HomeMy WebLinkAbout3104 MONROE WAY - Building Permitsr�
PflOJECT AOOflESS: 3 S O�I MONROE WY
OWNEP'SNAME: KIRBY, JO ANN S TR
nooness: 3104 MONROE WY
COSTA MESA,CA 92626
NflCH/ENGMEEB:
ROOXESS:
flEG.NO.:
UNIT:
UNIT:
PEflMITTEE: NOCK PLUMBING ( 714 ) 895-1246
ADOflESS: 1 1(j 1 O S EABOARD C I R
STANTON CA 90680
UCENSEO CONTflFCTOfl OECLPFATION: I hereby a�hrm �hat I am Iicense0 unAer pmvisions oi ChaD�ei 9(commencing wi�h Seciion
7000) ol Div�sion 3 oi Ine Business antl Pro�esnans Cotle. and m cense i5 in lull�orce anJ eileci.
cirr uc.: O S 3 8 STATE LIC.: S I 1 9% � cuss: C 6 EXP ;�/ 9 5
�ate: �� � Signa�ure: � t `. �—
WOBKENS COMPENSATION OECLA ATION: I �ere�y aflirm t�al I �ave a certifica�e o� consent �o self-insure or a cehificate af Workers'
Compensaiion I su{ a ?�cQiliheQ�c OY Ihereot (SecUon 3800, La�. C.
POLICYNO.: �+���JL—J� EXP.ORTE: �3/OS/9S
comraxr: STAT E
❑ Cemhed copy is here fumished. � Certitietl copy � file with the ciiy Buijdjpg �ivision.
t�
e'. � � � ApDlicani: �� �r /
..cEMPTION FBOM WORNEPS' COMPENSPTION OECLAflATION: (Tbis sec�ion neeA nol 0e comple�ed ii Ihe permi� is lor one huntlred �E100) or les5�.
I certiry Ihal in �he DeAormance o� the wark lor which I�is D¢rmii is i55ue0. I shall not employ any person in any manner sa as �o hecome
subleq to Ine Workers' Campensalion Laws of Calilomia,
�� Oaie: Signa�ure:
NOTICE: IL a��er making Ihis tleclaration, you 5hoW4 6ecome sublect �o Ihe Workers' Compensation pmvisions ot ��e Labor
Cod¢. yau must forihwith tOmply wi�h SUCh pmvisions Or �his permii 5hall be aeemee revokeE.
CONSTBUCTION LENOINC RGENCY: I hereby affirm t�at Nere i5 a cons�mction IenOing agency fof th¢ pedormance ot the woB for
which this permit is i=.sued (Setlion 3097. Civ. q.
LENDEH:
ROUFE55:
OwNEH BW�oEfl oECIAflAiION: I hereby alfirm Ihat I am exempt lrom the Coniractors' State License Law tor the follovnng reason
�Section 7031.5 Business anA Pmfessional Cotle'. Any city af counry which requires a permit �o construc6 alter, impwve, tlemolish, or
repair any s�mcNre. prior lo its issuance. aiso requires the applicant br such permi� to lile a signetl slaiement Ihai �e/she is Iicensed �
pursuanlloihe provisions ollhe CONraclorS State License Law(Chapter9(commencing with Section 7000�ot0ivision 3 o�the Business
and Pmlessions Cotle) or tha� he/she is exempt �herelwm and ��e basis for Ne alleged exemption. Any viola�ion o� Sec�ion 7031.5 by
any applicani �ar a permil sublects �he applicant �a a civil Denally ot no� more Ihan �ive �unGretl dallars (Y500).
I, as owner ol I�e pwDe�Y or my emplayees with wages as �heir sole compensation, will do �he wo�k, an0 ihe
❑ stNctureis notintendetl orolteretltorsale�Section 7044. Business an0 PrafessianalCotle: The Contractors' State License Law
Ooes not appty to an owner of a pm0eny who �uilds or impmves tAereon, ana wha Ooes such work himseli/herseli or ihmugh
his or her own employees. pmvitled ihat such improvemenis are not intended or aflere0 for sale. I( however the CuilOing or
impmvemeN is soltl within one year of completioq the owner will have the �urden oi pmving he/she ditl not �uiltl oi impmve
for tne purpose of sa�e�.
