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HomeMy WebLinkAbout351 NASSAU RD - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 351 NASSAU RD Suite No Vicinity: Parcel Nunmber: 14144202 Applicant: NOCK,TIM'����:. Address: 11612KNOTT�ST��- � / ' , �GARDEN GROVE; CA �, � � � � � Owner: BLAIR, RICHARD D TR Address � 351 NASSAU RD � ' COSTA MESA, CA Contractor. Address: Arch / Eng : Address: NOCK PLUMBING N612 KNOTT ST " GARDEN GROVE, CA PLUMBING PERMIT Phone: (714) 895-1246 Zip: 92841 _ Phone: Zip: 92626-6327 �" Phone: (714)895-1246 Zip: 92841 License: 707775 Phone: ZiP � � � License: , Status: ISSUED Applied: 06/11/2003 Issued: 06l11/2003 ISSUED BN H'�� �\ � SCOPE OP PERMIT CHANGE OUT WATER HEATER , FEE SUMMARY -. AMT QTY � AMT -.QTY -AMT QTY ISSUE FEE ' . . $23.50 , � � . Laundry Tub / Washer $0.00 0 -� � "� Sump Pump $0.00 0 BackFlow irrigation .$0.00 �0 � ''Landscape Irrigation $0.00 0 Swimming Pool " $0.00 0 BackFlow Preventer $0.00 0 , � P-Trap $0.00 0 � Trap Primer $0.00 0 Bathtub � $0.00 0 ,PressureRegulator $0.00 0 Urinal $0.00 0 Clarifer System �` $0.00 0 � Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect Qce,Soda,etc) ;$0.00 � 0-� �Receptors $0:00 0 Vacuum Brkr BkFlow(5+) $0.00 0 Dental Units �, $O.DO 0 � ' Septic Tank $0.00 0 Wash Basin, , $0.00 0 Dishwasher �$0.00 � 0�� Sewer Cap for Demo .$0.00 � 0 Wash Basin Set $0.00 0 Drain, Floor $0:00' 0 � Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 ' Sewer Private line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0- � -Shower $0.00 0 , Water Heater / vent $12.30 1 Drinking Fountain $0.00 0 ."Sink, bar . $0.00, 0� - Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 �Sink, commercial $0.00 0� Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor �" $0.00 0 Water Service $0.00 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 requfred 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) 7545626 2446-46(6/00) WORKERS' COMPENSATION DECLAHATION: ` I hereby aflirtn untler penalty of peryury one of the following declarations: ❑ I have end wlll meintain a certificete of consent to setl-Insure for workers' compensa�ion, es provided tor by section 3700 of �he Labor Code, for ihe pertormence of �he work tor whlch lhip permit is issued. ? I heve and will maintain workers' canpensation insurance, as requiretl by section 3700 of the Labor Code, for the pertormance ot ihe work tor which this pertnil is issuetl. My workere' compensrat'lon Insu/re�nce carner d policy number are: �J /� 'Car �:� �����(/� I _LY���.l� Policy�Plumber.�lC /UO�JO �� �`� '(This secbon�of�ie campleted il fhe erm�f �s valued ( one hundred dollare ($100J or less.) ❑ I certify �ha� in �he pertortnanre of �he work for h� h this permi� is issued, I s�all not employ any person in any manner so as lo becoma subject to t�e workers' compensation laws oi Celifo a, Ftl agn e t if shoulA become subject to the workers' compensation provisions of Saction 3700 of the Labor Cotle, I shall forthwith comply wi�h Ihese provisio . �� ,y � .ApplicanCSignaNre: i DaleP �% (/ WARNING: FAILURE TO SECURE 7flKER5' PENSATIIXJ COVERAGE IS UNLAWFUL M10 SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND dVIL FINES UP TOONE MUNDRED TFIOUSNNDDOILARE($100,000),I ADDITIONTOTHEWSTOFCOMPENSATION,DAMAGESASPROVIDEDWRINSECTION3�O60FTMELABORWDE,IMEREST,ANDAiTORNEPSFEES. LICENSED CONTRACTORS DECIARATION: I hereby aMirm Ihat I.am licensed under provisic force entl ettecL Lio.