HomeMy WebLinkAbout858 CENTER ST - Building PermitsowrrEx brr.r.MaN & sltu2�
JOB ADDRESS �j58 Cente
GENERAL CONTRACTOR
AP No. 116-031-33 LOT
INSPECTIONS
Soil
C
� r
OCCUPANCY
�
TRACT PIRE ZONE
� Signature � DATE GROUP
DATE 11-30-62
BUILDING PERMIT NO.
VALUE $j$,85o.00
D�SCRIPTION OR WORK 2,pt
TYPE V 7.ONE
SUBCONTRACTOR
3
Pfl0.1ECTP'lOBESS: SSS CENTER ST
'r9�ti17EW�i1AME: RYAN, CRAIG O
aooness: RYAN MARGUERITE F
406—� E 1ST ST #1407
LONG bEACE.CA 90802
ABCHIENGINEEP:
PDDRESS:
flEG.NO.:
liN1T:
UNIT:
PEflMITTEE: R. P. HIRSCHMACI ( 714 > 960-8329
aooness: °855 ATLAPJTA 285
HUNTINGTON bEACH CA 92646
IItENSEO CONTHAC70N OECU�NAT�ON: � nereGy allirm ihat I am licensetl unaer v�ovisions ol Cnapter 9lcommencing witn Section
7000� ol Division 3 of ihe Business antl Pmfessions Code. an0 my license is in lult force an0 effecl.
cirvuc.:038468 sTaTeuc.:475Q^�t�C39 EXP; OA/95
at _� 2 "' ^4� Signai . _ _
ONNE85' COMPENSF710N OECIABRTIUN: I hereby atfirm thaU have a certilicale o1 consent ta selbinsure or a certilicate al Workers'
comvenution �n �r�c� o�ry c�nire�tl r�aov �hereoi ISecuon 7soo. �ao.1�0 / O 1/ 9 S
POLICY NO.: STATE FUND E%P. ORTE:
COMPANY: ,+,�,
7 Cenilietl copY �s hereby lurnishee. C� Ceniliea copy is liletl wiln ine city Builtling Oivision.
Dai � Z � �+ `F`� Ppplica '�
%EMPTION iPOM WONHEflS' GOMPENSRTION OECIABATION: (This set�ion n¢ed no� be tomple�eU il�he De�mii is forone hunOreO (511p) of less�.
I cetli�y Ihal in I�e OehormanGe ol ��e work for whic� �his permil is is5ue0, I s�all not employ any person in any manner so as to became
suoject to Ine Workers' fAmCensdtion Laws ol Califomia.
Dale: SignaWre:
NOTILE: II. a�ter making this Geclaration, you s�ould bewme SUGIeti Io I�e Workers' Compensation provision5 of I�e LaOor
Code, you must fon�vnih romply wi�� 5uc� pmvisions or Inis Dermii sAall Oe deem¢d revokeE.
CONSTflOCTION LENOING PGENCW. I here�y affirm ��at Ihere is a constmclion lentling aAency lor ��e performance oi lhe work lor
whith Ihis Dermil i5 i<SueO (SeCiian 3097. Civ. C).
LENUEH:
ADOHESS:
OWNEP BUILUEH DECNMT�ON: I here�y alfirm t�ai I am exempt Imm ihe Con[racmrs' Sta�e License Law for Ne tollowinq reason
(Section 7031.5 Business and Prafessional CaEe: Fny ciry ot county whic� repuires a De�mit to construct, alter, imprme, demol¢h, or
repair any simcmre, prior �o ��s issuance. aim requires ihe ap0licant lor sucA Dermii to tAe a siqneE statement tha� hels�e rs licensetl
pursuant lo Ihe provisions ol lhe Coniractors' S�a�e license Law (Chapte� 9lcommencing wiN Sec�ion 7000) of Division 3 oi Ihe Business
anU Pmlessions Cotle) or thai he/s�e is erempt iAeretmm anA the hasis tor tAe allegeE exemptian. Any Molaiian al Section 7031.5 by
any aOPlicant lor a permit suDlecls tlle apDlicant to a civil penalty ol nol more tAan five AundreE aollars (E500�.
