HomeMy WebLinkAbout265 MONTE VISTA AVE - Building PermitsJ
PP0.IECTAOOflE55: 'z(S MON'TE VISTA AV � uxir:
OWNEH'SNAME:CITY OF COSTA MESA
nooncss: �/ FAIR DR 3RD FLR
COSTA MESA
CA 92626
(714)754-5309
PflCNIENGINEEN:DAVID EVANS L ASSOCIATES pEc.xo.:NONE
aooeess: 1000 E. GARVEY AVE SOU'fH ux�T:250
WEST COVINA CA 91790-2720
PEflM1TTEE:CITY OF COSTA MESA ( 714 ) 754-5304
aooaess: 7 7 FA I R DR
COSTA MESA CA 92626
LICENSEU LONTBRCTOB UECUINATION: I �ereby alfirm I�ai I am Iicen5e0 unaer O�ovisions ol CAaD�e� 9(cammencing witA Setlion
7000� ol Oivision 3 al Ihe Business anG Pmlessions CoEe. anG my license is in full lorce anG ellecl.
ciTr uc.: sTnTe uc.: cuss: EXP :
Oate: Signature:
WOBRENS' COMPENSP710N UECLABRTION: I hereby affirm Uat I have a cenilicaie al consenl to seii-insure ar a cenilicate al WOMers'
Comoensation Insurance. or a certihetl copy ihereof (5ec�ion 3800, Lab. C).
POLICY NO.: E%P. ORTE:
LOMPFNY:
rJ Cenifietl coOY �s �ereUy furnis�ea. ❑ CertilieC capy is fiied wit� ihe city BuiiEing Divisian.
date: _
E%EMPTION
I cenily ina
sublec� lo I
ol
� NOTICE:A. afler ryldMing ihis Oeclaralion, you s�oJfA 6ecome si
Code. yau musl Iorihwn� camply wi�A suc� pmvisions or ihis 0
CONSTHULTION LENUING AGENCY: I �ere0y aflirm t�ai IAere i5 a
wnich mis permii is issued 15ection 3097. Civ. C).
iexoen:
aooxess:
fai ane nunCreO (57001 or less�.
any mannerw aslo become
�Jorke�' CamOenution provisions o� IAe LaEor
: Oeemed r¢voketl.
IenGing aAe�cy for ��e petlarmence ol I�e work �or
OWNEfl BWLOEfl OECIANRTION: I �ereGy allirm IAa� I am eKempl Imm t�e Contracmrs' State License Law for t�e tollawinq rtason
ISection 703t.5 Business ana Pmlessional Code�. Any ci�y ol coun�y wnich reQuires a permit io cons�mct, alter, improve, tlemolish, or
repair any simclure. Orior to its issuance. also repuires t�e aOPlicant for such Oermit ta file a siqneC statemenl that Ae/s�e is Iicense0
purouanl 10 ��e provisions ol ihe Comraclors' S�ale Lic¢nse Law �CAaO�er 9(commentinp with Sectian 7000) ol Divisian 3 0l ��e Bu5ine55
ana Pmlessions CoOe) or �hal helshe is exempl I�erefrom antl Ihe basis lor I�e allege0 exemplion. Any violation o� Seclion 7031.5 by
any apDlicanl lor a oermit suble��s IAe applicant to a civil oenalty ol not more than live hunC�ea dollars (550111.
� I. as owner ol Ihe pmperty or my employees wi�� wa8e5 as I�eir sole com0ensalion, will ao Ih0 work, antl IAe
simcwre is not imeneetl or ollereE lor sale (Section 70a4, Business antl Pmiessional Cotle: T�e Coniracrors' State License Law
tlaes na� aDPly ro an owner ol a D�openy wAo �uil�s or improves chereon, ana w�o �oes suc� waM �imsell/�ersetl or thmup�
his or her own employees, proviUeE t�at such improvemen�s are not intenCetl or ollered lo� sale. II, however ihe Euiltling or
impmvemenl is SoIU wilhin one year o� complelion, t�e owner will have ��e 6urden ol Drovinp he/she ditl nal build or impmve
lar I�e Ourpose a� sale�.
