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HomeMy WebLinkAbout1590 MYRTLEWOOD ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1590 MYRTLEWOOD ST Suite No Vicinity: Parcel Nunmber: 13919324 Status: ISSUED Applied: 02/11/2005 Issued: 02/16/2005 ISSUED BY:lkrt Applicant: COAST ROOTER PLUMBING HTG & A/C Address: 17390 MT CLIFFWOOD FOUNTAIN VALLEY Owner: DISARRO,MICHAEL D Address 1590 MYRTLEWOOD ST COSTA MESA, CA Phone: (714)241-1414 Zip: 92708 Phone: Zip: 92626 Contractor: COAST ROOTER PLUMBING HTG & A/C Address: 17390 MT CUFFWOOD FOUNTAIN VALLEY WATER HEATER CHANGE OUT. AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 i:�onnect (Ice,Soda,etc) $0.00 --, nits $0.00 QTY Phone: $0.00 Zip: $0.00 t9ter $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY Phone: (714)241-1414 Zip: 92708 License: 529127 SCOPE OF PERMIT 'FEE SUMMARY AMT QTY AMT QTY Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 ft) .: $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Receptors $0.00 , 0 Vacuum Brkr Bkflow(5+) $0.00 0 Septic Tank - $0.00 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 - REINSPECTION $0.00 0 TOTAL CALCULATED FEES: $35.80 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 required 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) 754-5626 2"6-46 (6/00) C DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Ihave and will maintain workers' compensation insurance, as required by section 3700 of the LaborCode, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: A-/ _Cartier.^ -<Y `Pot Number: I, _(This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) y ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree th I she Id become subject to the workers' compensation provislons of Section 370 of the Labor Code, I shall forthwith comply with these provisions. V Applicant Signature�Date: 1 Z`( b OS WARNING' FAILURE -TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIEIS AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and offeclrbcrq— 7 ClasS —3 D Contractors Signature: Date: 2 /!n O S' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Coda for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). r future e buildin occupant need to file a registration form for acute) hazardous materials? Yes No ..........................................................................P........... ...... ..... 2 Does or will the applicant or resent o g p g y ❑ ❑ (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at a one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet compressed gas at standard temperature and pressure). ........................ .................. ... ................................... ...................................................................................... -............ ....................................... ................. ......................................................................................................... ....................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................... ................ .............-.................................. ............................................... ......................................................................................... ......................................................... ............................................................................................ 4 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..................................... ............... -... ........................ ........................................................................................................................................... ........................................... ...... .................................... ,.......................... ................ .............. .................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 Yes LJ No (Section 65850.2 of the California . . Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................... ......................................................................................................................................................................................................... ......................................................................................................I...................