HomeMy WebLinkAbout289 OGLE ST - Building Permits�
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vnaecTaoosess: 289 OGLE ST
OWNEP'S NRME: CLARX, PERRY A TR
aooaess: 77-538 AVE MADRUGADA
LA QUINTA,CA 92253
969-6100
AflCH/ENGINEEN: NEG.NO.:
nooaEss:
UNIT:
uxiT:
PEflMITTEE: ALPINE ROOF COMPANY (310)437-3282
aooness: 712 E ALTA WAY
LONG BEACH CA 90802
LICENSEO LONTflALTOP OECIABpTION: I �ere0y ailirm I�al I am lirensed untler D�ovi4on5 0l C�ap ommencing wi�h SetliOn
� 7000� ol Divson 3 ol1Ae Business ana Pmfessions COUe. ana my lice i lulliorce ana elf .
cirxuc.: 059404 sTnTeuc.:592101 � C39 n:X"�; 06/94
Oate: _��(J '4 4 Sipnamre: _ _ .
wOBNENS' CaMPENSRTION UEClANA7lON: I nere�y allirm Ihat I have a cenifi ale of consent lo sell�insure or a teniticate of Workers'
fAmoensation Insurance. o� a cendietl copy tnereol (Section 3800. lae. q.
POLICY NO.: E%P. DRTE:
COMPRNY:
.� Cenibetl copy is Oere�y lumishetl. ❑ Cehilietl copy is lilea vn�� �he city Building Division.
Dale: ApDlicanl:
E%EMPTIONFflOMWOPKE85'COMPENSATIONOECIABAT10N: (Thisseclionne ecomdele0il ermt} oranehurt7tttl�51W�orless�.
I[etli�y IM1ai in I�e Dertormante o� Ihe w0ik lor whiC� I�is permil i5 i55 I SA oi emD�o y per rfin any n ae�o Eecame
su0iecl io Ihe Workers' Comoensalion laws ol Califomia.
Oa�e: � W � S� Siqnature:
NOTICE: II, atler makinp Ihis Ueclaraiion, you s�oultl Eecome 5u0ject f I�e Workers' Comp¢nsation pmvisions ol Ihe labor
Catle, you must lorihwith compty wilh such provisions or this permit shall Ee �eemetl reuoketl.
CONSTPUCTION 1EN01NG AGENCY: I herehy afiirm Ihal Ihere i5 a tonslmt�ion Ien4inA aAency fof Ihe peAormanCe 0� Ihe xrork lor
wnicn ihis permit is issue0 (Section 3097. Civ. C1.
LENOEB:
A�OflE55:
OWNEB BWLDEP OECLANATION: I �ere�y atlirm Ihal 1 am exempi �mm Ihe Conlractor5' Staie License Law �or I�e lollovnng reasun
(Seclion 7031,5 Business antl Prolessional Cotle: Any ciiy ol counly which requires a permit Ia conslmc�, atler, improve, tlemolish, or
repair any s�mclure. prior Io ns issuance, also repuires ihe apDlicanl for suc� permi� lo lile a signed statemeni �hal helshe is licensetl
Oursuam m �he pmvisions of �he Comractors' Sta�e License Law (Chapter 9(commencinp with Section 7000) of �ivision 3 0l ihe Business
antl Pmfessions CoOe) or Ihat he/she is exempt Iheretmm and Ihe Uasis for Ihe allegeA exemption. Any viola�ion oi Seclion 703L5 by
any apDlicani lor a permit sublecis I�e applitanl to a civil penally ol no� mare ihan live hunOretl CollaR �E500�.
I, as owner oi t�e PmOeny or my employees wit� waAes as their sa�e compensa�ion, will do tAe wark, and the
❑ simclureis notintenEed orofferedlorsale�5ection 7004. Business anC ProfessionalCode: TAe Caniractor5' State License Law
tloes nal apO�Y �o an owner o� a prope�y wha builtls or impmves I�ereon, antl who Aoes SucA work himSelVhersell or �hrough
his or her awn employees, pwvitletl Inal such impmvemenls are nat intentled or oflere0 for Sale. II, �owever tAe huilAing or
impmvemeni is SoIA wil�in one year ol comple�ion, t�e owner will have Ihe burden o� pmvinA he/she die no� bui10 or imD�ove
for the purpose of sale).