�k /� %C� % � with Section 7000) of Division 3 of the Busine�s a�Pfofessions Code, and my license is in full Cless Y � � Dal f� ,�=(��� CONSTRUCTION LENDING AGENCY: � ❑ I hereby aflirm thet there is a conslmction lending agency for the pedormance of the work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lendar's Address: SigneWre: Date: OWNER•BUILDER DECLARATIONS: I hereby aHirtn thei under penalty ot parjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business en0 Protessions Code: Any ciry or counry which raquires a permit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires the epplicant for such pertnit to file e signetl statement Ihat he or she is licensetl pursuant to the provisions ot the Contractors License Law (Chaptar 9(commencing wit� Sectlon 7000) of Division 3 of the Business and Professions Code) or thet he or she is exempt therelrom end the basis for the alleged e:emption. Any violation of Section 7031.5 by eny applicant for a pertnit su6jeds t�e applicant to a civil panalry of not more than five huntlred tlollars ($500).): ❑ I, as owner of ihe property, or my employees with wages as their sola compensation, WILL DO TME WORK, antl the structure is not intendetl or ottered for sale (Sec. 7044, Business and Professions Cotle: The Coniractors License Law does not apply lo an owner of properry who builds or improves thereon, and who does such work himseN or herseN or through �is or her own employees, provided that such improvemems ere not intentled or oHered for sale. If, however, the huilding or improvement is soitl within one year oi completion, the ownerbuiltler will havelhe burden of D�oving t�at he or she tlitl not build or improva tor purpose of sele.). � ❑ I, as owner ol �he propehy, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Protessions Cotla: T�e contrectors License Law tloes not appiy to an owner ol property who builds or Improves ihereon, and who coniracts for such projeci with e coniractor(s) license pursuant to ihe Conirac�ors License Laws.). ❑ I em exempt under sec. 8usiness and Professions Code tor Ihis reason: Signature: Date: Owner ID verified by dnver's license. Veriticalion of OwnerShip by (type of ❑ No Driver's License No. i.e. - property tax bill or deedj: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby certify Ihat no ezcavation five (5) or more feet in depth imo which a person is required to descend, will be made in connection with work authorized by this permit, and that no building stmcWre, sceHolding, talsework, or demolition or dismantling thereot, will be more than thirty-sia (36) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Title B, Celibmie Adminislrative Code). ❑ As owner-builtler, 1 will not employ anyone to do work which would require a permit from Ihe Division ot Industnel Satety, as noted above, unless such person hfls a pertnit to do such work irom the division. Signature: Date: Division at Industnel Safery Permi� Number: CERTFICATE OF COMPLIANCE ANO A ORIZA710N OF ENTRV: I ceniy under penalry