HomeMy WebLinkAbout2198 RALEIGH AVE - Building PermitsJob Address: 2198 RALEIGH AV
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42240116
Applicant: GALARZA,GALE
Address: 2198 RALEIGH ST
COSTA MESA, CA
Owner: GALARZA, ELIAS
Address 2198 RALEIGH ST
Contredor.
Address:
Zip:
Arch :
Address:
COSTA MESA, CA
Zoning:
Phone: 949-650-3874
Zip: 92627
Phone:
Zip: 92627
Phone:
License:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 09/09/2003
Issued: 09/09/2003
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF, INSTALL NEW SHEATHING AND COVER WITH 30 YEAR COMP. INCLUDES ATTACHED GARAGE.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$11125
$0.50
$0.00
$0.00
$0.00
$111.75
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
FEESUMMARY
PLANNING & ZONING
Rear 0- 0 Left 0- 0
Rear 0- 0 Left 0- 0
Re uired: 0 Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Righl 0- 0 '
$4,500.00
$4,500.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for lhe work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all
Irequired Inepeetlona and finel approval must be obtained. Failure to obtain inspections and final approval will resNt in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
taasafi 15�00)
WORKERS' COM7ENSATION DECLARATION:
I hereby aXirm under penalry of perjury ona of the following tleclarations:
❑ I hava and will maintain e cetliticete of consent to self-Insure for workers' compensation, es providetl for by section 3700 of iha Labor Cotle, tor the pertormenca ot ihe
work for which ihis pertnit is issuad.
❑ I hava and will maintain workers' compensation insurance, as requiratl by sec"on 3708 N.Ihe Labor Code, for the pertortnence of ihe vorl For which Nis permit is Issued.
My workere' Compens Iqn�ln rence carn r n polic umber ere:
Carner: (J Policy Numher:
(Thls s ion need �ot be cromp/ete the ermit alued af one hundred dollars ($/00J or less.)
certify that in the peAormance ot iha work f which Ihis permit is issuetl, 1 shall not dmploy any person in eny manner so as to �ecome subject to tha workars'
compansation laws of Califor e, ai agree thet if I should become subjact to ihe workers' comFhnsetion provisions of Sect n 3700 f the Labor Cotle, I shell forthwith
comply with tnese provisio . /
Applicent SignaNre: Date:
WARNING: FAIWFE YO SECU E WORKERS' COMPENSA COVERAGE IS UNLAWFUL ANO SHALL SUBJECT AN EMPLOYER TO CRIMINA� P TIES ND CI IL FlNES UP TO qJE HUNDRED
i/qUSrW D OOLLARE (510p,000). IN ADDRIIXJ TO THE COST OF COMPENSATIdJ, DAMAGES NS PROVIOED FOR IN SECTIIXJ 31O60F THE UBOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTpACTORS DECLARATION:
I hereby aMirm ihat I am licensed undar provisions of Chapter 9(commencing with Section 7000) ot Division 3 oi ihe Business and Professions Code, and my license is in full
torce antl afled. Lfa � Class N
Contrectofs SignatUre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I �ereby aHirm that there is a constmction lending agency for ihe pertormance of t�e work tor which ihis permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lentlers Address:
Signeture: Date:
OWNER-BUILDER DECLAFATIONS:
I here6y aflirm thet under penalry oi perjury Ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Code: Any city or c0unry which requires a permit to constmct, alter, improve, demolish, or repair any stmcwre, prior to its issuance, also requires Ihe applicant tor such permit
to flle e signed statoment that he or she Is Ilcensed pursuent to ihe provlsions oi ihe Contracbrs License Law (Chapter 9(commencing with Section 7000) ot Dlvislon 3 of t�e
Business end Professions Code) or Ihat he or she is exempt therefrom end ihe basis for ihe elleged exemption. Any violation of Section 7031.5 by any applicant for e permit
subjects the applicant to a civil penalry of not more Ihan five hundred tlollars ($500).):
❑ I, es owner of the properry, or my employees with wages as iheir sole compensation, WILL DO TME WORK, and the strucNre Is not intended or otteretl for sele (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply lo an owner ot properry who builds or improves ihereon, and who does such work
himselt or herealf or through his or her own employees, pmvitled that suc� improvemenis ere not intended or otteretl br sele. If, �owever, the builtling or improvemeM is
sold within one year of completion, the owner-huilder will have the burden of proving that he or she tlid not build or improve for purpose of sale.). '
�I, as owner of the propeny, am E%CLUSIVELY CONTRACTING WI7H LICENSED LONTRACTORS to constmct the prolect (Sec. 7044, Business and Professions
\ Cotle: The conbactors License Lew does not apply to an owner ol proparty who builtls or Improves ihereon, and who contracts for such project with a contractoqs)
license pursu2nt to Ihe Contractors License Laws.).
