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Home My WebLink About3097 MOLOKAI PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 , BUILDING PERMIT Job Address: 3097 MOLOKAI PL Suite: Vicinity: Parcel Number: 13915415 npplicant: COLLAZO, FERNANDO _ Address: 2220 E ORANGEWOOD ANAHEIM, CA; �' � � � � Owner: BRANGHAM,�EMILYS' ' Address /309TMOLOKAI PL - - / � ,' ' ; -COSTA MESA, CA ; -�� - - � , Contracror. WIN-DOR.INC Address: 2220 E ORANGEWOOD � , , �� ANAHEIM,CA „ Zip: 92806 Arch : Address: Zip: ` Phone: ' , ' License: Zoning: R1 R1 Phone: 714-385-1202 Zip: 92806 . Status: ISSUED Applied: 08/10/2004 Issued: 08/10/2004 ISSUED BY: � . �� .�� _ � ._ � Phone: . � � Zip: 92626 ' � ; •. ,�� : � , i; . '��.�.�, � ,. �� ' %� �� Phone: 714-385-1202 , , , � , „� License: 545553 , , - � �, , � . � Eng. � - - Address:� � � � � ' � � � , � Phone: � � � License: � ` i t - ; - SCOPE OF PERMIT . _ . - CHANGE OUT 6 WINDOWS AND 1 PATIO SLIDER THROUGHOUT S.F.D. TO�MEET 1997 U.B.C. EGRESS REQUIREMENTS. HEADERS ARE TO REMAINTHE�SAME. - - � �, , � �r Plan Check: � $0.00 Permit: ' , - $139.25 � � SMIP Rex `,'; $0.61 , SMIP Com z. $0.00 �,,�- Other �:��$0.00 Inspection.` �$0:00 ; .�. . � � � • , �� A, _ � ;, , � TotaL• ` 1. $139.86 � - � �, , � ;,/ ; SETBACKS �� :- . MAIN STRUCTURE Front 0- 0 ACCESSORY Front, -0-0 PARKING Ezistinq: o � . FEE SUMMARY ,- , -- - — . : � Calc Valuation: ;_ $s;�oo.00 "' ' Claim Valuation: i, - Ss,ioo.00 '�. . _ ��„ �. , ,: �, " — ' i /'i "� ' � ,�' ! ,,,; ,,.� %,, � �i � � � t l -.,- ; ' ; %„ � .. �'�%" _ � C � , ',. � - � _ : � _ ; , / x � �:, ,;,ii - \. , � � `` �', . , i� . . . .', � �._ �_� � I �,: . �, , � � , Rear � 0- 0 � Rear . .0- 0 - Reauired: �0 ?LANNING�&ZONING ;--"i" />"�j� ��,' �� -, ��%' <��i �v /"/ _: ; . � /-�, , - .. � — ' �- �., � � � �"' Left �0-0'�� -' Right, ;0,-0, , , "� - , � ; , i j � . , Left -�0;0 � Right �0=0%%�� , , Pr000sed: �- -0 -� �� ; i7..i � . � ., -._",:--�.' . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order ror rne work autnorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. I FOR INSPECTIONS CALL: (714) 7545626 zanere �voo� 5 WORKERS'COMPENSAnONDECLARAnON: I hereby eKrm untler panelry oi perjury one oi ihe tollowing tledarations: ❑ I have and will maintain e certiticete ot consent lo setl-Insure tor workars' compensatlon, es provided tor by sectlon 3700 ot ihe Lebor Coae, tor the pertortnence of Ihe j'�ofk fof whiCh thi5 pef111ii is i55ued. ��Ilhava end will maintain workers' compensatlon insurance, as required by section 3700 of ihe labor Cotle, for the peAortnance of ihe work for which this pertnit Is Issuetl. nd Il�rare: �2S— ��QD `S 7� Pollry Number:_ ve/uetl at one hun retl dallers ($100) orless.) ❑ I certity that in the peAormance ot ihe work for which this permit is issued, I shell nol employ any person in any mannar so as to becoma subject to lhe workers' rqmpensetlon laws o1 Califomia g hat ii I shoulC become subject to the workers' compensatlon provislons of Sectlon 3700 of the Labor CoOe, I shell forthwith comp� Ihese pmvisio �//O /y A,ppltcentSign_ e�;, - rDet-"'� �� WARNIN�.TFAILURE TO S ' COMPENSATION COVERAGE IS UNLAWFUL AND SHALI SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CML FINES UP TO ONE HUNORED TTqUSANDDOLLAFE(5 . . ADDRIOMTOTHEC0.STOFCOMPENSATION,DAMAGESASPROVIDEOWRINSECTIIXJ37060FTHEUBORWDE,IMEREST,AN�A170fiNEY5FEE5. