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Home My WebLink About2202 MINER ST - Building Permits, (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cBaUILDING PERMIT �� FAIR ORIVE, COSTA MESA, CA 92626 JobAddress: 2202 MINERST Suite: Vicinity: HOUSE & ATTACHED GARAGE ParcelNumber: 42219312 Applicant: HENNINGER, NORM Address: 13052 EDWARDS WESTMINSTER, CA Owner: HART, WALTER C TR Address 2202 MINER ST Zoning: Phone: (714) 895-6677 Zip: 92683 Phone: COSTA MESA, CA Zip: 92627 Contractor: AFFORDABLE ROOFING & REPAIR Address: 13052 EDWARDS WESTMINSTER, CA Zip: 92683 Arch : Address: Phone: (714)895-6677 License: 755616 Eng: Address: ISSUED BY: Status: ISSUED Applied: 07/09/2001 Issued: 07/09/2001 Phone: � Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (30 SQ). TEAR OFF EXISTING ROOFING, INSTALL 30# ASTM FELT UNDERLAYMENT, 8 REROOF WITH 25 VEAR COMPOSITION SHINGLES ON PITCHED AREA & BUILT-UP ROOFING ON FLAT AREA. . - Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.55 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.80 FEE SUMMARY _ Calc Valuation: Claim Valuation: '" .. �� . PLANNWG & ZONING < '"- � SETBACKS MAIN STRUCTURE Front 0- 0' Rear 0- 0 ACCESSORY Fmnt 0-0 � Rear 0-0 PARKING Existinq: o Required: o NOTES: Left 0- 0 � Right �0-0 Left 0- 0 . " Right � 0- 0 Pr000sed: .0--�� - $5,500.00 $5,500.00 NOTICE: The work authonzed by ihis permit shall comply with all applicable handicap access raquirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) 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 tinal approval will result in Ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 ?da8�d8 (W00) WORKERS'COMPENSAnON DECL�NAnON: — � I hereby afflrm under penelry of Derjury one oi ihe following declarations: ❑ I have end will meinlain e cerli�lcate of consenl Io self-Insure tor workers' compensation, as provitled for by section 3700 of the Lebor Code, for t�e pertormence of the "'��work toi which Ihis permit Is Issuod. � ��I�have antl will meintain worker5' compensalion Insurance, as requiretl by section 3700 of the Lebor Cotle, for the peAormanca ot ihe work lor whic� Ihis pertnit is Issuetl. __My.wor ^compensatlon Insurar�e�arrier ntl policy number are: .__ __ [Y Carrier: (� f= U,N� Pollcy Number: I S' ��) Y�- �� ((hls sectlar need nof be comp/eted 7/ the permit is ve/uetl e! one hundred dollars ($100) or /essJ ❑ I certity thet in the peRormancd ol ihe work for which this pertnit is issued, I shall not employ any person in eny menner so as to become subject to the workers' compensatlon law oi Cell mle, and egrea thet tl I should become sub�ect to the workars' compensetlon provislons of Sac' n�700 of the Labor Cotle, I shall torthwlth complY with th se ro;s s. AppllcenCSlgneture:� � � � CDete:_ � �/� � �� 7 WARNItJG: FAILURE-TO5 RE WOPKERS' COMPENSATO�t' �RAGE IS UNLAWFUL �NU SHALL SU91ECi AN EMPLOVER TO CRIMINAL PENALTIES AND dVIL FlNES UP TOIXJE HUNORED THOUS4ND DOLURE (5100,000), IN ADDRIOM TO THE COST O M ENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3]OB OF THE UBOR �DE, INrEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirtn.that Lem.11^ense� � er prpvjsions of Chapter 9(commencing wilh Section 7000) ol Division 3 of torce and elfecL Llc. a i� ��f LC Code, and my license is in full CONSTRUCTION LENDING AGENCV: U ❑ I hereby aflirm ihat there is e cons�ruction lending agency for Ihe peAormance of the work for whic� ihis permit is issuetl. (Sec. 3097, Civil Code). Lendefs Name: Signeture: _ Lentler's Atldress: Dete: OWNER-BUILOEF OECLARA710NS: I hereby aNlrm thet untler penalry ot Per�ury that I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, eusiness entl Protessions Code: Any city or