, as owner o� Ihe pmpetly ar my employees with waqes as Iheir sole compensalion, will do �he woB, and ihe
❑ stmaure is noi imenden ar oilerea for sale ISectian 70aa, Business antl Pmtessional CoEe: T�e Contractors' State license Law
does not aDP�Y �o an owner ol a o�ooeny wno ouiitls or improves ihereon, and who tloes such work himsell/herseli or InmuAh
�is or �er own empl0yee5, pmvide0 ihat SucA improvements are no� in�entletl or ofleretl for sale. II, ho�+'ever �he �uildinA of
impmvement is soltl ��hin one year of com0letioq t�e owner will have lhe burden o( provinA he/she Aid not �uilA ur improve
lor ine putpo5e ol 531e1.
I, as owner oi �Oe proVerty. am exclusively conirac�ing wilh licensetl conlratlors to cons�mct Ihe pwjec� (Setlion 7044, Business
❑ antl Prolessions CoOe: The Contraciors' State license law aces �ot aoWY �o an ovmer ot properry who CWQs or impmves itrereon
anU w�o coniracts lar sucA O�ole��s vnih a contracloqs) license Dursuam to ��e Coniractars' Slate License Law). I am aware
Illat pmol at �heir WOBer'S Compensalion insurance shoultl be pmvitled �o me.
� I am exempt untler 5ection: . B. 8 P. C.
mr mis reason:
�ate: Ormec
i ao hereby cenily tnat I am aware ol ana understanU �he requiremenis ol Calibmia HealtA anA Saleiy CaAe Sections 25505, 25533, anA
255J4 and thal I or any IuWre buildmg otcu0ant wilVvnll not (tir[le one) neeA lo tompy wit� 5aitl Slate cotl¢5 ane t�e rtauir¢menis lar a
permit lor con9mctian or mM��icalion fmm I�e Air Oualily Managemeni Dislrici. Nesitlentul consirut�ion aDPlicd�ions are exempi imm
inese pmvisions.
Oate: Applicanl:
I here�y cerlilythat I have reAdihis apPlication antl state ihat Ihe aboue information is correct. I aB�ee lo comply with allcity and county
ortlinances antl slalelawsrelatinglo Guileing conslmction antl �ereby authorize representatives otihis cityto enlerupont�e a�ove�mentioneA
�tly brin50eciwn OurpOses.
j2—a =sY 5�
Driver's license or Social Sewrily x:
t6<i�a6 W�ile-9uildmg; G�een—CoEu EntorcemenC Canary—Applicanl; Pink—Revenue: GolCanroe—Assessor
CITY OF COSTA MESA — bUILDING PERHIT PERM NO: B Q7031j
PERMIT NO: 8 070313 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTFiUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION ; T/OFF REROOF W/BUILT—UP S¢ FT: 3,698
CLAIM C'ALUE: 3,648.00 CALC—VALUE: 3,648.00 GROUF OCC: R-1 ;
COMMENTS: SMOKE DETECTORA ARE REQUIRED AS FER 1991 UHC
�-*+�r*+t�r�trt�r****rx�r**rir+�*+r«*r;�x**-u� ar�r**�+ra�r�r<;F�x-r�r�cr�racrs+r�-+c**v-r*r�-�c�-.�.r+c�srir+F+r;:*aa+tv
Z O N I N G R E Q U I R E M E D1 T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDINC ---------
FRNT; FT ZN REAR: FT IN FRNT; FT IN P.EAA: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGAT: FT IN
PARKING RE�• PROV; PARCEL: 4'1919:21 ZNE: REF NO:
PLANNING N TES>
1
if ii iF iE iE if iF if iF iF 1F iE jf aF #i4 i{ if it M if iE �1M1 iF iE 1F if iF �E iF jf iE af aE iF if 1f ?4 ac 4 iE if ic iE iE iF �f * iF iFs � M iF �%N- %aF iE iF it {{+f ic iF ic ic 1F {4 iR iF aF if it �1R+F iE �F iF
D E V E'L O P M E N T 5 E R V I C E S R E Q U I R E M E N T S
ZONING APPP,OC'EU BY DATE:
bUILDING APPROVED HY : DATE;
APPLICATION ISSUED HY: �/� 'nL �l,
**+��cx-�rt�x�r�*+t�E�c*�ri��t**�s�7i�.a.* .������a�-i�'iFr;.+i-�#�3.4a'��3:'iz�t�s��*+�rc***�cDA+�c*�i:+c��.��itu'aca�
if �E if if iF i:'N' if x iE if Y-ai if if aE M �f iF jf iR iF iG if 4 iF aE i' af K�iF �M if if iE iR Yr iG if if �1E aE iR ih-N- iF iG 1F If if r �F+f �k Y- iR v if �f iF i4 �ii if aR iF iG ir iR iF if Y� it iF jF �lf ic-lF �4 jF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC "FIRE SMZF/RES GRADINC
