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Home My WebLink About415 HAMILTON ST - Building Permits/ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job nddress: 415 HAMILTON ST Suite: Viciniry: Status: ISSUED Applied: 01/18/2005 Issued: 01/18/2005 - Parcel Number: 41918114 Zoning: npplicant DAN HILL _ _ ISSUED Bv: �`� � „-�� Address: . ,,� ' - - _ - . ' � ' -- �'� Phone: 71'4-326-7724 . �•� � ' , ��P� � -' . � � , Owner: NEISSER, CARL TR � � � �- Address j °/NEISSER, RICHARD-C _ -- _ � - ; �COSTA MESA,.CA� - Phane: i �" ; "-2063 TUSTW AVE�#A' �, : " Zip: 92627 Contractor. STEVE SUDDUTH CONSTRUCTION �Address: 20221�BRIGHTWOOD CT _ , � � � � � � ��, �. � ' -.,� �. ' �✓ ��.-�� - -I'•. A -�� _ � i ` ,�AA � �� . / i�, `.��A � � >� �_ ; � - . . Phone.' p14)423-1623 � „`-, � � � ,� . '-, YORBALINDA,CA , �`��' .- � Zip: 92886 . � License: 746046 _ � � ' " ' ' � . , . _. . .. . ��\� � � � Arch : � . . . E�9; , , . . . .,\ , � � Address� � � _ ' � � "� -- - Address: , � ' , , ' ' ' ' , .. - ` Phone: � . _ , � . Phone: � Zip: , � �" License: - � �License; � y � -� � � ,,-� SCOPE OF PERMIT- - - � � . tT/OFF AND REROOF 2400SF RESIDENCE.W/COMP SHINGLES. . . . . . - .. � _ . ' � � ' � Plan Check: $0.00 - Permit: $125.25 SMIP Res: $0.57 SMIP Com: ' ` , $0.00 Other.�- '• .,�$0.00 Inspection: ', �'., $0.00 ��` -TotaL � ` , $125:82 SETBACKS�'�� - . : �. MAIN STRUCTURE�Front �. 0-.0 t, \ �, ACCESSORY Front � 0- 0 PARKING Existin �: � 0 NOTES: FEE SUMMARY . i. . Calc Valuation: , _ 'gs,�oo.00, Claim Valuation: ; gs,�oo.00 e �, �. .'� , � . �`-� .:,:.: �,,- , ` � ; ,; �' _, r tr-, ; : ��' �' _ � �� ;�, ' � ; �� _ , � ` ' �, i%; i '. • _ PLANNING & ZONING � � . � ,ij /i:� /I�� _ . _ >- � ; ��, �� / �Rear- �0=0,-, LeR 0�0'�: Right- �0-0-� "� � - �� _ _-- _ 'ci �/ _ - , � ,, � r� �Rear - 0-0 ' Lek � 0.0. � � Right.� �0.0�J � � y�� c� . . , Req`uired: 0 � Proposed: � -0' . ' � �,� i/ NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutas and related regulations. (Ord. Nb. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commencad within 780 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 requlred Inapectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expira�ion ot this permit. FOR INSPECTIONS CALL: (714) 7545626 2aas-a6 (s/ool WORKERS'COMPENSAnON DECLARATON: I hereby attlrm under penelty o1 perjury one of the following declaretions: ❑ I have end will meintain e certiticate of consent to self-Insure for workers' compensetion, as provlded for by section 3700 of the Labor CoCe, for the pertortnence of ihe work for which ihis Dertnit is issued. ❑ I have anO wlll maintein workere' compensation insurance, as required by section 3700 oi the Lebor Code, for the peAortnance of t�e work tor which ihis pertnit is issued. My workers' compe tion Insuran e carrier and policy number ere: /- / Certier: .�� / Policy Number. f � � �P �_� — z0�'� (This sectlon need nof be completetl rl the peimif Is ve/ued et one hundred tlallars ($100) or less.) ❑ I ceNty thet in Ihe peAartnance of Ihe work for which this pertnit is issued, I shall not employ any person in eny menner sa es to become sublect to the warkers' compensetion lews ot Callfomle, e a ee that i hould become sub�ect to the worker ' ompensetlon provisions of Sectlon 370 of the r Cotle, I shell fonhwith comply with Uese Drovlslons. e �Q� � ApplicentSlgneture: •.