Sink I�iigation Sewer Cap ' ' Sewer ConnectiOn Solar Collectors '� Solar Piping � Ing Fountains Drains :>d5 $C�YIC2 Interceptors Kitchen Sink Lavatories P—Trep Roof Orains �U[ICLS Solar Tank Swimming Pool w/Spa Urinal Wacer Closet Water Hearer Water Service . Auto-Wash Laundry Trays Reinspection Fee � $15 I I • Issue Fee . I $ 3 � , MECHANICAL FEE Boiler Duct - Under Ground ' Duct - Structurel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Blt. IC80 # Heating System & Ducting ❑6100,000 BTU �100,000 Reinspection Fee � $75 ]0/84 White - BuilOing; Canary - Appliwnt: Pink - Accounting; GOltlenro0 • Assessor Hood or Typel ❑ Canopy Type I I ❑ Refrigeration SVstem Oaioo,000sru ❑ioo,000 System Repair/Alteration f ire Dampers Registers � . 15sue Fee ' � $ 3 A.P. #E S Main Buildi E T Front ' B Rear A C Right " K Left S Ping. Ref. # Planniny Notes: Aummatic Washer Construction Pole Sub. Cookifg Unit Dishwasher Fan F.A.U. ' Fixtures Device Boxe: OU[1Ct5 $WItCF1E5 Garbage Disposal Generator �65 KW Fee 1538 7/i�:/°7 � 2 � 2one Accessory Building: , Perking Req./Provided r�.�.ei.�. i... ELECTRICAL � FEES Transformer ❑ 15-50 KW ❑ 50+ KW Meter Qup to 100 amps Meter ❑over100amps Sub Panel Moron d0-1 HP O1'h - 8 Inc.Solar 09-75 HP �16-15+ Microwave Pole Light � Range Standing Sections 5-75 KW Trash Compactor $15 luue Fee DEVELOPMENT SERVICES NEQUIREMENTS: Zoning Appraved By Building Approwd By � n � $ 3 SUM V O FEES BUILDING PERMIT $ �� •,� SMIP $ •� �6 PLANCHECK $ �3.5 pERMIT PWMBWG �$ �SSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ � � ELECTRICAL § GRADING $ � PIAN CHECK 50% $ - MICROFILM $ �} MECHANICAL $ � TOTALFEE $ � 3•.�" PLAN CHECK 25% $ � 2 O N I N G R E � M T S CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# � Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . , 4. Electrical Conduit-Undrgrnd. 55. Elecirical Bonding 5. Steel Reinforcement , � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gmd. -, 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, �•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 13. 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 . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace ' APPROVALS Permit # �_ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Froduct Piping OGas ❑Oil 23: Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurap & 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. Orywall Nailing HEALTH DEPT. REQUIREMENT ,. I 31. Plaster Brown Coat � 79. FINAL INSPECTION �� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � '. Notes: 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test . ' � ' 36. Hood or Canopy 37. Final Factory Fireplace � - � 38. Final�Plumbing � , 39. Water Service�Final � ' 40. Gas Service-Final � 41. Solar pomestic-Final � � � ' 42. Backflow Preventer � . - . . 43. Backflow Irrigation � . '44. Landscape Irrigation System 45. Sound Attenuation -- 46. Handicap Regulations Y c�d , 47. FINALSTRUCTURE & BUILDING _ _ _ . 3a3 � � X� l�gc.