counry which requi�as e permit to consimct, altar, improve, demolish, or re0eir eny stmcwre, prior to its Issuance, elso requires iha appliceN for such permit to Nle e signed statement ihet he ar she Is Iicensetl pursuent Io ihe provislons of the Contrectors Llcensa Lew (Chepler 9(commencing wllh Sectlon 7000) oi Divlslon 3 of the Business entl Protesslons Code) or thet he or sha is ezempt thereFrom and the besis for tha ellegod exemption. Any vloletion of Section 7031.5 by any epplicant tor e permit subjects the epplicam to e civil penalry ol not more ihan live hundred dollers ($500).): � I, es owner oi the properry, or rtiy employees with wages as their sole compensation, WILL DO THE WORK, ena the structure is noi intendetl or oflered tor sale (Sec. 7044, Business antl Professions Code: The Contractors License Law tloes not epply to an owner ol properry who 6uilds or improves ihereon, and who tloes suc� work himself or hersetl ar throu9h hiS or her own employees, pravitletl that such Improvements ere not Intended or otteretl lor sele. If, however, ihe builaing or improvement is sold within one yaer oi compledon, the owner-builder wiil have ihe burden ol proving that he or she tlitl not build or improve for purpose ot sale.). ❑ I, as owner ot the Droperty, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Protessions Coda: The contrectors LJcense �-ew doas not epply to en owner ot propeny who 6uilds or impmves thereon, end who contracts br such pmject with a contrector(s) licanse pursuent to the ConlraG�ors Licen50 Laws.). ❑ I am e:empt untler sec. Business entl Prolessions Code tor this reason: Signature: Date: Owner ID veniied by drivefs license. ❑ Ves ❑ No DriveYs License No. Expires: Vedlication oi Ownership by (rype of documem, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMR CER7IFICA710N: ❑ I hereby certity Ihet no excavetl� live (5) or more teet in depth into which a person is requiretl to tlescend, will be metle in wnnaction with work authoAzetl Dy Ihis permit, entl t�at no building siNCWra, scaftolding, falsework, or demoli�ion or dismantling t�areoi, will be more Ihen thirry-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Ttle 8, Celifomia Atlminislretive Code). ❑ As owner-bulldar, I will not employ enyone to tlo work which would require e permit trom lhe Division of Industnel Sefety, es notetl a�ove, unless such person hes e permit to tl0 5uth work from ihd divi5ion. Signature: Date: Division oi Intlus�rial Selety Permit Number: CERTIFICATE OF COMPLIANCE ANO AUTHORIZATION OF ENTRV: I cenify under penalty of perjury Ihat I have read �his eDPlication and state that the informe�ion given is correct I agree to comply with ell sta�e lews and ciry ordinances relating to bullding constmctlon, end euthorize representatives of the City of Costa Mesa to entar upon the above-descnbed property for inspection purposes. I agree not to acupy or allow acupancy ot any building euthorized by this permit until linel inspection. GODE /. INSGELTIONTYPE 1616 Fised System Final Fire Pr 7266 Pool Spa Finel 200 Finel RB-Rool 201 Final BIocWRetaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Finel Demolitlon QR¢ IHf1iIRL5 � � 0 COOEI INSPECTONTYVE 206 Flnal Mec�aniWl 20B Final Plumhing 210 Final Electriwl 212 Final Fira Preventlon 220 Final Planning Approval 222 250 Final Site Final Building/Occupancy u� u�s i Applicant la fill in all SpdCCS e%[!p� 1hO58 Wit11111 CiTY OF COSTA MESA CONSTRUCTION PERMIT ProjectAddress 72 �' a M/J��7� �� 7 ', Applicant's Mailing1 .A�d ress .S�M� —��'�E' z/ Owner's Name �'✓ �L-� �- ��7— Phone E`f�'" 7 Address Arch/Eng. License No. Address Coniracmr's Nam Phone � Address (mailing) City License