I, as owner ol Ihe pmperty. am eeclusively comrac�inA wiih licensetl conVactors lo con5tmc� IAe prolec� (Section 7044, Business
� antl Pmiessians Catle: T�e Coniractors' Stale License Law Aaes na� applY �o an ovmer ol O�oDe�Y `^'�a UutlQt or im ov¢s lhereon
antl wha conVac�slor such O�ojetls wi10 a conlracioqs�license pursuan �e Conlraciors' S�ak Li<ense a I am aware
ihat pmol al �heir Worker's Compensation insurance shoultl be pmvid Io ie. n ///yyy
� I am exempt un0er SecU n: B. 8 P. C. � �/1 / A�
lor �his re�on: �., �/,� � � J L . .. ./I / V /e���/ .
I do hereGy ahtlily Ihai I yn aware al anE unCers�ana I�e reQuirements ol
2553G and �Aal I or anV �G�ure OuilOmg occupant will/will not (circle one) n
permit lor constmclion or motlilication imm Ihe Air Oualily Management
Ihese pmvisions.
Oate', ApPlicanP. _
Ihereby Cerliiylhal I �ave�ead ��is aOVlitalion an0 Slale I�af
ortlinances and Slate la s rela�ing ta utldmg consimclion antl h
awpeny for inspeclior�purpo�� � �
� Sipnature:
i6ai.ac wnue—BmiOing: Green—Cotle Eniorcemem;
:uEe Sections 25505. 25533, anU
cotles an0 t�e mQuirements lar a
ion applications are exemo� �mm
vnih a�l city anA county
onlhe above�mentionetl
GolOenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT RM NO: B 070385
PERMIT NO; H 0�0385 PLAN CHECK NO: 00118-99 L GOVT: Y SUFP: N
COT7S'TRUCTION TYPE: PERMIT TYPE: STR PURPOSE; OTH
JOB DESCRIPTION : DEMOLISH S REPLACE 'TOT LOT' E()UIPMENT SQ FT: 400
CLAIM VALUE: 40.000.00 CALC—VALIIE: 40.000.00 GROUP OCC: A-4 /
COMMENTS: DEMOLISH OLD 'TOT LOT' EQUIP. S REPLACE W/NEW @"BRENTWOOD PARK"
*�iE�iEiE*****iE****�**iEiE�****iE*�*iE�xif**��iE**�*�**�iEiE*�*iEif*iEiE**��x�*iE**xiEiE*�iE*****x�
2 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 RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING RE(): PROV: PARCEL: 00000000 ZNE; RI REF NO:
PLANNING NOTES> UPGRADE TOT LOT TO COMPLY WITH ADA REQS,
i
�********��****���x**�**�*�*�***�,�**���,�*�,��*��**�***�**������******�**�*���x��
D E V E L O P M E N T S E R V I C E 5 R E Q U I R E M E N T S
ZONING APPROVED BY :�_. DATE: �,�y�
BUILDING APPROVED BY � DATE: _._L����
APPLICATION ISSUED BY: � DATE• I'� ��}
ifiEiEiEiEjEiEifiEjfjEifififiEiEifjfifiEifiE il"iE�f�iF'iFiF'3F"jF�lFiEiEiE�fiE-lf�fiEiEjEiE� iEif
iEiEiEifiEiFiE�EiEiEifiEiEiEiEiEiEiEiFiEifiEiEiE�EifiEifjElfifif�lEifjEiEjfjFiEiEifiE iEififififififiEifiEiEiEiE�EiEiEiFlfiEiEiEiEiE�fiEiEiflfiEiEiEiEiEiEiEiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC, MECHANIC FIRE SMIP/RES GRADING
PERMIT 349,50 '
. � SMIP/NON—RES
PLAtJ 227.18 8.40