I, as owner ol the pmoeny, am exclusively coniraclinp wiih IicenSeE [onlraciors b conslmct the pmlect (Sec�ion 7694, 9usiness
❑ and Proiession5 fAtle: T�e Contratiars' State Lkense Law Ooes noi apDly la an avmer o� prop¢rty wh0 hudAs of imD�a�as ��ereon
and who conlrac�s br suc� pmlec�s wi1� a coniraclor(5)license pursuant to IAe ConVac[o�s' Sta�e License �aw�. I am aware
ihat pmol of Ineir Worker's Camvensalion insuranre snoultl be orovidetl to me.
� I am edempi unaer Seclion: B. 8 P. C.
for tnis reason:
Oate: Owner.
I tlo hereby ceniry tna� I am aware ol an0 uneers�ana ine requiremenis ol Calilomia Healih ana Safety Cotle Sepions 25505, 25533, antl
2553i an� t�al l or any luture builOmg attu0anl wilVwill not (cirtle one) neetl ta wmply with SaiG state EaEes and t0e repuiremenis for a
permil br conslmciion or mo0ihcalion Irom ine Air Ouah�y Managemeni Di9riti. Residenlial constmc�ion applications are exempt irom
Ihese pmvisi0n5.
Dale: AOPlitanl:
I hereby [erlilylAal I �averead I�is ap0lication ana slalel�al I�e aEoveinlor ' is corr¢ct.lagr ply wil� allciiy and niy
ottinances antl sta�elaw5 Rlatinglo OuilOing WnslNtlionanG herehyau e repr enldiives af ' n NerupOnl - entionea
pmpenV b� inspeciion purposes.
oa�e: 6-�i -r�Y Signamre:
Unver s �icense o� Socia� Securiry r:
t6aL46 W�ne—BUACmg: Green—Co�e Enlorcement; Canary—Applicanl: Pink—Revenue; GolOenrotl—Auessor
CITY OF COSTA MESA - HUILDING PERMIT PERM NO: B 067670
PERMIT NO: B 067670 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: 5-N PEAMZT TYPE: STR PURPOSE: OTA
JOB DESCRZPTZON ; T/O REROOF FLAT W/H.U, SLOPED AT/COMP SH SQ FT: 4,750
CLAIM VALUE: 4,750.00 CALC-VALUE; 4,750.00 GROUP OCC; R-1 /
COMMENTS: SMOKE DETCTRS REQRD PER 91 UBC, REROOF 1000SF FLAT, 3200SF SLOPED
��***�*,�*�*****���,��**#���*��*��****�#*Q*���**�����******���'9V�OKE�D'�'��:��f0�.
Z O N I N G R E U I R E M E N T S
S E T B A C K S �
------------ MAIN BUILDING ---------- --------- ACCESSORY BUIiLiiJ�����--
FRNT: FT IN REAA: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42522209 ZNE: REF NO:
PLANNING NOTES>
>
1E it iE iE it iF if 1E iE iE iE ie iF i(� iE ii iE iF iE �f iE iE iF #�E if� iE if aE iF if iF # i4 ia i(� 3f iE �1F if iF dE #�1E iE if if iE iF if if dG iF if 9f +f �f iF iE iF if iE if� iE if %�1F ff iE iE �3f �F # iE is if iF if� ii
D E V E L O P M E N T S E R V Z C E S R E Q U I P. E M E N T S
ZONZNG APPROVED BY .
BUILDING APPROC�ED BY :
DATE:
DATE: _
APPLICATION ISSUED BY: �.. DATE: �' ?-o I(``'{�
iE�Ek1ElEihiEiEifiEilMiEiflfiElfiflfifikif �iE�EiE�fif�itifkifiFMif ����}�3t��itiF
iE if it� if if� iE it M iE iE i! iE it iF 1t if M iE if� i: iF iE iE if� iF iF iF M iF iE if if it if-�)k if �lE i1� # if if if 1E iE i(� IL ik jE iE iE iE iE iE iE iE jE if iE iF iE �%jf iE if� if 9f if iE it� iE if aE ik �k ih iE iE �lh if
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/RES GRADING
PERMIT 72,00 .SO
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSOE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 72.50 0.00 0.00 72.50 72.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 72.50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHAPIIC FIRE SMIP/TOT GP.ADING PLAN-CHECK
72.00 .50
1E iE if �fF 7f !E if iE iF iE !E if iE iE iE iE 1F i! 1k if iE f! iE iE M if if iE 1E 1f if iE iElE 7f� iF aF iE 4 if 1E ik'M� ik if 1E i! if if iE iE%!E')E if ff M i} it iElF iF if !f 1E K-1F �1! �E 1E 9E # 1h it iF i! iF iE iF
Z N D I C' I D U A L F E E B 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 4750 REROOF BY VALUE RESIDENTIAL NOZONE 1,.00 4,750.00
END OF FEES
�1 00262578-00162`79 T Q T 72.`0
DA1E: Q6/20/94 TIt1E: 08:SE
� � \
c�
CONSTRUCTION AND PLANNING POOI & SPA
APPROVALS Permit # Date inspector p.PpROVAIS Permit # Date Inspector
i. TemPorary Electrical Service or Pole 52. Pooi & Equipment Locaiion
2. Spil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Eiectrical Conduit Utility�Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Foovngs 58. Etectrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Tes[
