HomeMy WebLinkAbout459 18TH ST - Building Permits(714) 754-5273 • Fex (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
459 E 18TH ST
11737219
ELECTRICAL PERMIT
ApplicanC ELIEZER CHEDDY CASTILLO-
� -c . .. ,
Address: 13722 BECKNER ST . � ` � � - � � � . �
. .i
� = � � " Phone: 6262557629 ' �
LA PUENTE, CA �� Zip: 91746 ,� -
/..
Owner: �, HILC; ANN-M}TR �
Address-, 4$9 18TH ST �
COSTA MESA, CA
Convactor. QWNER-BUILDER
Address:
Phone:
Zip: 92627
Phone:
Zip.
License: 000000
Status: ISSUED
Applied: 08/02/2004
Issued: 08/02/2004
ISSUED BY:
SCOPE OF PERMIT
RELOCATE 100 AMP SERVICE,�ADD t SUB PANEL UP TO 200 AMPS, AND ADD 4 OUTLETS IN YHE
GARAGE.
� FEE SUMMARY � �
' Quantity � ' - - � - - Quantity ; -
ISSUE FEE $23.50 Temp Dist System! Lighting 50.00 0- � �,
Temp service test $0.00 � Busway /100 ft . �-50.00 0,�
Res. alc package , $0.00 Standing Sectlon � 50.00 ,0 � � ' � -
New Res (1-2 units) � $0.00 0 Misc Electrical Equipment $0.00 :; 0", -- ,
New Res (3+uniLs) , �, $0.00 0 ;�?,"• Transformers up to 1 kva/kw $0.00 : i„-0` .
Pool I Spa . . . -$0.00 0 - .......... � ..;up to 10 kvalkw 50.00 t : � -0 � � "�
�:..
..::?l.�' .. , i'
Lightlng Fizts �� �� '$0.00 0 �� " � � ..............:..up'to,50 kva/kw $0.00; � � 0 .� , -
Recept Outlets ��$4.40 , 4 � " �� ..... `..........uP to 100-kJalkw � � �. � -50.00, � 0 • ;
Switches � - � $0.00 � 0 � - � . ..................over 100 kva/kw 50.00 0 �
Non Res Appl � j $0.00 0 '� , Low Voltage Equipment "%50.00� �� 0 "
i
Res Appl � . 50.00 � - � 0 � �� Low VOIt Wiring 5ystem / Ckt' .��30.00 ,i :-0� �/
�
Service to 200a �� - � $30.50�- � 1 � � �� - " ' ; Misc. Conduit �=_.= % `� 50.00 . � <�0 ��-
i -
Serviceto t000a $0.00 : 0 �-, - � �. ;Misa Conductor ' � � ':50.00 �� 0; �i��
Service over t000a � $0.00 � 0 � Circus ( gen or ride) � �,\ �$0,�00 �� 0�
Motors to thp � $0.00 �� 0 , Circus (mech ride or lights) ���50.00 i'� 0
Motors to 10hp �$0.00 0'- ', Christmas Tree Stand 50.00 �j 0
Motors to SOhp $0.00 0 � � Flreworks Sland- .� _ ��50.00� 0
Motore to t00hp $0.00�- 0 �- - ' , Other Electrical�Pee � "� $0.00
Motors over 100hp $0.00 0.- . -%'- i�
Communicatlon drops j0.00 0 � . -' _ . _ ,, - Investlga0on Fee - � � 50.00 i
Sub panel to 200a $30.50 1 -- � Plan Check Fee � 50.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
�egulations. (O�d. Nb. 92-28, § 1, 72-27-92)
EXPIRATION: This permit shall automatically expire and become void Ii work is not commenced within 180 days, or ii work is suspentled or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlona and Iinal approval must be obtalned. Failure to obtain inspections and finai approval will result in the expiration of ihis permit. .
FOR INSPECTIONS CAIL: (714) 754-5626
� '3_:�(�:9]
WORKEHS' COMPENSATION DECIARATION:
I �ereby eMrtn under penalry oi perjury one ot the following declaretions:
❑ 1 heve end wlll maintein e certlticete of wnsem to seu-Insuro 1or workers' wmpensetian, es pmWded for by sectlon 3700 at the Lebor Code, for the partormence oi the
work for which Ihis permit is Issued.
