HomeMy WebLinkAbout2739 DESOTO AVE - Building Permits0
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CITY OF COSTA MESA
BYILDING DIVISION
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77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B09-00153
PERMIT TYPE B_ROOF2
APN: 14164207
JOB ADDRESS: 2739 DESOTO AV CM
Vicinity:
Squares: 3300
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
� � Valuation
ISSUED
08112/2009
KJB
$10,000.00 , ,�,,,,
SCOPE OF WORK: TEAR OFF EXISTING ROOF. RE-SHEATH. COVER WITH 30 YEAR COMP SHINGLE PER CODE. ROOF PITCH IS
3:12. INCLUDES ATTACHED GqRAGE. 33 SQUARES.
OWNER: STORM, SARA �YNN
PHONE: 714-556-7437 -
APPLICANT: STORM, SARA LYNN
PHONE: 714-556-7437
CONTRACTOR:
Address: Unit:
City/State/Zip:
ARCHITECT:
ENGINEER:
r;
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
F2einspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$181.25
$0.00
$1.00
$18225
Address: 2739 DE SOTO AVE
City/State/Zip: COSTA MESA, CA
Address: 2739 DE SOTO AVE
City/State/Zip: COSTA MESA, CA
License No.
License No.
PHONE:
Unit:
Unit: :
, :..�k°';�i:?3
License No.
CELL:
PHONE:
PHONE:
�,.. ::itCH �::
�il.
. '� d C�j
'dNOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
�regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF �AST INSPECTION.
'INSPECTIONS: In order for the work authonzed under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
�COOEt. INSPECTIONTYPE DATE IN7ITIRLS COOEN INSPEGTIONTYPE OATE`''=".5. IN7I71A�
1616 Pized System Final Fire Prevention ///��� 206 Final Mechanical
�1266 Pool Spa Final � � 208 Final Plumbing
200 FinalRe-Roo( �/U/S' 210 FinalElecirical
—�'��__
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval ��� '
203 Final Sign 222 Final Site � �
204 Final �emolition 250 Final Building/Occupancy
WORKERS' COMPENSAAON DECLARATION:
I hereby aHlrm udder penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to sel(-Insure (or workers'
compensa�ion, as providetl (or by sec�ion 3700 of the Labor Cotle, !or the
peAormance of the work for which Ihis permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of [he Labor Code, for Ihe peAormance o( the work for which Ihis
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Cartier.
(Thksecfiwrneednolbem d AI epe�mrtavalued t n vndiedCdlars(5f00)wlessJ
Policy ber:
I certify that in the pertorman e of the rk for which this permit is
s d, I shall not employ any person in any manner so as to become subject
to the workers' wmpensation laws of California, and agree that i( I should
become subject to the workers' compensation provisions of ection 3700 of
the Labo�—r Cod'e`�hall fort with comply with Ihese provision .
/ V �►�+==-�Tf�TLe
WARNING: FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FlNES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
AlTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pmfessions Code, antl
my license is in tull torce and eHect.
Lic. # Class #
Gontractor's Slgnawre
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm thal there is a construciion lending agency for the
pedortnance o( the work fa which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's AdOress:
SignaWre Da�e
OWNER•BUILDER �ECLARATIONS:
I hereby a(frm that under penally of perjury [hat I am EXEMPT FROM TME
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Professions Code: Any cily or county which requires a permit to
constmcl, alter, improve, demolish, or repair any sUucture, prior [o its
issuance, also requires the applicant for such pertnit to fle a signed slatement
thal he or she is licensed pursuant ro the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0( �he
Business and Professions Code) or Iha[ he or she is exempt thereGom and
Ihe basis for the alleged exemp�ion. Any violation of Section 7031.5 by any
applica 1!or a permit subjects Ihe applicant [o a civil penally of nol more than
fve h dred dollars ($500).):
I, as owner o( the property, or my employees with wages as their sole
ensation, WILL DO THE WORK, and the stmcture is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or ihrough his or her own
employees, provided that such improvements are not intended or ofteretl for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving Ihat he or she
did not build or improve for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
UCENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and
Professions Code: The contractcxs License Law dces not apply to an owner of
pmperty who builds or improves thereon, and who contracts for such project with
a cont2ctw(s) license pursuanl to lhe Contractors License Lavrs.).