PEP.MIT 53.U0 . .50 �
• • SMIPlNON—RES
PLAN ' ,
ISSUE FEE
BUILDING—DZV—> PERMZT ISSUE PLAN—CHECK TOTAL FAID DUE
TOTALS----> 63.50 0,00 0,00 63,50 63.50 ,00
RPVENUE DIC'ISION TOTALS--> COLLECTED: 63.50'�OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING PLAN—CHECK
63.00 .50
#' if iE 1f +E iE iF if if it iE iE �7(� i! 4 iF iE if i� 1F iF �1F jf ff iF if i� iF �)f il� k i� if if iF �If 1E 1f if i� # if if fE iE if fi 1f ih+E ii # k{t iE iF'u iE i(� if if ic'Y� if i4 M?t-IF iF �iF fF if 4 iE iF'r. �k af iF
I N D I C' I D U A L F E E H R� A K D O W N
TYPE QTY D E S C A I P T Z O N UNIT COST TOTAL COST
SFR 3648 REROOF BY VALIIE RESIDENTZAL NOZONE � 1.00' 3,648,00
END OF FEES '
EXPIRED
�nc p, t�+ lr.sp�ct�ion/s
� _.�,1 ���1� S;�(—'/' /-/�— -
V
SMOKE..DETECTOR
r REQUIRED __
OS �01�32�J6-001?3207 T C�T
pt+TE= 12)04/9t iIME: 09:08
!
63.`0
,
' CONSTRUCTION AND PLANNING �� / POO. SPA
'�APPROVALS Permit# Date lnspector pPpROVALS Permit# Date 4nspector
, i. 7emporary Electrical Service or Poie 52. Pool & Equipment Locat(on
2. Soil Pipe-Undrgrnd. 53. Steel Reiniorcement
3. Electrical Conduit Utility-Undrgmd. 54. Forms
4. Electrical Conduit-Undrgmd. 55. Electrical Bonding
5. Steel ReinSorcemem 56. Rough Ptumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings ' ' 58. Electrical Conduit�Undrgrnd.
8. Poundation 59. Gas Pipe, O Undrgrnd., Test
9. Water PIpe�Undrgmd. 60. Backwash Lines, P�Trap, G' Undrgmd. '
70. Struciural Floor Svstem ' 67. APPflOVAL TO DECK
11. Property Sewer Line & House Connection g2, Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
t3. F3oof Orains 64. Ptumbing System - Finat
14. Rough P�umbing � 65. Electrical�Final
15. Rough ElectricabConduit 66. Solar System�Final
16. Rough Electrlc Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 6$. APPROVED FOR PLASTERING
18. Fough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEA,7S F�NAI
19. flough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Pactory Fireplace APPROVALS Permit �
21. Oucu, in Structure 7p, Underground Hydro
22. Ducts, Ventilati�g 77. Product Piping OGas GOiI
23. Gas Pipe�Rcu9h & Test 72. Underground Flush
2A. Roof Framing 73. Underyrnd. Storage Tank �7 Gas ❑ Oil
25. Roof Sheathing /Z_(t�_l�!( �w`/ 74. Overhead Hydro _
[
26. T�Bar Ceiling (Strucwral) & Monocoat 75. Dry Chemical -�
27. Frame and Elashing 76. Dry Standpipe -
28. Laihing & Siding 77. FIXED SYSTEM FINAL "
29. insulation 7B. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT �.� `
31. Piaster Brov.n Coat 79. FINAL INSPECTION ��'��
32. Eiectrical Power hheter�Finaf 80. FOOD CER7IFICATE ISSUED
33. F�nal Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test .
36. Hood or CanopY �
37. Final Factory Firepluce
38. Final Plumbing
39. Water Service-Final
40. Gas Se�vice-Final
41. Solar pomesticFinal �2� �Z-q�� (,�,o �ovG s"�,/ /`
�` ��Qt(
42. Backfiow Preventer �,o, f ,L,�� ` ��f,(
43. Bdcktlow Irri9ation fz-���%.�=^�/,�? •. (n0 py,Q �,n �C�
L �44. Landscape irrigation System ��E� l_ (yf�'
45. Sound Attenuation -,� '
46. Handicap Regulations � '
47. FINAL STRUCTURE & BUILDING _ .. '
48. FINAL PIANNING t _
49. Electric Release to Edison � , �
50. Gas Release to Southern California Gas Ca •""
51. CERTIFICA7E OF OCCUPANCY �
No. Date
Cti Y dF GOSTA MESA
'-�r-�TRUCTION PERMIT
- ADo��Gnt to eill In al�sD+us axc
P MIT NO.
