HomeMy WebLinkAbout2995 MILBRO ST - Building Permits(714) 7543273 �• Fax (714) 754-4856 �• www.cl.costa-mesa.g�yyLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2995 MILBRO ST
Suite:
Vicinity: ROOF
Primary Occ: R-3 Dwellings/ Cong Res <10 Type ot Construction: V-N
Parcel Number: 141Z331J Zoning:
Applicant: GUTIERREZ, FRANCISCO
Address: 2995 MILBRO ST
COSTA MESA, CA '
Owner: GUTIERREZ, FRANCISCO
Address 2995 MILBRO ST . ,
COSTA MESA, CA . �
Co n va c tor: O W N E R-B U I L D E R
Address:
Zip:
Arch :
Address:
Phone:
Phone: 714-754-1581
Zip: 92626
Phone: 714-754-7581
Zip: 92626
Phone:
License: 000000
Eng:
Address:
Status: ISSUED
Applied: 04/27I2005
Issued: O4I27I2005
ISSUEDBY: � 1 !l"
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOFING, INSTALL 30# FELT UNDERLAYMENT, & REROOF WITH 30 YEAR COMP SHINGLES (19 S�). �
Plan Check: $0.00
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: 50.00
Total: $83.75
SETBACKS-
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin1 0
NOTES: \�
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0.0 -
Lek 0- 0
Proposed: - 0'
Calc Valuation:
Claim Valuation:
� �
Right , 0- 0 �
Right 0- 0
5z.800.00
52,aoo.00
NOTICE: The work authorized by this permlt shall compty with �all applicable handicap.access requirements under Califomia statutes and related
�regulations. (Ord. No. 92-28, § 1, 12•21-92)
�EXPIRATION: This permlt shall automatically expire and become void if work is not cammenced wlthin 180 days, or If work Is suspended or abandoned
for a period ol 180 days.
INSPEGTIONS: In order for the work.euthorized untler this permil�.to be considered legel, �such work muat comply with all apDlicable codes, and all
�requlred Inepeetlons�and Iinel approvaPmusfbe obtained.'Failure to�obtain inspectlonsantl Ilnal epproval wilFresult in the expiration ol this pertnit.
'FOR INSPECTIONS�CALL: (714) 754-5828
.2MB�B (B�W)
WORKERS'GOMPENSATION DECLARATON: " ' . . ' �
I hereby aHirtn under penalry ot perjury one of Ihe I011owing dederatlons: • ,' 8 � ' �•
❑ I have and will maintein a certilicete ol consent to self-Insure br workers' tompen5allon, as pmvitletl for by section 3700 0l the Lebar CoOe, tor lhe peAormance of the
work lor which ihis pertnit is issueA. � .
❑ I have antl will maintain workers' compensstlon Inwrance, a9 requiretl by sectlon 3700 of the Lahor Code, for tha pertartnance ol Ihe work for whIG��Nis pertnit is L55ued.
My workers' campensetlon Insurence carder and pollcy number ere: � ,
Carrier: Policy Number.
f,�Tl /ssecfion need nat be comp/efed!! fhe permlt Is valued e( one buntlred dallers ($ 700J or IessJ .
�0"I certify Ihat in Ihe peAortnence ot the work lor which this permit is issued, I shall not emplay eny person in eny manner so as to Decome subject to the warkers'
wmpensatlon laws ot Califomia, end egree thet if I should became sub�ect to t�e workors compensatlon pravisions of Section 3700 of the Labor Cade, I shall forthwith
comply with these sions. /a� ' L -7
9P.PIIGenLSignanire: iii..�l� ��// . /th/ Date:: - � �' 2 / "fl �
WARNINO: FAI�URE TO SEWRE WORNEfiS' CiF.IPEN5AT10N FiAGE IS UMAWFUL M'D SMALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HVNDRED
T110USAND DOLLHRE (St00,000�.IN ADIXiKKJ TO THE WST OF COMPENSATqN, DAM4GE5 0.S PROVI�ED FOR IN SECTIqJ 3N80F THE LABOR CODE, IMEREST, AND ATTORNEI"S fEES.
LICENSED CONTAACTORS DECLARA710N:
I hereby ettirm that I em Ilcensetl unAar provisions ol C�aO�er 9(commendng wilh Section 7000) ol Division 3 oi lhe Business antl Proleuians Code, and my license is in tull
larce end ettec�. Lic. a Class a
Comrectors Signewre: Date: '
CONSTRUCTON LENDING AGENCV: '
❑ I hereby ettirtn t�e� �here Ls a constructlon lentling agen�y for the perfortnence ol Iha wark lor which �his Oermll Is issuetl. (Sec. 3097, Civil Cotle).