�9'_ 48. Special Requirements Completed � 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co � 57..CERTIFICATE OF OCCUPANCY { - � No. Date � � �`� � `'� 4'736 COSTA MESA BUILDING DEPARTMENT • P.O. BOX 31� COSTA MESA, CALIFORNIA FOR OWNER � MAIL ADDRE55 CITY ARCHITECT OR ENGINEER APPLICANT TO FILL IN � �' / 9 �i a.f COSTA MESA. CALIFORNIA i � 6 �9 � � '� TEL. �j�_ NO. LIC. NO. LEGRL �ILOT oEScwipilorv NO. A.P. NO. f / �' SIZE � OF LOT � USE OF E%ISTING BLDG. ISETBPCK LINE FROM CErvTEF OF STREET� SIDE YARD DE REPAIR BUIIDING SIZE EXTEftiOR W, COVERING USE OF NEW BUILDING ciTv uc. � NO. �� BLOCK 0 ^ /i ' / i FEE RECEiVEO , � FINANCE`D�EPT�� y C�,T'1 0� COSTA MESA AP LICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY BUILDING A�DRE55 COSTA MESA. CALIFORNIA FIRE � ZONE 20NE � NO.OF TYPE ; PLRNS ^40�� BPPROVED � � /�� INOW ON LOTS l �� REAR YARD S/ / JCu$P_^ C!� ��/ IGHT � LEFT ' IF ON OF WORK �7� ALTERATION AODITION MOVING DEMOLISH NO. OF ROOMS STORIES — ROOF �� COVERING A�.,��n S G♦ 0 G7 ` pLAN1JING DEPT. P 1 STATE THAT THE A60VE IS CORPECT ANO AGREE TO COMPLY WITH ALL CITY OROINANCES AND STATE LPWS REGULFTING B LDING CONSTRUC- iiorv. VALUATION � SIGNATURE OF � EFMIT FEE $ '� PERMITTEE � � � . $ PLAN CHECK $ � � AUTHORIZED AGENT TOTAL FEE $ � / �eMr ' , _ __ , �;; '�,_ 358 5 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNlA 92626 For Applicant to Fill in Com l tely BUII.DING R (/ � �j [''�L ADORESS J / � // � y/ � OWNER `j O � �7 {.�"Q.�jJ IC C�I �I� CITV BRANCH ADDRESS A�OFESS CONTtiACTO♦R ��✓iv1 yV I I's�'� AODRESS / L 0 GO �O � r�) CI T V �� y(¢, STATE � S�y� / LIC. NO. (� SI2E OF LOT USE OF ,� ` � EXISTING BLDG. SIZEOF {/ '. �% � NO.OF BUIIDING AND WORK TO BE � �y NOLDO�� TEL. PAIO 1rdl—fi-73c;,.=-00 427s **':�t��5.50 FOR BUILDING PERMIT f y PE A.P. NO. `' O �� BUILDING 33 y r � � �( ADDRESS TFACT �S 3 LOT � OWNER FIR VALUE �� .• ii v.. . TEL. C ZONE(� NO.OF USE OF NEW NO. JJ I^G�� '`I PLANS � BUILDING (A�V � CITV VARDSAPPROVED VARDSAPPROVED LIC. NO. MAIN BUIIOING A CESSORV BUILDI NO.OF BlOGS. (FROM C/I.sTyE�,T) NpW pN LOT FRONT G` `�' FT FT. R S�IIF IO FT T DISTANCE BET. MAIN BLDCS. VAR. iW C.U.P.qW APPROVED �, DATE APPROVED I heraby aCknOwletlBO Net I have reatl [h(z aOPlicaiion antl rte[e / �" ` that Sha above intormation is correct en0 ap�ee to comply with ell Iews repulat(ng buildin0 consiruction, and I shell not amploy O eny person in vlolation of the workman'z campensatlon laws of � Ma Stero of Cali(omia. � m 1 heroby certity thut 1 em properiy t7censad as e eontractor untler $Q. FT. � 6 ihe Stata of Californle Business antl Profassions Cotla, Divisicn 3, TNE AMOUNT SHOWN UNDER VALUATION IS fOR Chaptar 9, antl that s licenses are In full tOrce antl atfeci, or I TME PURPO6E OF FSTABIISMING A PEflMIT FEE ONLV: q em eaempt from pr visions of iha Stete ot Calitorn�a Business VALUATION antl Professiont otl , Oj'�'�slon 3, H / � ,� �q//� 'M PERMR FEE $ ) sipnnture o��%{� // �� ""i/ � ///�� 'v m Parmlttoe � � � � $ � /1-.�J PLqN CHECK $ �- E �� C� � O Authorizatl Agent LL TOTAL FEE S