� �E - 772
t�ow wit�in �savy GorEar Ilnef a�E si9� ���+C��oorlata Eeclantions.
Aop�icenc'a Maiiing n - TVPE OF CONSTRUC7�ON U NEW LI ADD LI ALTERATION L� REPAIR
PrOjeCtAddr ' ❑ CONVEi:510N ❑ DEMOLI ❑ OTNER
OWnef's Neme ` � g y D�c RIPTION OF WORK � •
w �` K/TGffEN. W P.4 TiTiOa.�S' -
Addl05s /'' TVPEOFPERMIT GRADING UNDATION STRUCTURALri
Afth/Eng. �(�%`T ���� —LiCEnSB NO. . ❑ TENANT ELECTRICAL �MBIN6 ❑ MECHANICAL
Addl@SS ����/��� �, UTH E R
Contrector's Nem honepi.�.]�p�> PRaECT DESCRIPTION 5Q. FT, ocCUPA
Add�05SImB111ng) � GONSTRUCT,IONTVP VALUATIONS.�T�,
' i • � ZON� GRADINGCV.VDS. '' ACRFS ���a
Licenm No. �
LICENSEO CONTRACTOR DHCLARATION Ramarkt: ' � � � �+`
I�.heraDy affl�m t�at 1' am Ilcensetl untler proY�5ion5 of Cbarte� 9(commencinq . , ,
with saction 7000) of Dldslon 3 of the BuS��ass antl Vrofesslons Code, antl ' _ • y . �_!
my Ilcense Is In }WI torce ana'e}tect. ' �
Llcenu Class Llcense No. � pLUM61NG -. -
Date ''' ' Slqnature . Ber Si�k Sewer CBp
-^ORKERS' COMPENSATION DECIARATION ' - - -
�reEy aHlrm that 1 hava e CertI/1Wte of consent to Selfansure or a Certlfiwte �� •. geckflow Preventer - SaWer Conn2Ction. ��;,. --�
Workers' Compansatlon Insurance. or a certifletl copy t�ereof ($ection", � �
380q I�b. G.) . � �, Backflow Irrigation $oiar Collectors � � i�
PolicY No. ComPanY . .. "` -. _ - •
�CerUfieC�coDY Is hareby furnlshatl. � � ' � � �� , Bathtubs � �Sola�•Piping � i
Certlfletl Copy IS fllatl with tha clty,Bulltlin9 DIVISion. � ,
Date ADPii�nt • � - � Clarifiers � �SalarTank ^. ,
ExEMVT10N,PROM WORKERS' COMPENSATION DECLARATION DiShWBshef ' � Swirilrtting Po01 N//SpB:
(T�Is sectlon neetl not Ce com01ete0 if tha permit Is tor ona h(�untlreE (5300) oi�,� ._. _
1 ca�rtllv that In the oerlormance of1hB_work tb� whl�thlzbei�mR Is Iss�(e , i . Dlinking Founteins Urinal � w, �'� ; ,
Date
aftar
I haroby affirm tha here
of the .work t L
Lontler's Name -
-Lantler's naarass
OWNER BUIIDER DEC
I harabva/tirm t�at I ar
n, you shoulC �become'subjact to the'
ha L9bor Cotle, you. murt forthw(th
Derm�� shall ba -tleametl� revokaA.'
i
�n 1 ntling a9ency tor the Dertormanca
s Isiue (Sectlon 309Z Clv. CJ
tha'Lontiactor'S'Ucense Law 10r ShB
Floor DrainS
FloorSinks �
GasService' �Outlet
Interteptors ' '
KitchemSink' .