❑ I em exempt yT}Qe�c. Business antl Protessions Code lor this reason: /.l �/� I.�i-f
Signalure:
Owner ID ve ' ed by dri er's licens es ❑ No DriveYs License No.
Veritication of Ownership by (type ot docum t, i.e. � property tex bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby cetlify ihat no excevation tive (5) or more feet in dapth into which e parson is required to descenq will be made in connection with work authorized by Ihis
pertni6 antl thai no building siructure, scafrolding, talsework, or tlemolition or tlismantling Ihereof, will be more ihan thirty-six (38) leat high. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle 8, Califomia Atlministrative Code).
❑ As ownar-builder, 1 will not employ arryone to tlo work which wouitl require a partnit from Ihe Dlvision of Indostrial Sefety, es noletl above, unless such person has e
permit to tlo such work from iha division.
Signeture: Date:
Division of Intlustrial Satery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I certify under penalty ot perjury ihat I heve read this epplication and state thet ihe intormation given is
correct. I egree to cOmply with all state lews and ciry ordinences rela�ing to Cuiltling cons�ruc�ion, antl authorize representalives of ihe Ciry ot Coste Mese to enter upon the
ebove-described pro lor i pectioy puryoses. 1 agree not to occupy or ellow occupancy oi eny builtling authorized by this permit until finel inspection.
///A
���5 n t�e Oi a wner(s) Date
Antl/OrAuthonzed Applicant Date
COOE �, ixsvecnoxr[e€
1 fit6 Fixatl Sysiem Final Fire Prevamion
12fi6
200
201
202
203
204
Pool Spa Final
Final Ra-Rtlot
Final BIaWRetaining Well
Final Facrory Fire Place
Final Sign
Final �emolition
ceie u�s
�i'2-a3 �
CODE I INSPECTION TYiE
206 Fina1 MechaMcal
208 Final Plumbing
210 Final Electncal
212 Final Fire Preventlon
220 Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
PEg II�Lfl
PB0.IECT NODflESS: L 1 9 8 RAL E I'GH AV
,awNeR•sxnmE: KALAMA, MARY ANN
nooness: 2198 RALEZGH ST
COSTA MESA,CA
•, PflCH/ENGINEEP: 6 4 2— �`; 1 7
AOUPESS:
UNIT:
92627
REG.NO.:
UNIT:
PEPMITTEE: GEORGE BRA'LIL ( 714 ) 535-7905
nooxEss: 3�07'2j'J2� Nn. HESPERIAN WY lU1
LICENSED CONTHACT�( DECUAATIO�l:'Nh�ereby a��irm ma� � am �icensed undeCpmvisians o�COO�er 9(tommencing wilh Sec�ion
7000) ol Oivision J o��he Business antl Prolessions Co�e, ana my license is in lull brce an0 efiecl.
CIiY LIC.: STPTE LIC.: SLASS:
; //�0299. 44306 y nA 36 ,, '/
oC — // — f�� Signalure: — _ .��Li��CQ�%ii""�
WONNEBS' COMPENSA710N oECIABRTION: I �ereby atiirm ihai I have a cenilicate ot consent to sell-insure or a cetlificate of Workers'
Gompensation Insurance. or a ceNhetl copy tnereoi (Section 3800. La�. CI.
POUCYNO.:nH0298489-00 E%P.UATE: O�.IOLI9J
COMPANY: kELIANCE ZD15 CO
� � 7 Cenirea coov is nereey fumisnen. �3i CertiheE co is filetl wiih the c/ity Buildning Division.
. �� ��'� / / ADOlicant�il/il.W 1 �.(��
E%EMPTIONFROMWOflNEPS'COMPENSPTIONOECIABATION: (ihis5ec�ionneednol0ecompleleailihep¢rmi�i5loronehuntlrea�4100�or1e55�.
I ceNly iha� in Ihe pedormance o� the work lor whic� Ihis Dermii is i55ue0, 1 shall noi emDloy any person in any manner so as �o become
sublecl to tAe WOBers' Compensa�ion Laws ol Calilomia.