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and SafetyCode). .......................................... ........................................................................................................................... -........................................... ... .....- ......................... ........................... ................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ....................................................................................................................................................................................................................................................................................................................................................................................... 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignature f eg Owner(s) Z /,pate L_ -� <LOI.Oth!?nzod'Applicant CODE r. INSPECTION TYPE Q,1TE INfBAL$ CODE INSPECTION TYPE g9IE INTMALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy -I- Applicant to in all spaces except those within heavy border lines and sign all appropriate declarations. CY;sOF COSTA MESA CONSTRUCTION PERMIT ��filTill NO '^ PP`R1 �1 /V 9.11 TRACT NO. LOT NO. UNIT NO. Duct - Under Ground Project Address 1590 MYVtlewood ! ! Duct - Ventilating SUMMARY OF FEES _ �` BUILDING PERMIT $ 2 1'�C] SMIP $ PLAN CHECK $ PERMIT ISSUANCE $ Exhaust System ❑ Multiple 13 System Repair/Alteration Applicant's Mailing Address ���Comme Commercial b4a�f C.M. TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � same 11 CONVERSION ❑ DEMOLISH OTHER _ A.P. # Owner 'sN ����Y���1 Lilly Phone 979-45 6 D SCRIPTION OF�yyO /USE F G. ��ass oft �i�erg s ng es S Main Building: Address 1990 Mrvtlewood, C.M. I�e-roof W1tC1 ass ET Arch/Eng. License No. TYPE OF PERMIT Ll GRADING FOUNDATION STRUCTURAL Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Address ❑'OTHER A Rear Contractor's Name Crank BYO. Bf_q, Phone 548-5569 C Right 126 917tTg11[ Way, Costa Mesa 92627 PROJECT DESCRIPTION SO. FT. X671 OCCUPANCY K Address (mailing) TC'lal resicien�l 3,57=-e— Left CONSTRUCTION TYPE VALUATION $ S City License No. O ZONE GRADING CU.YDS.' ACRES Ping. Ref. � LICENSED CONTRACACTORR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 o the Business and Professions Code, and my license is in full force and effect. License Clas — License 4 7 Date Signatur PLUMBING FEES IORKERS' COMPENSATION CLARATION Bar Sink Showers . hereby affirm that I have a t' icate of consent to self -insure ora certificate of Workers' Compensation n ranee, or a certified copy thereof (Section Backflow Preventer Service Sink Automatic Washer 3800, Lab. c Cub Houle Policy Company - Backflow Irrigation Sewer Cap Construction Pole Su Certified copy is hereby furnished. Certif'ed yn is (ileo. with the city Bkilding Ovion. l;ral'llC J:Sros. Rooflna CO. Bathtubs Sewer Connection Cooking Unit Date 7�T-l�t� Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping Dryers ❑Gas ❑EIS less): I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Workers' Compensation Laws of California. . Date Signature IFloor Drains Swimming Pool w/Spa F.A.U. NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name _ Lender's Address Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto -Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair P—Trap Laundry Trays Generator 00-5 KW any structure, prior to its issuance, also requires the applicant for Such permit file a Signed statement that he/she is licensed pursuant to the provisions of Roof Drains :e Contractor's License Law (Chapter 9 (commencing with Section 7000) of ,ivision 3 of the Business and Professions Code) or that he/she is exempt r herefrom and the basis for the alleged exemption. Any violation of Section - 7031.5 by any applicant for a permit subjects the applicant to a Civil - of not more than five hundred dollars ($500). $ 3 Jenalty I, as, owner of the property or my employees with wages as their sole R¢inSpection Fee $15 Issue Fee compensation, will do the work, and the Structure is not intended or offered Reinspection Fee for sale (Section 7044, Business and Professional Code: The Contractor's d not a 1 to an owner of a property who builds or improves MECHANICAL FEES 8102 2/gib/81, c705J TL Zone Accessory Building: 2 O N 1 N G R Parking Req./Provided E D M T S ELECTRICAL FEES Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑ 0.1 HP ❑ 1 W- 8 Ina Solar 09-15 HP 016.15+ Microwave Pole Light Range Standing Sections SKTrash Compactor $15 I, I Issue Fee 1 $ 3 L cense La OCS pp Y thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project' Section 