❑ I heve entl wlll mainteln worker9' compansetlon Insurance, as requiretl by section 3700 of Ne Lebor Cade, far the perfortnence ol tha work lor whiU thls pertnit IS issued.
My workere' compensation Insurence cartler end policy number ere:
Carrier. Pollcy Num�er:
(Thls sectbn need not be complefed ll fhe pemrl( fs ve/ued af one hundred dollers ($ f00) or /ess.)
in the peAormence of Iha wark tor whic� Ihis pertnit Is issued, I ahell not employ any person In any manner so es to become subJect to the workere'
ui laws o1 Celltomla, end epree Net it I should Decome sub�ect to t�e workers' compensetbn provisions of Sectlm 3700 of the Lebor Cade, I shell forthwith
tnese p�rovisl 4 ��� � _9 C
�8:� %/ t e e: %/1 � � /
Tp CURE WOHKERS' COMPEN54TIIXJ COVERAOE IS UNUW FUL MlD SW�LL SUBJECT Ml EM�FA.TO.CiSAUNAL PENALTIES AND CML FlNES UP TOIXJE HUNDRED
IE (E100,000I. IN ADDITIIXJ TO THE WST OF COMPENSATION, DAMFGES AS PRONDED FOR IN SEC710N 3/W OF TNE IABOR COOE, INfEREST, AND ATTORNEI"5 FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby eKrm Ihat I am Iicensed unOer proNsions ot Chapter 9(wmmendng wlth Section 7000) of DiNsion 3 ot the Business and Professlons Code, and my license Is In full
10tce end Bflect. Lit. M Cless M
Conireccofs Signeture: Date:
CONSTRUCTON LENDING AGENCY:
❑ I here�y eKrm that there is e construction lending agency for ihe peRortnance oi the work far which Ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lentlefs Nama: Lentler's Adaress:
Signeture: Date:
OWNER-BUILDER DECLARATONS:
I hereby aitirtn that untler penalry ol perJury t�at I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tw the following reason (Sec. 7037.5, Business end Prolessions
Coda: My Gty or counry which reqWres e permit to conswcl, elter, improve, demolish, or repair eny sWcture, prior to its issuance, also requlres Ihe applicant for such pertnit
to Ole a signeC stetement Nat he or she is Ilcensed pursuant to the proNslons ot the Con[ractars Lkerue Law (Chapter 9(commendnp wlth Sectlon 7000) of DMsion 3 01 t�e
Business en0 Pmfessions Code) or thet �e or ahe is exempt Iherefrom end the basis for Ihe ellegetl e:emption. My vldatlon ot SecUon 703L5 by eny epplicent br e permit
sub�ects Ihe eppllcent ta e clvil penelry of not mora then five huntlred tlallars (E500).):
❑ I, es owner ol the properry, or my employees wlth wages es their sole compensetion, WILL DO THE WORK, end the stn�qure Is rrot Iniended or oMered tor sele (Sec.
7044, Business anC Professions Code: The Contractors lJcense Lew tloes not appty lo an axner af praperry who builtls or improves thereon, end who does such work
�Imself or herself or through his o� her own employees, provitletl thet such Improvemems ere not intended or ottered for sale. If, however, Ihe builEing or Impmvement is
sold within one year oi campletlon, the ownerDuiltler will have Ihe burden of pmving that he or she did nat build or impmva tor purpose oi eale.). '
❑ I, es owner ot the properry, em E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construd the pro�ect (Sec. 7044, Businese and Proteaalons
CoOe: The conirectors Liconse Lew tlaes nat epply to en owner ol property who bullds or improves I�ereon, entl who conlrecis lor such pro�ect wlth e contrector(s)
Ilcense pursuent to ihe Contractors Licensa Lews.).
❑ I em exempt under sec. Business end Prolessions Cotle lor ihis reason:
Signature: Date:
Owner ID verifietl by drivers Ilcensa. ❑ Yes ❑ No Drivefs lJcense No.
Verification of Ownership by (type of Cocument I.e. - DroDeny tex bill or tlaetl):
DIVISION OF INDUSTRIAL SAFE7V PERMIT CER7IFICATION:
E:pires:
❑ I hereby certtly that na e:cavetlon five (5) or more feet In depth into which e pereon is requlred to tlescend, wlll be made in connection wlth work euthorized by this
pertnil, end that no bullding structure, scettoltling, ielsowork, or demolition or dlsmantling t�ereol, wlll be more ihen ihirry-sla (36) leet hig�. (Chep. 32, Grp 2, An 2, Sec.
