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Home My WebLink About2868 HICKORY PL - Building Permitss ;, CITY OF COSTA MESA � p MfS BUILDING DIVISION >t�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us � � FOR INSPECTIONS CALL: (714) 754-5626 '+rqv�� fi PERMIT NUMBER: 610-00162 , PERMIT TYPE B_ROOF2 APN: 13929621 JOB ADDRESS: 2868 HICKORY PL CM Vicinity: APARTMENT RpOF Squares: 1000 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: Valuation: ISSUED 0610712010 RMD $5,500.00 SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL 2 LAYERS OF 15 # FELT ON A 2:12 PITCHED ROOF AND REROOF WITH 30 YEAR COMp SHINGLES ON A 4 UNIT APARTMENT BUILDING, APPROX 1,000 SF. REPAIR AND REPLACE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO CITY PERMIT AND JOB CARD. OWNER: MITMAN ANDREA AND MAY BETH P1iONE: APPLICANT: VU, MICHAEL PHONE: 714-283-9977 CONTRACTOR: WESTIN pEVELOPMENT CO Address: 6091 E NUGGET CTUnit: City/State/Zip: ANAHEIM, CA 92807 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $12525 Reinspection Fee: $0.00 Bldg Sld Admin Fund $1.00 Address: 2868 HICKORY PL City/State/Zip: COS7A MESA, CA Address: 6091 E NUGGET CT City/State/Zip: ANAHEIM, CA License No. License No. PHONE: License No. 578613 714-283-9977 CELL: PHONE: PHONE: Unit: Unit: TOTAL FEES $126.25 HOURS FOR CONS7RUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am ihru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the tollowing Federal New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksqivinq Dav and Christmas Dav NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requiremenis under California stalutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed 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 fnal approval will result in the expiration of this permit. GODEO. INSPECTIONTYPE OATE IN1111RL OOER INSPECTIONIYPE OrITE INitMLS 1676 Fized System Final Fire PreVention 206 Final Mechanical 1268 Pool Spa Final L u 208 Final Plumbing 20o Final Re-Root "� IS�Ln—Wt'lJI7(�i� 210 Final Electrical 201 Final Block/Relaining Wall 212 Final Pire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition ' 250 Final BuildingiOccupancy ...` \ WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty o( perjury one of Ihe following declarations: ❑ I have and will maintain a certifcate of consent to self-Insure for workers' compensation, as provitletl (or by section 3700 of the Labor Cotle, for the per(ormance o( the vrork (or which this permi[ is issued. ❑ I have and will maintain workers' compensation insu2nce. as required by section 3700 of the Labor Code, for the peAortnance of the vrork for which this pertnii is issued. My workers' compensation Insurance carrier and policy numberare: `"� �� C�2RI211 ) (IDis sec(.on need iro De romdetetl �(he pe mR is valued af one huneied cbllars (3100J a less.) POIk�yN mber. � ��i L� — �� ❑ I certi(y that in the peAormance 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' compensalion laws of California, and agree tha[ if I should become subject to Ihe workers' compensa[ion provisions of Seciion 3700 of the Labor Cod , hall f rth 1th i iply with these provisions. `^ ` � ,.^. �_._ .. _. Applianl'rSignaWre O� al,. i:--..a. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAI.TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions o( Chapter 9(commencing with Section 7000) ot Division 3 of the Business antl Professions Code, and my license is i/n —tull'f')orpce and effect. �j .6ic,xtf--.. � / D �, � � (T_kGfass # V V� c"?`_��n�"'..t �f i/' r. c^. 