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licen ed u der ovision ha ter 9(commencing with Section 7000) of Division 3 of the Business an�/� rofessions Cotle, and my license is in full toroe 0no eHec'y L LiC: N``r� ��S Class k .� 7'X (.G C/7 Conh Sr'a isoe gneture,_,� - �---Date:. � �� ,1 � CONS7RUCTION LEN CV: ❑ I hereby aAirm Ihat there is e construction landing agenty for Ihe peAormance ot Ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lentlels Name: Lender's Atltlress: Signeture: _ Date: OWNER-BUILDER DECLARATIONS: I hareby aHirtn thel under penalry oi perjury thet I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Business anC Professions Code: Any ciry or counry which raquires e permit to construct, alter, improve, demolish, or repair any structure, Dnor to its iuuance, elso requires the epplicant for such pertnit to flle a signed statement thet he or she Is Ilcensetl pursuant to the provislons af the Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) of DiWsion 3 of ihe Business end Professions Code) or that he or she is exempt therefrom end the basls for the allegad ezemption. Any violatlon of Section 7031.5 by any epplicant for e permit subjecis Ihe epD�icant to e clvil penalry of not more then live hundred dollars ($500).): ❑ I, es owner of tha properry, or my employees with wages as their sola compensatlon, WILL DO THE WORK, entl i�e structure Is not intentletl ar oNered for sele (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builtls or improves thereon, and w�o does such work himself or herseN or through his or her own employees, providad that such improvements are not intentlad or oHered for sale. If, however, t�e builtling or improvement is sold within one year of completion, ihe owner-builder will have the burden of proving that he or sha ditl not build or improve For purpose of sale.). � ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct iha projec� (Sec. 7044, Business entl Prolessions Code: 7ha wnirectors Llcense Lew does not apply to an owner oi pmperty who bullds or improves thereon, and who contrects tor such project with a contractor(s) . licensa pursuant to ihe Coniractors License Laws.). ❑ I em axempt under sec. Business antl Protessions Code for Ihis reason: SigneWre: Date: Owner ID veritied by drivers license. ❑ Ves ❑ No Dnvafs License No. Veriilcatian of Ownership by (type ot tlocument, i.e. - property tac bill or deed): DIVISION OF INDUSTRIAL SAPE7V PERMIT CERTIFICA710N: Expires: ❑ I hereby cenity that no ezcavation five (5) or more feet in tlepih into which e person is required to descend, will be made in connection with work euthonzeG by this permiL and that no builtling swcture, scaHolding, falsework, or tlemolition or dismantling thereof, will be more than thirty-siz (36) feet high. (Chep. 3.2, Grp 2, An 2, Sec. 341, Ttle 8, Califomia Atlminisirative Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit irom the Division ot Indusirial Safery, as notetl above, unless such person hes e permit to do such work Irom the division. SignaNre: Date: Division oi Indusidal Safety Permit Number. CERTIFlCATE OF COMPLIANCE AND AIfTHORIZATON OF ENTRV: I cenity under penalty ot perjury that I heve read ihis application and state that the informalion given is cortect. I agree to comply with all stete laws entl ciry ordinances relating �o building consiruction, and authonze representatives of the Ciry of Costa Mesa to emer upon t�e ebove-describetl property for ins0ection purposes. I agree not to occupy or allow occupancy of eny 6uildinq authorized by Ihis permit until finel inspection. 