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HomeMy WebLinkAbout1854 OHIO PL - Building Permits CITY OF COSTA MESA ita 5 BUILDING DIVISION f•4. .-�I p 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us t4. Pri41 :g FOR INSPECTIONS CALL: (714)754-5626 `"'""°"° PERMIT NUMBER: E11-00035 • PERMIT TYPE ELEC STATUS: ISSUED APN: 13904119 DATE ISSUED: 02/23/2011 ISSUED BY: CAC emn O P c ,N ., JOB ADDRESS: 1854 Of I -Lb%CM Suite/Unit: Vicinity: SCOPE OF WORK: REVISION TO PERMIT ON 01/25/11 TO INCLUDE 12 LIGHT FIXTS, MISC CIRCUITS AND 1 60 A SUB PANEL. UPGARDE THE HOUSE PANEL TO 200 AMP. 10 OUTLETS 8 SWITCHES 1 MISC. • OWNER: PRIM, KATHLEEN T Address: 1854 OHIO PL Unit: PHONE: - - City/State/Zip: COSTA MESA,CA APPLICANT: DAVID E BURGER Address: 374 COSTA MESA ST Unit: 1 .f PHONE: 949-331-3692 City/State/zZip: COSTA MESA,CA " , ,.��u-•;LS..,z CONTRACTOR: DAVID E BURGER License No. 835541 Address: 374 COSTA MESA STUnit: PHONE: 949-331-3692 City/State: COSTA MESA,CA ZipCode: 926271 CELL: 949-601-4663 • ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $135.70 Reinspection Fee $0.00 TOTAL FEES $135.70 --n-hs `^r h6 ,• ; e.efor,) Rcv P tnto1/4) itric_ricr\ 0 e...iv.) • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related ;regulations. (Ord. No.92-28, § 1, 12-21-92) 'EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 'INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all 'required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE#. INSPECTION TYPE DATE INTITIALS CODE# INSPECTION TYPE DATE INTITIALS 1676 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 206 Final Re-Roof 210 Final Electrical :x-31-(( {4 P 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval .) '203 Final Sign 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: El I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. El I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and.policy El I hereby certify that no excavation five(5)or more feet in depth into which a number are: -.. ,person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This seUvon need not be completed A the permit is valued at one hundred dollars($100)or less.) 2.Alt 2Sec.341,Title 8,California Administrative Code). licy Number: El As owner-builder, I will not employ anyone to do work which would ❑ II certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date th- -..r o.:, sh- r with comply with these provisions. 7-1( Division of Industrial Safety Permit Number: oat HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? El Yes El No (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No C r �Pe/0 (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by aar — ;—©l W/(/' each business which at any one time has on hand a quantity of acutely e hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ElYes ElNo (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? El Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? El Yes El No issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors (Section 65850.2 of the California Govemment Code requires that the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? El Yes ❑ No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars(5500).): of the California Health and Safety Code). El I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the,work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? El Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If ", attach certificate of compliance from the employees, provided that such improvements are not intended or offered for Yes P appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ID I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .gn.,. L; l Dater Signature Date v 3057-46(3107) And/or A onzed App i Da•- I , r 1 . r 0-a%• • • CITY OF COSTA MESA • as_ BUILDING DIVISION > •-�::,,' : `' DEVELOPMENT SERVICES DEPARTMENT PER NUMBER ;1 w.rr�� 1 t . • PERMIT 4144se e#. B04-01874 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1854 OHIO PL Status: ISSUED Suite: Applied: 11/04/2004 Vicinity: ROOF Issued: 11/04/2004 Parcel Number: 13904119 Zoning: Applicant: BRIAN DOUGLAS PRIDEMORE ISSUED BY: Address: 2090 FLAMINGO DR - - " Phone: 949-887-1267 COSTA MESA, CA • - - ." Zip: 92626 •- Owner: PRIM, KATHLEEN T .* Address 1854 OHIO PL - - _ - �- 1. A • . - - -Phone: _ ' COSTA-MESA, CA • - Zip: 92626 - . • • _ . • Contractor: ' OWNER-BUILDER- � Address: . - " Phone: Zip: License:.. 000000 Arch : - Eng: - ' Address: . _ - Address: . ,' . Phone: Phone: Zip: License: License: - ' SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 15#AND 30#;LAYER OF FELT,REPLACE/REPAIR SHEATHING AS NEEDED,AND 30 YEAR COMPOSITION SHINGLES,TIMBERLINE.2300 S.F. INCLUDES ATTACHED-GARAGE: :_\ �', FEE SUMMARY • 3, Plan Check: $0.00 `" - Calc Valuation: 53,000.o0' • Permit ' $83.25 - -- - - - - -- — - - - - - . -='�" Claim Valuation: ' $3,0000$3;oo0 SMIP Res: ' $0.50 ' 'SMTP Corn: $0.00 -- - „t. Other:, $0.00 ' Inspection: - '$0.001 ,., v .;Total: N $83.75, ` /,'i / • , PLANNING &ZONING SETBACKS " 'i MAIN STRUCTURE'Front -0=0 •,- Rear- 01' 0 ' - " " Left •0 0- - Right y0-;0; ACCESSORY Front. 