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
To•rnLs----> o.00 o.00 o.00 o.00 .00 .00
REVENUE DIVISION TOTALS--> COLLECTED: .00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELEC'TRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
iE if aE �* if if ** aEif if iEif iEif iF �Eif aE if if aEif iE if iE if if if if if if if *� if ef if if iF if if if iE if if if if if � if if iEif if if if *� *if *��if aE iF iEiE*�if iE* if iE if iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE Q'TY D E S C R I P T I O N UNIT COST TOTAL COST
SFC 400 ALTER BY VALUATION COMM. /5100.00 100.00 40.000.00
END OF FEES
�
o� ooi�aaao-aor�s4aa rr�-r
DpTE: ;2i1c�l94 TIHE: lO:J9
��a
CONSTRUCTION AND PLANNING POOL lA "� . "�
APPROVAlS Permit# Oate Inspector pppROVAIS Permits�" Date Inspector'
t. Temporary Electrical Service or Poie 52. Pool & Equipment Locacion
2. Soil Pipe�Und�9rnd. 53. Steel Reinforcement . �
3. Electricat Conduit Utility-Undrgrnd. 54. Forms (
4. Elechical Eonduit-Undrgrnd. 55. Electrical 8onding
5. Steel RCin�forcemeqt� 56. Rough Pium6ing & Pressure Test �
6. Etectricat UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd. �
' 8. Foundation � � 59. Gas P�pa, O Undrgrnd., Test ' �
i
� 9: Water Pipe•Undsgrnd. ' _ 60. Backwash Lines. RTrap, O Undrgrod. � �
10. Structurel Floor SYstem � 61. APPROVAL TO DECK
7 t. Prope�ty Sew2r Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap � . � 63. Heater & Vent�Final � - . �
73. Roof Drains . � 64. Plumbiny System - Final � i
14. Rough Plumbing ��. � 65. Electrical�Fina�
15. Rough E�ectriral�Conduit 66. Solar SYstem-Finai
i 6. Rough Electric Wiring 67. Fencing & Access Approval . ' � �
77. Rough Wiring Siyn 68. APPROVED FOR PLASTERING
,
78. Rough ElectriCal-T Bar Ceiling 69. POOL/SPA SYSTEPlS FINAI �
19. flough Heating & Air Condiuoning ,PIRE DEPT. REQUIREMENT I
. �• i
20. Rough Factory ��rgplace �� .- , _ � APPROVALS �� Permit# � � I
21. Duces, in Struaure �• � - : ;70. Undergrou�d NVdro �
22. pucts, Ventilating � _ ��77, Product.Piping dGas OOiI i
23. Gaz Pipe�Rough & Test � � � - " 72. Underground Flpsh '
24. Roof Framiny ' � " " .. 73. Undergrnd. Storage Tank O Gas ❑ pil
25. Roof Sfieathing • . r � ' 74. �Overhead Hydro �
26. T�Bar Ceilin9 (Structurall & (vjfjnocoat : . .. . � 75: Dry Chemical . . i
27. Frame and FlBshing- •-. r: � _ 76. Dry Standpipe ��� � I
28. Lathing & Sid�ng � " � � '!"�,- .� � �' - • ' ' ' 77; � FIXED SYSTEM FINAL
29. Insulation - � 76. FIRE PREV. FINAL --
30. Ory�valF Nailing ,, ' . HEALTH DEPT. REQUIREI4IENT
�37. Plaster Brown Coat� � . . � . ` � . -79. FINAL INSPECTION .