I, as owner ol l�e pwpehy, am exclusivety conVacting wi�h licensed contractors �o cons�mct Ihe pmle�� (Section 704d, Busin¢55
� , ana Pmtessions Cotle: The ConVaclors' Stale License Law tloes not apply �o an owner oi DmOerty who builds or improves ��e2on
antl w�o con�racisfor such pmjects with a conVaclor(5) license pursuantto the Contraclors' Sta�e License Law�.l am aware
Ihat pmol ot �heir Worker'S Compensation insurance shoultl be D�ovitle0 �o me.
� I am exempl under Semian: 8. 8 P. C.
lor ��is reasorc
Dale: Ownec
IOo �ereny cenifythatlam aware oi and untlerstan0ihe requirements of Calitornia Heallh an0 Safery Cotle Sections 25505, 25533. and
2553A antl tha� I or any �uiure builUing occupan� will/will no� (circle one) neetl to compty with said slaie codes and the reQuir¢menis for a
permtl lor cons�mclion or modifica�ion imm t�e Air puahry Managemenl Dislrici. Fesideniial consfmction apDlica�ions afe exempt �rom
IhQSE p�Ovi5i0n5.
Date: Applicanl:
I hereby certtly that I �ave reatl Ihis applicalion antl state lhal lhe above in�armalion is correct I agree to wmply wi�h all city anA counry
ordinancesandslalelawsrelatinglobuiltlingconsimciionantl Ihorizerepreseni 'vesoflhisci�y�oenierupontheabove-mentioned
pmperlV lor mspeciion mposes.
�aie: � � �L Signalure
onver's �icense ar Socia� Security x:
164t�46 W�ile—Builtling; Green—CoOe EnlorcemenL Canary—Appllcam: Pink—Revenue; GOICenmd—Assessor
CITY OF COSTA MESA - BUILDZNG PERMIT
PERMIT NO: P 068875 PLAN CHECK NO; N
CONSTRUCTION TYPE: V-N PERMIT TYPE; PLU
PERM NO; P 068875
GOCJT : N SUPP : N
PURPOSE: OTH
JOB DESCRIPTION ; DISHWASHER REPAIR-C!O SQ FT:
CLAIM VALUE; CALC-VALUE: GROUP OCC; R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
*x�**+�**�r*+rx�*�r**+r*�r**�-�r*x-�r+r�t*�+�****�*+�**+�***********�*****+r**�»*+r+c�*�r�r***+�*x�*-x-x-x�*
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 RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ; PROC�: PARCEL; 14165265 ZNE: REF NO:
PLANNING NOTES>
>
iE iklFlE iE iE 1f !f ft 1E iF i! iE 1E'lE 1F �E fE fE iElf iE iE if i!� 1E iE 1E iE iElE iE iE iE iE i! 1E iE 1E 1E iE iE if !k fk ih iE if iE 1E 1E N� iE ik iE ff if iE iF if iE iE 1E if # if if if if iE iE Ik iE # iF iE iE if i!