40uE �. 7676 1266 Fi:ed Sys�e�i r�inal Fire Prevention Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 203 204 Final Fadory Fire Place Final Sign Final Demoliiion PPIE INLIiIpLS CODE� INSPECTIONTYPE 206 Final Mechanical 208 210 212 220 222 250 Finel PlumDing Final Electrical Finel Fire Prevention Final Planning Approval Final Site Final Builtling/Occupency �E � � .iu .:•JII (714) 754-5273 • Fax (714) 754-a856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT �ob Address: 3097 MOLOKAI PL Suite: Vicinity: ROOF Parcel Number: 13915415 Applicant: SHULMAN, ,IOE Address: 7727 ETNA CL HUNINGTON BEACH, CA Owner: BRANGHAM, EMILY S Address 3097 MOLOKAI PL. . COSTA MESq, CA Contractor. ' SHULMAN ROOFING �Address: 7721 ETNA'CL . HUNINGTON BEACH, CA 2ip: 92648 Arch : Addre55: Zip: Phone: License: Zoning: R1 R1 Phone: (714)536-5116 Zip: 92648 Phane: Zip: 92626 Phone: (714) 536-5116 License: 690617 Eng: Address: _ _ SCOPE OF PERM TEAR OFF EXISTING ROOF. INSTALL 2 PLY OF �15it FELT, NEW FLASHING, CER" REPAIR/REPLACE SHEATHING AS NEEDED."25 SQUARES INCLUDES ATTACHEI FEE SUMMARY Plan Check: $0.00 _ . _ _ Permit: SMIP Res: SMIP Com: . Other: Inspection: Total: $125.25 $0.59 $0.00 $0.00 �$0.00 $125.84 SETBACKS, MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- p PARKING Existin : 0 Status: ISSUED Applied: OS/10/2004 Issued: OS/10/2004 ISSUED BY: � Phone: License: �NTEED 30 YEAR FIBERGLASS SHINGLES, AND GARAGE. Calc Valuation: gs,s35.00 Claim Valuation: gs,s35.00 PLANNING & ZONING Rear 0- 0�� Left 0= 0 Righl � 0- 0 Rear 0- 0 Left 0- 0 - Right 0- 0 i : Re uired: 0 � Praposed: "0 � - / NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become voitl if work is not commenced within 180 days, or it work is suspended or abandoned for a periotl of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspecuons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOF INSPECTIONS CALL: (714) 7545626 !dd6-46(6I00) WORKERS' COMPENSATION DECLARATION: -� i I here6y attirtn under penalry oi perjury one of the tollowing tlaclarations: ` ' ❑ I have and will maintein a cetlificate of consent b self-Insure tor workers' compensation, as provided for by section 3700 of the Lebor Code, for ihe peAormenca oi ihe w or which this permit is issu9tl. 1 have antl will maintain workers' Wmpensetion insurance, as required hy secGon 3700 ot Ne Lebor Code, for the peRortnence of the work for which this permit is issued. My workers' co pe sation Insur�yce c rner and policy number are: /M e Cartier. �i �yw� PolicyNumber: l ��(dN � O7 (This secfion neeC not be completetl i/ the permit is valueO at one hundred dWlars ($f 00J or less.) ❑ I certity that in the pertortnance f the work for whjc this p rtnit is issued, I shall not employ any parson in eny manner so es to become subject to the workers' compensation