HomeMy WebLinkAbout916 18TH ST - Building Permits`�
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(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 916 W 18TH ST
Suite:
Vicinity: GARAGE FOR FRONT UNIT
Parcel Number: 42434105
Applicant: QUACH, HUNG THE
Address: 20 COPPS HILL ST -'
LAGUNA NIGUEL, CA��
Owner: QUACH, HUNG THE,
Address 20 COPPS HILL ST � �
LAGUNA NIGUEL; CA �
C o ntra cto r: O W N E R- B U I L D E R
Address: ' � �
Zip:
Arch :
Zoning:
Phone: 714-839-8770 �
� Zip: 92677 , � � .
Phone:
Zip: 92677
Phone:
Status: ISSUED
Applied: 10103I2001
Issued: 10/03/2007
ISSUED BY:
License: 0
. Eng:
Address� , � � . � � Address: - ' '
, � � ! � Phone: � , � Phone:
Zip: � License: License:
�
SCOPE OF PERMIT
� DEMO PERMIT TO DEMOLISH AN ILLEGALL'Y CONVERTED BEDROOM BACK TO A GARAGE.
REF: EXPIRED PERMIT B0738W � � ' �
Plan Check: $D.00
Permit: $38.75
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection:. $0.00
Total: $39.25.
SETBACKS. ��� �"
MAINSTRUCTURE Pront� 0-0
ACCESSORY � Front' 0-0 �
PARKING Ezistina: o
NOTES:
6
Rear 0- 0
� Rear 0. 0
Reouired: 0
FEE SUMMARY
PLANNING 8 ZONING
Left 0. 0
Left 0- 0
, Proposed: 0
Calc Valuation:
Claim Valuation:
Righl 0- 0
Righl 0- 0
si,000.00
sr,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order far ihe work author(zed under this permit to be considered legal, such work must comply with all epplicable codes, end ali
requlred Inspeetlons and final approvel must be obtalned. Failure to oblain inspections and final approval will result In the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
tsaaee �eroo�
WORKERS' COMPENSAnON DECLAfiAnON:
I hereby eNirtn untler penalty ot per�ury one of Ihe lollowing dedarations:
❑ I have entl wlll malntain e certllicate of consent to setl-Insure lor workers' compensation, es O��ded far by sectian 3700 of the Labor Code, for the pertortnance of Ihe
work tor which Ihis pertnit is Issuetl.
❑ 1 heve enC wlll meintein workers' compensatlon insurence, as required by gec(bn 3700 of Ue Labor CaAe, lor the perlortnanca of Na work for whiU NLs pertnit is issued.
My workers' campe�setlon Insurflnce carrier entl policy number ere:
Cerdor: Policy Number.
(7his SBction need not be complefetl ll O�e permit !s velue0 ef one hundretlOollers ($100) ar less.)
❑ I canity that in the peAortnance of the work for which this permit is issued, I shell not employ eny pereon in eny menner so es ta bewme subject to Ihe workers'
compensation lews of Celifomie, end egree thet il I shoultl become sub�ect to the workers' campensetlon provisions of Section 3700 of the Lebor CaCe, I shall forthwlth
wmply with these provlsions.
Ap011cant Slpnature: - Date:
WARNINO: FAILURE TO SECURE WORNERS' COMPENSATION COVERA6E IS UNLAWFUL ANO SIWL SUBJEGf AN EMPLOVER TO CRIMINAL PENpLT1E5 M1D GVIL FlNES UP TOONE MUN�RED
T1qUSPND OOLLARE (5100,000). IN ADDRION TO THE COST OF COMPENSATION, OAAIhGES AS PROVIDED FOR IN SECTION 31O80F THE UBOR CODE, IMEREST, AND ATTORNEY'S FEES.
IICENSED CONTRACTORS DECLARATION:
I �ereby ettlrm that I em Iicensetl under provisions oi Chapter 9(commencing vnth Sectlon 7000) ot Dlvision 3 0l tha Business antl Protessions Code, flnd my Ilcense Is in tull
fOfCe Bntl BNBC�.LIt. M C18S4 M
Contrenors Slgnemre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eflirtn that Ihera Is a construIXion lentling agency for ihe pertortnance ol the work br w�ich Ihi9 permit is issuetl. (Sec. 3097, Civil Code).
