HomeMy WebLinkAbout3108 GIBRALTAR AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant
Address:
3108 GIBRALTAR AV
13915608
STILES, JEFF W
3108 GIBRALTAR AVE � - -
COSTA MESA, CA "
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owner." ;STILES, JEFF W
Address% =3108 GBRALTAR AVE
COSTA� MESA, �CA
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.Contractor: � � -
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, Address: . �
_ �
ELECTRICAL PERMIT
Phone: 714-979-0964
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License:
. SCOPE OF PERMIT ' - -
� `EIECTRICAL FOR ABOVE GROUND PORTABLE SPA. _ . - - . _
t',
� . - � , �uantity
ISSUE�FEE . $23.50
Temp service test $0.00
Res. a/c package ' $0.00
New Res (1-2�units) �, $0.00 0
New Res�(3+units) - � _ � $0.00 0
Pool/Spa�,., � ",$49.50 1
Lighting Fixts�. � � �� $0.00 0 �
Recept Outlets �� � $0.00 0 �
Switthes V`;'�_ , $0.00, ,=-,0�, �
Non Res Appl,� �� ', $0.00 � = 0 � �
Res Appl � �`-'� � - $0 00 � \ �0 - _
Service to 200a �� � ` G. $0.00 �`��0^. ���
Service to 7000a ���� $0.00�� � 0�= ��` ,�
Service over t000a � �' � $0.00 0
Motors to ihp � �� �, $OAO ' � 0 � �
Motors to 10hp ��� � $0.00 �.; ; ' 0- .
Motors to SOhp ��� $0.00,-� � =�0 , .
Motors to 100hp $0.00 �. - 0� � - '
Mo[ors over 100hp $0.00�-� �- � 0 �
Communicationdrops $0.00 ,-0 . ,
Sub panel to 200a $0.00 0 _
Pole Light Pkg $0.00 0 �
Si9n Circuits $0.00 0
Temp Pwr Pole $0.00 0
Intermed Pole $0.00 0
Status: ISSUED
Applied: 01/25/2007
Issued: 01/25/2001
ISSUED BY:
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- � i
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FEE SUMMARY � _ / ; r�
- - + '
i
- _ Quantity j �; , . ? � �! r
Temp Disl System / Lighting $0.00 0 �;� " .
Busway /100 k , $0.00 0 ! %�� �' -
Standing Section � $0.00 0%',�� ! � ;�� �
MiscElectricalEquipment $0.00 0,�'� ' �;� 't���
_ Transformers up to 1 kva/kw $0.00 .%0� - w�
�. . /
� ..:i........,...up to 10 kva/kw $0.00 - � 0 \ J�% .,� � �
...........:..:..up to 50 kva/kw $0.00 0 ' i�
..... :. .up to 100 kva/kw . $0;00, , 0 , ' . �; i
�� ....over100�kva/kw.�- �, $OAO� 0 � �' i �' '
. Low �Voltage EqwpmenC $0.00 � 0 \' ��� f
Lovi VOIt Wiring System / Ckt. ��$0.00( i: 0_ �;��
Misc Cond'uit �ii/� �$000� ��0 �i�
' 'Misc: Conductor, - '"/ $0 00%, ,� 0 /, ��
� Circus ( gen or rid'e) ,� $0 00�� 0; :�
Circus (mech ride or lights) �� $0 00 � 0'
Chrislmas Tree Stand V ` ,;' $0.00�,� `� 0�
. Fir"eworks Stand � � ' ' $0.00 ; 0
Other Electripl Fee - � , �$0.00�
�. �
Investigation Fee � , ��� $0.00
PlamCheck Fee . � $0.00
Reinspec[ion Fee $0.00
TOTAL CALCUTATED FEES 573.00
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 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
tor a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inepeetlons and fl�al approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration. of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-46 (C✓00)
WORKERS' COMPENSATION DECLARATION: �
I hereby eRirm under penalry of perjury one ot the following declarations:
❑ I have antl will malntain e certificate of consent to self-Insure for workers' compensetion, es provided for by section 3700 of the Lebor Codo, lor the paAormanca of the
work tor which ihis permit is Issued.