Lentlers Neme: Lentlefs Atltlress:
SignaWre: Dete:
OWNER-BUILOER OEGLARATIONS:
I hereby eNirtn Ihet under penalry of per�ury Nat i am EXEMPT FROM TME CONTiiACTORS LICENSE LAW lor the tollowing reawn (Sec. 7031.5, Buslness end Protessions
Code: Any ciry or couny w�ich requires e permit to construct, elter, Improve, tlemolish, or re0air eny strucWre, pnor lo its issuance, elso requires Ue applicant tor such permit
to File e signetl stetement t�at �e or she is licensetl pursuant to Ihe provisions oi ihe Contractors Ucensa Lew (Chepter 9(commendng with Section 7000) of Division 3 oi Ihe
Business antl Prolessions Code) or that he or she is exempt iherelrom entl the besis lar tha elloged exemption. Any violation ol Section 7031.5 by any applicant for e permit
subjBcts the eppiicant to a cn�i penairy ot not more than live hundred doners (5500)J:
��?'�I�es owner oi Ihe pmperty, or my employees wit� wages as t�elr sole compensatlon, WILL 00 TME WORK, end the siructure Is not intentletl or oHeretl tor sale (Sec.
7d44, Business and Professions Cotle: The Contractors License Lew does not apply to en owner ol property who builds or improves Iheraon, entl who tloes such work
�imself or herself ar through his or her awn employees, proNdetl Ihat such improvemems ere not Intentletl or oXeretl tor sale. If, however, Iha builtling or improvement Is
soltl within one year ot completion, the ownerbuilder will heve the burden of praving that he ar she tliG not build or impmve for purpose ot ule.j. -
❑ I, as owner of Ihe pmperty, am E%CLUSIVELV CONTRACTING WliTf LICENSED CONTRACTORS to construct the projeci (Sea 7044, Business and Professions
Cotle: The contractors Ucense Law does no� epply to en owner ol propeny who bullds or improves thereon, and who coniracts lor such project with a contractor(s)
license pursuant ta the Contractors License LewsJ.
❑ I am �ezem t untler sec. Business end Pmlessions Code br this reason:
`asi9y� 1"=,.s,u`�l' _ _ �ayS� ��_.�..-�� �"Qdle� 1 �%` $�
bwnar 10 venfied by ddvefs license. �. i�es ❑ No Driva .rs Licenea�No. � Ek ires:
Venficetian of Ownership by (rype ot tlocumem, I.e. - properry ler bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby cenity Ihet no excavatlon tive (5) or more feet In Oept� into which e person is requlred to tlescend, will be meda in connaction with work authorized by this
permi�, entl that no bulltling sirucNre, scaNdtling, lelsework. or tlemWition or tlismentling thereof, will be more I�an Ihirry-six (36) feet �ig�. (C�ap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Celllornle Atlministretive Code).
❑ As owner-bulltler, I wlll not employ enyone to tlo work which would requlre e parmlt from the Divislon ol Intlustrial Sefety, as notetl ebova, unleu such person hes e
permit to tlo such work Irom Ihe division.
Signa�ure: Daie:
Division oi lndusinel Salety Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AUfHORRA710N OF ENTRV: I certify under penalty of perjury ihat I have reatl �his flpplication and state chat the infortnation given is
correcL I agree Io compty with ell state laws end ciry ortlinances releling to Cuiltling wnscructlon, an0 authonze representatives of Ihe Clry ot Cas�a Mesa to enter upon ihe
ebove-descnbed properry tor inspection Ourposes. I epr�e no to occupy or allow occupenry ol eny builAing authorized by this permit until final inspection.
N L
����.g ii , i� .
Signawre,qf�Lege�_ n sl�^-_ '.' Dale '�
. cf���e�S
AnNOr Authorized Ap0licent Date
[dd�7�1�F�J3TFP,f�7�
1818
202
203
204
Fi:ed System Final Fire Prevention .
Pool Spe Finel
Finel Re-Rool
Final BIocWRetaining Well
Final Factory Fire Place
Final Sign
Final Demoll�ion
PdIE � - II�LS
eooe� iNsvecnoxnve �
206 Finel Mechanical .
208
210
212
Final Plumbing
Final Electrical ' •
Finel Fire Prevention
'220 Flnal Planning A{iprovel '
222 Finel Sile
250 FinelBullding/Occupancy
P� 1[�E15
��
/
/ / I / � � / • / , ♦ /
OWNER-BUILDER
VERIFICATION
A ciry or cuunty, which is rcyuired to givc noticc punuant to Scction 19R30, shall attach to such noticc, and,
as a condition precedent to issuing a buiWing permit, reyuire the completion and require the rewm o(, an
owncr-buildcr vcrifica�ion.