1..1'�-k..At� Eo 1 �or's Signat �T��te.} CONSTRUCTION LENDING AGENCY: ❑ 1 hereby aKrtn Ihal Ihere is a constructbn lending agency for the peAortnance o( the work (or which [his pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaWre Dale OWNER•BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury ihat 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 constmct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit to fle a signed statement that he or she is licensed pursuant to the provisions of Ihe Contracrors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of Ihe Business and Professions Code) or Ihat he or she is exempl there(rom and [he basis for �he alleged exemp[ion. Any violation of Section 7031.5 by any applicant for a permit subjects the applican[ to a civil penalty of not more than fve hundred dollars (5500).): ❑ 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 oftered for sale (Sec. 7044, Business and Pmfessions Code: The Contractors License Law does not apply to an ovmer of property who huilds or improves thereon, and who does such work himself or herselt or thmugh his or her own employees, provitled that such improvements are not intended or offered for sale. If, however, ihe building or improvement is sold within one year of completion, the ovmer-builder will have the burden of proving that he or she did no[ build or improve (or purpose of sale.). ❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business antl Professions Code: The contractors License Law dces not appty to an ovmer of property who Duiltls or improves Ihereon, and who coni2cts for such project vrith a contracta(s) license pursuant tothe Contractws License Laws.�. ❑ I am exemp� under sec. Business and Professions Cotle for ihis reason: aoszas �sro�� Owner ID verified by driver's license. ❑ Ves ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property [ax bill or deed�: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cerYrfy that no excavation frve (5) or more feet in depth into wfiich a person is required to descend, will be made in connection with work authorized by this pertni�, and Ihat no builtling struc�ure, scaFfdding, (alsework, or demolition or dismantling thereof, will be more than Ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TRIe 8, Califomia Atlminist2live Code). ❑ As owner-builtler, I will not employ anyone to tlo work which woultl require a permit fmm the Division of Indusirial Safery, as no[ed above, unless such person has a permit to do such work from the division. Applirant's SignaWre Dale Division o( Industnal Sa(ety Permit Number: HAZARDOUS MATERIALS AN� EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant need to (le and certify a Business Plan for emergency response ro release or threa[ened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, tha[ a Business Plan be fled 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 lhan a weight o� 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressetl gas at s[andartl lemperature and pressure). 2. Does or will the applicant or present or future builaing occupant need to (le a registration form (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 0( ihe Cali(omia Health and Sa(ety Cotle, vrith some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any 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 teet of compressed gas at standard temperature and pressure). 