HomeMy WebLinkAbout2766 PORTOLA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.caB. UILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2766 PORTOLA DR
Suite:
Viciniry: ROOF
Parcel Number: 14130224
Applicane QEEDEE RASOA
Address: 939 SERRA WAY
Zoning: R1 R1
, Phone: (774)434-2525
COSTA MESA, CA- Zip: 92626
Owner: LENTZ, THOMAS G
Address 2766 PORTOLA DR _
, , � � Phone:
COSTA MESA, CA � - Zip: 92626-5819
Contractor. #1 BEST ROOFING CONSTRUCTION
Address: 939 SERRA WAY
, ' Phone: (714) 434-2525
GOS7A MESA, CA
Zip: 92626 License: 722805
Arch :
Address:
Eng:
Address:
Status: ISSUED
Applied: 08/14/2003
Issued: OB/14/2003
ISSUED BY: �✓
. Phone: Phone:
Zip: � License: License:
_ SCOPE OF PERMIT
TEAR OFF EXISTINC� ROOF. INSTALL 2 LAYERS OF 15# FELT, 30 YEAR COMPOSITION SHINGLES, AND TORCH DOWN ON FLAT SECTION.
3,200 S.F. INCLUDES ATTACHED GARAGE. "
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$125.25
$0.60
$0.00
$0.00
$0.00
$125.85 ,'
SETBACKS
MAIN STRUCTURE Front 0= 0 Rear 0- 0
ACCESSORY Front 0-0 Rear 0-0
PARKING xistin : 0 Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Righl 0- 0
$s,000.00
ss,000.00
NO710E: The work authqrized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
i required inspections and }inal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-4fi�fi/00)
WORKERS'CO�PENSAnON DECLARAnON: �
I hereby attirm under penalry of perlury one ot the tollowing declarations: )
❑ I have and will malntain e certificate of wnsent to sell-Insure for workers' compensation, as pmvided for by section 3700 ot the Labor Code, for Ihe pertortnence oi the
wark tar which this pertnit is issued.
❑ I have an0 will maintain workers' compensation insurance, as requiretl by section 3700 0l the Labor Code, for the peAortnance of the work for which this permit is issued.
My worker ' cp7�p�.pe�n a^tio-n �Insurance carner policy1 number ara: / ' I �7 L'�
Ce�ne�: ��21! l�G ""'V /�.�% d PoliCy NUmber: I Sy� 1 T I�
(This secfion need no! be comp/e ed i! fhe permit is valuetl at one huntlred dollers (5/00) or less.)
❑ I cenify ihat in ihe pertormance oi the work lor which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
wmpensatlon laws oi California, and egrea that it I shoultl become subject ro ihe workers' compensation proWsions ot Sectlon 3700 ot the Labor Code, I she0 forthwith
compy with these proh}�'�/�,,�, p /�
Appllwnt Signeture: ('LKl.�tA/^� Date: O - /T � �
WAPNM�: FAILURE TO SECURE WOfiKERS' COMPENSATION COVERAGE IS UNUWFUL AND SHPLL SUBJECT AN EMPLOYER TO CRIMINAL PENALilES AND CIVIL FlNES UP TOONE HUNDRED
TlIOUSAND DOLLARE (5100,000), IN n�DITIqJ TO THE COST OF COMPENSATION, DAMNGES AS PROVI�ED f-0R IN SECTION 3]W OF THE IABOR CO�E, INTEREST, AND ATTORNEI^5 FEES.