❑ I am exempt under sec.
Business antl Professions Code (or �his reason:
/.t��� 'I� � .�/A�1
� — � i�] •
Owner ID verifed by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of tlocument, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify that no excavation (ive (5) or more feet in depth into which a
person is required to descen4 wiil be made in connec[ion with vrork authonzed
by this permit, antl that no building struc�ure, scaHdding, talsevrork, or demolition
or tlismanUing thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2. Art 2. Sec. 341, Title 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work (rom the division.
Fppllcanfs Signatare
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certi(y a Business Plan (or emergency response to release or lhreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
excep[ions, that a Business Plan be filed with the Costa Mesa Fire
Departmen[ by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
a[ standard temperature and pressure).
2. Does or will the applicant or present or fulure building occupant need to file
a registration form for acutely hazardous ma�erials? ❑ Yes ❑ No
(Section 25533 of �he Cali(ornia Health and Safety Code, with some
exceptions, requires registration with Ihe Cosla Mesa Fire Department by
each business which a� any one time has on hand a quantiry of aculely
hazardous malerials equal ro or grea[er than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
tempereture and pressure).
3. Does or will Ihe applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Pmgram for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safe�y Code provitles Ihal the
Costa Mesa Fire Department may require [he preparation, certifica�ion antl
filing wi�h �he Fire Departmen[ o( an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Sec�ion 25534 0( the California
Healih and Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require !or
the work which is the su6ject of this application a permit for such construction
or modifcation from the South Coast Air Quali�y Management District or from
any olher air pollution con[rol district or agency? ❑ Yes ❑ No
(Section 658502 0( the Cali(omia Govemment Code requires thal ihe requestetl
in(ortnation be (umished on applica�ions (or non-residential building pertni[5�.
6. Will any part of Ihe facility ro be constructed under this permit be within
1000 (eet from Ihe outer boundanes of a school? ❑ Ves ❑ No
Qf 'yes", Ihe faciliry must meet the requirement of Sections 25534 antl 42303
of Ihe California Health and Sa(ety Code).
7. If a permil from the South Coast Air Quality Management District or other
air pollution conirol district or agency is required tor the work which is the
subject of lhis application, have all of lhe disclosures prescribed by Cali(ornia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance from the appropriate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is cortecl. I agree to comply vrith all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
SignaWre Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penatty of perjury that I have read this application and state that
the information given is correct I agree to comply with all state laws and ciry
ordinances relating to builtling construction, antl au[horize representa[ives of
the City o( Costa Mesa to enter upon the above-described pmperty for
inspection purposes. I agree not to occupy or allow occupa y o( an building
authy ized bf y th�s permit until fnal insp_ ection.
( ��`9�.0.ii..wln���l�flvr•vt
gna ure ega F�
Hndlor Aut�onzed Applicanl Date
Applicant to flil in all soaees ezcept those witnin heavY eortler Ilnas anC si9n al1 appropriata Ceclarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CITY oF COS7A MESA CONSTRUCTION PERMIT B 3 g' � A P il�
Rroject A�dress �l 39 n/C; �70� ��- _ S Main Buildi
"7RME TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR E
Applicanl'S Mailing Addr255 ❑ CONVERSION ❑ DEMOLISH ❑ OTHE�Bj� T front
Owner'sName r?CTVk S\O1�IH Phone 3'�' 00 DESCRIPTIONOFiNO(iK/USEOFBLDG. 1-�e^1Q�2_ � B Rear
Address /�� �� �e 5�'�0 �1/e
Arch/Eng.' License No.
