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Home My WebLink About2264 PAMELA LN - Building PermitsI FT). (�ta) 75a-52�s • Fax (��a) 750-oe56 • www.ci.costa-mesa.�.UILDING PERMIT �� F^iR oarve, cosin nntsA, cn szeze .lob Address: 2264 PAMELA LN Suite: Vicinity: 3-UNIT APARTMENT BUILDING Parcel Number: 42237218 • npp�icanr. SERKOVICH, MILAN Address: 2835 E 15TH ST LONG BEACH, CA Owner: FLUSS, DEAN AND DAWN Address 21662 SEASIDE LANE HUNTINGTON BEACH, CA Contractor: MILAN G SERKVOICH Address: 2835 E 15TH ST LONG BEACH, CA Zip: 90804 Arch : Address: Phone: Zoning: Phone: (562) 498-8711 Zip: 90804 Phone: Zip: 92646 Phone: (562) 498-8717 License: 714929 Eng: Address: ISSUED BY: Status: ISSUED Applied: 10/09/2000 Issued: 10/09/2000 Phone: Zip: License: License: SCOPE OF PERMIT REMOVE WOOD SIDING OF EXISTING 3 UNIT APARTMENT BUILDING AND INSTALL NEW STUCCO (APPROX. 2400 SQ Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.60 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.85 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existin : 0 NOTES: Rear 0. 0 Rear 0-0 Reouired: 0 FEESUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: gs,000.00 Claim Valuation: se,000.00 Right Right EXPIRED nxrE �► au � � .�,�� c�� - �° ��'� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes antl 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 for a period of 180 days. INSPECTIONS: In order for �he work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspectiona entl final epproval must be obtainad. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545628 24d6-461fi�001 WORKERS' COMPENSATION DECLARA710N: - I hereby aHirtn un0er penalry of perjury one of Ihe tollowing declera�ions: ❑ I have and will maintain a cetlificate ot consent m self-Insure tor workers' compensation, as provitled for by section 3700 ot the Labor Code, tor the pertortnance of the work for which t�i5 pertnit is issuea. � I have and wlll mainWin workers' compensatlon insurance, as required by secUon 3700 of t�e Labor Code, for the perfortnance ot t�e work for whiU this pertnit is iswed, My.ivork ' compensation Insura e carrier and poliry number are: //- p Carrier: �T�T� Fu /J� Policy Numb`er. � l T� �� /�- — O � (T=SeGbnneed not be camplefed i/ the permif /s velued et one hundred dollars (5100) or less.J ❑ I certify thal in the pedortnance oi the work for which this pertnit is Issued, I shall not employ any person in any manner so as to 6ecome subject to Ne workers' compense�ion lews of Californie. and egree �ha� if I shoul0 batome subject to the workers' compensation provisions of Secilon 3700 0l ��e Labor Cotle, I shall lorihwith comply with �hese prav�'sJons.' /�� Applicant Signeture: - - " �h •�"•r oete: _ � 4/7 �a O WARI�HNG.`FAICURE TO SECURE WOfiKEPS' COMPENSAiION OpVERAGE IS UNL4WFU� rWD SHML Sl/B1ECT rW'EMPLOVER TO CRIMINAL P NAL IES rWD GVIL FlNES UP TOONE HUNDRED TFIOUSAND OOLLARE �5100,000), IN ADDRIIXJ TO iNE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SELTION 3)OG OF THE IABOR CADE, INTEFEST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: ol Chepter 9(commencing with Section 7000) of Dlvision 3 force entl eHecL Lic. a CONSTRUCTION LENDING AGENCY: oate: _P�rofessions Code, end my license is in tull ❑ I hereby aMirm ihat ihere is e consWction lentling agency for ihe peAormance ot t�e work tor which ihis permit is issued. (Sec. 3097, Civil Code). Lontlefs Neme:� Lentlers Atltlress: Signatura: OWNER-BUILDER DECLARATIONS: Date: I hereby attirm Ihel under penalty of perjury Ihat 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any strucWro, prior to its issuance, elso requires ihe epplicani for such pertnit to file e signed statement ihat he or she Is licensed pursuent to Ihe provisions of the Conirac[ors License Law (Chapter 9(wmmencing with Section 7000) of Division 3 of the Business entl Pmfession5 Code) ar that he or sha i5 e:empt therefrom antl t�e basis