HomeMy WebLinkAbout2279 MINER ST - Building Permitsa
.
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c��ILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
,lob.4ddress: 2279 MINER ST
Suite:
Vicinity: 4-UNIT APT COMPLEX �
Pomary Occ: R-� HotelslApLSIRes >70 Occ Type of ConsWction: V-N
Parcel Number: 42216214 Zoning:
ApplicanC SCHULZ, JOHNNA
Address: 555 W 182ND ST
GARDENA,CA
Owner: WAKABAYASHI, DAVID TADAO
Address TR
HUNTINGTON BEACH, CA
9791 KINGS CANYON
Contracmr. CENTRAL ROOFING COMPANY
Address: 555 W 182ND ST
GARDENA,CA
Zip: 90248
Arch :
Address:
Phone:
Phone: (310)527-6770
Zip: 90248
Phone:
Zip: 92646
Phone: (310)527-6770
License: 684960
Eng:
Address:
ISSUED BY:
Slatus: ISSUED
Applied: O6/29I2005
Issued: O6I29I2005
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF APT BLDG: T/O EXISTING ROOF, INSTALL NEW 1/2' PLYVJOOD TO LOWER 10 S�UARES OF FRONT LOWER MAIN HOUSE,
REPAIR/REPLACE SHTG ON PITCHED ROOF, 1 LAYER 15ii FELT, APPLY 30-YEAR COMP SHINGLES.' 26 SQUARES
CARPORTS: INSTALL 28# BASE, APP MODIFIED BITUMEN BY TORCH DOWN. 7 SQUARES
Plan Check: $0.00
Permit $139.25
SMIP Res: $0.61
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.86
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existina: o
Rear 0-0
Rear 0. 0
Reouired: 0
FEE SUMMARY
Calc Valuation: 5s.�oo.00
Claim Valuation: ss,ioo.00
PLANNING & ZONING
left 0- 0 Right
Left 0- 0 Right
Pr000sed: 0
0- 0
0- 0
NOTICE: The work aulhorfzed by ihis permit shall comply with all applirable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § 1, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this pertnit to be considered �egal, such work must comply with all appilcable cotles, ena ell
requlred Inepectiona end final epprovel must be obtained. Feilure to obtain inspections and final approval will resul� in ihe expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545628
2N&�8(fl�00)
WORKERS'COMPENSAnON DECLARAnON:
I hereby eKrtn under penelry of perjury one ol tha tollowing dedaratbns:
❑ I heve entl will mainWin e certllicete at consent to sell�lnsure tor workers' compensetlon, es proWded lor by section 3700 ot the Labor Code, for Ne pertortnence of the
work for whic� Ihis permit Ls Issued.
��iavo antl will mainWin wwkers' canpensatian insurarxe, as repulretl by section 3700 ot Ihe Lebor Cade, tw I�e perto�mence ol the woAc for which this pertni� I515weC.
eMy workgrs: Qwn�tlan Iqeme� r�ier an0 pdky number ere: P�� r ���j ��
(71i�5� 'f�� � ,�'_� l
on need not be complefetll! fhe pertnif !s velued et one hundred ddlers (5100) or Iess.J
❑ I certily that in the peAormenc af t�e w lar w ich tNs permlt Is Issued, I shell not employ eny person in an mflnner so es to bqqq¢¢¢ome sub'ec))) �o t�e workera'
wmpensatlan lews of Celtlo a, end e re Iha I sha ,ome sub�ect to the warkers' compensatlon praAslons o��tlon 37� o� e Lq�r Ca�e, I sliell fonhwiN
comply wlth Ihese / / r
A��Ice�t$Ip0 ure: petV--a J '
WA♦NJJ(NCiiFNWRE T SECURE • ENSATIdJ �VE E IS W R1L MlD SHALL SU6JECr M! EMPLOVEP TO CRIMIIUL ENALTIES D CML FlNES UP TO ONE HUNDRED
THWSWDDOILARE�5100.OW),I MDITIONTOlHEWSTOFCOMP TION,QAANGESASPROVIDEDFIXiINSEC(ION3]OBOFTHELABORCODE,IMEREST,ANDATTORNEV'SFEES.