La'vatories
P—Trep
to flle a signetl�statement that �e/ihe Is IlcenseC pursuan[ to the'provl5ion5 of ,� ���V� V�
$ck4� Contraclor's LJcense l.aw,(Chapter 9(commencing,with SecNon 7000) of �
.e,a sion,3 01 the Buzinozs anE'R'oTazzlons C.otlej'ar [hat he/She..l5.ex¢mOt -. ShOWCf3 ^
atrom'anC tne' basiz for t�e allegetl exerr�Vtlon: My violation-ot SacHon
1,5 Gy �any appBtant for a permit_ suPlects.the applican[ to a� civll
e alty of not more than five huntlretl tlollars (E500). .', - � Seivice Sink � �
I, as-owner of the oroperty or�my emp�aveas with wages as their sole
O pBn5dtl00 wlll tl0 thB wOik, dntl,tfle'itN�tUlB ii nOt In[8ntl2tl Ol o}Teletl � -
for wle (Sac4lon 7044, Businezs antl ProTe55ional,Code:'The,Cantractor's
License Law� Coes not apply to�an owner oi a property who bulltls or Improves 80i12[ ' - -
thereon„antl who Ooes such work himsalf/h¢rself or through his or her own
�e o�oy eas, provitletl tnat such Imorovaments are not Intenaetl or ofreretl tar � Duct - Under Graund '
e. 1(, �owever, the bulltling or ImDrovement Is soltl within one year ot com-
tlon, the owner will �ave the burtlen of provin9 he/s�e tl10 not buittl or Im- �
r ve tor the purpose of sale). Duct - Strucfural
1, as owner of tha property, am excluslvelY contractingtwith.licansetl con-
bactors b construct tne oroject (Section 7044. Businesz antl Protessions Cotla: . { Duct - Ventilating _ _
The Contractor'i Licensa Law does not applY to an owner of property who
bulltls or Improves thereon, antl who contraGts for sucn Drojects with a<on- f Exhaust SyStem ❑ Multiple ❑
tractor(s) Ilcenze Ourivant to the Contractor•5 Littnsa law).
❑ I am exempt under Sectlon _ B. & P. C. far this reason Fi�epl/FaCt.81t. ICBO **
Data ' ' Ownar � � ' ' � Heating'System & Ducting
�I-heraby�-certlfythat9'��ave�reatl iaOPliGation-antl�statetliatrthe•above - -- �b100,00�BTU�O100,0008T1
In(ormatlon is corre ree o c Iy with all c ty anA county ortlinances �
antl'st o struct , a tl hereby authorize repre- HOOd o� Type I ❑�
sentatives / t Is r. n th a v-mantlonatl rty for ��p Y� e II ❑
.InsDection r e . ' ll
Signaturo I � Date�J W ' •
, Drivers' Ucansa or�55 � � � ' Registen . ',
CMF 0865-46 rov, ] 2/82 wnite - Bulltlln9: CY�ary - Applluni; Pink - Accountin9; Goldenrotl - Assassor
WBLBf`CI050L ' l+ .
Water.Heater; . �
WaterService �, ' ,,, • '
' � ' ' ' � �.,�
. i
� Reinsoection'Fee .
� Issue Fee
❑aioopoosTu �ioo,000eru
System Repair/Alteration .,
. � _ . _ . • ..'
Rei�Kpection Fee
Issue Fee ,
$ 3
0
$15
$ 3
PLNG. REF. �
TO BUILDING
PROPERTV LINE
LEFT SIDE VARD
P KG. SPACE qEQ.
STREET WIDTH
LIC W85h8f
ction Pole
I Unit
her
❑Gas ❑Electric
Boxas
' 1070 6/2:J/B:
REAR YARO (TO P/U
RIGHTSIDE VARD
PROVIDED
. . PARK FEE $
�il•:iJV �
Sub Panel �: �
t Sub Pole • ,� ,
Motors �0-1 HP ❑1:5-8 �
Inc.Solar 09-15HP �16-15+ '
�Micrawave ' ,
�Pole Light ' �• y^
,Ranga � i%' �
� Sian• • . . i
ing Sections
Compactor
Garbage Dispoml
Generator �0-5 KW �5-15 KW . , ,
Transformer ❑75-50KW
❑5U+KW . ReinspectionFea
Meter ❑up to 100 amps .Issua Fee �$ 3
Zoning Approved By � • Date
Application Approved By ate �
3
Applintion laued By � Date
SUMMARV OF FEES � •
BUILDING PERMIT $ � � , SMIP � $ �� �• `�
PLAN CHECK $ � � PERMIT '
�PLUMBING � � $ � . O j ISSUANCE $ �
.PLAN CHECK � $ ' �' . GRADING , S � �
'ELECTRICAL � $ � , � � $ �
PLANCHECK ' $ O� O MICROFILM $
MECHANICAL � $ TOTAL FEE, $ ' �
PLAN CHECK $ LESS � 1 , �.
� , � � ADVANCEDPC � $ '
� FINAL FEE $ � � '
` .