Lentlefs Neme: LenAer's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirm that un0er penelry of perjury that I em EXEMPT FNOM THE CONTFiACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business anO Protessions
CoOe: Any ciry or counry which requires e partnit to cronsiruct, alte�, improve, demolish, or repair eny strucNra, prior to its luuance, also requires the applicant for such permit
to file e slgneC statement Ihat he or she is Ilcensed pursuant to t�e proNslons of the Contrectors LJcense Lew (Chepter H(commanGng wilh Section 7000) at Divislon 3 0l the
Busineas end Prolessions CoCa) or that he or she is e:empt �heroirom and the basis for the ellegeC exomptlon. Any violation ot Sectlon 7031.5 by eny epplicent for e perrt+'
sub cta ihe eppllcant to e clvll penalry of nat more Ihen live huntlred tlollars (E500)J:
I, as owner oi Ihe properry, or my employees wit� wages as iheir sole compensetlon, WILL DO THE WORK, and the structure is no� Intended o� oHered for sale (Sec.
7044, Business and Professions Code: The Coniractors Licensa Lew does not epply to an owner oi properry who builds or improves ihereon, end who does such work
himself or hersetl or I�rough his or her own employees, provided [hat such improvements are not Intended or otteretl for sele. If, however, the building or Improvement Is
soltl wilhin one yeer o1 complation, ihe owner-Dulitler wlil �ave ihe burden ol pmvinp ihat he or she did not builtl or improve for Durpose of sale.).
❑ I, es owner ol t�e praperry, em EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construd ihe pro�ect (Sec. 7044, 8usiness and Professlons
Cotle: The contrectors Llcense Lew tloes not eppty to an owner of pmperty who bulltls ar improves thereon, and who contrects for such pro�ect wlth a conirector(s)
license pursuant to the Conirectors Ucense Lews.).
❑ I am e m t untler sec. Business end Protessions Code for Ihis reeson:
Signeture: ��� [A n�%��� Date:
Owner ID venfietl by drivals license. ❑ es ❑ No Drivals License No. Evpires:
Vedticellon oi OwnersNp by (type ol tlocumeni, i.e. - praperty tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON:
❑ I hereby canlfy Ihat no excavetlon frve (5) or more feet in depth into which e person Is requiretl to tlescen4 wlll Ee made in connection with work authorized by �his
pertnit, and �ha� no building structure, scatfolding, falsework, or demolilion or dismantling Ihereot, will be more Ihan t�irty-six (36) feet high. (Chflp. 3.2, Gry 2, Art 2, Sec.
341, Title B, Calilomla Adminlsiretive Cade).
❑ As owner-builder, I will not employ enyone to do work which would require e pertnil trom Ihe Divislon ot Industrial Selery, es noted flbove, unless such person �es e
permit to Oo such work irom Ihe tlivision.
Signeture: Dale:
Division o� Industnal Safery Permil Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certity untler Denelry ol perjury that I heve read this epplication end state t�et Ihe Informetlon given is
wrrecl. I egree to rnmply with ell state laws entl ciry ardinances releting to builtling consiruc0on, end euthorize reD�esentetives ol the Ciry ol Coste Mesa to enter upon tha
ebove-desCribed pmperty for inspection purposes. I egree not to occupy or ellow occupancy al any Duilding euthorized by this permil until final inspecti n.