❑ I have and will maintain workers' compensation insurance, es reduired by sectlon 3700 ot ihe Lebor Cotle, for ihe paAortnance of lho work for which ihis pertnil is issuetl.
My workers' compensatlon Insurance carner end Oollcy number ere:
Carner: Policy Number:
(This section need naf be comp/eted il the permi( is valued at one AunOred dollars ($100) or less.)
❑ I certify ihat in the performance of ihe work �or which thi5 permit is iasueQ I shell not employ any person in eny manner so as to hocome sublect to Iha workers'
compensation laws oi Celifornla, entl agree thet If I should become subject to ihe workars' compensetion provislons ol Section 3700 of Ihe Labor Coda, I shall forthwith
comply with these provisions.
Applicent Signature: Date:
WARNING: FAILI/RE TO SECURE WORKERS' COMPENSATION CAVERAOE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FMES UP TOONE HUNDRED
THIXISAND OOLLARE (5100,000), IN ADDITION TO THE G�T OF COMPENSATION, OAMAGES AS PROVI�E� fOR IN SECTION 31O80F THE UBOR CODE, INTEFEST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn ihat I am licensetl under provisions o� Chapter 9(commencing with Seclion 7000) of Divlsion 3 oi the Business antl Prolessions Cotle, and my license Is in lull
torce ana eHecL Lic. x Class q
Contrador's Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby ettirm ihet fhere is a consimction lending agency tor the pedortnance of the work lor which this permit is issuetl. (Sec. 3097, Civil Code).
Lenders Name: Lender's AtlCress:
SignaNre: Date:
OWNER-BUILDER DECLARA710NS:
I hereby attirtn Ihat under penelty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (SecJ031.5, Buslness entl Professlons
Cotle: Any ciry or counry which requires a permit �a consWct, elter, improve, tlemolish, or repalr eny structure, pnor to ils issuance, elso requires the epplicant lor such permit
to fila e signed statement that he or she is Ilcensetl pursuant to �he proNsions oi Ihe Contractoro License Lew (C�epter 9(commencing wlth Section 7000) oi Dldslon 3 ot ihe
Business and Professions Code) or ihet he or she is exempt therefrom end tha besis lor Ihe elleged ezemption. Any violetion ol Seclion 7031.5 by any applicent for e pertnit
s jects the epplicanl to a civil penelry of not mor� lhan five hundred dollere ($500).J:
I, as owner oi Ihe properry, or my employees with wages as Iheir sole compensetion, WILL DO THE WORK, antl the structure is not intendetl or ofleretl for sale (Sec.
7044, Business and Professions Code: The Cwnractors License Law does not apply to an owner of praperty who builds or improves Ihereon, and who tloes such work
himself or herselt ar through his or har own amployeas, proNded �het such impmvements ere not Imentletl or oHeretl lor snle. If, however, Ihe building ar improvement is
sold wi�hin one yeer of completion, the owneo-builder wlll heve tha burden ol proving t�at he or she did not build or impmve lor puryose of sale.j.
❑ I, as owner of the property, em EXCLUSIVELY CONTRACTINC WITH LICENSED CONTRACTORS to construct the prolect (Sec. 704d, 9usiness antl Prolessions
Cotle: 7Te con�reciors License Law does no� epply to an owner of propetly who builds or improves lhereon, end who contrecis lor such Droject with a contrector(s)
licensa pursuant to the Contractors License Lews.).
Business and Prolessions Code tor this reason:
tlrivefs license. �es ❑ No Drivafs License No.
