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COS7A MESA BUIIDING-SAFETY DEPARTMENT(/ IM
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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ForApp�icant to Fill in Comp�etely ' APPLICATION FOR BUILDING PERMIT
L RECEIV/E�O BY DATE fl� IVED DATE ISSUED/ �
ADORE55 Gi GL ��� I.� N P I l ✓ h.l e/` V/G� 'J � i't '/ �/ -� -[^�
_1/� I.-{� I�I—�C7I- �Z P�MITNO.�
OWNER � Ia I V /^'. `� I�t �. �� N.4 1- A.P. NO.
MA I L �j �- BUI LDING �
ADDRESS �i f �Q /.-J 'C�� � f� i� � 1 AOOFESS ��(� �jqR� 2 `�.
CITY � O S f TEL.� 1C TRACT LOT BLOCK
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OWNER /w r/Gi�f .'x . i� iii
ADDRESS � J �/ / ,� / VALUE � �'J
ARCHITECT {-� TEL S �(�'l� �.C*� �7�� s c!'n
ORENGI EER �I� �1)• {C e f� C7 R�'!.I N ���� �•Z
ADDFESS �/ 4 I SO � ��'. � U �j' ��� . FIRE ��_• /ryJ,��
'� � 20NE T/VPE /l.1 GFOUP.,'
� APPROVED `( �� � J /Ji�// �n
CONTRACTOR !� � /= � ) p (D � n,-�f �_ BY �/-r ZtJ- DATE (7 /
ADDRESS ��f � rj � 1�' S 1 h �� ' !,�
TEL. ZO�N,{E NO.OF �j USE OF NEW /E Vi D«��
CITV j��(_;-�('�� NO. �=f ��Vj(� IVII P�� (� BUILDING
T.��� Seai�c�
STATE / / CITV VARDS APPROVED VARDS APPROVEO
LIC. MO. /�J �[p L� Ll0. NO. MAIN BUIIDING ACCESSORY BUILDING
SI2E NO.OF BLDGS. (FROM C/LSTREET)
OF LOT NOW ON LOT FRONT FT. �''I/, J FT.
USE OF "'� ) �v
E%I5TING BIDG. E �� T. �. 1+�' FT
SIZE OF NO.OF
� 1 �
NEW BLDC.. ROOMS STORIES L. SI�E V � FT�. FT.
EXTERIOR WALL ROOF � ,�1Y � '
COVERING COVEqING REAR�7 ✓FT. FT. �
USE OF 9UILDING AND WOFK TO BE PERFORMED DISTANCE BET. BET. MAIN & \���
MAIN BLDGS. ACCE55. BLDGS.
/` � � � y �i; VAR. # DATE
i� � � / I'1 � /// � I' 7�I 7 �/ i(. �� C.U.P. a1`-� APPROVED
APPROVED //Il �/ n/( .�- .�"' F� /
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I hereby acknowietlpe that 1 hava reed this application entl smte
thet tha above information is carrect antl agrea to comply with
all laws reBulatin8 builtling construcxion, antl I shall not employ
any pers0� in violation of the workman's compansation lawz of
t�e State of Celitornia. W
I hereby certity [hat 1 am prOperly licansetl es e contrac[or untler SQ. FT. O
Me State of California Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VAIUATION IS FOR
Chaptar 9, antl that such licanses ara in full force entl ettett, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: Q
am exemPi from the provisians ot the S[a[a of CalitOrnia Businass VA�U/+TION
antl Professions Cotle, Division 3, Chapier 9. � pERM1T FEE $ � �
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Sipnaara.o�i i��/ �� �� � OU �___ E
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Permitte'e-% �-' ��� /���' ' S�` PLAN CHECK 5
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Au[horizdtl Agent TOTAL FEE 5 � ' LL
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� COSTA MESA BUILDING,SAFETY DEPARTMEN7
' P 0 BOX IZ00
f . . _ -
� Costa Meaa, Califoroia � -
ADDRE55 � J.--
CITV {V - � '�� ,-
NO. IT�M
Dwellin9, Sq. Ft.
Garage, Sq. Ft.
Firsf ZO Outlat�, aach
Oullat�, Additional
Firsl �0 FixNrss, aach
Fiatures, Additional
Dryar
Fon
Heater
Oven, Domastic
Pole, Comtructioq�
7�
Range, Dpmaslic�
� '�� ' I 7RqCT NO. t+i PERMIT NO.
REC'D BY � '� � �� �� ,
� � i AI �� � r " LOT NO. - . �
� 7 � __-- DATE ISSUED
BUILDING USE .ry
���^_1�TEL.NO.G;�_�-�;�% `'!. �1/
: ( %CUSS � ! �
BWtDING �.�, �r� �"j � �
�� }�� ADDRE55 �/f � � � � "
�ACN �flf C0.5TA MESA, CALIfORNIA ,�
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F�/I � ���1 �.
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I XEREBY� ACKNOWLEOGE THAT i MAVE READ TMIS APPLI•
GTION AND �STATE TMAi THE ABOVE IS CORRECT AND AGREE
TOiCOMPIY�WITH ALL CITY ORDINANCES AND STATE lAWS REG�
`U4'ATI�C EIECTRICAI WIRING.
y�l CE0.71FY TMAT 1 PoSSE55 TNE ABOVE VALID STATE OF
GIIFORNIA CLASSIFIUTION OR,.I�AM TNE LEGAL OWNER OF
THE SINGLE FAMIIY RESIDEMIAI PROPERTY DESCRIlED ABOVE.