7�-r, ,G�,,.� r�.� /�1�, ,o �03 %i
Signature L elOwner(s) Date
AnNOr Aut�adzetl Applicanl
COUE �, INSPECTIONTYPE
1616 Fixed Sysiem Final Fire Pravention
1266 Pool Spa Final
200 Flnal Re-Roof
201 FIneI81ock1Retaining Well
202 Final Fectory Fire Place
203 Final Sign
20a Final Demolltion
Q�/jF� ��$ COpE� INSFECTIONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel Electrical
212 Finel Fire Preventlon
220
222
250
Finel Planning Approval
Finel Slte
Finel Building/Occupancy
�
monEss a euwwc: 916 W 18 TH S T
OfMERSW�I/EIGpqWN: QUACFI, HUNG THE
.^✓ �o� NGUYEN, TAM—MINH T
� 20 COPPS HILL ST
LAGUNA NIGUEL,CA 92677
AppL, yWlINO �DDAESS:
urcnrt[cr on u+m'�+:
41CN.OF FNO: S �WNE55:
car+rx�crars w�:
CONfPACLOfIS YYUNO
�DDNE55
UNT:
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LICEN4ED COMRACTONS OECLIN�TION; � �y�apy a11im uMs prWy d pe�ury Met I em licsnaetl uMer praviana d Cheptar 9
(commenenY v.rh SeUbn ]000) d Drvwun 3 tl Ne B�insa� rd PMatim� Code. eM mY 4mnw u In tutl lacs vd sllad.
cmuc.No.: uc.cuss: uc.r+o.: EXP:
Dme: GoNretla:
OWNEP BUILDEfl DECIAFATON; I Mreb� qf iuder psuly d parjwy thet I am examq trom On CONreCon Lironsa lew lor iM
Idbw'vq romon (5aeion )W t.5 &»iwsa vM PMeaaiom COEe: �iry cry o oounry xAiM rpuirae e pemin lo ewutruct. Mm, impro».
Eemd'o�, a rapei eny sUucwn, pia b b'e�ynm, e6o rpiuu �M eppGu'tl lor euch pamC �o Ns e apneA petemeN Mtl M a she
licenaed Wnuent to IM pwisbna W tM ��edys Imnee lew �Chepls e(commenvp w4h Seqion )OW) d DNeion � d ihe
uln<m and vro�esaior�s coa.I «�na ne «.he o<.amq inadrum end �ne nase �n u�e eAaee ummN�. aiv �ide�un a seaon
. JJ1.5 Ay e�ry eppliraM fw e pumC wibjenf IM eppficaN lo e dd peneAy d M mae lhen ( s hund�ed ddlen �5500��.
C7 I.novmvdtMVW�YamY�Mesw(h �n�AeiwbmmD�.vnTdolhow�k.eMtMawnunendWaMed
7c «MeeWbreebl.`•eclion]oM.6u�e.yeedPrdeaaiomCods:TMCavreaonli�emalawEomndwdvmanormrdpropeny
who WiEa or in V�*^ Owean, ad �1q Aroa cutl� wark h"vnrE a hene� a tlrwp� liu a Mr am emObM�.O��b ihm wcA
impwpnwa era nd "vuaMeE w dleM tor aab. �. hm�wer. �Iw delavp a inpwamW b eotl vmAn one Yev d aomdMun. Ns
owMrbuilder wJl heve ths buMm W pebvieq M a Me EiC nd bdd a imPa+ la tM W�Vae d ubl.
� I. m mmsr d IM popeny. am uMQ.aly wnvmiq wuh YroroeE caVrMon to w�Nud Ma pojeU (SeUion 10u. &niross enA
Pmleunns Code: The Caurrfm �unr law doee m� eDdY b an ww d PWNY who bultl� a'v�wa'a tMrson ud Ma
oontrxn lu wrh prqeae �Mh e murerJor�s) licrosd pveueeu to the Comrmm Licaws lnx�.
� I am e+emp vMr Sec�im: B. 8 P.C.. be Nu �auon:
o�, g � ti a.f �..: � au.a.c.�-
I Eo Miaby cMiy iMl I em ewa d mtl wdenwd Ne ip�umne�v d C �mie Ilaelh E SYsry Cods Seaiom 25505, 259�, vM
2551�. vd Nel l w erry Mws dddW ocaperu rri0/ wi na (ucb aa) nsotl a camCN wiA mJ ama ooMs end IM �F�Ama�ro br
eV��lawavuclionamoAdrNianhomtMAi e�wpanwmOmrid.RoridrYNamY�utlioneppiretomenaRamqlmmiM�a
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Dela: Md�:
WORKEN'S COYVENS�TION OECLAP�TON: I MraEy alfirm uiWr peneGy tl pr�ury ar d the Idbx'vp dsdvNbn:
� I hm� vM vnl mdmen e cMtli�ats d canaeni to �etlamun br wkas' campanW bn. u pwiEaU la Ey 9atlbn �10p d tM laba
Cotle.la ihe parlarmerca ol Ns xwk Iw Mich i�u pxmG w u�uetl.