Auemion Property Owncr:
An 'owncr-builder' building perrnit has bccn applicd for in yuur namc and hcaring your signaturc.
Plcase complele and return this informalion in the envclupe pruvided a� yuur earlies� oppottunity iu ��void
unnecessary deluy in prucessing and issuing your huilding pennil. No building permil will he issued until this
vcrification is rcccivcd.
I. I persnn;dly plan tu pruvide Ihc major labnr and materials for construction of the proposed
prnpcny imprmemem. � Yes ❑ Nu
2. I(have/have nol) �K� °� signed an application for a building permii fur
thc proposcd work.
l. I hav� contracied with the follou•ing persun (limi) lo pruvide �he proposed conslruction:
Namc
Address
Phonc (
City _
Contractur's Lic. No.
4. I plan tn pruvide purtiuns of ihe work, but I h:rve hired the fullowing person to coordina�e,
supervi.c anJ pruvidc thc major wurk:
Nmnc
Addresti
Phunc (
City -
Contrac�or's Lic. Nu.
5. I will providc ,ome of ihe work bW I have cuNrac�ed (hired) thc folluwing persuns to
pro��idc ihc work indicated:
Namc Address Phune "1'ypc of Wnrk
iM?�a6 �FEV 998)
1 hereby affirtn [hat 1 have rueived a copy of the infortnation set forth in Section 19830 of the State
of Califomia Health and Safety Code'and have completed the above information to Ihe bes[ of my personal
knowledge, in compliance with this S[a[e law.
Signed: �iX�cui,n\ 0_�./1�__ �u;..� Date: 7^ 27�0 -S
i
IYame: _�lZt4-,(/C( S GO Qv�LE yvc g-
(Printed or Typed)
C.D.L. #
For more information call City of Costa Mesa Building Division at (714) 754-5273.
�az�.s �nev. asal
ADP�icant to fill in all spaces except thosa wilhin neavY bortler iines antl si9� all aoaroo��ate aeclantions.
PERMIT
�ing Address �6�-�+P�•� �✓� l�rr�i�Fdn' Gyz�i
T �
Owner's Name �'Cr�*!• ✓�✓G�✓✓r Phone
Address �g95 .r/i.:6.�0 �.c L�ofi.f .a'/eTfl �.
Arch/Eng. License No.
Address
Contractor's Nam C�r �Jnii�.v6 � oP GJ/ Phone 6�%r'�Z=y
Address (mailingl �� S3 .i�r/'d2r2 /�/i TA �i:/1� G�•
City License No.
LICENSED CONTRACTOR OECLARATION
1 �¢rCby afflrm thal I am licensetl untle� provislons ot Charter 9(commencing
wilh seclion 7000) of Divislon 3 0/ the Busi s antl Professions Cotle, antl
my license is in full force antl eHect.
License Class G' 3 license No. 6 p
Date Signature —
W00.K RS' COMPENSATION OECL � AT
I hereby affirm Ihat I nave a certifica 'ot consent to se e or a certificate
' Workers' Compensztion Insura �e, or a certifie thereot (Section
00, Lab. C.)
✓olicy No. � Company �/� � T Ca
Certifietl copy is hereby (urnishetl. �
Ce�tifie copy i5 t'letl wi[h the city Buil i5ion.
ate T� Applic
EXEMGTI N ROM WORKERS a66G1-A '
(ThiS SeGlion neetl not be com0letetl if the rm s tor on¢ _ (5100) or
IC55). /
I certity that in Ihe perto�mance of the work for wbich t p m�t is Iszuetl, I
5hali nOt employ any per5on in any manner zo a5 to become subjecl to the
WOrk¢rs' Compensation Laws of Callfomia.
I Date Si9nature
I NOTICE: If, afler mdkinq Ihis tleclaration, you ShoWC become Subject to the
Worke�s' CompensatiOn Provisions ot the labo� Cotle, you mus[ forthwith
comply with Such 'p�ovisions or tnls peimlt shall be tl¢eme0 �evoketl.
CONSTRUCTION LENDING AGENCV
I M1ereby aHirm thal [here is a construction lentling a9ency tor the pe�fo�mance
of tne work for which this permit is issuetl (Sectlon 309] Civ. C.)
