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Home My WebLink About3058 HAYES AVE - Building PermitsJob Address: 3055 HAYES AV , Swtus: ISSUED Suite No Applled: Ot/25/2007 Issued: O125l2007 Vlcinity: GARAGE Parcel Nunmber: 14772207 Applicant COOK, JEFF Address: 1175 BOISE WAY � COSTA MESA, CA �, Phone: 714-322-6442 Zip: 92626 Owner: CHURCH, HARBOR TRINITY � Address � BAPTIST � � ' � , "COSTA MESA,CA. Phone: / ��'7230 BAKER ST � �-- Zip: 92626 c o n tra cto r: O W N E R-6 U I L D E R Address � ' Phone: Zip: ticense: 000000 ( SCOPE OF PERMIT CHANGE OUT WATER HEATER AND RELOCATE TO GARAGE. , � AMT ISSUE�FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 ClarifierSystem $0.00 Conned (Ice,Soda;etc) $0.00 Dental Units � � � $0.00 Dishwasher $0.00 Drein, Floor $0.00 Drain, Rainwater . $0.00 Drain, Roof , $0.00 DrinkingFountain ,��$0.00 ExpanSionTank � ��$0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) 50.00 Gas (Over 4 outlets) $0.00' ,� Gas Repipe $0.00 � � Gas Service �, �� $0.00, Interceptors (Grease, Oiq ��50.00,', Interceptors (Sand Auto) � �$0.00 �� 0 0 0 0 - 0 : - 0 � 0 0 0 0 0 0 0 0 �. ; 0 p � 0� ,C p FEESUMMARY • '-�� ,- . .... .AMT -�TY- Laundry Tub / Washer' -$0.00 0 � Landscape irrigafion � � 50.00 0 P-Trap $0.00 0 Pressuie Regulator 50.00 0 �Frocess Piping (per 10.fl). .$0.00 , -0 � � . -- Receptors - -- - - �$0.00,', �0� � _ - SepticTank� �$0.00 ' 0 Sewer Cap tor Demo $0.00 0 SewerConned �$0.00 0 Sewer Private Line $0.00 - 0 Shower $0.00 0 Sink, bar ., $0.00 0 Sink, commercial� . $0.00 0 Sink, Floor� $0.00 0 Sink; kitchen $0.00 - 0 Sink, service/mop $0.00 0 Spa (private) � $0.00 0 � -Spa (public) ' " $0.00 0 �.� , -, COMMENTS I.SPECIAL CONDITIONS / ISSUED BY: SumpPump Swimming Pool Trep Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+). Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping pnst or Rep.) Water Re-pipe Water Service W ater Softener OTHER VIOLATION PIAN CHECK REINSPECTION . AMT $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 $12.30 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 $0.00 TOTA� CALCULATED FEES: 535.60 � QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 NO710E: The work authorized by this permit shall compty with all applicable handicap access requiremems under Calitomia statutes and related regula[ions. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or il work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for Ihe work authorized under this permit to be consitlered legal, such work must comply with all applicable codes, and all required inepectlona end Iinel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2G46-4fi (N00) WORKERS'COMPENSAnON DECLARAnON: I here6y aHirtn under penalry of perjury ona of the tollowing daclaretions: ❑ 1 have and wlll malntain a certificete of consent to self�lnsure for workers' compensation, es provitletl tor by section 3700 of Ihe Lebor Code, lor the pertormance of ihe work for which Ihis permit is issuetl. ❑ I have and will maintain woAcars' compensatlon insurence, es required by section 3700 of ihe Lebor CoEe, for t�e peAortnance ol the work for which Nis pertnit is issuetl. My workers' compensauon Insurance wrrier an0 polity number are: Certier: Policy Number: (This section neetl nof be comp/ered il (he permit is valuetl af one huntlretl tlollars ($100) or less.) ,�_I.certify thet in the pedormance of ihe work for ich this permit is issued, I shall not employ eny person in any manner so as to become subject to the workers' compensatlon lews oi Californie, end egree ii I shoultl become sub�ect to Ihe workers' compansation provislons of Section 3700 of Ihe Lebor Cotla, I shall forihwith complY with Ihese provisions. - 7C ApplicentSignature: GDele�—1 ��C-J -v� WRPNING� FAIWRE TO SECURE WORKER5 NSAiION OOVERAGE IS UNLAWFUL M1D SHALL SUBIECi rW EMROYER TO CRIMINAL PENALTIES AND GNL FlNES UP TOONE HUNDREO TKKISAND DOLURE (5100,000�, IN A�DIiIQV TO THE COST OF