HomeMy WebLinkAbout2275 FOUNTAIN WAY - Building Permits�
CITY OF COSTA MESA
J,t _ � B1/1LDIN6 DIVISION
; DEVELOPMENTSERVICESDEPARTMENT 6a8-01�38 n�
� PERMIT PERMIT NUMBER
��
(714) 754-5273 • Fau (714) 754-4856 gUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 2275 E FOUNTAIN WY
Suite:
Vicinity:
Parcel Nunmber: 93074042
npp�icant: FONTAINE, JIM
Address:
Zoning:
Phone:
Zip: ,
� SCHROEDER-WICSON� " � �
Status: ISSUED /�
Applied: 07/0711998 �/i /�-
Issued: 07I07/1998 � � � j
Ownec _ � . : �
Address 2411 E COAST� HWY STE ' � � '�
CM �ij� �- � . �. ,,-� , Phone: �� � � � � , �
%SCHROEDERCO '/ j _ � - Zip: 92625 - _ � ��, ����,�
� r, � � \ /� � '�\ �� � � � � \ \
contraaor FONTAINE AND ASSOCIATES - � � � � ; �� . ��
Address: /; � � ' �� � / �-: �; - . i� � , A �, �.
/•�. '-� A/���% Phone: ' �.- V , �� ' .,
�;i ;% . / %G,' '� � � i � ��
�� // �� Zip: A- . �. � A - . .
v�"�� �/i �\;.\�. , ��
' . , ' //�i�� License:.," �. ` . .
i � i��
Arch�lEn9: � ���� �� . � �. �, - ,
,' �Address: �J �.' �� � - .. .. . ; . .
. / - � , � , ' Phone: . � ��
' - � ;� _ �� ' � '�. Zip: . ' , .
� ' . .. , � i� �,�.. _License: - . �, ,,,�. ,
' " .�� �-. - _- . .�-.
�
, <" "� � SCOPE OF PERMIT � :
' T/O AND REROOF.2000SF FOURPLEX WI BUILT UP 2275, 2277, 2279 AND 2281.
i "- / - �
� . ,. ,�� ._ �� ,.-V'�.: � _-'�- i ,�
Plan Check: , $0.00
Permit: � $99.75
�SMIP Res: , � $0.50
SMIP Com: $0.00
� =' Other:�� ��'$0.00
Ir.spection: � $0.00
� .�
..
�Total: � $100.25
�.
` � �" �'::F'LANNING2L
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.
� ,' �c'� • `'' `'�' -
SETBACKS: � ' � ,. '- � �' � ' �:�-
� r.
MAIN STRUCTURE Front„ 0- 0� ��-Rear �'_ 0- 0�.�, ^��� Left .,
.�. -
ACCESSORY Front 0- 0 -' � Rear 0-.0 - -' Le%
!
_ `'. . _ � �- � , , ��% , ,
_ . . '�
�.��
�'' ..
PARKING Existina: -_ o
NOTES:
� _
' Reauired: 0
Catc Valuation: ss,000.00
Claimed Valuation: Ss,000.00
''
i' . - '.. .. �
ZONING ,-; ;"; �
� �� � � f. �
•�0-0�: ;Right �0-�0��.� '��/
. � i
0-0- - ' Right � •�0-0 � j
i
� -- -- ,Proposed: , 0. . �� - � ,
a
EXPIRA710N: This permit shall eutomatically expire arW become vold if work is not commenced within 180 days, or If work is susperMed or ebandoned
for a period of 180 tlays. �
INSPECTIONS: In order for the work eulhorized under ihis permit to be considered legal, auch work must comply with all applicable codes, end all
required Inepeetlone end flnel epproval must be obteined. Feiiure to obtain inspections and final approval will result in the ezpiretion ol th(s permit.
FOR INSPECTIONS CALL: (714) 7545828
WORKERS' COMPENSATION DECLARATON:
1 hereby eHirtn under penalty of perJury one of Ihe following declaratlons: ' '�
❑ I heve enC wlll meinteln e certiflcete W cronsent to self-insure for workers' compensetlon, ae provldeA tor Cy sectlon 3700 at the Lebor Code, for the pedortnence of t�e
work 1ar whlch this permlt is bsuetl.
