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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 r � a V c? �c+i6��ao-oai6��ac T �� T ?�.op �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