� I luw and vAI meiNen wakan' mnWmelian i�wrvca. n rpwM by Sadion �)00 d IM lnEu COM. br iM psAamenw d tM
' waM la wM1ich Nu Wrt^� u outl. W wvFen' canDM�ian'vncnerce earrier W D�Y m�m Wr ar�:
c.�;..:
� PdiY Numbr:
r...aon new nw w mmd.�.d r w oam. e m� on. ni.wiw doEu. I+�ool o. w.J
�,] I cenh � In iM psAamencs d iM wM Ior whic� IM pmn4 b WueE. 1 NeA nol wnplvy ury prcn In ury menMr o u lo
b«orm .uMed �o �M woM1ere' comPemetbn lews N cefilamie, anE New ihm x I Jwuk Esrome wbjaa io �M xaMen'
comM�utlion M�'wq W SMbn �100 d �M leba Cod�. I Me0loMrrilh mnM/ rriN �Iw� PW��.
Uob: ApqiceM:
W�minp: F�Nun ro weun woik�ri ro�Itl011 COY�IIy1I� IMMHY( IIIC INII IY�flf III MhIOyM f0 CIIMN/ pMIMM 1lle
n.ii nnu w ro om nuw..e rnou.w Mw. (sixlaooA n.maon m m. co.� or mnn�uen dmw u pcvm.a ror �n
91ctlen 1106 0l tl�� labor Ceb, Intw�s4 �nC �mrmy'� Np.
CONSTRUf.TON LENDINU AOENCY: I hyWy tlfum �vMr q'ully d{wjvy thet tMn b a muuwion bM'vq epxcy br �M
ps�ormancs M tM wk la xfiidi Ih's qeml u'swed (SW ion ]W]. C'v. CI.
LENOEH'S NAYE:
LENUEN'9 AOOPE49:
I ceNh Iha� I heve'eed Nu epqicNion uk qele Ihtl ihe abws'uJom+etion u conec. I pne to campy v,imh eA rYy eM aouruy adirorcm
end clme lev.e releiirq ro huiM'rq cmmuctian ud Mreby eNharrte iapmenletrves d ihe dly to an�m upon the ebvn�meMionaE papeM
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CITY OF COSTA MESA — BUILDZNG PERMIT
PERMIT NO: B 073807 PLAN CHECK NO: N
PERM NO: B 073807
GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: DEM
JOH DESCRIPTION : DEMOLISH ILLEGAL WORK ' SQ FT:
CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000.00 GROUP OCC: R-3 /
COMMEh]TS:=DEMOLISH ILLEGALY CONVERTED HEDROOM BACK TO ORIGINAL AS A GARAGE
3E K iE 1E �IE �E i! �E iE iE if iE iE iE 1E if iE iF �E iE iE 1E if ih if 1E 1k if if 1E �If IE iE ah 1E i! IE jE iE iE IE 1k if iE 1f 1F iE IF i(� 1F IF iF ik iE 1F if 1E iF iF ik iE iE'IE iF 1E IE iE iF 1E iE 1E iE iE iE 1F iE if iE iE
� 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 REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT:� FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ:' �•- PROV: PARCEL: 42434104 ZNE: REF NO:
PLANNING NOTES>.