LICENSED CONTAACTORS DECLARATION:
I hereby eHlrm ihat I em Ilcenj etl r sPi
lorce end eHecl. Liofl/-1 l�% ��/'
Section 7000) ol DlNslon 3 of t�e
and my Ilcense Is in tull
CONSTRUCTON L�NgING AGENCY: �,
❑ I herehy eflirtn thet Ihere is a cansWcOon lentling e9ency tor the peAortnance ol Ihe work lor whlch this pertnil is Issued. (Sec. 3097, Civil Cotle).
Lentler's Neme: Lendnrs Addrass:
Signetura:
OWNEH-BUILDER DECLARA710N5:
Date:
I hereby eMirtn thet under penalry ot perjury Net I flm EXEMPT FROM TME CONTHACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5, Buslness entl Pmfessions
COGe: Any ciry or counry which repuires e pertnit ro construct, alter, improve, demolish, or repair eny slructure, pnor to its luuance, also reqWres Ihe applicam tor suc� pertnll
to iile a slgneC stetement ihet he or she Is Iicensed pursuant m ihe proWslons of �he Contractors License Lew (Chepter 8(commencing wit� Section 7000) of DMsion 3 of the
Business end P�ofessions CoAe) or ihat �e or she is exempt therelrom end the besis for the elloped exemptian. Any vialatlon of Sectlon 7031.5 by eny epplicenl far e pertni�
sub�ects Ihe epplicant to e cMl penely ot not more than frve hundred dollars ($500).):
❑ I, es owner oi the praparry, or my employees with wages es t�eir sole compensetion, WILL DO THE WORK, end Ihe structure Is not intended or oHeretl tor sale (Sec.
7044, Business and Professions Coae: The Contractors LJcense Law does not apply to an owner of properry who builds or improves t�ereon, and who does such work
himsell or hersetl or through his ar her own emplqrees, provlEed thet such imprwemen45 ere not Intendad or aHered tor sale. II, however, Ihe building or imprwement is
sold within one year of completion, the owner-builtler will heve the burden of proving ihat ha or s�e tlitl not build or improve for purpose of sale.). '
❑ I, as owner of lhe properry, em EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct the prqect (Sec. 7044, eusiness end Pmfesslons
CoEe: The conireccors LJcense Lew does not appty to an owner of property who �uiltls or improves Ihereon, and who contrecis for such project vrilh a contractor(s)
license pursuant to the CoNrecloro License Laws.).
❑ I em evempt untler sec. Business end Professions Code for �his reeson:
Signature: Dete:
Owner ID veAfietl by drivers Ilcense. ❑ Ves ❑ No Drivers Ucense No. Expires:
Ved11ce11on of Ownership by (type at tlocument, i.e. - property tex blll or tleetl): __
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFlCATION:
� I hereby cenify that no excevetlon fNe (5) or more feet in tlepth Into which e person Is requlretl to Cescend, wlll be mede In connectlon with work euthorized by Nis
pertnit, and Ihat no buiMing structure, scattdAing, falsework, or tlemdltlon or dismantling thereol, wlll be more then thirty�sla (36) feet high. (Chep. 32, Gry 2. An 2, Sec.
341, Tltle B, Califomia Adminlstrativa Code).
❑ As ownervbuilder, � will not employ enyone to tlo work w�ich would require e pertnit trom the Divlsion oi Intlustnel Sefery, es noted ebove, unless such person hes e
pormlt to do sucn work irom Ine tliWslon.
Signeture: Date:
Division of Industnel Safery Permil Number:
CERTIFlCATE OF COMPLIANCE AND AIJfliOR¢ATION OF EHTRY: 1 certity under penalry ot perjury ihat I have reatl this epplicalion antl state thet Ihe Informatlon given is
correct. I egree �o comply wilh ell stele lews entl dty orAlnances relailnp to Ouiltling construction, end euthoAza represeniatives of Ihe Clry of Coste Mese to enier upon Ihe
ebove-descdbed property tor �nspecUon purposes. I egree not to oaupy or ellow oxupenty ot eny bulltling euthorized by this pgrmil until fnal inspecUon.