CAMPENSATION, OAMAGES AS PROVIDED FOii IN SECTIIXJ 31O60F THE LABOF CODE, INiEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Saction 7000) ol Division 3 of the Business and Prolessions Cotle, and my license is in full fome and eflect. Lia a Class x Coniraciors Signeture: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby aRirm Iha� there is a constmction lending agency for the pedormance of the work for wNch ihis permit is issuad. (Sec. 3097, Civil Code). Lender's Name: Lendar's Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm Ihel untler penalry of perjury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ne fotlowing reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires e permit to constmct, elter, improve, damolish, or repair eny stmcWre, prior to its issuance, also requires the epplicant for such permit to tlle a signed statement that he or s�e Is Ilcensetl pursuent to Ihe pmvisions ol ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) of DiWsion 3 ot the Business and Professions Code) or ihet he or sha is ezempt iheretrom and the basis for the alleged ezemption. Any violation of Section 7031.5 by eny applicant for a permit sublects the applicam to e civil penalry ot not more than live hundred dollars (5500).): ❑ I, as owner ot the property, or my employees with wages as their sole compensation, WILL DO TME WORK, and the structure is not intended or oftered for sale (Sec. 7044, 8usiness end Professions Code: Tlie Contractors License Law does noi 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, pmvitletl that such improvements are not intended or oRered for sale. If, however, Ihe building or improvement is sold within one year ot compietion, Ihe owner-builder will heve Ne burtlen ol pmving that he or she did not build or improve lor purpose of sele.). ❑ I, as owner of t�e property, am E%CLUSIVELV CONTRACTING WITH LICENSEO CONTRACTORS to cons�ruct Ihe project (Sec. 7044, Business and Protessions Code: The contrectors License Lew does not apply to en owner ol pmparty who builtls or impmves thereon, and who coniracis for such pmject with a coniracror(s) license pursuent lo the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for Ihis reason: Signeture: Date: Owner ID verifietl by tlriver's license. ❑ Ves ❑ No Driver's License No. Verificalion of Ownership by (type of document, i.e. - property taz bill or dead): Expires: DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATON: ❑ I here6y canity Ihat no excavation five (5) or more faet in dep�h into which a person is required to tlescen4 will be made in wnnection with work authorized Dy ihis pertnit, and Ihat no builtling swcture, scattolding, falsework, or demolition or dismamling thereof, will be more than �hirty�six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TiNe 8, Celilomia Atlministretive Code). � As owner-builtler, I will not employ enyone to do work w�ich woultl require a permit fmm lhe Division ol Industrial Sefety, as notetl eDove, unless such person has a pertnit to do such work from the division. Signawre: Date: Division of Industnal Salery Pertnit Number: ICERTIFlCATE OP COMPLIANCE AND AIffHORIZATON OF ENTRY: I cenily under penalty of perjury that I hava reatl this application and slale that �he information given is I correcL I agree to comply with all state laws entl ciry ordinances relating to huilaing construction, antl euthorize representatives ol the City of Costa Mesa to enter upon Ihe e6ove-descn6ed property br inspection Durposes. I agrea not to occupy or allow occupency of any building euthorized by t�is pertnit umil final inspection. COOE �. INSPECTONTYPE 1616 Fixetl System Final Fire Prevention 7266 Pool Spa Finel 200 Final Re-Rool O�TE IN�q�@ �QQfy! INSPECTIONTYPE 206 Final Mechanical 20B Final Plumhinq 210 Finel Electncal �.1 �III. / =]� /� 201 Final BIocWReteining Wall 212 Final Fue Prevention .yy, .. . •. v : _ m. .:�. Ull t�' >V10111 -E�V IJ>YST� 202 � ,F.mal Fectory Fue�P.lace �; �� , , �i , , , � � „ ; � ?ZO , Final Plamm�g Approval, ;,,,�� ae l�m - . '. ' . .,an. `. ; . 