for Ihe alleged exemption. Any violallon ot Section 7031.5 �y any appliwnt for e pertnit subjects the applicant to a civil penalry of not more ihan five huntlretl tlollers ($500).): ❑ I, as owner ot the property, or my employees with wages es t�eir sola compensation, WILL DO TME WORK, antl the stmcWre is not intentletl or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contrectors License Ww dces noi appy ro an owner oi property who builds or improves thereon, and who does such work himself or hersetl or ihrough his or her own employees, provitletl tha� such impmvemems are not intendetl or ottered for sale. If, however, ihe building or improvement is sold wi�hin one year of completion, ihe ownerbuiltler will have the 6urden of proving that he or she did no� build or improve for purpose ot sale.). ❑ I, as owner of ihe properry, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTAACTORS to construct the project (Sec. 7044, Business antl Protessions Cotle: The coniractors License Law tloes no� appty Io an owner of propeny w�o builds or improves thereon, antl who contracts tor such project with a coniractor(s) license pursuant to Ihe Coniractors License Laws.). ❑ I am exempt under sec. Business and Pmfessions Code tor this reason: Signature: Date: Owner ID venfietl 6y tlrivefs license. ❑ Yes ❑ No Driver's License No. Verificetion of Ownership by (type of document, i.e. - property tax bill or tleetl): Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby ceniy that no eacavation five (5) or more feet in depih into which e person is requiretl to descend, will be mede in connection wilh work authorizetl by this pertnit, end Iha1 no building siruciure, scattolding, talsework, or tlemolition or dismantling ihereol, will be more Ihen thirry-si: (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, Califomle Atlministrative CotleJ. ❑ As ownervbuiltler, I will not emplq anyone to do work which would require a permit fmm ihe Division ot Industnel Sefery, as noted above, unless such pereon �es e permit to do such work fmm the division. Signawre: Date: Division of Industrial Salery Permii Number: CER7IPICATE OF COMPLIANCE AND AUTHORIZA710N OF EN7RY: I certify under penalry of perjury ihaf I have read ihis application and state Ihat ihe infortnation given is correct I egree Io comply with all stete lews end ciry ortlinances relating to builtling cons�ruaion, antl authorize representatives of the City of Costa Mesa to entar upon the above-descnbed property for inspec�ion purposes. I agree not to occupy or allow occupancy of any builtling auNorizea by this permit until finel inspection. [5�77�7�CFi9�iIF]:JNJ7 1616 Flxed System Final Fire Preventlon 126fi Pool Spa Finel 200 Final Re-Rool 201 Final8locWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition PdIE 1[�LS �0�9 cooe� ixsrecnoxtrae 206 Finel Mechenical 208 Final Plumbing 210 Final Eleciricel 212 Final Flre Prevention 220 Final Plenning Approval 222 Final Site 250 FinalBuilding/Occupancy PAg Y�ELS � 1 AGP��ant to fill in all spaceslxcept thase wilhin �eavy Gortler lines ana sign all aoorapriate aeelaretions. CITV OF CUSTA MESA CONSTRU/CTION PERMIT . Pro�tt Address Z ZG� �Q M��q LN ,�es �'o Masa 4�� Applicant's Mailing Add/ress SQ (�h��t-eMro��o��4pi Owner's Name ��GHaGYI D'-�� phone�/s�-�38�' Address 2�-Gy- 13 Pa �* �. w L�, Cms �+ �"1.as v Arch/Eng. �'7 /lvi P License No. Aiidress Contractor's Nam �^ —Phone Address Ima ��g� . � City License No. ' LICENSED CONTRHCTOR DECLARATION I htreby affirm that I am Iicensetl untle� prOvi5iOn5 of Cha�te� 9(commencing with section ]000) of Divislon 3 of [he Business antl Professlons Cotle, and my Iicense is in tull for<e antl elfect. . License Class License No. .Dat¢ Si9nature WORKERS'COMPENSATION DECLARATION •ereby aftirm t�at I M1ave a certificate of consent to Self-Insure or a certlflcata Workers' Compensation Insurance, or a certlfletl copy thereof (Sectlon . a800, Lab. CJ • , Policy No. Company BCertitietl copy is hereby furnizhetl. Certifie co�py J"s file0 with the city Byi�ing�Dlv�on n Oate�y4.