341, Ttla 8, Celitomia Administrative Cotle).
❑ As ov.ner-bullder, I wlll not employ anyone to tlo work w�ich would require a permit irwn the Dlvlslon of Indusiriel Sefey, es notetl eUove, uNess such person hes e
pertnit lo tlo suU work from the division.
Signeture: Date:
Dlvisim of Intlusirial Safety Pertnit Numbar.
CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF EMRV: I cenity under penalty ol perjury ihat I have reatl Uis epplicatlon entl sWte thet the information given is
cortect I egree to compy wllh ell state laws end city ortlinances reletinp to builAing constructlon, en0 euthotlze represematives of t�e Ciry ol Costa Mesa to enter upon the
ebove-tloscribed properry tor Inspection Dwposes. I agree not ta accupy or allow occupanry ot eny building euthonzad by this permil until finel inspeciion.
COOE �. INSVECTION TYPE
7818 FIxeC System Final Fire Preventlon
1268 Pool Spa Final
200 Finel R�Roo1
201 Flnei Block/Retaining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
I�LS �cQPE,( INSPECTIONTYVE
208 Final Mechanical
20B Finel PlumDing
210 Final Electrical
212 Flnal Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final BuildinyOccupancy
I�
Pfl0.1ECT RUDflE55: q S 9 E 1 B TH ST '
OWNEN'SNAME: HILL ANN M TR
`. aoneess: 4 5 9 � 8 TH ST
COSTA MESA,CA 92627
646-9576
AHCM/ENGINEEfl: qEG.NO.:
ROUflESS:
UNIT:
UNIT:
renrninee: GREATER PACIFIC ROOFING ( 714 ) 836-1966
noowess: 1016 E. FIRST ST
SANTA ANA CA 92701
I�tENSE� CONTflRCTON OECIAflRTION: I IlereEy alfirm tlul I am IicenSM unEer pmvisions of C�apier 9(commencinq wii� Section
70001 0l DiviLon 3 0l Ihe Business ane Prohss�ong �e. ana my license is in lull lofce anJ eflect.
ciTruc.: 056858 sTnreuc.:62136Q/� ss: C-39/
te: �_ 2 � SiAnaiure� �(�P-G (,�( � �f
WaNNEPS COMP�U8F710N: I here�Y allirm i�at I have a certilicaie ol consenl to sell�insure or a certiliwte of WorkeK
Compen5ation Ipcy��e_qi 4cetU�ie4yppytperyoL��c�ion 3800, lae C1
POLILYNO.: �� 7 UIV11UVltib E%P.DRTE: 0�1/O1/95
I coMraxr: STATE FUND,-Y
IQ Cendie0 cap rs here0y fumisne0. L? Ceni�ietl covY �s ' �y Buil0in9 OiviS'
ate: � pppiicai���
EXEMPTI FpOM PREXS' COMPENSITION OECIAFUTION: (TNs section need no1 Ge compkleE il ihe ptt 'I b lor qre hunErtG (5100) a lus�.
I cenify Inal in �ne oeAormance al ihe work lor wnich Ihis permil is issuea. I snall not emD�oy any oerson in any manner so as to Gecome
suE�ect io ine woBers' Comoensation Laws ol Calilamia.
Oate: Si9nature:
NO710E: II. after making I�is Eeclaration, you shoula Uecame sublect lo ihe Workers Compensation Dradsions of t�e laEor
COE¢. y0u mus� IOrthwit� COmpiy wil� suc� prphsions ar this permi� shall Ge C¢em¢d revoketl.
CONSTBUCT10N LENOING RGENCY: I nere0y affirm that there is a mnslNction IenOinp aAency for tAe DeAormance of ihe wOd for
w�ic� t�i5 oermil is issue0 (Stttion 3097. Gv. C�.