LICENSED CONTRACTORS DEClARA710N:
I hereby aHirtn ihat I am licenpsed und r pr ions of Chapter 9(commencing with Section 7000) of Division 3 of the Business ann7 a�rofessions Code, and my license is in tull
torce end eHect. LJc. M7L p- -� � Class k C�'7�7
Contrector's S�gnawre: do ar�— oate: "� - IQ_ a�
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirm that ihere is a constmction lentling agency for Ihe peAormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lentle/s Name: Lenders Address:
SignaWre: Date:
OWNER-BUILDER DECLARATIONS:
I herehy aMirtn Ihet untler penalty of perjury thet I am E%EMPT PROM THE CONTRAC70RS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry which requires a permit to construct, alter, improve, tlemolish, or repair any stmcture, pnor lo its issuance, also requires the appliwnt tor such pertnit
to file e signed statement that he or she is licensetl pureuent to Ihe proNsions oi the Contractors License Law (Chapter 9(commencing with Section 7000) oi Division 3 oi [he
Busineu end Prolessions Code) or Ihel he or she is e:empt t�erefrom antl Ihe 6asis for the alleged exemption. Any violation oi Section 7031.5 by any applicent for a pertnit
subjects tha applicent to e civil penalry of not more than five hundred dollars ($500).):
❑ I, as owner of the pmperty, or my employaes with wages as Iheir sole compensation, WILL DO TME WORK, and the siructure is not intendetl o� oflered for sale (Sec.
7044, Business end Professions Code: The Coniractors License Law tices noi apply to an owner of property who builtls or improves thereon, and who does such work
himselt or hersell or through his or her own employees, provided that such improvaments are not intentletl or oHered for sale. If, however, the 6uilding or Improvement is
sold within one year ol completion, the owner-builder will heve tha burden ol proving that he or she did not build or improve for purpose ot sale.). �
❑ I, as owner ol lhe property. am E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions
Code: Tlia conirectors Llcensa Law does not appty to an ownar oi property who builtls or improves Ihereoq entl who coniracts for such project with a contractor(s)
license pursuant to ihe Coniractors License Laws.).
� I am eaempt untler sec. Business and Protessions Cade tor this reeson:
Signature: Date:
Owner ID veniietl by tlrivers license. ❑ Yes ❑ No Drivefs License No. Expires:
Verificetion ot Ownership by (type of dxument, I.B. - properry taz blll or tleetl):
DIVISION OF INDUS7RIAL SAFETV PERMIT CER7IFICA710N:
❑ I hereby cerlify that no excavation tive (5) or more feet in depth into which e person is required to tlescend, will ba made in connection with work euthorized by Ihis
pertnit, and Ihat no building sWCNre, scattolding, falsework, or demolition or tlismantling thereot, will be more then ihirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Aaministrative Code).
❑ As owneo-builtler, I will not amploy anyone to do work which woultl require a pertnit irom ihe Division of Intlustnal Satery, as no�etl above, unless such person has a
permit ta do such work irom the tlivision.
SignaNre: Date:
Division oi Intlustrial Satery Permit Number:
CERTIFICA7E OF COMPLIANCE AND AUfHORIZATION OF ENTFiV: I certity untler penalry of perjury ihat I have read this application and state that the infortnation given is
correct. I agree to comply with all steta laws end ciry ortlinances relating to building consiruction, and euthorize representatives oi the Ciry oi Costa Mesa to enter upon Ihe
ebovadescribed property for inspection purposes. I egree not to occupy or allow occupancy oi eny builtling authonzed by Ihis permit until final inspection.
�i neture Ot Legal Owner(s) Date
/��,�._ 8 - /4_ � i
-� AnNOr Authorized Applicant Date
COOE 1. INSPECTIONTVPE QaIE IMITIALS
1616 Fixetl System Final Fire Prevenfion
1266 Pool Spa Final
200 Final Re-Root
201 Finel BIocWReteining Well
202
2D3
204
Final Factory Fire Place
Final Sign
Final Demoli�on
� '/
COOE 1 INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Site
Final Building/Occupancy
PAIF 1t�4S
PP0.IECTPOOBESS: Z%[j( FORTOLA DR
OWNEX'SNRME: LGNTZ CLAIRE
aoosess: 2'766 �OcZTOLA UR
COSTA A;ESA, CA
544-158:
FNCH/ENGINEEH:
AOOFESS:
926J6
UNIT:
XEG.NO.:
UNIT:
PEPMITTEE: DP PLUMH:ING 6 iNSTALL. ( 714 ) 99i-4477
aooRess: 1569 S, ANAHEIM BLVD A
ANAHEIM CA 92801
UCENSED CONTPRCTOB OECIAflFTION: 1 hereby aifirm �M1ai I am Iicen5e0 untler provi5ions o� C�apler 9(�ommencing wilh Settion '�,
7000) oi Oir�sion 3 0l i�e Business and Pwiessions CoAe, and my license is in fu0 �orce and enec�.