laws oi Califom' , and agree tha ( shoul ecome subject to Ihe workers' compensation provisions of Seclion 3700 ot the Labor Code, I s�ell forthwilh compty with these provisian ` Applicant5igneWre: Date: J �Q^�y WARNING: FAIW RE TO SECUPE OPKERS� ��PENSATION COVEMGE IS UNL4W FUL AND SHALL SUBJECT AN EMPLOVER TO CFi1hVNAL PENPLTIES AN� CIVIL FlNES UP TO ONE HUNpRED T11IX15PND DOLLARE (E100,000), INADDIT10�'1 TOiHE COSTOFCOMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 31060F THE LABOR COOE, INTEREST, AND AiTOFiNEY'S FEES. LICENSED CONTRACTORS DECLAFA710N: I hereby aXirtn that 1 am torce and eNect. Lic. e_ Coniracbrs SignaWre: of Chapter 9(commancing with Section 7000) of Division 3 of ihe Business�=d P�fe;sions Code, anA my license is in lull qass x h �/ Date: S—/C��V LONSTAUCTON LENDING AGENCY: ❑ I hereby aflirm that ihere is a conS�Nction lending agency Por the pertormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle). LentleYs Name: Lender's Atldress: __ _ Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby efllrtn ihat under penalry oi pe�ury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Protesslons Code�. Any ciry w connry which requires a pertnit to construct, alter, improve, demWish, a repait any 54ucture, prior to its issuance, also raquiras ihe applicant for such pertnit to file e signed statement Ihat he or sha is licensed pursuant to Ihe pmvisions of the Contractors License Lew (Chepter 9(commencing with Section 7000) ot Divislon 3 oi the Business end Pmfeuions Code) or ihat �e or she is ezempt Iherefmm and the basis for the alleged exemption. Any violation ot Section 7031.5 by eny applicant for a permit subjects tha applicant to a civil penalry of not more than tive huntlretl Aollars (3500).): � ❑ I, as owner of the property, or my employees with wages es their sole compensation, WILL DO 7HE WORK, antl the structure is not intentletl or offeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law tloes not apply to an owner of property who Ouilds or improves Ihereon, antl who does such work himselt or herselt or Ihrough his or her own employees, prwided that such improvemanis ere not in�ended or oHered for sale. If, however, ihe building or improvement is sold within one year ot wmpletion. the owner-builder will have the burden of proving Ihat he or she tlid not build or improve for purpose of sale.). ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to wnsiruct the project (Sec. 7044, Business and Professions Cotle: The contractors License Lew does not apply to an owner ol pwperty who builtls or Improves thereon, and who contrects for such project with e contractor(s) license pursuani to the Contracto�5 LiCense Laws.). ❑ I am exempt under 5ec. Business and Protessions Catle for thi5 reason: Signature: Date: Owner ID veniied by tlriver's license. ❑ Ves ❑ No Drivers License No. Expires: Verification oi Ownership by (rype of tlo�ument, i.e. - property ta: bill or deed): DIVISION OF INDUSTRIAL SAFETY CERMIT CERTIFICATION: ❑ I hereby certity that ao axcavation iive (5) or more teet in depth inm w�ich a person is required to tlescand, will be made ia conoectbn wlth work authorizetl hy this permit, and that no builtling sirucWre, scaHoltling, falsework, or demolition