Address
Contracror's Name � � Phone
Address (m� I'n�l Cl �
City ticense No. D
LICENSED CONTRACTOR DECLARATION
�hereby affirm that I am licensetl untler provisions of Charter 9(commencinq
ith section ]000) of Division 3 ot the BuSiness antl Professions Cotle, antl
�ny license is in full force anC e(tect.
License Class llcense No.
Date Signature
WORKERS' COMPENSATION DECLARATION
1 hereby aftirm that 1 have a certificate ot consent to self-insure or a certificate
o/ Workers' Compenwtion Insurance, or a certifletl coOY thereot (Section
3800, Lab. C.) ' �
Policy No. Company
eCertilietl copY i5 hereby tumishetl.
Cer[i/ie0 copy is filetl with the city Builtlinq Oivislon.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION '
(This seclion neetl not be completetl if the permit is for one huntlretl (g100) or
less).
I ca�tify that in the pe�to�mance of th¢ work fo� whlch thi5 peYm�t is i55uetl, I
sna11 not employ any person in any manner so as lo become subject to the
Worker5' C�Qm Pen a ion Laws at California..y�/� ..Q_ (�n^
Date �-�a�l� �� Signature [.L!(,� �++�'
NOTICE: If, af[er making this tleclaration, you should become subject to tM1e
Workers' Compensation provisions of tM1e l.abor Cotle, you must forthwith
tomply witn such provisions o� this permit shall be tleemetl revoketl.
CONSTRVCTION LENOING AGENCV
1 hereby aHirm that there is a construction lentlin9 agency tor the pertormance
of t�e work for wnicn this permit is issuetl (Section 309� Civ. C.)
LenOer's Name
' entler's Atltlress -
�WNER BUILDER DECLARATION
. hereby affirm Ihat I am ezemot from the Contractor's License Law tor the
following reazon (Section ]031.5 Business antl Professional Cotle: Any city or
county which requires a permit to wnstrucl, alter, ImOrove, aemolish or repair
any structure, prior to its iszuance, also requires Ihe applican� tor such permil
to file a signetl stat<ment that he/she is lit¢nSeC pur5uant to th¢ prOvisions of
the Contractor'S License Law (Chapter 9(commen<inq with Section 7000) of
Division 3 of the Businezs antl Pro(essions Cotle) or that he/she is exempt
' theretrom antl Ihe ba5i5 fOr tlte allegetl ezemption. Any viola[ion ot Settion
7031.5 by any applicant tor a permit subjec[s the applicant to a civil
�e alty of no[ more than five huntl�etl tlollars (5500).'
1, as owner of the property or my employees witn wages as their sole
compensation, will tlo the work, antl the StructurB is not intentletl or-otter¢tl
for sale (Settion 7�44, Business antl Protessional Cotle: The Contractor's
License I.dw tloes not apply to an owner of a properry who bUiltls Or imp�oves
thereon, antl who Goes such work nimself/herself or through his or her own
employees, p�ovitletl tha[ such improvements are not Intentletl or oiforetl tor
sale. If, M1owever, th¢ builtling or imp�ovemen[ Is soltl within one year of com-
plelion, the own¢r will have the burtlen of proving he/she tlid not builtl o� im-
prove for the purpose of sale).
❑ 1, a5 own2� of the property, am exclusively cont�acting with IicenSetl con-
tractors [o construct the project (Section 7044, 8usine55 antl Profe55ions Cotle:
The Contractor's License Law does not apply to an owner ot property wM10
- builtls or improves tnerean. antl who conVacts for such oroiects with a con-
tractor(s license pur5uan[ m me ConVactor's Licanse Law). i am aware tM1at
I� proof O� [hel� Worket's Compensation in5uranc¢ Shoultl be provitle0 to me.