of perjury that 1 have read this application and state Iha� �he information given is correct I agree �o comply with all siate s entl ciry ordinances relating to building construction, and authonze represem��tives oi ihe Ciry oi Coste Mesa to enter upon the ebove-described property br inspectio p rposerd. I agree r�t m occupy or ellow occupancy ot eny building authorized by this permit until final inspection. COUE �. INSPECTONTYPE PAIE IIi�184$ 1616 Fixetl System Final Fire Prevention 7266 200 201 202 203 Pool Spe Final Final Re-Roof Finel Block/Retaining Well Final Factory Fire Place Finel Sign 204 Final Demolition COOE II INSPELTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Oaupancy �' onTE INTITULS 11 • Y �� PflOJECT POOflE55: 3 S 1 NASSAU RD (�'.H'S NAME: BLAIR, RICHARD D nooness: BLAIR DOROTHEA K 351 NASSAU RD COSTA MESA,CA 92626 545-4911 AflCHIENGINEEN: HEG.NO.: AOOflE55: uNiT: CSTY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06946 PERMIT NO; B 069461 PLAN CHECK NO; N GOVT; N SUPP; N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT y9 eeRmmee: FAIRWEATHER ROOFING ( 714 )�'vers J'aa7 aoonEss: 3845 E CASSELLE AVE ORANGE CA 92669 LICENSED CONTHPCTOfl DECLAflATION: I hereby aflirm tha� t am licensetl untler D�ovisions ot Chap�er 9(commencing with Section 7000) nl Divlsinn 3 of the Business and Pmlessions Cotle and my license is in full force antl ef�ect. cirruc.: �47g� sTnreuc.:515125 /� c ss: 39 EXP; 06/95 a�e: — ° L'j � � Signamre�. t/.� � � WOflKERS' COMPENSRiION OECLAflFT10N: I hereby aflirm tnat I nave a cenilicale ot consent to self-insure or a cenilicate ot Warkers' . Compensalion Insurance. or a cenifiea copY ��e�eoi (Section 3800. Lao. C1. �' POLICY NO.: EXP. DATE: COMPANY: ❑ Ceriilied co�J �e� I mis� . qertiliea coOY is �il tl wi�� �e Cily Buildinp Division. iii �ate: pplicanL � [IH/v E%EMPTIONFAOMWOflREflS'COMPENSFTIONOECLABRTION: (Thissectionneetlnolbecomplete4ilthepermi�i5loroneAuntlretl(E100�arless�. I certily Ihat in Ihe Derformance o� Ihe work lor whic� this permii is i55ue0. I s�all not m loy any person in any manner so as �o Oecome sublect lo Ihe WJpr kers' Compensa�ion Laws ol Calilomia. //� Oate: ��/l'SI�I,y Signa�ure: �/ NOTICE: If, a��er making— Ihl i5 4etlaralion. you should �ecome Subleci Ia ihe Workers' Compen5ation O�ovisians of Ihe LahOr CONSTXUCTION LENDINGWAGENCV'lY I �er¢�y alfrm I� ' i t u�Qi a d mea�e�Ce�IpE'V�� �h¢ wOrk tor wnic� Ihis permi� is i<sued �Section 3097. Crv. C). C �� � � aooness: R EQ�' RE D OWNEH BWLOEB UECLAflRTION: I hereby allirm Ihat I am exempt tmm ihe Coniractors' State License Law for �he following reason (Sec�ion 7031.5 Business an0 Pwlessional Cotle: Any ciry o� counry wAich requires a permit �o consimc�, al�er, improve, demolish, or repair any Simt�ure. prior Io iis i55uante. also requires Ihe applitant br Such Oe�mit to file a SigneG sta[emenl lhal he/S�e is lic¢n5e0 pursuant lo Ihe provisions of ihe Contractors' S�ate License Law �ChaO�er 91�ommencine wi�h Section 7000) o� Division 3 0l IAe Business and Pmlessions Code� or iha� Ae/she is ¢xempi I�erefrom anE ��e basi5 lor Ihe aileged exemp�ian. Any viola�ion o� Section 703L5 Dy any applicant lor a permit sublecis I�e a001icant �o a civil penalry ot nol