No. LICEf�lSED CONTRACT00. DECLARATION ' 1 hereby affirm tnat I am Ilcensetl untler provi5ion5 of Charter 9(commencing with sec[ion 7000) Ot Division 3 ot Ihe Busine45 antl Profezsions Cotle, antl my Ilcense is in full force ana e ect License Class �(cenze No. Dale Sig atur WORKERS' COMPENSATION DECIARATION � ' I hcreDy affirm Shat I have a certificate of consent co 5¢It-lnsure or a certiticate of Workers' Compensation Insurance,��or a cert�fietl copY Ihereot (Section 400, Lab. C.) �Ilcy No. Company �Cet[ifietl capy is hereby tu�ni5M1e0. Certifietl copy is filea with the city Builtling D��sion. Dat¢ AOPlicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be compleletl i/ Ih¢ permit �5 for one huntlretl (E100) or less). I certify tha[ in the pertormante Ot [h2 work for which thi5 perm�t is i55uetl, I snall not employ any person in any manner so as to become subj ct to the Worker'LComy ensa(�on ya ws of CalHomia�. � / > Dale S^ 8 �-•i%`Y Si9nature r/v�/ �-L��/ �� NOTICE: If, after inaking this tleclaration, you s�oultl become subject to tlte Workers' Compenution provisions of the Labor Cotle, you must torthwith comO�Y w�th SUCh provisionz or [his permit Shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I he�eby at9rm that th¢r¢ is a[onstruction lentling agenty tor the p¢rtormance of the work fOr whiGh Ihis permlt is i55uetl (Sec[iOn 3097 Civ. C.) Lanaer's Name� Lentle�'s'Ftltlre55 OWNER 9UILDER DECLARIITION� � I �ereby a(firm that I am exempt from che Contractor's Li<ense L.aw tor tne following reason (Section 7031.5 Businesz antl Professional Cotle: Any <ity or COunty which requires a pe�mit [o construct, alte/, improve, tlemoli5h Or repair any structure, prlor lo its issuance, also requires Ihe applicant for sucn oermit to file a signetl Statement that he/she is licensetl Pursuant to Ihe provisions of the Contractor's License Law (Chap[er 9.(commencin9 �+Itb SecUon ]000) ot Dlvision 3 of the Bu5ine55 antl Profe55wn5 Code) or that he/she i5 exempt Iherefrom antl the basis fo� th¢ allegetl exemption. Any vlolation ot SeCtion �31.5 by any aoo�icant tor a petmlt subjeG�s the appliwnt t0 a civil ' alty ot not more than five nuntlretl tlollars (5500). I, as owner o( the propetly or my employees with wa9e5 as lhei� Sole comp¢nsation, will Uo lhe work, antl Ihe itructJ�e is not intentl¢tl Or Oft¢retl tor sale (Sec[ion 7044, BuSin¢55 antl ProtessiO�al Cotl¢: The Con[ractor's Licenze l.aw tlo¢s not apply to an owner of a proPertY "/ho GuiltlS or Improvez thereon, antl wno Coes such work hlmselt/hers6lt or through hiz or her own employees, p�ovltletl that sucM1 Impruvements arL ��ol Intentletl or otPoretl tor sale. If, however, the builtlinq c� imOrovement is soltl wllhin one yea� of com- o�etion, the owner will have tne burtlen of provi�9 he/she tlIG not bulltl or im- �rOve for the purpose of Sale). LI I, az owner ot the prooerty, am exclusivety tontracting with Ilcensatl con- , IfdCtO�5t0 ConSt�UCI [hC P�q¢Ct ISection 7044, Business antl ProfesSions Cotle: The ConVactor•s License Law does not appty Co an owner of Property who bulltls or improves thereon, antl who mntracts for such projects with a<on- [ractor 51 license pursuant ro the Contractor's Utense Law). I am aware tnat p�oo f their WprkeYs Compensation in5u�anLe shoultl be provitletl to me. I am exempt untler Section � B. & P. Q(or this reason Da[e � ' Owner LVn C-tP �'� A � I hereDy certity that I have r¢atl thls apptication antl sfate that the above Iniorma[ion is correct. 