LENDEfl:
RODNESS:
OWNEfl BUILOEB OECLAflRT10N: 1 �¢r¢by a�lirm �pai I am enempl Imm �he COnlrac�or5' State License Law lor tne fallowinp reason
(Seciron 7031.5 Business anA Pmfeuional Cotle: Any city of county wnicn repuires a Oermit to canslNci. alter, imprOve, demolisn. or
repair any S�mcWre. Orior to its issuanc¢. also repuire5 the aDUlicanl for such permi� [o �ile a signed s�a�emen� �ha� h¢/s�e is licensed
pursuam m �ne pmvisions ol ine Conlractors' State License Law �Chapter 9 �commencinA ��h Section 7000) ol �ivision 3 0l tAe Business
anC Pwtes9ons CAEe) ot I�at �e/zhe is eKempt the�elrom and the Uasis for the alleAe� exemp�ion. Any nolatian ol Sectbn 7031.5 Gy
any applitan� tor a permit suGj¢[I5 I�¢ aOPlicant lo a civil penal�y oi no� more Ihan tive �undreE Eoliars (SSOU).
I. as owner of tne pmperty or my emy�py¢es with waAes as ineir sole compen5atbn, will Aa the work. ana tAe
❑ strucNre is not intenOeE or ottereG lor saie (6ection 70d4. Buvness anC Prolessianal CoEe: TAe Contactors' SWte license Law
Eoes nol appty to an Owner o� a pmp¢rty w�p puilAs or imD�oveS I�ereOn, antl wh0 tloe5 SUC� wOM1 AimSelOherself or [hrwq�
nis or �e� wm emplayees, proviCeE ihat spc� imD�ovements.are notinten0etl or offere0 tor ule.11, however ihe builtlinq or
imprwemem is mla vnt�in one year ol completion. t�e owner xill Aave ihe 6ur0en of Omvinp �e/s�e Gid not EWO or impmve
lor ine ourpose ol sale�.
1. as awner ol ihe pmpeny. am eeclusively coniracting with IicenseE coniractars to consimct tAe D�olect 4Section 7044, Business
�J anU Rolestims CaEe: TAe Coniractars Sta�e License Law Ooes nol appry to an owner of pm0erty who bwlds or improves tAertron
antl w�o cantracts lor suc� pmjec�s wilh a camraclor(s� license pursuan� �a ��e Comracmrs' Slaie License Law�. 1 am awam
t�at pmol of t�eir Worker's Compensation insurance s�oultl be provitle0 to me.
� 1 am e.empt un0er Section: B. 8 P. C.
lor IN5 reason:
Date: Ovmer:
I ao nertW cenity �nat I am aware ot an0 un0ersiantl tne repuirements ol Calilomia Healih anU Safery COEe Sections 25505, 25533, an0
2553< a�b tnat I or any lumre GuiiGinB acupam vnllnMp �o� (diUe one� nee0 io compty vni� saiA state co�es an0 t�e repuiremrnts lor a
Oermil Im conslmclion or moGilicatian imm Ine Fir uatily ManaAemem Uislric�. flesidential conslmciion aODlica�ions are exempi Imm
tnese Wovisians.
Dale: AOPlican�: _
I �eiepy terlityillal I have featl IhiS applicali0n and SIa121halille a
Ortlmantt5 an0 Slate laws relatinp t0 OuilGinp tonslmc�ion an0 here0y
properiy lor injpeClian Ourposei ,
�/[/ � Sipnature:,
or soc�i securay �:
I agree �o com0ly wilh all city anU county
tAis ciry to enter upan the a0we�mentioneG
1841.a6 Wnne—euilamg: Gwen—CaOa Enio¢BmenL Ganery—Applicant; Pink—Rovenoe;
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06656
PERMIT NO: B 066560 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PEAMIT TYPE: STA PURPOSE: ALT
JOB DESCRIPTION ; T/OFF REROOF W/COMP SQ FT: 3,090
CLAIM VALUE: 3,090,00 CALC—VALUE: 3,090.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR REQUIRED PRIOA TO FINAL
+tit**+�it*�+�*+r+r+t****+�*****�+�+e+r+t�r�*+�*w+r+��rr�*******w*�ir*+titit��+�it�*+�*it*+t**+r+�it�*x�+�+r*x�*+t
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAA; FT ZN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL: 11737219 ZNE: REF NO:
PLANNING N25TES>
�
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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
20NSNG APPROVED BY DATE:
BUILDING APPROVED HY �c ., /1 , DATE:
APPLICATION ISSUED BY
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LEGALIZATION:N
BLDG PMT
PERMIT 63,00
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F E E S M M A R Y
PLUMBING ELECTRIC MECHANIC
.Z �
STROCTURAL SEGMENT:Y
FIRE SMIP/R55� GRADING
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CE{ECK TOTAL PAID DUE
TOTALS----> 63.50 0.00 0,00 63,50 63.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHORT: .00
BLDG PMT PLOMBING ELECTRIC MECfiANIC FIRE SMIP/TOT GRADING PLAN—CHECK
63.00.. .50
it 1k k k 1F 1! 1f 1E 1t 1F iE 7t iE if i! M if 7F iE iE 1t iE 1f 1E 1t 4 4/f 1k 1F ik iE iE iE ik iF iF if M 1F M if if if M if �f !F if 1k 1f ik iE it iF M it if iE if if 1F ik iF M 1f M iF 1E 1F 1k 1f itr It k if it fE if
I N D I V I D U 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 3090 REKOOF BY VALUE RESIDENTIAL NOZONE 1.00 3,090.00
END OF FEES
01 001`7854—QD157855 TC�T 63.50
DA7E� 03/28/94 TIME� 13�35
.