9. Water Pipe-Undrgmd. 60. Backwash Lines, RTrap, O Undryrnd.
10. Structurai Floor Svstem 67. APPROVAL TO DECK
7 i, Praperty Sewer Line & House Connection g2, Backwash & Receptor�Final
72. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbi�g System • Final
74. Rough Plum6ing 65. Electricai�Final
15. Rough Electrica�-Conduit 66. Solar SVstem•Final
16. Rough Eiectric Wiring 67. Eencing & Access Approvat
17. Rough Wiring Siyn 68. APPROVED FOR P�ASTERING
18. Rough Electrical�T Bar Ceiting 69. POOUSPA SYSTEMS FINAL
19. Rouyh Heating & Air Conditioning PIRE �EPT. REQUIREMENT
20. Rouyh Factory Fireplace APPROVALS Permit #
2L Ducts, in Structure 70. Underground HYdro
22. Duets, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas P�Ae�Rough & Test 72, Undergrou�d Flush
24. Roof Framing 73, Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing Z3'� �yG� 74. Overhead Hydro
26. T-Bar Celing (Structurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywafl Nailing HEALTH DEPT. REQUIREMENT
31. Plasrer Brown Coai 79. FINAL INSPECTION
32. Electricai Power Meter�Flnal 80. FOOD CERTIFICATE ISSUED
33. Fina� Eleciric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. HoPd or Canopy
37. Finai Factory Fireplace
38. Final Pfumbing �
39. Water Service-Final
40. Gas Szrvice•Final
41. SolBr pomesiic�Final
42. Backflow Preventer
43. Batkflow Irrigation 6,,.L�..Lt'�/ S�_ �Q,��
7`
44. Landscape irri9ation.�ystem �y�,��
45. Sound Attenuationt; ,:
46. Handicap Regulatio,{: jT�
47. FINAL STRUCTURE & BU�LDWG ? 7�'U ���+
_�
46. FINAL PLANNINGr
49. Electric Release to Edison �'- -
50. Gas Release (o Southem California Gas Co '
51. CEflTIFICATE OF•(jCCUPANCV
No. Date
1
Applicant to flll in all soares ezcept those within neavy bortler I1nes ana slgn all approvriate tleclarations.
CITY OF COSTa MEsn CONSTRUCTION PERMIT
Project Address Z89 OKle �
� Applicant's Mailing Address 10422 Trask Ave.
Owner'sName Mr. P.A. CLaIk Phone�619�564-
Address 77538 Avenida Madrugada 3778
Arch/Eng. Licenu No. g��
Address
Contractor'sNameA�e�es P1umblRg�HEet. pho�e 530-2440
Address (mailing) 1Ua22 Trask Ave.
City Licenu No. 6664
LICENSED CONTRACTOR DECLARATION
I hereby atfirm that I am licensetl u f Charter 9(mmmencing
with sectian ]000) of pivision t tha Business a Professions Cotle, an❑
i
my license i5 irvJ�l2brte antl ef c[.
LicenSe Gas��� �� License N .
Date � Signat e .
-`�OftKERS' COMPENSATIO 1 "CIARAT� p
�ereby a(tirm that I nave a ertificate of coEwlnt to selt-insure or a certitiWte
r Worke�s' Compensation InSurance, or a ce�tifietl copy thereof (S¢ction
3800, Lab. C.) ggg990 - blic Indem i y
PBolicy No. Comp � �
Certifietl copy is hereby iurnishetl
certii��g�t��s (iletl with the ' ision.
Date Appllcan
EXEMPTION FROM WORKERS' ATI ECLA ATION '
(Thi55e[tion neetl not Do complete if the perml ' or one huntlretl (b100) or
less). ' _ . '
I certify tha[ in ltle perfo�manca of th¢ work tOr which this perm�t IS issuetl, I
shall not employ any person in any manner so as to become sub7ect lo the
Workers' Compenzation Laws ol Calitomia. -'
Date SiqnaWre
NOTICE: If, after making this tleclaratlon, you 5houltl becoma subj¢<t to [ha
Workers' Compenzation O�ovisions of the LabOr Cotle, you must fOrthwi[h
tomply witn such p�ovi5ion5 or thi5 permit shall be tleeme❑ �evoketl.