.� I am exempt untler Section , B. 6 G. C, (or this reason
-�-5 '
I hereby�certi(y tnat 1 have reatl this application antl state that the above
intormation is correct. I agree to comply with all city antl county ortlinances
antl-state laws relating to builtling construction, antl hereby au[horize repre-
sentatives o( this city� to enter upon the above-menUonea property for
Inspectianpurpo5e5 - __ �o_>Q
Siqnature • DateJ_d � o0
Drivars' License or 55 � �
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5c1. FT. oCCUaANcv
CONSTRUCTIONTVVE� � VALUATION$
ZONE GRAOINGCV.YDS. ACRES—
Remarks: Q � � .�.�
� II
Bar $ink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers .
Dishwasher
Drinking Fountains
Floor Drains �
. Floor Sinks
Gas Service � Outlets
Interceptorr
Kitchen Sink '
Lavatories .
P-Trap
Roof Orains
Reinspectiom�Fee $15
Duc[-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. iCBO dk
Heating Sys[em & Ducting
� ai oo,000 aru o i oo,000
Reinspection Fee � $15
0865-46, rev. 5/88 White - Builtling; Canary - Appllcant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection �
Solar Collecrors
Solar P.iping
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Heater
Water S icE
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Type II ❑
iefrigeration Sys[em ,
�100,000 BTU ❑ 100,000 BTU
System Repair/Alteration
Fiie Dampers
Registers '
Issue Fee
A
C Right
K . Left
S
Ping. Ref. #
Pianning Notes:
ES Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U. -
Fixture5
Device Boxes
OuUe[5
Switches
Garbage Dispoul
Generator OU5 KW C
� Rainspection Fee '
—
$ 3 DEVELOPMENTSER�
Zonin9 APProved BY—
FEES Building Approved By.
$ 3
Iding:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps �
Meter ❑over100amps'.o
Sub Panel �-
M ors061 HP�tY:-8 �
na Solar �9-75 HP �16-15+
Microwave ' ' .
Pole Light , - -
• � $tanding Sections
75 KW Trash Compactor
, : i
�$15 P'�� luue Fee .- • '
REQUIREMENTS: � "
BUILDING PERMIT �'$ f �: 00
PLAN CHECK $ �
PLUMBING $
PLAN CHECK � 25% $' �
ELECTRICAL $ -
PLAN CHECK 50% $ • � "-
MECHANICAL $ +
PLAN CHECK 25% $ '
N
I
N
G
H
E
�
M
T
S.
FEES
$ 3
SMIP $ a J�
PERMIT
ISSUANCE $ �
ENERGV P.C. $
GRADING $
MICROPILM $
TOTAL FEE � $ 94.�
OS OOO1D817-DOO1d818 ' T�T". 99.53
DATE: Q7/29/88 TIME: 1;,�36
��CONSTRUCTION AND PLN�vNING POOL & SRA � ;,_
�APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
'�! Temporary Electrical Service or Pole Y� 52. Pool & Equipment Location
2. Soil Pipe-Undrgr�d. � 53. Steel ReinforcemenY
..i
3.' Electrica'I Conduit Utiliry�Undrgrnd. �- 54. Forms . '
4.,ElectricalConduibUnd�grnd. 55. ElectricalBonding
5. Steel-Reinforcement� -� 56. Rough Plumbing & Pressure Test
6� Electrical UFER �Grnd. 57. APPROVAL TO COVER-GUNITE
7. Fdotings 58. Electrical Conduit-Undrgmd. , '
8. Foundation �,i 59. Gas Pipe, O Undrgrnd., Test •
9..Water Pipe-Undrgrnd. ' 60. 8ackwash 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
13. Roof DrairF 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Elec!rical-Conduit � 66. Solar System-Final
Fj'6. Rough Electric Wiring - 67. Fencing & Access Approval
,17. Rough Wiring Sign z 68. APPROVED FOR PLASTERING
;18, Rough Elecirical-T Bar CeilYi„ny _'! 69. POOUSPA SYSTEMS FINAL
19}' Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
�20: Rough Factory Ficeplace ` ���� APPROVALS Permit#
c
' 21. Ducts, in Structure ' ;� �' 70. Underground Hydro
. � ..-^
22. Ducts, V� ntilatin ' 1���
9 S' -=C 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & TeSt .° -_ 72. Clnderground Flush '
24. Roof Framing � , •�� ,-'y„- ,73. Undergrnd.StorageTank OGas ❑Oil,�
25. Roof Sheathing � 74. Overhead Hydro �
26. T-BSr�Cei{in9lStructural� &�Mo �ocoat 75. Dry Chemical
27.�Frameand Flashing .-�;�. 76. DryStandpipe
28. Lathir�g &+Siding '�_ 77. FIXED SYSTEM FINAL
29. Insula�ion 'i.: 78. FIRE PREV. FINAL
, �-.