cirruc.: 050672 srnTeuc.:563793 e s: C36
�ate: ��' � Z Signamre:�'1t� ���ei�
WOflREBS' COMPENSPTION DECLAPATION: I �ereby alf Iha� I have a certificale oi consent �o sel4insure or a cert�f WOBers'
CamDensation aqc or a c A e copy mereot (Se ian 3800. Lab
roucv xo.: �� =� �'� �`� g exr. onte: l! 0 L/ 9 4
cornraxr: FAkN,ER5 ,-+�
.� Ceriified capy is here�y fumishetl. L'F Cehitietl copy is fil9 wi�� @ ciry Builtli vision.
oa�e 7-23—QZ- qpplicanC / �
E%EMYfION FflOM WOPREBS' COMPENSATION UECIAPATIO (ihis Setlion ne¢tl not be compleicd il tlre permil is for One huntlred (5700) of leu).
I ceriily I�ai in Ihe Oetlormance ol ��e work ior wnic� ih' permii is issued, I s�all noi emDloy any Oerson in any manner so as �o Uecome
sublecl �o Ihe Workers' Compensalion Laws of Calitorma.
Oate'. Signa�ure:
NOTICE: II. atter making Ihis declaralion. you shoultl become sublec� m the Workers' ComDensation provisions oi Ihe LaOor
Code. you mu5� totlhwi�h tomply wiih SUth pmvisions ar this p¢rmii 5hall 6e AeemeU revoketl.
CONSTflUCTION LENOING RGENCY: I nereby a��irm iha� Ihere is a constmclion lending agency �or �he peAormance o� �he work �or
whic� Ihis Oe�mn is i=sued (Sectian 3qJ7. Civ. C).
LENOEfl:
RO�NESS:
OWNEfl BOILOEN OECLABRTION: I Aereby affirm that I am exempt �mm lhe Con�mc�ors' State Lic¢nse Law for �he following reason
(Seclion 70.31 5 Business anA Prolessional Code: Any city of county which requires a permi� to constmct. alter, impmve, aemolish, or
repair any s�mcture. prior lo ils issuance, also reQuires ihe applicani ior such permi� �o file a signed statement Nal he/she is licensetl
pursuan� lo the pmvisians ol ��e Conlrac�ars' State License Law (CAaO�e� 9(commencing wi�h Sec�ion 7000) of Oivision 3 0� the Business
and PmlesSions Cotle� or I�al helshe is exempt �here�rom antl �he basis lor �he allege0 exemption. Pny viola�ion o� Sec�ion 703L5 by
any applicant tor a permit su�lecis Ihe aDPlicani �o a civil penaliy o� not more than live huntlretl Oollars (5500).
I, as owner of the Ompeny or my employees with wages as their sole compensation, will tlo the work, and ihe
❑ slmcNre is no� Inlentletl or o��eretl tor sale (Semion 7044, Business antl Pm�essional CoOe: The ConVacmrs' S[ate License Law
tlaes na� aOPly �o an owner o� a pmpetly wha builds or impmves Ihereon, antl w�o Does 5uch work �imself/hersel� or Ihmugh
ha or her own employees. pmvitled �hat such impmvemen�s are no� inlenaetl or o��ere0 fo� sale. �i, however ��e 6uiltling or
impmvemenl is sola within one year o� cam0�e�ion. th¢ owner will �ave �he burtlen o� pmving Ae/she tlitl not Ouiltl or impmve
lor ��e purpOse o� Sale)_
� I, as owner af �he pmperty, am eaclusively coniracting wi�� licensed con[ramors m constmct �he D�ole�l (Section 7044, Business
�❑ antl Pmlessions Coae: The Con�rac�ors' State License Law does no� appry to an owner o� Oroperty who budas or improve5 �hereon
, and who coniracis lor such pmleds with a coniracmr(s� license pur5uantio Ihe Comractors' S�a�e license Law).1 am aware
., Iha� proal oi Iheir Worker'S Compensa�ion insurance shoultl be pmvideA Io me.