3. Does or will ihe applicant or present or (uture building occupant need to prepare an RMPP (Risk Management and Prevention Program for awtely hazardous materials)? � Yes ❑ No (Section 25534 of lhe Califomia Health and Safety Code pmvides that the Costa Mesa Fire Departmenl may require ihe preparation, certi6cation and fling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with Ihe Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Heal[h and Safery Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or fuWre building occupant require for the work which is the subject of this application a permi� for such cons[ruction or modifiwtion fmm lhe South Coast Air Quality Management Disirict or from any other air pollution contml tlistrict or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Code requires that the requested information be tumishetl on applications for non-residential builtling permits). 6. Will any part of �he facility to be cons(ructed under this permit be within 1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No (If "yes", fhe (acili[y must meet Ihe requirement of Sections 25534 and 42303 of the Califomia Health and Sa(ety Code). 7. I� a permit from the South Coast Air Quality Management DisVict or other air pollulion control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Heal[h and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Q('yes", attach certificate of compliance from the appropriate air polNtion control o(fcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcL I agree to wmply with all state laws and city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information qiven is correcL I agree to comply with all state laws and ciry ordinances relating to building consWc�ion, and authorize represen�atives 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 fnal inspec�ion. Signawre ol Legai Owner�s� Date (YL�%fi_[i� � � �� /l o �;Ad'VlofAuNonzea AOPlicam �Date Q Certificate General In(orm:rtion '�'E� �2 -C SiteAddress: Z��FS +..`� �� BuildingType O SingleFamily �Mulii Family Conditioned Flooi Area (CFA): NOTE: T6is jorm ir no� m bc D�sulntiw� V�ducs Gor Opnyu Residenti.il Agency: �n F11 Circle the Front Orientation: I�, E, S, Vd, or degrees Yrojec� Type: ❑ Alterations ❑ Envelope i �'v Replacement or Chan�.e Ow d lluct Rep1 Cnrcstrncted 6uildings nr AAdi�inns °w'rinr uselhe Mnss and Furrinx Slrins Consiruclion mGle n Pa�e 7 ot q uf $tories � Openins of L�amed caviq• alnne-ALera�ions ihnl invoh�e ihe opening oJnc� fi�aned caviq� ojo wall, ceiling, orJloor must insml/!he mand��orr minimum insidation vnfue yer §ISO,ja� �he n6ered assemGlp. Fil/ in Columns A-C and enter ntandalw7� insulafion value in Coh�mn H. D Replacement of entire nssembl y-Replucemeni oJan emire wal/, ceiling, or floa� assembl�, requires 1he installarion oJComponem Packuee- D insulatian valuer in Ta61e ]57-C. Fil/ in Columns A- J. . For the (urred oortiuned of Mass N'alls see A � B � C � D Pro osed "ho" Framing Thickness Tag/ AssemblyName Ma[erial Spacing, ID� orTy e� andSize' or0[he� Nofe: For furmd asse+nblies. accounlinr (or CoNinuour Jnsulafion 1 U- factor' see Construction Table beloe•. Values From JA4 Table Fmmed Continuous JA4 Proposed JA4 Table Cavity Insulation Assembly Assembly Numba'� R-value� R-Value' Cell Valuea U-facmr9 use the Moss and 1. For Tag/ID indica�e the identification name lhal nmlches Uve building plans'. 