0-0 _ ' Rear 0-0 Left 0-0 - Right , 0-0 - PARKING Existinq:, 0- Required: 0 • Proposed: ' 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for 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 required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS S fl • n WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty 01 perjury one of the following declarations: • O I have and will maintain a certificate o• ,nsent to self-Insure • orkers'compensation, :: pro ••ed for by section 379. of the Labor Co.e,for the performance of the w• for which this p:rmit is issued./ . . mil 1,:ve and wit ainta workers'co pen .tion insurance, : requi :• •y section 3799 . the Labor .•e,for the pert• a :of the wo for hich this permit is issued. M workers'c=mpen•ation Insure e carri•r and policy mber are: cErOli"r'umber: !f4L i .i s:•ion need of be • plated I the permit is.", at one hundred dollars($10O)or less.) - a-�""'"� W ❑Nr.a 'I that n the patio• an•:o he work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' c=mp:• : on laws of Ca •j .l nd agr if I uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith ••mply with these provisoc'!"-- L / g cam Sig nature:` tr-/...�+-." �� �.•--..n o / Date: r+•✓/ O :FiF N ( WORKERS'ITIOMPE COSI ON COVERAGE IS UN.DAMAGWFUL AND SHALLSUBJECTFOR I AN T3706 O FAL PENALTIES AND CIVIL FINES UP TO ONE'SHUNDRED. THOUSAND DOLLAREOLLAE( 9.9•.•,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.N Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: -awl 4+7f's- I hereby affirm that under penalty ofpertury,that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires apermifto construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statementthat he or she is'llcensed,pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes u No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection, ar� �SignaLire Of Legal Owner(s) Date (lo('e , • t_ ItTICOCItAutihorizeid'Applicant :.;. f T?,Date; i„t:vs, CODE# INSPECTION TYPE j1i1¢, INTRIALE CODE( INSPECTION TYPE DdIE MILS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re-Roof 5 10 Final Electrical 201 Final Block/Retaining Wall i -'t !."O /4 212 Final Fire Prevention 202 Final Factory Fire Place • . 220 Final Planning Approval ,203 Final Sign 222 Final Site aRa2-Adv(4 rt)Li IAD al4MTO3CP1,11atl3 `204••• •••Flnat'Demofltlon • • - - - - - ' - ' "' """®' s250'FinaPBuitdIngl08ctipar , .. , - , I DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS This Permit# • • Sheet Address: VCA 5 O k4 L P AP Number: 1. 1 rer./icpig) ���� J declare that I am the Owner of Title of the above referenced real pr.perty, and that II((we)hereby authorize: • • Name: r I a Vl J p ) d tr ' )Or Telephone Number° 11 W 1 7-'67 Street Address:)-0"IO eV ` )�I Gk- ASC) 0 L OA 61267 // 7 City: l' State: OA Zip: 61 Z6 G 7 to obtain permits in my behalf, as owner/builder,for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Workers Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa,as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this day of 20 ,at , California. ���,() ��")-} /r� • Print-Name: l /� L E—LAM • l /7 / s9i nu 44_�._C 111 J. 16./L Date:,_ 1lI910 Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 0779-46(rev.11/00) • eery eneet %fi t 'deet t f V laude OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will he issued until this verification is received. 11. I personally plan to wide the major labor and materials for construction of the proposed property improvement. ❑ No 2. I have/have not) K 1t!. I signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone ( ) Contractor's Lic. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: • Name Address Phone Type of Work • • J 104240 (REV.91911) • 1_2 >9 FEE RECEI ED ___Qa. MAY 16 1960 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 917 COSTA MESA, CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUIL ADDRESS 1 •5/I Ohio Plane COSTA MESA. CALIFORNIA For Office Use Only • I RECEIPT NO, PERMIT NO. OWNER Vermont n Aveue Tand Co. Tnn. I- A r,.-,r.e RECEIV Y D E�/ CtT GATE.(�BSUED 1 ,ADDRESS 419 E. 17th St. ��//(/'-/7` MAIL BUILDING CITY Costa Mesa NoId81159 ADDRESS ARCHITECT Carlson & TEL. { OR ENGINEER p]I NO. COSTA MESA. CALIFORNIA kddlebrook � FIRE ADDRESS (SArd Pn &COVE ZONE TYPE GROUP CONTRACTOR Dike & Colegrove, Inc. APPROVED DATE ADDRESS /19 E. 17th St. ZONING ZONE I NO.OF I USE OF NEW sings. talt. CITY Costa Mesa ,.., BUILDING R-] DL- wyi wilt ger. STATE NO. 167293 TEL Li. 8-1159 DESCRIPTION Tot. 51 Ir. 36/R SIZE NO. OF BUDGE. r OF LOT 571 x 901 I NOW ON LOT none A P NO none USE OF YARDS EVES EXISTING BLDG. None APPROVED ALLOWED 1 SETBACK LINE FROM (CENTER LINE ST.) /1 ' Off/I� CENTER OF STREET 621 REAR YARD 20' FRONT 5IJ FT. "� IN. SIDE YARD I LEFT 61 I RIGHT 71 R.SIDE 7 FT. 111 IN. • DESCRIPTION OF WORK ' - FT. IN. L.SIDE NEW I X I ALTERATION I II ADDITION REAR 9 U - FT.* IN. REPAIR I II MOVING I II DEMOLISH I APBYPROVED W T. D. DATE ] 60 • BUILDING, NO. W//44I / v[ 5- 3- BUI 1105 .4Cl., ROOMSOF 6 STORIES ]- EXTERIOR WALL I ROOF COVERING . e COVERING •Ru & R• . USE OF BUILDING A D WORK TO BE PERFOR ED Single family residence with • attached •ara:e. Plan 10A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMEU NT SHOWN UNDER A PERMIT IS FOR THE PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITHALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE PERMITTEE OF Cd /L PERMIT FEE $ 3L.. n $ 14,1790 PLAN CHECK $ 17. "I' Dike & C egrove, Inc. p AUTHORIZED AGENT TOTAL FEE $ 51. O ..