more t�an �ive hundred tlollars (5500). I, as owner of the OmDeny or my employees with waAes as t�eir sole compensation, will Go the work, antl the ❑ s�mcture is not intenaed or ollered lor sale (Section 70ad, Business and PmleSsionai CoOe: The Coniraciors' State License Law Aoes not apply to an owner of a pmperty who builOs or impmves Ihereon, antl who does such work tlimsell/�erself or tllmuAh his or her own ¢mployees, pmviEeU Iha� Suth impwvemen�s are nol intendetl or oflereE for 5ale. I�, hOwever Ihe �uildinp or impmvement is so10 within one year oi complelioq Ihe owner will have t�e burtlen oi pmving he/she tliU no� builtl or improve �or �he purpose ol sale). I, as owner of t�e pmpeny, am exclusively contracting wilh licensetl coniractors to constNct ihe prole�� (Section 704d, Business ❑ anA Professions Cotle: The Commc�ors' Slate License Law Ooes no� apply to an owner o� proDenY who Uuiltls or impmves IAereon and who cantracis �or such O�olens wi�h a conVacmr(s) license Dursuant to t�e Comractors' Stale License Law). I am aware thal pmof of �heir Worker's Compensation insurance shaula 6e proviUed [o me. � I am exempt under Section: 8. 8 P. C. lor ��is reason: . Dale: O�vnec I Go here�y cenity that I am aware ol ana unaerstand t�e requiremems ol Cahlomia Heallh anU Safery Code Sections 25505, 25533, antl 25534 ana Ihat I ar any �u�ure �uilding occupan� will/will no� (circle one) neeA lo comply wi�h saitl s�a�e cotles antl Ihe reQuiremen�s for a permn �ar canslmction ar mo4ificalion Irom I�e Air Oualiiy Managemen� Disiricl. ResiUential constmclion aDPlications are exemp� �mm Ihese pmvisions. Dale'. Npplicant I hereby c¢rtity tha� I have reatl Ihis application and state ��at ��e above inlormaiion is mrretl. I aqr¢¢ ta compty wit� all ciry antl coun�y orOmancesaM �elawsrelatinglo�uiltlmqcons�mctionan�ce�au�reseni vesoflhisci�y�oenteruponihea�Ove�mentionea pmpetly fori pecuo purposes. Daie: �� Zf y Signamre. roriver'si¢e�sea�sociaisecudiyx: 16<ba6 WMe-9uilding', Gieen—Cotle Enlorcemen�: Canary—Applicanl; Pink—Fevenue; GolOenro4—Assessor JOB DESCRIPTION ; T/OFF REROOF W/FIBERGLASS SHINGLE SQ FT: 2,910 CLAIM VALUE; 2,910.00 CALC—VALUE: 2,910.00 GROUP OCC; R-3 /M-1 COMMENTS: SMOKE DETECTOR REQUIRED PRIOR TO FINAL *��r*�r***********r**r***r�*�r*�r*�r***�r****�r**�r�r*rr**r***rxw****�r****�r***rr�+r*�e��r*�r Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN AGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REQ• PAOV; PARCEL; 14144202 ZNE: REF NO: PLANNING NdTES> � � . �r�r********�r�r**�r****�r+t�+t**�r*�t*�r****x�*�r�t�r*+r+r+rx**�rr****+r+rr****�r***ir�r**+rir*********�+r D E V E'L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPAOVED BY DATE: HUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY; DATE: ifMiFifikitiFitifkitifififiFkMitilkifiF 1flf4itiffkikMM itif lfiFltMitMltMff�tiflflfikltlfihMiFlhiF1lffitifMfFifilitlflfifkifftMilitllM4lfMifiFMlflFklfffMkifMMMMk1l1l1fitilfffflf7! itKiEif Mif1k1E LEGALIZATION;N F E E S U M M A R Y STRUCTURA SEGMENT;Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMZT 54,00 .50 PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 54,50 0,00 0.00 54,5� 54,50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 54.50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 54.00 ,50 M�tlfitiFklfiflfiFifififltlkitifMitlfititkifllitMlfif�fitilffMil�hififlklFifkikitlFikllili�ifM1l�lMikMilitMiEifiFlFMk4MitihillliliFifiElffflfif I N D I V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 2910 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 2,910,00 END OF FEES US DOl7019?