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 5
ZONING APPROVED BY ' DATE;
HUILDING APPROVED BY :
DATE;
APPLICATION ISSUED HY;�It• , DATE: � I /`
lFfEif�9E�EiEfElFiElEfEifikiEfE9EiE�E9FiEiFlEiFifi4 E!F!! ��EitiFlE k�PitiF�t�it�tlFiEifif�lit E��EiE�EiEiElEiEiFiFiFlffEihiF.-iFfh iF4iE-1F�IEffiE
1EikitifiEiEitiEiElEiEiEikikikkiEiEiEiFiEiEiEiFifiFiEif iFiEiE9EfEiEiEfE�EjEiEifiEfEiEiEiEiEiEiEifiEkiElEiEiEiEiEiEiEiEifiEiFiFlEiEiEifiEiEiFif*iEiEiEiF
LEGALIZATION:N E E S 0 M M A R Y STRCTCTURAL SEGMENT:N
PERMIT BLDG PMT PLUM�IN�G� ELECTRIC .MECHANIC FIRE SMIP/RES GRADING
25R — � ;� SMIP/NON-RES
PLAN - " -
ISSUE FEE 20.00 �
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID , DUE
TOTALS----> 7,00 20.00 0.00 `, 27,0/0/ 27.00 .00
REVENUE DIVISION TOTALS--> COLI,ECTED; 27,OQ' OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
2 7 , � � _ _
iE iF i! fF if iE �F iFlE 1E iE fF fElE iE 1E iF 1f iE �k fE 1E iF iE iE if �f iF iE>E iE iF iF 1E iE if !F iE 1E if iE �f fF �f af iE iElE 9E 1E iE iE 1E iE iE iE iE ik 1E fE if iE iE if fE 9E iF iF iF jF 1E it?E if �! iE fF iE fF
I N D I V 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
PLU 1 DISHWASHER - 7,00 7.00
END OF FEF,S
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�STE: 09/i<.l94 ?I[9E: 2�7:Q3
�• -
CtlNSTRUCTION AND PLANNING POOL &
APPROVALS Permit $-` Oate Inspector APpAOVALS Permit # Date Inspector
7. Temporary Electrical Service�or Poie � 52. Pooi & Equipment Location
2. $oil Pipe-Undrgrnd. , 53. Steel Reinforceme�t
3. Electrical Condu(t ULility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Stee! Reinforcement 56. Rough Plum6ing & Pressure Tzst
6. Electr.cal UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Fuotings 58. Electricai Conduit�Undrgrnd. �
8. Foundation � 59. Gas Pipe, (J Undrgmd., Tee[ �
9. Water Pipe-Und�grnd. 60. Backvazsh Lines, P�Trap, � Undryrnd.
10. St�uctural Floor SYstem ' 61. APPROVAL TO DECK
tt. ProPeriY Searer Line & House Connection 62. Eackwash & Receptor�Flnal
� i
12. S¢wer Cap 63. Heater & Vent�Final �
13. Roof Drains 64. Plumbiny System - Final
14. flough Ptumbing 65. Efectricaf-Finat
1
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wir(ng 67. Pencing & Access Approvai
17. Rough Wirinq Si9^ 68. APPROVED FOR PLASTERING '
18. Rough Electricai-T Bar Ceiling 69. POOLlSPA SYSTEMiS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '
20. Rou9h Factory Fireplace " ' APPROVALS Permit # ,
21. Ouctf, in Structure . � , � 70. Under9round Hydro
22. Ducts, Ventilating ' 77, product Piping C7 Gas � Oil
23. Gas Pipe-Rough &�Test 72. l)nderground Flush
24. Roof 'rraming . 73. �Undergrnd`Storage Tank O Gas ❑ Oil �
25. RooT Sheathing � , 74. Overhead Flydro
26. T�Bar Ceiling fStructural} & NSonocozt � 75. Dry Chemical
27. Frame and F!ashing ' 76. Dry Standpipe � � -
28. La;hing & Siding . ' • 77. FIXED SYSTEA4 FINAL
29. Insulation - �. 78. FIRE PREV. PINAL �
30. D�Ywail Naitin9 . � HEALTH DEPT. REQUIREMENT
31. Piaster Brov��n Coat , 79. FINAL iNSPECTiON
32. Electricai Power Meter�Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric - Notes:"'7 �f ni j_/l}h �:/n �.. 2/1