❑ I heva entl wlll melntein woAcers' campensfltbn Insurence, es requireG by seclion 3700 oi I�e labor Cotlo. lor ihe peAortnence of ihe wwk far whid� Ihis pertnit Ls issueA.
My workers' compensetlon Insurance caMer and pollcy number ere:
CeMer. Pollcy Number.
(mis sec�d nof be oanplefed Ir fhe perm;r la velued er me nundred dol/ers (St00) or less.)
j]� 1 cenify that in Ihe peAortnance of the wark tor wh� n �pirpermit is issue4 I shell not employ eny pereon In eny menner so es to become subject to t�e warkers'
compensetlon laws of ellPomle, antl epree t� Mif'rshoultl become sub�ecl ta the workere' oompensetlon proNslons o1 Sedion 3700 ot tha Lehor Cotle, I shell fanhwlth
com wIN Nese r ion
� PN P � � /� �i
Applicent SlpnaWre: _ Da1e: � � � C,
WARNINO: FN�URE TO S� PE WORI�RS' COMPENSATION CBJERAGE IS UNLAW FUL AND SWLLL SU6IECT Ml EMPLOYER TO CRIMINAL PENALTIES AND GML FlNES UP TO IXJE HUNDRED
TFIOUSAND DOUARE R��.�1. �N AOOITIIXJ TO THE Ca'if OF COMPENSATqN, DAA440E5 AS PiqNOED FOR IN SECf10N 37080F THE IABOfi OOOE, INiERESf, AND /TTOfiNEYS FEES.
LJCENSED CONTfiACTOR3 UECLAHATION:
I hereby eXirm that 1 em Iicensed untler rovlslpns,pf C ter 9(oommendnp wiN SecUon 7000) of DlNsion 3 01 the Business entl Professbna Cotle, end my Ikense is In lull
fOrce end BMBM. LJC. k ��� qess M
,ContrectofaSipneWre��/ Date: � � %^— �
7� �
CONSTRUCTION LENDING AGENCY:
❑ I hereby etllrm ihat ttiere Is a conslruction Iending egenq tor Ihe pertortnance of the wark for wNch Ihis permit is Issuetl. (Sec. 3097, Civil Code).
Lender'a Neme: LenCeYs AtlOross:
Sipnature:
OWNER•BUILOEP DECLARA710NS:
Date:
I hareby eHlrm thet untler penelry of perJury that I em EXEMM FROM 7HE CON7RACTOR3 LICENSE LAW lor the fallowinp reeson (Sec. 7037.5, Buslness end Protessions
Cade: Any clry or counry wNch requires e permit to consWct, elte4 Improve, demolis�, or repair eny atructure, pdor to Its Issuance, elso requires ihe appllcant tor euch pertnit
to flle e signetl statement that he or she Is Ilcensetl pureuam ro the Orovisions ol the Comrectors Llcense Lew (Chepter 9(commencing with SecNon 7000) o� Didslon 3 of I�e
Business end Professions Code) or thet he or she is exempt theretmm and Ihe hasis for Ihe elleped exemption. Any dUation oi Section 7037.5 by any appliwnt for e permit
sub�ects Ihe eppllcaM to e dvil penelry of not more IDan flve hundrad dollars (5500).):
❑ 1, es owner of the properry, or my employees wlih wages as their sole compensatlon, WILL DO TlIE WORK, antl the structure Is not Intended or offeretl tor sele (Sec.
7044, Business end Professions Code: The Contrectors License Lew does not epply ta en owner ot properry w�o builtls or impraves thereon, end who does such work
hlmselt or hersetl or Nrough his or her own employees, praNded ihat suU improvements ere not intentled or oflered for sele. If, howevar. Ne bulltling or Improvement Is
soltl wlthin one year of completbn, ihe owner-builOer will heve the burden ol proving Net �e or she did nat bulltl or improve for purpose at sale.).
❑ I, es owner at ihe properry, am EXCLUSIVELV CONTRACTING WfT}i LICENSED CON7RACTOHS to wnstruq the pro�ect (Sec. 7044, Buslness anE Pmtessions
Code: The contrectors License Lew tloes not epply to en owner of property who bullds or Improves thereon, end who contrecis for such project wit� e contractor(s)
license pursuant to �he ConlreIXors LJcense Laws.).