-0017Q20D T l�T i4.50 DaTE: 10/25/94 TiI1E� 11:10 �CONSTRUCTION ANDPLANNING POG_.vSPA ' �qPPROVALS Permit # Date Irspecto* APPROVALS Permit # Oate tnspector i. 7emporary Blectrical Serwce or Pole 52. Pool & Equipment Location Z, $oil Pipe�Undrgmd. �� 53. S[eel Reinforcement . `3?�f�etrical Contiv� �tility-C.indrgrnd. 54. Forms ,.: � .�4.�f�iectrical Condvit-Undrgmd. 55. Electrical 8onding � 5, 51�'ei'Reinfor�'ent . 56. Rough Pfumbing & Pressure Test .' �•,6:T�e�trical UFEFi Gmd. -� 57. APPROVA� TO COVER�GUNITE � :.T �FOot,ings y� � _ 58. Electricai ConduibUndrgrnd. � °� $;`�oundation � ' "_ 59. Gas Pipe, '+_'�.. Undrgrnd., Test : Water Pipe�Undrgrnd. • �� 60. Backwash Lines, P-Trap, C Undrgrnd. 70. Struciurel Fioor"$ystem 61. APPROYAL TO DECK 11. property Sewer Line & House Connection . .. .-62. Backwash & Receptor�Pinal 72. SewAr Cap . �� � 63. Heater & Vent�Final .� 13. Foof Drains , __ ", 64, Plumbin3 System • Pinal 14. Fough Ptumbing ' - ', 65. Electricai�Final 15. Fough Electriwl-Condwz- ',_ 66. Solar SYstem-Final 16. Rough Elect4ioWiring • 67. Fencing & Access Approval U, poogh Wir�ng�Sign ` 68. APPROVED FOR PLASTERING 18. Rough Eieci'rT�al-T Bar Ceiling 69. POOUSPA SYSTEPAS FINAL 19. Fough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20;:Rough F�ctory E'treplace � =:.�. ' � - APPROVALS- _ Permit # H - � 21,flu�ts,ia,St��cn.re; � `�`,; ' ; -� �; � ;7p, Undergioune�Hydro ' 22. �ucts,Venti}atir�g � � . ' _ �:� � � 7�, productPip�ngLlGas QOiI 23�Gas�PiptiRa."9h ffi 7est � �': _ . � •. . .. �' �{ a ,, �.� �, .72. Under97oiinil FI'usfi . . _. , 24. Roo,f Framing _ '-��, •� �� :> � u ':73!`Undergmcl�.StorayeTank OGas �Oii Y 25. Robf Sljeathin9 �� ' , !Q �6-.q(.('�(,�j�. � 74;-�Qverhead�FiY�ro '� . 26.;7�Bar Ce�ling (Structural� & jvlonocoat � r � 75.'D.Y Chemical - - - Y 27:=Frameand Flashing ^;f_�, , ., �'� � ; 76.'DryStandpipe �'� � ' � 28. �Lathing-& Sjdiny; . ; � � '^ � . r 77." FIXED SYSTEM 61NF1L � 29. Insulatibn 'r • '- '.' " .. ` . `'� , � " . + � � 78�; FiflE PREV. FI�VA�L . :30. DrytvalLNailing r. � � � � I -� MEALTH�OEPT. REQUIREMENT _31. Plaster Brown Coa[ � �; `, ,79� FINAL INSPECTIQN ° � �� ;_,32-Eiectrical Power�Metej,-Finati � :�� i #,�80,rPO0B CER7iFICATE ISSUED f r _33..Fina1 Electric �,, ' ' � � !' '�Noies: ' '�'; a '+ � ,. '94`Fina_1 Heating& Air C3n.ditioning_ " ' � � �.- � � �, r � ,.._ � �35.' F�nal GaS Pipe-Test • � � i ' �" ' ' ' - " 1 ''" J �� � . .36. Hood or CanoPV-. ' . :-� .-. � ,^ � I .• �, �� - .. . . . 37:.Final Pac'tory FiFepiace "' r � � � _ _ `' � �= 38. Final Plumbing " .. .. . . 1 � - n _ -- - ; 39. Wafer Service•Pinaf• i . ` � ' "� " •� � _ , r0. GasServjce-Flina4 . ,. ' �', , - . � ° - �" x �41. SO�ar pomestic-Finel :': ' '.- �. .-' � r � ' -42, Backflow Preventer# � `L ' I I ��� > _ . � ,i - 43. Backflow Irrigatiort� _ + ^ � �, . �. i ;T,44. LandscaPe IciiAatio� SYstem�. �'" .y � - �. ; 1, 7 . � �i . . �.,.. :' - . R5. Sound Aitequation� ��x � +'� °� - + ' " '� , " �, 'r ..: ` - - r� :46. Nandica�.ReQulations � � �� - - � � - - a _ _ 47.