32. Electrical Power MeterFinal '� .� 80.' FOOD CERTIFICATE ISSUED
33. Final Elec:ric � „' Notes•/��- 6 Tp.Q �O%17��7i5o �
34. Final Heatir4g;& Air Conditioning , � , �j � �(/„I .��e�
' � - '�� To��' @f�� �.I r�,...� �
35. Final Gas PipE-Test , ' • �j�/� �Gtl�e^'"`�' � �71 LO�eL[!/C_
36. Hood or� CanoPY " � _ � _ � � : �
. 37. F�nai Faaory Ficeplace , � , - -
38. Final Plum6ia9 - '
39. Water Service•Final � . ' -
40. Gas Service•Final - � . � � � �
47. Solar OomeSticFinal� � � �
42. Backflow Preventer � � . � �
43. Backflow Irri�ation� =
44. Landscape Irrigation System -� . � ' • -
45. Sound Aitenuatiors ' • , ,� - �_ . „ j
46.�Handicap:Regulations � � � �
47. F WAL STRUCTURE & BUILOING � � �
46. FINAI. PIANNING -�
49. Electric Release to Edison ._ ' � _
50. Gas Release to Southern California Gas Co . .'. �
51. CERTIFICA7E OF OCCUPANCY
No. Date
Applicant ta ���� �� all spaces wltM1ln
CITY OF COSTA MESA I aggnaiT�o.,�
CONSTRUCTION PERMIT �5 �f 2
Addres
Address
Contractor
EorUer Iines antl sign all appropriala Oeclaratlons.
TRACT NO. LOT NO. � BLDG. NO.
./� TVPE,OF CONSTRUCTION
Phone s �.iEyy � ADD ❑ ALTERATION
❑REPAIR ❑CONVERSION �EMOLISH
LiCenSe No. � ❑ OTHER
_ _ _ —1 DESCRIPTION OF WORK
I here�y aftirm lhat i am Ilcanietl untler Drovislons of Charter 9(tom-
mencing with section 7000) of Divisioh 3 oi the Business antl
Professlons Coae, anC my II<enze is In full forca antl etlect,
llcense Clazs_ Llcense No.
Date 5�9�ature
WORKERS' COMPENSATION OECLARAY�ON � �
I hereby affirm that I �ave a certlficate of consent to selhinsure or a
certlficate o( Workers' Compensatlon InzVrance, or a certifiea copy
thereot (Sectlon 3800, Lab. CJ. .
°olity No. Company
� Certlfietl copy is hereby Tumishetl.
J Certifietl copy is tiletl with the city Builtl�ng DivlSion.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neea not be tompletetl if the Permit is tor one huntlretl
�E300) or leu1. ' �
<¢/tify thdt In the performance of the work for which thts permit is
issuatl, I shall not employ any person In anY �nner so as to become
suGjeCt f0 the Wo�ker5' Compensa[IOn Ldws o� Cdlifornla.
Date Si9ndture - --
NOTICE: If after making thls tleclaration, you ihould become subject
to the Workers' Compensation prorisions of lhe Labor Cotle, you must
forthwith comply with suth provi5ion5 or th15 permit ihall be tleGm¢tl
revoketl. " - ' - '
CONSTRVCTION LENOING AGENCV
I hereby atfirm that there is a COnstru<tlon Ientling agGnCy tor th¢ per
formance ot the work tor wnich this pern��t is issuetl (Section 309]
Civ. CJ.
i lentler's Name
i �ender's AOGress
IOWNER BUILDER DECLARATION
I heraby atfirm that I am exemol from.the Ca��ractor•i Llcense Law for
Afly ❑[y O!-COUlIfy whlCb f¢qUI!¢S d p21T1[ {O COOS[fUCt,��dliBl�
impwve, tlemollsh or repair any structure, prlor to Its Issuance, also re-
quir85 the appli�nt fo� such pe�mit to tila a slgnGtl Stdtem¢nt [hat he
Is IIC¢nsetl Dursudnt to the provislons ot thE Contractor's LI<ens¢ taw
I(CM1ap[er 9(tommencing with Section J000) of Dlvision 3 ot the
Buslness antl Prdessions Cotle) or that he l9 exempt therefrom antl the
� nasis for the allegetl exemptlon. Any viola�lon ol-Sc<tion ]031.5 by
�y appllWn[ (or a pe�mlt subjects the aPPlit�vnt to a civil p¢nalty
' nol more.than 8ve �untlretl tlollars (E500). .