i
�E IE dE 1E �F iF 1F'If iE �E iE iElE if iE iE 1E 1E �E 1E �1E iE 1E 1E 1F i616 iE if iE iF 1E'IE �E IE 1E iE if if 1E if 1E �If 1E ih �E 1E 1E iF 3E IE if IE iF jE 1E If If 1E 1E ik if ik if iE �h 1E if if ik if ik aE i(� 1E jE iE if if
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
BUILDING APPROVED BY :
APPLICATION ISSUED HY:
iF if 1E 1E 1E aE 1E 1E if IE iE if 1E 1E 1E iE iE iE �E IF if IE��F
LEGALIZATION:Y
BLDG PMT� PLUMBING
PERMIT 50.00
PLAN
ISSUE FEE
HUILDING—DIV—>
TOTALS---->
DATE:
DATE:
DATE:
F�E E ,S U M M A R Y STRUCTURAL SEGMENT:Y
ELECTRIC MECHANIC FIRE SMIP/RES GRADING
SMIP/NON—RES
. 5 �
PERMIT � ISSUE PLAN—CHECK
50.50' 0.00, • 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMHING ELECTRIC MECHANIC
50.00 ,
TOTAL PAID DUE
50.50 50.50 .00
50.50 OVER/SHORT: ,00
FIRE SMIP/TOT GRADING PLAN—CHECK
.50
if 1F iE 1E iE 1k 1E iE 1f if !F iF 161f k iE fE if iE 1f i! iE i! 1E �E iE 1F fk �E iE 1E ik 7E 1E 1E if dk 1E 1f IE'N' iE'IE 1f �IE 1E iE-0E iE 1E i! IE iE 1E 11� 1E 1! 1F 78 iE if ik 1k iE 1E ik 1E 1k if 1E ik IE 1(� 1E i! iE 1f ik 1!
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
NO FEES WERE SELECTED FOR THLS PERMIT
EXPIRED
nA� _ �-l.o- al "} LI�
GI �U?JR�23—QC1834t9 T Ce� 50.5�
OATE= OE�1S%95 TIfi�: p£'3�
� �'
' Pao1 >a
,�CONSTRUCTION AND PLANNING
; APPROVALS Permit�- Date Inspector qppROVALS Permit # Date � Inspector
i
1, Temporary Electrical Service or Pole `'� 52. Pool & Equipment Location .
♦'-9
2. Soil Pipe�Undrgrnd. ^. 53. Steel Reinforcement y
-3. Elettrical Conduit Utility-Undrgmd. ,�: 54. Porms ,.�
4. Electricai Conduit-Undrgrnd. 55. Electrical Bonding -
5. Steel Re�nforcement 56. Rough Plumbing & Pressure Test �
,,
-6. ElEcttical 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, O Undrgrnd.
10. Strucwral Floor SYstem ' 67. APPROVAL TO �ECK
11, Property Sewe. Line & House Connection � 62. Backwash & Receptor•Final
12, Sewer Cap -' 63. Heater & Vent-Final
13. Roof Orains � - 64, Plumbing System � Final
14. Rough Plumbing -+ 65. Electrical-Final
15. Rough Electrical-Conduit : 66. Soiar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18, Rouqh Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � PIRE`UEPT..REQUIREMENT
20. Rough Factory FirAqlace - - ' APPROV};65 . Permie #
21, Ducts�, in Structure ' , '' � � " � � 70. Undergrqund Hydro '.
22. Ducts, VeFltilating 77. ProduFt�Piping OGas �Oil
23. Gas Pipe-Rough & Test � � _ ' 7p, Underground Flush - '
24. Roof Froming' � �� _` 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing - � ' t ��� � 74. Overhead Hydro _
c
26. T-Bar,Ceiling (StruttS�ral) & Monocoat �. 75. Dry Chemical :y
27, Frame and Flasbing _ . � 76. Dry Standpipe ' �
ti.a
28. Lathing&Siding _,' � 3 '� '�� 77, fIXEDSYSTERQ,FINAL , N
29. IneulaCion � � . . .. � ` 78,. FfRE PREV. FINAL � -
30. Drywall Nailing ' . , -,HEALTH DEPT. REQUIf�EMENT ''
31. Plaster Brown Coat ' � * 79. FINAL INSPECTION ''
32. Electrical Power AReterFinal y'� ` 80. FOOD CERTIFICATE 15SUED
33. Final�Electric � . . � Z • Notes � �
� -
34. Fin2f Heating & Air�CQnditionirig= z , . ,
35. Final�Gas Pipe•7est . ' ' -
- 36. Hood or Canopy �� �� . � � -
� 37. Final•Factory Fireplace r � •
38. Final Plumbing . ' : ' . -
3g. Water Service-Fina� � .. � �
40. Gas Service-Final � '- ' - �
qt. $olar OomesiioFinal � � � �. �� '
42. Backflow Preventer ' • - ��
43. Backftow irrigAtion � - r �
A4. Landscape Irrigation System _ � . ' '' : _
q5, Sound Attenuation � . �. • - � ' � _ �
46. Handicap Regulations ! �
47,� FINAL S7RUCTURE & BUILOING . �
48. FINAL PLANNING , - , ' - � ,
49. Electric Release to Edison _ � _
50. Gas Release to Southem Cali(ornia Gas Co ' , ,
51. CERTIFICATE OF OCCUPANCY ' '
No. Date
,j r•�, . 1V�5 i
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
�
fOR APPUCANT TO f/Ll /N COMPLfTE[Y
TYPE OR PR�NT
BUILDING /� . /
ADORESS �9
,COSTA MESA, GALIFORNIA
MAIL � I/ � �(�w�+Cl
AODRE55
TEI.,
CITY NO.
