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Home My WebLink About889 GOVERNOR ST - Building PermitsCITY OF COSTA MESA BUILDING DIVIS/ON DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fex (714) 754-4856 • www.ci.cos[a-mesa.ca.us JobAddress: 889 GOVERNORST Suite No Vicinity: Parcel Number: 42243303 Applicant: Address: Owner: Address: CLARK, WILLIAM RUSH, EARL TR 889 GOVENOR ST COSTA MESA, CA MECHANICAL PERMIT Contrector. SOCO AIR CONDITIONING Address: 6892 CARNELIAN Arch / Eng : Address: ALTA LOMA CA REPLACE WALLHEATER. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Coolinq/Heat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Fumace Floor or Suspend Heater $23.50 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 L0.00 $0.00 $0.00 $0.00 $0.00 $14.80 �uantity Phone: 909-344-1340 Zip: Phone: Zip: 92627 Phone: (909)944-1340 Zip: 91701 License: 333239 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY PERMIT NUMBER M00-00550 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 12/26/2000 Issued: 72/26I2000 ISSUED BY: Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial I n ci nerato r Domestic Incinerator Compressors / Absorption SVstems Upto3hp/100kBTU 3 To 15 hp / 500 k BTU 15To30hp/7,OOOkBTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDIT�ONS duantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 $0.00 $0.00 538.30 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and ralated regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlretl Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244&66(N00) WORKERS' COMPENSATION DECLAqATON: I hereby aflirtn untler penalry ol perjury one ol Ihe lollowing tleclawtions: ❑ I have entl will maintain a certllicate ot consenl Io selFlnsure tor workers' compensation, as provitled for by seclion 3700 oi the Lebor Code, tor the peAortnance of the work for which this permit is issued. ❑ I have antl will maintain workers' compensatlon Insurance, as requiretl by section 3700 0l Ne Labor Code, for the peAortnence ol the work tor which this partnit is issuetl. My workers' compensatlon Insurence carner entl poliry number are: Carrier: Policy Number: (Thls section need nof be completeU i/ the permit I5 velued a( one hundred dollars ($ f00) or less.) ❑ I certity Ihat in ihe peRortnente of Ihe work for which this permit is issueQ I shell not employ eny person in eny manner so as to 6eCome subject ta the workers' compensetion laws ol Celifomia, antl egree Nat II hould become subject to the workers' compensatlon provislons ol Sectlon 3700 0l the Lebor Code, I she111orthwith comply with ihese pravisi s. ,�Q� �} G �MAppp�Uca�nl.Si� ie:' ��( j[ �'0� ��fi � � � � (,, WARNING-FAILURE TO SECURE WORKEFS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBiECT AN EMPLOVER TO CPIMINPL PENALTIES AND CIVIL FINES UP TO IXJE HUNDRED THOUSAND OOLL4RE ($100,Op0), IN ADOITIQY TO THE COST OF fAMPENSATIqJ, pAMAGES NS PflOVIDED FOR IN SECTION 3]OB OF THE IABOR CADE, INTEREST, AND ATTORNEV'$ FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm Ihat I am Ilcensetl untlar provislons of Chapter 9(commencing with Section 7000) of Divisian 3 of the Business end Professlons Code, end my license Is in full force end eHec� _Lic. x_ _ � Class a Ennh�Rinnd�rn� /�� i.A f n�i .'