or dismantling ihereof, will be more ihan thirty-six (36) feei high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornia Atlministra�ive Coda). ❑ As ownerbuil0er, I will noi employ anyone ro do work which woultl require a permit fwm the Division oi Indusirial Sefery, es noted above, unleu such person has e pertnit to da such work from the divisian. Signeture: Date: Division of Intlustrial Safery Permit Numbec CEHTIFlCATE OF COMPLJANCE AND AllT}iORWT10N OF ENTAY: I certity under penelry ot perjury that I have read this application and state ihat Iha information given is correct I agree to comply with all state laws and city ordinances relating to builtling construction, end authonze representatives ot ihe Ciry of Costa Mesa to enter upon the above-described property for inspectio� purposes. I agree not to occuOY or allow occupancy of any building euthorized 6y this permit until tina� inspection. LODE �, INSPECTONTYPE 1676 Fixed System Final Fire PrevBntion 1266 Pool Spa Final 200 Final Re-Root 201 Final BIocWRataining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition � � uu --'--�t Gw6� Data �S=/6-��f Date COpE♦ INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final PlanNag App�Qval 222 Final Site 250 Final BuildinryOccupancy ;' .2� � �s �.2�2�� q��2 � TESTING Aprit 22,, 1976 - r-. T�s�s��a� ��sn�� of �'ou�Ez,Z �u�'�fo�,��, �,u. P.O. 80X a7 . 33i0 AIRPORT w.1Y�. LONG 9eACH, CP.LIF. 9p601 .(217� 4tEJ355 .(2I3� 636�2786 . �7N� 8?8-6471 B4ANCu pFFICES: ISI��D�o��AMequ�Suea� "�`^' Nnn�nnmcliv.l.•rinu ' �:;_,.,,�"` v.o. eo..� s.�y�...G�du,.,.an^� /i�� pi.�vi�tws � �� Lo.qBmh_GIII.408011��I6JE�t)9e ��.,� COMPRESSION TE5T5 ON GUN fTE Jack Hubbard 3106 Ostrom Avenue Long Beach, California 90808 PROJECT ADDRESS SAMPLE FROM . ' 11RCHITECT r fN01NEER ,r Farrell Miles Y 9 H��x DATE CAST DATE TESTED CYIINDER NO. COMPRESSION TOTAL IOAD, LBS. POUNDS PER SQ. IN. REHARKS: COMPLIANCE CYLINDERS Examinafion: 76-2582 SWIMMING POOLI - V. BRANGHAM �� 3097 �lolokai P1., Costa N�esa, CA Shallow end;�deep end, bond beam. CONTRACTOR Keystone Pools ' SU6CONiRACTOR ; Enterprtse Guntte � SPECIFIED 4.0 to I ' STRENG7N 4/15/76 � stuMa 4/22/76 � 4/22/76 1 2 7 Days 7 Days i16,oGo 104,000 4,165 3,680 7-Day test average 3,99$ 7-Day test complies with specificatfons MADE EY DELIVERED EY Will Jack Hubbard ' oisrtieunoH: . Jack Hubbard - 3 ✓ Costa Mesa Buil'ding Department 4/22/76 3 7 Days 119,000 4,210 RECEIVED ON 4/16/76 �� •ll I�C�ORT6 AN[ lU�MIT�[D I.! TN[ CONIID[NTI/�L rXOPCRTY OI CIICNTl. /�UTNORI2AiIQH fpR pUOIIC�TION OI OVR RC�`OPT9, GONCLVlIONS. OH CS. TNACIO IItOM f1M M[GAROINO THCM IS ME9ERVCD �lNO1NG OVR WRITT[N M1PPROVAL .�0 M1 MVTV�L VROTCCTION TJ C�ICNil. TME PUOLIC .�N� OUROELVf6., �,) 390��2 OWNER ggpN�AM VPrn DATE 3-30-76 JOB ADDRESS 3097 Molokai Place BUILDING PERMIT N0. 41481 Q "-`�ERAL CONTRACTOR tcP..stone iPools DESCRIPTION of WORKpvt. Swim Pool y io. 139- i�vPECT10N! Pool Location Forms _ Main Drain Steel Reinforce Efec. Bond _ Approval to Cover Underground Electric _ Gas Piping Test Filtering System Lines _ Backwash Lines and Recep. Electrical Final �r and Vent Final ,r System Final Backwash and Recep. Final Fanrinn Final TRACT FIRE ZONE VALUE Signarore Date GROUP___J _ TYPE T�i�b SUBCONTRACTOR E lectric Plumbing ��. 