�] I, a5 owne� ot lhG property, or my emp�oYees with wages as [�elr
I SoIE Compensallon, will tlo Ihc work, antl tpe Structur¢ Is not Int¢ntletl
or olferatl for sale. (Section 704a, Businezs antl Aofe55ion5 Cotle: The
I ConVaclor'i-Llcense Law tloes not apply to an owner of a pro0erty
who builtls or improves thereon, an0 who tlOes sucn work himself or
t�rough hls own empl0yees, provitletl that Such improvem¢nt5 are not
intentletl or offere0 for sale. If, howeveq the bull0ing or improvement
is s witnin ono year oi completlon, Ue owner wi11 nave tne buraen
roving he tlitl not bulltl or Improve �o� th¢ purpoSe of sale).
as owner o/ [he property, am ¢zclu5ively cont�ac[ing wi[h
ce etl Wnt�acto�s [o const�uct [he proje[t ($eGtion 7044, Business
antl Professions Cotle: Tne Contracror's License Law tloes not apply ro
an owner of.property who builtl5 or Improves t�ereon, antl who con-
SIdCIS ifOT SpCh plOjCCSS WI[h d WII[IdCf01(5) licesnea ptllSUdll( [O
the.Contractor's �icense l.aw).
❑ I am Gxempt untlGr $ection B. & P. C. fo� Ihis
v
reason
Da[e - Owner -
I hereby certifytM1at I M1ave r¢atl this'applitation antl StatG [ha[ [he above
in/ormalion is c4 I agree to mmpty �+'��h all ci[y antl Wunty
orainances tl state aws relatin9 So m t Gtion, antl hereby authOriEe
representa ves of is city to e e � Ihe above mentionetl
......... .. ... ........ ...... _.. [-1_ Y - -.. _ .
Signature �.(
Drivers' License or
_�CMF0865-46 V
Canary-APPIiWn ;
TVPE OF PERMIT �.,/
❑ GRADING ❑ FOUNDATION �q'$TRUCTURAL
❑ TENANT ❑ ELECTRICAL �PLUMB)NG OMECHAI
❑ OTHER •
PROJECT� SQR�,IPTION� � ' �
SQ. FT. �J ' .
OCCUPANCV CONSTRVCTIONTVPE
VALUATION �D D��� ZONE -
GRADING CU. VDS. ACRES
REMARKS:
PLUM8ING'
TOILETS
LAVATORIES
KIT. S�NKS
SERVICESINKS '
FLOOR SINKS
DRINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOLr •
WATER SERVICE
GASSERVICE
PLAN CHECK
SHOWERS
URINALS
DOUBLE LAVS
DISHWASHERS
SUMP$
F�OOR ORAINS
CLARIFIERS
PTRAP
ALT,ERATION
OVTLETS
BTU OUTPUT
SEWERCONNECTIONS
SOLAR TANK COLLECTOR$
SOLAR PIPING SYS.
ISSV E FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTV _
AND DUCTING 300,000 + gTU _
REFRIGERATION 0-100,000BTV_
SVSTEM
300,000 t BTV _
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAVSTSVSTEM MULTIPLE
ISSUE FEE
GOltlenrotl:Assesso� � , ��� � � �� � •,'.\ A!..� ..
� � � �-
ING
A.P. � —
ZONE �
SETBACK GL ST.