ARCHITECT LIC.
OR ENGINEER NO.
ADL. SS
STATE�'/
CONTRACTOR LIC. NO. 'j"O
ADDRE55 J� � o� /L, , ^ I
LEGRL ILOT � I
nescniPTON NO. BLOCK TRAC
A.P.NO. I( � r � %��—
S12E / l r ♦_ e_.. I NO.OF BLDGB.
USE OF �' ���
EXISTING BLDG. -
SET9ACK L�NE FFOM L—O REAR YAI
CENTER OF STREET �/
SIDE YARD I LEFf �/ I RIGHT
DESCRIPTION OF WORK
REPn... I IIMOVING
BUILDING / NO.O
SIZE �/� x � ROON
EXTERIOR WALL IROOF
COVERING COVE
USE OF BUILOING AND WORK TO
f �
1 HEHEBY ACK�j
AND STATE THd
PLY WITH ALL
BUILDING CONS'
SIGNATURE OF
PERMIITEE_
NAVE fiEAO THIS APPLICATION
CORRECT AND AGFEE TO COM�
AND STATE �-AWS REGUIM1TING
n �A f.(.�C- C�.
L l.�-/-✓La-/
_, i�, � k_ �. �. C J k.. �
AU G i l 1959
FINANCE DEPT.
CITY OF r,(1Crq MESA
APPLICATION FOR PERMIT
BUILDING
FOR Off/CE USE ONLY
HECEIP� NO. PERMIT
,� /�
REC�`Y � O(�TE%%CCIVEp.� I D�T%58
jri j Q �7
BUILDING' e
ADDRE55
COSTA MESA. CALIFORNIA
ZONING
ZONE ,1- I NO.OF � U8E OF NEW
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PLA
DEPT.
AMOUNT BNOWN UNDER VALl1ATION IB fOH THE
'OSE OF ESTAB48HING A PEFMIT FE6 ONLV.
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j , PERMIT FEE $
f/% r
�H � ,,L N CHECK S ��
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' � 1222�
CBSTA MESA BUILDING-SAFETY•DEPARTMENT
P. O. BOX 917 C08TA M68A. CALIFOiWIA
For Applieant fo Fill In Complefely
TYPE OR PRINT
BUILDING s.__ o„ i i /t TN �-.,�
COSTA MESA. CALIFORNIA
r�r
FEE RECEIVED
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FlNANCE DEPT.
CfTY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RCC8IPT NO. PBNNIT NO.
PEC81V8D !Y OAiB pECE�VED
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CITY � f �/ ESH NO. ~� �'✓C qDDRE55 I V NY O r�' �
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OR ' �INEER NO.
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SIZE NO. OF BIDCB.
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USE OF YAROS EVES
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DESCRIPTION OF WORK
WA�L
WORK TO BE
L. SIDE I �
— REAR
APPROVED
— BY
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I X80.8BV �CKNOWLHDG6 T11AT 1 HAVH RBAD iN18 MVLIGTION
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VALUATION
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VALUATION IB POH THH
• PBRMIT F88 ONLY.
' FEE $ � � �
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