� G 4 Appllcant /�G ��%�'"" ' � �EXEMP ON FkOM WORKE0.5' COMPENSATION DECLARATION (Thissectian neetl not be completeE it the permit Is for one huntlretl (E300) or less). ' I certlfy that in the performance of tha work for which thls permR is issuetl I zhall noi �employ any petson In any manner 5y d5 to ¢COme Subj¢Ct to I�B Wo�kers' C9mpen5ation LawS of CalifOmia�./ �_ • . , �NOTICE:4t, aREr making this tleclaration, you shoultYbecome subject to tna Workers"Compenzatlon provlsions of the Labor.-Cotla, you.must forthwlth -. tomply wilh such p�ovisions or thi5 p¢rmit Shall be tle¢m¢tl r¢voketl. CONSTRUCTION LENDING AGENCV ' • . I hereby aftirm that tbere is a tonstruction lentlin9 agency for the performance oi the work for which this permlt is Issued (Section ,3097 Civ. C.) Lentler's Name Lentler's Atltlress OWNERBUILDER �ECIARATION � I hereby affirm that I am exempt trom the Contractor's License Law tor the following reason (5¢ction 7031.5 Busin¢55 antl Protessional Cotle: Any city or munty wn�cn �equires a pe�mit to cOnSVuct, alter, improve, tllm011sh o� repak any structure, prior to its issuance, also requires the appliwnt for such permit [o tiie a signee statement that he/she is licensetl pursuant to the.provisions,of the Contractor's License Law (Chapter 9(commencing with Section 7000) oi � livislon 3 of Ihe Business antl Prof¢55IOns Cotle) o� that hG/Sh¢ is �exempt �erefrom antl the basis for lhe alleqeC exemption. Any violation ot Section .031.5 by any-applican[ t0� a permit-subj¢<ts the applicant to d civll � enalty ot not more than five nuntlretl tlollars (E500). I, as owner of'the �property or my emO�oYeeS with wa9es as their So10 ,' ompensation, wi1LUo the work, antl ihe structure is not iritentletl or, offeretl � for sale (Section 7044; Business antl �Pmfessional Cotle: The Contractor'S License Law aoes not apply to an owner ot a property who builtlz or improves thereon, ana who tloes,such work himself/herselt or through his or ner own , em01oy ees, provitletl [M1at such Improvement5 are nOt In[entletl or offeretl fOr sale. If, however, tha buil0lnq or improvement Is soltl wlfhin one yea� of com- � pletion, ihe owner will have the burtlen Of p�oving h¢/Sh¢ ditl nOt build o� Im- . prove for the purpose of sale). � � � I, as owner ot the property, am ez<lusively mntracting with II<ensea con- . tractorsto constructthe project (Section 7044, Business and'Protesslons Cotle: ' '�. The Coniractor's License Law does not apply to an owner of property who ', builtlz or improves thereon, entl who contracts for such orojects with a'con= ' tractor(s} license pursuant�to the Contracror's License Law). I am aware that � proot oi.their Worker's Compensatlon' Insurancu shoultl be provitletl to me. ,❑ I�am exempt untler Section � B. & P. C. for [hi5 reason Date � Owner I hereby certify tna[ 1.have r¢aq this appllcatlon antl state' intormation iSlwrtecL I agree t0 compty m'�th au city antl coi antl State laws relating to ulltling cons(ru[tion, dntl hereby � sentatives ot this pi[y t nter upon the above-mentlone� insoection ourqpye% ' / _ ' ' DriverY License or 55 � � above ' iances repre- v for � . S��S TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR." S ❑ CONVERSION ❑ �EMOLISH ❑ O�}iER - '%'�'np # DESCRIPTION OF WORK/USE OF BLDG.