�-'�� - � oa�a: � /11' 05' . WARNING: FAILURE TO SECURE WORK ' G1�MPENSATIqJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND pVIL FlNES UP TO ONE HUNDRED THOUSW D DOLLAFE (5100.000�. IN ADDRIIXJ TO THE CQST OF WAIPENSATIIXJ, DAMAGES AS PfiOVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, INTEHEST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I herehy attirtn that I em Ilcensed under provis`c force end eXect. Uc. N � Contractofs Signeture: � with Section 7000) of �Ivision 3 ot Ihe Business and Professions Code, and my license is in full _� Class n fi � G '3 � � Date: / /. C� ..� CONSTRUCTION LENDING AGENCV: ❑ I hereby attirtn Ihat Ihere Is a wnsWction lending egency tor the performance oi lhe work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lentler'e Neme: Lendefs Adtlress: Sipneture: Date: OWNER-BUILDER OECLARATIONS: I hereby eNirm thet under penelry oi perjury Ihet 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Professions Cotle: My ciry or counry which requires e pertnit to consiruct, elter, improve, demolish, or repair eny structure, prior to its issuanca, also requires the applicant for such pertnit to flle e signed atatement ihat he or she is Ilcensetl pursuent to ihe provislons of the Coniractors License Law (Chapter 9(commencing with Sacllon 7000) of Divislon 3 of the Business flntl Professlons Code) or that he or she Is eaempt therefrom end the basis for tha alleged exemptian. Any vialatian of Section 7031.5 by any appllwnt for e permit sublecta the epplicant to e civll penelry ot not more ihan tive hundred dollers ($500).): ❑ I, as owner oi Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, end the structure Is not Intended or offeretl tor sale (Sec. 7044, Business and Professions Code: The Contradors License Law does not apply to en owner of property who builds or improves Ihereon, and who does such work himself or �ersetl or through his or her own employees, provitletl that such improvements ere not intended or oHeretl for sale. It, however, the huilding or improvement is soltl within one year ot wmpletion, Ihe owner-builder will have �he burden of proving that ha or she tlid not builtl or improve for purpose of sale.). ' ❑ I, as owner of ihe properry, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construct Ihe prolect (Sec. 7044, eusiness antl Professions Cotle: The contractors License Lew does not eppty to en owner ot property who builds or Improves Ihereon, antl who comrects for such pm�ect with a contrecbr(s) . license pursuent to Ihe CoNradars License Lews.). ❑ I em e:empt under sec. Signature: Owner ID venfied by driver9license. ❑ Ves ❑ No Business and Profes5ions Code for ihi5 ree5on: Vedficatlan ot Ownership by (type oi tlocumem, i.e. - property �ac 6ill or tleed): DIVISION OF INDUSTRIAL SAFETV PERMIT CEPTFICATION: Drivefs License No. Date: Expires: ❑ I hereby certify thet no excavation five (5) or more feei in depth into which e person is required to descend, will ba made in connection with work euthonzetl Dy this permit, and that no building