Verification of �u%rship 6y (type of document, i.B. - property tea bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CHAnFICATION:
❑ I hereby certity Ihat no excavation five (5) or more teet in depth into which a perwn Is requiretl to descend, will be metle in connection wiih work authorizetl Dy this
pertnit, and ihat no huiltling sWcture, scaRolding, falsework, or demolition or dismantling thereol, will be more Ihan thirty-six (38) leet high. (C�ap. 32, Gry 2, Art 2, Sec.
34i, Ttle B, California Administretive Code).
❑ As owner-builder, I will not employ anyone to tlo work w�ich woultl require e permil Irom ihe Division of Intlustriel Sefety, es noted ebove, unless such person has e
permit to tlo such work irom the divisian.
Signature: Date:
Division of Intlusinal Safery Partnit Number:
CERTIFlCATE OF COMPLIANCE ANO AUTMOR17A710t10F EMRY: I cenity under penalry ot perjury lhat I have read this apPliw�ion an0 state that the intortnalion given is
correcc I agree to o ly w h all state laws entl ciry ordinances relating to bulltling consWction, entl authodze representatives ot Ihe City ol Costa Mesa to enter upon ihe
ebove-described pr i pection purposes. I eqrea not to wcupy or allow occupency ol eny building emhonzed by tMis er�mit u�r /yI finel inspection.
I ___�—� `( �✓ / �1
�gneture O1 Legal Owner(sy Date
And/Or Authonzed Applicant Date
COOE I. iHsvecnoxTrre
1616 Fixed System Final Fire Prevention
12fi6 Pool Spe Finel
200 Finel RB-Ro01
201 Flnal Block/Aeteining W ell
202
203
Final Factory Fire Place
Final Sign
204 Finel Demalition
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INTITIRLS CO�EI INSPECTIONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel Eleclncal
212 Fina1 Fire Prevemion
220 Final Planning Approval
222 Final Site
250 FinelBuiltling/Occupency
PdTE ItI�1dL5
�
C� � G��ta ?�'�a �u���sy D�a�
OWNER-BUILDER
VERIFICATION
A city or county, which is required to give notice pursua o Section 1983 -s�hall attach to such notice, and,
as a condition precedent to issuing a building permit, equire mpletion and require the retum of, an
ownervbuilder verification.
A[tention Property Owner.
An `ownervbuilder' building permit has been applied for in your name and bearing your signamre.
Pfease complete and remm this information in the envelope provided at your eazliest opportunity [o avoid
unnecessary delay in processing and issuing your building pertnit. No building permit will be issued until this
verification is received.
L I personally plan ro pro 'de major labor and ma[erials for conswction of [he proposed
property improvement. Yes ❑ No
2. I(have/have not) signed an applica[ion for a building pernti[ for
the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address
Phone (
City _
Con[ractor's Lic, No.
4. I plan to provide portions of the work, but 1 have hired [he following person [o coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide [he work indica[ed:
Name Address Phone Type of Work
t0E2�G8 (flEV.9/98)
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ON OF BUILDING SAPETY � ���"C'��
CITY OF COSTA MESA
APK� OVED
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nans ard sQecifl . ions MUS i be!cap' �n �n:s jo,, at all L nes aid i is ur: �;�lul to
la'I"yC5 G( nBBfdi'�fi0 n152�P.? W7�hON tHTi?G F2T,IISF'pf i INifl �ti2'.'li7il0� Qi BcIldiOj
City of Co:?a �d2az.
ag ot this plan and speafiaaons SNI-iL WOT be h�!d •o p°rmil o; to be a�� aGP�ovai
:iian cf any D�o'���1u°s et ar.y CII! ,f :;os`,a .�'�:: Ordlnance an,]�m Slate law.
. � : _,� „�,�d if �he buildin oi
IS df�d P:((ili� 5115ii cXjl1i'L bf�'.,m,��7f1%:"F �9 l. � t! P,t r of issuance
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AVP�����< <o fill in all spaces within heavy bor0er lines ana si9n all aporopriate tleclarations.