Lentler's Name,
lentler'z Atltlre55
OWNER BUILDER DECLARATION �
I hereby aftirm that I am exempt from the ConVactor's License Law for the
f011owing reason (Seclion 7031.5 Business antl Prote55ional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
any ztructure, prior to its issuance, also requires the applicant tor such permit
t0 lile a signatl sla�ement Ihat he/she i5 IicenseE pursuanl to lhe provisions ot
tne Conlractor's Llcense Law (Chap[er 9(commencing wilh Section 7000) of
Division 3 O1 Ihe BuSiness antl Protession5 CotlC� o� [hat hC/She is exempf
^��?{eretrom antl the bas6 for the allegetl ex¢mptlon. Any violation of Section
�_.r„Ii31.5 by any ap0licant for a permi[ subjecl5 Ihe applicant t0 a civil
''nalty ol not more than (ive huntlretl tlollars (5500).
�j�� I, as Owne� o� [he pro0erty or my emplOyees with wages as their Sole
compensaHon, will tlo tne work, antl the structure is not intentletl or offeretl
for sale (Se<tion 7044, Business antl Vrofessional Code: The Contractor'S
Litense ldw tloes not apply to en owner ot a prope�ty wito builtls or improves
thereon, antl who tloet such work nimseli/herselt or throu9h his or her own
employees, provitletl [hat such improvements ara n0[ Intentletl or ofteretl for
Shc¢. If, however, lhe builtling or imPtovement Is sold within one year of com-
pletion, tne ownm will have.the bu�tlen of proving he/She tlitl not builtl ot im-
��Ove to� thC Pu�pose of sale).
I, a5 owne� ot the prope�ty, am exclusively Contracting with IicenSetl con-
tractorsto construct the project (Section ]044, Business antl Pwtessions Cotle:
The Contractor'S License law tloes not apply to an owner of D/operty who
builtls or ImD�ows the�eon, antl who contracts Por Such prolects with a con-
t�actor(s Ilcense Oursuant to the Contracfo�'S Lic¢nie Ww). I am aware that
proof O� their Worker'S Compensation inzurance shoultl be provitletl to me.
❑ 1 am ex¢mpt untler Section B. d P. C. torthis reason
Oate
Signature �
Drivers' Licens or
CMF 0865-46, rev. 4/ 4
i state
antl ca
above
iances
repre-
v for
�J1512 �
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH �OTHE9 %z��/S'Ar��� ' ' q,p, �jtr
DESCRIPTI�OFWORK/USEOFBLDG. T/oFa= Krde� �'.sr.✓6sr7•
� ' � i n �k /f¢c ' j > L�� � �G. ' S Main Building:
' E
TYPE OF PERMI7 GRADirvG FOVrvDATiorv STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL B Rear
C�OTHER %jVri�'�'C A
PROJECT DESCRIPTION SQ. FT. ��%'r� C Right
OCCVPANCV
CONSTRUCTION TVPE ��r+'�'G VALUATION $ 3/L7� v'D • g Left
ZONE � GRADING CU. VDS. ACRES Ping. Ref. #
Remarks: Planning Notes:
8ar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
lavatories
P—Trap '
Roof Drains
Reinspection Fae $15
Boiler
Duct � Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0100,000 BTU 0100,000
I I ReinspectionFee I 515
ng; Canary - Applicanh Pink - Accoun[ing; Goltlenrotl - Assessor
$howeri
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Wacer Service
Isue Fee $ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
0111 10/12/84
• Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Switches
Garbage Dispoul
Generator �OS KW �5-15 KW
Meter LJup to 100 amps
Meter ❑over700amps
Sub Panel
Morors �0-1 HP �i %- 8
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light
Ran9e
Sign
Standing Sections
Trash Compactor
IANICAL ' FEES Reinspection Fee I$15 Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Hood or Type I ❑ Zoning Approved By
Canopy Type I I ❑
Building Approved By
Fetrigeration Sys[em
❑o�ioo,000sru ❑ioo,000
System RepaidAlteration
Issue Fee , � $ 3
I�aO❑ 5�,.
FEES
$ 3
SUMju1ARV OF FEES.
BUI�DWG PERMIT $ I �' S� SMIP $ �'��
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% 5 ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE 5 ' � �
PLAN CHECK 25% $
2
O
N
I
N
G
R
E
�
M
T
S.
I
STRUCTION'AND PLANNING
OVALS Permit#
mporary Electrical Service or Pole
il Pipe-Undrgrnd.