�2 �/_ � C� CONSTRUCTION LENDING AGENCY: ��. ❑ I hereby ettirm that ihere is e constmctlon lending egency for ihe peAormance oi the work lor which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: SignaWre: Date: OWNER-BUILDER DECLARA710NS: I hereby aHirm t�et untler penalry ol Oerjury lhat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which requires e permit b construc4 atler, improve, tlemolish, or repair eny structure, pnor to its issuance, also requires the applicant for such permit to file e signed stetement Ihat he or she is Ilcensed pursuant to the provisians of the Contractors License Lew (Chepter 9(commenUng with Sectlon 7000) oi Divlslon 3 ot iha Business an0 Pmteuions Code) or that he or she is exempt therefrom and che basis for the alleged exemption. Any vialatlon oi Sectlon 7031.5 by any appliwnt for e pertnit suhjecis ihe eppllcanl to a civil penalry of no1 more than tive huntlretl tlollars ($SW).): ❑ I, as owner of lhe property, or my employees with wages as lheir sole compensetion, WILL DO TME WORK, end ihe structure is not intendetl or oHeretl for sele (Sec. 7044, Business antl Pmfessions Code: The Contractors License Law dces not apply to an owner ot property who builds or improves thereon, and who does such work himsetl or herselt or through his or her own employees, provided that such improvements ere not intentletl or oflered for sele. II, �owever, the building or improvement is soltl within one year of completion, the awner-builder will heve tha burden ot proving ihat he or she did not �uild or improve tor purpose of sale.). ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS fo consiruct the project (Sec. 7044, Business antl Professions Code: The contrectors License Law does not apply to en owner ol property who Duilds or Improves thareon, end who wntracts tor such project with a contractor(sj license pursuant to ihe CoNractors License Lews.). ❑ I em ezempf under sec. Signe�ure: Owner ID verified by tlnveYs licanse. ❑ Ve5 ❑ No Busine5s and Professions Cotle for this reeson: Verification af Ownership by (type ol tlocumeM, I.e. � pmperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMI7 CER7IFICA710N: Driver's License No. Dete: Expires: ❑ I hereby cehity thet no excavetion five (5) or mora feet in depth into which a person is requiretl to descend, wlll ba mede In connecilon with work euthorized by this pertnit, antl that no 6uildinq s�ructure, swttolding, talsework, or demolition or tlismantling thereof, will be more than thlrty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 71t1e 8, Celifomia Adminlstrative Code). ❑ As owneo-buildar, I will not emplay anyone m do work whic� woultl require a pertnit irom the Division of Industriel Sefety, es notetl above, unless such person hes e pertnit to tlo