CITY OF COSTA MESA • vERfvIIT N(J�� � TRACT NO. LOT NO. BLOG. NO.
CONSTRUCTION PERMIT �I =s�-
Address ��rs�f'�� -//-
Arch/Eng.� License No. -
Address _ .. " - -
LICENSED CONTRACTOR DECLARATION(/
I hereby affirm th:.t I am licensetl untler provislons o( Charter 9(com-
mBncing wltn section 7000) o( Olvision 3 of the Businezs and
Protesslons Co , ntl y license is in full force antl e�ffqect.
Lltense CI ss (�-� � . License o L-l---
Date � �Y� Si9 t � ����
WORKERS' COMPENSATION OECLARA ION
I hereby aHirm that 1 have a cartifltate of consent to self-insure or a
certifiwte of Workers' Compensation In urance, or a certifietl� copy
thereof �Seuioa380Q�y.ab.S•3,0 � � 0. d /�. .�.. _ /LQ.
r.i;Cerpfletl Copy is h¢r¢by furnisheU. -✓ �%
�-',"-CertHIBtl COpy is filetl with the city Builtlinq Divi5lon.
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sectlon neetl not ba completetl if the.permit is for one nuntlretl
(E100) or less�.
I«rt�fy that n the perlo�mance of [he wO�k fo� which this permit�is
ISSuetl, I shdll nOt emplOy any person In any manne� so as to become
subje<t to the Workers' Compensd[ion Laws of Glitornia. _
TVPE OF CONSTRUCTION �
❑ NEW O ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMI7 -
❑ GRADING ❑ FOUNOATION ❑ STRUCTV RAI.
❑ TENANT'O ELECTRICAL OPLUMBING��}.�ECHAI
❑ OTHER
PROJECT DESCRIPTION
SQ. FT. �
OCCUPANCV_CONSTRUCTION TYPE
VALVATION ZONE
GRADING CU. VDS. ACRES
Da[e Signature BATHTUBS
NOTICE: It afte� making lhis tleCla�ation, you shOultl becom¢ subject TOILETS
to the Work¢rs' Compensation provlSiOns of the L., bor Cotle, you must
torthwitn comply wit0 suth provi5ions or this permit Shall be tle¢metl �AVATORIES
revok¢tl. ' ._ . .
CONSTRUCTION LENDING AGENCV KIT.SINKS
I hGr¢by a/i1tT that there I5 a mnStruCtion lentlin9 agenq for the per- SERVICE SINK$ '
formance oi tne wo�k far which this permit is IssueC' (Section 3097
Civ. C.). " - � - " - FLOOR SINKS
L.entler's Name �
Lentler's Atlaress DRINKING FOUNTAINS
OWNER BUILDER DECLARATION � INTERCEPTORS-
1 he�etiy alfirm that I am exempt from the ConVactor'S license Law for
the tollowing-reason �Settlon ]031.5 Bustness antl Professions Cotle:� SWIMMING POOL"
Any City or couniy wltich reqW�eS a permi[ to consVuct, alter,
IrtPproJe; tlemolish or repair any structure, prior [o Itz Issuance, also're= yyATER SERVICE
.ires th¢ apFlitvnt to� sucn permit to file a siqnetl statement that he
licensetl pursuant to the provisions'of tbe Contrattor's'License t,aw
napter 9(tommencing with Section �000) ot Division 3 of the
ISine55 antl %des5iOn5 Cotle) or thdt hE Is ezempt thetetlom antl the
sis for the allegetl exemp[ion. Any violation of Section ]031.5 by
'• appliWnt fofa p¢�mlt'Subject5 th¢-applicant [O a'tivi� penalty
�oc more man nve nunareo aouars �yow�.