4 I 48� COSTA MESA BUILDING-SAFETY DEPARTMENT P.0.90X1200 COSTAMESA,CALIFORNIA92626 For Applicant to Fill in Completely aooRes"s 3097 Molokai P1. py�NEF Vern Brangham � MA�L Z AODRESS above a v c�r� No.`"540-0358 2 Z Q Cp�VSiRUCTION O N LENDEF unknown am J 7 BFANCH J N a W ADOFESS AIiCHITECT TEL. pq ENGINEER N L Q yZj � ADDRESS aW � o CONTRACTOR Ke stone Pools Inc. �� ADDRE55 1019 N. Mdlll $t. Pat�, S .��a�:l 50 =.14R 30-76�F:�:-OOL8pss 18.� APPLICATION FOR BUILDING PERMIT FE BV TE ECEI D TE SUED ¢-� . / Q� PEFMIT NO. A.P. NO. { AD'DRESS 3097 Molokai TRACT 3115 LOT 95 BLOGK W A A P X OWNEF B ham V E S � $ FIRE ZONE TYPE GROUP 4PPROVED � BV DATE O w w TEL ZONE NO.OF USE OF NEW rM � z� o�T� Orange, CA No. 532-1641 P�� 2 BVILDING 0 STATE CITY /� VARDSAPPROVED YARDSAPPpOVED y� ��c. No. 269289 LI0. NO.('� MAIN BUILDING ACCESSORV BUILDI 7O (FROMGLSTREET) � � $ � Z E NO. OF BLDCiS. . r OF LOT � NOW ON LOT FRONT FL V V/ FL � USE OF EX15i�NG BLDG. � F SIZE OF NO. OF Z NEWBLDG. ROOMS U EXYERIOF WALL ROOF COVERING COVERI J US� OF BVILDING AND WORK TO BE D VAR. # BET y W K Z O VI h9reby acknowledge thet I have reatl this applicetion and rtate � that the abova information is correct and agree to comply with � all lews regulatin8 builtling construction, and I shall not employ � any person in violatio� ot tha workman's compensatian laws of y Me State of California. ? I hereby certify that I am properly licensetl as a contrector under SQ. FT. Me State of California Business antl Professions'Cotla, Divisicn 3, THE AMOUNT SF Chapter 9, antl tFat such licenus ara In full force antl etfact, or 1 THE PURPOSE OF ,,, axempc from the provisions ot the State of CeliforNa Buslness VALUATION ' end Professlons Code; Di ision 3 Chapter 9. Sipna[ure of � Perrr�ittee $ � O �v AuH+orizetl Agent - BET. MAIN & TOTAI FEE 7Co V AI.UATION IS F< A PERMIT FEE ONL E § 3Z.� KS I� � 0 b ¢ � m E `o LL JOs ADDRESS GENERAL CONTRACTOR AP. No. LOT JS � ��jP I&J �. .�ECTIONS T :nQ Pixtw ,ias Test 1'YPE V ZONE DATE � SUBCONTRACTOR DATE i2-3i-5& BUILDING PERMIT NO. B PLAN NO. �PERM-ITSISSUED I NUMBER ' ' . r � &'�3��1 COSl'f4 MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN ADDREI55 OJ MOI.O�I�• �j COSTA MESA. CALIFORNIA OWNER Mesa Verde �atates ADDRE55 1701 Gisler S�r. TEL. QTY M t{, NO. ORCNGENEER J. R.Shellev NIO� arr uc. CONTRACTOR NO. TEL. ADORE55 NO. LEGAL LOT DESCRIPTION NO. BLOCK A.P. NO. NO.OF BLDGS. �IOW ON LOT none USE OF E%ISTING BLDG. � SETBtCK LiNE FPOM c[rvien or 5'rw[[i O�� .i1C> REAR YAR F/�.0 SiOEYARD RIGHT 1�F71119 LEFT- J��11115 DESCRIPTION OF WORK NEW � ALTERATION ADDIT�ON REF MOVING DEMOLISH SIZIEDING 156o sq�FT�i� �ROOMS STORIES 1 EXTERIOR WALL ROOF COVERING S�CO COVERINGAS 113�.ti B/ RO USEOFNEW Residence & Attached aarage 9111L I]INf: ISTATE THFT TIQTN OROIN SIGNATUA PERMITTE R.icna�r��v,caau� ��.� ��C�6��9L� • Jq�y 5 1959vr✓ FlNRNCE REPT. cnv c� c�s7� P+=sk APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY BUILDING ADDRE55 COSTA MESA, CALIFORNIA FIRE ZONE ZONE� / PLwNS TYPE , / t� APPROVED BV DATE � CORRECTIONS C LY WITH FLL E U G CONSjFVC� BQG $OUT. Iv��. �$T. / VALUATION ' �QQ ��ASAD A.� A F�R`I�I�A�LZ/ PERMIT FEE S �� L (r . . $ /!l(/LJS � PLAN CHECK $ �7 SO � ri � TOTAL FEE $ �` G�- �� °'�� ri.