❑ I em exempt under sec. Business enA Professions Code for Ihis reason:
Slgneture: Dete:
Owner ID veritietl by drivefs Ilcense. ❑ Yes ❑ No Drivels License Na.
Veriflcetlon o1 Ownership by (type ol dacumem, I.e. - properry tax bitl or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PEHMR CERTFlCAiION:
❑ I hereCy cerUfy ihet no excevetlan Me (5) or more feet in tlepN into whlch e peraon is reQulred to descen4 wlll Oe meAe In connectlon with work auNorized by NL5
pertnit, end Uet no builtllnp atructure, scattalding, falsawork, or tlemolition or tlismantlinp thereof, will be more Ihen t�irry-slx (38) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tltle 8, Celifomle AtlmlNstretive Cotle).
❑ As owner-bulltler, I will nat employ enyone to do work which would requlre e permit trom Ne DlWslon of Industrlal Selery, es notetl ebove, unless such person �as e
permlt to do such wark tmm the dMsion.
Signeture: Dete:
DlWsion o1 Industrfel Se1ery Pertnit Number.
CERfIFlCA7E OF CAMPLIANCE AND AllTHOROATON OF ENTHY: 1 ceNfy under penelry o1 per�ury lhet I have read this epplication end stete thet the Infortnation given Is
cortect. I eprae lo comply wlth ell stete laws flntl dry ordinances relating to builCing wnsWcOon, end euthodze representatives of the Ciry of Caste Mese to enter upon the
flbovadexAbed Oroperty for inspectlon Duryoses. I agree not to ocwpY or ellow occupenry of eny 6uildinp authorized by this pertnit until tinfll Inspectbn.
COOE �, INSPECTIONTYPE
1618 Fixetl System Finel Flre PrevenUon -
1268 Pad Spe Flnal
200 Flnel RaRoof
201 Flnal Block/Fleteining Wall
202 Flnel Fectory Flre Plece
203
204
264&4e
Finel Slpn
Finel Demolltion
�ff ��
cooe� u�svecrroxrrve
208 Finel Mechenical
20B Finel Plumbing
210 Flnal EIeclAcel
212 Final Flre Preventlon
220 , Flnel Plenninp Approvel
222 Final Slte
250 Finel BuilCing/Occupanq
QAg . It�ElS
ApPlicant to fill in all s0a
Ci7Y oF COSTA MESA CO"7NSTR,UpCTI N PERMI�T/
Project Address r�a` 7�� 7/ ��� o���7%�/�li W/�'� ��S �
Applicant'sMailingAddress �C+Q ���F.tiu �'� N�
Owner's Name ��f p ���5 Phone
Address
Arch/Eng. License No.
Address ��� �'��,�
Contractor's Nam � E� Phone 11 -Zp—�3�
Address (mailingl ��g � �L}SaA1��_
City License No. �C1-Q 33�
LICENSED CONTRACTOR OECLARATION
I hereby atfirm that I am licensetl untler provi5ions of Charter 9(commencing
with section 7000) oi Division 3 oi the Business antl Protessions Cotle, antl
my Iicense is in iWl rce1g tl eftecL • • �
ucenu ciass �LJ�O �icenze rvos�g3h5 i
Date ��"1R —R� Signature
WORKEHS'COMPENSATION DECLARATION -
� hereby attirm that I have a certi(icate ot consen[ lo self-insure or a certificate
f Worke�s' Compensation Insurance, or a ce�titied coDY thereot (Section
800, Lab�. C
Policy No. jj�%�' companv '
8 Cerfifietl cop_yy is he�re�1b,y furnizhetl. �j[� // /�
Dateer0if�etl��K'��1C WApPhcantY �in9 IvL�I l, '"�r l/
� �i��.
EXEMPTtON FROM WORKERS' COMPENSATION OECLARATION
(This section neetl not be com0�etetl it the permil is tor one huntlretl (E300) or
Iess).