System Flnal Fire Preventlon
1288 Pool SOe Flnal
200 Flnal Re-Roof
201 Flnal BIacWRetelnlnp Well
202
203
204
Finel Factory Fire Place
Flnel Sign
Flnal Demalltlon
�_7 ��
SY 2-DS' L(�
COOE� INSPECTIONTYYE
208 Finel Mechanicel
20B Finel Plumbing
210 Finel Eledrlcal
212 Finel Fire Prevention
220 Finel Planning Approval
222 Flnel Slte
250 Flnel Bulidlnp/Occupancy
P�ff. It�
PNOIE�TAU0flE55: ZZ'�c3 ,u,IPIER ST
'owxexsxame: WAKAHAYASHI, DAVID TASAO
noosess: TR
9�9i KZNGS CANYOhI DR
HUNTINGTON BEACH,CA 92646
AflCNIENGINEEfl:
AUDXESS:
NEC.NO.:
UNIT:
UNIT:
PEXMITTEE: TOM BYER ROOFING ( 719 ) 847-9332
nooness: 17662 METZLER LN B
HUNTINGTON BEACH CA 92647
LICENSEo CONTFlAC70H OECUPATiON: I nere0y allirm itut I am licensea under provisions ai ChaD�er 9lcammencinp witn Section
7000� ol Oivisian 7 0l ��e Business ana Pmlessions COUe, an0 my litense is in lull for and eHec�.
cirruc.: p� q7;lz srareuc.:57500� ss ( 3� EXD� �9/95
ate'_�. — 1yC�� SipnaNr¢: _ - —
� --`�
PRENS'COM ENSpT10NOELNM710N: I�er¢Dyallirmi�atl�aveacertilicateotrnnsen �� araceniliwteofWorkers'
Compensa�ion Insurance, a� a ceniliea copy thereol (Sec�mn 9800. LaG. C�.
raucrNo.: 285-99 UNZT 255 ExP.oaTc: 01/01/95
COMPANY: STATE FUND
� CenifieJ opY is Aereby tumk�eE. CQ Cenifie0 eopy u IileG vui� the ciry BWEinA ��on.
Oa�e� L _I�_�G`4._ AVGlitan.
%E EMPTION F M WOH8EP5' fAMPENSl1➢ON OECUIIATION: QNs secian nee0 iwt De mmplete0 ii tA r n i r one huntlreC (5700) or less�.
I t¢tlity Ihal in Ihe pedormdnt¢ 01 �he wOrk far whit� �his pCrmii i5 i55ue4 I Shall noi empl0y any per50n in ny manner so as to 6ecome
suble�� �o ihe Workers' Campensation Laws ol Califomia.
Oa�e: SiQna�ure:
NOTICE; II. al�er making t�is EeGaraiim, you s�oulG 6ecame su0ittt Io IAe Wotkers' Compensauon O�avisions ot �he LaUar
Catle. you must taMvnt� mmpty wit� suc� provisions w tNs permit slull Oe tleeme0 rewkM.
LONSTPOCTION LENOING �GENCY: I he20y atlirm itut t11ert is a mnstructian lending a9enty lor Ne pe�ormance ol tAe work tar
whicn inis Dermn is rcsuea (Sectmn 3097. Civ. C1.