�T� s� �-�Q / _ • �- , S Main Buildi TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL. . T Front ❑ TENANT ❑ E} ECTRICAL ❑ PWMBING ❑ MECHANICAL ' 8 Reaf � �OTHER ��/q(i � g�9 Y � ' ' C Ri9ht PROJECT DESCRIPTION 54. F7. OCCUPANCV K. CONSTRVCTION TVPE VALUATION S�OOQ-- S Left ZONE GRADING CU. VDS. ACRES Ping. Ref. �k Remarks: - ` , — �v� . � Planning Notes: 3ar Sink 3ackflow Preventer 3ackflow Irrigation 3athtubs Clarifiers Dishwasher . � Drinking Fountains Floor Drains � • Floor Sinks - - Gas Service Outlets Interceptors ' Kitchen5ink, � Lavatories P-Trap Roof Drains � ,Reinspection Fee , � $15 Boiler � Duct - Under Grountl � DuCt-Strucmral i Duct � Ventileting Exhaust System ❑ Multiple �� Firepl/Fact.BILIC80# Heating System & Ducting - �0-100,000 BTU 0100,000 Reinspection Fee � $15 OB65-46, rev. 10/84 White - Building; Canary - Applicanh Pink - Ac<ounting; Goltlenrod - Assnssor Showers Service Sink $ewer Cao Sewer Connection $olar Collxtors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinat Water Closet ' Water Heater Water Service Auto�Wash . LaundryTrays ' Iuue Fee , . $ 3 FEES Hood or Type I � ❑ ' 'Canopy Typell ❑ ' Refrigeretion System , - ❑aioo,oaoaru ❑ioo,000i �Sysiem Repair/Alteration FireDempers' � Registers Issue Fee $ 3 Automatic Washer Construc[ion Pole Sub. Cooking Unit Dishwasher - Dryers �Gas ❑Elecvic Fan Fixtures ' Device Boxes � Outlecs . Switches Garbage Disposal - GeneratOr �45 KY Fee 2839 II/26/B4 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps • Meter �over100amps Sub Panel Motors �0.1 HP � 1'h - 8 � Inc. Solar �9-15 HP 016-75+ Pole Liqht Range Sign ; Standing Sections 545 KW Trash Compactor $15 � � luue Fea DEVELOPMENT SERVICES REQUIREMENTS: � Zonin9 APProved BY � Buiiding Approved 8y �� 0 32.30 Tl FEES 0 $ 3 Z O N I N G R E Q M T 5 � ' SUMMARY OF FEES � � ' / , ' BUILDING PERMIT $ SMIP $ � PLAN CHECK � $ PERMIT , � � , PWMBING § �. DD ISSUANCE �$ ., PLAN CHECK 25% �$ �v ENERGV 7.C. '$ � ELECTRICAL i$ i .00 GRADING• $ .� PLAN CHECK 50% $ • SO MICROFILM $ MECHANICAL �$ � TOTAL FEE '$ ,'� 7_� PLAN CHECK 25% '$ � i� " I CM1 CONSTRUCTION AND PLANNING POG_ „� SPA �_ _ APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector , 1. Tempora�y Electrical Service or Pole � 52. Pool & Equipment Location 2.,Soil Pipe,Undrgrnd. , � � 53. Steel Reinforcement 3.�Electrical�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 Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test � .i 9.,Wa'ter 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 73. �Rodf=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. 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. REnUIREMENT 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 7ank O Gas ❑ Oil 25. 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 37. Plaster Brown Coat • ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 7/� �r C�A Notes:G��/�'Id',f LEYT CFMO �.,�li• 34. Final Heatin9 & Air Conditioning (� �� .1j U PG - Y Z6 �S G� 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing , � � 39. Water Service-Final 40. Gas Service-Fina 41. Solar pomestic-Final � `� `�D 42. Ba r - 43. Backflow Irrigation . 44. Landscape Irriga�tion SYstem 45. Sound Attenuation � � . � 46. Handirap Regulations � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ' 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date � , � , � ' • CITY OF COSTA MESA BUILDING DIVISION OWNER-BUILDER VERIFICATION 6 A citY o� county, which is required to give notice pursuant to Seaion 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 buiiding permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. � Yes ❑ No 2. I(have/have not) � signed an application for a building permit for the proposed work. 3. I have contractg�d with the following person (firm) to provide the proposed construction: Name Address City Phone ( I Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name � �� Address City Phone ( 1 Contractor's Lic. No 5 1 will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone 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 mpl' nce with this State law. Signed: —.,�� . Date: ��O_�� Name: .�i K� if.U� (Printed or Typed) C.D.L. or S.S. # �! � _ 7545273 CMF 3042-46 . � _ . . ,. o . d��.@. ` . . - -~�.� . � STRUCTURAL APPROV --'_"_------� SEPARA7� pER,��i� �'�� fOR EicC?;:!r;; RFQ�IRED HEATC!G, i.�r � r:; ' ` .;, ,::,.,, RE; p ,� ., .,..G �,�D ��„cr._,n�. .. . . � r;'fl'il �Il •�'��9`tn�' �= -,....