1 certily that in the perto�mance of the work fo� whi h thi Oerm�t is i55uetl, 1
sM1all not emPloy any person in any manner so�o 13 ome bject to the
Workers' Compensation laws of Califorfl�� / �, /
Date Signature T � �
NOTICE: If, after makin9 thls tleclaration, you shoultl become subject to the
Wo�ke�s' Compensatlon O�ovisions ot [he I�bo� Code, you must forthwith
comply with such p�ovi5iOn5 or tnis pe�mil snall be tleemetl revoke0.
CONSTRUCTION LENDING AGENCV
I her¢by affl�m thal thEr¢ is a const�uction lentling agency fOr fhe pe�fo�mance
of the work for whicb tnis permit is Issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDER DECLARHTION�
I hereby afflrm that I am exemp[ from [M10 Cont�aclor'S Litense �aw for the
following reason (Section �031.5 BuSiness antl Profezsional Cotle: Any city or
county which requires a pe�mlt to cOns[�uCt, alter, imProve, demolish or �epair �
any structure, prior to Its issuance, also requires tne applicant lor such permit
to file a slqnetl stalemenl that he/she IS licensetl pu�suant lo th¢ ProviSions of
[he ConVactor's License law (Chapter 9(commencin9 `N��h Section ]000) ot
Division 3 of the Business antl Proteszions Cotle) or thal he/slte i5 exempt
he�efrom antl the basis for the allegetl exempliOn. AnY violation of Section
D31.5 by any ap0licant for a De�mit subjecls Ne applicant to a clvil
/enalty of not more than five huntlretl tlollars (5500�.
❑ I, as owner of the property Or my employees with wage5 a5 thelr sole
compensation, will tlo the work, ana tne structure is not inlentletl or o(feretl
tor sale (Section ]044, Business antl Prote55ional Cotle: TM1e Con(ractOr'S
Litense Law tloes nOt apply to an owner of a property who builtls or Imp�oves
tnereon, antl who tloes such work himsel//herself or lhrough nls or her own
employces, orovitletl that such imorovements are noi intentletl or oHeretl for
sa1e. If, noweveq tne builtling cr improvement is sola within one year ot com-
O�etlon, the Owner will have lhe bu�tlen Of Proving he/sh¢ tlitl not bulltl or im-
�IOVB fOl thC pllfp05¢ Of ShcO).
I, a5 owne� ot the p�operty, am exclusivety contractlng with licensetl mn-
tractorsto consVucl the pro7ect (Section �044, Business antl Professions Cotle:
The ConVactor's License Law tloes not apply to an owner oi property who
builtls or Impwves thereon, antl who contracts for such projects with a con-
tractor(51 lic¢nse pu�suant-to tM1e Contractoi'S License Law). I am aware (hat
proof o( thei� Worker's COmpensatlon in5uranc¢ shoultl be prOvitletl to me.
❑ I am exempt unaer Seccion B. & P. C. for [nis reason
t�asa within �eavy borGer lines anE si9n all approDriate Eet�arations.
TRACT NO. . LOT NO. UNIT Nn
TYPE OF CONSTRUCTION LJ rvEw LJ Aoo U ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.p, �,
DESCRIPTION OF WORK/USE OF BLOG.
S Main Building'
E
TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL A Rear
❑ OTHER
PHOJECT DESCRIPTION SCd. FT. oCCUaArvGv C Right
K
CONSTRUCTIONTVPE VALVATION$ S Left
ZONE - GRA�ING CU. VDS. ACRES p�ng. Ref. #
Remarks: Planning NOtes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Duct - Under Ground
Duc[ - Strucmral
Duct - Vencilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Bit. ICBO #
Date Owner Heating System & Ducting
I hereby certity that I nave reatl this application ana state that the above ❑0-100,000 BTU �100,0006Ti
inPormation is correct. I agree to comply with all tlty antl munty ortlinances
antl state laws relating to builtling construcNon, antl hereby authorize repre-
5entatives of [his city t ent r upon [he above-mentionetl property for
inspection p oses. /_ u }�
Signatu�e � f Dat —ZJ"J
Orivers' License or 55 � Reinspection Fee
CMF 0865-46, rev. 4/84
White - Builtling; Cana�y - AppliWnt; Pink - Accounting; Goltlenrotl -As5es5or
$15
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Warer Closet
Water Heater
Water Service _,.
laue Fee
Hoodor Typel ❑
Canopy Typell ❑
Refrigeration System
Oo-ioo,000eTu ❑ioo,000eTu
System Repair/Alteration
laue Fee
FEES
$ 3
$ 3
Automatic Washer,
Constructior Poie Sub.