CONSTRVCTION LENDING AGENCV
I he�eby aftirm that lhera is a Constructlon Ientling a9ency for tM1e Oerto�mance
ot [he work for whicn this pe�mit is issuetl (Section 309� Civ. CJ
Len�er's Name
.Lentler's Atltlress
OWNER BUILDEN DECLARFTION
1 hereby altirm that 1 am ¢xempt irom the COntracto�'s License Law fOr lhe
following reason (Sec[ion 7031.5 Business antl Protessional Cotle: Any city or
county wnich requires a permit to construct, alter, improve, tlemolish or repair
any structure, prlor to Its issuance, also requires Me applicant for such permlt
to file a siqnetl slatement lha[ he/sM1e is liGensetl pursuant to the provisions of
[he Contracror's License Law (Chapter 9(commencing with SecHon 7000) of
Division 3 of the BuSinass antl Profe55ion5 COGe) or that h¢/She is exempt
thmefrom antl Ihe basis (or the allegetl exemption. Any violation ot Section
7031.5 by any applicant tOr a permil subjects Ihe applicant to a civil
�enalty of not more than five huntlretl tlollars (5500).
LJ 1, as owne� of the Property Or my employees with wages as their Solo
compensation, will tlo tM1e work, antl the sVucture is not intentletl or offeretl
tor sale (SettiOn 7044, Business antl Professional Cotle: The ConVactor'S
License 12w tloe5 no[ appty to an owne� of a property wno builtls or imp�oves
thereon, antl who tloes suth work himsel!/herself or tnrough his or her own
employees, provltletl tha[ such improv¢menis are not intentl¢tl o� oHeretl fo�
sdle. If, however, Ihe bulltling or Imp�ovement is soltl within one year of com-
pletloq lhe owner will nav¢ the burtlen ot proving he/She tlitl not buIIG or im-
ptove for [he pur0ose ol sale).
❑ 1, as owner ot the property, am exclusively contracting with licensetl con-
t�actors t0 consl�uct thC p/oject ($ection ]044, Businezs antl P�ofe55ion5 Cotle:
The Contractor's License Law tloes not apply to an owner oi property who
builtls or Improvez thereon, antl wno conVactS for Such projects with a con-
Vactor(sl license pursuanl [o [he Conlrac[or'S License Law). I am aware that
proof O( Iheir Worker'S ComOensation Insurance shoultl be provitletl ta me.
❑ I am exempt untler $ection B. & P. C. for this reason
Ori
CMF 01
enter
rte tnat the above
county orGinances
�y authoriEe reprc-
netl property for
PER I NO. I HACI rvV. LV I NV. UNIT NU.
� I
TYPE OF CONSTRUCTION NEW ADD AITERATION REPAIq
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p. #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL T Front
❑ TEIVANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION 5�. FT. OCCUaANCv C Right
K Left
CONSTRUCTIONTVPE VALUATION$ $
ZONE GRADING CU. VDS. ACRES � Ping. Ref.'/k
Remarks: Pianning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen $ink
Lavarories
P—Trap
Roof Drains
Reinspection Fea � $75
Boilet
Dutt - Under Ground
Duct - Structurel
Duct � Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.6lt. ICBO #
1 Heating System & Ducting
C�P100,000 BTU 0100,000
:ense or 55 � Reinspection Fee $15
rev. 10/84 Wnite - BUlltling; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
AULO�W85I1
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0.100,OOOBTU ❑100,0006T
System Repair/Alteration
Fire �ampers
Registers
Issue Fee
FEES
Automatic Washer
Construction Pole Sub.
- Cooking Unit
' Dishwasher
' Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Genereror �0�5 KW C
$ 3
ss
7374 3/23/E' 2400 �!.
Zone
Accessory Buildin9:
2
O
N
I
N
G
J R
Parking Req./Provided ' E
M
� $
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors �0-7 HP 01'/h � 8
Inc Solar 09-75 HP �� 16-15+
Microwave
Pole Light
Range
I I Standing Sections
5�15 KW I I Trash Compactor
� Reinspection Fee I$75 f � Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
Building Approved By .