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PERMITTEE I!_/:. � • � " " ' -7
110.' ITIM - UCM lfFf
Siyn 6 1 Tronf. 2.00
Tranfforman KW
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HP $ub-Total Fess
HP • APPROVAlS
t Meteri, aa. � � ���lQOR — OATE
- TEMP. POLE I I
Permif Fee UNDERGROUND CONDUIT I I
3 00 R�H � I
Suh-Tofal Fss� � � ` FI%TURES ( �
POWE0. � �
iotal Fee� �y UTILITY CO. NOTIFIED � �
� FINAL
CMF 0313-46, rev. 7/75 For items not listed refer to Fee Sthedule s�DG. PERMIT NO. "
� � � �r EE RECEiVEU
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COS'fA MESA BUILDING-SAFETY DEPARTMENT „qr��� • FINANCE DEPT.
P. O. BOX 917 C06TA MHBA. CALIRORNIA �Q- CITY Of COS'�A MESA
For Appllconf o Fill Corpplefely APPLICATION FOR PERMIT
� rr R P A
"` — � BUILDING
BUILDING
AD�RE53
cosTa ESA. CALIFORNIA For Offlce Use Only
S�F E F � R6C81PT NO. BHMIT.NC
OWNER �� �
MAIL ReGe� D BY DA RCC V6O D�TH IB/gN
ADDRE56 O �.. '� �� I � / �'
CI�OS � NEO. I ADD EI88 C — � 1`
ARGHITECf TE�• COSTA MESA. CALIFOR A
OR ENGINEER NO.
A��RESS .�Ll/.J � {'�� ��. i �nue �.�vov �/Y r:cn��e � �
STATE TEL.
LIC. NO. NO. �
OF LOT f�/{ � J �/1 �i �� I NOW ox oTe �
USE OF
EXI6TING BLDG.
BHTBACK LINE FROM
GaNTER OF 6lHZET REAR YARD
SIDE YARD I LEF'� I RIGHT
DESCRIPTION OF WORK
� EXTERIOR
20N6I��r I PUNB ,�BUIlDIN6�/�,�� �/�1 J
�
/� ��%'T' �
LEOAL +!1 71 � (c1 J �!� 'T Z �
DEBCRIGTION �I ��
VAROS�` EVE6
fC6NT8R uNH BT.1 �L� Y+<t����l �7
FRONT S� FT. �J` IN.
R.61DE 1...� FT. IN.
L.SIDE [� � FT. � IN.
REAR O FT. IN.
APPROVED (7 �_/ '
BY I.la Li.164,4 DATE M1 �E�
� �7_00
a V ��L u-� p�
I HEREBV ACI(NOWLED06 THAT 1 NAVB R6AD TXIB APPLIGTION 7H8 AMOUNT BXOWN UNDEH VALUATION IB POR THE
AND 9T/.iE THAT �H6 ABOVe IB CORfleCT AND A6R88 TO CON-
PUPPOBH OF 88TABLIBXIN6 A veRMIT FEE ONLY.
PLY WITH ALL CI1'Y ORDINANCE9 AND HTATE IAWB 1iepUL�TiNO
eU�LDINo coNeTRu lo VALUATION
SIGNATURE OF FQ �,p PERMIT FEE $��� O
PERMITfH /O n .1D � /��O o
$ J� L �/ PLAN CHECK $ �
AUTHORIZED AGE T � �
TOTAL FEE 5 .s� 4
�
�UWNtK A�L.�RA
a�10B ADDRESS 646-64t3
� �GENERAL CONTRACTOR H
As '� 141-081-12 LOT
IN .CTIONS
SOIL
� GAS
WATER
ROUGH PLUMBIN�
PROP. $WR. LIN�.
SPRINKLING SVS
MISCELLANEOUS
ROUGH HEATING AND AIR
�
�
_
TEMPORARV SERVICE OR POLE
UNOERGROUND � POWER �
ROUGH WIRING
TRENCHES � FORMS �
FLOOR SYSTEM
90N0 BEAM ❑ STEEL flEll
SHEATHING
FRAME AND FLASHING
LATHING — IN � OUT
PLASTER,BROWN COAT
5' "l1RAL, FINAL
HE,. .dG, VENT., REFRIG.
PLIIMBING, FINAL AND GAS
E�ECTRIC, FINAL
BUIL�ING, FINAL
REINF.
FINAL
Sigmfure
un e 5-5-f24—
BUILDING PERMIT N0.
DESCRIPTION of WORK Cut Exit Door -
FIRE ZONE VALUE $200.00
GROUP F-2 TYPE III ZON
SUBCONTRACTOR PERMII
P
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2 � 3�,' �
C� �a �� � DEp��E..�Ti .
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$"�diDa per�tC � R r l F��, C� �F C�gT Da � ' 1528 C
Use � B, No�J A j E F A MESA //
�1d� /�'"'��/ecthea, per O O C C, .
TGe 6 _.% m3t �yo V P q IV C
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aas y�n utsPe� side for M�S . J�_ ��
!SS � apPlicable� and fa�d �add B°°°ds) � ^ r
��n p� �e �° For a C� PplY with tb' P r o vySioyS Li
l of
F o� � p� ��er � 8� ��7'� �� cuPaa � Cl�' of Cqs� �n
t zoe s,8 p el�Ow�e �B) - CStp g y �esa 0
t� � �t ��AY 8 �g �ffici�
'Gas Co � ---���
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