such work from the division. Signewre: Date: Division of Industrial Safery Permi� Number: CERTFICATE OF COMVLIANCE AND AUTHORIZATON OF ENTRV: I certity under penalty of perjury that I heve read ihis epplication and state that ihe information given Is correct. I agree lo comply with ell stete laws and ciry ortlinances relafing to building construction, and euthodze representatives ol the Ciry ol Cwta Mesa to enter upon the above-describetl properry tor inspection purposes. I eqree not to occupy or allow occupancy oi eny building authorized by ihis permil until finel inspection. CODE I. INSVECTIONTYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Finel 200 Final Re-Root 201 Final Block/Retalning Well 202 Final Fectory Fire Placa 203 Final Sign 204 Finel Demolition Q�LF INiIilALS CODE� INSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final ElectAcel 212 Finel Fire Preventian 220 Final Planning Approval 222 Final Site 250 Final Builtling/Octupenty — C(/ PHOJECT AOOFESS: E{8 9 ,qOVzRNOR ST OWNEfl'S NPME: � JSFI EARL W aooeess: ggg �pVE�NOR ST COSTA M�SA,CA 548-0718 AflCM/ENGINEEH: p00HES5: uNiT: 4.�.627 flEG.NO.: I1NIT: PENMITTEE: AKC�' �LC�'(`(`ail (714.7641-35�0 aooxess: i3i5 EAST ST. ANDREWS PLACE C �AN1A ANA CA 9270� LICENSED CONTBACTOB OECUIBRTION: I here�y afiirm that I am licensetl untler pmvisions o� Chapier 9(commencing with Sec�ion 1000� ol Orv�sion 3 of Ihe Business antl Pm�essions Code. antl m cense is in full torce ana effecl. aTv uc.: p 6� p sTnrc uc.: 9 8 0 2 Z 4— -- cws f1t% f��y_� �� at . �� Signa�ure: /l/�'�� WOBREPS' COMPENSNTION OECLAPRTION: I hereby a��i Ihai I have a certificate af conseni Io self-insure or a�rtiZa erke�s' Compensaiion Insurance. or a cenifie0 coDY Ihe�eoi (Senion 3800. Lab. C�. roucvNo.: WP$054050�e E%P.UATE: �O�OII�2 comraxv: FIREN.ANS FliND . � Cetlilietl copy is herehy lumishea. � Certified coDY is f Q'�I h t�e city Bui ing Oivision. j !, .� �/�//.i�/4� / Applicant i E%EMPiIONFflOMWONREPS'COMPENSFTIONOECIABATION: (Thissec�ionneetlnolbecomplete4i�t�epermiiisloronehuntlr �orless). I cetli�y thal in Ihe Oedormance af Ihe work lor whicA �his permit is i55ue0. I shall no� employ any Deaon in any s �o become sublec� �o ��e Worker5' Compensation Laws oi Calilomia. �ate: SignaNre: NOTICE: II, al�er making Ihis Ueclaration, you s�oulA become su�ject m[he Workers' Compensation pmvisions o� Ihe La6or CoOe. you musi �otlhwith comply wilh suc� O�ovisions or this permit shall be Oeemetl revoked. CONSTNUCTION LENOING RGENCY: 1 �ereby atlirm I�al there is a cons�mction lentling agency lor Ihe pedarmance o� Ihe work for which ihis permit is issued (Section 3097. Civ. C�. lENOEP: ADOflE55: OWNEfl BUILOEN OECLABATION: I hereby aifirm �hal I am exempl Imm Ihe Confractors' Stale License Law far t�¢ tollowing reasan (Sectmn 703L5 Business antl Protessional Cotle'. Any ciry oi county which requires a De�mi� Io constmc�, alier, impmve, demolis�, or repair any 9mclure. prior lo iis issuance. also reQuires the apPlicani for such p¢rmit �o �ile a