struclure, scattdding, falsework, or demolition or dismantling ihereot, will be more then ihirty-si: (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tltle 8, Califomia Atlministrative Cotle). ❑ As owner-builder, I will not employ enyone to do work which would requlre a pertnit from tha Division of Industnel Safety, es noted a6ove, unless such person has a pertnit to tlo such work from Ihe division. SignaWre: � Date: Dlvision of Indusirial Safery Pertnit Number: CERTIFlCATE OF COMPLJANCE AND AllT}10RIZA710N OF ENTRY: I cenity under penalty of perjury ihat I have reatl this epplication and state that ihe information given is correct. I egree to comply with ell state laws en0 ciry ordinances relating to building construction, antl authonze representatives oi the Ciry ot Costa Mesa to enter upon the ebove-descnbed D�operty lor inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by ihis permit until fnel inspection. COUE �. INSFECTIONTYPE 1818 Fizetl System Final Fire PrevenUon 7268 Pool Spe Finel 200 Finel Re-Root 201 Finel BIocWRetelning Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition ?AIE INTITIALS 1-25—ci°.� . ""^- COOE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Elecidcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinyOccupancy QdIF I�L@ � . Applicant to till in all spaces exceD� tnose wit�in �eavy bortler linez antl sign all aDPropriate tleclarations. _ � CITY OF COSTA MESA CONSTRUCT�ION PERMIT � .; ,PER T NO. ' . , � TRACT NO� GOT NO. UNIT N6. � . . ' . ^ � � `� . a�aD , . 6430 12/86/65 5oft� . Pro�cetAddress • 41Jr H8[II11tOII � ' � �W , . . ' . , , , , ' i •,AppiicanYs�,Mailing-Address, 1O4Y2 TreBk'AVE. CiiCi.�92642 TVPEOFCONSTRUCTION '� � NEW ADD �� ALTERATION � REPAIR � 645-341�SH � CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# ' Zp�e _' " ,�Owner's Name $111 Cj�L '� Phone DESCRIPTION OF WORK/USE OF BLDG._ � �., f i ,_Address � 415 H�milton � ' ' ' - 851-0232W-'' ' � � . . . ' � ' � ' - ' _ �• � -E MainBuilding: ' AccessoryBuilding: � iArch/Eng. � License No. �TVPE OF PERMIT' . •GRFlowG �� EOUNDATION� ❑ STRUCTURAL ' � T Ffont � "' � � -- " Z '� . � � � . ' ❑ TENANT ❑ ELECTRICAL � ' ' ' ' " � O � Address - l ' ' , � PIVMBING � MECHANICAL B� Redr • - • N Controctor'sName A'8�es Plumbing-Heati�ho�3O�Z�{GO ' - ❑�OTHER - '- ' _ ' , � . � , C Right � - � .. � - - " N 10422 Trask pve. G.i�i..92642 PROJECTDESCRIPTION Sa.FT. OCCUPaNcv K G Address lmailingl, . CONSTRUCSION TVPE VALUATION $ ' S Left �� - .R ~City License No. - 6664 ZONE � GRADING�CU. VDS. � E LICENSED CONTRACTOR DECLARATION - ' PIOg. REf. # � Pa�king R¢q./PfOvidCd � �, I hereby aftirm that I am licensetl untlerpc vrsiortl�ojCbarter 9 co�mencing �Remarks: RE �L8C0 Water'Heater Planning Notes: ' � � , �_ � � � M with' sec[ion 1000) of Division 3 of- �Se siness an P�ofe o o , antl � �my license is in full for ntl effe [ � ' � ' � � , � � �- n � � � � , T �.�icensg �ia�s � C'�� , ' �cenze iv_ o . ZS 3 , , , � S 'Date 1 Si9nat '� � , PLUMBING �� ,Tf FEES i . . '-� 'ORKERS'_COMPENSATION CLARATI , , - ' �. . , ' , 1 ereby affirm that I have a ce iticate of m se to self insure�or a certiticate Bar Sink Sh , y ELECTRICAL � -FEES i ! . Wo�kers' Compensation Ins,rance, or ertilietl cOpY thereot (Section' gackflowPreventer , -- rmceSi -^ 3800, Lab.' � AutomatiC WaSher ''TranSformer' �'-15-50'KW �' � rl^�� /8832 lic demit 9 p' � ConstructionPole � �� 50+KW ' Policy ,No. Comp y Backflow Irri ation Sewer Ca Sub.