Appliwtion Issued By n
FEES
$ 3
SUMMARY OF FEES �
BUILDING PERMIT $ SMIP $
- PLAN CHECK $ PEfiMIT �
PLUMBING $ ��UANCE $
PLAN CHECK 25% 3 ENERG� P.C. $
ELECTRICAL $ GflADING $
PLAN CHECK 50% MICROFILM $
MECHANICAL � TOTAL FEE $ Z4.00
PLAN CHECK 25% $
CONSTRUCTION AND'PLANNING POOL & SPA
� Date Inspector - Date Inspector
APPROVAL � Permit # APPROVALS Permit #
.'�
1: Temporary Electrical.Seivice or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
,�
3. Electrical Conduit Utility-Undrgmd. 54. Forms '--
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � �,
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grriil., 57. APPROVAL TO COVER-GUNITE
�,
,�-
7.�F,�ootings ' ' 58. Electrical Conduit-Undrgrnd..:
8:��Foundation 59. Gas Pipe, O Undrgrnd., Test=
9'i �ater Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O�Undrgrnd.
10;?,�t�'ructural Floor System 61. APPROVALTO DECK -`��
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap , 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumb�ng 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
48. Rough,�lectrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
•�-21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil -
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding , 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT -'
31. Plaster Brown Coat 79. FINAL INSPECTION ��
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �. �
33. Final Electric Notes: 6j.6' �b+ LGp'r" C,�¢?,a� (�.�;0 .
3. Final� Heating & Air Conditionin '�.���� P�Q,�y� �,�(P�,�O �d O� S(�G."'-�`
35. Final Gas Pipe-Test � ��p � (� y�G� L��,�
36. Hood or Canopy • ; o ,
rt ,
37.. Final Factory Fireplace �� ",a � n rev
38: Final Plumbing � �� ^ n � �D
F, . • c c�;
39. Water Service-Final , r, y. �
� �.
40. Gas Service-Final �• �
� � •
r41. Solar pomesticFinal . ' ,�c� f - ;,
42. Backflow Preventer • ' . . � � °i °
. r c.
, i �. �
43. �Backflow Irrigation ! � � �=' C ��
R
44. Landscape Irripation System � x �' �:i i� c
45. Sound Attenuation ' °' �� ^ �� �'
N � ? t
46, Handicap Regulations , � �., �� �' ; a�
'47. FINALSTRUCTURE&BUILDING °'r '' � '
�' c f- � . �
48. Special Requirements Completed a �c
.. V Gb r.
c a � '•
49. Electric Release to Edison • ^
� '�. n
'50.. Gas Release to Southern California Gas Co � �� .
- 51. CERTIFICATE OF OCCUPANCY ,
No. Date �
� 9��3
COSTA MESA BUILDING DEPARTMENT
P.0.80X 31�
COSTA MESA, CALIFORNIA
9UILDING
ADDRE55
FOR APPLICANT TO FILL IN
COSTA MESA. CALIFORNIA
OWNER Jajly'3 ya$ LayyQ
MAIL 1555 Placentia
nooaess ..
n TEL.
CITY Ne�roort Beach� V&�-. NO.
ARCHITECT s�e LIC.
OR ENGINEER � NO.
A�DRE55 $$II8
co�Rn��rbr�oll ConSt. �. c�Tv No:
AODRE55
LEGhL
OESCRIPTION
A.P. NO.
OF LOT �
USE OF
E%ISTING BLDG
SETBACtt t NG F
CENTER OF STREETM
� 0 ��
same
NO.OF BLDGS.
�IOW ON LOT
SiDe VARD RIGHT J6� SI LEFT �%� -�[o�/
DESCRIPTION OF WORK
NEW p ALTERATION AODITION
REPAIR MOVING �EMOLISH
SIZIE DING �r� RO MS 1�J STORIES 2
C.
EXTERIOR WALL ROOF
COVERING StlxQCO COVERING hot—mop
USE OF NEW
BUILDING
%.�. �i��;ti�l�i�
� MA'f 21 1959
FlNANCE �EPT.
APPLICAT'ION �FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
pECEIPT NO. y/PJERMIT O
/ �
'ECEIVEO 6Y DnTE RECEIVE� O4TE ISSVE
Q c-�� _ _rra c- �i .
COSTA ME5.4. CALIFORNIA
%/'I'F/F � DAT'� t�,
ORRECTIONS
s'dence nd att. ara e.
Plan 4-� X E (Z
I HEREBY wCKNOWLEDGE TMR? 1 MqVE PEA� iH15 wPPLIC4TION AND
STPTE TNFT THE ABOVE IS COFRECT PND AGREE TO COMPLY WiTH ALl
CITV OROINFNCES FND $TM1TE LPWS qEGULATING OVILUING CONSTRVC-
TiOrv. • VALUATION
SIGNATURE OF PERMIT FEE �
PERMITTEE � n
$ 26,378��� PLAN CHECK � 43���
,oRizeo acervr TOTAL FEE 5 69.00
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VeMi
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