signe� statemen� �ha� he/she is licensed pursuanua the piovisions of Ihe Conlracmrs' State License Law (Chapier 9(commencing wi�� Sec�ion 7000) ol Division 3 oi �he Business antl Pmfessmns Code) or that he/sne is exempt there�mm and �he basis lor the allegetl eKempiion. Any violation at Section 7037.5 by any applicant for a permii SuGjeciS ihe applicant lo a civil penalry ol not more than five hundretl tlollars ($500�. I. as owner of ihe D�oDerty or my employees with wages as their sole compensation, will do the work, an0 the ❑ siwcture is not intenaed or ollerea lor sale �Seclion 70da, Business antl Protessianal CoOe: T�e Contracbrs' State License Law does nol appty b an owner ol a D�oDehy w�o builtls ar impmves Ihereon, antl who tloes such work himsel�/herselt or Ihmug� his or her own empioyees. provide0 �hat such improvemenis are nol inlentletl or oflere0 �ar 5ale. I�, �owever �he 6uildicg or impmvemeni is 5010 wi�hin one Vear oi complelioq Ihe owner will have �he burden o� pmving he/s�e ditl no� build or impmve for Ne purpase of sale�. ' , I. as ownero�ihe pmperiy, am exclusively coniracting with licensetl contraclorslo consimc��he pmlect(Seciion 7044, Business �� ❑ antl Professions Coae: The Contrac�ors' S�a�e License Law tloes not apDly to an owner ol Omperly who huilas or im0�ove5lhereon antl who conlracis br suc� pmlecls wi�� a conlractor�s)license pursuanl�o �he ConVacbrs $ta�e License Law�. I am aware �ha� Dmo� ot I�eir Worker's Compensa�ion insurance 5houlU be pmvidetl to me. � I am exempl unAer Sec�ion: B 8 P. C. �or this reason: �ale: Owner I tlo here�y certily �hal I am aware of anA untlerslantl Ihe requiremems o� Califomia Heal�� ane Sa�e�y Code Sec�ions 25505, 25533, antl 2553a and Ihai I or any �uWre bmltling occupant will/will not (circle one) neetl to comply wit� sai0 staie coees antl IM1e requiremenis �or a permi� lor conslmciion or modtlica�ion �mm Ihe Air Oualiry Mana9emen� �iSVic�. flesidential conSlmciion applica�ions are exemp� �mm th¢5¢ p�Ovi510f15. Oate'. Applicani:. I M1ereby cetlify I�ai I have reatl Ihis appllcalian and stale ortlinances and sta�elawsrelating�o builtling cons�mc�ion: propeny larinsp ciion urposes. �_ �7 SignaNre: onver�s License or Social Security x: inlormation is correcL I agreelo comply wilh all city antl couniy �rize representatives o( Nis aty la enter upan Ihe above-mentioned 164bafi WM1lte—Builtling: Green—Cotle EniorcemenL Canary—Applicanl; Plnk—Pevenue'. CITY OF COSTA MESA — BUILDIISG PERMTT FERMIT NO: E 0`9y28_ ' PLAN CH£CI: NO: N CONSTRUCTION TYPE; V—N PERMIT TYPE; £LE JOB DESCRIPTION : SERVZCE CHANGE & CONTcCTIUN CLALH VALUE; CALC—VALUE: � PERN: NO: E 059928 � GOVT; Y St7PP: N \ PJRPOS$: O'tH S�Q r T : GROUP OCC: R-3 / COMMENIS: *�'� CiTY PROJEC'I' NO. 9i-07 'x*� iF 9c iE }: 9i �74 Y ��-IE %iE �IF -IE �lF it dE �%�� k �7F )f iE �Yf iF ic •ii iE i( �k �k' -1e �k iF if �E �3E �M #f �x �A�ic �Se i4 �I( �%# �lE �f �f �if if iF i'r iE if if 3F �7(-jE iE lf 3e #` �1E ii 1E?f �li� ie �� 3¢ �� 3Fif if d'r�E �1f k Z O N I N G R E Q U I R E M E N'f S S E T H A C K S ------------- MAIN BUILDZNG ------- — --------- ACCESSc7RY 3UILDING --------- FRNT; FT IN REAR; rT IN FRNT; FT IN REAR; FT IN LBFT'; FI' TN RGHT: 'rT IN LEFT; FT IN RGHT; rT Tid PARKZNG REQ• FROV; PARCcL: 42243303 ZNE: REF NO; PLA�NIUG Ni�'fES> i # iF %�li� 1F ## if iF iF # if 1E� iE if ih %� # 3e * N' iE i(- iE if 3F ie if �lf ih if ?F �£ if vl it� iF iE iE iF 7F i't iE if 3i�?h i� i!