' 1 t_v • s.� _}�...Kdi.CIIJ ��-
34. Final Heating & Air Conditioning . �� J� 6„� „�.�/' „ Ql.nn �n ����
I�VIV`U l�l 1C.k1�7
35. Final Gas Pipe�Test � ' � �
36. Hood or CanoPY � '. � 2�^!. /�l�r� .' �t� ��' '. '��1�. ;� ' �
� ' - �i ./`� .S
37. Final Factory Firepiace ,� � �`� � �$�..� -
'�-_! -�,,,',2
38. Final P�umbing .���
39. Water Service�Final , /��~
40. Gas Service-Final �
41. So�ar pomestirFinal ' � ' f .
42. Backflow Preventer � �
43. Backtlow Irrigation ' .
44. Landscape irriqation System �
q5. Sound Attenuation
46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDWG -
48. FINALP�ANNING
49. E�ectric Release to Edison
50. Gas Releate to Southem California Gas Co � -
51. CEiiTiFICATE OF OCCUPANCY
No. Date
_y
, I
CITY OF COS'
�P�1yr,t_Address
Applicant's Mai
PERMIT
AOp�icant ta till in all sDaees except those within
Owner's Na�� � ' � Phone
Address
Arch/Eng. License No.
Address �7.j���
Contracto' Nama7d,de2��� [� Ph�o �,�p�,
Addresslm�'�'�nl ��!c��7/' �taC�6W �C`3yf�01uN
Ciry License No. �G����
LICENSEp CONTRqCTOR DECLARATION
I hereby affirm that 1 am licensetl untler provisions ot Charter 9(Commencing
with section 7000) ot Division 3 of the Businezs antl Professions Cotle, antl
my license is in ful c- ct. ����/�
License,�W4 - _-�/E�q�pL,icense No.
Date ��%� 5'9 t �"_�
WORKE 5' CO PENSATION DECLARATION
� hereby affirm that I have a certificate of consent to selt-insure or'a certificate
' Workers' Compen5ation Insurance, or a certifietl copy thereOf (Sectlon
,00, lab. C.)
Volicy No. Company
BCer[ifietl copy is hereby fumisM1etl. ,
Certifietl mpy is filetl with the city Builtling Division.
Date Applicant .
EXEMPT�ON F0.0M WORKERS' COMPENSATION DECLARATION
(This section neetl not be wmplet¢tl if the permit i5 for one huntlr¢tl ($100) o�
less).
I certify that in the peRo�mance ot th¢ work for which this perm�t is i55uetl, I
shall.no[ em loy any per5on in any ma�nn�r � s to become subject [o the
Workers' Laws of CallfwdiA[ �
Date ___f2��5i9nature L1/i - -�
NOTICE: If, after king this tleciavation, you should become subject to the
Workers' Compensation provislons ot the Labor Cotle, you must forthwith
compiy witn such� provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCV '
1 he�eby affi�m that tFtere is a const�uction lentling agency for the perfo�mance
of tM1e work for which this permit is issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress - � -
OWNER BUILDER��ECLARATION
I hereby affitm that I"am exempt irom' [he Contractor's License Law tor the
following reason (Section ]031.5 Business antl Professional Cotle: Any tlty or
munly which requir,es a permit to con5truct, alte�, improve, tlemolish or repai�
any strutture, prior'to�iis issuance, alm requires the applicant for Such pe�mit
to tile a siqnetl statement that he/she is licensetl pu�suant to the provi5ion5 of
the Contraclor'S License law (Chapter 9(commencing with Section 700�) ot
DiviSiOn-3 of the Bu5ine55 antl Profe55ion5'Cotle) or that he/she I5 exempt
'herefrom antl the basis for the alle9etl exemption. Any violation of Section
'031.5 by any applicant for a pe�mit Subjects the applicant to a civil
`enalty,of not more than five huntlretl tlollars ($500).