'�I � I am e�empt un0er Section: B. 8 P. C.
lor ihis reason�.
Da1e Ownec
I tlo hereDy cenity tha� I am aware of ana un0ers�antl ��e requirements ol Calilomia Heal�h antl Sa�ery Cotle Sections 25505, 25533, antl
25574 ana ��al I or any �uNre building occupan� willlwill no� (circle one) neetl Io comply wi�h saitl state codes and the requirements �or a
permit for cons�mciion ar motli�ication �mm ihe Pir Ouabry Management OistricL Residemial consimdion applica�ions are exemp� Irom
�Aese pmvisions.
Oa�e: ApplicanP.
I here�y cetlify Ihat I have reatl Ihis aODlica�ion antl state ��at Ihe above iniormalion is corBCL I e o comply wiih all cily antl county
ordinances antl 9ate laws rela�ing ta bml0ing constmclion and �ere aul�presenlaiive5 of 5 c lo enter upan the above�men�ioned
pmpetly Im inspection purposes.
�ate: � � �� ��
164b46 WOue—Bmldmq', Green—Cotle En�o¢ ene. Canary—Aoolicant: Pink—Revenue: Goltlenrotl—Ns.sessor
CITY OF COSTA MESA - B(JZLDING PERMIT PERM NU: 1$ --
FERMIT NO: P 058285 PLAN CiiECK NO: �V �_�
j.] c�v �7: N surY:
CONSTROCTION TYPE; V-N I'ERMIT Typg: pyU PUkPOSE• OTH
JOB DESCRIPTIdN ; REPLACE WA1ER Hr.ATER g� rT;
CLAIM VALUE; 500.00 CALC-VALUE; GROUP OCC; R-3 /
COMMENTS: SM�KE DETECTOR RE�UIRED IN THF. ;iOi�tE
ifiF1E3F1FiEiEiFiE�lE1E�lE#Fi'tit�(iFiFieif�3elhiE�F3fiFjE �FiF-1f1FiElE3fif�lE3EiE�F�3F#1f�li�1E3E?fk�%ii�ififiFitifififlEif�iFlFi'tiE3'tk�f�aEY-iFif*IfiF3Fifkkf(.�.
Z O N I N GS ERT�BQAUCIgRSE M E N T S
------------ MAIN BfJILDTNG -- — ------ --------- ACCcSSORY BUiLDING --------
FRNT; FT TN REAR: FT IN FRNT; FT IN REAR: FT ZAi
LEFT: �'T IN RGHT; FT IN LcFT; FT ZN RGH'=: FT IT7
FARKING RE � PROV: PARCEL; ].4130229 ZNE; REF NO;
PLANNING N T'ES>
i
jE+�±F ?i iF �lf iE IF!'r �lF �1F iEiF # 1E �k ic 3F if iE �%�1f� iE N� iP %3F iF 1E *!f if iE if iEiE �1F i(� iF �Y� if �lE # tF �lf iF k�; ?( ie ii� if iE f!�-k� #`.� if 3E 1'r feif iE IE 3f� 3Fic if �E iF �}f lE +k iE )f iE dE iF �. *
D E V E L O P M E N T 5 E R V I C E S✓. R E Q II I R:: M E N T S
ZONING APPROC�ED BY i DATc:
HliILDING APPROVEI) BY ; �
DATe.:
APPLICATION ISSUED BY:�� '� � DATE; ���3�
lk#�iEifiE3flfif#ifiFif#Gif��iEiC�lEiciFlfih ��iFft -res �,, ' . : �} if.'� :. _ �. 1T� � -7Fic�lFihififiEfEi!�3f . tt1F-1(�
ifiEjElEiEifie-X�ii��%�tiEi(��iFiEfEif#ifif-jfiElfaFiEiEifif3f3'rjFiEififltiE �if�' 3Fikif', iE3F1E�Eie3tiEif�FifiFiEiF-�fif�lflfiFif#�)k1ElFiE�e4iE3i#�k3i�i�*
LEGALZZATION:N F E E S U N M A R Y STRUCTURAL BEGMENT_N
P�RMZT HLDG PMT PLUMHIN�G� ELECTRIC MECHANZC FIRE SMIP/RES GRADiNG
�5� i-• SMIP/NQN-�ES
E'LAN !'