Caoking Unit �
Dishwasher
Dryers ❑Gas ❑Elec
Fan l
F.A.U.
Fixtures
Device Boxes
Outlecs
Switches
Garbage Disposal
Generator O65 KW C
Fea
6534 I/2B/�5
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
T�ansformer ❑ 75-50 KW
❑SO+KW
5-75 KW
$15
Meter lJup to 700 amps
Meter ❑over 100amps
Suh Panel
Motors OO-7 HP O1'f. - 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
luue Fee
DEVELOPMENT SERVICES RE�UIREMEN7S:
Zoning Appraved By
BUilding Approved By ,��
SUMMARV OF FEES
BUILDINGPERMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ �SD �t ISSUANCE
PLAN CHECK 25% $ ENERGY P.C.
EI.ECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
5
doi+
FEES
$ 3
Z
O
N
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N
G
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E
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CONSTRUCTION AND PLA NING POOL rA
APPROVALS Permit# � Date Inspector AppROVALS Permit# Daie Inspector
1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location
2. Soil Pipe�Uhdrgmd. � � "; 53.. Steel Reinforcement
3. Electrical Conduit•Utility-Undrgrnd. • � 54. Forms
4. Electrical COnduit-Undrgmd. , � 55. Electrical Bonding
5. Steel Reinforcement. � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings .- 58. Electrical Conduit-Undrgrnd.
, 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.� y � 60. Backwash Lines, P-Trap, O Undrgmd.
10. Structural F�oor System � ' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
72. Sewer Cap • ' 63. Heater & Veni-Final
13. Roof Drains .. - ` �� 64. Plumbing System - Final
14. Rough Plumbing •� 65. Electrical-Final
15: Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring . 67. Fencing & Access Approval
]7. Rough Wiring Si4� 68. APPROVED�FOR PLASTERING
18. Rough Elecirical-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 OGas ❑Oil
23. Gas�Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frameand Flashing 76. Dr�y�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-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
3S. Final Plumbing � � (,�,p .
39. Water Service-Final '
40. Gas Service-Final
41 . Solar pomestic-Final
42. Backtlow Preventer, .
43. Backflow Irrigation .. . .
44. -Landscape Irrigation System
45. Sound Attenuation .
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Reyuirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co � ' �
57. CERTIFICATEOFOCCUPANCY
No. Date
b[TiI.Y3ING SAFETY DEPARTMENT NO 13 9 7 C
P�O. Bos No. 317 "
C Mesa, California
Date J� H�� � % 4/ G n
I
CPl'Y OF COSTA MESA
CERTIFICATE OF OCCUPANCY
Building Permit No%p `"�� Electrical Permit No Plumbing Permit No.
Use of Building � � f/ t 7`� ti F�' 7� . �r-� �.. a.r. s
7'h'e building located
Legal Descrlption
(See reverse side for Mekes and Bounds)
fias been inspected and found to comply with t e provisions of all City of Costa Mesa Ordin-
2s applicable thereto for a Group �Occupancy.
ISSUED TO: �...- -^�
--� t City Bdilding Official ; �
�� v� E. 1� � i3 �= /;'T y � n� { yfe,� � � �/
(Owner of Building) Byt , ^�-•^'-'"�' " � �-""^�"''` ; !
CC: �p Origival—Owner ❑ lst copy—Gas Co. ❑ 2nd copy—E�d+is� Co. ❑ 3rd copy�File
Form 208 SB P 1M 1-80 L'
�;,..� .
� 1�fl.��'7
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 GOSTA MESA. CALIFORNIA
fOR APPC/CANT TO F/LL /N COMPCETf[Y
TYPE OR_PRINT . .. ��:
COSTA MESA, CALIFORNIA
Paul E. Robertaon Inc
� '.�:.