Electrical Conduit Utility-Undrgrnd.
�.'Electrical Conduit-Undrgrnd. , �
5. Steel Reinforcement �
� 6. Electrical UFER Grnd.
� 7. Footings �
8. Foundation '
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
73. Roof Drains -
14. Rough Plumbing
15. Rough Electrical-Conduit
16.,RoughElectricWiring .
77. Rough Wiring Sign
78. Rough Electrical-T Bar Ceiling
79. Rough Heating & Air Conditioning
20. Rough, Factory Fireplace � �
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test �
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing .
31. Plaster Brown Coat
32. Electrical Power Meter�Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation _
44. �Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requiremen[s Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No, Date
Date
POO, ;PA
Inspector AppROVALS Permit#
52. Pool & Equipment Location
� 53. Steel Reinforcement
54. Forms � �
55. Electrical Bonding � �
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
56. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTODECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final•
65. Electrical-Final
� � 66. Solar System-Finaf �
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
77. Product Piping OGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
�-V�-- 74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:�0 ,(� � �� �
I o g9- ' �A�a L. �.
�1,,,,1,tY /'✓'�,- f.�isi �.-�i � �II
Date � Inspector I
i�
OWNER WE,7+C�TiL' H�ME$ DATE 5'18-56
ay9s
JOBADORESS � �M11bI'O Sti'8Bt . BUILDINGPERMITNO. 3OI}I{
GENERAL CONTRACTOR Welcome Homes VALUE $ %�].6�.�0
� 36 BLOCK TRACT 2896 Jingle Res. W�3tt Q8T'
GROUP I Bc J TVPE i% ZONE R,I1 F�RE DISTRICT 3nfi�i
PERMI7S ISSUED
INSPECTIONS I DATE SUBCONTRACTOR
DATE I NUMBER
Foundation Forms and Grade to
Rouah Framinp � _ l.,
P
Wi
Heatiny, Final rn 7�7'°' /�! � L/. b—/S—.S t� /�c+: � �
ewer, House Sewer, St. � / � � �� ���_v . -�J—//_ ( �a � � �—
Septic 7ank or�Ce.sspool �
L '�g, �^ Out �% �a
F. .ering ��j�, ��^�•
Plumbing, Final, Fixtures Complete}'/%`' S�)D �5�7 _/71 _�— I
Plumbing,FinaIGaSTest/�' }JJCS �'au-S"7 7';' � � e2,/ ���:J�
wiring, Final FEB 8 1957 VCB
OccupanCy �rn �Jc /�y��� �-).p-S7
FORM 210 3M 10-•v5
Costa Mesa Bnilding Department
P. O. Boz 3! 7
' �� COSTA MESA, CALIFORNIA
: FOR APPLICANT TO FILL IN
Building
nddress �Y:-h?ilbro Street
Costa Mesa, California
Nearest
crossst. Beker
Owner SYelcotre Homes, InC.
Mail
nadress �2a tiYe�tminster Ave.,
Te I.
Gty Wostminster rvo. i7em. �
Architect or Lic_
Contracto�`AlOOIRe HOIIB S� InO. No� �
adaress �8 h`estminster,Ave.,
Metes and
No. of
Existing Bldg. NOI18
SetbackLinefrom 50 Ft.
CP�ILP� 07 StPPP*
�IPPLICATION FOR PERIVIIT
3i�8�: BUiLDING '
FOR OF'FICE USE ONLY
Receipt No. Permit No.
30 ��
Received Date Rec'd. Date Issued
-� i� � s_��,5� S_� � S6
Costa Mesa, California
Nearest
PP
N0w � X � Altereti0n � � Additian � ` `VS �
Repair I I Moving I I Demolish I
Buiiding ���n No. of
S�ze 2�ju.Fc. Rooms �j Stories 1
Exterior Wall Roof
Plans
Covering StuaC• I Covering ��jpp3 ApP$.�VEiL�'
Use of New
Building Single fatPily residence and Foundation Location Inspecto
Forms, Materlals,
two car garage attached. under-rinniny
j' Frame: Fire Stops,
� Bracing, Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath. Int.
with all Clty Ordinances and State Iaws regulating
building co tru�n. Lath. Ext.
3lgnature o� p��� �
Permittee `—'��`�— � Plaster,lnt ____
Valuatlo�� PermitFee $ /� 5� �
Plan Check $ p� '�
$ � /6 6 To�� ,3G
Fee $ J
NAL
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PLOT PLAN
Show Ioeation and distances from
proper[y Iina and between buildings
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