IENUEfl:
AODNESS:
OWNEB BUILDEB OECIAflATION: I h¢ce0y aflirm Ihdl I am ¢K¢mpi IrOm f�e CAnVaCiors' $Iaie Lit¢n5e law �or IAB �ollowinp reason
�Senion 7031.5 Business antl Protessionat Cotle�. Any ciiy ol county w�ic� repui2s a Dermit to constmct, alter, imD�ove. Demolish, or
ieDair any simcture. Drior lo ils issuance. also Rpui�es Ine aoVliWnt lor sucn oermit to lile a sipnetl stalement tnat he/sne is licensetl
pursuant �o ine pwvisions ot ine Convacmrs S�ate License Law �Cnapier 9lcommencin0 ��h Section 7000) ot Oivision 3 ot �ne Business
ana Pm�¢SSions CoOC) Or I�ai M1e/S�C is ezempi t�¢relmm anOl�e Ea5i5lOr I�e all¢pe0 exempli0n. Any viola�i0n o� SeCiion 7031.5 by
any applicanl tor a p¢rmi� SUUIe��s I�e applitanl l0 a Civil penally 01 noi more I�an �ive �unEreO 40I1ar5 (5500).
i, as owner of ine propeny or my emVloyees vnt� wapes as t�eir sole compensatian, will Eo tAe woA, an0 t�e
❑ stmcmre is not intenaea ar onerea for sale (Secuon 70aa, Business anC Prolessional COAe: The Contractors' State License Law
eoes noi aOVry to an owner of a pmpeny wlp OuilOs ar imOrwes �Aereon, anU wM Eoes SucA work �imsel0�erseli or tAmuAh
�i5 or A¢r own employee5. O�OviOeE Ilui Suc� imD��emCniS are n0i intentl¢0 or Offtr¢E �or sale. I1, however l�! GuilJinA or
impmvement is SOIE vnt�in one year ol comDletion, �he ovmer xill have ihe CurOen ol prov'm0 �Ushe Uitl nol Ouib or imDmve
• br Ine pWpose ot 5dle�.
1, as owner ol Ine prapeny, am exGusively conirattinp wiln liG¢nuC contractoR lo CanSlNct t�e D�olecl ($¢ction 704a, Business
❑ an0 Pmfesims Code: t�e Contracmrs' State License Law aces nol appry to en owner al o�ace�Iy wM hm10s or imprwes t�ereon
and w�o COntratl5 �Or SUCh prole�u wii� 2 Conlratioqs) liCense pursuanl �a l�e CAnlrattOrS' S�ale Litense Law). I am aware
i�dl 0�001 01 i�¢i! WOd¢i 5 COmp¢n5dti0n inSufdOt¢ SIIOUIO CB pfONOEtl IO mE.
� I am e�empt unEer Sxiion: 8. 6 P. G.
mr inis reason:
oaie: Ovmer.
I AD �er¢by terlily Iha� I am aware of and undef5lanA (he repuir¢menls al Calilomia Heallh anG Sa�eiy CoOe Setli0n5 25505, 25533, an0
2553d anG ihat I or any fuWte builUing acupant wilVvnll nol (Grcle one) neetl to compty xilh SaiO state coGes ana Ihe repuiaments for a
permil lor con5imclion o� motltlicalion Imm ��e Air Oualiiy ManaAemeni DiS�ncL ReSiEentidl consiruc�ion appliwti0ns are exemp� Irom
IAeSe p�ovisions.
Dale: AOO�icani:
1 �ereEy ceilAy Inal I hdv¢ read iNs applicatian an0 state I�al ihe aUOve in�o�mation is Correct. I agree ta
orainancesarb<Ialelaw5�elatingtoDuilCmgtonstru[IqnaM�e� !nmbe.en.a<=nm' saft'
propeity loi in tlion urposes.
Da :1(� Signamre:
Orivefs Li[ense or Social $¢curi�y �:
t6aLa6 W�i�e—BuilCinq; Green—Cotle EntorcemenL Canary—App6cant; Pink—Revanue; GOltlenroE—Agsessor
ana
CITY OF COSTA l7ESA — BUTLDING PERMIT
PER[�IIT NO: B 069342 FLA;J CHECK NO: N
CONSTRUCTION TYPE: V—N PEA:]IT TYPE: STR
JOH DESCRIPTION ; T/OFF RESTH 6 REROOF W/COAiP
PERt� P10: H Oo934.