2. Indicate �he Assembh� Nume or rype: Roa(/Ceiling, Wa71s. Floors, Slabs, Crawl Space, Doors and em...lndicote the Frame rype and Size: For N'ood, Meral, Metal Buildings, Nloss, emer 3z4, 2xG, or e�c... see JA4 ja' o�her possible.fi�ame type assenb(ies. 3. Eiver (he thickness for mass in inches or Spacing Genveen f'uming members e»�er; 16'br 24 "OC; or Other fa� al[ other assembl�+ descrip�ion e•uch as Cnncrete Sand wiclr Panel, Spandre/ Panel, Logs, Sn�an• Bale Pane! and etc.... 4. Based ora �he Climate Zone; enter 7he Sianda�d U_(acim� fi�onr Table I51-B, C or D fm� each differem assem6l�+Name or rype. 5. Emer !he Table number Umi cfosel�� revemGles !he yroposed osrernbh�. G. E+ver die R-value that ix beircg insia(led in the wa(1 canip' or between die fi�aming: alhenvise, enler .•0,'. Z Emcr rhe Coniinunus Lisida�ion R-i�nlue fw� U�e praposed ussemblp; nlherwisr, enier "D". S. Emer �he roa� and enlunm oj�he U facior value based on Co(umn FTa61e Number and en�er �he Assem6lr U fuc�or in Cofumn J ). The Propnsed Assem6lv U-(acior. Calwnn J, nmxi Ge equal ia or less than the Standnrd U-I�c�or in Column E �n comnh�. Futring Strips Consm�ction Table for Mass Walls Onl � � A Ii G D E F G H I .i K L M Praposed Yroperties uf Masonr�• �and Concretc Added Interior or Ex[erior InsulAtiun Walis i�rom IZeference in Turring Space from Referenee doint A i�endia 7�uble 4.3.5, 4.3.G. 4.3.7 doint A endix Table 4.3.13 v yG V C m >. V V LL O j V �F '� N < � o F i=' �.. „ Asscmbly z. j � c't 9 d� � �.� > Final Mass Nmne or JA4 Table a 3 ,�, _ b � � o '� � o- ` c Assertibly Thickness' T r' Num6er' <" - = ui =� � �i 3 � c 4�' m c U-faC[or�'� Commenl I I I Regi.ru�utinn Naunbe�r Regi,rmolinn Du1e/Tinve: HE12S Provider: 20pb' Residential Compliunce Form,s �lubnes! 2009 of Compliance: Residential 2esidentinl A[terrstions Climat�Zone # ��" i 3 of III ROOFING PRODUCTS (COOL ROOFS) §IS](QI2 , When the areu ojer[eriot rooJsurjace tn be replaced rxceed.r u�are tHan 50% oJUre cris[ing raojarea, ar more U�an l,000 j�, �vhichever is less', Urc nerv roofrng arer� nmst meet tlte roofirrg prod�rcl "Coo(Roof'requrrenren[s oj§I52(bJIHi, l52(bJlNii, or I52(b)7Nrii. Check applicaLle alternntiwe ar ezception belom if �he rooJaheration is esemp� jroni �he ronfingproduc� "Coo/ Xoof' reguirements. Note: /Jany one ojthe allernatives or ezception belom is checked, 1he Aged Solar ReJlecmnce mid Thermol Eminance requirements for roofing products in are nol apylicable. Do no� fi(( �abfe belo�+�. &7 Cool Roofs Not Required in Climate Zones I-12, I4, and 16 with a Low Sloped. Less or 2:12 pitch. �Cool Roofs Noi Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less Jternatives [o §152(b)1Hi and §152(b)Hii, Steep-slope roof (pi�ch > 2:12) Lf] Insu]ation wiW a thermal resistance ofat least 0.85 hr� °F/Btu or ai least a 3/4 inch air-spaee is added ro the roof deck over an ariic; or ❑� Existing ducts in the attic are insulated and sealed acwrding to §I51(�10; or ❑ In climate zones 10, 12 and !3, with 1 ft''.of free ventilation area of attic ventilation for every I50 ft' of attic floor erea, and where at least 30 perceni of the free veniilaiion azea is within 2 Ceei vertica! dis�ance of the roof ridge; or ❑ Building has at least R-30 ceiling insulation; or ❑ Building has radiant bamer in the attic meeting Ihe requirements of §151(�2; or ❑ Building has no ducts in the anic; or ❑ In climate zones 10, 1 l, i3 and 14, R-3 orgreaterroofdeck insulation above vented attic. Exception to §I52(b)1Hiii, Low-slope roof (pitcl� <2:12) ❑ Building has no ducts in the attic. Other Exceptions ❑ Roofing area covered by building integrated; photovoltaic panels and solar Ihermnl panels are ❑ Roof constructions thai have thermal mass over the roof inembrane wi[h at Ieast 25 Ib/ft is ex Note: CRRC