��.�� .�.,.yx �?�_��35/ � r;-�:i,x.� �, . .^ ;�,�;°;r ,...__. . 'or'.. ..�. 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BOX 7200 COSTA MESA, CALIFOHNIA 92626 For App/icant to Fill in Complete/y BUILDING 216 Pamela Lane ADDRE55 4 OWNER ROy �. Ward Co. ADDRESS 170'7 Westcliff Dr� cirv Newport Beach No'646-0228 CONSTRUCTION BRANCH ADDRESS ORENGINEER Roy Kiter No`�548-524 ADDRESS 211 W�nut St, Newpmrt Beach CONTRACTOR ADOFESS TEL. CITV NO. STATE CITY LIC. NO. IIC. NO. OF LOT 54 X l 11��6 I NOW ON LO � � USE OF 07LE EXISTING BLDG. SIZE OF NO. OF EXTERIOF WALL wOOd ROOF COVERING COVERING USE OF BU�J,DING ANO WOfiK�O,BE PERF�OFMED PLAN 1 I hereby acknowletlpe that I have r¢atl this application antl state that the abova information is correct antl agree to comply wlth all lawz regulating builtling consiruction, antl I zhall not employ any person in violation of the workman's compensation laws ot the State of Calitornia. I he�eby certify Shat 1 em prope�ly licensetl as a conttac[o� unde� the State ot California Business antl Professions Cotle, Divisicn 3, Chap[er 9, antl that such licenses are in tull force and effect, or I am ezempt fram the pr isio ot the S[ate of California Business antl Professions C Q97 v i 3 Chapter 9. % Signature of G� Permlttee Authorized Agent kUG -4-72'A'o00 390�+ *�**66.04 CNSA APPLICATION FOR BUILDING PERMIT REC�jVE�J,Bv D/�f R EIV D DATE I UE C�/I.• V � � �_/ A.P.NO. II��Jo2I �� PER IT' �I BUILDING � fLl \�a��i��2�E_ ��._ / � AODRESS �� Q/ TRACT �/ LOT.�_J BLOCK OWNEF FIRE • ZONE APPilO V ED DATE ZONE � NO.OF USE OF NEW PIAfS a BUILDING VARDSAPPROVED VARDSAF MAIN BUILDING ACCESSOR' REAR �� DISfANCE BET MAIN BLOGS. VAR. �W G.U.P.� �� APPROVED �/ BET. MAIN & L m e � e SQ. FT. eln �!l O TH AMOVNTSHOWN UNDER VALUATI N IS FOR � THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m ¢ VALUATION m PERMIT FEE $ �� j $� ///�� Aw /ry^m � Q�V` PI..QN CHECK $ W`,i � E O` J I i LL TOTAL FEE $ '�� 3 s� 3 E, t�c� 19-72�ASioa ea� �u� u i z6.�o Z . d V Z 2Q O v~i d m J � J � Q W p] J J m Q U � Z a W � d W W Z J � m z J � W W O= Z F— W� � � � � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT Fo� Applicant to Fill in Completely �n � / RECEIVEDBV DATEFECEIVED O�A{TE 5 UE�D7 BUILDING �i�_ �EG%� �I/%+ �D�� '-�Z LV�I��LZ ADDRESS l �p T` � � � �� / PEFMIT NO. OWNER 11 A.P. NO. b MAIL ' ADIDRE S 42�C.. /4"/v(�L./' � ADDRESS TEL TRACT OT�� BLOCK CITV NO. CONSTRUCTION NEW DD ALT R P LENDER BRANCH ` � � D OWNER ADDRESS VALUE ARCHITECT TEL. USE 5 OR ENGINEER N . FIRE ADORESS ZONE TVPE GROVP APPROVED (J CONTRACTOR BV DATEJO— 7`��— ADDRESS TEL. ZONE NO.OF � USE OF NEW �� „ CITV NO. PLANS BUILDING STATE CITV �ARDSAPPROVED VARDSAPPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUI�DING SIZE NO.OF BLDC$. (FROM G/LSTREET) OF LOT NOW ON LOT FRONT C FT. L FT. USE OF EXISTING BLDG. 1 FT. FT SI2E OF � NO. OF NEWBLDG. ROOMS STORIES L.SIDE I FT. FT. EXTEftIOR WALL FOOF COVERING COVERING REAR FT. FT. USE OF BUIIDING AN� WOftK TO BE PERFORMED DIS7ANCE BET. � BET. MAIN & MAIN BLDG:. ACCESS, BLDGS. /- . ' C URP � ZE-�a-Y APPROVED // Z APPROVED �'S 1�S Z { � I hereby acknowletlge tha[ I have reatl ffiis application antl state � ihat the above intormation is correct antl agree to comply with all laws rogulating building consttuction, antl I shall not employ any person in violation of the workman's compenution laws of the State of California. Q�� p I hereby certify that I am ptoperly licensetl as a contractor untler � � SQ FT. �+^-� � vo the State of Calitornia Business antl Protessions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR Chapter 9, and that such licenses are in tull force antl effect, or I THE PUflPOSE OF ESTABLISHING A PERMIT FEE ONLV: amexempttromth o i IsotffieStateofCaliforniaBusiness VALUATION $��J_+� and Profes5ions o, �v si , Chapter 9. PERMIT FEE (O Signature ot Permittee $ �� PL,AN CHECK $ Authorizetl Agent �^ (/ TOTALFEE $ �`�/ �