, . �v-t<<�s`(
; }�� �,��:CC DEP�. v k
`���-� ^I' !�i�C�il �.�''C��
APPLICATION FOR PERMIT
� � BUILDING
F
� FOR Off/CF USE ONIY
CITY Ci�8t8 MC98 �M1D. 6-1661 qDD E'S5
AOiCHI'ENEER W Jordan No`:C-1449
A�DRE55 /71 WeSt 19th 84k�8�88 ZONE
CONTRAg� $ R�bertson IIIC�IC�,ryp,1WOYO BYPROVED
ADDRESS 771 WeSt 19th Costa �8$
LEGTL ILOT I I� I�
oescairrioH NO. 15 BLOCK TR 1
A.P. NO. APPROVED
BV
I�FY�•]y
65 x
5 .0
NO.OF BLOGB.
DESCRIPTION OF WORK
� % �� .. ---'-'--. � �� ---'-'
BUILDING 32 $ SS NO.OF ({
SIZE ROOMS
EXTERIOR WA ROOF
COVERING �C11CC0 COVERING
USE OF BUILOING AND WORK TO BE PE
I HEREBY ACKNOWLEDGE THAT I
pNO 9TATE THAT THE ABOVE 18
PLY WITM �LL CITY OpU1NANCE6
9UILOING CON6TRUCTION.
SIGNATURE OF
PERMITTEE
AUTHORIZED AGEN
.92
,
r I D/T��E�1�E�I �O�t/�(
COSTA MESA. CALIFORNIA
TVPE GROUP
V DATE/'�� '1�
ONING
I P ANS � I BUELOFNGEW �
� �U
��"�.'J F]ATE 'C'I�_.
��
ALLOWED
iTJ
� FT. IN.
C�
�O THIS APPLICATION THE AMOUNT 9HOWN UNOEfl VALUATION IB FOP THE
.�ND I�GPEE TO COM- pURPOSE OF ESTABLI6HING A PERMIT FE8 ONLY.
2 L/�WS HEGULGTING
VALUATION �
PERMIT FEE S ��
g�4 L� �{
/J /�/ PLAN CHECK $ p/ y�
� �
TOTAL FEE $
':� 113�x3:�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APP[/CANT TO F/LL /N COMPLETELY
. _ TYPE OR PRINT �
COSTA MESA. CALIFORNIA
�ADDRE55 %%1 W Z9t11 SC
ARCHITECT LIC.
d IGINEER W. Sordan ND�C�1�4
ADURE55 771 W 19th St., Coata Mesa
LEGAL LOT
DESCRIPT�ON NO. � S BLOCK
OF LOT 6,5 X�.35 � rvO.Ov e�oc8.
NOW ON LOT
USE OF
EXISTING BLDG.
SETBACK 4NE FROM
cErvrER oF siR[ei 9O REAR YARD
SIDE YARD ILEFT ��b IRIGHT 16.6
DESCRIPTION OF WORK
Nr I X II ALTERATION I II ADDITION
BUILDING
SIZE
BUIL�ING AND WORK TO BE PERFORMED
1 XEREBY ACKNOWLEDGE THAT 1 HAVE FEhD THIS APPLIChTION
pNO STATE THAT THE ABOVE IS CO RECT PN� AGREE TO COM-
PLV WITH ALL CITY OR�INANCES F STATE LFWS FEGULATING
9UILOING CONSTRIICTION.
SIGNATURE OF �J , � /
�AUTHORIZED
�
��.� u��.��u'9 ��
��'-�`�-S�`7
FINAhCE DEPT. .�r K
(`.ITY n� rnCT:i �.�Gsfi
APPLICATION�FOR PERMIT
BUILDING
foR officF usE oacr
FIRE
YARDS
REQUIRED
(CENTER LINE
R. 51
DATE RECEiVED
COSTA MESA, CALIFORNIA
ZONING
NO. OF USE OF NEW
PLANS 'i BUILOIHG
h\�SH:9�.]
THE AMOUNT SHOWN UNDER VALUPTION IS FOR THE
PUFPOSE OF ESTABLISHING A PEflMIT FEE ONLY.
VALUATION
PERMIT FEE $ ! � �•
$ � �4C PLAN CHEGK $ J �
TOTAL FEE $ �'S �