� 1.,ONSTRUC710N AND PLANNING POOL Y S �
APPROVALS Permit# Date Inspector pPpqOVALS Permit,$ Date Inspector
1. Temporary Electrical Ser �e or Pole,v 52. Pool & Equipmeot Locacion �
2. Soil Pipe�Undrgrnd. x+ y�: 53. Steel Reinforcement
. [,3��f�ctt�kal Co�d�,li�Cltf�ity-'�tndrgrnt�,�"' 54. Forms
�;; 4..ElQctcsai Con'w D�� drgrnd. ��p 55. Electrical Bond�ng
"'�•SF�eel',-�teinforcmiz��{ �,�C'„ 56. Rough Plumhing & Pressure Test C
i,
��;z; ctrical UF ;6rnd, c� 57. APPROVAL TO COVER�GUNITE �
r:
� 7. Edotings -'� rt' 58. Electrical Conduit-Undrgrnd.
a. -
_�'8. Foundation .j' � �. ' 59. Gas Pipe. � Undrgrnd., Test V
9. Water Pipe-Un6kgnnd. , • 60. Backwash Lines,•P�Trap, O Undrgrnd.
�
10. Struccural Flodf System ._ 67. APPROVAL TO DECK
17. Pypperty Sewe�Lir�e,& Hqnse Conqection 62. Backwash & Recepior-final
n
� 2• Sek'e� CaP 4 y, . 63. Heater & Vent-Finai
73. Roof Drains ' 64. Plumbing System - Final .
14. Rough Plumbii�g ` 65. Electrical�Final
75. Rough Electric:jl�Condult 66. Solar SYstem-Final
i 6. Rough Electri ? �iring 67. Fencing & Access ApProval I
77. Rough Wirin9 $jgn 68. APPROVED FOR PLASTERING
18, Aough Electri6aY-T Bar Ceitin� 69. POOUSPA SYSTEPAS FINAL
19. Ro�gh Heating & Air Conditioning FIRE �EPT. REQUIREM1�tENT
20.-Ropgh F�cteaY �JaPlace � �p; ��� � O `. 7'x �� PPRflVALS ��:.Pecmit# � >- �
T-k � c .+ 1,> n�y� '� r '
21 ;:�u€js, i�Str�ct�c'� .. .. ",c' � ~ r y�� sA 9C4y Y m
#� ,-, � S p �..� « ,y 70. Under - H�ro
22. Dutvs. �bntttaurtg�t t J:_ r. f s'T *�71. Produc • i�ig CT��s �Oil
23.�Ga�iP�o�h &'Test � � � r' r. r. V' I 1' O;C�. • L', �-+
*.:: a tTt a � p�y: . 72. Under9��4 F�uiY.iro -. O
24: }io Framin9 � x� � r• r� � =-' % �� � � 73�Undergm77� Storag9Tank �O Gas ❑ CTrI
25. RoB� SFf��thing � + � ..�v,�(�3� �� C , i � ! ..�4,•�jPyerhead�Fiydro F'' �
26:1f-BeF Ceiling fSt�ycturall &�-�fAetwcoat O T�+ 75^Dry Chemical u"'� ■� ^ a
^� n,
2�. -Freme a�d Flash(n . • �� ^' ' F• O i: + S T: �
� :n`�: �a: ' �^ ?+ z i+ 76. D�'ry Stand�i,�e Fc.^ t O
,. 8:'La m =& 5 m � � , ~��•�^ ^ : s . ..i < ' ,.. .. .. T
th� 9_ ,�� 2-� •� h�c'.. -, a. 77N�FIXED9T+fiTENPE7NAL �
>29. Insulatidn � �t �' ��" " � ` � r t 78�FIRE PREV. FINq{ : ) � j
R30. Dry�va��,%Blaikrg n> " � ��' f r i -� kEALTIfipEPTz REQEJIREMENT
. ,
r31. Plaster 8'row,c�Coet� s, � ,',m �� • • .79�FINAL IN`�P.�CTI�tN � � �7