SLIDETVARD
5EpF
1R�IGHTA " _ -. \ 1 "�
REAR VARD (TO P/L)
PKG.SPACE RE�.�
STREET W1DT��
20NI NG APPRO V ED B VD
SPECIAL CONDITIONS:
ELEC7RICAL
V1AR 19 1982
REGULATIONS
PARK FEE $
PLAN CHECK
.GENERATOR 0-1 KW_ 1-30 KW _
TRANSFORMER -
.APPLIANCE 30-50 KW_50 * KW _
MOTORS p4 HP_]-10 HP _
(INC. SOIAR) 30-SO HP 50 + HP _
FIXTURES OVTLETS SWITCHES
GAS TUBE SIGNS
,POLE LIGHTS
PANELS MAIN ' SUB
SERVICE AMP
ISSUE FEE
APPLICATION
BUILDING
PERMIT E
PLAN CHECK b
PLUMBING S
PLAN CHECK E
ELECTRICAL S
PLAN CHECK S
MECHANICAL $
PLAN CHECK a
pATE
SUMMARV OF FEES �
�IP b '�
RMIT
SUANCE $ _
GRADING S—
E —
MICROF111N S_
TOTAL FEE S _
� l E55 AD-
VANCEPC 5—
� �K1\ i
v
�� FINALFEE $�
� 1•�Y1�! �� �/
�J1 v � ')^'. � � �"• '�
CONSTRUCTION AND PLANNING
APPROVALS Permit # ��
1. Temporary Electrical Service or Pole
9. Water pipe-Undrgrn
10. Structural� F�obr System
11�. Property Sewer Line & House Connection
-12.' Street`$ewer Connection
13. Rough Plumbing
14.' Rough Electric-Conduit � -
15. Rough Electric-Wiring
16. Rough Heating & Air Conditioning
17. Ducts, in Structure
18. Ducts, Ventilating
19. Gas Pipe;Rough & Test
20. Roof'Framing
21. Roof�Sheathing � �
22. Frame and Flashing
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final �
28. Final Electric
29. Final'Heating & Air Conditioning
30. Final Gas Pipe-Test
31. Final plumbing
32. Water Service-Final
Y
�
e
Date
POOL & SPA
Inspector qppROVALS Permit #.
43. Pool & Equipment Location
44. Sieel Reinforcement
- 45. Forms
46. Electrical Bonding �
- 47. Rough Plumbin & Pressure Test
48. APPROVALTOCOVER-GUNITE
49. Electrical Conduit-Undr m
50. Gas Pipe, ❑ Undrarn, Tesi
�56. Electrical-Final
57. Solar System-Final -
� encing & Access Approval
. APPROVED FOR PLASTERII
60. POOL/SPA SYSTEMS FINAL
,5-' �
,, NOTES:. r��. %:n:a.ivs�
Date
Inspector
36. Sound Attenuation � / ' ' � �
37. Handicap Regulations � ,/ -
36. FINqL STRUCTURE & BUI.LDING
39. Special Requirements Completed
40. Electric Release to Edison - . / - � ' - �
41. Gas Release to Southern California Gas Co. �
42. CER7IFICATE OF OCCUPQNCY
No. Date
� � � �� A!� S-5'-5-- t3-9 2-
�-I--/-�-e-^<�`-�f-G�r-e�=A-�_--E�9�+--1�H-RK-�-�n�•i,�,�r-TieK• 07`�---~�1¢ /� "'�
� ..
� ,
F �� �'i.S��
CC6TA MESA BUILDING DEPARTMENT
P. O. 80% 31 �
COSTA MESA. CALIFORNIA
eui�oiNc
nooRess.
OWNER
FOR APPLICANT TO FILL IN
� i ,%• I'
[/
cirv (�v S
ARCHITECT
OR ENGINEER
S C�, 7't� � S r H �•
COSTA MESA. CALIFORNIA
!c �. w i I�Idw..$on
� )'Io��Ye i�i S1'�
a )�eSd TNO.LIO'S�S
LIC.
S � I � �o.
�eGnL LOT
OESCRIPTION NO.