� [� Certi/ietl copy is hereby furnishetl. ' I��' IH�Ce ie rq p tiled with the city tli . ' Bathtubs Sewer Con ctio Cooking Unit � Meter ❑up to 100 amps � Date ��L�� ' APplicant � lumbing , � EXEMPTION FROM WORKERS' COMPENSATION'DECLARATION Clafifiers ; Solaf ColleCt � Dishwasher . � ' Metef ❑ovel 100 amps � (Thissection neetl"not be completetl if tfie permii is for one huntlred�($300) or� -- �- - -- - - - - less). � ' ' � � � Dishwdsher Solar Piping Dryers ❑Gas ❑Electric � � Sub Panel . � - I tertify tM1at in the performance ot the work tor which this perm�t is issuetl, I . , ' . shall not employ any; person in any manner so as to become subject to the Drinking Fountains ' � Solar Tank. ' Fan � � � Motors �0-1 HP 01'/x - 8 Workers' Compensatlon Laws of California. . ' � � r. Date - Signature ' � ' � Floor Drains � � Swimming Pool �w/Spa � F.A.U. , ' � � Inc Solar 09-75 HP �16-15+ �'NOTICE: If, after making this tleclaration, you shoultl become subject t0 th¢ .Workers' Compensation .provisions. of the Labor Cotle,.you mus[ torthwith _ Floor Sinki - Urinal� �- - - - - Fixtu�es • ^ - � �� - -- � - - •-� - - - comply with 5uch provisions or this permit shall be tleemetl revoketl. '�' 'MiC�owave'^ � CONSTRUCTION LENDING AGENCV _ , �� : - � . � , GasSENiC2� Outlets _ WaterCloset � . Device.Boxes � POI¢ Liyht ' I hereby atfirrti that there is a consV uction.leni]in9 agency fo��ihe pe�fo�rtiance - ofntne woik.�toc which'this�permit� is issuetl (Section 309]- Civ. C.): � 16terceptors -�- -Water'Heater �; ,OUtICts•r-� � Ran9e � � � �� , LRntler'S �Name � • ' - l . i _ Leneer's Htldress, � � � � � Kitchen Sink.. ' ' i '� � ' Water Service ' ' ' 'Switches .^. ' � Siy� . ' � OWNER BUILDER DECLARATION' ' ' �' � ' � ' . . , ' I M1e�eby affirm lhat I am exemp[ from�the,Contractor'S�Llcense L.aw tor the Lavatones , ' ' Auto-Wash �� ' - �Garbage Disposal ' ; Scanding Sections .' � � following reason (Section ]031.5 Businessantl Professional,Cotle:-Any ciry or - _ _ • � � county whicn requires a-permit to construct, alter, improve, aemolish or repair P-Trap . ' Laundry Trays ' - _ �Generamr �0-5 KW �5-15 KW Trash Compactor. ' +, any s[ructure, �p�ior to itz i55uance; also tequires lhe appliwnt fo� such permit � , • to file a signetl statement tnat ne/sne is licensetl pursuant to the provisions of ' Roof Drains� - ' �. ' ' - ! 'ne Con[ractor's License_Law (Chapter 9(commencing with Sec[ion ]000)�ot - �.. � 9 I livi5ion'3 �of-the Business antl Professions Cotle) or that,he/she is exempt � . _ �� ' . , nerefrom antl the ba5is fo� Ne allegetl exemption. Any violation of Section ' r , ' , _ . . � � � .. , � .