ISSUE FEE 3.U0
BUILDING-DIV-> FERMIT ISSUE .}?T,AN-CHECK TOTAL PAID n00
TOTALS-----> 2,00 3,00 � 0,00 5.00 S.UO
kEVET�IIE DIVISION TOTALS--> COLT,ECTED; 5,00 OVER/SAORT; 00
BLDC PMT i�LUMBING ELECTRIC MECAANIC FIRE 52✓,IP/TOT CRADTNG PLAN-C3EC}t
J . Q Q Q
%�:• ik �7f �l�?e iE iF it R�E if� �I(� �lE 3F 3F i: iF f@ iF 3f rE if K� 3E iF iE-!E 3F iF fF if iF 3E �(� iE it 1'r �N- iF 1F �lE �3i-3e 3F iE 3F 3f iF iE if iF iE �E #�N iE ��?E iE �%ie ie iF # 3Eii� ii-iE #�ii� i:- it iE �la ?E 3t� R;E
I N D I V I D U A-F F E E B R E A R D O W N
n
TYPE QTY D E S C R I P T I 9 N UNIT COST TOTAL COST
PLU 1 WATER AnATER A2hD/OR VE�T ?,pp �
�"�.ND OF FEES � • 00
ff�
:'1
yl
�t
Z
`� OE RQ12�f164-�D:�D0:,4 �, �Z-' � ,,
D�TE: 07i24�92 i'IC��: l:�:29 ..; �
CONSTRUCTION AND PLANNING_
APPROVALS Permit #
� i. Temporary Electrical $ervic��or Pole
�.
2. Soil Pipe-Undrgrnd. _ � • -
3..Electrical Conduit Utility-Undrgrnd.
4. Elecirical Conduit-Undrgrnd.
5. S4eel Reinforcement
6. Elecvfcat UFER Gmd.
7. Footings
i
8, Foundation �'
9. Water Pipe-Undrgrnd. � `
10. Structural Floor System ��
7 7. Property Sewer Line & HouSeFConnect
.�
12. Sewer Cap i
13. Roof Drains
14. Rough Plumbing "
15. Rougb Electrical-Conduit 'r
i6. Rou9hElettricWiring �
�%,
17.. Rough Wiring Sign
18. Rough Electrica6T Bar Ceilinq
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
27. DuCts,in Structure
22. Ducts, Ven[ilating
23. Gas Pipe�Rough & Test
24. Root Framirtg
25. Roof Sheathing
26. T�Bar Ceilin9 (Structurall & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nalling
31. Plaster Brown CoaT
32. Electriwl Power Meter�Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe•Test
36. �-lood oi �nopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irr�gat(on
44. landscape Irriqation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
l8. FINAL PLANNING '
9. Electric Release to Edison
�. �aS Release to Southern Caiifornia Gas
! . CERTIFICA?E OF OCCUPANCY
Date
Date
PO. S SPA
inspector pppROVALS Permit # Date
� 52.-Poot & Equipment Location'
53.-Steel Reinforcement �
54. Forms
55. Elecvical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAt TO COVER�GIINITE
58. Electrical Cqnduit�Undrgrncl.
. 59. Gas Pipe, �.Undrgrnd., Test
� 60. Backwash Lines, P-Trap, � Undrgrnd.