1, as owne� o( the pro0erty, or my employee5 with wages a5 Iheir
Sol¢ Compen5a[ion, will tlo the wa�k, antl the s[ruCturE is not intentletl
or offeretl tor sale. (Sectlon ]044, Business antl Professions Cotle: The
COM�actor'S lJcense Law tloez not apply to an owner ot a property
who builtls Or Improves the�eon, antl who tloes SUch wo�k himielt or
th�ouqh his own employee5, provitleG.that.such. imp�ovemen[s ar¢ not
int¢ntletl or offeretl tor sale. It, however, the builtling or imOrovement
issoltl witnin one year ot completion, the owner will have the burtlen
ot proving he Eitl not builtl or improve for th¢ purpose ol sale).
❑ I, as owner ot the property, -am exclu5ively con[racting with
Iicensetl COI1�1dC101S [O COOSS(t1CI L�1C p101eCL ($fCi�Ofl ��44. BUSI0055
dntl Pro/G55ions Cotle:'The-ConVactor'S License Law tloes not apply to
an owner ot property who builtls or improve5 thereon, antl who con-
[�act5'trOm such pro)ec[5' with a Con[rattor(s) Iicesnetl purzuant to
lhe Contiactor's License Law).
❑ I am exempt untler Section �' 6. & P. C. for this
�Dace� - Owner � - -
I,herebyCCrtily[hat I have reatl [his aOPlication antl state that Ihe above
IMormation Is mrrecL I a9ree to comply with all city anG county
ortlinances antl state IawS relating.[o tonSVuction, antl hereby authorize
rep�esentaljve$. of this- dty to en[er upon the above mentionetl
P�oPertY/F� i6iPP.itlpn�P�Y45�i � a_, ._ _. .. � _ �i.
GAS
PLAN CHECK
SHOWERS
DOVBLE LAVS
DISHWASHERS '
SVMPS �
FLOOR DRAINS
CLARIFIERS
P.TRAP
ALTERATION
OUTLETS
WATER HEATERS BTU OUTPUT.
SEWER CONNECTIONS
SOLARTANK � - COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLA�v cHECK
HEATING SVSTEM 0-300,000 BTU
ANO OUCTING 100,000 * BTV _
REFRIGERATION 0-100,000 BTU_
SVSTEM ' � 100,000+BTU_
BOILERS BTU
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
Drivers' LicenSe or 5� - � � I ISSUE FEE ---
CMF 0865-46 While-Builtling; Gnary-Applicanh Pink-Attowting; Goltlenrotl-Assessor
0652 7/01/82
A.P. �
ZONE
REAR YARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
ZONING APPROVED BV
SPECIAL CONDITIONS:
EIECTRICAL
TIONS
PLNG. (3EF. �
PROVIDED
PARK FEE $
PLAN CHECK -
GENERHTOR 0-1 KW_ 1-10 KW _
TRANSFORMER
APPLIANCE 30-SOKW_50+KW_
'MOTORS 0�1'HP_1-10 HP _
(INC. SOLAR) 10-50 HP W� HP _
FIXTURES OUTLETS SWITCHES
GAS TVBE SIGNS ' - -
�OLE LIGHTS "
PANEL$
SERVICE -
7.00 TL
METERED SUB
' MAIN SVB
AMP ' ' '
APPLICATIONAPPROVED'BV DATE-
SUMMA RY OF F EES
BUILDING
PERMIT § SMIP � .$
PLANCHECK b •�PERMIT
- - ISSUANCE S�
PLVMBING S _ GfEADING E
PLAN CHECK § . . , . �
ELECTRICAL § �� � - a
PLAN CHECK $ '
��'MICROFIINI E,��' �
MECHANICAL��OTAL FEE E� .