Daie: Signa�ure:
NOTICE: II, af�er making ihis declara�ion. you S�oWa G¢[ome sublec� to ��e WOrkers' Compensation pmvisions ai the Labor
COOe. you must Iorlhwii� wmply wit� Suth pwvisions ar I�is permii Shall be deemetl r¢voke0.
cONSTBUC7loN LENOING AGENCY: I hereby affirm �hat inere is a conslNction lenaing agency lor Ihe pedormance of Ue work for
which ihis permil is issued (Sec�ion 3097. Civ. C).
LENOEH:
FDONESS:
OWNEN BUILOEN oECIANpTION: I here�y afiirm ihat I am exempt trom the Comractors' State license Law tor ine following reason
�Sectmn 7o31.5 Business an0 Pmlessional Code: Any city ol counry which requires a permit m constmcL alter, impmve, demolisA, or
� repair any Slmtlure. prmr �o it5 i55uante, al5o r¢quires �Ite apDlitant for Such permil Io lile a Signetl statemeni Ihal he/She i5licenSetl
pursuam m the pmvisions o� �he Comracmrs' Sta�e License Law (Chapter 9(commencing wit0 Seclion 7000) ot �ivision 3 0� Ihe Business
ana Professions Cotle) or Ihal hefshe is e�emp� I�erelmm antl �he basis �or IM1e alleged exemption. Any violation of Sec�ion 7031.5 by
any applicani for a permit sublec�s Ihe applicanl �o a civil penally o� not mofe �han five hundretl dollars ($500�.
I, as owner of the D�opehY ar my employees with waBes as Iheir sole compensation, will eo ihe work, an0 ine
❑ slmcture is not imentled or ofieretl far sale �Section 7044, Business antl Pwfessional Code: The Contractors' State License Law
tloes no� apDly to an owner of a pmpeny who Ouilds or improves ihereon, antl who does such work himseli/�erself or ihmugA
�is or her Own employe¢5, pmvi0ea Ihal Such imDmvemenls are no� in�en0e4 Or Ofleretl �or Sale. I( �Owever th¢ builtling or
impmvemen� is solA within ane year ol compleiion. Ihe owner will have the hu�den ol pwving he/5Ae did no� bui10 or impmve
lor I�e purpose ol sale),
I, as owneroflhe pmperty, am e�clusively conlracting wil�licensed coniraclors b consimcithe D�olect(Section 7044, Business
❑ antl Pmiessions Catle'. The ConVattors' State License Law tloes nol appty to an owner ot pmperty who 6uilU5 or impmves �hereon
antl who conirac�s for such pmlec�s with a contracloqs) license pursuant�o �he ConVaclors' Sta�e License Law),I am aware
��at pma� oi Iheir Worker'S Compensation insurance shoulU be pravidetl �a me.
� I am e�empt under Sec�ion�. B. 8 P. C.
for mis reason:
�ate'. Ownec
I tlo here�y cenily �hal I am aware af an0 untlerstantl ihe requiremems ol Calilornia Heal�� and Salety Cotle Sec�ions 25505, 25533, an0
25534 antl ihat I ar any fulure builtlmg occuDanl willlwill nol (circle one) neetl �o camply wilh said s�a�e codes and the requiremenis br a
permii for consimciion or modilication �mm Ihe Air Oualiry Managemeni DisVicl. Resiaen�ial conslmction applica�ions are ezemD� �mm
Uese pmvisions.