Product ID Number� The CRRC Producl ID NumGer can cannot be usetl, use ••• ••� iZ]L'' �� 0� �0� �0� �n�7 Weight u npt from the below Cool Rooferiteria. t from the below Cool Roof criteria. Approach to show compliance, otherwise, Aged Solar Thertnal Retlectance�'4 Emittance SRIS �a ❑ I I ❑" `'7�Q� il �� Indicare !he type of producf is being nsed for !he roaf top, i.e aingle-p!y roof, asphal/ roof, rnelal rooJ, e(t. lJ1he Aged RePeclance is nal avuiluLle in.lhe Coo( RoofHaling Com�cil's Raled Pruducl Direcloi7� /l�en rare Ihelni(iol ReJleclance vnluc fr�om U�e same diret�or�� anJ use d�e equalim� (01+OJ(�1��a�- 0.7J la obmin n co7culared aged vaft�e. Where p is �he h�i�ialSolar ReJ(ecmnte. Check Loz ifJ�e AgedHeJlecmirce i.s n calcu(a�ed oalue using Ihe equarion a6ove. Caladaie Jhe SRl oolue Lr using the SR/- Workrheet ai Inrrr/Av�vo- enenm.ca env/lille74/ond emer Ihe res�dring value in Ihe SR/ CoLunrr above and ouuch acop�� of Ure SRI- IVarkshee� m�he CF-IR. i apply Liquid �ield Applied Coatings, the coating mus� be applied across the entire roof surface and meet the dry mil lhickness or coverage commended by the coatings manufacturer and meel minimum performance requiremcnts listed in § 118(i)4. Select the epplicable coating: Alwninum-Pigmented Asphah Roof Coating �0 Cement-Based Roof Coating Other Regisu�Wion Number: Registra�ion Dare/Time: HEILS Provider: 2008 Resideirrial Conrpliance Forms August 2009 ,� � . . . =� Ih�escriptive CertificuTe nf Cumpliance: Residential Resitlentirt/ A1lerntion.c � . CF-1 R-ALT i;-rul;Storiea� H�I:S V�F�IFICAT701� SUMMAPil'' The enforcernent ngcnc.r sliaidd ynr snecial uuemion rn !hr HE/iSldeasm�e,� s7>ecifierl u� lhie checldis/ Gelmr. A camplered mid s��ned CF-4R Fa'+n, jor nl! thc mea.sin�ea speciJied sholl be suLmiued ro liie Guilding irspector Lefmr Jinul D11C1 SBaling ci TCStilld HGIiS verifieniion is requirec!_Jor lhi.� mensure. ❑�'ES ❑ NO 1'CS: lu Climate Zones ? and 9-16, if more than 4U linear feet of new or replacemeni clucts are instnlled in unconditioned - space, the ducts ure io be setded per y152(b)1Dii and the newll' insl•ulled duc�s are �o be insulated pe� §151(i170. ❑ EXC�PT10�: Lzisting duct systems that are eztended; which nre cunstrucced, insW�ueU ur sealed �vith asbes[os. ❑ Y�5 ❑ NO YES: ]n Climate Zones 2 and 9-7 G, if the existing space-conditioning s�rstem (HVAC equipment and duciingl ic replaced, the - ducts are to be sealed per �] S2(b)1Di. � D YES D NO ]'ES: In Climate Zones � �nd 9-1 G; if the existing HVAC equipmeN is reyluced (including the replacement of� Ihe �ir handler; � owdoor condensing unii of a splii system, cooling or heating coil, or the furnace Leai exchan6erj the ducis ar=_ to be sealed per � ] 52(b)1 E. ❑�XCL�PT]On: Duct systems that are ducumented W Lave Ueen previuuslp sealed confirmed thruugli H�RS _ � veriication iu accm�dance with procedures in the Reference Residential Appentliz PJ.3. � � ❑ LXC�PT10�: Uuct systems with less than 40 Iinear feet in unronditiuned space.- . ❑ L�SC�PT]ON: Existin� duct svstems constructed, insulated or sealed with asbestos. RefYiverant Charee - Split Spstem HEILS veriJication is required (or �hi.s measwe. ❑ YiS ❑ NO YES: ln Ciimare Zones 2 and 5-15, when the existine HVAC equipment is replaced (including th: replacement of the air hacidler, outdoor condensing unit of a spli� system A/C m� beat pump, coo]ing or l�eating eoil; or ihe furnace heat Central Fan Inteerated (CFI) Ventilation S,ystem and Fan �'att Dra�� Tlie ventilation renuirements of6lSOfo1 do not apply tn