30. Drywall Nailing �':"� �� HEALTH DEPT. REQUIREMENT
31. Plaster BroN'n CqaY;� r: ; 79. FINAL INSPECTION
32. Electrical PowerlMeter-Final� 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' - Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace ' �
38. Final Plumbing
39. Water Service-Final, . '" - r-�.
40. Gas Service-Final e S' �e. � �
�
41. Solar pomestic-Final ' t,�,
42. Backflow Preventer � g ��
�
43. Backflow I�rigation , � � � ;
44. Landscape Irriqation System -��/!
45. Sound Attenuation � k}:'
46. Handicap Regulations � �'
47. FINALSTRUCTURE & BUILDING � �
48. Special Reduirements Completed
49. Electric Release to Edison . "',�'
50. Gas Releass to Southem Califomia Gas Co � ��, � ,
57. CERTIFICATEOFOCCUPANCY ,i �'
. .i �'� . i
No. Date
COMPLAINTINVESTIG
Received by ��
M*'� by: I�N'
Againsr. , , /
Diroc[ions:
Na[ure oF Com��nint:
CQSTA MESA BUILDING SAFETY DEPARTMENT
P.O. BOX 1200
COSTA MESA, CALIFORNIA �
— 646-2411 QQ Date�
Address �^ ��� � � Ph..Vo. �6 "�l��9�
Addmss
Complete: Yes
Compleinant Yes
ey
No Interviewed: No Date:
FORM BU01-2M-5�6<—CP �
I
� .
I 8£377
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
ADDRE6S 2739 De Soto Ave.
COSTA MESA. CALIFORNIA
I, ARCHITEGT
OR ENGINEER M3C
I� STATE
NO. OP
SHTB�CK LINC FROM t� no
e8NT8R Ov 8TRlei µO � REAR YARD GU �
SIDE YARO I LEFT 'rj ��1�� I RIGMT ��
� DESCRIPTION OF WORK
' SIZE�b l � -b��X�LI � -Z�� ROOMS
EXTERIOR WALi. qt.0 CO ftOOF'�
__ __ _ Y:I"S �'___'
I XEREBY ACKNOWLEDG6 THAT i HAVE RlAD TM19 MPLICATION
� AND BTATE THAT THE ABOVH I8 CORReCT AND AGREE TO COM-
PLY WITH ALL CITY OPDINANCEB AND 8TAT8 LAWB eEGULATINO
BUILDINO CON8TRl1CT10N.
.,^�_6�„ppcosra,75a +aa*�99.OQ
APPLICATION FOR PERMIT
BUILDING
For Offlce Use Only
rseceirr r+o. ne�
�
aec�^eo ar I o�e aycerveD I,MAR T
/,� ,� i!) / 3
BUILDING
ADORE68
COSTA MESA. CALIFORNIA
LEGAL
ZONING
NO. OF ��U6C OP
PLAN9 9UILDIN
BT.1
/�
I,ivin� Area: 1896 S
THE AMOUNT 9HOWN UNDBR VALUATION 19 POP THE
PUPP08H Op EBTAfiLI8HIN6 A PEqMIT FEE ONLY.
VALUATION � � _
PERMIT FEE $ H
0
s 20, 288.00 PLAN CHECK $�.J� �-
. f
�
TOTAL FEE LL