Dale' NppliCant:
I hereby wr�ily �hai I have reatl �his applicalion antl sla�e Ihal Ihe above iniormaiion is correc�. I agree Io compty wi�h all ciry anA counry
ortlmancesantls�alelawsrelalinglobuildingcon5lmclionanU byaulharizerepre5enlativeso�Ihisciry�oenierupantheabove-mentioned
pmpeny lor inspeciion pwposes. A Q�� /
�e ia � � � -y � Signalure ��1 �-� A ' `� ' v
�nvefs License oi Social Secunty p: �� � � �����
t6aba6 Wmte—Bmldmg'. Green—Cooe Enlorcement: Canary—Applicant: Pink—Revenue; Goltlenrotl—Assessor
CITY OF COS'PA MESA — BUILDING PERMIT PERN NO; M U55959
FERMIT NO: M U55454 PLAN CHECK NO: N GOVT: N SUPF: N
CONSTRUCTZON TYPE; V—N PERN,IT' TYPE; MEC PURPOSE; OTH
JOB DESCRIPTZON : C/O EXISTING FAU 6 IAISTALL A NEW ONE SQ FT;
CLAIM VALT7E: 1,800.00 CALC—C�ALUE: GROiJP UCC; R-3 /
COMMENTS• SMOKE DETECTOR RE�UIftED IN TAE HOME
�+��r�******�*x**�x�+r;�*�*��r** ***+��***��r���****���r*�t**�***��*x�******�r*��*��***+��
Z O N I N G R E Q U Z R E M E N T S
ss;BAcxs
------------ MAZN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR• FT IN FRNT; FT IN REAFt; FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGiiT; FT IN
PARKING REQ• PROV: PARCEL: 42240116 ZNE; REF NO:
PLAIJNING NCST'ES>
i
����**��**�;�*���x*x**�*�***�*�*�*�,�*.�.*���*�**����x��x*��+�*���*�*���**��±��x**�*�
D E V E L O P M E N T 5 E Ft;V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY '' DATE;
BUSLDING APFROVED BY : "� DAT'E:
APPLICATION ISSUEU BY• �� DATE: p7"�
iE3fif3(-ifiFiE3FiE3EiE�EifiE#i43E3FiP3ffF1f�'iF'iFie3F�R iE3FiFir'iF7F3e �if�EiF3FiFlFiriF�iF�TF�FiFirf�FifiEf!�IFIEiF1Eif3E7f � 1f1E
�1E iF � i!� it # 3F aF iF iE iE iE 1E 1E iE 3E iE i4 iF �lE *# 3E iF iE if ��1E iF iE iF iE if iF iF i4lF iE 3E 1E iE IE iF iE iE i(� �'t �E if iF it �)f 1f if iE 1F i!�!f -1F iE iE �F 3E iF �7h iF ie if iF af � iE 1!� #'� iE iF iElf� �Y
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMnNT:N
BLDG.PMT PLUMBTNG ELECTRIC N,ECHANIC FIRE SMIP/RES GRADING
PERMIT 9.00
258 SMIP/NON—RES
PLAN
ISS(JE FEE 15.00
BUILDING—DSV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTAL5----> 9,00: 15.OU 0,00 29,U0 29,00 ,00
REVENUE DIVISION TOTALS'=—> COLLECTED; 24.00 OVER/SHORT; ,00
BLDG PMT PL"UMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
24.00
�E #� if iE it� �F iE if if 3F iE 3f� iF #F 3F if 3't iE if iF if iE �iE if iE 3E 1E iE iE * i(� if iE iF 3h K� if i(� 1E iP i(� ib iE 3E if IF ik 1E �1E jF #� ih 3Eai lf iE 1f if IE aE if if jE 3E If 3E iE �4� 3'r iE fE iF li iF 3F i if k#F
I N D I V I D U A L F E E H R E A K ll O W N
TYPE QTY D E S C R I P T I O N tJNIT COST 'fOTAL COST
N,EC 1 INST FORC—AIR/GRAV FtJRN <= 100 K HTU 9.00 9.00
END OF FEES
r, R'i!1�! I�'.—�L�'!�'.1:�C "" ., . �� ;'1
'.:"'�--,.. '..�.lS't. 7itiF= _'. _'-�
� f
,� CONSTRUCTION AND PLANNING � � POOL ,PA
APPROVALS Permit # 'Date Inspector qppROVALS Permir # Date Inspe�tor
?. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electric8l Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6., Electrical UFER Gmd. 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 Lines, P-Trap, � Undrgrnd.
10. Struttural Floor Syscem 61. APPROVAL TO DECK
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap . 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
74. 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 66. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Condi[ioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPR6VALS - Permit # _
27. Ducts, in Structur6 � 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. Fioof Sheathing . �. � 74. Overhead Hydro �
26. T-Bar Ceiling (SvucturaU & 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 ��?�q� GED. �
35. Final Gas Pipe-Test �I -s •
36. Hood or Canopy • -
37. Final Factory FirePlace ' ,
38. Final Plumbing • -
39. Water Service-Final '
40. Gas Service-Final . ; . � �
41. Solar pomesticFinal �
i
42. Backflow Preventer � � I "
43. Backflow Irrigation ' . �
44. Landscape Irriqation System . � � .
45. Sound Attenuation � -
46. Handicap Regulations � � .
47. FINAL STRUCTURE & BUILDING ;S'
48. FINAL PI.ANNING i . *
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co . ���
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER MESA MANORi--INC: DATE Q_Q8_5'] �
JOBADDRESS 2198 Raleigh Street BUILDINGPERMITNO. �%�y�y�7
GENERALCONTRACTOR Richard Hart VAWE � 9�96l�.00
LOT u BLOCK TRACT 29�y% S1R�18 PeS. W�Btt. �ar. '
GROUP I& J TVPE V ZONE FIREDISTRICT 43OS
PEHMITS ISSUED
INSPECTIONS / DATE SUBCONTRACTOR DATE NUMBER
FnntinaTrench �/If:� �i /—S� I
Foundation F
Rouah Frami
Plumbing, Rough to Slab
Plumbing, Raugh Complete
Temporary Pole
Heati
St.
L����1°�"��1�yrC= ��
' "vi � .'l!.''�.
, . � ...r�
Wiring, Final U�� 1° i���
Occupancy OCT 1 6 195i
FORM 210 3M IO�vS
S'+7
Addre� 219� Raleigh St I I � V'/
Costa Mesa, California Received by Date Rec'd. ate Issued
�C F�B 2 8 1957
Nearest � v
c�oss st. Victoria B,,;ia;,,g
Address
owoe� Mesa �anor� Inc
Mail Costa Mesa, California
Address 17639 Vanowen St Nea�est
c�cy 4an Nu s Calif N;�: DI 36606 Zone st.
Architector Lic. 1�
Engineer T'CS & Fiepe No. C 31�1 Appro�e�
by
Address1�253 Coldwater Canyon N Hollyctood
co�t�actor Richard Hart NaY Lic�152S6
Address 1 6 9 Vanowen St. Van Nuys
Legal I Lot _ I I
Description No. Block I Traet 29�.1
(Atta�h Metes and Bounds)
No. of Bldgs
Size of Lot 133X54 Now on Lot None
l�seof No.ot No.oi
Existing Bldg. I Familieg I Room;
Setback Line from Rear Yard
Center of Street 55 � Side Vard 5 �
DESCRIPTION OF WORH
New I p I Alteration I I Addition I
Bui
6 Stories 1
rvering wOOd Shlri�
Residence
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to mmply
with all CIty Ordinances and State Laws regulating
building rnnstruction.
Signature of
Permfttee �eSa T!aT10I'� �riA. w �n,,iy�t
N o.
CORRECTIONS
APPROVALS
Foundation Location Inspector � D,ate
Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Brecina. Bolts
Valuatlon / Permit Fee $ oZ fL — Masonr
� 9U/ �� Plan Check $ /� �' gond B
$ l Total
Fee 3� — FINAL
RM 204 IO�SS D. P. a S,
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PLOT PLAN
Show Iowtlon and dlstances from
property Iine and between buildinga
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OWNER EF
JOB ADDILESS
INSPECTIONS
coat
OCCUPANCY
�,'aUG $ 196� DATE �
BUILDING
tom Konstruction VALUE $
CT FIRE ZONE DESCRIPTION 0.
DATE I GROUP J TYPE �
---I SUBCONTRACTOR I ____
Form 210-5M—I1-59 S-B P . 117((�
�:, .
. 1��G�
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. dOX 9f7 COBTA MEBA. CALIFORNIA
For Applieanf fo Fill In Compiefely
TVPE OR PRINT
BUILDING P �
ADDRESS Q L�'"�'
COSTA MESA CALI ORNIA
ADDRES6 �
ciiv �
6TATE ��� ;
LIC. NO.
61ZE f
OF LOT� •�
U6E OF
EXI6TING BLtlG.
9GTBACK LINe VROM
NO. OR BLDGB.
NOW ON LOT
DESCRIPTION OF WORK
BUILDING NO. OF
81ZE ROOMS STOF
EXTERIOR WALL ftOOF
COVERING COVERING
USE OP BUILD�NG AND WORK TO BH PERFORMED
eu
�EE RECEIVEU
6F-/i- � o Y�
FINANCE DEP�T�.�p
APPL'IQ:(4'�bI�PQ� P�RH11T
BUILDING
For Office Use Only
COSTA MESA.
ZONING
2 8 I NO. OF I UBE OF P
r PLAN6 Y BUILDING
�ecw� - ^
DEBCRIPTIOt Q
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aultnlNa coNeirtu O . VALUATION �
81GNATURE OF PERMIT FEE $
PERMIITE A - B{J
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AUTHORIZED AGENT _ �