ezistine residenVal homes. Ducted Split S,ystems - Air Conditioners and Heat Pumps: Airflow HER:S ve,�ificatiai is reguirec! jar this nreasure. ❑ Y�S ❑ N 0 YES: ln Climate Zones ] 0 through 15, when the existing spaee-conditioning system (H VAC equipmenl and ducting) is replaced, the airfloH� and ian watt draH� shall be verified uer § 1 S2(b) I Ci to meet the requirements of & I51(fl7B. Company: Author's Declaration Statement this Certificate of Compliance documentation is i 1.Lf /�(�l , � J �. �„%• If Applicable O CEH or (Cer[ification i!): cc � R y � - ci� O � d / Responsible Builcline Designer's Declaratior Statement ' � � J am eligible under Di��ision 3 of tlie Califorma Business and 1'rofessions Code Ln �ceept responsibiGty for tbe build3ng design identiLed on this CertiScate of Compliauce, •] certify Ihat the energy features und performance speciSenUons for the buildfng design ideniified on this Cer�iLcaite of Cnmpliunce confonn to [hc requirements- of 7itic 24, Par�s J and 6 0(� the Celiforniti Code of Itegulations. • The building design lealures identiGed on this Certificate nf Compliance are consistenl wilh lhe infonnntion provided tu documeN this bdJdin� design on the other applicable compliuncc lorme; worLsheets: calculations, ��lans and speciLcnions submitted tu tl�c eidvrcement neener for a�prov�d wii6 �his buildinp permil apPlication. Namc: _ Si�nature: Q ,/ i �'ompanY: Address: CiiylStaiel"Gip�. Uate: License Fnr as.��i.etttnce nr yuestinns r•egurding ihe L•iicroi' Sttuidartls, contacl qic Energ�� Hotli�ic at: 7-k00-i72-3311(/. Icegia'trrnion h4m�ber� Regisvuiinr. Laic?imc: NEI;S Proriner: 2DOS ]tesidei�tial Con�plfance Forms Azigusi 2bOl �� APPROVED CITY OF COSTA MGSA PLANNING DIVlSION SUBIECT TO BLDG. DEPT. REG. NOTE: ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. � � � � a 0 a�6a I�►�K G�y P� F6N�i�J6 '�V-��+�� L��ec. w� �,��, s�� -��/ : T(t-t' 17if,-�r�r 4� � � APPROV ED CITY OF COS'CA MESA PLANNING DIVISION SUaJECT TO BLDv. DEPT. REG. NOTF: ,1DDITIONS, DELfi'CIONS, �OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. i SY:� % _DATE: _�e�[�� - - = - - - - - - - - -� I �� -- g � --�i ' � I r i i � y„ (? � (',v,vC2►�-rF r� I � I� n e �+% �u� �.3n � 1 I a.''-�� i�'�`�e�KS� � ��_ � C w� �' � .� _ � -� , , - -- - - - --.:_�_._-.__._ �.u- _--�-----___. __ -�---- —=-- R �f e� Io' �-e�.L. (�D (1 itAb G �� pn� � ��5 COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFORNIA FOR APPL/CANT TO F/LL /N COMPLETEC TYPE OR PRINT ,� BUILDING e��"� ��Lk� ADDRE55 z�b�. ��lOLI�t- � COS7A MESA, CALIFORNIA � MAIL esa C�a1if, Carlson & LEG�L ILOT DESCRIPTION NO. A.P. NO. SIZE 1�1� X OF LOT USE OF EXISTING BLDG. T ^��'�•^" • "'E FFOM B EXTERI Inc. NO.OF BLDGb. �AEET 50� �C� REAR YARD ],2� ILEFT 12� IRIGHT I.S� DESCRIPTION OF WORK NO.OF RA(]Mc ROOF r ,�`�tE��t�Ez1VE�3 APPLICATION FOR PERMIT fIN��j� . CITY 0� CnS1A M€�A FOR OFF/CE USE ONLY PECEIPT NO. PEANIT NO. Z�L4tti:� N�D §Y. I DRTF� RELEIVEU_�I DATE ISSUED BUILDING FIRE �� COSTA MESA. CALIFORNIA TVPE � GROUf�'� DATE ZONING NO. OF USE OF NEW PLANS ^ BWLDING IL. ST.) .73 � � attached garage. (Four living units} I HEREBY ACKNOWLEDGE THAT 1 M�VE NEAD THIS APPLICATION THE AMOUNT SHOWN UNDEH VqLUAT10N IS FOR THE /NO BTPTE THRT THE A90VE IS CONPECT AND qGFEE TO COM� pVRPOSE OF ESTqBL19HiNG q PERMIT FEE ONLY. pLY WITH ALL CITY OpO1NANCES AN� 9TATE LAW$ REGIILATINC 0ulLotnG CONSTftuQ(ON. VALUATION - SIGNATURE OF � PERMIT FEE $ f�� PERMITTEE $ PLAN CHECK $ QS.00 AUTHORRED AGENT D�e & C egirove, Zi1C. 30,973"�.BD TOTAL FEE $ %rJ.