LI I, as owner of the' property or my employees with wages as their sole
compensation will tlo the wo�k, antl the structure is not in[entled o� ofteretl
, for, sale (Section ]044,' Business and Professional Gode: The ConVactor's
' License Law tloes not apply to an owner ot a property who builtls or imprOves
I thereon, and who does such,work nimself/herself or tnrou9h his or ner own
IemO�oyees, provitletl that suth Improvements are not intentletl or offeretl for
sdle. If, howevet, the builtling o� improvement is soltl within one yea� of com-
pletion; tne owner will have the burtlen oi provin9 he/she tlitl not builtl or Im-
prova for Ihe pu�pose�of sale).
❑�I, as owner of the.property, am exclusively contracting with licensetl con-
lractoR [o constNct ihe pwjec[ (Secfion ]044, Business antl Protessionz Cotle:
The Contractor's License Law does not appry to an owner of property who
�builtls or improves thereon, antl who contracts for such project5 with a ron-
tractor(s) bcenseipursuant to the ConVactor's License Law). I am aware that
proof of their Worker's Compen5ation insurance Shoultl pe prOvitletl to me.
❑�I am exempt untler Section 6. & P. C. for this reason
Date Owner
I hereby certify that I have reatl�tnis application antl state
Information is rorrect. I agree to comply with all city antl cc
antl state laws relating to builtling construction, antl hereby
sentatives of thi city to enter upon the above-mentione
inspection p y e
Signature �if ��c—�_ Dati
Drivers' License or 55 � . �� — ,/
above
nances
TYPE OF CONSTRUCTION . LJ NE�
❑ CONVERSION ❑ DEMOLISH
DE$ChiIPTlO[�,OF�WQRKIUSE OF B
borEer 17nes antl sign all aDOropriale tleclarations.
LOT NO. UNIT NO. �
ADD ALTERATION REPAIR
4CW L- � i�l � ��
TYPE OF PERMIT GaaoirvG FOUNDATION 5TR
❑ TENANT ❑ ELECTRICAL ❑ PI.UMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT. ' 6� oCcuaa CZ
CON STRUCTION TVPE VALUATION 5�
ZONE � GRADING CU. VOS. ACRES_
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains.
Floor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trep
Roof Drains
Reinspection Fee � $15
Duct-UnderGround �
Duct-Strucmral '
Duct - Ventilating
Exhaust System ❑ Multiple �_
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,OOOBTI
Reinspectian Fee I $15
CMF OB65-46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - ASse55o�
Showers
Service Sink
Sewer Cap
Sewer Connection
$013! COIICCLOIS �
Solar Piping �
Solar Tank '
Swimming Pool wlSpa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
A.P. �
�S MainBuilding:
E
T Front
B Rear
A
C Right "
S�eft
Ping. Ref. #
Planning Notes:
- Automatic Washer
• � � Construction.PoleSub.
' Cooking Unit
' Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes �
Outlets
� - Switches �
Garba9e Dispoul �
Generator �65 KW.0
Hood or Typel ❑
Canopy Type I I ❑ ;
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
System Repair/Alteration
Fire Dampers �
' Registers '
Issue Fee
$ 3
$ 3
Zone , _
Accessory Building:
Parking Req./Provided
ELECTRICAL �
Trensfarmer ❑ 15-50 KW
❑ SO+ KW
. Meter �up to 100 amps
Meter ❑over100amps
�
Z
O
N
�
. . . . N
G
R
E
Q
M
T
� S
FEES �'�
Suh Panel
Momrs�0-1 HP OLh-6
IncSolar �9-15 HP �16-15+ '
Microwave �
Pole Light� ' � �
Range �
_ Sign .. .. . . . , _
Standing Sections '
Trash Compactor , .
I Reinspection Fee !$15 ', I Issue
DEVELOPMENT SERVICES REQUIREMENTS:
Zonin9 APProved BY .