� � �809�
vOSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. GLIFORNIA
For Applicanf fo Fill In Complefely
COSTA MESA CALIFORNIA
OWNER Dillman & Brummell Enterprisea
ADORESS 1322 �. Ocean r'TOIlt.
an Balbos ' �30 /��� No�
ORC TE EER W� JOTf�BII No: Li87151
AD�RESS 771 w. l�h St'• C06t.8 MESB
CONTRACTOR �er-Bldr•
aoorzEss r
cirr'-'--�--
SiATE �����..�� TEL. ��_��
LIC. NO. NO.
SIZE �/ oi X�O� NO. OP BLD09. ��
OF LOT NOW oN LOT
USE OF ���_
E%18TING BLDG
88iBAtll LINB FRON c � C�
CHaicx On BiHa6T /O REAR YARD 2/
� 8� � 8�
61DE YARD LEFf RIGHT
DESCRIPTION OF WORK
_ I x II ..____..I II ___.__.. I
28�^�5' ROOM6 2�
WALL s�uCC(➢COV�BRING IO
i1LDING AND WORK TO BH PHRFOI
I HBREBY /�CKNOWL8D06 THAT I MAVB RHAO TNI6 APPLIGTION
ANO BT�Te THAT TH6 �9 CORPB AND AaP88 TO COM-
PLY WITN ALL CIT' �AND Te LAWB p66ULATINO
OUILDINO COHB
61GNATURE OF , /
� AUTHORIZED AGENT
�r � �. �9 �..1,+�, �<i.:y
� t�tOV 1 1�2
!' FINI',il�CE DEPT.
CITY OF COSTN MtSA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
BY
COSTA MESA
�ATe 198UHG
.��nu .. . �T
ZONING
ZONPa7 _� I NO. OP �I U98 OP NtW �
L PL.�N9 BUILDINO
H9CNIPTI0f�11' 1 �Gs/� l/!C ��
A.P.NO. �I�>.�UJl�J�
YARDS EVE6
APPROVED ALL WED
lCBNTtR LINe BTd 71 1/�n��
FRONT S v FT. lXM/
�S
_ Q l
�^ !i7
IN.
DATE O � � �� -G 7
�' � L '(6 n�i
�_ ��G�,
TNB AMOUNT BHOWN UNDHR VALUATION �8 POH TNe
PURPO88 OP EBTABLIBMINO � PeRMIT P88 ONLY.
VALUATION
G PERMIT FEE $ /�� �"'
S � ��• `� �V � PLAN CHECK $ ���'SC
TOTAL FEE S /" �'��
«, i $so2
.COSTA MESA BUILDING-SAFETY DEPARTMENT
� P. O. BOX 917 C08TA MHBA. CAL�PONNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDIN6 1
ADDRESS
COSTA MESA, CA4IFORNIA
� MAIL
SI'ATE
LIC. NO.
81ZE / / • �� � _ � I NO. OP BLOOB.
OF LOT ! NOW ON LOT
USE OF S �
EXI6TIN� BLD6:
BBTB�CK LIN6 PNOM �
CHNTep OP BTp88T REAR YARD �
BIOE VARD LERT RIGHT
DESCRIPiION OF WORK
OP
WALL
I HEq88Y ACKNOWL8O08 THAT 1 XAVe pBAD TNI9 �PPLIGTION
AND BTATB THAT TH8 ABOV6 IB COppEGT ANO AOR88 TO COM.
PLY WITH M1LL CITY OROINANCeB AND BTATB LAWB qBOYLATINO
BUILOINO CON6TpUGT10N.
H�6NATUREOF����a���� ��A
PERMITTEa
AUTHOqIZEDAOENT �w a
�tt R�c�iv��
fE8 " a 1963
FINANCE DEPT.
CITY OF COSTA Il��q
APPLICATION FOR PE
BUILDING
For Office Usa Only
116C61I� NO. P6PMIT f
ll
�eo��
YARDSAPPPOVEO
MAIN BUILDIN6
( FROM C/L HTflEET 1
VAR.#
ZONING
BHALL BE L868 THAN
(l/. B. C. REQUIREMENTI
VARDBAPPROVED
ACCE6SORY BUILDING
/ er ��.
DATH
5�
0
G �S Z'' �
„
so. �. �
TN! AMOUM BMOWN UNOBH V�LU�TION IB ROR TXH =
PURPo88 Op 89TABLIBXINO A PEPMIT F88 ONLY. �
VALUATION m
PHRMIT FEE — �
�
$ � ��.�'d � o
d S"� '
._ __ >