�iE �iE k'1F ii 9# if ie if �f 3F K� �f if �%iF 3f �1E iE it ie iP iF 3PiE le iFif iF iF i4 D E V E L O P M E 1� T �� "�' R V I C E s' R E Q U I R E M E N 1 S ZONING APPROVED BY � %* DATE: BU3LDING APPROVED BY • " ' DATB: APPLICAiION ISSJED BY: • ,/ DATE• ��,� �H-%�i6iF#iEit�k)FR3EiE3FifiEifii�lFifiFiflfi�t'iFir r e. r�. e t+ex , .. iFlc'.'ri(�irii�iEli�#jEiriF� ir �!�iR *�i'�i�')l'jl'j('�("K'ii'if'i('i�'iFjl")l'�?i'i('j('*1�*?f'i('�'�'�ifj('�.ii-.'�"�i�'}{j!' � jf'3('jfit'afif'ifitifj('�itiEitiT�f�{'�('�jl'if�f'if'�('*if'�'ii'iF�'il'3f*�R�"1FY'if�'� LEGALIZATION;N "r E E S U M M A R Y STRUCTURAL SEGMEnaT:N BLDG PMT PLUM3IiVG ELECTRIC A'iECHANIC FTRE SNIP/RES GRADING PERD;IT 1R Sp • �U� SMIPIIvON—�ES PlAN ISSiiE FEE 15.00 BC7ILDING—UIV—> PERMIT ISSIIE PLAN—CHECK TOTAL PAID DUF, TOTALS----> 0,00 0,00 0,00 0.00 .QO ,00 REVENUE DIVISION TOTALS--> COLLECYED: .UO OVcR/SHORT; .QO HLDG PMT PLiJMHING ELnCTRIC N.ECHANTC cIRE SNiIP/TOT GRADSNG PLAN—CHECH if iF iF'!F iF }E iF � K� if iE if iF 1E if ie ic �14 ii�-1i ?E iF-1E !f �7e if iE �lh �lF ih iF # iF�%ic �1E #?i; iF3E 1F li 1E 1E if iE iF i'ti'r �1Eif iE iE iE #� �lf if'i. if iF i't iE i(� ie fF 1f iE iF ae ii� 1f if iF±f #%if if # I N D I V T D U A L F E B B R E A K U O W N TYPE [iTY D E S C R Z P T I U N UNIT COST TOTAL COST ELE 1 SERVICES BELOW 600 V& HELOW 201 AMP 18.50 18,SU END OF FEES f�, �d�n'.1„Lt��;^�:rvl�} �`:i'7"_'_ "" „hrct �'�.'t,7`,+.�;,�`r �{3iy', i!: -- ��r CONSTRUCTION ANDPLANNING - POOL 'A APPROVALS Permit# Date Inspector APPROVALS Permir# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. ' 53. Steel Reinforcement � 3. Electrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical ConduibUndrgrnd. �� - 55. Electrical Bonding 5. Steel ReinforcemenY 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. � � • 60. 8ackwash �ines. P�Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 1 i. 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 , 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Reugh Wiring Sign ' 68. APPROVED'FOR PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOUSPA SVSTEMS 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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 35. 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. Electrical Power Meter-Final �� ;� 80. FOOD CERTIFICATE ISSUED 33. Final Electric � � �� Notes: 34. Final Heating & Air Conditioning "\, � 35. Final Gas Pipe-T2st I � 36. Hood or Canopy 37. Final Factory Fireplacc 38. Final Plumbing 39. Water Service�Final 40. Gas Service-Final 47. Solar pomestic�Final� 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINALSTRUCTURE & BUILDING -" 48. FINAL PI_ANNING , 49. Elearic Release to Edison � �; 50. Gas Release to Southern California Gas Co � ,'' � �f t. 51. CERTIFICATE OF OCCUPANCY ' �� No. Date p r� � 3/E,c s� s�l��(� ., OWNER JOB ADDRESS GENERAL CONTRE � AP_No. 115- 0 �' I�TSPECTIONS �3oi1' �t Gas Water DAT,E DATE BUILDING PER.MIT ZONE DATE IGROUP J TYPE I SUBCONTRACTOR Fortn BU�SM-3-&9--5-B P . 