COVT: N SUPE�: N
FURPOSE: AL"
SQ FT: ;,160
CLAIf�1 VALUE: 3,340,00 CALC—VALUE; 3,340,U0 GROUF OCC: R-3 /
COMMENTS: SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM 6 HALLWAY,1991 UBc:
fr*�w*itir#i�ftx�x��ti�itat*#��t+r*,�x�*+�***�r*�t�-*it-irx�x��c�****t�u-�it**i�+a�x�x���ia�����* ��ia*rr�i:��:�*+�*v ���n�� f�
Z O N I N G R E Q U I R E M E N T S
S E T B A C X S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IA1 FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ; PROV; PARCEL; 42216214 ZNE: REF NO:
PLANNING NOTES> .
>
�**��,�,���*��**��*****��«���*�***#,�����.,�#�+�#�*#*��*�.�#�,����« *�����*�#*�*��.�3�*���#*,�
D E V� L O P M E N T S E R V I C E S R E Q U I R E M E N.T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY ; DATE: 1_
APPLICATION ISSUED BY: _��'� DATE: '!� ///�� /I
iF**�cfr��r��**w��E***�*f�f�* � 3. � t•��:�x��**+t�rit;.3F'�r /'i�rt;��*�
if if 1f # �i' !E if *" 1(' if M' i(' i! i(' iF iE i(' iI' IF'1(' if'lE �E ih iE i{ iF iE iF iE if #'Y 1f iM1 %• if')f i(' 1f if 1! i4 if i(' iE iE iF ih if if if if ## iF 1F if #+E i(' iF iE # 1F iF if'?� } if �!�Y' ie # K�1K {:. i(..'.5
LEGALIZATIOPI:N F E E S U M M A R Y STRUCTURAL SEGt4EUT:Y
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 50
PLAN SMOKE DETECTORMZP/NON—RES
ISSUE FEE �
TOTALSNG_D;V—> P63M50 IOS00 PLAN—C�HEC�K� REQU�I�R�G.D b3A50 D00
REVENUE DIVZSION TOTALS--> COLLECTED; 63.50 OVER/SHORT: .00
HLDG PMT PLUMBINC ELECTRIC MECHANIC FIRE SMZP/TOT GRADING PLAN—CHECK
63,00 ,50
ftikftiElEitltlf#1FiYik1'iEk>E�flfibi!#iE#iEiflfi!##!flfifi0#iklf#if#}fif�ifik#iE#ik1lifiEiflfiElt#ih##bk�#iF#1E#lEitlf##1!*#iF##k"t`
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3340 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 3,340.00
END OF FEES
�1 0015?743—OOt69744 T CAT 53.59
�ATE� 10/18/94 TIt1E� Q8719
��' POOI & SPA
CONSTRUCTION AND PLANNING
APPROVALS Permit# Date Inspector APPflOVALS Permit# Date Inspector
�
� t. Temporary Electriwl Service or Pole 52. Pooi & Equipment Location
2. Soi� Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility•U�drgrnd. 54. Forms �
4. Electrical Conduli�Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcemenc 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Fpotings 58. Electrical Cond�iFUndigrntl. �
8. Foundation 59. Gas RPe, C Undrgrn,l., Test i
9. Water P�pe-Und�gmd. 60. Backwash Line:, P�Trap, 7 Urdrgrnd. ^��
70. Sc�uctural Floor System 61. APPROVAL TO DECK
11, PropertY Sewer Line & HouseConnection . 62. Backv+ash & Recepto��Final �
12. Sewer Cap 63. Heater & Vent�Final
73. Raof Drains 64. Plumbin� System � Pinal
14. Rough Piumbing 65. Electricaf�Fina1
15. Rough Electrital-Conduit 66. Solar System-Final
16. ROugh Electric VJiring 67. Fencing & Access Anproval
V. Rough Wirin9 Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL'SPA SYSTEM17S FINAL
19, ROugh Heating & Air Cendit�oning FIRE DePT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Duccs, in Structure 70. Underground Hvdro I
22. Ducts, Ventilating 7). Product Piping �Gds GOd
23. Gas Pipe�Rough & Test 72. Under9round Flush
24. Roof Freming 73. Undergrnd.Storage`ankOGas '.70�i
25. Roof Sheathing ���Ci_G�ef �(� 74. Overhead Hydro
26. T•Bar Ceiling IStructural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lething & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEAL7H DEPT. REQUIREfv1ENT