� 67. APPROVALTODECK
62. Backwash & Receptor�Final
63. Heater & Vent-Final
� 64. P.lumbing System - Final
65. � Electrical-Final
66. Sotar SYstem-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL �
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas � Oil
72. Underground Flush
73. Undergrnd.StorayeTank�GaS OOif
74. Overhead'Hydro
75. Dry Chemical -
76. Dry Standpipe � .
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
. HEAITH DEPT. REQUIREMENT
� • 79. FiNAL INSPECTION
I �- 80. F000 CERTIFICATE ISSUED
i
Inspector
. .
�F
� �
.�
/ .
',,' Notes:�r�i,y/4LF.(op►{s�µomE'L,q,pTY�q¢v-C.EU
,4,
0
. 12���
C057A MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 COSTA MEHA. CALIPORNIA �
For Applicant fo Fill In Complefely
TYPE OR PRINT
■ 6TATE
COSTA MESA. CALIFORNIA .
esa Dal Mar Development Co.
Suite 1. 3800 E. Coast High
No:Or 342
Levanas �,E�' Or 370
3800 E. Coaet
NEo: Or 34220
� v�;.,��ua��a. p
USE OF '
EXISTING BLDG.
CBNTEAR OP'NSTRE TM 42 REAR YARD. Z9
SIDE YARD ILEFT 5 IRIGHT 5
DESCRIPTION OF WORK
.,�.., I x II ., t�e.T,�a I II e.,�,r,�.,
■ BUILDING
7VERING Rock
TO BE PERFORMED
Residence
��E R�cE���o
��juriF(�,4PSCE DEPT.
CITY OF CUSTA MESA
APPLICATION FOR PERMIT
Lot �k 81 BUILDING
P1an.R 2A
For Office Use Only
RECEIPT NO. PERMIT NO.
RECEI/J"� � I� �A�R�'b D I /'J� �L
ADDRESS 2766 Portola Driv�
- COSTA MESA, GALIFORNIA
TYPE I� GROUP � k
APPROVED
ZONING
ZONE NO. OF U6E OP NEW
PLAN6 BUILDING
DESCRIPTION /Lot Tract � 3749
ICENTER LINE
REAR �/
APPROVED �
Ip� �
)
q �_ Y
V .
with attached garage
1 HEREBY ACKNOWLECGE THAT � HAVE READ TXI6 PPLIWTION THE AMOIINT BHOWN UNDER VALUATION 18 FOR TXE
wNo eTqiE THAT THE AB YE 16 CORRlLT ANO A Ee TO GOM• pURP09E OF E9TABL19HING A P¢PMIT FEE ONLY.
PLY WITN ALL CITY ORO ANC AND ST TE LA 6 R6GULATNG
9wLo�No cONeTRUCTIo VALUATION
BIGNATURE OF PERMI7 FEE $3Z.00
PERMITTE
s 13,S15�OO PLAN CHECK $16.00
AUiHORIZED AGENT Project Manager
_,,.,.. «< a48.00
, � ` 25298
,COSTA MESA BUILDING-SAFETY DEPARTMEM
P.O. BOX 72W COSTA MESA, CALIFORNIA B262E
For Appllcanf to F711 In Complotaly
TYPE OR PRINT
i 7 � � /'� r�c l.¢_ �--� �'
COSTA MESA, CALIFORNIA
e�nnevaa � 7
33/
Sy
e�urv n �r
ZONL
�
L[OAL
CITY �F � ;��� M£SA
FEB 14 1966
wyf
�<
ZONIN(3 d2��� ��C `1
NO.O� /-� UY[OIN[W
�LAN/ _/ euLLolno �
�' � A. P. NO. / / � O � — �"`
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