1 agree to comply wiih aP city antl countY ortlinan<es an0 state lawz rela[inq to builtling con5truction, anU hereby auth0/Ize repre- snntatives oi this city to enter upon the abPve-mentionetl o�operty tor Inspection purpose�� - �r Date � -9^'d"` Signature i DrWers' License Or 55 � CMF 0865-46, rev. 4/84 barOer linas antl si9n ali apD/o0/iate Oeclarations. LOT NO. UNIT N0. �-/�SO�� I � I I TVPE OF CONSTRUCTION �JEW L� ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCV_ C O N ST RUCTI ON T V PE V A LUATION 5 ZONE GftADING CU. VpS. � ACRES— Remarks: Bar Sink 8ackflow Preventer � Backflow Irti9ation Bathtubs Clarifiers Dishwdsher ' Drinking Fountains Floor Drains Floor Sinks Gas Service Intercepmrs ( Kitchen Sink � � Lavatories P-Trap Roof Drains Showers Service Sink $ewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Hea[er Wa[er Service FEES Reinspectian Fee � � $15 � � laue Fee . � $ 3 Duct � Under Ground Duct - Struc W ral Duct - Ventilating ExhaustSystem ❑ MWtiple Firepl/Facc elt. ICBO # Heating System & Ducting ❑0.700,000 BTU 0100,000 Reinspection Fea White - Builtling: CanaYY - APPlicant; Pink - Accounting; Goltlenrotl - Aszessor $15 Hood or. Typel ❑ Canopy Typell ❑ Refrigeration System Oaioo,000aTu ❑ioo,000sr System Repair/Alteration Issue Fee A.P. # S Main Buildi E T Front B Rear A C Right K g Left Ping. Ref. # Planning Notes: 0005 5/OB/B4 Bui Parking Req./Provided ELECTRICAL � Automatic Washer Transformer 0 15-50 KW � Consvuction Pole Sub. . � 50 + KW Cooking Unit . Meter ❑up to 100 amps , Dishwasher Meter ❑over100amps Dryers ❑Gas ❑Electric Sub Panel Fan � Momrs�0-1HP�1X-6 ' F.A,U. Inc.Solar 09�75 HP �16-15+ Fixtures Microwave Device Boxes pole Light Outlets � Range Switches S�gn Garbage Diiposal Standing Sections Generator �0.5 KW 05-15 KW Trash Compactor Zone g.00 TI FEES Z O N 1 N G R E � M T S. Reinspection Fee ' $75 Issue Fee $ 3 FEES DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved BV Date Building Approved By Data—�_�-��j�p�� Applintion 15sued By � � �� / Data_�+L.:.C�-= SUMMARV OF FEES BUILDING PEFiM1T $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ _�� ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% § MICFOFILM $ MECHANICAL $ TOTALFEE $ .�, Od $ 3 PLAN CHECK 25% $ CONSTRUCTION ANDPLA ING POOLF > APPROVALS Permit# � �� Date Inspector qppROVALS Permit# _ Date Inspector 1. Temporary Electrical Service or Pole • . 52. Pool & Equipment Location � i2. Soil Pipe-Undrgrnd. - . 53. Steel Reinfarcement • �3. �lectrical Conduit Utility-Undrgrnd. , � 54. Forms � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � 5. Steel Reinforcement - � 56. Rough Plumbing & Pressure Test , 6" Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE • � 7. Footings ' - , 58. Electrical ConduibUndrgrnd. • 8. Foundation � � 59. Gas Pipe, O Undrgrnd., Test � • 9.� Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, O 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 � i6. 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 � 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. C.as Pipe-Rough & Test 72. Underground Flush oof Framing 73. Undergrnd.StorageTank OGas ❑Oil t'5. 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. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.�Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � �y ,� 39. Water Service-Final . � 40. Gas Service-Final 41. Solar pomestic-Final , i 42. Backflow Preventer � 43. Backflow Irrigation , 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electrie Release to Edison 50. Gas Release to Southern California Gas Co • . 51. CERTIFICATE OF OCCUPANCY � I No. Date - • � CITY OF COSTA MESA BUILDING DIVISION OWNER-BUILDER VERIFICATfON 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 permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delaY in processing and issuing your building permit. No building permit will be issued until this verification is received. r 7. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No 2. I(hav have not) signed an application for a building permit for the p posed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name � ✓ b �P4 ,f�(p Address �� d/� /�O �%� City MP Phone ( 1��'`��D% — Contractor's Lic. No. �'�Q 7.�/ 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the malor work: Name Address City Phone ( 1 Contractor's Lic. No 5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phane Type of Work I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this St��ate/// law. Signed: _�'Y�� `-(''��Yl�� Date: 6 '_�-_`Q � Name: �°/� `�Pl� �• /T a�1-%� � (Printed or Typed) C.D.L. #or S.S. # �` / CMF 3042-46 754-5273 owrr�x p�S, CHARLES H, nnTE 11-1-61 JOB ADDRESS p202 Miner Street BUILDING PERMIT NO. 15759 . GL:NEI{AL CONTRACPOR ��r��lli�dEr VALU� S�QQQ�Qp � rps AP No.115_08�_1!i LOT TRACT FIRE ZONE DESCRIPTION OF WORKAdd F3m.rm.tn / INSPECTIONS DATF. � GROUP T TYPE p ZONE SUI3CON'PRACPOR /� i�� . r\ / � • �rJ'��9 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 9f7 COBTA MEHA. GLIFORNIA For Applicanf to Fill In Complefely TYPE OR PRINT BUILDING � ADDRE65 .Z O ��vr'��/ COSTA MESA. CALIFORNIA 0 61ZE No. or etoas. / OF LOT NOW on Lor USE OF EXISTING BI�G. SEfBACK LIN6 RRON DESCRIPTION OF WORK BUILDING .(� / � NO. OF SIZE �`� O ROOMS EXTERIOR W.4LL IROOF COVERING COVEF USE OF BUILDING AND WORK TO E � rs.�n� , i� /JYiw /�' �.Q.I � I HERHBY ALKNOWLEOOH THAT 1 X�VE REAO THIB APPLIGTION AND BTATE THAT TXE ABOVE 18 CORRECT AND AOPEE TO COM- PLY WITH A�� CITY OPOINANCEB AN� eTATH LAWB REOUI-ATINO BUILOING C�N6TNUCTION. SIGNATURE OF PERMITfEF Ftr RECEIVED OC7 31 !�� FINANCE DEPT. CITY OF COSTA MESA APPLICATION fOR PERMI7 suaoiN� For Office Use On1y ar L�ING � �O -7 � V IRESS ` .( �,}1_ COSTA MESA. CALIFORNIA ZONlNG ZO NO.OF UBE OF � I nLANe . BUILD�NG LEOAL � U I� \ OEBCHIPTION K .L A. P. NO. 1 1� — O� J ` I VARDS EVES APPROVED AI.LOWEC (CLNTER LIN6 8T.) ' -�� 1/ GG / TXE AMOUNT BHOWN UNOEP VALUATION I6 FOR THE PUIiP08B OP EBTABLI6HING A PERMIT FEE ONLY. VALUATION n � PERMIT FEE $ � S� � `� � � PLAN CHECK $ J TOTAL FEE S /� y �H OWNER O�CONNOR, Frank J. DATE 7_9�k'j ]OB ADDRESS 2202 MiReT St. Bll1LDING PERh71T NO. 5409 GENP.RAL CONTRACTOR S31rt2 � __ ' VALUE $ 9�996.00 AP. No. LOT 12 '1'aACT 323q [�[uE ZOtvs DESCRIPTION OF WORK Res W�Btf, g�r GROUP I& J 1'YPE V ZONE RJi PLAN NO. 5351 ECTIONS I DATE_I gUBCONTRACTOR I DATE PERMITSNUMu ER Tut ' - -'�� 5351 GOSTA MESA BUILDING DEPARTMENT P.O. BO% 31l COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN ADDREI55 ZZ�Z �/v(/%%�rL �� COSTA MESA. CALIFORNIA OWNER .�/�G v[ D �fi(f/CJO�� CITY ARCHITECT OR ENGINEEF ADDRI CONTRACTOR ADDRE55 LEGAL oEscnirnoH A.P. NO. y`4 G� EXISTING BLOG. SETBRCK IINE FROM � CENTER OF STnEEi iv �� =Ji TEL. NO � � LIC. NO. ��rv ��. �4 NO. TEL. NO. TRAp �l�/I BLOG6. �1'AYY ON LOT SIDE VARD PIGHT � LEFT � F� DESCRIPTION OF WORK NEW ALTERATION I AODITION REPAIf // MOVI/NG DEMOLISH BUILDING /yL1� p .S'�i(O ROOMS � STORIES / SIZE y�0�y'+�' E%TERIOR WALL `Gu� ROOF COVERING �• GOVER"IN�G �B� USE OF NEW . fi_ $�! � y- /�` � BUILDING /Gf% L� L/ V—' l��.L(�!__/ FEE RECEIVED � �"-� � � lP �"� � � � . FINANCE DEPT. A�LI�A��1ME$&R PERMIT BUILDING FOR OFFICE USE ONLY wECE1PT NO. < PERMIT NqO V �� / ECENEO BV [�FTE RECErvEO D<TE ISSVE �/ i _ �,i_,r � - q -.� BUILDING AOORE55 COSTA MESA, CALIFORNIA APPROVED BY DATE CORRECTIONS STnTE TMnT TME /�BOVE I5. OARECT �ND �GflEE i0 COMPLY WITH wLL CITY OPDININCES �ND 5 E L�WS REGULAi1NG BVILDING CONSTRVC� iioN. VALUATION /� SIGNATURE OF PERMIT FEE 5 r PERMITTEE qqq��•/� �7 PLAN CHECK S l Y 5 AUTHORIZED AGENT TOTAL FEE 5 �� v°'"i