203 Final Sign 222 Pinal Site ;;y.2-?3C (i:t�) ...1. �� cv�v� i J3'��o.�� n.�� ;204_r�„Final,DemoliGon�.,,,t,�_,�„-�.,__ _, _,,,�.,,,,,__ 250.�,_FinelBuilding/Occupencyx�--`uy-.- �� ,�lys; C�'l`� , i 2Lo ZCo �� DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Street Address: Bldg. Permit # This Permit # AP Number: I(we), h`¢iJd� ��Qli�rT�- �%�°l2�if , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: Name: ��iLl ! Ls-vF� - Telephone Number. !�� 3ZZ'� d F� Street Address: /� r Ciry: W� /, YZ.�I`� State: �' Zip:��uli to obtain pertnits in my behalf, as owner/builder, for ��y- %2ir,•T�' � ffy✓'i fr at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workefs Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. 1 agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. . Executed this � day of 077946 (rev.11/00) 20 Q� , at COStA- /t(�'S/4- , California. Print�Namej (��i'/LY �/�2Cc:— Date: -- �- �-= 07 Note: This author¢ation does not grant authorization to perfortn the work as owner, it soley provides for limited power of attomey to sec:ure this permit in any behalf. C� o� C'oa,ta %'� S'uiE'du� Du�idia� OWNER-BU[LDER VERIFICATION Ef A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building pemiit, require the completion and require the remrn of, an owneo- builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and re[um this information in the envelope provided at your earliest opportuniry to avoid unnecessary delay in processing and issuing your building permit. No buildine pertnit will be issued until this verification is received. Cl =`I:personally plan to provide the major labor and materials for cons[ruc[ion of the proposed property improvement. �Yes ❑ No �1�(have/havenot) signed an application for a building permit for the proposed work. � �—�1 have contracted with the following person (firtn) to provide the proposed construction: Name Address Phone ( City _ Contractor's Lic. No. 4. 1 plan ro provide portions of the work, bu[ [ have hired the following person to coordinate, supervise and provide the mnajor work: Name��L�CY f �'�e'/�'�07 Address /3od /r�,am (' f� (/a= .$` /(� Q City �S'�iy /y�s'� Phone (7il�)S�/4-3 2I7 Contractor's Lic. No. L,I � will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042�46 (Rev.i1104) I hereby a�rtn Utat I have received a copy of the information set forth in Section 19830 of the State of Califomia Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. i�� r��, C.D.L._N OR S.S. # /'�� / �_:. DLate"t / zS—O7 For more information call City of Costa Mesa Building Division at (714) 754-5273. t0/N6 Iftev. H/00) August 31, 2009 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPM�NTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Jeff Coak Harbor Trinity Church 3058 Hayes Avenue Costa Mesa CA 92626 PERMIT NUMBERS: P07-00059 PROJECT 3058 Hayes Ave., Costa Mesa, CA FOR: Water Heaier Our records indicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of the last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on September 11, 2009. Additional fees will be required to finalize expired permits. Requestinq an inspection - If you need to request an inspection, please call our Inspection Request Line at 714-754-5626. Requestinn an extension -If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. The accuracy of records affecting your prope y is our goal and we appreciate your working with us to resolve this matter. Sincerely, Uu� �Barbara J. wart Office Specialist II Building Division (714) 754�5273 • Cotle En(orcement (714) 754.5623 • Planning Division (714) 754-5245 FA%(71a17S1-4q55 • TpD(7141754-5244 • wvrH,ci.costa-mesa.ca.us pia) �sa-sz�a • Fex (�ia� �sa-aess CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT ,� JobAddress' 3058 HAYESAV Suite: Vicinity: RESIDENCE & ATTACHED GARAGE. Parcel Nunmber: 