7�5�7 22562 COSfiA MESA BUILDING-SAFE7Y DEPARTMEM P.O. BOX 1P00 COSTA MESA, CALIFOHNIA 9TOZ6 For Appilcanf fo F711 In Completoly TYPE OR PRINT 1LD1NO �� G o V� R N D�i )DRES9 v COSTA ME3A, CALIFORNIA Cm s A t`?cs.� No Cy� aop ?CT T6L. ver� vn SfATE TBL LIG. NO. p N slze /� J / O�. SJ ( xo. or ■�no.. OF LOT D J� nOW ON t0T USEOF 'r_ . � . / . . _ [PT / O � I RIOXT DESCRIPTION OF WORK 9 ZELD�NO �� X 3e EXTERIOR WALL COVERIN6 uae oP eu��na �nc w 2G,fe4/�4 / O 4- �-C-o�(-� /.Z X � � � .� �"; I X8R6BY ACKNOWLHD06 THAi 1 XAV[ pHAD TNIB APPLIGT N I�ND HTATt TXAT TIB ASOV! 1� CORP6CT�ANO I.OpB[ TO CON• PLY WITX I�LL QTY ORO)NANC/� M!D �TAT[ LAW➢ R[OYLATINO BUILDINO CONBiR J 1 N, A ^, � � AUTHORIZQD AGtM � FEE RECEiV�� JUL 7 1964 fINANCE DEPl. CI I t UF COSTA MESP APPLICATION FOR PERMR BUILDIN�i For Office Use Only ZONIN�3 no. or uoi or •uw ew�p�e �. NO. u � ` � Li � � C�' fQ: NO QAV! OV[RHANO SHALL EH LEBB TXAN ' TO HID6 S RBAR P. L ree .OWBD <U.B.C.REOUIRBMHHT7 YARDHMPROVlD YARD6APPROVHD MAIN BUILDIN6 AGCEY80RV BUILDINO / vwn. tt DAT6 �T I�I . � DAT! ��O a � � � so. Fr. o TX8 IIMOUNT BMOWH UNOBR VALUATION 10 POp Tl16 j ■URPo86 OP [{TABLIBHINa A PERMIT IBB ONLY. .� VALUATIOfV / �' � w/) PERMIT FEE L'� p s ��D �� G w � TOTAL FEE $ ORANGE COUNTY BUILDING DEPARTMENT 636 North Broadwar ' SANTA ANA, CALIFORNIA % FOR APPLICANT TO FILL IN BUILOING $89 Governor ADDRE55 SCHOOL DIST. OR TOWN CO.StR Z'IeSB NEAREST CRoSssr. N�ti�nal OWNER Chevenne H�me`9 InC• MAIL 6 Wil ire Blvd, ADDRE55 '} CITV RavPrlv 11j.11.9 NOLCR J 1 ADORE55 F' wp�pl7 . �TRACTORUa1bOa Vl'gta PUDRE55 q (, klilshire- LEGAL LOT DESCRIPTION NO.I��iv%) BLOCK �/ NO. OF BLOGS. SIZE OF LOT h7 X ZO I NOW ON LOT USE OF I NO. OF I N( E%ISTING BLDG. FeniuGs RC SETBACK LINE FROM: r'O l,t. SIDE YARq � CENTER OF STREET 7 1 —] DESCRIPTION OF WORK NEW I i� I ALTERATION I I ADOITII REPAIR I I MOVINf�GO� SIZIEDING �Oal. .SQ�qObNS J4- E%TERIOR WAG.L 1 COVERING Rti�rr.�L 'E OF NEW aoiHc ResidenCe� APPLICATION FOR PERMIT � � � � � � � � FOR OFFICE USE ONLY I RECEIPT NO. I PFRM � , �IAY 5 BUILDING �� C , nooaess eT SCNOOL OIST. 1 ' OR TOWN , NEAREST CFO55 ST.' ZO NO.OF �^ PLAl15 I It � APbROVED 231 aY 1 1 HEREBY ACKNOW�E�GE THAT I HAVE READ TNIS APPLICATION AND STATE THAT THE ABOVE IS CORREGT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING GONSTRUCTION. SIGNATURE OF y�1bOa V1.StB �+0. PERMITTE /� AUTHORIZED AG/T.• P[FNIT FEE S ��% VALUATION v 5 4830�� ;' P��n CNecrc 3 d TOTAL � FEE S / CORRECTIONS APPROVALS : LOCATION INSPEC' MATERIALS, ,� � . DATE � O A � Z D r STREET 0 PLOT PLAN Show location and distances from .. property line and between buildings.