�_PINFhL STR�ICTURE & BUYLDING � . � _ : ' . . _ ! = 3(�r.( �ct�(� : _ .48.'_�INALPLANiVItV� � _ . r � ! , ,�r x ,- ,:� • , -49. �Elecvic�Release to Edison � !� - .,: � i �50. Gas 6elease to Soujhem Califorpia GasCo "' ! � `��h ' - � • ' ;; • � `• �51. CEA, IFICA?E OFyOCCUPANCY , �` , , �, ; ' _ • • . . No. Date ' OWNER RutgeTs DeV. CO. �aTR. 8-29-58.. ��-� _ JOB ADDRESS 351 Nassau Rd � ' BU. NG PERMIT NO. � 7369 GENERAL CONTRACTOR Dike & COle OVe Inc. VALUE $ 16,598.00 AP. No. LOT 25 T��T 2954 � zorre DESCRIPTION OF WORK Res. w att. garage GR011P I& J TYPE V ZONE � R1 � PLAN NO. ��f>fiF%!!q �,_ _ � B__I PERMITS ISSUED INSP � v DATE SUBCONTRACTOR DATE NUM � ?ixtuces Pinal C � a.I. -39 Test /r .VLL� l� -�"O . � ' '7��9 COSTA MESA BUILDING DEPARTMENT P.O.80X 31� � COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BUILDING 1 Nassau Road AOORE55 COSTA MESA. CALIFORNIA IOWNER I CITY CO$ta �� ��.:v�� J�,., AUG 27 1958 r•^.�,.�nr �1 1. . u.� J'.1�L t'�iJ APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY PECEIPT NO, jYAM� d a : 1. JL • t{O C�]1• TN�• 8-1159 qDDRE55 � ���' COSTA MESA. CALIFORNIA nk No. Garden Grove FIRE ZONE e :o�E Co egrove Inc. "T� H"o: 841 R �J 1+• llth St• H�:�. 5-1159 ByPROVED �Ec�� lpQ DESCr+ivnOrv NO. BLOCK TRACT2 A.P. NO. SIZE �O �. '1� MO.OF BLDG6. n�ne OF LOT NOW ON LOT SETBaCK LINE FFOM f.ol ��lOI CENTER OF STREET � REAR YARD SIDE YARD RIGHT S' L'cFT Jt DESCRIPTION OF WORK NEW x ALTERATION ADDITION REPAIR MOVING DEMOLISH 5�Z'E°'"G1647 $ • �i• ROOMS / STORIES 1 E%TERIOR WALLai..___ ROOF �__ Plan 760HR I HEflEBY ACKNOWLEOGE TX�T I N STRTE TNiT TME .�BOVE IS C FECT CITV OFOIMwNCES wND ST W TION. $IGNATURE OF / garage. 1ND AGREE TO COMPLV WITH .�ll RIZED AGEN�ke & C018grov2� InC. VALUATION s16,598.00 DATE CORRECTIONS PERMIT FEE S3g�OO PLAN CHEGK $���OO TOTAL FEE 5 � "OY/ _� �OSTA MESA BUILDING-SAFETY DEPARTMENT P.O.80X 3f] COSTA MESA, CALIFORNIA fOR APPC/CANT TD F/LL /N COMACETECY TYPE OR PRINT BUILDING J AODRE55 �7 �1/%i/�,� COSTA MESA, CALIFORNIA � ARCH ITECT AD�LEGhL SIZE �J/, {. O / NO.OF BLOGS. OF LOT / V !/� NOW ON LOT USE OF EXISTING BLDG. SETBACK LINE FROM �� % CENTER OF STREET �O T REAR YARO SIDE YARD ILEFT C% �� IRI�HT C DESCRIPTION OF WORK BUILDING NO.Oc SIZE ROOM_ EXTERIOR WALL IROOF COVERING COVER FIRE ZONE ZONE u��.� R�CEI�l�.D FIiVA CE DEP1.�3 �s�9 . CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING fOR OFf/CE USE ONIf' �I RECEIPT NO. I PERMIT N Mn � v ED BY I� A��EC<VC/ I�OA� ISSU J 3 NG 55 COSTA MESA. CALIFORNIA ZONING NO.OF lISE OF NEW PLNNS �] I BWLDING i / YARDS � EVES REQUIRED ALLOWED (CENTER LINE STJ /� FRONT -/ �FT._�, � 1� R.SIDE FT. C� ` L. SIDE FT. O � „ X��O'�' �' lWY/Yl�L� I HEFEBY ACNNOWLEOGE THAT I HAVE REAO THIS APPLIC/�TION ♦NO STATE TMAT TXE �190VE IS CORPECT qN� AGFEE TO COM� PLV WITH ALL CITY OpDINANCE3 RNO STAT//E LAWS REGl1LilTING BUILDING CONSTRUCT� �� /� J� ` / l�` SIGNATUREOF Airi / A.i�r I � AUTHORIZED AGENT THE wMOIINT SHOWN IINDER VALUATION �3 FOP THE PURPOSE OF ESTilBLISHING A PERMIT FEE ONLY. VALUATION �' � PERMIT FEE $ $ � � 1 PLAN CHECK $ � V ,H ` � V TOTAL FEE S