n32,-Electricai Poe�yer ea rFinai � . .. � '�r� ' J' � { 'J r •
t�9 fl, x n5 �fi -. O.;-F000 CERTIFI.CF.C�E tSSUED
- - s .. ..n r- i
3.=Fin31 EIp�tri�1 { i : � i . � � No'f'es. '=' "' '� �`7
'�' t !� T� IT� * � r: •:i7 '1 N� -
�34.-fin�S Hc�ting�& r�i�Coriditioj��c��' �j ' ir � � � ?j:z '� ^ .� ap
- . ,.�
35.Yfinai Gas Pipg•Te`ts x�� + �: r C, i' 015 � C" SL`
� �L~ '1 H f. •� � xo �;.w . t-�r•
,;36'Noo� or Canopyi_• ,2 .• • i n � T � . � r
O* � 'N�" '� + ( i t 6... E f1C t. S'n
� 1 . M „y �
`97.�.Fin�i Factory FifEpYaccr �_'z '_ #'" 1 i 'k s E r C� r. m
�8. Find{ Plumbing ,� k '� � •• .. � T ! I �; + `� � H R. y. -
'39. Wai9Y Service�inal^ T i a� �. S , { T.` � C` �er x� G
I
=�h0. Gas Service-'inal � � '� � " � �-' . • « ,•, .•
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+ �
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� h ! � C'
48.:FII�L P�AF3NIN� i ��, x :ti: I � . �+ i ? • . ��� �
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i .�' •� � �
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� - F• r. .7 o m
.51. CEF�jIFICA7E OF__ CCUPANC __ � „ ; y �. _ G f, �. �� .�
No. Dace
� _.. •
6632
COSTA MESA BUILDiNG DEPARTMENT
P.O.BO% 31�
COSTA MESA. CALIFORNIA
FOR
MAIL
ADDRE55
CITY �
ARCHITECT
OR ENGINEER
ADO
TO FILL IN
's9 �/�'�.
COSTA MESA.0
o �. t �
.w/\ i� )r��'�' �
�
�
i e�.
NO.
LIC.
NO.
CITV LIC.
NO.
oescnivrion INO. � IBLOCK ITRACT//_L
H
A.P. NO. � �
SIZE NO.OF DGS.
OF LOT � now orv �oi
USE OF �(� ��� J�e
EXISTING BLDG. /j � ��
SETBI.CK LINE FROM � �
c[Niea or sincei � REAR VARD
5 � 3�
SIDE YARD RIGMT LEFT
DESCRIPTION OF WORK
NEW ALTERATION AODITION
REPAIF MOVING DEMOLISH
BUILDING r10.OF
SIZE ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
BUELDINGEW Q�QL.LI�� �/��,-(���
V 1
��� ��CEI�E�
N—a � —sg o �.
fiNANCE DEPT.
APPLICi4'T�ON�°FOR�cFERMIT
BUILDING
OR OFFICE USE ONLY
RECEIPT NO. PEHMIT NO
30
E IVBOBY FT�I�Q, �p�5
L // �
r
.DING t�'S�9' ��-sr /b''`<
RE55
COSTA MESA. CALIFORNIA
//f7J(C� DATE �/Z�
CORRECTIONS
TO AIbG. DEPT. REG.
�
�
STSTE TMAT THE /�BOVE IS CORRECT �rvD 46NEE TO COMPLV WITH wLL
CITY ORDIN�NCES • T�TE 5 REGUL�TING BWLDING CONSTPUU
TiON, yq�UATION
SIGNATURE OF PERMIT FEE S ��
PERMITTEE �f
� /� � � � � � �'L/N CHECN 5 Y�
Eld $
AUTHORIZE AGENT � ` TOTAL FEE 8� Z� ��r