14172201 Applicant: SWORD, LARRY Address: 3364 NEVADA AV 92626 C.M. Owner: CHURCH, HARBOR TRINITY Address BAPTIST COSTA MESA, CA 1230 BAKER ST Contrector: SENTRY ROOFING CO Address: 3364 NEVADA AV 92626 C.M. Zip: Arch : Address: Phone: Zoning: R1 R1 Phone: 714-751-7663 Zip: Phone: Zip: 92626 Phone: 714-751-7663 License: 487659 Eng: Address: PERMIT NUMBER � 699-00536 '� 77 FAIR DRIVE, COSTA MESA, CA 92626 �SSUED BY: Status: ISSUED Applied: 04/1911999 Issued: 04/19/7999 Phone: Zip License: Zip: License: SCOPE OF PERMIT REROOF OVER EXISTING COMPOSITION SHINGLES USING 25 YR ASPHALT 3-D "ELK PRESTIQUE II" SHINGLES. Plan Check: Permik SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $87.25 $0.50 $0.00 $0.00 $0.00 $87.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Reauired: 0 FEE SUMMARY PLANNING 8 ZONING Left 0. 0 LeR 0. 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $3,500.00 $3,500.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) '� EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a penod of 180 days. INSPECTIONS: In order for the work authonzed under this pertnit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectione end flnal approvel must be obtained. Feilure to obtain inspections and final epproval will result in the axpiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATON DECLARATION: I heraDy eHirtn untler penalry ai perjury one of the following Oaclaretlons: � ❑ I have end will mainteln e certificate ot consent to setl-Insure lor workers' compensauon, es pmvided tor by sectlon 3700 of Ihe Lebor Cotle, tor the peAormence oi ihe work 1or wnich inis permit is issued. ❑ I have and will mainlaln wo�lcers' compensallon Insurence, es requlred by sectbn 3700 of Ihe Lebor Code, for the peAortnance of the work for which this pertnit is issueA. My worker9' Compen9etlon Insurence carrier end policy number ere: Carrier: Policy Number: (�Th//s�e cNon neetl nof be cromp/etetl il the permit is ve/uetl et one huntlretl dollers ($f 00J or less.) I:{' 1 certity lhat In the pertortnance of the work for which Ih' pertnit is issued, I shall not employ any person in any manner so as to becoma subJect to Ihe workers' compensation laws of Celif 'a, and agree thet if I sho become su ject to i�e workers' compensetion proNsions of Section 3700 of the Lebor Code, I shell forihwith comply with Ihese rovi ' //Z 1� ApplicantSlgnaNre: Date:� J� WARNING: FAILURE TO SECURE WORKE PENSATION COVERAG'c IS UNUWFUL PND SHALL SUBIECT Ml EMPLOYER TO CRIMINAL PENNLTIES AND CMl FlNES UP TO ONE HUNDRED TI%%1SAND DIX.LARE (5100.000). IN AD TO THE COST OF COMPENSATIIXJ, �AMAGES 0.S PROVIDED FOR IN SEGf10N �OB OF TME LABOR CODE, IMEREST, AND ATTORNEI^5 FEES. LICENSED CONTRACTORS DECLARATON: I hereby aHirm that I am force end eNecL Lic. p Contrectofs Signature: m with Section 7000) of Division 3 oi iha E _ Class a Da�9: _ Coda, antl my Ilcense is in full CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm t�et Ihere is a conswction lending egency tor the peAormence oi the work tor which Ihis permll Is issued. (Sec. 3097, Civil Gode). lenders Neme: Signature: _ Lentlers Atltlress: Date: OWNER•BUILDER DECLARA710NS: 1 hereby eHirm that under penalry of perjury t�a� I am E%EMPT FROM 7HE CONTRAC70R5 LICENSE LAW for Ihe lollowing reason (Sec. 7031.5, Busineu end Professions Code: Any ciry or counry which requires e pertnit to construct, alter, improve, demolish, or repair eny structure, prior to its issuance, also requires the applicant tor such pertnit to file e signed stetement ihet he or she is licensetl pursuen� lo ��e provislons of ihe Coniractors License Lew (C�epter 9(commencing with Sectian 7000) of Divlslon 3 of ihe Busineu entl Protessions Code) or ihet �e or she is esempt Ihereirom entl the Desis for the allegeO exemption. Any violatlon of Sedion 7031.5 by eny applicant lor a pertnit subjacts t�e epplicant ro a civil penalry of not more than Ilve huntlretl tlollars ($500).): ❑ I, as owner of the D�aPerry, or my employees with weges es their sole compensetion, WILL DO THE WORK, entl the structure is not intended or oXered tor sala (Sec. 7044, eusiness end Professions Cotle: The Contrectors License Law tloes not eppy to en owner oi property who builds or impraves thereon, and who tloes such work himself or herselt or Ihrough his or her own employees, provided thet such improvements are not Intended or oNered for sale. If, howaver, the building or improvement is sold within one yeer oi completion, the owner-builder wlll �eve the burtlen of proving that he or she did not build or improve tor purpose of sale.). ❑ I, es owner of t�e property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business entl Professlons Cotle: The conirectors License Law does not apply to en owner of property who builds or improves Ihereon, entl who contracis for such project with e cantrecior(s) license pursuant to the Contractors License Lews.). ❑ I am ezempt under sec. Business end Professions Code br thls reeson: Signeture: Date: Owner ID vanfied by dnvefs license. ❑ Ves � No Dnvers License No. Venfication ol Ownership by (rype of daument, i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby certity ihat no axcavation five (5) or more teet In depth Into which e person is require0 to tlescentl, will be mede in connecilon wlih work auihonzetl by thls pertnit, end that no builtling structure, scettolding, telsework, or demolitlon or tlismantling Nereof, will be more t�an thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calilamie Adminisiretive Code). ❑ As owner-builtler, I will not employ anyone to do work which woul0 require e pertnit fmm Ihe Didslon of Intlustdal Safery, es noted above, unless such person has a pertnit to do such work from ihe division. Signature: Date: Division oi Intlustrial Sefery Permit Number: CERi1flCATE OF COMPLIANCE AND AIfTF10RQATON OF ENTRV: I certity untler penalry of perjury that I have read this application and state that ihe intormation given Is correct. I agree ro compty with all state laws and dry ordinances relaling to buildin9 construction, and authorize representatives ol the Ciry of Costa Mesa to enter upon the above-descdbetl proDerry for inspection purposes. I agree not to occupy or allow wcupancy of any bulltling aut�odzetl by this pertnit until final inspection. GOOE I, 1616 1266 Fixetl System Finel Fire PrevenGan Pool Spa Finel 200 Finel Re-Roof 201 Final Block/Retaining Wall 202 Final Feclory Fire Place 203 Finel Sign 204 Finel Demolition . 2d46d6 pejE INTRIALS COOE I INSVECTION TYVE 206 Finel Mechenical 20B Final Plumbing 210 Final Electricel 212 Finel Fire Preventlon 220 Finel Planning Approvel 222 250 Finel Site Finel Bullding/Occupancy p7.\I�I,Y6il.lbj �a�o� COSTA MESA BUILDING-SAFEtY DEPARTMENT P.O. BOX 91] COSTA MEBA. CALIFORNIA For Applicani to Fill In Comp►etely TYPE OR PRINT BUILDING AOORESS AB C9 Avenue COSTA �MESA. CALIFORNIA 1304 W. Commonwealth Ave. Fullerton No�871-2710 E. 4th St.. Tustin F'ul l erton. Cal if . / No, o� BLDoB. 0 J NOW ON leT BETBACK LINE FROM CENTEP Op BTRHHi �O REAR 81�8 YAROI LEFT O I RIGHT DESCRIPTION OF WORK BUILDIN6 / �"� t �' NO.OF 61ZE �� ROOMS � EXTERIOR WALL,.. ROOF 7J4U — LOL 4Y Plan 612B R-1 Reaidence / - 1 HEFEBY ACKNOWLEOOB TXAT I NA HCAD THI APPLIGTION ANO BTATB THAT THE RBOVB IB COpRECT ANU A R8E TO COM. PLY WITH �LL <IiY OHOINANC88 ANO BTI�TB UW Ffi0{1LATINO BUILDINO CONBTqUR10N. � SI�NATURE OF PERMITTE - AUTHORIZED A6ENT CITY 0� C£�ST� MESA MAY 5 196� BUILDINO ZONING 1 � NO.OP(� U860PN8 �' PLANB / iBUILDINPo 11 YARDSAPPROVED MAIN BUILOIN lOMC/LBTREE � )NT Ff. �,�G �7 � VAR. # iasueo BHALL BE`LH88 THAN (U.B.C.R84UIREMENT7 YARDSAPPROVED ACC6550RY BUILDIN6 BET. MAIN @ ACCESS.BL[ DATE �� / �/Zeo. Fr. ,d�o 2" � TH6 �MOUNT BXOWN UNDHP VALU�TION 18 POH THE PURP086 OP 88TABLIBH�NO A PERMIT FE8 ONLY. VALUATION (� G J PERMIT FEE $ � / $ � � � o� PLAN CHECK $ /� � TOTAL FEE $ (��