7044, Business and Professions Code: The contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such projects with a con. ' tractor(s) license pursuant to the contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Boiler Hood or Type I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date 'L 2 Application Issued By Date_ Duct - Under Ground Duct -Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct - Ventilating SUMMARY OF FEES _ �` BUILDING PERMIT $ 2 1'�C] SMIP $ PLAN CHECK $ PERMIT ISSUANCE $ Exhaust System ❑ Multiple 13 System Repair/Alteration Firepl/Fact. Bit. ICBG+ Fire Dampers Date Owner 1 hereby certifyyy...fthat 1 have rea. information IS pO rect. I agree to and state laws/ r ating to builtlm sentatives of t s city to enter this nosen property Heating System & Ducting 130-100,000 BTU ❑ 100,000 BT' Signature ✓ — / — v l ua,, I I Reinspection Fee I $15 Drivers' nse or SS CMF 0865 , rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - ASWSSor Registers PLUMBING $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ - MECHANICAL $ TOTAL FEE $ 27-.5 PLAN CHECK 25% $ Issue Fee $ 3 CONSTRUCTION AND PLANNING �t APPROVALS * Permit # Date Inspector F _ & SPA APPROVALS Permit # Date Insper.Tor 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. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO 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 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 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 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. Irisulation 78. FIRE PREY. 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 kNotes: G O 34. Final Heating & Air Conditioning JL�OQwWJ.� ea./ �ayt.(itiv� � 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 Domestic -Final ' 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation _ 46. Handicap Regulations 47. FINA4STRUCTURE&BUILDING FS 48. Special Requirements Completed - 49. Electric Release to Edison - - - - lease to Southern California Gas Co F51.CERTIFICATEOF OCCUPANCY Date OWNER ADAMS ACRE, INC. DATE 6-3-59 JOB ADDRESS 1590 Aitlew BUILDING PERMIT ATO. 9413 GENERAL CONTRACTOR Dike & Colegrove VALUE S 1 ,52.00 AP. No. LOT TR -FACT eoe FIRE ZONE DESCRIPTION OF WORK Re9.W/att.Gar. INSPECTIONS /(� Sfi DATEI GROUP �` TYPE ZONE' 1 Underground SoilWater i- SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NU_ MBE_R__ Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous -4/-511' —S�% SY11_j6c���% q -,. 5 1 • ,(' �- .:-lr _-- [•-`57-'� _.1i / -— Prop. Sw . L H_ e Con. St. Swr. G "5 =- ,%.� �T l—•33ii r_ — . Sprinkling System Healing, Final � Plumbing Fixtures Final Gas Test/ Construction Pole Underground Power Rough Wiring r G Wt, 7-/5--S-9 Z/�9- i Trenchese,$_q lForms'� Steel ' Floor System' ' Steel Reinforce Chimney Re -Rod Bond Beam Sheathing Frame and Flashingk—te— Lathing, In f- Out Plaster, brown coat Plumbing Fixtures, Final /yl-ir Electric Fixtures, Final Building, Final OCCUPANCY Form 210-3M-4-59 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 317 COSTA MESA, CALIFORNIA F PP[/CANT to flit /N COMPLETELY TYPE OR PRINT COSTA MESA, CALIFORNIA JUJ 3 1959 F!N,1,NCE DEPT. APPLICATION FOR PERMIT BUILDING fm Off/Cf m ONLY RECEIPT NO. PERMIT NO. OWNER Adams Acres Inc• I E. 17th St. RECEIVED BY DATE RECEIVED DATE ISSUEDT AMAIL DDRESS] s -� I Costa ,,a TEL cf CostMesa BUILDING CITY NO. O ADDRESS ARCHITECT Carlson & LIG' COSTA MESA, CALIFORNIA OR ENGINEER NO. Middlebrook ZONEe �}— ADDRESS group Ga I dwi Grove n Colegrove� Inc.LCTNO. 167293 APPROVED CONITPACrz.A DATE ADDRESS 419 E. 17th St. Costa Mesa ZONING LEGAL I LOT 1 ?022 ZONE NO. OF IPLAN6 USE OF NEW (BUILDING DESCRIPTION NO. 1/{ 1 BLOCK TRAQZ^' APPROVED A. P. NO. BY DATE .) SIZE60 107 NO. OF ­DGS.GS. YARDS EVES OF LOT VV X Now oN LOT WGnFl REQUIRED (CENTER LINE ST.) ALLOWED USE OF EXISTING BLDG. none FRONT FT. IN. SETBACK LINE FROM �] 261 i CENTER OF STREET 81 REAR YARD R. SIDE FT. IN. SIDE YARD ILEFT 51 (RIGHT 1 ( L. SIDE S FT. IN. DESCRIPTION OF WORK �� REAR IN NEW Ix II ALTERATION I II ADDITION I REPAIR I II MOVING II DEMOLISH BUILDING NO.OF 6 1 SIZE 1 ROOMS STORIES EXTERIOR WALL ROOF COVERING StIl co COVERING Shingly USE OF BUILDING AND WORK TO BE PERFORMED Single attached double garage. Flail 1�mlft. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION F SIGNATUREO PERMITTEE PERMIT FEE S JL_ 00 .•WW S 14j.552 /l PLAN CHECK S 17.00 TOTAL FEE 5 52.00 AUTHORIZED AGENT D