PLAN CHECK S LE55 AD- _
VANCEPC'S_"'
' FINAL_FEE E .�tO�
CONSTHUC710N AND PLANNING POOL & SPA • , • �
APPROVALS Permit# M41�3 Date Inspector qppROVALS Permit# �� - Date_ Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment�Locatiom - - - �� - �
. Soil ipe-Undryrn 44. Steel Reinforcement
3. Electrical Con uit Utility-Undrgrn 45. Forms
4.. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce . 47. Rough Plumbin & Piessure Test ,
6. Electrical UFER Grn 48. APPROVALTO COVER-GFJNITE • �-
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation � 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Unclrgm 57. Backwash Lines P-Tra �' ndr m - �
10. Structural Floor System 52. APPROVALTO DECK� "' '� " ' �-
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing ' " - -'
14. Rough Electric-�onduit �56. Elec[rical-Final �
75. RoughElectriaWiring • 57. SolarSysterti-Finat �
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts, in Structure ' 9. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
��
22. FrameandFlashin NOTES: G qi✓ow-�o� �� µsw�G�
23. Insulation r.i.�, - -Q i
24. Lathing & Siding
25. Drywall Nailing ��1...= ' e � Q 2
26. Plaster Brown Coat -
27. Electrical Power MeterFinal �
28. Final Electric
29. Final Heating & Air Conditioning $2
30. Final Gas Pipe•Test �
31. Final Plumbing '
32. Water Service-Final
33. Gas Service-Final
34. Solar pomesti�-Final -
35. Landsca e S rinklin S stem '` ' '
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING � '
39. Special Requirements Completed � - � � �
40. Electric Release to Edison ' -
41. Gas Release to Southern CalifoFnia Gas Co.' � � -
42. CERTIFICATE OF OCCUPANCY .
' No. Date
owNEa Mesa Verde Estates DATE 12-�1-5$
JOB ADDRESS 3108 Gibrlatar Avenue BIIILDING PERMIT NO. 33
GENERAL CONTRACTOR L. G. Robinson
AP. No. LOT 100 TRACT 3115 FIRE ZONE DESCRIPTION OF WORIC Res. & Att. G32'.
GROUP TR..T 1'YPE V ZONE A1 PLAN NO.
1. 'ECTIONS I DATE I�SUBGONTRACTOR I PERMITSI&SUED
DATE NUMBER
1'rcnches h Forms // Stccl NJ-L< /—i/. —t�a
coat
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COSTA MESA BUILDING DEPARTMENT
P. o. eox 3i�
COSTA MESA. CACIFORNIA
eui�oiNc
nooRess
FOR APPLICANT TO FILL IN
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COSTA MESA. CALIFORNIA
OWNER Mesa Verde E
MAIL
ADDRE55 ��j �{ p_� p
ar� Costa Mesa
ORCE ��ENEeR J.R,Shell
noo.._.,5 T�nnn AAarh
LEG�L LOT
OESCRIPTION NO.
A.P. NO.
SIZE �Q X 1
OF LOT
USE OF
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SET9cCK^LI=E FCPOM Gn,
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NO. g,{
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ey No. C-21
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NO
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BLOCK TRACT�
NO OF BLOGS
now or� �or III
REAR VARDZO
DESCRIPTION OF WORK
NEW py ALTERATION I ADDITION •
ftEPA�.. I MOVING I OEMOLISH
5 ZELDING1S6O S rjt � NO.OF � �
ROOMS STORIES
E%TERIOR WALL ROOF
GOVERING StllCCO COVERINGA8D�12.Zt Bf R(
USE OF NEW . _ _ . _ . - _ _
I MEREBV iCKNi
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CITY OROINANCE
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SIGNATUR �Of
PERMIT? _�
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JAP! 5 1�5J�.
�=(f� °,�;r,E DEPT.
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APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. (r[]�(�
LlV
REC� /,�TE3/E��i� DECTJ�119
Bl11LDING
FIRE
ZONE
=o��
APPR
BY
COSTA MESA. CALIFORNIA
CORRECTIONS
WITM ALL
CONSTRUC
r VA�UATION RC
n� / PERMIT FEE � 3 j�
-si✓
PLAN CHECK S /', s �
$/�/ ��S r TOTAL FEE $ � a.1 v°"'