A.P. NO. G
$IZE ry��
OF LOT P__Yl
USE OF
EXISTING BLOG.
SETBRCK LINE FROM
CEviEw OG STREET
CITV LIC.
NO.
�O.OF BLDG6.
DESCRIPTION OF WORK -
NEW ALTERATION qODIT10N
REPAIR � MOVING DEMOLISH
BUILDING NO.OF
SIZE ROOMS STOf�lES
E%TERIOR WALL
COVERING
USE OF NEW _
�F
V
o� �i� �3���1�� �''� �
� -y-S s � —
��a�tic� o��.
catv �� ��rA r: �a
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. �V�j��
V J
'ECEIVf'O BY DATE RECEIV D DAiE ISSVE
�� �-9- i-y�
COSTA MESA. CALIFORNIA
APPROVED
BY
TE
OF COSTA N:ESa
ST<TE�TNwT THEVABOVE IS COflRECT �NO wGFEE TO COMPIY WITM �Ll purpose of establishing a permit fee only.
CITY ORDIN�rvCE9 �vp ST�Tf L�WS nEGUL�TING BVILOING CONSTRUC-
iior+. \J VqLUATION
SIGNATURE OVYJ / PERMIT FEE S �Q
PERMITTEE G
/�O. � PLAN CHEGK $ �
5
AUTHORIZED AGENT TOTAL FEE S o�. �D �s��
�` _�, '' � 4 I ��
�� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� AppGcant to Fill in Completely — Use Ink Only
� BUILDI /_ n-. i'r f/�� . rn �
OWNER � �
MAIL
ADDRESS,
CITV
CONSiRUCT10N
LENDER
BRANCH
ADDRE55
ARCHITECT
OR ENGINEER
ADOflE55
ADDFESS
CITY
STATE
LIC. NO.
512E
OF LOT
USE OF
EXISTING E
.. _ ! 0� COS�A RI�ESA
' JUi�I 1 G i977
FbR STRUCTURAL PERMI'
JA�T.E-RECEIVED qT
T' A 3A- •'�
�.�
T � A.P. NO. �Y' ��'� �
BUILDING
� (� � ADDRESS � S
TEL�/ ��� TRACT ��EO
L.
TEL.
NO.
CITY
LIC. NO.
NO. bF BLDGS.
NOW ON LOT
Separate permits are required for
electric, plumbing a�d heating work.
USE�f�F BUI�DipIG AND'�- Tp BE PF,FiFdpM1
I hereby acknowletlBe that I hepe read this applicetion and state
thet the above informetlon is correct and agree to comply with
ell laws regulat{np bulltling conAttuctlon, antl I shell not amploy
any Oerson in violallon of the y�.orkman's compensation laws of
tha Stete of Celifornie.
I hereby certify that I am properly Iicensetl aa e conirecior untler
the State of Californie eusinass ¢�d Profass(ons Cotle, Olvlsion 3,
Chap[er 9, and that such licenug ere in full force ond effect, ar I
am exempt from the p vislons at tha State of Cellfornia Businass
antl Professian e,� n 3/Chapie ///���������
/
$Ipneriraof /_�
Pnrmittee NR" 1
Authorized ABant
ZON —' NO.OF /
PLANS
VAR�SAPPflOVED
MAIN BUILDING
(FROM GL STREET)
VALUE
USE OF NEW��
BUILDING �
VARDS APPROV ED
ACCESSORY BUILDING
DISiANCE BET. I BET. MAIN &
MAIN BIDGS. ACCESS. BLD
VAR.# DATE
N
n
m
. i
m
SQ. FT. w
THE AMOUNTSHOWN UNDEFi VALUATION IS FOR m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
VALUATION PERMIT FEE $ d
tif
�1 m
p'� vV PLANCHECK $ �� o
/� /1 J LL
5 �R•P�l(TA 7AX S � �
U
TOTALPAID S '3 �(