� � ' 1 � � ]031.5 by any applicant tor a permit subjects the applicant to a civil . - penalty of not more [ban five huntlretl tlollars ($500). i' . � ' ' ' . . :� , - ' . ' � ' �: �,' . � , � ' , ❑,I, as owner of tbe property o� �my�employees' with wages as� Iheir sole �Rein5p0ction' Fee. $15 �'_ � • Issue Fee . ' $ 3 ��, � � i compensation, will tlo the �work, antl the structure Is not intentletl or offeretl Reinspection Fee $15 luue Fee $ 3 for sale (Section �044, Business-and 'Protessional Cotle: The Contractor's _. . "� MECHANICAL � � FEES � - � License Caw tlaes not appty to an owner of a property who builtls or improves ' - : � � thereon, antl who does such work himzelf/herself or through his or her own � � � Hood or Type I ❑ � - DEVELOPMENT.SERVICES REQUIREMENTS: ' i employees, provitletl that such improvements are�not inientletl or of(eretl tor BOiI¢f - � 1 � , � sale. It, however, ihe builtlin9 or improvement is soltl witnin one year of�com- . . � Canopy Type II ❑ .. Zoning Apploved'By Data� pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im� Du`tt - Under Ground • . `r � � 1 Building Approved By _ Data /• � prove fnr the purpose of sale). . ' ' �� ; � : � . , - � � , . . j � � � ❑ I, zs owner ot the' pro0erty, am exclusivery, cdnvactlng with licensetl con- Duct -Structural Refrigeration Sys[em '; , Application;lisued By' � Dat tractorstd const�uct the projeot;(Section ]044,,Business antl Protessions Cotle: ' ' . . The Contractor's License l.aw tloes not appty to an owner of property who Duct � Ventilating � � . ❑0-100,000 BTU ❑100,000 BTU ,� ��(� +'" . SUMMARV OF FEES builtls or improves thereon, antl who contracts for such projects with a'con- " - , i_ - l i 1 tractor(st license pursuantito tne Convactor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration � f�BUI�DING PERMIT $ � SMIP 1 $ proot of their Worker's Compensation insurance should be prov�tletl m me. -PLQN'CHECK $, ' PERMIT ' � � ❑� 1 am exempt untler Section B. & P. C: for this reason Firepl/Fact. BIL ICBO # Fire Dampers �� ' ' '"pLU^MBING � $� 5.�� ISSUANCE $ � Date � � wner ' . - Heatin9 System & Ducting � Registers � ' �PLAN�CHECK 25% $ ' ' ENERGY P.C. $ -�I hereby ce ' y that I-have atl this�application antl state that�the above ❑0-100,OOOBTU �100,OOOBT , � �� / . GfiADING $ informati ,is correct. I agreefo com II ' y antl munty ortlinances %�ELECTRICAL $: antl st [ laws relatin to fitling c nstruc � n, tl hereby authoriae �epre- � ' , ' �� MICROFILM, $ sent v s of o, enter u n ve-mentionetl property Poc • � PI:AN CHECK 50% $� � � � � insp i n purpo , IZ�SZ-HS � MECHANICAL ' $ � TOTAL FEE � $ S.00 D,9 ri' License or 55� Da e -painspection Fee • $15 Issue Fee � � �. $ 3 ' PLAN CHECK 25% $' � � � ' ' CMF 065-46, rev. 10/B4 hite - Builtling; Canary - Applicant; Pink - Acmunting; Goltlenrotl - Assessor _ _ .f� . _ . . ._ , . . �. . _ __ .. _ . � ,. . - ..: , _ � � CONSTRUCTION AND PLANNING � � PG . SPA � - - Date Inspector - Date Inspector " A�PROVALS Permit # APPROVALS Permit # � . 1. Temporary Electrical Service or Pole , . _ 52. Pool & Equipment�Location - 2. Soil Pipe-Undrgrnd. `�� _ ' '"' ' 53: Steel Reinforcement - . ' 3. Electrical;ConduitUtility-Undrgmd. "� ' 54. Forms . � 4. Electrical Conduit-Undrgrnd�. . � - 55. Electrical Bonding � �� 5.,'Steel Reinforcement. � - - -56. Rough Plumbing & Pressure Test � � . "r � 6...Electrical UFER.Gmd. - � 57: APPROVAL TO COVER-GUNITE - � 7.-=Footings . , �� . . 58. Electrical Conduit-Undrgrnd. . . 