31. Plaster Brown Coat 79. FINAL INSPEC710N
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Condrtioning ,
35. Final Gas Pipe•Test � �
36. Hood or CanopY .
37. Final Factory Fireplace ��- , �
38. Final Ptumbinq •
39. Wdter Service-Fina� • �
40. Gaz Service-Final
41. Solar pomestic-Final � �•
42. Backflow Preventer . �
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attewation
46. Handicap Regulations _ �
/-/� ��
47. FINAL STRUCTURE & BUILDING �( �
4B. FINAL PLANNING -
49. Electric Release to Edison .-�'
S0. Gas Release to Southern California Gas Co . �
51. CERTIFICATE OF OCCUPANCY .
No. Dare
Ciry of Costa Mesa
Building Safety DepaAmenf
P. O. Box 317
�osta Mesa, Colifornio
CERTIFICATE OF OCCUPANCY N�� 1$O1 C
The Building located at 2279 ��'� SEx'QEti� 9� H� .": C
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applitab!e thereto
for a Group �� J ' Occupancy.
Use of Building TT��'� r�Bi,�AIICe �'t'h ti'�'t'73ChP� C'Bi��R'i' ii �Ol�l�_
Legal Description �� li � ='s 'i'='arst 3141
{$ee reverse side for Metas and Bo�nds)
Building Permit No. 2�� Electrical Permit �^ �-%� PI b' p • N 36951
Floor Load Signs have been installed as
requirsd under Sec. 2308 U..B. C. —
um ing ermit o.
Room Capacity Signs have been instaled as
required under Sec. 3301 (7) U. B. C. —
17050. CERTIFICATE OF OCCUPANCY. (a) No aparfinent house, hotel, or lodging house shall be used or occupied
unti� the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(6) A new certificate of occupancy shall be obtained whenever there is a change in: �
1) Occupancy classification of a building or portion thereof
2) The number of aparimenis or g�est rooms
3) Ownership
If GroUp H Occupancy, number of apariments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrafive Code, Title 8, Chapter 9, Article 8. '
Number of apartments 3 and/or guesf rooms
ISSUED TO: Building Official
Ca.4�11 @: StTuoe by /� . j�ji �' ���%e9-u-��'�.
Date g0��9 5s 1��
This Csrtificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by The Building Official of ihe City of Costa Mesa under Sec. 306 (e) U.B.C. Fon„ svan—iM—ii-ea�s_s a
20030
COSTA MESA BUIIDINGSAFETY DEPARTMENT
P.O. BOX 917 C09TA ME6A• CALIFOPNIA
For Applicant fo Fill In Completely
7'YPE OR PRINT
BUILDIN6 � hJ,/��� �/
ADDRESS � /i
COSTA MESA. CALIFORNIA
i �,;ia�•
TEL
■ BBTBACK LINC FROM
NO.OF
DESCRIPTION OF WORK
NEW x A4TERATIONI_ AOO
RF MbVING DEM
SZE�INg 3000� ROOMS 11 !
GOVERN6WALL StC�I COV�ERIN6'S
US6 OF BUILDII�IG ANO WORK TO B¢ PERF�R
Ieuaotno consraurna
SIGNATUREOF �
PERMITTfiE
AUTHORIZfiD AGE T
FEE RECEIVED
,�iif� � 8 j���%
APPLICATION FO PERMfT
FINAf���lf��.
CITfOfOP�{9sTa=A1L�3Alr
116C[I�T NO. �Iy
PIRE
ri v bATH � ,e
ZO ING '
NO.O/A U6HOIN6Wm . �
L6GAL
NOTE: NO EAVE OVERHANO BHALL BE LE39 THAN
90' TO SIDE 8 REAR P. L
°AVEB
ALLOWED <U.B.C.REQUIREMfiNT7
YARD9APPROVEO YARDSAPPROVED
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