Building Approved By ' %'
SUI�Q�RVDFFEES �
'
BUILDING PERMIT $ �� 4� �SMIP $ �
PLAN'CHECK $. ' PERMIT ,
PLUMBING .$ ISSUANCE $'
PLAN CHECK 25°h $ � ENERGV P.C. $ �
ELECTRICAL� $ GRADING $ ' '
PLANCHECK 50% $ MICROFILM $ �
MECHANICAL $ TOTALFEE $� ��_
PLAN CHECK 25% $ � �
CONSTRUCTION ANO.PLANNING POOL & SPA r'
APPROVALS �Fermit�# Date Inspector - qppROVALS Permit# � Date Inspector
1�.� Temporary Electrical Service or Pole ' 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. '� 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms _
4. Electrical Conduit-Undrgrnd. 55. EI¢Ct�iC21 BOnding
5. Steel Reinforcement. ' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd. �
8. Foundation ' �",f � 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Und�g�nd. � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
i t. Property Sewer Line & House Cannection 62. Backwash & Receptor-Final
12. Sewer Cap , � 63. Heater & Vent-Final
13. Roof Drains. 64. Plumbing System - Final
14. Rough Plumbing 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 `
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL i V
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro •�
c
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 � 1 �
29. Insulation � 78. FIRE PREV. FINAL � �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION � ,�J
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED '•"�
33. Final Electric, Notes: � ��
/
34. Final Heating & Air Conditioning � r1n
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 � -o
�
i 42. Backflow Preventer . - �
' 43. Backflow Irrigation � � • . �
;.
� 44. �Landscape Irrigation System , � - - • .
45. Sound Attenuation - ' ' - ' ';
'r* -
46. Handicap Regulations �^ � . � � - .
47. FINALSTRUCTURE&BUILDING � . • . •� -�
: �'
48 _ Special Requirements Completed � � � - ' . �
49:�Electric Release to Edison . ' . '
50. Gas Release to Southern California Gas Co . ,' p
51.'CERTIFICATE OF OCCUPANCY � e . �
.
No. Date � ' •�
\.� .. . ...... .. ... .._ . . . . .
. 18715
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 CP6TA ME9A. CALIFORNIA
For Applieanf +o Fill In Complefely
TYPE OR PRINT
DDRESS 1�f l�lortno e'7�Y-e,nsce w�
COSTA MESA. CALIFORNIA
■ MAIL
■ ARCHITECT
■ STATE
� BBTBACK LINE FROM
I'�
ING
TEL.
TEL.
NO. OP BLDO9.
OF WORK
ROOF
� ������'���
�� FEB 3 S 1963
F�NI�NCE DEPT.
APPLICATION� FOR7�PERMITSA
BUILDING
For Office Use Only
I REG�-'IPT fi0. I pEF
/
�
�Y DATE flECEIVED DATE ISSl1EO
tko 1� i96: tka i,, �:
.�105Li�2?e�r/t�i ,�lnc�
COSTA MESA. CALIFORNIA �
FIRE
ZONE
APPROVED
aoNiN�
ZONE NO. OF USE OF �
R�� I PLANS 2 BUILDING
LE�AL � � I p
UEBCRIPTION V � ��
(CEMER IINE BT.1
FRONT SS
0
�
�
3
—� `f —C
- .. ,y �
�� G/ C/�GJ��' �OCP/
1 HER¢BY ACKNOWLEOGE TXAT I XAVE RBA� THIB APPLIWTION THE FMOUNT eHOWN UNDER VALU ION IB FOR THE
ANo si'wiE T�tAT TH6�ABOVe �5 COPREGT AND AGREE TO GOM-
PURPOBE OF, EBTABLIBHING A PERM�T FEH ONLY,
PLY WITH qLL CITY OROINANGE9 AND HiATE LAWH REOULATINO
emt��Ha coNern ION. VALUATION ,/
SIGNATURE PERMIT FEE $ % / -�
PERMI7TE
$ '� J `��� PLAN C1iECK $ '��r� �
AUTHORIZEO AGENT /
TOTAL FEE C� � ����
/�i' 3 D