8. Foundation � � '� � 59. Gas Pipe, � Undrgrnd., Test - 9. Water Pipe-Undrgmd� v , 60. Backwash Lines, P-Trap; � Undrgmd. . • % 10. Structural Floor System ' ' _ , 61. APPROVAL TO DECK � � ! � :' � i 11. Property Sewer Line & House Connection '�. .r 62. Backwash�& Receptor-Final � �� . 12. Sewer CaP . :!! a . � � _ . .. r_ � 63. Heater & Vent-Final 13. floof'Drains ' � �� 64. Plumbing System - Final �1 _' 14. Rough Flumbing � ' 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 Elect�ical-T Bar Ceiling 69. POOL/SPA 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 O Gas O Oil 23. Gas Pipe-Rough & Test �, � - - 72. Underground Flush � - - � 24. Roof Framing ; � " - 73. Uridergrnd. Storage Tank O Gas ❑ Oil ' - 25. Roof Sheathing , � t -� 74. Overhead Hydro � � 26. T-Bar Ceiling (Structural) &.7Jlonocoaf 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-F.inal � 80. FOOD CERTIFICATE ISSUED 33. Final Electric - . � ' Notes:' � j� �(� .(�Fr �/�-QiJ. C.alJ. ' 34. Final Heating & Air Conditioning �� - J - � � - 35. Final Gas Pipe-Test " ��;, 36. Hood or Canopy � � 37. Final Factory Fireplace - 38. Final Plumbing . � ' . � 39. Water Service-Final � , ia- � � . ' � - . -_ . . . . . 40. Gas Service-Final � ,' � � 41. Solar pomestic-Final � 42. Backflow Preventer '�'� . � 43. Backflow Irrigation �, � - . • , l 44. ,Landscape Irrigation System � "-` � � � , . , ' � �r .45. Sound Attenuation . . . ' � '� � ��. 46. Handicap Regulations . . � � � � ' ' � i � 47. FINALSTRUCTURE&BUIL'DING � • 48. Special Requirements Completed � � � � , . 49. Electric Release to Edison • � � 50. Gas Release to Southern Califomia Gas Co . � � � �� 51. CERTIFICATE OF OCCUPANCY � ' ' No. � Date, - ' � "� �' � � ' � � � JOB ADDRFSS GENERAL COS INSPECTIONS 'ti Lf/ I DATE T �arnnnd Cnit/ �iiC Wehn� !// i /_/ SUBCONTRACTOR � � � I P. OCCUPANCY Form 210-5M-11-59 5-B P DATE 6-21-60 - BUILDING PERMIT NO. ' ,� ��2�s COSTA MESA BUILDING-SAFETY DEPARTMENT ' P. O. BOX S7'l COBTA MEBA. CALIPORNIA For Applieanf +o Fill In Complefely. TYPE �R PRINT AODRESS �� HA131SZt'iOTI Sti• COSTA MESA. CALIFORNIA MAIL lyl Hamilton St. ADDRESS arv COSt8 Mesa CONiRACTOR Jack Cornair Const. ADDRESS 1536 Newport Blvd. QTY Costa Mesa �;�rNo.128344-s-1 NEO.MT 6-1655 size 50 x Gl� .1+9 I"o",��a`�:a' 1 (1C 1 11T FEE �I�C�iVED �_��_(t o �;c.e FINANCE DEPT, CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Offiee Use Only 0.ECEIVT NO. P¢RMIT N ,�a�� RECEIVED BY DATE RECEIVE� DATE 189UEO � -/� -6O � /,� - /- d BUIL�ING . / /!� /d.J �% � . _. _ _ . . APPROVEO LEGAL COSTA MESA. CALIFORNIA- I � "" ZO"NING rvo. or e or n vurve am�oixc `a�pQ . � r�f -- ,a I / .i T ./� EVES 66TBACK LINE FROM G (CENTER LINC 6TJ CENTER oF BTREET 111 �'� � REAR YARDGI ,��' FRONT 61DE YARD I LEFT S��n I RIGHT 15'-6n R.SIDE DESCRIPTIOtd OF WORK ■ BUI �Tr 1 NEREBY AGKNOWLEDGE THAT 1 HAVE READ TH�6 APPLIGTION AND BTAT¢ THAT TXE ABOV¢ I8 CORPEGT AND AGREE TO LOM- PLY WITH ALL CITY OR�INANG¢8 ANG BTATE LAWB fiE6ULATINO BUILpIN6 CONBTRUCTION. • SIGNATUREO� _ � a/1__/ll�i�f AGENT � APPROVED ` / '��$ S p -- � %e"-. '`'.�v / SJ/ O 'O - �- �`�-� 3% n �-. � - �'�i/ TXE AMOUM BHOWN IINDER VALUAT�ON 16 FOR THE PURP08E OF, EBT�BLI6HIN6 A PERMIT FEE ONLV. VALUATION �( � �.Q PERMIT FEE $ iJJ r [� n $, /S / 7�j PLAN CHECH $ I 7. S D E sa.sa o iOTAL FEE LL